Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Thermotropic and hydration studies of membranes formed from gemini pseudoglyceryl lipids possessing polymethylene spacers

Membrane formation from gemini pseudoglyceryl lipids bearing n-C14H29 and n-C16H33 chains has been reported. These lipid aggregates have been characterized using transmission electron microscopy (TEM), dynamic light scattering (DLS), high sensitivity differential scanning calorimetry (DSC), and Paldan fluorescence studies. The length of the spacer between the cationic ammonium headgroups has been varied from -(CH2)(3)- (propandiyl) to -(CH2)(12)- (dodecandiyl) in these lipids. All gemini lipids were found to generate stable suspensions in aqueous media. Electron microscopic studies revealed the smaller size of the gemini lipid aggregates as compared to their monomeric lipid counterparts. DLS measurements showed that the gemini lipid suspensions with a -(CH2)(8)- spacer length were bigger in size than that of other analogues. DSC studies suggest the unusual behavior of the gemini lipids bearing -(CH2)3- propanediyl spacer based lipids. These observations were consistent irrespective of the hydrocarbon chain lengths of the lipids. Paldan fluorescence based hydration studies showed that the hexadecyl chain based gemini lipid aggregates bearing a -(CH2)(12)- spacer were the most hydrated in their gel states among all the gemini lipid series investigated herein

Advances in gene delivery through molecular design of cationic lipids

This feature article describes the recent developments in the design of cationic lipids and their applications in gene delivery. Various structure-activity investigations explaining the variations in gene transfection efficacies with respect to different molecular structures of the cationic lipids have been discussed. Gene transfer abilities are presented in relation to aggregation properties of different aqueous formulations such as cationic liposomes and surfactant aggregates from various amphiphiles and cationic lipids, as a function of their hydrophobic parts, linkers and head groups

Recent advances in lipid molecular design

The area of lipid molecular design is attracting widespread interest among numerous research groups worldwide. Diverse lipid assemblies in aqueous media, such as vesicles, bilayers and nanorods, offer new applications in chemical biology. Lipids with specifically tailored molecular architecture have been successfully employed as gene delivery vehicles, for controlled drug release and the preparation of supramolecular gels. Such molecular design of lipids, as well as their characterization upon membrane formation, offers an insight into the possible molecular basis of their properties. This in turn helps in the design of further generations of lipid systems with more predictable characteristics. Here, we present an overview of the current trends in lipid design and their utilization in various biochemical, physical and chemical applications

Membrane-forming properties of gemini lipids possessing aromatic backbone between the hydrocarbon chains and the cationic headgroup

Membrane-forming properties of five new gemini cationic lipids possessing an aromatic backbone between the headgroup and hydrocarbon chains have been presented. These gemini lipids differ by the number of polymethylene units [-(CH2)n-] between the cationic ammonium -[N+(CH3)2]- headgroups. The membrane-forming properties of these gemini lipids have been studied in detail by transmission electron microscopy (TEM), dynamic light scattering (DLS), X-ray diffraction (XRD), high-sensitivity differential scanning calorimetry (DSC), Paldan fluorescence studies, and UV-vis absorption spectroscopy. The electron micrographs and dynamic light scattering of their aqueous suspensions confirmed the formation of vesicular-type aggregates. The vesicle sizes and morphologies were found to depend strongly on the n-value of the spacer. Information on the thermotropic and hydration properties of the resulting vesicles was obtained from differential scanning calorimetry and temperature-dependent Paldan fluorescence studies, respectively. Examination of the thermotropic phase-transition properties of the lipid aggregates revealed interesting features of these lipids, which were found to depend on the length of the spacer chain. Paldan fluorescence studies indicate that the membranes of the gemini lipids are less hydrated as compared to that of the monomeric counterpart in their solid-gel state. In contrast in their fluid, liquid-crystalline phase, the hydration of gemini lipid aggregates was found to depend strongly on the length of the spacer. UV-vis absorption studies suggest an apparent H-type aggregate formation in the gemini lipid membranes in the gel states. In fluid state of the lipid membranes, H-aggregate formation was found to be enhanced depending on the length of the spacer. Such an understanding of the properties upon membrane formation from this new class of gemini lipids will be useful for further development of related gene delivery systems

Membrane-forming properties of pseudoglyceryl backbone based gemini lipids possessing oxyethylene spacers

