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

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

Identification and characterization of potato protease inhibitors able to inhibit pathogenicity and growth of Botrytis cinerea

Different tissues of potato, tobacco, and bean plants were screened for anti-fungal protease inhibitor (PI) activity, also following fungal pathogen inoculation or mechanical wounding. A potato (Solanum tuberosum var. Desireé) sprout protein extract showed a strong inhibitory activity against chymotrypsin and Botrytis cinerea fungal proteases, but also on spore germination, hyphal elongation, and development of necrotic lesions. An active mixture of different proteins was affinity column purified and sequenced. Two new anti-fungal genes, PKI1 and PPI3B2, coding, respectively, for a Kunitz-type inhibitor and a Proteinase Inhibitor 1 capable of reducing fungal lesion development, were cloned and partially characterized. Direct effect on leaf necrosis formation was found to be dependent on the anti-chymotrypsin activity of both selected inhibitors. The PKI1 transcript was found to accumulate in untreated sprout tissues, although homologues of this gene seemed to accumulate following Bemisia tabaci attack. In the case of PPI3B2, we provide preliminary evidence that a member of the Proteinase Inhibitor 1 family is active against not only herbivorous insects but also phytopathogenic fungi and foliar lesions caused by them