Genetic deletion of fibroblast growth factor 14 recapitulates phenotypic alterations underlying cognitive impairment associated with schizophrenia

Cognitive processing is highly dependent on the functional integrity of gamma-amino-butyric acid (GABA) interneurons in the brain. These cells regulate excitability and synaptic plasticity of principal neurons balancing the excitatory/inhibitory tone of cortical networks. Reduced function of parvalbumin (PV) interneurons and disruption of GABAergic synapses in the cortical circuitry result in desynchronized network activity associated with cognitive impairment across many psychiatric disorders, including schizophrenia. However, the mechanisms underlying these complex phenotypes are still poorly understood. Here we show that in animal models, genetic deletion of fibroblast growth factor 14 (Fgf14), a regulator of neuronal excitability and synaptic transmission, leads to loss of PV interneurons in the CA1 hippocampal region, a critical area for cognitive function. Strikingly, this cellular phenotype associates with decreased expression of glutamic acid decarboxylase 67 (GAD67) and vesicular GABA transporter (VGAT) and also coincides with disrupted CA1 inhibitory circuitry, reduced in vivo gamma frequency oscillations and impaired working memory. Bioinformatics analysis of schizophrenia transcriptomics revealed functional co-clustering of FGF14 and genes enriched within the GABAergic pathway along with correlatively decreased expression of FGF14, PVALB, GAD67 and VGAT in the disease context. These results indicate that Fgf14(-/-) mice recapitulate salient molecular, cellular, functional and behavioral features associated with human cognitive impairment, and FGF14 loss of function might be associated with the biology of complex brain disorders such as schizophrenia

Environmental enrichment and social isolation mediate neuroplasticity of medium spiny neurons through the GSK3 pathway

Resilience and vulnerability to neuropsychiatric disorders are linked to molecular changes underlying excitability that are still poorly understood. Here, we identify glycogen-synthase kinase 3b (GSK3b) and voltage-gated Na+ channel Nav1.6 as regulators of neuroplasticity induced by environmentally enriched (EC) or isolated (IC) conditions\u2014models for resilience and vulnerability. Transcriptomic studies in the nucleus accumbens from EC and IC rats predicted low levels of GSK3b and SCN8A mRNA as a protective phenotype associated with reduced excitability in medium spiny neurons (MSNs). In vivo genetic manipulations demonstrate that GSK3b and Nav1.6 are molecular determinants of MSN excitability and that silencing of GSK3b prevents maladaptive plasticity of IC MSNs. In vitro studies reveal direct interaction of GSK3b with Nav1.6 and phosphorylation at Nav1.6T1936 by GSK3b. A GSK3b-Nav1.6T1936 competing peptide reduces MSNs excitability in IC, but not EC rats. These results identify GSK3b regulation of Nav1.6 as a biosignature ofMSNs maladaptive plasticity

A Systematic Scoping Review of the State of Pharmacovigilance and Governance in the MENA Region: Challenges and Opportunities

Introduction Pharmacovigilance (PV) systems around the world vary in capacity and maturity. Many factors can influence PV. Objectives This systematic scoping review aims to explore the opportunities for effective PV in the Middle East and North Africa (MENA) region by (1) using the pharmacogovernance (PG) framework to evaluate the PV systems and (2) determining the factors influencing PV, including regulatory governance, PG, and international actors influence. Methods In accordance with Cochrane Collaboration guidelines, the STARLITE criteria were used to guide the systematic literature search and review process. The search included English and Arabic language databases, search engines, and grey literature and a supplementary search of the reference lists of included articles. Inclusion criteria were pertinent to the influence of PV, governance and health, PG framework domains, international actors, and MENA countries. Data synthesis followed the meta-aggregation process. Results From the 32 included records, the majority of PV-enhanced actions were from Saudi Arabia, Iran, and Morocco. The ‘policy, law, and regulations’ domain was the strongest in the MENA, whereas public ‘participation and representation’ was lacking. Further, the PG framework allowed the identification of shortcomings, including a lack of public inclusiveness and participation, resource scarcity, misalignment of resource allocation, issues with existing regulations, and deficiencies in ‘accountability and transparency’. Conclusion Most of the existing systems are still in their infancy, and disparities exist at national and regional levels. The operationalization of effective PV systems requires actions that assure (1) the development and enforcement of comprehensive regulations, (2) adequate and equitable aid for core PV processes, and (3) accountability and participation from all stakeholders.Funding This systematic scoping review was funded by Qatar University (Grant number: QUST-2-CPH-2017-7).Scopu

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas