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Denervation increases the degradation rate of acetylcholine receptors at end-plates in vivo and in vitro.

We have studied the effect of denervation on the degradation of the existing junctional acetylcholine (ACh) receptors at end-plates in rat muscles. ACh receptors were labelled by injecting animals with iodinated alpha-bungarotoxin (I-alpha BT); 1 day later the left hemidiaphragm was denervated. The degradation of bound I-alpha BT in normal and denervated muscles was examined in organ culture, beginning at various times after denervation in vivo. The original, pre-labelled end-plate ACh receptors are degraded more rapidly after denervation. The rate of degradation begins to increase shortly after the nerve is cut and reaches a maximum value at about 9 days of denervation. Muscles denervated only on transfer to organ culture also show an increase in the degradation rate of bound I-alpha BT with increasing time of denervation (time in culture). In normal diaphragm muscles, the initial rate of degradation of functional ACh receptors, after correcting for non-degradative loss of I-alpha BT, is 0.0018 h-1 (t1/2 = 383 h). The maximal rate at denervated end-plates is 0.0073 h-1 (t1/2 = 94 h). For soleus, sternomastoid, plantaris and intercostal innervated muscles the apparent rate of ACh receptor degradation either in vitro or in vivo ranged from 0.0005 h-1 to 0.002 h-1. The rate of loss of bound I-alpha BT in vivo is more rapid at denervated end-plates than at innervated end-plates. For diaphragm muscles, the rates of I-alpha BT degradation measured in organ culture are able to describe the relative rates of loss of I-alpha BT from innervated and denervated muscles in vivo. At short times after labelling, a fraction (10-20%) of the I-alpha BT bound to innervated muscles is degraded more rapidly than the remaining toxin. The possibility that these I-alpha BT binding sites are degraded at the rate characteristic of extrajunctional receptors on denervated muscle fibres is discussed.

Acetylcholine↗

Respiratory response to partial paralysis in anesthetized dogs.

The ability to maintain alveolar ventilation is compromised by respiratory muscle weakness. To examine the independent role of reflexly mediated neural mechanisms to decreases in the strength of contraction of respiratory muscles, we studied the effects of partial paralysis on the level and pattern of phrenic motor activity in 22 anesthetized spontaneously breathing dogs. Graded weakness induced with succinylcholine decreased tidal volume and prolonged both inspiratory and expiratory time causing hypoventilation and hypercapnia. Phrenic peak activity as well as the rate of rise of the integrated phrenic neurogram increased. However, when studied under isocapnic conditions, increases in the severity of paralysis, as assessed from the ratio of peak diaphragm electromyogram to peak phrenic activity, produced progressive increases in inspiratory time and phrenic peak activity but did not affect its rate of rise. After vagotomy, partial paralysis induced in 11 dogs with succinylcholine also prolonged the inspiratory burst of phrenic activity, indicating that vagal reflexes were not solely responsible for the alterations in respiratory timing. Muscle paresis was also induced with gallamine or dantrolene, causing similar responses of phrenic activity and respiratory timing. Thus, at constant levels of arterial CO2 in anesthetized dogs, respiratory muscle partial paralysis results in a decrease in breathing rate without changing the rate of rise of respiratory motor activity. This is not dependent solely on vagally mediated reflexes and occurs regardless of the pharmacological agent used. These observations in the anesthetized state are qualitatively different from the response to respiratory muscle paralysis or weakness observed in awake subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗

The use of chest wall muscle flaps to close bronchopleural fistulas: experience with 21 patients.

Nineteen patients with bronchopleural fistulas associated with tuberculosis and 2 patients with fistulas following resection for bronchiectasis underwent closure of the fistulas with pedicled flaps of chest wall muscle. The muscle grafting was combined with a limited thoracoplasty in 13 patients. The initial myoplasty produced prompt fistula closure in 15 patients and delayed closure in 2 others. A repeat myoplasty was successful in 2 patients in whom the initial myoplasty failed. Compared with other methods of treating bronchopleural fistulas used during the same period, muscle grafting carried a higher rate of successful fistula closure and a lower mortality rate.

Adult↗

Inspiratory muscle training in patients with chronic obstructive pulmonary disease.

To investigate the effects of inspiratory muscle resistive loading training (IMT) on exercise performance in chronic obstructive pulmonary disease (COPD), 13 patients undergoing standard pulmonary rehabilitation were divided into control (n = 6) and experimental (n = 7) groups. Prior to training, we measured inspiratory muscle strength and endurance, resting pulmonary function, and exercise performance on a bicycle ergometer (a progressive test and an endurance test at two thirds of maximal work load). We then determined their resistive loads for training by measuring their 10-min maximal sustainable resistance. Training by patients in the experimental group involved inspiring against a predetermined resistive load. The control subjects breathed through a sham training tube, so that studies were performed in double-blind fashion. The training consisted of 15-min sessions twice daily for 4 wk. The IMT dramatically improved inspiratory muscle endurance--represented as either sustainable inspiratory pressure (SIP) or endurance time at 60% of maximal inspiratory mouth pressure (Pimmax) at functional residual capacity. The SIP of the trained group increased from 29 +/- 11 to 46 +/- 11% of Pimmax (p less than 0.005). Training slightly increased inspiratory muscle strength (p less than 0.05), as determined by Pimmax. In contrast, resting pulmonary function and performance of both progressive and constant-load exercise remained unchanged. We conclude that 4-wk IMT in a pulmonary rehabilitation setting improves inspiratory muscle endurance in patients with COPD without changing pulmonary function or exercise performance.

Aged↗

Respiratory muscle activity during rapid eye movement (REM) sleep in patients with chronic obstructive pulmonary disease.

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD) periods of hypopnoea occur during rapid eye movement (REM) sleep, but the mechanisms involved are not clear. METHODS: Ten patients with stable COPD were studied during nocturnal sleep. Detailed measurements were made of surface electromyographic (EMG) activity of several respiratory muscle groups and the accompanying chest wall motion using magnetometers. RESULTS: Hypopnoea occurred in association with eye movements during phasic rapid eye movement (pREM) sleep. During pREM sleep there were reductions in EMG activity of the intercostal, diaphragm, and upper airway muscles compared with non-REM sleep. Episodic hypopnoea due to partial upper airway occlusion ("obstructive" hypopnoea) was seen consistently in four subjects while the others showed the pattern of "central" hypopnoea accompanied by an overall reduction in inspiratory muscle activity. Although activity of the intercostal muscles was reduced relatively more than that of the diaphragm, lateral rib cage paradox (Hoover's sign) was less obvious during pREM-related hypopnoea than during wakefulness or non-REM sleep. CONCLUSIONS: Hypopnoea during REM sleep in patients with COPD is associated with reduced inspiratory muscle activity. The pattern of hypopnoea may be either "obstructive" or "central" and is generally consistent within an individual. Relatively unopposed action of the diaphragm on the rib cage during REM sleep is not accompanied by greater lateral inspiratory paradox.

Aged↗

Extirpation of tumors located near the thoracic cage. A method for increasing the margin of healthy tissue on the deep side of the tumor.

When an aggressive tumor develops in a flat muscle near the thoracic cage the question may arise as to how achieve an adequate margin on the deep side of the tumor. This is especially the case if the tumor has recurred after a previous non-radical operation. A method is described by which the external thoracic fascia, the external intercostal musculature, and the periosteum on the external surface of the ribs can be included in the specimen as a continuous wall of healthy tissue on the deep side of the tumor. This technique has been used in 11 patients, 9 of whom had undergone one or more inadequate operations earlier. Eight patients had a malignant tumor, three an extra-abdominal desmoid. In one of the latter patients, in whom a recurrent tumor was adherent to rib periosteum, the method was unsuitable. In the other patients the method appears to have been adequate for local control of the tumor.

Adult↗

Disturbance of respiratory muscle function in patients with mitral valve disease.

