Summary of changes in SOD, GR, and CAT activities with postharvest UV-C treatment of crops.
\r\n\t
\r\n\tRecently in 2019, International Council on Systems Engineering (INCOSE) has released the latest version of the “Guidelines for the Utilization of ISO/IEC/IEEE 15288 in the Context of System of Systems (SoS) Engineering” to industry for review and comments. The document was developed under the Partner Standards Development Organization cooperation agreement between ISO and IEEE, as it was approved by Council Resolution 49/2007. This document provides guidance for the utilization of ISO/IEC/IEEE 15288 in the context of SoS in many domains, including healthcare, transportation, energy, defense, corporations, cities, and governments. This document treats an SoS as a system whose elements are managerially and/or operationally independent systems, and which together usually produce results that cannot be achieved by the individual systems alone. This INCOSE guide book perceives that SoS engineering demands a balance between linear procedural procedures for systematic activity and holistic nonlinear procedures due to additional complexity from SoS perspectives.
\r\n\tThe objective of this book is to provide a comprehensive reference on Systems-of-Systems Engineering, Modeling, Simulation and Analysis (MS&A) for engineers and researchers in both system engineering and advanced mathematical modeling fields.
\r\n\tThe book is organized in two parts, namely Part I and Part II. Part I presents an overview of SOS, SOS Engineering, SOS Enterprise Architecture (SOSEA) and SOS Enterprise (SOSE) Concept of Operations (CONOPS). Part II discusses SOSE MS&A approaches for assessing SOS Enterprise CONOPS (SOSE-CONOPS) and characterizing SOSE performance behavior. Part II focuses on advanced mathematical application concepts to address future complex space SOS challenges that require interdisciplinary research involving game theory, probability and statistics, non-linear programming and mathematical modeling components.
\r\n\tPart I should include topics related to the following areas:
\r\n\t- SOS and SOS Engineering Introduction
\r\n\t- Taxonomy of SOS
\r\n\t- SOS Enterprise (SOSE), SOSE CONOPS, Architecture Frameworks and Decision Support Tools
\r\n\tPart II should address the following research areas:
\r\n\t- SOS Modeling, Simulation & Analysis (SOS M&SA) Methods
\r\n\t- SOS Enterprise Architecture Design Frameworks and Decision Support Tools
\r\n\t- SOS Enterprise CONOPS Assessment Frameworks and Decision Support Tools.
Phytochemicals are bioactive non-nutrient plant components that have gained considerable attention as photoprotective agents in providing certain health benefits and are well known for their powerful antioxidant and free radical scavenging potential [1-2, 8]. Phytochemicals found in plant-based foods (fruits, vegetables, legumes, nuts, cereals, and grains) belong to several classes according to their chemical structures and physiological functions and include polyphenols, flavonoids, isoflavonoids, phytoalexins, phenols, anthocyanidins, nitrogen compounds (polyamines), chlorophyll derivatives, beta carotene (pro-vitamin A), and other carotenoids, ascorbic acid (vitamin C), folic acid, and α-tocopherol (vitamin E). Figure 1 illustrates the classification of dietary phytochemicals, which are widely distributed with different structures at the tissue, cellular, and sub-cellular levels. While it has been reported that there are over 4,000 phytochemicals, the most studied are the phenolics (largest category of phytochemicals) and carotenoids [3, 5], whereas some phytochemicals are distributed only among limited taxonomic groups. For example, glucosinolates are only found in the cruciferous vegetables crops, whereas the occurrence of sulfides is restricted to the Liliaceae. Additionally, each fruit and vegetable species has a distinct profile of phytochemicals, which is also within a special phytochemical group [4]. Many phytochemicals, particularly the pigment molecules, are often concentrated in the outer layers of the various plant tissues [5]. Some sources of phytochemicals include lycopene from tomatoes, isoflavones from soy, β-carotene from carrots, and anthocyanins from blueberries and grapes. The phytochemicals lutein and zeaxanthin are carotenoids found in spinach, kale, and turnip greens. Another group of phytochemicals called allyl sulfides are found in garlic and onions. http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/phytochemicals
Classification of dietary phytochemicals (Adapted from [3]).
The beneficial effects of phytochemicals are mediated through several mechanisms that include enzyme stimulation, interference with DNA replication, anti-bacterial effect, and physical action. Enhancing the health benefits of fresh produce through physical methods could therefore add value and create new opportunities for growers and processors by tapping into health-oriented markets [12, 57]. Abiotic stresses (negative impact of non-living environmental factors on growth and productivity of crops) are significant determinants of quality and nutritional value of crops along the food value chain. While abiotic stress is essentially unavoidable, simple modifications to postharvest handling systems may result in significant reduction in stress exposure, which will positively impact on phytochemical content and storage and/or shelf-life extension [7, 10]. There is a need to provide technologies that can ensure the delivery of high-quality products with high levels of the desired phytonutrients [6, 11-12, 15]. There is now considerable literature on the use of low dose UV-C radiation to control postharvest pathogens, delay postharvest senescence, and improve shelf-life of many horticultural crops. It also has potential for commercial use as a surface treatment in the food industry, particularly for whole and fresh-cut produce. However, the use of UV-C radiation as an elicitor of phytochemicals which enhances additional health benefits and mechanisms related to improvement in shelf-life or increase in the content of phytonutrients are still not well understood. The objective of this chapter will focus on a review of recent studies of UV-C abiotic stress on the production and activation of phytochemicals and its effect on the quality of crops.
UV radiation is generally divided into three classes: UV-C (200-280 nm), UV-B (280-320 nm), and UV-A (315-400 nm) [21]. Each band can induce significantly different biological effects in plant systems. UV-C wavelengths (highly energetic) result in high levels of damage very quickly [22]; however, such radiations are effectively absorbed by ozone and atmospheric gases and are not present in sunlight at the earth’s surface. UV radiation below 320 nm is actinic, which means it causes photochemical reactions [21]. Such reactions occur as a result of the absorption of photons by chromophores (chemical grouping of molecules) at particular wavelengths.
The destructive action of UV radiation results from both direct absorption of photons by DNA and indirect mechanisms involving excitation of photosensitizers and the generation of reactive oxygen species (ROS). Nucleic acids, proteins, lipids, indole acetic acids, flavor-proteins, and phytochromes are molecules that contain conjugated double bonds and absorb energy in the UV region. They have key roles in plant cell function and structure and any alterations of these compounds due to UV radiation might be expected to cause physiological alterations in crops. Plants may differ in resistance to ROS depending upon the efficiency of the plant defense systems that involve DNA repair systems and quenching systems involving either a suppression of ROS production or scavenging of ROS, which have already been produced with enzymatic and non-enzymatic scavenging pathways. This can affect the secondary metabolism of fresh produce and increase the synthesis of phytochemicals or reduce the synthesis of undesirable compounds [4, 12, 16]. The biological consequences of free radical reactions leading to cellular dysfunction and cell death are summarized in Figure 2.
Schematic representation of the photobiological effects of UV-C radiation in plants [26].
Harvested crops can be potentially exposed to various abiotic stresses that impact on quality in the food value chain. These include qualitative and quantitative losses including sensorial, microbial, and nutritional losses [7]. Wide variation in resistance to stress injury exists in higher plants and the stress tolerance threshold are determined by plant species, the developmental stage of the plant, type of stressor, exposure time, as well as other factors such as the plant stress-coping mechanisms. Abiotic stresses play a major role in determining the distribution of plant species across different types of environments. Many breeding programs impose abiotic stresses on the plants in a very quantitative way to develop stress tolerance that will allow crops to adapt to climate change [10]. However, it is not clear whether breeding in the field will also extend stress resistance characteristics in the postharvest phase including shelf-life extension and phytonutrient quality of crops.
Various abiotic stresses (salinity, water stress, drought, heavy metals, wind, air pollution, altered gas composition, light, temperature extremes, and exposure to ultraviolet or gamma radiation) are known to have deleterious effects on plant tissues as a result of the production of ROS, causing progressive oxidative damage, which can damage biomolecules and may affect biochemical pathways, leading to cell death (as shown in Figure 2) and cause substantial crop losses worldwide [13, 16, 18-19]. Postharvest abiotic stressors can lead to numerous quality problems in fruits and vegetables, including scald, core and flesh browning of fruits, sweetening, pitting, water-soaked appearance, abnormal ripening, russeting, tissue softening, and loss of nutrient constituents [10]. Hence an understanding of the effects of field abiotic stresses on postharvest stress susceptibility will become more important since postharvest stresses limit the storage and shelf-life potential of crops. Characterization of mutants and transgenic plants with altered expression of antioxidants is also a potentially powerful approach to understanding the functioning of the antioxidant system and its role in protecting plants against stress [6, 13]. The use of genetically modified crops has its biases as in most cases it is considered as potential biological hazards that create an ecological imbalance [6, 9].
As a secondary response, some postharvest abiotic stress treatments could induce some mechanisms that affect the metabolic activity of the treated produce, such as triggering antioxidants. Studies have shown that plants with higher levels of antioxidants, whether constitutive or induced, showed a greater resistance to different types of environmental stresses [13]. Plants possibly protect themselves against increased UV irradiation by an increased synthesis of pigments in the epidermis [23]. However, the mechanisms of cellular oxidative stress are complex, and other biochemical and physiological mechanisms may act in concert under UV stress. Figure 3 illustrates possible mechanisms for using controlled postharvest abiotic stresses to enhance the phytochemical content of crops [7].
Effect of postharvest abiotic stress on the production of phytochemicals (adapted from [7]).
Non-ionizing artificial UV-C irradiation is a postharvest treatment that can be adjunct to refrigeration for delaying postharvest ripening, senescence, and decay in different fruit and vegetable species. UV-C radiation is mainly used as a surface treatment because it penetrates only 5-30 microns of the tissue and is beneficial for keeping the integrity and freshness of fruits and vegetables [27, 65]. It has been extensively used for many years in the disinfection of equipment, glassware, and air by food and medical industries. Exposure to abiotic UV-C radiation stress is well known to have deleterious effects on plant tissues however low levels may stimulate beneficial responses of plants, a phenomenon known as Hormesis [14, 28]. The use of UV-C hormesis to improve the postharvest quality of fresh fruits and vegetables has been the subject of numerous research activities during the last two decades, with some early applications in the eighties on the control of postharvest pathogens. UV-C doses above the optimal level can lead to detrimental color development and poor appearance of fruits and vegetables, thus lowering aesthetic value and lead to poor marketability of such treated produce [15]. Turtoi [27] and Ribeiro [11] conducted recent reviews on the effects of UV-C primarily on decontamination and disease control in fresh fruits and vegetables. UV-C irradiation also holds considerable promise as a non-chemical treatment to delay ripening and senescence and to improve shelf-life of fresh fruits and vegetables and the associated health and therapeutic benefits with their consumption [11, 28]. In a more recent study, UV-C hormesis was induced at the pre-harvest stage, which has commercial implications particularly for crops that are easily damaged during postharvest treatment [20]. UV-C treated crops, with the ability to scavenge and/or control the level of cellular ROS with the consequential activation of phytochemicals may be useful to improve postharvest storage life and enhance nutritional quality and health benefits. However, the reported biochemical and molecular mechanisms of such effects are complex and quite diverse and depend on several factors such as differences in crops sensitivity, maturity levels, UV-C doses, equipment, and environmental conditions as previously noted.
UV-C irradiation can be applied using low and medium pressure mercury vapor discharge lamps with a peak emission at 254 nm inside an enclosed chamber that is kept closed during irradiation. The lamps are suspended directly over the sample in the chamber at a fixed distance from the sample and radiation doses are varied using different exposure times. The intensity of the light is affected by the distance the source is from the sample. Manual rotation is generally employed to the treated commodity to ensure irradiation uniformity. The use of devices to rotate the crops to ensure radiation uniformity is noted in [20]. The dose is calculated from the product of exposure time and irradiance, as measured by portable handheld digital radiometers. The irradiance, sometimes called intensity, has the preferred units of mWcm-2 while the UV dose has the preferred units of kJm-2 [21]. UV dose may be calculated from the following formula:
D = I (T)
where D = dosage, I = applied intensity, and T = time of exposure.
