Displaying the types of dementia and their prevelance. (Source: Abbott A. Dementia: a problem for our age.
\\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:"7036",leadTitle:null,fullTitle:"Advances in Lipid Metabolism",title:"Advances in Lipid Metabolism",subtitle:null,reviewType:"peer-reviewed",abstract:"This edited volume is a collection of reviewed and relevant research chapters concerning developments within the field of lipid metabolism. It includes scholarly contributions from experts in the field that cover such topics as roles of lipids in cancer, analytical tools for lipid assessment in biological assays, plant lipid metabolism, the effect of nanoparticles on lipid peroxidation in plants, and fatty acid compositions in fermented fish products. This book provides a thorough overview of the latest research efforts by international authors on lipid metabolism, and opens new possible research paths for further novel developments.",isbn:"978-1-78984-459-7",printIsbn:"978-1-78984-458-0",pdfIsbn:"978-1-78985-137-3",doi:"10.5772/intechopen.73796",price:100,priceEur:109,priceUsd:129,slug:"advances-in-lipid-metabolism",numberOfPages:98,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"f6c8e0623ad7d860b95d3e2eda4b904c",bookSignature:"Rodrigo Valenzuela Baez",publishedDate:"June 3rd 2020",coverURL:"https://cdn.intechopen.com/books/images_new/7036.jpg",numberOfDownloads:7229,numberOfWosCitations:2,numberOfCrossrefCitations:16,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:27,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:45,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 16th 2018",dateEndSecondStepPublish:"June 14th 2018",dateEndThirdStepPublish:"August 13th 2018",dateEndFourthStepPublish:"November 1st 2018",dateEndFifthStepPublish:"December 31st 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"72355",title:"Prof.",name:"Rodrigo",middleName:null,surname:"Valenzuela Baez",slug:"rodrigo-valenzuela-baez",fullName:"Rodrigo Valenzuela Baez",profilePictureURL:"https://mts.intechopen.com/storage/users/72355/images/system/72355.jpeg",biography:"Rodrigo Valenzuela Baez completed his pre-graduate studies (nutritionist) at the University of Chile (2003), his Masters in nutrition and food science at the University of Chile (2007), and Doctoral degree in nutrition and foods at the University of Chile (2012). Dr. Valenzuela was postdoctoral fellow in the Nutritional Science Department in the University of Toronto (2019-2021). Currently, he is an Associate Professor (full time) in Nutrition Department at the Faculty of Medicine, University of Chile, Santiago, Chile. He does research in nutrition and food sciences. Dr. Valenzuela\\'s teaching areas are food science and nutrition, and fats and oils in human nutrition. His current research areas are lipids and antioxidants in health and disease, metabolism and cytoprotection by long-chain polyunsaturated fatty acids from marine origin, bioconversion of n-3 and n-6 fatty acids from vegetable and marine oils, and physiological effects of n-3 fatty acid as a functional food. Dr. Valenzuela has more than 90 research publications in the lipid and metabolism area.",institutionString:"University of Chile",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"University of Chile",institutionURL:null,country:{name:"Chile"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"380",title:"Molecular Biology",slug:"biochemistry-genetics-and-molecular-biology-biochemistry-molecular-biology"}],chapters:[{id:"64118",title:"Roles of Lipids in Cancer",doi:"10.5772/intechopen.80788",slug:"roles-of-lipids-in-cancer",totalDownloads:1644,totalCrossrefCites:3,totalDimensionsCites:7,hasAltmetrics:1,abstract:"The term ‘lipids’ refers to a class of biological molecules primarily composed of hydrocarbons such as fatty acids, glycerolipids, sphingolipids and sterol lipids. Lipids take part in a variety of physiological functions and have specific roles depending on their chemical structure and localisation within or outside cells. For example, glycerolipids (e.g. triglycerides) are often used as energy stores, sterol lipids (e.g. cholesterol) and glycerophospholipids as structural components of cell membranes (e.g. the lipid bilayer), and sphingolipids as part of a signalling cascade. Since lipids are a source of energy and basic building block of all living cells, it is not surprising that development of cancer (i.e. uncontrolled proliferation of cells) is closely tied to the metabolism of lipids. This notion is supported by studies into the reprogrammed metabolic machinery in cancer cells, and also cell and animal model experiments showing that cancer growth and metastasis can be induced or inhibited by the exogenous addition of lipids. Here, we review how cancer cells can alter their lipid metabolism to meet their metabolic requirements, and the potential tumorigenic and tumour-suppressive mechanisms in which lipids are involved.",signatures:"Jin Yan Lim and Hiu Yee Kwan",downloadPdfUrl:"/chapter/pdf-download/64118",previewPdfUrl:"/chapter/pdf-preview/64118",authors:[{id:"221060",title:"Dr.",name:"Hiu Yee",surname:"Kwan",slug:"hiu-yee-kwan",fullName:"Hiu Yee Kwan"},{id:"266223",title:"Dr.",name:"Jin Yan",surname:"Lim",slug:"jin-yan-lim",fullName:"Jin Yan Lim"}],corrections:null},{id:"64008",title:"Analytical Tools for Lipid Assessment in Biological Assays",doi:"10.5772/intechopen.81523",slug:"analytical-tools-for-lipid-assessment-in-biological-assays",totalDownloads:1436,totalCrossrefCites:4,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Lipids are heterogeneous biological molecules with many important roles. In human body, lipids can be energy substrates, steroid hormones, inflammatory lipid mediators, transporters, and feature as structural cell and organelle membrane elements. At the cell membrane, lipids influence the distribution of surface proteins and, in part, protein signaling and, consequently, the activation of transcriptional factors. One of the best explored relationships in chemistry and science is the structure/activity one. Therefore, if the composition of a mixture is discovered and the structure of its components is known, a task of proposing relationship among all components and their activity would be closer to understanding. There are many powerful and advantageous analytical and bioanalytical tools available for the study of lipids, but all show at least some limitations. Knowing the advantages/disadvantages of each technique is essential for choosing the most appropriate one for the analysis as to answer a scientific question about lipid composition and role within a biological model. Often, inexperience and little familiarity with the cited analytical resources may limit the validity of the obtained results. Our chapter aims to present and discuss different tools available for the study of lipids and their main applications in biological assays.",signatures:"Banny Silva Barbosa Correia, Raquel Susana Torrinhas, William Yutaka Ohashi and Ljubica Tasic",downloadPdfUrl:"/chapter/pdf-download/64008",previewPdfUrl:"/chapter/pdf-preview/64008",authors:[{id:"260276",title:"Prof.",name:"Ljubica",surname:"Tasic",slug:"ljubica-tasic",fullName:"Ljubica Tasic"},{id:"263666",title:"Dr.",name:"Banny",surname:"Silva