A reduced total lung capacity associated with a normal or decreased lung recoil pressure at full inflation (Pel max) has been noted in patients with valvular heart lesions. In order to investigate the mechanism underlying this inappropriately low Pel max, we measured respiratory mechanics in a group of 15 patients with mitral valve disease uncomplicated by other illness. The total lung capacity was 81 percent of control. The static pressure-volume curve of the long intersected the normal one in the vicinity of functional residual capacity (i.e., the recoil pressure was increased at large lung volumes and diminished at low lung volumes), and both expiratory compliance and Pel max were significantly decreased. In 13 of the 15 patients, the minimal (inspiratory) pleural pressure-volume curve was shifted so that the pressures generated by the inspiratory muscles were less negative than normal at any given lung volume. The decrease in Pel max was proportional to the alteration in muscle pressures. These findings indicate (1) that patients with mitral valve disease have compromised function of the inspiratory muscles, and (2) that this alteration is responsible for the low Pel max. Respiratory muscle weakness contributes to the restriction of lung volume in patients with pulmonary vascular congestion and is probably implicated in cardiac dyspnea.

Adolescent↗

Vestibular influences on cat lumbar paravertebral muscles.

Recordings were made from nerves innervating ventral lumbar paravertebral muscles (quadratus lumborum) during natural vestibular stimulation in vertical planes. The best direction of vestibular stimulation for producing an increase in nerve activity was near nose-up pitch in two-thirds of the animals, but was near nose-down pitch in the others. The response gain (re. position) was flat across the frequency range of 0.05-1 Hz, and the responses persisted throughout 11-s static tilts. These data suggest that otolith organs activated by pitch influence activity in the lumbar paravertebral muscles. These responses may serve to stabilize the vertebral column during movements involving body pitch, such as vertical climbing.

Animals↗

The serratus anterior free tissue transfer for craniofacial reconstruction.

The serratus anterior muscle was used as a free tissue transfer to reconstruct complex craniofacial defects in 5 patients. Serratus anterior muscle alone and serratus anterior muscle with rib were the transfers made. All flaps survived and scapular winging did not occur. The serratus anterior muscle has several advantages for the reconstruction of medium-sized craniofacial defects. Because of its position, a two-team approach is possible. It has a consistent pedicle anatomy and low donor site morbidity. It has a large caliber vessel and a long pedicle. When compared with the commonly employed rectus abdominis flap for moderate-sized defects, the serratus muscle offers greater versatility in design and has the option of incorporating bone and innervated muscle without increasing significant donor site morbidity.

Adolescent↗

The sensation of respiratory muscle force.

The sensation of respiratory muscle force was examined in 8 normal subjects using the direct scaling method of magnitude production. At the end of a normal expiration, at functional residual capacity (FRC), subjects generated an inspiratory effort against a closed airway to produce a force that correspond to specific numerical values for sensation magnitude. Thereafter, at lung volumes of 2 L above FRC and 1 L below FRC, subjects attempted to reproduce the same force as that previously generated at FRC. Diaphragm electromyographic activity, recorded with an esophageal electrode, was used as a measure of central respiratory motor output. The difference between the mouth pressure during relaxation against a closed shutter and the peak airway pressure during the static inspiratory maneuver (Pmus) was employed as an index of muscle tension. The exponent for the magnitude production of force during maneuvers at FRC, i.e., the slope of the line relating log airway pressure and log sensation magnitude was 1.60 +/- SE 0.15. The exponent for force scaling was 1.47 +/- SE 0.17 after correcting for differences in inspiratory duration during maneuvers of different force. During inspiratory maneuvers at FRC plus 2 L, diaphragm EMG was 441 +/- SE 70%, but Pmus was 111 +/- SE 11% of the respective values during subjectively equal efforts at FRC. During inspiratory maneuvers at FRC minus 1 L, diaphragm EMG was 54 +/- SE 5%, but Pmus was 94 +/- SE 4% of the respective values during efforts at FRC perceived to be of equal force. These results suggest that the sensation of respiratory muscle force depends primarily on signals related to the tension generated by the contracting muscles rather than on the sensation of innervation associated with the central nervous system motor command.

Adult↗

Calcium channel blockers and transmitter release at the normal human neuromuscular junction.

