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PubMed2003

[Restoration of elbow joint flexion by transfer of the pectoralis major muscle in patients with arthrogryposis multiplex congenita. Part II. Results of electromyographic and histologic examinations].

PURPOSE OF THE STUDY: In the framework of a prospective study on transposition of the m. pectoralis major according to Clark in patients with type I arthrogryposis multiplex congenita, electromyography was carried out in order to determine pre-operative states of the elbow joint flexors and m. pectoralis major and then the post-operative electric activity of a transposed muscle and to correlate changes with clinical findings. Histological examination was performed to reveal changes in muscle morphology and to complete a comprehensive assessment of muscle transposition. MATERIAL AND METHODS: Electromyography was carried out on nine upper limbs of five pediatric patients aged 4.3 to 8.9 years. Using a needle electrode, activities of the elbow flexors (m. biceps and m. brachialis), m. pectoralis major, m. triceps brachii and m. deltoideus were examined. In the post-operative period, activity was repeatedly measured in both the transposed and non-transposed parts of the m. pectoralis major. In one patient, histological examination of muscle tissue was performed at 26 months after transposition; light microscopy of paraffin-mounted sections stained with hematoxylin-eosin was used. RESULTS: Out of seven arms examined by electromyography before muscle transfer, six showed complete and one incomplete atrophy of the m. biceps brachii and m. brachialis. The m. pectoralis major had a five- to four-degree electric activity, which provided enough strength for transposition. Post-operative examination revealed changes leading to re-innervation of the transposed muscle, which corresponded to a partial denervation of the muscle followed by repair of innervation. None of the muscles was markedly atrophic due to denervation. In muscles with a higher electric activity, clinical outcomes were better, although electric activity always slightly exceeded clinical activity. In terms of electric activity, the transposed muscle was stabilized a year after surgery. Non-transposed parts of the muscle were not damaged by the surgical procedure, as shown by electromyography. Histological examination showed the muscle at a state of partial atrophy but with signs of ongoing regeneration of muscle fibers. DISCUSSION: No data on examination of the electric activity of the m. pectoralis major following its transposition in patients with arthrogryposis multiplex congenita have been reported in the literature. Electromyography in this study proved useful for providing information on the electric activity of a muscle before transposition and on contractility of the muscle after surgery; it also allowed us to distinguish between a mechanical failure of transfer and muscle atrophy due to neurogenic or vascular causes. All transposed muscles that were examined revealed changes indicating a minimum denervation followed by re-innervation. This finding was confirmed by the results of histological examination. CONCLUSIONS: Electromyography showed that the electric activity of a transposed muscle corresponded to the clinical presentation of this muscle and thus became an indispensable part of both pre- and post-operative examination. Both electromyographic and histological examination confirmed the applicability of the treatment described here.

Arthrogryposis↗
PubMed1983

Ultrastructural localization of M-band proteins in chicken breast muscle as revealed by combined immunocytochemistry and ultramicrotomy.

Cryo-ultramicrotomy and "conventional" plastic sectioning have been used in combination with extraction and immunolabeling techniques to determine the location of the two M-band proteins characterized to date, MM-creatine kinase (MM-CK: Mr, 80,000) and M-protein "myomesin" (Mr, 165,000) within the M-region of chicken pectoralis muscle. The following main results were obtained. (1) The M-band in chicken pectoralis muscle contains five major striations (M1, M4 and M4', M6 and M6' in the terminology of Sjöström & Squire, 1977a). (2) Extraction of the bulk of the electron-dense M-band with low ionic strength removes the M-striations M1, M4 and M4' while M6 and M6' are retained. Cross-sections through the M-region of such muscles lack primary M-bridges connecting the thick myosin filaments. (3) Labeling with antibodies against MM-CK enhances the M-striations M4 and M4'; sometimes the whole region between M4 and M4' is labeled. (4) Incubation with antibodies against myomesin results in the labeling of the whole M-band from M6 to M6'; no label is found in the rest of the bare zone outside M6 and M6'. (5) Incubation of low ionic strength extracted muscle fibers with antibodies against myomesin leads to an "incomplete" labeling of the M-band between M6 and M6'; lines M6 and M6' are sometimes seen to be enhanced presumably due to antibody labeling. From these results it is concluded that MM-CK is the major protein of the M4 and M4' (and possibly also of the M1) M-bridges. Myomesin is bound within the M-band along the thick filaments from M6 to M6'. Two hypothetical models for the possible location of myomesin are discussed. According to these models myomesin would either make up the M-filaments or be directly attached to and along the central bare zone of thick myosin filaments.

