Clinical practice guidelines for perioperative care in bariatric surgery 2023: Adapted ERAS (enhanced recovery after surgery) guidelines with consensual voting of the working group of the Joint Bariatric and Metabolic Surgery Section of the Czech Surgery .

INTRODUCTION: Currently, bariatric surgery is the most effective treatment for the morbid obesity. It provides sustained weight loss as well as demonstrated positive effects on obesity-related comorbidities. The number of procedures performed worldwide has seen a sharp increase in the past twenty years. Therefore, an effort has been developed to establish a consensus in perioperative care based on best evidence. METHODS: The working group of the Joint Bariatric and Metabolic Surgery Section of the Czech Surgery Society and Czech Society of Obesitology prepared clinical practice guidelines for the ERAS (enhanced recovery after surgery) concept in perioperative care in bariatric surgery. The working group based its guidelines on ERAS guidelines published in 2021. The working group adopted the original text and then adapted the text and added its comments to specific items as appropriate. Electronic voting of all members of the working group was the final phase, by which the strength of consensus was expressed with respect to individual elements of the guidelines. RESULTS: The Czech working group reached a consensus with ERABS (enhanced recovery after bariatric surgery) guidelines for most elements. The quality of evidence is low for some interventions of the ERAS protocol for bariatric surgery. Therefore, extrapolation from other surgeries and fields is needed for evidence-based practice. CONCLUSION: The guidelines are intended for clinical practice in bariatric surgery with the ERAS protocol based on updated evidence and guidelines. It is based on recent and comprehensive ERAS guidelines adopted and adapted by the Czech working group of the Joint Bariatric and Metabolic Surgery Section of the Czech Surgery Society and Czech Society of Obesitology. Some supplementations and specifications are reflected in comments added to the Czech version.

Isolation and biochemical characterization of two novel metagenome-derived esterases.

The metagenomes of uncultured microbial communities are rich sources for novel biocatalysts. In this study, esterase EstA3 was derived from a drinking water metagenome, and esterase EstCE1 was derived from a soil metagenome. Both esterases are approximately 380 amino acids in size and show similarity to beta-lactamases, indicating that they belong to family VIII of the lipases/esterases. EstA3 had a temperature optimum at 50 degrees C and a pH optimum at pH 9.0. It was remarkably active and very stable in the presence of solvents and over a wide temperature and pH range. It is active in a multimeric form and displayed a high level of activity against a wide range of substrates including one secondary ester, 7-[3-octylcarboxy-(3-hydroxy-3-methyl-butyloxy)]-coumarin, which is normally unreactive. EstCE1 was active in the monomeric form and had a temperature optimum at 47 degrees C and a pH optimum at pH 10. It exhibited the same level of stability as EstA3 over wide temperature and pH ranges and in the presence of dimethyl sulfoxide, isopropanol, and methanol. EstCE1 was highly enantioselective for (+)-menthylacetate. These enzymes display remarkable characteristics that cannot be related to the original environment from which they were derived. The high level of stability of these enzymes together with their unique substrate specificities make them highly useful for biotechnological applications.