Physical properties of paraffin, alumina nanoparticles, and nanocomposite.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"5902",leadTitle:null,fullTitle:"Interdisciplinary Expansions in Engineering and Design With the Power of Biomimicry",title:"Interdisciplinary Expansions in Engineering and Design With the Power of Biomimicry",subtitle:null,reviewType:"peer-reviewed",abstract:'People have been finding inspiration in nature in solving their problems, from the very beginning of their existence. In the most general sense, biomimicry, defined as "inspire from the nature," has brought together the engineers and designers nowadays. This collaboration creates innovative and creative outcomes that encourage people with their interdisciplinary relationships. Accordingly, the aim of this book is to bring together different works or developments on biomimetics in interdisciplinary relationship between different areas, especially biomimicry, engineering, and design. The twenty-first century has conceived many new and amazing designs. The book in your hands will surely be an important guide to take a quick look at the future possibilities.',isbn:"978-953-51-3936-2",printIsbn:"978-953-51-3935-5",pdfIsbn:"978-953-51-3993-5",doi:"10.5772/65987",price:119,priceEur:129,priceUsd:155,slug:"interdisciplinary-expansions-in-engineering-and-design-with-the-power-of-biomimicry",numberOfPages:194,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"074a748d02254c7c5643be52cb70be68",bookSignature:"Gulden Kokturk and Tutku Didem Akyol Altun",publishedDate:"March 28th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/5902.jpg",numberOfDownloads:12309,numberOfWosCitations:3,numberOfCrossrefCitations:7,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:14,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:24,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 24th 2016",dateEndSecondStepPublish:"November 14th 2016",dateEndThirdStepPublish:"July 29th 2017",dateEndFourthStepPublish:"August 29th 2017",dateEndFifthStepPublish:"October 29th 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"95921",title:"Dr.",name:"Gulden",middleName:null,surname:"Kokturk",slug:"gulden-kokturk",fullName:"Gulden Kokturk",profilePictureURL:"https://mts.intechopen.com/storage/users/95921/images/7119_n.jpg",biography:"Assist. Prof. Dr. Gülden Köktürk is an electrical and electronic engineer in Dokuz Eylül University, Department of Electrical and Electronic Engineering in Izmir (Turkey). She has been working as a lecturer in Dokuz Eylül University since finishing her PhD degree. She obtained her graduate degree and PhD degree in Electrical and Electronic Engineering in 1987 and 1999, respectively. Her research interests are signal and image processing, biomedical image processing, sustainability in energy, biodesign, and biomimicry. Dr. Köktürk has published many scientific papers, conference presentations, and exhibitions. She is one of the founding members of the Turkish Biodesign Team (TBT), which is the first biodesign team of Turkey and has an interdisciplinary structure study between biomimetic, engineering, science, and design intersection. She continues to work on biodesign in science and engineering with her teammates.\n\nOther InTech publications \nBook chapter Wavelet Based Speech Strategy in Cochlear Implant by Gulden Köktürk in the book Cochlear Implant Research Updates edited by Cila Umat and Rinze Anthony Tange, ISBN 978-953-51-0582-4, InTech, April 4, 2012.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Dokuz Eylül University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"198922",title:"Dr.",name:"Tutku Didem",middleName:"Akyol",surname:"Altun",slug:"tutku-didem-altun",fullName:"Tutku Didem Altun",profilePictureURL:"https://mts.intechopen.com/storage/users/198922/images/7120_n.jpg",biography:"Assoc. Prof. Dr. Didem Akyol Altun is an architect in Dokuz Eylül University, Department of Architecture. She lives in Izmir (Turkey), a city located in the west of the country. She has been working at the Dokuz Eylül University as an instructor for 17 years now. She obtained her graduate degree in 2000 and PhD degree in Architecture in 2010. She deals with all areas of design and continues to work in the biomimetics, nature-inspired architecture, and design-engineering interface. She has many published scientific papers, conference presentations, exhibitions, awards from architectural competitions, and one TUBITAK (Scientific and Technological Research Council of Turkey) project coordinatorship. She is one of the founding members of the Turkish Biodesign Team (TBT), which is the first biodesign team of Turkey and has an interdisciplinary structure study between biomimetic, science, and design intersection. She continues to work on biodesign with her teammates.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"690",title:"Biomimetics",slug:"biomimetics"}],chapters:[{id:"58587",title:"Towards an Agile Biodigital Architecture: Supporting a Dynamic Evolutionary and Developmental View of Architecture",doi:"10.5772/intechopen.72916",slug:"towards-an-agile-biodigital-architecture-supporting-a-dynamic-evolutionary-and-developmental-view-of",totalDownloads:1391,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:1,abstract:"Architecture and biology are fields of high complexity. Generative design approaches provide access to continuously increasing complexity in design. Some of these methods are based on biological principles but usually do not communicate the conceptual base necessary to appropriately reflect the input from biology into architecture. To address this, we propose a model for analysis and design of architecture based on a multistaged integrated design process that extends the common morphological process in digital morphogenesis with a typology-based ontological model. Biomimetics, an emerging field to strategically search for information transfer from biology to technological application, will assist in delivering a frame of reference and methodology for establishing valid analogies between the different realms as well as integration of the biological concept into a larger framework of analogy to biological processes. As the biomimetic translation of process and systems information promises more radical innovation, this chapter focuses on the dynamic perspectives provided by biological development and evolution to model the complexity of architecture. The proposed process was used to inform five parallel workshops to explore dynamic biological concepts in design. The potential of the process to investigate biomimetic processes in architecture is then discussed, and future work is outlined.",signatures:"Petra Gruber, Tim McGinley and Manuel Muehlbauer",downloadPdfUrl:"/chapter/pdf-download/58587",previewPdfUrl:"/chapter/pdf-preview/58587",authors:[{id:"201922",title:"Dr.",name:"Petra",surname:"Gruber",slug:"petra-gruber",fullName:"Petra Gruber"},{id:"203307",title:"Dr.",name:"Tim",surname:"McGinley",slug:"tim-mcginley",fullName:"Tim McGinley"},{id:"203308",title:"Ms.",name:"Manuel",surname:"Muehlbauer",slug:"manuel-muehlbauer",fullName:"Manuel Muehlbauer"}],corrections:null},{id:"58436",title:"Human Eye Behaviors Inform Systems Design for Inter-Building Communication",doi:"10.5772/intechopen.72911",slug:"human-eye-behaviors-inform-systems-design-for-inter-building-communication",totalDownloads:1044,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Adaptive sensory environments optimize in real time to consistently improve performance. One optimization method involves communication between buildings to dramatically compound positive effects—but the way these buildings communicate, matters. To design such a communication framework, this chapter uses a biomimetic approach to derive lessons from the human eye and its focusing abilities. With each focusing action, coordination occurs as muscles move to expand and contract the eye’s lens to achieve varying focal distances. And when both eyes focus together, they are able to achieve stereopsis, a field of depth and perception not attainable with only the focus of one eye. By dissecting this collaboration between eye muscle coordination and stereopsis, this chapter uncovers how a communication framework between adaptive sensory environments can create indirect, yet powerful, collective occupant and building behaviors. For example, communicating adaptive sensory environments evoke greener occupant behaviors, which, in turn, bring added benefit to the natural environment. Communication framework aspects include gamification, social media, and augmented reality that blur the boundaries between built-environments in different ways. These “communication bridges” allow buildings to take on new symbiotic relationships with each other to harness and enhance how entire urban areas uplift quality of life.",signatures:"Maria Lorena Lehman",downloadPdfUrl:"/chapter/pdf-download/58436",previewPdfUrl:"/chapter/pdf-preview/58436",authors:[{id:"205780",title:null,name:"Maria Lorena",surname:"Lehman",slug:"maria-lorena-lehman",fullName:"Maria Lorena Lehman"}],corrections:null},{id:"58691",title:"Taking Inspiration from Flying Insects to Navigate inside Buildings",doi:"10.5772/intechopen.72918",slug:"taking-inspiration-from-flying-insects-to-navigate-inside-buildings",totalDownloads:1198,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"These days, flying insects are seen as genuinely agile micro air vehicles fitted with smart sensors and also parsimonious in their use of brain resources. They are able to visually navigate in unpredictable and GPS-denied environments. Understanding how such tiny animals work would help engineers to figure out different issues relating to drone miniaturization and navigation inside buildings. To turn a drone of ~1 kg into a robot, miniaturized conventional avionics can be employed; however, this results in a loss of their flight autonomy. On the other hand, to turn a drone of a mass between ~1 g (or less) and ~500 g into a robot requires an innovative approach taking inspiration from flying insects both with regard to their flapping wing propulsion system and their sensory system based mainly on motion vision in order to avoid obstacles in three dimensions or to navigate on the basis of visual cues. This chapter will provide a snapshot of the current state of the art in the field of bioinspired optic flow sensors and optic flow-based direct feedback loops applied to micro air vehicles flying inside buildings.",signatures:"Julien R. Serres",downloadPdfUrl:"/chapter/pdf-download/58691",previewPdfUrl:"/chapter/pdf-preview/58691",authors:[{id:"201014",title:"Dr.",name:"Julien",surname:"Serres",slug:"julien-serres",fullName:"Julien Serres"}],corrections:null},{id:"58540",title:"Biomimetic Design for a Bioengineered World",doi:"10.5772/intechopen.72912",slug:"biomimetic-design-for-a-bioengineered-world",totalDownloads:1343,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Biodesign can be explained as a method that includes various researches and applications related to taking inspiration from natural functions, systems, components, or processes in solving a problem. Accordingly, biodesign is commonly used in the design of artificial devices, structures, and buildings in the field of bioengineering. The recent developments in the field of biotechnology and bioengineering bring out various products that are designed in collaboration with different engineering disciplines. In this chapter, the possible use of bacteria, microalgae, and fungi for biomimetic design and the role of biomimicry for these designs will be briefly discussed.",signatures:"Irem Deniz and Tugba Keskin-Gundogdu",downloadPdfUrl:"/chapter/pdf-download/58540",previewPdfUrl:"/chapter/pdf-preview/58540",authors:[{id:"204855",title:"Dr.",name:"Irem",surname:"Deniz",slug:"irem-deniz",fullName:"Irem Deniz"},{id:"204856",title:"Dr.",name:"Tugba",surname:"Keskin Gundogdu",slug:"tugba-keskin-gundogdu",fullName:"Tugba Keskin Gundogdu"}],corrections:null},{id:"59632",title:"Biomimetic Facade Applications for a More Sustainable Future",doi:"10.5772/intechopen.73021",slug:"biomimetic-facade-applications-for-a-more-sustainable-future",totalDownloads:2733,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:1,abstract:"Mankind has often taken inspiration from the nature to solve problems since nature has sophisticated processes, refined for thousands of years. While manmade systems are unsustainable, natural processes embody sustainability principles; therefore, there are many things to learn from nature in order to solve design problems and create a more sustainable future. This is the promise of a biomimetic design approach. Another design approach is biodesign, and it also involves utilizing natural elements inside the design. The building façade is a problematic research area since it is at the intersection between living spaces and natural environment; thus it faces many problems especially regarding energy-air-water transition between indoors and outdoors. Application of key sustainability concepts in architecture such as energy requirements, form and structure, and sustainability considerations can be enhanced by learning from natural processes. This chapter looks at cutting-edge design principles, materials, and designs in building façades through the lens of biomimetics and biodesign. First, the design principles and then the materials and some cases are explained. The concepts of biomimicry and biodesign are in harmony with the concept of sustainability; however, to reach sustainable façade solutions, the