Methane Emission from Enteric Fermentation: Methanogenesis and Fermentation

Rumen fermentation of carbohydrates plays a fundamental role in ruminant metabolism as the main source of energy. Acetic, propionic and butyric acids (namely, volatile fatty acids, VFA) are the main products of the rumen fermentation of structural and nonstructural carbohydrates con- tained in the ruminant’s diet. The metabolic pathways involved in VFA production are strictly linked to methane emission, because hydrogen is actively produced during the fermentation of structural carbohydrates, and it is rapidly metabolised by methanogens, in order to maintain the optimal thermodynamic condition for the metabolism of the microbe consortium in the rumen. Hydrogen plays also a fundamental role in the maintenance of the equilibrium among VFA pathways and in their interconversion. In this chapter, after a brief chemical description of dietary carbohydrates, individual VFA pathways are described in order to put in evidence the thermodynamic control points of each pathway and the production of energy and reductive equivalent. Then, the relationship between hydrogen, VFA and methane production has been reviewed, considering the role of some dietary factors, the substrate competition between different meta- bolic pathways and the models of VFA estimation

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas