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

Frecuencia de casos e identificación molecular de Cryptosporidium spp. en corderos lactantes mantenidos en pastoreo en el estado de Veracruz, México

The objective was to determine the frequency of Cryptosporidium spp., and to identify the species or genotype of the oocysts found, in suckling lambs kept grazing in the Huasteca Alta region, State of Veracruz, Mexico. Fecal samples were collected from 210 lambs Pelibuey, Black Belly, and Katahdin, 7 to 21 d old from 21 sheep farms. Samples were stained with Kinyoun, nested PCR was used to amplify the 18S rRNA gene region of the parasite (830 bp), and positive samples were sequenced. The frequency of animals positive to Cryptosporidium spp by microscopy was 19.5 % (41/210), with a 10 to 50 % range among herds; with molecular techniques, the frequency of positive lambs was 26.8 % (11/41) with a 14 to 50 % range; all other samples were negative to both tests. All 11 samples sequenced showed 100 % homology with the 18S rRNA region of C. parvum. Results confirm the relevance of C. parvum as a major etiology of cryptosporidiosis in lactating lambs and show its broad distribution in this region of Mexico. This identification highlights that sheep can be considered as a significant potential source of human cryptosporidiosis, since it is considered a zoonotic disease, mainly for the people handling the flocks.El objetivo fue determinar la frecuencia de la infección por Cryptosporidium spp., y realizar la identificación de especie o genotipo de los ooquistes en corderos lactantes Pelibuey, Black Belly y Katahdin mantenidos en pastoreo en la región de la Huasteca Alta del estado de Veracruz, México. Las muestras de excremento se recolectaron de 210 corderos de 7 a 21 días de edad, procedentes de 21 granjas; se procesaron mediante frotis fecal teñido con Kinyoun y por PCR anidada para amplificar la región del gen 18S rARN del parásito (830 pb); las muestras positivas fueron secuenciadas. La frecuencia de corderos positivos a Cryptosporidium spp., por microscopía fue 19.5 % (41/210), con una escala entre rebaños de 10 a 50 %; en tanto que por técnicas moleculares fue de 26.8 % (11/41) con un intervalo de 14 a 50 %; las demás muestras fueron negativas a ambas pruebas. Las 11 muestras  secuenciadas tuvieron una homología del 100 % con la región 18S rARN de C. parvum. Estos resultados confirman la importancia de C. parvum como principal agente de la criptosporidiosis en corderos lactantes y su amplia distribución en esta región de México. Esta identificación destaca que las ovejas pueden considerarse como una fuente potencial notable de criptosporidiosis humana, porque se considera una enfermedad zoonótica, principalmente para las personas que manipulan los rebaños.

Novel genes and sex differences in COVID-19 severity.

Here we describe the results of a genome-wide study conducted in 11 939 COVID-19 positive cases with an extensive clinical information that were recruited from 34 hospitals across Spain (SCOURGE consortium). In sex-disaggregated genome-wide association studies for COVID-19 hospitalization, genome-wide significance (p < 5x10-8) was crossed for variants in 3p21.31 and 21q22.11 loci only among males (p = 1.3x10-22 and p = 8.1x10-12, respectively), and for variants in 9q21.32 near TLE1 only among females (p = 4.4x10-8). In a second phase, results were combined with an independent Spanish cohort (1598 COVID-19 cases and 1068 population controls), revealing in the overall analysis two novel risk loci in 9p13.3 and 19q13.12, with fine-mapping prioritized variants functionally associated with AQP3 (p = 2.7x10-8) and ARHGAP33 (p = 1.3x10-8), respectively. The meta-analysis of both phases with four European studies stratified by sex from the Host Genetics Initiative confirmed the association of the 3p21.31 and 21q22.11 loci predominantly in males and replicated a recently reported variant in 11p13 (ELF5, p = 4.1x10-8). Six of the COVID-19 HGI discovered loci were replicated and an HGI-based genetic risk score predicted the severity strata in SCOURGE. We also found more SNP-heritability and larger heritability differences by age (<60 or ≥ 60 years) among males than among females. Parallel genome-wide screening of inbreeding depression in SCOURGE also showed an effect of homozygosity in COVID-19 hospitalization and severity and this effect was stronger among older males. In summary, new candidate genes for COVID-19 severity and evidence supporting genetic disparities among sexes are provided

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field