The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP. DATABASES AND DATA TREATMENT: We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data. RESULTS: A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship. CONCLUSIONS: These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP. SIGNIFICANCE: The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.

Different Densities of Na-Ca Exchange Current in T-Tubular and Surface Membranes and Their Impact on Cellular Activity in a Model of Rat Ventricular Cardiomyocyte.

The ratio of densities of Na-Ca exchanger current (INaCa) in the t-tubular and surface membranes (INaCa-ratio) computed from the values of INaCa and membrane capacitances (Cm) measured in adult rat ventricular cardiomyocytes before and after detubulation ranges between 1.7 and 25 (potentially even 40). Variations of action potential waveform and of calcium turnover within this span of the INaCa-ratio were simulated employing previously developed model of rat ventricular cell incorporating separate description of ion transport systems in the t-tubular and surface membranes. The increase of INaCa-ratio from 1.7 to 25 caused a prolongation of APD (duration of action potential at 90% repolarisation) by 12, 9, and 6% and an increase of peak intracellular Ca2+ transient by 45, 19, and 6% at 0.1, 1, and 5 Hz, respectively. The prolonged APD resulted from the increase of INaCa due to the exposure of a larger fraction of Na-Ca exchangers to higher Ca2+ transients under the t-tubular membrane. The accompanying rise of Ca2+ transient was a consequence of a higher Ca2+ load in sarcoplasmic reticulum induced by the increased Ca2+ cycling between the surface and t-tubular membranes. However, the reason for large differences in the INaCa-ratio assessed from measurements in adult rat cardiomyocytes remains to be explained.

Modelling the cardiac transverse-axial tubular system.

The transverse-axial tubular system (TATS) of cardiac ventricular myocytes is a complex network of tubules that arises as invaginations of the surface membrane; it appears to form a specialised region of cell membrane that is particularly important for excitation-contraction coupling. However, much remains unknown about the structure and role of the TATS. In this brief review we use experimental data and computer modelling to address the following key questions: (i) What fraction of the cell membrane is within the TATS? (ii) Is the composition of the TATS membrane the same as the surface membrane? (iii) How good is electrical coupling between the surface and TATS membranes? (iv) What fraction of each current is within the TATS? (v) How important is the complex structure of the TATS network? (vi) What is the effect of current inhomogeneity on lumenal ion concentrations? (vii) Does the TATS contribute to the functional changes observed in heart failure? Although there are many areas in which experimental evidence is lacking, computer models provide a method to assess and predict the possible function of the TATS; such models suggest that although the surface and TATS membranes are electrically well coupled, concentration of ion flux pathways within the TATS, coupled to restricted diffusion, may result in the ionic composition in the TATS lumen being different from that in the bulk extracellular space, and varying with activity and in pathological conditions.

Quantification of t-tubule area and protein distribution in rat cardiac ventricular myocytes.

The transverse (t-) tubules of cardiac ventricular myocytes are invaginations of the surface membrane that form a complex network within the cell. Many of the key proteins involved in excitation-contraction coupling appear to be located predominantly at the t-tubule membrane. Despite their importance, the fraction of cell membrane within the t-tubules remains unclear: measurement of cell capacitance following detubulation suggests approximately 32%, whereas optical measurements suggest up to approximately 65%. We have, therefore, investigated the factors that may account for this discrepancy. Calculation of the combinations of t-tubule radius, length and density that produce t-tubular membrane fractions of 32% or 56% suggest that the true fraction is at the upper end of this range. Assessment of detubulation using confocal and electron microscopy suggests that incomplete detubulation can account for some, but not all of the difference. High cholesterol, and a consequent decrease in specific capacitance, in the t-tubule membrane, may also cause the t-tubule fraction calculated from the loss of capacitance following detubulation to be underestimated. Correcting for both of these factors results in an estimate that is still lower than that obtained from optical measurements suggesting either that optical methods overestimate the fraction of membrane in the t-tubules, or that other, unknown, factors, reduce the apparent fraction obtained by detubulation. A biophysically realistic computer model of a rat ventricular myocyte, incorporating a t-tubule network, is used to assess the effect of the altered estimates of t-tubular membrane fraction on the calculated distribution of ion flux pathways.

Changes in action potentials and intracellular ionic homeostasis in a ventricular cell model related to a persistent sodium current in SCN5A mutations underlying LQT3.

