Is the quality of systematic reviews influenced by prospective registration: a methods review of systematic musculoskeletal physical therapy reviews

INTRODUCTION

It is unknown if verified prospective registration of systematic reviews (SRs) and the randomized clinical trials (RCTs) that they use affect an SR's methodological quality on A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2).

METHODS

Data originated from interventional SRs published in International Society of Physiotherapy Journals Editors (ISPJE) member journals, indexed in MEDLINE, between 1 January 2018 and 18 August 2021. Blinded reviewers identified the SRs and extracted the data for the variables of interest for the SRs and the RCTs.

RESULTS

Two of 14 ISPJE member journals required prospective SR registration. Twenty SRs were identified, and 169 unique, retrievable RCTs were included within those SRs. One (5.0%) of the 20 SRs and 15 of the 169 (8.9%) RCTs were prospectively registered and published consistent with this intent. Nineteen (95.0%) of the 20 identified SRs was categorized as 'critically low' on the AMSTAR 2.

DISCUSSION

SRs and the RCTs identified within them were infrequently prospectively registered, prospectively verifiable, or prospectively verified based on the established research record.

CONCLUSIONS

Ensuring that SRs and RCTs have fidelity with the research record from conception to publication may help rule out low-value interventions, decrease variability in physical therapy practice, and solidify evidence-based physical therapy practice.

Adaptation in motor strategies for postural control associated with sensory reweighting

The purpose of this study was to identify and differentiate the motor strategies associated with sensory reweighting adapted during specific sensory integration tasks by healthy young adults. Thirty-six subjects (age range: 21-33 years) performed standing computerized dynamic posturography balance tasks across progressively increasing amplitudes of visual (VIS), somatosensory (SOM) and both (VIS+SOM) systems perturbation conditions. Adaptation in the motor strategy was measured as changes in electromyographic (EMG) activities and joint angles. The contribution of the perturbed sensory input in maintaining postural stability was calculated to determine the sensory reweighting. A multivariate design was used to model a linear combination of motor adaptation variables that discriminates specific sensory integration tasks. Results showed a significant progressive decrease in postural sway per unit amplitude of sensory perturbation in each condition, indicating dynamic sensory reweighting. Linear discriminant function analysis indicated that the adaptation in motor strategy during the VIS condition was associated with increased activity of EMG and joint angles in the upper body compared to the lower body. Conversely, during the SOM and VIS+SOM conditions, the adaptation in motor strategy was associated with decreased activity of EMG and joint angles in the lower body compared to the upper body. Therefore, the adaptation in motor strategies associated with sensory reweighting were different for different sensory integration tasks.

Exploration of arm weight effects on hemiparetic stroke participants' gait performance

BACKGROUND

This study explores the potential benefits of an arm weight intervention for improving gait performance in stroke survivors. Consistent with an interlimb neural coupling mechanism, the investigators hypothesized that arm weight would improve gait performance.

METHODS

Nine stroke and nine healthy participants (1 female; age: 58.0 ± 6.8 years) participated. Participants walked over-ground at their preferred speed in four conditions: no weight (C1), non-hemiparetic (healthy: dominant) side weights (C2), hemiparetic (non-dominant) side weights (C3), and bilateral weights (C4). Statistical analyses included repeated analysis of variance (ANOVA) and paired t-test planned comparisons to explore the effects of added weight on gait speed, step width, step length, cadence, and arm swing amplitude. Single-subject analyses used randomization tests to delineate further the weight's effect on gait speed.

FINDINGS

The stroke group walked significantly faster with arm weight (p = 0.048), exhibiting large ANOVA (η²_p = 0.28) and C1 vs. C4 planned comparison (p = 0.021; d_D = 0.95) effect sizes. Four of nine stroke participants significantly increased gait speed in at least one condition, and seven of nine exhibited large effect size increases (d = 0.85-4.71). The stroke group's hemiparetic-side step length and cadence significantly (p = 0.008) increased in C4 compared to C1, exhibiting large effect size increases (r_b = 0.96). Four of nine healthy participants significantly increased gait speed in at least one condition, with five of nine exhibiting large effect size increases (d = 0.80-6.63).

INTERPRETATION

This study's exploratory results demonstrate arm weight's potential for improving higher-functioning stroke survivors' gait performance. Arm weight addition merits further investigation as a possible rehabilitation intervention in the stroke population.

Do Prospective Intent and Established Metrics Correlate with Journal Impact Factor in Musculoskeletal Physical Therapy Trials?: A Secondary Analysis of A Methodological Review

OBJECTIVES

To determine if there are any statistically significant associations between: 1) randomized clinical trials (RCTs) investigating physical therapy musculoskeletal interventions, 2) journal impact factor (JIF), 3) frequency of RCT citation, 4) whether prospective intent was identifiable, and 5) the Physiotherapy Evidence Database (PEDro) scores.

METHODS

MEDLINE indexed RCTs addressing musculoskeletal interventions published between January 2016 and July 2020 in physical therapy journals were included. Two blinded reviewers identified the RCTs and extracted the variables of interest.

RESULTS

With a familywise alpha adjustment, there was no statistically significant correlation between JIF and number of citations (rho = 0.187; p = 0.0280). Statistically significant weak positive correlations were identified between the JIF and prospectively registered RCTs (rho = 0.240; p = 0.0046), JIF and PEDro scores (rho = 0.250; p = 0.0031), and PEDro scores and prospectively registered RCTs (rho = 0.335; p < 0.0001).

CONCLUSION

The findings of this study suggest that JIF and PEDro scores may not be accurate measures of RCT quality. Failing to ensure that published RCTs followed their prospective intent and using bibliometrics that fail to accurately measure what they propose appears to create untrustworthy preprocessed resources for practicing physical therapists during the evidence-based practice process.

LEVEL OF EVIDENCE

1a.

Immediate Improvements in Patellofemoral Pain Are Associated With Sagittal Plane Movement Training to Improve Use of Gluteus Maximus Muscle During Single Limb Landing

OBJECTIVE

The authors sought to examine the immediate effects of movement training aimed at improving use of gluteus maximus (GMAX) in the sagittal plane on hip internal rotation and self-reported patellofemoral pain (PFP) during single-limb landing.

METHODS

Seventeen females with PFP participated. Lower extremity kinematics and kinetics, GMAX activation, and self-reported PFP were obtained before and after a single-session movement training program aimed at increasing the use of GMAX. Dependent variables of interest included self-reported PFP, average GMAX activation, average hip extensor moment, and peak hip internal rotation. Post-training changes were evaluated using paired t tests and Wilcoxon signed rank tests.