sustainability principles should be at the core of the design problem definition.",signatures:"Ayça Tokuç, Fatma Feyzal Özkaban and Özge Andiç Çakır",downloadPdfUrl:"/chapter/pdf-download/59632",previewPdfUrl:"/chapter/pdf-preview/59632",authors:[{id:"200339",title:"Ph.D.",name:"Ayça",surname:"Tokuç",slug:"ayca-tokuc",fullName:"Ayça Tokuç"},{id:"200342",title:"Dr.",name:"Feyzal",surname:"Ozkaban",slug:"feyzal-ozkaban",fullName:"Feyzal Ozkaban"},{id:"200536",title:"Dr.",name:"Özge",surname:"Andiç Çakır",slug:"ozge-andic-cakir",fullName:"Özge Andiç Çakır"}],corrections:null},{id:"58622",title:"Bio-inspired Adaptable Facade Control Reflecting User's Behavior",doi:"10.5772/intechopen.72917",slug:"bio-inspired-adaptable-facade-control-reflecting-user-s-behavior",totalDownloads:1625,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The purpose of this research is to develop the process of methodology in designing adaptable façade. This study focuses on the processes of façade operation control for each resident’s unit according to the user’s lifestyle. This study aims to develop the design methods that are applicable to the adaptable facade, which is inspired by the design inspiration of the biomimicry. The ideal façade to increase comfort in internal space is an adaptable façade that can constantly respond to changes in the environments. This chapter attempts in active adoption of adaptable facade that makes it possible to respond to changing requirements and environments, eventually enabling the creation of customized services for users. This chapter explores the processes of designing an adaptable façade controlled by three rules inspired by the behaviors of flocks of birds. This chapter shows how adopted bird intelligence can produce various façade controls. Also, this chapter demonstrates biomimetic façade control that has been implemented by behavior-based design. Through this demonstration, this chapter identifies the potentials of biomimetic design in facade using rules of bird flocking as source of design inspiration. This study concludes that a behavior-based approach provides flexibly responding façade to environments increasing users’ quality of life.",signatures:"Hyunsoo Lee and Nayeon Kim",downloadPdfUrl:"/chapter/pdf-download/58622",previewPdfUrl:"/chapter/pdf-preview/58622",authors:[{id:"220502",title:"Prof.",name:"Hyunsoo",surname:"Lee",slug:"hyunsoo-lee",fullName:"Hyunsoo Lee"},{id:"220507",title:"Ms.",name:"Nayeon",surname:"Kim",slug:"nayeon-kim",fullName:"Nayeon Kim"}],corrections:null},{id:"58676",title:"Switchable and Reversible Superhydrophobic Surfaces: Part One",doi:"10.5772/intechopen.73022",slug:"switchable-and-reversible-superhydrophobic-surfaces-part-one",totalDownloads:1740,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:"In this chapter, most of the methods used in the literature to prepare switchable and reversible superhydrophobic surfaces are described. Inspired by Nature, it is possible to induce the Cassie-Baxter−Wenzel transition using different external stimuli such as light, temperature, pH, ion exchange, voltage, magnetic field, mechanic stress, plasma, ultrasonication, solvent, gas or guest. Such properties are extremely important for various applications but especially for controllable oil/water separation membranes, oil-absorbing materials and water harvesting systems.",signatures:"Sabri Taleb, Thierry Darmanin and Frédéric Guittard",downloadPdfUrl:"/chapter/pdf-download/58676",previewPdfUrl:"/chapter/pdf-preview/58676",authors:[{id:"201524",title:"Dr.",name:"Thierry",surname:"Darmanin",slug:"thierry-darmanin",fullName:"Thierry Darmanin"},{id:"201530",title:"Dr.",name:"Sabri",surname:"Taleb",slug:"sabri-taleb",fullName:"Sabri Taleb"},{id:"201531",title:"Prof.",name:"Frédéric",surname:"Guittard",slug:"frederic-guittard",fullName:"Frédéric Guittard"}],corrections:null},{id:"58690",title:"Switchable and Reversible Superhydrophobic Surfaces: Part Two",doi:"10.5772/intechopen.73020",slug:"switchable-and-reversible-superhydrophobic-surfaces-part-two",totalDownloads:1236,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In this book chapter, most of the methods used in the literature to prepare switchable and reversible superhydrophobic surfaces are described. Inspired by Nature, it is possible to induce the Cassie-Baxter-Wenzel transition using different external stimuli such as light, temperature, pH, ion exchange, voltage, magnetic field, mechanic stress, plasma, ultrasonication, solvent, gas or guest. Such properties are extremely important for various applications but especially for controllable oil/water separation membranes, oil-absorbing materials, and water harvesting systems.",signatures:"Sabri Taleb, Thierry Darmanin and Frédéric Guittard",downloadPdfUrl:"/chapter/pdf-download/58690",previewPdfUrl:"/chapter/pdf-preview/58690",authors:[{id:"201524",title:"Dr.",name:"Thierry",surname:"Darmanin",slug:"thierry-darmanin",fullName:"Thierry Darmanin"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"3587",title:"Biomimetics",subtitle:"Learning from Nature",isOpenForSubmission:!1,hash:"0ab0daea3f9b4d2228b70d2a47e8d362",slug:"biomimetics-learning-from-nature",bookSignature:"Amitava Mukherjee",coverURL:"https://cdn.intechopen.com/books/images_new/3587.jpg",editedByType:"Edited by",editors:[{id:"5759",title:"Prof.",name:"Amitava",surname:"Mukherjee",slug:"amitava-mukherjee",fullName:"Amitava Mukherjee"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"42",title:"Advances in Biomimetics",subtitle:null,isOpenForSubmission:!1,hash:"65af8330f495764de3acf1bf959143b5",slug:"advances-in-biomimetics",bookSignature:"Anne George",coverURL:"https://cdn.intechopen.com/books/images_new/42.jpg",editedByType:"Edited by",editors:[{id:"21288",title:"Prof.",name:"Anne",surname:"George",slug:"anne-george",fullName:"Anne George"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"251",title:"On Biomimetics",subtitle:null,isOpenForSubmission:!1,hash:"b41b2ea8322b21ee4f4423498d3a196e",slug:"on-biomimetics",bookSignature:"Assoc. 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In general, the thermal energy storage techniques exploit latent heat, sensible heat, and thermo-chemical. Among the aforementioned three types, latent heat thermal energy storage which employs phase change material is praiseworthy owing to its advantageous characteristics, such as high storage density and nearly isothermal operating characteristics during the phase change process [1, 2, 3, 4, 5]. Consequently, it owns versatile applications in the fields of solar energy utilization, waste heat recovery, and active and passive cooling of electronic devices. Among the investigated PCMs, paraffin wax is regarded as the most promising phase change material because of its desirable characteristics such as large latent heat, minimal volume change, chemical stability, no phase segregation, nontoxicity, and commercial availability at low cost [6]. Inspite of these desirable properties of paraffin wax, the low thermal conductivity (0.21–0.24 W/m K) is its major drawback. Different approaches have been used to enhance the thermal conductivity of PCM, such as dispersion of high thermal conductive materials into PCMs, encasing the PCM within finned tubes, and impregnation of porous materials like carbon and metal foams [7]. Dispersing nanoparticles in paraffin has the potential to improve the thermal conductivity, thereby significantly improving its thermal energy storage characteristics. Zeng et al. [8] investigated the effect of copper nano wires (Cu NWs) dispersed in tetradecanol (TD). The thermal conductivity of the composite PCMs improved nine times better than that of pure PCM, when the composite PCM was containing 11.9 vol% Cu NWs. In this chapter, emulsion of alumina nanoparticles into melting paraffin wax in different volume fractions was prepared to study the thermophysical properties like melting/freezing point, latent heat, thermal conductivity, and dynamic viscosity. Stable composites were prepared, and a significant thermal conductivity enhancement is reported in this chapter. The distinguishing feature of this chapter is to compare the present thermal conductivity results of various volume fractions with the predicted Maxwell model as reported in the literature [9].
In the present study, paraffin wax (
Parameter | Alumina nanoparticles | Paraffin wax, ϕ = 0 | Nanocomposite, ϕ = 10 vol% |
---|---|---|---|
Latent heat of fusion, Melting Temperature, | 121.9 J/g* 58.9°C* | 119.9 J/g* 58.6°C* | |
Solid density, | 3600 kg/m3 | 860 kg/m3 | 930.692 kg/m3 |
Liquid density, | 780 kg/m3 | ||
Thermal conductivity, | 40 W/m K | 0.24 ( 0.15 ( | 0.42 W/mK @ 59°C |
Specific heat, | 765 J/kg K | 2.9 kJ/kg K ( 2.1 kJ/kg K ( | 2686 J/kg K |
Dynamic Viscosity, | — | 0.205 Ns/m2 | 0.2188 Ns/m2 |
Physical properties of paraffin, alumina nanoparticles, and nanocomposite.
Measured values (DSC)
Nanocomposite PCMs were prepared by adding different volume fractions of Al2O3 nanoparticles into paraffin wax; however, no surfactant was used. Figure 1 illustrates the steps involved in the preparation of composite PCMs with the addition of alumina nanoparticle in volume fractions of 5 and 10%. Initially, paraffin wax was heated to a temperature of 80°C, and the Al2O3 nanoparticles were then dispersed into the liquid paraffin wax. Suspensions were prepared by strong shear mixing at 1000 rpm for 20 min using a magnetic stirrer. The mixture was sonicated using an ultrasonic vibrator (Toshiba, India), generating ultrasonic pulses of 100 W at 36 ± 3 kHz. However, to ensure stability and homogeneity, intense sonication was done for a period of 6 hours. The mixture was kept in the liquid state throughout the process by maintaining a constant temperature of 65°C. There was no settling observed thereafter, and thus, the prepared composites were stable.
Preparation procedure of latent heat storage nanocomposite made of paraffin wax and alumina.
The phase change behavior of paraffin and paraffin/alumina composite involves two parameters: the latent heat and the phase change temperature, which can be measured by DSC (NETZSCH DSC 204) analysis. DSC thermogram of the paraffin and paraffin/alumina composite with 5 and 10 vol% of alumina nanoparticle is shown in Figure 2a, b, and c. The test results infer that nanocomposite exhibited only a single peak confirming to the solid-liquid transition, and no traces of solid-solid secondary peak were observed. These aspects are especially good for PCMs to maximize their heat storage and release capabilities at one stretch during melting and freezing cycles [11]. In DSC, the main peak represents the phase-change behavior of paraffin and paraffin/alumina composite. Phase change temperature is taken as onset temperature in DSC curve. With an increase in the volume fraction of alumina nanoparticle, the phase change temperature of paraffin/alumina composite increases and latent heat capacity of paraffin/alumina composite reduces compared to paraffin wax (heating curve) as shown in Figure 2b and c. The DSC results of paraffin, 5 vol%, and 10 vol% of alumina nanoparticle are presented in Table 2.
(a) DSC thermogram of paraffin wax, (b) DSC thermogram of composite with 5 vol% of alumina nanoparticle, and (c) DSC thermogram of composite with 10 vol% of alumina nanoparticle.
PCM/Composite | Melting temperature, | Freezing temperature, T | Latent heat of fusion on heating curve (J/g) | Latent heat of fusion on cooling curve (J/g) |
---|---|---|---|---|
0 (paraffin wax) | 58.9 | 44.4 | 121.9 | −110.2 |
5 vol% | 56.8 | 45.8 | 121 | −102 |
10 vol% | 58.6 | 47 | 119.9 | −111.2 |
Melting/freezing temperatures and latent heat of fusion of paraffin and composite.
The melting temperature of 10 vol% of alumina shifted to 58.6°C, whereas paraffin was 58.9°C. On the other hand, the freezing temperature of 10 vol% of alumina shifted to 47°C, whereas paraffin wax was 44.4°C. The latent solid-liquid phase change for the composites are around 121 J/g, which is very close to the value of 124.4 J/g for pure paraffin. This is because no chemical reaction takes place between paraffin and nanoparticles in the preparation of nanocomposites. This is consistent with observations made by Ho and Gao [12] and Kim and Drzal [13]. Nanoparticle dispersions neither agree to affect the melting/freezing behavior nor the phase change temperature. The measured and calculated latent heat of paraffin/alumina composite is shown in Table 3. Using a simple mixture theory, the latent heat of fusion of the composite PCMs is calculated by:
Volume fraction of alumina, | Phase change latent heat | |
---|---|---|
Calculated value (J/g) | Experimental value (J/g) | |
5 | 122.85 | 121 |
10 | 121.90 | 119.9 |
Experimental and calculated values of latent heat of fusion.
where
DSC thermograms of pure paraffin (C18H38) and Al2O3 nanoparticles in paraffin emulsion in various mass fractions 5 and 10 wt% are shown in Figure 3. The latent heat and phase change temperature are significantly different for paraffin-alumina emulsion composites.
DSC thermograms of heating and cooling curves for Al2O3 in paraffin emulsions and pure paraffin (C18H38) in the range of 20–40°C [
Table 4 compares the latent heat of fusion of alumina nanoparticles in the
Nanoparticle mass fraction ( | Latent heat of fusion on heating curve (kJ/kg) | Nanoparticle volume fraction ( | Latent heat of fusion on heating curve (J/g) |
---|---|---|---|
0 | 243.1 | 0 | 124.4 |
5 wt% | 225.6 | 5 vol% | 114.3 |
10 wt% | 212.3 | 10 vol% | 107.2 |
Comparison of latent heat of fusion of Al2O3—in octadecane emulsion with present study.