Animals↗
PubMed1983

Assembly and kinetic properties of myosin light chain isozymes from fast skeletal muscle.

Myosin from chicken pectoralis muscle consists of isozymes that differ in their alkali light chains. It is possible to isolate alkali 1 (A1) and alkali 2 (A2) homodimers of native myosin by immunoadsorption methods, and to compare their steady-state kinetics as well as their assembly into synthetic filaments under a variety of ionic conditions. Bipolar filaments of the isozymes formed at low salt concentrations had a narrow length distribution and did not differ from controls made from unfractionated myosin. Chicken myosin also assembles into highly homogeneous minifilaments similar to those formed by rabbit myosin in a citrate/Tris buffer. Analytical ultracentrifugation and electron microscopy showed that A1-homodimer, A2-homodimer and unfractionated myosin assembled into 0.3 micron short, bipolar minifilaments, which were indistinguishable from one another in size and shape. The steady-state myosin ATPase activity of the two homodimeric isozymes was identical in K+(EDTA) and Ca2+ assay media. The actomyosin Mg2+ ATPase measured at 25 and 55 mM-KCl (pH 8.0) showed only minor differences in both Vmax and Kapp. Actomyosin activity was also determined for the more homogeneous minifilament preparations of the isozymes and these, as well, produced essentially indistinguishable kinetic parameters. Thus we find no evidence to support the hypothesis that a particular alkali light chain of myosin can affect either the structure of the filaments or the steady-state rate of ATP hydrolysis.

Actomyosin↗
PubMed2004

Mitochondria and blood supply of chicken skeletal muscle fibers in ontogenesis.

Skeletal muscles have been studied during ontogenesis to reveal morphological and functional parameters that at most influence the formation of muscles with different levels of oxygen consumption. Development of oxidative red gastrocnemius muscle (RGM) and glycolytic white pectoralis muscle (WPM) has been studied at a period from being 10-day-old chicken embryos until they become 6-month-old chickens. By morphometry, we measured diameter, length, and numerical density of capillaries; muscle fibers diameter; as well as mitochondria's size, density, and volume fraction in muscle fibers. During the post-embryonic period, the blood flow was estimated by hydrogen clearance method. The data obtained were compared to previously published data on O2 consumption rate in fibers being at the same stages of ontogenesis [Microvasc. Res. 60 (2000) 168]. As shown, relationships between the parameters in the muscles studied appear at different ages. They are described by exponential equations with varying slopes. Beginning with the middle stages of embryogenesis, the clear dependency is seen in both types of muscles between O2 consumption rate in a fiber and summarized perimeter of mitochondria at a fiber section. Capillary bed during embryonal period is superfluous. The clear dependency between capillary-to-fiber number ratio and oxygen consumption in fibers becomes apparent in chickens only 10 days after birth, when the fiber diameter amounts to 20 microm. Since that period, redistribution of mitochondria toward the periphery of a fiber takes place, being especially pronounced in RGM. The regularities found between oxygen delivery and consumption systems enable to search for the leading factors of specialization of skeletal muscles in accordance with the level of oxidative metabolism. These factors may be used for calculation and numerical simulation of the parameters of oxygen transport in skeletal muscles.

Animals↗
PubMed1990

Characterization of calsequestrin of avian skeletal muscle.

