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Sharma",authors:[{id:"151166",title:"Dr.",name:"Vas",middleName:null,surname:"Dev",fullName:"Vas Dev",slug:"vas-dev"},{id:"169007",title:"Dr.",name:"Vinod",middleName:null,surname:"P. Sharma",fullName:"Vinod P. Sharma",slug:"vinod-p.-sharma"}]},{id:"45385",title:"Vector Biology and Malaria Transmission in Southeast Asia",slug:"vector-biology-and-malaria-transmission-in-southeast-asia",signatures:"Wannapa Suwonkerd, Wanapa Ritthison, Chung Thuy Ngo, Krajana\nTainchum, Michael J. Bangs and Theeraphap Chareonviriyaphap",authors:[{id:"151663",title:"PhD.",name:"Wannapa",middleName:null,surname:"Suwonkerd",fullName:"Wannapa Suwonkerd",slug:"wannapa-suwonkerd"},{id:"151737",title:"Dr.",name:"Michael",middleName:null,surname:"J. Bangs",fullName:"Michael J. Bangs",slug:"michael-j.-bangs"},{id:"169010",title:"Dr.",name:"Wanapa",middleName:null,surname:"Ritthison",fullName:"Wanapa Ritthison",slug:"wanapa-ritthison"}]},{id:"43254",title:"Understanding Anopheles Diversity in Southeast Asia and Its Applications for Malaria Control",slug:"understanding-anopheles-diversity-in-southeast-asia-and-its-applications-for-malaria-control",signatures:"Katy Morgan, Pradya Somboon and Catherine Walton",authors:[{id:"154092",title:"Dr.",name:"Catherine",middleName:null,surname:"Walton",fullName:"Catherine Walton",slug:"catherine-walton"},{id:"154867",title:"Dr.",name:"Katy",middleName:null,surname:"Morgan",fullName:"Katy Morgan",slug:"katy-morgan"},{id:"169019",title:"Dr.",name:"Pradya",middleName:null,surname:"Somboon",fullName:"Pradya Somboon",slug:"pradya-somboon"}]},{id:"44155",title:"The Systematics and Bionomics of Malaria Vectors in the Southwest Pacific",slug:"the-systematics-and-bionomics-of-malaria-vectors-in-the-southwest-pacific",signatures:"Nigel W. Beebe, Tanya L. Russell, Thomas R. Burkot, Neil F. Lobo and\nRobert D. Cooper",authors:[{id:"152080",title:"Dr.",name:"Nigel",middleName:null,surname:"Beebe",fullName:"Nigel Beebe",slug:"nigel-beebe"},{id:"169012",title:"Dr.",name:"Tanya",middleName:null,surname:"L. Russell",fullName:"Tanya L. Russell",slug:"tanya-l.-russell"},{id:"169013",title:"Dr.",name:"Thomas",middleName:null,surname:"R. Burkot",fullName:"Thomas R. Burkot",slug:"thomas-r.-burkot"},{id:"169014",title:"Dr.",name:"Neil",middleName:null,surname:"F. Lobo",fullName:"Neil F. Lobo",slug:"neil-f.-lobo"},{id:"169015",title:"Dr.",name:"Robert",middleName:null,surname:"D. Cooper",fullName:"Robert D. Cooper",slug:"robert-d.-cooper"}]},{id:"43671",title:"Ecology of Larval Habitats",slug:"ecology-of-larval-habitats",signatures:"Eliška Rejmánková, John Grieco, Nicole Achee and Donald R.\nRoberts",authors:[{id:"151632",title:"Prof.",name:"Nicole",middleName:null,surname:"Achee",fullName:"Nicole Achee",slug:"nicole-achee"},{id:"152601",title:"Prof.",name:"Eliska",middleName:null,surname:"Rejmankova",fullName:"Eliska Rejmankova",slug:"eliska-rejmankova"},{id:"169016",title:"Dr.",name:"John",middleName:null,surname:"Grieco",fullName:"John Grieco",slug:"john-grieco"}]},{id:"43954",title:"From Anopheles to Spatial Surveillance: A Roadmap Through a Multidisciplinary Challenge",slug:"from-anopheles-to-spatial-surveillance-a-roadmap-through-a-multidisciplinary-challenge",signatures:"Valérie Obsomer, Nicolas Titeux, Christelle Vancustem, Grégory\nDuveiller, Jean-François Pekel, Steve Connor, Pietro Ceccato and\nMarc Coosemans",authors:[{id:"131417",title:"Dr.",name:"Valérie",middleName:null,surname:"Obsomer",fullName:"Valérie Obsomer",slug:"valerie-obsomer"},{id:"152754",title:"Prof.",name:"Marc",middleName:null,surname:"Coosemans",fullName:"Marc Coosemans",slug:"marc-coosemans"},{id:"153949",title:"Dr.",name:"Pietro",middleName:null,surname:"Ceccato",fullName:"Pietro Ceccato",slug:"pietro-ceccato"},{id:"153950",title:"Dr.",name:"Gregory",middleName:null,surname:"Duveiller",fullName:"Gregory Duveiller",slug:"gregory-duveiller"},{id:"153952",title:"Dr.",name:"Christelle",middleName:null,surname:"Vancutsem",fullName:"Christelle Vancutsem",slug:"christelle-vancutsem"},{id:"153980",title:"Dr.",name:"Nicolas",middleName:null,surname:"Titeux",fullName:"Nicolas Titeux",slug:"nicolas-titeux"},{id:"154158",title:"Dr.",name:"Steve J",middleName:null,surname:"Connor",fullName:"Steve J Connor",slug:"steve-j-connor"},{id:"167685",title:"MSc.",name:"Jean-Francois",middleName:null,surname:"Pekel",fullName:"Jean-Francois Pekel",slug:"jean-francois-pekel"}]},{id:"43960",title:"Simian Malaria Parasites: Special Emphasis on Plasmodium knowlesi and Their Anopheles Vectors in Southeast Asia",slug:"simian-malaria-parasites-special-emphasis-on-plasmodium-knowlesi-and-their-anopheles-vectors-in-sout",signatures:"Indra Vythilingam and Jeffery Hii",authors:[{id:"151116",title:"Dr.",name:"Indra",middleName:null,surname:"Vythilingam",fullName:"Indra Vythilingam",slug:"indra-vythilingam"},{id:"169006",title:"Dr.",name:"Jeffery",middleName:null,surname:"Hii",fullName:"Jeffery Hii",slug:"jeffery-hii"}]},{id:"44039",title:"Thermal Stress and Thermoregulation During Feeding in Mosquitoes",slug:"thermal-stress-and-thermoregulation-during-feeding-in-mosquitoes",signatures:"Chloé Lahondère and Claudio R. Lazzari",authors:[{id:"151619",title:"Prof.",name:"Claudio",middleName:null,surname:"R. Lazzari",fullName:"Claudio R. Lazzari",slug:"claudio-r.-lazzari"},{id:"151620",title:"Ms.",name:"Chloé",middleName:null,surname:"Lahondère",fullName:"Chloé Lahondère",slug:"chloe-lahondere"}]},{id:"43955",title:"The Anopheles Mosquito Microbiota and Their Impact on Pathogen Transmission",slug:"the-anopheles-mosquito-microbiota-and-their-impact-on-pathogen-transmission",signatures:"Mathilde Gendrin and George K. Christophides",authors:[{id:"154007",title:"Dr.",name:"Mathilde",middleName:null,surname:"Gendrin",fullName:"Mathilde Gendrin",slug:"mathilde-gendrin"},{id:"154008",title:"Prof.",name:"George",middleName:"K",surname:"Christophides",fullName:"George Christophides",slug:"george-christophides"}]},{id:"43829",title:"Bacterial Biodiversity in Midguts of Anopheles Mosquitoes, Malaria Vectors in Southeast Asia",slug:"bacterial-biodiversity-in-midguts-of-anopheles-mosquitoes-malaria-vectors-in-southeast-asia",signatures:"Sylvie Manguin, Chung Thuy Ngo, Krajana Tainchum, Waraporn\nJuntarajumnong, Theeraphap Chareonviriyaphap, Anne-Laure\nMichon and Estelle Jumas-Bilak",authors:[{id:"50017",title:"Prof.",name:"Sylvie",middleName:null,surname:"Manguin",fullName:"Sylvie Manguin",slug:"sylvie-manguin"},{id:"75315",title:"Prof.",name:"Theeraphap",middleName:null,surname:"Chareonviriyaphap",fullName:"Theeraphap Chareonviriyaphap",slug:"theeraphap-chareonviriyaphap"},{id:"88985",title:"Prof.",name:"Anne-Laure",middleName:null,surname:"Michon",fullName:"Anne-Laure Michon",slug:"anne-laure-michon"},{id:"88986",title:"Prof.",name:"Estelle",middleName:null,surname:"Jumas-Bilak",fullName:"Estelle Jumas-Bilak",slug:"estelle-jumas-bilak"},{id:"156016",title:"MSc.",name:"Chung Thuy",middleName:null,surname:"Ngo",fullName:"Chung Thuy Ngo",slug:"chung-thuy-ngo"},{id:"156018",title:"MSc.",name:"Krajana",middleName:null,surname:"Tainchum",fullName:"Krajana Tainchum",slug:"krajana-tainchum"},{id:"156019",title:"Dr.",name:"Waraporn",middleName:null,surname:"Juntarajumnong",fullName:"Waraporn Juntarajumnong",slug:"waraporn-juntarajumnong"}]},{id:"43899",title:"Distribution, Mechanisms, Impact and Management of Insecticide Resistance in Malaria Vectors: A Pragmatic Review",slug:"distribution-mechanisms-impact-and-management-of-insecticide-resistance-in-malaria-vectors-a-pragmat",signatures:"Vincent Corbel and Raphael