Vegetation index class (NDVI).
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{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"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"632",leadTitle:null,fullTitle:"Wide Spectra of Quality Control",title:"Wide Spectra of Quality Control",subtitle:null,reviewType:"peer-reviewed",abstract:"Quality control is a standard which certainly has become a style of living. With the improvement of technology every day, we meet new and complicated devices and methods in different fields. Quality control explains the directed use of testing to measure the achievement of a specific standard. It is the process, procedures and authority used to accept or reject all components, drug product containers, closures, in-process materials, packaging material, labeling and drug products, and the authority to review production records to assure that no errors have occurred.The quality which is supposed to be achieved is not a concept which can be controlled by easy, numerical or other means, but it is the control over the intrinsic quality of a test facility and its studies. The aim of this book is to share useful and practical knowledge about quality control in several fields with the people who want to improve their knowledge.",isbn:null,printIsbn:"978-953-307-683-6",pdfIsbn:"978-953-51-6073-1",doi:"10.5772/1142",price:159,priceEur:175,priceUsd:205,slug:"wide-spectra-of-quality-control",numberOfPages:546,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"9f7ce64f86daee44a8c5604e8924de1c",bookSignature:"Isin Akyar",publishedDate:"November 9th 2011",coverURL:"https://cdn.intechopen.com/books/images_new/632.jpg",numberOfDownloads:218352,numberOfWosCitations:165,numberOfCrossrefCitations:58,numberOfCrossrefCitationsByBook:10,numberOfDimensionsCitations:169,numberOfDimensionsCitationsByBook:14,hasAltmetrics:1,numberOfTotalCitations:392,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 4th 2010",dateEndSecondStepPublish:"December 2nd 2010",dateEndThirdStepPublish:"April 8th 2011",dateEndFourthStepPublish:"May 8th 2011",dateEndFifthStepPublish:"July 7th 2011",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"36323",title:"Dr.",name:"Isin",middleName:null,surname:"Akyar",slug:"isin-akyar",fullName:"Isin Akyar",profilePictureURL:"https://mts.intechopen.com/storage/users/36323/images/123_n.jpg",biography:"Dr. Isin Akyar graduated from School of Medicine, Cukurova University, Adana, in Turkey in 1989. She finished her Medical Microbiology Specialty training in Gazi University, Ankara in Turkey in 1999. She joined the Acibadem Labmed Clinical Laboratories in Istanbul in Turkey as a Specialist of Microbiology in 2004. She became Coordinator of Microbiology in 2007. Since 2004 she had several Quality Control trainings. She works in the first accredited laboratory according to ISO 15189 for clinical laboratories in Turkey. In 2008, she joined the Department of Medical Microbiology at Acibadem University in Istanbul in Turkey. In 2011, she was promoted to serve as an Assistant Professor. Her special interests are laboratory quality control, molecular microbiology, parasitology and proteomics studies. \nCurrently she is both serving as Microbiology Coordinator and Assistant Professor. She has been serving as an Associate Editor for the Journal of Acibadem University Science of Health since 2009.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Acıbadem University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"806",title:"Quality Control Management",slug:"industrial-engineering-and-management-quality-control-management"}],chapters:[{id:"23726",title:"Analytical Method Validation",doi:"10.5772/21187",slug:"analytical-method-validation",totalDownloads:27947,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Pedro Lopez Garcia, Ernesto Buffoni, Fabio Pereira Gomes and Jose Luis Vilchez Quero",downloadPdfUrl:"/chapter/pdf-download/23726",previewPdfUrl:"/chapter/pdf-preview/23726",authors:[{id:"42129",title:"Dr.",name:"Pedro",surname:"López García",slug:"pedro-lopez-garcia",fullName:"Pedro López García"},{id:"54461",title:"MSc",name:"Fabio",surname:"Pereira Gomes",slug:"fabio-pereira-gomes",fullName:"Fabio Pereira Gomes"},{id:"54462",title:"MSc",name:"Ernesto",surname:"Buffoni",slug:"ernesto-buffoni",fullName:"Ernesto Buffoni"},{id:"87969",title:"Prof.",name:"Jose Luis",surname:"Vilchez Quero",slug:"jose-luis-vilchez-quero",fullName:"Jose Luis Vilchez Quero"}],corrections:null},{id:"23727",title:"General Introduction to Design of Experiments (DOE)",doi:"10.5772/23878",slug:"general-introduction-to-design-of-experiments-doe-",totalDownloads:7986,totalCrossrefCites:2,totalDimensionsCites:7,hasAltmetrics:0,abstract:null,signatures:"Ahmed Badr Eldin",downloadPdfUrl:"/chapter/pdf-download/23727",previewPdfUrl:"/chapter/pdf-preview/23727",authors:[{id:"47874",title:"Dr.",name:"Ahmed",surname:"Badr Eldin",slug:"ahmed-badr-eldin",fullName:"Ahmed Badr Eldin"}],corrections:null},{id:"23728",title:"Good Clinical Laboratory Practice (GCLP) for Molecular Based Tests Used in Diagnostic Laboratories",doi:"10.5772/23963",slug:"good-clinical-laboratory-practice-gclp-for-molecular-based-tests-used-in-diagnostic-laboratories",totalDownloads:15404,totalCrossrefCites:1,totalDimensionsCites:8,hasAltmetrics:0,abstract:null,signatures:"Raquel V. 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Sarcoidosis is an inflammatory granulomatous disease that can affect multiple organ systems, most commonly the lungs. It can also affect other organs, such as the nervous system and heart. Although the exact etiology of sarcoidosis is unknown, it involves the development of noncaseating granulomas in various organs. Noncaseating epithelioid granulomas are the pathological hallmarks of sarcoidosis and symbolize the inflammatory sign of the disease. granulomas are structured masses of activated macrophages and their derivatives (i.e., epitheloid and giant cells). Neurosarcoidosis is a manifestation of sarcoidosis specifically in the nervous system. It is caused by inflammation and abnormal cell deposits in the central and/or peripheral nervous system, including the brain, spinal cord, or peripheral nerves. In this chapter, we intend to give a brief overview of the common neurologic manifestations of sarcoidosis, as well as diagnosis and management of these symptoms. We will also discuss management of steroid resistant neurosarcoidosis and atypical cases, as well as the overall prognosis of the disease.
Cases of sarcoidosis have been reported worldwide, with a prevalence of approximately 10-80 cases per 100,000 in North America and Europe. Within the United States, African Americans have a greater lifetime risk of developing sarcoidosis than Caucasians (2.4% vs. 0.85%). Worldwide, females have a slightly greater risk of developing this disease. The incidence of sarcoidosis can be described as having a bimodal pattern, with most cases occurring between the ages of 20-40 years old and a second commonly affected group being females who are over the age of 50 [1].
About 5-16% of patients with sarcoidosis have neurologic involvement. The most frequent neurologic abnormality includes cranial and peripheral neuropathy, followed by mononeuropathy, myopathy, psychiatric disorders, cerebellar ataxia, hydrocephalus and papilledema. Neurosarcoidosis is also more prevalent in people of African descent and uncommon in people of Chinese descent and Southeast Asians. It is estimated that isolated neurosarcoidosis, without clinical evidence of systemic sarcoidosis, occurs in less than 1% of sarcoidosis patients [2].