RESULTS

Following movement training, self-reported PFP decreased significantly (mean [standard deviation]) (3.9 [1.1] vs 0.8 [1.3] on a 0-10 scale). Additionally, significant increases were observed for the average hip extensor moment (0.6 [0.3] vs 1.8 [0.4] Nm/kg) and average GMAX activation (41.0% [18.3] vs 51.6% [25.7] maximum voluntary isometric contraction), whereas peak hip internal rotation decreased significantly (8.5 degrees [5.8] vs 6.0 degrees [5.3]).

CONCLUSION

Movement training aimed at improving the use of GMAX in the sagittal plane resulted in clinically relevant changes in self-reported pain, GMAX activation, and hip kinetics and kinematics. Improving the use of GMAX during movement merits consideration when designing rehabilitation programs for females with PFP.

IMPACT

The current study highlights the clinical utility of movement training for persons with PFP and provides a biomechanical rationale for its use as a potential intervention in this population.

Should low-quality evidence dominate high-level evidence? A systematic review and meta-analysis of systematic reviews of musculoskeletal physical therapy interventions

OBJECTIVES

To determine the: 1) quality of articles cited in systematic reviews (SRs); 2) methodological quality of the SRs; and 3) impact of quality on level 1A evidence.

METHODS

SRs related to musculoskeletal physical therapy interventions were identified. The methodological quality of the SRs and articles cited by the SRs were assessed by two blinded reviewers. Data analysis was performed by a third blinded researcher. Additional comparisons were made based on the Journal Impact Factor, spin, financial bias, and conflict of interest.

RESULTS

Twenty-four SRs were identified; 21/24 SRs had 'critically low' quality on the AMSTAR 2. Thirty-four percent of included studies were 'low quality,' and 58% of SRs included studies that had unreported external validity. One-half of the SRs represented 'spin,' and one-third of the SRs generated conclusions based on low-quality clinical trials.

DISCUSSION

The 'critically low' SRs methodological quality was exacerbated by low-quality research inclusion. Most SRs failed to follow best practices, including prospective registration and integration of professional librarians in the search process. Based on the high proportion of SRs that include low-quality trials and overall low methodological quality, further discussion regarding practice recommendations on level vs. quality of evidence is warranted.

LEVEL OF EVIDENCE

1a.

Low reproducibility of randomized clinical trials methodology related to sampling: a systematic methodological review

Objectives: The reporting of sampling methods in Randomized Clinical Trials (RCTs) allows for research quality assessment, determination of sampling bias, and assures the presence of details necessary for reproducibility in future trials. The purpose of this study was to: (1) determine if sampling methodology was reproducible in RCTs related to musculoskeletal physical therapy (MSKPT) interventions to treat non-specific low back pain (NSLBP) and (2) establish if there was a relationship between sample reproducibility and established measures of research quality.Methods: Data were collected through a systematic review by a professional librarian. The identified RCTs were assessed for methodological quality by two blinded individual reviewers. Data analysis was performed by a third, blinded researcher; additional comparisons were made based on Journal Impact Factor and PEDro score.Results: Ninety-nine published peer-reviewed RCTs were identified that met inclusion criteria. Only 29% of the articles were judged to be reproducible based on the reported sampling methodology. There were meaningful correlations between two out of ten of the sampling reporting criteria and the judgement made if the sample was reported in significant detail to allow for replication. There was no relationship between sampling reporting criteria, Journal Impact Factors (JIFs), and Physiotherapy Evidence Database (PEDro) scores.Discussion: The reporting of sampling methodology needs to be considered to ensure reproducibility and avoid sampling bias. Despite the proliferation of measures of research quality, the overall reporting quality of RCTs continues to be inadequate to allow widespread reproducibility of trials.Level of Evidence: 1a.

Volitional Preemptive Abdominal Contraction and Upper Extremity Muscle Latencies During D1 Flexion and Scaption Shoulder Exercises

CONTEXT

The abdominal-bracing maneuver, a volitional preemptive abdominal contraction (VPAC) strategy, is commonly used during resisted shoulder exercises. How VPAC affects shoulder-muscle function during resisted shoulder exercise is unknown.

OBJECTIVE

To identify the effects of VPAC on selected parascapular and glenohumeral muscles during specific shoulder exercises with or without resistance.

DESIGN

Cross-sectional study.

SETTING

Clinical biomechanics research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-two asymptomatic volunteers between 18 and 40 years of age.

INTERVENTION(S)

Participants performed arm elevation in scaption and D1 shoulder-flexion (D1F) patterns with and without resistance and VPAC.

MAIN OUTCOME MEASURE(S)

Electromyography was used to test the muscle-contraction amplitudes and onset timing of the anterior deltoid, posterior deltoid, upper trapezius, lower trapezius, and serratus anterior. Muscle-response amplitudes were quantified using root mean square electromyography. Shoulder-muscle relative-onset timing was quantified in reference to kinematic elbow-movement initiation.

RESULTS

The VPAC increased serratus anterior amplitude during D1F ( P < .001) and scaption ( P < .001) and upper trapezius amplitude ( P < .001) in scaption. All muscle amplitudes increased with resistance. The VPAC decreased muscle-onset latencies for the anterior deltoid ( P < .001), posterior deltoid ( P = .008), upper trapezius ( P = .001), lower trapezius ( P = .006), and serratus anterior ( P = .001) during D1F. In addition, the VPAC decreased muscle-onset latencies for the anterior deltoid ( P < .001), posterior deltoid ( P = .007), upper trapezius ( P < .001), lower trapezius ( P < .001), and serratus anterior ( P < .001) during scaption.

CONCLUSIONS

The VPAC affected only the parascapular muscles that had the greatest scapular-stabilizing roles during the specific open chain movement we tested. It decreased latencies in all muscles. These neuromuscular changes may enhance the stability of the shoulder during D1F and scaption exercises.