Barbosa Correia",slug:"banny-silva-barbosa-correia",fullName:"Banny Silva Barbosa Correia"},{id:"263668",title:"Dr.",name:"Raquel",surname:"Torrinhas",slug:"raquel-torrinhas",fullName:"Raquel Torrinhas"},{id:"270981",title:"BSc.",name:"William",surname:"Ohashi",slug:"william-ohashi",fullName:"William Ohashi"}],corrections:null},{id:"64549",title:"Plant Lipid Metabolism",doi:"10.5772/intechopen.81355",slug:"plant-lipid-metabolism",totalDownloads:2636,totalCrossrefCites:8,totalDimensionsCites:14,hasAltmetrics:0,abstract:"In plants, the synthesis of fatty acids takes place in the chloroplast and the fatty acid synthase is prokaryotic type. In plants, the structure of membrane lipids is different from that of eukaryotic cells. The membranes of the chloroplasts are essentially formed of galatolipids. This chapter will also focus on the structure and biosynthesis of fatty acids and membrane lipids in plants. Lipids of seeds are essentially composed of TAG; it would be interesting to describe their synthesis during the maturation of the seeds. Some plants contain in their reserve lipids unconventional fatty acids such as gamma linolenic acid in Borrago officinalis L., short-chain fatty acids C: 12 and C: 10, fatty acids with very long chains, and fatty acids that are cyclical. All of these fatty acids can have industrial and/or pharmaceutical applications.",signatures:"Fatiha AID",downloadPdfUrl:"/chapter/pdf-download/64549",previewPdfUrl:"/chapter/pdf-preview/64549",authors:[{id:"256576",title:"Prof.",name:"Fatiha",surname:"Aid",slug:"fatiha-aid",fullName:"Fatiha Aid"}],corrections:null},{id:"68367",title:"Effect of Nanoparticles on Lipid Peroxidation in Plants",doi:"10.5772/intechopen.88202",slug:"effect-of-nanoparticles-on-lipid-peroxidation-in-plants",totalDownloads:832,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The size of the nanoparticles is between 1 and 100 nm. Nanoparticles are widely used in consumer and medical products, as well as in agricultural and industrial applications. The excessive use nanoparticles increases its release into the environment. Plants are an important part of the environment that is affected by nanoparticles. Studies have examined the effect of nanoparticles on plants. The results showed that high concentrations of nanoparticles showed a negative effect. Reactive oxygen species generation is a toxicological mechanism of nanoparticles in plants. When the production of radicals is greater than its removal, oxidative stress occurs. The key indicator of oxidative stress is lipid peroxidation. The unsaturated fatty acids in the cell membrane are a major target for radicals. Radical absorbs hydrogen from unsaturated fatty acids to form water. Therefore, the fatty acid has a non-coupled electron, which is then able to capture oxygen and form a peroxyl radical. Lipid peroxyl radical can lead to a chain of radical production. Enzymatic and nonenzymatic systems exist for the removal of radicals in plants. Enzymatic systems include catalase, guaiacol peroxidase, ascorbate peroxidase, superoxide dismutase, glutathione reductase, and dehydroascorbate reductase. Nonenzymatic systems include ascorbate and carotenoids, glutathione, tocopherol, and phenolic compounds.",signatures:"Shahla Hashemi",downloadPdfUrl:"/chapter/pdf-download/68367",previewPdfUrl:"/chapter/pdf-preview/68367",authors:[{id:"256542",title:"Dr.",name:"Shahla",surname:"Hashemi",slug:"shahla-hashemi",fullName:"Shahla Hashemi"}],corrections:null},{id:"69984",title:"Fatty Acid Compositions in Fermented Fish Products",doi:"10.5772/intechopen.90110",slug:"fatty-acid-compositions-in-fermented-fish-products",totalDownloads:681,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Fish fermentation differs from one region to another in the world. Different types of fish, different fermentation conditions, and different fermentation processes are used, thus resulting in different fermented fish products. The most investigated fermented fish products in regard to the fatty acid contents are Kejeik from Sudan, Fseekh from Egypt, Hatahata-zushi from Japan, and Tareeh and Mehiawah from the Middle East. The results of those studies were not consistent regarding the effect of the fermentation process on the contents of saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs). Some of those studies reported an increase in the level of SFAs and a decrease in the PUFAs contents, while other studies reported the opposite. The fermentation process itself was attributed to different microorganisms such as lactic acid bacteria (LAB), halophilic bacteria, the bacterial flora of Micrococcus and Bacillus species, and a new bacillus strain named Bacillus mojavensis-ASK. Autolytic enzymes from the fish were also reported to be responsible for the fermentation process.",signatures:"Afnan Freije and Aysha Mohamed Alkaabi",downloadPdfUrl:"/chapter/pdf-download/69984",previewPdfUrl:"/chapter/pdf-preview/69984",authors:[{id:"305397",title:"Prof.",name:"Afnan",surname:"Freije",slug:"afnan-freije",fullName:"Afnan Freije"},{id:"321747",title:"M.Sc.",name:"Aysha Mohamed",surname:"Alkaabi",slug:"aysha-mohamed-alkaabi",fullName:"Aysha Mohamed Alkaabi"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"2552",title:"Lipid Metabolism",subtitle:null,isOpenForSubmission:!1,hash:"66b8e95379ce94691627be9279b5a616",slug:"lipid-metabolism",bookSignature:"Rodrigo Valenzuela Baez",coverURL:"https://cdn.intechopen.com/books/images_new/2552.jpg",editedByType:"Edited by",editors:[{id:"72355",title:"Prof.",name:"Rodrigo",surname:"Valenzuela Baez",slug:"rodrigo-valenzuela-baez",fullName:"Rodrigo Valenzuela Baez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6073",title:"Non-Alcoholic Fatty Liver Disease",subtitle:"Molecular Bases, Prevention and Treatment",isOpenForSubmission:!1,hash:"6141320881651ddc40a3f35893c209e7",slug:"non-alcoholic-fatty-liver-disease-molecular-bases-prevention-and-treatment",bookSignature:"Rodrigo Valenzuela",coverURL:"https://cdn.intechopen.com/books/images_new/6073.jpg",editedByType:"Edited by",editors:[{id:"72355",title:"Prof.",name:"Rodrigo",surname:"Valenzuela Baez",slug:"rodrigo-valenzuela-baez",fullName:"Rodrigo Valenzuela Baez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3203",title:"Oxidative Stress and Chronic Degenerative Diseases",subtitle:"A Role for Antioxidants",isOpenForSubmission:!1,hash:"7014dbaa632114f7220802475ccd0402",slug:"oxidative-stress-and-chronic-degenerative-diseases-a-role-for-antioxidants",bookSignature:"José A. Morales-González",coverURL:"https://cdn.intechopen.com/books/images_new/3203.jpg",editedByType:"Edited by",editors:[{id:"109774",title:"Dr.",name:"Jose Antonio",surname:"Morales-Gonzalez",slug:"jose-antonio-morales-gonzalez",fullName:"Jose Antonio Morales-Gonzalez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5407",title:"The Transcription Factor Nrf2",subtitle:null,isOpenForSubmission:!1,hash:"0788a269796226b416cf12529a57ecbb",slug:"a-master-regulator-of-oxidative-stress-the-transcription-factor-nrf2",bookSignature:"Jose Antonio Morales-Gonzalez, Angel Morales-Gonzalez and Eduardo Osiris Madrigal-Santillan",coverURL:"https://cdn.intechopen.com/books/images_new/5407.jpg",editedByType:"Edited by",editors:[{id:"109774",title:"Dr.",name:"Jose Antonio",surname:"Morales-Gonzalez",slug:"jose-antonio-morales-gonzalez",fullName:"Jose Antonio Morales-Gonzalez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7346",title:"Biogenic Amines",subtitle:null,isOpenForSubmission:!1,hash:"0438601a19ebd4d9dd37f88692b4196a",slug:"biogenic-amines",bookSignature:"Charalampos Proestos",coverURL:"https://cdn.intechopen.com/books/images_new/7346.jpg",editedByType:"Edited by",editors:[{id:"198333",title:"Dr.",name:"Charalampos",surname:"Proestos",slug:"charalampos-proestos",fullName:"Charalampos Proestos"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8095",title:"Liposomes",subtitle:"Advances and Perspectives",isOpenForSubmission:!1,hash:"02b0d76190d551561ad19af0c80f98f2",slug:"liposomes-advances-and-perspectives",bookSignature:"Angel Catala",coverURL:"https://cdn.intechopen.com/books/images_new/8095.jpg",editedByType:"Edited by",editors:[{id:"196544",title:"Prof.",name:"Angel",surname:"Catala",slug:"angel-catala",fullName:"Angel Catala"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6365",title:"Molecular Docking",subtitle:null,isOpenForSubmission:!1,hash:"ca23ec77de0bb7a434608335e1d6a963",slug:"molecular-docking",bookSignature:"Dimitrios P. 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\r\n\tThis book is intended for professionals dealing with diagnostics and treatment of infertility and aims to provide comprehensive information on the current state of assisted reproductive technologies and their directions of development.
\r\n\tAssisted Reproductive Technologies (ART) is a key technology for treating infertility, which occurs in 10-15% of the general population in reproductive age. This has been one of the most tumultuously developing interdisciplinary technologies in medicine in recent decades. Thanks to in vitro methods, more than 5 million children were born in the whole world. For 40 years, the success rates of this treatment have increased many times, respectively in the first years from less than 10% to more than 50% in present days (in some groups of patients). The reason for this rapid increase is the introduction of new drugs and stimulation protocols, improvement of embryo culture media, and the use of new types of laboratory equipment that improve the conditions for embryo development. Last but not least, the introduction of modern genetic methods, as well as new gamete and tissue freezing techniques, has improved the methods' diagnostic and therapeutic capabilities.
Human immunodeficiency virus-1 (HIV-1) engulfs 33 millions of life as per the latest UN AIDS report [Saxena, Tiwari., et al., 2012] and the effect worsens up when it causes dementia with alarming occurrence worldwide but the mechanism through which it happens is still not well understood, and is in the embryonic stages. The estimated overall prevalence of nervous system disorders among patients receiving highly active antiretroviral therapy but also requiring neurological care is over 25% (Singh et al., 2011). According to WHO there are ~ 34 million people in the world infected with HIV. Out of that 95 percent of these cases as well as deaths from AIDS occur in the developing world. Dementia (HIV-associated dementia) is becoming common in HIV infected adults having prevalence up to 40% in western countries where clade B prevails (Sacktor et al., 2007). Dementia cannot be considered as a disease by itself but it is the term used to describe a set of symptoms resulting from damages and disorders affecting the brain. These symptoms can be caused by a multitude of diseases and depend upon the specific brain regions affected. These symptoms appear as a variety of cognitive, behavioural, affective, motor, and psychiatric disorders. Dementia can be caused by a variety of diseases, known as neurodegenerative diseases resulting from protein aggregation in the brain. Many studies related to this area are been carried out in respect to this, to provide new insights (Saxena et al., 2012). HIV-1 infects macrophages and microglia, and there is an indirect pathway to neuronal injury which happens due to release of macrophage, microglial and astrocytes toxins and viral proteins. The toxins which are released over stimulate neurons, form free radicals, finally leading to neurodegenerative diseases. The cognitive and motor dysfunction which is observed in HIV patients is termed as HIV associated dementia (HAD). The prevalence of the dementia is eventually increasing as AIDS patients are now surviving more. HIV-1 replicates in monocyte and macrophage but not as severe as in infected T cells and blood mononuclear cells (Sundaravaradan et al., 2006). These cells differentiate and travel to several organs, henceforth acting as a source of infectious virus and secreted viral proteins to cause pathological issues and alternating several signalling pathways and distorting many cellular transcription factors, ultimately resulting in HIV-1 pathogenesis. Increased transcription leads to the upregulation of virus production, and hence increased production of viral proteins (gp120, Tat, Nef, and Vpr) (Gandhi et al., 2020; Samikkannu et al., 2010; Saiyed et al., 2011; Saxena et al., 2012; Saxena et al., 2012). The high concentration of these toxic proteins lead to distorted cellular functions, and increased production of toxic metabolites, finally leading to organ-specific like neuroAIDS, in case of viral entry inside the brain (Kilareski et al., 2009). Antiretroviral therapy has increased the lifespan of HIV patients, but CNS function often remains diminished sometimes developing into HIV-associated dementia and the severity and progression of dementia is studied to be increased with the effect of drug abuse [Reddy et al., 2012; Ferris et al., 2008].
The prevalence of HAD is estimated to be more than 30% of HIV infected patients, and it is still reported to be increasing (Dean et al., 2012). Improvements in control of peripheral viral replication and the treatment of opportunistic infections, helps in extending life expectancy, resulting in an increase in neuropathogenesis. We are seeing a linear increase in prevalence in rich countries, but an exponential increase in low-income countries. Just under half of people with dementia live in high-income countries, 39% live in middle-income countries, and only 14% live in low-income countries. Increasing living standards, in low income countries such as India (Shankar et al., 2005), may lead to increased life expectancy, which may increase the frequency of dementia cases. As biggest risk factor for dementia is age, a longer-living global population means there will be more people with dementia. The report predicts that the numbers of people with dementia will double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. Most of this increase will be in developing countries (Prince et al., 2012). A more complete understanding of the pathogenesis of HAD will help in identifying therapeutic targets for its prevention and treatment. The global age standardized death rate for dementia is ~ 6.7 per 100,000 for males and 7.7 per 100,000 for females. According to the World Health Organization, dementia mortality rate for India is 13.5 per 100,000 males and 11.1 for 100,000 females, which is quite alarming (Prince et al., 2012).