N’Guessan",authors:[{id:"152666",title:"Dr.",name:"Vincent",middleName:null,surname:"Corbel",fullName:"Vincent Corbel",slug:"vincent-corbel"},{id:"169017",title:"Dr.",name:"Raphael",middleName:null,surname:"N'Guessan",fullName:"Raphael N'Guessan",slug:"raphael-n'guessan"}]},{id:"43851",title:"Perspectives on Barriers to Control of Anopheles Mosquitoes and Malaria",slug:"perspectives-on-barriers-to-control-of-anopheles-mosquitoes-and-malaria",signatures:"Donald R. Roberts, Richard Tren and Kimberly Hess",authors:[{id:"151439",title:"Prof.",name:"Donald",middleName:null,surname:"R. Roberts",fullName:"Donald R. Roberts",slug:"donald-r.-roberts"},{id:"151656",title:"Mr.",name:"Richard",middleName:null,surname:"Tren",fullName:"Richard Tren",slug:"richard-tren"},{id:"154152",title:"Ms.",name:"Kimberly",middleName:null,surname:"Hess",fullName:"Kimberly Hess",slug:"kimberly-hess"}]},{id:"43874",title:"Residual Transmission of Malaria: An Old Issue for New Approaches",slug:"residual-transmission-of-malaria-an-old-issue-for-new-approaches",signatures:"Lies Durnez and Marc Coosemans",authors:[{id:"152754",title:"Prof.",name:"Marc",middleName:null,surname:"Coosemans",fullName:"Marc Coosemans",slug:"marc-coosemans"},{id:"169018",title:"Dr.",name:"Lies",middleName:null,surname:"Durnez",fullName:"Lies Durnez",slug:"lies-durnez"}]},{id:"44330",title:"Vector Control: Some New Paradigms and Approaches",slug:"vector-control-some-new-paradigms-and-approaches",signatures:"Claire Duchet, Richard Allan and Pierre Carnevale",authors:[{id:"151662",title:"Dr.",name:"Pierre",middleName:null,surname:"Carnevale",fullName:"Pierre Carnevale",slug:"pierre-carnevale"},{id:"169000",title:"Dr.",name:"Richard",middleName:null,surname:"Allan",fullName:"Richard Allan",slug:"richard-allan"},{id:"169008",title:"Dr.",name:"Claire",middleName:null,surname:"Duchet",fullName:"Claire Duchet",slug:"claire-duchet"}]},{id:"43870",title:"New Salivary Biomarkers of Human Exposure to Malaria Vector Bites",slug:"new-salivary-biomarkers-of-human-exposure-to-malaria-vector-bites",signatures:"Papa M. Drame, Anne Poinsignon, Alexandra Marie, Herbert\nNoukpo, Souleymane Doucoure, Sylvie Cornelie and Franck\nRemoue",authors:[{id:"151515",title:"Dr.",name:"Papa Makhtar",middleName:null,surname:"Drame",fullName:"Papa Makhtar Drame",slug:"papa-makhtar-drame"},{id:"151648",title:"Dr.",name:"Franck",middleName:null,surname:"Remoué",fullName:"Franck Remoué",slug:"franck-remoue"},{id:"154034",title:"Dr.",name:"Anne",middleName:null,surname:"Poinsignon",fullName:"Anne Poinsignon",slug:"anne-poinsignon"},{id:"154035",title:"MSc.",name:"Alexandra",middleName:null,surname:"Marie",fullName:"Alexandra Marie",slug:"alexandra-marie"},{id:"154037",title:"Dr.",name:"Souleymane",middleName:null,surname:"Doucoure",fullName:"Souleymane Doucoure",slug:"souleymane-doucoure"},{id:"154038",title:"MSc.",name:"Herbert",middleName:null,surname:"Noukpo",fullName:"Herbert Noukpo",slug:"herbert-noukpo"},{id:"154039",title:"Dr.",name:"Sylvie",middleName:null,surname:"Cornélie",fullName:"Sylvie Cornélie",slug:"sylvie-cornelie"}]},{id:"44149",title:"Transgenic Mosquitoes for Malaria Control: From the Bench to the Public Opinion Survey",slug:"transgenic-mosquitoes-for-malaria-control-from-the-bench-to-the-public-opinion-survey",signatures:"Christophe Boëte and Uli Beisel",authors:[{id:"98400",title:"Dr.",name:"Christophe",middleName:null,surname:"Boëte",fullName:"Christophe Boëte",slug:"christophe-boete"},{id:"167749",title:"Dr.",name:"Uli",middleName:null,surname:"Beisel",fullName:"Uli Beisel",slug:"uli-beisel"}]}]}]},onlineFirst:{chapter:{type:"chapter",id:"72714",title:"The Brain Stress System in the Neurobiology of the “Dark Side” of Addiction and Its Relation to