\r\n\t1. To draw spotlight on recent studies and research concerned with the regeneration process in animal kingdom and models with emphasis on the cellular origins of regeneration.
\r\n\t2. Then, we will be dealing with the reasons for the differences in the regenerative capacity of animals on many levels, including the molecular mechanism, gene expression, epigenetic regulation, common elements affecting regeneration and comparing their contributions to regeneration.
\r\n\t3. To provide new insights into how to promote regeneration in mammals.
Aphasia is one of the most common and also frustrating disabilities secondary to stroke; over 25% of the patients who suffer an acute ischemic stroke are dealing with this complex syndrome in their evolution. It is also considered an important stroke severity marker, being associated with a higher risk of mortality, poor functional prognosis, and augmented risk of vascular dementia. This syndrome is a real challenge not only for the patients or their relatives but also for the specialists (neurologists, speech therapists, psychologists, and physiotherapists) involved in the diagnosis and treatment of those patients.
\nThe assessment of aphasias in clinical practice is based on classical analysis of oral production and comprehension. The language disturbances are frequently combined into aphasic syndromes (nonfluent/fluent aphasias), which are constituents of different vascular syndromes, being accompanied by motor deficit of the right limbs or visual deficit (hemianopia). The main determinant of the type of vascular aphasia is the infarct location (especially left middle cerebral artery territory). Recent studies at the hyperacute stage of ischemic stroke have observed features of aphasia, have reanalyzed its neuroanatomy using new imaging techniques, and have shown that aphasias have a parallel course to that of cortico-subcortical hypoperfusion. Thus, the reversal of hypoperfusion, following recanalization (spontaneous or secondary to thrombolysis or thrombectomy), is associated with resolution of aphasia. Speech therapy is needed as soon as permitted by clinical condition. Unfortunately, pharmacotherapy remains to be evaluated. Other studies examined the potential interest of new treatment, such as transcranial magnetic stimulation.
\nThis chapter is meant to clarify different aspects regarding the definition, classification, diagnosis criteria, and therapeutically strategies for the most common vascular aphasic syndromes due to ischemic stroke.
\nIn the field of neurolinguistics, there are two words, often misused as synonyms: “language” and “speech,” although each one of these terms describes different functions regarding distinct processes and involving distinct neural networks [1].
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The language system consists of five domains [1]:
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Speech results from the extremely coordinated rapid motor functions, thereby requiring the combination of phonation (voicing), resonance (nasality), articulation, fluency, and prosody. It is responsible for the actual act of vocal expression of language. The most important neural structures involved in the regulation of speech are represented by the cortical systems, the basal ganglia, the cerebellum, and the corticobulbar tracts, via the nuclei of the trigeminal, facial, glossopharyngeal, vagal, accessory (spinal), hypoglossal, and phrenic nerves. All these structures maintain the control and coordination between all the muscles involved in speaking: oral, lingual, palatal, pharyngeal, laryngeal, and respiratory muscles [1].
\nAphasia represents an acquired central disorder of language that impairs a person’s ability to understand or/and produce spoken language, often associated with impairment in reading (alexia) and writing (agraphia). Aphasia may supplementary affect the person’s ability to use musical notation, mathematical operations, etc.; in consequence, the aphasic may present difficulties to generate and use symbol systems. Aphasia is different from a peripheral (sensory-motor) disorder of language that may mimic aphasia (such as weakness of the muscles of articulation). In the same time, it is an acquired phenomenon that appears after the language has already been learned [1, 2, 3, 4].
\nNowadays, in the era of functional neuroimaging, using a variety of complex techniques, organization of the language network has been partially understood. The outward production of language is the effect of neural activation in huge network including different regions in the cortex, basal ganglia, cerebellum, and brainstem. An overlap in that network or with other networks of specialization determines the huge clinical spectrum following an acquired injury. One lesion in an area can produce numerous signs, and injuries concerning distinct areas can result in similar deficits [1].
\nFunctional neuroimaging studies mentioned that the “language network” is strikingly similar across different language tasks and across different healthy people:
Aphasia is caused by a localized brain damage. Using a combination of different neuroimaging techniques, it has been suggested that
Anterior areas | \nPosterior areas | \n
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Recent studies [2], using MRI, noted the following correlations between different linguistic disturbances and cerebral lesions due to ischemic strokes:
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The assessment of aphasias in clinical practice is based on the analysis of six different language domains, which are represented by oral production (expressive language), comprehension (language understanding), repetition, naming, reading, and writing (Figure 1) [1, 2, 3, 4, 5, 6].
\nThe assessment of aphasias in clinical practice is based on the classical analysis of oral production (fluency), comprehension, and repetition.
It refers to modifications of fluency, prosody and volume, and presence of deviations at various linguistic levels [1, 2, 3, 4, 5, 6, 7].
\nFluency is represented by the flow of speech (number of words per minute: wpm) and effort (smoothness).
\nThe main deviations at different linguistic levels of oral production are as follows:
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Other deviations are represented by oral production restricted to a few stereotyped utterances (e.g., “tan tan”), jargon aphasia (associating frequently multiple phonemic and verbal deviations leading to neologisms), echolalia, and the “conduit d’approche” (i.e., numerous attempts to correct phonemic deformations by successive approximations).
\nThere are two types of aphasias: nonfluent (Broca’s aphasia, transcortical motor aphasia, and global aphasia) and fluent (Wernicke’s aphasia, transcortical sensory aphasia, and conduction aphasia). On the one hand, a nonfluent spontaneous speech presents less than 50 wpm, augmented effort, dysprosodia, sometimes hypophonia, dysarthria, few paraphasias (especially phonological paraphasias), substantive words in excess, and short sentences. On the other hand, a fluent speech presents a normal of words per minute (100–200 wpm), with a normal effort, normal prosody and volume, no deviation at sound level (correct articulation of a sound), many paraphasias (including verbal paraphasias), relatively lack of substantive words, and normal sentences (including 5–8 wps) [1, 2, 3, 4, 5, 6, 7].
\nIt analyses comprehension at the linguistic levels of word and syntax [1, 2, 3, 4, 5, 6, 7]. Oral comprehension is formally examined by (a) asking the aphasic to point an object, a body part, etc. and (b) presenting different verbal commands with augmenting complexity. Impaired oral comprehension is usually underdiagnosed in clinical practice. We should think at this language disturbance when a patient does not behave according to the examiner’s tasks, especially during object pointing on verbal command and tasks using sentences of progressive complexity. The shortened Token Test is the test usually used to exam if the comprehension is impaired (adjusted score <29) and to differentiate Broca from global aphasia (adjusted score <17) [2, 6].
\nWhen testing repetition, it is essential to use different types of items (short-long verbal information and meaningful-meaningless utterances) [1, 2, 3, 4, 5, 6, 7].
