Tentative Reference Acts? ‘Recognitional Demonstratives’ as Means of Suggesting Mutual Knowledge – or Overriding a Lack of It

In an explorative study on German oral corpus data we investigate recognitional use of proximal demonstratives as a means of explicit speaker-hearer interaction shaping the discourse structure. We show that recognitionals mark tentative reference acts in that speakers suggest - or pretend - mutual knowledge of the referent, at the same time appealing to the hearers to accept the reference. Hearers may tacitly or explicitly accept the referential act or deny it asking for clarification, in the latter case making speakers change the intended local discourse topic. On these grounds we argue against a differentiation between recognitional and indefinite demonstratives, subsuming both as kinds of recognitional use under ‘pretended’ cognitive proximity

Buttressing staples with cholecyst-derived extracellular matrix (CEM) reinforces staple lines in an ex vivo peristaltic inflation model

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ Springer Science + Business Media, LLC 2008Background - Staple line leakage and bleeding are the most common problems associated with the use of surgical staplers for gastrointestinal resection and anastomotic procedures. These complications can be reduced by reinforcing the staple lines with buttressing materials. The current study reports the potential use of cholecyst-derived extracellular matrix (CEM) in non-crosslinked (NCEM) and crosslinked (XCEM) forms, and compares their mechanical performance with clinically available buttress materials [small intestinal submucosa (SIS) and bovine pericardium (BP)] in an ex vivo small intestine model. Methods - Three crosslinked CEM variants (XCEM0005, XCEM001, and XCEM0033) with different degree of crosslinking were produced. An ex vivo peristaltic inflation model was established. Porcine small intestine segments were stapled on one end, using buttressed or non-buttressed surgical staplers. The opened, non-stapled ends were connected to a peristaltic pump and pressure transducer and sealed. The staple lines were then exposed to increased intraluminal pressure in a peristaltic manner. Both the leak and burst pressures of the test specimens were recorded. Results - The leak pressures observed for non-crosslinked NCEM (137.8 ± 22.3 mmHg), crosslinked XCEM0005 (109.1 ± 14.1 mmHg), XCEM001 (150.1 ± 16.0 mmHg), XCEM0033 (98.8 ± 10.5 mmHg) reinforced staple lines were significantly higher when compared to non-buttressed control (28.3 ± 10.8 mmHg) and SIS (one and four layers) (62.6 ± 11.8 and 57.6 ± 12.3 mmHg, respectively) buttressed staple lines. NCEM and XCEM were comparable to that observed for BP buttressed staple lines (138.8 ± 3.6 mmHg). Only specimens with reinforced staple lines were able to achieve high intraluminal pressures (ruptured at the intestinal mesentery), indicating that buttress reinforcements were able to withstand pressure higher than that of natural tissue (physiological failure). Conclusions - These findings suggest that the use of CEM and XCEM as buttressing materials is associated with reinforced staple lines and increased leak pressures when compared to non-buttressed staple lines. CEM and XCEM were found to perform comparably with clinically available buttress materials in this ex vivo model.Enterprise Irelan

Probioticaprofylaxe bij voorspeld ernstige acute pancreatitis : een gerandomiseerde, dubbelblinde, placebogecontroleerde trial

OBJECTIVE: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. METHOD: A total of 296 patients with predicted severe acute pancreatitis (APACHE II score > or = 8, Imrie score > or = 3 or C-reactive protein concentration > 150 mg/l) were included and randomised to one of two groups. Within 72 hours after symptom onset, patients received a multispecies preparation of probiotics or placebo given twice daily via a jejunal catheter for 28 days. The primary endpoint was the occurrence of one of the following infections during admission and go-day follow-up: infected pancreatic necrosis, bacteraemia, pneumonia, urosepsis or infected ascites. Secondary endpoints were mortality and adverse reactions. The study registration number is ISRCTN38327949. RESULTS: Treatment groups were similar at baseline with regard to patient characteristics and disease severity. Infections occurred in 30% of patients in the probiotics group (46 of 152 patients) and 28% of those in the placebo group (41 of 144 patients; relative risk (RR): 1.1; 95% CI: 0.8-1.5). The mortality rate was 16% in the probiotics group (24 of 152 patients) and 6% (9 of 144 patients) in the placebo group (RR: 2.5; 95% CI: 1.2-5.3). In the probiotics group, 9 patients developed bowel ischaemia (of whom 8 patients died), compared with none in the placebo group (p = 0.004). CONCLUSION: In patients with predicted severe acute pancreatitis, use of this combination of probiotic strains did not reduce the risk of infections. Probiotic prophylaxis was associated with a more than two-fold increase in mortality and should therefore not be administered in this category of patients.

