Test and scale for the assessment of balance in stroke populations.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"9184",leadTitle:null,fullTitle:"Biorefinery Concepts, Energy and Products",title:"Biorefinery Concepts, Energy and Products",subtitle:null,reviewType:"peer-reviewed",abstract:"The interest in biofuel production and application is governed by the depletion of fossil fuel resources and the threatening pollution of the atmosphere because of the extensive emissions of greenhouse gases, which the present global vegetation cannot cope with. A remedy against the greenhouse gas emissions is the use of biomass presently grown as a source for biofuels. Biofuels can be further utilized as substrates for bulk chemical products. This approach is known as the biorefinery concept as an analogue to the oil-based refineries.The present book offers some examples and new ideas for the broader applications of biofuels and the resulting raw materials for energy and chemical products as alternatives to the traditional fossil fuels.",isbn:"978-1-78985-676-7",printIsbn:"978-1-78985-675-0",pdfIsbn:"978-1-83968-821-8",doi:"10.5772/intechopen.83180",price:119,priceEur:129,priceUsd:155,slug:"biorefinery-concepts-energy-and-products",numberOfPages:140,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"b97398a8e5c5fef9494e8ef39361a7dd",bookSignature:"Venko Beschkov",publishedDate:"October 7th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/9184.jpg",numberOfDownloads:4757,numberOfWosCitations:0,numberOfCrossrefCitations:8,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:17,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:25,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 12th 2019",dateEndSecondStepPublish:"April 29th 2019",dateEndThirdStepPublish:"June 28th 2019",dateEndFourthStepPublish:"September 16th 2019",dateEndFifthStepPublish:"November 15th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"191530",title:"Prof.",name:"Venko",middleName:null,surname:"Beschkov",slug:"venko-beschkov",fullName:"Venko Beschkov",profilePictureURL:"https://mts.intechopen.com/storage/users/191530/images/system/191530.jpg",biography:"Venko Beschkov was born in 1946 in Sofia, Bulgaria. He graduated in chemistry from the Sofia University, St. Clement Ohridski, Bulgaria (1969). He received his PhD in 1978 and his DSc degree in 1996. His present interests are chemical and biochemical processes for environment protection and utilization of renewable energy sources. He participated in 36 scientific projects, as well as in 20 applied projects.\nHe has published over 200 scientific papers, 2 monographs, and 7 chapters in selected issues (encyclopedia, books). Over 1500 citations of his papers have been noted. He was Head of the Institute of Chemical Engineering at the Bulgarian Academy of Sciences for 21 years (1993/2014) and Deputy-minister of Environment in the Bulgarian Government (1991/92).",institutionString:"Bulgarian Academy of Sciences",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Bulgarian Academy of Sciences",institutionURL:null,country:{name:"Bulgaria"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"885",title:"Bioenergy",slug:"sustainable-energy-bioenergy"}],chapters:[{id:"68068",title:"Biorefinery Safety: A Case Study Focused on Bioethanol Production",doi:"10.5772/intechopen.87990",slug:"biorefinery-safety-a-case-study-focused-on-bioethanol-production",totalDownloads:770,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"With reference to the framework for energy and climate, the European Union (EU) has stated that at least a 32% share of renewable energy consumption has to be achieved within 2030. This context generates attention to the potential hazards, which are associated with flammable biofuels, such as the bioethanol. One of the main hazards, referred to such biofuel, is the formation of potentially explosive atmospheres due to its evaporation from pools in case of accidental releases. In fact, in a bioethanol production plant (biorefinery), there are several components (flanges, valves, pumps, etc.), which can become potential emission sources in case of failure. Bioethanol is a high-boiling liquid, because its boiling temperature (Tboiling = 78°C) is higher than ambient temperature. Therefore, in case of release and spreading on a certain medium, evaporation occurs because of vapor diffusion. The chapter is focused on a case study. In particular, the chapter illustrates a comparison between two predictive models aimed at estimating the bioethanol evaporation rate, which is a fundamental parameter for determining the dilution degree and classifying the workplaces, where potentially explosive atmospheres could occur. The study investigates the influence of bioethanol release temperature and therefore of its vapor pressure on evaporation rate.",signatures:"Roberto Lauri and Biancamaria Pietrangeli",downloadPdfUrl:"/chapter/pdf-download/68068",previewPdfUrl:"/chapter/pdf-preview/68068",authors:[{id:"221280",title:"Dr.",name:"Biancamaria",surname:"Pietrangeli",slug:"biancamaria-pietrangeli",fullName:"Biancamaria Pietrangeli"},{id:"224518",title:"Dr.",name:"Roberto",surname:"Lauri",slug:"roberto-lauri",fullName:"Roberto Lauri"}],corrections:null},{id:"70804",title:"Biogas as a Source of Energy and Chemicals",doi:"10.5772/intechopen.90558",slug:"biogas-as-a-source-of-energy-and-chemicals",totalDownloads:923,totalCrossrefCites:4,totalDimensionsCites:8,hasAltmetrics:0,abstract:"The global economic development in the twentieth century has led to extensive use of fossils, such as oil, natural gas, and coal as fuels and chemical feedstocks. This extensive use of fossil fuels has led to enormous emissions of carbon dioxide as final product of combustion. The high absorption rate of infra-red rays by carbon dioxide has led to the so-called “greenhouse” effect. Nowadays, the renewable energy sources based on biomass have become very important with a trend to replace oil consumption at least partially and hence to remediate the emissions of greenhouse gases in atmosphere. Biofuels could be used as alternative raw material for chemical production. One of these biofuels is biogas released at anaerobic digestion of different natural organic waste. Another feature of biogas applications is its utilization as feedstock for the production of synthetic fuels and chemicals being now produced from oil and coal. A new approach is to use biogas as a fuel in fuel cells as a very promising option for energy production from renewable sources. The present review summarizes the applications of biogas for chemicals, starting with dry reforming and Fischer-Tropsch syntheses and as a source of energy, as heat and electricity production by co-generation and fuel cells.",signatures:"Sonia Damyanova and Venko Beschkov",downloadPdfUrl:"/chapter/pdf-download/70804",previewPdfUrl:"/chapter/pdf-preview/70804",authors:[null],corrections:null},{id:"68180",title:"Integrated Soybean Biorefinery",doi:"10.5772/intechopen.88111",slug:"integrated-soybean-biorefinery",totalDownloads:686,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The concept of biorefinery is analogous to that of petroleum refineries, but it uses renewable raw materials. However, the main objective of the biorefinery is to transform renewable agricultural materials into numerous and different commercially applicable products, allowing a viable economic competitiveness to traditional petrochemical refineries. In this chapter, we present a proposal for a biorefinery integrated from soybean as raw material, demonstrating its potential in this sector. In addition, special focus was given to the high value-added products present in the soybean oil deodorizer distillate (SODD), such as tocopherol, fatty acids, and squalene, which can be applied in the food, pharmacy, and cosmetic industries. In conclusion, the use of soybean raw material as a biomass in a biorefinery presents numerous environmental and economic advantages as high value-added products are formed. It is important to highlight that in this highly evolved integrated biorefinery model, the additional benefits of operational and administrative synergies will emerge over time.",signatures:"Fernando Luiz Pellegrini Pessoa, Hugo Villardi, Ewerton Emmanuel da Silva Calixto, Erika Durão Vieira, Ana Lucia Barbosa de Souza and Bruna Aparecida Souza Machado",downloadPdfUrl:"/chapter/pdf-download/68180",previewPdfUrl:"/chapter/pdf-preview/68180",authors:[null],corrections:null},{id:"68588",title:"Integrating Whole Cell Biotransformation of Aroma Compounds into a Novel Biorefinery Concept",doi:"10.5772/intechopen.88158",slug:"integrating-whole-cell-biotransformation-of-aroma-compounds-into-a-novel-biorefinery-concept",totalDownloads:806,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The synthesis of aroma compounds that are utilized as precursors of multiple synthesis chains in the pharmaceutical industries and as ingredients in food and fragrance industries can be carried out using chemical processes, enzyme biocatalysis and whole cell biotransformation. Whole cell biotransformation has the potential of being more environmentally benign than chemical synthesis and more cost-effective as compared to enzyme catalysis. In a recently published study by the authors, the aroma compound Ethyl(3)hydroxybutyrate was produced by whole cell biotransformation under aerobic and anaerobic conditions. The yield of the anaerobic processes was similar to that of the aerobic processes, but additionally generated CO2 and ethanol as useful by-products. In this chapter we illustrate how the production process of Ethyl(3)hydroxybutyrate by whole cell biotransformation can be integrated into a novel biorefinery concept, based on the finding that the production of Ethyl(3)hydroxybutyrate under anaerobic conditions is efficient and environmentally friendly. CO2 may be converted to bio-methane together with H2 produced from excess regenerative power. A life cycle assessment confirmed that the anaerobic whole cell biotransformation process embedded into a biorefinery concept including bio-methane production has a lower environmental impact as compared to a concept based on the aerobic whole cell biotransformation.",signatures:"Roland Hirschmann, Waldemar Reule, Thomas Oppenländer, Frank Baganz and Volker C. Hass",downloadPdfUrl:"/chapter/pdf-download/68588",previewPdfUrl:"/chapter/pdf-preview/68588",authors:[null],corrections:null},{id:"70885",title:"Lignin Hydrothermal Liquefaction into Bifunctional Chemicals: A Concise Review",doi:"10.5772/intechopen.90860",slug:"lignin-hydrothermal-liquefaction-into-bifunctional-chemicals-a-concise-review",totalDownloads:846,totalCrossrefCites:2,totalDimensionsCites:5,hasAltmetrics:0,abstract:"Lignin, the second largest biomass after cellulose is underutilized. Yet, it remains the only natural source of aromatic, and phenolic compounds. It is imperative to, amidst the expanding interest on biomass conversion, to accord the necessary attention towards lignin degradation into value added chemicals. Specifically, its phenyl, guaiacyl, and syringyl derivatives. Understanding lignin degradation chemistry, goes a long way in its selective valorization into fuels and chemicals via thermochemical routes such as hydrothermal liquefaction (HTL). Therefore, development of technologies targeting value addition of products and by-products from lignin, would undoubtedly give way to emerging markets in the industry. Previous review papers focused on the general HTL of biomass, food waste, algae, and their model compounds. However, review on HTL of lignin is scarcely available. This paper presents the detailed literature analyses of the current trend in lignin degradation via HTL. Effect of HTL conditions including temperature, heating rate and catalyst has been reviewed. In-depth discussion on use of ionic liquids as catalyst for HTL of lignin has also been compiled. Other lignin degradation techniques such as pyrolysis and hydrolysis were also discussed. This is aimed at bringing together an up-to-date information on lignin degradation into selected chemical intermediates.",signatures:"Yahaya Alhassan, Ursel Hornung and Idris M. Bugaje",downloadPdfUrl:"/chapter/pdf-download/70885",previewPdfUrl:"/chapter/pdf-preview/70885",authors:[null],corrections:null},{id:"72722",title:"Biodiesel Production as a Renewable Resource for the Potential Displacement of the Petroleum Diesel",doi:"10.5772/intechopen.93013",slug:"biodiesel-production-as-a-renewable-resource-for-the-potential-displacement-of-the-petroleum-diesel",totalDownloads:726,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In the quest to comply with the Intergovernmental Panel on Climate Change (IPCC) on reducing the global temperature to 1.5–2.0°C as a measure to minimize the climate change caused by the emission of greenhouse gases from the combustion of fossil fuels, and the need for replacement of these fossil fuels, which are also generally believed to be depleting, biodiesel is being studied as a potential replacement for the conventional petroleum diesel. This fuel among other desired properties is renewable, biodegradable, sustainable, and emits less particles. It also contains no amount of sulfur, in addition to possessing most of the good characteristics of petroleum diesel. At the moment, more than 95% of biodiesel produced globally is obtained from vegetable oil feedstocks, which are usually very expensive and thus, without tax waiver and subsidy, makes biodiesel non-competitive with the petroleum diesel. Based on this, non-edible feedstocks are being investigated. Although, their oil yield is low, studies are carried out to ensure efficient extraction. The economics of the process is considered to determine the most economic variables that impact the profitability of biodiesel production. This chapter deals with the biodiesel classification, feedstocks, lipid/oil extraction, biodiesel production methods and the economic aspect of the process.",signatures:"Ifeanyichukwu Edeh",downloadPdfUrl:"/chapter/pdf-download/72722",previewPdfUrl:"/chapter/pdf-preview/72722",authors:[null],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6784",title:"Biofuels",subtitle:"State of Development",isOpenForSubmission:!1,hash:"9a31143f106bba91ce8430f49d3339af",slug:"biofuels-state-of-development",bookSignature:"Krzysztof Biernat",coverURL:"https://cdn.intechopen.com/books/images_new/6784.jpg",editedByType:"Edited by",editors:[{id:"155009",title:"Prof.",name:"Krzysztof",surname:"Biernat",slug:"krzysztof-biernat",fullName:"Krzysztof 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2019",bookSignature:"Muhammad Sarwar Khan and Kauser Abdulla Malik",coverURL:"https://cdn.intechopen.com/books/images_new/6976.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"212511",title:"Prof.",name:"Muhammad Sarwar",middleName:null,surname:"Khan",slug:"muhammad-sarwar-khan",fullName:"Muhammad Sarwar Khan"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"211046",title:"Dr.",name:"Ghulam",middleName:null,surname:"Mustafa",fullName:"Ghulam Mustafa",slug:"ghulam-mustafa",email:"drmustafa8@gmail.com",position:null,institution:{name:"University of Agriculture Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"212508",title:"Dr.",name:"Faiz",middleName:null,surname:"Ahmad",fullName:"Faiz Ahmad",slug:"faiz-ahmad",email:"faizahmad1980@gmail.com",position:null,institution:null},{id:"212511",title:"Prof.",name:"Muhammad Sarwar",middleName:null,surname:"Khan",fullName:"Muhammad Sarwar 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Postural control is the ability to maintain balance against gravitational forces by maintaining or returning the body mass center on its base support [1, 2]. This emerges from the interaction between subjects, tasks, and environment [2, 3]. Any task requires adequate postural control, but each task also requires an orientation and a stability component [2].
