TEG Parameters
\r\n\tEqually important are the consequences deriving from the extraordinary nature of the present times. The COVID-19 pandemic and the restrictive measures to contain the infection (lockdown and "physical distancing" in primis) have revolutionized the lives, and a distortion/modification of habits, rhythms, arrangements will continue to be necessary.
\r\n\tGovernments have implemented a series of actions to mitigate the spread of infections and alleviate the consequent pressure on the hospital system. On the other hand, the Covid-19 pandemic has caused a series of other cascading effects that will probably be much more difficult to mitigate and which expose to complex consequences. The past two years have brought many challenges, particularly for healthcare professionals, students, family members of COVID-19 patients, people with mental disorders, the frail, the elderly, and more generally those in disadvantaged socio-economic conditions, and workers whose livelihoods have been threatened. Indeed, the substantial economic impact of the pandemic may hinder progress towards economic growth as well as progress towards social inclusion and mental well-being.
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\r\n\tAlthough in all countries the knowledge on the impact of the pandemic on mental health is still limited and mostly derived from experiences only partially comparable to the current epidemic, such as those referring to the SARS or Ebola epidemics, it is likely that the demand for intervention it will increase significantly in the coming months and years. The extraordinary growth of scientific research in the field of neuroscience now offers the possibility of a new perspective on the relationship between mind and brain and generates new scenarios in understanding the long wave of the pandemic and in the prospects for treatment. Moreover, the pandemic also has led to opportunities to implement remote monitoring and management interventions.
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\r\n\tOverall this volume will address the complex relationship existing between COVID-19, mental health, acquired knowledge, and possible interventions taking a highly multidisciplinary approach; from physiological and psychobiological mechanisms, and neuromodulation through medical treatment, psychosocial interventions, and self-management.
The liver is the largest gland in the body. The average human liver weighs approximately 1.5-1.7 kg, and holds a blood volume of approximately 500 ml. It receives approximately 25% of the cardiac output, of which 75% is supplied by the portal vein and the other 25% by the hepatic artery. Its venous drainage is to the inferior vena cava via the hepatic veins. The hepatic ductal system produces the bile which is then stored in the gall bladder.
\nThe liver synthesizes most proteins, with the exception of gamma globulins and factor VIII. It is also responsible for protein degradation, glucose homeostasis, fatty acid β-oxidation, bilirubin production and excretion. Hepatocytes are embryologically less differentiated; hence the liver is the only organ capable of regeneration after surgical resection or trauma.
\nHepatic blood flow is predominantly dependent upon systemic blood flow and pressure-based on pressure flow regulation and hepatic arterial buffer response. There is also central nervous system control of the hepatic blood flow via the thoracic sympathetic fibers. Sympathetic stimulation may cause the blood volume which is present in the liver to be expelled into the circulation, thus providing additional circulatory volume if needed.
\nHepatic blood flow is reduced by all anesthetic agents and techniques via reductions in hepatic blood flow and hepatic oxygen uptake. The volatile agents, desflurane and sevoflurane have the least significant effect on total hepatic blood flow. Other perioperative causes of a reduction of hepatic blood flow include mechanical ventilation, hypercarbia, positive end-expiratory pressure, hypotension, hemorrhage, hypoxemia and surgery. A significant decrease in hepatic blood flow can result in parenchymal centrilobular necrosis when extreme resulting in further worsening of perioperative liver dysfunction.
\nIn liver disease, anesthetic drug distribution, metabolism and elimination may be altered. Uptake and onset of anesthetic drug action is usually unaffected. Hepatic clearance of an agent is dependent upon volume of distribution, functional hepatic blood flow, hepatic extraction ratio and hepatic microsomal activity. As a result, opioids may accumulate and the pharmacological actions of drugs such as benzodiazepines maybe prolonged. In extreme situations, actions of non-depolarizing muscle relaxants such as vecuronium and rocuronium maybe also be prolonged.
\nThe liver plays a critical role in coagulation as it is the principal site of synthesis for the majority of clotting factors: II, V, VII, IX, X, XI, and XII. All coagulation factors except for VIII, which is mainly produced by the endothelium, are markedly reduced in patients with liver disease. Patients with chronic liver disease may also develop thrombocytopenia secondary to splenomegaly caused by prolonged portal hypertension. Additionally, reduced levels of thrombopoietin, which regulates platelet production in the liver, may also further contribute to platelet counts in more advanced disease. Also, antithrombin-III (AT-III) levels fall due to reduced synthesis and/or increased consumption due to fibrinolysis. All of the proteins involved in fibrinolysis except for tissue plasminogen activator (tPA) and plasminogen activator inhibitor (PAI-1) are synthesized in the liver. However, tPA levels can be increased due to decreased clearance by the liver predisposing patients to further risks of intra- and perioperative hemorrhage. Hemostatic changes associated with surgical bleeding are thrombocytopenia, platelet function defects, inhibition of platelet aggregation and adhesion by nitric oxide and prostacyclin, decreased levels of coagulation factors: II, V, VII, IX, X, XI, quantitative and qualitative abnormalities of fibrinogen, low levels of α2-antiplasmin, Factor XIII and thrombin activatable fibrinolysis inhibitor, and elevated tPA. Hemostatic changes associated with thrombosis are elevated vWF, decreased levels of ADAMTS-13 (a vWF cleaving protease), and decreased levels of anti-coagulants: ATIII, Protein C and S, α2 macroglobulin, elevated levels of heparin cofactor II, elevated VIII, decreased levels of plasminogen, normal or increased PAI-1. Hypercoagulability can occur in patients with liver disease, especially those with cholestatic disease.
\nIn the setting of acute liver failure (ALF), the coagulopathy encountered can be much more severe. Plasma concentrations of coagulation factors with the shortest half-life fall first; factors V and VII (12 hrs and 4-6hrs respectively) and factors II,VII and X subsequently. In a review of over 1000 patients with ALF by the US Acute Liver Failure Study Group, the mean international normalization ratio (INR) in ALF was 3.8 +/- 4.0 (range 1.5 - >10) with most having a moderately prolonged INR (1.5 to 5) and only 19% with an INR >5. Moreover, thrombocytopenia is common with 40% of patients having platelet counts < 90,000 on admission. [1]
\nLiver disease can be acute or chronic. Common causes of chronic liver disease are viral hepatitis (B & C), autoimmune hepatitis, non-alcoholic steatohepatitis (NASH), Laennec’s cirrhosis, cryptogenic cirrhosis, and metabolic diseases such as hemachromatosis and Wilson’s disease. Cholestatic causes of liver disease include primary biliary cirrhosis and primary sclerosing cholangitis.
\nPredominant pathophysiological manifestation of liver disease is portal hypertension. There is increased resistance to portal blood flow due to hepatic parenchymal scarring and fibrosis, and splanchnic hyperemic resulting in hypersplenism, thrombocytopenia and the progression formation of varices. Normal portal pressures are usually in the range of 5-12 mmHg. Portal hypertension is generally defined when any 2 of the following 3 criteria are met: splenomegaly, ascites or bleeding esophageal varices. Portal pressures at this time are usually > 20 mmHg.
\nThe combination of decreased production of albumin and portal hypertension results in the accumulation of ascites. It also occurs due to renal retention of sodium and water, and localization of this excess fluid in the peritoneal cavity. Tense ascites may decrease functional residual capacity (FRC), adversely affect pulmonary gas exchange and increase risk of aspiration. Hydrothorax or pleural effusions may produce atelectasis. Secondary hyperaldosteronism may manifest as hypokalemic metabolic alkalosis. Additionally, there is intra- and extra-pulmonary shunting, elevated mixed venous oxygen saturation (SvO2), altered lactate metabolism. The hyperdynamic circulation is a result of decreased systemic vascular resistance (SVR) and compensatory increased cardiac output to maintain tissue perfusion. Inadequate synthesis of coagulation factors produces coagulopathy. There is delayed gastric emptying creating putting the patient at-risk for aspiration. Increased ammonia levels (hyperammonemia) can result in hepatic encephalopathy.
\nPortopulmonary hypertension (POPH) is a pulmonary hypertension syndrome with vascular obstruction and increased resistance to pulmonary arterial flow due to varying degrees of pulmonary endothelial/smooth muscle proliferation, vasoconstriction and in-situ thrombosis. The development of POPH has not been demonstrated to correlate with the severity of liver disease.
\nHepatopulmonary syndrome (HPS) is characterized by arterial hypoxemia caused by intra-pulmonary vascular dilatations. The clinical triad of 1) portal hypertension; 2) hypoxemia; and 3) pulmonary vascular dilatations characterizes the clinical presentation of HPS [2].
\nHepatorenal syndrome is a form of pre-renal acute kidney injury that occurs in decompensated cirrhosis. The syndrome is classified into two types: Type 1 is characterized by a doubling of the serum creatinine level to greater than 2.5 mg/dl in less than 2 weeks while Type 2 is characterized by a stable or slower progressive course of renal failure [3].
\nHepatic encephalopathy occurs due to accumulation of circulating neurotoxins such as unmetabolized ammonia, gamma aminobutyric acid, gut-derived false neurotransmitters leading to altered neurotransmission by glutamate or altered cerebral energy homeostatsis. [4] Clinically, it is manifested by neuropsychiatric abnormalities and generalized clonus on clinical examination.
\nPatient operative risk is dictated by severity of liver disease, co-existing medical diseases and type of surgery (i.e., upper abdominal, emergent, cardiac etc.) It may also be dependent on s on the anesthetic conducted and ability to maintain of hepatic blood flow.
