Degree and grade of hydronephrosis and its description.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\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:"10704",leadTitle:null,fullTitle:"Cardiac Arrhythmias - Translational Approach from Pathophysiology to Advanced Care",title:"Cardiac Arrhythmias",subtitle:"Translational Approach from Pathophysiology to Advanced Care",reviewType:"peer-reviewed",abstract:"Cardiac arrhythmias are common triggers of emergency admission to cardiology or high-dependency departments. Most cases are easy to diagnose and treat, while others may present a challenge to healthcare professionals. A translational approach to arrhythmias links molecular and cellular scientific research with clinical diagnostics and therapeutic methods, which may include both pharmacological and non-pharmacologic treatments. This book presents a comprehensive overview of specific cardiac arrhythmias and discusses translational approaches to their diagnosis and treatment.",isbn:"978-1-83969-506-3",printIsbn:"978-1-83969-505-6",pdfIsbn:"978-1-83969-507-0",doi:"10.5772/intechopen.94674",price:119,priceEur:129,priceUsd:155,slug:"cardiac-arrhythmias-translational-approach-from-pathophysiology-to-advanced-care",numberOfPages:152,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"0e5d67464d929fda6d8c83ec20c4138a",bookSignature:"Endre Zima",publishedDate:"March 9th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/10704.jpg",numberOfDownloads:852,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:0,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 11th 2021",dateEndSecondStepPublish:"April 19th 2021",dateEndThirdStepPublish:"June 18th 2021",dateEndFourthStepPublish:"September 6th 2021",dateEndFifthStepPublish:"November 5th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"201263",title:"Dr.",name:"Endre",middleName:null,surname:"Zima",slug:"endre-zima",fullName:"Endre Zima",profilePictureURL:"https://mts.intechopen.com/storage/users/201263/images/system/201263.png",biography:"Endre Zima, MD, is head of Cardiac ICU at Semmelweis University Heart and Vascular Center, Budapest, Hungary. He is specialized in anesthesiology, intensive care, and cardiology. He received a Ph.D. in 2006 and a medical habilitation degree in 2017 from Semmelweis University. As a professor, he has been holding graduate and postgraduate lectures and practices in anesthesiology/intensive care and cardiology. He has a European Heart Rhythm Association (EHRA) accreditation for Cardiac Pacing and Implantable Cardioverter Defibrillators and is a Full Instructor of Advanced Life Support (ALS) and Basic Life Support (BLS) for the European Resuscitation Council. Dr. Zima is a fellow of the European Society of Cardiology, EHRA, and the Acute Cardiovascular Care Association. He is also the president of the Working Group on Cardiac Arrhythmias and Pacing and a board member of the Hungarian Society of Cardiology and WG of Heart Failure. His fields of research are acute and intensive cardiac care, cardiogenic shock/acute heart failure, cardiopulmonary resuscitation, post-cardiac arrest intensive care, invasive hemodynamic monitoring, arrhythmias, ICD/IPG/CRT therapy, and defibrillator waveform development. Dr. Zima has one accepted and one submitted patents patent to his credit. He is the author of thirteen book chapters, sixty-six international journal articles, and fifty-six native-language papers. He is currently supervising the research works of three Ph.D. students and seven medical students.",institutionString:"Semmelweis University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Semmelweis University",institutionURL:null,country:{name:"Hungary"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"170",title:"Cardiology and Cardiovascular Medicine",slug:"cardiology-and-cardiovascular-medicine"}],chapters:[{id:"77447",title:"Molecular Mechanism and Current Therapies for Catecholaminergic Polymorphic Ventricular Tachycardia",doi:"10.5772/intechopen.98767",slug:"molecular-mechanism-and-current-therapies-for-catecholaminergic-polymorphic-ventricular-tachycardia",totalDownloads:120,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The rhythmic contraction of the heart relies on tightly regulated calcium (Ca) release from the sarcoplasmic reticulum (SR) Ca release channel, Ryanodine receptor (RyR2). Genetic mutations in components of the calcium release unit such as RyR2, cardiac calsequestrin and other proteins have been shown to cause a genetic arrhythmic syndrome known as catecholaminergic polymorphic ventricular tachycardia (CPVT). This book chapter will focus on the following: (1) to describing CPVT as a stress-induced cardiac arrhythmia syndrome and its genetic causes. (2) Discussing the regulation of SR Ca release, and how dysregulation of Ca release contributes to arrhythmogenesis. (3) Discussing molecular mechanisms of CPVT with a focus on impaired Ca signaling refractoriness as a unifying mechanism underlying different genetic forms of CPVT. (4) Discussing pharmacological approaches as CPVT treatments as well as other potential future therapies. Since dysregulated SR Ca release has been implicated in multiple cardiac disorders including heart failure and metabolic heart diseases, knowledge obtained from CPVT studies will also shed light on the development of therapeutic approaches for these devastating cardiac dysfunctions as a whole.",signatures:"Bin Liu, Brian D. Tow and Ingrid M. Bonilla",downloadPdfUrl:"/chapter/pdf-download/77447",previewPdfUrl:"/chapter/pdf-preview/77447",authors:[{id:"351973",title:"Assistant Prof.",name:"Bin",surname:"Liu",slug:"bin-liu",fullName:"Bin Liu"},{id:"418354",title:"MSc.",name:"Brian D.",surname:"Tow",slug:"brian-d.-tow",fullName:"Brian D. Tow"},{id:"418355",title:"Dr.",name:"Ingrid M.",surname:"Bonilla",slug:"ingrid-m.-bonilla",fullName:"Ingrid M. Bonilla"}],corrections:null},{id:"79960",title:"COVID-19 and Cardiac Enzymes",doi:"10.5772/intechopen.101402",slug:"covid-19-and-cardiac-enzymes",totalDownloads:48,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Since December 2019, the COVID-19 pandemic has caused widespread mortality and adverse economic impact throughout the world. Though predominantly a respiratory disease, concerns regarding cardiovascular effects have been highlighted. Cardiac biomarkers and their elevations in COVID-19 have been associated with higher cardiovascular disease burden and worse prognosis. The mechanism of cardiac enzyme elevation in COVID-19 can be explained under two broad categories- direct injury caused by downregulation of ACE2 and hypoxemia, and indirect injury, which is mediated by the cytokine storm. Cardiac troponin and high sensitivity troponin are the most extensively studied cardiac enzymes in COVID-19. Studies have shown comparable and in some cases better predictive value than traditional markers of inflammation like d-dimer, C-reactive protein, lactate dehydrogenase. Natriuretic peptides such as BNP have utility as a robust prognostic marker in COVID-19 when considering outcomes like the need for mechanical ventilation and mortality. Emerging data from studies investigating the role of newer cardiac biomarkers in COVID-19 like mid-regional proadrenomedullin, growth differentiation factor-15 have also yielded promising results. As advances are made in our understanding of the pathogenesis, diagnosis, and management of COVID-19, it is evident that investigating the role of cardiac biomarkers in COVID-19 provides vital information.",signatures:"Meher Singha, Abhishek Madathanapalli and Raj Parikh",downloadPdfUrl:"/chapter/pdf-download/79960",previewPdfUrl:"/chapter/pdf-preview/79960",authors:[{id:"357532",title:"Dr.",name:"Raj",surname:"Parikh",slug:"raj-parikh",fullName:"Raj Parikh"},{id:"451881",title:"Dr.",name:"Meher",surname:"Singha",slug:"meher-singha",fullName:"Meher Singha"},{id:"451882",title:"Dr.",name:"Abhishek",surname:"Madathanapalli",slug:"abhishek-madathanapalli",fullName:"Abhishek Madathanapalli"}],corrections:null},{id:"78843",title:"A High Fidelity Transmural Anisotropic Ventricular Tissue Model Function to Investigate the Interaction Mechanisms