IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\n
By listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
All three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
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"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
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"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
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In conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n
“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\n
We invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\n
Feel free to share this news on social media and help us mark this memorable moment!
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\n
By listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
All three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n
"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n
"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\n
In conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n
“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\n
We invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\n
Feel free to share this news on social media and help us mark this memorable moment!
\n\n
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"6061",leadTitle:null,fullTitle:"Ascites - Physiopathology, Treatment, Complications and Prognosis",title:"Ascites",subtitle:"Physiopathology, Treatment, Complications and Prognosis",reviewType:"peer-reviewed",abstract:'The term "ascites" is from the Greek word askites meaning "baglike." Although most commonly due to cirrhosis, severe liver disease or metastatic cancer, its presence can be a sign of other significant medical problems, such as Budd-Chiari syndrome. Diagnosis of the cause is usually done with blood tests, an ultrasound scan of the abdomen, and direct removal of the fluid by a needle or paracentesis (which may also be therapeutic). Treatment using medications (diuretics), external drainage, or other treatments is clearly defined. In this book, the authors describe the physiopathology of the diverse causes of ascites,the types of treatments recommended, the recent advances achieved, the complications and the prognosis of the different clinical situations that doctors must face.',isbn:"978-953-51-3614-9",printIsbn:"978-953-51-3613-2",pdfIsbn:"978-953-51-4599-8",doi:"10.5772/67965",price:119,priceEur:129,priceUsd:155,slug:"ascites-physiopathology-treatment-complications-and-prognosis",numberOfPages:174,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"ead9b3e5c36413f9ff2c3129fbc57574",bookSignature:"Luis Rodrigo",publishedDate:"November 29th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/6061.jpg",numberOfDownloads:13682,numberOfWosCitations:3,numberOfCrossrefCitations:5,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:9,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:17,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 23rd 2017",dateEndSecondStepPublish:"March 16th 2017",dateEndThirdStepPublish:"September 22nd 2017",dateEndFourthStepPublish:"October 22nd 2017",dateEndFifthStepPublish:"December 22nd 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"73208",title:"Prof.",name:"Luis",middleName:null,surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo",profilePictureURL:"https://mts.intechopen.com/storage/users/73208/images/system/73208.jpg",biography:"Dr. Luis Rodrigo, MD, is a Professor Emeritus of Medicine, at the University of Oviedo, Spain. He has been Chief of Gastroenterology Service at HUCA Hospital, Oviedo, for more than forty years. He obtained a Ph.D. in 1975 and has developed a long teaching and research career. Dr. Rodrigo has published 716 scientific papers, 435 written in English and the rest in Spanish. He has participated as the main investigator in forty-five clinical trials and has directed forty doctoral theses. He has contributed actively to the formation of around 100 specialists in gastroenterology working in his hospital and other hospitals in Spain and abroad. He has written around thirty-five book chapters and edited twenty-six books in his specialty and related diseases.",institutionString:"University of Oviedo",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"17",institution:{name:"University of Oviedo",institutionURL:null,country:{name:"Spain"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1021",title:"Hepatology",slug:"gastroenterology-hepatology"}],chapters:[{id:"56496",title:"Introductory Chapter: Treatment of Ascites Associated with Cirrhosis and Its Complications",doi:"10.5772/intechopen.70232",slug:"introductory-chapter-treatment-of-ascites-associated-with-cirrhosis-and-its-complications",totalDownloads:1465,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Luis Rodrigo",downloadPdfUrl:"/chapter/pdf-download/56496",previewPdfUrl:"/chapter/pdf-preview/56496",authors:[{id:"73208",title:"Prof.",name:"Luis",surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo"}],corrections:null},{id:"56859",title:"Cirrhotic Ascites: Pathophysiological Changes and Clinical Implications",doi:"10.5772/intechopen.70537",slug:"cirrhotic-ascites-pathophysiological-changes-and-clinical-implications",totalDownloads:1406,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Liver cirrhosis is associated with a wide range of systemic and pulmonary vascular abnormalities. Cardiac dysfunction also occurs in patients with advanced liver disease (cirrhotic cardiomyopathy). The circulation in cirrhosis is hyperdynamic, which is typically characterized by hypotension resulting from the associated vasodilatation and reflex tachycardia. The circulatory dysfunction in cirrhosis is the proposed pathophysiological mechanism leading to sodium and water retention in patients with liver cirrhosis. Hyperdynamic circulation is triggered by increased intrahepatic resistance due to cirrhosis, leading to a progressive increase in portal venous pressure. As portal hypertension worsens, local production of vasodilators increases due to endothelial activation, leading to splanchnic and systemic arterial vasodilation. Nitric oxide (NO) is considered one of the most important vasodilator molecules in the splanchnic and systemic circulation. The reduction in the effective arterial blood volume results in diminished renal arterial blood flow and subsequently triggers the rennin-angiotensin-aldosterone system (RAAS), antidiuretic hormones (ADHs) and sympathetic nervous system (SNS), leading to renal artery vasoconstriction. All these changes lead to sodium retention and volume expansion, manifested as ascites and peripheral edema. Furthermore, disease progression is associated with various degrees of renal dysfunction.",signatures:"Abdulrahman Bendahmash, Hussien Elsiesy and Waleed K. Al-\nhamoudi",downloadPdfUrl:"/chapter/pdf-download/56859",previewPdfUrl:"/chapter/pdf-preview/56859",authors:[{id:"188636",title:"Dr.",name:"Hussien",surname:"Elsiesy",slug:"hussien-elsiesy",fullName:"Hussien Elsiesy"},{id:"189855",title:"Prof.",name:"Waleed",surname:"Al-Hamoudi",slug:"waleed-al-hamoudi",fullName:"Waleed Al-Hamoudi"},{id:"212539",title:"Dr.",name:"Abdulrahman",surname:"Bendahmash",slug:"abdulrahman-bendahmash",fullName:"Abdulrahman Bendahmash"}],corrections:null},{id:"56637",title:"Modern Tools for Diagnosis in Tuberculous Ascites",doi:"10.5772/intechopen.70417",slug:"modern-tools-for-diagnosis-in-tuberculous-ascites",totalDownloads:1924,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Tuberculosis (TB) is a highly contagious bacterial infection caused by Mycobacterium tuberculosis (MTB), affecting about 1/3rd of the world population and being responsible for lot of deaths worldwide, despite the progress achieved in the diagnosis and treatment fields. TB can affect the peritoneum, the TB ascites being a concern for physicians, especially when dealing with immunocompromised patients. The clinical presentation of TB ascites is challenging, due to nonspecific symptoms that make confusion with other diseases and the late results of cultures from ascites. The late diagnosis leads to a delayed treatment and high mortality. This manuscript describes recent tools used for early diagnosis in TB ascites. Molecular methods based on mycobacterial nucleic acid amplification tests (NAATs), polymerase chain reaction (PCR) detecting minimal amounts of bacterial DNA, or interferongamma release assays (IGRA) and biochemical methods such as the serum-ascites albumin gradient (SAAG) <1.1 g/dL, ratio between lactic dehydrogenase (LDH) in ascites fluid/serum total protein (TP) ratio of 0.5 and fluid ascites/serum LDH ratio of 0.6, and adenosine deaminase activity (ADA) > 40 UI/ml were recently considered more accurate diagnostic procedures. These methods allow a rapid and accurate differential diagnosis of ascites fluid, making possible the early treatment with appropriate drugs.",signatures:"Andra-Iulia Suceveanu, Despina Todescu, Laura Mazilu, Filippos\nGoniotakis Manousos, Roxana Hulea, Felix Voinea, Eugen Dumitru\nand Adrian Paul Suceveanu",downloadPdfUrl:"/chapter/pdf-download/56637",previewPdfUrl:"/chapter/pdf-preview/56637",authors:[{id:"165823",title:"Dr.",name:"Andra-Iulia",surname:"Suceveanu",slug:"andra-iulia-suceveanu",fullName:"Andra-Iulia Suceveanu"},{id:"166632",title:"Dr.",name:"Adrian-Paul",surname:"Suceveanu",slug:"adrian-paul-suceveanu",fullName:"Adrian-Paul Suceveanu"},{id:"202493",title:"Dr.",name:"Felix",surname:"Voinea",slug:"felix-voinea",fullName:"Felix Voinea"},{id:"206377",title:"Dr.",name:"Despina",surname:"Todescu",slug:"despina-todescu",fullName:"Despina Todescu"},{id:"206378",title:"Dr.",name:"Filippos",surname:"Goniotakis",slug:"filippos-goniotakis",fullName:"Filippos Goniotakis"},{id:"206379",title:"Dr.",name:"Eugen",surname:"Dumitru",slug:"eugen-dumitru",fullName:"Eugen Dumitru"},{id:"206380",title:"Dr.",name:"Laura",surname:"Mazilu",slug:"laura-mazilu",fullName:"Laura Mazilu"},{id:"216766",title:"Dr.",name:"Roxana",surname:"Hulea",slug:"roxana-hulea",fullName:"Roxana Hulea"}],corrections:null},{id:"56802",title:"Ascitic Fluid in Ovarian Carcinoma – From Pathophysiology to the Treatment",doi:"10.5772/intechopen.70476",slug:"ascitic-fluid-in-ovarian-carcinoma-from-pathophysiology-to-the-treatment",totalDownloads:1699,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Due to low symptomatology, a lack of screening, and relatively complicated diagnostic procedures of ovarian carcinoma, more and more women are believed to visit their doctors in advanced stage of the disease, complicated with ascitic fluid. There is an increasing evidence that peritoneal cytology is a subjective assessment with certain percentage of false-positive and false-negative results that may cause application of unnecessary chemotherapy or nonapplication of necessary chemotherapy. Maximal cytoreductive surgery followed by intraperitoneal or systemic chemotherapy remains to be the gold standard in preventing ascites. Ascites is not only a symptom of a disease, but a specific microenvironment for formation and mediation of protumorigenic signals that control ovarian cancer progression, proliferation, invasion, anti-apoptosis, chemoresistance and tumor heterogeneity. Acellular cytokines and immunological factors influence ovarian cancer progression and its ability to prevent immune responses of the body and tumor reaction to chemotherapy. Ascites contributes to disease dissemination, changing its course and final outcomes. Management of patients with ascites and ovarian carcinoma is complex and often the goal of the treatment is to target palliative procedures. Multidisciplinary approach is necessary in the management of these patients. Further investigations of new drugs and immunomodulators are needed aiming at prolonged periods between relapses.",signatures:"Radomir Živadinović, Aleksandra Petrić, Dane Krtinić, Sonja Pop-\nTrajković Dinić and Biljana Živadinović",downloadPdfUrl:"/chapter/pdf-download/56802",previewPdfUrl:"/chapter/pdf-preview/56802",authors:[{id:"69225",title:"Dr.",name:"Sonja",surname:"Pop-Trajkovic",slug:"sonja-pop-trajkovic",fullName:"Sonja Pop-Trajkovic"},{id:"206551",title:"Prof.",name:"Radomir",surname:"Živadinović",slug:"radomir-zivadinovic",fullName:"Radomir Živadinović"},{id:"206555",title:"Dr.",name:"Aleksandra",surname:"Petric",slug:"aleksandra-petric",fullName:"Aleksandra Petric"},{id:"206591",title:"Dr.",name:"Dane",surname:"Krtinic",slug:"dane-krtinic",fullName:"Dane Krtinic"},{id:"216424",title:"Dr.",name:"Biljana",surname:"Živadinović",slug:"biljana-zivadinovic",fullName:"Biljana Živadinović"}],corrections:null},{id:"56674",title:"Ascites: Treatment, Complications, and Prognosis",doi:"10.5772/intechopen.70384",slug:"ascites-treatment-complications-and-prognosis",totalDownloads:2093,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Ascites is the most common complication in patients with cirrhosis. It can lead to several life-threatening complications resulting in a poor long-term survival outcome. Ascites is due to the loss of compensatory mechanism to maintain effective arterial blood volume secondary to splanchnic arterial vasodilatation in the progression of liver disease and portal hypertension. Refractory ascites, spontaneous bacterial peritonitis (SBP), hyponatremia, and hepatorenal syndrome (HRS) are complications that can occur with ascites, all of them leading to a worse quality of life and short-term mortality. When complication appears, liver transplantation as a definitive and curative treatment should be considered. Other common therapeutical approaches to control ascites such as diet, sodium restriction, or the use of diuretics are needed to avoid these complications, although some patients will require further treatments when ascites becomes refractory to standard treatment. This chapter will review the complex treatment of ascites, and its related complications.",signatures:"Patricia Huelin, Jose Ignacio Fortea, Javier Crespo and Emilio\nFábrega",downloadPdfUrl:"/chapter/pdf-download/56674",previewPdfUrl:"/chapter/pdf-preview/56674",authors:[{id:"207062",title:"Ph.D.",name:"Emilio",surname:"Fabrega",slug:"emilio-fabrega",fullName:"Emilio Fabrega"},{id:"207063",title:"Dr.",name:"Javier",surname:"Crespo",slug:"javier-crespo",fullName:"Javier Crespo"},{id:"207064",title:"Dr.",name:"Jose Ignacio",surname:"Fortea",slug:"jose-ignacio-fortea",fullName:"Jose Ignacio Fortea"},{id:"207065",title:"Dr.",name:"Patricia",surname:"Huelin",slug:"patricia-huelin",fullName:"Patricia Huelin"}],corrections:null},{id:"56804",title:"Pharmacological Therapy of Ascites",doi:"10.5772/intechopen.70544",slug:"pharmacological-therapy-of-ascites",totalDownloads:1221,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Ascites refer to accumulation of fluids in the peritoneal cavity. Ascites is caused by multiple causes, among which liver cirrhosis is the commonest. Confirming the etiology is the first and most important step toward proper management. Assuming that ascites is always caused by cirrhosis can lead to unnecessarily sending patients with different etiologies for liver transplantation, particularly patients with non-cirrhotic portal hypertension. Calculating serum albumin ascitic gradient is important in differentiating ascites due to portal hypertension from other etiologies. The first-line therapy for ascites in cirrhosis is low salt diet and diuretics. It is important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) and nephrotoxic medications in these patients.",signatures:"Aziza Ajlan, Waleed K. Al-hamoudi and Hussein Elsiesy",downloadPdfUrl:"/chapter/pdf-download/56804",previewPdfUrl:"/chapter/pdf-preview/56804",authors:[{id:"188636",title:"Dr.",name:"Hussien",surname:"Elsiesy",slug:"hussien-elsiesy",fullName:"Hussien Elsiesy"},{id:"189855",title:"Prof.",name:"Waleed",surname:"Al-Hamoudi",slug:"waleed-al-hamoudi",fullName:"Waleed Al-Hamoudi"},{id:"207151",title:"Dr.",name:"Aziza",surname:"Ajlan",slug:"aziza-ajlan",fullName:"Aziza Ajlan"}],corrections:null},{id:"56136",title:"Predictors of the Response to Tolvaptan Therapy and Its Effect on Prognosis in Cirrhotic Patients with Ascites",doi:"10.5772/intechopen.69849",slug:"predictors-of-the-response-to-tolvaptan-therapy-and-its-effect-on-prognosis-in-cirrhotic-patients-wi",totalDownloads:1218,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Aims: The vasopressin V2 receptor antagonist, tolvaptan, has been reported to be effective in cirrhotic patients with ascites. Here, we evaluated predictors of the response to tolvaptan. Methods: A total of 97 patients with cirrhosis (60 males; median age, 63 years) who had been treated for ascites with oral tolvaptan were enrolled. Tolvaptan efficacy was defined as urine volume increase of ≥500 mL or a urine volume ≥2000 mL/day on the day following treatment. Normalization of the serum sodium (Na) level after 1 week of treatment and the posttreatment survival rate was analyzed. Results: Tolvaptan therapy resulted in effective urination in 67% of patients. A multivariate analysis revealed that the blood urea nitrogen/creatinine (BUN/Cr) ratio and urinary Na/potassium (Na/K) ratio were predictive of the tolvaptan response (p <0.05). The serum Na level was 135 (121–145) mEq/L, and normal levels were recovered in 50.0% of the patients with an initial Na level of <135 mEq/L. The posttreatment survival rate was significantly higher in patients who responded to tolvaptan therapy (p <0.05). Conclusions: The combination of the initial BUN/Cr and urine Na/K ratios and a normalized serum Na level after 1 week was predictive of a favorable outcome to tolvaptan therapy.",signatures:"Tomomi Kogiso, Kuniko Yamamoto, Mutsuki Kobayashi, Yuichi\nIkarashi, Kazuhisa Kodama, Makiko Taniai, Nobuyuki Torii, Etsuko\nHashimoto and Katsutoshi Tokushige",downloadPdfUrl:"/chapter/pdf-download/56136",previewPdfUrl:"/chapter/pdf-preview/56136",authors:[{id:"76593",title:"Dr.",name:"Katsutoshi",surname:"Tokushige",slug:"katsutoshi-tokushige",fullName:"Katsutoshi Tokushige"},{id:"206017",title:"Dr.",name:"Tomomi",surname:"Kogiso",slug:"tomomi-kogiso",fullName:"Tomomi Kogiso"},{id:"206066",title:"Dr.",name:"Kuniko",surname:"Yamamoto",slug:"kuniko-yamamoto",fullName:"Kuniko Yamamoto"},{id:"206067",title:"Dr.",name:"Mutsuki",surname:"Kobayashi",slug:"mutsuki-kobayashi",fullName:"Mutsuki Kobayashi"},{id:"206068",title:"Dr.",name:"Yuichi",surname:"Ikarashi",slug:"yuichi-ikarashi",fullName:"Yuichi Ikarashi"},{id:"206069",title:"Dr.",name:"Kazuhisa",surname:"Kodama",slug:"kazuhisa-kodama",fullName:"Kazuhisa Kodama"},{id:"206070",title:"Dr.",name:"Makiko",surname:"Taniai",slug:"makiko-taniai",fullName:"Makiko Taniai"},{id:"206071",title:"Dr.",name:"Nobuyuki",surname:"Torii",slug:"nobuyuki-torii",fullName:"Nobuyuki Torii"},{id:"206072",title:"Prof.",name:"Etsuko",surname:"Hashimoto",slug:"etsuko-hashimoto",fullName:"Etsuko Hashimoto"}],corrections:null},{id:"56781",title:"Non-pharmacological Treatment of Ascites",doi:"10.5772/intechopen.70511",slug:"non-pharmacological-treatment-of-ascites",totalDownloads:1305,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Diuretics are considered the first-line pharmacological treatment option for ascites. Diuretic treatment begins with spironolactone and furosemide. Non-pharmacological options include salt restriction, large-volume paracentesis (LVP), transjugular intrahepatic portosystemic shunt (TIPS), and peritoneovenous shunt. Ascites can be mobilized if renal sodium excretion tops 78 mmol daily (88 mmol–10 mmol daily) after restricting sodium intake to 88 mmol/day (about 2000 mg/day). The majority of patients with cirrhotic ascites respond to a combination of sodium restriction and diuretics such as spironolactone and furosemide (90%). Ascites that does not respond to sodium restriction and high-dose diuretic treatment (400 mg/day of spironolactone and 160 mg/day of furosemide) or following paracentesis is labeled refractory. Refractory ascites can be managed with large-volume paracentesis or transjugular intrahepatic portosystemic shunt. Peritoneovenous shunting is considered as a third-line treatment option after all other measures such as diuretics, large-volume paracentesis, or transjugular intrahepatic portosystemic shunt deemed unsuccessful or contraindicated. It has a high rate of shunt obstruction.",signatures:"Asma Alnajjar, Faisal Abaalkhail, Tala Beidas, Mohamed R.