\r\n\tThere will be a chapter on secondary causes of sexual dysfunction disorders related to diabetes, cardiovascular disease, and obesity. A chapter on remedial measures to enhance sexual activity and maintain human relationships will be discussed. As there is a growing number of cancer survivors a chapter on cancer-related sexual dysfunction will be welcomed for including it.
",isbn:null,printIsbn:null,pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"b988fda30a4e2364ee9d47e417bd0ba9",bookSignature:"Dr. Dhastagir Sultan Sheriff",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11889.jpg",keywords:"Sex, Sexual Response Cycle, Erection, Premature Ejaculation, Libido, Orgasm, Painful Intercourse, Psychological, Female, Lack of Desire, Erectile Disorders, Pain Disorders",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 8th 2022",dateEndSecondStepPublish:"May 6th 2022",dateEndThirdStepPublish:"July 5th 2022",dateEndFourthStepPublish:"September 23rd 2022",dateEndFifthStepPublish:"November 22nd 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"3 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dhastagir Sultan Sheriff is a life member of the European Society for Human Reproduction and Early Human Development, Association of Physiologists and Pharmacologists of India, member of the National Academy of Medical Sciences, New Delhi, and resource person for UNESCO for Medical and Bioethics. Dr. Sheriff has authored five books including a textbook on medical biochemistry with additional interest in human sexology. He has done extensive research in andrology, sex education, and counseling.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"167875",title:"Dr.",name:"Dhastagir Sultan",middleName:null,surname:"Sheriff",slug:"dhastagir-sultan-sheriff",fullName:"Dhastagir Sultan Sheriff",profilePictureURL:"https://mts.intechopen.com/storage/users/167875/images/system/167875.jpg",biography:"Dhastagir Sultan Sheriff is a life member of the European Society for Human Reproduction and Early Human Development, Association of Physiologists and Pharmacologists of India, member of the National Academy of Medical Sciences, New Delhi, and resource person for UNESCO for Medical and Bioethics. Dr. Sheriff has authored five books including a textbook on medical biochemistry with additional interest in human sexology. He had editorials written in the British Journal of Sexology, Journal of Royal Society of Medicine, Postgraduate Medicine, and Scientist. He was a former Rotarian, Citizen Ambassador, and was selected for the Ford Foundation Fellowship.",institutionString:"University of Benghazi",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Benghazi",institutionURL:null,country:{name:"Libya"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:null},relatedBooks:[{type:"book",id:"6934",title:"Psycho-Social Aspects of Human Sexuality and Ethics",subtitle:null,isOpenForSubmission:!1,hash:"44731b106aa0d1ab5c64a7394483c7d5",slug:"psycho-social-aspects-of-human-sexuality-and-ethics",bookSignature:"Dhastagir Sultan Sheriff",coverURL:"https://cdn.intechopen.com/books/images_new/6934.jpg",editedByType:"Edited by",editors:[{id:"167875",title:"Dr.",name:"Dhastagir Sultan",surname:"Sheriff",slug:"dhastagir-sultan-sheriff",fullName:"Dhastagir Sultan Sheriff"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7163",title:"Infertility, Assisted Reproductive Technologies and Hormone Assays",subtitle:null,isOpenForSubmission:!1,hash:"6db6e4ccb7088f17f819121f7eb6424d",slug:"infertility-assisted-reproductive-technologies-and-hormone-assays",bookSignature:"Dhastagir Sultan Sheriff",coverURL:"https://cdn.intechopen.com/books/images_new/7163.jpg",editedByType:"Edited by",editors:[{id:"167875",title:"Dr.",name:"Dhastagir Sultan",surname:"Sheriff",slug:"dhastagir-sultan-sheriff",fullName:"Dhastagir Sultan Sheriff"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"57621",title:"Multimodal Treatment for Cancer of the Esophagus",doi:"10.5772/intechopen.70991",slug:"multimodal-treatment-for-cancer-of-the-esophagus",body:'\nThere are about 500,000 new cases of cancer of the esophagus and 400,000 esophageal cancer-related deaths recorded annually around the world. The disease is three to four times more frequent in men than in women, being the sixth most common cancer and the fifth most frequent cancer-related death among men [1].
\nEven though esophageal cancer was not very common in Western populations, the incidence of esophageal adenocarcinoma and its related mortality have increased in the USA and certain European countries [2]. The incidence of adenocarcinomas involving the esophagogastric junction, the distal esophagus and the gastric cardia has recorded a more significant increase [3]. The transition from squamous cell carcinoma to Barrett’s metaplasia-associated adenocarcinoma in Western populations could have been determined by the increase in the incidence of obesity and obesity-induced reflux [4, 5].
\nThere are two main subtypes of the disease, namely esophageal squamous cell carcinoma and esophageal adenocarcinoma. The most common causes of squamous cell carcinoma are tobacco and alcohol, and the most common causes of adenocarcinoma are tobacco, obesity and acid reflux [5]. There has been a major increase in the incidence of adenocarcinoma in North America and Europe, while squamous cell carcinoma is still the most common type of esophageal cancer in Asia [6].
\nThe two subtypes of esophageal cancer have different clinical and biological characteristics. While squamous cell carcinomas occur in the middle or upper third of the esophagus, adenocarcinomas occur in the lower third of the esophagus. Abdominal lymph node metastasis is usually present in adenocarcinomas, and the incidence of cervical or upper mediastinal lymph node metastasis is more frequent in squamous cell carcinomas. Thus, the therapeutic approach is different for each subtype [7].
\nThe prognosis of esophageal cancer is quite poor, despite advances in surgical procedures (two-field and three-field lymph node dissection) and perioperative management, which is still controversial [7]. The use of chemotherapy and radiotherapy in combination with surgery might be a new approach for future treatment. Progress in optical technology has led to the development of a new minimally invasive surgical approach for the treatment of esophageal cancer, namely esophagectomy. Long-term survival in resectable esophageal cancer is also influenced by definitive chemoradiotherapy [8]. Salvage esophagectomy is used in patients with esophageal cancer who were treated with chemoradiation as definitive therapy [9].
\nAlthough cancer of the esophagus is among the most common cancers in the world, there are few studies on this malignancy. There have been significant changes in the epidemiology of esophageal cancer in the past 30 years, with a striking increase in incidence in Western populations, where the number of adenocarcinomas has exceeded those of the squamous cell type [6]. On the other hand, squamous cell carcinoma is the most frequent subtype in Asian countries, mainly developing in the middle third of the esophagus, without any dramatic increase in the incidence of adenocarcinoma on this continent. New diagnostic, staging, and therapeutic options have improved survival rates for esophageal cancer.
\nEarly stage adenocarcinoma of the esophagogastric junction (AEG) could be detected based on efficient screening for gastroesophageal reflux disease (GERD) and Barrett’s metaplasia, which might be cured using endoscopic ablation or surgery [10].
\nThe infection with
The potential role of COX-2 inhibitors in the effective chemoprevention of esophageal adenocarcinoma, characterized by COX-2 overexpression, is another aspect to be considered [13]. The types of surgery for cancer of the esophagus are divided based on the complex lymphatic drainage from the esophagus and gastric cardia and their anatomy.
\nHulscher et al. conducted a meta-analysis and obtained a 20% 5-year survival rate [14] following any of the two approaches. However, there were much higher rates of early morbidity and mortality in the case of transthoracic resection. On the other hand, in another study conducted by Hagen et al. [15], better survival rates (41% vs. 14%; p < 0.001) were obtained in 30 patients following en bloc esophagectomy compared with 39 patients undergoing transhiatal esophagectomy, suggesting the use of extended en bloc esophagectomy instead of transhiatal resection in the case of carcinoma of the lower third of the esophagus and gastric cardia [15].
\nOutcomes in esophageal cancer are often poor [16]. The best and most efficient surgical method in patients without evidence of spread to other parts of the body is the combination between esophagectomy and reconstruction surgery [7]. There are three more frequent minimally invasive techniques for esophagectomy: transhiatal esophagectomy, the Ivor Lewis esophagectomy (upper midline laparotomy combined with a right posterolateral thoracotomy), and the McKeown technique (right thoracotomy, upper midline laparotomy, and left neck incision). Several randomized trials compared transhiatal esophagectomy and standard transthoracic esophagectomy, showing no significant differences between them. The differences between transthoracic and transhiatal esophagectomy were examined in three randomized trials [17–21]. The results of these clinical trials showed no significant differences between the two approaches in what concerns patient survival. Hulscher et al. [22] conducted a randomized trial in patients with adenocarcinoma of the esophagus and gastric cardia (106 patients with transhiatal esophagectomy and 114 with transthoracic esophagectomy). There were lower morbidity rates in the case of transhiatal esophagectomy than in transthoracic esophagectomy with extended en bloc lymph node dissection. Despite the absence of statistically significant differences in terms of disease-free, median overall, and quality-adjusted survival, there was an improvement in long-term survival of patients with extended transthoracic resection. Asia, especially Japan, accounts for the majority of the more aggressive surgery records. Five-year survival rates following three-field lymph node dissection were 48.7% in a study conducted by Kato et al. [23] and 55.0% in a study by Akiyama et al. [24].
