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

Trace elements analysis in biological samples by proton nuclear activation

A method for the multielemental analysis of trace elements in biological samples by medium energy proton nuclear activation (PNA) has been developed. The response linearity, reproducibility and reliability of the method have been tested by a set of preliminary measurements. Results concerning the quantitative determination of the concentrations of Sr, Cu, Fe, Zn and Se in human serum are presented. Activation was induced with a 23 MeV proton beam from the AVF cyclotron of the University of Milan, by means of (p, 2n) reactions on the nuclei of the elements under study. The quantitative determination was obtained by an internal reference method and by comparison with a standard sample of serum doped with known quantities of the elements of interest. A clinical investigation of the zinc content of serum in children has been performed

Cadmium and titanium in human serum determined by proton nuclear activation

An investigation of the quantitative content of Cd and Ti in human serum samples by proton nuclear activation (PNA) has been performed and the results are presented. The activation had been induced by a 13.5 MeV proton beam of the AVF cyclotron of the University of Milan, via a (p, n) reaction on the nuclei of the target. For the quantitative determination a known amount of a reference element has been added to the samples and comparison has been made with a standard sample containing also known quantities of the elements studied. Response linearity, reproducibility and possible contaminations have been tested

Isolation and characterization of glutamine synthetase from the diazotroph Azospirillum Brasilense

Glutamine synthetase was purified from the diazotroph Azospirillum brasilense. The holoenzyme with a M(r) of 630,000 is composed of 12 subunits of M(r) 52,000. A modified subunit of M(r) 53,000 was also found by electrophoresis under denaturing conditions. It is shown that the M(r) 53,000 species is the adenylylated subunit. The apparent K(m) values for glutamate, ATP and ammonia were 2.5 \ub1 0.3 mM, 200 \ub1 20 \u3bcM and 42 \ub1 2 \u3bcM, respectively. Levels of glutamine synthetase activity in A. brasilense cells varied by a factor of 8 depending on the nitrogen source and its concentration in the growth medium

Chromium in human serum determined by proton activation

A method for Cr determination in biological samples based on proton nuclear activation is presented. The activation was induced by a 13.8 MeV proton beam of the AVF Cyclotron of Milan University via a (p, n) reaction on the nuclei of the target. For the quantitative determination Cd has been chosen as reference element. The method has been applied to Cr determination in human serum samples. The experimental procedure is described and results are presented and discussed

A functional heterologous electron-transfer protein complex: Desulfovibrio vulgaris flavodoxin covalently linked to spinach ferredoxin-NADP+ reductase

The water-soluble carbodiimide, N-ethyl-3-(3-dimethylaminopropyl)carbodiimide was found to readily promote formation of cross-links between spinach ferredoxin-NADP+ reductase and bacterial flavodoxins. The covalent complex between ferredoxin-NADP+ reductase and the Desulfovibrio vulgaris flavodoxin had a stoichiometry of 1 mol of flavodoxin per mole of the reductase, as assessed by denaturing electrophoresis, gel filtration and spectral analysis. The reductase moiety of the cross-linked complex gained the capacity to catalyze at a high rate the electron transfer from NADPH to cytochrome c without addition of free flavodoxin in the assay. The pH optimum for this activity was shifted to the alkaline region with respect to that for the noncovalent complex. FMN, the prosthetic group of flavodoxin, is required for electron transfer from the reductase FAD to cytochrome c. Structural studies carried out on the cross-linked complex allowed the identification of the peptide regions of the proteins involved in the interaction. The CNBr peptide 61-155 of the reductase was found cross-linked to the uncleaved flavodoxin, while the cross-linked region in flavodoxin appeared to be within the tryptic peptide 37-86. Treatment of flavodoxin with the carbodiimide in the presence of glycine ethyl ester brought about the modification of a few carboxyl groups and prevented its interaction with the reductase. It can be concluded that the bacterial flavodoxin binds to the reductase in a way similar to that of the physiological substrate ferredoxin (G. Zanetti, D. Morelli, S. Ronchi, A. Negri, A. Aliverti, and B. Curti, 1988, Biochemistry 27, 3753-3759). The cross-linked complex here described represents an useful model for studying electron transfer between the two flavoproteins

Two weeks\u2019 quetiapine treatment for schizophrenia, drug-induced psychosis and borderline personality disorder : a naturalistic study with drug plasma levels

OBJECTIVE: To evaluate clinical outcomes and the tolerability of 2 weeks' quetiapine (QTP) treatment for hospitalised patients in a naturalistic setting. METHODS: Patients with schizophrenia (n = 18), drug-induced psychosis (n = 10; 3 cocaine, 4 hashish and marijuana, and 3 all three substances) or borderline personality disorder (n = 13), were diagnosed by two expert clinicians on the basis of an unstructured clinical interview, and were treated with QTP (250-1000 mg/day). The subjects were then clinically assessed at baseline, and after 7 and 15 days, using the Brief Psychiatric Rating Scale, the Positive and Negative Symptoms Scale (PANSS) and the Hamilton Rating Scale for Depression. At the end of the study, plasma QTP levels were determined and examined in relation to clinical outcome and tolerability. RESULTS: The mean scores of each rating scale were significantly lower at the end of the study in the population as a whole, and within each diagnostic group. The percentage improvement was significantly greater in the patients with drug-induced psychosis than in those with schizophrenia (42.4 +/- 9.1% versus 23.6 +/- 13.5%). QTP was well tolerated, and the incidence of extrapyramidal side effects was low. There was a linear correlation between plasma levels and dose/kg of QTP (r = 0.31; p < 0.05). The improvement in PANSS significantly correlated with plasma levels and dose/kg in each diagnostic category (Spearman's coefficient was 0.75 [p < 0.01] for schizophrenia and borderline personality disorder, and was 0.68 [p < 0.05] for drug-induced psychosis). CONCLUSION: The results suggest that 2 weeks' QTP treatment may improve the clinical outcome of psychotic re-exacerbation phases in different diagnostic categories and indicate that QTP improves clinical outcome in drug-induced psychosis, as QTP levels correlated with the clinical improvement measured by PANSS

Method for measuring suture tension in surgery

This note describes the principles and the electronic circuitry used for a device to measure suture tension during surgery. As suture tension is the force per unit length necessary to bring into contact the two lips of the cut, the authors used a transducer which converts force into an electrical quantity, and which is applied to two holders which are fixed on each border of the cut. 4 Refs