\nAbdelfattah and Hussien Elsiesy",downloadPdfUrl:"/chapter/pdf-download/56781",previewPdfUrl:"/chapter/pdf-preview/56781",authors:[{id:"188636",title:"Dr.",name:"Hussien",surname:"Elsiesy",slug:"hussien-elsiesy",fullName:"Hussien Elsiesy"},{id:"178823",title:"Prof.",name:"Mohamed",surname:"Abdelfattah",slug:"mohamed-abdelfattah",fullName:"Mohamed Abdelfattah"},{id:"217665",title:"Dr.",name:"Asma",surname:"Alnajjar",slug:"asma-alnajjar",fullName:"Asma Alnajjar"},{id:"218911",title:"Dr.",name:"Faisal",surname:"Abaalkhail",slug:"faisal-abaalkhail",fullName:"Faisal Abaalkhail"},{id:"218912",title:"Dr.",name:"Tala",surname:"Beidas",slug:"tala-beidas",fullName:"Tala Beidas"}],corrections:null},{id:"57347",title:"Ascites in Ovarian Cancer Progression: Opportunities for Biomarker Discovery and New Avenues for Targeted Therapies",doi:"10.5772/intechopen.70993",slug:"ascites-in-ovarian-cancer-progression-opportunities-for-biomarker-discovery-and-new-avenues-for-targ",totalDownloads:1352,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Until recently, ovarian cancer research has mainly focused on the tumor cell themselves ignoring for the most part the surrounding tumor environment. However, one of the major conceptual advances in oncology over the last few years has been the appreciation that major aspects of cancer biology are influenced by the tumor environment. Malignant ascites accumulates in the peritoneal cavity during ovarian cancer progression and constitutes a unique pro-inflammatory tumor environment providing a framework that orchestrates cellular and molecular changes contributing to aggressiveness and disease progression. The composition of ascites, which includes cellular and acellular components, constantly adapts during the course of the disease in response to various cellular cues originating from both tumor and stromal cells. Increasing evidence now supports an active role of ascites in the progression of ovarian cancer. Although much work is still needed to fully understand the contribution of ascites to ovarian cancer aggressiveness, this tumor environment potentially provides a wealth of opportunities for translational research including biomarker discovery and novel therapeutic target identification. In this review, we discuss recent advances in our understanding of ascites pathophysiology, the characterization of its cellular and acellular contents, the intercellular crosstalks, and how these data can be used to improve the outcome of ovarian cancer.",signatures:"Isabelle Matte, Paul Bessette and Alain Piché",downloadPdfUrl:"/chapter/pdf-download/57347",previewPdfUrl:"/chapter/pdf-preview/57347",authors:[{id:"71046",title:"Dr.",name:"Alain",surname:"Piché",slug:"alain-piche",fullName:"Alain Piché"},{id:"162148",title:"BSc.",name:"Isabelle",surname:"Matte",slug:"isabelle-matte",fullName:"Isabelle Matte"},{id:"207084",title:"Dr.",name:"Bessette",surname:"Paul",slug:"bessette-paul",fullName:"Bessette Paul"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"932",title:"Acute 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\r\n\tIn this book, the technological and functional properties of barley will be highlighted comprehensively. Moreover, Nutritional and bioactive profiles and barley utilization in different baking products will also be in the limelight of this book. This depiction will be valuable for all consumers from health points of view.
\r\n
\r\n\tFood security is an alarming issue in developing countries as the population is increasing day by day. So, researchers have to think about alternative sources of staple diet(wheat) that should have the same nutritional composition as compared to wheat. Among cereals, barley is an alternative source because of its nutritional and functional properties, despite all the functional ingredients it is rarely used in the food industry. From different researches, it is revealed that it contains 24 % dietary fiber, so it is beneficial for CVDs and other health-related disorders. Now a day, barley consumption is very rare. There are many barley products in the food market such as malt flour, grits, flakes, pot, and pearled barley. Bread formulations also involve the usage of barley flour and cracked barley. The possibility of high fiber barley utilization in breakfast cereals production through blending with other grains, flaking, puffing, and extrusion is becoming common. So, there is a dire need to do value addition of barley into various products. Furthermore, the most important reason for wheat replacement with barley is its allergy-causing nature in some cases. Keeping in view all of the above facts, the present book has been designed.
",isbn:"978-1-80356-924-6",printIsbn:"978-1-80356-923-9",pdfIsbn:"978-1-80356-925-3",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"996125d4599193b3b6b749f5d8aa3cb2",bookSignature:"Dr. Farhan Saeed and Dr. Muhammad Afzaal",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11793.jpg",keywords:"Cereal, Barley, Dietary Fibers, Nutritional Composition, Grains, Technology, Processing, Milling, Flour, Rheology, Bioactive Profile, Utilization",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 6th 2022",dateEndSecondStepPublish:"June 14th 2022",dateEndThirdStepPublish:"August 13th 2022",dateEndFourthStepPublish:"November 1st 2022",dateEndFifthStepPublish:"December 31st 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Farhan is an Assistant Professor at Government College University Faisalabad-Pakistan where he finished his Ph.D. at the age of 28 years. He has an h index of 16 and has published more than 70 papers in reputed journals with an impact factor of more than 140. His research focus is on finding innovative and effective practices to improve food production, quality, and safety, keeping in view the betterment of human health.",coeditorOneBiosketch:"Dr. Muhammad Afzaal is working as an Assistant professor in the Department of Food Science. Government College University Faisalabad. He has 10 years of teaching and research experience. He has more than 40 publications in well-reputed journals and 5 book chapters published. His research interests are food science and technology, food microbiology and biotechnology, microencapsulation, probiotics, prebiotics & synbiotics, biopreservation, and waste value addition.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"192244",title:"Dr.",name:"Farhan",middleName:null,surname:"Saeed",slug:"farhan-saeed",fullName:"Farhan Saeed",profilePictureURL:"https://mts.intechopen.com/storage/users/192244/images/system/192244.jpg",biography:"PERSONAL STATEMENT\r\nMy name is Farhan Saeed. During Master study, I received an Indigenous Fellowship from Higher Education Commission (HEC) Pakistan. The selection process was a rigorous process starting from a GRE-based test. After being short listed by HEC, part of the Fellowship was the opportunity to complete doctorate degree mainly within Food Science and Technology field. I did my Doctorate thesis entitled 'Biochemical characterization of non-starch polysaccharides in relation to end-use quality of spring wheats” under the supervision of Dr. Imran Pasha. The doctorate research was focused on value addition of bioactive components extracted from spring wheats. The addition of extracted non-starch polysaccharides enhances the quality of baked products as well as important in nutraceutical point of view. The products under proposed study were thoroughly investigated for assessment of nutritional and end use quality of bread. The output of the proposed research work was highly beneficial to the consumers as well as Government of Pakistan for their intended purposes. The awareness about nutritional significance of non-starch polysaccharides enriched bread was really set the new horizons in product development in Pakistan. In 2012, I joined Institute of Home & Food Sciences, Government College University Faisalabad as Assistant Professor. In 2014, I became HEC Approved Supervisor. During 2015, I have visited Massachusetts, Amherst, USA under Pakistan Program for Collaborative Research (PPCR), HEC Pakistan for two months training program for the development of innovative project. After that, I have been selected to receive a 2016 'Endeavour Research Fellowship” to undertake proposed program in Australia. I did work in Centre for Nutrition & Food Science, The University of Queensland, Brisbane, Australia under the supervision of Professor Mike Gidley. The commencing date of current program is May 17, 2016 and the expiry is on November 15, 2016. In October, 2018. I was promoted to Tenured Associate Professor. I have published more than 70 papers in reputed journals with impact factor more than 140. I have 20 book chapters in international books. I presented research works in international level at Huazhong University Wuhan, China and Conference on Food Properties in Sharjah. I also got two research projects funds from Higher Education Commission Islamabad, Pakistan. I would like to be granted the KGSP because it will offer me with the opportunity to partake in Post-Doctoral program of Food Science and Biotechnology at Kyungpook National University (KNU) among the best universities in Korea. In my home country, vital issues stressed in this particular degree program are quite overlooked, and this scholarship program will bring me a great chance to come within reach of them. By taking this course, I am optimistic for finding innovative and effective practices to improve food production, quality and safety, keeping in view the betterment of human health; and moreover, to improve the end-product quality for maintenance of customer’s health. To sum up, winning the KGSP will enable me not only to broaden my knowledge, but also to gain experience from people and culture of both countries Korea and Pakistan. In the longer term, I sturdily desire to contribute to the cause of assuring food security and safety initially in my country and laterally worldwide. The main objective of applying here to get international exposure while working with world class food experts especially those working in the area of functional foods and nutraceuticals. The knowledge and expertise together with the international interaction developed through this project will finally be utilized for the development of laboratory of functional foods and nutraceuticals at my home institute.",institutionString:"Government College University, Faisalabad",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}}],coeditorOne:{id:"245894",title:"Dr.",name:"Muhammad",middleName:null,surname:"Afzaal",slug:"muhammad-afzaal",fullName:"Muhammad Afzaal",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSF1qQAG/Profile_Picture_1618812051691",biography:"Dr. Muhammad Afzaal, Ph.D., is an Assistant Professor in the Department of Food Science, Government College University Faisalabad, Pakistan. 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From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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1. Introduction
Earth sheltering is an age long traditional practice. In modern times its benefits has prompted new definitions for its practice. With the potential thermal conservation qualities and physical characteristics of earth as a building mass, earth shelters can now be defined as structures built with the use of earth mass against building walls as external thermal mass, which reduces heat loss and maintains a steady indoor air temperature throughout the seasons. The popularity of earth sheltering was advanced mostly by research in energy conservation in residential housing. Originally conceived as dwellings developed by the utilization of caves within the traditional context, its evolution through technologies led to the construction of customized earth dwellings all across the globe. These structures in the past were built by people not schooled in any kind of formal architectural design or with identifiable building techniques rather they depended on the cover the very structure of the earth could provide them for purposes of shelter, warmth and security. Investigations into the traditional earth sheltered dwellings also identified sunken earth houses with characteristics that suggested potentials in passive building insulation which utilizes ground thermal inertia.
In the view of some researchers on earth supported housing, building underground provides energy savings by reducing the yearly heating and cooling loads in comparison with known conventional structures. Not only is the temperature difference between the exterior and interior reduced, but mostly because the building is also protected from the direct solar radiation [1].
One significant value of earth-sheltered housing and the reason for its evaluation is its potential energy savings when compared to conventional aboveground housing. This potential is based on several unique physical characteristics. The first of these characteristics is in the reduction of heat loss due to conduction through the building envelope because of the high density of the earth. According to [2], in an earth sheltered building even at very shallow depths and given normal environmental conditions, the ground temperatures seldom reaches the outdoor air temperatures in the heat of a normal summer day. This condition allows the conducting of less heat into the house due to the reduced temperature differential.
In the case of colder climates, it was noticed that during winters the rate of heat loss in bermed (earth supported) structure was less in comparison to that in on-grade structures. This indicates through results that the floor surface temperature increased by 3° C for a 2.0m deep bermed structure due to lower heat transfer from the building components to the ground, thus suggesting the presence of passive heat supply from the ground even at the extreme cold temperatures of winter [3]. This evidently contributes as a factor for energy saving in earth shelter buildings in cold climates.
Other characteristics include the reduction of air infiltration within the dwelling which is mainly surrounded by earth walls with very little surface area exposed to the outside air. These characteristics have been investigated in previous studies and the analysis on each location provides results and findings in terms of climatic effects, design styles and residential activities of the dwellers that bring about the unique energy saving value of these buildings.
Single unit earth sheltered houses are unique energy conservation ideas based on their earth contact characteristics as mentioned above. In order to achieve the maximum benefits from earth sheltered housing, its application could be examined also at an entirely community scale rather than simply at the scale of individual houses. One of the biggest challenges to the overall performance of earth sheltered housing would be the built conventional surroundings. While contemporary use of earth sheltering is confined to individual homes built on single plots of land or a small cluster of houses which will absolutely be affected by the surrounding conventional structures around, the traditional use encompassed entire communal design or villages that will stay within the same conditions the micro-environment provides. This communal development option is identified to be most effective as isolated pockets of earth sheltered houses do not really reach the scale needed for sustainable development [4]. Earth sheltered mass-housing may thence become the general concept for design and building with earth whereby entire communities are created, enjoying dual land use by locating all housing underground [5]. If a single case of earth sheltering is found to have significant advantages, these advantages can only increase in magnitude if applied to whole communities.
2. Fundamentals of Earth sheltered housing
The values of energy conservation in earth shelters are dependent on certain principles. These principles which form the ground rules for the design and construction of earth sheltered dwellings have been existent since prehistoric periods. Earth sheltered homes were primarily developed for shelter, warmth and security for the earliest human dwellers. Most of the recorded cases of these shelters are found extensively in areas like Asia and Northern Africa. In one of the earliest cases in Japan was discovered the oldest human habitation in a layer of earth about 600,000 years old in Kamitakamori, Miyagi Prefecture. Archaeologists from the Tohoku Paleolithic Institute, Tohoku Fukushi University and other institutes believed that the finding may be one of the oldest in the world. There are only a few remains of human dwelling structures from the early Paleolithic period in the world, as early humans such as the Peking-man lived in caves. Researchers believed the dwellings were built by primitive man who appeared some 1.6 million years ago and likely reached Japan 600,000 years ago at the latest, according to the archaeologists. The buildings could have been used as a place to rest, a lookout for hunting, a place to store hunting tools or to conduct religious rites.
In Tunisia, residents of Matmata were discovered to have lived in manmade caves for centuries (Figure 1). Here rooms were carved into the soft rock to create atrium houses that had several excavated rooms with up to 4 to 10 meter high and vaulted ceilings opening out onto a single sunken courtyard. The original objective for going below the ground in this case was to protect the inhabitants from the extremes of daytime North African heat and nighttime cold, typical of this desert region.
Figure 1.
Aerial view of a typical Matmata earth shelter dwelling. Image by Tore Kjeilen
However through the years, more modern earth sheltered dwellings were revealed as studies on the earliest forms of human settlements progressed. In China, modern earth shelters habitats were discovered with histories that dated back to before 2000 B.C. This type of habitats were commonly called cave dwellings as they were strictly home units hewed out of the mountains. It is believed that underground housing preceded above ground housing in this area. Studies on these existing Chinese earth habitats presented analytical data on the climatic and topographical relationships to the unique design elements utilized to attain living comfort by the cave shelter dwellers. Such analysis as the rain, wind, sun and seasonal weather conditions that exist in these areas where these dwellings were located possibly necessitated the advantage of its existence in these locations [6]. Analysis on each location also provided results and findings in terms of climatic effects, design styles and residential activities of the dwellers. In the North-west of China, variety of these structures evolved, ranging from the cave dwelling units to the more advanced subterranean types. In the case of the traditional subterranean homes in China (called \'yao dong\'), rooms were dug into loose, silty soil to primarily combat the hot summers and bitterly cold winters. In the early 20th century the provinces of Shanxi, Jiansu and Henan still had traditional dwellers that faced with the need to preserve agricultural land and housing for their people, dug entire cities beneath their lands. Today, it is still believed that more than 10 million Chinese live underground, perhaps the largest number of troglodytes ever to inhabit a single region. The Shanxi homes (Figure 2, 3 and 4) were buried at depths of up to 10 meters with their underground homes built around courtyards. This atrium-style design offer ample sunlight as well as surface spaces for other activities.
Research conducted in [6] also provided analytical data on climatic and topographical relationships to the structural design styles with single unit design solution, multi unit designs and finally urban planning initiatives on how to achieve a sunken city that exists beneath rather than above ground level as seen in Figure 2 below. Also fascinating in discovery included methods and techniques of ventilating the building units naturally. Such natural ventilation techniques are viewed today as ideas that advanced the notion of passive aeration of interiors which ultimately is a cost and energy efficient alternative to the whole process of earth sheltered housing.
Figure 2.
Aerial view of an earth shelter neighborhood in Lian Jiazhuang, Shanxi Province, North-western China
Figure 3.
a) Courtyard view of an Atrium type subterranean earth shelter dwelling in Lian Jiazhuang, Shanxi Province. (b) Interior view of a typical room space. Image by Kevin Poh.
Figure 4.
A typical earth shelter home layout in North-western China
With the challenges of global warming and fossil energy reduction, energy saving ideas has become an essential element in building designs and occupation. Since energy conservation is the practice of saving energy use without compromising occupant thermal comfort [7], building below the ground thence presents certain fundamentals that with the aid of research can significantly influence energy conservation efforts in modern housing. From reviews of the basic background of traditional earth sheltered housing, the fundamental objectives for building below the ground and significant energy conservation principles are listed as follows:
Indoor temperature enhancement based on the natural principles of annual heat storage (PAHS) whereby the earth collects free solar heat all summer and cools passively while heating the earth around it, and keeping warm in winter by retrieving the stored heat from the soil in winters. This dual function presents a scenario that makes the practice of earth sheltered housing effective in both hot and cold climates.
Huge temperature differential between the ground temperatures and the outdoor air temperatures. In this case the normal ground temperature seldom reaches the outdoor air temperatures in the heat of a normal hot day, thereby conducting less heat into the house due to the reduced temperature difference.
Building protection from the direct solar radiation, thereby elimination the challenge of direct thermal load due to heat radiation through the building envelope.
Apart from the energy values which the subsurface climate of the earth provides, the other significant characters beneficial to earth shelters includes the major goal of recycling surface space by relocating functions to underground, by this earth shelters liberates valuable surface space for other functional uses and improves ground surface visual environment, open surfaces for landscaping and thus a more greener atmosphere.
3. Modern construction techniques and design typology
The structural make up of a typical earth shelter house is made up of the supporting members and the compacted backfills in which case strength and composition can determine the ability to withstand overhead loads of moisture, dead and live loads, the distribution of which depend on the compaction strength of the backfill or supports.
However in modern designs, the supports are the parts of the house that brace against the side walls of soil and overlaying roof members that are made of backfills as in the case of underground homes. The design method and material choice will determine the resistance to failure of these structural members. In the traditional construction scenario where the earth-soil is used as building material; its strength is determined by the soil stability, which goes to improve the resistance to wind and in most cases rain erosion.
3.1. Earth shelter structural integrity
The structural make up of earth homes is mainly made up of the supporting members and the compacted backfills. As earlier mentioned, the strength and composition of the material used as backfill can determine the ability to withstand overhead loads. The supports are the parts of the house that brace against the side walls of soil and overlaying roof members that are made of backfills. The building design method and material choice will determine the resistance to failure of these structural members. In the case where the earth-soil is used as building material, its strength is determined by the soil stability, which goes to improved the resistance to wind and rain erosion. In most earth shelter construction the significant structural areas are the soil, walls and roof area. Apart from serving as a building material, the soil-walls of the shelter trench are regarded as the most valuable structural member of the Earth house structure. It provides the necessary support a normal wall gives in an ordinary house design. Nevertheless, not all soil types are efficient in use for earth sheltered house construction. From studies it is identified that the best soils are granular, such as sand and gravel. These soils compact well for bearing the weight of the construction materials and are very permeable, which means they allow water to drain quickly. The poorest soils are cohesive, like clay, which may expand when wet and has poor permeability. Soil tests, offered through professional testing services, can determine load-bearing capability of soils and possible settlements that may occur after construction. Study in [6] revealed certain traditional considerations for deciding the depth, thickness of mass and curvature of the support ceilings (vault) of the Chinese earth homes which can also be applied in modern day construction of earth shelters (figure 5).
Figure 5.
Structural consideration for a typical room space excavation in the Shanxi traditional earth shelters
h =1 ~2, Ø = 18°.
½ B₁ = ½ B + H₁ t g (45° - Ø ⁄ 2)
= 3.5 ⁄ 2 + 3 t g (45° - 18°⁄ 2)
½ B₁ = 1.75 + 2.19 = 3.94 m
Then S = Thickness of Earth thermal mass wall
H3 = Extent of depth clearance
Assuming B (room span) = 3.5m and H₁ (room height) = 3m
H3 = Depth from ground surface to ceiling. This should be greater than h\n\t\t\t\t
The Dotted/shaded area indicates possible fault lines due to the pressure from the overlaying earth mass
Varieties of techniques have been used in the past for earth shelter wall construction. The construction materials for the walls of each type of structure will vary, depending on characteristics of the site, climate, soils, and design. However, general guidelines show that houses more deeply buried require stronger, more durable structural walls. Walls must provide a good surface for waterproofing and insulation to withstand the pressure and moisture of the surrounding ground. When soil is wet or frozen, the pressure on the walls and floors increases as pressure also increases with depth.
For the traditional earth supported homes built in the Chinese and Arid (dessert) climatic regions, there usually is no use for supporting walls as the naturally compressed soil structure already serves the function. However through recent research on improving the state of earth homes for most other climatic regions, the walls of Earth homes can be made of various materials ranging from Compressed Earth bricks to Concrete, while providing cavities and drainage patterns to aid damp proofing. In most earth home designs, the roof is usually the most challenging part of the entire structure. With recent ideas in ecology, the roof of earth shelters assume interesting landscaping functions. Especially for earth supported shelters which already posses the natural materials of earthen walls and members, the roof can also be finished to assume a natural finish too. Since the basic idea of this study is to discover techniques to achieve high performance as possible, the basic structural form for constructing the earth shelter roof is as follows:
A frame strong enough to support the dead load brought by the soil overlay, rain, snow and ice loads where applicable.
A solid deck built over the frame and a waterproof membrane installed on the deck prior to final earth cover.
Treated soil backfill placed on the membrane (as the roof layer) and covered with a fine thick layer of soil. The roof will either grow a vegetation of its own or become a life garden depending on the appropriate type of maintenance.
Reinforced concrete is the most commonly used structural material in earth shelter construction. Products like Grancrete and Hycrete are becoming more readily available. They claim to be environmentally friendly and either reduce or eliminate the need for additional waterproofing. However, these are new products and have not been extensively used in earth shelter construction.
Some other unconventional approaches are also utilized in earth shelter construction. These techniques utilize recycled material of various forms and applications. One of such approaches is referred to as an Earth ship (figure 6). These houses are built to be self-contained and independent; their design allows occupants to grow food inside and to maintain their own water and solar electrical systems [8]. Some builders believe they have proven the design\'s ability to tap into the constant temperature of the earth and store additional energy from the sun in winter. These Earth ships carry out their environmentally conscious theme by employing unusual building materials in the form of recycled automobile tires filled with compacted earth for thermal mass and structure. While the tires form the major structural frames for the building, aluminum or tin cans are used for filling minor walls that are not load-bearing. Foam insulation can be applied to exposed exterior or interior walls and covered with stucco. Interior walls are also dry-walled giving it a conventional look.
Figure 6.
An Earth Ship design, using recycled materials
3.2. Earth shelter construction typology
Earth sheltered houses are often constructed with energy conservation and savings in mind. Though techniques of earth shelter construction have not yet become common knowledge, study into the most efficient application of the earth shelter principles reveals classifications of the major typologies that are utilized in the construction of earth houses. These major construction concepts are the Bermed or banked with earth type and the Envelope or True underground type. The energy conservation values of these typologies also vary depending on climate and physical challenges indigenous to each typology (table 1).
Bermed earth shelter: In this type of construction, earth is piled up against exterior walls and heaped to incline downwards away from the house. The roof may, or may not be, fully earth covered, and windows/openings may occur on one or more sides of the shelter. Due to the building being above ground, fewer moisture problems are associated with earth berming in comparison to the fully underground construction. Other variations of bermed construction are the elevational and in-hill construction (figure 7). This type of construction is particularly appropriate for colder climates. With regards to energy efficiency in colder climates, all the living spaces may be arranged on the side of the house facing the equator. This provides maximum solar radiation to the most frequently used spaces like bedrooms, living rooms, and kitchen spaces [9]. Rooms that do not require natural daylight and extensive heating such as the bathroom, storage and utility rooms are typically located on the opposite in-hill side of the shelter. The compact configuration of this construction provides it with a greater ratio of earth cover to exposed wall thereby improving its energy performance benefits through the earth-contact principles. However the case for both climates, the three major determinants for the building orientation remains the sun, wind and outside views. Proper orientation with respect to solar path and wind is significant for energy savings.
Figure 7.
a) Elevational (beremed) and in-hill designs, (b) Atrium (bermed) design
Envelope or True underground earth shelter: In the true underground construction, the house is built completely below ground on a flat site, with the major living spaces surrounding a central outdoor courtyard or atrium. The windows and glass doors that are on the exposed walls facing the atrium provide light, solar heat, outside views, and access via a stairway from the ground level. The atrium effect offers the potential for natural ventilation. In the view of some researchers, this concept reduces the energy conservation properties in colder climates mostly due to the reduced solar exposure within the courtyard or atrium opening [9]. However recent studies in the area of soil temperature analysis with respect to energy conservation in earth shelters, provides information on the prospect of efficient underground earth shelter design. Such studies as in [10], provides mathematical method for predicting the long-term annual pattern of soil temperature variations as a function of depth and time for different soils and soil properties that are stable over time and depth. The likes of these studies were utilized by John Hait\'s [11] in his book on Passive Annual Heat Storage (PAHS) to advance the ideas of earth shelter housing. With the development of modern passive solar building design, during the 1970s and 1980s a number of techniques are developed to enabled thermally and moisture-protected soil to be used as an effective seasonal storage medium for space heating, with direct conduction as the heat return method. Other variations of the true underground typology are the Atrium/courtyard concept and the Penetrational type where earth covers the entire house, except where it is retained for windows and doors for cross-ventilation opportunities and access to natural light from more than one side of the house (figure 8).
Figure 8.
Underground earth shelter design
One of the most significant earth sheltered buildings in modern times is the Aloni House (figure 9). It was built in Antiparos Island in Greece and won the Greek Piranesi Award in 2009. The building epitomizes all that a modern time earth shelter represents. It combines all the design types mentioned above within a unique terrain. It also provided courtyard spaces with its landscape appearing to drift naturally into the courtyard thereby allowing for free solar penetration to the desired areas.
Factor
Earth shelter building type
Bermed
Envelope/true underground
Passive solar potential
Excellent
Less effective
Thermal stability
Less effective
Excellent
Natural lighting potential
Effective
Less effective
Wind protection
Less effective
Excellent
Noise protection
Less effective
Excellent
Visual convenience
Excellent (one directional view)
Poor (allows only open sky view)
Appropriate Climate
Effective for temperate
Most effective for tropical
Structural cost
Modern design
Vernacular design
Modern design
Vernacular design
Intermediate
Less expensive
Most expensive
Least expensive
Table 1.
Comparing efficiency values of the earth shelter building typology
Figure 9.
Images of the Aloni House. (a) view from the hill top, (b) view from the top of the house, (c) opening leading to the courtyard, (d) the central courtyard, (e) interior view of the living room, (f) interior view from the kitchen. (Images by Julia Klimi)
4. Evaluation of energy conservation principles in earth shelter schemes
The most significant value of earth shelters and the basis for the exploitation of earth in energy saving building initiatives is its energy preservation potential. This is based on several unique physical characteristics of earth. As stated earlier, the dependability of earth in energy conservation designs is related to the natural principles of annual heat storage; huge temperature differential between the ground temperatures and the outdoor air temperatures and the insulation properties from direct solar radiation. In the cold climates, the significant property is the reduction of heat loss due to conduction through the building envelope. The amount of heat lost in this manner is a function of the thermal transmission coefficient (R-factor) of the envelope and the temperature difference between the inside of the envelope and the outside. While the R-factor for earth is substantially lower than that of other insulating materials, the large amount of earth inherent in earth sheltering can provide an overall R-factor comparable with more highly insulated structures [12].
According to investigations in [12], the temperature differential for conventional above ground structures is the difference between the outside air temperature and the interior temperature maintained for the comfort of its inhabitant. Under extreme conditions, this differential can be as much as 32°C. However, since the daily and seasonal fluctuations of temperature below the surface of the ground never equals that of the air above, therefore the deeper the temperature is taken, the less severe will be the variation. This reduced temperature differential results from the thermal storage capabilities of the soil which moderate extremes of temperature and create seasonal intervals, wherein energy from one season is transferred to the next season as in the principle of PAHS.
4.1. Solar radiation and energy conservation in earth sheltered houses
It is common knowledge that the sun is one of the most significant determinants in energy efficient building design. The radiant energy from the sun can be used as both active and passive heat generators for a building. Generally in colder climates, the active solar receptor system is oriented directly to the south, whereas all passive solar collection methods are based on trapping the radiant energy of the sun which enters through the openings on the building envelope. In the case of earth sheltered houses, the best site orientation (in cold climates) is the south-side orientation which maximizes the presence of all of the window openings whereas the remaining sides of the building are completely earth covered. The use of passive solar collection in combination with other energy conservation values is a very desirable energy efficient concept in buildings since it does not involve the capital expense that an active solar collector does. Conversely, it is important to note that, while solar radiation is desirable in the heating season of cold climates, they are not as efficient in the cooling season of hotter climates. The effect of wind on the orientation of an earth sheltered structure is a serious energy consideration [13]. Since direct exposure to cold winter winds increases heat loss due to infiltration which consequently creates a wind chill effect, it is desirable to protect a building as much as possible from this exposure. In the north hemisphere the prevailing winter winds are from the northwest. Minimizing window and door openings on the north and west sides of the house in this region will enhance energy performance.
4.2. Effects of seasonal thermal storage systems on energy conservation in earth sheltered houses
A seasonal storage system can broadly be defined as one which stores energy in one season and delivers that energy in another season. Naturally for seasonal storage systems that function as solar thermal collectors, this means that energy is collected in periods of high radiation as is the case in summer seasons and delivered in winter seasons during periods of low radiation. However to further improve the efficiency of any of the seasonal thermal storage systems, very effective above-ground insulation or super insulation of the building structure is required to minimize heat-loss from the building, thereby improving the amount of heat that needs to be stored and used for space heating.
There are three major types of seasonal (annualized) storage systems that are classified as effective or beneficial to earth shelter buildings. These are:
4.2.1. Low temperature systems:
This system utilizes the earth (soil) adjoining the building as a low-temperature seasonal heat store, thereby reaching temperatures similar to average annual air temperature while drawing upon the already stored heat for space heating. These systems can also be seen as an extension to the building design itself as the design involves some simple but significant differences when compared to conventional above ground buildings.
4.2.2. Warm temperature inter-seasonal heat system:
This also uses soil to store heat, but utilizes active solar collection mechanisms in summer to heat up thermal banks (earth mass) in advance of the heating season. Warm temperature heat stores are generated from low-temperature stores in that solar collectors are used to capture surplus heat in summer and actively raise the temperature of large mass of soil so that heat extraction is made cheaper in winter.
4.2.3. Passive annual heat storage system (PAHS):
With the development of modern passive solar building design, during the 1970s and 1980s a number of techniques were developed that enabled thermally induced and moisture-protected soil to be used as an effective seasonal storage medium for space heating, with direct conduction as the heat return method. The concept of Passive Annual Heat Storage (PAHS) is such that solar heat is directly captured by the structure\'s spaces and surfaces in summer and then passively transferred through its floors, walls and roof into adjoining thermally-buffered soil by conduction. It is then passively returned to the building\'s spaces through conduction and radiation as those spaces cool in winter. This idea was originally introduced by John Hait [11]. It includes extensive use of natural heat flow methods, and the arrangement of building materials to direct this passive energy from the earth to the building, all without using equipment. PAHS is believed to be one of the most significant ideas for energy conservation in earth sheltered buildings.
Concept of passive annual heat storage system (PAHS):
Globally, the earth receives electromagnetic radiation from the sun which is typically defined as short-wave radiation and emits it at longer wavelengths known typically as long-wave radiation. Figure 10 below shows an analysis of the earth’s shortwave and long-wave energy fluxes produced with details from [14]. This absorption and re-emission of radiation at the earth’s surface level which forms a part of the heat transfer in the earth’s planetary domain yields the idea for the principle of PAHS. When averaged globally and annually, about 49% of the solar radiation striking the earth and its atmosphere is absorbed at the surface (meaning that the atmosphere absorbs 20% of the incoming radiation and the remaining 31% is reflected back to space). This absorbed 49% of the solar radiation presents a premise for energy efficiency in building design. The concept of earth shelter design focuses fundamentally on the utilization of the absorbed/retained heat from this annual absorption and re-emission of radiation for indoor thermal environment control.
