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INTRODUCTION: Oesophagectomy is the mainstay of curative treatment for oesophageal cancer, but it is associated with a high risk of major complications. Goal-directed fluid therapy and individualised blood pressure management may prevent complications after surgery. Extending goal-directed fluid therapy after surgery and applying an individual blood pressure target may have substantial benefit in oesophagectomy. This is a protocol for a clinical trial implementing a novel haemodynamic protocol from the start of anaesthesia to the next day with the patient's own night-time blood pressure as the lower threshold.METHODS: This is a single-centre, single-blind, randomised, clinical trial. Oesophagectomy patients are randomised 1:1 for either perioperative haemodynamic management according to a goal-directed fluid therapy protocol with an individual target blood pressure or for standard care. The primary endpoint is the total burden of morbidity and mortality assessed by the Comprehensive Complication Index 30 days after surgery. Secondary endpoints are complications, reoperations, fluid and vasopressor dosage and quality of life at 90 days after surgery.CONCLUSIONS: The results from this trial provide an objective and easy-to-follow algorithm for fluid administration, which may improve patient-centred outcomes in oesophagectomy patients.FUNDING: The trial is supported by Aarhus University (1,293,400 DKK) and the Novo Nordisk Foundation (625,200 DKK).TRIAL REGISTRATION: EudraCT number: 2021-002816-30.

Persistent, open-vent degassing of Erebus volcano, Antarctica, is a significant point source of gases and aerosol to the austral polar troposphere. We report here on the chemical composition and size distribution of the Erebus aerosol, focusing on the water-soluble fraction. The aerosol was sampled at the rim of the active crater using a cascade impactor, which collected and sized particles in 14 size bins from >10 to 0.01 μm. The soluble fraction of the Erebus aerosol is distinct from other volcanic sources in several respects. It is dominated by chloride-bearing particles (over 30% of total mass) and has an unusually high Cl -/SO 4-2 molar ratio of 3.5. Coarse particles contribute little to the total mass of the soluble fraction. Elevated concentrations of F -, Cl -, Br -, and SO 4-2 are found in a narrow particle size fraction of 0.1-0.25 μm. The detection of particulate Br - reinforces our understanding of the potential for quiescent volcanic emissions to deplete tropospheric ozone. The small aerosol size reflects the low atmospheric temperature and humidity, which inhibit particle growth. Halide-alkali metal salts (Na, K)(Cl, F) appear to be the most abundant species in the aerosol. The concentration of Pb is high compared to other volcanoes; its exsolution may be promoted by the high abundance of halogens in Erebus magma. Despite the previously reported high NO x content in the plume, we did not detect significant quantities of nitrate in the near-vent aerosol. Our findings emphasize the potential regional significance of emissions from Erebus for understanding the Antarctic atmospheric composition and glaciochemical records. © 2010 by the American Geophysical Union.

Since the 19 March 2008 explosion within Halema‘uma‘u that formed the new vent at Kilauea’s summit, degassing rates have been greatly elevated above the levels typical of previous years. The location and subsequent dispersion of this new degassing presents its own specific problems compared to that in the east rift zone. For example, throughout 2008 the Halema’uma’u plume was generally blown through the Kau desert, directly affecting downwind communities. In this study we present measurements made in July and halogens (HF, HCl, HBr and HI) in the new 2008. We characterize the gas chemistry in terms of SO 2 plume from Halema’uma’u in order to compare them with other plumes worldwide, including those from subduction zone settings and other emissions from Kilauea itself. Further to this we characterize the plume’s chemistry in terms of emissions of environmentally important metallic species both in the size- segregated aerosol (important for determining atmospheric lifetime and potential speciation) and in the case of Hg in the gas phase (both in the elemental form and reactive forms). To complement this plume characterization we also looked at preliminary environmental samples of grasses, rainwater and fog in order to investigate potential future avenues for research into the environmental consequences of Kilauea’s volcanic emissions.

The young woman described sought evaluation for infertility and was found to have virilization due to a large left adrenal tumor. Further endocrine studies confirmed a syndrome of pure virilization with normal glucocorticoid function. Resection of this apparently benign tumor resulted in regression of virilization, as well as pregnancy. Pure virilization is an unusual manifestation of benign adrenocortical tumors, and adrenal tumors of this size are most frequently malignant.

