Association between antihypertensive treatment and adverse events: systematic review and meta-analysis

OBJECTIVE

To examine the association between antihypertensive treatment and specific adverse events.

DESIGN

Systematic review and meta-analysis.

ELIGIBILITY CRITERIA

Randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or higher blood pressure targets compared with lower targets. To avoid small early phase trials, studies were required to have at least 650 patient years of follow-up.

INFORMATION SOURCES

Searches were conducted in Embase, Medline, CENTRAL, and the Science Citation Index databases from inception until 14 April 2020.

MAIN OUTCOME MEASURES

The primary outcome was falls during trial follow-up. Secondary outcomes were acute kidney injury, fractures, gout, hyperkalaemia, hypokalaemia, hypotension, and syncope. Additional outcomes related to death and major cardiovascular events were extracted. Risk of bias was assessed using the Cochrane risk of bias tool, and random effects meta-analysis was used to pool rate ratios, odds ratios, and hazard ratios across studies, allowing for between study heterogeneity (τ2).

RESULTS

Of 15 023 articles screened for inclusion, 58 randomised controlled trials were identified, including 280 638 participants followed up for a median of 3 (interquartile range 2-4) years. Most of the trials (n=40, 69%) had a low risk of bias. Among seven trials reporting data for falls, no evidence was found of an association with antihypertensive treatment (summary risk ratio 1.05, 95% confidence interval 0.89 to 1.24, τ2=0.009). Antihypertensives were associated with an increased risk of acute kidney injury (1.18, 95% confidence interval 1.01 to 1.39, τ2=0.037, n=15), hyperkalaemia (1.89, 1.56 to 2.30, τ2=0.122, n=26), hypotension (1.97, 1.67 to 2.32, τ2=0.132, n=35), and syncope (1.28, 1.03 to 1.59, τ2=0.050, n=16). The heterogeneity between studies assessing acute kidney injury and hyperkalaemia events was reduced when focusing on drugs that affect the renin angiotensin-aldosterone system. Results were robust to sensitivity analyses focusing on adverse events leading to withdrawal from each trial. Antihypertensive treatment was associated with a reduced risk of all cause mortality, cardiovascular death, and stroke, but not of myocardial infarction.

CONCLUSIONS

This meta-analysis found no evidence to suggest that antihypertensive treatment is associated with falls but found evidence of an association with mild (hyperkalaemia, hypotension) and severe adverse events (acute kidney injury, syncope). These data could be used to inform shared decision making between doctors and patients about initiation and continuation of antihypertensive treatment, especially in patients at high risk of harm because of previous adverse events or poor renal function.

REGISTRATION

PROSPERO CRD42018116860.

Pulmonary rehabilitation referral and uptake from primary care for people living with COPD: a mixed-methods study

Healthcare service and patient barriers contribute to low referral to and uptake of pulmonary rehabilitation (PR). Solutions should support skilled clinician-patient conversations and span primary care-PR boundaries to prevent disjointed working. http://bit.ly/2PVKHZf.

Muscarinic blockade slows and degrades the location-specific firing of hippocampal pyramidal cells

The firing of rat hippocampal pyramidal cells is determined both by the animal's location and by the state of the hippocampal EEG. Because cholinergic transmission plays a role in EEG activity, we expected that its modification would alter place cell activity. We therefore investigated the effects on place cell activity of blocking muscarinic transmission with intracerebroventricular injections of scopolamine. Scopolamine reduced both the rate of place cell discharge inside firing fields and the spatial coherence of the fields; discharge outside of the fields also showed small increases. After injections, fields were shifted farther from their previous location than for saline controls, indicating reduced reproducibility after muscarinic blockade. Scopolamine increased the time rats were stationary, but changes in place cell activity persisted even after analysis was restricted to periods of walking, suggesting that the behavioral changes cannot account for the cell discharge changes. The scopolamine effects were dose dependent to an extent that varied between different measures. The firing rates of interneurons showed only a minor trend to decrease after scopolamine. Nevertheless, the spatial coherence of interneuron firing patterns was reduced, consistent with the recent demonstration that their positional firing is mediated by the location-specific firing of pyramids (Marshall et al., 2002). These results demonstrate that acetylcholine enhances positional firing patterns in the hippocampus. Muscarinic blockade weakens the positional firing of most place cells and therefore renders them less useful for precise representation of the environment. This effect may underlie the difficulties in spatial learning and problem solving caused by abnormalities of cholinergic transmission.

