The anatomical myofascial continuum between the neck and eyes.

The posterior myofascial chain (PMC) or superficial back line encompasses a series of muscles interlinked by the deep fascia, extending from the foot to the fascial sheath of the eyeball. The deep cervical fascia of the neck, the epicranial aponeurosis of the head, and the fascial sheath of eyeball, form the proximal PMC. Although the literature has reported an anatomical myofascial continuum between the neck, head, and eyes, the anatomical descriptions vary substantially. Moreover, there is still no plausible functional interrelationship between the proximal structural myofascial links. Chronic neck pain is usually associated with a plethora of symptoms including craniofacial pain and oculomotor disorders. Understanding the anatomy of the proximal myofascial chain could help clinicians improvise treatment strategies for managing such painful head and neck disorders.

The plausible role of Deep Cervical Fascia and its continuum in chronic craniofacial and Cervicobrachial Pain: A case report.

BACKGROUND: The painful conditions of the Upper quarter region (UQR) such as chronic Craniofacial Pain (CFP) and Cervicobrachial Pain (CBP) usually occur with a plethora of symptoms. Although biological and psychosocial factors are attributed to such conditions, the involvement of the Deep Cervical Fascia (DCF) is ambiguous and needs further exploration. OBJECTIVE: We reported a case of CFP and CBP with an intent to showcase the possible involvement of impaired DCF in such presentations and to explore the short-term effect of Fascia directed approach (Fascial Manipulation). METHODS: This is a report of a 25-year-old female college student with chronic head, temporomandibular, neck, and arm pain over the past four years with acute pain exacerbation. After identifying the densified Centre of Coordination points along the myofascial continuum of the DCF, Fascial Manipulation (FM) was performed by deep manual friction. The patient-reported outcomes such as the Numerical Pain Rating Scale (NPRS), Temporomandibular disability index (TMDI), and Patient-Specific Functional Scale (PSFS) were assessed. RESULTS: Following FM treatment, there is a reduction in pain and improved function between the baseline and follow up evaluation after one week based on all the outcomes (NPRS, PSFS, and TMDI). CONCLUSION: This case report highlights the possible role of dysfunction of the DCF and the importance of assessing myofascial chains in patients with pain in the UQR. The report has also shown that FM may be beneficial and can be considered an adjunct in the rehabilitation of chronic CFP and CBP. Nevertheless, future studies with multiple sessions and follow-ups are imperative.

Probing the Limits of Supramolecular G-Quadruplexes Using Atomistic Molecular Dynamics Simulations.

Guanosine and related derivatives self-assemble in the presence of cations like potassium into supramolecular G-quadruplexes (SGQs), where four guanine moieties form planar tetrads (T) that coaxially stack into columnar aggregates with broad size distributions. However, SGQs made from 8-aryl-2'-deoxyguanosine derivatives (8ArGs), form mostly octamers, or two-tetrad (2T)-SGQs, while some form dodecamers (3T-SGQs), or hexadecamers (4T-SGQs), and none reported to date form higher assemblies. A theoretical model that addresses the configurational space available for the multiple pathways available for 8ArGs to self-assemble into SGQs is used to frame a series of molecular dynamics simulations (MDS) with selected SGQs. Some key insights from this work include: (a) The predicted entropic costs are not significantly higher for SGQs with more subunits due to their hierarchical assembly pathways; (b) The multiple isomeric SGQs vary in the interfacial contacts between consecutive tetrads, due to their two distinct sides (head, h; tail, t), with the MDS supporting the predicted order of stability of hh > ht > tt for octamers. (c) Such order also applies to dodecamers and hexadecamers, but with context-dependent exceptions due to strong allosteric effects. (d) The main factor disfavoring the tt interface is the repulsive dipolar interactions between the O4' from ribose moieties on adjacent tetrads. (e) SGQs with 5 or more tetrads are disfavored because the attractive interactions are not large or strong enough to overcome the many repulsive forces resulting from the addition of further tetrads. We expect these findings provide some guidelines to enable the further development of SGQs into functional materials.