A calsequentrin (CS)-like glycoprotein is present in the sarcoplasmic reticulum (SR) of chicken pectoralis muscle, which displays unusual properties: it binds relatively low amounts of Ca2+, compared to CS in mammalian skeletal muscle (Yap & MacLennan, 1976), it does not exhibit a marked pH-dependent shift in mobility in sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE), and its metachromatic staining properties with Stains All are likewise peculiar (Damiani et al., 1986). We have now definitively localized the same protein to the junctional terminal cisternae (TC) fraction of the SR of chicken pectoralis muscle and have further characterized it, following purification by crystallization with Ca2+ and by Ca2(+)-dependent elution from phenyl-Sepharose columns. The purified protein (apparent Mr: 51 kDa), isoelectrofocuses at pH 4.5, and is readily identified on blots by a 45Ca overlay technique, similar to CS of rabbit skeletal muscle, but it binds half as much Ca2+ (about 20 moles of Ca2+ per mole of protein), as estimated by equilibrium dialysis. However, the chicken protein shares extensive similarities with mammalian CSs, concerning Ca2(+)-induced changes in maximum intrinsic fluorescence and the Ca2(+)-modulated interaction with phenyl-Sepharose, as well as in being protected by Ca2+ from proteolysis by either trypsin or chymotrypsin. We discuss how the presence of a Ca2(+)-regulated hydrophobic site in the CS molecule appears to be the most invariant property of the CS-family of Ca2(+)-binding proteins.

Animals↗
PubMed1992

[Histology, immunocytology, histochemistry and muscle fiber innervation of the pectoralis major and supracoracoideus muscles of Excalfactoria chinensis chinensis (L.)].

The morphology of the pectoralis major muscle and its antagonist, the supracoracoideus muscle, of the Chinese quail was studied in comparison with the Japanese quail, in relation to behavioral characteristics. The actomyosin ATPase reaction after alkaline and acid preincubation reveals two fibre types. The indirect immunofluorescence, using specific antibodies against 'slow' (twitch) myosin from the human vastus lateralis muscle, provokes a weak reaction. All fibres observed show focal, monoaxonal 'en plaques' endings, typical of the phasic motor system. For the two quail species, the muscle structure seems adequate in relation to the movement characteristics, meaning muscle activity of migratories, flying long distances.

Animals↗
PubMed1985

Myosin heavy chain in avian muscular dystrophy corresponds to the neonatal isozyme.

We have previously demonstrated, based on comparison of homologous amino acid sequences and of two-dimensional CNBr peptide gel patterns, that the myosin heavy chain in pectoralis muscles of Storrs, Connecticut dystrophic chickens is different from that of their normal controls (Huszar, G., Vigue, L., De-Lucia, J. Elzinga, M., and Haines, J. (1985) J. Biol. Chem. 260, 7429-7434). Others have shown, however, that genomic banks and mRNA complements of the control and dystrophic birds are not different. In the present studies, we have examined the hypothesis that the "dystrophic" myosin heavy chain is not a novel gene product, but is a developmental isozyme which is expressed in pectoralis muscles of adult chickens due to the dystrophic process. Two-dimensional maps of myosin heavy chain CNBr peptides were prepared from breast muscles of 17-day in ovo (embryonic), 25-day posthatch (neonatal), and adult birds of the Storrs dystrophic and of two control strains. Also, myosin and actomyosin ATPase enzymatic activities of the various preparations were determined in the pH range of 5.5 to 9.0. Analysis of the peptide maps demonstrates that the embyronic, neonatal, and control adult myosin heavy chain isozymes are distinctly different gene products with only minute variations between the respective developmental isozymes in dystrophic and control muscles. However, the pectoralis myosin heavy chain of adult dystrophic birds, which is a homogeneous isozyme population by amino acid sequences and gel patterns, corresponds to that of the neonatal-type myosin heavy chain. The ATPase properties of the embryonic, neonatal, or adult pectoralis myosins and actomyosins were not different, whether the level of specific activity or the pattern of pH activation is considered. Since the mobility of neonatal chicks (primarily neonatal-type isozymes) is not restricted, the differences in myosin heavy chain structures are part of the syndrome, but not the cause of avian muscular dystrophy.

Adenosine Triphosphatases↗
PubMedDate not supplied

Genotype and sexual influences on growth and muscle development of chicken embryos.