Neurodegeneration",doi:"10.5772/intechopen.93152",slug:"the-brain-stress-system-in-the-neurobiology-of-the-dark-side-of-addiction-and-its-relation-to-neurod",body:'DSM-5 defines addiction as an evolving and chronically relapsing disorder, characterized by a compulsion to take drugs, the development of dependence and a motivational withdrawal syndrome with a negative emotional state when access to the drug is prevented [1, 2]. The profound malaise and anxiety during withdrawal, protracted abstinence syndrome marked by a low-level anxiety/dysphoria, and a high vulnerability to relapse upon exposure to an acute stressor is aptly termed ‘the dark side’ of addiction. It is the common element of the disorder, although all addictions to different drugs are characterized by distinct patterns with emphasis on different stages of the addiction cycle.
The disorder typically progresses in a cyclical manner through three stages, namely preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect (see Figure 1). The early stages of the cycle are characterized by impulsivity, whereas terminal stages are dominated by compulsivity. The former refers to rapid reactions to internal and external factors with no concern about negative outcomes whilst the latter to perseveration in actions despite adverse consequences or in the face of incorrect responses in choice situations. As the cycle of drug taking and withdrawal continues, the different components of the addiction cycle become more intense, and progressively evolve into a more severe pathology [1]. This process is accompanied by changes in the motivational behavioral mechanism that maintains addiction. Inasmuch as removal of negative emotional state associated with drug withdrawal becomes the mechanism driving the dependence-induced drug intake, there is a shift from positive to negative reinforcement maintaining the motivated behavior [3].
The progression of alcohol dependence over time marked by a shift in underlying motivational mechanisms. From initial, positively reinforcing, pleasurable drug effects, the addictive process progresses over time to being driven by negatively reinforcing relief from a negative emotional state.
In relation to the dark side of addiction, a wealth of data supports that symptoms of acute withdrawal from chronic drugs of abuse tend to be affective in nature, persist beyond the acute phase to protracted abstinence, and precede relapse to drug-seeking [4, 5]. Tension, fatigue and anxiety related to alcohol withdrawal have been shown to last from 5 to 9 months post-withdrawal [6, 7]. Furthermore, negative affective symptoms appear to be the leading precipitant of relapse [8, 9]. By way of example, the association between relapse and a subclinical negative affective state was shown to be particularly strong in patients with alcohol dependence, who underwent a 12-week clinical trial [10]. Animal data further shows that a history of dependence lowers the “dependence threshold” and makes the subsequent addiction more severe, relative to subjects receiving alcohol for the first time [11, 12, 13, 14]. Moreover, the former category evidenced a prolonged elevation in ethanol self-administration after acute withdrawal and detoxification [15, 16, 17, 18], and this was accompanied by increased overt responsivity to stressors and increased responsivity to antagonists of the brain CRF systems [19, 20, 21]. Finally, evidence exists to support that a history of prior dependence increases sensitivity to stress-induced reinstatement upon exposure to variety of stressors such as footshock, social stress, or pharmacological stress (e.g., yohimbine) [22]. Notably, the neural mechanism of stress-induced reinstatement overlaps with that of acute motivational withdrawal [23]. In what follows, next sections of the chapter provide a conceptual framework linking addiction to stress systems.
In neural terms, the “dark side” of addiction is posited to be mediated by activation of brain stress system that interacts with hormonal stress systems. Emerging evidence have highlighted that dysregulation of brain arousal/stress systems plays a key role in pathophysiology of drug addiction [2]. More relevant to this chapter, the negative emotional state associated with the dark side of addiction has been linked to a cycle of increasing dysregulation of brain reward/anti-reward mechanisms. Therein, corticotropin releasing factor (CRF) appears to be the prominent component of the negative reinforcement processes that drive the compulsivity of addiction [2].
CRF is a 41-amino acid polypeptide that mobilizes the body’s hormonal, autonomic, and behavioral responses to stressors (for a review of the biology of CRF systems see [24, 25]). It has a wide distribution across the brain with particularly high concentrations of cell bodies in the paraventricular nucleus of the hypothalamus, the basal forebrain, and the brainstem [26]. Therein, majority of stress-like effects are mediated by the brain and pituitary CRF1 receptors [25]. The urocortin/CRF2 systems have been less explored, with some data pointing to neuroadaptation associated with chronic drug use, also in opposition to the effects of the CRF1 receptor.
Initial drug use at the binge/intoxication stage of addiction cycle activates the hypothalamic pituitary-adrenal (HPA) axis, which initiates acquisition of drug-seeking behavior through activity in the brain motivational circuits [27, 28, 29, 30]. HPA axis activity is characterized by a cascade of physiological changes within the paraventricular nucleus of the hypothalamus, the anterior lobe of the pituitary gland, and the adrenal gland (for review, see Ref. [31]).
The CRF is synthesized by neurosecretory neurons in the medial parvocellular subdivision of the paraventricular nucleus and released into the portal blood vessels of the anterior pituitary gland. Therein it binds to the CRF1 receptor on pituitary corticotropes triggering the release of adreno-corticotropin hormone (ACTH) into the systemic circulation, which induces glucocorticoid synthesis and secretion from the adrenal cortex.
Once drug-seeking behavior is initiated, the transition from acute to chronic administration of drugs of abuse is mediated by progressive changes in the HPA axis that can lead to subsequent activation of extrahypothalamic brain stress systems characterizing the withdrawal/negative affect stage [32, 33, 34]. The HPA axis is regulated via negative feedback from circulating glucocorticoids that act on glucocorticoid receptors in the paraventricular nucleus and the hippocampus. Although high levels of glucocorticoids can feedback to shut off the HPA axis, they can also sensibilize CRF systems in the central nucleus of the amygdala and basolateral amygdala involved in behavioral responses to stressors [35, 36, 37, 38, 39]. This observation lends support to the thesis that CRF has a key role in the dark side of the addiction process.
As the cycle of drug taking and withdrawal continues, the different components of the addiction cycle become more intense, changes also the motivational behavioral mechanism that maintains addiction. The shift from positive to negative reinforcement behind motivation in compulsive drug use might be explained by allostatic model of the brain motivational systems. It defines addiction as a failure of counteradaptive processes of optimal homeostatic reward functioning to return to their normal range [2, 40]. Therein, the posited mechanism of pathology is mediated by within-system neuroadaptations (changes in reward pathways) and between-system neuroadaptations (brain stress systems) [1, 41].
The body’s response to stress related to addiction is controlled by CRF in the paraventricular nucleus of the hypothalamus. It maintains homeostasis by orchestrating rapid and sustained responses to anticipated challenges to normal operating level of the regulatory system. Upon exposure to an environmental challenge, a feed-forward mechanism continuously re-evaluates the environmental demand for adaption, and accordingly readjusts all parameters toward new set points to mobilize resources quickly. However, it might become the engine for pathology if insufficient resources are available to shut off the response. This leads to an allostatic state, defined as a stability with an altered set point [42]. In this view, CRF becomes the key contributor to allostasis and it is hypothesized to mediate the compulsivity and relapse to drug-seeking and drug-taking in addiction [43].
