Amyloidosis presentations in different ocular tissue
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"2223",leadTitle:null,fullTitle:"Data Mining Applications in Engineering and Medicine",title:"Data Mining Applications in Engineering and Medicine",subtitle:null,reviewType:"peer-reviewed",abstract:"Data Mining Applications in Engineering and Medicine targets to help data miners who wish to apply different data mining techniques. 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These set of disorders with similar pathophysiology, and involvement of metabolic pathways result in protein deposition in different tissue.[1-3]
Amyloid deposits in various groups of amyloidosis have these common findings:
Homogeneous granular, filamentous eosinophilia in hematoxylin and eosin staining.
Metachromasia in crystal violet staining.
Ultraviolet fluorescence in Thioflavin-T staining
Orange-red staining with Congo red, which exhibits two additional properties – Birefringence (ability to rotate polarized light by 90°) and Dichroism (red to green color change under polarized light).
These amyloid proteins can be classified into:
Immunoglobulin light chains (AL) in primary systemic amyloidosis.
Amyloid A protein (AA) in secondary amyloidosis.
Transthyretine in familial amyloidosis.
A protein known as Amyloid P component (AP ). These conditions may be primary or secondary, localized or systemic, and familial or nonfamilial. Primary systemic amyloidosis includes so many clinical disorders like heart failure, gastrointestinal tract involvement, neuropathies, and other disorders. Secondary systemic amyloidosis results from chronic inflammatory diseases such as tuberculosis or syphilis. [4-8]
Various ocular structures may be involved in any subgroup of systemic amyloidosis, as well as in localized amyloidosis limited to the eye. We will discuss in detail in this chapter about ocular manifestations of amyloidosis. Table-1 summarizes ocular involvements of different subgroups of amyloidosis.
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\tWaxy eyelid papules with purpura, | \n\t\t\tPrimary Systemic | \n\t\t\t\n\t\t |
Proptosis, diplopia, Ptosis, accommodative paresis | \n\t\t\tPrimary localized, primary systemic | \n\t\t||
Keratoconjunctivitis sicca, upper lid mass | \n\t\t\tPrimary localized, primary systemic, secondary systemic | \n\t\t||
\n\t\t\t\t | \n\t\t\tTumefactive or diffuse yellow infiltrative masses | \n\t\t\tPrimary localized, secondary localized, primary systemic | \n\t\t\t\n\t\t |
\n\t\t\t\t | \n\t\t\tPolymorphic Amyloid Degeneration | \n\t\t\tPrimary localized | \n\t\t\tSecondary to climatic Effects | \n\t\t
Primary Gelatinous Drop-Like Dystrophy | \n\t\t\tPrimary localized | \n\t\t\tAutosomal-Dominant Inheritance | \n\t\t|
Lattice Stromal Dystrophy (Type I, III) | \n\t\t\tPrimary localized | \n\t\t\tAutosomal-Dominant Inheritance | \n\t\t|
Lattice Stromal Dystrophy (Type II = Meretoja Syndrome ) | \n\t\t\tPrimary systemic | \n\t\t\tAutosomal-Dominant Inheritance with Systemic Symptoms | \n\t\t|
\n\t\t\t\t | \n\t\t\tParticulate glaucoma | \n\t\t\tHeredofamilial (neuropathic) | \n\t\t\t\n\t\t |
Scalloped pupils, amyloid particles pupillary margin | \n\t\t\tHeredofamilial (neuropathic), primary systemic | \n\t\t||
\n\t\t\t\t | \n\t\t\tFundus abnormalities, decreased vision | \n\t\t\tHeredofamilial, I and II (neuropathic) | \n\t\t\t\n\t\t |
Amyloidosis presentations in different ocular tissue
Ophthalmic presentations of Amyloidosis are not a common entity. Amyloidosis can affect any ocular and periocular structures with multifarious clinical presentations so reaching to correct diagnosis is often an arduous task. Periocular and orbital amyloidosis is generally a slowly progressive disease, but it potentially can lead to devastating ocular complications.
The most common signs and symptoms include: visible or palpable periocular mass or tissue infiltration and ptosis. Other less common signs are; pain or periocular discomfort, recurrent periocular subcutaneous haemorrhages, keratoconjunctivitis sicca, ocular motility disturbances, pupillary abnormalities, proptosis and globe displacement. Proptosis may result from a localized orbital mass or from diffuse amyloid infiltration. Mild pain or painless status in clinical presentations of ocular amyloidosis can differentiate this disease from idiopathic inflammatory pseudotumor.[9-11]
In this section different involvements of periorbital tissues by amyloidosis will be discussed in detail.
Dermal and ocular amyloidosis can affect eyelid skin either as a part of primary systemic amyloidosis or secondary to dermal conditions like basal cell carcinoma, Bowen’s disease and seborrhoeic keratosis.
Nodular or diffuse deposits of amyloid in eyelids are either unilateral or bilateral. Eyelids can be either isolated site of involvement or get involved beside the other sites (e.g. scalp, head and neck or axillae).
Eyelid skin is the preferred site of amyloid deposits both in primary and secondary (reactive) amyloidosis; so unlike other periocular amyloidoses, eyelid skin involvement indicates systemic workup for presence of systemic disease and even some ophthalmologists believe that cutaneous involvement of the eyelid is a sign of primary systemic amyloidosis unless otherwise proved; on the other hand periocular involvements that spares eyelid skin is probably localized.
Amyloid protein deposits in the eyelid skin vessel walls and secondarily increase their fragility, making them very susceptible to hemorrhage after minor trauma (or even spontaneously), so waxy eyelid papules with hemorrhagic appearance can be diagnostic clue of systemic amyloidosis.
Dermatologic conditions like basal cell carcinoma, Bowen’s disease, and seborrheic keratosis can lead to secondary localized forms of amyloid deposits in the eyelids although this condition is a histopathologically incidental finding.
Waxy eyelid papules (A ) with hemorrhagic appearance (B ) in systemic amyloidosis Sophie R Silverstein MB BChir MA; Primary, systemic amyloidosis and the dermatologist: Where classic skin lesions may provide the clue for early diagnosis; Dermatology Online Journal 11 (1): 5
Primary localized cutaneous amyloidosis of eyelid is not a common condition and can be overlooked easily. In this condition we can see Amyloid light chains (AL) deposits in the tissue. As this condition is usually associated with B-cell or Plasma cell proliferation so plasma cell dyscrasia must be excluded.[9,11,12-16]
Orbital involvement is more common in primary compared to secondary amyloidosis and is rare in hereditary/familial or senile amyloidosis. Localized amyloidosis is a rare condition usually affecting head and neck region and only 4% of them involve orbital region. Although some sight threatening complications like secondary glaucoma and optic neuropathy have been reported, orbital localized amyloidosis is usually considered a benign condition with a slowly progressive nature.
Two types of localized orbital amyloidosis have been described. One type presents with progressive proptosis and limitation of ocular movements and is associated with bilateral nodular infiltration of extraorbital muscles and nearby adnexal tissues. Second form is rare cases of Amyloidoma that occurs usually in anterior orbital region next to lacrimal glands. These Amyloidomas have yellow waxy appearances with fragile consistency that shows calcification in orbital CT-scan. [10, 17-22]
Ptosis and Ophthalmoplegia are two common clinical presentations of periocular involvement that can occur coincidentally or respectively (ophthalmoplegia may follow the ptosis by weeks or months). These two manifestations are due to infiltration and secondary necrosis of extraocular muscles, including levator and Muller’s Muscles.
Although Extra-Ocular muscle involvements can present with proptosis, ocular motility restrictions or diplopia, in some cases no prominent signs suggestive of this involvement can be found and Orbital imaging is necessary to make the accurate diagnosis.[9-11,23]
Lacrimal gland involvement is not common in amyloidosis and most commonly presents with hard and mobile Superior-temporal orbital mass, rarely fixated to periocular bones. Other manifestations include proptosis, ocular motility disorders, keratoconjunctivitis Sicca and mild pain.
Amyloid deposits in systemic Amyloidosis involve lacrimal glands bilaterally, whereas primary localized amyloidosis usually affects them unilaterally. Lacrimal Gland involvement can mimic disorders like vascular malformations, dacryoadenitis, or lacrimal gland neoplasms.
Computed tomography and MRI although not diagnostic but are important in localizing the involved orbital structures. Lacrimal gland involvement on orbital CT scan usually presents as a homogenous mass, with a slightly higher density than brain with involvement of nearby extra-ocular muscles, although sometimes lobulated gland with areas of calcification and orbital wall erosion can be seen.
Patient-1. (a) Right-sided ptosis. (b) Orbital mass prolapsing through the right upper fornix. (c) and (d) Intraoperative photographs at the time of biopsy. (e) First CT orbits showing the right-sided orbital mass. (f) Repeat CT 9 years later showing the mass to be unchanged. Patient-2. (g). Translucent, yellow, and nodular orbital mass prolapsing through the left upper fornix. (h) MRI of orbits showing the mass in the left orbit. S Dinakaran, A D Singh and I G Rennie: Orbital amyloidosis presenting as ptosis; Eye (2005) 19, 110–112. doi:10.1038/sj.eye.6701411
Although both CT and MRI can be useful in detecting the involvement of periocular tissue in amyloidosis, CT scan is generally more informative than MRI because of the higher sensitivity in detecting specific bone changes and calcifications.
The mass effect can cause globe displacement. Extraocular muscle enlargement, soft tissue infiltration/mass, and calcifications are also characteristic findings on imaging and are seen almost always in orbital involvement.
Other signs of extra-ocular muscle involvement include highly irregular nodular enlargement of muscles with extension to nearby fat tissue with a reticular pattern, fusiform enlargement of muscles with islands of calcification. Extraocular muscle tendons usually are spared. and muscle involvement may be either unilateral or bilateral. [ 9,11,22-26]
Although orbital amyloidosis rarely involves optic nerve primarily, orbital or muscular amyloid masses especially those located at the orbital apex can involve optic nerve secondarily and can lead to vision loss. Moreover compressive optic neuropathy secondary to dural infiltration is another cause of optic nerve involvement. As a rule, the neuropathic amyloidosis spares the optic nerve.[9-11]
A primary localized form of Amyloidosis is Amyloid plaque deposition in substantia properia of the conjunctiva that usually occurs in healthy young and middle-aged persons with no sex predilection.
