Management options for penile urethral strictures.
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These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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Salgado-Jiménez, Luis G. García-Valdovinos and Guillermo Delgado-Ramírez",authors:[{id:"22633",title:"Dr.",name:"Luis",middleName:null,surname:"Garcia-Valdovinos",fullName:"Luis Garcia-Valdovinos",slug:"luis-garcia-valdovinos"},{id:"22640",title:"Dr.",name:"Tomás",middleName:null,surname:"Salgado-Jiménez",fullName:"Tomás Salgado-Jiménez",slug:"tomas-salgado-jimenez"},{id:"26741",title:"MSc.",name:"Guillermo",middleName:null,surname:"Delgado-Ramirez",fullName:"Guillermo Delgado-Ramirez",slug:"guillermo-delgado-ramirez"}]},{id:"15222",title:"Sliding Mode Control Applied to a Novel Linear Axis Actuated by Pneumatic Muscles",slug:"sliding-mode-control-applied-to-a-novel-linear-axis-actuated-by-pneumatic-muscles",signatures:"Dominik Schindele and Harald Aschemann",authors:[{id:"11584",title:"Prof.",name:"Harald",middleName:null,surname:"Aschemann",fullName:"Harald Aschemann",slug:"harald-aschemann"},{id:"11585",title:"Dr.",name:"Dominik",middleName:null,surname:"Schindele",fullName:"Dominik 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Wen",authors:[{id:"22312",title:"Mr.",name:"Bor-Jiunn",middleName:null,surname:"Wen",fullName:"Bor-Jiunn Wen",slug:"bor-jiunn-wen"}]},{id:"15225",title:"Sliding Mode Control of Second Order Dynamic System with State Constraints",slug:"sliding-mode-control-of-second-order-dynamic-system-with-state-constraints",signatures:"Aleksandra Nowacka-Leverton and Andrzej Bartoszewicz",authors:[{id:"18337",title:"Prof.",name:"Andrzej",middleName:null,surname:"Bartoszewicz",fullName:"Andrzej Bartoszewicz",slug:"andrzej-bartoszewicz"},{id:"22681",title:"Dr.",name:"Aleksandra",middleName:null,surname:"Nowacka-Leverton",fullName:"Aleksandra Nowacka-Leverton",slug:"aleksandra-nowacka-leverton"}]},{id:"15226",title:"Sliding Mode Control System for Improvement in Transient and Steady-state Response",slug:"sliding-mode-control-system-for-improvement-in-transient-and-steady-state-response",signatures:"Takao Sato, Nozomu Araki, Yasuo Konishi and Hiroyuki Ishigaki",authors:[{id:"10959",title:"Dr.",name:"Nozomu",middleName:null,surname:"Araki",fullName:"Nozomu Araki",slug:"nozomu-araki"},{id:"18155",title:"Dr.",name:"Takao",middleName:null,surname:"Sato",fullName:"Takao Sato",slug:"takao-sato"},{id:"24185",title:"Prof.",name:"Yasuo",middleName:null,surname:"Konishi",fullName:"Yasuo Konishi",slug:"yasuo-konishi"},{id:"24186",title:"Prof.",name:"Hiroyuki",middleName:null,surname:"Ishigaki",fullName:"Hiroyuki Ishigaki",slug:"hiroyuki-ishigaki"}]},{id:"15227",title:"A New Design for Noise-Induced Chattering Reduction in Sliding Mode Control",slug:"a-new-design-for-noise-induced-chattering-reduction-in-sliding-mode-control",signatures:"Min-Shin Chen and Ming-Lei Tseng",authors:[{id:"21070",title:"Dr.",name:"Min-Shin",middleName:null,surname:"Chen",fullName:"Min-Shin Chen",slug:"min-shin-chen"},{id:"21674",title:"Prof.",name:"Ming-Lei",middleName:null,surname:"Tseng",fullName:"Ming-Lei 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Knowledge was gathered about the treatment of urethral stricture disease by ancient Egyptians and other civilizations more than two millennia ago. Nonetheless, little has changed until about 60 years ago. Since then, the management of urethral strictures, including the penile urethral segment, has been in continuous and rapid evolution. Although various reconstructive techniques are available for the treatment of penile urethral stricture, no single technique has been identified as the method of choice. An understanding of the penile urethral anatomy is important for the diagnosis and treatment of penile urethral stricture disease.
\nUrethral strictures, in general, are associated with significant impact on patients’ quality of life. Penile urethral strictures, in particular, due to their exposed anatomic location and their surgical treatment, may cause significant impact on patients’ sexual function and perception of (un)satisfactory penile cosmesis.
\nThe anatomical and physical characteristics of the penile urethra are associated with additional challenges when compared to other urethral locations, especially due to its unsuitability for anastomotic repair and its relatively thinner corpus spongiosum. The choice of penile urethroplasty technique is largely influenced by etiology, location, length of the stricture, as well as prior surgical treatments. There are a number of challenges and controversies in the surgical reconstruction of penile urethral strictures, such as the use of grafts vs. flaps, use of skin vs. oral mucosa graft (OMG) tissue for augmentation or substitution techniques, the most appropriate indications for a single or a staged (at times, multiple) reconstruction, and, lastly, the management of particularly complex cases such as panurethral stricture disease and hypospadias “cripples” to achieve the best possible outcome.
\nAlthough penile urethral strictures can be managed by any of the above-mentioned procedures individually, they can also be more adequately treated by a combined approach. Among the various procedures available for treating urethral stricture, one-stage buccal mucosal graft urethroplasty is the current standard practice. The selection of technique for penile urethroplasty for an individual patient largely depends not only on the expertise of the surgeon but also upon the stricture’s etiology, pathological characteristics, and location. Therefore, contemporary reconstructive urologists working in this field should be aware of, and permanently keep themselves updated on, the numerous surgical techniques required to deal with any condition of the urethra that might surface at the time of surgery.
\nThis review provides a brief update of the options for the surgical reconstruction of different types and sites of penile urethral stricture as well as discussing current controversies, innovations, and possible future research in urethral reconstruction of the penile urethra.
\nClassically, the anterior urethra is divided, at the level of the penoscrotal junction inferiorly and the suspensory ligament superiorly, into bulbar and penile segments, the penile part consisting of the external meatus, fossa navicularis, and the penile shaft urethra. The penile urethra extends from the distal margin of the bulbospongiosus (or penoscrotal junction) to the external meatus. The bulbar (proximal) segment is the shorter of the two and is located in the midline between both the penile crural and the cavernosal bodies. The penile urethra (distal segment of the anterior urethra), also called pendulous, lies in a dorsal groove between the two corpora cavernosa and extends from the penoscrotal junction to the tip of the glans penis. It is surrounded in its full length by the corpus spongiosum; it is mobile and stretches during penile erection; and its length varies according to the penile length. The caliber of the anterior urethral lumen is relatively uniform, widening distally to form the fossa navicularis, and narrowing again to end at the external meatus (Figure 1).
\nSagittal sectional view of the male urethra. The areas in blue and yellow represent the corpus spongiosum and lumen of the anterior urethra, respectively. The penile urethra extends distally from the penoscrotal junction or pubourethral ligaments (reproduced with permission from Dr. Enzo Palminteri).
Histologically, the penile (distal anterior) urethra is surrounded by five tissue layers: urethral epithelium and lamina propria (urethral mucosa), corpus spongiosum, tunica albuginea, and Buck’s fascia [1]. Most of the penile shaft urethra is lined by a stratified and pseudostratified columnar epithelium, except for the distal penile urethra, including the fossa navicularis, which is lined by ciliated stratified columnar epithelium or stratified nonkeratinizing squamous epithelium. The lamina propria of the penile urethra is a fibroconnective tissue with elastic fibers and scattered, longitudinally oriented smooth muscle fibers. Multiple mucus-secreting glands drain into the anterior urethral lumen, known as Cowper’s glands in the bulbar urethra and Littre’s glands in the penile urethra.
\nThe anterior urethra obtains its blood supply from the first of three penile branches of the internal pudendal artery, which in turn is a branch of the internal iliac artery. The internal pudendal artery travels through the Alcock canal and gives the inferior rectal artery, posterior scrotal artery and perineal artery, and then terminates as the common penile artery. Three branches arise from the common penile artery: the paired urethral or, most commonly, bulbourethral arteries that pierce the perineal body at a posterolateral location and supply the urethra, spongiosum, and the glans. The other branches are the paired cavernosal arteries that pierce the penile hilum to travel in the center of the erectile tissue, and the deep dorsal penile artery that travel between the crura and beneath the pubic bone to run under the Buck’s fascia sending multiple circumflex branches to the corpus spongiosum and terminal branches to the glans penis, thus providing in a retrograde fashion a dual blood supply to the corpus spongiosum and urethra. It also sends cavernosal branches to contribute to the hemodynamics of the erection (Figure 2A and B). The venous drainage is through the emissary veins into the circumflex branches of the deep dorsal penile vein as well as through the urethral and bulbar veins into the internal pudendal vein. The anterior urethra is innervated by the urethrobulbar nerve, a branch of the perineal nerve derived from the pudendal nerve. The bulbocavernosus nerve, which is a branch of the pudendal nerve, gives off two branches that penetrate the rhabdosphincter at the three and nine o’clock positions. The pudendal nerve, gathering fibers from the second, third and fourth sacral spinal nerve, is both motor to the urethral rhabdosphincter and sensory to the urethra and glans penis (Figure 3). The lymphatic drainage of the anterior urethra is via the superficial and deep inguinal nodes, whereas the lymphatic drainage of the more proximal (the bulbar, membranous, and prostatic) urethra can take three routes: to the external iliac nodes, to the obturator and internal iliac nodes, or to the presacral nodes [2].
\nSchematic illustration of vascularization of the penis and urethra: (A) arterial blood supply and (B) venous blood drainage.
Schematic illustration of autonomic and somatic innervation of the penis and urethra (reproduced with permission from Dr. Enzo Palminteri).
Understanding the penile anatomy and, in particular, the penile skin arterial blood supply is an important resource for penile urethral surgical reconstruction. The penis is covered with an elastic layer of skin that has no subcuticular adipose tissue: the dartos fascia, a layer of loose areolar subcutaneous connective tissue in the penis and scrotum. It lies immediately beneath the penile skin, allowing the skin to move freely over the shaft of the penis and is contiguous with Colles fascia in the perineum. The dartos, also with no adipose tissue, slides freely over the underlying Buck’s fascia and is an extension of Scarpa’s fascia of the abdominal wall, carrying superficial nerves, lymphatics, and blood vessels, which make this fascia extremely useful in bringing blood supply and preventing fistulation in urethral reconstruction. Beneath the dartos fascia lies the Buck’s fascia, which surrounds the tunica albuginea of the two corpora cavernosa and the corpus spongiosum.
\nThe development of fasciocutaneous penile skin island flaps, either as a vertical flap (as in Orandi flap) or as a circular transverse flap (as in McAninch/Quartey flap), takes advantage of the natural anatomical, relatively avascular cleavage planes between the skin and the dartos fascia and another between the dartos fascia and Buck’s fascia.
\nThe blood supply to the penile skin and anterior scrotal wall comes from the external pudendal arteries, whereas the inferior and posterior aspect of the scrotum derives its blood supply from the posterior scrotal arteries, which are branches of the perineal artery, which in turn is a further branch of the internal pudendal artery (Figure 4). The superficial/superior branches of the external pudendal artery travel from medially and across the femoral triangle and within Scarpa’s fascia to enter the base of the penis. After giving off anterior scrotal branches, they arborize to form an arterial network within the dartos fascia. Also, at the base of the penis, branches from the axial penile artery form a subdermal plexus to supply the distal penile skin and prepuce. Because the communicating vessels between the subcutaneous and subdermal arterial plexuses are minimal, a relatively avascular plane can be developed between the dartos and Buck’s fascia. This fascial plexus, that is considered axial, is the true blood supply to the penile island skin flaps used in urethroplasty and, therefore, they can be mobilized widely and transposed aggressively and reliably.
\nSchematic illustration of the superficial arterial supply and venous drainage of the penis and scrotum.
The venous drainage of the penis includes the superficial dorsal vein, the deep dorsal vein, and the crural veins. The superficial dorsal vein drains the skin of the penis and empties into the superficial external pudendal vein and then into the saphenous vein. The deep dorsal vein begins at the base of the glans and retro coronal area and then travels deep to the Buck’s fascia between the paired deep dorsal arteries. Along its course, it receives circumflex veins from the spongiosum until it passes under the pubic bone to join the periprostatic venous complex. The cavernosal veins drain into a subtunical venous plexus; then through emissary veins, they join the circumflex veins, which in turn empty into the crural vein and the periprostatic plexus or the internal pudendal veins. The lymphatic drainage of the penis is primarily to the superficial inguinal nodes.
\nA detailed understanding of the anatomy of the anterior urethra is a critical prerequisite for the accurate diagnosis and successful management of urethral strictures.
\nThe etiology of contemporary urethral stricture disease involves a traumatic, iatrogenic, inflammatory, and idiopathic origin [3, 4]. Pathophysiology differs with age. The major causes of anterior urethral stricture in children are more likely to be trauma, mainly straddle injury, and complications from hypospadias surgery. Congenital and idiopathic strictures may also occur in children. In adult patients, most urethral strictures have an iatrogenic origin, mainly traumatic catheterization or transurethral manipulation or instrumentation. In the <10-year-old age group, strictures are mainly localized in the penile urethra, whereas in the >10-year-old age group, the bulbar urethra is the most common location [5].
\nUrethral dilatation |
Internal urethrotomy |
Laser urethrotomy |
Grafts |
Flaps |
Combination of grafts and flaps |
One-stage urethroplasty |
Staged urethroplasty |
Management options for penile urethral strictures.
In the past, inflammatory urethral strictures were predominantly associated with gonococcal urethritis, which has been effectively eradicated with penicillin-based antimicrobial agents. However, the emergence of resistant strains of
Stricture etiology is of particular significance in the penile urethra, as they tend to be more diffuse in nature (averaging 6.1 cm), especially if associated with LS, and shorter in the bulbar urethra (averaging 3.1 cm). Urethral strictures can be classified by their most common urethral location. Strictures involving the external meatus and fossa navicularis are predominantly inflammatory and iatrogenic in origin in 33–47% [3]. In the series reported by Fenton et al., globally, the etiology of anterior urethral strictures was idiopathic in 34%, iatrogenic in 32%, inflammatory in 20%, and traumatic in 14% [3].
\nIatrogenic strictures are typically associated with instrumentation, such as transurethral resection, prolonged catheterization, and cystoscopy, totaling 90% of all penile strictures. Prior hypospadias repair and radical prostatectomy contributed to 6.3 and 3.2%, respectively [3, 8]. Such strictures are mainly the result of an ischemic injury secondary to traumatic urethral manipulation or instrumentation, particularly when a large bore catheter or resectoscope is used. Therefore, whenever relatively prolonged catheterization is necessary, smaller caliber/Fr catheters are recommended. For more extended periods of time, a suprapubic catheter is a better option.
\nMalignant strictures should be approached in a different clinical context and most likely require mutilating radical surgery.
