Joseph Miller, a 52-year-old farmer, presents to the local Emergency Department accompanied by his spouse. Joe is unable to speak but is able to acknowledge yes and no questions with noticeably painful head gestures. His wife Marjorie explains that Joe’s hand was cut badly while repairing a tractor attachment about nine days ago. The wound was quite deep and dirty, and Joe cleaned and bandaged it himself. Despite these measures, the wound became progressively more red, swollen, and painful. Three days ago, Joe began to experience muscle cramps, especially in the muscles around his jaw and neck. Eventually Joe began to have difficulty speaking and swallowing, at which point his wife insisted that he seek treatment.
At first glance, some might dismiss this as a simple wound infection. After all, Joe did not seek medical care for a rather deep and dirty wound, which creates perfect conditions for an infection. But remember that Joe has also experienced cramps, or muscle spasms—painful, involuntary muscle contractions. Is this a separate problem, unrelated to his wound, or are the two related?
1. In Joe’s case, which of the three types of muscle tissue would you expect to be affected?
a. Smooth muscle tissue
b. Skeletal muscle tissue
c. Cardiac muscle tissue
d. All three muscle tissue types would be affected.
2. Define the five common properties of muscle cells, and explain how each of these might be affected in Joe’s case.
Joe was examined by the nurse practitioner at the clinic. She notes that the wound is approximately 1 cm deep, and there is exposed muscle tissue with areas of apparent tissue death. In addition, Joseph’s head and neck muscles are in a continuous spasm, they resist passive flexion and extension, and there is increased tone in his muscles of mastication and muscles of facial expression
The findings from the physical exam lead us to think that there may be more to this story than a simple wound infection. The continuous spasm of the muscles of the head, neck, and face indicates something potentially more serious. Remember that the muscular system is responsible for vital functions such as breathing, so any disturbance in skeletal muscle homeostasis must be closely monitored.
1. Describe the structural components of the myofibril. What are the different proteins associated with the thick and thin myofilaments?
2. What would you expect the different regions of the sarcomeres to look like in the muscles of Joe’s jaw and neck?
a. The I band would increase in length as the sarcomere increased in length.
b. The A band and zone of overlap would increase in length as the sarcomere increased in length.
c. The I band would decrease in length as the sarcomere decreased in length.
d. The A band would decrease in length as the sarcomere decreased in length
Due to the progression of Joe’s symptoms, the nurse practitioner admits Joe to the hospital with a severe wound infection. She consults with a physician, and they prescribe immediate therapy with muscle-relaxing agents to try to lessen Joe’s muscle spasms. They also order tests to determine the cause of his illness and the best course of therapy.
Based on Joe’s recent medical history, the emergency room nurse practitioner diagnoses him with tetanus, a disease caused by the bacterium Clostridium tetani. C. tetani, which is a normal inhabitant of the soil, can easily contaminate dirty wounds, especially those due to farm implements, as with this case.
In the body, these bacteria produce a toxin called tetanospasmin. The toxin enters the central nervous system (the brain and spinal cord) where it blocks the mechanisms that inhibit motor neurons from firing when a muscle relaxes. With this inhibition removed, the neurons fire repeatedly and continually stimulate the muscle, causing painful and increasingly stronger muscle spasms. The masseter (jaw) muscles are often the first muscles involved, and it is the spasm of these muscles that gives rise to tetanus’ common name: lockjaw, also called trismus. The muscles of the face, neck, back, and proximal limbs are also commonly affected. The contraction of the facial musculature leads to a characteristic facial expression with a teeth-baring grin and raised eyebrows. Contraction of the back muscles may cause the back to arch posteriorly.
The worldwide incidence of tetanus is around one million cases per year. The mortality rate is nearly one hundred percent if no medical care is available. Fortunately, Joe is now in a hospital where his condition can be monitored and treated.
The most serious complication of tetanus is respiratory failure, which is usually due to spasms of the muscles around the throat. When respiratory failure develops, the only treatment is mechanical ventilation: inserting a tube into the trachea (windpipe) and having a machine breathe for the patient. Will Joe face this potentially deadly complication?
1. Why would repetitive stimulation from a motor neuron lead to a sustained muscle contraction? (Hint: Think about the processes of excitation-contraction coupling and relaxation.)
2. Which component of the neuromuscular junction is directly affected by the toxin produced by the tetanus organism?
a. The synaptic cleft
b. The axon terminals
c. The motor end plate
d. The sarcoplasmic reticulum
A potentially serious complication of tetanus is the destruction of the muscle fibers themselves, a condition known as rhabdomyolysis. The breakdown of muscle fibers releases myoglobin into the blood, which can put a strain on the kidneys and lead to a decline in their function.
Joe’s physician notes that his kidney function has declined. She suspects that this may be a result of this muscle fiber breakdown, because myoglobin was detected in Joe’s urine. She initiates immediate therapy for the kidney dysfunction and orders additional tests to look at the level of myoglobin in his blood. This is a setback for Joe’s recovery, and makes his prognosis more serious. Fortunately, his physician has discovered this complication early and has taken measures to protect his kidneys from the circulating myoglobin.
1. Joe’s skeletal muscles affected by the tetanus toxin would require an enormous amount of energy to continue to progress through repeated excitation-contraction coupling and relaxation cycles. (a) What is the role of myoglobin in muscle fiber energy production, and where is it normally found? (b) What would you expect to happen to the ATP level in Joe’s affected skeletal muscle fibers, given enough time?
2. Which of the following processes is/are used to regenerate ATP as it is consumed for energy during both muscle contraction and relaxation?
a. The creatine phosphate reaction in the cytosol
b. Glycolytic or anaerobic catabolism in the cytosol
c. Oxidative or aerobic catabolism in the mitochondria
d. Each of the above reactions is involved in ATP regeneration
Joe has now had eleven days of therapy with muscle-relaxing drugs, and is showing slow but steady improvement. He continues to have spasms in his neck and back, but they are less severe. . Joe’s physician feels that he should be able to go home soon, providing he continues to improve over the next few days.
Although he is still symptomatic, it seems as if Joe has avoided the most serious complication of tetanus: respiratory failure. However, even with improvement, he will still need to remain hospitalized for a few days to ensure that his body continues to respond to treatment.
1. If you were to do a myogram of Joe’s muscles while in spasm, what do you think it would show: isolated twitches, unfused tetanus, or fused tetanus? Why? Considering this, explain why this disease is called tetanus.
2. What would you expect to see and feel if you examined Joe’s affected skeletal muscles?
a. Flaccid or soft muscles with little muscle tone–hypotonia
b. Flaccid or soft muscles with abnormally high muscle tone–hypertonia
c. Rock hard muscles with little muscle tone–hypotonia
d. Rock hard muscles with abnormally high muscle tone—hypertonia
1. Describe the effects of disuse on Joe’s muscles if he was bedridden in the hospital for several months.
2. Damaged skeletal muscle fibers do not generally regenerate, because they are no longer capable of dividing by mitosis. Which of the following cells can assist in the repair of damaged skeletal muscle?