\nEsophagectomy can be either transhiatal or transthoracic, performed using the Ivor Lewis technique (combined laparotomy and right thoracotomy) and the modified McKeown procedure, involving laparotomy, right thoracotomy with neck anastomosis, left thoracotomy, or left thoracoabdominal incision [25]. The approach is chosen depending on tumor location and surgeon preferences. Good treatment outcomes result from the complexity of these surgical procedures, the experience of the surgeons, and intensive care resources [26].
\nA comprehensive randomized study assessing the differences between the transthoracic and the transhiatal approach indicated similar mortality rates for both procedures, whereas morbidity rates were lower for the transhiatal approach. The transthoracic group showed non-significant associations between this procedure and overall and disease-free survival. However, there was an improvement in locoregional disease-free survival following transthoracic esophagectomy in a subgroup of patients who did not present extensive nodal involvement [27].
\nLong-term survival rates following open esophagectomy do not differ significantly when comparing these surgical procedures, as shown by various meta-analyses and randomized trials [28]. In their study, Tabira et al. [29] recommended the use of three-field lymph node dissection in patients with one to four lymph node metastases. As indicated by Shiozaki et al. [30], neck dissection might be eliminated in patients with carcinoma in the middle or lower third of the esophagus without lymph node metastasis along the recurrent nerve chain. Lerut et al. [31] also proved an improvement in patient survival following three-field lymph node dissection.
\nWhen comparing three-field with two-field lymph node dissection for squamous cell carcinoma of the esophagus, Kato et al. obtained 5-year survival rates of 48.7% for the first approach and 33.7% for the second. However, this study was contested due to differences in patient characteristics. Isono et al. [32] conducted a nationwide study and obtained better survival rates when using three-field dissection instead of the two-field approach. Fujita et al. [33] also presented much better survival rates following three-field lymph node dissection (p < 0.05) for carcinoma in the upper or middle third of the esophagus spreading to the lymph nodes. Still, there were no differences in mortality, morbidity, and postoperative quality of life between the two approaches [33]. Radical esophagectomy helps remove ≥80 lymph nodes and 5-year survival rates are around 40–60% [34].
\nPulmonary complications after transthoracic esophagectomy are high. The minimally invasive thoracoscopic approach might result in lower morbidity and mortality rates. Being minimally invasive, thoracoscopy should replace the open approach. In a study conducted by Cuschieri et al. [35], the researchers performed right thoracoscopy (esophagectomy and lymph node dissection) in a small group of patients and paved the way for the future use of thoracoscopic esophagectomy. This procedure proved to be feasible and even superior to open surgery. Nevertheless, the first outcomes using this approach were not significantly better than those obtained with the open approach, mainly as a result of the great number of pulmonary complications [36–38]. However, a few medical research centers in Japan found a new stimulus. For example, Akaishi et al. [39] obtained good outcomes in 39 patients with cancer of the esophagus who underwent en bloc esophagectomy with radical lymph node dissection via right thoracoscopy, with the following parameters: 200±41 min operating time, 270±157 ml blood loss, and the number of harvested lymph nodes was 19.7±11. All patients survived and there was a modest decrease in vital capacity in 22 of them, without requiring postoperative ventilation. A significant finding of the study was that pulmonary complications were reduced compared with the open procedure.
\nIn their study, Luketich et al. [40] proved that minimally invasive esophagectomy (MIE) is efficient and safe in the United States. The study was conducted on 1033 consecutive patients and results indicated a significantly lower mortality rate (0.9%), with an 8-day median hospital stay. In a study performed in the United Kingdom, Mamidanna et al. [41] assessed 7502 patients undergoing esophagectomy (E) and MIE (n = 1.155) and results showed no differences in terms of 30-day morbidity and mortality. MIE proved to be safe for use by professionals, without supplementary patient safety risks. Despite the low number of annual esophagectomies (2) per medical center, study results were similar and MIE was preferred in terms of perioperative outcomes. On the other hand, there are insufficient and incomplete cancer comparative research data. Certain centers noted higher lymph node retrieval following MIE with lymph node dissection [42–44], whereas others did not find any considerable differences [45]. In a study performed on 168 patients, Palazzo et al. [46] demonstrated that long-term survival was twice better in patients who underwent MIE (hazard ratio—2.0). Despite significant patient and tumor variables, there were concerns related to the ability to reproduce the major differences in results obtained for these groups. Additionally, the small number of patients might assign any variations to defective regulations.
\nIn a study assessing three-field lymph node dissection, Osugi et al. compared 77 patients with squamous cell cancer who underwent minithoracotomy to 72 controls who underwent conventional three-stage treatment. Exceptional outcomes were obtained in terms of lymph node retrieval (33 vs. 32), operating time (227 vs. 186 min), reduced vital capacity (15% vs. 22%, p = 0.016), 3-year survival (70% vs. 60%), and 5-year survival (55% vs. 57%) [44]. Resection via thoracoscopy showed almost similar results to open esophagectomy. Moreover, surgical trauma was reduced. The differences in outcome between the first 34 and the next 46 patients who underwent surgery in the same study group demonstrated the impact of the learning curve on obtaining shorter operating times and better results by using this approach. Other advantage is that greater experience helps reduce postoperative pulmonary complications (5% incidence). Reduced blood loss, shorter operating time for thoracoscopy, reduced postoperative respiratory complications and higher lymph node retrieval were all observed in the last group [44]. In a study conducted on 222 patients undergoing thoracoscopic and laparoscopic esophageal resection, Luketich et al. (Ann Surg 2003; 238:486–494) showed an incidence rate of pneumonia of 7.7%. A significant finding was the reduced length of intensive care unit stay (1 day) and hospital stay (7 days) and the 1.4% operative mortality. Quality of life indicator was comparable to baseline scores and population standards. Nguyen et al. [47] assessed 46 consecutive patients and found similar results to Luketich et al. There have also been studies supporting robot-assisted thoracoscopy; however, there is still need for further investigation regarding robotic esophagectomy [48].
\nThe results obtained by Biere et al. [49] in the TIME (Traditional Invasive vs. Minimally Invasive Esophagectomy) trial comparing the outcomes of 115 British patients who underwent either E or MIE showed that besides a decrease in perioperative pulmonary complications, the two procedures were more or less similar. However, the main competence of the trial was to show differences in short-term outcomes, with lower capacity in pointing out other outcomes. Patient outcomes were adapted to a population, improving the ability to perform a multivariate analysis of small differences in survival. There are few data on comparative differences in robot-assisted esophagectomy. In a study conducted on 43 patients who were treated with MIE (of which 11 underwent robot-assisted esophagectomy), Weksler et al. [50] reached the conclusion that robot-assisted and conventional procedures were similar. There were not enough patients included in the study, the results were disorganized, and there were no cancer data. Our study also experiences difficulties due to this aspect when comparing robotic with conventional MIE, but we managed to explain certain confounding variables for our outcomes. The limitations of our study are represented by the inability to determine specific MIE approaches (the McKeown procedure, the Ivor Lewis approach, and the transhiatal procedure). Earlier studies have demonstrated that the three procedures have similar outcomes, even though there are differences in terms of perioperative complications [51]. Another drawback was the difficulty in differentiating between patients who underwent hybrid procedures, such as laparoscopy combined with minithoracotomy, and patients who were treated with total MIE. These limitations pave the way for the occurrence of unknown interactions and confounding variables. Currently, there are two different clinical trials comparing E to MIE patients, namely the French MIRO trial [52] and the British ROMIRO trail [53]. Still, the study that we conducted is the most extensive comparative effectiveness research of MIE assessing long-term survival. As a result, MIE determines poor improvement in perioperative outcomes, with no negative impact on survival rates.
\nThe use of preoperative chemotherapy compared with surgical treatment has been assessed in randomized trials in order to obtain improved surgical outcomes. However, the results are highly disputed. The three meta-analyses built on these randomized trials showed no difference in survival when the endpoint was 1-year survival in six of these trials. On the contrary, in comparison with surgical treatment, 2-year survival rates were improved following preoperative chemotherapy (4.4%) when the endpoint was 2-year survival in seven randomized trials [53]. When the meta-analysis was restricted to four recently randomized trials based on cisplatin and 5-fluorouracil therapy, there was a 6.3% improvement in 2-year survival. Still, this increase did not occur in one meta-analysis where the endpoint was 2-year survival [54]. The impact of preoperative chemotherapy is still uncertain.
\nUsed in Europe and America since the end of the 1980s, preoperative chemoradiotherapy determined survival rate improvement in patients with cancer of the esophagus. Despite being used on a small scale due to the advanced surgical procedures available in Japan, a randomized trial reported the efficiency of hyperthermochemoradiotherapy in esophageal cancer [55]. Five meta-analyses built on five to seven randomized trials assess the impact of surgery alone, on the one hand, with preoperative chemoradiotherapy used in combination with surgery, on the other hand. There were no improvements in survival rates following preoperative chemoradiotherapy when the endpoint was 1-year or 2-year survival. When the endpoint was 3-year survival, there was an increase in perioperative mortality within 90 days after surgery, contrasted by a decrease in local recurrence and an improvement in 3-year survival rates in analogy to surgery alone (Int J Hyperthermia 1992; 8:289–295). There was a 14% decrease in death risk following preoperative chemoradiotherapy when the endpoint was the hazard ratio of survival curves [56]. Several reports [57–59] of six randomized trials showed higher survival rates following preoperative chemoradiotherapy than after surgery alone. Another report focusing on esophageal adenocarcinoma reported much higher survival rates following preoperative chemoradiotherapy versus surgery alone [60].
