Dermoscopic features of plaque psoriasis and its differentials.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{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"}]},book:{item:{type:"book",id:"5431",leadTitle:null,fullTitle:"Breast Cancer - From Biology to Medicine",title:"Breast Cancer",subtitle:"From Biology to Medicine",reviewType:"peer-reviewed",abstract:"Breast Cancer - From Biology to Medicine thoroughly examines breast cancer from basic definitions, to cellular and molecular biology, to diagnosis and treatment. This book also has some additional focus on preclinical and clinical results in diagnosis and treatment of breast cancer. The book begins with introduction on epidemiology and pathophysiology of breast cancer in Section 1. In Section 2, the subsequent chapters introduce molecular and cellular biology of breast cancer with some particular signaling pathways, the gene expression, as well as the gene methylation and genomic imprinting, especially the existence of breast cancer stem cells. In Section 3, some new diagnostic methods and updated therapies from surgery, chemotherapy, hormone therapy, immunotherapy, radiotherapy, and some complementary therapies are discussed. This book provides a succinct yet comprehensive overview of breast cancer for advanced students, graduate students, and researchers as well as those working with breast cancer in a clinical setting.",isbn:"978-953-51-3000-0",printIsbn:"978-953-51-2999-8",pdfIsbn:"978-953-51-4882-1",doi:"10.5772/62922",price:159,priceEur:175,priceUsd:205,slug:"breast-cancer-from-biology-to-medicine",numberOfPages:568,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"d90527637742a2483c1d96d5a5f7cc02",bookSignature:"Phuc Van Pham",publishedDate:"April 5th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5431.jpg",numberOfDownloads:44419,numberOfWosCitations:27,numberOfCrossrefCitations:33,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:58,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:118,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 11th 2016",dateEndSecondStepPublish:"May 2nd 2016",dateEndThirdStepPublish:"July 29th 2016",dateEndFourthStepPublish:"October 27th 2016",dateEndFifthStepPublish:"December 26th 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"28799",title:"Ph.D.",name:"Phuc Van",middleName:"Van",surname:"Pham",slug:"phuc-van-pham",fullName:"Phuc Van Pham",profilePictureURL:"https://mts.intechopen.com/storage/users/28799/images/system/28799.png",biography:"Phuc Van Pham received his Ph.D. in Human Physiology from Vietnam National University, Ho Chi Minh City, Vietnam. He is currently an Associate Professor of Biology at Vietnam National University; Direct of Stem Cell Institute; Director of the Laboratory of Stem Cell Research and Application; and Vice-Director of the Laboratory of Cancer Research. He is a longstanding lecturer and translational scientist at the University, and is a member of several societies and journal editorial boards focused on stem cells as well as cellular therapy.",institutionString:"VNU-HCM University of Science",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1075",title:"Breast Oncology",slug:"breast-oncology"}],chapters:[{id:"53860",title:"Epidemiology, Pathology, Management and Open Challenges of Breast Cancer in Central Sudan: A Prototypical Limited Resource African Setting",doi:"10.5772/67175",slug:"epidemiology-pathology-management-and-open-challenges-of-breast-cancer-in-central-sudan-a-prototypic",totalDownloads:2028,totalCrossrefCites:3,totalDimensionsCites:5,hasAltmetrics:0,abstract:"Little is known about breast cancer in Sudan. According to the recent data published by the Khartoum Cancer Registry, breast cancer was the most common cancer among Sudanese women. Generally, breast cancer in native African women is characterized by young age at onset, occurrence in multiparous premenopausal patients, advanced stage at diagnosis, large tumor size, high‐grade and triple‐negative phenotype, with correspondingly poor prognosis. In Sudan, it was reported that about 70% of the women diagnosed with breast cancer were younger than 50 years old. We present here data from local and international publications as well as primary information from the National Cancer Institute in Wad Medani (one of the only two cancer hospitals of the country, both located in Central Sudan in Khartoum and Wad Medani). We provide an up‐to‐date situation analysis of breast cancer in Central Sudan as an example for an African reality and the various open challenges of breast cancer in a limited resource setting. A better understanding of breast cancer in black African women is of global relevance, as there is an alarming increase in breast cancer among young black women worldwide, and these patients have the lowest survival rates.",signatures:"Renato Mariani-Costantini, Moawia Mohammed Ali Elhassan,\nGitana Maria Aceto, Ahmed Abdalla Mohamedani and Khalid\nDafaallah Awadelkarim",downloadPdfUrl:"/chapter/pdf-download/53860",previewPdfUrl:"/chapter/pdf-preview/53860",authors:[{id:"34845",title:"Prof.",name:"Renato",surname:"Mariani Costantini",slug:"renato-mariani-costantini",fullName:"Renato Mariani Costantini"},{id:"43821",title:"Dr.",name:"Khalid",surname:"Awadelkarim",slug:"khalid-awadelkarim",fullName:"Khalid Awadelkarim"},{id:"190476",title:"Dr.",name:"Moawia",surname:"Elhassan",slug:"moawia-elhassan",fullName:"Moawia Elhassan"},{id:"190485",title:"Dr.",name:"Gitana",surname:"Aceto",slug:"gitana-aceto",fullName:"Gitana Aceto"},{id:"194585",title:"Prof.",name:"Ahmed Abdalla",surname:"Mohamedani",slug:"ahmed-abdalla-mohamedani",fullName:"Ahmed Abdalla Mohamedani"}],corrections:null},{id:"52969",title:"Histopathological Characteristics: Clinical Course of Breast Cancer Subtypes Depending on the ER(+) (−)/PR(+) (−) Receptor Status",doi:"10.5772/66176",slug:"histopathological-characteristics-clinical-course-of-breast-cancer-subtypes-depending-on-the-er-pr-r",totalDownloads:1907,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Breast cancer patients were divided into separate groups, which were the estrogen receptor (ER)+/progesterone receptor (PR)+ HER2−, the ER or PR+ HER2−, the ER+/PR+ HER2+, the ER or PR+ HER2+, the ER−/PR− HER2−, and the ER−/PR− HER2+ groups. Patients with the ER/PR(+)/HER2− subtype breast cancers show better clinical prognosis compared to the hormone-negative, triple-negative (TN), and HER2+ subtypes. TN, HER2+ tumors in postmenopausal women were of higher grade, showing lymph node and lymphovascular invasion with poor prognosis in all case series. However, the ER+/PR−/HER2+ subgroup had the lowest survival rates in 2- and 5-year follow-ups. Comparison between the ER+PR+HER2+ and ER+PR−HER2− subgroups showed that HER2− status is an indicator of improved prognosis in long-term follow-up. Single hormone receptor (HR)(+) status, particularly HER2(−) cases, was in between the favorable and poor survival subgroups. The ER−, PR−, and HER2+ properties were found to be risk factors for frequent recurrences. In this chapter, breast cancer subtypes are compared with each other. Results from different studies highlight the importance of ER/PR/HER2 receptor variations in the choice of treatment and prognosis of breast cancer.",signatures:"Nilufer Bulut",downloadPdfUrl:"/chapter/pdf-download/52969",previewPdfUrl:"/chapter/pdf-preview/52969",authors:[{id:"189255",title:"Associate Prof.",name:"Nilufer",surname:"Bulut",slug:"nilufer-bulut",fullName:"Nilufer Bulut"}],corrections:null},{id:"54191",title:"Breast Cancer as an Epstein-Barr Virus (EBV)-Associated Malignancy",doi:"10.5772/66988",slug:"breast-cancer-as-an-epstein-barr-virus-ebv-associated-malignancy",totalDownloads:1479,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The Epstein Barr Virus is among the very first oncogenic viruses to be identified as culprits of human malignancies. Its role as an etiologic agent of breast cancer however remains debated despite mounting molecular evidence. In this chapter we address the challenge of multiple molecular etiologies of breast cancer (BC) with emphasis on the Epstein Barr Virus (EBV) as a potential causative agent within a frame work of gene/environment interaction. We also hope to contribute to a critique of the a concept of universal single agent or gene in cancer etiology. In addition to reviewing further reasons of why EBV should be considered a tumor virus, coupling molecular targets at the initiation stage, we examine evidence for the culpability of EBV as oncogenic virus in relation to the genetic and epigenetic events that leads to carcinogenesis of cancer; and the subsequent downstream interaction including genetic and epigenetic modifiers of signaling and molecular function underlying the cancerous phenotype. The TNF family is taken as an example of how the epigenetic reprogramming process, impacts molecular targets and how these combined interplay of molecular events impinges on pathogenesis and malignancy of breast cancer in humans.",signatures:"Ghimja Fessahaye and Muntaser E. Ibrahim",downloadPdfUrl:"/chapter/pdf-download/54191",previewPdfUrl:"/chapter/pdf-preview/54191",authors:[{id:"69817",title:"Prof.",name:"Muntaser",surname:"Ibrahim",slug:"muntaser-ibrahim",fullName:"Muntaser Ibrahim"}],corrections:null},{id:"53856",title:"Early-Stage Progression of Breast Cancer",doi:"10.5772/65633",slug:"early-stage-progression-of-breast-cancer",totalDownloads:1713,totalCrossrefCites:4,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Breast cancer can be defined as a group of diseases with heterogeneous origins, molecular profiles and behaviors characterized by uncontrolled proliferation of cells within the mammary tissue. Around one in eight women in the US will develop breast cancer in their lifetime, making it the second most frequently diagnosed cancer behind skin cancer [1]. In 2015, an estimated 231,840 cases of invasive carcinoma were diagnosed, and over 40,000 deaths were caused by breast cancer which accounts for almost 7% of all cancer mortality each year. In 2015, 60,290 cases of in situ breast cancer were diagnosed, representing over 14% of all new cancer cases among women and men. The steep increase in diagnosis of early‐stage breast cancer over the past 10 years is believed to be a result of more frequent mammography. However, since over half of these in situ lesions will not progress to invasive breast cancer, controversies have arisen about approaches to treatment and prevention of progression of early‐stage in situ breast cancer. Understanding the mechanisms of transition of normal breast to in situ pre‐neoplastic lesions and invasive breast cancer is currently a major focus of breast cancer research with implications for preventive and clinical management of breast cancer. In this review, we give an overview of current knowledge on the molecular and pathological changes that occur during early‐stage progression of breast cancer and describe some of the current models that are used to study this process.",signatures:"William Kietzman, Anna T. Riegel and Virginie Ory",downloadPdfUrl:"/chapter/pdf-download/53856",previewPdfUrl:"/chapter/pdf-preview/53856",authors:[{id:"190578",title:"Prof.",name:"Anna",surname:"Riegel",slug:"anna-riegel",fullName:"Anna Riegel"},{id:"190580",title:"Dr.",name:"Virginie",surname:"Ory",slug:"virginie-ory",fullName:"Virginie Ory"},{id:"190583",title:"MSc.",name:"William",surname:"Kietzman",slug:"william-kietzman",fullName:"William Kietzman"}],corrections:null},{id:"54190",title:"GWAS in Breast Cancer",doi:"10.5772/67223",slug:"gwas-in-breast-cancer",totalDownloads:2002,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Breast cancer is the most diagnosed cancer in women, and the second cause of cancer-related deaths among women worldwide. It is expected that more than 240,000 new cases and 40,450 deaths related to the disease will occur in 2016. It is well known that inherited genetic variants are drivers for breast cancer development. There are many mechanisms through which germline genetic variation affects prognosis, such as BRCA1 and BRCA2 genes, which account for approximately 20% of the increased hereditary risks. Therefore, it is evident that the genetic pathways that underlie cancer development are complex in which networks of multiple alleles confer disease susceptibility and risks. Global analyses through genome-wide association studies (GWAS) have revealed several loci across the genome are associated with the breast cancer. This chapter compiles all breast GWAS released since 2007, year of the first article published in this area, and discuss the future directions of this field. Currently, hundreds of genetic markers are linked to breast cancer, and understanding the underlying mechanisms of these variants might lead to the discover of biomarkers and targets for therapy in patients.",signatures:"Paulo C.M. Lyra‐Junior, Nayara G. Tessarollo, Isabella S. Guimarães,\nTaciane B. Henriques, Diandra Z. dos Santos, Marcele L.M. de Souza,\nVictor Hugo M. Marques, Laura F.R.L. de Oliveira, Krislayne V.