Myopathies

肌病
  • 文章类型: Journal Article
    热应激会极大地挑战肉鸡的生长和肉质,研究正在寻找可持续的成分,比如微藻,这也可以减轻其负面影响。因此,在本研究中,576只1-D-old雏鸡(罗斯308)被饲养,直到在禽舍的2个房间的36个围栏中进行商业屠宰(42D),根据包含2个室温的全阶乘设计(标准与高),2性别(女性与male),和3种饮食治疗,也就是说,饮食C0(控制饮食),饮食C3和含0、3和6%的饮食C6,分别,普通梭菌粉代替相同量的大豆粉。与对照日粮相比,普通梭菌的最高含量降低了采食量(P<0.001)和体重(P<0.0001);它增加了胸肌的黄色和红色指数(P<0.0001),n3多不饱和脂肪酸(PUFA)的比例(P=0.028)。热应激降低采食量(P=0.001),乳房(P=0.001)和P.主要产量(P=0.036),增加肉的pH(P=0.008)和烹饪损失(P<0.001),鲜味(P=0.021)和肉汤味(P<0.001),n3PUFA比例(P=0.027),同时降低胸肉中几种氨基酸的含量(P≤0.05)。与女性相比,雄性表现出更高的采食量和生长,和更有利的饲料转化率(P<0.001)。car体和p.主要产量在女性中更高(P<0.001),与男性相比,意大利面条的发生率也更高(P<0.001)。总之,C.vulgaris可用于替代肉鸡日粮中3%的豆粕,而不会产生负面影响,同时根据消费者的喜好积极影响胸肉颜色。然而,微藻的掺入并不能减轻慢性热应激对生长性能的负面影响,也不能减少任何肌病的发生。
    Heat stress can greatly challenge growth and meat quality of broiler chickens where research is looking for sustainable ingredients, such as microalgae, that could also alleviate its negative impacts. Thus, in the present study, 576 1-D-old chicks (Ross 308) were housed until commercial slaughtering (42 D) in 36 pens in 2 rooms of a poultry house, according to a full factorial design encompassing 2 room temperatures (standard vs. high), 2 sexes (females vs. males), and 3 dietary treatments, that is, diet C0 (control diet), diet C3, and diet C6 containing 0, 3, and 6%, respectively, of C. vulgaris meal replacing the same quantities of soybean meal. The highest inclusion level of C. vulgaris decreased feed intake (P < 0.001) and body weight (P < 0.0001) compared to the control diet; it increased yellow and red indexes (P < 0.0001) of the breast muscle, besides the proportion of n3 polyunsaturated fatty acids (PUFA) (P = 0.028). Heat stress decreased feed intake (P = 0.001), breast (P = 0.001) and p. major yields (P = 0.036), and increased meat pH (P= 0.008) and cooking losses (P < 0.001), umami (P = 0.021) and brothy flavor (P < 0.001), and the proportion of n3 PUFA rates (P = 0.027), while reducing the contents of several amino acids in the breast meat (P ≤ 0.05). Compared to females, males displayed higher feed intake and growth, and more favorable feed conversion (P < 0.001). Carcass and p. major yields were greater in females (P < 0.001) which also showed a higher occurrence of spaghetti meat compared to males (P < 0.001). In conclusion, C. vulgaris can be used to replace until 3% of soybean meal in diets for broiler chickens without negative implications, while positively affecting breast meat color according to consumers\' preferences. However, the microalgae inclusion did not mitigate the negative effects of a chronic heat stress on growth performance nor reduced the occurrence of any myopathies.
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  • 文章类型: Journal Article
    心肌病,通常由编码肌肉蛋白的基因突变引起,传统上通过对心脏进行表型分析并解决不可逆损伤后的症状。随着基因分型的进步,早期诊断是可能的,有可能防止这种损害。然而,肌肉的复杂结构及其无数的蛋白质使得治疗预测具有挑战性。在这里,我们使用空间明确的半肌节肌肉模型来解决估计小鼠肌肉突变的治疗靶标的问题。我们在模型中选择了9个与小分子和引起心肌病的突变相关的速率参数。然后,我们随机改变这些速率参数,并为每个组合模拟等距抽搐,以生成大型训练数据集。我们使用这个数据集来训练条件变分自动编码器(CVAE),贝叶斯参数估计中使用的一种技术。给定模拟或实验的等距抽搐,然后,该机器学习模型能够预测最有可能产生该结果的速率参数集。然后,我们预测与小鼠小梁中的对照和心脏肌钙蛋白C(cTnC)I61Q变体相关的一组速率参数,以及恢复异常61QcTnC抽搐的模型参数。
    Cardiomyopathies, often caused by mutations in genes encoding muscle proteins, are traditionally treated by phenotyping hearts and addressing symptoms post irreversible damage. With advancements in genotyping, early diagnosis is now possible, potentially preventing such damage. However, the intricate structure of muscle and its myriad proteins make treatment predictions challenging. Here we approach the problem of estimating therapeutic targets for a mutation in mouse muscle using a spatially explicit half sarcomere muscle model. We selected 9 rate parameters in our model linked to both small molecules and cardiomyopathy-causing mutations. We then randomly varied these rate parameters and simulated an isometric twitch for each combination to generate a large training dataset. We used this dataset to train a Conditional Variational Autoencoder (CVAE), a technique used in Bayesian parameter estimation. Given simulated or experimental isometric twitches, this machine learning model is able to then predict the set of rate parameters which are most likely to yield that result. We then predict the set of rate parameters associated with both control and the cardiac Troponin C (cTnC) I61Q variant in mouse trabeculae and model parameters that recover the abnormal I61Q cTnC twitches.
    CONCLUSIONS: Machine learning techniques have potential to accelerate discoveries in biologically complex systems. However, they require large data sets and can be challenging in high dimensional systems such as cardiac muscle. In this study, we combined experimental measures of cardiac muscle twitch forces with mechanistic simulations and a newly developed mixture of Bayesian inference with neural networks (in autoencoders) to solve the inverse problem of determining the underlying kinetics for observed force generation by cardiac muscle. The autoencoders are trained on millions of simulations spanning parameter spaces that correspond to the mechanochemistry of cardiac sarcomeres. We apply the trained model to experimental data in order to infer parameters that can explain a diseased twitch and ways to recover it.
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  • 文章类型: Journal Article
    在体内,肌肉和神经元细胞是有丝分裂后的,它们的功能主要受蛋白质抑制调节,维持蛋白质稳态微妙平衡的多层分子过程。泛素-蛋白酶体系统(UPS)是蛋白质稳定的关键调节剂。功能失调的UPS是肌肉老化的标志,并且通常在神经肌肉疾病(NMD)中受到影响。UPS的功能异常通常导致异常蛋白质积累,这可导致蛋白质聚集和/或错误定位,影响其功能。去泛素化酶(DUB)是UPS中的关键参与者,控制蛋白质周转和维持自由泛素池。DUB编码基因中的一些突变与人类NMD有关,例如ATXN3,OTUD7A,UCHL1和USP14,而其他NMD与DUB表达失调有关。USP5、USP9X和USP14参与神经肌肉接头处的突触传递和重塑。缺乏USP19的小鼠显示出增加的瘦肌肉质量维持。在这次审查中,我们强调了DUB在肌肉生理学和NMD中的参与,特别是在影响肌肉再生的过程中,肌肉损伤后的变性和炎症。DUB最近作为有希望的药物靶标获得了很多尊重,以及它们在肌肉成熟中的作用,再生和变性可以为治疗包括NMD在内的肌肉疾病的新疗法提供框架,肌少症和恶病质。
    In vivo, muscle and neuronal cells are post-mitotic, and their function is predominantly regulated by proteostasis, a multilayer molecular process that maintains a delicate balance of protein homeostasis. The ubiquitin-proteasome system (UPS) is a key regulator of proteostasis. A dysfunctional UPS is a hallmark of muscle ageing and is often impacted in neuromuscular disorders (NMDs). Malfunction of the UPS often results in aberrant protein accumulation which can lead to protein aggregation and/or mis-localization affecting its function. Deubiquitinating enzymes (DUBs) are key players in the UPS, controlling protein turnover and maintaining the free ubiquitin pool. Several mutations in DUB encoding genes are linked to human NMDs, such as ATXN3, OTUD7A, UCHL1 and USP14, whilst other NMDs are associated with dysregulation of DUB expression. USP5, USP9X and USP14 are implicated in synaptic transmission and remodeling at the neuromuscular junction. Mice lacking USP19 show increased maintenance of lean muscle mass. In this review, we highlight the involvement of DUBs in muscle physiology and NMDs, particularly in processes affecting muscle regeneration, degeneration and inflammation following muscle injury. DUBs have recently garnered much respect as promising drug targets, and their roles in muscle maturation, regeneration and degeneration may provide the framework for novel therapeutics to treat muscular disorders including NMDs, sarcopenia and cachexia.
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  • 文章类型: Journal Article
    散发性包涵体肌炎(sIBM)是以进行性肌无力和骨骼肌炎症为特征的特发性炎性肌病的亚组。sIBM中肌纤维形态的定量数据仍然很少。Further,以前没有研究过卫星细胞(SC)的纤维型缔合,肌核数目,巨噬细胞,毛细血管,和sIBM患者的肌核结构域(MD)。先前获得的sIBM患者(n=18)的肌肉活检(NCT02317094)包括在纤维类型特异性肌纤维横截面积(mCSA)的分析中,SC,肌核和巨噬细胞,肌核结构域,和毛细管化。mCSA(p<0.001),外周肌核(p<0.001)和MD(p=0.005)与1型(慢抽搐)的相关性高于2型(快抽搐)纤维.相反,静止的SCs(p<0.001),位于中心的肌核(p=0.03),M1巨噬细胞(p<0.002),与1型纤维相比,2型纤维的M2巨噬细胞(p=0.013)和毛细血管(p<0.001)更高。相比之下,增殖(Pax7+/Ki67+)SCs(p=0.68)与每种纤维类型相似.晚期sIBM患者的2型肌纤维表现出明显的肌肉萎缩迹象(即mCSA减少),伴随着较高数量的相关静止SCs,位于中心的肌核,与1型纤维相比,巨噬细胞和毛细血管。相比之下,与2型纤维相比,1型纤维患有病理性肿大,MD更大,单位面积的细胞核和毛细血管更少。需要更多的研究来检查包括针对性运动在内的不同治疗干预措施在多大程度上可以减轻这些纤维类型特定的特征,并应对其在功能表现受损中的后果。
    Sporadic inclusion body myositis (sIBM) is a subgroup of idiopathic inflammatory myopathies characterised by progressive muscle weakness and skeletal muscle inflammation. Quantitative data on the myofibre morphology in sIBM remains scarce. Further, no previous study has examined fibre type association of satellite cells (SC), myonuclei number, macrophages, capillaries, and myonuclear domain (MD) in sIBM patients. Muscle biopsies from sIBM patients (n = 18) obtained previously (NCT02317094) were included in the analysis for fibre type-specific myofibre cross-sectional area (mCSA), SCs, myonuclei and macrophages, myonuclear domain, and capillarisation. mCSA (p < 0.001), peripheral myonuclei (p < 0.001) and MD (p = 0.005) were higher in association with type 1 (slow-twitch) than type 2 (fast-twitch) fibres. Conversely, quiescent SCs (p < 0.001), centrally placed myonuclei (p = 0.03), M1 macrophages (p < 0.002), M2 macrophages (p = 0.013) and capillaries (p < 0.001) were higher at type 2 fibres compared to type 1 fibres. In contrast, proliferating (Pax7+/Ki67+) SCs (p = 0.68) were similarly associated with each fibre type. Type 2 myofibres of late-phase sIBM patients showed marked signs of muscle atrophy (i.e. reduced mCSA) accompanied by higher numbers of associated quiescent SCs, centrally placed myonuclei, macrophages and capillaries compared to type 1 fibres. In contrast, type 1 fibres were suffering from pathological enlargement with larger MDs as well as fewer nuclei and capillaries per area when compared with type 2 fibres. More research is needed to examine to which extent different therapeutic interventions including targeted exercise might alleviate these fibre type-specific characteristics and countermeasure their consequences in impaired functional performance.
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  • 文章类型: Journal Article
    目的:Pompe病(PD)是由溶酶体酶酸性α-葡萄糖苷酶(GAA)缺乏引起的,导致进行性糖原积累和严重肌病伴进行性肌无力。在婴儿发作PD(IOPD)中,死亡通常发生在1岁以下。没有治疗IOPD的方法。PD的小鼠模型不能完全再现人类IOPD严重程度。我们的主要目标是产生第一个IOPD大鼠模型,以评估创新的肌肉定向腺相关病毒(AAV)载体介导的基因治疗。
    方法:采用CRISPR/Cas9技术制备PD大鼠。新型高度肌力生物工程衣壳AAVMY03和优化的肌肉特异性启动子与转录顺式调节元件一起用于在整个肌肉系统中实现稳健的Gaa表达。几种代谢,分子,组织病理学,和功能参数进行了测量。
    结果:PD大鼠表现出早发性广泛的糖原积累,肝脏和心脏肿大,身体和组织重量减少,严重的肌肉功能受损和存活率下降,非常类似于人类IOPD。用AAVMY03-Gaa载体治疗导致Gaa在全身肌肉中广泛表达,使糖原贮积病理学正常化,恢复肌肉质量和力量,抵消心脏肥大和正常生存率。
    结论:这种基因治疗具有治疗IOPD糖原代谢改变的巨大潜力。此外,AAV介导的方法可以用于其他遗传性肌肉疾病,这也受到治疗性转基因在整个肌肉系统中的低效广泛递送的限制。
    OBJECTIVE: Pompe disease (PD) is caused by deficiency of the lysosomal enzyme acid α-glucosidase (GAA), leading to progressive glycogen accumulation and severe myopathy with progressive muscle weakness. In the Infantile-Onset PD (IOPD), death generally occurs <1 year of age. There is no cure for IOPD. Mouse models of PD do not completely reproduce human IOPD severity. Our main objective was to generate the first IOPD rat model to assess an innovative muscle-directed adeno-associated viral (AAV) vector-mediated gene therapy.
    METHODS: PD rats were generated by CRISPR/Cas9 technology. The novel highly myotropic bioengineered capsid AAVMYO3 and an optimized muscle-specific promoter in conjunction with a transcriptional cis-regulatory element were used to achieve robust Gaa expression in the entire muscular system. Several metabolic, molecular, histopathological, and functional parameters were measured.
    RESULTS: PD rats showed early-onset widespread glycogen accumulation, hepato- and cardiomegaly, decreased body and tissue weight, severe impaired muscle function and decreased survival, closely resembling human IOPD. Treatment with AAVMYO3-Gaa vectors resulted in widespread expression of Gaa in muscle throughout the body, normalizing glycogen storage pathology, restoring muscle mass and strength, counteracting cardiomegaly and normalizing survival rate.
    CONCLUSIONS: This gene therapy holds great potential to treat glycogen metabolism alterations in IOPD. Moreover, the AAV-mediated approach may be exploited for other inherited muscle diseases, which also are limited by the inefficient widespread delivery of therapeutic transgenes throughout the muscular system.