\nAn important measure for assessing mortality risk is the Child-Pugh Classification. Though this was first used to stratify risk for surgical correction of portal hypertension, it is also found to be predictive of survival in cirrhosis. The score is assigned based upon bilirubin, albumin, prothrombin time (PT), ascites and encephalopathy. One point is given for each of the following: albumin > 3.5 g/dl, INR < 1.7, bilirubin <2mg/dl, no ascites, no encephalopathy. 2 points are given for each of the following: Albumin 1.8- 3.5 g/dl, INR between1.7-2.3, bilirubin 2-3 mg/dl, slight to moderate ascites, grade 1-2 encephalopathy. 3 points are given for each of the following: albumin < 1.8 g/dl, INR >2.3, bilirubin > 3 mg/dl, tense ascites, grade 3-4 encephalopathy. Class A = 5-6 points, Class B = 7-9 points, Class C = 10-15 points. [5] Child Pugh A, B, C predicts a perioperative mortality risk of 10, 30 and 80 % respectively. [6]
\nOther measures for predicting mortality include ascites, increased serum creatinine, preoperative GI bleed, high ASA physical status score and previous abdominal surgery. Steatosis and steatohepatitis may also be considered as risk factors for postoperative complications, especially after abdominal procedures. The Model of End Liver Disease (MELD) score predicts severity based upon serum creatinine, total bilirubin, and PT INR. It is used to estimate long term survival, as well as list patients for liver transplantation with the United network of Organ Sharing (UNOS). (need a reference here)
\nElective surgery is contraindicated when the patient has acute viral hepatitis, alcoholic hepatitis, fulminant hepatic failure, severe chronic hepatitis, is a Child Pugh C patient or has other manifestations of end stage liver disease.
\nPatients with advanced liver disease should be effectively managed so that hepatic perfusion and hepatic oxygen delivery are maximized l and sequelae of their liver disease such as hepatic encephalopathy, cerebral edema, coagulopathy, hepatopulmonary syndrome, portopulmonary hypertension and portal hypertension has been identified and treated accordingly if possible.
\nAssessment of hepatic function includes evaluating risks for aggravating underlying liver disease, extra-hepatic complications, alterations of hepatic synthetic function and altered drug disposition.
\nLiver function tests do not measure hepatic function. They represent release of damaged or dead hepatocyte intracellular contents into the systemic circulation, hence provide a snapshot at that point in time only. Actual liver function is represented by albumin, prothrombin time and pseudocholinesterase concentrations. Obtaining liver function tests in healthy patients is not recommended as abnormal liver function tests (LFTs) exist in about 1 in 700 patients, and a vast majority of these patients do not have advanced liver disease. Thus, patients with asymptomatic elevations in serum transaminase levels (less than two times normal values) may undergo anesthesia and surgery with good outcomes.
\nPatients with chronic hepatitis should be screened prior to elective surgery even if they are asymptomatic. The INR is the most sensitive indicator of hepatocellular dysfunction. At present, though it is accepted that abnormal hemostasis is a result of liver disease, it is debatable whether the abnormal tests really predict bleeding risk [7]. Moreover, the relationship of coagulation profiles to the risk of bleeding with chronic as well as acute liver disease is uncertain [8]. Low platelet count may not be solely responsible for an increased risk of bleeding as the platelet function is also important. Bleeding time is no longer recommended as a test of platelet function. The current consensus is for a pre-procedure platelet count > 50,000, since it appears that a platelet count above 50,000 is likely to be adequate based on previous studies [9].
\nIt is also important to assess the patient for extra-hepatic pathophysiology related to liver disease. The diagnostic criteria for POPH include a mean pulmonary artery pressure (mPAP) greater than 25 mmHg at rest and a pulmonary vascular resistance (PVR) of > 240 dynes.s.cm-5 [10]. A better measure is a transpulmonary gradient > 12 mmHg (mPAP-PAOP) as this reflects the obstruction to flow (PVR) and also distinguishes the contribution of intravascular volume and flow to the mPAP [11].
\nThe European Respiratory Society (ERS)/European Association for Study of the Liver (EASL) Task Force have certain set diagnostic criteria for hepatopulmonary syndrome (HPS). These include diagnosis of liver disease, an A-a oxygen gradient > 15 mmHg, pulmonary vascular dilatation documented by “positive" delayed, contrast-enhanced echocardiography with left heart, detection of microbubbles for > 4 cardiac cycles after right heart opacification of microbubbles and brain uptake > 6% following 99mTc macroaggregated albumin (MAA) lung perfusion scanning. HPS can be diagnosed when there is a cirrhosis with ascites, serum creatinine of >1.5 mg/dL, no improvement of serum creatinine after at least 2 days with diuretic withdrawal and volume expansion with albumin, absence of shock, no current or recent treatment with nephrotoxic drugs and absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/day, microhematuria, and/or abnormal renal ultrasonography. [12]
\nCirrhotic patients with ESLD may suffer from cirrhotic cardiomyopathy. This is comprised of increased cardiac output and compromised ventricular response to stress. This entity is likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators resulting in cardiac depression, and accompanying repolarization abnormalities [13-18]. Low systemic vascular resistance and bradycardia are also commonly seen in ESLD. Patients with ESLD may also demonstrate diastolic dysfunction. [19]. The electrophysiologic abnormalities found in cirrhotic cardiomyopathy include QT-interval prolongation, electrical and mechanical dyssynchrony and chronotropic incompetence [20-22]. Carvedilol administered to patients with ESLD has been demonstrated to reduce portal pressures by decreasing net splanchnic blood flow. [23].
\nAdditionally, ESLD are also at risk for the development of coronary artery disease (CAD), however the liver itself has not been implicated. Approximately 25 % of these patients have at least one moderate or severe coronary artery with critical stenosis. Obstructive CAD was most common among patients with 2 traditional cardiac risk factors such as smoking, diabetes mellitus ( DM),and/or hyperlipidemia [24]. Left ventricular hypertrophy and hyperdynamic systolic function in ESLD may result in hemodynamically significant left ventricular outflow tract obstruction (LVOTO). One retrospective review of 106 transplant recipients found inducible LVOTO on pre-operative dobutamine stress echocardiography (DSE) in 40% of patients [25]. In this study, an outflow gradient of 36 mm Hg was significantly associated with intraoperative hypotension. Many ESLD patients also have prolonged corrected QT interval (QTc) on an electrocardiogram which can be associated with an increased risk of ventricular arrhythmias. Though it is not a contraindication to surgery and anesthesia, one should look for electrolyte disturbances or the use of QT interval-prolonging drugs. All patients with ESLD should undergo a preoperative echocardiography to assess ventricular function, ventricular size, valvular function, pulmonary artery pressure, and to exclude the presence of a significant LVOTO or pericardial effusion. Pre-operative echocardiography is useful to calculate pulmonary artery systolic pressure. Pulmonary artery systolic pressures (PASP) values of 45-50 mmHg and /or right ventricular dysfunction are usually used for screening POPH. Right heart catheterization should be performed to gauge the mean pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) and transpulmonary gradient (TPG) as 5% to 10% of ESLD candidates have POPH [26],. A preoperative mPAP of 35 to 50 mm Hg has been associated with a 50% risk of mortality after liver transplantation in patients with POPH [26], and mortality approached 100% among patients with POPH and mPAP ≥50 mm Hg [27]. Thus, POPH warrants perioperative treatment with vasodilators such as epoprosterenol, sildenafil or nitric oxide. Stress testing of ESLD patients can be done to detect CAD. Dobutamine stress echocardiography has been found to have a negative predictive value in ESLD patients to be 85%.[28,29]. The predictive value of nuclear single-photon emission computed tomography (SPECT) stress imaging is limited by the chronic vasodilatory state exhibited by patients with ESLD [30]. The specificity of abnormal SPECT findings for obstructive CAD by coronary angiography is only 61% [31]. Coronary angiography is the gold standard for detecting CAD. When possible, it is important make an assessment of CAD risk in the ESLD patient before revascularization becomes contraindicated (usually an excessive bleeding risk due to coagulopathy and/or thrombocytopenia). Transesophageal echocardiography (TEE) and/or pulmonary artery catheterization may be used intraoperatively to allow for real-time hemodynamic monitoring and volume management..
\nAll volatile anesthetics decrease the mean arterial pressure and portal blood flow. Halothane has consistently the most dramatic effect in reducing hepatic arterial blood flow. [32,33]. On the other hand, sevoflurane, desflurane and isoflurane have been consistently shown to better preserve hepatic blood flow and function. Intravenous anesthetics have a modest impact on hepatic blood flow, and no meaningful adverse impact on postoperative liver function if the mean arterial pressure is adequately maintained throughout the time anesthetized. Induction agents such as etomidate and thiopental decrease hepatic blood flow, either from increased hepatic arterial vascular resistance or from reduced cardiac output and/or blood pressure. [34]. Ketamine has little impact on hepatic blood flow. [35] Propofol increases total hepatic blood flow in both hepatic arterial and portal venous circulation, suggesting a significant vasodilator effect. [36,37].
\nOpioids such as morphine have significantly reduced metabolism in patients with advanced cirrhosis. The elimination half-life of morphine is prolonged, potentially exaggerating sedative and respiratory depressant effects. Fentanyl is highly lipid soluble with a short duration of action, which is also metabolized in the liver. Fentanyl elimination is not appreciably altered in patients with cirrhosis. [38,39]. However, unlike fentanyl, the half-life of alfentanil is almost doubled in patients with cirrhosis. [40]. Remifentanil is a synthetic opioid with an ester linkage that allows for rapid hydrolysis by blood and tissue esterases. It elimination is unaltered in patients with severe liver disease. [41].