In LQT3 patients, SCN5A mutations induce ultraslow inactivation of a small fraction of the hNav1.5 current, i.e. persistent Na+ current (IpNa). We explored the time course of effects of such a change on the intracellular ionic homeostasis in a model of guinea-pig cardiac ventricular cell [Pasek, M., Simurda, J., Orchard, C.H., Christé, G., 2007b. A model of the guinea-pig ventricular cardiomyocyte incorporating a transverse-axial tubular system. Prog. Biophys. Mol. Biol., this issue]. Sudden addition of IpNa prevented action potential (AP) repolarization when its conductance (gpNa) exceeded 0.12% of the maximal conductance of fast INa (gNa). With gpNa at 0.1% gNa, the AP duration at 90% repolarization (APD90) was initially lengthened to 2.6-fold that in control. Under regular stimulation at 1 Hz it shortened progressively to 1.37-fold control APD90, and intracellular [Na+]i increased by 6% with a time constant of 106 s. Further increasing gpNa to 0.2% gNa caused an immediate increase in APD90 to 5.7-fold that in control, which decreased to 2.2-fold that in control in 30s stimulation at 1 Hz. At this time diastolic [Na+]i and [Ca2+]i were, respectively, 34% and 52% higher than in control and spontaneous erratic SR Ca release occurred. In the presence of IpNa causing 46% lengthening of APD90, the model cell displayed arrhythmogenic behaviour when external [K+] was lowered to 5 mM from an initial value at 5.4 mM. By contrast, when K+ currents IKr and IKs were lowered in the model cell to produce the same lengthening of APD90, no proarrhythmic behaviour was observed, even when external [K+] was lowered to 2.5 mM.

A quantitative model of the cardiac ventricular cell incorporating the transverse-axial tubular system.

The role of the transverse-axial tubular system (TATS) in electrical activity of cardiac cells has not been investigated quantitatively. In this study a mathematical model including the TATS and differential distribution of ionic transfer mechanisms in peripheral and tubular membranes was described. A model of ventricular cardiac cell described by Jafri et al. (1998) was adopted and slightly modified to describe ionic currents and Ca2+ handling. Changes of concentrations in the lumen of the TATS were computed from the total of transmembrane ionic fluxes and ionic exchanges with the pericellular medium. Long-term stability of the model was attained at rest and under regular stimulation. Depletion of Ca2+ by 12.8% and accumulation of K+ by 4.7% occurred in the TATS-lumen at physiological conditions and at a stimulation frequency of 1 Hz. The changes were transient and subsided on repolarization within 800 ms (Ca2+) and 300 ms (K+). Nevertheless, the course of action potentials remained virtually unaltered. Simulations of voltage clamp experiments demonstrated that variations in tubular ionic concentrations were detectable as modulation of the recorded membrane currents.

Electrophysiological analysis of the negative chronotropic effect of endothelin-1 in rabbit sinoatrial node cells.

1. Electrophysiological effects of endothelin-1 (ET-1) were studied in rabbit sinoatrial node (SAN) using conventional microelectrode and whole-cell voltage and current recordings. 2. In rabbit SAN, RT-PCR detected ET(A) endothelin receptor mRNA. ET-1 (100 nM) increased the cycle length of action potentials (APs) from 305 +/- 15 to 388 +/- 25 ms; this effect was antagonised by the ET(A) receptor-selective antagonist BQ-123 (1 microM). ET-1 increased AP duration (APD50) by 22%, depolarised the maximum diastolic potential (MDP) from -59 +/- 1 to -53 +/- 2 mV, shifted the take-off potential by +5 mV and decreased the pacemaker potential (PMP) slope by 15%. Under exactly the same experimental conditions, ET-1 caused a positive chronotropic effect in guinea-pig SAN with a decrease of 13% in APD50, a shift of -4 mV in the take-off potential and an increase of 8% in the PMP slope. 3. Rabbit SAN exhibited two major cell types, distinguished both by their appearances and by their electrophysiological responses to ET-1. Whereas the spontaneous pacing rate and the PMP slope were similarly decreased by ET-1 (10 nM) in both cell types, ET-1 depolarised MDP from -67 +/- 1 to -62 +/- 4 mV in spindle-shaped cells but hyperpolarised it from -73 +/- 1 to -81 +/- 3 mV in rod-shaped cells. ET-1 decreased APD50 by 8 and 52% and shifted the take-off potential by +5 and -9 mV in spindle- and rod-shaped cells, respectively. 4. ET-1 decreased the high-threshold calcium current (I(CaL)) by about 50% in both cell types, without affecting its voltage dependence, and decreased the delayed rectifier K+ current (I(K)) with significant shifts (of +4.7 and +14.0 mV in spindle- and rod-shaped cells, respectively) in its voltage dependence. It was exclusively in rod-shaped cells that ET-1 activated a sizeable amount of time-independent inward-rectifying current. 5. The hyperpolarisation-activated current (I(f)), observed exclusively in spindle-shaped cells, was significantly increased by ET-1 at membrane potentials between -74.7 and -84.7 mV whereas it was significantly decreased at more negative potentials. ET-1 significantly decreased the slope of the current-voltage (I-V) relation of the I(f) tail without changing its half-maximum voltage. 6. The overall negative chronotropic influence of ET-1 on the whole rabbit SAN is interpreted as resulting from the integration of its different actions on spindle- and rod-shaped SAN cells through electrotonic interaction.

Propafenone blocks ATP-sensitive K+ channels in rabbit atrial and ventricular cardiomyocytes.

Propafenone, a class I antiarrhythmic agent, inhibits several membrane currents (I(Na), I(Ca), I(K), Ito), however, its effects on ATP-sensitive potassium current (I(K)ATP) of cardiac cells have not been tested. We evaluated the blocking effects of 0.1 to 100 microM propafenone applications at 35 degrees C on the whole-cell I(K)ATP as triggered by dinitrophenol (75 microM) in adult rabbit dissociated atrial and ventricular cardiomyocytes in comparison. The block of I(K)ATP by propafenone was dose-dependent, fully reversible and voltage-independent. The dose-response relation, as evaluated at 0 mV for atrial myocytes (ED50 = 1.26+/-0.17 microM, Hill number = 1.25+/-0.22) was significantly shifted to the left vs. that in ventricular myocytes (ED50 = 4.94+/-0.59 microM, Hill number = 1.22+/-0.14). It is concluded that propafenone blocks cardiac I(K)ATP at a single site with 4 times higher affinity for the drug in atrial myocytes. This block of cardiac I(K)ATP might play a role in the beneficial and adverse effects of the drug.

Localization of K(+) channels in the tubules of cardiomyocytes as suggested by the parallel decay of membrane capacitance, IK(1) and IK(ATP) during culture and by delayed IK(1) response to barium.

Adult ventricular myocytes lose T-tubules over few days in culture, which causes the loss of about 60% of the cell membrane capacitance (Cm) (Mitcheson et al., 1996). In this study, we have measured, in whole-cell voltage-clamped rabbit right ventricular myocytes at 0, 1, 2 and 3-5 days of culture (nine to 20 myocytes at each age) in a defined Dulbecco's modified Eagle's medium, the value of Cm and the magnitudes of the background inward rectifier current (IK(1)) and of the 2,4-dinitrophenol-induced ATP-sensitive potassium current (IK(ATP)). Cm, IK(1) and IK(ATP) all had decreased significantly by 51, 83 and 88%, respectively after 4 days of culture. Analysis using a single exponential decay function of time gave time constants of, 2.6+/-0.2, 2.2+/-0.5 and 2.4+/-0.4 days, respectively. Linear regressions of IK(1) and IK(ATP) versus Cm had regression coefficients of 0.93 and 0. 98, respectively. These observations are consistent with a strong link of the decay of IK(1) and IK(ATP) currents to that of Cm. Furthermore, the time course of changes in IK(1) when an external blocker (100 microm BaCl(2)) was applied and washed by local perfusion (95% change in 50 ms) agrees with a model including a diffusion time constant of 300 ms. This value is consistent with the known kinetics of diffusion of divalent cations in the T-tubules. Taken together, these results could be explained by the localization of a major part of the IK(1) and IK(ATP) currents of ventricular cardiomyocytes in the T-tubules. As a consequence, transient accumulation of K(+) ions in cardiac T-tubules may take place and modulate excitation-contraction coupling.

Control of cardiac performance by Ca-turnover.

A quantitative model of Ca-turnover in cardiac cells that incorporates negative feedback modulation of sarcolemmal calcium transport (via Ca channels and Na/Ca exchange) has been designed. The Na/Ca exchange current was expressed as INaCa = INaCar + delta INaCa. The component INaCar reflects slow changes of Ca2+ and Na+ concentrations and depends on the Na/K pump. delta INaCa is the fast component related to the Ca2+ transient. The single input to the model is an arbitrary sequence of intervals between excitations; outputs are sequences of calcium amounts transferred among the compartments during individual intervals. The model operates with a combination of discrete variables (amounts of Ca transferred during contraction, relaxation and rest) and continuous variables - slow changes in ionic concentrations. Since the model is not formalistic but respects the nature of the underlying elements of the system, it enables us to stimulate the known effects of cardiotropic drugs or to predict their unknown mechanisms by visualizing the changes in individual Ca compartments. By altering the parameters, the model also stimulates the known species and tissue differences in rate-dependent phenomena.

Use-dependent features of 4-aminopyridine block of transient outward current in rat ventricular myocytes.

The inhibition of the calcium-independent transient outward current (Ito) by the widely used blocker 4-aminopyridine (4-AP) was studied in adult Wistar rat ventricular myocytes, enzymatically isolated and voltage-clamped in the whole cell configuration using patch-clamp pipettes. 4-AP at 1 mmol/l concentration caused complete steady-state block of Ito at resting or hyperpolarized voltages. The block was partially removed during repeated depolarizations applied at frequencies above 0.25 Hz. Changes in the level of block during a depolarizing pulse (to + 40 mV) and during a following rest period (at -90 mV) were analyzed. On depolarization, the recovery from 4-AP block (at 0.5 mmol/l) started with a delay approximately corresponding to the time constant of Ito inactivation and then followed a monoexponential time course (time constant of about 44 ms). The restoration of block at a holding voltage of -90 mV, after recovery of Ito from inactivation, followed a monoexponential time course (time constant of about 1.2 s). The results are consistent with the hypothesis that the binding site for 4-AP at the Ito channel is available in the closed and open states but not when inactivated. Unblocking of Ito at stimulation intervals shorter than approximately 1 s may occur at 4-AP concentrations below 4 mmol/l.

Two active Na+/K+-ATPases of high affinity for ouabain in adult rat brain membranes.

The degree of heterogeneity of active Na+/K(+)-ATPases has been investigated in terms of ouabain sensitivity. A mathematical analysis of the dose-response curves (inhibition of Na+/K(+)-ATPase) at equilibrium is consistent with the putative existence of three inhibitory states for ouabain two of high (very high plus high) and one of low affinity. The computed IC50 values are: 23.0 +/- 0.15 nM, 460 +/- 4.0 nM and 320 +/- 4.6 microM, respectively. The relative abundance of the three inhibitory states was estimated as: 39%, 36% and 20%, respectively. Direct measurements of [3H]ouabain-binding at equilibrium carried out on membrane preparations with ATP, Mg2+ and Na+ also revealed two distinct high affinity-binding sites, the apparent Kd values of which were 17.0 +/- 0.2 nM (very high) and 80 +/- 1 nM (high), respectively. Dissociation processes were studied at different ouabain concentrations according to both reversal of enzyme inhibition and [3H]ouabain release. The reversal of enzyme inhibition occurred at three different rates, depending upon the ouabain doses used (10 nM, 2 and 100 microM). When the high-affinity sites were involved (ouabain doses lower than 2 microM) the dissociation process was biphasic. A similar biphasic pattern was also detected by [3H]ouabain-release. The time-course of [3H]ouabain dissociation (0.1 microM) was also biphasic. These data indicate that the three catalytic subunits of rat brain Na+/K(+)-ATPase alpha 1, alpha 2 and alpha 3 (Hsu, Y.-M. and Guidotti, G. (1989) Biochemistry 28, 569-573) are able to hydrolyse ATP and exhibit different affinities for cardiac glycosides.

Use-dependent effects of 4-aminopyridine on transient outward current in dog ventricular muscle.

The use-dependent features of 4-aminopyridine-induced block of the transient outward current were investigated under voltage clamp conditions in dog ventricular myocardial bundles. The block depended strongly on the pattern of voltage clamp pulses. Its level (settled in rested membranes) became deeper at early time during depolarization. In contrast, prolonged depolarization (above 50 to 100 ms) produced relief of block. Our results suggest that the block strongly depends on the state of the channel gating system.

Membrane responses to large hyperpolarizations in trabecles and single cells of frog atrium.

Atrial trabeculae (studied in voltage-clamping conditions and in the presence of 0.5 mmol/l BaCl2 to abolish gK1) responded to 1 s hyperpolarizations to beyond approximately E = -140 mV (from HP of about E = -80 mV) with an inwardly directed current increasing with time. Quite similar results were obtained with enzymatically dissociated frog atrial cells studied in whole cell voltage clamp with a patch-clamp pipette. This behaviour could be accounted for by assuming the presence of an "if" current at this quite negative range of potentials or by the fact that the cell membrane may undergo reversible electropermeabilization when its potential is brought to values negative to about -140 mV (Stämpfli 1958). When a brief (1 ms) and large (150 mV) hyperpolarization was applied 1 s before the test pulse, an inwardly directed current increasing with time was elicited by test pulses to beyond approximately E = -120 mV. This current was neither abolished in the presence of 1 mmol/l CsCl nor greatly reduced in the absence of Na+ ions, unlike "if" (Di Francesco 1981). We conclude that this current having a time course similar to that of "if" is of different nature and we argue that it might be accounted for by electropermeabilization of the membrane (reversible within about 2.5 min) due to the electrical shock represented by a brief and large hyperpolarization.

An in vitro evaluation of the hemostatic activity of topical agents.

An in vitro method has been developed for human non-anticoagulated blood to evaluate the enhancing effect of hemostatic agents on both plasmatic and cellular activation of the coagulation cascade. The coagulation time and the sequential generation of fibrinopeptide A (FpA) have been used as parameters. The kinetics of generation of FpA has been modelized and mathematically analyzed using the latence time, the slope of the linear part of the curve, and the time necessary to reach half maximal amplitude of FpA in the tube. A maximal amplitude of FpA in the tube. A very precise evaluation of the hemostatic activity of five different molecules, four being collagenous in nature, is given.

Possible role of Na+ ions in intracellular Ca2+ release in frog auricular trabeculae.

Membrane potential-current and mechanical tension of frog atrial muscle were studied in a Ca and Mg-free solution containing 1 mmol/l EGTA (Ca-free solution). Exposure to Ca-free solution resulted in a shortening of action potential duration within 1.5 min and a subsequent lengthening which were paralleled by changes in magnitude and duration of the contraction. Similarly, the slow inward current quickly disappeared and progressively reappeared with a quite slower inactivation time-course. Its reversal potential varied with [Na]0 as for a pure Na current. By 12 min in Ca-free solution, the tension-voltage relation could be interpreted as the sum of two components correlated with the slow inward current and the membrane potential respectively. Contractures in response to sustained large depolarizations had similar time courses in Ca-free solution and Ringer's containing Na-Ca exchange blockers (Mn2+ 15 mmol/l or La3+ 3 mmol/l). Intracellular Na loading by voltage-clamp depolarizations (40 mV from the resting potential for 100 ms, at 0.2 Hz) in the presence of Veratrine (7.5 X 10(-6) g/ml) caused a large progressive increase in tonic tension. An intracellular Ca2+ release is invoked, partly related to Na+ entry and partly to membrane potential changes. The potential dependent part could be influenced by intracellular Na+.

Effects of low [K+]o on the electrical activity of human cardiac ventricular and Purkinje cells.

Ventricular and Purkinje action potentials were recorded with a microelectrode in a strip of human papillary muscle. Lowering the K-content of the superfusing solution from 5.9 to 0.5 mmol.litre-1 at 37 degrees C hyperpolarised ventricular diastolic potential steadily as long as [K+]o was low (up to 70 min tested). Ventricular action potentials were transiently lengthened and then shortened. A positive inotropic effect was noted and attributed to Na-K pump inhibition since it was reversed by the addition of 2 mmol.litre-1 thallous chloride to the low [K+]o solution. Beyond 40 min, transient depolarisations and after-contractions were found. During the first minutes in low [K+]o, Purkinje diastolic potential was hyperpolarised and the action potential was lengthened at all levels of repolarisation. Afterwards, the Purkinje diastolic potential suddenly depolarised by 30 mV. Restoration of the control solution caused a slow repolarisation and then a sudden return of the diastolic potential to near control value. This was reproduced during drive (38 stim.min-1) and at rest. At the depolarised level of potential, stimulation elicited slow action potentials with diastolic slow depolarisation and spontaneous oscillations of potential appeared at rest. In Purkinje cells, increasing concentrations of tetrodotoxin from 10(-7) to 8 X 10(-6) mol.litre-1 in the control solution shifted the diastolic potential in negative direction by a few mV and shortened the action potential duration at all levels of repolarisation. The possible implications of these phenomena in the genesis of some cardiac arrhythmias is discussed.