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Changes in total body composition during normal and diabetic pregnancy: Relation to oxygen consumption. Leucine uptake by splanchnic and leg tissues in man: Relative independence of insulin levels. Effects of supplemental methionine on antiserum-induced dysmorphology in rat embryos cultured in vitro. Correlations between brain tryptophan and plasma neutral amino acid levels following food consumption in rats. Short-term neuroendocrine effects of a large oral dose of monosodium glutamate in fasting male subjects. Rat embryo development on human sera is related to numbers of previous spontaneous abortions and nutritional factors. Correlation of aspartate dose, plasma dicarboxylic amino acid concentration, and neuronal necrosis in infant mice. Aspartate-induced neuronal necrosis in infant mice: Protective effect of carbohydrate and insulin. The 24-h whole body leucine and urea kinetics at normal and high protein intakes with exercise in healthy adults. Effect of chronic dietary treatment with L-tryptophan on spontaneous salt appetite of rats. Role of insulin and branched-chain amino acids in regulating protein metabolism during fasting. Impact of supplemental lysine or tryptophan on pregnancy course and outcome in rats. Adaptation of protein metabolism in relation to limits to high dietary protein intake. Human protein requirements: the effect of variations in energy intake within the maintenance range. Mutagenic activity of glycine upon nitrosation in the presence of chloride and human gastric juice: A possible role in gastric carcinogenesis. Protein-energy requirements of prepubertal school-age boys determined by using the nitrogen-balance response to a mixed-protein diet. Protein-energy requirements of boys 12-14 y old determined by using the nitrogen-balance response to a mixed-protein diet. Gaudichon C, Mahe S, Benamouzig R, Luengo C, Fouillet H, Dare S, Van Oycke M, Ferriere F, Rautureau J, Tome D. Net postprandial utilization of [15N]-labeled milk protein nitrogen is influenced by diet composition in humans. Multicenter, double blind, placebo-controlled, multiple-challenge evaluation of reported reactions to monosodium glutamate. Oral L-histidine fails to reduce taste and smell acuity but induces anorexia and urinary zinc excretion. Effect of oral alanine on blood beta-hydroxybutyrate and plasma glucose, insulin, free fatty acids, and growth hormone in normal and diabetic subjects. Human protein requirements: Assessment of the adequacy of the current Recommended Dietary Allowance for dietary protein in elderly men and women. Mutagenicity spectra in Salmonella typhimurium strains of glutathione, L-cysteine and active oxygen species. Effects of central administration of alanine on body temperature of the rabbit: Comparisons with the effects of serine, glycine and taurine. Substituting ornithine for arginine in total parenteral nutrition eliminates enhanced tumor growth. Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Influence of leucine on arterial concentrations and regional exchange of amino acids in healthy subjects.

It carries sensory taste fibres from the anterior two-thirds of the tongue via the chorda tympani and supplies motorfibrestothestapediusmuscle. The earliest sign is slowing of one side of the face: for example, on baring the teeth. The nerve may be damaged within the bony facial canal, within whichliesthesensorygeniculateganglion(receivingtastefibresfromtheanteriortwo-thirds ofthetongueviathechordatympani). Patients should be reassured that the prognosis is good and thattheconditionisunlikelytorecur. Paradoxically,bilateral weakness is often less obviously apparent than unilateral weakness, as there is no facial asymmetry. It starts in the orbicularis oculi and usually progressesgradually over the years to involve other facial muscles on the same side. Surgicaldecompressionof thefacialnerveintheposteriorfossainvolvesinterposinganon-resorbablespongebetween the nerve and any adjacent vascular loop identified at operation. Otherinvoluntaryfacialmovements Myokymia of orbicularis oculi is an irritating twitch, usually of the lower eyelid. Tics and tardive dyskinesia frequently involve facial or perioral muscles (see pp. Nerve impulses generated by movement of hair cells within the three semicircular canals detect head motion in the three planes (yaw/pitch/roll). Vertigo Vertigo is the illusion of movement of the subject or surroundings, typically rotatory, and should be distinguished from other causes of non-specific dizziness. Although vertigo occasionally occurs in isolation with brainstem pathology, it is more typically a single component of a more complex clinical picture, associated with other symptoms or examination findings. The brainstem nuclei and tracts are tightly packed into a small space and most pathological processes affect multiple contiguous neural pathways, resulting,forexample,indiplopia,eyemovementdisorders,cranialnervepalsies,cerebellar signsorhemiparesis. Specialist testing is occasionally required to assess vestibular function and hearing. Vestibularneuronitis Vestibular neuronitis is a common but poorly understood problem. It is an acute attack of isolated vertigo with nystagmus, often