\nThiopental has a small hepatic extraction ratio. However, its elimination half-life is unchanged in cirrhotics, as it has a large volume of distribution. The clearance of etomidate is unchanged in cirrhotic patients, but its clinical recovery time maybe unpredictable due to increased volumes of distribution [42]. The elimination kinetic profile of propofol is similar in cirrhotic patients as well as normal patients, but the mean clinical recovery times maybe longer after discontinuation of infusions. [43]. The half-life of midazolam is prolonged due to reduced clearance, reduced protein binding, resulting in a prolonged duration of action and an enhanced sedative effect, especially after multiple doses or prolonged infusions. [44] Dexmedetomidine, an α2-adrenergic agonist, with sedative and analgesic properties, is primarily metabolized in the liver. Dose adjustments are therefore indicated when used in patients with significant hepatic dysfunction. [45].
\nVecuronium and rocuronium are steroidal muscle relaxants which undergo hepatic metabolism, hence have decreased clearance, prolonged half-lives, and prolonged neuromuscular blockade in patients with cirrhosis. [46,47]. Atracurium and cisatracurium which undergo Hofmann elimination and ester hydrolysis respectively, have clinical duration of actions similar to those in normal patients. [48,49]
\nFor liver surgery where major bleeding is anticipated, it is prudent to secure intravenous access using large bore peripheral catheters as well as central venous access catheters. Rapid sequence induction is recommended in patients with tense ascites to minimize the risk of aspiration. Circulatory collapse should be prevented by concomitant administration of intravenous colloid solutions because intravascular volume re-equilibrium occurs 6 to 8 hrs after removal of larger volumes of ascitic fluid. [50]. Large volumes of colloids and crystalloids maybe given within a few minutes with the assistance of commercially available rapid infusion devices. Red cell salvage should be facilitated with use of Cell savers with/without leukocyte filters. Blood administration may be associated with hyperkalemia and hypocalcemia.
\nBleeding during liver surgery could be either surgical, due to previous or acquired coagulation disturbances, or both. The preoperative INR has no predictive value in relation to intraoperative blood loss and the value of fresh frozen plasma (FFP) administration to correct abnormal INR values is debatable and may even increase bleeding due to the volume load [51]. Intraoperative hemostasis panels consisting of INR, fibrinogen and platelet count, and platelet function assays for both platelet count and function, may help to differentiate between the above. A very useful intraoperative test for coagulation is the thromboelastograph (TEG). This test denotes the net effect of pro and anti-coagulants and pro and anti-fibrinolytic factors and the resulting clot tensile strength. It provides information on the rate and strength of clot formation and also clot stability/fibrinolysis. (Table 1)\n
\n\n | \n \n | \n \n | \n
R | \nR is the time of latency from the time that the blood was placed in the TEG® analyzer until the initial fibrin formation. | \nFFP | \n
α | \nThe α-value measures the rapidity (kinetics) of fibrin build-up and cross-linking and the speed of clot strengthening. | \nCryoprecipitate | \n
K | \nK time is a measure of the rapidity to reach a certain level of clot strength. | \nFFP | \n
MA | \nMA, or Maximum Amplitude, is a direct function of the maximum dynamic properties of fibrin and platelet bonding and represents the ultimate strength of the fibrin clot. | \nPlatelet | \n
TEG Parameters
The Normal TEG Graph
Prolonged Reaction Time
Reduced Angle
Reduced Maximum Amplitude.
Fibrinolysis
Hypercoagubility.
In addition, it is possible to detect heparin-like activity and to measure functional fibrinogen.(Figure 1-5,) Moreover, the only way to currently detect intraoperative hypercoagubility is via TEG. (Figure 6) Thus, TEG may act to facilitate specific goal directed therapy. If fibrinolysis is diagnosed on the TEG and it is causing clinically significant microvascular ooze, small doses of epsilon aminocaproic acid (EACA) or tranexamic acid (TA) are suitable anti-fibrinolytics. Factor VII has been used to control massive bleeding during liver surgery; however, it has not proved to be consistently effective to control bleeding and is associated with significant side effects. [52]
\nTransesophageal echocardiography (TEE) is a very useful cardiac monitoring tool to monitor function of the ventricles and assess intraoperative regional wall motion abnormalities (RWMAs), especially in patients with CAD. The monitoring of right heart systolic function is essential in patients with POPH. Moreover, it can be used effectively to assess volume status and guide fluid therapy.
\nSurgery and anesthesia can further worsen hepatic function. Moreover, undiagnosed pre-existing liver disease is often the cause of hepatic dysfunction postoperatively. Depending upon the surgical procedure, one may observe continued “third space“ losses.. Potential for renal dysfunction or failure as a result of surgery is exacerbated with preexisting liver disease. As well, preoperative or intraoperative coagulopathy can continue postoperatively or can develop during first 24-48 hrs after surgery secondary to worsening hepatic dysfunction.
\nPostoperative jaundice occurs as a result of overproduction and under excretion of bilirubin, direct hepatocellular injury, or extra-hepatic obstruction. [53] Multiple blood transfusions can increase the levels of unconjugated bilirubin because approximately 10 % of stored whole blood undergoes hemolysis within 24 hours of transfusion. Each 0.5 – 1 unit of blood stored in CPDA-1 yields 7.5 g of hemoglobin, which is then converted to approximately 250 mg of bilirubin. [54] This may overwhelm the liver’s ability to conjugate and excrete bilirubin. Immediate postoperative jaundice (< 3wks) can also occur due for multiple reasons including but not exclusive to hemolysis, anesthesia, hypotension, hypovolemia, drugs, infection, sepsis, bleeding, resorption of hematoma, bile duct ligation or injury, hepatic artery ligation, retained common bile duct stone, postoperative pancreatitis, Gilbert’s syndrome, Dubin-Johnson Syndrome, inflammatory bowel syndrome, heart failure. [53] Delayed postoperative jaundice (>3 wks) can be a result of drugs, blood transfusion, post-intestinal bypass status and total parenteral nutrition. [53]
\nThoracic epidural analgesia provides excellent analgesia for liver resections. [55] The catheter is usually inserted at the T6-T9 space. Ropivacaine or bupivacaine are common local anesthetics used with or without the addition of small amounts of opioids such as fentanyl, sufentanil, hydromorphone or morphine. It also reduces the gastrointestinal paralysis compared with systemic opioids. [56]. There is benefit of using combined general and epidural anesthesia in patients with high-risk surgery, but this has not been extensively studied in hepatic surgery. The reasons are probably associated with the concerns with coagulation issues in this group. Additional concerns maybe harbored as neuroaxial blocks themselves are associated with risks. Estimated risk of having serious neurological injury may be as high as 0.08 %.[57, 58]. Moreover, direct spinal cord injury can occur without paraesthesias, whereas pain is more common in lesions affecting nerve roots. [59]. The incidence of persistent neurological deficit has been reported as 0.005-0.07 %. [60,61]. At our institution, we follow a practice where time from anticoagulant drug administration to epidural catheter placement is 3-5 days for warfarin, INR < 1.5, 4 hrs for heparin low dose subcutaneously, 12 hrs for low molecular weight heparin (LMWH), 5 days for clopidogrel and zero for aspirin. The time from epidural catheter removal to anticoagulant drug administration is at least 24 hrs for warfarin, 2 hrs for low dose heparin and 6-8 hrs for LMWH.
\nIt is essential to understand that the degree of underlying parenchymal disease is not the only factor which is responsible for perioperative coagulopathy. Other important factors include amount of blood loss, dilution coagulopathy, amount and quality of residual liver parenchyma, its exposure to ischemia to name a few. [62-64]. Persistent pain or transient coagulopathy may cause delayed epidural catheter removal in patients undergoing partial hepatectomy [65]. The risk of meningitis or epidural abscess is in the range of 0.0004-0.05% [66,67].
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TIPS is a procedure used in patients with end stage liver disease to decrease portal pressure and attenuate complications related to portal hypertension. It is usually done in the interventional radiology suite. The goal of this procedure is diversion of portal blood flow into the hepatic vein. The stent is passed through the internal jugular vein over a wire into the hepatic vein, which is located using fluoroscopic guidance. This stent is then advanced through the hepatic parenchyma into the portal vein. This will decompress the portal circulation. Usually, general anesthesia is requested for this procedure, as the radiologists prefer that the patients do not move during this procedure and it may be prolonged. Sedation is usually not preferred as there maybe potential respiratory depression in cirrhotic patients with underlying pulmonary dysfunction or hypoxemia from hepatopulmonary syndrome. Additionally, the presence of ascites may produce risk of aspiration. For this procedure, the central venous pressure (CVP) is monitored. After the stent is placed, the portal pressures are measured. Reduction of the difference between the two reflects the effectiveness of TIPS. Potential complications of this procedure include pneumothorax with internal jugular vein (IJV) cannulation, hematoma formation, inadvertent carotid puncture, cardiac arrhythmia with intracardiac catheter passage, acute life threatening hemorrhage with hepatic artery puncture, hepatic capsular tear, extrahepatic portal venous puncture, development of pulmonary edema and congestive cardiac failure.