Sarcoidosis was first clinically described in 1878 by a dermatologist Dr. Johnathan Hutchinson, who called the disease ‘Mortimer\'s Malady’, in reference to his patient’s name [3]. He wanted to prove it by a biopsy but the patient refused. Then in 1889, Dr. Ernest Besnier described a similar case which he called lupus pernio due to the “chillblain-like swelling” of the nose and the lupus-vulgaris appearance of the fingers. Besnier also did not have histologic findings. It was not until 1892, Tenneson showed a second case of lupus pernio accompanied by histological studies showing lesions which contained epithelioid cells and giant cells. This was the first description of a sarcoid granuloma. Cesar Boeck, in 1899, called it `Multiple Benign Sarkoid of Skin’ which later gave birth to the term ‘sarcoidosis’. A few years later, central nervous system (CNS) involvement by sarcoidosis was recognized in 1905 by Winkler [3].
Currently, the etiology of sarcoidosis is unknown. There have been hypotheses made including infectious agents, occupational/environmental factors, genetic factors and autoimmune disorders. There has not been a specific pathogen or pathogenic agent linked to the disease. One thought is that the inflammatory response in sarcoidosis, which is characterized by large numbers of activated macrophages and T lymphocytes bearing the CD4-helper phenotype, along with cytokine production is most consistent with a Th1-type immune response commonly triggered by antigens [4]. Also, seeing the trends of blacks and family clusters having increased numbers of the disease, there is a possibility that it is genetic. Many patients with sarcoidosis have the HLA-Factor B 8 (on chromosome 6) and DR 3. Another theory includes inhalation of an antigen that causes granulomatous inflammation in mediastinal lymph nodes and then extends to the lungs and other tissues.[5] Environmental factors involve infections, such as
Neurosarcoidosis and multiple sclerosis can present with similar symptoms, such as optic neuritis. It is important to be able to differentiate the two, due to different responses to management and therapy. Since sarcoidosis is often a multisystem disease, solitary nervous-system sarcoidosis is difficult to diagnose, which may delay treatment. The neurological symptoms make it a serious and commonly devastating complication of sarcoidosis [6].
Neurosarcoidosis is seen in approximately 5% of sarcoidosis patients. Of these patients, some may have neurological findings on initial presentation, while others present de novo with neurological signs and symptoms that are consistent with a diagnosis of sarcoidosis [7]. Onset of neurosarcoidosis is most common in the fourth or fifth decades, and typically occurs after patients have had systemic symptoms for some time.
Cranial mononeuropathies frequently occur in neurosarcoidosis. In 2009, Joseph and Scolding conducted a study of 30 new cases of sarcoidosis, and reported cranial neuropathies in 80% of the patients [8]. The 7th cranial nerve is often affected. In fact, peripheral facial nerve palsy has been noted in up to 50% of patients with neurosarcoidosis. Oftentimes, Bell palsy is found to be the first manifestation of sarcoidosis and may resolve prior to development of additional symptoms. While facial neuropathies may arise due to basilar meningitis, some cases can be attributed to granulomatous inflammation of the extracranial part of the nerve [9].
Recent studies have found optic neuropathy to be a more common manifestation than previously thought. Patients can present with myriad complaints, ranging from blurry vision and papilledema to retro-bulbar pain and pupillary abnormalities. Palsies of the 8th cranial nerve also occur, leading to auditory and vestibular problems. Extra-ocular movements can become impaired due to involvement of the 3rd, 4th, and 6th cranial nerves. Olfactory involvement is rare, but has been reported in some cases, leading to anosmia and impaired taste.
Neuroendocrine dysfunction is often seen in neurosarcoidosis patients, causing them to present with polyuria, changes in thirst, sleep, appetite, temperature, or libido. The hypothalamus and pituitary gland are also often affected, leading to thyroid, gonadal, and adrenal- related symptoms. This usually occurs as a result of subependymal granulomatous infiltration of the 3rd ventricle [9]. Other common symptoms include impaired taste and smell, slurred speech, weakness of trapezius and sternocleidomastoid muscles, and tongue deviation and atrophy. Additionally, carpal tunnel syndrome appears to occur more often in sarcoidosis patients, than in the general population. Occasionally, patients may present with the rare Heerfordt syndrome, characterized by fever, uveitis, parotid gland swelling, and facial nerve palsy [10].
In addition to the hypothalamus and pituitary gland, central nervous system involvement can affect the cerebral cortex, cerebellum, and occasionally the spinal cord. This can occur due to granulomatous inflammation in a perivascular pattern. Granulomas in various parts of the brain parenchyma have even been known to mimic brain tumors such as gliomas, meningiomas, and schwannomas.
Meningeal symptoms have been reported in a substantial number of patients; and can cause many of the aforementioned symptoms. Examination of the cerebrospinal fluid typically shows a mononuclear infiltrate and elevated protein. Cognitive and behavioral problems, along with focal neurologic deficits can occur. If the spinal cord is affected, myelopathies and radiculopathies can occur, and the cauda equina may be affected. Communicating and non-communicating hydrocephalus have been seen in these patients, and sudden death can also occur due to an acute obstruction of CSF flow. Seizures may also occur due to a variety of causes. They are seen as an initial finding in 10% of patients. Sudden death can also occur with involvement of the brainstem leading to central hypoventilation [9].
Patients can present with various types of peripheral neuropathies, including, but not limited to mononeuropathy, sensory polyneuropathy, and acute and chronic inflammatory polyneuropathy. Nerve biopsy typically shows noncaseating granulomas, but necrotizing vasculitis may also be seen. Muscle involvement is commonly seen, and is typically secondary to granulomas in the perimysium; however, only a very small number of patients are actually symptomatic. Onset of myopathy usually occurs later in the course of the disease, after involvement of other organ systems has already been noted. Patients may present with acute myopathy, in a similar manner to polymyositis, or may have more chronic symptoms with associated muscle wasting [9].
Sarcoidosis has been shown to affect many parts of both the central and peripheral nervous systems, and patients present with a wide variety of neurological symptoms. Often this can cause difficulties in making a diagnosis, as the reported symptoms are diverse and can mimic several other disease processes, such as Guillain-Barre Syndrome, Multiple Sclerosis, and even psychiatric diagnoses. In April 2012, Spiegel et al noted psychiatric manifestations, such as delirium and psychosis, in about 20% of neurosarcoidosis patients, which is equivalent to approximately 1% of all patients with sarcoidosis. Although this is a rare occurrence, these patients can experience striking auditory and visual hallucinations and delusions [11].
Patients have also reportedly presented with hypersomnolence and hyperphagia consistent with Kleine-Levine-Critchley syndrome [12]. In sum, as neurosarcoidosis can present in many ways, clinicians should maintain a high index of suspicion for the disease, especially in those patients who are not known to have sarcoidosis prior to presenting with neurological manifestations. The disease can be very severe and often life-threatening.
