\r\n\t
\r\n\tContamination with biomedical waste and its impact on the environment are global concerns. Biomedical waste that has not been collected and disposed in accordance with the regulations can become a total environmental hazard and cause negative impact on human health and the environment. Medical centers including hospitals, clinics, and places where diagnosis and treatment are conducted generate waste that is highly hazardous and put people under risk of fatal diseases. On the other hand, food waste is commonly produced in all the steps of food life cycle, such as during agricultural production, industrial manufacturing, processing and distribution, and is even consumer-generated within private households. Food waste mostly contains high-value components such as phytochemicals, proteins, flavor compounds, polysaccharides, and fibers, which can be reused as nutraceuticals and functional ingredients. Adsorption is a practicable separation method for purification, along with bulk separation where surface characteristics and pore structures are the main properties in determining equilibrium rate. Managing waste materials on the whole is often unsatisfactory, especially in developing countries, and the unreasonable disposal of waste is a major issue worldwide.
\r\n\tThe following issues will be of particular interest for this book: effects of waste on environment and health, biomedical waste - storage, management, treatment, and disposal, biomedical waste contamination, food waste, potential applications of low-cost sorbents in agricultural and food sectors, biosorbents and bioadsorbents, adsorption of modified agricultural and biological wastes (biosorption), compounds recovered from food waste, and agricultural and food waste-derived sorbents.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"fef68f549e98b68c60ae17bb2b3c64e4",bookSignature:"Dr. Parisa Ziarati",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9842.jpg",keywords:"Biomedical waste, Food waste, Classification, Hazardous waste, Sources, Treatment and disposal, Contamination, Bioaccumulation, Sorbents, Sorption, Biosorption, Food waste recovery",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"December 4th 2019",dateEndSecondStepPublish:"March 3rd 2020",dateEndThirdStepPublish:"May 2nd 2020",dateEndFourthStepPublish:"July 21st 2020",dateEndFifthStepPublish:"September 19th 2020",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 years",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"312371",title:"Dr.",name:"Parisa",middleName:null,surname:"Ziarati",slug:"parisa-ziarati",fullName:"Parisa Ziarati",profilePictureURL:"https://mts.intechopen.com/storage/users/312371/images/system/312371.jpg",biography:"Parisa Ziarati currently works at Nutrition and Food Sciences Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. She is a hardworking researcher since she has published 168 research articles in leading technical and scientific journals. She is the author of 3 books. She has delivered 138 lectures at national and international conferences on relevant subjects, primarily environmental chemistry. She has also supervised 118 master’s theses and mediated 108 theses as an advisor. She has also published several papers on new findings in phytoremediation, a topic of current and original research attracting commercial interest. Moreover, she has worked exhaustively on turning low-cost waste products (food, agricultural, forestry, industrial, and mine waste) into valuable resources for water / wastewater remediation and pollution prevention. It is notable that remediation of soils contaminated with heavy metals and organics, detoxification and removal of heavy metals from foods, including rice and vegetables by adsorbents / bio adsorbents is her current research passion.",institutionString:"Nutrition and Food Sciences Research Center",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"12",title:"Environmental Sciences",slug:"environmental-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"297737",firstName:"Mateo",lastName:"Pulko",middleName:null,title:"Mr.",imageUrl:"https://mts.intechopen.com/storage/users/297737/images/8492_n.png",email:"mateo.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"117",title:"Artificial Neural Networks",subtitle:"Methodological Advances and Biomedical Applications",isOpenForSubmission:!1,hash:null,slug:"artificial-neural-networks-methodological-advances-and-biomedical-applications",bookSignature:"Kenji Suzuki",coverURL:"https://cdn.intechopen.com/books/images_new/117.jpg",editedByType:"Edited by",editors:[{id:"3095",title:"Prof.",name:"Kenji",surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3828",title:"Application of Nanotechnology in Drug Delivery",subtitle:null,isOpenForSubmission:!1,hash:"51a27e7adbfafcfedb6e9683f209cba4",slug:"application-of-nanotechnology-in-drug-delivery",bookSignature:"Ali Demir Sezer",coverURL:"https://cdn.intechopen.com/books/images_new/3828.jpg",editedByType:"Edited by",editors:[{id:"62389",title:"PhD.",name:"Ali Demir",surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"872",title:"Organic Pollutants Ten Years After the Stockholm Convention",subtitle:"Environmental and Analytical Update",isOpenForSubmission:!1,hash:"f01dc7077e1d23f3d8f5454985cafa0a",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",bookSignature:"Tomasz Puzyn and Aleksandra Mostrag-Szlichtyng",coverURL:"https://cdn.intechopen.com/books/images_new/872.jpg",editedByType:"Edited by",editors:[{id:"84887",title:"Dr.",name:"Tomasz",surname:"Puzyn",slug:"tomasz-puzyn",fullName:"Tomasz Puzyn"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3569",title:"Biodegradation",subtitle:"Life of Science",isOpenForSubmission:!1,hash:"bb737eb528a53e5106c7e218d5f12ec6",slug:"biodegradation-life-of-science",bookSignature:"Rolando Chamy and Francisca Rosenkranz",coverURL:"https://cdn.intechopen.com/books/images_new/3569.jpg",editedByType:"Edited by",editors:[{id:"165784",title:"Dr.",name:"Rolando",surname:"Chamy",slug:"rolando-chamy",fullName:"Rolando Chamy"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"78891",title:"Role of LncRNA in Rheumatoid Arthritis",doi:"10.5772/intechopen.99525",slug:"role-of-lncrna-in-rheumatoid-arthritis",body:'Rheumatoid arthritis (RA) is a chronic and systemic autoimmune disease. It is associated with progressive joint destruction complications and decreased life expectancy [1]. RA’s main clinical features are typically symmetrical polyarthritis with swelling, redness, and pain in the distal joint, particularly the small joints of the hands and feet [2]. Advances in understanding the pathogenesis of the disease, RA treatment greatly improved with an emphasis in the early stage. To our best knowledge, lots of laboratory tests used for RA generally include rheumatoid factor (RF), c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and anti-cyclic peptide containing citrulline (anti-CCP) antibodies [3]. Nevertheless, RA pathogenesis is still unclear, but it is most likely related to the physiological structure of the joint and anatomy [4].
Long non-coding RNAs’ (lncRNAs) lengths are greater than >200 nucleotides, which are subclassified into five categories that include the natural antisense lncRNAs according to their positions relative to protein-coding genes, long intergenic ncRNAs (lincRNAs), intronic lncRNAs, bidirectional lncRNAs, sense-overlapping lncRNAs [5, 6]. Referring to the GENCODE database (version 31), 17,904 lncRNA genes were identified in the human genome. lncRNAs play a role as critical regulators of cellular processes and disease stage or progression. lncRNAs have been studied in cancer [7, 8], innate and adaptive immunity [9], and inflammation [10]. Recently, studies of the role of lncRNA in RA pathogenesis are increased. Sequencing or microarray analyses revealed the expression profiles of lncRNAs in RA. The lncRNA expression profile in RA is different in various immune cell types such as B cells, natural killer (NK) cells, and T cells, indicating immune cell-type specificity of lncRNA expression. Identification of aberrantly expressed lncRNAs in RA and investigation of the underlying molecular mechanisms.
Emerging evidence suggests that lncRNAs are involved in the development of RA. Although numerous aberrant-expressing lncRNAs (HOTAIR, MALAT1, GAPLINC, PVT-1, LERFS, GAS5, DILC, NEAT-1, Lnc-p21, THRIL, RMRP, NTT, MEG3, Lnc-IL7R, ZFAS1, UCA1, C5T1LncRNA) have been reported in RA [11, 12], only a few of them are functionally determined. In this chapter, we summarize here the current findings of lncRNAs that may be involved in the pathogenesis of RA, aiming to encourage future research on this topic.