Action potentials and relations to the theta rhythm of medial septal neurons in vivo

The influence of the medial septal nucleus and the nucleus of the diagonal band of Broca (MS-DB) on the hippocampal theta rhythm includes both cholinergic and gamma-aminobutyric acid (GABAergic) components. To understand the intrinsic septal interactions and the separate contributions of the cholinergic and GABAergic septohippocampal neurons to the theta rhythm in behaving animals, it is essential to be able to identify these two classes from extracellular recordings. Here the durations of extracellularly recorded action potentials are compared with the other characteristics of the neurons. Extracellular recordings were taken from neurons of the MS-DB both in freely moving rats (114 cells) and in urethane-anesthetized rats (112 cells). These were compared with intracellular recordings taken from MS-DB neurons in urethane-anesthetized rats (58 cells). Hippocampal EEG was recorded from above the CA1 pyramidal cell layer (CAI theta) and near the hippocampal fissure (dentate theta) to compare the firing phase across cells. Here it is shown that two major types of rhythmically bursting cells in the MS-DB that had been distinguished previously in intracellular recordings in vivo are also separable in extracellular recordings in vivo on the basis of the durations of their action potentials. In both awake and anesthetized rats the main properties of the two cell types were found to differ: firing rate, phase-relation to the hippocampal theta rhythm and sensitivity of their rhythmicity to blockade of muscarinic transmission. As was previously shown for intracellular recordings in anesthetized rats, it is shown here that in awake rats, too, the more rapidly firing brief-spike (putative GABAergic) cells fired with highest probability on the negative phase of the dentate theta, whereas the more slowly firing long-spike (putative cholinergic) cells fired mostly on the positive phase. Previous work showed that in intracellular recordings from anesthetized rats the rhythmic firing of most brief-spike cells was still retained even during muscarinic blockade, but that of most long-spike cells was lost. Here we also report a recategorization according to spike duration of existing extracellular recordings taken from anesthetized rats, confirming the above observation with much larger numbers of cells. Three additional major new findings are also reported here. (1) In awake rats, muscarinic blockade has relatively little effect on either cell type. (2) Under anesthesia, the firing rates of both cell types are lower than in awake rats, but the effect is greater on the long-spike cells, where the anesthesia also reduces the rhythmicity of the cell firing. (3) Rhythmicity of the putative GABAergic cells is also retained after local injection of GABA-A antagonist, whereas that of the putative cholinergic cells is eliminated. We conclude that either systemic muscarinic blockade or urethane anesthesia alone have relatively little effect on neurons in the defined above MS-DB, but a combination of the two has profound effects on the rhythmicity of the cholinergic cells, largely sparing the GABA-ergic cells. Taken together, the results suggest that generation of theta rhythm requires a background of excitatory influences on the hippocampus (that can be maintained by either muscarinic or glutamatergic inputs) in combination with the phasic disinhibitory action mediated by the GABAergic MS-DB projection. They also provide additional support for the notion that the phasic activity in local collaterals of GABAergic MS-DB cells contributes to the phasic modulation of the firing of cholinergic septohippocampal neurons.

The outreach-assisted model of partner notification with IDUs

OBJECTIVE

This analysis describes the Outreach-Assisted Model of Partner Notification, an innovative strategy for encouraging seropositive injecting drug users (IDUs) to inform their partners of shared human immunodeficiency virus (HIV) exposure. The analysis focuses on two core components of the notification process: the identification of at-risk partners and preferences for self-tell vs. outreach assistance in informing partners of possible exposure to the virus.

METHODS

Using community outreach techniques, 386 IDUs were recruited for HIV pretest counseling, testing, and partner notification over a 12-month period. Of these, 63 tested HIV seropositive, and all but three returned for their test results. The 60 who were informed of their serostatus were randomly assigned to either a minimal or an enhanced intervention condition. Participants assigned to the minimal (self-tell) group were strongly encouraged to inform their partners of possible exposure. Those assigned to the enhanced (outreach-assisted) group had the option of either informing one or more of their partner(s) themselves or choosing to have the project's outreach team do so.

RESULTS

Together, the 60 index persons who received their results provided names or at least one piece of locating information for a total of 142 partners with whom they perceived having shared possible exposure to the virus within the past five years. By itself, drug use accounted for half of all partners named. Sexual behavior alone accounted for 25% of named partners. Eighty-two percent of the enhanced group preferred to have the outreach team tell at least one partner; the team was requested to notify 71% of the total number of partners whom this group named.

CONCLUSIONS

Findings suggest that IDUs want to notify their partners of shared HIV exposure. Outreach assistance was the preferred mode in the majority of cases. Expanding traditional community-based HIV outreach activities to include delivering street-based counseling, test, a partner notification appears to be a positive and workable prevention strategy.

Application of the combined single-cell recording/intracerebral microdialysis method to alcohol research in freely behaving animals

Intercellular communication in brain is coded in neuronal firing patterns, determined by the interplay of intra- and extracellular molecular systems. It is not clear how ethanol perturbs this molecular interplay in the motivational, emotional, and cognitive neural networks in brain to induce those specific, aberrant, cell-firing patterns that lead to craving for alcohol, excessive alcohol consumption, and impaired cognition. However, resolution of this problem is essential to an understanding of the basic mechanisms of alcohol-related disorders and to develop effective therapies for their treatment. It is difficult to obtain information on the molecular background of cell-firing regulation in brain during behavioral events. We have recently developed a new in vivo method, combined single-cell recording/intracerebral microdialysis in freely behaving animals, which has the ability to extract such information from brain. The principal feature of the technique is that it records the firing of single neurons in discrete brain sites and deliver drugs, alone or in combinations, via microdialysis, into the extracellular environment of the recorded cells, while the experimental animal is behaving freely. Accordingly, the method allows the determination of drug actions on cellular firing within distinct neural circuits during normal and abnormal behaviors. Thus, it can provide insights into the physiological or pathophysiological molecular machinery of the examined cells. The present paper describes this method, demonstrates how administration of ethanol via intrahippocampal microdialysis affects the firing of hippocampal place cells, and discusses the potential of the technique in future alcohol research.

Intracellular recordings from medial septal neurons during hippocampal theta rhythm

The electrophysiological properties of neurons of the medial septal nucleus and the nucleus of the diagnonal band of Broca (MS/DB) were studied using intracellular methods in urethane-anesthetized rats. Three types of rhythmically bursting neurons were identified in vivo on the basis of their action potential shapes and durations, afterhyperpolarizations (AHPs), membrane characteristics, firing rates and sensitivities to the action of muscarinic antagonist: (1) Cells with short-duration action potentials and no AHPs (2 of 34 rhythmic cells, 6%) had high firing rates and extremely reliable bursts with 6-16 spikes per theta cycle, which were highly resistant to scopolamine action. (2) Cells with short-duration action potentials and short-duration AHPs (8 of 34 rhythmic cells, 24%) also had high firing rates and reliable bursts with 4-13 spikes per theta cycle, phase-locked to the negative peak of the dentate theta wave. Hyperpolarizing current injection revealed a brief membrane time constant, time-dependent membrane rectification and a burst of firing at the break. Depolarizing current steps produced high-frequency repetitive trains of action potentials without spike frequency adaptation. The action potential and membrane and characteristics of this cell type are consistent with those described for GABAergic septal neurons. Many of these neurons retained their theta-bursting pattern in the presence of muscarinic antagonist. (3) Cells with long-duration action potentials and long-duration AHPs (24 of 34 rhythmic cells, 70%) had low firing rates, and usually only 1-3 spikes per theta cycle, locked mainly to the positive peak of the dentate theta rhythm. Hyperpolarizing current injection revealed a long membrane time constant and a break potential; a depolarizing pulse caused a train of action potentials with pronounced spike frequency adaptation. The action potential and membrane properties of this cell type are consistent with those reported for cholinergic septal neurons. The theta-related rhythmicity of this cell type was abolished by muscarinic antagonists. The phasic inhibition of "cholinergic" MS/DB neurons by "GABAergic" MS/DB neurons, followed by a rebound of their firing, is proposed as a mechanism contributing to recruitment of the whole MS/DB neuronal population into the synchronized rhythmic bursting pattern of activity that underlies the occurrence of the hippocampal theta rhythm.

Manipulation of pyramidal cell firing in the hippocampus of freely behaving rats by local application of K+ via microdialysis

In this study, microdialysis was performed in the hippocampus of freely behaving rats, and the firing of pyramidal cells, including place cells, was recorded at the site of the microdialysis probe. For 10-min periods, the artificial cerebrospinal fluid (ACSF) in the microdialysis system was replaced with ACSF containing 50 mM K+ (high K+ solution). Complementary in vitro tests determined that microdialysis with such high K+ solution produced an outflow of 5% of the perfused K+ from the microdialysis probe. Application of K+ with this method into the CA1 region significantly increased the firing of the local pyramidal cells, including place cells, during both movement and sleep. On average, K+ exposures increased the firing rate of the neurons to 306% and 448% of the control firing rate during movement and sleep, respectively. After the termination of the K+ outflow, the cells continued to discharge for 5-30 min with a significantly higher frequency than before the K+ challenge. This phenomenon also occurred in both behavioral states. During the period of enhanced firing, the out-of-field firing rate of the recorded place cells was dramatically increased. It was also found that during the K+ applications, otherwise silent pyramidal cells often became electrically active. The K(+)-induced firing modifications were usually not accompanied by behavioral or EEG changes. The data raise the possibility that transient elevations in the extracellular K+ concentration contribute to the ionic/molecular processes which are responsible for plastic firing pattern modifications in hippocampus. Pharmacological manipulation of place cells with the described method offers a new strategy to understand the molecular bases of spatial memory.

The suppressant effect of ethanol, delivered via intrahippocampal microdialysis, on the firing of local pyramidal cells in freely behaving rats

Intrahippocampal microdialysis was performed on 14 freely behaving rats, and the firing of pyramidal cells within the dialysis area was recorded. In one group of rats, the microdialysis was conducted only with artificial cerebrospinal fluid (ACSF) for 2-4 h. In this control group, the recorded neurons displayed normal firing patterns. In another group, ACSF was replaced for 30-60 min with various concentrations of ethanol to deliver this drug via the microdialysis probe into the cell recording area. Ethanol at the concentration of 5% (w/v) significantly and reversibly suppressed the firing of the recorded neurons. The marked firing rate alterations were not accompanied with apparent changes in the hippocampal EEG activity or the behavior of the rats, indicating localized drug actions. These data demonstrate for the first time that in the physiologically functioning brain, ethanol exerts principally a suppressant effect on the electrical activity of hippocampal pyramidal cells.