Neurosarcoidosis has no pathognomonic sign, therefore it is a diagnosis of exclusion. This presents a great challenge, especially when the patient does not previously have a confirmed diagnosis of systemic sarcoidosis. The differential diagnosis encompasses a diverse number of pathologies such as Bell’s palsy due to Lyme disease, optic neuropathy due to MS, tuberculosis, carcinomatous or lymphomatous meningitis causing multiple cranial nerve palsies. Additional pathologies include metastatic lesions, encephalopathy via syphilis or CNS vasculitis, peripheral neuropathy, or parenchymal lesions such as astrocytomas. Therefore, it is important to think of all the possibilities and rule them out [8].
If neurosarcoidosis is suspected, the patient should be evaluated for evidence of extraneural disease due to the difficulty of obtaining nerve tissue for evaluation. It is imperative to check the skin, lymph nodes and lungs. Other tests that may be useful include ophthalmologic examination, endoscopic nasal and sinus examinations. Radiological tests include neuroimaging (discussed later) and chest x-ray or CT scan to search for hilar adenopathy or parenchymal changes consistent with pulmonary sarcoidosis, serum angiotensin converting enzyme (ACE) assays (nonspecific) and lumbar puncture to analyze CSF. CSF findings may show an increased opening pressure, protein up to 250mg/dL, mononuclear pleocytosis, IgG elevation, oligoclonal bands, glucose normal or low; and CSF ACE is possibly elevated. CSF ACE levels have a relative low sensitivity. Although most studies do not mention immunoglobulins levels in CSF, there is evidence that elevation of immunoglobulin IgG with a high CSF to serum IgG index may be common in CNS sarcoidosis [13]. CSF eosinophilia has also been reported as a consequence of neurosarcoidosis, [14] but may also be present in other infections, inflammatory, and neoplastic conditions, including lepto-meningeal spread of gliomas [15]. Of note, always be cautious of doing a LP in a patient that possibly has increase intracranial pressure. If this is suspected, check for papilledema by using a fundoscope and MRI imaging preceding the LP [8]. Routine laboratory tests may show hyperglobulinemia, hypercalcemia or elevation of alkaline phosphatase [16]. Hypercalcemia occurs in approximately 13-20% of cases due to high levels of 1,25-dihydroxy-vitamin D causing hyperabsorption of calcium [17,18].
Sarcoid lesions in the CNS do not differ from those encountered in other organs. Most cases of CNS sarcoidosis diagnosed by histology have shown variable degrees of meningoencephalomyelitic infiltration, either localized or widespread. This results in focal or disseminated meningeal nodules or plaques, and affecting particularly the basal meninges. Although sarcoid lesions can occur almost anywhere in the central nervous structures, most often they are located perivascularly, with varying degrees of associated gliosis and fibroblast proliferation [3].
Noncaseating granuloma in parietal lobe showing the granuloma surrounded by epithelioid cells and nodular inflammatory infiltrates (hematoxylin and eosin, 10x). [
One may need to use other tests such as EEG, evoked potentials, and angiography to exclude other causes. Another test, the Kveim-Siltzbach, is not standardized and is not available universally. However, it can show positive granuloma results 4-6 weeks after injecting part of a spleen from a patient with known sarcoidosis into the skin. According to a study by C K Liam and A Menon, the Kveim-Siltzbach test can show false negative results when done in conjunction with corticosteroid use possibly due immunosuppressive effects. There is also concern that HIV and hepatitis transmission could occur through this technique [8].
As a last resort, a biopsy is done of the meninges, brain, or spinal cord. Biopsies from extraneural tissue are recommended as it is less risky, but if it is highly suspected and a person with known sarcoidosis with neurologic involvement is deteriorating despite therapy, the neural tissue can be sampled [19]. Most common sites include the meninges and mass lesions.
Neurosarcoidosis does not have a specific finding on imaging that can assure the diagnosis. However, neuroimaging along with neurologic evaluation, CSF analysis, biopsy and others can aid in making the diagnosis. Oftentimes, it is a brain contrast-enhanced MRI and CSF analysis that gives the presumptive diagnosis. Contrast MRI allows one to visualize meningeal or parenchymal involvement of active inflammation with disruption of the blood brain barrier as well as masses and hydrocephalus.
As mentioned previously, cranial nerve palsies are the most common presentation in neurosarcoidosis, which can be seen on MRI with inflammation along with spinal cord involvement as well [20]. There have been studies done in which enhanced CT was shown to be normal, but the enhanced MRI was abnormal, implying greater sensitivity of MRI for detection neurosarcoidosis lesions [21].
In neurosarcoidosis, leptomeningeal disease is a common pattern of involvement, which may be localized or widespread. Less commonly, granulomatous masses can be found within the cerebral parenchyma. There have been cases showing patients with cranial nerve palsies demonstrating clear evidence of focal meningeal disease on gadolinium-DTPA enhanced MRI brain scans. Neurosarcoidosis is difficult to diagnose when patients have no evidence of granulomatous disease outside the nervous system because of the difficulty of obtaining tissue for histological examination. Therefore, primarily neurological evaluation, neuroimaging and lumbar puncture are done. However, diffuse meningeal infiltration particularly in the skull base region is frequently found at necropsy. Two cases presented by Khaw et al showed Gadolinium-DTPA enhanced MRI’s in patients with cranial nerve palsies; one with solely cranial nerve palsies and the other along with gynecologic manifestations. In both of these cases, the meninges were affected by the disease and patients presented with multiple lower cranial nerve palsies, which was not picked up by CT or non-contrast MRI [22].
According to Pawate et al, a study done on 54 cases of neurosarcoidosis, the majority (23%) were found to have intraparenchymal T2 hyperintense lesions on brain MRI. 19% were found to have meningeal involvement seen with gadolinium enhanced MRI. Few of these cases showed intracranial masses, normal brain or solely spinal cord involvement on MRI [23].
When the CNS is involved, brain enhanced MRI and CSF studies are sensitive in the detection of CNS inflammation, however they lack specificity. This continues to make diagnosing neurosarcoidosis a clinical challenge.
Neurosarcoidosis involving the pituitary-hypothalamic axis. T-1 gadolinium-enhanced Axial (a) and coronal (b) views shows an area of abnormal enhancement involving the sellar, suprasellar regions and the interpeduncular cistern. The diagnosis was confirmed by a biopsy [
Meningeal neurosarcoidosis. Axial (a) and coronal (b) MRI T-1 weighted images post infusion of gadolinium DTPA in a patient with systemic sarcoidosis show thickening and enhancement of the dura surrounding the left hemisphere [
While sarcoidosis is a progressive autoimmune disease and there is currently no cure, symptomatic treatment is available. Corticosteroids have become the treatment of choice for neurosarcoidosis. The dosage and duration of therapy varies based upon the type and severity of the symptoms. For instance, patients who present with peripheral facial nerve palsy or meningeal symptoms are given about 0.5mg/kg/day of prednisone for two weeks. On the other hand, a patient with myopathy is given the same dosage for four weeks, and a patient with a mass lesion or symptomatic hydrocephalus is given two to three times this amount for four weeks. Very severe cases of neurosarcoidosis benefit from IV methylprednisone 20mg/kg/day for three days, followed by 1-1.5mg/kg/day of prednisone for two to four weeks [24].