LncRNAs play epigenetic regulation, cell cycle regulation, and cell differentiation and genetic roles [13] such as physiological and pathological and regulator process; also, lncRNAs are Central regulators of the immune response, but they are poorly conserved in species [14]. LncRNAs regulate the coding genes directly various molecular mechanisms [15]. LncRNAs expressed differentially and effects on immune cells in autoimmune diseases. The regulatory mechanism of lncRNAs is complex and needs to be investigated by more functional and mechanistic experiments. A group of lncRNAs is associated with clinical indicators such as CRP, ESR, serum proinflammatory cytokines, and DAS28, suggesting that lncRNAs may serve as biomarkers to monitor RA activity.
In RA patients, the expression of HOX transcript antisense RNA (HOTAIR), HOTAIR is decreased in fibroblast-like synoviocytes (FLSs), also HOTAIR suppresses the activation of MMP-2 and MMP-13. lncRNA HOTAIR, miR-138, and NF-kB axis have also been established in chondrocytes in RA, LncRNA HOTAIR may target miR-138 and inhibit the activation of NF-kB pathway [16], and the expression of HOTAIR increases in peripheral blood mononuclear cell and blood exosomes using lncRNA array analysis [17].
In RA FLSs, MALAT1 plays a role regulation of cell proliferation and inflammation [18]. MALAT1 binds to the beta-catenin promoter in the WNT signaling pathway [19]. One group study suggests that MALAT1 plays a role in apoptosis proteins [19]. MALAT1 silencing suppressed Bax, and Bcl-2, caspase-3, caspase-9 in RA FLSs [19].
LncRNA long intergenic non-coding RNA (GAPLINC) may play act as a molecular sponge of miR-382-5p and miR-575. There is a negative correlation observed between the expression of GAPLINC and the miRNAs [20]. Also, GAPLINC may be a new therapeutic target for RA [21].
Knockdown of plasmacytoma variant translocation 1 (PVT-1) in RA’s FLSs suppresses the TNF-α and IL-1β pro-inflammatory cytokines [22]. In the same study, PVT1 regulates inflammation and apoptosis in RA-FLSs through the Sirt6 demethylation. Furthermore, PVT-1 increase at synovial tissue of RA patients and RA model and PVT-1 bound to miR-543 positively regulated the expression of signal peptide-CUB-EGF-like containing protein 2 (SCUBE2) by inhibiting the miR-543, guide to FLSs inhibition of apoptosis and IL-1β secretion. Inhibition of PVT1 may be a new idea for the treatment of RA [23].
Lowly expressed in rheumatoid fibroblast-like synoviocytes (lncRNA LERFS) negatively regulated the invasion, proliferation, and migration of joint synovium by interacting with heterogeneous nuclear ribonucleoprotein Q (hnRNP Q) but in RA FLSs, LERFS is low expressed in RA FLSs and the reduced LERFS led to the reduction of LERFS-hnRNP Q complex [24]. In this study, LERFS regulates the expression and activity of CDC42, Rac1, RhoA and, probably by binding to the hnRNP Q complex.
In RA FLSs, LncRNA growth arrest-specific transcript 5 (GAS5) overexpression organizes cell apoptosis by activating cleaved caspase-9 and caspase-3 and inhibits PI3K/AKT signaling pathway [25, 26]. Also, GAS5 plays a role in the inflammatory response in RA. In synovial tissue and FLSs, GAS5 expression is decreased and expression of homeodomain-interacting protein kinase 2 (HIPK2) increases significantly and GAS5 reduced the level of TNF-α and IL-6 [27]. Also, overexpression of LncRNA GAS5 affects IL-18 levels, and IL-18 is downregulated by LncRNA GAS5 [28].
DILC of plasma RA patients was downregulated, while IL-6 was upregulated and DILC level is negatively correlated with RA. DILC overexpression promoted the inhibition of IL-6 expression and FLSs apoptosis and in RA [29].
NEAT-1 is significantly upregulated in th17 cells differentiated CD44 cells from RA patients. Also, upregulation of NEAT-1 plays a role differentiation of CD4+ T cells into Th17 cells by regulating its downstream molecule STAT3 [30].
In RA, Lnc-p21 expression is so low and can be renovated by the methotrexate treatment [31]. This LncRNA-p21 suppresses inflammation and is downregulated [31].
According to the information obtained from RA, THRIL is on the upward path [32]. This LncRNA may use as a biomarker for RA. THRIL expression in the blood of RA patients was positively correlated with TNF-α and erythrocyte sedimentation rate. THRIL inhibition is reversed the regulatory effect of TNF-α, and significantly reduced the activity of p-AKT and phosphoinositide 3-kinase (PI3K) signaling pathways. Also, expression of THRIL may promote the activating of the PI3K/AKT signaling pathway, and this leads to the result of inflammation and proliferation of FLSs [33, 34].
LncRNA RMRP expression is high in T cells from patients with RA [32]. Also, LncRNA RMRP has a positive correlation with RA progression [35]. This LncRNA may be a biomarker for RA.
NTT expression is increased in a peripheral blood mononuclear cell (PBMC) from early patients with RA [36]. In the same study, the researchers found that in RA, lncRNA NTT/PBOV1 is capable of regulating monocyte differentiation.
The level of LncRNA maternally expressed gene 3 (MEG3) is significantly downregulated in FLSs of patients with RA [37]. Also, this study suggests that in lipopolysaccharide (LPS)-treated chondrocytes LncRNA MEG is downregulated. Overexpression of LncRNA MEG3 has an inhibitory effect on RA pathology can be achieved by increasing the rate of chondrocyte proliferation through negative regulation of miR-141 and AKT/mTOR signaling pathway [38, 39, 40]. In RA patients, low MEG3 expression correlated negatively with serum level of HIF-1α and vascular endothelial growth factor A (VEGF) and positively correlated with BAX. MEG3 gene rs941576(A/G) polymorphism has been confirmed to be associated with increased RA severity in the population [41]. We can say that LncRNA MEG3 promotes proliferation and it has an inhibitory effect.
LncRNA long noncoding-interleukin-7 receptor (Lnc-IL7R) inhibits apoptosis and leads to proliferation [42]. Also, Lnc-IL7R interacts with the enhancer of zeste homolog 2 (EZH2) to assist the FLSs’ growth and it is necessary for PRC2-mediated inhibition of the cyclin-dependent kinase inhibitors 1A and 2A [42].
Ye et al. found that LncRNA ZFAS1 has abnormal activity in RA FLSs. Also, the knockout of LncRNA ZFAS1 suppresses the migration and invasion of FLSs and it takes miR-27 s as a target and increased the expression of miR-27a [43].
As with other pathological and chronic diseases, RA affects patients’ life and status. Many pieces of evidence have confirmed the role of lncRNAs in the pathogenesis of RA [47]. Luo et al. found 5.045 irregular lncRNAs in PBMCs (2.635 downregulated and 2.410 upregulated) of RA patients compared to controls [48], 135 potential lncRNA-mRNA target pairs and RP11-498C9.15 targeted RA-related genes and pathways. Lots of LncRNAs such as PVT-1, MEG3, HOTAIR suggest that LncRNAs may serve as novel biomarkers to monitor RA pathogenesis.
LncRNAs are of great importance in gene regulation and various RA biological processes. Expression profiles of lncRNAs vary in PBMCs, serum exosomes, osteoclasts, FLS, synovial tissues, plasma, synovium in RA. Some of these are differentially expressed, and LncRNAs are related to RA activity.
Emerging evidence shows us that lncRNAs are important regulators in RA. Continuing to explore the functions of lncRNAs in RA, their aberrant expression profile, and determining their role and mode of action will help us understand the underlying causes of the disease. Also, the identified lncRNAs related to the pathogenesis of RA may be potential diagnostic markers or target molecules that regulate RA progression. In the future, LncRNA-based therapeutic tools will likely lead to treatment insights into RA.