\nRadiofrequency ablation of tumors up to 3 cm in size is currently used to treat non-resectable malignant tumors. During this procedure, a high-frequency, alternating current is delivered through a needle-like probe into the tumor, which induces coagulative necrosis of the tumor and surrounding tissue.[68,69]. PFA is done either percutaneously or laparoscopically. In a study which analyzed nationwide RFAs, it was found that procedure-specific complications were frequent (18.2 %), with transfusion requirements (10.7 %), intraoperative bleeding (4.3 %), and hepatic failure (2.8 %) being the most common. Postoperative complications were also common (12.0 %), with arrhythmias, heart failure, coagulopathy, and open surgical approach acting as significant predictors. [70]
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Usually, an adequate amount of emulsion containing oil-based contrast agent Lipiodol and anticancer agents is injected through a catheter then the selected arteries are embolized by embolic agents. Superselective TACE is generally used to minimize damage to non-tumorous areas by using a microcatheter to embolize only the cancerous subsegment.[71-73] Epirubicin and cisplatin are commonly used as anticancer agents, and miriplatin, a new platinum drug, came into use in 2010.[74,75]. Indications for TACE are wide-ranging, and the procedure is generally performed in patients with hypervascular hepatocellular cancer (HCC) who are not indicated for surgery or local therapy for reasons such as multiple bilobar HCC, liver dysfunction, old age or co-morbidity, and in whom the first branch from the main portal vein is not occluded. In practice, this technique is commonly indicated for patients who are Child–Pugh class A or B with multiple tumors with a diameter of 3 cm or more or with four or more HCC. [76,77]. When TACE is combined with RFA, there may be several advantages. For example, TACE decreases the blood flow which in turn reduces the heat loss, thus increasing the size of the RFA ablative zone. In addition, the inclusion of TACE makes the evaluation of ablative margins easier, and enhances the control of satellite lesions.
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Liver resections can be done either open or robotic/laparoscopic. Hepatic resection procedures include partial resection, subsegmental resection, segmental resection, two segment resection, extended two-segment resection or three-segment resections. Pre-operative assessment should include the evaluation of the risk assessment using the CTP or MELD score, hepatic parenchymal function, and correction of severe anemia or coagulopathy, management of severe esophageal varices. The choice of anesthetic drugs as well as their doses should be based on the above assessment. There is a risk of significant blood loss. Therefore, it may be prudent to secure large bore intravenous access and be prepared for rapid infusion of colloids and crystalloids. Blood and blood products should be made available for perioperative use. Control of bleeding during resection is usually done with pressure, coagulation and hilar clamping or via the Pringle maneuver. Hilar occlusion produces a minimal increase in systemic arterial pressure, increase in systemic vascular resistance and a minimal decrease in cardiac index. There may be risk of air embolism with extensive resection and disruption of hepatic veins. Most surgeons request a low central venous pressure to facilitate dissection and minimize blood loss from the hepatic vessels and vena cava. Postoperative concerns are similar to those in major abdominal surgery. Central neuroaxial analgesia is not recommended if there is risk of coagulopathy which may result in hematoma formation in the epidural or spinal space.
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One method of expanding donor pool for liver transplantation is the use of living donor grafts. Adult-to-adult living donor liver transplantation (LDLT) is a complex procedure that poses serious health risks to and provides no direct health benefit for the donor. Because of this uneven risk-benefit ratio, ensuring donor autonomy through informed consent is critical. However, informed consent for LDLT is sub-optimal as donors do not adequately appreciate disclosed information during the informed consent process, despite United Network for Organ Sharing/CMS regulations requiring formal psychological evaluation of donor candidates. [78] Types of donor liver grafts can be left lobe, left lobe and caudate, right lobe, extended right lobe and right lateral sector. After preoperative evaluation and screening, a virtual resection and volume analysis is done using contrast enhanced computed tomography (CT). These not only estimate SLV but can also determine segmental volume, delineate surgical planes, define anatomical landmarks of hepatic vasculature and biliary structures and calculate anticipated graft and remnant liver volumes post resection. It is essential that the minimal donor remnant volume be at least 30% of the original volume. Additionally, when right-lobe LDLT is planned, whether the middle hepatic vein (MHV) should remain in the donor or be resected is controversial. The MHV primarily provides various drainage of the right anterior lobe and segment IV. Most transplant surgeons prefer to leave the MHV in the donor to avoid congestion of segment IV and reduce the risk of liver failure in the donor.[79] The anesthesia management is similar to that of hepatectomy. In donors, several complications have been reported. In one study, right hepatectomy (resection of segments 5–8) was done in 101 donors, left lobectomy (resection of segments 2–3) in 11 donors, and left hepatectomy (resection of segments 2–4) in one donor. Minor anesthetic complications were shoulder pain, pruritus and urinary retention related to epidural morphine, and major morbidity included central venous catheter-induced thrombosis of the brachial and subclavian vein, neuropraxia, foot drop and prolonged postdural puncture headache. One of 113 donors died from pulmonary embolism on the 11th postoperative day. [80]. It was also observed that donor patients experienced significant postoperative pain despite the use of thoracic patient-controlled epidural analgesia (PCEA) infusion catheters as compared to patients who had undergone major hepatic resection. This was attributed to the longer surgical duration for donor hepatectomy and neuroplasticity which may play a role in exaggerated postoperative pain perception along with various psychological factors.[81]. It is also interesting to note that approximately 10% of donors had a platelet count < 150,000 x 109/liter, 2 to 3 years post-donation. [82]
\nPatients with liver disease are at increased risk for both perioperative morbidity and mortality. They require delineation of the degree of liver dysfunction present prior to undergoing surgery and have outcomes that are primarily dictated by the degree of hepatic dysfunction and type of surgery performed. They can certainly pose significant challenges for perioperative care.
\nUndoubtedly, plastics play a major role in our everyday life, since plastic parts are used in numerous applications, such as packaging (for instance, food containers), automotive industry, electric and electronic equipment (EEE), etc., due to their unique properties [1]. Some of their most important characteristics that necessitate their use in these applications are lightness, ease of processing, resistance to corrosion, transparency, and others. Nevertheless, their wide use in various applications in combination with the short life span of many plastic products leads to large amounts of end-of-life plastics. Taking all these into account, along with plastic nonbiodegradability, research has focused on exploring environmentally friendly approaches for their safe disposal [2]. Plastic handling involves collection, treatment, and afterward recycling. Unfortunately, finding environmentally friendly approaches for their disposal is no mean feat (Figure 1); due to the variation in types of plastics, which are often of unknown composition, the existence of polymer blends, or composites, multilayer structures with other materials apart from polymers, as well as the wide range of additives (such as UV and thermal stabilizers, antistatic agents, (brominated) flame retardants, colorants, plasticizers, etc.) they may contain [3, 4].
Difficulties encountered during end-of-life plastic handling.
The disposal of post-consumer plastics occurs via landfilling, primary recycling, energy recovery, mechanical recycling, and chemical recycling [2]. Although landfilling is an undesirable, non-recycling method, since it results in serious environmental problems, such as soil and groundwater contamination, until now large amounts of end-of-life plastics still end up in landfilling [5, 6]. With a view to eliminating plastic landfilling, research has focused on recycling methods (Figure 2) that can be applied, which are primary recycling, recycling without quality losses, energy recovery-quaternary, mechanical or secondary recycling-downcycling into lower qualities and chemical or tertiary recycling-recovery of chemical constituents [7]:
In primary recycling (re-extrusion), the plastic scrap is reinserted in the heating cycle of the processing line in order to increase the production [8]. It remains a very popular method, because of its simplicity and low cost. However, it can be applied only in case of clean, uncontaminated single-type waste [2].
Mechanical recycling involves reprocessing and modification of plastic waste using mechanical-physical means with the aim of forming similar, plastic products, at nearly the same or lower performance level when compared with the original products [6]. Since mechanical recycling can be used only in case of homogeneous plastics, heterogeneous plastics require sorting and separation before their recycling. In mechanical recycling, the presence of brominated flame retardant (BFR) incorporated in plastics must be identified before its application, in order to avoid the possible formation of toxic substances, such as polybrominated dibenzo-p-dioxins/furans (PBDD/Fs) [9, 10]. Its main drawback is the fact that product’s properties are deteriorated during every cycle [2]; and it should be underlined that each polymer can endure only a limited number of reprocessing cycles [11]. An additional challenge is the existence of mixed plastic waste (polymer blends), since different polymer types have different melting points and processing temperatures. In such cases, the processing temperature is usually set to the highest melting component. Nevertheless, this may result in overheating and possible degradation of the lower melting components and so, in reduced final properties [12].
In chemical or feedstock recycling, plastic wastes are converted into lower-molecular-weight products, such as: fuels, monomers, or secondary valuable products that can be used as feedstock for refineries. Conversion takes place through chemical reactions in the presence of solvents and reagents [10]. It is an environmentally friendly method, since, as mentioned previously, it results in the formation of valuable products or monomers [9].
During energy recovery, plastics are incinerated in a boiler or in other industrial equipment, taking advantage of their high energy value; for energy production in the form of heat and electricity. Nevertheless, if incomplete incineration takes place, then toxic substances, such as dioxins, furans, and others, may be formed and released into the atmosphere, resulting in environmental issues [2, 8, 9, 10].
Recycling methods for post-consumer plastics.
In conclusion, during chemical recycling, plastics are converted into smaller molecules (mainly liquids and gases), which can be used for the production of new, valuable products; and that is why it is considered as an environmentally friendly and economically feasible technique. Furthermore, chemical recycling seems to be more advantageous than the other existing methods; taking into account, for instance, the fact that during chemical recycling, both heterogeneous and contaminated polymers can be treated, only with a limited pretreatment. Moreover, the energy consumption of the process is very low, if compared with that of mechanical recycling or energy recovery [6].
Chemical recycling comprises two processes: solvolysis and thermolysis. During solvolysis, polymers are dissolved in a solvent and treated with or without catalysts and initiators.
Chemical recycling routes.
Generally, it should be underlined that pyrolysis can be considered as one of the best options for plastics recycling, since its advantages are aplenty. Specifically, pyrolysis enables material and energy recovery from polymer waste, as a very small amount of the energy content of waste is consumed for its conversion into valuable hydrocarbons. Furthermore, pyrolysis products are valuable, since they can be used as fuels or chemical feedstock. Last but not least, in case that flame retardants are present in plastic waste, via pyrolysis the formation of toxic substances may be restricted, due to the fact that it takes place in the absence of oxygen [17]. Of course, catalyst’s presence, as mentioned previously, plays a vital role. Apart from catalysts, various other parameters, including temperature, heating rate, residence time, operating pressure, etc., can strongly affect the quality and distribution of pyrolysis products [6].
As mentioned previously, many obstacles can be found during the end-of-life plastic recycling. In this unit there are presented in detail three case studies, including: polymeric blends (difficulties due to the coexistence of mixed plastic wastes), plastics originating in multilayer packaging (challenging because of the coexistence of different materials, such as plastics, paper, and metals), and brominated flame-retarded plastics from WEEE (possible formation of undesirable, toxic substances due to the BFR’s presence), along with suggestions on how to overcome these difficulties.
Polymer blends are mixtures of two or more polymers in concentration greater than 2%wt. The blends can be miscible or immiscible, a parameter that depends on the thermodynamics of the system and molecular structure, weight, and polymer concentration. More information on the complicated thermodynamics that govern polymer blend miscibility can be found in the Polymer Blends Handbook [18, 19]. Miscible polymer blends are also known as homogeneous blends and are monophasic while immiscible blends with morphologies that differ such as, spheres, cylinders, fibers, or sheets (Figure 4) [12].
(a) and (b) are a visual representation of the differences between miscible and immiscible Polymer Blends. Images (c), (d), and (e) show the spherical, fibrous, and cylindrical morphologies of immiscible Polymer Blends, respectively. Image inspired by Ragaert et al. [
Subject to polymer compatibility, polymer blends can exhibit synergistic, antagonistic, or additive behavior. A common method used to assuage the immiscibility of polymers blends is the inclusion of compatibilizers—a polymeric surface tension reduction agent that promotes interfacial adherence—in the blend. The three most common types of compatibilizers are reactive functionalized polymers, nonreactive polymers containing polar groups, and block or graft polymers [12, 19, 20].
The difficulty during polymer blend recycling lies in the different properties presented by its component parts such as melting points and processing temperatures between polymers [12]. Most recycling efforts are concentrated on the procedure of pyrolysis to extract energy through the oils, wax, char, and gasses produced. Furthermore, research in recent years has focused on the use of various, different catalysts in order to lower the energy consumption of the whole process and increase the exploitable yield. Along with those some novel methods of polymer blend recycling will be explored.
Polymer composites are made up of two or more elements resulting in a multiphase, multicomponent system that exhibits superior properties compared with the constituent materials due to a synergistic effect. It comprises two parts:
A polymeric matrix that can be either thermoplastic polymers such as polypropylene (PP), polycarbonate (PC), acrylonitrile-butadiene-styrene (ABS) and poly(ethylene terephthalate) (PET) or thermoset polymers such as epoxy, vinyl ester, and polyester.
A reinforcing filler such as glass, carbon, and aramid [21].
One way that polymer blend can be recycled is by acting as the matrix for secondary elements creating composite materials. In this way it is possible to unite the two components in a form that reinforces the secondary materials and reuses the polymer blends. This method can be adapted to use natural fillers or fibers as the reinforcing fillers. Those can be added along with a coupling agent to optimize the interaction of the fillers with the matrix further and have the positive side effect of making the whole process environmentally friendly. It is important, however, that these fillers have the capacity to be chemically treated.
In a research conducted by Choudory et al., [22], Low-density polyethylene (LDPE)/Linear low-density polyethylene (LLDPE) blend extracted from milk pouches was used as a matrix for coir fibers. The result was composites with properties only slightly lacking from the virgin material ones. In case a maleated styrene pretreatment was applied, the mechanical properties and thermooxidative stability were drastically increased [23].
In another research conducted by Lou et al., [24], PET/PP blend and bamboo charcoal were used to create extruded or injection-molded composite materials. A great increase in mechanical properties was observed in the injection-molded composites, which maintained their mechanical properties even after three rounds of processing. The percentage of total mass of PET in the blend plays a particularly significant role in the product’s final behavior [23].
Pyrolysis is a promising choice as regards the recycling of polymer blends. With pyrolysis, high levels of conversion of the polymer blend into oil and gas with high calorific values can be attained. These can be used afterward to either fuel the process, or they can be utilized elsewhere [25]. This can be an invaluable asset to the petrochemical industry and a green way for the recycling of plastic waste [26].
Another advantage of pyrolysis is that a sorting process is not needed in contrast to other recycling methods that are extremely susceptible to contamination. This can of course save money and time when recycling polymer blends. Lastly, with the use of the pyrolysis procedure, waste management becomes easier as it is a cheap and environmentally friendly method. In the meanwhile, it allows for minimization of landfill capacity—a serious contemporary difficulty [5]. As the combination of polymers that make up polymer blends is wide, with every blend presenting different properties and pyrolysis behavior, it would be impractical to analyze each one of them. Instead, this chapter will focus on the pyrolysis route taken for the most common polymer blends by examining the research conducted by scientists in the field.
In general, the pyrolysis process can be either thermal or catalytic. In practice, however, the latter is widely preferred by the industry as it demands lower operating temperatures—and thus cost is minimized—that produce a more satisfactory yield of pyrolytic oils, if the correct catalyst has been elected [5].
In a study conducted by Vasile et al., [26], a blend with a composition similar to that originating in municipal waste—24%wt high-density polyethylene (HDPE), 39%wt LDPE, 21.5%wt isotactic polypropylene (IPP), 10%wt PS, 4%wt ABS, and 1.5%wt PET—was investigated. The blend underwent the process of catalytic pyrolysis two separate times each with a different catalyst—HZSM-5 in the first batch and PZSM-5 zeolite catalyst in the second batch, in order to find which catalyst led to better results. It was concluded that the PZSM zeolitic catalyst was characterized by higher selectivity and stability. The optimal temperature for the pyrolysis was found to be 450–480°C, and the gas produced increased sixfold in comparison to the non-catalytic process. Furthermore, the liquid products were found to contain high concentrations of aromatic hydrocarbons. As such, both the liquid and the gas phase can be utilized by the petrochemical industry. Lastly, the pyrolysis oil could be useful as petrochemical feedstock [26].
A novel research conducted by Bober et al. [27] proposed a way to produce hydrogen gas from the catalytic pyrolysis of different consistency HDPE/ poly(methyl methacrylate) PMMA polymer blends. After trial and error, the optimal temperature for maximum hydrogen production was found to be 815°C, a temperature where the catalyst used, Ni/Co, operated the best for hydrogen production. It was also found that, the higher the HDPE content in the blend, the bigger the hydrogen output. In contrast, when PMMA was the dominant polymer in the blend, CO was produced at a greater rate than the previous procedure. The research team proposed that the best ratio for HDPE/PMMA in the blend is 4:1 [27].
It must also be noted that concerning the production of hydrogen from pyrolysis of polymer blends, a popular option is the co-pyrolysis of the polymer blends with biomass [28].
A largely untapped potential of Polymer Blends is their recycling as feedstock for the chemical industry. A study presented by Plastics Europe [29], displays that only 2–3% of the collected plastic waste in Europe is utilized as feedstock (Figure 5).
The fate of the European collected plastic waste. Image inspired by Donaj et al. [
A possible procedure for the creation of feedstock from pyrolysis of Polymer Blends on the group of polyolefins was suggested by Donaj et al., [30]. For the purposes of the process, the researchers used a blend of polyolefins—46% LDPE, 30% HDPE, 24% PP- taken from MSW/plastic waste. The collected material was firstly reduced in size to about 3 mm pieces and then pyrolysis ensued under temperatures of 600–700°C in a fluidized bed reactor and with the use of steam and a catalyst if that was deemed feasible as the latter materials increase the yield of olefines. To optimize the procedure, Ziegler-Natta catalyst was used.
The research noted that after the procedure’s conclusion, plastic pyrolysis had directly yielded 15–30% gaseous olefins that can then be channeled directly into a polymerization plant. The residue produced consists of a naphtha-like consistency. To be used, this residue must undergo reformation via petrochemical technologies to be upgraded into olefins. Also, as in the previous cases of pyrolysis, the products of the process can be used to fuel the procedure itself. However, work still needs to be done on this field as the process described is not as cost-effective as desired [30].
A last noteworthy method for the utilization of immiscible Polymer Blends is their direct melting processing into fibers with good mechanical properties proposed by Shi et al. [31]. The blend used in this research was PS/PP while fibers were chosen due to two distinct reasons: (a) The fiber spinning technique is known to endow improved properties to polymer blends. (b) Fibers from polymer blends may display new properties in comparison to pure polymers. This method is widely cost-effective for preparing strong fibers for the industry, and it is expected to see great development in the coming years [31].
In this age of climate change and overall pollution, it has been the priority of policymakers to ensure the viable and sustainable future of human development. An example of this is the EU with the European Plastic Strategy dictating that all packaging used should be reusable or recyclable by 2030 [32].
A prime example of the challenges the industry faces to reach this standard is Tetra Pak, a multilayer packaging used mostly in the food, medicine, chemical, and commodities industry. Tetra Pak most usually consists of three elements: paper cardboard, aluminum, and LDPE.
As stated by the Tetra Pak company, its composition is as follows: (a) 71% paperboard, (b) 24% plastics, and (c) 5% aluminum foil (Figures 6 and 7).
Raw materials used to produce Tetra Pak. Image inspired by the Tetra Pak site information.