Stress response and pubertal development in the male common carp, Cyprinus carpio L.

Summary electronic version I Every organism experiences the effects of stress in its day to day life. Stress can be defined as any disturbance of the organisms homeostasis.The inter-nal or external stimulus that causes stress is called the stressor. Usually, the organ-ism is well equipped to adapt to the stress. It has the mechanisms, generally referred to as the stress response, to restore its disturbed homeostasis. However, severe and chronic stress may exceed the ability to adapt and this may then lead to suppression of growth, the immune response or the reproductive perform-ance. In fish, as in higher vertebrates, stress adaptation has been shown to be related to an activation of the hypothalamic-pituitary-interrenal (HPI) axis. In teleost fish, cortisol is the main glucocorticoid produced by the interrenals under influence of stress. Cortisol plays a key role in the restoration of home-ostasis and is frequently indicated to be the major factor mediating the suppres-sive effect of stress on the reproductive performance. This thesis addresses the effect of stress adaptation on the pubertal development. Puberty is the developmental process by which the animal acquires the capaci-ty to reproduce. In males, the period of pubertal development may be defined as the time span that starts with the beginning of spermatogonial multiplication until the appearance of the first flagellated spermatozoa. The onset and regula-tion of puberty is determined by functional development of the brain-pituitary-gonad (BPG) axis. Stress effects have been reported to affect all levels of the BPG-axis. However, the precise mechanisms via which the stress response has its adverse effects on reproduction are still unknown. The present study is an attempt to find more answers to solve this intriguing question. Firstly, we investigated the effects of repeated temperature stress on the pubertal development (Chapter 2). Since cortisol has been shown to play a key role in the homeostatic adaptation during or after stress, we focussed in chapter 3 on the effects of cortisol on the pubertal development. In the same chapter we also paid attention to the question at which level the BPG-axis is affected by cortisol. Since our results indicate that all levels of the BPG-axis were affected by cortisol, we studied the cortisol effects on the pituitary and?the testis in more detail (chapter 4 and in chapter 5) and tried to answer the question whether cortisol has its effects, directly or indirectly on the different components of the BPG-axis. Based on these studies we hypothesized that the cortisol-induced suppression of pubertal development is mediated by effects on the androgen production. In the following chapter, chapter 6, we therefore intensified our research on the testis, focussing on the steroid synthesis. Finally, in chapter 7, we investigated the role of the androgens, which possibly play a key role in the cortisol-induced suppression of pubertal development, by combined cortisol treatment and steroid replacement therapy

Tentative reference acts? 'Recognitial demonstratives’ as means of suggesting mutual knowledge - or overriding a lack of it

Zweitveröffentlichun

"Nahe Referenten": ein integrativer Ansatz zur Funktion demonstrativer Referenz

Zweitveröffentlichun

Robotic rectal prolapse repair

This chapter gives a comprehensive overview of the current standards in the evaluation and surgical management of rectal prolapse, using the Da Vinci surgical system. Rectal prolapse is a disabling condition mostly seen in middle-aged women. The rectal wall protruding in or through the anal canal can lead to symptoms of obstructed defecation and fecal incontinence. A thorough preoperative multi-disciplinary evaluation of patients with rectal prolapse should be performed to look for concomitant prolapse of the middle and anterior pelvic floor compartments. The only definite treatment for rectal prolapse is surgery. This aims at correcting the abnormal anatomy and relieving the associated functional complaints. Numerous procedures have been described including perianal and abdominal approaches and open and minimally invasive techniques. Although there is no international consensus on preferred treatment strategy, currently the two most widely applied surgeries are the ventral rectopexy and the resection rectopexy. Both procedures have been shown safe and feasible performed by either laparoscopy or robot-assisted. Robot-assisted procedures seem to be advantageous in rectal prolapse surgery due to its enhanced maneuverability while performing dissection and suturing deep down the narrow pelvis.</p