of Drug: An In-Silico Model for Pharmacotherapy",doi:"10.5772/intechopen.99873",slug:"a-high-fidelity-transmural-anisotropic-ventricular-tissue-model-function-to-investigate-the-interact",totalDownloads:119,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"A high fidelity transmural anisotropic ventricular tissue model consisting of endocardial, mid myocardial, and epicardial myocytes were configured to investigate drug interaction, such as Hydroxychloroquine (HCQ), under hypoxia conditions without and with pro-arrhythmic comorbidity like hypokalemia in (a) ventricular tissue b) its arrhythmogenesis for different dosages and (b) two different pacing sequences (Normal and tachycardiac). In-silico ventricular modeling indicates HCQ has an insignificant effect on hypoxia with and without comorbidities, except in the combination of mild hypoxia with moderate hypokalemia condition and severe hypoxia with mild hypokalemia where it initiated a re-entrant arrhythmia. Secondly, incorporating drug dosage variations indicates the 10 μM HCQ created PVCs for all settings except in severe hypoxia conditions where re-entrant arrhythmia occurred. In addition to the dosage of HCQ utilized for treatment, the pacing protocol also influences the appearance of re-entrant arrhythmia only for severe hypoxia with 10 μM HCQ dosage alone. For all other conditions, including tachycardiac pacing protocol, no arrhythmia occurred. These findings infer that the arrhythmic fatality rate due to HCQ treatment for hypoxia can be effectively alleviated by subtly altering or personalizing the dosage of HCQ and aid in the treatment of hypoxia-induced symptoms caused by COVID.",signatures:"Srinivasan Jayaraman and Ponnuraj Kirthi Priya",downloadPdfUrl:"/chapter/pdf-download/78843",previewPdfUrl:"/chapter/pdf-preview/78843",authors:[{id:"59563",title:"Dr.",name:"Srinivasan",surname:"Jayaraman",slug:"srinivasan-jayaraman",fullName:"Srinivasan Jayaraman"},{id:"417382",title:"Dr.",name:"Ponnuraj",surname:"Kirthi Priya",slug:"ponnuraj-kirthi-priya",fullName:"Ponnuraj Kirthi Priya"}],corrections:null},{id:"78490",title:"The Evolving Concept of Cardiac Conduction System Pacing",doi:"10.5772/intechopen.99987",slug:"the-evolving-concept-of-cardiac-conduction-system-pacing",totalDownloads:161,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Cardiac pacing is an established treatment option for patients with bradycardia and heart failure. In the recent decade, there is an increasing scientific and clinical interest in the topic of direct His bundle pacing (HBP) and left bundle branch pacing (LBBP) as options for cardiac conduction system pacing (CSP). The concept of CSP started evolving from the late 1970s, passing several historical landmarks. HBP and LBBP used in CSP proved to be successful in small cohorts of patients with various clinical conditions, including binodal disease, atrioventricular blocks, and in patients with bundle branch blocks with indications for cardiac resynchronization therapy. The scope of this chapter is synthesis and analysis of works devoted to this subject, as well as representation of the author’s experience in this topic. The chapter includes historical background, technical, anatomical, and clinical considerations of CSP, covers evidence base, discusses patient outcomes in line with the pros and cons of the abovementioned methods. The separate part describes practical aspects of different pacing modalities, including stages of the operation and pacemaker programming. The textual content of the chapter is accompanied by illustrations, ECGs, and intracardiac electrograms.",signatures:"Iurii Karpenko, Dmytro Skoryi and Dmytro Volkov",downloadPdfUrl:"/chapter/pdf-download/78490",previewPdfUrl:"/chapter/pdf-preview/78490",authors:[{id:"351164",title:"M.D.",name:"Dmytro",surname:"Skoryi",slug:"dmytro-skoryi",fullName:"Dmytro Skoryi"},{id:"351921",title:"Prof.",name:"Dmytro",surname:"Volkov",slug:"dmytro-volkov",fullName:"Dmytro Volkov"},{id:"352958",title:"Prof.",name:"Iurii",surname:"Karpenko",slug:"iurii-karpenko",fullName:"Iurii Karpenko"}],corrections:null},{id:"80348",title:"Out-of-Hospital Cardiac Arrest in General Population and Sudden Cardiac Death in Athletes",doi:"10.5772/intechopen.101813",slug:"out-of-hospital-cardiac-arrest-in-general-population-and-sudden-cardiac-death-in-athletes",totalDownloads:78,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Sudden cardiac death (SCD) is still one of the leading causes of cardiovascular death in the developed countries. The incidence of out-of-hospital cardiac arrest in Europe varies from 67 to 170 per 100,000 population. The chain of survival will be described in detailed steps. We are going to summarize the treatment options for sudden cardiac arrest from recognition of SCD to resuscitation and post cardiac arrest care. The role of awereness and Automated External Defibrillator and Public Access Defibrillation (AED-PAD) programs will be discussed in brief. SCD is one of the most common causes of death among athletes. Sport can trigger SCD in individuals who already have unknown form of heart disease. Our aim was to detail the underlying causes of SCD in athletes and to identify the possible screening techniques. Existing disease (e.g., myocardial hypertrophy, fibrosis) can be seen as a substrate, and sport as a trigger can cause arrhythmias, increased catecholamine release, acidosis, and dehydration. We will highlight the importance of sports medicine and periodic examination in screening for these conditions. Depending on the etiology, this may include exercise ECG, Holter monitor, CT, MR, echocardiography, and coronagraphy. We are going to conclude the new recommendations for COVID-19 post-infection care for athletes.",signatures:"Bettina Nagy, Boldizsár Kiss, Gábor Áron Fülöp and Endre Zima",downloadPdfUrl:"/chapter/pdf-download/80348",previewPdfUrl:"/chapter/pdf-preview/80348",authors:[{id:"201263",title:"Dr.",name:"Endre",surname:"Zima",slug:"endre-zima",fullName:"Endre Zima"},{id:"442213",title:"Ms.",name:"Bettina",surname:"Nagy",slug:"bettina-nagy",fullName:"Bettina Nagy"},{id:"442214",title:"Dr.",name:"Boldizsár",surname:"Kiss",slug:"boldizsar-kiss",fullName:"Boldizsár Kiss"},{id:"442215",title:"Dr.",name:"Gábor Áron",surname:"Fülöp",slug:"gabor-aron-fulop",fullName:"Gábor Áron Fülöp"}],corrections:null},{id:"79449",title:"Life-Threatening Cardiac Arrhythmias during Anesthesia and Surgery",doi:"10.5772/intechopen.101371",slug:"life-threatening-cardiac-arrhythmias-during-anesthesia-and-surgery",totalDownloads:182,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Life-threatening arrhythmias are frequently encountered during anesthesia for cardiac or non-cardiac surgery. They result in a significant cause of morbidity and mortality, particularly in elderly patients. Predisposing factors like electrolytes abnormalities, pre-existing cardiac disease, intubation procedure, anesthetic medications, and various surgical stimulation need to be determined. Early diagnosis and commencement of an appropriate treatment protocol may be lifesaving. Treatment usually involves correction of the underlying causes, cardiac electroversion, and the use of one or more antiarrhythmic agents. Although ventricular tachycardia, ventricular fibrillation, torsade de pointes, and pulseless electrical activity are considered malignant arrhythmias that can lead to cardiac arrest, other types of Brady and tachyarrhythmias are also included in this chapter to enable adopting a more objective approach in the management of arrhythmias intraoperatively, avoiding risks of inappropriate management strategies.",signatures:"Zuraini Md. Noor",downloadPdfUrl:"/chapter/pdf-download/79449",previewPdfUrl:"/chapter/pdf-preview/79449",authors:[{id:"353513",title:"Dr.",name:"Zuraini",surname:"Md. Noor",slug:"zuraini-md.