Figure 10.
Earth’s energy budget diagram showing the short-wave (a) and long-wave (b) energy fluxes
4.3. Analysis of soil thermal performance in earth shelter designs
The thermal property of an earth-shelter soil is an essential factor in determining its performance against other conventional above-grond houses. Due to the relatively stable temperature of the soil, the earth shelter house in summer loses heat to the cool earth rather than gaining heat from the surrounding air, and in winter the relatively warm soil offers a much better temperature environment than the subzero air temperatures. This concept is clearly confirmed by examination of the daily and yearly soil temperature fluctuations at various depths. Daily fluctuations are virtually eliminated even at a depth of 20 cm of soil. At greater depths, soil temperature responds only to seasonal changes, and the temperature change occurs after considerable delay [15]. A reasonable level of soil study is necessary in order to facilitate the comparison of the energy needed for construction (soil excavation, dewatering and concrete works) with the energy to be saved in the long run, conditions related to the insulation efficiency of the soil [16]. However the expected efficiency varies with the soil type and its water content which in some cases may have a marked effect on the thermal properties of the soil. The figure below (Figure 11) presents a typical relationship between the annual air temperatures and corresponding temperature fluctuation below the ground surface.
Figure 11.
Annual temperature fluctuations in Riyadh from below zero to 48 ◦C and expected temperature fluctuation at 3.0m below ground level between 14◦C and 24◦C. (Data taken from [16])
In earth shelter houses, the overlaying thick earthen layer around much of the building effectively eliminates possibilities of infiltration through the building skin (as is the case in conventional above-ground houses). This can contribute significantly in reducing energy loss due to infiltration, except only through the exposed portions of the structure. Apart from the reduction of infiltration, studies identified that the application of thermal coupling of the earth-soil to the building wall places significant values to the thermal conditions of the earth shelter environment in winters. This process allows for improved thermal storage through the soil into the building walls. Since majority of modern earth shelters are built with concrete which possesses a large thermal storage capacity which can absorb the excess energy from the earth-soil, this absorbed heat is naturally released back into the building whenever the indoor air temperature is below that of the thermal mass. This thermal absorption and releasing process can provide essential heat energy required in the house for days without mechanical heating. The effect of this process is presented below (figure 12) in a thermal investigation study of a berm-type earth sheltered house in Missouri (US) covering a 4 day assessment period under a 6-hourly measurement interval [12].
Figure 12.
Temperature stability graph of an earth sheltered house in Missouri (Data taken from [12])
Determining the thermal performance of the soil for earth shelter construction involves assessing the long-term subsurface environment and above-ground temperature data. Consequently, this requires accurate environmental information on the boundary conditions, one of which is the temperature of the surrounding soil. For instance, in the case of a single basement study, a change in the mean annual ground temperature from 10◦C to 6 ◦C caused a 36% increase in heat loss [17]. Therefore, accurate data regarding diurnal and annual variation of soil temperatures at various depths is necessary to accurately predict the thermal performance of earth sheltered structures.
Study shows that actual data on soil temperatures is not usually abundant. However research has facilitated the evaluation of the underground climate in order to assess the suitability of earth sheltered structures. Algorithms for this calculation of the soil temperatures at various depths have already been developed based on existing field measurements in different regions of the world and by this, the annual pattern of soil temperatures at any depth can be accurately considered as a ‘sine’ wave about the annual average of the ground surface temperature. Accordingly, a mathematical method was developed to predict the long-term annual pattern of soil temperature variations as a function of depth and time for different soils and soil properties that are stable over time and depth [10]. This method is sufficiently accurate in the case certain thermal and physical characteristics are accurately estimated. The equation for estimating subsurface temperatures as a function of depth and day of the year is as follows (with the unit of cosine expressed in rad):
T(x,t)= subsurface temperature at depth x(m) on day t of the year (◦C),
Tm= mean annual ground temperature (equal to steady state) (◦C), as the annual temperature amplitude at the surface (x = 0) (◦C),
x = subsurface depth (m),
t = the time of the year (days) where January 1 = 1 (numbers),
t0= constant, corresponding to the day of minimum surface temperature (days),
α = the thermal diffusivity of the soil (m2/day)
Through this equation, the resulting temperature profile at different depths can now be graphed and compared with the annual average air temperatures. Following the evaluation of the subsurface climate, the calculated soil temperatures can then be used to calculate the heat flux through the building surfaces. The energy efficiency of a wall in contact with the earth at varying depths can thus be investigated for local climatic conditions. This can be done by simulating the heat transfer through a subsurface wall at varying depths using a computer program, and comparing the results with an above-ground wall using the same method. This procedure is a typical preliminary assessment method with minimal input required. The expected results from the simulations provides preliminary insight into the magnitude of reduction of heat flow that the building soil climate can provide in comparison to the above-grade climate and the analysis also provides a faster approach for determining the optimum depth placement for an earth sheltered building.
Although this theory seems rightly beneficial to the energy conservation concepts in earth shelter house construction, it is also right to consider other detrimental factors like the soil\'s heat and cooling losses due to normal thermal transmittance factors. Earth shelters are subjected to heat and cooling losses partly via the soil to the external air, via the soil to the groundwater below or directly to the groundwater. The quantity of loss is calculable in this case and the equation is generated in [18] as follows:
QT = Atotal(vi−vOT)RAL+vi−vGWRGW[W]E2
\n\t\t\t\t
Where:
ϑOT= mean outside temperature
≈ 0 to -5°C ≈ (ϑe+ 15K)
ROT= Ri+ RλA+ RλB+ Re= equivalent resistance to thermal transmission room-outside air.
RλA= equivalent resistance of the soil to thermal conductivity.
RλB= resistance of building component to thermal conductivity.
R=23\\*ALPHABETICW= Ri+ RλB+ Rλs= equivalent resistance to thermal transmission room-groundwater.
Rλs= T/λs = thermal conductivity resistance of soil to groundwater.
D = depth of groundwater
λs= thermal conductivity coefficient of soil
≈ 1.2 W/mK
ϑ=23\\*ALPHABETICW= groundwater temperature = 10°C.
4.4. Energy conservation values in earth shelter design
Earth is a great moderator of temperature change. When warmed up, it can stay warm a long time without losing much of its heat [9]. Earth does not react as fast to temperature change as air does. This means that for instance if air surface temperatures ranges from -15°C to 35°C through the year (winter through summer), then about 3 meters below, the temperature of the earth will vary only between 10°C to 15°C. This short range in difference explains the ability of earth to maintain stable temperatures throughout the year. This is a significant energy conservation tendency in the case of reducing the load on home heating and air-conditioning systems. With regards to total operating cost (excluding estimates from heat-recovery systems), energy savings of up to 60% to 70% may be realized in residential scale structures within mid-temperate zones. Instances of this were presented in [19] from the energy cost studies undertaken in [20]. In this study, a conventional 135 sq m (9m x 15m) single level residence with a hypothetical subsurface structure of the same dimension was compared. With the use of climate data and energy rates of Denver metropolis in Colorado, the study establish that the underground house provides a 72% energy savings over the surface dwelling (Table 2, 3 and 4).
Measured unit
Conventional surface house
Earth shelter house
Heat loss in winter (B.T.U. per hour)
39,927
12,720
Heat gain in summer (B.T.U. per hour)
44,650
0
Table 2.
Evaluation of rates of heat loss and gain in a typical above ground house and an earth sheltered house [20]
Evaluation of annual energy consumption cost in a typical above ground house and an earth sheltered house [20]
Building type
Gas
Oil
Electricity
Above ground design (AGD)
($395)
($459)
($758)
Earth sheltered design (ESD)
($120)
($135)
($283)
Cost conservation comparison between ESD and AGD
30%
29%
37%
Table 4.
Evaluation of annual cost of environmental control requirements in a typical above ground house and an earth sheltered house [20]
5. Soil suitability analysis for earth sheltered building construction
As already discussed earlier, not all soil types are efficient in use for earth sheltered building construction. The choice of construction site is mainly determined by the soil type available in a given geographical area for issues of safety against landslides and other moisture originated hazards. Some types of soil are more suitable than others in the construction of sub-grade buildings. The strength of the soil must be determined for the proposed depth of building below ground level. Though may be desirous, excavations in a very strong soil may be difficult and in the case of rocky ground, may prove impossible. On the other hand, in very weak soils the excavations are easy. In the first two cases, the capital cost and the energy expenditures involved in construction need careful examination [21]. For the third case, however, the excavation may be difficult because high lateral earth pressure requires construction of heavy walls (retaining walls), preferably made of reinforced concrete, which implies increased capital costs and energy consumption. In modern earth sheltered home construction, compaction and permeability values are the most essential standards considered in the backfill process when building a berm or elevational type construction. This is mostly due to the dangers of soil drainage. It has been noted earlier that soil-water content has distinctive effect on the thermal properties of the soil hence may affect the overall energy performance of earth-homes. Choosing a site where the water will naturally drain away from the building is the best way to avoid water pressure against underground walls. In order to improve the energy performance of the earth-soil in temperate, humid or arid tropical scenarios, drainage systems must be designed to draw water away from the structure to reduce the frequency and length of time the water remains in contact with the building\'s exterior. Survey has identified that ideal sites are those of hilly or mountainous terrain. The partially buried (bermed-elevational) earth-sheltered home is identified as most suitable for maximizing passive-solar heating in cold climates, however since water tends to drain down the hill toward the building and off the roof toward the back of the home, it is advisable to build in highly water-permeable soils and to install water drainage systems around the perimeter of the buried walls. Hydrology discusses infiltration as the rate at which water passes into the soil. This is also affected by the ratio of macro to micro-pores of the soil in question. The more macro-pores a soil has the easier it is for water to soak into it and drain away. Soils with coarse particles like sand or gravel or nutty or block soil structures have a high proportion of macro-pores and as a result have high infiltration rates. Soils such as clays have a high proportion of micro-pores and therefore have low infiltration rates. Figure 14 below illustrates different infiltration rates based on soil structure and texture [22].
Through the analysis below, it could be said that a good earth home design site with natural drainage also requires permeable soils. The most permeable soils as identified above are the granular type which consists of a fair amount of sand or gravel while soils with high clay content are less permeable as they expand and contract as moisture levels fluctuate. Nonetheless, it is advisable to perform percolation tests on the construction site\'s soil to determine the earth shelter soil permeability before construction.
Figure 13.
Infiltration curves for different soil textures
6. Thermal Integrity Analysis of earth sheltered houses
Thermal integrity factor (TIF) is a combined system for evaluating and comparing the energy performance values of building types. It is expressed in units which allow for direct comparison among such criterion as heating, ventilating, and air conditioning systems as well as the effect of various climatic conditions on different housing types. The standard unit for measuring thermal integrity values is Btu/ft2 per degree day of the provided space condition. A TIF of 7.5 Btu/ft2 per heating degree day is considered as representative of a baseline-factor for moderately insulated houses [23], while values in the ranges of 0.6 to 1.1 Btu/ft2 per heating degree day are predicted for super-insulated houses [24]. Early indication of the performance of earth sheltered buildings against the conventional above-ground ones were recorded as far back as the late 1970s and 80s. Measurements were conducted on existing earth sheltered houses in some US cities. In one of the houses located in South Dakota which was monitored during 1978 and 1979, it consumed about 28,000 Btu/ft2 for 8144 heating degree days, which yields a TIF of 3.5 Btu/ft2 per heating degree day. The report on this house went on to note that typical above-ground framed homes in the same location generally required about 10 to 12 Btu/ft2 per heating-degree day. This displays a 70% difference in the TIF of these two homes in the same location. Figure 13 below shows the comparative energy consumption for the above-ground and earth sheltered homes. In some other cases, earth sheltered houses display TIFs of 0 (zero) Btu/ft2 per heating degree day. Below (table 5) are the results of the TIFs for five different buildings in Minnesota all of which recorded TIFs of less than 4.0 [25].
Figure 14.
Comparison of monthly total energy usage in conventional above-ground and earth sheltered homes (taken from [12])
House
June 1980
July 1980
Aug. 1980
Sept. 1980
Oct. 1980
Nov. 1980
Dec. 1980
Jan. 1981
Feb. 1981
Burnsville
nil
nil
nil
0.65
0.84
nil
nil
nil
2.03
Camden
0
0
0
0
0.89
1.20
2.65
1.92
nil
Seward
0
0
0
0
0
2.14
3.60
2.53
3.19
Wild River
0
0
0
0
0.19
2.05
1.08
0.91
1.27
Willmar
nil
nil
nil
2.28
2.34
1.23
2.72
2.01
nil
Table 5.
Monthly thermal integrity factor for five Minnesota earth-sheltered residences
7. Conclusion
In this study, the following factors were analyzed in the hope of throwing light into the common questions that arise in the discourse of earth sheltered housing:
Energy conservation elements for earth shelter housing,
Thermal integrity values,
Techniques for maximizing the thermal loads necessary for comfort conditions in passively heated or passively cooled earth shelters,
Soil suitability, depth of placement and design techniques that optimizes structural integrity in earth sheltered house construction.
This study also presented some of the valuable analysis and results in earth shelter building evaluations as premise for assessing the potentials of passively heated earth sheltered houses. This is achieved through a review of previous performance assessments of monitored conditions in existing earth sheltered buildings. Through this review, thermal integrity factors (TIF) of existing earth sheltered homes were identified, which when compared with other housing types, perform significantly better than conventional above-ground dwellings. It also looked at both summer and winter impacts of earth shelter house types utilizing the passive approach under the different climate conditions. This study identified that the thermal integrity value of passively heated earth sheltered house is comparable with other energy-efficient approaches such as super-insulated and passive solar constructions which are much better in energy conservation performance than the conventional above-ground constructions. It further presents the criteria for identifying the appropriate soil type (sub-grade materials) needed in building earth sheltered houses with passive thermal approach. These are categorized under thermal inertia properties, bearing capacity and drainage properties. Based on the available information to date, it can be said that earth sheltered houses maintain heating energy consumption that is lesser by up to 75%. This claim appears to be substantiated as earth sheltered house compared to conventional above-ground house presents a lesser calculated or monitored TIF.
Having looked through the benefits and potentials of earth and the overall understanding of its potential for energy conservation through earth-sheltered construction, it is hoped that this review contributes to the information available so far on means of assessing the performance of earth shelters and associated thermal properties that affects it. It is then possible for designers and planners in different regions to have access to a simple framework for assessing its efficiency at the initial planning stages. The resulting outputs can then be used for the heat transfer and energy conservation analysis within the building units. Results from this analysis will provides insight into the degree of passive heating and cooling or reduction in heat flow that the soil climate can provide as compared to the surface climate as well as suggesting parameters for depth placement of earth shelter buildings for more efficient results.
