\r\n\r\nThe publication of this book was supported by the Secretariat of the Convention on Biological Diversity, United Nations\r\n\r\n',isbn:null,printIsbn:"978-953-51-0255-7",pdfIsbn:"978-953-51-4324-6",doi:"10.5772/1410",price:139,priceEur:155,priceUsd:179,slug:"tropical-forests",numberOfPages:402,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:"55286837c680e9be2bc357abf678212e",bookSignature:"Padmini Sudarshana, Madhugiri Nageswara-Rao and Jaya R. 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She was also involved in Biosafety & Regulation of transgenic research & Scientific/Community Outreach programs at Monsanto. During post-doctoral tenure at Indian Institute of Science, and University of Agricultural Sciences, she studied hormonal regulation in parasitic plants and genetic diversity in tropical forests respectively. She worked on post-harvest storage of fruits and vegetables for her doctoral thesis. She has to her credit several research articles, book chapters, popular articles and patents. She received “Above and Beyond” and “Genomics Team” awards for significant contributions to projects in Monsanto. She was recognized as ‘member-in-spotlight’ by Genome India International. Dr. Sudarshana obtained her M.Sc. and M.Phil. from Mysore University and Ph.D from Central Food & Technological Research Institute, India.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"120847",title:"Dr.",name:"Madhugiri",middleName:null,surname:"Nageswara-Rao",slug:"madhugiri-nageswara-rao",fullName:"Madhugiri Nageswara-Rao",profilePictureURL:"https://mts.intechopen.com/storage/users/120847/images/5440_n.jpg",biography:"Madhugiri Nageswara-Rao, Ph.D. works in the areas of plant breeding; genomics; bioenergy; genetic engineering; population, and eco-evolutionary genetics. He is the author of peer-reviewed research articles, book chapters, popular articles, has guest-edited special issues for journals, edited books and newsletters. He was Adjunct Faculty at Polk State College, USA. His work has been broadcasted on Fox News, USA. He was invited by CBC-Radio, Canada, to speak on air. He has served in the ‘Executive Committee’ of GII. He was recognized as ‘Young Scientists’ by Bioclues, in ‘Member-in-spotlight’ of GII and featured in ASPB-News. The University of Florida’s International Programs appraised his contribution in ‘International Focus’. He has peer-reviewed manuscripts for prominent international journals and grant proposals for international institutions. \nDr. Rao obtained his B.Sc., M.Sc. from Bangalore University and Ph.D. from FRI, India. He was featured as ‘Tomorrow’s Principal Investigators: Rising Young Investigators’ by Genome Technology, USA. He secured ‘Silver Award’ as a team member from American Museum of Natural History, USA. He was also selected for AAAS/Science Program for Excellence in Science. 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\r\n\tThis book examines several issues related to the development of vaccines for Pneumococcal disease. This book intends to provide the reader with a comprehensive overview of recent trends in Pneumococcal disease, as well as general concepts of immunobiology, pathology, metagenomics, antibacterial-pharmacology to current clinical recommendations in the management of Pneumococcal disease, highlighting the ongoing issues, recent advances, with future directions in diagnostic approaches and therapeutic strategies. The book focuses on various aspects and properties of Pneumococcal disease, whose deep understanding is very important for safeguarding the human race from more loss of resources and economies.
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1. Introduction
Water erosion is a phenomenon that results from the degradation of the surface layers of the ground cover and the displacement of the constituent materials [1] under the effect of the kinetic energy of the raindrops and the transport of soil particles from their original location [2]. It is one of the main causes of soil degradation in the world [3] leading to a significant threat to both human societies and the environment [4]. It also affects the quality of surface water and/or groundwater [5], reducing the capacity of the dams [6] and decreasing the soil fertility for agricultural activities [7]. Accordingly, the land area damaged by soil erosion is estimated at 1100 million hectares of land worldwide [8] resulting in the transportation of 2.0 to 2.5 x 1010 Mg of soil to the oceans each year [9]. This makes it a serious problem on a global scale and particularly worrying in certain regions of the world [10].
In 1930, in the United States, 20% of arable land was severely damaged by erosion following a prolonged drought. This is the dark era of the “dust bowl” phenomenon [11]. This resulted in the establishment of a water and soil conservation service by the US government. At the same time, a network of research stations was set up, which, thirty years later, resulted in the formulation of the USLE Equation [12].
Globally, [13] showed that of 13.5 billion hectares of land affected by water erosion, only 22% of the land is cultivable. During the last decades, the losses of cultivable land increased from 7 to 10 million hectares per year and at this rate, two centuries would be enough to destroy all the cultivable/agricultural land.
According to the United Nations Report on the State of the World’s Soil Resources, published in 2015, cereal production losses due to erosion have been estimated at 7.6 million tons per year [14]. As a result of this report, researchers around the world have found that if nothing is done to mitigate erosion, we could achieve a reduction of more than 253 million tons of cereals by 2050. This loss of yield would be equivalent to removing nearly 15 billion hectares of land from farming [15]. According to this author, these more dramatic figures raised the alarm in different countries of the world in order to take all the necessary measures. In fact, due to the torrential nature of the rains, the high vulnerability of the land and the unfavorable human activities impact (deforestation, fires, overgrazing, poor agricultural behavior, chaotic town planning, etc.) more degradation will affect the agricultural landscape. Consequently, due to the relevance of this problem, several studies have been carried out on agricultural plots of about 100 square meters [2, 16, 17, 18, 19], on micro-watersheds of a few hectares [20, 21, 22, 23], on large basins of thousands of square kilometers [6, 24, 25, 26] and over large areas (countries and/or regions of the world) [27, 28, 29].
The results of soil loss vary from 1 to 200 t/ha/year (up to 700 t/ha/year) under crops specific to forest regions where slopes ranging from 30 to 60% and 0.5 to 40 t/ha/year under millet, sorghum, peanuts and cotton on long tropical ferruginous glacis of the Sudano-Sahelian regions whose slopes vary between 4 and 25% [30]. In the United States, on cultivated land, soil losses were estimated between 5 and 12 t/ha/year [31]. In Europe, [32] estimates that 25 million hectares have been seriously affected by erosion.
In the Maghreb, the water and soil potentials are seriously threatened [22, 33, 34, 35, 36] and the phenomenon of water erosion is very widespread. The majority of watersheds are characterized by severe degradation exceeding 20 tons/ha/year [6], which leads to an average annual siltation of dam reservoirs at a rate of 125 million m3 [37]. According to [38], water erosion in Morocco causes soil losses ranging from 5 t/ha/year to more than 50 t/ha/year depending on the region, and an average annual siltation of the reservoirs of the dams of the order of 75 million m3. That is to say an annual reduction of 0.5% of their storage capacity, which causes deterioration in the quality of the drinking water mobilized and a decrease in water resources that can irrigate 10000 ha/year. Northern and central Tunisia currently has more than 30 dams with a total storage capacity of 3.5 billion m3 [23, 38, 39]. Monitoring the siltation of these hydraulic structures made it possible to assess a loss of their storage capacity estimated at 30 million m3/year, i.e. an annual reduction of 1%. Soil erosion has affected nearly 3 million hectares of agricultural land in the country, or more than half of the useful agricultural area in affecting the production capacity of Tunisian agriculture [23, 40].
In Algeria, the annual volume of sediment deposited in the 74 dams is estimated at 65 million m3 [41]. Although soil erosion is characterized as a natural phenomenon, human activities such as agriculture can accelerate it further in Algeria [42]. Thus, 14 million hectares of land in the country are threatened by water erosion [43]. Therefore, Algeria is a country that witnesses an enormous deficit of water (i.e. below the theoretical scarcity threshold set by the World Bank, which is around 1000 m3 per inhabitant/year) [44]. According to [45], Algeria is qualified in the category of the poorest African countries in terms of water potential. In 1962, the theoretical availability of water/capita/year was 1500 m3; it was only 720 m3 in 1990, 680 m3 in 1995, 630 m3 in 1998, 430 m3 in 2020. To meet Algeria’s urgent water needs, the States has implemented a strategy consisting of creating 94 hydraulic dams for the mobilization of surface water resources distributed throughout the national territory. The sector expected to build around 139 dams by 2030 [46]. One of these dams is that of wadi Mina catchment with a filling capacity of 241 million m3. The dam Sidi Mhamed Benaouda (also named dam Es-Saada) is threatened by the silting from its site [6]. It is located at the extreme north of watershed of the wadi Mina (Algeria); its catchment area is subjected to intense water erosion with a volume of sediments which reaches the tank annually. This volume is on average about 3.2 million m3 [47]. During these last decades and in a preoccupation with a management fight by the Algerian State, the catchment area of the wadi Mina was retained within the framework of a pilot project of integrated installation and development [47, 48]. The dam Sidi Mhamed Benaouda was built in 1978 with the downstream of this zone. According to [49], the marly sector located in the northern part constitutes the major source of sediments deposited in this dam.
Thus, the problem of water erosion mobilizes the scientific community to find solutions likely to ensure soil conservation [50]. In a context marked by global climate change and sustained human pressure on natural resources, the threat of soil erosion requires special and continued attention [51].
2. Methodology and data used
2.1 Tolerance to erosion
The tolerance level for soil loss varies from region to region of the world. It is linked to the productivity of the land and its uses [6]. Indeed, in Asia, [20] found that the tolerance threshold for soil loss in the Kelara sub-watershed in India was less than 1.5 t/ha/year. According to [52], the results of the study of water erosion in the Tamil Nadu basin (India) indicate that the average soil losses in this region are of the order of 6 t/ha/year. In Europe, [27] deduced that when soil losses exceed a threshold of 5 t/ha/year on cultivated land, the latter becomes intolerable. In a study conducted in the south-eastern region of Spain by [53], a rate of soil loss was recorded below the tolerable annual rates for the northern Mediterranean region. Almost 90% of its basins have average annual rates of less than 2 t/ha. In northwestern Turkey, the results obtained in the Buyukcekmece region by [54], show that a soil loss rate is low for a value of less than 1 t/ha/year, while beyond 10 t/ha/year, the phenomenon of erosion becomes a serious problem. Also, in the Alaca basin in Turkey, [55] estimated a water erosion tolerance rate of up to 12 t/ha/year. [56] underlines that any loss of soil greater than 1 t/ha/year is considered irreversible over a period of 50 to 100 years. A soil loss of 12 to 15 t/ha/year, or about 1 mm of soil per year (surface stripping) is sufficient to exceed the rate of alteration of the rocks. [54, 57] estimated the global tolerance rate for soil loss to be 10.2 t/ha/year.
In Morocco in regions similar to our study area, [58, 59] reported that soils can sustain loss of up to 7.4 t/ha/year on average. In Tunisia and according to the work of [22] carried out in the wadi Jannet watershed, a tolerance threshold of 8 t/ha/year has been suggested, above which the level of erosion risk will be high.
According to the above published work regarding the quantification of soil loss by the RUSLE model, it is clear that the tolerance threshold presents some difference. This is linked to the type of soil and its pedogenesis. In fact, in a region with shallow soil in a climate of accentuated summer aridity, the production of soil (pedogenesis) will be slow and consequently the tolerance threshold will be less. This is the case, for example, in arid and semi-arid Mediterranean regions [60].
2.2 Classification of soils and relationship with soil erosion
Given the objective pursued aimed at identifying the regions participating in the siltation of the Sidi Mhamed Benaouda dam, we have therefore adopted the American classification which is based on a tolerance threshold of 7.4 t/ha/year on average while supporting sustainably a high level of agricultural production and that if the losses exceed 20 t/ha/year, they can become dangerous [58]. We note that this classification has been adopted in Morocco, in the wadi Boussouab watershed, region similar to our study region in terms of climate, vegetation cover and soil substrate.
According to this classification, soil losses will be divided into five categories:
Very low, when they do not exceed 5 t/ha/year.
Low, when they are between 5 and 7.4 t/ha/year.
Moderate when they are between 7.4 and 12 t/ha/year.
Strong when they have values between 12 and 20 t/ha/year.
Very strong and dangerous when losses exceed 20 t/ha/year.
2.3 Study area
Before proposing such a development, it is necessary to give a bibliographical overview of the research work relating to water erosion carried out in this region of interest. The watershed of wadi Mina is located at the northwest of Algeria in the Tellian hill area between 34° 42″ 36″ to 35° 35″ 2″ N latitude and between 0° 23″ 51″ to 1° 8″ 56″ E longitude (Figure 1). It lengthens on 90 km on Frenda and Mina mounts at north and on 50 km from the west to east between Bani-Chougrane mounts and the Ouarsenis massive. This watershed covers an area of 4800 km2 [6].
Figure 1.
Study area location map (source: [6]).
2.4 Data used
The methodology adopted for this study rests on the exploitation of the multi-source data (satellite, pedological, climate condition and of the observations to carry out on the ground (in situ)). All these data are integrated and analyzed by the GIS for the cartography of the zones exposed to soil erosion in our study area. 1- Four images Shuttle Radar Topography Mission of resolution 30 m, coordinates: N35E000, N35E001, N34E000 and N34E001, were obtained from the SRTM (2011). 2- Two spectral scenes multi Landsat_8 OLI/TIRS (Operational Land To color) (Thermal Infrared Sensor) of Path_197/Row_035 (LC81970352014077LGN00) and that of Path_197/Row_036 (LC81970362014077LGN00) were acquired on March 18th, 2014. These satellite images are uploaded from USGS (2014), with the Geotif format. 3- Observations on the ground, obtained after a descent on the ground in March and April 2014. 4- A detailed pedological map, catchment area of wadi Mina, drawn up by the BNEDER (2004). 5- Rainfall records (daily precipitations) provided by the National office of Meteorology on twenty two stations. They are spread over a period of 36 years (1978–2014) and cover our zone of interest.
