\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"6813",leadTitle:null,fullTitle:"Cancer Prognosis",title:"Cancer Prognosis",subtitle:null,reviewType:"peer-reviewed",abstract:"Cancer is a DNA disease in which the early stage is represented by the inactivation of suppressor genes and activation of oncogenes, which result in transformed cells that grow out of biological control. Tumor progression is locally favored by mitogenic effects of hormones, or growth factors that stimulate the tumor's growth, or by inducing angiogenesis. The book contains chapters written by experts in the topic, and exhibits current developments in the methodology of cell and molecular biology, which have deeply advanced the understanding of cancer's prevention and prognosis. We hope that it will be helpful for physicians, researchers, and students in life sciences, and will stimulate discussion and research for new therapeutic approaches against cancer.",isbn:"978-1-78984-775-8",printIsbn:"978-1-78984-774-1",pdfIsbn:"978-1-83881-722-0",doi:"10.5772/intechopen.73142",price:100,priceEur:109,priceUsd:129,slug:"cancer-prognosis",numberOfPages:76,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"003e408f4cf707dd4bbf3332fe49eeb0",bookSignature:"Guy-Joseph Lemamy",publishedDate:"December 5th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6813.jpg",numberOfDownloads:4755,numberOfWosCitations:10,numberOfCrossrefCitations:6,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:9,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:25,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 9th 2018",dateEndSecondStepPublish:"March 2nd 2018",dateEndThirdStepPublish:"May 1st 2018",dateEndFourthStepPublish:"July 20th 2018",dateEndFifthStepPublish:"September 18th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"182568",title:"Dr.",name:"Guy-Joseph",middleName:null,surname:"Lemamy",slug:"guy-joseph-lemamy",fullName:"Guy-Joseph Lemamy",profilePictureURL:"https://mts.intechopen.com/storage/users/182568/images/system/182568.png",biography:"Guy Joseph Lemamy, PhD, is currently General Manager of High Institute of Medical Biology at University of Health Sciences, in Libreville, Gabon (Institut Supérieur de Biologie Médicale de L'Université des Sciences de la Santé) Professor at the Department of Cellular and Molecular Biology-Genetics, he also leads the Laboratory of Cellular and Molecular Pathobiology. Dr Lemamy obtained his PhD in Biochemistry and Cell Biology at the Faculty of Medicine, Université Montpellier, France. His PhD thesis concerned the research for new tumor markers in breast cancer led by Medical Research Institute (INSERM U148) in Montpellier, France. Dr Lemamy is the author of many book chapters and journal articles about tumor markers and is involved in other scientific activities in his country Gabon. He is a Member of Scientific Advisory Board of Gabon Scientific Research Guiding Plan and CHEVALIER DES PALMES ACADEMIQUES of International Order of Academic Palms of African and Malagasy Council for Higher Education.",institutionString:"University of Health Sciences",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Université des Sciences de la Santé",institutionURL:null,country:{name:"Gabon"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"428",title:"Cancer Biology",slug:"biochemistry-genetics-and-molecular-biology-oncology-cancer-biology"}],chapters:[{id:"64394",title:"Introductory Chapter: Genes Expression in the Control of Cell Cycle and Their Potential Value in Cancer Prognosis",doi:"10.5772/intechopen.81917",slug:"introductory-chapter-genes-expression-in-the-control-of-cell-cycle-and-their-potential-value-in-canc",totalDownloads:1010,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Guy Joseph Lemamy",downloadPdfUrl:"/chapter/pdf-download/64394",previewPdfUrl:"/chapter/pdf-preview/64394",authors:[{id:"182568",title:"Dr.",name:"Guy-Joseph",surname:"Lemamy",slug:"guy-joseph-lemamy",fullName:"Guy-Joseph Lemamy"}],corrections:null},{id:"61662",title:"The Human Epidermal Growth Factor Receptor 2 (HER2) as a Prognostic and Predictive Biomarker: Molecular Insights into HER2 Activation and Diagnostic Implications",doi:"10.5772/intechopen.78271",slug:"the-human-epidermal-growth-factor-receptor-2-her2-as-a-prognostic-and-predictive-biomarker-molecular",totalDownloads:1695,totalCrossrefCites:6,totalDimensionsCites:9,hasAltmetrics:1,abstract:"The human epidermal growth factor receptor 2 (HER2) is a transmembrane tyrosine kinase receptor protein. HER2 gene amplification and receptor overexpression, which occur in 15–20% of breast cancer patients, are important markers for poor prognosis. Moreover, HER2-positive status is considered a predictive marker of response to HER2 inhibitors including trastuzumab and lapatinib. Therefore, reliable HER2 determination is essential to determine the eligibility of breast cancer patients to targeted anti-HER2 therapies. In this chapter, we aim to illustrate important aspects of the HER2 receptor as well as the molecular consequences of its aberrant constitutive activation in breast cancer. In addition, we will present the methods that can be used for the evaluation of HER2 status at different levels (protein, RNA, and DNA level) in clinical practice.",signatures:"Daniela Furrer, Claudie Paquet, Simon Jacob and Caroline Diorio",downloadPdfUrl:"/chapter/pdf-download/61662",previewPdfUrl:"/chapter/pdf-preview/61662",authors:[null],corrections:null},{id:"60973",title:"Is Melanoma a Hormone-Dependent Cancer or a Hormone-Responsive Cancer?",doi:"10.5772/intechopen.76499",slug:"is-melanoma-a-hormone-dependent-cancer-or-a-hormone-responsive-cancer-",totalDownloads:1044,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Melanoma, a potentially fatal form of skin cancer is on the rise. This review not only underlines the close connection between skin and endocrine system, but also lists evidences from multiple sources epidemiological, clinical, previous in vivo and in vitro studies regarding the involvement of sex steroids in melanoma. Incidentally, clinical studies underscored the involvement of sex steroids in the protective function in melanoma in menstruating females. But, none of these studies identified the sex steroids involved in the protective function in melanoma in menstruating females. The sex steroid involved in this innate protection in melanoma in menstruating females has not been investigated by scientists, though advances have been made in immunotherapy with accompanying side effects. In this context, our in vitro studies on mouse and human melanoma cell lines, along with literature survey, pointed to progesterone as the possible female sex steroid involved in the protective function in melanoma. Based on our findings and previous studies, it is concluded in this review that melanoma is not a hormone-dependent cancer. But, it may be a hormone-sensitive or responsive cancer, as hormones (sex steroids) inhibited melanoma cell proliferation in vitro. This new understanding will help in developing new therapy or target for melanoma treatment.",signatures:"Pandurangan Ramaraj",downloadPdfUrl:"/chapter/pdf-download/60973",previewPdfUrl:"/chapter/pdf-preview/60973",authors:[{id:"182424",title:"Dr.",name:"Pandurangan",surname:"Ramaraj",slug:"pandurangan-ramaraj",fullName:"Pandurangan Ramaraj"}],corrections:null},{id:"61893",title:"CBX4 Expression and AFB1-Related Liver Cancer Prognosis",doi:"10.5772/intechopen.78580",slug:"cbx4-expression-and-afb1-related-liver-cancer-prognosis",totalDownloads:1006,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Background: Previous studies have shown that chromobox 4 (CBX4) expression may involve in the progression of liver cancer, however, it is unclear whether it affects the prognosis of hepatocellular carcinoma (HCC) related to aflatoxin B1 (AFB1).",signatures:"Qun-Ying Su, Jun Lu, Xiao-Ying Huang, Jin-Guang Yao, Xue-Min\nWu, Bing-Chen Huang, Chao Wang, Qiang Xia and Xi-Dai Long",downloadPdfUrl:"/chapter/pdf-download/61893",previewPdfUrl:"/chapter/pdf-preview/61893",authors:[{id:"202142",title:"Prof.",name:"Xi-Dai",surname:"Long",slug:"xi-dai-long",fullName:"Xi-Dai Long"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"8171",title:"Genes and Cancer",subtitle:null,isOpenForSubmission:!1,hash:"209b5cea5cbc980442ef0c22782b3792",slug:"genes-and-cancer",bookSignature:"Guy-Joseph Lemamy",coverURL:"https://cdn.intechopen.com/books/images_new/8171.jpg",editedByType:"Edited by",editors:[{id:"182568",title:"Dr.",name:"Guy-Joseph",surname:"Lemamy",slug:"guy-joseph-lemamy",fullName:"Guy-Joseph Lemamy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5793",title:"Novel Implications of Exosomes in Diagnosis and Treatment of Cancer 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Gordon, MD, developed DeltaRex-G (formerly Rexin-G) from bench to bedside, establishing Cyclin G1 blockade (dnG1, silver bullet) as a singular, pivotal, and strategic locus for applied/targeted cancer gene therapy. Dr. Hall served progressively as Director of Research in the departments of orthopedic, cardiothoracic, and colorectal cancer surgeries at the USC Keck School of Medicine; former President, CEO, and CSO of Epeius Biotechnologies; acting CSO of the Aveni Foundation rescue mission; current partner in Counterpoint Biomedica and Delta NextGene supportive biotechnology firms. 