Zargar classification of corrosive esophageal injury.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"1915",leadTitle:null,fullTitle:"Practical Applications of Agent-Based Technology",title:"Practical Applications of Agent-Based Technology",subtitle:null,reviewType:"peer-reviewed",abstract:"Agent-based technology provides a new computing paradigm, where intelligent agents can be used to perform tasks such as sensing, planning, scheduling, reasoning and decision-making. 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\r\n\tUmbilical cord blood (UCB) and umbilical cord tissue (UCT) have been worldwide stored cryopreserved in private and public cord blood and tissue banks in order to obtain hematopoietic (HSCs) and mesenchymal stem cells (MSCs) to be used in several clinical applications, most of them still under study in pre-clinical and clinical trials or even in in vitro testing. Deep knowledge of the regulatory issues is crucial for the implementation and development of umbilical cord blood and umbilical cord tissue banks where the quality of the samples is of the most importance. The UCT and UCB have been used in several clinical trials concerning a wide range of pathologies and diseases that can be daily consulted.
\r\n\r\n\tFurthermore, Advanced Therapy Medicinal Products (ATMPs) derived from UCB and UCT, from clinical translation, will bring exciting studies and new data for stem cells therapies, gene therapy, and gene editing, and immunotherapy promoting the Regenerative Medicine. UCB and UCT will probably become important in Regenerative Medicine therapies, presenting unique challenges related to product testing, scientific protocols, product quality and specifications, performance characteristics, and compliance criteria. This field of knowledge implies a multidisciplinary team where pre-clinical trials using appropriate animal models can also allow the application of cell-based therapies in Veterinary Medicine working in a One Health approach.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"f27ca50afb10a506c369451107433e90",bookSignature:"Prof. Ana Colette Maurício",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9823.jpg",keywords:"Umbilical Cord Blood, Umbilical Cord Tissue, Cryopreservation, GMP, ATMPs, Cell-based Therapy Commecialization, Gene Editing, Gene Therapy, Regenerative Medicine, Tissue Engineering, Stem cells, Biomaterials",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 2nd 2019",dateEndSecondStepPublish:"March 11th 2020",dateEndThirdStepPublish:"May 10th 2020",dateEndFourthStepPublish:"July 29th 2020",dateEndFifthStepPublish:"September 27th 2020",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 years",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"56285",title:"Prof.",name:"Ana Colette",middleName:null,surname:"Maurício",slug:"ana-colette-mauricio",fullName:"Ana Colette Maurício",profilePictureURL:"https://mts.intechopen.com/storage/users/56285/images/system/56285.jpeg",biography:"Ana Colette Pereira de Castro Osório Maurício has a degree on Veterinary Medicine since 1995, a PhD on Veterinary Sciences since 1999 from Faculdade de Medicina Veterinária (FMV) - Universidade de Lisboa (ULisboa) and Habilitation in Veterinary Sciences (ICBAS-UP) since 2011. The PhD experimental work was developed at Instituto Gulbenkian Ciência (IGC) in Oeiras, Portugal, at Freiburg Medicine Faculty in Germany and at Faculdade de Ciências e Tecnologia (FCT) from Universidade Nova de Lisboa (UNL). At the present, she is an Associated Professor with Habilitation, from the Veterinary Clinics Department of Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), she is the vice-President of the Pedagogic Council of ICBAS – UP. She is a Member of the Scientific Council and Member of the Representatives Council of ICBAS-UP. She is the Director of the Veterinary Sciences Doctoral Program at ICBAS – UP. She is the Scientific Coordinator of Regenerative Medicine and Experimental Surgery sub-unit from Centro de Estudos de Ciência Animal (CECA) of Instituto Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA). For the past 12 years she coordinates a multidisciplinary research group of Experimental Surgery and Regenerative Medicine, working with several biomaterials and cellular therapies. She started working with embryonic stem cells obtained by somatic nuclear transfer for therapeutic use; with Ian Wilmut´s group (Dolly’s cloned sheep). Several relevant publications had been produced and conducted to a PhD thesis that she co-supervised together with Ian Wilmut and to the first Portuguese cloned animal (R Ribas, B Oback, W Ritchie, T Chebotareva, J Taylor, AC Maurício, M Sousa, I Wilmut, 2006. Cloning and Stem Cells 8(1): 10; R Ribas, J Taylor, C McCorquodale, AC Maurício, M Sousa, I Wilmut, 2006. Biology of Reproduction 74: 307; R Ribas, B Oback, W Ritchie, T Chebotareva, T Ferrier, C Clarke, J Taylor, E Gallagher, AC Maurício, M Sousa, I Wilmut, 2005. Cloning and Stem Cells 7(2): 126). But ethical issues related to the collection and manipulation of human embryonic stem cells, even for therapeutic use is very controversial and understandable. So, more recently the potential of fetal stem cells derived from extra-embryonic tissues has been deeply investigated by her research group. Therefore, a continued effort to identify and characterize novel stem cell populations appears critical for widespread clinical success. This effort implies in vitro studies, experimental surgery and in vivo testing, before the clinical trials and the compassive treatment in such clinical cases where the traditional and standard treatments failed. Her research groups works exactly in this direction, so she created a multidisciplinary team, including Veterinaries, Engineers, Medical Doctors that through Experimental Surgery have a crucial role in the development of biomaterials and cellular therapies, allowing a close share of knowledge between biomaterials design, development of cellular systems, and surgeons needs when related to specific clinical cases. This group has several recent relevant publications in the research areas of nerve, bone, musculoskeletal and vascular tissue regeneration. In her laboratory have been working several PhD and Post-Doctoral students from various countries who have acquired a high level of competence in the study of tissue regeneration. She is the supervisor of several PhD, Post-Doctoral and Master students (16 PhD thesis already concluded with success and 14 PhD thesis on going), she is the co-author of a large number of scientific articles published in Indexed Journals (she publishes as Maurício AC) and of several scientific book chapters. She was the principal researcher of several national and international scientific projects. Editor of three international scientific books, inventor of three international patents.",institutionString:"University of Porto",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"10",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Porto",institutionURL:null,country:{name:"Portugal"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"280415",firstName:"Josip",lastName:"Knapic",middleName:null,title:"Mr.",imageUrl:"https://mts.intechopen.com/storage/users/280415/images/8050_n.jpg",email:"josip@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, copy-editing and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"5369",title:"Umbilical Cord Blood Banking for Clinical Application and Regenerative Medicine",subtitle:null,isOpenForSubmission:!1,hash:"711421bf3bdb0e540fc84267b82b1995",slug:"umbilical-cord-blood-banking-for-clinical-application-and-regenerative-medicine",bookSignature:"Ana Colette Mauricio",coverURL:"https://cdn.intechopen.com/books/images_new/5369.jpg",editedByType:"Edited by",editors:[{id:"56285",title:"Prof.",name:"Ana Colette",surname:"Maurício",slug:"ana-colette-mauricio",fullName:"Ana Colette Maurício"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5852",title:"Peripheral Nerve Regeneration",subtitle:"From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Development",isOpenForSubmission:!1,hash:"d1cd2e797f008dcee9dd0c1010145eb8",slug:"peripheral-nerve-regeneration-from-surgery-to-new-therapeutic-approaches-including-biomaterials-and-cell-based-therapies-development",bookSignature:"Ana Colette Mauricio",coverURL:"https://cdn.intechopen.com/books/images_new/5852.jpg",editedByType:"Edited by",editors:[{id:"56285",title:"Prof.",name:"Ana Colette",surname:"Maurício",slug:"ana-colette-mauricio",fullName:"Ana Colette Maurício"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. 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The hair shaft (the visible fiber that is growth above the skin), is a fiber with a variety of color depending of the melanin content that pigmented the keratin fiber. The dermal element in the hair follicle is the dermal papilla, which is majorly former by fibroblast cells, this dermal element controls the hair cycle.
The fiber of the hair, the hair shaft, grows from the hair follicle which is a tubular structure that forms a bulb around the matrix of the hair bulb, specialized dermal stem cell and different types of keratinocytes, from this hair bulb that form the dermal papilla the hair shaft growth by division of proliferative cells, thus cells goes to a process of differentiated, keratinized, and pigmented in the hair follicle to form the hair shaft in a cycling manner. The diameter of the hair shaft is directly related to the size of the papilla, and allows us to define the miniaturized hairs and normal hair.
The hair structure is composed by concentric layers that forms the hair follicle, the medulla which is the center is includes the cortex and outwards the cuticle of the cortex, and is surrounded by the inner and outer root sheath, and all the mini-organ is surrounded by connective tissue.
The functional aspect of hair is not only to protect from radiation, heat or cold and any extern agent but also contribute to the appearance and personality. The loss of the hair contributes to psychological, social and psychosocial problems, generating a cosmetic and social impact in our society.
The hair follicle has the unique capacity of undergoing periods of growth (anagen), regression (catagen), and rest (telogen and exogen) before regenerating itself to restart the cycle [1, 2, 3, 4] (Figure 1). This dynamic cycling capacity enables mammals to change their coats, and for hair length to be controlled on different body sites [5].
Hair cycle stages scheme, phase of growth (anagen), regression (catagen), and rest (telogen) before regenerating itself to restart the cycle.
Unlike what is observed in many animals in which the pelage synchronously passes from one phase of the cycle to other all stages of growth cycle are simultaneously found in the human, the growth pattern is a mosaic where the hair cycling staging of one hair root is completely independent of it nearest hair follicle, meaning that each follicular unit (FU) can contain follicles in different stages at any given time. In healthy individuals, 80–90% of follicles are in the anagen phase, 1–2% in the catagen phase, and 10–15% in the telogen phase [6]. The hair grows around one centimeter a month, and has a variable growth speed being faster in the summer than in winter. The growth phase, or anagen phase, lasts an average of 3–5 years. This normal hair-growth cycle can be modified or by internal or external factors such as hormones, stress, sun, disease, exposure to environmental pollution, drugs and smoking. This changes in the growth cycle and quality of hair can leads to hair loss by a shortening of the anagen phase, a premature ingression of the catagen phase, the prolongation of the telogen phase or a loss of the hair follicle function [6, 7]. Common hair loss is medically named as alopecia, and can be suffer by men and women.
Research has shown that in hair loss, the percentage of telogen follicles is increased, while the percentage of anagen and catagen follicles is reduced. A healthy individual loses approximately 100–150 hairs per day [6]. Cell-signaling pathways in hair follicular cells resulting in the induction of apoptosis, changes in usual pattern of hair cycling, inducing the hair follicle to turn into regression or resting phase and thinning or fracture of the hair shaft leads to progressive hair loss and alopecia [7].
Hair loss is a universal problem for numerous people in the world, is a disorder in which the hair falls out from skin areas such as scalp, the body and face. Multiples factors contribute to hair loss including genetics, hormones, nutritional status, and environmental exposure (exposure to radiations, environmental toxicants…), medications and nutrition.
Androgenic alopecia can be suffered by women and men and the androgens hormones are the most important of the factors that cause the hair lost patron characterized by a miniaturized of the hair follicles that leads to hair lost in the frontal to parietal area.
Other forms of hair loss are for example caused by immunogenic hair loss, like alopecia areata, this is characterized by a spot of hair lost all around the scalp. The approved therapies such as finasteride and minoxidil, are the traditional medication used for this hair lost diseases, a few others are in progress, like a wide variety of diverse phytochemicals, including those present in ginseng, the ginsenosides which have demonstrated hair growth-promoting effects in a large number of preclinical studies [7].
Androgenic baldness (androgenic alopecia) and circular/spot baldness (alopecia areata) are the most common forms of hair loss. The first is characterized by high sensitivity of the hair follicles to DH, while the second is induced by an autoimmune reaction [8, 9]. Hair also possesses its own immune system, the failure of which can lead to spot baldness (alopecia areata).