There are several advantages in the use of UV-C technology such as:
it leaves no residues after treatment, including moisture residues,
it does not involve complex expensive equipment,
it is simpler and more economical to use than ionizing radiation, and
it generally lacks regulatory restrictions.
The beneficial effects from UV-C radiation result from the use of very low UV doses ranging from 0.125 kJm−2 to 9 kJm−2 and the time scale for the induction of such effects is generally measured over hours (h) or even days [11, 15, 17]. The design of UV-C equipment and technology on a commercial scale for fresh fruits and vegetables and fresh-cut food industry poses a challenge with respect to ensuring affordable technology and simultaneously protecting operators from harmful effects of UV-C rays while effectively treating fruit tissue to ensure significant and consistent microbial load reduction and activation of beneficial phytochemicals.
Plants possess a variety of phytochemicals to protect against the adventitious production of ROS caused by specific postharvest elicitor treatments [4, 13]. Such phytochemicals include the enzymes superoxide dismutase (SOD), catalase (CAT), peroxidase (POD), ascorbate peroxidase (APX), monodehydroascorbate reductase (MDHAR), dehydroascorbate reducatase (DHAR), glutathione reductase (GR), polyphenol oxidases (PPO), guaiacol peroxidase (GPX), as well as water and fat-soluble antioxidants (ascorbic acid, thiol containing compounds, tocopherols, carotenes) and general antioxidants such as phenolic compounds. Non-enzymic phytochemicals play a significant role in protecting the cell from oxidative stress that occurs when there is a disturbance between the production of free radicals and antioxidant defenses [13, 18, 24]. A summary of some changes in enzymic and non-enzymic phytochemicals in postharvest UV-C treatment of some crops are illustrated below.
SOD is a ubiquitous defensive enzyme against superoxide damage to aerobic organisms. SOD catalyzes the dismutation of the one-electron reduced form of oxygen (O2⋅-) or superoxide radical resulting in the production of the less toxic hydrogen peroxide and oxygen: 2 O2⋅- + 2H +\n\t\t\t\t\t\t
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
Banana (cv. Cavendish) | \n\t\t\t0.02 kJm−2, 0.03 kJm−2 and 0.04 kJm−2 and storage at 5°C and 25°C for 7 days and 21 days | \n\t\t\tSOD activity in both control and UVC-treated fruit decreased with storage time, with a slight increase at the end of storage, but UV-C treated fruit maintained higher SOD activity throughout storage. UV-C treatment led to significantly higher activities of SOD, CAT, POD, APX, and GR compared to control fruit during later storage. | \n\t\t\t[30] | \n\t\t
Yellow Bell Pepper | \n\t\t\t2.2 kJm−2, 4.4 kJm−2, and 6.6 kJm−2 and storageat 12 ± 1°C for 15 days | \n\t\t\tUV-C illumination at 6.6 kJm−2 enhanced the activities of enzymes such as CAT, SOD, GPX, and APX in yellow bell pepper during storage when compared to control fruit. | \n\t\t\t[32] | \n\t\t
Pear (cv. Yali) | \n\t\t\t5 kJm−2 and storage at 20°C for 42 days | \n\t\t\tActivities of SOD, GR, and CAT in Yali pear fruit were significantly enhanced with UV-C dose compared to control fruit even up to the end of the storage period. | \n\t\t\t[33] | \n\t\t
Strawberry | \n\t\t\t0.43 kJm−2, 2.15 kJm−2, and 4.3 kJm−2 and storage at 10°C for 15 days | \n\t\t\tTotal SOD activity decreased in both control and UV-C treated strawberries, but after 15 days of storage all UV-treatments showed higher SOD levels that controls. UV-treated fruits at 2.15 kJm−2 dose (5 min) had the highest GR activity. GR activity increased during the first 10 days of storage and then declined after 15 days of storage. | \n\t\t\t[34] | \n\t\t
Strawberry | \n\t\t\t0.25, 0.5 kJm−2 and 0.75 kJm−2 and storage at 10°C for 15 days | \n\t\t\tSOD activity increased at day 5 but then declined during storage. Extracts from all UV-C treated fruits had higher SOD activities compared to control fruits during storage. UV-C doses at 0.5 kJm−2 and 0.75 kJm−2 enhanced SOD and CAT activities in fruit after 5 days but levels declined after. | \n\t\t\t[35] | \n\t\t
Tomato (cv. Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16°C for 28 days | \n\t\t\tSOD levels were lowest at day 0 and increased during the pre-climacteric phase attaining a maximum level by day 14 for control and day 21 for UV-C treated fruits (both doses) prior to declining in the post-climacteric phase. SOD levels were generally lower for UV-C treated fruit than controls. | \n\t\t\t[36] | \n\t\t
\n\t\t\t\tTurnera diffusa Willd (Damiana medicinal plant) | \n\t\t\t0.38 mWcm-2; 5, 10, and 20 min day-1 and storage for 10 days | \n\t\t\tNo significant differences were found in SOD activity of damiana leaves between UV-C treatments and control plants. \n\t\t\t | \n\t\t\t[37] | \n\t\t
Fresh-cut watermelon | \n\t\t\t1.6, kJm−2, 2.8 kJm−2, 4.8 kJm−2, and 7.2 kJm−2 and storage at 5°C for 11 days | \n\t\t\tThe general trend in CAT activity was a decline from initial values however the 1.6 kJm−2 and 4.8 kJm−2 treatments kept the initial activity of this enzyme throughout shelf-life. | \n\t\t\t[39] | \n\t\t
Summary of changes in SOD, GR, and CAT activities with postharvest UV-C treatment of crops.
Resistance to infection by pathogen or abiotic stress is correlated with the induction of plant defense mechanisms and this is manifested through the stimulation of anti-microbial compounds such as phytoalexins. Allixin was the first compound isolated from garlic as a phytoalexin and a possible compound for cancer prevention. Trans-resveratrol produced by a large number of plants has a wide range of beneficial biological properties including being attributed with a relatively low incidence of cardiovascular disease and associated with reduced cancer risk [8]. A more detailed review of the stilbene resveratrol in grape and grape products irradiated with UV-C can be found in [8] and in peanuts [38, 43]. Resveratrol was present in substantial amounts (1.2-2.6 μg/g FW) in leaves, roots, and shells, but very little (0.05-0.06 μg/g FW) was found in developing seeds and seed coats of field-grown peanuts. Accumulation of resveratrol in leaves increased over 200-fold in response to UV light, over 20-fold in response to paraquat, and between 2- and 9-fold in response to wounding, H2O2, salicylic acid (SA), jasmonic acid, and ethephon, 24 h after treatment. Changes in resveratrol content were correlated with levels of resveratrol synthase (RS) mRNA, indicating a transcriptional control of resveratrol synthase activity [40]. These gene changes underline the biochemical and physiological changes induced by UV-C such as increased defense ability, delayed softening, better maintenance of nutritional and sensory qualities and extension of shelf-life [30-31]. Table 2 summarizes the changes in phytoalexin content with postharvest UV-C treatment of some crops.
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
Tomato (cv. Zhenfen 202) | \n\t\t\t4.0 kJm−2 and storage at 14°C for 24 h | \n\t\t\tA number of PR genes, like PR5-like protein, β-1,3-glucanase and chitinase were highly up-regulated in response to UV-C treatment. | \n\t\t\t[31] | \n\t\t
Peanut Seedlings | \n\t\t\t300 µWcm−2 at 15 cm for 1 h and storage at 25°C for 60 h | \n\t\t\tResveratrol concentrations increased immediately after UV-C radiation and peaked at 12 h, followed by a decline nearly to control concentrations by 24 h, indicating that resveratrol synthesis could be induced by UV-C irradiation. | \n\t\t\t[38] | \n\t\t
Star Ruby grapefruit | \n\t\t\t0.5 kJm−2, 1.5 kJm−2, and 3.0 kJm−2 and storage at 7°C for 28 days | \n\t\t\tScoparone and scopoletin increased in flavedo tissue with UV treatment. Both phytoalexins showed similar accumulation patterns, although the concentrations of scoparone were much lower than those of scopoletin and when compared to non-irradiated fruit that exhibited no detectable levels of scoparone and scopoletin. | \n\t\t\t[41] | \n\t\t
Tomato | \n\t\t\t3.7 kJm−2 and storage at 7°C for 35 days | \n\t\t\tUV-C dose induced synthesis and accumulation of rishitin. The capacity to accumulate rishitin declined with ripening in both control and UV-treated fruit. | \n\t\t\t[42] | \n\t\t
Summary of changes in phytoalexin content with postharvest UV-C treatment of crops.
The largest category of phytochemicals and most widely distributed secondary products in plants are the phenolics. They exist in higher plants in many different forms including hydroxybenzoic derivatives, cinnamates, flavonoids (flavonols, flavones, flavanols, flavanones, isoflavones, proanthocyanidins), lignans, and stilbenes, and affect quality characteristics of plants such as appearance, flavor, and health-promoting properties. Besides their role as antioxidants, phenolic compounds also possess antimicrobial properties and are involved in disease resistance by contributing to the healing of wounds by lignification of cell walls around wounded sites [44]. The accumulation of phenolic and flavonoid compounds may act as a protective filter against excessive UV radiation [28, 45-48]. Phenolics also serve as substrates for browning reactions. The enzymes phenylalanine ammonia-lyase (PAL; EC 4.3.1.5), polyphenol oxidases (PPO; EC 1.14.18.1) and peroxidises (POD; EC 1.11.1.7) are the main enzymes responsible for phenolic degradation that often leads to quality loss in crops [44]. Skin discoloration or external browning is one effect of UV-C treatment and is dose dependent with the effect being more pronounced as the dose is increased and has been reported in several crops notably tomato, strawberries, peaches, and Star Ruby grapefruit [28]. Table 3 summarizes the changes in Phenolics content with postharvest UV-C treatment of some crops. Time course measurements of the effects of UV-C have shown that the strongest responses of fruit to UV-C treatment occurred instantly after the illumination and the effects diminished with time.
