Impairment of functional health in prostate cancer.
\\n\\n
These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\\n\\n\\n\\n\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\n\n\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:"10356",leadTitle:null,fullTitle:"Natural Medicinal Plants",title:"Natural Medicinal Plants",subtitle:null,reviewType:"peer-reviewed",abstract:"This book, Natural Medicinal Plants is a comprehensive overview of drugs derived from medicinal plants and their use in treating human illnesses such as cancer. Chapters include scientific evidence on flora rich in active ingredients.",isbn:"978-1-83969-276-5",printIsbn:"978-1-83969-275-8",pdfIsbn:"978-1-83969-277-2",doi:"10.5772/intechopen.91542",price:139,priceEur:155,priceUsd:179,slug:"natural-medicinal-plants",numberOfPages:302,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"943e56ccaaf19ff696d25aa638ae37d6",bookSignature:"Hany A. El-Shemy",publishedDate:"May 11th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/10356.jpg",numberOfDownloads:4298,numberOfWosCitations:0,numberOfCrossrefCitations:6,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:13,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:19,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 6th 2020",dateEndSecondStepPublish:"December 4th 2020",dateEndThirdStepPublish:"February 2nd 2021",dateEndFourthStepPublish:"April 23rd 2021",dateEndFifthStepPublish:"June 22nd 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"54719",title:"Prof.",name:"Hany",middleName:null,surname:"El-Shemy",slug:"hany-el-shemy",fullName:"Hany El-Shemy",profilePictureURL:"https://mts.intechopen.com/storage/users/54719/images/system/54719.jpg",biography:"Prof. Hany A. El-Shemy received a Ph.D. in Biochemistry from the University of Cairo, Egypt, and a Ph.D. in Genetic Engineering from the University of Hiroshima, Japan. He holds two patents and has written thirteen international books. He has also published more than 100 SCI journal papers and 55 conference presentations. Dr. El-Shemy was a technique committee member as well as chair of many international conferences. He has also served as editor for journals including PLOS ONE, BMC Genomics, and Current Issues in Molecular Biology. He has received several awards, including state prizes from the Academy of Science, Egypt (2004, 2012, and 2018), the Young Arab Researcher prize from the Shuman Foundation, Jordan (2005), and Cairo University Prizes (2007, 2010, and 2014). He served as an expert for the African Regional Center of Technology, Dakar, Senegal, as well as a visiting professor at Pan African University, African Union. He served as vice president of the Academy of Science and Technology, Egypt, from 2013 to 2014. Since 2014 he has been the dean of the Faculty of Agriculture, Cairo University. In 2018, he was elected a fellow of the African Academy of Science.",institutionString:"Cairo University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"13",institution:{name:"Cairo University",institutionURL:null,country:{name:"Egypt"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"991",title:"Herbalism",slug:"herbalism"}],chapters:[{id:"78514",title:"Natural Products Altering GABAergic Transmission",doi:"10.5772/intechopen.99500",slug:"natural-products-altering-gabaergic-transmission",totalDownloads:156,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Gamma-amino butyric acid (GABA) is a major inhibitory neurotransmitter found in several regions of the brain and known to have various significant physiological roles as a potent bioactive compound. Malfunction of GABAergic neuronal signaling prompts to cause severe psychiatric symptoms in numerous mental disorders. Several drugs are available in clinical practice for neuropsychiatric disorders targeting through GABAergic pathway, with notable adverse effects. Interestingly, in recent years, researchers are focusing on natural compounds altering GABAergic neurotransmission for various psychiatric disorders due to its wide range of therapeutic efficacy and safety. The enormous variety of natural compounds, namely alkaloids, flavonoids, terpenoids, polyacetylenic alcohols, alkanes and fatty acids were reported to alter the GABAergic transmission through its receptors and or by influencing the transmission, synthesis and metabolism of GABA. Natural compounds are able to cross the blood brain barrier and influence the GABA functions in order to treat anxiety, mania, schizophrenia and cognitive disorders. Therefore, this current chapter describes on natural products which have the potential to alter the GABAergic neurotransmission and its therapeutical benefits in treating several neuropsychiatry disorders using various pharmacological methods.",signatures:"Sayani Banerjee, Chennu Manisha, Deepthi Murugan and Antony Justin",downloadPdfUrl:"/chapter/pdf-download/78514",previewPdfUrl:"/chapter/pdf-preview/78514",authors:[{id:"344701",title:"Dr.",name:"Antony",surname:"Justin",slug:"antony-justin",fullName:"Antony Justin"},{id:"427929",title:"Dr.",name:"Sayani",surname:"Banerjee",slug:"sayani-banerjee",fullName:"Sayani Banerjee"},{id:"427930",title:"Dr.",name:"Chennu",surname:"Manisha",slug:"chennu-manisha",fullName:"Chennu Manisha"},{id:"427931",title:"Dr.",name:"Deepthi",surname:"Murugan",slug:"deepthi-murugan",fullName:"Deepthi Murugan"}],corrections:null},{id:"76353",title:"The Ghanaian Flora as a Potential Source of Anthelmintic and Anti-Schistosomal Agents",doi:"10.5772/intechopen.97417",slug:"the-ghanaian-flora-as-a-potential-source-of-anthelmintic-and-anti-schistosomal-agents",totalDownloads:218,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Parasitic infections including schistosomiasis and soil transmitted helminthiasis are the most commonly encountered Neglected Tropical Diseases (NTDs) in the world. These diseases remain a major public health concern affecting millions of people especially those living in poor regions where access to effective conventional health care is a challenge. Interventions to control these infections in endemic areas have not been successful due to the high cost of drugs, limited availability as well as inequity of access to preventive chemotherapies. Another problem is the development resistance to the limited number of recommended medications due to their intensive use in both human and live-stock. There is an increasing awareness of the potential of natural products as chemotherapeutic agents to combat parasitic infections. Natural products may offer an unlimited source of chemically diverse drug molecules which may be safe, efficient, less toxic, less expensive and readily available for use especially in low-income countries. The Ghanaian flora provides such a ready source for new therapeutic interventions for the local population. Several researches have provided evidence of the anti-parasitic activity of Ghanaian medicinal plants. This chapter provides a review with special focus on medicinal plants collected from Ghana with anthelmintic and anti-schistosomal activity. Evidence of pharmacological activities of crude extracts, fractions and bioactive phytoconstituents as well as possible mechanisms of action where investigated are discussed.",signatures:"Evelyn Asante-Kwatia, Abraham Yeboah Mensah, Lord Gyimah and Arnold Donkor Forkuo",downloadPdfUrl:"/chapter/pdf-download/76353",previewPdfUrl:"/chapter/pdf-preview/76353",authors:[{id:"217045",title:"Dr.",name:"Arnold Forkuo",surname:"Donkor",slug:"arnold-forkuo-donkor",fullName:"Arnold Forkuo Donkor"},{id:"303360",title:"Dr.",name:"Evelyn",surname:"Asante-Kwatia",slug:"evelyn-asante-kwatia",fullName:"Evelyn Asante-Kwatia"},{id:"309974",title:"Prof.",name:"Abraham Yeboah",surname:"Mensah",slug:"abraham-yeboah-mensah",fullName:"Abraham Yeboah Mensah"},{id:"347910",title:"Mr.",name:"Lord",surname:"Gyimah",slug:"lord-gyimah",fullName:"Lord Gyimah"}],corrections:[{id:"76505",title:"Corrigendum: The Ghanaian Flora as a Potential Source of Anthelmintic and Anti-Schistosomal Agents",doi:null,slug:"corrigendum-the-ghanaian-flora-as-a-potential-source-of-anthelmintic-and-anti-schistosomal-agents",totalDownloads:null,totalCrossrefCites:null,correctionPdfUrl:null}]},{id:"75561",title:"Traditional African Medicine",doi:"10.5772/intechopen.96576",slug:"traditional-african-medicine",totalDownloads:322,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"African traditional medicine is defined as one of the holistic health care system comprised of three levels of specializations namely divination, spiritualism, and herbalism. The traditional healer provides healing services based on culture, religious background, knowledge, attitudes, and beliefs that are prevalent in his community. Hence the current chapter focuses on the different types of african healing system, traditional healers, traditional practices and modern herbalism and also describes the phytochemical and pharmacological evidences of the traditional african herbs like Acanthus montanus (Acanthaceae), Amaranthus spinosus (Amaranthaceae), Bridelia ferruginea (Euphorbiaceae) etc.",signatures:"Motamarri V.N.L. Chaitanya, Hailemikael Gebremariam Baye, Heyam Saad Ali and Firehiwot Belayneh Usamo",downloadPdfUrl:"/chapter/pdf-download/75561",previewPdfUrl:"/chapter/pdf-preview/75561",authors:[{id:"339686",title:"Dr.",name:"Motamarri V.N.L.",surname:"Chaitanya",slug:"motamarri-v.n.l.-chaitanya",fullName:"Motamarri V.N.L. Chaitanya"},{id:"340066",title:"MSc.",name:"Firehiwot",surname:"Belayneh",slug:"firehiwot-belayneh",fullName:"Firehiwot Belayneh"},{id:"340068",title:"Prof.",name:"Heyam",surname:"Saad Ali",slug:"heyam-saad-ali",fullName:"Heyam Saad Ali"},{id:"348052",title:"BSc.",name:"Hailemikael",surname:"Gebremariam Baye",slug:"hailemikael-gebremariam-baye",fullName:"Hailemikael Gebremariam Baye"}],corrections:null},{id:"76298",title:"Ethnomedicine Study on Medicinal Plants Used by Communities in West Sumatera, Indonesia",doi:"10.5772/intechopen.96810",slug:"ethnomedicine-study-on-medicinal-plants-used-by-communities-in-west-sumatera-indonesia",totalDownloads:143,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Currently, the development of conventional medicine is getting more advanced, it cannot be denied that medicinal plants still occupy their main role as medicine for various human diseases, especially in developing countries. This is rooted in the knowledge of the local community about plants that can be used as medicine for various diseases. Ethnomedicine is a field of study that raises local knowledge of the community to maintain their health. From numerous studies on the field, 33 species of plants have been found which are believed by the natives to West Sumatra as medicine. Ethnomedicinal data were analyzed using Index of Cultural Significance (ICS) value. The results of the analysis showed that the species of plants that is voted most important for the community were soursop (Annona muricata) and red betel (Piper sp.). In general, the part of plant that is most often used as medicine is the leaf, and the way to consume it is by boiling it so that you can get the herbs from the plant extract.",signatures:"Skunda Diliarosta, Monica Prima Sari, Rehani Ramadhani and Annisa Efendi",downloadPdfUrl:"/chapter/pdf-download/76298",previewPdfUrl:"/chapter/pdf-preview/76298",authors:[{id:"342268",title:"Dr.",name:"Skunda",surname:"Diliarosta",slug:"skunda-diliarosta",fullName:"Skunda Diliarosta"},{id:"346504",title:"Ms.",name:"Rehani",surname:"Ramadhani",slug:"rehani-ramadhani",fullName:"Rehani Ramadhani"},{id:"346505",title:"Ms.",name:"Annisa",surname:"Efendi",slug:"annisa-efendi",fullName:"Annisa Efendi"},{id:"346920",title:"Mrs.",name:"Monica",surname:"Prima Sari",slug:"monica-prima-sari",fullName:"Monica Prima Sari"}],corrections:null},{id:"75771",title:"Advanced Pharmacological Uses of Marine Algae as an Anti-Diabetic Therapy",doi:"10.5772/intechopen.96807",slug:"advanced-pharmacological-uses-of-marine-algae-as-an-anti-diabetic-therapy",totalDownloads:231,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Marine seaweeds are a promising source of bioactive secondary metabolites that can be utilized in drug development and nutraceuticals. Diabetes mellitus is a leading non-communicable disease, and it is the third leading cause of death worldwide. Among the types of diabetes, type 2 became the major health problem as it is associated with severe health complications. Since available oral hypoglycemic drugs cause several adverse effects, it is worth searching for a natural cure with fewer or no side effects that may benefit patients with type 2 diabetes. Among the marine seaweeds, brown and red seaweeds are extensively studied for the anti-diabetic activity compared to the green seaweeds. Bioactive compounds present in marine seaweeds possess anti-diabetic potential through diverse mechanisms, mainly by reducing postprandial hyperglycemia and associated complication. Most of the studies emphasized that the marine seaweeds control the hyperglycemic condition by inhibiting carbohydrate hydrolyzing α-amylase,α glucosidase enzymes, and the inhibitory effect of dipeptide peptidase-4 that are involved in the degradation of incretins. Similarly, bioactive compounds in marine seaweeds can reduce diabetes complications by inhibiting angiotensin-converting enzymes, aldose reductase, protein tyrosine phosphatase 1B enzyme. This chapter focuses on the anti-diabetic potential of marine brown, green, and red seaweeds through different mechanisms.",signatures:"Thilina Gunathilaka, Lakshika Rangee Keertihirathna and Dinithi Peiris",downloadPdfUrl:"/chapter/pdf-download/75771",previewPdfUrl:"/chapter/pdf-preview/75771",authors:[{id:"219479",title:"Prof.",name:"Dinithi",surname:"Peiris",slug:"dinithi-peiris",fullName:"Dinithi Peiris"},{id:"343219",title:"Mrs.",name:"Thilina",surname:"Gunathilaka",slug:"thilina-gunathilaka",fullName:"Thilina Gunathilaka"},{id:"356401",title:"Dr.",name:"Lakshika Rangee",surname:"Keerthirathna",slug:"lakshika-rangee-keerthirathna",fullName:"Lakshika Rangee Keerthirathna"}],corrections:null},{id:"75758",title:"Safety Review of Herbs and Supplements in Heart Disease, Diabetes, and COVID-19",doi:"10.5772/intechopen.96811",slug:"safety-review-of-herbs-and-supplements-in-heart-disease-diabetes-and-covid-19",totalDownloads:229,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Usage of supplements has increased dramatically this last decade. From herbs to vitamins and mineral, consumers are interested in improving health, self-treatment and preventing diseases. Often using information from the internet to self-prescribe, many consumers believe that natural products are safe, while many others avoid using these products because of the lack of an approval process by health officials in many countries. Herbs and other supplements including proteins, vitamins and minerals provide significant benefits to health. The lack of guidance from health professionals however can be problematic. When combined with drugs and disease, herbs can interact and cause side effects. Some of the steps to evaluate the safe use of supplements is to know their mechanism of action, clinical effect, and consumers’ medical history. For example, an herb that induces liver enzymes will reduce the effect of a drug that is metabolized by these same enzymes. This can be life threating if the patient depends on this drug for normal function. Based on drug-herb interaction experience and literature review, this book chapter provides insights into safe use of echinacea, licorice, turmeric, and black seed in patients with heart disease, diabetes, and COVID-19.",signatures:"Paula Vieira-Brock",downloadPdfUrl:"/chapter/pdf-download/75758",previewPdfUrl:"/chapter/pdf-preview/75758",authors:[{id:"343363",title:"Ph.D.",name:"Paula",surname:"Vieira-Brock",slug:"paula-vieira-brock",fullName:"Paula Vieira-Brock"}],corrections:null},{id:"76486",title:"Pharmacological Investigation of Genus Pistacia",doi:"10.5772/intechopen.97322",slug:"pharmacological-investigation-of-genus-em-pistacia-em-",totalDownloads:199,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Several plants in the genus Pistacia are used in the treatment of various pathogenic and non-pathogenic disorders. Especially important are the major species belonging to this genus such as Pistacia lentiscus, Pistacia atlantica, Pistacia vera, Pistacia terebinthus, and Pistacia khinjuk, among others; these have been reported for their potential benefits both in medical and commercial purposes. In addition, members of this genus exhibit numerous ethnomedicinal uses, such as analgesic, anti-inflammatory, anticancer, antimicrobial, antihypertension, antihyperlipidemic, antiviral, and antiasthma. In light of these potential uses, the present chapter aimed to collect and summarize the literature about all of this medicinal information. Accordingly, this chapter focuses on the pharmacological uses and benefits of the genus Pistacia, especially those related to health issues.",signatures:"Abdur Rauf, Yahya S. Al-Awthan, Naveed Muhammad, Muhammad Mukarram Shah, Saikat Mitra, Talha Bin Emran, Omar Bahattab and Mohammad S. Mubarak",downloadPdfUrl:"/chapter/pdf-download/76486",previewPdfUrl:"/chapter/pdf-preview/76486",authors:[{id:"192295",title:"Dr.",name:"Abdur",surname:"Rauf",slug:"abdur-rauf",fullName:"Abdur Rauf"},{id:"207131",title:"Prof.",name:"Mohammad S.",surname:"Mubarak",slug:"mohammad-s.-mubarak",fullName:"Mohammad S. Mubarak"},{id:"348414",title:"Dr.",name:"Yahya",surname:"Al-Awthan",slug:"yahya-al-awthan",fullName:"Yahya Al-Awthan"},{id:"348415",title:"Dr.",name:"Naveed",surname:"Muhammad",slug:"naveed-muhammad",fullName:"Naveed Muhammad"},{id:"348417",title:"Prof.",name:"Muhammad",surname:"Mukarram Shah",slug:"muhammad-mukarram-shah",fullName:"Muhammad Mukarram Shah"},{id:"348418",title:"Dr.",name:"Saikat",surname:"Mitra",slug:"saikat-mitra",fullName:"Saikat Mitra"},{id:"348419",title:"Dr.",name:"Talha",surname:"Bin Emran",slug:"talha-bin-emran",fullName:"Talha Bin Emran"},{id:"348420",title:"Dr.",name:"Omar",surname:"Bahattab",slug:"omar-bahattab",fullName:"Omar Bahattab"}],corrections:null},{id:"77125",title:"Medicinal Plants and Traditional Practices of Baiga Tribe in Amarkantak Region of Eastern Madhya Pradesh",doi:"10.5772/intechopen.97697",slug:"medicinal-plants-and-traditional-practices-of-baiga-tribe-in-amarkantak-region-of-eastern-madhya-pra",totalDownloads:221,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The present ethnobotanical study was carried out in Amarkantak region eastern part of Madhya Pradesh during January 2018 to January 2019 to document the medicinal plants used by the Baiga tribes. Traditional medicinal plants used by the Baiga tribes of 37 plant species belonging to 35 genera and 28 families used to menstrual disorder, piles, sore throat, respiratory disorder, haematuria, miscarriage, jaundice, fever, insanity, leucorrhoea, bleeding during pregnancy, spermatorrhea, infertility in women, motiabind, scorpion bite, wounds of animals, stomach disorder, intestinal worms, diabetes, leukoderma, rheumatism, scabies, wart and easy delivery etc. and other various unreported medicinal plants are reported here.",signatures:"Ramesh Kumar Ahirwar",downloadPdfUrl:"/chapter/pdf-download/77125",previewPdfUrl:"/chapter/pdf-preview/77125",authors:[{id:"340104",title:"Dr.",name:"Ramesh",surname:"Kumar Ahirwar",slug:"ramesh-kumar-ahirwar",fullName:"Ramesh Kumar Ahirwar"}],corrections:null},{id:"77433",title:"Extraction of Bioactive Compounds from Medicinal Plants and Herbs",doi:"10.5772/intechopen.98602",slug:"extraction-of-bioactive-compounds-from-medicinal-plants-and-herbs",totalDownloads:1280,totalCrossrefCites:2,totalDimensionsCites:5,hasAltmetrics:1,abstract:"Human beings have relied on herbs and medicinal plants as sources of food and remedy from time immemorial. Bioactive compounds from plants are currently the subject of much research interest, but their extraction as part of phytochemical and/or biological investigations present specific challenges. Herbalists or scientists have developed many protocols of extraction of bioactive ingredients to ensure the effectiveness and the efficacy of crude drugs that were used to get relief from sickness. With the advent of new leads from plants such as morphine, quinine, taxol, artemisinin, and alkaloids from Voacanga species, a lot of attention is paid to the mode of extraction of active phytochemicals to limit the cost linked to the synthesis and isolation. Thus, the extraction of active compounds from plants needs appropriate extraction methods and techniques that provide bioactive ingredients-rich extracts and fractions. The extraction procedures, therefore, play a critical role in the yield, the nature of phytochemical content, etc. This chapter aims to present, describe, and compare extraction procedures of bioactive compounds from herbs and medicinal plants.",signatures:"Fongang Fotsing Yannick Stéphane, Bankeu Kezetas Jean Jules, Gaber El-Saber Batiha, Iftikhar Ali and Lenta Ndjakou Bruno",downloadPdfUrl:"/chapter/pdf-download/77433",previewPdfUrl:"/chapter/pdf-preview/77433",authors:[{id:"224515",title:"Dr.",name:"Fongang Fotsing",surname:"Yannick Stéphane",slug:"fongang-fotsing-yannick-stephane",fullName:"Fongang Fotsing Yannick Stéphane"},{id:"227816",title:"Dr.",name:"Bankeu Kezetas",surname:"Jean Jules",slug:"bankeu-kezetas-jean-jules",fullName:"Bankeu Kezetas Jean Jules"},{id:"227817",title:"Prof.",name:"Lenta Ndjakou",surname:"Bruno",slug:"lenta-ndjakou-bruno",fullName:"Lenta Ndjakou Bruno"},{id:"349790",title:"Prof.",name:"Gaber",surname:"El-Saber Batiha",slug:"gaber-el-saber-batiha",fullName:"Gaber El-Saber Batiha"},{id:"357350",title:"Dr.",name:"Iftikhar",surname:"Ali",slug:"iftikhar-ali",fullName:"Iftikhar Ali"}],corrections:null},{id:"77108",title:"Controversy, Adulteration and Substitution: Burning Problems in Ayurveda Practices",doi:"10.5772/intechopen.98220",slug:"controversy-adulteration-and-substitution-burning-problems-in-ayurveda-practices",totalDownloads:229,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Ayurveda is an Indian traditional system of medicine. In present era, world is looking towards herbal medicine because of acceptability and safety. Medicinal plants constitute an effective source of Ayurvedic and other traditional system of medicines as well as modern medicine. In India, about 80% of the rural population depends on herbal medicines in primary health care level. A large percentage of plants used in herbal industries are subject of controversy. Non-availability of plants, poor understanding and parallel evolved knowledge systems are some of the reasons attributed to it. The existing practices of polynomial nomenclature system of Sanskrit, different perceptions in various communities, vernacular equivalents, all are cumulative factors for controversy, adulteration and substitution. “ Sandigdha Dravaya “ is a term used for that type of medicinal plants which are mentioned in Ayurvedic classics but their exact botanical source is not known. Adulterants and substitutes are the common practices in herbal raw material trade. Adulteration is a debasement of an article. The motives for intentional adulteration are normally commercial that which involves deterioration, admixture, sophistication, inferiority, spoilage and other unknown reasons. Substitution is a replacement of equivalent drugs in place of original drugs. The principles to select substitute drugs are based on similar Rasa, Guna, Virya, Vipaka and mainly the Karma. At present the adulteration and Substitution of the herbal drugs is the burning problem in herbal industry and in Ayurvedic practices. So it is necessary to develop reliable methodologies for correct identification, standardization and quality assurance of Ayurvedic drugs.",signatures:"Puneshwar Keshari",downloadPdfUrl:"/chapter/pdf-download/77108",previewPdfUrl:"/chapter/pdf-preview/77108",authors:[{id:"339545",title:"Dr.",name:"Puneshwar",surname:"Keshari",slug:"puneshwar-keshari",fullName:"Puneshwar Keshari"}],corrections:null},{id:"76024",title:"Phytochemical Profile and Antiobesity Potential of Momordica charantia Linn.",doi:"10.5772/intechopen.96808",slug:"phytochemical-profile-and-antiobesity-potential-of-em-momordica-charantia-em-linn-",totalDownloads:175,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Momordica charantia L. is growing in many tropical and subtropical regions; the fruits of bitter melon are also gradually becoming popular for treating diabetes and associated diseases. Over 248 compounds belonging to the lipids, phenolics and terpenoids class are reported by diverse studies. However, M. charantia L. appears to be an inimitable species that synthesizes a diverse range of natural products in the fruits, leaves, stems and roots. The cucurbitane types of triterpenes exist in the various tissues of the plant in their aglycone as well as glycosylated forms. The bitter melon seems to exert their lipid lowering and antiobesity effects via several mechanisms like PPARs, LXRs, SREBPs, and Sirts mediated fat metabolism in various tissues, prevent adipocyte hypertrophy and visceral fat accumulation. M. charantia L. has been comprehensively studied worldwide for its therapeutic properties to treat a number of diseases like diabetes, dyslipidaemia, obesity, and certain cancers. This chapter apparently displays an encompassing literature review on vast potential of bitter melon as antiobesity agent and assembles data on complex phytochemistry.",signatures:"Pushpa Anantrao Karale, Shashikant Dhawale and Mahesh Karale",downloadPdfUrl:"/chapter/pdf-download/76024",previewPdfUrl:"/chapter/pdf-preview/76024",authors:[{id:"340628",title:"Ph.D. Student",name:"Pushpa",surname:"Anantrao Karale",slug:"pushpa-anantrao-karale",fullName:"Pushpa Anantrao Karale"},{id:"346847",title:"Dr.",name:"Shashikant",surname:"Dhawale",slug:"shashikant-dhawale",fullName:"Shashikant Dhawale"},{id:"346907",title:"Dr.",name:"Mahesh",surname:"Karale",slug:"mahesh-karale",fullName:"Mahesh Karale"}],corrections:null},{id:"79065",title:"Medicinal Plants and Its Pharmacological Values",doi:"10.5772/intechopen.99848",slug:"medicinal-plants-and-its-pharmacological-values",totalDownloads:178,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Plants have been used as a source of medicine for the treatment of different diseases from thousands of years ago. There is numerous evidences are available for use of plants as a medicine in the treatment of diseases in Indian, Egyptian, Chinese, Greek and Roman system of medicine. Pharmacognosy is the study of medicines derived from natural sources, mainly from plants which may further lead to development of new drug. The exploration, extraction and screening of biological diversity such as herbs, spices, microbes and other natural resources is the worldwide activity in recent years. Phytochemicals are the naturally available bioactive compounds which are derived from different plant parts and are primarily responsible for biological activities. The most important chemical compounds which are present in the plants are alkaloids, phenols, saponins, carbohydrates, terpenoids, steroids, flavonoids and tannins etc.",signatures:"Smita G. Bhat",downloadPdfUrl:"/chapter/pdf-download/79065",previewPdfUrl:"/chapter/pdf-preview/79065",authors:[{id:"343927",title:"Ph.D. Student",name:"Smita G.",surname:"Bhat",slug:"smita-g.-bhat",fullName:"Smita G. Bhat"}],corrections:null},{id:"78916",title:"Traditional Usage of Plants of Costus Species in Assam, India",doi:"10.5772/intechopen.100532",slug:"traditional-usage-of-plants-of-costus-species-in-assam-india",totalDownloads:133,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Customary use of plants in the treatment of ailments in Assam, India is a typical situation. Ethno medicinal study was led in a few topographically unique zones of the state and utilization of plants from Costus species were reported. The extent of study chose for the investigation range across seven organizational regions spread across Assam, India. The regions include Dibrugarh, Golaghat, Tinsukia, Dhemaji, Karbi Anglong, Goalpara and Kokrajhar. Different plants were reported and plants fitting with the said species were chosen for determining the relevance concerning its use in customary medication. The survey divulged that plants associated to three species of the genus Costus namely Costus speciosus, Costus pictus and Costus scaber were espied to be primarily ubiquitous in traditional medicine in the discrete contemplated regions. The species were predominantly utilized as prime ingrediants in hepatoprotactive and anti-diabetic formulations. Costus speciosus was perceived to be chiefly used in the treatment of hepatic disorders and ailments. Costus pictus was observed to be used customarily in the upper Assam region bordering Nagaland for treating diabetes and Costus scaber was being used in the area bordering Arunachal Pradesh for tending people with jaundice, snake bite etc. The research climaxed with the profiling of the costus species as annotated from the ethnomedicinal survey.",signatures:"Biman Bhuyan, Dipak Chetia and Prakash Rajak",downloadPdfUrl:"/chapter/pdf-download/78916",previewPdfUrl:"/chapter/pdf-preview/78916",authors:[{id:"272268",title:"Prof.",name:"Biman",surname:"Bhuyan",slug:"biman-bhuyan",fullName:"Biman Bhuyan"},{id:"420787",title:"Mr.",name:"Prakash",surname:"Rajak",slug:"prakash-rajak",fullName:"Prakash Rajak"},{id:"420788",title:"Prof.",name:"Dipak",surname:"Chetia",slug:"dipak-chetia",fullName:"Dipak Chetia"}],corrections:null},{id:"76563",title:"Benefaction of Medicinal Plant Uraria picta",doi:"10.5772/intechopen.97731",slug:"benefaction-of-medicinal-plant-em-uraria-picta-em-",totalDownloads:22,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Medicinal plants are very significant as they not only maintain the health and vitality but most importantly also cure the various ailments in humans and animals without causing any toxic side effects. These are readily available and cost effective therapeutic agents. Uraria picta was first proposed by Desvaux, (1813), is highly medicinal and critically endangered plant species found throughout India and other parts of the world like Africa, Australia, Philippines, Malaysia, Japan, Nigeria etc. This herb is full of antiseptic, anti-inflammatory, antimicrobial, anti-emetic, aphrodisiac, analgesic, cardiovascular and expectorant properties. Due to its high therapeutic use and growing need, the plant is becoming rare and endangered, therefore it is necessary to create awareness of this plant to support its propagation in large numbers. This herb also shows properties of anti-cancer and anti-cholinergic properties hence can manage depressions, anxiety, sleeping problems. Analgesic property helps in reducing body pain.",signatures:"Harsha Kashyap",downloadPdfUrl:"/chapter/pdf-download/76563",previewPdfUrl:"/chapter/pdf-preview/76563",authors:[{id:"341318",title:"Dr.",name:"Harsha",surname:"Kashyap",slug:"harsha-kashyap",fullName:"Harsha Kashyap"}],corrections:null},{id:"75500",title:"Spices-Reservoir of Health Benefits",doi:"10.5772/intechopen.96471",slug:"spices-reservoir-of-health-benefits",totalDownloads:222,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Spices contribute to the quality, nutritive value, and flavor of food. Since ancient times, they hold a great medicinal value. Their antimicrobial, antiviral, antibacterial, anti-inflammatory, and other numerous properties have made them a potent source of therapeutic agents. Phytochemical analysis revealed presence of active constituents such as eugenol, curcumin, carotenoids in clove, turmeric, saffron respectively that explains the efficacious nature of these spices. Owing to their easy availability and consumption, it is advised to make spices daily part of our diet though in balanced amount as sometimes excess usage bear few consequences. Evaluating multiple benefits offered by these as immunity boosters especially in times of pandemic and incorporating them in our routine diet would improve disease management strategies. This chapter discusses the reservoir of activities exhibited by few spices along with the components responsible for these activities. Here, we also discussed their negative effects if at all.",signatures:"Cheryl Sachdeva and Naveen Kumar Kaushik",downloadPdfUrl:"/chapter/pdf-download/75500",previewPdfUrl:"/chapter/pdf-preview/75500",authors:[{id:"341343",title:"Assistant Prof.",name:"Naveen Kumar",surname:"Kaushik",slug:"naveen-kumar-kaushik",fullName:"Naveen Kumar Kaushik"},{id:"341345",title:"Ms.",name:"Cheryl",surname:"Sachdeva",slug:"cheryl-sachdeva",fullName:"Cheryl Sachdeva"}],corrections:null},{id:"75373",title:"Historical Evidence and Documentation of Remedial Flora of Azad Jammu and Kashmir (AJK)",doi:"10.5772/intechopen.96472",slug:"historical-evidence-and-documentation-of-remedial-flora-of-azad-jammu-and-kashmir-ajk-",totalDownloads:343,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Determining the pharmacognostic specifications of medicinal plants used in several drugs is very necessary and actually crucial. Ethnobotany has significant role in understanding the active relations between the biological diversity and cultural systems. Azad Jammu and Kashmir (AJK) is gifted with variety of medicinal plants. The theme of this chapter is to present information about wild medicinal plants in different areas of Azad Jammu and Kashmir. Common woody species are Diospyros lotus, Taxus wallichiana, Viburnum cylindricum, and perennial herbs comprise Geranium nepalense, Oxalis acetosella and Androsace umbellata. Betula utilis, Berberis lycium, Cedrus deodara, Abies pindrow, Pinus wallichiana, Juglans regia and Salix species with large number of herbal diversity at elevations are common. Most of people use wild plants as traditional food and medicine. This ethnic flora not only plays important role in human health care but it is also an important source for present and future drug development. There is need for correct documentation, conservation of plants samples in herbarium of research institutes, and growing plants in gardens.",signatures:"Fozia Abasi, Muhammad Shoaib Amjad and Huma Qureshi",downloadPdfUrl:"/chapter/pdf-download/75373",previewPdfUrl:"/chapter/pdf-preview/75373",authors:[{id:"343051",title:"Dr.",name:"Muhammad Shoaib",surname:"Amjad",slug:"muhammad-shoaib-amjad",fullName:"Muhammad Shoaib Amjad"},{id:"343054",title:"Ms.",name:"Fozia",surname:"Abasi",slug:"fozia-abasi",fullName:"Fozia Abasi"},{id:"343057",title:"Dr.",name:"Huma",surname:"Qureshi",slug:"huma-qureshi",fullName:"Huma Qureshi"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"497",title:"Soybean and Nutrition",subtitle:null,isOpenForSubmission:!1,hash:"11aa0c9ed0f6ea8da765be93b50954bb",slug:"soybean-and-nutrition",bookSignature:"Hany El-Shemy",coverURL:"https://cdn.intechopen.com/books/images_new/497.jpg",editedByType:"Edited by",editors:[{id:"54719",title:"Prof.",name:"Hany",surname:"El-Shemy",slug:"hany-el-shemy",fullName:"Hany El-Shemy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"496",title:"Soybean and Health",subtitle:null,isOpenForSubmission:!1,hash:"66d40dbc031b2825ba95f7ac2bfae1b6",slug:"soybean-and-health",bookSignature:"Hany El-Shemy",coverURL:"https://cdn.intechopen.com/books/images_new/496.jpg",editedByType:"Edited by",editors:[{id:"54719",title:"Prof.",name:"Hany",surname:"El-Shemy",slug:"hany-el-shemy",fullName:"Hany El-Shemy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3244",title:"Soybean",subtitle:"Bio-Active Compounds",isOpenForSubmission:!1,hash:"b21aa6107fce439bd06d53fbe0bc3c9e",slug:"soybean-bio-active-compounds",bookSignature:"Hany A. 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\r\n\tToday, scientists describe the Universe mainly in terms of two theories: (1) Einstein's general theory of relativity (GTR), which describes the force of gravity and the large-scale structure of the Universe, and (2) quantum mechanics (QM), which describes the physics of the very small. However, as emphasized by Stephen Hawking and others, these two theories are known to be inconsistent with each other, so one needs to accommodate the gravitational force within the domain of QM by developing a quantum theory of gravity that will apply to both the large and small scales of the Universe. In a recent book entitled "The God Equation: The Quest for a Theory of Everything, Michio Kaku discusses the history and the nature of such a theory, which made significant progress during the 20th century through the development of the Standard Model (SM) of particle physics that represented the best understanding of the subatomic world at that time. Unfortunately, the SM makes no mention of the gravitational force. However, by removing several dubious assumptions made during the development of the SM, an alternative model, the Generation Model (GM), was developed from 2002-to 2019. The GM proposes that the gravitational force is not a fundamental force, as believed for centuries, but is a universal attractive, very weak residual interaction of the strong nuclear force, acting between the three massive particles, the proton, the neutron, and the electron, which are the constituents of a body of ordinary matter: this residual force provides a quantum theory of gravity. The main aim of this book is to discuss both the flaws of the SM and the GTR and also the considerable successes of the GM.
",isbn:"978-1-83768-018-4",printIsbn:"978-1-83768-017-7",pdfIsbn:"978-1-83768-019-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"085d4f6e00016fdad598675f825d6775",bookSignature:"Prof. Brian Albert Robson",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11861.jpg",keywords:"Standard Model, Twelve Elementary Particles, Higgs Boson Research, Universal Weak Force, CP-Violating Research, Big Bang Theory, Dark Matter, Dark Energy, Modified Gravity, Massless Elementary Particles, Quarks in Hadrons, Mixed Parity States",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 10th 2022",dateEndSecondStepPublish:"July 13th 2022",dateEndThirdStepPublish:"September 11th 2022",dateEndFourthStepPublish:"November 30th 2022",dateEndFifthStepPublish:"January 29th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"13 days",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"A pioneering researcher in theoretical nuclear physics and the scattering of polarized particles, recognized by Marquis Who’s Who Top Scientists for achievements and leadership in education and research. 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Currently he is an Honorary Professor in the Research School of Physics, The Australian National University, Canberra. During his academic career, he served for four years as Officer-in-Charge of the Australian National University’s first computer, for nine years as Head of the Department of Theoretical Physics, and for two years as Associate Director of the Research School of Physics and Engineering. 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Prostate cancer is one of the most frequent male malignancies in the world [2]. The development of serum prostate-specific antigen (PSA) and advanced cancer treatment modalities increased 10-year survival rates from ~60% to >70%. Prostate cancer can occur as a local disease or an advanced metastatic disease. Surgical removal of the prostate gland, hormonal therapy, radiation therapy, cryoablation, and expectant monitoring are some of the treatment options for patients with prostate cancer [3].
\nThese treatment options are associated with the risk of some side effects including fatigue, pain, urinary incontinence, erectile dysfunction, cognitive problems, decrease in bone density, weight loss, gynecomastia, and hot flushes with stress-related psychosocial problems [4]. Relative to other cancers, the prognosis of men with prostate cancer is much better, and the potential treatment-related side effects have important implications which can affect the health-related quality of life (QOL) of the patients; besides, these treatment-related side effects are significant in this population [5].
\nIncreased rates of survival and support required for functional, physical, and psychological status led to a considerable interest in rehabilitation needs and the approaches used to increase the QOL of the patients with prostate cancer [5]. Recent studies support the efficiency of multimodal treatment to recognize, prevent, and increase functional recovery with an interdisciplinary rehabilitation team which includes physical and occupational therapists. These professionals provide inpatient care, outpatient follow-up and education, and services in home care, palliative, and hospice care settings [6].
\nPhysical therapists play a vital role in the rehabilitation of patients with prostate cancer by teaching and implementing weight-bearing and gentle exercise, resistive exercises, and vibration exercises which transmit energy to the body with special techniques that strengthen the posture, balance, and body fitness, maintain or improve bone density, and prevent falls [6, 7]. In addition, pelvic floor training helps alleviate symptoms of urinary incontinence and maintain normal pelvic floor muscle functions [8]. Physical therapy also focuses on restoring the cardiovascular system which helps improve blood flow; this has been shown to improve symptoms associated with cancer-related fatigue and erectile dysfunction. Physical therapists assess the patients and develop individualized intervention programs including exercise programs to increase the endurance, muscle strength, mobility, and balance of patients with prostate cancer [6–8].
\nOccupational therapists play a vital role in increasing the occupational participation of the patients with prostate cancer [5]. Occupational therapists use training in activities of daily living, assistive technology approaches, education of energy conservation techniques, management of treatment-related problems such as pain, fatigue, and nausea. Moreover, occupational therapists give occupational balance training for regaining value of engagement in meaningful activities with a holistic view of creative and therapeutic use of activity [5, 9]. Occupational therapists focus on adaptations and offer education assistance for sexual activity for patients where certain sexual positions are limited or impossible due to pain, fatigue, or positioning issues. This complication in prostate cancer treatments is one of the most important limitations of activities of daily living that men face [9]. Occupational therapists offer ways to help patients with prostate cancer to confirm, express, accept, and use problem-solving techniques to present the changes due to prostate cancer and its treatment. Effective stress management must include relaxation and social support in a supportive environment. Such interventions decrease treatment-related symptoms, reduce the physiological accompaniments of stress, and improve mood. Patients who participate in such rehabilitation interventions are shown to have improved mental health by feeling more controlled and experiencing reduced interpersonal conflicts and distress related to cancer-related intrusive thinking [5]. In addition, cognitive therapy and changing life style with cognitive behavioral therapy are the mostly used occupational therapy interventions for patients with prostate cancer [5]. Futhermore, remaining in or returning to work is increasingly important for patients with and survivors of prostate cancer. Occupational therapists support men to remain in or return to work by providing fast-track care, counseling, and monitoring the men in work environment [10].
\nThis chapter describes briefly cancer rehabilitation and rehabilitation approaches for prostate cancer patients at every stage of the disease for minimizing the morbidity rates associated with prostate cancer treatment to increase occupational participation and improve QOL. The chapter also focuses on physical and occupational therapy approaches for patients with prostate cancer with psychosocial and vocational rehabilitation after prostate cancer treatment.
\nConventionally, function is the most important indicator of activity and is strongly associated with physical performance and interrelated areas such as range of motion, muscular strength, and endurance [11]. The more contemporary function is a perspective that encompasses individual’s physical conditions, emotional and psychological states, and the environmental and social circumstances of the individual [12]. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) describes a framework that focuses this multidimensional or biopsychosocial approach for a deeper understanding of function [11, 12]. Within the ICF framework, function is defined as the interactions between an individual, their health conditions, and the social and personal situations in which they thrive [13]. The complex interactions between these variables determine function and disability. In the context of prostate cancer, morbidity associated with the disease and its treatments can lead to functional problems or impairments in physiological, psychological, or behavioral attributes (body functions and structures), potentially leading to limitations in the ability to execute desired tasks (activity) and participation in social demands (participation) [14]. A variety of approaches and a framework for cancer rehabilitation are based on the ICF to diagnosis and treatment of function for prostate cancer survivors [15].
\nThe overall aim in rehabilitation of all cancer types is to overcome all symptoms causing functional difficulties and increase QOL [16]. De Lisa mentioned the importance of maintaining QOL at a high level; therefore, rehabilitation should not only focus on improving function and prognosis [17]. In general, cancer rehabilitation goals are classified as restorative, supportive, palliative, and preventive according to progression and the nature of cancer.
Body functions and body structures | \n
---|
Direct operation sequences (wound healing, lymphocele, urinary retention, urinary) | \n
Radiation effects (cystitis, proctitis, lymphedema) | \n
Treatment-related hormone deficiency symptoms | \n
Urinary incontinence | \n
Post-therapeutic pain syndromes | \n
Sequelae cytostatic chemotherapy (polyneuropathy), myelosuppression | \n
Sexual dysfunction (erectile dysfunction) | \n
Problems of coping | \n
Depression | \n
Relapse fears | \n
Sleep disorders | \n
Partnership problems | \n
Fatigue syndrome | \n
Post-traumatic stress disorder | \n
| \n
Reduction in exercise capacity | \n
Restriction in the field of transportation (incontinence, bone pain, edema) | \n
Social withdrawal | \n
Problems in integrating into the social environment | \n
Problems with the reintegration | \n
Limitation of mobility and participation in cultural life (incontinence) | \n
Impairment of functional health in prostate cancer.
General rehabilitation goals | \nEvaluation instruments | \n
---|---|
Physical performance | \nWHO Activity Index, Karnofsky Performance Score, Harvard Step Test, Ergometry, Muscle Strength Measurement (Vigorimeter, Digimax Muscle Testing), Quality of Life Questionnaires (EORTC-QLQ-C30), Functional Assessment of Cancer Therapy (G: General, F: Fatigue, P: Prostate-FACT) | \n
Function-related treatment goals | \nDirect Assessment of Functional Abilities (DAFA) Direct Assessment of Functional Status (DAFS) | \n
Reducing post-surgical problems (scars discomfort, seroma) | \nClinical observation | \n
Reducing symptoms after radiotherapy (cystitis, proctitis) | \nMicturition, Chair Diary | \n
Reducing hormone deficiency symptoms (vasomotor reactions, osteoporosis) | \nVisual Analog Scale (VAS) *Osteodensitometry must be checked | \n
Reducing symptoms after cytostatic chemotherapy (polyneuropathy) | \nCommon Toxicity Criteria of the National Cancer Institute (NCI-CTC), Sensitivity Measurement, Vibration Sense | \n
Reduction of fatigue | \nMultidimensional fatigue Inventory (MFI), Functional Assessment of Cancer Therapy, Fatigue (FACT-F), Visual Analog Scale (VAS), EORTC-QLQ-C30, Fatigue Module | \n
Reducing pain | \nVisual Analog Scale (VAS), Pain Diary | \n
Reduction of lymphedema | \nClinical observation, Rating scale | \n
Bladder in post therapeutic Urge symptoms | \nVoiding diary *Must be checked with the urologist | \n
Improvement in urinary incontinence | \nMiktions protocol, PAD test, Biofeedback, *Residual urine and results of uroflowmetry must be checked with the urologist. | \n
Dealing with sexual dysfunction, improvement of erectile dysfunction | \nDiary, International Index of Erectile Function (IIEF) | \n
Improvement of functional disorders of the musculoskeletal system | \nRange of motion | \n
Improving self-sufficiency | \nDetailed activity analysis, Functional Independence Measure (FIM), Barthel Index (BI), Instrumental Activities of Daily Living Scale (IADL), Role Checklist (RL) | \n
Reduction of long-term care | \nFunctional Independence Measure (FIM), Barthel Index (BI) | \n
Learning proper movement, sporting and leisure activities | \nOQ (Occupational Questionnaire), Interest Checklist and Activity Checklist (ICAC) | \n
Improvement of cognitive performance | \nd2-test (attention stress test), Benton test (visual memory-BT), Multiple Choice Vocabulary Intelligence Test (MWT-B), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) | \n
Promoting disease management, improving self-awareness and self-acceptance, emotional stabilization | \nEORTC, SF-36, Functional Assessment of Cancer Therapy (G: General, F: Fatigue, P: Prostate-FACT), | \n
Coping with stress and anxiety depressive states and relaxation | \n“Stress thermometer”, Hospital Anxiety and Depression Scale (HADS-D), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Visual Analog Scale (VAS) | \n
Reduction of Progression | \nFear of Progression Questionnaire | \n
Assistance in transition and when dealing with stroke-related disabilities (incontinence, erectile dysfunction) | \nQLQ-C30, prostate module | \n
Breakdown of family and partnership problems | \nInterview, Couples Climate Scales | \n
Reduction of insomnia | \nSF, Diary | \n
Construction of meaning and objective perspectives | \nInterview | \n
Treatment goals in the social sphere and Preparation of reintegration, possibly initiating professional promotions | \nCIO Community Integration Questionnaire, ISSI (Interview Schedule For Social Interaction) | \n
Obtaining self-sufficiency, financial management and participation in social life and counseling and assistance for reintegration, placement of self-help groups | \nReintegration to Normal Living Index, Instrumental Activities of Daily Living Scale (IADL) | \n
Learning to continence training and transfer in activities of daily living | \nMiktions protocol, Diary, Barthel Index (BI), Instrumental Activities of Daily Living Scale (IADL) | \n
Reduction of risk behavior (smoking alcohol abuse, overwork) | \nLife Habits Assessment (LIFE-H), Questionnaires | \n
Positive influence of eating habits within the meaning of health promotion | \nDiet Protocol, Body Mass Index (BMI), Bioelectrical Impedance Analysis (BIA) | \n
Vocational rehabilitation | \nWorker Role Interview, Valpar Component Work Samples (VCWS), COPM | \n
Rehabilitation goals and the evaluation instruments mostly used for patients with prostate cancer.
