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

Theranostic Nanoparticles for cancer treatment using one or two-photon photodynamic therapy

L'augmentation du nombre de cancers de faible taille dans le monde a incité le développement de nouveaux nanomatériaux multifonctionnels appliqués à de nouvelles thérapies non invasives. Ces nouvelles thérapies peuvent éliminer sélectivement la tumeur en réduisant ou en supprimant les effets secondaires induits dans les tissus sains par les traitements actuels, tels que la chimiothérapie ou la radiothérapie, qui présentent une efficacité élevée mais une faible sélectivité. Ce travail décrit l'élaboration de nanomatériaux pour le diagnostic et le traitement des cancers de faible taille grâce à une nouvelle thérapie: la thérapie photodynamique (PDT). Cette nouvelle technique, implique l'activation d'une molécule photosensibilisatrice (PS) grâce à des longueurs d'onde spécifiques. Cette activation conduit à des cascades de transfert d'énergie qui produisent des espèces oxygénées réactives cytotoxiques provoquant la mort cellulaire.Dans un premier temps, l'élaboration de nanoparticules de silice mésoporeuses (MSN) contenant un agent photosensibilisant de type porphyrine est présentée pour le traitement in vitro du cancer de la prostate et du rétinoblastome grâce à la thérapie photodynamique à un photon. Des nanoparticules fonctionnalisées avec de nouveaux ligands ont été essayées pour cibler les nanoparticules vers les cellules cancéreuses de la prostate. La diminution de la taille des nanoparticules à 20 nm a été élaborée pour traverser la barrière hémato-rétinienne et traiter les rétinoblastomes.D'autre part, deux nouveaux types de nanomatériaux ont été conçus pour le traitement à deux photons qui conduit à une pénétration plus profonde dans les tissus. Des nanoparticules polysilsesquioxane pontés (BS) et des nanoparticules d’organosilice mésoporeuses (PMO) ont été conçues à partir de différents types de molécules photosensibilisatrices tétra-silylées ou octa-silylées et de bis-organo-alcoxysilanes comme l'éthane, l'éthylène ou le disulfide. L’efficacité des BS en imagerie à deux photons en thérapie photodynamique a été démontrée in vitro. Des nanoparticules de BS à base de disulfides ont été conçues comme nouveaux nanomatériaux biodégradables.Enfin, en plus de l'imagerie et la thérapie, les PMO ont été testés in vitro pour la délivrance de médicaments en raison de leur mésoporosité. La gemcitabine et doxorubicine ont été encapsulées dans les pores obtenant des charges élevées en médicaments. Outre les photosensibilisateurs classiques, des PMO cœur-coquille contenant des nanodiamants ont été testés en tant que PS. Pour finir, des PMO à base de porphyrines sont présentés pour la délivrance de gènes in vitro et in vivo utilisant le poisson-zèbre comme modèle.Nowadays, the increase of the number of low-size cancers in the world has prompted the development of novel multifunctional nanomaterials applied to new non-invasive therapies. These new therapies are expected to selectively eradicate the tumor, decreasing or suppressing the side effects induced in healthy tissues by current treatments. This study describes the elaboration of nanomaterials for the diagnostic and the therapy of low size cancers through a novel therapy: photodynamic therapy (PDT). This new technique involves the activation of a photosensitizer molecule (PS) with specific wavelengths of light giving rise to energy transfer cascades that yield cytotoxic reactive oxygen species leading to apoptotic and necrotic cell death.First, the elaboration of mesoporous silica nanoparticles (MSN) containing a porphyrin photosensitizer are presented for the treatment in vitro of prostate cancer and retinoblastoma through one-photon therapy. Functionalized nanoparticles with new ligands were synthesized to target the nanoparticles to prostate cancer cells. The decrease of the nanoparticle size to 20 nm was elaborated to cross the blood-retinal barrier and treat retinoblastomas.On the other hand, two new types of nanomaterials were designed for two-photon nanomedicine which leads to a deeper penetration in tissues. Bridged silsesquioxane (BS) and periodic mesoporous organosilica (PMOs) nanoparticles were designed from different types of tetra or octasilylated-photosensitizers and bis-organoalkoxysilanes such as ethane, ethylene or disulphide. Pure PS bridged silsesquioxane nanoparticles lead to efficient two-photon imaging and photodynamic therapy which were demonstrated in vitro. Disulfide-based BS nanoparticles were designed as biodegradable nanomaterials.Finally, in addition to the imaging and therapy, PMOs nanoparticles were tested in vitro as nanocarriers for drug delivery due to their mesoporosity. Gemcitabine or doxorubicin were encapsulated into the pores leading to high drug loadings. Beside the classical photosensitizers, nanodiamonds core-shells PMOs were tested as PDT agent. In addition, pure porphyrin nanoPMOs are presented for gene delivery in vitro and in vivo in a zebrafish model

Nanoparticules à visées théranostiques pour le traitement du cancer par thérapie photodynamique à un ou deux photons

Nowadays, the increase of the number of low-size cancers in the world has prompted the development of novel multifunctional nanomaterials applied to new non-invasive therapies. These new therapies are expected to selectively eradicate the tumor, decreasing or suppressing the side effects induced in healthy tissues by current treatments. This study describes the elaboration of nanomaterials for the diagnostic and the therapy of low size cancers through a novel therapy: photodynamic therapy (PDT). This new technique involves the activation of a photosensitizer molecule (PS) with specific wavelengths of light giving rise to energy transfer cascades that yield cytotoxic reactive oxygen species leading to apoptotic and necrotic cell death.First, the elaboration of mesoporous silica nanoparticles (MSN) containing a porphyrin photosensitizer are presented for the treatment in vitro of prostate cancer and retinoblastoma through one-photon therapy. Functionalized nanoparticles with new ligands were synthesized to target the nanoparticles to prostate cancer cells. The decrease of the nanoparticle size to 20 nm was elaborated to cross the blood-retinal barrier and treat retinoblastomas.On the other hand, two new types of nanomaterials were designed for two-photon nanomedicine which leads to a deeper penetration in tissues. Bridged silsesquioxane (BS) and periodic mesoporous organosilica (PMOs) nanoparticles were designed from different types of tetra or octasilylated-photosensitizers and bis-organoalkoxysilanes such as ethane, ethylene or disulphide. Pure PS bridged silsesquioxane nanoparticles lead to efficient two-photon imaging and photodynamic therapy which were demonstrated in vitro. Disulfide-based BS nanoparticles were designed as biodegradable nanomaterials.Finally, in addition to the imaging and therapy, PMOs nanoparticles were tested in vitro as nanocarriers for drug delivery due to their mesoporosity. Gemcitabine or doxorubicin were encapsulated into the pores leading to high drug loadings. Beside the classical photosensitizers, nanodiamonds core-shells PMOs were tested as PDT agent. In addition, pure porphyrin nanoPMOs are presented for gene delivery in vitro and in vivo in a zebrafish model.L'augmentation du nombre de cancers de faible taille dans le monde a incité le développement de nouveaux nanomatériaux multifonctionnels appliqués à de nouvelles thérapies non invasives. Ces nouvelles thérapies peuvent éliminer sélectivement la tumeur en réduisant ou en supprimant les effets secondaires induits dans les tissus sains par les traitements actuels, tels que la chimiothérapie ou la radiothérapie, qui présentent une efficacité élevée mais une faible sélectivité. Ce travail décrit l'élaboration de nanomatériaux pour le diagnostic et le traitement des cancers de faible taille grâce à une nouvelle thérapie: la thérapie photodynamique (PDT). Cette nouvelle technique, implique l'activation d'une molécule photosensibilisatrice (PS) grâce à des longueurs d'onde spécifiques. Cette activation conduit à des cascades de transfert d'énergie qui produisent des espèces oxygénées réactives cytotoxiques provoquant la mort cellulaire.Dans un premier temps, l'élaboration de nanoparticules de silice mésoporeuses (MSN) contenant un agent photosensibilisant de type porphyrine est présentée pour le traitement in vitro du cancer de la prostate et du rétinoblastome grâce à la thérapie photodynamique à un photon. Des nanoparticules fonctionnalisées avec de nouveaux ligands ont été essayées pour cibler les nanoparticules vers les cellules cancéreuses de la prostate. La diminution de la taille des nanoparticules à 20 nm a été élaborée pour traverser la barrière hémato-rétinienne et traiter les rétinoblastomes.D'autre part, deux nouveaux types de nanomatériaux ont été conçus pour le traitement à deux photons qui conduit à une pénétration plus profonde dans les tissus. Des nanoparticules polysilsesquioxane pontés (BS) et des nanoparticules d’organosilice mésoporeuses (PMO) ont été conçues à partir de différents types de molécules photosensibilisatrices tétra-silylées ou octa-silylées et de bis-organo-alcoxysilanes comme l'éthane, l'éthylène ou le disulfide. L’efficacité des BS en imagerie à deux photons en thérapie photodynamique a été démontrée in vitro. Des nanoparticules de BS à base de disulfides ont été conçues comme nouveaux nanomatériaux biodégradables.Enfin, en plus de l'imagerie et la thérapie, les PMO ont été testés in vitro pour la délivrance de médicaments en raison de leur mésoporosité. La gemcitabine et doxorubicine ont été encapsulées dans les pores obtenant des charges élevées en médicaments. Outre les photosensibilisateurs classiques, des PMO cœur-coquille contenant des nanodiamants ont été testés en tant que PS. Pour finir, des PMO à base de porphyrines sont présentés pour la délivrance de gènes in vitro et in vivo utilisant le poisson-zèbre comme modèle

Synthesis and Characterization of Core-Shell Magnetic Mesoporous Silica and Organosilica Nanostructures

Initial results en route toward construction of complex magnetic core-shell silica and organosilica nanotheranostics are presented. Magnetite nanoparticles are synthesized by three different methods and embedded within mesoporous silica and organosilica frameworks by different surfactant-templated procedures to produce three types of core-shell nanoparticles. Magnetite nanoparticles (15 nm in diameter) are embedded within mesoporous silica nanoparticles to produce cell-like material with predominantly one magnetite nuclei-resembling core per nanoparticle, with final particle diameter of ca. 150 nm, specific surface area of 573 m(2)/g and hexagonally structured tubular pores (2.6 nm predominant diameter), extended throughout the volume of nanoparticles. Two forms of spherical core-shell nanoparticles composed of magnetite cores embedded within mesoporous organosilica shells are also obtained by employing ethylene and ethane bridged organobisalkoxysilane precursors. The obtained nanomaterials are characterized by high surface area (978 and 820 m(2)/g), tubular pore morphology (2 and 2.8 nm predominant pore diameters), different diameters (386 and 100-200 nm), in case of ethylene- and ethane-composed organosilica shells, respectively. Different degree of agglomeration of magnetite nanoparticles was also observed in the obtained materials, and in the case of utilization of surfactant-pre-stabilized magnetite nanoparticles for the syntheses, their uniform and non-agglomerated distribution within the shells was noted

Efficient Photodynamic Therapy of Prostate Cancer Cells through an Improved Targeting of the Cation-Independent Mannose 6-Phosphate Receptor

This article belongs to the Special Issue Insights into Photodynamic TherapyThis is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).International audienceThe aim of the present work is the development of highly efficient targeting molecules to specifically address mesoporous silica nanoparticles (MSNs) designed for the photodynamic therapy (PDT) of prostate cancer. We chose the strategy to develop a novel compound that allows the improvement of the targeting of the cation-independent mannose 6-phosphate receptor, which is overexpressed in prostate cancer. This original sugar, a dimannoside-carboxylate (M6C-Man) grafted on the surface of MSN for PDT applications, leads to a higher endocytosis and thus increases the efficacy of MSNs. View Full-TextKeywords: mannose 6-phosphate analogues; binding affinity; mesoporous silica nanoparticles; photodynamic therap

Porphyrin-functionalized mesoporous organosilica nanoparticles for two-photon imaging of cancer cells and drug delivery

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Synthesis of disulfide-based biodegradable bridged silsesquioxane nanoparticles for twophoton imaging and therapy of cancer cells

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The photodynamic therapy: state of the art and perspectives

International audiencePhotodynamic therapy (PDT) is a method of medical treatment using the concomitant action of aphotoactivatable molecule called the photosensitizer (PS), light, and oxygen naturally present in thebiological medium. After light excitation of the photosensitizer, an energy transfer to oxygen allows togenerate the formation of reactive oxygen species, especially singlet oxygen reactive leading to cell death.This technique proves to be very efficient for certain types of cancer (especially in dermatology) and ispromising in other pathologies (prostate, brain). This article briefly describes the principle of PDT and thenanalyzes the latest advances in PDT in terms of clinical applications (actinic keratoses, prostate, braincancer, retinoblastoma) and the use of PDT for antibacterial applications. Finally, the prospects of thistechnique with among others the development of new vesicles or the use of X-rays as a source of energy toovercome the problems of light penetration in tissues are presented

Chick chorioallantoic membrane assay as an in vivo model to study the effect of nanoparticle-based anticancer drugs in ovarian cancer

がんの個別化医療を可能にする患者癌由来の鶏卵モデル. 京都大学プレスリリース. 2018-06-06.New therapy development is critically needed for ovarian cancer. We used the chicken egg CAM assay to evaluate efficacy of anticancer drug delivery using recently developed biodegradable PMO (periodic mesoporous organosilica) nanoparticles. Human ovarian cancer cells were transplanted onto the CAM membrane of fertilized eggs, resulting in rapid tumor formation. The tumor closely resembles cancer patient tumor and contains extracellular matrix as well as stromal cells and extensive vasculature. PMO nanoparticles loaded with doxorubicin were injected intravenously into the chicken egg resulting in elimination of the tumor. No significant damage to various organs in the chicken embryo occurred. In contrast, injection of free doxorubicin caused widespread organ damage, even when less amount was administered. The lack of toxic effect of nanoparticle loaded doxorubicin was associated with specific delivery of doxorubicin to the tumor. Furthermore, we observed excellent tumor accumulation of the nanoparticles. Lastly, a tumor could be established in the egg using tumor samples from ovarian cancer patients and that our nanoparticles were effective in eliminating the tumor. These results point to the remarkable efficacy of our nanoparticle based drug delivery system and suggests the value of the chicken egg tumor model for testing novel therapies for ovarian cancer