Types and purposes of roadmaps, cited from Phal et al. [7, p. 16].
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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We do know today how to design and how to build near-zero-emission buildings. Even plus-energy building performance can be achieved [1] by the integration of highly energy-efficient building design, advanced energy systems and solar energy applications. Under most climate conditions in the world, the annual energy demand and energy generation in buildings can be balanced in the buildings’ annual performance, if advanced design principles and technologies are employed, and the ratio between the usable floor area and the solar roof area is not too large [2]. Technically, such performance can be achieved in newly designed, but also in retrofitted buildings. The key technologies are available and technical development is progressing to make low energy performance buildings more and more feasible in future in all climate zones worldwide.
However, although the global climate crisis is apparent, today only a tiny percentage of buildings is built as near-zero-emission buildings and the existing building stock is not performing anywhere near the required efficiency. In the European Union, at least 75% of the buildings that exist today will still exist in 2050, and only 20–25% will be built new in this period [3]. Therefore, besides the design of new buildings, the retrofit of existing buildings towards zero-emission performance and plus-energy performance is to be pursued throughout the entire building stock worldwide.
While the 2050-building stock is already existing today in the developed countries to a large extent, in other places with currently ongoing urbanisation, new buildings need to be constructed that are able to fulfil the future requirements for low-carbon performance. The low-emission goal is the same, but the starting points and boundary conditions in the various countries are significantly different [4]. Often in rapidly developing economies, where most of the construction activity takes place today, other priorities than the objective to build low-carbon buildings drive this development. Also, the governance framework and the building ordinance are not developed yet, and the local market capacities are not as advanced as necessary to build zero-carbon buildings at the current stage. For example, in many countries, the necessary testing facilities to ensure compliance with high-performance specifications for material, building systems and technical appliances do not exist today [5]. The broad implementation of zero-carbon buildings is also hindered by the available budget for energy-saving investment and other spending priorities. Nevertheless, many clients are aware today that energy prices will rise in the foreseeable future. Also, the connection between fossil fuel consumption for energy services in the building sector and climate change is well known to the clients and the other stakeholders today so that efforts towards advanced performance targets are not hindered by ignorance anymore, but clearly by other barriers.
While a single pilot project is still useful today, the challenge today lies in the implementation of the low-emission performance concepts in the building stock in the markets worldwide. However, there are surely crucial technologies, which continue to be required to be developed, designed and demonstrated in zero-energy building pilot projects in the various contexts around the world. Meanwhile, the effort to transform the global building stock is becoming more process- and policy-oriented, rather than being targeted towards the application of specific technologies and the integration of technology systems on building level. Today, the available technologies need to be rolled out for broad application.
Technically, the fundamental principles for low energy and zero-energy performance of buildings differ in the various climates. The impact of the various components of the building energy balance will result in different configurations of the physical building systems and the building energy systems depending on the local conditions.
It is also evident that some of these technical configurations while being technically feasible based on international best practice are not economically feasible today and might also overstress the local market capabilities, the skills of the workforce and economic capabilities and the willingness of the local clients to invest in low-carbon design. However, as the building sector is a significant part of all local economies today, with about 30–40% of the national energy demand in most countries, in order to advance the zero-carbon development, especially the building sector must contribute. The building sectors’ development in such contexts needs to be guided since there currently is, and there will be, significant pressure from the urbanisation and the parallel socio-economic development in the available time frame. In order to avoid login effects through unsuitable building design and the omission of required technical provisions under these conditions, the design must be prepared with appropriate foresight to achieve the intended performance if not now then at least in the long run before 2050.
In the assessment of advanced energy concepts besides these conditions of the application of key technologies in each market, also other factors of the market context need to be observed. For instance, under the usual accounting methodology to offset unavoidable emissions, such as for heating in winter or for electricity use in the night with credits for energy generation in times of availability of renewable sources, the assessment will change depending on the change of the emission factors of the delivered energy to the site. Therefore, in a context where clean electricity is supplied by the local grid, building integrated renewable energy systems can contribute less to reduce the carbon account of a building than in a context with emission-intensive energy infrastructure.
As we can assume that the energy mix will move towards a higher percentage of renewable energy sources through the transformation of the national energy infrastructure in many places, the building-related balance calculation needs to be updated regularly over time towards the intended 2050 performance. In case conventional energy sources are used for heating or domestic hot water generation, the results will show that the building’s low-carbon performance decreases if the energy consumption is not decreased at the same time, or the building-integrated renewable energy supply is not increased. In other words in situations with emission factors of 600 g/kWh in the local energy mix, 1 kWh renewable energy produced inside the building will off-set double the amount of CO2 emission from fossil energy carriers than in situations with a carbon-emission factor of 300 g/kWh.
In consequence, while it is essential to reduce the carbon emission factor of the local electricity grid as a strategy on the national and local municipality level, the zero-carbon strategy on building level must reduce the use of fossil energy carriers for building operation through energy-saving measures and in the last consequence by replacing these fossil applications with clean alternatives in the course of the buildings’ life cycle.
The feasibility of such alternatives currently rests with the ability to align the time profiles of energy demand and energy supply from alternative energy sources. As renewable sources depend on environmental processes such as wind and solar radiation, storage technologies are needed. There are three possible solutions to this problem, which differ in their demand for infrastructure and investment:
Installation of energy storage solutions as public infrastructure to buffer clean feed-in energy centrally and then to supply seamlessly back to the end-users.
Installation of energy storage applications as part of the building system to buffer available clean energy until it is used inside the building by the end-user.
To adjust the users’ demand to the available resources and to accept that not all demands can be met in the building at all times.
These three strategies can be combined in the building’s renovation roadmap. Design in a developing market might first rely on a sufficiency approach (option 3), in which the building design can support the best possible functionality and reduce discomfort, but not guarantee the complete set of performance, which could be achieved when energy would be available at all times. Then, option 1 or 2 could be installed later in the buildings’ life cycle as a more functional solution when funds and other capacities are available. Also, in the case of the more extended future where central solutions are developed (option 1), an individual approach (option 2) might only be used as an intermediate solution. In all these cases, the original building design needs to be prepared from the beginning to accommodate the necessary change.
A similar situation can be observed in many developing countries for the installation of room conditioning systems for cooling and heating. Traditionally, the building users are used to free-running conditions. In such situations, the users have to adapt to the climatic conditions in order to find comfort. At a later stage in the buildings’ life cycle, the comfort demand changes and technology becomes affordable in the given market. In consequence, the retrofit of conditioning systems becomes necessary. As we can foresee such change of demands, the retrofit should be factored into the design from the beginning. The initial design should include sufficient installation spaces in appropriate locations for the indoor and outdoor units, and airtightness of the building envelope and appropriate zoning of the interior spaces must be prepared.
A future-proof design of buildings takes the long-term goals and developments into account at the time of designing. It is not only considered what can be implemented today, but what is to be added and retrofitted in future to complete the building system in order to achieve the intended performance. Future-proof design can consider future energy retrofit measures towards the projected zero-emission performance, but also other objectives, such as barrier-free design or the extension of the floor space area in case that the occupants’ living situation is changing in the building’s lifespan.
For instance, “solarisation” of master plans is an objective of master plan development to allow for the installation of functional and economically feasible solar systems. This solarisation would include the orientation of unshaded roof areas to the south, the roof slope, the size and dimensions of roof areas so that solar systems can be fit as well as the location of the buildings in the neighbourhood in case these roofs are planned to be part of a district heating system in future [6]. Such foresight in master planning is essential for solar thermal systems and also to achieve the highest electricity harvest in case of PV installations. Hence, in order to prepare our buildings for future retrofit of solar systems, provisions need to be made. The requirements thereby depend on the context. In situations with low module prices and high energy tariffs (as in Germany), the design of PV systems is not as restricted anymore by economic constraints and therefore building design for integrated PV systems is freer than in situations with high technology prices compared to the available budget and low saving potentials due to low energy tariffs in a given market, such as in Vietnam.
Future-proof design will make provisions for installation of available technologies that are not economically feasible at the time of the first construct, due to high installation cost with the available budget or uneconomic performance due to low energy prices. In many countries and especially in the emerging economies, energy tariffs are subsided for economic and social reasons. It can be expected that subsidies are reduced and that energy rates will increase and that at a point in time in the building’s lifespan retrofit of energy-saving measures and renewable energy applications will become more feasible and convincing than they are today. An example of future-proof design is given in Figure 1.
Zero-emission-ready building design.
Future-proof design can also be made in the expectation of future technologies, such as new energy storage systems or new low-carbon fuels. As such systems move up the technology readiness levels in research and development, they will become available for installation in future.
A technology roadmap is an instrument to outline the expected future development and the boundary conditions of such development. The application of roadmaps built on the hypothesis that the future does not simply happen but can be constructed with a view towards a desirable future [7]. A roadmap helps to align short-term targets with long-term goals and directions [8]. The roadmap also helps to understand the context of technical developments better. A technology roadmap will document the current context and will draft the desired future performance. It will then develop a pathway from the current situation towards the intended future performance. In the original form, a roadmap requires a graphical representation and the time axis to depict the required steps in their sequence towards the desired state. Today, besides the graphical representation, table structures and narratives are used in the development and communication of roadmaps. Such roadmap is not static-once developed and then applied until the end of its time frame- but a roadmap design requires mechanisms for its review and continuous improvement [7].
As instruments for planning for the future and for directing the development towards the desired state, roadmaps have been used on various levels in management, economy and policy contexts. Policy roadmaps and sector roadmaps are used widely today to understand the contexts and requirements of transformation processes on the larger scale of countries or worldwide. In companies, roadmaps are used for product planning, the development of capabilities and strategic knowledge assets and to align activities between departments towards a coordinated goal. Phal et al. [7] list various types of roadmaps as given in Table 1 and their specific purposes, and obviously, roadmaps can be used for further applications.
Purpose | Description |
---|---|
Product planning | A common type of roadmap, aligning technology and product strategy, typically including more than one generation of product |
Capability planning | More suited to service-based enterprises, focusing on the insertion of technology into organisational capabilities |
Strategic planning | Includes a strategic dimension, supporting the evaluation of different opportunities or threads typically at the business level |
Long-range planning (foresight) | Typically developed at the sector or national level incorporating longer time horizons (e.g., industry, science and policy‚ foresight roadmaps) |
Knowledge and asset planning | Focus on aligning knowledge assets and knowledge management initiatives with business objectives |
Programme planning | Focuses on the implementation of strategy, to support the management of integrated R&D programmes. This type is more closely related to project planning methods (Gantt charts) |
Process planning | Supports the management of knowledge, focusing on the knowledge flows necessary to support a particular process area, such as new product development |
Integration planning | Focuses on the integration and/or evolution of technology, and how different technologies combine to form new technologies |
Types and purposes of roadmaps, cited from Phal et al. [7, p. 16].
A multilevel approach is required involving the identification of technologies and the technological context, the assessment of its compatibility and the complementary of various technologies and the integration of the technologies into the system as well as the implementation of first implementation instances to introduce new technologies and concepts into a market [9].
Often technology roadmap designs are structured with the layers such as the science layer, the technology layer, the application layer and the market layer (S-T-A-M framework) [7], each addressing one aspect of a product’s life cycle. On a higher level of technology application in the design of a governance framework, the layers social context, technology context, economic context, environmental context, political context, legal context and infrastructural factors could be used. A roadmap can be designed to fit the needs of the specific application. In this chapter, a retrofit plan for a low-emission building is to be promoted with layers along with the main components of the energy balance and the elements of the energy concept.
Rockström et al. [8] suggest a global roadmap for rapid decarbonisation. The authors remark the model-based decarbonisation strategies often fall short of capturing transformative change and the dynamics of development involving disruption, innovation and nonlinear change in human behaviour. Therefore, they suggest drafting a roadmap towards the achievement of global decarbonisation based on simple principles, such as halving the anthropogenic carbon dioxide emissions every decade. Such a goal will serve as guide rail with increasing ambition every decade to achieve the required change in steps until the long-term goal is reached.
However, the simpler the roadmap to guide policies, the lesser its use to achieve the goal in the field. We need to translate the goals on the global policy level to national goals in every country and sector goals in every sector in every country. Ultimately, these goals must be applied in every facility and case of the building sector for every existing and newly built building. Rockström et al. [8] structure their roadmap framework and suggest developing narratives in the dimensions innovation, institution, infrastructure and investment to understand the required conditions and steps in the various sectors. These narratives could be reviewed and newly aligned to the actual development in regular steps. The narratives developed in the various sectors by the sector stakeholders and experts can be used to align actors and organisations to achieve a common goal through trans-sectoral transformation.
In consequence, not only one broad roadmap is required, but countless individual roadmaps are required towards delivering the individual share to the solution. Since all these individual roadmaps are directed towards the same common goal, actions are aligned and are in the best case supportive to each other.
Benefits can be realised through an interplay of the roadmaps on the various levels. For instance, in many situations, the first movers are essential to start the required market transformation, but these first movers often face disadvantages, such as pioneering costs, reluctance in the market and the investment in early technology generations. In such situations, a roadmap on a higher level can provide security for first movers’ investment and activity [1], so that the early majority can follow, and the application is taken up by the mainstream. The long-term framework of the German feed-in tariff is an example of such support. Since the feed-in tariff was guaranteed for 20 years, investors were willing to invest in an early generation of solar photovoltaic systems, which in turn provided the market for first movers in the solar industry in Germany and later worldwide.