Figure 4 shows the DSC heating and cooling curve of 10 wt% copper oxide nanoparticle-enhanced paraffin (CNEP). The heating and cooling curve indicate two phase transition peaks. The primary peak at around 35°C corresponds to the solid-solid phase change in paraffin, and the secondary peak at around 55°C corresponds to the solid-liquid phase change. The latent heat solid-liquid of 10 wt%
DSC thermograms of 10 wt% copper oxide nanoparticle enhanced paraffin [
The specific heat is one of the important properties and plays an important role in influencing heat transfer rate in nanocomposite. Predicted specific heat values (Cp) of the nanocomposite for various volume fraction can be calculated using mixture formula Eq. (2), and it is shown in Table 5. This formula is valid for homogenous mixtures.
Volume fraction ( | Specific heat capacity of nanocomposite (J/kg K) |
---|---|
5 | 2793 |
10 | 2686 |
Specific heat capacity of nanocomposite.
As the thermal conductivity of nanocomposites is expected to be higher due to high thermal conductivity of Al2O3 particles, the nanocomposites show higher ability to conduct heat. This obviously results in lower heat storage capacity. From Table 5, it is depicted that the specific heat of nanocomposites decreases, the volume fraction of nanoparticle will be increased.
Thermal conductivity is measured by the procedure given in the literature [14]. However, a constant temperature hot water bath was also incorporated to maintain the composite at constant temperature to avoid solidification of the samples during the measurement. Thermal conductivity measurement of nanocomposite was made by KD2 Pro thermal property analyzer (Decagon Devices, Inc.; USA). Schematic view of KD2 Pro thermal property analyzer is shown in Figure 5. The KD2 Pro analyzer consists of a handheld microcontroller along with sensor needles. The sensor needle is composed of a heating element and thermistor. The controller module consists of three sets of batteries, a 16 bit microcontroller/AD converter, and power control circuit. The sensor needle (KS-1) made of stainless steel is 60 mm long and has a diameter of 1.3 mm and closely approximates an infinite line heat source. Each measurement cycle lasts for 90 s and consists of three stages. The instrument will equilibrate during the first 30 seconds, which is followed by heating and cooling of the sensor needles for 30 seconds each. At the end of the reading, the controller computes the thermal conductivity using the change in temperature (
Schematic sketch of KD2 pro thermal property analyzer. 1-Microcontroller, 2-Sensor, 3-Septum, 4-Hot water bath, 5-Vial, 6-Cable.
where q is the constant heat rate applied to an infinitely long and small “line” source,
Thermal conductivity is the most important property of phase change materials and need detailed investigation. The thermal conductivity was measured as a function of temperature with respect to nanoparticle loading. Figure 6 depicts the thermal conductivities of paraffin and composite assessed at various temperatures. It is explicit from the Figure 6 that the influence of temperature on the thermal conductivity of paraffin as well as composites is less significant in solid and liquid states.
Thermal conductivity of paraffin wax and composite versus temperature.
However, an atypical rise in thermal conductivity was observed near the solid - liquid phase change temperature, and the same suddenly falls down when the paraffin wax and nanocomposite PCM turned completely into liquid state. Thermal conductivity of paraffin wax and composites of various volume concentration is summarized in Table 6. The increase in thermal conductivity near the phase change is attributed to the accelerated molecular vibrations in the matrix of ordered solid structure when the temperature was increased [15]. The thermal conductivity of the composite with 5 vol% of alumina is 0.2677 W/mK at 45°C in the solid state and 0.24 W/mK at 65°C in the liquid state. After phase change, there is a breakage of the orderly solid structure into a disorderly liquid structure, and therefore, the thermal conductivity of paraffin wax and composite has become less than that in the solid state. The thermal conductivity of the paraffin wax is 0.2375 W/mK (45°C) in solid state and 0.1590 W/mK (65°C) in the liquid state. Thermal conductivity of composite with 10 vol% of alumina is higher than paraffin wax by 0.2834 W/mK at 45°C and 0.2560 W/mK at 65°C. However, higher thermal conductivity measured, i.e.,
Temperature (°C) | Thermal Conductivity (W/mK) | ||
---|---|---|---|
Paraffin wax | |||
30 | 0.2450 | ||
36 | 0.2390 | 0.2620 | 0.2760 |
37.5 | 0.2380 | ||
43 | 0.2344 | ||
48 | 0.2427 | ||
50 | 0.2406 | 0.2729 | 0.2906 |
59 | 0.3200 | 0.4000 | 0.4200 |
Thermal conductivity of paraffin and various volume fraction of alumina at different temperature.
Note: Show the temperature values in solid and liquid state (Bold).
Thermal conductivity enhancement ratio was calculated by
Thermal conductivity of composite as a function of temperature.
The liquid molecule close to particle surfaces is known to form layered structures and behave much like a solid. The results also showed that the thermal conductivity of paraffin could be achieved further by the addition of alumina more than 10 vol% of alumina nanoparticle. However, this volume fraction is adequate to obtain form-stable composite PCM, and further increase in alumina over 10 vol% of alumina nanoparticle will result in an increase in a latent heat capacity of the composite.
The theoretical thermal conductivity of solid phase paraffin/alumina composite PCMs was calculated using Maxwell’s model [16].
where
Table 7 shows the measured and predicted thermal conductivity of various ANEP samples at 45°C, and it is compared with Arasu [9] predicted Maxwell model at 47°C. Enhancement of thermal conductivity measurement is slightly higher than the theoretical predicted result. This is attributed to the fact that the interaction between the high-conductive alumina nanoparticles and the matrix molecule affecting the relative thermal conductivity of NEPCMs [17]. The predicted thermal conductivity values of Arasu (@ 47°C) were 1ower than our recent study.
Volume fraction ( | Predicted Maxwell model with Arasu (W/mK) | ||
---|---|---|---|
0 | 0.2375 | 0.2375 | 0.12 |
5 vol% | 0.2677 | 0.2462 | 0.17 |
10 vol% | 0.2834 | 0.2559 | 0.22 |
Measured and calculated ANEP samples at 45°C (solid state).
Table 8 compares the increase in thermal conductivity of pure paraffin(C18H38)-nanoparticle composites of various phases with the present study. Relative thermal conductivity enhancement of more than 2 and 6% for the paraffin containing 5 and 10 wt% of alumina nanoparticle at temperature 30°C. The enhancement of thermal conductivity in a liquid state of Al2O3 nanoparticle in n-octadecane (
State | Temperature (°C) | 10 vol% ANEP | Temperature (°C) | 10 wt%(n-octadecane-alumina emulsion) |
---|---|---|---|---|
Solid | 45 | 19.32% | 30 | 6% |
Liquid | 65 | 61% | 60 | 17% |
Percentage increase in thermal conductivity during solid and liquid phases.
Figure 8 compares the percentage increase in thermal conductivity of 10 wt% CNEP with the present study. Enhancement in thermal conductivity in the liquid state was more pronounced than in the solid state or during phase change.
Comparison of percentage increase in thermal conductivity during different phases.
A maximum of 61% (0.2560 W/mK for ANEP as compared to 0.1590 W/mK for pure paraffin) and 16.35% (0.185 W/mK for CNEP as compared to 0.1590 W/mK for pure paraffin) enhancement of thermal conductivity in the liquid state at 65°C have been achieved in 10 vol% ANEP and 10 wt% CNEP respectively. A maximum of 31.25% (0.42 W/mK for ANEP as compared to 0.32 W/mK for pure paraffin) and 14.37% (0.35 W/mK for CNEP as compared to 0.3060 W/mK for pure paraffin) enhancement of thermal conductivity during phase change (59°C) was achieved in 10 vol% ANEP and 10 wt% CNEP, respectively. A maximum of 19.32% (0.2834 W/mK for ANEP as compared to 0.2375 W/mK for pure paraffin) and 13.04% (0.26 W/mK for CNEP as compared to 0.23 W/mK for pure paraffin) enhancement of thermal conductivity in the solid state at 45°C was found in 10 vol% ANEP and 10 wt% CNEP, respectively. It can be clearly seen that aluminum oxide nanoparticles lead to a higher thermal conductivity enhancement than copper oxide nanoparticles, even though the size of the copper nanoparticles was less than that of the alumina nanoparticles.
The density of nanocomposite is determined using density-correlation equation developed by Pak and Cho [18].
where
The density of the nanocomposites is calculated using the correlation and is presented in Table 9.
Volume fraction ( | Equivalent volume fraction ( | Density of nanocomposite (kg/m3) |
---|---|---|
5 | 0.0124 | 893.976 |
10 | 0.0258 | 930.692 |
Density of nanocomposite.
Since the density of Al2O3 particles is much higher than paraffin wax, the quantity of nano particles replacing equivalent volume of paraffin wax in the composite would add more mass. Hence, the density of nanocomposites increases with increase in volume fraction of nano particles.
The viscosity of the composite was measured by using Brookfield cone and plate viscometer (LVDV-I PRIME C/P) equipped with a 2.4 cm 0.8°cone supplied by Brookfield Engineering Laboratories, USA, is shown in Figure 9. In Brookfield cone and plate viscometer, the cone is connected to the spindle drive, whereas the plate is mounted in the sample cup. Water at a constant temperature of 60°C, 65°C, and 70°C was circulated to the outer surface of the sample cup from a constant temperature hot water bath to prevent the solidification of the samples in the cup, maintain the temperature constant, and measure the viscosity. Measurements were done at three different temperatures for each sample. To measure viscosity in the range of 0.3–1028 cP, spindle CPE-40 was used. Between the plate and cone, a gap of 0.013 is maintained. An adjusting feature of the cone and plate Viscometer is an electronic gap, which is used to place the test fluid in the gap. To rotate the spindle, the viscous drag of the fluid is measured by spring deflection. To attain the temperature equilibrium quickly within a minute, the sample volume required is 0.5–2 ml. To obtain adequate results in spindle/speed combination when applied torque is between 10 and 100% of maximum permissible torque. Measurement can be taken as superfluous if the applied torque does not fall within the possible range. Readings were discarded if the applied torque did not fall within this prescribed range. In cone and plate viscometer, the spindle speed is in the range of 0–100 rpm, and the shear rate is 0–750 s−1.
Cone and plate assembly. 1. Cone; 2. Plate.
Figure 10 shows the measured dynamic viscosity of paraffin and volume fraction of alumina at various temperatures, respectively. The dynamic viscosity decreases with temperature and increases with an increasing volume fraction of alumina nanoparticles is shown in Figure 10. This shows that the addition of nanoparticles makes paraffin more viscous. Table 10 presents the dynamic viscosity of paraffin and various volume fractions of alumina at different temperatures, respectively. Figure 10 indicates that the dynamic viscosity has a nonlinear increase with nanoparticle concentration for paraffin-nanoparticle composites. In the liquid state, dynamic viscosity decreases sharply with temperature, while the thermal conductivity has a weak dependence on temperature. For a particular concentration of nanoparticles, the increase in dynamic viscosity is almost the same at different temperatures, while the enhancement of thermal conductivity increases with increase in temperature. So, at higher temperatures, the thermal conductivity enhancement will shoot over the percentage increase in dynamic viscosity.
Measured dynamic viscosity for various volume fraction of alumina from 60 to 70°C.
Temperature (°C) | Dynamic viscosity (Cp) | ||
---|---|---|---|
Paraffin wax | 5 vol% | 10 vol% | |
60 | 2.14 | 2.55 | 2.63 |
65 | 2.07 | 2.401 | 2.492 |
70 | 1.98 | 2.35 | 2.44 |
Dynamic viscosity of paraffin and various volume fractions of alumina at different temperature.
The viscosity of the ANEP samples is predicted using the Brinkman’s correlation [19] and is given by:
where
Volume fraction ( | Dynamic viscosity of nanocomposite (Ns/m2) |
---|---|
5 | 0.2114 |
10 | 0.2188 |
Dynamic viscosity of nanocomposite.
Nanoparticle enhanced paraffin composites were then prepared by dispersing the aluminum oxide nanoparticles in liquid paraffin under the intense signification to make the mixture stable.
The effect of nanoparticle volume concentration and the temperature was also investigated. Differential scanning calorimetry reveals that there is only one peak during meting/freezing cycle in paraffin/alumina composites and latent heat decreased with the addition of alumina nanoparticles compared to paraffin wax. There is no significant difference in latent heat value between the 10 vol% ANEP and 10 wt% CNEP.
Relative thermal conductivity enhancement of Ho and Gao (17%) was lower than our present study. Compared to Ho and Gao, the latent heat of paraffin/alumina composites was nearly 8 and 14%.
