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

Combination of Capecitabine and Phenytoin May Cause Phenytoin Intoxication: A Case Report

Capecitabine is an oral antineoplastic agent, and phenytoin is an anticonvulsant drug with a narrow therapeutic index. Although the interaction between capecitabine and phenytoin is rare, it may be potentially fatal. This interaction is thought to be at the level of CYP2C9 isoenzyme system in the liver. Here, we present a patient with metastatic breast cancer who developed phenytoin intoxication when using capecitabine and phenytoin together. Closely monitoring plasma phenytoin levels is essential if capecitabine is used with phenytoin concurrently

Chondrostoma smyrnae, a new nase from the Tahtalı reservoir drainage in the Aegean Sea basin (Teleostei, Leuciscidae)

Chondrostoma smyrnae, a new species, from the Tahtalı reservoir drainage is distinguished by having a slightly arched lower jaw with a well-developed keratinised edge, a deep and cylindric body, a complete lateral line with 47–52+1 total scales, 8–9 scale rows between the lateral line and the dorsal-fin origin, 4 scale rows between the lateral line and the pelvic fin-origin, and 19–23 gill rakers on the first gill arch. Moreover, molecular analyses using full cyt b (1141 bp) and partial coI (652 bp) sequences of the mitochondrial genome from specimens of the new species, C. smyrnae and specimens belonging to other Chondrostoma species from central and western Anatolia demonstrated that the C. smyrnae is easily differentiated by their high pairwise genetic distances of cyt b and coI data set (>2.20 and 1.03%, respectively) and by their position in the phylogenetic trees obtained through Maximum Likelihood (ML) methodology

Effects of Irrigation Levels on Biochemical Traits of Popcorn Kernels

Biochemical quality traits of popcorn may exhibit significant variations based on growing conditions. Number of studies about the irrigation-dependent changes in biochemical traits of popcorn kernels is quite limited. This study was conducted to determine the effects of different irrigation levels (50%, 75%, 100% and 125% of depleted water from the field capacity) on protein characteristics (crude protein and pepsin protein digestibility), starch characteristics (total starch, resistant and non-resistant starch, amylose-amylopectin content), oil and fatty acids and mineral contents of popcorn kernels. Experimental results were assessed through variance and biplot analyses. Irrigation levels had highly significant effects on biochemical traits of popcorn kernels. Irrigations increased kernel protein and starch contents and decreased dietary fiber and amylose contents. Linoleic acid contents increased and oleic acid contents decreased with increasing irrigation levels. The greatest palmitic and stearic acid contents were obtained from I100 treatments. Na and Fe contents increased with increasing irrigation levels. The greatest Mg and Zn contents were obtained from I100 irrigation level and the greatest Ca content was obtained from I75 irrigation level. In present biplots generated for visual assessment of the changes in investigated traits with irrigation levels, oleic acid, amylopectin and dietary fiber contents were placed into the same sector with I50 treatment; Zn, stearic acid, palmitic acid and Mg contents were placed into the same sector with I100 treatment; the other traits were placed into the same sector with I125 treatment. Two principle components (PC1 and PC2) explained 96.55 of total variation indicating significance of investigated traits based on irrigation levels. It was concluded based on present findings that biochemical traits, fatty acid composition and mineral contents of popcorn kernels could be improved through the use of different irrigation levels and irrigation levels should be arranged based on soil conditions to improve quality traits of popcorn kernels

Phylogeography of the genusChondrostomaAgassiz, 1835 (Teleostei: Leuciscidae) in Anatolia, as inferred from mitochondrial DNA analysis