-noor",fullName:"Zuraini Md. Noor"}],corrections:null},{id:"79424",title:"The Initial Assessment and Management of the Post-Cardiac Arrest Patient",doi:"10.5772/intechopen.100132",slug:"the-initial-assessment-and-management-of-the-post-cardiac-arrest-patient",totalDownloads:31,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Cardiac arrest is the most common cause of death in North America and in the developed world. Advances in care have resulted in improved survival and favorable neurological outcomes in recent times. The initial management and interventions of the post-cardiac arrest patient are reviewed here. Following the return of spontaneous circulation (ROSC) the priorities are to (A) determine and treat the cause of the cardiac arrest, and (B) optimize the cardiorespiratory function of the to prevent further cardiac arrests. The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce post-resuscitation care guidelines for adults following cardiac arrest.",signatures:"Amad Hania",downloadPdfUrl:"/chapter/pdf-download/79424",previewPdfUrl:"/chapter/pdf-preview/79424",authors:[{id:"351348",title:"Dr.",name:"Amad",surname:"Hania",slug:"amad-hania",fullName:"Amad Hania"}],corrections:null},{id:"79475",title:"Prognostication in Post-Cardiac Arrest Patients",doi:"10.5772/intechopen.101348",slug:"prognostication-in-post-cardiac-arrest-patients",totalDownloads:115,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"After resuscitation from cardiac arrest, a combination of the complex pathophysiologic process, known as post-cardiac arrest syndrome (PCAS), is attributed to multiple organ damage. Global ischemic cascade occurs in the brain due to generalized ischemia during cardiac arrest and the reperfusion process after the return of spontaneous circulation (ROSC), leading to hypoxic/ ischemic brain injury. Targeted temperature management (TTM) is a well-known neuroprotective therapy for ischemic/hypoxic brain injury. This global brain injury is a significant cause of death in PCAS. The implementation of TTM for PCAS leads to a reduction in mortality and better clinical outcomes among survivors. Prognostication is an essential part of post-resuscitation care. Before the TTM era, physicians relied on the algorithm for prognostication in comatose patients released by the American Academy of Neurology in 2006. However, TTM also announced more significant uncertainty during prognostication. During this TTM era, prognostication should not rely on just a solitary parameter. The trend of prognostication turns into a multimodal strategy integrating physical examination with supplementary methods, consisting of electrophysiology such as somatosensory evoked potential (SSEP) and electroencephalography (EEG), blood biomarkers, particularly serum neuron-specific enolase (NSE), and neuro-radiography including brain imaging with CT/MRI, to enhance prognostic accuracy.",signatures:"Dilok Piyayotai and Sombat Muengtaweepongsa",downloadPdfUrl:"/chapter/pdf-download/79475",previewPdfUrl:"/chapter/pdf-preview/79475",authors:[{id:"64867",title:"Dr.",name:"Sombat",surname:"Muengtaweepongsa",slug:"sombat-muengtaweepongsa",fullName:"Sombat Muengtaweepongsa"},{id:"427100",title:"Dr.",name:"Dilok",surname:"Piyayotai",slug:"dilok-piyayotai",fullName:"Dilok Piyayotai"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6209",title:"Endothelial Dysfunction",subtitle:"Old Concepts and New Challenges",isOpenForSubmission:!1,hash:"f6e76bbf7858977527679a6e6ad6a173",slug:"endothelial-dysfunction-old-concepts-and-new-challenges",bookSignature:"Helena Lenasi",coverURL:"https://cdn.intechopen.com/books/images_new/6209.jpg",editedByType:"Edited by",editors:[{id:"68746",title:"Dr.",name:"Helena",surname:"Lenasi",slug:"helena-lenasi",fullName:"Helena Lenasi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7220",title:"Congenital Heart Disease",subtitle:null,isOpenForSubmission:!1,hash:"f59bacfffcccc636ec3082869d10a82e",slug:"congenital-heart-disease",bookSignature:"David C. 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Computed tomography of kidneys, ureters and bladder (CT KUB) is a quick non-invasive technique for diagnosis of stone disease. It was initially used in the evaluation of radiolucent stones only however, Smith et al. [1] in 1995 showed CT has superiority over intravenous urography (IVU). CT KUB subsequently became the first choice in the diagnostic imaging of urinary tract for obstruction of stones. It has replaced IVU almost completely in the last two decades [2]. It is usually considered the initial imaging modality for suspected acute renal colic and dipstick positive haematuria in an emergency setting and initial diagnostic evaluation of upper tract obstruction. CT KUB has certain clear advantages over other urinary tract imaging for stones. It is not dependent on stone chemical composition; all stones are well seen on CT except for the Indinavir stones [3], it does not require contrast, it can be rapidly performed and can be used in planning endourological treatment.
\nActual protocol of CT KUB for evaluation of stone disease and haematuria will vary depending on institutional guidelines. The general parameters are (i) non-contract examination is performed on multi-detector computed tomography scanner; (ii) supine or supine and prone patient positioning (prone has the advantage of assessing stones near the VUJ); (iii) data interpretation with the use of axial, coronal, sagittal and sometimes curved oblique images for proper evaluation; (iv) scan parameters which includes slice thickness(recommended 5 mm or less), field of view: patient size algorithm: standard technique ( 120 kV/Auto MA .5 rotation); Anatomical start point: 1 cm above the liver Anatomical stop through inferior pubic rami).
\nCT KUB is a quick non-invasive technique for diagnosis of stone disease. It is usually considered the initial imaging modality for suspected acute renal colic and dipstick positive haematuria in an emergency setting. Unenhanced CT is also increasingly being used for treatment planning and post-treatment surveillance for stone recurrence.
\nThis is a study without intravenous or oral contrast, relatively low-dose (in CT terms), and has a very high sensitivity for the detection of renal and ureteric stones. CT KUB allows a rapid, contrast-free, anatomically accurate diagnosis of urolithiasis with a sensitivity of 97–98% and a specificity of 96–100%.
\nThe effective dose of a standard CT KUB examination has been estimated to be between 3 and 5 mSv, which is up to three times that for intravenous pyelography. However, radiation dose in CT KUB is gradually decreasing with the introduction of ultra-low radiation dose CT KUB (0.5–0.7 mSv). These doses are almost comparable to plain film KUB and have shown favourable outcomes similar to standard radiation dose CT KUB. Reductions in CT dose inherently create an increase in image noise. Therefore, a balance has to be found between image quality (signal-to-noise ratio) and restraining the radiation dose.
\nIn comparison to conventional CT, spiral CT is significantly faster. It thus allows acquisition of a complete data set in a single breath-hold and prevents the misregistration of slice location that is typical of conventional CT. In addition, multi-slice spiral CT reduces the time needed for image acquisition, allowing for thinner slice collimation and retrospective reconstruction of thin slices to review challenging areas of analysis.
\nFrom the top of the kidneys through the base of the bladder (mid-liver [T-12] through symphysis pubis), data acquisition is uninterrupted using a maximum of 5-mm collimation with table speed of 5 mm/s. Slice collimation with multi-slice CT is usually 2.5–3 mm with table speed up to 5 mm/s.
\nMultislice technique allows slices as thin as 1 mm to be obtained for problem solving. The thinner slices can be viewed retrospectively without rescanning the patient. Thin slices enable identification of extremely small sized calculi that may be overlooked if the slices are thicker.
\nTurning the patient to a prone position permits differentiation of stones impacted at the ureterovesical junction from stones that have already passed into the bladder.
\nActual protocol of CT KUB for evaluation of stone disease and haematuria will vary depending upon institutional guidelines but following are the general parameters:
\nNon-contrast examination is performed on multi-detector computed tomography scanner.
