Specifications of the developed test bed.
\r\n\tThis book intends to provide the reader with a comprehensive overview of the current state-of-the-art novel imaging techniques by focusing on the most important evidence-based developments in this area.
",isbn:null,printIsbn:null,pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"d9159ce31733bf78cc2a79b18c225994",bookSignature:"Dr. Gabriel Cismaru",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11867.jpg",keywords:"Hypertrophic Cardiomyopathy, Dilated Cardiomyopathy, Restrictive Cardiomyopathy, Transesophageal Echocardiography, Intracardiac Echocardiography, 3-Dimensional Echocardiography, Adult Congenital Heart Disease, Tetralogy of Fallot, Transposition of the Great Vessels, Coronary Artery Disease, Risk Stratification, Revascularization",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 21st 2022",dateEndSecondStepPublish:"May 19th 2022",dateEndThirdStepPublish:"July 18th 2022",dateEndFourthStepPublish:"October 6th 2022",dateEndFifthStepPublish:"December 5th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"3 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Cismaru Gabriel is an Assistant Professor at the University of Medicine and Pharmacy Cluj-Napoca, certified in Cardiology. After completing his certification in cardiology, Dr. Cismaru began his electrophysiology fellowship at the Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu. He has authored or co-authored peer-reviewed articles and book chapters in the field of cardiac pacing, defibrillation, electrophysiological study, and catheter ablation.",coeditorOneBiosketch:"Raluca Tomoaia is an MD, Ph.D. in novel techniques in Echocardiography at the University of Medicine and Pharmacy in Cluj-Napoca, Romania., assistant professor, and a researcher in echocardiography and cardiovascular imaging.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"191888",title:"Dr.",name:"Gabriel",middleName:null,surname:"Cismaru",slug:"gabriel-cismaru",fullName:"Gabriel Cismaru",profilePictureURL:"https://mts.intechopen.com/storage/users/191888/images/system/191888.png",biography:"Dr. Cismaru Gabriel is an assistant professor at the Cluj-Napoca University of Medicine and Pharmacy, Romania, where he has been qualified in cardiology since 2011. He obtained his Ph.D. in medicine with a research thesis on electrophysiology and pro-arrhythmic drugs in 2016. Dr. Cismaru began his electrophysiology fellowship at the Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, France, after finishing his cardiology certification with stages in Clermont-Ferrand and Dinan, France. He began working at the Rehabilitation Hospital\\'s Electrophysiology Laboratory in Cluj-Napoca in 2011. He is an experienced operator who can implant pacemakers, CRTs, and ICDs, as well as perform catheter ablation of supraventricular and ventricular arrhythmias such as ventricular tachycardia and ventricular fibrillation. He has been qualified in pediatric cardiology since 2022, and he regularly performs device implantation and catheter ablation in children. Dr. Cismaru has authored or co-authored peer-reviewed publications and book chapters on cardiac pacing, defibrillation, electrophysiological studies, and catheter ablation.",institutionString:"Iuliu Hațieganu University of Medicine and Pharmacy",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:null},relatedBooks:[{type:"book",id:"5970",title:"Bedside Procedures",subtitle:null,isOpenForSubmission:!1,hash:"ba56d3036ac823a7155f40e4a02c030d",slug:"bedside-procedures",bookSignature:"Gabriel Cismaru",coverURL:"https://cdn.intechopen.com/books/images_new/5970.jpg",editedByType:"Edited by",editors:[{id:"191888",title:"Dr.",name:"Gabriel",surname:"Cismaru",slug:"gabriel-cismaru",fullName:"Gabriel Cismaru"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9064",title:"Epidemiology and Treatment of Atrial Fibrillation",subtitle:null,isOpenForSubmission:!1,hash:"1cd6bf2b3181eb82446347fbe478a2bc",slug:"epidemiology-and-treatment-of-atrial-fibrillation",bookSignature:"Gabriel Cismaru and Keith Andrew Chan",coverURL:"https://cdn.intechopen.com/books/images_new/9064.jpg",editedByType:"Edited by",editors:[{id:"191888",title:"Dr.",name:"Gabriel",surname:"Cismaru",slug:"gabriel-cismaru",fullName:"Gabriel Cismaru"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"51410",title:"Load Leveling Utilizing Electric Vehicles and their Used Batteries",doi:"10.5772/64432",slug:"load-leveling-utilizing-electric-vehicles-and-their-used-batteries",body:'\nThe massive dissemination of electric vehicles (EVs) is believed to be able to improve the total energy efficiency of the vehicles as well as reduce the emission of greenhouse gases and oil consumption [1]. In Japan, considering that the gasoline price, total annual driving distance, electricity price during night time, and fuel consumption of both gasoline-fueled vehicle and EV are 110 JPY l−1, 10,000 km, 12 JPY kWh−1, and 15 km l−1 and 6 km kWh−1, respectively, the total operational cost of EV may be less than 30% of gasoline-fueled vehicle. Furthermore, the acceleration in the development of EV also has been influenced strongly by some various factors including fluctuating oil and gas prices, successful advancements in battery technology, and broader supporting infrastructure [2, 3]. Unfortunately, there are still some challenging problems to expand in a broader scope of the community including high capital cost, long charging time, and relatively short travelable distance [4]. In addition, although the operational cost of EVs is cheaper than the conventional gasoline-fueled vehicles (internal combustion engine–based vehicles), the initial cost of EV is still higher due to high production cost.
\nTo further reduce the initial and operational costs of EV (increase its economic performance), innovative value-added utilization of EV is requested. Furthermore, massive deployment of EVs can disturb significantly the grid electricity, especially when individual charging of EVs in large capacity and number occurred. According to [5], in case that a half of vehicles in Kanto (Tokyo and its surroundings) area are transformed to EVs and half of them are demanding a quick charging simultaneously, about 7.31 GW of additional electricity supply is required. Recently, to give an answer to the above problems, the idea of vehicle-to-grid (V2G) has been proposed and investigated [6–8].
\nThe adoption of EVs to support the electricity of grid or any electricity-related system becomes possible because of controllable charging and discharging behaviors resulting in the possibility of scheduled and coordinated charging and discharging. Therefore, the parked and connected EVs can be assumed as a largely bundled battery which is able to consume (absorb) the electricity from the grid, store it, and release back to the grid. In addition, V2G can be achieved when minimally three fundamental preconditions are totally satisfied: (1) an electricity line connecting both EV and power grid, such as charging station, (2) a communication system transferring the information and control command between EV and grid operator, and (3) an accurate and trusted metering system facilitating fair service measurement [9]. Furthermore, in case that there is any demand for electricity, the grid operators and/or energy management system (EMS) are able to dispatch a control command instructing the connected EVs to discharge their stored electricity to the grid. On the other hand, they can instruct the connected EVs to absorb the electricity due to surplus of electricity or decrease of electricity demand. Therefore, the balance between supply and demand, as well as quality of grid electricity can be maintained.
\nV2G provides various possible ancillary services to the electricity grid or any electricity-related system such as load leveling and spinning reserve. In addition, the distributed EVs also can be assumed as a large-scale energy storage (battery) which is potential to be bundled and utilized to minimize the effect of fluctuating supply. As EVs are moving from and to different times and places, they also could be employed as an energy carrier transporting the electricity in different places and times due to some factors such as electricity price difference and emergency condition. From the economic analysis, the massive adoption of EVs to give ancillary service to the grid (V2G) is considered beneficial because the projected profit is still significantly higher than the initial cost of EVs, especially the battery including the consideration of battery wear and life cycle [4]. This feasibility study has been performed based on the actual data of EVs, especially the life cycle of battery.
\nUntil now, battery cost stands as the highest share in total EV production cost. In addition, as the number of produced EVs increases, the number and total capacity of the used batteries increase accordingly. According to [10], the EV batteries are generally replaced after their storage capacity drops to about 70–80% of its initial capacity. The decrease in battery capacity leads to shorter possible driving range. Therefore, although these used EV batteries are not appropriate anymore for EVs, they can be reutilized as a stationary energy storage (stationary battery). This kind of battery utilization is believed to be able to further improve the overall economic performance of EV as well as reduces their impacts to the environment because it can lengthen the battery end-of-life. The study on the utilization of EV batteries acting as stationary battery to take part in ancillary service to certain EMS or grid can be found in several literature [11, 12].
\nSeveral studies focusing on theoretical analyses of the application of both EVs and used EV batteries have been conducted well. However, those studies are generally lack of experimental investigation including demonstration tests and real application. This chapter deals mainly with the employment of EVs and used EV batteries in supporting the electricity in any typical small-scale EMS including both theoretical and experimental studies. In addition, the results from the demonstration test are also studied and analyzed.
\nCharging of EVs basically can be categorized into three different capacities: (a) slow charging with capacity lower than 4 kW, (b) fast charging with capacity of 10–20 kW, and (c) ultrafast charging with a maximum capacity of 50 kW or higher [13]. Ultrafast charging is conducted generally under high DC voltage and current. In Japan, this ultrafast charging follows the standard of CHAdeMO (the acronym of “charge de move”, equivalent to “move by charge”) which offers charging capacity of 10–50 kW. Until the end of 2015, there are about 6000 ultrafast chargers following CHAdeMO standard across Japan [14]. CHAdeMO chargers can facilitate bidirectional electricity flows resulting in possible charging and discharging of EVs. In addition, intelligent controlling system is also generally installed inside the charger, hence high level communication and control can be achieved.