Figure 2 depicts the scheme of a layered integrated implementation roadmap towards zero-carbon building performance in 2050. Only the aligned interplay between the layers will allow the stakeholders on the building layer to implement near-zero-emission buildings effectively and to align their efforts towards the same goal. Formulation and communication of the specific roadmaps will allow the individual layers’ stakeholders to link into the activity of the other layers in order to contribute to transformative change together.
Schematic depiction of the layers of an integrated implementation roadmap framework towards zero-carbon building performance.
In the context of building’s design and the broader field of urban development, a more elaborate narrative of a desirable future defined by a framework of sustainable qualities and performance characteristics can be formulated. Such a narrative can then give direction for the required development and the communication and alignment of strategies.
In this sense, following the global goal, the requirements set in the Paris Agreement, it is the aim to reduce the carbon emissions of the German building stock towards 0 kg CO2 emissions till 2050. Such a time perspective provides 30 years to reduce the emission of the building stock by improving the building performance and the performance of the energy infrastructure. However, the activities towards the desired performance must be planned in order to make effective use of the given time. Long-term goal setting will provide security to the market but will also create the required pressure. It will allow all the stakeholders to plan and to start the individual transformation process and will avoid overwhelming the stakeholders by abrupt changes.
It is possible today to evaluate the performance of buildings before they are built, and the performance of different configurations of retrofit measures can be assessed for the development of a retrofit plan, for example through computational simulation studies. To calculate the future performance, the assessor has to make predictions on the development of economic parameters, such as system costs, energy tariffs and operation cost and environmental impacts, such as the composition of the energy mix and the resulting CO2 emissions.
In case a roadmap approach is applied as part of a governance framework or for performance assessment in a subsidy scheme, these predictions can be defined by the operating body to support the designers and assessors of the individual building projects. Such a definition of the evaluation context is an example, where the country-level roadmap and the building-level roadmap are interlinked. By defining and providing such context information on a higher layer with the mid-term and long-term perspective, the assessment for single building projects but also higher-layer policy interventions can be supported on the lower layers.
In this context, the German sustainable building council has issued a framework for “carbon-neutral buildings and sites” [10]. Herein, carbon accounting rules, rules for CO2 reporting and carbon management rules (or a climate protection roadmap) are provided. The framework sets current and future individual performance targets of a building or a group of buildings by assessment of the current annual carbon emissions and the target carbon emission of <0 kg CO2 emission in 2050. The target values in between are retrieved by simple linear interpolation between the current values and the targeted value, as shown in Figure 3. If the building performance remains below this line, and the retrofit roadmap is followed, the building can be labelled “carbon-neutral by 2050”.
Roadmap to the climate-neutral building stock. Reproduced from DGNB “Framework for carbon-neutral buildings and sites” [
Such a roadmap framework will allow preparing for planned future enhancement of the technical installations in the given time frame until the most ambitious target is reached. Since it sets performance targets in terms of carbon emissions, the framework is not restrictive to any technology and operation strategy.
It will allow identifying technology fields that require or allow the installation of advanced solutions immediately and to schedule the retrofit of other solutions in the building’s life cycle. For example, the client could decide to install double-glazed windows today but to schedule the installation of triple-glazed windows in the next renovation cycle in 2040 after the technical lifetime of the first set of windows. At that time, triple-glazed windows might be better available in the local market. Another example could be a building concept that relies on natural ventilation first to reduce the initial cost of construction, but that is prepared for retrofit of a controlled ventilation system with heat recovery in future when such systems are better available from local suppliers. For other technologies with long technical lifetimes, high-performance solutions should be implemented from the beginning. In any case, login effects must be avoided, so that high-performance solutions can be implemented at a later time in the building’s lifetime. Therefore, roof spaces must be designed suitable for solar collectors and shafts must be provided to run the required cables and pipes (see Figure 1). For some solutions, road-mapping also gives hints where leapfrogging of inferior technologies is required.
Architects and engineers can model the building and its future performance under the local conditions and test and develop such design variants in the computational thermal building simulation model today. In contrast to the usual application of computational simulation models, the optimisation target is first set to <0 kg CO2 emission with the anticipated boundary conditions of 2050. A building concept with the desired performance and design qualities in 2050 is developed, and the design is detailed, although not all planned systems are to be installed at the time of first construction. The design is then reduced step by step and solutions for the later retrofit towards 2050 performance are developed. The technical systems are evaluated based on their technical lifetime and the required maintenance, and replacement cycles are considered in roadmap development, thereby retrofit, and energy upgrade steps are scheduled in the period till 2050. The performance of each retrofit step is simulated and evaluated with the anticipated boundary conditions at that time.
In order to apply such a roadmap approach, the assessor will need to make predictions of the development of economic parameters, such as installation costs, energy tariffs and operation costs. The assessor will also have to make predictions on future technical development, the technical and economic lifetime of systems, as well as on the development of the market context. Parameters such as labour cost for installation and maintenance work as well as the available skills for technology installation and maintenance need to be considered. Many of these required assumptions can be provided by central bodies, such as the government, administrations, funding institutions or professional associations to support strategic road-mapping on building level towards the international climate protection goals.
Such central generation and provision of required data would reduce the individual degrees of freedom in modelling and thereby make the modelling results more comparable. The boundary conditions can be supplied from higher layer roadmaps and agreed and consolidated research results. For instance, the German Ministry of Construction has recently provided new test reference year datasets for the current climate conditions, but also for the climate in 2050 including the predicted climate change effects to be used in thermal simulation studies for future situations [11].
An example for the application of roadmaps is the “individual renovation roadmap” (individual Sanierungsfahrplan, iSFP) as it is currently introduced by the German Federal Ministry for Economic Affairs and Energy (BMWE) for the application in energy-retrofit projects in Germany [12]. In future, an iSFP will be the basis for a financial support scheme for the retrofit of building projects in Germany. Before isolated retrofit measures are planned, an individual renovation roadmap is drafted to define the intended development of the building’s functions and performance. In this way, it is possible to avoid lock-in effects and to make use of synergies in the energy system of the building. The method is explained in detail in the “Handbuch für Energieberater” [12] in relation to the existing building assessment framework in Germany.
Also, the subsidy schemes in Germany support the preparation for renewable energy retrofit. In one programme, investment grants are provided for “renewable ready” condensing boiler systems in case these systems are prepared for later renewable energy integration with prepared additional fittings for necessary piping and functions in the control system. Investment grants are paid to the investor if the renewable energy system is installed within 2 years after the installation of the heating system.