Supine or prone patient positioning. Prone has the advantage of assessing stones near the VUJ. Some institutions may perform a limited pelvic scan in prone if the supine scan shows a calculus near the VUJ.
Data interpretation with the use of axial, coronal, sagittal and sometimes curved oblique images for proper evaluation.
Scan parameters:
\nSlice thickness: 5 mm
Field of view: patient size
Algorithm: standard
Technique: 120 kV/Auto MA .5 rotation
Anatomical start: 1 cm above the liver
Anatomical stop: through inferior pubic rami
Filming/windowing: soft-tissue window with 3 mm coronal and sagittal reconstructions.
Dual-energy CT scanning is a new technique that can more correctly distinguish different stone types. It involves acquiring CT data at two different X-ray energies (80 and 140 peak kilovoltage [kVp]). Post-processing software can make use of the different attenuation properties of calculi of various chemical compositions at low and high X-ray energies.
\nDecreased exposure is most commonly achieved by modifying tube current and applying new image reconstruction algorithms. Low-dose CT has been shown to maintain diagnostic accuracy compared with standard-dose CT, even in overweight and obese patients when using automated tube current modulation.
\nA clinical decision to order CT KUB has to be made in two different clinical presentations. First is a patient with flank pain presenting in emergency department. The classic clinical presentation of a young man writhing in pain is usually distinctive. However, atypical presentations are not uncommon. CT KUB is still reasonable first-line investigation for all patients presenting in emergency with flank pain as it increases diagnostic accuracy in atypical cases and can detect other pathologies. In a study of 1500 consecutive CT examinations in patients with flank pain, 14% had CT findings other than stone requiring immediate or deferred treatment [4]. Although this diagnostic superiority of CT KUB for flank pain is well established, recent studies have questioned whether it influences management decision in emergency setting. A multicentre, randomised controlled trial of carefully selected patients with suspected nephrolithiasis compared ultrasound with CT KUB and concluded that initial ultrasound decreases cumulative radiation exposure by obviating need of CT in some patients without significant difference in missing high-risk diagnoses, serious adverse events and re-admissions [5].
\nIn a clinical setting, the choice of CT KUB versus ultrasound for initial diagnostic imaging in patients with flank pain should be individualised. Patients who are obese, clearly sick or have associated gross/microscopic haematuria are more likely to benefit from CT scan. On the other hand, children, pregnant women and those assessed to have musculoskeletal pain clinically are more appropriate for ultrasound first approach. Available local resources, for example, expert sonologist should also be taken into account when making this decision.
\nSecond clinical setting requiring CT KUB is incidental finding of hydronephrosis on ultrasound. The decision to request CT KUB will depend on information available on ultrasound and suspected cause of underlying obstruction. In some cases, ultrasound will provide sufficient information to decide further management. For instance, in classic ureteropelvic junction obstruction (UPJO) in a child, ultrasound alone would provide enough anatomical detail to proceed for radionuclide imaging. Similarly small ureterovesical junction stone seen clearly on ultrasound combined with clinical picture is usually sufficient to proceed for management decision. CT KUB is suitable if renal or ureteric stones are suspected as underlying cause of hydronephrosis or a benign pathology, for example, ureteric stricture/retroperitoneal fibrosis is presumed after history and examination. If an upper tract tumour or extrinsic malignant obstruction is suspected, a contrast-enhanced study is more appropriate.
\nUpper tract obstruction may lead to derangement in renal function and it is not uncommon to find raised creatinine in such patients especially if obstruction is bilateral. European Society of Urogenital Radiology recommends that an estimated glomerular filtration rate (eGFR) of less than 45 ml/min/1.73 m2 particularly with other risk factors, for example, diabetic nephropathy and dehydration increases the risk of contrast-induced nephropathy (CIN) [6]. This effectively precludes contrast-enhanced study in such patients. CT KUB is helpful in excluding calculi and may even provide a definitive diagnosis in up to 40% cases of non-calculus obstruction [7]. MR urography will be required for making a definitive diagnosis in remaining cases.
\nCT KUB is currently considered as the first line imaging in the evaluation of stone and obstruction (Figure 1) and is preferred over an IVU [2]. This is in view of high sensitivity and specificity of CT over other imaging modalities. It is particularly useful in the diagnosis of ureteral stones (Figures 1 and 2) with sensitivity of 95–98% and specificity of 96–98% [8, 9]. It is of particular value in patients with renal failure, which precludes use of intravenous contrast, and ultrasound has limited value [10]. The sensitivity of ultrasound in the evaluation of ureteral stones when compared with CT KUB is only 46% and for hydroureter in half of the cases. CT KUB in the evaluation of ureteral stones is able to identify ureteral dilation in 83%, hydronephrosis in 80% and perinephric oedema in 59%, and ipsilateral nephromegaly in 57.2% of cases [11].
\n(a) Hydronephrosis (asterik), reduced peripelvic fat (white arrow) and increased perinephric fat stranding (black arrow) as compared to contralateral side and (b). CT KUB axial, sagittal and coronal sections demonstrating multiple calcific densities near the bulbar urethra likely representing urethral diverticulum with stone formation.
CT KUB axial and coronal sections demonstrating an obstructing right proximal ureteric calculus.
In addition to diagnosis of stone and obstruction, it is also used in the work up haematuria. Asymptomatic micro-haematuria (AMH) is relatively common and is often not associated with urinary tract malignancies. The current guidelines indicate evaluation of upper urinary tract with contrast-enhanced CT (CECT). This often leads to identification of extra-urinary tract abnormalities. The diagnoses of such conditions often require extensive work for most conditions, which are inconsequential [12]. These are often observed on non-contrast CT imaging as well [13]. In vast majority of cases, ASH is idiopathic followed small renal stones (Figure 3) and other benign causes. Ultrasound is often the initial imaging, however, CT KUB can be used in lieu.
\nCT KUB axial and coronal sections demonstrating a left renal pelvis calculus (a and b) and left distal ureteric calculus (c).
Acute onset flank pain suggestive of ureteral obstruction is a common presentation in the emergency room (ER) setting. Introduction of CT has decreased the time in decision-making [14] about the possible aetiology of cause of flank pain [15, 16]. Clinical evaluation and ultrasound often makes it difficult to differentiate ureteral obstruction from other pathologies. However, CT not only quickly identifies urolithiasis but also identifies other causes of flank pain [17]. This includes both genitourinary and extra-genitourinary abnormalities. Stones from ureter-vesical junction sometimes pass into the urethra (Figure 4) without significant changes in symptoms, these can be diagnosed by careful inspection of the CT.
\nCT KUB axial, coronal and sagittal sections demonstrating a calculus in the prostatic urethra.
Initial clinical evaluation including dipstick test for micro-haematuria also lack sensitivity. Li et al. [18] noted during the period of 4 years that there were 159,083 emergency visits. During this period, 397 had urolithiasis, in these patients absence of haematuria was noted in 9% (95% confidence interval 7–12%). The next step in the management of patients with stone is to determine the extent of obstruction and of any complications from obstruction and stone. None of the conventional imaging, that is, IVU, ultrasound and plain X-ray KUB is sensitive enough to answer the question. CT KUB due to its high specificity and sensitivity to diagnose ureteral stones is ideal imaging in such a situation. However, CT without contrast has limitations being a non-contrast study. Secondary signs of obstruction like perinephric, periureteral stranding and unilateral nephromegaly are sometimes helpful. Bird et al. [19] in a study assess the significance of secondary signs of obstruction on CT KUB and noted that they do not correlate with degrees of obstruction on MAG-3. The authors suggested use of CT KUB in combination with radioisotope scans [9]. This is cumbersome particularly in an emergency room setting. As an alternate, Kravchick et al. [20] suggested the use of dynamic renal sonography in combination with CT KUB, particularly in patients with raised white cell count and stone larger than 4 mm. This is particularly useful in triaging patients who need admission in the hospital.
