Neuroplasticity of the Sensorimotor Cortex during Learning

We will discuss some of the current issues in understanding plasticity in the sensorimotor (SM) cortices on the behavioral, neurophysiological, and synaptic levels. We will focus our paper on reaching and grasping movements in the rat. In addition, we will discuss our preliminary work utilizing inhibition of protein kinase Mζ (PKMζ), which has recently been shown necessary and sufficient for the maintenance of long-term potentiation (LTP) (Ling et al., 2002). With this new knowledge and inhibitors to this system, as well as the ability to overexpress this system, we can start to directly modulate LTP and determine its influence on behavior as well as network level processing dependent at least in part due to this form of LTP. We will also briefly introduce the use of brain machine interface (BMI) paradigms to ask questions about sensorimotor plasticity and discuss current analysis techniques that may help in our understanding of neuroplasticity

Cognitive impairment andbehavioral characteristics in children who snore

OBJECTIVES: The primary objective was to compare the cognitive impairment and behavioral changes of children with or without snoring. The secondary objective was to compare the same in children with or without OSA, based on overnight pulse oximetry. METHODS: 51 children in the 4 to 9 year age group were divided into 2 groups based on the presence of snoring in a hospital based prospective cross sectional study. After an ENT evaluation, an OSA 18 questionnaire was administered to assess quality of life. X-ray nasopharynx and rigid nasal endoscopy were done in the snoring group. Both groups underwent cognitive and behavioral assessment using Binet-Kamat IQ test and Revised Connor’s Parent Rating Scale respectively. Data was analysed using appropriate statistical tests with p < 0.05 considered as significant. RESULTS: In this study we compared 26 snoring children between the age group of 4-9 years to their 25 siblings who never snored. No significant neurocognitive impairment was seen in children with snoring compared to non snoring children however it was seen trending towards significance. In children with moderate to severe quality of life issues due to sleep disordered breathing, based on OAS 18 scores significant neurocognitive impairment was seen (p 0.009). No significant behavioral changes were seen, however oppositional behavior was seen trending towards significance (p 0.057). On assessing the severity of OSA using overnight pulse oximetry, the study was inconclusive in 81% of the snoring children. CONCLUSION: In this study we compared 26 snoring children between the age group of 4-9 years to their 25 siblings who never snored. NEUROCOGNITION: No significant neurocognitive impairment was seen in children with snoring compared to non snoring children however it was seen trending towards significance. In children with moderate to severe quality of life issues due to sleep disordered breathing, significant neurocognitive impairment was seen compared to those with mild issues. BEHAVIORAL CHANGES: Compared to children without snoring, none of the snoring children showed any significant adverse behavioral changes however oppositional behavior was seen trending towards significance. No significant behavioral changes were seen in children with moderate to severe quality of life issues and morbidity due to sleep disordered breathing, compared to those with mild issues. OVERNIGHT PULSE OXIMETRY: On assessing the severity of OSA using overnight pulse oximetry, the study was inconclusive in 81% of the snoring children. Hence we conclude that overnight pulse oximetry is not a sensitive tool to assess severity of OSA

The prothrombotic tendency of metabolic-associated fatty liver disease

Our understanding of the function of the liver has evolved over the centuries. Early theories proposing that the liver could be used to divine the future have been superseded by our current knowledge of the importance of the liver in processes such as digestion and detoxification. Similarly, although liver disease was previously associated with only an increased risk of bleeding, there is now a substantial body of evidence demonstrating an increased thrombotic potential in patients with this disease. Metabolic-associated fatty liver disease (MAFLD) is increasing in frequency and is likely to overtake alcoholic liver disease as the primary indication for liver transplant in the future. In this review, we discuss the evidence linking liver disease, and MAFLD in particular, with arterial and venous thromboembolic disease. We review the safety and efficacy of anticoagulation in advanced liver disease and consider whether antithrombotic agents could slow or halt the progression of fibrosis in MAFLD.</p

Heparin - Messias or Verschlimmbesserung?