In clinical practices, there is no consensus about only conceptual definitions related to equilibrium, balance, or postural control, and their elements like posture, orientation, and stability. Therefore, it is interesting to at least define basic biomechanical concepts to better understand postural control and further definitions addressed in this chapter.
From a biomechanical point of view, posture refers to the alignment and orientation of the body with respect to its environment [3]. Postural orientation is the ability to maintain an adequate relation between body segments and environment due to performing a task, and postural stability is the ability to control the center of mass within the base support [2, 3].
Nowadays, postural control is no longer considered as only one system or reflex set for upright position and balance, it is considered a complex motor skill due to the interaction of multiple sensorimotor processes [4]. The two main goals of postural control are keeping postural orientation and postural equilibrium [2, 3, 4].
The human body in order to achieve stability and orientation requires a complex interaction between musculoskeletal components, neuromuscular synergies, individual sensory systems, sensory strategies, anticipatory and adaptive mechanisms, and internal representations [2]. The central nervous system (CNS) must organize the information coming from the different sensory receptors to determine the position of the body in space [2]. The sensory information coming from the different sensory systems (visual, somatosensory, and vestibular) allows to detect the position of the body and the movement in space in relation to the force of gravity and the environment [2, 3, 5]. Each sense provides specific information about the position and movement of the body, that is, each sense provides different references for postural control [2]. In the higher levels, the CNS sensory information is transformed into significative information, known as perception, and then it is selected the best sensorimotor strategies to achieve the goal of a specific task, to control external perturbance, and to adapt movement to the environmental requirements [2].
Also, postural orientation involves active control of alignment and tone of the body related to gravity, base support, visual information, and internal references [2, 3]. Spatial orientation requires the interpretation and integrated information of the visual, vestibular, and somatosensory systems. On the other hand, postural equilibrium involves the coordination of sensorimotor strategies to control the center of mass during internal and external disturbances [3, 4]. For a better explanation of the different sensory systems and sensory strategies to maintain postural control, see the diagram in Figure 1.
Postural control by sensory systems and strategies. Summary information collected from Shumway-Cook and Woollacott [
There are multiple causes and factors that could lead to dysfunctions in postural control and balance systems. In neurological populations, is commonly observed that this deficit affects the ability to stand and walk, increasing the risk of falling and injury [2].
Within neurological populations, we can find stroke patients. Stroke is a common disease [6] that generates great morbidity, mortality, and different degrees of disability, causing a great economic impact on families and society [1].
A stroke can lead to a wide range of impairments that predispose the subjects to falls. One of the principal impairments observed in this population is balance dysfunction [7, 8]. It has been reported that 83% of stroke patients present balance impairments, which lead to gait problems, such as low gait speed and alterations in different gait phases increasing the risk of falling [1]. The incidence of falls in this population within the first six months after a stroke is about 37 and 73%, and the rate of falls in chronic stroke patients is double than healthy subjects [8].
Falls and fear of falling contribute to a sedentary lifestyle with increased limitations in activities of daily living (ADL) and decreased quality of life. In addition, falls increase hospitalization time and generate a large emotional and economic impact for patients, families, and society [1, 9, 10].
The present chapter pretends to expose the principal deficiencies related to balance impairments, observed during the sit-to-stand transfer and gait after a stroke. Also, the main scales and tests for the assessments of balance used in clinical settings, as well as the technologies and new trends that allow for objective analysis of balance dysfunction in this population are reviewed.
As said before, postural control alterations contribute to a loss of stability with a high impact on the quality of life in neurological populations [1, 2]. Balance and postural control impairments cause a series of alterations and dysfunctions during daily life activities, mainly during sit-to-stand transfer and gait [11, 12].
In this section, the main alterations on the sit-to-stand transfer as well as in gait related to balance impairments in post-stroke populations are reviewed.
Sit-to-stand (STS) transfer is considered a fundamental prerequisite to achieve successfully daily life activities [11, 12, 13]. Also, it is considered a strong predictor factor of independence and is the main rehabilitation goal because it promotes independent locomotion, as well as upper limb and hand recovery [13]. In post-stroke populations, this transfer is commonly affected, and it is not easy to regain the ability to stand up from a chair safely [11].
The STS transfer has been widely analyzed [11, 14, 15], and has been described as the movement of the body mass center towards the vertical from a sitting position to an upright position without losing balance [11]. This transfer is a transition to the upright position, and it requires a movement of the mass center from a more stable position into a less one with both lower limbs extended [11, 15]. In order to simplify its analysis, the STS transfer has been divided into phases, depending on kinematics variables, ground action forces, and the movement of the mass center [11].
One of these classifications includes four phases for the analysis, considering trunk movement, seat-off, the achievement of an upright position, and the vertical stabilization at the end of the transfer [11]. Another classification considers two principal phases [11, 15], which basically includes three events, onset of STS, seat-off, and end of STS [15].
Associated with this transfer, there have been described different movement determinants in healthy subjects, such as angular displacements of lower limbs and trunk, as well as muscle activation pattern and weight-bearing distribution [16].
Indeed, there are differences in the performance of sit-to-stand transfer between healthy and post-stroke subjects [11, 13, 14, 15].
Normally, people with hemiparesis show a loss of coordinated movement between the trunk and knees. Therefore, it can be observed a completed knee extension at the end of the STS despite the hip it is still extending. Also, they show an increased center of pressure and move the trunks in a mediolateral direction towards the non-paretic side, as well as a decreased anterior pelvic tilt [11, 15, 16]. When observed lower limbs, it can be identified less muscle activity in the paretic limb, specifically of tibialis anterior, quadriceps, and soleus, showing problems in the correct activation muscle timing to achieve STS [11, 15].
To avoid the risk of falling, people with stroke adopt compensatory strategies, such as exaggeration of the anterior projection of the center of mass before standing up. This population also shows a decrease in knee moment on the paretic side and an increase in weight distribution asymmetry [11, 15, 16]. It has been suggested a correlation between asymmetry in weight-bearing with functional abilities in stroke. It states that those who carry less weight on their paretic limb obtain poor mobility scores in the functional independence scales. These same results have been demonstrated by Cheng et al. who consider the asymmetric distribution of weight-bearing during STS as a mediator of falls [11, 16].
All of these compensatory strategies are carried out to achieve the sit-to-stand transfer successfully and safely, but this population takes more time in the execution of this task, increasing the risk of falling. Because of the big amount of compensatory strategies used by the stroke population, this transfer is considered an indicator of the risk of falling [11, 16].
Similar to STS, independent walking or ambulation is also considered a prerequisite for the performance of activities of daily living [14]. Gait requires an adequate speed to be considered community ambulation, between 1.1 and 1.5 m/s [14]. Also, locomotion is a motor skill, in which control systems in every step must bear weight, give anterior and lateral stability, and keep the center of mass forward, as well as an antigravitatory postural control to provide support and balance to prevent falls [10, 11, 14].
Gait dysfunction represents a major problem in the stroke population and causes difficulties in daily life activities [12, 17]. Approximately 80% of stroke patients experience gait problems in the first 3 months after symptom onset. It has been reported that 18% of subjects are unable to walk, while 11% walk with assistance and the remaining 50% walk independently [12]. It is important to note that only 7% of users who walk independently achieve community walking, which means that they manage to walk 500 meters continuously at an adequate walking speed that allows them to cross the street safely [16].
On the other hand, 70% of stroke patients with community walking suffer falls in the first year, most of these falls are the result of loss in balance. Therefore, there is a high risk of falls in those subjects with stroke who walk independently [12].
Post-stroke gait disturbances and their treatment have been extensively researched [12, 18, 19, 20]. Mainly, we could find impairments associated with alterations in spatial-temporal characteristics and biomechanical alterations [12, 19].
Some of the characteristics of hemiparetic gait related to spatiotemporal variables include decreased cadence, prolonged swing duration on the paretic side, prolonged duration on the nonparetic side, and asymmetry in stride length [19]. As well as the increase of the double support phase and the decrease in gait speed [16, 19].
These characteristics contribute to an unsteady gait pattern, leading to restricted walking within the home and an increased risk of falls [21].
In general, due to a stroke, we can observe different impairments that may occur in the paretic lower extremity, such as abnormal recruitment of motor units, muscle weakness, abnormal activation of muscle synergies, spasticity, proprioceptive impairment, restriction in range of motion, which could enhance a poor gait pattern along with balance disturbances and increased risk of falls [13, 18, 22].
Figure 2 shows the main features in balance impairments related to sit-to-stand, standing balance, and gait after stroke. It is important to highlight that there are more features related to each transfer, but we aim to clarify the most common one in this population.
Balance and gait impairments after stroke. Summary information collected from Boukadida et al. [
Nowadays, it has become relevant to observe the quality of the movement patterns to discriminate between actual recovery and compensatory movement patterns in stroke rehabilitation [10]. Balance impairments are common in this population and they are determinants factor that influences independence and quality of life; therefore, balance became an important goal to be included in rehabilitation programs [21]. For this purpose, the use of accurate, reliable, and valid assessment tools to measure outcomes in stroke populations related to research and clinical practice is recommended [7].
Normally, rehabilitation professionals perform the evaluation by means of observation and the application of scales and instruments, which provide a certain level of objectivity [27]. Generally, the different methodology used for assessing balance can be divided into observational (e.g., the Romberg test), scales and tests, and testing instrumental equipment (e.g., posturography) [28].
The Berg balance scale (BBS) is a widely used tool in clinical settings and is considered the gold standard for assessing functional balance and fall risk in adults [2, 3, 21, 29]. It has been used extensively to measure outcomes in research involving older adults with a variety of conditions, for example, balance impairments, stroke, Parkinson’s disease, vestibular disorders, and in a variety of health care settings [30, 31, 32]. It contains 14 items related to the static and dynamic tasks of daily living [3]. The tasks on this scale progress in difficulty from sitting to bipedal, to bipedal with a narrow support base, to tandem gait and one leg support. The score is calculated on a 5-point ordinal scale for each item, where 0 refers to the inability to complete the test and 4 refers to being able to complete the test independently [3, 29]. The maximum score is 56 points that indicates adequate postural balance and no risk of falls, and a score equal to or less than 45 points indicates a risk of falls [3]. Specifically, values between 56 and 41 points indicate a low risk of falling, between 40 and 21 points a medium risk of falling, and between 20 and 0 points a high risk of falling. Its application lasts between 10 and 20 minutes [29, 30, 31, 32]. Another widely used test is the Timed up and Go (TU & Go) test, which measures dynamic balance and functional mobility in adults, as well as in the neurological population [33, 34, 35]. The TU & Go is a simple test that can be applied anywhere and consists of the subject standing up from a chair, walking three meters, turning around, walking back to the chair, and sitting down on the chair again. The controlled variable is the total time in seconds the subject takes to perform the test, which is then correlated with the risk of falling [34, 35, 36]. Score assumed to be normal if the time is ≤10 seconds, mild risk of falling between 11 and 20 seconds, and high risk >20 seconds [37]. This test has demonstrated excellent inter- and intra-rater reliability with values greater than 0.95, with adequate predictive value for falls in older adults and stroke patients [38, 39]. Some advantages of the TU & Go test are its simplicity and short duration of application. Additionally, it requires little equipment and allows subjects with functional impairment to perform the test [3]. However, one limitation is that although it provides information on the risk of falls, it is not able to determine the risk objectively in subjects with greater difficulties. Barry et al. mention that a limitation in the predictive value of the test could be explained by the fact that it is a single test that evaluates balance and equilibrium in a general way. Therefore, it could be improved by being combined with technological tools for motion analysis [40].
Commonly, in clinical practice, this test is combined with the application of other clinical tests such as the 10-meter walk test, and its results are compared with those obtained in the Berg balance scale [30]. These tests as a whole make it possible to assess the risk of falls, walking speed, and balance of the different patients, making it possible to objectively assess their functional level and to determine the relevant intervention strategies.
Gait speed has been shown to be a predictor for different clinical outcomes, such as response to rehabilitation, level of dependency, frailty, disability, falls, institutionalization, cognitive loss, hospitalization, cardiovascular events, and mortality. Its decrease has been associated with a lower quality of life, social participation, and the presence of depressive symptoms [41]. Middleton et al. define it as the sixth vital sign due to its broad predictive capacity. The 10-meter walk test has proven to be a robust, validated, reliable, and sensitive tool that can be applied in both clinical and research contexts, and in a wide range of pathologies, such as the elderly, chronic stroke, incomplete spinal cord injury, multiple sclerosis, Parkinson’s disease, among others [18, 38, 41, 42].
This test measures walking speed in meters per second (m/s) when walking a short distance of 10 meters. Then, the value obtained will be categorized into the four categories proposed by Perry et. Al, which are intra-domicile gait with speeds between 0 to 0.4 ms; dependent community gait with speeds from 0.4 to 0.8 m/s; community gait 0.8 to 1.2 m/s; and safe gait for crossing the street greater than 1.2 m/s [43].
On the other hand, there is the Functional Reach Scale. This scale was developed to assess the maximum limits of standing stability. Subjects are held in a standing position with feet shoulder-width apart and with one arm (hand grasped) elevated to 90 degrees of flexion. Without moving the feet, the patient is asked to reach as far as possible without losing balance. The distance reached is measured and compared with standardized references by age group as defined by Duncan et al. The functional reach test has satisfactory inter-rater reliability and has been reported as a predictor of falls in older adults [2, 3].
Table 1 summarizes some specific characteristics of the tests and scales listed before.
Test/scale | Aim | Area | Assessment | Description | Cost | Duration |
---|---|---|---|---|---|---|
Berg balance scale [3, 44] | Static balance and risk of falling. | Balance, functional mobility. | Performance measurement (score). | Scale that considers 14 items that include static and dynamic activities of varying difficulty. Each activity is evaluated from 0 to 4 points, determined by the patient’s ability to perform the activity in question. Maximum score 56. | Free (Paper and pencil) | 10 to 20 min. |
Timed up and go [37, 44] | Risk of falling. | Balance, functional mobility, vestibular assessment. | Observer. | Subject begins seated with his back against the back of a chair. At the beginning of the test, the patient gets up from the chair and walks 3 meters, and then turns and returns to the starting point and sits down. The time taken to complete the circuit is recorded. | Free (paper and pencil) | ≤3 min. |
10-M walk test [43, 44] | Independence level. | Mobility, gait, vestibular assessment. | Performance measurement (gait speed). | Subject walks a predetermined distance (depending on the variation applied), in which time is measured. The distance walked in meters is divided by the measured time. | Free (paper and pencil) | ≤ 5 min. |
Tinetti [44] | Balance perception and stability during daily life activities. | Daily life activities, Balance, Functional Mobility, Gait, and Vestibular Assessment. | Patients perception. | 10-item questionnaire designed to assess patient confidence in performing 10 activities of daily living without risk of falling as an indicator of how fear of falling impacts physical performance. The higher the score (100 max) the lower the patient’s confidence. | Free (paper and pencil) | 10 to 15 min. |
BESTest [44, 45, 46] | Postural stability and balance. | Balance, functional mobility, vestibular assessment. | Performance measurement (score). | Orients and identifies the six balance control systems in order to design better approaches to balance rehabilitation from 35 items in six sections, evaluated from 0 to 108 points. | Free (paper and pencil) | 10 to 20 min. |
Activities of Balance confidence (ABC) scale [44] | Self-reporting of the balance confidence measure. | Balance, functional mobility. | Patients perception. | Subjective measure of confidence to perform various ambulatory activities without falling or experiencing feelings of instability out of 16 activities scored from 0 (no confidence) to 100 (confidence). | Free (paper and pencil) | 5 to 10 min. |
Test and scale for the assessment of balance in stroke populations.
One of the most recent scales to measure balance is the Balance Evaluation Systems Test (BESTest), which is a balance assessment scale that allows identifying specific problems in postural control, such as biomechanical alterations, stability limits, postural response, anticipatory postural adjustments, sensory orientation, dynamic balance during gait, and cognitive effects. Although it is a new multitask scale, it includes 36 items to be evaluated with an estimated application time of 30 to 35 minutes [2, 3, 45, 46]. Its short version, the Mini-Balance Evaluation Systems Test (Mini-BESTest), was created in 2010, which contemplates 14 items and takes a total of 10 minutes to complete the assessment, with good inter- and intra-rater reliability in a sample of people with mixed conditions. The mini-BESTest has been shown to be a reliable and validated tool for assessing balance in chronic stroke patients [47].
As can be seen in this section, there is a wide range of scales and clinical tests that allow not only to assess balance but also to observe how the different components behave during the performance of different tasks. Some of them are not only validated in populations with stroke. Therefore, the reader is suggested to review the specific psychometric properties of each of them and their validation in other neurological populations before using it.
There are different therapeutic interventions to improve balance after stroke. According to Stein et al. [21] these interventions could be categorized into five main areas, exercise programs, biofeedback training, sensory training, cognitive training, and external devices.
Each of these areas will address different aspects of the multiple problems that can be found associated with balance impairments [21, 22]. Exercise programs are varied in form, maybe individual or group-based, and include a variety of impairment-oriented elements. Some may include functional activities such as sit-to-stand and balance tasks due to daily life activities, for example, reaching and standing on unstable surfaces [21].
Also, there are different intervention models such as constraint-induced therapy, task-oriented approach, as well as neurophysiological intervention approach such as the Bobath concept, proprioceptive neuromuscular facilitation, and other neurodevelopment models, which have been traditionally used in the treatment of post-stroke patients [5].
The incorporation of visual and sensory training has been shown to be effective in the treatment of balance, as well as the promotion of weight-bearing in seated and upright positions [21, 22, 23, 48]. On the other hand, the incorporation of therapeutic strategies that involve trunk work in the recovery of dynamic balance during sitting, sit-to-stand, and gait is relevant [49].
Since, trunk function has been associated with gait and balance ability in stroke patients and has been shown to be a useful predictor of recovery of gait, balance, and activities of daily living [49].
Recently, a meta-analysis by Hugues et al. concluded that physical therapy has various benefits on postural balance and stability after stroke. It suggests that functional task training, associated with musculoskeletal and/or cardiopulmonary interventions, as well as sensory interventions, appear to be effective in improving balance and postural stability. However, the authors ask for caution with this result, due to “the weak methodological quality of studies,” among other methodological elements [21, 42].
Even though there are several therapeutic approaches and categories of physical therapy, we believe it is important to highlight that each exercise program should be individualized according to the individual’s own capabilities and should be supervised by a therapist.
At a commercial level, a large number of technological systems allow to evaluate different aspects of gait, balance, and strength beyond the typical clinical methodologies, as seen in the previous section.
From the perspective of systems that are capable of evaluating movement and even mobility variables for clinical use, there are camera-based motion analysis laboratories whose measurement is carried out using software for motion analysis (Figure 3).
Optitrack system for human motion analysis using a camera-based system. Image obtained from Optitrack official website [
On the other hand, in the last 30 years, there has been an increase in the use of inertial sensors for motion analysis, whose reduction in size and consumption, in addition to the improvement in algorithms for motion tracking, have allowed them to be positioned as an attractive alternative for the study of movement objectively and quantitatively (Figure 4).
Inertial-based systems for a clinical movement analysis perspective. From left to right: APDM mobility lab, G-walk, and QMUV. Images obtained from the official website of G-walk [
Some other commercial alternatives are illustrated in Table 2.
System | Technology | Description | Area |
---|---|---|---|
Vicon [54] | Optic | Leading optical system in motion analysis used in both clinical and entertainment applications. It incorporates the ability to track reflective passive markers and, together with its tracking platform, it is possible to capture the movement made by people. Using its proprietary software, such as NEXUS, clinical biomechanical and sports motion analysis can be performed. It also offers the possibility of performing biomechanical analysis by incorporating other analysis software, such as Biomechanics of Bodies. | Clinical, sports, entertainment, academic |
Optitrack [50] | Optic | Optical system that incorporates a flexible system to perform biomechanical motion analysis, providing the possibility of natively incorporating other commonly used tools for motion analysis such as electromyography modules, force platforms, and analog sensors. Incorporates the ability to track passive reflective and active markers. It allows the use of other analysis software commonly used in the academic research area such as in Visual3D, The MotionMonitor, MATLAB, and Biomechanics of Bodies. | Clinical, sports, entertainment, academic |
MTw Awinda – X-SENS [55] | Inertial | System with inertial technology that incorporates the possibility of evaluating variables of acceleration, speed, and ranges of movement of some segments or the whole body including hands and phalanges. It offers the possibility of performing biomechanical analysis by incorporating other analysis software such as Biomechanics of Bodies. | Clinical, sports, entertainment, academic |
Perception Neuron – NOITOM [56] | Inertial | System with inertial technology that incorporates the possibility of evaluating variables of acceleration, speed, and ranges of movement of some segments or the whole body including hands and phalanges. It offers the possibility of performing biomechanical analysis by incorporating other analysis software such as Biomechanics of Bodies. | Entertainment, academic |
Ultium Motion – Noraxon [57] | Inertial | System with inertial technology that incorporates the possibility of evaluating variables of acceleration, speed, and ranges of movement of some segments or the whole body with a maximum of 16 sensors. | Clinical, sports, entertainment |
G-WALK [51] | Inertial | Sensorization of several clinical tests with a single inertial sensor to assess gait, balance, ranges of motion, and risk of falls. In addition to the incorporation of evaluation of aspects of sports performance such as jumping power and aerobic resistance. | Clinical, sports, academic |
MobilityLab – APDM [52] | Inertial | Matrix of six inertial sensors that measure different aspects of gait and risk of falls. | Clinical, academic |
QMUV [53] | Inertial | Sensorization of several clinical tests with a single inertial sensor to assess gait, balance, ranges of motion, and risk of falls. | Clinical, academic |
Commercial technological alternatives used to evaluate motor impairment conditions in post-stroke patients.
Another type of element is highly used in the clinical field for the evaluation of gait and static and dynamic balance correspond to systems that measure plantar pressures for the estimation of mobility variables. Technological alternatives range from highly accurate mats for gait and balance evaluation, to systems that embed pressure sensors within insoles to evaluate uncontrolled environments (Figure 5).
Pressure-based systems to analyze gait and posture. From left to right: GAITRite and Xsensor. Images obtained from the official website of Xsensor [
Some other examples are illustrated in Table 3.
System | Description | Area |
---|---|---|
Xsensor [58] | Insoles with plantar pressure points to measure gait variables in sports and clinical applications. | Clinical, sports |
Moticon [60] | Insole for gait analysis in rehabilitation and sports training. | Clinical, sports |
Feetme–Health [61] | Insole with inertial sensor analysis and plantar pressure point for clinical-grade measurement of spatiotemporal variables of gait. | Clinical |
GAITRite [59] | Gait analysis mat, leader in analysis for spatiotemporal variables of the gait cycle. | Clinical, academic |
P-Walk [62] | Mat that measures static balance variables through the acquisition of postures and control of the center of mass and spatiotemporal variables of the gait cycle. | Clinical, academic |
Technological systems to assess motor impairments using plantar pressures in post-stroke patients.
As mentioned at the beginning of this section, the technological tools for the treatment of post-stroke subjects seek to reduce the impact of the disabling condition to improve the quality of life of the patient through rehabilitation therapies to train or adapt the lost function.
From this perspective, the development of serious games for rehabilitation has taken on great importance in the treatment since, they make patients hooked on their treatment, avoiding problems associated with early abandonment from their therapies. Systems that use interactive platforms such as the famous Kinect (camera system) [63] and Nintendo Wii (multisensory system with inertial control and pressure platform) [64] started a massive adoption in the field of game development to support the rehabilitation. However, although they continue to be used in clinical settings for interactive treatment, these technologies are no longer commercially available and are obsolete.
Because of the great technological advance in animation and graphic processing systems, serious games for immersive or semi-immersive rehabilitation using virtual reality helmets (HTC-vive, Oculus, among others) have allowed to establish an environment that mimics in controlled conditions in the daily life of people in order to train typical activities such as brushing teeth, cooking and eating in a safe environment [65]. Also, semi-immersive elements have made it possible to instrumentalize the highly used mirror movement test to increase patients’ perception of movement. All these systems that support the mobility of the upper and lower extremities allow the development of augmented reality environments or interactive systems that enrich the experience of the patient and provide more information about the patient’s condition [66]. Some commercial rehabilitation options include Tyromotion’s PABLO (interactive upper extremity therapy), TYMO (interactive system for balance and coordination training), and DIEGO (interactive arm and shoulder rehabilitation) systems (Figure 6) [67].
Interactive rehabilitation systems developed from Tyromotion. From left to right: PABLO, TYMO, and DIEGO. Images obtained from the official website of Tyromotion [
Leaving aside the treatment systems and focusing on systems that have the potential to be used in everyday life, functional electrical stimulation tools (FES) appear, which correspond to systems that, through the injection of controlled electrical pulses, allow to recover the mobility of limbs, improving grip in upper limb cases and improving gait in case of foot drop stimulators. Although upper limb stimulators have not yet become widespread, in the literature, there is great evidence of efforts by researchers to generate alternatives to train or regain mobility of the arms and hands. Alternatively, and more commonly, there are electronic orthoses for droop foot, where by means of a system that allows the generation of controlled pulses from the detection of gait cycle events, the control of dorsiflexion can be recovered in post-stroke patients [68]. Commercial examples are SmartFES, XFT-2001, ODFS Pace, among others (Figure 7) [68, 69, 70].
Functional electrical stimulation systems commercially available. From left to right: ODFS pace, SmartFES, and XFT-2001. Images obtained from the official website of SmartFES [
On the other hand, health professionals and the scientific community have developed alternatives to treat post-stroke who, due to different factors such as economical, geographical, physical, and/or environmental, are unable to attend rehabilitation centers. The need for the above has increased as a result of the recent COVID-19 pandemic that incorporates post-stroke people as a population at risk [71]. Regarding this, different types of treatment that use technology to rehabilitate communication skills [72], upper limb rehabilitation, and/or remote activities of daily living have been evaluated, proving to be almost as effective as face-to-face treatments. Although there is a lack of information on the cost-effectiveness relationship with respect to traditional treatments, it is evident that the role of telerehabilitation is of vital importance in rural areas or in health emergencies where patients do not have access to opportune care or monitoring of their condition [73, 74].
In this section, some tools typically used for the evaluation and treatment of post-stroke patients are mentioned. However, the intention is to provide a general overview of the systems most used internationally, existing alternatives that improve their proposal in terms of accessibility and costs.
Stroke generates primary and secondary impairments that reduce the functional capacity of these patients, leading to less functional independence and quality of life. One of the main impairments associated with this population is impaired balance, both static and dynamic. This impairment in particular generates a great impact on the dysfunction of activities of daily living and main transfers such as bipedal sedentary transfer and gait. Moreover, in this pathology, 14–65% of individuals fall at least once in the hospital, and between 37 and 73% suffer falls in the next 6 months after discharge [75].
Specifically, people with stroke are at increased risk of fall-related fractures. Other adverse consequences may include fear of falling with subsequent reduction in activity, de-conditioning, and increased risk of falls. Bower et al. state that it has recently been shown that the identification of movement and balance variables, for example by measuring walking speed, application of the timed up and go test, and the Berg Balance Scale, have been shown to be strong predictors of fall risk following stroke [8].
However, as mentioned above, there are some deficiencies in the clinical tests and scales, since they fail to fully determine the variables and problems associated with balance impairment. The use of clinical scales and tests, associated with the use of technologies, could allow the adequate assessment of each of the limitations in static and dynamic balance during the different transfers performed by people with sequelae of stroke.
In this chapter, we have presented a list of alternatives to treat and evaluate the stroke patient in all phases of treatment, providing plenty of evidence of systems for movement analysis and treatment, especially useful for the treating professional, and of highly technological elements to improve adherence to rehabilitation therapies.
Finally, it is important to highlight that a specific assessment of the impairments that contribute to an unfavorable balance in subjects with stroke is necessary for each rehabilitation process, as well as the early incorporation of functional therapeutic activities aimed at their recovery and the prevention of the risk of falls.
This work was supported by the Vice-rectory for research and development (VRID) of the Universidad de Concepción: “Clinical validation of a human motion analysis system based on inertial measurement sensors in a Chilean population at risk of falls” [Cod.- 220.092.003-M].
Pablo Aqueveque, Britam Gómez and Francisco Saavedra were developers of SmartFES and QMUV devices. The remaining authors have no conflicts of interest to declare.
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Cretoiu, Dragos Cretoiu Anca Simionescu and Laurentiu M. Popescu",authors:[{id:"65176",title:"Dr.",name:"Dragos",middleName:null,surname:"Cretoiu",slug:"dragos-cretoiu",fullName:"Dragos Cretoiu"},{id:"71558",title:"Dr.",name:"Sanda",middleName:"Maria",surname:"Cretoiu",slug:"sanda-cretoiu",fullName:"Sanda Cretoiu"},{id:"71561",title:"Dr.",name:"Anca",middleName:null,surname:"Simionescu",slug:"anca-simionescu",fullName:"Anca Simionescu"},{id:"71562",title:"Prof.",name:"Laurentiu M.",middleName:null,surname:"Popescu",slug:"laurentiu-m.-popescu",fullName:"Laurentiu M. Popescu"}]},{id:"27068",doi:"10.5772/25611",title:"Sex Differences and the Role of Sex Steroids in Sympatho-Adrenal Medullary System and Hypothalamo-Pituitary Adrenal Axis Responses to Stress",slug:"sex-differences-and-the-role-of-sex-steroids-in-sympatho-adrenal-medullary-system-and-hypothalamo-pi",totalDownloads:1990,totalCrossrefCites:2,totalDimensionsCites:22,abstract:null,book:{id:"805",slug:"sex-steroids",title:"Sex Steroids",fullTitle:"Sex Steroids"},signatures:"Anne I. Turner, Charlotte L. Keating and Alan J. Tilbrook",authors:[{id:"63906",title:"Dr.",name:"Anne",middleName:null,surname:"Turner",slug:"anne-turner",fullName:"Anne Turner"},{id:"68259",title:"Prof.",name:"Alan",middleName:null,surname:"Tilbrook",slug:"alan-tilbrook",fullName:"Alan Tilbrook"},{id:"135282",title:"Dr.",name:"Charlotte",middleName:null,surname:"Keating",slug:"charlotte-keating",fullName:"Charlotte Keating"}]},{id:"27072",doi:"10.5772/26844",title:"Sex Steroids Modulate Fish Immune Response",slug:"sex-steroids-modulate-fish-imnune-response",totalDownloads:3129,totalCrossrefCites:4,totalDimensionsCites:19,abstract:null,book:{id:"805",slug:"sex-steroids",title:"Sex Steroids",fullTitle:"Sex Steroids"},signatures:"Elena Chaves-Pozo, Isabel Cabas and Alfonsa García-Ayala",authors:[{id:"68013",title:"Prof.",name:"Alfonsa",middleName:null,surname:"Garcia-Ayala",slug:"alfonsa-garcia-ayala",fullName:"Alfonsa Garcia-Ayala"},{id:"68015",title:"Dr.",name:"Elena",middleName:null,surname:"Chaves-Pozo",slug:"elena-chaves-pozo",fullName:"Elena Chaves-Pozo"},{id:"68016",title:"Ms.",name:"Isabel",middleName:null,surname:"Cabas",slug:"isabel-cabas",fullName:"Isabel Cabas"}]},{id:"22049",doi:"10.5772/28538",title:"Antiandrogenic and Estrogenic Compounds: Effect on Development and Function of Male Reproductive System",slug:"antiandrogenic-and-estrogenic-compounds-effect-on-development-and-function-of-male-reproductive-syst",totalDownloads:3401,totalCrossrefCites:7,totalDimensionsCites:18,abstract:null,book:{id:"2013",slug:"steroids-clinical-aspect",title:"Steroids",fullTitle:"Steroids - Clinical Aspect"},signatures:"Anna Hejmej, Małgorzata Kotula-Balak and Barbara Bilińska",authors:[{id:"74273",title:"Dr.",name:"Anna",middleName:null,surname:"Hejmej",slug:"anna-hejmej",fullName:"Anna Hejmej"},{id:"119777",title:"Dr.",name:"Małgorzata",middleName:null,surname:"Kotula-Balak",slug:"malgorzata-kotula-balak",fullName:"Małgorzata Kotula-Balak"},{id:"119779",title:"Prof.",name:"Barbara",middleName:null,surname:"Bilińska",slug:"barbara-bilinska",fullName:"Barbara Bilińska"}]},{id:"27793",doi:"10.5772/26892",title:"Sex Steroids in Insects and the Role of the Endosymbiont Wolbachia:A New Perspective",slug:"sex-steroids-in-insects-and-the-role-of-the-endosymbiont-wolbachia-a-new-perspective",totalDownloads:3646,totalCrossrefCites:5,totalDimensionsCites:12,abstract:null,book:{id:"804",slug:"sex-hormones",title:"Sex Hormones",fullTitle:"Sex Hormones"},signatures:"Ilaria Negri and Marco Pellecchia",authors:[{id:"68168",title:"Dr.",name:"Ilaria",middleName:null,surname:"Negri",slug:"ilaria-negri",fullName:"Ilaria Negri"},{id:"74147",title:"Dr",name:"Marco",middleName:null,surname:"Pellecchia",slug:"marco-pellecchia",fullName:"Marco Pellecchia"}]}],mostDownloadedChaptersLast30Days:[{id:"22048",title:"11β-Hydroxysteroid Dehydrogenase Type 1 and the Metabolic Syndrome",slug:"11-hydroxysteroid-dehydrogenase-type-1-and-the-metabolic-syndrome",totalDownloads:3218,totalCrossrefCites:0,totalDimensionsCites:2,abstract:null,book:{id:"2013",slug:"steroids-clinical-aspect",title:"Steroids",fullTitle:"Steroids - Clinical Aspect"},signatures:"Cidália D. Pereira, Maria J. Martins, Isabel Azevedo and Rosário Monteiro",authors:[{id:"74789",title:"Prof.",name:"Rosário",middleName:null,surname:"Monteiro",slug:"rosario-monteiro",fullName:"Rosário Monteiro"},{id:"74796",title:"Dr.",name:"Cidália",middleName:null,surname:"Pereira",slug:"cidalia-pereira",fullName:"Cidália Pereira"},{id:"74800",title:"Prof.",name:"Isabel",middleName:null,surname:"Azevedo",slug:"isabel-azevedo",fullName:"Isabel Azevedo"},{id:"160587",title:"Prof.",name:"Maria João",middleName:null,surname:"Martins",slug:"maria-joao-martins",fullName:"Maria João Martins"}]},{id:"27067",title:"Telocytes in Human Fallopian Tube and Uterus Express Estrogen and Progesterone Receptors",slug:"telocytes-in-human-fallopian-tube-and-uterus-express-estrogen-and-progesterone-receptors",totalDownloads:2272,totalCrossrefCites:0,totalDimensionsCites:22,abstract:null,book:{id:"805",slug:"sex-steroids",title:"Sex Steroids",fullTitle:"Sex Steroids"},signatures:"Sanda M. Cretoiu, Dragos Cretoiu Anca Simionescu and Laurentiu M. Popescu",authors:[{id:"65176",title:"Dr.",name:"Dragos",middleName:null,surname:"Cretoiu",slug:"dragos-cretoiu",fullName:"Dragos Cretoiu"},{id:"71558",title:"Dr.",name:"Sanda",middleName:"Maria",surname:"Cretoiu",slug:"sanda-cretoiu",fullName:"Sanda Cretoiu"},{id:"71561",title:"Dr.",name:"Anca",middleName:null,surname:"Simionescu",slug:"anca-simionescu",fullName:"Anca Simionescu"},{id:"71562",title:"Prof.",name:"Laurentiu M.",middleName:null,surname:"Popescu",slug:"laurentiu-m.