\nModern endourological interventions are becoming increasingly minimally invasive. Percutaneous nephrolithotomy is performed with 24–30 Fr. Amplatz; however, finer nephroscope has led to the introduction of mini (2001), micro (2011) and ultra mini (2013) [21]. Planning for these interventions require precise pre-operative assessment of stone size, location and anatomical abnormalities including caliceal narrowing, presence of caliceal diverticulum, etc. CT can be instrumental in making pre-operative assessment. It has been seen that increasing stone volume can influence post-operative complication rate. It is being observed that >4 cm stones are associated with significantly higher rate of post-operative pyrexia and need for transfusion [13].
\nThe sensitivity and specificity of CT in the diagnosis of stone is well established. Even small stones, which would otherwise be missed on most other imaging, can be identified on CT. However, CT has utility beyond recognising the presence of stone in the urinary tract. It can be used in planning endourological interventions. Stone size, composition, location, skin to stone distance, etc. are some of the well recognised parameters used in the risk stratification and predicting success of treatment [22].
\nShock wave lithotripsy (SWL) is the most minimally invasive treatment in the management of urolithiasis. Prediction of success for renal stones is often done on a CT KUB using estimation of stone volume, density (using Hounsfield Units) and skin to stone distance [23]. In a recent work, Park et al. [24] noted that BMI and perinephric oedema in addition to stone density are independent predictors of success of SWL. Ureteral stones requiring interventional treatment are either treated by SWL or ureteroscopy. Success of ureteral stone is dependent on stone size [25]. The success of treatment is assessed not only by stone free rate but also need for ancillary treatment and number of sessions required to clear the stone [26]. One important factor responsible for failed medical SWL for ureteral stone is stone impaction, defined as stone stuck in one location for over 1 month. Sarica et al. [27] recently noted that of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success.
\nStone size is one of the most important parameter in deciding the management of ureteral stone. In a recent work, Soomro et al. [28] compared the mean stone size, as measured on bone window versus standard soft-tissue window setting using multi-detector computed tomography (MDCT) in patients with a solitary ureteric stone. They noted that the stone size measured using the soft-tissue window setting on a MDCT is significantly different from the measurement on the bone windows. Earlier work also indicated that the transverse stone diameter on axial images of CT KUB underestimates the size of ureteric stone [29]. The authors suggested that coronal re-formatted images be used for size estimation.
\nPercutaneous nephrolithotomy (PCNL) is a minimally invasive treatment modality used in the management of >20 mm kidney stones, and as such, is considered as the primary modality by EAU and AUA guidelines [30, 31]. Predicting complications and success of percutaneous surgery for urolithiasis can now be reliably done using one of the several nephrolithometry scores [22]. Nephrolithometry scoring systems are based on pre-operative stone and patient features and they demonstrate and stratify relationships between kidney’s anatomy and stones. Currently there are three scoring systems; Guy’s score [32] described in 2011, S.T.O.N.E. nephrolithometry system [33] and CROES nephrolithometry nomogram [34] in 2013. In a recent work by Choi et al. comparing these three scoring systems for tubeless PCNL, noted that Guy’s stone score was the only significant predictive factor for stone free and complication rates. However, Tailly et al. [35] earlier noted no difference in the ability to predict stone free rate comparing the three scoring systems after PCNL.
\nPCNL is safe surgical procedure and is not associated with high grade on Clavien grading. The most frequently reported complication following PCNL is infection and haemorrhage, however one of the most devastating complication is a surrounding organ injury including bowel injury. According to the Clavien-Dindo classification of surgical complications, colonic injury is regarded as a stage IVa complication. The incidence of colon injury is reported to be 0.3–0.5%, however in a large recently reported series, AslZare et al. [36] noted 11 cases in 5260 cases of PCNL. Colonic injuries are seen in patients with retro-renal colon, the prevalence of retro-renal colon in males to be 13.6% on the right and 11.9% on the left, whilst in females it was 13.4% on the right and 26.2% on the left [37]. CT KUB is instrumental in recognising retro-renal colon prior to PCNL. Most of the colonic injuries are now managed conservatively with drainage of colon via percutaneous drain, insertion of JJ stent to drain kidney, intravenous antibiotics and bowel rest by giving intravenous nutrition.
\nOnce a CT KUB abdomen is ordered for suspected upper tract obstruction, it should be reviewed for secondary radiological signs of obstruction, site of obstruction and underlying pathology. Moreover, associated findings, for example, dilated appendix, ovarian cysts, spinal pathologies should be considered and systematically reviewed.
\nClassic secondary radiological signs on CT KUB suggesting upper tract obstruction include: dilatation of renal pelvis, dilated ureter and perinephric stranding (Figure 1a and b). Renal pelvis is identifiable as area of low attenuation compared to adjacent renal parenchyma. Dilatation of renal pelvis (hydronephrosis) usually appears as anterior and medial bulging of this low attenuation structure. In some cases, dilated renal pelvis may be difficult to differentiate from a prominent extra renal pelvis. However, dilated calices that obliterate the renal sinus fat help in making this differentiation. CT is also valuable in differentiating between stone and stent (Figure 5), particularly with the use of bone windows.
\nCT KUB axial, coronal and sagittal sections demonstrating a left-sided double J stent in place.
An assessment of degree of obstruction can also be made on CT KUB (Table 1). The Society of Foetal Ultrasound first described the grading system for hydronephrosis [38]. Similar description has also been applied to other imaging modalities like intravenous urography and CT [39].
\nGrade | \nDegree | \nDescription | \n
---|---|---|
Grade 0 | \n\n | No dilation caliceal walls opposed to each other | \n
Grade 1 | \nMild | \nDilation of renal pelvis without dilation of the calyces | \n
Grade 2 | \nMild | \nDilation of renal pelvis and calyces, no cortical thinning | \n
Grade 3 | \nModerate | \nDilation of the renal pelvis and calices with blunting of papillary impression with or without cortical thinning | \n
Grade 4 | \nSevere | \nGross dilation of the renal pelvis and calices with associated cortical thinning | \n
Degree and grade of hydronephrosis and its description.
Dilatation of ureter when present should be traced down to the site of obstruction, to differentiate between phlobolith and stone (Figure 6). The dilated ureter is usually traceable from ureteropelvic junction when viewing coronal sections at a workstation. However, combining information from both axial and coronal images may be needed, especially for the lower ureter obscured by bowel loops or iliac vessels (Figure 6). Curved planar re-formatted images have been utilised to provide images mimicking a contrast-enhanced study and improve diagnostic yield for ureteric lesions [40]. UVJ stones could be differentiated from vesical stones by prone CT of the bladder area (Figure 7).
\nCT KUB axial and coronal sections demonstrating s in the pelvis.
CT KUB axial supine and prone positions demonstrating a left-sided VUJ calculus.
Once tracing the dilatation of ureter identifies site of obstruction, it should be reviewed for intraluminal, luminal or extra luminal obstructing lesions. Intraluminal pathologies include stones, blood clot and papilla. Fortunately the most common obstructing lesion, that is, stone is almost always CT dense and easily identifiable. In the absence of obstructing stone and positive radiological signs of obstruction, one should consider differential diagnosis of passed stone, pyelonephritis or obstruction caused by lesion not visible on CT KUB. Such lesions include blood clot, papilla and Indinavir stone. Reviewing clinical picture can narrow these differentials. For instance, Indinavir stone occurs only in patients treated with this protease inhibitor for HIV and papillary necrosis is more common in diabetic patients with analgesic nephropathy.
\nPresence of ureteric thickening or narrowing at the site of obstruction is suggestive of ureteric stricture. Differentiating benign from malignant strictures would require a contrast-enhanced study or endoscopy. Extramural lesions causing obstruction include pelvic tumour, retroperitoneal mass and retroperitoneal fibrosis. Retroperitoneal fibrosis is classically seen as irregular, well-defined iso-dense mass surrounding aortic bifurcation. It usually follows the common iliac arteries and expands laterally to trap ureters. Differentiation from retroperitoneal malignancies may be difficult even after contrast-enhanced study. Enhancement after contrast administration is variable and depends on degree of metabolic activity and on-going fibrosis. Presence of bone destruction and displacement of major vessels will be suggestive of malignant process [41].
\nLimitations of CT KUB include the fact that CT has limited spatial resolution. Therefore, its negative predictive value in completely excluding sub-millimetre calculi and small stone fragments is significantly less than its negative predictive value in excluding larger calculi (>4 mm). In addition, repeated use of CT in patients with recurrent urolithiasis can result in a substantial cumulative dose.
\nDetails of pelvicalyceal anatomy may not be apparent on non-contrast-enhanced study. Intravenous urography or CT urography may be required if specific anatomical details are needed for making a management decision, for example, bifid system, stone in a calyceal diverticulum or narrow lower pole infundibulum.
\nCT KUB is a static study and the abnormalities related to urinary dynamics, that is, UPJ obstruction, obstructive versus residual dilatation of the collecting system, etc. cannot be appreciated. Complementing CT KUB with either MAG3 scan or dynamic Doppler ultrasound are some of the modifications recommended.
\nThe other major limitation of the CT KUB is the risk of radiation exposure. Dose reduction by various technical modifications has been recommended [42]. In a systematic review, Xiang et al. [43] noted that lowering the dose of radiation of CT does not negatively impact the sensitivity and specificity in the diagnosis of stone and obstruction. They noted that low dose CT KUB has a cumulative sensitivity of 93% and specificity of about 97% [19].
\nIn a meta-analysis reported by Niemann and colleagues [44] some 9 yeas back, they noted that dose reduction attempts resulted in mean dose of less than 3 mSv without jeopardizing the pooled sensitivity (97%) and specificity (95%). However in the last decade, there has been significant interval improvement with iterative reconstruction techniques, detector series and arrangements. These modifications have allowed a further reduction in dose to <1 mSv [45]. This is quite comparable to plain X-ray KUB at 0.7 mSv [46].
\nNon-contrast CT abdomen has emerged as first line investigation in suspected upper tract obstruction. Underlying cause can usually be ascertained on CT KUB. However, further investigations may be required to delineate/confirm underlying pathology like UPJ obstruction, differentiation between obstruction and residual dilatation, etc. CT KUB is not only extremely sensitive and specific in the diagnosis of stone; it is now used in the pre-operative nomograms in predicting success of various endourological interventions like PCNL an SWL. Determination of stone density, stone volume, stone composition, skin to stone distance, presence of ureteral wall oedema, perinephric oedema are highly predictive of stone free rate. CT recognition of various anomalies, presence of retro-renal colon, horse-shoe kidney, malrotation, etc. can help in better planning to avoid complication. One of the major limitations of CT is the radiation dose. Modification in technique and technological innovation has resulted in significant dose reduction from 4.5 mSV to about 1 mSv.
\nWith the increase in population and urbanization, energy use also has grown rapidly worldwide. Energy use in the building sector (commercial and residential buildings) has increased between 20 and 40% in developed countries [1]. Several researchers have worked on moderating the use of fossil fuels by introducing alternative energy sources such as industrial waste heat, biogas and biomass, nuclear energy, geothermal and solar energy, groundwater [2, 3, 4, 5]. The European Union is responsible for 33% of the total CO2 emission [2]. Based on the European Green Deal, the European Commission has provided an action plan to ensure energy transition as the EU aims to become the first climate-neutral continent by 2050 [6]. To oblige with these implications, energy-saving technologies have to be integrated into different energy sectors, especially the building sector since the energy demand is 36% of the global final energy use [7]. Studies have been conducted to analyze the increased use of biomass to reduce CO2 emission in different sectors such as transportation and building sectors [8, 9]. One way of reducing the amount of resource use is to connect several customers’ heat and cold demands with the available sources [10]. District energy systems are said to promise energy security as they offer flexibility in their energy use compared to individual energy systems [11]. The heating or cooling resources can be from renewable sources of energy as well as non-renewable sources.
The cooling energy demand for buildings varies depending on countries and their outdoor temperatures. Buildings have various cooling demands due to the differences in the construction material, size, occupant behavior, the purpose of the building, etc. However, it should be pointed that even identical buildings have different cooling demands depending on the kind of activities within the building. Due to the recent changes in climate and its implications on the energy performance of the buildings and indoor thermal conditions, different space cooling technologies have gained more attention. It is likely to predict the growth of cooling demand in Europe due to rising ambient temperatures (including heat waves), heat island effects, higher thermal insulation levels, increased comfort desires/requirements, and the fact that saturation of cooling demand is significantly lower than in the USA and Asia. Estimated cooling saturation for commercial and residential buildings in the USA was 80 and 65%, respectively, and Japan had 100 and 85%, respectively, in the year 2005. Corresponding cooling saturation numbers for Europe were 27 and 5%, respectively [12]. The cooling saturation for EU27 has passed 40% for the service sector and is around 7% for residential buildings [12]. It has been estimated that 10% of all building areas in EU28 were cooled and covered around 16% of the total cooling demand in the year 2014 [13]. In Europe district cooling was introduced in the 1990s; however, it is still a rather uncommon cooling solution with a market share of only around 1% of the cooling market in 2014 [12].
The desired indoor conditions can be met using individual cooling devices such as air conditioners, central air conditioning systems, or district cooling system (DCS). The district cooling system supplies chilled water for cooling and dehumidification to a group of buildings in a district (city, neighborhood, or campus). The coolant (usually water) is typically generated at a central chiller plant and circulates through a distribution network between a central cooling plant and the buildings in the district [14, 15]. Figure 1 depicts a DCS using a natural source such as a lake/sea to cool the buildings. It is generally referred to as free cooling.
Schematic of a district cooling system (DCS). Reprint with permission from Gävle Energi AB [
Water in the district cooling network gets cold from nearby natural cold sources, such as a river/sea, and if needed from the cooling machines, that is, when the temperature of the cold source (the river) is high. The combination of free-cooling and cooling machines demands less electricity compared to separate heat pumps or cooling machine installations in every building.
Water from the river/sea is used to cool the water in the district cooling network. When the district cooling water is cooled to 6°C, it is pumped to the connected building/consumers through the distribution network that comprises supply and return pipe. The cold and heat carriers in the district network are generally in the form of pressurized water and to be economical, the dense urban areas appear to be a fulfilling choice as the distribution pipes should be short [10].
Cold is delivered to the consumers (offices, buildings, industries, server halls, etc.) through the district cooling network with the help of the heat exchangers at user buildings [17]. Cold can be delivered to the cooling coils (to cool the supply air in the air handling units) or via chilled beams installed in the building zones.
Overall, as seen in Figure 1, four major parts could be introduced in a district heating or cooling system: the main supply unit, distribution networks, user stations, and finally the heating or cooling system inside the building’s zones. Cold can be supplied for industrial purposes too, such as food preparation, although it is beyond the scope of this chapter.
