Summary of ESC and ACC/AHA guidelines for the role of BAV in managing symptomatic severe AS.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"},{slug:"intechopen-identified-as-one-of-the-most-significant-contributor-to-oa-book-growth-in-doab-20210809",title:"IntechOpen Identified as One of the Most Significant Contributors to OA Book Growth in DOAB"}]},book:{item:{type:"book",id:"29",leadTitle:null,fullTitle:"Advances in Induction and Microwave Heating of Mineral and Organic Materials",title:"Advances in Induction and Microwave Heating of Mineral and Organic Materials",subtitle:null,reviewType:"peer-reviewed",abstract:"The book offers comprehensive coverage of the broad range of scientific knowledge in the fields of advances in induction and microwave heating of mineral and organic materials. Beginning with industry application in many areas of practical application to mineral materials and ending with raw materials of agriculture origin the authors, specialists in different scientific area, present their results in the two sections: Section 1-Induction and Microwave Heating of Mineral Materials, and Section 2-Microwave Heating of Organic Materials.",isbn:null,printIsbn:"978-953-307-522-8",pdfIsbn:"978-953-51-4520-2",doi:"10.5772/562",price:159,priceEur:175,priceUsd:205,slug:"advances-in-induction-and-microwave-heating-of-mineral-and-organic-materials",numberOfPages:768,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:null,bookSignature:"Stanisław Grundas",publishedDate:"February 14th 2011",coverURL:"https://cdn.intechopen.com/books/images_new/29.jpg",numberOfDownloads:158865,numberOfWosCitations:295,numberOfCrossrefCitations:92,numberOfCrossrefCitationsByBook:9,numberOfDimensionsCitations:289,numberOfDimensionsCitationsByBook:23,hasAltmetrics:0,numberOfTotalCitations:676,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 20th 2010",dateEndSecondStepPublish:"May 18th 2010",dateEndThirdStepPublish:"September 22nd 2010",dateEndFourthStepPublish:"October 22nd 2010",dateEndFifthStepPublish:"December 21st 2010",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7,8,10",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"14397",title:"Prof.",name:"Stanisław",middleName:"Teodor",surname:"Grundas",slug:"stanislaw-grundas",fullName:"Stanisław Grundas",profilePictureURL:"https://mts.intechopen.com/storage/users/14397/images/1560_n.jpg",biography:"Prof. Stanisław Grundas was born in 1944 in Majdanek, commune of Tomaszów Lubelski, Poland. In 1971 he graduated as a Master of Engineering from the Department of Agricultural Technology of the Agricultural University in Lublin and began working at the Institute of Agrophysics, Polish Academy of Sciences in that city. In 1977 he obtained PhD, Technical Sciences, at this Department, and in 1988 the degree of DSc, Agricultural Sciences of that University. In 1994 he was granted the title of Professor of Agricultural Sciences. Since the beginning of his work he held the positions of, initially, the Deputy Head and then the Head of the Department of Physical Properties of Plant Materials at the Institute. The list of his publications amounts to a total of 250, including articles in several encyclopaedias on the cereal grain. After returning from a sabbatical at the Institute of Agrophysics, Leningrad, Russia in 1986, he developed the roentgenography of plant materials. He is a member of the AACC, and of the Committee of Agrophysics of the PAS.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Institute of Agrophysics",institutionURL:null,country:{name:"Poland"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"704",title:"Thermal Engineering",slug:"engineering-chemical-engineering-thermal-engineering"}],chapters:[{id:"13436",title:"Recent Studies on Fundamentals and Application of Microwave Processing of Materials",doi:"10.5772/13200",slug:"recent-studies-on-fundamentals-and-application-of-microwave-processing-of-materials",totalDownloads:3782,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:null,signatures:"Noboru Yoshikawa",downloadPdfUrl:"/chapter/pdf-download/13436",previewPdfUrl:"/chapter/pdf-preview/13436",authors:[{id:"14092",title:"Dr.",name:"Noboru",surname:"Yoshikawa",slug:"noboru-yoshikawa",fullName:"Noboru Yoshikawa"}],corrections:null},{id:"13437",title:"Review of Numerical Simulation of Microwave Heating Process",doi:"10.5772/13387",slug:"review-of-numerical-simulation-of-microwave-heating-process",totalDownloads:5026,totalCrossrefCites:14,totalDimensionsCites:28,hasAltmetrics:0,abstract:null,signatures:"Xiang Zhao, Liping Yan and Kama Huang",downloadPdfUrl:"/chapter/pdf-download/13437",previewPdfUrl:"/chapter/pdf-preview/13437",authors:[{id:"14582",title:"Dr.",name:"Xiang",surname:"Zhao",slug:"xiang-zhao",fullName:"Xiang Zhao"},{id:"16798",title:"Dr.",name:"Liping",surname:"Yan",slug:"liping-yan",fullName:"Liping Yan"},{id:"16799",title:"Prof.",name:"Kama",surname:"Huang",slug:"kama-huang",fullName:"Kama Huang"}],corrections:null},{id:"13438",title:"Modeling and Analysis of Induction Heating Converters",doi:"10.5772/14057",slug:"modeling-and-analysis-of-induction-heating-converters",totalDownloads:7770,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"András Kelemen and Nimród Kutasi",downloadPdfUrl:"/chapter/pdf-download/13438",previewPdfUrl:"/chapter/pdf-preview/13438",authors:[{id:"16660",title:"Dr.",name:"Andras",surname:"Kelemen",slug:"andras-kelemen",fullName:"Andras Kelemen"},{id:"16661",title:"MSc.",name:"Nimrod",surname:"Kutasi",slug:"nimrod-kutasi",fullName:"Nimrod Kutasi"}],corrections:null},{id:"13439",title:"Numerical Modelling of Industrial Induction",doi:"10.5772/13525",slug:"numerical-modelling-of-industrial-induction",totalDownloads:3907,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"A. 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\r\n\tThe UN Climate Change Conference, UK 2021, came up with the Zero-Emission Vehicles Transition Council: 2022 Action Plan, with this highlighted statement: "We have agreed that our shared aim is to make zero-emission vehicles the new normal by making them accessible, affordable, and sustainable in all regions by 2030". At face value, this statement spells doom for the internal combustion engine. Though we desire to have zero-emission vehicles as soon as possible, however, practical realities will not make this possible as quickly as we want! MOTORTREND succinctly captured this essence in its feature article, HOW GASOLINE ENGINES CAN SURVIVE IN AN ELECTRIC CAR FUTURE "Advancing technology can keep conventional engines humming for decades. Combustion engines won't completely disappear any time soon, if ever. Certain transportation tasks or operating environments simply don't lend themselves to the battery- or hydrogen-powered electric propulsion. A century and a half of research and development have greatly increased the efficiency of combustion engines, and engineers have loads of additional tricks up their sleeves that promise to extract even more work from a molecule of fuel while producing even fewer harmful emissions". Therefore, the internal combustion engine will continue to be around for decades to come. Thus, the purpose of this book will be to bring together all current research and development work on the internal combustion engine targeted at further reducing its harmful emissions, to have an environmentally sustainable world even with its use.
",isbn:"978-1-80356-909-3",printIsbn:"978-1-80356-908-6",pdfIsbn:"978-1-80356-910-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"99cc881bcb3efe05085f2728ccbeab6b",bookSignature:"Prof. Akaehomen Akii Ibhadode",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11521.jpg",keywords:"Power Losses, Lightweighting, Downsizing, New Configurations, Biofuels, Synthetic Fuels, Fossil Fuels, Other Fuels, Carbon Dioxide, Carbon Monoxide, Hydrocarbons, Particulate Matter",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 5th 2022",dateEndSecondStepPublish:"May 3rd 2022",dateEndThirdStepPublish:"July 2nd 2022",dateEndFourthStepPublish:"September 20th 2022",dateEndFifthStepPublish:"November 19th 2022",remainingDaysToSecondStep:"14 days",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Prof. Akaehomen Ibhadode is a researcher in IC engine, manufacturing engineering, and former Shell Professor of Lightweight Automobile Engine Development (2016 - 2020). He is a Fellow of the Nigerian Academy of Science, the Nigerian Society of Engineers, the Materials Science and Technology Society, and the Solar Energy Society of Nigeria. He holds four patents. He was the winner of the Nigeria Prize for Science and the winner of the Edwin Walker Prize of the Institution of Mechanical Engineers, UK.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"253342",title:"Prof.",name:"Akaehomen",middleName:"Akii",surname:"Ibhadode",slug:"akaehomen-ibhadode",fullName:"Akaehomen Ibhadode",profilePictureURL:"https://mts.intechopen.com/storage/users/253342/images/system/253342.jpg",biography:"AKII IBHADODE is a distinguished Professor of Manufacturing Engineering and former Shell Professor of Lightweight Automobile Engine Development (2016 - 2020). He was the Vice-Chancellor of the Federal University of Petroleum Resources, Nigeria from 2015 - 2020. He obtained a B.Sc. (Mechanical Engineering), University of Lagos in 1981, M.Eng. (Production Engineering), University of Benin in 1984, both in Nigeria, and a Ph.D. (Mechanical Engineering), University of Birmingham, United Kingdom in 1987. He has pioneered a number of researches leading to patents and industrial products. \n\nHe was the winner of the Nigeria Prize for Science (2010) of the Nigerian Academy of Science sponsored by the Nigerian Liquefied Natural Gas Limited, and the winner of the Edwin Walker Prize for 1988 of the Institution of Mechanical Engineers, United Kingdom. Since 2013 till date, he has mentored student teams which design and build Shell Eco-marathon Competition vehicles. He has supervised over one hundred M.Sc/Ph.D students. \n\nProf. Ibhadode is a Fellow of the Nigerian Academy of Science; Fellow of the Nigerian Society of Engineers; Fellow of the Materials Science and Technology Society of Nigeria, and Fellow of the Solar Energy Society of Nigeria, Chartered Engineer of the Council for the Regulation of Engineering in Nigeria; editor and reviewer of a number of journals among which is the International Journal of Engineering Research in Africa (JERA) published by Trans Tech Publications, Switzerland which he founded in 2009 and is the Editor-in-Chief.",institutionString:"University of Benin",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Benin",institutionURL:null,country:{name:"Nigeria"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"444312",firstName:"Sara",lastName:"Tikel",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/444312/images/20015_n.jpg",email:"sara.t@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"10198",title:"Response Surface Methodology in Engineering Science",subtitle:null,isOpenForSubmission:!1,hash:"1942bec30d40572f519327ca7a6d7aae",slug:"response-surface-methodology-in-engineering-science",bookSignature:"Palanikumar Kayaroganam",coverURL:"https://cdn.intechopen.com/books/images_new/10198.jpg",editedByType:"Edited by",editors:[{id:"321730",title:"Prof.",name:"Palanikumar",surname:"Kayaroganam",slug:"palanikumar-kayaroganam",fullName:"Palanikumar Kayaroganam"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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\nThe diagnosis and staging of AS is primarily based on symptoms and Doppler echocardiography. AS is considered severe when the patient has a mean transvalvular gradient >40 mmHg, a peak aortic jet velocity >4 m/s, an aortic valve area (AVA) <1.0 cm2, indexed aortic valve area (iAVA) <0.6 cm2/m2 and a dimensionless velocity index <0.25 [2, 3, 4].
\nHowever, in up to 40% of patients with AS, there is discordance between aortic valve area (<1 cm2 suggesting severe AS) and transvalvular gradients (<40 mmHg suggesting non-severe AS) on Doppler echocardiography [5, 6, 7]. These patients are referred to as having “low gradient” severe AS. Most of these patients have a “low flow state” across the aortic valve, which is defined as an indexed stroke volume <35 ml/m2. Many of these patients may be quite advanced in the natural history of severe AS. Despite challenges in establishing accurate diagnosis, “low gradient” severe AS patients tend to have poorer outcomes compared to patients with “high gradient” severe AS. This chapter describes the etiology, classification, diagnosis and management options of low flow low gradient (LFLG) severe AS.
\nAll major guidelines have classified aortic stenosis based on hemodynamic parameters, symptoms and the left ventricular (LV) systolic function (Figure 1). According to the American College of Cardiology/American Heart Association, severe aortic stenosis is classified into asymptomatic severe AS (stage C) and symptomatic severe AS (stage D). Asymptomatic severe AS depending on LV function is further sub classified into stage C1—with normal LV function and stage C2—with reduced LV function (left ventricular ejection fraction (LVEF) <50%). Symptomatic severe AS is sub classified into three stages depending on blood flow across the aortic valve and hemodynamic characteristics (Figure 2). Normal flow (>35 ml/m2), high gradient (>40 mmHg), severe AS (AVA <1 cm2/iAVA <0.6 cm/m2) is the most easily recognized entity with little diagnostic confusion (stage D1).
\nStage of aortic stenosis—adapted and modified from Nishimura et al. [
Subtypes of low-gradient aortic stenosis. AS, aortic stenosis; AVA, aortic valve area; LVEF, left ventricular ejection fraction; MG, mean transvalvular gradient; SVi, stroke volume index. Reproduced with permission from Clavel et al. [
Low flow low gradient (LFLG) severe aortic stenosis (stages D2 and D3) represents an advanced stage in the hemodynamic spectrum of severe AS with poor prognosis and higher surgical morbidity and mortality than normal flow high gradient severe AS [8, 9, 10, 11, 12].
\nAlthough not incorporated into guidelines some authors recognize another variant called normal flow low gradient severe AS. This is a relatively poorly defined entity with unclear pathophysiology. Apart from measurement errors, one proposed explanation is that these patients have reduced arterial compliance (stiff arteries), which leads to a faster arterial wave reflection from the periphery. The early reflection of the arterial wave at the end of systole may dampen the transvalvular gradients, independent of transvalvular flow. This phenomenon may, in part, explain the small AVA and low gradient discordance observed in patients with normal flow, low gradient severe AS.
\nThis entity is found in about 5–10% of patients with severe AS. It is more prevalent in men, and is very often associated with coronary artery disease [13]. LFLG severe AS is defined as indexed stroke volume <35 ml/m2, LVEF <50%, AVA <1.0 cm2/iAVA <0.6 cm2/m2 and mean aortic valve gradient <40 mmHg [2]. As severe AS progresses over several years, the left ventricle responds to the increase in afterload by concentric left ventricular hypertrophy. This compensatory mechanism helps the left ventricle pump against an increase in afterload as well as offset the increase in wall tension. The compensatory mechanism is reflected in the natural history of aortic stenosis where patients with severe AS who are truly asymptomatic have a relatively long symptom free period. However onset of symptoms indicates a significant turning point in the natural history with poor prognosis when left untreated (Figure 3). The average life expectancy for patients with severe AS is 2 years for those with shortness of breath, 3 years for patients with syncope, and 5 years for those with angina [16].
\n(A) Natural history as reflected by event-free survival in asymptomatic patients with AS. Initial aortic jet velocity (Vmax) stratifies patients according to the likelihood that symptoms requiring valve replacement will develop over time [
Patients who start out as normal flow high gradient severe AS eventually transform into LFLG severe AS with reduced LVEF through a number mechanisms (Figure 4). The long standing persistent left ventricular hypertrophy leads to oxygen supply demand mismatch, reduced capillary density, chronic subendocardial ischemia and interstitial fibrosis. Another important reason for LV dysfunction is coexistent coronary artery disease seen in a majority of these patients—49–76% [8, 9, 12].
\nFactors leading to transformation of high gradient severe aortic stenosis to low flow low gradient severe aortic stenosis with reduced ejection fraction.
Eventually the left ventricle fails to keep up with the high pressure gradients and decompensates due to the afterload mismatch. The LV dilates, stroke volumes drops and LVEF falls. As the flow across the stenosed aortic valve declines, the ability of the valve to open (which is flow dependent) reduces and hence the calculated aortic valve area is low. The pressure gradients across the valve are measured by modified Bernoulli’s equation (
As opposed to patients with “classic” LFLG AS with reduced LVEF, those with “paradoxical” LFLG AS have preserved LVEF. This entity is defined as an LVEF >50%, the presence of a low flow (stroke volume index <35 ml/m2), an AVA <1.0 cm2, an iAVA <0.6 cm2/m2, and a mean aortic valve gradient <40 mmHg [2, 5, 17]. LFLG pattern is seen in 5–15% of patients with severe AS and is more prevalent in women and elderly patients. These patients have excessive LV hypertrophy in response to the hemodynamic stress. As a result they have small LV cavities and hence a low stroke volumes despite the preserved LVEF. Other factors (Figure 5) that contribute to low forward flow across the aortic valve include mitral regurgitation/stenosis, tricuspid regurgitation/stenosis, atrial fibrillation and infiltrative cardiomyopathies like amyloidosis. Paradoxical LFLG AS shares clinical, pathological and hemodynamic similarities with heart failure with preserved ejection fraction. Both conditions are characterized by significant concentric left ventricular hypertrophy leading to small cavity size and restrictive physiology. In addition there is marked reduction in intrinsic LV systolic function that may not be apparent by routinely used echocardiographic indices. Global longitudinal strain is a more sensitive parameter that helps unmask the apparently normal LVEF in these patients. It is reduced to a larger extent due to fibrosis along the subendocardial layer. These findings suggest that paradoxical LFLG AS is a more advanced stage in the hemodynamic spectrum of severe AS [5, 18, 19] and classified in guidelines as stage D3.
\nFactors leading to transformation of high gradient severe aortic stenosis to paradoxical low flow low gradient severe aortic stenosis.
One of the main challenges in the diagnosis of LFLG severe AS is distinguishing it from pseudo-severe AS, i.e., moderate AS with underlying LV dysfunction, unrelated to aortic stenosis. In this case, the primary culprit is LV dysfunction; typically due to associated cardiomyopathy (ischemic or idiopathic) or myocarditis. The myopathic ventricle fails to generate adequate blood flow to open the aortic valve sufficiently, hence overestimating severity of AS on echocardiography. At the same time, the gradients across the aortic valve are low related to lower transvalvular flow. This produces a hemodynamic picture similar to LFLG severe AS. Studies have shown that in patients with pseudo-severe AS, the 5-year survival with medical therapy is better than in true severe AS and comparable with that of propensity matched patients with heart failure with reduced ejection fraction and no evidence of valve disease (Figure 6) [20].
\nKaplan-Meier survival estimates under conservative treatment among 28 patients with pseudo-severe aortic stenosis and 28 propensity-matched patients with systolic heart failure. Reproduced with permission from Fougères et al. [
Paradoxically, moderate aortic stenosis for a normal ventricle may be functionally more significant for the myopathic ventricle. Some studies have suggested that moderate AS may have a detrimental effect on outcomes in patients with coexistent LV dysfunction. This concept raises the hypothesis that aortic valve replacement (AVR) may be beneficial in such patients [21, 22]. Trans-catheter Aortic Valve Replacement to UNload the Left ventricle in patients with ADvanced heart failure (TAVR UNLOAD) trial is designed to test the above hypothesis. Patients with heart failure with reduced ejection fraction and moderate AS confirmed by resting and/or dobutamine stress echocardiography are randomized to optimized heart failure therapy alone versus optimized heart failure therapy plus transcatheter AVR.
\nTransthoracic echocardiogram is the gold standard to detect the “low flow state” across the aortic valve. Accurate Doppler echocardiographic measurements of stroke volume, AVA, and gradient are important to minimize underestimation of severe AS or an overestimation of moderate AS.
\nTypically Doppler echocardiographic assessment is operator dependent. Optimal alignment of the continuous wave Doppler beam with the direction of the aortic flow jet is crucial to accurately quantify aortic valve gradient, aortic valve area and thereby severity of AS. The apical window detects peak velocity in 40% of cases where as the right parasternal window picks up peak velocity in 50% of cases [23]. A multiwindow approach is recommended which includes apical, right parasternal, suprasternal and right supraclavicular windows.
\nThe most common technical pitfall that may lead to an erroneous diagnosis of low-flow state and overestimation of AS severity is underestimation of the left ventricular outflow tract (LVOT) diameter. The effective AVA is determined by the continuity equation method (Figure 7), which is based on the principle that the flow across the left ventricular outflow tract should be equal to the flow across the aortic valve. Since the LVOT diameter is squared in the equation, an underestimation of the LVOT diameter may lead to underestimation of valve area and thus the false conclusion that the patient has LFLG severe AS when, in fact, the patient has normal flow and/or moderate AS.
\nContinuity equation, formula to calculate aortic valve area. The LVOT is assumed to be cross sectional in area.
The 2009 European Association of Echocardiography/American Society of Echocardiography guidelines suggest measuring the diameter and velocity 5–10 mm below the aortic annulus. However, recent studies suggest measuring the LVOT diameter inner-edge-to-inner-edge from the base of the right coronary cusp anteriorly to the commissure posteriorly [24, 25]. From a practical standpoint, an easy way to measure the LVOT diameter is to assess the pulse wave Doppler signal from the distal to proximal LVOT in the apical view. The LVOT velocity time integral is then measured just below the point where aliasing is seen, when the flow signals are smooth with sharp borders. The LVOT diameter is ideally measured at this point in the parasternal long axis view (Figure 8).
\nThe pulse wave Doppler is walked from the distal to proximal LVOT. At point 3, aliasing is noted suggesting that the Doppler signal is within the turbulent aortic jet. The pulse wave Doppler is moved just distal to point 3 (at point 2) where laminar LVOT velocities are seen. The LVOT VTI is measured at this point and the LVOT diameter at this corresponding point in the parasternal long axis view.
Once technical errors in measurement are ruled out, it is essential to distinguish LFLG true severe AS from pseudo-severe AS. deFilippi et al. [26] were the first to demonstrate that low dose (up to 20 μg/kg/min) dobutamine stress echocardiography (DSE) may be used in these patients to distinguish true versus pseudo-severe stenosis. The use of DSE for this purpose has received a class IIa (level of evidence: B) recommendation in the American College of Cardiology/American Heart Association-European Society of Cardiology (ACC/AHA-ESC/EACTS) guidelines [1, 2, 3], and a similar protocol has also been used for invasive assessment in cardiac catheterization laboratory by Nishimura et al. [27].
\nDobutamine recruits myocardial contractility in normal and hibernating myocardium, thus enhancing stroke volume and transvalvular flow. This is referred to as “stroke volume reserve.” Patients with more than 20% rise in stroke volume at peak dobutamine levels are referred to as having stroke volume reserve. When the flow across the valve increases, depending on the underlying condition, one of two possibilities occurs. If the patient has true severe AS, the valve being intrinsically restricted cannot open up further. In this case the transaortic gradients will increase with little or no change in aortic valve area. On the other hand in patients with pseudo-severe AS, aortic valve area increases significantly (>0.6 cm2/m2) with little or no change in trans-aortic gradients (Figure 9).
\nIn the presence of stroke volume reserve, if the valve area remains more or less constant with increase in gradient >40 mmHg, it is suggestive of true severe AS. On the other hand, if the valve area increases with no significant change in gradients, it is suggestive of pseudo severe AS.
Though not incorporated into guidelines, in our experience, DSE can also be used in patients with LFLG severe AS with preserved LVEF. Dobutamine is able to recruit the subendocardial longitudinally oriented myocardial fibers and further increase transvalvular flow. Studies have estimated that about 30–40% of patients with LFLG severe AS may not have adequate stroke volume reserve (<20% rise in stroke volume with peak dobutamine stress) [9, 21, 26, 27, 28]. They have higher operative mortality (22–33%) than those with flow reserve (5–8%) [9]. However the presence or absence of flow reserve cannot be used to predict recovery of LV function after valve replacement and cannot be used to determine long term prognosis. The French Multicenter Study of LFLG AS reported that, in patients with no LV flow reserve who survived surgical aortic valve replacement (SAVR) had similar improvement in post-operative LVEF and late survival rate compared to patients with preserved LV flow reserve [29] (Figure 10).
\nPatients with no LV flow (contractile) reserve (Group II) defined as 20% increase in stroke volume during DSE have markedly reduced survival compared with those with LV flow reserve (Group I), regardless of the type of treatment. Aortic valve replacement is associated with dramatic improvement in survival in patients with LV flow reserve and a trend for better survival in those with no flow reserve. *
These findings suggest that DSE is useful to distinguish true severe from pseudo-severe AS and estimate operative risk. However, DES does not predict recovery of LV function, improvement in symptom status, and late survival after SAVR [9, 13, 30]. Though the absence of flow reserve portends higher perioperative mortality, DSE should only be used as a diagnostic modality. The absence of LV flow reserve should not exclude patients for AVR [9, 12].
\nDSE results maybe inconclusive in 30–40% due to inadequate stroke volume reserve [9, 13]. In this patient subset, the investigators of the TOPAS (Truly or Pseudo-Severe Aortic Stenosis) study proposed to calculate the projected effective orifice area (EOA) that would have occurred at a standardized flow rate of 250 ml/s (EOAProj) [21, 31] (Figure 11). This parameter, standardized for flow, has been shown to better predict the actual hemodynamic severity of the valve stenosis and the clinical outcome of patients with classical or paradoxical LFLG AS, as compared with standard stress echocardiography parameters [8, 21, 33]. A projected AVA <1.0 cm2 confirms the presence of true severe AS (Figure 11). Some patients may not have an adequate increase in stroke volume but nevertheless will have an increase in transvalvular flow rate due to shortening of ejection time. The phase III of the TOPAS study is currently underway and is expected to be completed by 2022.
\nDSE in a patient with low flow low gradient state across the aortic valve. Even with dobutamine the valve area is 0.81 cm2 and the mean gradient is still <40 mmHg. Due to inconclusive results, the projected effective orifice area is calculated at a normalized flow rate of 250 ml/s which is 0.84 cm2 suggesting the presence of true severe AS. Adapted with permission from Clavel et al. [
About 15–20% of patients may have inconclusive results from DSE and may not have adequate transvalvular flow rate to calculate projected effective orifice area. DSE can be used in patients with paradoxical LFLG AS; however, some patients with very small LV cavities can develop dynamic LVOT obstruction and hypotension. For such patients, an alternative method to assess aortic stenosis severity is proposed.
\nMulti detector computerized tomography (MDCT) scan without contrast can accurately quantify calcium distribution along the AV leaflets. Calcium burden along the AV leaflets has been shown to correlate with severity of aortic stenosis [34]. It is an anatomical test independent of hemodynamics, blood flow and does not require administration of contrast or any stress agents. For the quantitation of calcification, a non-contrast MDCT scan during trained end-inspiration breath-hold is performed. Radiation exposure for such an examination is <3 mSV. The amount of calcification in the region of the aortic valve is quantitated using the modified Agatston method, in which calcification is defined as four adjacent pixels with a density >130 Hounsfield Units [35]. The aortic valve calcium score measured by MDCT strongly correlates with hemodynamic severity, the progression rate, and the clinical outcomes of AS patients [34, 36, 37]. Women tend to develop less calcification for the same degree of severity of stenosis. Cut off values for valve calcification to differentiate severe versus non-severe AS in men is >2000 AU and in women >1200 AU [34, 38]. The same approach should be applied when using cutoff point for aortic valve calcium density (i.e., calcium score indexed to LVOT area): >500 AU/cm2 in men versus >300 AU/cm2 in women [34, 35, 36, 37, 38] (Figure 12).
