Features which have been considered in different classifications of psoriasis [6]
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
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This has been a major factor in the widespread use of magnesium alloy castings and wrought products, powder metallurgy components, sacrificial anodes for the protection of other metals, tools. The present book, "New Features on Magnesium Alloys", gives us an overview in some special areas of magnesium alloys concerning technological applications and eco-friendly requirements. Each chapter brings us a new facet relating to the magnesium alloy application: magnesium alloys quasicrystals used to magnesium alloys reinforcement; rare earth metals as alloying components in magnesium implants for orthopaedic applications; magnesium alloys surface treatment by applying physical vapor deposition processes; casting magnesium alloys subjected to laser treatment; ductility enhancement on special magnesium alloys; welding and joining processing of magnesium alloys; transport application of magnesium and its alloys.',isbn:null,printIsbn:"978-953-51-0668-5",pdfIsbn:"978-953-51-6219-3",doi:"10.5772/2810",price:119,priceEur:129,priceUsd:155,slug:"new-features-on-magnesium-alloys",numberOfPages:188,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"53dc0d4a1e2c1d85bd0d14191457a343",bookSignature:"Waldemar Alfredo Monteiro",publishedDate:"July 11th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/2460.jpg",numberOfDownloads:22601,numberOfWosCitations:44,numberOfCrossrefCitations:38,numberOfCrossrefCitationsByBook:5,numberOfDimensionsCitations:68,numberOfDimensionsCitationsByBook:11,hasAltmetrics:0,numberOfTotalCitations:150,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"December 5th 2011",dateEndSecondStepPublish:"January 9th 2012",dateEndThirdStepPublish:"April 14th 2012",dateEndFourthStepPublish:"July 13th 2012",dateEndFifthStepPublish:"August 12th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"118821",title:"Dr.",name:"Waldemar Alfredo",middleName:null,surname:"Monteiro",slug:"waldemar-alfredo-monteiro",fullName:"Waldemar Alfredo Monteiro",profilePictureURL:"https://mts.intechopen.com/storage/users/118821/images/system/118821.png",biography:"Physicist, MSc (Solid State Physics), DSc (Nuclear Technology) at the University of São Paulo (USP), São Paulo, Brazil. He is a Senior Researcher on Materials Science and Technology Center at IPEN (Nuclear and Energy Research Institute). Also, he is a lecturer and scientific advisor (MSc and DSc) on graduate course on IPEN – USP. His expertise areas are physical metallurgy, powder metallurgy, nuclear technology (materials), materials characterization (optical and electron microscopy; microanalysis techniques). He has published more than 160 articles (scientific journals and congress proceedings), chapters and books in the material sciences area. 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\r\n\tCurrently, numerous biomaterials-based studies are being conducted, including research into chitin and chitosan, the second most abundant polysaccharide after cellulose. Chitin is obtained at an industrial scale from a variety of natural sources including, crustacean and insect exoskeletons, fungi cell walls, squid pen, etc. Chitosan is biodegradable, biocompatible, non-toxic, water-soluble under acidic conditions, and linear cationic amino polysaccharide derived from the deacetylation of chitin. It contains free amino and hydroxyl groups that can be functionalized by binding with the cationic and anionic groups. It has numerous applications, especially in the environmental remediation, biomedical, pharmaceutical, agriculture, and food industries.
\r\n\r\n\tThis book will present an update of articles addressing isolation, properties, and certain applications of chitin and chitosan, including films, fibers, nanoparticles, composite materials, hydrogels, polymeric complexes, water purification, antimicrobials, textile, cosmetics, biosensors, nanoporous scaffolds, and membranes. We invite world-class researchers from around the world, industry, academia, government, and private research institutions are encouraged to publish research or review articles on chitin and chitosan.
",isbn:"978-1-80356-693-1",printIsbn:"978-1-80356-692-4",pdfIsbn:"978-1-80356-694-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"69f009be08998711eecfb200adc7deca",bookSignature:"Dr. Brajesh Kumar",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11670.jpg",keywords:"Solvent, Acidic, Microwave, Binding, Biodegradable, Biocompatible, FTIR, NMR, XRD, Fibers, Nanoparticles, Composite Materials",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 23rd 2022",dateEndSecondStepPublish:"May 26th 2022",dateEndThirdStepPublish:"July 25th 2022",dateEndFourthStepPublish:"October 13th 2022",dateEndFifthStepPublish:"December 12th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"3 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Brajesh Kumar is a pioneering researcher in nanoscience and green chemistry. He is a member of the American Chemical Society, Indian Society of Chemists and Biologists, Indian Science Congress Association, Dr. Kumar, and holder of two registered patents. Dr. Kumar is also included in the top 2% of the scientist list prepared by experts at Stanford University, USA.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"176093",title:"Dr.",name:"Brajesh",middleName:null,surname:"Kumar",slug:"brajesh-kumar",fullName:"Brajesh Kumar",profilePictureURL:"https://mts.intechopen.com/storage/users/176093/images/system/176093.JPG",biography:"Dr. Brajesh Kumar is currently working as an Assistant Professor and Head in the Post Graduate Department of Chemistry, TATA College, Chaibasa, India. He received a Ph.D. in Chemistry from the University of Delhi, India. His research interest is in the development of sustainable and eco-friendly techniques for (a) nanoparticles synthesis and their applications for environmental remediation, (b) active films of organic solar cells, (c) nanomedicine, (d) sensors, (e) natural product extraction, purification, and analysis,(f) natural polymers, (g) peptide chemistry, (h) microwave and ultrasound-assisted organic synthesis and (i) organic synthesis. Dr. Brajesh Kumar has been credited for different national and international fellowships and he has also worked as a faculty member in various universities of India, Ecuador, and South Korea. He has also published numerous SCI/ SCIE/ Scopus research articles (h index = 29, Citations 2917) and is also an active reviewer of more than 50 Journals. He is also included in the top 2% of the scientist list prepared by experts at Stanford University, USA.",institutionString:"TATA College, Kolhan University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"6",title:"Biochemistry, Genetics and Molecular Biology",slug:"biochemistry-genetics-and-molecular-biology"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"278926",firstName:"Ivana",lastName:"Barac",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/278926/images/8058_n.jpg",email:"ivana.b@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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The incidence is highest at the age of 20–39 years in males and 40–59 years in females, with an equal male-to-female ratio [2]. Psoriasis clinically manifests as raised, well defined erythematous plaques with irregular borders and silvery scales, affecting the upper and lower extremities equally, but with a predilection for the elbows, knees, scalp, and trunk. Psoriasis vulgaris or plaque psoriasis accounts for almost 90% of the dermatological presentation of the disease, but several other forms, including guttate, inverse, erythrodermal, pustular, and palmoplantar psoriasis may occur, as well as nail involvement. Psoriasis may have significant systemic involvement, which is underscored by the coexistence of various clinical disorders, including eye, cardiovascular, and intestinal problems, metabolic syndrome, and joint inflammation. It has a very high negative impact on quality of life, requires long-term treatment which usually has a high social and economic impact and is also associated with a decreased life span [3] [4].
No one classification of psoriasis satisfies all the mentioned requirements. Usually, criteria are intermingled (Table 1), and subclasses are nonexclusive. Similar problems exist with the clinical classification of psoriatic arthropathy [5].
Morphologic aspects of elementary lesions | \n\t\t\tPustular, non-pustular but also plaque, nummular, guttate, gyrate, rupioid, elephantine, ostraceous, etc. | \n\t\t
Degree of inflammation | \n\t\t\tMainly inflammatory vs mainly hyperkeratotic | \n\t\t
Pattern distribution | \n\t\t\tExtensory, inverse, seborrhoeic, widespread | \n\t\t
Extent | \n\t\t\tOne site (scalp, nail, etc.), many sites, generalized | \n\t\t
Time of first onset | \n\t\t\tEarly vs late onset | \n\t\t
Velocity of propagation | \n\t\t\tStable, unstable, eruptive | \n\t\t
Features which have been considered in different classifications of psoriasis [6]
Classification criteria based on purported etiology rank higher in formalization compared with purely morphological ones.
Psoriasis, a papulosquamous skin disease, has several different types, including:
The commonest type of psoriasis, accounting for 90% of all cases, is psoriasis vulgaris, in which papulosquamous plaques are well-delineated from surrounding normal skin. The plaques are red or salmon pink in color, covered by white or silvery scales and may be thick, thin, large or small (Figure 1). They are most active at the edge: rapidly progressing lesions may be annular, with normal skin in the centre. Plaques are usually distributed symmetrically, and occur most commonly on the extensor aspects of elbows and knees; scalp (where they rarely encroach beyond the hairline), lumbosacral region, and umbilicus. Active inflammatory psoriasis is characterized by the Koebner phenomenon, in which new lesions develop at sites of trauma or pressure [7].
There is also variation of features of psoriasis dependent on anatomical sites. Until the reasons for this variation are fully understood, they are proposed to be recorded as a phenotypic entity, although subsequently they may be shown to be part of a common pathogenetic mechanism. A further distinction arises according to the age of onset of plaque psoriasis [8]. Henseler and Christophers are credited with identifying two ages of onset: type I occurring at or before the age of 40 years—this accounts for approximately 75% of patients; and typeII presenting after the age of 40 years, with a distinct peak at 55–60 years [9].
As a consequence, chronic plaque psoriasis is the form of the disease entered into clinical trials and the object of the majority of investigations of genetics and pathogenesis of psoriasis. It is characterized by red, scaly, discoid lesions varying in size from 0.5 cm in diameter to large confluent areas on the trunk and limbs (Figure 1). There is a sharp line of demarcation between a plaque and clinically normal, uninvolved skin. Longitudinal studies of individual plaques have demonstrated that plaques are dynamic [10] with an active and expanding edge, sometimes to the extent that the advancing edge may become annular (Figure. 2) leaving clinically normal skin in the centre of the original plaque. The variety of plaque is characterized by well-demarcated plaques with a loosely adherent silvery-white scale, which preferentially affect the elbows, knees, lumbosacral area, intergluteal cleft, and scalp. Occasionally, pustular lesions may appear in the plaque (so-called psoriasis with pustules). Chronic plaque psoriasis is the most common variety of psoriasis, representing about 70% to 80% of psoriatic patients [11].
Typical plaque of Psoriasis Vulgaris.
Annular psoriasis showing clearance in centre of plaque.
Under the heading of plaque psoriasis, it is proposed to include, as subdivisions, a new, more logical nomenclature of phenotypes associated with specific anatomical sites, distribution, size and thickness of plaques [8].
Site-specific variants of psoriasis vulgaris exist. Flexural (inverse) psoriasis in intertriginous sites is shiny, red, and typically devoid of scales (figure 3); sebopsoriasis, which can be confused with seborrhoeic dermatitis, has greasy scales and occurs in eyebrows, nasolabial folds, and postauricular and presternal sites. Psoriasis vulgaris will probably prove to be several closely related but phenotypically and genotypically distinct conditions [8].
Flexural psoriasis, notes the relative lack of scale.
Seborrhoeic psoriasis, nasolabial, ‘greasy’ appearance and finely scaled.
Psoriasis of the scalp.
Plantar involvement by plaque psoriasis.
Psoriasis affects approximately 2% of the world population, and of these cases, 2% manifest as guttate psoriasis [16]. Guttate means "drop" in Latin; aka Teardrop Psoriasis, Raindrop Psoriasis or Psoriasis Exanthematic) is the second most common type of psoriasis. Guttate psoriasis (GP), an important clinical variant, most frequently occurs in adolescents and young adults. It is characterized by the sudden onset of widely dispersed small red scaly plaques mainly over the trunk and proximal limbs. The symptoms of GP are numerous small, red, drop-like spots which cover a large portion of the skin. Spots have an abundant scaling. Lesions are usually located on the trunk, arms, legs and scalp. GP can clear up without treatment or disappear and resurface in the form of plaque psoriasis. GP is especially common in children or young adults with a family history of psoriasis and follows streptococcal infection and/or acute stressful life events [17]. Guttate flares in patients with established psoriasis vulgaris (PV) are also frequently observed. These observations, taken together with investigative studies, indicate an important pathogenetic link between GP and PV [15]. GP is often associated with a preceding streptococcal throat infection or a rise in anti-streptococcal serum titer [16] [18]. Bacterial streptococcal infections (strep throat, chronic tonsillitis) or a viral respiratory infection usually precede and trigger the first signs of Guttate Psoriasis in persons predisposed to psoriasis. Herein, Dr. Loh in 2012 reports a case that suggests such an association. This 15-year-old girl presented with a case of acute guttate psoriasis shortly after the onset of mononucleosis. The structural characteristics of her eruption and her skin biopsy findings are consistent with guttate psoriasis (Figure 7).
Clinical photographs of the abdomen with guttate psoriasiform papules and plaques. A,Unmagnified image. B, Image at higher unspecified magnification [
Early phase of generalized pustular psoriasis with edematous plaques and pustules.
Acrodermatitis continua showing crops of pustular lesions at the tips of the fingers.
Palmoplantar pustulosis.
As already mentioned, plaque psoriasis is a rather stable disorder. The transition to a more extensive involvement, due to frequently unidentifiable triggering factors, is frequently marked by the onset of an inflammatory phase with predominant erythema and limited scaling associated with itching and rapidly progressing lesions. This unstable psoriasis may sometimes evolve to whole-body involvement. The erythrodermic phase is dominated by generalized erythema, loss of peculiar clinical features of psoriasis, and skin failure, that is, inability to maintain homeostatic functions [26]. Erythrodermic psoriasis characterized by severe scaling, itching, and pain that affects most of the body, erythrodermic psoriasis disrupts the body\'s chemical balance and can cause severe illness (Figure11). This particularly inflammatory form of psoriasis can be the first sign of the disease, but often develops in patients with a history of plaque psoriasis.
Erythrodermic psoriasis.
Approximately 50% of all patients with psoriasis develop characteristic nail changes as a clinical correlate of psoriatic inflammation of the nail matrix and/or nail bed. The most frequent signs of nail psoriasis are pitting and distal onycholysis [27]. Clinical manifestations range from pitting, yellowish discoloration, and paronychia, to subungual hyperkeratosis, onycholysis, and severe onychodystrophy (Figure 12) [28].
Yellowish discoloration of fingernails.
Psoriatic arthritis (PsA) is a chronic inflammatory joint disease occurring in 6–39 % of patients with psoriasis with a prevalence of PsA in the general population of about 0.1–0.25 % [29] [30]. Based on the several common clinical and radiological features, PsA is considered as a member of the family of spondyloarthritides [31]. This type of arthritis can be slow to develop and mild or it can develop rapidly. PsA can be a severe form of arthritis with prognosis similar to that of rheumatoid arthritis (RA) [32]. Psoriatic arthritis (PsA) is characterized by focal bone erosions mediated by osteoclasts at the bone–pannus junction. Importantly, 80% of patients with psoriatic arthritis have nail psoriasis (Figure13) [33]. Recognition of bone as an active organ that interacts with its environment is a relatively new development. In the pathogenesis of bone destruction associated with rheumatoid arthritis, the synovium is a site of active interplay between immune and bone cells. The interaction between T cells and osteoclasts is a critical issue in the field of osteoimmunology [34]. Further differentiate mechanisms of bone resorption and repair in PsA and RA and likely will uncover additional therapeutic targets [35].
Psoriatic arthritis hand changes over time.
Today, psoriasis is recognized as the most prevalent autoimmune disease caused by inappropriate activation of the cellular immune system. There are two main hypotheses about the process that occurs in the development of Psoriasis. The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the epidermis and its keratinocytes and is characterized by hyperproliferation with incomplete differentiation of epidermal keratinocytes and decreased keratinocyte apoptosis. The second hypothesis sees the disease as being an immune-mediated disorder (immunosuppressant medications can clear psoriasis plaques) in which the excessive reproduction of skin cells is secondary to factors produced by the immune system. T cells become active, migrate to the dermis and trigger the release of cytokines which cause inflammation and the rapid production of skin cells. It is not known what initiates the activation of the T cells. That work initially pointed towards a major role of T lymphocytes as inducers of the disease phenotype and the pathogenic contribution of this cell type has now been tested through clinical studies of more than a dozen immune modifying biological agents in patients with psoriasis. The inflammatory cytokines such as tumor necrosis factor (TNF) are likely to play major pathogenic roles in this disease and that other types of inflammatory leucocytes may also serve key pathogenic functions. Here we will review some recent works on psoriasis that advances our overall understanding of disease pathophysiology regarding neuroendocrine immunology. The concept of Psoriasis & Supersystems considers site of recognition, skin barrier in the sympathetic nervous (beta2 adenoceptors) and immune systems.
The brain and the immune system, or the “supersystems”, a term recently coined by Tada (1997), are the two major adaptive systems of the body [36]. Although the immune system has been often regarded as autonomous, the last two to three decades provided strong evidence that the central nervous system (CNS) receives messages from the immune system and vice versa messages from the brain modulate immune functions. Thus, the brain and the immune system are involved in functionally relevant cross-talk, whose main function is to maintain homeostasis [37]. In psoriasis it seems that the most important components of these supersystems are ß2 adenoceptors and tumor necrosis factor alpha (TNFα). Recent studies show that the ß2-adrenergic receptor is specifically associated with the homeostasis of skin barrier. Ca has critical role in this function. Increasing evidences indicate that TNF may have immunosuppressive effects, since long-term exposure to TNF can directly prevent the activation of T cells. ß2-adrenergic receptor interacts with TNFα which is evaluated in below, respectively.
The skin barrier homeostatic function is a self-referential system because it is always monitoring its original function, i.e., water impermeability. This function is regulated by the peripheral function [38]. Epidermal homeostasis is understood as the maintenance of epidermal tissue structure and function by a fine tuned regulatory mechanism balancing proliferation and cell loss by desquamation and apoptosis [39]. Stem cells of the basal layer or stratum basal in the epidermis have a crucial role in maintaining tissue homeostasis by providing new cells to replace those that are constantly lost during tissue turnover or following injury [40]. cAMP and calcium influence the formation and maintenance of barrier function [41].
The first protective barrier is provided by the skin, our largest organ. It serves as the interface between the organism and the outside world and it serves many functions, such as the retention of body fluids, maintenance of body temperature, and protection against UV-light, chemical influxes, wounds, and the invasion of micro-organisms. The protective barrier function is performed by the keratinocytes of the epidermis, which are continuously produced by proliferating stem cells of the basal layer or stratum basal and differentiate during a 14 day journey towards the surface [42].
