",isbn:"978-1-80356-966-6",printIsbn:"978-1-80356-965-9",pdfIsbn:"978-1-80356-967-3",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"f86a9f720cc3ac0f1c385d0367ea89b9",bookSignature:"Dr. Fiaz Ahmad and Prof. Muhammad Sultan",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11624.jpg",keywords:"Agricultural Waste, Reuse, Reduction, Soil Health, Recycling, Agriculture and Environment, Modelling and Simulation, Agro-Industrial Waste, Bioresource Processing, Processing and Management, Crop Residue, Forest Waste",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 8th 2022",dateEndSecondStepPublish:"June 16th 2022",dateEndThirdStepPublish:"August 15th 2022",dateEndFourthStepPublish:"November 3rd 2022",dateEndFifthStepPublish:"January 2nd 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Fiaz Ahmad is a researcher in the field of Agricultural Engineering with fifteen years of field and academic experience, currently in charge of the Agricultural Machinery Design Laboratory at Bahauddin Zakariya University. He applied for two patents at the national level.",coeditorOneBiosketch:"A renowned researcher in the field of Agricultural Engineering with 14 years of academic experience at Bahauddin Zakariya University. Winner of various prestigious fellowships, awards, and research grants. Published 250+ articles along with several books and chapters. Guest editor of seven ISI-SCI journals for publishers like SAGE, MDPI, and Frontiers.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"338219",title:"Dr.",name:"Fiaz",middleName:null,surname:"Ahmad",slug:"fiaz-ahmad",fullName:"Fiaz Ahmad",profilePictureURL:"https://mts.intechopen.com/storage/users/338219/images/system/338219.png",biography:"Dr. Fiaz Ahmad is an assistant professor and lecturer at the Department of Agricultural Engineering, Bahauddin Zakariya University, Multan, Pakistan. He obtained his Ph.D. in Agricultural Bioenvironmental and Energy Engineering from Nanjing Agriculture University, China, in 2015, and completed his postdoctorate in Agricultural Engineering from Jiangsu University, Zhenjiang, China, in 2020. He was awarded a fellowship from the Higher Education Commission of Pakistan for Ph.D. studies and from the Chinese Government for post-doctoral studies. He earned a BSc and MSc (Hons) in Agricultural Engineering from the University of Agriculture, Faisalabad, Pakistan, in 2004 and 2007, respectively. He is the author of more than fifty journal and conference articles. He has supervised six master’s students to date, and is currently supervising six master and two doctoral students. Dr. Ahmad has completed three research projects with his research interest focusing on the design of agricultural machinery, agricultural waste management, artificial intelligence (AI), and agricultural bioenvironment.",institutionString:"Bahauddin Zakariya University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Bahauddin Zakariya University",institutionURL:null,country:{name:"Pakistan"}}}],coeditorOne:{id:"199381",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sultan",slug:"muhammad-sultan",fullName:"Muhammad Sultan",profilePictureURL:"https://mts.intechopen.com/storage/users/199381/images/system/199381.png",biography:"Muhammad Sultan is an Assistant Professor at the Department of Agricultural\r\nEngineering, Bahauddin Zakariya University, Multan (Pakistan). He completed his Ph.D.\r\nand Postdoc from Kyushu University (Japan) in the field of Energy & Environmental\r\nEngineering. He was an awardee of MEXT and JASSO fellowships (from the Japanese\r\nGovernment) during Ph.D. and Postdoc studies, respectively. He also did a Postdoc as\r\na Canadian Queen Elizabeth Advance Scholar at Simon Fraser University (Canada) in\r\nthe field of Mechatronic Systems Engineering. He worked for Kyushu University\r\nInternational Institute for Carbon-Neutral Energy Research (WPI-I2CNER) for two years.\r\nCurrently, he is working on 4 research projects funded by the Higher Education\r\nCommission (HEC) of Pakistan. He has completed six projects in past in the field of\r\nagricultural engineering. He has supervised 10+ M.Eng. and Ph.D. thesis and 10+\r\nstudents are currently working under his supervision. He has published 120+ journal\r\narticles, 100+ conference articles, 13 book chapters, and 6 books. He is serving as guest\r\neditor for the journals like Sustainability (MDPI), Agriculture (MDPI), Energies (MDPI),\r\nAdvances in Mechanical Engineering (SAGE), Frontiers in Mechanical Engineering, and\r\nEvergreen Journal of Kyushu University. His research is focused on developing energy-\r\nefficient temperature and humidity control systems for agricultural storage, greenhouse,\r\nlivestock, and poultry applications. His research keywords include desiccant air-\r\nconditioning, evaporative cooling, adsorption heat pump, Maisotsenko cycle (M-cycle),\r\nenergy recovery ventilators; adsorption desalination; wastewater treatment.",institutionString:"Bahauddin Zakariya University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Bahauddin Zakariya University",institutionURL:null,country:{name:"Pakistan"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"5",title:"Agricultural and Biological Sciences",slug:"agricultural-and-biological-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"440212",firstName:"Elena",lastName:"Vracaric",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/440212/images/20007_n.jpg",email:"elena@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. 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1. Introduction
During the past decade, simultaneous pancreas kidney transplantation has been widely accepted as the most effective way to achieve normoglycemia in patients with type1 diabetes and end-stage renal disease. This procedure was performed for the first time on a human in 1966 but it was in the 1980s, with advances in surgical technique and introduction of cyclosporine for immunosuppression, that the success rates of SPK became acceptable. According to international pancreas transplant (IPTR) report as of December 31, 2004, 23,043 pancreas transplants were performed worldwide. These included more than 17,000 (17,127) performed in the United States (US) and nearly 6,000 (5,916) from outside the US (non-US). In the US, the majority of the cases, 78% (n=11,898), have been simultaneous pancreas-kidney transplants (SPK); 16% (n=2427) are pancreas after kidney (PAK) transplants; 7% (n=1,008) are pancreas transplants alone (PTA).
Indications for pancreas transplantation include the development of diabetic complications such as ESRD, retinopathy or multiple attacks of hypoglycemic unawareness. Unfortunately, pancreas transplantation has been associated with the highest surgical complication rate of all the routinely performed organ transplant procedures (except for small intestinal or multivisceral transplantation) and the risk of pancreas graft loss from surgical complications (technical failures) is higher than from immunological reasons. The overall incidence of surgical complications in PTx is reported to be around 10% to 38%. This high rate of complications leads US centers to preclude PTA in most centers and now over 95% of pancreas transplantations are performed in patients with renal disease or a previous functioning kidney transplant. One year patient, kidney, and pancreas survival rates for recipients of an SPK transplant are 95%, 91%, and 86%, respectively. Compared to patients with diabetes who receive a kidney alone, the addition of a pancreas improves long-term patient and kidney graft survival.Recipients of a pancreas-after-kidney transplant or a pancreas transplant alone have an average 1-year pancreas graft survival rate of 78-83%.
In this chapter we will thoroughly describe many aspects of this complex transplantation procedure including:
The history of pancreas transplantation
Indications for pancreas transplantation
Surgical aspects of pancreas graft procurement from the deceased donor
Current surgical techniques for pancreas transplantation
Immunosuppressive regimens
Postoperative care of pancreas transplant recipients
Complications of pancreas transplantation
Long term results of pancreas transplantation
2. History of pancreas transplantation
Experimental transplantation of the pancreas in animals began as early as 1890 with proved success in the treatment of insulin dependent diabetes mellitus (Burke GW, et al, 2004). Grafting 3 pieces of sheep pancreas into the subcutaneous tissue of a diabetic child by Williams in 1893 was another attempt to treat diabetes but the patient died after 3 days because of severe ketoacidosis (Williams PW, 1903). The first clinical attempt to cure type 1 diabetes by vascular pancreas transplantation was done simultaneously with kidney transplantation, at the University of Minnesota in 1966 three years after first successful kidney transplantation (Kelly WD, et al, 1967), but the procedure was not performed with any frequency until many years later. Only 12 cases were done between 1967 till 1973 at the same center but almost all of them rejected before the first year after the operation. Segmental pancreas transplantation from living donors first introduced in 1979. Besides the rejection and vascular problems, dealing with pancreas exocrine secretion was complicated this type of procedure from the early days. By the mid-70s three different techniques were in use: enteric drainage, urinary drainage (into the ureter or directly into the bladder and duct injection. Ureteral drainage was first introduced by Gleidman et al (Gleidman et al, 1973). Bladder drainage first by direct anastomosis of the pancreatic duct to the bladder by Sollinger et al (Sollinger HW, et al, 1984) and then by duodenocystostomy by Nghiem and Corry (Nghiem DD & Corry RJ, 1987) was the most common method for exocrine drainage during the 1980s and 1990s and was still in use in some centers around the world specially for solitary pancreas transplantation. In the early 80\'s, a dramatic improvement in outcomes happened due to introduction of cyclosporine for immunosuppression (Squifflet JP, et al, 2008). In 1984, Starzl et al (Starzl et al,1984) reintroduced the technique of enteric drainage as originally described by Lillehei which is now is the routine procedure in most pancreas transplant centers.
In 1992, systemic venous drainage which was done through anastomosis of the portal vein to recipient iliac veins was replaced by direct portal drainage by Rosenlof et al (Rosenlof LK, et al, 1992) and also Shokouh-Amiri et al (Shokouh-Amiri MH, et al, 1992) because of its more physiologic pattern of insulin delivery. Now during the modem era of immunosuppression, the whole pancreas transplantation technique with portal - enteric drainage became the gold standard for simultaneous pancreas and kidney transplantation (SPK), and even for pancreas after kidney (PAK) or pancreas transplantation alone (PTA) and as of December 31, 2004, 23,043 pancreas transplants were reported to the international pancreas transplant registry (IPTR) of whom over 60% were performed in the united states.
3. Indications for pancreas transplantation
Patients with type 1 or insulin dependent type 2 diabetes mellitus are eligible for pancreas transplantation when they have any major complications of their disease, but because of complications of this type of surgery and need for lifetime immunosuppression therapy and frequent interventional surveillance (such as protocol biopsies), both the clinicians and the patients should be aware of those conditions that really might benefit from pancreas transplantation. Most common indications are as follows: diabetic nephropathy, retinopathy, neuropathy, disabling or life threatening hypoglycemic unawareness or incapacitating emotional or clinical problems associated with insulin therapy (White et al, 2009). Some of the rare indications (which are not accepted by all transplant surgeons) are diabetic complications after total pancreatectomy, presence of other autoimmune diseases, insulin allergy or resistance to subcutaneous insulin.
Patients should be considered as potential candidate for pancreas transplantation only when their morbidity or mortality risk of the surgical procedure or long term immunosuppressive treatment are lower than the diabetic complications (Meloche RM, 2007). Unfortunately, most patients with chronic diabetes who develop these complications have major comorbidities such as obesity, cardiovascular, cerebrovascular or peripheral vascular diseases, diabetic gastropathy, and vascular or neuropathic diabetic foot. These patients are most suitable for pancreatic islet cell transplantation which is very simpler and has fewer and more minor complications that the relatively complex surgical procedure of whole pancreas transplantation.
Patients with diabetic nephropathy who need concomitant renal transplantation are the most common eligible patients who benefits from simultaneous kidney pancreas transplantation (SPK). Those who previously underwent kidney transplantation are candidate for pancreas after kidney (PAK) transplantation. According to 2004 annual IPTR report (The University of Minnesota, modified on May 28, 2009, available from www.iptr.umn.edu/annual_reports/2004_annual_report/3_txs_cat/home.html) pancreas transplant alone (PTA) now performed in less than 5% of all pancreas transplant recipients because unlike SPK or PAK recipients they don’t otherwise need immunosuppression for their renal allograft and surgical complications of this procedure and higher rejection rate of this type of operation outweigh the potential benefits of glycemic control. PTA is best appropriate for those patients with hypoglycemic unawareness, stable renal function, and minimum proteinuria (White et al, 2009), because calcineurin inhibitor immunosuppressive therapy reduces the glomerularfiltration rate at least 20% in the first year after pancreas transplantation (Mazur et al, 2004) PAK transplantation is performed mostly in patients who have an appropriate living donor for kidney graft and also are simultaneously candidate for pancreas transplantation. When coordinate logistics available, these operation using kidney graft from the living donor and pancreas graft from a deceased donor may be performed at the same time and at the same center. In some centers partial segmental pancreas transplantation technique is used for SPK when the living donor is suitable for this complex procedure firstly performed by Merkel in 1973 (Merkel et al, 1973).
The contraindications for pancreas transplantation are the same as other types of transplantations (Tiong & Krishnamurthi, 2011): active infections, coronary angiographic evidence of significant non-correctable or untreatable coronary artery disease, recent myocardial infarction, ejection fraction below 30%, history of recent, incompletely treated malignancy (excluding non-melanoma skin cancer), positive HIV serology, positive hepatitis B surface antigen serology, substance abuse, major ongoing psychiatric illness, recent history of noncompliance, inability to provide informed consent, any systemic illness that would severely limit life expectancy or compromise recovery, significant, irreversible hepatic or pulmonary dysfunction. In major pancreas transplant centers like University of Wisconsin, Minnesota, correctable (by stenting, angioplasty or bypass) coronary artery disease is not considered as a contraindication for pancreas transplantation (Sollinger HW, et al, 2009). Most pancreas transplant programs exclude patients older than 45-50 years of age, because higher age is an independent risk factor for predicting poorer surgical outcome, although the rejection rate is significantly lower in this age group (Gruessner AC & Sutherland DE, 2005).
4. Surgical aspects of pancreas graft procurement from the deceased donor
Not all deceased donors are suitable for pancreas graft procurement. Absolute contraindications for pancreas donation are active infection or malignancy, positive serologic evaluation for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T cell lymphotropic virus type 1 (HTLV-1), proved diabetes mellitus, pancreatitis (acute/chronic), severe pancreatic steatosis or edema, previous pancreatic surgery and intra-abdominal sepsis. Donor hyperglycemia is common because of stress condition and use of high dose corticosteroids and not a contraindication for use of the pancreas, although it may contribute as a minor risk factor for long-term graft loss (Gores, et al, 1992). Most surgeons only select younger non-obese donors (age 10-50 years, weight 30-100 kg) who are hemodynamically stable without need to high doses of vasopressors. Also a cardiocerebrovascular cause of brain death and massive volume resuscitation are other risk factors for postoperative complications in the recipients (Troppmann C, 2004). Because of these stringent criteria, according to IPTR report, in the United States only 21% of the deceased donor pancreata were used for transplantation during the year 2004. Because pancreas transplantation is not life saving, procurement of other donor organs are more important. If the surgeon considers that the pancreas is not suitable for transplantation it may be used for research or pancreas islet cell transplantation (Shapiro, et al, 2000).
The procedure starts with a long midline incision from suprasternal notch to symphysis pubis area usually by the liver team. All intrathoracic and abdominal organs are evaluated systematically to rule out any suspicious lesion. First, all usual dissections for controlling supraceliac and infrarenal aorta, arc of thoracic aorta and superior or inferior mesenteric vein should be performed, so in case that patient becomes unstable the surgeon can rapidly proceed with cold perfusion of the organs for their safe retrieval. The right colon is completely mobilized from retroperitoneum and then an extended Kocher maneuver is done. All ligaments of the liver are transected and then arterial anatomy of the liver and pancreas is evaluated by palpating the hepatic artery pulsation in the hepatodudenal portion of lesser omentum. The surgeon should have complete knowledge of hepatic artery abnormalities and possibility of existence of a right accessory or right replaced hepatic artery that originate from superior mesenteric artery. In rare cases the entire hepatic artery are originated from superior mesenteric artery. With novel microsurgical techniques none of these anomalies is considered as a contraindication for concomitant liver, pancreas or small intestinal harvesting from a deceased donor. It’s better to perform a dissection of the supraduodenal area to reveal the anatomy of common hepatic artery, gastroduodenal and celiac trunk branches specially the origin of the splenic artery. The other dissections may be performed after cold perfusion. The common bile duct is divided and infrarenal aorta and superior or inferior mesenteric vein are cannulated at the next stage. Supraceliac aorta is clamped 3-5 minutes after systemic heparinization and the heart team also clamps the aortic arc and cold perfusion is started.
The most commonly used solutions for cold perfusion are Belzer University of Wisconsin (UW), histidine - tryptophan - ketoglutarate (HTK) and Celsior solution with no significant difference in the results when cold ischemia time is less than 12 hours, but UW is the standard solution in most centers (Fridell et al, 2010).
The donor blood evacuated through the supradiaphragmatic or in some certain cases(such as history of previous thoracic surgery)infrarenal inferior vena cava (IVC). After removing the heart and lungs, liver, pancreas and small intestine usually are procured en bloc and the remaining dissection may be performed in the bench procedure. The duodenal lumen is irrigated by 500 ml of 20% Betadine, 50 mg/ml amphotericin B and metronidazole solution through the nasogastric tube and distal and proximal part are transected by gastrointestinal (GIA) staplers. The portal vein is divided 1 cm to 2 cm above the pancreas border. The gastroduodenal artery is divided and suture ligated and the splenic artery is divided close to its origin and marked by a nonabsorbable 6-0 suture for future identification. The base of mesentery at the inferior border of pancreas is transected by another GIA stapler and the whole pancreas-duodenum-spleen graft removed.