It is possible to incorporate either a single or multiple cooling technologies in the DCS central chiller plant depending on the available energy sources (thermal or electrical), environmental and economic considerations as well as the demand profile. Absorption chillers are among the available options for chiller plants. Absorption chillers use heat and not electricity as their primary source of energy [18]. They possess a lower COP (coefficient of performance); however, the electricity consumption and primary energy use are reduced in these chillers and the mechanical compressor of a compression chiller is substituted by a thermal compressor [19]. Renewable thermal energy such as biomass waste or solar energy could be utilized using heat-driven chillers or thermal power plants. In such plants, the heat could be transferred to electrical or mechanical energy to drive the vapor compression chillers. The triple-effect lithium bromide absorption chillers could be exploited for DCS as they could be driven by higher-grade sustainable heat sources [20].
Free cooling is another option for a central plant. The available natural cold sources are involved in cooling the building; the heat will naturally flow out without the need of the compressor and the vapor-compression refrigeration system [15, 21, 22, 23]. Rivers, lakes, the sea, and outdoor air are among the natural cold sources. By using seawater air conditioning, deepwater conditioning could be employed as in this situation, and the water temperature is well below the ambient temperature (generally around 5°C). For such DCS, it is possible to utilize 100% free cooling. However, given the lack of natural cold sources, free cooling could be combined with other cooling technologies such as absorption chillers to compensate for the lack of available cold from the lake/sea, especially on a seasonal basis. An approach to using naturally cold water is cold district heating and cooling [24]. In this context, the cold water from the lake, sea, etc., is used for direct or active cooling in the system and serves as the cooling fluid. With the help of the decentralized chillers or pumps, the water is chilled or heated for the district system. A research project introduced seawater district cooling and analyzed the system through a case study in Diego Garcia [25]. It was concluded that the system was economically efficient and reduced maintenance and electricity usage.
This book chapter aims to investigate the implementation of district cooling systems by exploring research studies reported in the literature. The topics addressed include typologies and design parameters, benefits and limitations, applications of the system, and the technology readiness level.
To provide an overview of the available district cooling systems and their performance for different applications in various climate conditions, a literature review was performed.
Different databases have been used to identify available books and academic literature, including ScienceDirect, Google Scholar, and Scopus.
Keywords such as district energy, district cooling system, free cooling, absorption chillers, the resilient building were used. No limitation was applied on the publication period, though recently published works were prioritized.
In this section, three different classification groups are proposed. The primary proposed classification is based on the system: Centralized and decentralized DCS. The former category is suitable for large-scale regions where the energy is distributed among several buildings in an area. The latter category is more suitable for small capacities where the energy conversion takes place in the units outside the buildings and then is transferred to the buildings [2, 26, 27, 28].
The second proposed category is based on the central plant: free cooling systems or the use of heat pumps and chillers [29, 30, 31].
The third category is based on the occupant behavior as well as the building typology, which is design parameters that can affect the energy use in the buildings. Occupant behavior mainly consists of interactions with operable windows, lighting, blinds, thermostats, and plug-in appliances. Building types are such as villa, retail, public office.
Literature covers the benefits and limitations (disadvantages) of DCS. These benefits and limitations are categorized from three perspectives; environmental, operational, and economical.
Environmental advantages:
District heating and cooling (DHC) possesses the ability to be integrated with renewable resources, consequently reducing greenhouse gas (GHG) emissions, and saves energy. The central water-cooled chiller plants on the large scale use a lower amount of energy and appear more efficient compared to the on-site small capacity systems [20, 32, 33, 34]. Therefore, DCS appears more successful in dense areas in a city or municipality since nearby these areas, there are generally some natural cooling or waste energy sources available [35]. However, these two criteria can be found in many areas and cities.
A DHC system aims at saving primary energy, electricity, space, inhibiting air pollution, and reducing environmentally harmful refrigerants [36].
A DHC system aims at saving energy and space, and inhibiting air pollution, and helps to eliminate environmentally harmful refrigerants [36, 37].
District cooling can greatly reduce the electricity use and peak power demand, and thus reduce energy use, during the cooling season [35].
Environmental disadvantages:
Depending on the central plants, DCSs may not totally be environmentally friendly as long-term use of the free cooling sources such as sea or lake might affect the temperature of the sources and limit the cooling capacity if no anticipating measures are considered. It also could affect the ecosystem of the sources [38].
A free cooling system uses a vast amount of water, which is a problem in areas lacking water [30].
Operational advantages:
Prevention of intensive use of chillers and machinery space in the user stations [39].
Noise and structure load reduction [39].
Saves space by removing the cooling tower and chiller plant from the buildings or roofs [39].
A wide range of production methods and always the latest type of equipment are integrated with DCS due to mitigation measures against global warming [30, 40].
District cooling has less requirement for technical staff on building level [34].
Operational disadvantages:
Heat loss within the plant itself as well as the building serviced by the DHC due to distribution losses in pipes and heat exchangers is inevitable [41, 42].
Economic advantages:
The transparency of costs and future proof investment due to easy payment of utility bills [30].
The DCS is relatively flexible as different central plants could be utilized based on the fuel cost, therefore reducing the cooling cost [20, 35, 43].
Owned by the municipality, a district cooling system can capture cash flows that were previously paid for imported natural gas or electricity [35].
DCS can provide more job opportunities as it provides more reliable and flexible services by a specialized professional team [39].
Economic disadvantages:
Selection of a system that shows large environmental benefits may, in fact, end up not being economical as both the environmental and economic aspects have to be considered together [32].
In purpose to utilize cogeneration of district system and electricity, larger DHC is required [44].
High initial investment costs and lack of negotiable prices and tariffs from the customer’s side as DCS are often owned by few local energy companies, and there is a risk of monopoly for the cooling prices and tariffs [10].
In this section, DC cooling technologies, energy sources, operational aspects, and the applications of DC systems are reviewed based on implemented DC technologies through published DC design and analysis research. Before heading to the applications of the DC systems, the concept of resilience is introduced.
The resilience of the building is its ability to withstand extreme weather conditions and recover from the possible incurred damages efficiently and quickly [45]. Chen et al. [46] investigated the resilient cooling strategies and Hay [47] investigated resilience as a developing planning tool for communities. District energy was recommended as the technology that can balance the relationship between the communities and the region [47]. Sharifi et al. advocated for developing district energy systems, net-zero buildings, and neighborhoods as criteria for assessing urban energy resilience [48].
Based on a report from International District Energy Association (IDEA) [49], in 2019, 303 buildings and Ca 10.8 million ft2 were added to the district systems, beyond North America, which is a strong growth in the district systems employment. The number of buildings and the area that was used for the system in 2018 correspond to 156 buildings and Ca 50 million ft2. Based on the statistics in [50], 70% of residential end users in high-population areas in Europe were powered by fossil fuel in 2015. Hence, DHC networks show great potentials that can help in decarbonization and improvement of indoor air quality as these systems help to reduce the primary energy use by utilizing renewable sources of energy and reducing the thermal losses [51].
A few studies are introduced to show the performance of DCS through simulation and real data collection in different climate conditions and their effects on building’s cooling loads. The studies that were dedicated to Asian countries are presented to show the diversity of DHC systems as Asian countries are developing more DHC systems to reduce air pollution, primary energy use, etc. Later in this section, research projects dedicated to DHS in Europe are introduced.
A study was conducted on the performance of DCS vs. individual cooling systems (ICS) in Hong Kong considering different chilled water pump schemes [52, 53] for commercial buildings. Based on the simulation results, DCS consumes around 15% less energy compared to ICS. The annual operation cost of DCS also is 10% lower than ICS under the electrical tariffs of Hong Kong.