In patients with prostate cancer, fatigue, urinary incontinence, sexual dysfunction, impaired physical performance, psychological distress, weight gain, and changes in male body image are stated as the long-term sequelae of disease. Therefore, while considering general rehabilitation framework, special attention has to be given and specific methods must be used while making a treatment plan for patients with prostate cancer.
\nThe evaluation for rehabilitation program of patients with prostate cancer for determining the individual rehabilitation needs can be identified after completion of the primary treatment of prostate cancer to verify the success of rehabilitation intervention [19]. During the follow-up treatment in patients who are taken directly from the acute care settings, the results of the current status of malignancy and PSA levels must be recorded in addition to the results of special rehabilitation evaluation tests, instruments, or interviews on the day of admission to check the rehabilitation capacity of patients with prostate cancer. Patients must be evaluated by functional and goal-oriented evaluation instruments in the somatic, psychosocial, and vocational rehabilitation and participation in daily living activities and public life with contextual factor areas; thus, the therapist can obtain a top-down view of these patients [20]. Table 1 shows the impairment areas of functional health in prostate cancer which must be analyzed by rehabilitation therapists.
\n\n\nEvaluation tests for assessing body structure and functions, activity, and participation conducted at the beginning and end of rehabilitation to assess the level of achieving success in terms of the rehabilitation goals. Table 2 shows the rehabilitation goals and the evaluation instruments which are mostly used by the therapists for patients with prostate cancer.
\nCancer rehabilitation must include different therapies from different specialists to improve muscle strength and cardiopulmonary endurance, preserve energy for daily living activities, decrease stress, and especially decrease the effects of prostate cancer and its treatments. Physical therapy and occupational therapy specialists may be involved in the care of prostate cancer patients from the beginning of treatment to the end of a patient’s life. They provide evidence-based interventions during inpatient care, outpatient follow-up, education, and services in home care and hospice care settings.
\nHerein, it is important to remember that rehabilitation programs are driven for men with prostate cancer. Therefore, physical therapists should also be aware of the factors threatening men’s health. These factors are stated as obesity, overweight, and bad habits (smoking and drug or alcohol abuse). Epidemics in many diseases are directly related to smoking, poor diet, excess alcohol consumption, and sedentary lifestyles [21]. For a man with prostate cancer and life-threatening habits, the rehabilitation program must also include preparation of a healthy life plan for him as well as his partner. Smoking and other substance abuse should be avoided and such patients can be referred to psychotherapy or cognitive behavioral therapy to redesign their lifestyle. A coordinated plan of rehabilitation team aiming at a healthy diet and lifestyle can lead to good recovery after cancer diagnosis. The main role of physical therapy is to inhibit sedentary behavior and maintain adequate exercise for patients with prostate cancer.
\nProstate cancer and its treatments can cause inactivity and disuse syndrome which must be avoided, while fitness and active lifestyles should be encouraged [16]. It is important to preserve and restore function through exercise as exercise has several, evident positive effects on patients with cancer. Graded exercise has been suggested as a treatment strategy for cancer-related fatigue that has the strongest evidence [22]. Aerobic exercise has been found to have effects on not only fatigue but also psychological well-being, QOL, physical performance, and weight control [16, 22, 23]. Improvements in the sense of personal worth, self-esteem, self-image, and confidence have also been stated as good results of exercise. Therefore, exercise improves the positive mood of people and decreases negative moods such as depression and anxiety [16, 22–24]. Some studies also stated the reduced risk of disease recurrence [22–24].
\nIt is stated that aerobic exercise is helpful if it is given in low to moderate intensity (50–70 heart rate%), starting from 15 minutes to 30 minutes duration 3–5 times a week in a progressive way. The current exercise guidelines indicate that cancer survivors should achieve 150-min aerobic exercise per week and resistance (strength) training twice weekly [24, 25]. Most importantly, exercise needs to become a habit. Patients can be encouraged to start exercise with a short duration (15 min a day, several times a week) and then shape the pattern. Electronic monitoring bracelets can be helpful while following this pattern [21]. The patient can also control himself via this bracelet.
\nBerglund offered a physical training program for men with prostate cancer for an hour lasting for 7 weeks. This training started with light physical training, breathing exercises, and relaxation, and then included exercises of the pelvic floor [26]. The participants stated the benefit of this exercise program. The physical therapist should prepare a patient-specific aerobic exercise plan. Strengthening and endurance exercises should be performed in addition to aerobic training to improve participation in the activities of daily living [16]. Pelvic floor exercises must be added to physical therapy program for prostate cancer patients. These exercises will be mentioned during the management of urinary incontinence.
\nUrinary incontinence is common in patients with prostate cancer who underwent surgery or radiation therapy. Stress incontinence characterized with loss of urine with a cough, sneeze, or laugh is the most common type of urine leakage after prostate surgery, while the need to frequently urinate with episodes of leakage is the most common type seen after radiation therapy [27]. The treatments are as follows:
\nMost cancer patients experience fatigue and loss of energy. This severe and activity-limiting symptom is also common among patients with prostate cancer. Fatigue is mostly related with cancer treatment [16, 31]; however, it may also be present after or before treatment due to cancer [32, 33]. From our experience, in the presence of fatigue, patients, their relatives, and even some professionals suggest to rest and slow down activities. During the day time, many patients sleep a lot and cannot sleep well at night. Prolonged rest and inactivity induces muscular catabolism and the time of being fatigue increases [16]. Therefore, cancer patients suffering from primary fatigue should not be advised to increase the amount of daily rest. As we have mentioned earlier, exercise has a positive effect on fatigue. Therefore, patients should not be advised to rest more but carry out aerobic exercise [34]. It is supported that an 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved the overall QOL and helped prevent fatigue [31].
\nOccupational therapists follow other strategies in terms of physical, psychological, cognitive, and social dimensions of fatigue. Graded activity and diversional should be planned in the manner of giving exercise [33]. Other interventions to reduce the degree of fatigue are stress management, nutritional management, and energy conservation techniques [16]. During energy conservation, patients should be taught to spread out activities through the use of timetables, organize activities to the energy level required, ensure breaks during activities, and use adaptive devices [33]. Providing good rest/sleep patterns, teaching structured sleep is also an important role of a therapist [16]. The patient should be recommended to maintain a schedule of sleeping and waking times, avoid sleeping constantly during day time, open curtains in the morning, and avoid doing things that can affect night sleep [33]. Therapists should remember that fatigue is an important symptom of cancer and help their patients to manage this symptom.
\nLymphedema can be observed in patients with prostate cancer as a result of radiation damage or following the removal of lymph nodes during surgery. It is characterized with the collection of fluids in the lower extremities, and compression therapy helps the fluid to move and reduce swelling which can help the patient move easily and comfortably [34, 35].
\nBoth occupational and physical therapists may decide the kind of compression therapy and the effective manual techniques for patients with prostate cancer. Elevation, exercise, and using custom-fitted compression wear can help increase the lymph flow in the early stages of lymphedema. Compression wears are worn continuously throughout the day and removed at night. They are reapplied as soon as the patient awakens in the early morning. Additionally; to drain the lymph from the extremity pneumatic pump compression which provides sequential, active compression can be used in the home [34, 35]. For severe edema, compression bandaging after manual lymphatic drainage using light massage (complete decongestive therapy) can be effective. Manual massage can help collateral lymph vessels to milk the lymphedema. To determine the effectiveness of the treatment, the size of the extremity always must be monitored by the therapist [36–38].
\nPeripheral neuropathy is one of the side effects of chemotherapy. It is characterized with tingling, burning, or shooting pain sensation of hands and feet depending on nerve damage. Patients with prostate cancer may also experience loss of sensation which can cause problems on somatosensory perception, finger movements and grasping problems, balance problems, tripping, and/or decreased reflexes. Physical and occupational therapy can help the patients with prostate cancer to improve coordination, balance and gait, fine motor skills, and dexterity. The primary aim of treating peripheral neuropathy is to decrease the risk of falling and injuries [39].
\nRadiation therapy can cause scar tissue which may increase pain and decrease the flexibility of the skin. Physical therapists can use manual therapy and tissue techniques for stretching and tissue and nerve mobilization to decrease pain and increase the tissue mobility of the patients with prostate cancer [39].
\nIf patients underwent surgery, early postoperative ambulation and improving physical functions is the main goal of physical therapy [22]. During chemotherapy, physical strength tends to diminish; hence, rehabilitation aims to encourage ambulation consistent with the patient’s condition even during chemotherapy and prevent disuse syndrome and maintain physical and muscle strength by performing early ambulation [24, 26].
\nOccupational therapy (OT) offers a client-centered approach to patients with prostate cancer. OT clinical reasoning assessments and interventions focus on functioning and participation by rehabilitating the abilities of the patients with prostate cancer. Therapists guide goal-directed activities that give meaning to the patient’s life [40]. According to the ICF, the affected performance areas of prostate cancer on which OT focuses are shown in Table 3.
\nICF | \n|||
---|---|---|---|
Body structure/body function | \nImpairment | \nActivity | \nParticipation | \n
Sensory | \nBasic ADL* Instrumental ADL* | \nLoss of sense of self as a sexual being | \n|
\n | Cognitive | \n\n | Loss of ability to participate in activities (self-care, sport, and leisure) | \n
\n | Psychological | \n\n | Loss of occupational roles: work/ family | \n
\n | Motor | \n\n | Inability to be independently involved in daily occupations | \n
Affected performance areas and occupational therapy focus in patients with prostate cancer.
*ADL = Activities of Daily Living.
As shown in Table 3, OT mainly focuses on activity and participation limitations in the rehabilitation phase. Patients with prostate cancer generally require activity education, sensory training breathing and relaxation education, stress management education, sensory stimuli and praxis skills, cognitive therapy, erectile dysfunction and sexual rehabilitation, cognitive therapy, vocational rehabilitation, patient education and counseling, and also rehabilitation during palliative care and supportive care to engage in activities independently.
\nReasons of limitation of activity are both dysmotility and muscle weakness. Activity limitation interventions are important for improving the activity performance of patients with cancer. The occupational therapist describes and measures activity performance necessitated to be carried out by patients with prostate cancer. After the activity for individual needs is identified, intervention strategies may be determined. The practitioner must determine the appropriate intervention approach for each patient. These strategies are divided into four parts: restoration, compensation, environmental modification, and education of patient [41].
\nPatients have many different activities related to their roles. It is important to determine the most important activities for their life. The focus of the restorative approach is to develop patient skills and abilities or restore the activity performance of the patient with prostate cancer. A restorative approach is planned specifically to the situation of the patient. In this stage, grading of the activity level can be done. Grading can be done according to the following parameters:
\nThe compensation approach focuses on using the patients’ skills to achieve the highest possible stage of functioning in the activities. Therapists may teach the patients with prostate cancer new methods for modifying task performance to compensate for deficient areas of occupation, performance, and individual factors. If the patients still require help for participation in new activities, the occupational therapist should also give some advice regarding the use of adapted techniques or equipment. Patients with prostate cancer may need to use some assisted technology devices such as activity facilitator or computer-aided software to perform the activities. These instruments can help decrease symptoms (i.e., fatigue and pain) of cancer and increase participation in the activities of patients.
\nEnvironmental modifications consist of compensation, modification, and adaptation strategy. The compensation approach directly influences patient functioning. However, environmental modification approach influences patients’ functioning indirectly. Patients with prostate cancer will need help for home or work environment. Occupational therapists should give advice to redesign the home or work environment of the patient with prostate cancer where the patients can participate in activity easier than before. Modifications can include low-cost and easily accessible strategies to improve participation in domestic and community activities. Patients can also have problems in a social environment. They might not want to participate in social activities owing to general reluctance to do any activities. Besides, they may be exposed to stigma and pity from other people. For these reasons, occupational therapists must consider both physical and social aspects. Daily living activity education needs to be holistic and must integrate the activity, environment, and the patient with prostate cancer. Using occupation-based activity, education improves participation and supports wellness and QOL of patients with prostate cancer.
\nTreatment modalities such as surgery (e.g., radical prostatectomy), androgen deprivation therapy, radiation therapy, and chemotherapy affect the sensory–neural ways in body. After treatment, some deficiencies can occur in sensory skills. In particular, body composition may be affected if patients receive ADT. The generally observed side effects such as fatigue and pain might negatively affect patient body. Literature evidence demonstrates that sensory training is an important part of intervention program in patients with prostate cancer [42]. The purpose of sensory training is to develop body image by increasing body awareness. The body awareness includes these trainings and sensory stimuli, breathing, and relaxation techniques.
\nCancer and its treatment can be stressful for patients with prostate cancer and their partners and caregivers. Relaxation techniques and other body/mind practices can help calm the patient’s mind, reduce stress, and sharpen the ability to focus to maintain inner peace. Some patients with prostate cancer use these techniques to help themselves relax while they wait for the results of treatments or tests. Breathing techniques include slow inhalation and exhalation to reduce tension in the shoulders, trunk, and abdomen. The process begins with focusing on normal breathing in a quiet and comfortable place when the patients feel stressful. Patients should perform deep inhalation and slow exhalation. During this phase, the abdominal muscles should be relaxed during inhalation; the abdominal muscles should be contracted during exhalation [41]. Relaxation techniques involve teaching the patient with prostate cancer to cope with stress which results in deficiency of body composition. During relaxation education, the patient with prostate cancer is instructed to contract and relax his major skeletal muscles systematically and then asked to repeat phases silently and finally asked to use purposeful images to achieve the goals [41]. OT practitioners have a core role in providing therapeutic activities that enable the patients with sensory problems to develop body imagination in occupational performance.
\nOccupational therapists help patients with prostate cancer to acknowledge, express, accept, and use problem-solving techniques to address the changes that result from prostate cancer and its treatments. Effective stress management can include relaxation training, education, a supportive environment, social support, and participation in daily living activities. It is supported that these interventions can help decrease the treatment-related symptoms, the physiological accompaniments of stress, and improve mood of the patient with prostate cancer. Patients who participate in such rehabilitation programs are shown to control and experience reduced interpersonal conflicts and distress related to cancer-related intrusive thinking and have improved mental health [5].
\nThe patients involve in many activities which include various sensory stimuli. The basic activities involve tactile and proprioceptive inputs. Occupational therapists impart sensory training to patients with prostate cancer and also suggest somatosensoriel perception activities that involve tactile and proprioceptive inputs especially after chemotherapy or hormonal therapy. Patients use these senses during routines of activity in daily life. In addition, mirror activities and visual perception skills must be added to intervention programs to promote sensorial perception, harmony with the environment, and the body imagination of patients with prostate cancer [43–45].