\nAny relevant past history of urethral instrumentation, hypospadias surgery, and genital trauma should be obtained. Obstructive voiding symptoms should be assessed with a validated questionnaire. Presence of risk factors and comorbidities that may provoke ischemia or impair wound healing should be probed for. These include obesity, diabetes mellitus, severe peripheral vascular disease, cigarette smoking, long-distance bicycle riding, horseback riding, and sexually transmitted infections.
\nPhysical examination should include palpation of the penile shaft for nodules or dense urethral scarring or constriction. The urethral meatus should be examined for narrowing and the surrounding glans for signs of LS. The penis should be examined to assess whether the patient has been circumcised, or there is sufficient shaft skin to allow development of a penile skin flap. The bladder should be assessed for potential detrusor hypocontractility, distention, and presence of an abdominal scar from a previous suprapubic cystostomy.
\n“En plateau” obstructive uroflow in a patient with anterior urethral stricture.
Retrograde urethrogram of long, irregular, “saw-toothed” penile urethral stricture typical of lichen sclerosus.
Any appropriate treatment plan needs accurate identification of the stricture characteristics: location, length, depth, and thickness of fibrotic tissue (spongiofibrosis). It is critical that both the proximal and distal ends of a urethral stricture are completely and accurately assessed with endoscopy and bougienage during reconstruction as to not miss any diseased segment of the urethra. Both patient and urethral reconstructive surgeons must understand completely the goal(s) of treatment before a decision is made. The decision to choose urethroplasty over another approach to a specific urethral stricture depends on patient expectations, goals, and comorbidities. In elderly or frail patients, an expectant or conservative management is more likely to be offered. Therefore, treatment options and their individual potential outcomes in terms of cure, or simply palliation, and complications should be carefully discussed with the patients and their family. On the other hand, urethral reconstructive surgeons need to keep themselves updated and abreast regarding the vast array of treatment options and their precise and specific indications and, therefore, should be flexible enough to intraoperatively adapt and/or adopt a different strategy for a specific scenario, which was not anticipated preoperatively. Thus, it is only legitimate and ethical to embark on urethral reconstruction if one can master and offer the patient all necessary surgical options to treat his specific urethral problem. It is very important to bear in mind that the penile urethra is the most exposed segment of the male urethra, and any surgical procedure or technique should achieve not only a satisfactory functional outcome but also a cosmetic one.
\nThe key techniques include mainly urethral dilatation, endoscopic urethrotomy, anastomotic repairs (rarely in the penile urethra), substitution repairs (ventral, dorsal, double-faced), free grafts of skin (full thickness and split thickness skin), oral mucosa, lingual mucosa, bladder mucosa, retroauricular skin (Wolf’s graft), and skin flap repairs (circumferential, longitudinal and variants) from penile and (less commonly) scrotal skin, as well as the use of adjunctive maneuvers such as the use of advancement flaps for additional blood supply or defect coverage (Table 1).
\nA meta-analysis of outcomes and complications of laser versus cold-knife urethrotomy compared unfavorably regarding laser: 12 versus 6.5%, respectively [21]. Laser urethrotomy may look appealing for the anterior urethra but with no definitive benefit over cold-knife urethrotomy.
\nOral mucosal graft is currently the graft of choice, owing to their short harvest time, easy harvest technique, and the physical characteristics including resistance, durability, immunogenic properties, excellent vascularity, hairlessness, low oral morbidity, concealed donor site and high success rates [24, 25]. For these reasons, over the past 20 years, oral mucosal grafts have shown better handling characteristics and long-term stricture-free outcomes, and have replaced both penile skin grafts and flaps. However, patients with long and complex urethral abnormalities or with contraindications to oral mucosal graft use, such as those with leukoplakia, systemic skin disease of the oral cavity or history of chronic tobacco chewing may still necessitate split or full thickness skin grafts.
\nOne controversy in anterior urethral grafting is related to dorsal or ventral placement of the graft on the urethra. Some urethral surgeons favor dorsal placement in both bulbar and urethral strictures, whereas others opt for ventral placement [26, 27, 28, 29, 30, 31]. Although several studies have demonstrated comparable success rates for dorsal and ventral onlay grafting, the author of this chapter favors the use of dorsal placement of the graft in the penile urethra because the spongiosal vascularity in the ventral urethra is thinner and the graft support is less reliable when compared to the dorsal urethral surface.
\nVarious penile skin flaps have been described, which can be raised ventrally or dorsally on the penile shaft and taken longitudinally or circumferentially [37, 38, 39]. These flaps are fasciocutaneous in nature and are based on dartos fascia pedicle. The ventral, longitudinal flap, as described by Orandi, is best suited for penile shaft urethral strictures that do not reach the base of the penis or any part proximal to the penoscrotal angle because hair-bearing skin will inevitably be involved in the reconstruction. On the contrary, the transverse, circumferential preputial/distal penile skin flaps are long enough to bridge defects of the entire penile urethra and most of the bulbar urethra for example in panurethral defects. Ideally, flaps should be hairless, adapted to a moist environment, with a reliable vascular pedicle, mobile, and cosmetic. In general, anterior urethral reconstruction with the use of flaps has become less prevalent due to the increased popularity of oral mucosa grafts. A rise in prevalence of genital and urethral LS has also contributed to the near abdication of the use of flaps. Nonetheless, island skin flaps still find an important indication in reoperative cases with extensive spongiofibrosis and ischemic urethral mucosal plates where chances of graft take are minimal. These circumstances occur after irradiation, severe trauma, or infection.