Presently, neuropathogenesis is winning, because there is an incomplete knowledge about the mechanism of HIV infection causing neuronal injury and apoptosis in the host (Fig. 1). HIV enters the central nervous system through infected monocytes and leads to pathogenesis involving activation of macrophages and microglia and further toxin release, that activates several pathways leading to neuronal dysfunction. There are several extracellular and intracellular signalling pathways, which when activated lead to macrophage or microglial activation, and induction in neurons and astrocytes. These pathways are of potential therapeutic importance as targets for the prevention or treatment of neuropathogenesis.
HIV virus can enter the CNS by altering the integrity of blood brain barrier.
HIV-1 is capable of causing a multi-system disorder including the CNS. HIV-1 enters the CNS at the early phase of infection, it persists and induces several motor and cognitive disorders leading to behavioural changes. Major clinical symptoms include impaired short term-memory, reduced mental concentration, weakness, slowness of hand and leg movement and depression accompanied by behavioural issues like personality disorders, lethargy and social withdrawal. These neurological and psychiatric symptoms caused by HIV-1 infection, constitute together as neuropathogenesis. A more subtle form of CNS dysfunction, known as minor cognitive motor disorder (MCMD), is also seen common in HIV patients. HAD cannot be controlled by HAART, HIV-1 infection becomes chronic and even rise in disease has been reported. The HIV-1 associated neuropathology is characterized by the infiltration of macrophages into the CNS, the formation of microglial nodules and multinucleated giant cells, astrocyte activation and damage; neuronal loss in ganglions and hippocampus, myelin damage, axonal damage and presence of HIV-1 in the CSF. MRI reports say that HIV infection is associated with progressive cortical atrophy which might be caused by neuronal loss and demyelination worsening in certain cognitive functions (Ghafouri et al., 2006).
HIV-1 infects cells having major HIV-1 receptors, CD4 and CD8, and several chemokine receptors which are known to be as HIV-1 co-receptors which help in the attachment of the virus to the cell and membrane fusion leading to viral entry. Infected CD4+ T cells and monocytes circulating in the blood are the potential source of CNS infection. HIV-1 infected cells can be either highly active producers or low/non producers of viruses. Both types of infections occur in the CNS. Studies of different astrocytes cell lines, demonstrated the presence of large quantities of Rev in the cytoplasm. Changes in cell environment, like the elevation in the level of cytokines such as TNF-α and IL-1β, might reactivate virus production (Ghafouri et al., 2006). During early infection, HIV enters the CNS (Bertin et al., 2012) and attacks cells macrophages and microglial cells (Foley et al., 2008). But along with this infection, periphery factors (non-CNS) are also important for initiating neurodegeneration and triggering dementia, which are like for example; increased number of circulating monocytes that express CD16 and CD69. The cells which get activated by viral entry, progressively adhere to the endothelium membrane of the brain microvasculature, and further transmigrate, triggering a spontaneous array of harmful processes which might finally lead to the loss of Blood Brain Barrier (BBB) integrity making it easy for virus to enter and replicate inside the brain. The BBB is crucial in HIV infection of the CNS. BBB is composed of specialized Human brain microvascular endothelial cells (HBMECs), which do not have any opening and are connected by intercellular junctions in an impermeable single layer. BBB plays a central role in neuropathogenesis as it serves as the channel through which free virus and infected immune cells enter the brain. The BBB loses its integrity and permeability due to progressive HIV infection and immune compromisation, which leads to easy entry of toxins, free virus, infected and activated monocytes into the brain. It has been reported that HIV-1 gp120 protein and also Tat protein are behind BBB disregulation. PKC signaling pathways and receptor-mediated Ca2+ release are the involved pathways resulting into cytotoxicity of the brain endothelial cells (Kanmogne et al., 2005) leading to downregulation and rupture of tight junction proteins (TJPs) of HBMECs, by the induction of proteasome by HIV-1. It has been studied that circulating virus or envelope proteins may also cause BBB dysfunction during primary infection. CNS infection of HIV is detected by viral RNA load in CSF (Woods et al., 2009; Morgan et al., 2011). Chemokines like monocyte chemoattractant protein (MCP)-1 control PBMCs relocation through BBB. Cellular migration engages adhesion molecules and differential regulation of inflammatory cytokines, leading to BBB disintegration and finally immune dysregulation by letting sufficient entry of infected or activated immune cells into the brain causing neuronal injury.
BBB is selectively permeable, made up of firmly concurrent brain microvascular endothelial cells, and its major role is to separate the CNS from the periphery. It manages the trafficking of cells and molecules across it into the brain parenchyma. For the purpose of brain entry, HIV-1 has to cross the BBB using several mechanisms which are still poorly understood and are unclear. Numerous
HIV-1 neuroinvasion. 1) "Trojan Horse hypothesis" for entry of HIV-1 into the brain via migration of infected monocytes which differentiate into perivascular macrophage. 2) The passage of infected CD4+ T cells into the brain. Other probable causes of CNS infection might be: 3) the direct entrance of the virus via tight junctions across the membrane and 4) entrance of HIV-1 by transcytosis phenomenon.
The way by which HIV-1-infected monocytes escape immune surveillance can be explained by “Trojan horse cell” model. The “support” needed for the viral entry is through CNS-produced chemokines like MCP-1 and IFN-γ-inducible peptide, CXCL10, whereas the “opposition” is through peripheral immune activation (Yadav et al., 2009). Upon entry in the brain, HIV-1-infected blood-borne macrophages secrete proinflammatory cytokines like tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), and viral proteins which affect neuronal function (Brabers and Nottet, 2006). Within the brain, astrocytes serve as principal regulators for neural homeostasis. They bring out a neurotoxic secretory response in macrophages, resulting to upregulation of certain acids and metabolites, chemokines, and cytokine secretions. They can also alter macrophage phenotype, which may help in neuroprotection. But on the contrary astrocytes can also influence autocrine and paracrine inflammatory cascades, which may lead to immune activation, increased viral infection, and allowance of cellular entry via BBB (Kraft-Terry et al., 2010). Also CD16+ monocytes are linked to infection of the brain as they can be easily infected by the virus, they carry virus into the brain and help in viral dissemination and serve as viral reservoirs as they are apoptosis resistant. HIV proteins like nef require adaptive selection in brain for efficient replication in macrophages or when it is exposed to brain specific immune selection (Olivieri et al., 2010). Neuropsychiatric disorders associated with HIV infection result in substantial morbidity and fatality. HIV injures the CNS and PNS, leading to neuropsychiatric disorders, which together constitute for neuroAIDS (McCombe et al.,2009), which includes neurocognitive disorders like HAD, minor neurocognitive disorder (HAND), mania, anxiety, depression, seizures, myelopathy and neuropathy, and also involves display of several symptoms like neurocognitive impairment, mood disorders, neuropathic pain, epilepsy, addiction, physical disability, loss of memory, mood swings etc (Fig.3).
Associated disorders and symptoms which are commonly seen in patients suffering from neuroAIDS.
One form of dementia is Alzheimer’s disease caused by amyloid pathology, during which peptides of amyloid-β generate and clump together into plaques which release toxic fragments of amyloid-β leading to neuropathogenesis. Another form of dementia is caused by vascular pathology in which blood vessels leak and hence deprives small areas of the brain of blood and oxygen, which damage brain tissue resulting in cognitive defects. Both forms exist equally, even though Alzheimer pathology is more common, but it coexists with vascular pathology. (Abott et al., 2011).
\n\t\t\t\t | \n\t\t|||
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Alzheimer\'s | \n\t\t\tWeakened memory power, leading to confusion, disinterest depression and bad judgement skills. | \n\t\t\tFormation of amyloid plaques and also neurofibrillary tangles. | \n\t\t\t50–80% | \n\t\t
Vascular dementia | \n\t\t\tMemory is weakened, but not as intense as in the case of Alzheimer’s patients. | \n\t\t\tCausing microstrokes due to reduced blood flow to brain | \n\t\t\t20–30% | \n\t\t
Frontotemporal dementia | \n\t\t\tPersonality disorders, mood swings and difficulty in understanding different languages. | \n\t\t\tDamage limited to frontal and temporal lobes | \n\t\t\t5–10% | \n\t\t
Dementia with Lewy bodies | \n\t\t\tWeakened memory power, leading to confusion, disinterest depression and bad judgement skills, hallucinations and tremors. | \n\t\t\tCortical Lewy bodies (of the protein a-synuclein) inside neurons. | \n\t\t\t<5% | \n\t\t
Displaying the types of dementia and their prevelance. (Source: Abbott A. Dementia: a problem for our age.
Dementia is considered as loss of memory and other cognitive abilities which reduces the lifespan of patients. Dementia is often associated with physical, mental and financial burden. 37% of the dementic population in developing countries have vulnerable living environment and they require specialised care. Diagnosis of dementia involves investigations for decline in memory and disturbance in several cognitive abilities like coherent speech, understanding spoken or written language, recognizing objects, executing motor activities, sensory function, thinking abstractly, making sound judgments, planning and carrying out complex tasks. Dementia reduces the lifespan of affected people. In the developed countries life span after dementia diagnosis can be expected to be ~7 years, but in low and middle income countries survival may be shorter. Dementia symptoms and linked issues can be understood in three stages of early stage (1-2 years) which is often overlooked because the onset of dementia is gradual, making it difficult to predict when it begins, leading to problems in talking, memory loss. Secondly, the middle stage (2-5 years) which makes patients life more difficult and restricted, giving them difficulty in day-to-day living and forgetting recent events and people’s names, etc. Thirdly, the late stage (>5 years) leading to total dependence and inactivity, serious memory disturbances difficulty in physical works like walking, eating, incapability of communicating, not recognizing familiar objects, displaying inappropriate behavior in public etc.
HIV associated dementia, referred as the syndrome of cognitive and motor dysfunction resulting in progressive neurodegeneration observed after infection with human HIV-1, also known as HIV encephalopathy (HIV-E) and AIDS dementia complex (ADC) (Kaul et al., 2001). In the last stage of HIV, HAD a severe neurological complication affects 15–20% of the patients (Van de Bovenkamp et al., 2002). The relationship between spreading of HIV in brain tissue and pathology has not been thoroughly assessed in HAART era (Lamers et al., 2010). Inspite of preventing former end stage complications of AIDS by HAART however, with increased survival times, the prevalence of minor HIV-1 associated cognitive impairment appears to be rising among AIDS patients. Further, HIV-1 associated dementia (HAD) is still prevalent in treated patients as well as attenuated forms of HAD and CNS opportunistic disorders (Ghafouri et al., 2006). Infected macrophages with HIV have an ability to cross BBB infect inhabitant brain macrophages initiating the development of HAD. Cytokines are released from infected resident brain macrophages which further attract more macrophages to sites of infection and a series of self-inflammatory process emerges (Williams et al., 2002). Studies have suggested that the process of entering in the CNS causing HAD mostly depends on the HIV variants as some HIV variants have capability of entering in the CNS and develops HAD but in contrast other variants don’t have capability to develop HAD even after entering in the CNS (Fischer-Smith et al., 2008; Fischer-Smith
Some studies suggest that neurological involvement of infected patients occurs at different frequencies, depending on the HIV subtype involved in the infection (Liner 2nd et al., 2007). HIV-1 Subtype D has more prominent chance for developing dementia (89%) than subtype A (24%) in the patients localized in a region of Uganda, Africa suggesting genetic determinants exist within HIV that influence the ability of the virus to replicate in the central nervous system. HIV-1 proteins have been shown to be released from HIV infected cell and/ or they have found to be present in the extracellular milieu in the HIV-1-infected brain. In vitro, neurotoxic and/or neuromodulatory effects have been shown by HIV proteins: nef, env, tat, rev, vpr and vpu that might play a role in the development of HIV-1-associated dementia in vivo (Sactor
Dementia is engulfing bigger proportion of HIV patients and is expected to worsen more. It is expected that a significant proportion of dementia is driven by amyloid-β. But so far none of the amyloid-based strategies has been successful, but still drug developers are strategising on the concept which can combat against it. More reliable biomarkers are being developed potentially making it possible to carry out trials on patients before symptoms. Some scientists are also wondering to target vascular pathology as well, which is equally responsible for causing dementia. So cholesterol level lowering drugs and blood pressure reducing drugs are also given long term to patients, who are at higher risk of heart attack which may also help protect from dementias as well (Abott et al., 2011). There are several extracellular and intracellular signalling pathways, which when activated lead to macrophage or microglial activation, and induction in neurons and astrocytes. These pathways may act as a potential therapeutic importance as drug targets against neuropathogenesis. NeuroAIDS is challenge to patients, their families, society and our country, thus development of preclinical models appropriate for new compounds testing with neurotrophic and neuroprotective potential is necessary (Crews et al., 2008; Williams et al., 2008).