It was found that increase in thermal conductivity of ANEP is consistently higher than that of CNEP. The maximum increase in thermal conductivity (61%) was observed for 10 vol% ANEP in the liquid state at 65°C. The maximum increase in dynamic viscosity (23%) was observed for 10 vol% ANEP at 70°C.
Maxwell’s model of the predicted result (
This chapter is presented to be only a baseline study to study the charging and discharging characteristics of horizontal double pipe latent heat energy storage system. This is a very important topic and will be addressed in later chapter.
A | external surface area of heat transfer fluid pipe (m2) |
Cp | specific heat of PCM/alumina (kJ/kg°C) |
H | latent heat of paraffin/composite (J/g or kJ/kg) |
M | mass of PCM (kg) |
T | temperature (°C) |
t | time (min) |
Greek symbols | |
μ | dynamic viscosity of paraffin wax(kg/m s) |
ρ | density (kg/m3) |
W | weight |
ϕ | volume fraction |
Ψ | thermal conductivity enhancement ratio |
Subscripts | |
eff | effective |
bf | base fluid |
m | melting temperature/composite |
v | volume fraction or volume |
l | liquid |
s | solid |
w | water |
f | freezing temperature |
c | nanocomposite |
p | paraffin wax/copper oxide nanoparticle/alumina nanoparticle |
k | thermal conductivity (W/m K) |
DSC | differential scanning calorimetry |
LHTESS | latent heat thermal energy storage system |
ANEP | alumina nanoparticle enhanced paraffin |
CNEP | copper-oxide nanoparticle enhanced paraffin |
PCM | phase change material |
About 7% of the population >65 years suffer from a painful heel, even though younger people are often affected, too [1]. The most common cause of this symptom is the so‐called “plantar fasciitis” [2]. This term is widely used, although “plantar fasciopathy” or “plantar fasciosis” would be a better description to point out the degenerative nature of the disease. However, as more than 1100 citations in Pubmed quote “plantar fasciitis” (in comparison with only 50), we will use the traditional term in the following.
Plantar fasciitis has been associated with obesity, with acute or chronic work overload, or with work on hard surfaces [2, 3]. It seems that physiological degeneration of the fascia at the calcaneal insertion exacerbates due to repetitive microtraumas caused by vertical compression [4]. This causes inflammatory tissue reactions. As a result, the fascia is thickened with an associated fluid collection to 4.0 mm and more in ultrasonography [5]. Furthermore, this inflammation may trigger bone formation, the so‐called “plantar heel spur.” This process has been studied intensively by Kumai and Benjamin [6]. They proposed three stages of spur growth: “(a) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (b) thickening of the subchondral bone plate at the enthesis as small spurs form; and (c) development of vertically oriented trabeculae buttressing the proximal end of larger spurs” [6]. The first description of this spur formation and correlation with the clinical symptoms was carried out by Plettner in 1900 [7]. However, not every heel spur is associated with heel pain, as these spurs are found in 11–16% of the normal asymptomatic population [4]. On the other hand, some patients with painful plantar fasciitis do not have a radiographic confirmation of a spur formation.
A similar mechanism (although caused by longitudinal traction and not by vertical compression) of bone formation has been described at the insertion of the Achilles tendon [8].
According to the American clinical practice guidelines from 2010, diagnosis is established by the typical anamnesis and the characteristic localizations of tenderness. Still, weight‐bearing radiographs are also recommended [9].
Single doses of external beam radiotherapy (EBRT) in the range of 0.3–1 Gy are called “low dose EBRT” (LD‐EBRT). These single fractions are applied two or three times a week until a total dose of about 3–6 Gy is reached. Such radiotherapeutic concepts are used for diverse nonmalignant conditions, e.g., osteoarthrosis, tendinopathy, epicondylitis, or bursitis. A comprehensive review of the historical developments in LD‐EBRT for benign diseases is given by Trott [10].
In contrast, EBRT in oncology is characterized by much higher single and total doses. “Normofractionation” describes single doses of 1.8–2 Gy, applied about five times a week. To treat breast cancer, the total doses of about 62 Gy are necessary, in prostate cancer even more than 72 Gy. From a radiobiological point of view, these high cumulative doses are used to induce DNA double strand breaks. Due to errors in a repair mechanism (nonhomologous end joining), dicentric chromosomes can occur. These can result in unfinished mitoses, the so‐called “mitotic catastrophe,” the main mechanism to reduce clonogenic survival in tumor cells [11]. High doses of EBRT induce local inflammation and tissue reactions.
The much lower doses of LD‐EBRT act via different mechanisms. In the last two decades, several anti‐inflammatory effects have been discovered, contrary to the effects of the above‐mentioned high EBRT doses.
Furthermore, doses between 0.1 and 0.5 Gy reduced the adhesion of PBMC significantly to endothelial cells (ECs)
A third mechanism was the suppression of nitric oxide (NO) production in activated macrophages by LD‐EBRT between 0.3 and 1.25 Gy [18]. As the expression of inducible nitric oxide synthases (iNOS) proteins was not altered, the LD‐EBRT seemed to act at the translational or posttranslational level. Furthermore, a dose of 0.5 Gy significantly reduced oxidative burst and superoxide production of stimulated macrophages [19]. A diminished release of reactive oxygen species (ROS) can also contribute to the anti‐inflammatory effects of LD‐EBRT.
Taken together, all of these pathways and mechanisms showed a similar dose dependence with a maximum effect between 0.3 and 0.7 Gy regarding a discontinuous dose‐effect relation [20].
There are several
Since 1937 [21] for decades, large retrospective studies on the efficacy of LD‐EBRT in calcaneodynia have been published (overview in 22). In 1970, one negative randomized trial was reported and heavily criticized but had not been repeated [23]. Starting in the 1980s, patients were systematically clinically examined and interrogated in a structured manner to try to control for diverse risk factors and to compare the efficacy of different fractionation schemes and total doses [24].
It took until the past decade to perform and report prospectively randomized trials to proof the efficacy of LD‐EBRT and to identify the optimal dose fractionation schedule. In the following, we report the design and the results of these trials. Table 1 gives a short overview of the studied dose concepts and the results. Due to methodological reasons, we will describe the studies not following their publications dates, but according to a systematic order.
Since the publication of the first randomized trial on LD-EBRT in 1970, the efficacy of LD‐EBRT was questioned [23]. Goldie et al. randomized 399 patients, however, only nine patients suffered from calcaneodynia. This is why these results cannot be extrapolated to LD‐EBRT of a painful heel spur. Furthermore, endpoints were not clearly defined, and therapy was started in an acute stage of the disease [25].
The landmark study to prove the efficacy of LD‐EBRT was performed by the German cooperative group on the radiotherapy for benign diseases (GCGBD) under the responsibility of Niewald et al. [26]. A very low dose EBRT (6 × 0.1 Gy applied twice a week up to a total dose of 0.6 Gy) was randomized to a standard dose LD‐EBRT (6 × 1 Gy twice a week up to a total dose of 6 Gy). In the case of an unfavorable response after 3 months, the patient was offered a second treatment series (“reirradiation”) applying a standard dose. The dosage of the experimental arm was chosen to examine if very low doses are effective at all. Second, it acted as a placebo irradiation, as a sham irradiation was regarded unethical. LD‐EBRT was applied using a linear accelerator (4‐ to 6‐MV photons) using lateral parallel opposing fields.
Inclusion criteria were tenderness of the calcaneus with a limitation of the painless walking distance and duration of the symptoms for more than 6 months. Furthermore, a radiological proof of a heel spur was required, and the patients had to be least 40 years of age. Patients with previous traumata to the foot, rheumatic or vascular diseases, lymphatic edema, pregnancy, or breastfeeding were excluded. Concomitant therapy with oral analgesics was not limited. However, local injections with steroids during the study period were not permitted.
Initially, 200 patients were planned [27] to detect a difference of 10% in the quality of life (QOL) sum score (SF‐12) [28] and calcaneodynia sum score (CS) [29] (Table 2) with a power of 80% and an error probability of 5%. Furthermore, the visual analogue scale (VAS) to evaluate pain intensity was used. However, after randomization of 66 patients and interim analysis of 62 patients (4 had to be excluded due to a withdrawal of informed consent or violation of the inclusion criteria), the differences in efficacy between the two treatment arms were so pronounced, that the trial was closed early.
Author | Year | N | Standard arm | Experimental arm | Results | Conclusions |
---|---|---|---|---|---|---|
2012 | 66 | 6 × 1 Gy twice a week | 6 × 0.1 Gy | 3 months: VAS/CS/SF12 sig. better with standard | 1. Dose‐response relationship | |
1 year: less second treatment series with standard | 2. Proof of therapeutic effect of LD‐EBRT | |||||
2007 | 130 | 6 × 1 Gy twice a week | 6 × 0.5 Gy | 6 months: CS no sig. differences | 6 × 0.5 Gy as standard fractionation | |
2014 | 457 | 6 × 1 Gy twice a week | 6 × 0.5 Gy | 6 weeks, 2.5 years: VAS/CS no sig. differences | 6 × 0.5 Gy as standard confirmed | |
2015 | 127 | 6 × 1 Gy twice a week | 12 × 0.5 Gy thrice a week | 3 months: VAS/CS/SF12 no sig. differences | Efficacy not increased with 12 × 0.5 Gy standard still 6 × 0.5 Gy |
Summary of contemporary randomized trials on LD‐EBRT of painful heel spurs: tested schedules, results, and conclusions.
Criteria | Extent of symptoms/alteration | Points |
---|---|---|
S = Pain at | 6 / 4 / 2 / 0 | |
(total: 30%) | N = Pain during D = Pain during R = Pain at I = Pain at none = 6 ; slight = 4 ; moderate = 2 ; severe = 0 points ⇨ | 6 / 4 / 2 / 0 6 / 4 / 2 / 0 6 / 4 / 2 / 0 6 / 4 / 2 / 0 |
per single criterion | ||
(total: 15%) | None Orthopedic shoe, insoles, heel cushion One cane or crutch Two canes or crutches ⇨ | 15 10 5 0 |
(total: 20%) | No limitation, maximum professional strain possible Slight limitation, normal professional work possible Moderate limitation, reduced professional activity Severe limitation, daily professional work impossible ⇨ | 20 10 5 0 |
(total: 15%) | No limitation of daily and leisure activities and sports Slightly limitation/reduced leisure activities and sports Moderate limitation/no leisure activities and sports Complete limitation of any daily and leisure activities ⇨ | 15 10 5 0 |
(total: 20%) | No limp, normal walking is possible without a limitation Slightly altered, limp after walking Moderately altered, limp after walking Severely altered, normal walking is impossible ⇨ | 20 10 5 0 |
The mean age of patients was 54 years in the standard dose group and 58 years in the 6 × 0.1 Gy group. Sixty‐one patients had a plantar, one patient a dorsal heel spur. In mean, patients in the standard dose group suffered for 15.3 months before the start of LD‐EBRT, in the 6 × 0.1 Gy group for 18.8 months. Twenty‐one patients had symptoms on both sides. In 28 patients the pain irradiated into the calf, only in 18 patients it was localized to the sole of the foot. Two patients had received surgery for LD‐EBRT.
Three months after therapy VAS values, CS‐ and QOL‐scores were significantly better after the standard dose in comparison with the very low dose treatment arm. The higher pain relief resulted in a better QOL. Twelve months after therapy about 64% of the patients after 6 × 0.1 Gy had to receive a second treatment series due to insufficient treatment results, in comparison with only 17% of the patients in the standard dose treatment group. As the second series was applied with a standard dose (6 × 1 Gy), patients in the 6 × 0.1 Gy group who were reirradiated showed equally favorable results compared with those in the standard‐dose group who did not receive a second course [26]. This is why the second treatment series in this clinical setting acted as a “salvage therapy.” Another interesting finding was that patients with a good response already at 3 months remained stable or even improved at 12 months. Furthermore, this underlines the long‐lasting efficacy of LD‐EBRT.
Acute side effects or long‐term toxicity did not occur.