\nAphasias with impaired repetition ability (perisylvian aphasias) differ from this point of view from transcortical (extrasylvian) aphasias, with normal repetition (even if oral comprehension is severely impaired in transcortical sensory aphasia).
\nWhile testing naming, different types should be included: objects, body parts, actions, and colors (“What is this?”) [5, 6, 7]. If we want to assess the understanding ability of the patient, we have to exam pointing (“Show me, please, where the…is!”), which is the opposite of naming [5, 6].
\nWhile testing reading, we should focus on two aspects: (a) the mechanisms of reading (the conversion of visual signs-graphemes into phonemes) and (b) reading comprehension (using written commands, etc.) [5, 6, 7].
\nWe should exam spontaneous writing, writing by dictation, and copying at different levels of the writing language: letters, syllables, words, sentences, and texts [5, 6, 7].
\nThe different language disturbances observed are frequently combined into aphasic syndromes (nonfluent/fluent aphasias) [1, 2, 5, 7].
\nAn experimented examiner can diagnose the aphasic syndrome based on analysis of six language domains (oral production, etc.).
\nHowever, clinical examination can produce two kinds of errors: (a) underestimation of oral comprehension deficit and (b) misdiagnose of verbal stereotypies with jargon aphasia.
\nThese errors are not found in the case of assessment of aphasias using an aphasia battery test:
Boston Diagnostic Aphasia Examination (BDAE) [8]
Western Aphasia Battery (WAB) [9]
Montreal-Toulouse Language Assessment Battery [10]
Minnesota Test for Differential Diagnosis of Aphasia [6]
Multilingual Aphasia Examination [6]
Bilingual Aphasia Test [6]
Each test provides well-defined cut-off scores, so the description of the aphasic syndrome is more precise than that obtained on clinical grounds [2].
\nBilingual Aphasia Test (BAT) [6] was realized to exam each of the languages of a bilingual or polyglot aphasic in an equivalent way. The test is available in dozens of different pairs of languages. Thus, the various versions of the BAT are linguistically equivalent tests [6].
\nThe main determinants of the type of aphasias are
Types of aphasic syndromes (nonfluent/fluent aphasias) [1, 2, 8] are:
Broca’s aphasia
Wernicke’s aphasia
Conduction aphasia
Transcortical aphasias:
Transcortical motor aphasia
Transcortical sensory aphasia
Mixed transcortical aphasia
Global aphasias
Anomic plus aphasias
The global aphasia (24–38%) and anomic plus aphasia (20%) are more frequent in acute ischemic stroke; Broca (10–15%), Wernicke (15%), and transcortical motor aphasias (15–20%) present an intermediate frequency, and other aphasias are rare [1, 2, 5].
\nAbout 10% of aphasias remain unclassifiable, especially in patients with a previous ischemic stroke (atypical aphasias: mixed aphasias, thalamic aphasias, and capsulo-striatal aphasias) [2, 12, 13, 14].
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Assessment of oral production (spontaneous speech)
Fluency
When there is no aphasic mutism or when mutism has regressed, the patient presents a nonfluent, arduous verbal output, characterized by difficulties to initiate spontaneous speech, effortful with hesitations and slow output (10–15 words/minute), and interrupted by word-finding pauses. Sometimes, he presents dysprosody (oral expression is monotonously, melodic modulation being absent) [1, 2, 3, 4, 5, 15, 16, 17, 18].
Presence of deviations at various levels
Sound/arthric level (incorrect articulation of a sound)—dysarthria.
Phonemic level (omission, substitution, addition, or inversion of a phoneme)—phonemic paraphasias.
Verbal level (naming): semantic (verbal) paraphasias; word-finding difficulty (anomia), especially in spontaneous speech; deficits in action naming are more severe than deficits in object naming.
Syntactic level: agrammatism, usually more apparent after the acute phase: omission of functional/grammatical words (prepositions, conjunctions, articles, auxiliary verbs/e.g. “the,” “an,” and inflections), while conceptual words (nouns, verbs, and adverbs) are used in a greater proportion—“telegraphic speech.” Sometimes, the oral production can be restricted to a few stereotyped utterances (e.g., “tan tan”) [4, 5, 17, 19].
Assessment of repetition
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Assessment of oral comprehension
Usually, good oral comprehension, at least for commands, is needed to permit clinical exam. In some cases, syntactic comprehension can be affected as requested to understand complex sentences and multiple instructions [2]:
The patient is unable to distinguish between different operational words like “on” or “in.”
Comprehension of passive reversible sentences can be affected [18, 22].
Example:
(Q): “The girl was kissed by the boy. Who kissed whom?
(A): Girl kiss boy.”
Assessment of reading and writing
Reading (frontal alexia-literal alexia) and writing (frontal agraphia) are also impaired [20].
In conclusion, three characteristics represent the core of Broca’s aphasia: dysarthria, agrammatism, and preserved comprehension [1, 2, 3, 4, 5].
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Contralateral hemiparesis—lesions that cause Broca’s aphasia also interrupt adjacent cortical motor fibers and deep fiber tracts.
Facial weakness.
Buccofacial apraxia/apraxia of speech, which represents a disturbance in motor programming of speech articulation. The patient is aware of his deficit, so he tries unsuccessfully to correct his disturbance by trial and error. Instead, he presents difficulty in initiating utterances, groping articulatory movements, and articulatory inconsistency on repeated attempts of the same utterance.
The patient with Broca’s aphasia is aware of his oral expression disorders; consequently, he can develop depression [1, 2, 3].
Lesions or dysfunctions usually involves on the left side in right-handed individuals (Figure 2):
\nDifferent types of aphasias: anatomo-clinical correlations.
Broca’s area: the posterior part of the third frontal gyrus-Brodmann areas 44 and 45.
\nLesions in this area determine transitory apraxia of speech. Larger lesions, involving Broca’s area and its subjacent white matter, produce transitory mutism, which is replaced by a rapidly improving syndrome with prominent arthric deformations and deficits in action naming that are more severe than deficits in object naming.
\nRolandic operculum: lower part of motor area: Fa.
\nLesions can extend or separately affect insular cortex, and subjacent white matter, centrum semiovale, capsulostriatum (caudate nucleus head and putamen), and periventricular areas. Infarctions involving together these structures and Broca’s area can produce the complete syndrome of Broca’s aphasia.
\nBroca’s aphasia is produced by infarcts/severe hypoperfusion (MRI of the brain) of the superior division of the left MCA [1, 2, 5, 23, 24, 25].
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Assessment of oral production (spontaneous speech)
Fluency
The verbal output is fluent, with easy initialization of speech, plentiful output (100–200 words/minute), the phrase length is normal (~5–8 words/phrase), with normal prosody. There is no quantitative reduction of spontaneous speech. In some cases, the oral production may be augmented (logorrhea), concerning patients with jargon aphasia and anosognosia (differential diagnosis with acute delirium) [1, 2, 5, 26, 27, 28].
Presence of deviations at various levels:
Sound/arthric level: good articulation of sounds, well-articulated speech
Phonemic level: verbal paraphasias (semantically related word substitutions), phonemic paraphasias (phonologically related word or nonword substitutions), and jargon aphasia (associating frequently multiple paraphasias leading to neologisms)
Verbal level (naming): word-finding difficulty anomia (naming is severely affected), frequently associated circumlocutions, perseveration, and occasional neologisms
Syntactic level: paragrammatism: nouns replaced by pronouns (“that” and “those”) or by unspecific words (“thing” and “something”) [1, 2, 5, 26, 27, 28]
Assessment of repetition
Assessment of oral comprehension
Oral comprehension is severe impaired, due to disturbances in language sounds perception (repetition is impossible); incapacity of accessing the meaning of the word (repetition is normal); decrease in verbal memory (repetition may be disturbed depending on the length of the verbal output of the speaker); perturbation in comprehension of the lexicosemantic relations of the phrase or utterance [1, 2, 5, 26, 27, 28].
Sometimes, comprehension is more difficult for isolated words; on the other hand, verbal reception of some lexicosemantic categories may be partially or totally preserved. Syntactic comprehension is significant affected [1, 2, 5, 26, 27, 28].
Assessment of reading and writing
Reading is frequently impaired (alexia).
Writing (agraphia): spontaneous and dictated writing are fully of paragraphia and paragrammatism; copying a text is easier than writing after hearing one [1, 2, 5, 26, 27, 28].
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Homonymous hemianopia—frequently associated.
Complete/dissociated Gerstmann syndrome (agraphia, acalculia, finger agnosia, and inability to distinguish between the right and left sides of one’s body).
Limb apraxia.
Anosognosia—it can be observed at the initial stage and decreases gradually; high excitation: logorrhea and exaggeration of mimico-gestural language. The patient with Wernicke’s aphasia, in contrast to a Broca’s aphasic, is unaware of his disorders and seems unconcerned [1, 2, 5, 26, 27, 28].
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Wernicke’s area: posterior part of the first two temporal gyri-T1/T2 (BA 22) (Figure 2).
Inferior parietal lobes: angular gyrus (BA 39) and supramarginal gyrus (BA 40).
Lesions can extend to the insular-external capsule region and anterior part of temporal gyri (BA22). Besides the cortical destructions from these areas, subjacent white matter can be also affected.
Wernicke’s aphasia is the result of an infarct/sever hypoperfusion (MRI of the brain) of the inferior division of the left MCA (supplies the posterior part of the temporal lobe and inferior parietal lobule), usually an embolic occlusion/atherothrombotic [1, 2, 5, 23, 24, 25].
\nWernicke’s aphasia is more current in elderly women, due to a higher frequency of infarct in the inferior-posterior territory of the MCA in these patients [1, 2, 5].
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Assessment of oral production (spontaneous speech)
Fluency: verbal output (spontaneous speech) is fluent, although some hesitations and self-correction attempts to interrupt the flow are noted [1, 2, 5, 29, 30, 31, 32].
Presence of deviations at various levels
Sound/arthric level: normal articulation (speech well-articulated).
Phonemic level: phonemic paraphasias are typically for conduction aphasia. The production of phonemic paraphasias across verbal tasks represents the cardinal feature of conduction aphasia.
Semantic/verbal paraphasias or neologisms are less frequent in conduction aphasia than in other fluent types of aphasia.
Verbal level (naming): anomia—naming may be mildly impaired.
Syntactic level: the grammar is preserved. Sentences are short and have simple syntax [1, 2, 5, 29, 30, 31, 32].
Assessment of repetition
Repetition is impaired, contrasting with the sparing of the oral comprehension. Repetition of monosyllabic or bisyllabic words can be normal, but repetition of polysyllabic words and of sentences is always incorrect. The patient often paraphrases the sentence rather than repeating it.
Repetitive self-corrections, word-finding difficulties, and paraphrasing are attempts to correct phonemic deformations by successive approximations, named “conduit d’approche” [2, 29, 30, 31, 32].
Assessment of oral comprehension
It involves sparing of oral comprehension. The patient understands simple, active sentences, but guesses at comprehension of passive sentences [1, 2, 5, 29, 30, 31, 32].
Assessment of reading and writing
It involves usually good reading comprehension, but paraphasic oral reading. More precisely, the patient has difficulties in spelling and reading unfamiliar words, but correctly reads and spells words.
In conclusion, conduction aphasia presents three major characteristics: a relatively fluent, though phonologically paraphasic speech; poor repetition; and relatively spared comprehension [1, 2, 5, 29, 30, 31, 32].
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\n\nThe lesions affect the inferior parietal lobes, especially the supramarginal gyrus or/and the external capsule; they classically disrupt the arcuate fasciculus (a large bundle of fibers), although its role remains debated for the repetition impairments: probably disconnection between the superior temporal cortex and the inferior frontal gyri, respectively (Figure 2).
\nOther explanations for the repetition impairments have been noted, such as short-term memory syndrome (the repetition impairment due to limited working memory)—so, the associated lesions are situated in areas critical for working memory: inferior parietal lobule (supramarginal and angular gyri), inferior frontal cortex, posterior temporal lobe, and/or their white matter connections (the external capsule).
\nConduction aphasia is the result of an embolic infarct of the inferior division (posterior temporal or parietal) of the left MCA [1, 2, 5, 23, 24, 25].
\nIt is rarely observed at the acute stage of stroke and more frequently affects younger patients.
\nTranscortical aphasias are the less common type of aphasias. They are characterized by preservation of word repetition, even of those words without meaning. Repetition of words is mediated by the perisylvian cerebral region (fronto-temporo-parietal region). Generally, in this type of aphasia, Broca’s area, Wernicke’s area, and the arcuate fasciculus are intact. In transcortical aphasia exists a disconnection between motor and/or sensory areas of language from hemispheric cortex, a process that occurs from lesions of border areas: (a) from ACA and MCA (transcortical motor aphasia) and (b) from MCA and PCA (transcortical sensory aphasia) [1, 2, 23, 24, 25].
\nIt is characterized by poor spontaneous speech (nonfluent, reduced oral output with possible initial mutism, loss of initiation, hypophonia, perseveration, and reduced phrase length). Minor dysarthria is noted in opposition with sever arthric deformation noted in Broca’s aphasia. Sometimes, simplification of grammatical form is noted. Echolalia and perseveration are usually observed. Naming is frequently preserved.
\nRepetition and oral comprehension are typically spared [1, 2, 5, 33, 34, 35, 36].
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Cortical frontal lesions of border areas (watershed area) between the left anterior cerebral artery (ACA) and middle cerebral artery (MCA); less frequently left premotor and prefrontal regions, situated anterior and superior of Broca’s area (dorsolateral region-sparing Broca area), and supplementary motor area (supero-medial area of the frontal lobe) (Figure 2)
Subcortical frontal lesions: thalamus, centrum semiovale with variable extension into the striatum (hypophonia is noted) [1, 2, 5, 23, 24, 25]
Spontaneous speech (oral output) is fluent, with verbal paraphasias, word-finding difficulty (especially by naming infrequent objects and animals), and circumlocutory speech (use of generic words such as “bird” for a hen and “furniture” for a showcase).
\nComprehension is severely impaired at the word level, especially for unusual nouns. This contrasts with repetition sparing (this is the key feature that distinguishes it from Wernicke’s aphasia). The patient is incapable to describe accurately a name that is correctly repeated. The comprehension deficit is usually associated with semantic impairment [1, 2, 5, 33, 34, 35, 36].
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Cortical lesions of border areas from MCA and posterior cerebral artery (PCA) territories: temporo-parieto-occipital junction region and inferotemporal region (second and third temporal gyri) (Figure 2)
Subcortical lesions: anterolateral thalamus
Alzheimer’s disease, semantic variant of primary progressive aphasia (PPA) or Creutzfeldt-Jakob disease can produce a similar syndrome [1, 2, 5, 23, 24, 25].
Nonfluent reduced spontaneous speech (verbal output), palilalia, or even transitory mutism, combined with impaired comprehension, impaired reading (alexia), and impaired writing (agraphia), relatively spared repetition. It combines signs of both transcortical motor and sensory aphasia. It looks like a global aphasia with relatively normal repetition [1, 2, 5, 33, 34, 35, 36].
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Cortical lesions isolating the spared perisylvian language areas (watershed territory between the left ACA and MCA in addition to the watershed territory between the left MCA and PCA) (Figure 2)
Subcortical lesions: large thalamic hemorrhage interrupting the temporal isthmus; infarcts in the left thalamus, putamen, and periventricular white matter [1, 2, 5, 23, 24, 25]
It is the most severe form of aphasia, which associates with the following:
Major disorders of oral production, represented by aphasic mutism (oral output lost), or by a spontaneous speech restricted to some stereotyped utterances (with dysarthria). Repetition is severely affected (it does not improve oral output, differing from mixed transcortical aphasia).
Major disorders of the oral and written comprehension. Global aphasia differs from Broca’s aphasia by the severity of oral comprehension impairment [1, 2, 5, 37].
Right hemiparesis/hemiplegia, right hemi-hypoesthesia, right homonym hemianopia, limbs apraxia, and facio-buccolingual apraxia [1, 2, 5, 37].
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Extended lesions (including left perisylvian anterior and posterior language areas), which are the result of a left MCA/C1 occlusion (with a total left MCA infarct), produce global aphasia with hemiplegia, hemisensory deficits, and hemianopia (Figure 2) [2].
Broca’s and Wernicke’s areas may be simultaneously hypoperfused in the acute period. Thus, global aphasia can be the initial aphasic syndrome.
Early involution into Broca’s aphasia (with early recovery of comprehension) may result from reperfusion of Wernicke’s area. In this case, the patient presents only left frontal lobe, left basal ganglia, and left insula ischemic lesions (diffusion-weighted image shows infarct in superior division of left MCA territory, which includes Broca’s area), sparing in the same time the left temporoparietal region (global aphasia with hemiplegia and early improvement of comprehension).
Later recovery of comprehension may appear from the reorganization of the language network:
Frontal and temporoparietal lesions (two lesions) produce global aphasia without hemiplegia. When sensory-motor deficit is missing, we should search for mixed transcortical aphasia.
Subcortical infarct extended into basal ganglia [1, 2, 5, 23, 24, 25, 38].
Typical anomic aphasia is a fluent aphasia with word-finding difficulty anomia (noted in spontaneous speech and naming), usually associated with circumlocutions. Comprehension and repetition are spared.
\nAnomic plus aphasia presents additional minimal deficit of language (mild arthric deformation or mild impairment of oral comprehension or repetition). It is the mildest aphasic syndrome [1, 2, 5, 39].
\nThis is a very rare condition (1% of all acute ischemic stroke aphasias) [39], defined by an aphasic syndrome in a right-handed patient (free from developmental disorders and previous brain lesions, fully lateralized, which is demonstrated using a questionnaire like Edinburgh Inventory) [40], caused by a right hemisphere lesion (nondominant hemisphere).
\nThe anatomical determinants are similar to those observed in left hemisphere lesion, although a higher proportion of deviant cases are observed, particularly with mild aphasia contrasting with the large lesion. This fact is usually reported as evidence for bilateral representation of the language [2].
\nIn the past, crossed aphasia was considered to be nonfluent, although today is reported that all aphasic syndromes can be registered (some cases of crossed Wernicke’s aphasia in right-handed patients with lesions in the homologous area of the right cerebral hemisphere are noted [2].
\nPure left striatocapsular infarcts (left deep MCA infarcts) can produce different types of aphasias (mainly nonfluent, especially motor transcortical aphasia and Broca’s aphasia). Frequently, hypophonia (poor speech volume) can be noted.
\nFluent and nonfluent aphasias have been reported in thalamic lesions. Usually, a thalamic aphasia presents a significant impairment of spontaneous speech, with verbal paraphasias, but with oral comprehension and repetition relatively spared [1, 2, 5, 28]. Patients with subcortical aphasias are older, because the main mechanism of ischemic stroke is small vascular disease.
\nThere are two distinct mechanisms concerning subcortical vascular aphasias: (a) a possible sustained cortical hypoperfusion and infarction not visible on structural imaging studies and (b) a possible thalamic disconnection, due to striatocapsular infarcts [28].
\nAny type of lesion (localized/diffuse, acute/chronic, intermittent, progressive, or permanent) restricted to any of all mentioned language network from the dominant hemisphere in right-handed subjects (and rarely, in the nondominant hemisphere in right-handed subjects—“crossed aphasia”) can cause aphasia [1, 2].
\nThe most common causes of aphasia are the vascular pathology (ischemic and hemorrhagic stroke, aneurysm, cerebral veins, and dural sinus thrombosis), which produces vascular aphasias, traumatic brain injury, brain tumors, neuroinfections (especially Herpes simplex encephalitis), stroke mimics (aura migraine, epilepsy - ictal EEG sustaining the diagnosis of an epileptic seizure, and MRI-DWI), multiple sclerosis (rarely), and neurodegenerative diseases such as Alzheimer disease and primary progressive aphasia.
\nAphasia has a prevalence of 25–30% in acute ischemic stroke; it is a marker of stroke severity and of poststroke outcome, being associated with a higher risk of mortality, poor functional prognosis (can have a dramatic impact on person’s ability to communicate), and increased risk of poststroke dementia [1, 2, 7, 8, 9, 10, 11, 41, 42, 43].
\nVascular aphasias have not typically corresponded to linguistic domains network due to the fact that ischemic injuries specifically imply arterial territories, rather than being limited to the language network. Thus, the arterial syndromes include different concomitant neurological signs (hemiparesis, hemianopia, etc.,) that are reported together with aphasia because they all represent functions that depend on arterial supply of a peculiar brain region (vessel which can be occluded, producing an ischemic stroke) [1, 22, 44].
\nThe main determinant of the type of vascular aphasia is the infarct location [1, 2]. Recent studies concerning the hyperacute stage of ischemic stroke have demonstrated that aphasic symptoms have a similar evolution to that of cortical hypoperfusion; thus, improvement in cortical perfusion (following spontaneous or therapeutic recanalization) generates recovery of aphasia [1, 2, 5, 28]. Recanalization of an occluded M1 branch of MCA through development of collateral blood flow or through treatment in a patient with aphasia and a striatocapsular infarct can reverse the aphasia (the patient may present the late vascular syndrome due to the infarct rather than the initial vascular syndrome due to the hypoperfused area [1, 2, 5, 28].
\nUsing different functional imaging techniques (perfusion computer tomography, diffusion- and perfusion-weighted magnetic resonance imaging, and positron emission tomography), recent studies have indicated characteristics of aphasia (in hyperacute stage), suggested prognosis (in the era of thrombolysis), and observed even the potential new treatments [such as transcranial magnetic stimulation (TMS)] [2].
\nMeasuring cerebral blood flow and volume enables the definition of maps of penumbra (diminution of cerebral blood flow and normal/increase of cerebral blood volume) and infarct (diminution of cerebral blood flow and volume) in the hyperacute stage of ischemic stroke. It has been demonstrated that penumbra dynamics is the major determinant for aphasia evolution. Saving a cerebral area implicated in a specific language function (naming, etc.) clinically improved this modality [2].
\nFunctional MRI studies demonstrated that cerebral tissue at risk of infarction (as indicated by the mismatch of PWI and DWI) can survive if recanalization occurs quickly. This represents the major site explaining postischemic recovery, as proved by language task-specific activation adjacent to the infarct lesion within the region certified by the imaging mismatch.
\nDifferent studies using positron emission tomography reported that spontaneous recovery of vascular aphasias still occurs with the persistence of the lesion and it takes place by a few distinct mechanisms. The activation appears in some spared left hemisphere language areas, new left hemisphere areas not commonly involved in language processing (pars orbitalis of the inferior frontal gyrus, anterior insula, and middle frontal gyrus), and right hemisphere areas homotopic to control subjects language network. Interestingly, compensation by the right hemisphere respected the aphasia subtype network, the right F3 being recruited when the left F3 was affected [1, 2].
\nUsually, vascular aphasias become less severe in the first 3 months after stroke. The spontaneous recovery depends on the severity of the initial aphasia (which has been related to the lesion location and size), but also on general stroke severity, etiology (ischemic and hemorrhagic), time from onset, age, gender, handedness, treatment, motivation and personality, associated disorders, etc. [1, 2, 5].
\nNonfluent aphasia can rarely evolve into fluent aphasia, whereas a fluent aphasia never evolves into a nonfluent aphasia [45].
Global aphasia may regress to Broca’s aphasia (or less frequently to Wernicke’s aphasia). Prognosis for global aphasia persisting at 1 month is poor, because only one-third of aphasics communicate satisfactorily at 2 years [2, 13, 46].
Broca’s aphasia may transform to anomic-plus aphasia. The prognostic for Broca’s aphasia is relatively poor, because only 40% of patients regain ability to communicate satisfactorily [2].
Transcortical-motor aphasia may transform to anomic-plus aphasia. The prognosis of transcortical-motor aphasia is relatively good, depending on the severity of spontaneous speech diminution and associated executive and memory impairment.
Wernicke’s aphasia may transform to conduction aphasia. The prognosis is relatively good, as nearly 60% of patients regain ability to communicate satisfactorily (those involving in conduction aphasics) [2].
Conduction aphasia has a relatively good prognosis, because 70% of patients regain ability to communicate [2].
Transcortical sensory aphasia has a relatively good prognosis, because 60% of patients regain ability to communicate satisfactorily in everyday activities [2].
Anomic aphasia has a good prognosis (they have a good ability to communicate) [2, 13, 46].
The outcome of aphasia at 1 year after stroke can be predicted in the first week [45] by stroke subtype, the phonology score (the strongest predictor), age, educational level, and the Barthel Index score. Severe comprehension impairment is reported as a negative factor for stroke recovery, as the aphasic could not understand the rehabilitation tasks. In 2009, Parkinson et al. [47] observed improvement in object and action naming in chronic vascular aphasics. They noted that better recovery was associated with larger lesion in the anterior regions of the brain and absence of lesion in the subcortical regions.
\nVascular aphasics may present some spontaneous language amelioration (spontaneous recovery), but speech therapy can significantly contribute to a better aphasia rehabilitation.
\nA very good language assessment is the key point for any program of speech therapy (the role of a dedicated and competent neurologist is very important) [48].
\nSpeech therapy should not be used in the hyperacute stage of stroke. In this stage, we should focus on reperfusion (i.v. thrombolysis/thrombectomy) of the affected arterial territory. Speech and language therapy should be typically started as soon as the clinical condition becomes favorable, which is nowadays generally possible in acute stroke units (in the acute/subacute stage of stroke) [2].
\nThe speech therapy has five objectives:
\n
\n
\n
\n
\n
Bhogal et al. [50] reviewed 10 studies and noted that intense speech therapy over a short period (approximately 9 hours of therapy per week during 12 weeks) ameliorate outcome. Conversely, lower intensity (2 hours a week) over a longer period (more than 20 weeks) did not improve evolution compared with informal support. In conclusion, speech therapy intensity should be of at least of 1 hour per day in the first 3 months after stroke onset [2].
\nDue to the specific level of the language which is affected, the speech therapy strategy to be used will be different (auditory analysis, word identification, etc.). For example, in global aphasia, the main goals of therapy are represented by helping the patient to use remaining abilities, to restore language abilities, to learn other methods (nonverbal) of communicating, etc. [48].
\nNowadays, treatment of reperfusion (designed to restore cortical perfusion (i.v. thrombolysis/thrombectomy)) during the first 4–5 h (thrombolysis), and 6–12 h (thrombectomy) from the clinical onset, represents the main prevention approach.