\nQuantitation of aortic valve calcium by multi-detector computed tomography for the assessment of stenosis severity in low-gradient aortic stenosis. (A) Multi-detector computed tomography can be used to quantitate aortic valve calcification by the modified Agatston method. With this method, calcification is defined as four adjacent pixels with density 0.130 Hounsfield units. Different cut-point values of valve calcium score should be used in women (0.1200 AU) versus men (0.2000 AU) to differentiate true-severe versus pseudo-severe stenosis in low-flow, low-gradient aortic stenosis. (B) Serial multi-detector computed tomography slices at the level of the aortic valve showing a severely calcified valve with a calcium score of 5040 AU consistent with true-severe aortic stenosis. Calcified areas are displayed in yellow in the bottom images. (C) Mild calcification (score 271 AU) consistent with pseudo-severe aortic stenosis. (D) Pitfalls in the assessment of aortic valve calcification by multi-detector computed tomography. For the calculation of calcium score, it is important to only include aortic valve calcification and exclude calcification of aorta, coronary arteries, LVOT, and mitral annulus. Adapted with permission from Clavel et al. [
It is important to note that MDCT grossly underestimates valve fibrosis and hence significantly underestimates severe AS in younger patients [39]. Hence this technique may be used in older patients where the degenerative aortic valve pathology is driven by valve calcification.
\nThe advent of echocardiography revolutionized the field of cardiology providing hemodynamic data that could only be previously obtained by invasive cardiac catheterization. However echocardiographic derivations are based on some basic assumptions, which might not be reliable for all patient anatomy. Furthermore, there are limitations on subjective assessment by personnel with varying experience. Doppler measurements are dependent on the angle of insinuation of the sound waves against the jet of blood flow across the aortic valve (Figure 13). Depending on the restriction along the leaflet coaptation edges, the jet of blood through the stenosed AV, can be eccentric. This makes it almost impossible to align the continuous wave Doppler perpendicular to the jet. The peak velocity is inversely proportional to the cosine of the angle of insinuation. Even a 1° off axis tilt may reduce the peak velocity by 0.04 m/s representing an error of 1%, considering a cut off value of 4 m/s for severe aortic stenosis. When the estimated velocity is squared to calculate pressure gradient across the aortic valve, any error is exponentially increased.
\nDoppler measurements are angle dependent. For optimal values the angle of insinuation should be parallel/antiparallel (0 or 180°) to the flow of blood. As the Doppler angle increases, the measured velocities decrease, thus underestimating velocities.
Another common limitation of echocardiography is the assumption that LVOT is circular in cross section, when in fact it is circular in only 1–2% of cases (Figure 14). The LVOT is a three-dimensional (3D) dynamic structure that is often elliptical, with the antero-posterior dimension representing the smaller minor axis diameter, as compared with the generally larger diameter in the sagittal plane. Hence, 2D echocardiography may underestimate the LVOT area compared with 3D imaging modalities such as 3D echocardiography, MDCT, or cardiac magnetic resonance [40, 41, 42, 43]. To overcome the potential underestimation of the LVOT diameter and stroke volume and AVA by 2D echocardiography, the use of a hybrid approach has been suggested, where the LVOT area is measured by MDCT or 3D echocardiography and the LVOT and aortic flow velocities are measured by Doppler echocardiography [43, 44]. However, it is also important to note, the AVA value generally used to define severe AS <1.0 cm2, has been established and validated by outcome studies, where AVA was measured by standard 2D Doppler-echocardiography [2, 4]. A recent study demonstrated that the hybrid approach systematically overestimates the LVOT area and thus AVA. The best discriminative hybrid AVA to predict mortality in patients with AS under medical treatment was larger (1.2 cm2) versus the Doppler-echocardiographic AVA (1.0 cm2) [43].
\nCT showing elliptical shape of the LVOT.
Finally, it becomes difficult to obtain LVOT velocity time integral when there is associated subaortic fixed or dynamic obstruction contributing to transvalvular gradients.
\nCurrently invasive measurement is recommended only when non-invasive tests are inconclusive, the patient has poor echo windows or when there is significant discrepancy between the patient’s clinical symptoms and echocardiographic data. Figure 15 shows the steps of invasive assessment of aortic stenosis in the catheterization lab. Ideally simultaneous pressure gradients are measured by obtaining dual arterial access. Single arterial puncture may also be used for diagnosis by inserting a 7F long sheath reaching the ascending aorta from where pressure can be transduced from the side port of the long sheath. The pressure from the left ventricle should be transduced through a 5F pigtail catheter inserted into the left ventricle through the long sheath. The cardiac output is measured either by thermodilution using a Swan Ganz catheter or by Fick’s principle. Dobutamine stress can be achieved using incremental doses, infused through a venous sheath. Cardiac output, mean gradient across the aortic valve, aortic valve area and iAVA is calculated after at least 2 minutes of incremental dobutamine infusion [27].
\nInvasive assessment of low flow gradient AS in the Cathlab. Panel A shows the initial setup of the catheters. A 7F long sheath is positioned with its tip in the ascending aorta from where aortic pressures are transduced. A 5F pigtail is positioned in the LV through the long sheath to measure LV pressures. A Swan Ganz catheter is positioned in the pulmonary artery to measure cardiac output at each stage. Panel B—at baseline the patient is shown to have an indexed valve area of 0.5 cm2, with a mean gradient of 34 mmHg across the aortic valve. Panel C—with 10 μg/min of dobutamine, the trans-aortic gradients increase from 34 to 57 mmHg with no significant change in indexed valve area suggesting the presence of true severe AS.
Invasive assessment is not limited by the factors that confound echocardiographic measurement mentioned above. In the presence of serial obstruction, an end hole catheter can be positioned above and below the point of interest and pressure gradients can be reassessed. In this scenario, it is possible to determine the site that contributes maximally to gradients—either the valve or the obstruction further down in the LVOT, thus facilitating accurate diagnosis.
\nAnother advantage of invasive assessment is that the operators often perform coronary angiography prior to potentially inducing dobutamine stress. When there is no flow limiting coronary artery disease, higher doses of dobutamine (up to 40 μg/kg body weight) can be used to obtain a conclusive result. When there is associated significant coronary artery disease, high dose dobutamine (>30 μg/kg body weight) can result in a “biphasic response,” further reducing blood flow across the aortic valve, thus confounding results. This is one of the main reasons why a low dose dobutamine is recommended when doing a DSE. In the cardiac catherization laboratory however, any significant coronary artery disease can be treated percutaneously before escalating to higher doses of dobutamine to diagnose LFLG severe AS.
\nThe disadvantage of invasive assessment is the potential complications of cardiac catheterization, especially when crossing the heavily calcified aortic valve; in particular stroke. In the presence of a small aortic root, the phenomenon of “pressure recovery” may confound gradients by increasing aortic pressure and under estimating transvalvular pressure gradients.
\nThe diagnosis of LFLG severe aortic stenosis requires a systematic approach with a series of tests. Figure 16 summarizes an algorithm for assessment of low flow low gradient aortic stenosis.
\nFour-step algorithm for the diagnostic and therapeutic management of low-gradient AS. AVC ¼ aortic valve calcification; AVCd ¼ aortic valve calcification density; AVR ¼ aortic valve replacement; CMR ¼ cardiac magnetic resonance; MDCT ¼ multi-detector computed tomography; RCT ¼ randomized controlled trial; TEE ¼ transesophageal echocardiography; TTE ¼ transthoracic echocardiography. Reproduced with permission from Clavel et al. [
The importance of establishing the diagnosis of LFLG severe AS is reflected in its differing prognosis to high gradient severe AS. Not only are the outcomes with conservative management worse in LFLG AS, studies have also suggested poorer outcomes following intervention.
\nAmong the subgroups of severe AS, classical LFLG AS has the worst clinical outcome. With medical management the 2-year survival is approximately 40–60%. Thirty-day mortality of SAVR is high depending on the presence or absence of flow reserve (8–33%) [8, 9, 12, 13, 29]. However, if patients survive SAVR, there is a prognostic benefit compared to medical therapy. There is limited head to head randomized data comparing SAVR and TAVR in patients with LFLG severe AS. There are few studies that suggest that TAVR leads to better and faster LV function recovery compared to SAVR [45, 46]. It is well known that TAVR, especially with supra-annular valves leads to less patient prosthesis mismatch, which is an independent predictor of worse outcomes [46], especially in patients with reduced LV ejection fraction. In patients with no flow reserve who represent the highest risk subgroup, TAVR may have a definite survival benefit over SAVR. Thought the PARTNER I trial conclusively proved the superiority of TAVR to medical management and similar outcomes to SAVR [47], patients with no LV flow reserve as well as those with very low LVEF were excluded. More randomized studies are needed to confirm the superiority of TAVR over SAVR in patients with classical LFLG severe AS (stage D2).