In conclusion, this randomized trial established a dose‐response‐relationship of the analgesic effect of LD‐EBRT, thus providing a clinical and methodological proof of the efficacy of 6 × 1 Gy LD‐EBRT on the clinical course of painful heel spurs. The early termination of the study was justified due the interim analysis showing significant differences in the clinical outcome between both treatment arms. Still, the trial was not blinded, so both the patients and the staff were aware of the received dose. With modern linear accelerators, a complete blinding of the staff is nearly impossible. The only option would be a shame irradiation with closed collimator jaws, reducing the dose to the unavoidable “leakage” radiation. A much easier and straight forward way was used in the above‐mentioned study by application of a minimal physical dose with 0.1 Gy. Another critical point might be that only half of the patients were examined 12 months after therapy (
Another potential confounder not only in this study but also in all other published prospective and retrospective case series might be that a lot of the patients had received diverse and other conservative therapies before being referred to LD‐EBRT. An interaction between one of these other treatments and LD‐EBRT cannot be ruled out due to methodological reasons. This reflects clinical reality. Still, an interaction between one of these therapies and LD‐EBRT is rather unlikely and counter‐intuitive, as patients were referred to LD‐EBRT after the clinical failure of all the other conservative treatments.
Two randomized studies investigated the efficacy of 0.5 Gy single dose in comparison to 1 Gy.
The first trial was conducted by Heyd et al. [30]. They randomized 130 patients between 6 × 0.5 Gy twice weekly (low dose) and 6 × 1 Gy (standard dose). A linear accelerator was used, applying a single field technique.
Inclusion criteria were clinical signs of a painful heel spur, radiological evidence of spur formation, patient age ≥30 years and a relapse after previous conservative treatments, in patients >45 years LD‐EBRT could be used as the primary treatment. Endpoints of the study were changes in the “original” calcaneodynia score [31], that was documented before LD‐EBRT, at the end of the course, and 6 weeks and 6 months afterward.
One hundred and thirty patients were randomized. Mean age was 58.4 years. A 102 patients suffered from a plantar, one patient from a dorsal, and 27 patients from combined spurs. In mean, patients had been suffering from symptoms for 9.8 months. The symptoms had been present in 58 patients for less than 6 months, in 72 patients for a longer time. In 7 heels LD‐EBRT was the first therapeutic approach.
At the end of LD‐EBRT, 66% in the low dose group vs. 59% in the standard dose experienced an improvement in symptoms, 6 weeks later 80 vs. 85%. At this time point, 1.5% in each group reported an increase in symptoms, 19 vs. 14% no change. No statistically significant differences were noted. In case of insufficient treatment results patients were offered a second EBRT series. Thus 26 vs. 37% were treated a second time. Six weeks after that, 71 vs. 79% of these patients reported a further improvement. Six months after LD‐EBRT 88% of the patients in both groups had an amelioration of their symptoms, the remaining patients reported no change. During the EBRT series a slight increase in pain was reported by 26 vs. 29% of the patients. No other acute or late toxicity occurred.
In conclusion, 6 × 0.5 Gy twice weekly was as effective as 6 × 1 Gy.
These results were confirmed by a second randomized trial [32, 33]. Ott et al. randomized 457 patients between 6 × 0.5 Gy (low dose) and 6 × 1 Gy (standard dose). In contrast to the above‐cited “Heyd‐study” [30] an X‐ray unit (orthovoltage) and not linear accelerators was used. Patients received a single field (6 × 8 cm on the plantar calcaneus) with 150 kV, 15 mA, 1 mm Cu‐filter, with source‐to‐skin distance (SSD) of 40 cm. Six weeks after the LD‐EBRT a second series was offered to patients with an insufficient response. The endpoint was pain reduction. CS score and VAS values were measured before and at the end of LD‐EBRT (early response), 6 weeks (delayed), and 2.5 years (long‐term) afterward.
With a median follow‐up of 32 months the mean VAS values before treatment, for early, delayed, and long‐term response for the 0.5 and 1.0 Gy groups were 65.5 ± 22.1 and 64.0 ± 20.5 (
Taken together, the above‐mentioned studies proofed an equivalent clinical efficacy of 6 × 0.5 Gy in comparison to 6 × 1 Gy, thus defining a new clinical treatment standard with six times 0.5 Gy twice weekly as the minimum effective dose.
Before proofing 0.5 Gy as the new standard single dose, another randomized study tried to increase efficacy in reaching the “old” cumulative dose of 6 Gy with a single dose of 0.5 Gy. Niewald et al. randomized between 6 × 1 Gy twice a week (old “standard dose”) and 12 × 0.5 Gy three times a week (“experimental dose”) [25]. The aim was not just to get comparable results, but to further improve the analgesic effects. Linear accelerators (6 MV photons) applying a lateral opposing field technique were used.
Inclusion and exclusion criteria were quite similar to the ones used in the landmark study [26]: Clinical evidence of a painful heel spur, and duration of the symptoms for more than 6 months; radiological proof of a spur formation; age at least 40 years; Karnofsky‐Index at least 70%. Patients with previous radiotherapy or previous trauma to the foot, rheumatic or vascular diseases, lymphatic edema, pregnancy, breastfeeding, or severe psychiatric disorders were excluded. Concomitant therapy with analgesics was allowed. However, patients receiving surgery or shock wave therapy after randomization were excluded.
Endpoints were the SF‐12 sum score, the CS sum score (Table 2), and VAS. Follow‐up was scheduled every 6 weeks for 1 year.
Two‐hundred and forty patients were calculated to detect a difference of 15% in the VAS and CS score, with a power of 80%, and an error probability of 5%. After randomization of 127 patients and an interim analysis of 107 patients, the study was closed early, as the intended increase in analgesic efficacy by the experimental treatment was very unlikely to be achieved.
The mean age of the patients in the standard group was 56.1 Gy in comparison with 58.1 Gy in the experimental group. The mean duration of symptoms before initiation of LD‐EBRT was 17 vs. 16 months. In 98% of the standard group and 93% of the experimental group a plantar spur was treated, in 2 and 7% a combined (plantar and dorsal) spur.
Results after 3 months have been issued so far [25], longer follow‐up has yet to be published. After 3 months, there were no significant differences neither in the VAS (standard 42.3 vs. experimental 44.4) nor the CS sum score (28 vs. 28.4) nor in the QOL (SF‐12) scores. Although longer follow‐up has to be awaited, a further increase in the analgesic effect by applying 12 × 0.5 Gy three times a week is unlikely. This is why this fractionation schedule is currently not recommended, as it does not follow the “as low as reasonable achievable” principle of radiation protection.
Further reduced single doses in LD‐EBRT (with the exception of 0.1 Gy [26]) have never been tested in a prospectively randomized clinical trial. In radiotherapy of degenerative joint disorders, single doses of about 0.3–0.4 Gy were established by von Pannewitz in the late 1920s and published in 1933 and 1970 [34, 35]. However, two studies on calcaneodynia have raised serious concerns on single doses as low as 0.3 Gy.
Seegenschmiedt et al. analyzed treatment efficacy in 141 patients (170 irradiated heels), who were treated from 1984–1994 with X‐ray units (250 kV/200 kV, 20 mA, 40 cm SSD), applying a single field of 6 × 8 cm [24]. Seventy‐two heels received 12 Gy with 6 × 1 Gy (three times a week) –6 weeks break – 6 × 1 Gy (group A), 50 heels were treated with 10 × 0.3 Gy every day (group B1), and 38 heels 10 × 0.5 Gy every day (group B2). The endpoint was the value of a semiquantitative pain score 3 months and in mean 4 years after LD‐EBRT.
The median age of patients was 55 years in group A and 59 years in group B1/B2. The mean duration of symptoms before LD‐EBRT was 8 months, in one‐third, the symptoms persisted for more than 6 months.
Complete pain remission was achieved in 68–71% of the patients without significant differences between the treatment groups. However, there were differences in the clinical course of patients with partial remission of the symptoms: The best results in these patients were achieved during longer follow‐up in group B1 (10 × 0.5 Gy), followed by group A (6 × 1–6 × 1 Gy), followed by group B2 (10 × 0.3 Gy). The latter group showed a significantly worse amelioration of symptoms than the other groups.
A reduced efficacy was also reported in another retrospective case series, comprising 673 heels treated with a single dose of 0.3 Gy three times weekly up to 1.5 Gy (X‐ray) [36]. In case of insufficient treatment results the patients were offered a second course. After the first treatment, only 13% reported CR, nearly all patients had undergone a second LD‐EBRT.
Taken together, to the best of our current knowledge a single dose of 0.5 Gy is standard of care and should only be modified in controlled clinical trials.
In Table 3 selected contemporary randomized trials and patient series are shown broken down into several factors that might be correlated with treatment efficacy. For a better overview, we did not differentiate between univariate and multivariate analyses. We did not try to collect all ever published data.
Duration of symptoms before start of LD‐EBRT has been shown to be correlated with treatment efficacy in numerous studies.
Muecke et al. analyzed in a retrospective multicenter study 502 patients [22]. Duration of symptoms ≤6 months was associated with 76% treatment success vs. 44% after a history >6 months. Also Seegenschmiedt et al. found in their large collectives a correlation between the duration of heel pain and treatment outcome [24]. A significant influence of duration of symptoms before LD‐EBRT was also reported in 73 heels by Schneider et al. [37]. With a history of 3–6 months, the VAS value was reduced by 85%, 28 months after LD‐EBRT in comparison with a reduction of 58% with a history > 6 months. Similar results were obtained by Hermann et al. in 285 heels comparing <12 month history of pain vs. >12 months [38].
In contrary, another study could not confirm these results [30].
To the best of our knowledge, in no study, an influence of gender on treatment outcome has been confirmed [22, 24, 30, 38, 39]. In contrast to radiotherapy for oncological indications with high doses, efficacy and tolerability of LD‐EBRT seems to be the same concerning gender.
Several studies described a correlation between older age and better treatment results, at least 6 weeks after LD‐EBRT [37]. Age somewhat over 50 years seems to be important: >50 years [40], > 53 [38], or > 58 [22]. For a possible explanation see Section 2.3.7.
However, other studies found no influence of this patient characteristic on treatment outcome [24, 30, 39].
A very precise registration of changes in pain intensity (VAS) was done by Schneider at al. [37]. Sixty‐two patients (73 treated heels) were prospectively scored every week during LD‐EBRT, at the end of therapy, 6 weeks, 28 months, and 40 months later. Additionally, subjective mechanical heel stress during LD‐EBRT was estimated. A linear accelerator (10 MV) was used, applying one single field with a size of 12 × 17 cm. Patients were treated twice a week to a total dose of 5 Gy, with increasing single fraction doses (0.25 – 0.25 – 0.5 – 1 – 1 – 1 – 1 Gy). Mean patient age was 54 years, and all had a radiologically proven plantar spurn, mean symptom duration before LD‐EBRT was 6.5 months. Nearly all patients had received other conservative therapies before LD‐EBRT with insufficient results.
Interestingly, VAS scores decreased continuously during LD‐EBRT: before treatment the mean value was 6.3 ± 1.5, after the first week of LD‐EBRT 6.2 ± 1.8, after the second week 5.5 ± 2 (
In standard schedules with fixed single doses a slight increase in pain during the treatment series was reported by 26% (during 6 × 0.5 Gy) vs. 29% (6 × 1 Gy) of the patients [30]. Unfortunately, a possible correlation of this phenomenon with definite treatment results was not investigated.
Without further quantification, another study (6 × 1 vs. 6 × 0.1 Gy) stated, that this initial increase in symptoms “had no influence on the final pain relief 3 and 12 months after treatment” [26]. Older studies postulated a temporary reduction of the pH value in the irradiated tissues at the beginning of the treatment series, without consequences for the long‐term efficacy of LD‐EBRT [41].
This is contrasted by observations of LD‐EBRT in peritendinitis humeroscapularis [42]. In 73 patients (86 shoulders) initial increase of pain during the treatment course was significantly associated with a good response.
Muecke et al. analyzed in a retrospective multicenter study the influence of different treatment techniques in 502 patients [22]. Treatment failure was defined as pain persistence after LD‐EBRT and recurrence of pain during follow‐up. Treatment with MV (6–10 MV) was a significant prognostic factor for pain relief in multivariate analysis, as MV was associated with an eight‐year event‐free probability of 68 vs. 61% after X‐ray beams (175 kV). There are two possible explanations for this finding: besides the possibility of a random result, the authors postulate a more homogenous dose distribution with MV treatment in comparison with KV [22].
Schneider et al. reported an efficacy of just one‐third after a second LD‐EBRT course (so‐called “re‐irradiation”) in comparison with the effects of the first course [37]. Out of 73 heels treated with 5 Gy LD‐EBRT 18 heels received reirradiation due to insufficient treatment response. However, pain reduction measured by means of changes in VAS shortly after the second course and during long‐term follow‐up was significantly diminished in comparison with the efficacy of the first course (about 30% reduction in pain at the last evaluation vs. 86%).