The biggest issue which comes in front of drug developers is the incapability of the drugs to cross the BBB, which leads to low bioavailability of the drugs into the CNS. HIV-1 protease inhibitors are totally incapable in entering the CNS, while other HIV-1 therapies such as zidovudine (AZT) are reported to have efficient BBB penetration. Recently, a broad range of nanomedicines are being developed to improve drug delivery across BBB, development of nanoparticulate– antiretroviral therapy (nanoART), against CNS disorders as the structure of the BBB, efflux pumps and the expression of metabolic enzymes make it difficult for the regular drug to reach brain. Nanoformulations can evade the BBB and can boost CNS-directed drug delivery (Fig. 4) (Saxena et al., 2012; Nowacek et al., 2010; Nowacek
Comparative display of nanocarrier mediated method of drug delivery (A) versus the classical method of drug delivery across the Blood Brain Barrier (BBB), which is less efficient than the former in the process of drug delivery.
Since dementia is quite prevalent in HIV patients, in developed countries and has also been reported to extend its grip towards developing countries as well due to increase in patient survival rates and life expectancy due to HAART treatment and increased living standards. Low prevalence of HAD in underdeveloped and developing countries have been attributed to under diagnosis, short life expectancy and short survival following HIV infection associated with opportunistic infections and also low prevalence of HIV related neuroinfections and pathology is not available due to inadequate medical facilities, social stigma and ignorance that lead to under diagnosis (Vivithanaporn et al., 2010). So a need of collaboratory studies is there which can be used, for learning the cause, prevalence and diagnosis of neuropathogenesis. A synchronised effort is needed by researchers, drug makers, physicians, policy makers, government bodies nationally as well as globally. A proper and deep understanding about the entry of the virus into the CNS and the various mechanisms it employs to undertake the host machinery would be of great help in understanding the issue and combating against the virus.
Optimal thyroid function is necessary for growth and development as well as for reproductive function. Iodine deficiency is the leading cause of thyroid dysfunction. In areas unaffected by iodine deficiency, thyroid dysfunction is due to autoimmunity. Thyroid pathology can be divided into nodular and diffuse pathology. One in 20 Americans will develop a thyroid disorder in their lifetime, with women being seven times more affected than men [1, 2]. In this chapter, we will address diffuse thyroid diseases (DTD) that can be divided into non-autoimmune (subacute thyroiditis, silent thyroiditis) and autoimmune diseases such as Hashimoto thyroiditis (HT) and Graves’ disease (GD) [3].
Hashimoto thyroiditis is also known as chronic autoimmune thyroiditis (CAT) is considered the most common endocrine disorder, and autoimmune pathology, as well as it represents the most common cause of hypothyroidism. HT can be divided into primary and secondary based on its etiology. Primary HT includes classic form, juvenile form [4], fibrous form, painless thyroiditis, Hashitoxicosis, and IgG4-related form [5]. Secondary HT is often iatrogenic, for example, caused by interferon [6] or monoclonal antibodies [7]. The diagnosis is established by correlating the clinical manifestations with the presence of antithyroid peroxidase (ATPO) antibodies and antithyroglobulin (ATG) antibodies correlated with the ultrasound aspect. Symptoms may vary from dysphonia, dysphagia, and dyspnea to systemic symptoms of hypothyroidism or may even be absent. The antibodies listed earlier are found in over 95% of HT cases, thus being an important diagnostic criterion [8]. The ultrasound image usually reveals hypoechogenicity and heterogeneity (Figure 1).
US image of a patient with CAT.
The presence of fibrous septae may explain the pseudolobulated appearance of the parenchyma. Micronodules may also be present. Increased vascularity may be observed using color Doppler. The volume of the thyroid gland is often increased, but can be normal or even decreased, atrophic in the final stages of the disease [9, 10].
Graves’ disease is characterized by the presence of thyrotoxicosis, ophthalmopathy, and goiter, although not all three characteristics are always present. In iodine-sufficient areas, GD accounts for 70–80% of cases of thyrotoxicosis, being more frequent in women over 50 years old. Symptoms of hyperthyroidism include irritability, palpitations, weight loss, shortness of breath, tremor, heat intolerance, sweating, and excessive fatigue. The diagnosis is usually based on anti-TSH-receptor antibodies (TRAB) correlated with the ultrasound appearance [11, 12, 13]. The echogenicity is usually decreased, and the appearance is not homogenous. Increased volume and high blood flow may also suggest the diagnosis [10, 12, 14].
Subacute thyroiditis (SA) is usually caused by a viral infection with symptoms including mild fever, swelling, and pain in the neck area, irradiating to the ear or jaw and fatigability. Thyroid stimulating hormone (TSH) is usually suppressed and inflammatory markers are elevated [15]. The presence of focal or diffuse hypoechoicity together with diminished vascularization may suggest the diagnosis if it is associated with the mentioned symptoms [16].
Post-partum thyroiditis (PPT) occurs in the first year after giving birth and may occur after an induced or spontaneous abortion. PPT prevalence may vary from 1 to 18%, but usually is reported approximatively 5%. In general, PPT has two evolutionary stages, transient thyrotoxicosis due to tissue destruction followed by the phase of hypothyroidism with or without restauration to euthyroidism [17]. Ultrasonography (US) shows the hypoechogenic inhomogeneous texture of the thyroid with decreased vascularity [18].
The ultrasonographic examination is the most sensitive imaging method for evaluating the thyroid. The most important indications of the US are: confirmation of the presence of thyroid nodules, their measurement and characterization, evaluation of diffuse tissue changes, detection of post-operative residual tumors, screening for the patients at high-risk (multiple endocrine neoplasia, history of thyroid cancer, and neck irradiation), and the guidance of the fine needle aspiration (FNA). US is widely available, non-invasive, and reproducible [19, 20, 21].
A relatively new imaging technique is elastography, which adds value by assessing tissue elasticity. There are more types of elastography, but the two most used are strain elastography (SE) and shear-wave elastography (SWE). SE evaluates the stiffness by applying external pressure which deforms the tissue. The deformation is named strain. The pressure being exerted by the operator, SE requires longer training to obtain high-quality images. To measure the stiffness, SWE uses shock waves generated by the machine. Both methods have advantages and disadvantages [22, 23]. SWE will be further described in detail, emphasizing the principles, technique, and the value of this method as well as the peculiarities of diffuse thyroid diseases.