Epidermal barrier capacity is controlled by lipids that fill the extracellular space of the skin\'s surface layer-the stratum corneum. Lipid synthesis for skin barrier function takes place within the keratinocytes in all nucleated epidermal layers. Lipids are stored within the epidermal lamellar bodies (secretory organells) or keratinosomes, which are ultrastructurally visible at the level of the upper spinous layer and in the granular layer. In the outermost granular layer, the contents of lamellar bodies are secreted into the intercellular domains of the stratum granulosom–stratum corneum interface. Lamellar bodies mainly contain phospholipids, glucosylceramides and cholesterol as well as hydrolytic enzymes, which convert phospholipids, glucosylceramides and sphingomyelinase to free fatty acids and ceramides. Then, lamellar bodies cause in the formation of an impermeable, lipid-containing membrane that serves as a water barrier and is required for correct skin barrier function. The Stratum Corneom (SC) contains three types of lipids -- ceramides, cholesterol and free fatty acids. These lipids have different chemical compositions and different functions throughout the body. There are nine different types of ceramides in the Stratum Corneom, conveniently named ceramide 1 through ceramide 9, and they account for 40-50% of the lipids in this outermost layer. A ceramide is composed of sphingosine and a fatty acid. Ceramides are found in high concentrations within the cell membrane of cells. They are one of the component lipids that make up sphingomyelin, one of the major lipids in the lipid bilayer. Ceramide can actually act as a signaling molecule. The most well-known functions of ceramides as cellular signals include regulating the differentiation, proliferation, programmed cell death (PCD), and apoptosis (Type I PCD) of cells [43].The proliferation rate of keratinocytes to corneocytes is matched by the shedding of old corneocytes at the SC [44] and skin tissue maintains a steady number of SC layers regardless of age [45].
Stratum corneum (SC) & Proteases (kallikrein family of serine proteases)
Interestingly, two major proteases of stratum corneum SCCE/KLK7/hK7 and SCTE/KLK5/hK5 together can destroy three major components of the corneodesmosomes: DSC1, DSG1 and CDSN [47]. These enzymes belong to kallikrein family of serine proteases. Their expression starts in suprabasal keratinocytes where their inactive precursors undergo a processing by an unidentified trypsin-like protease [48]. In stratum corneum, these enzymes appear in the intercellular spaces suggesting their involvement in the desquamation [49]. Recent discoveries have highlighted the importance of various proteases, protease-inhibitors, and protease targets as key players in epidermal barrier function [50]. It has become clear in recent years that serine proteases have an important role in epidermal homeostasis, and the signaling cascades are gradually being identified [41].
The specific differentiation program in stratified skin requires a specialized proteolytic system to detach the corneocytes from each other without causing a barrier defect. A number of different proteases have been reported to be involved in the desquamation process and to contribute to the barrier function of the skin. Based on their proteolytic domain, proteases are classified into serine, threonine, cysteine, aspertate, metallo, and glutamate proteases. Especially serine proteases (SPs) seem to be involved in epidermal permeability barrier homeostasis as it was reported that SP activity was increased after acute barrier disruption and that blockade by topical SP inhibitors accelerated barrier recovery after acute abrogation [51].
The Epidermal junction (EJ) plays a crucial role in the formation and maintenance of epithelial and endothelial barriers. The EJ is a complex basement membrane synthesised by basal keratinocytes and dermal fibroblasts. It plays a fundamental role as a mechanical support for the adhesion of the epidermis to the dermis and regulates the exchanges of metabolic products between these two compartments; besides, it serves as a support for keratinocytes migration during wound healing, and is traversed by various cell types (LC, lymphocytes...) during immunologic and inflammatory processes [52]. Basal keratinocytes are connected to adjacent cells by several types of intercellular junctions (including gap and adherens junctions), the most characteristic of which are the desmosomes. Formation of adherens junctions and desmosomes requires extracellular calcium [53].
Although the Psoriasis is a multifactorial disease, the studies show that disruption the homeostasis in skin’s barrier is the main factor. Several factors interfere of hemostatic establishment in skin. 1) Heterogeneous Structure (lipid/protein) of this barrier that is the main cause of hemostasis. This two compartment structures is renewed continuously and when the barrier function is damaged, it is repaired immediately. 2) Several proteases important for desquamation (skin shedding). 3) The Epidermal junction (EJ) plays a crucial role in the formation and maintenance of epithelial and endothelial barriers. Formation of adherens junctions and desmosomes requires extracellular calcium. Raising the calcium concentration in the cell culture medium from 0.05 to 1.2mM [53] stimulates keratinocytes to form strong cell-cell adhesions in vitro. 4) In epidermal keratinocytes, both extracellular and intracellular Ca++ is reported to be important to cell differentiation and proliferation.
The skin is a complex organ containing afferent and efferent neural networks, glands, blood vessels, smooth muscle elements, connective tissues and immune cells, many of which are modulated by catecholamines and glucocorticoid hormones. Glucocorticoids and catecholamines reach skin tissues as circulating hormones and catecholamines are released in skin by projections of the sympathetic nervous system. The sympathetic division of the autonomic nervous system within the skin is supplied by postganglionic fibers of the paravertebral chain ganglia. Catecholamines also are produced locally by keratinocytes [54] [55].
Beta2 adrenergic receptors were identified in keratinocytes more than 30 years ago, but their function in the epidermis continues to be elucidated [56]. The β-adrenergic (β-ARs) agonists are capable of modulating the two distinct components of keratinocyte directional migration via divergent signaling pathways: 1) migration rate via a cAMP-independent, mitogen-activated-protein-kinase-dependent pathway [57] and 2) galvanotaxis by a cAMP-dependent one. Previous data have shown that both endogenous and exogenous catecholamines act to attenuate the permeability response to various inflammatory mediators via β1- [58] and β2-adrenoceptors [59] [60] [61] [62]. Additionally, because β-adrenergic agonists and antagonists modulate both keratinocyte migration and galvanotaxis, they could be valuable tools for controlling reepithelialization and restoration of barrier function, an essential component of the wound healing process.
In skin, it has been proposed that epinephrine activates keratinocyte beta2AR to modulate calcium influx and begin the differentiation cascade crucial to the native architecture of the epidermis [54]. The beta2AR desensitizes upon repeated activation through several mechanisms, including downregulation of the number of beta2AR receptors [63] [64]. Indeed, beta2AR expression is more highly expressed at the basal layers of the epidermis and decreases in expression toward the stratum corneum [54], suggesting that epinephrine may be activating the receptor to increase intracellular calcium levels and induce differentiation.
The cyclic nucleotide phosphodiesterases comprise a group of enzymes that degrade the phosphodiester bond in the second messenger molecules cAMP and cGMP. They regulate the localization, duration, and amplitude of cyclic nucleotide signaling within subcellular domains. The PDE superfamily of enzymes is classified into 11 families, namely PDE1-PDE11, in mammals. PDEs have different substrate specificities. Some are cAMP-selective hydrolases (PDE4, 7 and 8); others are cGMP-selective (PDE5, 6, and 9). A phosphodiesterase type 4 inhibitor, commonly referred to as a PDE4 inhibitor, is a drug used to block the degradative action of phosphodiesterase 4 (PDE4) on cyclic adenosine monophosphate (cAMP). It is a member of the larger family of PDE inhibitors. The PDE4 family of enzymes is the most prevalent PDE in immune cells. They are predominantly responsible for hydrolyzing cAMP within both immune cells and cells in the central nervous system [65]. Since the late 1980s, PDE4 inhibitors have been under investigation as anti-inflammatory therapies against asthma and chronic obstructive pulmonary disease. Due to the broad anti-inflammatory activity of PDE4 inhibitors, their possible use in the treatment of atopic dermatitis and psoriasis was examined.
In psoriasis, keratinocytes within the psoriatic lesions demonstrate a low cAMP response to ß2-AR activation [66]. These findings point to a role for the cutaneous ß2-AR network in maintaining epidermal function and integrity. Moreover, it has also been shown that ß2-AR density in the human epidermis depends on the calcium concentration [67] [54], where undifferentiated keratinocytes express approximately 7500 AR per cell and differentiated keratinocytes express only 2500 receptors underlining an important function for the 2-AR in the differentiation process in human skin [68]. Stimulation of the beta2-AR leads to a transient increase in the keratinocyte intracellular calcium concentration [69] [70] and this likely occurs through several signaling cascades. The mean increase in intracellular calcium of psoriatic keratinocytes was significantly reduced compared with control keratinocytes when intracellular calcium stores were mobilized from endoplasmic reticulum with thapsigargin (an inhibitor of the endoplasmic reticulum Ca2+ ATPase was used to empty the Ca2+ stores from endoplasmic reticulum) [71].
It has already been established that the skin is an important peripheral neuro-endocrine-immune organ that is tightly networked to central regulatory systems. These capabilities contribute to the maintenance of peripheral homeostasis. Skin cells and skin as an organ coordinate and/or regulate not only peripheral but also global homeostasis. Activation of the sympathetic system is the most common studied in literature, but other possibilities have to be considered, like impairment of epidermal barrier function, which is already described. ß2-AR density in the human epidermis depends on the calcium concentration and calcium plays an important part in the regulation of proliferation and differentiation of keratinocytes.
Keratinocytes can sense pathogens and mediate immune responses to discriminate between harmless commensal organisms and harmful pathogens. Keratinocytes are continuously in contact with external stimuli and have the capacity to produce several soluble mediators. Pathogen-associated molecular patterns (PAMPs) are recognized, among others, by Toll-like receptors (TLRs). Epidermal keratinocytes express several TLRs, located either on the cell surface (TLR1, TLR2, TLR4, TLR5 and TLR6) or in endosomes (TLR3 and TLR9) [72]. Keratinocytes are also an important source of chemokines and express chemokine receptors, and therefore can modulate an immune response by attracting different cell types into the skin.
Keratinocytes produce a wide array of cytokines, including tumor necrosis factor and interleukin 1α (IL-1α), IL-1β, and IL-6. Disruption of the permeability barrier increases the expression of these cytokines [73] [74]. Studies in mice deficient in these cytokines or their receptors have shown delays in permeability barrier recovery after acute disruption, suggesting that the increased cytokine production facilitates barrier repair [75] [76]. Cytokines are well known to stimulate lipid synthesis and metabolism, and one could anticipate that an increase in epidermal lipids induced by cytokines could facilitate lamellar body formation and permeability barrier recovery [75] [77] [78].
Activation of the sympathetic nervous system (noradrenergic nerves and adrenal medulla) exerts a potent anti-inflammatory action upon the innate immune system. Adaptive immune cells are known to express primarily the β2AR, while innate immune cells appear to express the β2AR, a1AR, and a2AR. In the case of adaptive immune responses, however, signals from the brain are transmitted back to the periphery, primarily via activation of the HPA and the SNS [79]. The magnitude of an adaptive immune response appears to be regulated by the release of norepinephrine within the direct vicinity of activated CD4+ T cells and B cells located within lymphoid tissue. The released norepinephrine stimulates the β2AR expressed on the immune cells to regulate the level of gene activity. The immune cell self-regulated immune response develops and progresses normally with the participation of norepinephrine to regulate the level of the response in an attempt to maintain immune homeostasis [80]. The importance of sympathetic nervous system has been studied in skin disorders. In vitiligo, there is a dysregulation of catecholamine biosynthesis with increased plasma and epidermal noradrenaline levels associated with high numbers of β2-ARs in differentiating keratinocytes and with a defective calcium uptake in both keratinocytes and melanocytes. In atopic eczema, a point mutation in the β-AR gene could alter the structure and function of the receptor, thereby leading to a low density of receptors on both keratinocytes and peripheral blood lymphocytes [81]. In psoriasis, β-ARs are downregulated, because the increased circulating levels of catecholamines have been observed in psoriatic patients [82] [83] [84] and a 10-fold increase in the expression of the Phenylethanolamine N-methyltransferase (PNMT), the epinephrine sythetic enzyme is also found in basal keratinocytes in involved psoriatic epidermis [85]. It is tempting to propose that long-term exposure to increased levels of catecholamines, in the circulation or locally derived by the keratinocytes themselves, in combination with increased desensitization of beta 2AR in individuals, may predispose to psoriasis. Cathecolamines regulate the immune system at regional, local and systemic levels via adrenergic receptors expressed on immune cells [86] and interestingly, β-AR blockers may cause this inflammatory autoimmune skin disease [87] [88].
Psoriasis is a chronic inflammatory, immune-mediated skin disease, which affects 2%-3% of the population worldwide [89]. Psoriasis was until recently regarded as a T-cell-driven disease with presumed (auto) immune mechanisms as its primary cause [90] [91].
The innate immune system provides the first line of defense against infection by detecting the presence of invading pathogens in a non-specific manner. Cells of the innate immune system include macrophages, dendritic cell (DC), monocytes, neutrophils, mast cells, natural killer (NK), NKT cells and γδ T cells. Innate immune cells recruit additional leukocytes to the site of inflammation by releasing cytokines and chemokines. Many innate immune cells can also directly kill invading pathogens. In addition, the innate immune system plays a crucial role in the initiation and direction of the adaptive immune response. Mechanisms regulating barrier integrity and innate immune responses in the epidermis are important for the maintenance of skin immune homeostasis and the pathogenesis of inflammatory skin diseases [92].
The existence of an association between the brain and immunity has been documented. Data show that the nervous and immune systems communicate with one another to maintain immune homeostasis. Activated immune cells secrete cytokines that influence central nervous system activity, which in turn, activates output through the peripheral nervous system to regulate the level of immune cell activity and the subsequent magnitude of an immune response. One key mechanism responsible for such coordination involves the autonomic nervous system (norepinephrine), which serves as the messenger from the mind to the body for all organ systems, including the immune system [93]. The antigen-activated immune system regulates CNS activity through the release of cytokines that bind to receptors located peripherally on the vagus nerve or sympathetic nerve terminals or centrally within the CNS or at the blood-brain barrier. Subsequently, the CNS communicates back to the immune system by activating the SNS or the HPA to release the neurotransmitter norepinephrine or a corticosteroid hormone, respectively. Lymphocytes express receptors that bind norepinephrine and corticosteroids, providing a mechanism for these ligands to activate intracellular signaling pathways, which regulate the level of immune cell activity. A bidirectional communication between the nervous and immune systems is to maintain homeostasis, whether this requires an increase or decrease in immune cell activity. Also, skin-brain axis fMRI studies on patients with psoriasis have revealed that the processing of facial expressions of disgust is significantly impaired in subjects with psoriasis as compared with normal controls in that blood flow in the anterior insular cortex is reduced. This appears to be a coping mechanism [94].
The brain and the immune system are the two major adaptive systems of the body. During an immune response the brain and the immune system “talk to each other” and this process is essential for maintaining homeostasis. Two major pathway systems are involved in this cross-talk: the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). This overview focuses on the role of SNS in neuroimmune interactions, an area that has received much less attention than the role of HPA axis. Evidence accumulated over the last 20 years suggests that norepinephrine (NE) fulfills the criteria for neurotransmitter/neuromodulator in lymphoid organs. The immune cell self-regulated immune response develops and progresses normally with the participation of norepinephrine to regulate the level of the response in an attempt to maintain immune homeostasis. Cathecolamines regulate the immune system at regional, local and systemic levels via adrenergic receptors expressed on immune cells.
The more common comorbidities include psoriatic arthritis and anxiety/depression disorder [95] [96]. More recently, psoriasis has also been reported to be associated with metabolic disorders including obesity, dyslipidaemia and diabetes [97] [98]. Moreover, an increased mortality from cardiovascular disease in patients with severe psoriasis has been documented, and psoriasis may confer an independent risk of myocardial infarction especially in young patients [99].
Recent studies of epinephrine stimulation at the β2 adrenergic receptor reveal important potential long-term beneficial effects in the metabolic syndrome [100]. The association between psoriasis and metabolic disorders such as obesity, dyslipidemia, and type 2 diabetes has shown that severe psoriasis might be associated with increased mortality rate due to cardiovascular disorders [97] [98] [101].
The study by Gelfand et al. in 2006 indicated that patients with psoriasis are more likely than the general population to have diabetes, high cholesterol, and other “traditional” risk factors for heart disease [99] [102]. Recent studies suggest that psoriasis, particularly if severe, may be an independent risk factor for atherosclerosis, myocardial infarction (MI), and stroke. Mehta et al. in 2010 conducted a cohort study using the General Practice Research Database to determine if severe psoriasis patients have an increased risk of cardiovascular (CV) mortality [103].
The existence of shared risk factors between psoriasis and both CV and metabolic conditions has been shown in several epidemiological studies which demonstrate that the same co- morbidities are present in psoriasis patients, regardless of age or ethnicity [104] [105].
This review shows that the overactivity of sympathetic nervous system occurs in Psoriasis disease. Abnormalities of β-ARs in their expression, signaling pathway, or in the generation of endogenous catecholamine agonists by keratinocytes have been implicated in the pathogenesis of cutaneous diseases such as atopic dermatitis, vitiligo and psoriasis. These studies suggest that mainly the localization of Beta2-adrenergic receptors in the epidermis and play an important part in the calcium dynamics and barrier homeostasis of epidermal keratinocytes [106].The decrease expression of beta2 adrenergic receptor mRNA in involved psoriatic epidermis shown by RT-PCR [107]. Together, these findings suggest that the downregulation of the number of beta adrenergic receptors, rather than an inherent defect in the receptor itself, is the mechanism that is responsible for the reduced beta-adrenergic responsiveness seen in psoriatic epidermis. This decreased response to endogenous agonists then results in a decrease in intracellular cAMP and thus an increase in keratinocyte proliferation. This downregulation can be about overactivity of sympathetic nervous system. Polimorphism studie show that inactivity of Beta2 adrenoceptor is the main cause in this disorder. Beta2 antagonists wreck this condition and reduction of cAMP could cause disruption in skin barrier hemostasis. Freund et al. in 2012 have used boron-based molecules to create novel, competitive, reversible inhibitors of phosphodiesterase 4 (PDE4). The co-crystal structure reveals a binding configuration which is unique compared to classical catechol PDE4 inhibitors, with boron binding to the activated water in the bimetal center. These phenoxybenzoxaboroles can be optimized to generate submicromolar potency enzyme inhibitors, which inhibit TNF-α, IL-2, IFN-γ, IL-5 and IL-10 activities in vitro and show safety and efficacy for topical treatment of human psoriasis [108]. However, it may be that currently utilized therapies also work by modifying this signaling pathway. For example, vitamin D, currently used as a topical treatment of psoriasis, has been shown to increase the generation of cAMP in response to betaAR agonists [109] Glucocorticoids, the mainstay of topical therapy for psoriasis, increase both the expression of beta2AR in keratinocytes, and the generation of cAMP in response to agonists [110]. UVB irradiation, another mainstay in the treatment of psoriasis, has been shown to increase beta2AR-mediated cAMP accumulation [111].