In the past years, the incidence of psychiatric disorders increased. Meanwhile, the majority of absence from work due to illness is attributable to psychiatric disorders. This not only impairs the affected individual but also puts a strong financial pressure on health systems [1]. Commonly, psychiatric disorders are described, classified and treated based on phenotypic symptoms. However, the success of this approach is limited since our understanding of the mechanisms leading to psychiatric pathology is far from complete and explanations to all facets of the disease remain to be discovered [2]. A first starting point to better elucidate the etiology of psychiatric disorders and to offer new treatment options is to better understand the impact of life events on physiology. These environmental influences are known to proceed onset of pathology, and together with some level of genetic susceptibility can alter brain function and overall physiology. Chronic stress is one such environmental factor and is considered a common trigger of psychiatric disorders [3]. Thus, an improved understanding of the phenomenon of stress and its consequences on physiology will support the discovery of novel treatment options or even preventive strategies. At its core, the chronic or acute inability of an individual to cope with any demand produces stress. This generic definition of stress as a response to unmet requirements proposed by Hans Selye introduces the need of responding to an adverse situation to resolve the stress exerted on the affected individual. The triggers of stress can be internal or external in nature. All non-specific reactions of the body to allow coping with challenges can be summarized under the umbrella term ‘stress response’. First, an instantaneous ‘fight or flight’ reaction mediated by beta-adrenergic signaling introduces a shift from anabolic and restorative processes towards catabolic and energy consuming processes. Secondly, effects of hypothalamic–pituitary–adrenal axis (HPA-axis, used abbreviations are listed in 8) activation come into play to support this potential increase in energy expenditure and coordinate longer-termed stress responses. Glucocorticoids (GCs) are the messengers of this phase of stress response. They are secreted from the adrenal glands to fulfill their eponymous actions on blood glucose levels. In addition, glucocorticoid effects involve the mobilization of fatty acids and amino acids, maintenance of a sufficient blood flow to distribute nutrients and oxygen, the induction of functional changes in mitochondrial dynamics, alertness of the immune system and processing of cues in the central nervous system (CNS). In sum, these actions guarantee the necessary supply of vital tissues with adenosine-tri-phosphate (ATP) to fuel the stress response and to ultimately promote survival. After resolving the stressful situation, the HPA-axis is turned down via a negative feedback loop. Furthermore, alterations in metabolism are reverted and restoration of the emptied energy depots, healing of wounds, and mental processing of the experienced situation takes place. The body returns back to homeostasis, a term coined by Walter Bradford Cannon that translates to ‘stability through constancy’. However, if certain stressors occur repeatedly, a change to these default settings might be more cost-efficient. Such a training effect can result in permanent adaptation. This process is termed allostasis, from the greek ‘stability through change’. Both, the high flexibility to cope with several stressors and the ability to adapt to them were of evolutionary advantage, since less fit individuals were eliminated. Thus, an efficient and tight networking of systems required for homostasis and allostasis evolved, of which the psycho-immune-neuro-energy (PINE) network is part of.
Signaling of the HPA-axis mutually effects the metabolism, CNS, autonomous nervous system and the immune system. This is implemented by pleiotropic actions of glucocorticoids via multiple modes of actions, including non-genomic and genomic components allowing them to exert power on manifold processes. As an example for non-genomic mode of action, intercalation of GCs with plasma and mitochondrial membranes and interaction with membrane-associated receptors has been described, which enables fast-forward reactions [4]. Furthermore, GCs can trigger other non-genomic effects via their target receptors, the mineralocorticoid receptor (MR) and glucocorticoid receptor (GR) since these can interfere with cytoplasmic signaling complexes. In the medium-term, the genomic effects of glucocorticoids come into play, which are mediated by both nuclear receptors. Upon ligand binding, they translocate into the nucleus to interact with other transcription factors for example at glucocorticoid response elements (GRE) in the DNA to transactivate or transrepress a multitude of targets (reviewed in [5]. While GR and MR are ubiquitously expressed, the actual response to GCs varies widely [6].
In light of the high number of genes that is directly or indirectly affected by GR-mediated signaling, this illustrates that a tight regulation of GC signaling is present. At cellular level, this regulation is partly implemented via receptor maturation and turn over. In the cytoplasm, the functioning of the GR is modulated by a molecular hetero-complex that comprises heat shock proteins (HSP), protein phosphatases and a number of co-chaperones. The immunophilin FK506-binding protein 51 FKBP51, encoded by the FKBP5 gene, is one of them. This co-chaperone functionally inhibits glucocorticoid signaling by interfering with the maturation of the glucocorticoid receptor complex. If the GR-HSP90 complex is bound to FKBP51, the GR is in a low affinity state [7]. With these altered dissociation kinetics, more ligand, more GRs or a longer time is needed in order to elicit the same amount of nuclear translocations of the GR as in the presence of fewer FKBP51 molecules. Thus, the abundance of GR and FKBP51 influences the cellular responsivity to GCs and is part of the cellular identity [8]. In the CNS, astrocytes and microglia express the GR at comparable levels, but more than neurons. Astrocytes were found to express lower levels of FKBP5 than microglia and neurons, which upon GC-stimulation resulted in a stronger responsiveness of astrocytes, followed by microglia and neurons (Figures 1–3 modified from [8]). This indicates that abundance of GR relative to FKBP51 imparts a cell-type specific fine tuning of the GC response magnitude at a given time. In addition, this ratio is modulated by recent fluctuations in GC exposure. These modulations are essential for proper functioning [9, 10].
Cells were cultured and RNA analyses were performed as described in
Mechanistic overview of the interaction between Fkbp5 expression and GC abundancy on GC-induced gene transcription.
The exposure of cells to GCs relies on the activity of the HPA-axis. Once triggered, neurosecretory nerve terminals within the hypothalamic paraventricular nucleus are activated to release corticotropin-releasing hormone (CRH) into the portal system of the anterior pituitary, where in response, adreno-cortico-tropic hormone (ACTH) is secreted, transported across the blood–brain-barrier into the peripheral circulation and in the adrenal glands to stimulate the secretion of glucocorticoids into the blood. Over the course of the day, the levels of glucocorticoids undergo substantial fluctuations. While in man cortisol levels peak in the morning, in nocturnal animals like laboratory rodents nadir levels are observed in the morning. Chronic exposure to stress triggers changes in the pattern of this diurnal rhythmicity i.e. shifts in the timing of the peak (Figure 4 modified from [11]). Besides the diurnal pattern, ultradian rhythms influence the actual plasma levels [12].
These oscillations are enabled via feedback loops between components of the HPA-axis and inside each cell. The feedback occurs at different kinetics and thus introduces phase shifts. Such delays are based on differential glucocorticoid affinity and expression of MR compared to GR, episodic transcription of the rate-limiting enzymes necessary for steroidogenesis, as well as offsets between secretion and distribution of glucocorticoids. In addition, an ultra-short negative feedback loop within each cell is present, since GCs induce the transcription of their functional inhibitor FKBP5 and have the potential to shut down their own signaling [13]. Thus, FKBP5 levels can regulate cellular GC-responsiveness temporally dependent on previous fluctuations in glucocorticoid levels. This generates an additional degree of freedom and flexibility in the stress response system. Interestingly, dynamic changes of GCs are known to be required for normal emotional and cognitive reactions [10, 14]. In humans, several single-nucleotide polymorphisms (SNPs) have been described, which are associated with differential induction of FKBP5 upon glucocorticoid stimulation and thus contribute to the variability of stress perception and coping in the population [15].This illustrates that appropriate negative feedback is required to allow for diurnal and ultradian oscillations of GCs, and that attenuation of the latter goes hand in hand with altered HPA-axis responsiveness and stress coping, which ultimately can impact health. Together, the 24 hours cycle and the ultradian oscillations of GC levels are known to have strong influence on functioning of the body. For reference, the interplay of dynamic GC levels with the PINE network is described in the following sections.
After their release from the adrenal glands, glucocorticoids are distributed throughout the body via the blood, which is not only the medium for information transportation, but also a home base of the immune system. The reactions of the immune system to glucocorticoids are known to be time-, condition- and dose-dependent. This results in several phases. As part of the fight or flight response, catecholamines are immediately released via the sympathetic-adrenal-medullary system and trigger the mobilization of monocytes from the bone marrow as a consequence of stress [16]. Glucocorticoids and catecholamines then act together in this preparatory phase with an increased perfusion of peripheral tissues ensuring the energy supply of peripheral tissues for the fight or flight response but also the distribution of the mobilized monocytes. In the event of wounding, blood can flush out pathogens and contribute to an initial sealing of the wound. During the acute phase of stress and high glucocorticoid exposure, the immune system itself is suppressed to reduce inflammation-associated swelling of tissue. Furthermore the liberated energy can be allocated for fighting the current situation rather than pathogens. In the clinic, these immunosuppressive effects of GC are widely exploited in the treatment of inflammatory diseases and autoimmune disorders. On a molecular level, this can be explained by the GC-mediated inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells (NF
The brain is a highly adaptive organ and retains the ability to change throughout life via a process termed (neuro-)plasticity. In response to experiences and learning, plasticity involves the weakening or strengthening of synapses on a cellular level and circuits between brain areas on an anatomical level. Given the individuality of experiences, this results in unique wiring of the brain and could explain why stress has a different meaning for different people under different conditions. During childhood and adolescence the brain is still maturing and undergoes changes that require even more plasticity. During these developmental phases, the processing of inputs is less deterministic than in adults, which on one side enables flexible learning but on the other side puts young individuals at risk to adopt adverse stress coping and emotional processing approaches that ultimately render them more vulnerable to develop psychiatric symptoms [20]. Indeed, stress and trauma have been reported to severely damage the developing brain [21]. Comparisons of normally developed brain functionality, brains from individuals that suffered from early life adversity such as abuse or neglect, or brains of psychiatric patients revealed that a defined set of brain areas is most commonly affected by stress, namely the hippocampus, amygdala, and prefrontal cortex (PFC). These brain regions are strongly connected and their networking determines what is perceived as threat and how individuals cope with stress and adversity. Protective factors associated with adequate coping include the ability to stay optimistic, a controlled regulation of emotions, high levels of attention set shifting to focus on different aspects of the current situation, the capacity to reflect on experiences and own reactions and higher cognitive abilities required for executive functions. All of these functions are biologically linked within the network comprising the hippocampus, amygdala, and PFC. Upon perception, the medial PFC filters and processes sensory inputs to initiate thoughts and actions in accordance with internal goals, based on previously learned behaviors retrieved from the hippocampus. To orchestrate defensive physiological and behavioral responses, the PFC is connected to the amygdala, the emotion regulation area of the brain, which in turn contributes to sympathetic and HPA-axis activation and intensifies long-term memory consolidation of adverse emotional events in the hippocampus. By dampening emotions produced in the amygdala, the PFC supports maintenance of cognitive flexibility in challenging situations. This indirectly influences learning processes in the hippocampus, but the PFC can also directly dampen hippocampal signaling and thus modulate memory formation. In the context of memory formation, an inverted U-shaped association of glucocorticoid levels and plasticity has been observed. Since the modulation of cellular activity via glucocorticoids was reported to be brain region-dependent, this could indicate that differential expression of GC-responsive receptors play a role in this biphasic pattern [9]. Indeed, activation of GRs in the presence of high glucocorticoid concentrations were reported to impair long-term potentiation (LTP) by high-frequency stimulation and enhanced long-term depression. While low levels of GCs selectively activate MR signaling, which increases LTP via
Mitochondria are the main providers of energy, namely ATP. Besides glycolysis and fatty acid oxidation, the majority of ATP is produced during oxidative phosphorylation. The motor for the production of ATP is an inward rectifying proton gradient across the inner mitochondrial membrane. In the process of generating this gradient, a series of redox-reactions occurs at complex I to V of the electron transport chain (ETC), which consumes oxygen and substrates generated in the tri-carboxic acid cycle [24]. According to the endosymbiont theory, mitochondria are remnants of bacteria which were incorporated as cell organelles into eukaryotic cells. As such, mitochondria still harbor 37 genes on their own mitochondrial DNA (mtDNA), while genes encoding other mitochondrial components were transferred to the nuclear DNA. Glucocorticoids hence can not only influence mitochondria by intercalating into their membranes or by regulating the expression of nuclear genes relevant for mitochondrial function, but also directly interfere with mtDNA in a time and dose-dependent manner [25]. These interactions guarantee a sufficient energy supply during stress. In a chronic mild stress study carried out in Wistar Kyoto rats, an adaptive activation of the ETC and higher respirometric performance was observed (Figures 5–7, modified from [11]). However, increased activity of the ETC leads to the production of reactive oxygen species (ROS). Complex I activity is associated with more production of ROS than complex II [26]. In a defined manner, ROS serve as important signaling molecules [27] and are essential for the oxidative burst observed in granulocytes to fight microbial infections. In higher doses, ROS can outbalance anti-oxidative defense system which results in oxidative stress [28]. In that event, proteins, lipids and DNA becomes damaged and lose functionality. Based on their microscopic structure and cellular location, mitochondria are especially vulnerable to oxidative stress [29]. In the long run, chronically elevated mitochondrial activity can thus result in a decompensation of the energy providing system. A shift away from ETC complex I towards complex II, as seen in the above cited chronic mild stress study, might be a possibility to reduce ROS overload and to evade the risk of oxidative stress. In addition to their bioenergetic role, mitochondria are involved in regulation of apoptosis and calcium homeostasis which were shown to be modulated by GC signaling [30, 31]. This contributes to their key role in regulating synaptic transmission, brain function, and cognition [32]. Taken together, mitochondria are an interesting platform for further communication of GC signaling [33]. Notably, the communication from the HPA-axis to mitochondria is not unilateral, because mitochondria are the site of glucocorticoid production. As such, they express stress-inducible translocator proteins (TSPOs) that modulate oxidative stress and transport cholesterol from the outer to the inner mitochondrial membrane [34]. In addition, mitochondria harbor enzymes required for the cleavage of nutrition-derived cholesterol into precursors of GCs as well as enzymes involved in the conversion of the inactive 11-deoxycortisol or deoxicorticosterone to the bio active cortisol and corticosterone. Thus, mitochondria regulate GC availability and are an additional set screw in the complex feedback structure of GC signaling and the stress response system.
Schematic of the mitochondrial electron transport chain (ETC) and the sites of action of the inhibitors and uncouplers used to study respirometric performance.
Animal housing and stress protocols are described in
Animal housing and stress protocols are described in
Given the importance of the PINE network for stress responses and health, additional ways of communication between its components in addition to GC signaling evolved. The brain is a central hub for the orchestration of stress responses. At the same time it is anatomically rather isolated from the rest of the body and thus contains highly specialized cells that generate functional output and cells that support, shape and surveil the activity in that micro model of the body. The following sections issue in more detail how these tasks are shared in the central nervous system and how chronic stress modulates this.
In the brain, full blown immune reactions including sudden tissue loss would be deleterious for the fine-tuned neuronal circuits and networks. Therefore, the brain is especially protected from wounding via the skull and a tight interface of astrocytes, pericytes and endothelial cells, termed blood brain barrier, limits the access of blood-born immune responses to the brain. As replacement for the peripheral immune cells, the brain harbors specialized tissue-resident immune competent cells, the microglia. These belong to the monocyto-phagocyting-system like macrophages and are of mesenchymal origin. Besides their phagocytic properties to clear debris, microglia contribute to the pruning of synapses during development and learning. In addition, microglia have a ramified shape in the resting state and monitor the brain parenchyma for pathogen associated molecular patterns or danger associated molecular patterns. Upon detection of such patterns, microglia become activated and change towards a more amoeboid shape that allows for increased mobility. In parallel, different receptors like the cannabinoid receptor 2 or toll-like receptors become expressed on their surface to guide microglia via chemotactic signaling to the site where the activating signal originated from. Once activated, microglia proliferate and produce inflammatory cytokines like interleukin 1
Astrocytes are an essential component of the blood brain barrier and thus play a crucial role in the protection of the CNS from peripheral cues. In addition, astrocytes regulate the flow of nutrients. This enables astrocytes to metabolically support neurons [35]. For example, astrocytes are involved in the glutamate-glutamine cycle and catabolize glucose via the tri-carboxic acid cycle, which generates lactate that is shuttled to neurons to allow them to directly perform oxidative phosphorylation. While glycolysis produces only 2 ATP molecules from one molecule glucose, oxidative phosphorylation is more efficient and produces between 30 and 36 ATP molecules, dependent on proton leakage across the mitochondrial membrane [36]. In the presence of GCs, this alternative energy source for neurons becomes especially relevant, since GCs reduce the cellular uptake of glucose and glutamate [37]. Enhanced clearance of the synaptic cleft from glutamate by astrocytes could therefore be another way to safe-guard neurons from short-comings in energy. Besides their supportive role in terms of metabolism, astrocytes were shown to influence information processing and cognition by integrating local sensory information and behavioral state [38, 39]. In response to glucocorticoids, astrocytes were reported to directly influence (emotional) learning by regulating neurogenesis and structurally reorganizing neuronal networks [40]. This is possibly due to their role in stabilizing synapses and their responsibility for the rapid clearance of the synaptic cleft. As an example, astrocytes express excitatory amino acid transporters (EAAT1–5) to remove glutamate from the synapse and furthermore recycle it for further use in neurons [41]. Astrocytes hence play an important role in shaping plasticity in response to emotional stress and set the stage for future stressful encounters [42]. In addition, glia cells can regulate neurotransmission by generating neuroactive substances. The kynurenine pathway is one example where balancing of astrocytes and microglia activity is required for adequate modulation of neuronal communication.