\nThe management of energy, especially the electricity, is usually coordinated and controlled by certain independent operator. In North America, independent system operator (ISO) and regional transmission operator (RTO) act as the independent and neutral organizations that are responsible to coordinate, control, and monitor the electric transmission throughout the state or region [15]. In addition, ISO and independent transmission operator (ITO) were established in Europe which are quite similar with ISO/RTO in North America. The main differences between the US-type ISO/RTO and the EU-type ISO/ITO are the absence of profit motives, and participation and transparency of all the involved stakeholders [16]. ITO in Europe owns the assets and it belongs to certain stakeholders, but has a regulation to guarantee its independence. On the other hand, ISO is fully unbundled operator having no assets although still belongs to certain stakeholders.
\nIn Japan, community energy management system (CEMS) has been proposed and demonstrated. The main purpose of CEMS is realizing a resilient and smart community, especially related to efficiency in energy utilization and minimization of CO2 emission. The concept of CEMS comes from the demand to optimize the energy services, maximize the potential economy, and minimize the environmental impacts. CEMS coordinates and monitors all the energy supply and demand throughout the community, hence improving the comfort, security, and safety of the whole community members. In CEMS, the streams of energy and information are flowing simultaneously covering supply, demand, storage, and distribution. As a system, CEMS must be robust and secured because it deals with individual information and its authentication.
\nBasic concept of CEMS.
Figure 1 shows the basic concept of CEMS. CEMS has an important role of monitoring and controlling all the energy involved in the community. It becomes the core of efficient, secured, and optimized energy utilization throughout the community. CEMS is able to communicate with other entities inside and outside its authority. Inside the community, CEMS communicates intensively with its lower EMSs such as home energy management system (HEMS), building energy management system (BEMS), and factory energy management system (FEMS). In addition, it also may communicate directly with EVs distributed in the community which are not controlled under certain EMS. CEMS is also able to communicate with other CEMS, large-scale energy providers (utilities), transmission operators, and energy storage operators.
\nInside the community, CEMS initially forecasts both energy supply, especially generable renewable energy (RE) and demand. This forecast is usually performed based on historical (for several years before) and meteorological data. Furthermore, it calculates the most optimized energy balance in terms of quality, security, and economic cost. In case the energy balance between the supply and demand cannot be self-achieved inside the community due to lack of power generation capacity, high and fluctuating demand, and emergency condition, CEMS communicates with other CEMS, utilities, and energy storage providers to deliver or increase their power to the community. On the other hand, in case there is surplus electricity inside the community (due to high supply and/or low demand), CEMS can offer to other CEMS or utilities to buy this surplus electricity.
\nCEMS is also performing a demand side management (DSM). DSM includes efficient energy usage and demand response (DR) in demand side, instead of adding larger generation capacity at the supply side. DSM can be considered as a dispatchable resource, in which the consumer lower voluntarily their demand, therefore the grid quality can be maintained without any additional power supply.
\nEVs can be applied to support the grid electricity, mainly providing energy storage and ancillary services, due to the above-mentioned characteristics. As energy storage, EVs can be charged when the electricity price is relatively low because of surplus electricity in supply side, including RE and excess power, and lower demand (such as during night time). Furthermore, the ancillary services which can be performed by EVs to support the grid electricity mainly cover frequency regulation (up and down regulations), electricity storage, and spinning (synchronous) reserve. Compared to other energy storages or generators, EVs have a very advantageous characteristic which is its ability to charge and discharge instantaneously their electricity once they received the command from the operator or EMS. The above-mentioned ancillary services are required to preserve the balance between supply and demand of electricity, therefore the electricity can be appropriately reliable.
\nTo participate in the ancillary services, the EV owners are requested to have any service contract with the operator or EMS. Possible utilization contract schemes of EVs to support the grid electricity or any electricity-related system are shown in Figure 2. In general, the participation of EVs in the electricity market could be conducted through two types of participation contracts, they are direct and aggregator-based contracts. To facilitate a communication between EVs and operators, a real time data collection is conducted by vehicle information system (VIS) in a certain time interval from EVs covering battery state of charge (SOC), position (GPS data), and predicted arrival time. VIS might be owned and managed directly by EMS, aggregator or it is independent as service operator which provides EV information services to EMS and aggregator.
\nPossible contract schemes of EV in EMS: (a) direct contract and (b) aggregator-based contract.
In a direct contract, the EV owners have the service contract directly with the energy service providers (EMS). In this contract scheme, both the electricity and information are transferred privately and directly between EVs and energy service provider. Therefore, this type of contract is considered applicable for a relatively small-scale EMS, including BEMS and FEMS, and in where EVs are parked and connected to the chargers for relatively long time, for example during working hours. The main advantage of this type of contract scheme is the ability to optimize the profit for the involving entities (EV owners and EMS). Furthermore, controls for both charging and discharging are more simple and faster as EVs are directly and fully under control of EMS. The report in this chapter describes mainly on this type of contract scheme.
\nOn the contrary, in an aggregator-based contract scheme, EV owners have service contracts with the aggregators which are providing and managing electricity services. Therefore, there is no direct contract between EV owners and EMS or other electricity-related entities. The information including EV position (GPS), battery condition (SOC), and estimated arrival time is basically coordinated by aggregator via VIS. Based on these data, the aggregator calculates the available number of EVs as well as the total capacity of the battery which is potential for power services. Furthermore, the aggregator can offer and negotiate for electricity services with other electricity-related entities including aggregators, EMS, and/or electricity utilities. It is assumed that this kind of contract scheme is suitable to be adopted for comparatively large-scale EMS or electricity utilities. The participating EVs are not only located in certain single place, but they might be distributed in different places as long as both electricity connection and communication are available and possible to perform ancillary services. The electricity absorbed from and discharged to the grid can be transferred through power wheeling service utilizing the available distribution and transmission lines. Aggregator acts as service operator, hence they offer some possible ancillary services to the EV owners. On the contrary, the EV owners have the right to select the offered ancillary service programs and receive the service fee from the aggregator.
\nLoad leveling has a strong correlation with the management of both electricity demand and supply. The main objective is to lower the total grid load (electricity purchased from grid) during peak-load hours and avoid the electricity usage higher than the contracted power capacity by shifting the load from peak to off-peak-load hours. In this study, load leveling is conducted by employing both peak-shift and peak-cut. The former is defined as dislocating the electricity load during peak-load time to off-peak-load time. It can be performed by utilizing the stationary battery or other power storage devices which can absorb and store the electricity during off-peak-load time and discharge it during peak-load time. The latter is described as the effort to reduce the electricity which is purchased from the grid. In real practice, this can be conducted by generating its own energy supply especially during peak-load hours, such as RE, or by purchasing the electricity from other entities including the connected EVs. In the case that additional power supply is purchased from EVs, EVs are considered as energy storage and carrier which are storing and transporting the electricity from and to different times and places. Therefore, the economic performance of EVs can be improved by participating in this kind of ancillary services.
\nAlmost all of EVs adopt lithium-ion batteries to store the electricity with consideration of high-energy density, high stability, long lifetime, and relatively lower environmental impact. Charging and discharging behaviors of EVs are influenced by some factors including SOC and temperature [13]. Temperature influences some interface properties of the batteries including viscosity, density, dielectric strength, and ion diffusion capability [17]. Lower temperature results in poor charging and discharging performances because of lower performances of those properties as well as electrolyte limitation [18]. In addition, as temperature decreases, the transfer resistance increases [19].
\nRelationship among charging rate, battery SOC, and charging time during EV charging in different seasons: (a) winter and (b) summer.
Aziz et al. [13] have performed an experimental study confirming the effect of battery SOC and temperature to the charging behavior of EVs in both summer and winter using DC ultrafast charger (maximum charging rate of 50 kW). Figure 3 shows their experimental results, i.e., the relationship among the charging rate, battery SOC, and charging time. Generally, charging rate is influenced strongly by the SOC of battery. EVs with lower battery SOC can absorb higher electricity and their charging rate decreases gradually as their battery SOC increases. In addition, charging in relatively higher temperature (summer) results in higher charging rate, therefore shorter charging time can be achieved. Lithium-ion batteries are generally charged employing a constant current (CC)-constant voltage (CV) method. Charging under higher temperature leads to higher charging current, therefore shorter charging time can be realized.
\n\n\nThe conceptual diagram of integration of EVs and used EV batteries in supporting the electricity in a small-scale EMS is presented in Figure 4. To take part in the ancillary services coordinated by EMS, there must be an initial contract between the EV owners EMS, either direct contract or aggregator-based contract through third entity such as an aggregator. Because of the mobility characteristic of EVs, their charging and discharging behaviors can be fully controlled by EMS in case EVs are connected to the designated charging stations. In addition, the used EV batteries are employed as stationary storage which are always connected to and managed completely by EMS. These used EV batteries are utilized mainly for peak-shift. Therefore, they are charged when the electricity price is low, such as during night time, and discharged during peak-load time or when the electricity price is relatively high, such as noon time. Hence, the amount of electricity which is purchased from the grid during peak-load time can be reduced, resulting in total low electricity cost.
\nConceptual diagram of integration of EVs and their used batteries to small-scale EMS.
EMS is basically controlling all the electricity flows including demand and supply sides. Some types of small-scale EMSs include BEMS, FEMS, and HEMS. A direct contract scheme is adopted in this case. EMS requests the required information from different sources covering its own demand (load), weather information from meteorological agency, EV information from VIS, electricity condition in the community from CEMS, and grid electricity condition from utility. Regarding the weather information, EMS generally has a service contract with certain meteorological agency providing the weather forecast in a certain interval of time in a day. Based on the received weather forecast, EMS will estimate its own load, including base load and fluctuating load. The former is generally defined as the minimum load which is required to run the system for sequential 24 hours. Therefore, this kind of load is usually constant along the day and insignificantly effected by the weather or human behavior. On the contrary, the latter is determined as the load which is influenced strongly by the surrounding weather and human behavior. The fluctuating load includes air conditioning, heating, and lighting. Moreover, the possibly generated electricity from RE, such as wind and solar, is also predicted by EMS utilizing the weather information received from meteorological agency.