Psoriasis is skin disease with unknown etiology. There is no cure for psoriasis, but there are many treatments that can decrease the symptoms and appearance of the disease.
In general, there are three treatment options for patients with psoriasis: Phototherapy, topical and systemic. A combination of therapies is often recommended. Combining various topical, systemic and light treatments often allows lower doses of each and can result in increased effectiveness.
First line management of adult mild-to-moderate adult plaque psoriasis is with topical treatment, including vitamin D analogues and topical corticosteroids. Topical therapies are indicated for patients whose affected area is < 10% of the body surface area (BSA). Topical vitamin D analogues (VD) and topical steroids (TS) are both widely used topical treatments for psoriasis. Calcipotriol is a vitamin D analogue that regulates epidermal cell proliferation and differentiation, as well as production and release of pro-inflammatory cytokines. TS present a wide range of biological effects such as inhibition of the recruitment and migration of inflammatory cells, modulation of cytokine synthesis, chemokines release and regulation of DNA synthesis [112].Topical corticosteroids are available in different potencies and formulations but despite more than 40 years of experience, their use remains mostly based on individual experience. Published guidelines often specify the place of topical steroids within psoriasis treatment strategies [113] [114] [115] but not the efficacy and practical modalities of use. It should be noted that the majority of adverse events seen with topical therapies are cutaneous rather than systemic in nature and that the risk–benefit ratio for these patients is better with topical therapies than with biological [116].
Solar ultraviolet (UV) radiation has been used since ancient times to treat various diseases. This has a scientific background in the fact that a large number of molecules (chromophores) in different layers of the skin interact with and absorb UV. These interactions may have both positive and negative biological implications. Most of the positive effects of solar radiation are mediated via ultraviolet-B (UVB) induced production of vitamin D in skin [117]. In our day’s phototherapy is a valuable option in the treatment of many psoriatic and nonpsoriatic conditions, including atopic dermatitis, sclerosing skin conditions such as morphea, scleroderma, vitiligo, and mycosis fungoides [118]. UVB radiation reaches the epidermis and the upper dermis where it is absorbed by DNA, trans-urocanic acid (trans-UCA), and cell membranes [119]. Absorption of UVB by nucleotides leads to the formation of DNA photoproducts, primarily pyrimidine dimers. UVB exposure reduces the rate of DNA synthesis. In addition, UVB radiation causes photoisomerization of trans-UCA to cis-UCA which has immunosuppressive effects. Furthermore, UV radiation can affect extranuclear molecular targets (cell surface receptors, kinases, phosphatases, and transcription factors) located in the cytoplasm and in the cell membanes [119]. Keratinocytes, circulating and cutaneous T lymphocytes, monocytes, Langerhans cell, mast cells and fibroblasts are all targeted by narrowband UVB [119]. Narrowband UVB induces also local and systemic immunosuppressive effects which may particularly contribute to the beneficial effects of this light source. UVA radiation penetrates more deeply into the skin than UVB, and reaches not only epidermis, but also dermis with blood vessels affecting dermal dendritic cells, dermal fibroblasts, endothelial cells, mast cells, and granulocytes [120]. UVA radiation is absorbed by pyridine nucleotides (NAD and NADP), riboflavins, porphyrins, pteridines, cobalamins and bilirubin [120] Porphyrins and riboflavins are photosensitizers. UVA effects are dominated by indirect DNA damage caused by reactive oxygen species such as singlet oxygen. The ability of UVA radiation to cause skin erythema is approximately 103 to 104 times lower than that of UVB. As UVA-1 is even less erythematogenic than broadband UVA much higher doses of UVA-1 can be tolerated by the patients. UVA-1 phototherapy works mainly through induction of apoptosis of skin infiltrating T cells, T-cell depletion and induction of collagenase-1 expression in human dermal fibroblast [121] [122].
Patients with moderate to severe disease generally require systemic agents (e.g. cyclosporin, methotrexate, oral retinoids, fumaric acid esters) to control their disease adequately. The severity of psoriasis traditionally has been evaluated by objective measurement of the extent of the body surface affected and consideration of the subtype of psoriasis, degree of disability, and feasibility of topical therapy [124].
Currently, there is no universal standard of care for patients with moderate to severe psoriasis, and the benefits and risks of systemic therapy must be weighed carefully for each patient to ensure optimal management of psoriasis symptoms and minimization of acute and cumulative toxicities [143]. Whether the symptoms are mild, moderate, or severe, the optimal treatment plan is the one the patient is most likely to follow. For those with localized disease, topical therapy is a suitable first choice. Phototherapy is generally the first-line treatment for patients with extensive psoriasis or disabling symptoms. When phototherapy is not feasible or is ineffective, systemic treatments with conventional oral agents or biologics are indicated [144]. Psoriasis is a common skin disorder that needs long-term management, not only because of its prevalence but also because of the profound impact it can have on quality of life.
Cancer remains the killer disease in the world, and currently it has become a dangerous public health problem in many countries. In all kinds of cancer, the problem arises when cancer cells begin to grow in uncontrolled manner or do not die when they should do so. In addition, breast cancer is a malignant tumor that is considered the most common type of cancer occurs in women and the second type of cancer in general. It has been announced, that more than 2 million new cases have been registered worldwide in 2018 [1]. Awareness of symptoms and the need for screening are very important to reduce the risk of cancer [2].
In medical imaging, it has been shown that early detection and proper treatment of breast cancer reduces the mortality rate by 20–40% [3]. The use of Mammography, represents an effective tool in the early detection of the breast cancer. As a result, many computer-aided diagnostic (CAD) systems have been developed using digital image processing techniques applied to mammography images. These systems are very useful to help radiologists in the early detection of breast cancers and then to classify the breast tumor as malignant or benign [4, 5, 6].
In general, any CAD system can be composed of three different steps: image pre-processing step, features extraction and selection step and finally the classification step. For the breast cancer detection and classification, many works have been presented to improve the efficiency of the CAD systems. In the pre-processing step, the pectoral muscle removal and the region of interest (ROI) extraction rest a big challenge. Numerous segmentation algorithms have been also proposed to suppress the pectoral muscle [7, 8, 9, 10]. However, there is no universal segmentation algorithm that can give acceptable results for all cases.
In the features extraction step, different techniques can be used like, shape and texture features [11, 12], morphological and texture features [13], independent component analysis (ICA) [14], the discrete cosine transform (DCT) [15], the discrete wavelet transform (DWT) [16, 17] and other transforms. In [18], the authors used non-subsampled contourlet transformation together with discrete wavelet transform with gray level co-occurrence matrix for texture features extraction. Salabat Khan et al. used a Gabor filter blank (GBF) optimized by Particle Swarm Optimization (PSO) for the extraction of Gabor characteristics [19]. Mughal B et al. used the backpropagation neural network on the hat transformation with gray level co-occurrence matrix (GLCM) features [20].
For the classification step, the most used classifiers are Artificial Neural Networks (ANN), Support Vector Machine (SVM), Naïve Bayes (NB) and
In this chapter, we propose a new computer-aided diagnostic system to classify breast tumors as malignant or benign. In the pre-processing step, we have proposed a new algorithm to select a limited triangular region that contains the pectoral muscle to be eliminated, and then apply the SRG segmentation algorithm. Features extraction and selection are also very important processes to improve the system performances in classification and pattern recognition methods. By using discrete Fourier transform or discrete cosine transform, we obtain a frequency domain representation of the image that can be considered as a set of features for pattern recognition problems. While the FFT give complex coefficients, the DCT provide real values in the frequency domain. We have used the DCT transform for feature extraction, and we have proposed the selection of the most significant features using the (DPA) algorithm [24]. Finally, we have evaluated the performances of the algorithm using SVM, ANN, NB and KNN classifiers and the MIAS database mammograms [25].
The proposed Computer-aided diagnostic system (CAD) that is used to classify the breast tissue in mammograms as malignant or benign is divided into three basic processing steps as shown in Figure 1.
Flow chart of CAD system for breast cancer classification.
This step represents an important one in most CAD systems. The image pre-processing helps strongly in the selection of the region of interest (ROI) that contains the abnormalities. It is performed to remove the unwanted objects, which include artifacts, labels, background noises and to suppress the pectoral muscle (Figure 2). The use of efficient image processing methods is an indispensable step for achieving a high accuracy classification in CAD systems for the diagnosis of breast cancer.
The preprocessing steps of mammogram image: (a) original image, (b) noise removed image, (c) binary image, (d) largest area, (e) image right flipped, (f) parenchyma of the breast.
There are various types of noises affected on mammogram images, such as Salt and pepper noise, Speckle noise, Gaussian noise and Poisson noise. Therefore, it is important to remove the noises to enhance the image quality on the preprocessing step. Traditionally, the median filter is a well-known used filter for this kind of noises, due to its nonlinear behavior, its simplicity and capability to preserve edges [26]. The median filter replaces each pixel value by the median of all the neighboring pixels values in a window. In this chapter, we used a (3x3) median filter to reduce noise in the mammogram images.
In order to remove all unwanted objects in the selected image and separate the breast profile, we follow the next four steps:
Step (1) Thresholding of the mammogram image by 0.0706 normalized value.
Step (2) Mark all regions in the thresholded image (i.e., Artifacts, labels, …).
Step (3) Calculate the area of each region, and select the largest one.
Step (4) The result of the step (3) is then used as a mask of the original grayscale mammography image.