\nCognitive therapy approach was generally used in patients with mental health problems. However, patients with prostate cancer may have some deficiencies in cognitive skills owing to cancer and its treatments [16]. OT intervention should focus on cognitive skills and activity function, and it includes orientation, memory, attention, motor planning, and executive functions of the patient with prostate cancer [44, 45].
\nRehabilitation approach to erectile dysfunction is focused on pelvic floor muscle training and the muscle strength at the base of the penis. After the initial examination and determining an intervention plan, the physical therapist may guide the patient to perform specific pelvic floor muscle exercises and indirectly related muscles such as abdominal and gluteal muscles. These exercises help increase oxygen supply to the tissues. Vacuum therapy can also be used to generate negative pressure that increases the blood flow to the penis [47].
\nSexual rehabilitation is one of the most important components of rehabilitation of patients with prostate cancer and significantly related to quality of life. Men with prostate cancer are more stressed about sexual dysfunction if they are younger. Both younger and older men are in need of physical, social, emotional, and psychological treatment assistance for this issue [28].
\nSafe and less fatigue sex positions for patients with prostate cancer.
Sexuality is an intimate issue and occupational therapy practitioners can examine both societal attitudes toward patients with prostate cancer and their own beliefs, values, and attitudes about sexuality. Patients can be emotionally vulnerable and recessive. The occupational therapists may provide information about the sexual rehabilitation. Rehabilitation should consists of an interdisciplinary team including nurses, physiotherapists, occupational therapists, social workers, sexologists, dieticians, massage therapists and psychologists. Die Perink et al. had conducted a rehabilitation program, with a 4-day course developed based on the experience with rehabilitation of more than 7000 cancer survivors, included physical activity, pelvic floor exercises, couples massage and relaxation, diet, and education of sexuality. They advise to practice sexual rehabilitation about sexual dysfunction [28]. Occupational therapists may give physically advice not only patients, but also partners regarding favorable sex positions (Figure 1). These positions can be more comfortable and safe for men. Thus, the occurrence of symptoms such as fatigue and pain will be reduced with occupational therapy intervention. Patients with prostate cancer will thus have normal sexual function. The patients and their partners should be informed about social support. It has many dimensions, including emotional, material assistance, and information. The occupational therapist should give lifestyle advice to patients for applying to their daily life. Thus, the patients and their partners will be improved.
\n\nLong survival with good quality of life make the patient with prostate cancer to think about returning to work after prostate cancer treatment and also 6 months after the radical prostatectomy surgery, men can return to their work. This may be a big positive step for men, and men might look forward to re-establishing his usual routine and it is understandable if they feel anxious or worried. But from a view of occupational therapy, having a return-to-work plan can help the patient to make the transition easier. Most of the mentally and physically healthy prostate cancer survivors do not require a job change, while others need some adjustments such as reduced working hours, modified duties, trying to do similar jobs, making self to do lists with time use with fatigue management, or the use of assistive technology. An occupational therapist can help the man determine if he is ready to go back to work, identify accommodations that will help him do his job, and help him get training or seek new employment if needed. In addition, improving self-management skills of prostate cancer survival helps him identify his needs and borders which can help him prepare for independent daily life and social reinteraction [48].
\nPatient, partner, family, and caregiver education are an important part of occupational therapy because nearly all of the approaches (restoration, compensation, environmental modification, etc.) involve learning new strategies and combining these strategies into persons’ lifestyles. Education contains information about prostate cancer; symptoms create and raise awareness about management skills. At the same time, an occupational therapist can use various materials such as demonstration, written format, pictures, and videotapes to help the patient and family participate in their activities. In addition to general education, it is supported that the main education resource of the patient with prostate cancer is internet but this way may not be helpful for psychosocial healing of the patient with prostate cancer or the survivor. Hence, in recent studies, new education programs were designed such as “Between men,” which offers group online therapy sessions and education. The aims of these programs were to give the patients all the available information about prostate cancer, treatment, side effects, and how to deal with the side effects. Program planned once a week for 7 weeks and it included patients’ experiences and reactions, patients’ communication difficulties especially sexual and emotional effects, prostate cancer disease and treatments, incontinence, sexuality, importance, and problem solving. Online education programs must be improved and generalized for patients and survivors with prostate cancer [5, 49].
\nIn palliative and hospice care, both physical and occupational therapists support men with prostate cancer by minimizing the secondary symptoms related to cancer and its treatments. The role of the occupational therapist and physical therapist in palliative and hospice care is quite similar and important.
\nAt the end of life, physical therapy offers functional training, therapeutic exercise, and soft tissue mobilization. The goals of physical therapy are to improve overall strength, range of motion, and endurance of the patient with prostate cancer. Physical therapists may use heat, cold, and TENS (transcutaneous electrical nerve stimulation) for pain relief and design exercises that improve endurance and positioning regimens that help the patient maintain functional range of motion [50, 51].
\nIn this stage, occupational therapists identify the roles and activities which are meaningful to the patient with prostate cancer and try to present the barriers that limit their performance. Occupational therapists support the patient both for physical and psychosocial/behavioral health requirements and pay close attention to what is most important for the patient. They look at the available activity and environmental resources to increase patient participation. The main goal of occupational therapy is to improve the quality of life according to patients’ values and maximize residual functional abilities [50].
\nPatients with prostate cancer can face problems about body structure and functions, activity, and participation which may limit their participation to life. Patients with prostate cancer require skilled rehabilitation and supportive care from the initial process of diagnosis through clinical reasoning and treatment to posttreatment periods. Qualified interdisciplinary rehabilitation interventions may help men regain their performance and independency and maintain the highest quality of life.
\nPregnancy is a distinct situation marked by physiological insulin resistance that disappears after delivery. It is also marked by changes in the endocrine, metabolic, and circulatory systems, all of which are intended to supply energy and sustenance to the developing fetus [1]. Gestational diabetes (GDM) and pre-eclampsia (PE) may occur as complications during metabolic dysregulation in pregnancy. GDM is a type of glucose intolerance that develops or is first noticed during pregnancy [2]. A previous diagnosis of gestational or pre-diabetes, impaired fasting glycemia, a family history of type 2 diabetes mellitus (DM) in a first-degree relative, maternal age, ethnic background, being overweight, and a history of previous pregnancy resulting in a child with a high birth weight (>4 kg) are all risk factors for developing GDM [3].
The major goal of this study was to look at the relationship between adipokines, lipids, and preeclampsia, as well as the efficacy and accuracy of these markers in predicting PE [4]. PE is a pregnancy-specific illness in which women who were previously normotensive develop hypertension and proteinuria after 20 weeks of pregnancy [5]. PE affects between 2 and 5% of pregnancies and contributes significantly to fetal, neonatal, and maternal morbidity and mortality. In Ghana, the incidence rate is around 7% [6, 7], however, a prevalence of 8.3% was reported in a study at the Volt Regional Hospital, Ho [8]. PE can develop anywhere from 20 weeks post-conception to 6 weeks post-delivery, and it’s commonly considered early inception if it happens before 34 weeks. It shares some of the risk factors of metabolic syndrome, such as insulin resistance, subclinical inflammation, and obesity, and data suggests that women with PE are more likely to develop cardiovascular disease later in life [1].
Adiponectin, also known as gelatin-binding protein of 28 kDa (GBP28), adipocyte complement-related protein of 30 kDa (ACRP30), adipoQ , adipose most abundant gene transcript 1 (apM1) is an adipocyte-specific secreted protein with roles in glucose and lipid metabolism [9]. The adiponectin gene is located on chromosome 3q27.3 and it is the most abundant protein released by adipose tissue and circulates in plasma as a low-molecular-weight trimer, a middle-molecular-weight hexamer, and a high-molecular-weight 12–18-mer [10, 11]. The biological activity of various variants varies, with HMW adiponectin being the most physiologically active [12]. The effects of adiponectin on glucose metabolism are mediated by two receptors, AdipoR1 and AdipoR2, respectively [13]. AdipoR2 is particularly abundant in the liver, whereas AdipoR1 is found in almost all bodily tissues [14]. Adiponectin activates adenosine monophosphate protein kinase (AMPK) and peroxisome proliferator-activated receptor alpha (PPAR-) by binding to its receptors AdipoR1 and AdipoR2, which leads to the activation of adenosine monophosphate protein kinase (AMPK) and peroxisome proliferator-activated receptor alpha (PPAR-α). In obesity-related insulin resistance, both adiponectin and its receptors are downregulated [13].
Adiponectin levels in the blood have a positive correlation with HDL cholesterol and a negative correlation with triglycerides [15]. Gender, age, and lifestyle all influence plasma adiponectin levels. Adiponectin gene expression is inhibited by β-adrenergic stimulation, glucocorticoids, and TNF-α [16, 17]. Type 2 diabetes, insulin resistance, obesity, hypertension, and left ventricular hypertrophy are all linked to low adiponectin levels in the blood [18].
Even in the absence of obesity, increased fat buildup in the body during pregnancy leads to a steady drop in adiponectin secretion [19]. Both adiponectin concentration and adiponectin mRNA are negatively correlated with fat mass hence with increased adipose tissue secretion during pregnancy, it’s possible that signals are sent to the adipose tissue, resulting in a decrease in adiponectin production even in the absence of obesity [19]. Despite the fact that some researchers have been unable to find adiponectin mRNA expression in the placenta [20, 21], studies show that it could be a source of the hormone [22].
A counterintuitive and considerable increase in adiponectin concentration has been found in several studies during pregnancy complicated with PE [23, 24]. Other researchers, on the other hand, discovered no significant differences in adiponectin mRNA expression in adipose tissue between PE patients and healthy controls [25].
Leptin is a 16 kDa protein product of the ob gene located on chromosome 1p31 and was identified in 1994 [1]. The name “leptin” comes from the Greek word “leptos,” which means “thin,” because this protein causes increased energy expenditure and reduces calorie intake by acting on satiety signals in the hypothalamus [26]. Its amino acid sequence exhibits no major homologies to other proteins [27] and it’s made by differentiated adipocytes, but it’s also made in other tissues like the stomach fundus, skeletal muscle, the liver, and the placenta [28]. Leptin suppresses food intake and increases energy expenditure by acting on the hypothalamus [29]. It is also a pro-inflammatory protein and a member of the IL-6 super-family of cytokines [30]. Leptin enhances insulin sensitivity in the periphery and regulates pancreatic β-cell activity [13]. Despite a functioning leptin receptor and high leptin levels, leptin does not cause weight loss in the majority of cases of obesity. This reduced response to the anorexigenic and insulin-sensitizing effects of leptin is called “leptin resistance” [13].
During pregnancy, leptin modulates gonadotrophin-releasing hormone release and facilitates implantation [31]. It also boosts amino acid uptake, regulates placental growth, enhances mitogenesis, and induces human chorionic gonadotrophin synthesis in trophoblast cells [31]. Tumor necrosis factor (TNF) and interleukin (IL)-6 stimulate the synthesis of placental leptin mRNA [32]. Leptin levels begin to rise in the early stages of pregnancy, regardless of maternal weight gain [33], peaking approximately 28 weeks of pregnancy and then dropping to pre-gravid levels shortly after delivery [34]. The placenta, rather than maternal adipose tissue alone, appears to play a significant role in the rise in maternal leptin concentrations throughout pregnancy [35]. The presence of a distinct promoter region in the human placental leptin gene indicates that placental leptin is regulated differently from adipose-derived leptin [36]. The fetus itself contributes to leptin production starting early in the second trimester [37]. In comparison to the placenta, however, the fetus produces a modest amount of it. Furthermore, leptin concentrations in umbilical cord plasma correlate positively with birth weight of newborns [38].
Leptin levels are higher in pregnant women with PE [23] and they may be higher before the disease manifests itself clinically [39, 40], with peaks occurring around 28 weeks of gestation [34]. As a result, leptin may play a role in the disease’s pathogenesis. However, other authors have observed lowered [25] or unchanged [41] circulating levels in patients with PE.
Resistin is a 12.5 kDa dimeric protein that circulates in human blood as two 92-amino-acid polypeptides connected by disulfide bridges at Cys-26 [42]. The signaling molecule resistin is found in monocytes, macrophages, and adipocytes [1]. The resistin gene is located on chromosome 19p13.3 and although the exact physiological role in humans is unknown, available evidence suggests that its presence in the blood is linked to a number of inflammatory indicators, including C-reactive protein, soluble TNF-receptor-2, IL-6, and lipoprotein-associated phospholipase A2 [43]. Coronary artery disease has been linked to high levels of resistin in the blood [43], and to severity of disease in sepsis and septic shock [44] and may be involved in the pathogenesis of rheumatoid arthritis [45].
Resistin concentration in PE has been reported by various researchers to remain unchanged [23] decreased [46] or increased [25]. The increased circulating resistin levels in PE could be related to the fact that its concentration in plasma is dependent on glomerular filtration, therefore as renal impairment progresses, resistin levels in plasma may rise [47].
Visfatin is a 52-kDa protein and is extensively produced in both human and mouse adipose tissue, and its plasma levels rise as obesity progresses [1]. Visfatin gene is located on chromosome 7q22.2 and is widely expressed in adipose tissue but can also be found in the placenta and fetal membranes [48] and myometrium [17]. It is also expressed in bone marrow, liver, muscle, heart, lung, and kidney [49] as well as by the lymphocyte. It is referred to as a pre-B cell colony enhancing factor because it enhances the maturation of B cell precursors [49]. Visfatin is released by amniotic epithelial cells during pregnancy [50] and has nicotinamide phosphoribosyltransferase activity [51].
Some contradictory results have been published on visfatin levels during pregnancy affected by preeclampsia. Some authors published increased visfatin levels in PE [52] while other investigators reported decreased levels [53] or values similar to normal pregnancy [54].
In a normal pregnancy, lipid profile changes are characterized by increases in total plasma cholesterol and triglyceride (TG) levels as a result of increased TG synthesis by the liver and very low-density lipoprotein-cholesterol (VLDL-C) synthesis in response to elevated estrogen levels [55]. The clearance of VLDL-C is reduced when the activity of lipoprotein lipase (LPL) is reduced due to estrogen-induced downregulation of LPL gene expression during pregnancy [56]. Women with PE had higher TG, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C), according to a study conducted in the Cape Coast metropolis in Ghana [57].
The differences in lipid profiles and abnormalities in certain adipokine metabolism described by different researchers warrant a closer look at their implications in the pathophysiology of PE. The main goal of this study was to see if the metabolism of adiponectin, leptin resistin, and visfatin are affected in the first trimester of pregnancy in pregnancies that go on to develop PE, and if these changes are significant enough in the prediction of PE to prompt interventions early enough to save the mother and baby.
This case-control study was carried out at the Ho Teaching Hospital (HTH) located in the capital of Volta Region of Ghana between January and December 2016.
Pregnant women over the age of 18 with or without hypertension were included in the study (cases and controls, respectively). Pregnant women without dipstick proteinuria and blood pressures less than 140/90 mmHg were assigned to the control group, whereas those with hypertension and proteinuria were assigned to the case group. Pregnant women with renal disease, diabetes, cancer, multigravida, and pre-gestational hypertension were excluded.
We studied first trimester data in 90 pregnant women who later developed PE and 100 women who did not. Participants were chosen from a large prospective observational study of women attending the HTH prenatal clinic for early prediction of pregnancies that are prone to develop problems. Women with pregnancies between 11 and 13 weeks of gestation were invited to take part in the study. Participants’ maternal characteristics and medical histories were documented.
Participants wore light clothing and after removing their shoes, stood on a Bioimpedance analyzer (BIA; BSD01, Pure Pleasure, a division of the Stingray Group, Cape Town, South Africa) and their weights were recorded to the nearest 0.1 kg. The study participants were made to stand upright, heels together, head in the horizontal plane, and height was measured with a stadiometer to the nearest 0.5 cm without shoes. BMI was estimated as weight/height squared (kg/m2).