Comparaison de 12 donneurs de rein (1 a 10 ans apres la nephrectomie), 5 malades ayant subi une nephrectomie pour affection unilaterale et 7 temoins normaux. Chez les donneurs l'epreuve d'effort ne provoque pas d'albuminurie, ce qui indique que ce type de nephrectomie n'entraine pas de troubles d'hyperfiltration pouvant entrainer une proteinurie

A major uncertainty regarding the environmental impacts of volcanic Hg is the extent to which Hg is deposited locally or transported globally. An important control on dispersion and deposition is the oxidation state of Hg compounds: Hg(0) is an inert, insoluble gas, while Hg(II) occurs as reactive gases or in particles, which deposit rapidly and proximally, near the volcanic vent. Using a new high temperature thermodynamic model, we show that although Hg in Etna's magmatic gases is almost entirely Hg(0) (i.e., gaseous elemental mercury), significant quantities of Hg(II) are likely formed at Etna's vents as gaseous HgCl2, when magmatic gases are cooled and oxidised by atmospheric gases. These results contrast with an earlier model study and allow us to explain recent measurements of Hg speciation at the crater rim of Etna without invoking rapid (

Sweet chestnut leaves (Castanea sativa) collected from the flanks of Mt Etna volcano in 2005-2007 were analysed by inductively-coupled plasma mass spectrometry to investigate the spatial and temporal variability of element concentrations. The aim of this work was to determine whether these leaves are a bio-indicator for volcanic gas, aerosol and ash deposition and to gain new insights into the environmental effects of quiescent and eruptive volcanic plumes. Results show a positive correlation between sample variability in the concentration of elements in Castanea sativa and enrichment factors of elements in the plume. The spatial and temporal variability of chalcophilic elements (As, Cd, Cu, Mo, Tl, Zn) is consistent with prevailing winds transporting eruptive plumes to the south-east of the summit, resulting in enhanced plume deposition onto the flanks of the volcano. Similar spatial and temporal variability was found for the halide-forming elements (Cs, K, Rb) and intermediate elements (Al, Co, Mn). The spatial variability of chalcophilic, intermediate and halide-forming elements during quiescent periods was diminished (relative to eruptive periods) and could not be explained by plume deposition. In contrast, the concentrations of lithophilic elements (Ba, Ca, Mg, Sr) did not show any clear spatial variability even during eruptive periods. Comparisons between enrichment factors for elements in Castanea sativa and literature values for enrichment factors of the volcanic plume, groundwater and lichen were made. Whilst Castanea sativa offers insights into the spatial and temporal variability of deposition, the species may not be a bio-indicator for plume composition due to biological fractionation. © 2008 Elsevier B.V. All rights reserved.

Active biomonitoring using moss-bags was applied to an active volcanic environment for the first time. Bioaccumulation originating from atmospheric deposition was evaluated by exposing mixtures of washed and air-dried mosses (Sphagnum species) at 24 sites on Mt. Etna volcano (Italy). Concentrations of major and a large suite of trace elements were analysed by inductively coupled mass and optical spectrometry (ICP-MS and ICP-OES) after total acid digestion. Of the 49 elements analysed those which closely reflect summit volcanic emissions were S, Tl, Bi, Se, Cd, As, Cu, B, Na, Fe, Al. Enrichment factors and cluster analysis allowed clear distinction between volcanogenic, geogenic and anthropogenic inputs that affect the local atmospheric deposition. This study demonstrates that active biomonitoring with moss-bags is a suitable and robust technique for implementing inexpensive monitoring in scarcely accessible and harsh volcanic environments, giving time-averaged quantitative results of the local exposure to volcanic emissions. This task is especially important in the study area because the summit area of Mt. Etna is visited by nearly one hundred thousand tourists each year who are exposed to potentially harmful volcanic emissions.

Mt. Etna is a major natural source of Hg to the Mediterranean region. Total mercury concentrations, [Hg] tot, in Castanea sativa (sweet chestnut) leaves sampled 7-13km from Etna's vents (during six campaigns in 2005-2011) were determined using atomic absorption spectroscopy. [Hg] tot in C. sativa was greatest on Etna's SE flank reflecting Hg deposition from the typically overhead volcanic plume. [Hg] tot also showed Hg accumulation over the growing season, increasing with leaf age and recent eruptive activity. [Hg] tot in C. sativa was not controlled by [Hg] tot in soils, which instead was greatest on Etna's NW flank, and was correlated with the proportion of organic matter in the soil (% Org). An elevated [Hg] tot/% Org ratio in soils on Etna's SE flank is indicative of increased Hg deposition. This ratio was also found to decrease with local soil pH, suggesting that Hg deposited to the low pH and organic-poor soils on Etna's SE flank may not be retained but will instead be released to groundwater or re-emitted to the atmosphere. These results show that the deposition of volcanic Hg has clear impacts and confirm that Etna is an important source of Hg to the local environment. © 2012 Elsevier B.V.