\nRepairs in adults who failed hypospadias repair in childhood pose a particular reconstructive challenge because of dense scarring, tissue inelasticity, inflammation, impaired blood supply, and penile and urethral shortening from previous, often multiple, operations [44, 45, 46, 47]. Penile urethroplasty should be performed in a single stage, whenever feasible, to avoid discomfort and disability to the patient from a multistage repair. Most strictures associated with trauma, infection, or instrumentation, where the penile skin, dartos fascia and spongiosum are not significantly damaged, can be approached through a single-stage procedure. On the other hand, presence of local infection or inflammation associated with a specific underlying disease process obliterated urethral segments with dense surrounding fibrosis, and a history of prior interventions, especially prior flap or hypospadias repairs, are contraindications for single-stage repairs and, therefore, should not be advised. The two-stage reconstruction involves surgical opening of the stricture, augmentation, or substitution (more commonly with use of oral mucosa grafting) of the diseased urethral segment and creation of temporary urethrostomy for drainage (first stage), followed between 4 and 6 months later by neourethral tubularization (second stage). Therefore, it should be confined to situations where it is inappropriate to maintain the axial integrity of the urethral plate and a full circumference urethral reconstruction is mandatory.
\nIn order to facilitate description and discussion of the various surgical procedures used for adult penile urethral reconstruction, we will group them according to stricture location in the urethra: (1) external meatus and fossa navicularis and (2) penile shaft urethra. Furthermore, a separate section will be devoted to procedures used for previously failed repairs or reoperative procedures (Table 2).
\n• Meatotomy/meatoplasty • Longitudinal skin flap techniques \n• Transverse ventral/circumferential fasciocutaneous skin island flaps \n• Graft techniques \n• Combination of grafts and flaps [65] • Endourethroplasty techniques \n
\n
\n
• Flap reconstruction \n• Graf reconstructions \n
\nTissue engineering/stem cell therapy |
Urethral reconstruction by stricture location.
Strictures involving exclusively the external meatus may be treated with
In 2004, Malone described a technique to relieve stenosis of the external urinary meatus resulting from LS [48]. The procedure is rapid and easy to perform on an outpatient basis, providing good cosmesis and functional voiding without spraying. The meatotomy is carried out dorsally avoiding a hypospadiac meatus. If the stricture extends into the fossa navicularis, oral mucosa graft reconstruction is performed. The final result is a slit-shaped with good caliber meatus at the tip of the glans. The procedure has been successfully reproduced by others [49].
\nSeveral variants have been reported. Cohney in 1963 described a penile flap procedure based on a circumferential elevated random penile skin flap. The distal urethra is well open, but the patient is left with a less appealing cosmetic result and a retrusive meatus (Figure 7A and B). Blandy-Tresidder in 1967 developed a flap procedure based on dartos fascia vascularity. It also provides good functional outcomes, but only modest improvement of the cosmetic final appearance. The meatus is usually left at the coronal level (Figure 7C and D). The Brannen flap repair [52], a modification of Blandy’s procedure, was described in 1976 to try to create a better cosmetic appearance of the glans and distal penile segment [53]. However, some mechanical problems associated with the flap advancement make this procedure inefficient and, therefore, offer marginal improvement in terms of cosmesis (Figure 7E and F). Designed to create a cosmetically normal meatus and glans penis, De Sy in 1984 further modified the Blandy and Brannen techniques using an advancement midline skin island flap [54]. However, the proximal portion of the flap is de-epithelialized leaving a distal skin island on dartos fascia (Figure 7G and H). Again, the mechanics of the flap advancement is inefficient.
\nSchematic illustration of several techniques for surgical reconstruction of strictures of the urethral meatus and fossa navicularis. (A, B) Cohney’s meatoplasty: an eccentric, transversely oriented, subcoronal flap is developed, and the urethrotomy is extended to normal urethra. The transverse flap is rotated into the urethrotomy defect. (C, D) Blandy’s meatoplasty: creation of a midline flap. Urethrotomy is extended till normal urethral lumen. The flap is advanced into the urethrotomy defect. (E, F) Brannen’s meatoplasty: a longer midline dartos-based flap is developed and is then widely advanced. (G, H) De Sy’s meatoplasty: a midline flap similar to Brannen’ technique is mobilized. The proximal portion of the flap is de-epithelialized leaving a distal skin island attached to a dartos pedicle. The de-epithelialized surface of the flap is anastomosed, and the ventral glans is reapproximated over the reconstruction (from Jordan and McCammon [
Schematic illustration of Jordan’s ventral transverse skin island flap procedure. (A–C) After urethrotomy is made till normal urethra, a ventral skin island flap is elevated above Buck’s fascia, and the lateral glans wings are exposed. The skin island is rotated, transposed, and inverted into the urethrotomy defect. The glans wings are sutured ventrally. Inset shows details of the rotation, transposition, and inversion of the flap (from Jordan and McCammon [
Fasciocutaneous distal penile flap urethroplasty as described by McAninch. (A–H) Urethral exposure followed by ventral longitudinal urethrotomy. The fossa navicularis is exposed with either a glans-cap or a glans-wings technique. A fasciocutaneous distal, transverse, ventral penile flap is developed. The urethral stricture can be corrected by either a ventral onlay or a neourethral tube. The glans wings or cap is sutured to cover the flap reconstruction (from Armenakas and McAninch [
Two-stage distal urethra reconstruction as described by Bracka. (a–b) Marsupialization of the urethra and placement of the oral mucosal graft after excision of the diseased urethral mucosa at the first stage. Aspect of the graft 6 months later, which is then prepared for tubularization at the second stage.
Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral meatus as described by Nikolavsky. (a-e) Transurethral ventral shallow resection of scar tissue. Placement of double-armed suture through buccal graft and through apex of urethrotomy (inside out). External apical suture tying, meatal BMG edge fixation, and additional inside-out quilting of the graft with double-armed sutures (reproduced with permission from Springer Science + Business Media Dordrecht, Ref. [
Intraoperative demonstration of the procedure described in
Schematic illustration of single-stage, combined flap graft technique as described by Gelman. (A–C) Oral mucosal graft is placed and quilted dorsally followed by closure of the urethrotomy defect by a penile skin flap (from Gelman and Sohn, Ref. [
For penile shaft urethral strictures, a stricturotomy and onlay or inlay patch graft, or alternatively a flap reconstruction, can be used for simple strictures. More complex cases may eventually require total excision of the strictured area and circumferential reconstruction with OM grafts or penile skin flap. In more complex situations, such as after previous failed repairs and compromised or obliterated urethras, a staged reconstruction is preferable. Penile urethral strictures are rarely cured by dilatation or DVIU. If either of these procedures fail once, the chance of a better outcome with a second attempt is almost nil, making urethroplasty the only curative option. Anastomotic urethroplasty should be avoided in the penile urethra, even in short strictures, as ventral curvature usually occurs.
\nPatient advanced age and comorbidities may steer the urologist away from open surgery. In these circumstances, periodic urethral (self)-dilatation or definitive urethrostomy should be strongly considered.
\nWith the penis on stretch, a longitudinal nonhair-bearing skin island is marked on the ventral aspect of the penis. The description of the surgical technique is outlined in Figure 14. The penis is snugly dressed to avoid hematoma. Drains are rarely required. Patients are kept on strict bed rest for 3–5 days to minimize swelling. Intravenous antibiotics are administered for at least 48 h, followed by oral antibiotic prophylaxis for one additional week. Erections should be avoided. The use of a suprapubic catheter for urinary drainage is not mandatory but preferable, which should be kept for 2 weeks. The urethral catheter is left plugged to act as a stent only. After 2–3 weeks, the urethral catheter is removed and the patient is sent home with the suprapubic tube occluded, allowing the patient to resume urethral voiding. The suprapubic tube is removed after a few days of normal urethral voiding. If a fistula develops, the urethral catheter is not reinserted and the suprapubic diversion is maintained for another week. If still persistent, then it should be repaired after 4–6 months.
\nOrandi flap procedure. (A–C) Deep skin incision is made over the strictured urethra. Dotted line indicates skin incision. Dartos pedicled flap is created lateral to the superficial skin incision, which will cover the urethrotomy defect. The skin is closed in the midline (from Elliott and McAninch [
The Orandi flap is a reliable and relatively easy flap to harvest. It is a useful solution for a single-stage reconstruction of penile urethral strictures.
\nQuartey flap procedure. (A, B) Hockey stick skin island flap is fashioned. The length of the flap may be tailored as needed. After ventral longitudinal urethrotomy, the flap is anastomosed similar to the Orandi technique.
McAninch fasciocutaneous circular distal penile island flap. (A–D) Flap harvesting followed by ventral division of flap and pedicle, and then, it is rotated and anastomosed to the urethrotomy defect (from McAninch [
(A-B) Asopa technique used in long penile urethral stricture approached through a ventral incision.
Kulkarni’s one-sided dorsal onlay graft for anterior urethroplasty for long urethral strictures. (a-c) The penile shaft has been inverted into the perineum where the entire reconstruction is performed. This technique can be used to repair the entire length of the anterior urethra (reproduced with permission from Sanjay Kulkarni, MD).
Johanson’s two-stage procedure. (A–C) The anastomosis of the skin edges and the longitudinal urethrotomy is performed at the first stage. The urethrotomy is fashioned as a neourethral tube at the second stage. Modification with use of oral mucosal graft has been described.
Mesh graft urethroplasty as described by Schreiter. Meshed skin graft has been placed on the wound ground and quilted to the host bed (first stage). The prepared urethral plate is tubularized approximately 6 months later (second stage).
Algorithm of surgical reconstruction of strictures of the meatus, fossa navicularis, and penile urethral shaft. FN = fossa navicularis, LS = lichen sclerosus, TIP = tubularized incised plate, and OMG = oral mucosal graft.
To generate new tissues, biomedical engineering investigators have utilized three basic tools: cells, scaffold, and growth factor. The earliest use of human cells dates back to approximately 30 years ago [81]. Several different tissue-engineered grafts have been used for urethral reconstruction. There are two types of urethral grafts: (1) those that contain living autologous cells and (2) those that are cell free. The latter include grafts obtained from cadaveric or animal sources. This tissue undergoes treatment to become completely cell free. The resultant biological matrix is then implanted. A good vascular bed is needed to allow take and infiltration of host cells. As a rule, these techniques would only be expected to be particularly successful for substituting short urethral defects. In contrast, cellularized grafts contain a matrix populated with autologous cells, which are obtained from a small biopsy from the patient. The cells are cultured, expanded, and seeded onto the matrix. The matrix containing cells is then implanted onto the host bed [82].
\nA critical element required for successful tissue engineering is the cell source. Cells can be isolated from autologous urine-derived stems cells, smooth muscle cells, adipogenic, chondrogenic, and neural lineages [83]. Because simple cell injection to a target site is rarely feasible, a scaffold, or a template, also called artificial extracellular matrix, is necessary. The major function of a scaffold is to assist proliferation, differentiation, and biosynthesis of cells [84, 85].
\nScar modulation represents another potential development that may revolutionize urethral reconstruction. Antifibrotic injectables, acting as scar inhibitors, may be placed into the stricture after stricturotomy. Stents impregnated with tacrolimus or paclitaxel have been tried in animal and human models with apparently promising early results [86, 87].
\nRegenerative medicine (cell therapy and tissue engineering) has made solid progress over the last three decades. We cautiously hope that these technologies will finally enter the routine clinical environment and be applicable in the treatment of urethral strictures/stenosis.
\nThe spectrum of lower urinary tract symptoms (LUTS) at initial presentation for urethral stricture disease (USD) is well described. Anterior urethral stricture disease most commonly presents as urinary obstruction and may occasionally present as acute urinary retention. However, there is little data addressing these symptoms in patients after urethroplasty. LUTS after urethroplasty for anterior USD and the relationship of these symptoms to USD recurrence has also been observed [93]. It was reported that men with a successful outcome after urethroplasty tend to remain asymptomatic, whereas those who recur have LUTS, typically with weak urinary flow but without dysuria and hematuria. The authors supported the need for a USD-specific validated questionnaire to be used for follow-up after urethroplasty.
\nAll men being evaluated for lower urinary tract symptoms (LUTS) should include urethral stricture in the differential diagnosis and include a combination of patient-reported symptom measures, uroflowmetry to assess severity of obstruction, and postvoid residual volume by ultrasound to determine degree of urinary retention. Patients with urethral stricture typically present a weak flow rate. However, evaluation of urethral stricture requires further specific testing to delineate the location, length of the stricture, and degree of narrowing such as urethroscopy and retrograde urethrogram with or without voiding cystourethrogram. LUTS are the usual clinical manifestation of urethral strictures, regardless of location, etiology, and severity. However, LUTS after urethral stricture repair are not uncommon. Urgency has been reported in 40% of men and urge incontinence in 12% of men after anterior urethroplasty. De novo urgency and urge incontinence is seen in 9 and 5% of men, respectively, after urethroplasty. Once a complication of urethroplasty (such as recurrent urethral stricture or diverticulum) has been excluded as a cause, evaluation of LUTS in such patients should focus on the differential diagnosis between bladder dysfunction (overactive bladder and underactive bladder) and other outlet obstructions (such as benign prostatic obstruction), dysfunctional voiding, or medical causes (such as nocturnal polyuria). Management of overactive bladder has different treatment options, which may include behavioral modification, physical therapy, anticholinergic, and/or beta-3 agonist medications. In more severe cases, intravesical onabotulinum toxin, sacral neuromodulation, or peripheral tibial nerve stimulation may be indicated. Definitive treatment for underactive bladder is limited in number and success. Although management of LUTS for patients after urethral stricture repair can usually proceed similarly as for patients without prior history of urethral reconstruction, special consideration and alterations in management need to be made when instrumenting the urethra, as the urethral lumen may be narrower in these patients.
\nRecently, an analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture (BNC) following transurethral resection of prostate (TURP) has been performed [94]. The authors have found that lower resection speed, intraoperative urethral mucosal rupture, and postoperative continuous infection were associated with a higher risk of urethral stricture, whereas more severe storage symptoms and smaller prostate volumes were associated with a higher risk of BNC after TURP.
\nPenile urethroplasty has evolved significantly over the last eight decades, since the first attempts at reconstruction using preputial tubes or a staged approach using penile skin [95]. An improved understanding of the pathophysiology of LS and a high complication rate following skin-based reconstructions favored a shift to the use of oral mucosal grafts, particularly in LS strictures. To date, very little advances have been achieved with conservative/pharmacological therapeutic options to stabilize or modulate the scarring process of this recalcitrant cutaneous disease.
\nCurrently, one of the critical limitations of penile urethroplasty is the common need for a staged reconstruction with all the inconveniences for the patient, and a 20–31% incidence of graft failure following the first stage, which leads to further revision(s) prior to the final tubularization [95]. Insufficient oral mucosal grafts for panurethral stricture reconstruction, especially in redo cases, add serious problems.
\nConsiderable research has been done in the areas of biomaterials, regenerative medicine, including scar modulation, and tissue engineering to overcome the limitations of current penile urethral stricture management. These experimental technologies appear exciting, revolutionary, and ripe with potential. The main goals of these research areas would be to produce scar inhibitors that might be placed into the stricture after urethrotomy, on the one hand, and to generate an ideal biomaterial in unlimited quantities, easily cultured in laboratory, readily available “off the shelf” and without the morbidity associated with graft harvesting, on the other hand. Unfortunately, we are not quite there yet.
\nThe surgical treatment of penile urethral stricture is continually evolving. No one technique is appropriate for all situations, and the successful reconstructive urologist needs to be comfortable with a repertoire of different, versatile techniques in order to best treat each individual patient’s problem. Since the early 1990s, OMG was introduced in urethral reconstructive surgery and has become the first choice of most urethral surgeons.
\nAlthough all are grouped as anterior urethral strictures, penile urethral strictures are different from bulbar urethral strictures. Flaps are still preferred to grafts in long, recurrent penile urethral strictures by some surgeons. Recently, one-stage dorsal OMG urethroplasty via perineal approach has been suggested for the management of most strictures of the penile shaft urethra with both good functional and remarkable cosmetic outcomes. However, in patients who have experienced failed hypospadias repair or in whom the penile skin and urethral plate are not suitable for urethroplasty, two-stage (usually multistage) urethroplasty is recommended. Management of some lengthy, complex strictures remains a great challenge even for experienced reconstructive surgeons. Staged urethroplasty, such as the Johanson’s technique with or without the use of grafts, is still a good surgical option. Regenerative medicine continues to show promise, but further investigation is needed to reach clinical application in the future. All in all, these great improvements in penile urethral surgical technique should lead to optimization of the surgical treatment algorithm.
\n"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges".
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",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
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The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. 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In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. He has also been appointed to review many scientific manuscripts by established journals such as the British Medical Journal (BMJ). He has presented his research works at numerous local and international conferences such as the European Association for Cardiothoracic Surgery (EACTS) and the European Society of Cardiovascular Surgery (ESCVS), to name a few. He has also won many awards for his research presentations at meetings and conferences like the prestigious International Invention, Innovation & Technology Exhibition (ITEX); Design, Research and Innovation Exhibition, the National Conference on Medical Sciences and the Annual Scientific Meetings of the Malaysian Association for Thoracic and Cardiovascular Surgery. He was awarded the Darjah Setia Pangkuan Negeri (DSPN) by the Governor of Penang in July, 2015.",institutionString:null,institution:{name:"Monash University Malaysia",country:{name:"Malaysia"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. He is currently working on the following subjects: Aluminium toxicity, Neuroinflammation, Oxidative stress and Purinergic system. Since 2011 he has presented more than 80 abstracts in scientific proceedings of national and international meetings. Since 2014, he has published more than 20 peer reviewed papers (including 4 reviews, 3 in Portuguese) and 2 book chapters. 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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"}}},subseries:[{id:"14",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",annualVolume:11411,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. Thus all studies on metabolism will be considered for publication.",annualVolume:11413,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",fullName:"Anca Pantea Stoian",profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"203824",title:"Dr.",name:"Attilio",middleName:null,surname:"Rigotti",fullName:"Attilio Rigotti",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"300470",title:"Dr.",name:"Yanfei (Jacob)",middleName:null,surname:"Qi",fullName:"Yanfei (Jacob) Qi",profilePictureURL:"https://mts.intechopen.com/storage/users/300470/images/system/300470.jpg",institutionString:null,institution:{name:"Centenary Institute of Cancer Medicine and Cell Biology",institutionURL:null,country:{name:"Australia"}}}]},{id:"18",title:"Proteomics",keywords:"Mono- and Two-Dimensional Gel Electrophoresis (1-and 2-DE), Liquid Chromatography (LC), Mass Spectrometry/Tandem Mass Spectrometry (MS; MS/MS), Proteins",scope:"With the recognition that the human genome cannot provide answers to the etiology of a disorder, changes in the proteins expressed by a genome became a focus in research. Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",annualVolume:11414,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null,editorialBoard:[{id:"72288",title:"Dr.",name:"Arli Aditya",middleName:null,surname:"Parikesit",fullName:"Arli Aditya Parikesit",profilePictureURL:"https://mts.intechopen.com/storage/users/72288/images/system/72288.jpg",institutionString:null,institution:{name:"Indonesia International Institute for Life Sciences",institutionURL:null,country:{name:"Indonesia"}}},{id:"40928",title:"Dr.",name:"Cesar",middleName:null,surname:"Lopez-Camarillo",fullName:"Cesar Lopez-Camarillo",profilePictureURL:"https://mts.intechopen.com/storage/users/40928/images/3884_n.png",institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}},{id:"81926",title:"Dr.",name:"Shymaa",middleName:null,surname:"Enany",fullName:"Shymaa Enany",profilePictureURL:"https://mts.intechopen.com/storage/users/81926/images/system/81926.png",institutionString:"Suez Canal University",institution:{name:"Suez Canal University",institutionURL:null,country:{name:"Egypt"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"chapter.detail",path:"/chapters/5341",hash:"",query:{},params:{id:"5341"},fullPath:"/chapters/5341",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()