WOS: 000550952000001The molecular phylogeny of the Anatolian species of the genusChondrostoma(Cypriniformes: Leuciscidae) was studied by sequencing of the mitochondrial cyt b gene. A total of 144 tissue samples from 14 described species were collected from 35 different localities in Turkey. in total, 74 cyt b haplotypes were identified. Haplotype network construction and phylogenetic analysis allocated all 14 species to two main haplogroups that are congruent with those currently accepted on the basis of morphological characteristics. the first haplogroup, the Nasus lineage, is distributed across Caucasia and the Black Sea and Marmara regions and is also represented in the Aegean basin. the second haplogroup, the Regium lineage, is distributed from eastern Anatolia to the Mediterranean Sea basin. Based on estimates generated in this study, the radical divergence between the mainChondrostomahaplogroups in Turkey occurred during the late Miocene (Tortonian stage) and late Pliocene Period, approximately 5.82 Mya (8.48-3.45 Mya). the splitting of the Nasus lineage occurred approximately 5.11 Mya, in the early Pliocene, and the Regium Lineage diverged from its sister group, the Nasus lineage approximately 4.77 Mya. the primary diversification events for the species belonging to these two haplogroups occurred in the Late Pliocene to Early Pleistocene which coincides with the uplifting of the Anatolian plateau about 2.5-3.0 Mya.Scientific and Technological Research Council of Turkey (TUBITAK), Directorate of Academic Research Funding Programmes (ARDEB)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [KBAG-111T900]This study was funded by a government grant from the Scientific and Technological Research Council of Turkey (TUBITAK), Directorate of Academic Research Funding Programmes (ARDEB) (Project No: KBAG-111T900)

The association between aspirin resistance and extent and severity of coronary atherosclerosis

WOS: 000453318400008PubMed ID: 30859163OBJECTIVE: Uncontrolled inflammatory responses could contribute to the pathogenesis of many leading causes of human morbidity and mortality. Aspirin is an anti-inflammatory and antithrombotic drug that is used in the primary and secondary protection in atherothrombotic diseases and complications. The aim of the present study was to analyze the effect of aspirin resistance on the extent and severity of atherosclerosis. METHODS: One hundred patients who underwent coronary angiography with suspected or known coronary artery disease and were using aspirin were enrolled in the study. RESULTS: Of these 100 patients, 30 (8 female and 22 male) formed the aspirin-resistant group (ARG), and 70 (22 female and 48 male) formed the control group. Gensini scoring system (GSS) was significantly higher in the ARG than in the control group (80.5 (36-166) vs. 45 (2-209); p<0.001). The number of percutaneous coronary intervention (PCI) patients was significantly higher in the ARG (13 of 30 (43.3%) ARG vs. 13 of 70 (18.6%) control group; p=0.01). Furthermore, when we evaluate the 16 reintervention patients, stent restenosis was significantly higher in the ARG (11 of 16 (68.75%) ARG vs. 5 of 16 (31.25%) control group; p=0.016). Multivariate logistic regression analysis revealed that GSS (p=0.038; 95% CI: 1.001-1.026) and PCI history (p=0.017; 95% CI: 1.182-89.804) were independent risk factors for aspirin resistance. CONCLUSION: In conclusion, atherosclerotic burden as calculated by the GSS is significantly higher in aspirin-resistant patients. According to this result, we suggest that aspirin treatment can be prescribed in higher doses in aspirin resistance patients with coronary events. Furthermore, GSS and PCI history could be independent predictors of aspirin resistance

Taxonomic review of the Chondrostoma (Teleostei, Leuciscidae) species from inland waters of Turkey: an integrative approach

The genus Chondrostoma (Leuciscidae: Leuciscinae), composed of small to medium-sized fish with a scraper feeding characteristic, is distributed in the West and Middle East, Caucasus, Europe and Northern Mediterranean drainages. This genus spreads across Anatolia and Thrace, with the exception of Göksu and Eşen rivers in Turkey’s Mediterranean basin. It is also difficult to understand the systematics of Chondrostoma, which is complicated morphologically. Therefore, in this study, an identification key was made by evaluating external morphology, osteology (some jaw bones and 5th ceratobrachial) and molecular features together. A total of 13 valid species have been so far recorded from Turkish inland waters, among which are C. beysehirense, C. ceyhanensis, C. colchicum, C. cyri, C. holmwoodii, C. kinzelbachi, C. meandrense, C. nasus, C. regium, C. smyrnae, C. toros, C. turnai and C. vardarense. Our molecular data showed that C. angorense (Kızılırmak and Sakarya rivers) is a synonym of C. colchicum (Çoruh and Yeşilırmak rivers). In addition, C. angorense was morphologically similar to C. colchicum. Therefore, we explored the systematic position of C. vardarense (from Meriç River) and C. nasus (from Simav River) in this study