Also, the US Department of Energy has developed a “Zero Energy Ready Home” [13] building labelling system, which builds on top of the existing and forthcoming low energy building requirements and requires the client to prepare for the later retrofit of renewable energy systems. Within the scheme, the client has to demonstrate that the maximum allowable loads of the roof structure are sufficient for the installation of PV solar collectors, that the conduits run from the roof to the dedicated location of the inverter and that the inverter can be connected to the electrical panel and circuit breakers are prepared for installation.
Since in many situations, the current building practice is too remote from the intended performance, such as plus-energy performance or zero-carbon performance, a roadmap approach will be instrumental for the development of the building stock in many countries.
In summary, the following will draft the steps in the integrated and the individual renovation roadmap. The concept is illustrated in Figure 4. It is suggested to develop narratives and technical concepts for the state of the art, the goal in 2050, the situation today and of intermediate steps.
Illustration of individual renovation roadmap under the influence of the integrated implementation roadmap layers.
In the development of roadmaps for a zero-emission building in a specific context, state of the art needs to be reviewed and currently available advanced options for retrofit are to be listed. Thereby the commonly used technologies, as well as the local and international front runner technologies, need to be addressed to benchmark the current and the possible future performance.
The review of state-of-the-art technologies will inspire the designers for the design of the building today and envision the developments of potential key technologies in future. Thereby, a front-runner technology review and the review of technology development, which are currently still on the low end of the technology-readiness level scale of research projects, are very informative.
The performance goal defines the “2050” narrative and the intended performance. In the case of the DGNB roadmap to climate-neutral building stock, it is a total annual carbon-emission of 0 kg. Also, the technical configuration of the building and the boundary conditions for the calculation need to be specified in order to be useful for the building owner. The configuration able to achieve the intended performance can be determined through computational simulation. The technical description is the target for the successive retrofit.
Today’s state of the building is either in case of building retrofit projects the current condition of a building at the time of assessment or it is the state of a new building at the time of construction in case of a newly built building. This condition is documented as the starting point for roadmap development.
In order to design a “climate-neutral by 2050“ building, it is advisable to determine the 2050-configuration first and then to subtract the elements until construction is technically and economically feasible at the current time. The subtraction of elements can be due to financial constraints, or due to technical availability or market maturity or also due to changing demand. Obviously, it is not possible to predict the future precisely, but the road-mapping approach will help to avoid login effects and allow for the design of future-proof buildings.
The intermediate steps are defined by the current state and the intended state in 2050. In the method introduced earlier, these intermediate steps are determined by subtraction components from the high-performance configuration. In this process, the technical lifespans of the building components and service systems are considered. For example, double-glazed windows installed in 2020 are exchanged for triple-glazed windows at the end of their lifespan in 2040 to achieve the intended performance in 2050.
The chapter has introduced the concept of future-proof design and integrated implementation roadmaps towards the step-by-step achievement of zero-carbon performance in 2050. The application of these concepts has been discussed on the level of governance and the level of single building projects as tools for goal setting and strategic development of future-proof building designs. While on building level, components of the building and energy concepts are addressed in a renovation roadmap; on the higher international, national, municipal and building sector layers, support schemes for research, technology development, capacity building and financial support are introduced in an implementation framework towards zero-carbon building performance. Especially for rapid construction activity in developing countries but also the existing building stock in developed countries, the future-proof design approach, supported by tools such as the DGNB framework for climate-neutral building stock or the individual renovation roadmap (iSFP), can be instrumental in overcoming inherent individual market barriers.
The pleura is composed of two sections: the mesothelium, a single layer of flattened cells, and a deeper sub-mesothelial layer formed by a matrix of collagen, elastic fibres, lymphatic and blood vessels.
Primary pleural tumours may originate from any of the pleural components.
Out of all the pleural neoplasms, 90% are malignant mesotheliomas, 5% are solitary fibrous pleural tumours (SFPT) and the remaining 5% consists of less frequent variants (Table 1) [1].
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Classification—rare pleural tumours.
Solitary fibrous tumours of the pleura originate from one of the components of the sub-mesothelial connective layer; therefore, its origin is mesenchymal. It usually presents as a well-circumscribed mass of occasional finding at chest X-rays performed for other reasons, since it presents asymptomatically.
SFTPs are the most common non-mesothelial primary pleural neoplasms, but still remain relatively rare. In fact, to date, <2000 cases have been reported in the literature [2]. They originate most frequently from the visceral pleura and have a benign course; only in a small percentage of cases (10–15%) their behaviour is malignant, presenting a de-differentiated pattern, aggressive clinical behaviour (invasion of adjacent organs or cardiac compression due to its huge mass) and a trend to relapse after several years, therefore requiring long-term follow-up.
Although surgery is the main approach to treating SFTPs, local and distant recurrences may be observed after a complete resection [3, 4].
In this chapter we will discuss the characteristics of the disease reported in the literature with respect to its clinical presentation, diagnosis and treatment; also, we will present the results of patients who underwent surgery for SFTP in our Department from 1989 to 2019.
Lieutaud was the first to report a tumour of pleural origin in 1767 but the first report of what was thought to be a SFTP dates back to 1870 in the work of Wagner [5].
In 1931, Klemper and Rabin [6] provided the first pathological distinction for pleural tumours classifying them into diffuse and localised mesotheliomas. They assumed a sub-mesothelial mesenchymal origin for the localised type.
Eleven years later, Stout and Murray [7] described the typical histological feature of the fibrous tumour of the pleura, the so-called patternless pattern, initially thought to be a vascular neoplasm related to smooth muscle perivascular cells (pericytes), therefore naming it hemangiopericytoma.
Since its pathological features were first described, the nomenclature has become confused, and the disease has also been referred to as localised mesotheliomas, localised fibrous tumours, fibrous mesotheliomas, or pleural fibromas.
The introduction of electron microscope and immunohistochemistry clarified the hypothesis that SFTP does not originate from the mesothelial layer but from the sub-mesothelial, undifferentiated mesenchymal layer [8, 9].
SFTP is now recognised as occurring anywhere in the body, including soft tissue and viscera, albeit with a peculiar predilection for body cavity sites, including pleura, peritoneum, and meninges.
In recent studies, SFTPs distribution is as follows: 30% in the thoracic cavity (pleura, lungs and mediastinum); 30% in the peritoneal cavity, in the retroperitoneum or pelvis. When SFTP arise in the abdominal cavity it is mainly localised in the retroperitoneum followed by the pelvic soft tissue [10].
Nearly 20% of SFTPs are found in the head-neck district (including meninges). The remaining diseases develop in soft tissue of the trunk and extremities [11].
Data on presentation, clinical features and natural history of SFTPs are almost exclusively derived from retrospective series and case reports.
Since the discovery of SFTP, there has been some confusion in the classification by body site (pleural vs. extra-pleural), the histology (SFTP vs. hemangiopericytoma) and changes in diagnostic terminology has resulted in a fragmented and unsystematic approach to this uncommon neoplasm.
Robinson and Chmielecki’s [12, 13] recent discovery of a common driver mutation for pleural and extra-thoracic SFTPs in 2013 drastically changed our understanding of SFTP pathogenesis and led to new opportunities for diagnosis, characterisation and treatment.
Usually, the SFTP is discovered in asymptomatic middle-aged adults (occasionally in children) and affects men and women equally. It is more common in the fifth and sixth decades of life. Some authors have reported that the tumour shows a slight predilection for women [2, 4, 14, 15].
It seems not to be associated with exposure to asbestos fibres exposure or tobacco smoke [16, 17].
Although the majority of SFTP are benign, it is reported that nearly 10–20% are malignant or show a malignant behaviour [18, 19].
Histologically, malignant tumours are classified according to England et al. [18] criteria:
mitotic count with more than four mitosis/10 high power fields (HPF) (×400)
presence of necrosis
hyper cellularity as judged by nuclear crowding and overlapping
presence of nuclear atypia
Mostly, patients are asymptomatic, but when they present symptoms, these usually include cough, chest pain, dyspnoea due to pleural effusion or the mass effect of the tumour. Haemoptysis and obstructive pneumonia may be observed as a result of airway obstruction. Chest pain has been reported more commonly with tumours arising from the parietal pleura.
A higher incidence of symptoms is also described in malignant variants [20], with a large variability of presentation varying from 43 to 73% [2, 14]; only few cases have been reported associated to paraneoplastic syndromes: 3% with hypertrophic pulmonary osteoarthropathy (HPO) and 2% with Doege-Potter syndrome [2].
Hypertrophic pulmonary osteoarthropathy (HPO) describes a rheumatoid like disease of the bones and joints. The symptoms include clubbing of the fingers and toes, stiffness of the joints, oedema over the ankles and occasionally the hands, arthralgia, and pain along the surfaces of the long bones, especially the tibia [20].
Finger pressure on the surface of the tibia can elicit pain before the onset of any radiographic evidence of SFTP.
When clubbing and HPO are attributed to a paraneoplastic syndrome, this is referred to as the Pierre Marie-Bamberger syndrome since they first described the symptoms in 1890 [21, 22].
This is reported in up to 20% of patients and it is more commonly associated with large tumours (>7 cm) [20].
Some authors have reported that these clinical features usually resolve within 2–5 months (or sometimes longer) after radical surgery and may reappear if the tumour relapses [3, 15, 18].
It is believed that local production of growth factors including PDGF and VEGF is implicated in the pathophysiology of HPO. In support of this, in a recent study the administration of zoledronate resulted in bone pain remission [23].
In another study, Hojo et al. suggested the abnormal production of hepatocyte growth factor as responsible for digital clubbing [24].
The association between hypoglycaemia and a mesenchymal tumour has been reported for the first time in 1930 by Doege and Potter. This is present in <5% of patients affected by SFTP [25, 26].
Hypoglycaemia is equally distributed between benign and malignant SFTs albeit it occurs mostly in large peritoneal/pleural tumours [27].
Symptoms of hypoglycaemia include convulsions, syncope and coma and potentially death resulting from severe hypoglycaemia, if not corrected promptly.
Hypoglycaemia seems to be caused by an excessive production and secretion of a partially processed, high molecular weight form of insulin-like growth factor 2 (IGF-2) by the tumour [28]. The aberrant production of IGF-2 by the neoplasm is also the cause of refractory hypoglycaemia suppressing compensatory mechanism as gluconeogenesis in the liver and lipolysis in adipose tissue.
The paraneoplastic syndrome is generally cured after tumour’s resection, with the return to normal levels of insulin within a few days after the operation [29].
Generally, SFTPs are an occasional finding in chest X-ray performed for other reasons.
They appear as a solid, sharply marginated, well-circumscribed solitary lesion originating from the periphery of the chest or from a lung fissure. It may grow to remarkable dimensions, at times occupying the entirety of the hemithorax. It is very difficult, if not impossible, to distinguish them from other masses of the lung by means of a plain chest X-ray (Figure 1).
Chest X-ray lateral view of a large SFTP located in the right hemithorax.
In particular, in neoplasms that reach a considerable size, areas of necrosis, haemorrhage and cystic or myxoid degeneration may be evident.
A pathognomonic radiological feature of pedunculated forms of SFTP originating from the visceral pleura is a change in shape and location of the mass during breathing or repositioning of the patient [30].
At the computed tomography (CT) scan, SFTPs appear as a single lesion with well-defined margins arising from the chest wall (parietal pleura) or within a lung fissure (visceral pleura). They may grow up to reach remarkable dimensions, at times occupying the entire hemithorax and giving respiratory issues.
Distinctively, SFTP presents with its maximum diameter abutting the chest-wall. The lesion usually forms right or acute angles with a smooth tapering margin with the chest-wall (Figure 2).
Preoperative CT scan of a large SFTP in the right hemithorax.
Tumours arising in an interlobar fissure may be more difficult to differentiate from an intraparenchymal mass since they are surrounded by lung parenchyma.
A pathognomonic finding in pedunculated lesions is the mobility of the tumour with changes in patient position. However, this data is conditioned by the size of the tumour: the larger the tumour, the less mobile it is due to the greater number of adhesions it contracts with the surrounding tissues. It is important to evaluate the relationships with the surrounding tissues as SFTP usually presents with well-defined cleavage plans.
Another distinctive aspect of the fibrous tumour is its enhancement at the CT scan. Nearly 90% of lesions appear heterogeneous after administration of contrast, and in 75% of these a typical pattern may be recognised. Among these, the “geographic” one is the most represented. Small neoplasms tend to appear as sharp marginated masses with smooth margins, forming right or obtuse angles with the chest wall. Attenuation is homogeneous and similar to the adjacent musculature. This is a helpful feature to differentiate SFTPs from fatty lesions or saccular fluid collections. In regards to voluminous ones, they present as sharply marginated lesions with lobulated margins, creating acute angles with the chest wall. The contrast-enhanced CT evidences high attenuation of the mass due to its muscle fibres rich vascularisation, mainly and heterogeneous enhancement pattern (“geographic” the most common) with areas of necrosis, haemorrhages or cystic degeneration.
Absence of lymph nodal involvement and preservation of cleavage planes with adjacent structures provides evidence in support of the lesions’ benign nature. For this reason, the presence of regional lymphadenopathy is suggestive of an alternative diagnosis.
CT therefore proves to be a very reliable imaging exam, especially when integrated with clinical and biopsy findings [30].