\nThe heart team plays the central role in selecting the most appropriate modality of treatment, i.e., TAVR versus SAVR versus medical management (Figure 17). A comprehensive risk stratification algorithm that takes into consideration risk scores (STS), frailty indices, major organ compromise and procedure specific impediments is used by the heart team to risk stratify the patient. Ideally the risk stratification process may also take into consideration specific factors that are not mentioned in the guidelines. These include preoperative NHYA class >III, low trans-aortic gradient (<20 mmHg), absence of flow reserve and reduced global longitudinal strain. A reduced global longitudinal strain, by itself suggests high risk, independent of risk scores (STS/Euroscore) [8, 9, 12].
\nAlgorithm for the management of classical (reduced left ventricular ejection fraction) low-flow, low-gradient aortic stenosis. AoV, aortic valve; BAV, balloon aortic valvuloplasty; MDCT, multi-detector computed tomography; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement. Reproduced with permission from Clavel et al. [
Palliative balloon aortic valvuloplasty and medical management should be considered in patients with an expected life expectancy <1 year (Figure 17). In patients with classical LFLG severe AS with prohibitive and high surgical risk TAVR is recommended. In patients with intermediate surgical risk, SAVR or TAVR may be considered depending heart team evaluation; depending on other factors such as frailty, major organ compromise and procedure specific impediments (hostile chest in case of SAVR or vascular access route for TAVR).
\nPatients with paradoxical LFLG AS fare better than patients with classical LFLG AS [5, 18, 48]. The PARTNER I cohort B is the only randomized trial that reports better survival after TAVR compared to medical management [47], all other studies being observational. AVR reduces mortality by 57% in patients with paradoxical LFLG AS [49].
\nLVEF is a relatively poor and misleading parameter in assessing LV function especially in paradoxical LFLG AS. Higher degree of myocardial fibrosis documented either by cardiac magnetic resonance imaging or global longitudinal strain are independent risk factors for mortality in patients with paradoxical LFLG AS [50, 51].
\nThe role of plasma brain natriuretic peptide (BNP) in risk stratification of patients with paradoxical LFLG AS is unclear [30]. Owing to significant LV concentric remodeling and small LV cavities, the LV wall stress may even be normal, thus the extent of myocardial stretch and release of BNP may not accurately reflect the severity of impairment of myocardial structure/function in these patients.
\nA systematic heart team approach is recommended to optimize outcomes (Figure 18). Aortic valve replacement should be considered in symptomatic patients with paradoxical LFLG and true severe AS. TAVR may be superior to SAVR in patients with paradoxical LFLG AS [47]. Certain factors intrinsic to patients with paradoxical LFLG AS pose higher surgical risks compared to patients with high gradient AS. These include higher prevalence in female sex, older age, systemic hypertension, atrial fibrillation, restrictive LV physiology and smaller aortic annulus that predisposes to patient prosthesis mismatch [52, 53, 54]. TAVR was associated with better 1-year survival compared with SAVR in patients with paradoxical LFLG AS in the PARTNER-I Cohort A trial. Further studies are needed to confirm the potential superiority of TAVR versus SAVR in this subset of patients.
\nAlgorithm for the management of paradoxical (preserved left ventricular ejection fraction) low-flow, low-gradient aortic stenosis. AVAi, indexed aortic valve area; MR, mitral regurgitation; MS, mitral stenosis; TR, tricuspid regurgitation. Reproduced with permission from Clavel et al. [
In 1986, Cribier et al. [55] first described balloon aortic valvuloplasty (BAV) as a treatment strategy for patients with symptomatic severe AS presenting in cardiogenic shock, or who were deemed too high risk for conventional SAVR. Due to procedural complications, high incidence of restenosis within 6 months, lack of sustained clinical and hemodynamic benefit, BAV was not routinely performed. Furthermore, mortality rates within a year of BAV was similar to others with severe AS who were managed conservatively [56].
\nTable 1 lists the current status of BAV according to major guidelines. BAV has a class IIb recommendation for use as a bridge therapy to TAVR or SAVR in hemodynamically unstable patients at high risk for surgery. In the European guidelines (2017) BAV is recommended as a palliative measure in patients not suitable for TAVR or SAVR and in patients with symptomatic severe AS who require urgent noncardiac surgery. The American Heart Association (AHA)/American College of Cardiology (ACC) guidelines (2014) are similar to the European guidelines except they do not recommend the use of BAV as a palliative procedure nor its use in patients undergoing urgent non-cardiac surgery. However it does acknowledge that some patients report an improvement in their symptoms post BAV. The role of BAV as bridge to decision in high-risk patients has been supported by a number of studies [57]. The rationale behind such a strategy is listed below.
BAV helps to choose the best therapeutic option for each patient; avoiding expensive or high risk intervention for patients who may not have prognostic benefit from definitive treatment of AS.
BAV may be utilized to palliate symptoms and reduce operative risk while awaiting TAVR or SAVR.
BAV may be used as a diagnostic procedure especially in patients with concomitant severe pulmonary disease. The improvement in symptom status post BAV can attribute dyspnea to severe AS rather than lung disease alone.
DSE is used to assess contractile reserve in patients with severe AS. It helps in diagnosis and predicting perioperative mortality but cannot predict LV function recovery. In this subgroup of patients, LV function can be reassessed after 4–8 weeks after “diagnostic” BAV. Recovery of LV function post BAV is a good indicator of contractile reserve and predicts sustained LV function improvement post SAVR/TAVR [58].
It has been demonstrated that nearly 50% of patients with severe AS and coexistent mitral regurgitation (MR) showed a reduction in the magnitude of MR after BAV [59]. A similar reduction is also seen with pulmonary artery systolic pressure [60]. BAV therefore negates the need for multiple valve intervention and reduces the overall the risk of SAVR.
BAV may be used as a palliative procedure in patients with serious comorbidities, frailty, cognitive alteration, severe lung disease or life expectancy less than a year.
Summary of ESC and ACC/AHA guidelines for the role of BAV in managing symptomatic severe AS.
Clinicians should be mindful that patients with symptomatic severe AS may well have low flow and thereby low gradient. Occasionally symptoms may represent severity of underlying heart failure rather than the severity of AS. Established minimally invasive trans-catheter therapies, although has improved associated morbidities of SAVR for intermediate and high-risk patients, it is important that treatment is directed to those who will benefit the most. Accurate diagnosis of severe AS is important as treatment modalities and its timing can offer prognostic benefits in the immediate and long term.
\nFaeez Mohamad Ali and Vindhya Wilson—no conflict of interest.
Rajesh Nair—proctor for Medtronic.
Rabbits are raised for many different purposes, such as breeding stock for meat, wool and fur, as an educational and experimental animal model, and as pets and show animals. However, this species is used mainly for meat production. China and Mediterranean countries concentrate 78% of world production meat [1]. It must note highlighting the leadership of France, Italy and Spain in development of the rabbit selection programs, which have been key to enhance the efficiency in meat production.
The selection objectives in breeding programs are established according to the economic importance of the traits. Economic weights in rabbit meat production have been estimated in different markets, such as the Spanish [2, 3], Australian [4] and French one [5], and in all these studies, the litter size and the feed conversion rate have been reported as the most important traits for rabbit industry (see Table 1). The growth rate is easier and cheaper to record than feed conversion rate and has a favourable genetic correlation with it [6]. For this reason, rabbit commercial schemes are based on three-way cross. Two selected lines for litter size at birth or at weaning are crossed to create a commercial doe [7, 8, 9, 10, 11, 12, 13], which is mated with a terminal sire from other selected line for growth rate post-weaning or for body weight at a point close to market age [14, 15, 16, 17]. The aim of the cross between the maternal lines is to exploit advantage of the expected positive heterosis in reproductive traits, the possible complementarity among the lines and the dispersion of the inbreeding accumulated within the lines [8].
Traits | Unit | Spain | Australia | France | |
---|---|---|---|---|---|
[2] | [3] | [4] | [5]a | ||
Litter size | Increase by 1 | 16.90 | 15.66 | 15.03 | 45.52 |
Lactation survival | Increase by 1% | 1.96 | 1.71 | 1.70 | |
Replacement rate per does and year | Increase by 1% | −0.45 | −0.29 | −0.23 | |
Daily feed intake during fattening | Decrease by 1 g/d | 0.41 | 0.50 | 0.49 | |
Daily gain during fattening | Increase by 1 g/d | 1.53 | 1.33 | 1.23 | 11.82 |
Feed conversion rate during fattening | Decrease by 0.1 g/g | 18.80 | 20.19 | 10.26 | |
Resistance to enterocolitis | 4.41 |
Economic weights of the main traits of the profit function in €/unit of the trait.
