Muscle ultrastructure is characterised by a complex arrangement of many protein-protein interactions. The sarcomere is the basic repeating unit of muscle, formed by two transverse filament systems: the thick and thin filaments. While actin and myosin are the main contractile elements of the sarcomere, other proteins act as scaffolds, control ultrastructure composition, regulate muscle contraction, and transmit tension between sarcomeres and hence to the whole myofibril. Elucidation of the structures of muscle proteins by X-ray crystallography and nuclear magnetic resonance spectroscopy has been essential in understanding muscle contraction, enabling us to relate biological to structural information. These structures reveal how components of the muscle interact, how different factors influence conformational changes within these proteins, and how mutant muscle proteins may interfere with the regulatory fine-tuning of the contractile machinery, hence leading to disease in some cases. Here, structures solved within the sarcomere have been reviewed in order to put the numerous components into context.
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real‐time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label‐free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non‐invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
Chronic wounds are a major problem: an estimated 6.5 million people in the United States have chronic wounds that are highly susceptible to infection and difficult to manage. 1 Early identification of problematic wounds allows effective treatment, capable of changing disease course. 2 Accurate documentation and measurement of wounds are critical. The gold standard for measuring wounds is a ruler: measuring the longest axis (length) and the greatest perpendicular width. This can overestimate wound area by up to 73.9%. Measuring wounds with digital photography has been shown to be more reliable. 3 Swift Medical (Toronto, Ontario, Canada) has created a mobile application (Swift app) for wound management. The application calculates wound dimensions, including surface area, allowing highly accurate and reliable measurements, enabling wound progress to be tracked over time. 4 There are also administrative advantages in digitizing the wound documentation and measurement workflow (eg, time saving and accessing images). The study objective was to investigate the impact of the Swift app on clinicians' time efficiency, specifically wound assessment and documentation time, compared to the ruler method. Twenty medical students and dermatology residents (Faculty of Medicine, McGill University) participated voluntarily. The Swift app was used to photograph, measure, and document model wound images, using an iPhone (Apple, Cupertino, California), following training on the app. The time taken for each participant to measure the wound images (20 in total) using the Swift app and ruler method was recorded. For the ruler method, participants were instructed to draw an image representing the wound and indicate where they measured length and width. Mixed analysis of variance was used to compare measurement type (time taken to measure wound length and width, ruler vs app) across the 20 wounds repeated by each subject. Reliability was determined using intraclass correlation coefficients (ICCs) calculated in R. 5 We compared time efficiencies when measuring and documenting wounds using the ruler method compared to the Swift app (Figure 1A [dashboard] and Figure 1B,C [drawing vs photo documentation comparison]). Measurement time by the ruler method was significantly slower than using the Swift app (Table 1; mean [SD], 48.17 [7.81] vs 30.77 [5.21] seconds; P < .001, ruler vs Swift app). For the ruler method, measurements took 16.85 seconds, while charting time took an additional 31.32 seconds. Hence, for combined measurement and documentation, the Swift app was 57% faster than the ruler method and paper charting.
Z band alternately spliced PDZ-containing protein (ZASP) is a sarcomere Z disk protein expressed in human cardiac and skeletal muscle that is thought to be involved in a dominant familial dilated cardiomyopathy. The N-terminal PDZ domain of ZASP interacts with the C terminus of alpha-actinin-2, the major component of the Z disk, probably by forming a ternary complex with titin Z repeats. We have determined the structure of ZASP PDZ by NMR and showed that it is a classical class 1 PDZ domain that recognizes the carboxy-terminal sequence of an alpha-actinin-2 calmodulin-like domain with micromolar affinity. We also characterized the role of each component in the ternary complex ZASP/alpha-actinin-2/titin, showing that the alpha-actinin-2/ZASP PDZ interaction involves a binding surface distinct from that recognized by the titin Z repeats. ZASP PDZ structure was used to model other members of the enigma family by homology and to predict their abilities to bind alpha-actinin-2.
OBJECTIVE To review the clinical and scientific literature on remote monitoring and management of postsurgical wounds using smartphone applications (apps). DATA SOURCES MEDLINE, PubMed, EMBASE, and Cochrane libraries were searched for relevant articles on patients who received surgery and were monitored postdischarge via an app. STUDY SELECTION Articles were selected with the terms “mobile phones,” “smartphones,” “wounds,” “monitor,” and “patient preference.” DATA EXTRACTION The authors found 276 review articles related to telemedicine in wound care. Investigators reviewed the titles and abstracts of the search results and selected 83 articles that were relevant to the remote monitoring of wounds using smartphone apps. DATA SYNTHESIS The topics explored in selected literature included smartphone app importance to telemedicine, benefits (medical and financial), app examples, and challenges in the context of wound monitoring and management. The authors identified several challenges and limitations that future studies in the field need to address. CONCLUSIONS Remote monitoring and management of wounds using smartphone apps is a valuable technique to enhance the quality of and access to healthcare. However, although some patients may prefer this technology, some lack technological competence, limiting telemedicine’s applicability. In addition, issues remain with the reliable interpretation of data collected through apps.
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