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Topics covered include effects of dietary intake of shellfish in humans, beneficial effects of herbal compounds on the cognitive ability of molluscs, seasonal variation of molluscs acting as intermediate hosts of human parasites, current understanding of freshwater pearl culture, and the role of environmental parameters on the infectivity of freshwater snails and their paleoecological aspects. 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It was Albert Bernhard Frank (1885), a forest pathologist, who for the first time introduced the term mycorrhiza. In the Greek language, “mykes” refers to fungus and “rhiza” refers to root. Since Frank’s description of mycorrhizal association in the 1880s [1], a lot of work has been generated by different investigators as a consequence of which it is estimated that 86% of terrestrial plant species are benefited as they acquire their mineral nutrients via mycorrhizal roots [2]. These groups of fungi establish a symbiotic relationship with the roots of plants, called mycorrhizas. Frank established two large subdivisions of mycorrhizas, ecto- and endomycorrhizas. Ectomycorrhizal fungi form mantle and Hartig network of intercellular hyphae in the roots of forest species. Endomycorrhizas are classified as arbuscular mycorrhizas, ericoid mycorrhizas, arbutoid mycorrhizas, monotropoid mycorrhizas, ectendomycorrhizas, or orchid mycorrhizas [3]. The Arbuscular Mycorrhizal fungi (AM) form arbuscules and vesicles, they are more variable than ECM fungi since they form symbiosis with trees and herbaceous plants. Each of these categories is characterized by the invasion of plant root cells by fungal hyphae but differs in the nature of intracellular hyphal development [4, 5].
Ectomycorrhizal fungi are predominantly
The community of mycorrhizal fungi can be determinant in the structure of the plant community [9]. Therefore, the identification of the mycobiont partner and its functional structure [10] are fundamental to understand the ecological importance of this symbiotic relationship. ECM fungal diversity studies were initially based on studies of fruiting bodies and, more recently, on the direct identification of ectomycorrhizal morphoanatomical characters [11]. Despite recent advances in the use of molecular techniques, there are still many advantages associated with classical methods for studying ECM fungal diversity. For the recognition of fungal relationship and type of mycorrhizal association is advantageous over molecular method [7]. Sometimes morphoanatomical-based taxonomy is not well supported by molecular taxonomy. To overcome such discrepancy, the combined approach of morphoanatomical and molecular characterization of ectomycorrhizas in combination with phylogeny was applied [12].
Most of the cultivated species of edible fungi are saprophytes, and only some of them are ECM fungi [13]. The tickets (
In different forest ecosystems, ECM fungi have been reported to play an important role in seedling survival, establishment, and growth [3, 17, 18]. Researches have confirmed that ECM fungi play a key role in terrestrial ecosystems as drivers of global carbon and nutrient cycles [19].
Some of these traditionally known functions of the ECM fungi on the ecosystem are:
ECM fungi increase the water and nutrient supply plant, extending the volume of land accessible to the plants.
Different fungal species (drought-sensitive hydrophilic or drought-tolerant hydrophobic) can have different effects on hydraulic redistribution patterns [20]. The mechanisms to enhance the acquisition of P by tree mycorrhizal roots are the extension of extramatrical mycorrhizal hyphae, the increase of inorganic P transfer, the increase of inorganic P transporters in the fungus/soil interface, the mobilization of organic P (labile) by emission of phosphatases, and the mobilization of mineral insoluble P by the emission of organic acids (LMWOAs) [21, 22].
The mechanisms of improvement in nitrogen (N) absorption would be the intervention in the mineral N cycle (NH4+, NO3−) and the assimilation of organic N (by emitting proteases, chitinases, and others) [23, 24].
Currently, recent advances in the knowledge of nutrient translocation processes in the fungus-plant and fungus-soil interaction are especially interesting, in particular the priority role of transporters of P, N, and C [25]. The inorganic P and mineral or organic forms of N, such as NH4+, NO3−, and amino acids (AA), are absorbed by transporters specialized located in the fungal membrane in the extraradical mycelium. NH3/NH4+ and inorganic P (from polyphosphates) are imported from the symbiotic interface to the cells of the plant through selective transporters. Transporters of hexoses import carbon of plant origin into the fungus. The nutritional strategies seem to be different between symbiotic and pathogenic fungi, for example, in the translocation of C. Even different transport strategies have been found between ECM symbionts
On the other hand, the ECM colonization of the root can provide protection against soil pathogens [27]. Also, the non-nutritive benefits to plants due to changes in water relations, the level of phytohormones, the assimilation of carbon, etc. have already been verified [3]. The carbon is transferred through the ECM fungal mycelium that connects different species of plants. This can reduce competition among plants and contribute to the stability and diversity of ecosystems [28]. The extraradical mycelium of the ECM fungi provides a direct pathway for the translocation of photosynthesized carbon to microsites in the soil and a large surface area for interaction with other microorganisms [29, 30]. Recently, Hupperts et al. [31] proposed two competing models to explain carbon mobilization by ectomycorrhizal fungi. “Saprotrophy model”, where decreased allocation of carbon may induce saprotrophic behaviour in ectomycorrhizal fungi, resulting in the decomposition of organic matter to mobilize carbon and second, “nutrient acquisition model”, where decomposition may instead be driven by the acquisition of nutrients locked within soil organic matter compounds. Moreover, epigeous and hypogeal sporocarps of ECM fungi are important food sources for placental and marsupial mammals [32]. The ectomycorrhizal roots, the mycelium, and the fruiting bodies of the fungi are important as food sources and habitats for invertebrates [33]. The hyphal networks produced by ECM fungi significantly alter and improve the structure of the soil [34]. In a global way, the ECM fungi improve the plant tolerance to (biotic and abiotic) environmental stresses.
Much of our understanding of the functions of ECM fungi has come from research directed toward practical application in forestry. Some of the most common criteria considered for the selection of a most valued species or strain of ECM fungi (some of them implicit in others) are the abiotic criteria: climatic conditions such as temperature, insolation, and humidity; improvement of soil properties, such as texture and permeability; abiotic soil stress mitigation; soil contamination mitigation; soil metal mobilization; or nutrient cycling. There may also be criteria regarding the host, such as the plant/fungus specificity, the improvement of plant health, or the increase in the biomass of the plant. Finally, there are criteria regarding the fungus, such as abundance, effectiveness, propagules competitiveness, fungus growth rate, or edibility. Other criteria may be the conservation of native biodiversity, the functioning of the ecosystem, human health, food, nutraceutical value, etc. [30, 35].
Since the late 1950s, mycorrhizal fungi were utilized as biofertilizers to promote plant growth, because of their ability to increase the plant uptake of P, N, mineral nutrients, and water [36, 37, 38]. The idea of inoculating ECM fungi on seedlings in plant nurseries was developed by Fortin [39]. Vozzo and Hacskaylo [40] while working on ECM in the United States experimentally demonstrated that field survival and growth of tree seedlings with specific potential ECM enhance the performance of seedlings and contribute to the proper functioning of forest ecosystems.