Effects of arm weight on gait performance in healthy subjects

Previous studies have investigated how additional arm weights affect gait. Although light weights (0.45 kg) seemed to elicit performance improvements in Parkinsonian patients, it was not studied how light weights affect gait parameters in healthy individuals. It is important to understand normal responses in a healthy population so that clinical effects might be better understood. Therefore, the purpose of this study was to investigate the effects of arm weights on arm swing amplitude, gait performance, and muscle activity in healthy people. Twenty-two subjects walked overground at their preferred speed under different weight carriage conditions (C1: no weight; C2: unilateral arm weight; C3: bilateral arm weights; C4: waist weights). Gait speed increased in C2 (p = 0.018) and C4 (p = 0.013) when compared with C1(C1: 1.21 ± 0.08; C2: 1.25 ± 0.11; C3: 1.24 ± 0.11; C4: 1.25 ± 0.11 m/s) with an increase in cadence during C2 (p < 0.001), C3 (p = 0.008), and C4 (p < 0.001) (C1: 105.5 ± 5.2; C2: 108.5 ± 5.6; C3: 107.9 ± 5.6; C4: 108.5 ± 5.3 steps/min) and in tibialis anterior electromyographic activity on the unweighted side in C2 (p = 0.048) (C1: 21.05 ± 4.59; C2: 25.10 ± 6.10; C3: 23.93 ± 4.75; C4: 24.33 ± 6.32 μV). The results indicate that an additional sensory input with the application of the weights may result in an overcompensation with the whole body and facilitate faster walking speed when applied on one arm or around the waist. The locations of the weights and amount of the weights may elicit different responses. Various strategies of adding weights should be further investigated as a potential intervention to improve performance in individuals with various gait impairments. Although there is evidence for benefits of this intervention in Parkinsonian patients, further study is warranted in other patient populations, such as stroke patients, who might benefit from this intervention to improve gait performance.

A systematic review of orthopaedic manual therapy randomized clinical trials quality

Study Design: Systematic review and meta-analysis. Objectives: To conduct a systematic review and meta-analysis of randomized clinical trials (RCTs) in the orthopaedic manual therapy (OMT) literature from January 2010 to June 2014 in order to determine if the CONSORT checklist and Cochrane Risk of Bias (RoB) assessment tools: (1) are reliable; (2) have improved the reporting and decreased the risk of bias in RCTs in the OMT literature; (3) differ based on journal impact factor (JIF); and (4) scores are associated with each other. Background: The CONSORT statement is used to improve the accuracy of reporting within RCTs. The Cochrane RoB tool was designed to assess the risk of bias within RCTs. To date, no evaluation of the quality of reporting and risk of bias in OMT RCTs has been published. Methods: Relevant RCTs were identified by a literature review from January 2010 to June 2014. The identified RCTs were assessed by two individual reviewers utilizing the 2010 CONSORT checklist and the RoB tool. Agreement and a mean composite total score for each tool were attained in order to determine if the CONSORT and RoB tools were reliable and varied by year and impact factor. Results: A total of 72 RCTs in the OMT literature were identified. A number of categories within the CONSORT and RoB tools demonstrated prevalence-adjusted bias-adjusted kappa (PABAK) scores of less than 0.20 and from 0.20 to 0.40. The total CONSORT and RoB scores were correlated to each other (r = 0.73; 95% CI 0.60 to 0.82; p < 0.0001). There were no statistically significant differences in CONSORT or RoB scores by year. There was a statistically significant correlation between both CONSORT scores and JIF (r = 0.64, 95% CI 0.47 to 0.76; p < 0.0001), and between RoB scores and JIF (r = 0.42, 95% confidence interval 0.21-0.60; p < 0.001). There was not a statistically significant correlation between JIF and year of publication. Conclusion: Our findings suggest that the CONSORT and RoB have a number of items that are unclear and unreliable, and that the quality of reporting in OMT trials has not improved in recent years. Improvements in reporting are necessary to allow advances in OMT practice. Level of Evidence: 1A.

The Effects of Volitional Preemptive Abdominal Contraction on Postural Control Responses in Healthy Subjects

OBJECTIVE

To investigate the effect of volitional preemptive abdominal contraction by using an abdominal bracing maneuver (ABM) on postural control responses.

DESIGN

A within-subjects, repeated-measure, experimental design.

SETTING

Laboratory.

PARTICIPANTS

Sixty-five healthy subjects between 18 and 50 years of age.

METHODS

Subjects performed ABM alternating with No-ABM during 2 rounds of 2 Neurocom computed dynamic posturography tests: the Motor Control Test (MCT) and conditions 1 (eyes open), 2 (eyes closed), and 5 (eyes closed, sway-referenced support) of the Sensory Organization Test (SOT).

MAIN OUTCOME MEASUREMENTS

(1) MCT Response Latency (milliseconds) and Response Scaling (magnitude of active postural correction) and (2) SOT Equilibrium Scores and 2-Dimensional Sway (°/second), and SOT Movement Strategy, which measure postural sway and movement strategies (ankle versus hip strategy), respectively.

RESULTS

The use of ABM (versus No-ABM) produced: (1) a small but statistically significant decrease in SOT Equilibrium Score for condition 2 (-1.0%; P = .004); (2) an increase in SOT 2-Dimensional Sway (°/second) during conditions 1 (16.9%; P = .0001) and 2 (15.0%; P = .0001); (3) a small decrease in SOT Movement Strategy scores during condition 1 (-0.5%; P = .001) and condition 2 (-1.0%; P = .017); and (4) a reduction of MCT Response Latency by 3 milliseconds (-2.1%; P = .005) and reduction of Response Scaling by 0.33°/second (-9.2%; P = .001).

CONCLUSION

Individuals can incorporate the ABM without substantively altering postural control. Although selected SOT and MCT scores exhibited small decreases in postural response integrity, those outcomes did not reflect functionally meaningful changes. These findings can enhance clinicians' confidence in prescribing the ABM as a means to protectively stabilize the spine and potentially prevent injury in healthy subjects without concern for reducing postural control, especially during more complex postural perturbations that introduce sensory conflict.

Association of disturbances in the thoracic outlet in subjects with carpal tunnel syndrome: a case-control study

INTRODUCTION

A limited amount of research has investigated the potential relationship between carpal tunnel syndrome (CTS) and thoracic outlet dysfunction.

PURPOSE OF THE STUDY

To compare the prevalence of positive clinical tests suggestive of disputed neurogenic thoracic outlet syndrome (TOS) in subjects with CTS (CTS+) with that of subjects without CTS (control).

STUDY DESIGN

Case-control study.

METHODS

Subjects with electrodiagnostically confirmed CTS (CTS+) were recruited consecutively and matched by age (±2 years) and gender with asymptomatic (control) subjects. Subjects underwent clinical testing for neurogenic TOS using two provocative tests: modified Cyriax release test and elevated arm stress test (EAST). Subjects were tested for the presence of an elevated first rib using cervical rotation lateral flexion (CRLF) test.

RESULTS

A total of 32 investigational subjects and 32 matched control subjects was included in each group (mean age: 43.5+5.9 years). A significantly greater number of CTS+ subjects presented with positive provocative testing for TOS (modified Cyriax release test p=0.005; EAST approached significance p=0.027) and for the presence of an elevated first rib (CRLF test p=0.003) as compared with controls. The likelihood of neck pain, shoulder pain, or an elevated first rib was 16 times greater in the CTS+ group as compared with that in the control group.