2.5 RUSLE-Model
RUSLE- model proposes the same formula as the USLE [12] but several improvements were carried out for the determination of the various erosive factors. This included an approach different from the erodibility of the soil K-factor, a new equation for topographic LS-factor, and a new value for the crop management C-factor and the practices of conservation P-factor. The application of RUSLE model requires the calculation of the various factors intervening on the erosive processes and their spatialization in the form of the thematical maps. The integration of these data in the GIS makes it possible to superimpose them and evaluate the rate of water erosion by applying the formula of: A = R*K*LS*C*P.
Where: A: is the soil loss per unit of area (t/ha/yr). The R-factor is rainfall and runoff erosivity factor (MJ mm/ha h yr). K (t h/MJ mm) is soil erodibility factor, LS (unit-less) is a topographic factor, C (unit-less) is a crop management factor and P (unit-less) is a conservation practice factor.
3. Results and discussion
The combination of different thematic maps of erosive factors with their data bases was a subdivision of these into 1315 homogeneous plots with a total annual amount of land loss of 60 million tones. These losses vary between 0 t/ha/year and 521 t/ha/year, with an annual average of 11.2 t/ha and a standard deviation of 18.6/t/ha/yr. Spatially (Figure 2), the resulting map shows that the rate of soil loss varies from one sector to another in the study area. In fact, the low to very low soil loss classes are mainly located in the middle of the study area.
Figure 2.
Map of soil losses in the Wadi Mina basin.
Although, this sector is characterized by steep topography and relatively high soil vulnerability. Our results are in agreement with those of the work of [61]. These authors found that in Algeria, not only runoff, but also soil erosion, does not systematically increase with the topography, in particular the slope. In addition, we note that the erosion risk in this sector is generally very low, recording an average of around 3.5 t/ha/year (Table 2). This clearly explains why the plant cover factor, in particular the forest one, plays a protective role. Indeed, [62] show that factor C decreases the risk of erosion to 0.01 under perennial crops with cover plants or meadows and to 0.001 under forests associated with mulched crops compared to a bare plot.
The high and dangerous soil loss classes are noted exclusively in the northern and northeastern part of the study area. These regions are subject to an interweaving of natural and anthropogenic factors every year. The nature of the soils and the superficial lithological formation resulting from mainly marly terrain shows great fragility to water erosion. This is all the more important since the land has been almost completely bare and cultivated. [63, 64] show that these areas, which form an important part of the wadi Mina basin (1000 km2), are strongly affected by water erosion.
According to the soil loss map obtained and according to the classification described above, the distribution of soil loss classes in the wadi Mina watershed is shown in Table 1.
Risk of erosion
Soil loss class (t / ha / year)
Area (Km2)
Area (%)
Category
Very low
0–5
1709.8
35.6
C
Low
5–7.4
688.9
14.4
Moderate
7.4–12
665.9
13.9
B
Strong
12–20
903.7
18.8
A
Very strong and dangerous
> 20
831.7
17.3
Table 1.
Soil loss classes in the Wadi Mina catchment.
The results of soil losses show that approximately 50% of the study area is classified in category where the erosion risk is low to very low (< 7.4 t/ha/year). 13.9% of the study area are classified in category where soil losses are moderate (7.4 to 12 t/ha/year). Actually, 36.1% of the study area is considered to be located in high risk and dangerous regions where losses exceed a threshold of 20 t/ha/year. The average rate of soil loss estimated at 11.2 t/ha/year is in the moderate erosion risk category.
Figure 3 highlights the following points (i) Sectors where soil loss exceeds the average of 11.2 t/ha/year, represent only 31.7% of the watershed. Their contribution to the overall soil loss is estimated at 92.5%. (ii) The sectors where the soil loss is lower than the average, occupy 68.3% of the surface of the basin. Their contribution represents only 7.5% of the global loss of soil.
Figure 3.
Distribution of soil loss compared to the average in the Mina basin.
The wadi Mina watershed has been the subject of several studies. These were carried out following the development of the Sidi Mhamed Benaouda dam and concerns raised by the scale of the erosive phenomenon and its consequences on the siltation of the dam and the degradation of soil fertility from the 1990s. [65] established, from the classified parameters, the map of the sensitivity of marly lands to gullying in the western part of the watershed. This shows a predominance of land sensitive to linear erosion processes on the order of 57% of the territory. In fact, 25% of the land is strongly and very strongly sensitive to the incision and is mainly located on the right bank of wadi Mina, as well as in the downstream sector of the left bank of wadi Haddad. However, 18% of the basin surface is highly sensitive to solifluxion.
According to [62] and his collaborators observed that the different marly textures evolve by landslide and skin slide and those other environmental variables determine linear erosion namely: the slope, the vegetation cover and the morphology of the walls. The specific erosion of the wadi Mina basin estimated by the National Dams and Transfer Agency was on average around 3.26 t/ha/year, while the estimated soil losses in micro-watersheds with an area of 1000 km2 located in the marly part can exceed a rate of 16 t/ha/year.
In 2001, [66] evaluated soil losses between 0.5 t/ha/year and 36 t/ha/year over the entire territory of the watershed. Most of this loss was recorded in the marl area with a rate exceeding 20 t/ha/year. However, [67] found that not only the marly areas participate in the production of sediments but the southern part of the basin of the wadi Mina can also participate with a significant contribution of sediments deposited in the lake of the Sidi Mhamed Benaouda dam.
In parallel, in 2004, the Algerian State under the supervision of Ministry of Agriculture and Rural Development launched a cooperation project with GTZ in order to develop a master plan for land use in the wadi Mina watershed. This is part of the conservation of soil and water strategy/planning. In 2006, under the supervision of the Ministry of Water Resources in collaboration with the Canadian consultancy firm (TECSULT), the Algerian State launched a study to identify and specify the measures to be undertaken to adequately fight against the siltation of reservoirs located in the Tellian hill including the wadi Mina basin which is one of these regions. The proposed developments have only been affected in areas classified as priorities A and B located in the marly region. According to this study, experts have shown that, if the improvements are made correctly in time, the lifespan of the Sidi Mhamed Benaouda dam will be increased twice as much as without it.
Before carrying out the development works according to the land use of our study area, it is first necessary to determine the average loss of each class as well as the degree of erosion risk. Table 2 shows the sensitivity of the different types of land use to the risk of erosion. In fact, heavily vegetated areas, represented by vegetable crops and forests, are associated with low to very low soil losses, with 5.5 t/ha/year and 3.5 t/ha/year respectively. However, the higher and more dangerous ones correspond to bare soils with an average soil loss of around 29.8 t/ha/year. Soils used for agriculture, often protected during heavy spring showers, represent the type of vegetation cover most sensitive to erosion processes with an average soil loss of 16.1 t/ha/year. These last results are in agreement with those found by [68]. These authors have shown that cultivated fields can contribute significantly to sediment production. The formations based on scrub/scrubland, pasture and steppe produce moderate soil loss values with respective averages of 12 t/ha/year, 10.5 t/ha/year and 8.4 t/ha/year. This would be due to deforestation, overgrazing and bush fires which tend to substitute primitive formations for secondary cover of a different nature, such as savanna grassland.
Land use class
Area
R (Mj.mm/ha.h.year)
K (t.h/Mj.mm)
LS
C*
E avrg. (t/ha/year)
Risk of erosion at the threshold of 7.4 t/ha/year
Km2
%
Forest
821.0
17.1
864
0.144
2.7
0.01
3.5
Very low
Agglomerations
64.7
1.3
902.8
0.023
1.6
0
0
00
Agriculture
160.2
33.4
743
0.039
0.9
0.65
16.1
High
Firewall
75.4
1.6
872
0.013
1.9
1
1.9
High
Market gardening
718.4
15.0
844
0.203
1.8
0.018
5.5
Low
Scrub and Scrubland
532.6
11.1
889
0.034
1.8
0.25
12
Moderate
Pasture
61.3
1.3
489
0.19
1.03
0.1
10.5
Moderate
Bare soil
150.0
3.1
565
0.032
1.7
1
29.8
dangerous
Steppe
767.0
16.0
611
0.064
1.1
0.25
8.4
Moderate
Dam
8.4
0.2
0
0
0
0
0
00
Total/Moyenne
4800
100
523
0,0501
1,5
/
11,2
Modéré
Table 2.
Soil losses according to land use classes in the Wadi Mina basin.
C*: Factor C data are obtained from National Research Institute for Rural Engineering, Water and Forestry (INRGREF), Tunisia (2014).
The results of the evaluation of soil losses allowed us to deduce that an area of nearly 2400 km2 of the slopes of the study area (Table 2) will require intervention measures to counter soil erosion. However, in order to optimize the allocation of resources intended for the short-term reduction of the siltation of the Sidi Mhamed Benaouda dam, we propose that only priority areas receive special attention in terms of anti-erosion measures, including those classified in the two categories A and B where the risk of erosion is moderate to dangerous (> 7.4 t/ha/year) (Table 1).
Bare soils and firebreaks covering 150 km2 and 75.4 km2, respectively, are the main lithological occupations, and will require the most interventions in the watershed. These interventions are mainly intended to counter the gullying. These areas produce a significant amount of sediment estimated annually at an average of 29.8 t/ha and 19.9 t/ha respectively (Table 2). The protection strategy for these lands consists of installing torrential correction sills, constructing drains and outlets on slopes in order to avoid landslides with marly substrate, implanting dry stone lines and prohibiting their exploitation by livestock during the spring period when the soils must be covered.
The areas with agricultural activity adjacent to the Sidi Mhamed Benaouda dam and which come in second priority are responsible for a significant proportion of the siltation of this reservoir where soil losses exceed a threshold of 16.1 t/ha/year on an area of 1601.2 km2, or 33.4% of the study area. The anti-erosion interventions recommended in these areas are the installation of arboriculture on terraces built along the contour lines, the establishment of living hedges, stone lines, drains and outlets along the road accesses as well as torrential correction thresholds in order to reduce the speed of runoff. In addition, it is important to ensure that farmers adhere to the principles of protection of arable slopes by mastering good mechanization which consists of working along the contour lines.
The scrubland and pastures with degraded soils and steppes are the third types of land use in terms of priority. Their erosion risk is between 7.4 t/ha/year and 12 t/ha/year requiring anti-erosion interventions. These interventions suggested over an area of approximately 600 km2 include the establishment of torrential correction thresholds in the gullies, the planting of opuntia, revegetation and the installation of bulges, drains and outlets.
4. Conclusions
In view of our results, using the RUSLE approach in a GIS environment has many advantages, especially those related to the large number of findings. Indeed, it makes it possible to rationally manage a considerable quantity of quantitative and qualitative data relating to the various erosive factors. This allow, to disentangle their interdependence by successive crossing of thematic maps and to establish a synthetic map of the degree of erosion as well as the vulnerability of the different soils. Although the validity of soil losses is debatable, this method helps:
Planners to suggest specific devices and techniques to prevent erosion processes
Simulate landscape degradation while considering different management scenarios
Acknowledgments
The authors are very grateful to the Laboratory of Biodiversity, Conservation of Water and Soil (LBCWS) University of Abdel Hamid Ibn Badis, Mostaganem, to the University of Amar Telidji Laghouat (Algeria) and to the National Institute for Research in Rural Engineering, waters and forests (Tunisia). This scientific collaboration is dedicated to the exchange of experience and scientific know-how in the field of water resources management at the watershed scale. S. Jebari acknowledge helpful funding from the European Union Horizon 2020 programme, under Faster project, grant agreement N°[810812].
