\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\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:"6658",leadTitle:null,fullTitle:"Stromal Cells - Structure, Function, and Therapeutic Implications",title:"Stromal Cells",subtitle:"Structure, Function, and Therapeutic Implications",reviewType:"peer-reviewed",abstract:"Stromal cells are connective tissue cells of any organ, and they support the function of the parenchymal cells of that particular organ. Stromal/stromal stem cells are fundamentally a heterogeneous population of cells with contradictory differentiation potential depending upon their environmental niche. Stromal cell biology is not only intriguing, but equally stromal cell ontogeny in vivo remains challenging. In recent years there has been substantial advances in our understanding of stromal cell biology, especially stromal cell isolation, characterization, differentiation, and interactions in physiological (epithelial-stromal interactions) as well as pathophysiological (stromal-cancer interactions) contexts. In addition, stromal cells are also utilized more and more as a therapeutic tool not only in the field of gene therapy but also in the translational field of tissue engineering and regenerative medicine. Therefore, the goal of this book is to consolidate the recent advances in the area of stromal/stromal stem cell biology covering a broad range of interrelated topics in a timely fashion and to disseminate that knowledge in a lucid way to a greater scientific audience. This book will prove highly useful for students, researchers, and clinicians in stem cell biology, developmental biology, cancer biology, pathology, oncology, as well as tissue engineering and regenerative medicine. This quick reference will benefit anyone desiring a thorough overview of stromal cell structure, function, and its therapeutic implications.",isbn:"978-1-78984-985-1",printIsbn:"978-1-78984-984-4",pdfIsbn:"978-1-83881-624-7",doi:"10.5772/intechopen.71899",price:119,priceEur:129,priceUsd:155,slug:"stromal-cells-structure-function-and-therapeutic-implications",numberOfPages:260,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"c215f02d4268e4b7cccdaea141ec8647",bookSignature:"Mani T. Valarmathi",publishedDate:"January 23rd 2019",coverURL:"https://cdn.intechopen.com/books/images_new/6658.jpg",numberOfDownloads:12809,numberOfWosCitations:15,numberOfCrossrefCitations:12,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:30,numberOfDimensionsCitationsByBook:1,hasAltmetrics:0,numberOfTotalCitations:57,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 27th 2017",dateEndSecondStepPublish:"December 18th 2017",dateEndThirdStepPublish:"February 16th 2018",dateEndFourthStepPublish:"May 7th 2018",dateEndFifthStepPublish:"July 6th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",slug:"mani-t.-valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",biography:"Mani T. Valarmathi is currently Director of Research and Development at Religen Inc., a life science company in Pennsylvania, USA. He began his scientific career as a cancer geneticist but soon became captivated with the emerging and translational fields of stem cell biology, tissue engineering, and regenerative medicine. After obtaining a bachelor’s degree in Chemistry from the University of Madras, Chennai, Tamil Nadu, India, he obtained an MBBS in Medicine and Surgery and an MD in Pathology from the same university. Dr. Valarmathi also holds a Ph.D. in Medical Biotechnology from the All-India Institute of Medical Sciences, New Delhi, India. Over the past two decades, he has had extensive experience in research on various types of stem cells, focused on creating bioengineered human 3D vascularized tissues constructs for implantation purposes. At present, much of his research is directed towards developing innovative molecular genetic testing for precision and genetic medicine. He is a member of many prestigious national and international professional societies and scientific organizations, including the International Society for Stem Cell Research (ISSCR), Tissue Engineering and Regenerative Medicine International Society (TERMIS), American Association for Cancer Research (AACR), American Society for Investigative Pathology (ASIP), American Society for Clinical Pathology (ASCP), American Chemical Society (ACS), European Society of Cardiology (ESC), International Society for Heart Research (ISHR), American Society of Gene & Cell Therapy (ASGCT), and American Heart Association (AHA).",institutionString:"Religen Inc. | A Life Science Company, United States of America",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"4",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"990",title:"Stem Cell Research",slug:"medicine-cell-biology-stem-cell-research"}],chapters:[{id:"61988",title:"Stromal Stem Cells: Nature, Biology and Potential Therapeutic Applications",doi:"10.5772/intechopen.77346",slug:"stromal-stem-cells-nature-biology-and-potential-therapeutic-applications",totalDownloads:1053,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Stromal cells are connective tissue cells of any organ. Mesenchymal stromal cells (MSCs), are multipotent progenitors, which were first described by Caplan and colleagues in 1991. MSCs hold great potential for regenerative medicine because of their ability for self-renewal and differentiation into tissue-specific cells such as osteoblasts, chondrocytes, and adipocytes. Recent studies indicate that MSCs resemble pericytes and emerge from the peripheral stromal region surrounding blood vessels, thus clarifying their broad regenerative potential in adult tissues. The development of uniform protocols for both preparation and characterization of MSCs, including standardized functional assays for evaluation of their biological potential, are critical factors contributing to their clinical utility. Nowadays, due to the capacity of modulating immunological responses, supporting hematopoiesis and repairing tissues, MSCs have been widely used to treat immune-based disorders, such as Crohn’s disease, rheumatoid arthritis, diabetes, and multiple sclerosis. Based on animal experiments and clinical studies, the most successful clinical application of MSCs is in the field of hematological disease.",signatures:"Amira Hassouna, Marwa M. Abd Elgwad and Hoda Fahmy",downloadPdfUrl:"/chapter/pdf-download/61988",previewPdfUrl:"/chapter/pdf-preview/61988",authors:[{id:"239276",title:"Prof.",name:"Amira",surname:"Hassouna",slug:"amira-hassouna",fullName:"Amira Hassouna"},{id:"239999",title:"Dr.",name:"Marwa",surname:"Abdelgwad",slug:"marwa-abdelgwad",fullName:"Marwa Abdelgwad"},{id:"240000",title:"BSc.",name:"Hoda",surname:"Fahmy",slug:"hoda-fahmy",fullName:"Hoda Fahmy"}],corrections:null},{id:"62246",title:"Stromal Cell Ultrastructure",doi:"10.5772/intechopen.76870",slug:"stromal-cell-ultrastructure",totalDownloads:1092,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Regenerative medicine and tissue engineering therapies present an attractive treatment alternative to the current traditional clinical treatments. Stem cells are capable of self-renewal and multilineage differentiation. They also have the ability to create immunomodulatory microenvironment, and thus help to minimize organ damage caused by the inflammation and cells activated by the immune system. Human bone marrow mesenchymal stem/stromal cells (MSCs) have great potential for cellular therapy, as they possess the abilities to proliferate as well as to differentiate. MSCs are present in all tissues interacting with tissue cells and easy to isolate and expand in culture. Indeed, histological examination of MSCs is one of the main goals for studying their morphology. Both the light and the electron microscopes are essential tools where the histologist can identify the structure as well as the detailed ultrastructure of these cells. This will guide users to clearly understand their behavior, both in vivo and in vitro. Thus, the aim of this chapter is to give a spot of light on these cells and their histology.",signatures:"Amany A. Moneim