Mechanisms of fatigue in normal intercostal muscle and muscle from patients with myasthenia gravis

Fatigue mechanisms in normal intercostal muscle and muscle from patients with myasthenia gravis (MG) were evaluated by monitoring the compound muscle action potential (CMAP) and tetanic tension responses to repetitive nerve or muscle stimulation in vitro. When fatigue was induced by nerve stimulation at 30 Hz for 0.5 s every 2.5 s, about half of the original tension decreased after 30 min in normal muscle and 5 min in MG muscle. Analysis of the changes in area of CMAPs and tension indicated that impairment of neuromuscular transmission, muscle membrane excitation, and excitation-contraction (E-C) coupling and contractility accounted for 40%, 29%, and 31% of fatigue in normal muscle, and 83%, 0%, and 17% of fatigue in MG muscle. When fatigue was induced by muscle stimulation at 30 Hz, tension declined by a quarter after 30 min in normal muscle, but by a half after 17 min in MG muscle. Impairment of muscle membrane excitation and E-C coupling and contractility accounted for 58% and 42% of fatigue in normal muscle, and 22% and 78% of fatigue in MG muscle. Thus, fatigue of normal muscle is caused by impairment of at least four processes, and enhanced fatigue of MG muscle is caused by greater impairment of neuromuscular transmission, E-C coupling, and contractility. © 1993 John Wiley & Sons, Inc.     

Possible mechanisms related to contraction of the bovine iris sphincter in the presence of acetylcholine and carbachol

Using tension-recording methods, we compared the effects of acetylcholine (Ach) and carbachol on the bovine iris sphincter. The isolated muscle strips were mounted in a 0.2 ml organ bath, through which Krebs solution at 36 °C flowed continuously. There was a tenthousandfold difference in potency between carbachol and Ach in this tissue. Neostigmine or eserine, acetylcholinesterase (AchE) inhibitors, produced a larger contraction of the muscle than did Ach. Ach-induced contractions were potentiated by low doses of anti-AchEs and were inhibited by atropine.This in vitro study suggests that Ach and/or endogenous chemical agents may be spontaneously released from tissues and that AchE activities in this tissue strongly inhibit or mask the Ach action, probably in order to protect the nerve terminals from released Ach.     

Na+ currents near and away from endplates on human fast and slow twitch muscle fibers

Fast and slow twitch muscle fibers have distinct contractile properties. Here we determined that membrane excitability also varies with fiber type. Na⁺ currents (I_NA) were studied with the loose-patch voltage clamp technique on 29 histochemically classified human intercostal skeletal muscle fibers at the endplate border and <200 μm from the endplate (extrajunctional). Fast and slow twitch fibers showed slow inactivation of endplate border and extrajunctional I_NA and had increased I_NA at the endplate border compared to extrajunctional membrane. The voltage dependencies of I_NA were similar on the endplate border and extrajunctional membrane, which suggests thatboth regions have physiclogically similar channels. Fast twitch fibers had larger I_NA on the endplate border and extrajunctional membrane and manifest fast and slow inactivation of I_NA at more negative potentials than slow twitch fibers. For normal muscle, the differences between I_NA on fast and slow twitch fibers might: (1) enable fast twitch fibers to operate at high firing frequencies for brief periods; and (2) enable slow twitch fibers to operate at low firing frequencies for prolonged times. Disorders of skeletal membrane excitability, such as the periodic paralyses and myotonias, may impact fast and slow twitch fibers differently due to the distinctive Na⁺ channel properties of each fiber type. © 1993 John Wiley & Sons, Inc.     

带蚓状肌的游离足趾再造拇、手指

自１９７２年以来，在游离足趾再造拇、手指手术中，应用足趾蚓状肌与缺损拇、手指蚓状肌残端或关节囊进行缝合的方法共完成手术３００例，由于再造拇、手指的蚓状肌得到修复，既改善了其指间关节屈曲畸形，又防止了掌指关节的过伸。术后随访１－２２年，再造拇、手指的外形及功能均满意。     

Role of Papillary Muscle Dysfunction in the Pathogenesis of Mitral Regurgitation in Myocardial Infarction:

To elucidate the pathogenesis of mitral regurgitation (MR) after myocardial infarction (MI), the incidence of papillary muscle dysfunction (PMD), mitral annular size, and the extent of wall-motion abnormalities were examined in 81 patients with previous MI by two-dimensional echocardiography and real-time two-dimensional Doppler flow imaging. The prevalence of pathological MR was lower in patients with anterior MI (36%) than in those with inferior (65%) or anterior and inferior MI (88%) (P < 0.01 vs anterior MI group). The incidence of PMD in patients with MR in the anterior MI group (15%) was lower than that in the inferior (50%, P < 0.01) or anterior and inferior MI group (43%, P < 0.05). The mitral annular dimension in patients with MR was significantly greater than in those without MR, but it was similar among the three groups. The extent of wall-motion abnormality correlated significantly with the area of MR jet in the anterior MI group (y = 3.1x + 15.5, r = 0.52, P < 0.01) and in the inferior MI group (y = 8.3x + 32.7, r = 0.57, P < 0.01). However, the slope of this relationship was significantly steeper in the inferior MI group than in the anterior MI group (P < 0.05). These results indicated that the degree of MR with inferior MI was greater than with anterior MI for a given MI area. PMD may play an important role in the higher prevalence and greater degree of MR in inferior MI.     