Economic weights estimated in a context of restricted feeding.
Genetic progress in the selection programs depends mainly on the heritability of the selected trait and on the selection intensity. In this section, a review of quantitative genetic components for litter size and growth traits will be carried out. For litter size at birth, the estimates of the heritability show in general low values (0.05 to 0.20 and 0.11 on average) and tended to decrease slight from birth to slaughter (0.00 to 0.13 and 0.08 on average for number born alive, 0.02 to 0.12 and 0.07 on average for litter size at weaning, and 0.06 to 0.08 and 0.07 on average for litter size at slaughter, see Table 2). The estimates of the ratios of permanent environmental variance to the phenotype variance are also rather low for litter size at birth. In agreement to heritability, the estimated values decrease from birth (0.11 on average) to market time (0.08 on average). These findings are an indication of high effect of environmental influence on litter size and the low repeatability. Regarding genetic correlations between litter size traits, the estimates present positive and high values, ranging from +0.96 to +0.99 for litter size at birth and number born alive, and from +0.60 to +0.98 for number born alive and litter size at weaning [11, 24, 33].
LS | NBA | NW | NS | Line/breed | References | ||||
---|---|---|---|---|---|---|---|---|---|
h2 | p2 | h2 | p2 | h2 | p2 | h2 | p2 | ||
0.20 | 0.25 | 0.09 | 0.12 | New Zealand White | [18] | ||||
0.10 | 0.07 | 0.07 | 0.09 | 0.07 | 0.07 | 0.07 | 0.06 | Line selected by OR and LS | [19] |
0.10 | 0.09 | Environmental Variance of LS | [20] | ||||||
0.11 | 0.08 | 0.10 | 0.09 | 0.09 | 0.07 | Line A | [10, 21, 22] | ||
0.08 | 0.12 | 0.05 | 0.09 | 0.02 | 0.07 | Line H | [21, 22] | ||
0.09 | 0.10 | 0.08 | 0.08 | Line LP | [21] | ||||
0.09 | 0.11 | 0.07 | 0.13 | Line R | [21, 22] | ||||
0.18 | 0.09 | 0.07 | 0.10 | 0.05 | 0.08 | 0.05 | 0.07 | Line V | [23] |
0.13 | 0.05 | 0.05 | 0.09 | 0.02 | 0.06 | ITELV2006 line | [24] | ||
0.05 | 0.09 | Pannon White | [25] | ||||||
0.13 | 0.10 | 0.00 | 0.06 | Pooled Poured Breed | [26] | ||||
0.05 | 0.09 | 0.03 | 0.09 | Brazilian Synthetic Line | [27] | ||||
0.12 | 0.06 | 0.09 | 0.07 | Pannon Ka | [28] | ||||
0.05 | 0.11 | 0.07 | 0.11 | Pannon Large | [29] | ||||
0.07 | 0.10 | 0.07 | 0.09 | Pannon White | [30] | ||||
0.11 | 0.09 | 0.08 | 0.08 | 0.06 | 0.03 | Line Prat | [10] | ||
0.09 | 0.21 | 0.12 | 0.20 | 0.09 | 0.16 | 0.07 | 0.12 | Local line | [31] |
0.19 | 0.19 | 0.08 | 0.19 | Danish While | [32] |
Heritability (h2) and permanent effect (p2) of litter size at birth (LS), number of kits born alive (NBA), number of kits at weaning (NW) and number of rabbits at slaughter (NS).
OR: ovulation rate.
For growth traits, there are many estimates of heritability for weaning and slaughter weight (see Table 3). The average values of these estimates are moderate (0.18 for weaning weight and 0.22 for slaughter weight). However, these estimates present widely range of values (0.03 to 0.48 for weaning weight and 0.06 to 0.67 for slaughter weight); that can be related to different weaning age, from 28 days in semiintensive management to 42 days of age in extensive management, and different slaughter time, from 9 week in Spain to 13 weeks of age in Italy (see review by [46]). Contrarily, the estimates of heritability for growth rate show a narrow range (0.12 to 0.34) and moderate average value (0.22). A reduced number of studies has been carried out to analyse the genetic determination of feed conversion rate (see Table 3). The average value of heritability for feed conversion rate is similar those of growth rate (0.29), varying in a small range such as growth rate (0.22 to 0.42). The litter effect is especially important for weaning weight (0.47 on average), and in lesser extent for slaughter weight (0.28 on average), growth rate (0.19 on average) and feed conversion rate (0.12 on average). Some studies have also estimated maternal genetic effects for growth traits. Maternal heritability seems to be slightly higher for weaning weight (0.17 on average) than for slaughter weight (0.10 on average). There is only one estimation for growth rate (0.21), and no estimate has found for feed conversion rate in bibliography. In general, maternal genetic effects are much lesser important than litter effects.
WW | SW | ADG | FCR | Line/Breed | Reference | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
h2 | c2 | p2 | h2m | h2 | c2 | p2 | h2m | h2 | c2 | p2 | h2m | h2 | c2 | ||
0.41 | New Zealand White | [34] | |||||||||||||
0.06 | 0.43 | 0.13 | 0.26 | 0.19 | 0.13 | 0.22 | 0.10 | ConsoResidual line | [35] | ||||||
0.04 | 0.33 | 0.11 | 0.22 | 0.22 | 0.17 | 0.23 | 0.16 | ADGrestrict line | [35] | ||||||
0.15 | 0.27 | 0.19 | 0.14 | 0.21 | 0.10 | Line B | [36] | ||||||||
0.15 | 0.18 | 0.15 | 0.12 | 0.17 | 0.10 | Line R | [36] | ||||||||
0.03 | 0.64 | 0.07 | 0.06 | 0.38 | 0.08 | ITELV2006 line | [24] | ||||||||
0.20 | a | 0.25 | a | Pannon White | [37] | ||||||||||
0.27 | 0.14 | Pannon White | [38] | ||||||||||||
0.04 | 0.72 | 0.12 | 0.51 | 0.17 | 0.40 | Line selected by body weight at 70 d | [15] | ||||||||
0.48 | 0.25 | 0.39 | 0.11 | Brazilian Synthetic Line | [27] | ||||||||||
0.08 | 0.44 | 0.18 | 0.08 | 0.26 | 0.05 | Brazilian Synthetic Line | [27] | ||||||||
0.24 | 0.31 | 0.01 | 0.17 | 0.18 | 0.18 | 0.00 | Angora line | [39] | |||||||
0.09 | 0.35 | 0.11 | 0.13 | 0.28 | 0.05 | 0.14 | 0.27 | 0.01 | Line selected by OR and LS | [40] | |||||
0.41 | a | 0.37 | a | 0.34 | a | Line Prat | [33] | ||||||||
0.21 | 0.17 | 0.25 | 0.22 | Line Prat | [6] | ||||||||||
0.21 | 0.12 | 0.32 | 0.07 | Line Caldes | [41] | ||||||||||
0.17 | 0.32 | Danish White | [42] | ||||||||||||
0.42 | 0.18 | 0.09 | 0.27 | 0.27 | 0.21 | 0.21 | New Zealand White | [43] | |||||||
0.25 | 0.44 | 0.24 | 0.22 | 0.22 | 0.09 | 0.33 | 0.07 | AGP39 | [44] | ||||||
0.12 | 0.52 | 0.14 | 0.27 | 0.12 | 0.12 | 0.42 | 0.07 | AGP59 | [44] | ||||||
0.09 | 0.52 | 0.67 | 0.26 | 0.41 | 0.21 | 0.27 | 0.17 | Divergent lines for residual feed efficiency | [45] |
Heritability (h2), common litter effect (c2), permanent effect (p2) and genetic maternal effect (h2m) of weaning weight (WW), slaughter weight (SW), average daily gain (ADG) and feed conversion rate (FCR).
OR: ovulation rate. LS: litter size. a: effect included in the model but not display.
Regarding genetic correlations between growth traits, weight at weaning is positive and highly correlated with weight at slaughter in agreement with [24, 33], ranging from +0.61 to +0.74. Genetic correlation between growth rate and weight at slaughter is higher than at weaning (+0.56 vs. +0.31 [33, 47]). Genetic correlation between growth rate and feed conversion rate is negative and moderate (−0.4 to −0.5 [6, 35]). The bibliography is scarce and contradictory for genetic correlations between litter size traits and growth traits. There are high and negative estimates between litter size and weight at weaning (−0.85, −0.92 and −0.85 for litter size at birth, number born alive and litter size at weaning, respectively [24]) and estimates close to zero (−0.05, −0.07 and −0.25 for litter size at birth, number born alive and litter size at weaning, respectively [33]). Indeed, it was reported that increases in litter size resulted in a decrease of individual weight at weaning [48, 49]. The genetic correlations between litter size traits with weight at slaughter (+0.11, +0.03 and −0.16 for litter size at birth, number born alive and litter size at weaning, respectively [33]) and growth rate (+0.04, −0.06 and −0.16 for litter size at birth, number born alive and litter size at weaning, respectively [33]) show also values close to zero.