Each participant was instructed to sit comfortably, stretch her left arm on a table, and relax for 10 minutes. A mercury sphygmomanometer and stethoscope were used to take measurements from the left upper arm after the subjects had rested for at least 5 minutes. The mean blood pressure was recorded to the closest to 2.0 mmHg in triplicate, with at least 5 minutes of waiting time between tests following the American Heart Association’s standards [58].
Five milliliters of blood were drawn between 7:00 and 8:00 a.m. during the first trimester and placed in serum separator tubes before being placed on ice packs. Within an hour, serum samples were separated and stored in aliquots at −80°C for biochemical analysis. Each participant was given a clean, dry, wide mouth, leak-proof container to collect 5 mL of urine sample after the 20th week of pregnancy.
Sandwich enzyme-linked immunosorbent assay technique (Elabscience Biotechnology Co. Ltd., Wu Han, People’s Republic of China) was used to analyze adiponectin, leptin, resistin, and visfatin in the baseline samples of both cases and controls, while the lipid profiles were performed using the Vitros dry chemistry analyzer (Ortho-Clinical Diagnostics, Johnson & Johnson, High Wycombe, UK). None of the samples in this investigation had been thawed and frozen before.
For less than 2 seconds, a urine strip was put into a urine sample up to the test area. To remove surplus urine, the strips’ margins were drawn around the brims of the vessels, ensuring that the test areas did not come into contact with them. To eliminate any residual urine, the strips were held vertically and tapped on absorbent papers [59]. Under bright light, the urine strip was horizontally held and compared to the color chart on the vial label.
The intensity of the blue-green color, which was related to the quantity of protein in the urine, was then used to determine the amount of protein. Proteinuria was defined as the presence of urine protein at concentrations of “+” or higher [60].
After the twentieth week of pregnancy, every pregnant woman in this hospital is screened for PE. PE occurrence (yes/no), as determined by PE diagnosis criteria, was the primary outcome. Urine protein was measured using the dip-stick qualitative/semi-quantitative method (Urit Medical Electronic Co., Ltd., Guangxi, People’s Republic of China) after 20 weeks of pregnancy. PE was diagnosed by a qualified Obstetrician/Gynecologist based on systolic and diastolic blood pressures of 140 mmHg or more on two occasions at least 4 hours apart (or both) in addition to proteinuria of + or more.
The SPSS software, version 20, and Graph Pad Prism, version 5.0, San Diego, California, USA, and Systat, Inc. Germany were used to analyze the data. The Shapiro-Wilk test was used to determine the normality of the variables under investigation, followed by a Mann-Whitney
After correcting for potential confounding variables, multivariate analysis was performed on the individual adipokines as predictors of PE (age, BMI, relatives with hypertension, family history of diabetes mellitus, family history of preeclampsia, and parity). After correcting for confounders, the goal was to determine the independent contribution of each adipokine in predicting PE.
The parameters for the goodness of fit test for the models were −2Log (Likelihood), R2 (Cox and Snell), R2 (Nagelkerke), Akaike Information Criterion (AIC), and Correct Classification Rate (CCR).
The −2Log (Likelihood) statistic indicates how well a model predicts a certain occurrence, the lower the number, the better the model.
The coefficients of determination Cox and Snell R2 and Nagelkerke R2 are used to measure the amount of variation in the dependent variable that is explained by the independent variable. The Cox and Snell R2 has been modified to create the Nagelkerke R2. The AIC is also a relative quality estimator for statistical models. The better the model, the smaller the estimate. The Correct Classification Rate is another valuable metric for evaluating the utility of a logistic regression model (CCR).
The baseline demographics, lipids, and adipokine characteristics of those with PE were compared to those without PE (Table 1). The mean age of those who acquired PE was significantly greater than that of those who did not (35.1 vs. 28.44 years;
Var | BMI | Age | ADP | LP | RTN | VF | TG | TC | HDL | LDL | VLDL | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PE | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | Yes |
Min | 18.9 | 27.1 | 16 | 24 | 17.7 | 15.2 | 2.7 | 9.9 | 1.3 | 4.0 | 0.3 | 0.5 | 0.5 | 0.5 | 2.4 | 2.6 | 0.1 | 0.1 | 0.2 | 0.2 | 0.2 | 0.2 |
Max | 37.3 | 37.3 | 41 | 46 | 258.2 | 90.6 | 40.7 | 41 | 12.4 | 13.9 | 11.2 | 19.4 | 3.3 | 3.4 | 9.6 | 9.3 | 3.4 | 3.4 | 7.8 | 7.8 | 1.5 | 1.4 |
Mean | 25.0 | 32.6 | 28.4 | 35.1 | 83.6 | 39.3 | 18.5 | 36.3 | 6.4 | 10.2 | 4.4 | 7.4 | 1.7 | 1.6 | 5.8 | 5.9 | 1.6 | 1.4 | 3.8 | 4.0 | 0.8 | 0.7 |
LB | 24.2 | 32.0 | 27.4 | 34.0 | 77.3 | 35.3 | 16.8 | 34.7 | 6.0 | 9.8 | 3.9 | 6.7 | 1.5 | 1.5 | 5.5 | 5.5 | 1.4 | 1.2 | 3.5 | 3.6 | 0.7 | 0.6 |
UB | 25.8 | 33.2 | 29.5 | 36.2 | 90.0 | 43.2 | 20.2 | 37.9 | 6.8 | 10.7 | 5.0 | 8.0 | 1.8 | 1.8 | 6.1 | 6.3 | 1.7 | 1.7 | 4.1 | 4.4 | 0.9 | 0.8 |
0.86 | 0.826 | 0.589 | 0.73 |
Mann-Whitney
significant at p < 0.05
significant at p < 0.01
Values in bold are significant at p < 0.05
ADP, adiponectin; LP, leptin; RTN, resistin; VF, visfatin; TG, triglyceride; TC, total cholesterol; LDL, low density lipoprotein cholesterol; HDL, high density lipoprotein cholesterol; VLDL, very low density lipoprotein cholesterol.
Reproduced from: Ref. [62].
The ROC curves were used to assess the performance of the screening. Table 2 shows the areas under the ROC curve, the sensitivities and specificities, as well as the threshold points for detecting PE. The accuracy with which biochemical markers can differentiate on the condition of PE was tested in this study. As shown in Table 2, the adipokines leptin (92.0%), resistin (91.4%), and adiponectin (90.5%) have good accuracy levels, whereas visfastin (77.1%) has fair accuracy levels in diagnosing PE, according to Table 2 ratings. With a cut-off point of 50.55 ng/mL, adiponectin had a sensitivity and specificity of 87.8 and 86%, respectively, while leptin had a sensitivity and specificity of 92% with a threshold of 27 ng/mL. Furthermore, resistin had a sensitivity and specificity of 94 and 91%, respectively, with a cut-off point of around 9 ng/mL, whereas visfatin had a sensitivity and specificity of 69 and 83%, with a threshold of 6.67 ng/mL. This suggests that adiponectin, leptin, resistin, and visfatin are effective PE predictors (Table 2).
Variables | AUC (%) | Sensitivity (%) | Specificity (%) | Threshold point |
---|---|---|---|---|
ADP | 90.5 | 87.8 | 86 | ≤50.552 |
LP | 92 | 92.2 | 92 | ≥27.273 |
RTN | 91.4 | 94.4 | 91.4 | ≥8.949 |
VF | 77.1 | 68.9 | 83 | ≥6.667 |
AUC, sensitivity, specificity, and threshold point for the adipokines in the pregnant women.
ADP, adiponectin; LP, leptin; RTN, resistin; VF, visfatin.
Reproduced from: Ref. [62].
Furthermore, a detailed examination of the ROC plots (Figure 1) reveals that they are all far from the diagonal line, which represents 50%, indicating that they are not random guesses but rather meaningful. This indicates that they are quite good at predicting pregnancies that are likely to result in PE. After adjusting for BMI, none of those in the normal BMI category had PE (Table 3); as a result, no AUC values for all of the adipokines studied were obtained. The overweight group, on the other hand, had greater AUCs, sensitivities, and specificities. Obese people, on the other hand, had lower sensitivities and specificities. These findings point to a possible influence of BMI on adiponectin, leptin, resistin, and visfatin, as well as a possible negative feedback mechanism in the metabolism of these adipocytokines during pregnancy. However, BMI does not appear to have an effect on the predictive ability of these PE signaling molecules.
ROC curves for the adipokines. AUCs (%): ADP (95.0), LP (92.0), RTN (91.4), and VF (77.1). ADP, adiponectin; LP, leptin; RTN, resistin; VF, visfatin.
Adipokine | BMI category | Prevalence (%) | AUC (%) | Sensitivity (%) | Specificity (%) | Threshold point |
---|---|---|---|---|---|---|
ADP | Normal weight | 0 | — | — | — | — |
Overweight | 23 | 97.7 | 100 | 97.7 | ≤36.163 | |
Obese | 89 | 83.2 | 71.4 | 90 | ≤44.980 | |
LP | Normal weight | 0 | — | — | — | — |
Overweight | 23 | 99.3 | 100 | 97.7 | ≥27.245 | |
Obese | 89 | 70.7 | 61 | 80 | ≥38.482 | |
RTN | Normal weight | 0 | — | — | — | — |
Overweight | 23 | 95.5 | 100 | 90.9 | ≥8.949 | |
Obese | 89 | 93.5 | 93.5 | 70 | ≥8.949 | |
VF | Normal weight | 0 | — | — | — | — |
Overweight | 23 | 89.5 | 84.6 | 90.9 | ≥6.628 | |
Obese | 89 | 48.2 | 66.2 | 60 | ≥6.243 |
AUC, sensitivity, specificity, and threshold point for levels of the adipokines in the pregnant women controlling for BMI.
ADP, adiponectin; LP, leptin; RTN, resistin; VF, visfatin. BMI classification: Normal Weight = (18.5–24.9 kg/m2), Overweight = (25.0–29.99 kg/m2), Obese = (Above 30.0 kg/m2)
Reproduced from: Ref. [62].
There were minor variations in the AUCs, sensitivities, specificities, and threshold points for predicting PE after controlling for family history of hypertension, which is a known confounding factor, but these variations were minor, and the overall effect of these adipocytokines’ predictive abilities remained intact (Table 4).
Prevalence (%) | AUC (%) | Sensitivity (%) | Specificity (%) | Threshold point | ||
---|---|---|---|---|---|---|
RWHP | ||||||
ADP | YES | 73 | 83.6 | 84.2 | 78.6 | ≤50.552 |
NO | 38 | 92.2 | 84.6 | 95.3 | ≤44.980 | |
LP | YES | 73 | 90.6 | 89.5 | 92.9 | ≥25.611 |
NO | 38 | 92.2 | 94.2 | 91.9 | ≥27.273 | |
RTN | YES | 73 | 89.8 | 89.5 | 85.7 | ≥9.012 |
NO | 38 | 91.6 | 94.2 | 93 | ≥8.949 | |
VF | YES | 73 | 72.5 | 78.9 | 78.6 | ≥6.349 |
NO | 38 | 75.1 | 61.5 | 83.7 | ≥6.667 |
AUC, sensitivity, specificity, and threshold point for the adipokines in the pregnant women controlling for those who have relatives with hypertension.
ADP, adiponectin; LP, leptin; RTN, resistin; VF, visfatin; RWHP, relatives with hypertension; YES, those who have relatives with hypertension; NO, those who do not have relatives with hypertension.
Reproduced from: Ref. [62].
Table 5 shows a multivariate analysis of individual adipokines as PE predictors. Adiponectin, leptin, resistin, and visfatin were included as predictors in Models 1, 2, 3, and 4, respectively, while correcting for confounding factors such as age, parity, BMI, and relative with hypertension, and family history of diabetes and preeclampsia. Based on the criteria analyzed, Model 1 including adiponectin as a predictor was the best model. This means having the greatest Nagelkerke R2 and CCR values of 95 and 95.26%, respectively, implying that after correcting for confounders, adiponectin is the strongest predictor of PE. With Nagelkerke R2 and CCR statistics of 89 and 91.58%, respectively, Model 4 with visfatin as a predictor had the least predictive performance.
Model 1 (ADP) | Model 2 (LP) | Model 3 (RTN) | Model 4 (VF) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR | OR CI (95%) | OR | OR CI (95%) | OR | OR CI (95%) | OR | OR CI (95%) | |||||
Intercept | 0.50 | <0.0001 | ||||||||||
ADP | 0.93 | (0.9, 0.96) | ||||||||||
LP | 1.15 | (1.08, 1.22) | ||||||||||
RTN | 1.65 | (1.3, 2.11) | ||||||||||
VF | 0.01 | 1.28 | (1.07, 1.55) | |||||||||
Age Cat. | ||||||||||||
20–35 years | ||||||||||||
Above 35 years | 8.86 | (1.16, 67.68) | 0.07 | 4.60 | (0.88, 24.08) | 6.25 | (1.46, 26.69) | 5.67 | (1.41, 22.74) | |||
Less than 20 years | 0.89 | 1.39 | (0.01, 135.01) | 0.12 | 32.85 | (0.41, 2604.47) | 0.39 | 7.86 | (0.07, 901.18) | 0.12 | 27.92 | (0.41, 1895.49) |
BMI category | ||||||||||||
Overweight | ||||||||||||
Obese | 44.24 | (7.5, 260.91) | 20.43 | (4.75, 87.87) | 19.88 | (5.06, 78.17) | 26.52 | (7.73, 90.98) | ||||
Normal weight | 0.16 | 0.12 | (0.01, 2.29) | 0.20 | 0.15 | (0.01, 2.62) | 0.10 | 0.08 | (0, 1.67) | 0.06 | 0.07 | (0, 1.07) |
Parity | ||||||||||||
1 | ||||||||||||
2 | 0.84 | 1.18 | (0.22, 6.41) | 0.19 | 2.76 | (0.6, 12.76) | 0.08 | 4.00 | (0.84, 19.14) | 0.16 | 2.75 | (0.67, 11.2) |
3 | 11.34 | (1.53, 84.29) | 0.02 | 7.51 | (1.29, 43.58) | 0.13 | 3.73 | (0.69, 20.11) | 0.05 | 4.40 | (0.99, 19.5) | |
>4 | 9.07 | (1.03, 80.17) | 17.35 | (2.72, 110.49) | 14.38 | (2.45, 84.57) | 12.19 | (2.41, 61.59) | ||||
Family Hist. of Hyp. | ||||||||||||
No | ||||||||||||
Yes | 0.19 | 2.93 | (0.59, 14.48) | 4.58 | (0.97, 21.64) | 0.10 | 3.84 | (0.79, 18.77) | 0.07 | 3.43 | (0.89, 13.21) | |
Family Hist. of DM | ||||||||||||
No | ||||||||||||
Yes | 0.40 | 2.23 | (0.35, 14.34) | 0.76 | 1.28 | (0.26, 6.21) | 0.72 | 0.75 | (0.16, 3.53) | 0.88 | 0.90 | (0.21, 3.77) |
Family Hist. of PE | ||||||||||||
No | ||||||||||||
Yes | 0.79 | 0.82 | (0.19, 3.52) | 0.11 | 0.34 | (0.09, 1.26) | 0.22 | 0.45 | (0.12, 1.62) | 0.14 | 0.41 | (0.12, 1.36) |
Goodness of fit statistics | ||||||||||||
Model 1 | Model 2 | Model 3 | Model 4 | |||||||||
−2Log (Likelihood) | 27.186 | 37.24 | 40.66 | 54.11 | ||||||||
0.71 | 0.70 | 0.69 | 0.67 | |||||||||
0.95 | 0.93 | 0.92 | 0.89 | |||||||||
AIC | 51.19 | 61.24 | 64.66 | 78.11 | ||||||||
CCR (%) | 95.26 | 93.16 | 92.63 | 91.58 |
Multivariate analysis of clinical factors affecting preeclampsia.