CONCLUSIONS

A greater number of subjects with CTS presented with proximal dysfunctions suggestive of TOS and history of neck and shoulder pain. Evaluation of proximal structures involved with thoracic outlet dysfunction in persons with CTS has clinical merit.

LEVEL OF EVIDENCE

Level III-b.

Effects of tai chi exercise on posturography, gait, physical function and quality of life in postmenopausal women with osteopaenia: a randomized clinical study

OBJECTIVE

to evaluate the effects of tai chi exercise on risk factors for falls in postmenopausal women with osteopaenia through measurements of balance, gait, physical function and quality of life.

DESIGN

a randomized, controlled, single-blinded, 24-week trial with stratification by age and bone mass.

SETTING

general community.

PARTICIPANTS

Sixty-one independently living elderly females aged 65 years and older with low bone mass.

INTERVENTIONS

subjects were recruited and randomly assigned to 24 weeks of tai chi (60 minutes/session, three sessions/week, n = 30) or a control group (n = 31).

OUTCOME MEASURES

computerized dynamic posturography, gait, 'timed up and go', five-chair sit-to-stand and quality of life assessed at baseline, 12 and 24 weeks.

RESULTS

after 24 weeks, subjects in the tai chi group demonstrated an increase in stride width (P = 0.05) and improvement in general health (P = 0.008), vitality (P = 0.02) and bodily pain (P = 0.03) compared with those in the control group. There was no significant difference in balance parameters, 'timed up and go', five-chair sit-to-stand and other domains of quality of life.

CONCLUSION

tai chi exercise may reduce risk factors for falls by increasing the stride width, and may improve quality of life in terms of general health, vitality and bodily pain in postmenopausal women with osteopaenia.

The double crush syndrome: a common occurrence in cyclists with ulnar nerve neuropathy-a case-control study

OBJECTIVE

To evaluate the incidence of double crush syndrome in the upper limbs of cyclists with clinical diagnosis of ulnar nerve neuropathy.

DESIGN

Case-control study.

SETTING

Outpatient clinics and university setting.

PARTICIPANTS

Consecutive sampling of 70 cyclists (140 upper limbs) with a mean age of 36 years (+/-11.3). Seventy-two upper limbs were excluded, leaving 40 upper limbs with a clinical diagnosis of ulnar nerve neuropathy [ULNN (+)] and 28 without symptoms of ulnar nerve neuropathy [ULNN (-)].

ASSESSMENT

Cyclists were examined clinically for the presence of proximal dysfunction using the following testing (independent variables): (1) thoracic outlet syndrome provocation testing: elevated arm stress test and modified Cyriax release test; (2) presence of an elevated first rib: cervical rotation lateral flexion test; and (3) presence of proximal symptoms: reports of neck pain and shoulder pain.

MAIN OUTCOME MEASUREMENTS

The upper limbs of cyclists were categorized into 2 groups (dependent variable)-ULNN (+) and ULNN (-)-based on history, symptoms, motor, sensory, and provocative clinical testing.

RESULTS

A significantly greater number of upper limbs of cyclists with ULNN (+) presented with positive provocative testing for thoracic outlet syndrome (elevated arm stress test P = 0.005; modified Cyriax release test P = 0.002) than did the upper limbs of cyclists with ULNN (-). The likelihood for the presence of neck pain, shoulder pain, and an elevated first rib was 3, 5, and 12 times greater, respectively, in the ULNN (+) than the ULNN (-) group.

CONCLUSION

A statistically significant greater number of the upper limbs of cyclists with clinical diagnosis of ulnar nerve neuropathy presented with proximal dysfunctions suggestive of double crush syndrome.

2006 Young Investigator Award Winner: lumbosacral nerve root displacement and strain: part 2. A comparison of 2 straight leg raise conditions in unembalmed cadavers

STUDY DESIGN

An inferential cadaveric study.

OBJECTIVES

To compare the displacement and strain of the lumbosacral nerve roots during different conditions of straight leg raise (SLR) with intact foraminal ligaments.

SUMMARY OF BACKGROUND DATA

Clinicians use sensitizing movements such as dorsiflexion during neurodynamic testing, assuming that these prepositions influence the displacement or strain to the lumbosacral nerve roots. Little is known about the effect of these prepositions on neurodynamic behavior.

METHODS

Lower limbs and associated nerve roots of 5 unembalmed cadavers (n = 10) were used to evaluate the displacement and strain of the L4, L5, and S1 roots during 2 different SLR conditions. Fluoroscopic images of intraneural metal markers were digitized to evaluate displacement and strain during SLR with no preposition (SLR NPP) of the ankle and SLR with dorsiflexion preposition (SLR DF) of the ankle, respectively.

RESULTS

SLR NPP produced larger distal displacement at L5 and S1, (P < 0.001) when compared with SLR DF. Displacement comparisons at L4 were nonsignificant (P = 0.051). While nonsignificant, medium to large effect sizes (0.60-0.96) suggest that SLR DF may produce more strain than the SLR NPP condition.

CONCLUSIONS

Prepositions of the SLR test alter the displacement and possibly the strain of the lumbosacral nerve roots in the lateral recess.

2006 Young Investigator Award Winner: lumbosacral nerve root displacement and strain: part 1. A novel measurement technique during straight leg raise in unembalmed cadavers

STUDY DESIGN

A descriptive cadaveric study incorporating a novel nerve root marking technique.

OBJECTIVES

To describe the displacement and strain of the lumbosacral nerve roots in the lateral recess during straight leg raise (SLR) without disrupting the foraminal ligaments.

SUMMARY OF BACKGROUND DATA

Previous studies document 2 to 8 mm of lumbosacral nerve root displacement during SLR. Prior dissection methods incorporated laminectomy and facetectomy.

METHODS

Lower limbs and associated nerve roots of 5 unembalmed cadavers (n = 10) were studied. Metal markers were inserted intraneurally within the lateral recess of L4, L5, and S1 with a modified spinal needle. Fluoroscopic images were digitized to evaluate displacement and strain during SLR.

RESULTS

The lumbosacral nerve roots in the lateral recess moved less and experienced less strain during SLR than described in previously published reports. Statistically significant distal displacement occurred at hip positions greater than 60 degrees of flexion at all nerve root levels (P < 0.01).

CONCLUSIONS

The lumbosacral nerve roots (L4, L5, S1) moved less and underwent less strain during SLR testing than previously reported and may require hip motion greater than 60 degrees to produce substantive displacement in the lateral recess. Additional research is needed to examine the effects of prepositioning during SLR.