\n\nFigure 5 represents the average total load of the office building, especially in Japan, in four different seasons. The highest total building load takes place in summer, and is followed by one in winter, due to air conditioning demand. In addition, building loads in both spring and autumn are almost similar, which are lower than one in winter. Furthermore, daily peak-loads occur twice in a day (weekday), i.e., before noon and afternoon peak-loads. This is because of the immediate drop of load following the lunch break for about 1 hour. The afternoon peak-load mostly takes place in a longer duration, which is about 3 hours, and is higher than the before noon peak-load. Moreover, the highest value of peak-load during summer takes place during afternoon time (13:00–16:00) due to cooling demand. On the contrary, this highest value of peak-load moves to evening time (16:00–17:00) during other three seasons (autumn, winter, and spring) due to heating demand.
\nAverage electricity loads for office building in different seasons.
EMS also receives the EV information from VIS including their position (GPS data), battery SOC, and predicted arrival time. In addition, VIS monitors and collects the information from its EV members wirelessly. It might be an independent service operator and a part of EMS or aggregator. It is responsible to communicate with each EV and provide the collected data to the EMS or aggregator in which VIS has a contract with. In addition, these data are used for coordinating both charging and discharging of EVs, maintaining the balance of electricity and avoiding any peak-load in EMS. Furthermore, VIS is also able to provide additional services to the EV drivers/owners concerning the available ancillary service programs which are being offered by EMS or aggregator. Hence, the EV owners can select according to their interests or conditions. Furthermore, EMS can request the electricity utilities to provide the information including the electricity condition and price in advance (such as one day ahead). This information is important to plan and optimize the electricity supply as well as calculate the amount of electricity which should be purchased from utilities. In addition, EMS also calculates the charging and discharging behaviors of both EVs and used EV batteries which are available according to the information provided by VIS.
\n\nFigure 6 shows the assumed one day specific curve of EV battery SOC during a weekday. EVs are departed in the morning and they reach the destination (office building) at around 9 am. In this study, EVs are used for peak-cut during the afternoon peak-load due to higher peak-load and limited number of EVs in a demonstration test. EV discharging is stopped in case that the peak-cut (load leveling) finishes or the SOC of EV batteries drops to minimum SOC (SOCmin). SOCmin might be determined by the EV drivers/owners, EMS, or aggregator. In addition, EVs leave the office building at around 6 pm with minimum battery condition (SOCmin). On the other hand, in case that the total building load is relatively low (such as in the morning, lunch break, and night) EVs might be charged to enhance their discharging capacity or extending their traveling.
\nTypical SOC state of EVs in weekdays (commuting).
\nFigure 7 presents the basic concept of load leveling which is developed for a small-scale EMS employing EVs, used EV batteries and RE generators including photovoltaic (PV) and wind. Four main continuous steps are proposed: (1) forecasting of the possibly generated RE and building load, (2) load leveling calculation including peak-shift and peak-cut, (3) value recalculation and correction, and (4) charging and discharging controls of both EVs and used EV batteries. The first step, load and RE forecasting, is basically conducted by EMS for 24 hours ahead. Furthermore, because the electricity amount in Japan is measured for a duration of 30 min, the electricity amounts (kWh) in this study are also measured and calculated as the total summation for a duration of 30 min.
\nDeveloped load leveling concept utilizing EVs and their used batteries.
To forecast both load and possibly generated RE, EMS initially sends a request to meteorological agency to deliver the local weather forecast information. This weather information is very crucial for calculating the electricity which can be potentially generated by RE, such as PV and wind. Because the amount of RE generation is significantly smaller than the total load, in this study, this generated electricity from RE is used directly for peak-cut, hence it will be delivered directly and consumed entirely without being stored in the battery. Moreover, the weather information is also used to forecast the fluctuating load of the office building, especially to calculate the demand of air conditioning (cooling and heating) and lighting. The outputs from this first step include the predicted power generation from RE and daily load curves of the next day (defined as day starting from 00:00 to 24:00).
\nAs the building load and possibly generated electricity from RE have been predicted, EMS will calculate the achievable load leveling (peak-cut) for the next day. In order to realize it, EMS sends a request to VIS to calculate and send the information related to the available EVs, including their battery SOCs, which will potentially participate for the load leveling program. This information is required to estimate the total available electricity which can be supplied by the EVs for load leveling.
\nIn order to perform the given request by EMS, VIS initially collects the traveling schedule from the EV drivers (planned departure time and predicted arrival time). Next, EMS forwards this information, as well as calculates the total availability of EVs and their batteries, together with basic information including EV’s ID. This registration of traveling schedule is conducted up to 24 hours before the planned departure. Finally, using the data from the first and second steps, EMS is able to estimate the peak-cut threshold which can be applied for the next day.
\nIn this study, a peak-cut threshold is determined as the maximum electricity which is purchased from the electricity grid. To calculate this peak-cut threshold, some important factors need to be considered including price of electricity at the corresponding time, contracted power capacity, possibly generated electricity from RE, available electricity supply from other sources with low price, and potential energy storage.
\nIn case that the electricity which is consumed by the office building rises resulting in the condition that the purchased electricity from the grid increases and reaches nearly the calculated peak-cut threshold, EMS immediately sends the control command to both connected EVs and used EV batteries to release their electricity supporting EMS to cover the demand. Therefore, the electricity purchased from the grid can be kept to be the same to or lower than the calculated peak-cut threshold. As a result, a higher price of electricity during peak-load time or penalty due to higher capacity than the contracted one can be avoided.
\nWhen EVs are not connected to the designated charging stations, such as in motion or being parked in other places, the information of EVs is sent wirelessly to VIS in an interval of several seconds to minutes (adding and renewing the information). Thereafter, VIS transmits the updated data to EMS. EMS will recalculate the potential availability of electricity from EVs. Moreover, EMS also recalculates the building load based on the present real load of building and real weather which is measured using thermometer and hygrometer. Next, EMS renews its energy management plan, especially the calculated peak-cut threshold.
\nFurthermore, when EVs arrive at the office building and are plugged to the designated charging stations, EV start to communicate directly with EMS and bypassing VIS through the charging lines. EMS will read the information from EVs and update the previous data received from VIS, especially the battery SOC. As EVs are connected directly to EMS via charging station, EVs are completely under EMS management. Therefore, their charging and discharging behaviors are controlled completely by EMS. After receiving the updated data from EVs, EMS recalculates the peak-cut threshold accurately. As the electricity demand reaches the updated peak-cut threshold, EMS sends the control command to EVs and used EV batteries to discharge their electricity. After finishing the load leveling, EMS can manage the charging for EVs, hence another peak-load due to uncoordinated EV charging can be avoided.
\n\nFigure 8 shows the schematic diagram of the demonstration test bed developed in this study. Solid and dotted lines represent the electricity and information flows, respectively. In addition, Figure 9 shows the pictures of the developed test bed. This demonstration test bed was constructed in the factory area of Mitsubishi Motors Corporation which is located in Okazaki, Aichi prefecture, Japan. Due to limited number of EVs and used EV batteries in this study, this test bed is connected to the electricity of the main office building (office building is considered as BEMS), and not to the whole electricity of the factory. PV panels having total maximum capacity of 20 kW is installed at the rooftop of the test bed as RE generator. In addition, five Mitsubishi EVs, i-Miev G, are participating in this demonstration test. The drivers are the employees who are working in the factory and EVs are used for commuting purpose. Therefore, EVs are basically available during working hours, especially during the day. They are parked and plugged to charging stations installed in the test bed. Furthermore, five used EV batteries are also employed as stationary battery. These used EV batteries are basically detached from the same type of EVs after about one year usage.
\nSchematic diagram of the developed test bed.
Overview of the developed system involving PV, EVs, and used EV batteries.
Components | \nProperties | \nValue | \n
---|---|---|
PV panels | \nType | \nMonocrystalline | \n
Capacity | \n20 kW | \n|
Direction, angle | \nSouth, 30° | \n|
PCS capacity | \nAC 200 V, 100 A | \n|
EVs | \nType | \ni-Miev G | \n
Number | \n5 | \n|
Battery capacity | \n16 kWh | \n|
Charging capacity | \nDC 370 V, 15 A | \n|
PCS capacity | \nAC 200 V, 15 A | \n|
Used EV batteries | \nOriginal EV | \ni-Miev G | \n
Number | \n5 | \n|
Condition | \n1-year usage | \n|
Battery capacity | \n16 kWh | \n|
Charging capacity | \nDC 370 V, 15 A | \n|
\n | PCS capacity | \nAC 200 V, 15 A | \n
Specifications of the developed test bed.
EMS is controlling the balance of both demand and supply of the main office building and test bed. EMS also forecasts and measures the demand of the office building. In addition, VIS is also developed as an independent system which communicates with EVs and transmits the received information to EMS. Table 1 shows the detailed specifications of the developed demonstration test bed.
\nThe drivers submit their daily traveling plans to VIS up to one day before the scheduled departure. To facilitate this, a web-based system has been developed facilitating the drivers to input and check their traveling plan from any computers or mobile devices. If EVs are not connected to the designated charging stations of EMS, such as in motion, EVs send their data to VIS in an interval of 10 s wirelessly. In addition, VIS transmitted the received data from EVs to EMS simultaneously. EMS receives EV data from VIS and weather information from meteorological agency. Although the weather information is received basically one day before, meteorological agency will update these data automatically once there is any renewal or correction in the weather information.