In back table or bench procedure, all excessive fat tissue and spleen should be removed and the origin of mesentery and all small arterial and venous branches in the inferior border of pancreas is reinforced again for future hemostasis. Duodenum is shortened again and reinforced in both distal and proximal side by non-absorbable sutures. Arterial reconstruction is performed by anastomosis of the donor iliac Y-graft, external and internal iliac branches to the graft superior mesenteric and splenic artery, respectively. We also recommend using a small segment of donor left gastric or inferior mesenteric artery for reperfusion of gastroduodenal artery for better circulation of duodenum and head of pancreas to prevent future frequent duodenal ulcers in the graft.
5. Current surgical techniques for pancreas transplantation
Forty five years after the first SPK, controversy continues regarding the site of both venous effluent and exocrine drainage and also many other aspects in this complex surgical procedure. In most centers, SPK is performed separately by two teams. During kidney transplant procedure, the pancreas team prepares the pancreas graft for transplantation. Usually an intraperitoneal approach is used by a long midline incision and the kidney graft is transplanted by standard technique to left iliac fossa (renal artery to internal or external iliac artery and then renal vein to external iliac vein and at last ureter to the bladder or native ureter as described in other chapters of this book). Use of right side for pancreas transplantation is recommended due to more superficial iliac artery position in this side, which makes arterial anastomosis easier. The next step is arterial or venous reconstruction. Except for a few minor changes in arterial reconstruction technique (such as reperfusion of gastroduodenal artery or changing the site of arterial inflow), there is no significant change in the arterial reconstruction technique during these era. There are at least 2 options for venous drainage: systemic or portal drainage. It’s better to reconstruct the venous drainage before arterial anastomoses because a short portal vein of the graft may limit the later maneuvers needs for venous anastomosis. In our center we use the recipient superior mesenteric vein at the base of mesentery below the transverse mesocolon for venous outflow(portal drainage) and right common iliac artery for arterial inflow to the donor iliac Y-graft. Those surgeons that prefer to use systemic venous drainage use the right external or common iliac vein as the venous outflow, perfectly as the same manner that they used external iliac artery and vein for kidney transplantation. After completing the arterial and venous anastomoses, the graft is reperfused and complete hemostasis is done. Usually despite every effort for complete hemostasis during back table preparing of the pancreas graft, there is brisk bleeding around the borders of the graft at the time of reperfusion and crystalloid and blood product replacement should be used to prevent hypotension and subsequent damage to the kidney and pancreas grafts. Graft splenectomy is done at this stage by some surgeons. The next step is anastomosis of the graft duodenum to the recipient jejunum (enteric drainage) or bladder (bladder drainage). When portal drainage is chosen, the pancreas head should be directed cephalad and use of bladder drainage is almost impossible and vice versa. In other words, if the surgeon selects bladder drainage for duct management (as is the case for most PTA surgeries), the pancreas head should be directed caudad and use of portal venous drainage won’t be possible. Also if portal drainage is used we need a rather longer donor common iliac artery or even an extension graft for arterial reconstruction of the graft.
Drains are inserted at the end of operation around the kidney and pancreas graft separately to monitor for postoperative bleeding and leakages. We prefer to perform the kidney transplant operation retroperitoneally in the left iliac fossa and at the end use the peritoneum to hide the kidney to be able to monitor the kidney graft complications such a urine leakage and lymphocele s1eparately from the pancreas graft.
It is worthwhile to describe briefly about the evolution of these techniques in the leading center of pancreas transplantation in the world, University of Minnesota (Sutherland DE, 2001). For pancreas graft duct management they used many techniques during this long term period: a cutaneous graft duodenostomy, open duct free intraperitoneal drainage, duct occlusion (simple ligation or polymer-injection), enteric drainage (ED) and urinary drainage (bladder and only 4 cases to the ureter). Except for ED and bladder drainage (BD), the other techniques of duct management were used only in the early years of pancreas transplantation evolution in a small portion of their cases because of their recognized complications and now they (along with most other pancreas centers around the world) lose their early enthusiasm to BD technique because of its chronic complications such as hyperchloremic metabolic acidosis, dehydration, chemical cystitis and urethritis, recurrent hematuria, bladder stones, and recurrent graft pancreatitis, recurrent urinary tract infections, urethral stricture and perineal excoriations (Han DJ & Sutherland DE, 2010). They recommended using BD for duct management because they could monitor the graft function by serial measurement of urinary amylase and they had showed that decrease in urinary amylase always preceded hyperglycemia as a manifestation of rejection in pancreas grafts. For SPK bladder drainage transplants, monitoring of urine amylase was less important to detect rejection because a serum creatinine elevation usually preceded a urine amylase decline when the rejection episode affected both organs. In the past, severe complications would lead to conversion of BD to ED in up to 25% of patients within 10 years (Sollinger HW, et al, 1992). Enteric drainage also has many complications (at least risk of enteric contamination) that may be devastating in case of duodenal necrosis and gastrointestinal leakage.
Several options are available for enteric drainage: side-to-side duodenojejunostomy, or duodenojejunostomy with a Roux-en-Y limb and duodenoduodenostomy (Hummel et al, 2008). The site of duodenojejunostomy (distance from the Treitz ligament) and its length are different between authors. Although duodenoduodenostomy complications are more dangerous but endoscopic biopsy and hemostasis of duodenal ulcers of the transplanted pancreas-duodenum complex will be made feasible by this technique.
Systemic venous drainage is technically less demanding and used with less difficulty and more frequently by those surgeons who are familiar with kidney transplantation technique. In the early days of pancreas transplantation in the University of Minnesota, portal venous drainage was used for the pancreas graft venous effluent only in seven cases. Systemic hyperinsulinemia caused by systemic drainage first was showed by Diem et al (Diem et al, 1990). This concept lead Rosenlof et al (Rosenlof LK, et al, 1992) and Shokouh-Amiri et al (Shokouh-Amiri MH, et al, 1992) to recommend routine use of portal drainage for SPK transplants in 1992 because of its more physiologic pattern of insulinemia, although the carbohydrate metabolism is not different in both groups some authors showed that de-novo hyperinsulinemia predisposes to accelerated atherosclerosis (Fontbonne A, et al, 1991) and increasing the level of low density lipoprotein( LDL) (Hughes TA, et al, 1995) but its relevance to pancreas transplant recipients is not certain.
Some centers now use extra- or retroperitoneal approaches for better accessibility of the pancreas graft for postoperative routine percutaneous biopsies and easier arterial anastomosis and some of them suggest using an en bloc kidney-pancreas transplantation from the same donor. The technique of retroperitoneal pancreas transplantation with portal-enteric drainage was first described by Boggi et al in 2005 (Boggi et al, 2005). This method may be used in patient with severe intraperitoneal adhesions due to multiple previous abdominal surgeries and also for pancreas retransplant. Kahn et al described the same technique by systemic venous drainage (Kahn et al, 2008). They recommend this approach in obese patient with severe iliac artery atherosclerosis because of best exposure of the aorta and inferior vena cava by this method. In the en bloc techniques donor pancreas and left (or right kidney) is harvested en bloc in line with abdominal aorta so that the superior mesenteric, celiac artery and renal artery origins are maintained intact on the aorta and no arterial reconstruction by donor iliac artery would be needed in the back table procedure. Then the aorta could be used as the complex graft inflow conduit. Portal vein and renal vein may be anastomosed separately (Schenker P, et al, 2009) but we recommend to anastomose the graft portal vein to the left renal vein in the bench procedure, and then use the graft renal vein as the venous outflow of the graft. This will reduce the warm ischemia time by reducing the number of vascular dissections and anastomoses.
6. Immunosuppressive regimens
Unlike other solid organ transplantations, pancreas transplantation needs immunosupression for prevention of alloimmune rejection or autoimmune recurrence of diabetes mellitus even in transplant between identical twins (Sutherland DE, et al, 1984). In the early years of pancreas transplantation, only azathioprine and prednisone were used for immunosupression, but such a regimen was not adequate for prevention of rejection in PTA recipients (Sutherland et al, 2001). In the later years Minnesota antilymphocyte globulin added to this regimen for induction and maintenance immunosupression evolved to triple therapy by cyclosporine, azathioprine and prednisone. This change along with better surgical methods and better preservation of the deceased donor pancreas by UW solution resulted in better long term results of pancreas transplantation during the era of late 80’s and early 90’s. The pancreas rejection rate remained as high as 78% in this era (Stegall MD, et al, 1997). Gradually, cyclosporine and azathioprine were replaced by Tacrolimus(Prograf™) and Mycophenolate mofetil (MMF, Cellcept™) during the later years and monoclonal anti T cell antibodies such as basiliximab and daclizumab added to induction immunosuppressive regimen of these patients. By use of these new regimens, risk of rejection decreased to less than 8-11% in the modern era of pancreas transplantation (Cantarovich D & Vistoli F, 2009).
The routine immunosupression regimen in most pancreas transplant centers includes a T cell depleting agent such as rabbit antithymocyte globulin (rATG or Thymoglobulin™) with a total dose of 4-12 mg/kg in divided doses, or alemtuzumab (Campath™) or an interleukin-2 receptor antagonist such as basiliximab(Simulect™) or daclizumab (Zenapax™) for induction immunosupression. We add a low dose intravenous methylprednisolone (Solumedrol™) in the day of operation to prevent allergic reactions to these agents. Unfortunately, these induction regimens only reduce the biopsy proven acute rejection (BPAR) episodes, but had no or modest effect on the patient or graft long term survival (Sutherland DE, 2009). Information about use of anti inter leukin-2 receptor antibodies are confounding. For example, Becker et al. found no significant differences in patient and graft survival comparing the outcomes of no induction versus daclizumab or basiliximab in 63 SPK transplant recipients receiving tacrolimus, MMF and prednisone. There was, however, a slightly higher rate of deaths due to sepsis in the anti-IL-2R induction group (Becker et al, 2006). Newer data mostly agree with the use of alemtuzumab for induction immunosuppression,without incurring a risk of increased infections or malignancies except for cytomegalovirus. (Sollinger et al, 2011). A new randomized trial has showed that in the short term follow-up after SPK, alemtuzumab and rATG induction therapies has been similarly safe and effective but alemtuzumab is more cost-effective and has been associated with less BPAR episodes (Farney AC, et al, 2009).
For maintenance immunosupression, perhaps the best current regimen is prednisolone free or rapidly steroid tapering regimens which consist of tacrolimus and MMF combinations. Omitting the steroids from the maintenance regimens results in better wound healing and also prevents from steroid induced insulin resistance. Replacing the MMF with sirolimus has no effect on pancreas rejection rates, but had poorer long term kidney graft survival in the SPK recipients, because sirolimus accentuates the nephrotoxicity of tacrolimus (Gallon LG, et al, 2007). Tacrolimus per se had diabetogenic effects in other solid organ transplant recipients, but such an effect has not been shown in pancreas transplant recipients, may be due to more cautious use of this nephrotoxic drug in SPK recipients or use of healthier donors for pancreas transplantation (Ming CS & Chen ZH, 2007). Because of known nephrotoxicity of calcineurin inhibitors (CNIs) e.g. tacrolimus or cyclosporine, avoidance of these drugs in all pancreas transplant recipients who are potentially at risk of renal damage (SPK or PAK recipients) or future renal failure (PTA recipients) is desirable but all initial attempts with calcineurin inhibitor avoidance or minimization are less promising (Singh RP & Stratta RJ, 2008). Although newer agents such as sirolimus, everolimus, and CTLA-4 Ig are agents known to be either both nonnephrotoxic and nondiabetogenic or less so when compared with CNIs, but their impact on pancreas transplant results are not yet evaluated by randomized trials and their solitary use may be dangerous for the recipients and end up with graft loss (Cantarovich D & Vistoli F, 2009).
7. Postoperative care of pancreas transplant recipients
Perioperative care of pancreas transplant patients has no difference with any other major operation in diabetic patients. Kidney-pancreas recipients should be dilysed briefly for 1-2 hours before the operation to maintain the serum potassium below 5.5 meq/l and also to optimize the platelet function. Complete fluid removal is unnecessary. During the operation all of these patients need routine anesthesiologist monitoring with special attention to hemodynamic stability, tight control of blood sugar (to prevent both hypo- or hyperglycemia) and serum potassium, arterial blood gas and prevention of volume overload by keeping central venous pressure (CVP) around 8-10 mmHg. Ketoacidosis may be occur and should be prevented by intravenous insulin infusion if required. Sterile aseptic techniques are recommended for all venous and arterial line placements.
In kidney-pancreas recipients, usually kidney transplantation is done before the pancreas operation. During the kidney operation the patient is kept mildly volume expanded and before declamping the renal vasculature, the systolic blood pressure should be around 120 mmHg and Mannitol and furosemide should be infused as described in the other chapters of this book. Induction immunosuppressant (methylprednisolone or any types of t-cell receptor or interleukin-2 antibodies) usually started preoperatively and continued throughout the operation. Some surgeons advise to use these agents prior to declamping of vascular anastomoses.
After completion of kidney transplantation, the anesthesiologist should carefully monitor the brisk urine output and maintain it at least around 4 ml/kg/hour with appropriate fluid and electrolyte management throughout the remaining of the operation. Hypovolemia leads to acute tubular necrosis (ATN) of the renal allograft and volume overload will result in bowel and pancreas graft edema and may lead to postoperative abdominal compartment syndrome and graft dysfunction. Anticoagulation is not recommended for general kidney transplant alone recipients unless in the instance of presence of any other indications like mechanical heart valve or history of coagulopathy. But because pancreas is a low blood flow organ, especially when portal drainage is chosen as the preferred method for surgery, before clamping of the inflow veins or arteries, it’s better to use systemic heparinization of the patient and we prefer to continue intravenous heparin postoperatively at least for 5 days to maintain the activated partial thromboplastin time (aPTT) around 1.5 times the normal value (between 55 – 85 seconds) to prevent graft vascular thrombosis.
After the operation the patient is transferred to transplant intensive care unit and CVP, vital signs, arterial blood gas, blood pressure, urine output and blood glucose are monitored continuously. Almost all patients are extubated in the operating room and don’t need postoperative mechanical ventilation.
Kidney transplant patients usually have large urine outputs (as much as 20 liters/day) that should be replaced according to the patient fluid and electrolyte condition as discussed in the other chapters. Hypotension is usually due to intraabdominal bleeding (even in the absence of drainage from abdominal drains) or gastrointestinal bleeding from duodenal anastomosis and should be treated emergently by reexploration of the patient and fluid management. Hypertension should be avoided and treated appropriately to prevent bleeding and graft malfunction.
Oral immunosuppressive drugs (usually tacrolimus and MMF) are started after the day of operation. Prednisolone replaces intravenous methylprednisolone after 3 days by a dose of 0.5-1 mg/kg/day, but rapidly tapered to near zero during the next 4 weeks-3 months. All patients should receive prophylactic broad spectrum antibiotics for 2-5 days and most centers add antifungal drugs (such as amphotericin B or an azole derivative or caspofungin) and anti cytomegalovirus (CMV) drugs (e.g. gancyclovir) to this regimen. These protocols are different slightly among pancreas transplant centers and its better and mandatory that each physician follow the routines of her/his center to avoid and confusion in the patients and personnel and future evaluations of the center. During the first 24 hours the patient may need small doses of intravenous insulin for maintaining the blood sugar below the 200 mg/dl because of delayed graft function or use of high doses of corticosteroids but after that or in case of any unusual increase in the serum glucose level, prompt assessment of graft vascular status by Duplex ultrasound and appropriate intervention should be done emergently. We routinely monitor the graft vasculature by Duplex ultrasound at least every 12 hours for 5 days after the operation. Many other means are available for continuous monitoring of graft function besides the blood sugar and duplex scanning. Serial measurements of serum amylase and/or lipase, C-peptide, and urine amylase and protocol ultrasonographic or computerized scan (CT) guided biopsies are among them (Han DJ & Sutherland DE, 2010).
Drains should be monitored for unusual leakage or bleeding and removed as soon as possible (usually after 5 days for pancreas drains and 24 after removing the Foley catheter for perirenal drain). Nasogastric tube remains until the return of gastrointestinal function usually for at least 72 hours. A recent study has showed that omission of a nasogastric tube has been associated with earlier return of bowel function, less discomfort, and shorter length of stay (Barth RN, 2008). Ambulation of the patient is desirable in the first 24 hours after the operation to prevent deep vein thrombosis and also other known complications of bedridden patients such as atelectasis or postoperative ileus.
8. Complications of pancreas transplantation
Despite large improvements in immunosuppression and surgical techniques, the history of pancreas transplantation, unlike that of other abdominal organ transplants, has largely been shaped by its associated complications (Troppmann C, 2010). We can discuss about these complications in 3 distinct categories: surgical, infectious, immunologic and other non-immunologic. Infectious complications are not specific for pancreas transplantation and many of their aspects are in common with other solid abdominal organ transplantation and discussion about them is presented in other chapters of this book.
