Cervical Contractions Research Articles

Variations of cervical head entrapment in vaginal breech births: New insights on how to prevent, manage and resolve

This paper presents a novel, systematic way to understand the causes of cervical head entrapment in vaginal breech births, and new insights into management. Three different types of cervical head entrapment are described, with detailed illustrations: unpredictable and potentially catastrophic, manageable, and preventable. The first affects preterm and growth-restricted fetuses. The second involves some degree of uterine prolapse. The third may result from prolonged head entrapment at the pelvic inlet, leaving time for cervical contraction or oedematous entrapment. Traditional and innovative strategies to resolve and prevent this complication are described and illustrated, with suggestions for further research.

Pregnancy state before the onset of labor: a holistic mechanical perspective

Successful pregnancy highly depends on the complex interaction between the uterine body, cervix, and fetal membrane. This interaction is synchronized, usually following a specific sequence in normal vaginal deliveries: (1) cervical ripening, (2) uterine contractions, and (3) rupture of fetal membrane. The complex interaction between the cervix, fetal membrane, and uterine contractions before the onset of labor is investigated using a complete third-trimester gravid model of the uterus, cervix, fetal membrane, and abdomen. Through a series of numerical simulations, we investigate the mechanical impact of (i) initial cervical shape, (ii) cervical stiffness, (iii) cervical contractions, and (iv) intrauterine pressure. The findings of this work reveal several key observations: (i) maximum principal stress values in the cervix decrease in more dilated, shorter, and softer cervices; (ii) reduced cervical stiffness produces increased cervical dilation, larger cervical opening, and decreased cervical length; (iii) the initial cervical shape impacts final cervical dimensions; (iv) cervical contractions increase the maximum principal stress values and change the stress distributions; (v) cervical contractions potentiate cervical shortening and dilation; (vi) larger intrauterine pressure (IUP) causes considerably larger stress values and cervical opening, larger dilation, and smaller cervical length; and (vii) the biaxial strength of the fetal membrane is only surpassed in the cases of the (1) shortest and most dilated initial cervical geometry and (2) larger IUP.

Do cypermethrin and fenvalerate disturb the function of the bovine cervix in vitro?

This study aimed to investigate the effect of pyrethroid insecticides on the regulation of bovine cervical function. Cervical cells or strips obtained from cows during the periovulation period were treated with cypermethrin and fenvalerate (0.1-10 ng/mL). None of the pyrethroids exerted a cytotoxic effect, whereas only fenvalerate increased the cervical contraction force and mRNA expression of receptor of oxytocin and prostaglandin (PG) synthases. Both pyrethroids inhibited PG secretion and decreased the amount of diacylglycerol, which is the second messenger involved in oxytocin signal transmission, and fenvalerate decreased the myosin light-chain kinase level. These findings indicate that fenvalerate induces greater disruption of cervical function than cypermethrin.

Intrathecal Injection of Ropivacaine Reduces Cervical Resistance in Late-Pregnant Rats.

PurposeNeuraxial (spinal and epidural) anesthesia is the cornerstone of ensuring the satisfaction rate of painless delivery; however, whether it prolongs the first stage of labor remains controversial. Although current clinical research results tend to be negative, the conclusions are not convincing due to the lack of basic research. This study was conducted to provide a theoretical reference for this controversy through basic research.Materials and MethodsA spinal anesthesia model was established by the intrathecal injection of 0.1% ropivacaine in late-pregnant rats (day 22). The cervical resistance test was used to measure the tension of different groups of isolated cervical tissues. Western blotting and cervical tissue cyclic AMP (cAMP) enzyme-linked immunosorbent assay were performed to clarify the possible related mechanisms.ResultsCervical resistance experiments showed that the intrathecal injection of ropivacaine decreased the cervical resistance, and norepinephrine injection reversed this effect. Western blotting showed that α2A adrenergic receptor (α2A-AR) levels gradually increased over time in pregnant rats. The cAMP enzyme-linked immunosorbent assay revealed that the intrathecal injection of norepinephrine reversed the increase in cervical tissue cAMP concentration caused by ropivacaine injection.ConclusionRopivacaine relaxes the cervix. Further, α2-AR may be involved in the process of cervical contraction.

Do commonly used herbicides (atrazine and glyphosate) have the potential to impair the contractions, prostaglandin releasing and conducting of oxytocin signal at the bovine cervix in vitro?

Glyphosate (Gly) and atrazine (Atr) are among the most commonly used herbicides in global agriculture. It was previously shown that both Atr and Gly impair the ovarian and uterine secretion of regulators of myometrial motility (oxytocin (OT) or prostaglandins (PGs)) in cows, and Atr can also decrease the force of contractions in strips from the uterine horn. Hence, the aim of this study was to compare the effects of Atr and Gly on the motor and secretory function of the bovine cervix in vitro as well as receptivity and signal transduction in cervical cell cultures.Cervical strips or cells obtained from cows before ovulation were treated with environmental doses of Atr or Gly (0.1–10 ng/ml) since these herbicides exerted no cytotoxic effect at a dose of 100 ng/ml. Only Atr increased the force of cervical contractions, while both Atr and Gly decreased the secretion of prostaglandins (PGs) without disturbing their synthesis. Moreover, Atr decreased the mRNA expression and protein level of oxytocin receptor (OTR), while Gly increased OTR protein levels. Both Atr and Gly decreased the contents of gap junction proteins (GAPs), Atr decreased the contents of second messengers (diacylglycerol - DAG, inositol-tris-phosphate - IP3), and Gly decreased the level of myosin light chain kinase (MLCK) but increased DAG levels.Atr directly enhanced the cervical strips contractions. Both herbicides disturbed cellular signalling and inhibited PGs secretion. It suggest that Atr and Gly have the potential to impair the activity of cervical cells in vitro, which might be followed by failure of maintenance with gestation.

Chloroorganic (DDT) and organophosphate (malathion) insecticides impair the motor function of the bovine cervix

Dichlorodiphenyltrichloroethane (DDT) is a representative organochlorine insecticide and a known endocrine disruptor. Malathion is an organophosphate insecticide and a next-generation pesticide. Previously, it was shown that oxytocin (OT) and prostaglandins (PGs) are involved in the mechanism of the adverse effect of DDT on bovine myometrial contractions. However, disruption of myometrial contractions without disruption of cervical activity may not be sufficient to cause preterm delivery. Hence, the aim of this study was to determine the effects of insecticides on the function of the bovine cervix at preovulation period. Bovine cervical cells or strips were treated with DDT or malathion (0.1–100 ng/ml), and neither DDT nor malathion (each at a dose of 100 ng/ml) affected the viability of cervical cells. Malathion (0.1–10 ng/ml) and the high doses of DDT (10 ng/ml) decreased the force of cervical contractions, in contrast to a low dose of DDT (0.1 ng/ml). Both insecticides also decreased the mRNA expression of the OT receptor and the level of the second messenger (inositol triphosphate, IP3). Moreover, DDT decreased the amount of other second messengers (diacylglycerol, DAG), while malathion decreased the amount of gap junction protein (GAP). Only malathion increased PGE2 and decreased PGF2α secretion, while neither insecticide had an effect on both prostaglandins synthesis. Both DDT and malathion impaired cervical contractions, secretory function and cellular signalling. It is also possible that malathion-mediated induction of locally produced PGE2 can be followed by cervical softening. Admittedly it was shown that DDT and malathion can evoke failures in the regulation of motor function of cervix during oestrus cycle, while their harmful effect on gestation can be also not excluded.

The Influence of Acupressure Li4 and Sp6 Techniques to the Endorphins Level And Progress of Labor in Period I Active Phase

Pain in labor is physiological because the pain comes from the cervical dilatation and uterine contractions that needed for labor (Potter & Perry, 2005). Research conducted by Brown, Douglas and Flood (2001) using 10 nonpharmacological methods performed on 46 people found that acupressure technique is the most effective technique to reduce pain during labor through the increased of endorphins and shorten the length of labor. The purpose of this study is to know the influence of acupressure method on endorphin levels and the progress of labor in the first period. This type of research is quantitative research by using quasi experiment design with pretest approach and posttest design with control group by performing acupressure on primipara maternal mother during period I active phase. The study was conducted at Bidan Praktik Mandiri. The population of this study is primipara mother inpartu period I active phase using Non Probability sampling technique with Consecutive Sampling. The results showed a significant difference in endorphin levels before and after receiving acupressure in the intervention group (p = 0.048) and there was a significant difference in the progress of labor before and after receiving acupressure in the intervention group (p = 0.001). Acupressure can be used as a routine care in every care of normal childbirth thus mother's care and baby care can be created well.

Guanfacine as an effective drug for the treatment of tic disorder. Case report

IntroductionA 15-year-old man who comes to the consultation referred from neurology for a poorly progressive tic disorder that is resistant to treatment. This is a patient with no relevant medical history. He has good academic performance, without symptoms of inattention, hyperactivity or impulsivity. He does not present buccophonatory ticsObjectivesTo Show guanfacine as a efficient treatment fot tics disorderMethodsCase reportResultsHe has presented complex motor tics as cervical contractions that have had to receive physiotherapeutic treatment. He also presents simple ocular tics. The patient at our evaluation is on a 4 mg dose of pimozide without response. He was previously on risperidone. It was decided to start treatment with guanfacine up to 5 mg with reduction of pimozide, to 1 mg. The patient with this dose adjustment shows a notable improvement in the frequency and intensity of the tics, both cervical and ocular. The patient also refers to a feeling of being calmer and being able to face stressful situations such as being exposed to social relationships, intervening more in class without increasing their anxiety levels.ConclusionsGuanfacine is a selective alpha-2a adrenergic receptor agonist that has an indication for attention deficit hyperactivity disorder. Like its precursor, clonidine, there is more and more literature that proposes this medication and others for ADHD as useful drugs in pathologies such as tic disorder. It has a safe use profile, which with progressive adjustment and hardly any side effects is placed as a treatment to take into account in this pathology.DisclosureNo significant relationships.

PENGARUH PEMBERIAN ISCHEMIC COMPRESSION DAN STRETCHING UNTUK MENGURANGI NYERI MYOFASCIAL TRIGGER POINT OTOT UPPER TRAPEZIUS PADA PEGAWAI KLAIM BPJS DI RUMAH SAKIT GRANDMED LUBUK PAKAM TAHUN 2020

Background: Myofascial Trigger point syndrome is a local pain trigger point characterized by irritation, inflammation, and swelling. The main problem is that when the emphasis is made, it creates a hypersensitive pain. Myofacial trigger point occured by adhesions, increase by malnutritions and oxygen to ischemic. The problems are pain on muscle cervical contraction and spasm, tenderness, tightness, stiffness, decrease muscle strength.Physiotherapy modalities that can be used for Myofascial Trigger point syndrome are Ischemic Compression and Stretching exercise. Objectives: The study aims to determine influence of Ischemic Compression and Stretching exercise in patients with the myofascial trigger point syndrome with pain of the Upper Trapezius muscle Trigger Point at the Grandmed Lubuk Pakam Hospital. Research method: uses quasi experiments with one group pre test and post test. Samples for this research are 20 respondents got Ischemic Compression and Stretching exercise intervention. Respondents divided into two variable, dependent variable got stretching and ischemic compression method and independent variable is measure for pain in myofascial trigger point syndrome. Results: Hypotheses test results with the Wilcoxon saigned rank test result obtained by P-value ≤ α (0.000 < 0.05). Mean of pain based on Numeric rating scale before intervention (pre test) is 4,60 and after interventiom (post test) is 2,00. Conclusion:According to experimental decisions, there is an influence Ischemic Compression and Stretching exercise to decrease pain in the Myofascial trigger point syndromeof the upper trapezius muscle trigger point at the Grandmed Lubuk Pakam Hospital.

