Indications for colonoscopy
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In the 1960s, Drs. William Wolff and Hiromi Shinya developed a way to probe the full length of the colon using a tube with electronic sensors [1]. Since its inception, colonoscopy has become a very popular method for screening of colorectal cancers and for treating a variety of conditions of the lower gastrointestinal tract. The decision to perform colonoscopy should take into account the indication and contraindication for the procedure, the risks of the procedure, and the cost. A key quality measure of colonoscopy is the indication for the procedure, because as high as 20-50% of colonoscopies are performed for inappropriate indications [2]. Performing colonoscopy for inappropriate indications not only exposes patients to procedure-related complications such as bowel perforation, bleeding, infection, and cardiovascular events, but also increases on the health-care-related cost. Therefore, several societies including the American Society of Gastrointestinal Endoscopy (ASGE) and the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE), have established guidelines for appropriate use of colonoscopy. In this chapter, we aim to outline the common indications and contraindications for performing colonoscopy and detail the evidence supporting the facts.
Lower GI bleeding may occur in the form of occult bleeding, melena, scant intermittent hematochezia, or severe hematochezia [3]. Lower GI bleeding from any cause requires colonoscopy either urgently or routinely. Patients with occult GI bleeding require colonoscopy to exclude malignant or adenomatous etiologies. Patients who are not good candidates for colonoscopy can be evaluated using CT colonography [4]. In patients presenting with melena, upper GI endoscopy is performed first to identify any upper GI causes. If the upper GI endoscopy does not reveal a source of bleeding, colonoscopy is then indicated to identify any colonic source. Intermittent scant hematochezia can be diagnosed by anoscopy with/without sigmoidoscopy for low-lying lesions in the anus, rectum, and sigmoid in patients who are younger than 40. However, colonoscopy may still be required if a definitive source cannot be identified. On the other hand, colonoscopy is the recommended procedure for patients with intermittent hematochezia who have one of the following risk factors: age >50, family history of colon cancer, or other alarming symptoms such as weight loss, anemia, and change in bowel habits [5, 6]. Overall, colonoscopy has been reported to have a higher yield than other modalities such as proctosigmoidoscopy, single-contrast barium studies, or combined flexible sigmoidoscopy and double-contrast barium enema for diagnosis of lower GI bleeding. In case of severe hematochezia, hemodynamic stability determines the diagnostic and therapeutic approach [7-9]. In hemodynamically stable patients, urgent (within 8-24 h) colonoscopy is recommended [10-13]. In critically ill patients, upper endoscopy is indicated first followed by colonoscopy after excluding the upper GI tract as the source of bleeding [14]. The therapeutic indications of colonoscopy for the treatment of lower GI bleeding are discussed separately in this chapter.
\n\t\t\t\t | \n\t\t
1.Lower GI bleeding | \n\t\t
2.Screening and surveillance of colorectal polyps and cancers: a. Colon cancer b. Surveillance after polypectomy c. Colorectal cancer post-resection surveillance d. Inflammatory bowel diseases | \n\t\t
3.Acute and chronic diarrhea | \n\t\t
4.Therapeutic indications for colonoscopy: a. Excision and ablation of lesions b. Treatment of lower GI bleeding c. Colonic decompression d. Dilation of colonic stenosis e. Foreign body removal | \n\t\t
5.Miscellaneous indications: a. Abnormal radiological examinations b. Isolated unexplained abdominal pain c. Chronic constipation d. Preoperative and intraoperative localization of colonic lesions | \n\t\t
Indications for colonoscopy
According to the World Health Organization report in 2012, colorectal cancer (CRC) is the third most common cancer in men (746,000 cases, 10% of the total) and the second in women (614,000 cases, 9.2% of the total) worldwide. In 2014, the American Cancer Society predicted that about 136,830 people would be diagnosed with colorectal cancer in the United States, and about 50,310 people were predicted to die of the disease. Recent studies show declining in the CRC incidence and mortality rates, which have been attributed to the awareness of the risk factors and reduced exposure to them, the effect of early detection and prevention through polypectomy, and improved treatment [15]. The recommendations for screening colonoscopies are divided based on the known risk factor profile: 1) screening in the average-risk population and 2) screening in patients with a family history of colon cancer.
In the average-risk patient, current American, European, and Asian guidelines recommend beginning CRC screening with colonoscopy at the age of 50 years and every 10 years thereafter regardless of the gender. However, the American College of Gastroenterology recommends that the screening colonoscopy begin at the age of 45 years in African Americans [16, 17]. Published evidence favoring the effectiveness of colonoscopy in reducing mortality from CRC by routine colonoscopy is insufficient because of a lack of randomized controlled trials and the limited consensus in guidelines on the appropriateness of colonoscopy. However, a few studies have modeled and predicted the impact of screening colonoscopy on CRC incidence and mortality using various transition models in hypothetical average-risk individuals aged 50 years. These studies have found that initial screening colonoscopy and repeat colonoscopy every 10 years might reduce CRC incidence by 58% and the reduction in CRC mortality is approximately 64% [18, 19]. In the average-risk individuals, yearly fecal occult blood testing (FOBT) and flexible sigmoidoscopy (FSIG) every 3 years are also accepted methods of screening for CRC. A follow-up colonoscopy, however, is warranted to completely visualize the entire length of the colon for patients with positive FOBT results or FSIG findings of adenoma in the distal colon [20-23].
Family history of CRC is a major risk factor for CRC. It has been estimated that the first-degree relatives of CRC patients have two- to threefold increased risk of dying from CRC, and the risk is inversely associated with the age of diagnosis of the affected family member [24]. Patients with a single first-degree relative with CRC or advanced adenoma (adenoma ≥1 cm in size, with high-grade dysplasia, or villous elements) diagnosed at age ≥60 years are recommended to undergo routine CRC screening same as an average-risk individual beginning at age 50 years. On the other hand, patients with a single first-degree relative with CRC or advanced adenoma diagnosed at age <60 years, or two first-degree relatives with CRC or advanced adenomas should receive colonoscopy every 5 years beginning at age 40, or 10 years earlier than the age at diagnosis of the youngest affected relative, whichever comes first [16]. The data supporting these recommendations emerge from the retrospective studies rather than the randomized control trials [25, 26].
Patients with a family history of hereditary nonpolyposis colorectal cancer (HNPCC), an autosomal dominant disease, are recommended to start the CRC screening at the age of 20-25 years or 10 years prior to the earliest age of HNPCC diagnosis in the patient’s family member, whichever comes first. The recommended interval for colonoscopy is every 1-2 years until age 40, then annually thereafter [27-30]. This condition, in particular, has two-thirds of adenomas occurring on the right side and warrants colonoscopy for complete colonic surveillance [31]. Indications for performing colonoscopy in individuals with a history of familial adenomatous polyposis (FAP) are guideline-dependent after genetic testing returns positive. FSIG and colonoscopy have not been compared head-to-head regarding their effectiveness and reducing mortality in patients with FAP in the clinical trials and, as such, either FSIG or colonoscopy annually is recommended, starting at the age of 10-12 years [16]. A colonoscopy is deemed necessary when polyps are detected on FSIG and a decision to perform polypectomy is made.
Post-polypectomy surveillance constitutes 20% of the performed colonoscopies, thereby constituting a large share in the amount of health care expenditure [32, 33]. Adhering to the indications for the repeat colonoscopy for the surveillance of CRC after the first colonoscopy, therefore, is very important as earlier colonoscopy can increase the risks to the patient and add to the health care cost whereas delaying the surveillance can also increase the risks by increasing the chances of missed interval cancers. Various observational studies report a 2-5% risk of an advanced neoplasia 5-10 years after a negative colonoscopy, a risk that is comparable to the risk of advanced colonic neoplasia in the average-risk patients undergoing their first colonoscopy [34-39]. Moreover, the risk of developing CRC 10 years after a negative colonoscopy is reported to be significantly lower (adjusted OR 0.26) [36, 40], supporting the current recommendation of repeat colonoscopy every 10 years in the average-risk general population.
Although the detection and removal of polyp(s) can offer a significant reduction in the mortality of CRC, the development of interval cancers, i.e., the cancers occurring after the initial colonoscopy with polypectomy, appears to be the highest in the first 3-5 years. In 2012, the United States Multi-Society Task Force (USMSTF) published a revision of the 2006 guidelines on post-polypectomy surveillance and divided recommendations based on the presence of polyp(s) (hyperplastic vs. adenomatous), the number and the size of adenomatous polyp(s), villous component and high-grade dysplasia in the polyp, and the presence of serrated lesions or serrated polyposis syndrome (>20 serrated polyps of any size throughout the colon) at baseline colonoscopy. In 2013, the European Society of Gastrointestinal Endoscopy (ESGE) published its post-polypectomy surveillance guidelines, stratifying risk into: low risk (1-2 adenomas <1 cm), intermediate risk (3-4 small adenomas or one >1 cm), and high risk (>5 small adenomas or >3 adenomas with at least one >1 cm) based on the first colonoscopy. According to the USMSTF guideline, it is indicated that patients with 1-2 tubular adenomas <1 cm have a repeat colonoscopy in 10 years; whereas patients with a high-risk adenoma (defined as adenoma with villous histology, high-grade dysplasia, adenoma>10 mm, or three or more adenomas) are recommended to have surveillance interval of 3 years. According to the ESGE guideline, the high-risk group should undergo surveillance at 1 year, the intermediate-risk group at 3-yearly intervals until two consecutive examinations are negative, and the low-risk group requires no surveillance colonoscopy or 5-yearly colonoscopy until one negative examination after which surveillance can be discontinued. The evidence supporting the indications in the arena of surveillance for the serrated polyp is insufficient. According to the USMSTF guideline, sessile serrated polyp(s) <1 cm with no dysplasia should be considered low risk and can be followed at a 5-year interval. However, sessile serrated polyp(s) ≥1 cm or sessile serrated polyp with dysplasia or serrated adenoma should undergo surveillance at 3 years and serrated polyposis syndrome should be surveyed annually. The ESGE recommends that patients with serrated polyps <10 mm in size without dysplasia should be classified as low risk, whereas patients with large serrated polyps (≥10 mm) or those with dysplasia as high risk and undergo surveillance accordingly. Patients with ≥5 serrated polyps proximal to the sigmoid, of which ≥2 are sized ≥10mm, or with ≥20 serrated polyps of any size are classified as serrated polyposis and should be referred for genetic testing.
There are no clear survival benefits for performing colonoscopy in patients who have had colon cancer resection. However, a majority of the groups and societies such as American Cancer Society (ACS), and a joint American Cancer Society/US Multi-Society Task Force on Colorectal Cancer, Cancer Care Ontario [41-44], recommend post CRC resection surveillance. An indication to perform colonoscopy in these patients will help detect metachronous CRCs and polyps as well as anastomotic recurrences of the initial primary cancer at a stage that would allow further treatment. Currently, a follow-up colonoscopy is indicated at 1 year after the surgical removal of CRC. If no new cancer or polyp(s) is identified, a colonoscopy is repeated at 3 years and at 5 years if the findings are negative for interval development of cancer. An exception to this indication is HNPCC, which requires colonoscopic surveillance every 1-2 years regardless of the surgical resection of the cancer.
The indications for colonoscopy in inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn’s disease (CD) fall under a large spectrum. Colonoscopic diagnosis and differentiation between the UC and CD, assessment of the extent and severity of disease activity, treatment effectiveness, surveillance of malignancies, and endoscopic treatment, such as stricture dilation, are all within the scope of colonoscopy and its indications in IBD. Currently, American, European, and other international societies and guideline-defining bodies recommend endoscopic visualization of the entire colon for the initial diagnosis of IBD and other colitis [45-48]. The clinical presentation and laboratory data characterizing both diseases may overlap but endoscopic visualization of the mucosa of the rectum, colon, and terminal ileum, and the extent of the disease involvement may help differentiate the disease processes. Moreover, colonoscopy offers the opportunity to perform biopsy, which is the major advantage of colonoscopy. Unless contraindicated because of severe colitis or possible toxic megacolon, a full colonoscopy with intubation of the terminal ileum should be performed during the initial evaluation of patients with a clinical presentation suggestive of IBD. Ileoscopy is superior for the diagnosis of CD of the terminal ileum when compared with radiological methods, especially for mild lesions [49, 50]. During the colonoscopic examination, biopsy samples should be obtained both from areas affected by the disease and from unaffected areas. After initiating therapy, a smaller number of biopsy samples may be necessary to confirm the diagnosis. In postsurgical follow-up, biopsies of the neoterminal ileum are indicated when disease recurrence is suspected. In patients who have undergone ileal pouch-anal anastomosis, biopsies of the afferent limb are indicated when Crohn’s disease is suspected [46]. Other forms of colitis, such as drug-induced, infectious, vascular, and radiation colitis also present in a similar pattern and require colonoscopy at baseline for the diagnosis and the assessment of severity.
Patients with IBD have an increased risk of CRC compared to those without IBD [51-55]. In fact, CRC accounts for one-sixth of ulcerative colitis-related deaths [56]. There is a lack of randomized control studies demonstrating the effectiveness of colonoscopy in improving survival in the IBD patients from CRC. However, numerous observational studies have reported that colonoscopic surveillance of CRC in IBD offers early detection of cancers and improves CRC-related survival in IBD patients [57, 58]. In a retrospective study of 6,823 patients with IBD in US tertiary referral hospitals followed-up for at least 3 years, the incidence of CRC among patients without a recent colonoscopy was 2.7% which was significantly higher than among patients with a recent colonoscopy (1.6%) [59]. Additionally, a colonoscopy within 6-36 months before diagnosis was associated with a 64% reduction in mortality rate [59]. According to most guidelines, colonoscopies are indicated for CRC screening starting at 8-10 years from initiation of IBD-related symptoms [48, 53, 60-62]. The National Institute for Health and Clinical Excellence (NICE) London 2011 guideline, however, recommends only offering colonoscopic surveillance to patients with Crohn’s colitis involving more than 1 segment of the colon or left-sided or more extensive UC, but not isolated ulcerative proctitis. Most guidelines recommend yearly follow-up colonoscopy for high-risk patients (those with primary sclerosing cholangitis, extensive colitis, active endoscopic or histologic inflammation, a family history of CRC in a first-degree relative before 50 years of age, personal history of dysplasia, presence of strictures on colonoscopy, and, possibly, gender), and every 2-5 years for those without major risk factors.
Patients presenting with acute diarrhea should undergo initial evaluation with stool studies. If blood and stool cultures are inconclusive, or if symptoms persist or worsen despite empiric therapy, then colonoscopy is indicated due to its high diagnostic yield [63]. For most patients with chronic diarrhea, patients with suspected acute diffuse
Histology is an integral component of colonoscopic evaluation of chronic diarrhea because several diseases, such as microscopic colitis, eosinophilic colitis, amyloidosis, and IBD, may appear normal on endoscopy but are abnormal on microscopy. In patients undergoing colonoscopy for chronic diarrhea, IBD or colitis is the most likely disease to be detected [64]. Microscopic colitis can be lymphocytic or collagenous and is characterized by nonbloody, watery diarrhea. On endoscopy, microscopic colitis can be missed because of patchy colonic involvement. Even if mucosa appears normal endoscopically, multiple biopsies from both sides of the colon are necessary to avoid missing microscopic colitis [65]. If there is suspicion of inflammatory diarrhea, then a biopsy of the terminal ileum is helpful in the diagnosis. However, a biopsy of the terminal ileum has the highest diagnostic yield in patients with known or suspected Crohn’s disease, terminal ileal abnormalities on imaging, or endoscopic findings of ulcers, ileitis, or erosions [66].
Colonoscopy is not routinely used to evaluate acute diarrhea because it is commonly due to infectious etiology. If stool tests are negative and/or if diarrhea persists, then endoscopy is indicated. An additional important exception is the case of an immunocompromised patient. In a patient with diarrhea with HIV, organ or bone marrow transplant, or on immunosuppressive medications, a colonoscopy with biopsy is necessary to exclude CMV colitis and graft versus host disease (GVHD). In such cases, colonoscopic evaluation of diarrhea has higher sensitivity and cost-effectiveness than FSIG [67]. Patients who undergo stem cell transplant often present with diarrhea in the initial 3 months following transplantation. In these patients, abnormal mucosa on endoscopy has not been shown to correlate with biopsy results. Therefore, biopsies of normal and abnormal-appearing mucosa are indicated, especially of the distal colon, which has the highest diagnostic yield in patients undergoing endoscopy for gastrointestinal symptoms [68]. Based on the location of highest diagnostic yield, a flexible sigmoidoscopy with distal colon biopsy is indicated in patients with diarrhea suspected of acute GVHD. However, some centers endorse combined upper GI endoscopy as well as colonoscopy in patients following hematopoietic stem cell transplantation to diagnose disease more quickly.
Endoscopic mucosal resection (EMR) is a method for treating early CRC. Most adenomas and intramucosal cancers can be removed by EMR. For tumors larger than 2 cm, EMR is less likely to achieve complete resection (histopathologically tumor-free lateral and vertical margins of the resected specimens) [69, 70]. Another method, known as endoscopic submucosal dissection (ESD) is also performed in several countries. The procedure is simpler than the laparoscopic colectomy but is time-consuming and carries a higher risk of perforation than EMR. ESD is indicated in lesions >2 cm, lesions that are suspected to be invasive submucosal cancer, and mucosal lesions with fibrosis or local residual early cancer after endoscopic resection. The rate of complete resection for large colorectal tumors by ESD has been reported to be 80-98.9% [71-74]. However, both procedures are operator-dependent and have limited data supporting their use.
Treatment of acute lower GI bleeding from any sources described earlier is indicated either urgently or as an elective procedure. In case of urgent colonoscopy, the colon is prepared using polyethylene glycol based solution administered orally or via nasogastric tube. Currently, metallic clip placement, thermal coagulation, and epinephrine injection are the available methods. Depending on the lesion and the severity of bleeding, colonoscopic intervention with any one of these methods is indicated as the first step in achieving hemostasis. In case of persistent diverticular bleeding, a bleeding vessel can be treated with metallic clip placement [75, 76]. Vascular ectasias can be treated with either thermal or epinephrine injection, though thermal cauterization has 87% of success rate [77]. Cases where a definite bleeding site cannot be located or cases where the visualization of the bleeding source is poor due to inadequate views due to bleeding need referral for angiographic or surgical treatment.
Acute colonic obstruction is a common presentation of colon cancer and, often, the presenting patient is in poor overall health making surgical intervention a suboptimal choice. Since 1990, the utility of colonoscopic interventions via either self-expanding metal stent (SEMS), placement of a decompression tube, or tumor debulking has become very popular and has been studied more frequently in recent years in various populations. Endoscopic interventions serve as a bridge to surgery or as a palliative measure in patients who are poor surgical candidates. A majority of the studies comparing SEMS placement with surgery has reported high clinical success rates (92%), better symptomatic relief, lower complication rates (<5%), cost-effectiveness, and higher patient acceptance and shorter hospital stay with endoscopic SEMS placement [78-83]. Argon plasma coagulation (APC) and snare polypectomy have been used to treat colonic obstruction and maintain luminal patency, and are good alternatives to endoscopic SEMS in treating colonic obstruction [84-86].
Endoscopic decompression of an acute colonic pseudo-obstruction or Ogilvie syndrome is another therapeutic indication for colonoscopy. The etiology of this condition is multifactorial (post-intraabdominal surgery, sepsis, hypothyroidism, neurological disorder, spinal cord injury, etc.) in the absence of a true mechanical obstruction. Bowel ischemia and perforation are dreaded complications and management is often conservative, involving the correction of the underlying disorder. However, in cases where the initial management fails, colonoscopic decompression is indicated [87, 88].
Colonoscopy is also used for decompression of sigmoid and cecal volvulus. Volvulus is a condition in which a part of colon twists upon itself. Due to venous congestion and obstruction to blood flow, tissue viability becomes a major issue. Patients presenting with signs of perforation, peritonitis, bowel necrosis or profound hemodynamic instability need immediate surgery. However, patients with less severe sigmoid and cecal volvulus can be managed endoscopically [89, 90]. Endoscopic correction of sigmoid volvulus achieves better success rates than the correction of cecal volvulus and is associated with a lesser need for surgical intervention [91]. A study by Oren and colleagues reported that sigmoidoscopic correction of sigmoid volvulus with a rectal tube was successful in 78% of patients [92]. Nevertheless, the rate of recurrence of sigmoid volvulus is high, ultimately requiring surgical treatment [93]. Cecal volvulus has been treated endoscopically but due to the high failure rate, often requires surgical intervention for most patients. Surgeons usually combine operative detorsion of cecal volvulus with right hemicolectomy (to prevent recurrence) and either a primary anastomosis or an ileostomy with mucus fistula. In medically unstable, high-risk patients who are poor surgical candidates or have poor vascular supplies to the cecum, cecal volvulus detorsion may be achieved with a cecostomy and cecopexy, which also are associated with significant morbidity and mortality [94]. Colonic volvuluses in other areas such as flexural territories are less common and the indication to perform colonoscopic interventions in these situations is not well studied.
Colonoscopic intervention of stenotic lesions such as anastomotic strictures and strictures caused by IBD are among the common indications for performing colonoscopy. Several studies have reported high success rate with a low complications rate. However, recurrence is common. The methods commonly employed for the treatment of colonic stenosis are balloon dilation with or without steroid injection and electro-incision, all of which have been shown to have a variable amount of success [95-101].
The current management of the foreign bodies lying in the lower GI tract is based on the type of foreign body, the proximity to the anus, the injury to the adjacent structure, as well as the surgical and endoscopic expertise at the health care center. A foreign body in the GI tract presents after voluntary or involuntary insertion or ingestion of the foreign body. Very often, the patient tries to manipulate the object and attempts self-exploration to remove it before presenting to the hospital. Endoscopy provides an opportunity to avoid abdominal exploration. However if the radiological exam or clinical presentation indicates perforation or higher-lying object(s), colonoscopy may fail and may pose a delay in surgical management [102-106].
Colonoscopy is commonly performed after an abnormal or suspicious radiological finding in the search for true pathological lesions such as cancers or ulcerative lesions. Filling defect or mucosal defect on barium enema or a luminal narrowing on barium enema or CT scan is routinely evaluated with a colonoscopy. Patients presenting with symptoms suggestive of acute diverticulitis with supportive CT scan findings also need to be evaluated with colonoscopy, but only after the acute inflammation has resolved. Air insufflation during colonoscopy in acute diverticulitis can lead to the bowel perforation and is considered a contraindication. A luminal defect or polyp(s) on CT scan or CT colonography is usually followed-up by a colonoscopy when feasible. However, controversy exists between the American College of Radiology, the American Gastroenterology Association, and American College of Gastroenterology regarding the size and number of polyps on CT colonography that meet the requirement for colonoscopy [107-109]. Patients with abnormal positron emission tomography (PET) scan showing a possible colorectal lesion should undergo colonoscopic evaluation. Nevertheless, in the light of insufficient clinical data, the indications for colonoscopy after abnormal radiological exam are based on individual presentation, availability of the endoscopist, age, and other comorbidities of the patient.
Patients presenting with symptoms of chronic (>3 months) abdominal pain and nonspecific abdominal discomfort might require colonoscopy. In the era of thorough radiologic studies, the need for colonoscopy emerges after noninvasive diagnostic modalities fail and symptoms persist. There is no clear indication for performing colonoscopy in patients presenting with unexplained abdominal pain or discomfort. A detailed history and physical examination provide diagnostic clues but a diagnostic workup often ends up requiring colonoscopy. The diagnostic yield of colonoscopy has been previously studied in retrospective studies. For example, in a study by Neugut et al., a total of 7% of patients who presented with abdominal pain (n=113) either had carcinoma or a polyp >1 cm in size on colonoscopy [110]. It is worth mentioning that detection of the pathological process does not offer symptomatic relief in these cases. In a more recent study by Kueh and colleagues, the diagnostic yield of colonoscopy was evaluated from 2005 to 2010 in a tertiary center in New Zealand among the patients who presented with isolated abdominal pain, which accounted for 1.2% of all colonoscopies (n=2633). The diagnostic yield of colonoscopy for a cancer, adenoma, diverticulosis, or hemorrhoid in the patients with abdominal pain was significantly lower in this cohort than the yield of colonoscopy performed for other symptoms such as rectal bleeding and/or iron deficiency anemia [111].
Chronic constipation, as defined by the Rome III criteria [112], is reported to be associated with an increased risk of colon cancer in retrospective studies from the United States [113, 114], Australia [115], and Japan [116]. In contrast, no such association was found in several other studies [117-119]. Interestingly, the yield of colon cancer in colonoscopy performed for constipation alone was lower than in colonoscopy performed for routine colorectal cancer screening [120]. Patients with chronic constipation who present with alarming symptoms such as rectal bleeding, melena, iron-deficiency anemia, unintentional weight loss, or are >50 years should be evaluated with a colonoscopy to identify the etiology of the obstruction, such as cancer, stricture, or extrinsic compression. Colonoscopy can be used to treat chronic constipation based on the etiology. In patients who have undergone prior abdominal surgery, have inflammatory bowel disease, or are prone to ischemia, colonoscopy is used to dilate fibrotic strictures that lead to constipation [121-123]. Patients suffering from chronic constipation due to neurogenic bowel or acute colonic pseudo-obstruction also benefit from a percutaneous endoscopic colostomy [124]. Importantly, chronic constipation as a procedural indication for colonoscopy is independently associated with poor colon preparation requiring a rigorous amount of laxative(s) or a longer duration of preparation [125, 126].
Colonic lesions, depending on the size and consistency, may pose some difficulty in localization by surgeons during the surgical procedure, and this could be even more difficult for laparoscopic surgeries than for open procedures. In such cases, localization of a mass or polyp of interest is very important. Preoperative colonoscopy to localize the lesion using penetrating India ink, Spot, or indocyanine green is becoming a common practice [127, 128]. The dye migrates to the peritoneal surface and allows for accurate localization. An alternative colonoscopic method of applying clips around the area of interest has also been studied, which requires intraoperative ultrasound to precisely locate the site. Both methods have their own advantages and disadvantages, such as inflammatory reaction to the dye, micro-abscesses, broad spreading of the dye in the field in smaller lesions, migration of the metallic clips, false localization, or inadvertent injection of dye in the adjacent vital structures. A recent review reported that the accuracy of endoscopic tattooing is 70-100% and the incidence of intraoperative invisible lesions is 1.6-15% [129]. The complications reviewed were mostly related to transmural injection and the spillage rates varied from 2.4 to 13% and were asymptomatic. Intraoperative colonoscopy can also be performed to localize the site of a tumor or a polypectomy site. However, intraoperative colonoscopy is an understudied field and has reported problems with insufflated air in the colon which interferes with the surgical technique.
