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Helical Smooth Muscle: Reconstructing the Three-Dimensional Paradigm Beyond the Two-Dimensional Circular Model
Abstract
Conventional smooth muscle physiology predominantly relies on the "circular muscle contraction" model to explain peristalsis in tubular organs, representing a reductionist two-dimensional projection of complex three-dimensional architecture. This review synthesizes robust evidence of helical smooth muscle organization and its functional significance in the cystic duct, ureter, esophagus, tracheobronchial tree, vasculature, and myocardium. We establish that helical arrangement is a fundamental 3D structural principle enabling multidirectional force generation, optimized fluid transport, and tissue resilience. The classical circular model omits critical biomechanical dimensions (longitudinal shortening, torsion, shear stress), necessitating a paradigm shift in textbooks and physiological modeling.
Distinguished Professor and Alice McNeal Endowed Chair of Anesthesiology
Director, Division of Molecular and Translational Biomedicine
Director, UAB Pulmonary Injury and Repair Center
Editor-in-Chief, Physiological Reviews
Organization of the Acrosome and Helical Structures in Sperm of the Aplysiid, Aplysia kurodai (Gastropoda, Opisthobranchia)
译文：
黑斑海兔(Aplysia kurodai，腹足纲，后鳃亚纲)精子顶体及螺旋结构的组织学研究
EN → ZH
2025-07-03 23:14
原文：
NERVOUS CONTROL OF OVULATION AND EJACULATION IN HELIX ASPERSA
译文：
褐云玛瑙螺排卵与射精的神经调控
EN → ZH
2025-07-03 23:13
原文：
Abstract
The ovotestis duct transports male and female gametes from the ovotestis, through the seminal vesicle, and into the fertilization pouch-spermathecal complex. All these structures are innervated by small branches of the intestinal nerve. Electrical stimulation of the nerve increased the rate at which gametes were transported in the duct and caused autosperm to flow into the fertilization pouch-spermathecal complex. These events were accompanied by stimulation-induced peristaltic contractions along the duct and activation of the cilia lining the interior of the duct. Acetylcholine and serotonin were identified as excitatory transmitters in this system, while FMRFamide was identified as a muscle relaxant. The nervous control of ejaculation may contribute to optimizing the size of the ejaculate in a context of sperm competition, while the involvement of the nervous system in ovulation may stem from a requirement for sensory integration that is peculiar to the Stylommatophora.
Stereocilia are also found in the spiral organ (of Corti), where they convert auditory stimuli into electrical stimuli. They are embedded in a gel-like structure called the tectorial membrane arranged in three rows, increasing in length.
The circular layer is the most prominent and forms a tightly wound spiral, whereas the longitudinal layers are formed by muscle bundles slightly helical in their arrangement. The outer longitudinal smooth muscle cells are up to 30–40 μm in length and 2–5 μm in diameter (Figure 1). Each smooth muscle cell is closely associated with 6–12 other cells, with gaps as close as 15–20 nm (Elbadawi and Goodman, 1980).
Abstract
The vas deferens smooth muscle (VDSM) cells contract to direct and propel sperms from the epididymis to the urethra. It is well known that membrane electrical activity, particularly the action potential (AP) is an essential prerequisite for the initiation of contraction in all types of muscle cells. As the coordinated activation of a number of ion channels in the VDSM cell membrane causes AP generation, any mutation or dysfunction of any ion channel will modulate the AP generation and hence the contraction. To explore the quantitative contribution of individual active ionic current to the AP generation, a biophysically based single guinea-pig VDSM cell model is presented. The simulated ionic currents and AP show good agreement with the experimental recordings in terms of several parameters. Therefore, this electrophysiological model can be a preliminary platform to investigate the various electrical properties of VDSM cells in both normal and pathological conditions.