\nSiqueira, Ian V. Silva, Leticia B.A. Rangel and Alan T. Branco",downloadPdfUrl:"/chapter/pdf-download/54190",previewPdfUrl:"/chapter/pdf-preview/54190",authors:[{id:"60359",title:"Dr.",name:"Letícia",surname:"Rangel",slug:"leticia-rangel",fullName:"Letícia Rangel"}],corrections:null},{id:"54294",title:"Circulating Tumor Cells in Breast Cancer: A Potential Liquid Biopsy",doi:"10.5772/66439",slug:"circulating-tumor-cells-in-breast-cancer-a-potential-liquid-biopsy",totalDownloads:2039,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Circulating tumor cells (CTCs) have emerged as a new generation of liquid biomarker that allows for noninvasive longitudinal disease monitoring. CTCs represent a rare cell population in the blood, surrounded by billions of hematopoietic cells. Due to the rarity of CTCs in the blood, the isolation of pure CTCs’ populations has proven to be challenging. However, a number of new technologies have emerged using CTCs cytometric/immunological and physical characteristics. Currently, patients with greater than 5 CTCs have a shorter progression-free survival, as compared with those with less than 5 CTCs per 7.5 ml of whole blood. Although the CTC count itself is an independent prognostic marker, the field is shifting toward understanding metastasis-relevant marker expression on CTCs for the improvement of the prognostic significance of CTCs. This chapter first introduces the principles of CTC isolation and detection methods, then the clinical utility of CTCs for prediction of prognosis and therapy response. Lastly, the heterogeneity of CTCs will be discussed.",signatures:"Mohamed Kamal, Wajeeha Razaq, Macall Leslie, Smita Adhikari and\nTakemi Tanaka",downloadPdfUrl:"/chapter/pdf-download/54294",previewPdfUrl:"/chapter/pdf-preview/54294",authors:[{id:"188855",title:"Dr.",name:"Takemi",surname:"Tanaka",slug:"takemi-tanaka",fullName:"Takemi Tanaka"},{id:"196565",title:"Dr.",name:"Mohamed",surname:"Kamal",slug:"mohamed-kamal",fullName:"Mohamed Kamal"},{id:"196566",title:"Dr.",name:"Wajeeha",surname:"Razaq",slug:"wajeeha-razaq",fullName:"Wajeeha Razaq"},{id:"196568",title:"BSc.",name:"Macall",surname:"Leslie",slug:"macall-leslie",fullName:"Macall Leslie"}],corrections:null},{id:"53849",title:"DNA Hypermethylation in Breast Cancer",doi:"10.5772/66900",slug:"dna-hypermethylation-in-breast-cancer",totalDownloads:1805,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Cancer development is a complex process with multiple steps. Many factors, including radiation, chemicals, viruses, genetic and epigenetic changes, lead to abnormal proliferation of a single cell, which results in the outgrowth of a population of clonal-derived tumour cells. It has established that DNA hypermethylation, an epigenetic mechanism that occurred by the addition of a methyl group at 5′ position of the pyrimidine ring of cytosine residues at CpG islands through the action of DNA methyltransferase enzymes, has been considered as the cause of human tumorigenesis, including breast cancer development. Moreover, DNA hypermethylation holds a promising application as a potential biomarker for the early detection, prognosis and prediction of drug sensitivity in cancer. Therefore, this chapter focuses on the description and exemplification of the DNA hypermethylation changes, particularly, highlight the DNA hypermethylation as a potential biomarker applied in predictive, diagnostic, prognostic and therapeutic monitoring of breast cancer.",signatures:"Le Huyen Ai Thuy, Lao Duc Thuan and Truong Kim Phuong",downloadPdfUrl:"/chapter/pdf-download/53849",previewPdfUrl:"/chapter/pdf-preview/53849",authors:[{id:"188780",title:"Dr.",name:"Huyen Ai Thuy",surname:"Le",slug:"huyen-ai-thuy-le",fullName:"Huyen Ai Thuy Le"},{id:"190443",title:"Ph.D. Student",name:"Thuan Duc",surname:"Lao",slug:"thuan-duc-lao",fullName:"Thuan Duc Lao"},{id:"201479",title:"MSc.",name:"Phuong",surname:"Kim Truong",slug:"phuong-kim-truong",fullName:"Phuong Kim Truong"}],corrections:null},{id:"53690",title:"ErbB2 Receptor in Breast Cancer: Implications in Cancer Cell Migration, Invasion and Resistance to Targeted Therapy",doi:"10.5772/66902",slug:"erbb2-receptor-in-breast-cancer-implications-in-cancer-cell-migration-invasion-and-resistance-to-tar",totalDownloads:1586,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Overexpression of ErbB2 is found in several types of human carcinomas. In breast tumors, ErbB2 overexpression is detected in up to 20% of patients. Breast cancers in with amplification of ErbB2 are characterized by rapid tumor growth, lower survival rate and increased disease progression. The molecular mechanisms underlying the oncogenic action of ErbB2 involve a complex signaling network that tightly regulates malignant cell migration and invasion and hence metastatic potential. Recent efforts have been made to identify gene expression signatures of ErbB2-positive invasive breast cancers that may represent important mediators of ErbB2-induced tumorigenesis and metastatic progression.\nIn this chapter, we will discuss the canonical ErbB2 signaling pathways responsible for tumor growth and dissemination along with newly identified mediators such as adaptor protein p130Cas and miRNAs. From a therapeutic point of view, the treatment with anti-ErbB2 monoclonal antibody trastuzumab has greatly improved the outcomes of patients with ErbB2 aggressive cancer. Nevertheless, de novo and acquired resistance to trastuzumab therapy still represent a major clinical problem. In the second part of the chapter, we will provide an overview of the mechanisms so far implicated in the onset of resistance to targeted therapy and of the new strategies to overcome resistance.",signatures:"Maria del Pilar Camacho-Leal, Marianna Sciortino and Sara Cabodi",downloadPdfUrl:"/chapter/pdf-download/53690",previewPdfUrl:"/chapter/pdf-preview/53690",authors:[{id:"189004",title:"Ph.D.",name:"Maria Del Pilar",surname:"Camacho Leal",slug:"maria-del-pilar-camacho-leal",fullName:"Maria Del Pilar Camacho Leal"}],corrections:null},{id:"52973",title:"Analysis of 10086 Microarray Gene Expression Data Uncovers Genes that Subclassify Breast Cancer Intrinsic Subtypes",doi:"10.5772/66161",slug:"analysis-of-10086-microarray-gene-expression-data-uncovers-genes-that-subclassify-breast-cancer-intr",totalDownloads:1643,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Breast cancer is a complex disease comprising molecularly distinct subtypes. The prognosis and treatment differ between subtypes; thus, it is important to distinguish one subtype from another. In this chapter, we make use of high-throughput microarray dataset to perform breast cancer subtyping of 10086 samples. Aside from the four major subtypes, that is, Basal-like, HER2-enriched, luminal A, and luminal B, we defined a normal-like subtype that has a gene expression profile similar to that found in normal and adjacent normal breast samples. Also, a group of luminal B-like samples with better prognosis was distinguished from the high-risk luminal B breast cancer. We additionally identified 33 surface-protein encoding genes whose gene expression profiles were associated with survival outcomes. We believe these genes are potential therapeutic targets and diagnostic biomarkers for breast cancer.",signatures:"I-Hsuan Lin and Ming-Ta Hsu",downloadPdfUrl:"/chapter/pdf-download/52973",previewPdfUrl:"/chapter/pdf-preview/52973",authors:[{id:"49774",title:"Prof.",name:"Ming-Ta",surname:"Hsu",slug:"ming-ta-hsu",fullName:"Ming-Ta Hsu"},{id:"172713",title:"Dr.",name:"I-Hsuan",surname:"Lin",slug:"i-hsuan-lin",fullName:"I-Hsuan Lin"}],corrections:null},{id:"52901",title:"Jab1/Csn5 Signaling in Breast Cancer",doi:"10.5772/66174",slug:"jab1-csn5-signaling-in-breast-cancer",totalDownloads:1329,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"c-Jun activation domain-binding protein1 (Jab1), also known as a monomer or the fifth component of the constitutive photomorphogenesis 9 signalosome (Csn5) complex, regulates cell proliferation, cell-cycle progression, and apoptosis and affects a series of pathways. Jab1/Csn5 also promotes cell transformation and tumorigenesis, and its overexpression in many tumor types suggests it is involved in cancer progression and closely associated with poor cancer prognosis. Jab1/Csn5 dysregulation contributes to oncogenesis by deactivating several tumor suppressors. Increasing evidence of the role of Jab1/Csn5 overexpression in breast and other cancers has spurred interest in Jab1/Csn5 inhibitors for cancer therapy. In this chapter, we summarize the evidence demonstrating the importance of Jab1/Csn5 expression in breast and other cancers and review recent advances in dissecting the Jab1/Csn5 signaling pathway along with its potential as a therapeutic target for cancer.",signatures:"Yunbao Pan and Francois X. Claret",downloadPdfUrl:"/chapter/pdf-download/52901",previewPdfUrl:"/chapter/pdf-preview/52901",authors:[{id:"108913",title:"Dr.",name:"Francois",surname:"Claret",slug:"francois-claret",fullName:"Francois Claret"},{id:"190726",title:"Dr.",name:"Yunbao",surname:"Pan",slug:"yunbao-pan",fullName:"Yunbao Pan"}],corrections:null},{id:"52920",title:"Splicing Factors in Breast Cancer: Drivers of the Breast Tumor Fate",doi:"10.5772/66162",slug:"splicing-factors-in-breast-cancer-drivers-of-the-breast-tumor-fate",totalDownloads:1585,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Splicing is a critical step in gene expression, responsible for the excision of introns, producing the mature form of mRNA. Also, the possible arrangements of exons enlarge the proteome in 80%, enabling one gene to encode more than one protein isoform, thus increasing proteome. Growing data show deregulation of splicing events in cancer, being breast cancer the most studied. This aberrant pattern of splicing has an important role in breast tumor progression. These alterations are mainly caused by misexpression of some critical alternative splicing factors. The behavior of these splicing factors is implicated with important clinical features, such as chemoresistance, aggressiveness, and also metastases. In this chapter, the role of five splicing factors is discussed in the light of relevant data about in vitro, in vivo, and ex vivo studies to construct a representative scheme of their behavior in breast cancer progression. Although the presented five splicing factors have important role in breast cancer, only three of them (ESRP1, RBFOX2, and SRSF1) have a more prominent role in tumorigenesis and tumor progression. These concepts will elucidate their role in tumorigenesis and a prospective use as biomarkers in breast cancer.",signatures:"Felipe A. C. da Luz, Paula C. Brígido, Alberto S. Moraes, Rogério A.\nAraújo and Marcelo J. B. Silva",downloadPdfUrl:"/chapter/pdf-download/52920",previewPdfUrl:"/chapter/pdf-preview/52920",authors:[{id:"190065",title:"Prof.",name:"Marcelo",surname:"Silva",slug:"marcelo-silva",fullName:"Marcelo Silva"},{id:"190214",title:"MSc.",name:"Felipe",surname:"Da Luz",slug:"felipe-da-luz",fullName:"Felipe Da Luz"},{id:"190215",title:"Prof.",name:"Rogério",surname:"De Araújo",slug:"rogerio-de-araujo",fullName:"Rogério De Araújo"},{id:"190216",title:"Dr.",name:"Alberto",surname:"Moraes",slug:"alberto-moraes",fullName:"Alberto Moraes"}],corrections:null},{id:"53577",title:"The Role of Stem Cells in Breast Cancer",doi:"10.5772/66904",slug:"the-role-of-stem-cells-in-breast-cancer",totalDownloads:1813,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"A significant progress has been made in describing cellular hierarchy and the stem cell niche in the human mammary gland. Mammary stem and progenitor cells exist in two different states: epithelial-like and mesenchymal-like. Several features of the mammary stem cells predispose them to play a critical role in breast cancer initiation, progression and metastasis. Signaling pathways contributing to the self-renewal, such as Wnt, Notch, Hh and BMP, have been shown to be linked with breast cancer stem cells. Furthermore, biomarkers connected with stemness, such as CD44, CD24, EpCAM and ALDH1, have been identified and used to characterize these cells. Additionally, many different miRNA families and microenvironmental factors were shown to regulate a lot of cancer stem cells properties and maintain their stemness. All these findings have started a new era of breast cancer research. In present breast cancer, stem cells have become the targets of breast cancer therapy, although the tests are mainly on the basic stage level. Since the cancer stem cells are able to escape chemotherapy and are resistant to drugs, radiotherapy and apoptotic processes, the therapeutic targeting is mostly concentrated on the disruption of survival signaling pathways and the use of modern technology, like nanotechnology.",signatures:"Joanna Magdalena Zarzynska",downloadPdfUrl:"/chapter/pdf-download/53577",previewPdfUrl:"/chapter/pdf-preview/53577",authors:[{id:"175016",title:"Dr.",name:"Joanna",surname:"Zarzynska",slug:"joanna-zarzynska",fullName:"Joanna Zarzynska"}],corrections:null},{id:"54049",title:"Ion Channels in Breast Cancer: From Signaling to Therapy",doi:"10.5772/66172",slug:"ion-channels-in-breast-cancer-from-signaling-to-therapy",totalDownloads:2040,totalCrossrefCites:3,totalDimensionsCites:6,hasAltmetrics:1,abstract:"Breast cancer consists of an assortment of illness and therapeutic failure is mostly due to the complex and heterogeneous phenotype of the disease. Recently, changes in expression of several ion channels have been associated with malignancy including breast cancers. This suggests that breast cancer cells might gain a selective advantage by controlling ion channel expression/activity and that ion channels can contribute to the hallmarks of cancer. Due to the growing body of research demonstrating that ion channels are key factors in breast cancer biology. In this chapter, we discuss the role of specific ion channels in contributing to hallmarks of breast and whether these ion channels can be used as potential pharmacologic targets for breast cancer.",signatures:"Dowd Jonathan, Hendin Josh, Daniela F. Fukushiro-Lopes, David\nLaczynski and Saverio Gentile",downloadPdfUrl:"/chapter/pdf-download/54049",previewPdfUrl:"/chapter/pdf-preview/54049",authors:[{id:"185692",title:"Prof.",name:"Saverio",surname:"Gentile",slug:"saverio-gentile",fullName:"Saverio Gentile"}],corrections:null},{id:"53531",title:"Modern Radiotherapy Era in Breast Cancer",doi:"10.5772/66906",slug:"modern-radiotherapy-era-in-breast-cancer",totalDownloads:1852,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Radiation therapy (RT) is one of the major treatment modalities that are used in breast cancer treatment, and depending on the chest-wall anatomy, RT fields have to be customized. Techniques used in planning have been evolving since last two decades from two dimensional (2D) to three-dimensional (3D), while intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and even proton therapy have been an option in daily approach. In addition, technological hardware and software advances in delivery and planning systems, total treatment duration of breast RT have been shortened in last decades along with recent hypofractionated radiotherapy schemes or emerging partial-breast irradiation protocols. The other attractive approach—accelerated partial breast irradiation (APBI) could be a reasonable option for highly selected subpopulation of early-stage breast cancer patients out of a clinical trial. Long-term follow-up results have emerged heart and coronary sparing with maximum safety and efficacy. The most important advance could be named as cardiac sparing—deep breath-hold approach—in all the modern technique improvement. Although most advanced techniques in management of breast cancer have not been verified to increase survival, we suggest recommending resource stratified advanced in order to provide best technical and clinical care in this long-term survivor candidates.",signatures:"Yasemin Bolukbasi and Ugur Selek",downloadPdfUrl:"/chapter/pdf-download/53531",previewPdfUrl:"/chapter/pdf-preview/53531",authors:[{id:"189528",title:"Dr.",name:"Ugur",surname:"Selek",slug:"ugur-selek",fullName:"Ugur Selek"},{id:"190551",title:"Dr.",name:"Yasemin",surname:"Bolukbasi",slug:"yasemin-bolukbasi",fullName:"Yasemin Bolukbasi"}],corrections:null},{id:"53892",title:"Breast Cancer and Flavonoids as Treatment Strategy",doi:"10.5772/66169",slug:"breast-cancer-and-flavonoids-as-treatment-strategy",totalDownloads:2064,totalCrossrefCites:4,totalDimensionsCites:7,hasAltmetrics:1,abstract:"Breast cancer is the most prevalent cancer type among women. Despite recent progress in early detection and therapeutic strategies, the rate of mortality is increasing. Anti-estrogens or aromatase inhibitors are preferred to treat the women diagnosed with estrogen-receptor (ER) positive tumors. However, breast tumors usually show intra-tumoral heterogeneity with ER-positive and -negative cells. The advanced breast cancer cells lose the estrogen responsiveness and become aggressive by developing new strategies for rapid proliferation such as mutations in cell cycle machinery. New promising drugs are still being investigating against these types of tumors especially to overcome acquired resistance against chemotherapeutic drugs; however, a successful treatment for metastatic tumors is still unclear. Flavonoids, with various pharmacological activities, are plant or fungus secondary metabolites present in human diet. In plants, beside their role in pigmentation, they may also act as messengers, regulators and cell cycle inhibitors. Therefore, they are being tested in ovarian, cervical as well as breast cancer. Due to the positive correlation between flavonoids-rich diet and lower risk of cancer, flavonoids are referred as chemopreventive agents. The current chapter emphasizes the therapeutic potential of flavonoids and their synthetic analogues as anti-cancer agents in breast cancer providing new insights into the molecular mechanisms.",signatures:"Pinar Obakan-Yerlikaya, Elif Damla Arisan, Ajda Coker-Gurkan and\nNarcin Palavan-Unsal",downloadPdfUrl:"/chapter/pdf-download/53892",previewPdfUrl:"/chapter/pdf-preview/53892",authors:[{id:"183217",title:"Dr.",name:"Damla",surname:"Arisan",slug:"damla-arisan",fullName:"Damla Arisan"},{id:"183665",title:"Dr.",name:"Ajda",surname:"Coker-Gurkan",slug:"ajda-coker-gurkan",fullName:"Ajda Coker-Gurkan"},{id:"183666",title:"Prof.",name:"Pinar",surname:"Obakan-Yerlikaya",slug:"pinar-obakan-yerlikaya",fullName:"Pinar Obakan-Yerlikaya"},{id:"183669",title:"Prof.",name:"Narcin",surname:"Palavan-Unsal",slug:"narcin-palavan-unsal",fullName:"Narcin Palavan-Unsal"}],corrections:null},{id:"52931",title:"Translational Challenges and Therapeutic Opportunities in BRCA1-Related Breast Cancer",doi:"10.5772/66168",slug:"translational-challenges-and-therapeutic-opportunities-in-brca1-related-breast-cancer",totalDownloads:1242,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Although significant progress has been made in the management of the hereditary cancer syndrome related to mutations of BRCA1, two fundamental and clinically relevant questions regarding BRCA1-related cancer syndrome remain unresolved: (1) What factors account for the tissue specificity of the BRCA1-related cancer risk? (2) How does a mutation or loss of BRCA1 lead to the basal-like phenotype of breast cancer? This review focuses on recent studies in BRCA1-related pathways that lead to specific characteristics of the hereditary cancer syndrome and discusses the current translational evidence for exploiting these pathways in new therapeutic strategies. Mounting evidence suggests that estrogen signaling and metabolism, oxidative stress, specific secondary mutations, and regulation of specific progenitor cells and transcriptional programs are critical in BRCA1-associated breast cancer. Strategies geared toward estrogen reduction may play a role in treatment and prevention. Therapies aimed at mitigating oxidative stress may be a strategy for risk reduction, while cancer-cell-specific sensitivity to oxidative stress may also be an opportunity for specific targeting. BRCA1-related transcriptional regulation and signaling provide a number of therapeutic targets, including the PI3-AKT and Notch pathways. Thus, significant opportunities exist in translational and clinical research for developing the treatment strategies for the management of BRCA1-related breast cancer.",signatures:"Jeffrey Johnson, William Audeh, Hisashi Tanaka, Farin Amersi,\nArmando E. Giuliano and Xiaojiang Cui",downloadPdfUrl:"/chapter/pdf-download/52931",previewPdfUrl:"/chapter/pdf-preview/52931",authors:[{id:"188836",title:"Dr.",name:"Xiaojiang",surname:"Cui",slug:"xiaojiang-cui",fullName:"Xiaojiang Cui"},{id:"194416",title:"Dr.",name:"Jeffrey",surname:"Johnson",slug:"jeffrey-johnson",fullName:"Jeffrey Johnson"},{id:"194417",title:"Dr.",name:"William",surname:"Audeh",slug:"william-audeh",fullName:"William Audeh"},{id:"194418",title:"Dr.",name:"Hisashi",surname:"Tanaka",slug:"hisashi-tanaka",fullName:"Hisashi Tanaka"},{id:"194419",title:"Dr.",name:"Farin",surname:"Amersi",slug:"farin-amersi",fullName:"Farin Amersi"},{id:"194420",title:"Dr.",name:"Armando",surname:"Giuliano",slug:"armando-giuliano",fullName:"Armando Giuliano"}],corrections:null},{id:"53631",title:"Molecular Fingerprints and Biomarkers of Breast Cancer",doi:"10.5772/66899",slug:"molecular-fingerprints-and-biomarkers-of-breast-cancer",totalDownloads:1691,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Substantial progress has been made over the past three decades in understanding breast cancer (BC) molecular biology, genomics, and targeted therapy. The recent comprehensive molecular and pathological diversity observed in BC patients indicates that BC is not a homogeneous disease; It may be appropriately defined as a myriad of diseases. The explosion of molecular information in the past 10 years has led to a better understanding of the biologic diversity of breast cancers (BCs), and clues to the different etiologic pathways to BC development. It will be useful to study the epigenetics of BC cells and define the mechanisms of both genetic and epigenetic driving alterations beside the mutations. Identifying the oncogenes and tumor suppressor genes is the purpose cancer diagnostics and therapeutics. Oncogenes as well as novel ones involved in the significantly altered regions would enable researchers to identify new causes and molecular pathways that may be targeted at BC treatment. Our main goal is to provide comprehensive understanding of underlying molecular mechanisms and hallmarks of BC, focusing on the identification of fingerprints and novel molecular targets that will greatly improve the cancer predictive, prognostic, and diagnostic biomarkers and, in addition, the possible targets for novel therapies.",signatures:"Hala Fawzy Mohamed Kamel, Hiba Saeed Bagader Al-Amodi and\nHanan Mohamed AbdElmoneim",downloadPdfUrl:"/chapter/pdf-download/53631",previewPdfUrl:"/chapter/pdf-preview/53631",authors:[{id:"179315",title:"Dr.",name:"Hala",surname:"Fawzy Mohamed Kamel",slug:"hala-fawzy-mohamed-kamel",fullName:"Hala Fawzy Mohamed Kamel"},{id:"184928",title:"Dr.",name:"Hiba",surname:"Al-Amodi",slug:"hiba-al-amodi",fullName:"Hiba Al-Amodi"},{id:"190459",title:"Prof.",name:"Hanan",surname:"Mohamed AbdElmoneim",slug:"hanan-mohamed-abdelmoneim",fullName:"Hanan Mohamed AbdElmoneim"}],corrections:null},{id:"53942",title:"Cardiac Toxicity of HER2-Directed Therapy in Women with Breast Cancer: Epidemiology, Etiology, Risk Factors, and Management",doi:"10.5772/66437",slug:"cardiac-toxicity-of-her2-directed-therapy-in-women-with-breast-cancer-epidemiology-etiology-risk-fac",totalDownloads:1578,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The HER2-targeted therapy have profoundly changed the outcomes of women with HER2-positive breast cancers. Trastuzumab and pertuzumab, HER2-targeting monoclonal antibodies, lapatinib and Neratinib, small molecule inhibitors of HER2 and the epidermal growth factor receptor, and ado-trastuzumab emtansine, a HER2-positive directed antibody drug conjugate, are approved for the treatment of HER2-positive breast cancer.",signatures:"Shahid Ahmed, Arooba Talat, Nayyer Iqbal, Mohamed Emara, Duc\nLe, Amir Sami and Jim Xiang",downloadPdfUrl:"/chapter/pdf-download/53942",previewPdfUrl:"/chapter/pdf-preview/53942",authors:[{id:"178507",title:"Dr.",name:"Shahid",surname:"Ahmed",slug:"shahid-ahmed",fullName:"Shahid Ahmed"}],corrections:null},{id:"53499",title:"Aspects of Immediate and Delayed Alloplastic Breast Reconstruction After Mastectomy",doi:"10.5772/66876",slug:"aspects-of-immediate-and-delayed-alloplastic-breast-reconstruction-after-mastectomy",totalDownloads:1409,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Seventy percent of patients with early breast cancer can be treated by breast-conserving surgery, while the remaining 30% are forced to receive mastectomy. Nearly 30% of these patients choose breast reconstruction. In the last decade, new alternative techniques and improved surgical devices have significantly improved techniques for breast reconstruction that especially include immediate or delayed breast reconstruction with silicone implants as an excellent option. In general, implant reconstruction may be single- or two-stage procedures. Single-stage reconstruction is the preferred technique for patients with small breasts and minimal ptosis, while large breasts with ptosis require reduction mastopexy either combined with dermoglandular flap or with titane net for covering the caudal pole of the implant. Thus, excellent cosmetic results can be achieved. Recent studies showed a significant survival benefit for postmastectomy irradiation in nodal-positive patients, so that many candidates for breast reconstruction are irradiated with a higher probability of wound-healing complications after breast reconstruction and increased rates of other complications like capsular fibrosis.",signatures:"Michael Friedrich and Stefan Kraemer",downloadPdfUrl:"/chapter/pdf-download/53499",previewPdfUrl:"/chapter/pdf-preview/53499",authors:[{id:"189408",title:"Prof.",name:"Michael",surname:"Friedrich",slug:"michael-friedrich",fullName:"Michael Friedrich"},{id:"189826",title:"Prof.",name:"Stefan",surname:"Krämer",slug:"stefan-kramer",fullName:"Stefan Krämer"}],corrections:null},{id:"52933",title:"Internal Mammary Sentinel Lymph Node Biopsy",doi:"10.5772/66158",slug:"internal-mammary-sentinel-lymph-node-biopsy",totalDownloads:1391,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The conception of internal mammary sentinel lymph node biopsy (IM‐SLNB) has been added to the 2009 American Joint Committee on Cancer breast cancer staging manual. However, there has still been slight variation in the surgical treatment model owing to the low visualization rate of internal mammary sentinel lymph nodes (IM‐SLN) with the traditional radiotracer injection technique. According to the hypothesis of IM‐SLN, a modified injection technique (periareolar intraparenchymal, high volume, and ultrasound guidance) was established, which could significantly improve the IM‐SLN visualization rate, and make the IM‐SLNB procedure possible in routine practice. IM‐SLNB could provide minimally invasive staging, prognosis, and decision‐making individually, especially for the patients with clinically positive axilla lymph nodes. Moreover, radiotherapy targeting on internal mammary lymph nodes (IMLN) should be tailored and balanced between the potential benefit and toxicity, and radiotherapy guided by IM‐SLNB could achieve this goal. In the era of emphasizing the effective adjuvant therapy, within the changing therapy approach—more systemic treatment, less loco‐regional treatment—oncologist should reconsider the application of regional IMLN therapy.",signatures:"Yong‐Sheng Wang, Peng‐Fei Qiu and Bin‐Bin Cong",downloadPdfUrl:"/chapter/pdf-download/52933",previewPdfUrl:"/chapter/pdf-preview/52933",authors:[{id:"189822",title:"Prof.",name:"Yong-Sheng",surname:"Wang",slug:"yong-sheng-wang",fullName:"Yong-Sheng Wang"},{id:"190524",title:"Dr.",name:"Peng-Fei",surname:"Qiu",slug:"peng-fei-qiu",fullName:"Peng-Fei Qiu"},{id:"190526",title:"Dr.",name:"Bin-Bin",surname:"Cong",slug:"bin-bin-cong",fullName:"Bin-Bin Cong"}],corrections:null},{id:"53532",title:"Nanobiotechnology for Breast Cancer Treatment",doi:"10.5772/66989",slug:"nanobiotechnology-for-breast-cancer-treatment",totalDownloads:2803,totalCrossrefCites:7,totalDimensionsCites:11,hasAltmetrics:0,abstract:"Despite many technological breakthroughs, even the best breast cancer treatments available today are not 100% effective. Chemotherapy has improved, but many drugs still do not reach the tumor site at effective doses and are often associated with high systemic toxicity and poor pharmacokinetics. Moreover, for many malignancies, diagnosis is obtainable only in metastatic stages of development, reducing the overall effectiveness of treatment. The choice of available treatments depends on tumor characteristics such as biomarkers, tumor size, metastatic disease, ligands, and antigen or endocrine receptor expression. Combined with surgical resection, chemotherapy and radiation remain the first line of treatment for patients with cancer. Even with these treatments, however, cancer continues to have high fatality rates and current therapeutic modalities have yet to significantly improve the often dismal prognosis of this disease. Nanotechnology is a highly focused approach, which may provide more effective and less toxic treatment when compared to chemotherapy. This area of research has emerged as cancer treatment in the form of new drugs and has reached promising results in preclinical and clinical trials proving its value as a potential tumor therapy.",signatures:"Márcia Rocha, Natalia Chaves and Sônia Báo",downloadPdfUrl:"/chapter/pdf-download/53532",previewPdfUrl:"/chapter/pdf-preview/53532",authors:[{id:"147895",title:"Dr.",name:"Sônia Nair",surname:"Báo",slug:"sonia-nair-bao",fullName:"Sônia Nair Báo"},{id:"190527",title:"MSc.",name:"Natalia",surname:"Chaves",slug:"natalia-chaves",fullName:"Natalia Chaves"},{id:"190529",title:"MSc.",name:"Marcia",surname:"Oliveira Da Rocha",slug:"marcia-oliveira-da-rocha",fullName:"Marcia Oliveira Da Rocha"}],corrections:null},{id:"53910",title:"Immunotherapeutic and Preventive Role of Purified Extract Rich in Beta-Glucans Derived from D-Fraction of Grifola frondosa Mushroom in Experimental Mice Biomodel of Mammary Carcinogenesis",doi:"10.5772/66890",slug:"immunotherapeutic-and-preventive-role-of-purified-extract-rich-in-beta-glucans-derived-from-d-fracti",totalDownloads:1400,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The overall vision of the modern science needs to change to a revalorization of the natural compounds and their beneficial effects on human diseases, such as cancer. Medicinal mushrooms have been used since thousands of years due to its healing properties. Maitake (Grifola frondosa) is presented as one of the most interesting medicinal mushrooms that have been studied. Until now, Maitake D-Fraction may have anticarcinogenic activity, preventing oncogenesis and metastasis in certain tumor types. However, the exact molecular mechanism by which D-Fraction acts are yet unknown. The results shown in this chapter suggest that Maitake D-Fraction Pro4X, administered intraperitoneally, prevents significantly the development of mammary tumorigenesis, increases survival, and reduces the process of angiogenesis in BALBc mice. Although yet to determine the active component of the extract and the molecular mechanism by which it operates in the breast carcinogenesis process. The socioeconomic impact of this research project could be important, considering that in Argentina similar studies using natural compounds derived from medicinal mushrooms for cancer therapy have not yet been performed. The beneficial effects of Maitake, if proven, could be useful for the treatment of cancer patients who are undergoing chemotherapy or radiation or for breast cancer prevention in high-risk population.",signatures:"Aguilera Braico, Diego Máximo and Gabriela Andrea Balogh",downloadPdfUrl:"/chapter/pdf-download/53910",previewPdfUrl:"/chapter/pdf-preview/53910",authors:[{id:"190412",title:"MSc.",name:"Diego",surname:"Aguilera Braico",slug:"diego-aguilera-braico",fullName:"Diego Aguilera Braico"},{id:"190413",title:"Dr.",name:"Gabriela",surname:"Balogh",slug:"gabriela-balogh",fullName:"Gabriela Balogh"}],corrections:null},{id:"53993",title:"Breast Cancer: From Transcriptional Control to Clinical Outcome",doi:"10.5772/66888",slug:"breast-cancer-from-transcriptional-control-to-clinical-outcome",totalDownloads:1607,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Breast cancer is the most common malignancy in women worldwide. The risk of breast cancer in women increases with age, and this is partly attributable to the accumulation of genetic lesions. Growing evidence demonstrates the role played by epigenetic modifiers and the tumor microenvironment in contributing to the increased risk of breast cancer. This chapter provides a comprehensive overview of the epigenetic regulatory signatures that impact the well-studied signaling pathways in breast tissues. Additionally, we will also delve into the therapeutic and diagnostic potential of noncoding RNAs in breast cancer.",signatures:"Sudhakar Jha, Deepa Rajagopalan, Shainan Hora and Shweta\nPradip Jadhav",downloadPdfUrl:"/chapter/pdf-download/53993",previewPdfUrl:"/chapter/pdf-preview/53993",authors:[{id:"190426",title:"Dr.",name:"Sudhakar",surname:"Jha",slug:"sudhakar-jha",fullName:"Sudhakar Jha"}],corrections:null},{id:"54012",title:"Immune Regulation in Breast Cancer Metastasis and Immunotherapy",doi:"10.5772/66991",slug:"immune-regulation-in-breast-cancer-metastasis-and-immunotherapy",totalDownloads:1443,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"There are significant alterations in the tumor surrounding stromal cells in addition to the cancer cells in tumor microenvironment. Tumor cells can metastasize by acquiring the ability to escape immune control and surveillance. A decline in the ability of the immune cells to recognize and kill the tumor leads to tumor relapse or metastasis after primary treatment. Comprehensive review in this chapter will be conducted to further investigate into the mechanism of immune evasion in metastatic tumor microenvironment. The immune cells, stromal cells, extracellular matrix protein/component, and their interaction will be reviewed and summarized. Breast cancer has not been previously viewed as a particularly immunogenic type of tumor. Nevertheless, immune parameters have been increasingly studied in breast cancer, and accumulating data show that they are relevant for the development and progression of this tumor type. Consequently, immunotherapies of breast cancer are now tested in different clinical trials. The prospect of immunotherapy in metastatic breast cancer will be introduced. The importance of host‐targeted modulation/therapy will be increased in addition to cancer‐targeted strategies. We have to better define subpopulations of breast cancer patients to optimize the immunological way to overcome the cancer metastasis.",signatures:"Ming-Shen Dai",downloadPdfUrl:"/chapter/pdf-download/54012",previewPdfUrl:"/chapter/pdf-preview/54012",authors:[{id:"190480",title:"Dr.",name:"Ming-Shen",surname:"Dai",slug:"ming-shen-dai",fullName:"Ming-Shen Dai"}],corrections:null},{id:"53440",title:"Felt Needs for Rehabilitation After Breast Cancer Treatment in Mexico",doi:"10.5772/66436",slug:"felt-needs-for-rehabilitation-after-breast-cancer-treatment-in-mexico",totalDownloads:1448,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Breast cancer (BC) is the most frequent type of malignancy among women worldwide and the most common cause of mortality, particularly in low and middle‐income countries. As detection and treatment have improved, a larger number of surviving women need adequate rehabilitation after treatment. However, awareness among affected patients remains low. Thus, the aim of this study was to explore the needs and expectations concerning rehabilitation among Mexican women after breast surgery. An ethnographic approach was used. Eight focus groups were conducted in the north‐central state of San Luis Potosí, Mexico, in 2014, in which women under treatment and survivors participated. Results showed that women had insufficient and misleading information concerning the need for rehabilitation from health care authorities. Women seemed to focus more on survival than on quality of life after treatment even though impairments limiting their daily life activities caused frustration and feelings of uselessness. In conclusion, many women perceived the need for rehabilitation, but information was largely lacking. Public health services fail to provide rehabilitation services, which are now partially covered by private organizations. Treatment for breast cancer should be accompanied by rehabilitation. Awareness, availability and access to physiotherapy services need to be put in place.",signatures:"Viveka Hammelin, Luz María Tejada‐Tayabas, Dulce María Galarza‐\nTejada and Joel Monárrez‐Espino",downloadPdfUrl:"/chapter/pdf-download/53440",previewPdfUrl:"/chapter/pdf-preview/53440",authors:[{id:"190554",title:"Associate Prof.",name:"Joel",surname:"Monárrez-Espino",slug:"joel-monarrez-espino",fullName:"Joel Monárrez-Espino"}],corrections:null},{id:"53341",title:"Naringenin Inhibits Proliferation and Survival of Tamoxifen‐ Resistant Breast Cancer Cells",doi:"10.5772/66698",slug:"naringenin-inhibits-proliferation-and-survival-of-tamoxifen-resistant-breast-cancer-cells",totalDownloads:1527,totalCrossrefCites:4,totalDimensionsCites:7,hasAltmetrics:0,abstract:"The majority of breast cancers are estrogen receptor positive (ER+) and utilize estrogen to promote cell proliferation. Thus, the ER has been the target of many therapies. While this strategy has been successful, the long‐term use of antiestrogen therapies, such as tamoxifen (Tam), frequently results in Tam resistance (Tam‐R). Tam‐R cells may proliferate due to the activation of the phosphatidylinositol‐3 kinase (PI3K) and the mitogen‐activated protein kinase (MAPK) pathways. Targeting these proliferation and survival pathways after the development of resistance is critical for the treatment of drug‐resistant cancers. We have identified the flavanone Naringenin (Nar) as an inhibitor of both the PI3K and MAPK pathways. Here, we show that Nar impairs cell proliferation and induces apoptosis of Tam‐R MCF‐7 breast cancer cells. We also demonstrate that Nar treatment reduced the levels of both ERK and AKT in Tam‐R cells. Furthermore, Nar treatment localized ERα to a perinuclear region in Tam‐R cells. Nar may function by inhibiting both the PI3K and MAPK pathways as well as localizing ERα to the cytoplasm to impair cell proliferation of Tam‐R MCF‐7 cells. These studies provide insight into the molecular mechanisms involved in cell proliferation of Tam‐R breast cancer cells.",signatures:"Joseph Ramos, Talia Hatkevich, Lauren Eanes, Idalys Santos‐Sanchez\nand Yashomati M. Patel",downloadPdfUrl:"/chapter/pdf-download/53341",previewPdfUrl:"/chapter/pdf-preview/53341",authors:[{id:"192549",title:"Dr.",name:"Yashomati",surname:"Patel",slug:"yashomati-patel",fullName:"Yashomati Patel"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"5770",title:"Mesenchymal Stem Cells",subtitle:"Isolation, Characterization and Applications",isOpenForSubmission:!1,hash:"8d2f6e69167ad835f02cf8848065c202",slug:"mesenchymal-stem-cells-isolation-characterization-and-applications",bookSignature:"Phuc Van Pham",coverURL:"https://cdn.intechopen.com/books/images_new/5770.jpg",editedByType:"Edited by",editors:[{id:"28799",title:"Ph.D.",name:"Phuc Van",surname:"Pham",slug:"phuc-van-pham",fullName:"Phuc Van Pham"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"329",title:"Breast Cancer",subtitle:"Carcinogenesis, Cell Growth and Signalling Pathways",isOpenForSubmission:!1,hash:"ebf7902b7672e9142e56de2289bcaa5a",slug:"breast-cancer-carcinogenesis-cell-growth-and-signalling-pathways",bookSignature:"Mehmet Gunduz and Esra Gunduz",coverURL:"https://cdn.intechopen.com/books/images_new/329.jpg",editedByType:"Edited by",editors:[{id:"46056",title:"Prof.",name:"Mehmet",surname:"Gunduz",slug:"mehmet-gunduz",fullName:"Mehmet Gunduz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1278",title:"Breast Cancer",subtitle:"Focusing Tumor Microenvironment, Stem cells and Metastasis",isOpenForSubmission:!1,hash:"bd2df7c338f309db645c7c183571f6a8",slug:"breast-cancer-focusing-tumor-microenvironment-stem-cells-and-metastasis",bookSignature:"Mehmet Gunduz and Esra Gunduz",coverURL:"https://cdn.intechopen.com/books/images_new/1278.jpg",editedByType:"Edited by",editors:[{id:"46056",title:"Prof.",name:"Mehmet",surname:"Gunduz",slug:"mehmet-gunduz",fullName:"Mehmet Gunduz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1277",title:"Breast Cancer",subtitle:"Current and Alternative Therapeutic Modalities",isOpenForSubmission:!1,hash:"9c0bc3b171254b2a3f7d52bee5c559aa",slug:"breast-cancer-current-and-alternative-therapeutic-modalities",bookSignature:"Esra Gunduz and Mehmet Gunduz",coverURL:"https://cdn.intechopen.com/books/images_new/1277.jpg",editedByType:"Edited by",editors:[{id:"61074",title:"Dr.",name:"Esra",surname:"Gunduz",slug:"esra-gunduz",fullName:"Esra Gunduz"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2883",title:"Oncogene and Cancer",subtitle:"From Bench to Clinic",isOpenForSubmission:!1,hash:"ba08b50f799acf44d8d2f0f0c6c2e768",slug:"oncogene-and-cancer-from-bench-to-clinic",bookSignature:"Yahwardiah Siregar",coverURL:"https://cdn.intechopen.com/books/images_new/2883.jpg",editedByType:"Edited by",editors:[{id:"137622",title:"Dr.",name:"Yahwardiah",surname:"Siregar",slug:"yahwardiah-siregar",fullName:"Yahwardiah Siregar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1276",title:"Targeting New Pathways and Cell Death in Breast Cancer",subtitle:null,isOpenForSubmission:!1,hash:"e1541edf35e439e637938657d6ac482b",slug:"targeting-new-pathways-and-cell-death-in-breast-cancer",bookSignature:"Rebecca L. 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Although the medical education and medical research are focused mainly on individual diseases, the study of multimorbidity is increasingly common. A recent bibliometric study revealed that the number of publications regarding this topic increased 60% after 2010 [2]. Nevertheless, the study of multimorbidity is still not sufficient to reduce the gap between the available evidence for single condition vs. multiple conditions [2].