SWE technique relies on the production and detection of shear-waves. The wave propagation velocity depends on tissue elasticity. Tissue deformation generated by the production of waves produces changes in the echo pattern. Tissue motion is monitored among the US probe in multiple locations. Shear waves are generated at low frequencies (10–2000 Hz) and their speed (~1–50 m/s) is related to tissue density [22, 24]. SWE is used for evaluation of various tissues: liver [25, 26, 27], kidney [28, 29], breast [30, 31], thyroid [32, 33, 34], prostate [35], and muscles and tendons [36]. There are three types of dynamic elastography: transient elastography (TE), point shear-wave elastography (pSWE), and 2D-SWE [37].
Transient elastography, usually used for measuring liver stiffness, uses a mechanical push. The wave velocity is proportional to tissue fibrosis. The usefulness of TE was demonstrated in many studies [38, 39].
Compared to the previous technique, point shear-wave elastography has the advantage of image guidance so the operator can choose the best acoustic window to perform the measurements. It is an acoustic radiation force impulse (ARFI)-based method that displays the elasticity as a numerical output (the average speed of shear wave within a region of interest [ROI], expressed in meters per second) [40, 41].
In 2D-SWE, multiple ARFI pulses generate shear waves on a larger area. The machine creates a colored map to display the stiffness. By convention, red is considered stiff and blue is considered soft. Quantitative results are expressed in meters/second (wave propagation speed) or kilo-Pascals (kPa). 2D-SWE is a reproductible, quantitative, and operator-independent technique (Figure 2) [42, 43].
Normal thyroid tissue—2D SWE.
The SWE evaluation is usually made after the conventional ultrasound examination. The method is non-invasive, completely painless. The subject is asked to stay in a supine position with the head tilted back for better exposure of the neck, without speaking or swallowing. The probe is positioned on one side of the neck, collecting images in longitudinal plane and SWE mode is initiated. The machine displays a color map from blue to red. The subject is asked to hold his/her breath for a few seconds. The image is frozen, and the tissue elasticity is measured and displayed.
Being a common pathology, HT has been studied in detail. In recent years, the elastographic differences between this type of thyroid damage and other diffuse thyroid pathologies have also been studied. A group of Japanese researchers included in a study 229 subjects, healthy controls and patients diagnosed with CAT. The shear-wave velocity (SWV) was measured, and significant differences were observed between the two groups (2.47 ± 0.57 m/s for CAT vs. 1.59 ± 0.41 m/s for the control group;
Similar results were found in a study conducted in Turkey on 50 patients diagnosed with CAT and 40 control subjects. Significant differences were found between the SWV of the two groups (2.56 ± 0.3 m/s vs. 1.63 ± 0.12 ms;
Rahatli et al. compared SWV in three groups of patients: HT, GD, and control subjects. Significant differences were found in SWV (2.5 ± 0.2 m/s for HT group, 2.71 ± 0.22 m/s for GD group and 1.92 ± 0.14 m/s for healthy subjects;
Kara et al. conducted a study on 74 HT patients and 75 healthy controls. They propose cut-off value of 2.15 m/s (Se 85.1%, Sp 78.7%, PPV 79.7%, NPV 84.2%, and diagnostic accuracy 81.8%) and 2.45 kPa (Se 82.4%, Sp 81.3%, PPV 81.3%, NV 82.4%, and diagnostic accuracy 81.8%). The mean values of the elastic index were 25.01 ± 10.53 kPa and 2.70 ± 0.53 m/s for the HT group and 12.49 ± 3.23 kPa and 1.94 ± 0.23 m/s for the control group. A positive correlation was found between SWE values and ATG antibodies. No significant correlation was found between SWE values and ATPO antibodies [48].
Other studies have also observed differences in thyroid stiffness. Ruchala et al. studied groups of patients diagnosed with CAT, SAT, GD, and healthy controls and significant differences were found. The mean values for the CAT group were 36.15 ± 18.7 kPa, higher than values for the control group (16.18 ± 5.4 kPa),
SWE in CAT.
Thyroid stiffness was evaluated in a study to compare tissue elasticity in patients diagnosed with GD compared to healthy controls. The study group consisted of 51 patients with GD and 54 volunteers for the control group. The median SWE values were significantly higher compared to those of the control group (17.34 kPa and 2.28 m/s vs. 12.05 kPa and 1.92 m/s;
Another study conducted in China on 207 subjects, 45 healthy volunteers and 162 patients with GD concluded that SWE is a useful tool in diagnosing GD. The control group SWE values were significantly lower than those in the GD group. Mean, minimum, and maximum values were recorded for each subject. The mean values for the control group were 8.4 ± 2.4 kPa (min); 14.3 ± 2.7 kPa (mean), and 22.1 ± 5.4 kPa (max). GD group values were 10.7 ± 6.4 kPa (min); 17.6 ± 6.4 kPa (mean), and 25.6 ± 10.6 kPa (max);
Another study published in 2019 evaluated the usefulness of SWE in differentiating thyroid autoimmune diseases. In the GD group, the mean SWV was 2.61 ± 0.32 m/s (range 2.1–3.21 m/s) while in HT group, the mean SWV was 2.85 ± 0.52 m/s (range 2.31–3.82 m/s). The mean SWV value for the control group was 1.75 ± 0.37 m/s (range 1.24–2.36 m/s). The mean values for HT and GD groups were significantly higher than the control group (
SWE in GD.
Given the difference in prevalence, studies on subacute thyroiditis are fewer. Ruchala et al. comparatively studied different types of diffuse thyroid damage, including subacute thyroiditis. This study was included two patients with acute thyroiditis, 18 with SAT, 18 with CAT, and 40 healthy controls. Patients diagnosed with SAT were evaluated three times: at baseline, at 4 weeks follow-up and 10 weeks after diagnosing and treatment initiation. There were significant differences between the three measurements: 214.26 ± 32.5 kPa at the baseline, 45.92 ± 17.4 kPa at 4 weeks and 21.65 ± 5.3 kPa at 10 weeks. The thyroid stiffness was significantly higher at baseline in SAT compared to CAT (36.15 ± 18.7 kPa) or healthy control group (16.18 ± 5.4 kPa). Undertreatment, the values were restored close to normal. The SWE values for the two patients with acute thyroiditis equaled 216.6 and 241 kPa and after treatment, it decreased to 17.93 and 85.384 kPa. All evaluated categories had higher stiffness levels than healthy thyroid (
SWE in subacute thyroiditis.
Liu et al. also studied thyroid stiffness in SAT. The mean SWE values were 118.01 ± 51.02 kPa. However, the time of measurement is not mentioned, only the fact that all SAT patients had hyperthyroidism at the moment of evaluation. The AUROC for differentiating SAT from CAT was 0.989. The AUROC for distinguishing SAT from GD was 0.975 [54].
Both mentioned studies concluded SWE utility in diagnosing SAT and differentiating it from CAT and GD (Figure 6).
Radiation-induced thyroiditis.