The influence of sex and genotype on growth of chick embryos was studied using eggs from commercial broiler hens mated with broiler strain males (BrBr) or with bantam males (BaBr) and using eggs from bantam females mated to bantam males (BaBa) or to broiler strain males (BrBa). Male BrBr embryos were first significantly heavier than females at 9 days of incubation. The influence of sire's genotype was expressed between 6 and 16 days of incubation but not at 20 days. Dam's genotype, and the associated difference in egg weight, significantly affected embryo weight by 12 days of incubation and by 20 days it alone influenced embryo weight. Plasma insulin-like growth factor-I (IGF-I) levels of BrBr and BaBr embryos did not differ at 8, 10, 12, or 14 days of incubation, nor were there sex differences. There were no genotype differences in whole body protein concentration, DNA concentration or protein:DNA ratios at 4 or 8 days of incubation. At 12 days the pectoralis major DNA concentration of BaBa embryos was significantly higher than that of all other groups. Pectoralis muscle protein concentration of BrBa embryos was significantly lower than those of BaBr embryos at 12 days of incubation, but by 16 days it was highest. The protein:DNA ratios of embryos developing in bantam eggs were significantly lower than those in broiler eggs at 12 days. In summary, genotypic and sex differences in body weight and muscularity that develop after hatching appear to be predetermined by differences in embryonic growth patterns, but there is no clear relationship between embryonic growth, plasma IGF-I concentration or the concentration of DNA or protein in pectoralis muscle.

Age Factors↗
PubMed2002

Use of mesh to repair the submuscolar pocket in breast reconstruction: a new possible technique.

The reconstruction of the female breast after mastectomy has become a crucial part of primary breast cancer therapy. Setting of an implant is possible only in case of locally abounding soft tissue coverage and when no radiation has before performed. It is necessary a complete integrity of the submuscolar pocket and good blood supply of the skin to avoid failure of the procedure. In Author's experience, started since 1994, an immediate breast reconstruction after mastectomy is performed using gel-silicon implants directly when it was possible or setting first an expander. In six cases the condition of major pectoralis muscle after mastectomy was so foul that an immediate breast reconstruction with prosthesis was not realizable. However, the Authors tried a new technique using polypropylene mesh sutured on the major pectoralis muscle to cover the muscle partially destroyed. Preliminary data from the 6 pts seems to be encouraging.

Adult↗
PubMed1978

[Our experience in treatment of the inhibition of demand pacemaker by muscle potentials (author's transl)].

The inhibition of demand pacemakers by muscular potentials is rarely described in the literature. The Authors have found an interference of the pectoralis muscle's electric activity with pacemakers in 4 patients suffering from occasional faints. Extending this study to a group of 10 asymptomatic electrostimulated patients, pacemaker's inhibition by sub-maximal contraction of pectoralis major muscle has been found in 9 of them. The 4 symptomatic patients have been operated displacing the battery near the sternum. The poor thickness of the pectoralis muscle's fibres suggested the treatment. The controls performed from 2 to 8 months respectively have shown disappearance of the symptoms.

Action Potentials↗
PubMed1991

Reconstruction strategy for temporal bone and lateral facial defects.

Large or recurrent tumors of the auricular and parotid areas sometimes require resections involving the temporal bone and adjacent structures, including the facial nerve, the auditory apparatus, ascending ramus of the mandible, and the temporomandibular joint. At times, these resections can include the skull and even the underlying dura. Although these massive resections can provide good palliation and sometimes cure for these advanced patients, incumbent on the strategy for this treatment is a reliable one-stage technique for repair of the resultant defect. We have found the use of free-tissue transfer and the pectoralis muscle flap to be useful in the reconstruction of these defects. The pectoralis muscle flap is used when the defect is at or inferior to the external auditory meatus. More cephalad lesions require free-tissue transfer; for small surface area defects, the free scapular flap has been found to be useful, whereas for larger surface area defects, the free latissimus muscle flap with overlying skin graft has been used with good success. This paper is a report of our experience with this strategy in 14 patients. Our results are discussed and 3 patients are presented.

Adult↗
PubMed1992

Developmentally regulated troponin C mRNAs of chicken skeletal muscle.