A new Chondrostoma species from the Buyuk Menderes River Basin, Turkey (Teleostei: Cyprinidae)

GUCLU, Salim Serkan/0000-0002-9256-449XWOS: 000445800000004In a study of the fishes of the Buyuk Menderes River Basin, Aegean region of Turkey, two populations of Chondrostoma were found which showed clearly distinctive characters: the population from the Upper B. Menderes (Ikl Lake) was attributed to C. meandrense Elvira, 1987, while the population from the Cine Stream in the Lower B. Menderes River basin proved to be a hitherto undescribed species: Chondrostoma turnai sp. n. Altogether 24 metric and 7 meristic parameters were compared. the new species is distinguished from C. meandrense and all other cogeners by a combination of the number of lateral line scales, the number of scale rows between the lateral line and the dorsal-fin origin, the number of scale rows of the lateral line and pelvic-fin origin, and the number of gill rakers on the first gill arch.http://www.zoobank.org/urn:lsid:zoobank.org:pub:811C213D-BEDD-4C8C-AE57-BFFA7964781AScientific and Technological Research Council of Turkey (TuBTAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [KBAG-111T900]This study was supported by a grant from the Scientific and Technological Research Council of Turkey (TuBTAK) (Project No: KBAG-111T900)

Same Chemotherapy Regimen Leads to Different Myelotoxicity in Different Malignancies: A Comparison of Chemotherapy-Associated Myelotoxicity in Patients With Advanced Ovarian and Non-Small-Cell Lung Cancer.

Carboplatin-paclitaxel chemotherapy combination is the standard first-line treatment of advanced ovarian cancer and is the most commonly used treatment combination shown to be effective in advanced non-small-cell lung cancer (NSCLC). The most important dose-limiting side effect is hematologic toxicity. In this study, the severity of treatment-related myelotoxicity is compared in patients with advanced ovarian and lung cancers who received same schedule of carboplatin-paclitaxel. The study was prospectively performed from February 2009 to July 2011 and involved 103 patients with stages Ic-IV ovarian (n = 51) and advanced NSCLC (n = 52) who were administered a maximum of 6 cycles of carboplatin-paclitaxel as a first-line treatment. Full blood counts were measured before treatment, before each chemotherapy cycle during therapy, and at the first and sixth month after therapy. The median ages were 59 years (range, 35-77 years) for patients with NSCLC and 56 years (range, 38-75 years) for patients with ovarian cancer. The frequencies of anemia were 17% and 28.6% before the initiation of chemotherapy, 39.2% and 68.0% at the third cycle of treatment, and 44.2% and 45.2% at the sixth cycle of treatment in patients with NSCLC and ovarian cancer, respectively. Initial leukopenia rates were 3.4% and 0%; at the third cycle 46.0% and 41.2%; and at the sixth cycle 41.9% and 48.8% in patients with NSCLC and ovarian cancer, respectively. At the third cycle, 2.5% of the patients with NSCLC and 10.4% of the patients with ovarian cancer had thrombocytopenia, and at the sixth cycle, 23.3% of the patients with NSCLC and 25% of the patients with ovarian cancer had thrombocytopenia. Hemoglobin, leukocyte, and platelet values at the third cycle were significantly lower than those at admission in both cancer groups. Declines in hemoglobin levels in patients with NSCLC and in platelets in patients with ovarian cancer at the sixth cycle were statistically significant compared with the third cycle. In conclusion, the same schedule of chemotherapy may lead to different myelotoxicities in different types of cancer. These results should be taken into consideration in terms of supportive care and management of toxicity