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  • 文章类型: Journal Article
    目的:肌病与典型的体征和症状有关,但也有可能危及生命的并发症,在紧急情况下可能需要援助。这种现象在文献中研究不足。我们旨在评估演示文稿,管理,以及可能与需要转诊至成人急诊科(ED)和住院治疗的肌肉疾病相关的临床表现的结局。
    方法:使用国际疾病分类检索的匿名患者数据,回顾性分析了与4年以上肌肉疾病相关的第九次修订代码。评估医疗报告以提取人口统计学和临床变量,以及结果。根据到达时诊断出的肌肉疾病的存在(已知诊断[KD]组)或不存在(未知诊断[UD]组)来定义两组。
    结果:共包括244例患者,51%的人受到已知肌病的影响,主要是肢带肌营养不良和肌强直性营养不良。KD组ED就诊的主要原因是呼吸道问题,肌肉无力的恶化,还有肠胃问题.心脏并发症不太普遍。在UD组中,27例患者在ED进入后接受了特定原发性肌肉疾病的新诊断,主要是炎症性肌病.记录了26例患者住院期间的死亡,KD组和受线粒体和炎性肌病影响的患者的发病率较高。脓毒症和呼吸困难与死亡风险增加相关。
    结论:呼吸系统并发症是肌病患者进入ED的最常见原因,其次是胃肠道问题。感染是严重威胁,一旦住院,这些患者的死亡率相对较高。
    OBJECTIVE: Myopathies are associated with classic signs and symptoms, but also with possible life-threatening complications that may require assistance in an emergency setting. This phenomenon is understudied in the literature. We aimed to assess the presentation, management, and outcomes of clinical manifestations potentially related to a muscle disorder requiring referral to the adult emergency department (ED) and hospitalization.
    METHODS: Anonymized patient data retrieved using the International Classification of Diseases, Ninth Revision codes related to muscle disorders over 4 years were retrospectively analyzed. Medical reports were evaluated to extract demographic and clinical variables, along with outcomes. Two groups were defined based on the presence (known diagnosis [KD] group) or absence (unknown diagnosis [UD] group) of a diagnosed muscle disorder at arrival.
    RESULTS: A total of 244 patients were included, 51% of whom were affected by a known myopathy, predominantly limb-girdle muscular dystrophies and myotonic dystrophies. The main reasons for ED visits in the KD group were respiratory issues, worsening of muscle weakness, and gastrointestinal problems. Heart complications were less prevalent. In the UD group, 27 patients received a new diagnosis of a specific primary muscle disorder after the ED access, mostly an inflammatory myopathy. Death during hospitalization was recorded in 26 patients, with a higher rate in the KD group and in patients affected by mitochondrial and inflammatory myopathies. Sepsis and dyspnea were associated with increased death risk.
    CONCLUSIONS: Respiratory complications are the most common reason for myopathic patients accessing the ED, followed by gastrointestinal issues. Infections are severe threats and, once hospitalized, these patients have relatively high mortality.
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  • 文章类型: Journal Article
    目的:血清肌酸激酶(CK)升高或高CK血症被认为是肌病的生物学标志。然而,在一些肌病中,血清醛缩酶与正常CK的选择性升高已被报道,包括皮肌炎,免疫介导的肌病伴有肌周病理和筋膜炎伴有相关肌病。目的是研究孤立的醛缩酶升高的肌病的疾病谱。
    方法:回顾了医疗记录,以确定1994年12月至2020年6月期间发现的18岁以上的患者,这些患者经病理证实患有肌病,醛缩酶升高和CK水平正常。排除具有醛缩酶升高的替代原因的患者。
    结果:确定了34例不同类型的肌病患者。肌病可治疗27例。三种最常见的病因是皮肌炎(n=8),重叠肌炎(n=4)和非特异性肌病(n=4)。包膜周围病理包括炎症,碎片化,血管炎,在17/34患者(50%)中发现钙化的子宫周围血管或胞外淀粉样蛋白沉积。将八名选择性醛缩酶升高的皮肌炎患者与24名性别和年龄匹配的皮肌炎和高CK血症患者进行了比较。CK正常的皮肌炎患者(p<0.05)的皮肤受累频率较低(50.0%vs.100.0%)和纤颤电位(50.0%vs.90.5%),但红细胞沉降率中位数较高(33.5vs.13.5mm/h)和更常见的束状线粒体病理学(37.5%vs.4.2%)。
    结论:孤立的醛缩酶升高可以在比最初认为的更多的肌病中发现,并且大多数是可以治疗的。皮肌炎是我们队列中最常见的肌病,醛缩酶选择性升高,与皮肌炎伴高CK血症相比,具有一些独特的特征。
    OBJECTIVE: Elevation of serum creatine kinase (CK) or hyperCKemia is considered a biological marker of myopathies. However, selective elevation of serum aldolase with normal CK has been reported in a few myopathies, including dermatomyositis, immune-mediated myopathy with perimysial pathology and fasciitis with associated myopathy. The aim was to investigate the disease spectrum of myopathies with isolated aldolase elevation.
    METHODS: Medical records were reviewed to identify patients >18 years old seen between December 1994 and June 2020 who had pathologically proven myopathies with elevated aldolase and normal CK level. Patients with alternative causes of aldolase elevation were excluded.
    RESULTS: Thirty-four patients with various types of myopathies were identified. Myopathies were treatable in 27 patients. The three most common etiologies were dermatomyositis (n = 8), overlap myositis (n = 4) and nonspecific myopathy (n = 4). Perimysial pathology comprising inflammation, fragmentation, vasculitis, calcified perimysial vessels or extracellular amyloid deposition was found in 17/34 patients (50%). Eight dermatomyositis patients with selective elevated aldolase were compared to 24 sex- and age-matched patients with dermatomyositis and hyperCKemia. Dermatomyositis patients with normal CK significantly (p < 0.05) had less frequent cutaneous involvement (50.0% vs. 100.0%) and fibrillation potentials (50.0% vs. 90.5%) but higher median erythrocyte sedimentation rate (33.5 vs. 13.5 mm/h) and more common perifascicular mitochondrial pathology (37.5% vs. 4.2%).
    CONCLUSIONS: Isolated aldolase elevation can be found in a greater variety of myopathies than initially thought and most were treatable. Dermatomyositis is the most common myopathy with selective elevation of aldolase in our cohort, which features some unique characteristics compared to dermatomyositis with hyperCKemia.
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  • 文章类型: Journal Article
    本研究旨在评估运动训练对全身性自身免疫性肌病(SAMs)患者肌内脂质含量和胰岛素途径相关基因的影响。
    在2016年1月至2019年5月之间,共有7名皮肌炎患者(DM;3名男性,4名女性;平均年龄:49.8±2.3岁;范围,43至54岁),6例免疫介导性坏死性肌病(IMNM;3例男性,3名女性;平均年龄:58.5±10.6岁;范围,46至74岁),和10名对照个体(CTRL组;4名男性,6名女性;平均年龄:48.7±3.9岁;范围,包括41至56岁)。干预前后进行肌肉活检以评估肌内脂质含量。患者接受了12周的联合运动训练计划。分析骨骼肌基因表达,DM与CTRL组,DM前和后-,比较干预前后的IMNM。
    与CTRL组相比,DM组的II型肌纤维肌内脂质含量更高。干预之后,DM和IMNM组的I型和II型纤维脂质含量降低。CTRL组显示与胰岛素和脂质氧化途径相关的基因表达明显更高(AMPKβ2,AS160,INSR,PGC1-α,PI3K,和RAB14)与DM组相比。经过运动训练,在DM组中,与胰岛素途径和脂质氧化相关的基因表达增加(AMPKβ2,AS160,INSR,PGC1-α,PI3K,和RAB14)和IMNM组(AKT2,AMPKβ2,RAB10,RAB14和PGC1-α)。
    运动训练减少了DM和IMNM患者I型和II型肌纤维中的脂肪量,并增加了DM和IMNM中与胰岛素途径和脂质氧化相关的基因表达。这些结果表明,运动训练可以改善这些疾病中骨骼肌的质量和代谢功能。
    UNASSIGNED: This study aims to evaluate the effects of exercise training on intramuscular lipid content and genes related to insulin pathway in patients with systemic autoimmune myopathies (SAMs).
    UNASSIGNED: Between January 2016 and May 2019, a total of seven patients with dermatomyositis (DM; 3 males, 4 females; mean age: 49.8±2.3 years; range, 43 to 54 years), six with immune mediated necrotizing myopathy (IMNM; 3 males, 3 females; mean age: 58.5±10.6 years; range, 46 to 74 years), and 10 control individuals (CTRL group; 4 males, 6 females; mean age: 48.7±3.9 years; range, 41 to 56 years) were included. The muscle biopsy before and after the intervention was performed to evaluate the intramuscular lipid content. Patients underwent a combined exercise training program for 12 weeks. Skeletal muscle gene expression was analyzed and the DM versus CTRL group, DM pre- and post-, and IMNM pre- and post-intervention were compared.
    UNASSIGNED: The DM group had a higher intramuscular lipid content in type II muscle fibers compared to the CTRL group. After the intervention, there was a reduction of lipid content in type I and II fibers in DM and IMNM group. The CTRL group showed a significantly higher expression of genes related to insulin and lipid oxidation pathways (AMPKβ2, AS160, INSR, PGC1-α, PI3K, and RAB14) compared to the DM group. After exercise training, there was an increase gene expression related to insulin pathway and lipid oxidation in DM group (AMPKβ2, AS160, INSR, PGC1-α, PI3K, and RAB14) and in IMNM group (AKT2, AMPKβ2, RAB10, RAB14, and PGC1-α).
    UNASSIGNED: Exercise training attenuated the amount of fat in type I and II muscle fibers in patients with DM and IMNM and increased gene expression related to insulin pathways and lipid oxidation in DM and IMNM. These results suggest that exercise training can improve the quality and metabolic functions of skeletal muscle in these diseases.
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  • 文章类型: Journal Article
    近端肌病表现为全身性肌无力,通常累及上肢和/或下肢肌肉。毒素,长期使用他汀类药物,皮质类固醇,酒精,SGLT2抑制剂,COVID-19疫苗接种,抗疟药被归因于它的发展。在内分泌和代谢紊乱中,据报道,包括肾上腺激素过度分泌和不足在内的肾上腺功能障碍可导致肌病。此外,甲状旁腺和甲状腺疾病以及垂体疾病也可以直接或间接导致这种情况。在特发性炎性肌病,包括多发性肌炎,皮肌炎,包涵体肌炎(IBM),和系统性红斑狼疮(SLE),干燥综合征,和重叠综合征,已观察到中度至重度肌肉无力。据报道,IBM是50岁以上最普遍的获得性肌病。遗传性或先天性肌病包括四肢带肌营养不良,面肩肱肌营养不良,Duchenne和Becker肌营养不良症,和近端强直性肌病。除了这些,糖原贮积病如McArdle病也会导致快速耗尽,肌痛,工作肌肉抽筋。这里有必要提到一类遗传性代谢性肌病,称为“脂质沉积肌病”导致脂质在骨骼肌纤维中积聚,导致病变和变性。在病毒原因中,艾滋病毒,登革热病毒,流感病毒,乙型肝炎病毒,丙型肝炎病毒,SARS-CoV2也与肌肉无力有关。结节病,炎症性疾病,也可以表现为肌肉无力和肌痛。由于近端肌病的这种复杂的病理生理学,这篇综述旨在总结与这一现象相关的现有文献,以及其他有关导致广泛性肌无力发展的事件的最新进展。据作者所知,这是第一次详细讨论与近端肌病相关的原因和条件的叙述性综述。
    Proximal myopathy presents as generalized muscle weakness commonly involving the muscles of upper and/or lower limbs. Toxins, long-term use of statins, corticosteroids, alcohol, SGLT2 inhibitors, COVID-19 vaccination, and antimalarials have been attributed to its development. In endocrine and metabolic disorders, adrenal dysfunction including both overproduction and insufficiency of the adrenal gland hormones has been reported to cause myopathy. Moreover, parathyroid and thyroid disorders along with pituitary gland disorders can also directly or indirectly contribute to this condition. In idiopathic inflammatory myopathies including polymyositis, dermatomyositis, inclusion body myositis (IBM), and Systemic Lupus Erythematosus (SLE), Sjögren\'s Syndrome, and overlap syndromes, moderate to severe muscle weakness has been observed. IBM has been reported to be the most prevalent acquired myopathy above the age of 50. Hereditary or congenital myopathies include limb girdle muscular dystrophies, facioscapulohumeral muscular dystrophy, Duchenne and Becker muscular dystrophy, and proximal myotonic myopathy. In addition to these, glycogen storage diseases such as the McArdle disease can also cause fast exhaustion, myalgia, and cramping in working muscles. It is pertinent to mention here that a class of hereditary metabolic myopathies, referred to as \"lipid deposition myopathy\" causes lipids to accumulate in skeletal muscle fibers, leading to lesions and degeneration. Among viral causes, HIV, dengue virus, influenza virus, hepatitis B virus, hepatitis C virus, SARS-CoV2 are also associated with muscle weakness. Sarcoidosis, an inflammatory disease, can also manifest as muscle weakness and myalgia. Owing to this complicated pathophysiology of proximal myopathy, this review aims to summarize the existing literature on conditions associated with this phenomenon and other recent developments that have been made regarding events leading to development of generalized muscle weakness. To the authors\' knowledge this is the first narrative review that discusses causes and conditions associated with proximal myopathy in thorough detail.