\nPreliminary positive results were found using piracetam in nonfluent aphasias [51], but it has not been proven to be effective in long-term use [52]. Despite positive preliminary reports, bromocriptine did not improve nonfluent aphasias in a randomized, double-blind, placebo-controlled clinical trial [53]. Preliminary positive results were also noted using cholinergic agents (donepezil) in fluent aphasias [2, 54]. Efficacy of pharmacological treatments in the chronic phase needs to be demonstrated.
\nFunctional imaging studies of language in nonfluent aphasics usually report a possible overactivation in right hemisphere language homologues [55].
\nEvidence exists that left hemisphere functional recovery is clinically more relevant than right hemisphere activation as a compensatory mechanism after stroke. Thus, right hemisphere activation might be a negative factor for aphasia recovery after stroke [55]. Use of TMS could provide right hemisphere inhibition and, therefore, ameliorate regression of language deficits. Preliminary reports suggested that TMS can improve naming in nonfluent vascular aphasics [55]. This assertion needs to be confirmed by randomized controlled trials.
\nAs a general rule, pharmacological treatment or TMS would be better delivered just before speech and language therapy [2].
\nVascular aphasia is a term that covers complex syndromes, and it is considered not only a stroke severity marker outcome (it is associated with a higher risk of mortality) but also a poststroke poor functional outcome (can have a dramatic impact on person’s ability to communicate and increased risk of developing poststroke dementia). Taking into consideration the unpredictable evolution of all mentioned aphasic syndromes and the lack of treatment strategies, next researches should focus on combined methods of improving patients’ language after acute and even chronic stage of stroke (such as transcranial magnetic stimulation and speech therapy applied in consecutive, consequent, and sustained sessions).
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These capabilities, as well as the high sensitivity and robustness of the test and a small price, make it possible to quickly and reliably diagnose diseases in most laboratories. Besides, ELISA is a test that is also used in veterinary medicine, toxicology, allergology, food industry, etc. Despite the fact that it has existed for almost 50 years, different ELISA tests with different technical solutions are still being developed, which improves and expands the application of the this exceptional test. The aim of this chapter is to empower the rider to optimize, standardize and validate an enzyme linked immunosorbent assay.",book:{id:"9850",slug:"norovirus",title:"Norovirus",fullTitle:"Norovirus"},signatures:"Rajna Minic and Irena Zivkovic",authors:[{id:"325806",title:"Ph.D.",name:"Irena",middleName:null,surname:"Zivkovic",slug:"irena-zivkovic",fullName:"Irena Zivkovic"},{id:"325839",title:"Dr.",name:"Rajna",middleName:null,surname:"Minic",slug:"rajna-minic",fullName:"Rajna Minic"}]},{id:"56750",title:"Laboratory Approach to Anemia",slug:"laboratory-approach-to-anemia",totalDownloads:6181,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"Anemia is a major cause of morbidity and mortality worldwide and can be defined as a decreased quantity of circulating red blood cells (RBCs). The epidemiological studies suggested that one-third of the world’s population is affected with anemia. Anemia is not a disease, but it is instead the sign of an underlying basic pathological process. However, the sign may function as a compass in the search for the cause. Therefore, the prediagnosis revealed by thorough investigation of this sign should be supported by laboratory parameters according to the underlying pathological process. We expect that this review will provide guidance to clinicians with findings and laboratory tests that can be followed from the initial stage in the anemia search.",book:{id:"5942",slug:"current-topics-in-anemia",title:"Current Topics in Anemia",fullTitle:"Current Topics in Anemia"},signatures:"Ebru Dündar Yenilmez and Abdullah Tuli",authors:[{id:"183998",title:"Ph.D.",name:"Ebru",middleName:null,surname:"Dündar Yenilmez",slug:"ebru-dundar-yenilmez",fullName:"Ebru Dündar Yenilmez"},{id:"209103",title:"Prof.",name:"Abdullah",middleName:null,surname:"Tuli",slug:"abdullah-tuli",fullName:"Abdullah Tuli"}]},{id:"33133",title:"Waist Circumference in Children and Adolescents from Different Ethnicities",slug:"waist-circumference-in-children-and-adolescents-from-different-ethnicities",totalDownloads:8e3,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"642",slug:"childhood-obesity",title:"Childhood Obesity",fullTitle:"Childhood Obesity"},signatures:"Peter Schwandt and Gerda-Maria Haas",authors:[{id:"29867",title:"Prof.",name:"Peter",middleName:null,surname:"Schwandt",slug:"peter-schwandt",fullName:"Peter Schwandt"}]},{id:"54411",title:"Isolation and Characterization of Escherichia coli from Animals, Humans, and Environment",slug:"isolation-and-characterization-of-i-escherichia-coli-i-from-animals-humans-and-environment",totalDownloads:6141,totalCrossrefCites:5,totalDimensionsCites:8,abstract:"Working on a diverse species of bacteria that have hundreds of pathotypes representing hundreds of strains and many closely related family members is a challenge. Appropriate research design is required not only to achieve valid desired outcome but also to minimize the use of resources, including time to outcome and intervention. This chapter outlines basics of Escherichia coli isolation and characterization strategies that can assist in research designing that matches the set objectives. Types of samples to be collected, collection and storage strategies, and processing of samples are described. Different approaches to isolation, confirmation and concentration of various E. coli strains are summarized in this chapter. Characterization and typing of E. coli isolates by biochemical, serological, and molecular methods have been explained so that an appropriate choice is made to suite a specific E. coli strain/pathotype. Some clues on sample and isolate preservation for future use are outlined, and general precautions regarding E. coli handling are also presented to the researcher to avoid improper planning and execution of E. coli-related research. Given different options, the best E. coli research design, however, should try as much as possible to shorten the length of time to outcomes.",book:{id:"5493",slug:"-i-escherichia-coli-i-recent-advances-on-physiology-pathogenesis-and-biotechnological-applications",title:"Escherichia coli",fullTitle:"Escherichia coli - Recent Advances on Physiology, Pathogenesis and Biotechnological Applications"},signatures:"Athumani Msalale Lupindu",authors:[{id:"185959",title:"Dr.",name:"Athumani",middleName:"Msalale",surname:"Lupindu",slug:"athumani-lupindu",fullName:"Athumani Lupindu"}]},{id:"53085",title:"Malaria in Pregnancy",slug:"malaria-in-pregnancy",totalDownloads:3194,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Malaria infection during pregnancy is an important public health problem with substantial risks to both the mother and foetus. Pregnant women are the most vulnerable group of malaria‐associated morbidity and mortality. A pregnant woman has an increased risk (up to four times) of getting malaria and twice the chances of dying from malaria, compared to a non‐pregnant adult, becuase the immune system is partially suppressed during pregnancy. Malaria in pregnancy not only affects the mother but also has a dangerous sequel for the developing foetus, resulting in premature delivery or intrauterine growth retardation. Diagnosis of malaria in pregnancy remains a challenge due to the low parasite density and placental sequestration of Plasmodium falciparum. Thus, there is an urgent need for new diagnostic methods to detect malarial parasites in the pregnant women. Though antimalarial drugs are available, which can be safely given in the pregnancy, increasing drug resistance of malarial parasite may pose a big problem in the future. In this chapter, we review the burden of pregnancy‐associated malaria (PAM), its pathogenesis, diagnostic issues during pregnancy and recent guidelines for chemoprophylaxsis and treatment.",book:{id:"5270",slug:"current-topics-in-malaria",title:"Current Topics in Malaria",fullTitle:"Current Topics in Malaria"},signatures:"Kapil Goyal, Alka Sehgal, Chander S. Gautam and Rakesh Sehgal",authors:[{id:"181967",title:"Prof.",name:"Rakesh",middleName:null,surname:"Sehgal",slug:"rakesh-sehgal",fullName:"Rakesh Sehgal"}]}],onlineFirstChaptersFilter:{topicId:"1046",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81939",title:"Translational Research on Chagas Disease: Focusing on Drug Combination and Repositioning",slug:"translational-research-on-chagas-disease-focusing-on-drug-combination-and-repositioning",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.104231",abstract:"Chagas disease, caused by the protozoan Trypanosoma cruzi, is a major neglected disease endemic to Latin America, associated to significant morbimortality comprising a remarkable socioeconomic problem mainly for low-income tropical populations. The present chapter focuses translational research on Chagas disease, approaching drug combinations and repositioning, particularly exploiting the parasite oxidative stress by prospecting prooxidant compounds combined with antagonists of antioxidant systems, for developing low-cost and safe therapies for this infection. The pertinent literature on protozoal parasitic diseases is reviewed as well as on repurposing disulfiram aiming the combination with the Chagas disease drug of choice benznidazole. Both disulfiram and its first derivative sodium diethyldithiocarbamate (DETC) are able not only to inhibit p-glycoprotein, possibly reverting resistance phenotypes, but also to reduce toxicity of numerous other drugs, heavy metals, etc. Therefore, this innovation, presently in clinical research, may furnish a novel therapeutic for T. cruzi infections overcoming the adverse effects and refractory cases that impair the effectiveness of Chagas disease treatment.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Marcos André Vannier-Santos, Ana Márcia Suarez-Fontes, Juliana Almeida-Silva, Alessandra Lifsitch Viçosa, Sandra Aurora Chavez Perez, Alejandro Marcel Hasslocher-Moreno, Gabriel Parreiras Estolano da Silveira, Luciana Fernandes Portela and Roberto Magalhães Saraiva"},{id:"81702",title:"The Saga of Selenium Treatment Investigation in Chagas Disease Cardiopathy: Translational Research in a Neglected Tropical Disease in Brazil",slug:"the-saga-of-selenium-treatment-investigation-in-chagas-disease-cardiopathy-translational-research-in",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.103772",abstract:"This chapter describes the steps from basic research to the definition of a putative public health recommendation in the clinical protocols and therapeutic guidelines for selenium (Se) supplementation for patients with Chagas disease. From 1998 to 2018, we conducted a translational research project to test the concept that chronic Chagas disease cardiopathy (CCC) severity could be associated with low levels of blood selenium (Se), and if oral Se supplementation could help to sustain the asymptomatic cardiac stage and reduce disease severity. Pre-clinical studies in mice and a clinical trial conducted in the early asymptomatic cardiac stage of CCC patients (B stage) were performed, identified as “Selenium Treatment of Chagasic Cardiopathy (STCC)” trial. The roadmap of the selenium project was/is a real saga, with important obstacles that tested team resilience and revealed Brazilian conditions of science development. We discuss the main possible mechanisms involved in the physiopathology of CCC and the lessons learned in this process. In this chapter, we also organized the timeline of the translational project and described the crucial moments of the journey, as well as the next steps driving the research teams and their international and health industry connections.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Tania C. de Araujo-Jorge, Anna Cristina C. Carvalho, Roberto R. Ferreira, Luciana R. Garzoni, Beatriz M.S. Gonzaga, Marcelo T. Holanda, Gilberto M. Sperandio da Silva, Maria da Gloria Bonecini-Almeida, Mauro F.F. Mediano, Roberto M. Saraiva and Alejandro M. Hasslocher-Moreno"},{id:"81938",title:"How Do Mouse Strains and Inoculation Routes Influence the Course of Experimental Trypanosoma cruzi Infection?",slug:"how-do-mouse-strains-and-inoculation-routes-influence-the-course-of-experimental-trypanosoma-cruzi-i",totalDownloads:12,totalDimensionsCites:0,doi:"10.5772/intechopen.104461",abstract:"Chagas’ disease outcomes depend on several factors including parasite and host genetics, immune response, and route of infection. In this study, we investigate the influence of inoculation route and host genetic background on the establishment and development of Chagas disease in mice, using an isolate of Trypanosoma cruzi SC2005 strain (TcII), which was obtained from an oral Chagas’ disease outbreak in Santa Catarina, Brazil. Comparative analysis of the immunopathological, histopathological, and hematological profiles of mice was performed demonstrating the influence of the route of infection in disease severity. In outbred mice, intraperitoneal (IP) infection led to higher infection and mortality rates and more severe parasitaemia, when compared with intragastric (IG) infection. Nevertheless, tissue colonization was similar, showing severe damage in the heart, with intense lymphocytic inflammatory infiltrates, regardless of the route of infection. On the other hand, in mice IG-infected, the host genetic background influences the start timing of immune response against Trypanosoma cruzi. The susceptible BALB/c inbred mouse strain presented an earlier development of a cytotoxic cellular profile, when compared with A mice. We hypothesize that the cytotoxic response mounted before the parasitaemia increase allowed for a milder manifestation of Chagas’ disease in intragastrically infected mice.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Flávia de Oliveira Cardoso, Carolina Salles Domingues, Tânia Zaverucha do Valle and Kátia da Silva Calabrese"},{id:"81814",title:"Evaluation of Molecular Variability of Isolates of Trypanosoma cruzi in the State of Rio de Janeiro-Brazil",slug:"evaluation-of-molecular-variability-of-isolates-of-trypanosoma-cruzi-in-the-state-of-rio-de-janeiro-",totalDownloads:11,totalDimensionsCites:0,doi:"10.5772/intechopen.104498",abstract:"Trypanosoma cruzi, the etiological agent of Chagas disease, presents considerable heterogeneity among populations of isolates within the sylvatic and domestic cycle. This study aims to evaluate the genetic diversity of 14 isolates collected from specimens of Triatoma vitticeps from Triunfo, Conceição de Macabu, and Santa Maria Madalena cities (Rio de Janeiro—Brazil). By using PCR based on the mini-exon gene, all isolates showed a profile characteristic of bands zymodeme III and with a lower intensity characteristic of TcII. To verify possible hybrids among the strains analyzed, the polymorphisms analysis of the MSH2 gene was performed. HhaI restriction enzyme digestion products resulted in characteristic TcII fragments only, demonstrating the absence of hybrids strains. In our attempt to characterize isolation in accordance with the reclassification of T. cruzi into six new groups called DTUs (“discrete typing unit”), we genotyped the mitochondrial cytochrome oxidase subunit two gene, ribosomal RNA gen (24Sα rDNA), and the spliced leader intergenic region (SL-IR). This procedure showed that TcII, TcIII, and TcIV are circulating in this area. This highlights the diversity of parasites infecting specimens of T. vitticeps, emphasizing the habit of wild type and complexity of the region epidemiological study that presents potential mixed populations.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Helena Keiko Toma, Luciana Reboredo de Oliveira da Silva, Teresa Cristina Monte Gonçalves, Renato da Silva Junior and Jacenir R. Santos-Mallet"},{id:"81252",title:"Modulation of Host Cell Apoptosis by Trypanosoma cruzi: Repercussions in the Development of Chronic Chagasic Cardiomyopathy",slug:"modulation-of-host-cell-apoptosis-by-trypanosoma-cruzi-repercussions-in-the-development-of-chronic-c",totalDownloads:32,totalDimensionsCites:0,doi:"10.5772/intechopen.103740",abstract:"Trypanosoma cruzi is an intracellular parasite, which causes Chagas disease, affecting millions of people throughout the world. T. cruzi can invade several cell types, among which macrophages and cardiomyocytes stand out. Chagas disease goes through two stages: acute and chronic. If it becomes chronic, its most severe form is the chagasic chronic cardiomyopathy, which accounts for most of the fatalities due to this disease. For parasites to persist for long enough in cells, they should evade several host immune responses, one of these being apoptosis. Apoptosis is a type of programmed cell death described as a well-ordered and silent collection of steps that inevitably lead cells to a noninflammatory death. Cells respond to infection by initiating their own death to combat the infection. As a result, several intracellular microorganisms have developed different strategies to overcome host cell apoptosis and persist inside cells. It has been shown that T. cruzi has the ability to inhibit host cells apoptosis and can also induce apoptosis of cells that combat the parasite such as cytotoxic T cells. The aim of this chapter is to present up-to-date information about the molecules and mechanisms engaged by T. cruzi to achieve this goal and how the modulation of apoptosis by T. cruzi reflects in the development of chronic chagasic cardiomyopathy.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Fiordaliso Carolina Román-Carraro, Diego Maurizio Coria-Paredes, Arturo A. Wilkins-Rodríguez and Laila Gutiérrez-Kobeh"},{id:"80917",title:"Digestive Disorders in Chagas Disease: Megaesophagus and Chagasic Megacolon",slug:"digestive-disorders-in-chagas-disease-megaesophagus-and-chagasic-megacolon",totalDownloads:25,totalDimensionsCites:0,doi:"10.5772/intechopen.102871",abstract:"Chagas disease, also known as American trypanosomiasis, caused by Trypanosoma cruzi and transmitted by hematophagous vectors, is a parasitic disease, which according to the WHO ranks fourth as a cause of loss of potential years of life due to complications that can occur in multiple body systems. According to the reports presented by the World Health Organization, there are between 16 and 18 million infected people in the world, predominantly in endemic areas of Latin America, of which only 1% receives an adequate diagnosis and full treatment, thereby that the chronic phase comes to present digestive disorders that are one of the main causes of loss in the quality of life of patients, as well as complications that can lead to life-threatening surgical emergencies.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Víctor Hugo García Orozco, Juan Enrique Villalvazo Navarro, Carlos Solar Aguirre, Carlos Manuel Ibarra Ocampo, César Iván Díaz Sandoval, Carlos Alejandro Ortíz Gallegos, Diego Javier Oregel Camacho and Araceli Noriega Bucio"}],onlineFirstChaptersTotal:6},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. 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His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. 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Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}]},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",slug:"current-topics-in-neglected-tropical-diseases",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Alfonso J. Rodriguez-Morales",hash:"61c627da05b2ace83056d11357bdf361",volumeInSeries:3,fullTitle:"Current Topics in Neglected Tropical Diseases",editors:[{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. 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Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. Her knowledge of English is at an advanced level.",institutionString:null,institution:null},{id:"332914",title:"Dr.",name:"Muhammad Saad",middleName:null,surname:"Shaikh",slug:"muhammad-saad-shaikh",fullName:"Muhammad Saad Shaikh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jinnah Sindh Medical University",country:{name:"Pakistan"}}},{id:"315775",title:"Dr.",name:"Feng",middleName:null,surname:"Luo",slug:"feng-luo",fullName:"Feng Luo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sichuan University",country:{name:"China"}}},{id:"423519",title:"Dr.",name:"Sizakele",middleName:null,surname:"Ngwenya",slug:"sizakele-ngwenya",fullName:"Sizakele Ngwenya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419270",title:"Dr.",name:"Ann",middleName:null,surname:"Chianchitlert",slug:"ann-chianchitlert",fullName:"Ann Chianchitlert",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419271",title:"Dr.",name:"Diane",middleName:null,surname:"Selvido",slug:"diane-selvido",fullName:"Diane Selvido",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419272",title:"Dr.",name:"Irin",middleName:null,surname:"Sirisoontorn",slug:"irin-sirisoontorn",fullName:"Irin Sirisoontorn",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"355660",title:"Dr.",name:"Anitha",middleName:null,surname:"Mani",slug:"anitha-mani",fullName:"Anitha Mani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"355612",title:"Dr.",name:"Janani",middleName:null,surname:"Karthikeyan",slug:"janani-karthikeyan",fullName:"Janani Karthikeyan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"334400",title:"Dr.",name:"Suvetha",middleName:null,surname:"Siva",slug:"suvetha-siva",fullName:"Suvetha Siva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}}]}},subseries:{item:{id:"19",type:"subseries",title:"Animal Science",keywords:"Animal Science, Animal Biology, Wildlife Species, Domesticated Animals",scope:"The Animal Science topic welcomes research on captive and wildlife species, including domesticated animals. The research resented can consist of primary studies on various animal biology fields such as genetics, nutrition, behavior, welfare, and animal production, to name a few. 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