Reproduced from: Ref. [62].
Values in bold are significant at p < 0.05.
In their respective models, adiponectin, leptin, resistin, and visfatin were found to be significant predictors of PE (
Obesity was revealed to be a significant confounder in all four models, with overweight as the reference category under BMI and parity of four or more with parity one as the reference category. In Models 1, 3, and 4, advanced maternal age above 35 years, with the age group 20–35 years as the reference category, was also found to be important.
Although adiponectin showed a mild positive link with HDL and a weak negative correlation with TG and VLDL, it did demonstrate a favorable correlation with HDL. Although leptin and resistin had minor negative relationships with HDL, visfatin had a strong negative link with HDL. Leptin, resistin, and visfatin all had negative correlations with adiponectin. Positive associations were found between leptin, resistin, and visfatin (Table 6). These links were weak in those of normal weight, but they were stronger in individuals who were overweight or obese (Table 7). This reemphasizes the link between adiposity and some of these adipokines. We had earlier examined the associations between maternal factors and PE in a report published in the International Journal of Women’s Health [63].
Variables | ADP | LP | RTN | VF | TC | HDL | LDL | VLDL | TG |
---|---|---|---|---|---|---|---|---|---|
ADP | 0.0549 | 0.0531 | 0.0390 | ||||||
LP | 0.0629 | 0.0963 | 0.0092 | ||||||
RTN | 0.0911 | 0.0671 | 0.0227 | 0.0395 | |||||
VF | 0.1252 | ||||||||
TC | 0.0549 | 0.0629 | 0.0911 | ||||||
HDL | 0.0531 | ||||||||
LDL | 0.0390 | 0.0963 | 0.0671 | ||||||
VLDL | 0.0227 | 0.1252 | |||||||
TG | 0.0092 | 0.0395 |
Correlation among adipokines and lipids.
Values in bold are different from 0 with a significance level alpha = 0.05.
Reproduced from: Ref. [62].
BMI category | Variables | ADP | LP | RTN | VF |
---|---|---|---|---|---|
ADP | 0.1259 | 0.0157 | 0.1568 | ||
Normal weight | LP | 0.1259 | |||
RTN | 0.0157 | ||||
VF | 0.1568 | ||||
ADP | |||||
Overweight | LP | ||||
RTN | |||||
VF | |||||
ADP | 0.031 | ||||
Obese | LP | ||||
RTN | |||||
VF | 0.031 |
Correlation of adipokines according to BMI category.
Values in bold are different from 0 with a significance level alpha = 0.05. ADP, adiponectin; LP, leptin; RTN, resistin; VF, visfatin. BMI classification: Normal Weight = (18.5–24.9 kg/m2), Overweight = (25.0–29.99 kg/m2), Obese = (Above 30.0 kg/m2).
Reproduced from: Ref. [62].
“We had earlier examined the associations between maternal factors and PE (Table 8) in a report published in the International Journal of Women’s Health [63]. That report indicated that those with PE had significantly higher number of miscarriages, number of previous pregnancies and number of children compared to those without PE.”
Sum of squares | Mean square | Sig. | ||||
---|---|---|---|---|---|---|
Age | Between groups | 832.197 | 1 | 832.197 | 25.723 | <0.0001 |
Within groups | 10029.175 | 310 | 32.352 | |||
Total | 10861.372 | 311 | ||||
BMI | Between groups | 1248.068 | 1 | 1248.068 | 76.461 | <0.0001 |
Within groups | 5060.084 | 310 | 16.323 | |||
Total | 6308.152 | 311 | ||||
RWHP | Between groups | 0.378 | 1 | 0.378 | 1.771 | 0.184 |
Within groups | 66.084 | 310 | 0.213 | |||
Total | 66.462 | 311 | ||||
NC | Between groups | 3.721 | 1 | 3.721 | 6.182 | 0.013 |
Within groups | 186.584 | 310 | 0.602 | |||
Total | 190.304 | 311 | ||||
MC | Between groups | 2.856 | 1 | 2.856 | 6.199 | 0.013 |
Within groups | 142.808 | 310 | 0.461 | |||
Total | 145.663 | 311 | ||||
SB | Between groups | 0.416 | 1 | 0.416 | 3.216 | 0.074 |
Within groups | 39.855 | 308 | 0.129 | |||
Total | 40.271 | 309 | ||||
CS | Between groups | 0.003 | 1 | 0.003 | 0.026 | 0.871 |
Within groups | 28.607 | 300 | 0.095 | |||
Total | 28.609 | 301 | ||||
NP | Between groups | 13.344 | 1 | 13.344 | 8.634 | 0.004 |
Within groups | 479.105 | 310 | 1.545 | |||
Total | 492.449 | 311 |
Comparison of maternal characteristics and family history of respondents with those who developed PE (
RWHP, relatives with hypertension; NC, number of children; MC, number of previous miscarriages; SB, number of previous stillbirths; CS, number of previous cesarean operations; NP, number of pregnancies.
Reproduced from: Ref. [63].
The goal of this study was to estimate the levels of adiponectin, leptin, resistin, and visfatin, between 11 and 13 weeks of pregnancy and to see how successful it was to predict PE using first trimester levels of these biomarkers together with maternal factors.
Leptin levels were found to be considerably greater in those who developed PE later on compared to those who did not. This is in line with a previous study that found a rise in leptin levels several weeks before a clinical diagnosis of PE [8]. This observation is also consistent with another study that found an imbalance between adiponectin and leptin in the plasma of women with PE, resulting in raised leptin and decreased adiponectin levels; consequently, these two adipose-derived hormones may play a role in the pathogenesis of PE [64]. Similarly, as compared to normal pregnant controls, leptin levels were found to be 78% higher at 13 weeks of gestation in women who ultimately developed PE [65]. When comparing pregnant women whose first-trimester leptin levels were 25 ng/mL to pregnant women whose first-trimester leptin levels were 25 ng/mL, the risk of PE increased 18.8 fold [66]. Other studies have shown that leptin levels rise before the clinical beginning of the disease, and our findings support that theory [39, 40]. The findings of this study, together with prior research, suggest that leptin is involved in the pathophysiology of PE, rather than a rise in leptin as a result of impaired renal clearance. Hyperleptinemia has been shown to promote sodium reabsorption in the renal tubules, leading to water retention and elevated blood pressure [67]. Furthermore, tumor necrosis factor (TNF)-α and interleukin (IL)-6 upregulate placental leptin mRNA synthesis and increase the formation of endothelin, a vasoconstrictive peptide [68]. The constriction of the blood vessels leads to high blood pressure leading to PE.
Adiponectin levels in the first trimester were considerably lower in women with PE compared to the control group in this study. Other research has found that adiponectin levels are inversely proportional to coronary artery disease but not strongly related to blood pressure levels [69]. In another study, individuals with preeclampsia had lower median maternal high molecular weight and low molecular weight adiponectin concentrations than those with normal pregnancies [70]. Previous reports have demonstrated lower first-trimester adiponectin levels in women who subsequently developed PE compared to their peers [71, 72]. However, this study contradicts a publication that stated that circulation levels of adiponectin were higher in preeclamptic patients than in normal pregnant women [73, 74]. In another study, women with preeclampsia had approximately 50% greater third-trimester adiponectin levels than their normotensive counterparts [75]. In a similar study, women with preeclampsia had higher levels of circulating adiponectin [74]. The compensatory feedback mechanisms to the metabolically altered, anti-angiogenic, and pro-atherogenic condition of severe preeclampsia could explain these increases, which normally occur after the first trimester [74]. Hypoadiponectinemia in the first trimester of pregnant women who later developed PE implies that this adipocytokine is involved in PE etiology [16, 17]. Pregnancy is an inflammatory state associated with elevated plasma TNF-α, which could cause adiponectin levels to drop even further. An increase in TNF-α leads to an increase in endothelin levels [68] which constricts the blood vessels leading to high blood pressure [68]. Adiponectin appears to block the synthesis of angiotensin II, according to available evidence [76]. As adiponectin levels fall, angiotensin II levels rise, resulting in an increase in aldosterone levels. Hypertension results from a rise in aldosterone levels, which causes sodium and water retention.
When comparing pregnancies that resulted in PE to those that did not, this study discovered considerably greater resistin levels in PE pregnancies. A recent study found that preeclamptic pregnancies had higher levels of several adipokines, notably resistin, than healthy pregnant women [25]. Other studies, on the other hand, found no significant difference in resistin levels between preeclampsia patients and healthy pregnant women [77, 78]. Women with PE had significantly lower resistin levels than normotensive women of the same gestational age, according to some studies [46]. The involvement of resistin in the pathophysiology of PE is indicated by the rise in resistin levels months before the clinical diagnosis of PE. Resistin levels in the blood have been associated with coronary artery disease [43]. Resistin levels in the blood have been linked to a number of inflammatory indicators, including C-reactive protein, soluble TNF-α receptor-2, IL-6, and lipoprotein-associated phospholipase A2 [43]. Increased levels of endothelin result from increased TNF-α receptor-2 and IL-6 concentrations, resulting in high blood pressure [68].
Plasma visfatin levels were shown to be considerably higher during PE in our research. Visfatin levels rose during PE from the first trimester onwards, suggesting that visfatin may play a role in the disease’s development. Visfatin is widely expressed in adipose tissue, placenta, and fetal membranes [48]. Visfatin concentrations in the second and third trimesters of normal pregnancy have been found to be higher than those in the first trimester [79] indicating that this protein is produced by the placenta and fetal membrane. Thus, it’s probable that normal visfatin production is regulated to support the growing baby; yet, in some pregnancies, visfatin’s supporting role may be interrupted, resulting in PE. Our findings are consistent with one of similar research which showed greater visfatin levels in the PE compared to normal pregnancy [80]. One study found no significant differences between normal and preeclamptic pregnancies [54] while another found lower levels [53]. Different researchers’ reports on visfatin levels during pregnancy could be attributed to variances in sample procedures, ethnic or geographical differences, or the specific test methods used. This study’s findings imply that visfatin levels rise before preeclampsia develops.
Visfatin’s potential as a marker of preeclampsia, particularly in obese women, will need to be explored further with bigger sample size. Such research will add to the body of knowledge on how to predict this disease and how to start intervention programs to reduce maternal and fetal morbidity and mortality from PE.
The fact that the AUCs and respective sensitivities and specificities did not significantly change after controlling for family history of hypertension (Table 4) shows that these biomarkers can predict PE independently regardless of family history of hypertension. When maternal weight was taken into account (Table 3), these adipokines were found to be ineffective in predicting PE in women of normal weight (BMI 18.5–24.9 kg/m2). However, the fact that the overweight group (BMI 25–29.9 kg/m2) fared better in terms of predicting these adipokines than the obese group (BMI 30.0 kg/m2) implies a possible negative feedback mechanism that lowers plasma concentrations of these peptides as weight rises. To explain this occurrence, more research with bigger sample size is needed.
This study found that overweight pregnant women are more likely than normal-weight pregnant women to get PE during their pregnancy, corroborating an earlier study that found that the likelihood of developing PE increased by two to three times in women with a higher BMI [81] and also similar to another study, which associated higher maternal BMI to a number of pregnancy complications including PE [82]. In addition, this study backs up a recent analysis that showed that advanced maternal age, especially, 35 years or more was a risk factor for preeclampsia [83] as well as a BMI greater than 30 kg/m2 [84]. Obesity may play a role in the development of PE, according to the findings of this study. Obesity affects nitric oxide production and causes endothelial dysfunction [85] therefore an excessive buildup of fat in a pregnant woman could lead to hypertension during pregnancy which could lead to PE.
With the exception of HDL cholesterol, which was considerably lower in the PE group (Table 1) compared to the normotensive group, this investigation found no significant differences in lipids between women who acquired PE and those who remained normotensive during pregnancy. This study contradicts a report by Brazilian researchers who found a substantial difference in TG-rich proteins (VLDL 1) and small dense lipoprotein (LDL III) in women with PE compared to normal pregnant women [86]. Our findings contrast with those published in the Cape Coast region of Ghana, where researchers found substantial dyslipidemia in women with PE compared to women without PE [57]. The variations could be related to the different stages of pregnancy during which the samples were taken. The samples for this study were taken before the commencement of PE, whereas the samples for the other investigations were taken after the disease had begun to manifest. The lack of a significant difference in first trimester lipids between those who got PE and those who did not show that the atherogenic lipid profile commonly seen in pregnant women as reported by other researchers may be insufficient in predicting the chance of getting PE. However, because lower HDL is a substantial risk factor for hypertension, it’s probable that the significantly lower HDL seen in individuals who went on to develop PE was linked to the disease’s etiology [87]. Adiponectin and resistin were found to be more significant and better predictors of PE than leptin and visfatin after correcting for these potential confounding variables (age, parity, BMI, family history of diabetes, and preeclampsia). Angiotensin II production is reduced by adiponectin [76] while resistin is linked to elevations in TNF-α receptor-2 and IL-6, and so promotes high blood pressure [43], leading to an increased level of endothelin which constricts blood vessels and raises high blood pressure [68]. A family history of PE has been linked to a threefold increase in the chance of developing PE [88, 89] however, we did not detect a significant link between PE and a family history of hypertension which is likely attributable to the fact that the data obtained from the participants in this study was focused on hypertension in general rather than PE.
According to the findings of this study, obesity may play a role in the development of PE. Obesity induces endothelial dysfunction by reducing nitric oxide production [85], hence if a pregnant woman has an excessive amount of fat on her body, she may develop hypertension and, as a result, PE. Obesity and having four or more children were discovered to be significant PE confounders.
The study’s limitations were limited sample size and insufficient information regarding the individuals’ nutritional state. Potassium is abundant in leafy greens like spinach and kale, as well as cherries and red beets. Potassium operates on the kidneys, allowing the salt to be excreted more easily through the kidneys, decreasing blood pressure. Because of the small sample size and lack of nutritional data, conclusions about the association between these adipocytokines and preeclampsia may be difficult to draw, since nutritional status could not be controlled in the multivariate analysis.
PE was found to be significantly predicted by low adiponectin and high leptin, resistin, and visfatin, with resistin being the greatest predictor when stratified by BMI categories. After controlling for age, parity, BMI, and family history of diabetes and preeclampsia, adiponectin was the greatest predictor.
Adiponectin concentration in patients with PE starts decreasing as early as 11 weeks of pregnancy and continues to decrease until after 24th weeks of pregnancy when proteinuria becomes apparent and blood pressure rises to an abnormal level and consequently, preeclampsia develops. The decrease in adiponectin contributes to the pathogenesis of PE and can be used to predict this disease.
Leptin concentration starts increasing by 11 weeks of pregnancy in patients who subsequently develop PE. The increase in leptin correlates with proteinuria and elevated systolic and diastolic blood pressure irrespective of maternal age and BMI and hence could be involved in the pathogenesis of GDM.
Resistin in pregnant women who go on to develop PE starts increasing between 11 and 13 weeks of gestation culminating in an excessive increase in blood pressure accompanied by proteinuria by 24 weeks of gestation when a diagnosis of PE becomes apparent.
Visfatin in pregnancies complicated by PE starts increasing during the first trimester of pregnancy and continues to increase until the second trimester when blood pressure increases resulting in the diagnosis of PE in women with concomitant proteinuria. This suggests that hypervisfatinemia can be used to predict hypertensive disorders during pregnancy and hence involved in the pathogenesis of PE.