\nMultimorbidity is a relatively new concept and a challenging area in clinical practice globally, and some confusion persists regarding its definition. For instance, the terminologies multimorbidity and comorbidity have been used interchangeably despite their differences. Comorbidity, as originally described by Feinstein in 1970 [3], is used to describe any clinical entity coexisting with an index disease under study. This term and its definition are widely accepted and used. However, the definition of multimorbidity, which is the term most frequently used when no index disease is designated, is still not consensual. Indeed, only in 2018, the term multimorbidity was accepted as a Medical Subject Heading (MeSH) by the United States National Library of Medicine and with the simple definition “the complex interactions of several co-existing diseases”. Despite this somehow insufficient definition, it is usually accepted that multimorbidity takes into account chronic or long-term diseases or conditions, including both physical and mental diseases, with none considered the index disease [4].
\nDespite the stated differences, the concepts of comorbidity and multimorbidity are not mutually exclusive or contradictory, but consider a patient with more than one disease at the same time from different perspectives. While comorbidity considers any additional disease as consequence, complication, or coincidence, multimorbidity is a more generic, patient-centered concept, where all morbidities are regarded of equal importance irrespective of whether they started before or after any other disease in question, and that contemplates all aspects of a patient’s condition, including potential disease interactions and potential pathophysiological links [5]. Multimorbidity considers that the pathophysiological links between these diseases, syndromes, or conditions may overlap and that their management may interact to varying degrees.
\nHighly prevalent chronic diseases, such as arthritis, diabetes, chronic lower respiratory tract disease, or stroke, are known to co-occur frequently [6], and even less prevalent conditions still may occur in the same person at the same time. It is clear that, at the population level, diseases may aggregate due to chance alone, i.e., the more frequent a disease is, the more likely it is to coexist with others even in the absence of a direct causal relation, particularly for conditions which become more common with increasing age. However, non-communicable diseases (NCDs) also frequently aggregate due to shared pathophysiological mechanisms, either as sequential steps in the same causal pathway (causal multimorbidity) or as common results of the same exposures (associative multimorbidity) [7]. One example is a known causal pathway between rheumatoid arthritis and cardiovascular disease [8]. Another example is the increased risk of both osteoarthritis and type 2 diabetes in people with obesity, a shared risk factor between several NCDs that consequently increases the likelihood of these diseases clustering in the same subject [9]. This framework provides a causal or associative meaning to several mechanisms commonly used to explain for disease co-occurrence: general disease susceptibility, interaction between gene and environment, association between morbidities in a mutually reinforcing causal loop, effects on different organs of psychosocial and cultural factors, life events and coping styles, and common underlying pathogenic mechanisms, such as chronic inflammation [7, 10].
\nMultimorbidity is becoming increasingly important in research and daily clinical practice. Its burden to both the individual and society is increasing, probably due to higher life expectancy, lowered thresholds for diagnoses, advances in medical care, and possibly due to a true increase in the prevalence of some chronic diseases [11]. Despite the existence of abundant information regarding epidemiology, risk factors, and management of individual chronic diseases, for multimorbidity only a few clinical guidelines exist making informed decisions harder. For example, following clinical practice guidelines for individual chronic conditions, a recent systematic review reported that a hypothetical 78-year-old woman with five chronic conditions [osteoporosis, osteoarthritis, diabetes type 2, hypertension, and chronic obstructive pulmonary disease (COPD)] would be prescribed up to 12 separate medications, taken at five times during the day, and should be engaged in 14 non-pharmacological activities [12, 13]. Given that each one of these diseases has different therapies, the management strategy for the patient with multimorbidity may be influenced by the care provided to each one of the conditions, including limitations of life expectancy, interactions between therapies, and/or contraindications to therapy for one condition due to other conditions [14]. Additionally, most times, the use of many services to manage individual diseases can become duplicative and inefficient and may be burdensome and unsafe for patients because of poor coordination and integration. In fact, a key aspect of multimorbidity is that chronic diseases are likely to act synergistically [15], causing an overall burden that can be larger than the sum of their individual impacts.
\nAt the patient level, multimorbidity is associated with higher mortality [16], worsened functional status, and poorer quality of life [17]. Additionally, people living with multimorbidity have greater self-care needs [18] and are especially likely to rely on a caregiver for health management [19]. At the healthcare level, it implies increased risk of receiving less than best practice care [20], more frequent postoperative complications [21], longer hospitalization, higher likelihood of readmission [22], more frequent healthcare utilization, higher direct costs [23, 24], and increased use of polypharmacy with the potential for adverse drug effects [25]. With all these adverse health outcomes, the ramifications of suffering from multimorbidity affect the individual within social, educational, cultural, behavioral, economic, and environmental circumstances, which in turn affect disease management.
\nStudies have shown that age, household income, and family structure are the most important measured predictors of the multimorbidity status [26]. Moreover, multimorbidity tends to be more common in females than in males [26, 27]. The presence of multimorbidity also suggests higher risk of additional conditions, i.e., people with multimorbidity are at a higher risk of being diagnosed with two or more new diseases than those with no disease [28], probably due to increased interaction with healthcare professionals and higher healthcare utilization. Additionally, several important modifiable risk factors that are associated with the development of individual chronic diseases may play an important role in multimorbidity. These include lifestyle factors such as tobacco smoking and alcohol intake, over- and undernutrition, physical inactivity, and occupational exposures [29, 30, 31, 32]. Many of these factors are common to multiple diseases. For instance, smoking increases the risk of chronic respiratory diseases, cardiovascular diseases, and neoplasms, while obesity increases the risk of cardiovascular diseases and musculoskeletal disorders. Therefore, it is not surprising that the presence of these risk factors increases the risk of a particular combination of chronic diseases. A recent bibliometric study showed that the risk factors most commonly mentioned in multimorbidity studies are physical activity and obesity/high body mass index [2]. Additionally, a recent overview of systematic reviews summarized the evidence on risk factors for multimorbidity into four groups: biomedical and individual factors (aging, women, high number of previous diseases, negative life events, external health locus of control, and mental disorders), health behaviors (smoking, overweight, obesity, high waist to hip ratio, and low physical activity), socioeconomic characteristics (lower social economic status, lower education, less social networks, full dependency, and unemployment), and social and environmental factors (living in urban areas in lower middle income country) [33].
\nDespite the increase in research outputs regarding multimorbidity, the evaluation of the burden of multimorbidity and its population impact remains challenging. In the European Union, there are an estimated 50 million people with multimorbidity, and this number is expected to grow as the population ages [34]. Estimates of the prevalence of multimorbidity vary from 4.4% to over 90% [35, 36, 37], a discrepancy driven by distinct study populations or data sources, usually involving differences in demographic characteristics and disease types or classification. Despite this, up to the present, no gold standard exists regarding how to assess multimorbidity, and there is no consensus on which conditions should be considered or on the method used for measuring multimorbidity, which makes comparisons among studies difficult.
\nRheumatic and musculoskeletal diseases (RMDs) are among the most prevalent groups of NCDs [38]. They are strong determinants of pain [39] and disability [40] and the first to third largest contributors to years lived with disability (YLDs) in almost all world regions [41]. Additionally, they have a high impact on quality of life [42], complexity of medication regimens [43], and affect the ability to continue paid employment [44]. Due to their high incidence and low case fatality, RMDs frequently co-exist with other conditions [37, 45]. Despite their well-known association with a wide scope of adverse health outcomes [46, 47, 48, 49], the inclusion of RMDs in multimorbidity research tends to be inconsistent and selective. However, evidence supports that RMDs appear to form a principal component of certain multimorbidity clusters [50] and are common in multimorbidity [51, 52], with one study reporting that even after adjustment for age and gender, the odds of multimorbidity were greater in respondents with musculoskeletal conditions than those with any of the non-musculoskeletal conditions included in different definitions of multimorbidity assessed [51].
\nRMDs are also a highly heterogeneous group of NCDs [38], from inflammatory rheumatic diseases (such as rheumatoid arthritis and spondyloarthritis) to degenerative conditions (such as osteoarthritis), fragility conditions (such as osteoporosis), or regional pain syndromes (such as low back pain, neck pain and, the chronic widespread pain syndrome) [53]. RMDs are common throughout the life course, but some become even more common at older ages, in particular osteoarthritis. Despite this, RMDs are not always assessed in multimorbidity studies, and when assessed, they are usually restricted to osteoarthritis [54] or to broadly encapsulating categories that include arthritis, other joint disorders, or other painful conditions in the same category [26, 55].
\nIt is plausible that the prevalence of multimorbidity might vary for subtypes of RMDs included in each definition. The subgroups with the highest prevalence of multimorbidity are typically osteoporosis, osteoarthritis, and inflammatory arthritis [51], but it remains to be determined whether RMDs in general, or only particular subgroups of RMDs, are associated with increased prevalence of multimorbidity.
\nFurthermore, multimorbidity research typically focuses on older people, naturally excluding generally less disabling RMDs, such as work-related musculoskeletal conditions. However, multimorbidity is not simply a process of aging [36], suggesting that to fully capture the burden of RMDs in multimorbidity a broader age range should be evaluated. As a matter of fact, considering that the presence of one condition increases the risk of multimorbidity in disease-specific populations (probably due to shared lifestyle and biomedical disease risk factors, as well as medication use [56] or iatrogenic effects [57]), the study of the role of RMDs in multimorbidity should start at young ages to fully capture the heterogeneity of RMDs, including soft tissue disorders or others that start at younger working ages.