Simultaneous single-cell recording and microdialysis within the same brain site in freely behaving rats: a novel neurobiological method

We present a method for performing intracerebral microdialysis in freely behaving rats while recording the firing of neurons within the dialysis site. Studying hippocampal theta cells and complex-spike cells with this technique, it has been found that: (1) when the microdialysis fluid contained only artificial cerebrospinal fluid, both types of neurons displayed normal electrical activity, (2) the simultaneous single-cell recording/microdialysis procedure could be readily performed for as long as 3 days, and (3) inclusion of drugs into the microdialysis fluid, at appropriate concentrations, caused clear changes in firing pattern. For example, microdialysis with 1% lidocaine completely abolished, whereas that with 50 mM K+ markedly increased, the neuronal electrical activity. These cellular changes developed without apparent EEG or behavioral manifestations and were reversible. In some of the experiments, the extracellular concentrations of glutamate and aspartate in the recording/dialysis site were also measured. The described method allows the extracellular environment of recorded brain cells to be manipulated by drugs delivered through the microdialysis probe and simultaneously allows determination of the neurochemical composition of that environment over a remarkably long period of time and in intact, physiologically functioning, neural network. Such studies will provide new insights into the molecular basis of neuronal activity in the brain in the context of behavior, including learning.

Current source density analysis of the hippocampal theta rhythm: associated sustained potentials and candidate synaptic generators

Single-electrode depth profiles of the hippocampal EEG were made in urethane-anesthetized rats and rats trained in an alternating running/drinking task. Current source density (CSD) was computed from the voltage as a function of depth. A problem inherent to AC-coupled profiles was eliminated by incorporating sustained potential components of the EEG. 'AC' profiles force phasic current sinks to alternate with current sources at each lamina, changing the magnitude and even the sign of the computed membrane current. It was possible to include DC potentials in the profiles from anesthetized rats by using glass micropipettes for recording. A method of 'subtracting' profiles of the non-theta EEG from theta profiles was developed as an approach to including sustained potentials in recordings from freely-moving animals implanted with platinum electrodes. 'DC' profiles are superior to 'AC' profiles for analysis of EEG activity because 'DC'-CSD values can be considered correct in sign and more closely represent the actual membrane current magnitudes. Since hippocampal inputs are laminated, CSD analysis leads to straightforward predictions of the afferents involved. Theta-related activity in afferents from entorhinal neurons, hippocampal interneurons and ipsi- and contralateral hippocampal pyramids all appear to contribute to sources and sinks in CA1 and the dentate area. The largest theta-related generator was a sink at the fissure, having both phasic and tonic components. This sink may reflect activity in afferents from the lateral entorhinal cortex. The phase of the dentate mid-molecular sink suggests that medial entorhinal afferents drive the theta-related granule and pyramidal cell firing. The sustained components may be simply due to different average rates of firing during theta rhythm than during non-theta EEG in afferents whose firing rates are also phasically modulated.

The mere exposure effect for stimuli presented below recognition threshold: a failure to replicate

Repeated exposure to a stimulus increases one's affect toward that stimulus. This finding, termed the mere exposure effect, has been obtained even when the exposure durations are below the threshold of recognition. Reported are three experiments designed to assess whether the mere exposure effect for stimuli presented below the threshold of recognition could be obtained for meaningful stimuli. Analysis showed that meaningfulness of the stimuli had no effect on ratings of affect; however, we did not replicate previous findings of a mere exposure effect for stimuli that were not recognized. The robustness of the mere exposure effect for stimuli presented below the threshold of awareness was questioned.

Effects of atropine on hippocampal theta cells and complex-spike cells

The medial septal nuclei are essential for the naturally occurring hippocampal theta rhythm. Evidence that the rhythmic activity of the septum is carried via cholinergic afferents to the hippocampus has been: (a) the existence of a cholinergic septo-hippocampal projection, and (b) the sensitivity of one type of theta rhythm to antimuscarinic agents or cholinergic depletion. The muscarinic action of acetylcholine on pyramidal cells, however, is too slow to carry even a 4 Hz signal. Recent in vitro studies have confirmed a fast excitatory response by some hippocampal interneurons to muscarinic agonists. In urethane anesthetized rats, iontophoretic application of atropine to 17 hippocampal theta cells (presumed interneurons) during the theta rhythm, reduced their firing rates to an average of 24% of control rates. The effect of iontophoretic atropine application to 4 CA1 complex-spike cells (presumed pyramidal cells) was a selective elimination of their bursting activity with no significant effect on overall firing rate. The data suggest that: (1) interneuronal firing, during the hippocampal theta rhythm, is dominated by an excitatory cholinergic input and not by excitatory collaterals of pyramidal cells; and (2) somatic burst firing by CA1 pyramidal cells requires the presence of acetylcholine.

Hippocampal laminar glucose utilization and theta rhythm following unilateral fimbria-fornix lesions in rats

Laminar profiles of glucose utilization were related to the presence or absence of movement-related hippocampal theta rhythm in CA1 and dentate gyrus of rats after aspirative unilateral combined lesions of the fimbria-fornix and cingulum. Three groups were studied: (1) sham-operated rats, (2a) lesioned rats with an ipsilateral loss of theta activity at 4 weeks post-lesion that persisted at 12 weeks post-lesion, and (2b) lesioned rats with a loss of theta activity at 4 weeks post-lesion, but a recovery of theta rhythm at 12 weeks post-lesion. Fimbria-fornix/cingulum lesions served both to abolish ipsilateral theta rhythm and to decrease ipsilateral glucose metabolism in all cell layers of CA1 and the dentate gyrus, when normalized to the contralateral hemisphere. Although glucose metabolism in lesioned animals with a recovery of theta rhythm was not as high as control levels, in several laminae it was significantly higher than that of lesioned animals with persistent loss of theta rhythm. These laminae included the dentate hilus and strata oriens, pyramidale and lacunosum-moleculare of CA1. The increased glucose metabolism associated with the return of theta rhythm suggests a functional reinnervation of these layers of the hippocampus in such animals.

Firing relations of medial entorhinal neurons to the hippocampal theta rhythm in urethane anesthetized and walking rats

The firing of neurons from layers II and III of medial entorhinal cortex (MEC) was examined in relation to the hippocampal theta rhythm in urethane anesthetized and walking rats. 1) MEC neurons showed a significant phase relation to the hippocampal theta rhythm in both walking and urethane anesthetized rats, suggesting that this region contributes to the generation of both atropine-resistant and atropine-sensitive theta rhythm components. 2) The proportion of phase-locked cells was three times greater in walking rats (22/23 cells) as compared to anesthetized rats (8/23 cells), indicating that MEC cells made a greater contribution during walking theta rhythm. This difference was also manifest in the greater mean vector length for the group of phase-locked MEC cells during walking: 0.39 +/- 0.13 versus 0.21 +/- 0.08. Firing rate differences between walking and urethane conditions were not significant. 3) In walking rats, MEC cells fired on the positive peak of the dentate theta rhythm (group mean phase = 5 degrees; 0 degrees = positive peak at the hippocampal fissure). This is close to the reported phases for dentate granule and hippocampal pyramidal cells. The distribution of MEC cell phases in urethane anesthetized rats was broader (group mean phase = 90 degrees), consistent with the phase data reported for hippocampal projection cells. These findings suggest that medial entorhinal neurons are the principal determinant of theta-related firing of hippocampal neurons and that their robust rhythmicity in walking as compared to urethane anesthesia accounts for EEG differences across the two conditions.

The propagation potential. An axonal response with implications for scalp-recorded EEG

An electrophysiological response of axons, referred to as the "propagation potential," was investigated. The propagation potential is a sustained voltage that lasts as long as an action potential propagates between two widely spaced electrodes. The sign of the potential depends on the direction of action potential propagation. The electrode towards which the action potential is propagating is positive with respect to the electrode from which it is receding. For normal frog sciatic nerves the magnitude of the propagation potential was 17% of the peak of the extracellular action potential; TEA increased it to 32%. For normal earthworm median or lateral giant fibers it was 30%. A ripple pattern on the propagation potential was attributed to variation in resistance along the length of the worm. Cooling increased the duration of the propagation potential and attenuated the higher frequency components of the ripple pattern. Differential records from two widely spaced intracellular microelectrodes in the same axon differed from the propagation potential. The amplitude of the plateau relative to the peak was smaller, it decreased as the action potential propagated from one electrode site to the other, and the potential did not return to zero as rapidly as for extracellular records. When propagation was blocked by heat, the propagation potential slowly decayed. There was no ripple pattern during the decay. In a volume conductor, electrodes contacting the worm did not show the typical propagation potential, but electrodes located a few centimeters away from the worm did. Simple core-conductor models based on classical action potential theory did not reproduce the propagation potential. More complex, modified core-conductor models were needed to accurately simulate it. The results suggest that long, slowly conducting fibers can contribute to the scalp-recorded EEG.

Hippocampal theta activity in monkeys

The hippocampal theta rhythm has been extensively studied in many subprimate mammals. Considering the technical difficulties involved in recording from freely moving animals during voluntary motion and REM sleep, it was thought that urethane anesthesia might be appropriate for initial studies of the primate hippocampal EEG. Three of three macaques and one of two squirrel monkeys showed clear rhythmic hippocampal EEG activity. One very old squirrel monkey (a 16-year-old female) showed no theta activity in the hippocampal EEG. Similarities of the monkey theta activity with theta rhythm of urethane-anesthetized rats included: (1) a high coherence between recordings from electrodes separated by several millimeters within the hippocampal formation; (2) sensitivity of the theta activity to muscarinic drugs; and (3) its correlation with spontaneous movements during light anesthesia. Important differences were: (1) the frequency of the monkey theta activity was 7-9 Hz compared to the 4-5 Hz found in rats; (2) theta activity was not detected in the distal apical dendritic regions of CA1 or dentate in the monkey; (3) considerable amounts of low-frequency EEG co-existed with the monkey theta activity; and (4) the durations of bouts of theta activity in monkeys were much shorter than in rats. We conclude that primates generate hippocampal theta activity homologous, but not identical, to that of rats.

Do septal neurons pace the hippocampal theta rhythm?

The hippocampal theta rhythm (rhythmical slow activity, RSA) is one of the most thoroughly studied EEG phenomena. Much of this experimental interest has been stimulated by suggestions that the mnemonic functions of the hippocampus may depend upon theta-related neuronal activity. Inputs from the medial septal nuclei to the hippocampus were shown to be essential for the theta rhythm in the 1950s, but the role of these basal forebrain projections has not been clearly defined. Four models of the septo-hippocampal connections involved in theta rhythm production are reviewed as the precise roles of these projections are discussed. In our final, consolidated model both cholinergic and GABAergic septal projection cells fire in rhythmic bursts that entrain hippocampal interneurons. The resulting rhythmic inhibition of hippocampal projection cells, together with their excitatory interconnections, generates at least one component of the theta rhythm.