The exact mechanism by which corticosteroids have benefited patients with neurosarcoidosis is unclear, but is generally believed to be secondary to its anti-inflammatory and immunomodulatory effects. Corticosteroids are known to prevent leukocytes from gaining access to sites of inflammation, interfere with their function along with that of endothelial cells and fibroblasts, and suppress production of various humoral factors [25]. It is always important to keep in mind, however, that as with all medications, corticosteroids are not without side effects. Common side effects of corticosteroids include cognitive and personality changes, weight gain with central obesity, development of striae, diabetes mellitus, cataracts and predisposition to various infections. Cardiovascular effects are also known to occur, such as hypertension, dyslipidemia, and increased risk of myocardial infarction and stroke. Patients receiving long term corticosteroid therapy are at risk for osteoporotic fractures, especially in the setting of other general risk factors such as being over age 60 or having osteoporosis prior to corticosteroid treatment. Additionally, avascular necrosis, especially of the hip, has been known to occur in a number of patients [1]. Therefore, it is important to carefully monitor the dosage, and to always use the lowest possible effective dose. If treatment with corticosteroids is to be discontinued, it is essential to decrease the dose gradually. Abrupt discontinuation of corticosteroid therapy can cause adrenal insufficiency.
Several therapies have been proposed for those patients in whom corticosteroid treatment is unsuccessful, or in those who have contraindications to treatment. Many of these studies have shown methotrexate to be an effective treatment. Methotrexate has been successful in two-thirds of sarcoidosis patients regardless of the organ systems that are affected. In one study, EE Lower et al observed 554 sarcoidosis patients, of which 71 had neurosarcoidosis. They found that treatment with methotrexate and cyclophosphamide was associated with higher response rates than treatment with corticosteroids only [26].
In 2007, TF Scott et al used aggressive therapy with corticosteroids and alternative immunosuppressants in 48 patients. Over half of these cases had favorable outcomes [27]. Later, in 2011, G Androdias et al observed a small group of patients with neurosarcoidosis, and found evidence suggesting that Mycophenolate mofetil was effective in treatment of CNS symptoms. The agent was also found to have a steroid sparing effect and was better tolerated than several other immunosuppressive agents [28]. Additional studies have shown anti-TNF agents such as infliximab to be effective; and cytokine modulators such as thalidomide and pentoxifylline have also been used in a limited number of cases [29].
Surgical resection of CNS mass lesions is usually not recommended, unless the mass persists or continues to enlarge despite appropriate immunomodulatory therapy. If the patient presents with symptomatic hydrocephalus, a ventriculoperitoneal shunt can be placed. It is important to continue immunosuppressive treatment following placement of the shunt as inflammation can lead to obstruction. Cranial or spinal irradiation is suggested in refractory cases if no response is seen with corticosteroids and at least two other agents [30]. Additionally, symptom-specific treatment may be needed, such as hormone replacement therapy for hypopituitarism, and antipsychotics for patients with psychosis.
While many patients with neurosarcoidosis have a monophasic illness, relapsing-remitting and progressive disease patterns are also seen. RA Luke et al followed 25 patients with neurosarcoidosis for a minimum of 5 years or until death. 68% of the patients were found to have the monophasic pattern and 32% had a relapsing pattern [31]. The authors also noted that relapses were more common in patients with cerebral symptoms and in those presenting with hydrocephalus. Furthermore, relapses occurred more frequently in those who were taking smaller doses of corticosteroids (10mg or less).
Although the long term outcomes in neurosarcoidosis patients have not yet been clearly defined in studies, some general conclusions can be made. Patients with peripheral facial nerve palsy often show improvement within 2-4 weeks. Some patients with optic neuropathy show improvement, while others with a more progressive disease pattern can become blind. In 1999, G.A. Christoforidis et al conducted a retrospective study of 461 patients with sarcoidosis, confirmed on biopsy. These researchers reported that patients with optic nerve involvement often did not respond as well to corticosteroid treatment as those with other CNS manifestations did. The researchers suggest that because the other cranial nerves are surrounded by Schwann cells, they can regenerate more easily than the optic nerve, whose myelin sheath is produced by oligodendrocytes [32].
Symptoms such as peripheral neuropathy and myopathy also tend to follow a more chronic and progressive pattern. Aseptic meningitis usually improves within a few weeks, yet CSF abnormalities (asymptomatic chronic pleocytosis) can persist for some time after. Mass lesions often persist for some time, but can also resolve on occasion. Additionally, patients with encephalopathy often exhibit a progressive pattern. Typically immunomodulatory medications are not helpful in patients with endocrinopathies, and these patients need to be treated with hormonal replacement therapy. Also, a series of 68 patients were followed by JP Zajicek et al in 1998, who noted spinal cord involvement in 28% of the patients [33]. The authors concluded that spinal cord disease had a poorer prognosis, as a significant percentage of these patients were found to have deteriorated at follow-up. Patients with seizures have historically been shown to have a poorer prognosis, but more recent studies have disproved this [8].
In general, as the outcome in patients with neurosarcoidosis depends on the severity and types of neurological symptoms, it is difficult to make a conclusive statement regarding the prognosis of the disease. Reportedly, about 10% of patients with neurosarcoidosis die of the disease, typically secondary to CNS parenchymal involvement, hydrocephalus, or other severe symptoms; or due to immune-compromise secondary to treatment.
Neurosarcoidosis can range from mild to life threatening; and can affect any part of the central and peripheral nervous systems. It can present at any point during the course of the disease process. Many patients do not experience neurological symptoms until the disease has progressed for some time, and systemic symptoms are present. Other patients have neurological manifestations of the disease at the time of initial presentation. Overall, however, neurosarcoidosis only represents a small portion of the total population of patients with a diagnosis of sarcoidosis - about 5%. If patients present with neurological symptoms, with no prior diagnosis of sarcoidosis, it might prove difficult for clinicians to make a diagnosis. This is because these symptoms are quite general and can be seen with a multitude of other diseases. Patients have been reported to have not only general cranial nerve palsies and peripheral neuropathies, but also have been known to present with meningeal symptoms, hydrocephalus, seizures, and even psychosis.
Since the exact cause of neurosarcoidosis is not known, it is important to be aware of any clinical signs early on. It is also important to differentiate it from other diseases with similar manifestations, such as multiple sclerosis due to differences in management and treatment. There are many clinical and lab tests available, as well as imaging that can help determine if one has neurosarcoidosis. Although there is no pathgnomonic sign, brain contrast MRI is a vital tool along with CSF analysis that can give a presumptive diagnosis. They are highly sensitive, although lack specificity, which makes it difficult to definitively diagnose it. Gullapalli and Phillips found a sensitivity of brain MRI of about 82–97% for MS; for CSF abnormality and CSF ACE, sensitivity was 50–80% and 50%, respectively [34]. The most definitive diagnosis can be made from histological analysis of neural tissue via biopsy if there is still doubt despite the other tests or at autopsy. However, it is used as a last resort due to being the most invasive method.
As with other sarcoidosis patients, corticosteroids are the main treatment for neurosarcoidosis. However, some manifestations are more responsive to steroids than others. Additionally, many patients taking corticosteroids for an extended period of time often experience serious side effects; and there are also several contraindications to taking these medications. For this reason, several alternative therapies have been proposed for sarcoidosis patients, and several studies have found methotrexate and cyclophosphamide to be especially effective in treatment of neurological symptoms. Many other immunomodulatory medications have also been shown to be effective along with various symptom- specific treatments.