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
\n\t\t\t\tSpilanthes acmella (toothache plant) | \n\t\t\t1.5 kJm−2 and storage in field conditions after 3 and 5 days | \n\t\t\tAnthocyanin and flavonoid concentration increased with UV-C treatment. | \n\t\t\t[29] | \n\t\t
Banana (cv. Cavendish) | \n\t\t\t0.02 kJm−2, 0.03 kJm−2, and 0.04 kJm−2 and storage at 5 and 25°C for 7 and 21 days | \n\t\t\tUV-C doses reduced both the incidence of CI and its severity compared with controls in banana fruit peel. UV-C treatment activated PAL and resulted in higher levels of total phenolic compounds in comparison with untreated controls. | \n\t\t\t[30] | \n\t\t
Yellow Bell Pepper | \n\t\t\t2.2 kJm−2, 4.4 kJm−2, and 6.6 kJm−2 and storage at 12 ± 1◦Cfor 15 days | \n\t\t\tUV-C illumination at 6.6 kJ/m2 enhanced total flavonoid content. | \n\t\t\t[32] | \n\t\t
Pear (cv. Yali) | \n\t\t\t5 kJm−2 and storage at 20°C for 42 days | \n\t\t\tEnzyme activities of PAL and β-1,3-glucanase were induced to high levels by UV-C treated pears and thought to be responsible for the reduction in postharvest decay. | \n\t\t\t[33] | \n\t\t
Tomato (cv. Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16°C for 28 days | \n\t\t\tA 4.5- and 4.9-fold increase in total phenols with UV doses of 3.7 kJm−2 and 24.4 kJm−2, respectively, when compared to controls on day 14 was observed. Levels of total phenols were higher with UV-treated fruits than controls at the end of the storage. | \n\t\t\t[36] | \n\t\t
\n\t\t\t\tTurnera diffusa Willd (Damiana medicinal plant) | \n\t\t\t0.38 mWcm-2; 5, 10 min day-1 and 20 min day-1 exposure and storage for 10 days | \n\t\t\tLevels of phenols increased immediately upon exposure to UV-C dose (5 min day-1) and in all UV-C doses (5, 10 and 20 min day-1) by day 7. | \n\t\t\t[37] | \n\t\t
Tomato (Light Red and Mature Green) | \n\t\t\t1.0 kJm−2, 3.0 kJm−2, and 12.2 kJm−2 and storage atRT for 2 days | \n\t\t\tUV-C doses (3.0 kJm−2 and12.2 kJm−2) caused a 1.2-fold increase in total phenolics of both maturities but the same effect was not observed in the individually analyzed phenolic compounds. | \n\t\t\t[45-46] | \n\t\t
Fresh-cut pineapple (cv. Honey), banana (cv. Pisang mas) and Thai seedless guava | \n\t\t\t10 min day-1, 20 min day-1, and 30 min day-1 exposure and storage at RT | \n\t\t\tIn bananas and guava, UV-C radiation resulted in an increase in total phenols and flavonoids. In pineapples however, there was a significant increase in flavonoids but UV-C irradiation did not have any significant increase in total phenol content. | \n\t\t\t[47] | \n\t\t
Fresh-cut Mango (cv. Tommy Atkins) | \n\t\t\t1 min day-1, 3 min day-1, 5 min day-1, and 10 min day-1 exposure and storage at 5°C for 15 days | \n\t\t\tAn increase in the total phenols and total flavonoids were observed for all doses, with the longer irradiation exposure time proportional to the increases in levels of total phenols and flavonoids and lowest antioxidant capacity with controls. | \n\t\t\t[48] | \n\t\t
Blueberries | \n\t\t\t0.43 kJm−2, 2.15 kJm−2, 4.30 kJm−2, and 6.45 kJm−2 and held forvarious times at 20°C | \n\t\t\tUV-C doses increased total phenols and anthocyanins levels versus controls. Levels of flavonoids in blueberries increased with UV-C doses. Significantly higher antioxidant capacity in blueberries was detected in fruit treated with doses of 2.15 kJm−2 and 4.30 kJm−2 compared to the control fruit. | \n\t\t\t[49] | \n\t\t
\n\t\t\t\tButton mushrooms | \n\t\t\t0.225 kJm−2, 0.45 kJm−2, and 0.90 kJm−2 and storage at 4°C for 21 days | \n\t\t\tAlthough there was a general increase in total phenolics during storage, UV doses showed lower total phenolics content during the first week of storage beyond which there was no significant difference among treatments. | \n\t\t\t[50] | \n\t\t
\n\t\t\t\tKorla Pears | \n\t\t\t3 kJm−2 and 6 kJm−2 and storage at 20°C for 15 days | \n\t\t\tUV-C 3 kJm−2 dose had higher levels of total phenolics compared to the dose of 6 kJm−2 and control. Similar results were noted for flavonoids where at the end of storage, residual flavonoid content in control was 82% of initial values compared with 108% in 3 kJm−2 dose, and 98% in 6 kJm−2 dose of initial values. | \n\t\t\t[51] | \n\t\t
Broccoli heads (cv. de Cicco) | \n\t\t\t4 kJm−2, 7 kJm−2, 10 kJm−2, or 14 kJm−2 and storage at 20°C for 6 days | \n\t\t\tTotal phenols and flavonoids increased in both control and UV-treated broccoli. Lower levels of total phenols and flavonoids were found in UV-treated florets after 4 and 6 days in storage compared to controls. | \n\t\t\t[53] | \n\t\t
Summary of changes in phenolics and flavonoids content with postharvest UV-C treatment of crops.
During chlorophyll degradation, chlorophyll a is transformed to chlorophyllide a through the action of the chlorophyllase enzyme [52]. Chlorophyllide a is then acted by the enzyme Mg-dechelatase removing Mg2+ from the molecule and forming pheophorbide a, consequently the green color is lost. In general, the chloroplast is the first organelle to show injury response with UV radiation and reduction in the chlorophyll contents may be due to inhibition of biosynthesis or due to degradation of chlorophyll and their precursors [29]. Table 4 summarizes the changes in chlorophyll content with postharvest UV-C treatment of some crops. Photosynthetic pigments such as chlorophyll a and b as well as total chlorophyll contents were considerably reduced in UV-C treated crops [29, 37]. In these studies, chlorophyll a and chlorophyll b were more sensitive to UV-C radiation. The reduction of chlorophyll content is thought to have a negative effect on plant photosynthetic efficiency due to UV-C radiation being too severe. Previous studies have demonstrated the inhibitory effect of UV-C light on chlorophyll breakdown and on the activities of Mg-dechelatase, chlorophyllase and chlorophyll degrading peroxidase in crops [53-55].
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
\n\t\t\t\tSpilanthes acmella (toothache plant) | \n\t\t\t1.5 kJm−2 and storage in field conditions after 3 and 5 days | \n\t\t\tChlorophyll a, chlorophyll b,and total chlorophyll contents were considerably reduced with UV-C treatment. | \n\t\t\t[29] | \n\t\t
\n\t\t\t\tTurnera diffusa Willd (Damiana medicinal plant) | \n\t\t\t0.38 mWcm-2; 5 min day-1, 10 min day-1, and 20 min day-1 exposure and storage for 10 days | \n\t\t\tChlorophyll a content significantly decreased in plants exposed to UV-C radiation for 5 and 20 min day-1 while chlorophyll b content significantly decreased with UV-C 20 min day-1 dose relative to control plants. | \n\t\t\t[37] | \n\t\t
Broccoli heads (cv. de Cicco) | \n\t\t\t4 kJm−2, 7 kJm−2, 10 kJm−2, or 14 kJm−2 and storage at 20°C for 6 days | \n\t\t\tAll UV treatments delayed yellowing and chlorophyll degradation. UV-C dose of 10 kJm−2 reduced the degradation of both chlorophyll a and b in broccoli florets and this was correlated to a reduced activity of chlorophyllase and chlorophyll peroxidase in treated florets, which maintained a greener color than the controls. UV-C treated broccoli also maintained lower Mg-dechelatase level than controls. | \n\t\t\t[53] | \n\t\t
\n\t\t\t\tBrassica oleracea var. alboglaba\n\t\t\t\t (Chinese kale) | \n\t\t\t1.8 kJm−2, 3.6 kJm−2, 5.4 kJm−2, and 7.2 kJm−2 and storage at 20°C for 8 days | \n\t\t\tUV-C doses of 3.6 kJm−2 and 5.4 kJm−2 delayedleaf yellowing and chlorophyll loss depicted as higher chlorophyll contents and lower activity of chlorophyllase, Mg-dechelatase and chlorophyll-degrading peroxidase as compared to the other treatments. | \n\t\t\t[54] | \n\t\t
Mature Green Tomato (cv. Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16°C for 28-35 days | \n\t\t\tThere was a significant decrease in chlorophyll degradation, with levels significantly higher in UV-C treated fruit compared to controls with storage time for both UV-C doses. | \n\t\t\t[55] | \n\t\t
Summary of changes in chlorophyll content with postharvest UV-C treatment of crops.
Carotenoids (β-carotene) or pro-vitamin A are quenching agents that facilitate the return of singlet oxygen to its ground state. Table 5 summarizes changes in Total Carotenoids Content (TCC) and Lycopene content with postharvest UV-C treatment of some crops. In some cases, decreases in β-carotene as a result of UV-C treatment, are due most likely to the phenomenon of photobleaching [37, 45]. These observations appear to be at variance with those of other authors where carotenoid levels increased in medicinal plants [29], tomato [55], and minimally processed carrots [61] with UV-C treatment. The increase in total carotenoids may be part of the antioxidant system where carotenes are involved in protection of the chloroplast against photooxidation.
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
\n\t\t\t\tSpilanthes acmella (toothache plant) | \n\t\t\t1.5 kJm−2 and storage in field conditions after 3 and 5 days | \n\t\t\tTCC increased with UV-C treatment. Lycopene was not analyzed. | \n\t\t\t[29] | \n\t\t
Yellow Bell Pepper | \n\t\t\t2.2 kJm−2, 4.4 kJm−2, and 6.6 kJm−2 and storage at 12 ± 1◦C for 15 days | \n\t\t\tUV-C illumination at 6.6 kJ/m2 enhanced TCC. | \n\t\t\t[32] | \n\t\t
\n\t\t\t\tTurnera diffusa Willd (Damiana medicinal plant) | \n\t\t\t0.38 mWcm-2; 5 min day-1, 10 min day-1, and 20 min day-1 exposure and storage for 10 days | \n\t\t\tTCC significantly decreased in plants exposed to UV-C (20 min day-1) compared to control. Lycopene was not analyzed. | \n\t\t\t[37] | \n\t\t
Light Vine-Ripe Red Tomato | \n\t\t\t1 kJm−2, 3 kJm−2, and 12.2 kJm−2 and storage at RT for 2 days | \n\t\t\tUV-C doses caused a decrease in β-carotene while UV-C doses at 1 kJm−2 and 12.2 kJm−2 enhanced the increase in total lycopene (E+Z isomers), by about 20% over control samples. UV-C 1 h treatment favored an increase in E-lycopene, while UV-C 12 h treatment affected mainly Z-isomers, which is considered to be better from a nutritional point. | \n\t\t\t[45] | \n\t\t
Mature Green (Breaker stage)Tomato | \n\t\t\t1 kJm−2, 3 kJm−2, and 12.2 kJm−2 and storage at RT for 8 days | \n\t\t\tUV-C doses caused a decrease in β-carotene while total lycopene increased 8-fold at doses of 1.0 kJm−2 and 3.0 kJ/m2 over those of control. E-lycopene decreased with 12.2 kJ/m2 dose. | \n\t\t\t[46] | \n\t\t
Fresh-cut Mango (cv. Tommy Atkins) | \n\t\t\t1 min day-1, 3 min day-1, 5 min day-1, and 10 min day-1 exposure and storage at 5°C for 15 days | \n\t\t\tβ-carotene content decreased with storage in all treatments including controls with the major reduction observed in fruits treated for 10 mins and 5 mins. | \n\t\t\t[48] | \n\t\t
Mature Green Tomato (cv. Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16°C for 28-35 days | \n\t\t\tThere was a significant decline in lycopene accumulation with time for both UV-doses. UV-3.7 kJm−2 exhibited significantly higher levels of TCC compared to control fruits throughout storage. | \n\t\t\t[55] | \n\t\t
Mature Green (Breaker stage)Tomato | \n\t\t\t13.7 kJm−2 and storage at 12°C-14°C for 21 days | \n\t\t\tLycopene content was enhanced by UV-C treatment but the concentration of β-carotene was not affected by UV-C. | \n\t\t\t[56] | \n\t\t
Mature Green Tomato | \n\t\t\t3.7 kJm−2 and storage at 13°C for 30 days | \n\t\t\tUV treatment significantly reduced the lycopene content. | \n\t\t\t[57] | \n\t\t
Fresh-cut Carrots (cv. Nantes) | \n\t\t\t0.78-0.36 kJm−2 and storage at 5°C for 10 days | \n\t\t\tA 64% loss in TCC in UV-C treated samples compared to controls was noted just after processing. However, UV samples exhibited a consistent increase in TCC levels with levels reaching 3-fold higher at day 7 than at day 0. | \n\t\t\t[61] | \n\t\t
Summary of changes in total carotenoids content (TCC) and lycopene with postharvest UV-C treatment of crops.