with vomiting, and is believed to follow viral infections. Vagus(X) the vagus is a mixed nerve, largely motor, which supplies striated muscle of the pharynx (efferent gag reflex pathway), larynx (including vocal cords via recurrent laryngeal nerves) andupperoesophagus. A Xth nerve palsy produces ipsilateral failure of voluntary and reflex elevation of the soft palate (which is drawn to the opposite side) and ipsilateralvocalcords. There is no visible palatal weakness; vocal cord paralysis is seen endoscopically. Theleft recurrent laryngealnerve (loopingbeneath theaorta) isdamaged more commonly thantheright. Emotional lability (inappropriate laughing or crying) often accompanies pseudobulbar palsy. Seen mainly in the elderly, it is often due to isolated neck extensor myopathy of uncertain cause but may be a presenting feature of motor neurone disease, myasthenia or variousmyopathicdisorders. Corticospinal(pyramidal)system the corticospinal tracts originate in neurones of the cortex and terminate at motor nuclei of cranial nerves and spinal cord anterior horn cells. Characteristicsofpyramidallesions Signs of an early pyramidal lesion may be minimal (Box 21. With a pyramidal lesion, when both upper limbs are held outstretched, palms uppermost, the affected limb drifts downwards and pronates.

Approximately 25% of patients are diagnosed before their 18th birthday and there is evidence that disease commencing in youth is more extensive and more aggressive than that occurringinolderpatients. However, there is also evidence of an immunoregulatory role for the commensal microbiota, which protects against intestinal inflammation and upregulates epithelial defence mechanismsinanimalmodelsofcolitis. Bacterial ligands interact with the innate and acquired mucosal immunesystem via Toll-like receptorsexpressedonbothepithelialandantigen-presentingcells. Deficienciesoccurinthe clearance of invading bacteria by aspects of the innate immune system, such as neutrophils, whichmayallowinappropriateactivationoftheacquiredimmunesystem. These mechanisms result in increased adhesion moleculeexpressionontheintestinalvascularendothelium,whichfacilitatestherecruitmentof leucocytes from the circulation and the release of chemokines, all of which lead to tissue damageandalsoattractmoreinflammatorycellsinaviciouscircle. It may also involve the whole of the colon (total colitis), sometimes without macroscopicsmallbowelinvolvement. In a few of these patients, there is also inflammation of the distal terminal ileum (backwashileitis). Intra-abdominal fistulae and abscesses may be seen, which reflect penetrating disease. An early feature is aphthoid ulceration in the colon, usually seen at colonoscopy (Fig. In severe disease, there may be extensive ulceration, with the adjacent mucosa appearing as postinflammatory(pseudo-)polyps. In fulminant colonic disease of either type, most of the mucosa is lost, leaving a few islandsofoedematousmucosa(mucosalislands),andtoxicdilatationoccurs. These two diseases can usually be differentiated not only on the basis of clinical and radiologicaldatabutalsoonthehistologicaldifferencesseenintherectalandcolonicmucosa obtainedbybiopsy(Box13. However,symptomspersisting beyond 5days are unlikely to be caused by infective gastroenteritis. Constitutionalsymptoms of malaise, lethargy, anorexia, nausea, vomiting and low-grade fever may be present and in 15% of these patients there are no gastrointestinal symptoms. However,patientswithextensive disease have frequent recurrences and progress from inflammatory to stricturing and penetratingdisease. Clinical features are very variable and depend partly on the region of the bowel that is affected. Abdominal pain can be colicky, suggestingobstruction,butitusuallyhasnospecialcharacteristicsandsometimesincolonic disease only minimal discomfort is present. Diarrhoea can also be due to bile acid malabsorption,occurringasaconsequenceofilealresectionorilealdisease. Examination Physical signs are few, apart from loss of weight and signs of malnutrition. Abdominal examination may be normal, although tenderness and/or a right iliac fossa mass are occasionally found. The mass is due either to inflamedloopsofbowelthataremattedtogetherortoanabscess,whichmayalsocausepsoas muscle irritation. The anus should always be examined to look for oedematous anal tags, fissuresorperianalabscesses. Alternativecauses for symptoms, such as gastroenteritis, extraintestinal sepsis, stricture formation, functional gastrointestinal disease or bile salt malabsorption, must be excluded before commencing immunosuppressive therapy. Patients with mild symptoms and no evidence of extensive disease may require symptomatic treatment only. Anaemia, if due to vitamin B12, folic acid or iron deficiency, should be treated with the appropriatereplacement. Mostpatientscanbetreatedasoutpatients,althoughsevereattacksmayrequire admission, and prophylaxis for thromboembolism (see p. Mild to moderate ileocaecal disease should be treated with controlled-release corticosteroids, such as budesonide, which has reduced systemic availabilityandisassociatedwithalowerfrequencyandintensityofsteroidalside-effects. Steroids should be avoided in patients with penetrating intestinal disease or perianalsepsis.