Our findings suggest that BMI may have an effect on adiponectin, leptin, resistin, and visfatin, as well as a possible negative feedback mechanism in the metabolism of these adipocytokines during pregnancy. More importantly, BMI does not appear to have an effect on the predictive ability of these PE signaling molecules. Advanced maternal age was shown to be an important factor in the development of PE.
These biomarkers can be used in combination with maternal characteristics for the early prediction of PE. This will help health care providers to institute measures such as diet control, medication, and exercises tailored for pregnant women with these risk factors so as to reduce the incidence of preeclampsia.
Prof. Francis Agyemang Yeboah, Department of Molecular Medicine, School Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Telephone: +233 24 5005500. Email: drfay1801@gmail.com.
Prof. Robert Amadu Ngala, Department of Molecular Medicine, School Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Telephone: +233 207722162. Email: rngala2000@yahoo.com.
Mr. Salifu Nanga, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana. Telephone: +233 243667951. Email: snanga@uhas.edu.
The authors declare no conflict of interest.
BMI | body mass index |
PE | preeclampsia |
ADP | adiponectin |
LP | leptin |
RTN | resistin |
VF | visfatin |
TG | triglycerides |
TC | total cholesterol |
HDL | high-density lipoprotein cholesterol |
LDL | low-density lipoprotein cholesterol |
VLDL | very low-density lipoprotein cholesterol |
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The effect of factors (such as, nanoparticle size, nanofluid concentration, flowrate of nanofluid and geometry of channel containing nanofluid) influencing the efficiency of PV systems has been discussed. Collective results of different researchers indicate that the efficiency of the PV/T systems (using nanofluids as coolant) increases with increasing flowrate. Efficiency of these systems increases with increasing concentration of nanofluid up to a certain amount, but as the concentration gets above this certain value, the efficiency tends to decline due to agglomeration/clustering of nanoparticles. Pertaining to the most recent studies, stability of nanoparticles is still the major unresolved issue, hindering the commercial scale application of nanofluids for the cooling of PV panels. Eventually, the environmental and economic advantages of these systems are presented.",book:{id:"6514",slug:"microfluidics-and-nanofluidics",title:"Microfluidics and Nanofluidics",fullTitle:"Microfluidics and Nanofluidics"},signatures:"Hafiz Muhammad Ali, Tayyab Raza Shah, Hamza Babar and\nZargham Ahmad Khan",authors:[{id:"187624",title:"Dr.",name:"Hafiz Muhammad",middleName:null,surname:"Ali",slug:"hafiz-muhammad-ali",fullName:"Hafiz Muhammad Ali"},{id:"229676",title:"Mr.",name:"Hamza",middleName:null,surname:"Babar",slug:"hamza-babar",fullName:"Hamza Babar"},{id:"241251",title:"Mr.",name:"Tayyab",middleName:"Raza",surname:"Raza Shah",slug:"tayyab-raza-shah",fullName:"Tayyab Raza Shah"},{id:"241252",title:"Mr.",name:"Zargham Ahmad",middleName:null,surname:"Khan",slug:"zargham-ahmad-khan",fullName:"Zargham Ahmad Khan"}]},{id:"59009",doi:"10.5772/intechopen.72505",title:"Thermal Transport and Challenges on Nanofluids Performance",slug:"thermal-transport-and-challenges-on-nanofluids-performance",totalDownloads:1721,totalCrossrefCites:4,totalDimensionsCites:15,abstract:"Progress in technology and industrial developments demands the efficient and successful energy utilization and its management in a greater extent. Conventional heat-transfer fluids (HTFs) such as water, ethylene glycol, oils and other fluids are typically low-efficiency heat dissipation fluids. Thermal management is a key factor in diverse applications where these fluids can be used, such as in automotive, microelectronics, energy storage, medical, and nuclear cooling among others. Furthermore, the miniaturization and high efficiency of devices in these fields demand successful heat management and energy-efficient materials. The advent of nanofluids could successfully address the low thermal efficiency of HTFs since nanofluids have shown many interesting properties, and the distinctive features offering extraordinary potential for many applications. Nanofluids are engineered by homogeneously suspending nanostructures with average sizes below 100 nm within conventional fluids. This chapter aims to focus on a detail description of the thermal transport behavior, challenges and implications that involve the development and use of HTFs under the influence of atomistic-scale structures and industrial applications. Multifunctional characteristics of these nanofluids, nanostructures variables and features are discussed in this chapter; the mechanisms that promote these effects on the improvement of nanofluids thermal transport performance and the broad range of current and future applications will be included.",book:{id:"6514",slug:"microfluidics-and-nanofluidics",title:"Microfluidics and Nanofluidics",fullTitle:"Microfluidics and Nanofluidics"},signatures:"José Jaime Taha-Tijerina",authors:[{id:"182402",title:"Dr.",name:"Jose",middleName:"Jaime",surname:"Taha-Tijerina",slug:"jose-taha-tijerina",fullName:"Jose Taha-Tijerina"}]},{id:"57228",doi:"10.5772/intechopen.71002",title:"Thresholding Algorithm Optimization for Change Detection to Satellite Imagery",slug:"thresholding-algorithm-optimization-for-change-detection-to-satellite-imagery",totalDownloads:1639,totalCrossrefCites:6,totalDimensionsCites:11,abstract:"To detect changes in satellite imagery, a supervised change detection technique was applied to Landsat images from an area in the south of México. At first, the linear regression (LR) method using the first principal component (1-PC) data, the Chi-square transformation (CST) method using first three principal component (PC-3), and tasseled cap (TC) images were applied to obtain the continuous images of change. Then, the threshold was defined by statistical parameters, and histogram secant techniques to categorize as change or unchanged the pixels. A threshold optimization iterative algorithm is proposed, based on the ground truth data and assessing the accuracy of a range of threshold values through the corresponding Kappa coefficient of concordance. Finally, to evaluate the change detection accuracy of conventional methods and the threshold optimization algorithm, 90 polygons (15,543 pixels) were sampled, categorized as real change/unchanged zones, and defined as ground truth, from the interpretation of color aerial photo slides aided by the land cover maps to obtain the omission/commission errors and the Kappa coefficient of agreement. The results show that the threshold optimization is a suitable approach that can be applied for change detection analysis.",book:{id:"6126",slug:"colorimetry-and-image-processing",title:"Colorimetry and Image Processing",fullTitle:"Colorimetry and Image Processing"},signatures:"René Vázquez-Jiménez, Rocío N. Ramos-Bernal, Raúl Romero-\nCalcerrada, Patricia Arrogante-Funes, Sulpicio Sanchez Tizapa and\nCarlos J. 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Examples (with emphasis on those from the authors’ laboratory) are highlighted. Among them, they involve plasma miniaturization via microplasma formation inside micro-fluidic (and in some cases millifluidic) channels fabricated on 2D and 3D-chips. Questions addressed include: How small plasmas can be made? What defines their fundamental size-limit? How small analytical plasmas should be made? And what is their ignition voltage? The discussion then continues with the science, technology and applications of nanofluidics. The conclusions include predictions on potential future development of portable instruments employing either micro or nanofluidic channels. Such portable (or mobile) instruments are expected to be controlled by a smartphone; to have (some) energy autonomy; to employ Artificial Intelligence and Deep Learning, and to have wireless connectivity for their inclusion in the Internet-of-Things (IoT). In essence, those that can be used for chemical analysis in the field for “bringing part of the lab to the sample” types of applications.",book:{id:"6514",slug:"microfluidics-and-nanofluidics",title:"Microfluidics and Nanofluidics",fullTitle:"Microfluidics and Nanofluidics"},signatures:"Vassili Karanassios",authors:[{id:"60925",title:"Prof.",name:"Vassili",middleName:null,surname:"Karanassios",slug:"vassili-karanassios",fullName:"Vassili Karanassios"}]}],mostDownloadedChaptersLast30Days:[{id:"53106",title:"Dynamical Particle Motions in Vortex Flows",slug:"dynamical-particle-motions-in-vortex-flows",totalDownloads:2264,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Circular vortex flows generate interesting self-organizing phenomena of particle motions, that is, particle clustering and classification phenomena. These phenomena result from interaction between vortex dynamics and relaxation of particle velocity due to drag. This chapter introduces particle clustering in stirred vessels and particle classification in Taylor vortex flow based on our previous research works. The first part of this chapter demonstrates and explains a third category of solid-liquid separation physics whereby particles spontaneously localize or cluster into small regions of fluids by taking the clustering phenomena in stirred vessels as an example. The second part of this chapter discusses particle classification phenomena due to shear-induced migration. Finally, this chapter discusses about process intensification utilizing these self-organizing phenomena of particle motions in vortex flows.",book:{id:"5370",slug:"vortex-dynamics-and-optical-vortices",title:"Vortex Dynamics and Optical Vortices",fullTitle:"Vortex Dynamics and Optical Vortices"},signatures:"Steven Wang and Naoto Ohmura",authors:[{id:"186403",title:"Prof.",name:"Naoto",middleName:null,surname:"Ohmura",slug:"naoto-ohmura",fullName:"Naoto Ohmura"},{id:"187311",title:"Dr.",name:"Steven",middleName:null,surname:"Wang",slug:"steven-wang",fullName:"Steven Wang"}]},{id:"67203",title:"Introductory Chapter: Swirling Flows and Flames",slug:"introductory-chapter-swirling-flows-and-flames",totalDownloads:1643,totalCrossrefCites:0,totalDimensionsCites:2,abstract:null,book:{id:"7409",slug:"swirling-flows-and-flames",title:"Swirling Flows and Flames",fullTitle:"Swirling Flows and Flames"},signatures:"Toufik Boushaki",authors:[{id:"101545",title:"Dr.",name:"Toufik",middleName:null,surname:"Boushaki",slug:"toufik-boushaki",fullName:"Toufik Boushaki"}]},{id:"53651",title:"Vortex Spinning System and Vortex Yarn Structure",slug:"vortex-spinning-system-and-vortex-yarn-structure",totalDownloads:5014,totalCrossrefCites:1,totalDimensionsCites:5,abstract:"Studying the yarn formation with the swirling air concept arouse of interest of the researchers for a long time because it appears to be easy to understand as a spinning principle. These kinds of systems are known as the vortex yarn spinning systems. The air-jet spinning methods have been developed since it is possible to eliminate the movable elements as the spindle and the traveler in ring spinning or the centrifuge in rotor spinning. The success of Murata vortex spinning (MVS) system which is the newest system after all studies of air-jet systems has been much acceptable especially for the spinning ability of 100% cotton in high speeds (500 m/min) and the yarn structure resembling ring yarn structure rather than rotor yarns. This study summarizes the historical background of vortex spinning, the spinning principle and the structure of the yarn spun on this system, as well as the factors influencing the yarn quality and finally the developments in vortex spinning technology.",book:{id:"6028",slug:"vortex-structures-in-fluid-dynamic-problems",title:"Vortex Structures in Fluid Dynamic Problems",fullTitle:"Vortex Structures in Fluid Dynamic Problems"},signatures:"Gizem Karakan Günaydin and Ali Serkan Soydan",authors:[{id:"186277",title:"Dr.",name:"Gizem",middleName:null,surname:"Karakan Günaydin",slug:"gizem-karakan-gunaydin",fullName:"Gizem Karakan Günaydin"},{id:"186607",title:"Dr.",name:"Ali",middleName:null,surname:"Serkan Soydan",slug:"ali-serkan-soydan",fullName:"Ali Serkan Soydan"}]},{id:"59009",title:"Thermal Transport and Challenges on Nanofluids Performance",slug:"thermal-transport-and-challenges-on-nanofluids-performance",totalDownloads:1724,totalCrossrefCites:4,totalDimensionsCites:15,abstract:"Progress in technology and industrial developments demands the efficient and successful energy utilization and its management in a greater extent. Conventional heat-transfer fluids (HTFs) such as water, ethylene glycol, oils and other fluids are typically low-efficiency heat dissipation fluids. Thermal management is a key factor in diverse applications where these fluids can be used, such as in automotive, microelectronics, energy storage, medical, and nuclear cooling among others. Furthermore, the miniaturization and high efficiency of devices in these fields demand successful heat management and energy-efficient materials. The advent of nanofluids could successfully address the low thermal efficiency of HTFs since nanofluids have shown many interesting properties, and the distinctive features offering extraordinary potential for many applications. Nanofluids are engineered by homogeneously suspending nanostructures with average sizes below 100 nm within conventional fluids. This chapter aims to focus on a detail description of the thermal transport behavior, challenges and implications that involve the development and use of HTFs under the influence of atomistic-scale structures and industrial applications. Multifunctional characteristics of these nanofluids, nanostructures variables and features are discussed in this chapter; the mechanisms that promote these effects on the improvement of nanofluids thermal transport performance and the broad range of current and future applications will be included.",book:{id:"6514",slug:"microfluidics-and-nanofluidics",title:"Microfluidics and Nanofluidics",fullTitle:"Microfluidics and Nanofluidics"},signatures:"José Jaime Taha-Tijerina",authors:[{id:"182402",title:"Dr.",name:"Jose",middleName:"Jaime",surname:"Taha-Tijerina",slug:"jose-taha-tijerina",fullName:"Jose Taha-Tijerina"}]},{id:"61556",title:"Microfluidics and Nanofluidics: Science, Fabrication Technology (From Cleanrooms to 3D Printing) and Their Application to Chemical Analysis by Battery-Operated Microplasmas-On-Chips",slug:"microfluidics-and-nanofluidics-science-fabrication-technology-from-cleanrooms-to-3d-printing-and-the",totalDownloads:1850,totalCrossrefCites:6,totalDimensionsCites:10,abstract:"The science and phenomena that become important when fluid-flow is confined in microfluidic channels are initially discussed. Then, technologies for channel fabrication (ranging from photolithography and chemical etching, to imprinting, and to 3D-printing) are reviewed. The reference list is extensive and (within each topic) it is arranged chronologically. Examples (with emphasis on those from the authors’ laboratory) are highlighted. Among them, they involve plasma miniaturization via microplasma formation inside micro-fluidic (and in some cases millifluidic) channels fabricated on 2D and 3D-chips. Questions addressed include: How small plasmas can be made? What defines their fundamental size-limit? How small analytical plasmas should be made? And what is their ignition voltage? The discussion then continues with the science, technology and applications of nanofluidics. The conclusions include predictions on potential future development of portable instruments employing either micro or nanofluidic channels. Such portable (or mobile) instruments are expected to be controlled by a smartphone; to have (some) energy autonomy; to employ Artificial Intelligence and Deep Learning, and to have wireless connectivity for their inclusion in the Internet-of-Things (IoT). In essence, those that can be used for chemical analysis in the field for “bringing part of the lab to the sample” types of applications.",book:{id:"6514",slug:"microfluidics-and-nanofluidics",title:"Microfluidics and Nanofluidics",fullTitle:"Microfluidics and Nanofluidics"},signatures:"Vassili Karanassios",authors:[{id:"60925",title:"Prof.",name:"Vassili",middleName:null,surname:"Karanassios",slug:"vassili-karanassios",fullName:"Vassili Karanassios"}]}],onlineFirstChaptersFilter:{topicId:"224",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"\r\n\tSustainable approaches to health and wellbeing in our COVID 19 recovery needs to focus on ecological approaches that prioritize our relationships with each other, and include engagement with nature, the arts and our heritage. This will ensure that we discover ways to live in our world that allows us and other beings to flourish. We can no longer rely on medicalized approaches to health that wait for people to become ill before attempting to treat them. We need to live in harmony with nature and rediscover the beauty and balance in our everyday lives and surroundings, which contribute to our well-being and that of all other creatures on the planet. This topic will provide insights and knowledge into how to achieve this change in health care that is based on ecologically sustainable practices.
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