\n',keywords:"Oranian hill, catchment, Sidi Mhamed Benaouda, soil loss modeling",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75239.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75239.xml",downloadPdfUrl:"/chapter/pdf-download/75239",previewPdfUrl:"/chapter/pdf-preview/75239",totalDownloads:328,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,impactScore:0,impactScorePercentile:42,impactScoreQuartile:2,hasAltmetrics:0,dateSubmitted:"June 22nd 2020",dateReviewed:"January 25th 2021",datePrePublished:"March 9th 2021",datePublished:"May 12th 2021",dateFinished:"February 13th 2021",readingETA:"0",abstract:"To meet the pressing water needs in Algeria, the state has put in place a strategy consisting of the creation of hydraulic infrastructure for the mobilization of surface water resources. In fact, 74 dams are currently in operation; these structures are silting up at a rapid pace, generating an estimated annual loss of 45 million m3. Sidi Mhamed Benaouda dam located in the Oranian hill, with a water capacity of respectively 241 million m3 plays a crucial economic role in this region. The protection of this dam against erosive processes is a pressing economic goal. To do this, the RUSLE/GIS approach was used to map the erosive hazard. The results obtained in the Mina catchment, following a subdivision of 1315 homogeneous land parcels, show a total annual loss of 60 million tons/year with an average loss of 11.2 t/ha/year. About 50% of the catchment area was predicted to have very low to low erosion risk, with soil loss between 0 and 7.4 t/ha/year. Erosion risk is moderate over 13.9% of the catchment, where calculated soil loss is between 7.4 and 12 t/ha/year. Erosion risk is high to dangerous over 36.1% of the catchment, where calculated soil loss is more than 12 t/ha/year. According to this study, it appeared clearly that we must intervene quickly by using reliable and effective conservation techniques.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75239",risUrl:"/chapter/ris/75239",book:{id:"10409",slug:"soil-erosion-current-challenges-and-future-perspectives-in-a-changing-world"},signatures:"Ahmed Benchettouh, Sihem Jebari and Lakhdar Kouri",authors:[{id:"308992",title:"Prof.",name:"Sihem",middleName:null,surname:"Jebari",fullName:"Sihem Jebari",slug:"sihem-jebari",email:"sihem.jebari@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"314333",title:"Dr.",name:"Ahmed",middleName:null,surname:"Benchettouh",fullName:"Ahmed Benchettouh",slug:"ahmed-benchettouh",email:"ahben17@yahoo.fr",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"325116",title:"Prof.",name:"Lakhdar",middleName:null,surname:"Kouri",fullName:"Lakhdar Kouri",slug:"lakhdar-kouri",email:"kourilakhdar@yahoo.fr",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Methodology and data used",level:"1"},{id:"sec_2_2",title:"2.1 Tolerance to erosion",level:"2"},{id:"sec_3_2",title:"2.2 Classification of soils and relationship with soil erosion",level:"2"},{id:"sec_4_2",title:"2.3 Study area",level:"2"},{id:"sec_5_2",title:"2.4 Data used",level:"2"},{id:"sec_6_2",title:"2.5 RUSLE-Model",level:"2"},{id:"sec_8",title:"3. Results and discussion",level:"1"},{id:"sec_9",title:"4. Conclusions",level:"1"},{id:"sec_10",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Antoni, V., Le Bissonnais, Y., Thorette, J., Zaidi, N., Laroche, B., Barthès, S., … & Arrouays, D. (2006). Modélisation de l’aléa érosif des sols en contexte méditerranéen à l’aide d’un Référentiel Régional Pédologique au 1/250.000 et confrontation aux enjeux locaux. Etude et Gestion des Sosls, 13(3), 201-222'},{id:"B2",body:'Kinnell, P.I.A. (2016). A review of the design and operation of runoff and soil loss plots. 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(2006). approche de calcul de l\'exposant climatique en cas d\'insuffisance de donnees: cas de la region de Tipaza. Production scientifique-Communications, 1'},{id:"B68",body:'Alejandro, M., & Omasa, K. (2007). Estimation of vegetation parameter for modeling soil erosion using linear Spectral Mixture Analysis of Landsat ETM data. ISPRS Journal of Photogrammetry and Remote Sensing, 62(4), 309-324'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Ahmed Benchettouh",address:"ahben17@yahoo.fr;, a.benchettouh@lagh-univ.dz",affiliation:'
Laboratory Biodiversity and Conservation of Water and the Soils, University Abdelhamid Ibn Badis, Amar Telidji University, Algeria
Laboratory Biodiversity and Conservation of Water and the Soils, University Abdelhamid Ibn Badis, Algeria
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Favas, Dibyendu Rakshit and K.K.\nSatpathy",authors:[{id:"169746",title:"Dr.",name:"Paulo",middleName:null,surname:"Favas",fullName:"Paulo Favas",slug:"paulo-favas"},{id:"10088",title:"Prof.",name:"Santosh",middleName:"Kumar",surname:"Sarkar",fullName:"Santosh Sarkar",slug:"santosh-sarkar"},{id:"169951",title:"Dr.",name:"Dibyendu",middleName:null,surname:"Rakshit",fullName:"Dibyendu Rakshit",slug:"dibyendu-rakshit"}]},{id:"46266",title:"The Effect of Industrial Heavy Metal Pollution on Microbial Abundance and Diversity in Soils — A Review",slug:"the-effect-of-industrial-heavy-metal-pollution-on-microbial-abundance-and-diversity-in-soils-a-revie",signatures:"Anna Lenart-Boroń and Piotr Boroń",authors:[{id:"169734",title:"Dr.",name:"Anna",middleName:null,surname:"Lenart-Boroń",fullName:"Anna Lenart-Boroń",slug:"anna-lenart-boron"},{id:"169933",title:"Dr.",name:"Piotr",middleName:null,surname:"Boron",fullName:"Piotr Boron",slug:"piotr-boron"}]},{id:"46128",title:"Pollution of Pb in Soils Affected by Pyrite Tailings: Influence of Soil Properties",slug:"pollution-of-pb-in-soils-affected-by-pyrite-tailings-influence-of-soil-properties",signatures:"F. Martín, M. Simón, I. García, A. Romero and V. González",authors:[{id:"77540",title:"Dr.",name:"Francisco",middleName:"José",surname:"Martin Peinado",fullName:"Francisco Martin Peinado",slug:"francisco-martin-peinado"},{id:"85596",title:"Prof.",name:"Mariano",middleName:null,surname:"Simon",fullName:"Mariano Simon",slug:"mariano-simon"},{id:"169955",title:"Dr.",name:"Ines",middleName:null,surname:"Garcia Fernandez",fullName:"Ines Garcia Fernandez",slug:"ines-garcia-fernandez"},{id:"169956",title:"Dr.",name:"Veronica",middleName:null,surname:"Gonzalez",fullName:"Veronica Gonzalez",slug:"veronica-gonzalez"},{id:"169967",title:"Ph.D. Student",name:"Ana",middleName:null,surname:"Romero",fullName:"Ana Romero",slug:"ana-romero"}]},{id:"45991",title:"Copper Accumulation in Vineyard Soils: Distribution, Fractionation and Bioavailability Assessment",slug:"copper-accumulation-in-vineyard-soils-distribution-fractionation-and-bioavailability-assessment",signatures:"Marija Romić, Lana Matijević, Helena Bakić and Davor Romić",authors:[{id:"63363",title:"Dr.",name:"Marija",middleName:null,surname:"Romic",fullName:"Marija Romic",slug:"marija-romic"}]},{id:"46045",title:"Characterization and Remediation of Soils and Sediments Polluted with Mercury: Occurrence, Transformations, Environmental Considerations and San Joaquin’s Sierra Gorda Case",slug:"characterization-and-remediation-of-soils-and-sediments-polluted-with-mercury-occurrence-transformat",signatures:"I. Robles, J. Lakatos, P. Scharek, Z. Planck, G. Hernández, S. Solís and\nE. Bustos",authors:[{id:"169733",title:"Dr.",name:"Erika",middleName:null,surname:"Bustos",fullName:"Erika Bustos",slug:"erika-bustos"}]},{id:"46310",title:"Conducted and Investigate Arsenic (As), Cobalt (Co) Copper (Cu), Manganese (Mn), Lead (Pb), and Zinc (Zn) Contamination in Agricultural' Soils and Wheat Crops Projects at Three Regions in Libya",slug:"conducted-and-investigate-arsenic-as-cobalt-co-copper-cu-manganese-mn-lead-pb-and-zinc-zn-contaminat",signatures:"Youssef F. Lawgali, Andy A. Meharg and Yousef M.T. Elgimati",authors:[{id:"169748",title:"Dr.",name:"Youssef F.",middleName:"F",surname:"Lawgali",fullName:"Youssef F. Lawgali",slug:"youssef-f.-lawgali"},{id:"170459",title:"Dr.",name:"Andrew",middleName:null,surname:"Meharg",fullName:"Andrew Meharg",slug:"andrew-meharg"},{id:"170460",title:"Dr.",name:"Yousef",middleName:null,surname:"Elgimat",fullName:"Yousef Elgimat",slug:"yousef-elgimat"}]},{id:"46350",title:"Risks of Heavy Metals Contamination of Soil-Pant System by Land Application of Sewage Sludge: A Review with Data from Brazil",slug:"risks-of-heavy-metals-contamination-of-soil-pant-system-by-land-application-of-sewage-sludge-a-revie",signatures:"Alysson Roberto Baizi e Silva and Fábio Camilotti",authors:[{id:"169727",title:"Dr.",name:"Alysson Roberto",middleName:null,surname:"Baizi E Silva",fullName:"Alysson Roberto Baizi E Silva",slug:"alysson-roberto-baizi-e-silva"},{id:"169728",title:"Dr.",name:"Fábio",middleName:null,surname:"Camilotti",fullName:"Fábio Camilotti",slug:"fabio-camilotti"}]}]}],publishedBooks:[{type:"book",id:"410",title:"Soil Erosion Issues in Agriculture",subtitle:null,isOpenForSubmission:!1,hash:"ab3ad713d24941e8ce0649ae94643ec3",slug:"soil-erosion-issues-in-agriculture",bookSignature:"Danilo Godone and Silvia Stanchi",coverURL:"https://cdn.intechopen.com/books/images_new/410.jpg",editedByType:"Edited by",editors:[{id:"313983",title:"Dr.",name:"Danilo",surname:"Godone",slug:"danilo-godone",fullName:"Danilo Godone"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"411",title:"Soil Contamination",subtitle:null,isOpenForSubmission:!1,hash:"02b616b9401d15f1c0e8e4e5ad11a48d",slug:"soil-contamination",bookSignature:"Simone Pascucci",coverURL:"https://cdn.intechopen.com/books/images_new/411.jpg",editedByType:"Edited by",editors:[{id:"60200",title:"MSc",name:"Simone",surname:"Pascucci",slug:"simone-pascucci",fullName:"Simone Pascucci"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1354",title:"Soil Erosion",subtitle:"Studies",isOpenForSubmission:!1,hash:"54b680a6a971eb10ae500071207ab86d",slug:"soil-erosion-studies",bookSignature:"Danilo Godone and Silvia Stanchi",coverURL:"https://cdn.intechopen.com/books/images_new/1354.jpg",editedByType:"Edited by",editors:[{id:"313983",title:"Dr.",name:"Danilo",surname:"Godone",slug:"danilo-godone",fullName:"Danilo Godone"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2112",title:"Soil Health and Land Use Management",subtitle:null,isOpenForSubmission:!1,hash:"3065f0ce00f5f86227cc7f2069cdb89a",slug:"soil-health-and-land-use-management",bookSignature:"Maria C. 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1. Introduction
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Spinal cord injury (SCI) is an event that affects the quality of life of patients as a consequence of affected sexual function, impaired sensory and motor function, including bowel and bladder control, walking, eating, grasping, pain, and spasticity [1, 2, 3]. For many years, SCI has been considered irreversible [4]. However, research on plasticity after SCI has opened new paths and generated a shift in rehabilitation of SCI patients in the past three decades: its former focus on learning compensatory movements to regain function gradually changed to restoration of function through repetitive movement training combined with the stimulation of the nervous system [5].
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The term neural plasticity describes the ability of the nervous system to adapt a new functional or structural state in response to intrinsic or extrinsic factors [6]. Thus, plasticity encompasses the underlying mechanisms that lead to a spontaneous return or recover of motor, sensory and autonomic functions to different degrees. The concept of plasticity at the cellular level can be tracked back to Ramon y Cajal’s work, who suggested that modification of synaptic connections could play a very important role in memory [7]. After that, the work of Donald Hebb was very important to the concept of long-term potentiation (LTP), namely by suggesting that two neurons that fire together and are close enough may grow some connections or undergo metabolic changes that increase their ability to communicate [8]. This happens because chemical synapses have the ability to change their strength [9].
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Sensory information from Ia afferent fibers (transmitting information about muscle activity and movement) play an essential role in inducing functional and morphological changes that lead to the maturation of the brain and the spinal cord [9], independently of the SCI level and whether it is complete or incomplete [10]. Thus, activity-dependent plasticity refers to the changes in the central nervous system (CNS) associated with movement [9] and reflects one of the basic forms of learning in humans [11]. These neural changes happen throughout the life span at both the brain and spinal cord level. However, not all plasticity is beneficial: adverse changes may also appear [12]. This is known as maladaptive plasticity and encompasses events such as excessive plasticity associated with some disease symptoms like focal dystonia, spasticity, and chronic pain. Current SCI rehabilitation is based on task-specific programs aiming at promoting neurorecovery through beneficial activity-dependent plasticity and avoiding maladaptive plasticity [6].
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This chapter summarizes the main effects on motor and functional recovery, as well as spasticity and pain, when using noninvasive modalities in the rehabilitation of SCI patients, either in the research or the clinical setting. Some of these techniques aim at stimulating different levels of the central (brain or spinal cord) and peripheral nervous system, while others combine some sort of stimulation with devices that may assist and allow for repetitive motor training (e.g., hybrid exoskeletons and FES driven cycling).
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2. Brain stimulation
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Recent research has shown that even complete SCI patients may preserve some residual pathways connecting supraspinal and spinal circuits [13]. Given that these patients may preserve muscle activity below the level of injury, target rehabilitation for SCI also includes modalities that stimulate the brain. This might strengthen the efficacy of the residual neural pathways and, therefore, improve volitional control after SCI [14]. This section describes two different types of noninvasive brain stimulation (NIBS): repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Both techniques have been used in the research and clinical setting aiming at improving motor and functional recovery, as well as spasticity and pain after SCI [4].
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2.1 Repetitive transcranial magnetic stimulation (rTMS)
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Transcranial magnetic stimulation (TMS) is a form of noninvasive brain stimulation in which short magnetic fields are generated by a coil in order to induce electric current pulses in the brain, which can then elicit depolarization and action potentials in cortical neurons (see Figure 1). Since its first application in humans in 1985, TMS has become a standard electrophysiological technique to assess the excitability of the corticospinal circuitry, due to its usability and ability to directly activate brain structures without causing harm to the subject. The most extended protocol applies single TMS pulses to activate motor cortex at a specific area where topographic projections of a group of muscles are represented. This cortical activation elicits action potentials that propagate until reaching the muscles, inducing a motor evoked potential (MEP), which can be measured by electromyography (EMG) [2].
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Figure 1.
The magnetic field generated by the TMS coil will induce electric current pulses in the brain, which can elicit depolarization and action potentials in cortical neurons.
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Repetitive transcranial magnetic stimulation (rTMS) is a form of TMS where several TMS pulses are applied sequentially in order to induce long-term changes in the targeted neural pathways. The underlying physiological mechanism of rTMS lies in the repeated activation of a network of synapses that may lead to long-term potentiation (LTP) or long-term depression (LTD) of those synapses [4]. The induction of long-term changes in neural circuits using rTMS can be applied to revert the effects of neurological disorders. For instance, rTMS received FDA approval and has become a promising treatment for major depression.
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Due to its ability to induce long-term changes in neural systems, rTMS has been also applied in patients with motor disorders as a modality to modulate the activity of residual (cortical, subcortical, and corticospinal) pathways and thus promote functional recovery [2]. Moreover, rTMS has been applied in a wide range of protocols, with varying frequencies and intensities of stimulation, or even the number of pulses and sessions, among others. The main stimulation protocols explored so far may be encompassed in the following:
Theta burst stimulation (TBS) consists of three 50 Hz pulses delivered in blocks at 200-ms interval (5 Hz). Intermittent TBS (iTBS) involves the delivery of TBS for 2 s, followed by a resting period of 8 seconds, for a total of 3 min; this is hypothesized to facilitate LTP [15]. On the other hand, continuous TBS (cTBS) applied in 40 s blocks promote LTD.
