Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery.

INTRODUCTION: Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS: The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4 hours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3 years, within 50 hospitals worldwide. ETHICS/DISSEMINATION: The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN39653756.The OPTIMISE II trial is supported by Edwards Lifesciences (Irvine, CA) and the UK National Institute for Health Research through RMP’s NIHR Professorship

Energy Drinks – a Real Danger or a Scapegoat? an Analysis of the Commercially Available Products in Romania

Energy drinks are beverages that contain caffeine, taurine, ginseng, guarana, vitamins, herbal supplements, and sugar. Their ingredients are generally regarded as safe for consumption, but some of them raise some concerns. Caffeine is especially regarded as problematic, especially for some categories of consumers. Nevertheless, energy drinks also offer some advantages. In this study, we aimed to analyze the ingredients found in the energy drinks that were commercially available on the Romanian market. We analyzed products gathered over one year (March 2018 – March 2019). We used the information found on the companies' websites and directly on the products. We included 120 energy drinks found on the market. Most of the inspected products (93.4 %) contained caffeine and/or taurine (75 %). Many other products contained herbal ingredients such as guarana and ginseng. Vitamins and minerals were also abundant in these products. The vitamin concentrations are mostly negligible. Finally, all the energy drinks contained preservatives, food colorants or stabilizers, ingredients that are safe and authorized for use. In conclusion, energy drinks' consumption is mostly safe and all their ingredients are approved. However, special attention should be dedicated to some particular classes of consumers. Energy drinks should not be used in large quantities and children should be discouraged to consume them. The population must be further informed in regards to their risk, the negative effects when consumed in combination with alcohol and the danger they represent for children

Towards method validation for selenium speciation analysis in human serum

Se is one of the most investigated trace essential elements in the last years, mostly due to its cancer prevention properties. Nevertheless, the accurate determination of its biologically active species present in human serum, such as selenoproteins (SeProt), is currently a challenging task. This is because of the lack of appropriate quantification standards, certified reference materials (CRMs) and/or reference measurement methods. Additionally, most of the methods developed so far for the determination of SeProt in human serum were applied to the analysis of control (volunteers) serums, which are not available to other laboratories, therefore making the method inter-comparison virtually impossible. We present here for the first time indicative levels of SeProt in a commercially available human serum, namely the BCR-637 CRM (with certified level of total Se). The selenium levels associated with glutathione peroxidase (GPx), selenoprotein P (SelP) and selenoalbumin (SeAlb) in this serum were calculated by means of the results obtained by using 13 different analytical methods on the basis of (double column) affinity HPLC coupled to ICP-MS. The indicative levels of SeProt in the BCR-637 serum can be used as preliminary reference values for validation of methods dealing with the determination of SeProt in human serum

Towards method validation for selenium speciation analysis in human serum

Se is one of the most investigated trace essential elements in the last years, mostly due to its cancer prevention properties. Nevertheless, the accurate determination of its biologically active species present in human serum, such as selenoproteins (SeProt), is currently a challenging task. This is because of the lack of appropriate quantification standards, certified reference materials (CRMs) and/or reference measurement methods. Additionally, most of the methods developed so far for the determination of SeProt in human serum were applied to the analysis of control (volunteers) serums, which are not available to other laboratories, therefore making the method inter-comparison virtually impossible. We present here for the first time indicative levels of SeProt in a commercially available human serum, namely the BCR-637 CRM (with certified level of total Se). The selenium levels associated with glutathione peroxidase (GPx), selenoprotein P (SelP) and selenoalbumin (SeAlb) in this serum were calculated by means of the results obtained by using 13 different analytical methods on the basis of (double column) affinity HPLC coupled to ICP-MS. The indicative levels of SeProt in the BCR-637 serum can be used as preliminary reference values for validation of methods dealing with the determination of SeProt in human serum

Wine, despair and women's clothing: gender anxieties in screen representations of Marcus Antonius

The love affair between Cleopatra and Mark Antony has been the subject of considerable mythological reworking in the 2000 years since their suicides, and the reputations of both have fallen foul to manipulation by Augustan propaganda. As such, Antony is generally represented in popular culture as a deeply flawed character, subject to emotional and physical excesses that are understood in gendered terms as relating to his exhibition of defective or inadequate masculinity. Covering a period of over seventy years, this thesis analyses textual engagements with the Antony-myth on both the large and small screen in an attempt to sketch the progression, in western, English-speaking popular culture, of the representation of masculinities, both idealized and defective, and to situate the screen Antony as a critical meme in the transmission of hegemonic masculinity. Whilst the cultural function of Cleopatra has been widely interrogated by feminist scholars of a variety of disciplines, in an attempt to recuperate her iconography from Augustan invective, this thesis is the first attempt to effect a similar study of Antony's mythologization and function within popular culture. The thesis 'is divided into six chapters, with a separate Appendix. Chapter 1 discusses the roots of the Antony-icon in Roman political invective, whilst Chapter 2 examines two elements of that invective that have been left out of his screen iconography. The third chapter considers Shakespeare's Antony as a cultural template for Antony-on-screen, and the fourth looks at the iconography of his screen narratives. Chapter 5 begins to unpack Antony's modern construction by analyzing his masculine performance alongside the other key male figures in his narratives, and 'the final chapter considers the adaptations made to the legend in the service of making Antony's deficient performance of masculinity intelligible to twentieth and twenty-first century audiences. The thesis concludes by situating these developments along a continuum of changing cultural conceptions of masculinityEThOS - Electronic Theses Online ServiceGBUnited Kingdo