Alopecia is extended all round the world, reaching nowadays approximately to 10 million patients suffering from alopecia. Considering the pathological background of alopecia and its impact on an individual’s health and social value, there is now a growing interest in the development of novel therapeutics for its medical management [7].
Given the negative psychosocial impact of hair loss, patients follow different therapies, conventional treatments such as the two medications approved by the United States Food and Drug Administration (US-FDA): Minoxidil and Finasteride, for the treatment of alopecia.
Finasteride has a potent effect against androgens, being non-steroidal, it has shown to prevent male and female hair loss through the inhibition of type II 5α-reductase, which affects androgen metabolism avoiding the conversion of free testosterone into 5α-dihydrotestosterone, playing an important role in the pathogenesis of androgenetic alopecia in men and women [10].
The effect of minoxidil as hair growth stimulating has been known over last decades, since it was introduced in the early 1970 as a treatment for hypertension. But yet the basic mechanism of action on the hair follicle is not clearly understood [11, 12].
These drugs work improving the quality of the hair follicles and reducing the hair lost but exhibit certain adverse effects, such as allergic contact dermatitis, erythema, and itching, and also stop recommended guideline of minoxidil leads to recurrence of alopecia and a prolonged use of finasteride causes male sexual dysfunction and appears as a major cause of infertility and teratogenicity in females.
Patient that do not see significant hair restoration with conventional therapies or suffer side effects often change from these conventional treatments to alternative medicine trying new treatments from the vast resources of natural products, in an attempt to find safe, natural and efficacious therapies to restore the hair.
Natural products as it is known in the market “Dietary supplements” includes diverse subgroups like vitamins, probiotics, minerals, herbs, extracts, gels that do not require Food and Drug Administration (FDA) approval [13].
To treat hair loss are available treatments using amino acids, caffeine, capsaicin, curcumin, garlic gel, onion gel and extract, cinnamon,
Ginseng is an ancient herbal remedy that was recorded in The Herbal Classic of the Divine Plowman, the oldest comprehensive Materia Medica, which was scripted approximately 2000 years ago [9].
Among different species which are known as ginseng,
Nowadays has gained fame as one of the most popular herbs originating from Eastern Countries, because contemporary science has revealed that ginseng contains a wide variety of bioactive constituents, especially a group of saponin compounds collectively known as ginsenosides, which have been proposed to account for most of the diverse biological activities, including the hair-growth potential of ginseng [9]. Ginsenosides can be classified, depending on the number of hydroxyl groups available for glycosylation via dehydration reactions, as protopanaxadiol (PPD) and protopanaxatriol (PPT). Common PPD-type ginsenosides include ginsenosides Rb1, Rb2, Rc, Rd., Rg3, F2, Rh2, compound K (cK), and PPD, whereas PPT-type ginsenosides include Re, Rf, Rg1, Rg2, F1, Rh1, and PPT [9] and malony ginsenosides mRb1, mRb2 and mRbc [15]. Ginseng extract or its specific ginsenosides have been tested for their potential to promote hair growth.
The major bioactive constituents of ginseng are ginsenosides and there has been evidences suggesting that promote hair growth by enhancing proliferation of dermal papilla and preventing hair loss via modulation of various cell-signaling pathways [9, 16, 17].
The role of 5α-reductase enzyme in the hair-loss process has been well-documented [18], affects androgen metabolism, and it is the pathway how drugs approved are used nowadays.
Novel therapeutics ways for the management of hair loss and alopecia improving hair-follicle proliferation and reducing hair-loss need new targets (Figure 2). These targets include, matrix metalloproteinases (MMPs), extracellular signal-regulated protein kinase (ERK), and Janus-activated kinase (JAK), the activation of the proliferation by WNT/Dickkopf homolog 1 (DKK1), sonic hedgehog (Shh), vascular endothelial growth factor (VEGF), apoptosis inhibition by transforming growth factor-beta (TGF-β).
The effect of the 5α-reductase enzyme, dihydrotestosterone, and the growth factor TGF-β on hair loss and the potential targets of ginseng in hair growth and loss.
Photo aging is skin damage induced by radiation exposure (Sun exposure) characterized by different inflammatory responses to ultraviolet radiation (UVR). Excessive UV irradiation is known to cause skin photo damage by release of oxidative species which leads to skin inflammation, and keratinocyte cell death producing photo aging and carcinogenesis.
There are evidences that suggest that misbalances in the hair-growth cycle, affecting keratinocyte and dermal papilla growth [19] is cause by UVR exposure not only producing the damage of the hair shaft as an extracellular tissue, as it is clearly evident but also alters the molecular growth [19].
The Reactive Oxidative Species (ROS) accumulation and activation of matrix metalloproteinase (MMPs), a tissue-degrading enzymes, produced by UV irradiation compromises dermal and epidermal structural integrity [9].
The inhibitory effect of ginsenosides on UVB-induced activation of MMP2 suggests the potential of these ginseng saponins in hair-growth regulation [9]. Ginsenosides Rb2 [20] and 20 (S) PPD, have been reported to reduce the formation of ROS and MMP-2 secretion in cultured human keratinocytes (HaCaT) cells after exposure to UVB radiation. Ginsenoside Rg3 20 (S), reduced ROS generation in HaCaT cells and human dermal fibroblasts without affecting cell viability. The 20 (S) Rg3 also attenuated UVB-induced MMP-2 levels in HaCaT cells [21]. Ginsenoside Rh2 reduced UVB radiation-induced expression and activity of MMP-2 in HaCaT cells, but UVB-induced ROS formation was only suppressed by 20 (S)-Rh2 [22].
Ginsenosides extracts from the Ginseng radix have shown attenuates radiation-induced cell death in the skin, improving hair growth. Ki67 positive number of cells and Bcl2 protein expression, an antiapoptotic protein, are induced by Total-root saponins and ginsenoside Rb1 diminishing apoptotic cells in UVB-exposed human keratinocytes [9, 23]. Ginsenoside F1, an enzymatically modified derivative of ginsenoside Rg1, by maintaining a constant level of the antiapoptotic protein Bcl-2 expression in UVB-irradiated HaCaT cells, protect keratinocytes from radiation-induced apoptosis [9, 24].
Skin aging is a multifactorial process consisting of two distinct and independent mechanisms: intrinsic and extrinsic aging.
Ginsenosides, extracted from Ginseng have been tested in several studies in antiaging [25, 26]. This antiaging effects, of ginseng extract and ginsenosides is produced by maintaining skin structural integrity and regulating hair-growth by stimulating wound healing cells, collagen and hyaluronic acid.
Lee et all incubates fibroblasts, which are key wound-healing cells, with
Wrinkle formation, is associated as marker of dermal aging and present a reduced level of hyaluronan in the dermis [29]. On HaCaT cell treated with major ginseng metabolite (compound K, 20-O-beta-D-glucopyranosyl-20(S)-protopanaxadiol) were report that hyaluronan synthase2 (HAS2) gene is one of the most significantly induced genes [30] and also was tested that topical application of compound K on mouse skin and shows elevated the expression of hyaluronan synthase-2 [30]. The hyaluronan synthase-2 is an enzyme essential to hyaluronan synthesis, hyaluronan is a major component of most extracellular matrices that has a structural role in tissues architectures and regulates cell adhesion, migration and differentiation.
These antiaging effects of ginseng extracts through Src kinase-dependent activation of ERK and AKT/PKB kinases in the dermis and papillary dermis result in improved skin health, thereby ensuring hair-follicle health and a regular hair cycle [9, 30].
The exposure to androgens is the major triggers for hair loss is which in most cases is genetically predetermined in androgenic alopecia patients [9, 31, 32].
The androgen that mainly plays a role in altering hair cycling is 5α-dihydrotestosterone (DHT), which is a metabolite of testosterone. The conversion of testosterone to DHT is mediated by the 5α-reductase (5αR) enzyme in each follicle [33, 34] (Figure 2). Treatment with 5α-reductase inhibitors, e.g., finasteride, prevents the development of alopecia and increases scalp-hair growth [9].
Topical application of ginseng extract or ginsenosides was reported to enhance hair growth. Rhizomes of
Major components of hair regenerative capacity such as linoleic acid (LA) and β-sitosterol (SITOS) were significantly restored with Red Ginseng Oil (RGO) after testosterone (TES)-induced delay of anagen entry in C57BL/6 mice, also RGO and its major components reduced the protein level of TGF-β and enhanced the expression of anti-apoptotic protein Bcl-2, suggesting that RGO is a potent novel therapeutic natural product for treatment of androgenic alopecia [37].
Red Ginseng Extract (RGE) and ginsenosides protect hair matrix keratinocyte proliferation against dihydrotestosterone (DHT)-induced suppression and affects the expression of androgen receptor.
Moreover, RGE, ginsenoside-Rb1, and ginsenoside-Rg3 at lower levels that have been shown to inhibit 5a-reductase [35] inhibit the DHT-induced suppression of hair matrix keratinocyte proliferation and the DHT-induced upregulation of the mRNA expression of androgen receptor in hDPCs [16]. DHT is the product of testosterone and does not require the activity of 5a-reductase to affect hair follicles, and the inhibitory effect of DHT on hair growth is mediated by the androgen receptor in DPCs [38]. These results suggest that red ginseng may promote hair growth in humans through the regulation of androgen receptor signaling [16].
Majeed et al. review the recent perspectives of ginseng phytochemicals as therapeutics in oncology and explain the chemotherapeutic effect of ginsenoside as result of its appetites, ant proliferative, anti-angiogenic, anti-inflammatory and anti-oxidant properties [39]. The anticancer effect of ginseng was proven in various types of cancer: breast, lung, liver, colon and skin cancer. It increases the mitochondrial accumulation of apoptosis protein and down regulate the expression of anti-apoptotic protein, reducing cancer development. It also aids in the reduction of alopecia, fatigue and nausea, the known side effects of chemotherapeutic drugs [39].
Alopecia induced by chemotherapy is one of the most distressing side effects for patients undergoing chemotherapy. One drug used as chemotherapy is Cyclophosphamide (CP), also known as cytophosphane. Cyclophosphamide metabolite, 4-hydroperoxycyclophosphamide (4-HC) inhibited human hair growth, induced premature catagen development, and inhibited proliferation and stimulated apoptosis of hair matrix keratinocytes inducing the side effect of alopecia. In human hair follicle organ culture model pre-treatment with Korean Red Ginseng (KRG) before cyclophosphamide metabolite Dong In Keum et all shows that KRG suppress 4-HC-induced inhibition of matrix keratinocyte proliferation and stimulation of matrix keratinocyte apoptosis, playing a protective effect on 4-HC-induced hair growth inhibition and premature catagen development. Moreover, KRG restored 4-HC-induced p53 and Bax/Bcl2 expression [17].
Different intracellular signaling pathways are involving and plays a critical role in stimulating hair growth by promoting dermal papillary-cell proliferation.
Hair growth is promote by Ginsenoside Rg3 upregulating Vascular Endothelial Growth Factor (VEGF) expression [36]. VEGF is a signaling protein which is released from the epithelium and increases the angiogenesis of the hair follicle [9, 40, 41, 42]. Was also demonstrate by Shin et al. that Rg3 increased the proliferation of human dermal papillary cells, associating this proliferation with an upregulation of mRNA expression of VEGF also stimulated stem cells by upregulating factor-activating CD34 and CD8 [36] and promoted hair growth even more than minoxidil in mouse [43] it was conclude that Rg3 might increase hair growth through stimulation of hair follicle stem cells [36].
RGE and ginsenoside-Rb1 enhanced the proliferation of hair matrix keratinocytes, human hair-follicle dermal papillary cells (hDPCs). Treated hair with RGE or ginsenoside-Rb1 exhibited substantial cell proliferation and the associated phosphorylation of ERK and AKT [16], it was recently demonstrated that ERK activation plays an important role in the proliferation of hDPCs [42] and AKT mediates critical signals for cell survival and also regulates the survival of DPCs as an antiapoptotic molecule [9, 16, 44] proliferation and the prolongation of the survival in the hDPCs by red ginseng may be mediated by the ERK and AKT signaling pathway [9, 16].
Human DPC treatment with Gintonin-enriched fraction (GEF) stimulated vascular endothelial growth factor release. Topical application of GEF and minoxidil promoted hair growth in a dose-dependent manner. Histological analysis showed that GEF and minoxidil increased the number of hair follicles and hair weight [45].
The Bcl-2 family proteins is notable for their regulation of apoptosis machinery, a form of programmed cell death, the member of this family either acts as antiapoptotic or pro apoptotic in nature. During the hair cycle, the dermal papillary cells (DPC) is the only region where Bcl-2 is expressed consistently and is considered to resist apoptosis [9, 46, 47, 48]. In mice Fructus
Shh/Gli and Wnt/β path way and related proteins (Shh (Sonic hedgehog,) Smoothened (Smo), β-catenin, Cyclin D1 Cyclin E and Gli1 (glioma-associated oncogene homolog)) are associated to hair regeneration, promoting telogen-to-anagen transition, hair follicle formation and growth [50, 51, 52, 53, 54, 55, 56].
Wingless-type integration-site (WNT) signaling plays a key role in hair-follicle development. Activation of WNT signaling is necessary for initiation of follicular develop, the blockade of WNT signaling by overexpression of the WNT inhibitor, Dickkopf Homolog 1 (DKK1), prevents hair-follicle formation in mice [50] and inhibited hair growth [9, 50].
β-catenin signaling is essential for epithelial stem-cell fate since keratinocytes adopt an epidermal fate in the absence of β-catenin [51], and this signaling pathway is related to WNT [52] affecting hair follicle placodes formation, when β-catenin is mutated during embryogenesis, formation of placodes that generate hair follicles is blocked [53].
The role of TGF-β in hair loss has been documented through the study revealing that treatment with a TGF-β antagonist can promote hair growth via preventing catagen progression [57]. Also through the activation of TGF-β and brain-derived neurotrophic factor (BDNF), it was describe that it was enhanced the transition from the anagen to the catagen phase [58].
Since TGF-β1 induces catagen in hair follicles and it is closely related to alopecia progression it can be say that acts as a pathogenic mediator of androgenic alopecia [57, 59] and red ginseng extract can delay the catagen phase and holds the potential to promote hair growth, thought downregulation or inhibition of the TGF-β pathway.
On Young Go Kim investigation was concluded that on ultraviolet B (UVB)-irradiated skin aging in mice, oral administration of Red Ginseng extract protects from skin damage induced by ultraviolet B (UVB)-irradiation, increases of skin thickness and pigmentation, reduction of skin elasticity, inhibited the increases of epidermis and corium thickness. The administration of Red Ginseng extract exert the protective action on UVB-radiation skin aging inhibiting the increase of skin TGF-beta1 content induced by UVB irradiation [60].
Furthermore on Zheng Li the hair-growth-promoting effects of Protopanaxatiol type ginsenoside Re were associated with the downregulation of TGF-β-pathway-related genes, which are involved in the control of hair-growth phase-transition-related signaling pathways [61]. On their study shows that topical administration of ginsenoside Re on to the back skin of nude mice for up to 45 days significantly increased hair-shaft length and hair existent time, and stimulated hair-shaft elongation in the ex vivo cultures of hair follicles isolated from C57BL/6 mouse [61].
The hyper activation of the c-Jun-N-terminal kinase (JNK) pathway in associate with an activation of TGF-β-induced hair loss. Korean red ginseng has been attributed to exert protective effects onTGF-β-induced hair loss by the inhibition of JNK on radiation-induced apoptosis of HaCaT cells [62].
By promoting telogen-to-anagen transition of follicular cells and epidermal growth, Shh/Gli regulates hair-follicle development, growth and cycling [54, 55]. Shh−/− mice develop have abnormal hair follicular cells in the dermal papillae and blocking Shh activity mice diminished hair growth, this results indicates the importance of Shh signaling in hair-growth promotion [56].
Androgenetic alopecia is related to testosterone (TES)-induced delay of anagen phase and hair loss. In C57BL/6 mice Red-ginseng oil (RGO) reversed testosterone-induced suppression of hair regeneration through early inducing anagen phase by up-regulating the expression of Shh/Gliand Wnt/β pathway-related proteins, Shh, Smoothened (Smo), β-catenin, Cyclin D1 Cyclin E and Gli1. Additionally, RGO reduced the protein level of TGF-β but enhanced the expression of anti-apoptotic protein Bcl-2 [37] suggesting that RGO is a potent therapeutic natural product for treatment of androgenic alopecia possibly through hair re-growth activity [37].
The signaling pathway and anagen induction effect of ginsenoside F2 were investigated and compared with finasteride on the effect of hair growth induction in Heon-Sub Shin at all paper [43] where MTT assay results indicated cell proliferation in human DPC increased a 30% with ginsenoside F2 treatment compared to finasteride [43]. Studding the expression of β-catenin and its transcriptional coactivator Lef-1, the Ginsenoside F2 compared to finasteride group, increased the expressions while decreased the expression of DKK-1. Tissue histological analysis shows that administration of ginsenoside F2 promoted hair growth as compared to finasteride, increase in the number of hair follicles, thickness of the epidermis, and follicles of the anagen phase [43]. Heon-Sub Shin conclude that ginsenoside F2 might be a potential new therapeutic compound for anagen induction and hair growth through the Wnt signal pathway [43]. In another study by Matsuda et al., ginsenosides Rg3 and Rb1 [63] extracted from red ginseng stimulates hair growth activity in an organ culture of mouse vibrissa follicles. No detailed explanations are given in this paper about the mechanism of hair growth, but the results presented by Matsuda et al. [63] indicated that Ginseng Radix possesses hair growth promoting activity.
Growth factors and cytokines have been proved to influence hair follicle development or cycling [65] overexpression and/or secretion of Cytokines, such as interleukins (ILs) and interferons (IFN), cause skin inflammation, TGF beta 1 partially inhibited hair growth and EGF, TNF alpha and IL-1 beta completely abrogated it [66]. There is an aberrant expression pattern of cytokines in alopecia areata hair follicles.
The presence of CD8+ T cells and NKG2D+ cells around the peri-bulbar area of the affected hair follicles [67] and upregulation of several ILs, such as IL-2, IL-7, IL-15, and IL-21, and IFN-γ leads to immune activation area where’re main suppressed natural killer (NK) cells [68] and is defined as immune-tolerated area. Loss of immune tolerance [68] or immune activation [67], leads to hair-follicle dystrophy and acceleration of the catagen phase [9] by the activation of a cytotoxic cluster of differentiation 8-positive (CD8+) and NK group 2D-positive (NKG2D+) T cells. In alopecia Areata (AA) are found more CD57 − CD16+ NK cells and there is a association between NK cells and the collapse of HF-IP (immune privilege) while normal human scalp skin—that indeed there is no sign of an NK attack on normal anagen VI HFs [69].
Phosphorylate Stat3 in the Janus Kinase (JAK)/Signal transducer and activator of transcription-3 (STAT3) pathway regulate the activation of CD8+ and the NKG2D+ CD8+ T cells [70]. The inhibition of the upstream pathway JAK appears as a plausible target for developing a therapy for hair loss [67]. In fact, a number of JAK inhibitors, such as tofacitinib, ruxolitinib, baricitinib, CTP-543, PF-06651600 and PF-06700841 are in the progress of developing a therapy for alopecia [71, 72] more often in alopecia areata a common form of non-scarring hair loss that usually starts abruptly with a very high psychological impact [73], it is a T-cell-mediated disease which produces circular patches of non-scarring hair loss and nail dystrophy [72].
Ginsenoside Rk1 inhibited the lipopolysaccharide- stimulated phosphorylation of JAK2 and STAT3 in murine macrophage cells [74] and Ginsenoside 20(S)-Rh2 exerts anti-cancer activity through targeting IL-6-induced JAK2/STAT3 [75]. Topical application of ginsenoside F2 by inhibiting the production of IL-17 and ROS, ameliorated dermal inflammation skin [69]. In the pathogenesis of alopecia areata is believed to be an imbalance of inflammatory cytokines IL-17. Monoclonal antibodies against IL-17A leads to hair regrowth in human volunteers [76]. Treatment with
Ginseng may be a multipurpose natural medicine with an extended history of medical application throughout the globe, particularly in Eastern countries.
The beneficial effects of Ginseng cover a good spectrum from immune to cardiovascular, cancer and sexual diseases. New advances in the science leads elucidate new pharmacological activity of the ginseng and its ginsenosides. There are some studies of the use of Ginseng in dermatology investigating its effects from molecular to physiological in a skin cancer, dermatitis, alopecia wound injury and of course hair loss because also ginseng and its ginsenosides regulate the expression and activity of major proteins involved in hair-cycling phases, so the medical use of ginseng is not only restricted to the improvement of general wellness, but also extended to the treatment of organ-specific pathological conditions, like hair.
Ginseng and its metabolites are associate with the induction of anagen phase preventing hair lost and promoting hair growth although further studies should be done to elucidate and clarified the mechanisms by which ginseng and its metabolites regulate human hair health.
The authors declare no conflict of interest.
Alopecia Areata Androgenetic Alopecia Follicular Unit United States Food and Drug Administration Dickkopf homolog 1 sonic hedgehog vascular endothelial growth factor transforming growth factor-beta matrix metalloproteinase extracellular signal-regulated protein kinase Janus-activated kinase protopanaxadiol protopanaxatriol compound K ultraviolet radiation reactive oxygen species linoleic acid β-sitosterol testosterone human hair-follicle dermal papillary cells red-ginseng extract hair follicle dermal papilla cells Gintonin-enriched fraction Korean Red Ginseng Dermal papillary cells NK group 2D-positive UL16-binding protein 3 glioma-associated oncogene homolog cluster of differentiation 8-positive interleukins interferons outer root sheath Signal transducer and activator of transcription-3 Wingless-type integration-site Gintonin-enriched fraction
Corrosive ingestion is a medical emergency that is especially prevalent in developing countries such as Thailand [1, 2, 3, 4, 5, 6, 7, 8, 9]. Since 2020, the COVID-19 has had an enormous impact on many sectors worldwide, and it had affected the trend of rising incidence and severity of diseases [10]. However, the actual incidence should not be precise as the tip of the iceberg phenomenon is probably under-report [4, 8]. Currently, various studies on this topic are still being developed for medical knowledge to the achievement goal of the best practice. Perforation and stricture are complications of corrosive ingestion which are currently being researched and which are discussed in this chapter.
Caustic injuries are caused by the ingestion of substances with acid or base properties. Acids cause coagulation necrosis, and alkalis cause liquefaction necrosis. Corrosive ingestion in children is usually accidental. In adults, it might be related to suicide. Therefore, it is a public health concern with mental and socioeconomic aspects [1, 2, 6, 11].
Morbidity with mortality rates of corrosive injuries are high [12, 13]. Airway assessment and prompt management are priorities in emergency settings, especially in severe cases [2, 13, 14]. Extensive burns can cause the fragile esophageal wall to become perforated. Physicians must evaluate this condition as soon as possible. Stricture is another complication that physicians need to evaluate. Post-corrosive esophageal strictures cause patients to suffer and are difficult to treat [2, 3, 4, 9, 12, 15, 16, 17, 18, 19].