\nMany important risk factors for common RMDs show remarkable overlap with risk factors for multimorbidity. For example, age and female gender are two of the most important non-modifiable risk factors for some RMDs [58], and as previously stated, they are also common risk factors for multimorbidity. Modifiable risk factors such as obesity or low physical activity are importantly associated with osteoarthritis and regional pain syndromes, including low back pain [59]. Additionally, smoking is the main modifiable risk factor for inflammatory arthritis, and smoking, poor nutrition, and low physical activity are lifestyle risk factors for osteoporosis [60]. All these risk factors have been linked to multimorbidity in recent publications [29, 30, 31, 32].
\nBecause of the heterogeneous multimorbidity definitions used in different studies, it is difficult to fully assess the impact of RMDs on multimorbidity. However, RMDs usually aggregate with a wide set of NCDs. An Australian systematic review of population-based studies in the elderly found that over 50% of elderly patients with arthritis also had hypertension followed by cardiovascular diseases, dyslipidemia, diabetes, and mental health problems, whereas 60% of elderly patients with asthma reported arthritis followed by cardiovascular diseases and diabetes [61]. According to several systematic reviews, arthritis or osteoarthritis is usually comorbid with hypertension, cardiovascular diseases, dyslipidemia, diabetes, mental health problems, asthma, depression, and metabolic conditions [45, 61, 62, 63].
\nAs previously described [64, 65, 66], RMDs frequently cluster with cardiometabolic conditions due to common pathophysiological risk factors, such as immobility, obesity, and systemic inflammation [67]. Additionally, pleuropulmonary disease may occur in patients with systemic autoimmune rheumatic diseases due to several causes, including infection in the treated patient, toxic medication reactions, and inherent manifestations of the diseases themselves [68]. Also, studies have shown a slightly increased risk of specific malignancies in people with rheumatoid arthritis [69], possibly due to smoking as a common risk factor for rheumatoid arthritis and lung cancer [70] and estrogen changes, which are common to rheumatoid arthritis and breast cancer [71]. A strong bidirectional relation between depressive states and musculoskeletal symptoms, especially pain, is well documented, which accounts for the clustering of these conditions [72]. These findings can be interpreted in the light of the current discussion about inflammatory as well as oxidative and nitrosative stress pathways that underpin the common pathophysiology of depression and RMDs [73]. Additionally, inflammatory cytokines, glucocorticoid treatment, immobilization, and reduced physical activity due to tender joints and muscle weakness have shown to play a key role in favoring low bone mineral density in RMDs [74], especially in people with rheumatoid arthritis [75].
\nThe specific combination of RMDs with other NCDs also seems to have a strongly deleterious effect in adverse health outcomes. For example, co-occurrence of pulmonary and cardiac diseases is most often associated with mortality, but work disability is more strongly associated with depression [76]. Therefore, when trying to assess how multimorbidity affects prognosis, we need to define which disease combinations we are referring to and which outcome is of greatest interest. Slater and colleagues [77] found that among people with diabetes, cardiovascular, and respiratory diseases, comorbid musculoskeletal conditions increased the risk and accounted for a substantial proportion of activity limitations. Also, patients with rheumatoid arthritis and comorbidities are less likely to achieve treatment targets such as remission or low disease activity [78]. Others demonstrated that multimorbidity and depressive symptoms are strongly linked to functional limitations and lower self-rated health [79], that RMDs in multimorbidity worsen daily functioning and quality of life [17], and that multimorbidity is associated with frequent healthcare utilization and higher costs for the healthcare system [80]. Depression seems to interact synergistically with arthritis and neck/back disorders to increase the odds of reporting chronic pain beyond an additive model [81]. Additionally, the presence of RMDs in the context of multimorbidity tends to amplify the risk of adverse work outcomes and especially of sick leave [52].
\nThe management of patients with multimorbidity is challenging. Although it could be expected that people with multimorbidity might be receiving better quality of healthcare than that individuals with only one disorder, at least partly because of greater contact with healthcare services [82], people with multimorbidity have more difficulties with disintegration of care, polypharmacy, and medical error because much specialized care is focused on the treatment of one disease [5]. Those with multimorbidity frequently receive care from family physicians, other medical specialists, and other healthcare professionals, such as nurses or physiotherapists, who may not be communicating effectively with each other [83]. Additionally, and despite the confirmed effectiveness of many individual treatments commonly used in chronic conditions, each additional therapy carries an additional burden, known as treatment burden, which includes physical effects of treatment, financial losses, and the psychosocial effects of time demands and dependence on others for assistance [84]. This means that people often suffer from a combination of disease and treatment burdens and that people receiving multiple treatments will have a higher treatment burden than those receiving only one treatment.
\nCurrently, the main challenge of health professionals when targeting multimorbidity is to try to step aside from a disease-centered perspective, very deeply rooted in health professionals’ education and strongly encouraged through pay-for-performance systems, to switch to the patient as the focus of treatment. For example, the typical treatment perspective for a patient with RMDs and other conditions focuses on the comorbidity concept, i.e., in the treatment of the index disease [5]. A medical doctor, usually a rheumatologist, will apply the treat-to-target concept to induce remission of that disease [85], hoping that this treatment will also positively affect non-RMD comorbidities. The treat-to-target approach is generally defined as a proactive treatment strategy, operationalized as a precise treatment algorithm, in which the clinician treats the patient aggressively enough to reach and maintain specific goals, such as remission or low disease activity [85]. In contrast, when considering the multimorbidity concept, the focus is on treating the patient, usually trying to improve overall well-being. In multimorbidity, it is harder to assess treatment effectiveness, and other concepts such as quality of life, overall function or health, and the patients’ preferences should be also considered [5]. In order to help the clinicians, a recent clinical guideline suggesting a patient-centered approach to multimorbidity was published [86, 87]. It is important to notice that it is very difficult to publish guidelines concerning a disease-centered treatment for every combination of chronic conditions, which is one of the reasons why multimorbidity guidelines are more likely to take a patient-centered approach, targeting general well-being, quality of life, independence, autonomy, and improved function, but especially patient’s goals, values, and priorities [86]. By implementing the concept of patient-centered care in daily practice, a greater effectiveness of diagnosis and treatment approaches and also improved clinical outcomes are expected.
\nThis new clinical guideline suggests that in patient-centered care it is important to understand the patient’s life, establishing what is important to them, and acknowledge the current disease and treatment burdens. After that, a revision of the patient’s current medicines and other treatments should be done. The risks and benefits of each treatment (including non-pharmacological ones) should be weighted, and later, an individualized management plan, including timing of follow-up, should be developed and agreed upon with the patient [86]. Health professionals will have the most difficult task: to balance medical knowledge and expertise with patients’ goals, when trying to reduce the impact of any conditions on the adverse health outcomes that really worry the patient. It is not only about attaining one disease remission but rather to achieve a “healthy” life, and this is even more important when the patient is chronically ill.
\nPatient-centered care for patients with multimorbidity can be described as a care which (1) is attentive to patient’s psychosocial as well as physical needs, (2) explores the patient’s concerns and priorities for care, (3) conveys a sense of partnership between the patient and physician, (4) facilitates active patient involvement in decision-making, and (5) is coordinated across professionals, facilities, and support systems [88, 89]. However, the evidence regarding the effectiveness of such care is still lacking. The need for such evidence, including the need for patient care guidelines and health programs that are multiple disease-centered, is nowadays well established. Despite the recent publication of new guidelines and frameworks regarding patient-centered and integrated care [90, 91], the implementation of these recommendations in day-to-day work will require a re-organization in the way care is delivered. In a qualitative study, Bayliss and colleagues [18] explored the healthcare priorities of patients with multimorbidity. The priorities for patients were easy access to care and clinicians, but especially they desired healthcare providers who had a caring attitude and listened to them, understanding that their needs were unique and fluctuating. A recent systematic review [92] described comprehensive care programs targeting multimorbidity patients and estimated their effectiveness regarding improvement of patient- and caregiver-related outcomes, healthcare utilization, and costs. The authors concluded that providing comprehensive care might result in higher patient satisfaction, less depressive symptoms, a better health-related quality of life, or functioning, but also found that the evidence is still insufficient. More (good quality) studies using more appropriate outcome measures are needed [92].
\nPatient-centered care must be provided by a multidisciplinary team, and this is a great challenge. There must be clarity about who will be responsible for carrying out the different actions outlined in a plan, with appropriate support and coordination between professionals. Although it would be expected that several health professionals would have expertise in assessment and management of RMDs and differ mainly by the types of interventions they use, this is often not the case, given that different professionals have different curricula and often different perspectives regarding diseases and treatment goals [93]. So, it should be recognized that an integrated approach with all the disciplines and professionals working together is the ideal way of achieving the best outcome for the patient. Healthcare services should be aware of this paradigm shift and must provide integrated coordinated multidisciplinary care; however, this is a multifaceted challenge that cannot be overcome with a single effort.
\nComplex patients, such as some of those with multimorbidity, are nowadays the norm, implying a growing concern that clinical practice guidelines fail to adequately address the care of complex patients. As already mentioned, the ramifications of suffering from multimorbidity unfold for each patient, within their social, educational, cultural, behavioral, economic, and environmental contexts, which in turn affect disease management. The healthcare system in several countries is typically guided by clinical practice guidelines that are oriented toward single disease [94]. This poses a challenge for primary care professionals who try to implement evidence from these guidelines in patients with multimorbidity. As described by Duffield and colleagues [53], people with multimorbidity are often required to carry out numerous tasks to maintain their health. The responsibilities listed by the authors include managing different tablets to be taken at specific times of day, week, or only occasionally; keeping stock of their pills, creams, inhalers, and injections; requesting repeat prescriptions on time; visiting the pharmacy to collect items; performing non-pharmacological treatments such as physiotherapy or other complementary interventions; and monitoring treatment effectiveness with regular lab analyses, physical tests, and medical appointments [53]. The time and effort required to remember and attend these appointments, including travel time, may require an additional treatment burden placed upon the individual [84]. Having a RMD as part of multimorbidity makes all of these activities even more difficult. People with arthritis report great difficulty or inability to grasp small objects; reach above one’s head; sit more than 2 hours; lift or carry 10 pounds; climb a flight of stairs; push a heavy object; walk a 1/4 mile; stand for more than 2 hours; and stoop, bend, or kneel [95]. As a result of restricted mobility and function, having a RMD can hamper the execution of many of the tasks required in multimorbidity care, limiting people’s ability to manage their health.
\nThe impact of RMDs on patients and society should be acknowledged, as they are mostly non-fatal conditions with great effects at older ages. Regardless of the multimorbidity definition applied, musculoskeletal conditions are a common component of multimorbidity [51], and most working-age adults who met the definition of multimorbidity had a musculoskeletal condition [96]. This is an important finding because the strategies to include and classify musculoskeletal conditions within multimorbidity research have been inconsistent. Policy makers and public health teams should be aware of the importance of musculoskeletal health. Frequently, osteoarthritis and osteoporosis are seen as a natural consequence of aging and back pain as normal in working ages. The importance of early appropriate treatment for many musculoskeletal conditions in order to prevent chronicity and to reduce disability is undervalued. Often, adherence to treatment plans is less than optimal since patients are typically given little information about their condition; and many have misconceptions about treatments [97]. However, it is important to understand that even if the condition itself cannot be suppressed, health professionals can contribute to improve the patient’s general well-being, quality of life, independence, autonomy, and general function.
\nGovernments and public health teams along with healthcare stakeholders should take multimorbidity into account when designing, implementing, and evaluating public health education, programmes, and campaigns. They should identify and understand the needs and requirements of people living with multimorbidity (and with RMDs in particular) in their populations. They should also identify, prioritize, and target adverse health outcomes. They should acknowledge that targeting risk factors can potentially reduce the burden of multimorbidity in the long term. It is time to face multimorbidity.
\nIn conclusion, although population aging has been a remarkable achievement of public health and clinical medicine, it poses great challenges that can only be overcome if clinicians, researchers, and policy makers are aware of the complexity of multimorbidity, which needs specialization, but also a holistic approach to ensure that patients receive coordinated care. However, more studies on RMDs and multimorbidity are still needed. Further evidence may help to better understand reasons for poorer health in certain groups and to aid their disease management. It may also contribute to assess the effect of multimorbidity on long-term outcomes, to identify prognostic factors, to develop effective interventions, and to support integrated patient-centered care programmes.
\nAll authors have declared that no conflict of interest exists.
Psoriasis is a chronic inflammatory skin disease that progresses with remission and exacerbations [1, 2]. It constitutes an important percentage, approximately 6–8% of patients who apply to dermatology clinics [3]. Due to its high prevalence and chronic course, it is important to diagnose it early and clearly to manage patient appropriately and avoid functional losses as much as possible. In addition, in some situations that should be intervened swiftly such as erythrodermic psoriasis or generalized pustular psoriasis; the sooner we diagnose, the better we take control of disease setting.