Wpływ sedacji w trakcie echokardiografii przezprzełykowej na zmienność rytmu serca: porównanie sedacji za pomocą hipnozy z sedacją farmakologiczną

Background: There is no ideal sedation technique that can be used during transoesophageal echocardiography (TEE), and the data concerning the effects of available sedation techniques on heart rate variability (HRV) are limited. Aim: To compare the effects of sedation through hypnotherapy with medical sedation achieved by midazolam on HRV. Methods: We recruited 76 patients with an indication of TEE; the age range was 18–83 years. In Group T there were 26 patients who had the procedure under topical pharyngeal anaesthesia, in Group D there were 23 patients who received midazolam, and in Group H there were 27 patients receiving hypnosis. All patients had an IV access; throughout the procedure heart rate, rhythm electrocardiography, and peripheric O2 saturation were monitored with a non-invasive monitor, and blood pressure measurements were taken every 3 min. Rhythm Holter recordings were obtained from all patients and TEE was performed. Results: When time domain parameters for HRV were compared in all three groups, the hypnosis group had significant increases in pNN50 and RMSSD compared to Groups D and T (p &lt; 0.05). As concerns frequency domain parameters, there were no significant differences between groups where low frequency (LF) was decreased in hypnosis group and high frequency (HF) was increased (p &gt; 0.05). However, LF/HF was decreased statistically significantly (p &lt; 0.05) when compared with the midazolam group. Conclusions: Contrary to standard sedation in TEE patients, when hypnosis is used autonomic cardiac tone is modified to a significant extent. Hypnotic sedation achieves this by increasing the parasympathetic activity, decreasing the sympathetic activity, and changing the sympathovagal interaction balance.  Wstęp: Nie ma idealnej metody sedacji, która mogłaby być stosowana w trakcie echokardiografii przezprzełykowej (TEE), a dane dotyczące wpływu dostępnych metod sedacji na zmienność rytmu serca (HRV) są ograniczone. Cel: Badanie przeprowadzono w celu porównania wpływu na HRV sedacji uzyskanej metodą hipnoterapii i sedacji farmakologicznej z zastosowaniem midazolamu. Metody: Do badania włączono 76 chorych ze wskazaniami do wykonania TEE, w wieku 18–83 lat. Grupa T obejmowała 26 chorych, u których badanie wykonano po zastosowaniu miejscowego znieczulenia gardła, grupa D — 23 chorych, którym podano midazolam, a grupa H — 27 chorych, których poddano hipnozie. U wszystkich pacjentów zapewniono dostęp dożylny. Przez cały czas trwania badania monitorowano częstość rytmu serca, zapis elektrokardiograficzny i saturację tlenem krwi obwodowej metodą nieinwazyjną; pomiary ciśnienia tętniczego wykonywano co 3 minuty. U wszystkich pacjentów uzyskano zapis rytmu serca metodą Holtera i przeprowadzono TEE. Wyniki: Porównując parametry HRV uzyskane w trzech grupach, stwierdzono, że w grupie poddanej hipnozie wartości pNN50 i RMSSD były istotnie wyższe niż w grupach D i T (p &lt; 0,05). Na podstawie oceny parametrów analizy częstotliwościowej nie wykazano istotnych różnic między osobami poddanymi hipnozie, u których stwierdzono zmniejszenie mocy widma w zakresie niskich częstotliwości (LF) i zwiększenie w zakresie wysokich częstotliwości (HF) (p &gt; 0,05). Jednak zaobserwowano statystycznie istotną (p &lt; 0,05) redukcję współczynnika LF/HF w porównaniu z grupą, której podano midazolam. Wnioski: W przeciwieństwie do standardowej metody sedacji u chorych poddanych TEE stosowanie hipnozy wiązało się z istotną zmianą napięcia autonomicznego układu nerwowego serca. Sedacja za pomocą hipnozy powodowała zwiększenie aktywności przywspółczulnej, zmniejszenie aktywności współczulnej i zmianę balansu interakcji między układem współczulnym a przywspółczulnym (nerw błędny)