Energy modeling of DCS was conducted in [14] in the South East Kowloon Development Project in Hong Kong for residential and commercial buildings. Based on the simulation results, chilled water, eutectic salt, and ice storage could respectively result in a 38, 38, and 22% reduction in installed cooling capacity. An et al. [54], Yan et al. [55], and Nagota et al. [56] analyzed the performance of DCS in districts in China and Japan and concluded the energy-saving effect of DCS. Studies were conducted with absorption chillers as the cooling technology in other parts of Asia such as Thailand [57], Turkey [58], Iran [59] and concluded the energy and carbon emission-saving effect of DCS. As it could be seen from the mentioned studies so far, the positive economic implication of the DHC system is generally observed from the conducted studies.
The Scandinavian market is taking the lead with 49 operating DCS, followed by Germany (28 operating DCS) and Italy (14 operating DCS) [30].
A detailed study on the market of DCS in Sweden is done by [60]. Major district cooling systems appear in Stockholm, Gothenburg, Linköping, Solna-Sundbyberg, Lund, and Uppsala. Based on the statistics reported by Energiförtagen [61], deliveries for 2018 totaled 1156 GWh. It was a record year for Swedish district cooling and an increase of 26 percent compared to 2017, due to an exceptionally hot summer. The total length of district cooling pipelines increased to 627 km, while in 2019, deliveries totaled 991GWh. Figure 2 shows deliveries and network length from 1996 to 2019 [61].
District cooling deliveries (GWh) and network length (km) in Sweden [
From Figure 2, and the economic and environmental benefits provided through the expansion of DC capacity, a continued growth in DCS is expected.
Fahlén et al. [62] presented a study based on the DHC system of Gothenburg. Combined heat and power (CHP) plants and excess heat from industries supply about 80% of the heat. The study assesses the potential of absorption cooling technology to improve the economic and environmental performance of the DHC system. The results show potentials for cost-effective CO2 emission reduction.
The use of absorption chillers in a DCS in Sweden was studied in [63, 64] and the energy performance of the system appeared to improve. A DCS was initiated in 1995, in the city center in Södermalm, Stockholm. Later, it was expanded and another area was added to the system. Both the districts are connected by pipes located in lake Mälaren [65]. In the Södermalm DCS, existing heat pumps in Hammarbyverket were used.
DCS design has evolved over the years from for example constant to variable flow in the distribution loop. These evolutions and updates in design practices have continuously been upgraded and employed in the system. A long-term security of supply is a driving factor in the heating/cooling systems especially in DHC since the heat/cold is generally supplied by local units. Therefore, it is important to upgrade the design in such a way as to achieve this aim. To be able to express a general reliability level, a definition has been anticipated as the system reliability rate for a DH system [10]. The rate is regarded as the ratio between the numbers of supplied available district heating to the customers during a year by total hours in a year [10]. Many factors are responsible for low system reliability rates such as the fuel supply, pipe failures in the distribution networks, water leakages caused by corrosion or pressure surges, and power outages. The latter mentioned factor also influences the short-term reliability of the system. All the mentioned incidents affect the resilience of the system. To compensate for the power outage, a backup electricity generation is generally anticipated for the main distribution pump. To measure the technology readiness level also, the U.S. Department of Energy has introduced a method to calculate the readiness level [66].
Another problem associated with DHC systems that affect the resilience of the system is the high delta-T syndrome. Due to several reasons, degradations occur over time, which deteriorates the standard temperature difference between the supply and return water that in turn affects the performance of the system. A research project was conducted on the low delta-T problem of the DCS in Gothenburg, Sweden [67]. The problem was analyzed by collecting operational data from the Gothenburg district cooling system along with chilled water systems from 37 of the connected buildings. The results depicted several solutions in the district cooling system to overcome a low delta-T and increase the return temperature. For instance, it was recommended to comply with the building design guidelines as well as limit the flow on the primary side of the heat exchanger, and this helps to restrict the operation in the saturation zone of the heat exchanger. A similar study was carried out by Henze et al. [68] on two university campuses in Massachusetts and Colorado and proposed a solution that provided additional cooling load to the campuses with the same central plant system. The mentioned issues raise the importance of maintenance of the system since the system has to be able to retain its ability to withstand future shocks such as those mentioned above, as well to extend its technical lifetime to remain resilient.
To quantify the energy efficiency of the DCS, three energy efficiency factors were proposed [55]. These factors are presented using Eqs. (1)-(3) and each is explained in this section.
“Coefficient of performance” of the chiller plant is represented by
SCOP represents the “system coefficient of performance,” which is the overall energy efficiency of the chiller plant and the distribution system (Eq. (3)). Based on the previous studies, 80% of the energy consumed by the chilled water pumps leads to cooling loss, which is due to the chilled water distribution; therefore, it must be accounted for in the calculation process.
Keeping the efficiency of the system aside, the feasibility of a DHC system could be investigated by taking into account the cost analysis. To provide an effective evaluation of the energy system and the cost-effective alternatives, life cycle cost analysis (LCCA) could be considered. The energy performance and cost analysis of DCS have been evaluated in several studies [69, 70, 71].
LCCA takes into account the costs involving the construction, operation, and demolition phases [72]. The life cycle cost (LCC) is as below [71]:
where
The dynamic payback period (PP) of investment, considering the time value of the capital, is calculated using Eq. (6):
where
With the increase in energy demand, especially cooling energy due to climate changes and the rise in comfort requirements in buildings, meeting the future energy demand has gained more attention. Resilient, economic, and environmentally friendly solutions are required to meet the future energy demand. To fulfill the growing cooling demand and the community’s growing concern about carbon footprint reduction and energy resilience, DC systems are becoming increasingly attractive to communities. District energy is a flexible system in terms of the sources as they can accommodate both cooling and heating. The main focus of the chapter was the district cooling systems and it was aimed to outline the possibilities and benefits of using a district energy system specifically the DCS. Three classification groups based on the system, central plant, and occupant behavior were proposed.
DCS can reduce electricity use and peak demands and be integrated with renewable resources, and, therefore, contributes to reducing greenhouse gas emissions and air pollution. Several sources can be used—free cooling together with electricity or thermally driven chillers. These systems are more efficient in more populated districts. Since the coolant is produced in the central chiller plant, not only the use of space in the building is minimized, but the noise pollution also is reduced. District cooling systems have been reported as economic and environmentally friendly solutions to meet the cooling demand of buildings. The investigated studies in this chapter reported a decrease in energy use when DCS was implemented.
The authors declare no conflict of interest.
Funding of the study by the Swedish Energy Agency, Termo program, is greatly acknowledged (District cooling vs. local solutions for space cooling, project number 48296-1, Dnr: 2019-003410).
CHP | combined heat and power plant |
CO2 | carbon dioxide |
COP | coefficient of performance |
COPplant | coefficient of performance of a chiller plant |
DC | district cooling |
DCS | district cooling system |
delta-T | temperature rise of the cooling water |
DH | district heating |
DHC | district heating and cooling |
GHG | greenhouse gases |
ICS | individual cooling system |
SCOP | system coefficient of performance |
Q | cooling supply of a chiller plant |
Wdistri | energy use of a cooling distribution system |
Wplant | energy use of a chiller plant |
WTFdistri | water transport factor |
PWFin | present worth factor |
CIC | initial capital cost |
Cfuel | natural gas cost |
COM | operational and management cost |
CDispose | abandoned equipment cost |
Ccool | cooling cost |
Cheat | heating cost |
Chotwater | hot water cost |
n | life cycle period |
i | interest rate |
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He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. 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He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. Voyich",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Montana State University",country:{name:"United States of America"}}},{id:"330412",title:"Dr.",name:"Muhammad",middleName:null,surname:"Farhab",slug:"muhammad-farhab",fullName:"Muhammad Farhab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"349495",title:"Dr.",name:"Muhammad",middleName:null,surname:"Ijaz",slug:"muhammad-ijaz",fullName:"Muhammad Ijaz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}}]}},subseries:{item:{id:"14",type:"subseries",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11410,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). 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