The conjunctiva can either be the only site of involvement or involve as well as other structures like the orbicularis occuli or levator muscles. Nodular or diffuse amyloid deposits in these structures can clinically present with Salmon patch nodules and blephariptosis. Conjunctival amyloidosis usually involves the fornixes (superior fornix more than inferior) and tarsal conjunctiva. Amyloid deposits may be unilateral or bilateral and have firm or rubbery and waxy appearance.
Conjunctival deposits are usually painless, but may cause epiphora or significant local swelling and irritation. Recurrent subconjunctival haemorrhages is another presenting symptom of conjunctival amyloidosis that can be missed easily and is usually due to increased fragility of orbital vasculature secondary to amyloid deposits.
Although initial systemic evaluation for primary systemic amyloidosis in patients with conjunctival deposits is usually negative, progression of a local primary-amyloidosis to a systemic disease has been reported and should be kept in mind when following a presumed localized amyloid patient. Although disorders like trachoma, recurrent bacterial conjunctivitis, or immune conjunctival involvements like GVHD can lead to secondary conjunctival Amyloidosis, this is not a common phenomenon.
A. Tumefactive conjunctival amyloidosis.B. Nodular amyloid infiltration of the conjunctiva with spontaneous hemorrhage. Albert & Jakobiec\'s Principles & Practice of Ophthalmology- 3rd Ed,2008,Vol 3,chapter 331,Page 4524,4525
In review of literatures some reports can be seen about conjunctival amyloid deposits after recent strabismus surgery and conjunctival involvement secondary to reactive systemic amyloidosis in rheumatoid arthritis.[9-11, 27-33]
For diagnosis of periorbital and orbital amyloidosis usually tissue biopsy is required and Congo red staining shows characteristic red-green dichroism in unidirectional polarized light.
The first step in management of periocular amyloidosis is determining the type of disease and coincidental systemic involvement. Some treatment modalities like Surgical debulking, radiotherapy and observation have been descried for localized amyloidosis but surgical debulking remained mainstay of treatments in patients with symptomatic diseases including ocular motility disturbances, compressive optic neuropathy, and unacceptable cosmetic appearance.
In patients with medical contraindications for surgery or with extensive infiltrative disease, radiotherapy either with or without surgical debulking may be useful.
Observation is a choice of treatment in asymptomatic or mildly symptomatic patients with localized amyloidosis.
Because complete surgical excision of periocular masses is not possible in most patients, and some case reports showed significant progression after surgical debulking, often symptom revealing treatments for restoration of visual functions and prevention of ocular complications is the goal of treatment.
For Extensive conjunctival infiltration close follow-up is the best option because surgical removal and other modalities are not effective for these lesions.[9-11]
Anterior chamber involvement is usually accompanied by vitroretinal involvement in hereditary systemic amyloidosis. Clinical manifestations in this form of involvement include white flocculent debris in aqueous, anterior lens capsule and on the iris surface and scalloped pupil borders that indicate amyloid deposition in iris stroma or disruption of parasympathetic innervation of the iris sphincter.
Hallmark of ocular amyloidosis presenting in anterior chamber is amyloid glaucoma that is very similar to pseudoexfoliation syndrome and only microscopic studies can differentiate these entities. A close relationship between the onset of glaucoma and pupillary abnormalities has been described in this condition. This is a unilateral asymmetric condition with multiple mechanisms involved in its pathophysiology. Increased episcleral venous pressure secondary to perivascular amyloid deposition and increased resistance to aqueous outflow are two probable mechanisms of increased intra-ocular pressure (IOP) in this situation. Familial amyloid polyneuropathy (FAP) is often complicated with glaucoma and vitreous opacity.
As previously mentioned amyloid deposition on the pupil border is a strong predictor of glaucoma. It is proposed that fringed pupil may be secondary to high amount of amyloid deposit on the pupil border and these deposits may involve trabecular meshwork, reduce aqueous outflow and secondarily increase intra-ocular pressure (IOP).
Medical management with aqueous suppressants is treatment of choice to decrease IOP but vitrectomy may have some benefits in aphakic eyes. [34-40]
As in amyloid glaucoma, iris stromal deposits originated from blood vessels in amyloidosis is associated with vitreoretinal diseases and usually occur in familial amyloid polyneuropathy (FAP ).
Scalloped border pupils have been found to be the classic sign of iris involvement in amyloidosis, although not a pathognomonic sign.
Secondary localized Amyloidosis has been reported after conditions like recurrent or chronic uveitis and rare disease like ocular leprosy.
Scalloped pupil seen in heredofamilial neuropathic amyloidoses. From Lessell S, Wolf PA, Benson MD, Cohen AS: Scalloped pupils in familial amyloidosis. Reprinted from the New England Journal of Medicine, 1975; 293:914–915.
Histopathological review of eyes from patients with rheumatoid arthritis has showed amyloid deposition in iris and posterior uvea. More than the iris, the choroid may also be infiltrated with amyloid in patients with primary systemic amyloidosis.
There are some reports of pupillary abnormality such as pupillary deformity, decrease in pupillary reaction to light, and amyloid deposition in the pupillary border. [34-35,41,42]
Vitreous Amyloidosis as a rare condition usually presents in Familial Amyloid Polyneuropathy (FAP) but isolated vitreous deposits in the absence of a family history (primary nonfamilial amyloidosis of the vitreous) are extremely rare. FAP usually results from mutations in transthyretin (TTR) gene and is the most common form of hereditary amyloidosis. Although TTR (also known as prealbumin) is usually produced in the liver, retinal pigment epithelium and choroid plexus of brain can synthesize this protein too. TTR transfers thyroxine and retinol binding proteins in plasma.
Vitreous opacities, manifested as bilateral (but highly asymmetric) cobweb-like or sheet-like veils or string of pearls white opacities are the most common presentations of this condition, and density of this opacities determines severity of visual symptoms. These symptoms include glare, floater, blurred vision and acute decrease in vision secondary to dislocation of these opacities to the visual axis. These vitreous opacities usually spread from cortical vitreous to the center and are often the only sign of ocular involvement but can be in association with other signs like Iris deposits, choroidal infiltration and amyloid glaucoma. Unfortunately this condition can be misdiagnosed easily with uveitis, vitritis, intra-ocular lymphoma, and vasculitis. In FAP, vitreous opacity incidence is variable between 5.4% and 35%. Vitreous involvement in FAP may be accompanied by other organs involvement so systemic workup is necessary.
Retinal vessels usually appear normal in vitreous involvement, although sometimes these opacities may involve perivascular regions and appear as focal plaques, tortuosity, beading or vascular sheathing. Retinal vasoocclussive accidents that appear as cotton-wool spots and neovascularizations have been reported too.
Congo red preparation of amyloid infiltration of outer retinal vessel wall. From Schwartz MF, Green WR, Michels RG, et al: An unusual case of ocular involvement in primary systemic nonfamilial amyloidosis. Ophthalmology 1982; 89:394–401.
Typical lens footplates seen in advanced vitreous amyloidosis (deposits aligning themselves on posterior lens capsule). From Doft BH, Machemer R, Skinner M, et al: Pars plana vitrectomy for vitreous amyloidosis. Ophthalmology 1987; 94:607–611.
Retinal hemorrhages with dot and linear shapes may be seen. In angiography, retinal vascular involvement present with blockage from vasocclusive abnormalities and focal or diffuse leakage that is more prominent in posterior pole than retinal periphery. Another clinical presentation of vitreous amyloidosis is central vitreous opacities that make footplate-like opacities on the posterior lens capsule.
In OCT (optical coherence tomography) veil like vitreous opacities shows needle-shaped deposits on the retinal surface that extend to the vitreous cavity and immunohistochemistry studies demonstrate amyloid-light chain deposits.
Magnified view of vitreous opacification. From Schwartz MF, Green WR, Michels RG, et al: An unusual case of ocular involvement in primary systemic nonfamilial amyloidosis. Ophthalmology 1982;89:394–401.
Treatment modalities for vitreous amyloidosis is limited to vitrectomy and leads to significant visual improvement, but unfortunately opacities can reoccur in one-fourth of patients over months. Incomplete vitrectomy proposed as the reason of this amyloid reaccumulation. Tight adhesion of these opacities to the perivascular regions potentially can lead to formation of retinal breaks during surgery.
Glaucoma as an independent condition in vitreous amyloidosis or concurrently developed complication, can be managed with filtering surgery at the time of vitrectomy or at any time postoperatively.[43-55]
The Cornea as an important transparent structure of human visual system can be affected in Systemic and localized amyloidosis, either as a primary site of Amyloid deposition or secondarily.
Gelatinous drop-like corneal dystrophy (GDCD),( also known as : Lattice corneal dystrophy type III, Familial subepithelial corneal amyloidosis, primary familial amyloidosis of the cornea) is a rare corneal dystrophy,first described by Nakaizumi in 1914 and mainly affects Asian descent but can occurs in diverse ethnic groups throughout the US, Europe and the Asia.14,15
Inheritance pattern of this dystrophy is Autosomal Dominant and its gene ( TACSTD2 gene ) located on 1p32. Although More than 25 mutations in TACSTD2 gene encoding
This dystrophy presents in young adulthood (within the 1st and 2nd decades ) and tends to be slowly progressive.
Primary, gelatinous droplike dystrophy of the cornea. From Ohnishi Y, Shinoda Y, Ishibashi T, Taniguchi Y: The origin of amyloid in gelatinous drop-like corneal dystrophy. Curr Eye Res 1982–1983; 2:225–231.
Cornea of this patients on slit-lamp biomicroscopy shows gelatinous white deposits of amyloid in the subepithelial and Bowman Layer, gives multilobulated mulberry-like appearance to the cornea. These deposits spread laterally and deeply within the stroma with time and can make larger nodular lesions leading to photophobia, vision loss and foreign body sensation. These lesions marked on with fluorescein staining and sometimes superficial vascularization appears on the cornea. Sever vision loss is secondary to coalescence of this deposits on the cornea surface. Some cases of cataract have been reported in young patients with this dystrophy. Fusiform appearance of deposits in corneal stroma of some patients resembles Lattice Corneal Dystrophy (LCD) and some ophthalmologists categorize Gelatinous Drop-like dystrophy as LCD type III. In this disease, the amyloid contains lactoferrin, but the disease is not linked to the lactoferrin gene.
Treatment is with repeated superficial keratectomy because of early recurrences on corneal grafts. In GDCD, the response to both lamellar and penetrating keratoplasty as well as to a superficial keratectomy is unsatisfactory as amyloid deposition recurs in the graft within about 5 years. Soft contact lenses are effective in managing the abnormal epithelial permeability to decrease recurrences.[56-69]
Lattice corneal dystrophy is the second form of inherited localized amyloidosis and is the most common form of corneal stromal dystrophies. This dystrophy typically is a bilateral disease with an autosomal dominant inheritance which presents at the first and second decade of life with symptoms like recurrent corneal erosion and decreased vision.
The term of Lattice for this dystrophy has been originated for the network of thin and delicate interdigitating branching opacities of the cornea in two separate common types of this stromal dystrophy. Lattice Corneal Dystrophy type 1 (LCD I ) and its variants are due to a specific mutation in the TGFBI gene and patients with this form of corneal dystrophy have no systemic manifestations, but in LCD type II systemic manifestations are inevitable part of corneal disease and this form resulting from a mutation in Gelsolin (GSN) gene.
Five subtypes of LCD have been identified,we will discuss in this section about Lattice corneal dystrophy type I, II,III. Other sub-types of this dystrophy are very rare disorders.[56,70,75]
This type of LCD is the most common form and also known as Biber-Haab-Dimmer corneal dystrophy. LCD1 usually presents its manifestations at the end of the first decade of life, but occasionally it begins in middle life and rarely in infancy and typically is a bilateral disease although occasional unilateral involvement may occur. Corneal sensation is often decreased and the network of interdigitating corneal filamentous opacities has some similarity to nerves, although these lesions are not apparent in all affected members of families with LCD1. Although LCD 1 is seen most often in the western world but some cases have been reported from Bulgaria, Spain and China.
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t||
\n\t\t\t | \n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t |
\n\t\t\t\t | \n\t\t\t<10 years | \n\t\t\t>20 years | \n\t>40 years | \n<20 years | \n
\n\t\t | \n\tMarkedly impaired by age 40–60 years | \n\tUsually good until after age 65 years | \n\tImpaired after 60 years | \n\tMarkedly impaired by age 10–30 years | \n
\n\t\t | \n\tNo | \n\tYes | \n\tNo | \n\tNo | \n
\n\t\t | \n\tAutosomal dominant | \n\tAutosomal dominant | \n\tAutosomal recessive | \n\tAutosomal recessive | \n
\n\t\t | \n\tNormal | \n\tMasklike facial expression, blepharochalasis, floppy ears, protruding lips | \n\tNormal | \n\tNormal | \n
\n\t\t | \n\tNormal | \n\tCranial and peripheral nerve palsies | \n\tNormal | \n\tNormal | \n
\n\t\t | \n\tNormal | \n\tDry, itchy, and lax with amyloid deposits | \n\tNormal | \n\tNormal | \n
\n\t\t | \n\tDelicate interdigitating network of filaments; no lines present at early stage; lines difficult to see at late stage | \n\tThick and radially oriented lines | \n\tThick lines | \n\tMultiple prominent subepithelial nodules | \n
\n\t\t | \n\tYes | \n\tYes | \n\tNo | \n\tNo | \n
Comparison of Inherited Varieties of Corneal Amyloidosis.
From Hida K, Tsubota Kigasawa K, et al: Clinical features of a newly recognized type of lattice dystrophy. Am J Ophthalmol 1987; 104:241–248, 1987.
At the time of presentation in the first or second decade of life Rod-like fine glassy opacities in the anterior stroma appear and over time this opacities become denser and combine together and make a network of linear branching and interdigitating opacities. These opacities usually are denser anteriorly and centrally but peripheral cornea is usually spared and classical branching lattice figures may not be present in all cases. The lines are relatively fine, as opposed to the more ropy opacities seen in lattice dystrophy Type III.
LCD I in light microscopy reveals Amyloid deposits in anterior stroma and subepithelial region that may lead to poor adhesion between corneal epithelium and stroma and secondary recurrent corneal erosion. Other pathologic features of this dystrophy in light microscopy include epithelial atrophy and disruption, degeneration of basal epithelial cells, and focal thinning or absence of Bowman layer increasing progressively with age and presence of an eosinophilic layer between the epithelial basement membrane and Bowman layer. Stromal deposition of the amyloid substance can lead to distortion of the corneal lamellar architecture. Amyloid deposition in this dystrophy shows typical Amyloid histopathologic features including metachromasia with crystal violet; ultraviolet fluorescence (yellow-green) with Thioflavin T; and orange-red staining with Congo red and stain with periodic acid-Schiff, and Masson\'s trichrome, exhibits dichroism and birefringence previously mentioned in this chapter.
Lattice corneal dystrophy type I. Klintworth Orphanet Journal of Rare Diseases 2009 4:7 doi:10.1186/1750-1172-4-7
Lattice dystrophy Type 1.HistopathologyusingCongoredstain showstheamyloidaccumulationsthroughoutthestromaarrows Yanoff & Duker: Textbook of Ophthalmology, 3rd ed. )
Lattice corneal dystrophy type I variant. Deposits of amyloid throughout the corneal stroma due to a p. Ala546Asp mutation in the TFGFBI gene in a patient with a variant of LCD type 1. Eifrig DE Jr, Afshari NA, Buchanan HW IV, Bowling BL, Klintworth GK: Polymorphic corneal amyloidosis: a disorder due to a novel mutation in the TGFBI (BIGH3) gene. Ophthalmology 2004, 111:1108-1114
Diagnosis of LCD I is based on clinical findings. As mentioned before; this dystrophy has an autosomal dominant inheritance and is due to mutation in the TGFBI gene resulting in isolated amyloid deposition in the cornea without any systemic manifestation.
Recurrent corneal erosions as a common complication of this dystrophy can be manage with options like therapeutic contact lenses, superficial keratectomy or phototherapeutic keratectomy. Despite the fact that this dystrophy may recur in the corneal grafts, severe cases of lattice dystrophy with decreased vision can be treated with lamellar keratoplasty (DALK) or Penetrating Keratoplasty (PK).[56,70-79]
(Familial amyloid polyneuropathy Type IV (Finnish type), also known as Meretoja\'s syndrome)
This dystrophy as a part of systemic disease involves corneal stroma bilaterally and is similar to LCD I, histopathologically and clinically but fine glass-like lines are randomly scattered, radially oriented, less numerous, and more delicate, than those in LCD I. Stromal lattice lines in this dystrophy reach to the peripheral cornea and limbus and central cornea is almost spared in contrast to LCD I. Although corneal sensitivity and nerve density is reduced in this type of LCD, Lattice lines are not related to corneal nerves. Patients with this disease are at increased risk of Open-Angle Glaucoma.
This dystrophy is secondary to the GSN (Gelsolin) gene mutation located on chromosome 9. Gelsolin is an actin severing protein and the abnormal Gelsolin molecule leads to deposition of highly amyloidogenic protein throughout the body. Amyloid deposits in this systemic disease can be seen in the conjunctiva, sclera, and ciliary body, along the choriocapillaris, in the ciliary nerves and vessels, and in the optic nerve. Extraocularly, amyloid is detected in arterial walls, peripheral nerves, and glomeruli. The amyloid in this condition is related to Gelsolin and does not stain for type AA or AP.
LCD II present usually after second decade of life but patients that are homozygous for mutated GSN gene may reveal symptoms earlier. Recurrent corneal erosions are not a common complication in LCD II and vision loss does not significantly occur before sixth decade of life. The pathology is similar to lattice dystrophy Type I. Light microscopy shows amyloid in the lattice lines as a discontinuous band under Bowman layer and within the sclera.
Mask like facies of patient with familial amyloid polyneuropathy type IV (Meretoja, Finnish type). From Purcell JJ Jr,Rodrigues M, Chishti MI,et al: Lattice cornealndystrophy associated with familial systemic amyloidosis.Ophthalmology 1983;90:1512–1517.)
Treatment modalities are similar to LCD type I, but exposure keratopathy secondary to facial neuropathy in some patients may need additional considerations. [56,80-87]
Corneal deposits of Meretoja’s syndrome (lattice type II, familial amyloidotic polyneuropathy type IV). Note the location along the course of corneal nerves. From Purcell JJ, Jr, Rodrigues M, Chishti MI, et al: Lattice corneal dystrophy associated with familial systemic amyloidosis. Ophthalmology 1983;90:1512–1517.
Lattice dystrophy Type III is an autosomal recessive disease that presents often after forth decade of life (later that LCD type I). Lattice lines in this dystrophy are thicker than type I and corneal erosions rarely occur. Amyloid usually deposits in the superficial stroma and beneath the Bowman’s layer and also can be found in mid-stroma.
LCD IIIA has been described with autosomal dominant inheritance and corneal changes similar to LCD type III; but in this subtype recurrent corneal erosions are more prevalent. This disorder is due to a defect in the keratoepithelin gene, demonstrated at various codons.
LCD IV is a late-onset corneal dystrophy that has been reported in Japanese population and is secondary to mutation in TGFBI gene. In this subtype of LCD amyloid deposition is in deeper stromal layers of cornea.[88-91]
Thick ropy lattice lines in patient with LCD III. From Hida T, Tsubota K, Kigasawa T, et al: Clinical features of a newly recognized type of lattice corneal dystrophy. Am J Ophthalmol 1987; 104:241-248.
This is a specific type of corneal amyloid degeneration that generally occurs after fifth decade of life. This condition is usually bilateral and incidental finding in elderly without much affect on vision. In slit-lamp biomicroscopy deposits with punctate glass-like appearance can be seen in central corneal stroma with extension to descemet’s membrane. Sometimes these deposits resemble lattice dystrophy although usually these deposits are less denser than LCD. Histopathologically there is a similarity between polymorphic degeneration and LCD. The reason of this degeneration has not been clearly described and no treatment is usually required for this patients.