Although successful inoculation of tree seedlings (already planted) in the field has been known, nursery inoculation is more common. Seedlings inoculated in the nursery can establish a healthy ECM system before planting. The challenge in the controlled synthesis of the ectomycorrhizal symbiosis is to produce a quality mycorrhizal plant, only colonized by the desired fungus. Accurate identification of the inoculum used and avoiding contamination during the growth of the inoculated plants are essential parts of the production process to avoid the introduction of unwanted species and to avoid the mixing of their genetic material with indigenous species [41]. The appropriate selection of suitable plant-host species is essential for the success of mycorrhization [42]. Relatively fast-growing fungi are generally preferred for inoculation because of their short incubation period. Unfortunately, many otherwise desirable ECM fungi grow slowly. According to Marx [43], fresh cultures are preferred to cultures repeatedly transferred and stored for several years. He further suggests passing important fungus cultures through a host inoculation and mycorrhiza formation followed by re-isolation, every few years to maintain mycorrhiza-forming capacity. Moreover, fungi, which produce large hyphal stands of rhizomorphs in the culture of the soil, may be superior in soil exploration and mineral uptake to those which lack rhizomorphic growth. On the other hand, the fruiting of the ECM fungi species is not based solely on the mycorrhizal state of the seedlings. After planting, in addition to the presence of indigenous competitors, the biotic and physicochemical characteristics of the soil also influence the persistence and spread of the cultivated fungus [44]. The type of ECM material used for inoculation can affect the success of a mycorrhizal inoculation program. In addition to remaining viable during storage and transport, the inoculant must also maintain its infectivity for several months after its introduction [45].
There are three main sources of fungal inoculum: soil, spores, and mycelium.
Initially, the soil or humus collected from the mycorrhizal plantation area was frequently used. Its main disadvantage is the lack of control of ECM species in the soil or of microorganisms and harmful germs. Another problem with this type of inoculant is that large amounts of soil are required to inoculate nursery plants. This method is widely used in developing countries, although it is currently discarded in mycorrhization programs. Also, planting mycorrhizal “nurse” seedlings or incorporating chopped roots of ECM hosts into nursery beds as a source of fungi for neighboring young seedlings has been successful [46].
Other sources of inoculum are the spores of fruit bodies collected in the field. The main advantages are that the spores do not require the extension of the aseptic culture and that the spore inoculum is not heavy [47]. Most of the recent research has been with
The most appropriate inoculum is the use of hyphae in a solid or liquid medium or substrate. Hyphae are cultivated mainly from sterile parts of fruiting bodies, less frequently from mycorrhiza due to their low (approx. 5–20%) success rate [48] and rarely from sclerotia [49] or sexual spores [50]. It is considered the most appropriate method since it allows the selection of particular strains of a fungus previously tested for its ability to promote the growth of plants [43]. Many species do grow well in culture, e.g., most species of
The concept of “mycorrhiza helper bacteria” (MHB) was introduced in a “Tansley Review”: Helper Bacteria—a new dimension of mycorrhizal symbiosis [53], which has led to new research in the plant-fungus model system, as for the meaning of these bacteria that promote the formation of mycorrhizas and cause many physiological effects of mutualistic interaction. In general, the ability of some microorganisms to influence the formation and functioning of the symbiosis is known, through activities of various kinds such as the activation of infective propagules of the fungus in presymbiotic stages [54], facilitating the formation of entry points in the root [55] and increase of the growth rate [56]. The MHB improve mycorrhiza formation, although the same MHB can benefit mycorrhization for certain fungi and be negative for others [57]. The above reflects the fungal specificity by isolate, which exemplifies the genetic distance between isolates of different origin.
Among the mechanisms presented by the MHB are:
Promotion of the establishment of the symbiosis by stimulation of the mycelial extension. The germination of spores and mycelial growth are improved by the production of growth factors [58].
Increased contact and colonization root-fungus: increase in the number of lateral roots, mediated by the production of phytohormones [59] and the improvement of radical colonization by induction of flavonoid production [60].
Reduction of the impact of adverse environmental factors on the mycelium of the mycorrhizal fungus. Bacteria can detoxify soils, restoring their conductivity, similarly freeing them from contamination generated by heavy metals [61], and reducing the concentrations of phenolic antagonist compounds produced by the same mycorrhizal fungi [62]. The rhizospheric microorganisms also have an effect on the growth of the plants, reaching a synergistic effect, where the presence of the microfungus and the other microorganism produces an increase in the growth, vigor, and protection of the plant [63]. These effects are based on activities such as the acquisition of nutrients, inhibition of the growth of pathogenic fungi [64], and improvement of the root ramification [65]. In recent years, a potential capacity of bacteria associated with ectomycorrhizas to fix atmospheric nitrogen has been suggested [66]. Several studies suggest a real possibility that the bacteria present in mycorrhizal tissues contribute to the nutritional needs of both the fungus (ascocarp development) and consequently the plants, by providing them with available nitrogen derived from atmospheric nitrogen (N2).
MHB belong to a wide range of genera (
Research in mycorrhizas should, therefore, strive toward an improved understanding of the functional and molecular mechanisms involved in interactions in the mycorrhizosphere, in order to develop ad hoc biotechnology that allows the application of optimized combinations of microorganisms as effective inoculators within sustainable systems of plant production [74].
A polymicrobial formulation containing a diverse mixture of beneficial rhizosphere microorganisms with multiple functionalities is attractive because combining different classes of soil organisms can take advantage of multiple plant growth-promoting mechanisms and could be applied to multiple crops [75, 76, 77, 78, 79]. A key concept in constructing effective polymicrobial multifunctional formulations is the selection and use of a right combination of rhizosphere bacteria and fungi that are mutually compatible, have complementary functionalities, effectively colonize the rhizosphere of the crop(s) of interest, and bring about a synergistic promotion of growth and yield of crop(s) [75, 80, 81, 82]. It is to be expected that well-designed multifunctional formulations such as the one described would be a welcome addition to the fast-growing inoculant enterprises worldwide. Such an inoculant is also expected to be eco-friendly and suitable for organic farming and other integrated production systems, where synthetic fertilizer inputs are not allowed or restricted by law. However, construction of such complex formulations is technically demanding [83].
Ectomycorrhizal fungi exhibit synergistic interactions with other plant-beneficial organisms such as symbiotic N2-fixers. For example, ectomycorrhizal symbiosis enhanced the efficiency of inoculation of two
Also, using plant growth-promoting microorganism (PGPM) strains that form stable and effective biofilms could be a strategy for producing commercially viable inoculant formulations [78, 87]. A majority of plant-associated bacteria found on roots and in the soil are found to form biofilms [88]. Bacterial, fungal, and bacteria/fungal biofilms were suggested as possible inoculants. This is a novel and interesting idea, but to what extent this approach would be practiced remains to be seen [83].
The inoculation of ECM fungi can be done with the objective of producing edible carpophores but also because of its considerable value in forest management; in particular, they have had great importance in reforestation programs where it was expected that the quality and economic productivity of the plantations would increase [89]. The success of the plantations with mycorrhizal seedlings from the nursery depends on their ability to quickly access the nutrients and water available within the soil matrix [90]. The relationships between the various native edible ECM fungi have been, until relatively recently, insufficiently considered in the strategies of forest management [91].