Effect of sex hormones on neuromuscular control patterns during landing

The purpose of the study was to investigate the effects of sex hormones across menstrual cycle phases on lower extremity neuromuscular control patterns during the landing phase of a drop jump. A repeated-measures design was utilized to examine sex hormone effects in 26 recreationally active eumenorrheic women. Varus/valgus knee angle and EMG activity from six lower extremity muscles were recorded during three drop jumps from a 50 cm platform in each phase of the menstrual cycle. Blood assays verified sex hormone levels and cycle phase. The semitendinosus muscle exhibited onset delays (p0.006) relative to ground contact during the luteal phase, and demonstrated a significant (p0.05) difference between early and late follicular phases. Muscle timing differences between the gluteus maximus and semitendinosus were decreased (p0.05) in the luteal compared to early follicular phases. These results suggest a different co-contractive behavior between the gluteus maximus and semitendinosus, signifying a shift in neuromuscular control patterns. It appears that female recreational athletes utilize a different neuromuscular control pattern for performing a drop jump sequence when estrogen levels are high (luteal phase) compared to when they are low (early follicular phase).

The effects of graded forward and backward walking on heart rate and oxygen consumption

STUDY DESIGN

Single-group repeated-measures design.

OBJECTIVES

To compare the effects of forward walking (FW) and backward walking (BW) on heart rate (HR) and oxygen consumption (VO2) at treadmill grades of 5%, 7.5%, and 10%.

BACKGROUND

Previous studies of locomotion by humans on a treadmill have reported larger cardiovascular exertion and potential biomechanical benefits of BW as compared to FW for treadmill grades ranging from 0% to 5%. The present study extends these findings by examining the cardiovascular effects of BW and FW at treadmill grades greater than 5%.

METHODS AND MEASURES

Twenty-nine volunteers participated in this study. Two subjects were excluded, leaving 27 study subjects (15 females, 12 males; mean age +/- SD, 24.0 +/- 3.4 years). VO2 and HR were measured using open-circuit calorimetry and electrocardiogram, respectively. For both forward and backward walking, subjects performed each of the 3 grades for 6 minutes, during which HR and VO2 were measured. Two-way repeated-measures ANOVAs were employed for inferential statistical analysis.

RESULTS

Percent maximum heart rate (HR(max)) and percent maximum oxygen consumption (VO2(max)) increased incrementally for treadmill grades of 5% to 7.5% to 10% for both FW and BW (P < .00001). For each of the 3 treadmill grades, percent HR(max) and percent VO2(max) was 17% to 20% higher for BW than for FW (P < .00001). No statistically significant interactions were detected between direction of walking and treadmill grade.

CONCLUSIONS

Backward walking on a treadmill at 67.0 m/min (2.5 mph) and grades of 5%, 7.5%, and 10% elicits a greater percent HR(max) and percent VO2(max) than does forward walking under the same conditions and, if incorporated into sustained training regimens, would be expected to improve aerobic endurance.

Single neuronal responses in medial prefrontal cortex during cocaine self-administration in freely moving rats

Chronic single neuronal recording techniques were applied to investigate the involvement of the medial prefrontal cortex (mPFC) during cocaine self-administration in the rat. Rats were trained to press a lever for cocaine under continuous reinforcement and fixed ratio schedules. Different patterns of phasic neuronal activity changes were found to be associated with lever-pressing for cocaine. The neuronal responses could be classified into five categories: 1) increases in neuronal firing before the lever press (15 out of 121 neurons, 12.4%); 2) decreases in neuronal firing before the lever press (13 neurons, 10.7%); 3) increases in neuronal firing after cocaine infusion (4 neurons, 3.3%); 4) decreases in neuronal firing after cocaine infusion (32 neurons, 26.4%); and 5) no alteration of neuronal activity throughout the self-administration session (67 neurons, 55.4%). The anticipatory responses, i.e., neuronal activity appearing before the lever press, were observed for both the continuous reinforcement and fixed ratio schedules. In a few cases, alteration of firing rate was not observed for the first lever press but appeared before subsequent lever presses in fixed ratio schedules. Eliminating cocaine abolished the inhibitory neuronal responses observed after lever press, suggesting that these inhibitory responses after cocaine self-administration were attributable to the pharmacologic effect of cocaine. The data provide initial electrophysiological evidence that the mPFC may play a role in mediating the task sequencing which leads to cocaine self-administration.

Neuronal spike activity in rat nucleus accumbens during cocaine self-administration under different fixed-ratio schedules

Chronic ensemble recording techniques were used to investigate neuronal activity in the nucleus accumbens in freely moving rats during different cocaine self-administration schedules. The issue of concern in this study was the role of nucleus accumbens in initiating and sustaining cocaine self-administration. Specifically, to determine the nature of the neuronal activity, either motor or motivational, which precedes the multiple bar presses required to self-administer cocaine and of the post-lever press neuronal response, we used conventional fixed ratio-5, fixed ratio-10, and modified fixed ratio-3 schedules. In the modified fixed ratio-3 schedule, the first lever press resulted in retraction of the lever for 2 s; the second lever press retracted the lever and turned on a cue light; the third lever press turned off the cue light and delivered cocaine (1.0 mg/kg) intravenously. In the fixed ratio-5 and -10 schedules, rats continuously pressed the lever 5 or 10 times, respectively, to obtain a single infusion of cocaine. Phasic alterations in neural spike activity were observed in 50% of nucleus accumbens neurons before (termed "anticipatory" responses) and after lever pressing for cocaine self-administration. Neurons with anticipatory responses typically exhibited such responses for all lever presses in the modified fixed ratio-3, fixed ratio-5, and fixed ratio-10 schedules, but instances were found when the activity correlate was absent. In addition, some neurons had a prominent alteration in firing rate lasting 1-5 min after cocaine self-administration, and some of these neurons also had anticipatory responses. When cocaine was eliminated during self-administration sessions, the post-lever press inhibitory responses were largely abolished or even reversed, whereas anticipatory responses were not markedly changed when rapid lever presses occurred before behavior ceased. Post-cocaine inhibitory responses compared between self-administered and passively administered cocaine were not significantly different between these two conditions. The results suggest that nucleus accumbens may be involved in initiating general reward-seeking behaviors and action which are not exclusively associated with cocaine self-administration. Moreover, the neuronal responses in the nucleus accumbens to cocaine self-administration may play an essential role in maintaining cocaine reinforcement.

