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Muscle Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Muscle and links to relevant pages within the course. Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.

Antinuclear Antibody Testing: Methods and Pattern Interpretation Cytoskeletal

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This sample is demonstrating an anti-cytoskeletal pattern in the cytoplasm of the cells.The cytoskeleton of eukaryotic cells is comprised of microfilaments such as actin, intermediate filaments such as vimentin and microtubules such as tubulin. Autoantibodies to these proteins are seen in a variety of autoimmune diseases.Whenever an ANA is read the first step is to see if there is a clearly discernible pattern in the nucleus of the interphase cells. In this case the answer is no (a). However, there is considerable staining in the cytoplasm. This fibrous staining of the cytoskeleton is a discernible cytoplasmic pattern and should be reported (b).This sample is reported as ANA Negative, suspect cytoskeletal antibodies present. (The term "suspect" is used because the ANA substrate is not considered "confirmatory" for the identification of cytoskeletal antibodies. Additional follow-up testing is required).Follow-up testing would include testing for anti-smooth muscle antibodies. Anti-smooth muscle antibodies are seen in autoimmune liver disease.Reporting anti-Cytoskeletal Antibodies:Cytoplasmic pattern: Fibrous strands in cytoplasmReport as: Suspect cytoskeletal, suggest follow-up Clinical Significance: Actin: Autoimmune hepatitis, PBC Vimentin and others: SLE, RA, others Cardiac Biomarkers The Human Heart The human heart is a muscular organ that is formed into four chambers with an interconnecting vascular system. Venous blood from the body enters the right atrium, is pumped into the right ventricle and from there is pumped to the lungs for reoxygenation.

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Oxygenated blood from the lungs accumulates in the left atrium and is pumped into the left ventricle and out to the body. Myocytes (muscle cells) require large amounts of energy and oxygen to accomplish this. The capacity of the heart to pump adequately is regulated by the volume of blood, systemic blood pressure, and the force of contraction achieved in the left ventricular wall. Infarction is an inadequate blood supply that decreases the availability of oxygen. Terminology Describing Ischemic Heart Disease and Heart Failure

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Descriptions of cardiac biomarkers and their use require knowledge of several terms. These terms and their definitions follow.Acute Coronary Syndrome (ACS) Includes all the ischemic events that can occur in the heart. These events range from angina (where there is no cell death or reversible cell injury) to an AMI with large areas of cell necrosis. A continuum of events that are involved in ACS is illustrated on the page that follows this glossary of terms.Acute Myocardial Infarction (AMI) Commonly referred to as a heart attack. A sudden loss of circulating blood and oxygen that causes necrosis of myocardial tissue. It is most often caused by the narrowing of coronary arteries by atherosclerosis, a thrombus, or dislodged plaque material.Angina Chest pain caused by inadequate supply of oxygen to heart myocardium. It is synonymous with angina pectoris, pectoris meaning chest.Congestive Heart Failure (CHF) Usually, a left ventricular dysfunction resulting from aging, hypertension, atherosclerosis or muscle damage from an AMI or repeated AMIs. In CHF, the heart is not able to effectively pump blood through its chambers and to the body. Fluid accumulates in the lungs and tissues causing edema because less blood leaves through the arteries than what entered the heart from the veins. Electrocardiogram (ECG or EKG) The tracings of the electrical current that passes through the myocardium. The heart contractions are stimulated by this current. In areas of myocyte necrosis, the current does not pass and the tracings display abnormal patterns.Infarction An area of tissue death that occurs due to lack of oxygen. Clogging of an artery will cause dead muscle tissue or infarction. Ischemia An inadequate blood supply that decreases availability of oxygen. Atherosclerosis is the main cause of myocardial ischemia. Troponins View Page Currently, the troponins are the definitive markers of myocyte injury. The troponins are contractile proteins that regulate muscle contractions; they work with calcium ions and another protein, tropomyosin. There are three types of troponin: Troponin C -- CalciumBinding Component Troponin I -- Inhibitory Component Troponin T -- TropomyosinBinding ComponentIsoforms of the troponins are found in cardiac muscle and in slowtwitch and fast-twitch skeletal muscle. Troponin C is found in both cardiac and skeletal muscle in the same form. Troponin I has a specific form found in cardiac muscle, cTnI; cTnT is the cardiac specific form of troponin T. Troponin Measurement and Ranges View Page Rapid immunoassays provide concentration levels of cTnI and cTnT that are approximately 96% sensitive and 94% specific for cardiac injury.Each diagnostic company develops their unique antibody against epitopes on the proteins. There is only one assay available for cTnT. However, there are several different antibodies that are used

by manufacturers to detect cTnI. Consequently, different assay methods may not correlate well. Standardization is needed for intra-laboratory comparisons. Reference Ranges for an adult: cTnT <0.01 ng/mL No cardiac injurycTnI references may vary with different assay methods, but approximate these values: Equal to or < 0.03 ng/mL -- No detectable cardiac injury 0.04-0.49 ng/mL -- Cardiac muscle injury Equal to or > 0.5 ng/mL-- Myocardial infarction CK-MB Measurement and Ranges View Page CK-MB assays used in cardiac damage diagnosis are mass immunoassay measurements. CK-MB is also present in skeletal muscle; therefore, skeletal muscle injury can also cause CK-MB elevation. CK-MB normal value for an adult: < 5.0 ng/mL Myoglobin View Page Myoglobin can also be used as a diagnostic indicator of an AMI. Myoglobin is an oxygenbinding protein in cardiac and skeletal muscle. It is released earlier after muscle injury than cardiac troponins and CK-MB and returns to normal faster than either of these other markers. It rises within 2 - 4 hours after chest pain, peaks in 6 - 12 hours, and is usually normal within 24 - 36 hours.Because of myoglobin's increase after skeletal muscle injury, it lacks the needed specificity for diagnosis of ACS and an AMI. False-positive elevation of myoglobin may also occur in a patient with impaired renal function since myoglobin is cleared through the kidneys.Myoglobin reference ranges for adults when an immunoassay method is used are approximately: Male 17-106 ng/mL Female 1-66 ng/mL Variation in ranges may be seen with different measurement methods. Select the correct statements regarding troponins. View Page Which ones of the following cardiac biomarkers can be used as a stand-alone marker, and View is therefore the preferred biomarker to indicate the presence of an AMI? Page While driving home after work, a 45-year-old male construction worker is involved in a View collision with another car. Upon arrival in the emergency department, the patient Page complains of chest pain along with severe pain from accident injuries. X-rays and laboratory assays including cardiac biomarkers are ordered. BiomarkerReference ValuePatient Result at PresentationPatient Result at 6 HoursPatient Result at 12 Hours CK-MB< 5.0 ng/mL7.0 ng/mL6.0 ng/mL6.5 ng/mL cTnI<0.4 ng/mL0.03 ng/mL< 0.03 ng/mL< 0.03 ng/mLDo the cardiac marker results indicate that an AMI is causing his chest pain? Case Studies in Clinical Microbiology Gas gangrene may be seen in infections with all the following clostridia EXCEPT: Chemical Screening of Urine by Reagent Strip False Positive Results A false positive result for blood on the reagent strip can occur when oxidizing contaminants, such as hypochlorite (bleach), remain in collection bottles after cleaning. Contamination of the urine with provodine-iodine, a strong oxidizing agent, used in surgical procedures can result in a false positive reaction. Microbial peroxide found in

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association with urinary tract infections may also cause false-positive results. Capoten (Captopril) can cause decreased reactivity. The muscle tissue form of hemoglobin, myoglobin is a well-known cause of false-positive reactions on the blood portion of the reagent strip. When tissue hemoglobin is present, the urine specimen has a clear red appearance. Patients suffering from muscle-wasting disorders or muscular destruction due to trauma, prolonged coma, or convulsions or individuals engaging in extensive exertion may have myoglobin in their urine. Specific tests for myoglobin, such as immunodiffusion techniques or protein electrophoresis, are needed to confirm the presence of this substance in a urine specimen. Levels of ascorbic acid normally found in urine do not interfere with this test. Chemistry / Urinalysis Question Bank - Review Mode (no CE) Creatinine excretion correlates best with which of the following parameters:

View Page Following a myocardial infarction which of the following enzymes will be the first to View become elevated: Page Increases in the MB fraction of CK is associated with: View Page Increases in LD fractions 4 and 5 are indicative of: View Page Match the tissues on the left with the corresponding LDH isoenzyme peak on the right. View Page The following LDH Isoenzyme pattern would be seen in: View Page The following LDH Isoenzyme pattern would be seen in: View Page The following LDH Isoenzyme pattern would be seen in: View Page Label the scan with CK isoenzyme fractions: View Page Label the scan: View Page The following CK isoenzyme pattern would be seen in: View Page Introduction to Bioterrorism Agent: Tularemia (bacterium)

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Most likely means of dissemination: Solid or aerosolPrimary route of entry: Inhalation, absorption, or ingestionGeneral signs and symptoms: Sudden fever, chills, headaches, muscle aches, joint pain, dry cough, progressive weakness, and pneumonia.The disease is not transmissible through human contact. When used as a WMD, infection would be acquired by handling infected material, eating or drinking contaminated food or water or by breathing in the bacterium. Agent: Viral hemorrhagic fevers (Ebola, Marburg, Lassa and Argentine) View Page

Most likely means of dissemination: Solid, liquid or aerosolPrimary route of entry: Absorption, inhalation, ingestionGeneral signs and symptoms: Vary by type of viral hemorrhagic fever (VHF), but initial signs and symptoms often include marked fever, fatigue, dizziness, muscle aches, loss of strength, and exhaustion. Severe cases of VHF often show signs of bleeding under the skin, in internal organs, or from body orifices like the mouth, eyes, or ears. Photo courtesy of the CDC archives. Laboratory Ergonomics Causes of Work-related Musculoskeletal Disorders The primary goal of ergonomics is the prevention of musculoskeletal disorders (MSDs). There are many potential causes of MSDs. Injury can occur from a single event (strain, sprain, slip, or fall) or result from build-up of tissue damage from many small injuries. An MSD can develop over time if a motion is repeated consistently so that the constant trauma causes damage to a muscle, tendon, bone, or bursa of a joint. Force, vibration, or maintenance of an awkward position for a prolonged period of time can cause MSDs.Some specific causes of MSDs that are related to laboratory tasks are: Prolonged use of a keyboard or mouse Prolonged sitting at a microscope Pipetting Screwing and unscrewing vial caps Standing at a laboratory instrument for a prolonged period of time Lack of rest - intensive hours at the workstation with few breaks Sustained awkward position Metabolic Syndrome Role of Adipokines Over twenty adipokines have been identified. Some adipokines are secreted solely by adipocytes; several are secreted by adipocytes and other body cells. Their role is very widespread as they integrate with various body organs and tissues: skeletal muscle, adrenal cortex, brain and sympathetic nervous system. Adipokines function in: Energy balance Immune reactions Insulin sensitivity Angiogenesis Blood pressure maintenance Lipid metabolism Hemostasis IL-6

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IL-6 responds to tissue injury. IL-6 is synthesized and secreted by many different cells in addition to adipocytes including immune cells, fibroblasts, endothelial cells and skeletal muscle. IL-6 is increased in obesity and insulin resistance and those with elevated levels are at higher risk for type 2 diabetes and myocardial infarction. Similar to TNF-a, IL-6 increases NEFA release and reduces adiponectin secretion. IL-6 increases insulin resistance by inhibiting insulin receptor signal transduction in liver cells. It also increases other inflammatory cytokines, interleukin-1 (IL-1) and TNF-a, and stimulates the liver to produce C-reactive protein (CRP), an important protein marker of inflammation. Adiponectin View Page Adiponectin is very different from TNF-a, IL-6, and PAI-1. It is synthesized and secreted almost exclusively by the adipocytes and is an anti-inflammatory cytokine. Levels of

adiponectin are decreased in weight gain, obesity and in those who are insulin resistant. Secretions of TNF-a and IL-6 reduce adipocyte secretion of adiponectin. Adiponectin is a protective adipokine. It inhibits several steps in the inflammatory process and increases insulin sensitivity by enhancing glucose transport into muscle cells. Adiponectin also decreases liver glucose production. Adiponectin slows and inhibits steps in plaque formation in blood vessels and is thus antiatherogenic. Insulin Resistance View Page Insulin is a pancreatic hormone that plays a vital role in carbohydrate and lipid metabolism. Insulin regulates glucose concentrations by: Promoting glycolysis - the uptake of glucose by cells for energy Stimulating glycogenesis - the conversion of excess blood glucose to glycogen storage in the liver Inhibiting glycogenolysis - the conversion of glycogen back to glucose Inhibiting gluconeogenesis - the formation of glucose from noncarbohydrates Insulin increases lipid synthesis in the liver and fat cells and inhibits lipolysis, the release of non-esterified fatty acids (NEFAs) from triglycerides in fat and muscle cells. Insulin also promotes protein synthesis.If insulin resistance occurs, carbohydrate and lipid metabolism are impaired. Insulin resistance ordinarily results in increased insulin levels as the body senses a need for more insulin action. The impaired insulin action results in elevated plasma glucose levels. The increase in lipolysis increases blood concentrations of NEFAs and causes abnormal blood lipid levels. Mycology: Yeasts and Dimorphic Pathogens The most common eye complication in patients with candidiasis is: OSHA Electrical Safety Which of the following identifies a major mechanism of electricity-induced injury? Electricity-induced Injury The major mechanisms of electricity-induced injury include: Electrical energy causing direct tissue damage Conversion of electrical energy into thermal energy causing massive tissue destruction Direct trauma resulting from falls or violent muscle spasms Parasitology Question Bank - Review Mode (no CE) Which of the parasites listed here is/are transmitted via ingestion of contaminated pork?

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View Page This suspicious form was recovered in muscle tissue. View Page This parasite, found in striated muscle, is responsible for which of the following View conditions? Page Stool is the specimen of choice for the recovery of which of the following parasites? View Page Which of the following parasites lay live larvae? View Page Match each parasite listed here with its corresponding optimal specimen type from which View it may be recovered: Page

A 29 year old male steak house owner from Arizona presented to his doctor complaining View of weight loss, abdominal pain and diarrhea. Patient history revealed that the man eats all Page of his meals at his restaurant and his favorite meat is rare sirloin steak. The man also noted that he had recently been on anti-parasitic medication. The doctor ordered a stool for parasitic examination. These two suspicious forms were seen. The patient is most likely suffering from an infection with: Which of the following parasites may be recovered in the peripheral blood? View Page Semen Analysis In reference to semen analysis microscopic examination, "round cells" could refer to which of the following types of cells? The Influenza A Virus: 2009 H1N1 Subtype Signs and Symptoms of the H1N1 Virus Symptoms of the Influenza A 2009 H1N1 virus are similar to what is currently recognized as typical flu-related symptoms. The most common symptoms for the H1N1 virus include: fever (greater than 100.0 F or 37.8 C) sore throat fatigue cough runny / stuffy nose chills diarrhea nausea / vomiting headaches body aches (muscle & joint pain) More severe symptoms may be present. Transfusion Reactions Iron Overload A unit of red blood cells (RBCs) contained 250 mg of iron as part of the hemoglobin molecule. A long-term complication of red cell transfusion is iron overload, or hemosiderosis. As red cells are destroyed, they release iron. The iron cannot be excreted and is stored as hemosiderin and ferritin. Iron accumulates in the liver, heart, spleen, and endocrine organs. Tissue damage, heart failure, liver failure, diabetes, and hypothyroidism can occur. Patients who are transfused frequently are at the greatest risk for iron overload. Diseases such as sickle cell disease, thalessemia, aplastic anemia, and other chronic anemias usually require frequent transfusions. Signs and symptoms of hemosiderosis include muscle weakness, fatigue, weight loss, mild jaundice, anemia, and cardiac arrhythmias. Ferritin levels and other iron studies should be assessed. Specific stains may be used to detect iron in tissue biopsies. Iron chelation may be used to treat and prevent iron overload. Chelation works by using an agent which binds to iron and helps remove it through the urine or feces.

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