\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/40549.pdf",chapterXML:"https://mts.intechopen.com/source/xml/40549.xml",downloadPdfUrl:"/chapter/pdf-download/40549",previewPdfUrl:"/chapter/pdf-preview/40549",totalDownloads:7797,totalViews:1474,totalCrossrefCites:1,totalDimensionsCites:15,totalAltmetricsMentions:50,introChapter:null,impactScore:6,impactScorePercentile:95,impactScoreQuartile:4,hasAltmetrics:1,dateSubmitted:"November 8th 2011",dateReviewed:"July 25th 2012",datePrePublished:null,datePublished:"October 31st 2012",dateFinished:"October 26th 2012",readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/40549",risUrl:"/chapter/ris/40549",book:{id:"2438",slug:"energy-conservation"},signatures:"Akubue Jideofor Anselm",authors:[{id:"139659",title:"Dr.",name:"Akubue",middleName:"Jideofor",surname:"Anselm",fullName:"Akubue Anselm",slug:"akubue-anselm",email:"akjideofor@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Fundamentals of Earth sheltered housing ",level:"1"},{id:"sec_3",title:"3. Modern construction techniques and design typology",level:"1"},{id:"sec_3_2",title:"3.1. Earth shelter structural integrity",level:"2"},{id:"sec_4_2",title:"3.2. Earth shelter construction typology",level:"2"},{id:"sec_6",title:"4. Evaluation of energy conservation principles in earth shelter schemes",level:"1"},{id:"sec_6_2",title:"4.1. Solar radiation and energy conservation in earth sheltered houses",level:"2"},{id:"sec_7_2",title:"4.2. Effects of seasonal thermal storage systems on energy conservation in earth sheltered houses",level:"2"},{id:"sec_7_3",title:"4.2.1. Low temperature systems: ",level:"3"},{id:"sec_8_3",title:"4.2.2. Warm temperature inter-seasonal heat system: ",level:"3"},{id:"sec_9_3",title:"4.2.3. Passive annual heat storage system (PAHS): ",level:"3"},{id:"sec_11_2",title:"4.3. Analysis of soil thermal performance in earth shelter designs",level:"2"},{id:"sec_12_2",title:"4.4. Energy conservation values in earth shelter design",level:"2"},{id:"sec_14",title:"5. Soil suitability analysis for earth sheltered building construction ",level:"1"},{id:"sec_15",title:"6. Thermal Integrity Analysis of earth sheltered houses",level:"1"},{id:"sec_16",title:"7. Conclusion ",level:"1"}],chapterReferences:[{id:"B1",body:'CarpenterP.1994Sod It: An Introduction to Earth Sheltered Development in England and Wales, Coventry University, Coventry,.'},{id:"B2",body:'CarmodyJ.SterlingR.1984Design considerations for underground buildings, Underground Space 8352362'},{id:"B3",body:'KumarR.SachdevabS.KaushikS. C.2007Dynamic earth-contact building: A sustainable low-energy technology, Building and Environment 4224502460'},{id:"B4",body:'DoddJ.1993Earth sheltered settlements, a sustainable alternative, in: Proceedings of the Earth Shelter Conference, Coventry University 32636'},{id:"B5",body:'Moreland F.L,1975An alternative to suburbia, in: Proceedings of the Conference on Alternatives in Energy Conservation: The Use of Earth-covered Buildings, National Science Foundation, Fort Worth, TX,.'},{id:"B6",body:'GolanyG. S.1983Earth Sheltered Habitat (History, Architecture and Urban Design), Van Nostrand Reinhold Company Inc., New York.'},{id:"B7",body:'Rahman M.M, Rasul M.G, Khan M.M.K,2010Energy conservation measures in an institutional building in sub-tropical climate in Australia. Applied Energy 8729943004\n\t\t\t'},{id:"B8",body:'ReynoldsM.1991Earth-ship Systems and Components, Solar Survival Press'},{id:"B9",body:'WellsM. B.1975To Build without Destroying the Earth. 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M.1991Earth Sheltered Housing: An Approach to Energy Conservation in Hot Arid Areas Architecture and Planning Riyadh. 3318\n\t\t\t'},{id:"B17",body:'Mitalas G.P,1982Basement Heat Loss Studies, DBR/NRC, Ottawa.'},{id:"B18",body:'KlausD.2003Advanced Building Systems: A Technical Guide for Architects and Engineers, Published for Architecture Basel, Boston, Berlin. 50\n\t\t\t'},{id:"B19",body:'LabsK.1975The Architectural Use of Underground Space: Issues and Application. Master’s Thesis/Washington University, May, Mechanicsville PA. 121\n\t\t\t'},{id:"B20",body:'HarrisonL.1975Is it time to go Underground? The Navy Civil Engineer, Fall. 2829\n\t\t\t'},{id:"B21",body:'HennaA. M.1980Building Underground Alternatives. Miami published research for the Energy Conservation Conference, Florida.'},{id:"B22",body:'Mc LarenR. G.CameronK. C.1990Soil science. An introduction to Properties and Management of New Zealand Soils. Oxford university press, Auckland.\n\t\t\t'},{id:"B23",body:'LewisD.FullerW.1979Solar Age, 31\n\t\t\t'},{id:"B24",body:'ShurcliffW. A.1980Super-insulated Houses and Double-Envelope Houses, A Preliminary Survey of Principles and Practice, 2nd Ed., Cambridge, Mass. 6'},{id:"B25",body:'GoldbergL. F.LaneC. A.1981A Preliminary Experimental Energy Performance Assessment of Five Houses in the MHFA Earth-sheltered Housing Demonstration Program, University of Minnesota, Minneapolis. 10\n\t\t\t'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Akubue Jideofor Anselm",address:null,affiliation:'
Architecture Department, University of Nigeria, Nigeria
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1. Introduction
1.1 Introduction and pathophysiology
Aortic valve stenosis (AVS) represents the most common heart valve condition requiring treatment among adults in developed countries [1, 2]. The precursor and main determinant of AVS is the aortic valve calcification (AVC), characterized by thickening and calcium deposition of the aortic cusps, prevalence of which in the elderly population is approximately 50%, of which at least 25% develops AVS during follow-up [3, 4, 5]. While the rate of execution, success, and complications of the aortic valve replacement (AVR) (surgical-SAVR or transcatheter-TAVR) are improving, pushing more and more toward the treatment even of patients with severe asymptomatic AVS as emphasized by the recent AVATAR trial [6], to date no drug therapy has been shown to be effective in altering the natural history of AVS. This would seem attributable to the fact that AVS pathogenesis is complex and does not reflect exactly that of atherosclerosis. The difference in pathobiology of valvular calcification versus vascular plaque is further emphasized by the fact that calcifications of the aortic valve appear relatively early in the disease process compared with the calcifications of atherosclerotic plaques [7].
One of the key contributors to these pathophysiological differences may be the lipoprotein (a) [Lp (a)], a low-density lipoprotein (LDL)-like particle whose plasma levels are primarily (90%) genetically determined by the LPA gene [8].
The main difference with LDL is related to an additional protein termed as apolipoprotein (a) [apo (a)] covalently bound to apolipoprotein B-100 by a single disulfide bond [9]. The extreme structural similarity between these two lipoproteins implies that the laboratory measurement of low-density lipoprotein cholesterol (LDL-C) also includes the content of Lp (a) cholesterol, even when LDL-C is measured directly and not obtained via the Friedewald formula [10]. Therefore, in clinical practice, to obtain the “real” LDL-C, the following formula should be applied: “real” LDL-C = measured LDL- C—Lp (a) mass in mg/dl x 0.3 [11].
This gimmick can prove extremely useful in the case of “non-responders” patients to statin therapy. Indeed, extremely high Lp (a) values, which are not lowered by statins, can falsely raise LDL-C. Therefore, the use of this formula could guide the choice of the most appropriate lipid-lowering therapy [11].
Very early after Lp (a) discovery in 1963 by the genetist Kaare Berg in Norway, [8] its important role in the development and progression of atherosclerosis was demonstrated. Indeed, Lp (a) levels >30 mg / dL and > 50 mg/dL, which are found in about 30 and 20% of individuals worldwide, respectively, confer an impressive 2–2.5-fold increased risk of myocardial infarction and cardiovascular disease [12]. Furthermore, a recent study [13] showed that Lp (a) is associated with accelerated progression of coronary low-attenuation plaque, a marker of necrotic core, which provides powerful prediction of future myocardial infarction outperforming clinical risk scores, severity of luminal stenosis, and computed tomography (CT) calcium scoring [14]. The European Society of Cardiology (ESC) guidelines consider hyperlipoproteinemia (a) the most widespread genetic dyslipidemia in the world and recommend that all individuals should have Lp (a) measured at least once in life, to identify subjects at significantly increased cardiovascular risk [15]. Again, the 2021 ESC guidelines on cardiovascular prevention stress the fact that Lp (a) dosage may play a role in the reclassification of global cardiovascular risk, particularly in subjects at moderate cardiovascular risk.
The possible association between Lp (a) and aortic valve sclerosis and calcification was first described only in 1995 by Gotoh et al., about 30 years after the discovery of the existence of LP (a)[16]. The landmark genome study that found that a genetic variation in the LPA locus (rs10455872), resulting in elevated Lp (a) levels, was associated with AVC across multiple ethnic groups and with incident clinical AVS and AVR surgery published only in 2013 [17]. After this cornerstone study, a rich and fervent literature has developed in support of the possible etiopathogenetic role of Lp (a) in AVS and AVR. Data from the ASTRONOMER trial demonstrated that elevated Lp (a) levels are associated with faster AVS hemodynamic progression and need for AVR in patients with mild-to-moderate AVS [18]. Two large patients’ longitudinal analyses conducted in the European Prospective Investigation into Cancer (EPIC)-Norfolk study [19] and in the Copenhagen City Heart Study and Copenhagen General Population Study [20] demonstrated that Lp (a) is not only a strong risk factor for AVS but is also associated with higher risk of hospitalization and mortality due to AVS. All these findings have been extensively replicated even in patients with heterozygous familial hypercholesterolemia [21] and in patients with established coronary artery disease (CAD) [22]. Finally, in 2019, Zheng et al. elegantly showed that AVS patients with elevated Lp (a) levels are characterized by increased valvular calcification activity, as measured with 18F-sodium fluoride (18FNaF) positron emission tomography (PET), increased AVC on CT, more rapid progression of AVS on serial Doppler echocardiography, and increased incidence of AVR and death [23].
The mechanism by which Lp (a) determines AVC and AVS is complex, and the result is of wide debate [24]. Currently, the main hypothesis foresees that Lp (a) acts simultaneously on three pathophysiological pathways:
Lp (a) promotes inflammatory response within the valvular endothelium.
Inflammation process is the principal mediator of the AVC stenosis initiation phase: within affected regions, macrophages, T-lymphocytes, and mast cells produce widespread microlesions and subsequent microcalcifications [25, 26].
Lp (a) facilitates the phenotypic switch of interstitial valve cells into osteoblast-like cells capable of depositing calcium hydroxyapatite.
Lp (a) is known to bind with proteoglycans and fibronectin on the endothelial surface and infiltrate the inner layers of the aortic valves to act locally on valvular interstitial cells (VICs) phenotype [27]. Indeed, Lp (a) is the major lipoprotein carrier of oxidized phospholipid, which is a substrate for the enzyme Lp-phospholipase 2 to produce lysophosphatidylcholine (LPC), which promotes valve mineralization [23]. Once LPC is converted into lysophosphatidic acid by the enzyme Autotaxin present on Lp (a) surface, it acts directly on VICs favoring their differentiation into osteoblasts-like cells by producing the major osteoblastic transcription factors RUNX2, BMP2, and the key inflammatory mediator IL6 [28]. To further increase calcium deposition, Lp (a) increases alkaline phosphatase activity through BMP2, which plays a crucial role in facilitating mineralization through hydrolysis of pyrophosphate and providing inorganic phosphate to fuel mineralization [29]. This osteogenic differentiation of VICs actually is believed to represent the pivotal mechanism by which Lp (a) is involved in valvular calcification and AVS development.
Lp (a) promotes thrombosis.
Apo (a), the main structural protein of Lp (a), is extremely similar to plasminogen [30], thus it may promote thrombotic apposition in the valve site by competing with plasminogen and thereby inhibiting the role of plasmin in dissolving fibrin clots [31]. Indeed, Lp (a) affects platelet activation and aggregation, increases plasminogen activator inhibitor-1 synthesis, and inhibits synthesis of the tissue factor pathway inhibitor [32].
1.2 Comparison between Lp (a) and other risk factors for aortic valve calcification
Since many epidemiologic studies have suggested an association between AVC and traditional cardiovascular risk factors for atherosclerosis, including male sex, smoking, hypertension [33], hyperlipidemia, diabetes mellitus [34], and metabolic syndrome [35], one might think that the “pathogenetic weight” of Lp (a) is lower once adjusted for these other risk factors for aortic valve calcification.
Liu et al., analyzing 652 patients, demonstrated that even after a multivariate logistic regression analysis adjusting for traditional risk factors, such as age, sex, body mass index (BMI), hypertension, diabetes, smoking, and LDL-C, higher Lp (a) levels were an independent predictor of severe AVS, as evaluated by echocardiography (OR = 1.78,95% CI: 1.18–2.66, P = 0.006 [36]. These critical findings were soon replicated among 2412 participants from the population-based Rotterdam Study and 859 apparently healthy individuals from the Amsterdam University Medical Center cohort. The study of Kaiser et al. showed that individuals with elevated Lp (a) levels have a significantly increased prevalence of AVC, independently from age, sex, BMI, smoking, use of antihypertensive medication, and non-high-density lipoprotein cholesterol serum levels. Moreover, they found that additional adjustment for a sensitive parameter such as the coronary artery calcium, which reflects the global atherosclerotic burden, did not alter in any way the strong relationship between Lp (a) and AVC [37].
1.3 Imaging features about lipoprotein(a) involvement in aortic stenosis
Transthoracic echocardiography (TTE), which is the modality of choice to provide a comprehensive hemodynamic assessment of AS severity, yields only a qualitative assessment of AVC. CT is, indeed, a highly sensitive technique for the assessment of established macroscopic deposits of AVC. However, CT does not quantify early valve calcification (often referred to as “microcalcification”).
PET/CT imaging can provide, instead, both anatomic and molecular data and is accurate and reproducible to detect and quantify inflammation (18F-fluorodeoxyglucose uptake) and develop microcalcification activity (18F-NaFuptake) into aortic valve hydroxyapatite. 18F-NaF uptake beyond macrocalcifications has been shown to predict new areas of calcium deposition and subsequent increase in AVC [19]. Thus, 18F-NaF uptake not only correlates with AS severity, but it appears to be a measure of the pathological process of ongoing calcifying activity [20].
Besides, various studies revealing increased valvular calcification activity using 18F-NaF PET confirmed faster rates of disease progression using both CT calcium scoring and echocardiography. In patients with AS, in the end, elevated Lp (a) levels were associated with increased AVC activity measured by 18F-NaF uptake on PET/CT, more rapid AS progression, and increased risks of aortic valve replacement and death [21].
1.4 Pharmacological approach to lowering Lp (a) and course of aortic valve stenosis
AVS is a progressive disease, so follow-up of patients plays a fundamental role as recommended by European and American guidelines [2, 38]. The rate of progression in patients with moderate AS is highly variable from patient to patient and mainly depends on the presence of risk factors such as advanced age, elevated leaflet calcification, and presence of aortic bicuspid valve. On average, there is an annual increase of peak aortic jet velocity (Vmax) of 0.3 m/s, of the mean pressure gradient of 7 mmHg and a decrease of functional area (AVAfx) of 0.1cm2 [2]. When patients develop severe symptomatic AS, the risk of major adverse cardiovascular events, especially sudden cardiac death, becomes very high. The only available therapy in these cases is SAVR or TAVR, with a strong positive effect on survival, symptoms, and left ventricular (LV) systolic function. Patients with non-critical asymptomatic severe AVS (with preserved ejection fraction (EF) (Vmax <5 m/s) instead have similar survival rates of age-matched controls, with a low risk of sudden death (<1% per year) [2].
In the field of cardiovascular diseases, increasing importance is being given to prevention of pathologies, especially for highly prevalent diseases such as AVS (2–7% of the population older than 65 years of age). Despite this, unfortunately nowadays there is no medical therapy that has proven effective in preventing the onset of AVS nor in slowing its progression. The pursuit of this goal has always been linked to the world of cholesterol-lowering therapies. The first promising results were obtained with statins. The first double-blind, placebo-controlled study was the SALTIRE trial in 2005 [39]. The study enrolled 155 patients, randomized to Atorvastatin 80 mg once daily versus placebo. To be enrolled, patients had to present AVC on TTE and a transvalvular gradient of at least 2.5 m/s; patients with LDL levels below 140 mg/dl or with statin intolerance were excluded. Primary endpoints were changes in Vmax assessed with Doppler echocardiography and calcium score (assessed with CT) after 25 months. The results of this first trial were disappointing: despite a significant reduction in LDL-C, there was no statistically significant difference not only in the primary endpoints, but also in clinical endpoints such as AVR and cardiovascular death. These results were certainly influenced by the numerous limitations of the study: a follow-up of only 2 years certainly too short to observe the effects on a slowly progressive disease; the choice of Vmax>2.5 as the cutoff may have excluded patients with initial disease in whom an early intervention could have led to greater benefits. The next trial was designed to overcome these limitations: the SEAS trial was published in 2008 [40]. Inclusion criteria were a diagnosis of asymptomatic AVS with Vmax between 2.5 and 4 but with a significantly higher sample size (1873). Patients with traditional indication for lipid-lowering therapy, such as atherosclerotic disease, hyperlipidemia, high cardiovascular risk profile and diabetes mellitus, were excluded, so placebo treatment was permitted. Patients were randomized to Simvastatin 40 mg plus Ezetimibe 10 mg versus placebo. A great novelty of this trial was the choice to use clinical and no longer parametric outcomes as primary endpoints (a composite of major cardiovascular events, including death from cardiovascular causes, AVR, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, heart failure, coronary-artery bypass grafting (CABG), percutaneous coronary intervention, and non-hemorrhagic stroke) with a doubled follow-up (52 versus 25 months). Despite the substantial changes made, the results were again disappointing: no statistically significant difference between the two groups in terms of AVS progression was observed. On the other hand, significant results were obtained confirming the fundamental role that lipid-lowering therapy has in the secondary prevention of atherosclerotic disease: in the statin arm was observed a reduction in the risk of ischemic cardiovascular events [−22% ([CI] -37 -3; con P = 0.02)], especially the need for CABG [−32% ([CI] -50 -7; con P = 0.02)].The last trial published on the role of statins in AVS was the ASTRONOMER trial [41]. A small sample of patients (269) were enrolled in the study. Inclusion criteria were like SEAS’ ones, but at the end of enrolment, the study population was on average 10 year younger and with less calcified valves compared with the other two studies. Patients were randomized to receive either placebo or Rosuvastatin 40 mg. the results confirm what emerged from the two previous studies: despite an excellent reduction in LDL-C, no effects were found on AS progression (as measured by aortic Vmax and AVAfx) nor on outcome events (cardiac death or AVR). Considering the results of these three well-designed and large trials, it can be stated with scientific certainty that there is no benefit in the use of statins on the progression of AVS in patients without other indications for lipid-lowering therapy. In fact, most recent American practice guidelines on heart valve disease state: “statin therapy is not indicated for prevention of hemodynamic progression of aortic stenosis” because of no benefit class III level of evidence A [2].