QuadroPulse (qQPS) applies four high-frequency pulses repeated every 5 s. The facilitator or inhibitory excitability effects depend on the inter-pulse intervals.
I-wave protocol involves the repetitive stimulation of the motor cortex at 1.5 ms rate, seeking to mimic the indirect waves (I-waves) of corticospinal neurons and to increase their excitability [4].
Paired associative stimulation (PAS) relies on the Hebb’s theory, which states that a synaptic connection is enhanced when two stimuli converge in time repeatedly. PAS protocol combines a peripheral nerve stimulus with a TMS pulse over the motor cortex, aiming to pair both stimuli in time at the cortex, which will promote corticospinal excitability. PAS can present different variants, in which the TMS pulse can be replaced by physiological activation of the motor cortex (e.g., imaginary movement), or the pairing site targets of TMS and peripheral stimulus are the motoneurons at the spinal cord.
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Regardless of its incipient stage and current limitations, rTMS has become a promising approach for SCI rehabilitation, not only to improve motor function but also to decrease spasticity and neuropathic pain. This technique enables targeting and promoting long-term changes in neural pathways, by exploiting the plastic properties that may facilitate function recovery. Improvements seem to be present when higher rTMS stimulus intensities are used [2]. On the other hand, the few studies that investigated the effects of rTMS on spasticity in iSCI patients reported some reduction in the clinical symptoms of spasticity [2]. Moreover, the few studies that tested the effect of rTMS on neuropathic pain reported some reductions in the clinical symptoms of pain [2].
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Notwithstanding, these results hold a great variability, are not reproducible in all patients, and are limited to certain clinical assessment scales or neurophysiological measurements. Several constraints can explain current limitations of the rTMS application in SCI patients. First, there is a shortage of studies providing evidences of sustained benefits of rTMS therapy beyond conventional treatments. Besides the different stimulation protocols and parameters applied, type of lesion and nonuniform assessment methodologies hamper the development of consistent evidences. Although evidences so far do not suggest any harm to the subjects, safety issues should be also considered when using rTMS in SCI patients, especially because of the high threshold needed to evoke motor responses in the impaired pathways [16].
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More research is needed to provide robust evidence that can support the use of rTMS as an alternative to standard therapies. In addition to bigger sample sizes used in each study, researchers should also test the same (or very similar) stimulation parameters and protocols to provide reproducible results. Finally, it is critical to better understand the pathophysiology of neural structures affected by rTMS to design optimal and customized protocols that might boost beneficial neural changes coupled with functional recovery after SCI [2].
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2.2 Transcranial direct current stimulation (tDCS)
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Transcranial direct current stimulation (tDCS) is a technology that delivers continuous low current stimulation (1–2 mA) via paired anode and cathode electrodes over the scalp [4, 14, 17] (see Figure 2). This modality is usually combined with motor training to promote activity-dependent plasticity [14]. tDCS may change brain function by causing neurons resting potential to depolarize or hyperpolarize. Depolarization happens when positive stimulation (anodal tDCS) is delivered, which increases neural excitability and, therefore, neural firing. Cathodal tDCS (negative stimulation) causes hyperpolarization and, thus, decreases neural firing [4].
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Figure 2.
Transcranial direct current stimulation delivers continuous low current stimulation by applying a positive (anodal) or negative (cathodal) current via paired electrodes over the scalp.
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This technique is still in the early stage. To our knowledge, just seven studies have examined improvements in motor function after SCI related to the use of tDCS: four studies evaluated its effect on upper limb function [18, 19, 20, 21] and three studies evaluated the tDCS effect on lower limb function and gait [22, 23, 24]. All these studies used anodal stimulation and showed improvements in upper and lower limb motor function.
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The use of tDCS has led to improvements in pinch force, manual dexterity, and force modulation when combined with repetitive practice [18]. Other study reported that stimulation intensity affects functional outcomes when tDCS was delivered at rest: increased corticospinal excitability to affected muscles was obtained when using 2 mA stimulation, but not 1 mA, in nine chronic SCI patients [19]. Another study also reported gains in hand motor function after a single session of 2 mA tDCS, though no improvements were described in clinical scales [20]. When combining tDCS with robot-assisted arm training, SCI patients improved arm and hand function post-treatment and at the 2-month follow-up [21].
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The three studies that evaluated the tDCS effect on lower limb function and gait showed improved motor function [22, 23, 24]. However, one of these studies combined tDCS with robotic gait training and also showed no significant differences between these improvements and those verified in the group who received sham stimulation combined with robotic gait training [22].
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tDCS is an attractive noninvasive modality option for the treatment after SCI: it is affordable and does not present substantial adverse events (when present, they included redness of the skin, sleepiness, headache, and neck pain [4]). However, further research is still needed to provide robust evidence that support the use of tDCS to improve motor function and to be used in the clinical setting as a long-term strategy after SCI.
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3. Transcutaneous spinal cord stimulation (tcSCS)
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In the recent years, spinal cord electrical stimulation (SCS) has arisen as a promising tool to modulate corticospinal excitability and modify the motor output in SCI individuals. The most extended form of SCS is epidural SCS, which consists on delivering electrical currents through arrays of electrodes implanted in the epidural space of the spinal cord, in order to modify the excitatory output of the spinal cord. It has been widely studied as an application for chronic pain relief [14]. Promising results from a recent research showed its potential to improve neurological recovery and support the activities of daily living (including walking) after SCI [25].
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Transcutaneous spinal cord stimulation (tcSCS) is a novel form of SCS that delivers superficial stimulation, usually over the skin that overlies the lower thoracic and/or lumbosacral vertebrae [26]. The principles underlying tcSCS rely on the physiology of the corticospinal pathways in the spinal cord that can produce excitability changes in the different neural populations of the spinal circuitry [27, 28]. Central pattern generators (CPGs) are pools of neurons able to elicit rhythmic and coordinated movements without the contribution of supraspinal centers. CPGs use proprioceptive information to provide real-time and coordinated control of motor output. The propriospinal system serves as an integratory interface between supraspinal and spinal centers, modulating motor activity. tcSCS is able to modulate the excitability properties of these systems by means of different stimulation protocols, in which the surface array placement along the spinal cord, direction of the current, intensity, frequency, and timing of stimulation result in different modulation outcomes. tcSCS was able to activate GPGs in healthy volunteers, eliciting coordinated and synchronized nonvoluntary movements of the lower limb [28]. These findings have been reproduced in SCI individuals, namely by reactivating damaged spinal circuitries that were previously considered as nonfunctional. When tcSCS was applied over several training sessions in SCI patients, there was improved voluntary modulation of movement of the lower limbs [29]. Moreover, combining tcSCS training with pharmacology therapy and exoskeletons increased motor control enhancement [26].
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tcSCS overcomes the invasiveness and costs of epidural SCS with the trade-off of poor spatial stimulation resolution. Although the number of studies using this technique is considerably low, and the exact physiological mechanisms behind the improvements shown are still yet to be fully understood, tcSCS is already a promising tool to be considered in future SCI rehabilitation. Multi-approach therapies including tcSCS, pharmacological, active movement, and robotic-assisted training should be considered to exploit the combination of different physiological effects produced by each modality and maximize motor recovery [26].
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4. Peripheral stimulation and assistive devices
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Motor control and the execution of voluntary movements require the interaction between afferent feedback and supraspinal input to accurately plan and execute movements. This interplay induces activity-dependent plasticity at both the brain and spinal cord level [30, 31]. After SCI, afferent feedback is impaired and becomes essential to reorganize spinal circuits below the lesion area [30]. Therefore, noninvasive modalities that apply surface electrical stimulation at the peripheral level (either alone or combined with assisted training) to augment or modify neural function are very appealing and have been applied in SCI rehabilitation.
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This section overviews two forms of surface stimulation that are user friendly and can be easily administered by a therapist during SCI rehabilitation: transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES). The second part of this section reports the main results attained when using cycling driven by electrical stimulation and the combination of electrical stimulation with external robotic devices.
TENS is the most common noninvasive modality used in physical therapy [32]. This type of stimulation delivers high-frequency (50–150 Hz) and low-intensity (below motor threshold) surface electrical current [33].
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Though TENS has been commonly used in pain control and to reduce muscle stiffness/tone, there are also some reports on decreased spasticity due to the use of this modality. For instance, TENS has recently reduced spasticity in SCI patients and the effects outlasted up to several hours after treatment [34]. This is because TENS activates sensory nerves that in turn may activate inhibitory interneurons that will inhibit the spastic muscle activity [34]. More specifically, these anti-spastic effects are due to the release of gamma-aminobutyric acid (GABA) that acts as inhibitory neurotransmitters, achieving similar anti-spastic effects to those of baclofen [32], which is a first-line treatment for spasticity, especially in adults who suffered a SCI [35]. Results of spasticity treatment using TENS seem to improve when combined with physical therapy [36].
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Given its low cost, lack of adverse event effects, and ease to use, TENS seems to be a very good solution to treat spasticity after SCI. Moreover, since TENS alleviates pain and fatigue and can be used for periods of several hours, it seems to be appropriate for the beginning of the rehabilitation after SCI, when training is not very intensive.
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4.2 Functional electrical stimulation (FES) and brain-machine interfaces (BMIs)
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FES is another modality of electrical stimulation that has become very popular in the clinical setting. FES is similar to TENS in the sense that the two modalities use electrodes on the skin to provide electrical stimulation to a desired location of the body; but they differ in the settings and especially in the purpose of their use. Unlike TENS, FES delivers trains of electrical stimulation above motor threshold to stimulate a muscle or the efferent nerve supplying a muscle in order to attain a muscle contraction [14]. The higher the amplitude of this stimulation, the bigger is the number of recruited efferent fibers and, therefore, the higher the muscle contraction.
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FES has been used to restore bladder and bowel control, as well as sexual function, which are ranked among the most important functions to regain among SCI patients [37]. FES has also been widely used for the treatment of muscle weakness, gait training, and muscle reeducation [34]. In the case of SCI, it is well known that artificially induced contraction of weak or paralyzed muscles brings several therapeutic benefits, such as prevention of lower limb muscle atrophy, increased muscle strength, endurance, and cardiovascular fitness [38, 39]. In addition to these benefits, the coordinated stimulation of efferent nerves (usually to stimulate agonist-antagonist muscles of a joint) can be paired with a functional activity to produce a given biomechanical task and, thus, restore motor function [34].
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On the other hand, there is evidence that peripheral stimulation, if synchronized with patients’ voluntary effort, can further promote recovery [14]. In fact, improved modulation together with volitional control seems to be key factors to reinforce connectivity during rehabilitation of SCI patients, presumably through synaptic enhancement [14]. In this sense, brain-machine interfaces (BMIs) are currently the most sophisticated neuromodulation tools to restore voluntary limb movements after SCI. In the context of the noninvasive modalities described in this chapter, BMIs can be used to stimulate the peripheral nervous system by use of decoded brain signals recorded with electroencephalography (EEG) [14].
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Finally, FES has also been used to reduce spasticity in SCI patients, usually by stimulating the spastic muscle. This is hypothesized to modulate recurrent inhibition via Renshaw cells [34]. These inhibitory interneurons are excited by collaterals of the axons of motoneurons and make inhibitory synaptic connections with several populations of motoneurons, including those that excite them [40]. This reciprocal inhibition is important to prevent overshooting muscle contraction induced by FES.
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Despite all the benefits here described, FES presents several challenges for tasks that are executed for long periods of time. Limited muscle force generation, rapid onset of muscle fatigue, and nonlinear, time-dependent mechanical responses, as well as the redundancy of the musculoskeletal system are the main challenges of this technology that traditionally hamper generalized use for rehabilitation and/or motor compensation of walking. However, multi-electrode techniques are showing promising results [41] and should be explored.
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4.3 FES driven cycling
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Physical activity of SCI people whose limbs are paralyzed is very important to maintain their physiological well-being. A promising approach is the application of FES during cycling movements. This technique, called FES cycling, is a noninvasive training protocol used in medical rehabilitation, mostly addressed to individual affected by SCI. This method can be applied continuously for tens of minutes, with direct benefits on muscle strength. Besides muscle strengthening, FES cycling is beneficial for cardiovascular and respiratory functions [42].
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FES training for lower limb muscles can be performed on stationary cycle ergometers or mobile tricycles. As shown in Figure 3, FES is managed by a controller, which receives signals from a crank angle sensor and, depending on the actual crank position, transfers sequences of electrical impulses to surface electrodes to stimulate muscles and generate active muscle force. The power output produced by the application of FES depends on three main aspects. The first is the number of muscle groups stimulated. The second is the parameters of the stimulating current, that is, amplitude, pulse width, and frequency. The third is the timing of the stimulating signal sent to the individual muscles.
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Figure 3.
FES driven cycling: a controller sends electrical signals (stimulation current) to selected muscles. The actual muscle forces depend on the actual crank angle value transferred to the controller and on the parameters and timing of the stimulation signals sent to individual muscles.
