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

Método óptimo para la obtención de plasma rico en plaquetas en el Servicio de Clínica del Dolor del CMN 20 de noviembre ISSSTE

Objective: To determine the optimal method to collect platelet-rich plasma (PRP). Material and methods: We collected 15 ml of blood from 36 healthy adults to determine platelet count and to test which of the following three protocols were the best to collect PRP. We used 3 ml of blood for each method: protocol 1: (n = 21) the blood tube was tested at 1200 revolutions per minute (RPM) in 2 centrifuge cycles of 8 minutes each; protocol 2 (n = 8): 1200 RPM/1 cycle/8 minutes, and protocol 3: (n = 7): 1200 RPM/1 cycle/10 minutes. From the blood samples that we collected, we also analyzed 1 ml of plasma to determine platelet performance by using an automatic flow cytometer (BD FACSCanto II). Platelet performance was determined by the following formula: platelet PRP count (100)/platelet count from total blood. The statistical method used were measures of central tendency, Chi-square, t-test, analysis of variance and the Wilcoxon and Kruskal-Wallis tests. Results: The basal overall count of platelet was 261.2 miles/mcl for the three methods (p = 0.906), 662.3 ± 243.3 (p = 0.001) for protocol 1; 377.9 ± 101.4 (p = 0.008) for protocol 2 and 30.9 ± 18.8 (p = 0.016) for protocol 3. Platelet performances were 255.2 ± 57.6 %; 149.3 ± 24.6 %; 13.3 ± 11.6 % respectively. Conclusion: Applying the first protocol we obtain PRP (1200 RPM/2 cycles of 8 minutes each). This study was done in healthy adults; however, future studies with a larger sample size are needed to confirm our findings of this method. In case of collecting platelets in studies with greater population being the adequate, its clinical utility should be validated by including patients with chronic and degenerative diseases and take care of associated diseases.Objetivos: Describir el método óptimo para obtener plasma rico en plaquetas (PRP). Material y métodos: Previo consentimiento informado, se obtuvieron de 36 pacientes sanos una muestra sanguínea de 15 ml distribuidos en 5 tubos estériles: uno para obtención de biometría hemática y el resto se sometieron a alguno de los 3 protocolos para obtención de plasma rico en plaquetas. Protocolo 1 (n = 21): 1200 rpm/2 ciclos/8 minutos (cada ciclo); protocolo 2 (n = 8): 1200 rpm/1 ciclo de centrifugado/8 minutos. Protocolo 3 (n = 7): 1200 rpm/1 ciclo de centrifugado/10 minutos. De las muestras obtenidas, se analizó 1 ml de plasma mediante citómetro de flujo automatizado (BD FACSCanto II) y se determinó el rendimiento plaquetario mediante la fórmula: recuento de plaquetas PRP (100)/recuento de plaquetas de sangre total. El método estadístico empleado fue medidas de tendencia central, Chi cuadrado, t de Student, análisis de varianza, prueba de Wilcoxon y probabilidad de Kruskal-Wallis. Resultados: El promedio de concentración basal plaquetaria fue de 261.2 miles/mcl para los 3 métodos (p = 0.906). Después del proceso de centrifugado para protocolo 1 fue 662.3 ± 243.3 (p = 0.001); protocolo 2, 377.9 ± 101.4 (p = 0.008) y 30.9 ± 18.8 (p = 0.016) para el 3. El rendimiento fue: 255.2 ± 57.6 %; 149.3 ± 24.6 %; 13.3 ± 11.6 %, respectivamente. Conclusión: Se logró obtener PRP aplicando el primer protocolo (1200 rpm/2 ciclos/8 minutos cada ciclo). El estudio se realizó en pacientes adultos sanos, sin embargo, se tendrán que realizar estudios posteriores con una mayor población para comprobar la efectividad de este método. En caso de que la obtención plaquetaria en estudios con mayor población sea la adecuada, deberá validarse su utilidad clínica en paciente con enfermedades crónico degenerativas y se tomen en cuenta las enfermedades concomitantes

Parkinson’s disease: an update on preclinical studies of induced pluripotent stem cells

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease among adults worldwide. It is characterised by the death of dopaminergic neurons in the substantia nigra pars compacta and, in some cases, presence of intracytoplasmic inclusions of α-synuclein, called Lewy bodies, a pathognomonic sign of the disease. Clinical diagnosis of PD is based on the presence of motor alterations. The treatments currently available have no neuroprotective effect. The exact causes of PD are poorly understood. Therefore, more precise preclinical models have been developed in recent years that use induced pluripotent stem cells (iPSC). In vitro studies can provide new information on PD pathogenesis and may help to identify new therapeutic targets or to develop new drugs. Resumen: La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más común a nivel mundial en adultos mayores. Se caracteriza por la pérdida de neuronas dopaminérgicas (nDAs) en la sustancia nigra pars compacta del mesencéfalo y en algunos casos acompañada de la aparición de cuerpos intracitoplásmaticos de Lewy de α-sinucleína, signo patognomónico de la enfermedad. La EP se diagnostica clínicamente por la presencia de alteraciones motoras principalmente y en la actualidad los tratamientos presentan nula actividad neuroprotectora. Aún no se han establecido las causas exactas de la EP, por lo que, en los últimos años se ha buscado el desarrollo de modelos preclínicos más precisos, utilizando células troncales pluripotentes inducidas (iPSCs). Permitiendo el estudio de la enfermedad de manera in vitro para generar conocimiento novedoso sobre su patogénesis y el descubrimiento de nuevos posibles blancos terapéuticos o el desarrollo de nuevos fármacos

Ultrathin Plasma Polymer Passivation of Perovskite Solar Cells for Improved Stability and Reproducibility

Despite the youthfulness of hybrid halide perovskite solar cells, their efficiencies are currently comparable to commercial silicon and have surpassed quantum-dots solar cells. Yet, the scalability of these devices is a challenge due to their low reproducibility and stability under environmental conditions. However, the techniques reported to date to tackle such issues recurrently involve the use of solvent methods that would further complicate their transfer to industry. Herein a reliable alternative relaying in the implementation of an ultrathin plasma polymer as a passivation interface between the electron transport layer and the hybrid perovskite layer is presented. Such a nanoengineered interface provides solar devices with increased long-term stability under ambient conditions. Thus, without involving any additional encapsulation step, the cells retain more than 80% of their efficiency after being exposed to the ambient atmosphere for more than 1000 h. Moreover, this plasma polymer passivation strategy significantly improves the coverage of the mesoporous scaffold by the perovskite layer, providing the solar cells with enhanced performance, with a champion efficiency of 19.2%, a remarkable value for Li-free standard mesoporous n-i-p architectures, as well as significantly improved reproducibility