What is the length of the A band after the shortening produced by the muscle contraction? A 66-year-old man who lives alone has a severe myocardial infarction and dies during the night. The sarcoplasmic reticulum of skeletal muscle functions in which of the following? Cellular Ca2+ storage Cellular glycogen storage Glycogen degradation Transport of Ca2+ into the terminal cisternae during muscle contraction Ca2+ release from the transverse tubules during muscle relaxation 127. Observation of a histologic preparation of muscle reveals crossstriations and peripherally located nuclei. The use of histochemistry shows a strong staining reaction for succinic dehydrogenase. The same tissue prepared for electron microscopy shows many mitochondria in rows between myofibrils and underneath the sarcolemma. Fibers that contract rapidly but are incapable of sustaining continuous heavy work c. In skeletal muscle contraction, the "powerstroke" is initiated by which of the following? In muscular dystrophy, the actin-binding protein dystrophin is absent or defective. Enhanced smooth-muscle contractility Deficiency in skeletal muscle actin synthesis Loss of binding of the I and M bands to the cell membrane Loss of organelle and vesicle transport throughout the muscle cell Loss of integrity of the desmosomal components of the intercalated discs of cardiac muscle Muscle and Cell Motility 219 130. Phagocystosis Bidirectional transport of vesicles Fast axoplasmic transport Chromosomal movements Ciliary movement 131. Which of the following is absent in smooth-muscle cells compared to skeletal muscle cells? Troponin Calmodulin Calcium Myosin light-chain kinase Actin and tropomyosin interactions 220 Anatomy, Histology, and Cell Biology 132. In the transmission electron micrograph of skeletal muscle shown below, which of the following is true of the zone labeled C? This structure bisects the H band and is formed predominantly of creatine kinase d. The mechanochemical enzyme that can be found on the surfaces of cellular organelles where it mediates movement toward the plus end of microtubules is which of the following? They are supportive cells for maintenance of muscle and a source of new myofibers after injury or after increased load. There is no dedifferentiation of myocytes into myoblasts (answer b), or fusion of damaged myofibers to form new myotubes (answer c). Hypertrophy, not hyperplasia (answer d), occurs in existing myofibers in response to increased load. Proliferation of fibroblasts may occur in the damaged area but leads to fibrosis, not repair of skeletal muscle. In the development of skeletal muscle, myoblasts of mesodermal origin undergo cell proliferation. Myoblasts, which are mononucleate cells, fuse with each other end to end to form myotubes. This process requires cell recognition between myoblasts, alignment, and subsequent fusion. However, as the degree of overlap of thick and thin filaments is altered, the thin filaments, which form the I band and are anchored to the Z line, are pulled toward the center of the sarcomere. As this occurs, the I band decreases in length and the H band is no longer visible. The filaments themselves do not decrease in length; they slide past one another in the sliding-filament model of muscle contraction. If there is a 20% contraction of the muscle (contraction to 80% of its length), then the sarcomere is reduced in length from 2. The size of the A band 221 222 Anatomy, Histology, and Cell Biology remains unchanged.