In ectomycorrhizal plantations (productive or conservation reforestations), a consequence of the recognition of the advantages of fungal diversity in ecosystems will be an increase in the refusal to introduce potentially dominant species in mixed communities. On the other hand, unfortunately, it seems that many of those fungi selected for optimal colonization in the nursery have been poor competitors in the field, especially when the planting sites contained indigenous populations of mycorrhizal fungi. There are several possible explanations for the inoculation failure (from the nursery) to produce beneficial effects in the planting sites. Probably, among the most important of these is the inability of inoculum introduced to persist in the roots of the plant after the transfer of the nursery to the field. The soil conditions experienced in the nursery and with the plant growing in a container are very different from those of most of the planting sites; in addition, the raising, storage, and transport of seedlings can reduce the vigor of fine roots and their fungal associates. Species such as
In the restoration of ecosystems, the biofertilization, the bioremediation, and the biocontrol of soil pathogens are prominent roles of the ectomycorrhizal fungi. Degraded ecosystems are the result of a wide range of characteristics and factors related to unfavorable land management or industrial activities. Environmental degradation of the soil is increasing worldwide at an alarming rate due to erosion, acidity, salinization, compaction, depletion of organic matter, and water scarcity. On the contrary, in a healthy ecosystem, there is a balanced microbiota of the soil, in such a way that the potential of pathogenic and mycorrhizal fungi coexists in apparent harmony. Ectomycorrhizal fungi can survive in extreme habitats with high or low temperature [95, 96], salt and metal concentration [97, 98], drought [99], and other circumstances related to the degradation of the ecosystem. The importance of ECM fungi in the balance of the ecosystem can be enormous, since they can be used to increase the tolerance of plants against biotic or abiotic stresses, especially their capacity to fix heavy metals or to degrade a wide variety of persistent organic compounds; to interact with soil bacteria; to attack fungi, bacteria, and pathogenic nematodes; and to improve the vegetative growth and the nutritional status of its symbiont plant.
It has been documented by several authors that mycorrhizal fungi improve the disease resistance of their host plant primarily by direct competition, enhanced or altered plant growth, nutrition and morphology, induced resistance, and development of antagonist microbiota. Direct competition or inhibition is reported to be due to the production and release of antibiotics and physical sheathing by the mantle of ECM [27, 100, 101, 102]. For example, ECM fungi have been shown to protect trees from
Under drought stress, ectomycorrhizal symbiosis has been documented to possess a remarkable capacity to the uptake of water and alter hydraulic properties of plant roots by altering both apoplastic and symplastic pathways and by their impact on plant aquaporins (AQPs) [103, 104, 105, 106]. A symbiosis between plants and ECM fungi has been documented to help plants to cope with salt stress [97, 107, 108, 109]. Li et al. [110] reported that there is ECM fungus-mediated remodeling of ion flux which helps to maintain K+/Na+ homeostasis by increasing the release of Ca2+. Also, ECM fungi have been reported to change the plant phytohormone balance during salt stress [111, 112]. Research efforts are still in progress to select new pioneer symbiotic couples for land reforestation [113].
Till date, most studies have indicated that ECM plants accumulate less metal inside their tissue and grow better than non-mycorrhizal plants when exposed to heavy metal stress [114, 115, 116, 117, 118]. Also, Meharg and Cairney [119] revised potential ways in which ectomycorrhizal fungi might support rhizosphere remediation of persistent organic pollutants (POPs). Krupa and Kozdrój [120] documented the importance of mycorrhizal fungi in forming an efficient biological barrier for checking the movement of heavy metals into the host tissues. Recently, the importance of LMW organic acids and metal chelating agents (such as siderophores) from ECM fungi in the fixation of metal ions and their transmission or not to the root of the host plant has been described [121]. The cellular mechanisms involved in detoxification of heavy metals by mycorrhizal fungi include biosorption of metals to fungal cell wall, chelation of metal ion in the cytosol by compounds such as glutathione and metallothioneins, metal exclusion mechanisms in metal-tolerant ECM fungi, and the compartmentation of metals in the vacuole, where metal ions are probably complexed in a chemically inactive form [98, 118, 122, 123].
The ectomycorrhizal fungi are predominantly
We live in an era in which outcomes, guidelines and clinical trials are at the forefront of medical training. We observe well-trained technological physicians with a reduced humanistic perspective which leads to attitudes that lack ethics and professionalism. It is necessary to overcome the dichotomy that scientific knowledge is objective, while everything that is subjective - of the subject, of the patient - is second-class information. This statement is not only false, but also an obstacle to alleviating suffering [1].
The vocation of doctors is to care for patients. Nevertheless, the frequent dissatisfaction of patients points more to the human deficiencies of medical professionals than to their technical shortcomings. Complexity comes mostly from patients, not from diseases. While technical knowledge helps in solving disease-based problems, the patient affected by these diseases remains a real challenge for the practicing doctor.
There is a growing concern about the human dimension of the future physician and how it can be taught or reinforced in the educational environment [2]. Medical students - often young people learning to be doctors as they develop as human beings- could have their attention captivated by emerging technology. It is up to educators to be attentive to overcome this challenge and facilitate a balance in student’s education, using humanities and culture in general. It is well known that while technical dimension and knowledge grow through training and study, improving attitudes, developing virtues and incorporating values require reflection.
Researchers on this subject [3] comment on the balance that always existed in medicine, between the two inseparable facets that compose it: medicine as science and medicine as an art. The vertiginous scientific advances would require, to maintain that balance, an extension of the scope of humanism, that is, a humanism at the height of scientific progress. And it would be this expansion of humanism, adapted to the current days, in a modern version.
When this humanist update is missing, it falls into a disproportion that is reflected in technically trained professions but with serious human deficiencies. Deformed professionals, with hypertrophy, without balance, who naturally do not conquer the confidence of the patient who expects a balanced doctor. It would be, therefore, a function of the University and the academic institutions, to expand the humanist concept in modern molds, without the aroma of mothballs, knowing how to open horizons and new perspectives. For achieving this goal methodology, systematics, and relearning to do things are required; specially when these things are too many, wrapped in high technology, and commanded by the scientific progress that advances for seconds [4].
The French thinker Gustave Thibon [5] brings together in a volume a set of essays, to which he gives the title “Balance and Harmony.” The balance is the composition of opposing forces, compromise solution, resulting from vectors that cancel each other out. Harmony is the perfect fit of the parts into a whole, so that they collaborate for the same purpose. And, quoting Victor Hugo, he comments: “Above balance is harmony, above the balance is the harp”.
When we look at the actions that seek to humanization - without achieving it - we realize that the mistake is, perhaps, in seeking balance and not harmony. The balance assumes that the forces are antagonistic, that modern science supported by evidence has to be seasoned with humanitarian attitudes such as, for example, hearing the patient’s history with love and feeling compassion. We recognize that this is already enormous progress and an advance on what, unfortunately, we contemplate daily, where the patient is a mere adjuvant that often disturbs the doctor’s practicing. But that balance is insufficient, it lacks consistency. They are still two attitudes that do not mix, like water and oil. The clear water of the evidence, and the comforting oil. But each of them with its density and applied each to its time and in its moment. This “medical performance schizophrenia” is unsustainable in itself, it lasts for a short time, and when the doctor gets tired, he will pay attention to one to the detriment of the other.
Medical science, cutting edge medicine, demands a new humanism [6]. A position that knows how to place liver function and neurological sequelae in the same reasoning, with the meaning of life; transaminases and albumin combined with humiliation, suffering and loss. A science that is an art and therefore manages to place in the same equation dimensions so different, that apparently do not mix. In truth, they are completely mixed in life: prothrombin and discouragement, neurotransmitters and tiredness of living, hepatocytes and indignation.
This seems to be the time to invoke the construction of harmony, and know how to play, with different strings to get the perfect chord. Balance is to assume a monotonic composition, or science, or art, a bit of albumin and measured doses of affection. Harmony is to put each competence in its place and have the soul of an artist to know how to play in the harp of life - of that person who is unique - the strings of different shades. These are the chords that allow the doctor to travel the path between the sick person and the meaning that the disease has for the patient, which is a way of being in life. A way of life that has its own language and must find, in the sensitive physician, the receiver necessary to properly decode the meanings. This implies for the doctor to have an attitude of active anthropology: Humanism and anthropology are possibilities of his self-demand, challenges to his rational thought, levels of knowledge in style and ascending aspiration of nonconformity [7].