Climatic proteoglycan stromal keratopathy is another condition similar to spheroidal degeneration of cornea first time described in Saudi Arabia. Patients with this condition have bilateral oval, central horizontal haziness in anterior stroma that may accompany with refractile stromal lines but does not usually affect vision. In histopathologic review of these patients proteoglycan and amyloid deposits have been found.[92,93]
Polymorphic amyloid degeneration of the cornea. From Ohnishi Y, Shinoda Y, Ishibashi T, Taniguchi Y: The origin of amyloid in gelatinous drop-like dystrophy. Curr Eye Res 1982–1983; 2:225–231.
Wide variety of chronic ocular disorders can lead to corneal amyloid deposition including; keratoconus, trachoma, phlyctenulosis, leprosy, bullous keratopathy (of any etiology), prolonged contact lens wear, trichiasis, uveitis, and severe retinopathy of prematurity with glaucoma.
Amyloid Deposits secondary to these conditions are usually subepithelial and appear as cream-colored nodules very similar to Gelatinous-drop like corneal dystrophy. Corneal vascularization in relation to primary disorder can be seen. Genetic work up must be done to rule out systemic inherited amyloidosis.
Keratoconjunctivitis sicca may be associated with amyloidosis with several mechanisms. The first mechanism is lacrimal gland infiltration in primary localized amyloidosis, with secondary hyposecretion of tears. The second mechanism is orbital nerve infiltration with associated autonomic neuropathy. Reactive (secondary) systemic amyloidosis has been reported with Sjögren syndrome, a condition frequently heralded by dry eyes. Finally, a systemic immunocyte dyscrasia, with or without systemic amyloidosis may result in neoplastic infiltration of the lacrimal gland and associated dry eye.[94-96]
The chapter describes the change of banking regulation toward governance and environmental sustainability challenges. It shows that it has not been fully understood how these new types of environmental and social risks affect differently banking activity. As risks are global and systemic, it is necessary regulatory coordination. The main international and European initiative to assess the relevance of environmental climate risks for banking regulation considers some banking policy recommendations for countries to coordinate their regulatory actions. This is due to the fact that banks play a crucial role in providing credit and financial resources that can be used to mitigate the negative effects of environmental risks enabling the economy to become more resilient.
Regulators are now aware that there are linkages between natural disasters and financial market instability. In fact, climate change could potentially threaten financial resilience in general and economic prosperity over the longer term.
In recent times, the frequency and intensity of natural disasters have increased, causing much greater damage to economies. The negative effects are not only physical and material, but they can lead to high loan losses and provisioning for banks located in those areas with hard difficulties.
The main environmental risks create potentially negative externalities for the banking sector and for this reason banks are analyzing these risks and are putting them into their risk management models and governance frameworks.
By affording these challenges, banks also play an important role in supporting the economy’s adaptation to environmental changes and in creating financial resilience to environmental risks. For this reason, new loan policies are devoted to reallocating credit to more sustainable sectors of the economy; by doing so banks contribute to reducing environmental sustainability risks, mitigating their impact.
Banks are facing these risks by adopting different types of green banking practices. These practices are referred to as the option of the ESG guidelines with a particular focus on risk management in the area of project finance and the allocation of credit to renewable energy resources. Other practices are specifically positioned to mobilize capital to the green economy, including renewable and clean energy projects by making loans and investments, and structuring specialized transactions [1].
Banks are facing new challenges. For this reason the European regulatory framework for sustainable finance has greatly developed. European leadership in sustainable finance has given rise to several regulations. In particular, banks will consider the CRR Pillar 3 and EU taxonomy disclosures, also because EBA is also aligning its position to this view.
The structural shift toward the green transition and the climate crisis is exposing banks to physical and transition risks, which they need to be ready to manage. Banks will need to strengthen their risk management frameworks and reassess their business strategies. A recent ECB assessment shows that banks have made some progress in adapting their practices to manage these risks, but none are close to meeting the supervisory expectations [2]. For this reason, supervisors have already planned a number of specific measures for next years and beyond, including a thematic review of banks’ environmental risk management practices and a stress test on climate-related risks. Many of the proposed regulatory changes actually stem from research conducted by the European Banking Authority and the ECB and are focused on issues identified in the use of internal models by European banks. The chapter is structured with paragraph 2 that describes the relevance of ESG principles in the banking and financial sector and the source of ESG risks, with particular relevance for climate-related risk; paragraph 3 focuses on the difficulties of regulators to define so new rules and guidelines to define new strategies to control these new risks; paragraph 4 concludes the chapter pointing out the main policy implications of this new era for banks and financial institutions.
During the last years banking and financial sector has been involved in a great change, which has been characterized by the introduction of the new principles of Environmental Social and Governance (ESG). These principles are forcing banks toward an innovative vision of management both internal and external. It is known that there is a wide interpretation of the meaning of the ESG principles. In general, banks are becoming more and more active in investment and asset allocation, and in new business models as well. The attention to the environment and its exploitation, to the reduction of pollution or carbon emissions, are influencing their choices and strategies. New attention to social justice and social principles are very relevant so new governmental bodies are under control. The final goal is a more sustainable framework for financial activity with a selection of assets and sectors to finance.
The first step toward sustainable finance was the Action Plan of Financing Sustainable Growth, which was published in 2018 by the European Commission. The regulatory framework began to be defined to give banks and financial institutions a new scheme that granted the real development of innovative strategies about the introduction of sustainability principles as the basis for new growth of the financial system.
Beyond EC’s Action Plan there was EBA’s Plan which gave other guidelines to banks and rules about the adoption of ESG principles. In particular, it became necessary for regulators to implement ESG principles in their rules for the financial sector.
The definition of a complete framework of ESG principles is very important but it is still long to be completed; anyway it is important to reach a full acceptance and a full change toward sustainable finance.
The ESG principles are tied with the 2030 United Nations Sustainable Development Goals (SDG) agenda that considers environmental challenges, including climate change, as a major concern to the stability of the global economy. The most important step toward the control of the climate risk was the Paris Agreement was adopted in 2015 to strengthen the global response to the threat of climate change. Financial policy and regulation are increasingly recognized as important for managing the transition toward a more environmentally sustainable economy. The evolution to a more sustainable economy requires the adoption of new paradigms and the green guidelines in lending activity to reach a better selection of economic activities to finance [1]. At the same time, governmental or regulatory intervention is necessary to guide the banking sector in allocating more credit and investment to sustainable activity and in protecting the economy against related financial risks. The role of financial regulation in supporting the transition to a more sustainable economic path has been deemed critical by international organizations. The definition of ESG factors is not simple or easy also because there are a number of guidelines and rules formulated by various institutions. Table 1 presents the existing frameworks currently used by international institutions.
Framework | Year | Content |
---|---|---|
Equator Principles | 2003 | Guidelines used to identify, assess and manage environmental and social risks when financing projects |
Principles for Responsible Investment (PRI) | 2006 | Referred asset owners/institutional investors, investment managers, and service providers to incorporate ESG factors into their investment and ownership decision |
International Integrated Reporting Council (IIRC) | 2010 | Framework for integrated reporting along the lines of six capitals (financial, manufactured, intellectual, human, social and relationship and natural) |
International Finance Corporation Environmental and Social Performance Standards (IFC Performance Standards) | 2012 | Definition of IFC clients’ responsibilities for managing environmental and social risks. |
United Nations Sustainable Development Goals (SDGs) | 2015 | Collection of 17 interlinked global goals designed to be a blueprint to achieve a better and more sustainable future intended to be achieved by 2030 |
Global Sustainability Standards Board Global Reporting Initiative (GRI) | 2016 | Principles used by organizations to better understand, manage and communicate their impacts on sustainability-related issues |
OECD Due Diligence Guidance for Responsible Business Conduct | 2018 | Guidelines covering non-binding principles and standards for responsible business conduct in a global context consistent with applicable laws and internationally recognized standards |
Committee of Sponsoring Organizations of the Treadway Commission (COSO) and the World Business Council for Sustainable Development (WBCSD) Guidance for Applying Enterprise Risk Management to ESG-related risks | 2018 | Guidelines to overcome ESG-related risk challenges across the ERM process and provides methods for managing both upside and downside ESG-related risks. |
United Nations Environment Programme Finance Initiative (UNEP FI) | 2019 | Principles aiming at aligning banks’ business strategies with the objectives of the SDGs and the Paris Agreement |
Sustainability Accounting Standards Board (SASB) Standards | 2019 | Standards that help companies disclose financially-material sustainability information to investors |
World Economic Forum (WEF) report on ‘Measuring Stakeholder Capitalism’ | 2020 | Common metrics and disclosures on non-financial factors can be used by companies to align their mainstream reporting on performance against ESG indicators and track their contributions to the SDGs |
Recommendations of the Financial Stability Board Taskforce on Climate-related Financial Disclosures (TCFD) | 2017 | Framework to disclose climate-related risks and opportunities through their existing reporting processes. |
International Capital Market Association Green Bond Principles | 2017 1ST ed. updated 2021 | Principles for the qualification of green bonds |
Natural Capital Protocol + Supplement (Finance) | 2018 | Framework for organizations to identify, measure, and value their impacts and dependencies on natural capital. |
Climate Bond Initiative Climate Bonds Standard | 2018 | Sector-specific eligibility criteria for assets and projects that can be labeled as green investments |
Climate Disclosure Project (CDP), UN Global Compact (UNGC), World Resources Institute (WRI), and World Wildlife Fund (WWF) Science-Based Targets initiative (SBTi) | 2018 | Targets and guidelines referred to the Paris Agreement |
Partnership for Carbon Accounting Financials Global GHG Accounting and Reporting Standard for the Financial Industry | 2019 | Guidelines for the specific asset class |
International frameworks and standards defining ESG factors.
Elaboration from EBA 2021.
In Table 1, if one considers the frameworks addressing ESG factors, it can be noticed that the idea to have a wider vision of the factors different from the economic and financial ones, begins in 2003 with the Equator Principles that induce banks to consider and measure environmental and social risks in lending activity. The most recent Principles of UNEP FI are specifically devoted to the adoption of SDGs and the Paris Agreement in banking activity.
Guidelines, frameworks, and principles try to offer a multi-layer dimension of ESG factors. This effort is due to regulators’ position to recognize the relevance of these aspects for banks and to induce their choices and managerial strategies.
