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

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

Effect of different levels of Napier grass (Pennisetum purpureum) on milk production of buffaloes

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Targeting the PI3K p110alpha isoform inhibits medulloblastoma proliferation, chemoresistance, and migration.

PURPOSE: The phosphoinositide 3-kinase (PI3K)/Akt pathway is frequently activated in human cancer and plays a crucial role in medulloblastoma biology. We were interested in gaining further insight into the potential of targeting PI3K/Akt signaling as a novel antiproliferative approach in medulloblastoma. EXPERIMENTAL DESIGN: The expression pattern and functions of class I(A) PI3K isoforms were investigated in medulloblastoma tumour samples and cell lines. Effects on cell survival and downstream signaling were analyzed following down-regulation of p110alpha, p110beta, or p110delta by means of RNA interference or inhibition with isoform-specific PI3K inhibitors. RESULTS: Overexpression of the catalytic p110alpha isoform was detected in a panel of primary medulloblastoma samples and cell lines compared with normal brain tissue. Down-regulation of p110alpha expression by RNA interference impaired the growth of medulloblastoma cells, induced apoptosis, and led to decreased migratory capacity of the cells. This effect was selective, because RNA interference targeting of p110beta or p110delta did not result in a comparable impairment of DAOY cell survival. Isoform-specific p110alpha inhibitors also impaired medulloblastoma cell proliferation and sensitized the cells to chemotherapy. Medulloblastoma cells treated with p110alpha inhibitors further displayed reduced activation of Akt and the ribosomal protein S6 kinase in response to stimulation with hepatocyte growth factor and insulin-like growth factor-I. CONCLUSIONS: Together, our data reveal a novel function of p110alpha in medulloblastoma growth and survival

Esterco bovino e biofertilizante no cultivo de erva-cidreira-verdadeira (Melissa officinalis L.) Cattle manure and biofertilizer on the cultivation of lemon balm (Melissa officinalis L.)

A importância fitoterápica e, consequentemente, econômica da Melissa officinalis tem contribuído para expansão do cultivo. O óleo essencial das folhas é formado por constituintes químicos que podem ser largamente empregados na indústria farmacêutica por possuírem atividades antioxidativa, antivirótica e sedativa. Assim sendo, objetivou-se no presente trabalho avaliar o efeito de combinações de doses de adubação orgânica com biofertilizante comercial e esterco bovino no cultivo de Melissa officinalis. Os tratamentos foram constituídos de quatro doses de biofertilizante orgânico (Vitassolo®) e esterco bovino, sendo estes de 0, 30.000, 60.000 e 90.000 L ha-1. Os tratamentos foram arranjados no delineamento experimental blocos casualizados no fatorial 4x4, com 3 repetições. As características avaliadas foram altura de planta, rendimento de folha, teor e rendimento de óleo essencial. As maiores doses de esterco bovino resultaram em um maior desenvolvimento das plantas, em relação às mesmas doses do biofertilizante.<br>The phytotherapic and economic importance of Melissa officinalis has contributed to its cultivation expansion. The essential oil of leaves is composed of chemical constituents, which can be largely employed in the pharmaceutical industry due to their antioxidant, antivirotic and sedative activities. Thus, the aim of the present work was to evaluate the effect of level combination of organic fertilization with commercial biofertilizer and cattle manure on Melissa officinalis cultivation. Treatments constituted of four levels of organic biofertilizer (Vitassolo®) and cattle manure at 0; 30,000; 60,000 and 90,000 L ha-1. Experimental design was in randomized blocks, in split plot 4X4 factorial arrangement, with three replicates. The characteristics evaluated were plant height, leaf yield, essential oil content and yield. The highest cattle manure levels resulted in higher plant development, compared with the same biofertilizer levels