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  • 文章类型: Systematic Review
    背景:对于患有肌肉疾病(MD)的患者来说,吃足够的饮食和保持健康的体重可能是具有挑战性的。开始管饲可以对营养状况产生积极影响,功能和生活质量。缺乏关于何时开始成人MD管饲的指南。
    目的:我们的目的是回顾有关成人面肩肱骨营养不良(FSHD)开始管饲适应症的科学文献,包涵体肌炎(IBM),肌营养不良1型(DM1),眼咽肌营养不良(OPMD)和先天性肌病。
    方法:此范围审查是根据系统审查的首选报告项目和范围审查的荟萃分析扩展(PRISMA-ScR)指南进行的。相关研究在Pubmed,Embase和Cinahl(2022年4月)。使用的医学主题词(MeSH)和文本词与FSHD相关,IBM,DM1,OPMD或先天性肌病和吞咽困难,肠内营养或营养不良。
    结果:在1046篇独特文章中,包括9例病例报告和2例回顾性病例系列。开始管饲的适应症是吞咽困难,营养不良/体重减轻和呼吸道感染(由于误吸)。经皮内镜胃造瘘术(PEG)最常用,并发症为呼吸衰竭,管子本身有问题,意外拆卸管,皮肤症状,消化症状,和腹膜炎.
    结论:关于MD管饲的数据很少。在各种MD中,开始管饲的指示相似。我们呼吁在这一领域进行更多的研究,并建议包括筛查吞咽困难,用于治疗各种MD的误吸和营养不良。
    BACKGROUND: Eating an adequate diet and maintaining a healthy body weight can be challenging for patients with muscular disorders (MD). Starting tube feeding can have a positive impact on nutritional status, functioning and quality of life. Guidelines on when to start tube feeding in adults with MD are lacking.
    OBJECTIVE: We aim to review the scientific literature on indications to start tube feeding in adults with facioscapulohumeral dystrophy (FSHD), inclusion body myositis (IBM), muscular dystrophy type 1 (DM1), oculopharyngeal muscular dystrophy (OPMD) and congenital myopathies.
    METHODS: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Relevant studies were identified in Pubmed, Embase and Cinahl (April 2022). The medical subject headings (MeSH) and text words used were related to FSHD, IBM, DM1, OPMD or congenital myopathies and dysphagia, enteral nutrition or malnutrition.
    RESULTS: Of 1046 unique articles, 9 case reports and 2 retrospective case series were included. Indications to start tube feeding were dysphagia, malnutrition/weight loss and respiratory infections (due to aspiration). Percutaneous endoscopic gastrostomy (PEG) tubes were used most often and complications were respiratory failure, problems with the tube itself, accidental tube removal, cutaneous symptoms, digestive symptoms, and peritonitis.
    CONCLUSIONS: Data on tube feeding in MD is scarce. Indications to start tube feeding were similar across the various MD. We call for more research in this field and suggest to include screening for dysphagia, aspiration and malnutrition in for the treatment of various MD.
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