Abstract— Smooth muscle cells (SMCs) play a pivotal role in
regulating vascular tone in arteries, and are therefore an
essential part of constitutive models of the artery wall. In the
present study, we developed a method to quantify in 3D the
orientation of SMCs in the intact artery wall. We stained cell
nuclei in excised mouse carotid arteries mounted between
micropipettes and imaged these in 3D using two-photon laser
scanning microscopy. A clustering method was used to identify
individual nuclei. Orientations of these nuclei (as a
representative of the SMC orientations) were found by
calculating the inertia matrix eigenvectors. Subsequently, SMC
locations and orientations were converted to cylindrical and
spherical coordinate systems, respectively. We found SMCs to
be arranged in two distinct layers. For each of these layers,
SMC orientations were described by a Bingham distribution.
Distributions showed a statistically significant helical and
transversal angular component in both inner and outer layers.
In conclusion, this study demonstrates that SMC orientation
can be quantified in 3D, and shows a distinct helical as well as
transversal orientation. The acquired distribution data are
essential to improve current constitutive models of the artery
wall, by describing physiological SMC orientation and
dispersion.
Mucus clears from the trachea in a helix: a new twist
to understanding airway diseases
ABSTRACT
Background Mucociliary clearance (MCC) is critical to
lung health and is impaired in many diseases. The path
of MCC may have an important impact on clearance but
has never been rigorously studied. The objective of this
study is to assess the three-dimensional
path of human
tracheal MCC in disease and health.
Methods Tracheal MCC was imaged in 12 ex-smokers,
3 non-smokers
(1 opportunistically imaged during acute
influenza and repeated after recovery) and 5 individuals
with primary ciliary dyskinesia (PCD). Radiolabelled
macroaggregated albumin droplets were injected into
the trachea via the cricothyroid membrane. Droplet
movement was tracked via scintigraphy, the path of
movement mapped and helical and axial models of
tracheal MCC were compared.
Measurements and main results In 5/5 participants
with PCD and 1 healthy participant with acute influenza,
radiolabelled albumin coated the trachea and did
not move. In all others (15/15), mucus coalesced into
globules. Globule movement was negligible in 3 ex-smokers,
but in all others (12/15) ascended the trachea
in a helical path. Median cephalad tracheal MCC was
2.7 mm/min ex-smokers
vs 8.4 mm/min non-smokers
(p=0.02) and correlated strongly to helical angle (r=0.92
(p=0.00002); median 18o ex-smokers,
47o non-smokers
(p=0.036)), but not to actual speed on helical path
(r=0.26 (p=0.46); median 13.6 mm/min ex-smokers
vs
13.9 mm/min non-smokers
(p=1.0)).
Conclusion For the first time, we show that human
tracheal MCC is helical, and impairment in ex-smokers
is often caused by flattened helical transit, not slower
movement. Our methodology provides a simple method
to map tracheal MCC and speed in vivo.
Despite the assumptions made in our analysis, the
results strongly suggest that the orientation of the
smooth muscle around an airway (i.e., the pitch of the
helix) could have a dramatic effect on bronchial responsiveness.
To write a superb literature review, focus on a clear structure, critical analysis, and synthesis of existing research while avoiding common pitfalls.
Understanding the Purpose
A literature review serves to demonstrate your understanding of the existing research on a particular topic. It should not merely summarize previous studies but critically evaluate and synthesize the findings to highlight gaps, trends, and future directions in the field.
Nature
Key Steps to Writing a Literature Review
Define Your Research Question: Start with a clear and focused research question or objective. This will guide your literature search and help you stay on track.
Conduct a Comprehensive Literature Search: Use academic databases and libraries to find relevant articles, books, and other sources. Ensure you include both classic studies and the latest research to provide a well-rounded perspective.
Organize Your Findings: As you gather literature, categorize the studies based on themes, methodologies, or chronological order. This will help you structure your review logically.
Critically Analyze the Literature: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the validity of the findings, and how they contribute to the field. This critical analysis is essential for a high-quality review.
Synthesize the Information: Instead of summarizing each study individually, synthesize the findings to identify patterns, contradictions, and gaps in the research. This will help you build a narrative that supports your research question.
Write Clearly and Coherently: Use clear and concise language. Ensure that your review flows logically from one section to the next. Use headings and subheadings to guide the reader through your arguments.
Revise and Edit: After completing your draft, take the time to revise and edit. Check for clarity, coherence, and consistency in your arguments. Ensure that all sources are properly cited.
Common Pitfalls to Avoid
Being Overly Ambitious: Focus on a specific aspect of your topic rather than trying to cover everything. A narrow focus will allow for a more in-depth analysis.
Lack of Critical Engagement: Avoid simply summarizing studies; engage with them critically to show your understanding and insight.
Neglecting Recent Research: Ensure that your review includes the most recent studies to reflect current trends and developments in the field.
By following these steps and avoiding common pitfalls, you can write a superb literature review that effectively contributes to your field of study and demonstrates your scholarly abilities.
We regret to inform you that we will not be processing your submission
further. Submissions sent for peer-review are selected based on discipline,
novelty and general significance, in addition to the usual criteria for
publication in scholarly journals. Therefore, our decision does not
necessarily reflect the quality of your work.
We wish you every success if you choose to pursue publication elsewhere.
Images in Clinical Medicine are classic images of common medical conditions. Images are an important part of much of what we do and learn in medicine. This feature is intended to capture the sense of visual discovery and variety that physicians experience. Images in Clinical Medicine are not intended as a vehicle for case reports.
Fifty strip preparations of human gall bladder from 25
specimens removed at operation were studied. Immedia
tely after removal the unopened gall bladder was placed
in Ringer lactate solution chilled to 4°C and gassed with
95% 02 and 5% CO2. Strips of the wall of the organ,
containing muscle and mucosa, and about 20 mm by
2 mm, were cut within two hours of removal. In the
majority of experiments a pair of strips were set up to
gether in the same organ bath giving a simultaneous
record of the circular and longitudinal muscle.
The preparation was suspended in modified Krebs
solution at 37°C equilibrated with the 95% 02 and
5 % CO2 mixture. Recordings were made on a smoked
drum using an isotonic system with a load of IG. A
vibrator was used to reduce friction.
SPONTANEOUS ACTIVITY Human gall bladder muscle
strips show rhythmic spontaneous contraction and
relaxation. Sustained tone is also shown. Slow but
considerable changes in tone may also occur, as for
example, during the period of 30 minutes after the
preparation has been set up when a gradual rise in
tone is often seen (Fig. 1). In any preparation there
is a general correspondence between the degree of
spontaneous activity, the sensitivity to added drugs,
and the absence of fibrosis. In general, circular
muscle strips are more active and more sensitive
than are longitudinal.
The gall bladder acts as a reservoir for bile and
plays a part in the regulation of biliary pressure.
There has been argument in the past as to whether
the muscle tissue in the wall plays an active role in
the expulsion ofstored bile or simply aids in prevent
ing distension and in adjusting to variations in the
volume of the contents as suggested by Halpert and
Lewis (1930).
Objectives Heister valves are mucosal folds located on the endoluminal surface of the cystic duct (CD) and were first described by Lorenz Heister in 1732. Their presence could represent an obstacle that impedes transcystic exploration. It has been suggested that the distribution of Heister valves follows a steady rhythmic pattern in a spiral disposition; however, there is no conclusive data to support this claim. The aim of this study was to describe the main characteristics of the CD and Heister valves in adult human cadavers. Methods A descriptive cross-sectional study was performed on 46 extrahepatic biliary tracts. Results The CD has an average length of 25.37 mm and diameter of 4.53 mm. The most frequent level of junction was the middle union. Heister valves were present on 32 CDs; in most cases, they were distributed uniformly on the duct and presented an oblique disposition. A nonreticular pattern was the most frequent reticular pattern. The most frequent type of the nonreticular type was the B1 subtype. The most frequent type of distribution was the nonreticular type, particularly the B1 type. Conclusions The cystic fold could hinder transcystic exploration. The cysticotomy incision should not be determined by the distribution of the fold on the CD. The morphology of the Heister valves does not show evidence of a steady systematic pattern.
Eponyms are very commonly used in medicine. Eponyms serve the goal of honoring scientists who have made important contribution to medicine. The article describes widespread and seldom used eponyms found in biliary structures. Priority of discovery of the "Heister's valve", "Luschka's ducts", "sphincter of Odd", "Vater's papilla" was established. An author provides biographical sketches of physicians in whose honor some anatomic entities were named.
The most detailed description of these ureteral folds
was published in 1942 by Ostling [1] in a scholarly paper
on the genesis of hydronephrosis, particularly with regard
to changes at the ureteropelvic junction. He studied
the ureters of 250 fetuses in various stages of development,
as well as specimens from a number of newborns
and infants, by means of microscopic sections, retrograde
thorotrast injections, and ureteral cast techniques.
Ureteral folds identical both grossly and histologically to the ones we describe were found in all fetuses as early
as the fourth month of gestation, in 37 of 40 newborns,
and in all of 10 infants less than 1 year old. Ostling
concluded that these folds were normal developmental
structures and postulated that they were due to a length
reserve of the ureter which was used during growth of the spine and the retroperitoneum after birth. He also
hypothesized that disturbances in the development of
these fetal folds might be an important factor in the
genesis of hydronephrosis. In his paper, Ostling [1]
referred to previous similar observations by W#{244}lfler
(1877) and Englisch (1879).
Our review of normal excretory urograms in infants
confirms the high frequency of upper ureteral folds. The
radiology and anatomy of folds in our patients are
identical to those described by Ostling. Transverse upper
ureteral folds are felt to represent a persistence of
normal fetal structures. They have no postnatal clinical
significance.
Trarisverse folds
in the proximal ureter. A normal variant in infants
译文：
近端输尿管的横行皱襞。婴儿期的正常变异
EN → ZH
2025-05-21 11:43
原文：
THE diagnosis of varicose veins of the ureter as a cause
of haematuria will rarely be made preoperatively.
Usually exploration is carried out to exclude more
serious disease, although occasionally the bleeding
itself has been so profuse as to endanger life.
Since the first reported case in 1922 there have been
14 cases reported, I in the British literature. I would
like to add a further case, discuss the pathology and
anatomy, and suggest an aid to diagnosis in the
future.
Ureteric varicosities usually present with painless
haematuria. The condition is commoner in the male
(12 : 3) and on the left side (12 : 3). Although portal
hypertension or other intraperitoneal disease may
predispose to their formation this is unusual-on the
other hand, varicocoele and varicose veins of the
lower limb are commonly associated.
It may have been surmised that the gonadal vessels
would have been always involved, but this is not so.
Ahlberg, Bartley, and Chidekel (1966), in cadaver
studies, have shown that the valves at the upper end
of the gonadal vessels are more commonly incom-
petent on the left than on the right, and in men than
in women. Arey (1944) showed that the develop-
ment of the left renal vein is more complicated than
that of the right and that potential embryological
portacaval anastomoses are common here. Doehner,
Ruzicka, Rousselot, and Hoffman (1956), also working
on cadavers, have confirmed connexions between the
splenic and renal veins on the left side.
Folsum, in I 922, during a discussion on haematuria
of obscure cause, described a man with bleeding seen
cystoscopically to be coming from the right ureteric
orifice. 'The patient had marked varicose veins of the
lower limbs, scrotum, and penis. An intravenous
pyelogram was not carried out, but at operation large
veins were found over the ureter and pelvis of the
kidney, one of which had ruptured into the urinary
tract. Unfortunately he does not describe the outcome.
Sporer and Pollock, in 1947, carried out a left
nephrectomy in a 62-year-old man for profuse
haematuria. In this case the intravenous pyelogram
was normal and the side was determined by cysto-
scopy. ,4t operation marked caval and portal veins
were present, one large varix having ruptured at the
pelvi-ureteric junction. Subsequently the patient
died from a carcinoma of the stomach and it is
probable that this lesion was the prime cause of the
prominent veins.
Maslow and Aron (1949) similarly performed a
right nephrectomy for a ruptured varix at the pelvi-
ureteric
junction.
The intravenous pyelogram
suggested an irregularity at this spot preoperatively.
The patient was only 33 years old and he had required
bilateral varicose-vein operations in the past.
Berman and Copeland (1953) appear to be the
first to describe the scalloped ureteric appearance
typically seen on the intravenous pyelogram in the
majority of these patients. Their 57-year-old male
had haematuria, and the intravenous pyelogram
showed multiple filling defects of the upper two-
thirds of the ureter. Cystoscopically, multiple
'benign polyps' were seen in the bladder. These
were dealt with endoscopically and subsequently a
left retrograde pyelogram confirmed the persistence
of the ureteric defects. The ureter was explored and
large veins were found emptying into a vein on the
anterior surface of the pelvis of the kidney. The
spermatic vein was reported as normal.
SUMMARY
I. Fifteen cases of ureteric varicose veins are
discussed. They nearly all (a) present with haematuria
or (b) show a scalloped corkscrew-like appearance
to the ureter on the intravenous pyelogram
without evidence of proximal obstruction.
2. Varicose veins of the lower limbs and varicocoele
are commonly present.
3. It is suggested that there are two main types:
those draining vertically via the renal pedicle and
those draining via a ‘communicating’ vein in the
gonadal vessels.
4. Spermatic phlebography is suggested as a
possible aid to differential diagnosis in the future.
“Corkscrew ureter” has previously been de-
scribed as occurring in the upper ureter, result-
ing from either ureter-al varices which occur at
any age, or transverse folds in the proximal
ureter as a normal finding in neonates. 1-4 Herein
we report 3 cases of a corkscrew appearance of
the distal ureter, all of which were secondary to
extrinsic compression.
’ A review of the literature
reveals that terms such as corkscrew ureter,
UROIOGY / AUGUST 1982 / VOLUME XX, NUMBER 2
scalloped ureter, and notched ureter have all
been used to describe the effects on the ureter
secondary to varices in the proximal ureterSS7
The term “corkscrew ureter” has also been
applied to the appearance on intravenous urog-
raphy of transverse upper ureteral folds which
are prominent in the neonatal period. These are
postulated to be of no clinical importance.2-4
We have seen a typical corkscrew appearance
of the distal ureter which has not been previously
described. In all 3 cases the original radio-
graphic appearance of these lesions on. retro-
grade pyelography suggested intrinsic ureteral
disease. All 3 patients ultimately were proved to
have extrinsic ureteral compression.
Abstract
A "corkscrew deformity" of the proximal ureter is a rare congenital anomaly that typically lacks any postnatal clinical significance. The rarity of this entity, however, has not allowed the clarification of its natural history and the ideal approach to its management. We herein present a case of a 27-year-old female patient who presented with right flank pain and significant hydronephrosis. On retrograde ureterography, a typical spiral configuration of the proximal ureter was noted. The patient underwent successful reconstruction by laparoscopic transperitoneal dismembered pyeloplasty. We report the first use of laparoscopic reconstruction for the management of "corkscrew deformity" of the proximal ureter and we focus on the imaging findings, technical details, advantages and limitations of this technique.
Then, the patient was admitted. The following
day he developed a septic shock with urinary cultures
positive for multi-drug resistant Klebsiella
pneumoniae. A new abdominal bedside ultrasound
showed a hydronephrosis of the right kidney with
an unusual ureteral dilatation. An emergency
percutaneous pielostomy was performed and anterograde
urethrography showed that the right
ureter was twisted along its long axis with a
characteristic corkscrew appearance (Figure 1).
A ‘‘corkscrew deformity’’ of the proximal ureter
is mainly due to a rare congenital anomaly that
typically lacks any postnatal clinical significance
(1). We probably report a rare case of secondary
corkscrew deformity due to the chronic inflammation/
infection and obstruction (2–4).
The rarity of this entity has not allowed the clarification
of its natural history and the ideal approach
to its management.