In diagnosis of psoriasis, usually clinical observation is enough; however, in doubtful cases, histopathological examination is required as gold standard technique. However, it requires an invasive procedure and needs time for pathological preparation. With dermoscopy, we can mostly distinguish psoriasis from other resembling diseases in clinic noninvasively. Despite it not being gold standard, easily applicable and noninvasive properties of dermoscopy make it a helpful diagnostic tool and reduce the need of performing biopsies.
Plaque psoriasis is the most common clinical subtype of psoriasis with 90% of all cases [4]. It is characterized by erythematous, well-defined, and usually indurated plaques greater than 1 cm in size with white-silvery scales on them (Figure 1). They can vary in size and may coalesce. Especially rapidly progressing lesions can be seen in annular configuration (Figure 2) [4, 5]. Removal of psoriatic scales may cause pinpoint bleedings, which is called Auspitz sign. Psoriatic plaques are mostly located in the scalp, trunk, lumbosacral area, and extensor surfaces of extremities (Figure 3) [6].
Erythematous, well-defined indurated plaque with white scales.
Erythematous, annular plaques with white scales.
Psoriatic plaques located on the trunk and extensor surfaces of the arms.
Dermoscopic examination of a psoriasis plaque should be done in three categories: background, vessels, and scales. Examination should be done with minimal pressure to visualize vessels better and with immersion oil if possible.
In dermoscopic examination of plaque psoriasis with handheld dermoscope, we usually see regularly distributed dotted vessels in a reddish-pinkish background and white scales (Figure 4) [7]. In some cases, background can be grayish-white due to highly hyperkeratotic scales (Figure 5).
Regularly distributed dotted vessels on reddish background with patchy distributed white scales. Note dot blood hemorrhages (red circle). Anatomical localization: Upper extremity (×10).
Background color can barely be seen due to diffuse thick white scales. Dotted vessels can be seen in the center. Note dot blood hemorrhages (red circle). Anatomical localization: Elbow (×10).
Apart from regular distribution, vessels can be distributed scattered, in clusters, in rings, and patchy (Figure 6a). In higher magnifications (with videodermoscopy), these dotted vessels can be seen as bushy capillaries, globules, radial capillaries, globular rings, hairpin capillaries, and comma vessels in descending order [8] (Figure 6b). Rarely dot blood hemorrhages can be seen in vessel locations (Figure 5). Scales can be distributed diffuse, patchy, central, or peripheral in descending order; however, white color is key point for scales [8, 9].
a: Vessel distribution patterns (regular, scattered, in clusters, in rings, patchy, respectively). b: Vessels subtypes can be seen in higher magnifications (bushy, globular, radial, globular ring, hairpin, and comma vessels, respectively).
Differential diagnosis of plaque psoriasis should be done with skin diseases, which are characterized by erythematous plaques with scales such as dermatitis, tinea corporis, pityriasis rosea, pityriasis rubra pilaris, lichen planus, and non-pigmented squamous cell carcinoma in situ.
In dermoscopic examination of dermatitis, we usually see patchy or scattered distributed dotted vessels with yellow globules (corresponding to sero-crusts) [10]. Background can be erythematous or not depending on lesions phase (acute or chronic). Hemorrhagic crusts can be seen as well secondary to traumatization (Figure 7).
Yellow globules, dot blood hemorrhages, and hemorrhagic crusts, patchy distributed dotted vessels (red circle). Background is slightly pinkish. Anatomical localization: Lower extremity (×20).
In dermoscopic examination of tinea corporis, we usually see peripherally located dotted vessels and rough white scales (Figure 8). In contrast with psoriasis, dotted vessels are not regularly distributed and not uniform. In addition, scales are only located peripherally, tend to peel outward, and shaped in moth-eaten pattern [11].
Peripherally located dotted vessels and white scales. Note the moth-eaten pattern (red circle). Anatomical localization: Trunk (×10).
Pityriasis rubra pilaris shows dotted and more frequently linear vessels, perifollicular yellow-orange halos, follicular plugs with central hair on them (Figure 9). Scales can be yellowish or whitish. Background is usually dark or yellowish red [7, 12].
Dotted vessels regularly distributed on pinkish background. Note the follicular plugs and central hairs (red circles). Anatomical localization: Elbow (×20).
Squamous cell carcinoma in situ and psoriasis can be challenging especially in solitary plaques. Dermoscopic clues for non-pigmented squamous cell carcinoma in situ are dotted or glomerular vessels in clusters in the center and arranged in lines at the periphery with yellowish white scales (Figure 10) [13, 14].
Glomerular vessels in the center, white scales. Note the linear arrangement of dotted vessels at the periphery (red circles) and actinic keratosis area at top left. Anatomical localization: Forearm (×20).
Dermoscopic features of plaque psoriasis and its differentials are summarized in Table 1.
Background | Vessel types | Vessel arrangement | Scales | Additional features | |
---|---|---|---|---|---|
Reddish-pinkish Whitish (due to hyperkeratotic scales) | Dotted | Regular | Whitish-grayish | ||
Skin colored-pinkish | Dotted | Scattered/patchy | Yellowish | Irregularly distributed dot blood hemorrhages due to traumatization | |
Reddish | Dotted | Peripheral | White and rough; peripheral; moth-eaten pattern; tend to peel outwards | ||
Dark red/yellowish red | Linear and/or dotted | Scattered | Yellowish-whitish; follicular | Perifollicular yellow-orange halos, follicular plugs, central hair | |
Pinkish | Glomerular or dotted | Regularly in center, may organize in lines at the periphery | Yellowish white scales | Peripheral actinic keratosis areas may help (white and wide follicular openings, rosettes) |
Dermoscopic features of plaque psoriasis and its differentials.
Guttate psoriasis, a psoriasis variant that is more common in pediatric population and young adults. Distinctly from other variants, we know that guttate psoriasis is selectively triggered by beta hemolytic streptococcal infections [15]. It is characterized by erythematous, well-defined flat papules/plaques lower than 1 cm in size with white-silvery scales on them. Lesions mostly located in the trunk and extremities (Figure 11a and b).
a: Slightly erythematous flat papules/plaques with white scales on them in an adolescent. Trunk localization. b: Slightly erythematous flat papules/plaques with white scales on them in an adolescent. Extremity localization.
Dermoscopic features of guttate psoriasis are very similar with plaque psoriasis, which is characterized by regularly distributed dotted vessels in a reddish background and white scales on them (Figure 12). Due to guttate psoriasis’ smaller lesion sizes (lower than 1 cm in diameter), findings may be insignificant when compared with plaque psoriasis (Figure 13).
Regularly distributed dotted vessels in reddish background. White scales. Anatomical localization: Upper extremity (×10).
Regularly distributed dotted vessels on pinkish background. Scales are white, thin, and patchy. Anatomical localization: Upper extremity (×10).
Differential diagnosis of guttate psoriasis should be done with skin diseases, which are characterized by erythematous papules/small plaques with scales. Pityriasis rosea, lichen planus, nummular dermatitis, secondary syphilis, tinea corporis, pityriasis lichenoides chronica, and disseminated eruptive porokeratosis may count as differential. (Dermatitis and tinea corporis will not be mentioned because they were discussed above.)
Dermoscopic examination of pityriasis rosea shows irregular distributed dotted vessels and peripheral thin white scale (Figure 14) [10]. Scales tend to peel outward as in tinea corporis. But note the white scale is not rough and vessels are not in the same distribution with scales. Background is generally skin-colored or slightly pinkish.
Patchy distributed dotted vessels and peripheral thin white scale. The configuration of the scales named “collarette sign.” anatomical localization: Back (×10).
In dermoscopic examination of lichen planus, key point is detecting Wichkam striaes, which cannot be seen macroscopically sometimes. In fair-skinned patients, dotted and linear vessels around Wickham striae make these structures more visible (Figure 15); however, in dark-skinned patients, absence of peripheral vascular structures around Wichkam striaes may lead to misdiagnosis [16].
Reticular arranged white lines (Wickham striae). Note the dotted vessels around Wickham striae in this fair-skinned patient. Anatomical localization: Lower extremity (×10).
In dermoscopic examination of secondary syphilis, yellowish-orange background and absence of vascular structures are key points (Figure 16) [17]. Scales may be present, however, thinner and smaller when compared with psoriatic scales.
Yellowish-orange structureless area with thin white scales. Note the absence of vascular structures. Anatomical localization: Back (×10).
In dermoscopic examination of pityriasis lichenoides chronica, we usually see orange-yellowish structureless areas and focally distributed dotted or linear vessels (Figure 17) [18].
Yellowish-orange structureless areas with thin white scales. Note the focal dotted vessel areas (red circles). Anatomical localization: Hand dorsum (×10).
In dermoscopic examination of porokeratosis, key clue is peripheral double lines resembling railways (Figure 18). This feature is called “cornoid lamella” [19].
Small white scales on yellowish-brown background. Note the railway-like “cornoid lamella” at the periphery (red arrows). Anatomical localization: Hand dorsum (×10).
Dermoscopic features of guttate psoriasis and its differentials are summarized in Table 2.
Background | Vessel types | Vessel arrangement | Scales | Additional features | |
---|---|---|---|---|---|
Reddish-pinkish | Dotted | Regular | Whitish-grayish, thin and small | ||
Pinkish | Dotted (vascularization is not dominant) | Patchy | White, thin, peripheral and tend to peel outwards “collarette sign” | ||
Pinkish, violaceus | Dotted or absent | Aroud Wickham striae | Whitish, patchy distributed, thin and small | ||
Yellowish-orange | Absent | White and thin | |||
Pinkish, yellowish-orange | Dotted or linear | Focal | White, patchy, thin | ||
Yellowish-brown | Unsignificant | White, small | Peripheral railway like double lines called “cornoid lamella” |
Dermoscopic features of guttate psoriasis and its differentials.
Inverse psoriasis is another clinical variant of psoriasis, which involves flexural areas such as axillary, inguinal, and inframammary [20]. The prevalence of inverse psoriasis is not clear and varies in 3–36% because of diagnostic challenges [21]. And also it is controversial that if genital involvement is a part of inverse psoriasis; however, we include genital involvement under this topic for convenience of expression.
Inverse psoriasis is typically present with well-defined erythematous plaques located in flexural areas (Figure 19a and b). It can present with or without typical psoriasis plaques. In contrast with plaque and guttate psoriasis, scales are insignificant or absent.
a: Erythematous plaque located in inframammary fold. b: Erythematous papules and plaques located in axillary fold. Note peripheral lesions have mild white scales.
Genital involvement shares similar clinical features with inverse psoriasis such as well-defined erythematous papules and plaques (Figure 20). However, occlusion in the genital areas is not as much as flexural areas, scales could be more visible in the genitals.
Coalesced erythematous papules located in the glans penis and penile dorsum.
Dermoscopic features of inverse psoriasis are characterized by regularly distributed dotted vessels on reddish background (Figure 21). In contrast with other variants, scales are absent. Absence of scales enhances visualization of vascular structures. Consequently, dermoscopic differential diagnosis of flexural dermatosis mainly leans on evaluation of vascular structures.
Regularly distributed dotted vessels on pinkish background. Anatomical localization: Inframammary (×10).
Differential diagnosis of inverse psoriasis should be done with skin diseases, which present with erythematous patches/plaques in flexural and genital areas. Mechanical intertrigo, seborrheic dermatitis, lichen planus inversus, and fungal/bacterial infections may count as differential. Because no clear dermoscopic features have been defined for mechanical intertrigo and flexural infections, we will discuss dermoscopic features of seborrheic dermatitis and lichen planus inversus under this topic.
The main dermoscopic features of seborrheic dermatitis of flexural areas are irregularly distributed linear, blurry vessels [22]. As we mentioned before, we do not see classical yellowish scales of seborrheic dermatitis in flexuras.
When we review the literature so far, there are only three reports about dermoscopic features of lichen planus inversus. In all of these reports, dermoscopic features of only pigmented variant of lichen planus inversus were evaluated and defined as diffuse brown patches containing multiple granular gray-brown dots [23, 24, 25]. In our clinical practice, we see non-pigmented lichen planus inversus more than pigmented subtype. According to our dermoscopic experience, Wickham striae, which is seen in lichen planus inversus, tends to be in “starry sky” or “radial streaming” pattern rather than reticular pattern. Background is usually pinkish or violaceous. Dotted vessels usually encircle Wickham striae (Figure 22).
Wickham striae in “radial streaming” pattern (red circle) and “starry sky” pattern (blue circle). Dotted vessels surround Wickham striae in a patchy arrangement. Anatomical localization: Intermammary (×10).
Dermoscopic features of inverse psoriasis and its differentials are summarized in Table 3.