As concerns the environmental factors international institutions and authorities are working in recent times. It consists of guidelines and best practices proposed as suggestions to banks and financial institutions. These guidelines are important because they are the first step to having a uniform discipline about sustainable finance and green financial assets. On the basis of these initial definitions, banks and financial institutions must face new risks deriving from these factors that should be considered in financial management and the financial markets.
ESG factors are characterizing the definition of new strategies for banks and financial institutions. This paragraph starts from EBA’s definition of ESG risks and shows some considerations about their evaluation and management.
According to EBA [3] “
These risks may have different and typical features, due to their main causes and effects. ESG risks influence banking activity both in lending and in asset class allocation. For this reason, banks must classify ESG risks. By doing they must consider separately the three factors, Environmental, Social, and Governance. As concerns environmental risks, which are caused by a number of factors, banks must face both their physical impact and the effects of transition, as it is specifically happening in the so-called “green transition.” Social risks are caused by the diffusion of social inequality, health troubles, or the exploitation of human labor. The governance risks are important as well; and for example they are caused by corruption or similar in the board of directors of the company.
This complex articulation of such risks imposes banks to become more selective in their activity. Moreover, these risks are also more difficult to be measured as they are mainly focused on subjective elements and all quantitative indicators are still to be defined. For this reason, ESG risks are considered systemic and can impact the financial system as a whole. Institutions need to build their resilience to ESG risks across different time horizons, by taking a comprehensive and forward-looking view, as well as early and proactive actions, under supervisory control.
According to EBA, it is necessary to include ESG risks into the banking regulatory and supervisory framework, giving a particular emphasis on climate and environmental risks although social and governance risks are already important and necessitate attention. The main attention to these risks is due to the fact that they seem to be the most relevant because of climate change and the governments’ requirements to move toward “green economy” by converting the “brown business.”
To manage these risks, their transmission channels must be considered and incorporated into disclosures, risk management, and supervision. ESG disclosure is very relevant for stakeholders interested in assessing banks’ risks and their sustainable finance strategy [3]. This is why the Basel Third Pillar must be integrated and the non-financial reporting is linked to this need.
The analysis of ESG risks is very important because it is considered by supervisors as the new frontier to reach a resilient business model and risk management system to ensure banks’ preparedness for ESG-related challenges. ESG risks-related considerations must be fully taken into account in the definition of strategies and objectives, as the same must be done integrating ESG risks in governance structures, and managing these risks as drivers of financial risks. The actual regulatory framework is based on these actions expected by banks and the new supervisory and evaluation process (SREP) will be performed including these risks [2].
The materialization of ESG factors has consequences on banks’ performance because it is linked to all financial risks, such as credit, market, operational, liquidity, and funding risks. In general, we can maintain that ESG risks can be defined as the negative materialization of ESG factors through their counterparties or invested assets [3]. For example, if a bank grants a loan to a company that is suffering under the transition risk and costs of a green economy, its difficulties will influence the bank’s credit position and credit risk. This happens because this company will have problems in loan repayment and reimbursement due to the high expenses caused by the transition itself.
It is evident that ESG risks must be considered under a double perspective, proposed by EBA as an outside-in and inside-out perspective. According to the first dimension, banks can be impacted by ESG risks through their counterparties and invested assets, but at the same time, they may be impacted by or have an impact on (inside-out perspective) ESG factors. Even if both perspectives are important, the inside-out becomes much more relevant. The relationship between the inside-out and outside-in perspective is explained by the double materiality, which is divided into financial materiality and environmental and social materiality.
The double materiality implies that banks must measure and evaluate both the internal choices and the influence of the external behavior of companies and clients referring to ESG factors. The financial materiality can be explained by considering the effects on the company’s economic and financial activities. The environmental and social materiality refers to the influence of the above-mentioned company’s economic and financial activities on ESG factors themselves. With a circular process, this influence may cause, at the same time, financial materiality.
The assessment of ESG risks is done using three different methods—portfolio alignment method, risk framework method, and exposure method.
At the core of the portfolio alignment method, there is the meaning of alignment. According to this method banks, investors and supervisors will consider how far portfolios are aligned with globally agreed targets. This method could mainly be used for strategic purposes rather than risk management purposes because it does not explain the link between the global targets and the risk indicators of the bank.
The risk framework method includes the climate-stress test. This method is particularly relevant for climate risk, which is a forward-looking risk and stress testing over a future time horizon is, therefore, a useful tool for modeling climate risk impacts. On the contrary, the other ESG risks are in general more backward-looking. The risk framework method focuses on the sensitivity of portfolios and the impact that climate change has on the real risk of the exposures. The actions to face the risk are derived from the level of measured sensitivity or direct risk of losses considering the current level of environmental factors (or climate factors, more specifically) and the possible developments under the selected scenario. The application of this method brings to a risk-based adjusted portfolio in the medium-long term and makes it possible to consider also internal components of banking and trading book.
An exposure method is a tool that banks can apply directly to the assessment of individual counterparties and individual exposures, even in isolation. This method is based on a direct evaluation of the performance of exposure in terms of its ESG attributes. This method can be used to complement the standard assessment of financial risk categories. Thanks to this approach, there is a calibration at the specific company level. It is possible to put in evidence the specific sensitivities to ESG factors of different segments and sub-segments of economic activity. This method suits well to all three aspects of ESG.
This method is considered the most suitable if compared with the others. Even if it is not based on complex scenario analysis, it considers backward-looking metrics and makes banks able to classify their ESG risks’ exposures. This method gives banks the possibility to take adequate decisions to face ESG risks. The exposure method has developed some methodologies that can bring to ESG risks measurement. Regulators classify them in the following four methodologies—a. ESG ratings provided by specialized rating agencies; b. ESG evaluations provided by credit rating agencies; c. ESG evaluation models developed by banks in-house for their own assessment; and d. ESG scoring models developed by asset managers and data providers.
With the first methodology ESG ratings are provided by specialized rating agencies. They are stand-alone ratings on ESG factors, and consider the risk exposure to ESG factors. Rating agencies consider also the ability of the management to afford risks and to catch opportunities. These methodologies are generally built on a quantitative analysis of key issues identified for each company, but they also consider qualitative information collected by analysts from public information and engagement with companies.
In the case of ESG evaluations provided by credit rating agencies (e.g., S&P ESG), these evaluations integrate ESG factors into the standard credit analysis. They measure how ESG factors affect both certain scorecard components such as cash flows and leverage, and elements outside of the scorecard. They contribute to giving additional input to the existing financial risk assessment. Anyway, some difficulties in comparing ESG ratings by different providers are present as they include the different weights applied to the individual elements of ESG factors.
The internal methodologies have been developed by larger banks that were organizing their information systems on the basis of internal data deriving from wide data sets concerning their customers. These are internal and need the validation of regulatory authorities to be compliant with the existing rules. Finally, the ESG scoring models developed by asset managers and data providers, are publicly available.
Even if there are a number of methodologies, they are still improving both by banks and by regulators and they can be still considered at the early stages of development. These methods are very different both for the factors that are considered and for the results. They also differ for time horizons and for these reasons banks are experimenting with them all on different basis and portfolios. Anyway, the exposure origination is very important because it shows the future composition of a bank’s portfolio and signals to counterparties, investors, and wider market participants that investments are no longer sustainable and supported by the financial sector. This is true and relevant because the EBA Guidelines on Loan Origination and Monitoring are oriented to consider ESG factors as taken into account in banks’ credit risk appetite, policies and procedures.
The analysis of ESG risks requires a real ESG disclosure; this means that banks must map all business units and divisions on the basis of ESG risks’ framework and above all on the basis of the inside-out and outside-in perspective.
This mapping is finalized to manage the risk of conflicting or inconsistent information being disclosed; to ensure consistency and/or alignment of the disclosure; and to identify the overlaps in the reporting pillars where common reporting metrics can be considered. This kind of risk disclosure is important as it is the expression of internal analysis and mapping of ESG risks, which must be constantly monitored in the next future. This mapping can be considered as an absolute improvement of Basel Third Pillar.
The environmental aspect is really important as it is considered as the core for climate risk. Climate risk has a double dimension; in fact, banks and financial institutions are both impacted by and contribute to climate risks. For this reason, regulators are prioritizing appropriate climate risk disclosures as part of ensuring the broader transition of the financial industry to more sustainable, and positively impactful business models. According to the Financial Stability Board [4], climate risk must be considered by banks as physical risk and transition risk.
Physical risk is
Transition risk
Many stakeholders are interested in these two dimensions of climate risk and want to understand banks’ strategies in financing the transition to a zero-carbon economy. Under EBA’s requirement banks are required to disclose information on climate risks, mitigation action, and green asset ratio [5].
The disclosure about climate risks is due to the fact that according to EBA it is important to put in evidence how climate change may reinforce and worsen other risks in banks’ balance sheets. Concerning mitigating actions banks must inform about what they have in place to address those risks including financing activities that reduce carbon emissions.
With the Green Asset Ratio, it is possible to understand how institutions are financing activities that will meet the publicly agreed Paris agreement objectives of climate change mitigation and adaptation based on the EU taxonomy of green activities. The Green Asset Ratio is based on the EU taxonomy. It is a measure of the financial support that banks are willing to give to sustainable activities. Through this ratio, it is possible to put in evidence the assets that can be considered environmentally sustainable as they are referred to grant finance to activities of climate change mitigation on climate change adaptation. It is important in setting strategies, and even a bank with a low Green Asset Ratio can identify how it wants to change its financing activities over time to meet the Paris agreement objectives and measures. It gives information about a strategy that must be monitored. It is expected by EBA to receive from counterparties subject to NFRD disclosure obligations reliable data for the Green Asset Ratio from December 2022, developing a framework that identifies the required disclosure standards and their materiality triggers. The most commonly referenced framework in the case of climate disclosures is the TCFD framework, which is recognized by regulators in the EU and is considered as guidance on climate-related disclosures.
Banks and financial institutions are exposed to climate-related risks through both their own operational impacts and the activities of their borrowers, customers, or counterparties. According to the outside-in and inside-out approaches, banks that provide loans or trade the securities of companies with direct exposure to climate-related risks suffer and accumulate climate-related risks via their credit and equity operations. In addition, as the markets for lower-carbon and energy-efficient alternatives grow, firms may assume material exposures in their lending and investment businesses.