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FES cycling is usually applied on several lower limb muscles simultaneously [43]. The main muscle groups considered are the hamstrings and quadriceps and, in some cases, the gluteus maximus. The quadriceps are stimulated either as a whole, that is, using only one pair of electrodes, or more selectively, in which three muscles composing them—that is, the vastus medialis, vastus lateralis, and rectus femoris—are stimulated individually. This more selective stimulation has demonstrated, in a recent pilot study, to improve up to 27% the power output in one patient with spastic muscles [44]. In this case, while the total stimulation current (the sum of the amplitude of currents applied in all of the channels) was higher, lower stimulation current amplitudes per muscle groups were sufficient to generate the required movement. The average current amplitude applied in FES cycling in SCI individuals is around 50–70 mA per muscles and it varies in a wide range. In some protocols, the current amplitude is increased until 120–140 mA to achieve power output around 10 W [45] and in extreme cases 20 W [46]. Others stimulated muscles with a frequency of 30 Hz, current amplitude of 70–90 mA, and pulse width of 500 μs, reaching a power output around 30 W [47]. The timing of stimulation is usually set according to recorded and processed muscle activities of able-bodied persons and/or on physiological, biomechanical parameters of the muscles and limbs of the participants. Nevertheless, these approaches are either not adaptive to the patient-specific musculoskeletal conditions, or very difficult to calibrate. For instance, when applying selective stimulation of the three quadriceps muscles separately [44], we found that the participant, even reaching higher power output, preferred to cycle for a shorter time, possibly due to a nonphysiological stimulation strategy. In our opinion, more studies are needed to explore these control combinations, in particular considering the case of selective stimulation. This will likely lead to new more efficient, natural, and adaptable stimulation protocols.
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Cadence is another important variable in FES-cycling rehabilitation. In the case of ergometer-based training, cadence is on average set to 45–50 rpm, in most of the stimulating conditions. To adapt the treatment to patient residual motor ability, cadence can be changed in combination with various crank resistances during the rehabilitation process. Tricycles have been proposed as an alternative to stationary cycle ergometers [48]. A recent study reported that the series of FES trainings on a tricycle resulted in increased speed of cycling of paraplegics with denervated muscles [49], which is normally not observed in similar ergometer-based protocols. FES-driven tricycling is gaining relevance, as testified by several competitions organized during the last couple of years [50, 51, 52, 53]. However, these competitions are only targeting people with SCI. We expect that wider range of participants, for example, stroke, will also be addressed in the near future, as supported by recent promising research works in this direction [54, 55].
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4.4 Exoskeletons and hybrid exoskeletons
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Repetitive and intensive task-specific training drives beneficial neuroplasticity, thus enhancing functional recovery [56]. Therefore, exoskeletons for motor rehabilitation purposes have emerged in the last decade as a convenient technology that allow multiple, intensive, and more effective sessions of gait training, allowing SCI patients to ameliorate their performance in daily life [56]. Moreover, a study reported that spasticity and pain intensity of SCI patients decreased after one single session of walking assisted by a powered robotic exoskeleton [56].
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A paradigmatic development of a stationary rehabilitation robot for gait training is the Lokomat system, which combines body-weight supported treadmill-training (BWSTT) with the assistance of a robotic gait orthosis. These robotic systems are able to provide guidance forces to the lower limb segments to induce a consisting stepping pattern with adjustable guidance. It has been shown that although the mechanical coupling and added guidance may change the task constraints and in turn alter voluntary leg movements, the basic neuromuscular pattern is preserved when intact humans walk assisted by this robot [57]. Robot-assisted gait training with the Lokomat after SCI has been shown in some studies to improve outcomes related to mobility when compared to conventional overground training [58, 59]. For example, it was shown improved gait distance, strength, and functional level of mobility and independence of acute SCI patients receiving robotic-assisted gait training than the group of patients receiving conventional overground training [60]. Also, it has been demonstrated that robot-assisted gait training combined with conventional physiotherapy could yield more improvement in ambulatory function of SCI patients than conventional therapy alone. However, the impact of such complementary tools to provide neuromuscular education is still not well established for a convincing penetration of these systems in the clinical rehabilitation environments. Some limitations of such stationary robotic tools are that robotic-assisted training can be limited in the range of gait speed at which the exoskeleton robot can provide a comfortable gait pattern. Also, the stationary machine imposes restrictions to the user movements to the sagittal plane, significantly preventing motion in the frontal and transversal plane that are required for overground walking.
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Wearable robots (WR) for overground untethered assisted walking are emerging devices that have the potential to overcome some of the above-mentioned constraints and opening a range of clinical application scenarios. Through wearable mechanical actuation and sensing, WRs are proliferating for their use as assistive and rehabilitation technologies due to their ability to replicate the complex motions involved in human movement. As a result, the past few decades have seen an increasing amount of research focused on developing robotic systems intended to interact with the neurologically impaired human body. This interaction (of the human body) with WRs has been established in foundational literature [61] as dual, bidirectional physical (pHRi), and cognitive (cHRi) interactions. While these systems have been proven to be useful for specific applications, such as in-clinic rehabilitation, current research in the area of pHRi for WRs is focusing more on developing lightweight and flexible force interactions with hardware solutions that might be more suitable to a broader range of applications (by adding compliance to rigid exoskeletons [62, 63] or developing “soft exosuits” [64]). However, these soft exoskeletons are in early stage and the majority of clinical evidence of their efficacy for treatment of SCI is in studies with motorized powered exoskeletons. A systematic review of the literature on powered WRs for overground gait rehabilitation pointed out that, although current technology is still under development, and hence its ultimate impact remains still unclear, a number of revised studies report positive changes in outcome variables and suggest that training time and improvements in gait speed using powered WRs are correlated in SCI population [65].
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On the cHRi side, efforts are focused on developing means for interpretation of mechanical and neural signals to establish adequate control methods that integrate WRs as parts of human functioning. In this regard, a scheme for “symbiotic interaction” between humans and WRs has been recently developed in the FET Project BioMot (FP7-ICT-2013-10-611695), yielding new technologies to interface human neuromechanics with robot-control algorithms to guide assistance; the point of increasing their proficiency is to make them more capable of sophisticated interdependent joint activity with the human wearer. Under this approach, a tacit adaptability is provided to modulate the compliance in the robot torque controller, to automatically modulate in turn the difficulty of the task [66].
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There is currently no agreement on the optimal robot-mediated treatment programs to induce plasticity and promote recovery of motor function following SCI, and the understanding of recovery mechanisms is still an open matter [67]. Whatever the robot hardware and patient’s functional status, a WR-mediated neurorehabilitation model could pave the way for effective restoration of mobility after major neurological conditions. In the last few years, the development of computational neurorehabilitation models is becoming a relevant topic in the domain of neural repair, as these computational models can be expected to provide the basis for future clinical robot software that suggests timing, dosage, and content of therapy. For example, an analytical modeling approach has been applied to robot-mediated rehabilitation data of a group of SCI subjects, providing insights with regard to patient grouping and gait recovery prognosis and also providing predictive quantitative measures to consider before starting the treatment [68]. This, together with the fact that in the past years we are witnessing an unprecedented number of wearable interactive robotics products that will populate even more the clinic environments, a reasonable long-term vision is to gather multicenter clinical data to equip rehabilitation WRs with computational neurorehabilitation modeling tools that will in turn provide enriched data to establish scientific bases of exoskeleton-guided recovery.
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On the other hand, the combination of FES with external orthotic devices that provide joint support and mechanical constraint to undesired movements was early proposed [69], but the challenges associated with the rapid onset of muscle fatigue and movement control still remained. In an attempt to further diminish the energy demand from the muscle while providing better joint control, FES systems were combined with lower limb exoskeletons, also called hybrid exoskeletons [70]. The combination of the lower limb robotic exoskeleton and the FES system can be shaped in different ways, depending on the configuration of the FES system and/or the exoskeleton. Regarding the former, the FES can be implanted [71] or superficial [72] and can be found either under open [71, 73] or closed-loop [72, 74] control of stimulation. With regards to the exoskeleton joints, it can provide means of dissipating energy, via the use of clutches or brakes [75, 76], or can feature active joints, which can also provide energy to the joints.
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The hybrid configuration presents some advantages with respect to the FES or exoskeleton applications alone. First, the exoskeleton structure provides passive control to the joints, constraining undesirable movements. The actuators can provide support to the joints, diminishing or eliminating the need for stimulation of certain muscles (e.g., quadriceps muscles during the stance phases of walking). In the case of active actuators, the movement produced by the FES is supported by the actuator, improving the control of the joint trajectory while delaying muscle fatigue [77]. On the other hand, the sensors of the exoskeleton provide information for closing the control loop of the FES system, which may further help on optimizing the performance of the muscle in terms of either force production or muscle fatigue [72].
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Despite hybrid exoskeletons show several advantages, the field is not mature. There is a markedly low activity in this field, and most of the groups working on this technology have discontinued their research on this topic. The rationale for this may come from the bottlenecks of each technology. First, hybrid exoskeletons share drawbacks with lower limb robotic exoskeletons, in which the combination with a FES system add complexity on the control and wearing aspects. Besides, although alleviated by the exoskeleton, the nonlinear muscle response of the stimulated muscles and the muscle fatigue is not adequately solved yet, and eventually all hybrid exoskeletons still have to be designed to function as conventional robotic exoskeletons once muscle fatigue appears.
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Lastly, there is a need of conducting clinical studies that can demonstrate the benefits of using hybrid exoskeleton with respect to exoskeleton alone that actually justify the extra complexity, cost, and cumbersomeness of the FES system.
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5. Conclusions and future directions
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This chapter presents an overview of the main effects on motor and functional recovery, as well as spasticity and pain, when using a wide range of noninvasive modalities in the rehabilitation of SCI patients, either in the research or the clinical setting. According to the level of stimulation, these modalities were divided into three different sections: brain, spinal cord, and peripheral stimulation. Regarding the last one, stimulation of the peripheral nervous system can also be combined with external devices that assist and allow repetitive motor training (e.g., hybrid exoskeletons and FES driven cycling).
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Noninvasive brain stimulation (NIBS) techniques such as rTMS and tDCS have the potential to improve motor function recovery and spasticity after SCI. Moreover, NIBS techniques are safe and relatively easy to administer, presenting infrequent mild effects. Very few studies have investigated motor function after delivery of rTMS on SCI patients. Improvements seem to be present when higher rTMS frequencies are used. On the other hand, the few studies that investigated the effects of rTMS on spasticity in iSCI reported some reduction in the clinical symptoms of spasticity [2]. There are less studies of the application of tDCS in motor function or spasticity than those of rTMS [4], though they all showed improvements in upper or lower limb motor function. Thus, more research is needed to address the full potential and incorporate NIBS techniques into SCI rehabilitation [4].
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At the spinal level stimulation, tcSCS has irrupted in the last years as a neurorehabilitation tool in SCI. It overcomes the limitation of invasiveness and costs of epidural stimulation at the expense of poor spatial stimulation resolution. The few evidences suggest that tsSCS alone improves voluntary modulation of lower limb movement [29] and increases motor control enhancement when combined with pharmacology therapy and exoskeletons [26].
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Noninvasive modalities that deliver different types of surface stimulation at the peripheral level (either alone or combined with cycling or robotic-assisted training, for example) are very appealing and have been applied in SCI rehabilitation. Surface electrical stimulation can modulate afferent and efferent pathways in order to induce corticospinal plasticity. For instance, TENS and FES have reduced spasticity in SCI patients and the effects outlasted up to several hours after treatment, though the two techniques target different nerve groups in order to reduce spasticity: TENS activates afferents that in turn activate inhibitory interneurons that will inhibit the spastic muscle activity; FES induces muscle contraction and is oriented to the spastic muscle [34]. The development of fatigue and discomfort produced by the intensity of stimulation of FES is a drawback for long sessions. Thus, TENS may be appropriate for the beginning of the rehabilitation, while FES may have better effects on those SCI patients presenting spasmodic behavior [34]. On the other hand, BMIs may enhance brain and spinal cord neurorecovery through activity dependent plasticity. Future advances in wireless devices may potentiate the widespread use of BMIs in the clinical setting.
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FES cycling is another modality that presents direct benefits on muscle strength, as well as cardiovascular and respiratory functions of SCI patients. However, more research on this technique is needed in order to design more efficient, natural, and adaptable stimulation protocols, which will likely improve motor function outcomes during SCI rehabilitation.
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Robotic devices, such as exoskeletons, are other solutions that have been used for rehabilitation purposed after SCI. These devices can provide intensive, long lasting repetitive task specific training to SCI patients, which is the principle behind motor rehabilitation and beneficial neuroplasticity [78]. These devices have allowed SCI patients to ameliorate their performance in daily life [56]. The hybrid configuration (exoskeleton combined with FES) presents some advantages with respect to the FES or exoskeleton applications alone: actuators can provide support to the joints, diminishing or eliminating the need for stimulation of certain muscles; the sensors of the exoskeleton provide information for closing the control loop of the FES system, which may further help on optimizing the performance of the muscle in terms of either force production or muscle fatigue. However, the field is not mature and there is a need of conducting clinical studies that can demonstrate the benefits of using hybrid exoskeleton with respect to exoskeleton alone that actually justify the extra complexity, cost, and cumbersomeness of the FES system.
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Part of the current SCI rehabilitation research uses the modalities described in this chapter and has presented promising results including neurorecovery.
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Some of these modalities are already being widely introduced into the clinical rehabilitation of SCI, such as TENS and FES. However, the actual uptake of technology in the clinical setting, especially for SCI rehabilitation, has been very low [5]. There are still some barriers to the clinical implementation of these techniques. Three of those barriers are the feasibility, appropriateness, and the cost. While the research here described is practical for SCI rehabilitation, some of these techniques are less practicable: they require specialized equipment and knowledge, which make them less feasible [5]. Despite the scientific evidence in favor of these technologies, the expertise required to operate and repair emerging technology is usually not found in the clinical setting, which makes it less appropriate. A third barrier that deserves attention is the economic cost, given the fact that most of the clinical centers cannot afford the maintenance of these technologies. To overcome these barriers, it is essential to develop a proactive dialog between researchers and clinicians in order to properly examine each of the emerging modalities that can maximize the outcomes for each individual that suffered a SCI.
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Acknowledgments
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This work was funded by the European Union’s Horizon 2020 research and innovation programme (Project EXTEND—Bidirectional Hyper-Connected Neural System) under grant agreement No 779982 and by the EFOP-3.6.1-16-2016-00004 grant.
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Conflict of interest
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The authors declare that this work was conducted in the absence of any commercial or financial relationships that could be considered as a potential conflict of interest.
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\n',keywords:"spinal cord injury, rehabilitation, noninvasive modalities, functional electrical stimulation, transcranial magnetic stimulation, exoskeletons",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/65272.pdf",chapterXML:"https://mts.intechopen.com/source/xml/65272.xml",downloadPdfUrl:"/chapter/pdf-download/65272",previewPdfUrl:"/chapter/pdf-preview/65272",totalDownloads:1150,totalViews:0,totalCrossrefCites:2,dateSubmitted:"October 7th 2018",dateReviewed:"December 19th 2018",datePrePublished:"January 21st 2019",datePublished:"November 27th 2019",dateFinished:"January 21st 2019",readingETA:"0",abstract:"In the past three decades, research on plasticity after spinal cord injury (SCI) has led to a gradual shift in SCI rehabilitation: the former focus on learning compensatory strategies changed to functional neurorecovery, that is, promoting restoration of function through the use of affected limbs. This paradigm shift contributed to the development of technology-based interventions aiming to promote neurorecovery through repetitive training. This chapter presents an overview of a range of noninvasive modalities that have been used in rehabilitation after SCI. Among others, we present repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface electrical stimulation tools such as transcutaneous electrical spinal cord stimulation (tcSCS), transcutaneous electrical nerve stimulation (TENS), and functional electrical stimulation (FES), as well as its integration with cycling training and assistive robotic devices. The most recent results attained and the potential relevance of these new techniques to strengthen the efficacy of the residual neuronal pathways and improve spasticity are also presented. Future efforts toward the widespread clinical application of these modalities include more advances in the technology, together with the knowledge obtained from basic research and clinical trials. This can ultimately lead to novel customized interventions that meet specific needs of SCI patients.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/65272",risUrl:"/chapter/ris/65272",signatures:"Filipe O. Barroso, Alejandro Pascual-Valdunciel, Diego Torricelli, Juan C. Moreno, Antonio Del Ama-Espinosa, Jozsef Laczko and José L. Pons",book:{id:"7879",type:"book",title:"Spinal Cord Injury Therapy",subtitle:null,fullTitle:"Spinal Cord Injury Therapy",slug:"spinal-cord-injury-therapy",publishedDate:"November 27th 2019",bookSignature:"Antonio Ibarra, Elisa García-Vences and Gabriel Guízar-Sahagún",coverURL:"https://cdn.intechopen.com/books/images_new/7879.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-78984-162-6",printIsbn:"978-1-78984-161-9",pdfIsbn:"978-1-78985-844-0",isAvailableForWebshopOrdering:!0,editors:[{id:"72488",title:"Dr.",name:"José Juan Antonio",middleName:null,surname:"Ibarra Arias",slug:"jose-juan-antonio-ibarra-arias",fullName:"José Juan Antonio Ibarra Arias"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"36836",title:"BSc.",name:"Antonio",middleName:null,surname:"Del Ama-Espinosa",fullName:"Antonio Del Ama-Espinosa",slug:"antonio-del-ama-espinosa",email:"ajdela@sescam.jccm.es",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"180150",title:"Dr.",name:"Juan",middleName:null,surname:"Moreno",fullName:"Juan Moreno",slug:"juan-moreno",email:"jc.moreno@csic.es",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Spanish National Research Council",institutionURL:null,country:{name:"Spain"}}},{id:"187371",title:"Dr.",name:"Diego",middleName:null,surname:"Torricelli",fullName:"Diego Torricelli",slug:"diego-torricelli",email:"diego.torricelli@csic.es",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"279946",title:"Dr.",name:"Filipe O.",middleName:null,surname:"Barroso",fullName:"Filipe O. Barroso",slug:"filipe-o.-barroso",email:"filipe.barroso@cajal.csic.es",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"283851",title:"MSc.",name:"Alejandro",middleName:null,surname:"Pascual-Valdunciel",fullName:"Alejandro Pascual-Valdunciel",slug:"alejandro-pascual-valdunciel",email:"alejandropv@cajal.csic.es",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"283852",title:"Dr.",name:"Jozsef",middleName:null,surname:"Laczko",fullName:"Jozsef Laczko",slug:"jozsef-laczko",email:"laczkoj@gamma.ttk.pte.hu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"283853",title:"Dr.",name:"José L.",middleName:null,surname:"Pons",fullName:"José L. Pons",slug:"jose-l.-pons",email:"jose.pons@cajal.csic.es",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Brain stimulation",level:"1"},{id:"sec_2_2",title:"2.1 Repetitive transcranial magnetic stimulation (rTMS)",level:"2"},{id:"sec_3_2",title:"2.2 Transcranial direct current stimulation (tDCS)",level:"2"},{id:"sec_5",title:"3. Transcutaneous spinal cord stimulation (tcSCS)",level:"1"},{id:"sec_6",title:"4. Peripheral stimulation and assistive devices",level:"1"},{id:"sec_6_2",title:"4.1 Transcutaneous electrical nerve stimulation (TENS)",level:"2"},{id:"sec_7_2",title:"4.2 Functional electrical stimulation (FES) and brain-machine interfaces (BMIs)",level:"2"},{id:"sec_8_2",title:"4.3 FES driven cycling",level:"2"},{id:"sec_9_2",title:"4.4 Exoskeletons and hybrid exoskeletons",level:"2"},{id:"sec_11",title:"5. Conclusions and future directions",level:"1"},{id:"sec_12",title:"Acknowledgments",level:"1"},{id:"sec_12",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Barroso FO, Torricelli D, Bravo-Esteban E, Taylor J, Gómez-Soriano J, Santos C, et al. Muscle synergies in cycling after incomplete spinal cord injury: Correlation with clinical measures of motor function and spasticity. Frontiers in Human Neuroscience. 2016;9(706). DOI: 10.3389/fnhum.2015.00706'},{id:"B2",body:'Tazoe T, Perez MA. Effects of repetitive transcranial magnetic stimulation on recovery of function after spinal cord injury. Archives of Physical Medicine and Rehabilitation. 2015;96(4 Suppl):S145-S155. DOI: 10.1016/j.apmr.2014.07.418'},{id:"B3",body:'van Middendorp JJ, Allison HC, Ahuja S, Bracher D, Dyson C, Fairbank J, et al. Top ten research priorities for spinal cord injury: The methodology and results of a British priority setting partnership. Spinal Cord. 2016;54(5):341-346. 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Training with FES-assisted cycling in a subject with spinal cord injury: Psychological, physical and physiological considerations. The Journal of Spinal Cord Medicine. 2018:1-12. DOI: 10.1080/10790268.2018.1490098'},{id:"B54",body:'Peri E, Ambrosini E, Pedrocchi A, Ferrigno G, Nava C, Longoni V, et al. Can FES-augmented active cycling training improve locomotion in post-acute elderly stroke patients? European Journal of Translational Myology. 2016;26(3):187-192. DOI: 10.4081/ejtm.2016.6063'},{id:"B55",body:'Wang X, Leung KW, Fang Y, Chen S, Tong RK. Design of functional electrical stimulation cycling system for lower-limb rehabilitation of stroke patients. Conference Proceedings—IEEE Engineering in Medicine and Biology Society. 2018:2337-2340. DOI: 10.1109/EMBC.2018.8512869'},{id:"B56",body:'Stampacchia G, Rustici A, Bigazzi S, Gerini A, Tombini T, Mazzoleni S. Walking with a powered robotic exoskeleton: Subjective experience, spasticity and pain in spinal cord injured persons. 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Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: A systematic review. Journal of Neuroengineering and Rehabilitation. 2017;14(1). DOI: 10.1186/s12984-017-0232-3'},{id:"B61",body:'Pons JL. Wearable Robots: Biomechatronic Exoskeletons. John Wiley & Sons; 2008'},{id:"B62",body:'Karavas NC, Tsagarakis NG, Saglia J, Galdwell DG. A novel actuator with reconfigurable stiffness for a knee exoskeleton: Design and modeling. In: Advances in Reconfigurable Mechanisms and Robots I. Springer; 2012. pp. 411-421. DOI: 10.1007/978-1-4471-4141-9_37'},{id:"B63",body:'Bortole M, Venkatakrishnan A, Zhu F, Moreno JC, Francisco GE, Pons JL, et al. The H2 robotic exoskeleton for gait rehabilitation after stroke: Early findings from a clinical study. Journal of Neuroengineering and Rehabilitation. 2015;12(54). DOI: 10.1186/s12984-015-0048-y'},{id:"B64",body:'Polygerinos P, Galloway KC, Savage E, Herman M, O\'Donnell K, Walsh CJ. Soft robotic glove for hand rehabilitation and task specific training. In: 2015 IEEE International Conference on Robotics and Automation (ICRA). 2015. pp. 2913-2919. DOI: 10.1109/ICRA.2015.7139597'},{id:"B65",body:'Contreras-Vidal JL, Bhagat NA, Brantley J, Cruz-Garza JG, He Y, Manley Q , et al. Powered exoskeletons for bipedal locomotion after spinal cord injury. Journal of Neural Engineering. 2016;13(3). DOI: 10.1088/1741-2560/13/3/031001'},{id:"B66",body:'Asín-Prieto G, Martínez-Expósito A, Alnajjar F, Shimoda S, Pons JL, Moreno JC. Feasibility of submaximal force control training for robot–mediated therapy after stroke. In: Converging Clinical and Engineering Research on Neurorehabilitation III; 2019. pp. 256-260. DOI: 10.1007/978-3-030-01845-0_51'},{id:"B67",body:'Gassert R, Dietz V. Rehabilitation robots for the treatment of sensorimotor deficits: A neurophysiological perspective. Journal of Neuroengineering and Rehabilitation. 2018;15(1). 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The Journal of Spinal Cord Medicine. 2003;26(3):254-258'},{id:"B72",body:'del-Ama AJ, Gil-Agudo A, Pons JL, Moreno JC. Hybrid FES-robot cooperative control of ambulatory gait rehabilitation exoskeleton. Journal of Neuroengineering and Rehabilitation. 2014;11:27. DOI: 10.1186/1743-0003-11-27'},{id:"B73",body:'Ha KH, Murray SA, Goldfarb M. An approach for the cooperative control of FES with a powered exoskeleton during level walking for persons with paraplegia. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2016;24(4):455-466. DOI: 10.1109/TNSRE.2015.2421052'},{id:"B74",body:'Kurokawa N, Yamamoto N, Tagawa Y, Yamamoto T, Kuno H. Development of hybrid FES walking assistive system—Feasibility study. In: The 2012 International Conference on Advanced Mechatronic Systems. 2012. pp. 93-97'},{id:"B75",body:'Goldfarb M, Durfee WK. Design of a controlled-brake orthosis for FES-aided gait. IEEE Transactions on Rehabilitation Engineering. 1996;4(1):13-24'},{id:"B76",body:'Gharooni S, Heller B, Tokhi MO. A new hybrid spring brake orthosis for controlling hip and knee flexion in the swing phase. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2001;9(1):106-107'},{id:"B77",body:'Goldfarb M, Korkowski K, Harrold B, Durfee W. Preliminary evaluation of a controlled-brake orthosis for FES-aided gait. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2003;11(3):241-248. DOI: 10.1109/TNSRE.2003.816873'},{id:"B78",body:'Barroso FO, Santos C, Moreno JC. Influence of the robotic exoskeleton Lokomat on the control of human gait: An electromyographic and kinematic analysis. In: 2013 IEEE 3rd Portuguese Meeting in Bioengineering (ENBENG). 2013. DOI: 10.1109/ENBENG.2013.6518442'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Filipe O. Barroso",address:"filipe.barroso@cajal.csic.es",affiliation:'
Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Spain
Department of Information Technology and Biorobotics, Faculty of Science, University of Pecs, Hungary
Hungarian Academy of Sciences, Wigner Research Centre for Physics, Hungary
'},{corresp:null,contributorFullName:"José L. Pons",address:null,affiliation:'
Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Spain
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Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
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CSIC affiliated authors can also take advantage of a central Open Access fund (amounting to 10,000 EUR) to cover up to 50% of the rest of the OAPF until it expires. Effective for chapters accepted from January 1, 2020.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
The Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\n
Corresponding authors will receive a 15% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
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\\n\\t
Virginia Polytechnic Institute and State University
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\n
CSIC affiliated authors can also take advantage of a central Open Access fund (amounting to 10,000 EUR) to cover up to 50% of the rest of the OAPF until it expires. Effective for chapters accepted from January 1, 2020.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
Corresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
The Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\n
Corresponding authors will receive a 15% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
The University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\n
Corresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\n
\n\t
Virginia Polytechnic Institute and State University
Important: You must be a member or grantee of the above listed institutions in order to apply for their Open Access publication funds.