Humanism is thus a source of knowledge that the doctor uses for his profession [8]. Knowledge is as important as those acquired by other paths that help you in the desire to take care of the human being who is sick. Humanism in medicine is not a temperamental question, an individual taste, not even an interesting complement. All that would lead to place “humanist attitudes” on the scale, to compensate for the excesses of science. Humanism as harmony, as musical virtuosity is, for the doctor, a true work tool, not a cultural appendix. It is a scientific attitude, weighting, the result of a conscious effort of learning and methodology [9, 10].
The doctor’s inspiration will often come from the cord of compassion that vibrates easily in a heart willing to help. That will be the note that will give the tonality for the further development of its performance, for the harmonic chords of clinical reasoning. Gregorio Marañón, a humanist doctor and a profound connoisseur of this harmonic symbiosis, warns: “The doctor, whose humanity must always be alert within the scientific spirit, must first count on individual pain; and although he is full of enthusiasm for science, he must be willing to adopt the paradoxical position of defending the individual, whose health is entrusted to him, against his own scientific progress” [11].
In this context, the narratives and life stories, now complete and harmonious - transaminases and distresses, albumin and heartbreak - have their true space and function: to approach the human being who suffers and awaits our care. Once more Marañón gives us a reflection in the perfect chord: “On several occasions I noted to those who work by my side, that a pure diagnostic system, deduced exclusively from analytical data, dehumanized, independent of the direct and endearing observation of the patient, it implies the fundamental error of forgetting the personality, which is so important in the etiologies and to stipulate the prognosis of the patient and teach us doctors what we can do to alleviate their sufferings” [11]. We know well from our own experience how difficult this harmony of action is: how to govern technique and humanism with expertise so we can offer a true symphony of health care [6].
The first step that the doctor must take if he wants to humanize medicine is admitting that he must humanize himself first. And for this, he cannot give up his efforts to reflect, to look for solutions and find resources that allow him to integrate technical science - which grows every second - with the humanism that medical practice requires [12].
Hans Jonas, with his ethics of responsibility [13], points out that what distinguishes human beings from animals is a tripod constituted by the tool, the image and the tumulus. The tool is the technique, and in this there is no doubt that we distinguish ourselves from animals, because when we are born, we quickly incorporate all the techniques accumulated in the history that precedes us. Animals lack a scientific heritage, and each one has to be built from scratch, without taking advantage of the experiences of the ancestors of their species. We can evoke Ortega [14] when he says that the current tiger is the same tiger of thousands of years ago, and that only the human being is born on a history that precedes him, the history that sets together with the technique and the corresponding progress.
The second element that distinguishes us from animals is the image, which includes the ability that mankind has to represent reality through art. Art and humanities are ways to better know the reality in which the human being is immersed and to know himself, in his bodily and spiritual dimension. Finally, the third leg of the tripod is represented by the tumulus. Only the human being has an awareness of transcendence, and the representation of death is what puts him in contact with a dimension that extends beyond his own being.
It is not difficult to conclude that if, as far as technique and progress are concerned, being noticeable the distance between mankind and animals, the other two elements of the tripod have been atrophied; and if not for that reason we necessarily become animalized, there is no doubt that the human equilibrium presents itself with dangerous instability. The man – the doctor, in the case at hand – stops frequenting the arts and humanities and deprives himself of ways of knowing the world; loses the ability to admire and feel that most of the phenomena that surround him are independent of him. And, not least, he loses the sense of transcendence, the spiritual dimension, the sense of eternity and the duration of time around him and his own. The consequences are alarming, because of not frequenting “the tumulus, door of transcendence” it becomes difficult to maintain the sense of mission, and the need to feel useful in this world, as part of the happiness we pursue. This reflection opens the way to the next point: the necessary contingency of the human being, surrounded by suffering and death.
Empathy, a Greek word that implies understanding the feelings of another, came to the English language to designate the perception that someone has when contemplating a work of art. Only later, from 1918 onwards, Southard incorporates it into the scenario of the doctor-patient relationship as a tool that facilitates diagnosis and treatment [15]. Empathy has to do with deeply understanding the other and is a path to bridge scientific knowledge with compassion for better caring.
Empathy, one of the most studied humanistic attitudes today, is the cornerstone of ethical and humanized behavior and medical professionalism. Empathy has also been considered an essential element in any humanization strategy [16]. It is a personal quality necessary for understanding the inner experiences and feelings of patients. It represents the essence of the doctor-patient relationship. Developing meaningful interpersonal relationships between patients and physicians is important even for improving clinical outcomes [17].
Before entering the concept of empathy in the context of the patient- physician relationship, it is worth pausing to understand the term from a philosophical point of view. In this field, we cannot fail to cite the work developed by Edith Stein (1891 – 1942), a philosopher who developed his doctoral thesis on empathy. Macintyre [18] in his book on the philosophical action of Edith Stein comments that an essential feature of empathic awareness is the awareness of the feelings of others. The relationship we have with the feelings of others is analogous to the relationship we have with our own past feelings. We may notice what the other is feeling, but we do not have to feel the same as him/her. The same is true when we remember our own feelings - even clearly - does not mean that we will feel the same way we have in the past. A deep understanding, real understanding, but no need to incorporate it. We can fully understand what we feel on one occasion, but we do not have to feel it equally at this time.
It takes caution to state that “I am putting myself in another’s shoes.” Yes, it is possible to do so, but with our own patterns (our feelings, our reactivity, our understanding of vital reality, our own biographical history) and not his own, so that I cannot truly understand. It is not enough to put ourselves hypothetically in the other’s place and continue to be ourselves experiencing this place in which I place myself. One must also be detached from one’s own standards to arrive at empathic knowledge. Regarding this perspective, Stein reminds us that empathy is not simply intuition, but an attitude that requires reflection, to turn back and again on ourselves and others, a course that enriches one’s own and others’ knowledge. It is not a spasm of knowledge, but something worked.
In the context of medical education, the concept of empathy has a broad and varied spectrum. Some authors consider empathy to be a predominantly cognitive quality: it would encompass an understanding of the patient’s experiences and concerns combined with communication skills [19]. Irving and Dickson [20] define it as an attitude that contemplates behavioral ability along with the cognitive and affective dimensions.
Most authors place empathy on the affective dimension, giving it the ability to experience the other person’s experiences and feelings. In this case, it can be deduced that the ability to be empathic implies a spontaneous feeling of identification with the suffering person, a process in which emotion is involved.
Most of the authors with an affective-oriented approach presuppose that, during the empathic event, there is something that can be characterized as a partial identification of the observer with the observed. This aspect also becomes clear especially in Carl Rogers’ definition, which describes empathy as being the ability “to sense the client’s private world as if it were your own, but without losing the ‘as if’ quality”. According to this definition, the differentiation between one’s own experience and the experience of another is the decisive criterion for defining effective empathy [21].
It is necessary to distinguish empathy from sympathy [22] because this distinction, which is not just semantic, has important consequences in the doctor- patient relationship. The patient’s emotions, which must be addressed, cannot become an obstacle to care. On the other hand, a sympathetic doctor may lack objectivity and professionalism. Empathy leads the physician to consider the quality of the patient’s emotional experience, while simple solidarity focuses more on the intensity and quantity of suffering. Researchers conclude that empathy does not need limits, while sympathy does need to be moderated [23].
It is not easy to separate the emotional from the cognitive components that make up empathy. Even so, two conclusions can be drawn from this difficult navigation in the definitions and components of empathy. The first is that an excessive preoccupation with oneself (of the subject who intends to act empathically) is an obstacle to helping others [24]. It is necessary to detach from the image itself to understand the other and understand him as “another me”. The second conclusion is that empathy could be an element of this necessary bridge to unite evidence-based medicine with patient-centered medicine. A personalization resource with broad diagnostic and therapeutic potential.
The question that arises at this point is whether it is possible to teach empathy, and what would be the teaching-learning process of this attitude [25, 26].