The ECB Guide [5] represents a shared document that shows how relevant are a disclosed analysis of such risks to grant that banks are managed in a sound and safe way. The relevance of climate-related risks is really great and the ECB has declared that banks conducted a self-assessment in light of the supervisory expectations outlined in the guide and to draw up action plans on that basis. The self-assessment plans will be considered by ECB as the first step toward more accurate monitoring of climate risk among all typical financial risks. This importance is also evident in the declaration of the climate-related risks stress test that will be run by ECB during this year.
As it has been described above, physical risks are specifically referred to as natural catastrophes and the economic losses caused by them; and this situation has increased in the last decades. The number of some types of extreme weather events has globally increased. Such events have become more likely or more severe due to the effects of climate change, and it is known that further warming will intensify them and consequently the negative effects at the basis of the increase of climate risk.
Physical risks include losses stemming from changes in physical capital because natural disasters destroy infrastructure and divert resources toward reconstruction and replacement. These risks affect also human capital, through deterioration in health and living conditions. The hard conditions due to the physical risks may have consequences on future expectations with a reduction of investment, given the prevailing uncertainty about future demand and growth prospects.
If there is no action to reduce the effects of climate change, physical risks will continue to increase in the future. The frequency and severity of extreme weather events might increase non-linearly and become increasingly correlated with each other over time. The consequences of physical risks can affect mainly market and credit risks.
The climate risk consequences may influence the value of financial assets causing losses for banks, investors, and financial institutions. The losses are the expression of market risk, but they are not directly caused by negative movement of financial variables (i.e., interest rates or assets prices), instead, their origin is connected with the losses due to the material destruction due to physical risk. As concerns credit risk it is almost easier to be understood as it is the consequence of the impossibility to repay and/or to reimburse loans, because of the physical destruction of assets, things, or the death of human beings. It is evident that banks are in presence of a large and composite number of risks and aspects of the same risk [4].
The impact of physical risk is not easy to be estimated with the effect on a bank’s assets. Estimates are based on a number of assumptions and subject to numerous sources of uncertainty concerning the global emissions with the potential increases in global temperatures and the severity of extreme weather events. So, the macroeconomic scenario and the variation in financial assets value are highly uncertain. Finally, there are the uncertainties associated with the future path of climate change and its impact on asset prices. Heating temperatures are increasing climate risk and physical risk in particular. They seem to be unavoidable, and this will cause an increase of negative effects on the financial system and assets prices [6, 7]. As physical risks are different in the sector and geographical areas, market and credit risks may be affected by these differences. This condition reinforces the situation in which other differences and in particular significant losses derive also from the disruption at the national level, and concentrated in certain countries with and exposure to operational risks that could disrupt firms’ operations, and affect other firms (financial and non-financial) provided by banks’ financial services amplifying risks for financial stability.
It is known the necessity of bringing the temperature to be below 2° C above pre-industrial level. Transition risks stem from the possible process of adjustment to a low carbon economy, and its possible effects are expected on the value of financial assets and liabilities. Such a transition to a low carbon economy would imply significant structural changes to the economy, including a major reallocation of investment. This could have a significant impact on firms involved in the production of fossil fuels, as well as other sectors whose business models rely on using such fossil fuels or that are energy intensive. The effect changes in asset prices with consequences on banks’ portfolios. These prospective effects might have also the consequence of reallocating financial resources from highly risky sectors or businesses tied, for example, in fossil fuels to new and less pollutant activities, by doing so supporting a real transition to a green economy. We can affirm that there will be a transformation of banks’ strategies and the support of market segments devoted to new and more sustainable sectors. We can say that the transition risks represent the lever to accelerate banks’ contribution to a renewal of economy and financial flows besides the real beginning of sustainable finance. On the contrary, a disorderly transition to a low-carbon economy, unanticipated by market participants, could have a destabilizing effect on the financial system. The most relevant effect will be an increase in credit risk due to the instability of such companies operating in brown sectors and receiving loans from banks. A transition to a low-carbon economy might reduce some borrowers’ capacity to generate sufficient income to service and repay their debts [8]. From this situation, banks are forced to face a higher credit risk, which is the result of a double scenario. The former is connected to the well-known difficulties in payments, and the latter is the increasing risks connected with the reduction of collateral value [7]. Transition scenarios are not able to catch all policy, technology and/or consumer preferences they change very rapidly. Moreover firms’ vulnerability to transition risks isn’t easy to be evaluated; in fact it is not only due to the firms’ operations, but also to their suppliers and customers.
Since time regulators are exploring this kind of risk and its widespread and are also analyzing possible ways to reduce them. However, the control of climate and ESG risks is at an early stage [9, 10, 11]. In the Appendices at the end of the chapter, there are the main initiatives that show the timeline and the complexity of the regulators’ activity with regard to ESG disclosure, climate risk analysis, and reporting for banks.
In this context, financial regulators are defining the principles about which climate risks are managed by banks. This interest derives from the necessity to reduce their impact both for banks themselves and for the financial system as a whole. Supervisory expectations aim at covering some institutional risk management elements (i.e., governance, strategy, scenario analysis, and/or risk management) and some financial standard-setting bodies are also starting to work on supervisory guidance related to climate risk. In fact, till now climate risks are considered as the worst for financial stability.
For example, scenario analysis can be used to quantify the totality of exposures of banks to climate-related risks within their framework and this is also called “climate stress test” [5]. There is also a significant approach to consider macro-prudential policies to mitigate climate risks to save the stability of the financial system, by giving banks a major resilience.
A large number of guidelines, best practices, and notices are the evidence that banking regulation shows a kind of difficulties to make a unitary proposal. As it has been said climate risk has a “liquid” structure that makes it really complex for banks to define their ambits and strategies.
The further evolution is the complete introduction of the ESG factors and ESG risks in the supervisory process and all control systems. These risks are not yet explicitly included in the CRD, the IFD, or in the SREP guidelines; at the same time, the consideration of these factors by supervisory authorities should be made with respect to the principle of proportionality, that links the conditions of each bank and its exposure to risks specifically referred to their dimension, context, and background [3].
Any way the integration of ESG risks into the supervisory review will be implemented gradually, considering the development of the related methodologies for the qualitative and quantitative assessment of ESG risks. The first step is the integration of these factors in the strategies and policies adopted by banks, with an improvement of the corporate and risk culture, and of the risk management frameworks. Only after the initial period when ESG risks will be completely introduced in banking management and there will be structured data, the supervisory assessment might cover all risks with the analysis of capital and liquidity.
The mechanism of the supervisory review is based on the consideration of the risk profile, but also the business model and the strategies adopted by the bank. Moreover, another check should be compliant with the IFD and IFR and with the financial risks afforded by the bank. The supervisory review is defined on the basis of the SREP elements; and so there is the business model analysis, the evaluation of the internal governance, of the internal controls, the analysis of the risks to capital and to liquidity and funding.
ESG factors are ESG matters that may have different impacts on banks’ financial performance because they can turn into ESG risks as financial risks as they are in the analysis of the supervisory process and in particular of the assessment of the viability and sustainability of banks’ business model. For this reason, supervisors are interested in the forward-looking analyses implemented by the banks themselves, in non-financial reporting that contains a number of information useful to discover the level of attention to a sustainable economy and in the bank’s ESG ratings. The supervisory process is changing in line with these new risks; banks are compelled to show their capacity and ability to afford and manage adequately their impact. New business models and a new and more effective supervisory function should be a forward-looking assessment of the future business environment.
In the previous paragraphs, the relevance of ESG factors and their possible characteristic of being a source of risks have been described. In addition, climate risk is considered one of the most important and actual risks in banks’ regulation. These two assumptions are influencing also banks’ business models.
Banks are organizing their activities to control their CO2 impact. At the same time, it is entering new selective methods in granting funds to green projects, avoiding the greenwashing trap that could increase ESG risks.
The business model is analyzed both under a quantitative dimension and from a qualitative point of view. The new business model being influenced by new risks requires also different capital adequacy. This adequacy is measured with respect to the capacity of absorbing ESG risks, while the qualitative analysis aims at the evaluation of the bank’s performance considering its risk appetite, but also the presence of other drivers.
According to EBA and Basel Committee [3, 6], to understand the impact of ESG factors on the current business model, the quantitative analysis should be based on the consideration of the portion of the bank’s profitability that derives from assets that are more exposed to ESG risks. The differences in the profitability of conventional loans and loans that include ESG risk-related objectives must be compared as the concentration of assets, highly exposed to ESG risks. The geographical concentration of lending or deposit-taking from households in a region where the economy heavily depends on carbon-intensive industries or that is prone to disasters is an example of the possible effects of ESG risks. The consequence is the search of assets and liabilities with more complex variables. For this reason, regulators are presenting new guidelines and banks are looking for new schemes for the development of more effective strategies.
From the previous discussion, it is evident that ESG risks impact the existing financial risks (e.g., credit risk, market risk, and operational risk). If it is so, it is evident that regulators and supervisors need to consider the impact on capital requirement [11]. According to the function of capital requirement, its entity is tied to the classification of risks to be faced. The risk-weighted assets are expressed on the basis of quantitative inputs classified by each bank starting from authorities’ rules and regulations. The definition of capital requirement for ESG risks is influenced by their measurement and it is not yet well complied. In fact, as concerns climate-related risks and environmental risks a number of quantitative indicators are developing; on the contrary social and governance risks are mainly managed through qualitative methods. The supervisory position is focused on the way used to manage these risks, or better to analyze how banks are becoming aware of these risks. Right now the relationship under monitoring is the effects on credit risk profile.
As concerns ESG climate risk and environmental risks in determining capital adequacy is relevant the consideration that they are long term risk; in fact, the physical impact of environmental change and/or because previously insufficient political action forces a sudden and comprehensive transition.
Consequently, the supervisory process will be adapted to review whether and how the banks ensure that their banking book is sustainable in the medium to long term. To simulate the condition of risk, banks can adopt scenario analysis that gives a measure of the bank’s resilience.
