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

Occurrence of Tetrameres confusa (Nematoda, Tetrameridae) in Ara ararauna (Psittacidae) Ocorrência de Tetrameres confusa (Nematoda, Tetrameridae) em Ara ararauna (Psittacidae)

<abstract language="por">Relata-se a ocorrência de Tetrameres confusa Travassos 1917 (= T. americana (Cram, 1927) Baylis, 1929) (Nematoda, Tetrameridae) em um novo hospedeiro, Ara ararauna Linnaeus, 1758 (Aves, Psittacidae). Este é o primeiro registro da ocorrência do nematódeo em psitacídeos no Brasil

Increased 27-hydroxycholesterol Plasma Level In Men With Low High Density Lipoprotein-cholesterol May Circumvent Their Reduced Cell Cholesterol Efflux Rate

Background: HDL is considered the most important mechanism for the excretion of intracellular cholesterol. The liver is the only organ capable to metabolize cholesterol into bile acid. The enzymatic conversion of cholesterol to bile acid is dependent on the cytochrome P450 microsomal system which is also responsible for the generation of oxysterols. The latter's plasma concentrations may reflect the metabolic processes of specific tissues where they are generated. The objective of this study was to investigate in healthy individuals who differ according to their HDL levels the concentration of oxysterols and relate it to the HDL-dependent cell cholesterol efflux rate. Methods: 24-Hydroxycholesterol, 25-hydroxycholesterol, 27-hydroxycholesterol were determined in plasma by GLC/mass spectrometry in 107 healthy subjects with low HDL (HDL-C. . 1.55. mmol/l). HDL-dependent in vitro cell cholesterol efflux rate was measured in 29 cases. Results: No differences were found in plasma oxysterol concentrations between the Low HDL and High HDL groups. There was a significant negative correlation between HDL-C and 27-hydroxycholesterol. Plasma oxysterol concentrations were significantly lower in female than in male subjects. The Low HDL male group had higher 27-hydroxycholesterol than the High HDL male group. Cell cholesterol efflux rate was lower in Low HDL than in High HDL and related inversely with 27-hydroxycholesterol. Conclusion: As compared to High HDL, Low HDL men have increased 27-hydroxycholesterol plasma level that may circumvent their reduced cell cholesterol efflux rate. © 2014 Elsevier B.V.433169173Gordon, T., Castelli, W.P., Hjortland, M.C., Kannel, W.B., Dawber, T.R., High density lipoprotein as a protective factor against coronary heart disease. The Framingham study (1977) Am J Med, 62, pp. 707-714Rothblat, G.H., Phillips, M.C., High-density lipoprotein heterogeneity and function in reverse cholesterol transport (2010) Curr Opin Lipidol, 21, pp. 229-238Nunes, V.S., Leança, C.C., Panzoldo, N.B., HDL-C concentration is related to markers of absorption and of cholesterol synthesis: study in subjects with low vs. high HDL-C (2011) Clin Chim Acta, 412, pp. 176-180Jakulj, L., Besseling, J., Stroes, E.S., Groen, A.K., Intestinal cholesterol secretion: future clinical implications (2013) Neth J Med, 71, pp. 459-465Tietge, U.J., Groen, A.K., Role the TICE?: advancing the concept of transintestinal cholesterol excretion (2013) Arterioscler Thromb Vasc Biol, 33, pp. 1452-1453Björkhem, I., Meaney, S., Diczfalusy, U., Oxysterols in human circulation: which role do they have? (2002) Curr Opin Lipidol, 13, pp. 247-253Monte, M.J., Marin, J.J., Antelo, A., Vazquez-Tato, J., Bile acids: chemistry, physiology, and pathophysiology (2009) World J Gastroenterol, 15, pp. 804-816Duane, W.C., Javitt, N.B., 27-Hydroxycholesterol: production rates in normal human subjects (1999) J Lipid Res, 40, pp. 1194-1199Axelson, M., Sjovall, J., Potential bile acid precursorsin plasma - possible indicators of biosynthetic pathways to cholic and chenodeoxycholic acids in man (1990) J Steroid Biochem, 36, pp. 631-640Beigneux, A., Hofmann, A.F., Young, S.G., Human CYP7A1 deficiency: progress and enigmas (2002) J Clin Invest, 110, pp. 29-31Lorbek, G., Lewinska, M., Rozman, D., Cytochrome P450s in the synthesis of cholesterol and bile acids-from mouse models to human diseases (2012) FEBS J, 279, pp. 1516-1533Pikuleva, I.A., Cholesterol-metabolizing cytochromes P450 (2006) Drug Metab Dispos, 34, pp. 513-520Lund, E., Andersson, O., Zhang, J., Importance of a novel oxidative mechanism for elimination of intracellular cholesterol in humans (1996) Arterioscler Thromb Vasc Biol, 16, pp. 208-212Bretillon, L., Lütjohann, D., Ståhle, L., Plasma levels of 24S-hydroxycholesterol reflect the balance between cerebral production and hepatic metabolism and are inversely related to body surface (2000) J Lipid Res, 41, pp. 840-845Dietschy, J.M., Turley, S.D., Thematic review series: brain lipids. Cholesterol metabolism in the central nervous system during early development and in the mature animal. (2004) J Lipid Res, 45, pp. 1375-1397Leoni, V., Caccia, C., 24S-hydroxycholesterol in plasma: a marker of cholesterol turnover in neurodegenerative diseases (2013) Biochimie, 95, pp. 595-612Leoni, V., Oxysterols as markers of neurological disease-a review (2009) Scand J Clin Lab Invest, 69, pp. 22-25Lund, E.G., Kerr, T.A., Sakai, J., Li, W.P., Russell, D.W., CDNA cloning of mouse and human cholesterol 25-hydroxylases, polytopic membrane proteins that synthesize a potent oxysterol regulator of lipid metabolism (1998) J Biol Chem, 273, pp. 34316-34327Russell, D.W., Oxysterol biosynthetic enzymes (2000) Biochim Biophys Acta, 529, pp. 126-135Weingärtner, O., Laufs, U., Böhm, M., Lütjohann, D., An alternative pathway of reverse cholesterol transport: the oxysterol 27-hydroxycholesterol (2010) Atherosclerosis, 209, pp. 39-41Karuna, R., Holleboom, A.G., Motazacker, M.M., Plasma levels of 27-hydroxycholesterol in humans and mice with monogenic disturbances of high density lipoprotein metabolism (2011) Atherosclerosis, 214, pp. 448-455Burkard, I., von Eckardstein, A., Waeber, G., Vollenweider, P., Rentsch, K.M., Lipoprotein distribution and biological variation of 24S- and 27-hydroxycholesterol in healthy volunteers (2007) Atherosclerosis, 194, pp. 71-78Babiker, A., Diczfalusy, U., Transport of side-chain oxidized oxysterols in the human circulation (1998) Biochim Biophys Acta, 1392, pp. 333-339Dzeletovic, S., Breuer, O., Lund, E., Diczfalusy, U., Determination of cholesterol oxidation products in human plasma by isotope dilution-mass spectrometry (1995) Anal Biochem, 225, pp. 73-80Ketomäki, A., Gylling, H., Siimes, M.A., Vuorio, A., Miettinen, T.A., Squalene and noncholesterol sterols in serum and lipoproteins of children with and without familial hypercholesterolemia (2003) Pediatr Res, 539, pp. 648-653Björkhem, I., Andersson, O., Diczfalusy, U., Atherosclerosis and sterol 27-hydroxylase: evidence for a role of this enzyme in elimination of cholesterol from human macrophages (1994) Proc Natl Acad Sci U S A, 91, pp. 8592-8596Janowski, B.A., Willy, P.J., Devi, T.R., Falck, J.R., Mangelsdorf, D.J., An oxysterolsignalling pathway mediated by the nuclear receptor LXR alpha (1996) Nature, 383, pp. 728-731Peet, D.J., Turley, S.D., Ma, W., Cholesterol and bile acid metabolism are impaired in mice lacking the nuclear oxysterol receptor LXR alpha (1998) Cell, 93, pp. 693-704Hirayama, T., Mizokami, Y., Honda, A., Serum concentration of 27-hydroxycholesterol predicts the effects of high-cholesterol diet on plasma LDL cholesterol level (2009) Hepatol Res, 39, pp. 149-156Umetani, M., Shaul, P.W., 27-Hydroxycholesterol: the first identified endogenous SERM (2011) Trends Endocrinol Metab, 22, pp. 130-135Yamamoto, Y., Moore, R., Hess, H.A., Estrogen receptor alpha mediates 17alpha-ethynylestradiol causing hepatotoxicity (2006) J Biol Chem, 281, pp. 16625-16631Nunes, V.S., Leança, C.C., Panzoldo, N.B., Plasma 27-hydroxycholesterol/cholesterol ratio is increased in low high density lipoprotein-cholesterol healthy subjects (2013) Clin Biochem, 46, pp. 1619-1621Kannenberg, F., Gorzelniak, K., Jager, K., Characterization of cholesterol homeostasis in telomerase-immortalized tangier disease fibroblasts reveals marked phenotype variability (2013) J Biol Chem, 288, pp. 36936-36947Björkhem, I., Diczfalusy, U., Lütjohann, D., Removal of cholesterol from extrahepatic sources by oxidative mechanisms (1999) Curr Opin Lipidol, 10, pp. 161-16

Ilex paraguariensis extracts extend the lifespan of Drosophila melanogaster fed a high-fat diet

<div><p>Studies have suggested that total energy intake and diet composition affect lifespan and ageing. A high-fat diet induces oxidative stress and affects the development of diseases. In contrast, antioxidants are capable of reducing its harmful effects. Yerba mate beverages are an important source of antioxidants, but there is scarce knowledge about their effects on suppressing fat accumulation. Here, we investigated the compounds present in yerba mate extracts and assessed their effects on Drosophila melanogaster given a high cholesterol diet. LS-ESI-MS analysis showed the presence of matesaponins, phenolic compounds and methylxanthines in all of the examined extracts. In Drosophila, under extract treatment conditions, the mean lifespan was significantly extended from 38 to 43 days, there was an increase in the ability to support induced stress and decrease in lipid peroxidation products. Moreover, yerba mate extracts recovered the glutathione S-transferases (GST) activity and reduced the cholesterol level. Taken together, our results support that extracts can extend lifespan by reducing the detrimental effect of a high-fat diet in D. melanogaster, and this outcome can be associated with the compound content in the extracts. This study improves the understanding of natural interventions that reduce stress-induced oxidative damage, which is fundamental in promoting healthy ageing.</p></div