Selection is more complicated for litter size traits than for growth traits. This complexity is due to the fact that the litter size traits display a low heritability and only express in the does, and consequently selection intensity is lower than when both sexes express the trait [12, 50]. In order to increase the accuracy in estimates of genetic values, and therefore the progress into selection program, it is recommended considering as many individual and relative records as possible for genetic evaluation of the does and males, even though generational interval increases [51]. Selection for average daily gain from weaning to slaughtering has been used traditionally as selection criterion to improve of feed conversion rate thus far, since this trait has a moderate heritability and it is lesser affected to common litter effects than the individual weight at specific age (Table 3). Moreover, it is much easier and cheaper to measure than feed conversion rate and it has a negative favourable correlation with it [6, 35]. However, the development cheap electronic devices nowadays that enable recording of individual feed intake in this species, together moderate heritability of this trait and its moderate genetic correlation with average daily gain (−0.4 to −0.5), have challenged whether selection for average daily gain is the best way to improvement of feed efficiency, instead of direct selection (see review [46]).
Traditionally, rabbit commercial schemes have based on development of specialised lines to improve prolificacy (maternal lines) and to improve growth rate (paternal line) as it was commented in Section 2 [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]. However, the foundation and development of specialised lines is an activity with the high requirements, organisation, experience, and money needed, that not all countries can carry out. In countries where the rabbit industry has not yet reached a proper level of organisation, it may not be appropriate to select dam and sire lines for a subsequent crossbreeding program [52]. An alternative could be the development of multi-purpose lines, through simultaneous selection for litter size and growth traits [27].
In maternal lines, the most common direct criteria used in selection programs is litter size at birth or at weaning (see Table 4). Although, litter size at weaning show a lower heritability than litter size at birth (see Table 2); the majority of maternal lines are selected by litter size at weaning, since this trait reflects both the prolificacy as well as the maternal ability of the doe (Table 4). In some commercial lines, the selection criterium is weight at weaning, a trait relates to the ability of the doe for lactating and nourishing the progeny [56]. The response due to selection in these maternal lines has ranged between 0.05-0.13 kits born alive or weaned per litter and generation [8].
Name | Country | Origen | Selection criteria | Number of generations | Reference |
---|---|---|---|---|---|
INRA2066 | France | Californian & Giant Himalayan | Litter size at birth | More than 34 generations | [53] |
INRA2666 | France | INRA2066 & Line V | Litter size at weaning | Since 1999 | [54] |
INRA9077 | France | New Zealand White & Bouscat White | Litter size at birth | Since 1998 | [55] |
INRA1777 | France | INRA1077 | Litter size at birth & individual weaning weight | More than 5 generations | [56] |
Line A | Spain | New Zealand White | Litter size at weaning | More than 44 generations | [57] |
Line V | Spain | Four specialised maternal lines | Litter size at weaning | More than 39 generations | [57] |
Line H | Spain | Hyperprolific commercial does | Litter size at weaning | More than 22 generations | [57] |
Line LP | Spain | Long-lived commercial does | Litter size at weaning | More than 8 generations | [57] |
Line PRAT | Spain | A closed population with crossbred animals | Litter size at weaning | Since 1992 | [58] |
Pannon Ka | Hungary | Crossbreds & Pannon White | Number of kits born alive | Since 1999 | [59] |
APRI | Egypt | Baladi Red & Line V | Litter weight at weaning | Since 2002 | [60] |
ITELV2006 | Argelia | INRA2666 and local population | Litter size at birth and body weight at 75 days | Since 2003 | [61] |
Uruguay NZW | Uruguay | New Zealand White | Litter size at weaning | More than 5 generations | [62] |
Uruguay V | Uruguay | Line V | Litter size at weaning | More than 5 generations | [62] |
Maternal lines for meat rabbit production.
In paternal lines, in order to improve feed conversion rate as comment before, the most common direct criteria used in selection programs is postweaning daily gain from weaning to slaughtering. Other selection criteria used in paternal lines are those related to the weight at slaughter (see Table 5). Recently, residual feed intake was investigated experimentally as a direct way to improve the feed conversion rate [44, 45, 48]. The response to selection in paternal lines range between 18 and 35 g/generation for weight at slaughter and between 0.45 and 1.23 g/d generation for daily gain, with positive correlated response on adult weight and feed intake and negative correlated response on feed conversion, dressing percentage and maturity at a fixed weight [8, 48].
Name | Country | Origen | Selection criteria | Number of generations | Reference |
---|---|---|---|---|---|
Line R | Spain | Two paternal lines | Postweaning daily gain | More than 32 generations | [57] |
Line Caldes | Spain | Crossbreds | Postweaning daily gain | Since 1992 | [63] |
Italian Silver | Italy | Argenté de Champagne | Postweaning daily gain | Since 2000 | [57] |
ALEX | Egypt | Baladi Black & Line V | Postweaning daily gain | More than 7 generations | [13] |
Altex | USA | ¼ California & ¼ Giant Himalayan & ½ Flemish Giat | Individual weight at 70 days | Since 1994 | [15] |
Paternal lines for meat rabbit production.
In multi-purpose lines, both growth and reproductive traits are selected (Table 6). Thus, there are lines selected simultaneously by individual weight at slaughter and litter size traits, and by thigh muscle volume (TMV) measured on computer tomography (CT) and litter weight or average daily gain. The problem of selection by TMV is the high costs and the long generation intervals [59].
Name | Country | Origen | Selection criteria | Number of generations | Reference |
---|---|---|---|---|---|
INRA1077 | France | New Zealand White & Bouscat White | Litter size at birth & Individual weight at 63 days | More than 30 generations | [64] |
Giante de España | España | Flemish Giant & Lebrel Español | Litter weight at weaning & growth rate during fattening | Since 1984 | [65] |
Italian New Zealand White | Italy | New Zealand White | Litter size at 21 days & Individual weight at 60 days | Since 1980 | [66] |
Italian California | Italy | California | Litter size at 21 days & Individual weight at 60 days | Since 1980 | [66] |
Pannon White | Hungary | New Zealand White & California | Litter weight at 21 days & Thigh muscle volume | Since 2010 | [59] |
Pannon Terminal L | Hungary | Crossbreds & Pannon White | Postweaning daily gain & Thigh muscle volume | Since 2005 | [59] |
Moshtohor | Egypt | Sinai Gabali & Line V | Litter weight at weaning & individual weight at 56 days | Since 2006 | [13] |
Saudi-3 | Saudi Arabia | Saudi Gabali & Line V | Litter weight at weaning and weight at 84 days | Since 2000 | [13] |
Botucatu | Brazil | Norfolk line | Litter size at weaning & Postweaning daily gain | Since 1998 | [27] |
Multi-purpose line for meat rabbit production.
The oldest program for rabbit breeding and improvement is the French program that was started in 1969 by French National Institute for Agricultural Research (INRA-SAGA, Toulouse), and followed by the Spanish programs that started in 1976 for the Department of Animal Science at Universitat Politècnica de València (UPV, Valencia) and in 1992 for Rabbit Science Unit at Institute of Agrifood Research and Technology (IRTA). The INRA-SAGA has developed several maternal lines as INRA2066, INRA2666, INRA1777 and INRA9077, and a synthetic multi-purpose line as INRA1077. In Spain, the UPV and IRTA have created the maternal lines A, V, H, LP and PRAT and the paternal lines R and Caldes. Besides, University of Zaragoza has developed a multi-purpose line Gigante de España [57].
Other selection programs in rabbits have been carried out both inside and outside Europe. For example inside Europe, Kaposvár University in Hungary has developed the maternal line Pannon Ka and multi-purpose lines Pannon White and Pannon Terminal L, and two cooperative centres from Emilia-Romagna in Italy have created the paternal line Italian Silver and the multi-purpose lines Italian New Zealand White and California. Outside Europe, we can found the maternal lines APRI (at the Animal Production Research Institute in Egypt), ITEL2066 (at the Institut Technique de l’Elevage -ITELV- and at Tizi Ouzou University in Algeria), and Uruguay NZW and V (at Instituto Nacional de Investigaciones Agropecuarias of las Brujas in Uruguay), and the paternal lines ALEX (at Alexandria University in Egypt) and Altex (at Texas A&M University in USA) as well as the multi-purpose lines Moshtohor (at Benha University in Egypt), Saudi-3 (at King Saud University in Saudi Arabia) and Botucatu (at Faculdade de Medicina Veterinária e Zootecnia of Botucatu in Brazil). It must note that most of the lines developed outside Europe have had the collaboration of the UPV and INRA-SAGA. Furthermore, the rabbit farmer can also purchase in market animals from the maternal and paternal lines from several private companies, mainly French and Spanish as Eurolap Hyla, Grimaud Frères Sélection, Hycole, Hypharm, and Granja Jordán among others.
New traits are emerging as criterium selection in breeding programs, both maternal lines and parental lines. Accordingly, selection experiments have been carried out in different rabbit populations. Different strategies have been adopted for estimating the genetic progress in these experiments, as the using divergently selected lines or the using a control population. Divergent selection allows us to use each line as control of the other, but estimated response can be biased when response is no symmetry in both lines. Control population provides an unbiased estimate of response to selection since working with non-selected animals from the same population. Selection for ovulation rate, prenatal survival, longevity, feed efficiency, meat quality, uniformity in production, and resistance to Pl digestive disorders has been reviewed in this section.
Selection for ovulation rate and prenatal survival has been proposed as an indirect approach for increasing litter size since these parameters limit it. In turn, uterine capacity limits prenatal survival, thus its selection has been postulated in order to improve litter size [67]. There has been carried out one selection experiment for ovulation rate [68], two divergent selection experiment for uterine capacity (one in UPV [69] and other in INRA-SAGA [70]), and one two-step selection experiment for ovulation rate and litter size [71]. The estimated response to selection for ovulation rate using a control population was 0.21 ova per generation without any correlated response in litter size, as consequence a reduction in fetal survival [68]. The difference between the divergent lines for uterine capacity showed that selection was effective for uterine capacity and a correlated response was found in embryo survival in the experiment of UPV [72] and in fetal survival in the experiment of INRA-SAGA [70]. An asymmetric correlated response in litter size was reported after 10 generation of selection in UPV experiment using a control population; whereas increasing uterine capacity was not accompanied by a correlated response in litter size, decreasing it reduced litter size by 0.19 kits per generation because of lower embryo and fetal survival [73]. Two-stage selection by ovulation rate and litter size has successful and showed a correlated response in litter size by 0.12 kits per generation [71].
Due partially to negative correlated response to high selection for production on voluntary culling in dam, the longevity has been proposed as new selection objective in breeding programs in rabbits. In this sense, two selection experiments have been performed to improve longevity: one in the UPV and other in the INRA-SAGA. The UPV’s experiment has allowed to create the LP line. This line was founded by selecting females from commercial farms with extremely high number of parturitions (between 25 and 41 parities) and a constraint on prolificacy (from 7.5 to 11.9 young born alive) [74]. Once the LP line was constituted, the selection is being carried out by litter size at weaning and this line is currently in 17th generation. The INRA-SAGA has performed a divergent selection experiment for longevity. The selection criterium was the total number of artificial inseminations after the first parity [75]. Both experiments have showed a favourable correlated response on doe’s body reserves. However, response to longevity has been limited, due to this trait has a small heritability and the time required obtaining pertinent information is long.
Feed efficiency has been traditionally measured as feed conversion rate, i.e., the ratio between feed intake and body weight gain over a fixed range of days. More recently, residual feed intake has emerged as new trait for improving of feed efficiency. However, residual feed intake is no ease to measure, since to require using equations in order to estimate the difference between actual feed intake and expected feed intake according to the requirements for the maintenance and the growth of the animal. Several divergent selection experiments in rabbits for feed conversion rate [76] and residual feed intake [35, 45, 77] have been carried out. The divergent selection experiment of Moura et al. [76] reports a difference between lines, having the high line lower feed conversion rate than the low one at the end of the experiment. The estimated response to selection using mixed model technique was 0.6% per generation. The divergent selection experiment on residual feed intake of Larzul and de Rochambeau [45] only had one generation of selection, nothing can be said about whether selection was successful since the difference between the lines was not significant. The experiment of selection for residual feed intake between 30 and 65 d of age of Drouilhet et al. [35, 77] showed a decreasing in residual feed intake of 0.9% per generation (−39 g), and a correlated response of 0.8% (−0.20 g) in feed conversion rate after nine generations. No correlated response was found for growth rate, showing that selection acted upon reducing appetite [78, 79].
Intramuscular fat is a main meat quality factor, since affecting sensory properties and the nutritional value of the meat. A divergent selection experiment on intramuscular fat in muscle
Uniformity in production is an interesting trait for rabbit industry. Two divergent selection experiments for environmental variability have been carried out one in INRA-SAGA for homogeneity in weight at birth and other in University Miguel Hernández de Elche (UMH) for homogeneity in litter size at birth. The INRA-SAGA’s experiment showed a lower within-litter birth weight standard deviation in the Homogeneous line than in the Heterogenous line after 10 generations (7.34 g vs. 11.26 g [85]). Moreover, the Homogeneous line exhibited higher litter size at weaning and lower mortality at birth and at weaning than the Heterogeneous line. No correlated response was reported for the individual weight at birth or the standard deviation and individual weight at weaning [86]. A higher homogeneity in weight birth within litter was related to higher length and capacity of the uterine horn, thus the divergence between the lines could be at least partly due to their characteristics of the reproductive tract [87]. In the experiment of UMH, after 10 generations of selection, the environmental litter size variance was 2.7 kits2 in the Homogeneous line and 4.4 kits2 in the Heterogeneous line [88]. A low variability in litter size in the Homogeneous line was related to better adaptation to environment with less response to stress and diseases, i.e. with does more resilient [89]. Therefore, decreasing litter size variability can favour the dam’s survival in the farm. Moreover, selection for litter size variability shows a negative response correlated to litter size, i.e., a reduction in litter size variability was accompanied by a larger litter size at birth [88]. A higher litter size in the Homogeneous line was related to a higher number of implanted embryos [90], as consequence a higher embryonic development at early gestation in this line [91, 92].
A divergent selection experiment to resistance to enteropathies disorders was performed in INRA-SAGA. A binary score based on the observed signs of enteropathy during the growing period was the selection criterion. The resistance animals showed similar mortality and growth rate to those of sensitivity animals, but cumulative mortality was lower in resistant than sensitivity animals, when animals were inoculated with an enteropathogenic
Traditionally, rabbit commercial schemes have based on development of specialised lines to improve prolificacy (maternal lines) and to improve growth rate (paternal line). However, not all countries have a proper level organisation, being an alternative the development of multi-purpose lines for litter size and growth. Universities and public research centers have played a leading role in the development of these lines. Litter size and growth rate have traditionally been the selection criteria in the selection schemes for these lines. Recently, others functional traits are emerging strongly as selection criteria in breeding programs such as ovulation rate, prenatal survival, longevity, feed efficiency, meat quality, uniformity in production, and resistance to digestive disorders.
The Project AGL2017-86083-C2-2-P funding by FEDER/Ministerio de Ciencia e Innovación-Agencia Estatal de Investigación and the Project AICO/2019/169 funding by Valencia Regional Government have allow to conduct this chapter.
The authors declare no conflict of interest.
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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. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"May 15th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:27,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:48,paginationItems:[{id:"81799",title:"Cross Talk of Purinergic and Immune Signaling: Implication in Inflammatory and Pathogenic Diseases",doi:"10.5772/intechopen.104978",signatures:"Richa Rai",slug:"cross-talk-of-purinergic-and-immune-signaling-implication-in-inflammatory-and-pathogenic-diseases",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81764",title:"Involvement of the Purinergic System in Cell Death in Models of Retinopathies",doi:"10.5772/intechopen.103935",signatures:"Douglas Penaforte Cruz, Marinna Garcia Repossi and Lucianne Fragel Madeira",slug:"involvement-of-the-purinergic-system-in-cell-death-in-models-of-retinopathies",totalDownloads:2,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81756",title:"Alteration of Cytokines Level and Oxidative Stress Parameters in COVID-19",doi:"10.5772/intechopen.104950",signatures:"Marija Petrusevska, Emilija Atanasovska, Dragica Zendelovska, Aleksandar Eftimov and Katerina Spasovska",slug:"alteration-of-cytokines-level-and-oxidative-stress-parameters-in-covid-19",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"81681",title:"Immunomodulatory Effects of a M2-Conditioned Medium (PRS® CK STORM): Theory on the Possible Complex Mechanism of Action through Anti-Inflammatory Modulation of the TLR System and the Purinergic System",doi:"10.5772/intechopen.104486",signatures:"Juan Pedro Lapuente",slug:"immunomodulatory-effects-of-a-m2-conditioned-medium-prs-ck-storm-theory-on-the-possible-complex-mech",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}}]},overviewPagePublishedBooks:{paginationCount:27,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. 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Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. She has more than fifteen years of teaching and research experience. She has published more than 550 scientific publications/communications, including 15 books, 50 book chapters, 100 original research papers, 380 research communications in national and international conferences, and 12 patents. She is a member of the editorial board of five journals and acts as a reviewer for several national and international journals. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"87",type:"subseries",title:"Economics",keywords:"Globalization, Economic integration, Growth and development, International trade, Environmental development, Developed countries, Developing countries, Technical innovation, Knowledge management, Political economy analysis, Banking and financial markets",scope:"\r\n\tThe topic on Economics is designed to disseminate knowledge around broad global economic issues. Original submissions will be accepted in English for applied and theoretical articles, case studies and reviews about the specific challenges and opportunities faced by the economies and markets around the world. The authors are encouraged to apply rigorous economic analysis with significant policy implications for developed and developing countries. Examples of subjects of interest will include, but are not limited to globalization, economic integration, growth and development, international trade, environmental development, country specific comparative analysis, technical innovation and knowledge management, political economy analysis, and banking and financial markets.
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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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