Supervisory activity tests capital adequacy by considering both qualitative and quantitative information. Anyway, the most important aspect is referred to the quantitative methodologies in which supervisory authorities assess bank’s risk measurement tools. Starting from this approach to measure the relationship between credit risk and ESG risk, the standard credit risk assessment is used to take into account the impact of ESG risks. As credit risk is assessed in the short to medium term, the use of forward-looking metrics is relevant to measure the impact of ESG factor on bank’s own exposure to credit risk. This evaluation is important to measure the sustainability of long-term loans in the bank’s banking book. In determining the capital requirement, the maturity of the loan portfolio is more and more important to absorb the impact of ESG risks. The starting point is connected to the evaluation of the awareness of how ESG risks drive credit risk for each portfolio and the connection with the risk appetite framework of the bank. For this reason, supervisors might check that institutions have properly embedded the material ESG factors into their rating assignment and review process.
The above-mentioned geographical variable is relevant also for determining capital adequacy; in fact, as said, the location has an influence on physical risk, so the higher is the risk of natural disaster, the higher should be the capital requirement to cover unexpected risks.
Even if there is the incorporation of ESG risks into the review of the credit quality of the portfolio, this causes a number of questions, one of which is the availability of reliable data and information. Supervisors will consequently check that the credit strategy is fully aligned and properly reflects the underlying ESG risk appetite. Performing these assessments also implies controlling how the responsibilities for implementing and monitoring the ESG-related targets are set.
The control of credit and loans implies the analysis of loans originating. At the end of this step, it means that it is necessary to identify projects, activities, and criteria used to select environmentally sustainable lending. This analysis is a guide to avoid greenwashing activities that might require a higher capital level, with a higher risk level [10]. This check on loan activity to quantify the capital requirement is necessary to cover the bank from the reputational risk, it might incur in.
While the link between ESG risks and liquidity and funding is seen by institutions as more indirect, it is deemed important to not overlook these links when evaluating the risks to liquidity and funding; ESG factors could also result in funding issues for institutions or make some assets less liquid. The evaluation of liquidity needs in the short and medium term, in particular, whether ESG risks could cause net cash outflows that negatively impact the institution’s liquidity position.
The analysis of ESG risks is still at an early stage, also because it is not yet simple in banking activity but it is relevant also for supervisory authority to assess the adequacy of internal capital to face these risks.
Environmental conditions and climate changes are influencing banking activity and regulators’ duties. For a few years, ESG factors are impacting financial context and are inducing managers to adopt new approaches in running their business. Banks are changing their methods to consider the principles of sustainable finance both as concerns the banking book and consequently the loans activity, but also the new green investments. On the other side, climate changes and climate-related risks have demonstrated that the brown economy must leave the place to a green economy.
This new approach has induced banks to consider new risks deriving from the ESG factor and from climate change itself. Banking managers are reshaping their risk management scheme introducing also ESG and climate-related risks.
The framework is aggravated by the fast evolution of the social and governance models that must be structured in a new way.
Regulators and supervisors are running in giving guidelines and new frameworks to induce banks to pay more and more attention to these risks.
The whole supervisory process is reshaping by introducing the measurement of ESG risks and climate-related risks but the greatest problem is due to the huge relevance of these risks and the overlapping of rules, regulations, and guidelines that are still at an early stage but are renewing the banking activity whose main role to bring the economy to put in practice a real new green deal.
Directive 2013/36/EU – Capital Requirement Directive Regulation (EU) 2019/876 – Capital Requirement Regulation Financial market participant Directive (EU) 2019/2034 – The Investment Firms Directive Regulation (EU) 2019/2033 Regulation (EU) 2019/2089 – The Low Carbon Benchmark Regulation Directive 2014/95/EU – The Non-Financial Reporting Directive Regulatory Technical Standards Regulation (EU) 2019/2088 – The Sustainable Finance Disclosure Directive Supervisory Review and Evaluation Process Regulation (EU) 2020/852 Task Force on Climate-related Financial Disclosures
Year/Date | |
---|---|
Banks must consider NFDR | |
February | EBA launches consultation about the revision of NFDR |
April | LCBMR in force |
September | EBA opens a survey on Pillar 3 disclosure on ESG risks |
November | Opening of EBA’s consultation on management and supervision of ESG risks for credit institutions and investment firms |
December | LCMBR level II in force |
Closing of IFRS consultation on Sustainable Reporting | |
February | Closing of EBA’s consultation on management and supervision of ESG risks for credit institutions and investment firms |
SFDR final draft RTS on indicators for the adverse impact of environment delivered to EC | |
March | Opening of EBA consultation on draft ITS on Pillar 3 disclosure |
SFDR principal website disclosure obligations apply to sustainability risk management; PAis; and remuneration policy | |
June | Proposal regarding the review of NFRD |
Closing of EBA consultation on draft ITS on Pillar 3 disclosure | |
EBA report on management and supervision of ESG risks | |
November | EBA on sustainable securitization |
December | SFDR final draft RTS on indicators for social and human matters |
EBA’s submission of the final draft of ITS on Pillar 3 disclosure | |
EBA guidelines and Standards on ESG integration in risk management and supervision | |
Publication of EBA discussion paper with a consultation on the classification and prudential treatment of assets from a sustainability perspective | |
EBA final report on the classification and prudential treatment of assets from a sustainability perspective |
Year/Date | |
---|---|
TCFD Guidelines available | |
June | EU publishes guidelines on reporting of climate-related information |
July | EU Taxonomy Regulation enters in force |
EBA delivers advice to EC on KPIs and methodology for disclosure under NFRD | |
June | EC adoption of a delegated act on the additional transparency requirement for financial and non-financial undertakings under the EU Taxonomy Regulation |
January | EU Taxonomy Regulation delegated acts on climate change mitigation and adaptation to apply |
Application of all EU Taxonomy Regulation delegated acts other than on climate change mitigation and adaptation |
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Societies",slug:"gender-differences-in-food-choice-and-dietary-intake-in-modern-western-societies",totalDownloads:17762,totalCrossrefCites:47,totalDimensionsCites:120,abstract:null,book:{id:"1811",slug:"public-health-social-and-behavioral-health",title:"Public Health",fullTitle:"Public Health - Social and Behavioral Health"},signatures:"Claudia Arganini, Anna Saba, Raffaella Comitato, Fabio Virgili and Aida Turrini",authors:[{id:"114665",title:"Dr.",name:"Aida",middleName:null,surname:"Turrini",slug:"aida-turrini",fullName:"Aida Turrini"},{id:"116008",title:"Dr.",name:"Claudia",middleName:null,surname:"Arganini",slug:"claudia-arganini",fullName:"Claudia Arganini"},{id:"116171",title:"MSc.",name:"Anna",middleName:null,surname:"Saba",slug:"anna-saba",fullName:"Anna Saba"},{id:"116173",title:"Dr.",name:"Fabio",middleName:null,surname:"Virgili",slug:"fabio-virgili",fullName:"Fabio 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Legumes are nutritionally valuable, providing proteins (20–45%) with essential amino acids, complex carbohydrates (±60%) and dietary fibre (5–37%). Legumes also have no cholesterol and are generally low in fat, with ±5% energy from fat, with the exception of peanuts (±45%), chickpeas (±15%) and soybeans (±47%) and provide essential minerals and vitamins. In addition to their nutritional superiority, legumes have also been ascribed economical, cultural, physiological and medicinal roles owing to their possession of beneficial bioactive compounds. Research has shown that most of the bioactive compounds in legumes possess antioxidant properties, which play a role in the prevention of some cancers, heart diseases, osteoporosis and other degenerative diseases. Because of their composition, legumes are attractive to health conscious consumers, celiac and diabetic patients as well as consumers concerned with weight management. 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The main global health organizations have incorporated patient safety in their review of work practices. The data provided by the medical laboratories have a direct impact on patient safety and a fault in any of processes such as strategic, operational and support, could affect it. To provide appreciate and reliable data to the physicians, it is important to emphasize the need to design risk management plan in the laboratory. Failure Mode and Effect Analysis (FMEA) is an efficient technique for error detection and reduction. Technical Committee of the International Organization for Standardization (ISO) licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. FMEA model helps to identify quality failures, their effects and risks with their reduction/elimination, which depends on severity, probability and detection. Applying FMEA in clinical approaches can lead to a significant reduction of the risk priority number (RPN).",book:{id:"9808",slug:"contemporary-topics-in-patient-safety-volume-1",title:"Contemporary Topics in Patient Safety",fullTitle:"Contemporary Topics in Patient Safety - Volume 1"},signatures:"Hoda Sabati, Amin Mohsenzadeh and Nooshin Khelghati",authors:[{id:"340486",title:"M.Sc.",name:"Hoda",middleName:null,surname:"Sabati",slug:"hoda-sabati",fullName:"Hoda Sabati"},{id:"348872",title:"M.Sc.",name:"Amin",middleName:null,surname:"Mohsenzadeh",slug:"amin-mohsenzadeh",fullName:"Amin Mohsenzadeh"},{id:"348874",title:"MSc.",name:"Nooshin",middleName:null,surname:"Khelghati",slug:"nooshin-khelghati",fullName:"Nooshin Khelghati"}]},{id:"69876",title:"Leadership Styles in Nursing",slug:"leadership-styles-in-nursing",totalDownloads:3157,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Recent developments in the field of management-organization and organizational behavior and new concepts have also led to the emergence of new leadership styles in leadership. Leadership in health services is important for following innovations and adapting to current situations. Nurses working together with other health personnel in hospitals providing health services constitute an important group in leadership. Nursing, which is a key force for patient safety and safe care, is a human-centered profession, and therefore leadership is a key skill for nurses at all levels. The leadership styles of nurse managers are believed to be an important determinant of job satisfaction and persistence of nurses. The need for nurses with leadership skills and the need for nurses to develop their leadership skills are increasing day by day. There are several leadership styles defined in nursing literature. These leadership styles are examined under the titles of relational leadership style, transformational leadership, resonant leadership, emotional intelligence leadership, and participatory leadership. The task-focused leadership style is explored under