Five pseudoglyceryl backbone based gemini lipids possessing varying lengths of oxyethylene [(-CH2-O-CH2-)n] spacers between cationic ammonium head groups have been synthesized, where n varies from 1 to 5. The membrane-forming properties of these gemini cationic lipids have been investigated. All the gemini lipids formed stable suspensions in water. The presence of membranous aggregates in such lipid suspensions was evidenced by transmission electron microscopy. The membrane-forming characteristics of these gemini lipids were compared with those of the corresponding monomeric lipid with one head group to understand the effect of lipid dimerization. The lipid suspensions were further characterized by dynamic light scattering and ζ potential measurements. Except for the gemini lipid with -CH2-CH2-O-CH2-CH2- spacer (2a), ζ potential of aggregates of all other gemini lipids were significantly greater than that of monomeric lipid suspensions. X-ray diffraction studies with lipid cast films revealed the increase in membrane bilayer width with increase in the length of the spacer (-CH2-O-CH2-)n. Clear thermotropic phase transitions typical of membranous assemblies were observed for all the lipid suspensions by high sensitivity differential scanning calorimetry. Aggregates of gemini lipid 2a bearing one oxyethylene [-(CH2-CH2-O-CH2-CH2)-] unit between headgroups manifested the highest phase transition temperature as compared to other gemini analogues as well as that of monomeric lipid 1. The phase transitions were reversible and exhibited large hysteresis, indicating that the observed phase transitions were of first order. To probe the surface hydration of these membranous aggregates, Paldan fluorescence studies were performed. These studies indicated the high polarity of the vesicular surface of gemini lipid 2a both in the gel and fluid melted phase as compared to vesicles of other gemini lipids

Advances in gene delivery through molecular design of cationic lipids

This feature article describes the recent developments in the design of cationic lipids and their applications in gene delivery. Various structure-activity investigations explaining the variations in gene transfection efficacies with respect to different molecular structures of the cationic lipids have been discussed. Gene transfer abilities are presented in relation to aggregation properties of different aqueous formulations such as cationic liposomes and surfactant aggregates from various amphiphiles and cationic lipids, as a function of their hydrophobic parts, linkers and head groups

Membrane-Forming Properties of Gemini Lipids Possessing Aromatic Backbone between the Hydrocarbon Chains and the Cationic Headgroup

Membrane-forming properties of five new gemini cationic lipids possessing an aromatic backbone between the headgroup and hydrocarbon chains have been presented. These gemini lipids differ by the number of polymethylene units $[-(CH_2)_n-]$ between the cationic ammonium $-[N^+(CH_3)_2]-$ headgroups. The membraneforming properties of these gemini lipids have been studied in detail by transmission electron microscopy (TEM), dynamic light scattering (DLS), X-ray diffraction (XRD), high-sensitivity differential scanning calorimetry (DSC), Paldan fluorescence studies, and UV-vis absorption spectroscopy. The electron micrographs and dynamic light scattering of their aqueous suspensions confirmed the formation of vesicular-type aggregates. The vesicle sizes and morphologies were found to depend strongly on the n-value of the spacer. Information on the thermotropic and hydration properties of the resulting vesicles was obtained from differential scanning calorimetry and temperature-dependent Paldan fluorescence studies, respectively. Examination of the thermotropic phase-transition properties of the lipid aggregates revealed interesting features of these lipids, which were found to depend on the length of the spacer chain. Paldan fluorescence studies indicate that the membranes of the gemini lipids are less hydrated as compared to that of the monomeric counterpart in their solid-gel state. In contrast in their fluid, liquid-crystalline phase, the hydration of gemini lipid aggregates was found to depend strongly on the length of the spacer. UV-vis absorption studies suggest an apparent H-type aggregate formation in the gemini lipid membranes in the gel states. In fluid state of the lipid membranes, H-aggregate formation was found to be enhanced depending on the length of the spacer. Such an understanding of the properties upon membrane formation from this new class of gemini lipids will be useful for further development of related gene delivery systems

Synthesis and gene transfer activities of novel serum compatible cholesterol-based gemini lipids possessing oxyethylene-type spacers

Four novel cholesterol-based gemini cationic lipids differing in the length of oxyethylene-type spacers [-CH2-(CH2-O-CH2)n-CH2-] between each ammonium headgroup have been synthesized. These formed stable suspensions in aqueous media. Cationic liposomes were prepared from each of these lipids individually and as mixtures of cationic lipid and DOPE. These were used as nonviral gene delivery agents. All the cholesterol-based gemini lipids induced better transfection activity than their monomeric counterpart. Inclusion of DOPE in co-liposomal formulation of the cationic gemini lipid potentiates their gene transfer activity significantly. A major characteristic feature of these oxyethylene spacer based cholesterol gemini lipids was that serum does not inhibit the transfection activity of these gemini lipids, whereas the transfection activity of their monomeric counterpart decreased drastically in the presence of serum. One of the cholesterol-based gemini lipids 2a possessing a -CH2-CH2-O-CH2-CH2- spacer showed the highest transfection activity