Background | Vessel types | Vessel arrangement | Additional features | |
---|---|---|---|---|
Reddish-pinkish | Dotted | Regular | ||
Pinkish | Linear, blurry vessels | Irregular | ||
Pinkish, violaceus | Dotted or absent | Aroud Wickham striae | According to our dermoscopic experience, Wickham striae, which is seen in lichen planus inversus, tends to be in “starry sky” or “radial streaming” pattern |
Dermoscopic features of inverse psoriasis and its differentials.
Pustular psoriasis is a rare clinical variant of psoriasis, which is characterized by sterile pustules on an erythematous skin (Figure 23). It could be either local or generalized [26]. In generalized pustular psoriasis, concomitant fever, malaise, dehydration may also be present [27].
Small pustules and lake of pus on erythematous background.
Dermoscopic features of pustular psoriasis are characterized by regularly distributed dotted vessels with milky globules (corresponding to sterile pustules) on reddish background (Figure 24) [28]. Attention should be paid on non-follicular localization of pustules. Typical vascular structures are seen. Nonspecific yellow crust may be seen. Dermoscopic features are same in both localized and generalized subtypes.
Milky globules and regularly distributed dotted and bushy vessels on reddish background in pustular psoriasis. Anatomical localization: Trunk (×10).
Dermoscopic differential diagnosis of pustular psoriasis should be done with acute generalized exanthematous pustulosis (AGEP). In life-threatening clinical conditions such as generalized pustular eruptions, rapid and right diagnosis is essential, and dermoscope is very helpful at that point. In both pustular psoriasis and AGEP, pustules are sterile, disseminated, may coalesce, and be non-follicular. Thereby, we cannot distinguish these two situations by their clinical view only. In dermoscopic examination of both pustular psoriasis and AGEP, non-follicular milky globules on reddish background are seen [28]. Discriminately, in pustular psoriasis we see regularly distributed dotted vessels (Figure 24). In dermoscopic examination of AGEP, background is usually pinkish and vascular structures are absent (Figure 25) [29].
Milky globules on reddish background. Globules are non-follicular (red circle). Note the absence of vessels. Anatomical localization: Trunk (×10).
Erythroderma is a life-threatening condition, which is defined as desquamation and erythema of more than 90% of body surface area [30]. Erythrodermic variant of psoriasis (Figure 26) generally occurs due to poor control of disease, withdrawal of anti-psoriatic treatments, triggering drug intake, underlying systemic infections or conditions [31]. Clinical clues for erythrodermic psoriasis diagnosis are known history of psoriasis, psoriatic nail changes, presence of psoriatic arthritis. However, if none of the mentioned features is present, dermoscopy could be a game-changer.
Desquamation and erythema of all body surfaces.
Dermoscopic features of erythrodermic psoriasis are the same as other psoriasis variants. Regularly distributed dotted vessels on a reddish background, and patchy white scales are seen (Figure 27) [32].
Regularly distributed dotted vessels and white scales. Anatomical localization: Lower extremity (×20).
Dermoscopic differential diagnosis of erythrodermic psoriasis includes dermatosis that can present with erythroderma such as atopic dermatitis, mycosis fungoides, and pityriasis rubra pilaris (Pityriasis rubra pilaris will not be mentioned because it was discussed above.)
Dermoscopic examination of atopic dermatitis shows typical dermatitis features. Yellowish globules (corresponding to sero-crusts) and patchy distributed dotted vessels on a pinkish background are demonstrative (Figure 28) [32].
Yellow globules, patchy distributed dotted vessels. Background is slightly pinkish. Tiny white scales are also present. Tiny white scales correspond to desquamation areas. Anatomical localization: Trunk (×10).
Dermoscopic features of erythrodermic mycosis fungoides are a combination of linear and dotted vessels on a pale pinkish background (Figure 29) [32]. Some short linear vessels may be curved and named as “spermatozoon-like” vessels.
Linear, serpiginous, and dotted vessels on pinkish background. Tiny white scales correspond to desquamation areas. Anatomical localization: Trunk (×10).
Dermoscopic features of erythrodermic psoriasis and its differentials are summarized in Table 4.
Background | Vessel types | Vessel arrangement | Scales | Additional features | |
---|---|---|---|---|---|
Reddish | Dotted | Regular | White, scattered-patchy scales | ||
Pinkish | Dotted | Patchy | Yellowish sero-crusts | ||
Pinkish (pale) | Linear and dotted | Scattered | Whitish scales can present. | . |
Dermoscopic features of erythrodermic psoriasis and its differentials.
Psoriasis is a common skin disease with different clinical presentations. Generally, clinical evaluation is enough for diagnosis, though dermoscope is a helpful and noninvasive examination technique that enhances true diagnosis ratio. Knowing psoriasis’ and its differentials’ dermoscopic features may reduce requirement for histopathological examination and also makes rapid diagnosis possible in life-threatening conditions such as erythroderma. Note that regularly distributed dotted vessels on a reddish background are the most important clues for any variant of psoriasis. In doubtful cases, histopathological examination should be done for verifying the diagnosis as a gold standard technique.
All photos used in this chapter were taken by Dr. Ece Gokyayla with iPhone (XS) and dermatoscope (DermLite, DL4 model, 3Gen, USA) connected to an iPhone (XS) via adapter (DermLite Connection Kit MagnetiConnect). Immersion oil was not used.
The authors declare no conflict of interest and no funding source.
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This chapter will discuss an innovation in seaweed cultivation of the genus Eucheuma, which is the prime marine commodity in the tropical regions of the world. Research conducted during 2015-2017 and 2019 in Southeast Sulawesi Province, Indonesia, provided an overview of the use of floating cage that showed very significant growth results. The research result showed that the growth rates of Eucheuma denticulatum and Kappaphycus alvarezii in floating cage seemed faster and resulted in better thallus morphology. Daily production of E. denticulatum and K. alvarezii that were cultivated in floating cage was higher than daily production of E. denticulatum and K. alvarezii cultivated on longline. Specific growth rate (SGR) of E. denticulatum and K. alvarezii cultivated by using floating cage method was also higher than E. denticulatum and K. alvarezii cultivated by using longline method. Moreover, the cultivation by using floating cages produces good growth rates with no effect of herbivore attacks.",book:{id:"8928",slug:"emerging-technologies-environment-and-research-for-sustainable-aquaculture",title:"Emerging Technologies, Environment and Research for Sustainable Aquaculture",fullTitle:"Emerging Technologies, Environment and Research for Sustainable Aquaculture"},signatures:"Ma’ruf Kasim, Abdul Muis Balubi, Ahmad Mustafa, Rahman Nurdin, Rahmad Sofyan Patadjai and Wardha Jalil",authors:[{id:"309893",title:"Prof.",name:"Maruf",middleName:null,surname:"Kasim",slug:"maruf-kasim",fullName:"Maruf Kasim"},{id:"313040",title:"MSc.",name:"Abdul Muis",middleName:null,surname:"Balubi",slug:"abdul-muis-balubi",fullName:"Abdul Muis Balubi"},{id:"313041",title:"MSc.",name:"Wardha",middleName:null,surname:"Jalil",slug:"wardha-jalil",fullName:"Wardha Jalil"},{id:"313042",title:"MSc.",name:"Ahmad",middleName:null,surname:"Mustafa",slug:"ahmad-mustafa",fullName:"Ahmad Mustafa"},{id:"313043",title:"MSc.",name:"Rahman",middleName:null,surname:"Nurdin",slug:"rahman-nurdin",fullName:"Rahman Nurdin"},{id:"313044",title:"MSc.",name:"Rahmat Sofyan",middleName:null,surname:"Patadjai",slug:"rahmat-sofyan-patadjai",fullName:"Rahmat Sofyan Patadjai"}]},{id:"62842",title:"Integrated Rice and Aquaculture Farming",slug:"integrated-rice-and-aquaculture-farming",totalDownloads:1919,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"The burning problems like scarcity of food for ever-growing human population in the present world are addressed by adapting various methods for production of protein, carbohydrate, oils and other food materials. One of the methods to produce high amount of food is integrated farming including rice-aquaculture farming, which produces protein and carbohydrate as major components besides others. Rice-aquaculture farming produces grain (carbohydrate) and animal protein without affecting the quality and quantity of rice yield on the same piece of land and renders additional financial gain besides main crop (rice) like conventional monoculture. The aquatic species grown in the integrated culture are mainly distinct types of fishes, selected crustaceans and other selected species. Profitable rice-aquaculture integrated farming is popular in Asian countries than in Western countries. However, the integrated rice-aquaculture farming has its own limitations. The type of methods, culture species, influencing factors, and pros and cons of rice-aquaculture integrated farming are discussed in the present chapter.",book:{id:"7229",slug:"aquaculture-plants-and-invertebrates",title:"Aquaculture",fullTitle:"Aquaculture - Plants and Invertebrates"},signatures:"Pamuru Ramachandra Reddy and Battina Kishori",authors:[{id:"242524",title:"Dr.",name:"Ramachandra Reddy",middleName:null,surname:"Pamuru",slug:"ramachandra-reddy-pamuru",fullName:"Ramachandra Reddy Pamuru"},{id:"255022",title:"Dr.",name:"Kishori",middleName:null,surname:"Battina",slug:"kishori-battina",fullName:"Kishori Battina"}]},{id:"24074",title:"Embryonic and Larval Development of Freshwater Fish",slug:"embryonic-and-larval-development-of-freshwater-fish",totalDownloads:7466,totalCrossrefCites:1,totalDimensionsCites:2,abstract:null,book:{id:"612",slug:"recent-advances-in-fish-farms",title:"Recent Advances in Fish Farms",fullTitle:"Recent Advances in Fish Farms"},signatures:"Faruk Aral, Erdinç Şahınöz and Zafer Doğu",authors:[{id:"25600",title:"Prof.",name:"Faruk",middleName:null,surname:"Aral",slug:"faruk-aral",fullName:"Faruk Aral"},{id:"29132",title:"Dr.",name:"Zafer",middleName:null,surname:"Dogu",slug:"zafer-dogu",fullName:"Zafer Dogu"},{id:"39952",title:"Dr.",name:"Erdinc",middleName:null,surname:"Sahinoz",slug:"erdinc-sahinoz",fullName:"Erdinc Sahinoz"}]},{id:"68966",title:"Novel Biofloc Technology (BFT) for Ammonia Assimilation and Reuse in Aquaculture In Situ",slug:"novel-biofloc-technology-bft-for-ammonia-assimilation-and-reuse-in-aquaculture-in-situ",totalDownloads:1951,totalCrossrefCites:2,totalDimensionsCites:8,abstract:"Ammonia is one of the most harmful risks for success of fish and shrimp culture. There is no effective solution for harmlessness of ammonia in traditional aquaculture operations except exchanging water, which would bring negative effects on environment, or fixing expensive equipment. Biofloc technology (BFT) that appeared in recent years supplies a novel solution for this issue without exchanging huge water and fixing equipment. This technology could assimilate ammonia almost in real time with many other supplemental benefits. Because of the very high nutritional value for fish and shrimp, bioflocs, the by-product of BFT, could also be reused as a complemented food in situ or a gradient for feedstuff to replace expensive fishmeal or be processed to pellet diet to feed fish and shrimp directly. However, some aspects with regard to the effective use of biofloc as a food source for fish and shrimp, such as high lipid content, productivity, and palatability, need to be further researched in detail.",book:{id:"8928",slug:"emerging-technologies-environment-and-research-for-sustainable-aquaculture",title:"Emerging Technologies, Environment and Research for Sustainable Aquaculture",fullTitle:"Emerging Technologies, Environment and Research for Sustainable Aquaculture"},signatures:"Hai-Hong Huang",authors:[{id:"305215",title:"Dr.",name:"Hai-Hong",middleName:null,surname:"Huang",slug:"hai-hong-huang",fullName:"Hai-Hong Huang"}]}],onlineFirstChaptersFilter:{topicId:"32",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:12,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. 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Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Bacterial Infectious Diseases",value:3,count:2},{group:"subseries",caption:"Parasitic Infectious Diseases",value:5,count:4},{group:"subseries",caption:"Viral Infectious Diseases",value:6,count:7}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2020",value:2020,count:3},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:303,paginationItems:[{id:"280338",title:"Dr.",name:"Yutaka",middleName:null,surname:"Tsutsumi",slug:"yutaka-tsutsumi",fullName:"Yutaka Tsutsumi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/280338/images/7961_n.jpg",biography:null,institutionString:null,institution:{name:"Fujita Health University",country:{name:"Japan"}}},{id:"116250",title:"Dr.",name:"Nima",middleName:null,surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/116250/images/system/116250.jpg",biography:"Professor Nima Rezaei obtained an MD from Tehran University of Medical Sciences, Iran. He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}}]}},subseries:{item:{id:"41",type:"subseries",title:"Water Science",keywords:"Water, Water Resources, Freshwater, Hydrological Processes, Utilization, Protection",scope:"