Alpha-tocopherol is a major lipid-soluble antioxidant that breaks the chain of free radical reactions of polyunsaturated fatty acids (PUFAs) in cell membranes. Alpha-tocopherol protects membrane PUFAs from ROS and free radical damage by reacting with lipid radicals produced in the lipid peroxidation chain reaction [16]. Levels of tocopherol in plants are as a result of synthesis, recycling, and degradation. Changes in α-tocopherol levels during plant responses to environmental stress are characterized by two phases; in the first phase there is an increase in tocopherol synthesis that was followed by a second phase of net tocopherol loss [24]. Endogenous α-tocopherol levels are also severely affected by the extent of its degradation and recycling under stress. As stress is more severe and the amounts of ROS in chloroplasts increase, α-tocopherol levels tend to decrease. Irreversible degradation of α-tocopherol may also occur when α-tocopheroxyl radicals, which result from the scavenging of lipid peroxyl radical by α-tocopherol, are not recycled back by ascorbate. Table 6 summarizes the changes in α-Tocopherol (Vitamin E) content with postharvest UV-C treatment of some crops. While it has been reported that α-tocopherol levels increase in photosynthetic plant tissues in response to a variety of abiotic stresses, results from a study with UV-C irradiated tomato exocarp demonstrated declining levels and do not support the hypothesis that antioxidants such as α-tocopherol are stimulated for plant defense against oxidative stress caused by UV-C radiation [36]. On the other hand, the increased vitamin E content in medicinal Damiana plants exposed to UV-C radiation may provide protection against the oxidative damage induced by UV-C radiation [37].
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
Tomato (cv. Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16°C for 28 days | \n\t\t\tLevels of α-tocopherol were considerably lowered with UV treatment. | \n\t\t\t[36] | \n\t\t
\n\t\t\t\tTurnera diffusa Willd (Damiana medicinal plant) | \n\t\t\t0.38 mWcm-2; 5 min day-1, 10 min day-1, and 20 min day-1 exposure and storage for 10 days | \n\t\t\tLevels of α-tocopherol increased with UV treatment. | \n\t\t\t[37] | \n\t\t
Summary of changes in α-Tocopherol (vitamin E) content with postharvest UV-C treatment of crops.
Vitamin C content, considered to be a nutritional quality index for fruits and vegetables occurs as L-ascorbic acid and dehydroascorbic acid (oxidised form of ascorbic acid). Ascorbate is an electron donor and this property explains its function as an antioxidant or reducing agent and is easily destroyed by oxidation, exposure to light or high temperatures. Ascorbic acid scavenges free radicals in the water soluble compartment of the cell and may also regenerate α-tocopherol (vitamin E), an important lipid-phase antioxidant [16]. Table 7 summarizes the changes in ascorbic acid (vitamin C) content with postharvest UV-C treatment of some crops. In most cases, UV-C treatment decreased the vitamin C content of fruits or did not affect ascorbic acid levels.
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
Yellow Bell Pepper | \n\t\t\t2.2 kJm−2, 4.4 kJm−2, and 6.6 kJm−2 and storage at 12 ± 1◦C for 15 days | \n\t\t\tNo effect on ascorbic acid levels with UV-C treatment. | \n\t\t\t[32] | \n\t\t
Tomato (cv. Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16°C for 28 days | \n\t\t\tUV treatment decreased ascorbic acid levels. | \n\t\t\t[36] | \n\t\t
Fresh-cut pineapple (cv. Honey), banana (cv. Pisang mas) and Thai seedless guava | \n\t\t\t10 min day-1, 20 min day-1, and 30 min day-1 exposure and storage at RT | \n\t\t\tUV treatment decreased ascorbic acid levels. | \n\t\t\t[47] | \n\t\t
Fresh-cut Mango (cv. Tommy Atkins) | \n\t\t\t1 min day-1, 3 min day-1, 5 min day-1, and 10 min day-1 exposure and storage at 5°C for 15 days | \n\t\t\tA reduction in total ascorbic acid content with UV treatment was observed. The lowest values for ascorbic acid occurred in fruits irradiated for 10 min. | \n\t\t\t[48] | \n\t\t
\n\t\t\t\tButton mushrooms | \n\t\t\t0.225 kJm−2, 0.45 kJm−2, and 0.90 kJm−2 and storage at 4°C for 21 days | \n\t\t\tApart from day 1 where UV treated mushrooms had lower ascorbic acid content than controls, during storage, levels increased to a maximum at day 14 and remained stable until day 21 for both control and UV-treated mushrooms. | \n\t\t\t[50] | \n\t\t
Tomato (cv. Trust) | \n\t\t\t3.7 kJm−2 at and storage at 16°C for 25 days | \n\t\t\tAscorbate oxidase activity exhibited a decline during storage for both control and UV-C treated fruit, however the amount of this enzyme was lower in UV-C-treated fruit and could correlate to decreases in levels of ascorbic acid. | \n\t\t\t[58] | \n\t\t
Fresh-cut mature green bell pepper | \n\t\t\t3 kJm−2, 10 kJm−2, and 20 kJm−2 and storage at 10°C for 8 days | \n\t\t\tThe antioxidant capacity of UV-C-treated fruit did not change during storage, but showed a slight increase in the control. | \n\t\t\t[59] | \n\t\t
Fresh fruit juices | \n\t\t\tVarious time intervals of exposure to UV-C | \n\t\t\tUV treatment decreased ascorbic acid levels. The longer the exposure to UV, the higher the losses of ascorbic acid content in fruit juices. | \n\t\t\t[60] | \n\t\t
Summary of changes in ascorbic acid (vitamin C) content with postharvest UV-C treatment of crops.
Thiol (-SH) groups and other functions readily donate hydrogen atoms and are scavengers of hydroxyl radicals. The tri-peptide Glutathione (γ‐glutamylcysteinylglycine) is a major free non-protein thiol compound found in plant tissues. In non-stressed cells, 90% of glutathione is mainly present in its reduced form (GSH) while the oxidized GSSG levels are lower. Upon oxidative stress, the glutathione redox status may shift to a more oxidized form, ROOH +2GSH →ROH +GSSG+H2O, due to increased GSH oxidation and/or decreased GSSG reduction. Such a shift in the glutathione status in plants has been reported upon exposure to a variety of environmental factors associated with oxidative stresses [62]. The ratio of reduced GSH to oxidized GSSG within the cells can be used to measure cellular toxicity. Table 8 summarizes the changes in glutathione content with postharvest UV-C treatment of some crops. Although glutathione has been used as an oxidative stress indicator in plants, there is conflicting evidence about glutathione responses under oxidative stress conditions. While some studies have found an increase in glutathione synthesis in response to oxidative stress, others have found no increase in GSH by environmental stresses.
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
Strawberry | \n\t\t\t0.43 kJm−2, 2.15 kJm−2, and 4.3 kJm−2 and storage at 10°C for 15 days | \n\t\t\tUV-C enhanced the increase of GSH in strawberry fruit during storage. | \n\t\t\t[34] | \n\t\t
Tomato (cv. Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16◦C for 28 days | \n\t\t\tUV-C treatment did not enhance GSH levels when compared to non-irradiated fruit. | \n\t\t\t[36] | \n\t\t
Young Pea Plants | \n\t\t\t9 kJm−2 and storage up to 72 h | \n\t\t\tApart from the initial increase in free thiols by 20% with UV-C, free thiol levels decreased with UV-treatment. | \n\t\t\t[63] | \n\t\t
Summary of changes in glutathione content with postharvest UV-C treatment of crops
Polyamines (PAs) are implicated in a variety of regulatory processes ranging from regulation of growth and cell division, regulating the activity of ribonucleotides and proteinase to inhibition of ethylene (C2H4) production and senescence. The anti-senescent activity of PAs may also be related to their ability to be effective free radical scavengers, as well as stabilizing DNA and membranes by their positively charged cations associating with negative charges on nucleic acids and phospholipids [26]. Changes in plant PA metabolism occur in response to a variety of abiotic stresses and have been shown to enhance the ability of plants to resist environmental stresses. However, the physiological significance of elevated PA levels in abiotic stress responses is still unclear in terms of whether such a response is as a result of stress-induced injury or a protective response to abiotic stress [64]. Table 9 summarizes the changes in PA content with postharvest UV-C treatment of some crops.
\n\t\t\t\t\tCrop\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUV-C conditions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tResults\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSource\n\t\t\t\t | \n\t\t\t
Young Pea Plants | \n\t\t\t9 kJm−2 and storage up to 72 h | \n\t\t\tExogenous application of PA (spermine) plus UV-C positively affected the plant in maintaining normal plant growth, stabilizing cell membranes and activating non-enzymatic antioxidants. | \n\t\t\t[63] | \n\t\t
Tomato (cv Capello) | \n\t\t\t3.7 kJm−2 and 24.4 kJm−2 and storage at 16°C for 21 days | \n\t\t\tUV-C treatment induced PA (free Putrescine) accumulation in tomato fruit. By day 21, levels were still high in UV-treated fruit compared to controls. Similarly, in another recent study, PA content of UV-C (3.7 kJm−2) treated tomato were higher that controls. | \n\t\t\t[65-66] | \n\t\t
Strawberry | \n\t\t\t0.72 kJm−2 and storage at 4°C | \n\t\t\tExogenous application of 2 mM putrescine plus UV-C resulted in positive effects on maintenance of firmness, reduction of weight loss and protection of total antioxidant capacity and vitamin C content against degradation. | \n\t\t\t[67] | \n\t\t
Intact Pea Plants | \n\t\t\t0.1 kJm−2 and 0.3 kJm−2 and storage | \n\t\t\tEndogenous free, conjugated, and bound PAs (Spm, Spd, and Put) in leaves of young pea plants reduced membrane damage as a result of UV-C irradiation. | \n\t\t\t[68] | \n\t\t
Summary of changes in polyamine (PA) content with postharvest UV-C treatment of crops.
Studies on the benefit of phytochemicals continue to be of interest, as researchers have been exploring alternative medicine in the management of common lifestyle diseases and preventative actions, as well as the promotion of good health and nutrition. Abiotic stresses are significant determinants of quality and nutritional value of crops during their life cycle. Notwithstanding, climate change has created additional environmental variables that may influence postharvest stress susceptibility of crops. While breeding programs are underway for many crops to develop stress resistance that will allow them to adapt to climate change, it is not clear that breeding for stress resistance in the field will also extend to stress resistance characteristics of harvested crops particularly fresh fruits and vegetables and fresh-cut produce. Proper postharvest management of crops can positively influence susceptibility to abiotic stress. It is important to understand the various response networks to abiotic stresses encountered in the field and in the postharvest continuum to better evaluate the benefits that may yield from such stresses. Controlled stresses may be used as tools by the fresh produce and food processing industries to obtain enhanced phytochemical or health promoting components of fresh-cut or whole fresh produce and for growers interested in finding alternative uses for their crops. In the context of the different postharvest handling treatments, the potential of UV-C irradiation has enormous possibilities as a non-chemical treatment to sanitize and reduce microbial loads, delay ripening, and improve shelf-life of fresh fruits and vegetables. Further, the elicitation of health promoting phytochemicals with UV-C is an indication that such an approach may be of benefit to growers, processors, and consumers in enhancing sensory characteristics of fresh fruits and vegetables. The beneficial action of UV-C is thought to be as a result of the activation of multiple defense systems involving secondary stress metabolites such as phytoalexins and enzymic and non-enzymic antioxidants. The intensification of natural defense mechanisms of higher plant so that they can defend themselves against infection or adverse stresses is one alternative approach to controlling postharvest losses. Depending on the experimental conditions including UV-C dose, commodity, maturity stage, storage, and environmental conditions administered, such bioactive compounds have been found to be variable, in some instances may decrease or increase, and this change may impact quality of the crops. In many studies, the strongest responses to UV-C treatment occurred almost immediately after the illumination with some beneficial effects of crops occurring after UV-C treatment with the effects decreasing with time. There is need for further research on the molecular and biochemical mechanisms by which these beneficial responses are derived in UV-C treated fresh fruits and vegetables. This is in order to help guide the development of approaches to reliably confer health and nutritional benefits. The potential application of UV-C is novel and relevant particularly for the fresh fruit and vegetable and fresh-cut trade industries.