the headings of transactional and autocratic leadership, laissez-faire leadership, and instrumental leadership.",book:{id:"9047",slug:"nursing-new-perspectives",title:"Nursing",fullTitle:"Nursing - New Perspectives"},signatures:"Serpil Çelik Durmuş and Kamile Kırca",authors:null},{id:"58916",title:"Factors Affecting the Attitudes of Women toward Family Planning",slug:"factors-affecting-the-attitudes-of-women-toward-family-planning",totalDownloads:8548,totalCrossrefCites:9,totalDimensionsCites:18,abstract:"Everyone has the right to decide on the number and timing of children without discrimination, violence and oppression, to have the necessary information and facilities for it, to access sexual and reproductive health services at the highest standard. Deficient or incorrect family planning methods, wrong attitudes and behaviors toward the methods and consequent unplanned pregnancies, increased maternal and infant mortality rates are the main health problems in most countries. Individuals’ learning modern family planning methods and having positive attitude for these methods may increase the usage of these methods and contributes the formation of healthy communities. It is considered important to examine the current attitudes and determinants in order to spread the choice of effective method.",book:{id:"6142",slug:"family-planning",title:"Family Planning",fullTitle:"Family Planning"},signatures:"Nazli Sensoy, Yasemin Korkut, Selcuk Akturan, Mehmet Yilmaz,\nCanan Tuz and Bilge Tuncel",authors:[{id:"216377",title:"Prof.",name:"Nazli",middleName:null,surname:"Sensoy",slug:"nazli-sensoy",fullName:"Nazli Sensoy"},{id:"216589",title:"Dr.",name:"Yasemin",middleName:null,surname:"Korkut",slug:"yasemin-korkut",fullName:"Yasemin Korkut"},{id:"216595",title:"Dr.",name:"Selcuk",middleName:null,surname:"Akturan",slug:"selcuk-akturan",fullName:"Selcuk Akturan"},{id:"216596",title:"Dr.",name:"Canan",middleName:null,surname:"Tuz",slug:"canan-tuz",fullName:"Canan Tuz"},{id:"216598",title:"Dr.",name:"Bilge",middleName:null,surname:"Tuncel",slug:"bilge-tuncel",fullName:"Bilge Tuncel"},{id:"216599",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yilmaz",slug:"mehmet-yilmaz",fullName:"Mehmet Yilmaz"}]},{id:"69631",title:"Cultural Practices and Health Consequences: Health or Habits, the Choice Is Ours",slug:"cultural-practices-and-health-consequences-health-or-habits-the-choice-is-ours",totalDownloads:902,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Human beings are social animals with an innate desire to conform to socially accepted norms and values. Over periods of time, some of these norms become standards that all members of the community are expected to adhere to. Deviance from these standards is seen as absurd, wrong, or frankly abnormal. However, many of these cultural mores have no scientific basis and, some of them actually promote behaviors with negative health consequences. This chapter examines the cultural practices of some communities in Africa and their health consequences and, explores ways to address the challenges.",book:{id:"9138",slug:"public-health-in-developing-countries-challenges-and-opportunities",title:"Public Health in Developing Countries",fullTitle:"Public Health in Developing Countries - Challenges and Opportunities"},signatures:"Radiance Ogundipe",authors:[{id:"302308",title:"Dr.",name:"Radiance",middleName:null,surname:"Ogundipe",slug:"radiance-ogundipe",fullName:"Radiance Ogundipe"}]},{id:"55808",title:"The Role of Legumes in Human Nutrition",slug:"the-role-of-legumes-in-human-nutrition",totalDownloads:5433,totalCrossrefCites:63,totalDimensionsCites:109,abstract:"Legumes are valued worldwide as a sustainable and inexpensive meat alternative and are considered the second most important food source after cereals. Legumes are nutritionally valuable, providing proteins (20–45%) with essential amino acids, complex carbohydrates (±60%) and dietary fibre (5–37%). Legumes also have no cholesterol and are generally low in fat, with ±5% energy from fat, with the exception of peanuts (±45%), chickpeas (±15%) and soybeans (±47%) and provide essential minerals and vitamins. In addition to their nutritional superiority, legumes have also been ascribed economical, cultural, physiological and medicinal roles owing to their possession of beneficial bioactive compounds. Research has shown that most of the bioactive compounds in legumes possess antioxidant properties, which play a role in the prevention of some cancers, heart diseases, osteoporosis and other degenerative diseases. Because of their composition, legumes are attractive to health conscious consumers, celiac and diabetic patients as well as consumers concerned with weight management. The incorporation of legumes in diets, especially in developing countries, could play a major role in eradicating protein-energy malnutrition especially in developing Afro-Asian countries. Legumes could be a base for the development of many functional foods to promote human health.",book:{id:"5963",slug:"functional-food-improve-health-through-adequate-food",title:"Functional Food",fullTitle:"Functional Food - Improve Health through Adequate Food"},signatures:"Yvonne Maphosa and Victoria A. Jideani",authors:[{id:"201151",title:"Ph.D. Student",name:"Yvonne",middleName:null,surname:"Maphosa",slug:"yvonne-maphosa",fullName:"Yvonne Maphosa"}]}],onlineFirstChaptersFilter:{topicId:"200",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82616",title:"The Quantum Theory of Reproduction. How Unique is an Individual?",slug:"the-quantum-theory-of-reproduction-how-unique-is-an-individual",totalDownloads:12,totalDimensionsCites:0,doi:"10.5772/intechopen.105769",abstract:"Our understanding of nature’s way is founded on quantum mechanics. In its existence of over 80 years, quantum theory has been describing the physical world. The attraction of studying quantum mechanics is the perception of the conceptual structure of nature. This is aided by the mathematical structure that exposes the internal logic of the subject by inventing a notation that embeds the philosophy of the question. To describe how unique each individual is. A calculation method was applied. The uniqueness of an individual is one in two nonillion, octillion, septillion, sextillion, quintillion, quadrillion, trillion, billion, million and thousand. Individuals are indefinitely unique.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Zouhair O. Amarin"},{id:"81930",title:"Smoking and Its Consequences on Male and Female Reproductive Health",slug:"smoking-and-its-consequences-on-male-and-female-reproductive-health",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104941",abstract:"Smoking contributes to the death of around one in 10 adults worldwide. Specifically, cigarettes are known to contain around 4000 toxins and chemicals that are hazardous in nature. The negative effects of smoking on human health and interest in smoking-related diseases have a long history. Among these concerns are the harmful effects of smoking on reproductive health. Thirteen percent of female infertility is due to smoking. Female smoking can lead to gamete mutagenesis, early loss of reproductive function, and thus advance the time to menopause. It has been also associated with ectopic pregnancy and spontaneous abortion. Even when it comes to assisted reproductive technologies cycles, smokers require more cycles, almost double the number of cycles needed to conceive as non-smokers. Male smoking is shown to be correlated with poorer semen parameters and sperm DNA fragmentation. Not only active smokers but also passive smokers, when excessively exposed to smoking, can have reproductive problems comparable to those seen in smokers. In this book chapter, we will approach the effect of tobacco, especially tobacco smoking, on male and female reproductive health. This aims to take a preventive approach to infertility by discouraging smoking and helping to eliminate exposure to tobacco smoke in both women and men.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Amor Houda, Jankowski Peter Michael, Micu Romeo and Hammadeh Mohamad Eid"},{id:"81468",title:"The Knowledge and Use of Intra-Uterine Device by Women Attending Ante-Natal Clinic at Enugu State Teaching Hospital, Parklane",slug:"the-knowledge-and-use-of-intra-uterine-device-by-women-attending-ante-natal-clinic-at-enugu-state-te",totalDownloads:24,totalDimensionsCites:0,doi:"10.5772/intechopen.104097",abstract:"Intrauterine contraception has been recognized globally as one of the modern long-term reversible contraceptive methods suitable for women of all reproductive ages. It represents the most cost-effective method for preventing unwanted pregnancies, scientifically proven for its safety, efficacy and cost-effectiveness and is known to last longer in preventing pregnancy than other methods. This study assessed the knowledge of mothers attending ESUT teaching hospital, Parklane on intrauterine contraceptive device, the use as well as the common side effects experienced by the users. A descriptive survey research design was used to sample 175 mothers. A structured researcher developed questionnaire was used for data collection. The findings revealed that more than half of the respondents have good knowledge of intrauterine device but only 23 (14%) respondents make use of it. The commonly experienced side effects identified were irregular bleeding (75%) and vaginal discharge (62.5%). Although, the respondents had good knowledge of intrauterine device, their uptake of the method was poor. Therefore, there is a need to improve contraceptive counseling to ensure that women understand the relative effectiveness of IUDS. The study also recommended the need for better education for both clients and providers to improve the accessibility and acceptability of intrauterine device.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Chukwuasokam Caleb Aniechi and Uloma Cynthia Ezuma"},{id:"81003",title:"Perspective Chapter: Modern Birth Control Methods",slug:"perspective-chapter-modern-birth-control-methods",totalDownloads:38,totalDimensionsCites:0,doi:"10.5772/intechopen.103858",abstract:"This chapter focuses on various modern birth control methods, including combined oral contraceptives, progestogen-only pills, progestogen-only injectables, progestogen-only implants, intrauterine devices, barrier contraceptives, and emergency contraceptive pills. Each contraceptive method is covered in detail, including mechanism of action, effectiveness, health benefits, advantages, disadvantages, risks, and side-effects.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Rahma Al Kindi, Asma Al Salmani, Rahma Al Hadhrami, Sanaa Al Sumri and Hana Al Sumri"},{id:"80084",title:"Contraceptive Implants",slug:"contraceptive-implants",totalDownloads:174,totalDimensionsCites:0,doi:"10.5772/intechopen.101999",abstract:"Contraceptive implants or implantable contraceptive are five subdermal implants, rods the size of pencil lead that are embedded just under the skin on the inside of the upper arm. The rods contain etonogestrel, the metabolite of desogestrel, an equivalent progestin. Implants are often used during breastfeeding without an impact on milk production. It was identified that age does not affect the use of contraceptive implants but educational status is significant to its usage; there is an association between the age at first birth and the use of contraceptive implants; the number of liveborn children has a significant impact or influence on the use of implants; etc. This chapter focuses on types of contraceptive implants and its mechanism of action; global statistics on contraceptive implants; side effects; health benefits and positive characteristics of contraceptive implants; those who can and cannot use contraceptive implants; reasons women are not interested in contraceptive implants and factors influencing its usage.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Paul Hassan Ilegbusi"}],onlineFirstChaptersTotal:5},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. 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Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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