Surgical complications
Surgical complications now decreased to at least 8% in large series reported by experienced pancreas transplant center s around the world and most of them frequently result in graft loss and increase recipient morbidity and mortality significantly and augment transplant cost considerably (Goodman J & Becker YT, 2009). Many of the surgical complications (such as hematuria, duodenocystostomy leakage, reflux pancreatitis, etc) are unique to the bladder drainage as previously discussed. These known complications lead pancreas transplant centers to avoid from bladder drainage and use this technique only for PTA cases. Over 25% of these cases require conversion of BD to ED.
Vascular thrombosis
Vascular thrombosis has remained the most common complication of pancreas transplant procedure with a frequency of 3-10% (Gruessner AC & Sutherland DE, 2009). Other major complications include: intraabdominal bleeding, gastrointestinal bleeding, leakage (from duodenal anastomosis), pancreatitis, pancreatic necrosis, pancreatic fistula, abscess formation and other complications of any other major abdominal surgery such as atelectasis, pneumonia, deep vein thrombosis, wound infection, dehiscence, and cardiovascular problem which is common in diabetic and chronic renal failure patients.
Graft vascular thrombosis has many factors that most of them are technical because of several vascular anastomoses that needs for pancreas transplantation. Rotation during arterial reconstruction at the time of back table preparing, inadvertent intimal damage to the iliac artery Y-graft during harvesting and over inflation of the arteries during flushing are the known causes of arterial thrombosis. Higher donor age, cardiocerebrovascular cause of brain death and massive fluid resuscitation and hemodynamic instability of the donor and use of HTK as the preservation solution, especially when cold ischemia time is over 12 hours, and recipient hypercoagulable states or use of sirolimus are other important factors (Troppmann C, 2010). Venous thrombosis may be secondary to arterial thrombosis, severe pancreas rejection, and severe graft pancreatitis or may be completely technical or due to use of venous extension graft. There is no difference in the rate of graft thrombosis according to the venous drainage (systemic or portal) technique. Also PAK transplantation has been an independent risk factor for graft vascular thrombosis (Troppmann C, et al, 1996). Most centers use systemic heparinization for prevention of vascular thrombosis and continue this treatment for 5-7 days and after that change this regimen to 325 mg/day acetyl salicylic acid (ASA) or warfarin for selected cases (second transplants or confirmed hypercoagulable state), although some authors hadn’t agree with this concept in the past (Sollinger HW, 1996). Usually the first sign of graft thrombosis is increasing the blood sugar level that should be promptly assessed by Duplex ultrasound. The patient may complain from abdominal pain and later abdominal tenderness will be revealed. Venous thrombosis will results in dark hematuric urine if bladder drainage had been used. Except for a few case reports most of these cases needs relaparotomy for graft removal, but if diagnosed early interventional radiologists or reanastomosis may be very rarely salvage the graft.
Leakage\n\t\t\t
Leakage from duodenojejunostomy or duodenoduodenostomy is a devastating complication of pancreas transplantation that may be associated with high morbidity and mortality, if recognized late. Because of spillage of enteric content, the patients develop signs and symptoms of peritonitis such as abdominal pain and tenderness, fever, high leukocytosis, and bilious content in abdominal drains. Sometimes this leakage is minor and the site of leakage contained by thegreater omentum. Using broad spectrum antibiotics and Roux-en-Y reconstruction help more to obscuring the symptoms. In this situation, signs and symptoms may be obscure and only developing ileus, low grade fever, tachycardia and tachypnea, mild hyperglycemia, hyperamylasemia, low platelet count, will lead the surgeon to perform additional imaging studies (mostly abdominal CT scan) to diagnose this problem. The patient should be undergone exploration and in most cases the best option is graft pancreatectomy if peritonitis is diffuse or associated by multiple intraabdominal abscesses, or the patient ids unstable. Leakage from bladder drained pancreas may have milder symptoms and treated by combined bladder decompression and percutaneous drainage or conversion to enteric drainage. In cases of severe sepsis or diffuse infection, graft pancreatectomy is inevitable. Obscure leakages may be revealed as late as 2 weeks after the operation by abdominal abscess or pancreatic fistula that may be treated conservatively by percutaneous drainage, but many times the patient will prefer the graft to be removed because of the associated bothering complications such as skin excoriations by pancreas secretions. Also, pancreas fistula may be a complication of focal necrosis (due to ischemia, rejection or infection) of the pancreas graft which communicate with the pancreatic duct or a complication of graft pancreatitis.
Many factors is contributed to anastomosis leakage, including technical errors, ischemia of the head of pancreas (due to vascular events, previous atherosclerosis of the donor, edematous duodenum at the time of reconstruction), reexploration for another causes, intraabdominal bleeding or diffuse primary peritonitis, severe acute rejections, and CMV infections. Some surgeons suggest that revascularization of the gastroduodenal artery or even the gastroepiploic artery may prevent ischemia of the head of pancreas and the duodenal C-loop (Nghiem DD, 2008 and Muthusamy ASR et al, 2008). We use this technique in every patient that the gastroduodenal artery is relatively large. This may also protect the duodenum from later ulcers and bleeding.
Pancreatitis
There is no uniformly accepted definition for graft pancreatitis, but all of the available definitions include the signs and symptoms of native pancreatitis with rising lipase and amylase, and maintained endocrine function (Troppmann C, 2010). Unfortunately these serum markers associated poorly with graft pancreatitis and may be prolong elevated after pancreas transplantation. Early pancreatitis is the result of poor graft handling, long ischemia time and preservation and reperfusion injury and may be visible during the operation, by graft edema and diffuse or focal fat necrosis around the graft. Prolonged cold ischemia time over 12 hours, use of HTK as the preservation solution and also poor donor quality are other risk factors (Han DJ & Sutherland DE, 2010). In case of bladder drained pancreas, pancreatitis may be the result of urine reflux. Most of these conditions are self limiting and adding the subcutaneous octreotide (0.1-0.2 mg every 8 hours) for 3-5 days after the operation, bowel rest and temporary total parenteral nutrition is the only treatment that needed. In rare cases it is so severe that the only option for treatment will be graft necrosectomy or pancreatectomy. In BD drained cases, the best treatment for resistant cases is conversion to enteric drainage. Rarely the cause of acute pancreatitis in these patients is CMV or other viral infections that if confirmed should be treated by gancyclovir or other antiviral agents.
Graft pancreatitis may be complicated just like the native pancreatitis with infections, pseudocysts, peripancreatic sterile fluid or pancreatic ascites, pancreatic fistula, and arterial or venous thrombosis or bleeding which should be treated accordingly.
Bleeding
Intraabdominal bleeding is relatively common after this operation. In most cases this is a technical error due to poor hemostasis of the pancreatic graft or the so many vascular anastomoses that used. Sometimes it is due to technical errors in the associated kidney transplant procedure. It may be due to heparin overdose that should be diagnosed by measurement of aPTT and if needs treated by protamine sulfate. Severe graft pancreatitis or pseudoaneurysms of the infected vascular anastomoses are another source of late abdominal bleedings in these patients that may be delayed as long as 2 weeks to several months after the operation. Early postoperative hypertension may cause transient bleeding from vascular anastomoses and through the abdominal drains that will be stopped spontaneously when the hypertension controlled appropriately with any need to reexploration.
Gastrointestinal bleeding is unique complication of enteric drainage. The site of bleeding may be duodenojejunostomy, distal jejunojejunostomy of the Roux-en-Y loop, duodenoduodenostomy (DD) or mucosal ulcers in the graft duodenal C-loop (Nikeghbalian S, 2009) due to ischemia, rejection or CMV infection. One should rule out other sources of bleeding, such as native small bowel CMV infections, stress native gastric or duodenal ulcers by upper GI endoscopy or enteroscopy and also obscure site of bleeding such as neoplasm or angiodyplasia of the colon. If DD had been used for enteric drainage, endoscopy can be used for diagnosis and treatment. In other cases, angiography, red blood cell isotope scan, or enteroscopy may be used for diagnosis, but in most cases at last the best option is to explore the patient (Orsenigo E, et al, 2005).
Lymphocele and chylous ascites
Because of diverse perivascular dissections (around the aorta, IVC, superior mesenteric vein and iliac arteries and veins) in pancreas transplantation surgery, intraabdominal or perigraft sterile collections due to lymphorrehea are common. These collections may be so much that exit through the abdominal drains and when the patient returns on oral diet being frankly chylous. Perigraft collections are one of the causes of graft dysfunction and should be drains percutaneously. Chylous ascites is usually self-limiting and therapy is only supportive (replacing the fluid and electrolytes and use of oral short chain fatty acids and removing the drains to prevent lymphocyte and protein depletion. The best treatment is prevention by meticulous dissections and ligation of all perivascular lymphatics during the dissections.
Immunologic complications
Acute rejection
Rejection of the pancreas graft is as much as 40 % in the past and pancreas transplant recipients receive the highest level of immunosuppressant drugs among other abdominal organ transplantations. One-year rates of rejection have steadily decreased and are currently in the 10–20% range depending on case mix and immunosuppressive regimen (Singh RP &Strata RJ, 2008). The highest rate of graft loss due to immunologic rejection is seen in PTA recipients and the lowest incidence is in SPK patients, probably due to immunologic protective effect of the renal graft or earlier diagnosis of the rejections with better response to therapy. In the era that BD pancreas transplant was a routine the best indicators of pancreas transplant rejection was decreasing urine amylase and lipase which was preceded by hyperglycemia. In other words, BD experience showed that pancreas exocrine function is affected sooner that its endocrine function and when hyperglycemia presents it would be too late to salvage the pancreas from acute rejection. In the SPK patient, increasing the serum creatinine due to rejection usually preceded the hyperglycemia, and then diagnosis of the renal graft rejection actually means the pancreas rejection as well and both can treated simultaneously by the same antirejection treatment except for rare instances. Nowadays, with increasing experience, protocol percutaneous pancreas biopsies are routine procedure in the armamentarium of any major pancreas transplant unit. By these timely scheduled biopsies, every pancreas rejection could be diagnosed before its clinical and paraclinical symptoms present but until now the controversies continued about the candidates and interval of this time of protocol biopsies for the surveillance of pancreas graft rejection (Gaber LW, 2007).
It’s shown that HLA mismatch is a major contributor to pancreas rejection and fully HLA matched recipients has the lowest levels of rejections when on the same immunosuppressive protocol (Burke, et al, 2004). Other series showed that combination immunosuppressive therapy including T-cell depleting antibodies for induction, tacrolimus and MMF could improve the outcome significantly, even in poorly HLA matched PTA recipients (Gruber SA, et al, 2000). However, in the PTA and PAK categories, HLA matching has remained an important outcome factor (Han DJ & Sutherland DE, 2010).
Signs and symptoms of pancreas rejection are obscure. Only 5-20% of patients developed mild fever, abdominal pain or distension or sometimes ileus or diarrhea (Sutherland DE, et al, 2001). The clinicians should be rely on paraclinical markers and after performing the biopsy the best approach is to treat empirically when a combination of paraclinical changes support existence of an acute rejection episode, if the results of the biopsy prepare with delay. The best treatment for confirmed acute rejection episodes is the use of pulse methylprednisolone therapy plus increasing the dose of oral drugs or adding the sirolimus to the previous drugs. Nephrotoxicity and diabetogenic effect of tacrolimus, and effect of corticosteroids on insulin resistance induction should be in mind. In severe cases use of thymoglobulin or other T-cell depleting antibodies may be required. As previously described many immunosuppressive protocol are under investigation now to better prevent these acute rejection episodes which most of them focused on corticosteroid spring and also use of T-cell depleting antibodies for induction.
Chronic rejection
Previously, chronic rejection does not appear to be as large a problem for pancreas-transplant recipients as it does for renal-transplant recipients (Hopt UT & Drognitz O, 2000).As the number of pancreas transplants surviving beyond the first year increases, chronic rejection is becoming increasingly common (Burke, et al, 2004). The rate of pancreas loss to chronic rejection was 8.8% in 914 pancreas transplants followed for 3 years. Chronic rejection was highest in the PAK (11.6%) and PTA (11.3%) and lowest for SPK (3.7%)( Humar A,et al, 2003). The most important pathologic changes in chronic rejection are replacing the pancreas tissue with fibrous band with distortion of architecture and loss of acini (Gaber LW, 2007). The severity of chronic rejection is not correlated well to the graft loss, but clinically the patients become hyperglycemic, first with response to oral hypoglycemic agents and then low dose insulin injection an at last completely depend on insulin injection for the rest of their lives. There’s no definite treatment for this type of rejection, which may be simply a non-immunologic “physiologic wear and tear “of the organ, but some authors try to use sirolimus in these conditions (Matias P, et al 2008).
Non-immunologic complications
One the known complications of every solid organ transplant is primary nonfunction or delayed graft function. Primary non-function is a definition of inclusion. No other cause of graft nonfunction should be found, e.g. graft vascular thrombosis, graft necrosis, or severe acute rejections or pancreatitis. In this condition the graft is viable and non-inflamed with no need for pancreatectomy, but no insulin secretion is found and the patient needs insulin injection as his/she preoperative situation. Some patients transiently need low doses of insulin for their blood glucose hemostasis, but after a maximum of 1 week this requirement decreased to zero. This condition is named “delayed graft function”. In both of this condition no frank anatomic or pathologic changes in the graft is found in the postoperative assessment of the patient. Poor donor quality and poor handling of the graft is the only causes that may contribute to these conditions.
Other non surgical and non-immunologic complications also may be seen in these diabetic patients. Many of these are due to preoperative diabetic complications. Delayed gastric emptying (gastroparesis), constipation or diarrhea, dizziness and lightheadedness (all due to autonomic neuropathy), peripheral neuropathy, poor visual acuity (accelerated retinopathy)and accelerated cataract are among these complications. Many of these diabetic signs and symptoms are multifactorial and side effects of the immunosuppressant drugs and multiple other antifungals and antivirals that used for these patients plus preoperative poor diabetic control accelerates them. Every effort should be used to diagnose the treatable causes and treat them accordingly. For example for diabetic gastroparesis, use of erythromycin or domeperidone has been moderately successful (Zaman f, et al, 2004). Intractable diarrhea may be due to CMV or other microbial or protozoal infections which should be treated. But when no known cause is found, the best treatment is dividing the dose o MMF to 4 times a day and also use of subcutaneous octreotide. Also every transplant team member should be completely remember the common complications of the immunosuppressive drugs and treat them appropriately or change the drugs if possible.
9. Long term results of pancreas transplantation
Long term results of pancreas transplantation improve day by day with better surgical experience and use of more potent immunosuppressive regimen. Pancreas graft 1 year survival rate improves from 75% in 1998 to 85% at the end of 2003 for SPK cases, and from 55 to 77% for PAK and from 45 to 77% in PTA patients (Gruessner AC & Sutherland DE, 2005).This improvement also is seen in PTA patients that traditionally have the worst outcome, as shows in many studies. For example in a report Stratta et al. by 1 year patient and graft survival has increased to 96% and 86%, respectively (Stratta RJ, et al, 2003). In one the largest recently published studies, the 5-year, 10-year, and 20-year patient survival for SPK recipients was 89, 80, and 58%, respectively (Wai PY & Sollinger HW, 2011).
Now, by decreasing the technical failures, the randomized studies to valuate other effective factors can be performed with better accuracy and less confounding bias. Perhaps the best statistics that show the effect of pancreas transplantation is the statistics about comparing the patient survival in kidney transplant alone recipients with SPK patients. Even in older studies, life expectancy of younger recipients (less than 50 years) of SPK is 10 years longer than diabetic patients who only received a kidney graft from deceased donors (23.4 years vs 12.9 years) (Tyden G, et al, 1999, Ojo AO,etal, 2001). When both grafts were procured from deceased donors, SPK transplant recipients has better survival rate than kidney transplant alone (KTA) recipients but this difference is not significant when KTA patients received their grafts from living donors. The presence of a functioning pancreas graft improved survival by 20% at 8 years (Reddy KS, 2003).
Patient survival is not statistically different according to the type of exocrine drainage (BD vs. ED), but quality of life is better and overall complications is less when BD is used (Sollinger HW, et al, 2009). Despite the improved survival, the most common type of death in these patients is death with a functioning graft and cardiovascular morbidity remains a major contributor to patient outcome in these patients (Sollinger HW, et al, 2009).
Comparing with KTA recipients, quality of life in those 95% of patient who survive after SPK transplantation is improved significantly, due to cessation of insulin injections, multiple needling for glucose monitoring and better emotional status (Sutherland De, et al, 2001 & Joseph JT, et al, 2003).
Effect on end organ damage
Pancreas transplantation improves glycemic control in long term follow up, manifested by lower hemoglobin A1C level, improved lipid profile and insulin mediated protein kinetics, normal hepatic glucose production and counter-regulatory effects of glucagon to hypoglycemia (White SA, et al, 2009).
Sollinger et al suggests that despite numerous reports of improvement in secondary diabetic complications after SPK, retinopathy and cardiac or vascular complications of diabetes are not reversible and show no improvements after SPK, but severe (peripheral and autonomic) neuropathy is an exception to this rule (Sollinger et al, 2009). Diabetic retinopathy will deteriorate after pancreas transplantation in over 30% of patients if it is in an advanced proliferative phase prior to the operation, but after 3 years the pancreas transplantation results in stabilization of retinopathy progression (Chow VC, et al, 1999). Cataract is a known complication of any organ transplantation and is the results of corticosteroids and calcineurin inhibitors and may become evident after pancreas transplantation as well.
Macrovascular effects of diabetes may not improve after pancreas transplantation, especially because of calcineurin inhibitor (CNI) effect on weight gain, dyslipidemia and hypertension, and many other risk factors that are very common in diabetic patients. Also the peripheral vascular disease in diabetics is often far too advanced to reverse. Because, most centers exclude patient with Macrovascular diabetes complications and no conclusive study exists about effect of pancreas transplantation on natural history of macrovascular disease in these patients (Sutherland De, et al, 2001). Deterioration depends on the ongoing risks. Some centers show the benefits of pancreas transplantation on cerebrovascular system, but again the results are inconclusive. Coronary artery disease, diastolic function, left ventricular geometry and cardiac autonomic function may be improved after SPK comparing with KTA recipients after a few years (White SA et al, 2009).
Normoglycemia also improves the diabetic glumerulopathy (but does not reverse it) and decrease the proteinuria. On the other hand, use of CNIs per results in nephropathy and may decrease the creatinine clearance. SPK recipients may not survive enough to benefit from the effects of normoglycemia on their nephropathy. In diabetic KTA recipients, the diabetic nephropathy is progressively leading to lower kidney graft survival and many studies show that PAK transplantation may improves the kidney graft survival by prevention of accelerated diabetic glumerulopathy in these patients. ). Some studies shows that PTA (if done early enough) can preserve renal function, but It takes at least 5 years until a pancreas transplant can reverse the lesions of diabetic nephropathy (Sutherland De, et al, 2001).
\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/19057.pdf",chapterXML:"https://mts.intechopen.com/source/xml/19057.xml",downloadPdfUrl:"/chapter/pdf-download/19057",previewPdfUrl:"/chapter/pdf-preview/19057",totalDownloads:4277,totalViews:172,totalCrossrefCites:0,totalDimensionsCites:1,totalAltmetricsMentions:0,introChapter:null,impactScore:1,impactScorePercentile:57,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"October 15th 2010",dateReviewed:"April 20th 2011",datePrePublished:null,datePublished:"September 6th 2011",dateFinished:null,readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/19057",risUrl:"/chapter/ris/19057",book:{id:"441",slug:"understanding-the-complexities-of-kidney-transplantation"},signatures:"Farzad Kakaei and Saman Nikeghbalian",authors:[{id:"26626",title:"Dr.",name:"Farzad",middleName:null,surname:"Kakaei",fullName:"Farzad Kakaei",slug:"farzad-kakaei",email:"fkakaei@yahoo.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/26626/images/544_n.jpg",institution:{name:"Tabriz University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}},{id:"38685",title:"Dr.",name:"Saman",middleName:null,surname:"Nikeghbalian",fullName:"Saman Nikeghbalian",slug:"saman-nikeghbalian",email:"nikeghbals@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Tabriz University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. History of pancreas transplantation",level:"1"},{id:"sec_3",title:"3. Indications for pancreas transplantation",level:"1"},{id:"sec_4",title:"4. Surgical aspects of pancreas graft procurement from the deceased donor",level:"1"},{id:"sec_5",title:"5. Current surgical techniques for pancreas transplantation",level:"1"},{id:"sec_6",title:"6. Immunosuppressive regimens ",level:"1"},{id:"sec_7",title:"7. Postoperative care of pancreas transplant recipients",level:"1"},{id:"sec_8",title:"8. Complications of pancreas transplantation",level:"1"},{id:"sec_9",title:"9. Long term results of pancreas transplantation ",level:"1"}],chapterReferences:[{id:"B1",body:'Barth RN, Becker YT, Odorico JS, et al.Nasogastric decompression is not necessary after simultaneous pancreas-kidney transplantation. Ann Surg. 2008247350356'},{id:"B2",body:'Becker LE,Nogueira VA, Abensur MP, et al. No induction versus anti-IL2R induction therapy in simultaneous kidney pancreas transplantation: A comparative analysis. Transplant Proc 20063819331936\n\t\t\t'},{id:"B3",body:'Boggi U, Vistoli F, Signori S, et al: A technique for retroperitoneal pancreas transplantation with portal-enteric drainage. Transplantation 79:1137, 2005'},{id:"B4",body:'Burke GW, Ciancio G, Sollinger HW: Advances in pancreas transplantation. Transplantation. 2004 May 15;77(9 Suppl):S62-7. Review.'},{id:"B5",body:'Cantarovich D, Vistoli F: Minimization protocols in pancreas transplantation. TransplInt2009; 22: 61–68.'},{id:"B6",body:'Chow VC, Pai RP, Chapman JR, et al: Diabetic retinopathy after combined kidney-pancreas transplantation.Clin Transplant. 199913356362'},{id:"B7",body:'Cohn JA, Englesbe MJ, Ads YM, et al.Financial implications of pancreas transplant complications: a business case for quality improvement. Am J Transplant\n\t\t\t\t\t2007716561660'},{id:"B8",body:'DiemP.AbidM.RedmonJ. B.et al.Systemic venous drainage of pancreas allografts as independent cause of hyperinsulinemia in type I diabetic recipients. Diabetes 199039534540'},{id:"B9",body:'Farney AC, Doares W, Rogers J, et al: A randomized trial of alemtuzumab versus antithymocyte globulin induction in renal and pancreas transplantation.Transplantation.\n\t\t\t\t\t2009 Sep 27;88(6):810-9.'},{id:"B10",body:'FontbonneA.MACharlesThibult. N.et al.Hyperinsulinaemia as a predictor of coronary heart disease mortality in a healthy population: the Paris Prospective Study, 15-year follow-up. Diabetologia1991199134356'},{id:"B11",body:'Fridell JA, Mangus RS, Powelson JA: Organ preservation solutions for whole organ pancreas transplantation.CurrOpin Organ Transplant.2011161116122\n\t\t\t'},{id:"B12",body:'Gaber LW: Pancreas allograft biopsies in the management of pancreas transplant recipients: histopathology review and clinical correlations.Arch Pathol Lab Med. 200713111921199\n\t\t\t'},{id:"B13",body:'Gallon LG, Winoto J, Chhabra D, et al: Long-term renal transplant function in recipient of simultaneous kidney and pancreas transplant maintained with two prednisone-free maintenance immunosuppressive combinations: tacrolimus/mycophenolatemofetil versus tacrolimus/sirolimus. Transplantation\n\t\t\t\t\t2007; 83: 1324–29.'},{id:"B14",body:'Gliedman ML, Gold M, Whittaker J, et al: Clinical segmental pancreatic transplantation with ureter-pancreatic duct anastomosis for exocrine drainage.Surgery.1973;74:171-180'},{id:"B15",body:'Goodman J, Becker YT: Pancreas surgical complications. CurrOpin Organ Transplant. 2009 Feb;14(1):85-9.'},{id:"B16",body:'Gores PF, Gillingham KJ, Dunn DL, et al: Donor hyperglycemia as a minor risk factor and immunologic variables as major risk factors for pancreas allograft loss in a multivariate analysis of a single institution’s experience.Ann Surg199221521730'},{id:"B17",body:'GruberS. A.KatzS.KaplanB.et al.Initial results of solitary pancreas transplants performed without regard to donor/recipient HLA mismatching. Transplantation\n\t\t\t\t\t2000388 EOF91 EOF'},{id:"B18",body:'Gruessner AC, Sutherland DE.Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004Clin Transplant. 2005 Aug;19443355\n\t\t\t'},{id:"B19",body:'Han DJ, Sutherland DE: Pancreas transplantation.Gut Liver.20104445065'},{id:"B20",body:'Hopt UT, Drognitz O. Pancreas organ transplantation: short and longterm results in terms of diabetes control. Langenbecks Arch Surg 2000; 385(6): 379.'},{id:"B21",body:'Hughes TA, Gaber AO, Amiri HS, et al. Kidney-pancreas transplantation.The eff ect of portal versus systemic venous drainage of the pancreas on the lipoprotein composition. Transplantation\n\t\t\t\t\t19956014061412'},{id:"B22",body:'Humar A, Khwaja K, Ramcharan T, et al. Chronic rejection: the next major challenge for pancreas transplant recipients. Transplantation.\n\t\t\t\t\t2003;76:918–923\n\t\t\t'},{id:"B23",body:'Hummel R, Langer M, Wolters HH, et al: Exocrine drainage into the duodenum: a novel technique for pancreas transplantation. TransplInt 21:178, 2008'},{id:"B24",body:'Joseph JT, Baines LS, Morris MC, Jindal RM: Quality of life after kidney and pancreas transplantation: a review.Am J Kidney Dis. 2003 Sep; 42(3):431-45\n\t\t\t'},{id:"B25",body:'Kahn J, Iberer F, Kniepeiss D, et al: Retroperitoneal pancreas transplantation with systemic-enteric drainage—case report. Clin Transplant 22:674, 2008'},{id:"B26",body:'Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC: Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy".Surgery1967:61 (6): 827–37'},{id:"B27",body:'LilleheiR. C.RuizJ. O.AquinoC.et al.Transplantation of the pancreas. ActaEndocrinol (Copenh)\n\t\t\t\t\t1976suppl 205): 303 EOF20 EOF'},{id:"B28",body:'Matias P, Araujo MR, Romão JE Jr, Abensur H, Noronha IL.: Conversion to sirolimus in kidney-pancreas and pancreas transplantation.Transplant Proc. 2008 Dec;40(10):3601-5.'},{id:"B29",body:'Mazur MJ, Rea DJ, Griffi n MD, et al: Decline in native renal function early after bladder-drained pancreas transplantation alone.Transplantation\n\t\t\t\t\t20047784449'},{id:"B30",body:'Meloche RM: Transplantation for the treatment of type 1 diabetes.World J Gastroenterol.\n\t\t\t\t\t2007134763476355'},{id:"B31",body:'MerkelF. K.RyanW. G.ArmbrusterK.SeimS.IngT. S.Pancreatic transplantation for diabetes mellitus. IMJ Ill Med J 1973144477479passim.'},{id:"B32",body:'Ming CS, Chen ZH: Progress in pancreas transplantation and combined pancreas-kidney transplantation.HepatobiliaryPancreat Dis Int.2007Feb;611723'},{id:"B33",body:'MuthusamyA. S. R.TzivanakisA.BrockmannJ. G.et al.Revascularization of the gastroepiploic artery in pancreas transplant. TransplInt\n\t\t\t\t\t20082111941195'},{id:"B34",body:'Nghiem DD, Corry RJ.Technique of simultaneous renal pancreatoduodenal transplantation with urinary drainage of pancreatic secretion. Am J Surg198715340506'},{id:"B35",body:'Nghiem DD.Revascularization of the gastroepiploic artery in pancreas transplant. Transplant Int\n\t\t\t\t\t200821774777'},{id:"B36",body:'Nikeghbalian S, Bahador A, Salahi H, et al: Non-marginal donor C-loop ulcers as a cause of gastrointestinal bleeding after pancreas transplantation: three case reports.Transplant Proc. 2009 Sep;41(7):2930-2.'},{id:"B37",body:'Ojo AO, Meier-Kriesche HU, Hanson JA, et al: The impact of simultaneous pancreas-kidney transplantation on long-term patient survival.Transplantation\n\t\t\t\t\t2001718290'},{id:"B38",body:'Orsenigo E, Fiorina P, Dell\'Antonio G, et al: Gastrointestinal bleeding from enterically drained transplanted pancreas.Transpl Int. 2005 Mar;18(3):296-302.'},{id:"B39",body:'Reddy KS, Stablein D, Taranto S, et al: Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis\n\t\t\t\t\t2003; 41: 464–70.'},{id:"B40",body:'Rosenlof LK, Earnhardt RC, Pruett TL, et al. Pancreas transplantation.An initial experience with systemic and portal drainage of pancreatic allografts. Ann Surg.\n\t\t\t\t\t1992215586595'},{id:"B41",body:'Schenker P, Flecken M, Vonend O, et al: En bloc retroperitoneal pancreas-kidney transplantation with duodenoduodenostomy using pediatric organs.Transplant Proc. 2009 Jul-Aug;41(6):2643-5.'},{id:"B42",body:'Shapiro AJM, Lakey JRT, Ryan EA, et al : Islet transplantation in seven patients with type I diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 343:230, 2000'},{id:"B43",body:'Shokouh-Amiri MH, Gaber AO, Gaber LW, et al.Pancreas transplantation with portal venous drainage and enteric exocrine diversion: a new technique. Transplant Proc.\n\t\t\t\t\t199224776777'},{id:"B44",body:'Singh RP, Stratta RJ: Advances in immunosuppression for pancreas transplantation CurrOpin Organ Transplant 13:79-84'},{id:"B45",body:'Singh RP, Stratta RJ: Advances in immunosuppression for pancreas transplantation.CurrOpin Organ Transplant.2008Feb;1317984\n\t\t\t'},{id:"B46",body:'Sollinger HW: Pancreatic transplantation and vascular graft thrombosis [editorial].J Am CollSurg\n\t\t\t\t\t1996'},{id:"B47",body:'Sollinger HW, Cook K, Kamps D, Glass NR, Belzer FO: Clinical and experimental experience with pancreaticocystostomy for exocrine pancreatic drainage in pancreas transplantation. Transplant Proc1984; 16: 749–51.'},{id:"B48",body:'Sollinger HW, Odorico JS, Becker YT, et al:Campath vs.basiliximab after simultaneous pancreas-kidney transplantation. Am J Transplant (in press).'},{id:"B49",body:'Sollinger HW, Sasaki TM, D’Alessandro AM, et al: Indications fo enteric conversion after pancreas transplantation with bladder drainage.Surgery\n\t\t\t\t\t199211284245'},{id:"B50",body:'Sollinger HW, Odorico JS, Becker YT, et al: One Thousand Simultaneous Pancreas-Kidney Transplants at a Single Center With 22-Year Follow-Up.Ann Surg2009250618630\n\t\t\t'},{id:"B51",body:'Squifflet JP, Gruessner RW, Sutherland DE: The history of pancreas transplantation: past, present and future.ActaChir Belg.\n\t\t\t\t\t2008May-Jun;108336778'},{id:"B52",body:'StarzlT. E.IwatsukiS.ShawB. W.et al.Pancreaticoduodenal transplantation in humans. SurgGynecol Obstet.\n\t\t\t\t\t1984159265272'},{id:"B53",body:'MDStegallSimon. M.MEWachsChan. L.NolanC.KamI.Mycophenolatemofetil decreases rejection in simultaneous pancreas-kidney transplantation when combined with tacrolimus or cyclosporine. Transplantation\n\t\t\t\t\t1997641695700'},{id:"B54",body:'StrattaR. J.LoA.Shokouh-AmiriM. H.et al.Improving results in solitary pancreas transplantation with portal-enteric drainage, thymoglobin induction, and tacrolimus/mycophenolatemofetil-based immunosuppression. TransplInt\n\t\t\t\t\t2003'},{id:"B55",body:'Sutherland DE, Goetz FC, Najarian JS: Living-related donor segmental pancreatectomy for transplantation.Transplant Proc.\n\t\t\t\t\t1980121925'},{id:"B56",body:'Sutherland DE, Gruessner RW, Dunn DL, et al: Lessons learned from more than 1,000 pancreas transplants at a single institution.Ann Surg.2001Apr;2334463501Review.'},{id:"B57",body:'Sutherland DE, Sibley R, Xu XZ, et al. Twin-to-twin pancreas transplantation: reversal and reenactment of the pathogenesis of type I diabetes. Trans Assoc Am Physicians\n\t\t\t\t\t1984; 97: 80–87.'},{id:"B58",body:'TiongH. Y.KrishnamurthiV.2011Selection and preparation of the pancreas transplant recipient. In: Kidney and pancreas transplantation, a practical guide.Srinivas TR and Shoskesisbn DA, 201209Springer science + business media, 978-1-60761-641-2New York'},{id:"B59",body:'TroppmannC.2004Surgical complications. In: Pancreas transplantation.Gruessner RWG, Sutherland DER, 206237Springer, New York.'},{id:"B60",body:'Troppmann C, Gruessner AC, Benedetti E, et al: Vascular graft thrombosis after pancreatic transplantation: univariate and multivariate operative and nonoperative risk factor analysis.J Am Coll Surg. 1996 Apr;182(4):285-316.'},{id:"B61",body:'Troppmann C: Complications after pancreas transplantation. CurrOpin Organ Transplant, 2010;15:112–118\n\t\t\t'},{id:"B62",body:'Tyden G, Bolinder J, Solders G, et al:Improved survival in patients with insulin-dependent diabetes mellitus and end-stage diabetic nephropathy 10 years after combined pancreas and kidney transplantation. Transplantation\n\t\t\t\t\t1999; 67: 645–48.'},{id:"B63",body:'Wai PY, Sollinger HW: Long-term outcomes after simultaneous pancreas-kidney transplant.CurrOpin Organ Transplant.2011161128134'},{id:"B64",body:'White SA, Shaw JA, Sutherland DE: Pancreas transplantation. Lancet.2009May 23; 3739677180817Review'},{id:"B65",body:'Williams PW: Transplantation of Pancreas in Diabetes.Br Med J\n\t\t\t\t\t1903580 EOF580 EOF\n\t\t\t'},{id:"B66",body:'Zaman F, Abreo KD, Levine S, Maley W, Zibari GB: Pancreatic Transplantation: Evaluation and Management J Intensive Care Med\n\t\t\t\t\t2004 19: 127'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Farzad Kakaei",address:"",affiliation:'
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1. Introduction
The human papillomavirus (HPV) is a double-stranded DNA virus whose only host is humans. It is the most common sexually transmitted pathogen in the world today. Epidemiological studies indicate the global prevalence of HPV is close to 12% [1]. The main reason for this high prevalence is that HPV infection is usually asymptomatic. The clinical course of HPV infection is divided into three periods—the latent, subclinical, and clinical phases [2]. Up to 90% of HPV infections are controlled by host adaptive immunity, thereby remaining in the latent phase and eventually becoming undetectable. However, 10% of cases progress to intraepithelial neoplasia or condylomatous lesions, and 1% transform into invasive cancer [3]. While over 200 HPV types have been identified to date, only 40 of them cause anogenital infections and HPV-associated malignancies [4]. Unlike many other viruses, HPVs are classified according to genetic sequence rather than antigenic structures. Therefore, instead of serotypes, they are numbered by genotype and in the order of discovery [5]. Despite its largely benign nature, HPV is a high-profile public health issue and poses a substantial socioeconomic burden due to its oncogenic properties. HPV and Epstein–Barr virus (EBV) are responsible for the most frequent virus-related cancers [6], with HPV linked to nearly 10% of cancers globally [7]. Based on their oncogenic potential, HPVs are divided into high-risk (HR-HPV) and low-risk (LR-HPV) types. HR-HPVs disrupt the cell cycle via their E6 and E7 oncoproteins, preventing progression from G1 to S phase [8]. The E6 oncoprotein inhibits the function of tumor suppressor protein p53. This increases the risk of cell transformation due to a lack of genetic stability and inhibition of apoptosis. The E7 oncoprotein inactivates another tumor suppressor protein, retinoblastoma (Rb). This results in the uncontrolled synthesis of the proteins necessary for cell cycle progression, and the cell enters a state of continuous proliferation [9]. Unlike HR-HPVs, the E6 and E7 oncoproteins of LR-HPVs do not inactivate p53 and Rb to the same degree [10].