While many studies have been conducted with regards to the long term outcomes of neurosarcoidosis patients, no definitive conclusions can be made as yet. However, the prognosis for these patients is mainly dependent on the neurological manifestations they experience. Patients with cranial nerve palsies, and particularly optic neuropathies, have been shown in many cases to respond well to corticosteroid treatment. More serious symptoms on the other hand, such as seizures and spinal cord involvement generally suggest a poor prognosis. However, one must also keep in mind, that various disease patterns have been reported in neurosarcoidosis patients. Neurosarcoidosis may present as a monophasic, relapsing-remitting, or chronic progressive pattern. Thus, additional studies need to be conducted before any conclusive statements can be made regarding the outlook for patients with neurosarcoidosis.
CNS: central nervous system
CD4: cluster of differentiation 4
Th1: type 1 helper cells
HLA: human leukocyte antigen
MS: multiple sclerosis
ACE: angiotensin converting enzyme
CSF: cerebrospinal fluid
LP: lumbar puncture
MRI: magnetic resonance imaging
HIV: human immunodeficiency virus
EEG: electroencephalogram
CT: computed tomography
DTPA: diethylene triamine pentaacetic acid
Mg: milligrams
Kg: kilograms
IV: intravenous
TNF: tumor necrosis factor
It is no stranger that forest areas and other vegetation areas are balancing components of various cycles in nature, including for circulation of climate and local-scale weather. Utomo argues that climate is a generalization of various weather conditions in a large area in a long time. Climates always change according to space and time. Based on certain timescale, climate change will form a particular pattern or cycle, daily, seasonal, annual, and several yearly cycles [1]. In addition to changes in patterned cycles, human activity causes climate patterns to change sustainably, both on a global and local scale. Forests regulate the temperature of the earth and weather patterns which are carried out by storing large amounts of carbon and water. This function as regulator also has a huge influence on the local climate. The role of forests as a regulator of the microclimate in the surrounding environment is very important [2]. Of course the different conditions of the forest in an area have different capabilities in regulating the microclimate in the forest environment, for example, air temperature, air humidity, reception of sunlight, and deficit of water vapor pressure. In general, the microclimate that arises is caused by the existence of various differences from the weather and climate conditions which are quite large, especially the physical properties of the atmosphere. Air temperature near the surface of the ground is strongly influenced by the amount of solar radiation absorbed by the surface of the soil itself. Some of the radiation received by the soil surface during the day is used to heat and propagate to deeper parts, and some of it is irradiated in the form of heat waves that heat the air and evaporate water. Short energy solar radiation that propagates into the soil is converted into heat energy in the soil which will affect the temperature of the soil.
The influence of forests on climate is very important with increasing forest area and forest stand density. At first the forest compiler vegetation was only affected by microclimate, but later it was gradually influenced by the macroclimate and mesoclimate. Climate elements that affect the growth of vegetation include rainfall, temperature, wind, sunlight, humidity, and evapotranspiration. In other words there is a close relationship between climate patterns and the distribution of forest stands. Therefore some climate classifications are based on the world of vegetation. Vegetation has been seen as something sensitive and complex to climate influences, such as solar radiation, heating of soil and air, soil and air humidity, and so on. Seeing the close relationship between forests and climate, the increasing number of forest areas that have been converted into non-forest areas resulting in degradation and deforestation in almost all parts of the world has triggered climate change. The impact of this climate change has caused human misery both in urban and rural areas. This paper intends to describe a city whose population is uncomfortable due to the many natural disasters that occur because of the illegal settlements of protected forest areas in the center of Ambon Island. Besides that, it is also due to the limited GOS in the city. This happened because of conflicts in the nuances of the tribe, religion, and race (TRR) that occurred in years 1999–2002.
This research uses survey and descriptive methods. The study was conducted in Ambon City, Maluku Province, Indonesia. Ambon City or Ambonese is a big city and also the capital of Maluku Province with a land area of 359.45 km
To find out rainfall patterns and climate information in Ambon City, it was conducted by collecting various climate data, i.e., humidity, precipitation, wind, temperature, etc., and the history of natural disasters in Ambon City. Based on everyday experience, if we are in a vegetated area, it will feel cooler and more comfortable. This is especially felt during the daytime during the dry season. This is closely related to air humidity and air temperature conditions around us. In this regard, to analyze the distribution of humidity, air temperature, and its relation to a fairly extensive urban vegetation distribution, spatial analysis on the geographical information system (GIS) can be used. Besides that, the normalized difference vegetation index (NDVI) approach is also used to monitor vegetated areas. NDVI quantifies vegetation by measuring the difference between near-infrared (NIR) (which vegetation strongly reflects) and red light (which vegetation absorbs) [3]. Remote sensing and GIS technology have advanced rapidly in recent decades and now play an important role in environmental fields, i.e., climate science, biodiversity conservation, forestry, urban–rural planning, land and water management, etc. Thus spatial data is becoming increasingly accessible and used by various governments and research institutions, private businesses, consulting companies, and others.
The distribution of vegetation in Ambon City is obtained by the NDVI value approach. The vegetation index value is calculated as the measured reflection ratio of the red (R) and near-infrared (NIR) bands on the electromagnetic wave spectrum. Both of these bands were chosen as vegetation index parameters because the measurement results were most affected by the absorption of leaf chlorophyll or green vegetation. In general the NDVI formula is written with the following equation:
where NIR is near-infrared and R is infrared. NDVI is classified into four classes of greenness level as presented in Table 1.
No. | Vegetation index class | Greeness level |
---|---|---|
1 | 0.40–1 | High |
2 | 0.25–< 0.40 | Medium |
3 | 0.03–< 0.25 | Low |
4 | −1–< 0.03 | Non-vegetated |
Through the NDVI distribution map, a ground check was then carried out. Locations selected, for example, are determined considering places that have high, medium, and low NDVI values and are not vegetated. In this case, nine sample points are set to take observational data in the field which include the distribution of vegetation (grass and trees), air temperature, air humidity, solar radiation, and noise that are evenly distributed in urban areas. The location mapping activity was carried out directly on the green lane along the road and the city park area in the corner of Ambon City spatial planning, and the distribution of the stand inventory lane was adjusted to the potential of plant species to facilitate recording and measurement. Vegetation mapping in open green areas in the spatial layout is done by GIS using ArcGIS 10.1 software. The collection of vegetation (grass and trees) plot points is carried out using global positioning system (GPS). Landsat ETM-8 imagery is processed using ENVI 4.7 and MAPINFO 10.5 software for merging image data bands. To find out the value of DI in this study, use the formula of DI [5] as follows:
where
No. | Discomfort index | Discomfort condition | Remarks |
---|---|---|---|
1. | DI < 21 | Comfort | 100% comfortable |
2. | 22 ≤ DI ≤ 24 | Less than 50% of the population feel discomfortable | 50% uncomfortable |
3. | 25 ≤ DI ≤ 27 | More than 50% of the population feel discomfortable | 60% uncomfortable |
4. | 27 ≤ DI ≤ 29 | Most of the population feel discomfortable | 70% uncomfortable |
5. | 30 ≤ DI ≤ 32 | High-level discomfort | 80% uncomfortable |
6. | DI ≥ 32 | Need health services | 100% uncomfortable |
Classification of
Based on the discomfort value in Table 2, three discomfort distribution maps are made, each of which includes six discomfort classes for Ambon city at 09:00–12:00 pm and 16:00 pm. Ground check is carried out in nine sampling locations by observing the discomfort distribution map created. The interview activities were carried out to 150 respondents or 150 head of families aged between 30 and 60 years at the sampling location. The aim is to see representation in capturing information and data on population comfort levels related to the existence of GOS in Ambon City. The next step is to overlay the NDVI distribution map with the three discomfort distribution maps. Thus three new maps were obtained, i.e., the NDVI distribution index map and discomfort in Ambon City at 09:00–12:00 pm and 16:00 pm.