About the expansion of the cervical contraction by plastic means

Prof. V. proposes a new operation for widening a narrow neck.

Partograph Utilization and Factors Associated with Poor Perinatal Outcomes in Wolaita Sodo University Referral Hospital, Southern Ethiopia

Background: Maternal deaths remain a major public health problem worldwide. The World Health Organization (WHO) has recommended the use of modified WHO partograph to monitor labour and delivery, in order to improve delivery care and reduce maternal and perinatal mortality rate. Objective: This study was aimed to assess utilization of partograph and factors associated with perinatal outcomes among women who delivered at wolaita sodo university teaching referral hospital. Methods: A facility based cross-sectional study was conducted from September 10_25, 2015 by conducting partograph review. A total of was 309 partographs were included in the study by using simple random sampling technique from the total frame of women who gave birth in the last one year and whose delivery was followed by partographs. A Pre-tested and structured checklist was used to collect data. Discriptive analysis was conducted and tables and graphs and summary statistics were used to depict data. Binary logistic regression analysis was conducted to check for variables that show association with neonatal outcomes at P value of 0.05. Finally, multiple logitic regression was conducted to identify factors independantely associated with fetal outcomes. Odds ratio with 95% Confidence interval was used to claim for statistical significance. Results: Out of 309 total of charts reviewed, only for 58%, 3.2% and 2% of mothers monitoring of fetal heart rate, liquor status and molding was done respectively. Labour parameters (cervical dilation, station and uterine contractions) were monitored to the standard in 155(50%), 12(3.9%) and 170(55%) respectively. Apgar score at 5 th minute was ≥7 in 268(86.7%) neonates and resuscitatation was done in 65(21%). 46(14.9%) of neonates were admitted to Neonatal Intensive Care Unit (NICU) for special. Most of the mothers 287(92.9%) had good outcome and only 22(7.1%) of them developed immediate adverse outcomes: There were significant association (p<0.05) between perinatal outcomes and factors like neonatal resuscitations, Apgar score at 1 st minute and liquor quality. Conclusion: This study showed poor quality of partogragh utilizations; despite good perinatal and immediate maternal outcomes. Hence, responsible departments and offices should be encouraged to ensure proper partograph utilization. Keywords : Perinatal outcome, parthograph, Wolaita sodo teaching and referral hospital DOI : 10.7176/JHMN/63-04 Publication date :June 30 th 2019

МОЖЛИВОСТІ ЛІКУВАННЯ ЗАГРОЗИ ПЕРЕДЧАСНИХ ПОЛОГІВ ПРИ БАГАТОПЛІДНІЙ ВАГІТНОСТІ З ВИКОРИСТАННЯМ СУБЛІНГВАЛЬНОЇ ФОРМИ МІКРОНІЗОВАНОГО ПРОГЕСТЕРОНУ

Мета дослідження – оцінити ефективність застосування сублінгвальної форми мікронізованого прогестерону (Лютеіна) у жінок із багатоплідною вагітністю з високим ризиком загрози передчасних пологів.Матеріали та методи. Обстежено 85 вагітних із двійнятами з ознаками невиношування у термінах 22–36 тижнів вагітності, котрі склали основну групу, сформовано дві підгрупи: Іа – 43 жінки, котрі отримували в комплексі лікування загрози передчасних пологів мікронізований прогестерон сублінгвально; підгрупа Іб – 42 вагітні, які не отримували під час лікування препарати прогестерону. Ретроспективно було проаналізовано 40 історій передчасних пологів при одноплідній вагітності (група порівняння). В основній групі було проведено загальноклінічне та біохімічне обстеження вагітних, визначення вмісту в сироватці крові АЛТ, АСТ, рівнів білірубіну та прогестерону. Проведений аналіз перебігу вагітності, пологів, післяпологового періоду та стану неонатальної адаптації новонароджених в обстежуваних вагітних.Результати дослідження та їх обговорення. Доведені основні чинники ризику розвитку передчасних пологів при багатоплідній вагітності, а також роль інфекційного анамнезу, даних трансвагінальної цервікометрії, неповного обстеження та несвоєчасного початку лікування загрози передчасних пологів, недостатньої профілактики ускладнень при багатоплідній вагітності. Динаміка вкорочення шийки матки була значно повільнішою у пацієнток Іа підгрупи, яким було призначено мікронізований прогестерон, це є ефективним методом профілактики та лікування невиношування у жінок із багатоплідною вагітністю, зниження частоти пізнього аборту та передчасних пологів, перинатальних втрат. Встановлено, що в жінок основної групи рівні АЛТ та АСТ, а також загального білірубіну не відхилялися від норми. Відмічено зниження рівня прогестерону в обох підгрупах. У вагітних Іа підгрупи на тлі лікування мікронізованим прогестероном відмічалося суттєве зростання рівня прогестерону у сироватці крові вже на 3-тю добу лікування до (1109±27) нмоль/л, а до кінця першого тижня лікування цей показник зростав до рівня (1280±39) нмоль/л, тоді як у Іб підгрупі його динаміка не змінювалась ((886±29) нмоль/л та, відповідно, (891±33) нмоль/л). Використання сублінгвальної форми мікронізованого прогестерону у період вираженої клінічної симптоматики загрози передчасних пологів при багатоплідній вагітності дозволяє отримати максимально швидкий терапевтичний ефект, що сприяє швидкому усуненню клінічних симптомів, регресу ультразвукових маркерів загрози переривання вагітності та запобігає подальшому прогресуванню структурних змін з боку шийки матки.Висновки. 1. При ознаках загрози передчасних пологів застосування сублінгвальної форми мікронізованого прогестерону дає можливість швидко відновити рівень прогестерону в сироватці крові до фізіологічних показників і тим самим знизити частоту передчасних пологів та покращити перинатальні наслідки у новонароджених. 2. Застосування сублінгвальної форми мікронізованого прогестерону у вагітних із загрозою передчасних пологів не впливає на функцію печінки. 3. Комплексна терапія загрози передчасних пологів із використанням мікронізованого прогестерону має високу ефективність терапевтичної дії та може бути рекомендована для широкого використання, сприяє коротшому періоду перебування в стаціонарі, зменшенню кількості ускладнень.

Ovulation and fertility responses for sows receiving once daily boar exposure after weaning and OvuGel® followed by a single fixed time post cervical artificial insemination

Boar exposure is used to stimulate follicle development and estrus in sows after weaning and also to improve semen uptake and sperm transport with insemination. However, the need and value of boar exposure is uncertain when ovulation induction is used. These studies were designed to determine the effect of daily boar exposure after weaning when used with ovulation induction and fixed time post-cervical artificial insemination (PCAI). In experiment 1, sows were weaned into stalls and assigned to receive 3 min of daily fenceline boar exposure (BE, n = 7) or no boar exposure (NBE, n = 8). All sows received OvuGel at 96 h after weaning and BE or NBE 30 min prior to a single PCAI 24 h after OvuGel. Ovaries were assessed daily for follicle size from weaning until ovulation. Cervical contractions were measured 30 min following BE or NBE and before PCAI, while uterine contractions were measured for 1 h following PCAI. In experiment 2, weaned sows (n = 244) were assigned by parity to receive once daily BE for 1.5 min each day or NBE. OvuGel, PCAI and ultrasound methods were performed similarly as in experiment 1. Results from experiment 1 indicated BE did not significantly influence follicle size or measures of fertility. However, BE did increase the frequency of cervical contractions (P < 0.05), but with no effect on the uterus. Results from experiment 2 indicated BE had no effect on catheter passage for PCAI but did increase the proportion of sows ovulating within 48 h after OvuGel (77.7 vs 67.5%, P = 0.05), and tended (P = 0.10) to increase the proportion of sows inseminated 24 h before ovulation (70.3 vs. 61.0%). However, BE had no effect on adjusted farrowing rate (84.4 vs. 77.4%) or total pigs born (13.2 vs. 12.5) for BE and NBE, respectively. There were treatment and parity interactions for follicle size at time of OvuGel and at time of PCAI (P < 0.05) with BE minimizing parity effects on follicle size. Parity effects were also evident on farrowing rate and litter size when inseminations occurred >24 h from ovulation but not when inseminations occurred ≤24 h before ovulation. The results indicate that boar exposure for only minutes each day after weaning had beneficial effects for improving follicle development, ovulation induction, and AI timing, most notably in parity 1 sows, but had no beneficial or detrimental effects on the ability to perform PCAI.