\n\nUsed EV batteries are utilized for peak-shift. Charging of used EV batteries is practically performed from midnight to morning (00:00–06:00). Threshold for charging and discharging of both EVs and used EV batteries is set to SOC 90% and SOC 40%, accordingly. In addition, load leveling is designed to be conducted during afternoon peak-load time starting from 12:00 until 18:00 (6 hours duration) because the total amount of potentially available electricity from EVs and used EV batteries is limited and very small compared to the total load of the office building. In addition, to diminish the effect of ambient temperature on charging and discharging behaviors of used EV batteries, the storage room of used EV batteries is controlled to have a temperature of 25 °C throughout the year at.
\nThe load of office building is estimated as the sum of the base load and fluctuating load, especially the air conditioning demand. The air conditioning demand is calculated using historical data for several previous years and forecasted ambient temperature received from meteorological agency. The demand of office building in certain typical time,
where
The available electricity from EVs,
where SOCEV,
To calculate the peak-cut threshold, a day load duration curve is initially created using the historical data of the averaged office building load for the same month in the last year. A peak-cut threshold,
where
In general, a load duration curve lines up all the loads in a descending order. Therefore, in this demonstration test, a day load duration curve is created by sorting all 30 min duration of office building loads from the largest to the smallest loads. Therefore, the plotted area represents the total electricity consumed by the office building for a day (starting from 00:00 to 24:00). Furthermore, the generated electricity from PV panels is directly delivered to the building without being managed by EMS to be stored in the battery. In addition, the total electricity which can be obtained from connected EVs, used EV batteries, and PV panels is plotted on the top of a day load duration curve for the corresponding day while its bottom is kept to be straight at the same value of load. Therefore, the created straight line is a peak-cut threshold which is used in load leveling.
\nTypical load duration curve and the calculated peak-cut threshold.
A result of load leveling demonstration test of one representative weekday is shown in Figure 11. It consists of the total grid load (net electricity purchased from the grid), building load (the total load consumed by the office building), electricity generated by PV panels, and total charging and discharging from and to EVs and used EV batteries. Charging and discharging of EV and used EV batteries are represented as dotted blocks in positive and negative sides, respectively. The total grid load during after-noon peak-load time (load leveling test from 13:00 to 16:00) is significantly lower than the building load. This is because of the power generated by PV panels and peak-cut threshold which order the EVs and used EV batteries to discharge their electricity.
\nCharging and discharging of EVs and used EV batteries in negative sides mainly occur due to charging of used EV batteries during the night time and EVs charging during morning time (before the peak-load time) and during lunch break time. As used EV batteries are charged during night time, the grid load during this time is higher than the building load. EVs generally arrive at the office building at around 08:00 and they are connected to the designated charging stations of EMS. From this moment, charging and discharging behaviors are fully controlled by EMS. Because the building load is still lower than the calculated peak-cut threshold, EVs charging can be conducted until the building load reaches nearly the peak-cut threshold to increase the discharging capacity of the EVs during peak-cut. Moreover, additional charging starts again during noon break (12:00–13:00) because the building load drops drastically creating any marginal grid load.
\nResults of load leveling test during weekdays.
From Figure 10, the peak-load occurs twice, i.e., before noon and afternoon, respectively. However, before noon peak-load is lower than the one in afternoon time. The generated electricity by PV is always consumed directly without being charged, hence peak-cut for the before-noon peak-load is conducted only by PV. In addition, the afternoon peak-load starts usually from 13:00 after the end of lunch break time. During this time, the building increases significantly and when it reaches approximately the calculated peak-cut threshold, EMS sends immediately the control command to EVs and used EV batteries to discharge their electricity according to the required amount for load leveling. Hence, the purchased grid load can be kept to lower than the contracted power capacity.
\nHowever, due to the limitation of available number of EVs and used EV batteries, load leveling only can be performed in a relatively short duration of time. It is estimated that as the number of EVs and used EV batteries taking part in this ancillary service program increases, more significant effect of load leveling can be achieved. In addition, a longer duration of load leveling and lower value of peak-cut threshold can be obtained accordingly.
\n\nFigure 12 shows the total amount of load leveling in a day by each PV panels, EVs, and used EV battery for 8 months of duration of demonstration test. Furthermore, Figure 13 shows the averaged total load leveling by each PV panels, EVs, and used EV battery in different months. The used EV batteries have the largest and most stable load leveling share compared to EVs and PV. On the other hand, the generated electricity from PV is quite fluctuating because it is influenced strongly by the weather condition, especially solar intensity. Furthermore, the share of EVs in load leveling is also strongly influenced by their main usage as vehicle because it will affect significantly their SOC (available electricity for load leveling).
\nThe amount of load leveling in a day by each component (PV, EVs, and used EV batteries).
Averaged total load leveling by each component (PV, EVs, and used EV batteries).
The uncertainties are brought mainly by three factors: EVs, PV, and building load. These factors result in divergence between the predicted and real values. In this demonstration test, because the capacity of office building load is significantly larger than the total electricity which can be provided by PV panels, EVs, and used EV batteries, it is assumed that the strongest factor influencing this uncertainty is the building load, especially demands for air conditioning. Moreover, PV also gives an additional influence to this uncertainty due to its fluctuation.
\nAs the results of conducted demonstration test, the predicted grid load showed a relatively high similarity with the real grid load. However, the difference between the predicted building load and its real load is relatively large due to the above-mentioned uncertainties.
\nThe divergences in office building load and generated electricity from PV panels can be lowered by controlling the charging and discharging amounts from both EVs and used EV batteries. In addition, in this demonstration test, the uncertainty related to EV availability and its capacity do not show any significant impact. It is because the drivers of EVs are basically the employees who are working in the office building and almost the commuting routes are constant every day. It is considered that although there is an uncertainty on EVs’ availability and their capacity, the divergence between the predicted and real grid loads could be reduced as long as the capacity of the used EV batteries which are owned by EMS are able to cover those fluctuating factors.
\nThere are some important findings and suggestions which can be derived from the above theoretical study and demonstration test which are related to the employment of EVs and their used batteries to support the electricity in a small-scale EMS.
To calculate an optimum peak-cut threshold, an accurate forecast of both demand and supply is required. The demand forecast is influenced strongly by two main factors (especially the fluctuating load): weather condition and human behavior inside the building. To achieve more accurate weather forecast, timely update of weather information from meteorological agency and utilization of historical meteorological data are considered very important. In addition, regarding the forecasting of the human behavior, a construction of database and knowledge of specific behavior patterns of the office building is demanded. In case that the measurement of behavior patterns is relatively difficult to be performed, the method of guiding the behavior of the residence by establishing some regulations or policies might be taken.
Objective and accurate metering system to measure the amount of charged and discharged electricity to and from EVs is crucially demanded to enhance the trust and transparency. It can be performed by independent third party which is trusted by both EV owners and EMS/aggregator, especially in an aggregator-based contract scheme. The measurement can also include the participating duration, including stand-by time.
The increase in EVs number taking part in this ancillary service results in larger available capacity for load leveling (peak-cut). Unfortunately, this phenomenon is also potential to cause higher risk of larger fluctuation in case that EMS cannot forecast accurately the number of EVs. Installation of larger amount of stationary battery (used EV batteries) is considered potential to buffer and absorb this fluctuation through charging and discharging controls.
If some EVs which are participating in the ancillary service stop suddenly their service and demand an emergence charging due to some factors, such as traveling distance which will be traveled, EMS also must be able to coordinate this kind of sudden charging demand for EVs. The uncoordinated charging can result in creation of a new peak-load.
Compared to peak-load during summer, peak-load during winter is generally lower. However, peak-load during winter occurs mainly during evening time, around 17:00. This is because the heating demand inside the office building increases following the decrease in ambient temperature. It is important to note that the basic working hour also ends in this time, therefore there is any possibility that some EVs are demanding an additional charging before leaving the office. As a result, a new peak-load can occur during this time if the demand for EV charging is high. EMS must be able to also predict this kind of emergency and uncoordinated charging, hence a new peak-load can be prevented.
Additional number of EVs and total capacity of used EV batteries will be required when the amount of electricity generated by REs, including PV and wind, increase due to larger amount of fluctuating electricity in the supply side.
This chapter discussed the enhanced utilization of EVs and their used batteries to participate in ancillary service to support the electricity, especially in a small-scale EMS. In addition, experimental study based on the real data collected from the demonstration test bed has also been described. The study showed that it is feasible to utilize EVs and used EV batteries in supporting small-scale EMS. Furthermore, load leveling which determines initially the peak-cut threshold and, then controls both charging and discharging behaviors of EVs and used EV batteries based on peak-cut threshold is considered as a valid technique. As a result, the purchased electricity from the grid can be kept to be lower than the contracted power capacity.
\nAccurate forecast of both load and supply is considered as one of the important issues in this utilization, in addition to the availability forecast of EVs and their batteries. The supply includes the condition of electricity market, possible generated power by REs, and available electricity which can be supplied by EVs. Furthermore, highly accurate load forecast, especially the fluctuating load including human behavior and air conditioning, is also very essential to achieve an optimum target condition as it has been estimated by EMS.
\nCancer is a major public health problem worldwide. It ranks as a leading cause of death along with cardiovascular disease (CVD). Cancer is the leading cause of death in 57 countries (including China), while CVD is the leading cause in 70 countries (including Brazil and India) [1]. In 23 other countries, it ranks either third or fourth. The GLOBOCAN 2020 report showed that there was approximately 19.3 million new cases and 10 million cancer deaths in 2020, thus making cancer the new challenge of the 21st century [2]. This increase in the number of cancer cases implies an increase in cancer-associated complications and morbidities. One such complication is malnutrition.