To the best of our knowledge, no specific papers have been published regarding shear-wave elastography in postpartum thyroiditis or other diffuse thyroid pathologies.
The important prevalence of diffuse thyroid diseases makes their imaging assessment essential. SWE proves to be an important tool in the diagnosis and differentiation of diffuse thyroid pathology. However, new studies on larger patient groups are needed to determine exactly whether there are significant differences in elasticity between CAT and GD, as well as have of a consensus on cut-off values.
The authors declare no conflict of interest.
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González Rodríguez, Rocío Baños Rodríguez and Citlalli Hernández Guerrero",authors:[{id:"108938",title:"Dr.",name:"Victor",middleName:null,surname:"Bravo-Cuevas",slug:"victor-bravo-cuevas",fullName:"Victor Bravo-Cuevas"},{id:"109673",title:"Dr.",name:"Katia",middleName:null,surname:"González-Rodríguez",slug:"katia-gonzalez-rodriguez",fullName:"Katia González-Rodríguez"},{id:"109689",title:"Prof.",name:"Rocio",middleName:"Elizabeth",surname:"Baños-Rodríguez",slug:"rocio-banos-rodriguez",fullName:"Rocio Baños-Rodríguez"},{id:"109690",title:"BSc.",name:"Citlalli",middleName:null,surname:"Hernández-Guerrero",slug:"citlalli-hernandez-guerrero",fullName:"Citlalli Hernández-Guerrero"}]},{id:"36322",doi:"10.5772/34019",title:"The Paleogene Dinoflagellate Cyst and Nannoplankton Biostratigraphy of the Caspian Depression",slug:"the-paleogene-dinoflagellate-cyst-and-nannoplankton-biostratigraphy-of-the-caspian-depression",totalDownloads:2381,totalCrossrefCites:2,totalDimensionsCites:4,abstract:null,book:{id:"1550",slug:"stratigraphic-analysis-of-layered-deposits",title:"Stratigraphic Analysis of Layered Deposits",fullTitle:"Stratigraphic Analysis of Layered Deposits"},signatures:"Olga Vasilyeva and Vladimir Musatov",authors:[{id:"98322",title:"Dr.",name:"Olga",middleName:"N.",surname:"Vasilyeva",slug:"olga-vasilyeva",fullName:"Olga Vasilyeva"},{id:"136891",title:"Dr.",name:"Vladimir",middleName:null,surname:"Musatov",slug:"vladimir-musatov",fullName:"Vladimir Musatov"}]},{id:"36325",doi:"10.5772/35219",title:"Sedimentary Tectonics and Stratigraphy: The Early Mesozoic Record in Central to Northeastern Mexico",slug:"sedimentary-tectonics-and-straigraphy-the-early-mesozoic-record-in-central-to-northeastern-mexico",totalDownloads:2566,totalCrossrefCites:0,totalDimensionsCites:4,abstract:null,book:{id:"1550",slug:"stratigraphic-analysis-of-layered-deposits",title:"Stratigraphic Analysis of Layered Deposits",fullTitle:"Stratigraphic Analysis of Layered Deposits"},signatures:"Jose Rafael Barboza-Gudino",authors:[{id:"103498",title:"Dr.",name:"José Rafael",middleName:null,surname:"Barboza-Gudiño",slug:"jose-rafael-barboza-gudino",fullName:"José Rafael Barboza-Gudiño"}]},{id:"36326",doi:"10.5772/35216",title:"Tektono-Stratigraphy as a Reflection of Accretion Tectonics Processes (on an Example of the Nadankhada-Bikin Terrane of the Sikhote-Alin Jurassic Accretionary Prism, Russia Far East)",slug:"tektono-stratigraphy-as-a-reflection-of-accretion-tectonics-processes-on-an-example-of-the-nadankha",totalDownloads:2360,totalCrossrefCites:0,totalDimensionsCites:4,abstract:null,book:{id:"1550",slug:"stratigraphic-analysis-of-layered-deposits",title:"Stratigraphic Analysis of Layered Deposits",fullTitle:"Stratigraphic Analysis of Layered Deposits"},signatures:"Igor V. Kemkin",authors:[{id:"103490",title:"Prof.",name:"Igor'",middleName:null,surname:"Kemkin",slug:"igor'-kemkin",fullName:"Igor' Kemkin"}]}],mostDownloadedChaptersLast30Days:[{id:"36319",title:"Orbital Control on Carbonate-Lignite Cycles in the Ptolemais Basin, Northern Greece - An Integrated Stratigraphic Approach",slug:"orbital-control-on-carbonate-lignite-cycles-in-the-ptolemais-basin-northern-greece-an-integrate",totalDownloads:2693,totalCrossrefCites:1,totalDimensionsCites:3,abstract:null,book:{id:"1550",slug:"stratigraphic-analysis-of-layered-deposits",title:"Stratigraphic Analysis of Layered Deposits",fullTitle:"Stratigraphic Analysis of Layered Deposits"},signatures:"M.E. Weber, N. Tougiannidis, W. Ricken, C. Rolf, I. Oikonomopoulos and P. Antoniadis",authors:[{id:"104271",title:"Dr.",name:"Michael E.",middleName:null,surname:"Weber",slug:"michael-e.-weber",fullName:"Michael E. 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The Kinta Limestone is a Paleozoic succession located within the Western Belt. Due to structural and tectonothermal complexity, the sedimentological and paleontological works in these carbonates have proven to be problematic unless combined with geochemical approach. Thus, the current study has integrated stratigraphical, sedimentological, and geochemical studies to assess the lithofacies variations and to interpret the depositional environments. An intensive fieldwork has been carried out in order to assess the extent of metamorphism and to locate the less altered sections for further studies. Three boreholes have been drilled on N-S transect of the Kinta Valley recovering a 360 m core. The core description, the mineralogical analysis, and the geochemical analyses including major and trace elements and organic carbon contents have allowed for a significant advancement of the knowledge existing on this basin. The obtained results have indicated that the Kinta Limestone is chiefly composed of carbonate mudstones, siltstones, shales, and minor cherty units. It preserves the main sedimentary features from metamorphism, especially in the northern part of the Kinta Valley. The detrital siliciclastic debris is minimum in the limestones. The overall dominance of fine-grained textures, the lacking of detrital siliciclastic deposits, presence of bedded cherts, and high organic carbon content outlined by geochemistry and the occurrence of uncommon benthic fauna have suggested the deposition in a slope environment with low energy and low oxygen content. The lithological changes from carbonate to siliciclastic deposits have outlined the occurrence of sea level fluctuations in the Paleozoic. The various analyses combined with chemostratigraphy, an independent of type locality and stratotype, enable to interpret the depositional environment of the Kinta Limestone. 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He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. 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She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. 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