International Small Animal Cardiac Health Council System (ISACHC) and American College of Internal Medicine (ACVIM) classification in dogs with heart failure.
\\n\\n
These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\\n\\n\\n\\n\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\n\n\n\n\n'}],latestNews:[{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"},{slug:"intechopen-identified-as-one-of-the-most-significant-contributor-to-oa-book-growth-in-doab-20210809",title:"IntechOpen Identified as One of the Most Significant Contributors to OA Book Growth in DOAB"}]},book:{item:{type:"book",id:"4458",leadTitle:null,fullTitle:"Mechatronic Systems Simulation Modeling and Control",title:"Mechatronic Systems",subtitle:"Simulation Modeling and Control",reviewType:"peer-reviewed",abstract:"This book collects fifteen relevant papers in the field of mechatronic systems. Mechatronics, the synergistic blend of mechanics, electronics, and computer science, integrates the best design practices with the most advanced technologies to realize high-quality products, guaranteeing at the same time a substantial reduction in development time and cost. Topics covered in this book include simulation, modelling and control of electromechanical machines, machine components, and mechatronic vehicles. New software tools, integrated development environments, and systematic design methods are also introduced. The editors are extremely grateful to all the authors for their valuable contributions.\r\n\r\nThe book begins with eight chapters related to modelling and control of electromechanical machines and machine components. Chapter 9 presents a nonlinear model for the control of a three-DOF helicopter. A helicopter model and a control method of the model are also presented and validated experimentally in Chapter 10. Chapter 11 introduces a planar laboratory testbed for the simulation of autonomous proximity manoeuvres of a uniquely control actuator configured spacecraft. Integrated methods of simulation and Real-Time control aiming at improving the efficiency of an iterative design process of control systems are presented in Chapter 12. Reliability analysis methods for an embedded Open Source Software (OSS) are discussed in Chapter 13. A new specification technique for the conceptual design of self-optimizing mechatronic systems is presented in Chapter 14. Chapter 15 provides a general overview of design specificities including mechanical and control considerations for micro-mechatronic structures. It also presents an example of a new optimal synthesis method to design topology and associated robust control methodologies for monolithic compliant microstructures.",isbn:null,printIsbn:"978-953-307-041-4",pdfIsbn:"978-953-51-5898-1",doi:"10.5772/216",price:139,priceEur:155,priceUsd:179,slug:"mechatronic-systems-simulation-modeling-and-control",numberOfPages:308,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"31ea5e16c55e6465f031797e79c774c7",bookSignature:"Annalisa Milella Donato Di Paola and Grazia Cicirelli",publishedDate:"March 1st 2010",coverURL:"https://cdn.intechopen.com/books/images_new/4458.jpg",numberOfDownloads:53370,numberOfWosCitations:30,numberOfCrossrefCitations:24,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:45,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:99,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"January 21st 2014",dateEndSecondStepPublish:"February 11th 2014",dateEndThirdStepPublish:"May 18th 2014",dateEndFourthStepPublish:"August 16th 2014",dateEndFifthStepPublish:"September 15th 2014",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"1065",title:"Dr.",name:"Annalisa",middleName:null,surname:"Milella",slug:"annalisa-milella",fullName:"Annalisa Milella",profilePictureURL:"https://mts.intechopen.com/storage/users/1065/images/system/1065.jpg",biography:"I received the Laurea (summa cum laude) and Research Doctorate degrees from the Politecnico of Bari, Italy, in 2002 and 2006, respectively, both in Mechanical Engineering. In 2005, I was a visiting PhD student at the EPFL Autonomous Systems Laboratory. Currently, I am a researcher at the Institute of Intelligent Systems for Automation (ISSIA), National Research Council (CNR) of Bari, Italy.\nMy main research interests include:\n- computer vision applied to robotics and intelligent systems\n- self-localization methods for mobile robots\n- robotic non-destructive inspection\n- robotic surveillance systems",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Institute of Intelligent Systems for Automation",institutionURL:null,country:{name:"Italy"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"17156",title:"Dr.",name:"Grazia",middleName:null,surname:"Cicirelli",slug:"grazia-cicirelli",fullName:"Grazia Cicirelli",profilePictureURL:"https://mts.intechopen.com/storage/users/17156/images/system/17156.jpg",biography:"Grazia Cicirelli received the Laurea degree (summa cum laude) in Computer Science from the University of Bari (Italy) in 1994. Until 2001 she held grants from the Italian National Research Council (CNR) for research activities in Robotics and Image Processing. From 2001 she is a Technologist Researcher at the Institute of Intelligent Systems for Automation (ISSIA) of CNR in Bari. Her principal interests include pattern recognition, artificial intelligence, image processing for robotic applications and intelligent systems for video-surveillance. She has worked on and directed numerous research projects in different research areas such as Quality Control, Intelligent Transportation Systems, Autonomous Mobile Robotics. She is author of numerous research papers published in International Conference Proceedings, National and International Journals. She is a co-inventor of 1 international patent on the development of a visual system for event detection in a sport context.\n\nDr. Cicirelli regularly serves as reviewer on various Conferences and International Journals including:\n\nIndustrial Robot: An International Journal\nInternational Journal of Advanced Robotics Systems\nIEEE Transactions on Intelligent Transportation Systems.\nShe received the 2013 Award for Excellence as Outstanding Reviewer to “Industrial Robot: An International Journal” (Emerald) for the significant contribution made throughout 2012. She is a member of the Editorial Board at the International Journal of Advanced Robotic Systems (IJARS). Furthermore, she is Editor of the permanent Topic “Robot Navigation” and Associate Editor of the permanent Topic “Vision Systems” at the same journal.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"National Research Council",institutionURL:null,country:{name:"Italy"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"820",title:"Mechatronics",slug:"mechanical-engineering-mechatronics"}],chapters:[{id:"10425",title:"Electromechanical Analysis of a Ring-type Piezoelectric Transformer",doi:"10.5772/9134",slug:"electromechanical-analysis-of-a-ring-type-piezoelectric-transformer",totalDownloads:3925,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:0,abstract:null,signatures:"Shine-Tzong Ho",downloadPdfUrl:"/chapter/pdf-download/10425",previewPdfUrl:"/chapter/pdf-preview/10425",authors:[null],corrections:null},{id:"10415",title:"Genetic Algorithm–Based Optimal PWM in High Power Synchronous Machines and Regulation of Observed Modulation Error",doi:"10.5772/9124",slug:"genetic-algorithm-based-optimal-pwm-in-high-power-synchronous-machines-and-regulation-of-observed-mo",totalDownloads:3041,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Alireza Rezazade, Arash Sayyah and Mitra Aflaki",downloadPdfUrl:"/chapter/pdf-download/10415",previewPdfUrl:"/chapter/pdf-preview/10415",authors:[null],corrections:null},{id:"10420",title:"Modelling and Control of Electromechanical Servo System with High Nonlinearity",doi:"10.5772/9129",slug:"modelling-and-control-of-electromechanical-servo-system-with-high-nonlinearity",totalDownloads:5276,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Grepl R.",downloadPdfUrl:"/chapter/pdf-download/10420",previewPdfUrl:"/chapter/pdf-preview/10420",authors:[null],corrections:null},{id:"10426",title:"Robust Shaping Indirect Field Oriented Control for Induction Motor",doi:"10.5772/9135",slug:"robust-shaping-indirect-field-oriented-control-for-induction-motor",totalDownloads:3396,totalCrossrefCites:4,totalDimensionsCites:4,hasAltmetrics:0,abstract:null,signatures:"M. Boukhnifer, C. Larouci and A. Chaibet",downloadPdfUrl:"/chapter/pdf-download/10426",previewPdfUrl:"/chapter/pdf-preview/10426",authors:[null],corrections:null},{id:"10419",title:"Modeling and Fault Diagnosis of an Electrohydraulic Actuator System with a Multidisciplinary Approach Using Bond Graph",doi:"10.5772/9128",slug:"modeling-and-fault-diagnosis-of-an-electrohydraulic-actuator-system-with-a-multidisciplinary-approac",totalDownloads:3972,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"M. H. Toufighi, S. H. Sadati and F. Najafi",downloadPdfUrl:"/chapter/pdf-download/10419",previewPdfUrl:"/chapter/pdf-preview/10419",authors:[null],corrections:null},{id:"10418",title:"Robust Control of Ultrasonic Motor Operating under Severe Operating Conditions",doi:"10.5772/9127",slug:"robust-control-of-ultrasonic-motor-operating-under-severe-operating-conditions",totalDownloads:3542,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Moussa Boukhnifer, Antoine Ferreira and Didier Aubry",downloadPdfUrl:"/chapter/pdf-download/10418",previewPdfUrl:"/chapter/pdf-preview/10418",authors:[null],corrections:null},{id:"10414",title:"Resonance Frequency Tracing System for Langevin Type Ultrasonic Transducers",doi:"10.5772/9123",slug:"resonance-frequency-tracing-system-for-langevin-type-ultrasonic-transducers",totalDownloads:4551,totalCrossrefCites:1,totalDimensionsCites:4,hasAltmetrics:0,abstract:null,signatures:"Yutaka Maruyama, Masaya Takasaki and Takeshi Mizuno",downloadPdfUrl:"/chapter/pdf-download/10414",previewPdfUrl:"/chapter/pdf-preview/10414",authors:[null],corrections:null},{id:"10424",title:"New Visual Servoing Control Strategies in Tracking Tasks Using a PKM",doi:"10.5772/9133",slug:"new-visual-servoing-control-strategies-in-tracking-tasks-using-a-pkm",totalDownloads:2671,totalCrossrefCites:7,totalDimensionsCites:9,hasAltmetrics:1,abstract:null,signatures:"A. Traslosheros, L. Angel, J. M. Sebastian, F. Roberti, R. Carelli and R. Vaca",downloadPdfUrl:"/chapter/pdf-download/10424",previewPdfUrl:"/chapter/pdf-preview/10424",authors:[null],corrections:null},{id:"10422",title:"Nonlinear Adaptive Model Following Control for a 3-DOF Model Helicopter",doi:"10.5772/9131",slug:"nonlinear-adaptive-model-following-control-for-a-3-dof-model-helicopter",totalDownloads:4477,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Mitsuaki Ishitobi and Masatoshi Nishi",downloadPdfUrl:"/chapter/pdf-download/10422",previewPdfUrl:"/chapter/pdf-preview/10422",authors:[null],corrections:null},{id:"10421",title:"Application of Higher Order Derivatives to Helicopter Model Control",doi:"10.5772/9130",slug:"application-of-higher-order-derivatives-to-helicopter-model-control",totalDownloads:2911,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Roman Czyba and Michal Serafin",downloadPdfUrl:"/chapter/pdf-download/10421",previewPdfUrl:"/chapter/pdf-preview/10421",authors:[null],corrections:null},{id:"10423",title:"Laboratory Experimentation of Guidance and Control of Spacecraft During On-Orbit Proximity Maneuvers",doi:"10.5772/9132",slug:"laboratory-experimentation-of-guidance-and-control-of-spacecraft-during-on-orbit-proximity-maneuvers",totalDownloads:2720,totalCrossrefCites:0,totalDimensionsCites:7,hasAltmetrics:0,abstract:null,signatures:"Jason S. Hall and Marcello Romano",downloadPdfUrl:"/chapter/pdf-download/10423",previewPdfUrl:"/chapter/pdf-preview/10423",authors:[null],corrections:null},{id:"10416",title:"Integrated Environment of Simulation and Real-Time Control Experiment for Control system",doi:"10.5772/9125",slug:"integrated-environment-of-simulation-and-real-time-control-experiment-for-control-system",totalDownloads:3442,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Kentaro Yano and Masanobu Koga",downloadPdfUrl:"/chapter/pdf-download/10416",previewPdfUrl:"/chapter/pdf-preview/10416",authors:[null],corrections:null},{id:"10413",title:"Reliability Analysis Methods for an Embedded Open Source Software",doi:"10.5772/9122",slug:"reliability-analysis-methods-for-an-embedded-open-source-software",totalDownloads:2623,totalCrossrefCites:4,totalDimensionsCites:6,hasAltmetrics:0,abstract:null,signatures:"Yoshinobu Tamura and Shigeru Yamada",downloadPdfUrl:"/chapter/pdf-download/10413",previewPdfUrl:"/chapter/pdf-preview/10413",authors:[null],corrections:null},{id:"10412",title:"Architecture and Design Methodology of Self-Optimizing Mechatronic Systems",doi:"10.5772/9121",slug:"architecture-and-design-methodology-of-self-optimizing-mechatronic-systems",totalDownloads:3766,totalCrossrefCites:3,totalDimensionsCites:7,hasAltmetrics:0,abstract:'The conceivable development of information and communication technology will enable mechatronic systems with inherent partial intelligence. We refer to this by using the term \\\\\\"self-optimization\\\\\\". Self-Optimizing systems react autonomously and flexibly on changing operation conditions. They are able to learn and optimize their behavior at runtime. The development of mechatronic and especially self-optimizing systems is still a challenge. A significant milestone within the development is the principle solution. It determines the basic structure as well as the operation mode of the system and is the result of the conceptual design. Additionally it is the basis for the concretization of the system which involves experts from several domains, such as mechanics, electrical engineering/electronics, control engineering and software engineering. This contribution presents a new specification technique for the conceptual design of mechatronic and self-optimizing systems. It also uses the railway technology as a complex example, to demonstrate how to use this specification technique and in which way it profits for the development of future mechanical engineering systems. Keywords Design Methodology, Mechatronics, Self-Optimization, Principle Solution, Conceptual Design, Domain-Spanning Specification',signatures:"Jurgen Gausemeier, Sascha Kahl",downloadPdfUrl:"/chapter/pdf-download/10412",previewPdfUrl:"/chapter/pdf-preview/10412",authors:[null],corrections:null},{id:"10417",title:"Contributions to the Multifunctional Integration for Micromechatronic Systems",doi:"10.5772/9126",slug:"contributions-to-the-multifunctional-integration-for-micromechatronic-systems",totalDownloads:3059,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"M. Grossard Mathieu and M. 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Whizar-Lugo"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"208429",title:"M.D.",name:"I Gusti Ngurah",middleName:null,surname:"Mahaalit Aribawa",fullName:"I Gusti Ngurah Mahaalit Aribawa",slug:"i-gusti-ngurah-mahaalit-aribawa",email:"mahaalit@unud.ac.id",position:null,institution:{name:"Udayana University",institutionURL:null,country:{name:"Indonesia"}}},{id:"209749",title:"Dr.",name:"Tjokorda Gde Agung",middleName:null,surname:"Senapathi",fullName:"Tjokorda Gde Agung Senapathi",slug:"tjokorda-gde-agung-senapathi",email:"tjoksenapathi@unud.ac.id",position:null,institution:null},{id:"209750",title:"Mrs.",name:"Pontisomaya",middleName:null,surname:"Parami",fullName:"Pontisomaya Parami",slug:"pontisomaya-parami",email:"ponti@unud.ac.id",position:null,institution:null},{id:"209752",title:"Prof.",name:"Made",middleName:null,surname:"Wiryana",fullName:"Made Wiryana",slug:"made-wiryana",email:"wiryana@unud.ac.id",position:null,institution:null}]},book:{id:"6221",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",subtitle:null,fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",publishedDate:"April 3rd 2019",bookSignature:"Víctor M. Whizar-Lugo",coverURL:"https://cdn.intechopen.com/books/images_new/6221.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"169249",title:"Prof.",name:"Víctor M.",middleName:null,surname:"Whizar-Lugo",slug:"victor-m.-whizar-lugo",fullName:"Víctor M. Whizar-Lugo"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"11433",leadTitle:null,title:"Human Migration in the Last Three Centuries",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tIn March 2022, another book on human migration seems important when the events or tragedies unfolding in Eastern Europe are considered. People have always migrated and have moved, but, specifically looking at the last three hundred years, involuntary migration is on the rise. Involuntary migration does not only affect Europe; Asia, Africa, and North as well as South America, have had their fair share of natural catastrophes, invasions, and wars.
\r\n\tThis book will intend to look at different migrant patterns, voluntary and involuntary migration, over the last three centuries. What influenced people to leave their home countries, family, and friends and settle somewhere else? The book may include histories of the 19th century, consider tragedies and movements activated by political events in the 20th century, and/or look at recent events of the 21st century. Push and pull factors are important points. While most of us may be influenced in a negative way by the current happenings in Eastern Europe, the Russian invasion and resulting tragedies also demonstrate some very positive human traits – the preparedness of Ukraine’s surrounding countries to help those in need and to provide a safe place for the present.
\r\n\tWhether one looks at voluntary or involuntary migration into any country, after a period of adjustment, migrants do play a positive role. The research found that migrants contribute to the economy (food, shelter, employment, tax) and enrich a country’s cultural norms. Prerequisites for successful settlements are that the host society adopts a tolerant approach and that the migrants recognize the law and the language of the host country. Nothing is ever easy or without controversy, but I am a migrant (German Australian), and life in Australia has been relatively harmonious. Issues that could be considered in the book are multicultural societies (do monocultural societies still exist?) and theories of acculturation versus integration (settlement processes).
\r\n\tTwo further issues are very important in relation to human migration. There is climate change, global warming, and the environment, which clearly affect people’s movement. Small island populations are very concerned about rising sea levels. 2021 has also seen floods costing human lives: Turkey (August 2021), Brazil (December 2021), Chile (January 2021), and South India (November 2021), to name but a few. In Australia (March 2022), farms and whole townships in New South Wales and Queensland have been flooded for the second time in five years, and plans to resettle these towns are considered. Official and social media provide ample coverage of the events, which leads me to the next issue. There is today’s very important role of the media, of the official and social media. We are constantly bombarded with images of human war tragedies and flood victims. People in industrialized, western countries must be the best-informed populace. How far do the images and up-to-date TV news influence us, make us change our behavior, and perhaps even consider us more generous than we have been?
\r\n\tClimate change and the media are relatively new to the human migration debate, but both issues play important parts, and some interesting discussions are appreciated.
\r\n\t
Chronic mitral valvular insufficiency (CMVI) is the most common cause of congestive heart failure (CHF) in small breed dogs [1, 2] and is characterized by progressive myxomatous degeneration of the atrioventricular valves [3]. Mitral regurgitation (MR) is the most common sequel to CMVI, which causes volume overload at the left atrial (LA) and left ventricle (LV) and progresses to CHF [4]. Underlying causes of CMVI have yet been identified, although aging and genetic causes were suggested in a certain breed of dogs [5–8] and humans [4]. CMVI is more often seen in old and small breeds of dog. Higher prevalence of CMVI was noticed in Cavalier King Charles Spaniels (CKCS) and Dachshund [9, 10]. CMVI has been noticed in ~50% of 6‐ to 7‐year‐old CKCS dogs and ~50% of 10‐year‐old Dachshund dogs. Those two studies strongly suggested genetic etiology for this disease, although other study found the aging is the major cause for this disease [11]. In these dog breeds, the CMVI is occurred at younger age and progressed more rapidly. List of dog breeds having high prevalence rate for CMVI are Chihuahuas, Malteses, Yorkshire Terriers, Poodles, Papillons, Pekingeses, Miniature Pinschers, Bologneses, Dachshunds, Shih Tzus, Cairn Terriers, Miniature Schnauzers, Bichon Frises, Carvalier King Charles Spaniels, Pugs, West Highland White Terriers, Fox Terriers, Boston Terriers, Welsh Terriers, Whippets, American Cocker Spaniels, Beagles, German Shepherds, and Great Danes [12], although almost one‐quarter of dogs over the age of 10 have degenerative changes on mitral valve in any breeds of dog. Higher prevalence rate in Maltese and Shih Tzu has been found in some Asian countries including Korea, Japan, and Taiwan [13].
\nCMVI is an animal model of human mitral valve prolapse (MVP), which is suggested of polygenic inheritance [14]. Several canine studies also suggested polygenic inheritance for CMVI [6, 8, 15]. Male dogs have higher rate of prevalence almost 1.5 times than female dogs [3]. One study found that the mitral valve was affected in ~60% case of CMVI, and tricuspid valve only was affected in ~10% of CMVI, while both atrioventricular valves (mitral valve and tricuspid valve) were affected in ~30% of CMVI [16].
Pathological features of canine CMVI are degenerative changes on mitral valve, mitral valve thickening and opacity, several degrees of leaflet retraction, node of valve’s end, and lengthened chordae tendineae (Figure 1) [17, 18] and are similar to human MVP [19, 20]. Disruption of collagen and deposition of glycosaminoglycans in mitral valve are also common microscopic feature in this disease [11, 19, 21]. Long‐standing mitral valvular insufficiency can cause volume overload of both the LA and the LV. Furthermore, the increased end‐diastolic volume in LV can cause pressure overload on the LA. Subsequently, the increased pressure in the LA inhibits drainage of blood from the lungs via the pulmonary veins and thus causes pulmonary congestion. If this condition is untreated, it will eventually develop LV dysfunction and CHF [22].
Pathological features of canine chronic mitral valvular insufficiency are degenerative changes on mitral valve, mitral valve thickening and opacity, several degrees of leaflet retraction, node of valve\'s end and lengthened chordae tendineae. (A) Diagram of normal mitral valve (top) and mitral regurgitation (bottom), (B) diagram of mitral valve insufficiency from chronic degenerative changes on mitral valve leaflets (box).
Coughing, especially nocturnal cough, may be the first clinical signs in CMVI. However, in dogs with advanced stage of heart failure (HF), dyspnea such as shortness of breath, difficulty breathing, and orthopnea may be the major signs. Depending on the severity of CMVI, the dog maybe had certain degree of exercise intolerance, lethargy, reduced appetite, and weight loss [23].
Heart murmur is a major finding in physical examination. Depending on the severity, clinicians can hear various grade of heart murmur before the onset of clinical signs. In early stages of the CMVI, heart murmur can be localized and weak as 1~2/6 scale at left apex. In late stages of the CMVI, heart murmur is gradually radiated and louder and is typically crescendo‐decrescendo type systolic regurgitant murmur (Figure 2A). Recent study found that the grade of heart murmur was closely related to the severity of CMVI [24].
(A) Phonocardiogram in dogs with CMVI. Heart murmur is gradually radiated and louder and is typically crescendo‐decrescendo type systolic regurgitant murmur. (B) ECG in dogs with CMVI. P-mitrale (wide P‐wave) and wide and tall QRS complexes indicating LA and LV dilation.
Common laboratory findings in dogs with CMVI are normal or slightly raise in kidney and/or liver chemistry profiles, probably due to the congestion and poor body perfusion [25]. One recent study evaluated hepatic panel in dogs at different stages of heart failure from CMVI [26].
\nSerum levels of ALT and GGT were statistically significantly higher in ISACHC II and III groups (
Poor tissue perfusion from CMVI causes pancreatitis in dogs, as indicated by serum pancreatic lipase concentrations. One recent study has evaluated the prevalence of pancreatitis in 62 client‐owned dogs consisting of 40 dogs with different stages of heart failure from CMVI and 22 age‐matched healthy dogs [27]. Serum canine pancreatic lipase immunoreactivity (cPLI) concentrations were determined by quantitative cPLI test in healthy and CMVI groups in this study. Serum cPLI concentrations were 54.0 μg/L (IQR: 38.0–78.8 μg/L) in control, 55.0 μg/L (IQR: 38.3–88.8 μg/L) in ISACHC I, 115.0 μg/L (IQR: 45.0–179.0 μg/L) in ISACHC II, and 223.0 μg/L (IQR: 119.5–817.5 μg/L) in ISACHC III. Also, close correlation of serum cPLI concentration was found in the left atrial to aorta (LA/Ao) ratio (
Reduction in glomerular filtration rate (GFR) is a common complication in advanced stages of heart failure (HF). The convenient and precise assessment for GFR would be useful for early detection of renal impairment in HF dogs. One recent study has evaluated the reduction in GFR in advanced stages of HF from CMVI, using renal markers including serum cystatin C (Cys‐C) and symmetric dimethylarginine (SDMA) concentrations [28]. Forty‐three client‐owned dogs consisting of 33 dogs with different stages of HF from CMVI and 10 age‐matched healthy dogs were enrolled in this study. Serum Cys‐C and SDMA concentrations along with other renal (i.e., urea nitrogen and creatinine) and echocardiographic markers were evaluated in healthy and CMVI dogs. Serum Cys‐C concentrations were 1.4 ± 0.4 mg/l in control, 2.1 ± 0.9 mg/l in ISACHC I, 2.9 ± 0.8 mg/l in ISACHC II, and 3.6 ± 0.6 mg/l in ISACHC III dogs, whereas serum SDMA concentrations were 8 ± 2 μg/dl in control, 14 ± 3 μg/dl in ISACHC I, 18 ± 6 μg/dl in ISACHC II, and 22 ± 7 μg/dl in ISACHC III dogs. There was close correlation of serum Cys‐C and SDMA concentrations with serum creatinine, urea nitrogen, and the severity of HF. This study demonstrated that the GFR was decreased in dogs with CMVI having earlier stages of HF [28].
In recent years, cardiac biomarkers have been developed that are differentiating cardiac and respiratory diseases to evaluate the progress of heart failure in dogs and cats. There are many cardiac biomarkers. The ideal biomarkers should reflect the therapeutic response, the pathophysiology of heart diseases, assist in the early diagnosis of CHF, and be applicable throughout the various phases of the syndrome from before the onset of its clinical manifestations through its end‐stage. Cardiac biomarkers have used as diagnostic tools [29], prognostic indicator [30], and monitoring system [31] for CHF.
\nTroponins are marker of myocardial necrosis and ischemia and found to be closely associated with the severity of heart failure in dogs [32] and cats [33], although it often elevated in many noncardiac disease [34–36]. Natriuretic peptides (NPs) are markers releasing from hemodynamic stress on the heart [37], responded against volume expansion/pressure overload [37]. The plasma concentration of N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP) is well correlated with severity of heart failure in dogs [38], although the level of NT‐proBNP can be affected by noncardiac factors such as body weight and renal function [39]. Cardiopet® proBNP is a commercially available diagnostic test. According to the manufacturer (Idexx, USA), dogs with <900 pmol/L of serum NT‐proBNP may not have heart failure, while dogs with 900–1800 pmol/L may have heart failure, but is required further discriminative tests. Dogs with >1800 pmol/L may have higher possibility of heart failure. C‐reactive protein (CRP) is an acute‐phase reactant protein [40, 41] that is increased in several diseases in dogs [42–47]. Although the level of CRP is increased in dogs with CMVI, the CRP concentration was not related to the presence of CHF or murmur grade [48].
Major findings on the electrocardiography (ECG) in dogs with CMVI are P mitrale (wide P‐wave) and wide and tall QRS complexes indicating LA and LV dilation (Figure 2B) [49]. Tachycardia may be occurred either persistently or intermittently as the CMVI progresses [50, 51]. Although atrial fibrillation is often observed in large breed dogs with CMVI, it is rarely found in the small breed dogs. However, if dogs have early stage of CMVI, there will be no abnormal finding on the ECG [23]. The ECG signs indicating myocardial hypoxic damage (i.e., the ST‐slurring) can be seen in dogs with advanced stage of heart failure [52].
Thoracic radiography is the diagnostic test of choice in dogs with CMVI [23]. Enlargement of the LA/LV and pulmonary venous vasculatures is common findings on thoracic radiography (Figure 3) [23, 53, 54]. Other radiographic signs indicating left‐sided heart failure including the dorsal displacement of trachea, the compression and/or elevation of left main stem bronchus, and the dividing view of left and right stem bronchus can be noticed as the disease progresses (Figure 3) [55]. In advanced stage, radiographic signs related to pulmonary edema (i.e., pulmonary venous engorgement, peribronchial pattern, air bronchograms) can be obvious in most cases [23]. Also, when complications with pulmonary hypertension (PHT) are combined, radiographic signs indicating right‐sided heart failure (i.e., hepatomegaly, ascites) can be observed [23].
Thoracic radiography in dogs with CMVI. Enlargement of the LA/LV and pulmonary venous vasculatures is common findings on thoracic radiography. Other radiographic signs indicating left‐sided heart failure including the dorsal displacement of trachea, the compression and/or elevation of left main stem bronchus, and the dividing view of left and right stem bronchus can be noticed as the disease progresses. (A) Ventrodorsal projection. (B) Right lateral projection.
The transthoracic echocardiographic examination is noninvasive diagnostic method and can help to identify mitral valvular lesions and to determine the severity of MR. Echocardiography can also assess its impact on cardiac remodeling, myocardial function, left ventricular filling pressures, and pulmonary arterial pressure [56–61].
\nMitral valve lesion can be identified using two‐dimensional and M‐mode echocardiography. The mitral valve lesions associated with CMVI are small and smooth, creating a club‐shaped appearance to the leaflet tips during early stages of the disease, but may become large and irregular during disease progression (Figure 4B) [56, 62, 63]. Mitral valve prolapse, which is characterized by one or both leaflets bent back into the left atrial chamber during systole, occurs commonly in dogs with CMVI (Figure 4A) [7, 64]. In one recent study, the severity of mitral valve prolapse was significantly correlated with MR severity [64]. Anterior leaflet of mitral valve is more commonly affected than posterior leaflet in dogs [64]. Abnormal excursion [i.e., decreased ejection fraction (EF) slope] and thickening of anterior mitral leaflet can also be detected in M‐mode echocardiography (Figure 5A).
2D and color Doppler echocardiography in dogs with CMVI. (A) Mitral valve prolapse, which is characterized by one or both leaflets bent back into the left atrial chamber during systole, occurs commonly in dogs with CMVI. The severity of mitral valve prolapse was significantly correlated with MR severity. (B) The mitral valve lesions associated with CMVI are large and irregular in advanced stage of CMVI. Anterior leaflet of mitral valve is more commonly affected than posterior leaflet in dogs. (C) Color‐flow Doppler imaging in 2D echocardiography revealed severe regurgitant jets from left ventricle to left atrium during systole and is widely used for detection and assessment of MR in dogs with CMVI. (D) The MR can be also detected in color M‐mode echocardiography on the LV short‐axis view. LV, left ventricle; CT, chordae tendineae; AMV, anterior mitral valve; PMV, posterior mitral valve; RV, right ventricle; RA, right atrium.
2D and M‐mode echocardiography in dogs with CMVI. (A) Abnormal excursion (decreased EF slope) and thickening of anterior mitral leaflet can be detected in M‐mode echocardiography. (B) The eccentric hypertrophy, which is characterized by an increase in end‐diastolic left ventricular dimensions (EDV), occurs in dogs with CMVI. (C)–(D) Hemodynamically significant chronic MR can induce volume overload, which subsequently can increase LV and LA volume and can result in LA and LV dilation. The degree of left atrial enlargement that is assessed by the left atrium to aorta (LA/Ao) ratio in 2D and M‐mode echocardiography and is closely correlated with the severity of heart failure.
Ruptured chordae tendineae is also common echocardiographic finding in dogs with CMVI [64]. The mitral valve leaflet is seen pointing back into the left atrium (LA) during systole and bent back on itself with in the left ventricular outflow tract during diastole [65–67]. Chordae tendineae of anterior mitral valve leaflet is more commonly ruptured in dogs [68].
\nIt is clinically important to evaluate severity of MR in dogs with CMVI. Color‐flow Doppler imaging (CDI) is widely used for detection and assessment of MR in dogs with CMVI (Figures 4C, D and 6B). Maximal area of the regurgitant jet signals to the left atrium area (ARJ/LAA) ratio, which is the maximal ratio of the regurgitant jet area signal to left atrial area, is used in semi‐quantification of MR [56, 69, 70]. The ARJ/LAA ratio lesser than 20–30% is indicative of mild MR. The ratio involves between 20 and 30, 70% is indicative of moderate MR, and >70% is indicative of severe MR [56, 69–71].
Pulse and continuous Doppler and tissue Doppler echocardiography in dogs with CMVI. (A) The transmitral flow profile consists of E and A and is affected by the pressure gradient between the LA and LV. Elevated E represents increased LA pressure and a worsening of heart failure. (B) Continuous Doppler echocardiography is useful to detect MR in dogs with CMVI. However, the degree of MR is not correlated with the severity of CMVI. (C) Pulse Doppler echocardiography in pulmonary venous flow is also useful to assess the progression of CMVI. The presence of pulmonary venous flow at atrial systole (PVa) indicates high LA pressure noticed in advanced stage of CMVI. (D) The early mitral inflow velocity to early mitral annular tissue velocity (E:Ea) ratio can be used to assess LV diastolic function. The E:E’ ratio is significantly correlated with left ventricular filling pressures.
The vena contracta is the measurement of smallest mitral regurgitant jet width through the valve and is correlated with MR severity [71]. Measuring the vena contracta uses parasternal long‐axis views that identify the vena contracta perpendicular to the sound plane. Very few data are available regarding vena contracta associated with dogs with CMVI [71]. In human study, a correlation was found between vena contracta and MR severity [72–74]. The proximal isovelocity surface area (PISA) method can be used in echocardiography to estimate the area of flow acceleration and convergence proximal to the mitral valve as the regurgitant jet approaches the orifice [75]. Left apical four‐chamber views confirming the mitral regurgitant jet are generally recommended for measurement. Regurgitant orifice area, regurgitant fraction, and volume can be measured by this method. In study performed on dogs with severe MR, mitral regurgitant fraction calculated using PISA method was significantly correlated with MR severity [76].
\nHemodynamically significant chronic MR can induce volume overload, which subsequently can increase LV and LA volume and can result in LA and LV dilation [63]. The degree of left atrial enlargement that is assessed by the left atrium to aorta (LA/Ao) ratio is closely correlated with the severity of heart failure (Figure 5C and D). Both two‐dimensional mode and M‐mode echocardiography should be used in order to determine left atrial enlargement. Other indirect signs of high LA pressures in dogs with CMVI are left atrial rupture or acquired atrial septal defect secondary to atrial septal rupture [77–79]. Due to volume retention, remodeling, and elevations in LA and pulmonary venous pressures, left ventricular volume overload can occur concomitantly with MR worsening [80]. The eccentric hypertrophy, which is characterized by an increase in end‐diastolic left ventricular dimensions (EDV), occurs in dogs with CMVI (Figure 5B) [81]. The diastolic left ventricular volume and diameters should be assessed by both M‐mode and two‐dimensional echocardiography.
\nThe common indices of left ventricular systolic myocardial function are ejection fraction (EF) and fractional shortening (FS). The EF is defined by the percent of the end‐diastolic volume ejected from left ventricle (LV) with each heart beat. The FS is a measure of the percent change in the dimension from end diastole to end systole [82]. FS is dependent on preload, afterload, and myocardial contractility. Left ventricular systolic myocardial dysfunction is traditionally characterized by reduced EF and FS. However, FS should be increased in dogs with CMVI because of elevated preload and reduced afterload, and hyperdynamic ventricular contraction.
\nSystolic myocardial dysfunction may be identified by end‐systolic left ventricular dimensions, such as end‐systolic diameter, end‐systolic volume, and end‐systolic volume indexed to body surface area (ESVI) [60, 61, 83]. Increased end‐systolic left ventricular dimensions are consistently referred to impaired left ventricular systolic function. There are three ultrasound methods, including the Teichholz method, the monoplane Simpson\'s derived method of discs, and the length‐area method, to measure ESVI. Because the Teichholz method tends to overestimate ESVI, other methods except Teichholz method may be recommended in dogs with CMVI [61].
\nSpectral Doppler methods, including pulsed wave Doppler (PWD) and continuous wave Doppler (CWD), can identify regurgitant jet, transmitral flow in dogs with CMVI (Figure 6A and B). PWD may be used to record transmitral flow profile. The sample gate should be located in the tip of the leaflet. The transmitral flow profile looks like “M‐shaped” and consists of E (peak early transmitral flow velocity) and A (peak late transmitral flow velocity) related to early filling and atrial contraction, respectively [84]. Diastolic function and left ventricular filling pressures can be assessed using PWD method [84]. CWD is generally used for assessing severity of MR and thus provides information on LA pressure, preload, and systemic arterial pressure. CWD can be used to identify elevated LA pressure, left ventricular systolic and diastolic dysfunction in dogs with CMVI [60]. The presence of pulmonary venous flow at atrial systole (PVa) indicates high LA pressure and is commonly noticed in advanced stage of CMVI (Figure 6C). Continuous Doppler echocardiography is useful to detect MR in dogs with CMVI (Figure 6B). However, the degree of MR is not correlated with the severity of CMVI.
\nAdvanced echocardiographic techniques, including tissue Doppler image (TDI), strain and strain rate imaging, and speckle tracking echocardiography (STE), are recently developed to assess myocardial abnormalities. TDI measures the myocardial velocities to quantify myocardial abnormalities. Systolic and diastolic myocardial abnormalities can be detected by TDI. TDI can be used in PWD and CDI. Myocardial velocity profile is characterized by a S wave, an E wave, and an A wave related to systolic myocardial velocity, early diastolic myocardial relaxation velocity, and late diastolic myocardial relaxation velocity, respectively. Strain and strain rate imaging are TDI‐based measurement and represent regional myocardial deformation and deformation rate, respectively [85, 86]. The two‐dimensional STE is recently available and can be used to assess regional myocardial function. The STE is created by irregularities in reflected ultrasound from neighboring structures [87]. Very few data are available regarding advanced echocardiographic techniques data associated with canine heart diseases. TDI provides myocardial and annular velocity. Unlike Doppler patterns of mitral inflow, TDI assessment of diastolic function is relatively load‐independent. The early mitral inflow velocity to early mitral annular tissue velocity (E:Ea) can be used to assess LV diastolic function (Figure 6D). The E:Ea ratio is significantly correlated with left ventricular filling pressures [88, 89].
\nBecause most dogs affected by CMVI are older, progression of CMVI can lead to diastolic dysfunction, with time. Diastolic dysfunction is characterized by increased resistance to filling and increased left ventricular filling pressure secondary to decreased compliance and impaired relaxation [90, 91]. The assessment of left ventricular diastolic function is difficult to undertake in the dogs with CMVI. Diastolic function can be assessed using several parameters, including isovolumetric relaxation time (IVRT), transmitral flow velocities, and myocardial velocities.
\nElevated LA pressure caused by MR and volume overload was found in dogs with moderate‐to‐severe CMVI [92, 93]. For the noninvasive assessment of LA pressure, the IVRT can be used in volume overload model [93]. IVRT is the time that elapses from aortic valve closure to mitral valve opening. In recent studies, the duration of IVRT and the ratio of E to IVRT were used in the diagnosis of elevated LA pressure [94, 95]. Decrease in IVRT is indicative for increase in LA pressure.
\nThe left ventricular diastolic function can be assessed by Doppler patterns of mitral inflow. The transmitral flow profile consists of E and A and is affected by the pressure gradient between the LA and LV. Elevated E represents increased LA pressure and a worsening of heart failure (Figure 6A) [5]. If diastolic function is normal, E is greater than A. In early diastolic dysfunction, a reversal of E and A can be occurred, as left ventricular compliance decreases. Further worsening of diastolic function leads to pseudonormalization associated with increased LA pressure. Because mitral inflow velocities are load‐dependent, the use of transmitral flow profile to assess diastolic function remains limited.
\nOne recent study has evaluated the diagnostic value of left atrial volume index (LAVi) and the ratio of early filling to early diastolic mitral annular velocity (E/Ea) on the progression of heart failure in 51 dogs with CMVI and body weight matched 18 healthy control dogs, along with other known echocardiographic markers [96]. The LAVi and E/Ea were well correlated with the severity of heart failure in this study group. Based on the receiver‐operating characteristic analysis on echocardiographic variables, the echocardiographic indications for advanced heart failure in this study were left atrium to aorta ratio (LA:Ao) >2.0, left ventricular diastolic dimension to aorta ratio (LVIDd:Ao) >2.4, end‐diastolic volume index (EDVI) >100 ml/m2, transmitral E‐peak >1.2 m/s, E/Ea >9.0 and LAVi 49 ml/m2, while indications for healthy or dogs with no signs of cardiac enlargement were LA:Ao <1.3, LVIDd:Ao <1.7, EDVI <45 ml/m2, E‐peak <0.65 m/s, E/Ea <6.0 and LAVi <15 ml/m2 in dogs with CMVI.
Before initiating treatment for dogs with CMVI, proper staging of heart failure in each affected dogs is required. Two classification systems can be applied in dogs: International Small Animal Cardiac Health Council System (ISACHC) and American College of Veterinary Internal Medicine (ACVIM) classification (Table 1).
\nISACHC | \nACVIM | \n||
---|---|---|---|
\n | \n | A | \nPatient at risk of developing heart disease in the future, e.g., patient from breed with high predisposition for cardiac disease | \n
Ia | \nAsymptomatic: no evidence of compensation for underlying heart disease (no volume overload or pressure overload detected radiographically or echocardiographically) | \nB1 | \nAsymptomatic patients with evidence of structural heart disease, e.g., presence of murmur: with no evidence of cardiac remodeling (radiographically or echocardiographically) | \n
Ib | \nAsymptomatic: clinical signs of compensation for underlying heart disease (volume overload or pressure overload detected radiographically or echocardiographically) | \nB2 | \nAsymptomatic patients with evidence of structural heart disease, e.g., presence of murmur: with evidence of cardiac remodeling | \n
II | \nMild‐to‐moderate heart failure with clinical signs at rest or with mild exercise. Treatment required | \nC | \nPatients with clinical signs of congestive heart failure (either past or present) Stage C1 (stabilized CHF) Stage C2 (mild‐to‐moderate CHF) Stage C3 (severe and/or life threatening CHF) | \n
IIIa | \nAdvanced heart failure; clinical signs of severe congestive heart failure: home treatment possible | \n\n | |
IIIb | \nAdvanced heart failure; clinical signs of severe congestive heart failure: requires hospitalization | \nD | \nRefractory heart failure. Patients showing clinical signs in spite of standard treatment for congestive heart failure | \n
International Small Animal Cardiac Health Council System (ISACHC) and American College of Internal Medicine (ACVIM) classification in dogs with heart failure.
Basic strategies for treating CMVI are (1) to lessen cardiac workload, (2) to improve clinical conditions from CHF, (3) to retard cardiac remodeling from neurohormonal response from heart failure, and (4) to reduce complications from heart failure. Several therapeutic strategies have been recommended in the veterinary literatures [18, 97–101]. In 2009, the ACVIM released an expert consensus statement and provided therapeutic guideline for dogs with CMVI [3]. In practice, the first‐line medications for heart failure in dogs with CMVI should include furosemide, pimobendan, and angiotensin‐converting enzyme (ACE) inhibitor. The route and dose of furosemide administration should be adjusted based on the degree of respiratory distress and disability. Monitoring renal function is necessary for every dogs, especially before and 3–5 days after initiation and adjustment of furosemide and an ACE inhibitor (ACEI). Either surgical replacement or valvuloplasty of damaged mitral valve has been successfully applied in dogs. Furthermore, experimental prosthetic devices for treating CMVI in dogs are under development and evaluation [102, 103].
\nSeveral studies have evaluated what cardiac medications can retard the progression of heart failure and can be more effective in asymptomatic HF dogs [18, 104], although most monotherapy was not able to achieve these goals, to date. One recent study has evaluated the outcome of dogs with preclinical cardiomyopathy with atrial fibrillation after either pimobendan monotherapy or benazepril monotherapy, and has found that pimobendan monotherapy provided significantly better outcome (i.e., prolonged time to onset of HF or reduced incidence of sudden death [105]). Unfortunately, several studies failed to find beneficial effects on survival and onset of HF in asymptomatic dogs with various heart diseases after the long‐term administration of ACEI including enalapril [99, 105]. One recent small pilot study in dogs with asymptomatic HF found modest evidence of beneficial effect on retarding the onset of clinical HF after pimobendan and enalapril dual therapy [106]. One other recent study in asymptomatic dogs with CMVI has also found echocardiographic evidences on improvement of cardiac performance (i.e., increased %LVEF and decreased ESVI) for the first few months after pimobendan monotherapy [107], although this effect did not last to the end of test period (6 months). One recent study on preclinical CMVI dogs after long‐term treatment of enalapril has found long‐term administration of enalapril could significantly delay onset of HF and the endpoint of HF‐all‐cause death [104], although the other study in asymptomatic Cavalier King Charles Spaniels with CMVI has failed to find this beneficial effect [99].
There are some complications due to heart failure from CMVI such as ruptured chordae tendineae (RCT), pulmonary hypertension (PHT), acute exacerbation of pulmonary congestion, LA rupture, and cardio‐renal syndrome (CRS) caused by forward heart failure from CMVI [23, 129].
\nRCT can cause acute exacerbation of pulmonary congestion and edema in dogs with CMVI. In particular, if the first‐order chordae attached to the septal leaflet is ruptured, the clinical signs tend to more rapidly aggravate from acute volume overload and fulminant pulmonary edema [68], although the RCT in different mitral leaflet may not cause significant clinical signs. In dogs with significant RCT, marked increase in LA and pulmonary venous pressures can lead to acute pulmonary edema, pulmonary artery hypertension, and right‐sided heart failure [22, 130]. Therefore, these dogs usually require intensive care to stabilize the condition along with the standard therapy for CMVI.
\nRight‐sided heart failure is common, especially in dogs with long‐standing history of CMVI. Right‐sided heart failure can be occurred by either/both concurrent chronic tricuspid insufficiency from myxomatous degeneration and/or the PHT from LA volume and pressure overload. Dogs with marked PHT generally show marked exercise intolerance with signs of weakness or collapse. Signs related to right‐sided heart failure (e.g., ascites, pleural effusion, hepatic and splenic congestion, and distention of the jugular veins with abnormal pulsations) can be noticed in physical examination. The presence and degree of PHT can be accurately assessed by Doppler echocardiography. Oxygen supplementation and pulmonary arterial vasodilator (e.g., sildenafil) are helpful to lessen clinical signs in dogs [131, 132].
\nTachyarrhythmias are more commonly occurred in dogs having an enlarged LA. Common tachyarrhythmias in dogs with CMVI are supraventricular premature beats, atrial fibrillation, and supraventricular tachycardia. If the tachyarrhythmia has ventricular rate >180 bpm, it can cause hemodynamically significant change in dogs with CMVI and cause an acute onset of pulmonary edema. This condition is more often seen in dogs with long‐standing CMVI. Therapeutic goals for these dogs are directed to relieve the pulmonary edema along with the reduction in heart rate to an acceptable rate for improving cardiac output.
\nLeft atrial rupture and cardiac tamponade can be occurred by marked dilation of LA in dogs with CMVI, because the LA becomes thin walled and more vulnerable to increase in pressure. One study found that endocardial splitting is more common in dogs with long‐standing CMVI [133]. Long‐standing and marked LA volume and pressure overload can progress to rupture of the LA, subsequently with the acute onset of hemopericardium, cardiac tamponade, and sudden death. Acute development of ascites, collapse, or marked exercise intolerance can be signs for sudden development of LA rupture and cardiac tamponade. Echocardiography is necessary for confirming the presence of significant pericardial effusion. Although immediate pericardiocentesis may be helpful to alleviate clinical signs, the prognosis is usually poor.
Cardio‐renal syndrome (CRS) is a clinical syndrome broadly in which dysfunctional hearts and dysfunctional kidneys can “initiate and perpetuate disease in the other organ though common hemodynamic, neurohormonal, and immunological/biochemical feedback pathways” [134]. General definition of CRS is a pathophysiologic disorder of the heart and kidneys, whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. According to human medical literature [134], the CRS is largely divided into five types: (1) Type I (acute CRS) is acute kidney injury induced by acute heart failure (e.g., acute cardiogenic shock or acutely decompensated CHF), (2) Type II (chronic CRS) is permanent and progressive chronic kidney disease induced by chronic heart failure (e.g., chronic abnormalities in cardiac function), (3) Type III (acute reno‐cardiac syndrome, RCS) is acute heart failure induced by acute kidney diseases (e.g., acute kidney ischemia or glomerulonephritis), (4) Type IV (chronic RCS) is chronic heart failure induced by chronic kidney disease (e.g., chronic glomerular or interstitial disease), and (5) Type V (secondary CRS) is heart and renal failure induced by systemic diseases (e.g., diabetes mellitus, sepsis). Major mechanisms of CRS include renal hypoperfusion directly resulting from a decreased cardiac output and neurohormone‐mediated renal damage as hypertensive nephropathy via activation of the renin‐angiotensin‐aldosterone system (RAAS) among others.
\nIn veterinary study, the prevalence of azotemia is high in dogs with CMVI and increases with the severity of the heart failure and azotemia is associated with a decrease in GFR [135]. Azotemia and renal impairment increase with the severity of CHF and are frequent findings in dogs with CMVI [129]. One retrospective study of 33 dogs with CMVI demonstrated that the prevalence of azotemia (defined as abnormally elevated serum levels of Cys‐C, SDMA, and creatinine) was increased in dogs with CMVI [28]. Azotemia and renal impairment increase with the severity of HF and are frequent findings in dogs with CMVI [129]. Keys for successful management of CRS are: (1) try to decrease the dosage of furosemide if azotemia was worsen during the CHF treatment, (2) increase water intake, (3) consider IV fluid, if patients have clinical sings of azotemia (e.g., 2.5% dex + 0.45% saline, 5% dextrose; 30–40 ml/kg/day), and (4) monitor patient\'s condition regularly to maintain proper dose of furosemide/ACEI.
Impaired function of digestive system is associated with malassimilation (i.e., maldigestion and malabsorption) induced weight loss [136]. The weight loss is a major clinical finding in certain degenerative diseases including CMVI [23], hepatobiliary disease [137], and pancreatitis [138]. Aging is involved in the pathogenesis of CMVI in dogs [6–8, 139] and can induce several anatomical changes and involve in progressive deterioration of the vital physiological functions. The organ congestion and poor body perfusion can be occurred by heart failure [25], and these can lead to organ damage (i.e., pancreas, liver, intestine) and dysfunction (i.e., maldigestion and malabsorption, hepatomegaly, ascites) [23, 140–144]. Therefore, pancreatic dysfunction associated with heart failure can be occurred in dogs with advanced stage of heart diseases. Ischemia can induce acute/chronic pancreatitis and is one of the important etiologies of acute pancreatitis in human. Several mechanisms are involved in pathogenesis of pancreatitis, such as hemorrhage or hypotension, mesenteric macro‐vessel occlusion, post‐transplantation pancreatitis, cardiopulmonary bypass. Different causes of ischemia can lead to a hypoperfusion of the pancreas with a consecutive induction of an inflammatory response. Diagnosis of pancreatitis is straightforward with in‐house diagnostic test kit (SNAP® cPLI™), which has 95% correlation on sensitivity to the reference laboratory. One recent study found that CMVI is associated with pancreatic injury in congestive heart failure caused by CMVI. Therefore, periodic monitoring on cPLI could be useful in monitoring dogs in heart failure [27].
\nOral cavity is one of the blood‐rich organs. Hypoxia can induce many dental problems including dental tartar and periodontitis, which is requiring general anesthesia for treatment. We developed anesthetic protocol for dogs with cardiac diseases [145]. Our study was designed to evaluate the effects on cardiovascular system in dogs using anesthetic combination of alfaxalone, butorphanol, and midazolam. Compared to the baseline value (before anesthesia), all cardiac indices were decreased, although only heat rate and aortic blood pressure were statistically significantly decreased (
Cardiac cachexia is generally seen in dogs with history of long‐standing CMVI [23, 99]. Once heart failure develops, an important indicator of a worsening condition is the occurrence of cardiac cachexia, which is unintentional rapid weight loss (a loss of at least 7.5% of normal weight within 6 months).
Many dogs with CMVI may live for years before developing any symptoms. Prognosis for dogs with CMVI is greatly depending on the severity of heart failure and duration and quality of medical therapy and patient monitoring. Generally, the average survival time of dogs with CMVI is ~3 years in dogs with ISACHC I stage heart failure, while 1–3 years in dogs with ISACHC II stage heart failure and ~6–12 months in dogs with ISACHC III stage of heart failure, respectively [13]. There are several prognostic indicators for dogs with CMVI. The degree of exercise intolerance [146], degree of cardiomegaly [53], degree of LA/LV enlargement [7, 147], and certain ECG indices (e.g., the degree of tachycardia or vagus tone index) [51] were closely related to the prognosis. Furthermore, certain echocardiographic indices (e.g., LA/Ao ratio, E/A wave ratio, EDVI) were found to be a good prognostic indicator in dogs with CMVI [84, 148]. Weight loss (e.g., cachexia) and degree of azotemia by reduced glomerular filtration rate (GFR) are indicators for worsening clinical signs.
Today mankind is facing the problem of severe shortage of power supply as a result of current consumption rate and low conventional energy reserves [1, 2]. Increased human activity has led to increased energy consumption and reduced conventional fuel reserves to dangerous levels, leading to the high price of world oil [3]. Scientists and researchers have begun to look for new sources of energy to replace conventional sources and replace it with a clean and environmentally friendly option [4]. Solar energy has been a priority for these concerns because it is cheap, is nonpolluting, and does not require high technology [5].
The passive solar heating system is a technique that generates thermal energy by collecting solar radiation and then moving it into the building naturally [6]. It is one of the most economical ways for solar energy utilization, which can reduce yearly heating demand by about 25% [7]. Among the passive solar heating systems that have been developed are solar roofs, solar chimneys, and a Trombe wall [8].
The Trombe wall is a method to use solar energy for heating without using any mechanical or electrical assistance, as shown in Figure 1 [9]. The name of the Trombe wall was taken from a French scientist named Michel Trombe, who discovered in 1880 [10]. It is considered a simple and inexpensive solution that uses solar energy in heating, which reduces heat load up to 47% [11]. A Trombe wall is always located on the southern face of buildings in the northern hemisphere to increase solar energy throughout the year. It consists of a wall of concrete or bricks for heat storage, and the wall is coated with black paint to increase the absorption of solar radiation. There are layers of glass at 5–10 cm distance from the concrete wall to increase the intensity of solar radiation. A Trombe wall is covered in the summer to prevent excessive warming [12]. The wall has two openings at the top and bottom to circulate the air. Solar heat is transferred from the Trombe wall into the room by convection heat transfer and conduction. Cold air passes from the lower opening of the wall, then the air is heated through the channel and moves into the room through the upper vent. Meanwhile, heat transfer through the thermal wall needs more time to move into the room. Although a commercial PV system is widely available, however, further research and development are necessary to improve efficiency and reduce costs. Passive solar techniques can reduce yearly heating demand by about 25%. Different architectural devices such as Trombe walls, solar roofs, solar chimneys, and others are used in buildings [13]. In the last years, modern technologies introduced that use solar cells to generate electricity. The photovoltaic cell can be integrated with buildings such as the PV-Trombe wall [14]. The increase in the solar cell temperature leads to lower efficiency as shown in Figure 2.
Classical Trombe wall.
Electrical efficiency as a function of solar cell temperature.
In early 1990s, the idea of building-integrated photovoltaic/thermal (BIPV/T) systems emerged. It has attracted increasing attention since 2000 because of its potential to facilitate the design of net-zero energy buildings by improving solar energy use [15]. Generally, a BIPV/T system has the following features:
BIPV/T system is physically attached to buildings.
The system produces electricity.
The system provides thermal energy ready to be collected and used by the building.
Figure 3 shows the PV modules installed on the roof of a room with an air duct at an angle of 34° to the horizontal, which corresponds to the latitude of Srinagar, India.
Photovoltaic-thermal system integrated on the roof.
Chow et al. [16] presented a comparative study of three different parameters for BIPV technology in China. The results showed no significant difference in electricity production as the indoor space with 24-hour temperature supplied continuous cooling of the solar cells through the outer façade. For semi-equatorial climate, PV/C and PV/T systems are better than the BIPV system because of their ability to limit the increase of space temperature. The PV/C system considered a better option because of its effectiveness in reducing the cooling power of elimination and has a simple design.
Hu et al. [17] compared three types of systems [i.e., solar cells affixed to glass (BIPVGTW), solar cell attached to the mass wall (BIPVMTW), and PV-blind-integrated Trombe wall system (BIPVBTW)] as illustrated in Figure 4, and the results showed that the electrical performance of BIPVGTW was better and the system adopted electrifying performance at the blindness angle. In terms of thermal performance, the BIPVBTW system increased room temperature during the winter season higher than other systems. The BIPVGTW system is better than BIPVBTW and BIPVMTW systems.
Three models of BIPV Trombe wall systems. (A) BIPVGTW. (B) BIPVMTW. (C) BIPVBTW.
Nagano et al. [18] studied the experimental thermal/PV hybrid exterior wallboards that incorporate PV cells, as shown in Figure 5. The clapboard-shaped hybrid wallboards permit modular assembly that is more suitable for building applications than former PV systems. Solar heat collected in the form of heated air circulating in the air duct between the thermal insulation of the exterior walls and the composite wallboard.
The concept of a new type of hybrid wallboard.
For the last 20 years, there has been a rapid development in the field of integrated solar technologies. The idea of building the photovoltaic-Trombe wall has appeared as one of the green technologies. The concept is to use solar cells with a Trombe wall to generate electricity as well as heating. The photovoltaic/thermal (PV/T) systems convert solar radiation into heat and electricity together, such as PV-Trombe wall (PV/TW) system.
The design of the PV/TW system is like the original design of the classical Trombe wall, just replacing the thermal wall by a solar cell, as shown in Figure 6 [19]. They are less expensive, environmentally friendly, and more suitable for a given house or building, and it is more efficient than the separate solar thermal and electrical systems. Furthermore, the PV/TW system can contribute to the reduction in the consumption of fossil fuels for large combined production [20].
Photovoltaic-Trombe wall.
Several modifications were performed to improve the performance of PV/TW. Verifying the thermal and electrical performance of the PV/TW system has been done by Ahmed et al. [21, 22]. The base configurations were modified to improve the performance of the PV/TW system. These modifications are inserting the DC fan, heat exchanger, porous medium, and glass cover. Incorporating the DC fan and bi fluid (air and water) cooling circuit offered desirable features of the system performance. This study dealt with the design of two different configurations PV/TW system, as shown in Figure 7 as follows:
The first configuration consists of a glass cover on the front, then the air duct, and the solar cell panel attached to the massive wall, as shown in Figure 7a.
The second configuration includes the solar cell panel in the front, then the air duct, and the massive wall, as shown in Figure 7b.
Modified Photovoltaic-Trombe walls.
Also, various suggestions were performed to improve system performance. These modifications for both configurations are inserting a cooling coil and DC fan. Moreover, the second configuration, the porous medium, was added inside the gap, as shown in Figure 7c, and a glass cover was attached to the front of the solar cell, as shown in Figure 7d.
PV/TW considers favorable architectural technology and utilizes solar energy for cooling and heating in different climate areas. Many factors affect the efficiency of PV/TW, and these factors should be considered when designing this system in buildings. These factors include operation parameters (mass flow rate, cooling, partial covering, southern window, air duct, and tilt angle of the solar cell) and design parameters [properties of glass, direct current (DC) fan, channel depth, thermal insulation, packing factor, and materials].
During the design of PV/TW, the characteristics of glass, such as the number of glass, glazing thickness, and types of glass (single glass, double glass, and double glass filled with argon), significantly affect the amount of solar radiation absorbed and transmitted, as well as the heat transfer between the interior and the ambient. Irshad et al. [23] presented a simulated model of a room with PV/TW. The performance evaluated by varying the airflow velocity for three different PV/TW glazing types (i.e., single glazing, double glazing, and double glazing filled with argon). The results showed that double-glazing PV/TW loaded with argon demonstrated a significant reduction in cooling load and room temperature, while PV productivity increased.
Jie et al. [14] introduced a novel system for PV/TW-solar cell connected to a DC fan and compared the performance of the system with a normal Trombe wall-solar cell, as shown in Figure 8. The results showed a significant increase in room temperature compared to the original room, as well as an increase in the electrical efficiency of the solar cell due to improved cooling. Yi et al. [24] presented a simulated system of novel PV/TW with a DC fan. The results showed that as fan speed increased, the electric and thermal efficiencies also increased.
Modified Photovoltaic-Trombe walls.
The influence of channel depth, which represents the distance between a glass cover and a solar cell, was investigated. Ji et al. [25] studied the electrical and thermal performance of the PV/TW system utilized in Tibetan residential buildings, as shown in Figure 8. It was found that when the width of the PV/TW system increased, the room temperature also increased, although electrical effectiveness was almost constant.
Changing the air gap and different types of PV glazing (i.e., double glazing, single glazing, and double glazing filled with argon) was studied by Irshad et al. [26]. The results affirmed that double glazing PV/TW system filled with argon gives the maximum PV efficiency at a roof pitch angle of 20° and an air gap of 0.2 m. Ventilated PV/TW system and PV cell installed through the roof also reduced the cooling load of the room.
Published studies have shown that reducing the packing factor leads to an increase in room temperature, as mentioned by Vats et al. [27]. The packing factor of a solar cell was dependent on changing the area of PV cells in a given area of the solar cell, as shown in Figure 9. The reduction in the temperature of the PV module was observed due to the reduction of the packing factor that enhances electrical effectiveness.
(a) PV module with a cell area of 0.0139 m2, (b) PV module with a cell area of 0.0069 m2, and (c) the proposed design of thin-film PV with glass.
The coverage ratio of PV glazing is defined as:
where
Xu and Su [30] carried out a numerical simulation of airflow in BIPV-TW, as shown in Figure 10. The results demonstrated that the airflow rate increased linearly with duct height. Also, Hu et al. [31] investigated experimentally three models of PV/TW, as shown in Figure 11, i.e., PV-BTW, PV-GTW, and PV-MTW at the University of Science and Technology of China. The results showed that the angle of 50° and the entry air flow rate of approximately 0.45 m/s were the best parameters for the PV-BTW type. The results also showed that the PV-GTW model produced the highest electricity output compared to PV-MTW and PV-BTW.
Physical and simplified models of BIPV-TW.
PV-Trombe wall modules of (a) PV-BTW, (b) PV-GTW, and (c) PV-MTW.
Previous works have shown that researchers are interested in finding a way to use solar energy as a substitute, useful, and clean energy. The researchers concluded the importance of studying design and operational information that led to an increase in the electrical and thermal efficiency of the PV/TW system. The following conclusions can be extracted from the previous studied:
The use of water to cool the solar cell reduces the temperature of the solar cell, which increases the electrical power produced that increases the efficiency of electricity generation. Also, it increases the overall thermal efficiency but reduces thermal air efficiency.
The use of a DC fan increases the produced electrical power and room temperature, which increases thermal and electrical efficiency.
The use of glass cover increases the temperature of the solar cell, which decreases the power and efficiency of the electricity generation. Also, the use of glass cover increases the room temperature and thermal efficiency.
The use of a porous medium increases the area of heat transfer, which increases the thermal and electrical efficiency and temperature of the room.
Thermal and electrical efficiencies have decreased in a dusty and cloudy climate due to a decrease in the amount of solar radiation reaching the solar cell of the PV/TW system.
IntechOpen is the first native scientific publisher of Open Access books, with more than 116,000 authors worldwide, ranging from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery. Established in Europe with the new headquarters based in London, and with plans for international growth, IntechOpen is the leading publisher of Open Access scientific books. The values of our business are based on the same ones that any scientist applies to their research -- we have created a culture of respect, collegiality and collaboration within an atmosphere that’s relaxed, friendly and progressive.
",metaTitle:"Social Media Community Manager and Marketing Assistant",metaDescription:"We are looking to add further talent to our team in The Shard office in London with a full-time Marketing and Communications Specialist position. The candidate will bring with them a creative and enthusiastic mindset, high level problem-solving skills, the latest marketing and social media platforms skills and strong involvement in community-best practices to engage with researchers and scholars online. The ideal candidate will be a dynamic, forward thinking, approachable team player, able to communicate with all in the global, growing company, with an ability to understand and build a rapport within the research community.",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"We are looking to add further talent to our team in The Shard office in London with a full-time Social Media Community Manager and Marketing Assistant position. The candidate will bring with them a creative and enthusiastic mindset, high level problem-solving skills, the latest marketing and social media platforms skills and strong involvement in community-best practices to engage with researchers and scholars online. The ideal candidate wll be a dynamic, forward thinking, approachable team player, able to communicate with all in the global, growing company, with an ability to understand and build a rapport within the research community.
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\n\nThe Social Media Community Manager and Marketing Assistant will report to the Senior Marketing Manager. They will work alongside the Marketing and Corporate Communications team, supporting the preparation of all marketing programs, assisting in the development of scientific marketing and communication deliverables, and creating content for social media outlets, as well as managing international social communities.
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\n\nEssential Skills:
\n\nDesired Skills:
\n\nWhat makes IntechOpen a great place to work?
\n\nIntechOpen is a global, dynamic and fast-growing company offering excellent opportunities to develop. We are a young and vibrant company where great people do great work. We offer a creative, dedicated, committed, passionate, and above all, fun environment where you can work, travel, meet world-renowned researchers and grow your career and experience.
\n\nTo apply, please email a copy of your CV and covering letter to hogan@intechopen.com stating your salary expectations.
\n\nNote: This full-time position will have an immediate start. In your cover letter, please indicate when you might be available for a block of two hours. As part of the interview process, all candidates that make it to the second phase will participate in a writing exercise.
\n\n*IntechOpen is an Equal Opportunities Employer consistent with its obligations under the law and does not discriminate against any employee or applicant on the basis of disability, gender, age, colour, national origin, race, religion, sexual orientation, war veteran status, or any classification protected by state, or local law.
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In this chapter, the authors will review the most common types of FIOEs, including bullet or “projectile” embolism (BPE), followed by intravascular catheter or wire embolization (ICWE), and conclude with intravascular noncatheter object (e.g., coil, gelatin, stent, and venous filter) migration (INCOM). In addition to detailed topic-based summaries, tables highlighting selected references and case scenarios are also presented to provide the reader with a resource for future research in this clinical area.",book:{id:"5839",slug:"embolic-diseases-unusual-therapies-and-challenges",title:"Embolic Diseases",fullTitle:"Embolic Diseases - Unusual Therapies and Challenges"},signatures:"Thomas R. Wojda, Stephen D. Dingley, Samantha Wolfe, W. T.\nHillman Terzian, Peter G. Thomas, Daniel Vazquez, Joan Sweeney\nand Stanislaw P. Stawicki",authors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. 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The majority will pass spontaneously or be removed endoscopically, but a few selected cases may require emergency surgery for removal. This chapter reviews the management of foreign bodies within the GIT including both instances of foreign body ingestions and foreign body insertions. The scope of this chapter is not limited to evidence‐based data on selection of cases for conservative management but also includes data on endoscopic and surgical management.",book:{id:"5280",slug:"actual-problems-of-emergency-abdominal-surgery",title:"Actual Problems of Emergency Abdominal Surgery",fullTitle:"Actual Problems of Emergency Abdominal Surgery"},signatures:"Obinna Obinwa, David Cooper, James M. 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These cystic dilatations of the biliary tree can involve the extrahepatic biliary radicles, the intrahepatic biliary radicles, or both. The etiology remains unknown, but choledochal cysts are likely to be congenital in nature. Cyst excision is the definitive treatment of choice for choledochal cyst because of the high morbidity and high risk of carcinoma after internal drainage, a commonly used treatment in the past. CDC is a congenital anomaly involving cystic dilatation of various ducts of biliary tree. The precise etiology of extrahepatic cysts continues to remain unclear. The most commonly accepted theory is an anomalous pancreatobiliary duct junction (APBDJ) and abnormal function of the sphincter of Oddi. Proper imaging plays an essential role in preoperative planning. Proper diagnosis evaluation and management is essential for optimal management. Type I cysts are the most frequently encountered. Choledochal cysts can have variable presentations. Hepatobiliary ultrasound and MRCP are the present day standards for imaging; early diagnosis should be the norm to avoid possible late complications of cholangitis, cirrhosis, hepaticolithiasis and spontaneous perforation. Excision of the cyst with hepaticojejunostomy is the best approach.",book:{id:"6352",slug:"gastrointestinal-surgery-new-technical-proposals",title:"Gastrointestinal Surgery",fullTitle:"Gastrointestinal Surgery - New Technical Proposals"},signatures:"Raashid Hamid, Nisar A. Bhat, Mansoor Ahmad and Balvinder Singh",authors:[{id:"213319",title:"Dr.",name:"Raashid",middleName:null,surname:"Hamid",slug:"raashid-hamid",fullName:"Raashid Hamid"},{id:"233782",title:"Dr.",name:"Nisar",middleName:null,surname:"Bhat",slug:"nisar-bhat",fullName:"Nisar Bhat"},{id:"233784",title:"Dr.",name:"Mansoor",middleName:null,surname:"Ahmad",slug:"mansoor-ahmad",fullName:"Mansoor Ahmad"},{id:"251293",title:"Dr.",name:"Balvinder",middleName:null,surname:"Singh",slug:"balvinder-singh",fullName:"Balvinder Singh"}]},{id:"69812",title:"Laparoscopic Retromuscular Repair of Ventral Hernias: eTEP and eTEP-TAR",slug:"laparoscopic-retromuscular-repair-of-ventral-hernias-etep-and-etep-tar",totalDownloads:1253,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Professors Jean Rives and Rene Stoppa published that the retrorectus space is the best for mesh placement in open ventral hernia repair and their technique has become the gold standard. This chapter presents a new technique in laparoscopic ventral hernia repair (LVHR), which combines the advantages of Rives-Stoppa procedure with the advantages of minimally invasive surgery (MIS)—it is about enhanced-view totally extraperitoneal (eTEP) approach. Restoration of the architecture of the abdominal wall and also of its functionality and the possibility to extend laterally the retromuscular dissection, if it is needed, performing transversus abdominis release (TAR) give laparoscopic retromuscular repair of ventral hernias the chance to become the gold standard in LVHR.",book:{id:"9113",slug:"techniques-and-innovation-in-hernia-surgery",title:"Techniques and Innovation in Hernia Surgery",fullTitle:"Techniques and Innovation in Hernia Surgery"},signatures:"Victor G. Radu",authors:[{id:"303278",title:"Dr.",name:"Victor",middleName:"Gheorghe",surname:"Radu",slug:"victor-radu",fullName:"Victor Radu"}]},{id:"68847",title:"The Tension-Free Repairs without Mesh: Desarda and Modified Bassini Techniques",slug:"the-tension-free-repairs-without-mesh-desarda-and-modified-bassini-techniques",totalDownloads:843,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Hernia repair has three principal objectives: suppress the hernia, prevent recidivism, and reduce postoperative pain. Many techniques have been developed especially the tension-free repair. The Lichtenstein technique is the gold standard, using a mesh. However, sub-Saharan population is known to be hard laborers leading to the high-risk factor of acquiring hernia by a parietal defect. Most of them need a heterologous hernioplasty but have limited resources. The challenge in these countries is respecting the principal objectives of a hernia repair with inexpensive prosthetic material or without it. During these previous years, two principal techniques have been developed and used with satisfied results: Desarda and Modified Bassini techniques.",book:{id:"9113",slug:"techniques-and-innovation-in-hernia-surgery",title:"Techniques and Innovation in Hernia Surgery",fullTitle:"Techniques and Innovation in Hernia Surgery"},signatures:"Frederica Jessie Tchoungui Ritz",authors:[{id:"304746",title:"Dr.",name:"Frederica Jessie",middleName:null,surname:"Tchoungui Ritz",slug:"frederica-jessie-tchoungui-ritz",fullName:"Frederica Jessie Tchoungui Ritz"}]},{id:"80147",title:"Robotic Complex Abdominal Wall Reconstruction: The Evolution of Component Separation",slug:"robotic-complex-abdominal-wall-reconstruction-the-evolution-of-component-separation",totalDownloads:97,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"From the first description of the component separation technique in the literature at the end of the twentieth century to the current state of complex abdominal wall reconstruction, this rapidly evolving field of General Surgery has advanced at an accelerated pace. With the advancement of technological breakthroughs that stem from the original open technique, endoscopic, laparoscopic, and more recently robotic approaches have been developed to facilitate complex abdominal wall reconstruction to restore the body’s anatomy and physiology to functional levels. This chapter will give an overview of the historic progression of these advanced techniques and will illustrate the key steps for their safe and effective performance including the endoscopic external oblique anterior release as well as posterior release techniques such as the robotic transversus abdominis release (TAR). Finally, other useful variations of complex repair such as the robotic extended totally extraperitoneal (eTEP) approach will be described.",book:{id:"11238",slug:null,title:"Hernia Surgery",fullTitle:"Hernia Surgery"},signatures:"Rodolfo J. Oviedo, Jeffrey Hodges, Joseph Nguyen-Lee, David Detz, Mary Oh, João Bombardelli, Anuj Shah, Atteeba Manzar and Alessandro Martinino",authors:null}],onlineFirstChaptersFilter:{topicId:"1138",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"80410",title:"Management of Obturator Hernia",slug:"management-of-obturator-hernia",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.102075",abstract:"The obturator hernia is a rare pelvic hernia that often presents with symptoms of bowel obstruction. Obturator hernia corresponds to 0.5–1.4% of all abdominal hernias. Entrapment of an intestinal segment within the obturator orifice, most often the ileum, less frequently Meckel’s diverticulum or omentum, can cause intestinal obstruction. The non-specific presenting symptoms make the diagnosis of this condition often unclear. Females are 6–9 times more likely than men to be subject to the pathology, mostly occurring in a multiparous, emaciated, elderly woman so it is also called “the little old lady’s hernia.” Risk factors such as chronic constipation, chronic obstructive pulmonary disease, ascites, kyphoscoliosis, and multiparty, can predispose patients to herniation. A sign of inconstant presentation may be the presence of a palpable mass or pain radiating from the inner thigh and knee—known as Howship–Romberg sign—but it could be misleading when confused with symptoms of gonarthrosis or lumbar vertebral disc pathology. CT scan of the abdomen and pelvis has been found to be the gold standard for preoperative diagnosis because of its superior sensitivity and accuracy with respect to other radiological exams. The only possible treatment for this pathology is surgery, and management depends on early diagnosis.",book:{id:"11238",title:"Hernia Surgery",coverURL:"https://cdn.intechopen.com/books/images_new/11238.jpg"},signatures:"Luigi Conti, Carmine Grassi, Filippo Banchini, Deborah Bonfili, Gaetano Maria Cattaneo, Edoardo Baldini and Patrizio Capelli"},{id:"81656",title:"Totally Extraperitoneal Approach (TEP) for Inguinal Hernia Repair",slug:"totally-extraperitoneal-approach-tep-for-inguinal-hernia-repair",totalDownloads:12,totalDimensionsCites:0,doi:"10.5772/intechopen.104638",abstract:"Laparoscopic inguinal herniorrhaphy was initially described by Ger in the early 1980s. Nowadays, two techniques are worldwide adopted: the transabdominal preperitoneal approach (TAPP) and the totally extraperitoneal approach (TEP). In these repairs, the myopectineal orifice is approached posteriorly and allows for inguinal, femoral, and obturator hernia repairs to be performed simultaneously. TEP is a relatively new technique. McKernan and Law first introduced TEP in 1993. Some proponents of TEP advocate for this technique over the transabdominal approach due to the shorter operative times, especially for bilateral hernias, and decrease the risks of vascular, bowel, and bladder injuries as well as bowel obstructions, adhesions, or fistula formation potentially associated with intraperitoneal dissection and intraperitoneal mesh exposure. When compared with open hernia repair, and in particular for recurrent (after open) and bilateral hernias, many surgeons prefer the laparoendoscopic approach due to quicker recovery times and less postoperative and chronic pain. In experienced hands, there are no absolute contraindications to TEP, although a careful decision should be made to tailor the approach to both patient and surgeon factors. In this chapter, we will describe the technical steps of totally extraperitoneal hernia repair, the potential complications, and troubleshooting when needed.",book:{id:"11238",title:"Hernia Surgery",coverURL:"https://cdn.intechopen.com/books/images_new/11238.jpg"},signatures:"Ioannis Triantafyllidis"},{id:"80570",title:"Spigelian Hernia: Clinical Features and Management",slug:"spigelian-hernia-clinical-features-and-management",totalDownloads:11,totalDimensionsCites:0,doi:"10.5772/intechopen.102809",abstract:"The Spigelian hernia is a rare variety of ventral hernia and has an incidence ranging from 0.1–2% of all abdominal wall hernias. It occurs through a well-defined defect in the Spiegel’s fascia adjacent to the semilunar line. It can be congenital or acquired. The acquired variety is predisposed by stretching and weakening of the abdominal wall by factors that increase the intraabdominal pressure. These hernias are most commonly located in the interparietal plane with no visible or palpable mass, and only 50% of cases could be diagnosed clinically before any surgical intervention. Radiological investigations like USG and CT scans confirm the clinical diagnosis or pick up the subclinical varieties that present with non-specific pain in the anterior abdominal wall. Surgery is the mainstay of management. These hernias are prone to early incarceration and strangulation and therefore should be operated at the earliest. It is stressed that a prosthetic mesh should be used for a better outcome as it decreases recurrence. Conventional open hernioplasty has been largely replaced by a laparoscopic approach such as TAPP, TEP, IPOM and robotic-assisted surgery. Early diagnosis and surgery prevent morbidity and dreaded complications.",book:{id:"11238",title:"Hernia Surgery",coverURL:"https://cdn.intechopen.com/books/images_new/11238.jpg"},signatures:"Aakansha Giri Goswami, Farhanul Huda, Sudhir Kumar Singh, Navin Kumar and Somprakas Basu"},{id:"80950",title:"Laparoscopic Hiatal Hernia Repair during in-Sleeve Gastrectomy",slug:"laparoscopic-hiatal-hernia-repair-during-in-sleeve-gastrectomy",totalDownloads:16,totalDimensionsCites:0,doi:"10.5772/intechopen.104395",abstract:"Obesity is one of the most important health problems in developed and developing countries. Morbid obesity is defined as having a body mass index (BMI) of more than 40 kg/m2. Obesity does not only predispose to gastroesophageal reflux, but is also an important independent risk factor for the development of hiatal hernia (HH). There are articles advocating about half of obese patients have a hiatal hernia. Hiatal hernia not only exacerbates reflux symptoms, but may also lead to incomplete removal of the gastric fundus during laparoscopic sleeve gastrectomy (LSG). When hiatal hernias are seen preoperatively or intraoperatively for bariatric surgery, surgical correction should ideally be made with mesh reinforcement to prevent further clinical progression.",book:{id:"11238",title:"Hernia Surgery",coverURL:"https://cdn.intechopen.com/books/images_new/11238.jpg"},signatures:"Seyfi Emir, Hasan Erdem, Mehmet Gençtürk, Muhammed Said Dalkılıç, Abdullah Şişik and Selim Sözen"},{id:"80352",title:"Anatomical and Surgical Principles of Ventral Hernia Repairs",slug:"anatomical-and-surgical-principles-of-ventral-hernia-repairs",totalDownloads:42,totalDimensionsCites:0,doi:"10.5772/intechopen.102734",abstract:"Hernias comprise a growing problem in surgical science. The most recent classification scheme for hernias emphasizes on the size of defect as well as on whether it is an incisional hernia. The latter group includes complex hernias, namely hernias that can not be managed with simple surgical techniques. This can be accomplished with retromuscular repairs or the more complex anterior and posterior component separation techniques. An anatomic repair is usually reinforced with interposition of mesh. Newest techniques, such as the use of botulinum toxin to induce temporary paralysis of the lateral abdominal wall musculature, referred to as chemical component separation, now present new tools in the restoration of anatomy-based repairs. The chapter entitled “Anatomical and surgical principles of ventral hernia repairs” aims to describe the anatomical and surgical principles of current practice regarding the repair of ventral -primary and incisional-hernias.",book:{id:"11238",title:"Hernia Surgery",coverURL:"https://cdn.intechopen.com/books/images_new/11238.jpg"},signatures:"Chrysanthi Papageorgopoulou, Konstantinos Nikolakopoulos, Fotios Efthymiou and Charalampos Seretis"},{id:"80646",title:"Hybrid: Evolving Techniques in Laparoscopic Ventral Hernia Mesh Repair",slug:"hybrid-evolving-techniques-in-laparoscopic-ventral-hernia-mesh-repair",totalDownloads:41,totalDimensionsCites:0,doi:"10.5772/intechopen.102413",abstract:"Laparoscopic repair is now the treatment of choice for most cases of ventral/incisional hernia. It is superior to open repair. Although the technique has undergone many refinements, there is no standard technique for difficult or complicated hernias. In cases with difficult hernias, combined open/laparoscopic hybrid techniques to avoid dissection of large subcutaneous flaps benefit the patients. It has been reported that hybrid methods are effective for treating cases of ventral hernias involving a large orifice. The techniques used and proposed by us are - (1) laparoscopic adhesiolysis, open sac excision with closure of defect and laparoscopic mesh placement, (2) laparoscopic adhesiolysis, omphalectomy with closure of defect and laparoscopic mesh placement and (3) open adhesiolysis, sac excision with closure of defect and laparoscopic mesh placement Laparoscopic Ventral Hernia Hybrid Mesh Repair (LVHHMR) is safe and feasible approach for complicated/difficult ventral hernias.",book:{id:"11238",title:"Hernia Surgery",coverURL:"https://cdn.intechopen.com/books/images_new/11238.jpg"},signatures:"Wasim Dar, Uday Muddebihal and Uliargoli Vasudeva Rao"}],onlineFirstChaptersTotal:10},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:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,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:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,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:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"May 15th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:27,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment"},{id:"5",title:"Parasitic Infectious Diseases",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology"},{id:"6",title:"Viral Infectious Diseases",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{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. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. 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"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"bookSubject",path:"/subjects/1138",hash:"",query:{},params:{id:"1138"},fullPath:"/subjects/1138",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()