Aortic root dilation (AoD) is frequently an incidentally discovered, asymptomatic finding in that is seen on various imaging modalities [1]. The anatomy of the aortic root includes the annulus, sinuses of Valsalva, sinotubular junction and ascending aorta [1], with the size being a function of a patient’s biologic variables such as height, age, BSA, and gender [1, 2]. However, while natural variations in the size of the aortic root are well known, the identification of progression from normal to pathologic AoD is a key clinical diagnosis that carries significant cardiovascular risk including aortic dissection, rupture, valvular regurgitation and cardiac tamponade [1, 3, 4, 5]. The etiology of pathological AoD is varied, ranging from congenital, infectious, autoimmune, and idiopathic conditions; and influences the medical and surgical management [1, 5]. Due to the variety of clinical conditions that can result in AoD, and the risks associated with worsening AoD, a thorough understanding of the pathophysiology of AoD, noninvasive imaging modalities and pharmacologic therapies is critical. The aim of this chapter is to review the most common conditions associated with AoD, appropriate imaging modalities, and treatment strategies to manage AoD.
\nMultiple etiologies of AoD exist such as Marfan syndrome, bicuspid aortic valve, Loeys-Dietz and Ehler-Danlos syndromes, idiopathic conditions, hypertension, infections, and inflammatory disorders. In this chapter, we will discuss the various etiologies categorized into two standardized groups—genetically-mediated and nongenetically mediated AoD.
\nGenetically-mediated aortic root dilation or enlargement is the leading cause of thoracic aortic aneurysms. Marfan syndrome (MFS), the prototype condition for AoD, and bicuspid aortic valve has led to a greater understanding of AoD pathophysiology, pharmacologic treatment, timing of surgical intervention and optimal surveillance strategies with noninvasive imaging [6].
\nMFS is one of the most common hereditary disorders of connective tissues and is characterized by manifestations in cardiovascular, skeletal, and ocular systems [7]. MFS is the most common genetic cause of thoracic aortic aneurysms (TAAs). Its inheritance is almost exclusively autosomal dominant and mostly involves a mutation of the fibrillin-1 (FBN1) gene encoding the connective tissue structural protein fibrillin-1 [8]. The widely accepted incidence of Marfan syndrome is ~1 in 5000 individuals [9].
\nAlthough the inheritance pattern is predominantly autosomal dominant, rare cases of autosomal recessive FBN1 gene mutations has been described [10]. While patients with Marfan phenotypes usually have an affected family member, 25% of the cases are sporadic due to de novo mutations [9]. In addition, in <10% of Marfan cases, no mutation of FBN1 was determined [11]. Since it was first identified as the main cause of Marfan syndrome, FBN1 mutations, depending on how it is mutated, were linked to a variety of syndromes and phenotypes [12]. Animal studies investigating the pathophysiology of the disease demonstrated over-expression of TGF-β in the mitral valve preceding prolapse, the aorta associated with dilatation, skeletal muscle associated with myopathy, and the dura leading to ectasia [12]. Later, mutations in TGF-beta receptor 2 (TGFBR2) and TGFBR1 genes were identified in some patients with Marfan phenotypes and subsequently implicated in the disease process in FBN1 mutation negative individuals [13, 14, 15]. These genes were also linked to another condition later, namely Loeys-Dietz syndrome (LDS) [14].
\nThe diagnosis of Marfan syndrome is established by using a combination of clinical manifestations, family history, and the presence of FBN1 mutation. In order to facilitate accurate recognition of the syndrome and improve patient management and counseling, a set of defined clinical criteria, called the Ghent nosology was developed [16] and later revised [17] (Table 1). Apart from the genetic testing for FBN1 mutation, Ghent nosology uses a systemic score calculation using clinical manifestations of Marfan and an aortic root dilatation Z-score (see noninvasive imaging below).
\nPatients with family history of Marfan disease | \n
\n
| \n
\n
| \n
\n
| \n
Patients without family history of Marfan disease | \n
\n
| \n
\n
| \n
\n
| \n
\n
| \n
Revised Ghent nosology.
One of the major causes of mortality and clinical hallmark of Marfan syndrome is aortic root dilation and related complications such as dissection, rupture and/or aortic valvular regurgitation. Aortic root dilation is typically first identified on echocardiography in 60–80% of Marfan patients [18]. Therefore, surveillance echocardiography has been routinely used to serially monitor aortic dimensions. If the aortic root diameter is above 4.5 cm in adults, aortic dilation rates are above 0.5 cm/year, and/or significant aortic insufficiency is already present, more frequent monitoring is recommended [6] (see Diagnosis and Surveillance of Aortic Root Dilation below for more detailed guidelines).
\nBicuspid aortic valve is one of the most frequent congenital heart anomalies in adults, affecting 0.9–2% of the population [19]. Most cases of bicuspid aortic valve are familial and studies show that heritability of the disease is ~90% making it an autosomal dominant pattern with incomplete penetrance [20]. Bicuspid aortic valve can occur alone or with other congenital cardiovascular disorders such as coarctation of the aorta, supravalvular or subvalvular aortic stenosis, and ventricular septal defect [21].
\nThe diagnosis is often established by transthoracic echocardiogram (TTE), which has high sensitivity (~92%) and specificity (~96%) [22]. TTE is also useful for surveillance of potential complications of bicuspid aorta such as aortic stenosis, aortic dilation, aortic regurgitation, and infective endocarditis [23]. Given the risk of inheritance, first degree relatives are also recommended to be screened with TTE [21].
\nPrevalence of aortic dilation in patients with bicuspid aortic valve disease ranges from 20 to 84% depending on the criteria used in different studies [24]. The risk of aortic dilation increases with age and the risk of dissection increases as the aortic diameter increases [25, 26]. When the aortic root diameter is above 4.5 cm, there is a family history of aortic dissection, or aortic diameter change is rapid it is recommended to perform echocardiogram annually [21]. More frequent surveillance is recommended for patients with aortic root diameters approaching surgical thresholds (see Surgical Interventions section below).
\nLoeys-Dietz syndrome (LDS) is a rare congenital syndrome characterized by hypertelorism (widely spaced eyes), a split uvula or cleft palate, tortuous arteries and aortic aneurysms. LDS shares many features with Marfan syndrome [14]. Most of the LDS cases are sporadic or show an autosomal dominant pattern of inheritance [14].
\nThe incidence and prevalence of the disease is still not well established.
\nLoeys-Dietz syndrome was initially classified into two subtypes based on the severity of the cutaneous and craniofacial features but later was divided into six subtypes stratified by genotypes [27]. These subtypes are labeled 1–6 and associated with mutations in TGFBR1, TGFBR2, SMAD3, TGFB2, TGFB3, SMAD2, respectively [27]. Type 1 and type 2 are the most commonly seen subtypes with frequencies of 20 and 55% among all subtypes, respectively [28].
\nAortic root dilation is a hallmark feature of this disease entity and is frequently seen in patients (~80%) [29]. Another vascular manifestation is aneurysms throughout the arterial tree. This is a concerning clinical manifestations of the disease and can cause aggressive arteriopathy; therefore, early operative intervention at ascending aortic diameters of ≥42 mm is recommended [30].
\nEhlers-Danlos syndromes (EDS) are a heterogeneous and relatively rare group of connective tissue disorders characterized by skin hyperextensibility, joint hypermobility, and tissue fragility [31]. Ehler-Danlos syndrome can present with a variety of clinical manifestations and can be caused by different kinds of genetic mutations. Overall prevalence of EDS is ~1 in 5000 and EDS hypermobile (hEDS) is the most common type [31].
\nVascular complications can be seen with different types of EDS; however, it is most commonly seen in type IV (vascular or arterial ecchymotic type; vESD), characterized by an autosomal dominant mutation in COL3A1 (collagen, type III, α-1 gene) encoding type III procollagen [32]. Up to 80% with vESD patients suffer from vascular complications by the age 40 years [32]. Therefore EDS patients, especially vEDS, patients should be routinely evaluated for aortic root disease. These patients are recommended to undergo elective operation at smaller diameters (4.0–5.0 cm) to avoid acute dissection or rupture. Patients with a growth rate of more than 0.5 cm/year in an aorta that is <5.5 cm in diameter are recommended to be considered for operation [33].
\nAortic root dilation is an established phenomenon that has shown strong correlations to key pathobiological factors such as age, body surface area (BSA), height and gender. The correlation of aortic root size with age and BSA were initially described in the development of screening nomograms using M-mode echocardiograms [34]. Follow up studies with 2D echocardiography further validated these correlations, allowing for the development of nomograms for normal patient populations or adjusted for patients with underlying congenital disorders (i.e., Marfan syndrome) [2, 35]. These studies evaluating AoD by echocardiograms are further supported by reviews of autopsy data that show clear correlations to key pathobiological factors such as increased age and height with AoD [36].
\nDespite the validation of age as being correlated strongly with AoD, the mechanism of age on the development of AoD still remains an area of active research. One of the predominant hypotheses is based on the idea of cyclic stress, and how the aorta degrades through gradual mechanical decline of elastin proteins [37]. Elastic arteries, namely the aorta, are estimated to dilate by 10% with each beat [38]. It is hypothesized that the shear stress over a normal lifetime results in the degradation of elastic lamella, resulting in arterial dilation and stiffening [38]. This is corroborated by histologic data demonstrating damage to medial elastin of the proximal aorta [38]. Furthermore, there is evidence to suggest that in the absence of risk factors such as hypertension or atherosclerosis, the aortic wall undergoes age-associated reprograming that is proinflammatory promotes progression of arterial disease [39]. Wang et al. demonstrated in pathologic samples of aortas that age correlated with increased smooth muscle cell invasion, and increased production of downstream angiotensin II mediators [39].
\nIn addition to age and BSA, gender is another key factor which can increase the risk and progression of AoD [40]. In the Framingham study of 1849 men and 2152 women, not currently diagnosed with cardiac disease or having a cardiac history, aortic root was 2.4 mm smaller in women than men with m-mode echocardiography [40]. A systematic review in 2014 of 10,741 patients with hypertension revealed men had a significantly higher incidence of AoD relative to women [41].
\nIn conclusion, a series of biological variables are correlated with AoD, and it is important to take these into account as they are potential confounders or contributors in the evaluation of patients with pathologic AoD. Even exercise capacity has been correlated with AoD, with a recent meta-analysis showing that athletes defined by participation in National Collegiate Athletic Association (NCAA) or international equivalent had an aortic root diameter that was larger than nonathletic controls [42], and a statistically significant increase by measurement of sinuses of Valsalva and aortic root annulus [42]. It is important to understand the significance of biological variables such as age, height, BSA, or gender to fully evaluate pathologic AoD without the influence of known confounders.