article i nfo Article history: Received 6 August 2009 Accepted 4 January 2010 Available online xxxx Biomagnetic monitoring, using tree leaves as passive surfaces for particle collection, has been shown to be a promising technique for assessing the dispersion and deposition of particles in the context of anthropogenic pollution. By comparing leaves' magnetic properties with trace metal levels measured in the leaves, we here assess the utility of the biomagnetic technique as a sensitive, fast and inexpensive method for assessment of volcanic plume deposition. Samples of sweet chestnut leaves (Castanea sativa) were collected from the area surrounding Mt. Etna volcano in Sicily during the 2008 growing season when the volcano was displaying mild eruptive activity. Previous work has shown that the trace metal concentrations of these leaves show promise as a bio-indicator of volcanic gas, aerosol and ash deposition on the flanks of Mt. Etna. For 2008, ICP- MS analysis of the elemental abundances within the leaves showed that As, Cd, Cu, Mo, Tl, K, B, Al and Co displayed elevated concentrations downwind of the volcanic source, to the E-ESE, but with overall reduced concentrations relative to 2007. Less explosive activity than 2007 and a broader, more easterly wind field may have distributed the volcanic plume over a wider area, both of which would account for reduced trace element concentrations in 2008. Correspondence of elevated concentrations in both years (2007 and 2008) with their respective wind fields suggests that plume deposition is the controlling factor rather than variability in the soils and that these leaves do indeed have potential as bio-indicators of the plume's dispersion. Magnetic analysis of the leaves shows that the spatial distribution of saturation isothermal remanent magnetisation (SIRM) and magnetic susceptibility (χlf) values display a strong correlation with the wind-influenced plume transport direction for 2008, with elevated concentrations of magnetic minerals on the eastern flanks, in broad agreement with the ICP-MS data. This spatial distribution provides further evidence of plume variability as the main control on the concentrations of magnetic particles on the leaf surfaces and on elemental uptake by the tree and suggests that biomagnetic monitoring may also hold promise as a method of assessing the dispersion and impacts of volcanic plumes. The dominant magnetic mineral on the leaf surfaces is a magnetite-like mineral (contributing >90% of the SIRM), of coarse, multi- domain (MD) grain size (∼ 5t o 15 μm). A volcanogenic source is most likely, as magnetites from anthropogenic sources are typically an order of magnitude smaller in grain size (∼0.1-1 μm). These new results from the use of environmental magnetism on leaves, in a volcanically-affected region, suggest that biomagnetic monitoring offers a new, sensitive and rapid means for the assessment of volcanic plume deposition over wide areas.

Particle size distributions for soluble and insoluble species in Mt. Etna's summit plumes were measured across an extended size range (10 nm < d < 100 μm) using a combination of techniques. Automated scanning electron microscopy (QEMSCAN) was used to chemically analyze many thousands of insoluble particles (collected on pumped filters) allowing the relationships between particle size, shape, and composition to be investigated. The size distribution of fine silicate particles (d < 10 μm) was found to be lognormal, consistent with formation by bursting of gas bubbles at the surface of the magma. The compositions of fine silicate particles were found to vary between magmatic and nearly pure silica; this is consistent with depletion of metal ions by reactions in the acidic environment of the gas plume and vent. Measurements of the size, shape and composition of fine silicate particles may potentially offer insights into preemission, synemission, and postemission processes. The mass flux of fine silicate particles from Mt. Etna released during noneruptive volcanic degassing in 2004 and 2005 was estimated to be ∼7000 kg d-1. Analysis of particles in the range 0.1 < d/μm < 100 by ion chromatography shows that there are persistent differences in the size distributions of sulfate aerosols between the two main summit plumes. Analysis of particles in the range 0.01 μm < d < 0.1 μm by scanning transmission electron microscopy (STEM) shows that there are significant levels of nanoparticles in the Mt. Etna plumes although their compositions remain uncertain. Copyright 2008 by the American Geophysical Union.

Measuring Hg/SO2 ratios in volcanic emissions is essential for better apportioning the volcanic contribution to the global Hg atmospheric cycle. Here, we report the first real-time simultaneous measurement of Hg and SO2 in a volcanic plume, based on Lumex and MultiGAS techniques, respectively. We demonstrate that the use of these novel techniques allows the measurements of Hg/SO2 ratios with a far better time resolution than possible with more conventional methods. The Hg/SO2 ratio in the plume of FO fumarole on La Fossa Crater, Vulcano Island spanned an order of magnitude over a 30 minute monitoring period, but was on average in qualitative agreement with the Hg/SO2 ratio directly measured in the fumarole (mean plume and fumarole ratios being 1.09 × 10-6 and 2.9 × 10-6, respectively). The factor 2 difference between plume and fumarole compositions provides evidence for fast Hg chemical processing, the plume. Copyright 2007 by the American Geophysical Union.