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

Scapulothoracic arthrodesis for winged scapula due to facioscapulohumeral dystrophy (a new technique).

We introduced a new scapulothoracic arthrodesis technique in 6 patients (2 bilaterally) with winging of the scapula due to facioscapulohumeral muscular dystrophy from 1984 to 2000. The procedure involved a combination of plating and wiring techniques. The indications were symptomatic winging, limitation of active shoulder motion, pain, and impaired daily living activity. Our objective was to improve motion, strength, and performance of activities of daily living, as well as to provide pain relief. As a result of the technique, active motion improved in all patients, flexion improved from 64 degrees to 104 degrees, and abduction improved from 67.5 degrees to 112.5 degrees. The only complication was a hemothorax in a bilateral case that was easily treated. The length of follow-up averaged 32.5 months (14-55 months), and results did not change with time

Do autologous growth factors enhance transforaminal lumbar interbody fusion?

10.1007/s00586-003-0548-5European Spine Journal124400-407ESJO

Feasibility, Safety, and Beneficial Effects of MCT-Based Ketogenic Diet for Breast Cancer Treatment: A Randomized Controlled Trial Study

The present study was aimed to evaluate the safety, tolerability, and beneficial effects of a ketogenic diet (KD) on body composition and blood parameters and survival in patients with breast cancer. In this randomized, controlled trial, 60 patients with locally advanced or metastatic breast cancer and planned chemotherapy, were randomly assigned to a group receiving KDs (n = 30) or to a control group with standard diet (n = 30) for 3 months. Serum biochemical parameters and body composition were analyzed at baseline, every 3 weeks and end of each arm. Compliance and safety of KD were also checked weekly. Fasting blood sugar (FBS) was significantly decreased in intervention group compared to the baseline (84.5 ± 11.3 vs. 100.4 ± 11.8, P = 0.001). A significant inter-group difference was also observed for FBS level at end of intervention. There was an increasing trend in serum levels of ketone bodies in intervention group (0.007�0.92, P < 0.001). Compared to the control group, BMI, body weight, and fat were significantly decreased in intervention group in last visit (P < 0.001). No severe adverse side effect was found regarding lipid profile and kidney or liver marker. Overall survival was higher in KD group compared to the control group in neoadjuvant patients (P = 0.04). Our results suggested that chemotherapy combined with KDs can improve the biochemical parameters, body composition, and overall survival with no substantial side effects in patients with breast cancer. © 2019, © 2019 Taylor & Francis Group, LLC

The estimation of survival function for colon cancer data in Tehran using non-parametric Bayesian model

Background: Colon cancer is the third cause of cancer deaths. Although colon cancer survival time has increased in recent years, the mortality rate is still high. The Cox model is the most common regression model often used in medical research in survival analysis, but most of the time the effect of at least one of the independent factors changes over time, so the model cannot be used. In the current study, the survival function for colon cancer patients in Tehran is estimated using non-parametric Bayesian model. Methods: In this survival study, 580 patients with colon cancer who were recorded in the Cancer Research Center of Shahid Beheshti University of Medical Sciences since April 2005 to November 2006 were studied and followed up for a period of 5 years. Survival function was plotted with nonparametric Bayesian model and was compared with the Kaplan-Meier curve. Results: Of the total of 580 patients, 69.9 of patients were alive. 45.9 of patients were male and the mean age of cancer diagnosis was 65.12 (SD= 12.26) and 87.7 of the patients underwent surgery. There was a significant relationship between age at diagnosis and sex and the survival time while there was a non-significant relationship between the type of treatment and the survival time. The survival functions corresponding to the two treatment groups cross, in comparison with the patients who had no surgery in the first 30 months, showed a higher level of risk in the patients who underwent a surgery. After that, the survival probability for the patients undergoing a surgery has increased. Conclusion: The study showed that survival rate has been higher in women and in the patients who were below 60 years at the time of diagnosis