\nHypertension is a well-known risk factor for aortic dissection, and in some studies, it is estimated to factor into roughly half of the overall risk for aortic dissection [43]. A recent prospective cohort study of 30,447 patients, 86% of patients who developed aortic dissection had hypertension [4]. However the relationship between hypertension and AoD is not as clearly established. In a Framingham study of 3195 patients, there was no relationship between the development of AoD with hypertension [44]. A subsequent follow up study of Framingham participants evaluating aortic root diameter was positively correlated with mean arterial pressure, but negatively associated with pulse pressure, indicating that the mechanism behind AoD is more complicated [45]. Moreover, investigations have shown that in patients with other comorbidities for AoD, such as, Turner syndrome, hypertension is significantly associated with increased prevalence of AoD [45]. This has led to interesting insights into the cyclic stress hypothesis of the development of AoD [43]. If AoD develops due to chronic shear stress, then it would be expected that AoD is correlated with higher pulse pressure (PP), which would presumably lead to greater stress and aortic dilation [43]. However, studies have reported an inverse relationship between AoD and PP [43]. Additionally a systematic review in 2014 showed that in a population of 10,791 hypertensive patients, 9.1% had AoD with a significant gender skew toward men [41]. However there was no significant correlation of mean arterial pressure or pulse pressure values and AoD [41]. While hypertensive patients have a higher incidence of AoD, the mechanism remains to be further investigated. Moreover, these unclear correlations between MAP, PP, and AoD suggest that the aorta is not static, but a dynamic structure whose response to stress, such as hypertension, is still being elucidated [43].
\nSince the first mass production of penicillin in 1945, the modern era of antibiotics has resulted in a decrease in the prevalence of mycotic aneurysms due to bacterial infections in developed countries [46, 47]. However they can still be found in developing countries, and are rare but well described causes of mycotic aneurysms [46]. Most common pathogens include Salmonella, Staphylococcus and Streptococcus pneumonia, and while rare have been in the pathogenesis of mycotic aneurysms of the aortic root [46, 48, 49]. Other common bacteria include Mycobacterium tuberculosis and Treponema pallidum, which will be discussed below, and more rare causes include Listeria, Bacteroides, Clostridium septicum, and Campylobacter jejuni [46]. With the majority of bacterial aortitis, aneurysm development is generally saccular, and Salmonella has been reported in case studies to predominantly affect the abdominal aorta than the thoracic [46, 48]. Infections with Staphylococcal species generally are related to underlying aortic valve infections, but have been reported to progress into aneurysms of the aortic root [46, 49].
\n\nTreponema pallidum, a sexually transmitted spirochete which is the causative organism of syphilis, is a well characterized cause of aortitis [46, 50, 51]. Cardiovascular involvement is limited to late stage, or tertiary syphilis, and generally occurs 5 to upwards of 40 years after primary infection [50, 51]. Aortitis, and aneurysm development is due to invasion of the vasa vasorum, resulting in obliterative endarteritis that leads to degradation of the aortic media [50, 51]. The chronic inflammation results in fibrosis of the intima, a phenomenon known as “tree-barking” that ultimately progresses to aneurysm development. In an autopsy study in 1960 of 51 aortic aneurysms secondary to syphilitic aortitis, 7.8% were found at the sinuses of Valsalva and 29.4% involved the ascending aorta, representing a majority of the sample [52]. This predominance to the ascending thoracic aorta have been further corroborated in later studies, however the detailed echocardiographic analysis of syphilitic aortitis, specifically in relation to AoD is limited due to the rarity of the disease presentation [46, 50].
\nTuberculosis is a relatively common infection especially in developing countries [53]. Mycobacterium tuberculosis, the causative pathogen, is a known cause of mycotic aortic aneurysms [46, 50]. Pathogenesis of tuberculous mycotic aneurysm is believed to be due to lymphatic spread or hematogenous seeding, and mortality rates are reported as high as 60% in patients who develop this complication [50]. While more commonly affecting the distal aortic arch and descending aorta, there are case reports detailing aortic root aneurysms due to tuberculosis [50, 54].
\nThere have been case reports proposing an association between aortic aneurysms and HIV [50]. In a variety of these cases the causes are generally multifactorial, as the majority of cases have reported coinfections (Q fever and leishmaniasis) or comorbid autoimmune conditions (giant cell arteritis) [55, 56]. It is still an area of investigation as to whether there is a true association, and there is sparse data showing a relationship with AoD.
\nAnkylosing spondylitis, a seronegative spondyloarthropathy, is a chronic, progressive rheumatologic disorder, and was one of the first found to be associated with aortitis [50, 57]. The proposed mechanism of AoD in ankylosing spondylitis is fibrous growth development along the intima, which leads to subsequent weakening [57]. Prior TEE studies further evaluated the prevalence of AoD in ankylosing spondylitis, and 82% of patients with ankylosing spondylitis had aortic root abnormalities [58]. Specifically, 61% of patients had aortic root thickening and 25% of patients had AoD [58]. AoD in these populations is a relatively common phenomenon and is associated with significant cardiac morbidity [45, 57].
\nRelapsing polychondritis is another autoimmune disorder, which is a multisystem inflammatory disorder that primarily affects the cartilaginous structures of the body [59]. Cardiovascular involvement is common, estimated to be the second most frequent cause of death and can result in aneurysm development in 5% of cases of both thoracic and abdominal aorta [50, 59]. AoD has been known to occur, albeit rare, with cases of requiring surgical revision after the development of aortic regurgitation [60, 61].
\nTakayasu arteritis is a chronic granulomatous large vessel vasculitis, predominantly found in pediatric populations [50, 62]. A rare disorder, the pathogenesis is characterized by granulomatous panarteritis that can affect the entirety of the aorta and major branches, however predominantly affects the common carotid and subclavian artery [62]. While rare, there are reports of AoD from Takayasu arteritis resulting in aortic regurgitation [63, 64].
\nGiant cell arteritis is a large vessel vasculitis that is characterized by chronic granulomatous inflammation [50]. While commonly affecting carotid, temporal and vertebral arteries, it has been known to affect the ascending aorta, at times resulting in dissection or aortic valve insufficiency [50]. The development of AoD from GCA may be influenced by other comorbid conditions such as HIV; however, this association is currently only supported with case reports [55].
\nAdditionally left ventricular hypertrophy is reported to be positively correlated with AoD. Early retrospective reviews of echocardiographic studies have shown a positive relationship between LVH and AoD, and this has been further supported in subsequent systematic reviews [41, 65]. Patients with AoD with concomitant left ventricular hypertrophy are shown to have an increased risk of adjusted cardiovascular events [66]. However as with previous studies, the exact mechanism between LVH and AoD is still being determined.
\nAortic root dilation is typically a silent disease, with most cases being diagnosed incidentally on imaging. AoD can become symptomatic as the aneurysm enlarges. Aortic root aneurysms grow at an average of 1–4 mm/year [5], with a faster rate of growth noted in patients with bicuspid aortic valves, Marfan syndrome, ESRD, male gender, and smokers [5, 67]. When the aneurysm enlarges to the point of compressing surrounding structures the patient may begin to observe symptoms—the most common of which is chest pain, seen in up to 75% of patients [5, 68]. Other nonspecific symptoms can include back pain, abdominal pain and fatigue (though only present in 5% of patients).
\nAdditionally, patients may present with symptoms secondary to complications of a dilated aortic root such as aortic insufficiency and congestive heart failure. Thus, patients can develop dyspnea as the presenting symptom of aortic root dilation up to 40% of the time [68]. Other presenting symptoms may be related to the complications noted in Table 2 [69, 70, 71, 72, 73, 74].
\nComplication of aortic root aneurysm | \nPresenting symptom | \n
---|---|
Aortic insufficiency, aortic regurgitation | \nDyspnea, diastolic murmur, congestive heart failure symptoms | \n
Aortic dissection | \nSharp chest pain, may radiate to the back | \n
Thromboembolism | \nSymptoms of stroke | \n
Compression of tracheal or bronchus | \nHemoptysis, cough, recurrent pneumonitis | \n
Compression of left recurrent laryngeal nerve | \nHoarseness | \n
Compression of superior vena cava | \nSigns of superior vena cava syndrome | \n
Compression of esophagus | \nDysphagia | \n
Complications and presenting symptoms of aortic root dilation.
Acute aortic emergencies that occur secondary to aortic root dilation include dissection, rupture, and aortic insufficiency. As the aortic root diameter increases, the risk for aortic dissection and rupture rises [75]. Aortic dissections are the most common acute aortic emergencies [76], and can be classified depending on the segment of the aorta affected: type A dissections involve the ascending aorta (seen in aortic root dilation), while type B dissections are those that occur distal to the left subclavian artery.
\nAortic dissection most commonly presents with acute onset chest pain that may radiate to the back. The character of the pain has traditionally been described as ripping or tearing in nature, however over half of patients may instead complain of sharp pain [77]. In addition, geriatric populations are less likely to have an acute onset of pain [78]. Physical exam findings that may be present include unequal blood pressures in the upper extremities, a new diastolic murmur indicative of acute aortic regurgitation, or muffled heart sounds secondary to tamponade (with proximal extension of the dissection). Imaging may be notable for widening of the mediastinum on CXR [77]. In order to aid in the diagnosis of a dissection, an aortic dissection detection risk score (ADD-RS) has been developed. The score is comprised of three categories: the presence of high risk conditions such as Marfan syndrome, the presence of typical symptoms (such as abrupt onset chest pain), and the presence of physical exam findings such as unequal blood pressure readings in the upper extremities. Each group is given a score of 1 if a feature is present, and the total score helps pave the next steps of workup—a score of 0 can be followed by diagnostic workup of other pathologies, while scores of 2–3 should be followed by expedited workup and immediate surgical consultation for possible aortic dissection [79].
\nAortic rupture is also an acute and life-threatening complication of aortic root dilation. It can present similarly to aortic dissection with regards to chest pain, however rupture can lead to severe and abrupt hypotension. Moreover, contingent with the site of rupture the patient may have symptoms such as hemoptysis [80] (if there is rupture into the lung), hematemesis [81] (if there is rupture into the esophagus), or cardiogenic shock [82] (if there is rupture into the pericardial cavity with resultant tamponade physiology).
\nAortic root dilation may also lead to aortic insufficiency. Roughly 30% of aortic insufficiency is now recognized as being caused by aortic root dilation, surpassing the incidence of any valvular cause [83]. The pathophysiology is related to stretching of the aortic valve annulus secondary to aortic root dilation, which results in incomplete closure of the aortic leaflets during diastole. Unfortunately, at the onset of aortic regurgitation, patients may be asymptomatic; therefore, congestive heart failure can develop when the regurgitant valve goes unnoticed.
\nWhile aortic root aneurysms are known to grow at an average of 1–4 mm/year [5], it is difficult to ascertain how fast an individual’s aortic root aneurysm will grow, therefore necessitating surveillance imaging. The frequency of surveillance imaging recommended is dependent on the etiology of the aortic root dilatation as well as its size, with genetically mediated aortic disease having a lower threshold for more frequent (biannual) imaging [84]. At the very least however patients are recommended to have annual imaging for aortic root dilation to closely monitor the aortic diameter. The impact that frequent imaging (CT, MR angiography or echocardiography) has on public health is likely significant, with cumulative costs. In addition, any patient with a bicuspid aortic valve should be screened for a thoracic aortic aneurysm, as well as screening all first-degree family members of a patient with genetic conditions such as Marfan syndrome [85].
\nThe aortic root is the most proximal segment of the aorta. It extends from the annulus of the aortic valve to the sinotubular junction (STJ). It is composed of the left, right, and non coronary sinuses of Valsalva. The diameter of the aorta decreases as it moves distally. The aortic root is assessed using multimodality imaging techniques. These include transthoracic echocardiogram (TTE), cardiac magnetic resonance imaging (cMRI), and cardiac computed tomography angiography (cCTA).
\nTTE is widely used for the detection and monitoring of aortic root pathology. Early studies established age- and sex-specific nomograms for aortic root measurements [86]. These studies used the motion mode (M-mode) of TTE, in which the amplitude of the ultrasound pulses amplitudes is converted to corresponding level on gray-scale imaging [86]. Using the M-mode, the American Society of Echocardiography (ASE) has recommended using the leading-edge to leading-edge approach for measuring the aortic root [87]. Later studies used 2D TTE and obtained reference measurements of the aortic root. This is now preferred over M-mode images, which may be off-axis and are subject to aortic motion that may produce erroneous measurements.
