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McCallum",authors:[{id:"50367",title:"Dr.",name:"Richard",middleName:null,surname:"McCallum",fullName:"Richard McCallum",slug:"richard-mccallum"},{id:"59813",title:"Mr.",name:"Zhiyue",middleName:null,surname:"Lin",fullName:"Zhiyue Lin",slug:"zhiyue-lin"}]},{id:"27018",title:"Associations of Metabolic Variables with Electrocardiographic Measures of Sympathovagal Balance in Healthy Young Adults",slug:"associations-of-metabolic-variables-with-electrocardiographic-measures-of-sympatho-vagal-balance-in-",signatures:"Richard M. Millis, Mark D. Hatcher, Rachel E. Austin, Vernon Bond and Kim L. 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A.",surname:"Tanskanen",fullName:"Jarno Tanskanen",slug:"jarno-tanskanen"},{id:"48965",title:"Dr.",name:"Jari",middleName:null,surname:"Viik",fullName:"Jari Viik",slug:"jari-viik"}]},{id:"27023",title:"Broadening the Exchange of Electrocardiogram Data from Intra-Hospital to Inter-Hospital",slug:"broadening-the-exchange-of-electrocardiogram-data-from-intra-hospital-to-inter-hospital",signatures:"Shizhong Yuan, Daming Wei and Weimin Xu",authors:[{id:"42911",title:"Prof.",name:"Daming",middleName:null,surname:"Wei",fullName:"Daming Wei",slug:"daming-wei"},{id:"42922",title:"Prof.",name:"Weimin",middleName:null,surname:"Xu",fullName:"Weimin Xu",slug:"weimin-xu"},{id:"50931",title:"Prof.",name:"Shizhong",middleName:null,surname:"Yuan",fullName:"Shizhong Yuan",slug:"shizhong-yuan"}]}]}],publishedBooks:[{type:"book",id:"10863",title:"Cardiac Rhythm Management",subtitle:"Pacing, Ablation, Devices",isOpenForSubmission:!1,hash:"a064ec49b85ebfc60585c9c3690af53a",slug:"cardiac-rhythm-management-pacing-ablation-devices",bookSignature:"Mart Min and Gabriel Cismaru",coverURL:"https://cdn.intechopen.com/books/images_new/10863.jpg",editedByType:"Edited by",editors:[{id:"62780",title:"Prof.",name:"Mart",surname:"Min",slug:"mart-min",fullName:"Mart Min"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"129",title:"Ventricular Assist Devices",subtitle:null,isOpenForSubmission:!1,hash:"2b6b9dbd504cdf6ed9c20a742e3f2a9d",slug:"ventricular-assist-devices",bookSignature:"Jeffrey Shuhaiber",coverURL:"https://cdn.intechopen.com/books/images_new/129.jpg",editedByType:"Edited by",editors:[{id:"22152",title:"Dr.",name:"Jeffrey",surname:"Shuhaiber",slug:"jeffrey-shuhaiber",fullName:"Jeffrey Shuhaiber"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"290",title:"Cardiac Pacemakers",subtitle:"Biological Aspects, Clinical Applications and Possible Complications",isOpenForSubmission:!1,hash:"d336ffc14d9ab1745072534d4448305f",slug:"cardiac-pacemakers-biological-aspects-clinical-applications-and-possible-complications",bookSignature:"Mart Min",coverURL:"https://cdn.intechopen.com/books/images_new/290.jpg",editedByType:"Edited by",editors:[{id:"62780",title:"Prof.",name:"Mart",surname:"Min",slug:"mart-min",fullName:"Mart Min"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"331",title:"Cardiac Defibrillation",subtitle:"Mechanisms, Challenges and Implications",isOpenForSubmission:!1,hash:"90fa2e9b5ad435b6518f47da7ade1efd",slug:"cardiac-defibrillation-mechanisms-challenges-and-implications",bookSignature:"Natalia Trayanova",coverURL:"https://cdn.intechopen.com/books/images_new/331.jpg",editedByType:"Edited by",editors:[{id:"38381",title:"Dr.",name:"Natalia",surname:"Trayanova",slug:"natalia-trayanova",fullName:"Natalia Trayanova"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"358",title:"Advances in Electrocardiograms",subtitle:"Methods and Analysis",isOpenForSubmission:!1,hash:"a61fed85204779463e6e483483601fdf",slug:"advances-in-electrocardiograms-methods-and-analysis",bookSignature:"Richard M. Millis",coverURL:"https://cdn.intechopen.com/books/images_new/358.jpg",editedByType:"Edited by",editors:[{id:"45295",title:"PhD.",name:"Richard",surname:"Millis",slug:"richard-millis",fullName:"Richard Millis"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[{type:"book",id:"331",title:"Cardiac Defibrillation",subtitle:"Mechanisms, Challenges and Implications",isOpenForSubmission:!1,hash:"90fa2e9b5ad435b6518f47da7ade1efd",slug:"cardiac-defibrillation-mechanisms-challenges-and-implications",bookSignature:"Natalia Trayanova",coverURL:"https://cdn.intechopen.com/books/images_new/331.jpg",editedByType:"Edited by",editors:[{id:"38381",title:"Dr.",name:"Natalia",surname:"Trayanova",slug:"natalia-trayanova",fullName:"Natalia Trayanova"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"76667",title:"Extra-Cranial Involvement in Giant Cell Arteritis",doi:"10.5772/intechopen.97715",slug:"extra-cranial-involvement-in-giant-cell-arteritis",body:'Giant cell arteritis (GCA) is a systemic vasculitis that predominantly involves large and medium-size arteries [1]. It occurs almost exclusively in subjects aged 50 years or older, and is the most common form of systemic vasculitis among the elderly [2]. GCA is more common among caucasian female patients, with a female–male ratio of about 2–3:1. The GCA annual incidence varies with geographical location and ranges from 1.6 to 32.8 cases/100000 persons ≥50 years of age [3].
GCA is commonly defined as Large-Vessel (LV) GCA if the aorta and its branches are involved. The systemic nature of the disease was noted as early as the first cases described by Horton and colleagues in 1932 [4]. Later on, Gilmour suggested that the disease should be called “giant-cell chronic arteritis” as the temporal arteritis appeared to be only part of a more widespread vascular disease [5]. Despite this early reports, physicians have mainly focused on typical cranial symptoms and visual disturbances and have relied mostly on temporal biopsy for diagnosis. This focus is well reflected in the 1990 ACR classification criteria that emphasised the importance of headache as a cardinal symptom and temporal biopsy as its primary diagnostic tool [6]. Unfortunately, the concept of GCA as a limited cranial disease is inaccurate and obscures essential clinical features. Furthermore, the misuse of classification criteria for diagnostic purposes, may lead to underdiagnose LV-GCA [7].
In recent years there has been an increased awareness of the systemic large-artery nature of GCA. Necropsy studies have shown histologic evidence of systemic large-artery vasculitis in approximately 80% of patients [8, 9]. Recent advances in diagnostic imaging techniques have confirmed these figures, suggesting that imaging will have an increasing impact in the diagnosis and management of GCA. [10, 11, 12, 13, 14]. Furthermore, patients with GCA are at increased risk of developing aortic dilation and aneurysms among other complications [15, 16, 17].
Altogether, these issues highlight the importance of the extra-cranial involvement of GCA which has been under-recognised and poorly managed.
GCA is an idiopathic inflammatory granulomatous vasculitis. The aetiology is unknown, and most probably, genetic, environmental, vascular, and age-related factors concur to the development of the disease [2, 18]. In GCA, a lymphocyte and plasma cell infiltrate originates at the
The critical event in initiating and sustaining the inflammatory response is thought to be the abnormal maturation and loss of tolerance of vascular Ddendritic cells (DCs), which is triggered by toll-like receptors (TLRs) [21, 22]. Differentiated DCs drive T cell and macrophage recruitment [21]. Upon the maturation of DCs, CD4+ T cells are also stimulated by local cytokines, such as IL12, to polarise into T-helper 1 (Th1) and IL6 and IL23 to polarise into Th17 cells [23].
TH17 cells are responsible for implementing a strong acute IL17 mediated inflammatory response, which leads to the overproduction of a cluster of cytokines, namely IL1β, IL6, IL23 and TNF-α [23]. Type II cytokine receptors (mainly IL6 and IL1β) signal through JAK1 homo-dimers [24] promoting further cellular activation and inflammatory response. The IL17 pathway is therefore responsible for most of the inflammatory response in the acute phase and explains the systemic nature of the disease [25, 26].
Th1 cells differentiation induces an immune response where IFN-γ is the central cytokine [27]. IFN-γ receptor signals through JAK1–JAK2 heterodimers [28]. The INF-γ signature further enhances the inflammatory response (through IL1β, IL6, and TNF-α), leading to macrophage differentiation and activation. Upon the stimulation by the granulocyte-macrophage colony-stimulating factor (GM-CSF) produced by T cells, macrophages act in sustaining inflammation and are key players in the interaction with the stromal and extracellular matrix [29, 30]. This interaction is mediated by matrix metalloproteinases (MMP) and several growth factors. MMP are proteases with elastolytic activity, released and activated by inflammatory cells. Smooth muscle loss and proteolytic imbalance may contribute to elastic fibre rupture, weakening of the artery wall, and cell migration [29, 31]. The IFN-γ signature is responsible for the histiocytic reaction, myofibroblast differentiation, intimal hyperplasia, neoangiogenesis, vascular remodelling, damage, and fibrosis [32]. These aspects explain the vascular manifestations and the LV complications of GCA. Current treatments efficiently inhibit the Th17-mediated response, but not the Th1 mediated expression of IFN-γ [27, 33]. Thus, the current management of vascular manifestations like artery stenosis and aneurysms is suboptimal, as vascular remodelling processes may subsist even in the absence of raised inflammatory markers [34].
Patients with polymyalgia rheumatica (PMR) present activated DCs in focal vessel infiltrates with the expression of inflammatory cytokine production (IL1β and IL6), but IFN-y is absent [35]. Therefore, it is thought that it is the IFN-γ pathway, and not IL17 activation that marks the progression to overt vascular inflammation and remodelling.
It is not yet clear why some patients have only PMR while others progress to periadventitial or transmural vasculitis. Different TLR expression on DCs may partly explain such patterns as TLR4 activation induces transmural panarteritis, while TLR5 ligands promote adventitial perivasculitis [36]. Moreover, DCs exhibit distinct combinations of TLRs in different vascular beds [37]. Thus, the phenotype of the vasculitis may depend upon the profile of the TLR driven T cell activation, which is specific of each vascular territory.
The interaction between T cells and B cells might also be implicated in the expression of LV-GCA. Recent findings in aorta tissue samples from 9 LV-GCA patients who underwent aortic aneurysm surgery, showed massive infiltration of B-cells, which outnumbered T-cells. B-cells were mainly found in the adventitia and were organised into tertiary lymphoid organs [38]. This is an uncommon observation in temporal artery biopsies.
The interaction of immune mechanisms and the vascular matrix is also demonstrated by the MMP expression in singular vascular fields. MMP2 tissue expression was observed in active temporal artery lesions and in aortic aneurysm samples obtained in 2 GCA patients. However, MMP9 was present only in temporal artery lesions and faintly detectable in normal temporal arteries and GCA-related aneurysms [17]. While MMP9 is mainly produced by inflammatory cells, MMP2 may also be expressed in smooth muscle cells and be involved in reparative mechanisms. Therefore, the expression of MMPs on different vascular beds may also impact on the clinical features of GCA.
Atherosclerosis is highly prevalent among GCA patients as it is most present at an advanced age. The coexistence of these two diseases and the underlying immune mechanisms of both may tailor the phenotype of the vasculitis. It is known that patients with cardiovascular risk factors have a higher risk of developing severe ischaemic manifestations of GCA [39]. In fact, patients with ischemic complications have lower expression of IL6 suggesting that IL6 may play a protective angiogenic role to compensate for ischemia [40]. Furthermore, at the supra-aortic level, atherosclerosis most commonly affects the carotids, while LV-GCA predominantly affects the axillary arteries. Regardless of the immune profile, age and genetic factors also influence the development of atherosclerosis. In caucasians, atherosclerosis occurs later and less extensively in intracranial arteries compared to extracranial arteries. Interestingly, Asian and African populations are more affected by intracranial atherosclerosis and also show a low prevalence of cranial GCA [3, 41]. Thus, atherosclerosis may alter vessel vulnerability or expression of GCA.
Age is an important factor that affects vascular and immune processes with a possible impact on disease vulnerability and manifestations [42]. Ageing induces significant changes in the expression of vascular MMP2 and MMP9 and reduces arterial smooth muscle proliferative capacity [43, 44, 45]. One of the main distinctions between LV-GCA and Takayasu arteritis (TAK) has been attributed to an age cut-off. Interestingly, TAK shows similar immunologic mechanisms with dysregulated activation of Th1 and Th17 pathways [46] and therefore age-related factors may be the key to explain the distinct manifestations between LV-GCA and TAK [20, 42].
LV-GCA usually presents with prominent constitutional symptoms and a marked increase in inflammatory markers. Systemic constitutional symptoms include fever, malaise, weight loss and night sweats. Symptoms are usually non-specific and, in up to 20% of the patients, systemic constitutional symptoms are the only clinical features of the disease with some cases being diagnosed following an investigation for fever of unknown origin [10, 18]. Aortitis is a common feature in LV-GCA. Aortitis is often pauci-symptomatic, but some patients may refer chest or back pain [18]. LV-GCA also affects the main arteries of the limbs, presenting most commonly as limb claudication. Limb claudication reflects intimal and muscular hyperplasia secondary to vascular inflammation, which leads to vessel wall thickening with lumen occlusion. Limb claudication involves the arms more frequently than the legs and may be present in up to 50% of LV-GCA patients. It can be intermittent and asymmetric despite vascular involvement being bilateral in around 80% of the patients [7, 10, 47].
The preferred vascular territories involved are the supra-aortic branches, particularly the axillary and subclavian arteries, which are involved in almost all patients with LV-GCA. Carotid and vertebral artery involvement are less frequent. Aortitis is present in around 50–65% of the patients with documented LV-GCA. Most commonly, it involves the aortic arch and the thoracic descending aorta. When the abdominal aorta is affected, there is usually involvement of the thoracic segment as well. Femoral arteries and inferior limb arteries are involved in only around 10–15% of the patients. Sometimes differential diagnosis with atherosclerosis, very commonly found in these arteries, may be difficult. Visceral arteries are rarely affected. [7, 10, 12, 47, 48, 49].
There is a considerable clinical and epidemiologic overlap between GCA and PMR. PMR is a clinical syndrome characterised by bilateral shoulder pain, morning stiffness, shoulder or pelvic girdle weakness, and peripheral arthralgia/arthritis [2]. Approximately 20% of PMR patients have GCA, whereas PMR is present in up to 60% of GCA patients [2, 50, 51]. PMR is also the main form of relapse in up to 50% of GCA patients, while cranial symptoms are relatively uncommon at relapse [52]. Interestingly, Positron Emission Tomography (18FDG-PET) LV fluorodeoxyglucose increased uptake was noted in 30% of patients with isolated polymyalgia rheumatica at diagnosis [53]. Therefore, PMR patients with incomplete response to corticosteroid treatment or a relapsing disease should be re-evaluated for LV involvement.
Patients with LV-GCA are more frequently women and present at a younger age, whereas patients with cranial GCA are usually men and older [7, 10, 54]. When compared with cranial GCA, patients with LV-GCA present less frequently with headache (35% in LV-GCA vs. 60% in cranial GCA), jaw claudication (22% in LV-GCA vs. 50% in cranial GCA) and also with fewer cranial ischemic symptoms (permanent visual loss in 4% in LV-GCA vs. 20% in cranial GCA) [10, 55, 56, 57]. Although there may be specificities concerning the presentation of cranial GCA and LV-GCA, they are not distinct entities (Table 1). More likely, we are facing a different spectrum of the same disease (Figure 1). Depending on the different imaging techniques used, 32–83% of the patients with confirmed cranial GCA also have LV vasculitis [10, 11, 12, 14] and 10–30% of the patients with GCA have only LV vasculitis, with no clinical, histologic or Doppler evidence of temporal artery vasculitis [10, 48, 58, 59].
The clinical spectrum of cranial GCA, LV-GCA and PMR.
Due to the more unspecific nature of the clinical presentation of LV-GCA, the diagnosis is often delayed or even missed. In general, patients with isolated LV-GCA have a delay in the diagnosis greater than one year compared with patients with cranial GCA [7]. It is still unknown whether this delay in diagnosis and treatment may impact the clinical course of the disease. However, LV-GCA patients relapse more frequently and earlier than those with cranial GCA and have higher corticosteroid cumulative doses and more frequently require additional immunosuppressive treatments [7, 54]. These facts suggest that patients with LV-GCA should be considered for a different management and treatment strategy, with a more tailored, eventually more aggressive approach.
Symptoms and signs | Cranial GCA | LV-GCA | PMR |
---|---|---|---|
Headache | ++ | + | — |
Jaw claudication | ++ | — | — |
Visual disturbances | ++ | — | — |
Limb claudication | + | ++ | — |
Fever, night sweats, weight loss | + | ++ | + |
Polymyalgic symptoms | + | ++ | ++ |
Peripheral arthralgia/arthritis | + | + | ++ |
Elevation of inflammatory markers | ++ | ++ | ++ |
Clinical symptoms and signs in different subtypes of GCA and in PMR.
GCA, Giant Cell Arteritis; LV, Large Vessel; PMR, Polymyalgia Rheumatica; −, uncommon symptom or sign; +, common symptom or sign; ++, very common symptom or sign.
The systemic LV involvement in GCA may resemble the presentation of Takayasu arteritis (TAK). Patients with Takayasu’s disease may present with raised inflammatory markers, vascular bruits, asymmetric blood pressure measurements and limb claudication, much like patients with LV-GCA. The recent widening of the concept of vascular involvement in GCA shows that there can be an overlap between these two conditions. However, some have proposed clear distinctions. Most importantly, the epidemiology is quite different. GCA is recurrent among northern European patients, whereas TAK is more prevalent among the Asian population [60]. Another difference is the age of disease onset. GCA is almost exclusively present in patients 50 years or older, whereas TAK is common under 40 [2, 61]. However, some argue age restriction to be arbitrary and without etiologic or pathophysiologic basis [20]. In a study of 96 Japanese patients with TAK, 22% were outside the proposed age cut-off [62]. Likewise, in the study that defined the 1990 ACR Classification Criteria for GCA, 23% of the patients had less than 50 years old at diagnosis [6]. Moreover, these definitions are elusive for patients with LV vasculitis aged between 40 and 50 years. So, distinguishing GCA and TAK based only on age and epidemiology may be difficult suggesting that we might, in fact, be looking at two forms of the same disease [63].
The histopathologic findings in both GCA and TAK show a lymphohistiocytic infiltrate in the vascular wall that may be indistinguishable [20]. However, this observation may be biased due to the small number of patients undergoing vascular biopsy in TAK. Pathophysiologic mechanisms also show common features between both diseases [42, 46]. Clinically, TAK presents with a more widespread vascular involvement. The carotid and mesenteric arteries are more frequently affected in patients with TAK than GCA, while subclavian and axillary artery involvement is more prevalent in LV-GCA [63, 64]. The aortic involvement is also distinct since stenotic/occlusive lesions are predominant in TAK, whereas aneurysmal disease is more common in GCA [64]. It is unclear, however, if the differences in imaging findings represent cumulative damage due to delay in TAK diagnosis or whether other age-related immunologic and vascular factors may explain these differences. Lastly, inflammatory markers seem to be higher in patients with GCA than in TAK. Around 44% of the patients with TAK may have active vascular inflammation despite normal inflammatory marker values [65].
Several cases of small and medium vessel vasculitis have been described with temporal artery involvement, particularly granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis [66]. However, the presentation of ANCA-associated vasculitis with aortitis is extremely rare [67] and even more so in other forms of primary vasculitis.
Other systemic diseases present with aortitis and may also be mistaken with LV-GCA (Table 2). Some infections like syphilis or sub-acute endocarditis may evolve with aortitis [68, 69]. In these cases, serologic and microbiologic studies often guide the diagnosis. Other immune-mediated diseases also have aortitis as a prominent clinical feature such as Behçets disease, IgG4-related disease, and Erdheim-Chester disease. These entities often have other distinctive organ involvement and typical histologic findings pointing to a different diagnosis [69, 70, 71]. Also, in IgG4-related and Erdheim-Chester diseases, aortic involvement occurs as periaortitis and retroperitoneal fibrosis which is different from vascular inflammation. Aortitis may also be a late complication of ankylosing spondylitis. It often involves de aortic root or the iliac periaortic peritoneum. It presents late in the disease, and articular symptoms often precede it by years. With recent advances in treatment, it is expected that it will become a less common manifestation of the disease [72].
Syphilis aortitis Sub-acute endocarditis Erdheim-Chester histiocytosis Amyloidosis Paraneoplastic retroperitoneal fibrosis Atherosclerosis | Takayasu Arteritis ANCA-associated vasculitis Panarteritis nodosa Systemic lupus erythematosus Rheumatoid arthritis HLA-B27 associated spondyloarthropathies Behçet disease Cogan disease Relapsing polychondritis Idiopathic aortitis IgG4-related disease Sarcoidosis |
Differential diagnosis of large-vessel giant cell arteritis.
Several imaging techniques have contributed to significant improvements in the assessment and management of LV-GCA, yet no single method is considered preferable (Table 3).
Doppler ultrasonography of a right axillary artery in a patient with Large Vessel Giant Cell Arteritis. White line shows a smoothly increased hypo-echoic intima-media thickness of around 1.5 mm.