In the mammogram preprocessing, the identification and extraction of the pectoral muscle is one of the major challenges in Medio lateral Oblique (MLO) view. It could be noticed here, that this step is important to improve the diagnostic accuracy of the CAD system. The difficulty in removing the pectoral muscle is due to the following reasons [27]:
Homogeneous area situated in the top left/right corner contains the brightest pixels in the image.
The pectoral muscle boundary shape is concave, convex or a mixture of both of them.
The density of the pectoral muscle area appears at approximately with similar density as the dense tissues.
Varying position, size, shape and texture from image to image.
In this chapter, we present a new algorithm for pectoral muscle suppression, this operation is based on the Localization of the triangular region that contains the Pectoral Muscle, where the Seeded Region Growing (SRG) algorithm is invoked in this operation.
Step (1) | |
Step (2) | |
Step (3) | |
Step (4) | |
Step (5) | |
Step (6) | |
Step (7) | |
The region of interest (ROI) |
Seeded Region Growing (SRG) is a useful image segmentation technique for medical images that is initially proposed by R. Adams et
The advantage of applying the (SRG) method into the localized triangular ABC region (Figure 3) is to remove only the pectoral muscle, without completely suppressing the triangular region as in some other methods. Figures 3–5 show a visual scheme of the proposed algorithm.
Localization of the ABC triangle in the left upper quadrant.
Pectoral muscle segmentation steps: (a) mammogram top left quadrant, (b) triangular mask, (c) masked top left quadrant, (d) suppression of the pectoral muscle, (e) cropped top left quadrant without pectoral muscle.
Identification of the region of interest (ROI). (a) Cropped image, and (b) Selected region of Interest (ROI).
The Seed point is selected automatically by considering the results obtained from step (4) of algorithm 1.
Figure 5(a) shows the cropped image, where Figure 5(b) shows the selected region of interest (ROI). All obtained (ROI) images are resized in order to get the same dimension.
Features extraction plays an essential role, and a challenging step in the accurate classification and diagnostic rate of mammograms. In this chapter, we have used features extracted from the image in the frequency domain representation. The most used transform to this domain is the discrete Fourier transform with its fast algorithm (FFT) [29]. In classification problems, for example, Fourier descriptors have been used for pattern recognition [30, 31]. Another interesting transform is the discrete cosine transform (DCT) which decomposes the image on a set of cosine functions. It provides a real representation of the image contrary to the FFT, which give complex coefficients.
The frequency domain features are very used in the classification and pattern recognition field. However, the hard task is the selection of the transformed coefficients, while these coefficients do not have the same aptitude to discriminate between the different classes. However, the use of the standard approaches to select these coefficients are not always efficient in selecting the most discriminative coefficients. In this chapter, we present a novel features extraction technique that is composed of two phases. In the first one, the discrete cosine transforms (DCT) is applied on all the obtained regions of interest (ROI), and then the low frequency coefficients in the upper left corner (ULC) are retained. In the second phase, a combination of the retained frequency coefficients with the discriminative power coefficients algorithm [24] is proposed to calculate the discrimination power matrix, which is given by the ratio between the two variances, the between-class variance and the within-class variance. Where, high classification accuracies are represented by high rate values.
This mathematical tool transforms any signal or image from the spatial domain to frequency domain. It has been widely used in digital signal and image processing, where its major advantages over the FFT reside in giving real coefficients. In addition, it concentrates the information in the low frequency region. Fast implementation can be obtained by using the FFT algorithm [29] which make the use of this transform very simple in real-time applications. It is defined by Eq. (1):
with
and
After the calculation of the DCT coefficients, we retain only the 512x512 region in the upper left corner (ULC coefficients). In the feature’s selection step, a new most discriminative power analysis (DPA) algorithm has been proposed to select the most significant features that have the high discrimination power (DP) values.
The calculation of the (DP) for each transformed coefficient is shown in the (DCT-DPA) algorithm shown below. Considering an image
The
with
The classification is the last step to identify if the breast tumor is benign or malignant. It plays a vital role in the medical image diagnosis field. Therefore, the images need to be classified with maximum accuracy. As a result, some automated classification methods have been proposed. In this part, we presented some of these classifiers including NB, SVM, ANN, and KNN that are used for breast cancer detection. A brief description of these algorithms will be presented as well as their advantages and disadvantages.
SVMs are a set of machine learning algorithms that help solve problems associated with classification, regression, and fault detection. They are considered to be among the algorithms that are distinguished by their strong theoretical guarantee and their great flexibility. They are also considered among the easiest algorithms in terms of ease of use even in cases where there is a little knowledge of data extraction.
The SVMs use increases widely in medical imaging field especially for breast cancer diagnosis [32]. The basic principle of SVM in this chapter is to separate and classify images into two categories malignant and benign using a hyperplane decision boundary, ensuring a maximum distance between different data sets and the boundary separating them. For linearly separable data, the hyperplane decision boundary is given by [33]:
where
SVM generally gives good accuracy with less memory use.
It works very well in cases where the separation margin between data sets is clear.
It can also solve any complex problem by specifying different kernel function.
The main disadvantages of the SVM algorithm are the difficulty of choosing the appropriate kernel function and the long training time for large datasets.
The artificial neural networks are feed-forward networks that can be trained to classify inputs according to target classes. Generally, a neural network is composed of three layers: an input layer, a hidden layer and an output layer [34]. Usually, only the input and output signals of the network are already known [17]. The process of training an artificial neural network before setting it up represents a serious operation and affects directly the final obtained results. This operation depends on some constraints like the initial parameters setting, the use weights, bias and finally the used algorithm learning rate. To adjust the weights of the ANN, one can use some learning methods like the back-propagation or an optimization algorithm. In this work, the input layer is based on the number of the features selected, the hidden layer contains 10 neurons, and finally the out layer.
Naive Bayes is becoming increasingly popular in many areas, it has shown excellent performances for classification tasks. It is a simple probabilistic classifier based on Bayes\' theorem, which is based on conditional probabilities [35]. A Naive Bayes classifier assigns a new observation to the most probable class, assuming the features are conditionally independent for a given the class value. It is easy and fast to predict the class of the test data set, but their biggest disadvantage is its requirement to an independent predictor [15].
where
To validate the proposed system, experiments were performed on the digital mammography images from the Mammographic Image Analysis Society (MIAS) database [25]. The MIAS database is a standard and publicly available database of digital mammogram images. Each mammogram is 1024 × 1024 pixels of size with a resolution of 200 microns. MIAS contains 322 mammograms for right and left breast of 161 patients in the mediolateral oblique (MLO) view, 61 mammograms were diagnosed as benign, 54 as malignant and 207 normal. The performance of the proposed method has been tested based on algorithms’ accuracy, sensitivity and specificity using the following expressions:
Where:
In this test, we have calculated the
Table 1 shows a comparison of the measured performances of the SVM, ANN, NB and KNN classifiers. It is observed that the classification accuracy can reach 100% for the (ANN) classifier, is 98.8, 96.7%, 87.3% for SVM, NB and KNN respectively. We have evaluated the classification performances of the proposed algorithm according to the number of the used features in the classification.
Classifiers | Sensitivity (%) | Specificity (%) | Accuracy (%) |
---|---|---|---|
KNN | 91.05 | 82.67 | 87.3 |
NB | 97.9 | 97.3 | 96.7 |
SVM | 99.5 | 98.1 | 98.8 |
ANN |
Classification performance using ANN, SVM, NB and KNN classifiers.
Abbreviations: ANN, artificial neural network; SVM, support vector machines; NB, Naive Bayes, KNN, K-nearest neighbors.
The SVM, ANN, NB and KNN classifiers are used to classify input images into benign or malignant. The sensitivity, accuracy and specificity are shown in Table 2. According to the results in Table 2, we can see that small number of features (100 features in this case) can achieve best performances in the case of 512x512 ULC size. In addition, we have studied the effect of the ULC size on the obtained results. The accuracy curve of the classification accuracy versus the ULC size is shown in Figure 6. The number of used features is 100 features.
ANN | SVM | NB | KNN | ||
---|---|---|---|---|---|
ULC size | N. of Features | Accuracy (%) | |||
128x128 | 60 | 95.6 | 86.76 | 90.6 | 77.9 |
80 | 96.5 | 90.3 | 92.3 | 78.5 | |
100 | 98.2 | 94.7 | 92.6 | 79.7 | |
256x256 | 60 | 98.2 | 91.2 | 93.2 | 75.0 |
80 | 97.3 | 91.7 | 95.3 | 75.8 | |
100 | 98.2 | 93.8 | 93.8 | 76.1 | |
512x512 | 60 | 98.2 | 92.1 | 93.8 | 77.0 |
80 | 99.1 | 97.3 | 97.3 | 79.1 | |
100 | |||||
1024x1024 | 60 | 98.2 | 92.6 | 93.1 | 82.6 |
80 | 96.5 | 88.5 | 93.2 | 83.5 | |
100 | 97.3 | 91.7 | 94.1 | 85.6 |
Classification accuracy with various sizes of ULC and different numbers of features. Where the best results are represented by bold values.
Abbreviations: ANN, artificial neural network; SVM, support vector machines; NB, Naive Bayes, KNN, K-nearest neighbors.
Classification accuracy performances vs. the ULC sizes with 100 features.
Figure 7 represents the variation of the classification accuracy according to different features’ number with a fixed ULC size of 512x512. Figure 8 demonstrates the classification performance of ANN using the confusion matrix for training, test and validation data.
Classification performances vs. the number of features. (ULC size of 512x512).
Confusion matrix for training, test and validation data.
