Cortical Mechanisms of Human Pelvic Floor Muscle Synergies

The human pelvic floor is an anatomically, functionally, and morphologically complex region that is associated with many disorders such as chronic prostatitis/pelvic pain syndrome (CPPS), chronic low back pain, and urinary incontinence. The purpose of this dissertation was to explore the cortical mechanisms that underlie human pelvic floor muscle synergies. Our first original experiment involved the study of 20 healthy male controls who were instructed to perform a variety of muscle tasks presumed to be associated with pelvic floor muscle synergies. Surface electromyography (EMG) method was used to detect timing onsets, as well as activation patterns of the pelvic floor, gluteus maximus, and first dorsal interosseous muscles. Functional magnetic resonance imaging (fMRI) was used to measure blood oxygenation density levels (BOLD) in the brain while subjects performed various prime mover tasks. Our second original experiment involved another set of 10 healthy male subjects who were trained to perform a complex synergy breaking/decoupling task that was confirmed with EMG. They repeated the coupling motor task (gluteal activation) as well as the more complex motor decoupling task while being scanned with fMRI, so that BOLD signals could be compared. The first experiment revealed evidence of cortically facilitated synergy of the pelvic floor muscles and the second experiment revealed that complex motor tasks such as the breaking of a cortically facilitated muscle synergy involves BOLD signals in the brain known to be involved with interoception

Whole brain 7T-fMRI during pelvic floor muscle contraction in male subjects

Aim: The primary aim of this study is to demonstrate that 7-tesla functional magnetic resonance imaging (7T-fMRI) can visualize the neural representations of the male pelvic floor in the whole brain of a single subject. Methods: In total, 17 healthy male volunteers (age 20-47) were scanned in a 7T-MRI scanner (Philips Achieva). The scanning protocol consisted of two functional runs using a multiband echo planar imaging sequence and a T1-weighted scan. The subjects executed two motor tasks, one involving consecutive pelvic floor muscle contractions (PFMC) and a control task with tongue movements. Results: In single subjects, results of both tasks were visualized in the cortex, putamen, thalamus, and the cerebellum. Activation was seen during PFMC in the superomedial and inferolateral primary motor cortex (M1), supplementary motor area (SMA), insula, midcingulate gyrus (MCG), putamen, thalamus, and in the anterior and posterior lobes of the cerebellum. During tongue movement, activation was seen in the inferolateral M1, SMA, MCG, putamen, thalamus, and anterior and posterior lobes of the cerebellum. Tongue activation was found in the proximity of, but not overlapping with, the PFMC activation. Connectivity analysis demonstrated differences in neural networks involved in PFMC and tongue movement. Conclusion: This study demonstrated that 7T-fMRI can be used to visualize brain areas involved in pelvic floor control in the whole brain of single subjects and defined the specific brain areas involved in PFMC. Distinct differences between brain mechanisms controlling the pelvic floor and tongue movements were demonstrated using connectivity analysis

Bladder Dysfunction in the Context of the Bladder-Brain Connection

The aim of the thesis "Bladder dysfunction in the context of the bladder-brain connection" written by Ilse Groenendijk, was to investigate potential diagnostic tools in the field of functional urology. The first aim was to define the brain areas involved in LUT control in healthy individuals and to investigate the clinical applicability of dynamic brain imaging as a diagnostic tool of functional bladder disorders in individuals. The second aim was to evaluate and improve traditional and patient reported outcome measurements in the field of functional urology

A systematic review and activation likelihood estimation meta-Analysis of the central innervation of the lower urinary tract: Pelvic floor motor control and micturition

Purpose Functional neuroimaging is a powerful and versatile tool to investigate central lower urinary tract (LUT) control. Despite the increasing body of literature there is a lack of comprehensive overviews on LUT control. Thus, we aimed to execute a coordinate based meta-Analysis of all PET and fMRI evidence on descending central LUT control, i.e. pelvic floor muscle contraction (PFMC) and micturition. Materials and methods A systematic literature search of all relevant libraries was performed in August 2020. Coordinates of activity were extracted from eligible studies to perform an activation likelihood estimation (ALE) using a threshold of uncorrected p 0.001. Results 20 of 6858 identified studies, published between 1997 and 2020, were included. Twelve studies investigated PFMC (1xPET, 11xfMRI) and eight micturition (3xPET, 5xfMRI). The PFMC ALE analysis (n = 181, 133 foci) showed clusters in the primary motor cortex, supplementary motor cortex, cingulate gyrus, frontal gyrus, thalamus, supramarginal gyrus, and cerebellum. The micturition ALE analysis (n = 107, 98 foci) showed active clusters in the dorsal pons, including the pontine micturition center, the periaqueductal gray, cingulate gyrus, frontal gyrus, insula and ventral pons. Overlap of PFMC and micturition was found in the cingulate gyrus and thalamus. Conclusions For the first time the involved core brain areas of LUT motor control were determined using ALE. Furthermore, the involved brain areas for PFMC and micturition are partially distinct. Further neuroimaging studies are required to extend this ALE analysis and determine the differences between a healthy and a dysfunctional LUT. This requires standardization of protocols and task-execution

Supraspinal Control of Urine Storage and Micturition in Men—An fMRI Study

Despite the crucial role of the brain in the control of the human lower urinary tract, little is known about the supraspinal mechanisms regulating micturition. To investigate the central regulatory mechanisms activated during micturition initiation and actual micturition, we used an alternating sequence of micturition imitation/imagination, micturition initiation, and actual micturition in 22 healthy males undergoing functional magnetic resonance imaging. Subjects able to micturate (voiders) showed the most prominent supraspinal activity during the final phase of micturition initiation whereas actual micturition was associated with significantly less such activity. Initiation of micturition in voiders induced significant activity in the brainstem (periaqueductal gray, pons), insula, thalamus, prefrontal cortex, parietal operculum and cingulate cortex with significant functional connectivity between the forebrain and parietal operculum. Subjects unable to micturate (nonvoiders) showed less robust activation during initiation of micturition, with activity in the forebrain and brainstem particularly lacking. Our findings suggest that micturition is controlled by a specific supraspinal network which is essential for the voluntary initiation of micturition. Once this network triggers the bulbospinal micturition reflex via brainstem centers, micturition continues automatically without further supraspinal input. Unsuccessful micturition is characterized by a failure to activate the periaqueductal gray and pons during initiatio

Deuxième révision du "Code européen contre le cancer"

Le "Code européen contre le cancer" est une série de recommandations élaborées par les meilleurs spécialistes européens de l'épidémiologie et de la prévention du cancer. Créé originellement en 1987, il a été révisé une première fois en 1994. La version 2003 vient d'être publiée. Elle répond notamment à l'extension des types de risques de cancers, inhérente à l'accession à l'Union européenne de nouveaux Etats membres, qui présentent un degré élevé d'hétérogénéité par rapport aux pays fondateurs pour ce qui concerne le style de vie et les risques de cancers associés. Les contrastes entre pays méditerranéens, nordiques et ceux de l'Europe centrale et de l'Est sont en effet considérables. Aussi, quarante scientifiques représentant les pays de l'UE et deux la Suisse ont-ils collaboré pour réviser la version de 1994 et élaborer cette version 2003. [Auteur]]]> Neoplasms ; Practice Guidelines as Topic oai:serval.unil.ch:BIB_A77DC4E07EF8 2022-05-07T01:24:30Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_A77DC4E07EF8 Textbook with Explanations, Illustrations and Examples, SKV-Verlag Eberle, Reto info:eu-repo/semantics/other misc 2008 eng oai:serval.unil.ch:BIB_A77F4C79876C 2022-05-07T01:24:30Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_A77F4C79876C Prevalence of measured and reported multimorbidity in a representative sample of the Swiss population. info:doi:10.1186/s12889-015-1515-x info:eu-repo/semantics/altIdentifier/doi/10.1186/s12889-015-1515-x info:eu-repo/semantics/altIdentifier/pmid/25778214 Pache, B. Vollenweider, P. Waeber, G. Marques-Vidal, P. info:eu-repo/semantics/article article 2015 Bmc Public Health, vol. 15, no. 1, pp. 1515 info:eu-repo/semantics/altIdentifier/eissn/1471-2458 urn:issn:1471-2458 <![CDATA[BACKGROUND: Little is known on the prevalence of multimorbidity (MM) in the general population. We aimed to assess the prevalence of MM using measured or self-reported data in the Swiss population. METHODS: Cross-sectional, population-based study conducted between 2003 and 2006 in the city of Lausanne, Switzerland, and including 3714 participants (1967 women) aged 35 to 75 years. Clinical evaluation was conducted by thoroughly trained nurses or medical assistants and the psychiatric evaluation by psychologists or psychiatrists. For psychiatric conditions, two definitions were used: either based on the participant's statements, or on psychiatric evaluation. MM was defined as presenting ≥2 morbidities out of a list of 27 (self-reported - definition A, or measured - definition B) or as the Functional Comorbidity Index (FCI) using measured data - definition C. RESULTS: The overall prevalence and (95% confidence interval) of MM was 34.8% (33.3%-36.4%), 56.3% (54.6%-57.9%) and 22.7% (21.4%-24.1%) for definitions A, B and C, respectively. Prevalence of MM was higher in women (40.2%, 61.7% and 27.1% for definitions A, B and C, respectively, vs. 28.7%, 50.1% and 17.9% in men, p &lt; 0.001); Swiss nationals (37.1%, 58.8% and 24.8% for definitions A, B and C, respectively, vs. 31.4%, 52.3% and 19.7% in foreigners, all p &lt; 0.001); elderly (&gt;65 years: 67.0%, 70.0% and 36.7% for definitions A, B and C, respectively, vs. 23.6%, 50.2% and 13.8% for participants &lt;45 years, p &lt; 0.001); participants with lower educational level; former smokers and obese participants. Multivariate analysis confirmed most of these associations: odds ratio (95% Confidence interval) 0.55 (0.47-0.64), 0.61 (0.53-0.71) and 0.51 (0.42-0.61) for men relative to women for definitions A, B and C, respectively; 1.27 (1.09-1.49), 1.29 (1.11-1.49) and 1.41 (1.17-1.71) for Swiss nationals relative to foreigners, for definitions A, B and C, respectively. Conversely, no difference was found for educational level for definitions A and B and abdominally obese participants for all definitions. CONCLUSIONS: Prevalence of MM is high in the Lausanne population, and varies according to the definition or the data collection method

Kortikale Repräsentationen der Beckenboden- und Beinmuskulatur: eine fMRT-Studie

Ziel dieser fMRT-Studie war es, die Repräsentationen der willkürlich steuerbaren Muskeln des Beckenbodens und verschiedener Beinregionen in den motorischen Kortizes vergleichend darzustellen. Achtzehn gesunde männliche Probanden führten wiederholt willkürliche Kontraktionen des Beckenbodens und verschiedener Abschnitte der Beinmuskulatur durch. Die Aufgaben fanden in festem Wechsel von Aktivierungs- und Ruhebedingungen (Blockdesign) in einem 3 Tesla MRT statt. Zur statistischen Auswertung der Bilddaten wurde die Software SPM verwendet (Statistical Parametric Mapping, Wellcome Department of Neuroscience, London). Die während Beckenbodenkontraktionen gemessenen signifikanten Signale ließen sich, nahe des Interhemisphärenspalts, dem supplementär-motorischen Areal (SMA) und zingulär-motorischen Areal (ZMA), und weiter lateral den ventralen prämotorischen Kortizes zuordnen. Bei Kontraktionen der Beinmuskeln fand sich Aktivität im SMA, ZMA und dem primär motorischen Kortex mit Schwerpunkten in der kontralateralen Hemisphäre; zusätzlich waren lateral prämotorische und posterior parietale Kortexgebiete aktiv. Es ergab sich keine eindeutige somatotopische Anordnung der Schwerpunkte der Aktivierungen, die bei Kontraktionen der Bein- und Beckenbodenmuskeln in den motorischen Kortizes parasagittal, nahe der Mittellinie, auftraten Diese Ergebnisse stehen im Einklang mit anderen Untersuchungen, die eine Überschneidung der motorischen Repräsentationsgebiete einzelner Abschnitte der unteren Extremitäten im motorischen Kortex beschreiben. Eine Erklärung für gemeinsame Aktivierungsgebiete des Beckenbodens und der Beinregionen könnten funktionelle Synergien des Beckenbodens bei Anspannungen der Beinmuskulatur darstellen, die der Sicherung der Harnkontinenz und der Lage der Beckenorgane dienen. Die motorische Repräsentation des Beckenbodens konnte in dieser Arbeit als medial der Mantelkante und vornehmlich im supplementär-motorischen Areal lokalisiert beschrieben werden

Applications of EMG in Clinical and Sports Medicine

This second of two volumes on EMG (Electromyography) covers a wide range of clinical applications, as a complement to the methods discussed in volume 1. Topics range from gait and vibration analysis, through posture and falls prevention, to biofeedback in the treatment of neurologic swallowing impairment. The volume includes sections on back care, sports and performance medicine, gynecology/urology and orofacial function. Authors describe the procedures for their experimental studies with detailed and clear illustrations and references to the literature. The limitations of SEMG measures and methods for careful analysis are discussed. This broad compilation of articles discussing the use of EMG in both clinical and research applications demonstrates the utility of the method as a tool in a wide variety of disciplines and clinical fields

Implicit Motor Imagery for Chronic Pelvic Pain: A Cross-Sectional Case–Control Study

Abstract: Implicit motor imagery (IMI), with an image laterality discrimination (LD) task, has been proposed as a useful therapeutic tool to restore body schema in patients with chronic pelvic pain (CPP). The aim of this study was to analyse the existence of differences between patients with CPP and healthy individuals in order to justify the use of IMI. An observational, cross-sectional study with non-probabilistic sampling was designed as a one-to-one matched case–control study. Through a web link designed for this purpose, a total of 40 abdominoperineal images were shown to 130 participants during the laterality task. Outcome measures were pain intensity (visual analogue scale, VAS), accuracy, response time (RT), and CPPQ-Mohedo score (Chronic Pelvic Pain Questionnaire—Mohedo). This was an observational, cross-sectional study with a total of 64 CPP patients and 66 healthy individuals. The comparative analysis between groups revealed significant differences in accuracy, CPPQ-Mohedo and VAS (p < 0.001), but not in RT; in patients with CPP, accuracy was correlated with a lower CPPQ-Mohedo score and RT and, the greater the pain intensity, the higher the CPPQ-Mohedo score and RT, and the lower the accuracy. In the LD task, the patients with CPP made more mistakes than the healthy individuals. IMI could be a useful and complementary tool in the therapeutic approach for patients with CP