More relevant to this treatise, repeated administration of drugs of abuse leads to an alteration in psychological homeostatic processes, characterized by overactivation of normal arousal or emotional systems in the body [44]. Given that addiction shares some common characteristic with chronic physiological disorders, it allows to speculate that it represents a chronic deviation of the regulatory system from its normal operating level, rather than mere homeostatic dysregulation of emotional function.
Just like any chronic physiological disorder, addiction is subject to significant environmental stressors, deteriorates with time, and is marked by a residual neural trace for rapid re-addiction even after years of abstinence. In response to excessive drug use the brain attempts to maintain homeostatic stability through molecular, cellular, and neurocircuitry changes that occur at the cost of allostatic state. Allostasis represents a chronic deviation from optimal brain emotional regulation marked by decreased function of reward circuits, strengthened stimulus–response associations, loss of executive control and recruitment of the brain stress systems. These neurobiological changes underpin the chronic elevation of reward threshold associated with negative emotional state, thereby contributing to the compulsive drug use [45]. In this view, the cycle of increasing dysregulation of brain reward/anti-reward mechanisms constitutes the posited mechanism of the negative emotions in addiction and compulsive drug use.
All drugs of abuse activate the HPA axis during acquisition of drug-taking and acute withdrawal from the drug by releasing CRF in the paraventricular nucleus of the hypothalamus. Activation of the axis during acute administration facilitates activity in the brain motivational circuits of drug reward, thereby promoting acquisition of drug-seeking behavior [27, 28, 29, 30]. Repeated administration dysregulates these acute changes beyond HPA axis to affect the brain extrahypothalamic stress system [46, 47, 48, 49]. Therein the repeated exposure to high levels of glucorticoids may have profound effects on the extrahypothalamic brain stress systems, contributing to the persistence and relapse to cycles of addiction to drugs of abuse [32]. Repeated addiction cycles not only blunt the HPA axis response but also sensitize the response of the extrahypothalamic CRF stress system in the amygdala [34]. Whilst initially the presence of glucocorticoids enhances response to novelty and reward, sensitization of CRF systems in the extended amygdala may contribute to a stress component of the shift from homeostasis to pathophysiology of drug addiction. The stress component is posited to constitute an opponent anti-reward process response to excessive activation of reward systems [2].
Compelling evidence exist to support the thesis that the neuroanatomical substrates for many of the motivational effects associated with the dark side of addiction constitute a common neural circuitry within the basal forebrain, termed the “extended amygdala” [50]. It represents a macrostructure comprising the bed nucleus of the stria terminalis, central medial amygdala, and a transition zone in the posterior part of the medial nucleus accumbens (i.e., posterior shell) [51, 52]. Importantly, the extended amygdala includes dopamine and opioid peptides associated with the positive reinforcing effects of drugs of abuse, and major components of the extrahypothalamic CRF systems associated with negative reinforcement mechanisms [33]. It receives afferent connections from limbic cortices, the hippocampus, basolateral amygdala, midbrain, and lateral hypothalamus and efferent connections to the posterior medial ventral pallidum, ventral tegmental area, various brainstem projections, and to the lateral hypothalamus [52]. The arousal/stress brain systems in the extended amygdala may play a key role in the negative emotional states that maintains addiction to drugs of abuse and may overlap with the negative emotional constituent of other psychopathologies.
Stress might exert either ameliorating or detrimental effects on physiological processes. In the short term it might be beneficial to an organism however in the long-term it plays a major role in various pathophysiology related to neurodegenerative diseases and mood disorders. Upon exposure to stress the body enters the ‘fight or flight’ stage, after which it builds resistance to the stress in the adaptation stage, and finally due to ‘wear and tear’ it reaches exhaustion [53]. In the adaptation stage, cortisol typically exerts a negative feedback effect to shut down the stress response. Multiple brain regions related to cognition are actively involved in feedback regulation including the hippocampus, amygdala, the brain stem and prefrontal cortex [54]. Accordingly, stimulation by corticosteroids induced at the level of the amygdala, the prefrontal cortex and the locus coeruleus was found to interfere with HPA activity and memory [55]. A deficient cortisol feedback effect caused by glucocorticoid resistance increases the activity of the HPA-axis have been found to be associated with neurodegenerative diseases, obesity, heart disease, depression, and a variety of other health issues [56]. Therein the vasopressin neurons of the central nervous system inhibit the regulatory influence of CRH neurons in the PVN resulting in a disproportionally high activity of the HPA system.