Solaiman",downloadPdfUrl:"/chapter/pdf-download/62246",previewPdfUrl:"/chapter/pdf-preview/62246",authors:[{id:"237379",title:"Prof.",name:"Amany",surname:"Solaiman",slug:"amany-solaiman",fullName:"Amany Solaiman"}],corrections:null},{id:"61053",title:"Adult Stem Cell Membrane Markers: Their Importance and Critical Role in Their Proliferation and Differentiation Potentials",doi:"10.5772/intechopen.76869",slug:"adult-stem-cell-membrane-markers-their-importance-and-critical-role-in-their-proliferation-and-diffe",totalDownloads:1336,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The stem cells are part of the cells that belong to the stromal tissue. These cells remain in a quiescent state until they are activated by different factors, usually those generated by an alteration in the parenchymal tissue. These cells have characteristic membrane markers such as CD73, CD90, and CD105. Those are a receptor, which in response to their ligand induces strong changes in different metabolic pathways that lead to these cells, both to generate molecules with different activities and to leave their stationary phase to reproduce and even differentiate. This review describes the metabolic pathways dependent on these membrane markers and how they influence on parenchymal tissue and other stromal cells.",signatures:"Maria Teresa Gonzalez Garza",downloadPdfUrl:"/chapter/pdf-download/61053",previewPdfUrl:"/chapter/pdf-preview/61053",authors:[{id:"181389",title:"Ph.D.",name:"Maria Teresa",surname:"Gonzalez Garza",slug:"maria-teresa-gonzalez-garza",fullName:"Maria Teresa Gonzalez Garza"}],corrections:null},{id:"63314",title:"Multipotent Stromal Cells in a Tumor Microenvironment",doi:"10.5772/intechopen.77345",slug:"multipotent-stromal-cells-in-a-tumor-microenvironment",totalDownloads:1170,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Multipotent mesenchymal stromal cells [also referred to as mesenchymal stem cells (MSCs)] as was previously described, are a heterogeneous subset of stromal cells with regenerative potential. Their present tropism for inflamed sites including tumors lesion may be adverse or therapeutic effects arising from MSC administration; in this context, their potential for producing trophic and immunomodulatory factors raises the question as to whether MSCs promote or interact with a tumor microenvironment. Previous studies show a paradoxical effect regarding MSCs, which seems to depend on isolation and expansion, cells source, dose and both route and timing of administration. The occurrence of neoplastic transformation in ex vivo expanded MSCs after a long-term culture has been reported, however, this event has been subsequently described as uncommon, with an estimated frequency of <10−9. Furthermore, neither ectopic tissue formation nor MSC-originating tumors have ever been reported so far in hundreds of patients treated with MSC therapy. The biosafety of these cells, both in precancerous and cancerous environments, has been little investigated to date. We found in an animal model of oral cancer that locally or systemically administered allogeneic MSCs do not aggravate the progression of precancerous lesions. Moreover, they preclude cancer progression and tumor growth, particularly at papilloma stage.",signatures:"Flavia Alejandra Bruna",downloadPdfUrl:"/chapter/pdf-download/63314",previewPdfUrl:"/chapter/pdf-preview/63314",authors:[{id:"231261",title:"Ph.D.",name:"Flavia Alejandra",surname:"Bruna",slug:"flavia-alejandra-bruna",fullName:"Flavia Alejandra Bruna"}],corrections:null},{id:"63044",title:"Stromal-Epithelial Interactions during Mammary Gland Development",doi:"10.5772/intechopen.80405",slug:"stromal-epithelial-interactions-during-mammary-gland-development",totalDownloads:1414,totalCrossrefCites:2,totalDimensionsCites:7,hasAltmetrics:0,abstract:"Mammary gland is an organ, which undergoes the majority of its development in the postnatal life of mammals. The complex structure of the mammary gland comprises epithelial and myoepithelial cells forming the parenchymal tissue and adipocytes, fibroblasts, vascular endothelial cells, and infiltrating immune cell composing the stromal compartment. During puberty and in adulthood, circulating hormones released from the pituitary and ovaries regulate the rate of development and functional differentiation of the mammary epithelium. In addition, growing body of evidence shows that interactions between the stromal and parenchymal compartments of the mammary gland play a crucial role in mammogenesis. This regulation takes place on a paracrine level, by locally synthesized growth factors, adipokines, and cytokines, as well as via direct cell-cell interactions. This chapter summarizes the current knowledge about the complex nature of interactions between the mammary epithelium and stroma during mammary gland development in different mammalian species.",signatures:"Żaneta Dzięgelewska and Małgorzata Gajewska",downloadPdfUrl:"/chapter/pdf-download/63044",previewPdfUrl:"/chapter/pdf-preview/63044",authors:[{id:"165068",title:"Dr.",name:"Malgorzata",surname:"Gajewska",slug:"malgorzata-gajewska",fullName:"Malgorzata Gajewska"},{id:"249847",title:"Ms.",name:"Żaneta",surname:"Dzięgelewska",slug:"zaneta-dziegelewska",fullName:"Żaneta Dzięgelewska"}],corrections:null},{id:"61441",title:"Molecular Aberrations in Bone Marrow Stromal Cells in Multiple Myeloma",doi:"10.5772/intechopen.77179",slug:"molecular-aberrations-in-bone-marrow-stromal-cells-in-multiple-myeloma",totalDownloads:1160,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Multiple myeloma (MM) is a B-cell malignancy characterized by an accumulation of malignant plasma cells within the bone marrow. Bone marrow mesenchymal stromal cells (BMMSCs) represent a crucial component of MM microenvironment supporting its progression and proliferation. Alterations in BMMSC of MM (MM-BMMSC) have become an important research focus. In this study, we analyzed MM-BMMSC and their modification through interaction with plasma cells in 128 MM patients. MM-BMMSC displayed a senescence-like state that was accompanied by an increase in senescence-associated β-galactosidase activity, a reduced number of colony-forming units, an accumulation of cells in S phase of the cell cycle, and the overexpression of microRNAs (miR-16, miR-223, miR-485-5p, and miR-519d) and p21. MM-BMMSC showed a reduced expression of mitochondrial stress response protein SIRT3 and an increased mitochondrial DNA mass that led to a higher amount of reactive oxygen species compared to healthy donor BMMSC. The interaction between MM cells and MM-BMMSC is a complex mechanism that relies on multiple interacting signaling pathways. Observed aberrations in MM-BMMSC should be confirmed in an in vivo model in order to clarify the importance for the pathogenesis of MM. Eventually, the result of MM therapy could be improved by understanding the interaction between MM cells and MM-BMSCs.",signatures:"Olga Blau, Rimma Berenstein, Marlies Wächter, Axel Nogai, Aline\nKünel, Mirgul Bayanova and Igor Wolfgang Blau",downloadPdfUrl:"/chapter/pdf-download/61441",previewPdfUrl:"/chapter/pdf-preview/61441",authors:[{id:"64876",title:"Dr.",name:"Olga",surname:"Blau",slug:"olga-blau",fullName:"Olga Blau"},{id:"235638",title:"Dr.",name:"Rimma",surname:"Berenstein",slug:"rimma-berenstein",fullName:"Rimma Berenstein"},{id:"235640",title:"Dr.",name:"Axel",surname:"Nogai",slug:"axel-nogai",fullName:"Axel Nogai"},{id:"236425",title:"Mrs.",name:"Marlies",surname:"Waechter",slug:"marlies-waechter",fullName:"Marlies Waechter"},{id:"236427",title:"Prof.",name:"Igor Wolfgang",surname:"Blau",slug:"igor-wolfgang-blau",fullName:"Igor Wolfgang Blau"},{id:"236444",title:"Dr.",name:"Mirgul",surname:"Bayanava",slug:"mirgul-bayanava",fullName:"Mirgul Bayanava"},{id:"255247",title:"Dr.",name:"Aline",surname:"Kuehnel",slug:"aline-kuehnel",fullName:"Aline Kuehnel"}],corrections:null},{id:"61954",title:"Mesenchymal Stromal Cells as a Therapeutic Intervention",doi:"10.5772/intechopen.78586",slug:"mesenchymal-stromal-cells-as-a-therapeutic-intervention",totalDownloads:1385,totalCrossrefCites:0,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Mesenchymal stem cells, also known as mesenchymal stromal cells (MSCs), are a safe and promising biologic therapeutic for inducing tissue repair and regeneration in a broad array of chronic diseases. The mechanisms underlying the beneficial effects of MSCs include immunomodulation, reduction in inflammation and fibrosis, and stimulation of neovascularization and endogenous regeneration. Accumulating evidence from a multitude of clinical trials support the notion that both autologous and allogeneic MSCs are not only safe but also possess the capacity for repair of diverse organ systems and amelioration of multiple chronic disease processes. However, there are many questions regarding the underlying mechanisms of action, the most efficacious cell characteristics, tissue source, dose/concentration, route of delivery, and timing of administration, interactions with concurrent therapies, sustainability of effect, donor and patient characteristics, and adverse effects, including infections and malignancy, that remain to be resolved. Answering these questions will require well-designed and rigorously conducted multicenter clinical trials with well-established and defined clinical endpoints and appropriately defined patient populations, number of patients, and duration of follow-up. This chapter will review the current state of knowledge in the use of MSCs as a therapeutic strategy for organ structural and functional repair in chronic diseases.",signatures:"Ivonne Hernandez Schulman and Joshua M. Hare",downloadPdfUrl:"/chapter/pdf-download/61954",previewPdfUrl:"/chapter/pdf-preview/61954",authors:[{id:"47873",title:"Dr.",name:"Ivonne",surname:"Schulman",slug:"ivonne-schulman",fullName:"Ivonne Schulman"},{id:"200961",title:"Dr.",name:"Joshua",surname:"Hare",slug:"joshua-hare",fullName:"Joshua Hare"}],corrections:null},{id:"61652",title:"Therapeutic Strategies of Secretome of Mesenchymal Stem Cell",doi:"10.5772/intechopen.78092",slug:"therapeutic-strategies-of-secretome-of-mesenchymal-stem-cell",totalDownloads:1312,totalCrossrefCites:1,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Great progress has been made in the therapeutic strategies of multiple diseases that lack curative treatments with the transplantation of mesenchymal stem cells (MSC), such as in onco-hematological diseases, myocardial infarction (MI), cerebrovascular diseases, degenerative diseases of the nervous system (multiple sclerosis, Alzheimer’s disease), and diseases of the immune system, among others. Stem cells (SC) participate in the biological processes of tissue regeneration and repair through cell replication. Recently, the beneficial therapeutic effects of SCs that are generated by the release of proteins with paracrine actions and not by cell differentiation are more well known, and 80% of the therapeutic effect of SC is attributed to paracrine actions. The MSCs release large amounts of proteins and growth factors (GF), nucleic acids, proteasomes, exosomes, and microRNA, and membrane vesicles known as the secretome are released into the extracellular space, regulating multiple biological processes. Currently, the therapeutic strategies in tissue engineering (TE) and regenerative medicine (RM) are focused on the management of products derived from cells that act, both locally and remotely, in the affected tissue or organ, achieving regenerative actions. The application of new knowledge of the secretome initiates a change in the paradigm of regenerative therapy by knowing more about and using cell products derived from cells as a “factory” for biological drugs.",signatures:"Daniel Ascencio González, Rogelio Hernández Pando, Miguel Ángel\nGómez Lim, Sergio Ayala Fraustro and Aaron Torres Garcia",downloadPdfUrl:"/chapter/pdf-download/61652",previewPdfUrl:"/chapter/pdf-preview/61652",authors:[{id:"239293",title:"D.Sc.",name:"Daniel",surname:"Ascencio",slug:"daniel-ascencio",fullName:"Daniel Ascencio"},{id:"246399",title:"Dr.",name:"Rogelio",surname:"Hernández Pando",slug:"rogelio-hernandez-pando",fullName:"Rogelio Hernández Pando"},{id:"246640",title:"Dr.",name:"Miguel Ángel",surname:"Gómez Lim.",slug:"miguel-angel-gomez-lim.",fullName:"Miguel Ángel Gómez Lim."},{id:"246646",title:"Dr.",name:"Sergio",surname:"Ayala",slug:"sergio-ayala",fullName:"Sergio Ayala"},{id:"246691",title:"Dr.",name:"Aaron",surname:"Torres",slug:"aaron-torres",fullName:"Aaron Torres"}],corrections:null},{id:"61187",title:"Clinical Applications of Mesenchymal Stromal Cells (MSCs) in Orthopedic Diseases",doi:"10.5772/intechopen.76868",slug:"clinical-applications-of-mesenchymal-stromal-cells-mscs-in-orthopedic-diseases",totalDownloads:1064,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Mesenchymal stromal cells (MSCs) have the capacity for self-renewal and multi-lineage differentiation, have many advantages over other cells, and are thought to be one of the most promising cell sources for cell-based treatments. In fact, MSCs have already been widely applied in clinics as a treatment for numerous disorders, including orthopedic diseases, such as bone fracture, articular cartilage injury, osteoarthritis (OA), femoral head necrosis, degenerative disc, meniscus injury, osteogenesis imperfecta (OI), and other systemic bone diseases. With the progressions in R&D, the safety and efficacy of MSC-based treatments in orthopedic diseases have been largely recognized, but many challenges still exist. In this chapter, we intend to briefly update the recent progressions and discuss the potential issues in the target areas. Hopefully, our discussion would be helpful not only for the clinicians and the researchers in the specific disciplines but also for the general audiences.",signatures:"Jiazhao Yang, Shiyuan Fang, Lei Xu, Li Li, Kai Xie, Jinsen Lu, Hao\nWang, Xujin Wang and Lixin Kan",downloadPdfUrl:"/chapter/pdf-download/61187",previewPdfUrl:"/chapter/pdf-preview/61187",authors:[{id:"238560",title:"Dr.",name:"Lixin",surname:"Kan",slug:"lixin-kan",fullName:"Lixin Kan"},{id:"245732",title:"Dr.",name:"Yang",surname:"Jiazhao",slug:"yang-jiazhao",fullName:"Yang Jiazhao"},{id:"246322",title:"Dr.",name:"Shiyuan",surname:"Shiyuan",slug:"shiyuan-shiyuan",fullName:"Shiyuan Shiyuan"},{id:"246323",title:"Dr.",name:"Lei",surname:"Xu",slug:"lei-xu",fullName:"Lei Xu"},{id:"246325",title:"Dr.",name:"Li",surname:"Li",slug:"li-li",fullName:"Li Li"},{id:"246326",title:"Dr.",name:"Kai",surname:"Xie",slug:"kai-xie",fullName:"Kai Xie"},{id:"246327",title:"Dr.",name:"Jinsen",surname:"Lu",slug:"jinsen-lu",fullName:"Jinsen Lu"},{id:"246328",title:"Dr.",name:"Hao",surname:"Wang",slug:"hao-wang",fullName:"Hao Wang"},{id:"246329",title:"Dr.",name:"Xujin",surname:"Wang",slug:"xujin-wang",fullName:"Xujin Wang"},{id:"399459",title:"Dr.",name:"Shiyuan",surname:"Fang",slug:"shiyuan-fang",fullName:"Shiyuan Fang"}],corrections:[{id:"65668",title:"Corrigendum to: Clinical Applications of Mesenchymal Stromal Cells (MSCs) in Orthopedic Diseases",doi:null,slug:"corrigendum-to-clinical-applications-of-mesenchymal-stromal-cells-mscs-in-orthopedic-diseases",totalDownloads:null,totalCrossrefCites:null,correctionPdfUrl:null}]},{id:"61292",title:"Human Placenta-Derived Mesenchymal Stromal Cells: A Review from Basic Research to Clinical Applications",doi:"10.5772/intechopen.76718",slug:"human-placenta-derived-mesenchymal-stromal-cells-a-review-from-basic-research-to-clinical-applicatio",totalDownloads:1827,totalCrossrefCites:5,totalDimensionsCites:11,hasAltmetrics:0,abstract:"Placenta-derived mesenchymal stem/stromal cells (PMSC) present several aspects that make them more attractive as cellular therapy than their counterparts from other tissues, such as MSC from bone marrow or adipose tissue in regenerative medicine. Placenta-derived MSC have been used to treat a variety of disorders, such as, cancer, liver and cardiac diseases, ulcers, bone repair, and neurological diseases. Placenta-derived MSC are relatively new types of MSC with specific immunomodulatory properties and whose mechanisms are still unknown. Placenta-derived MSC secrete some soluble factors that seem to be responsible for their therapeutic effects, i.e., they have paracrine effects. On the other hand, Placenta-derived MSC can also serve as cellular vehicles and/or delivery systems for medications due to their migration capacity and their tropism for injury sites. Nanotechnology is an important field, which has undergone rapid development in recent years for the treatment of injured organs. Due to the special characteristics of placenta-derived MSC, the combination of these cells with nanotechnology will be a significant and highly promising field that will provide significant contributions in the regenerative medicine field in the near future.",signatures:"Paz de la Torre, María Jesús Pérez-Lorenzo and Ana I. Flores",downloadPdfUrl:"/chapter/pdf-download/61292",previewPdfUrl:"/chapter/pdf-preview/61292",authors:[{id:"79367",title:"Dr.",name:"Ana Isabel",surname:"Flores",slug:"ana-isabel-flores",fullName:"Ana Isabel Flores"},{id:"248114",title:"Dr.",name:"Paz",surname:"De La Torre",slug:"paz-de-la-torre",fullName:"Paz De La Torre"},{id:"248128",title:"MSc.",name:"Maria Jesus",surname:"Perez-Lorenzo",slug:"maria-jesus-perez-lorenzo",fullName:"Maria Jesus Perez-Lorenzo"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"7870",title:"Muscle Cells",subtitle:"Recent Advances and Future Perspectives",isOpenForSubmission:!1,hash:"64634d90d737661d1e606cac28b79969",slug:"muscle-cells-recent-advances-and-future-perspectives",bookSignature:"Mani T. 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\r\n\tAssisted Reproductive Technologies (ART) is a key technology for treating infertility, which occurs in 10-15% of the general population in reproductive age. This has been one of the most tumultuously developing interdisciplinary technologies in medicine in recent decades. Thanks to in vitro methods, more than 5 million children were born in the whole world. For 40 years, the success rates of this treatment have increased many times, respectively in the first years from less than 10% to more than 50% in present days (in some groups of patients). The reason for this rapid increase is the introduction of new drugs and stimulation protocols, improvement of embryo culture media, and the use of new types of laboratory equipment that improve the conditions for embryo development. Last but not least, the introduction of modern genetic methods, as well as new gamete and tissue freezing techniques, has improved the methods' diagnostic and therapeutic capabilities.
Forest is a conditional renewable resource which can be regenerated but needs a certain period of time to maintain its sustainable functioning. In India, the forest resources have been found to be depleting at a pace which is much high [1]. Rapid industrialization, urbanization and over-exploitation have resulted not only in decline but also in permanent loss of forest cover to an alarming rate [2]. The major driver behind all these factors is the uncontrolled population growth of humans which leads to the dramatic increase in the demand for wood and forest products. The over-exploitation of forest resources has taken place beyond the sustained yields to fulfil the needs of humans, thus bringing a change in the net forest cover [2, 3]. With the current rate of population explosion, the world population could be expected to increase from 7.6 billion to about 10 billion in the next 30 to 35 years [4]. The growing demand for food can be expected to rise by 50% in the given period, and it is a matter of serious concern. Rational utilization and proper management of the forest resources are the most viable ways to prevent mass destruction of forests and large-scale species extinction. It is necessary to find the links between the growing demands and meeting the demands in a sustainable manner. The scope of future studies must focus on the solution to establish this link by incorporating the principles of forestry, restoration ecology and natural resource economics.
Deforestation occurs when a land initially dominated by naturally occurring tree species is converted to provide certain services in response to the human demand. The UN Food and Agricultural Organization (FAO) has defined deforestation as
The value of forest is simple to understand but sometimes tough to quantify. The various values of the forest have been shown in Figure 1. Forest has a major contribution on the global economy and supports livelihood of the majority of rural populations in the world [7]. The direct uses of forest are most easy to quantify as it is directly related to economic returns. The indirect use and option value although play a major role in defining the valuation of the forest resources are seldom quantified and are being intangible in nature [8]. There is also a no-use value of the forest resources which considers leaving the current forest intact as a heritage for the future generation and for satisfaction and happiness of the current population. But, these eco-centric views alone cannot suffice the support for a change in policy and land use pattern. There are some other important values of forests that are difficult to quantify. One of the major roles that forests play is that it acts as a major carbon sink [9, 10, 11]. Plants utilize carbon dioxide in the process of photosynthesis and store it in the form of carbohydrates, and these carbohydrates reach the soil as dead organic matter and contribute to soil carbon sink. When forests are cleared, less CO2 is absorbed by plants, and atmospheric CO2 concentration increases with the passage of time due to unavailable sink. Also, there is a marked reduction in soil organic carbon with the loss of vegetation cover, thereby affecting the productivity of the ecosystem. Productivity is believed to be an indicator of carbon assimilation capacity, and hence the more productive the forests are, the more carbon it stores [12, 13, 14]. The tropical forests are among the most productive as well as the most threatened ecosystem in present time with the maximum rate of deforestation. Thus, it is imperative to control the rate of deforestation in order to avoid the adversities associated with it.
Different values of forests ecosystems
The value and functions of forests are immense and diverse. Similarly, the impacts of deforestation are global and commune the whole forest community. One of the major constraints in understanding the true impact of desertification on forests is the inadequacy and imprecise form of data.
The effect of large-scale deforestation is global, but it is necessary to assess its impacts on microclimate, regional climate and global climate to form a holistic understanding of mechanism [15]. The association of deforestation with the increased CO2 concentration in the atmosphere and changes in the mass balances and surface energy can result in climate change at the local and global level [16]. The change in land use pattern especially the clearing of forest cover affects both hydrometeorological and global CO2 concentrations leading to more warming as CO2 readily absorbs infrared radiation [17]. Clearing tree cover and vegetation leads to increase in albedo of the region as bare soil reflects more solar radiation than vegetation, which again is a factor for altering regional radiation flux [15, 18]. One of the noticeable changes in regional climates occurs when the cloud formation shifts to higher elevations from lowland plains as a result of deforestation in the later area [19]. In a global scale, deforestation leads to warmer and drier weather due to the synergistic effect of reduced evapotranspiration, increased albedo and CO2 concentration that triggers desertification, loss in biodiversity and melting of polar ice caps, ultimately leading to food insecurity. All these effects are successors of extremes in climate variation that are produced by the large-scale reduction in forest cover [20]. The estimated quantity of CO2 added to the atmosphere due to deforestation in the tropics is roughly two billion tonnes [21]. It is interesting to note that the CO2 emissions due to clearing of forest will almost be equivalent to 25% of what is added to the atmosphere due to anthropogenic emissions [22]. The shift in climate is somehow correlated to reducing forest cover. Further researches can clearly define the mechanisms and pathways by which these shifts are progressing and how they can be mitigated.
The global water cycle depends on the amount and distribution of precipitation for which one of the influencing factors is evapotranspiration [23]. There is a direct effect on drinking water on the basis of quality and quantity, fisheries and aquatic habitats, occurrence of flood and drought, life of dams on account of increase siltation and agriculture due to poor quality irrigation and crop yield [24, 25]. It must be recognized that the protective role of forests is operative and has a major impact on urban water resources [26]. Forests play an important role in maintaining the watersheds [27]. The degraded or degrading watersheds can be recovered by forestation, but once the forest or vegetation cover is lost, the watershed becomes vulnerable to erosion. This erosion leads to siltation in the downstream areas and consequently reduces the depth of river bed increasing the chances of flood. There are two main effects of deforestation that increase the chances of flooding. One is by reducing the tree fountain effect, i.e. interception and moisture uptake by the trees would cease after deforestation reducing the moisture holding capacity of soil that leads to greater runoff and erosion. And other is by the process of soil compaction and poor soil structure that will lead to reduced organic matter content of soil devoid of vegetation cover [28]. There are severe long-term effects on soil as a cause of deforestation. During slash-and-burn or shifting cultivation, an area of forests clears and exposes the bare soil to weather extremes of high solar insolation and heavy rainfall [29]. In the absence of the forest cover and organic matter, soil could not accommodate heavy precipitation, and the fertile layers of soil used to be easily washed away ultimately reduces the long-term productivity. The effect on soil is dependent on the interrelation and synergistic effect of evapotranspiration and infiltration that are directly altered due to loss in vegetation cover [23].
Deforestation directly increases erosion and siltation rates. There is an increased risk of flooding in Yangtze River basin in China and the major river basins in East Asia and the Amazonian basin [23, 30]. The slopes and terrains are more vulnerable to such situations. There are formations of shallow gullies which may be accounted for the concentrated flow of runoff that prevails due to long-term erosion. Cultivation and ploughing along the slopes cause rapid erosion in the areas with less vegetation cover [31]. In the Loess Plateau, the slopes of steepness greater than 15° showed shallow gully erosion as a result of cultivation activities [32]. The availability of dead vegetation can reduce the surface runoff from the early season rain and check soil erosion [33]. It is necessary to sustain the forest and vegetation cover to maintain the soil productivity and water quality of both the surface and underground sources.
Forests are very rich in biodiversity and store a vast gene pool, and the majority of species occur in the tropical forests. It consists of two-thirds of all known species and 65% of 10,000 species that are recognized as endangered by the International Union for Conservation of Nature (IUCN) [34]. The biodiversity could be regarded as an important asset that is necessary to conserve for future utilization. The World Health Organization states that the traditional people, almost 80% of them, rely on the local biodiversity for traditional medicines. A loss in the biodiversity may directly affect their health care and well-being [35]. Another most noticeable impact of deforestation is the increasing human-wildlife conflict. The decreasing forest cover is limiting the habitats of many species due to which is forcing them to intrude with human welfare [36]. There are increasing instances of invasion and animal killing. The northern margin of West Bengal, India, forms a significant portion of the Himalaya Biodiversity Hotspot. The area has observed heavy fragmentation in the last decade, and as a result, there was a huge loss in the agricultural crop and both human and elephant life due to conflicts. There are reports of mortality of 20 elephants and 50 persons annually from this area [37]. It is also estimated that if deforestation in the Himalayas continue at the current rate, the dense forest cover (>40% canopy cover) will be restricted to 10% of land area in the Indian Himalayas by 2100. This may lead to a significant loss of 366 endemic plants and 35 endemic vertebrates [38]. The loss in biodiversity is of global concern irrespective of regional and local importance. Conserving the forest and an increase in forest cover certainly find a positive correlation with the increase and sustenance of biodiversity. Conversion of forest land to agricultural fields and other land use could be a threat to major loss in biological diversity in the near future.
Forests contribute to the world economy in terms of timber production and other forest produces. There are different contributions of forest as a means of direct employment in forestry services and other value-added contributions as recreation and aesthetics. The loss of tropical forest cover annually may account for about 45 billion US dollars [39]. The destruction of forest eliminates the sources of economic gain directly obtained and also eliminates the potential gain from the resources that the forest sustains as biodiversity, soil and water. Also, the destruction of forest increases the negative externalities in the form of increasing CO2 concentration, risk of flood and human-wildlife conflict [40]. The proximity of settlements to protected areas further intensifies the chances of human-wildlife conflict (HWC). It is reported that settled households face high risk of HWC due to their close proximity of the Kanha National Park in Central India [41]. Deforestation has its social influence in the form of long-term effect. Development is a serious concern for indigenous community as it certainly leads to a change or shift of their culture and tradition. The cultural and religious aspects of the community are seldom preserved amid infrastructural advancement that leads to land and social conflict [42]. In a study of household survey from rural areas of Madhya Pradesh and Chhattisgarh state of India, it was found that the poorest of the local community gained about 30% of their living from forest produce which was claimed to be even higher than the returns from agriculture. Also, forest provides an option as safety net during the period of crisis in rural areas [43]. Various ecological services provided by the forests have been lost due to deforestation which in turn has immediate effects on the local communities dependent on these services for their daily needs. The inclusive approach for the sustainable management of forest resource is a vital consideration that considers economy as a subset of the society which in itself is a subset of the environment. Such considerations can help sustaining the constantly declining forest cover and its long-term impacts.
The forest cover was found to be increased by ca. 1% for the year 2017 which is 21.54% of the total geographic area when compared to that of forest cover status in 2015 which is a positive sign towards the constant efforts that are being put in to protect the forest (Figure 2). This positive change in the forest cover is mainly attributed to the conservation and management practices that include afforestation activities, participation of local peoples for better protection measures in plantation areas and traditional forest areas, expansion of trees outside forest, etc. Also, with this increase in the forest cover, the country has procured 8th position among the top 10 countries reporting the greatest annual forest area gain. Although there has been an increase in the total forest cover in India, still there are certain regions within the country that has sought a reduction in the same (Figure 3). The main reasons attributed for this reduction are shifting cultivation, rotational felling, other biotic pressures, diversion of forest lands for developmental activities, etc. [44]. A transition in the various forest cover classes has also occurred over the past. The present status of forest cover (%) of India belonging to various forest cover classes has been shown in Figure 4. It has been found that there is a reduction in the moderately dense forest and an increment in the open forest depicting degradation of forest cover to some extent. Changes within the forest cover classes result in decrease in the production capacity, thereby leading to forest degradation [45]. Control and regular check of these activities can help in strengthening the conservatory efforts of forest protection. This is the necessity of the present time to conserve the forests in order to sustain the vital ecosystems and the major carbon sink to combat the effects of global climate change and ultimately maintain the environmental balance.
Forest cover status in India for the last 30 years (1987 to 2017).
MODIS-based land use/land cover map of India for the year (a) 2001 and (b) 2017.
Forest cover (%) of India for the year 2017 (Source: [
Forests are an invaluable resource that is being subjected to so many threats. In order to protect our forests, it is very much necessary to understand the reasons behind their destruction. Differentiating the agents and causes of deforestation will enable in understanding the same [36]. Several disturbances within the forest directly or indirectly contribute in destruction of the forest. This can be interpreted from the results obtained while surveying in different forest patches in India.
