Anti-platelet effect of aspirin is substantially reduced after administration of heparin during carotid endarterectomy

OBJECTIVES: Aspirin therapy is usually continued throughout the perioperative period to reduce the risk for thromboembolic stroke and myocardial infarction after carotid endarterectomy (CEA). Aspirin irreversibly binds cyclooxygenase-1, thereby reducing platelet aggregation for the lifetime of each platelet. However, recent research from this unit has shown that aggregation in response to arachidonic acid increases significantly, but transiently, during CEA, which suggests that the anti-platelet effect of aspirin is temporarily reversed. The purpose of the current study was to determine when this phenomenon occurs and to identify the possible mechanisms involved. METHODS: Platelet aggregation was measured in platelet-rich plasma from 41 patients undergoing CEA who were stabilized with 150 mg of aspirin daily. Blood was taken at 8 time points: before anesthesia, after anesthesia, before heparinization, 3 minutes after heparinization, 3 minutes after shunt insertion, 10 minutes after flow restoration, 4 hours postoperatively, and 24 hours postoperatively. Platelet aggregation was also measured at similar times in a group of 18 patients undergoing peripheral angioplasty without general anesthesia. RESULTS: All patient platelets were effectively inhibited by aspirin at the start of the operation. There was a significant intraoperative increase in platelet response to arachidonic acid in both groups of patients, which occurred within 3 minutes of administration of unfractionated heparin. In the CEA group this resulted in a greater than 10-fold increase in mean aggregation, to 5 mmol/L of arachidonic acid (5 mmol/L), rising from 3.9% +/- 2.2% preoperatively to 45.1% +/- 29.3% after administration of heparin ( P <.0001). This increased aggregation persisted into the early postoperative period, but by 24 hours post operation aggregation had returned to near preoperative values. Aggregation in response to other platelet agonists (adenosine diphosphate, thrombin receptor agonist peptide) showed only a small increase at the same time, which could be accounted for by a parallel increase in the level of spontaneous aggregation. CONCLUSION: Administration of heparin significantly increases platelet aggregation in response to arachidonic acid, despite adequate inhibition by aspirin administered preoperatively. This apparent reversal in anti-platelet activity persisted into the immediate early postoperative period, and could explain why a small proportion of patients are at increased risk for acute cardiovascular events after major vascular surgery, despite aspirin therapy.

Cognitive representation of colour in bilinguals: the case of Greek blues

A number of recent studies demonstrate that bilinguals with languages that differ in grammatical and lexical categories may shift their cognitive representation of those categories towards that of monolingual speakers of their second language. The current paper extended that investigation to the domain of colour in Greek–English bilinguals with different levels of bilingualism, and English monolinguals. Greek differentiates the blue region of colour space into a darker shade called ble and a lighter shade called ghalazio. Results showed a semantic shift of category prototypes with level of bilingualism and acculturation, while the way bilinguals judged the perceptual similarity between within- and cross-category stimulus pairs depended strongly on the availability of the relevant colour terms in semantic memory, and the amount of time spent in the L2-speaking country. These results suggest that cognition is tightly linked to semantic memory for specific linguistic categories, and to cultural immersion in the L2-speaking country.

Grammatical abilities of Greek-speaking children with autism

This study investigates pronoun reference and verbs with non-active morphology in high functioning Greek-speaking children with Autism Spectrum Disorders (ASD). It is motivated by problems with reflexive pronouns demonstrated by English-speaking children with ASD, and the fact that reflexivity is additionally expressed via non-active (reflexive) verbs in Greek. Twenty 5- to 8-year-old children with ASD and twenty vocabulary matched typically developing controls of the same age range completed a sentence-picture matching, an elicitation, and a judgment task. Children with ASD did not differ from controls in interpreting reflexive and strong pronouns, but were less accurate in the comprehension of clitics and omitted clitics in their production. The findings render clitics a vulnerable domain for autism in Greek, and potentially for other languages with clitics, and suggest that this could be a consequence of difficulties in the syntax-pragmatics or the syntax-phonology interface. The two groups did not differ in the comprehension of non-active morphology, but were less accurate in passive than reflexive verbs. This difference is likely to stem from the linguistic representation associated with each type of verb, rather than their input frequency.

Second Strike and you are (finally) out? The Quashing of the Prevention of Infiltration Law (Amendment no. 4)

The blog-post critically analyses the Israeli Supreme Court judgment (HCJ 8425/13 Anon v. Knesset et al) quashing the Prevention of Infiltration Law (Amendment no. 4), offering themes of comparative constitutional interest.

Projecting social and discursive identities through code-switching on facebook: the case of Greek Cypriots

Two varieties of Greek are spoken on the island of Cyprus: the local dialect, namely the Greek-Cypriot Dialect (GCD), and Standard Modern Greek (SMG). English is also influential, as Cyprus was an English colony until 1960. The dialect is rarely employed for everyday written purposes; however, it is now evident in computer-mediated communication (CMC). As a contribution to the field of code-switching in writing, this study examines how Greek-Cypriot internet users employ GCD, SMG, and English in their Facebook interactions. In particular, we investigate how identities (discursive and social) are performed and indexed through the linguistic choices of Greek-Cypriot internet users. The findings indicate that switches to GCD add a humorous tone and express solidarity and informality. SMG is mostly used for ‘official’ statements, and it is preferred by mature internet users, while English is used with expressions of affect and evaluative comments.

Introduction: the legacy of Greek political thought

This Introduction offers context for the individual papers by examining the intersections and productive tensions between political thought and classical reception studies. While Plato and Aristotle have long been privileged interlocutors for political philosophers, classical reception studies has pluralised both this ancient canon and given rise to a more complex understanding of the modern heirs of ancient political thought. Similarly, the insights of studying the history of political texts and ideas across a longer tradition calls into question the fixity of concepts such as democracy, empire and political freedom. Indeed, we query the very notion of tradition by emphasising how the past has been repeatedly constructed and reconstructed in divergent modern political discourses and conversely how modern political theories and realities have been shaped and reshaped by an idea of antiquity. The Introduction closes with a brief survey of the collected papers.

Regulating non-international armed conflicts: a review essay of 'The Law of Non-International Armed Conflict' by Sandesh Sivakumaran

This review essay engages with Sandesh Sivakumaran’s book The Law of Non-International Armed Conflict, exploring its significance both in international humanitarian law and international law more generally.