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Gaze"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9496",title:"Management of Dyslipidemia",subtitle:null,isOpenForSubmission:!1,hash:"1d1174ff4ed8ad553c944e99add28154",slug:"management-of-dyslipidemia",bookSignature:"Wilbert S. Aronow",coverURL:"https://cdn.intechopen.com/books/images_new/9496.jpg",editedByType:"Edited by",editors:[{id:"164597",title:"Dr.",name:"Wilbert S.",middleName:null,surname:"Aronow",slug:"wilbert-s.-aronow",fullName:"Wilbert S. Aronow"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7016",title:"Cardiovascular Risk Factors in Pathology",subtitle:null,isOpenForSubmission:!1,hash:"7937d2c640c7515de372282c72ee5635",slug:"cardiovascular-risk-factors-in-pathology",bookSignature:"Alaeddin Abukabda, Maria Suciu and Minodora Andor",coverURL:"https://cdn.intechopen.com/books/images_new/7016.jpg",editedByType:"Edited by",editors:[{id:"307873",title:"Ph.D.",name:"Alaeddin",middleName:null,surname:"Abukabda",slug:"alaeddin-abukabda",fullName:"Alaeddin Abukabda"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10124",title:"Sudden Cardiac Death",subtitle:null,isOpenForSubmission:!1,hash:"ca46358f48d8781fa3df4e80e393fc8f",slug:"sudden-cardiac-death",bookSignature:"Peter Magnusson and Jo Ann LeQuang",coverURL:"https://cdn.intechopen.com/books/images_new/10124.jpg",editedByType:"Edited by",editors:[{id:"188088",title:"Dr.",name:"Peter",middleName:null,surname:"Magnusson",slug:"peter-magnusson",fullName:"Peter Magnusson"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8300",title:"Vascular Biology",subtitle:"Selection of Mechanisms and Clinical Applications",isOpenForSubmission:!1,hash:"478078d1af7d5e3c606698a33dc2550b",slug:"vascular-biology-selection-of-mechanisms-and-clinical-applications",bookSignature:"Marcelo",coverURL:"https://cdn.intechopen.com/books/images_new/8300.jpg",editedByType:"Edited by",editors:[{id:"202594",title:"Dr.",name:"Marcelo",middleName:null,surname:"González",slug:"marcelo-gonzalez",fullName:"Marcelo González"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8217",title:"Aortic Aneurysm and Aortic Dissection",subtitle:null,isOpenForSubmission:!1,hash:"cffb188ad7ddd3f31691c098dc8b9c73",slug:"aortic-aneurysm-and-aortic-dissection",bookSignature:"Jeffrey Shuhaiber",coverURL:"https://cdn.intechopen.com/books/images_new/8217.jpg",editedByType:"Edited by",editors:[{id:"22152",title:"Dr.",name:"Jeffrey",middleName:null,surname:"Shuhaiber",slug:"jeffrey-shuhaiber",fullName:"Jeffrey Shuhaiber"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9060",title:"The Current Perspectives on Coronary Artery Bypass Grafting",subtitle:null,isOpenForSubmission:!1,hash:"cedc3547eae8f66f9440cc35216d7963",slug:"the-current-perspectives-on-coronary-artery-bypass-grafting",bookSignature:"Takashi Murashita",coverURL:"https://cdn.intechopen.com/books/images_new/9060.jpg",editedByType:"Edited by",editors:[{id:"192448",title:"Dr.",name:"Takashi",middleName:null,surname:"Murashita",slug:"takashi-murashita",fullName:"Takashi Murashita"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:128,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"45069",doi:"10.5772/54354",title:"The Immune Response in In Situ Tissue Engineering of Aortic Heart Valves",slug:"the-immune-response-in-in-situ-tissue-engineering-of-aortic-heart-valves",totalDownloads:5209,totalCrossrefCites:16,totalDimensionsCites:37,abstract:null,book:{id:"3384",slug:"calcific-aortic-valve-disease",title:"Calcific Aortic Valve Disease",fullTitle:"Calcific Aortic Valve Disease"},signatures:"S. L. M. van Loon, A. I. P. M. Smits, A. Driessen-Mol, F. P. T. Baaijens\nand C. V. C. Bouten",authors:[{id:"159635",title:"Prof.",name:"Carlijn",middleName:"V",surname:"Bouten",slug:"carlijn-bouten",fullName:"Carlijn Bouten"},{id:"161227",title:"MSc.",name:"Saskia",middleName:null,surname:"Van Loon",slug:"saskia-van-loon",fullName:"Saskia Van Loon"},{id:"161228",title:"MSc.",name:"Anthal",middleName:null,surname:"Smits",slug:"anthal-smits",fullName:"Anthal Smits"},{id:"161229",title:"Dr.",name:"Anita",middleName:null,surname:"Driessen-Mol",slug:"anita-driessen-mol",fullName:"Anita Driessen-Mol"},{id:"161230",title:"Prof.",name:"Frank",middleName:null,surname:"Baaijens",slug:"frank-baaijens",fullName:"Frank Baaijens"}]},{id:"47808",doi:"10.5772/59375",title:"Role of Oxidized LDL in Atherosclerosis",slug:"role-of-oxidized-ldl-in-atherosclerosis",totalDownloads:4994,totalCrossrefCites:18,totalDimensionsCites:29,abstract:null,book:{id:"4477",slug:"hypercholesterolemia",title:"Hypercholesterolemia",fullTitle:"Hypercholesterolemia"},signatures:"E. Leiva, S. Wehinger, L. Guzmán and R. Orrego",authors:[{id:"153453",title:"MSc.",name:"Elba",middleName:null,surname:"Leiva",slug:"elba-leiva",fullName:"Elba Leiva"}]},{id:"53316",doi:"10.5772/66405",title:"TGF-β Activation and Signaling in Angiogenesis",slug:"tgf-activation-and-signaling-in-angiogenesis",totalDownloads:2403,totalCrossrefCites:12,totalDimensionsCites:24,abstract:"The transforming growth factor-β (TGF-β) signaling pathway regulates various cellular processes during tissue and organ development and homeostasis. Deregulation of the expression and/or functions of TGF-β ligands, receptors or their intracellular signaling components leads to multiple diseases including vascular pathologies, autoimmune disorders, fibrosis and cancer. In vascular development, physiology and disease TGF-β signaling can have angiogenic and angiostatic properties, depending on expression levels and the tissue context. The objective of this chapter is to analyze the mechanisms that contribute to the activation and signaling of TGF-β in developmental, physiological and pathological angiogenesis, with a particular emphasis on the importance of TGF-β signaling in the mammalian central nervous system (CNS).",book:{id:"5682",slug:"physiologic-and-pathologic-angiogenesis-signaling-mechanisms-and-targeted-therapy",title:"Physiologic and Pathologic Angiogenesis",fullTitle:"Physiologic and Pathologic Angiogenesis - Signaling Mechanisms and Targeted Therapy"},signatures:"Paola A. Guerrero and Joseph H. McCarty",authors:[{id:"193482",title:"Dr.",name:"Paola",middleName:null,surname:"Guerrero",slug:"paola-guerrero",fullName:"Paola Guerrero"},{id:"195670",title:"Dr.",name:"Joseph",middleName:null,surname:"McCarty",slug:"joseph-mccarty",fullName:"Joseph McCarty"}]},{id:"44726",doi:"10.5772/52842",title:"Extracellular Matrix Organization, Structure, and Function",slug:"extracellular-matrix-organization-structure-and-function",totalDownloads:3116,totalCrossrefCites:12,totalDimensionsCites:24,abstract:null,book:{id:"3384",slug:"calcific-aortic-valve-disease",title:"Calcific Aortic Valve Disease",fullTitle:"Calcific Aortic Valve Disease"},signatures:"Dena Wiltz, C. Alexander Arevalos, Liezl R. Balaoing, Alicia A.\nBlancas, Matthew C. Sapp, Xing Zhang and K. Jane Grande-Allen",authors:[{id:"159730",title:"Ph.D. Student",name:"Dena",middleName:null,surname:"Wiltz",slug:"dena-wiltz",fullName:"Dena Wiltz"},{id:"160472",title:"Dr.",name:"Alicia",middleName:null,surname:"Blancas",slug:"alicia-blancas",fullName:"Alicia Blancas"},{id:"160474",title:"Ms.",name:"Liezl",middleName:null,surname:"Balaoing",slug:"liezl-balaoing",fullName:"Liezl Balaoing"},{id:"160476",title:"Mr.",name:"Alex",middleName:null,surname:"Arevalos",slug:"alex-arevalos",fullName:"Alex Arevalos"},{id:"160477",title:"Mr.",name:"Matthew",middleName:null,surname:"Sapp",slug:"matthew-sapp",fullName:"Matthew Sapp"},{id:"160478",title:"Dr.",name:"Xing",middleName:null,surname:"Zhang",slug:"xing-zhang",fullName:"Xing Zhang"},{id:"160479",title:"Dr.",name:"K. Jane",middleName:null,surname:"Grande-Allen",slug:"k.-jane-grande-allen",fullName:"K. Jane Grande-Allen"}]},{id:"59778",doi:"10.5772/intechopen.74768",title:"Epidemiology of Myocardial Infarction",slug:"epidemiology-of-myocardial-infarction",totalDownloads:4460,totalCrossrefCites:11,totalDimensionsCites:23,abstract:"Coronary heart disease (CHD) is the leading cause of morbidity and mortality throughout the world. The most common form of CHD is the myocardial infarction. It is responsible for over 15% of mortality each year, among the vast majority of people suffering from non-ST-segment elevation myocardial infarction (NSTEMI) than ST-segment elevation myocardial infarction (STEMI). The prevalence of myocardial infarction (MI) is higher in men in all age-specific groups than women. Although the incidence of MI is decreased in the industrialized nations partly because of improved health systems and implementation of effective public health strategies, nevertheless the rates are surging in the developing countries such as South Asia, parts of Latin America, and Eastern Europe. The modifiable risk factors represent over 90% of the risk for acute MI. The risk factors such as dyslipidemia, smoking, psychosocial stressors, diabetes mellitus, hypertension, obesity, alcohol consumption, physical inactivity, and a diet low in fruits and vegetables were strongly associated with acute MI.",book:{id:"6373",slug:"myocardial-infarction",title:"Myocardial Infarction",fullTitle:"Myocardial Infarction"},signatures:"Joshua Chadwick Jayaraj, Karapet Davatyan, S.S. Subramanian and Jemmi Priya",authors:[{id:"223196",title:"Dr.",name:"Joshua",middleName:null,surname:"Chadwick",slug:"joshua-chadwick",fullName:"Joshua Chadwick"},{id:"231054",title:"Dr.",name:"Karapet",middleName:null,surname:"Davatyan",slug:"karapet-davatyan",fullName:"Karapet Davatyan"},{id:"231055",title:"Ms.",name:"Jemmi",middleName:null,surname:"Priya",slug:"jemmi-priya",fullName:"Jemmi Priya"},{id:"244487",title:"Dr.",name:"S.S.",middleName:null,surname:"Subramanian",slug:"s.s.-subramanian",fullName:"S.S. Subramanian"}]}],mostDownloadedChaptersLast30Days:[{id:"80213",title:"Evolution of Heart Transplantation Surgical Techniques",slug:"evolution-of-heart-transplantation-surgical-techniques",totalDownloads:222,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation.",book:{id:"11236",slug:null,title:"Heart Transplantation - New Insights in Therapeutic Strategies",fullTitle:"Heart Transplantation - New Insights in Therapeutic Strategies"},signatures:"Samuel Jacob, Anthony N. Pham and Si M. Pham",authors:null},{id:"65757",title:"Prevalence of Dyslipidemia and Goal Attainment with Lipid-Lowering Therapy: Insights from Thai Multicenter Study and Overview of the Major Guidelines",slug:"prevalence-of-dyslipidemia-and-goal-attainment-with-lipid-lowering-therapy-insights-from-thai-multic",totalDownloads:2266,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Background Since the release in Thailand in 2001 of the Third Guidelines by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults or the Adult Treatment Panel (ATP III), there have been no nationwide studies on the proportion of dyslipidaemic patients who have achieved the low-density lipoprotein cholesterol (LDL-C) goals. The authors therefore aimed to estimate the percentage achievement of LDL-C goals based on the modified NCEP ATP III guidelines in intermediate- to high-risk patients. Methods The authors conducted a hospital-based, cross-sectional, epidemiological survey. Patients (1240) were selected consecutively from 50 hospitals across Thailand. Patients were included if they had been treated with statins for at least 3 months. Results Two-thirds were female, and the mean age was 61.7+69.5 years. The median duration of statin treatment was 21 months. Half (633/1240) of the patients achieved the LDL-C goal levels as defined by the NCEP guidelines (51.1%, 95% CI 48.3% to 53.8%). The very high-risk group had the lowest percentage achievement (11.6%; 95% CI 1.6% to 21.6%), compared with 54.2% (95% CI 50.9% to 57.4%) for the high-risk group and 47.0% (95% CI 41.1% to 52.8%) for the moderate-risk group. More males achieved the LDL-C goals than females (55.6% vs. 48.9%; P = 0.029). Conclusions Overall, 51.1% of the patients with cardiovascular risk, on statins treatment, achieved the NCEP ATP III LDL-C goal levels.",book:{id:"7556",slug:"dyslipidemia",title:"Dyslipidemia",fullTitle:"Dyslipidemia"},signatures:"Songkwan Silaruks, Charn Sriratanasathavorn, Petch Rawdaree, Rapeephon Kunjara-Na-Ayudhaya, Bandit Thinkhamrop and Piyamitr Sritara",authors:[{id:"256769",title:"Prof.",name:"Songkwan",middleName:null,surname:"Silaruks",slug:"songkwan-silaruks",fullName:"Songkwan Silaruks"},{id:"283455",title:"Dr.",name:"Charn",middleName:null,surname:"Sriratanasathavorn",slug:"charn-sriratanasathavorn",fullName:"Charn Sriratanasathavorn"},{id:"283456",title:"Dr.",name:"Petch",middleName:null,surname:"Rawdaree",slug:"petch-rawdaree",fullName:"Petch Rawdaree"},{id:"283457",title:"Dr.",name:"Rapeephon",middleName:null,surname:"Kunjara-Na-Ayudhaya",slug:"rapeephon-kunjara-na-ayudhaya",fullName:"Rapeephon Kunjara-Na-Ayudhaya"},{id:"283458",title:"Dr.",name:"Bandit",middleName:null,surname:"Thinkhamrop",slug:"bandit-thinkhamrop",fullName:"Bandit Thinkhamrop"},{id:"283459",title:"Prof.",name:"Piyamitr",middleName:null,surname:"Sritara",slug:"piyamitr-sritara",fullName:"Piyamitr Sritara"}]},{id:"59778",title:"Epidemiology of Myocardial Infarction",slug:"epidemiology-of-myocardial-infarction",totalDownloads:4460,totalCrossrefCites:11,totalDimensionsCites:23,abstract:"Coronary heart disease (CHD) is the leading cause of morbidity and mortality throughout the world. The most common form of CHD is the myocardial infarction. It is responsible for over 15% of mortality each year, among the vast majority of people suffering from non-ST-segment elevation myocardial infarction (NSTEMI) than ST-segment elevation myocardial infarction (STEMI). The prevalence of myocardial infarction (MI) is higher in men in all age-specific groups than women. Although the incidence of MI is decreased in the industrialized nations partly because of improved health systems and implementation of effective public health strategies, nevertheless the rates are surging in the developing countries such as South Asia, parts of Latin America, and Eastern Europe. The modifiable risk factors represent over 90% of the risk for acute MI. The risk factors such as dyslipidemia, smoking, psychosocial stressors, diabetes mellitus, hypertension, obesity, alcohol consumption, physical inactivity, and a diet low in fruits and vegetables were strongly associated with acute MI.",book:{id:"6373",slug:"myocardial-infarction",title:"Myocardial Infarction",fullTitle:"Myocardial Infarction"},signatures:"Joshua Chadwick Jayaraj, Karapet Davatyan, S.S. Subramanian and Jemmi Priya",authors:[{id:"223196",title:"Dr.",name:"Joshua",middleName:null,surname:"Chadwick",slug:"joshua-chadwick",fullName:"Joshua Chadwick"},{id:"231054",title:"Dr.",name:"Karapet",middleName:null,surname:"Davatyan",slug:"karapet-davatyan",fullName:"Karapet Davatyan"},{id:"231055",title:"Ms.",name:"Jemmi",middleName:null,surname:"Priya",slug:"jemmi-priya",fullName:"Jemmi Priya"},{id:"244487",title:"Dr.",name:"S.S.",middleName:null,surname:"Subramanian",slug:"s.s.