Dynamic Communications Between GABAA Switch, Local Connectivity, and Synapses During Cortical Development: A Computational Study

Several factors regulate cortical development, such as changes in local connectivity and the influences of dynamical synapses. In this study, we simulated various factors affecting the regulation of neural network activity during cortical development. Previous studies have shown that during early cortical development, the reversal potential of GABAA shifts from depolarizing to hyperpolarizing. Here we provide the first integrative computational model to simulate the combined effects of these factors in a unified framework (building on our prior work: Khalil et al., 2017a,b). In the current study, we extend our model to monitor firing activity in response to the excitatory action of GABAA. Precisely, we created a Spiking Neural Network model that included certain biophysical parameters for lateral connectivity (distance between adjacent neurons) and nearby local connectivity (complex connections involving those between neuronal groups). We simulated different network scenarios (for immature and mature conditions) based on these biophysical parameters. Then, we implemented two forms of Short-term synaptic plasticity (depression and facilitation). Each form has two distinct kinds according to its synaptic time constant value. Finally, in both sets of networks, we compared firing rate activity responses before and after simulating dynamical synapses. Based on simulation results, we found that the modulation effect of dynamical synapses for evaluating and shaping the firing activity of the neural network is strongly dependent on the physiological state of GABAA. Moreover, the STP mechanism acts differently in every network scenario, mirroring the crucial modulating roles of these critical parameters during cortical development. Clinical implications for pathological alterations of GABAergic signaling in neurological and psychiatric disorders are discussed

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Gene Editing and Human Induced Pluripotent Stem Cells for Advanced Modelling of Duchenne Muscular Dystrophy

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Dynamic communications between GABA A switch, local connectivity, and synapses during cortical development: A computational study

Several factors regulate cortical development, such as changes in local connectivity and the influences of dynamical synapses. In this study, we simulated various factors affecting the regulation of neural network activity during cortical development. Previous studies have shown that during early cortical development, the reversal potential of GABA A shifts from depolarizing to hyperpolarizing. Here we provide the first integrative computational model to simulate the combined effects of these factors in a unified framework (building on our prior work: Khalil et al., 2017a,b). In the current study, we extend our model to monitor firing activity in response to the excitatory action of GABA A . Precisely, we created a Spiking Neural Network model that included certain biophysical parameters for lateral connectivity (distance between adjacent neurons) and nearby local connectivity (complex connections involving those between neuronal groups). We simulated different network scenarios (for immature and mature conditions) based on these biophysical parameters. Then, we implemented two forms of Short-term synaptic plasticity (depression and facilitation). Each form has two distinct kinds according to its synaptic time constant value. Finally, in both sets of networks, we compared firing rate activity responses before and after simulating dynamical synapses. Based on simulation results, we found that the modulation effect of dynamical synapses for evaluating and shaping the firing activity of the neural network is strongly dependent on the physiological state of GABA A . Moreover, the STP mechanism acts differently in every network scenario, mirroring the crucial modulating roles of these critical parameters during cortical development. Clinical implications for pathological alterations of GABAergic signaling in neurological and psychiatric disorders are discussed. ? 2018 Khalil, Karim, Khedr, Moftah and Moustafa.KA 4267/3-1 Deutsche ForschungsgemeinschaftScopu

Trihalomethanes formation in marine environment in front of Nuweibaa desalination plant as a result of effluents loaded by chlorine residual

Trihalomethanes have been identified as the most important disinfection byproducts resulted from using chlorine in desalination plants. Nuweibaa desalination plant was chosen to study their effluents impacts on the marine environment in front of the plant in the coastal area of Gulf of Aqaba. Surface and bottom Water Samples were collected from nine locations in the outfall area of this desalination plant during spring and autumn 2014, and analyzed for water temperature, pH value, Salinity, Dissolved Oxygen, Biological oxygen demand, Oxidizible organic matter, Total, fixed and volatile suspended matter, residual chlorine (free and combined) and trihalomethanes. High total chlorine dosage discharged from the desalination plant achieved high levels of trihalomethanes in the receiving seawater of the outfall area. It has been estimated that about 14524.65671 kg of BOD, 74123.4 kg of OOM, 166896.4375 kg of total suspended solids, 623.634 kg of free chlorine, 469.21 kg of combined chlorine, 206.64 kg of chloroform and 76.48 kg of bromoform are discharged annually from this plant into the Gulf of Aqaba affecting the marine ecosystems. The results of THMs showed that the two main forms of THMs formed in the receiving seawater were chloroform and bromoform and ranged between (5.09–156.59), (2.82–566.06) μg/L respectively. High pH and High combined chlorine concentrations favored the formation of high concentrations of chloroform

Dynamic Communications Between GABAA Switch, Local Connectivity, and Synapses During Cortical Development: A Computational Study

Several factors regulate cortical development, such as changes in local connectivity and the influences of dynamical synapses. In this study, we simulated various factors affecting the regulation of neural network activity during cortical development. Previous studies have shown that during early cortical development, the reversal potential of GABAA shifts from depolarizing to hyperpolarizing. Here we provide the first integrative computational model to simulate the combined effects of these factors in a unified framework (building on our prior work: Khalil et al., 2017a,b). In the current study, we extend our model to monitor firing activity in response to the excitatory action of GABAA. Precisely, we created a Spiking Neural Network model that included certain biophysical parameters for lateral connectivity (distance between adjacent neurons) and nearby local connectivity (complex connections involving those between neuronal groups). We simulated different network scenarios (for immature and mature conditions) based on these biophysical parameters. Then, we implemented two forms of Short-term synaptic plasticity (depression and facilitation). Each form has two distinct kinds according to its synaptic time constant value. Finally, in both sets of networks, we compared firing rate activity responses before and after simulating dynamical synapses. Based on simulation results, we found that the modulation effect of dynamical synapses for evaluating and shaping the firing activity of the neural network is strongly dependent on the physiological state of GABAA. Moreover, the STP mechanism acts differently in every network scenario, mirroring the crucial modulating roles of these critical parameters during cortical development. Clinical implications for pathological alterations of GABAergic signaling in neurological and psychiatric disorders are discussed