Similar results were obtained in the large retrospective series (502 patients) by Muecke et al. [22]. Treatment failure was significantly associated with the number of treatment series: eight‐year event‐free probability was about 70% after the first course in comparison with just about 30% after reirradiation.
A systematic study on the efficacy of a reirradiation has been published by Hautmann et al. [43]. Eighty‐three patients (101 heels) with insufficient response to the first course or recurrent pain afterward due to plantar fasciitis (83 heels), or achillodynia (28 heels) received a second LD‐EBRT course in median 10 weeks (range 4 weeks to 63 months) after the first LD‐EBRT. About 75% of the patients were treated with 6 × 1 Gy, the others 6 × 0.5 Gy. The pain was assessed using the numeric rating scale (NRS) before and at the end of LD‐EBRT, 6, and 12 weeks, and 6, 12, and 24 months thereafter.
Before reirradiation NRS values were 6 (interquartile range 5–8), at the end of LD‐EBRT 5 (2–6), 6 weeks later 2 (1–4), at 12 weeks 1 (0–3), at 6 months 0 (0–2), at 12 and 24 months 0 (0–1). Interestingly, not only the patients with recurrent pain after the first course but also patients with insufficient responses to the first course experienced a profound and long‐lasting amelioration of their symptoms after the second course.
This is why a second treatment course should be recommended in case of insufficient efficacy of the first course.
A significant correlation between avoidance of heel stress during LD‐EBRT and efficacy of LD‐EBRT 6 weeks after therapy was reported by Schneider et al. in 73 heels [37]. With a Pearson\'s correlation coefficient of -0.467 (
An intuitive explanation is given by the authors [37]: As patient age was associated with positive treatment results, too, they proposed that older patients are often retired, thus being able to take more care of their heels.
Interestingly, all randomized trials required the radiological proof of a heel spur before including patients into the studies. Furthermore, most of the prospective and retrospective series warranted such an objective sign. However, as a substantial part of the patients suffers from plantar heel pain without having developed a heel spur, LD‐EBRT should be effective in these patients, too.
Hermann et al. analyzed treatment efficacy in 250 patients (285 heels), who received LD‐EBRT predominantly with 6 × 1 Gy [38]. In this series, 33% of the treated heels were without radiological evidence of a spur. In 185 patients a spur was confirmed with a mean length of 6.5 mm (range 0.6–25 mm). Patients without evidence of a plantar heel spur had a significantly higher chance of CR after LD‐EBRT (43 vs. 35%). Furthermore, the length of the spurs correlated directly with treatment outcome. Spurs >6.5 mm had just a 30% chance of experiencing CR in comparison with shorter ones. No statistical differences were found between treatment results of heels without spurs and those with spurs ≤6.5 mm.
Miszczyk et al. reported on 327 patients (623 LD‐EBRT series) mostly treated with X‐ray (180 kV, usually 1mm Cu filters) with single doses of 1.5 Gy (range 1–3 Gy) up to a total dose between 9 and 12 Gy (range 1–45 Gy) [39]. Mean spur size was 9 mm (range 1–30 mm). With a mean follow‐up of 74 months, no correlation between spur size and duration of pain relief was found. Analysis concerning spur length and treatment outcome in itself were unfortunately not reported.
Multivariate logistic regression enables the identification of factors independently predicting treatment outcome. By combining these factors, models can be calculated, that predict treatment outcome with a high probability. An example from the study of Hermann et al. is given in Table 4: in 285 heels treated with 6 × 1 Gy/6 × 0.5 Gy the influences of the patient characteristics age, spur length, and duration of symptoms before LD-EBRT alone and in combination were calculated [38]. The best results were obtained for patients > 53 years, spur length <6 mm, and a duration of symptoms <12 months with a probability for CR of 55% (CI 36–73%) and PR of 38% (CI 22–58%). Without these characteristics, the chance for CR was just 18% (CI 9–33%), for PR 31% (17–48%).
Study (citation) | [30] | [26] | [24] | [37] | [39] | [22] | [38] | [40] | [83] |
---|---|---|---|---|---|---|---|---|---|
Rand | Rand | Prospect | Prospect | Retrospect | Retrospect | Retrospect | Retrospect | Retrospect | |
130 | 66 | 170 | 73 | 623 | 502 | 285 | 161 | 7947 | |
MV | MV | KV | MV | KV | MV, KV | MV | KV | MV, KV | |
calcaneus | calcaneus | calcaneus | entire dorsal and middle foot | insertion of plantar fascia | calcaneus | calcaneus vs. insertion of calcaneus | calcaneus | entire dorsal foot vs. calcaneus vs. insertion of plantar fascia | |
6 × 1 vs. 6 × 0.5 Gy | 6 × 1 Gy vs. 6 × 0.1 Gy | 12, 3, 5 Gy | 5 Gy (increasing single dose) | 1.5 (1–3) up to 9–12 Gy (1–45) | 5–10 × 0.5–1 Gy | 6 × 1 Gy6 × 0.5 Gy | 6 × 1 Gy | 0.3–1.5 Gy; 2–3x weekly 2.5–18.76 Gy | |
History of symptoms | 0 | n.i. | + | + | 0 | + | + | + | + |
Gender | 0 | n.i. | 0 | n.i. | 0 | 0 | 0 | n.i. | n.i. |
Patient\'s age | 0 | n.i. | 0 | + | 0 | + | + | + | n.i. |
Initial worsening of pain during LD‐EBRT | n.i. | n.i. | n.i. | n.i. | n.i. | n.i. | n.i. | n.i. | n.i. |
MV vs. KV | n.i. | n.i. | n.i. | n.i. | n.i. | + | n.i. | n.i. | 0 |
Number of therapy series | n.i. | n.i. | n.i. | + | n.i. | + | n.i. | n.i. | + |
Heel stress during LD‐EBRT | n.i. | 0 | n.i. | + | n.i. | n.i. | n.i. | n.i. | n.i. |
Factors associated with treatment efficacy in contemporary studies.
Patient\'s age >53 | No spur or spur ≤6.5 mm | Duration of symptoms <12 months | Probability of | ||
---|---|---|---|---|---|
No change | Partial remission | Complete remission | |||
1 | 1 | 1 | 0.07 (0.03–0.14) | 0.38 (0.22–0.58) | 0.55 (0.36–0.73) |
1 | 1 | 0 | 0.13 (0.07–0.28) | 0.37 (0.21–0.57) | 0.50 (0.30–0.70) |
1 | 0 | 1 | 0.15 (0.06–0.24) | 0.53 (0.33–0.72) | 0.32 (0.17–0.53) |
1 | 0 | 0 | 0.25 (0.13–0.45) | 0.48 (0.27–0.69) | 0.27 (0.13–0.48) |
0 | 1 | 1 | 0.17 (0.10–0.31) | 0.33 (0.19–0.50) | 0.50 (0.33–0.66) |
0 | 1 | 0 | 0.34 (0.20–0.53) | 0.40 (0.24–0.59) | 0.26 (0.13–0.45) |
0 | 0 | 1 | 0.30 (0.20–0.46) | 0.29 (0.18–0.43) | 0.41 (0.27–0.56) |
0 | 0 | 0 | 0.51 (0.35–0.69) | 0.31 (0.17–0.48) | 0.18 (0.09–0.33) |
Probabilities (95%‐CI) for NC, PR and CR calculated by polytomous logistic regression in dependence of the risk factors age, spur length, and duration of symptoms before LD‐EBRT according to Hermann et al. in a collective of 285 heels treated with 6 × 1/6 × 0.5 Gy (taken from [38]).
In modern radiotherapeutic departments, X‐ray sources are less and less available. This is why nowadays most patients are treated with linear accelerators, which were initially developed for the treatment of oncological diseases. However, these machines can be used in the treatment of benign diseases without any modifications or problems. Due to the high efforts in physical, technical, and organizational quality assurances for the operation of an accelerator or an X-ray source, the concentration on accelerators and their use for all indications is recommended.
For irradiation of the heel, the patient has to be placed on the treatment couch with the feet toward the gantry of the accelerator (so‐called “feet first”). Two different patient positions are widely used. He can be placed in supine position, with the irradiated leg is stretched out, while the other leg is angled. Another option is to place the patient in a lateral decubitus position on the side of the involved heel. Again, the symptomatic leg is stretched, while the contralateral leg is bent, with a cushion placed beneath the knee. Using X‐rays, the ipsilateral knee is bent by 90% and the foot is positioned on the treatment table. One anterior‐posterior (AP) beam is usually applied in this technique.
For the treatment itself, there are also two different options. Irradiation may be given as a single stationary field (SSD 100cm by convention). Alternatively, parallel opposing fields from 0° and 180° gantry position (in decubitus position) or lateral opposing fields (90° and 270° in supine position) are also applicable but take a little bit longer in daily clinical practice. The hypothetical advantage of using two opposing fields is a uniform dose distribution in the entire beam path in the calcaneus (Figure 1). However, there has never been a clinical proof, whether this theoretical assumption translates into any clinical advantage for the patient. When applying opposing fields, the dose is specified according to the ICRU 50 report, normally in the center of the calcaneus.
Dose distribution of two different treatment techniques generated in a treatment planning system (XIO®). In A and B just one single 6 MV photon field (8 × 8 cm) is applied, while C and D shows the dose distribution with two opposing fields from 0 and 180°. In the upper row, the so‐called “beams eye views” are given, while in the lower row the respective dose distributions on an axial CT scan directly at the calcaneal insertion are shown. Note the more uniform dose distribution with opposing fields. The 95% isodose is given as a green line (2.85 Gy). This dose encompasses larger parts of the calcaneal bone in D (opposing fields) than in B (single field). More information is given in Section 2.4.
A third option is the so‐called “plantar field” with the patient lying in prone position. A single field is positioned directly over the plantar insertion/calcaneus, potentially with rotations of the patient table and the gantry to compensate for inclinations of the patients surface in the irradiated field. However, this technique is regarded problematic when using linear accelerators due to the dose build‐up effect in the critical tissue depth. This problem is illustrated in Figure 2: photons with 6 MV reach just the half of the prescribed dose at the skin level, 100% is reached at 1.5 cm tissue depth. This would result in an insufficient dose in the critical structures (plantar fascia and heel spur). To overcome this problem, a silicone flap of about 1 cm diameter must be positioned on the skin before radiation.
Depth curves of different megavoltage energies. Blue 6 MV photons, red 15 MV photons. At the surface of the body/skin (depth 0 mm), only half (or even less with 15 MV) of the prescribed dose is applied. By physical interactions between photons and the tissue/water, there is a steep increase in dose. A 100% is reached at 1.5 cm depth with 6 MV and at about 3 cm depth with 15 MV. KV‐radiation reaches the maximum dose directly under the surface/skin (not shown). More information is given in Section 2.4.
Patients are often sent to the radiotherapist after a long unsuccessful history of diverse conservative treatments. The reason for this is a widespread fear among general practitioners that LD‐EBRT might be associated with severe side effects and risks. These fears are not substantiated, as reactions of the nerves or vessels require much higher doses than used for LD‐EBRT. For example, a dose of 45 Gy in normofractionated oncological therapy is considered to be safe for the spinal cord and therefore daily clinical practice [44]. Peripheral nerves are even more radioresistant. Acute or chronic side‐effects have never been reported in all contemporary studies on LD‐EBRT.
Acute side effects are negligible, as very low doses of ionizing radiation (in comparison with oncological treatments) are applied to a distal extremity. The total dose of LD‐EBRT with 3 or 6 Gy is far too low to cause any acute or late reactions on the skin overlaying the calcaneus. During normofractionated EBRT (single doses of 1.8–2 Gy, treatment on 5 days a week) erythema and mild edema develop at about 30 Gy [45]. Hyperpigmentation occurs at about 45 Gy, moist epitheliolyses at about 50 Gy. A 50–60 Gy might cause telangiectasias years after the therapy. This is why there is no report on acute treatment side effects in LD‐EBRT until now to the best of our knowledge.
About one‐third of the patients might experience a slight increase in pain during LD‐EBRT. In the randomized trial by Heydt et al. this phenomenon was seen in 26% (during 6 × 0.5 Gy) vs. 29% (6 × 1 Gy) [30]. It does not seem to be correlated with treatment outcome; further detailed information is given in Section 2.3.4.
The dose scattered to the male gonads is somewhat higher than to the ovaries. Jansen et al. calculated for 6 × 0.5 Gy about 1.5 mSv received by the testes and 0.75 mSv to the ovaries [46]. Comparable results have repeatedly been measured in the past [47, 48].