The layers of Tetra Pak. Image inspired by Georgiopoulou et al. [
These three make up the six layers that combined make Tetra Pak. Each layer has a particular use elaborated on below:
However, this is not an absolute rule. For example, certain products with a short shelf life have no need for the protection given by the aluminum layer. On the other hand, when the aforementioned shelf life needs to be extended, the LDPE layers can be substituted by PP providing a chance for further heat treatment of the product. HDPE, PET, and PA are also possible options for replacing the LDPE layers. Lastly, polyurethanes and EMAA are often utilized as adhesives between layers [34] while the Tetra Pak carton may also contain various chemical additives such as plasticizers, stabilizers, lubricants, fillers, foaming agents, colorants, flame retardants, and antistatic agents [35].
As Tetra Pak cartons are composed of mainly paper, the removal and recycling of the carboard layer are of much significance. As such there are two main processing routes: recycling without hydropulping and recycling with hydropulping. The initial procedure processes the cartons as a whole, while the latter uses the technique of hydropulping to first separate the cellulosic fibers from the Al-LDPE laminate.
The main aim of those following this route is energy recovery or downcycling. Energy recovery is attained in combination with solid municipal waste through means of pyrolysis, gasification, or incineration. However, this method comes with many downsides. Paper—the main ingredient of Tetra Pak cartons—has a low heat combustion (16 MJ/Kg), high moisture content, and a significantly high ash value. This makes the entire process inefficient, and thus it is in general not widely used [34].
Before proceeding with the options in this category, it would be useful to briefly go over the hydropulping process. When the soon-to-be recycled material first arrives into the recycle unit, the hydropulper breaks apart the paper with rotating blades that use high pressure water and a slurry of fibers is produced. Further processing ensues in centrifugal cleaners that remove heavy materials such as sand, adhesives, staples, etc. [36]. The end result of this procedure is a pulp of cellulosic fibers and can be used as a substitute for wood pulp, in the production of brown paper and pulp board [37]. What remains after the process is the external LDPE layer and the Al-LDPE laminates. However, residual cellulosic fibers can account for up to 5% of the finished products (Figure 8).
The main recycling routes.
The appeal of this method lies in its simplicity and cost-effectiveness. The pyrolysis procedure has two steps: (a) the degradation of paper (200–400°C) and (b) the devolatilization of LDPE (420–515°C) [38, 39, 40]. It should be noted that the temperature plays an important role in the composition of the final products. For example, the production of char is minimized with higher temperatures, and the opposite is true for wax.
The solid products that follow the process are aluminum, char caused by paper degradation, wax from LDPE degradation and tar. A great deal of gaseous products are also formed that mainly consist of CO2, CO, H2, CH4, C2–6 hydrocarbons, and volatile matter. Lastly, there is an aqueous phase consisting of water and phenols.
Many uses have been proposed for those pyrolytic products. The produced gases could be used to sustain the pyrolysis procedure itself or used elsewhere entirely, the char and tar can be exploited as a solid and oil fuel, respectively, while char can also act as a primal resource for the production of carbon-based materials. Lastly, the wax and aqueous phase can readily be utilized as a raw material for the chemical industry [39, 40].
A novel approach has been taken by researchers in Mexico and Spain who have used the char and the aluminum from the pyrolysis to have them act as absorbents of mercury in aqueous solutions. By means of trial and error and using thermodynamical analyses, they did conclude that char obtained from pyrolysis at 600°C at a 3 h procedure demonstrated the most promising mercury adsorption capacity at 21.0 mg/g. The field of char absorbents is still expanding with hopes of Tetra Pak pyrolysis chars acting as major absorbents for industry in the future [41].
The basic principle of this approach is the immersion of the Al-PE laminate in a carefully selected solvent and under specific temperature conditions with the aim of the dissolution of the LDPE in the solvent. What follows is the removal by means of filtration of additives and impurities. Lastly an antisolvent is added, and as a result precipitation of the dissolved polymer follows. To maximize LDPE and pure aluminum recovery, the SDP process is repeated three times.
The LDPE produced is of quality that matches that of the virgin product while the aluminum collected is also of high purity. Along with the hydropulping process, this is a very promising option for Tetra Pak recycling. However, the procedure is not without drawbacks: firstly, because of the cost-effective energy consumption needed to separate the solvent-antisolvent mixture and secondly, due to its high environmental impact. The economic viability of this technique rests upon whether the solvent-antisolvent mixture can be separated cheaply (Figure 9) [33].
The SDP process. Image inspired by Georgiopoulou et al. [
This technique has been developed by researchers in China and focuses on the separation of LDPE and aluminum by means of a separation reagent, mostly aqueous solutions of organic acids or even mixtures of acids. The procedure works by breaking the mechanical bonds holding the laminate together and as such allows for recovery of the products.
The yield of the process is highly dependent on the conditions of the reaction. In the process some of the aluminum is dissolved by the acid—which is also consumed—and thus losses are to be expected. However, this depends on many factors such as acid used, temperature, etc. Product purity is also correlated with those factors.
After trial and error, it has been found that methanoic acid is the best separation reagent for Tetra Pak. Lastly, there seems to be a high correlation between the separation rate, the temperature the reaction is taking place at, and the concentration of the reagent. More specifically, reaction time decreases with the rise of reagent concentration and temperature (Figure 10) [37].
The acid-based delamination process. Image inspired by Zhang Ji-fei et al. [
Thanks to the high heating value of the Al-LDPE laminate (40 MJ/Kg), it can be used as a sufficient fuel source. This has taken precedent especially in Europe. Although the laminate can be used directly after the hydropulping process, it is most usually used in conjunction with other fuel sources. This recycling route can be considered environmentally friendly as the LDPE of Tetra Pak burns cleanly without producing fumes containing elements such as sulfur, nitrogen, or halogens.
Also, the Al2O3 produced during pyrolysis, by the reaction between Al and moisture in high heat conditions, is in big part exploited by the cement industry, which uses it as a desired component of cement production [36]. Lastly there is the choice of forming finished products directly by using the laminates in roof tile production, injection and rotational molding, and PE-Al agglomeration and pulverization [42, 43].
In these times that society demands a more environmental way of thinking from the industry, recycling of multilayer packaging becomes a priority for many scientists. They have developed a plethora of ways to recycle such packaging, from using it as a fuel to using its pyrolysis products as a mercury absorbent. It is most likely that this field will keep on expanding with ever more innovative and cost-effective ways to fully exploit, reuse, and transform the Tetra Pak multilayer packaging as human development is going into the future.
The rapid technological advances along with people’s need for better living conditions resulted in a global rise in the consumption of EEE over the last years and so in huge amounts of WEEE [44]. Plastics in WEEE account for ~30% of WEEE and in most cases contain BFR that necessitates careful handling [9], since BFR’s presence in plastics leads to the formation of various, toxic brominated substances in the liquid fraction obtained after pyrolysis, inhibiting its further use. In such cases a pretreatment step before or during the recycling is necessary in order to receive bromine-free products. So, due to the fact that
One very common pretreatment method for the removal of BFR applied before pyrolysis is
Apart from the typical soxhlet extraction, many advanced solvent extraction techniques have been explored over the years, including supercritical fluid extraction (SFE), pressurized liquid extraction (PLE), ultrasonic-assisted extraction (UAE), and microwave-assisted extraction (MAE). These techniques require less time and volumes of solvents than those during soxhlet extraction [47]. Vilaplana et al. applied MAE for the removal of TBBPA and decabromodiphenyl ether (Deca-BDE) from virgin high-impact polystyrene (HIPS) and standard samples from real WEEE. They found that complete extraction of TBBPA took place when they used a combination of polar/nonpolar solvent system (isopropanol/n-hexane) and high extraction temperatures (130°C). On the other hand, in case of Deca-BDE, there were obtained lower extraction yields due to its high molecular weight and its nonpolar nature [47].
In another study [48], UAE and MAE were investigated for the recovery of TBBPA from real WEEE samples that consisted of ABS, polypropylene (PP), polycarbonate (PC), and blends of ABS/PC. From the results obtained it was proved that MAE was more efficient in extracting TBBPA than UAE, especially in case of ABS polymers. The optimal solvent media was isopropanol: n-hexane (1:1), which is a binary mixture of a polar –nonpolar solvent, whereas pure isopropanol, as a solvent, could not result in complete extraction of TBBPA [48].
As mentioned previously, SFE has also attracted a lot of attention as regards the degradation of brominated flame-retarded plastics from WEEE, because of the supercritical fluids’ unique properties, such as high density, low viscosity, varied permittivity related to pressure, and high mass transfer, as well as the fact that their viscosity, density, and diffusion coefficient are very sensitive to changes in temperature and pressure. Supercritical fluids appear at temperature and pressure higher than their critical state. Supercritical CO2 is the most widely used fluid in SFE, since it presents remarkable advantages, including: low critical point, low cost, ease of availability, non-toxicity, recyclability, and simplicity as regards its operation. Water is also, a cheap, nontoxic, and easily available fluid, but it has a relatively high supercritical point [49].
Onwudili and Williams [50] studied supercritical water (T > 374°C and P > 22.1 MPa) due to the fact that it presents different characteristics in comparison with organic solvents. They focused on ABS and HIPS, since they are some of the most representative brominated plastics in WEEE and degraded them in supercritical water (up to 450°C and 31 MPa) in a batch reactor. Furthermore, they investigated the effect of alkaline additives, NaOH and Ca(OH)2, by treating the plastics both in the absence and in the presence of them. They noticed that oils, which were the main reaction products, had almost zero bromine and antimony content in the presence of NaOH additive [50]. In another work, [51] there was used subcritical water for the debromination of printed circuit boards (PCB) that contained BFR in a high-pressure batch reactor. They applied three different temperatures, 225, 250, and 275°C, and noticed that debromination increased with increase in temperature. After the debromination of the samples, they applied recycling methods, such as pyrolysis.