Caustic substances with pH less than two or more than 12 are especially destructive. Form, concentration, amount of ingestion, and contact duration also affect the results. Acidic substances generate coagulation necrosis which creates eschar formation. Eschar can limit the penetration of injuries [16]. On the other hand, alkaline substances melt the tissue protein and initiate liquefactive necrosis with saponification that can penetrate deeper into the esophageal wall [17].
Perforation occurs in the acute stage of severe esophageal injuries. As a consequence of perforation, stricture follows during the recovery stage. Tissue injuries after corrosive ingestion go through three phases. Phase 1 is characterized by cell necrosis and thrombosis, 48–72 hours after the event. Next, in Phase 2, there is mucosal sloughing with ulceration of the esophageal wall plus fibroblast colonization and granulation. This phase continues for 14 days from the Phase 1, and the esophagus is friable during this phase. Finally, in Phase 3, the healing process starts in the third week and usually continues 3–6 months [3, 20, 21].
When patients arrive at the emergency department, stabilization of the patient is the most important target for this stage [21]. Signs and symptoms that often occur in corrosive ingested patients include burning of the oral cavity, drooling, nausea, and vomiting. Upper gastrointestinal bleeding can be found in severe cases, indicating substance injuries to the alimentary tract. Respiratory trauma can result in hoarseness, difficulty to breathe, stridor, and airway compromise. Esophagus perforation can be expressed as mediastinitis, chest wall emphysema, and pneumothorax, depending on time and severity.
Physicians should first examine the airway, especially for signs of aspiration or laryngeal injury. Physical examination and history taking should be done for details of the corrosive substance, the volume, timing before admission, pre-hospital treatment, and cause of ingestion. The patient should be given nil per os (NPO) and adequate resuscitation. Nasogastric tube intubation, gastric lavage, administration of emetic drugs, and neutralizing agents are not recommended because reflux of these agents into the esophagus could result in further damage [1, 8, 21]. Intravenous broad-spectrum antibiotics may benefit a patient with high-grade esophageal injuries. The investigation by chest and abdominal radiography should be evaluated. In cases of attempted suicide, the patient should be evaluated by the psychiatric department [1, 3, 4, 9, 22, 23].
The initial evaluation of the severity of a caustic injury provides important information. Esophagogastroduodenoscopy (EGD) is recommended for grading esophageal injuries following the Zargar classification (Table 1). Zargar classification can assist prognosis and guide clinical management [16]. The EGD should be done as soon as possible within 24–48 hours. Performing endoscopy after 48 hours is not recommended because the tissue injuries go through Phase 2 when they should not be subjected to an unwanted event [16, 21]. For patients with Zargar grade 1 and 2a, an oral diet may be given. Patients with Zargar grade 2b and 3a can start an oral diet once they can swallow saliva. Esophagectomy should be performed on patients with Zargar grade 3b injuries.
Zargar classification | Description |
---|---|
Grade 0 | Normal finding on endoscopic examination |
Grade 1 | Edema and hyperemia of the mucosa |
Grade 2a | Friability, blisters, exudates, hemorrhages, whitish membrane, erosions, and superficial ulceration |
Grade 2b | Grade 2a plus deep discrete or circumferential ulceration |
Grade 3a | Small scattered areas of multiple ulceration and areas of necrosis with brown-black or grayish discoloration |
Grade 3b | Extensive necrosis |
Zargar classification of corrosive esophageal injury.
The method for assessing the degree of esophageal damage by computed tomography (CT) with scoring was recently established as a noninvasive modality [24]. Nowadays, the use of CT scans of the chest and abdomen is increasing. CT can assist prognosis after ingestion, but it is still inconclusive [25, 26, 27]. CT also provides extraesophageal information regarding anatomies such as the mediastinum, lung, and pleural cavity, which endoscopies do not (Table 2).
Score | Endoscopic score [16] | Computerized tomography score [24] |
---|---|---|
0 | Grade 0; Normal | Normal |
I | Grade 1; Edema and hyperemia of the mucosa | No definite swelling of esophagus wall (<3 mm, within normal limit) |
II | Grade 2a; Friability, blisters, exudates, hemorrhages, whitish membrane, erosion, and superficial ulceration | Edematous wall thickening (>3 mm) without periesophageal soft tissue infiltration |
Grade 2b; Grade 2a plus deep discrete or circumferential ulceration | ||
III | Grade 3a; Small scattered areas of multiple ulceration and areas of necrosis with brown-black or grayish discoloration | Edematous wall thickening with periesophageal soft tissue infiltration pulse well-demarcated tissue interface |
Grade 3b; Extensive necrosis | ||
VI | Grade 4; Perforation | Edematous wall thickening with periesophageal soft tissue infiltration plus blurring of tissue interface or localized fluid collection around the esophagus or the descending aorta |
Endoscopic score and computerized tomography score of corrosive esophageal injury.
Although an endoscopy is an important tool for initial evaluation, contraindications are suspected perforation, oral cavity necrosis, and airway injury with compromised respiration. CT scans can safely provide details about esophageal transmural necrosis consisting of esophageal wall blurring, peri-esophageal fat stranding, and no enhancement of esophageal wall after administration of intravenous contrast [24]. Recent studies reported that unnecessary esophagectomy following endoscopic evaluation of patients with Zargar grade 3b could have been avoided if CT had been used [28, 29, 30].
Both CT and endoscopy have distinctive advantages. CT is minimally invasive with high sensitivity and specificity [24, 25, 27, 28, 29, 30]. Intra-luminal evaluation by endoscopy reveals subtle details of the esophageal mucosa and degrees of damage [31]. The combination of CT and endoscopy is especially useful for examining patients with Zargar 3b injuries [8, 30, 31].