Taken together, the dose received by the gonads is insignificant. As the distal extremity is irradiated, scattered dose to the gonads is comparable to normal diagnostic radiological imaging [49]. The hereditary effects of these doses are very small and very likely negligible [46].
Although spermatogonial cells are very radiosensitive, a single dose of at least 100 mSv is needed to induce a temporary failure of spermatogenesis [50]. A single dose of 1000 mSv (equivalent to 1 Gy photon irradiation) results in an azoospermia for 9–18 months [51]. Interestingly, fractionated doses harm these cells even more. A temporary oligospermia is reported after receiving several fractions up to a cumulative dose of 160 mSv [52]. An azoospermia lasting for 14–22 months has been reported for fractionated doses of 620–860 mSv [53]. The actually during LD‐EBRT received testicular dose is about 100 times smaller than the lowest dose causing temporary changes in testicular tissues.
The dose to the testicles can be further reduced by utilizing a special testicular shielding. However, clinically meaningful dose reductions have been only measured in MV treatment of subdiaphragmatic/pelvine lymphatic regions or tumors [54, 55].
The mean lethal dose for human oocytes has been estimated at 2 Gy (2000 mSv) [56]. Permanent ovarian failure after radiotherapy is age dependent: in perimenopausal women, a dose of 6 Gy is sufficient [57], while in younger women up to 20 Gy are tolerated. The dose scattered to the ovaries during LD‐EBRT for calcaneodynia cannot cause such sequelae (0.75 mSv).
Naturally, pregnancy has to be excluded in all premenopausal women before beginning with LD‐EBRT, to avoid any risk to the fetus.
So far, no studies with long‐term observation periods have been published, describing a case of malignancy induced by LD‐EBRT for calcaneodynia. However, induction of malignancies is a stochastic effect of ionizing radiation. This means that there is no threshold dose—in contrast for example to the above‐mentioned reactions of the skin. A photon can accidentally trigger a mutation, which in turn leads to tumor formation many years later. The higher the radiation dose, the higher the probability of such an event occurring.
The best available data on tumor induction of full dose EBRT in oncology has been collected in patients treated with breast cancer. Almost 11,000 patients have been followed for over 20 years. The risk of a radiation‐induced tumor was approx. 1% per decade after radiotherapy [58].
To estimate the risk associated with much lower doses of LD‐EBRT, mathematical models on the basis of epidemiological long‐term observations of atomic bomb victims have been developed by the ICRP [59].
Jansen et al. applied the ICRP model on LD‐EBRT of a painful heel spur [46]. Assumed was a single field entering at the foot sole with a size of 8 × 10 cm, 200 kV photons, SSD 40 cm. For an LD‐EBRT series with 6 × 1 Gy the average attributable lifetime risk for induction of a fatal tumor was calculated to be about 0.5 in a thousand patients. An important risk factor for radiogenic‐induced cancer is the patient\'s age by the time the radiation exposure occurs. The risk is already reduced in the 3rd decade of the patient\'s life, it starts to decrease steadily from the age of 40 [60]. Applying these calculations, the estimated lifetime risk per one thousand patients for a fatal tumor accounts for the age of 25 0.6 (male)/0.8 (female), for the age of 50 0.2/0.3, for the age of 75 0.07/0.1 [46].
However, it must be critically noted that this mathematical model was developed for radiation protection and relates to the exposure of complete organ systems with approx. 1 Gy. Therefore, other groups argue that a significantly lower risk of radiogenic cancer induction— approx. ten times less—should be adopted [49, 61]. Furthermore, taken the new standard scheme with 6 × 0.5 Gy into account, these risks are additionally halved.
This risk (max. 1/1000, very likely much lower) must be seen in relation to the tumor risk of the not additionally radiotherapeutical‐treated population. In 2008, the lifetime risk of a man in Germany to suffer from cancer was 50.7% (25.9% to die from malignancy), in women 42.8% and 20.2% respectively [62].
By limiting the application of LD‐EBRT treatment to patients > 30 years of age, an exposure of the juvenile “relatively higher risk” patient population is avoided.
Traditionally target volume definition has been quite large. Field sizes of 12 × 17cm were treated, including the entire dorsal and middle foot, and not just the calcaneus [37, 82] (Figure 3A).
Field definitions in LD‐EBRT of a painful plantar heel spur/fasciitis. (A) traditional field definition including the entire dorsal and middle foot. (B) In randomized trials and large prospective series commonly used field definition encompassing the entire calcaneus, including insertion of the plantar fascia and the Achilles tendon. (C) Proposed small field definition for localized painful plantar fasciitis/plantar spur, encompassing only the painful area with 2 cm margins extending into the neighboring areas (calcaneus, fascia, fat pad).
In the recent randomized trials and prospective observational studies target volume definition was more restricted and confined to the calcaneus (Figure 3B). “The target volume consisted of the calcaneus and the region of the plantar aponeurosis” [26]. “The ventral margin is corresponding to the ventral surface of the calcaneus, the plantar and dorsal margins are surrounding the soft‐tissue border, and the cranial margin is below the ankle” [30]. “Target volume is the calcaneus, normally with a field size of 6 cm × 8 cm” [32]. “The calcaneus and the plantar aponeurosis were included in the target volume” [25].
In a German national survey 2001 on LD‐EBRT of painful heel spurs the target volume definition “large” (dorsal and middle foot) vs. “small” (entire calcaneus) was not correlated with treatment outcome [83]. Consequently, very large field definitions should be regarded as obsolete.
However, as the pathophysiological cause of calcaneodynia is thought to be a localized inflammatory process (see Section 1), it is questionable, whether the entire calcaneus has to be irradiated (as long as there are not a plantar as well as a painful dorsal spurs). There are some clinical data that support a further restriction of target volume definition.
Field sizes have been given in the study by Miszczyk et al. on 327 patients treated with X‐ray beams [39]. Target volume was “… the insertion of the plantar fascia with a calcaneal spur and a reasonable margin. The field size varied from 27 to 150 cm2 (mean 47 cm2).” However, although not explicitly stated, no correlation was found between field size and duration of pain relief after LD‐EBRT. Treatment efficacy in itself was apparently not investigated.
In the above‐mentioned series of 285 heels Hermann et al. analyzed treatment efficacy in dependence of field sizes, too [38]. The mean field size was 74 cm2. No correlation between field size (smaller vs. larger than 74 cm2) with treatment efficacy was found. Further analyses of small fields (< 6 × 6 cm), medium‐sized fields (36–64 cm2) and larger fields revealed no significant differences.
This is why it seems to suffice to encompass the painful region with 2 cm margins extending into the neighboring areas (calcaneus, fascia, fat pad; Figure 3C). However, this recommendation is deducted from pathophysiological considerations and the above‐mentioned case series. A randomized trial is necessary to proof clinical equivalence of a field definition “entire calcaneus” (Figure 3B) vs. “insertion of the plantar fascia” (Figure 3C).
The optimal fractionation schedule has not been elucidated yet. All randomized trial used twice weekly treatments. Only one experimental arm was scheduled three times a week [25]. In a National Survey in Germany with 146 answering institutions, about 45% applied two fractions and 37.5% three fractions weekly [83].
Interestingly, in the landmark study by von Pannewitz a fractionation schedule of only once per week was established [34]. Until now, there is no proof of a higher efficacy applying LD‐EBRT twice or three times per week.
In radiotherapy of another benign disease (endocrine orbitopathy) a 1 Gy per week over 20 weeks schedule was more effective than the standard schedules (10 × 2 Gy or 10 × 1 Gy every working day) [84]. Although other immunological mechanisms cause endocrine orbitopathy in comparison with plantar fasciitis, there is sufficient clinical evidence to test in a randomized trial different fractionation schedules (twice a week vs. once a week, possibly thrice a week).
Other therapies than LD‐EBRT have been applied in painful heel spur. In the following, just a rough overview can be given.
Different kinds of insoles and foot orthoses have been developed. The goal was to reduce plantar contact pressure and to distribute the pressure uniformly over the whole rearfoot [63]. Magnetic insoles do not seem to provide additional benefit [64]. As a short‐term treatment, low‐Dye taping techniques are often used. However, in a randomized trial only a modest improvement in ‘first‐step’ pain was seen in comparison with sham‐intervention [65].
Manual stretching is often recommended. A systematic review of six studies found only statistically significant differences in comparison with the control in one study combining calf muscle and plantar fascia stretches [66].
Several trials have investigated acupuncture. A systematic review from 2010 showed (limited) evidence for the effectiveness [67]. A randomized trial published in 2014 recruited 84 patients [68]. The authors concluded, that “dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.”
Ultrasound therapy has led to questionable results [69], but a randomized trial on cryo‐ultrasound with about 100 patients published in 2014 showed good effectiveness [70].
Low‐level laser light (635 nm), given twice a week for a total of six applications, reduced in a randomized trial VAS scores significantly after 8 weeks in comparison with placebo [71]. However, the study comprised of just 69 patients; other similar studies have not been reported so far.
Extracorporeal shock waves are widely applied. Three metaanalyses comprising at least five randomized trials found significant short‐term pain relief and improved functional outcomes for this therapeutic option [72–74]. Another study compared the analgesic efficacy of ultrasound and shock wave therapy in 47 patients [75]. The results suggested that the shock wave therapy had greater analgesic efficacy.
Another basic approach is the oral administration of nonsteroidal anti‐inflammatory drugs (NSAID) to achieve a symptomatic relief. Injections into the painful area are also recommended. A recent review summarized ten randomized trials on corticosteroid injections into the plantar fascia [76]. A significant effect of the steroids on the pain has been shown. However, it was usually short‐term, lasting 4–12 weeks in duration. No advantage of ultrasound‐guided injection techniques in comparison with palpation guidance was found, and no superiority of one type of corticosteroid over another was seen. A longer lasting pain relief has been suggested by a small randomized trial of botulinum toxin injections [77]. Another option is the injection of autologous platelet‐rich plasma. A recent review identified three randomized trials, all showing promising results [78]. However, a very small trial challenged this method of plasma preparation, as the same clinical effectivity was observed after the injection of whole blood [79].
Different surgical approaches have been developed. Releases of the plantar fascia are done, in some studies combined with a spur resection [80]. Due to a probably faster recovery after surgery with comparable functional results endoscopic procedures are recommended nowadays [81]. Surgery is usually indicated after failure of conservative therapies as the ultimate “salvage‐therapy.”
There is only a limited amount of studies randomizing patients between LD‐EBRT and the above‐mentioned alternative therapies.
Canyilmaz et al. randomized 123 patients between LD‐EBRT (6 × 1 Gy, three times a week) and 1 ml injection of 40 mg methylprednisolone and 0.5 ml 60 mg 1% lidocaine under the guidance of palpation [85]. After 3 and 6 months, VAS values and CS‐scores were compared between both groups. After 3 months, the results in the radiotherapy arm were significantly superior compared with those after injections.
To corroborate these findings, similar studies should be conducted. Furthermore, more studies randomizing LD‐EBRT against other therapies (e.g. extracorporeal shock waves) are needed. A minimum size of 50 patients per treatment arm should be assured to gain more statistically relevant results. Recruiting patients without prior excessive other therapies for these studies would be optimal.
The goal must be an evidence‐based algorithm defining the therapeutic sequence of the different conservative treatment modalities for plantar fasciitis.
LD‐EBRT for painful plantar fasciitis/heel spur is an effective and safe treatment option for patients over 30 years of age and after exclusion of pregnancy. A fractionation of 6 × 0.5 Gy twice weekly up to a total dose of 3 Gy is currently recommended. In the case of an insufficient response a second course can be offered to the patient.
Randomized trials on target volume definition and further optimization of LD‐EBRT fractionation are currently in the process of planning. Further trials to compare the different conservative therapies for plantar fasciitis with each other are necessary to allow the development of an evidence‐based treatment algorithm.
This chapter is dedicated to Professor Gisela Hermann‐Brennecke on the occasion of her 70th birthday.
