Changes in nucleolar dry mass of neurones of the paraventricular and supraoptic nuclei in the rat during pregnancy and lactation

Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-analysis

BACKGROUND

Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions.

DESIGN

Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews.

ELIGIBILITY CRITERIA

Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096).

RESULTS

We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [- 0.17, 2.06], P = 0.098, I² = 92.46%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 0.99 [0.66, 1.32], P < 0.001, I² = 92.43%, studies: n = 42), usual care controls (g [95% CI]: 0.64 [0.44, 0.83], P < 0.001, I² = 76.52%, studies: n = 33), and when all controls combined (g [95% CI]: 0.84 [0.64, 1.04], P < 0.001, I² = 90.02%, studies: n = 79).

CONCLUSIONS

There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.

Enhancement of calcium-dependent afterpotentials in oxytocin neurons of the rat supraoptic nucleus during lactation

The firing pattern of oxytocin (OT) hormone synthesizing neurons changes dramatically immediately before each milk ejection, when a brief burst of action potentials is discharged. OT neurons possess intrinsic currents that would modulate this burst. Our previous studies showed the amplitude of the Ca2+ -dependent afterhyperpolarization (AHP) following spike trains is significantly larger during lactation. In the present study we sought to determine which component of the AHP is enhanced, and whether the enhancement could be related to changes in whole-cell Ca2+ current or the Ca2+ transient in identified OT or vasopressin (VP) neurons during lactation. We confirmed, with whole-cell current-clamp recordings, our previous finding from sharp electrodes that the size of the AHP following spike trains increased in OT, but not VP neurons during lactation. We then determined that an apamin-sensitive medium-duration AHP (mAHP) and an apamin-insensitive slow AHP (sAHP) were specifically increased in OT neurons. Simultaneous Ca2+ imaging revealed that the peak change in somatic [Ca2+]i was not altered in either cell type, but the slow decay of the Ca2+ transient was faster in both cell types during lactation. In voltage clamp, the whole-cell, Ca2+ current was slightly larger during lactation in OT cells only, but current density was unchanged when corrected for somatic hypertrophy. The currents, ImAHP and IsAHP, also were increased in OT neurons only, but only the apamin-sensitive ImAHP showed an increase in current density after adjusting for somatic hypertrophy. These findings suggest a specific modulation (e.g. increased number) of the small-conductance Ca2+ -dependent K+ (SK) channels, or their interaction with Ca2+, underlies the increased mAHP/ImAHP during lactation. This larger mAHP may be necessary to limit the explosive bursts during milk ejection.

Chronic intracerebroventricular morphine and lactation in rats: dependence and tolerance in relation to oxytocin neurones

1. Acutely, opioids inhibit oxytocin secretion. To study the responses of oxytocin neurones during chronic opioid exposure, forty-five lactating rats were infused continuously from a subcutaneous osmotically driven mini-pump via a lateral cerebral ventricle with morphine sulphate solution from day 2 post-partum for 5-7 days; the infusion rate was increased 2- or 2.5-fold each 40 h from 10 micrograms/h initially up to 50 micrograms/h; controls were infused with vehicle (1 microliter/h, twenty-eight rats) or were untreated (eight rats). 2. Maternal behaviour was disrupted in 27% of the morphine-treated rats; in rats that remained maternal morphine did not affect body weight or water intake but increased rectal temperature by 0.82 +/- 0.14 degrees C (mean +/- S.E.M.) across the first 4 days. 3. Weight gain of the litters of maternal morphine-treated rats was reduced by 32% during 7 days, predominantly in the first day of treatment when milk transfer was also reduced. Observation of pup behaviour during suckling showed decreased frequency of milk ejections on only the second day of morphine treatment. Plasma concentration of prolactin after 6 days was similar in maternal morphine-treated and control rats, but reduced by 90% in non-maternal morphine-treated rats, indicating normal control of prolactin secretion by suckling in morphine-treated rats. 4. Oxytocin and vasopressin contents, measured by radioimmunoassay, in the supraoptic and paraventricular nuclei and in the neurohypophysis were similar between fourteen maternal morphine-treated, twelve vehicle-treated and eight untreated lactating rats; thus exposure to morphine did not involve increased production and storage of oxytocin. 5. Distribution of [3H]morphine infused intracerebroventricularly into six virgin female rats for 6 days was measured by scintillation counting of tissue extracts. Morphine concentration in the hypothalamus and neurohypophysis was 2.7 and 12.8 micrograms/g, respectively, and in blood plasma 0.75 micrograms/g. Tolerance was not due to failure of morphine infusion. In addition, naloxone (5 mg/kg s.c.) provoked typical withdrawal reactions ('wet dog' shakes, defaecation, burrowing) in lactating rats infused with morphine for 5 days. 6. Pups were suckled onto seven maternal morphine-infused and five vehicle-infused rats anaesthetized with urethane for recording of intramammary and arterial blood pressures after treatment for 5 days. The incidence and pattern of milk ejections, and mammary gland sensitivity to oxytocin were similar in the two groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuronal/glial plasticity in the supraoptic dendritic zone in response to acute and chronic dehydration

The magnocellular neurosecretory cells of the supraoptic nucleus increase production and secretion of oxytocin and/or vasopressin in response to dehydration, gestation and lactation. Dynamic neuronal/glial interactions have also been shown to occur in response to these stimuli, resulting in a reversible increase in soma-somatic direct membrane apposition at these times. Chronic (lactation, 10 days of saline drinking) but not acute stimuli (4-24 h water deprivation) are further accompanied by the reversible formation of axo-somatic double synapses (one presynaptic terminal contacting two postsynaptic elements), which are virtually absent in control animals. The dendrites of these cells course ventrolaterally toward the ventral glial lamina, and have also been shown to be involved in this plasticity: dendro-dendritic direct membrane apposition and axo-somatic double synapses significantly vary with gestation and parturition. The present study investigated the dendritic zone response to both chronic and acute dehydration and rehydration. Increased dendro-dendritic membrane contacts resulted from both stimuli. Rehydration following acute dehydration resulted in a dose-dependent return to control levels, while rehydrated chronic dehydrates did not show such a return until 35 days of rehydration. The percentage of dendrites contacted by double synapses did not vary with treatment, and there were no sex differences. The recalcitrance on the part of the dendrites to return to normal following chronic dehydration may reflect a readiness to respond to renewed hormone demand.

Neuronal/glial plasticity in the supraoptic dendritic zone: dendritic bundling and double synapse formation at parturition

The magnocellular neurosecretory cells of the supraoptic nucleus increase production and release of oxytocin and/or vasopressin under such conditions as parturition, lactation and dehydration. These stimuli have been shown to result in increased direct apposition of neuronal membranes and the formation of double synapses (one presynaptic terminal contacting two postsynaptic elements) within the supraoptic nucleus at the level of the cell bodies. These morphological changes are due to the retraction of the thin glial processes which are normally interposed between adjacent neurons. The present study was undertaken to ascertain whether, and to what extent, neuronal/glial plasticity occurs in the dendritic zone (i.e. the ventral glial laminar area) of the supraoptic nucleus. The instances of two or more dendrites with membrane in direct apposition (dendritic bundles), the number of dendrites per bundle, the amount of dendritic membrane in direct apposition and the percentage of dendrites contacted by double synapses were quantified at the ultrastructural level in virgin female, prepartum (21 days of gestation), postpartum (day of parturition) and lactating rats. All parameters measured varied significantly with the hormone demand states created by pregnancy and lactation, apparently due to glial retraction. Moreover, in the 2-24 h period between pre- and postpartum there was a significant increase in the number of dendrites per bundle, dendritic membrane in direct apposition and the percentage of dendrites contacted by double synapses. This time course corresponds to the known increased release of oxytocin and vasopressin at parturition. These findings constitute the first demonstration that dendritic bundles and double synapses occur in the ventral glial lamina/dendritic zone of the supraoptic nucleus and vary under the physiological conditions of pregnancy, parturition and lactation.

Dynamic neuronal-glial interactions in hypothalamus and pituitary: implications for control of hormone synthesis and release