Because HPV shows epithelial tropism, squamous cell carcinoma is the most common histologic type of HPV-related cancer. HPV association has been reported in 96% of cervical carcinomas, 75% of vulvar carcinomas, 41% of oropharyngeal carcinomas, and 36% of anal carcinomas [11, 12, 13]. The results of meta-analyses suggest that the presence of HPV is a favorable prognostic factor in anogenital and head and neck cancers [13, 14, 15]. Although it is not clear how the presence of HPV improves prognosis in these carcinomas, it was reported that HPV-negative primary cancers showed high metastatic potential and had more aggressive p53 mutations, resulting in more severe deregulation of normal growth control and poorer prognosis compared to HPV-positive cancers [16].
Considering the close anatomical proximity to anogenital carcinomas, researchers have investigated the relationship between HPV and urological malignancies for approximately three decades. Among these cancers, only penile cancer has been clearly associated with HPV. The relationship between HPV and other urological malignancies such as prostate, kidney, bladder, and testicular cancers remains controversial today. This lingering uncertainty is the result of limitations arising from methodological differences in past publications. These limitations can be summarized as small case series, lack of fresh tissue sampling, the use of serological tests for HPV detection, and the inadequacy of case–control studies [17, 18, 19]. In recent years, however, remarkable advances in polymerase chain reaction (PCR) assay technology have enabled the identification of more genotypes in a single sample, and DNA extraction from formalin-fixed, paraffin-embedded (FFPE) tissues, has become more efficient. Therefore, it is clear that results obtained two to three decades ago must be reevaluated.
2. Penile cancer and HPV
Penile cancer is rare, accounting for approximately 0.5% of all cancers in men, with a peak prevalence in the sixth decade of life [20]. The incidence of penile cancer varies by geographical region depending on the hygienic, cultural, and religious characteristics of the population. Its incidence is between 0.3 and 1 per 100,000 in developed countries, while it reaches 4 per 100,000 in developing countries [1]. At present, the main known risk factors are phimosis, chronic inflammation of the penis, poor personal hygiene, smoking, polygamy, and HPV infection. Histopathologically, 95% of penile cancers are different variations of squamous cell carcinoma [21]. The fact that HPV-associated cancers are of squamous histology led to the early discovery of the relationship between HPV and penile carcinomas. Although there are methodological differences in HPV detection among published studies, the prevalence of HPV in penile cancers is reported to be between 39.7% and 59.3% [22]. According to a recent meta-analysis evaluating 2531 patients in 270 studies, the prevalence of HPV-DNA in patients with penile cancer was 48% (confidence interval [CI]: 40.0%–57.0%) [7]. HPV type 16 is the dominant type identified in HPV-associated penile cancers, with more than half of cases attributed to this type alone [23]. The second most common strain detected in penile carcinomas is HPV type 18, and together these two types are responsible for more than 70% of HPV-associated penile carcinomas [24].
Penile intraepithelial neoplasia (PIN) is a penis cancer precursor lesion similar to cervical intraepithelial neoplasia (CIN). The extent to which the natural course of PIN mirrors that of CIN is unclear, and its clinical management is less standardized compared to CIN [25]. However, the link between PIN and HPV is noteworthy. Studies have indicated 70–100% association between HPV and PIN, much stronger than its relationship with penile carcinoma [26]. An important biomarker currently being studied in HPV-associated carcinomas is p16INK4a, a protein whose expression is stimulated by the E7 oncoprotein [27]. Numerous recent studies suggest that p16INK4a expression can be used as an alternative marker of infection in cervical and other HPV-associated carcinomas due to its association with HR-HPV carcinogenesis [27]. Martins et al. reported that the expression of p16INK4a was significantly associated with the presence of HR-HPV in penile cancers, and could serve as a marker of HPV in penile cancer [28]. A recent meta-analysis by Olesen et al. investigating p16INK4a positivity in penile cancers and PIN yielded the interesting finding that the rate of p16INK4a positivity was 79.6% in HPV-positive patients with penile cancer but only 49.5% among those with PIN [29]. In this meta-analysis, of the histological subtypes of HPV-related penile squamous cell carcinomas, the highest prevalence of HPV was reported to be 84% in basaloid squamous cell carcinoma, followed by 75.7% in warty-basaloid squamous cell carcinoma.
There is little information in the literature regarding the relationship between HPV and tumor grade in penile squamous cell carcinoma. However, tumor grade and lymph node metastasis are the most important prognostic factors for disease-free survival [30]. Hölters et al. observed an association between HPV and histological grade in their study, reporting that the prevalence of HR-HPV types was higher in poorly differentiated grade 3 tumors [31]. Similarly, a recent study also demonstrated a positive correlation between HR-HPV and high-grade penile squamous cell carcinoma, especially in HPV-related basaloid and warty-basaloid carcinomas [32]. In light of these findings, it can be speculated that unlike cervical, anal, and oropharyngeal carcinomas, the presence of HPV may be a negative prognostic factor in penile carcinomas.
Circumcision is known to be an important protective factor against penile cancer, though it is not clear whether circumcision protects against HPV infection. Van Howe et al. determined that the prevalence of HPV did not differ between circumcised and uncircumcised men but reported a longer HPV clearance time in men who were uncircumcised [33]. In a study by Lu et al., viral clearance was higher for HR-HPV types in circumcised men than uncircumcised men, while there was no significant difference between the two groups in the clearance of LR-HPV types [34]. Gray et al. showed that circumcision reduced transmission of both HR-HPV and LR-HPV types [35]. In the latest report from Davis et al., male circumcision was found to reduce HR-HPV viral load in female partners, leading the authors to recommend circumcision for the reduction of HPV infection in both men and women [36].
3. Bladder cancer and HPV
Bladder cancer is the fourth most common malignancy in men and the eighth most common in women, causing an estimated 400,000 new cases and 186,000 deaths per year worldwide [37]. Important known risk factors include age, ethnicity, smoking tobacco, chemical exposure (aromatic amines and hydrocarbons), and in some regions, schistosomiasis. Histologically, more than 90% of bladder cancers are urothelial cell carcinoma. The incidence of bladder cancer has shown a marked increase over the last three decades, and despite extensive efforts, it is still difficult to predict tumor progression, optimal treatment, and final clinical outcomes [38]. Over the same period, the relationship between HPV and bladder cancer has also been investigated and two hypotheses have been proposed to explain their association. The first hypothesis is that the urethra is the first point of contact during sexual transmission of the virus and serves both as a viral reservoir and direct connection between the urinary bladder and genital area, possibly providing a natural route of viral migration. The second hypothesis is based on the natural epithelial tropism of HPV [39]. In a pooled meta-analysis of 2855 cases in 52 studies, the prevalence of HPV in bladder cancer samples ranged between 0% and 100% [40]. However, this extremely wide range of HPV prevalence is open to interpretation. In the past, extracting DNA from FFPE tissue was a challenge, and most publications stating that there is no relationship between HPV and bladder cancer were conducted in FFPE tissues using older technologies in HPV research [41, 42, 43]. Li et al. emphasized this in their meta-analysis, noting that the prevalence of HPV was higher in studies using fresh tissue than in studies using FFPE and suggesting that FFPE tissues may yield false-negative results. In the same meta-analysis, it was also determined that the HPV prevalence in patients with bladder cancer was 16.88% and HPV types 16 and 18 were the major types detected [40]. Another meta-analysis by Jimenez-Pacheco et al. including 20 controlled studies of HPV-DNA revealed a significant association between HPV presence and bladder cancer, with a pooled odds ratio (OR) of 2.19 (95% CI: 1.40–3.43) [44]. Most recently, Sarier et al. conducted a case–control study using fresh tissue and demonstrated a strong correlation between urothelial carcinoma of the bladder and HPV infection (OR: 4.24, 95% CI: 1.63–12.34) [45].
Although squamous cell carcinoma of the bladder accounts for 2% of all bladder cancers, scientific interest in its relationship with HPV has persisted due to its histological structure [46]. However, because it is rare cancer, published series are small and studies have yielded conflicting results [47, 48, 49]. In a recent study by Collins et al. investigating the presence of p16 and HR-HPV in 33 patients with squamous cell carcinoma of the bladder using in situ hybridization (ISH), P16 expression was detected in 28% of the patients, while HR-HPV was not detected in any patient [50].
Tumor grade is an important factor in terms of bladder cancer progression. However, the literature also includes conflicting reports regarding the relationship between tumor grade and HPV. An association between HPV and low-grade tumors was reported by Tenti et al. [51], while an association with high-grade tumors was observed by Cai et al. [52]. In contrast, Sarier et al. observed no significant correlation between tumor grade and HPV in their study [45].
Tumor recurrence is an important and common event in bladder cancer. Exposure to infectious agents is recognized as one of the risk factors for urological malignancies, especially those with a high tumor recurrence rate [53]. Although the literature data on the relationship between HPV and bladder tumor recurrence are limited, the results are impressive and largely consistent among studies. Badawi et al. reported a significant association between HPV type 16 and tumor recurrence rate [54]. Moghadam et al. found that HPV was significantly associated not only with tumor recurrence but also with tumor stage [55]. In their 2-year follow-up study, Sarier et al. observed higher tumor recurrence rates in patients with bladder tumors associated with HPV-DNA [56].
4. Prostate cancer and HPV
Prostate cancer is the second most common cancer and a fourth most common cause of cancer deaths in men and therefore poses a serious burden worldwide [57]. The most important risk factors are age over 50 years, ethnicity, family history of prostate cancer, diet, and infection, although the available data are limited. There is evidence to suggest that chronic inflammation of the prostate is quite common in adults and may directly contribute to the development and progression of prostate malignancy [58]. This inflammation forms the basis of the main hypothesis for the relationship between HPV and prostate cancer. Epithelial damage caused by chronic inflammation may result in loss of tolerance to normal prostate-associated antigens, thereby triggering a sustained autoimmune reaction [59]. The immune evasion strategies of viruses contribute to persistent viral infection and induce chronic inflammation through cytokines. This presents a mechanism by which HPV may trigger chronic inflammation of the prostate glandular epithelium [59].
In fact, numerous studies have investigated the relationship between infection and prostate cancer. Taylor et al. demonstrated a significant association between prostate cancer risk and infection with any sexually transmitted disease-related agents in their meta-analysis of 29 studies including 6022 prostate cancer patients and 7320 control cases [60].
As with bladder cancer, a wide range has been reported for the prevalence of HPV in prostate cancer (0–100%). Again, methodological approaches are the major limitation. The use of serology-based tests for HPV detection is controversial. These tests identify general exposure to HPV infection but are not able to identify HPV infection in specific organs, such as the prostate. Although ISH is an effective method for detecting HPV, PCR is considered the gold standard [61]. By using multiple degenerate primary pairs in the amplification reaction, the PCR assay can easily be adapted to detect most HPV types associated with anogenital tract disease. A recent meta-analysis by Lawson et al. is valuable in this regard. In the part of their study evaluating 14 serology-based studies including 5149 prostate cancer patients and 7794 benign prostate controls, HPV antibodies were detected in 20% of both groups. Based on this finding, they stated that when evaluated serologically, there is no difference in the prevalence of HPV antibodies between men with and without prostate cancer. However, in another part including only PCR-based studies conducted after the year 2000 (including 1071 prostate cancer patients and 1103 benign prostate controls), the HPV prevalence was found to be 21.6% in prostate cancer patients and 6.7% in controls (p = 0.001) [17]. The authors concluded from this meta-analysis that HR-HPV has a causal role in prostate cancer. Other meta-analyses conducted in the last decade using different parameters also showed similar results. In a meta-analysis by Sasidharanpillai et al. evaluating the relationship between HPV and oropharyngeal and anogenital cancers based on recent molecular studies (nine studies, 876 men), significant HPV association was reported in prostate cancer tissue specimens (19%, CI: 10–29%) [7]. Yin et al. also determined that HPV was associated with an increased risk of prostate cancer (OR: 2.27) in their meta-analysis of 24 case–controlled studies including 971 prostate cancer and 1085 benign prostate patients [62]. In a meta-analysis of 26 tissue-based case–control studies conducted by Yang et al., the prevalence of HPV infection was found to be 18.93% and overall HPV positivity in prostate tissues was associated with a significantly higher risk of prostate cancer (OR: 1.79, 95% CI: 1.29–2.49) [57]. Moghoofei et al. reported that the two major genotypes associated with prostate cancer were HPV types 16 and 18, respectively [63].
Gleason score is an important pathological parameter for the prognosis of prostate cancer. However, the data on the relationship between HPV and Gleason score are controversial. Singh et al. reported that Gleason score was high (≥ 8) in 74% of patients with HPV-related prostate cancer (p = 0.003), whereas Moghadam et al. found no significant difference in Gleason score in his patient group [64].
Glenn et al. published an interesting study regarding HPV and prostate cancer. The researchers identified HR-HPVs in the benign prostate tissue specimens of patients who developed prostate cancer 1–10 years later. A remarkable finding from their study was that E7 oncoprotein expression was detected in 82% of samples at the time of benign prostatic hyperplasia diagnosis but only 29% of prostate cancer specimens were from the same patients. The authors suggested that HPV has an oncogenic role in the early stage of prostate tumorigenesis [65].
5. Kidney cancer and HPV
Kidney cancer is responsible for an estimated 2% of global cancer diagnoses and deaths, and its global burden is expected to increase [66]. The two most common subtypes are renal cell carcinoma and urothelial cell carcinoma. However, there are few studies on its possible association with HPV in the literature, and based on the evidence to date, the relationship between kidney cancers and HPV remains unclear. In a PCR-based study of 28 patients with kidney cancer, Grce et al. did not detect HPV in any patient [67]. Similarly, Hodges et al. did not detect HPV in any of their 62 patients with renal tumors by using ISH, leading the authors to conclude that HPV appears to have no oncogenic role in benign or malignant renal tumors [68]. In contrast, in their small case–control study (49 renal cell carcinoma cases, 16 controls), Salehipor et al. determined using PCR that the prevalence of HPV was 14.3% in the patient group and 0% in the control group [69]. Kamel et al. evaluated 56 patients with renal cell carcinoma using ISH and determined the prevalence of HPV to be 52% [70]. Although this is a remarkable finding, the fact that the study was not case-controlled can be seen as an important limitation. More recently, Farhadi et al. investigated the presence of HPV in 122 patients with renal cell carcinoma and demonstrated HPV association in 30.3%, with HPV type 18 being the most common type identified [71]. In terms of the case series, an important study by Koury et al. based on the Cancer Genome Atlas Database, which includes 3775 malignant neoplasms, indicated that there was no relationship between HPV infection and kidney cancer [72].