Given the inhibitory control of the hippocampus over the HPA-axis, damage to this structure is posited to be causally involved in disinhibition of the HPA axis activity thereby accounting for the age-related accumulation of hippocampal damage in Alzheimer’s disease (AD) and depression. This thesis is furthered by evidence of increased cortisol plasma levels in early stage of AD associated with cognitive decline [57], and a correlation of salivary cortisol levels with the severity of the disease [58]. Accordingly, neuronal atrophy was evidenced in the hippocampus of stressed or corticosteroid-treated rodents and primates [59]. Elevated CRH and cortisol levels were also shown to contribute to the symptoms of depression in a large subpopulation of depressed subjects [56]. This is corroborated by the normalizing effect of antidepressants on the synthesis of CRH by stimulation and/or upregulation of corticosteroid receptor expression, and reversal the clinical symptoms [60]. In light of these evidence, the ‘glucocorticoid cascade hypothesis’ is posited to be the dominant pathogenetic mechanism in human neurodegenerative diseases marked by HPA-axis alterations including depression and AD [61].
Although CRH and cortisol seem to be etiologically involved in the development of depression, conclusive arguments cannot be drawn due to no evidence for any major damage in the human hippocampus in the disorder. Moreover, reduced hippocampal volume does not necessarily translate in cell death and might alternatively be explained by changes is water content or the structure in glial cells.
Addiction to all drugs of abuse involves activation of the HPA axis. Pathophysiology of drug addiction involves dysregulation of the brain emotional system posited to be a key constituent of the negative emotional state produced by dependence that maintains drug-seeking through the mechanism of negative reinforcement. More specifically, the action of CRF in extra hypothalamic systems in the extended amygdala is considered a neural substrate of the pathophysiology of the disorder and plays a key role in maintaining the addiction cycle once it is initiated. It comprises the central nucleus of the amygdala, bed nucleus of the stria terminalis, and a transition area in the shell of the nucleus accumbens. Beyond providing insight into the neurobiology of the dark side of addiction, better characterization of the CRF systems in addiction hold promise for new targets for identifying vulnerability to addiction and novel treatments for the disorder.
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.
"I work with IntechOpen for a number of reasons: their professionalism, their mission in support of Open Access publishing, and the quality of their peer-reviewed publications, but also because they believe in equality. Throughout the world, we are seeing progress in attracting, retaining, and promoting women in STEMM. IntechOpen are certainly supporting this work globally by empowering all scientists and ensuring that women are encouraged and enabled to publish and take leading roles within the scientific community." Dr. Catrin Rutland, University of Nottingham, UK
",metaTitle:"Advantages of Publishing with IntechOpen",metaDescription:"We have more than a decade of experience in Open Access publishing. \n\n ",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"We have more than a decade of experience in Open Access publishing. The advantages of publishing with IntechOpen include:
\\n\\nOur platform – IntechOpen is the world’s leading publisher of OA books, built by scientists, for scientists.
\\n\\nOur reputation – Everything we publish goes through a two-stage peer review process. We’re proud to count Nobel laureates among our esteemed authors. We meet European Commission standards for funding, and the research we’ve published has been funded by the Bill and Melinda Gates Foundation and the Wellcome Trust, among others. IntechOpen is a member of all relevant trade associations (including the STM Association and the Association of Learned and Professional Society Publishers) and has a selection of books indexed in Web of Science's Book Citation Index.
\\n\\nOur expertise – We’ve published more than 4,500 books by more than 118,000 authors and editors.
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\\n\\nOur services – The support we offer our authors and editors is second to none. Each book in our program receives the following:
\\n\\nOur end-to-end publishing service frees our authors and editors to focus on what matters: research. We empower them to shape their fields and connect with the global scientific community.
\\n\\n"In developing countries until now, advancement in science has been very limited, because insufficient economic resources are dedicated to science and education. These limitations are more marked when the scientists are women. In order to develop science in the poorest countries and decrease the gender gap that exists in scientific fields, Open Access networks like IntechOpen are essential. Free access to scientific research could contribute to ameliorating difficult life conditions and breaking down barriers." Marquidia Pacheco, National Institute for Nuclear Research (ININ), Mexico
\\n\\nInterested? Contact Ana Pantar (book.idea@intechopen.com) for more information.
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\n\nOur platform – IntechOpen is the world’s leading publisher of OA books, built by scientists, for scientists.
\n\nOur reputation – Everything we publish goes through a two-stage peer review process. We’re proud to count Nobel laureates among our esteemed authors. We meet European Commission standards for funding, and the research we’ve published has been funded by the Bill and Melinda Gates Foundation and the Wellcome Trust, among others. IntechOpen is a member of all relevant trade associations (including the STM Association and the Association of Learned and Professional Society Publishers) and has a selection of books indexed in Web of Science's Book Citation Index.
\n\nOur expertise – We’ve published more than 4,500 books by more than 118,000 authors and editors.
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\n\nOur services – The support we offer our authors and editors is second to none. Each book in our program receives the following:
\n\nOur end-to-end publishing service frees our authors and editors to focus on what matters: research. We empower them to shape their fields and connect with the global scientific community.
\n\n"In developing countries until now, advancement in science has been very limited, because insufficient economic resources are dedicated to science and education. These limitations are more marked when the scientists are women. In order to develop science in the poorest countries and decrease the gender gap that exists in scientific fields, Open Access networks like IntechOpen are essential. Free access to scientific research could contribute to ameliorating difficult life conditions and breaking down barriers." Marquidia Pacheco, National Institute for Nuclear Research (ININ), Mexico
\n\nInterested? Contact Ana Pantar (book.idea@intechopen.com) for more information.
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She performed research in perioperative autotransfusion and obtained the degree of PhD in 1993 publishing Peri-operative autotransfusion by means of a blood cell separator.\nBlood transfusion had her special interest being the president of the Haemovigilance Chamber TRIP and performing several tasks in local and national blood bank and anticoagulant-blood transfusion guidelines committees. Currently, she is working as an associate professor and up till recently was the dean at the Albert Schweitzer Hospital Dordrecht. She performed (inter)national tasks as vice-president of the Concilium Anaesthesia and related committees. \nShe performed research in several fields, with over 100 publications in (inter)national journals and numerous papers on scientific conferences. \nShe received several awards and is a member of Honour of the Dutch Society of Anaesthesia.",institutionString:null,institution:{name:"Albert Schweitzer Hospital",country:{name:"Gabon"}}},{id:"83089",title:"Prof.",name:"Aaron",middleName:null,surname:"Ojule",slug:"aaron-ojule",fullName:"Aaron Ojule",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Port Harcourt",country:{name:"Nigeria"}}},{id:"295748",title:"Mr.",name:"Abayomi",middleName:null,surname:"Modupe",slug:"abayomi-modupe",fullName:"Abayomi Modupe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:null,institutionString:null,institution:{name:"Landmark University",country:{name:"Nigeria"}}},{id:"94191",title:"Prof.",name:"Abbas",middleName:null,surname:"Moustafa",slug:"abbas-moustafa",fullName:"Abbas Moustafa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94191/images/96_n.jpg",biography:"Prof. Moustafa got his doctoral degree in earthquake engineering and structural safety from Indian Institute of Science in 2002. He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). He was born in 1969 in Naama, Algeria. He received his BS degree in 1993, the MS degree in 1997, the PhD degree in 2007 from the Electrical Engineering Institute of Djilali Liabes University of Sidi Bel Abbes (ALGERIA). He is an active member of IRECOM (Interaction Réseaux Electriques - COnvertisseurs Machines) Laboratory and IEEE senior member. He is an editor member for many international journals (IJET, RSE, MER, IJECE, etc.), he serves as a reviewer in international journals (IJAC, ECPS, COMPEL, etc.). He serves as member in technical committee (TPC) and reviewer in international conferences (CHUSER 2011, SHUSER 2012, PECON 2012, SAI 2013, SCSE2013, SDM2014, SEB2014, PEMC2014, PEAM2014, SEB (2014, 2015), ICRERA (2015, 2016, 2017, 2018,-2019), etc.). His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. 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