It is worth remembering a classic study [27] designed to help choose candidates for medical schools, which emphasizes that those who have the potential to be good doctors, and not simply good students, should be chosen. In this way, 87 characteristics of a good doctor were classified, and classified according to the importance and ease of teaching-developing this characteristic. In this way, what the authors call the NTII was arrived at, an index that combines these two variables.
Thus, important and necessary characteristics for an excellent doctor are pointed out, which are very difficult to teach in medical school, or in further training. At the top of the list -important and difficult to teach characteristics- appear factors related to empathy: understanding of people, concern for others, idealism and compassion, service capacity, ability to persevere in difficulties with resilience, learning to establish priorities in care. All of these factors are important, but very difficult to teach - at least with the resources employed today in medical education.
Some neurophysiological studies provide some clues [28, 29] to resolve the dilemma of how to teach something that is difficult to teach. This is the case of empathy that can be fostered through examples. The so-called mirror neurons in the brain are involved in certain actions related to behavior and emotions. Contemplating another’s attitudes, mirror neurons somehow evoke those same attitudes and emotions [30]. It is the simple case of children who, without having a clear perception of their own emotions, end up mirroring the emotions they contemplate in their parents. In this way, the example -of the teacher, the doctor preceptor- is a resource to provoke empathy in the student. Something is known, but now it has a neurophysiological basis [31, 32]. The mechanism of functioning of mirror neurons can be considered a prerequisite for empathy [33].
Several questions arise here: would not “imitated” empathy be something artificial that the patient perceives as such? Wouldn’t this attitude end up being summarized in a checklist of routines that a physician must follow to build an empathetic attitude? The student’s own experiences -which are even more powerful than a simple example- would be a condition for growing in empathy. In other words: is it necessary for a physician to go through personal and family suffering to be empathetic with the patient’s suffering?
The experiences and biographical experiences are an important resource in medical education, when well used. Also, the example that promotes reflection and the construction of attitudes. Thus, establishing an educational setting where examples and experiences have space to be assimilated through reflection and facilitated discussion, seems to be a favorable resource to foster empathy. This model, which is classic -seeing doing, seeing acting, incorporating the example- is what is called Tag Along. A resource that has always been used, and that now, with modern communication tools, runs the risk of falling into oblivion. It must be rescued with a modern perspective. Along with this example-learning model, the experiences can be amplified through the arts. Humanistic education, cultural foundation, is necessary to promote those characteristics difficult to teach by traditional pedagogical methods. Literature, poetry, music, cinema bring resources that evoke experiences in students and allow for reflection [34].
Beside tag-alongs, some authors emphasize the importance of art, literature, cinema and reflecting over one’s own life in developing empathy [35]. To give an example, it is worth quoting a literary classic about a rural doctor, (A Fortunate Man) [36] where empathy is magnificently described under the name of recognition: “The task of the doctor is to recognize the man. (..) I am fully aware that I am here using the word recognition to cover whole complicated techniques of psychotherapy, but essentially these techniques are precisely tools for furthering the process of recognition. (..) To treat the illness fully, the doctor must first recognize the patient as a person. Good general diagnosticians are rare, not because most doctors lack medical knowledge, but because most are incapable of taking in all the possible relevant facts – emotional, historical, environmental as well as physical. They are searching for specific conditions instead of the truth about a patient which may then suggest various conditions. (..) A good doctor is acknowledged because he meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognizes them. Sometimes he fails, but there is about him the constant will of a man trying to recognize”.
Role modeling, giving the right example to follow, caring carefully for the emotional dimension of medical students and for that using arts and humanities are possible resources for preventing the erosion of empathy. Because, at the end, is not just about to teach how to be empathetic -people that enter in a medical school already have quite a degree of empathy- but, mainly, to prevent of losing empathy through the so-called educational process that in many cases lacks this perspective [37, 38].
While teaching ethics requires establishing rules, guidelines and rational decisions, creativity and recognizing the role that emotions play in decision-making are also required. The educator has, therefore, to go beyond protocols and to have the creativity for bringing together objective guidelines, prudence, and wisdom, as well as incorporating the affective dimension. It is not possible to ignore emotions because they get involved in the decisions that ethical dilemmas imply. Furthermore emotions, when properly handled, become an essential tool. Therefore, opening space to share emotions in an environment with pedagogical support is to pave the way for a true education of affectivity that will transform into better patient care [39, 40].
Fostering reflection is a permanent objective for educators who intend to go beyond the simple transmission of knowledge. Creating favorable environments for joint reflection allows us to get to know the students better, personalize teaching by adapting it to each one, and implement the pedagogical excellence that knows how to unite intellectual creation with the art of teaching. Art is necessary for dealing with the student’s unexpected questions. The humanities help to polish this artistic dimension of medical education [41].
To care implies comprehending the human being and the human condition and for this endeavor, humanities and arts help in building a humanistic perspective of doctoring. Humanities must be included in medical education, not as a simple appendix or a dilettantism, but with the same emphasis as teaching internal medicine, differential diagnosis, or complex case discussions. They are a tool that educates physicians, understanding the patient as a whole -as the person’s own unit- to provide the best care for that specific patient [42].
A doctor without humanism would be nothing more than a mechanic of people. To provide effective care, it is essential to incorporate the human dimension into medical practice [43]. This is the role of the humanities that bring the necessary balance to the reductionism related to positive science. Approaching the patient only with “technical objectives” resources will possibly lead to inefficiency in care. Technical progress requires constructing a new, modern, updated medical humanism to provide the necessary balance [44].
When incorporated into medical education, the arts and humanities allow us to approach human emotions, both patient and physician. The humanities make us think about the human being, about illness, about terminality, about transcendence. They lead us to reflect on the attitudes necessary to build professionalism and ethics in medical practice. The wide variety of issues raised with pieces of art, film clips, songs, and music, intuitively help in the decision that involves complex moral choices. As a well-known researcher put it, “the humanities are like the midwife who helps in the birth of human experience, with its mysteries and its certainties”. When cinema, poetry, music is used, student’s emotions arise easily, and teachers can take advantage of this scenario to broaden perspectives and educate affectivity. The characters that appear in the performing arts, and the values they carry, impact as an example, they are a learning path. Being attentive to the awakening of emotions in students is an expression of affection and love from the teacher, which strengthens learning more than a theoretical model [45].
Typically, students’ emotions precede concept construction. Affective intuition precedes emotion. First, the heart gets involved, then the rational process helps to build learning. This is the normal path, in medical education and in life, to assimilate sustainable concepts and values. But this does not mean that teaching should be limited to simple emotions [46]. Students, who are usually immersed in a culture where feelings and visual impact prevail, awaken to learning that, later, will be solidly leveraged, through the necessary reflection. Emotions are thus the gateway to learning processes, a shortcut, a runway for higher educational flights [47].
The arts and humanities, impregnated with narratives, arouse emotions, and prepare the ground for the transmission of concepts. Using students’ empathetic language, moving in the familiar terrain of the emotions that the student feels, acts as a facilitator that allows to provoke reflection and suggest attitudes. The teacher’s role is that of a catalyst for the process that takes the student from emotions, through reflection, to incorporate attitudes and values.
The teacher’s role is to identify emotions and then stimulate reflection. Based on this experience of reflected emotion, it is possible to generate attitudes that modulate behavior [48]. Through an environment that allows for reflection, the development of qualities that will enrich personal development becomes possible.
On the other hand, teachers also use emotions - although little time and space are left to discuss them. When this reflective environment is provided among teachers -a faculty development scenario-, joint reflection leads to improving teaching methods and understanding with the students themselves [49]. Teacher meetings are often monopolized by addressing problems, and problematic students. Little time remains to reflect and help each other, and thus build resources for better teaching performance. Here, too, the medical humanities are an effective resource. After all, any process that aims to humanize medical education must include reflection at all levels, both among professors and students, in addition to facilitating the environment and making time for this reflection to be regular and fruitful [50].
A predominantly biomedical focus attributed to teaching and practice in health sciences contributes to a dehumanization process. Any strategy that intends to address the issue depends on the presence of well-educated health professionals from both the technical and humanistic points of view. The greatest deficits concern humanistic education. Research about the effectiveness of using narratives as a didactic resource in humanistic education points out issues related to the concealed curriculum and the importance of medical students’ exposure to a patient-centered teaching model that gives priority to ethical reflections [51].
It is true that narratives are an important educational topic in the context of Medicine. Narrations, life stories, allow us to contemplate the patient’s world, meet him as a person, so that we can take care of him in a competent manner. There is also a tendency to think that the narrations are just a complement to positive science, which is not possible to measure with laboratory results. Thus, it would be just a methodology that broadens a way of aiming to reach out to the person, and focus on her care, without deterring the illness that affects her. That perspective takes the risk of being “complementary”, that is, the soft edge of what really matters. The dissociation between science and art remains, as two forces that act synergistically, but in parallel, and therefore never found themselves. The medical action that would fall would be condemned to these complementary positions, in which competency and compassion never meet.
Medicine as Art recognizes that each patient is unique. Not only from the perspective of the disease that attacks him/her, but in the way that pathology “becomes incarnate and concretized”: this is an illness, being sick [52]. The disease is always personalized, installed in someone who will become sick “in their own way”, according to their personal being. A bifocal perspective is necessary, which manages to unite in artistic symbiosis the attention to the disease - with all the technical evolution - and to the patient who feels sick – with the vital understanding that entails. This is a person-centered medical performance, simultaneous exercise of science and art [53].
Listening carefully is a skill that the doctor needs to heal [54]. This requires the rescue of the ancient resources of medical art [55]. Patients show subtle clues about their experience with the condition, but doctors often ignore them because we hear only “the voice of medicine” and have trained us to ignore the emotional side, that is, the “voice of the patient’s life.” [56].
Already in the middle of the twentieth century, Gregorio Marañón [11]– paradigm of art and science – warned of the danger of using purely technical tools without knowing the patient, without listening carefully, without really caring about him: “It must be admitted that ordinary medicine is usually reduced, or to problems that are easy to solve, or completely insoluble for the most gifted man of wisdom. The fundamental thing in any case is that the doctor be with his five senses in what he is, and not thinking about other things.” When the doctor sits and listens to the patient, he is communicating a humanistic attitude for excellence. Today we have sophisticated technology - important - but we are losing the pleasure of sitting down and hearing narratives of life. We lack chairs or, perhaps, patience to sit and listen.
A well-known researcher in medical humanities quotes: “we are midwifing a medicine that makes contact with the mysteries of human experience along with its certainties—a medicine that appreciates the deep beauty of health, the silence of health, the wisdom of the body, and the grace of its genius. It is an arch to far times and places, a site for all the living and the dying that go on; it is a link to what it means to be human” [57].
Teaching through humanities includes several modalities in which art is involved [58]. Literature and theater [59], poetry [60], opera [61] are all useful tools when the goal is to promote learner reflection and construct what has been called the professional philosophic exercise [62]. Teaching with movies is also an innovative method for promoting the sort of engaged learning that education requires today [63, 64]. For dealing with emotions and attitudes, while promoting reflection, life stories derived from movies fit well with the learners’ context and expectations. Teaching with films engages the emotions and could serve as a great launching point for discussions of both the emotions and ethical scenarios [65, 66, 67]. The crucial role of teaching is to help frame these discussions in such a way as to foster reflective practice among clinicians and clinicians-in-training.
A film is the favored medium in our current culture, teaching with cinema is particularly well-suited to the learning environment of medical education. Cinema is the audiovisual version of the narrative, framed in emotions and images. A reality very close to the language of the student who is inserted in this emotional and visual culture and which makes it easier for him to enter the world of his interlocutor: the patient, with all the circumstances that surround him.
We know of the pedagogical power of narratives, something secular that comes from classical Greece, where stories were resources to teach ethics and values [68]. Cinema, illustrating stories in a modern way, helps to expand life experiences, to get to know the human being. On the other hand, film stories act as a catharsis of emotions - something that Aristotle already warned with stories in Greek education. Emotions are revealed, brought out, and capable of being sorted, educated, through reflection. This is the core of the use of cinema in the education of affectivity.
Cinema provides a fast and straightforward teaching setting [69]. The scenes suggest important issues, emotions appear, students can better understand the universe of affection, which is often tumultuous. It is common for them to transport the projected scene to their own reality, to their own lives, because they act as an emotional wake-up call that evokes daily realities, not only from the medical learning environment, but from life itself. And in the same way, the experiences they have in the pedagogical environment with cinema are then taken to their daily lives, as a resource that helps to remember all that learning. Cinema, therefore, works as an emotional alarm that facilitates the student’s posture in analogous situations they face in their daily lives.
For teaching ethics, we can follow the rational method, approaching the theoretical basis to refine attitudes, acquire virtues and incorporate values. But this classic method of medical deontology classes finds an alternative path when using films. In cinema, the examples are accompanied by a strong emotional charge, leading the viewer to accept or reject that attitude presented. Reflection also accompanies this experience; and from reflection comes the desire to incorporate an attitude, not just intellectually, but beginning from emotions as a starting point. When individual reflections are amplified by facilitated discussion, the motivations, and incentives in the construction of ethics also grow in the group of students.
This learning scenario stimulates learner reflection. In life, important attitudes, values, and actions are taught using role modeling, a process that impacts the learner’s emotions. Since feelings exist before concepts, the affective path is a critical shortcut to the rational process of learning. While technical knowledge and skills can be acquired through training with a little reflection, reflection is required to refine attitudes and incorporate values. As already explained, this methodology with the cinema does not intend only to provide “sentimental, emotional education”, but to provoke reflection that leads to incorporating attitudes. Reflection is, without a doubt, the bridge that allows the transition from emotions to attitudes. This universe is not limited to the solution of purely medical issues, but it reaches out to life, awakens desires for integrity. Education with cinema does not intend to offer results - something like the moral of the fable, to show the right way to behave - but rather to provoke the reflection that leads to lasting attitudes [70]. To foster reflection is the main goal in this cinematic teaching set. The purpose is not to show the audience how to incorporate a particular attitude, but rather to promote their reflection and to provide a forum for discussion. And this works for any kind of audience, despite cultural background or language [71].
This is possible when reflection and discussion are allowed in the pedagogical environment where cinema is instituted. Doubts and dilemmas often emerge about the professional role, ethical attitudes, reporting of good examples – and some that are not edifying- for which the student usually does not have space in the curriculum. It is precisely this attitude, thinking and reflecting relentlessly, and not giving in to mediocrity, that Hannah Arendt suggested as prevention so as not to fall into the banality of evil [72].
Film education is also useful for continuing training with doctors, so that they learn to deal with their own emotions. Little attention is paid -both in the undergraduate and graduate curriculum space- to the education of emotions. When emotions -especially negative ones- are not ventilated and dealt with, the most common is to assume an attitude of emotional closure with the patient, a distance that leads to a lack of competence in care and destroys professionalism [73].
Cinema offers a wide range of possibilities for learning to deal with negative attitudes and values. Without necessarily solving dilemmas, it offers the opportunity to reflect calmly, with emotional detachment. The film allows us to go beyond illustrations of theories and principles so that we can develop a range of emotional and interpretive skills, including habits of the heart. Discussions among colleagues are exciting and enriching that make us reflect on who we are and who we want to be [74].
In this sense, film, like art, can affect the root of our being. Using film clips in a structured way allows for new opportunities in ethics education. Here comes the specific methodology using movie clips.