Cerebellar-responsive neurons in the thalamic ventroanterior-ventrolateral complex of rats: in vivo electrophysiology

In vivo intracellular recordings were obtained from identified thalamocortical neurons in the ventroanterior-ventrolateral complex in urethane-anesthetized rats. This thalamic nucleus has few interneurons. Neurons that responded to cerebellar stimulation were injected intracellularly with horseradish peroxidase or biocytin and examined with light and electron microscopy (see companion paper). Intrinsic membrane properties and voltage-dependent rhythmic activity of cerebellar-responsive ventroanterior-ventrolateral neurons were similar to those described previously for thalamic neurons. Thus, in addition to conventional "fast" Na(+)-dependent spikes, rat ventroanterior-ventrolateral neurons had "slow" Ca(2+)-mediated low-threshold spikes and membrane conductances that supported rhythmic oscillations. Two modes of spontaneous activity were observed: (i) a tonic firing pattern that consisted of irregularly occurring fast spikes that predominated when the membrane potential was more positive than about -60 mV, and (ii) a rhythmic firing pattern, observed when the membrane potential was more negative than about -65 mV, composed of periodic (4-8 Hz) membrane hyperpolarizations and ramp depolarizations that often produced a low-threshold spike and a burst of fast spikes. In some neurons, spontaneous fast prepotentials were also observed, often with a relatively constant rate (up to 70 Hz). Cerebellar stimulation elicited excitatory postsynaptic potentials that in some cases appeared to be all-or-none and were similar in form to fast prepotentials. Stimulation of ipsilateral motor cortex elicited a short-latency antidromic response followed by a monosynaptic excitatory postsynaptic potential, which had a slower rise time than excitatory postsynaptic potentials evoked from cerebellum, suggesting that cortical inputs were electrotonically distal to cerebellar inputs. In the presence of moderate membrane hyperpolarization, the cortically evoked excitatory postsynaptic potential was followed by a long-lasting hyperpolarization (100-400 ms duration), a rebound depolarization and one or two cycles resembling spontaneous rhythmic activity. Membrane conductance was increased during the initial component of the long hyperpolarization, much of which was probably due to an inhibitory postsynaptic potential. In contrast, membrane conductance was unchanged or slightly decreased during the latter three-quarters of the long hyperpolarization. The amplitude of this component of the long hyperpolarization usually decreased when the membrane was hyperpolarized with intracellular current injection. Thus, both disfacilitation and an inhibitory postsynaptic potential may have contributed to the latter portion of the cortically-evoked long hyperpolarization. The cortically-evoked inhibitory postsynaptic potentials likely originated predominantly from feedforward activation of GABAergic neurons in the thalamic reticular nuclei.(ABSTRACT TRUNCATED AT 400 WORDS)

Cerebellar-responsive neurons in the thalamic ventroanterior-ventrolateral complex of rats: light and electron microscopy

The morphology and synaptic organization of neurons in the ventroanterior-ventrolateral nucleus of rats was examined using in vivo intracellular staining techniques. Neurons were characterized electrophysiologically based on intrinsic membrane properties and synaptic responses to stimulation of motor cortex and cerebellar nuclei, as described in the companion paper. Cerebellar-responsive neurons were stained intracellularly with either horseradish peroxidase or biocytin. All stained ventroanterior-ventrolateral nucleus neurons were identified as thalamocortical neurons on anatomical (and often electrophysiological) grounds, consistent with previous findings that rat ventroanterior-ventrolateral nucleus is interneuron-sparse. Ventroanterior-ventrolateral nucleus neurons had three to eight thick primary dendrites. Proximal dendrites often exhibited a tufted branching pattern, from which many thinner, higher order dendrites arose. Dendrites branched to form a funnel-like infiltration of the neuropil that resulted in a spherical, roughly homogeneous dendritic field. The axon originated from the cell body or a proximal dendrite and coursed laterally and dorsally to innervate motor cortex. One to five axon collaterals were emitted in the rostral dorsolateral sector of the thalamic reticular nucleus; collaterals were not observed in the ventroanterior-ventrolateral nucleus or other nuclei in dorsal thalamus. The synaptic organization of the ventroanterior-ventrolateral nucleus was examined with electron microscopy, including two intracellularly labeled ventroanterior-ventrolateral nucleus neurons that were shown electrophysiologically to receive monosynaptic inputs from the cerebellum. The neuropil of rat ventroanterior-ventrolateral nucleus lacked the complexity and diversity found in corresponding thalamic nuclei of felines and primates, due to the paucity of interneurons. Vesicle-containing dendrites, dendrodendritic synapses and glomeruli were not observed. Three broad classes of presynaptic terminals were identified. (1) Small round boutons: small boutons containing densely-packed, small round vesicles that formed asymmetric synapses predominantly with the distal dendrites of thalamocortical neurons. These were the most prevalent type of bouton in the ventroanterior-ventrolateral nucleus (78% of presynaptic elements) and likely arose from the cerebral cortex. (2) Large round boutons: large terminals with loosely packed small round vesicles that made multiple asymmetric synapses with proximal and intermediate dendrites. Large round boutons comprised 8% of the neuropil, and likely arose from the cerebellar nuclei. (3) Medium size boutons with pleomorphic vesicles: medium-sized profiles containing pleomorphic vesicles that formed symmetric synapses with proximal, intermediate and distal dendrites and, less frequently, with cell bodies.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrophysiological and pharmacological evidence for the role of the nucleus accumbens in cocaine self-administration in freely moving rats

The goal of this study was to clarify the role of the nucleus accumbens septi (NAS) in the expression of cocaine self-administration behaviors. Rats were trained in a continuous reinforcement schedule to press a lever to activate a pump that provided an intravenous injection of cocaine. Once the rats were trained, neuronal activity in the NAS was monitored during cocaine self-administration with chronic recording techniques using permanently implanted microwires. In the NAS, 19% of 181 neurons exhibited either increased or decreased firing rates seconds prior to lever pressing (termed "anticipatory responses"), and 48% had altered, predominantly decreased, firing rates for a few minutes after lever pressing ("postcocaine responses"). Two-thirds of the neurons with anticipatory responses had postcocaine responses. Neurons with either of these response patterns were localized histologically to both core and shell regions of the NAS, with no statistically significant differences in the proportion of response types in either area. Analysis of videotaped cocaine self-administration behaviors revealed that anticipatory responses were specifically associated either with the animal orienting toward and pressing the lever or only with movements directly related to pressing the lever. Anticipatory-like phasic spike activity was not observed during similar movements unrelated to lever pressing. In some animals, D1 (SCH 23390) or D2 (pimozide) receptor antagonists were injected systemically prior to or during self-administration sessions to assess the effects of dopamine receptor blockade on anticipatory and postcocaine responses. Each antagonist, given separately, often produced extinction of lever pressing. Both antagonists blocked the post-cocaine inhibitory response of neurons that had anticipatory responses. Neither antagonist modified anticipatory unit responses, nor did they affect postcocaine inhibitory responses in neurons that did not exhibit anticipatory responses. Taken together, these results suggest that the role of the NAS in cocaine self-administration may consist of two different mechanisms: (1) An initiation or trigger mechanism, as represented by the anticipatory neuronal responses, in which the NAS participates in triggering or mediating the goal-directed behaviors (e.g., lever pressing) that lead to the acquisition of the reinforcing agent (e.g., cocaine).(ABSTRACT TRUNCATED AT 400 WORDS)