-subramanian",fullName:"S.S. Subramanian"}]},{id:"70032",title:"Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks",slug:"coronary-artery-bypass-grafting-surgical-anastomosis-tips-and-tricks",totalDownloads:1310,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"The definite feature of coronary artery disease is the focal narrowing in the vascular endothelium, and this leads to the decrease in the flow of blood to the myocardium. Atherosclerotic plaque is the main lesion. These patients can present with chest pain (angina or myocardial infarction) and need further workup noninvasively and invasively for the management. The main reasons for myocardial revascularization can be: (1) relief from symptoms of myocardial ischemia; (2) reduce the risks of future mortality; (3) to treat or prevent morbidities such as myocardial infarction, arrhythmias, or heart failure. Coronary artery bypass grafting (CABG) is the surgical technique of cardiac revascularization. In 1910, Dr. Alexis Carrel described a series of canine experiments in which he devised means to treat CAD by creating a “complementary circulation” for the diseased native coronary arteries. No clinical translation occurred at the time, but he was awarded the Nobel Prize in Medicine. Experimental refinements of coronary arterial revascularization, including the use of internal thoracic artery (ITA) grafts, were later reported by Murray and colleagues, Demikhov, and Goetz and colleagues in the 1950s and early 1960s. Dr. Rene Favaloro performed his first coronary bypass operation in May 1967 with an interposed saphenous vein graft (SVG) and shortly thereafter used aortocoronary bypasses sutured proximally to the ascending aorta. The stenosed segment is bypassed using an arterial or venous graft. Left internal thoracic artery is the most commonly used artery, and long saphenous vein is the most commonly used vein for the coronary artery grafting to reestablish the blood flow to the compromised myocardium. This can be performed with or without the help of cardiopulmonary bypass machine and also with or without arresting the heart. These techniques are called as on-pump beating or on-pump arrested and off-pump beating coronary artery bypass grafting surgery. Distal and proximal anastomoses are usually performed in an end-to-side manner, but in the case of doing sequential grafting, side-to-side anastomosis is also performed proximal to the end-to-side anastomosis. In this chapter we are going to discuss the coronary artery bypass grafting tips and tricks in details.",book:{id:"9060",slug:"the-current-perspectives-on-coronary-artery-bypass-grafting",title:"The Current Perspectives on Coronary Artery Bypass Grafting",fullTitle:"The Current Perspectives on Coronary Artery Bypass Grafting"},signatures:"Mohd. Shahbaaz Khan",authors:[{id:"278633",title:"Dr.",name:"Mohd. Shahbaaz",middleName:null,surname:"Khan",slug:"mohd.-shahbaaz-khan",fullName:"Mohd. Shahbaaz Khan"}]},{id:"53810",title:"Angiography and Endovascular Therapy for Below-the-Knee Artery Disease",slug:"angiography-and-endovascular-therapy-for-below-the-knee-artery-disease",totalDownloads:3085,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Critical limb ischemia (CLI) is growing in global prevalence and is associated with high rates of limb loss and mortality. “Endovascular-first” approach is considered to be the current standard care for symptomatic infrainguinal atherosclerotic disease. Given the facts that many CLI patients have severe comorbidities and endovascular-first approach is a common practice and may reduce the magnitude of the surgical trauma and systemic complications. In this chapter, updated angiographic approach for below-the-knee disease is described with endovascular technique.",book:{id:"5596",slug:"angiography-and-endovascular-therapy-for-peripheral-artery-disease",title:"Angiography and Endovascular Therapy for Peripheral Artery Disease",fullTitle:"Angiography and Endovascular Therapy for Peripheral Artery Disease"},signatures:"Akihiro Higashimori",authors:[{id:"195500",title:"Dr.",name:"Akihiro",middleName:null,surname:"Higashimori",slug:"akihiro-higashimori",fullName:"Akihiro Higashimori"}]}],onlineFirstChaptersFilter:{topicId:"170",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81437",title:"Pediatric Heart Transplantation",slug:"pediatric-heart-transplantation",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104518",abstract:"Despite advances in medical management, patients submitted for heart transplantation procedures still are at risk to development of complications. This chapter will discuss some specific topics of pediatric heart transplantation, focusing on perioperative care: (i) recipient management, (ii) donor evaluation, (iii) immunosuppression, (iv) early postoperative management, (v) complications, and (vi) conclusions.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Estela Azeka"},{id:"81451",title:"Donor Assessment and Management for Heart Transplantation",slug:"donor-assessment-and-management-for-heart-transplantation",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104504",abstract:"For many years, heart transplantation has been an established procedure for patients with end-stage heart failure using the so-called “Standard Criteria” for an optimal heart donor. However, annually listed patients for heart transplantation greatly increased worldwide, and the use of extended criteria donor hearts has been utilized as many as possible in many countries. In this chapter, firstly, pathophysiology of brain death is explained. Secondly, donor assessment and issues of extended criteria donors are introduced. Then, donor management to maximize the heart graft availability, and the Japanese donor assessment and evaluation system and its outcome are reviewed.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Norihide Fukushima"},{id:"81057",title:"Induction Therapy in the Current Immunosuppressive Therapy",slug:"induction-therapy-in-the-current-immunosuppressive-therapy",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.103746",abstract:"The current immunosuppressive therapy including calcineurin inhibitors, mycophenolate mofetil, and steroids, has substantially suppress rejections and improved clinical outcomes in heart transplant (HTx) recipients. Nevertheless, the management of drug-related nephrotoxicity, fatal acute cellular rejection (ACR), antibody-mediated rejection and infections remains challenging. Although previous some studies suggested that perioperative induction immunosuppressive therapy may be effective for the suppressing ACR and deterioration of renal function, increased incidence of infection and malignancy was concerned in recipients with induction immunosuppressive therapy. The international society of heart and lung transplantation (ISHLT) guidelines for the care of heart transplant recipients do not recommend routine use of induction immunosuppressive therapy, except for the patients with high risk of acute rejection or renal dysfunction, however, appropriate therapeutic regimen and indication of induction immunosuppressive therapy remains unclear in HTx recipients. We review current evidence of induction immunosuppressive therapy in HTx recipients, and discuss the appropriate therapeutic regimen and indication of induction therapy.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Takuya Watanabe, Yasumasa Tsukamoto, Hiroki Mochizuki, Masaya Shimojima, Tasuku Hada, Satsuki Fukushima, Tomoyuki Fujita and Osamu Seguchi"},{id:"80305",title:"Hepatic and Endocrine Aspects of Heart Transplantation",slug:"hepatic-and-endocrine-aspects-of-heart-transplantation",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.102418",abstract:"End-organ dysfunction is a progression that can often develop in patients with end-stage heart failure. Hepatic abnormalities in advanced systolic heart failure may affect several aspects of the liver function. Hepatic function is dependent on age, nutrition, previous hepatic diseases, and drugs. The hepatic dysfunction can have metabolic, synthetic, and vascular consequences, which strongly influence the short- and long-term results of the transplantation. In this chapter, the diagnostic and treatment modalities of the transplanted patient will be discussed. On the other hand, endocrine abnormalities, particularly thyroid dysfunction, are also frequently detected in patients on the waiting list. Endocrine supplementation during donor management after brain death is crucial. Inappropriate management of central diabetes insipidus, hyperglycemia, or adrenal insufficiency can lead to circulatory failure and graft dysfunction during procurement. Thyroid dysfunction in donors and recipients is conversely discussed.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Andrea Székely, András Szabó and Balázs Szécsi"},{id:"79970",title:"The Role of Large Impella Devices in Temporary Mechanical Circulatory Support for Patients Undergoing Heart Transplantation",slug:"the-role-of-large-impella-devices-in-temporary-mechanical-circulatory-support-for-patients-undergoin",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.101680",abstract:"Large microaxial pump systems (Impella 5.0, or Impella 5.5; i.e., Impella 5+) (Abiomed Inc., Danvers, MA, USA) have gained increasing levels of attendance as valuable tools of mechanical circulatory support (MCS). Patients undergoing heart transplantation (HTX) often need temporary MCS in the perioperative course, either as a preoperative bridge or occasionally in the early post-transplant period. Here we present our experience using Impella 5+ support for patients designated to undergo HTX, describe technical aspects of implantation and removal, and further analyze factors influencing the overall patient outcome. Significant factors are discussed in front of the background of contemporary international literature, and current scientific questions are highlighted.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Yukiharu Sugimura, Sebastian Bauer, Moritz Benjamin Immohr, Arash Mehdiani, Hug Aubin, Ralf Westenfeld, Udo Boeken, Artur Lichtenberg and Payam Akhyari"},{id:"80721",title:"Gene Therapy for Cardiac Transplantation",slug:"gene-therapy-for-cardiac-transplantation",totalDownloads:64,totalDimensionsCites:0,doi:"10.5772/intechopen.102865",abstract:"Gene therapy is an advanced treatment approach that alters the genetic composition of cells to confer therapeutic protein or RNA expression to the target organ. It has been successfully introduced into clinical practice for the treatment of various diseases. Cardiac transplantation stands to benefit from applications of gene therapy to prevent the onset of post-transplantation complications, such as primary graft dysfunction, cardiac allograft vasculopathy, and rejection. Additionally, gene therapy can be used to minimize or potentially eliminate the need for immunosuppression post-transplantation. Several animal models and delivery strategies have been developed over the years with the goal of achieving robust gene expression in the heart. However, a method for doing this has yet to be successfully translated into clinical practice. The recent advances in ex vivo perfusion for organ preservation provide potential ways to overcome several barriers to achieving gene therapy for cardiac transplantation into clinical practice. Optimizing the selection of the gene-carrying vector for gene delivery and selection of the therapeutic gene to be conferred is also crucial for being able to implement gene therapy in cardiac transplantation. Here, we discuss the history and current state of research on gene therapy for cardiac transplantation.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Michelle Mendiola Pla, Yuting Chiang, Jun-Neng Roan and Dawn E. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"
\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. Breakthroughs in computing, molecular biology, ecology, and sustainability science are enhancing our ability to utilize environmental sciences to address real-world problems. \r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.
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Dr. Summers is a systems ecologist and began his career at the EPA in 1989 and has worked in various programs and capacities. This includes leading the National Coastal Assessment in collaboration with the Office of Water which culminated in the award-winning National Coastal Condition Report series (four volumes between 2001 and 2012), and which integrates water quality, sediment quality, habitat, and biological data to assess the ecosystem condition of the United States estuaries. He was acting National Program Director for Ecology for the EPA between 2004 and 2006. He has authored approximately 150 peer-reviewed journal articles, book chapters, and reports and has received many awards for technical accomplishments from the EPA and from outside of the agency. 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Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. 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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. 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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",institutionURL:null,country:{name:"India"}}}]},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",slug:"current-topics-in-neglected-tropical-diseases",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Alfonso J. Rodriguez-Morales",hash:"61c627da05b2ace83056d11357bdf361",volumeInSeries:3,fullTitle:"Current Topics in Neglected Tropical Diseases",editors:[{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. 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In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null,series:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983"},editorialBoard:[{id:"72288",title:"Dr.",name:"Arli Aditya",middleName:null,surname:"Parikesit",slug:"arli-aditya-parikesit",fullName:"Arli Aditya Parikesit",profilePictureURL:"https://mts.intechopen.com/storage/users/72288/images/system/72288.jpg",institutionString:null,institution:{name:"Indonesia International Institute for Life Sciences",institutionURL:null,country:{name:"Indonesia"}}},{id:"40928",title:"Dr.",name:"Cesar",middleName:null,surname:"Lopez-Camarillo",slug:"cesar-lopez-camarillo",fullName:"Cesar Lopez-Camarillo",profilePictureURL:"https://mts.intechopen.com/storage/users/40928/images/3884_n.png",institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}},{id:"81926",title:"Dr.",name:"Shymaa",middleName:null,surname:"Enany",slug:"shymaa-enany",fullName:"Shymaa Enany",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRqB9QAK/Profile_Picture_1626163237970",institutionString:null,institution:{name:"Suez Canal University",institutionURL:null,country:{name:"Egypt"}}}]},onlineFirstChapters:{paginationCount:1,paginationItems:[{id:"81831",title:"Deep Network Model and Regression Analysis using OLS Method for Predicting Lung Vital Capacity",doi:"10.5772/intechopen.104737",signatures:"Harun Sümbül",slug:"deep-network-model-and-regression-analysis-using-ols-method-for-predicting-lung-vital-capacity",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Decision Science - 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Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},subseries:[{id:"14",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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