Exposure assessment of arsenic speciation in different rice types depending on the cooking mode

Total (Ast), inorganic arsenic (Asi = As(III) + As(V)) and dimethylarsonic acid (DMA) were determined in 37 commercial rice samples collected in France. Ast was measured by inductively coupled plasma-mass spectrometry (ICP-MS) whereas anion-exchange chromatography – ICP-MS was used for Asi and DMA determination. Ast in raw rice varied from 0.041 to 0.535 mg kg−1 whereas Asi varied from 0.025 mg kg−1 (polished Basmati rice) up to 0.471 mg kg−1 (organic rice duo). The daily intake and associated health risk for different population groups as a function of age and gender was also assessed. The intake varied between 0.002 and 0.184 μg kg−1 body weight for Ast and 0.002 and 0.153 μg kg−1 body weight for Asi, which do not pose a chronic toxicity risk. Organic wholegrain rice may entail a risk for children in the case of sole consumption at the expense of polished rice. The impact of rice cooking/boiling in terms of the overall toxicological risk related to As species was also investigated. Pre-rinsing and boiling the raw rice by using an excess of water is the most efficient mode to obtain a significant Asi removal and further reduction of the toxicological risk for children, particularly for white rice varieties. © 2016 Elsevier Inc.Total (Ass), inorganic arsenic (As-i=As(III)+As(V)) and dimethylarsonic acid (DMA) were determined in 37 commercial rice samples collected in France. As-t was measured by inductively coupled plasma-mass spectrometry (ICP-MS) whereas anion-exchange chromatography - ICP-MS was used for As; and DMA determination. Ast in raw rice varied from 0.041 to 0.535 mg kg(-1) whereas As; varied from 0.025 mg kg(-1) (polished Basmati rice) up to 0.471 mg kg(-1) (organic rice duo). The daily intake and associated health risk for different population groups as a function of age and gender was also assessed. The intake varied between 0.002 and 0.184 mu g kg(-1) body weight for Ast and 0.002 and 0.153 mu g kg(-1) body weight for As;, which do not pose a chronic toxicity risk. Organic wholegrain rice may entail a risk for children in the case of sole consumption at the expense of polished rice. The impact of rice cooking/boiling in terms of the overall toxicological risk related to As species was also investigated. Pre-rinsing and boiling the raw rice by using an excess of water is the most efficient mode to obtain a significant As; removal and further reduction of the toxicological risk for children, particularly for white rice varieties. (C) 2016 Elsevier Inc. All rights reserved

Selenoproteins speciation in serum: application to colorectal cancer patients

The hypertrophied manual claws and modified manus of megaraptoran theropods represent an unusual morphological adaptation among carnivorous dinosaurs. The skeleton of Australovenator wintonensis from the Cenomanian of Australia is among the most complete of any megaraptorid. It presents the opportunity to examine the range of motion of its forearm and the function of its highly modified manus. This provides the basis for behavioural inferences, and comparison with other Gondwanan theropod groups. Digital models created from computed tomography scans of the holotype reveal a humerus range of motion that is much greater than Allosaurus, Acrocanthosaurus, Tyrannosaurus but similar to that of the dromaeosaurid Bambiraptor. During flexion, the radius was forced distally by the radial condyle of the humerus. This movement is here suggested as a mechanism that forced a medial movement of the wrist. The antebrachium possessed a range of motion that was close to dromaeosaurids; however, the unguals were capable of hyper-extension, in particular manual phalanx I-2, which is a primitive range of motion characteristic seen in allosaurids and Dilophosaurus. During flexion, digits I and II slightly converge and diverge when extended which is accentuated by hyperextension of the digits in particular the unguals. We envision that prey was dispatched by its hands and feet with manual phalanx I-2 playing a dominant role. The range of motion analysis neither confirms nor refutes current phylogenetic hypotheses with regards to the placement of Megaraptoridae; however, we note Australovenator possessed, not only a similar forearm range of motion to some maniraptorans and basal coelurosaurs, but also similarities with Tetanurans (Allosauroids and Dilophosaurus)