-popescu",fullName:"Laurentiu M. Popescu"}]},{id:"27793",title:"Sex Steroids in Insects and the Role of the Endosymbiont Wolbachia:A New Perspective",slug:"sex-steroids-in-insects-and-the-role-of-the-endosymbiont-wolbachia-a-new-perspective",totalDownloads:3646,totalCrossrefCites:5,totalDimensionsCites:12,abstract:null,book:{id:"804",slug:"sex-hormones",title:"Sex Hormones",fullTitle:"Sex Hormones"},signatures:"Ilaria Negri and Marco Pellecchia",authors:[{id:"68168",title:"Dr.",name:"Ilaria",middleName:null,surname:"Negri",slug:"ilaria-negri",fullName:"Ilaria Negri"},{id:"74147",title:"Dr",name:"Marco",middleName:null,surname:"Pellecchia",slug:"marco-pellecchia",fullName:"Marco Pellecchia"}]},{id:"60756",title:"The Biological Role of Androgen Receptor in Prostate Cancer Progression",slug:"the-biological-role-of-androgen-receptor-in-prostate-cancer-progression",totalDownloads:1876,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Prostate cancer is the most commonly diagnosed cancer in men all over the world. Localized cancers in the early stages can be well managed by surgical or radiation therapy. Metastatic prostate cancer is treated with androgen deprivation therapy because androgen signaling is essential to the prostate tumor growth and anti-apoptotic ability. However, resistance develops quickly in the clinical course and leads to castration-resistant prostate cancer (CRPC). Androgen receptor (AR) functions as a nuclear receptor to facilitate ligand-dependent transcriptional activation in the nucleus. AR interacts with several tissue-specific transcription factors such as forkhead box protein A1 (FOXA1) and regulates epigenetic status by recruiting epigenetic factors. In addition, AR transcriptional activity is modulated by interacting directly or indirectly with non-coding RNAs such as long non-coding RNAs (lncRNAs) and micro RNAs (miRNAs). Notably, enhanced AR signaling in CRPC has been documented in several studies; however, which of these factors are important for the biological function it remains poorly understood. Here, I review our current knowledge of the mechanistic roles of AR involved in prostate cancer progression and discuss the importance of the prostate cancer-associated signals.",book:{id:"6762",slug:"advances-in-testosterone-action",title:"Advances in Testosterone Action",fullTitle:"Advances in Testosterone Action"},signatures:"Ken-ichi Takayama",authors:[{id:"239221",title:"Dr.",name:"Ken-Ichi",middleName:null,surname:"Takayama",slug:"ken-ichi-takayama",fullName:"Ken-Ichi Takayama"}]},{id:"75047",title:"Role of Sex Hormones in Human Body",slug:"role-of-sex-hormones-in-human-body",totalDownloads:566,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Gonadal Steroids hormones play an important role in the reproductive and non-reproductive systems. Estrogen has important rule in cardiovascular system as it has vasodilator effect and reduces or prevents platelet activation. In addition, it improves the profile of circulating lipoproteins. All of which may explain why women at premenopausal age are less likely to have heart disease than menopause women or men. E2 play a grate effect on the skeletal system as it is one of the strongest regulators of osteoblast and osteoclast function, and it is responsible for the reduction of adipose tissue and regulation of the body weight, and also has dermatological effect,hence it stimulates the proliferation of keratinocytes and prevents their apoptosis, in addition to the progesterone which increases collagen synthesis. Estrogen is necessary for the functioning and integrity of the tissues of the urinary system specially of the lower urinary tract. Sex steroid are crucial for nervous system, as progesterone is important for production of neurosteroid, and estrogen is currently used in Parkinson’s and Alzheimer’s disease because of its effects on mental health. The androgens also have a crucial biological effects on neural, muscle, bone, adipose tissue,prostate, cardiovascular, haemopoietic, and the reproductive systems. The gonadal steroid hormones play an important role in immune system and regulating the immune response against different viral or bacterial infections.",book:{id:"10313",slug:"reproductive-hormones",title:"Reproductive Hormones",fullTitle:"Reproductive Hormones"},signatures:"Nassrin Malik Aubead",authors:[{id:"329956",title:"Dr.",name:"Nassrin",middleName:null,surname:"Malik Aubead",slug:"nassrin-malik-aubead",fullName:"Nassrin Malik Aubead"}]}],onlineFirstChaptersFilter:{topicId:"1014",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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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:3,paginationItems:[{id:"7",title:"Bioinformatics and Medical Informatics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",isOpenForSubmission:!0,editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",slug:"slawomir-wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",biography:"Professor Sławomir Wilczyński, Head of the Chair of Department of Basic Biomedical Sciences, Faculty of Pharmaceutical Sciences, Medical University of Silesia in Katowice, Poland. His research interests are focused on modern imaging methods used in medicine and pharmacy, including in particular hyperspectral imaging, dynamic thermovision analysis, high-resolution ultrasound, as well as other techniques such as EPR, NMR and hemispheric directional reflectance. Author of over 100 scientific works, patents and industrial designs. Expert of the Polish National Center for Research and Development, Member of the Investment Committee in the Bridge Alfa NCBiR program, expert of the Polish Ministry of Funds and Regional Policy, Polish Medical Research Agency. Editor-in-chief of the journal in the field of aesthetic medicine and dermatology - Aesthetica.",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},{id:"8",title:"Bioinspired Technology and Biomechanics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",isOpenForSubmission:!0,editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",slug:"adriano-andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",biography:"Dr. Adriano de Oliveira Andrade graduated in Electrical Engineering at the Federal University of Goiás (Brazil) in 1997. He received his MSc and PhD in Biomedical Engineering respectively from the Federal University of Uberlândia (UFU, Brazil) in 2000 and from the University of Reading (UK) in 2005. He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. His research interests include Biomedical Signal Processing and Modelling, Assistive Technology, Rehabilitation Engineering, Neuroengineering and Parkinson's Disease.",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",isOpenForSubmission:!0,editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",slug:"luis-villarreal-gomez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",biography:"Dr. Luis Villarreal is a research professor from the Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana, Baja California, México. Dr. Villarreal is the editor in chief and founder of the Revista de Ciencias Tecnológicas (RECIT) (https://recit.uabc.mx/) and is a member of several editorial and reviewer boards for numerous international journals. He has published more than thirty international papers and reviewed more than ninety-two manuscripts. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. 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