As the esophagus is healing following ingestion of a corrosive substance, the possibility of stricture should be assessed. Post-corrosive esophageal stricture is a complication that produces suffering for victims [9, 15, 17]. Esophageal dilation is a therapeutic intervention of choice to perform at the onset of stricture. If left until later, the procedure becomes more difficult, decreasing the success and increasing adverse events [21, 32, 33, 34, 35, 36]. Esophageal dilatation can be performed repeatedly according to schedule and using various dilators such as Maloney-Hurst, Savary-Gilliard, and Balloon dilator under the endoscopy, fluoroscopy, or both. Alternative methods for post-corrosive esophageal stricture such as esophageal stenting [21, 37, 38], intralesional steroids [21, 39, 40, 41, 42, 43], and, Mitomycin-C [21, 44, 45, 46, 47, 48] have been published with various outcomes. These options might supplement dilation with better results. In cases of severe stricture, failure to dilate, or refractory strictures, surgery might be necessary (Figure 1) [4, 18, 19, 49, 50, 51, 52, 53, 54].
The treatment options for post-corrosive esophageal stricture. (A) Severe post-corrosive esophageal stricture; (B) Savary-Gilliard dilator; (C) endoscopic balloon dilation; (D) esophagectomy with open right thoracotomy; (E) esophagectomy with video-assisted thoracoscopic surgery (VATS); (F) reconstruction with cervical anastomosis after esophagectomy; (G, H) right side colonic conduit for esophageal replacement; and (I) subcutaneous colon interposition.
Post-corrosive esophageal stricture should highly consider inpatient with Zargar grade 2b and 3a [4, 5, 8, 9, 16, 55]. Although various treatment strategies have been developed, none of them can provide outstanding results. Stricture prevention would be the ideal method. Corticosteroids reduce inflammation, but the benefit is inconclusive. Steroids cause severe adverse side effects such as esophageal candidiasis, gastric ulcer, ethmoiditis, osteomyelitis, and osteoporosis [56, 57, 58]. Recent studies have demonstrated that omeprazole with proton pump inhibitor activity could enhance healing, reduce stricture, and reduce the short-term risk of developing esophageal stricture in patients with 2b and 3a corrosive injuries [9, 59, 60, 61]. However, further studies of omeprazole are needed to corroborate these findings (Figure 2).
Schematic diagram of corrosive ingestion in esophageal injury.
Corrosive ingestion is a serious medical emergency that is a global problem, especially in several developing countries. When patients arrive at the emergency department, stabilization of the patient is initially the most important target. Airway assessment and prompt management are the priorities for emergency settings, especially in severe cases. Any intervention that might cause substance reflux into the esophagus resulting in further damage is not recommended. Current methods for assessing the degree of esophageal damage are early endoscopy for Zargar classification and CT scan, which focuses on ruling out perforation. Post-corrosive esophageal stricture can be a consequent complication with poor treatment outcomes, and stricture prevention is an interesting idea.
The author declares no conflict of interest.
Special thanks to Michael Jan Everts for assistance in editing the English version of this chapter.
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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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The accumulated knowledge has shown turbulent flow to be composed of islands of vortices and uniform-momentum regions, which are coherent in both time and space. Research has been concentrated on these structures, their generation, evolution, and interaction with the mean flow. Different theories and conceptual models were proposed with the aim of controlling the boundary layer flow and improving numerical simulations. Here, we review the different classes of turbulence coherent structures and the presumable generation mechanisms for each. The conceptual models describing the generation of turbulence coherent structures are generally classified under two categories, namely, the bottom-up mechanisms and the top-down mechanisms. The first assumes turbulence to be generated near the surface by some sort of instabilities, whereas the second assigns an active role to the large outer layer structures, perhaps the turbulent bulges. Both categories of models coexist in the flow with the first dominating turbulence generation at low Reynolds number and the second at high Reynolds number, such as the case in the atmospheric boundary layer.",book:{id:"7214",slug:"turbulence-and-related-phenomena",title:"Turbulence and Related Phenomena",fullTitle:"Turbulence and Related Phenomena"},signatures:"Zambri Harun and Eslam Reda Lotfy",authors:[{id:"243152",title:"Dr.",name:"Zambri",middleName:null,surname:"Harun",slug:"zambri-harun",fullName:"Zambri Harun"},{id:"252195",title:"Dr.",name:"Eslam",middleName:null,surname:"Reda",slug:"eslam-reda",fullName:"Eslam Reda"}]}],mostDownloadedChaptersLast30Days:[{id:"63059",title:"Generation, Evolution, and Characterization of Turbulence Coherent Structures",slug:"generation-evolution-and-characterization-of-turbulence-coherent-structures",totalDownloads:3591,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Turbulence stands as one of the most complicated and attractive physical phenomena. The accumulated knowledge has shown turbulent flow to be composed of islands of vortices and uniform-momentum regions, which are coherent in both time and space. Research has been concentrated on these structures, their generation, evolution, and interaction with the mean flow. Different theories and conceptual models were proposed with the aim of controlling the boundary layer flow and improving numerical simulations. Here, we review the different classes of turbulence coherent structures and the presumable generation mechanisms for each. The conceptual models describing the generation of turbulence coherent structures are generally classified under two categories, namely, the bottom-up mechanisms and the top-down mechanisms. The first assumes turbulence to be generated near the surface by some sort of instabilities, whereas the second assigns an active role to the large outer layer structures, perhaps the turbulent bulges. 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Recently, spectrum slicing wavelength division multiplexing (SS-WDM)-based FSO systems provide improved link range, high capacity, and efficiency. In this chapter, the SS-WDM-based FSO system is proposed with four channels to increase the performance of communication under various wind speed and heights of the buildings. But, atmospheric turbulence fading, scintillation, and pointing errors (PE) are the main impairments affecting the performance of FSO communication systems. Predominantly, the turbulence variation due to wind velocity, refractive index, and height of buildings has been majorly focused and analyzed for Vellore weather conditions. A case study has been experimented on how the height of buildings and the atmosphere around VIT, Vellore campus, affect the transmission of light in free space. 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The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",hasOnlineFirst:!1,hasPublishedBooks:!1,annualVolume:11423,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. 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