Fast and slow/cardiac troponin C (TnC) are the two different isoforms of TnC. Expression of these isoforms is developmentally regulated in vertebrate skeletal muscle. Therefore, in our studies, the pattern of their expression was analyzed by determining the steady-state levels of both TnC mRNAs. It was also examined if mRNAs for both isoforms of TnC were efficiently translated during chicken skeletal muscle development. We have used different methods to determine the steady-state levels of TnC mRNAs. First, probes specific for the fast and slow TnC mRNAs were developed using a 390 base pair (bp) and a 255 bp long fragment, of the full-length chicken fast and slow TnC cDNA clones, respectively. Our analyses using RNA-blot technique showed that fast TnC mRNA was the predominant isoform in embryonic chicken skeletal muscle. Following hatching, a significant amount of slow TnC mRNA began to accumulate in the skeletal (pectoralis) muscle. At 43 weeks posthatching, the slow TnC mRNA was nearly as abundant as the fast isoform. Furthermore, a majority of both slow and fast TnC mRNAs was found to be translationally active. A second method allowed a more reliable measure of the relative abundance of slow and fast TnC mRNAs in chicken skeletal muscle. We used a common highly conserved 18-nucleotide-long sequence towards the 5'-end of these mRNAs to perform primer extension analysis of both mRNAs in a single reaction. The result of these analyses confirmed the predominance of fast TnC mRNA in the embryonic skeletal muscle, while significant accumulation of slow TnC mRNA was observed in chicken breast (pectoralis) muscle following hatching. In addition to primer extension analysis, polymerase chain reaction was used to amplify the fast and slow TnC mRNAs from cardiac and skeletal muscle. Analysis of the amplified products demonstrated the presence of significant amounts of slow TnC mRNA in the adult skeletal muscle.

Animals↗
PubMed1984

Changes in protein synthesis due to an inflammatory challenge.

Rates of protein synthesis in various chick tissues were examined 16 hr after an inflammatory challenge. Protein synthetic rates were calculated from the rate at which [14C]leucine was incorporated into protein and the specific activity of [14C]leucine in the precursor pool. An injection of either Escherichia coli or sheep red blood cells (SRBC) decreased the rate of protein synthesis in the gastrocnemius muscle, and increased the rate in liver, bursa, spleen, and thymus. E. coli, but not SRBC, decreased protein synthesis in the pectoralis muscle. E. coli significantly decreased the aggregation of pectoralis muscle polysomes and increased the aggregation of polysomes in the thymus, bursa, and spleen. E. coli increased the aggregation of free, but not bound, polysomes in liver, suggesting an increase in synthesis of export proteins. SRBC significantly increased polysomal aggregation in bursa and spleen only. A crude preparation of leukocyte endogenous mediator, isolated from peritoneal macrophages, decreased muscle-polysomal aggregation. These studies indicate that tissue-specific changes in protein synthesis occur after a noninfectious inflammatory challenge. These changes may be part of a homeostatic mechanism which supports the immune response.

Animals↗
PubMed1982

A serial study of muscle microsomes during the early growth of genetically dystrophic chickens.

Two lines of genetically involved and control chickens were compared with regard to the onset of muscle dystrophy during the early stages of growth ex ovo. Definite structural and functional involvement of pectoralis muscle developed within the first 4-5 weeks. In parallel experiments, microsomal membranes were obtained weekly from pectoralis muscle during the first 14 weeks ex ovo. The microsomes were studied with respect to ultrastructural features, protein composition, Ca2+ uptake and ATPase activity. Microsomal preparations obtained from all newborn chickens contain two types of vesicles: one type reveals an asymmetric distribution and 'high density' of particles on freeze-fracture faces which is characteristic of sarcoplasmic reticulum (SR) membrane; the other type reveals a symmetric distribution and 'low density' of particles. The yield of 'low density' microsomes from muscle of normal birds is very much reduced as the chicks grow from 1 to 4-5 weeks ex ovo. On the contrary, it remains high in chicks developing muscle dystrophy. Ca2+ uptake and coupled ATPase activity are found to be of nearly identical specific activity in control and genetically involved newborn chicks. The specific activity of the control birds, however, increases as the chicks grow from 1 to 4-5 weeks of age, while the specific activity of the dystrophic birds remains low. Such a difference appears to be related to the relative representation of sarcoplasmic reticulum and 'low density' vesicles in the microsomal preparations. It is concluded that failure to obtain a normal differentiation of muscle cell membranes is a basic defect noted in the early growth of genetically involved chickens. This defect appears along with the earliest signs of the dystrophic process.

Adenosine Triphosphatases↗
PubMed1987

Chest wall after mastectomy. Part II. CT appearance of tumor recurrence.