Transmitter release evoked by nerve stimulation is highly dependent on Ca2+ entry through voltage-activated plasma membrane channels. Calcium influx may be modified in some neuromuscular diseases like Lambert-Eaton syndrome and amyotrophic lateral sclerosis. We studied the pharmacologic sensitivity of the transmitter release process to different calcium channel blockers in normal human muscles and found that funnel web toxin and omega-Agatoxin-IVA, both P-type calcium channel blockers, blocked nerve-elicited muscle action potentials and inhibited evoked synaptic transmission. The transmitter release was not affected either by nitrendipine, an L-type channel blocker, or omega-Conotoxin-GVIA, an N-type channel blocker. The pharmacologic profile of neuromuscular transmission observed in normal human muscles indicates that P-like channels mediate transmitter release at the motor nerve terminals.

Action Potentials↗

Accumulation in fetal muscle and localization to the neuromuscular junction of cAMP-dependent protein kinase A regulatory and catalytic subunits RI alpha and C alpha.

Using probes specific for cAMP-dependent protein kinase, we have analyzed by in situ hybridization the patterns of expression of regulatory and catalytic subunits in mouse embryos and in adult muscle. RI alpha transcripts are distributed in muscle fibers exactly as acetylcholinesterase, showing that this RNA is localized at the neuromuscular junction. The transcript levels increase upon denervation of the muscle, but the RNA remains localized, indicating a regulation pattern similar to that of the epsilon subunit of nicotinic acetylcholine receptor. RI alpha transcripts have accumulated in the muscle by day 12 of mouse embryogenesis, and localization is established by day 14, at about the time of formation of junctions. This localization is maintained throughout development and in the adult. Immunocytochemical analysis has demonstrated that RI alpha protein is also localized. In addition, RI alpha recruits C alpha protein to the junction, providing at this site the potential for local responsiveness to cAMP. PKA could be implicated in the establishment and/or maintenance of the unique pattern of gene expression occurring at the junction, or in the modulation of synaptic activity via protein phosphorylation. Embryonic skeletal muscle shows a high level of C alpha transcripts and protein throughout the fiber; the transcripts are already present by day 12 of embryogenesis, and their elevated level is maintained only through fetal life. In the adult, the C alpha hybridization signal of muscle is weak and homogeneous.

Animals↗

Control of breathing in patients with myasthenia gravis.

Control of breathing has seldom been investigated in patients with myasthenia gravis (MG). We evaluated lung volumes and respiratory muscle strength by measuring maximal inspiratory (MIP) and expiratory (MEP) pressures in 12 patients with moderate generalized (IIb) MG before and after an orally administered therapeutic dose (120 mg) of Mestinon, and in 11 age- and sex-matched normal subjects. Breathing pattern, mouth occlusion pressure (P0.1), and surface electromyographic activity of the diaphragm (EMGd) and intercostal (EMGint) muscles were evaluated during both room-air breathing and hypercapnic rebreathing. Before Mestinon, patients exhibited a slight decrease in VC, and normal TLC and FEV1/VC ratio. Compared with the normal control group, patients also exhibited respiratory muscle weakness (marked decrease in MIP and MEP; p less than 0.001 for both), and more rapid and shallower breathing (RSB): lower tidal volume (VT), inspiratory time (TI), expiratory time (TE), and greater respiratory frequency (f); mean inspiratory flow (VT/TI) and P0.1 were slightly supernormal, whereas both EMGd and EMGint were significantly higher in patients. During hypercapnic rebreathing, ventilation (VE) (p less than 0.001), VT (p less than 0.001), VT/TI, (p less than 0.003), P0.1 (p less than 0.003), and EMGd (p less than 0.001) response slopes to increasing PCO2 were found to be lower, whereas EMGint response slope was normal. At 60 mm Hg of PCO2 in the two groups the difference in terms of breathing pattern, P0.1, and EMGd were similar to that observed during room-air breathing. After Mestinon, VC (p less than 0.005), MIP (p less than 0.02), and MEP (p less than 0.01) significantly increased, whereas spontaneous breathing remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Growth and metabolism in somatotropin-treated steers: III. Protein synthesis and tissue energy expenditures.