AP | anterior‐posterior |
CI | confidence interval |
CR | complete remission |
CS | Calcaneodynia score |
Cu | chemical element symbol for copper |
EC | endothelial cells |
GCG‐BD | German Cooperative Group on Radiotherapy for Benign Diseases |
Gy | Gray |
ICRP | International Commission on Radiological Protection |
IL | interleukin |
iNOS | inducible nitric oxide synthases |
KV | kilovoltage |
LD‐EBRT | low dose external beam radiotherapy |
mA | milliampere |
mRNA | messenger ribonuclein acid |
mSv | milliSievert |
MV | megavoltage |
NC | no change |
NF‐κB | nuclear factor kappa B |
NO | nitric oxide |
NSAID | non‐steroidal anti‐inflammatory drug |
PBMC | peripheral blood mononuclear cells |
PR | partial remission |
QOL | quality of life |
ROS | reactive oxygen species |
SSD | skin‐to‐source distance |
TGF‐β1 | transforming growth factor β1 |
VAS | visual analogue scale |
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Spontaneous mutation, the natural process that develops new allele copies of a gene was the only source of genetic diversity until the 20th century. Besides, mutations can also be induced artificially using physical or chemical mutagens. Chemical mutations received popularity due to its efficiency in creating gene mutations contrary to chromosomal changes. Mutation has played a vital role in the improvement of crop productivity and quality, resultantly > 3,000 varieties of 175 plant species have been developed either through direct or indirect induced mutation breeding approaches worldwide. The advances in plant breeding also achieved through molecular marker technology. The in vitro mutagenesis, heavy-ion beam, and space mutation breeding are being efficiently used to create genetic variability to improve various complicated traits in crop plants. In mutation breeding, TILLING (Targeting Induced Local Lesions in Genomes), a more advanced molecular technique is being used to identify specific sequential genomic changes in mutant plants. Therefore, the mutation breeding in combination with molecular techniques could be an efficient tool in plant breeding programs. This chapter will discuss and review the mutation breeding application for the improvement of crop productivity and environmental stresses.",book:{id:"9743",slug:"genetic-variation",title:"Genetic Variation",fullTitle:"Genetic Variation"},signatures:"Arain Saima Mir, Meer Maria, Sajjad Muhammad and Sial Mahboob Ali",authors:[{id:"329068",title:"Dr.",name:"Arain Saima Mir",middleName:null,surname:"Saima Mir",slug:"arain-saima-mir-saima-mir",fullName:"Arain Saima Mir Saima Mir"},{id:"330046",title:"Ms.",name:"Meer",middleName:null,surname:"Maria",slug:"meer-maria",fullName:"Meer Maria"},{id:"330047",title:"Dr.",name:"Sajjad",middleName:null,surname:"Muhammad",slug:"sajjad-muhammad",fullName:"Sajjad Muhammad"},{id:"330048",title:"Dr.",name:"Sial",middleName:null,surname:"Mahboob Ali",slug:"sial-mahboob-ali",fullName:"Sial Mahboob Ali"}]},{id:"65713",title:"Introductory Chapter: Population Genetics - The Evolution Process as a Genetic Function",slug:"introductory-chapter-population-genetics-the-evolution-process-as-a-genetic-function",totalDownloads:2369,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"6974",slug:"integrated-view-of-population-genetics",title:"Integrated View of Population Genetics",fullTitle:"Integrated View of Population Genetics"},signatures:"Rafael Trindade Maia and Magnólia de Araújo Campos",authors:[{id:"212393",title:"Prof.",name:"Rafael",middleName:"Trindade",surname:"Trindade Maia",slug:"rafael-trindade-maia",fullName:"Rafael Trindade Maia"}]},{id:"71577",title:"Single Nucleotide Polymorphisms (SNPs) in Plant Genetics and Breeding",slug:"single-nucleotide-polymorphisms-snps-in-plant-genetics-and-breeding",totalDownloads:1523,totalCrossrefCites:9,totalDimensionsCites:11,abstract:"Recent advances in genome technology revealed various single nucleotide polymorphisms (SNPs), the most common form of DNA sequence variation between alleles, in several plant species. The discovery and application of SNPs increased our knowledge about genetic diversity and a better understanding on crop improvement. Natural breeding process which takes an agelong time during collecting, cultivating, and domestication has been accelerated by detecting dozens of SNPs on various species using advanced biotechnological techniques such as next-generation sequencing. This will result in the improvement of economically important traits. Therefore, we would like to focus on the discovery, current technologies, and applications of SNPs in breeding. The chapter covers the following topics: (1) introduction, (2) application of SNPs, (3) techniques to detect SNPs, (4) importance of SNPs for crop improvement, and (5) conclusion.",book:{id:"7947",slug:"the-recent-topics-in-genetic-polymorphisms",title:"The Recent Topics in Genetic Polymorphisms",fullTitle:"The Recent Topics in Genetic Polymorphisms"},signatures:"Hande Morgil, Yusuf Can Gercek and Isil Tulum",authors:null},{id:"71702",title:"Single-Nucleotide Polymorphisms in Inflammatory Bowel Disease",slug:"single-nucleotide-polymorphisms-in-inflammatory-bowel-disease",totalDownloads:1002,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Inflammatory bowel disease (IBD) mainly includes ulcerative colitis (UC) and Crohn’s disease (CD). Both conditions are characterized by chronic inflammation of the gastrointestinal tract, with alternating periods of relapse and remission. Both forms of IBD involve an uncontrolled inflammatory process in the intestines, leading to worsening quality of life and requiring long-term medical and/or surgical intervention. Epidemiological and clinical studies suggest that the pathogenesis of inflammatory bowel disease is strongly linked to genetic predisposition. CD and UC are considered polygenic diseases in which familial clustering is observed in 5–10% of patients. Among genetic factors associated with IBD development, it has been found that many single nucleotide polymorphisms are associated with susceptibility to IBD progression. SNP can affect the production or function of a protein and thus affect the development of the disease. However, although the overall role of genes involved in the development of IBD is already in most cases known, as of today it is unclear how the SNPs in these genes affect cellular function, or how such changed cellular functions would contribute to the development of IBD. In the present work several selected polymorphisms in genes involved in IBD development are discussed.",book:{id:"7947",slug:"the-recent-topics-in-genetic-polymorphisms",title:"The Recent Topics in Genetic Polymorphisms",fullTitle:"The Recent Topics in Genetic Polymorphisms"},signatures:"Ewa Dudzińska",authors:null}],onlineFirstChaptersFilter:{topicId:"61",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"7",title:"Bioinformatics and Medical Informatics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",isOpenForSubmission:!0,editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",slug:"slawomir-wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",biography:"Professor Sławomir Wilczyński, Head of the Chair of Department of Basic Biomedical Sciences, Faculty of Pharmaceutical Sciences, Medical University of Silesia in Katowice, Poland. 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He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. His research interests include Biomedical Signal Processing and Modelling, Assistive Technology, Rehabilitation Engineering, Neuroengineering and Parkinson's Disease.",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",isOpenForSubmission:!0,editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",slug:"luis-villarreal-gomez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",biography:"Dr. Luis Villarreal is a research professor from the Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana, Baja California, México. Dr. Villarreal is the editor in chief and founder of the Revista de Ciencias Tecnológicas (RECIT) (https://recit.uabc.mx/) and is a member of several editorial and reviewer boards for numerous international journals. He has published more than thirty international papers and reviewed more than ninety-two manuscripts. 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His fields of interest are anterior segment disease, keratoconus, glaucoma, corneal dystrophies, and cataracts. His research topics include\nintraocular lens power calculation, eye modification induced by refractive surgery, glaucoma progression, and validation of new diagnostic devices in ophthalmology. \nHe has published more than 100 papers in international and Italian scientific journals, more than 60 in journals with impact factors, and chapters in international and Italian books. He has also edited two international books and authored more than 150 communications or posters for the most important international and Italian ophthalmology conferences.",institutionString:'University of Campania "Luigi Vanvitelli"',institution:{name:'University of Campania "Luigi Vanvitelli"',institutionURL:null,country:{name:"Italy"}}}]},{type:"book",id:"7560",title:"Non-Invasive Diagnostic Methods",subtitle:"Image Processing",coverURL:"https://cdn.intechopen.com/books/images_new/7560.jpg",slug:"non-invasive-diagnostic-methods-image-processing",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Mariusz Marzec and Robert Koprowski",hash:"d92fd8cf5a90a47f2b8a310837a5600e",volumeInSeries:3,fullTitle:"Non-Invasive Diagnostic Methods - Image Processing",editors:[{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null}]},{type:"book",id:"6843",title:"Biomechanics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6843.jpg",slug:"biomechanics",publishedDate:"January 30th 2019",editedByType:"Edited by",bookSignature:"Hadi Mohammadi",hash:"85132976010be1d7f3dbd88662b785e5",volumeInSeries:4,fullTitle:"Biomechanics",editors:[{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",institutionURL:null,country:{name:"Canada"}}}]}]},openForSubmissionBooks:{paginationCount:3,paginationItems:[{id:"11601",title:"Econometrics - Recent Advances and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11601.jpg",hash:"bc8ab49e2cf436c217a49ca8c12a22eb",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 13th 2022",isOpenForSubmission:!0,editors:[{id:"452331",title:"Dr.",name:"Brian",surname:"Sloboda",slug:"brian-sloboda",fullName:"Brian Sloboda"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"12141",title:"Leadership - Advancing Great Leadership Practices and Good Leaders",coverURL:"https://cdn.intechopen.com/books/images_new/12141.jpg",hash:"85f77453916f1d80d80d88ee4fd2f2d1",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 1st 2022",isOpenForSubmission:!0,editors:[{id:"420133",title:"Dr.",name:"Joseph",surname:"Crawford",slug:"joseph-crawford",fullName:"Joseph Crawford"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"12139",title:"Global Market and Trade",coverURL:"https://cdn.intechopen.com/books/images_new/12139.jpg",hash:"fa34af07c3a9657fa670404202f8cba5",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"July 21st 2022",isOpenForSubmission:!0,editors:[{id:"243649",title:"Dr.Ing.",name:"Ireneusz",surname:"Miciuła",slug:"ireneusz-miciula",fullName:"Ireneusz Miciuła"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:10,paginationItems:[{id:"82380",title:"Evolution of Parasitism and Pathogenic Adaptations in Certain Medically Important Fungi",doi:"10.5772/intechopen.105206",signatures:"Gokul Shankar Sabesan, Ranjit Singh AJA, Ranjith Mehenderkar and Basanta Kumar Mohanty",slug:"evolution-of-parasitism-and-pathogenic-adaptations-in-certain-medically-important-fungi",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fungal Infectious Diseases - Annual Volume 2022",coverURL:"https://cdn.intechopen.com/books/images_new/11400.jpg",subseries:{id:"4",title:"Fungal Infectious Diseases"}}},{id:"82367",title:"Spatial Variation and Factors Associated with Unsuppressed HIV Viral Load among Women in an HIV Hyperendemic Area of KwaZulu-Natal, South Africa",doi:"10.5772/intechopen.105547",signatures:"Adenike O. 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He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. 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He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. 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She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. 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Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. Voyich",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Montana State University",country:{name:"United States of America"}}},{id:"330412",title:"Dr.",name:"Muhammad",middleName:null,surname:"Farhab",slug:"muhammad-farhab",fullName:"Muhammad Farhab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"349495",title:"Dr.",name:"Muhammad",middleName:null,surname:"Ijaz",slug:"muhammad-ijaz",fullName:"Muhammad Ijaz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}}]}},subseries:{item:{id:"20",type:"subseries",title:"Animal Nutrition",keywords:"Sustainable Animal Diets, Carbon Footprint, Meta Analyses",scope:"An essential part of animal production is nutrition. Animals need to receive a properly balanced diet. One of the new challenges we are now faced with is sustainable animal diets (STAND) that involve the 3 P’s (People, Planet, and Profitability). We must develop animal feed that does not compete with human food, use antibiotics, and explore new growth promoters options, such as plant extracts or compounds that promote feed efficiency (e.g., monensin, oils, enzymes, probiotics). These new feed options must also be environmentally friendly, reducing the Carbon footprint, CH4, N, and P emissions to the environment, with an adequate formulation of nutrients.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11416,editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. He is a research professor at the Faculty of Veterinary Medicine and Animal Husbandry, Autonomous University of the State of Mexico. He is also a level-2 researcher. He received a Fulbright-Garcia Robles fellowship for a postdoctoral stay at the US Dairy Forage Research Center, Madison, Wisconsin, USA in 2008–2009. He received grants from Alianza del Pacifico for a stay at the University of Magallanes, Chile, in 2014, and from Consejo Nacional de Ciencia y Tecnología (CONACyT) to work in the Food and Agriculture Organization’s Animal Production and Health Division (AGA), Rome, Italy, in 2014–2015. He has collaborated with researchers from different countries and published ninety-eight journal articles. He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,series:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517"},editorialBoard:[{id:"175762",title:"Dr.",name:"Alfredo J.",middleName:null,surname:"Escribano",slug:"alfredo-j.-escribano",fullName:"Alfredo J. 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