Arunachal Pradesh is one of the states that has more than 75% forest cover and has the maximum very dense forest cover type [44]. The state is highly diverse in terms of climate as well as forest cover with tropical, sub-tropical, temperate and alpine forests having higher NDVI (≥7.0) [46]. However, the pressure on forest resources is consistently increasing with the rise in population, development activities, large number of wood-based industries and unsustainable land use practices resulting in their degradation [47]. This has also resulted in decrease in the forest cover of the state [44]. Several disturbances were being observed during the field survey in the forests of Arunachal Pradesh during 2007 to 2010. The major disturbances that were found include lopping, cut stumps, litter collection, soil removal, grazing, fire, NTFP collection and fuelwood collection (Figure 5). Of these, fuelwood collection was found to be the most recurrent activity followed by grazing. Generally, fuelwood collection has not been considered as the major cause of deforestation but leads to the same in certain regions with reduced forest area such as in the Philippines, Thailand and parts of Central America [36]. Forest fire has also been observed as an occasional event in certain parts of Arunachal Pradesh. Fires are generally used as a tool in clearing the forest for shifting cultivation which is one of the major agricultural practices performed in the state. Fires when used responsibly act as a valuable tool in managing forest and agriculture, but when abused, it can lead to deforestation [48, 49]. Other disturbances that can be an indicator of deforestation include NTFP collection and presence of cut stumps in certain forests. Forests of the state are highly diverse in endemic as well as nonendemic species, which need intensive monitoring and management to conserve the species-rich ecosystems from ever increasing anthropogenic pressure and changing climatic conditions [50].
Major disturbances in the forests of Arunachal Pradesh.
Madhya Pradesh is among one of the states of India which is endowed with rich and diverse forests and comprises the largest forest cover in the country [44]. This is mainly because of the efforts that the state has put in to conserve and harness this invaluable resource through innovative measures like community participation and decentralization (MP) [51]. Even after these continuous efforts, there are certain regions within the state where the occurrence of several types of disturbances in the forest has been found. The common disturbances that were being observed during the field survey (2017–2019) include fire, grazing, fuelwood collection, forage removal, litter collection, NTFP collection, lopping, thatch collection, root collection, soil removal, etc. (Figure 6). Among all these fire has been found as the major recurrent type of disturbance in the forests of Madhya Pradesh. Other major disturbances were grazing followed by fuelwood collection. Since every type of deforestation is not intentional but some which are the results of amalgamation of anthropogenic and natural factors like wildfires and subsequent overgrazing can prevent the growth of young trees [52] and thus eventually degrade the quality and productivity of the forest.
Major disturbances in the forests of Madhya Pradesh.
The name of the state ‘Jharkhand’ itself connotes ‘area of land covered with forests’ and has been exhibiting a unique relation with forests since time immemorial [53]. During the forest cover assessment [44], a net increase of 29 sq. km in the forest cover has been observed in the state which is mainly because of the plantation and conservation efforts within recorded forest areas. Although, there was an increment of 314 sq. km in the forest cover within the recorded forest areas, because of the felling of trees outside the forests area, its effect on forest cover has been offset. Also, several types of disturbances can be seen within the forest areas during the field survey (2016–2018), and the major disturbances were fuelwood collection, grazing, forage removal, lopping, cut stumps, thatch collection, root collection, soil removal, litter collection and NTFPs collection (Figure 7). Most of these disturbances were occasional in nature. Although these disturbances are not that recurrent, a regular check is necessary in order to prevent the forests from degrading and in achieving a sustainable forest cover. The forest management strategies should focus on the increasing demands of different timber and non-timber forest produce to conserve the plant diversity of the natural forests of the state [54].
Major disturbances in the forests of Jharkhand.
Forest management and protection by the local communities is an age-old practice in India which can be traced back to the protective nature of the Bishnoi Community of Rajasthan towards the local forest and animals as the black buck. The idea of community-based forest management emerged in an administrative level in the 1970s and 1980s. The declaration of the Government of India in June 1990 marked the establishment of Joint Forest Communities in different India states as per the National Forest Policy of 1988. The Earth Summit of 1992 provided with a clear objective of Sustainable Forest Management to which India responded in a positive way. From an increase in the forest cover, non-timber forest product (NTFP) to conservation of native flora and fauna, a whole new realm of forest management strategy by the collaboration of forest departments and local communities aided in decelerating the degradation of natural forest in India [55]. The Participatory Forest Management (PFM) is equivalent to an informal contract in which the local communities are allowed to consume a portion of harvest and NTFP if they protect and conserve it for 5–10 years. In India there is no legal authority of the local community on the forest resource where as in other countries as in Nepal the Community Forest User Groups (CFUG) are registered under their Forest Act, 1993 [56]. It is the positive effort of the local communities of India that the area under Joint Forest Management increased from 22,017,583 ha to 2,144,000 ha in March 2006 with 106,482 recognized Joint Forest Management committees countrywide [57].
Deforestation is a major environmental challenge which has been persistent from the past, and the situation is more worsened at present. Therefore, there is an urgent need to focus on the mitigative measures in order to prevent the distressing effects of deforestation in the near future. In order to alleviate the problem of deforestation, the strategies should be based on the underlying causes of the same. Also, the strategies for mitigating the problem of deforestation require its effective implementation that needs the recognition of the roles of national, state and municipal governments along with the pro-active role of the civil society and private society [36]. The continuous increase in the human population especially in the developing countries has resulted in enhanced pressure on the forests for human settlements and other land use practices. A reduction in the growth rate of human population plays a crucial role in reducing the practice of deforestation [36]. Alternatives to slash-and-burn agriculture can be adopted as a strategy to mitigate the deforestation by boosting the agricultural and forestry productions for the shifting cultivators ([58, 59]). The sustainable alternatives for slash-and-burn cultivation will assist the poor farmers in leading a better life without destroying additional forests [60]. Public policies and laws with greater security, accessibility to the minimal inputs required to maintain or enhance food production and an opportunity to the cultivators to market their products will aid in the sustainability of shifting cultivation systems [61].
Another strategy that can be applied to control the rate of deforestation is through the adoption of sustainable agroforestry, sustainable logging, agro-pastoral production systems, etc. [62]. The sustainable forest management practices can be promoted only if it is ecologically, economically and socially sustainable [36]. Agroforestry has been considered as one of the methods to curb deforestation which in turn aid in reduction of CO2 emissions and mitigation of climate change effect [63, 64]. The adoption of agroforestry practices has resulted in an increase in the income of agroforestry adopters as compared to that of non-agroforestry adopters and has also contributed towards improving soil fertility, reducing deforestation and conserving soil and water [65]. The provision of protected areas is one of the key steps towards an attempt to reduce deforestation which is generally motivated through biodiversity conservation [34]. Also, the global endeavours to reduce tropical deforestation are dependent heavily on the establishment of protected areas. It has been found that protection reduced deforestation as approximately 10% of the protected forests would have been deforested if they would have not been protected [66]. Tropical protected areas reduced deforestation which was liable for around one-tenth of total anthropogenic carbon emissions, thus playing a significant role in mitigating the effects of climate change and protecting biodiversity and ecosystem services [67]. Similarly, a total loss of 15.4% in the unprotected mangrove cover was compensated by the 15.7% rise in the protected mangrove cover (protected by government as per Ramsar Convention) which resulted in a net increase of 13.3% in mangrove cover across India in the last 25 years [68]. Implementation of forest certification can be among one of the strategies to control deforestation around the world. Forest certification is a process through which the producers identify their products in the marketplace and receive greater market accessibility and higher prices for their products by fulfilling certain stringent sustainable forestry standards [69]. Certification has played an important role in protecting Penten forests from 1986 to 2007, and the certified forests experience 20 times less deforestation than non-certified areas [70]. Thus, certification of forest can play a major role in controlling deforestation since the timber certification was found to be negatively related with deforestation, i.e. the increase in the certification process has resulted in a declination in the deforestation rate [71].