Rates of in vivo protein synthesis in intercostal, sartorius and semitendinosus muscle and in the heart, liver, kidneys, rumen and jejunum were determined in 20 growing Hereford steers treated for 112 d with daily subcutaneous injections of either saline (S) or recombinantly derived bovine somatotropin (rBST; 20.6 mg/d). In vitro rates of protein synthesis and energy expenditures associated with Na+, K+ transport also were determined in external intercostal muscle, liver, kidneys and jejunum. Neither in vivo nor in vitro tissue protein fractional synthetic rates (mg/[g protein.d]), using either the plasma (P) or intracellular fluid (ICF) phenylalanine specific radioactivity for the precursor pool, were affected by rBST treatments. Energy expended on Na+, K+ transport was greater (P less than .1) in the livers of rBST-treated steers, which would increase the maintenance energy expenditures of these steers. Protein accretion rates in the liver, kidneys, stomach, hide, and head, feet and tail of rBST-treated steers were greater (P less than .05) than in S steers. Tissue amino acid profiles were not affected by rBST treatments except in the rumen, where profiles suggested that less collagen was present in rumen wall tissue protein of rBST steers. Plasma phenylalanine entry rates also were not affected by rBST treatment; muscle protein synthesis accounted for a minimum of 20% of this entry rate.

Animals↗

The incidence of initial doublets in the discharges of motoneurones of two different inspiratory muscles in the cat.

1. Trains of action potentials in motoneurones frequently commence with an initial doublet; i.e. a uniquely short interspike interval. Previous authors have speculated on the functional importance of initial doublets. Here we test the hypotheses that these doublets are associated with particular classes of motoneurones or particular physiological conditions. 2. Discharges of inspiratory motoneurones were recorded extracellularly in the thoracic ventral horn of anaesthetized, paralysed cats. Seventy units (35 each with axons in the internal and external intercostal nerves) were classified on the basis of their maximum firing rates, start times in the respiratory cycle and axonal destination. 3. Initial doublets were defined by an interspike interval < 14 ms. Of seventeen units firing initial doublets, fifteen had axons in the external intercostal nerve and two had axons in the internal intercostal nerve. Neither maximum firing rate nor start time during the respiratory cycle predicted the occurrence of doublets. 4. The chemical drive to breathe was manipulated by altering the CO2 content of the inspired gas or by briefly stopping the respiratory pump. Varying the chemical drive to breathe had no consistent effect on the occurrence of initial doublets. 5. These results support the view that initial doublets are part of the normal pattern of discharge of motoneurones. However, because the incidence of doublets does not consistently support previous functional hypotheses, we argue that the occurrence of doublets may not necessarily be dictated by the CNS, but in some circumstances it is an epiphenomenon dependent on the state of the motoneurone, in particular on the statistical properties of its synaptic inputs.

Action Potentials↗

Electrical activity of mouse motor nerve terminals.

Focal extracellular recording was made from presynaptic motor nerve terminals made visible directly in in vitro preparations of mouse intercostalis intimi muscles. The demonstration of a net inward current distally in these terminals at sites of transmitter release allow the conclusion that the mammalian terminal is electrically excitable, contrary to a recent claim that it is not.

Animals↗

Assessment and management of breathlessness.

Breathlessness is a common symptom in patients with respiratory disorders and contributes significantly to functional disability. Recent studies of the psychophysics of respiratory sensation suggest that dyspnea is a function of the forces generated by the respiratory muscles during the act of breathing and may simply represent the intensity of the sense of effort arising from central respiratory motor command signals. It is important to recognize the multidimensional nature of respiratory sensations that include not only sensory aspects but also affective and cognitive components. At present there are no established satisfactory means of treating dyspnea. Efforts to minimize abnormalities in ventilatory system impedance are limited by the largely irreversible nature of most chronic lung diseases. Sedatives and narcotic agents have not proved to be effective in altering perceptual responses and may have an adverse effect, worsening respiratory failure. Physical measures to improve overall conditioning and respiratory muscle performance may be most effective in relieving breathlessness and improving exercise capacity in patients with chronic lung disease.

Carbon Dioxide↗