Firing relations of lateral septal neurons to the hippocampal theta rhythm in urethane anesthetized rats

The firing of lateral septal neurons was examined in relation to the hippocampal theta rhythm in urethane anesthetized rats. In general, the firing rates of these cells were low during both theta and non-theta EEG states. There was no significant change in firing rate between the two states (theta: 8.5 +/- 9.9 spks/sec; non-theta: 6.0 +/- 5.3). Sixty-four of 68 cells fired simple spikes and 4 cells were found to fire bursts of action potentials (complex-spikes). Approximately 30% (21/65) of the cells showed a significant phase relation to the hippocampal theta rhythm. The preferred phases of firing of these 21 cells were broadly distributed. The possibility that the phase-locked firing of LSN cells is due to the phase-locked firing of hippocampal projection cells is discussed.

Detection of an atropine-resistant component of the hippocampal theta rhythm in urethane-anesthetized rats

An important pharmacological feature of the hippocampal theta rhythm in urethane-anesthetized animals is its apparent sensitivity to antimuscarinic drugs. This sensitivity may be partly due to a masking of the theta frequency by increases in both higher and lower frequency EEG components that are unrelated to any residual theta rhythm. The discovery of atropine-resistant, rhythmic medial septal neurons has provided a physiological trigger for averaging EEG and unit activity after large atropine doses. Such averaging has permitted the detection of an atropine-resistant component of the hippocampal theta rhythm in urethane-anesthetized rats. The postatropine theta activity recorded from both CAl (superficial to the pyramidal cell layer) and dentate (near the hippocampal fissure) in 15 rats was typically reduced in amplitude, but the recordings from the two locations maintained their phase relations to the septal units and to each other. The presence of this residual theta component after doses as large as 100 mg/kg indicates that it cannot be mediated by muscarinic cholinergic receptors. The coupling of the signal to the atropine-resistant septal cells strengthens our previous suggestion that these septo-hippocampal neurons are not cholinergic, and are therefore probably GABAergic.

Firing relations of medial septal neurons to the hippocampal theta rhythm in urethane anesthetized rats

On the basis of spontaneous firing patterns and relations to the hippocampal theta rhythm, three cell types were identified within the medial septal nucleus and vertical limb of the nucleus of the diagonal band of Broca (MSN-NDB). In addition to the well known rhythmically bursting cells that fired in bursts on each cycle of the hippocampal theta rhythm, two other cell types are distinguished. "Clock" cells fired at high rates with a very regular, periodic firing pattern that was unrelated to the theta rhythm. "Irregular" cells fired at much lower rates, especially during theta rhythm, and had a pseudo-random firing pattern. The firing of "irregular" cells was often significantly phase-locked to the hippocampal theta rhythm. Crude estimates of the relative proportions of these cell types suggest that the rhythmically bursting cells comprise about 75% of the cells of the MSN-NDB. These three cell types bear a remarkable resemblance, in firing patterns and relative proportions, to the three principal cell types of the medial septal nuclei described in the freely moving rat (Ranck 1976). Measurements of the preferred phases of firing of 128 rhythmically bursting septal neurons (including 22 atropine-resistant and 11 atropine-sensitive cells) indicate that there is no single preferred phase of firing for the population. Rather the distribution of phases over the theta cycle is statistically flat. Variations in recording locations cannot account for this distribution since large differences in preferred phase were found for pairs of cells at the same location. Similarly, plotting only the group of cells identified as projection cells by antidromic activation from the fimbria/fornix, failed to reveal a peak in the distribution. In contrast to the rhythmically bursting cells, the distribution of preferred firing phases for the "irregular" cells with a significant phase-locking to the theta rhythm did have a clear peak. The peak occurred near the dentate theta rhythm positivity, consistent with the hypothesis that they are driven by feedback from CA1 complex-spike cells.

Membrane potential and impedance changes in hippocampal pyramidal cells during theta rhythm

Intracellular recordings were made from hippocampal pyramidal cells identified by their depths and their responses to commissural stimulation. Recordings were made during spontaneous bouts of hippocampal theta rhythm in urethane anesthetized rats. Membrane potentials (Vm) of pyramidal cells varied with the phase of the theta rhythm, that is, there was an "intracellular theta rhythm". The changes in Vm averaged about 2 mV peak to peak. Averaged intracellular theta waves showed that CA1 pyramids were most depolarized at the time of the positive peak of the extracellular theta rhythm recorded in (and superficial to) the CA1 pyramidal cell layer (CA1 theta). Peak depolarizations for CA3/4 pyramids were more broadly distributed, but occurred mainly in the interval just before the positive peak to just before the negative peak of the CA1 theta. Input impedance minima that were measurable at frequencies as high as 100 Hz occurred at about the same phases of the extracellular theta rhythm as the peak depolarizations (positive-going zero crossing to negative-going zero crossing of the CA1 theta). Such impedance changes imply conductance changes on the soma. The magnitude and localization of the conductance changes suggests that somatic IPSPs make major contributions to the intracellular theta rhythm. The phase relation between the intracellular and extracellular theta rhythms could be reversed by long duration current pulses that depolarized the cells slightly. This implies that either the intracellular theta-related IPSPs are depolarizing potential changes, or that they occur simultaneously with EPSPs. The phase of the intracellular theta rhythm was generally unaffected by long duration hyperpolarizing current pulses. Chloride leakage that reversed the evoked IPSPs usually had no effect on the phase of the intracellular theta rhythm, although in one case it appeared to cause its amplitude to increase.

Two populations of rhythmically bursting neurons in rat medial septum are revealed by atropine

1. Previous findings, such as the sensitivity of the hippocampal theta rhythm to cholinergic manipulation, support a "pacemaker" role for the cholinergic cells of the medial septal nucleus and the vertical limb of the nucleus of the diagonal band (MSN-NDB). To explore the mechanism(s) of action of systemic antimuscarinic drugs in eliminating the theta rhythm, recordings of hippocampal EEG and rhythmic MSN-NDB neurons that fired in phase with the hippocampal theta rhythm were taken during the administration of atropine in urethane-anesthetized rats. 2. Twenty-two of 33 rhythmic MSN-NDB cells continued to burst at the theta rhythm frequency after administration of a dose of atropine (25 mg/kg iv) that was sufficient to eliminate the theta rhythm (atropine-resistant cells). The remaining 11 cells lost their rhythmic firing pattern over the same time course as the loss of the theta rhythm (atropine-sensitive cells). 3. Both types of rhythmic MSN-NDB cells could be antidromically driven from the fimbria/fornix with similar latencies (range, 0.5-4.0 ms). The extracellularly recorded spike waveforms were not useful in predicting the atropine sensitivity of a given cell. Atropine-resistant cells frequently had higher firing rates than atropine-sensitive cells, but there was sufficient overlap of the two groups to make this a poor predictor of sensitivity. 4. Cooling the fimbria/fornix reversibly eliminated the hippocampal theta rhythm, but had no effect on 21/25 rhythmic MSN-NDB cells tested. This indicates that the atropine-sensitive MSN-NDB cells do not depend on the periodic output from the hippocampus for their rhythmic firing. Recordings from pairs of rhythmic MSN-NDB cells during cooling and/or atropine administration showed unchanged phase relations at the theta rhythm frequency. In rats in which the septohippocampal system was exposed by aspirating the overlying brain tissue, direct application of atropine (10 mg/ml) to the septal nuclei reversibly eliminated the hippocampal theta rhythm. 5. The rhythmic cells of the MSN-NDB are apparently composed of at least two distinct types, both of which potentially contribute to the production of the theta rhythm in the hippocampus. Elimination of hippocampal theta rhythm after local septal atropine application suggests that the loss of rhythmic activity in the group of atropine-sensitive septal cells is sufficient for the elimination of the theta rhythm. A model of the septohippocampal connections necessary for the theta rhythm is presented.

Hippocampal theta rhythm and the firing of neurons in walking and urethane anesthetized rats

Recordings were taken from single neurons in the hippocampus and dentate gyrus of rats during walking and urethane anesthesia. Firing histograms for these cells were constructed as a function of the phase of the concurrent extracellularly recorded hippocampal slow wave theta rhythm. Care was taken to be sure of the site of recording of the theta rhythm and its phase with respect to a reliable reference, so that comparisons of the phases of firing could be made across animals. The firing of most of these neurons is deeply modulated as a function of the phase of the theta rhythm. This is true whether the theta rhythm occurs during walking or during urethane anesthesia, but for some types of cells the mean phases of firing are different in the two types of theta rhythm. During walking, pyramidal cells and interneurons in all hippocampal subregions and dentate granule cells have a maximum probability of firing near the positive peak of the theta rhythm recorded in the outer molecular layer of the dentate (dentate theta). During urethane anesthesia, the maximum firing probability for interneurons in CA1 and for dentate granule cells occurs near the negative peak of the dentate theta, while the phases of maximum firing for pyramidal cells and interneurons in CA3 and CA4 become widely distributed. The phases of maximum firing of pyramidal cells in CA1 are, if anything, more narrowly distributed around the positive peak of the dentate theta during urethane anesthesia than during walking. These differences in the firing of hippocampal cells during walking and urethane anesthesia represent some of the differences in cellular mechanisms distinguishing two kinds of hippocampal theta rhythm.

Location of membrane conductance changes by analysis of the input impedance of neurons. II. Implementation

Mathematical modeling has shown that it should be possible to determine the electrotonic location of membrane conductance changes in single neurons by analysis of the associated changes in the magnitude of the alternating-current (AC) input impedance. The form of the plot of change in the magnitude of the input impedance as a function of frequency (delta [Zn(f)]) should differ for changes in membrane conductance located at different electrotonic distances from the recording/current-injection site. Due to the axial resistance and the membrane capacitance, the higher frequencies are attenuated with distance to a greater degree than are the lower frequencies. Thus delta [Zn(f)] should drop to zero more rapidly with increasing frequency for distal than for proximal conductance changes. For distal changes in conductance, the sign of the change in the magnitude of the input impedance can even reverse in the higher frequency range, so that increases in conductance would produce increases in impedance. This effect may explain the paradoxical increases in impedance at 100 Hz reported for motor neuron inhibitory postsynaptic potentials. Sine-wave impedance measurements were made in single embryonic chick spinal neurons in tissue culture, and gamma-aminobutyric acid (GABA) was iontophoretically applied alternately to the soma and to a neurite at a measured distance from the soma. The impedance changes produced by the GABA-induced conductance changes were consistent with the expectations from the mathematical modeling, but the results suggest that the axial resistance of the neurites must be quite high in some cases. Distortions due to microelectrode capacitance and stray capacitances in the input stage of single-electrode bridge amplifiers can make sine-wave impedance measurements impossible. This difficulty was eliminated by modifications to the capacity compensation circuit of an active bridge amplifier. Noise and distortion of several other types can also introduce serious errors. Methods for minimizing such problems are discussed. In spite of its limitations, this method can be of great practical value, because it can give the electrotonic location of spontaneously occurring membrane conductance changes in single neurons even when unitary synaptic potentials cannot be resolved. These methods are currently being applied to hippocampal pyramidal cells in vivo to locate conductance changes during the electroencephalogram (EEG) theta-rhythm in rats. In such laminated structures, the determination of the anatomical source of a group of active synapses can be aided by location of the resultant membrane conductance changes.

Location of membrane conductance changes by analysis of the input impedance of neurons. I. Theory

If the membrane conductance of a neuron changes, its response to injected current changes. If the change in membrane conductance is restricted to a given subregion of the neuron, that region can be located by analysis of the form of the change in the response of the neuron to current injection. The theoretical basis of this method is rigorously developed in this paper. Location of the membrane conductance change is possible because the higher-frequency components of the injected currents are progressively attenuated by the axial resistance and membrane capacitance of the neuron as they pass from the injection site to electrotonically more distant regions. For the lower-frequency components, this attenuation is less pronounced. Therefore, when a conductance change occurs relatively far from the recording/current-passing electrode, only the lower frequency components of the response are altered, because the higher-frequency components of the current do not even reach that site. When such a conductance change occurs relatively near the electrode, both the lower and the higher frequency components of the response are altered. Treating the neuron as a passive network, the input impedance at a given frequency is simply the voltage response of the neuron at that frequency divided by the current injected at that frequency. This is a complex value, having both magnitude and phase components. The change in the magnitude of the input impedance due to a conductance change occurring distally drops off more rapidly with increasing frequency than that due to a proximal conductance change. In addition, for distal conductance increases the magnitude of the input impedance can increase in the higher range of frequencies. This paradoxical effect is treated in APPENDIX I. For many neurons an estimate of the electrotonic location of a conductance change can be made knowing only the change in input resistance, the change in the magnitude of the input impedance at the characteristic frequency (omega 0 = 1/tau 0), and a reasonable estimate of the total electrotonic length of the neuron (L). The sensitivity of the method depends on the electrotonic length of the neuron. The method is most useful in neurons with dendritic trees longer than approximately 0.5 length constants. The dendritic-to-somatic conductance ratio of the neuron does not appreciably affect the forms of the responses. The time constant merely shifts the frequency range of interest.(ABSTRACT TRUNCATED AT 400 WORDS)

Hippocampal excitability related to the phase of theta rhythm in urethanized rats

Urethanized rats were studied to determine if excitability in the hippocampus is related to the phase of the theta rhythm. The responses recorded from area CA1 were clearly modulated at the theta frequency. Those recorded from the dentate region were not. The most excitable phase for CA1 differed significantly from that previously reported for walking rats. These findings suggested that the mechanisms for theta production differ for normal and urethanized rats.

Electrophysiological characteristics of hippocampal complex-spike cells and theta cells

Stimulating electrodes were chronically implanted in the ventral hippocampal commissure and the entorhinal cortex or angular bundle of rats. Moveable metal microelectrodes which could be passed through the hippocampus were implanted. All hippocampal units were classified s complex-spike cells or theta cells on the basis of the form of their action potentials and their rates of firing in various behaviors. Field potentials and unit firing evoked from the stimulating electrodes were recorded during slow wave sleep. Complex-spike cells (1) could often be antidromically activated in CA3 (it was not attempted in CA1); (2) could only be induced to fire one or two action potentials in response to a single stimulus; (3) had action potentials at the same time as the local population-spike and, in condition-test studies, were depressed when the population-spike was depressed. (The population-spike is presumably the summed synchronous action potentials of pyramidal cells.) Theta cells: (1) were antidromically activated in only one out of 25 cases; (2) usually could fire long bursts of action potentials in response to a sufficiently intense single stimulus; (3) this firing occurred before, during, and after the local orthodromic population-spike. Most complex-spike cells in Ammon's horn must be pyramidal cells (projection cells), and vice versa. The case for theta cells is more difficult. Some are non-pyramidal cells with locally ramifying axons, but at least some are projection cells. The data is consistent with most of them being inhibitory interneurons, but this is not established.