The climate in Ambon City is classified as a tropical climate with significant rainfall with precipitation even during the driest month. The climate here is classified as Af based on the Köppen-Geiger system. The average rainfall is 3392 mm, and the average temperature in Ambon City reaches 26.5°C. The lowest average precipitation in November is 103 mm, while the highest is 622 mm in June (Figure 1).
Ambon City climate. Source: Climate-Data [
In connection with the highest precipitation, the months June, July, and August are the months of caution for the city government and residents of Ambon City because it is the time of natural disasters (floods and landslides). The average air temperature is 27.5°C in January which is the hottest month and 25.0°C in July which is the coldest month of the year (Figure 2).
Air temperature of Ambon City. Source: Climate-Data [
Between the driest and wettest months, the difference in precipitation is 519 mm. The variation in annual temperature is around 2.5°C. The Ambon City climate is presented in Table 3.
Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Average temperature (°C) | 27.5 | 27.4 | 27.3 | 26.9 | 26.4 | 25.5 | 25 | 25.3 | 25.9 | 26.4 | 27.2 | 27.4 |
Minimum temperature (°C) | 24.1 | 24 | 23.9 | 23.9 | 23.7 | 23.2 | 23 | 23.1 | 23.2 | 23.3 | 23.7 | 24 |
Maximum temperature (°C) | 30.9 | 30.9 | 30.8 | 30 | 29.1 | 27.9 | 27.1 | 27.5 | 28.6 | 29.6 | 30.8 | 30.9 |
Average temperature (°F) | 81.5 | 81.3 | 81.1 | 80.4 | 79.5 | 77.9 | 77.0 | 77.5 | 78.6 | 79.5 | 81.0 | 81.3 |
Minimum temperature (°F) | 75.4 | 75.2 | 75.0 | 75.0 | 74.7 | 73.8 | 73.4 | 73.6 | 73.8 | 73.9 | 74.7 | 75.2 |
Maximum temperature (°F) | 87.6 | 87.6 | 87.4 | 86.0 | 84.4 | 82.2 | 80.8 | 81.5 | 83.5 | 85.3 | 87.4 | 87.6 |
Precipitation/rainfall (mm) | 126 | 118 | 136 | 261 | 508 | 622 | 587 | 405 | 248 | 148 | 103 | 130 |
During the last 7 years, there have been at least four floods, i.e., in year 2012, 2013, 2016, and 2017. Floods occurred in August 2012 in inundated five sub-districts: Nusaniwe, Sirimau, Ambon Bay, Baguala, and Leitimur [7]. In the village of Galala, floods soaked dozens of homes with 50 cm of water. In addition, the 3-m-high river water barrier and sea waves beside the Galala Bridge were damaged and collapsed [8]. Floods in year 2013 also occurred due to heavy rain for 2 days, July 29–30, 2013 [9]. These massive floods and landslides have caused 14 fatalities and forced thousands of residents to leave their homes and left huge infrastructure and environmental damage. The natural floods and landslides occurred again on July 16–17 and July 29–August 1, 2016. This disaster has caused damage to infrastructure and public facilities so that it covers the street body and shoulders at 10 points [10]. Moreover, floods also occur in the following year, 2017. A little description of the rainfall situation that triggers the occurrence of flooding is as follows: the rainfall in the Maluku Province exceeds the normal limit in the period of June 1–14, 2017. The amount of rainfall then continues to increase because it is the peak month of rain. Based on the Council of Meteorology, Climatology, and Geophysics measurements recorded 842 mm while normal rainfall in June ranges from 690 mm. This increase actually happened in the previous month (May 2017) where it was recorded at the Pattimura Ambon Meteorological Station, which was 753.3 mm, significantly exceeding normal rainfall of 400–500 mm. In addition the wind speed reaches 10–40 km/hour where the wind blows from east to southeast. This high rainfall is generally due to closed circulation around the Makassar Strait, attracting most of the saturated mass from the southern Pacific region through a large portion, Maluku region. As a result, there is a change in air mass in the central and northern Maluku regions. Meanwhile, the air humidity of the upper layers of the Maluku region shows a relatively wet condition (80–100%), which indicates the addition of water vapor supply. This is what drives the occurrence of high rainfall which will result in floods and landslides [11]. As a result of the overflowing of a number of rivers in the city of Ambon, dozens of houses and some roads in the city were submerged.
The amount of damage caused by floods is triggered by extreme rainfall, and there are also violations of the stipulated city spatial plan. As is known, Ambon City had been hit by social unrest motivated by the TRR between years 1999 and 2002. Residents of Ambon City felt the bad effects of riots that occurred more than a decade ago. One prominent factor is the construction of settlements that violate many spatial rules that have been set by the Ambon City government such as land clearing for settlements, agriculture and other activities in protected forests, etc. After the year of TRR conflict, many new settlements were built very heavily on cliffs, riverbanks, and valleys that were very risky for natural disasters. The most severe is the expansion of settlements in protected forest areas of Gunung Sirimau. This condition is exacerbated by the behavior of people who carelessly dispose of and accumulate garbage in places and areas that are not supposed to. This has an impact on natural disasters that are increasingly common in Ambon City and Islands. Ambon Island as a whole has a high disaster risk index.
In connection with the more frequent occurrence of floods, the Maluku Regional Development Planning Agency (BAPPEDA) has made the map of flood risk of Ambon City. The map was made from data on capacity and vulnerability of Ambon City to disaster and also disaster map of Ambon City (Figure 3). In this figure, it can be seen that almost half of Ambon City has a medium and high level of flood risk (yellow and red area).
The map of flood risk of Ambon City. Source: BAPPEDA Maluku [
Nara has analyzed rainfall trends toward extreme data on watersheds on Ambon Island for 32 years (1984–2015). In this study, the Mann-Kendall method and extreme value theory (EVT) were used to discuss extreme events that occurred and were modeled with the generalized extreme value (GEV) distribution, and the result was a trend of changes in rainfall in Ambon city. The annual maximum daily rainfall occurs in year 1984 which is 430.70 mm, and the minimum is 0 mm in year 1999, 2001, and 2003. Average rainfall varies between years 1984 and 2015, which is 25.63 to 131.408 mm, while the average value is 181.07 mm [13]. The distribution of average monthly rainfall in the study area tends to increase rainfall for 32 years but is not too significant because the rainfall data series is put together. Statistically, a significant trend was found for 8 months with an upward trend (positive) and 4 months experiencing a downward trend (negative). In other words, in a year there is an upward trend (positive) for 8 months, and the trend decreases for 4 months significantly (α = 0.05), and there is an increase in rainfall for the period of 1984–2015. Based on the results of the tests conducted, it has provided an analysis that rainfall data follows the form of GEV distribution with an average (μ) = 38,629, standard deviation (σ) = 36.64, and shape (ξ) = 0.436. This proves that rainfall in the watershed in Ambon Island has extreme distribution and has a maximum value distribution function for observing a period that is appropriate for the return period [13].
The ideal climate for humans is clean air with temperatures of approximately 27–28°C and air humidity between 40 and 75% [14]. However, this condition often changes in a certain period of time which is quite drastic. This is caused by a significant change in land use, due to changes in the designation function, for example, from forested land to non-forest. Not only humans, in fact flora and fauna also often feel unfavorable effects due to changes in microclimate conditions, especially air temperature and air humidity [14]. If based on Laurie’s opinion in 1986, the population of Ambon City is far from ideal climate conditions. Based on our direct measurement, results in 2017 are as follows: air temperature at 09:00, 12:00 pm, and 16:00 pm, respectively, is 26.73–29.97°C, 30.60–35.00°C, and 27.70–33.43°C; air humidity, respectively, is 85.67–97.00%, 35.00–64.33%, and 57.67%; and solar radiation, respectively, is 95–617 lux, 150–1299 lux, and 126–1252 lux. This situation will worsen if the wind speed on a certain day is very low. It is not surprising that the use of fans and air conditioners in government and private offices, shopping centers, and settlements has increased from year to year. Actually, this can be slightly overcome by the existence of urban green space (UGS)-GOS which is filled with a variety of vegetation. Unfortunately the existence of UGS-GOS is still very limited. UGS, green open space, city parks, vegetation areas, and others are useful in maintaining the natural balance of the city structure. Green spaces should not be considered as inefficient land or reserve land for urban development or simply a beauty program because they play a major role in balance, continuity, sustainability, comfort, health, and improvement of the quality of the city environment [15].
In general the development of urban areas will increase over time. The availability of facilities and infrastructure in urban areas to meet the living needs of the population (boards, food, clothing, vehicles, entertainment, etc.) has encouraged the increasing number of villagers to move toward urban areas or urbanization. Of course cities that have exceeded their carrying capacity will have many negative impacts on the environment. Not infrequently if in a large city, there are certain areas that are not maintained, slum, dirty, and become a source of criminalization. Having created a peaceful atmosphere from the existence of a patterned conflict of TRR in years 1999–2002 has triggered massive urbanization which will negatively impact the comfort of living in Ambon City. Therefore, it is not surprising that the negative effects associated with urbanization are increasing concerns that attract the attention of people around the world. Urbanization has a negative impact on the environment mainly due to modification of the chemical and physical properties of the atmosphere, pollution production, and ground cover. All the accumulated negative impacts are known as urban heat island (UHI). The UHI is understood to be a rise in the temperature of man-made regions, producing a clear “warm island” among the “cool seas” represented by lower temperatures than the nearby natural landscape. Hot islands on the spatial scale can actually be formed in urban and rural areas. Hot islands in cities are preferred because their surfaces tend to release large amounts of heat. Nevertheless, the negative impact of UHI not only affects the population in the urban environment but also humans and their ecosystems that are far from the city. UHI is indirectly related to climate change because of its contribution to the greenhouse effect. This situation will ultimately lead to global warming, the impact of which is beginning to be felt today by almost the majority of the population living in developed and developing countries [16]. The interaction between climate change and heat island effect occurs in two ways, namely, (1) the warming climate will increase higher temperatures in hot island areas, and (2) cooling strategies to reduce hot islands can help communities adapt to the effects of climate change. In addition, it can also reduce greenhouse gas emissions that cause climate change. Climate change generally causes higher temperatures and longer heat waves, more often and more severely. Therefore in urban areas that have suffered due to heat, the island will bear the brunt of this tougher heat event [17]. Furthermore, the climate change that occurs will contribute to the increase in the cost of “hot islands” for urban areas [18].
To find out how much the population feels comfortable living in Ambon city, an index is used which indicates the existence of a comfortable or uncomfortable situation by taking into account the humidity and air temperature. This index is known as the temperature humidity index (THI). Based on the editors of the
where Tdb (°F) is the temperature of water measured by a thermometer freely exposed to the air but shielded from radiation and moisture. It is a temperature thermometer, and it is the true thermodynamic temperature, and RH (%) is the relative humidity [19]. Besides that, there is also another THI, namely, discomfort index (DI). DI is intended to determine the inconvenience of the microclimate conditions in a place quantitatively. Basic calculation of DI also uses air humidity and air temperature data [5].
NDVI value is a value from the processing of vegetation indices from infrared satellite channels and red canals that show the level of leaf chlorophyll concentration which correlates with vegetation density based on spectral values in each pixel. NDVI always ranges from −1 to +1, but there isn’t a distinct boundary for each type of land cover. If we have negative values, it’s highly likely that it’s water. On the other hand, if we have a NDVI value close to +1, there’s a high possibility that it’s dense green leaves. In case NDVI is close to zero, there are no green leaves, and it could even be an urbanized area [20]. In other words, the distribution of NDVI shows the distribution of the amount of vegetation on a land. High NDVI values generally indicate a land cover with a lot of vegetation that will provide an atmosphere of coolness in the local environment. The vegetation index in this study is used to determine the percentage of green cover that can be assumed as a GOS from the LANDSAT-8 image so that it is expected to reflect the actual conditions in the study area. Based on the results of the analysis conducted, it shows that the higher the NDVI value, the higher the percentage value of green cover. This confirms that there is a close relationship between the value of the vegetation index and the percentage of green cover in the study area. The distribution of NDVI values in Ambon City is presented in Figure 4.
The distribution of NDVI values in Ambon City.
In general, high NDVI values in Ambon City are located in the northern part and a little in the south as shown in the area which is dark yellow to brown. Other regions have low NDVI values which indicate that there is very little vegetation in the area. The NDVI distribution consists of four levels of greenness, high, medium, low, and non-vegetated as presented in Figure 4, and then is overlapped with three discomfort distribution maps so that the three new maps are obtained, i.e., the NDVI map distribution and discomfort in Ambon City at 09:00–12:00 pm and 16:00 pm. The NDVI index distribution map illustrates clearly that the distribution of NDVI values is dominated by low NDVI followed by only a small number of medium NDVI in the northern and southern parts of the city. The non-vegetated area is also very small in the northwest, while high NDVI is not present.
The comfort level of an area is an indicator used in UGS planning in an urban area. Change in climate elements, namely, the increasing air temperature, is the most direct factor that can be felt and affect the level of human comfort [21]. Quantitatively, the comfort level of an area can be approached with various approaches. One of them is DI as implemented in this research. In addition to air temperature, comfort is influenced by other climate parameters and subjects who feel comfortable. A climate parameter that also affects human comfort is wind. The results of temperature measurements and the humidity of the green open space area of the city of Ambon in nine sampling locations showed different values based on the analysis of inconvenience index (DI) for the morning interval (at 09:00 pm); during the day (12:00 pm) and evening (16:00 pm) as presented in Table 4.
