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

Perinodal adipose tissue and fatty acid composition of lymphoid tissues in patients with and without Crohn's Disease and their implications for the etiology and treatment of CD

The physiological bases for roles of adipose tissue and fatty acids in the symptoms and dietary treatments of Crohn's disease are poorly understood. The hypothesis developed from experiments on rodents that perinodal adipocytes are specialized to provision adjacent lymphoid tissues was tested by comparing the composition of triacylglycerol fatty acids in homologous samples of mesenteric adipose tissue and lymph nodes from patients with or without Crohn's disease. Mesenteric perinodal and other adipose tissue, and lymph nodes, were collected during elective surgery for Crohn's disease and other conditions. Fatty acids were extracted, identified, and quantified by thin-layer and gas-liquid chromatography. Perinodal adipose tissue contained more unsaturated fatty acids than other adipose tissue in controls, as reported for other mammals, but site-specific differences were absent in Crohn's disease. Lipids from adipose and lymphoid tissues had more saturated fatty acids, but fewer polyunsaturates in Crohn's disease patients than controls. In adipose tissue samples, depletion of n-3 polyunsaturates was greatest, but n-6 polyunsaturates, particularly arachidonic acid, were preferentially reduced in lymphoid cells. Ratios of n-6/n-3 polyunsaturates were higher in adipose tissue but lower in lymphoid cells in Crohn's disease patients than in controls. Site-specific differences in fatty acid composition in normal human mesentery are consistent with local interactions between lymph node lymphoid cells and adjacent adipose tissue. But these site-specific properties are absent in Crohn's disease, causing anomalies in composition of lymphoid cell fatty acids, which may explain the efficacy of elemental diets containing oils rich in n-6 polyunsaturates

Avaliação do uso de periódicos em biblioteca especializada em saúde pública Evaluation of the usage of journals in a specialized public health library

Foi feita avaliação do uso de periódicos técnico-científicos da Biblioteca da Faculdade de Saúde Pública da Universidade de São Paulo (FSP/ USP), por um período de seis meses, em 1973/74, com a finalidade de verificar as tendências de interesse de seus usuários. Para a avaliação foi considerado o total de empréstimos realizados no período, sendo desprezados os dados de consulta local e do uso do periódico feito por meio de fotocópias de artigos. O número de consulentes matriculados no período era, em média, de 801, sendo 11,7% pertencentes ao corpo docente da FSP; 40,6% ao discente e 47,5% referentes a consulentes externos. O levantamento foi programado para medir os periódicos circulados considerando as seguintes variáveis: tipo de aquisição; categoria de consulentes; ano da publicação; língua em que o periódico foi publicado e assunto do periódico. Foi medido também o grau de freqüência da circulação, usando-se o método de Bradford. A análise dos resultados mostrou que a circulação foi de 36,5% do total de títulos da coleção (1.530); a zona de concentração dos títulos circulados foi muito baixa, com 3,6% do total de títulos da coleção. Quanto às demais variáveis, verificou-se que 68,3% da circulação coube a periódicos adquiridos por compra; 82,5% a periódicos dos 5 anos mais recentes (1969-1973); 61,2% a periódicos em língua inglesa; 72,5% foi a demanda por parte do corpo docente.<br>A study aiming at the use of periodicals was conducted at the School of Public Health Library, University of S. Paulo, Brazil, during a period of six months, in 1973/74, so as to identify the interest of the users. The total of journals borrowed was considered in this evaluation while local consultation and photocopying were not. The total number of users registered in the period of the study was, on average, 801 (11.4% corresponding to professors; 40.6% to students and 47.5% to other categories). The borrowed, journals were measured by kind of acquisition, category of users, date of publication, language and subject of the journals. Bradford's Law was adopted to measure the degree of frequency of the usage. This study reveals that the circulation was of 36.5% of the total titles of the Library' collection (1530); a core of journals supplies only 3.6% of total journals of the collection; 68.3% represent the subscribed journals; 72.5% was the demand of the Professors; 82.5% of use refers to volumes published in the last 5 years (1969-1973) and the use of English journals was of 61.2%

Insights into MMP-TIMP interactions

Bode W, Fernandez-Catalan C, Grams F, et al. Insights into MMP-TIMP interactions. In: INHIBITION OF MATRIX METALLOPROTEINASES: THERAPEUTIC APPLICATIONS. Annals of the New York Academy of Sciences. Vol 878. NEW YORK ACAD SCIENCES; 1999: 73-91.The proteolytic activity of the matrix metalloproteinases (MMPs) involved in extracellular matrix degradation must be precisely regulated by their endogenous protein inhibitors, the tissue inhibitors of metalloproteinases (TIMPs). Disruption of this balance can result in serious diseases such as arthritis and tumor growth and metastasis, Knowledge of the tertiary structures of the proteins involved in such processes is crucial for understanding their functional properties and to interfere with associated dysfunctions, Within the last few years, several three-dimensional structures have been determined showing the domain organization, the polypeptide fold, and the main specificity determinants of the MMPs. Complexes of the catalytic MMP domains with various synthetic inhibitors enabled the structure-based design and improvement of high-affinity ligands, which might be elaborated into drugs, Very recently, structural information also became available for some TIMP structures and MMP-TIMP complexes, and these new data elucidated important structural features that govern the enzyme-inhibitor interaction