The clear distribution of roles between neurons, microglia and astrocytes requires several sites of interaction in order to balance the different activities in the CNS. An example of these interaction points is the kynurenine pathway. The essential amino acid tryptophan is mainly catabolized via this pathway, while only a minor amount (
Overview of trypotophan catabolism by enzymes of the kynurenine pathway in the CNS.
Animal housing and stress protocols are described in
Animal housing and stress protocols are described in
Animal housing and stress protocols are described in
The strong inter-connectedness of psychology, immunology, neurology and energy metabolism in the PINE network is very cost and time effective (Figure 12, modified from [11]). While the secretion of glucocorticoids as universal messengers in this system is seemingly unspecific, their pleiotropic effects on physiology are well regulated. The fine-tuning is implemented by complex combinations of ultradian GC levels at the event of challenge, the medium-term history of diurnal GC rhythmicity influencing enzyme and receptor expression levels, and the long-term evolved adaptations of PINE component connectivity incorporating the lifetime history of (stress) challenges. In acute stressful situations that decide over life and death, quick and pronounced stress responses are beneficial. However, sola dosis facit venenum and too frequent or much stress can be detrimental for health. The presence of a certain level of GC resistance is a common symptom of stress-associated medical conditions [49]. Resistance of PINE network components to their universal messenger would impede their effective communication. It is thus not surprising that GC resistance in the diseased state is featured with dysregulated immune processes, metabolism and cognition. Regarding the immune system, altered inflammatory signaling has been observed together with glucocorticoid resistance. Respiratory diseases, cardiac disorders, arthritis and inflammatory bowel disease all share a systemic low-grade inflammation associated with chronic stress exposure and altered GC signaling [50]. This chronic low-grade immune activation is not only discussed as feature of somatic disorders, but is as well studied as part of the pathophysiology of depression [51], which itself is a common comorbidity in the aforementioned disorders.
Networking of the psycho-immune-neuro-energy system to balance allostatic load in response to stress.
A further entry point for stress to alter the immune system functioning is via energy allocation. The role of bioenergetics has been shown for several aspects of immune system functioning and discussed in the context of therapeutic interventions [52]. Metabolism is not only influencing the activation and proliferation of immune cells [53] but mitochondria are also important for the inflammatory response [54] and regulation of the innate immunity via sensing of danger associated molecular patterns, the inflammasome and ROS-mediated oxidative signaling [55]. Limited mitochondrial capacities to respond to GCs would thus impede immune system regulation. In line with this mechanism, decreased mitochondrial functioning and evidence of slowed metabolism has been observed in patients with disorders where sterile, low-grade inflammation is a commonly observed symptom [56, 57]. Oxidative stress and the associated accelerated biological aging through damage is a likely cause for impaired mitochondrial functioning [29, 58]. Already in the prodromal phase of chronic stress exposure, strong cortisol responses to acute stressors were associated with oxidative stress, suggesting that stress exposure promotes oxidative damage through frequent and sustained activation of the HPA-axis [59]. Interestingly, the excitatory neurotransmitter glutamate was shown to contribute to increased mitochondrial ROS production via a TSPO- and calcium-dependent mechanism, which adds to its excitotoxic potential [34]. In depressed patients, the loss of glial and neuronal cells in the PFC, amygdala and hippocampus has been observed [60, 61, 62]. Rumination of adverse thoughts in depression and strengthening of the fear-network in post-traumatic stress disorder could reflect enhanced memory recall based on increased hippocampal activity, which could explain the loss of cell density in later stages of the disease. Notably, timing and brain region seem to distinguish whether neuronal activity is beneficial or adverse. Increased hippocampal activity has been associated with stress and pathology, presumably given its sensitivity to compromised energy metabolism that might occur in the aftermath of chronic stress [63]. In contrast, synaptic weakening in the PFC has been associated with resilience to stress, which might be due to increased flexibility in the responsiveness to stress when response patterns are less fixed [48]. However, too few inhibitory outputs of the PFC to the hippocampus may lead to excess hippocampal activity and the resulting over-encoding of stress memory. Finding the right balance of excitatory and inhibitory signaling thus is essential for adequate stress responses and health. In psychiatric patients, this balance was reported to be disturbed [64]. Importantly, ‘balance’ does not mean a stable level, since the body needs to be able to respond to changes in its environment. As such, the system is never in balance during life but the ratio of excitation and inhibition oscillates following a diurnal rhythm alike glucocorticoids [65]. The need for rhythmicity in excitation and inhibition as well as GC levels is directly linked to the need of flexibility in the stress response system. Resiliency to stress is associated with a highly variable, adaptive capacity. This high degree of freedom in responsivity is key to evolutionary success in terms of fitting to constantly changing environments. Given that the specificity of glucocorticoid signaling is gained by its time and dose-dependency, attenuation in glucocorticoid rhythmicity in response to allostatic load would limit the fine-tuning of PINE network components. Decreased sensitivity or even resistance to GCs would limit their effective communication further. Likewise, the likelihood for persistency of taken adjustments would increase while the adaptive capacity of the PINE network would be reduced. This illustrates the clinical relevance of GC rhythmicity besides the role in sleep–wake regulation, plasticity or in the context of neurodegenerative disorders. Thus, monitoring the HPA-axis to effectively identify and treat many stress-related chronic illnesses begins to be part of the prevalent practice in the clinics. To fully access functionality, tracing of circadian rhythmicity and the cortisol-awakening response in addition to determination of the responsiveness of the HPA-axis is performed. The latter can be done using the Trier-Social-Stress-Test as challenge or by injecting dexamethasone, a synthetic glucocorticoid, to measure its suppressive effects on the HPA-axis. Patients with psychiatric disorders often show prolonged stress responses after challenge and less inhibition of ACTH and cortisol release when compared to healthy controls [66].
Taken together, altered GC signaling is a fundamental symptom in psychiatry that via its communicator role in the PINE network could explain certain other aspects of the diseased state like a pro-inflammatory milieu, compromised energy metabolism or changes in cognition. Whether the transition to disorder originates from this or the other components of the PINE network remains to be further elucidated. Presumably, disease development can not be explained by answering this linear hen-egg-problem but rather requires the joint integration of simultaneous alterations in all components. Therefore, no sequence of events that lead to disorder might be found, but rather patterns of local transitions [67]. These might differ from individual to individual based on the personal life experiences, genetic predisposition, and the surrounding environment. Moreover, the comorbidity of psychiatric and somatic disorders following chronic stress might suggests that maladaptive changes in the PINE network represent a shared prodromal stage in the etiology of these medical conditions. Our understanding of the mechanisms leading to pathology is far from complete and explanations to all facets of the disease remain to be discovered by holistic studies that consider the networking of psychology, immunology, neurology and energy metabolism.
The authors wish to thank their colleagues at Boehringer Ingelheim Pharma GmbH & Co KG Catherine Sweatman, Anne-Kathrin Ludwig, Margot Weiland, Sonja Diehl, Nadine Richter, Werner Rust, Nathan Lawless, Katrin Fundel-Clemens, Anna Lachenmaier, Tom Bretschneider, Silke Laack-Reinhardt, Yvonne Schneider, Sonja Hofbauer, Ralf Weber, Britta Gerth and Lukas Schmidt for their excellent support in performing the referenced own studies. We furthermore thank Alexander Karabatsiakis, Christina Böck, Iris-Tatjana Kolassa, Enrico Calzia and Peter Radermacher at Ulm University for their contributions to these studies.
The funding for the studies cited was provided by Boehringer Ingelheim Pharma GmbH & Co KG to provide a thesis project to V Nold. The company had no further influence on this work. V Nold and KA Allers are employees of Boehringer Ingelheim Pharma GmbH & Co KG.
ACTH | |
ATP | |
CNS | |
CRH | |
EAAT | |
ETC | |
FKBP5 | FK506 binding protein 5 |
GC | |
GR | |
HPA | |
HSP | |
IDO | |
KAT | |
KMO | |
LTP | |
MR | |
mtDNA | mitochondrial desoxyribonucleic acid |
NFκB | |
NMDA | N-methyl-D-aspartate |
OXPHOS | oxidative phosphorylation |
PFC | |
PINE | |
ROS | |
TDO | |
TRYCAT | trypotophan Catabolite |
TSPO |
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The traditional healer provides health care services based on culture, religious background, knowledge, attitudes, and beliefs that are prevalent in his community. Illness is regarded as having both natural and supernatural causes and thus must be treated by both physical and spiritual means, using divination, incantations, animal sacrifice, exorcism, and herbs. Herbal medicine is the cornerstone of traditional medicine but may include minerals and animal parts. The adjustment is ok, but may be replaced with –‘ Herbal medicine was once termed primitive by western medicine but through scientific investigations there is a better understanding of its therapeutic activities such that many pharmaceuticals have been modeled on phytochemicals derived from it. Major obstacles to the use of African medicinal plants are their poor quality control and safety. Traditional medical practices are still shrouded with much secrecy, with few reports or documentations of adverse reactions. 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Formal recognition and integration of traditional medicine into conventional medicine will hold much promise for the future.",book:{id:"6302",slug:"herbal-medicine",title:"Herbal Medicine",fullTitle:"Herbal Medicine"},signatures:"Ezekwesili-Ofili Josephine Ozioma and Okaka Antoinette Nwamaka\nChinwe",authors:[{id:"191264",title:"Prof.",name:"Josephine",middleName:"Ozioma",surname:"Ezekwesili-Ofili",slug:"josephine-ezekwesili-ofili",fullName:"Josephine Ezekwesili-Ofili"},{id:"211585",title:"Prof.",name:"Antoinette",middleName:null,surname:"Okaka",slug:"antoinette-okaka",fullName:"Antoinette Okaka"}]},{id:"76640",title:"Control of Clinical Laboratory Errors by FMEA Model",slug:"control-of-clinical-laboratory-errors-by-fmea-model",totalDownloads:1118,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Patient safety is an aim for clinical applications and is a fundamental principle of healthcare and quality management. The main global health organizations have incorporated patient safety in their review of work practices. The data provided by the medical laboratories have a direct impact on patient safety and a fault in any of processes such as strategic, operational and support, could affect it. To provide appreciate and reliable data to the physicians, it is important to emphasize the need to design risk management plan in the laboratory. Failure Mode and Effect Analysis (FMEA) is an efficient technique for error detection and reduction. Technical Committee of the International Organization for Standardization (ISO) licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. FMEA model helps to identify quality failures, their effects and risks with their reduction/elimination, which depends on severity, probability and detection. Applying FMEA in clinical approaches can lead to a significant reduction of the risk priority number (RPN).",book:{id:"9808",slug:"contemporary-topics-in-patient-safety-volume-1",title:"Contemporary Topics in Patient Safety",fullTitle:"Contemporary Topics in Patient Safety - Volume 1"},signatures:"Hoda Sabati, Amin Mohsenzadeh and Nooshin Khelghati",authors:[{id:"340486",title:"M.Sc.",name:"Hoda",middleName:null,surname:"Sabati",slug:"hoda-sabati",fullName:"Hoda Sabati"},{id:"348872",title:"M.Sc.",name:"Amin",middleName:null,surname:"Mohsenzadeh",slug:"amin-mohsenzadeh",fullName:"Amin Mohsenzadeh"},{id:"348874",title:"MSc.",name:"Nooshin",middleName:null,surname:"Khelghati",slug:"nooshin-khelghati",fullName:"Nooshin Khelghati"}]},{id:"64762",title:"Mechanism and Health Effects of Heavy Metal Toxicity in Humans",slug:"mechanism-and-health-effects-of-heavy-metal-toxicity-in-humans",totalDownloads:10122,totalCrossrefCites:91,totalDimensionsCites:219,abstract:"Several heavy metals are found naturally in the earth crust and are exploited for various industrial and economic purposes. Among these heavy metals, a few have direct or indirect impact on the human body. Some of these heavy metals such as copper, cobalt, iron, nickel, magnesium, molybdenum, chromium, selenium, manganese and zinc have functional roles which are essential for various diverse physiological and biochemical activities in the body. However, some of these heavy metals in high doses can be harmful to the body while others such as cadmium, mercury, lead, chromium, silver, and arsenic in minute quantities have delirious effects in the body causing acute and chronic toxicities in humans. The focus of this chapter is to describe the various mechanism of intoxication of some selected heavy metals in humans along with their health effects. Therefore it aims to highlight on biochemical mechanisms of heavy metal intoxication which involves binding to proteins and enzymes, altering their activity and causing damage. More so, the mechanism by which heavy metals cause neurotoxicity, generate free radical which promotes oxidative stress damaging lipids, proteins and DNA molecules and how these free radicals propagate carcinogenesis are discussed. Alongside these mechanisms, the noxious health effects of these heavy metals are discussed.",book:{id:"7111",slug:"poisoning-in-the-modern-world-new-tricks-for-an-old-dog-",title:"Poisoning in the Modern World",fullTitle:"Poisoning in the Modern World - New Tricks for an Old Dog?"},signatures:"Godwill Azeh Engwa, Paschaline Udoka Ferdinand, Friday Nweke Nwalo and Marian N. Unachukwu",authors:[{id:"241837",title:"Mr.",name:"Godwill Azeh",middleName:null,surname:"Engwa",slug:"godwill-azeh-engwa",fullName:"Godwill Azeh Engwa"},{id:"274194",title:"BSc.",name:"Paschaline Ferdinand",middleName:null,surname:"Okeke",slug:"paschaline-ferdinand-okeke",fullName:"Paschaline Ferdinand Okeke"},{id:"286975",title:"Dr.",name:"Friday",middleName:null,surname:"Nweke Nwalo",slug:"friday-nweke-nwalo",fullName:"Friday Nweke Nwalo"},{id:"286976",title:"Dr.",name:"Marian",middleName:null,surname:"Unachukwu",slug:"marian-unachukwu",fullName:"Marian Unachukwu"}]},{id:"65467",title:"Anesthesia Management for Large-Volume Liposuction",slug:"anesthesia-management-for-large-volume-liposuction",totalDownloads:5761,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The apparent easiness with which liposuction is performed favors that patients, young surgeons, and anesthesiologists without experience in this field ignore the many events that occur during this procedure. Liposuction is a procedure to improve the body contour and not a surgery to reduce weight, although recently people who have failed in their plans to lose weight look at liposuction as a means to contour their body figure. Tumescent liposuction of large volumes requires a meticulous selection of each patient; their preoperative evaluation and perioperative management are essential to obtain the expected results. The various techniques of general anesthesia are the most recommended and should be monitored in the usual way, as well as monitoring the total doses of infiltrated local anesthetics to avoid systemic toxicity. The management of intravenous fluids is controversial, but the current trend is the restricted use of hydrosaline solutions. The most feared complications are deep vein thrombosis, pulmonary thromboembolism, fat embolism, lung edema, hypothermia, infections and even death. The adherence to the management guidelines and prophylaxis of venous thrombosis/thromboembolism is mandatory.",book:{id:"6221",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery"},signatures:"Sergio Granados-Tinajero, Carlos Buenrostro-Vásquez, Cecilia\nCárdenas-Maytorena and Marcela Contreras-López",authors:[{id:"273532",title:"Dr.",name:"Sergio Octavio",middleName:null,surname:"Granados Tinajero",slug:"sergio-octavio-granados-tinajero",fullName:"Sergio Octavio Granados