Impact of dehydration on laparoscopic performance: a prospective, open-label, randomized cross-over trial.

INTRODUCTION: During laparoscopic surgery, surgeons may experience prolonged periods without fluid intake, which might impact surgical performance, yet there are no objective data investigating this issue. Therefore, the aim of this study was to elucidate the effect of prolonged dehydration on laparoscopic surgical performance and tissue handling. METHODS: A total of 51 laparoscopic novices participated in a single-center, open-label, prospective randomized cross-over trial. All participants were trained to proficiency using a standardized laparoscopic training curriculum. Afterward, all participants performed four different laparoscopic tasks twice, once after 6 h without liquid intake (dehydrated group) and once without any restrictions (control group). Primary endpoints were tissue handling defined by force exertion, task time, and error rate. The real hydration status was assessed by biological parameters, like heart rate, blood pressure, and blood gas analysis. RESULTS: 51 laparoscopic novices finished the curriculum and completed the tasks under both hydrated and dehydrated conditions. There were no significant differences in mean non-zero and peak force between the groups. However, dehydrated participants showed significantly slower task times in the Peg transfer task (hydrated: 139.2 s vs. dehydrated: 147.9 s, p = 0.034) and more errors regarding the precision in the laparoscopic suture and knot task (hydrated: 15.7% accuracy rate vs. dehydrated: 41.2% accuracy rate, p < 0.001). CONCLUSION: Prolonged periods of dehydration do not appear to have a substantial effect on the fundamental tissue handling skills in terms of force exertion among surgical novices. Nevertheless, the observed impact on speed and precision warrants attention.

Staging enmity: reading populist productions of shame with Jelinek's On the Royal Road.

Background: Populism is often perceived as a shamelessly loud segment of political discourse. However, Jelinek's play On the Royal Road, written on the occasion of Trump's 2016 election as US president, suggests that populism leads to societal silencing. Jelinek's text expounds that when a society's public sphere is marked by ubiquitous enmity against an imagined "we", grounded in antagonism, then the possibility of speaking to one another disappears, because speaking to one another is based on the willingness to give one's counterpart space and listen to them. In a public discourse that stages enmity, the counterpart vanishes. Therefore, populism, loud as it is, leads to the silencing of whole communities insofar as they are left with nothing in common but enmity. Method: Critical discourse analysis is used to contextualise close readings of select passages of Jelinek's play with recent social sciences and humanities research on global populisms to highlight what literary language and the dramatic form can contribute to understanding populism. Results: The silencing populisms entail is fed, in large part, by a dynamics linking the interpersonal emotion of shame to its discursive exploitation in shamelessness and shaming: populist voices transgress rules of democratic debate in the public sphere to elicit outrage by mainstream politics, media, and civil society, which often retort populist shamelessness by shaming populist actors. The audience excitement populist leaders and supporters generate is an important factor in normalizing the emotional, moralizing populist polarization of "us" versus "them" that undermines differentiated discussion and a dispute of arguments. Conclusion: While media and research commonly suggest that with the populist reduction of politics to a spectacle, citizens become a passive audience, the article expounds that audiences play a key role in the production of populist enmity. This insight offers an alley to counteract populism.

Do certain surgical steps increase postoperative morbidity after cytoreductive surgery and HIPEC- a retrospective analysis.

INTRODUCTION: It has been shown that cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for patients suffering from peritoneal malignancies. Despite good results, there is an ongoing debate about this treatment due to perioperative morbidity. The aim of this study is to identify relevant risk factors for an unfavorable postoperative outcome after CRS and HIPEC. MATERIALS AND METHODS: A retrospective analysis of a prospectively recorded database of all patients undergoing CRS and HIPEC between 2013 and 2020 in the Department of Surgery of the University Hospital Dresden was performed with a special focus on certain surgical steps of multivisceral resection, one- or 2- stage CRS/HIPEC and underlying diagnosis as possible risk factors for worse postoperative course. RESULTS: N = 173 CRS and HIPEC procedures were performed for various diagnoses. Relevant postoperative morbidity was 24% and 30d-mortality 1.2%. Simultaneous liver resections, preoperative hypalbuminemia and 2-staged CRS/HIPEC were significant risk factors for a worse postoperative course in multivariable analysis. Assessment of the association of simultaneous anastomoses and morbidity and mortality was inconclusive. CONCLUSION: CRS and HIPEC is a safe treatment without relevant intraoperative morbidity and mortality and acceptable postoperative outcome. One-stage CRS/HIPEC should be preferred.

Complicity at a distance: commemorating problematic involvement in perpetration in contemporary Central and Eastern European literatures.

Background: In the twenty-first century, literatures from Central and Eastern Europe are marked by a boom of documentary fiction portraying complicity Nazi perpetration, Soviet terror, or other instances of 20th century mass violence and totalitarianism. Since understanding the past serves requirements of the present, the boom prompts the question: Why the interest in past complicities now? My hypothesis is that the texts address convergences between involvements in past acts of mass violence and current forms of participation in wrongdoings in neoliberalism. While these issues differ profoundly, they are related: structurally, both present the challenge of forming a nuanced notion of participation. Historically, they are related since justifications of past involvements have established the terminology, narratives, and heuristics in which terror, repression, and mass violence are subsequently discussed, thus forming the frame for negotiating current problematic involvements. Method: Critical discourse analysis is used to scrutinize the legal concept of complicity and combined it with close readings of passages from four literary texts to outline how attention to reciprocity in language can enhance our understanding of problematic involvement. Results: Literary portrayals of historical complicity are ambivalent; they can help to find models for comprehending issues of the present in cultural memory, but they can also serve to establish distance between present and past to appease the sense that all is not quite well, even after the demise of Nazi and Soviet terror. The article outlines two modes of distancing: a) spacio-temporal distancing of the commemorating point of view in 'the West' from the portrayed violence in 'the East', and b) moral distancing that casts the audience as superior to complicit characters. Conclusion: By pressing for analytic or consoling distance, both strategies of distancing amount to a complicity with the transmission of discourses that justify, excuse, or deny mass violence and totalitarian terror.

Lake Tanganyika--a 'melting pot' of ancient and young cichlid lineages (Teleostei: Cichlidae)?

A long history of research focused on the East Africa cichlid radiations (EAR) revealed discrepancies between mtDNA and nuclear phylogenies, suggesting that interspecific hybridisation may have been significant during the radiation of these fishes. The approximately 250 cichlid species of Lake Tanganyika have their roots in a monophyletic African cichlid assemblage, but controversies remain about the precise phylogenetic origin and placement of different lineages and consequently about L. Tanganyika colonization scenarios. 3312 AFLP loci and the mitochondrial ND2 gene were genotyped for 91 species representing almost all major lacustrine and riverine haplotilapiine east African cichlid lineages with a focus on L. Tanganyika endemics. Explicitly testing for the possibility of ancient hybridisation events, a comprehensive phylogenetic network hypothesis is proposed for the origin and diversification of L. Tanganyika cichlids. Inference of discordant phylogenetic signal strongly suggests that the genomes of two endemic L. Tanganyika tribes, Eretmodini and Tropheini, are composed of an ancient mixture of riverine and lacustrine lineages. For the first time a strong monophyly signal of all non-haplochromine mouthbrooding species endemic to L. Tanganyika ("ancient mouthbrooders") was detected. Further, in the genomes of early diverging L. Tanganyika endemics Trematocarini, Bathybatini, Hemibatini and Boulengerochromis genetic components of other lineages belonging to the East African Radiation appear to be present. In combination with recent palaeo-geological results showing that tectonic activity in the L. Tanganyika region resulted in highly dynamic and heterogeneous landscape evolution over the Neogene and Pleistocene, the novel phylogenetic data render a single lacustrine basin as the geographical cradle of the endemic L. Tanganyika cichlid lineages unlikely. Instead a scenario of a pre-rift origin of several independent L. Tanganyika precursor lineages which diversified in ancient rivers and precursor lakes and then amalgamated in the extant L. Tanganyika basin is put forward as an alternative: the 'melting pot Tanganyika' hypothesis.