Recent genetic studies have confirmed the role of some atherogenic apo-B containing lipoproteins including Lp (a). Reducing these particles can be beneficial through the inhibition of leaflet mineralization, the inhibition of macrophage infiltration, the prevention of osteoblast-like phenotype transformation, and the reduction of leaflet cholesterol accumulation. We also know that patients with high levels of Lp (a) have a more rapid progression of the disease [23]. Statins increase Lp (a), and this may be one explanation for their failure. On the other hand, Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK-9i) are effective in reducing Lp (a) by an average of 20–30% with an incompletely known mechanism [42]. In a recent study with a large sample (49,617 patients), patients with PCSK9 R46L loss of function mutation presented lower levels of LDL, Lp (a) as well as a lower risk of AVS and myocardial infarction. PCSK9 R46L carriers had an age- and sex-adjusted odds ratio of 0.64 (95% confidence interval, 0.44–0.95) for AVS, 0.77 (0.65–0.92) for myocardial infarction [43]. These innovative but preliminary data have been confirmed in a recent meta-analysis of 10 studies. This document underlines that PCSK9 is not only present in the aortic valves and is involved in the calcification process but also that there is a correlation between levels of PCSK9 and severity of calcification. Indeed, experimental in vitro studies have shown that neutralizing PCSK9 reduces the accumulation of calcium in valve cells by up to 50% [44]. Important new findings also came from an intervention study. Trial FOURIER enrolled 27,564 patients with atherosclerotic disease randomizing them to Evolocumab versus placebo. In a recent subanalysis of this important trial, the authors evaluated the safety database for aortic events [44]. the data confirmed the association between plasma levels of Lp (a) and AVS after a full multivariable adjustment; on the other hand, there was no association between AVS and Lp (a)-corrected cholesterol levels. The most interesting aspect concerns the response to Evolocumab: in fact, the patients in therapy had a lower incidence of AS with an HR of 0.66 (95% CI, 0.40–1.09), with no apparent association in the first year (HR, 1.09 [95% CI, 0.48–2.47]) but an HR of 0.48 (95% CI, 0.25–0.93) after the first year of treatment; with also a lower incidence of AVR. This may further confirm the association between Lp (a) and AS, but more importantly, it may suggest that reducing Lp (a) levels may slow the onset and progression of AVS. All this has yet to be scientifically proven; a trial with PCSK-9i is still underway to evaluate the effect on aortic leaflet calcification (NCT03051360) [45]. Another pattern under study concerns the inhibition of the renin-angiotensin-aldosterone system. Drugs such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, in addition to the positive antihypertensive effect, could slow down the progression of the disease by reducing pro-fibrotic processes affecting the myocardium and especially the aortic leaflets. An ongoing trial is evaluating this hypothesis (NCT04913870) [46].
Studies have also been conducted regarding soluble guanylate cyclase (sGC) and nitric oxide. There is evidence on the effectiveness in preventing cardiac dysfunction and remodeling in patients with pressure overload with PDE-5 inhibitors. Moreover, the stimulation of sGC was correlated to an increase in aortic leaflet calcification [47]. A small phase 2 intervention study was also conducted with Ataciguat, obtaining a significant reduction in aortic leaflet calcification assessed by CT [48]. The calcification of the aortic leaflets is the cornerstone of the pathophysiology of AVS, leading to mechanical stress, inflammation, and further calcification. There is an association between osteoporosis and increased calcification of the cardiocirculatory system. In view of this, there were hopes for osteoporosis drugs [49]. Despite these premises in the recent SALTIRE II trial, Denosumab and Alendronate failed to slow the progression of AVS, assessed by fluoride F-18 PET [50]. Vitamin K supplementation as an enhancer of the anti-calcific effects of matrix-Gla protein is currently being investigated in the BASIK2 trial.
In Figure 1, we show Vmax through an AVS in the apical five-chamber view by continuous-wave Doppler.
Figure 1.
Recording of the peak velocity through a stenotic aortic valve in the apical five-chamber view by continuous-wave Doppler.
2. Aortic valve stenosis and cardiac amyloidosis
2.1 Introduction and pathophysiology
Cardiac amyloidosis (CA) refers to the deposition of amyloid fibrils in the heart. The two prevailing amyloid proteins with cardiac tropism are immunoglobulin light chain (AL) and transthyretin (ATTR) [51, 52] (Table 1). Describing AS and CA association has grown interest lately, as a consequence of increased facility of CA-ATTR diagnosis and novel treatments. As they share some characteristics, their discrimination still remains very challenging. Several retrospective or prospective studies have described the presence of CA, especially the ATTR form, in AS patients, with a prevalence ranging from 4–29% [53, 54]. Conversely, AL amyloidosis has rarely been described in patients with AS [55, 56, 57]. Only one group reported a majority of AL-CA in their study population [58]. Of 55 consecutive patients with CA, AS was found in 9 and 80% had AL amyloidosis. According to the authors, it is possible that a selection bias has affected the results. Thus, when describing AS-CA association, it is reasonable to consider mainly wild type (wtATTR).
AL: immunoglobulin light chain amyloidosis; ATTR: transthyretin amyloidosis; CNS: central nervous system; v: variant amyloidogenic; and wt: wild type.
The amyloidogenic process causes the aggregation and the precipitation of amyloid proteins in the extracellular space of different organs. In the heart, this results in increased thickness of ventricular wall and valves, impaired myocardial contraction, and restrictive filling due to interposition of the fibrils. Moreover, amyloid fibers have a direct toxic effect, mainly dependent on the type of CA: circulating light chains have demonstrated more significant direct cardiotoxicity when compared with ATTR [59, 60]. On the other hand, the mechanical stress and atherosclerotic process affecting leaflets in AS are responsible for triggering an inflammatory response, which leads to fibrosis, thickening, sclerosis, and calcification [61]. Therefore, oxidative stress, inflammation, and extracellular remodeling play a central role in the disease process of both AS and CA [62]. To complete the circle, the increased afterload in AS may induce and accelerate amyloid fibrils deposition [54, 57].
2.2 Characteristics of the patients and red flags
Patients with concurrent AS and CA are not a minority in clinical practice [54]. AS is common in older adults, affecting more than 4% of people >75 years old [63]. Likewise, up to 25% of the octogenarians have proven CA, according to postmortem studies [64]. Thus, because of the aging of the population, the diagnosis of this dual pathology is destined to grow. Patients with concomitant AS and CA tend to be more frequently male [57, 60, 65, 66]. As much as older age [56, 67], a history of carpal tunnel syndrome, especially if bilateral, is an independent predictor of the presence of amyloid deposits of ATTR in AS [55].
Since CA is an easily missed pathological entity, the crucial aspect for diagnosing it is the “suspicious phase.” In clinical practice, the rule “you find what you are looking for and you look for what you know” nearly always applies. For this reason, it is essential to know and recognize those clinical, laboratory, and imaging signs that are extremely useful to suspect the disease. These constellations of signs and symptoms are termed “red flags” and can be cardiac or extracardiac and specific or nonspecific to a type of amyloidosis [68, 69].
Among the extracardiac red flags, the main ones include proteinuria (even mild), macroglossia, skin bruises, carpal tunnel syndrome (typically bilateral), ruptured biceps tendon, lumbar spinal stenosis, and polyneuropathy (especially in AL amyloidosis) [70, 71]. A critical clinical condition to look out for is dysautonomia, i.e., a condition in which the autonomic nervous system does not work properly, affecting the functioning of multiple organs such as the heart, bladder, intestines, sweat glands, pupils, and blood vessels [72]. A typical manifestation of the CA associated dysautonomia is the finding of hypotension or normotensive in previously hypertensive patients [73]. Three simple diagnostic techniques to objectify dysautonomia are as follows:
A pathological Valsalva response: absence of heart rate increase in phase II of Valsalva maneuver and delayed blood pressure recovery in phase IV [74].
A heart rate variability during deep breathing blunted or even abolished. During the deep-breathing test, the patient is asked to breathe deeply at six breaths per minute for 1 min; in healthy individuals, heart rate rises during inspiration and falls during expiration with an heart rate variability >14 b.p.m. [75].
A nocturnal “non-dipping” or even “reverse-dipping” blood pressure pattern recorded through 24-hour ambulatory blood pressure monitoring [76].
Furthermore, CA is one cause of heart failure (HF) [77]. However, most of the studies reported more frequently a New York Heart Association (NYHA) functional class III and IV in patients with AS and CA compared with AS alone [55, 56, 57, 58, 66, 67, 78, 79, 80, 81, 82, 83, 84]. In addition, persistently high values of N-terminal pro-brain natriuretic peptide and high-sensitivity cardiac troponin (hs-cTn) are described in patients with dual pathology when compared with AS without CA [55, 56, 67, 78, 79]. Because of very wide ranges reported, no cutoff has been proposed, although cTn may have a potential predictive role in this setting [67].
The Electrocardiogram shows two features particularly suggestive: pseudo-infarction pattern (mainly in anterior leads) and low-voltage QRS complex. The discordance between QRS voltage and LV hypertrophy on imaging may help differentiate AS-CA patients from AS alone [60]. Atrial and ventricular arrhythmias and conduction abnormalities are often found in CA [60]. In particular, wide QRS and right bundle branch block are both independent predictor of concomitant AS-CA at multivariate analysis [56, 67].
TTE is mandatory in the diagnostic process of both AS and CA. AS-CA patients tend to have lower LV EF, lower stroke volume index (SVi), and lower transaortic gradient [78, 79, 80, 81]. All these parameters, besides high-grade diastolic dysfunction, greatly increased septal thickness and left atrial (LA) enlargement, showed predictive power on univariate analysis [67, 78]. However, only the systolic mitral annular velocity (S′) and the SVi were independent predictor of ATTR-CA in AS patients, with an area under the curve of respectively 0.95 and 0.77 [56, 78]. In particular, a cutoff value of S′ < 6 cm/s had 100% sensitivity (with a 57% specificity) in predicting a positive bone scintigraphy (17). Patients with CA and coexisting AS are more likely to present with paradoxical LFLG pattern that may be explained by LV restrictive physiology, LA remodeling and dysfunction, and right ventricular failure. This condition mainly affects individuals with the wtATTR [53].
A key aspect, in this scenario, is the evaluation of specific symptoms. The execution of a stress echocardiogram is useful when symptoms are not uniquely attributable to the valve defect, but dobutamine-induced stress, however, has proven incapable of increasing the outflow of LV in CA patients and may lead to inconclusive results.
At speckle tracking echocardiography (SPE), AS with CA has shown lower values of global longitudinal strain when compared with AS alone [55, 56, 78, 79, 82]. The typical SPE pattern of “apical sparing” is specific in CA [85]. It reflects the more preserved myocardial deformation of LV apical regions compared with mid and basal ones [60]. One study reported no significant difference in relative apical longitudinal strain in 151 patients with calcific severe AS with and without CA-ATTR [78]. Moreover, apical sparing could not predict ATTR-CA in AS because the wall stress and afterload imposed on the LV by a severely AVC may have masked the pattern. On the other hand, the apical sparing may also be observed in patients with lone AS [53]. To help clinicians in the detection of AS-CA patients, a scoring system has been recently created and validated in a cohort of 407 patients with AS undergoing TAVR [55]. The remodeling, age, injury, systemic, and electrical (RAISE) score includes five variables: LV hypertrophy and/or diastolic dysfunction, age, hs-cTn, carpal tunnel syndrome, and right bundle branch block or low QRS voltage. Scores ≥2 and ≥ 3 points had high sensitivity (93.6 and 72.3%), with adequate specificity (52.1 and 83.6%) for the presence of AS-CA. See Figure 2.
Figure 2.
Echocardiographic characteristics of a patient with amyloidosis. A: Long parasternal view, M-mode on the left ventricle, which has a thickness (> _12 mm). B: Four-chamber apical view, granular sparkling of myocardium. C: Parasternal short axis view, pericardial effusion (arrow). D: Longitudinal echocardiography strain depicted in bull’s-eye map showing preserved apical strain (apical sparing) with reduction of mid and basal strain that results in hallmark “cherry on the top” pattern.
2.3 Cardiac amyloidosis diagnosis
Traditionally, any form of CA can be diagnosed when amyloid fibrils are found within cardiac tissue; therefore, the endomyocardial biopsy demonstrating amyloid deposits with typical green refraction after Congo red staining represents the diagnostic gold standard [86]. Alternatively, the invasive diagnosis can also be confirmed if amyloid deposits within an extracardiac biopsy (e.g., of periumbilical fat) are accompanied either by characteristic features of CA by echocardiography or on cardiac magnetic resonance (CMR) [87].
Instead, noninvasive diagnostic criteria have also been proposed, the latter accepted only for ATTR forms of CA. According to the ESC 2021 myocardial working group position paper on CA, all those patients with LV wall thickness > 11 mm and at least one red flags among those mentioned above should undergo diagnostic screening [87].
As the large majority of cases of CA are AL and ATTR, the diagnostic screening algorithm proposed includes the execution of an imaging and a laboratory examination: the scintigraphy with bone-seeking tracers coupled to the assessment for monoclonal proteins by serum-free light chain (FLC) assay, serum (SPIE), and urine (UPIE) protein electrophoresis with immunofixation [88]. The combination of SPIE, UPIE, and quantification of serum FLC has a sensitivity of 99% for identifying abnormal pro-amyloidotic precursor in AL amyloidosis typically associated with clonal dyscrasias [89] while grade 2 or 3 myocardial uptake of radiotracer on scintigraphy allows the diagnosis of ATTR amyloidosis, both muted and wild-type [90].
Therefore, the results of these tests could lead to four typical scenarios [87]:
Positive scintigraphy and negative monoclonal proteins: in this case, the CA-ATTR is diagnosed, and it is therefore recommended to perform genetic testing to differentiate between hereditary amyloid transthyretin (vATTR) and wtATTR forms [91].
Negative scintigraphy and positive monoclonal proteins: in this case, AL amyloidosis has to be ruled out. Therefore, it is indicated to perform a biopsy of the periumbilical fat and perform the CMR to confirm or exclude cardiac involvement.
Negative scintigraphy and negative monoclonal proteins: in this case, there is a very low probability of CA and ATTR and AL amyloidosis are unlikely. Despite this, it is essential to underline that a negative scintigraphy does not completely rule out a diagnosis of CA when the clinical suspect is high [92].
Positive scintigraphy and positive monoclonal proteins: in this case, the overlap between a clonal dysplasia and ATTR CA is possible.
In Figure 3, we show an example of cardiac uptake grading in bisphosphonate scintigraphy.
Figure 3.
Cardiac uptake grading in bisphosphonate scintigraphy shows similar myocardial and bone uptake. Courtesy of Dr. R. Giubbini.
Furthermore, recently, a new score that uses only data from echocardiography and/or CMR has been proposed to obtain a noninvasive diagnosis, although it has not yet been external validated [93]. Indeed, the ESC position paper considers that a score > 7 points in the presence of LV wall thickness > 11 mm in combination with amyloid deposits in an extracardiac biopsy could also be considered diagnostic of CA [87].
This suggests that, despite most of the CMR findings in CA being nonspecific, some of these may be really helpful in diagnosis. Precisely, the association of diffuse subendocardial or transmural late gadolinium enhancement and an abnormal kinetics (myocardial nulling preceding or coinciding with blood pool), eventually coupled with an extracellular volume > 0.39%, is strongly supportive for the diagnosis of CA [94]. In support of this, a recent study published in Nature Scientific Reports suggests that CMR-based T1-mapping offers superior diagnostic value compared with longitudinal strain-based assessment of relative apical sparing in CA [95].
2.4 Medical therapy
Together with a more frequent detection of CA-ATTR and thanks to a better comprehension of pathophysiology, pharmacological research has produced and tested new effective drugs with specific target.
In CA, medical therapy has two main goals: treatment of HF and the “anti-amyloid” strategy. HF treatment is not different from other etiologies and should follow the recent guidelines for treatment of acute and chronic HF, with some precautions [77]. Loop diuretics are the mainstay for congestion relief. Maintenance of euvolemia is mandatory and, at the same time, challenging, because of the restrictive nature of CA and the reduced LV capacitance [77]. Renin-angiotensin-aldosterone system antagonists and beta-blockers may be not tolerated owing to a propensity to postural hypotension [52], while calcium-channel blockers should be avoided due to their tendency to form complexes with amyloid proteins [60]. Medical therapy also includes managing arrhythmic complications [60]. Atrial fibrillation is the most common arrhythmia in CA [54]. Once it is detected, anticoagulation is mandatory irrespective of CHADs-VASc score [60]. Rate control may be hard due to a narrow window of optimal heart rate; both tachycardia and bradycardia are poorly tolerated. Amiodarone is the preferred anti-arrhythmic drug [87], while data about catheter ablation are limited, possibly having a role in the early stages of the disease. Lastly, in case of conduction abnormalities requiring pacemaker implantation, the recommendations should follow current available guidelines [96]. The “anti-amyloid” strategy is etiology-dependent. The mainstay of the treatment of AL amyloidosis is the cytoreductive, plasma-cells-directed chemotherapy and/or immune-therapy [97]. The standard of care regimen is based on the use of a combination of agents, such as cyclophosphamide, bortezomib, and dexamethasone [98]. Recently, a monoclonal antibody, called daratumumab, directly targeting plasma cells has shown effective results [99], becoming part of the standard regimen. The aim of the treatment is to achieve hematological and cardiac response with a rapid and deep reduction of circulating free light chain. The available therapy does not directly affect amyloid deposition; thus, timing of diagnosis is of paramount importance. Novel agents are being tested in order to obtain amyloid reabsorption [97]. There are three therapeutic strategies for the treatment of ATTR amyloidosis: 1) TTR stabilization; 2) TTR mRNA silencing; and 3) amyloid fibrils disruption and/or extraction (Table 2) [60]. One TTR stabilizer, tafamidis, has been recently approved for use in clinical practice, thanks to the results of the ATTR-ACT trial [52, 100]. Tafamidis reduced all-cause mortality and cardiovascular hospitalization in 441 patients with CA-ATTR due to wtATTR or vATTR over a period of 30 months [100]. The effect was seen in patients in NYHA functional class I or II, while NYHA III patients had higher rates of hospitalization. Interestingly, functional improvement occurred within 6 months. Despite the improvement of mortality and morbidity, the cost of this drug still remains high. Apparently, the use of this drug does not affect outcomes after AVR [57]. The role of novel TTR tetramer stabilizer, as a concomitant or alternative treatment, has to be clarified yet. The ongoing ATTRact-AS (NCT03029026) trial will shed light on this challenging association.
Drug
Type/effect
Administ ration
Side effects
Cost
Use
Tafamidis
TTR stabilizer/binds to thyroxinebinding site on TTR
Oral
No known side effects
+++
Approve d for ATTRwt and ATTRv
Diflunisal
TTR stabilizer/binds the thyroxinebinding site on TTR
Thrombocy topenia; glomerulon ephritis; vitamin A deficiency
++++
ATTRv with polyneur opathy
Patisiran
TTR silencer/small interfering RNA
intraveno us
Infusion reactions; vitamin A deficiency
++++
ATTRv with polyneur opathy
Doxicicline/ taurodeoxy colic acid
TTR disruption/extrac tion
Oral
NA
+
No demonstrable effects on ATTR-CA
Human antibodies (i.e., PRX004)
TTR disruption/extrac tion
Intraveno us
NA
NA
NA
Table 2.
ATTR anti-amyloid drugs.
CA: cardiac amyloidosis; NA: not available; PPI: proton-pump inhibitor; and TTR: transthyretin.
2.5 Treatment options of aortic stenosis in patients with cardiac amyloidosis
CA is found to be a strong predictor of adverse outcome after SAVR, suggesting that its presence is a disease modifier in AS [82]. On the other hand, retrospective studies have shown that AS does not have an impact in terms of survival in patients with CA, despite some individuals undergoing SAVR, concluding that mortality in these patients affected by both diseases was driven by amyloidosis [101].
Even when there is a clear component of symptomatic AS, the amyloid-induced myocardial dysfunction persists once the valve is replaced, resulting in reticence in invasive intervention.
These results are conflicting with an analysis of a cohort of individuals with CA-ATTR and AS in which patients undergoing TAVR showed a significantly longer survival. A subsequent review of this study showed the presence of population selection bias, but it is anyway suggestive that a less invasive approach with TAVR could be better tolerated by CA patients [102].
Small studies suggest a better outcome of TAVR versus SAVR in the presence of CA [79], but various procedural complications of TAVR are more frequent in these individuals due to the increased fragility of amyloid infiltrated tissues. The fundamental characteristics that favor the less invasive approach of TAVR compared with SAVR are an intermediate or high surgical risk, the presence of an LVEF of less than 50%, an SVi <30 ml/m2, and an LV global longitudinal strain ≥ −10% [103].
The main factors of poor prognosis and usefulness of AVR in patients with AS and CA are represented by reduced LVEF, a severe reduction of LV global longitudinal strain, a grade III diastolic dysfunction, a moderate-to-severe reduction of the SVi, and a low gradient AS [79, 82]. These parameters should be considered in the assessment of risks and benefits during the multidisciplinary evaluation of the heart team, in addition to the classic criteria relating to the patient’s functional condition, comorbidities, fragility, and life expectancy.
Based on the small population studies in literature, their inconclusive results, and the lack of any head-to-head comparisons, a clear recommendation on the best therapeutic strategy (SAVR vs. TAVR vs. medical therapy) cannot be given. In case the invasive approach is considered futile by the heart team, HF medical therapy is optimized [15].
3. Conclusions
High circulation Lp (a) concentration is strongly associated with degenerative AS. The importance of a therapy that can prevent AVS progression is evident, but, to date, no therapy that specifically lowers Lp (a) levels has been approved for clinical use. Furthermore, up to one-third of patients with paradoxical AS may have concomitant CA, commonly due to wtATTR. The challenge in this context is to differentiate AS alone from AS with CA. Recognition of ATTR prior to any type of intervention is crucial for adequate risk stratification and to guide downstream management.
Acknowledgments
The publishing of this study was supported by Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico Via Francesco Sforza 35 – 20122 Milano VAT 04724150968.
Appendices and nomenclature
18FNaF
18F-sodium fluoride
AL
amyloid light chain
AF
atrial fibrillation
AS
aortic stenosis
AVAfx
aortic functional area valve
AVC
aortic valve calcification
AVR
aortic valve replacement
AVS
aortic valve stenosis
BMI
body mass index
CA
cardiac amyloidosis
CAD
coronary artery disease
CT
cardiac tomography
CMR
cardiac magnetic resonance
EF
ejection fraction
ESC
European Society of Cardiology
FLC
free light chain
GLS
global longitudinal strain
HF
heart failure
hs-cTn
high-sensitivity cardiac troponin
LA
left atrial
LDL
low-density lipoprotein
LFLG
low flow low gradient
Lp (a)
lipoprotein (a)
LPC
lysophosphatidylcholine
LV
left ventricular
PCKS9i
proprotein convertase subtilisin/kexin type 9 inhibitors
PET
positron emission tomography
SAVR
surgical aortic valve replacement
SGc
soluble guanylate cyclase
SPE
speckle tracking echocardiography
SPIE
serum protein electrophoresis with immunofixation
SVi
stroke volume index
TAVR
percutaneous aortic valve replacement
TTE
transthoracic echocardiography
UPIE
urine protein electrophoresis with immunofixation
VICs
valvular intestinal cells
vATTR
hereditary amyloid transthyretin
Vmax
peak aortic jet velocity
wtATTR
wild-type transthyretin amyloidosis
\n',keywords:"aortic valve calcification, aortic valve stenosis, cardiac amyloidosis, lipoprotein (a), diagnostic imaging, drug therapy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/80565.pdf",chapterXML:"https://mts.intechopen.com/source/xml/80565.xml",downloadPdfUrl:"/chapter/pdf-download/80565",previewPdfUrl:"/chapter/pdf-preview/80565",totalDownloads:50,totalViews:0,totalCrossrefCites:0,dateSubmitted:"January 25th 2022",dateReviewed:"January 27th 2022",datePrePublished:"February 23rd 2022",datePublished:null,dateFinished:"February 22nd 2022",readingETA:"0",abstract:"This chapter aims to address two peculiar aspects of pathophysiology and clinical management of aortic valve stenosis, such as coexistence with cardiac amyloidosis and association with lipoprotein (a). Calcific aortic valve stenosis is the most common heart valve condition requiring surgical or transcatheter aortic valve replacement among adults in Western societies. Lipoprotein (a) has been shown to play an important role in the pathophysiological pathways leading to degenerative aortic stenosis, similar to that in the pathogenesis of atherosclerosis. Studies are needed to verify whether therapies that drastically reduce Lipoprotein (a) serum levels offer the possibility of a first medical treatment to arrest the progression of aortic stenosis. A large percentage of patients with aortic stenosis may have concomitant cardiac amyloidosis, commonly due to wild-type transthyretin. The challenge in this context is to differentiate aortic stenosis alone from aortic stenosis with cardiac amyloidosis, as cardiac amyloidosis shares several clinical, electrocardiographic, and echocardiographic features with the aortic stenosis phenotype. Recognition of transthyretin-related amyloidosis prior to any type of intervention is crucial for adequate risk stratification and to guide downstream management.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/80565",risUrl:"/chapter/ris/80565",signatures:"Gloria Santangelo, Nicola Bernardi, Andrea Faggiano, Andrea Bonelli, Filippo Toriello, Pompilio Faggiano and Stefano Carugo",book:{id:"11221",type:"book",title:"Aortic Stenosis - Recent Advances, New Perspectives and Applications",subtitle:null,fullTitle:"Aortic Stenosis - Recent Advances, New Perspectives and Applications",slug:null,publishedDate:null,bookSignature:"Dr. Wilbert S. Aronow",coverURL:"https://cdn.intechopen.com/books/images_new/11221.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-604-8",printIsbn:"978-1-80355-603-1",pdfIsbn:"978-1-80355-605-5",isAvailableForWebshopOrdering:!0,editors:[{id:"164597",title:"Dr.",name:"Wilbert S.",middleName:null,surname:"Aronow",slug:"wilbert-s.-aronow",fullName:"Wilbert S. Aronow"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1 Introduction and pathophysiology",level:"2"},{id:"sec_2_2",title:"1.2 Comparison between Lp (a) and other risk factors for aortic valve calcification",level:"2"},{id:"sec_3_2",title:"1.3 Imaging features about lipoprotein(a) involvement in aortic stenosis",level:"2"},{id:"sec_4_2",title:"1.4 Pharmacological approach to lowering Lp (a) and course of aortic valve stenosis",level:"2"},{id:"sec_6",title:"2. Aortic valve stenosis and cardiac amyloidosis",level:"1"},{id:"sec_6_2",title:"2.1 Introduction and pathophysiology",level:"2"},{id:"sec_7_2",title:"2.2 Characteristics of the patients and red flags",level:"2"},{id:"sec_8_2",title:"2.3 Cardiac amyloidosis diagnosis",level:"2"},{id:"sec_9_2",title:"2.4 Medical therapy",level:"2"},{id:"sec_10_2",title:"2.5 Treatment options of aortic stenosis in patients with cardiac amyloidosis",level:"2"},{id:"sec_12",title:"3. Conclusions",level:"1"},{id:"sec_13",title:"Acknowledgments",level:"1"},{id:"sec_13",title:"Appendices and nomenclature",level:"1"}],chapterReferences:[{id:"B1",body:'Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nature Reviews. 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Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Cardiac Unit, University of Milan, Italy
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The aim of this chapter is to empower the rider to optimize, standardize and validate an enzyme linked immunosorbent assay.",book:{id:"9850",slug:"norovirus",title:"Norovirus",fullTitle:"Norovirus"},signatures:"Rajna Minic and Irena Zivkovic",authors:[{id:"325806",title:"Ph.D.",name:"Irena",middleName:null,surname:"Zivkovic",slug:"irena-zivkovic",fullName:"Irena Zivkovic"},{id:"325839",title:"Dr.",name:"Rajna",middleName:null,surname:"Minic",slug:"rajna-minic",fullName:"Rajna Minic"}]},{id:"56750",title:"Laboratory Approach to Anemia",slug:"laboratory-approach-to-anemia",totalDownloads:6255,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"Anemia is a major cause of morbidity and mortality worldwide and can be defined as a decreased quantity of circulating red blood cells (RBCs). The epidemiological studies suggested that one-third of the world’s population is affected with anemia. Anemia is not a disease, but it is instead the sign of an underlying basic pathological process. However, the sign may function as a compass in the search for the cause. Therefore, the prediagnosis revealed by thorough investigation of this sign should be supported by laboratory parameters according to the underlying pathological process. 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In this chapter, we are providing a surgical overview of the most relevant and updated information on etiology, incidence, pathophysiology, and management of secondary pneumothoraces.",book:{id:"11045",title:"Pleura - A Surgical Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11045.jpg"},signatures:"Simona Sobrero, Francesco Leo and Alberto Sandri"},{id:"80875",title:"Pneumothorax: A Concise Review and Surgical Perspective",slug:"pneumothorax-a-concise-review-and-surgical-perspective",totalDownloads:42,totalDimensionsCites:0,doi:"10.5772/intechopen.101049",abstract:"Pneumothorax is the collection of air in pleural cavity, which is commonly due to development of a communication between pleural space and alveolar space (or bronchus) or the atmosphere. In this chapter, we will discuss the various aetiologies of pneumothorax, the differences in their pathophysiology and the implications on the management of the disease. The chapter focusses on the surgical aspects in the management, the revolution brought in by video-assisted thoracoscopic surgery (VATS) and the advancement of the field by introduction of uniportal VATS and robotic-assisted thoracic surgery. The principles of management of catamenial pneumothorax are revisited. The chapter also throws light on the nuances of anaesthesia techniques and the latest developments are outlined. Lastly, a section is dedicated to COVID-19 associated pneumothorax and the approach to its management.",book:{id:"11045",title:"Pleura - A Surgical Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11045.jpg"},signatures:"Shilpi Karmakar"},{id:"79289",title:"Indwelling Pleural Catheters",slug:"indwelling-pleural-catheters",totalDownloads:86,totalDimensionsCites:0,doi:"10.5772/intechopen.100645",abstract:"Indwelling pleural catheters (IPC) are now being considered worldwide for patients with recurrent pleural effusions. It is commonly used for patients with malignant pleural effusions (MPE) and can be performed as outpatient based day care procedure. In malignant pleural effusions, indwelling catheters are particularly useful in patients with trapped lung or failed pleurodesis. Patients and care givers are advised to drain at least 3 times a week or in presence of symptoms i.e. dyspnoea. Normal drainage timing may lasts for 15–20 min which subsequently improves their symptoms and quality of life. Complications which are directly related to IPC insertion are extremely rare. IPC’s are being recently used even for benign effusions in case hepatic hydrothorax and in patients with CKD related pleural effusions. Removal of IPC is often not required in most of the patients. It can be performed safely as a day care procedure with consistently lower rates of complications, reduced inpatient stay. They are relatively easy to insert, manage and remove, and provide the ability to empower patients in both the decisions regarding their treatment and the management of their disease itself.",book:{id:"11045",title:"Pleura - A Surgical Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11045.jpg"},signatures:"Yuvarajan Sivagnaname, Durga Krishnamurthy, Praveen Radhakrishnan and Antonious Maria Selvam"},{id:"79221",title:"Surgical Challenges of Chronic Empyema and Bronchopleural Fistula",slug:"surgical-challenges-of-chronic-empyema-and-bronchopleural-fistula",totalDownloads:118,totalDimensionsCites:0,doi:"10.5772/intechopen.100313",abstract:"Chronic empyema has always been a clinical challenge for physicians. There is no standard procedure or treatment to deal with the situation, and multi-modality approach is often necessary. Surgical intervention plays a very crucial role in the treatment of chronic empyema. Since bronchopleural fistula is often seen in chronic empyema patients, therefore it should also be mentioned. In this chapter, the focus will be on the different treatment options, various surgical approaches, and the rationale behind every single modality. Certain specific entity will be included as well, such as tuberculosis infection, post lung resection empyema, and intrathoracic vacuum assisted closure system application. Even with the advancement of technology and techniques, chronic empyema management is still evolving, and we look forward to less traumatic ways of approach with better outcome in the future.",book:{id:"11045",title:"Pleura - A Surgical Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11045.jpg"},signatures:"Yu-Hui Yang"},{id:"78826",title:"Pneumothorax in Children",slug:"pneumothorax-in-children",totalDownloads:94,totalDimensionsCites:0,doi:"10.5772/intechopen.100329",abstract:"Pneumothorax is a common pleural disease worldwide and is defined as the free accumulation of air between visceral and parietal pleura. Pneumothorax can be spontaneous, iatrogenic, and traumatic. Although it is less common than adults, it is seen in about 1.1–4 per 100,000 per year in the childhood age group. In patients presenting with variable clinic according to the cause of etiology, diagnosis is confirmed on a PA chest radiograph, sometimes a computed tomography may be required. The management of pneumothorax is varying from conservative, over intermediate (chest tube drainage) to invasive methods (video-assisted thoracoscopic surgery—VATS, thoracotomy). Here, we planned to write a chapter that includes a text containing general information about pediatric pneumothorax, algorithms, and visual and clinical cases of the causes of pneumothorax in children, including age, etiology, and treatment approach of pneumothorax in children.",book:{id:"11045",title:"Pleura - A Surgical Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11045.jpg"},signatures:"Hatice Sonay Yalçın Cömert"},{id:"78760",title:"Bronchopleural Fistula after Pulmonary Resection: Risk Factors, Diagnoses and Management",slug:"bronchopleural-fistula-after-pulmonary-resection-risk-factors-diagnoses-and-management",totalDownloads:233,totalDimensionsCites:0,doi:"10.5772/intechopen.100209",abstract:"Bronchopleural fistula (BPF) after a pulmonary resection is rare with some of the most life-threatening consequences and a high mortality rate. Contamination of the pleural space resulting in empyema and spillage of the infected fluid into the remaining lung leading to respiratory distress remain the biggest concerns with BPF postoperatively. There are many patient characteristics and risk factors that can be evaluated to decrease the chance of a postoperative BPF. Presentation of BPF can be early or late with the late BPF more difficult to diagnosis and manage. Many options to treat BPF include surgical repair, conservative management, and endoscopic treatment.",book:{id:"11045",title:"Pleura - A Surgical Perspective",coverURL:"https://cdn.intechopen.com/books/images_new/11045.jpg"},signatures:"Kristina Jacobsen"}],onlineFirstChaptersTotal:8},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:140,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. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"August 12th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. 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His later study in cooperation with experts in nephrology and immunology resulted in the designation of the new diagnostic method of UTI, patented in 2017. He is currently working at the Department of Microbiology, Medical University of Gdańsk (GUMed), Poland. Since many years, he is a member of steering committee of Gdańsk branch of Polish Society of Microbiologists, a member of ESCMID. 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Her research interest is in antibiotic resistance, host-pathogen interaction, and therapeutics development for staphylococcal pathogens, mainly Staphylococcus aureus, which causes hospital-acquired infections. Currently, her research is mostly focused on the study of oral pathogens, particularly Staphylococcus spp.",institutionString:"Medical University of Gdańsk, Poland",institution:null},editorThree:null},{id:"4",title:"Fungal Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",isOpenForSubmission:!0,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. 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He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",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. 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Saxena",hash:"105e347b2d5dbbe6b593aceffa051efa",volumeInSeries:1,fullTitle:"Influenza - Therapeutics and Challenges",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",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. 