\nA meta-analysis of randomized trials conducted in Europe and America reported no improvement in survival with postoperative chemotherapy following curative resection in patients with cancer of the esophagus. In contrast, a randomized trial conducted in Japan showed that postoperative chemotherapy determined a major improvement in disease-free survival. In conclusion, postoperative chemotherapy recommends itself as an efficient measure to prevent recurrence after surgery.
\nFour randomized trials assessing the differences between surgery alone and postoperative radiotherapy (45–65 Gy) reported no major improvements in survival. However, there was a decrease in local recurrence in the irradiated area following postoperative radiotherapy. No major improvements in survival were observed in a meta-analysis of these randomized trials. In conclusion, postoperative radiotherapy is not a conventional treatment option.
\nThe incidence of postoperative mortality was assessed in a considerable number of studies [61–65], fewer assessed in-hospital mortality, and 30-day mortality was determined in two studies [66]. Values were higher in patients who were treated with salvage esophagectomy after definitive chemoradiotherapy (23 patients—9.50%) than in patients who treated with planned esophagectomy after neoadjuvant chemoradiotherapy (29 patients—4.07%). Pooling of results validated the much higher incidence of postoperative mortality in the case of salvage esophagectomy (prevalence odds ratios (POR) = 3.02; 95% CI 1.64–5.58;
Recycling is the process of converting materials from all kinds of waste to produce new products. Textile recycling implies the reuse and reprocessing of clothing scraps or any fibrous textile material [1]. All types of consumer or industry discarded textile goods are used as textile wastes for recovery. It is obvious that recycling, which has evolved into sustainability over time and its importance has been understood even in ancient times. It can be applied in many fields of the textiles as textile-to-textile (closed-loop) recycling or textile-to-nontextile (open-loop) recycling [2].
The demand for textiles and clothing is increasing day by day as a result of the increasing population, rising living standards, and the fast changing fashion trends [3, 4, 5]. Consequently, the amount of textile waste increases, and there are accumulations in landfills [4]. In addition to the consumption of high amounts of textile products, the packaging of these products also causes an increase in waste piles [6].
Textile and clothing waste causes environmental problems and deterioration of ecological balance. Therefore, the reclaim and disposal of waste clothing and textiles are important issues. Unfittingly and uncontrolled disposal of waste cause major problems [5]. The importance of recycling is considered in three subjects by Ref. 7 as economic, social, and environmental subjects [7]. Recycling of textile waste and diversifying the content of recycled raw materials could be a way to support the country’s economy. The employment opportunities in the textile sector as in other sectors increase with well-run waste management. The recycling sector is an important supplier to many industries, and wastes are considered as cheap raw materials [8]. A wide variety of garment brand companies offer their products that contain recycled materials at certain rates, as a social responsibility issue in the market and to increase their prestige. It also adds profit to the company by paying less for recycled materials obtained from waste products.
Although there are several methods for the disposal of clothing waste, the most effective methods are recycling and reuse. Evaluation of waste clothing is very complex since clothes are made from different raw materials and may contain various accessories. Clothing may have many components such as labels, sewing threads, buttons, zippers, and interlining, and these components make the separation process difficult. Clothing recycling and textile recycling are two independent topics that are needed to be considered separately [5]. Textile wastes arise out of many production processes, such as fiber and filament manufacture, spinning, weaving, knitting, nonwoven, and clothing manufacturing [9]. In this context, textile wastes can be classified as pre-consumer and post-consumer wastes [10, 11]. Pre-consumer textile waste includes manufacturing waste from the processing of fibers, yarn, fabric, and nonwovens and clothing manufacturing [12]. Pre-consumer textile waste is generally seen as “clean waste” as it is released during the textile production process [13, 14].
When all these wastes are well managed, positive results emerge both in terms of providing economic gains via the recycling of materials and reducing the ecological damage to the world. Despite all advantages, there are recycling limits for all kinds of textile wastes. Not only for textile wastes but also for other solid wastes recyclability variates. Some types of wastes can be easily and well recycled, whereas some types cannot or can formidably be recycled [1]. These limits pave the way for the emergence of new recyclable fibers for the textile industry.
The purpose of this chapter is to present a systematic study for recycling of textiles mentioning the limits and alternative sustainable fibers. The content started with the history of recycling, continued with processes, standards, and certificates about textile recycling. Subsections of recyclable common textile fibers and new recyclable textile fibers are given in detail.
Recycling dates back to ancient times [15]. It is claimed that waste management and waste disposal processes date to BC in several references [16, 17]. Recycling is known as an efficient and effective solid waste management system [18]. In 4000 BC, silkworm wastes were used as protein source food in fish raising in China [19]. Scientifically, the foundations of recycling were laid in the 1980s [20].
When we consider textile recycling, it is known that it is as old as recycling in other fields. There are even references stating that it is one of the oldest fields, so textile recycling is called original recycling [21]. China hosted applications where recycled fibers from used clothing were obtained by hand carding and mixed with virgin fibers BC [14]. The textile recycling industry took its first steps in the thirteenth century [22]. In pre-modern societies, there were sustainability models based on the reuse and recycling of textiles [14]. For example, recycling has been done for years in India, both at the household and industrial level [23]. In the early and mid-1800s, reclaimed spin waste and rags were used for the manufacture of new products, and the invention of carbonization made it a unique technique to separate textile waste comprising of cellulose-based and wool fibers blend [22].
Environmental awareness concept had been newly introduced in the 1960s. The conscious interest of consumers and producers had just begun to turn to recycle at that time. Today, it is argued that this interest has evolved into sustainability [24].
Early academic studies conducted in the 1990s focused on presenting a model for the textile waste lifecycle [25]; detailing biological, physical, and chemical treatments of textile wastes [26]; determination of the number of sewn product manufacturers that support recycling in an American state [27]; the recyclability of post-consumer fibers, and market applications, while revealing the advantages of recycling [28]. After this decade, a positive acceleration was observed in the studies on both recycling and textile recycling. When “textile” and “recycling” terms are searched in a topic currently 1843 documents in WOS were encountered at all times. Moreover, 188,487 documents were encountered with the only term “recycling” at all times. The variation of the number of publications by years are given in Figure 1 and in the first quarter of 2022, 41 documents were published about the textile recycling topic. As can be seen from the graph, the number of research on textile recycling has increased in parallel with the number of research on recycling over the years.
The number of publications encountered with search terms “recycling” and “recycling and textiles” in WOS.
Recycled fibers are used to make a variety of products. By producing yarns from recycled fibers, knitted or woven fabrics can be produced, or non-woven surfaces are obtained directly from these fibers. Recycled pre-consumer textile wastes are utilized in the construction, automotive, furniture, paper, and clothing industries. However, fibers obtained from pre-consumer textiles are used especially in coarse yarn production [29]. Many researchers studied about using pre-consumer waste and its conversion into a valuable product in the literature. Jamshaid et al. [30] span open-end rotor yarns from fibers in different blends reclaimed from yarn and fabric wastes. They evaluated the impact of various textile wastes on fiber and yarn quality. They underlined that the length and uniformity values of the fibers recycled from yarn wastes are better than those of the fibers recycled from fabric wastes. However, in terms of yarn manufacturing costs, it has been stated that yarns produced from recycled fabric/rag wastes are more economical than yarns produced from yarn wastes. The impact of cotton waste and various spinning conditions on rotor yarn quality was investigated by Halimi et al. [31]. The results showed that the quality of the rotor yarn is not affected by the addition of 25% waste in the first passage of the draw frame. Yilmaz et al. [32] produced yarns by blending the fiber wastes taken from the blow room, the carding and sucked in the draw frame, roving, and conventional ring spinning machines with the virgin cotton fibers at 5 different amounts varying from 5% to 40%. They emphasized that by designing machinery and process steps based on waste fiber type, it can be possible to produce yarns that are in comparable quality values and low cost.
The post-consumer textile wastes consist of clothing and home textiles that consumers no longer need for various reasons, such as damage, pulling on, or going out of fashion [14]. Contrary to pre-consumer wastes, post-consumer wastes are known as dirty and household waste [33]. Post-consumer wastes are evaluated with reuse and recycling techniques or incineration. The options to be applied to post-consumer waste vary according to many criteria such as the wear condition of the clothing, fiber content, and the technology of the recycling facilities [34]. The progress in recycling technology supports the sustainable disposal of waste clothing, and recycling is far more environmentally friendly and socially beneficial than incineration. In addition to this, technological advancements are required to produce upcycle products from waste clothing. Improvements in the collection and disposal of post-consumer textiles can be made with the application of environmental protection policies [5].
Post-consumer waste of sufficient quality is utilized as second-hand clothing by other consumers or sold to third-world countries. The volume of consumer waste is quite high, and clothes that cannot be worn again are shredded into fibers and used in new products, similar to pre-consumer wastes [6, 14]. The process of producing new clothing from post-consumer waste includes collecting waste, obtaining fiber from waste, and producing yarn by using a certain amount of blend in the yarn production stage [34].
When compared to original fibers, recycled fibers have different properties. The processes that the fibers are exposed to during the recycling process damage them and shorten their length. Fiber length is important factor in converting recycled fibers into yarn or producing nonwovens from these fibers, and the fibers must be long enough. Due to the short length of recycled fibers and the presence of non-fiber remnants such as fabric and yarn fragments, defining some quality parameters of these fibers is difficult. Fiber length, material break down degree, and fiber length distribution are three of the most widely analyzed properties of recycled fibers [35].
There are four different approaches to recycling (Figure 2) [36, 37]:
Primary approach,
Secondary approach,
Tertiary approach, and
Quaternary approach
Various recycling approaches.
Primary recycling is the most beneficial method, and in this approach, the product is recycled to its original form. This approach is also known as “original recycling.” It is aimed at synthetic fibers such as PET (polyethylene terephthalate) and PA (polyamide) [37]. In this method, which can also be blended with the similar original raw material in order to increase the product quality, cleaned and pure scraps from waste are collected and recycled. In addition to the important advantages of this process such as being cheap and easy, it also has the disadvantage that the type of recyclable material is limited [38].
Secondary recycling is the process of converting waste into a product with different physical or chemical properties than the original [39]. Secondary recycling, which converts post-consumer wastes into raw materials, includes the collection and recycling process [40]. The content of textile waste, the degree of purity of the end product, availability, cost, and processing techniques are important factors for secondary recycling.
In tertiary recycling, known as feedstock recycling, wastes are separated into chemicals through pyrolysis, gasification, hydrolysis, and condensation [41]. Tertiary recycling, which is preferred for converting plastic wastes into chemicals, monomers, or fuels, utilizes clean and well-sorted pre-and post-consumer wastes [40].
Quaternary recycling is the use of heat produced by the incineration of fibrous solid wastes [42]. In summary, primary and secondary recycling usually involve the mechanical processes of industrial by-products and waste, while tertiary and quaternary recycling includes the pyrolysis and incineration of textile wastes for energy generation [41].
Mechanical recycling is a low-cost and easy method [11], which is the preferred method for recycling a diverse variety of textile waste [43]. The recycling of post-consumer textile waste is generally carried out by mechanical recycling [42]. In the mechanical recycling technique, the fabric is broken down into fibers by cutting, shredding, carding, and other mechanical processes [44, 45]. Mechanical recycling machines gradually break the fabric into small pieces and make it fibrous, and these obtained fibers are reused in the production of yarn or nonwovens. In the mechanical recycling process, initially, wastes are sorted. Foreign components, such as metals and labels, are eliminated. After the fabric is cut into small pieces with rotary blades, it is separated into fibers by tearing [40].
Since garments are usually made from different raw materials, it is better to use pre-consumer waste instead of post-consumer waste in mechanical recycling. Fibers obtained by mechanical recycling from pre-consumer wastes such as denim scraps can be used to make higher-quality yarns. The length of the fibers recycled by the mechanical recycling process is short, despite the use of clean pre-consumer wastes [40]. The fiber length is shortened by the shredding/tearing process. The main reason for this is the friction between the fibers. Friction causes wear of fibers and melting of synthetic fibers. Lubricants are used to reduce friction between fibers during shredding and thus longer fiber lengths can be obtained [46]. In addition to the lubrication process, product quality is increased by blending original fibers with recycled fibers [45].
Recycled fiber properties such as length, fineness, and strength indicate the field the fibers can be evaluated in [47]. Good quality recycled fibers can be spun into fabrics, while lower quality fibers are used as decoration materials, construction materials [48], automotive components, insulation materials, and nonwovens [45, 47].
In thermal recycling, synthetic fibers are melted to be reshaped. The thermal recycling method is preferred for recycling synthetic fibers [48, 49]. Chips and pellets obtained by mechanical process from synthetic wastes are turned into fibers by melt extrusion [50].
Chemical recycling, which is another method used in the recycling of textile waste, is the depolymerization of polymers or the process of dissolving polymers [2]. Polymers are converted or broken down into their original monomeric building blocks by chemical and biological methods [51].
Monomer and polymer recycling are the two forms of chemical recycling. The polymer chain is frequently degraded during polymer recycling. As a result, the quality of the recycled fiber decreases. In monomer recycling, original quality fibers are obtained. While monomer recycling is only used for synthetic fibers, chemical recycling is applicable to many textile fibers [49]. In addition to the chemical recycling of synthetic fibers, such as polyesters, polyamides, and polyolefins, in cotton and polyester blend products, the fibers can be chemically separated and then converted into new fibers [47].
Downcycling occurs when the quality and economic value [40] of a product obtained from recycling processes is lower than that of the original product [2, 50]. The use of recycled clothing and home textile wastes in agriculture and gardening products, decoration materials [48], insulation materials, low-quality blankets, and upholstery fabrics are the examples of downcycling (Figure 3) [2, 50].
Downcycling applications in textile.
When the quality of the recycled material is the same or higher than the original product, this process is called upcycling [2, 50]. Upcycling is a process in which existing resources are used and converted into more useful products. This environmental-friendly process is an important step for a zero-waste policy [52]. Within the scope of sustainability and circular economy, the production of raw materials such as cotton fibers and yarns from textile wastes with polymer and monomer recycling is an example of upcycling [2, 50].
Open-loop recycling is defined as the use of a product’s raw material in a different production area. Secondary products obtained through open-loop recycling are generally destroyed after their lifetime [40]. The use of fibers obtained by recycling PET bottles in the textile industry (Figure 4) [40] and the usage of recycled textile fibers as insulation material in the construction industry are examples of open-loop recycling.
Open-loop recycling.
The reuse of recycled textile waste in the textile industry is called closed-loop recycling [2]. The use of mechanically recycled pre-consumer or post-consumer textile waste in garment production is an example of a closed-loop recycling (Figure 5) [40].
Closed-loop recycling.
The subject of recycling in textiles comes up with a lot of research based on the advantages created by the recycling process and with a limited number of studies based on recycling limits. In this subsection of the chapter, the limits of recycling in materials traditionally used in textiles are addressed.
Despite the approaches expressing that recycling is a process that only delays the conversion of waste to nature [53], several articles emphasized the importance of process development studies about the determination of recyclability limits [54]. Since it is impossible to apply a uniform recycling method for recycling all kinds of waste materials, different recycling techniques and their combinations have emerged over time [53]. For example, chemical recycling is raised in order to eliminate the limits in mechanical recycling [55]. As recycling can be classified as mechanical, chemical, thermal, and thermomechanical methods; each of them has numerous disadvantages in terms of the imperfections created on the recycled material. Considering these limits, alternatives purposed for the disposure of textile waste as anaerobic digestion, fermentation, composting, and acquisition of construction material [13].
An assessment can be made on the basis of fiber source for recycling limits. Based on the disadvantages, such as shortening or shredding the fibers created the fibers by each recycling cycle, it is stated in the literature that an average of 8 recycling cycles for synthetic fibers and an average of 5 cycles for natural fibers can be actualized [56, 57]. While the recyclability limits are more evident in natural fibers, the same rule is not valid for the fibers formed from thermoplastic polymers. This is the main reason why thermoplastic polymer-based textile waste is the most recycled waste [58].
To increase the quality of the recycled end product in cotton mechanical recycling, there is an obligation to use virgin fibers in addition to recycled fibers at a predetermined ratio. This can be attributed to the decrease in strength according to the recycling cycles as each cycle results in a lower degree of polymerization [59]. The upper usage limit of 30% for recycled cotton in fabrics is specified due to the shortened fibers. The amounts higher than this value causes decreases in fabric quality and performance [60]. Another study in the literature supported this result [61]. Since the fiber breakages are created in the mechanical recycling of cotton [59, 62], low-performance fabrics may be obtained not suitable for professional wear such as workwear, personal protective equipment, career wear, and uniforms [63].
Recycling is classified as primary and secondary recycling in several references. Secondary recycling can be handled as mechanical recycling and the limits mentioned above are also valid for this type of recycling. On the other hand, in primary recycling, the features of waste such as being from a single source and being pure are indisputable, while the low cycle number for each material and even the non-recyclability of some materials constitute these limits [64].
An important factor limiting the chemical recycling process of cotton is the use of harmful chemicals in the industry. While trying to minimize the damage to nature with waste disposal, the use of harmful chemicals which refers to the duality in this phenomenon creates greater harm to both nature and the consumer [59]. Moreover, the need for the separation of textile waste according to color and/or product type is inconvenient. One of the problems encountered in cotton recycling is that most of the cotton products are dyed ones and it is difficult to work with mixed-colored wastes [63]. Besides, there are studies proving that cotton fibers recycled from colored fabrics tended to possess lower quality values [65]. Thus, the demand for more environmentally friendly approaches continues [59].
Wool is a natural fiber that can only be mechanically recycled. The staple length of wool gets shorter with recycling, and it is used in blend ratios with virgin wool up to 70 recycled/30 virgin. The limited market of recycled wool is also a huge obstacle to the recycling of this fiber [63].
Nylon is a polymer with a wide variety of types that is stated as an infinitely recyclable polymer [66]. It is difficult to recycle nylon with mechanical recycling in the industry. In addition, the low number of nylon suppliers makes recycled nylon fibers more expensive [63]. Vidakis et al. studied the effects of multiple recycling cycles of PA12 on its properties. There was a decrease in mechanical properties above 5 recycling cycles. This weakening in mechanical properties is explained by the decrease in crystallinity and the beginning of degradation [67]. When the thermal recycling of polyamide 6 is evaluated, it was seen that a drying process is suggested before melting. It is revealed that the drying process prevents hydrolytic chain scission in wet materials and the intrinsic properties of PA6 polymer are remained [68].
Various studies were conducted in the literature in the last two decades for the determination of recycling cycle limits of polymers. PET which is a thermoplastic polymer widely used in the textile sector one of the polymers tested. Högg performed four recycling cycles on PET and characterized the basic polymer properties. He revealed that there was a considerable decrease in Young’s modulus according to the decrease in intrinsic viscosity [69].
The polyolefin fibers react with oxygen in remelting cycles. High temperature or UV light applied in remelting cycles result in molecular weight loss. The dissolution/reprecipitation process for the recycling of high-density polyethylene (HDPE) has been suggested to overcome this limit by Poulakis and Papaspyrides. It is remarked that both the polymer and the solvent has been recovered efficiently. According to this process applied as two recycling cycles to HDPE, no changes in molecular weight, distribution of grain sizes, crystallinity, and mechanical properties were observed [70]. The same researchers applied this technique to virgin PET in pellet form and PET in blow-molded bottle form in two cycles. It was observed that the properties of recycled PET did not change [71].
The effects of seven recycling cycles on PLA (polylactic acid) polymer which is also a polyester was evaluated by Pillin et al. They observed a notable decrease in the molecular weight of the polymer. They attributed the changes in stress and strain at break, modulus, and hardness via recycling cycles to the decrease in molecular weight [72]. Another group studied eight recycling cycles of PLA and concluded that there were no changes in the mechanical properties of the polymer due to the successive cycles [73].
PAN (polyacrylonitrile) is another polymer commonly used in the production of textile products as an alternative to wool. The most critical factors limiting the recycling of PAN are the easy accessibility of perfect virgin PAN and the harsh processing conditions. From this point of view, economic conditions come into play in the recycling of PAN. The high temperature applied during recycling is also shown as a disadvantage for acrylic, which is a polymer inclines to open-loop recycling [74].
Textile wastes consisting of blends of various fibers complicate the recycling process and sometimes even make it impossible. These fibers need to be separated, which should be done by expert workers to avoid problems with the recycled final product. In addition, when it is impossible to recycle these wastes, they reach their end-of-life by utilization in energy recycling [75].
From a different point of view, there are basically two main factors limiting the recycling of textile fibers. The first one is the technological limits of recycled fibers and their inability to be used within virgin fiber, yarn, or fabric production methods. The second is that the expected product quality value cannot be reached by using these recycled fibers [76].
There are two types of sustainable fashion drivers in a sustainable fashion as production and consumption drivers. Material, human and intellectual resources form the production drivers and purchasing decisions, usage, and post usage form the latter. While technical limits are considered in the first derivatives, unawareness of consumption causes a considerable increase in waste [77]. The fact that recycled materials are generally suitable for downcycling emphasizes an important point that should be evaluated economically. Another economic point is the low consumer demand for recycled products. The reason behind the low market demand is the use of dangerous chemicals in recycled products. In addition, waste sorting is a big problem and if it is not done properly, it negatively affects the recycling process from the beginning. Finally, the relevant standards are still in their infancy. All of these may be listed as examples of the limits of recycling [78].
Cotton and polyester are the most recycled fibers as referred before. Cotton is the most used type of natural fiber in the textile and clothing industry global consumption is reported as 26.16 million tons and the production rate is 26.43 million tons by the year 2021. When we evaluate cotton cultivation in terms of environmental aspects, it requires a large quantity usage of land occupation, water, and also pesticides. Due to pesticides, it pollutes clean water resources. In the textile production process, cotton dyeing needs a high amount of energy consumption, water, steam, and chemicals, such as bleaching agents, soap, softeners, and salts for obtaining the desired color [55, 79, 80]. Polyester is a non-biodegradable fiber in the environment. Its production process is very similar to polyamide. But polyester is extensively recycled especially as plastic bottles made of polyethylene terephthalate to reduce the landfills. Polyamide is used especially in carpets as referred before. But its recycling process is difficult because of the used dyes and chemicals added to its polymer solution [10].
Besides these types of common fibers, there have also been come out brands with the increasing recycling trend. Renewcell® technology is the upcoming brand from Sweden since 2017. For this process, used garments and textile production waste with high cellulosic content such as viscose, lyocell, modal, acetate, and other types of regenerated fibers (also called man-made cellulosic fibers) are used. Their accessories, such as buttons, zips are removed from the textile material, then it is turned into a slurry. Contaminants and non-cellulosic contents are sorted out from this slurry. This blend, brand named as Circulose® that is consisted of dissolved pulp from 100% recycled textiles dried and packaged as bales for being involved in the textile production process [81, 82].
Repreve® is known as the r-PET staple and filament yarns which are made from post-consumer water bottles and pre-consumer waste, and their fibers are used in many types of industrial product categories. Accessories, apparel, automotive, bedding, flooring, footwear, furnishings, medical accessories, military, outdoor, socks, and hosiery are some of them. As they stated they eliminated the processes; crude oil wellhead, crude oil refinery, Naptha, Xylenes, Paraxylene, TA (Terephthalic Acid) & MEG (Mono Ethylene Glycol). They have chip production (polymerization), extrusion, and texturing for Repreve® polyester filament yarns and feed stock preparation (polymerization), extrusion, and staple processing for Repreve® staple polyester fibers [83, 84]. Moreover, there is a recycled Nylon brand that is Repreve® Nylon 6 fibers. In production, they have also eliminated the processes; crude oil wellhead, crude oil refinery, benzene, cyclohexane, HMD (Hexamethylenediamine), adipic acid, and nylon salt. They have only chip production (polymerization), extrusion, and texturing processes [85].
Trevira® Sinfineco is the brand used for textiles that contain sustainable Trevira® products. They worked together with Thailand-based parent company Indorama whose manufactures recycled chips from PET bottles. They have certificates for recycled chips, fibers, and filaments from GRS (Global Recycled Standard) and RCS-NL (Recycled Claim Standard). Their products are mainly used in the automotive and apparel sectors. Trevira® Sinfineco PLA fibers and filaments are produced from plant sugars (sugar beet, sugar cane, and maize). So, they are recyclable and 100% biodegradable (industrially compostable) fiber materials. The plant sugar is subjected to the fermentation process and it is transformed into lactic acid. Besides their advantageous properties such as UV stability, fastness to light resistance, good wicking properties, it has less environmental impacts. 70% less CO2 is emitted and 42% less energy is consumed in the raw material production process. They have ISEGA certification for PLA fiber types used in hot water filtration applications (tea and coffee filters) and packaging materials contacting with food [86].
rPET companies supply post-consumer materials in different ways. One of these interesting materials is Bionic®, which collects its source from the coastline of the oceans and waterways to produce rPET PES. Besides environmental benefits, they also get community support both for collecting and cleaning, building up waste management systems including sorting by material and color, compacting, grinding, and warehousing. Besides, they teach the system wherever their collecting point is. Then, they send them for pelletizing. Finally, the recycling process goes in the traditional way. They have three kinds of yarns; FLX® from marine plastics, DPX® from recycled plastics, and natural or synthetic fibers for gaining softer texture, HLX® from 3 layers; core, recovered with rPET and natural fibers in the outer sheath [87].
As technological sustainability process Lenzing™ introduced Refibra™ Technology which is called as reborn Tencel® Fiber Technology and they addressed that it is one of the circular economy solutions. It is a closed-loop technology in which cotton scraps and wood are used for pulping processes. For cotton scraps, they use a special and patented method for transforming colored cotton rags into the lyocell grade pulp by dye removal process and degree of polymerization adjustment. Recycling and upgrading of cotton scraps to new virgin lyocell fibers are free from water and solvent usage. It is certified according to Recycled Claim Standard (RCS) and Global Recycle Standard (GRS) [88, 89]. Lenzing™ EcoVero™ fibers are sustainable viscose fibers that are produced by the use of certified and controlled sustainable wood sources, ecological production process, and supply chain transparency as stated. It has 50% lower emissions and water impact than generic viscose. Lenzing™ EcoVero™ fibers are certified with the EU Ecolabel. It means that the production method has a lower impact on the environment compared with other products in the market [90]. Livaeco by Birla Cellulose™ is eco-enhanced viscose manufactured using a closed-loop process. As they declared, they make a series of changes in the process to be more environmental-friendly. They used a molecular tracer so that they can follow the product from fiber stage to garment form and they can verify the product easily. They emphasize that their source is from certified sustainable forests, they consumed lower water compared with other types of natural fibers, lower greenhouse gas emissions and biodegrades in 6 weeks. They stated that cost of Livaeco™ is 4–5% higher than the conventional type of their fibers produced [91]. Livaeco™ has the FSC® C135325 certificate that refers wood is sourced from the forests following the principles of Sustainable Forestry Management provided environmental, social and economic benefits. They also have various certificates, tools, and documents about sustainability for different processes. They have Forest Stewardship Council (FSC®) certificate for obtaining wood, pulping, fiber production processes regularly; Rainforest Alliance certificate in pulping process; Higg Index, Thinkstep in fiber production step; Tracer tool (fiber, yarn, fabric, garment), OEKO-TEX 100, Sustainable Textile Solution for their Livaeco™ viscose fiber, BLOCKCHAIN for Fiber 2 Retail Process. Besides these certificates, they achieved Dark Green Shirt, Ranking in Canopy’s Hot Button Report in 2020 [92]. Kelheim Fibers have also CELLIANT Viscose which is introduced as the first in-fiber sustainable viscose infrared (IR) solution that is an alternative to synthetic fibers. They use natural minerals and embedded them into plant-based fibers. It is certified by FSC® or PEFC™ about raw material used. They are also awarded with a dark green/green shirt in Canopy’s 2021 Hot Button Report, which is a sustainability indicator for viscose fiber producers [93].
When polyamide is considered, one of the brand marks is Econyl® by Aquafil S.P.A. It has two types of nylon textile filament yarns; ECONYL® FDY yarns on beam and ECONYL® texturized yarns on cones that are both types of yarns produced via using 100% recycled post-consumer and post-industrial recycled content. They use fishnets, carpets, oligomers (generated by polymer industries), and other types of PA6 materials as wasted content. In ECONYL® plant operation processes has two steps as depolymerization step (where the specific mix of waste is transformed back into secondary raw material-caprolactam) and the purification step of caprolactam [94].
Fulgar is another company that has various types of sustainable fibers with the brand names; Q-NOVA®, Q-CYCLE®, EVO®, AMNI SOUL ECO®. Q-NOVA® PA 6.6. yarn has an eco-friendly process called as MCS (Spinning Continuous Melting). MCS is a mechanical regeneration system that does not involve using chemical materials which would lessen the sustainability of the end product. More than half of it is produced by pre-consumption waste. This waste is remolded using a mechanical regeneration process, then after, it is turned into a form of a polymer. Its prominent features are stated as lightness, breathability, having bright colors. It has certificates as The Global Recycled Standard (GRS), EU ECOLABEL, Higg index [95]. Q-CYCLE® yarn is their new eco-sustainable PA 6.6 yarn produced with their interaction with BASF’s ChemCycling™ recycling project. They use post-consumer recycled contents like plastic wastes (used tires) that is not possible to be mechanically recycled. Its certifications are under the evaluation process [96]. EVO® is the other trademark of Fulgar that is a bio-based origin polyamide that its polymerization is partially or completely sourced from castor oil (from castor seeds) [97]. AMNI SOUL ECO® has enhanced PA 6.6 formula, developed by Rhodia-Solvay group, which enables garments to be a biodegradable feature when left in landfills [98].
Considering the polyurethane known as elastane in the market, COREVA™ can be mentioned. It is a plant-based yarn obtained from natural rubber for replacing synthetic, petrol-based yarns and is patented by Candiani Denim. Organic cotton is wrapped around a natural rubber core, so they produce plastic-free yarn by replacing conventional synthetic and petrol-based elastomers. As they declared, Candiani has created an innovative, biodegradable stretch denim fabric but still, it has the features such as elasticity, physical qualities, and durability that are important factors for producing jeans [99].
Environmental issues are trending topic and their importance increase gradually. There are some international treaties to regulate the behavior of the countries to reduce greenhouse gases and protect the ozone layer. Kyoto Protocol and Montreal Protocol are exemplary treaties for the sign of industrialized countries, describing the precautions that they should take [55]. The carbon footprint is the amount of the greenhouse gases released from fossil fuels used for electricity, heating, and transportation purposes. Textile and clothing sectors are the leading sectors that have high carbon footprint generation and greenhouse gases emissions [37]. Energy is the other critical case for the textile industry. The consumed energy according to textile processes can be given as 34% for spinning, 23% for weaving, 38% for chemical process, and 5% for various purposes [100].
All the efforts for sustainability including getting certifications, discovering new sustainable processes, producing new sustainable fibers, getting textile ecolabels, United Nations’ The Sustainable Development Goals (UNSDGs) are playing a major role. United Nations’ 17 goals can be listed regularly as; no poverty, zero hunger, good health and well-being, quality education, gender equality, clean water and sanitation, affordable and clean energy, decent work and economic growth, industry, innovation and infrastructure, reduced inequalities, sustainable cities and communities, responsible consumption and production, climate action, life below water, life on land, peace, justice and strong institutions, partnerships for the goals. There are various studies about the relationship between UNSDGs and fashion brands, certifications, and new type of sustainable fibers [101, 102].
In the past, products are disposed of after the end-of-life or disuse of the products. But today, solutions and precautions for sustaining the environmental cycle are steadily taken. ISO 14040:2006 (Environmental Management-Life Cycle Assessment-Principles and Framework) is the valid standard to evaluate the sustainability of the product cycle [103, 104]. Life cycle assessment (LCA) is a methodology that is determined by the ISO 14040 and ISO 14044 [80]. It merges the environmental impacts of the studied product or service through the value chain [104]. It is possible to determine the potential environmental benefits of various systems of textile reuse and recycling processes within the methods of LCA [50]. LCA does not contain design and development stages because it is considered that design of the product has not environmental impact. But the design of the product can be affected by the other life cycle stages such as emissions to air, water, and land at each stage of manufacture, use, and disposal of the product [105].
There are various textile sustainability standards and certifications. EU Ecolabel supports Europe strategy for zero pollution and circular economy targets by minimizing products’ harmful impact on the environment. Products labeled with EU Ecolabel make a reduction in water consumption, make less pollution in the air, restrict the use of hazardous chemicals, and minimize the waste [106, 107]. Better Cotton Initiative (BCI) is claimed itself as the world’s leading sustainability initiative for cotton. Their mission is to help cotton communities survive and thrive while protecting and restoring the environment. They have selected five impact areas consisted of climate change mitigation, soil health, pesticide use, smallholder livelihoods, and women’s empowerment [108, 109]. In BCI’s Better Cotton Assurance Model, they have a roadmap for Better Cotton Farmers and farmer groups to move from baseline performance to meeting the key indicators of the Better Cotton Principles and Criteria and ultimately achieving long-term improvement goals. The model has four overarching goals. The first one is giving license to sell their cotton as Better Cotton if they can meet the standards and criteria to license for selling their cotton as Better Cotton. The second one is improvement in the framework for making sustainable practices. The third one is the development in the improvement of connection between producers and partners. The last one is measuring the sustainability performance of the farmers [109, 110].
Besides OEKO-TEX Standard 100, OEKO-TEX has series of Sustainability Standards comprising of Oeko-Tex Sustainable Textile Production (STeP), Made in Green by OEKO-TEX®, ECO PASSPORT by OEKO-TEX®, OEKO-TEX® DETOX TO ZERO. ECO PASSPORT by OEKO-TEX® is used for chemical products (textile and leather chemicals, colorants, and auxiliary agents) that are used in the textile, leather, and clothing industry. Oeko-Tex Sustainable Textile & Leather Production (STeP) is the standard for modules, such as chemical management, environmental performance, environmental management, social responsibility, quality management, health, and safety in production chain. To get Made in Green by OEKO-TEX® certificate, some criteria (some OEKO-TEX® certificates) should be taken due to finished products that consumers can buy at retailers or semi-finished products sold to companies within the supply chain. This certificate means that textile or leather products’ materials are tested for harmful substances, produced as environmentally, safe, and socially responsible workplaces are supplied [111].
GOTS is also one of the textile processing standard for organic fibers, also both for ecological and social criteria. It comprises the whole textile supply chain starting with harvesting of the raw materials till packing and labeling. It is important to use dyes and chemicals that have a low impact on environment and even it has water norms in production, besides this, it also considers fiber requirements, environmental criteria, social criteria, and traceability. GOTS have various production criteria limits. For example, additional fiber limits for natural fibers both for vegetable and animal fibers (linen, hemp, wool, silk, mohair, etc.) is up to 30%; for sustainable regenerated fibers is (Lyocell® & protein based fibers: from organic, FSC(Forest Stewardship Council™)/Programme for the Endorsement of Forest Certification (PEFC) certified recycled raw materials is up to 30%; for Recycled Claim Standard (RCS from Textile Exchange), Global Recycle Standard (GRS from Textile Exchange), Recycled Content Standard (from SCS) certified synthetic fibers (polyester, polyamide, polypropylene, and polyurethane) is up to 30%. There are also restricted fibers in blends like conventional cotton, virgin polyester, conventional angora hair, acrylic, asbestos, and carbon, silver. They have also an obligation for using virgin synthetic and regenerated fibers like viscose, modal, polyamide, elastane, and polypropylene in fiber blends as the maximum ratio is 10%. They have given some more examples like it is permitted to use 70% organic cotton, 30% lyocell from the organic plantation; but, it is not permitted to use 70% organic cotton, 30% lyocell from conventional wood [112, 113].
BlueSign® is one of the sustainability standards that offer a system with solutions for industry and brands for increasing their sustainability performance. They have various criteria such as chemical products for end-consumer use, surface treatment of metals, and plastics/non-textile substrates, fiber manufacturing, textile manufacturers, down and feathers processing, flame retardants, nanoscale materials/structures [114]. They have also a restricted substances list (RSL). In fiber manufacturing for production sites, it is stated that 99% solvent recovery (lyocell, acetate, etc.) rate should be aimed at dry spinning or wet spinning. They encourage their partners to develop fibers that meet their requirements for supporting a circular economy and to give ahead manufacturers to produce and use of recyclable and recycled fibers for circular textile production. It is obligatory for fiber manufacturing sites to pass the chemical assessment that they use Alkylphenol ethoxylates (APEO), free agents, in all preparation and sizing agents used. It is possible to give more examples for other type of fibers. In polyester fiber production, they have limited values of volatile organic compounds (VOCs) not only for year, but also limited emission factors per PET chips (one kg) and filament fiber (one kg). It is also important to have wood policy for cellulosic regenerated fibers, such as viscose, lyocell, and acetate. In production, 25% of sourced pulp fibers/pulp should be used from the wood certified by independent third-party certification with the label of the Forest Stewardship Council (FSC®). Besides this, independent third-party risk assessments, audits and on-site visits should be taken with positive results by audits (preferably a CanopyStyle Audit with at least bronze status) or independent third-party certification of sustainable forest management programs (e.g. Rainforest Alliance) [115].
The Higg Index is used as a tool for the standardization of sustainability measurement. It is comprised of five tools; the Higg Facility Environmental Module (FEM), Higg Facility Social & Labor Module (FSLM), Higg Brand & Retail Module (BRM), Higg Materials Sustainability Index (MSI), and Higg Product Module (PM). They evaluate the social and environmental performance of the value chain together with the environmental impacts of products. It gives an opportunity to consumers using the Higg Index to inform their individual sustainability strategies in crosswise topics, such as water use, carbon emissions, labor conditions, consumer goods brands, retailers, manufacturers, and governments [116].
The Recycled Claim Standard (RCS) and Global Recycled Standard (GRS) are stated as international and voluntary standards. They set requirements for third-party certification about recycled input and chain of custody. Their aim is to raise the usage ratios of recycled materials. The GRS contains also social and environmental processing requirements and chemical restrictions as additional criteria compared with RCS [117]. For RCS, labeling can be applied to all products containing at least 5% recycled material for textiles. It also enhances the traceability of recycled raw materials, transparent communication, clear labeling, and stakeholder engagement [118]. The GRS label assured that there are high percentages of recycled contents in products, the harmful impact is reduced both for people and the environment, traceability and stakeholder engagement are supplied [119].
Cradle to Cradle Certified® is another global standardization for safe, circular, and responsibly made products. It evaluates the safety, circularity, and responsibility of materials and products in five categories of sustainability performance such as material health, product circularity, clean air & climate protection, water and soil stewardship, and social fairness [120].
Forest Stewardship Council® (FSC) forest management certification endorsed that the management of forests is made by taking care of biological diversity and benefits the lives of local people and workers. There are 10 principles for forest operation for receiving FSC forest management certification. These principles include a broad range of issues, from maintaining high conservation values to community relations and workers’ rights, as well as monitoring the environmental and social impacts of forest management [121].
There are also some other sustainability standards like Cotton Made in Africa, Organic Content Standard (OCS), Soil Association Organic Standard, Responsible Down Standard (RDS), Responsible Wool Standard (RWS) [122, 123, 124, 125, 126].
Recycling has shown continuity since ancient times as a technique that people comprehended its importance towards the purpose of living with scarce resources and applied it even if not in a scientific sense. Recycling has reached scientific meaning throughout history, and then the subject has evolved towards sustainability. Textile recycling has a great place within the scope of this subject, which has been on the agenda for a long time and will also continue to be, with the advantages it creates in both environmental and economic terms. Human beings fall into textile products from the moment that they are born, they need these textile products throughout their lives (even when they die in some cultures—due to the rituals of burial with various fabrics). The indispensability of textile has always kept it at the forefront in various areas for years.
Engineering-based scientific research always aims to increase the quality of life and make the world habitable for a longer period. In this context, these purposes are embodied as the main objectives in the studies on recycling and sustainability. As the decrease in natural resources, population growth, changes in fashion causing excessive consumption of resources, and technological developments continue, the interest in recycling and sustainability will increase acceleratingly. As emphasized herein, recycling in textiles, recycling limits in textile wastes, and the search for sustainable new textile resources will continue to be hot topics of the area. In conclusion, approaches on more effective utilization of traditional fibers, the discovery, commercialization, and popularization of new sustainable fibers, and the representation of new models for the management of textile waste will be the focus of researchers for years.
The authors declare no conflict of interest.
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MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"46296",doi:"10.5772/57398",title:"Physiological Role of Amyloid Beta in Neural Cells: The Cellular Trophic Activity",slug:"physiological-role-of-amyloid-beta-in-neural-cells-the-cellular-trophic-activity",totalDownloads:5952,totalCrossrefCites:19,totalDimensionsCites:32,abstract:null,book:{id:"3846",slug:"neurochemistry",title:"Neurochemistry",fullTitle:"Neurochemistry"},signatures:"M. del C. Cárdenas-Aguayo, M. del C. Silva-Lucero, M. Cortes-Ortiz,\nB. Jiménez-Ramos, L. 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Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:193348,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. 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Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3565,totalCrossrefCites:4,totalDimensionsCites:10,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3622,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1370,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82953",title:"Early Visual Areas are Activated during Object Recognition in Emerging Images",slug:"early-visual-areas-are-activated-during-object-recognition-in-emerging-images",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105756",abstract:"Human observers can reliably segment visual input and recognise objects. However, the underlying processes happen so quickly that they normally cannot be captured with fMRI. We used Emerging Images (EI), which contains a hidden object and extends the process of recognition, to investigate the involvement of early visual areas (V1, V2 and V3) and lateral occipital complex (LOC) in object recognition. The early visual areas were located with a retinotopy scan and the LOC with a localiser. The participants (N=8) then viewed an EI, followed by the hidden object’s silhouette (disambiguation), and then, the EI was repeated. BOLD responses before and after disambiguation were compared. The retinotopy parameters were used to back-project the BOLD response onto the visual field, creating spatially detailed maps of the activity change. V1 and V2 (but not V3) showed stronger response after disambiguation, while there was no difference in the LOC. The back-projections revealed no distinct pattern or changes in activity on object location, indicating that the activity in V1 and V2 is not specific for voxels corresponding to the object location. We found no difference before and after disambiguation in the LOC, which may be repetition suppression counteracting the effect of recognition.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Marleen Bakker, Hinke N. Halbertsma, Nicolás Gravel, Remco Renken, Frans W. Cornelissen and Barbara Nordhjem"},{id:"82931",title:"Neuroinflammation in Traumatic Brain Injury",slug:"neuroinflammation-in-traumatic-brain-injury",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.105178",abstract:"Neuroinflammation following traumatic brain injury (TBI) is an important cause of secondary brain injury that perpetuates the duration and scope of disease after initial impact. This chapter discusses the pathophysiology of acute and chronic neuroinflammation, providing insight into factors that influence the acute clinical course and later functional outcomes. Secondary injury due to neuroinflammation is described by mechanisms of action such as ischemia, neuroexcitotoxicity, oxidative stress, and glymphatic and lymphatic dysfunction. Neurodegenerative sequelae of inflammation, including chronic traumatic encephalopathy, which are important to understand for clinical practice, are detailed by disease type. Prominent research topics of TBI animal models and biomarkers of traumatic neuroinflammation are outlined to provide insight into the advances in TBI research. We then discuss current clinical treatments in TBI and their implications in preventing inflammation. To complete the chapter, recent research models, novel biomarkers, and future research directions aimed at mitigating TBI will be described and will highlight novel therapeutic targets. Understanding the pathophysiology and contributors of neuroinflammation after TBI will aid in future development of prophylaxis strategies, as well as more tailored management and treatment algorithms. This topic chapter is important to both clinicians and basic and translational scientists, with the goal of improving patient outcomes in this common disease.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Grace Y. Kuo, Fawaz Philip Tarzi, Stan Louie and Roy A. Poblete"},{id:"82876",title:"Oxygen Tissue Levels as an Effectively Modifiable Factor in Alzheimer’s Disease Improvement",slug:"oxygen-tissue-levels-as-an-effectively-modifiable-factor-in-alzheimer-s-disease-improvement",totalDownloads:9,totalDimensionsCites:0,doi:"10.5772/intechopen.106331",abstract:"Despite the advance in biochemistry, there are two substantial errors that have remained for at least two centuries. One is that oxygen from the atmosphere passes through the lungs and reaches the bloodstream, which distributes it throughout the body. Another major mistake is the belief that such oxygen is used by the cell to obtain energy, by combining it with glucose. Since the late nineteenth century, it began to be published that the gas exchange in the lungs cannot be explained by diffusion. Even Christian Bohr suggested that it looked like a cellular secretion. But despite experimental evidence to the contrary and based only on theoretical models, the dogma that our body takes the oxygen it contains inside from the air around it has been perpetuated to this day. The oxygen levels contained in the human body are high, close to 99%, and the atmosphere only contains between 19 and 21%. The hypothesis that there is a supposed oxygen concentrating mechanism has not been experimentally proven to date, after almost two centuries. The mistaken belief, even among neurologists, that our body takes oxygen from the atmosphere is widespread, even though there is no experimental basis to support it, just theoretical models. Our finding that the human body can take oxygen from the water it contains, not from the air around it, like plants, comes to mark a before and after in biology in general, and the CNS is no exception. Therefore, establishing the true origin of the oxygen present within our body and brain will allow us to better understand the physio pathogenesis of neurodegenerative diseases.",book:{id:"11637",title:"Neuropsychology of Dementia",coverURL:"https://cdn.intechopen.com/books/images_new/11637.jpg"},signatures:"Arturo Solís Herrera"},{id:"82859",title:"Impact of Hypoxia on Astrocyte Induced Pathogenesis",slug:"impact-of-hypoxia-on-astrocyte-induced-pathogenesis",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106263",abstract:"Astrocytes are the most abundant cells of the central nervous system. These cells are of diverse types based on their function and structure. Astrocyte activation is linked mainly with microbial infections, but long-term activation can lead to neurological impairment. Astrocytes play a significant role in neuro-inflammation by activating pro-inflammatory pathways. Activation of interleukins and cytokines causes neuroinflammation resulting in many neurodegenerative disorders such as stroke, growth of tumours, and Alzheimer’s. Inflammation of the brain hinders neural circulation and compromises blood flow by affecting the blood–brain barrier. So the oxygen concentration is lowered, causing brain hypoxia. Hypoxia leads to the activation of nuclear factor kappa B (NFkB) and hypoxia-inducible factors (HIF), which aggravates the inflammatory state of the brain. Hypoxia evoked changes in the blood–brain barrier, further complicating astrocyte-induced pathogenesis.",book:{id:"10744",title:"Astrocytes in Brain Communication and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/10744.jpg"},signatures:"Farwa Munir, Nida Islam, Muhammad Hassan Nasir, Zainab Anis, Shahar Bano, Shahzaib Naeem, Atif Amin Baig and Zaineb Sohail"},{id:"82839",title:"Neurophysiology of Emotions",slug:"neurophysiology-of-emotions",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.106043",abstract:"Emotions are automatic and primary patterns of purposeful cognitive-behavioral organizations. They have three main functions: coordination, signaling, and information. First, emotions coordinate organs and tissues, thus predisposing the body to peculiar responses. Scholars have not reached a consensus on the plausibility of emotion-specific response patterns yet. Despite the limitations, data support the hypothesis of specific response patterns for distinct subtypes of emotions. Second, emotional episodes signal the current state of the individual. Humans display their state with verbal behaviors, nonverbal actions (e.g., facial movements), and neurovegetative signals. Third, emotions inform the brain for interpretative and evaluative purposes. Emotional experiences include mental representations of arousal, relations, and situations. Every emotional episode begins with exposure to stimuli with distinctive features (i.e., elicitor). These inputs can arise from learning, expressions, empathy, and be inherited, or rely on limited aspects of the environment (i.e., sign stimuli). The existence of the latter ones in humans is unclear; however, emotions influence several processes, such as perception, attention, learning, memory, decision-making, attitudes, and mental schemes. Overall, the literature suggests the nonlinearity of the emotional process. Each section outlines the neurophysiological basis of elements of emotion.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Maurizio Oggiano"},{id:"82172",title:"Neuroimaging in Common Neurological Diseases Treated by Anticoagulants",slug:"neuroimaging-in-common-neurological-diseases-treated-by-anticoagulants",totalDownloads:7,totalDimensionsCites:0,doi:"10.5772/intechopen.105128",abstract:"Stroke imaging/Cerebral Venous sinus thrombosis/Arterial dissecting disease in Head and Neck regions/Neurocomplication of anticoagulation therapy. Nowsday, anticoagulant drugs are common drugs used in daily practice for patients in neurology clinic. Anticoagulant treatment used for treated symptomatic patients as well as for prophylaxis therapy in asymptomatic patients. The purpose of this chapter based on the review of essential neuroimaging in the most common neurological conditions that benefit from treatment with anticoagulant drugs such as ischemic stroke, cerebral venous sinus thrombosis, and arterial dissecting disease of head and neck arteries and will be enclosed with neuroimaging in case of neurocomplication by anticoagulant therapy.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Pipat Chiewvit"}],onlineFirstChaptersTotal:12},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261",scope:"Modern physiology requires a comprehensive understanding of the integration of tissues and organs throughout the mammalian body, including the cooperation between structure and function at the cellular and molecular levels governed by gene and protein expression. While a daunting task, learning is facilitated by identifying common and effective signaling pathways mediated by a variety of factors employed by nature to preserve and sustain homeostatic life. \r\nAs a leading example, the cellular interaction between intracellular concentration of Ca+2 increases, and changes in plasma membrane potential is integral for coordinating blood flow, governing the exocytosis of neurotransmitters, and modulating gene expression and cell effector secretory functions. Furthermore, in this manner, understanding the systemic interaction between the cardiovascular and nervous systems has become more important than ever as human populations' life prolongation, aging and mechanisms of cellular oxidative signaling are utilised for sustaining life. \r\nAltogether, physiological research enables our identification of distinct and precise points of transition from health to the development of multimorbidity throughout the inevitable aging disorders (e.g., diabetes, hypertension, chronic kidney disease, heart failure, peptic ulcer, inflammatory bowel disease, age-related macular degeneration, cancer). With consideration of all organ systems (e.g., brain, heart, lung, gut, skeletal and smooth muscle, liver, pancreas, kidney, eye) and the interactions thereof, this Physiology Series will address the goals of resolving (1) Aging physiology and chronic disease progression (2) Examination of key cellular pathways as they relate to calcium, oxidative stress, and electrical signaling, and (3) how changes in plasma membrane produced by lipid peroxidation products can affect aging physiology, covering new research in the area of cell, human, plant and animal physiology.",coverUrl:"https://cdn.intechopen.com/series/covers/10.jpg",latestPublicationDate:"July 20th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:14,editor:{id:"35854",title:"Prof.",name:"Tomasz",middleName:null,surname:"Brzozowski",slug:"tomasz-brzozowski",fullName:"Tomasz Brzozowski",profilePictureURL:"https://mts.intechopen.com/storage/users/35854/images/system/35854.jpg",biography:"Prof. Dr. Thomas Brzozowski works as a professor of Human Physiology and is currently Chairman at the Department of Physiology and is V-Dean of the Medical Faculty at Jagiellonian University Medical College, Cracow, Poland. His primary area of interest is physiology and pathophysiology of the gastrointestinal (GI) tract, with the major focus on the mechanism of GI mucosal defense, protection, and ulcer healing. He was a postdoctoral NIH fellow at the University of California and the Gastroenterology VA Medical Center, Irvine, Long Beach, CA, USA, and at the Gastroenterology Clinics Erlangen-Nuremberg and Munster in Germany. He has published 290 original articles in some of the most prestigious scientific journals and seven book chapters on the pathophysiology of the GI tract, gastroprotection, ulcer healing, drug therapy of peptic ulcers, hormonal regulation of the gut, and inflammatory bowel disease.",institutionString:null,institution:{name:"Jagiellonian University",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"10",title:"Animal Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/10.jpg",editor:{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"306970",title:"Mr.",name:"Amin",middleName:null,surname:"Tamadon",slug:"amin-tamadon",fullName:"Amin Tamadon",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002oHR5wQAG/Profile_Picture_1623910304139",institutionString:null,institution:{name:"Bushehr University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",institutionURL:null,country:{name:"Spain"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",institutionString:null,institution:{name:"Miguel Hernandez University",institutionURL:null,country:{name:"Spain"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",institutionString:null,institution:{name:"Alexandria University",institutionURL:null,country:{name:"Egypt"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",institutionString:"Kafkas University",institution:{name:"Kafkas University",institutionURL:null,country:{name:"Turkey"}}}]},{id:"11",title:"Cell Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/11.jpg",editor:{id:"133493",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",profilePictureURL:"https://mts.intechopen.com/storage/users/133493/images/3091_n.jpg",biography:"Prof. Dr. Angel Catalá \r\nShort Biography Angel Catalá was born in Rodeo (San Juan, Argentina). He studied \r\nchemistry at the Universidad Nacional de La Plata, Argentina, where received aPh.D. degree in chemistry (Biological Branch) in 1965. From\r\n1964 to 1974, he worked as Assistant in Biochemistry at the School of MedicineUniversidad Nacional de La Plata, Argentina. From 1974 to 1976, he was a Fellowof the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor oBiochemistry at the Universidad Nacional de La Plata, Argentina. He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"186048",title:"Prof.",name:"Ines",middleName:null,surname:"Drenjančević",slug:"ines-drenjancevic",fullName:"Ines Drenjančević",profilePictureURL:"https://mts.intechopen.com/storage/users/186048/images/5818_n.jpg",institutionString:null,institution:{name:"University of Osijek",institutionURL:null,country:{name:"Croatia"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"79615",title:"Dr.",name:"Robson",middleName:null,surname:"Faria",slug:"robson-faria",fullName:"Robson Faria",profilePictureURL:"https://mts.intechopen.com/storage/users/79615/images/system/79615.png",institutionString:null,institution:{name:"Oswaldo Cruz Foundation",institutionURL:null,country:{name:"Brazil"}}},{id:"84459",title:"Prof.",name:"Valerie",middleName:null,surname:"Chappe",slug:"valerie-chappe",fullName:"Valerie Chappe",profilePictureURL:"https://mts.intechopen.com/storage/users/84459/images/system/84459.jpg",institutionString:null,institution:{name:"Dalhousie University",institutionURL:null,country:{name:"Canada"}}}]},{id:"12",title:"Human Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. 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:{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. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. 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We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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