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  <head>
    <title>083-03 Muscle, peripheral nerve, tissue renewal, inflammation, and repair</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Muscle, nerve, renewal, inflammation, and repair">
      <outline text="Skeletal muscle structure">
        <outline text="Long multinucleated cells from fused myoblasts"/>
        <outline text="Peripheral nuclei beneath sarcolemma"/>
        <outline text="Aligned sarcomeres create cross-striations">
          <outline text="A band thick, I band thin filaments"/>
          <outline text="Z discs anchor thin filaments"/>
        </outline>
        <outline text="Contraction shortens I band and H zone">
          <outline text="A-band length constant"/>
        </outline>
        <outline text="Transverse tubules form triads">
          <outline text="Calcium binds troponin C"/>
          <outline text="Tropomyosin moves, myosin cycles"/>
          <outline text="Calcium reuptake allows relaxation"/>
        </outline>
      </outline>
      <outline text="Skeletal muscle in health and disease">
        <outline text="Endomysium, perimysium, epimysium">
          <outline text="Merge with tendon, carry capillaries"/>
        </outline>
        <outline text="Slow oxidative fibres resist fatigue"/>
        <outline text="Fast glycolytic fibres fatigue sooner"/>
        <outline text="Reinnervation after denervation: fibre-type grouping"/>
        <outline text="Satellite cells beneath basal lamina">
          <outline text="Small injury regenerates if lamina intact"/>
          <outline text="Extensive injury: fibrosis, fatty replacement"/>
        </outline>
      </outline>
      <outline text="Cardiac muscle">
        <outline text="Branching cells with central nuclei"/>
        <outline text="Intercalated discs join cells end to end">
          <outline text="Fascia adherens and desmosomes transmit force"/>
          <outline text="Gap junctions couple electrically"/>
        </outline>
        <outline text="Dyads near Z discs">
          <outline text="Calcium entry triggers further release"/>
        </outline>
        <outline text="Abundant mitochondria for aerobic metabolism"/>
        <outline text="Very limited regeneration">
          <outline text="Infarct heals by scar, survivors enlarge"/>
        </outline>
      </outline>
      <outline text="Smooth muscle">
        <outline text="Spindle cells, central nucleus, no striations"/>
        <outline text="Dense bodies and plaques instead of Z discs"/>
        <outline text="Contraction twists nuclei into corkscrews"/>
        <outline text="Calcium-calmodulin activates light-chain kinase"/>
        <outline text="Regulated by nerves, hormones, stretch"/>
        <outline text="Single-unit coordinated by gap junctions"/>
        <outline text="Multi-unit permits finer independent control"/>
        <outline text="Hypertrophy and proliferation in uterus, vessels, airways"/>
      </outline>
      <outline text="Neurons and peripheral nerve">
        <outline text="Soma, dendrites, axon"/>
        <outline text="Nissl substance is rough endoplasmic reticulum"/>
        <outline text="Axon hillock gives rise to initial segment"/>
        <outline text="Myelinating Schwann cell wraps one axon segment">
          <outline text="Non-myelinating cells envelop several axons"/>
        </outline>
        <outline text="Nodes of Ranvier enable saltatory conduction"/>
        <outline text="Endoneurium, perineurial barrier, epineurium"/>
        <outline text="Sensory ganglia: central nuclei, satellite glial ring"/>
        <outline text="Autonomic ganglia: eccentric nuclei, synapses"/>
      </outline>
      <outline text="Nerve injury">
        <outline text="Distal Wallerian degeneration"/>
        <outline text="Macrophages and Schwann cells clear debris"/>
        <outline text="Basal-lamina tubes guide sprouts"/>
        <outline text="Better with close ends and short target distance"/>
        <outline text="Misrouting, scar, prolonged denervation limit recovery"/>
      </outline>
      <outline text="Renewal, regeneration, and repair">
        <outline text="Labile: surface epithelia, haematopoietic cells"/>
        <outline text="Stable: hepatocytes, endothelium, fibroblasts"/>
        <outline text="Permanent: neurons, cardiomyocytes"/>
        <outline text="Categories are approximate"/>
        <outline text="Regeneration needs stem cells, scaffold, supply, signals"/>
        <outline text="Repair replaces tissue with connective scar"/>
        <outline text="Resolution removes cells, fibrin, temporary matrix"/>
      </outline>
      <outline text="Inflammation">
        <outline text="Acute: dilation, permeability, exudation">
          <outline text="Neutrophils early, then macrophages"/>
          <outline text="Suppurative inflammation forms pus"/>
        </outline>
        <outline text="Chronic: macrophages, lymphocytes, plasma cells">
          <outline text="Destruction, repair, angiogenesis, fibrosis"/>
        </outline>
        <outline text="Granulomas surround persistent stimuli">
          <outline text="Distinct from granulation tissue"/>
        </outline>
        <outline text="Morphology narrows mechanism, rarely identifies cause"/>
      </outline>
      <outline text="Wound healing and fibrosis">
        <outline text="Platelet-fibrin clot as provisional matrix"/>
        <outline text="Keratinocytes migrate beneath the clot"/>
        <outline text="Granulation tissue, myofibroblast contraction"/>
        <outline text="Primary versus secondary intention"/>
        <outline text="Delay: infection, ischaemia, diabetes, glucocorticoids"/>
        <outline text="Abnormal: dehiscence, keloid, contracture"/>
        <outline text="Hypoxia signalling and endothelial growth factor">
          <outline text="New vessels are permeable and fragile"/>
        </outline>
        <outline text="Fibrosis from persisting injury signals">
          <outline text="Transforming growth factor beta and stiffness"/>
          <outline text="Impairs lung, liver, kidney, heart function"/>
        </outline>
        <outline text="Read unit, injured compartment, cells, matrix"/>
      </outline>
    </outline>
  </body>
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