Tinajero"}]},{id:"30178",title:"Chest Mobilization Techniques for Improving Ventilation and Gas Exchange in Chronic Lung Disease",slug:"chest-mobilization-techniques-for-improving-ventilation-and-gas-exchange-in-chronic-lung-disease",totalDownloads:31045,totalCrossrefCites:0,totalDimensionsCites:5,abstract:null,book:{id:"648",slug:"chronic-obstructive-pulmonary-disease-current-concepts-and-practice",title:"Chronic Obstructive Pulmonary Disease",fullTitle:"Chronic Obstructive Pulmonary Disease - Current Concepts and Practice"},signatures:"Donrawee Leelarungrayub",authors:[{id:"73709",title:"Associate Prof.",name:"Jirakrit",middleName:null,surname:"Leelarungrayub",slug:"jirakrit-leelarungrayub",fullName:"Jirakrit Leelarungrayub"}]}],onlineFirstChaptersFilter:{topicId:"3",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81532",title:"Ethnobotany",slug:"ethnobotany",totalDownloads:0,totalDimensionsCites:null,doi:"10.5772/intechopen.104754",abstract:"Ethnobotany is a life science which studies the interaction between human beings and flora in particular and broadly deals with the investigations, observations, and identifications of botanical diversity used for the prevention and treatment of human and livestock ailments. The current chapter reviews the history and development of ethnobotany and the involvement of this branch of science in the innovation and derivation of drug products which is originated from plants and claimed by the traditional healers and indigenous people used for the prevention and treatment of disease. This chapter also combines interdisciplinary and multidisciplinary methods that can lead to further productive, comprehensive, and systemic guesstimates in the investigation of the relationship between the plants and humans. Regardless of its various bottlenecks, ethnobotany becomes an attractive and hopeful area of research. It also covers ethnobotanical knowledge and modern science, ethnobotany research and their applications, plant conservation and sustainable management practices, taxonomy, and economic botany. The chapter also deals with the ways in which different societies and cultures have come to perceive, know, use, classify, and symbolically represent plants and animals.",book:{id:"11299",title:"Medicinal Plants",coverURL:"https://cdn.intechopen.com/books/images_new/11299.jpg"},signatures:"Jafer Siraj"},{id:"81943",title:"Surgical Education: Focus on Gender Equality in Academic Surgery and Related Areas",slug:"surgical-education-focus-on-gender-equality-in-academic-surgery-and-related-areas",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.103853",abstract:"Despite progress and advancements made to achieve gender equality, a glass ceiling still exists for women in surgery. Women remain largely underrepresented in academic surgery, with appointments to only 18% of surgery program director roles and 6.3% of surgical chair positions in the United States as of 2018. Inequities across various surgical subspecialties are also significant, especially in the areas of neurosurgery, orthopedic surgery, otolaryngology, and plastic and reconstructive surgery. Additional barriers exist for women in academics, including lack of high-quality female mentorship, implicit bias within letters of recommendation, and a greater incidence of reported moral injury and burn-out. Further efforts to address these inequities are necessary to retain the talents and contributions of women in surgery. Interventions that may counterbalance the continued gender gap within surgical fields include the implementation of implicit bias training, increasing institutional support, establishing formal mentorship initiatives, the introduction of early exposure programs during medical training, transparent institutional promotion policies, childcare support, and accommodation of maternity leave. The purpose of this chapter is to educate the reader regarding gender inequality in surgery and related fields and to highlight key issues central to the propagation of gender biases specifically as they relate to female surgeons across various roles and responsibilities (e.g., clinical practice, education/training, and leadership) within the contemporary academic landscape.",book:{id:"6947",title:"Contemporary Topics in Graduate Medical Education - Volume 2",coverURL:"https://cdn.intechopen.com/books/images_new/6947.jpg"},signatures:"Minuette Laessig, Lauryn Ullrich, Thomas J. Papadimos, Erin A. Handspiker, Cara A. Cama and Stanislaw P. Stawicki"},{id:"81568",title:"Extracellular Matrix in Tumor Angiogenesis",slug:"extracellular-matrix-in-tumor-angiogenesis",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.104661",abstract:"Extracellular matrix (ECM) is a complex three-dimensional network that provides structure, strength, and contextual information for cellular growth, communication, differentiation, survival, adhesion, and migration. ECM basic proteins resist compressive forces and/or allow rapid diffusion, others strengthen the matrix, and give resilience or modulate cell-matrix interactions. ECM undergoes turnover and remodeling physiologically and during inflammation, wound repair and tumor invasion. Remodeling of the ECM is an integral component of the angiogenic process and depends on the composition of matrix molecules, soluble pro-angiogenic and anti-angiogenic factors, and their spatial regulation. This review will focus on the myriad roles of those molecules and will emphasize their involvement in critical points of angiogenesis.",book:{id:"10833",title:"Tumor Angiogenesis",coverURL:"https://cdn.intechopen.com/books/images_new/10833.jpg"},signatures:"Gvantsa Kharaishvili"},{id:"81640",title:"Perspective Chapter: Sleep and Neuroimmunomodulation for Maintenance of Optimum Brain Function - Role of Noradrenaline",slug:"perspective-chapter-sleep-and-neuroimmunomodulation-for-maintenance-of-optimum-brain-function-role-o",totalDownloads:0,totalDimensionsCites:0,doi:"10.5772/intechopen.104868",abstract:"Immune reaction and sleep are two normal physiological processes to protect the living organism from falling sick. There is hardly any disease when they remain unaffected, the quantum of effect may differ though. Therefore, a strong correlation exists between sleep (quality or quantity) and immune response. This may be supported by the fact that sleep loss modulates many of the immunological molecules, which includes interferons; however, not much is known about their mechanism of action. Sleep is divided into rapid eye movement sleep (REMS) and non-REMS; most experimental studies have been conducted by inducing loss of REMS. It has been shown that withdrawal of noradrenaline (NA) is a necessity for the generation of REMS, its level increases in the brain upon REMS loss and the elevated NA is a causative factor for many of the sleep loss associated symptoms. In this chapter, we propose that sleep (and its disturbance) modulates the immune system by modulating the NA level in the brain or vice versa to maintain physiological homeostasis and normal healthy living.",book:{id:"11275",title:"Interferon - Immune Metabolism",coverURL:"https://cdn.intechopen.com/books/images_new/11275.jpg"},signatures:"Rachna Mehta, Rohosen Bhattacharya and Birendra Nath Mallick"},{id:"81942",title:"Surgical Correction of Ametropia with AddOn™ Intraocular Lens in Post-Penetrating Keratoplasty Pseudophakia",slug:"surgical-correction-of-ametropia-with-addon-intraocular-lens-in-post-penetrating-keratoplasty-pseudo",totalDownloads:0,totalDimensionsCites:0,doi:"10.5772/intechopen.104782",abstract:"Cataract surgery is the most common surgery in ophthalmology. The aim of cataract surgery is to restore vision in eyes in which the natural lens became opacified mostly due to the aging of the lens, or the presence of other ocular diseases, which promote earlier cataract formation. During cataract surgery, artificial intraocular lens (IOL) is implanted into the lens capsule and the value of the IOL is planned before surgery based on the preoperative IOL calculation. However, in the significant number of patients, cataract surgery may end up with a postoperative refractive error in which case patients have to wear glasses to reach the full vision for both distance and near correction (if monofocal IOL is used during cataract surgery!). Modern cataract surgery becomes more and more a refractive procedure as well, especially when multifocal and/or toric IOLs are implanted. However, in some specific cases where such IOLs are not applicable, high postoperative refractive error after cataract surgery can significantly influence the quality of the obtained vision. One such example is cataract surgery after penetrating keratoplasty. In this chapter, results of a novel approach of post-PK ametropia correction, namely implantation of sulcus placed AddOn IOLs (also called a piggyback lens) will be presented.",book:{id:"11302",title:"Refractive Surgery - Types of Procedures, Risks, and Benefits",coverURL:"https://cdn.intechopen.com/books/images_new/11302.jpg"},signatures:"Iva