6. Testicular cancer and HPV
Although testicular cancers represent only 1% of all malignancies in men, they are the most common organ malignancy in men between 20 and 40 years of age [73]. The main known risk factors for testicular cancer are undescended testes, a family history of testicular cancer, and the presence of germ cell cancer in the opposite testicle [74]. While testicular tumors are still relatively uncommon, there has been an unexplained increase in their incidence over the last two decades [75]. Researchers have recently focused on the potentially important role of inflammation in the formation and progression of testicular cancer, as seen in the pathogenesis of other cancers [76]. In fact, the relationship between viral infections and testicular cancer was first investigated approximately 40 years ago [77]. Unfortunately, few studies have been published on the relationship between HPV and testicular cancer in the intervening period. In their study of 39 testicular cancer and 48 control cases, Strickler et al. determined the prevalence of HPV to be 5% in testicular cancer specimens and 4% in the control group [78]. A PCR-based study evaluating the presence of HPV in 19 testicular cancer patients and one control case was not able to demonstrate a relationship between HPV infection and testicular cancer [79]. Similarly, Bertazzoni et al. reported that HPV was not detected by PCR in any specimens from 61 seminomas and 23 control cases [80]. Finally, in a meta-analysis of 20 studies and 265,057 patients to evaluate the relationship between testicular cancer and viral infections, Garolla et al. determined that testicular cancer was not associated with HPV, cytomegalovirus, or parvovirus b-19 infections, whereas EBV and HIV infections were significantly associated with a higher risk of developing testicular germ cell tumors (OR: 7.38, 95% CI: 1.89–28.75, OR: 1.71, 95% CI: 1.51–1.93, respectively) [81]. An important point to keep in mind when evaluating the relationship between testicular germ cell neoplasms and HPV is that HPV shows epithelial tropism, and germ cell neoplasms of the testicle do not arise from the epithelium.
7. Conclusion
The link between penile cancers and HPV is now well known. In this regard, the significant relationship between HPV and tumor grade should be taken into consideration and further studies should be conducted to elucidate the prognostic significance of HPV presence in penile cancers. The association between HPV and urothelial carcinoma of the bladder has become clearer in recent years with the use of molecular tests in HPV diagnosis and the findings of studies conducted with fresh tissue. In bladder cancer, the significant relationship between HPV and tumor recurrence should be kept in mind. The development of PCR technology has had a major impact on our understanding of the link between HPV and prostate cancer. Compared to previous serology-based studies, the results obtained using nucleic acid amplification tests such as PCR are noteworthy and show that a reevaluation of this relationship is needed. A key point here may be studied on the relationship between HPV and inflammation in the pathophysiology of prostate cancer. In contrast, it is premature to talk about an association between kidney cancer and HPV based on the limited evidence available today. Case-controlled studies with larger patient series will be elucidating. The existing evidence regarding testicular cancer indicates no association with HPV infection.
Abbreviations
CI
Confidence interval
EBV
Epstein–Barr virus
FFPE
Formalin-fixed, paraffin-embedded
HR
High-risk
HPV
Human papillomavirus
ISH
in situ hybridization
LR
Low-risk
OR
Odds ratio
PCR
Polymerase Chain Reaction
PIN
Penile intraepithelial neoplasia
Rb
Retinoblastoma
\n',keywords:"HPV, penile cancer, prostate cancer, kidney cancer, bladder cancer, testicular cancer",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/79734.pdf",chapterXML:"https://mts.intechopen.com/source/xml/79734.xml",downloadPdfUrl:"/chapter/pdf-download/79734",previewPdfUrl:"/chapter/pdf-preview/79734",totalDownloads:98,totalViews:0,totalCrossrefCites:0,dateSubmitted:"November 2nd 2021",dateReviewed:"November 5th 2021",datePrePublished:"December 20th 2021",datePublished:null,dateFinished:"December 20th 2021",readingETA:"0",abstract:"Human papillomavirus (HPV) is currently the most common sexually transmitted pathogen in the world, and as such imposes a substantial global burden due to its oncogenic properties. The significant association of HPV with anogenital and head and neck carcinomas is well established. In terms of urological malignancies, only the association between HPV and penile cancer has been well defined; despite close anatomical proximity, its relationship with bladder, prostate, kidney, and testicular cancers has remained unclear. With technological advances in the nucleic acid amplification tests used to detect HPV over the last two decades, the results of new studies have led to the need to reexamine these relationships. This brief review aims to evaluate the association between urological malignancies and HPV infection in light of recent data.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/79734",risUrl:"/chapter/ris/79734",signatures:"Mehmet Sarier",book:{id:"10793",type:"book",title:"Molecular Mechanisms in Cancer",subtitle:null,fullTitle:"Molecular Mechanisms in Cancer",slug:"molecular-mechanisms-in-cancer",publishedDate:"August 17th 2022",bookSignature:"Metin Budak and Rajamanickam Rajkumar",coverURL:"https://cdn.intechopen.com/books/images_new/10793.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83969-843-9",printIsbn:"978-1-83969-842-2",pdfIsbn:"978-1-83969-844-6",isAvailableForWebshopOrdering:!0,editors:[{id:"226275",title:"Ph.D.",name:"Metin",middleName:null,surname:"Budak",slug:"metin-budak",fullName:"Metin Budak"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Penile cancer and HPV",level:"1"},{id:"sec_3",title:"3. Bladder cancer and HPV",level:"1"},{id:"sec_4",title:"4. Prostate cancer and HPV",level:"1"},{id:"sec_5",title:"5. Kidney cancer and HPV",level:"1"},{id:"sec_6",title:"6. Testicular cancer and HPV",level:"1"},{id:"sec_7",title:"7. Conclusion",level:"1"},{id:"sec_10",title:"Abbreviations",level:"1"}],chapterReferences:[{id:"B1",body:'Tolstov Y, Hadaschik B, Pahernik S, Hohenfellner M, Duensing S. Human papillomaviruses in urological malignancies: A critical assessment. Urologic Oncology. 2014;32(1):46.e19-46.e27. DOI: 10.1016/j.urolonc.2013.06.012'},{id:"B2",body:'Schneider A. Pathogenesis of genital HPV infection. Genitourinary Medicine. 1993;69(3):165-173. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8392965 [Accessed date: 15 April 2019]'},{id:"B3",body:'Andersen ES, Thorup K, Larsen G. The results of cryosurgery for cervical intraepithelial neoplasia. Gynecologic Oncology. 1988;30(1):21-25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3366393 [Accessed date: 15 April 2019]'},{id:"B4",body:'Sarier M, Ozel E, Duman I, Yuksel Y, Demirbas A. HPV type 45-positive condyloma acuminata of the bladder in a renal transplant recipient. Transplant Infectious Disease. 2017;19(2):e12667. DOI: 10.1111/tid.12667'},{id:"B5",body:'Sarier M, Ceyhan AM, Sepin N, et al. HPV infection in urology practice. International Urology and Nephrology. 2020;52(1):1-8. DOI: 10.1007/s11255-019-02302-2'},{id:"B6",body:'Cobos C, Figueroa JA, Mirandola L, et al. The role of Human Papilloma Virus (HPV) infection in non-anogenital cancer and the promise of immunotherapy: A review. International Reviews of Immunology. 2014;33(5):383-401. DOI: 10.3109/08830185.2014.911857'},{id:"B7",body:'Sasidharanpillai S, Ravishankar N, Kamath V, Bhat PV, Bhatt P, Arunkumar G. Prevalence of human papillomavirus (HPV) DNA among men with oropharyngeal and anogenital cancers: A systematic review and meta-analysis. Asian Pacific Journal of Cancer Prevention. 2021;22(5):1351-1364. DOI: 10.31557/APJCP.2021.22.5.1351'},{id:"B8",body:'Heidegger I, Borena W, Pichler R. The role of human papilloma virus in urological malignancies. Anticancer Research. 2015;35(5):2513-2519. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25964524 [Accessed date: 30 November 2018]'},{id:"B9",body:'Kraus I, Molden T, Holm R, et al. Presence of E6 and E7 mRNA from human papillomavirus types 16, 18, 31, 33, and 45 in the majority of cervical carcinomas. Journal of Clinical Microbiology. 2006;44(4):1310-1317. DOI: 10.1128/JCM.44.4.1310-1317.2006'},{id:"B10",body:'Longworth MS, Laimins LA. Pathogenesis of human papillomaviruses in differentiating epithelia. Microbiology and Molecular Biology Reviews. 2004;68(2):362-372. DOI: 10.1128/MMBR.68.2.362-372.2004'},{id:"B11",body:'Rakislova N, Saco A, Sierra A, Del Pino M, Ordi J. Role of human papillomavirus in vulvar cancer. Advances in Anatomic Pathology. 2017;24(4):201-214. DOI: 10.1097/PAP.0000000000000155'},{id:"B12",body:'Assmann G, Sotlar K. HPV-associated squamous cell carcinogenesis. Pathologe. 2011;32(5):391-398. DOI: 10.1007/s00292-011-1442-2'},{id:"B13",body:'Urbute A, Rasmussen CL, Belmonte F, et al. Prognostic significance of HPV DNA and p16 INK4a in anal cancer: A systematic review and meta-analysis. Cancer Epidemiology, Biomarkers & Prevention. 2020;29(4):703-710. DOI: 10.1158/1055-9965.epi-19-1259'},{id:"B14",body:'Li P, Tan Y, Zhu LX, et al. Prognostic value of HPV DNA status in cervical cancer before treatment: A systematic review and meta-analysis. Oncotarget. 2017;8(39):66352-66359. DOI: 10.18632/oncotarget.18558'},{id:"B15",body:'Liu H, Li J, Zhou Y, Hu Q , Zeng Y, Mohammadreza MM. Human papillomavirus as a favorable prognostic factor in a subset of head and neck squamous cell carcinomas: A meta-analysis. Journal of Medical Virology. 2017;89(4):710-725. DOI: 10.1002/jmv.24670'},{id:"B16",body:'Goyal S, Singh UR, Sharma S, Kaur N. Correlation of mitotic indices, AgNor count, Ki-67 and Bcl-2 with grade and stage in papillary urothelial bladder cancer. Urology Journal. 2014;11(1):1238-1247. DOI: 10.22037/uj.v11i1.1500'},{id:"B17",body:'Lawson JS, Glenn WK. Evidence for a causal role by human papillomaviruses in prostate cancer - A systematic review. Infectious Agents and Cancer. 2020;15(1):1-11. DOI: 10.1186/s13027-020-00305-8'},{id:"B18",body:'Gutiérrez J, Jiménez A, de Dios LJ, Soto MJ, Sorlózano A. Meta-analysis of studies analyzing the relationship between bladder cancer and infection by human papillomavirus. The Journal of Urology. 2006;176(6 Pt 1):2474-2481. discussion 2481. DOI: 10.1016/j.juro.2006.07.157'},{id:"B19",body:'Gould VE, Schmitt M, Vinokurova S, et al. Human papillomavirus and p16 expression in inverted papillomas of the urinary bladder. Cancer Letters. 2010;292(2):171-175. DOI: 10.1016/j.canlet.2009.11.022'},{id:"B20",body:'Bleeker MCG, Heideman DAM, Snijders PJF, Horenblas S, Dillner J, Meijer CJLM. Penile cancer: Epidemiology, pathogenesis and prevention. World Journal of Urology. 2009;27:141-150. DOI: 10.1007/s00345-008-0302-z'},{id:"B21",body:'Cai T, Di Vico T, Durante J, Tognarelli A, Bartoletti R. Human papilloma virus and genitourinary cancers: A narrative review. Minerva Urologica e Nefrologica. 2018;70(6):579-587. DOI: 10.23736/S0393-2249.18.03141-7'},{id:"B22",body:'Backes DM, Kurman RJ, Pimenta JM, Smith JS. Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes & Control. 2009;20(4):449-457. DOI: 10.1007/S10552-008-9276-9'},{id:"B23",body:'Heideman DAM, Waterboer T, Pawlita M, et al. Human papillomavirus-16 is the predominant type etiologically involved in penile squamous cell carcinoma. Journal of Clinical Oncology. 2007;25(29):4550-4556. DOI: 10.1200/JCO.2007.12.3182'},{id:"B24",body:'Kidd LC, Chaing S, Chipollini J, Giuliano AR, Spiess PE, Sharma P. Relationship between human papillomavirus and penile cancer-implications for prevention and treatment. Translational Andrology and Urology. 2017;6(5):791-802. DOI: 10.21037/TAU.2017.06.27'},{id:"B25",body:'Ferrándiz-Pulido C, Masferrer E, De Torres I, et al. Identification and genotyping of human papillomavirus in a Spanish cohort of penile squamous cell carcinomas: Correlation with pathologic subtypes, p16INK4a expression, and prognosis. Journal of the American Academy of Dermatology. 2013;68(1):73-82. DOI: 10.1016/J.JAAD.2012.05.029'},{id:"B26",body:'Marchionne E, Perez C, Hui A, Khachemoune A. Penile squamous cell carcinoma: A review of the literature and case report treated with Mohs micrographic surgery. Anais Brasileiros de Dermatologia. 2017;92(1):95-99. DOI: 10.1590/abd1806-4841.20175009'},{id:"B27",body:'Steinestel J, Al Ghazal A, Arndt A, et al. The role of histologic subtype, p16INK4a expression, and presence of human papillomavirus DNA in penile squamous cell carcinoma. BMC Cancer. 2015;15(1):1-9. DOI: 10.1186/S12885-015-1268-Z'},{id:"B28",body:'De Andrade MV, Pinho JD, Júnior AALT, et al. P16INK4a expression in patients with penile cancer. PLoS One. 2018;13(10):e0205350. DOI: 10.1371/JOURNAL.PONE.0205350 [Published: 2018 Oct 12]'},{id:"B29",body:'Olesen TB, Sand FL, Rasmussen CL, et al. Prevalence of human papillomavirus DNA and p16 INK4a in penile cancer and penile intraepithelial neoplasia: A systematic review and meta-analysis. The Lancet Oncology. 2019;20(1):145-158. DOI: 10.1016/S1470-2045(18)30682-X'},{id:"B30",body:'Aita GA, Zequi S de C, Costa WH da, Guimarães GC, Soares FA, Giuliangelis TS. Tumor histologic grade is the most important prognostic factor in patients with penile cancer and clinically negative lymph nodes not submitted to regional lymphadenectomy. International Brazilian Journal of Urology 2016;42(6):1136-1143. doi:10.1590/S1677-5538.IBJU.2015.0416'},{id:"B31",body:'Hölters S, Khalmurzaev O, Pryalukhin A, et al. Challenging the prognostic impact of the new WHO and TNM classifications with special emphasis on HPV status in penile carcinoma. Virchows Archiv. 2019;475(2):211-221. DOI: 10.1007/S00428-019-02566-0'},{id:"B32",body:'de Araújo LA, AAP DP, da SC de PH, et al. Human papillomavirus (HPV) genotype distribution in penile carcinoma: Association with clinic pathological factors. PLoS One. 2018;13(6):e0199557. DOI: 10.1371/JOURNAL.PONE.0199557'},{id:"B33",body:'Van Howe RS. Human papillomavirus and circumcision: A meta-analysis. The Journal of Infection. 2007;54(5):490-496. DOI: 10.1016/J.JINF.2006.08.005'},{id:"B34",body:'Lu B, Wu Y, Nielson CM, et al. Factors associated with acquisition and clearance of human papillomavirus infection in a cohort of US men: A prospective study. The Journal of Infectious Diseases. 2009;199(3):362-371. DOI: 10.1086/596050'},{id:"B35",body:'Gray RH, Serwadda D, Kong X, et al. Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: A randomized trial in Rakai, Uganda. The Journal of Infectious Diseases. 2010;201(10):1455-1462. DOI: 10.1086/652184'},{id:"B36",body:'Davis MA, Gray RH, Grabowski MK, et al. Male circumcision decreases high-risk human papillomavirus viral load in female partners: A randomized trial in Rakai, Uganda. International Journal of Cancer. 2013;133(5):1247-1252. DOI: 10.1002/IJC.28100'},{id:"B37",body:'Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: A Cancer Journal for Clinicians. 2018;68(1):7-30. DOI: 10.3322/CAAC.21442'},{id:"B38",body:'Stein JP, Grossfeld GD, Ginsberg DA, et al. Prognostic markers in bladder cancer: a contemporary review of the literature. The Journal of Urology. 1998;160(3 Pt 1):645-659. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9720515 [Accessed date: November 24, 2018]'},{id:"B39",body:'Visalli G, Facciolà A, Aleo FD, et al. Hpv and urinary bladder carcinoma: A review of the literature. WCRJ. 2018;5(1):1-12'},{id:"B40",body:'Li N, Yang L, Zhang Y, Zhao P, Zheng T, Dai M. Human papillomavirus infection and bladder cancer risk: A meta-analysis. The Journal of Infectious Diseases. 2011;204(2):217-223. DOI: 10.1093/infdis/jir248'},{id:"B41",body:'Knowles MA. Human papillomavirus sequences are not detectable by Southern blotting or general primer-mediated polymerase chain reaction in transitional cell tumours of the bladder. Urological Research. 1992;20(4):297-301. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1324541 [Accessed date: November 26, 2018]'},{id:"B42",body:'Chang F, Lipponen P, Tervahauta A, Syrjänen S, Syrjänen K. Transitional cell carcinoma of the bladder: Failure to demonstrate human papillomavirus deoxyribonucleic acid by in situ hybridization and polymerase chain reaction. The Journal of Urology. 1994;152(5 Pt 1):1429-1433. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7933176 [Accessed date: 26 November 2018]'},{id:"B43",body:'Ben Selma W, Ziadi S, Ben Gacem R, et al. Investigation of human papillomavirus in bladder cancer in a series of Tunisian patients. Pathology, Research and Practice. 