A GABA immunocytochemical study of rat motor thalamus: light and electron microscopic observations

A light and electron microscopic study of GABA-immunoreactive neurons and profiles in the ventroanterior-ventrolateral and ventromedial nuclei of rat dorsal thalamus was conducted using antiserum raised against GABA. Less than 1% of the neurons in these motor-related nuclei exhibited GABA immunoreactivity, confirming previous reports that these nuclei are largely devoid of interneurons. Immunoreactive neurons in the ventral anterior-ventral lateral complex and ventromedial nucleus were bipolar or multipolar in shape, and tended to be smaller than non-immunoreactive neurons. GABA immunoreactivity in the neuropil consisted of labeled axon terminals and myelinated and unmyelinated axons, and was lower in the ventral anterior-ventral lateral complex and ventromedial nucleus than in neighboring thalamic nuclei. The density of neuropil immunolabeling was slightly higher in ventral anterior-ventral lateral complex than in ventromedial nucleus. GABA-immunoreactive axon terminals, collectively termed MP boutons for their medium size and pleomorphic vesicles (and corresponding to "F" profiles of some previous studies of thalamic ultrastructure), formed symmetric synapses and puncta adhaerentia contacts predominantly with large and medium-diameter (i.e. proximal) non-immunoreactive dendrites. Approximately 12 and 18% of boutons in the ventral anterior-ventral lateral complex and ventromedial nucleus, respectively, were GABA-immunopositive. Many of these immunoreactive profiles probably arose from GABAergic neurons in the thalamic reticular nucleus, substantia nigra pars reticulata and entopeduncular nucleus. Two types of non-immunoreactive axon terminals were distinguished based on differences in morphology and synaptic termination sites. Boutons with small ovoid profiles and round vesicles that formed prominent asymmetric synapses onto small-diameter dendrites were observed. Mitochondria were rarely observed within these boutons, which arose from thin unmyelinated axons. These boutons composed approximately 82 and 74% of boutons in the ventral anterior-ventral lateral complex and ventromedial nucleus, respectively, and were considered to arise predominantly from neurons in the cerebral cortex. In contrast, boutons with large terminals that contained round or plemorphic vesicles and formed multiple asymmetric synapses predominantly with large-diameter dendrites were also observed. Puncta adhaerentia contacts were also common. Mitochondria were numerous within large boutons with round vesicles, which arose from myelinated axons. Many of the large boutons were likely to have originated from neurons in the cerebellar nuclei. Approximately 6% of the boutons in the ventral anterior-ventral lateral complex and 8% in ventromedial nucleus were of the large type.(ABSTRACT TRUNCATED AT 400 WORDS)

Quantitative Golgi study of anatomically identified subdivisions of motor thalamus in the rat

A Golgi study of neurons in the ventroanterior-ventrolateral complex (VAL) and ventromedial (VM) nucleus in the dorsal thalamus of rats was performed. To facilitate the delineation of subdivisions of these nuclei, some animals received injections of horseradish peroxidase (HRP) into the afferent and efferent fields of VAL and VM, and alternate sections were processed for the histochemical detection of HRP. As an adjunct to subjective observations, a multivariate statistical analysis of morphometric variables was performed to provide an objective assessment of neuronal morphology. All Golgi-stained neurons in VAL and VM were tentatively identified as projection neurons; no cells with morphological features commonly ascribed to thalamic interneurons were impregnated. Four classes of morphologically distinct neurons were identified in VAL. Type 1 neurons, the most commonly impregnated cell, were found throughout the extent of VAL and resembled "tufted" or "multipolar bush" neurons described previously in many thalamic nuclei. The remaining three neuronal types differed in a number of morphometric parameters and were differentially distributed throughout VAL. Type 2 neurons, distinguished in part by dendritic spine morphology and elongated bipolar dendritic fields, were found only in the rostral sector of the dorsal division of VAL (VALD). Type 3 neurons, characterized by a large and evenly distributed dendritic field, were situated in rostral VAL (all subdivisions). Type 4 neurons had small soma and dendritic dimensions and were located in the ventromedial aspect of the ventral division of VAL (VALV) adjacent to VM. In contrast, the vast majority of neurons in VM were considered to be a single morphological class (similar in form to type 4 neurons in VAL), although a rarely impregnated second type of neuron was also observed. The apparent scarcity of interneurons in VAL and VM is consistent with previous evidence that the synaptic organization of motor thalamus in the rat is markedly different from that of higher-order mammals. Speculation about the functional attributes of the neuronal types in VAL and VM is necessarily restricted to considerations of afferent and efferent relations, since "motor modality" functions of neurons in these nuclei have yet to be elucidated.

Mesocortical dopaminergic neurons. 1. Electrophysiological properties and evidence for soma-dendritic autoreceptors

Mesencephalic dopaminergic neurons were electrophysiologically identified by a variety of criteria, including antidromic activation from prefrontal or cingulate cortex, neostriatum, or nucleus accumbens in urethane-anesthetized rats. The mean firing rate of 98 mesocortical dopaminergic neurons was 2.9 +/- 0.3 spikes/sec and did not differ from the mean firing rate found for nigrostriatal or nucleus accumbens dopaminergic neurons. Spontaneously active mesocortical dopaminergic neurons were inhibited by intravenous administration of either apomorphine (6 micrograms/kg) or amphetamine (0.25 mg/kg). Whereas most antidromic responses of nigrostriatal and mesoaccumbens neurons consisted of the initial segment spike only, cortically-elicited antidromic responses typically consisted of a full initial segment-soma-dendritic spike. These findings are discussed with regard to the presence of soma-dendritic autoreceptors on mesocortical dopaminergic neurons.

Mesocortical dopaminergic neurons. 2. Electrophysiological consequences of terminal autoreceptor activation

Measurement of drug- and stimulation-induced changes in the electrical excitability of dopaminergic terminals was employed to assess the effects of stimulation of dopamine terminal autoreceptors in the prefrontal cortex in urethane-anesthetized rats. Systemic or local administration of amphetamine decreased, whereas systemic administration of haloperidol increased the excitability of prefrontal cortical dopaminergic terminals of ventral tegmental area dopaminergic neurons. Mesoprefrontal dopaminergic terminal excitability was also responsive to spontaneous and stimulation-induced alterations in the rate of impulses reaching the terminal fields. These results are comparable to those previously reported for nigrostriatal and mesoaccumbens dopaminergic neurons, and are discussed with regard to the operational characteristics of autoinhibition in the mesocortical dopaminergic system.

