Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Immobilized β-d-galactosidases for improved synthesis of short chain galactooligosaccharides

As much as digesting of lactose emerged as an important health and nutritional problem and the deficiency of this hydrolytic enzyme showed increasing tendency, the consumption of lactose-free beverages became a possible solution for people owing lactose intolerance. Therefore, β-d-galactosidase (β-GAL), the enzyme responsible for lactose hydrolysis to glucose and galactose, has achieved wide utilization in the food technology, mainly in the dairy industry. In the same time, β-GAL is able to catalyze the transgalactosylation reaction leading to galacto-oligosaccharides (GOS). GOS belong to the group of nondigestible prebiotics that beneficially affect the organisms by stimulating the growth and activity of useful bacteria in the colon, reducing the gastrointestinal discomfort. GOS fortified foods and beverages have an important and increasing market potential in all age groups, but particularly in infant population. The GOS market is already consolidated, but technological improvements are always needed. Immobilization of enzymes is a well-known method to improve the stability and confer reusability of the enzymes, particularly in large-scale applications. The utilization of immobilized β-GAL for lactose hydrolysis was subject of numerous studies, while GOS synthesis with the same biocatalyst involves specific requirements, particularly when continuous processes are targeted. This review presents the recent advancements in the topic of β-GAL immobilization by various methods and a comparative overview on the main approaches concerning the synthesis of short-chain GOS using the immobilized biocatalyst, with possible applications in the beverage industry