The postoperative computed tomography (CT) scans of 19 patients with breast cancer and suspected local or regional recurrence were reviewed. Recurrence was documented by percutaneous biopsy in 15 and by overwhelming clinical evidence in two. CT correctly identified the sites of recurrence in all 15 biopsy-proved cases. In two patients, suspected areas on CT scans proved to be residual pectoralis muscles. In most cases, the CT findings of recurrence to the skin, subcutaneous fat, pectoralis muscle, axilla, and brachial plexus can be differentiated from the postoperative and postirradiation anatomy.

Breast Neoplasms↗
PubMed2005

Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: part 2. An electromyographic analysis.

BACKGROUND/OBJECTIVES: Shoulder pain is common in persons with complete spinal cord injury. Adjustment of the wheelchair-user interface has been thought to reduce shoulder demands. The purpose of this study was to quantify the effect of seat fore-aft position on shoulder muscle activity during wheelchair propulsion. METHODS: Shoulder electromyography (EMG) was recorded while 13 men with paraplegia propelled a wheelchair in the following 2 seat positions: (a) shoulder joint center aligned with the wheel axle (anterior) and (b) shoulder joint center 8 cm posterior to the wheel axle (posterior) in 3 test conditions (free, fast, and graded). Duration of EMG activity and median and peak intensities were compared. RESULTS: During free propulsion, the median EMG intensity of all muscles was similar between anterior and posterior seat positions. The major propulsive muscles (pectoralis major and anterior deltoid) demonstrated significant reductions in their median and peak intensities in the posterior seat position. Pectoralis major median intensity was significantly reduced in the posterior position during fast (52% vs 66% maximal muscle test [MMT]) and graded (41 % vs 49% MMT) conditions, and peak intensity was significantly reduced in the free condition (29% vs 52% MMT) and the fast condition (103% vs 150% MMT). Anterior deltoid intensity was significantly reduced in the posterior position during fast propulsion only (26% vs 31% MMT). For all muscles, EMG duration was similar between positions in all test conditions. CONCLUSIONS: Reduction in the intensity of the primary push phase muscles (pectoralis major and anterior deltoid) during high-demand activities of fast and graded propulsion may reduce the potential for shoulder muscle fatigue and injuries.

Acceleration↗
PubMed1992

[A study on the communication between the pectoral nerve and the extramural nerve branches of the intercostal nerves].

Kumaki et al. (1979) defined the extramural nerve as the rudimentary sensory nerve which appeared on the upper thoracic wall; it branched off the root of the lateral cutaneous nerve of the second, third or fourth intercostal nerve, ran inferomedially adhering to the fascia of the intercostalis externus muscle and ended supplying the membrane covering the adjacent rib. They also stated that the extramural nerve (Rxm) occasionally became a cutaneous nerve which pierced the pectoralis muscles and supplied the skin covering the thoracic wall similar to the lateral cutaneous nerve (Rcl) or the anterior cutaneous nerve (Rca). Further, they proposed that the muscular nerves to the obliquus externus abdominis muscle which are usually situated below the fifth rib might be considered a part of this Rxm series. Although the definition of Rxm is still not widely accepted, Rxm is thought to be a key morphological factor influencing the variations of peripheral nerve arrangement on the thoracic wall. In the student course of gross anatomy dissection at Iwate Medical University School of Medicine during the years 1987-1991, three cases of Rxm communicating with the pectoral nerve and supplying the pectoralis major muscle were observed. Some cases have been reported in which Rcl innervates part of the pectoral muscles. However, the communication between the pectoral nerve and Rxm has not yet been discussed. Therefore, to clarify the morphological significance of the communication between Rxm and the pectoral nerve, the branching pattern and the distribution of the pectoral nerves were extensively investigated and the intramuscular nerve supply of some pectoral nerves, especially the pectoral nerves which communicated with Rxm, was examined in detail under a stereomicroscope. The results are summarized as follows: 1. In the first case, Rxm of the second intercostal nerve originated from Rcl, ran inferomedially adhering to the fascia of the intercostalis externus muscle and pierced the origin of the pectoralis minor muscle at the third intercostal space. Then Rxm turned superolaterally to communicate with a pectoral nerve which originated from the loop composed of the lateral and medial pectoral nerves and passed inferior to the pectoralis minor muscle. After communication, the pectoral nerve with Rxm supplied the caudalmost part of the sternocostal portion of the pectoralis major muscle. In the second case, a similar branch of Rxm of the second intercostal nerve passed inferior to the pectoralis minor muscle.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