A heightened risk of thrombosis noted early on with the severe acute respiratory syndrome coronavirus 2 infection led to the widespread use of heparin anticoagulation in the coronavirus disease 2019 (COVID-19) pandemic. However, reports soon started appearing in the literature where an apparent failure of heparin to prevent thrombotic events was observed in hospitalized patients with this viral infection. In this review, we explore the likely mechanisms for heparin failure with particular relevance to COVID-19. We also explore the role of anti-Xa assays and global hemostatic tests in this context. The current controversy of dosing heparin in this disease is detailed with some possible mechanistic reasons for anticoagulant failure. We hope that lessons learnt from the use of heparin in COVID-19 could assist us in the appropriate use of this anticoagulant in the future

The prothrombotic tendency of metabolic-associated fatty liver disease

Our understanding of the function of the liver has evolved over the centuries. Early theories proposing that the liver could be used to divine the future have been superseded by our current knowledge of the importance of the liver in processes such as digestion and detoxification. Similarly, although liver disease was previously associated with only an increased risk of bleeding, there is now a substantial body of evidence demonstrating an increased thrombotic potential in patients with this disease. Metabolic-associated fatty liver disease (MAFLD) is increasing in frequency and is likely to overtake alcoholic liver disease as the primary indication for liver transplant in the future. In this review, we discuss the evidence linking liver disease, and MAFLD in particular, with arterial and venous thromboembolic disease. We review the safety and efficacy of anticoagulation in advanced liver disease and consider whether antithrombotic agents could slow or halt the progression of fibrosis in MAFLD.</p

Neuroplasticity of the Sensorimotor Cortex during Learning

We will discuss some of the current issues in understanding plasticity in the sensorimotor (SM) cortices on the behavioral, neurophysiological, and synaptic levels. We will focus our paper on reaching and grasping movements in the rat. In addition, we will discuss our preliminary work utilizing inhibition of protein kinase Mζ (PKMζ), which has recently been shown necessary and sufficient for the maintenance of long-term potentiation (LTP

Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach

Ventricular tachycardia (VT) occurring late after myocardial infarction is often due to reentry circuit in the peri-infarct zone. The circuit is usually located in the sub-endocardium, though subepicardial substrates are known. Activation mapping during VT to identify target regions for ablation can be difficult if VT is non inducible or poorly tolerated. In the latter, a substrate based approach of mapping during sinus rhythm in conjunction with pace mapping helps to define the reentry circuit and select target sites for ablation in majority of patients with hemodynamically unstable VT. Percutaneous epicardial catheter ablation has been attempted as an approach where ablation by a conventional endocardial access has been unsuccessful. We report a case of post myocardial infarction scar VT which could be successfully ablated with a substrate based approach from the epicardial aspect

The concept of rebalanced hemostasis in patients with liver disease:Communication from the ISTH SSC working group on hemostatic management of patients with liver disease

Patients with liver diseases acquire complex alterations in their hemostatic system that may lead to abnormalities in routine diagnostic test of hemostasis. Thrombocytopenia, prolongations in the prothrombin time and activated partial thromboplastin time, and decreased plasma fibrinogen are common in patients with advanced liver disease. Historically, liver diseases therefore have been classified as an acquired bleeding disorder. Laboratory and clinical observations have demonstrated that although routine diagnostic tests of hemostasis suggest a hypocoagulable state, patients with liver disease also tend to develop thrombotic events. Overall, patients have commensurate changes in both pro- and antihemostatic pathways. This new hemostatic balance, however, appears much more fragile than the hemostatic balance in individuals with normal liver function, and patients with liver disease can readily experience both hemostasis-related bleeding and thrombotic events. These insights into the hemostatic balance in patients with liver disease have led to revised recommendations for clinical management of hemostasis. In 2020, an SSC working group within the ISTH has been founded with the aim to disseminate new concepts on prevention and treatment of bleeding and thrombosis in patients with liver disease. The current document will outline the hemostatic changes in patients with liver disease, the limitations of routine diagnostic tests of hemostasis, and the concept of rebalanced hemostasis