Magnetic resonance imaging (MRI) plays a limited role in the assessment of pleural disease. This exam proved to be superior to CT in studying the morphology and its relationship with the mediastinum, large vessels and diaphragm.
It is helpful in differentiating the tumour from other structures and in confirming intrathoracic localisation when the tumour abuts the diaphragm. Unfortunately, MRI patterns are quite variable in both benign and malignant SFTP [30].
The role of F-18 fluoro-deoxy-glucose positron emission tomography (FDG-PET) in diagnosis of SFTP is limited and, to date, this exam is not able to discriminate between SFTP benign and malignant forms. However, it is reported its ability to identify areas of malignant transformation highlighting a focal increase of FDG uptake (SUVmax ≥ 3.0) within a large, otherwise benign appearing SFTP.
So, it would appear that PET scan could be useful to predict a clinically aggressive behaviour of SFTP identifying areas of malignant histology within benign SFTP [31, 32].
The role of ultrasound (US) in the diagnosis of SFTP is limited. These tumours, at US appear as homogeneous and hypoechoic masses, manifesting respiratory movement along-with the chest wall.
US could be useful to define the origin, thoracic vs. abdominal, of tumours which originate in close proximity with the diaphragm.
In conclusion, we can assume that it is difficult to differentiate between benign vs. malignant SFTPs based on specific radiological signs alone, albeit some radiological features are more commonly associated with malignancy (large size, central necrosis and the presence of a pleural effusion).
It is important to underline the difficulty of making a diagnosis of certainty of SFTP with the sole aid of radiological imaging, for example, as described in a case report in which a giant ectopic pleural thymoma was pre-operatively diagnosed as an SFTP due to its radiological and clinical characteristics [33].
SFTP is an uncommon mesenchymal tumour, characterised by typical clinical presentation and variable biological behaviour.
It was first described arising from the pleura, but similar tumours can occur in the lung, in the mediastinum (in particular in the anterior one) and in other extra-thoracic sites.
The distinctive macroscopic and histological features overlap with many other soft tissue tumours, so over the years it has been given different and very heterogeneous names such as benign mesothelioma, localised mesothelioma, solitary fibrous mesothelioma or the most famous name of hemangiopericytoma [7].
In the last decades, advances in histological, molecular and genetic research studies led to the discovery of more reliable methods of differentiating this tumour, bringing all these lesions together under the name of SFTP.
A preoperative diagnosis is usually preferable and obtained by means of a biopsy. In order to obtain as much tissue as possible for diagnosis, a radiologic guided core needle biopsy or an open incisional biopsy by an experienced surgeon is recommended [34].
The tumour mass is usually solitary but may also be multiple. Typically, it is well circumscribed, solid in appearance and greyish in colour, often pedunculate and with variable dimensions (often larger than 10 cm). Cystic, haemorrhagic, necrotic and calcified areas can be found.
SFTP typically displays a uniform spindle cell morphology, variable cellularity—without a specific growth pattern—a marked stromal hyalinisation and branching vascular pattern. The vascular pattern is characteristic and the vessels of different numbers and sizes are so-called “staghorn” and are very similar to those described for hemangiopericytoma [35].
The cells are characterised by having a tapered nucleus and a scarce and pale cytoplasm, the nuclear atypia is often minimal. Focally, a storiform or fascicular growth pattern could be present. The stroma could rarely be myxoid. Usually, <3 mitoses can be counted for 2 mm2, and the count of four mitoses per 2 mm2 seems to correlate with greater aggressiveness. Necrosis is infrequent, but when present is associated with poorer prognosis (Figure 3).
Histologic features of SFTP. Morphological appearance of SFTP: typical spindle cell proliferation with low cytologic atypia (haematoxylin-eosin stain).
Most lesions are positive for CD34 antigens but nevertheless this positivity lacks specificity in a conclusive way. Also, CD99 and Bcl2 positivity are not specific and therefore of little help. The most specific marker (>95% of cases), recently described, is STAT-6 [36] and in particular its strong and widespread nuclear reactivity (Figure 4). Since some de-differentiated liposarcomas can also express STAT-6, they should be kept in mind into differential diagnosis [37].
Histologic features of SFTP. Immunohistochemical nuclear stain for STAT6 (IHC stain).
Some cases may be positive for smooth muscle actin and others for EMA (epithelial membrane agent), pancytokeratin, S100 or desmin.
SFTP should be differentiated from synovial sarcoma, sarcomatoid mesothelioma, tumours of the nerve sheaths or type A Thymoma. The correct immunohistochemical reactions are necessary for a correct classification.
SFTP harbours the gene fusion NAB2-STAT-6, which results from the intra-chromosomal inversion inv(12)(q13q13), which causes the over-expression of the protein STAT-6, found through the use of the specific antibody for the immunohistochemical reaction [12]. The over expression of IGF-2 found in some cases seems to be due to the loss of IGF-2 imprinting [38].
Telomerase reverse transcriptase (TERT) promoter mutations have been seen in 28% of SFT and are associated with high-risk pathologic characteristics and outcomes [39].
The diagnosis of certainty of a SFTP is based on the histological examination of the specimen.
Usually, the first diagnostic step is a chest X-ray, performed for a different reason. The subsequent diagnostic procedure to further investigate the chest X-ray findings is a chest CT scan with contrast, which provides valuable information and orients the diagnosis towards a SFTP. As previously mentioned, this includes size and location of the tumour, the pleural origin or the presence of a stalk, areas of heterogeneity in larger lesions, an expression of the rich vascular network or intralesional haemorrhage or necrosis. These features also include the angle between the lesion and the thoracic wall which is useful when distinguishing between a pleural and a parenchymal lesion.
Larger tumours or tumours arising from the mediastinal pleura may be indistinguishable from mediastinal masses. In this case, the MRI scan is superior to the CT scan in studying the morphology and the relationship of the tumour with the mediastinum, large vessels and diaphragm. The MRI is also helpful in differentiating the tumour from other structures and better understanding margins and cleavages.
Fine needle aspiration biopsy (FNAB) is unreliable for providing a definitive diagnosis, which is mostly based on histological characteristics, as it provides insufficient tissue quantity [19], whereas a Tru-cut biopsy is more reliable. Weynand et al. reported a 100% diagnostic accuracy in determining a SFTP, using a transthoracic cutting needle [40].
A complete surgical resection is the mainstay of the treatment of both benign and malignant SFTPs, the absence of neoplastic residual (R0) being the main prognostic factor [41].
Due to the anatomical localisation and involvement, an anatomical resection (lobectomy, bi-lobectomy or a pneumonectomy) is seldom necessary, since offers no advantages over wedge resections, for which a free margin on healthy tissue of at least 1–2 cm is recommended. In order to guarantee an adequate free margin from disease, a frozen section analysis is sometimes very useful [29]. SFTPs may occasionally require a lobectomy or a pneumonectomy when the lesion is not pedunculated but the base of implant is broad and sessile, or in case of an “inverted” tumour which grows inside the lung parenchyma.
When the tumour originates from the parietal pleura and adheres or invades the chest wall an extra-pleural dissection and a chest wall resection may be necessary [42].
Either a standard open thoracotomy or a video-assisted thoracic surgery (VATS) approach is valuable for the removal of an SFTP.
The standard open approach (posterolateral/anterolateral thoracotomy) is mandatory for patients with large tumours, multiple synchronous lesions or with obvious malignant tumours, while the VATS approach is feasible in small (up to 5.0 cm) lesions.
In case a VATS approach is preferred, it is necessary to avoid tumour dissemination using an endoscopic bag during the removal of the specimen, since contact metastases have been reported at the site of tumour extraction.
It is important to emphasise that the resection must be microscopically complete, in order to prevent late recurrence. Relapse of a benign SFTP lesion may, in fact, result in the development of a more aggressive or malignant tumour [43].
The role of adjuvant therapy in SFTP is quite limited and has not really been explored, but occasional clinical series have been reported. Suter et al. [3] studied one alive patient with no recurrence for more than 20 years after subtotal resection of the tumour followed by radiotherapy, while, Veronesi et al. [44] report the significant reduction of a recurrent fibrous tumour, not eligible for surgery, after chemotherapy with Ifosfamide and Adriamycin.
As reported in a review [45], the overall survival of patients affected by a benign pedunculated SFTP is close to 100%. The percentage is reduced to about 92% in case of benign sessile tumour and lower in case of malignant pedunculated (85%) and malignant sessile tumour (37%). In a multicentre study, a clinicopathological staging system was presented in order to predict the clinical course or recurrences [46] with the recurrence rate distributed as reported in (Table 2).
Pathologically benign, pedunculated Pathologically benign, sessile Malignant pathology, pedunculated Malignant pathology, sessile | Stage 0 Stage I Stage II Stage III | 2% recurrence 8% recurrence 14% recurrence 63% recurrence |
De Perrot staging system.
Boddaert et al. [47] in their meta-analysis including over 700 patients reported a higher recurrence rate in patients with malignant histology (England’s criteria), sessile morphology and incomplete resection.
Despite a recurrence after a total resection is an uncommon event, recurrences are also reported after many years, especially subsequently an incomplete resection or excision of a malignant sessile SFTP.
The most important prognostic factor seems to be a disease-free resection margin (R0); in support of this statement, Van Houdt and colleagues [46] in their series of 81 patients reported that a positive resection margin after surgery with curative intent, was correlated with local recurrence. They also reported that a high mitotic rate and tumour size >10 cm are correlated with the development of metastasis.
Recurrences may be fatal due to mediastinal invasion and superior vena cava obstruction.
In case of relapse, the primary attempt should be surgical excision, if technically and oncologically feasible, for both benign and malignant tumours.
Most recurrences occur within 24 months from surgery and are localised in the pleural cavity while distant metastasis seems to be a late event [45]. For these reasons a long-term follow-up, more than 15 years is recommended [45].
In conclusion, despite the fact that SFTPs are considered benign tumours, they may express an aggressive behaviour which leads the tumour to relapse.
The University Unit of Thoracic Surgery of San Luigi Hospital deals with the diagnosis, treatment and follow-up of a wide range of diseases of the lung, trachea and bronchi, mediastinum and chest wall, with a specific commitment to oncological procedures by means of open and minimally invasive approaches (VATS).
Patients are referred to our Department from the outpatient clinic and through a multidisciplinary team meeting (MDT) held weekly. The present study describes a series of 64 consecutive cases, surgically treated at our Department during a 30-year period.
This is a single-centre retrospective analysis on prospectively collected data of patients operated on for a SFTP between December 1989 and March 2019 in our Unit of Thoracic Surgery. Data was retrieved form our surgical database and variables for each patient included: gender; age at operation; symptoms; smoking history; asbestos exposure; preoperative diagnosis; CT scan; PET scan (since 2003); bronchoscopy; preoperative diagnosis; tumour origin (visceral or parietal pleura) and side (right vs. left); tumour characteristics (implant on pleura—pedunculated vs. sessile—intrapulmonary growth; size); presence of associated paraneoplastic syndromes; comorbidities (Charlson Comorbidity Index); type of resection; postoperative complications; tumour histological characteristics (Ki67%; necrosis; mitotic count).
Surgical inclusion criteria included tumour resectability, no evidences of metastases or other tumours, a good performance status (PS < 3). All patients underwent a CT scan and a preoperative bronchoscopy was performed in case of voluminous tumours. Preoperative diagnosis was attempted by means of a fine needle aspiration biopsy (FNAB) in all patients.
Postoperatively, all patients had a chest X-ray performed in post day one and after chest drain removal. Chest drains were removed when there was no air-leak detected and <250 ml of pleural fluid drained in 24/hour (Figure 5).
Postoperative chest X-ray after radical excision of voluminous SFTP in the right hemithorax.
Patients’ follow-up was updated by contacting all those patients known to be alive at the time of their most recent outpatient clinic attendance. Information of patients lost at follow-up was retrieved through the General Register Office. The follow-up ended on the 1 March 2019.
A total of 64 patients were operated on for a SFTP. Twenty-eight patients were males (43.7%) and 36 females (56.3%). Mean age at surgery was 61.7 years (range 35–83 years). Thirty-one (48.4%) patients were smokers or had a history of smoking.
Thirteen patients (20.3%) were symptomatic at diagnosis with predominant symptoms being cough and chest pain. No patients reported a history of asbestos exposure (Table 3).
Age (mean, year) | 61.7 |
Sex | |
Male Female | 28 (43.7%) 36 (56.3%) |
Presenting symptoms | |
Cough Chest pain Fever Dyspnoea Weight loss Hypoglycaemia | 3 3 1 1 1 2 |
Smokers | 31 (48.4%) |
Charlson comorbidity index | |
CCI = 0 CCI = 1 CCI = 2 CCI = 3 CCI = 4 | 43 12 7 1 1 |
Patient characteristics.
All patients underwent chest X-rays and CT scans of the chest. Positron emission tomography was performed in 12 cases (18.8%).
Fifty tumours (78.1%) were based on the visceral pleura and 14 (21.9%) arose from the parietal pleura. Thirty-five tumours (54.9%) were pedunculated while 29 (45.3%) were broad based. Among tumours arising from visceral pleura, five (7.8%) showed a prevalent intrapulmonary growth (“inverted fibroma”).