Electrophysiologically identified nigral dopaminergic neurons intracellularly labeled with HRP: light-microscopic analysis

Intracellular recordings were obtained in vivo from neurons of the rat substantia nigra, pars compacta. Neurons that were identified as dopaminergic by a variety of electrophysiological criteria, including antidromic activation from ipsilateral neostriatum or globus pallidus, were microiontophoretically injected with horseradish peroxidase and examined at the level of the light microscope. Dopaminergic neurons were of medium size and had ovoid, polygonal, or fusiform cell bodies that emitted from 3-6 primary dendrites. Much of the sparse and relatively unbranched dendritic arborization of these neurons remained within pars compacta, except for 1 or 2 large dendrites that were directed ventrally or ventrolaterally into pars reticulata, roughly perpendicular to the plane of the pars compacta. In coronal sections, the dendrites of ovoid- or polygonal-shaped pars compacta neurons were oriented mainly along the dorsoventral axis, whereas fusiform-shaped neurons had dendrites that were oriented primarily mediolaterally. Although some of the dendrites of dopaminergic neurons exhibited variations in diameter, most were not markedly varicose. Dendrites were sometimes sparsely invested with spinelike appendages or other dendritic extrusions, particularly along their distal portions. The axons of dopaminergic pars compacta neurons were emitted from primary or proximal secondary dendrites, and were extremely fine processes, 0.5 micron or less in diameter. No local axon collaterals were observed.

Autoreceptor-mediated changes in dopaminergic terminal excitability: effects of potassium channel blockers

The effects of the potassium channel blockers, 4-aminopyridine (4-AP) and tetraethylammonium (TEA), on autoreceptor-mediated changes in dopaminergic terminal excitability were examined in urethane-anesthetized rats. Local infusions of 4-AP or TEA into neostriatal terminal fields of nigral dopaminergic neurons led to marked decreases in terminal excitability, as measured by the increase in stimulating current required to activate the neurons antidromically from the site of the infusion. The decreased excitability resulting from 4-AP could be reversed by subsequent i.v. injection of haloperidol, and was blocked in rats that had been depleted of endogenous dopamine by prior treatment with alpha-methyl-p-tyrosine (AMpT). Thus, the decrease in excitability elicited by the potassium channel-blockers was indirect, and apparently due to increased autoreceptor stimulation resulting from enhanced transmitter release. In addition, co-infusion of 4-AP and apomorphine in AMpT-treated animals led to decreased terminal excitability that did not differ from the effects of apomorphine alone, indicating that 4-AP did not block the effects of exogenous autoreceptor agonist administration. These results provide in situ electrophysiological evidence that autoreceptor-mediated processes occurring at dopaminergic terminals are not mediated by 4-AP- or TEA-sensitive potassium channels. Furthermore, our findings suggest that, as in other types of presynaptic terminals, blockade of voltage-sensitive potassium channels in dopamine terminals leads to enhanced release of transmitter.

Improving survival in the treatment of congenital diaphragmatic hernia

Thirty-two infants were treated for congenital diaphragmatic hernia at our institution from 1979 to 1984. Eight were in no or minimal distress at birth and had operative intervention when they were more than 24 hours old; survival was 100%. The remaining 24 neonates required immediate intubation and ventilation followed by operation at less than 12 hours of age. Overall survival was 54%; survival was 31% (4 of 13 patients, Group 1) in the first three years of the series and 82% (9 of 11 patients, Group 2) in the last three years (p less than 0.001). Apgar score, gestational age, birth weight, and incidence of associated congenital heart disease were equal for the two groups (all, p greater than 0.05). The two groups also were examined with reference to alveolar-arterial oxygen differences P(A-a)O2 and mean airway pressure (MAP). The best preoperative P(A-a)O2 was greater than 600 mm Hg for 7 neonates in Group 1 and 6 in Group 2, and survival was 0% and 71%, respectively (p less than 0.001). Infants with a postoperative MAP of 13 cm H2O or greater had a higher mortality (100% in Group 1 and 50% in Group 2, p greater than 0.05). Our treatment protocol was studied to determine those methods related to improved survival. Sodium bicarbonate infusion was used earlier in Group 2 as a prophylaxis against persistent fetal circulation (PFC) (p greater than 0.05). The incidence of severe PFC dropped from 85 to 54% (p greater than 0.05). Higher ventilator rates rather than pressures were used to achieve equally effective ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidromic activation of dorsal raphe neurons from neostriatum: physiological characterization and effects of terminal autoreceptor activation

Three types of neurons, distinguished on the basis of their spontaneous firing rates and patterns, extracellularly recorded waveforms and responses to neostriatal stimulation, were observed in the dorsal raphe nucleus in urethane-anesthetized rats. Type 1 neurons (presumed to be serotonergic) fired spontaneously from 0.1 to 3 spikes/s in a regular pattern, with initial positive-going bi- or triphasic action potentials. Type 1 cells exhibited long-latency antidromic responses to neostriatal stimulation (mean +/- S.E.M. 24.9 +/- 0.3 ms) that sometimes occurred at discrete multiple latencies, and supernormal periods persisting up to 100 ms following spontaneous spikes. Type 2 cells fired spontaneously in an irregular, somewhat bursty pattern from 0 to 2 spikes/s with initial negative-going biphasic spikes, and were antidromically activated from neostriatal stimulation at shorter latencies than Type 1 cells (21.8 +/- 0.9 ms). Type 3 cells were characterized by initial positive-going biphasic waveforms and displayed a higher discharge rate (5-30 spikes/s) than Type 1 or Type 2 cells. Type 3 cells could not be antidromically activated from neostriatal stimulation. The relatively long conduction time to neostriatum of the Type 1 presumed serotonergic neuron is discussed with respect to previous interpretations of the synaptic action of serotonin in the neostriatum. In conjunction with these antidromic activation studies, the neurophysiological consequences of serotonergic terminal autoreceptor activation were examined by measuring changes in the excitability of serotonergic terminal fields in the neostriatum following administration of the serotonin autoreceptor agonist, 5-methoxy-N,N-dimethyltryptamine (5-MeODMT). The excitability of serotonergic terminal fields was decreased by intravenous injection of 40 micrograms/kg 5-MeODMT, and by infusion of 10-50 microM 5-MeODMT directly into the neostriatum. These results are interpreted from the perspective of mechanisms underlying autoreceptor-mediated regulation of serotonin release.