Apart from water, organic solvents such as acetone, methanol, and ethanol can also be used as supercritical fluids in chemical recycling of plastics from WEEE [52]. For instance, Wang and Zhang [52] used various supercritical fluids: acetone, methanol, isopropanol, and water with a view to studying the degradation of waste computer housing plastics that contained BFR. They came to the conclusion that supercritical fluid process was efficient for the debromination and decomposition of brominated flame-retarded plastics enabling the recycling of bromine-free oil. As for solvent’s efficiency in debromination, the order was the following: water > methanol > isopropanol > acetone.
It should be highlighted here that although SFE technology is considered as a green choice for resource recovery, it has some important drawbacks as well. One of the main obstacles in such technology is the fact that only equipment able to withstand high pressures and temperatures and very resistant to corrosion can be used. These demands, however, increase the cost a lot, and along with the large amount of energy that is required, prevent its industrial implementation [49].
To avoid the latter difficulties, there are other approaches that can be applied in case of flame-retarded plastics. One such approach is that of
As described above, during co-pyrolysis, the end-of-life brominated plastics along with other (plastic) waste are pyrolyzed together and result in bromine reduction in the derived pyrolysis oil, without any kind of pretreatment before the pyrolysis process. Another idea, in order to reduce bromine while avoiding the extra pretreatment step, is that of the
During
In another study [59], there was investigated activated Al2O3 for catalytic pyrolysis of waste PCB examining three different temperatures: 400, 500, and 600°C, as well as different ratios of PCB: Al2O3. They noticed that higher temperatures improved the oil production; and the optimal results as regards the production of light oil and the debromination were obtained at 600°C. The catalyst’s presence increased the formation of light hydrocarbons and in the meantime the debromination. Wu et al. [60] carried out catalytic pyrolysis of brominated HIPS that also contained Sb2O3, in the presence of red mud, limestone, and natural zeolite, with a view to eliminating bromine and antimony from the pyrolysis oil. They found that in their presence, the total amount of bromine (and antimony) in the oil was reduced. Nevertheless, red mud was the most efficient catalyst in reducing bromine, since Fe2O3 present in red mud reacted with HBr that was formed during the degradation of the BFR and hindered the formation of the volatile SbBr3; in the meanwhile, its zeolite property catalytically destroyed the organobromine compounds [60].
Co-pyrolysis can also take place in the presence of catalysts, known as
An example that belongs in the first category is [63], in which they examined a small-scale two-stage pyrolysis and catalytic reforming of brominated flame-retarded HIPS at 500°C using four zeolites: natural zeolite (NZ), iron oxide–loaded natural zeolite (Fe-NZ), HY zeolite (YZ), and iron oxide–loaded HY zeolite (Fe-YZ). They observed that the bromine content in the oil was reduced in the presence of catalysts; however, Fe-NZ and Fe-YZ showed better debromination results, due to the reactions between the iron oxide that was loaded and the derived HBr. Compared with Fe-YZ, Fe-NZ did not greatly change the pyrolysis products and so preserved the valuable single-ring aromatic compounds. As a result, Fe-NZ was more effective and feasible for the feedstock recycling of brominated HIPS via the pyrolysis process.
Areeprasert and Khaobang [64] studied pyrolysis and catalytic reforming of a polymer blend (ABS/PC) and PCB, at 500°C, using some conventional catalysts: Y-zeolite (YZ), ZSM-5, iron oxide–loaded Y-zeolite (Fe/YZ), and iron oxide–loaded ZSM-5 (Fe/ZSM-5), as well as some alternative, green catalysts: biochar (BC), electronic waste char (EWC), iron oxide–loaded biochar (Fe/BC), and iron oxide–loaded electronic waste char (Fe/EWC). They found that all catalysts increased the single-ring hydrocarbon products of the liquid fraction. As for the debromination, it was noticed that in case of ABS/PC, the most effective catalyst was Fe/BC, whereas in case of PCB, it was Fe/EWC. Also, they concluded that the green-renewable catalysts could be a promising choice for removing bromine from the liquid fraction [64]. Ma et al. [65] investigated pyrolysis-catalytic upgrading of brominated flame-retarded ABS. The process took place in a two-stage fixed bed reactor; and the second stage included the catalytic upgrading of the vapor intermediates that were obtained from pyrolysis (first stage). The examined catalysts were: HZSM-5 and Fe/ZSM-5. Both catalysts had high catalytic cracking activities that led to an increased yield of oil and to a reduction of the bromine in the liquid fraction.
This chapter briefly presents all methods that are used nowadays for plastic recycling, including primary recycling, energy recovery, mechanical recycling, and chemical recycling. The advantages and disadvantages of each method are discussed. Emphasis though is given on chemical recycling and mainly, pyrolysis, due to its many benefits, which are fully described. Furthermore, three case studies that involve some difficulties in plastic recycling are thoroughly investigated. The first one includes the case of polymeric blends, where the coexistence of different plastic materials makes their recycling more difficult. The second one is focused on the recycling of plastics that come from multilayer packaging. The main obstacle in this case lies in the fact that multilayer packaging comprises various, different materials, such as paper and metals, apart from the plastics, so extra attention is required for their separation and recycling. The last case study that is presented here is that of brominated flame-retarded plastics from WEEE, since in such cases direct recycling is not that easy due to the formation of undesirable brominated compounds and more often than not a pretreatment step prior to their recycling is necessary. Taking into account the mentioned difficulties, the aim of this chapter is to present and analyze various recent literature data along with suggestions on how to overcome the mentioned problems.
The research work was supported by the Hellenic Foundation for Research and Innovation (HFRI) under the HFRI PhD Fellowship grant (Fellowship Number: 853).
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\n\nHOW COPYRIGHT WORKS WITH OPEN ACCESS LICENSES?
\n\nAgreement samples are listed here for the convenience of prospective Authors:
\n\nDEFINITIONS
\n\nThe following definitions apply in this Copyright Policy:
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\n\nAll Works published on the IntechOpen platform and in print are licensed under a Creative Commons Attribution 3.0 Unported and Creative Commons 4.0 International License, a license which allows for the broadest possible reuse of published material.
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The CC BY 3.0 and CC BY 4.0 license permits Works to be freely shared in any medium or format, as well as the reuse and adaptation of the original contents of Works (e.g. figures and tables created by the Authors), as long as the source Work is cited and its Authors are acknowledged in the following manner:
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\n\nThe same principles apply to Works published under the CC BY-NC-SA 3.0 license, with the caveats that (1) the content may not be used for commercial purposes, and (2) derivative works building on this content must be distributed under the same license. The restrictions contained in these license terms may, however, be waived by the copyright holder(s). Users wishing to circumvent any of the license terms are required to obtain explicit permission to do so from the copyright holder(s).
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After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). 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Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. 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Due to rapid depletion of agricultural areas and soil quality by means of ever-increasing population and an excessive addition of chemical fertilizers, a rehabilitated attention is a need of the hour to maintain sustainable approaches in agricultural crop production. Biochar is the solid, carbon-rich material obtained by pyrolysis using different biomasses. It has been widely documented in previous studies that, the crop growth and yield can be increased by using biochar. This chapter exclusively summarizes the properties of biochar, its interaction with soil microflora, and its role in plant growth promotion when added to the soil.",book:{id:"7305",slug:"biochar-an-imperative-amendment-for-soil-and-the-environment",title:"Biochar",fullTitle:"Biochar - An Imperative Amendment for Soil and the Environment"},signatures:"Jyoti Rawat, Jyoti Saxena and Pankaj Sanwal",authors:null},{id:"41378",doi:"10.5772/53343",title:"Nutrient balance as paradigm of plant and soil chemometricsNutrient Balance as Paradigm of Soil and Plant Chemometrics",slug:"nutrient-balance-as-paradigm-of-plant-and-soil-chemometricsnutrient-balance-as-paradigm-of-soil-and-",totalDownloads:3467,totalCrossrefCites:14,totalDimensionsCites:25,abstract:null,book:{id:"3405",slug:"soil-fertility",title:"Soil Fertility",fullTitle:"Soil Fertility"},signatures:"S.É. Parent, L.E. Parent, D.E. Rozanne, A. Hernandes and W. 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Shisanya, Jayne Mugwe,Monicah Mucheru-Muna and Daniel Mugendi",authors:[{id:"75158",title:"Dr.",name:"Felix",middleName:"Kipchirchir",surname:"Ngetich",slug:"felix-ngetich",fullName:"Felix Ngetich"},{id:"149578",title:"Dr.",name:"Jayne",middleName:null,surname:"Mugwe",slug:"jayne-mugwe",fullName:"Jayne Mugwe"},{id:"149579",title:"Dr.",name:"Monicah",middleName:null,surname:"Mucheru-Muna",slug:"monicah-mucheru-muna",fullName:"Monicah Mucheru-Muna"},{id:"149580",title:"Dr.",name:"Daniel",middleName:null,surname:"Mugendi",slug:"daniel-mugendi",fullName:"Daniel Mugendi"},{id:"200734",title:"Prof.",name:"Chris",middleName:null,surname:"Shisanya",slug:"chris-shisanya",fullName:"Chris Shisanya"}]},{id:"26954",doi:"10.5772/29151",title:"Integrated Soil Fertility Management in Bean-Based Cropping Systems of Eastern, Central and Southern Africa",slug:"integrated-soil-fertility-management-in-bean-based-cropping-systems-of-eastern-central-and-southern-",totalDownloads:5774,totalCrossrefCites:9,totalDimensionsCites:19,abstract:null,book:{id:"893",slug:"soil-fertility-improvement-and-integrated-nutrient-management-a-global-perspective",title:"Soil Fertility Improvement and Integrated Nutrient Management",fullTitle:"Soil Fertility Improvement and Integrated Nutrient Management - A Global Perspective"},signatures:"Lubanga Lunze, Mathew M. Abang, Robin Buruchara, Michael A. Ugen, Nsharwasi Léon Nabahungu, Gideon O. 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Due to rapid depletion of agricultural areas and soil quality by means of ever-increasing population and an excessive addition of chemical fertilizers, a rehabilitated attention is a need of the hour to maintain sustainable approaches in agricultural crop production. Biochar is the solid, carbon-rich material obtained by pyrolysis using different biomasses. It has been widely documented in previous studies that, the crop growth and yield can be increased by using biochar. This chapter exclusively summarizes the properties of biochar, its interaction with soil microflora, and its role in plant growth promotion when added to the soil.",book:{id:"7305",slug:"biochar-an-imperative-amendment-for-soil-and-the-environment",title:"Biochar",fullTitle:"Biochar - An Imperative Amendment for Soil and the Environment"},signatures:"Jyoti Rawat, Jyoti Saxena and Pankaj Sanwal",authors:null},{id:"67917",title:"Organic Fertilizer Production and Application in Vietnam",slug:"organic-fertilizer-production-and-application-in-vietnam",totalDownloads:1279,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Crop production is an important subsector of Vietnam’s agriculture, has an impressive achievement in last 30 years and based on the intensive production with increasing use of chemical fertilizer and pesticide. Consequences are the negative effects on environment and human health and food safety. Organic agriculture has become a trend worldwide and is developing rapidly in the world. In Vietnam the certified organic farming area has expanded since 2012. Organic market revenue in Vietnam is estimated to be at $132.15 million a year. Most Vietnamese certified organic products are exported to international markets. Organic agriculture using organic fertilizer is one of Vietnam government’s priorities. Vietnam already produced organic fertilizer from different materials by using different production technologies, but the production capacity is small and does not meet the demand for organic agriculture. Vietnam government encourages, promotes the organic fertilizer production, application and has the policy to develop the organic fertilizer in Vietnam.",book:{id:"8017",slug:"organic-fertilizers-history-production-and-applications",title:"Organic Fertilizers",fullTitle:"Organic Fertilizers - History, Production and Applications"},signatures:"Pham Van Toan, Ngo Duc Minh and Dao Van Thong",authors:null},{id:"62186",title:"Olive-Pressed Solid Residues as a Medium for Growing Mushrooms and Increasing Soil Fertility",slug:"olive-pressed-solid-residues-as-a-medium-for-growing-mushrooms-and-increasing-soil-fertility",totalDownloads:1094,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Organic fertilizer is the core of organic farming, which represents the most important way to provide crops and agricultural products that are safe and free of any chemical components and pesticides. From this point of view, the purpose of this study is to provide a source of organic fertilizers which was formerly an environmental problem. The northwestern region of Saudi Arabia is flourishing with olive production, leaving huge amounts of residues called olive press cake (OPC). These wastes are a major environmental pollution despite their good content of carbohydrates, protein, oil and cellulose alongside phenols and lignin. We tested the cultivation of Gliocladium roseum, Pythium oligandrum and Trichoderma harzianum and the mushroom Pleurotus ostreatus on OPC in order to reduce the high percentage of phenols that impede the germination of some plant seeds. Gliocladium roseum, Pythium oligandrum and Pleurotus ostreatus were able to reduce the percentage of phenols to more than 40% and thus support germination of seeds of Eruca sativa. This study gave than one benefit: firstly, reducing phenols that impede the germination of seeds. Secondly, Gliocladium roseum and Pythium oligandrum work against some plant diseases and also produce plant-like hormones that increase growth of plants.",book:{id:"7216",slug:"soil-productivity-enhancement",title:"Soil Productivity Enhancement",fullTitle:"Soil Productivity Enhancement"},signatures:"Hani Mohamed Awad Abdelzaher, Haifa Abdulaziz S. Alhaithloul\nand Shaima Mohamed Nabil Moustafa",authors:[{id:"238130",title:"Dr.",name:"Shaima M.N.",middleName:"Mohamed Nabil",surname:"Moustafa",slug:"shaima-m.n.-moustafa",fullName:"Shaima M.N. Moustafa"},{id:"242818",title:"Prof.",name:"Hani",middleName:"Mohamed Awad",surname:"Abdelzaher",slug:"hani-abdelzaher",fullName:"Hani Abdelzaher"},{id:"245646",title:"Dr.",name:"Haifa",middleName:null,surname:"Alhaithloul",slug:"haifa-alhaithloul",fullName:"Haifa Alhaithloul"}]},{id:"68604",title:"Composting",slug:"composting",totalDownloads:1100,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"Decomposition followed by stabilization of organic substances by biological actions has been taking place in nature from the very beginning of life appeared on our planet. Anthropogenic control and utilization of the process for sanitary disposal and reclamation of organic waste material have been termed composting and the final product is named compost. Microbial community leads the processes of both aerobic and anaerobic composting and converts wastes to a stable form of nutrients. The C/N ratio is the most important factor for decomposition, especially aerobic decomposition. Microorganisms respire two-third of carbon as CO2, and one-third combines with nitrogen in living cell, and huge amount of heat energy is released as end product of aerobic decomposition as compared to anaerobic process. In agricultural world, utilization of human and animal wastes has great importance. Extensive studies on composting were initiated in India. Different composting methods like pit method, heap method, ADCO method, vermicomposting, etc. presently exist in the world. Humus is the end product of composting, and different organic wastes contain macro, micro, and trace elements, which reflect valuable properties for growing vegetation and to the soil itself.",book:{id:"8017",slug:"organic-fertilizers-history-production-and-applications",title:"Organic Fertilizers",fullTitle:"Organic Fertilizers - History, Production and Applications"},signatures:"Niladri Paul, Utpal Giri and Gourab Roy",authors:null},{id:"67957",title:"Efficacy of Different Substrates on Vermicompost Production: A Biochemical Analysis",slug:"efficacy-of-different-substrates-on-vermicompost-production-a-biochemical-analysis",totalDownloads:1044,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"The rapid increase in the volume of waste is one aspect of the environment crisis, accompanying global development. Earthworms play an important role in the decomposition of organic matter and soil metabolism through feeding, fragmentation, aeration, turnover and dispersion. The type of substrates used and species of earthworms introduced plays a significant role in plant growth and yield. The waste to be stabilized should support an adequate biomass needed for effective processing. In the present study the vermicompost produced from banana as a substrate did not show a significant increase in NPK content from that of the control. On the other hand poultry waste and vegetable waste with goat dung showed significant increase in the NPK content. The enhancement of the vermicompost was probably due to mineralization of the organic matter containing proteins and conversion of ammonium nitrogen into nitrite. Mineralization and consequent mobilization of phosphorous by enhanced bacterial and phosphatase activities during vermicomposting leads to increase in Phosphorus. The earthworm processed waste materials contain high concentration of exchangeable potassium, due to enhanced microbial activity during the vermicomposting process, which accordingly enhanced the rate of mineralization. Vermicompost tends to hold more nutrients over larger periods without adverse effects on the environment.",book:{id:"8017",slug:"organic-fertilizers-history-production-and-applications",title:"Organic Fertilizers",fullTitle:"Organic Fertilizers - History, Production and Applications"},signatures:"Pawlin Vasanthi Joseph",authors:null}],onlineFirstChaptersFilter:{topicId:"677",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{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:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:320,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:133,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:107,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:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:17,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{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"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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At the Ministry of Justice of Slovenia, she is a member of examination boards for court expert candidates and judicial appraisers in the following areas: economy/finance, valuation of companies, banking, and forensic investigation of economic operations/accounting. 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She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. Voyich",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Montana State University",country:{name:"United States of America"}}},{id:"330412",title:"Dr.",name:"Muhammad",middleName:null,surname:"Farhab",slug:"muhammad-farhab",fullName:"Muhammad Farhab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"435274",title:null,name:"Muhammad",middleName:null,surname:"Shahid Khan",slug:"muhammad-shahid-khan",fullName:"Muhammad Shahid Khan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Islamia University of Bahawalpur",country:{name:"Pakistan"}}}]}},subseries:{item:{id:"14",type:"subseries",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11410,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,series:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983"},editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",slug:"ana-isabel-flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",slug:"christian-palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},onlineFirstChapters:{paginationCount:15,paginationItems:[{id:"82195",title:"Endoplasmic Reticulum: A Hub in Lipid Homeostasis",doi:"10.5772/intechopen.105450",signatures:"Raúl Ventura and María Isabel Hernández-Alvarez",slug:"endoplasmic-reticulum-a-hub-in-lipid-homeostasis",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Endoplasmic Reticulum",coverURL:"https://cdn.intechopen.com/books/images_new/11674.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"82103",title:"The Role of Endoplasmic Reticulum Stress and Its Regulation in the Progression of Neurological and Infectious Diseases",doi:"10.5772/intechopen.105543",signatures:"Mary Dover, Michael Kishek, Miranda Eddins, Naneeta Desar, Ketema Paul and Milan Fiala",slug:"the-role-of-endoplasmic-reticulum-stress-and-its-regulation-in-the-progression-of-neurological-and-i",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Endoplasmic Reticulum",coverURL:"https://cdn.intechopen.com/books/images_new/11674.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"80954",title:"Ion Channels and Neurodegenerative Disease Aging Related",doi:"10.5772/intechopen.103074",signatures:"Marika Cordaro, Salvatore Cuzzocrea and Rosanna Di Paola",slug:"ion-channels-and-neurodegenerative-disease-aging-related",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Ion Channels - From Basic Properties to Medical Treatment",coverURL:"https://cdn.intechopen.com/books/images_new/10838.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"81647",title:"Diabetes and Epigenetics",doi:"10.5772/intechopen.104653",signatures:"Rasha A. 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