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.

OMICS and BIOINFORMATICS Approaches for Next Generation Risk Assessmentwww.efsa.europa.eu/publications 2 EFSA Supporting publication 2022.e200506Acknowledgements: EFSA wishes to thank the following for drafting the scientific output: Also, Jaime

New Approach Methodologies www.efsa.europa.eu/publications 2 EFSA Supporting publication 2022:e200502 Revised theme paper in light of the comments received from the European Commission (DG SANTE, JRC), EU Agencies (EMA), EU Member States through the Advisory Forum, EFSA's Scientific Committee, international organisations (OECD, ILMERAC) and risk assessment bodies in Third Countries (FSCJ, CFSA, Health Canada, US EPA) and stakeholders through EFSA´s list of registered stakeholders. Disclaimer: This document does not present future project calls as part of EFSA's work programme, or any future position of EFSA. It aims to support the development of a roadmap for action and its content can be subject to change.

No abstract

The detailed research for more information on the very important area of tongue cancer is the purpose of the present study. We report two cases of pregnant women suffering from tongue cancer during pregnancy, the treatment of tongue cancer and information on the outcome of pregnancy. Pregnancy should not be considered an obstacle to the proper treatment of a mother's tongue malignancy. The epidemiological trend in recent years is to increase the overall survival of patients and keep them free of disease for a longer period of time. The reported pregnant women were in the third trimester of pregnancy with tongue cancer symptoms at 37 and 32 weeks, respectively. After detailed information, the cesarean section was performed and the two women treated according to the proposed protocols which were as following: surgical removal of tumors, lymph node dissection in 5 levels and postoperative radiotherapy. The first case of these recurred 3 months later, underwent surgical removal of the tumor and subsequently underwent chemotherapy and immunotherapy. She died one year after the primary diagnosis of tongue cancer. The perinatal effect was perfect in both cases. The lack of systematic randomized prospective studies and the difficulties in carrying them out in general, make bibliographic review even more useful in guidelines, retrospective studies, series of events and individual cases for future scientific studies to be performed in order to establish treatment protocols.