The tumour was right-sided in 30 patients (46.8%) and left-side in 34 (53.2%). The lesions had a median diameter of 60 mm, the smallest tumour was 10 mm at maximum diameter and the largest was 380 mm (interquartile range: IQR-40–130 mm) (Figure 6).
Surgical specimen after a radical excision of voluminous SFTPs located in the right hemithorax.
The Charlson comorbidity index (CCI) is reported for all patients in Table 3.
Local excision of the pleural tumour was accomplished in 57 patients (89%). In two (3.1%) cases a wedge resection was performed and in seven patients (10.9%) an anatomical resection was required (three lobectomies, one pneumonectomy and one segmentectomy).
Resection of the SFTP was performed through a thoracotomy in 51 cases (79.7%); VATS in nine cases (14.1%), and sternotomy in four cases (6.2%).
Histologically free margins were obtained in 63 cases (R0 residual disease). No patient was administered a neo-adjuvant or an adjuvant treatment.
Major postoperative complications included two atrial fibrillations, both treated with amiodarone, severe anaemia (two patients) with requirement of blood transfusions, one acute respiratory failure. Minor complications included subcutaneous emphysema (one patient), persistent air-leak from the chest drain (one patient) and atelectasis (one patient).
The histological analysis of the tumours, including Ki67% and mitosis is reported in Table 4.
Ki67 | |
>10% <10% | 8 (25%) 24 (75%) |
N° mitosis × HPF | |
>10 <10 | 7 (20.6%) 27 (79.4%) |
Necrosis | |
Present Absent | 6 (19.4%) 25 (80.6%) |
Histology.
All patients were evaluated as part of postoperative and oncological follow-up with clinical examination and chest X-ray after one and 6 months. Chest CT scan was performed every year for the first 5 years after surgery. After the first 5 years, an annual chest X-ray was recommended, or at the discretion of the general practitioner in the event of a new onset of symptoms. The annual examination is generally extended up to 15 years due to possible late onset of recurrences.
After a median follow-up of 135 months (IQR 49.2–198), 22 patients died (34.4%) and 42 are alive (65.6%). The mean disease-free interval (DFI) was 28.9 months (range: 8.7–106.1 months). In eight patients (12.5%) a single recurrence was reported while, in one patient two consecutive recurrences were identified.
Solitary fibrous tumours of the pleura are rare pathological entities and are mostly discovered incidentally. Their behaviour is mostly indolent; however, some may de-dedifferentiate into malignant and aggressive tumours. Surgical resection is the mainstay treatment for SFTP, even more so in case of voluminous masses, due to compression onto lung, mediastinum and great vessels. Surgery should be carried out after a complete radiological assessment and a preoperative diagnostic attempt (FNAB), however, the diagnosis of certainty is obtained only with the definitive histological examination on surgical specimens. A long follow-up is recommended due to possible tumour recurrence.
The authors declare no conflict of interest.
solitary fibrous tumours of the pleura hypertrophic pulmonary osteoarthropathy insulin-like growth factor 2 high power fields platelet-derived growth factor vascular endothelial growth factor computed tomography magnetic resonance imaging F-18 fluoro-deoxy-glucose positron emission tomography ultrasounds telomerase reverse transcriptase epithelial membrane agent fine needle aspiration biopsy video-assisted thoracic surgery multidisciplinary team meeting Charlson comorbidity index
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Kendrekar, MSc, MBA, Ph.D., is currently a visiting scientist at the Lipid Nanostructure Laboratory, University of Central Lancashire, England. He previously worked as a post-doctoral fellow at the Ben-Gurion University of Negev, Israel; University of the Free State, South Africa; and Central University of Technology Bloemfontein, South Africa. He obtained his Ph.D. in Organic Chemistry from Nagaoka University of Technology, Japan. He has published more than seventy-four journal articles and attended several national and international conferences as speaker and chair. Dr. Kendrekar has received many international awards. He has several funded projects, namely, anti-malaria drug development, MRSA, and SARS-CoV-2 activity of curcumin and its formulations. He has filed four patents in collaboration with the University of Central Lancashire and Mayo Clinic Infectious Diseases. His present research includes organic synthesis, drug discovery and development, biochemistry, nanoscience, and nanotechnology.",institutionString:"Visiting Scientist at Lipid Nanostructures Laboratory, Centre for Smart Materials, School of Natural Sciences, University of Central Lancashire",institution:null},{id:"428125",title:"Dr.",name:"Vinayak",middleName:null,surname:"Adimule",slug:"vinayak-adimule",fullName:"Vinayak Adimule",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/428125/images/system/428125.jpg",biography:"Dr. Vinayak Adimule, MSc, Ph.D., is a professor and dean of R&D, Angadi Institute of Technology and Management, India. He has 15 years of research experience as a senior research scientist and associate research scientist in R&D organizations. He has published more than fifty research articles as well as several book chapters. He has two Indian patents and two international patents to his credit. Dr. Adimule has attended, chaired, and presented papers at national and international conferences. He is a guest editor for Topics in Catalysis and other journals. He is also an editorial board member, life member, and associate member for many international societies and research institutions. His research interests include nanoelectronics, material chemistry, artificial intelligence, sensors and actuators, bio-nanomaterials, and medicinal chemistry.",institutionString:"Angadi Institute of Technology and Management",institution:null},{id:"284317",title:"Prof.",name:"Kantharaju",middleName:null,surname:"Kamanna",slug:"kantharaju-kamanna",fullName:"Kantharaju Kamanna",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284317/images/21050_n.jpg",biography:"Prof. K. Kantharaju has received Bachelor of science (PCM), master of science (Organic Chemistry) and Doctor of Philosophy in Chemistry from Bangalore University. He worked as a Executive Research & Development @ Cadila Pharmaceuticals Ltd, Ahmedabad. He received DBT-postdoc fellow @ Molecular Biophysics Unit, Indian Institute of Science, Bangalore under the supervision of Prof. P. Balaram, later he moved to NIH-postdoc researcher at Drexel University College of Medicine, Philadelphia, USA, after his return from postdoc joined NITK-Surthakal as a Adhoc faculty at department of chemistry. Since from August 2013 working as a Associate Professor, and in 2016 promoted to Profeesor in the School of Basic Sciences: Department of Chemistry and having 20 years of teaching and research experiences.",institutionString:null,institution:{name:"Rani Channamma University, Belagavi",country:{name:"India"}}},{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a scientist and Principal Investigator at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering the lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via artificial intelligence-based analyses of exosomal Raman signatures. Dr. Paul also works on spatial multiplex immunofluorescence-based tissue mapping to understand the immune repertoire in lung cancer. Dr. Paul has published in more than sixty-five peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award and the 2022 AAISCR-R Vijayalaxmi Award for Innovative Cancer Research. He is a senior member of the Institute of Electrical and Electronics Engineers (IEEE) and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. 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