Code of demonstration plot | Value of discomfort index at | |||
---|---|---|---|---|
09:00 pm | 12:00 pm | 16:00 pm | Remarks | |
A1 | 27.9 | 28.5 | 28.6 | |
A2 | 28.1 | 29.6 | 29.3 | |
A3 | 28.4 | 30.0 | 28.4 | |
B1 | 28.1 | 29.1 | 27.8 | |
B2 | 27.3 | 28.5 | 27.2 | |
B3 | 25.4 | 29.5 | 28.6 | |
C1 | 26.7 | 28.8 | 29.2 | |
C2 | 28.3 | 29.9 | 27.5 | |
C3 | 28.4 | 30.2 | 28.7 | |
Distribution of discomfort index value in Ambon City.
From Table 4, there are three new maps that describe the distribution of DI, which are discomfort map in Ambon City at 09:00–12:00 pm and 16:00 pm. Based on the results of interviews with 150 respondents in 9 sampling locations, 141 people fit the inconvenience as stated on the map, and 9 people stated that they did not match the distribution map of DI. Thus, this confirms that the making of the distribution map of DI is in accordance with the reality in the field regarding the discomfort felt during occupying in Ambon City. These three maps are then one-by-one overlaid with the map of the distribution of NDVI index so that the NDVI distribution index map and discomfort in Ambon City at 09:00–12:00 pm and 16:00 pm are obtained. The map is presented in Figures 5–7.
The NDVI index distribution and discomfort in Ambon City at 09:00 pm.
The NDVI index distribution and discomfort in Ambon City at 12:00 pm.
The NDVI index distribution and discomfort in Ambon City at 16:00 pm.
The majority condition of DI 70% is in the low NDVI and is followed by DI 60% in the southern part of the city (Figure 5). This situation shows that in the morning alone, more than 50% of the city population does not feel comfortable. In other words it may lead to physical symptoms and also influence mental health. The existence of medium NDVI is also due to too little area, so it cannot provide significant comfort for city residents.
DI conditions that rose sharply to DI 80% were in low NDVI, and those that remained were DI 70% only in the north especially near medium NDVI (Figure 6). This condition shows that during the day, medium NDVI plays a small role in maintaining a level of DI 70%. Although in the southern part of the city, two NDVI medium areas were found, they were found unable to maintain DI 60% in the area as shown at 09:00 pm in the morning. This condition illustrates that urban residents are increasingly uncomfortable as indicated by the increase DI 80%.
The condition in the evening at 16:00 pm remains the same as the condition at 09:00 pm in the morning (Figure 7). However, DI 80% still remains, especially in the western part of the city. The area of DI 60% which was originally in the south at 09:00 pm turned out at 16:00 pm it remained at DI 80%. This shows that there is no change in discomfort at all. Through the three NDVI distribution index maps and discomfort in Ambon City (at 09:00–12:00 pm and 16:00 pm), we can find out which areas have high and low vegetation. Thus we can plan which areas need to be planted with vegetation, both grasses and trees, including how wide the building needs to be planted. Thus, in general, Ambon City residents feel uncomfortable. Real effort is needed to carry out adaptations and mitigations in both the urban center and the environment. Based on the experience of daily living in European countries and Indonesia, the inconvenience is certainly felt more by developed countries than developing countries. Of course because of the people who have enjoyed abundant prosperity so that there is a small disturbance, there will be more complaints than people from developing countries.
Spatial analysis in GIS applications has supported in urban spatial planning. Good planning in the procurement of GOS in Ambon City can provide better comfort in the future. The more limited land for GOS due to development in urban areas has urged the application of the concept of green infrastructure, especially in every implementation of development. It is realized that the government of Ambon City has not had much in the development of green infrastructure such as green roofs, green facades, green walls, etc. This is certainly very different from urban planning in developed countries such as Switzerland, the United States, France, Canada, etc. that have intensively carried out the construction of green roofs, green facades, and green walls. Furthermore, green roofs are constructed for multiple reasons, for example, for architectural features or to achieve particular environmental benefits (improved diversity species, storm water capture and retention, insulation of a building against heat gain or loss, etc.). In addition to the green roof, the green facade and green wall are also known. A green facade is created by growing climbing plants up and across the facade of a building, either plants grown in garden beds at its base or by container planting installed at different levels across the building. A green wall is made up of plants grown in supported vertical systems that are generally attached to internal or external walls, although in some cases it can be freestanding. Green walls differ from green facades in that they incorporate multiple containerized plantings to vegetation cover rather than being reliant on fewer numbers of plants that climb and spread to provide cover. They are also known as vertical gardens or living walls or bio-walls [22]. Hopefully, the government of Ambon City in the future will be able to provide wider GOS and begin to apply the concept of green infrastructure in every implementation of development.
Ambon City has really been affected by climate change. Extreme rainfall that occurs in the rainy season has triggered big flooding and has been detrimental to city residents. The impact of the flood caused a huge loss of city residents. This is due to the expansion of settlements in the protected forest area of Gunung Sirimau, the construction of houses on steep slopes, as well as the impact of littering, etc. Conversely, very hot weather in the dry season makes the city residents uncomfortable. In Ambon City it was considered less comfortable as felt by residents because of the limitations of GOS. In this case, a solution needs to be sought, among others, by providing a wider area of GOS and starting to apply the concept of green infrastructure in each development implementation in Ambon City. In addition, the adequacy of GOS in Ambon City can be known by spatial analysis in GIS. With the support of NDVI distribution maps, DI maps for observations at 09:00–12:00 pm and 16:00 pm, and overlays of thematic maps, areas that are high in DI and areas that are still lacking in vegetation can be seen including how big the area is. This research is important because it can be used as preliminary study to see the development of GOS associated with DI in Ambon City. Similar research on a regular basis or time series will be able to know the development of GOS and DI in the future.
Acknowledgments are addressed to the Ministry of Research and Technology and Higher Education, Republic of Indonesia, that has helped fund research through research scheme
We (Gun Mardiatmoko and Jan Willem Hatulesila) as the authors of the paper entitled “Effects of Climate Change on City Life: Case Study in the City of Ambon, Indonesia East Region” hereby declare that there is no conflict of interest in making this paper.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. 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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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:43,paginationItems:[{id:"82374",title:"The Potential of the Purinergic System as a Therapeutic Target of Natural Compounds in Cutaneous Melanoma",doi:"10.5772/intechopen.105457",signatures:"Gilnei Bruno da Silva, Daiane Manica, Marcelo Moreno and Margarete Dulce Bagatini",slug:"the-potential-of-the-purinergic-system-as-a-therapeutic-target-of-natural-compounds-in-cutaneous-mel",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82103",title:"The Role of Endoplasmic Reticulum Stress and Its Regulation in the Progression of Neurological and Infectious Diseases",doi:"10.5772/intechopen.105543",signatures:"Mary Dover, Michael Kishek, Miranda Eddins, Naneeta Desar, Ketema Paul and Milan Fiala",slug:"the-role-of-endoplasmic-reticulum-stress-and-its-regulation-in-the-progression-of-neurological-and-i",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Endoplasmic Reticulum",coverURL:"https://cdn.intechopen.com/books/images_new/11674.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"82212",title:"Protein Prenylation and Their Applications",doi:"10.5772/intechopen.104700",signatures:"Khemchand R. 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Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:null}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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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:null},{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:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{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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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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