Which movies are useful for teaching this or that point? This is a common question people ask. The answer could be something like this: “What you get out of a film often depends upon what you bring to it”. Useful movies for teaching whatever you want, are those that are valuable to you, those that touched you and lead you to reflect. I can share what movies touched me and why, but I am not able to say what will impress you and be part of your life. When a movie seems remarkable for the educator, we always find a way to incorporate our teaching set. So, you need to build your own experience before sharing it with your audience. Keep in mind what you want to teach, the specific ethical dilemma.
Although, in education with cinema some use medical films-as a case discussion- it is not the usual pedagogical resource that we are discussing here [75], Our goal is to go beyond the medical scene to immerse into the human reality, where attitudes, emotions and responses emerge. Therefore, it is not medical-themed films that we have used the most in our pedagogical scenario. However, the “translation” of human problems to the medical environment is done with enormous facilities by students.
Do you use a whole movie or just some scenes? Here comes another usual question. The answer depends on what you want to point out, the time you have at your disposal, and the outcomes you expect. Our experience affirms the effectiveness of using the movie-clip methodology in which multiple movie clips are shown in rapid sequence, along with facilitator comments while the clips were going on [76]. Using clips with scenes from different movies is, in our experience, more profitable than projecting entire movies. Besides, the time available is not always a lot. With a few minutes, it is possible to raise many questions, all saturated with emotions, when the clips are used with agility. The facilitator’s comments enhance the reflection, amplifying it. They are not an obstacle to following the scenes presented, but, in our experience, they function as a resource that facilitates shifting the reflection from the clip’s report to life itself. As someone in the audience once commented: “the comments are not about the film, nor about the teacher’s experience… It’s something that goes in between and touches our lives”.
The comments are not sought for student agreement, but only intended to provoke individual reflection. In essence, the facilitator’s comments are their own reflections made aloud.
The most used resource in our experience are scenes from different films, with varied themes, which when presented together provoke a real flood of emotions. They are not projected according to a thematic background, but varied, showing a wide spectrum of attitudes. The joint reflection and discussion about this collection of scenes are what causes the real learning. Several previous publications have covered the methodology in detail, and the appendix of many of them contains a list of films, with suggested scenes to be used and comments [77].
Proving the effectiveness of this methodology is something that often arises in the academic community, especially in international congresses and various presentations. It should be remembered that excellent education does not imply measuring -with the usual metrics- all pedagogical tools. It is known that many of the so-called “intangible themes” are difficult to assess, although it is possible to see the results. Thus, themes such as empathy, ethics, compassion, and commitment -which are factors of professionalism- can be pointed out and promoted with the resource of education with cinema. Without a doubt, esthetic education -this is the core of the humanities- necessarily completes the education of physicians. They are, in Pascal’s words, “the reasons of the heart, which reason is not capable of understanding”.
In cinema education, the educational outcomes do not materialize simply from watching movies. People attend cinema all the time and see the same scenes, and while they might have similar emotions, the reflective process is lacking. This is where the competence and the teaching skills of the facilitator come into play, that is by putting all the scenes together and fostering reflection through comments and personal thoughts, even as unanswered open questions are introduced. That is the teacher’s role.
There is still a remaining question. Does this movie teaching methodology depend on the charisma of the presenter or can it be well developed by anyone? There is no definitive answer. All we can say is: if you love movies, if you like to teach deep from your heart you deserve to try this. Try it and wait for the surprises!
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Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. 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In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. Her knowledge of English is at an advanced level.",institutionString:null,institution:null},{id:"332914",title:"Dr.",name:"Muhammad Saad",middleName:null,surname:"Shaikh",slug:"muhammad-saad-shaikh",fullName:"Muhammad Saad Shaikh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jinnah Sindh Medical University",country:{name:"Pakistan"}}},{id:"315775",title:"Dr.",name:"Feng",middleName:null,surname:"Luo",slug:"feng-luo",fullName:"Feng Luo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sichuan University",country:{name:"China"}}},{id:"423519",title:"Dr.",name:"Sizakele",middleName:null,surname:"Ngwenya",slug:"sizakele-ngwenya",fullName:"Sizakele Ngwenya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419270",title:"Dr.",name:"Ann",middleName:null,surname:"Chianchitlert",slug:"ann-chianchitlert",fullName:"Ann Chianchitlert",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419271",title:"Dr.",name:"Diane",middleName:null,surname:"Selvido",slug:"diane-selvido",fullName:"Diane Selvido",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419272",title:"Dr.",name:"Irin",middleName:null,surname:"Sirisoontorn",slug:"irin-sirisoontorn",fullName:"Irin Sirisoontorn",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"355660",title:"Dr.",name:"Anitha",middleName:null,surname:"Mani",slug:"anitha-mani",fullName:"Anitha Mani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"355612",title:"Dr.",name:"Janani",middleName:null,surname:"Karthikeyan",slug:"janani-karthikeyan",fullName:"Janani Karthikeyan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"334400",title:"Dr.",name:"Suvetha",middleName:null,surname:"Siva",slug:"suvetha-siva",fullName:"Suvetha Siva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"334239",title:"Prof.",name:"Leung",middleName:null,surname:"Wai Keung",slug:"leung-wai-keung",fullName:"Leung Wai Keung",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Hong Kong",country:{name:"China"}}}]}},subseries:{item:{id:"10",type:"subseries",title:"Animal Physiology",keywords:"Physiology, Comparative, Evolution, Biomolecules, Organ, Homeostasis, Anatomy, Pathology, Medical, Cell Division, Cell Signaling, Cell Growth, Cell Metabolism, Endocrine, Neuroscience, Cardiovascular, Development, Aging, Development",scope:"Physiology, the scientific study of functions and mechanisms of living systems, is an essential area of research in its own right, but also in relation to medicine and health sciences. The scope of this topic will range from molecular, biochemical, cellular, and physiological processes in all animal species. Work pertaining to the whole organism, organ systems, individual organs and tissues, cells, and biomolecules will be included. Medical, animal, cell, and comparative physiology and allied fields such as anatomy, histology, and pathology with physiology links will be covered in this topic. Physiology research may be linked to development, aging, environment, regular and pathological processes, adaptation and evolution, exercise, or several other factors affecting, or involved with, animal physiology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/10.jpg",hasOnlineFirst:!1,hasPublishedBooks:!1,annualVolume:11406,editor:{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"306970",title:"Mr.",name:"Amin",middleName:null,surname:"Tamadon",slug:"amin-tamadon",fullName:"Amin Tamadon",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002oHR5wQAG/Profile_Picture_1623910304139",institutionString:null,institution:{name:"Bushehr University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón",slug:"juan-carlos-gardon",fullName:"Juan Carlos Gardón",profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",institutionString:"Catholic University of Valencia San Vicente Mártir, Spain",institution:null},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",institutionString:null,institution:{name:"Miguel Hernandez University",institutionURL:null,country:{name:"Spain"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",institutionString:null,institution:{name:"Alexandria University",institutionURL:null,country:{name:"Egypt"}}}]},onlineFirstChapters:{paginationCount:14,paginationItems:[{id:"82103",title:"The Role of Endoplasmic Reticulum Stress and Its Regulation in the Progression of Neurological and Infectious Diseases",doi:"10.5772/intechopen.105543",signatures:"Mary Dover, Michael Kishek, Miranda Eddins, Naneeta Desar, Ketema Paul and Milan Fiala",slug:"the-role-of-endoplasmic-reticulum-stress-and-its-regulation-in-the-progression-of-neurological-and-i",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Endoplasmic Reticulum",coverURL:"https://cdn.intechopen.com/books/images_new/11674.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"80954",title:"Ion Channels and Neurodegenerative Disease Aging Related",doi:"10.5772/intechopen.103074",signatures:"Marika Cordaro, Salvatore Cuzzocrea and Rosanna Di Paola",slug:"ion-channels-and-neurodegenerative-disease-aging-related",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Ion Channels - From Basic Properties to Medical Treatment",coverURL:"https://cdn.intechopen.com/books/images_new/10838.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"81647",title:"Diabetes and Epigenetics",doi:"10.5772/intechopen.104653",signatures:"Rasha A. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. 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