b. Satellite cells
Improvement of First Person Shooter (FPS) Games Distributed: 23rd March, 2015 Last Edited: third January, 2018 Disclaimer: This exposition has been presented by an understudy. This isn't a case of the work composed by our expert article essayists. You can see tests of our expert work here. Any assessments, discoveries, conclusions or suggestions communicated in this material are those of the writers and don't really mirror the perspectives of UK Essays. In the first place individual shooter (FPS) is a computer game that demonstrates the diversion play around firearm and shot weapon-based battle in the point of view of principle individual. The player encounters the activity by means of the hero eye see. When all is said in done, the principal individual shooter shares regular characters alongside some other shooter recreations. From the class' commencement, propelled 3D designs components have tested the equipment improvement, likewise the multiplayer gaming has been basic. Initially individual shooters are a sort of 3D shooter amusement, highlighting a first individual perspective with which the player sees the activity through the eyes of the player character. Normally, a player experiences a progression of levels. The best illustrations are Halo arrangement, the Left 4 Dead and Half-Life arrangement, and Golden Eye: 007. General: There are a wide range of sorts of PC recreations in the market today. From the pilot test programs to an ongoing technique, every one of the assortments have made specialty markets among a few PC gamers. To start with Person Shooter is one of the quickly developing amusement writes. Over-the-bear shooter amusements other diversion names which depend on moderately premises goes under First-Person Shooter as a subcategory. We can see through the eyes of fundamental character. The objective will be exceptionally straightforward for such diversions. In any case, decreasing the class to oversimplified components neglects to value the reasons that these diversions are so mainstream. In the first place individual shooters executes most recent innovation and stand out. Later it offered help for multi-player gaming, additionally created acclaim and judgment. As we as a whole realize that the activity amusements are fun-stuffed and exciting in this way turn out to be exceptionally prevalent. In this amusement, we have to utilize weapons, reflexes and uncommon moves with a specific end goal to beat the adversaries and push forward in the diversion. There are numerous kinds of shooter amusements. Content Analysis: Lately, rough computer games have turned out to be exceptionally famous. Each player makes their individual amusement content contingent upon the client s choices and activities in a diversion. Singular diversion content ideas are basic for the assessment of potential impacts of media use on discernments, influences, and conduct. This examination investigations the exclusively produced content with high fleeting determination. Consistent heart rate, skin conductance are related with diversion content, which recognizes the distinctive amusement playing stages and changes. In both intra-player and between player levels, Playing stages and changes between playing stages are investigated. History: The First-Person Shooters were developed since 1970 s. Labyrinth War and Spasim were begun in 1973. Notwithstanding, the consummation date is obscure. Later in 1974, University of Illinois was created which was a simple space pilot test program, and furthermore first-individual point of view. Point by point battle pilot test programs and tank test system improvement were impacted from Spasim. In 1980, Battlezone was discharged which is a tank amusement. In the first place individual perspective and 3D illustrations were effectively propelled in 1983 for home PCs In 1987, MIDI Maze was discharged which was an early first-individual shooter. Through the MIDI interface it used to arrange multiplayer amusements before Ethernet and Internet was presented. In 1991, Id Software's Hovertank 3D created beam throwing information to empower speedier gameplay for vehicle test systems. Later propelled surface mapping was presented however Ultima Underworld: The Stygian Abyss. In 1992, pretending diversion by Looking Glass Technologies presented first individual perspective and a propelled illustrations motor. Because of brutality related with the First individual shooters, they some of the time draw in the negative consideration of guardians and restriction. They are enjoyed by a few and abhorred by others. Be that as it may, now the First individual shooters have developed to be something other than careless savagery. The principal FPS is Wolfenstein which was discharged in 1992 by id programming. He Introduced super designs, great sound, and one of a kind playing styles and stayed well known. In 1993, Doom was discharged by id programming which was a major defining moment in the First individual shooters history. It was more intense and progressed than Wildenstein, as it has a considerably bigger weapons assortment. One of its fundamental offering indicates was its capacity arrange multiplayer amusements. Because of Doom s achievement, id programming has truly turned into the lord of FPS amusement designers. In 1995, Star Wars were made into a FPS-Dark Forces by LucasArts. It is propelled by the film, Star Wars. Later in 1996, RPG/FPS named Dagger fall was discharged by Bethesda Soft works. Amid this period, even alternate classifications are converged with FPS. One could battle foes with swords, ride ponies, join organizations, purchase houses, burglarize shops, and even turn into a demon. In 1996, ID Software discharged Quake which was the main FPS to move from 2-dimensional fly up adversaries to completely 3-dimensional models. The gamers require 3D quickening agent cards for elite to play this diversion. In 1997, its continuation was discharged as Quake 2, which won much praise from both the gamers and pundits. Brilliant Eye 007 which was a standout amongst the most famous comfort FPSs ever was discharged in 1997 impacted from the film of a similar name. In 1998, the amusement Half-Life was discharged by Valve. It changed the gaming scene by making its place as the best in the FP shooter. Astounding illustrations, exceedingly counterfeit condition, and a playing style impacted by film. Hoodlum: The Dark Project was discharged around the same time which underscores on stealth component. In 2000, Monolith Productions discharged "Nobody Lives Forever". In 2001, Halo for Xbox was discharged by Bungie Studios. The story is modern and includes Master Chief battling an outsider religion and zombies in marine. In 2004, an extraordinarily true to life Doom 3 was propelled with the story in view of blemishes. Later in 2004, Half-Life 2 was discharged which was considered as the best first individual shooter ever. It highlights incorporates very propelled illustrations, astonishing material science motor, and a super man-made brainpower. The entire history of First individual shooters in a word above shows how the First individual shooters have kept on pushing the sheath of designs, sound, and diversion play. In the previous decade, FPS accomplished new statures. Influencing the gaming to encounter considerably more true to life and reasonable, First individual shooters drench the player into a totally new intriguing world. Contrast between First Person Shooters and Third Person Shooters Because of hybrid of highlights and other late covers, contrasts between First individual shooters and third individual shooters keeps on existing some disarray. A standout amongst the most fundamental contrasts is the character s point of view. In a FP shooters diversion, the player is the primary character; and his perspective is through his own eyes. He won't have the capacity to see himself, in any case, can see the environment. In FP shooters, you nearly explode all that you see. Hands and weapons can be seen at the base of the screen as the move is making place through the eyes of the character. Be that as it may, in third individual shooter amusement, the fundamental character can see himself on the screen. In Third-individual shooters amusement, the encompassing condition was all the more plainly unmistakable to the players. It encourages the player to be more intuitive with the encompassing condition. The fundamental distinction, between FP Shooters and Third Person Shooters, is the player observation in associating with objects is more ideal. As the Third Person Shooter can see himself amidst the activity, he can for the most part do some truly kick-butt moves like Jackie Chan style reverse somersaults and side rolls. That is the reason, the amusement originator is permitted to make all the more unequivocally portrayed symbol, and coordinates the player's consideration as though watching a film. The limits between FP Shooters and Third-Person Shooters are not generally clear. While the fundamental character is driving a vehicle, numerous FPS amusements change to a third-individual perspective. In numerous different recreations like-Metroid Prime and Combat, the blend of first-individual for pointing and third-individual for driving has been utilized. Innovation Propelled innovation and Internet has prompted the improvement of various multiplayer First individual shooters. Multiplayer FP Shooter diversions online enables you to cooperate with players from all around the globe and appreciate the FPS recreations online with them. You can even make groups online in order to slaughter the foes effectively. A standout amongst the most well known FP Shooter diversions online is Counter Strike is. In Counter Strike, you can interface with group accomplices in order to frame the system on the choice of the weapons, choose the area and after that battle adversaries. Some FPS diversions center around the storyline as well, next to the activity. Encountering an alternate sort of world, you have to discover pieces of information and slaughter adversaries quietly in order to push forward in the amusement. Half-Life is one such diversion. As a gathering, first-individual shooters have a tendency to drive powers in quickening the improvement of PC programming and equipment. Different sorts of diversions are currently attempting to keep up, yet FPSs have a reasonable lead in the innovation race. The ascent of the 3D designs quickening agent can't be licensed to business applications; it is established solidly in PC amusements. It could be contended that 3Dfx, the organization that made the Voodoo chipset utilized by a few designs cards, owes quite a bit of its prosperity to GL Quake. A short rundown few FPS diversions: Zero Tolerance (Raycaster) Wolfenstein 3-D (Raycaster) Duke Nukem (Raycaster) Shadow Warrior (Raycaster) Fate (Raycast>GET ANSWER