Asymptomatic autoimmune chronic active hepatitis in a male adolescent

We report a 12-year-old boy presenting with smooth muscle antibody-positive auto-immune chronic active hepatitis. Suspicion of the diagnosis arose after a routine blood test which revealed abnormal liver function tests. In spite of the presence of cirrhosis and patchy necrosis on liver biopsy, our patient never showed any clinical feature of impaired liver function. This observation demonstrates that auto-immune hepatitis may exist for a long time before clinical symptoms appear and probably explains why some cases of auto-immune hepatitis finally present as fulminant liver failure.     

细胞内钙信号的变化调节血管平滑肌细胞增殖

目的探讨细胞内钙信号的变化对大鼠血管平滑肌细胞(VSMC)增殖作用的影响及其对细胞内信号转导机制的变化。方法以培养的大鼠VSMC为模型,用雷尼丁(RY)剌激VSMC内贮Ca2 释放入胞浆,用3H亮氨酸及3H胸腺嘧啶掺入量作为反应VSMC增殖的指标,加入不同的细胞内信号转导阻断剂,观察对RY效应的影响。结果与对照组相比,RY浓度依赖性地促进细胞内游离钙浓度的增高,差异显著(P<0.05或0.01)。RY剌激组蛋白核酸合成速率明显增高,与对照组相比差异显著(P<0.01);尼卡地平(Nicardipine),蛋白激酶C抑制剂(H7),钙调素激酶(CaMPK)抑制剂(W7)和丝裂素活化蛋白激酶(MAPK)抑制剂(PD98059)能明显抑制RY介导的VSMC蛋白核酸合成速率增高,与RY剌激组相比差异显著(P<0.01)。结论细胞内钙信号的变化明显促进VSMC增殖,但其效应可能通过Ca2 、PKC、MAPK来介导。钙离子拮抗剂可抑制血管平滑肌细胞增殖。     

An unusual neck lump: intramuscular haemangioma of the sternocleidomastoid muscle

Neck lumps can often present a diagnostic dilemma, with a wide pre-operative differential diagnosis. We present an unusual case of an intramuscular haemangioma arising in the sternocleidomastoid muscle. Pre operative diagnosis is often difficult, as these lesions are extremely rare in the head and neck region and only few sporadic cases have been reported in the literature. We report the presentation diagnosis and management of intramuscular haemangiomas of the sternocleidomastoid muscle.     

Posterior Acromioclavicular Dislocation with Clavicular Fracture and Trapezius Entrapment

AbstractBackground: Posterior acromioclavicular dislocation is rare. Dislocation associated with fracture of the clavicle and simultaneous entrapment of the lateral end of the clavicle by trapezius muscle has not been reported. Posterior dislocation occurs frequently owing to forceful move of the scapula anteriorly and superiorly or from direct force applied to the lateral end of the clavicle and this may be associated with clavicular fracture. In acute dislocations, open reduction, internal joint stabilization and soft tissues reconstruction have been recommended.Case Study: Acute posterior dislocation occurred in a 32-year-old man. The lateral end of the clavicle was displaced posteriorly and inferiorly, and firmly entrapped in trapezius muscle. The clavicular fracture was undisplaced. The coracoclavicular ligaments were stretched but intact. Open reduction was secured with two smooth Kirschner wires. The disrupted soft tissues were repaired. The clavicular fracture was not explored. Shoulder movement started at 6 weeks. Wires were removed. 10 years later he had pain-free, unrestricted shoulder movement, and the radiographs showed wellreduced, essentially normal acromioclavicular joint.Conclusion: Open reduction, internal joint stabilization and soft tissue reconstruction will result in return and long lasting unrestricted pain-free function of the shoulder.     

握力大小与前臂肌肉表面肌电活动模式的相关性研究

目的 研究手部握力大小与前臂肌肉表面肌电信号特征的相关性.方法 9名健康被试者参加了试验,包括最大自主收缩力(maximum volunteer contraction,MVC),80% MVC及40% MVC,记录指浅屈肌和腕长伸肌的表面肌电信号,并采用均方根和小波分析方法提取其特征参数;运用SPSS软件统计以被试者自身的MVC为基准的不同握力水平的相对特征值,使不同的被试者具有可比性.结果 对于单个被试者握力水平与表面肌电活动模式存在正相关性,即握力越大则对应的表面肌电信号的特征值也越大;对于所有的被试者这种正相关性也存在.结论 握力水平与肌肉活动模式具有相关性,这提示通过表面肌电信号的特征值不但可以预测握力的大小,还可用于运动功能测试及康复的评价.