Cancer-related malnutrition is a broad term that encompasses complex poorly understood processes that are associated with specific types of cancers and their treatment protocols. Specific cancers such as oesophageal and pancreatic cancer are a high risk for malnutrition. Factors such as cancer-related symptoms (e.g. anorexia, early satiety, fatigue), treatment complications (eg, mucositis, nausea, taste changes), and psychologic distress all play a role and/or are risk factors in the development of malnutrition. Malnutrition is a common problem among cancer patients with high negative consequences. In cancer, it is associated with poor prognosis, reduced survival, increased therapy toxicity, reduced tolerance and compliance to treatments, and diminished response to antineoplastic drugs. Surveys done in the past showed a prevalence rate of between 25 and 70% with about 10–20% linked to malnutrition and not the malignancy itself. Malnutrition in cancer patients is distinctly different from malnutrition as a result of starvation, as the former arises from a combination of anorexia and metabolic dysregulation, caused by the tumour itself or by its treatment. Malnutrition when left untreated can progress to cachexia. Cachexia is defined as “a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment” [3]. The pathophysiology of cachexia has an underlying variable combination of reduced food intake and abnormal metabolism leading to a negative protein and energy balance. Cachexia is frequent in chronic diseases, and in cancer, it may account for about 20% of cancer deaths [4]. A diagnosis of cachexia is made in patients when the total body weight loss is >5% in the past six months (in the absence of starvation) or weight loss >2% in patients with body mass index (BMI) of <20 kg/m2 [5]. Currently, cachexia is classified into three stages of clinical relevance, namely pre-cachexia, cachexia, and refractory cachexia [3]. Blum et al. defined pre-cachexia as weight loss >1 kg but <5% of usual body weight/6 months, but with an increased C- reactive protein (CRP) level and appetite loss, while refractory cachexia was weight loss >15% in the last 6 months + BMI < 23 kg/m2 or weight loss >20% in the last 6 months + BMI <27 kg/m2 [6]. If untreated, cancer cachexia would lead to a progressive functional loss, poor quality of life, chemotherapy-related toxicity, diminished response to antineoplastic treatments, and poor survival. At the refractory cachexia stage, the cancer is usually refractory to chemotherapy.
The relationship between malnutrition and the systemic inflammatory process is not a new one. Systemic inflammation is closely associated with weight loss and malnutrition in cancer [7, 8, 9]. Systemic inflammation has been fingered in the genesis and progression of malnutrition. It is known to affect important metabolic and neuroendocrine pathways as well as cause elevated energy expenditure at rest, decreased lean mass and reduced physical performance [10, 11]. Furthermore, cytokines especially tumour necrosis factor (TNF) alpha, interleukin (IL) 1 and IL-6 have been fingered in the induction of muscle wasting providing evidence for a link between malnutrition and inflammation. As aforementioned, systemic inflammation is thus a harbinger not only for malnutrition but for various comorbidities in cancer patients. Identification of cancer patients at risk of malnutrition is highly recommended. The PreMiO study highlighted the prevalence of malnutrition at the first visit by cancer patients [12]. The European Society for Clinical Nutrition and Metabolism (ESPEN) in its latest pre-operative nutritional care assessment highlighted the degree of systemic inflammation among other things for individuals at nutritional risk [13]. Soeters et al. reinforced the urgency of including an assessment of inflammatory activity in the diagnosis of malnutrition [14]. Recent studies have shown that inflammatory models can be used to predict prognosis, as well as cancer-related malnutrition [15]. High level of systemic inflammatory factors which can facilitate tumour cell proliferation and metastasis are also known to be induced by malnutrition [16]. Thus, malnutrition can enhance a systemic inflammatory response. Control of inflammation in cancer can help modify poor nutritional status resulting in better response to therapy and improved survival. The early recognition of systemic inflammatory response should therefore be an integral part of nutritional management in cancer patients to improve short and long term outcomes.
Malnutrition is a universal condition in cancer patients with grave clinical implications such as impaired quality of life, poor performance status, weight loss and cachexia. Studies from different countries across Europe shows a high prevalence of cancer-related malnutrition ranging from 25 to 70% based on nutritional assessments [17, 18, 19]. However, this differs across cancer types and stages of the disease [12, 20]. In the often-cited landmark study by Dewys et al., cancer type and treatment play a role in cancer-related malnutrition [21]. Tumour stage and age have also been noted as risk factors in malnutrition [22, 23]. In an epidemiological observation study, Pressoir et al. observed that pre-existing obesity (BMI⩾30), and Performance status ⩾2 were associated with increased risk of malnutrition among cancer patients in 17 French Comprehensive Cancer Centres [19]. The Prevalence of Malnutrition in Oncology (PreMiO), a cross-sectional, observational study involving almost 2000 patients in 22 sites in Italy, revealed that 51.1% of treatment-naïve patients at their first visit to a medical oncology centre were already affected by a nutritional impairment, including risk for malnutrition (43%) and overt malnutrition (9%). Poor appetite was present in over 40% of cancer patients, with variable severity scores depending on the tumour type and stage of the disease, and ascribed mainly to early satiety, taste changes, and nausea [24].
The picture is not very different in developing countries. Pastore et al. in Brazil reported only 13.7% of lung and gastrointestinal cancer patients in a study were well-nourished [8]. Opanga et al. in Kenya reported that 33.8% of participants required critical nutrition care, 34. 8% symptoms management, 14.2% constant nutrition education and pharmacological intervention [25]. Ntekim et al. at Ibadan, Nigeria used nutritional screening assessment tools and reported a prevalence of 60% [26]. Children with cancer are also known to develop some form of malnutrition [27], however, the frequency may vary according to the type of cancer [28], and region [29, 30]. Brinksma, et al. reported the prevalence of malnutrition at diagnosis for developed countries, through a systematic review which included patients with different types of childhood cancer, aged from 0 to 18 years of age for acute leukaemias, the prevalence was 10%, 20–50% for neuroblastoma, and those classified as “other malignancies” was 0–30% [31]. This prevalence is lower than what is obtained in developing countries [28, 29, 30]. Villanueva et al. reported a prevalence of almost 50% [32]. Lemos et al. in Brazil reported that the prevalence of malnutrition is higher among paediatric patients with malignancies than in the general population though the difference was not significant [33]. These facts high- light the need for nutritional assessment in cancer patients regardless of age or region. Cancer patients should be assessed at several points during their management to identify aetiology and candidates that require nutritional support.
Cancer-related malnutrition can have profound negative effects on cancer patients’ wellbeing and therapeutic outcomes. It usually results from local effects of a tumour, the host response to the tumour and anticancer therapies. Cancer cachexia which is a severe form of malnutrition is characterised by progressive weight loss, anorexia, asthenia, and anaemia. Cachexia is a poor prognostic sign, and is associated with reduced food intake and increased energy expenditure [34]. Cachexia also expresses itself as nutritional imbalances in a number of ways in cancer patients which include glucose intolerance and insulin resistance, loss of adipose tissue and lipolysis with increased fat oxidation rates [35], decreased lipogenesis, impaired lipid deposition and adipogenesis [36]. A decrease in protein synthesis and increase in protein degradation does occur in cancer cachexia [37] which is a key feature of skeletal muscle atrophy. Other features such as altered hormone levels [38], elevated cytokines [39, 40], increased insulin resistance [38], elevated synthesis of acute-phase proteins [34] and altered nutrient utilisation can be attributed to inflammatory mediators as well a host of other factors. Inflammatory markers have been implicated in all metabolic derangements in cancer-related malnutrition, and a better understanding of these markers with either the host or the tumour is necessary for better management of malnutrition and its complications.
Inflammation has been shown to play a major role in cancer development, progression and outcome and has been termed the seventh hallmark of cancer [41]. The observation of leukocytes within tumours by Rudolf Virchow in the 19th century gave a clue of a possible link between inflammation and cancer. This link is due to chronic inflammation which is mediated by pro-inflammatory cytokines, chemokines, adhesion molecules, and inflammatory enzymes with the promotion of all stages of tumorigenesis. Inflammation is the body’s physiological response to tissue damage as a result of any pathological insult to the body’s homeostasis. The body’s inflammatory response can either be a resolution to the insult, or persistence of the insult in the form of chronic inflammation. Chronic inflammation can cause cellular changes and influence innate and adaptive immunity towards tumour growth. When this happens, an imbalance of pro-inflammatory and anti-inflammatory mediators can lead to cell mutation and injury creating an environment that is conducive to the development of cancer. This scenario holds for the onset of cancer but is important for the progression of the disease. Such progression is characterised by clinical signs and symptoms including nutritional impact symptoms and co-morbid metabolic abnormalities. This invariably leads to weight loss, chronic anaemia, wasting syndrome, fatigue with loss of quality of life. These symptoms are very prominent in cancer-related malnutrition. While multiple mechanisms can be associated with these symptoms, however, they are interrelated and the unifying factor is inflammation.
Inflammation is associated with tumorigenesis at every stage of its development including survival and metastasis [42]. On the other hand chronic inflammation is known to facilitate treatment resistance and this form of acquired resistance is a result of the production of cytokines, chemokines and growth factors by the tumour micro-environment rendering chemotherapy ineffective [43]. Besides, inflammatory responses can be induced by anti-cancer therapies [44, 45]. chronic inflammation is also known to worsen chemotoxicity [46]. A better understanding of the relationship between chronic inflammation and cancer can lead to the development of new strategies in the management of cancers as well as some of the complications such as malnutrition and chemotoxicity that arise during treatments.
A large number of cancer patients are known to show a form of cachexia syndrome which is characterised by anorexia, loss of adipose tissue and skeletal muscle mass. Most of these symptoms have been linked to inflammation. The Global Leadership Initiative on Malnutrition (GLIM) requires the combination of at least one phenotypic and one etiologic criterion is to establish the diagnosis of malnutrition. The phenotypic criteria include non-volitional weight loss, low body mass index, reduced muscle mass. In addition to this, etiologic criteria include reduced food intake or assimilation and disease burden/inflammatory condition [47].
Inflammation is so intertwined with the pathogenesis of malnutrition that the ESPEN recommended dividing malnutrition into disease-related malnutrition with and without inflammation [48]. For Disease-related malnutrition with inflammation, it is defined as underlying diseases causing inflammation with a consecutive lack of food intake or as uptake with a negative nutrient balance [49]. Inflammation is reported to have several metabolic effects. Cytokines such as IL-6, and TNF-
Anaemia is a common problem in cancer patients. Anaemia prevalence is remarkably high and varies widely among cancer patients. It is estimated from various studies that between 30–90% of cancer patients had anaemia [54]. Anaemia is considered an indicator of poor nutrition and poor health especially through the malabsorption or non-utilisation of iron, folate, cobalamin and other micronutrients needed for the production of red blood cells. The prevalence is determined by the definition of anaemia. According to the World Health Organisation (WHO), normal Hb values are 12 g/dL in women, and 13 g/dL in men [55]. Maccio et al. reported a prevalence of 78.8% of anaemia in lung cancer patients [56]; Akinbami et al. reported a prevalence of 58% among breast cancer patients [57]. Anaemia is known to be associated with several co-morbidities including a decline in patients’ performance status (PS), cognitive function, and decreased survival [56, 58]. While anaemia in cancer generally is known to have various aetiopathology, cancer-related anaemia (CRA) is believed to arise as a consequence of chronic inflammation.
Cancer-related anaemia (CRA) refers to a condition occurring without bleeding, haemolysis, neoplastic bone marrow infiltration, kidney and/or hepatic failure [59], and principally results from the chronic inflammation associated with advanced-stage cancer and the synthesis of pro-inflammatory cytokines by both immune and cancer cells. Unlike iron deficiency anaemia, CRA is typically normochromic (MCH >27 pg), normocytic (MCV between 80 and 100 fl), with a low reticulocyte count (<25,000/mL) and a low value of reticulocyte index (normal range between 1 and 2 which is a more accurate measure of the reticulocyte count corrected against the severity of anaemia based on haematocrit). In addition, it has normal/low serum iron concentrations (normal range 55–160 mg/dl for men and 40–155 mg/dl for women) and reduced total iron-binding capacity (transferrin saturation < 50%); ferritin values may be normal (30–500 ng/ml) or more often increased (>500 ng/mL), with increased iron storage [59]. The normal level of iron within the bone marrow reflects the body tacit handling of iron metabolism which is termed as “functional iron deficiency” which is also present in other types of anaemia associated with chronic inflammation. In addition, circulating levels of erythropoietin (EPO) is often not optimal for the level of anaemia thus presenting with also bone marrow hypoplasia. Adamson highlighted some of the pathogenetic mechanism of inflammation of chronic anaemia which includes: shortened erythrocyte survival in conjunction with increased erythrocyte destruction, suppressed erythropoiesis in bone marrow, effects of inflammation on erythropoietin production and alterations in iron metabolism that result in iron-restricted erythropoiesis induced by hepcidin increase [60]. According to Jain et al., the soluble transferrin receptor/log ferritin index can differentiate pure cases of anaemia of chronic disease from iron deficiency anaemia [61].
Like other types of anaemia in cancer, CRA has multifactorial pathophysiology with immune, nutritional and metabolic components affecting its severity. Many studies have demonstrated that inflammatory cytokines are a major contributor to the aetiopathogenesis of CRA. They achieve this through the derangement of various metabolic pathways including glucose metabolism, impairment of lipoprotein lipase, which controls the uptake of circulating triglycerides into adipocytes, and changing protein synthesis and degradation, with subsequent depletion in lean body mass [62]. In particular, proinflammatory cytokines like interleukin 1 and 6 released by cancer and activated immune cells in response to malignancy, may result in anaemia by inducing changes to iron balance, inhibition of erythropoiesis, impairment of EPO synthesis and activity, reduction of erythrocytes lifespan and changes of energy metabolism. IL-1 and TNF also induce the transcription factors GATA2 and nuclear factor-kB, both of which are negative regulators of the hypoxia-inducible factor 1 (HIF1) expression [63]. Reactive oxygen species (ROS) which are a major player in chronic inflammation are known to inhibit EPO synthesis by mimicking a false O2 signal in the renal peritubular interstitial cells. They equally inhibit erythroid precursor proliferation [64]. IL-6 regulates the synthesis of hepcidin, a 25 amino acid peptide made by the hepatocytes and involved in iron homeostasis by mediating the degradation of the iron export protein ferroportin 1, thereby inhibiting iron absorption from the small intestine and release of iron from macrophages.
The process of CRA is not an isolated one. It has been shown that malnutrition along with weight loss and reduced food intake is correlated with anaemia in patients with the chronic inflammatory disease [65]. CRA is therefore not a single condition, but associated with weight loss and remodelling of energy metabolism; thus CRA is a crossroad for both inflammation and nutritional status. Therefore management of CRA would involve not only anaemia but malnutrition as a whole.
Anorexia can be defined as a loss of appetite associated with chronic illness in cancer patients and is associated with weight loss [66]. It is common in cancer patients and frequently associated with early satiety and taste changes. It occurs in half of the newly diagnosed cancer patients and up to 70% of patients with advanced disease. Cancer-related anorexia is an important clinical co-morbidity in cancer patients, and it harms nutritional status in advanced cancer. There are many causes of anorexia. They are classified as either being due to central or peripheral mechanisms. Peripheral causes include (i) tumours causing dysphagia or directly impinging on gastrointestinal function; (ii) tumours producing substances that alter food intake, e.g. lactate, tryptophan, or parathormone-related peptide; (iii) tumours leading to alterations in nutrients resulting in anorexia, e.g. zinc; or (iv) tumours producing inflammation leading to cytokine release. Alterations in gastrointestinal function can alter visceral receptor function, leading to altered secretion of gastrointestinal peptides, e.g. peptide tyrosine (PYY), and alterations in stomach emptying can alter feedback of satiating hormones. Peripherally, chemotherapy can alter taste perception and cause nausea, vomiting, mucositis, abdominal cramping, bleeding, and ileus [67]. Depression, pain, or a variety of alterations in central neurotransmitters are some of the central causes. Some centrally acting chemotherapy can also induce anorexia. For example, tamoxifen used in breast cancer treatment can inhibit fatty acid synthase in the hypothalamus, leading to an accumulation of malonyl coenzyme A (CoA). Increased malonyl CoA is associated with anorexia in cancer [68, 69]. The resultant effect of cancer-related anorexia is reduced caloric intake and alteration in nutrient metabolism with consequent loss of fat and lean mass.
Several studies have focused on the mechanisms underlying the metabolic changes observed in cancer-related anorexia and weight loss and some cytokines have been implicated including TNFα, IL-1, and IL-6 [70]. These cytokines are known to mimic leptin signalling and suppress orexigenic ghrelin and neuropeptide Y (NPY) signalling inducing sustained anorexia and weight loss. These cytokines are elevated in many cancers [71] and their chronic administration can induce anorexia and wasting [72, 73]. Interleukin 1 is produced by lymphocytes and macrophages and is a potent anorexigenic cytokine that is at least 1000-fold more effective than leptin [74]. IL-1 is reported to reduce the size, duration, and frequency of meals but does not reduce the desire for food [75]. It achieves this by the stimulation of corticotrophin-releasing factor (CRF) production by the hypothalamus [76]. TNFα is produced by monocytes, tissue macrophages and some tumours, and directly on the CNS to produce its anorectic effects by crossing the blood-brain barrier. An inhibitor of TNFα increased food intake in anorectic tumour-bearing rats [77].
Interferon-γ when administered centrally is known to reduce food intake and duration. Administration of TNF-α to laboratory animals induces a state of cachexia, with anorexia and depletion of adipose tissue and lean body mass [78]. Interleukin-6 is secreted by T-cells and macrophages as well as microglia, astrocytes, and neurons and has a well-established association with the onset of cachexia in both rodent and human wasting conditions [79]. While there are many mediators of anorexia in different disease states, IL-6 has been shown to regulate food intake and metabolism [80], signalling through neural gp130 receptors and even in non-cancer-related cachexia, plasma IL-6 is associated with the incidence of anorexia [81, 82].
Decreased caloric intake alone does not account for the profound weight loss observed in cancer patients. Metabolic abnormalities with subsequent elevation in basal energy expenditure are also contributing factors. Weight loss in cancer though affects both fat and lean mass, the latter seems more affected. In a study of 50 cancer patients by Cohn et al., Weight-losing cancer patients appeared to have lost both fat and lean tissue, but the loss of lean body tissue, particularly skeletal muscle, was the more striking feature [83]. This pattern is in contrast to starvation, in which fat is lost and lean tissue is better preserved. TNF-α, IL-1 and IL-6 have been shown to increase basal energy expenditure causing weight loss [84]. The muscle wasting that occurs in cancer is a result of a decrease in protein synthesis, an increase in protein degradation or a combination of both. These changes are attributed to the upregulation of inflammatory mediators, the activation of related transcription factors and signalling pathways, abnormalities in the expression of angiotensin II (Ang II), insulin-like growth factor-1 (IGF-1) and various receptors, proteins and kinases, and organelle dysfunction [85]. Muscle wasting thus occurs as a result of these processes.
