AimsContinuous ambulatory peritoneal dialysis (CAPD) has been proposed as an additional therapeutic resource for patients with advanced congestive heart failure (CHF). The objective of this study was to determine the therapeutic role of CAPD, in terms of surrogate endpoints, in the management of patients with advanced CHF and renal dysfunction. Methods and resultsA total of 57 candidates with New York Heart Association (NYHA) class III/IV CHF, renal dysfunction (glomerular filtration rate , 60 mL/min/1.73 m 2 ), persistent fluid congestion despite loop diuretic treatment, and at least two previous hospitalizations for acute heart failure (AHF) were invited to be included in the CAPD programme; however, 25 patients were finally included. The primary outcome was evaluated by the change at 6 and 24 weeks for the Minnesota Living With Heart Failure Questionnaire (MLWHFQ), the 6 min walk test (6MWT), NYHA class, serum natriuretic peptides [brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP)], serum carbohydrate antigen 125 (CA125), and hospitalization rates for AHF. CAPD was associated with a substantial improvement in the MLWHFQ (-21.3, P , 0.001; and -20.4, P , 0.001), the 6MWT (54.0, P , 0.001; and 45.6, P ¼ 0.023), and NYHA class ( -1.0, P , 0.001; and -1.4, P , 0.001) at 6 and 24 weeks, respectively. The Ln(CA125) decreased markedly (-0.8, P ¼ 0.003; and -0.98, P ¼ 0.003), with no effect on BNP and NT-proBNP. There was a marked reduction in the number of days hospitalized for AHF (6 month post-CAPD vs. 6 months pre-CAPD: -84%; P , 0.001). ConclusionsIn advanced CHF and renal dysfunction, CAPD was associated with short/mid-term improvement in severity parameters, with an acceptable rate of side effects.--

This article explores the role that markers play in the pragmatic discourse structure of Catalan and English oral narratives. It is argued that their meaning is directly related to the sort of coherence relation that they establish with preceding and following propositions and discourse segments, centring the discussion on four discourse structures/components: ideational, rhetorical, sequential and inferential. The aim is to show the textual form-pragmatic function relationship by means of specific lexical units placed at specific parts of the narrative. The hypothesis held in this article is that pragmatic markers help in the organization of narrative segments and that their semanticopragmatic traits make them appropriate for their use in specific segments.

This study investigates how epistemic stance is encoded and perceived in face-toface communication when language is regarded as comprised by speech and gesture. Two studies were conducted with this goal in mind. The first study consisted of a production task in which participants performed opinion reports.Results showed that speakers communicate epistemic stance both verbally and nonverbally, and that specific prosodic and gestural patterns are used to express different epistemic and evidential meanings. The second study consisted of a rating task in which listeners rated the degree of certainty expressed by the opinion reports. Results showed that the number of gestural high certainty markers used by a speaker was a good predictor of the perception of epistemic high certainty. We thus claim that prosodic and gestural markers can be regarded as overt manifestations of epistemicity and evidentiality, and they appear to be especially effective in the communication of epistemic stance.

No abstract