Various lines of evidence have suggested that astrocytes play a dynamic role in control of hormone synthesis and release from the CNS. The model system most studied has been the rat hypothalamo-neurohypophysial system, consisting chiefly of the supraoptic and paraventricular nuclei and their axonal terminals. Neurons of this system manufacture and secrete oxytocin and vasopressin. Electron microscopic studies have shown that certain physiological conditions (e.g., dehydration, lactation) produce increases in direct apposition among these neurosecretory cells, an effect due to withdrawal of glial processes from between the neurons. Neurohypophysial astrocytes (pituicytes) show dynamic interactions with the neurons at the level of the terminals, by engulfing them and interposing processes between the terminals and the basement membrane when hormone demand is low. Pituicyte processes retract from both areas when hormone demand is high, allowing the neuronal terminals direct access to the perivascular space. Recently, osmotic manipulations (in the physiological range) have shown that these changes can be produced in vitro in neurohypophysial explants without stimulated hormone release. Experiments on cultured adult rat pituicytes have revealed similar morphological changes in response to noradrenaline. These changes were reversed or blocked by propranolol. The increase in direct soma-somatic apposition (7-9 nm separation) of magnocellular neurons could produce a tonic rise in (K+)o which would increase protein synthesis and contribute to the raised excitability of these neurons. Also, the removal of interposed glia could allow the formation of gap junctions and specialised synapses which are known to occur between these neurons. These in turn may participate in producing the coordinated firing that maximizes hormone release. The interactions of pituicytes with the terminals in the neurohypophysis suggests that these astrocytes are also a part of the mechanism of control of hormone release.

Quantitative cytological analysis of functional changes in adrenomedullary chromaffin cells in normal, sham-operated, and pinealectomized rats in relation to time of day: I. Nucleolar size

Adrenaline (A)- and noradrenaline (N)-cells in juxtacortical and central areas of adrenal medullas of nonoperated, sham-operated, and pinealectomized male rats (n = 125) were investigated by quantitative electron and light microscopy. Animals were killed at eight time points during a standardized 24-h, light-dark (12:12) cycle 14 d after surgery. Diameters of nucleoli (n = 9,600) and the nucleolar margination rate were studied chiefly by light microscopy. Major findings include the following: Twenty-four-hour changes occurred in nucleolar diameters in adrenomedullary chromaffin cells in nonoperated animals, with the peak in the late dark phase (X +/- SD, A-cells: 1.29 +/- 0.06 micron; N-cells; 1.23 +/- 0.05 micron) and the minimum in the mid-light (A-cells: 1.16 +/- 0.04 micron) or early dark (N-cells: 1.14 +/- 0.03 micron) phase. These changes were markedly dampened (diminished) in sham-operated animals. Since this dampening of time-of-day changes after sham-operations was not seen in A-cells after pinealectomy, mediation by the gland of this dampening is suggested. Pinealectomized animals showed 24-h changes in nucleolar diameters, but these changes differed from those of nonoperated controls in their temporal and phase relations. For example, there was phase advance in A-cells in the juxtacortical area and desynchronization in N-cells. Furthermore, rhythm amplitude was slightly increased in A-cells and slightly decreased in N-cells after pinealectomy. A- and N-cells differed from each other consistently and significantly in the quantitative morphology of their nuleoli and nuclei, and slightly in the patterns of their time-of-day changes in nucleolar size. Nucleolar size usually showed a tendency for a regional gradient, decreasing slightly from periphery toward the center. These observations contribute to our understanding of the chronobiology and functional relations of adrenomedullary chromaffin cells, and of the effects of pinealectomy and sham operations upon this system.

Magnocellular neuropeptidergic neurons in hypothalamus: increases in membrane apposition and number of specialized synapses from pregnancy to lactation

Morphological changes which have been hypothesized to accompany functional alterations in magnocellular neuropeptidergic cells (MNCs) were studied in female rats. Direct soma-somatic appositions between the MNC profiles of two nuclear groups, the supraoptic nucleus (SON) and nucleus circularis (NC) were investigated at the ultrastructural level in 4 groups of animals: virgin females, immediately pre-partum pregnant rats, post-partum and 14-day lactating animals. The percentage of SON MNC profiles in soma-somatic apposition and the amount of membrane in direct contact significantly increased over control levels by the last day of pregnancy. Further significant increases in these measures were observed in lactating rats. MNCs in NC showed steady gradual increases on these measures with significant differences from controls occurring in the post-partum group. The percentage of SON cell profiles with double synapses (i.e., presynaptic terminals making synaptic contact with two postsynaptic neurons) was significantly elevated in lactating rats (approximately 10%) over the next highest group (approximately 1% for post-partum rats). In NC, approximately 10% of the cell profiles sampled had such synapses but no differences among treatments occurred. The changes during late pregnancy suggest that close appositions may serve to enhance the metabolic activity of MNCs at a time when there is a build-up of stored oxytocin. Further increases in cell-cell contact and the addition of double synapses on possibly electrotonically coupled MNCs during lactation may serve a synchronizing function, particularly in the oxytocin cells participating in the milk ejection reflex.