Ultrasonography has become widely used in GCA as it can be comparable to biopsy in the diagnosis of temporal arteritis [48, 73]. The presence of a regular hypoechoic non-compressible area around the lumen (the “halo sign”) that reflects an oedematous inflammatory intima-media thickening is considered diagnostic of medium and large vessel vasculitis [74]. It is distinguished from atherosclerotic plaques since atherosclerosis presents as irregular iso- or hyper-echoic extrusions. Ultrasonography identifies aspects compatible with LV-GCA in 29–48% of patients when axillary-subclavian arteries are systematically analysed, and this standard evaluation is particularly important as 13–33% of patients have LV-GCA in the absence of temporal involvement [10, 11, 48, 58, 59]. The identification in the axillary arteries of a smooth hypoechoic increase in the intima-media thickness (IMT) (with a local cut-off for IMT ≥1 mm) correctly identified LV-GCA (Figure 2) with a sensitivity and a specificity of close to 100% [75].
Ultrasonography has the advantage of being inexpensive, not using ionising radiation and can be readily accessible to use, as demonstrated in the implementation of fast track clinics [55, 57], though it requires experienced sonographers. Ultrasonography may also be useful in disease monitoring, as most patients show the disappearance of wall thickening over the course of steroid treatment [76]. This is why ultrasonographic signs are accurate for diagnosis purposes only within the first two weeks of corticosteroid treatment, losing sensitivity thereafter [74, 76], whilst thoracic aorta examination is not easily accessible by ultrasound.
Computed tomography (CT) and CT angiography (CTA) are useful for LV imaging: they have a short scanning time yet allowing for a comprehensive vascular assessment, including the thoracic and abdominal aorta. Prospective studies of newly diagnosed GCA patients assessed by CTA have revealed LV involvement in 45–68% of subjects [12, 77, 78]. Typical findings of LV include circumferential wall thickening and vessel wall contrast enhancement. However, CTA findings may be attenuated by an as short as three-day course of corticosteroid treatment [12]. Nevertheless, up to 43% of patients still present significant arterial wall thickening one year after treatment [79]. The simultaneous assessment of aortic dilation and the adequate distinction between vasculitis and atherosclerosis, which appears as focal calcifications, are other advantages of CTA. Ionising radiation is of concern when repetitive evaluations are performed, but novel low-dose CTA techniques may reduce radiation exposure (Figure 3) [80].
Computed tomography (CT) and CT angiography (CTA) revealing Large Vessel Vasculitis in Giant Cell Arteritis (GCA). Left image shows a CTA image with circumferential wall thickening >2 mm of the thoracic aorta. Central CTA image shows the extent of thoracic aorta wall thickening in the same patient, predominantly involving posterior wall. Right image reveals thoracic wall thickening in CT of another GCA patient. Arrow depicts vasculitic wall thickening, arrowhead depicts atherosclerotic calcified plaque.
Magnetic Resonance (MRI) conveys a wide vascular assessment with vasculitis appearing as a mural thickening or wall oedema, enhanced in T2 sequences. High-resolution MRI has been extensively used to assess temporal arteritis, but there is little experience with MRI in LV-GCA [13, 81, 82]. In contrast, and as MRI does not require iodinated contrast or ionising radiation, it has been exhaustively used for periodic assessment in younger patients with TAK [80].
18FDG-PET has become widely used in LV-GCA as it allows broad vascular assessment of inflamed vascular territories that have an increased glucose metabolism. Accordingly, 58–83% of patients with GCA show LV involvement in 18FDG-PET studies [14, 49, 83]. 18FDG-PET also has the advantage of suggesting possible differential diagnoses such as infectious or neoplastic disease. However, it is not as accurate in assessing vascular stenosis or occlusions and distinction with atherosclerotic plaques that also show increased vascular uptake may be troublesome in older patients. Furthermore, a consensus agreement regarding 18FDG-PET criteria of LV vasculitis is lacking. 18FDG uptake equal to or greater than liver uptake on PET has been proposed as the best criterion of LV inflammation in GCA [84]. The vascular uptake in LV is also attenuated after three-day corticosteroid treatment but nevertheless, maintains an adequate sensitivity for diagnostic purposes. Notwithstanding, after ten days of treatment, sensitivity may diminish considerably (Figure 4) [85].
Imaging technique | Findings of LV vasculitis | GCA with LV vasculitis | Diagnostic accuracy under treatment |
---|---|---|---|
Ultrasonography |
| 29–48% [10, 48, 58, 59] | 2 weeks |
CT and CTA |
| 45–68% [12, 77, 78] | 3 days |
MRI |
| ~54% [82] | — |
18FDG-PET |
| 58–83% [14, 49, 83] | 10 days |
Imaging methods in the diagnosis of large vessel inflammation in giant cell arteritis.
CT, Computed tomography; CTA, CT angiography; MRI, magnetic resonance; 18FDG-PET, 8F-deoxyglucose positron emission tomography; −, unavailable data.
18FDG-PET scans of Large vessel GCA. Left panel shows aortitis with involvement of the thoracic and abdominal aorta. Central panel shouws inflammatory uptake of the ascendeing aorta and subclavian arteries. Reight panel reveals inflammatory uptake of the aorta and common carotid arteries. Arrows reveal areas of increased vascular 8FDG uptake.
There are no studies specifically addressing the treatment of LV-GCA. As such, LV-GCA is currently managed in the same fashion of GCA. Corticosteroids remain the mainstay of treatment. Induction of remission should be started with 40-60 mg/day of prednisone equivalent to suppress systemic and vascular inflammation and prevent ischaemic complications such as blindness, and then followed by progressive tapering [2, 56, 86]. However, GCA relapses are frequent and corticosteroids account for significant complications. Therefore, adjunctive therapy should be considered in selected patients. Methotrexate (MTX) has been used as an adjunctive treatment with modest efficacy [87, 88]. TNF inhibitors have proven to be ineffective in GCA [89, 90, 91]. By contrast, the IL6-receptor blocker tocilizumab (TCZ) proved to be an effective and safe adjunctive therapy in GCA. Treatment with TCZ induced remission in over 50% of patients at 52 weeks, compared to less than 20% with placebo, and markedly reduced cumulative corticosteroid doses [92]. Recent results from real-life data corroborate the efficacy of TCZ shown in clinical trials [93].
There is some indirect evidence that LV vasculitis responds equally to standard treatment. This is corroborated by prospective imaging studies that show a decrease in LV inflammation over the course of treatment [76, 79, 85]. In a small study MTX was effective in corticosteroid-resistant LV-GCA [94]. However, it is widely accepted that patients with LV-GCA have a more relapsing disease course and receive higher doses of corticosteroids and more concomitant immunosuppressive therapy [7, 95].
In the GIACTA trial, 119 out of 251 patients included had evidence of LV vasculitis [96]. The outcomes measured did not include vascular imaging, and there is no sub-analysis directly aimed at patients with LV involvement. However, weekly TCZ was superior to biweekly TCZ or placebo in relapsing disease [92]. Being LV-GCA a more relapsing disease, it is possible that TCZ might be a preferred treatment option in this subgroup of patients [97].
Two other drugs have been studied in small GCA trials with data regarding LV-GCA. Ustekinumab, an IL-12/IL-23-blocking monoclonal antibody, was prospectively studied in 25 patients with refractory GCA, 10 of them with LV-GCA shown on CTA. Eight of these ten patients had multiple image assessments, and all of them showed improvement of wall thickening including four that had a complete resolution of the lesions [98]. However, in another prospective open-label trial with 13 patients with newly diagnosed or relapsing GCA, enrolment was prematurely closed due to lack of efficacy and high relapse rates [99]. Abatacept, an IgG1-CTLA4 fusion protein, was evaluated in a trial with 41 patients, (22% had LV vasculitis) and showed an improvement in relapse-free rate and duration of remission as compared to placebo [100]. Both these drugs need to be further evaluated in prospective and more extensive trials to further assess their efficacy.
Encouraging preliminary results were reported from a randomised controlled trial with mavrilumab, an anti-GM-CSF receptor α monoclonal antibody, which has shown sustained remission at week 26 in 83% of the patients, compared to 50% in the placebo group. These results were consistent across the different disease subgroups (final report is still pending) [101].
Another open question is whether current treatment significantly improves vascular remodelling and long-term LV-GCA complications such as aneurysms. The inhibition of both Jak1 and Jak2 may be a reasonable target to reduce the activation of the Th1 and Th17 pathways present in LV-GCA. Two Jak1 and Jak2 inhibitors are currently under investigation in clinical trials: baricitinib and upadacitinib [102, 103].
Vascular complications of LV-GCA include the formation of arterial stenosis, occlusions and aneurysms [15, 16]. Involvement of the aorta commonly occurs as dilation or aneurysm, as aortic stenosis is unlikely. Stenosis presents as limb claudication, involving more commonly the superior extremities, although the involvement of the inferior extremity is also possible [7, 47]. GCA patients are at an increased risk of developing aortic aneurysms/dissection or large artery stenosis (Figure 5). While stenosis mostly occur during the first year, the incidence of aortic aneurysms/dissection increases over the five years following the GCA diagnosis [104]. In the long-term, 10–33% of the patients may develop aortic aneurysms/dissection and around 13% may develop large-artery stenosis [16, 104, 105].
Interestingly, aortic dilation is already present in 15% of the newly diagnosed GCA patients [12] with the thoracic aorta being the most commonly involved [105]. Aortic aneurysms are more frequently found among male patients with identified cardiovascular risk factors that include hypertension, dyslipidaemia and coronary artery disease [16, 17, 106]. It is unlikely that aortic aneurysms result from the persistent inflammatory activity as patients with aortic dilation/aneurysms were found to have lower serum acute-phase reactants and a lower relapse rate [17, 105]. However, increased 18FDG uptake in the aorta on PET performed at the GCA diagnosis was associated with the subsequent development of aortic dilation [107, 108]. It is thus conceivable that a strong inflammatory response at the beginning of the disease followed by remodelling vascular factors and hemodynamic factors (like hypertension), may be more relevant to the development of aortic dilation and aneurysms than a continuous inflammatory process.
Computed tomography angiography showing ascending aortic dilation in a patient with Giant Cell Arteritis.
Despite all the possible complications, the overall prognosis of GCA is good, with a mortality rate similar to the general population [109]. However, GCA is responsible for a significant morbidity. Around 64% of the patients will have at least on relapse [52] and up to 86% of patients will develop at least on steroid related-complication [110]. Initially it would be thought that LV-GCA patients would not contribute to an increased morbidity as they have fewer ischaemic cranial events that classically have been responsible for the most relevant morbidity associated with GCA [10, 11].
However, LV-GCA patients have a more relapsing disease-course, have higher corticosteroid cumulative doses, and require additional immunosuppressive treatments [7, 95]. Moreover, patients with LV inflammation are at increased risk of developing large-artery stenosis and aortic arch syndrome [54, 105, 106]. In fact, when compared to the general population, survival is decreased in GCA patients with an aortic aneurysm/dissection [104], confirming the negative impact the involvement of large arteries has on both mortality and morbidity associated to GCA.
LV-GCA has been previously misregarded and underdiagnosed. However, there is consistent evidence confirming that large arteries are involved in around two-thirds of patients with GCA and one-third of patients with PMR. Classification criteria are inadequate for LV-GCA. A revision of the current criteria is required in the near future. LV-GCA presents a more relapsing-disease course and an increased risk of vascular complications, with LV inflammation being responsible for a considerable increment in the morbidity and mortality associated to this condition. This chapter emphasises the importance of carefully considering the large artery aspects in the management and treatment of patients with GCA.
We kindly thank Dr. Pedro Marques, from the Department of Radiology, Hospital Prof. Doutor Fernando Fonseca, for his collaboration with computed tomography image selection and editing.
We kindly thank Dr. Ângelo Ferreira Silva, from the Department of Nuclear Medicine, Champalimaud Foudation, for his collaboration with 18FDG-PET image selection and editing.
Ultrasound images collected by the authors (Serôdio and Trindade) during the assessment of GCA patients with Siemens Acuson X300 equipment, VF13-5 probe, bandwidth 4,4-13,0 MHz.
The authors declare no conflict of interest.
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Achilias"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10681",title:"Biodegradation Technology of Organic and Inorganic Pollutants",subtitle:null,isOpenForSubmission:!1,hash:"9a6e10e02788092872fd249436898e97",slug:"biodegradation-technology-of-organic-and-inorganic-pollutants",bookSignature:"Kassio Ferreira Mendes, Rodrigo Nogueira de Sousa and Kamila Cabral Mielke",coverURL:"https://cdn.intechopen.com/books/images_new/10681.jpg",editedByType:"Edited by",editors:[{id:"197720",title:"Ph.D.",name:"Kassio",middleName:null,surname:"Ferreira Mendes",slug:"kassio-ferreira-mendes",fullName:"Kassio Ferreira Mendes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10843",title:"Persistent Organic Pollutants (POPs)",subtitle:"Monitoring, Impact and Treatment",isOpenForSubmission:!1,hash:"f5b1589f0a990b6114fef2dadc735dd9",slug:"persistent-organic-pollutants-pops-monitoring-impact-and-treatment",bookSignature:"Mohamed Nageeb Rashed",coverURL:"https://cdn.intechopen.com/books/images_new/10843.jpg",editedByType:"Edited by",editors:[{id:"63465",title:"Prof.",name:"Mohamed Nageeb",middleName:null,surname:"Rashed",slug:"mohamed-nageeb-rashed",fullName:"Mohamed Nageeb Rashed"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:218,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"29369",doi:"10.5772/32373",title:"Textile Organic Dyes – Characteristics, Polluting Effects and Separation/Elimination Procedures from Industrial Effluents – A Critical Overview",slug:"textile-organic-dyes-characteristics-polluting-effects-and-separation-elimination-procedures-from-in",totalDownloads:29487,totalCrossrefCites:128,totalDimensionsCites:321,abstract:null,book:{id:"872",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",title:"Organic Pollutants Ten Years After the Stockholm Convention",fullTitle:"Organic Pollutants Ten Years After the Stockholm Convention - Environmental and Analytical Update"},signatures:"Zaharia Carmen and Suteu Daniela",authors:[{id:"91196",title:"Prof.",name:"Carmen",middleName:null,surname:"Zaharia",slug:"carmen-zaharia",fullName:"Carmen Zaharia"},{id:"92084",title:"Dr.",name:"Daniela",middleName:null,surname:"Suteu",slug:"daniela-suteu",fullName:"Daniela Suteu"}]},{id:"42059",doi:"10.5772/54048",title:"Adsorption Technique for the Removal of Organic Pollutants from Water and Wastewater",slug:"adsorption-technique-for-the-removal-of-organic-pollutants-from-water-and-wastewater",totalDownloads:30043,totalCrossrefCites:51,totalDimensionsCites:221,abstract:null,book:{id:"3426",slug:"organic-pollutants-monitoring-risk-and-treatment",title:"Organic Pollutants",fullTitle:"Organic Pollutants - Monitoring, Risk and Treatment"},signatures:"Mohamed Nageeb Rashed",authors:[{id:"63465",title:"Prof.",name:"Mohamed Nageeb",middleName:null,surname:"Rashed",slug:"mohamed-nageeb-rashed",fullName:"Mohamed Nageeb Rashed"}]},{id:"27305",doi:"10.5772/39363",title:"Water Stress in Plants: Causes, Effects and Responses",slug:"water-stress-in-plants-causes-effects-and-responses",totalDownloads:28496,totalCrossrefCites:72,totalDimensionsCites:172,abstract:null,book:{id:"911",slug:"water-stress",title:"Water Stress",fullTitle:"Water Stress"},signatures:"Seyed Y. S. Lisar, Rouhollah Motafakkerazad, Mosharraf M. Hossain and Ismail M. M. Rahman",authors:[{id:"110740",title:"Dr.",name:"Ismail M.M.",middleName:null,surname:"Rahman",slug:"ismail-m.m.-rahman",fullName:"Ismail M.M. Rahman"}]},{id:"62247",doi:"10.5772/intechopen.77315",title:"Application of Biosorption for Removal of Heavy Metals from Wastewater",slug:"application-of-biosorption-for-removal-of-heavy-metals-from-wastewater",totalDownloads:7645,totalCrossrefCites:75,totalDimensionsCites:152,abstract:"Fresh water accounts for 3% of water resources on the Earth. Human and industrial activities produce and discharge wastes containing heavy metals into the water resources making them unavailable and threatening human health and the ecosystem. Conventional methods for the removal of metal ions such as chemical precipitation and membrane filtration are extremely expensive when treating large amounts of water, inefficient at low concentrations of metal (incomplete metal removal) and generate large quantities of sludge and other toxic products that require careful disposal. Biosorption and bioaccumulation are ecofriendly alternatives. These alternative methods have advantages over conventional methods. Abundant natural materials like microbial biomass, agro-wastes, and industrial byproducts have been suggested as potential biosorbents for heavy metal removal due to the presence of metal-binding functional groups. Biosorption is influenced by various process parameters such as pH, temperature, initial concentration of the metal ions, biosorbent dose, and speed of agitation. Also, the biomass can be modified by physical and chemical treatment before use. The process can be made economical by regenerating and reusing the biosorbent after removing the heavy metals. Various bioreactors can be used in biosorption for the removal of metal ions from large volumes of water or effluents. The recent developments and the future scope for biosorption as a wastewater treatment option are discussed.",book:{id:"6137",slug:"biosorption",title:"Biosorption",fullTitle:"Biosorption"},signatures:"Sri Lakshmi Ramya Krishna Kanamarlapudi, Vinay Kumar\nChintalpudi and Sudhamani Muddada",authors:[{id:"238433",title:"Associate Prof.",name:"Sudhamani",middleName:null,surname:"Muddada",slug:"sudhamani-muddada",fullName:"Sudhamani Muddada"},{id:"244937",title:"Mrs.",name:"S L Ramyakrishna",middleName:null,surname:"Kanamarlapudi",slug:"s-l-ramyakrishna-kanamarlapudi",fullName:"S L Ramyakrishna Kanamarlapudi"},{id:"244938",title:"Mr.",name:"Vinay Kumar",middleName:null,surname:"Chintalpudi",slug:"vinay-kumar-chintalpudi",fullName:"Vinay Kumar Chintalpudi"}]},{id:"53211",doi:"10.5772/66416",title:"Biofloc Technology (BFT): A Tool for Water Quality Management in Aquaculture",slug:"biofloc-technology-bft-a-tool-for-water-quality-management-in-aquaculture",totalDownloads:16966,totalCrossrefCites:65,totalDimensionsCites:148,abstract:"Biofloc technology (BFT) is considered the new “blue revolution” in aquaculture. Such technique is based on in situ microorganism production which plays three major roles: (i) maintenance of water quality, by the uptake of nitrogen compounds generating in situ microbial protein; (ii) nutrition, increasing culture feasibility by reducing feed conversion ratio (FCR) and a decrease of feed costs; and (iii) competition with pathogens. The aggregates (bioflocs) are a rich protein-lipid natural source of food available in situ 24 hours per day due to a complex interaction between organic matter, physical substrate, and large range of microorganisms. This natural productivity plays an important role recycling nutrients and maintaining the water quality. The present chapter will discuss some insights of the role of microorganisms in BFT, main water quality parameters, the importance of the correct carbon-to-nitrogen ratio in the culture media, its calculations, and different types, as well as metagenomics of microorganisms and future perspectives.",book:{id:"5355",slug:"water-quality",title:"Water Quality",fullTitle:"Water Quality"},signatures:"Maurício Gustavo Coelho Emerenciano, Luis Rafael Martínez-\nCórdova, Marcel Martínez-Porchas and Anselmo Miranda-Baeza",authors:[{id:"146126",title:"Dr.",name:"Maurício Gustavo Coelho",middleName:null,surname:"Emerenciano",slug:"mauricio-gustavo-coelho-emerenciano",fullName:"Maurício Gustavo Coelho Emerenciano"},{id:"186970",title:"Prof.",name:"Marcel",middleName:null,surname:"Martínez-Porchas",slug:"marcel-martinez-porchas",fullName:"Marcel Martínez-Porchas"},{id:"186971",title:"Prof.",name:"Anselmo",middleName:null,surname:"Miranda-Baeza",slug:"anselmo-miranda-baeza",fullName:"Anselmo Miranda-Baeza"},{id:"195101",title:"Dr.",name:"Luis Rafael",middleName:null,surname:"Martínez-Córdoba",slug:"luis-rafael-martinez-cordoba",fullName:"Luis Rafael Martínez-Córdoba"}]}],mostDownloadedChaptersLast30Days:[{id:"69568",title:"Water Quality Parameters",slug:"water-quality-parameters",totalDownloads:10165,totalCrossrefCites:14,totalDimensionsCites:36,abstract:"Since the industrial revolution in the late eighteenth century, the world has discovered new sources of pollution nearly every day. So, air and water can potentially become polluted everywhere. Little is known about changes in pollution rates. The increase in water-related diseases provides a real assessment of the degree of pollution in the environment. This chapter summarizes water quality parameters from an ecological perspective not only for humans but also for other living things. According to its quality, water can be classified into four types. Those four water quality types are discussed through an extensive review of their important common attributes including physical, chemical, and biological parameters. These water quality parameters are reviewed in terms of definition, sources, impacts, effects, and measuring methods.",book:{id:"7718",slug:"water-quality-science-assessments-and-policy",title:"Water Quality",fullTitle:"Water Quality - Science, Assessments and Policy"},signatures:"Nayla Hassan Omer",authors:null},{id:"58138",title:"Water Pollution: Effects, Prevention, and Climatic Impact",slug:"water-pollution-effects-prevention-and-climatic-impact",totalDownloads:21554,totalCrossrefCites:18,totalDimensionsCites:38,abstract:"The stress on our water environment as a result of increased industrialization, which aids urbanization, is becoming very high thus reducing the availability of clean water. Polluted water is of great concern to the aquatic organism, plants, humans, and climate and indeed alters the ecosystem. The preservation of our water environment, which is embedded in sustainable development, must be well driven by all sectors. While effective wastewater treatment has the tendency of salvaging the water environment, integration of environmental policies into the actor firms core objectives coupled with continuous periodical enlightenment on the present and future consequences of environmental/water pollution will greatly assist in conserving the water environment.",book:{id:"6157",slug:"water-challenges-of-an-urbanizing-world",title:"Water Challenges of an Urbanizing World",fullTitle:"Water Challenges of an Urbanizing World"},signatures:"Inyinbor Adejumoke A., Adebesin Babatunde O., Oluyori Abimbola\nP., Adelani-Akande Tabitha A., Dada Adewumi O. and Oreofe Toyin\nA.",authors:[{id:"101570",title:"MSc.",name:"Babatunde Olufemi",middleName:null,surname:"Adebesin",slug:"babatunde-olufemi-adebesin",fullName:"Babatunde Olufemi Adebesin"},{id:"187738",title:"Dr.",name:"Adejumoke",middleName:"Abosede",surname:"Inyinbor",slug:"adejumoke-inyinbor",fullName:"Adejumoke Inyinbor"},{id:"188818",title:"Dr.",name:"Abimbola",middleName:null,surname:"Oluyori",slug:"abimbola-oluyori",fullName:"Abimbola Oluyori"},{id:"188819",title:"Mrs.",name:"Tabitha",middleName:null,surname:"Adelani-Akande",slug:"tabitha-adelani-akande",fullName:"Tabitha Adelani-Akande"},{id:"208501",title:"Dr.",name:"Adewumi",middleName:null,surname:"Dada",slug:"adewumi-dada",fullName:"Adewumi Dada"},{id:"208502",title:"Ms.",name:"Toyin",middleName:null,surname:"Oreofe",slug:"toyin-oreofe",fullName:"Toyin Oreofe"}]},{id:"45422",title:"Urban Waterfront Regenerations",slug:"urban-waterfront-regenerations",totalDownloads:14203,totalCrossrefCites:4,totalDimensionsCites:12,abstract:null,book:{id:"3560",slug:"advances-in-landscape-architecture",title:"Advances in Landscape Architecture",fullTitle:"Advances in Landscape Architecture"},signatures:"Umut Pekin Timur",authors:[{id:"165480",title:"Dr.",name:"Umut",middleName:null,surname:"Pekin Timur",slug:"umut-pekin-timur",fullName:"Umut Pekin Timur"}]},{id:"24941",title:"Tsunami in Makran Region and Its Effect on the Persian Gulf",slug:"tsunami-in-makran-region-and-its-effect-on-the-persian-gulf",totalDownloads:7575,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"406",slug:"tsunami-a-growing-disaster",title:"Tsunami",fullTitle:"Tsunami - A Growing Disaster"},signatures:"Mohammad Mokhtari",authors:[{id:"52451",title:"Dr.",name:"Mohammad",middleName:null,surname:"Mokhtari",slug:"mohammad-mokhtari",fullName:"Mohammad Mokhtari"}]},{id:"66307",title:"Bio-hydrogen and Methane Production from Lignocellulosic Materials",slug:"bio-hydrogen-and-methane-production-from-lignocellulosic-materials",totalDownloads:2953,totalCrossrefCites:6,totalDimensionsCites:8,abstract:"This chapter covers the information on bio-hydrogen and methane production from lignocellulosic materials. Pretreatment methods of lignocellulosic materials and the factors affecting bio-hydrogen production, both dark- and photo-fermentation, and methane production are addressed. Last but not least, the processes for bio-hydrogen and methane production from lignocellulosic materials are discussed.",book:{id:"7608",slug:"biomass-for-bioenergy-recent-trends-and-future-challenges",title:"Biomass for Bioenergy",fullTitle:"Biomass for Bioenergy - Recent Trends and Future Challenges"},signatures:"Apilak Salakkam, Pensri Plangklang, Sureewan Sittijunda, Mallika Boonmee Kongkeitkajorn, Siriporn Lunprom and Alissara Reungsang",authors:null}],onlineFirstChaptersFilter:{topicId:"12",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82465",title:"Agroforestry: An Approach for Sustainability and Climate Mitigation",slug:"agroforestry-an-approach-for-sustainability-and-climate-mitigation",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.105406",abstract:"Agroforestry Systems (AFS), or the association of trees with crops (or animals), is a strategy for land management and use that allows production within the sustainable development: (a) environmentally (production environmentally harmonic); (b) technically (integrating existing resources on the farm); (c) economically (increase in production), and (d) socially (equality of duties and opportunities, quality of life of the family group). As an intentional integration of trees or shrubs with crop and animal production, this practice makes environmental, economic, and social benefits to farmers. Given that there is a set of definitions, rather than a single definition of Agroforestry (AF) and AFS, it is justified to explore the historical evolution and the minimum coincidences of criteria to define them and apply them in the recovery of degraded areas. Knowing how to classify AFS allows us to indicate which type or group of AFS is suitable for a particular area with its characteristics. The greatest benefit that AFS can bring to degraded or sloping areas lies in their ability to combine soil conservation with productive functions. In other words, AF is arborizing agriculture and animal production to obtain more benefits including climate change adaptation and mitigation by ecosystem services.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Ricardo O. Russo"},{id:"82754",title:"Impact of Revegetation on Ecological Restoration of a Constructed Soil in a Coal Mining in Southern Brazil",slug:"impact-of-revegetation-on-ecological-restoration-of-a-constructed-soil-in-a-coal-mining-in-southern-",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.105895",abstract:"The main problems in the constructed soils are the generation of acid mine drainage promoted by the presence of coal debris in the overburden layer and the compaction of the topsoil promoted by the machine traffic when the material used in the overburden cover is more clayey. This book chapter aimed to show an overview of the impact of more than a decade of revegetation with different perennial grasses on the chemical, physical, and biological quality of constructed soil after coal mining. The study was carried out in a coal mining area, located in southern Brazil. The soil was constructed in early 2003 and the perennial grasses, Hemarthria altissima; Paspalum notatum cv. Pensacola; Cynodon dactylon cv Tifton; and Urochloa brizantha; were implanted in November/December 2003. In 11.5, 17.6 and 18 years of revegetation soil samples were collected and the chemical, physical, and biological attributes were determined. Our results show that liming is an important practice in the restoration of these strongly anthropized soils because this positively impacts the plants’ development, facilitating the roots system expansion. Biological attributes such as soil fauna and the microorganism’s population are the attributes that possibly takes longer to establish itself in these areas.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Lizete Stumpf, Maria Bertaso De Garcia Fernandez, Pablo Miguel, Luiz Fernando Spinelli Pinto, Ryan Noremberg Schubert, Luís Carlos Iuñes de Oliveira Filho, Tania Hipolito Montiel, Lucas Da Silva Barbosa, Jeferson Diego Leidemer and Thábata Barbosa Duarte"},{id:"82936",title:"Soil Degradation Processes Linked to Long-Term Forest-Type Damage",slug:"soil-degradation-processes-linked-to-long-term-forest-type-damage",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.106390",abstract:"Forest degradation impairs ability of the whole landscape adaptation to environmental change. The impacts of forest degradation on landscape are caused by a self-organization decline. At the present time, the self-organization decline was largely due to nitrogen deposition and deforestation which exacerbated impacts of climate change. Nevertheless, forest degradation processes are either reversible or irreversible. Irreversible forest degradation begins with soil damage. In this paper, we present processes of forest soil degradation in relation to vulnerability of regulation adaptability on global environmental change. The regulatory forest capabilities were indicated through soil organic matter sequestration dynamics. We devided the degradation processes into quantitative and qualitative damages of physical or chemical soil properties. Quantitative soil degradation includes irreversible loss of an earth’s body after claim, erosion or desertification, while qualitative degradation consists of predominantly reversible consequences after soil disintegration, leaching, acidification, salinization and intoxication. As a result of deforestation, the forest soil vulnerability is spreading through quantitative degradation replacing hitherto predominantly qualitative changes under continuous vegetation cover. Increasing needs to natural resources using and accompanying waste pollution destroy soil self-organization through biodiversity loss, simplification in functional links among living forms and substance losses from ecosystem. We concluded that subsequent irreversible changes in ecosystem self-organization cause a change of biome potential natural vegetation and the land usability decrease.",book:{id:"11457",title:"Forest Degradation Under Global Change",coverURL:"https://cdn.intechopen.com/books/images_new/11457.jpg"},signatures:"Pavel Samec, Aleš Kučera and Gabriela Tomášová"},{id:"82828",title:"Vegetation and Avifauna Distribution in the Serengeti National Park",slug:"vegetation-and-avifauna-distribution-in-the-serengeti-national-park",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106165",abstract:"In order to examine the bird species changes within different vegetation structures, the variations were compared between Commiphora-dominated vegetations with those of Vachellia tortilis and Vachellia robusta-dominated vegetations, and also compared the birds of grassland with those of Vachellia drepanolobium and Vachellia seyal-dominated vegetations. This study was conducted between February 2010 and April 2012. A total of 40 plots of 100 m × 100 m were established. Nonparametric Mann-Whitney U-test was used to examine differences in bird species between vegetations. Species richness estimates were obtained using the Species Diversity and Richness. A total of 171 bird species representing 103 genera, 12 orders, and 54 families were recorded. We found differences in bird species distribution whereby V. tortilis has higher bird species richness (102 species), abundance, and diversity when compared with Commiphora with 66 species and V. robusta with 59 species. These results suggest that variations in bird species abundance, diversity, and distribution could be attributed to differences in the structural diversity of vegetation. Therefore it is important to maintain different types of vegetation by keeping the frequency of fire to a minimum and prescribed fire should be employed and encouraged to control wildfire and so maintain a diversity of vegetation and birds community.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Ally K. Nkwabi and Pius Y. Kavana"},{id:"82808",title:"Climate Change and Anthropogenic Impacts on the Ecosystem of the Transgressive Mud Coastal Region of Bight of Benin, Nigeria",slug:"climate-change-and-anthropogenic-impacts-on-the-ecosystem-of-the-transgressive-mud-coastal-region-of",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.105760",abstract:"The transgressive mud coastal area of Bight of Benin is a muddy coastal complex that lies east of the Barrier/lagoon coast and stretches to the Benin River in the northwestern flank of the Niger Delta Nigeria. It constitutes a fragile buffer zone between the tranquil waters of the swamps and the menacing waves of the Atlantic Ocean. Extensive breaching of this narrow coastal plain results in massive incursion of the sea into the inland swamps with serious implications for national security and the economy. Climate change impacts from the results of meteorological information of the regions shows a gradual degradation in the past 30 years. Temperature, rainfall and humidity increase annually depict climate change, resulting from uncontrolled exploitation of natural resources is rapidly pushing the region towards ecological disasters. The ecosystem is very unique being the only transgressive mud coastal area of the Gulf of Guinea. The chapter describes the geomorphology, tidal hydrology, relief/drainage, topography, climate/meteorology, vegetation, economic characteristics, anthropogenic activities and their impacts on the ecosystem.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Patrick O. Ayeku"},{id:"82697",title:"Analyzing the Evolution of Land-Use Changes Related to Vegetation, in the Galicia Region, Spain: From 1990 to 2018",slug:"analyzing-the-evolution-of-land-use-changes-related-to-vegetation-in-the-galicia-region-spain-from-1",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106015",abstract:"Considering the complex dynamics, patterns, and particularities that the Galicia region present—e.g., the fragility, shown to achieve sustainable development and growth—a study that analyzes the Land-Use related to the vegetation of this region is seen as pivotal to identifying barriers and opportunities for long-term sustainable development. Using GIS (Geographic Information Systems), the present chapter enables us to identify the dynamics and patterns of the evolution of the Land-Use Changes related to vegetation in the Galicia Region from 1990 to 2018 (years 1990, 2000, 2012, and 2018 using CORINE (Coordination of Information on the Environment) data). This study permits us to reinforce that the Land-Use Changes related to vegetation in the Galicia Region have undergone multiple changes—marked by increasing and decreasing periods. Also, can be considered a surveying baseline for the comparative analysis of similar works for different Land-Use Changes related to vegetation trends in Europe or worldwide. Land-Use Changes related to vegetation studies are reliable tools to evaluate the human activities and footprint of proposed strategies and policies in a territory. This chapter also enables us to understand that the main actors should design development policies to protect, preserve and conserve these incomparable landscapes, environments, ecosystems, and the region as a whole.",book:{id:"11663",title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg"},signatures:"Sérgio Lousada and José Manuel Naranjo Gómez"}],onlineFirstChaptersTotal:77},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. 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She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}}]}},subseries:{item:{id:"41",type:"subseries",title:"Water Science",keywords:"Water, Water Resources, Freshwater, Hydrological Processes, Utilization, Protection",scope:"\r\n\tThe environment is subject to severe anthropic effects. Among them are those associated with pollution, resource extraction and overexploitation, loss of biodiversity, soil degradation, disorderly land occupation and planning, and many others. These anthropic effects could potentially be caused by any inadequate management of the environment. However, ecosystems have a resilience that makes them react to disturbances which mitigate the negative effects. It is critical to understand how ecosystems, natural and anthropized, including urban environments, respond to actions that have a negative influence and how they are managed. It is also important to establish when the limits marked by the resilience and the breaking point are achieved and when no return is possible. The main focus for the chapters is to cover the subjects such as understanding how the environment resilience works, the mechanisms involved, and how to manage them in order to improve our interactions with the environment and promote the use of adequate management practices such as those outlined in the United Nations’ Sustainable Development Goals.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/39.jpg",keywords:"Anthropic Effects, Overexploitation, Biodiversity Loss, Degradation, Inadequate Management, SDGs Adequate Practices"},{id:"38",title:"Pollution",scope:"\r\n\tPollution is caused by a wide variety of human activities and occurs in diverse forms, for example biological, chemical, et cetera. In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/38.jpg",keywords:"Human Activity, Pollutants, Reduced Risks, Population Growth, Waste Disposal, Remediation, Clean Environment"},{id:"41",title:"Water Science",scope:"