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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",institutionURL:null,country:{name:"India"}}}]},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",slug:"current-topics-in-neglected-tropical-diseases",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Alfonso J. 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Then take a masters degree in science in Germany (Animal breeding). Take a doctorate in animal science at the UANL.",institutionString:null,institution:{name:"Universidad Autónoma de Nuevo León",country:{name:"Mexico"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",slug:"miguel-quaresma",fullName:"Miguel Quaresma",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309250/images/9059_n.jpg",biography:"Miguel Nuno Pinheiro Quaresma was born on May 26, 1974 in Dili, Timor Island. He is married with two children: a boy and a girl, and he is a resident in Vila Real, Portugal. He graduated in Veterinary Medicine in August 1998 and obtained his Ph.D. degree in Veterinary Sciences -Clinical Area in February 2015, both from the University of Trás-os-Montes e Alto Douro. He is currently enrolled in the Alternative Residency of the European College of Animal Reproduction. He works as a Senior Clinician at the Veterinary Teaching Hospital of UTAD (HVUTAD) with a role in clinical activity in the area of livestock and equine species as well as to support teaching and research in related areas. He teaches as an Invited Professor in Reproduction Medicine I and II of the Master\\'s in Veterinary Medicine degree at UTAD. Currently, he holds the position of Chairman of the Portuguese Buiatrics Association. He is a member of the Consultive Group on Production Animals of the OMV. He has 19 publications in indexed international journals (ISIS), as well as over 60 publications and oral presentations in both Portuguese and international journals and congresses.",institutionString:"University of Trás-os-Montes and Alto Douro",institution:{name:"University of Trás-os-Montes and Alto Douro",country:{name:"Portugal"}}},{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",country:{name:"Portugal"}}},{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/283019/images/system/283019.png",biography:"Dr. Kerro Dego is a veterinary microbiologist with training in veterinary medicine, microbiology, and anatomic pathology. Dr. Kerro Dego is an assistant professor of dairy health in the department of animal science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. He received his D.V.M. (1997), M.S. (2002), and Ph.D. (2008) degrees in Veterinary Medicine, Animal Pathology and Veterinary Microbiology from College of Veterinary Medicine, Addis Ababa University, Ethiopia; College of Veterinary Medicine, Utrecht University, the Netherlands and Western College of Veterinary Medicine, University of Saskatchewan, Canada respectively. He did his Postdoctoral training in microbial pathogenesis (2009 - 2015) in the Department of Animal Science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. Dr. Kerro Dego’s research focuses on the prevention and control of infectious diseases of farm animals, particularly mastitis, improving dairy food safety, and mitigation of antimicrobial resistance. Dr. Kerro Dego has extensive experience in studying the pathogenesis of bacterial infections, identification of virulence factors, and vaccine development and efficacy testing against major bacterial mastitis pathogens. Dr. Kerro Dego conducted numerous controlled experimental and field vaccine efficacy studies, vaccination, and evaluation of immunological responses in several species of animals, including rodents (mice) and large animals (bovine and ovine).",institutionString:"University of Tennessee at Knoxville",institution:{name:"University of Tennessee at Knoxville",country:{name:"United States of America"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",country:{name:"Spain"}}},{id:"309529",title:"Dr.",name:"Albert",middleName:null,surname:"Rizvanov",slug:"albert-rizvanov",fullName:"Albert Rizvanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309529/images/9189_n.jpg",biography:'Albert A. Rizvanov is a Professor and Director of the Center for Precision and Regenerative Medicine at the Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU), Russia. He is the Head of the Center of Excellence “Regenerative Medicine” and Vice-Director of Strategic Academic Unit \\"Translational 7P Medicine\\". Albert completed his Ph.D. at the University of Nevada, Reno, USA and Dr.Sci. at KFU. He is a corresponding member of the Tatarstan Academy of Sciences, Russian Federation. Albert is an author of more than 300 peer-reviewed journal articles and 22 patents. He has supervised 11 Ph.D. and 2 Dr.Sci. dissertations. Albert is the Head of the Dissertation Committee on Biochemistry, Microbiology, and Genetics at KFU.\nORCID https://orcid.org/0000-0002-9427-5739\nWebsite https://kpfu.ru/Albert.Rizvanov?p_lang=2',institutionString:"Kazan Federal University",institution:{name:"Kazan Federal University",country:{name:"Russia"}}},{id:"210551",title:"Dr.",name:"Arbab",middleName:null,surname:"Sikandar",slug:"arbab-sikandar",fullName:"Arbab Sikandar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210551/images/system/210551.jpg",biography:"Dr. Arbab Sikandar, PhD, M. Phil, DVM was born on April 05, 1981. He is currently working at the College of Veterinary & Animal Sciences as an Assistant Professor. He previously worked as a lecturer at the same University. \nHe is a Member/Secretory of Ethics committee (No. CVAS-9377 dated 18-04-18), Member of the QEC committee CVAS, Jhang (Regr/Gen/69/873, dated 26-10-2017), Member, Board of studies of Department of Basic Sciences (No. CVAS. 2851 Dated. 12-04-13, and No. CVAS, 9024 dated 20/11/17), Member of Academic Committee, CVAS, Jhang (No. CVAS/2004, Dated, 25-08-12), Member of the technical committee (No. CVAS/ 4085, dated 20,03, 2010 till 2016).\n\nDr. Arbab Sikandar contributed in five days hands-on-training on Histopathology at the Department of Pathology, UVAS from 12-16 June 2017. He received a Certificate of appreciation for contributions for Popularization of Science and Technology in the Society on 17-11-15. He was the resource person in the lecture series- ‘scientific writing’ at the Department of Anatomy and Histology, UVAS, Lahore on 29th October 2015. He won a full fellowship as a principal candidate for the year 2015 in the field of Agriculture, EICA, Egypt with ref. to the Notification No. 12(11) ACS/Egypt/2014 from 10 July 2015 to 25th September 2015.; he received a grant of Rs. 55000/- as research incentives from Director, Advanced Studies and Research, UVAS, Lahore upon publications of research papers in IF Journals (DR/215, dated 19-5-2014.. He obtained his PhD by winning a HEC Pakistan indigenous Scholarship, ‘Ph.D. fellowship for 5000 scholars – Phase II’ (2av1-147), 17-6/HEC/HRD/IS-II/12, November 15, 2012. \n\nDr. Sikandar is a member of numerous societies: Registered Veterinary Medical Practitioner (life member) and Registered Veterinary Medical Faculty of Pakistan Veterinary Medical Council. The Registration code of PVMC is RVMP/4298 and RVMF/ 0102.; Life member of the University of Veterinary and Animal Sciences, Lahore, Alumni Association with S# 664, dated: 6-4-12. ; Member 'Vets Care Organization Pakistan” with Reference No. VCO-605-149, dated 05-04-06. :Member 'Vet Crescent” (Society of Animal Health and Production), UVAS, Lahore.",institutionString:"University of Veterinary & Animal Science",institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311663/images/13261_n.jpg",biography:null,institutionString:null,institution:{name:"National Dairy Research Institute",country:{name:"India"}}},{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",country:{name:"United Kingdom"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",biography:"Samir El-Gendy is a Professor of anatomy and embryology at the faculty of veterinary medicine, Alexandria University, Egypt. Samir obtained his PhD in veterinary science in 2007 from the faculty of veterinary medicine, Alexandria University and has been a professor since 2017. Samir is an author on 24 articles at Scopus and 12 articles within local journals and 2 books/book chapters. His research focuses on applied anatomy, imaging techniques and computed tomography. Samir worked as a member of different local projects on E-learning and he is a board member of the African Association of Veterinary Anatomists and of anatomy societies and as an associated author at local and international journals. Orcid: https://orcid.org/0000-0002-6180-389X",institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"246149",title:"Dr.",name:"Valentina",middleName:null,surname:"Kubale",slug:"valentina-kubale",fullName:"Valentina Kubale",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246149/images/system/246149.jpg",biography:"Valentina Kubale is Associate Professor of Veterinary Medicine at the Veterinary Faculty, University of Ljubljana, Slovenia. Since graduating from the Veterinary faculty she obtained her PhD in 2007, performed collaboration with the Department of Pharmacology, University of Copenhagen, Denmark. She continued as a post-doctoral fellow at the University of Copenhagen with a Lundbeck foundation fellowship. She is the editor of three books and author/coauthor of 23 articles in peer-reviewed scientific journals, 16 book chapters, and 68 communications at scientific congresses. Since 2008 she has been the Editor Assistant for the Slovenian Veterinary Research journal. She is a member of Slovenian Biochemical Society, The Endocrine Society, European Association of Veterinary Anatomists and Society for Laboratory Animals, where she is board member.",institutionString:"University of Ljubljana",institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",biography:"Dr. Fonseca-Alves earned his DVM from Federal University of Goias – UFG in 2008. He completed an internship in small animal internal medicine at UPIS university in 2011, earned his MSc in 2013 and PhD in 2015 both in Veterinary Medicine at Sao Paulo State University – UNESP. Dr. Fonseca-Alves currently serves as an Assistant Professor at Paulista University – UNIP teaching small animal internal medicine.",institutionString:null,institution:{name:"Universidade Paulista",country:{name:"Brazil"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",biography:"María de la Luz García Pardo is an agricultural engineer from Universitat Politècnica de València, Spain. She has a Ph.D. in Animal Genetics. Currently, she is a lecturer at the Agrofood Technology Department of Miguel Hernández University, Spain. Her research is focused on genetics and reproduction in rabbits. The major goal of her research is the genetics of litter size through novel methods such as selection by the environmental sensibility of litter size, with forays into the field of animal welfare by analysing the impact on the susceptibility to diseases and stress of the does. Details of her publications can be found at https://orcid.org/0000-0001-9504-8290.",institutionString:null,institution:{name:"Miguel Hernandez University",country:{name:"Spain"}}},{id:"350704",title:"M.Sc.",name:"Camila",middleName:"Silva Costa",surname:"Ferreira",slug:"camila-ferreira",fullName:"Camila Ferreira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/350704/images/17280_n.jpg",biography:"Graduated in Veterinary Medicine at the Fluminense Federal University, specialist in Equine Reproduction at the Brazilian Veterinary Institute (IBVET) and Master in Clinical Veterinary Medicine and Animal Reproduction at the Fluminense Federal University. She has experience in analyzing zootechnical indices in dairy cattle and organizing events related to Veterinary Medicine through extension grants. I have experience in the field of diagnostic imaging and animal reproduction in veterinary medicine through monitoring and scientific initiation scholarships. I worked at the Equus Central Reproduction Equine located in Santo Antônio de Jesus – BA in the 2016/2017 breeding season. I am currently a doctoral student with a scholarship from CAPES of the Postgraduate Program in Veterinary Medicine (Pathology and Clinical Sciences) at the Federal Rural University of Rio de Janeiro (UFRRJ) with a research project with an emphasis on equine endometritis.",institutionString:null,institution:null},{id:"41319",title:"Prof.",name:"Lung-Kwang",middleName:null,surname:"Pan",slug:"lung-kwang-pan",fullName:"Lung-Kwang Pan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41319/images/84_n.jpg",biography:null,institutionString:null,institution:null},{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/125292/images/system/125292.jpeg",biography:"Katy Satué Ambrojo received her Veterinary Medicine degree, Master degree in Equine Technology and doctorate in Veterinary Medicine from the Faculty of Veterinary, CEU-Cardenal Herrera University in Valencia, Spain.Dr. Satué is accredited as a Private University Doctor Professor, Doctor Assistant, and Contracted Doctor by AVAP (Agència Valenciana d'Avaluació i Prospectiva) and currently, as a full professor by ANECA (since January 2022). To date, Katy has taught 22 years in the Department of Animal Medicine and Surgery at the CEU-Cardenal Herrera University in undergraduate courses in Veterinary Medicine (General Pathology, integrated into the Applied Basis of Veterinary Medicine module of the 2nd year, Clinical Equine I of 3rd year, and Equine Clinic II of 4th year). Dr. Satué research activity is in the field of Endocrinology, Hematology, Biochemistry, and Immunology in the Spanish Purebred mare. She has directed 5 Doctoral Theses and 5 Diplomas of Advanced Studies, and participated in 11 research projects as a collaborating researcher. She has written 2 books and 14 book chapters in international publishers related to the area, and 68 scientific publications in international journals. Dr. Satué has attended 63 congresses, participating with 132 communications in international congresses and 19 in national congresses related to the area. Dr. Satué is a scientific reviewer for various prestigious international journals such as Animals, American Journal of Obstetrics and Gynecology, Veterinary Clinical Pathology, Journal of Equine Veterinary Science, Reproduction in Domestic Animals, Research Veterinary Science, Brazilian Journal of Medical and Biological Research, Livestock Production Science and Theriogenology, among others. Since 2014 she has been responsible for the Clinical Analysis Laboratory of the CEU-Cardenal Herrera University Veterinary Clinical Hospital.",institutionString:null,institution:null},{id:"201721",title:"Dr.",name:"Beatrice",middleName:null,surname:"Funiciello",slug:"beatrice-funiciello",fullName:"Beatrice Funiciello",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201721/images/11089_n.jpg",biography:"Graduated from the University of Milan in 2011, my post-graduate education included CertAVP modules mainly on equines (dermatology and internal medicine) and a few on small animal (dermatology and anaesthesia) at the University of Liverpool. After a general CertAVP (2015) I gained the designated Certificate in Veterinary Dermatology (2017) after taking the synoptic examination and then applied for the RCVS ADvanced Practitioner status. After that, I completed the Postgraduate Diploma in Veterinary Professional Studies at the University of Liverpool (2018). My main area of work is cross-species veterinary dermatology.",institutionString:null,institution:null},{id:"291226",title:"Dr.",name:"Monica",middleName:null,surname:"Cassel",slug:"monica-cassel",fullName:"Monica Cassel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/291226/images/8232_n.jpg",biography:'Degree in Biological Sciences at the Federal University of Mato Grosso with scholarship for Scientific Initiation by FAPEMAT (2008/1) and CNPq (2008/2-2009/2): Project \\"Histological evidence of reproductive activity in lizards of the Manso region, Chapada dos Guimarães, Mato Grosso, Brazil\\". Master\\\'s degree in Ecology and Biodiversity Conservation at Federal University of Mato Grosso with a scholarship by CAPES/REUNI program: Project \\"Reproductive biology of Melanorivulus punctatus\\". PhD\\\'s degree in Science (Cell and Tissue Biology Area) \n at University of Sao Paulo with scholarship granted by FAPESP; Project \\"Development of morphofunctional changes in ovary of Astyanax altiparanae Garutti & Britski, 2000 (Teleostei, Characidae)\\". She has experience in Reproduction of vertebrates and Morphology, with emphasis in Cellular Biology and Histology. She is currently a teacher in the medium / technical level courses at IFMT-Alta Floresta, as well as in the Bachelor\\\'s degree in Animal Science and in the Bachelor\\\'s degree in Business.',institutionString:null,institution:null},{id:"442807",title:"Dr.",name:"Busani",middleName:null,surname:"Moyo",slug:"busani-moyo",fullName:"Busani Moyo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Gwanda State University",country:{name:"Zimbabwe"}}},{id:"439435",title:"Dr.",name:"Feda S.",middleName:null,surname:"Aljaser",slug:"feda-s.-aljaser",fullName:"Feda S. Aljaser",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"423023",title:"Dr.",name:"Yosra",middleName:null,surname:"Soltan",slug:"yosra-soltan",fullName:"Yosra Soltan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"349788",title:"Dr.",name:"Florencia Nery",middleName:null,surname:"Sompie",slug:"florencia-nery-sompie",fullName:"Florencia Nery Sompie",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sam Ratulangi University",country:{name:"Indonesia"}}},{id:"428600",title:"MSc.",name:"Adriana",middleName:null,surname:"García-Alarcón",slug:"adriana-garcia-alarcon",fullName:"Adriana García-Alarcón",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428599",title:"MSc.",name:"Gabino",middleName:null,surname:"De La Rosa-Cruz",slug:"gabino-de-la-rosa-cruz",fullName:"Gabino De La Rosa-Cruz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"428601",title:"MSc.",name:"Juan Carlos",middleName:null,surname:"Campuzano-Caballero",slug:"juan-carlos-campuzano-caballero",fullName:"Juan Carlos Campuzano-Caballero",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}}]}},subseries:{item:{id:"18",type:"subseries",title:"Proteomics",keywords:"Mono- and Two-Dimensional Gel Electrophoresis (1-and 2-DE), Liquid Chromatography (LC), Mass Spectrometry/Tandem Mass Spectrometry (MS; MS/MS), Proteins",scope:"With the recognition that the human genome cannot provide answers to the etiology of a disorder, changes in the proteins expressed by a genome became a focus in research. Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11414,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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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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