Dekaris, Ivan Gabrić and Doria Gabrić"},{id:"81682",title:"‘Complete Coverage & Covering Completely’ for Breastfeeding with Able, Bold, & Confident Mothers, for Sustainable Development, & Medical Education Excellence",slug:"complete-coverage-covering-completely-for-breastfeeding-with-able-bold-confident-mothers-for-sustain",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.104297",abstract:"Complete coverage of all infants, everywhere with wonderful evidence, and covering completely with first six months of exclusive breastfeeding and thereafter proper weaning while continuing breastfeeding up to 2 years of age or beyond is desirable. Reaching all rightly and robustly is required. All this will contribute greatly towards the growth & development of infants and grandly towards the Sustainable Development Goals. We propose the “ABC mothers” plan. Progress for required practices for results possible with making mothers—“Able for practices advantageous, bold with pertinent awareness, and confident with propitious attitude”. Strong efforts on sound footing are necessary for health of all our infants and happiness all around with sustainable development. Scientific infant feeding will contribute to advance the attainment of this. Medical education teaching best beneficial practices is for excellence. One promoting breastfeeding is the best. The US Surgeon General’s Implementation Strategies elaborate “Education content”, “Enabling competency”, & “Education continuing”. Competency-based curriculum for Indian Medical Graduates includes “to promote and support optimal breast feeding”. Need for inclusion in teaching curriculum across US, UK, & internationally has been documented. Given all the evidence for breastfeeding benefits, it should be a consistent essential component of training in all medical schools worldwide.",book:{id:"11308",title:"Selected topics on Infant Feeding",coverURL:"https://cdn.intechopen.com/books/images_new/11308.jpg"},signatures:"Sunil Jain, Arvind Singh Kushwaha and Vishal Marwaha"}],onlineFirstChaptersTotal:766},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261",scope:"Modern physiology requires a comprehensive understanding of the integration of tissues and organs throughout the mammalian body, including the cooperation between structure and function at the cellular and molecular levels governed by gene and protein expression. While a daunting task, learning is facilitated by identifying common and effective signaling pathways mediated by a variety of factors employed by nature to preserve and sustain homeostatic life. \r\nAs a leading example, the cellular interaction between intracellular concentration of Ca+2 increases, and changes in plasma membrane potential is integral for coordinating blood flow, governing the exocytosis of neurotransmitters, and modulating gene expression and cell effector secretory functions. Furthermore, in this manner, understanding the systemic interaction between the cardiovascular and nervous systems has become more important than ever as human populations' life prolongation, aging and mechanisms of cellular oxidative signaling are utilised for sustaining life. \r\nAltogether, physiological research enables our identification of distinct and precise points of transition from health to the development of multimorbidity throughout the inevitable aging disorders (e.g., diabetes, hypertension, chronic kidney disease, heart failure, peptic ulcer, inflammatory bowel disease, age-related macular degeneration, cancer). With consideration of all organ systems (e.g., brain, heart, lung, gut, skeletal and smooth muscle, liver, pancreas, kidney, eye) and the interactions thereof, this Physiology Series will address the goals of resolving (1) Aging physiology and chronic disease progression (2) Examination of key cellular pathways as they relate to calcium, oxidative stress, and electrical signaling, and (3) how changes in plasma membrane produced by lipid peroxidation products can affect aging physiology, covering new research in the area of cell, human, plant and animal physiology.",coverUrl:"https://cdn.intechopen.com/series/covers/10.jpg",latestPublicationDate:"May 14th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:11,editor:{id:"35854",title:"Prof.",name:"Tomasz",middleName:null,surname:"Brzozowski",slug:"tomasz-brzozowski",fullName:"Tomasz Brzozowski",profilePictureURL:"https://mts.intechopen.com/storage/users/35854/images/system/35854.jpg",biography:"Prof. Dr. Thomas Brzozowski works as a professor of Human Physiology and is currently Chairman at the Department of Physiology and is V-Dean of the Medical Faculty at Jagiellonian University Medical College, Cracow, Poland. His primary area of interest is physiology and pathophysiology of the gastrointestinal (GI) tract, with the major focus on the mechanism of GI mucosal defense, protection, and ulcer healing. He was a postdoctoral NIH fellow at the University of California and the Gastroenterology VA Medical Center, Irvine, Long Beach, CA, USA, and at the Gastroenterology Clinics Erlangen-Nuremberg and Munster in Germany. He has published 290 original articles in some of the most prestigious scientific journals and seven book chapters on the pathophysiology of the GI tract, gastroprotection, ulcer healing, drug therapy of peptic ulcers, hormonal regulation of the gut, and inflammatory bowel disease.",institutionString:null,institution:{name:"Jagiellonian University",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:7,paginationItems:[{id:"10",title:"Animal Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/10.jpg",editor:{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"306970",title:"Mr.",name:"Amin",middleName:null,surname:"Tamadon",slug:"amin-tamadon",fullName:"Amin Tamadon",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002oHR5wQAG/Profile_Picture_1623910304139",institutionString:null,institution:{name:"Bushehr University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón",slug:"juan-carlos-gardon",fullName:"Juan Carlos Gardón",profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",institutionString:"Catholic University of Valencia San Vicente Mártir, Spain",institution:null},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",institutionString:null,institution:{name:"Miguel Hernandez University",institutionURL:null,country:{name:"Spain"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",institutionString:null,institution:{name:"Alexandria University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"11",title:"Cell Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/11.jpg",editor:{id:"133493",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",profilePictureURL:"https://mts.intechopen.com/storage/users/133493/images/3091_n.jpg",biography:"Prof. Dr. Angel Catalá \r\nShort Biography Angel Catalá was born in Rodeo (San Juan, Argentina). He studied \r\nchemistry at the Universidad Nacional de La Plata, Argentina, where received aPh.D. degree in chemistry (Biological Branch) in 1965. From\r\n1964 to 1974, he worked as Assistant in Biochemistry at the School of MedicineUniversidad Nacional de La Plata, Argentina. From 1974 to 1976, he was a Fellowof the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor oBiochemistry at the Universidad Nacional de La Plata, Argentina. He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"186048",title:"Prof.",name:"Ines",middleName:null,surname:"Drenjančević",slug:"ines-drenjancevic",fullName:"Ines Drenjančević",profilePictureURL:"https://mts.intechopen.com/storage/users/186048/images/5818_n.jpg",institutionString:null,institution:{name:"University of Osijek",institutionURL:null,country:{name:"Croatia"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"79615",title:"Dr.",name:"Robson",middleName:null,surname:"Faria",slug:"robson-faria",fullName:"Robson Faria",profilePictureURL:"https://mts.intechopen.com/storage/users/79615/images/system/79615.png",institutionString:null,institution:{name:"Oswaldo Cruz Foundation",institutionURL:null,country:{name:"Brazil"}}},{id:"84459",title:"Prof.",name:"Valerie",middleName:null,surname:"Chappe",slug:"valerie-chappe",fullName:"Valerie Chappe",profilePictureURL:"https://mts.intechopen.com/storage/users/84459/images/system/84459.jpg",institutionString:null,institution:{name:"Dalhousie University",institutionURL:null,country:{name:"Canada"}}}]},{id:"12",title:"Human Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:null,editorThree:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}},editorialBoard:[{id:"213786",title:"Dr.",name:"Henrique P.",middleName:null,surname:"Neiva",slug:"henrique-p.-neiva",fullName:"Henrique P. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. 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Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. 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He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. 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