2010;206(11):740-743. DOI: 10.1016/j.prp.2010.06.005'},{id:"B44",body:'Jimenez-Pacheco A, Exposito-Ruiz M, Arrabal-Polo M, Lopez-Luque A. Meta-analysis of studies analyzing the role of human papillomavirus in the development of bladder carcinoma. Korean Journal of Urology. 2012;53(4):240-247. DOI: 10.4111/KJU.2012.53.4.240'},{id:"B45",body:'Sarier M, Sepin N, Keles Y, et al. Is there any association between urothelial carcinoma of the bladder and human papillomavirus? A Case-Control Study. Urologia Internationalis. 2020;104(1-2):81-86. DOI: 10.1159/000500467'},{id:"B46",body:'Jørgensen KR, Jensen JB. Human papillomavirus and urinary bladder cancer revisited. APMIS. 2020;35(8):1-8. DOI: 10.1111/apm.13016'},{id:"B47",body:'Westenend PJ, Stoop JA, Hendriks JGM. Human papillomaviruses 6/11, 16/18 and 31/33/51 are not associated with squamous cell carcinoma of the urinary bladder. BJU International. 2001;88(3):198-201. DOI: 10.1046/J.1464-410X.2001.02230.X'},{id:"B48",body:'Alexander RE, Hu Y, Kum JB, et al. P16 expression is not associated with human papillomavirus in urinary bladder squamous cell carcinoma. Modern Pathology. 2012;25(11):1526-1533. DOI: 10.1038/MODPATHOL.2012.103'},{id:"B49",body:'Chapman-Fredricks JR, Cioffi-Lavina M, Accola MA, et al. High-risk human papillomavirus DNA detected in primary squamous cell carcinoma of urinary bladder. Archives of Pathology & Laboratory Medicine. 2013;137(8):1088-1093. DOI: 10.5858/ARPA.2012-0122-OA'},{id:"B50",body:'Collins K, Hwang M, Hamza A, Rao P. Prevalence of high-risk human papillomavirus in primary squamous cell carcinoma of urinary bladder. Pathology, Research and Practice. 2020;216(9):153084 epub. DOI: 10.1016/J.PRP.2020.153084'},{id:"B51",body:'Tenti P, Zappatore R, Romagnoli S, et al. p53 overexpression and human papillomavirus infection in transitional cell carcinoma of the urinary bladder: correlation with histological parameters. The Journal of Pathology. 1996;178(1):65-70. DOI: 10.1002/(SICI)1096-9896(199601)178:1<65::AID-PATH451>3.0.CO;2-W'},{id:"B52",body:'Cai. Human papillomavirus and non-muscle invasive urothelial bladder cancer: Potential relationship from a pilot study. Oncology Reports. 2011;25(2):485-489. DOI: 10.3892/or.2010.1083'},{id:"B53",body:'Alibek K, Karatayeva N, Bekniyazov I. The role of infectious agents in urogenital cancers. Infectious Agents and Cancer. 2012;7(1):35. DOI: 10.1186/1750-9378-7-35'},{id:"B54",body:'Badawi H, Ahmed H, Ismail A, et al. Role of human papillomavirus types 16, 18, and 52 in recurrent cystitis and urinary bladder cancer among egyptian patients. Medscape Journal of Medicine. 2008;10(10):232. Available from: /pmc/articles/PMC2605136/ [Accessed: 07 October 2021]'},{id:"B55",body:'Ohadian Moghadam S, Mansori K, Nowroozi MR, Afshar D, Abbasi B, Nowroozi A. Association of human papilloma virus (HPV) infection with oncological outcomes in urothelial bladder cancer. Infectious Agents and Cancer. 2020;15(1):4-11. DOI: 10.1186/s13027-020-00318-3'},{id:"B56",body:'Sarier M, Usta SS, Turgut H, et al. Prognostic value of HPV DNA in urothelial carcinoma of the bladder: A preliminary report of 2-year follow-up results. Urology Journal. 28 Apr 2021. DOI: 10.22037/uj.v18i.6429'},{id:"B57",body:'Yang L, Xie S, Feng X, et al. Worldwide prevalence of human papillomavirus and relative risk of prostate cancer: A meta-analysis. Scientific Reports. 2015;5:14667 epub. DOI: 10.1038/SREP14667'},{id:"B58",body:'Sfanos KS, De MAM. Prostate cancer and inflammation: The evidence. Histopathology. 2012;60(1):199-215. DOI: 10.1111/J.1365-2559.2011.04033.X'},{id:"B59",body:'Nahand JS, Khanaliha K, Mirzaei H, et al. Possible role of HPV/EBV coinfection in anoikis resistance and development in prostate cancer. BMC Cancer. 2021;21(1):1-19. DOI: 10.1186/s12885-021-08658-y'},{id:"B60",body:'Taylor ML, Mainous A, Wells B. Prostate cancer and sexually transmitted diseases: A meta-analysis. Undefined. Family Medicine. 2005;37(7):506-512'},{id:"B61",body:'Kösel S, Burggraf S, Mommsen J, Engelhardt W, Olgemöller B. Type-specific detection of human papillomaviruses in a routine laboratory setting--improved sensitivity and specificity of PCR and sequence analysis compared to direct hybridisation. Clinical Chemistry and Laboratory Medicine. 2003;41(6):787-791. DOI: 10.1515/CCLM.2003.119'},{id:"B62",body:'Yin B, Liu W, Yu P, et al. Association between human papillomavirus and prostate cancer: A meta-analysis. Oncology Letters. 2017;14(2):1855-1865. DOI: 10.3892/OL.2017.6367'},{id:"B63",body:'Moghoofei M, Keshavarz M, Ghorbani S, et al. Association between human papillomavirus infection and prostate cancer: A global systematic review and meta-analysis. Asia-Pacific Journal of Clinical Oncology. 2019;15(5):e59-e67. DOI: 10.1111/AJCO.13124'},{id:"B64",body:'Moghadam SO, Nowroozi MR, Nowroozi A, Rezaei P. Infection with human papillomavirus as a potential risk factor for prostate cancer: A case-control study. Archives of Clinical Infectious Diseases. 2021;16(1):16-20. DOI: 10.5812/archcid.107137'},{id:"B65",body:'Glenn WK, Ngan CC, Amos TG, et al. High risk human papilloma viruses (HPVs) are present in benign prostate tissues before development of HPV associated prostate cancer. Infectious Agents and Cancer. 2017;12(1):1-10. DOI: 10.1186/s13027-017-0157-2'},{id:"B66",body:'Padala SA, Barsouk A, Thandra KC, et al. Epidemiology of renal cell carcinoma. World Journal of Oncology. 2020;11(3):79-87. DOI: 10.14740/WJON1279'},{id:"B67",body:'Grce M, Furcić I, Hrascan R, et al. Human papillomaviruses are not associated with renal carcinoma. Anticancer Research. 1997;17(3C):2193-2196'},{id:"B68",body:'Hodges A, Talley L, Gokden N. Human Papillomavirus DNA and P16INK4A are not detected in renal tumors with immunohistochemistry and signal-amplified in situ hybridization in paraffin-embedded tissue. Applied Immunohistochemistry & Molecular Morphology. 2006;14(4):432-435. DOI: 10.1097/01.PAI.0000205059.42421.CB'},{id:"B69",body:'Salehipoor M, Khezri A, Behzad-Behbahani A, et al. Role of viruses in renal cell carcinoma. Saudi Journal of Kidney Diseases and Transplantation. 2012;23(1):53-57. Available from: http://www.sjkdt.org [Accessed date: 08 October 2021]'},{id:"B70",body:'Kamel D, Turpeenniemi-Hujanen TV, K, Pääkkö P, Soini Y. Proliferating cell nuclear antigen but not p53 or human papillomavirus DNA correlates with advanced clinical stage in renal cell carcinoma. Histopathology. 1994;25(4):339-347. DOI: 10.1111/J.1365-2559.1994.TB01352.X'},{id:"B71",body:'Farhadi A, Behzad-Behbahani A, Geramizadeh B, Sekawi Z, Rahsaz M, Sharifzadeh S. High-risk human papillomavirus infection in different histological subtypes of renal cell carcinoma. Journal of Medical Virology. 2014;86(7):1134-1144. DOI: 10.1002/JMV.23945'},{id:"B72",body:'Khoury JD, Tannir NM, Williams MD, et al. Landscape of DNA virus associations across human malignant cancers: Analysis of 3,775 cases using RNA-Seq. Journal of Virology. 2013;87(16):8916-8926. DOI: 10.1128/JVI.00340-13'},{id:"B73",body:'Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015;136(5):E359-E386. DOI: 10.1002/ijc.29210'},{id:"B74",body:'Sarier M, Tunç M, Özel E, et al. Evaluation of histopathologic results of testicular tumors in antalya: Multi center study. Bulletin of Urooncology. 2020;19(2):64-67. DOI: 10.4274/uob.galenos.2019.1412'},{id:"B75",body:'Cheng L, Albers P, Berney DM, et al. Testicular cancer. Nature Reviews. Disease Primers. 2018;4(1):29. DOI: 10.1038/s41572-018-0029-0'},{id:"B76",body:'Elinav E, Nowarski R, Thaiss CA, Hu B, Jin C, Flavell RA. Inflammation-induced cancer: Crosstalk between tumours, immune cells and microorganisms. Nature Reviews. Cancer. 2013;13(11):759-771. DOI: 10.1038/nrc3611'},{id:"B77",body:'Algood CB, Newell GR, Johnson DE. Viral etiology of testicular tumors. The Journal of Urology. 1988;139(2):308-310. DOI: 10.1016/S0022-5347(17)42394-9'},{id:"B78",body:'Strickler HD, Schiffman MH, Shah KV, et al. A survey of human papillomavirus 16 antibodies in patients with epithelial cancers. European Journal of Cancer Prevention. 1998;7(4):305-313. DOI: 10.1097/00008469-199808000-00006'},{id:"B79",body:'Rajpert-De Meyts E, Hørding U, Nielsen H, Skakkebaek N. Human papillomavirus and Epstein-Barr virus in the etiology of testicular germ cell tumours. APMIS. 1994;102(1):38-42. DOI: 10.1111/J.1699-0463.1994.TB04842.X'},{id:"B80",body:'Bertazzoni G, Sgambato A, Migaldi M, et al. Lack of evidence for an association between seminoma and human papillomavirus infection using GP5+/GP6+ consensus primers. Journal of Medical Virology. 2013;85(1):105-109. DOI: 10.1002/JMV.23431'},{id:"B81",body:'Garolla A, Vitagliano A, Muscianisi F, et al. Role of viral infections in testicular cancer etiology: Evidence from a systematic review and meta-analysis. Frontiers in Endocrinology (Lausanne). 2019;10(JUN):355. DOI: 10.3389/FENDO.2019.00355'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Mehmet Sarier",address:"drsarier@gmail.com",affiliation:'
Department of Urology, Istinye University, Turkey
Department of Urology, Medical Park Hospital, Turkey
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MS pathogenesis is not clear. Destruction of myelin by inflammation caused by autoimmune reactions has been proposed. Interestingly, healthy humans usually do not develop abzymes (Abzs). It was shown that DNase and MBP-hydrolyzing Abzs are easily detectable at the beginning of autoimmune diseases (ADs) including MS, when concentrations of antibodies to autoantigens are not yet significantly increased and correspond to levels in healthy donors. In addition, the relative enzymatic activity of antibodies from cerebrospinal fluid (CSF) is ~50-fold higher than that from the sera of the same MS patients. Experimental autoimmune encephalomyelitis (EAE) in C57BL/6 mice, a model mimicking relevant aspects of human MS was used. During development of spontaneous and MOG35-55-induced EAE in C57BL/6 mice, a specific reorganization of the immune system of mice was observed. 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Rakotonirina",authors:[{id:"31580",title:"Prof.",name:"Elisabeth",middleName:null,surname:"Ngo Bum",slug:"elisabeth-ngo-bum",fullName:"Elisabeth Ngo Bum"},{id:"46671",title:"Dr.",name:"Germain",middleName:"Sotoing",surname:"Taïwe",slug:"germain-taiwe",fullName:"Germain Taïwe"},{id:"46672",title:"MSc.",name:"Fleur",middleName:null,surname:"Moto",slug:"fleur-moto",fullName:"Fleur Moto"},{id:"46673",title:"Prof.",name:"Gwladys",middleName:"Temkou",surname:"Ngoupaye",slug:"gwladys-ngoupaye",fullName:"Gwladys Ngoupaye"},{id:"46674",title:"MSc.",name:"Espoir",middleName:null,surname:"Ayissi",slug:"espoir-ayissi",fullName:"Espoir Ayissi"},{id:"46675",title:"MSc.",name:"Christian",middleName:null,surname:"Dong",slug:"christian-dong",fullName:"Christian Dong"},{id:"46676",title:"MSc.",name:"Frédéric",middleName:null,surname:"Maidawa",slug:"frederic-maidawa",fullName:"Frédéric Maidawa"},{id:"46677",title:"MSc.",name:"Gildas",middleName:null,surname:"Djafsia",slug:"gildas-djafsia",fullName:"Gildas Djafsia"},{id:"46678",title:"MSc.",name:"Leopold",middleName:null,surname:"Nanga",slug:"leopold-nanga",fullName:"Leopold Nanga"},{id:"46679",title:"MSc.",name:"Saleh",middleName:null,surname:"Soudi",slug:"saleh-soudi",fullName:"Saleh Soudi"},{id:"46680",title:"Dr.",name:"Alice",middleName:null,surname:"Rakotonirina",slug:"alice-rakotonirina",fullName:"Alice Rakotonirina"},{id:"46681",title:"Dr.",name:"Silvère",middleName:null,surname:"Rakotonirina",slug:"silvere-rakotonirina",fullName:"Silvère Rakotonirina"}]},{id:"44560",doi:"10.5772/54744",title:"The Role of Epigenetics in Neurodegenerative Diseases",slug:"the-role-of-epigenetics-in-neurodegenerative-diseases",totalDownloads:4012,totalCrossrefCites:10,totalDimensionsCites:18,abstract:null,book:{id:"3278",slug:"neurodegenerative-diseases",title:"Neurodegenerative Diseases",fullTitle:"Neurodegenerative Diseases"},signatures:"Luca Lovrečić, Aleš Maver, Maja Zadel and Borut Peterlin",authors:[{id:"75615",title:"Dr.",name:"Luca",middleName:null,surname:"Lovrecic",slug:"luca-lovrecic",fullName:"Luca Lovrecic"}]}],mostDownloadedChaptersLast30Days:[{id:"44555",title:"Pharmacological Treatment of Acute Ischemic Stroke",slug:"pharmacological-treatment-of-acute-ischemic-stroke",totalDownloads:3670,totalCrossrefCites:6,totalDimensionsCites:9,abstract:null,book:{id:"3278",slug:"neurodegenerative-diseases",title:"Neurodegenerative Diseases",fullTitle:"Neurodegenerative Diseases"},signatures:"Humberto Mestre, Yael Cohen-Minian, Daniel Zajarias-Fainsod and\nAntonio Ibarra",authors:[{id:"72488",title:"Dr.",name:"José Juan Antonio",middleName:null,surname:"Ibarra Arias",slug:"jose-juan-antonio-ibarra-arias",fullName:"José Juan Antonio Ibarra Arias"},{id:"120571",title:"Mr.",name:"Humberto",middleName:null,surname:"Mestre",slug:"humberto-mestre",fullName:"Humberto Mestre"},{id:"165904",title:"Dr.",name:"Daniel",middleName:null,surname:"Zajarias-Fainsod",slug:"daniel-zajarias-fainsod",fullName:"Daniel Zajarias-Fainsod"},{id:"165905",title:"Mrs.",name:"Yael",middleName:null,surname:"Cohen-Minian",slug:"yael-cohen-minian",fullName:"Yael Cohen-Minian"}]},{id:"60608",title:"Mucuna and Parkinson’s Disease: Treatment with Natural Levodopa",slug:"mucuna-and-parkinson-s-disease-treatment-with-natural-levodopa",totalDownloads:4661,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Mucuna pruriens is a tropical bean containing large amounts of levodopa and is the most important natural remedy for Parkinson’s disease. Famous neurologists have patented methods of extraction for its advantages over the synthetic forms, Sinemet and Madopar. This natural levodopa is less toxic and has a faster and more lasting effect and can delay the need for pharmaceuticals and combination therapies. Currently, there are many patients with Parkinson’s disease who take Mucuna and spontaneously reduce the dose of conventional drugs and do so behind their doctors’ backs. Mucuna should always be taken under medical supervision.",book:{id:"6406",slug:"parkinson-s-disease-understanding-pathophysiology-and-developing-therapeutic-strategies",title:"Parkinson's Disease",fullTitle:"Parkinson's Disease - Understanding Pathophysiology and Developing Therapeutic Strategies"},signatures:"Rafael González Maldonado",authors:[{id:"214658",title:"Dr.",name:"Rafael",middleName:null,surname:"Gonzalez-Maldonado",slug:"rafael-gonzalez-maldonado",fullName:"Rafael Gonzalez-Maldonado"}]},{id:"19700",title:"Physiotherapy for Children with Cerebral Palsy",slug:"physiotherapy-for-children-with-cerebral-palsy",totalDownloads:21769,totalCrossrefCites:1,totalDimensionsCites:3,abstract:null,book:{id:"630",slug:"epilepsy-in-children-clinical-and-social-aspects",title:"Epilepsy in Children",fullTitle:"Epilepsy in Children - Clinical and Social Aspects"},signatures:"Mintaze Kerem Günel",authors:[{id:"38412",title:"Prof.",name:"Mintaze",middleName:null,surname:"Kerem Günel",slug:"mintaze-kerem-gunel",fullName:"Mintaze Kerem Günel"}]},{id:"51151",title:"Association Between Multiple Sclerosis Risk and Human Immunodeficiency Virus Infection: Insights and Challenges",slug:"association-between-multiple-sclerosis-risk-and-human-immunodeficiency-virus-infection-insights-and-",totalDownloads:2044,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Multiple sclerosis (MS) is a convoluted autoimmune and inflammatory disease of the central nervous system (CNS) in which the protective myelin sheath is eroded and the underlying nerve fibers are damaged. There is no conclusive knowledge on the role played by different etiological factors in its development, and studies have shown that it primarily results due to complex interactions between the genetic, geographic and infectious components. Among the risk factors reported to have a possible role in MS development, retroviruses also appear to influence it. Studies suggest human immunodeficiency virus (HIV) infection to be inversely related to MS risk, but to date, the association between the two remains enigmatic. This protective inverse association has become an area of active research and the most plausible explanations for this may be immune suppression and/or antiretroviral medications. The purpose of writing this chapter is to provide background information on the unfathomable relationship between HIV infection and the risk of developing MS while at the same time providing description of the insights garnered from recent studies. While highlighting the application of ART (antiretroviral therapy) as budding future alternative for MS management, this chapter provides momentum for further studies.",book:{id:"5156",slug:"trending-topics-in-multiple-sclerosis",title:"Trending Topics in Multiple Sclerosis",fullTitle:"Trending Topics in Multiple Sclerosis"},signatures:"Ehtishamul Haq, Insha Zahoor and