There are several clinical, biochemical and physiological indicators to diagnose malnutrition in cancer patients. One commonly used clinical indicator of malnutrition is the percentage of weight loss in a certain period. Α weight loss of more than 5% in the previous month or more than 10% in the last 3–6 months is considered significant malnutrition. Other anthropometric measurements, such as body mass index (BMI), mid-arm circumference and mid-upper-arm muscle area can give information about the nutritional status and body composition of these patients. The ASPEN guidelines for diagnosing malnutrition, which looked at six characteristics that incorporate some of these clinical indices [86].
Biochemical markers which are sometimes indicative of inflammation are often used as markers of malnutrition. They include albumin, prealbumin, C-reactive protein, transferrin, total lymphocyte count etc. However, more recently, inflammation-based scores and ratios are being seen as more sensitive markers than the traditional ones [87, 88]. Other nutritional assessment tools use questionnaires incorporated with factors such as estimation of nutritional intake, laboratory parameters and calculation of unintentional weight loss. Such tools that have been used in cancer patients include the Prognostic Nutritional Index (PNI), the Nutritional Risk Screening 2002 (NRS 2002), the Controlling Nutritional Status (CONUT), Mini Nutrition Assessment (MNA), Malnutrition Screening Tool (MST), the Nutritional Risk Index (NRI) etc. [89]. In children with cancer, the Frisancho table is used to assess their nutritional status [29].
Albumin is a serum hepatic protein with a half-life of 14–20 days. Albumin is the major carrier for many substances in the body, and also help maintain the body oncotic pressure. It enhances immunity, aids DNA synthesis as well as acts as an antioxidant [90, 91]. Due to its relatively long half-life and hepatic synthesis, it is seen as a good marker of malnutrition. However, albumin is a negative acute-phase protein, and its serum levels are down-regulated in response to inflammatory conditions and drugs especially those that affect the liver. Albumin is widely used as a marker of nutrition as well as a prognostic indicator of survival in cancer patients (though it is more of a marker for inflammatory response). Frutenicht et al. reported that albumin was a predictor of mortality in gastrointestinal tumour patients [92]. Das et al. reported that albumin was significantly correlated with Patient-Generated Subjective Global Assessment (PG-SGA) [93], thus hypoalbuminaemia is a marker of malnutrition. This was further affirmed by a study done on colorectal cancer patients where albumin was positively correlated with the MNA [94]. However, In a study of 74 cancer patients, Pastore et al. did not find significant variation between albumin and SGA [8]. In a recent study on 128 colorectal patients, at least two circulating cytokines (TNF-α and IL-10) affected the expression of serum albumin [95]. Albumin correlates with weight loss in cancer patients as well as with BMI. Albumin is equally incorporated into various indices such as the Glasgow prognostic score (GPS) and PNI. Albumin may not be the ideal marker for assessing malnutrition, but its incorporation into nutrition screening tools gives it a sense of validity.
CRP is the most common method used to assess the magnitude of systemic inflammatory response. Unlike albumin, it is a positive acute-phase protein. CRP is a prototype of short pentraxin present only in the pentameric form in plasma. It is synthesised by hepatocytes in response to trauma, inflammation and tissue damage. The synthesis of CRP is under the transcriptional control of cytokines and transcription factors. Interleukin-6 (IL-6) is the main inducer of CRP gene. CRP is associated with the development, progression and outcome of cancer [96]. In addition, some studies have found a positive association between altered CRP levels and weight loss in patients with cancer [97]. In a large international cohort of advanced cancer patients, Laird et al. reported that C-reactive protein was significantly associated with cognitive, physical, emotional and social functions as well as anorexia, pain and fatigue [98]. Yu et al. also observed a significant association between CRP and PG-SGA among patients with malignant tumours [99]. However, some other studies did not see any association between CRP and nutritional status [88, 92]. In a study done by Read et al., patients with advanced colorectal cancer were initially found to have a positive correlation between SGA and CRP. However, when two outliers were excluded, the association did not remain significant [100]. This observation may be a result of the effect of non-nutritional factors like cardiovascular disease and infections. CRP is positively correlated with weight loss, and negatively correlated with PNI. Like albumin, CRP is incorporated into some nutritional screening tools which give it some validity.
Traditional inflammatory markers like CRP and albumin have been shown to have some limitations in malnutrition diagnosis based on their low specificity. It has been muted that inflammation-based scores that combine CRP and albumin, such as the CRP/Albumin ratio (CAR), may have more significant prognostic value than each of these markers singly in malnutrition. These inflammation-based scores which include inflammatory ratios and indices, and haematological ratios have been reported to be associated with cancer progression and outcomes [101, 102].
The Glasgow prognostic score or modified Glasgow prognostic score indices which combine serum CRP and albumin levels have also been viewed as a prognostic indicator in many cancers. There have been more than 60 studies (>30,000 patients) that have examined and validated the use of the GPS or the modified GPS (mGPS) in a variety of cancer scenarios [103]. Silva et al. demonstrated the clinical utility of modified GPS in a palliative care setting and its association with SGA [104]. SGA was also strongly correlated with the Glasgow prognostic score in oesophageal cancer patients [105]. GPS currently serves an important significance as a nutritional marker in cancer.
The concept of the CRP/albumin ratio (CAR) was first proposed by Ranzani and demonstrated its value for the mortality of septic patients [106]. CAR unlike GPS is a continuous variable and is believed to have a wider clinical application than GPS. A high level of CAR is linked to survival in cancer patients [102, 107]. De Lima reported that CAR was significantly associated with weight loss and SGA in patients with gastrointestinal tumours [108]. A high preoperative CAR and low PNI strongly correlated with poor survival in pancreatic cancer [109]. In oral cancer patients, Park et al. showed that CAR was significantly associated with both PNI and mGPS, and was also a better marker for survival than the other markers [110]. Another related novel marker, CRP/Prealbumin ratio is seen as a prospective inflammatory nutritional prognostic tool in cancer [111], likewise the albumin/CRP ratio [8, 88].
Haematological test i.e. complete blood count is one of the most common, simple and accessible tests in cancer evaluation. As cellular markers of inflammation, they provide prognostic and treatment information about the cancer patient. It is now established that the presence of a pre-operative systemic inflammatory response is predictive of disease progression and poorer outcome, regardless of tumour stage, in patients with various cancers [112, 113]. Inflammation based scoring systems such as the modified Glasgow Prognostic Score (mGPS) and the Neutrophil-Lymphocyte ratio (NLR) have prognostic value in different solid tumours [112]. However, concerning the NLR, multiple thresholds have been used to define high and low NLR values and some have suggested that its prognostic value is mainly derived from the neutrophil count and that the lymphocyte count makes little contribution [114]. Platelets are known to shield tumour cells from shear forces and assault of NK cells, recruit myeloid cells by secretion of chemokines and mediate an arrest of the tumour cell platelet embolus at the vascular wall [115, 116], which indirectly makes the Platelet- lymphocyte ratio (PLR) a prognostic marker in cancer. Studies have revealed that combinations of these parameters could accurately predict the prognosis of a patient than a single index. Like with other inflammatory markers, haematological ratios are associated with malnutrition. Many studies have reported the relationship between NLR and nutritional status. In a recently published work, Siqueira et al. demonstrated the relationship between NLR and nutritional risk in some cancer patients [117]. Sato et al. equally reported a significant inverse relationship of prealbumin with NLR [118]. NLR was associated with SGA especially in severely malnourished cancer patients [119] as well as with percentage weight loss [92].
PLR is another haematological ratio and inflammation marker that has been reported to be associated with many conditions including cancers. Elevated PLR is associated with increased all-cause mortality in different conditions [120], is a prognostic marker in many cancers [121] and is also associated with nutritional status [122]. As a marker of nutrition, PLR was significantly correlated with PNI and BMI in pancreatic cancer patients [87]; along with NLR was significantly associated with PNI in hepatocellular carcinoma [123]. PLR is also associated with haemoglobin and post-op complications in colorectal cancer patients affecting morbidity rates [124]. Sarcopenia, characterised by a decline of skeletal muscle plus low muscle strength and/or physical performance was reported to be associated with NLR and PLR in both renal cell carcinoma and gastric cancer patients [125, 126]. In addition PLR significantly correlated with both BMI and haemoglobin [125]; while in the gastric cancer patients, both PLR and NLR were significantly associated with NRS, albumin, haemoglobin, and cancer stage [126]. NLR and PLR are also reported to be significantly associated with performance status in cancer [115]. The main shortcomings of the haematological ratios are the different cut off levels in various studies.
Some other haematological ratios and scores such as lymphocyte monocyte ratio (LMR), neutrophil platelet score (NPS) etc. have been reported to have some prognostic value in cancer [101]. The monocyte lymphocyte ratio (MLR) was reported to be significantly correlated to PNI and albumin [87] in pancreatic cancer making it a potential nutritional marker like NLR. Combination haematological indices such as the Combination of Platelet count and Neutrophil to Lymphocyte Ratio (COP-NLR), combination of neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) (CNP), fibrinogen and NLR (F-NLR) etc. have been shown to have good prognostic value, and their association with nutritional indices should broaden the nutrition/inflammation arena further.
Cytokines are protein molecules released by lymphocytes, monocytes/macrophages and mediate as well as regulate immunity, inflammation and haematopoiesis. Cytokines are the major players in cancer-associated malnutrition, being involved in every aspect of the pathophysiology as earlier explained. They hold great promise as inflammatory markers in nutrition, however, they pose some challenges, particularly their short half-lives [127, 128]. They can be measured in serum or plasma samples; however, measurements from the different sample types cannot be used interchangeably [129].tissues or supernatant from cultured peripheral blood mononuclear cell (PBMC) preparations can also be employed in their measurement. The effect of freezing and thawing can lead to its degradation affecting the measurement. There is an equal lack of standardisation of assays, and because cytokines affect multiple pathways, there is also a lack of specificity [130].
Despite its shortcomings, cytokines are still studied in nutrition research. IL-6 is incorporated into the newly validated CAchexia SCOre (CASCO) for staging cachexic cancer patients [131], although it is not included in the simplified MiniCASCO (MCASCO) [132]. IL-6 is also associated with weight loss, and also correlates with high Prognostic Inflammatory Nutritional Index [133, 134].
Other inflammatory markers for measuring malnutrition include prealbumin, haemoglobin, transferrin, and absolute lymphocyte count (ALC). Many of them are incorporated into nutritional indices either as ratios or as scores. Prealbumin, haemoglobin and ALC are incorporated into the CASCO score [133]. For ALC, levels are associated with various degrees of malnutrition. Levels >2000 cells/m3 (normal), 1200 to 2000 cells/m3 (mild depletion), 800 to 1199 cells/m3 (moderate depletion), and < 800 cells/m3 (severe depletion) [135]. Haemoglobin is part of the haemoglobin platelet ratio (HPR) which has been shown to have diagnostic value in colon cancer [136].
As it has been shown, inflammation plays a central role in cancer-related malnutrition which can lead to cachexia and eventually death. Malnutrition accounts for about 20% of all cancer deaths and is associated with reduced quality of life. Markers of inflammation play a prognostic role in cancer and are most times significantly associated with indices of malnutrition in cancer patients. Several studies have shown that inflammatory markers can be used as a screening test for malnutrition in cancer; though their specificity may be below as a result of other disease states. The inflammation-based scores are more sensitive than the single tests. These tests are cheap and easy to apply. However, their major shortcomings are different cut off levels.
The author declare no conflict of interests.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Beneficial treatment effects of cannabidiol (CBD), a major non-intoxicating compound isolated from the cannabis plant, have been shown in multiple states of cognitive impairment, including neurodegenerative (Alzheimer’s, Huntington’s and Parkinson’s disease), neuroinflammatory (sepsis-induced encephalopathy) and neurological disorders (ischemic brain injury). CBD can also treat some of the symptoms of schizophrenia, including cognitive deficits (impairments in learning and memory), which is a major symptom domain of the illness that is largely resistant to existing antipsychotic medications. However, empirical evidence suggests the presence of an ‘entourage effect’ in cannabis; that is, observations that medicinal cannabis seems to work better in some instances when administered as a whole-plant extract. While scientific evidence highlights isolated CBD as a strong candidate for treating cognitive impairment, the entourage effect suggests that the co-operation of other plant molecules could provide further benefits. This chapter explores the scientific evidence surrounding the benefits of CBD and other specific key phytochemicals in cannabis: linalool, α-pinene, β-caryophyllene, flavonoids and anthocyanin, on brain health and cognition.",book:{id:"7040",slug:"recent-advances-in-cannabinoid-research",title:"Recent Advances in Cannabinoid Research",fullTitle:"Recent Advances in Cannabinoid Research"},signatures:"Katrina Weston-Green",authors:null},{id:"64031",doi:"10.5772/intechopen.81224",title:"Trends of Protein Aggregation in Neurodegenerative Diseases",slug:"trends-of-protein-aggregation-in-neurodegenerative-diseases",totalDownloads:1622,totalCrossrefCites:6,totalDimensionsCites:11,abstract:"Protein aggregation trends in neurodegenerative diseases are largely unmapped due to the complex nature of protein-protein interactions and their regulatory machineries such as protein proteolytic systems. Since the protein aggregation process in humans is a slow process, early determination of the patients that will develop neurodegenerative diseases later in life is critical in terms of starting effective treatment, which will reduce the expensive health care. In this chapter, I will discuss the nature of protein aggregation of signature proteins and the status of protein proteolytic systems such as proteasome and autophagosome in Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, frontotemporal lobar degeneration, Huntington’s disease, and prion disease under the light of recent studies including our new findings.",book:{id:"7480",slug:"neurochemical-basis-of-brain-function-and-dysfunction",title:"Neurochemical Basis of Brain Function and Dysfunction",fullTitle:"Neurochemical Basis of Brain Function and Dysfunction"},signatures:"Abdulbaki Agbas",authors:[{id:"250609",title:"Prof.",name:"Abdulbaki",middleName:null,surname:"Agbas",slug:"abdulbaki-agbas",fullName:"Abdulbaki Agbas"}]}],mostDownloadedChaptersLast30Days:[{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3565,totalCrossrefCites:4,totalDimensionsCites:10,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"58817",title:"Clinical Application of MR Spectroscopy in Identifying Biochemical Composition of the Intracranial Pathologies",slug:"clinical-application-of-mr-spectroscopy-in-identifying-biochemical-composition-of-the-intracranial-p",totalDownloads:2097,totalCrossrefCites:0,totalDimensionsCites:5,abstract:"Magnetic resonance spectroscopy (MRS) provides useful information regarding metabolic composition in the tissues, and advanced spectroscopic methods are used to quantify markers of tumor membrane turnover and proliferation (e.g., choline (Cho)), energy homoeostasis (e.g., creatine (Cr)), intact glioneuronal structures (e.g., N-acetylaspartate (NAA)), and necrosis (e.g., lactate (Lac) or lipids). Results are usually expressed as metabolite ratios rather than absolute metabolite concentrations. Because glial tumors have some specific metabolic characteristics that differ according to the grade of tumor, there is a potential for MR spectroscopy to increase the sensitivity of routinely used diagnostic imaging. MRS also has many diagnostic applications in neurosciences to support the diagnosis in conditions like demyelination, infections, and dementia and in postradiotherapy cases. Biochemical changes in the metabolism of tumor cells related to malignant transformation are reflected in changes of particular metabolite concentration in the tumor tissue. Our prospective study aimed to analyze the usefulness of proton MR spectroscopy in grading of glioma and to correlate various metabolite ratios like choline/creatine, choline/N-acetylaspartate, N-acetylaspartate/creatine, and lactate/creatine with the histopathological grades of glioma.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"B C Hamsini, Bhavana Nagabhushana Reddy, Sankar Neelakantan\nand Sunitha Palasamudram Kumaran",authors:[{id:"211054",title:"Dr.",name:"Sunitha",middleName:null,surname:"P Kumaran",slug:"sunitha-p-kumaran",fullName:"Sunitha P Kumaran"},{id:"221485",title:"Dr.",name:"Sankar",middleName:null,surname:"Neelakantan",slug:"sankar-neelakantan",fullName:"Sankar Neelakantan"},{id:"398223",title:"Dr.",name:"B C",middleName:null,surname:"Hamsini",slug:"b-c-hamsini",fullName:"B C Hamsini"},{id:"398224",title:"Dr.",name:"Bhavana",middleName:null,surname:"Nagabhushana Reddy",slug:"bhavana-nagabhushana-reddy",fullName:"Bhavana Nagabhushana Reddy"}]},{id:"62431",title:"The United Chemicals of Cannabis: Beneficial Effects of Cannabis Phytochemicals on the Brain and Cognition",slug:"the-united-chemicals-of-cannabis-beneficial-effects-of-cannabis-phytochemicals-on-the-brain-and-cogn",totalDownloads:1845,totalCrossrefCites:4,totalDimensionsCites:12,abstract:"‘Medicinal cannabis’ can be defined as pharmaceutical grade cannabis-based products used for the treatment of illness. 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The process of synaptic transmission generates or inhibits electrical impulses in a network of neurons for the processing of information. Glutamate is the primary excitatory neurotransmitter in the brain, while GABA is the principal inhibitory neurotransmitter. The balance of glutamatergic and GABAergic tone is crucial to normal neurologic function. Through synaptic transmission, this information is communicated from the presynaptic cell to the postsynaptic cell. Amino acid neurotransmitters primarily glutamic acid, GABA, aspartic acid, and glycine are single amino acid residues released from presynaptic nerve terminals in response to an action potential and cross the synaptic cleft to bind with specific receptor on the postsynaptic membrane. The integral role of amino acid neurotransmitters is important on the normal functioning of the brain. The presynaptic and postsynaptic events in chemical synapses are subject to use dependent and highly regulated as per the changes in synaptic neurotransmitter release and function.",book:{id:"7480",slug:"neurochemical-basis-of-brain-function-and-dysfunction",title:"Neurochemical Basis of Brain Function and Dysfunction",fullTitle:"Neurochemical Basis of Brain Function and Dysfunction"},signatures:"Manorama Patri",authors:[{id:"196763",title:"Dr.",name:"Manorama",middleName:null,surname:"Patri",slug:"manorama-patri",fullName:"Manorama Patri"}]}],onlineFirstChaptersFilter:{topicId:"212",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}}]},{type:"book",id:"6924",title:"Adenosine Triphosphate in Health and Disease",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6924.jpg",slug:"adenosine-triphosphate-in-health-and-disease",publishedDate:"April 24th 2019",editedByType:"Edited by",bookSignature:"Gyula Mozsik",hash:"04106c232a3c68fec07ba7cf00d2522d",volumeInSeries:3,fullTitle:"Adenosine Triphosphate in Health and Disease",editors:[{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. 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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:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{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:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{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:"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:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{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"}}}]}},subseries:{item:{id:"86",type:"subseries",title:"Business and Management",keywords:"Demographic Shifts, Innovation, Technology, Next-gen Leaders, Worldwide Environmental Issues and Clean Technology, Uncertainty and Political Risks, Radical Adjacency, Emergence of New Business Ecosystem Type, Emergence of Different Leader and Leader Values Types, Universal Connector, Elastic Enterprise, Business Platform, Supply Chain Complexity",scope:"