To show the efficiency of the presented technique, Table 3 shows a comparison between the results of the proposed algorithm with previous results, which are reported in the literature. We can see that the proposed CAD system gives better accuracy results compared to those obtained using the other methods.
Authors | Year | Database | Classifier | Classes | Accuracy (%) |
---|---|---|---|---|---|
Lima [12] | 2016 | MIAS | SVM | 2 | 94.1 |
Singh [37] | 2017 | MIAS | RF | 2 | 97.3 |
Elmoufidi [38] | 2017 | MIAS | SVM | 2 | 94.4 |
Mughal [20] | 2018 | MIAS | NNB | 2 2 | 98.5 95 |
Benzebouchi [22] | 2019 | MIAS | SVM | 2 | 94.0 |
Benhassine [15] | 2019 | MIAS | ANN SVM NB | 2 | 100 94.1 92.6 |
El-Sokary [39] | 2019 | MIAS | SVM | 2 3 | 92.5 90.0 |
Benhassine [17] | 2020 | MIAS | ANN SVM RF NB | 2 | 99.1 99.4 98.2 97.7 |
Taifi [18] | 2020 | MIAS | SVM | 2 | 94.1 |
KNN | 2 | 88.8 | |||
Luqman [40] | 2020 | MIAS CBIS-DDSM | Deep Lab Mask-RCNN | 2 | 95.0 98.0 |
Proposed method | 2020 | MIAS | ANN SVM NB KNN | 2 | 100 98.8 97.6 87.3 |
Comparison results of the proposed method with existing methods.
Abbreviations: ANN, artificial neural network; SVM, support vector machines; NB, Naive Bayes; RF, random Forest; KNN, k-nearest neighbors; M-RCNN and Dee Lab (two deep learning-based instance segmentation Frameworks); Subset of CBIS-DDSM Curated Breast Imaging of DDSM (Digital Database for Screening Mammography).
We have developed in the present chapter a new CAD system used for mammogram images classification. It consists of three main parts. First, we remove all unnecessary regions or objects from the input image, where we have proposed a mixed approach for pectoral muscle removing which can improve the diagnostic accuracy of the developed CAD system. Then, we have focused in our work on frequency domain features where we have used the discrete cosine transform (DCT). The extracted features are subject to a selection process that choose only the most important features. This step is done using the discriminant power analysis (DPA) algorithm. Finally, some of the most known classifiers in the field are used to make the final decision. The proposed system is evaluated on mammogram images from the MIAS database, where we have shown that a small number of selected features can give good results of the accuracy, sensitivity and specificity. The obtained results prove that the frequency domain features can give high performances especially with the use of the discrimination power analysis, and highlight the importance of DCT transform in recent artificial intelligence applications. The comparison of the obtained results with those obtained using recently proposed techniques shows the superiority of the proposed algorithm against the other methods.
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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It is a leading cause of disability in children. Congenitally infected neonates often appear asymptomatic at birth or have nonspecific symptoms. An early diagnosis and subsequent early antiviral therapy associated to nonpharmacological therapy (e.g., hearing rehabilitation, speech-language therapy, and cochlear implants) can reduce long-term disability. Much research has been done in this field, but further studies are still necessary. Looking back at the most recent papers, we will draw a review on this topic trying to answer to the question: could universal CMV screening be a useful and cost-effective diagnostic tool?",book:{id:"8728",slug:"update-on-critical-issues-on-infant-and-neonatal-care",title:"Update on Critical Issues on Infant and Neonatal Care",fullTitle:"Update on Critical Issues on Infant and Neonatal Care"},signatures:"Sara Lunardi, Francesca Lorenzoni and Paolo Ghirri",authors:null},{id:"44446",doi:"10.5772/54310",title:"Neonatal Pneumonia",slug:"neonatal-pneumonia",totalDownloads:14797,totalCrossrefCites:1,totalDimensionsCites:5,abstract:null,book:{id:"2990",slug:"neonatal-bacterial-infection",title:"Neonatal Bacterial Infection",fullTitle:"Neonatal Bacterial Infection"},signatures:"Friedrich Reiterer",authors:[{id:"152025",title:"Prof.",name:"Friedrich",middleName:null,surname:"Reiterer",slug:"friedrich-reiterer",fullName:"Friedrich Reiterer"}]},{id:"68113",doi:"10.5772/intechopen.86715",title:"Platelets in the Newborn",slug:"platelets-in-the-newborn",totalDownloads:957,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Platelets were first described in the mid-nineteenth century. Since then, their roles were identified in hemostasis and thrombosis, inflammation, leukocyte interactions, angiogenesis, and cancer growth. But there is little information about such platelet functions in the newborn. Several studies highlighted some platelet differences between newborns and adults. Yet, in spite of these differences, healthy newborns appear to be adequately protected. A number of factors, however, were reported to negatively affect neonatal platelets. These include maternal hypertensive disorders or infections, neonatal asphyxia or respiratory distress, therapies such as ampicillin or indomethacin, and treatment modalities such as ventilators, nitric oxide, or extracorporeal membrane oxygenation (ECMO). Their effects on newborn platelets are usually transitory, lasting from several hours to a few days or weeks. If these effects are well characterized, they could serve as reporters for diagnosis and monitoring during therapy. Careful studies of neonatal platelets are needed to improve the understanding of basic physiology and pathophysiology in this cohort and to identify possible targets for intervention and therapy.",book:{id:"7527",slug:"neonatal-medicine",title:"Neonatal Medicine",fullTitle:"Neonatal Medicine"},signatures:"Ijeoma Esiaba, Iman Mousselli, Giulia M. Faison, Danilyn M. Angeles and Danilo S. Boskovic",authors:[{id:"255308",title:"Ph.D.",name:"Danilo",middleName:null,surname:"Boskovic",slug:"danilo-boskovic",fullName:"Danilo Boskovic"},{id:"274914",title:"Prof.",name:"Ijeoma",middleName:null,surname:"Esiaba",slug:"ijeoma-esiaba",fullName:"Ijeoma Esiaba"},{id:"274915",title:"Prof.",name:"Danilyn",middleName:null,surname:"Angeles",slug:"danilyn-angeles",fullName:"Danilyn Angeles"}]}],mostDownloadedChaptersLast30Days:[{id:"44446",title:"Neonatal Pneumonia",slug:"neonatal-pneumonia",totalDownloads:14796,totalCrossrefCites:1,totalDimensionsCites:5,abstract:null,book:{id:"2990",slug:"neonatal-bacterial-infection",title:"Neonatal Bacterial Infection",fullTitle:"Neonatal Bacterial Infection"},signatures:"Friedrich Reiterer",authors:[{id:"152025",title:"Prof.",name:"Friedrich",middleName:null,surname:"Reiterer",slug:"friedrich-reiterer",fullName:"Friedrich Reiterer"}]},{id:"53683",title:"Pre and Postoperative Management of Pediatric Patients with Congenital Heart Diseases",slug:"pre-and-postoperative-management-of-pediatric-patients-with-congenital-heart-diseases",totalDownloads:4931,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Stabilization during preoperative cardiac surgery especially in neonates has an important role to predict outcome for pediatric congenital heart surgery. We tried to elaborate general guidelines on how to diagnose and some anticipations for emergency treatments tailored by the type of congenital heart disease in neonates. Stabilization consists of medical treatment including emergent prostaglandin institution in some types of duct dependent lesion. The role of interventional catheterization such as patent ductus arteriosus (PDA) stent, balloon pulmonary valvotomy, etc. as modalities for stabilization before surgery was also elaborated. Some general and specific guidelines based on the type of surgeries for postoperative management were also discussed.",book:{id:"5473",slug:"pediatric-and-neonatal-surgery",title:"Pediatric and Neonatal Surgery",fullTitle:"Pediatric and Neonatal Surgery"},signatures:"Eva Miranda Marwali, Beatrice Heineking and Nikolaus A. Haas",authors:[{id:"191397",title:"Dr.",name:"Eva",middleName:"Miranda",surname:"Marwali",slug:"eva-marwali",fullName:"Eva Marwali"},{id:"191414",title:"Prof.",name:"Nikolaus",middleName:null,surname:"Haas",slug:"nikolaus-haas",fullName:"Nikolaus Haas"},{id:"202373",title:"Dr.",name:"Beatrice",middleName:null,surname:"Heineking",slug:"beatrice-heineking",fullName:"Beatrice Heineking"}]},{id:"68042",title:"Neonatal Bacterial Meningitis",slug:"neonatal-bacterial-meningitis",totalDownloads:1195,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Despite improvements in neonatal intensive care, neonatal bacterial meningitis continues to be a serious disease with mortality rates varying between 10 and 15%. Additionally, long-term complications are observed among 20–50% of survivors, depending on time of diagnosis and therapy and virulence of the infecting pathogen. It is more common during the neonatal period than at any other age with the estimated incidence of 0.25 per 1000 live births. The absence of specific clinical presentation makes diagnosis of meningitis more difficult in neonates than in older children. Culture of cerebrospinal fluid is the traditional gold standard for diagnosis of bacterial meningitis, so all newborn infants with proven or suspected sepsis should undergo lumbar puncture. However, deciding when to perform lumbar puncture and interpretation of the results are challenging. Although the pathophysiology of neonatal meningitis is complex and not fully understood, researches on diagnostic and prognostic tools are ongoing. Prevention of neonatal sepsis, early recognition of infants at risk, development of novel, rapid diagnostics and adjunctive therapies, and appropriate and aggressive antimicrobial treatment to sterilize cerebrospinal fluid as soon as possible may prevent the lifelong squeal of bacterial meningitis in newborn infants.",book:{id:"7527",slug:"neonatal-medicine",title:"Neonatal Medicine",fullTitle:"Neonatal Medicine"},signatures:"Mehmet Şah İpek",authors:[{id:"267903",title:"Associate Prof.",name:"Mehmet Şah",middleName:null,surname:"İpek",slug:"mehmet-sah-ipek",fullName:"Mehmet Şah İpek"}]},{id:"71427",title:"Factors Influencing Maternal Decision-Making on Infant Feeding Practices",slug:"factors-influencing-maternal-decision-making-on-infant-feeding-practices",totalDownloads:1014,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The decision to formula feed or breastfeed a child typically begins with an established prenatal intention. This chapter will examine the multiple dimensions influencing maternal decision-making in regards to the feeding practices of infants including 1) individual maternal characteristics, 2) organizational factors, 3) hospital/provider recommendations, and 4) systematic/policy factors. The chapter will also examine the impact of infant feeding practices on early infant and childhood health outcomes. Research has demonstrated the benefits of breastfeeding on infants and early childhood which includes but is not limited to protection against common illnesses and infections, improved IQ , and even increased school attendance. Moreover, the World Health Assembly global nutrition objectives focus on encouraging breastfeeding support across all sectors in addition to implementing tailored community-based approaches, limiting the excessive marketing of infant formula, and enforcing supportive breastfeeding legislation. The aim of this chapter is to provide an overview of the dynamic interplay between individual, interpersonal, community, and societal factors, such as policies that impact breastfeeding rates and more specifically the health of infants.",book:{id:"9805",slug:"infant-feeding-breast-versus-formula",title:"Infant Feeding",fullTitle:"Infant Feeding - Breast versus Formula"},signatures:"Whitney N. 