\nOn echocardiogram, the aortic root diameter is typically measured in the parasternal long-axis view from the right coronary sinus to the opposite sinus of Valsalva. When unable to obtain the long axis view, the parasternal short axis view may provide more accurate measurements. However, universal landmarks to measure the root in this view have not been established. Some suggest measuring the diameter from the right coronary sinus to the opposite commissure. These measurements are typically performed at end diastole, as this represents the resting aortic diameter [88]. In adults, these measurements correlate with age and body size. In addition, the aorta is about 2 mm larger in men compared to women due to differences in body size [89]. Normal values stratified by body surface area and age have been published by the ASE [87].
\nImportantly, TTE is limited by its two-dimensional images and thus does not give a complete depiction of the aortic root. It is also limited by patient factors that limit the visualization windows and thus aortic root measurement. Since the aorta is not a straight tube, it can be imaged obliquely leading to over-estimation of its true diameter. Newer modalities, such cMRI and cCTA, can provide three-dimensional images.
\nDespite ECG-gated CT being the most accurate modality for evaluating the thoracic aorta, it is limited by the radiation and contrast exposure. This is particularly important in younger patients with connective tissue disorders that require serial follow up imaging. Cardiac MRI provides an alternative approach for imaging the thoracic aorta including the aortic root and is considered the preferred modality in select groups. It can be performed with ECG gating to provide motion-free evaluation of the aorta. In addition, young patients, in whom this is more commonly used, can hold their breath for longer periods, allowing acquisition of images with high spatial resolution.
\nCardiac MRI evaluation of the aorta does not require contrast use. MRI sequences used include balanced steady-state free precession (SSFP) sequences, fast imaging employing steady-state acquisition (FIESTA), true fast imaging with steady-state precession (FISP), and balanced fast-field echo (FFE) sequences. These sequences provide a high signal-to-noise ratio and adequate contrast between vessel wall and blood pool [90]. When used with ECG gating and contrast enhanced MRA, images tend to have less artifact, higher resolution, and overall short imaging time. Another approach is to use ECG gating 2D balanced SSFP sequence that is oriented perpendicular to the aortic root in two planes to assess the aortic valve and root throughout the cardiac cycle. In addition, prospective ECG gating and respiratory navigation with three-dimensional balanced SSFP sequences can provide 3D aortic imaging without contrast administration [91, 92].
\nIt is important to note that different methods of aortic measurement have been described and guidelines are less well defined. Aortic root measurements can be challenging given different approaches. Burman et al. found in the Framingham Heart Study that cusp-commissure dimensions better corresponded with reference echocardiographic aortic root measurements [89, 93]. This best correlated with study measurements after averaging the three end-diastolic cusp-commissure measurements [93]. In addition, there is a lack of consensus with regard to measurements used (inner lumen only versus lumen and wall) and whether measurements should be adjusted to body surface area, sex, and age.
\nAlthough TTE is widely used for the imaging and surveillance of aortic root, cardiac computed tomography angiography (cCTA) is currently the most commonly used technique for the study of the thoracic aorta. Main advantages of cCTA are fast scanning times, low artifact sensibility, and wide availability including emergency rooms operating 24 h [94].
\nThe new generation CT scanners acquire high-resolution 3D datasets of the thoracic aorta, showing sensitivities up to 100% and specificities of 98–99% [95]. ECG synchronization is vital for detailed assessment of the aortic root anatomy since it allows suppression of pulsation artifacts [96]. ECG gating also allows viewing images in a particular phase of the cardiac cycle. Unfortunately, the ECG-gated technique can increase the acquisition time and required breath-hold time. In order to minimize the increased acquisition times, employment of a 64 or wider ECG-gated row detector system is suggested [95, 97].
\nModern CT scanners can be used to employ several different cardiac synchronization methods such as prospective ECG triggering where images are only acquired during a specified portion of the cardiac cycle, starting at a predetermined delay from the R wave; retrospective ECG gating where the desired cardiac phase is selected retrospectively from the raw data [95, 97]. The details of each technique will not be discussed in this chapter; however, it is important to determine the advantages and disadvantages of different techniques. The main limitations of CT are related to the radiation exposure and the use of iodinated contrast media and different techniques come at a higher cost of each limitation.
\nFor the surveillance of aortic root, any technique can be used and be useful; therefore, the technique with the least amount of radiation exposure should be selected such as prospective sequential triggering without padding, retrospective gating with tube-current modulation optimized for diastolic-phase datasets only, or a prospectively triggered high-pitch helical acquisition [95, 97]. Retrospective ECG gating acquires redundant helical CT data which allows the reconstruction of images at different cardiac phases and providing detailed images which can be useful in complicated cases and pre-/post-operative imaging since pseudoaneurysm or small leaks which are some of the most common complications of aortic root surgery can only be detected during a specific phase of the cardiac cycle. Iodinated contrast-media is another risk related to CT imaging given the risk of contrast induced nephropathy and allergic reactions of various severity. Surveillance CT data for the dimensions of aortic root can be acquired without contrast injection; however, a complete endoluminal evaluation can only be achieved by the injection of contrast-medium [97].
\nIt is standard of care to monitor the size of aortic aneurysms that are below surgical threshold, <5.5 cm for nongenetic aneurysms and <5.0 cm for genetically-mediated aneurysms [98]. In general, physicians should be conscientious about patient cumulative radiation exposure as there is evidence that it can increase cancer incidence and cancer mortality [99]. One study estimated that ionizing radiation exposure results in 0.7% of total expected baseline cancer incidence and 1% of total cancer mortality. These rates increase with greater cumulative exposure [99]. Therefore, physicians should opt to perform serial CT imaging with longer intervals in the most appropriate patients. A study investigating patients with moderate-risk thoracic aortic aneurysms (defined as size <5.0 cm) showed that patients with aneurysms below 4.3 cm had overall lower risk of significant aneurysm growth or size reaching surgical threshold. Thus, the authors suggested that these subset of patients undergo surveillance CT scans less frequently.
\nManagement focuses on slowing the rate of growth and the complications of aortic root dilation. The line of management that is chosen for a patient depends on symptoms and size of the aneurysm. For patients who are asymptomatic and have root dilation <55 mm, medical management is advised. In patients with Marfan syndrome or a bicuspid aortic valve, the cut off of ≤50 mm is used for medical management [1, 100].
\nThe use of beta blockers has shown a survival benefit in patients with aortic root dilation secondary to Marfan syndrome [101]. While data on survival benefits for patients with bicuspid aortic valves is sparse, the common practice is to also prescribe beta blockers given that both conditions share a similar pathology and therefore both are likely to benefit from beta blockade. The mechanism by which beta blockers slow the progression of aortic root dilation is through their negative inotropic and chronotropic effects, reducing the peak left ventricular ejection rate and therefore decreasing shear stress and the rate of aortic dilation [102].
\nThe goal blood pressure for patients with thoracic aortic aneurysms is <130/80 mmHg. In patients who cannot tolerate beta blockers, calcium channel blockers (CCB) are an alternative group of medications available. While less studied as compared to beta blockers, CCB have also been found to reduce the rate of aortic root dilation [103]. Other agents that can be used for additional blood pressure control include ACE-inhibitors and ARBs.
\nIn order to reduce the risk for complications such as aortic dissection, patients should be counseled on smoking cessation, and cessation of drugs that increase aortic wall stress such as cocaine or other stimulants. In addition patients should have dyslipidemia well controlled, which can be achieved through the use of atorvastatin 40–80 mg daily in individuals with aortic root aneurysms [104, 105].
\nPatients should be counseled on avoiding high intensity and collision sports, such as boxing and cycling. Instead patients should take part in low dynamic sports, such as, golf [5, 106]. Pregnancy should be avoided in patients with Marfan syndrome with an aortic diameter >40 mm, if a patient does chose to become pregnant however there must be close follow up with surveillance imaging of the aortic diameter [5, 101].
\nEmergent surgical interventions are indicated for management of an aortic dissection or rupture, or a symptomatic aneurysm. In addition, surgical repair can be performed electively in high risk patients to prevent propagation of an aneurysm (Table 3). Indications for elective surgical intervention include the absolute size of the aneurysm—if the diameter is over 55 mm, or over 50 mm in patients with Marfan syndrome or bicuspid valves. Other indications for elective surgery include if the rate of growth of an aneurysm surpasses 10 mm/year, and if there is concurrent aortic insufficiency [1, 100]. In addition, patients who undergo aortic insufficiency repair who have concurrent aortic root dilation should be considered for aortic replacement at the time of their surgery—that is since 25% of patients with aortic root diameters >40 mm will eventually also require intervention for their aortic aneurysm [107].
\nEmergent surgical repair | \nElective surgical repair | \n
---|---|
\n
| \n\n
| \n
Indications for emergent and elective surgical repair of aortic root dilation.
As opposed to supravalvular aortic aneurysms, aortic root aneurysms involve the coronary ostia as well as the aortic valve, which have implications on the type of surgical procedure available for patients. There are two approaches for a surgical intervention: radical and conservative. In a radial surgical intervention the patient’s aortic valve and root are replaced (commonly referred to as the Bentall procedure), whereas in conservative interventions only the aortic root is replaced [108].
\nThe Bentall procedure involves replacing the aortic valve with a prosthetic valve, and thus has the caveat of requiring indefinite anticoagulation [5]. If patients have a high bleeding risk it may therefore be worthwhile investigating replacement of the aortic root while preserving the valve. In addition, it is important to note that a large number of patients with aortic root dilation are young (secondary to its association with Marfan syndrome), and therefore lifelong anticoagulation in cases such as these confers a cumulative bleeding risk. Preserving the aortic valve while surgically treating the aortic root dilatation is made possible by the development of two surgical procedures: the first is removing the aortic root while keeping the valve intact. The second method is through re-implantation of the aortic valve [5]. Both the Bentall procedure as well as aortic valve-preserving procedures have been shown to have comparable short and long-term outcomes with regards to the risk of death and valve associated complications. The main difference however is that patients undergoing valve sparing operations were significantly more likely to develop moderate to severe aortic regurgitation later [108].
\nIn patients with both severe aortic stenosis and ascending aortic aneurysm, undergoing surgical aortic valve replacement (sAVR) and concomitant surgical intervention for aortic aneurysms above 4.5 cm is recommended by the American College of Cardiology (ACC) foundation guidelines [84]. However, in high-risk surgical patients, undergoing a transcatheter aortic valve replacement (TAVR) has become an alternative approach that obviates the need for parallel surgical aortic aneurysm intervention. This raises the concern for the safety of TAVR catheter-based delivery system in patients with aortic aneurysms since intraoperative rupture or dissection risk potentially increases. However, a clinical study showed that TAVR does not increase intraoperative aortic dissection/rupture risk or mortality with a median follow-up of 14 months [109]. Therefore, there are no recommendations against performing TAVR in patients with ascending aortic aneurysms.
\nNone.
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\\n\\n2.4 The Corresponding Author (on their own behalf and on behalf of each Co-Author) will not assert any rights under the Copyright, Designs and Patents Act 1988 to object to derogatory treatment of the Chapter as a consequence of IntechOpen's changes to the Chapter arising from translation of it, corrections and edits for house style, removal of problematic material and other reasonable edits.
\\n\\n3. CORRESPONDING AUTHOR'S DUTIES
\\n\\n3.1 When distributing or re-publishing the Chapter, the Corresponding Author agrees to credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen. The Corresponding Author warrants that each Co-Author will also credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen, when they are distributing or re-publishing the Chapter.
\\n\\n3.2 When submitting the Chapter, the Corresponding Author agrees to:
\\n\\nThe Corresponding Author will be held responsible for the payment of the Open Access Publishing Fees.
\\n\\nAll payments shall be due 30 days from the date of the issued invoice. The Corresponding Author or the payer on the Corresponding Author's and Co-Authors' behalf will bear all banking and similar charges incurred.
\\n\\n3.3 The Corresponding Author shall obtain in writing all consents necessary for the reproduction of any material in which a third-party right exists, including quotations, photographs and illustrations, in all editions of the Chapter worldwide for the full term of the above licenses, and shall provide to IntechOpen upon request the original copies of such consents for inspection (at IntechOpen's option) or photocopies of such consents.
\\n\\nThe Corresponding Author shall obtain written informed consent for publication from people who might recognize themselves or be identified by others (e.g. from case reports or photographs).
\\n\\n3.4 The Corresponding Author and any Co-Author shall respect confidentiality rights during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Corresponding Author and any Co-Author are confidential and are intended only for the recipient. The contents may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
\\n\\n4. CORRESPONDING AUTHOR'S WARRANTY
\\n\\n4.1 The Corresponding Author represents and warrants that the Chapter does not and will not breach any applicable law or the rights of any third party and, specifically, that the Chapter contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy. The Corresponding Author warrants and represents that: (i) the Chapter is the original work of themselves and any Co-Author and is not copied wholly or substantially from any other work or material or any other source; (ii) the Chapter has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) they themselves and any Co-Author are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) they themselves and any Co-Author have not assigned and will not during the term of this Publication Agreement purport to assign any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\\n\\nThe Corresponding Author also warrants and represents that: (i) they have the full power to enter into this Publication Agreement on their own behalf and on behalf of each Co-Author; and (ii) they have the necessary rights and/or title in and to the Chapter to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licenses expressed to be granted in this Publication Agreement. If the Chapter was prepared jointly by the Corresponding Author and any Co-Author, the Corresponding Author warrants and represents that: (i) each Co-Author agrees to the submission, license and publication of the Chapter on the terms of this Publication Agreement; and (ii) they have the authority to enter into this Publication Agreement on behalf of and bind each Co-Author. The Corresponding Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each such Co-Author.
\\n\\nThe Corresponding Author agrees to indemnify and hold IntechOpen harmless against all liabilities, costs, expenses, damages and losses and all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of or in connection with any breach of the aforementioned representations and warranties. This indemnity shall not cover IntechOpen to the extent that a claim under it results from IntechOpen's negligence or willful misconduct.
\\n\\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\\n\\n5. TERMINATION
\\n\\n5.1 IntechOpen has a right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Corresponding Author or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Corresponding Author or any Co-Author (being an individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Corresponding Author or any Co-Author (being a company) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for or enters into any compromise or arrangement with any of its creditors.
\\n\\nIn case of termination, IntechOpen will notify the Corresponding Author, in writing, of the decision.
\\n\\n6. INTECHOPEN’S DUTIES AND RIGHTS
\\n\\n6.1 Unless prevented from doing so by events outside its reasonable control, IntechOpen, in its discretion, agrees to publish the Chapter attributing it to the Corresponding Author and any Co-Author.
\\n\\n6.2 IntechOpen has the right to use the Corresponding Author’s and any Co-Author’s names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Chapter and has the right to contact the Corresponding Author and any Co-Author until the Chapter is publicly available on any platform owned and/or operated by IntechOpen.
\\n\\n6.3 IntechOpen is granted the authority to enforce the rights from this Publication Agreement, on behalf of the Corresponding Author and any Co-Author, against third parties (for example in cases of plagiarism or copyright infringements). In respect of any such infringement or suspected infringement of the copyright in the Chapter, IntechOpen shall have absolute discretion in addressing any such infringement which is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\\n\\n7. MISCELLANEOUS
\\n\\n7.1 Further Assurance: The Corresponding Author shall and will ensure that any relevant third party (including any Co-Author) shall, execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\\n\\n7.2 Third Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\\n\\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\\n\\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\\n\\n7.5 Variation: No variation of this Publication Agreement shall be effective unless it is in writing and signed by the parties (or their duly authorized representatives).
\\n\\n7.6 Severance: If any provision or part-provision of this Publication Agreement is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted.
\\n\\nAny modification to or deletion of a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\\n\\n7.7 No partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Corresponding Author or any Co-Author, nor authorize any party to make or enter into any commitments for or on behalf of any other party.
\\n\\n7.8 Governing law: This Publication Agreement and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with it or its subject matter or formation shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of or in connection with this Publication Agreement (including any non-contractual disputes or claims).
\\n\\nLast updated: 2020-11-27
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The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
\n\n1. DEFINITIONS
\n\nCorresponding Author: The Author of the Chapter who serves as a Signatory to this Agreement. The Corresponding Author acts on behalf of any other Co-Author.
\n\nCo-Author: All other Authors of the Chapter besides the Corresponding Author.
\n\nIntechOpen: IntechOpen Ltd., the Publisher of the Book.
\n\nBook: The publication as a collection of chapters compiled by IntechOpen including the Chapter. Chapter: The original literary work created by Corresponding Author and any Co-Author that is the subject of this Agreement.
\n\n2. CORRESPONDING AUTHOR'S GRANT OF RIGHTS
\n\n2.1 Subject to the following Article, the Corresponding Author grants and shall ensure that each Co-Author grants, to IntechOpen, during the full term of copyright and any extensions or renewals of that term the following:
\n\nThe aforementioned licenses shall survive the expiry or termination of this Agreement for any reason.
\n\n2.2 The Corresponding Author (on their own behalf and on behalf of any Co-Author) reserves the following rights to the Chapter but agrees not to exercise them in such a way as to adversely affect IntechOpen's ability to utilize the full benefit of this Publication Agreement: (i) reprographic rights worldwide, other than those which subsist in the typographical arrangement of the Chapter as published by IntechOpen; and (ii) public lending rights arising under the Public Lending Right Act 1979, as amended from time to time, and any similar rights arising in any part of the world.
\n\nThe Corresponding Author confirms that they (and any Co-Author) are and will remain a member of any applicable licensing and collecting society and any successor to that body responsible for administering royalties for the reprographic reproduction of copyright works.
\n\nSubject to the license granted above, copyright in the Chapter and all versions of it created during IntechOpen's editing process (including the published version) is retained by the Corresponding Author and any Co-Author.
\n\nSubject to the license granted above, the Corresponding Author and any Co-Author retains patent, trademark and other intellectual property rights to the Chapter.
\n\n2.3 All rights granted to IntechOpen in this Article are assignable, sublicensable or otherwise transferrable to third parties without the Corresponding Author's or any Co-Author’s specific approval.
\n\n2.4 The Corresponding Author (on their own behalf and on behalf of each Co-Author) will not assert any rights under the Copyright, Designs and Patents Act 1988 to object to derogatory treatment of the Chapter as a consequence of IntechOpen's changes to the Chapter arising from translation of it, corrections and edits for house style, removal of problematic material and other reasonable edits.
\n\n3. CORRESPONDING AUTHOR'S DUTIES
\n\n3.1 When distributing or re-publishing the Chapter, the Corresponding Author agrees to credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen. The Corresponding Author warrants that each Co-Author will also credit the Book in which the Chapter has been published as the source of first publication, as well as IntechOpen, when they are distributing or re-publishing the Chapter.
\n\n3.2 When submitting the Chapter, the Corresponding Author agrees to:
\n\nThe Corresponding Author will be held responsible for the payment of the Open Access Publishing Fees.
\n\nAll payments shall be due 30 days from the date of the issued invoice. The Corresponding Author or the payer on the Corresponding Author's and Co-Authors' behalf will bear all banking and similar charges incurred.
\n\n3.3 The Corresponding Author shall obtain in writing all consents necessary for the reproduction of any material in which a third-party right exists, including quotations, photographs and illustrations, in all editions of the Chapter worldwide for the full term of the above licenses, and shall provide to IntechOpen upon request the original copies of such consents for inspection (at IntechOpen's option) or photocopies of such consents.
\n\nThe Corresponding Author shall obtain written informed consent for publication from people who might recognize themselves or be identified by others (e.g. from case reports or photographs).
\n\n3.4 The Corresponding Author and any Co-Author shall respect confidentiality rights during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Corresponding Author and any Co-Author are confidential and are intended only for the recipient. The contents may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
\n\n4. CORRESPONDING AUTHOR'S WARRANTY
\n\n4.1 The Corresponding Author represents and warrants that the Chapter does not and will not breach any applicable law or the rights of any third party and, specifically, that the Chapter contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy. The Corresponding Author warrants and represents that: (i) the Chapter is the original work of themselves and any Co-Author and is not copied wholly or substantially from any other work or material or any other source; (ii) the Chapter has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) they themselves and any Co-Author are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) they themselves and any Co-Author have not assigned and will not during the term of this Publication Agreement purport to assign any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\n\nThe Corresponding Author also warrants and represents that: (i) they have the full power to enter into this Publication Agreement on their own behalf and on behalf of each Co-Author; and (ii) they have the necessary rights and/or title in and to the Chapter to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licenses expressed to be granted in this Publication Agreement. If the Chapter was prepared jointly by the Corresponding Author and any Co-Author, the Corresponding Author warrants and represents that: (i) each Co-Author agrees to the submission, license and publication of the Chapter on the terms of this Publication Agreement; and (ii) they have the authority to enter into this Publication Agreement on behalf of and bind each Co-Author. The Corresponding Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each such Co-Author.
\n\nThe Corresponding Author agrees to indemnify and hold IntechOpen harmless against all liabilities, costs, expenses, damages and losses and all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of or in connection with any breach of the aforementioned representations and warranties. This indemnity shall not cover IntechOpen to the extent that a claim under it results from IntechOpen's negligence or willful misconduct.
\n\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\n\n5. TERMINATION
\n\n5.1 IntechOpen has a right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Corresponding Author or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Corresponding Author or any Co-Author (being an individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Corresponding Author or any Co-Author (being a company) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for or enters into any compromise or arrangement with any of its creditors.
\n\nIn case of termination, IntechOpen will notify the Corresponding Author, in writing, of the decision.
\n\n6. INTECHOPEN’S DUTIES AND RIGHTS
\n\n6.1 Unless prevented from doing so by events outside its reasonable control, IntechOpen, in its discretion, agrees to publish the Chapter attributing it to the Corresponding Author and any Co-Author.
\n\n6.2 IntechOpen has the right to use the Corresponding Author’s and any Co-Author’s names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Chapter and has the right to contact the Corresponding Author and any Co-Author until the Chapter is publicly available on any platform owned and/or operated by IntechOpen.
\n\n6.3 IntechOpen is granted the authority to enforce the rights from this Publication Agreement, on behalf of the Corresponding Author and any Co-Author, against third parties (for example in cases of plagiarism or copyright infringements). In respect of any such infringement or suspected infringement of the copyright in the Chapter, IntechOpen shall have absolute discretion in addressing any such infringement which is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\n\n7. MISCELLANEOUS
\n\n7.1 Further Assurance: The Corresponding Author shall and will ensure that any relevant third party (including any Co-Author) shall, execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\n\n7.2 Third Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\n\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\n\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\n\n7.5 Variation: No variation of this Publication Agreement shall be effective unless it is in writing and signed by the parties (or their duly authorized representatives).
\n\n7.6 Severance: If any provision or part-provision of this Publication Agreement is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted.
\n\nAny modification to or deletion of a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\n\n7.7 No partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Corresponding Author or any Co-Author, nor authorize any party to make or enter into any commitments for or on behalf of any other party.
\n\n7.8 Governing law: This Publication Agreement and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with it or its subject matter or formation shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of or in connection with this Publication Agreement (including any non-contractual disputes or claims).
\n\nLast updated: 2020-11-27
\n\n\n\n
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I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). 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