A patient who is either unwilling to give informed consent, or has given informed consent but is uncooperative and/or unable to achieve adequate sedation for colonoscopy, should not undergo colonoscopy. Colonoscopy is also contraindicated for known or suspected colonic perforation. Medical conditions associated with a high risk of perforation such as severe toxic megacolon and fulminant colitis are considered contraindications to colonoscopy. Although not strictly contraindicated, severe IBD with deep ulceration in the rectum/distal sigmoid colon and acute diverticulitis increase the risk of colonic perforation. The risk factors for colonic perforation during colonoscopy are age > 65, low body mass index, female gender, hypoalbuminemia, inpatient status, critically ill condition, multiple morbidities, IBD, and other forms of colitis such as ischemic colitis, colonic stricture dilation, polypectomy, foreign body removal, and hemostasis such as cautery [130-132].
Patients who are or are suspected of becoming hemodynamically unstable should be medically stabilized before colonoscopy. In patients who have had a myocardial infarction, a colonoscopy performed in the first 3 weeks following the infarction can provoke an arrhythmia although the only reported complications during colonoscopy in the 30 days following an myocardial infarction are hypotension and bradycardia [133]. Adequate bowel preparation is necessary because inadequate or poor bowel preparation increases colonoscopy duration with an increase in complications as well as an increase in the number of missed adenomas and high-risk lesions [134].
\n\t\t\t\t | \n\t\t
1. Patient refusal | \n\t\t
2. Uncooperative patients | \n\t\t
3. Inadequate sedation | \n\t\t
4. Known or suspected colonic perforation | \n\t\t
5. Severe toxic megacolon and fulminant colitis | \n\t\t
6. Clinically unstable patients | \n\t\t
7. Recent myocardial infarction | \n\t\t
8. Inadequate bowel preparation | \n\t\t
9. Peritonism | \n\t\t
Contraindications for colonoscopy
Patients with severe abdominal pain and peritoneal signs may be at risk for possible complete obstruction or gangrenous bowel and should be evaluated by other modalities first. These patients should not undergo colonoscopy due to the risk of bowel perforation from air insufflation of a distended bowel [135]. Colonoscopic decompression of cecal volvulus, though reported, has a high failure rate. Therefore, cecal volvulus should be managed surgically [94]. Failure of endoscopic bowel detorsion, or colonic volvulus with bowel perforation, bowel infarction, or peritonitis are indications for emergent surgery [135].
The United Nations have ratified 17 goals of sustainable development, of which responsible consumption and production is directly, while economy, innovative industry, infrastructure, and climate action are indirectly related to circular economy and the need of sustainable production [1]. Sustainability in the processing industries can be applied along the main value chain, e.g. from metal extraction to metal recycling, but can also be applied to the associated waste materials. Copper and iron mining alone are estimated to generate yearly about 5 bn tons of tailings [2], i.e. the fraction of the processed ore, after extraction of the valuable minerals. Finding a way to successfully reuse vast amount of this material and other waste sources is a great step towards circular economy.
While recycling an initial waste or side-stream, the material can be upcycled, meaning the newly derived product is of higher intrinsic value and properties or downcycled, where the new material has lower value. A prominent example for downcycling is the reuse of plastic bottles as fleece and carpet material. The material has less intrinsic value, because the carbon chains of the plastic polymer are shortened. Geopolymerization of industrial side streams is an upcycling process, as the geopolymer (GP), utilized as concrete and binder, has a higher value than the initial industrial by-products. To obtain upcycling, energy is put into the system, however, since tailings have usually been milled, the material has already undergone energy intensive steps and can therefore readily be used as starting blocks for geopolymerization. Utilizing tailings for upcycling into GPs, is therefore beneficially in terms of waste management, process energy, and emission of greenhouse gases, as the energy used in the beneficiation process is passed onwards into the geopolymerization process. Upcycling often requires further energy sources to achieve higher valuable material. In geopolymeration or alkaline activation this means the addition of chemicals, and in some occasions, such as analcime tailings, the addition of thermal energy [3].
In this chapter the valorization of high volume, inorganic side streams from mining, chemical industries, steel processing, and waste incineration into new adsorbents useable for water treatment is discussed. The purpose is to show how the material undergoes value change from side stream to potentially highly functional material.
As every tailing and every ash has a different chemical and mineral composition, tailoring of the properties of resulting adsorbents is possible by careful choosing of precursor materials. Aluminosilicates form the backbone of the geopolymer structure, but ion exchange, channel size, and physical properties are affected by the minerals used for geopolymerization [4, 5, 6]. Lastly, by controlling of the geopolymerization conditions, also the macroscopic structures can be developed by using various manufacturing methods from foaming to granulation.
The ultimate goal of using GPs/AAMs in water purification is to be able to recover valuable materials such as nutrients or battery chemical metals from contaminant-rich wastewater streams. In other words, the target is to use one industrial side stream to recovery of valuable material from another side stream or waste water in order to multiply circular economy potential.
This section summarizes different types of aluminosilicate precursors, occuring naturally or derived from industrial processes. Materials, which are currently abundant and/or urgent to dispose of, fall within the ambit of the section, but cover only water treatment applications not geopolymer production for construction industry, e.g. substitutes for Portland cement or as tailings’ covering.
The composition of FA varies widely as it is derived initially from various primary sources: municipal waste/sludge co-incineration, different coal types, or subspecialized byproducts from industrial treatment plant (paper, forestry industry or agriculture). The combustion and cooling processes have profound impact on the characteristics of FA (particles size, shape, surface area, uniformity, etc.) as well as its composition and impurities’ inclusion.
Mainly, ASTM C 618 specification is applied to indicate the class of FA used for geopolymer preparation; however, a local/field or an unspecified labelling is also common. Coal FA (class F [8, 9] and C [10]) has been extensively considered as an aluminosilicate source for GP production, while the exploitation of biomass and co-incinerated FAs is less common [11, 12]. On the other hand, the utilization of these FAs particularly in the GP production for water treatment sector might be also beneficial. It would reduce the FA accumulation in landfills, and improve adsorbents’ LCA in comparison with metakaolin-based GPs.
Although FAs were studied as adsorptive materials previously [7, 13, 14], concerns on potential toxicity of impurities and convenience of use have encouraged to seek more suitable forms of FA-based materials for water treatment sector.
Pre-treatment of FAs and IBAs with various chemicals were suggested in order to reduce their toxicity and to meet the environment requirements of pristine materials or/and GPs/AAMs based on them [14, 25, 26, 27].
The accumulation of BOFS has become a significant issue due to its generation in large quantity, high disposal costs, and unsuitableness in cement industry due to high iron oxide content. Sarkar et al. adopted BOFS as a raw material for obtaining of GPs and investigated Ni2+ [39], Zn2+ [40], and F− [41] removal. BOFS was used by Sithole et al. as a precursor for AAM preparation [42, 43]. In order to achieve highly porous structures for percolation column tests, a foaming agent (hydrogen peroxide) was added.
Recently, much attention has also been paid on how zeolite could be synthesized from low-cost materials [70]. GP-zeolite composites and zeolite-like GPs are two different categories of adsorptive materials, which have recently attracted increased interest [71]. GP-zeolite composites are hybrid materials, unite the advantages of both constituents. The GP here serves as a durable support, while the zeolite provides a high surface area, porosity, and adsorption capacity. For instance, metakaolinite–zeolitic tuff GPs have been proposed in [72]. The report clearly showed the beneficial influence of the zeolitic tuff addition into a starting mixture on the microstructure and the adsorption potential of GPs. Andrejkovičová et al. [4] prepared metakaolin-based GPs blended with by 25, 50 and 75% of Nižný Hrabovec zeolite. It was shown that the zeolite particles are responsible for the higher amount of crystalline phases, producing a more compact and firm microstructure of blended GPs. The amount of blender has significant influence on the order of adsorbed metals and on the adsorption capacities of the formulations. Hayashi et al. [63] incorporated clinoptilolite into GPs though sol–gel protocol in order to further use of the resulting coatings for heavy metal ion adsorption.
It should be noted that zeolitic phase could be incorporated into GPs’ structures not only externally. Zeolite-like crystalline phases could be derived from synthesis routes through fusion method or even at moderate temperatures leading to zeolite-like GP structures. Javadian et al. [64] converted FA into a mesoporous aluminosilicate adsorbent through a fusion method at 600°C. Deng et al. showed that a hydrothermal synthesis of zeolite-like materials from IBA with higher crystallinity than through a fusion method is possible [73]. Similarly, Visa [74] converted FA into zeolite through a hydrothermal process. Rios et al. synthesized zeolite-like GPs from metakaoline at 100°C through the hydrothermal procedure [75]. Studies reported indicate that such materials have higher surface area and porosity than GPs/AAMs obtained through simple alkaline activation. Although the ultimate set of preferable conditions to form a GP instead of a zeolite are still under discussion, ratios Si:Al > 1.5 have been empirically established as providing more amorphous structures [60].
Not infrequently, industrial side streams cannot be used alone for geopolymerisation due to disharmonious Si/Al molar ratios. Therefore, by-products are commonly used as mixtures of aluminosilicate sources [76]. Table 1 summarizes the studies on different compositions of GPs/AAM that have been proposed for water and wastewater treatment applications. An afford was made to collect and match the precursors, synthetic protocol specificity, and distinctive characteristics resulting materials.
GP/AAM | Precursor/additives | Preparation method, prime oxide ratios | Surface Area/Pore Volume/Pore size | Type/form of GP | Ref. |
---|---|---|---|---|---|
MK-GP with TiO2 | MK | HT | 27.21 m2/g 0.207cm3/g 2.19 nm | Bulk | [77] |
MK-GP | MK | SSM | 53.95 m2/g 0.061 mL/g 5.38 nm | Porous/Spheres, 2–4 mm | [78] |
MK-GP | MK | AA Si/Al = 1.7 | ̶ | Bulk | [79] |
MK/Z-GP | MK Zeolitic tuff | AA SiO2/Al2O3 = 1 | ̶ | Bulk/Discs | [72] |
MK-GP | MK | AA Si/Al = | 12.21 m2/g 0.037cm3/g | Bulk | [80] |
MK-GP | MK SDS 0.06 wt% | SSM SiO2/Al2O3 = 1.6 | 53.95 m2/g 1.29 cm3/g 15 nm | Porous/spheres 2–4 mm | [81] |
MK/FA-GP | 2/3 MK 1/3 bioFA (w/w) | AA SiO2/Al2O3 H2O2 | ̶ | Porous/Monolith | [11] |
MK-GP | MK | AA foaming, SiO2/Al2O3 = 5 | ̶ | Foam/Powder <100 μm | [82] |
MK-GP/alginate hybrid | MK sodium alginate | AA + SSM SiO2/Al2O3 = 1.6 | 16.2 m2/g 0.05 mL/g 11.5 nm | Bulk/Spheres 2–4 mm | [83] |
MK-GP | MK | AA SiO2/Al2O3 = 3.2 | 39.24 m2/g | Bulk/Powder 150 μm | [84] |
MK-GP functionalized with CTAB | MK silica fume | AA CTAB | 216 m2/g 0.22 cm3/g | Bulk/rubbles, 1.5 mm | [85] |
MK/FA-GP | MK:FA 2:1 wt | AA | 7.9 m2/g | Porous/discs | [86] |
MK-GP | waste MK | AA SiO2/Al2O3 = 1.5 | ̶ | Bulk/Powder, granules | [59] |
MK-GP | MK | AA SiO2/Al2O3 = 3.2 | 39.24 m2/g | Bulk/Powder, 150 μm | [87] |
MK-GP activated with hull ash | MK BioFA TiO2 | SSM SiO2/Al2O3 = 3.18* | ̶ | Porous/Spheres 2–3 mm | [88] |
MK/FA-GP | MK:FA 50:50 wt% | SSM SDS | ̶ | Foam/ Spheres | [89] |
MK-GP/alginate-chitosan hybrid | MK alginate/chitosan | SSM AA 0.5 wt% H2O2, 1.5 wt% SDS | 230 m2/g 0.99 mL/g 35 μm | Porous/Spheres | [90] |
MK/FA-GP | MK FA class C 60:40 wt% | AA SiO2/Al2O3 = 2.7 | ̶ | Bulk/Powder 63–125 μm | [91] |
MK/BFS-GP | MK BFS 60:40 wt% | AA SiO2/Al2O3 = 3.1 | ̶ | Bulk/Powder 63–125 μm | [91] |
MK-GP | MK | AA SiO2/Al2O3 = 2.31** | ̶ | Bulk/Powder, 200 μm | [92] |
MK-GP/ coal gangue hybrid | MK gangue 50/50 wt% | AA SiO2/Al2O3 = 4.0 | 26.41 m2/g 0.330 cm3/g | Bulk | [93] |
MK-GP | MK | AA SiO2/Al2O3 = 2–8 | ̶ | Bulk/Pervious | [94] |
MK-GP | Waste MK Aluminum scrap recycling waste 1:1 (w/w) | AA SiO2/Al2O3 = 1.25** | 15.95 m2/g | Bulk/Granules 4–11.2 mm | [95] |
MK-GP | MK | AA | 8.16 m2/g 0.021 cm3/g 10.5 nm | Bulk/ Granules 0.5 mm | [96] |
MK-GP functionalized with HDTMABr | MK | AA HDTMABr | ̶ | Bulk/Powder, 53 μm | [97] |
MK-GP MK/aloxid ANA-GP ANA/aloxid-GP | MK analcime aluminum oxide | AA** MK-GP SiO2/Al2O3 = 3.96 MK/aloxid GP SiO2/Al2O3 = 2.13 ANA-GP SiO2/Al2O3 = 7.01 ANA/aloxid-GP SiO2/Al2O3 = 3.60 | MK-GP 19.97 m2/g 0.131 cm3/g 26.24 nm MK/aloxid GP 6.36 m2/g 0.036 cm3/g 23.18 nm ANA-GP 0.69 m2/g 0.003 cm3/g 21.69 nm ANA/aloxid-GP 38.29 m2/g 0.125 cm3/g 13.07 nm | Bulk/Powder, 63–125 μm | [50] |
MK/Z-GP | 25% MK 75% zeolite | AA SiO2/Al2O3 = 1 | 57.5 m2/g | Bulk | [4] |
MK-GP functionalized CTAB | Calcinated halloysite clay | Precipitation SiO2/Al2O3 = 2.91 CTAB/Cu2O/TiO2 | 34.8 m2/g 29.7 nm | Bulk | [98] |
MK-GP functionalized with CTAB | MK | AA CTAB | 26.45 m2/g 0.121 cm3/g 9.12 nm | Bulk/Powder, 125 μm | [99] |
MK-GP, magnetic hybride | MK Magnetite 5 wt% | AA SiO2/Al2O3 = 4.55* H2O2 | 19.5 m2/g 0.045cm3/g 10.4 nm | Porous | [100] |
MK/Silica-GP functionalized with Cr | MK silica fume 9:1 (w/w) | AA SiO2/Al2O3 = 1.90** | 30 nm | Bulk/Membrane | [101] |
MK-GP | MK | AA SiO2/Al2O3 = 2.14** | ̶ | Bulk/Powder, 355 μm | [102] |
MK/FA-GP | MK FA | AA SiO2/Al2O3 = 2.45** | 27 m2/g | Bulk/rubbl 1.0–0.3 mm | [103] |
MK-GP | MK | AA SiO2/Al2O3 = 4.0 | 21 m2/g 1252 mm3/g 0.32 μm | Bulk/Granules, 3 mm | [104] |
MK-GP alginate hybrid | MK sodium alginate TiO2 | SSM SiO2:Al2O3 = 4 | 20 m2/g 714 mm3/g 0.11 μm | Bulk/Spheres, 2 mm | [105] |
MK-GP/ magnetic hybrid | MK | AA SiO2/Al2O3 = 4.55 H2O2 | 42.92 m2/g 0.052cm3/g 4.88 nm | Porous | [106] |
MK-GP/LECA | MK LECA support | AA SiO2/Al2O3 = 1.5 | ̶ | Bulk/Granules, 4–8 mm | [107] |
MK/Biochar-GP | MK Biochar | AA H2O2 | 37.46 m2/g | Foam/membrane | [108] |
MK-GP functionalized with K4Fe(CN)6 | MK | AA SiO2/Al2O3 = 3.60 H2O2 | 35 m2/g 55 cm3/g | Foam | [109] |
MK-GP/graphene oxide hybrid | MK graphene oxide 10 wt% | AA SiO2/Al2O3 = 0.45 | ̶ | Bulk/ Particles, < 0.5 mm | [110] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 2.03 | ̶ | Bulk | [111] |
FA-GP | Fly ash, 75 μm | FM SiO2/Al2O3 = 1.98* | 8.22 m2/g 2.9 nm | Bulk/Powder | [64] |
FA-GP Iron-enriched | Calcinated FA, < 70 μm | FM SiO2/Al2O3 = 1.00 Fe2O3/Al2O3 = 0.151 | ̶ | Bulk | [112] |
FA-GP modified with iron | Coal fly ash | AA SiO2/Al2O3 = 1.43* | 162.38 m2/g 0.126 cm3/g 3.90 nm | Bulk/Powder | [113] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 4.61 | ̶ | Bulk/Powder, 71–90 μm | [9] |
FA/IOT -GP | Fly ash IOT 70:30 (w/w) | AA H2O2 | 6 nm - 360 μm | Porous/Cubes | [54] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 1.12** | 20.48 m2/g 19.62 nm 0.070 cm3/g | Bulk/Powder, 74 μm | [114] |
FA/Z-GP | Fly ash Fajustite | HT SiO2/Al2O3 = 0.69** | 174.35 m2/g 0.14 cm3/g 9.69 nm | Bulk/Powder, 74 μm | [114] |
FA-GP | Fly ash C | AA SiO2/Al2O3 = 3 | ̶ | Bulk/Powder | [115] |
FA-GP/LECA | Fly ash C LECA support | AA SiO2/Al2O3 = 1.5 | ̶ | Bulk/Granules, 4–8 mm | [107] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 5.36 | ̶ | Bulk/Powder, 71–90 μm | [116] |
FA-GP | Fly ash | HT | ̶ | Bulk | [117] |
FA/Z-GP | Fly ash BFS 4:1 (w/w) | HT SiO2/Al2O3 = 3.49* | ̶ | Bulk/Powder | [118] |
Fly ash/ iron oxide hybrid | Fly ash Fe2O3 5 wt% | AA SiO2/Al2O3 = 3.30** | 60.75 m2/g | Bulk/Powder, 50 μm | [119] |
FA-GP/Graphene hybrid | Fly ash graphene (1 wt%) | AA SiO2/Al2O3 = 3.41** | 20.41 m2/g 0.047 mL/g 9.73 nm | Bulk | [120] |
FA/BFS-GP | Fly ash BFS | HT SiO2/Al2O3 = 3.23* | 76.6 m2/g 0.24 cm3/g 12.5 nm | Bulk | [35] |
FA-GP | Boiler fly ash < 80 mesh | HT SiO2/Al2O3 = 2.75** | 27.51 m2/g 0.032 mL/g | Bulk | [121] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 3 | 29 m2/g 0.134 cm3/g | Bulk/Powder, < 74 μm | [122] |
FA-GP/Polyethersulfone hybrid | Fly ash | AA SiO2/Al2O3 = 3.05 | 168.3 m2/g | Bulk/Powder, 150 μm | [123] |
FA/Z-GP | Calcinated fly ash | SiO2/Al2O3 = 1.61** | ̶ | Bulk/Powder | [124] |
FA-GP | Fly ash | AA | 131.4 m2/g | Bulk/Powder, <105 μm | [125] |
FA-GP | Coal Fly ash | FM SiO2/Al2O3 = 1.25* | 93.8 m2/g 0.62 cm3/g | Bulk | [8] |
FA-GP | Fly ash silica | AA Si/Al = 2.2 | 31.87 m2/g 0.12 cm3/g 15.45 nm | Bulk/Powder, 125–212 μm | [126] |
FA-GP | Fly ash F, ≤ 177 μm | AA SiO2/Al2O3 = 2.97** | 30 m2/g 0.076 cm3g | Bulk | [127] |
FA/analcime-GP | Fly ash analcime | AA SiO2/Al2O3 = 2.10** | ̶ | Bulk/Membrane | [128] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 5.42 | 35.97 m2/g 124 cm3/kg 9 nm | Bulk/Powder, 150 μm | [31] |
FA-GP | Rice husk ash, waste alum cans | HT SiO2/Al2O3 = 1.82* | 36.15 m2/g 0.097 mL/g 5.4 nm | Bulk | [129] |
FA-GP | Fly ash class C and F | AA SiO2/Al2O3 = 6.6** (class C) SiO2/Al2O3 = 10.9** (class F) | 2463.64 mm2/g | ̶ | [130] |
FA/MK-GP | bioFA MK 70:30 (w/w) | AA aluminum powder, anionic surfactant | 46.3 m2/g | Foam/Membrane | [131] |
IBA-GP/Graphene hybrid | Bottom ash graphene | AA 0.15 wt% Mn2+ 19.5 wt% CuO | 29.28 m2/g 0.1078 mL/g 14.77 nm | Bulk/ Particles, 0.180–0.315 mm | [132] |
BFS –GP | BFS | AA SiO2/Al2O3 = 4.40* | 64.5 m2/g 0.095 cm3/g 5.93 nm | Bulk/Powder, 63–125 μm | [32] |
BFS –GP | BFS | AA SiO2/Al2O3 = 3.2 | ̶ | Bulk/Powder, 63–125 μm | [115] |
BFS –GP/graphene hybrid | BFS graphene 0.01 wt% | AA SiO2/Al2O3 = 2.61* | 146.17 m2/g 0.161 mL/g 4.40 nm | Bulk/Powder, 250-315 μm | [133] |
BFS –GP/barium modified | BFS | AA SiO2/Al2O3 = 4.00** | 63.1 m2/g 0.070 cm3/g | Bulk/Powder, 63–125 μm | [134] |
BOFS-GP | BOFS | AA SiO2/Al2O3 = 11.5** | 30.84 m2/g 0.091 cm3/g 11.8 nm | Bulk/Particles, ∼0.1 mm | [39, 40] |
Slag-based GP | Slag | SSM SiO2/Al2O3 = 4.02* 0.3 wt% SDS | 100.9 m2/g 7 nm | Porous/Spheres, d ≈ 100 μm | [33] |
Silicomanganese slag-GP | Silicomanganese slag (NH4)6Mo7O24·4H2O | AA SiO2/Al2O3 = 1.44** | 51.79 m2/g 0.192 mL/g 10.30 nm | Bulk/Particles, 0.16–0.315 mm | [135] |
BOFS-GP modified with Ni(II) or Zn(II) | BOFS-GP | AA | Zn/LDS-GP 58.14 m2/g Ni/LDS-GP 53.42 m2/g LDS-GP 30.84 m2/g | Porous/Powder, ∼0.1 mm | [41] |
Slag-based GP | Slag | SSM SiO2/Al2O3 = 3.08* | 87.74 m2/g | Bulk/Spheres | [34] |
Slag-based GP/ Fe2O3-hybride | Slag | SSM SiO2/Al2O3 = 70.65** Fe2O3/Al2O3 = 188 Fe2O3/SiO2 = 2.66 | 233.8 m2/g | Bulk/Microspheres, 75–300 μm | [136] |
Steel slag/fly ash/analcime-GP | Steel slag fly ash | HT SiO2/Al2O3 = 2.01** | 27.25 m2/g 0.050 cm3/g 8.12 nm | Bulk | [137] |
BFS –GP | BFS | AA SiO2/Al2O3 = 5.26 | 23.56 m2/g 73 cm3/kg 7.8 nm | Bulk/Powder, 150 μm | [31] |
EAFS-GP | electric arc furnace slag | AA SiO2/Al2O3 = 2.02* | 6.5 m2/g 0.014 cm3/g 8.7 nm | Bulk/Powder | [38] |
BOFS-GP | Basic Oxygen furnace slag | AA H2O2 | ̶ | Porous | [43] |
Slag-GP/CeO loaded | Slag | SSM SiO2/Al2O3 = 3.31** | 186.40 m2/g 0.352 cm3/g 7.56 nm | Bulk/Sphere, 75–300 μm | [138] |
Clay-based GP | Kaolin | FM SiO2/Al2O3 = 1.88** | 51.3 m2/g 0.324 cm3/g 25.25 nm | Bulk/Powder | [58] |
clay/gangue microsphere -GP | Kaolin coal gangue 50/50 wt% | AA SiO2/Al2O3 = 4.0 | 39.74 m2/g 52.00 nm | Bulk/rubbles, 0.45–0.15 mm | [139] |
Clay-GP/Fe3O4 hybride | Calcined bentonite clay | AA | 2.32 m2/g 0.008 cm3/g 13.76 nm | Bulk/Powder | [61] |
Clay-GP | Lateritic clay, 58 μm | AA | 17.441 m2/g 0.005 cm3/g 1,4 nm | Bulk/Powder, 58 μm | [62] |
Natural tuff-GP | Volcanic tuff | AA SiO2/Al2O3 = 3.74** | ̶ | Bulk/Powder, < 200 μm | [140] |
Alumino silicate-GP | Alumino silicate powder | AA SiO2/Al2O3 = 4 | 50.1 m2/g 0.36 cm3/g 0.04 μm | Bulk/Monoliths or granules | [141] |
Synthetic GP | Chemosynthetic Al2O3-SiO2 powder | SSM SiO2/Al2O3 = 2 | ̶ | Bulk/Spheres | [142] |
Chitosan modified geopolymer | Aluminum salt and silica solution, chitosan | Precipitation SiO2/Al2O3 = 3.06** | ̶ | Bulk/Powder | [143] |
OTB-GP | Pyrophyllite mine waste samples | AA SiO2/Al2O3 = 2.39** | ̶ | Bulk/Powder, <45 μm | [55] |
OTB-GP | Gold mine waste | FM | 74.92 m2/g | Bulk | [144] |
OTB-GP | Gold mine tailings Al2O3 | FM | 74.916 m2/g | Bulk | [51] |
Municipal solid waste-GP | Sludges | FM SiO2/Al2O3 = 3.12** | 0.496 m2/g 9.98 nm | Bulk | [145] |
Municipal solid waste-GP | Municipal solid waste biochar | AA | 6.5 m2/g - - | Bulk | [146] |
Dolochar ash based geopolymer | Dolochar < 100 mesh | AA SiO2/Al2O3 = 4.97** | 49.91 m2/g 0.087 cm3/g 8,9 nm | Bulk/Particles, ≈ 0.1 mm | [147] |
GP/AAMs compositions for water and wastewater treatment reported in literature.
Calculated using the amounts of raw materials in the slurry.
Calculated using the XRF of product.
Originally, a basic composition applied for manufacturing GP/AAM adsorbents consisted of an alumosilicate precursor, an alkali, and an additional source of silicate in a form of water glass. Initially, both sodium and potassium forms of alkaline activators were used to induce geopolymerization. In the vast majority of the research reviewed, sodium alkaline and water glass are used in the activation process. It was shown by Bakharev that dissolution rates of the minerals was higher when a sodium form is used [148]. Luukkonen et al. [149] found that adsorption characteristics of metakaolin-based GP prepared with NaOH is better than with KOH in case of ammonium removal. An in-depth discussion of G chemistry and vivid explanations could be found in the latest reviews [57, 150, 151].
Forms and manufacturing techniques of GPs/AAMs for water treatment application are emerging and evolving constantly. In the first instance,
Despite the fact that the first identification of GPs as unconventional construction materials was in 1979 [158], broader applications of GPs/AAMs started in late 90s. Although GPs/AAMs are to be considered by some authors as an economic alternative to zeolites or activated carbons for water purification, the lack of real cases reported is obvious. To urge commercial importance, GP/AAM adsorbents should be readily available, economically feasible, steady in characteristics, and easily regenerated. Several comprehensive reviews on the GP/AAM materials for the water treatment sector have been published just recently [57, 150, 151, 153]. Therefore, in this section the bright and promising works will be highlighted as well as challenges and trends for future studies revealed.
In order to obtain adequate adsorption parameters, an excessive alkaline residue in GP/AAM should be washed out properly (pH 7 ± 0.5 within 24 h required) [159]. Otherwise, the increment of pH of aqueous solutions containing heavy metals will favor the hydroxide precipitation process, leading to wrong result interpretation. For porous GPs, washing away the excessive alkalis resulted in the increment of total porosity [11], which led to better performance. Moreover, excessive alkalis were used intentionally to neutralize AMD [42] and remove metal ions. However, a strict protocol must be followed to characterize newly designed materials.
Selective adsorption is relies on several factors such as a metal ion activity, hydration radius and free energy of hydration, and a pore size distribution of GP.
Geopolymerisation by itself could lead to the formation of new ion-exchange sites at the GP surface, but additives in composite formulations could have even higher influence the adsorption characteristics.
An ionic exchange reaction between the heavy metal ions and sodium ions has resulted in heavy metal removal by the metakaolin GP [159]. The adsorption selectivity of heavy metal ions by the GPs at pH 4 in multi-component solution was in the following order: Pb2+ > Cd2+ > Cu2+ > Cr3+, while qe [mg/g]: 100 > 76 > 55 > 10. The order of adsorption was in accordance with the hydrated radius and free energy of hydration for selected ions. However, the free energy of hydration and the activity for Cr3+ are all higher compared to those of other metals, though its adsorption rate does not correspond to the assumed order. The selectivity towards Cr3+ was be explained through its ionic status. When the pH exceeded 4, Cr3+ transforms to Cr(OH)2+, which might lead to its lower adsorption ability. It is also noted that at lower pH, the balancing ions present on the GP surface tend to be replaced by the hydrogen ions instead of the metal ions that lead to lower capacity at acidic pH.
Lopez et al. [5] investigated the selectivity of metakaolin-based GPs in multicomponent solutions (Pb2+, Cu2+, Cd2+, Ni2+, Zn2+ and Cs+). For a composition with Si/Al ratio 2, the best capacities and selectivity towards Pb2+ and Cs+ were observed. The adsorption selectivity for the mixture of metal ions was in the following order Cs+ > Pb2+ > Cu2+ > Zn2+ > Ni2+ > Cd2+, while qm [mg/g]: 43 > 35 > 15 > 3 > 1 > 2. The adsorption capacity for individual elements were higher: 57 mg Pb2+/g > 52 mg Cs+/g > 46 mg Cu2+/g > 14 mg Cd2+/g > 9 mg Zn2+/g > 4 mg Ni2+/g. Moreover, the effect of solution salinity (NaCl, 5% and 10%, wt) was studied, and no considerable effect on the adsorption order of metal ions or GP capacity in multi-composition solution was found. The authors presumed the existence of at least two types of binding sites with different affinities toward the metal ions to explain such a tolerance.
Selectivity of GP composites with zeolite filler was studied by Andrejkovičová et al. [4]. The highest adsorption was observed for Pb2+ for all the GPs obtained, while an adsorption order was as follows: Pb2+ > Cd2+ > Zn2+ > Cu2+ > Cr3+. The adsorption of Cu2+ and Cr3+ increased as the amount of metakaolin in the GP increased, whereas the composite with 25% zeolite doping had higher adsorption characteristics towards Pb2+, Cd2+ and Zn2+. GPs prepared from zeolitic tuff and kaolinitic soil by El-Eswed et al. [160] showed totally different order of adsorption: Cu2+ > Pb2+ > Ni2+ > Cd2+ > Zn2+. Moreover, the adsorption order strongly depended on the GP composition, although Cu2+ and Pb2+ adsorption has always prevailed.
The ability of BFS- and metakaolin-based GPs to remove Ni2+ and metalloids (As and Sb) in form of oxyanions was shown in [32]. Both adsorbents completely removed Ni2+ that most likely was associated with precipitation of its hydroxides on the GPs, while both metalloid oxyanions were adsorbed by BFS-GP equally. Another remarkable merit is that the adsorption capacities were obtained with real matrixes (spiked mine effluents), and were 4.42 mg/g, 0.52 mg/g, and 0.34 mg/g for Ni2+, As3+, and Sb3+, respectively. It is specified by the authors that the low capacities could be a result of competition of some matrix ions (Sr, Ca, Mg, Mn) with the target ions for binding sites.
Researches with increasing frequency pay attention to this problem and try to demonstrate the removal efficiencies with real samples. Removal of Ca2+ and Mg2+ from intact groundwater was examined in [58] on kaolin-based GP. With adsorbent dose of 1 g/L, the removal rate were 37.5% and 16.2% for Ca2+ and Mg2+, respectively. Metakaolin-based GP was tested by Kara et al. [87] for Mn2+ and Co2+ removal from real wastewater. The removal rates in real wastewater decreased from 97.5% to 53.01% and 94.6% to 39.12% for Co2+ and Mn2+, respectively. The results demonstrated that the adsorption performance affected negatively by the coexistence of some other cations and/or anions in the adsorption medium. Bentonite-based GPs were used for heavy metals removal from synthetic wastewater [61]. Porous biomass FA-based GPs were used in [129] for simultaneous removal of heavy metals from wastewater samples. Mixed FA/metakaoline-based GPs were used in [103] for Cu2+ removal from real wastewater. In the showcase, the adsorption capacity of GPs towards Cu2+ decreased by 27% as compared to synthetic samples. Sithole et al. treated acidic industrial effluents by FA/BOFS-based GPs [42, 43]. New GPs containing hollow gangue microsphere were applied for Zn2+ removal from smelting plant wastewater in [93]. At an adsorbent dose of 30 g/L, a complete Zn removal was observed. The distinctive aspect of the reported cases was that a complex composition of treated solutions is likely to decrease substantially capacity of the GP. Thus, the adsorption capacities obtained for the ideal laboratory conditions should be primary used as the guiding not decision-making parameters.
The removal of phosphorus was attempted in [10] with a pervious FA-based GP. The removal rate increased with the increase of pH. Up to 85% of phosphorus were removed from a treated wastewater. Simultaneous removal of ammonium and phosphate by composite metakaolin/BFS-based GPs was demonstrated in [91]. Phosphate removal was enhanced in presence of ammonium. At slightly alkaline conditions (pH 7–8), the removal rate towards phosphate ions was relatively high (>86%), whereas the ammonium removal up to 35% was also achieved. FA-, BFS- and fiber sludge GPs were investigated as promising adsorbents for phosphorous removal from diluted solutions. The capacities at initial phosphate concentration of 100 mg/L are 26 mg PO4/g for BFS-GP, 36 mg PO4/g for FAF-GP, and 43 mg PO4/g for FSHCa-GP [115].
Sulfate ions were removed by barium-modified BFS-based GPs [134]. Adsorption capacities were 91.1 and 119.0 mg SO4/g for model solution and mine effluent, respectively. The surface complexation or precipitation of barium sulfate were suggested as probable removal mechanisms.
Removal of halides by GPs/AAMs is an emerging topic. For this end, composite or functionalized materials are designed. Removal of F ̶ was demonstrated by slag-based GP microspheres modified with CeO [138], Fe2O3 [136], and bivalent metallic species [41] with capacities towards the contaminant 127.7 mg/g, 59.8 mg/g, and 60 mg/g (zinc impregnated BOFS-GP), respectively. A metakaolin-based GP functionalized by surfactant was developed for efficient removal of radioactive iodide [97]. High concentrations of competitive anions had limited influence on the adsorption process.
Oxidative degradation or photodegradation after adsorption have been specified by authors as primary mechanisms of organic pollutants’ removal. Although conventional GPs have been reported for these purposes [86, 89, 104, 126, 139], they would rather have had low adsorption/degradation characteristics. Hybrid or composite materials were proposed to improve the removal efficiency of organic pollutants. Thus, graphene [120, 132, 133, 165], TiO2 [88, 98, 105], CdS [142], various metal oxides [101, 106, 135] were introduced in GP matrix in order to enhance degradation abilities of resulting materials.
In last a few decades, significant improvements were made in both efficiency and economy in removal of metal(oid)s and other substances by adsorbents. Nevertheless, regeneration and recycling of used adsorbents, or recovery of the removed species from the desorbing agents are still rarely reported. For regeneration and reuse of GPs/AAMs, various possible regenerating agents such as acids, alkalis and chelating agents could be used. Only a few of the reported studies were focused on recovery of adsorbed (from saturated adsorbents) and desorbed (from regenerating agents) metals [11, 87, 96, 131]. However, for industrial application and success completion of new GP/AAM adsorbents on the market, research studies on number of adsorption–desorption cycles are in high demand. Moreover, revenues gathered from resource recovery options will have a decisive role in further technology implementation.
The regeneration of metakaolin-based GP by sodium chloride under alkaline conditions after ammonium adsorption for the first time were demonstrated in [152]. Three adsorption–desorption cycles were carried out with a steady removal efficiency. Sodium chloride and sulfate, potassium sulfate and phosphate were studied in [59] as regenerating agents for saturated metakaolin-based GPs. Sodium sulfate showed better results during five cycles under continuous sorption–desorption experiment, only 34% of an initial overall capacity of the GP were lost. Sodium chloride regenerant was also efficient, but only 55% of ammonium could be removed after 5th desorption cycle. The same adsorbents were used to test a nitrogen recovery option in a laboratory-scale demonstration setup [166]. The layout consisted of an adsorption/desorption unit and Liqui-Cel® membrane. A liquid phase obtained during adsorbent regeneration was purified in the membrane contactor in order to recover ammonium nitrogen as ammonium sulfate or phosphate. The purified regeneration solution was used repeatedly for further adsorbent regeneration. Several regeneration-purification cycles were conducted to estimate system sustainability and chemical consumption demand. Operational conditions of a membrane process such as shellside and lumenside feed flows, temperature, and pH were adjusted to gain maximal capacity of the setup. One membrane contactor (2.5 × 8-inch Liqui-Cel) was used under following operational conditions: 100 L/h shellside and 60 L/h lumenside feed flows, 40°C working temperature, pH ≥ 10. Technical sulfuric or phosphoric acids, up to 5%, were used as lumenside phases. The concentration of ammonium-content salt in a resulting received phase were 17% and 22% for phosphate and sulfate salt, respectively.
Metal recovery from GPs/AMMs via ion-exchange mechanism can only take place if physical adsorption occurred and the pH was low enough to prevent precipitation of metal hydroxide during adsorption process. Acids of over 0.1 M strength affect the structure of the GPs, and while metals are regenerated by acid washing, the reuse of adsorbents are diminished both in batch [11] as also in continuous mode [87, 167] experiments. Mild acid washing with 0.01 M H2SO4 or HNO3 removed metals from GPs efficiently in short time (1–2 h). It has also been shown that the adsorption capacity after mild acid washing could increase [131], which could be explained by exchange of Na+ with easier replaceable H+ cations. Selective desorption of copper has been observed by ammonia. A linear desorption ability with respect to ammonia concentration was observed, and complete desorption being possible by 10% ammonia solution [50, 61].
Sequential desorption tests of Cd2+ have been conducted on a loaded metakaolin GP, establishing the percentages of physically adsorbed, ion-exchangeable, EDTA extractable, and residual forms of metal [96]. The authors showed that physical adsorption is negligible, and ion-exchange with MgCl2 constituted to only 2–8% of adsorbed Cd2+. The bulk amount of Cd2+ adsorbed by the metakaolin GP was EDTA extractable, and the adsorbent remained 85% of its adsorption capacity after EDTA desorption for 5 cycles. Luukkonen [32] and Naghsh [58] suggested the efficient metal desorption by 5% NaCl. However, care must be taken since the balancing ions can form a positively charged film on the adsorbent surfaces. El Esweed et al. have achieved ion-exchange based desorption of Cu2+ by 0.1 M NaCl [160]. From all the studies reported, only Cd2+ has been shown to be desorbed at pH > 8 with NaOH solution, achieving 24–84% desorption [64].
An efficient use of GPs/AAMs in real wastewater treatment practices including economic evaluation is little investigated. Above all, these adsorbents show rather low selectivity, and therefore the ubiquitous metal ions (Na+, Ca2+, Mg2+, Fe3+) present in wastewater solutions demonstrate either competing interaction with the target ions, or the interaction has not been studied [57]. Additionally, for economic and ecological assessment is essential that the adsorbent would be regenerable [168]. To be economically successful, exhausted adsorbents need to pass the non-hazardous leaching criteria of the adsorbed materials, while the amount of waste regenerated should be as little as possible. This means that the adsorption-regeneration cycle needs to be performed as often as possible. And yet, afterwards the adsorbent needs to find end storage place, e.g. in tailing pond, or further use, e.g. as binder, filler, or soil amendment.
Adsorption capacity of a powdered GP is usually higher, but technical implementation of powdered forms requires precise dosing, contact vessel with stirring, solid–liquid separation step, and transfer of exhausted adsorbent to regeneration vessel. The powder can then be regenerated by addition of suitable regenerant, e.g. mild acid, separated, and dried prior to the next adsorption cycle.
Technically, the use of granular forms is an easier option. However, the size of the column vs. wastewater stream can easily become very large, as granules per se, are larger particles and adsorption is a surface process. This puts additional burden on geopolymer production as the overall capacity should be sufficient, and the granules will need to show suitable compressive strength to withstand the gravimetric pressure in the purification column. Conversely, regeneration is technically easily realized by counter flow of regeneration liquid through the column.
Economic evaluation therefore needs to take these considerations into account during CAPEX estimation. OPEX, in turn, is not only the ongoing replacement of exhausted adsorbent, electricity consumed, maintenance, staff, and regeneration chemicals, but also the transportation costs of adsorbents, which can be high at low adsorption capacity.
As a thought experiment, an example of 55 mg/g adsorption capacity of copper adsorbent, with 85% cycling capacity has a 47 mg/g adsorption capacity after desorption cycle, shall be considered. For a mine effluent or process water with 5 mg/L Cu2+ and a flow of 200 m3/h requires about 21 kg adsorbent per hour. The price of GPs is given as 1–1.5 € per kg [103], and as such the treatment costs of merely 1 h would be between 10 and 21 €. Regeneration up to 20 times gives more realistic cost factors, of 0.5–1 € per h, only for adsorbent costs. It becomes quickly clear that without regeneration, high efficiency, and selectivity GPs/AAMs will be too expensive for wastewater treatment.
Much work has been done on the adsorption properties of GPs/AAMs towards a wide variety of inorganic pollutants during the last decade. While the effect of competing ions in real water samples remain an issue, the incorporation of new composite materials and the tailoring of reaction conditions have a high potential to increase their selectivity as adsorbents. However, more and more authors have understood the need to regenerate adsorbents and research are being conducted on the recovery of valuable materials, such as metals or nutrients. The recovery of high energy products from side streams utilizing adsorbents made from industrial side streams, will bring circular economy towards the next level. It is also of interest, to cover the costs of water treatment by the revenue of removed materials. While still much work needs to be done, the authors remain confident, that GPs/AAMs will continue to have a prominent place in wastewater treatment.
The research was partially funded by European Regional Development Fund (Leverage from the EU, WaterPro project № A74635; Keski-Pohjanmaan liitto/Kainuun liitto/Pohjois-Pohjanmaan liitto) and by Maa- ja vesitekniikan tuki (№ 13-8271-17).
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\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{},profiles:[{id:"396",title:"Dr.",name:"Vedran",middleName:null,surname:"Kordic",slug:"vedran-kordic",fullName:"Vedran Kordic",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/396/images/7281_n.png",biography:"After obtaining his Master's degree in Mechanical Engineering he continued his education at the Vienna University of Technology where he obtained his PhD degree in 2004. He worked as a researcher at the Automation and Control Institute, Faculty of Electrical Engineering, Vienna University of Technology until 2008. His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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Samim Al Azad and Slimane Ed-dafali",hash:"86a6d33cf601587e591064ce92effc02",volumeInSeries:1,fullTitle:"Leadership in a Changing World - A Multidimensional Perspective",editors:[{id:"418514",title:"Dr.",name:"Muhammad",middleName:null,surname:"Mohiuddin",slug:"muhammad-mohiuddin",fullName:"Muhammad Mohiuddin",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038UqSfQAK/Profile_Picture_2022-05-13T10:39:03.jpg",institutionString:null,institution:{name:"Université Laval",institutionURL:null,country:{name:"Canada"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Business and Management",value:86,count:1}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:1}],authors:{paginationCount:249,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. 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His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:null,editorThree:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. 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