Mushfiquddin Khan",authors:[{id:"181077",title:"Dr.",name:"Ehtishamul",middleName:null,surname:"Haq",slug:"ehtishamul-haq",fullName:"Ehtishamul Haq"},{id:"185233",title:"Dr.",name:"Insha",middleName:null,surname:"Zahoor",slug:"insha-zahoor",fullName:"Insha Zahoor"},{id:"185234",title:"Dr.",name:"Mushfiquddin",middleName:null,surname:"Khan",slug:"mushfiquddin-khan",fullName:"Mushfiquddin Khan"}]},{id:"63824",title:"Plasmapheresis in Treatment of Myasthenia Gravis",slug:"plasmapheresis-in-treatment-of-myasthenia-gravis",totalDownloads:1349,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Treatment of myasthenia gravis is still a rather difficult task, since there is no single tactic to use different drugs (corticosteroids, rituximab, immunoglobulins), especially since it is associated with a number of side effects. They are not able to remove the accumulating autoantibodies and immune complexes, the large size of which does not allow them to be excreted by the kidneys as well. Special problems of treatment arise when myasthenic crises develop associated with respiratory failure requiring artificial lungs ventilation. Plasmapheresis can help to solve this for it is possible to remove antibodies and other pathological metabolites. In addition, regular plasmapheresis is able not only to prevent exacerbations but also to reduce doses of the maintenance therapy with less risk of their side effects, which is confirmed by our own experience.",book:{id:"7160",slug:"selected-topics-in-myasthenia-gravis",title:"Selected Topics in Myasthenia Gravis",fullTitle:"Selected Topics in Myasthenia Gravis"},signatures:"Valerii Voinov",authors:null}],onlineFirstChaptersFilter:{topicId:"1056",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81721",title:"Atrial Fibrillation and Stroke",slug:"atrial-fibrillation-and-stroke",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.104619",abstract:"Atrial fibrillation (AF) represents a major cause of morbidity and mortality in adults, especially for its strong association with thromboembolism and stroke. In this chapter, we aim to provide an overview on this cardiac arrhythmia, addressing several important questions. Particularly, we faced the possible mechanisms leading to an increased risk of embolism in AF, emphasizing how Virchow’s triad for thrombogenesis is unable to fully explain this risk. Disentangling the risk of stroke caused by AF and by other associated vascular conditions is extremely challenging, and risk stratification of patients with AF into those at high and low risk of thromboembolism has become a crucial determinant of optimal antithrombotic prophylaxis. Moreover, we discuss the typical clinical and radiological characteristics of cardioembolic strokes, addressing acute, time-dependent reperfusional therapies in case of ischemic stroke. The role of anticoagulation in AF is also fully analyzed; the benefit of oral anticoagulation generally outweighs the risk of bleeding in AF patients, and a variety of scoring systems have been developed to improve clinical decision-making when initiating anticoagulation. With their predictable pharmacokinetic profiles, wide therapeutic windows, fewer drug–drug and drug-food interactions, and the non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have changed the landscape of thromboprophylaxis for AF patients, offering the opportunity to use effective anticoagulants without the need for intensive therapeutic drug monitoring.",book:{id:"10782",title:"Cerebrovascular Diseases - Elucidating Key Principles",coverURL:"https://cdn.intechopen.com/books/images_new/10782.jpg"},signatures:"Francesca Spagnolo, Vincenza Pinto and Augusto Maria Rini"},{id:"81639",title:"Atrial Cardiopathy and Cryptogenic Stroke",slug:"atrial-cardiopathy-and-cryptogenic-stroke",totalDownloads:24,totalDimensionsCites:0,doi:"10.5772/intechopen.103736",abstract:"Cryptogenic stroke (CS) is defined as the presence of cerebral infarcts, the cause which has not been identified despite an appropriate diagnostic evaluation, and it accounts for approximately 30–40% of all ischemic strokes. There is a certain subgroup of CS with embolic characteristics on neuroimaging studies and no evidence of atrial fibrillation alternative or any alternative cause. Recent data suggest that disorders of the atrium, even without atrial fibrillation, could increase thromboembolic risk. The pathological atrial substrate, or atrial cardiopathy (AC), may be an important and underrecognized cause of cryptogenic strokes. This chapter will review the information on the rationale and data behind the concept of atrial cardiopathy, its pathophysiology, proposed biomarkers of atrial cardiopathy, and therapeutic implications.",book:{id:"10782",title:"Cerebrovascular Diseases - Elucidating Key Principles",coverURL:"https://cdn.intechopen.com/books/images_new/10782.jpg"},signatures:"Marianela López Armaretti, Natalia Romina Balian and María Cristina Zurrú"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:33,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"COVID-19, Neuroimmunology and Neural Function",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"},{id:"80821",title:"Neuroimmunology and Neurological Manifestations of COVID-19",slug:"neuroimmunology-and-neurological-manifestations-of-covid-19",totalDownloads:59,totalDimensionsCites:0,doi:"10.5772/intechopen.103026",abstract:"Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.",book:{id:"10890",title:"COVID-19, Neuroimmunology and Neural Function",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Robert Weissert"},{id:"80005",title:"Infarct Stroke and Blood Glucose Associated with Food Consumption in Indonesia",slug:"infarct-stroke-and-blood-glucose-associated-with-food-consumption-in-indonesia",totalDownloads:64,totalDimensionsCites:0,doi:"10.5772/intechopen.101548",abstract:"Stroke is the primary cause of death in adults. It is predicted that the death caused by stroke will increase twice in the next 30 years. In Indonesia, stroke is one of the diseases of the circulatory system, which has been taking the first place of causing death since 2007. Indonesia has rice as the main type of daily food consumed, which has higher glycemic index than other sources. This study aims to find the risk of blood glucose level that determines the incidence of infarct stroke. There were 164 patients enrolled in this study, 82 patients in each stroke and not stroke group. The blood examination is using the enzymatic method, which is the hexokinase method. The results of research revealed that indicators of high blood glucose level were found in infract stroke incidence, including casual blood glucose, fasting blood glucose, 2-h postprandial blood glucose, and glycated hemoglobin. These four indicators were found in a higher level in the infarct stroke than the non-stroke group. Other epidemiological studies have shown that diabetes is a risk factor for stroke. Therefore, education about food selection should be a priority in the effort to prevent infarct stroke and diabetes mellitus in Indonesia.",book:{id:"10782",title:"Cerebrovascular Diseases - Elucidating Key Principles",coverURL:"https://cdn.intechopen.com/books/images_new/10782.jpg"},signatures:"Santi Martini, Hermina Novida and Kuntoro"},{id:"80391",title:"COVID-19 and Seizures",slug:"covid-19-and-seizures",totalDownloads:59,totalDimensionsCites:0,doi:"10.5772/intechopen.102540",abstract:"The past two years were deeply marked by the emergence of a global pandemic caused by the worldwide spread of the virus severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. The plethora of repercussions on the health of those affected is extensive, ranging from asymptomatic individuals, mild flu-like disease, and severe respiratory failure, eventually leading to death. Despite this predilection for the respiratory system, the virus is responsible for multisystemic manifestations and soon became clear that neurological involvement was a frequent issue of coronavirus disease 2019 (COVID-19). Much have been pointed out about the neurotropic nature of the virus, the ways by which it invades and targets specific structures of the central nervous system, and the physiopathology behind the neurologic manifestations associated with it (namely encephalomyelitis, Guillain-Barré syndrome, lacunar infarcts, and vascular dysfunction, just to list a few). This chapter aims to raise light about the association between COVID-19 and the mechanisms of acute symptomatic seizures, through neurotropism and neuroinvasion features of SARS-CoV-2, and to review the variety of clinical presentations reported so far.",book:{id:"10890",title:"COVID-19, Neuroimmunology and Neural Function",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Rafael Jesus, Carolina Azoia, Paulo Coelho and Pedro Guimarães"}],onlineFirstChaptersTotal:16},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:141,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:124,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:12,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. 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He is especially interested in the genetic differentiation pattern and speciation process that correlate to the flashing pattern and mating behavior of some fireflies in Japan. He then worked for Olympus Corporation, a Japanese manufacturer of optics and imaging products, where he was involved in the development of luminescence technology and produced a bioluminescence microscope that is currently being used for gene expression analysis in chronobiology, neurobiology, and developmental biology. 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He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:{name:"Association for Computing Machinery",country:{name:"United States of America"}}},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"426586",title:"Dr.",name:"Oladunni A.",middleName:null,surname:"Daramola",slug:"oladunni-a.-daramola",fullName:"Oladunni A. Daramola",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Federal University of Technology",country:{name:"Nigeria"}}},{id:"357014",title:"Prof.",name:"Leon",middleName:null,surname:"Bobrowski",slug:"leon-bobrowski",fullName:"Leon Bobrowski",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Bialystok University of Technology",country:{name:"Poland"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"354126",title:"Dr.",name:"Setiawan",middleName:null,surname:"Hadi",slug:"setiawan-hadi",fullName:"Setiawan Hadi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Padjadjaran University",country:{name:"Indonesia"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"332603",title:"Prof.",name:"Kumar S.",middleName:null,surname:"Ray",slug:"kumar-s.-ray",fullName:"Kumar S. Ray",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Statistical Institute",country:{name:"India"}}},{id:"415409",title:"Prof.",name:"Maghsoud",middleName:null,surname:"Amiri",slug:"maghsoud-amiri",fullName:"Maghsoud Amiri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Allameh Tabataba'i University",country:{name:"Iran"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}}]}},subseries:{item:{id:"1",type:"subseries",title:"Oral Health",keywords:"Oral Health, Dental Care, Diagnosis, Diagnostic Imaging, Early Diagnosis, Oral Cancer, Conservative Treatment, Epidemiology, Comprehensive Dental Care, Complementary Therapies, Holistic Health",scope:"
\r\n\tThis topic aims to provide a comprehensive overview of the latest trends in Oral Health based on recent scientific evidence. Subjects will include an overview of oral diseases and infections, systemic diseases affecting the oral cavity, prevention, diagnosis, treatment, epidemiology, as well as current clinical recommendations for the management of oral, dental, and periodontal diseases.
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Her qualifications are: a specialist in Dental Imaging and Radiology, Master in Dentistry (Periodontics) from the University of São Paulo (FORP-USP, Ribeirão Preto, SP), and Doctor (Ph.D.) in Dentistry (Stomatology Clinic) from Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul (HSL-PUCRS, Porto Alegre, RS). She held a postdoctoral internship at the Federal University from Jequitinhonha and Mucuri Valleys (UFVJM, Diamantina, MG). She is currently a member of the Brazilian Society for Dental Research (SBPqO) and the Brazilian Society of Stomatology and Pathology (SOBEP). Dr. Marinho's experience in Dentistry mainly covers the following subjects: oral diagnosis, oral radiology; oral medicine; lesions and oral infections; oral pathology, laser therapy and epidemiological studies.",institutionString:null,institution:{name:"State University of Paraíba",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,series:{id:"3",title:"Dentistry",doi:"10.5772/intechopen.71199",issn:"2631-6218"},editorialBoard:[{id:"267724",title:"Prof.",name:"Febronia",middleName:null,surname:"Kahabuka",slug:"febronia-kahabuka",fullName:"Febronia Kahabuka",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZpJQAW/Profile_Picture_2022-06-27T12:00:42.JPG",institutionString:"Muhimbili University of Health and Allied Sciences, Tanzania",institution:{name:"Muhimbili University of Health and Allied Sciences",institutionURL:null,country:{name:"Tanzania"}}},{id:"70530",title:"Dr.",name:"Márcio",middleName:"Campos",surname:"Oliveira",slug:"marcio-oliveira",fullName:"Márcio Oliveira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRm0AQAS/Profile_Picture_2022-08-01T12:34:46.jpg",institutionString:null,institution:{name:"State University of Feira de Santana",institutionURL:null,country:{name:"Brazil"}}}]},onlineFirstChapters:{paginationCount:2,paginationItems:[{id:"82936",title:"Soil Degradation Processes Linked to Long-Term Forest-Type Damage",doi:"10.5772/intechopen.106390",signatures:"Pavel Samec, Aleš Kučera and Gabriela Tomášová",slug:"soil-degradation-processes-linked-to-long-term-forest-type-damage",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Forest Degradation Under Global Change",coverURL:"https://cdn.intechopen.com/books/images_new/11457.jpg",subseries:{id:"94",title:"Climate Change and Environmental Sustainability"}}},{id:"82124",title:"Assessment of Diversity, Growth Characteristics and Aboveground Biomass of Tree Species in Selected Urban Green Areas of Osogbo, Osun State",doi:"10.5772/intechopen.104982",signatures:"Omolara Aremu, Olusola O. 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\r\n\tThe era of antibiotics led us to the illusion that the problem of bacterial infection is over. However, bacterial flexibility and adaptation mechanisms allow them to survive and grow in extreme conditions. The best example is the formation of a sophisticated society of bacteria defined as a biofilm. Understanding the mechanism of bacterial biofilm formation has changed our perception of the development of bacterial infection but successfully eradicating biofilm remains a challenge. Considering the above, it is not surprising that bacteria remain a major public health threat despite the development of many groups of antibiotics. Additionally, increasing prevalence of acquired antibiotic resistance forces us to realize that we are far from controlling the development of bacterial infections. On the other hand, many infections are endogenous and result from an unbalanced relationship between the host and the microorganism. The increasing use of immunosuppressants, such as chemotherapy or organ transplantation, increases the incidence of patients highly susceptible to bacterial infections in the population.
\r\n
\r\n\tThis topic will focus on the current challenges and advantages in the diagnosis and treatment of bacterial infections. We will discuss the host-microbiota relationship, the treatment of chronic infections due to biofilm formation, and the development of new diagnostic tools to rapidly distinguish between colonization and probable infection.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/3.jpg",keywords:"Antibiotics, Biofilm, Antibiotic Resistance, Host-microbiota Relationship, Treatment, Diagnostic Tools"},{id:"4",title:"Fungal Infectious Diseases",scope:"Fungi are ubiquitous and there are almost no non-pathogenic fungi. Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment"},{id:"5",title:"Parasitic Infectious Diseases",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology"},{id:"6",title:"Viral Infectious Diseases",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Infectious Diseases",id:"6"},selectedSubseries:null},seriesLanding:{item:null},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/130135",hash:"",query:{},params:{id:"130135"},fullPath:"/profiles/130135",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()