The Government of India has been continuously putting significant efforts in terms of conserving the forest resources. They have not only taken measures to conserve the present forest cover but also have initiated several measures to increase the forests and tree cover of the country. Both the national and state governments are jointly responsible for the sustainable management of the forest resources in India. Various steps, rules and laws have been brought and implemented in order to conserve the forest cover of India. Some of these rules and laws are [72]:
The Indian Forest Act, 1927: The act is an amalgamation of laws relating to forests, the transit of forest produce and the duty leviable on timber and other forest produces. It defines the procedures for declaring an area of a reserved forest, a protected forest or a village forest by the state government. With the amendment in the Act in 2012, it also prohibited the fresh clearances in forests and setting fire in a reserved forest.
Forest Conservation Act, 1980 (with an amendment in 1988): The main purpose of the proposition of this act was to conserve the forests and to look into the matters connected therewith or ancillary or incidental thereto. With the implementation of this act, a prior approval of the Central Government is required for any sort of diversion of forest areas for the non-forestry purposes.
[73]: The establishment of the National Forest Policy was also among one of the steps taken by the Government of India in order to ensure compensatory afforestation, essential environmental safeguards, sustainable utilization, maintenance, restoration and enhancement of forest areas.
Wildlife Protection Act, 1972: The wildlife protection act was enacted basically to protect wild animals, birds and plants and for matters connected therewith or ancillary or incidental thereto with a view to ensure the ecological and environmental security of the country.
The Scheduled Tribes and Other Traditional Forest Dwellers (Recognition of Forest Rights) Act, 2006: The act was framed with the purpose to recognize and vest the forest rights and occupation in forest land in forest dwelling scheduled tribes and other traditional forest dwellers who have been residing in such forests for generations but whose rights could not be recorded. These recognized rights of the forest dwelling scheduled tribes and other traditional forest dwellers include the responsibilities and authority for sustainable use, conservation of biodiversity and maintenance of ecological balance which in turn aid in strengthening the conservation regime of the forests while ensuring livelihood and food security of the forest dwellings scheduled tribes and other traditional forest dwellers.
Apart from these laws, the Government of India has also established Forest Survey of India (FSI), an organization under the Ministry of Environment, Forest and Climate Change, whose primary work is to gather and evaluate the country’s forest wealth through a nationwide survey to measure forest areas [74]. This in turn aids in determining the factors and drivers behind the loss or gain in forest cover of any particular region in India. Another council, i.e. the Compensatory Afforestation Fund Management and Planning Authority (CAMPA), was established by the Government of India in 2009 as a National Advisory Council under the chairmanship of the Union Minister of Environment, Forest and Climate Change for the monitoring, technical assistance and evaluation of compensatory afforestation activities. This was particularly meant to promote afforestation and regeneration activities as a way of compensating for forest land diverted to non-forest uses [75]. Certain scheme such as Integrated Forest Protection Scheme (IFPS) was being formulated by the government to save the forests from fire. The scheme was designed by combining the forest fire protection and management technique along with forest conservation. Various other missions and programmes such as the National Mission for a Green India (NMGI) and National Afforestation Programme (NAP) were also being launched by the Government of India where the main aim of NMGI was to improve the quality of five million hectares of degraded forests and to bring another five million hectares of non-forest areas under forest cover through social and farm forestry. On the other hand, the NAP was launched with the objective to develop the forest resources with people’s participation, with a focus on improving the livelihood of the forest-fringe communities, especially the poor [75].
The Ministry of Environment, Forest and Climate Change has been optimistic in strengthening the role of women in conservation of forest at local community levels since long. The National Forest Policy [73], for the first time, acknowledged the necessity of including woman members in forestry schemes. The Joint Forest Management Policy of 1990 mandated woman representatives not less than 40% in general body and 50% in executive body of the local forestry institutions like the JFM committee. Later in 2002, the Biodiversity Authority of India reframing the local biodiversity management committee structure mandated the reservation of one-third of its members as women. Thus, this understanding of the role of women in the local-level conservation measures and implementation of related rules has aided in improving the management of forest in rural regions of the country [76].
Lateral epicondylitis relates to pain in the humeral insertion of the hand extensor tendons, loss of hand grip strength and aggravation of the pain on grasping objects like turning the doorknob or handshaking [1, 2]. The name lateral epicondylitis is a misnomer in itself as it is not an inflammatory process but rather a tendinosis of the humeral insertion of the hand extensor muscles, usually the extensor carpi radialis brevis [3]. Despite its popular name—tennis elbow—only 5–10% of those suffering from it play tennis [4]. This condition arises from repetitive gripping with wrist extension, radial deviation and/or forearm supination [3, 5, 6], and its incidence is 1–3 per 1000 inhabitants/year [7, 8, 9, 10]. Lateral epicondylitis can be diagnosed clinically, as direct pressure to the lateral epicondyle reproduces the pain [11], and confirmed with the Thomsen test, in which resisted wrist extension with the elbow in an extended position aggravates the pain [12, 13]. It affects people aged 40–50 years with similar distribution between men and women [7] and can lead to work absenteeism and permanent work incapacities [2, 14].
In about 80% of cases of lateral epicondylitis, symptoms improve over a year [15, 16] often after the offending activity is stopped [17], but in the remaining 20%, it becomes a chronic condition [18].
Physical therapy is a first-line treatment [11, 18, 19, 20, 21], which can be supplemented with wrist orthoses [20].
Local steroid injections in the painful areas are commonly used in the treatment of lateral epicondylitis [16, 22] despite being associated with iatrogenic soft tissue calfication [23] and long-term poor outcomes in some cases [24, 25, 26].
Botulinum toxin injections weaken temporarily the hand extensor muscles facilitating the healing of the extensor tendon injury [27, 28, 29] but can induce weakness in wrist and finger extension, impairing hand grip [28].
Newer treatment modalities include injection in the lateral epicondyle of platelet-rich plasma [30, 31, 32, 33, 34], autologous whole blood [35, 36] and stem cell therapy [37, 38]. These are as effective as some more invasive techniques and thus are becoming increasingly popular [31].
Surgical treatment is indicated when all conservative treatments have failed, which occurs in 5–10% of the patients [39, 40, 41, 42]. Open surgical resection of the extensor carpi radialis brevis tendon was traditionally the gold standard [43, 44], but recently it is being reevaluated [45]. Some surgeons recommend more extensive procedures with simultaneous posterior interosseous nerve decompression and intra-articular pathology resolution [46], and others prefer collateral ligament repair [47]. To reduce the surgical aggressiveness, several arthroscopic extensor tendon release techniques have been introduced [48, 49, 50] finding that they render equivalent clinical results to the open surgical resection of the same anatomical structures [51, 52]. Further refinements are performing the extensor tendon release with an 18-gauge needle [53] or with ultrasound equipment [54]. On comparing open, arthroscopic and percutaneous procedures, no significant differences in clinical outcomes were observed [55], all of them rendering 10–20% of cases with persistent pain and functional incapacity [56, 57, 58, 59].
Moreover, lateral epicondyle innervation is provided by sensory branches coming mostly from the radial nerve [60, 61]. Open surgical removal of those branches was attempted [62, 63, 64], but it is an aggressive technique and yielded poor clinical results. Other nearby nerves also contribute to the lateral epicondyle pain perception such as the musculocutaneous, the median and the ulnar nerves [60, 65, 66]. Considering that the removal of the sensory branches from all of them was not feasible, other alternatives have been tried.
One of these alternatives is radiofrequency. Radiofrequency—both thermal and pulsed—is a well-stablished technique for chronic pain treatment [67, 68], but its application to recalcitrant cases of lateral epicondylitis is a relatively new procedure [69, 70]. The rationale was that the pulse radiofrequency modulates the nerve function and alters the pain transmission [71], while the thermal radiofrequency destroys the sensory nerve terminals and induces collagen fibre reorganization [72].
In 2005, Tasto et al. [70] were the first to report radiofrequency microtenotomy in the treatment of chronic lateral epicondyle pain that persisted after 6 months of conservative treatment. The procedure was performed with a Topaz Microdebrider device (ArthroCare, Sunnyvale, CA) through a 3 cm skin incision. In 13 patients and with a 24-month follow-up, they reported pain amelioration but did not quantify it. No complications were reported. It was Meknas et al. [69] in 2008 using the same equipment and 3 cm skin incision who compared the radiofrequency microtenotomy with the open surgical extensor tendon release and repair. At 18 months, both groups had similar pain relief rates, but hand grip strength improved only in the radiofrequency group. No side effects were reported. Further studies with more patients and longer follow-ups (7 [13] and 9 [73] years) confirmed these results [74, 75]. The reduced surgical aggressiveness correlated with a shorter operating time [13], lower rates of post-operative discomfort [76] and faster recoveries [75]. The percentage of patients with residual pain was 10% [75], similar to the reported for the open and arthroscopic procedures [57].
The next step was taken by Lin et al. [77] in 2011, where they investigated the applications of percutaneous radiofrequency. With a Radionics RFG-3C Generator (Radionics Inc., Burlington, Massachusetts, USA), special cannulas and under ultrasound guidance, they applied the radiofrequency with no skin incision in 34 patients that had been symptomatic for lateral epicondylitis for over 6 months and had exhausted all conservative treatment options. With an average follow-up of 14.3 months (range 12–21 months), Lin et al. [77] found an improvement of 78% in pain and 20.6–27.0 kg in hand grip strength. No complications were reported.
Subsequently, Weber and Kabelka [78] in 2012 reported the administration of radiofrequency directly on the skin to the lateral epicondyle without needles. The procedure—known as monopolar capacitive-coupled radiofrequency (mcRF)—was applied with the Alpha Orthopaedics’ AT2 System (Hayward, CA, USA). This equipment provides a maximum local temperature increase of 50°C [79], damaging selectively the unmyelinated fibres, while the myelinated axons are mostly spared [80]. This study involved 39 patients with an average 14-month follow-up, reporting an 81% successful outcome and an 89% patient satisfaction with no adverse effects.
Another possibility is pulsed radiofrequency, which can be applied without an irreversible neural damage [81] and has been used in many areas of chronic pain management. Oh et al. [82] in 2016 reported its use on elbow pain, aiming at the radial nerve as it crosses the elbow joint. The procedure was performed with a radiofrequency 22G cannula with a 5 mm active tip (SL-S505-2, Neuro-Them, Wilmington, DE, USA). Only two patients were treated this way but showed significant pain relief for 12 months. No long-term results were reported but no statistically significant data can be extracted from two isolated cases.
Patients must have confirmed lateral epicondyle chronic pain that has not been controlled after at least 6 months of conservative treatment [39, 43].
Exclusion criteria: elbow instability, rheumatic arthritis, cervical radiculopathy, severe cervical osteoarthritis and higher-grade extensor tendon damage [69, 74].
The techniques reported to apply the radiofrequency in the treatment of lateral epicondylitis are the radiofrequency-based microtenotomy, the monopolar capacitive-coupled radiofrequency, the monopolar thermal radiofrequency and the bipolar thermal radiofrequency. To these, we could add the pulsed radiofrequency, but as its used has only been described in two patients and there are no long-term results, we will not describe it.
The technique for radiofrequency-based microtenotomy as performed by several groups [13, 69, 70, 73, 74, 75] will be described first. Under general anaesthesia and in the supine position, a tourniquet is applied to the affected arm. The humeral insertion of the extensor tendons is exposed through a 3–5 cm skin incision. The tendons from the extensor carpi radialis brevis, the extensor carpi radialis longus and the extensor digitorum communis are identified. The radiofrequency-based microtenotomy is performed with the Topaz Microdebrider electrode. The electrode is inserted 3–5 mm deep inside the extensor carpi radialis brevis tendon at 5 mm intervals in a grid-like pattern. Usually 3–6 lesions are required [13]. Once the procedure is over, the wound is closed by layers. After the procedure, patients are discouraged from heavy work for 6 weeks.
The monopolar capacitive-coupled radiofrequency is performed with the Alpha Orthopaedics’ AT2 System and applied directly to the skin without any anaesthetic agent [78, 83]. The painful points are marked and a grid depicted on the skin to guide the treatment’s application. A grounding pad is placed on the forearm volar side. The energy pulses are delivered applying the equipment hand piece directly on the skin and concentrated on the most painful points. Patients are advised not to apply ice or NSAIDs over the treated area and to return the next morning to normal daily activities with no restrictions at all [78].
Another alternative is thermal radiofrequency, applied with a Radionics RFG-3C Generator (Radionics Inc., Burlington, Massachusetts, USA) [77]. The procedure is guided and controlled with ultrasound imaging. With the patient in the supine position, the painful lateral epicondyle areas are identified by manual palpation and marked with a pen. After local anaesthetic agent is injected, a 22-gauge cannula is inserted through the skin with a 30–45° angle and advanced to the painful spots parallel to the extensor carpi radialis brevis tendon. To confirm the painful spots, sensory stimulation is applied at 50H frequency and 0.5 V. Muscle stimulation is also performed to rule out proximity of any motor nerve or that the active electrode tip lies inside muscular tissue. Another 0.3 mL of local anaesthetic is injected though the lesioning cannula and the radiofrequency applied to achieve a temperature of 80° for 120 s. For optimal results, the lesion should be performed at the extensor muscle humeral insertion [77]. Patients are allowed to regain normal working activities by 6 weeks after the procedure.
To improve the results, we do a variation of this procedure. The thermal radiofrequency is applied not monopolar but bipolar. This increases the size of the lesion and covers the painful areas better. To do it, two radiofrequency cannulas are used (22 gauge, 100 mm length, 5 mm active tip, Halyard, Alpharetta, GA, USA) and the energy provided by a generator (Coolief Cooled Radiofrequency Pain Management Generator, Halyard Alpharetta, GA, USA) (Figure 1).
Bipolar radiofrequency treatment of lateral epicondyle chronic pain.
Lateral epicondylitis is a painful condition that often resolves spontaneously. The recalcitrant cases in which the pain persists can be treated with a vast array of options. Physiotherapy and local steroid injections are commonly used. Further conservative treatment modalities include local injection of botulinum toxin, platelet-enriched plasma, autologous blood or stem cells. The traditional open surgery has been subsided by other less invasive procedures like arthroscopic or percutaneous tenotomies. Radiofrequency, particularly thermal, has been proven as an adequate alternative to the surgical procedures and after failure of conservative treatments. Although in the past the radiofrequency was applied through a 3–5 cm skin incision, it is now possible to apply it through a cannula, minimising the surgical aggressiveness, reducing the patients’ discomfort and speeding up the recovery.
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May 18, 2022 | 1:00 PM - 2:00 PM CEST
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