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Reaching all rightly and robustly is required. All this will contribute greatly towards the growth & development of infants and grandly towards the Sustainable Development Goals. We propose the “ABC mothers” plan. Progress for required practices for results possible with making mothers—“Able for practices advantageous, bold with pertinent awareness, and confident with propitious attitude”. Strong efforts on sound footing are necessary for health of all our infants and happiness all around with sustainable development. Scientific infant feeding will contribute to advance the attainment of this. Medical education teaching best beneficial practices is for excellence. One promoting breastfeeding is the best. The US Surgeon General’s Implementation Strategies elaborate “Education content”, “Enabling competency”, & “Education continuing”. Competency-based curriculum for Indian Medical Graduates includes “to promote and support optimal breast feeding”. Need for inclusion in teaching curriculum across US, UK, & internationally has been documented. Given all the evidence for breastfeeding benefits, it should be a consistent essential component of training in all medical schools worldwide.",book:{id:"11308",title:"Selected Topics on Infant Feeding",coverURL:"https://cdn.intechopen.com/books/images_new/11308.jpg"},signatures:"Sunil Jain, Arvind Singh Kushwaha and Vishal Marwaha"},{id:"81544",title:"Infant and Young Child Feeding in the Developed and Developing Countries",slug:"infant-and-young-child-feeding-in-the-developed-and-developing-countries",totalDownloads:33,totalDimensionsCites:0,doi:"10.5772/intechopen.103012",abstract:"Infant feeding challenges continue to manifest in developed and developing countries. Worldwide, more than 80% of babies are breastfed in the first few weeks of birth. However, about 37%, 25%, and less than 1% are exclusively breastfed at 6 months of age in Africa, the United States of America, and the United Kingdom, respectively. These statistics are far below the World Health Organization targets of 50% and 70% by 2025 and 2030, respectively. Complementary feeding practices are varied as well due to nonadherence to Infant and Young Child Feeding (IYCF) guidelines among parents. This accounts for the current trends in malnutrition in children under−5 years of age, adolescents, and the youth, and leads to intergeneration malnutrition. In this chapter we have included sections on appropriate infant feeding; including how to initiate breastfeeding in the first hour of birth, how to exclusively breastfeed infants until 6 months of age, how to complement breastfeeding after 6 months of infant’s age as well as continuing to breastfeed until 24 months of age and even beyond. Furthermore, we have included a description of how mothers who are unable to breastfeed can feed their infants on expressed breastmilk or replace breastmilk with appropriate homemade or commercial formula. This chapter as well covers infant feeding in prematurity.",book:{id:"11308",title:"Selected Topics on Infant Feeding",coverURL:"https://cdn.intechopen.com/books/images_new/11308.jpg"},signatures:"Enos Mirembe Masereka, Clement Munguiko, Alex Tumusiime and Linda Grace Alanyo"},{id:"81207",title:"Breastfeeding during COVID Pandemic",slug:"breastfeeding-during-covid-pandemic",totalDownloads:25,totalDimensionsCites:0,doi:"10.5772/intechopen.104604",abstract:"As new mothers are understandably concerned about COVID-19 and its high rate of infection, they are often unsure if they should breastfeed their infants. In general, hospitals do not allow direct breastfeeding by mothers with an active infection of SARS-CoV-2. Some neonatal units in Hong Kong maintain safe practices by isolating infants and mothers for at least 7 to 14 days, even if the infant remains SARS-CoV-2 negative. During isolation, mothers encourage the expression of milk to maintain milk duct patency and to prepare for lactation when they and their infants are discharged. Infants are fed formula milk by cup feeding with added supplements based on the recommended daily feeding volume for neonates and their appetite during hospitalization. At present, data that indicates COVID-19 could be transmitted from mother to infant postnatally through breastfeeding are insufficient. Major organizations recommend that mothers should breastfeed exclusively for the first 6 months, and thereafter continue to provide their infants with breast milk up until the age of two or beyond. With new findings arising from research, updated information is important to reassure mothers that breastfeeding at home during the COVID-19 pandemic is safe and recommended for both the mother and the infant.",book:{id:"11308",title:"Selected Topics on Infant Feeding",coverURL:"https://cdn.intechopen.com/books/images_new/11308.jpg"},signatures:"Ka-Huen Yip, Mei-Kuen Chow, Yuk-Chiu Yip and Wai-King Tsui"},{id:"81129",title:"Research of Fat Component Safety and Pre-Clinical Evaluation of Infant Adapted Dry Milk Mixtures Physiological Effect",slug:"research-of-fat-component-safety-and-pre-clinical-evaluation-of-infant-adapted-dry-milk-mixtures-phy",totalDownloads:16,totalDimensionsCites:0,doi:"10.5772/intechopen.103069",abstract:"The aim of the study deals with determination of fat component safety and quality key indicators of adapted infant dry milk formulas provided by various manufacturers. The most popular in Russia adapted infant dry milk formulas were selected as study objects. It was found that the qualitative composition of the fat component of dry milk mixtures corresponds to the information placed on the package. However none of the samples under study in terms of the average composition of the prevailing fatty acids fully corresponds to human breast milk. The regulation documents of the Customs Union (TR CU 021/2011, TR CU 024/2011, TR CU 033/2013) establish only the organoleptic evaluation of the adapted breast milk formulas quality indicators. Among the fat component safety indicators only the determination of the peroxide value characterizing the accumulation of primary fat oxidation products. It was also found that the peroxide values of the studied mixtures do not exceed the regulated values. Meanwhile the samples of infant milk food made from dry milk mixtures almost all have unsatisfactory organoleptic characteristics. Defects of taste and smell are associated with the accumulation in the original adapted milk mixtures of a significant amount of secondary products of fat oxidation, which in a biological experiment on animals lead to a decrease in the content of leukocytes and a change of its blood count.",book:{id:"11308",title:"Selected Topics on Infant Feeding",coverURL:"https://cdn.intechopen.com/books/images_new/11308.jpg"},signatures:"Ekaterina Yurievna Volf, Inna Vladimirovna Simakova, Andrey Anatolyevich Terentyev, Aleksandr Sergeevich Fedonnikov, Nina Viktorovna Bolotova, Gloria Vladimirovna Guzeeva and Viktor Veniaminovich Zakrevsky"}],onlineFirstChaptersTotal:4},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. His research interests include Biomedical Signal Processing and Modelling, Assistive Technology, Rehabilitation Engineering, Neuroengineering and Parkinson's Disease.",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",isOpenForSubmission:!0,editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",slug:"luis-villarreal-gomez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",biography:"Dr. Luis Villarreal is a research professor from the Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana, Baja California, México. Dr. Villarreal is the editor in chief and founder of the Revista de Ciencias Tecnológicas (RECIT) (https://recit.uabc.mx/) and is a member of several editorial and reviewer boards for numerous international journals. He has published more than thirty international papers and reviewed more than ninety-two manuscripts. 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His fields of interest are anterior segment disease, keratoconus, glaucoma, corneal dystrophies, and cataracts. His research topics include\nintraocular lens power calculation, eye modification induced by refractive surgery, glaucoma progression, and validation of new diagnostic devices in ophthalmology. \nHe has published more than 100 papers in international and Italian scientific journals, more than 60 in journals with impact factors, and chapters in international and Italian books. 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He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}}]},{type:"book",id:"6843",title:"Biomechanics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6843.jpg",slug:"biomechanics",publishedDate:"January 30th 2019",editedByType:"Edited by",bookSignature:"Hadi Mohammadi",hash:"85132976010be1d7f3dbd88662b785e5",volumeInSeries:4,fullTitle:"Biomechanics",editors:[{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. 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