Predictors for prolonged interval from premature rupture of membranes to spontaneous onset of labor at term

Objective: To identify predictors for prolonged interval from premature rupture of membranes (PROM) to spontaneous onset of labor in women presenting with PROM and low Bishop score at term.Methods: A retrospective study of women presenting with PROM and Bishop score < 7 at term (≥37weeks) in a tertiary hospital (2013–14). Spontaneous onset of labor was defined as presence of regular uterine contractions and Bishop score ≥ 7. Women with interval from PROM to spontaneous onset of labor of <24hours (short interval group) were compared to those with interval ≥ 24 hours (prolonged interval group). Women who underwent induction of labor at < 24 hours from PROM were excluded.Results: Among 625 women who met inclusion criteria, 155 (24.8%) had a prolonged interval to onset of labor. In multivariate analysis, prolonged PROM was associated with (OR, 95%CI) cervical dilatation (0.35, 0.24–0.52, p < 0.001), effacement (0.97, 0.96–0.99, p < 0.001) and uterine contraction (0.51, 0.32–0.80, p = 0.004). A multivariable prediction model including maternal age, parity, cervical dilatation and effacement, gestational age and neonatal birthweight was associated with an AUC of receiver–operator characteristic curve of 0.739 (0.631–0.847, p < 0.001) for predicting prolonged PROM.Conclusion: Uterine contractions and cervical examination parameters can be used for prediction of prolonged interval to spontaneous onset of labor in women with term PROM.

Congenital midline cervical cleft: A retrospective case series of 8 children

ObjectivesCongenital midline cervical cleft is a rare developmental abnormality of the ventral neck of unclear etiology. It consists of a midline skin defect. This study reports a case series of 8 patients with congenital midline cervical cleft. MethodsRetrospective review chart including all children referred with congenital midline cervical cleft over 5 years in tertiary center. The study was conducted to determine the presence of associated malformations, to specify the cleft pathology, to analyze the nature of associated cysts, and to discuss surgical procedure. ResultsEight patients ranged from 3 days to 5 years. Two had an associated cervical midline cyst, 3 had a significant micrognatia. Pathological observations were in favor of a branchial origin. There was no recurrence of cervical contraction after a mean follow-up of 20 months. ConclusionCongenital midline cervical cleft is a rare and generally isolated congenital malformation. It does not require either extensive assessment or specific genetic. Described associated cysts might be part of the cleft and not bronchogenic or thyroglossal cysts. Early surgical excision reduces cervical contracture, but linear or Z-plasty closure is still debated.

Role of NO–cGMP pathway in ovine cervical relaxation induced by Erythroxylum caatingae Plowman

Erythroxylum caatingae Plowman has a myorelaxing effect on smooth muscle tissue. We investigated the effect of the crude ethanolic extract of E. caatingae Plowman (Ec-EtOH) on the contractility of the ovine cervix. In an isometric system, circular strips were subjected to 90mM potassium (K+) or 30μM carbamylcholine (CCh)-induced contraction. We then exposed the tissue to cumulative concentrations of Ec-EtOH (1–729μg/ml). In other bath solutions, the tissues were exposed to l-NG-nitroarginine methyl ester (l-NAME; 100μM), l-NAME (100μM)+l-arginine (300μM), 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, ODQ; 5μM), 4-aminopyridine (4-AP; 3mM), tetraethylammonium (TEA; 0.3mM), glybenclamide (1μM), atosiban (10μM) or verapamil (3μM), followed by the addition of Ec-EtOH (1–729μg/ml). We also evaluated the effect of cervical Ec-EtOH infusion (2mg) on cervical contractility in vivo. Ec-EtOH decreased cervical contractility induced by K+ or CCh, and 729μg/ml Ec-EtOH decreased 85.4±5.1% the amplitude of basal contractility in vitro, with an EC50 of 17.9±3.7μg/ml. This effect of Ec-EtOH was prevented by l-NAME or ODQ. l-arginine impaired the blunting effect of l-NAME on cervical relaxation caused by Ec-EtOH. However, the potassium channel blockers 4-AP, TEA, and glybenclamide did not modify this myorelaxation triggered by Ec-EtOH. Ec-EtOH also decreased acetylcholine-induced contractions in tissue preincubated with verapamil. In addition, Ec-EtOH decreased ovine cervical contractions in vivo. Thus, Ec-EtOH had a relaxant effect on ovine cervical contractions. This may involve the nitric oxide signal, mediated by cGMP cellular transduction, and be related to intracellular calcium sequestration.

Cervical Muscle Strength and Muscle Coactivation During Isometric Contractions in Patients With Migraine: A Cross-Sectional Study.

This cross-sectional study investigated potential differences in cervical musculature in groups of migraine headaches vs. non-headache controls. Differences in cervical muscle strength and antagonist coactivation during maximal isometric voluntary contraction (MIVC) were analyzed between individuals with migraine and non-headache subjects and relationships between force with migraine and neck pain clinical aspects. A customized hand-held dynamometer was used to assess cervical flexion, extension, and bilateral lateral flexion strength in subjects with episodic migraine (n=31), chronic migraine (n = 21) and healthy controls (n = 31). Surface electromyography (EMG) from sternocleidomastoid, anterior scalene, and splenius capitis muscles were recorded during MIVC to evaluate antagonist coactivation. Comparison of main outcomes among groups was conducted with one-way analysis of covariance with the presence of neck pain as covariable. Correlations between peak force and clinical variables were demonstrated by Spearman's coefficient. Chronic migraine subjects exhibited lower cervical extension force (mean diff. from controls: 4.4 N/kg; mean diff from episodic migraine: 3.7 N/kg; P = .006) and spent significantly more time to generate peak force during cervical flexion (mean diff. from controls: 0.5 seconds; P = .025) and left lateral-flexion (mean diff. from controls: 0.4 seconds; mean diff. from episodic migraine: 0.5 seconds; P = .007). Both migraine groups showed significantly higher antagonist muscle coactivity of the splenius capitis muscle (mean diff. from controls: 20%MIVC, P = .03) during cervical flexion relative to healthy controls. Cervical extension peak force was moderately associated with the migraine frequency (rs: -0.30, P = .034), neck pain frequency (rs: -0.26, P = .020), and neck pain intensity (rs: -0.27, P = .012). Patients with chronic migraine exhibit altered muscle performance, took longer to reach peak of force during some cervical movements, and had higher coactivation of the splenius capitis during maximal isometric cervical flexion contraction. Finally, patients with migraine reported the presence of neck and head pain complaints during maximal isometric voluntary cervical contractions.

Phasic contractions of the mouse vagina and cervix at different phases of the estrus cycle and during late pregnancy.

Background/AimsThe pacemaker mechanisms activating phasic contractions of vaginal and cervical smooth muscle remain poorly understood. Here, we investigate properties of pacemaking in vaginal and cervical tissues by determining whether: 1) functional pacemaking is dependent on the phase of the estrus cycle or pregnancy; 2) pacemaking involves Ca2+ release from sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA) -dependent intracellular Ca2+ stores; and 3) c-Kit and/or vimentin immunoreactive ICs have a role in pacemaking.Methodology/Principal FindingsVaginal and cervical contractions were measured in vitro, as was the distribution of c-Kit and vimentin positive interstitial cells (ICs). Cervical smooth muscle was spontaneously active in estrus and metestrus but quiescent during proestrus and diestrus. Vaginal smooth muscle was normally quiescent but exhibited phasic contractions in the presence of oxytocin or the K+ channel blocker tetraethylammonium (TEA) chloride. Spontaneous contractions in the cervix and TEA-induced phasic contractions in the vagina persisted in the presence of cyclopiazonic acid (CPA), a blocker of the SERCA that refills intracellular SR Ca2+ stores, but were inhibited in low Ca2+ solution or in the presence of nifedipine, an inhibitor of L-type Ca2+channels. ICs were found in small numbers in the mouse cervix but not in the vagina.Conclusions/SignificanceCervical smooth muscle strips taken from mice in estrus, metestrus or late pregnancy were generally spontaneously active. Vaginal smooth muscle strips were normally quiescent but could be induced to exhibit phasic contractions independent on phase of the estrus cycle or late pregnancy. Spontaneous cervical or TEA-induced vaginal phasic contractions were not mediated by ICs or intracellular Ca2+ stores. Given that vaginal smooth muscle is normally quiescent then it is likely that increases in hormones such as oxytocin, as might occur through sexual stimulation, enhance the effectiveness of such pacemaking until phasic contractile activity emerges.

The use of botulinum toxin in the treatment of the consequences of bruxism on cervical spine musculature

Hypertonia and hyperactivity of masticatory muscles are involved in pain and contractions of the cervical spine musculature, but their pathophysiology remains nonetheless unknown and its treatment far to be codified. In this study, 8 patients, showing disabling posterior neck muscle contractures linked with bruxism were prospectively treated and followed for an average 15 months period, after having received Injections of botulinum toxin A essentially in masticatory muscles. Injections were made every 3 months, varying from 10 to 100 U Botox* by muscles, without administrating more than 300 U Botox* in the same patient. The angle of cervical lordosis were calculated on lateral sitting radiographs in neutral position, good results being considered to be achieved in the case of a 2 point diminution of VAS score as well as at least a 5° positive gain in the curve. 7 patients out of 8 showed a real improvement in their symptoms after an average of 3 injections, showing a decrease of 4.5 points on the VAS score and an average increment of 15° in cervical lordosis. Although the follow-up period of patients was relatively short and the sample quite small, the general impression, confirmed by the patients' experience, seems to suggest a potential place for the use of botulinum toxin amongst the array of treatments which can be offered in certain selected cases which associate bruxism and posterior cervical contractions.

Muscular Aftereffects and the Maintenance of Balance in Healthy Subjects and Patients with Impaired Sensorimotor Integration

The vertical posture of patients with impaired sensorimotor integration was compared with that in healthy subjects before and after 30 sec of involuntary cervical muscle contraction. Studies were performed on seven patients with impaired sensorimotor integration. The movement trajectories of the center of mass were recorded for 30 sec in the standing position with the eyes open and closed and on foam rubber with the eyes open before and after involuntary contraction of the cervical muscles. The areas of oscillation of patients standing with the eyes open and on foam rubber were greater than those in healthy subjects, while the mean positions of the center of mass standing with the eyes open and closed were closer to the axis of the talocrural joints. Closing of the eyes had a smaller destabilizing effect on patients than on healthy subjects. Contraction of the cervical muscles for 30 sec in healthy subjects led to a backward displacement of the center of pressure toward the axis of the talocrural joints, especially on standing with the eyes open, along with a decrease in the length of the center of pressure curve, especially its frontal components, on standing on foam rubber. In patients, the aftereffects of involuntary cervical muscle contraction consisted of a reduction in the area of oscillations on foam rubber and a relative increase in frontal oscillations while standing with the eyes closed. These results lead to the conclusion that standing in patients with impaired sensorimotor integration was more sensitive to changes in proprioceptive than visual afferentation, while 30-sec involuntary cervical muscle contraction brought measures of vertical stability in patients closer to age-normal values.