ATP binds to the myosin head and causes the ‘ratchetting’ that results in contraction according to the sliding filament model. Creatine phosphate stores energy so ATP can be rapidly regenerated within the muscle cells from adenosine diphosphate (ADP) and inorganic phosphate ions, allowing for sustained powerful contractions that last between 5–7 seconds. Glycogen is the intramuscular storage form of glucose, used to generate energy quickly once intramuscular creatine stores are exhausted, producing lactic acid as a metabolic byproduct. Contrary to common belief, lactic acid accumulation doesnt actually cause the burning sensation we feel when we exhaust our oxygen and oxidative metabolism, but in actuality, lactic acid in presence of oxygen recycles to produce pyruvate in the liver which is known as the Cori cycle.Substrates produce metabolic fatigue by being depleted during exercise, resulting in a lack of intracellular energy sources to fuel contractions. In essence, the muscle stops contracting because it lacks the energy to do so. Diagnosis
Grading
The severity of muscle weakness can be classified into different "grades" based on the following criteria:
Grade 0: No contraction or muscle movement. Grade 1: Trace of contraction, but no movement at the joint. Grade 2: Movement at the joint with gravity eliminated. Grade 3: Movement against gravity, but not against added resistance. Grade 4: Movement against external resistance with less strength than usual. Grade 5: Normal strength. Classification
Proximal and distal
Muscle weakness can also be classified as either "proximal" or "distal" based on the location of the muscles that it affects.
Relapse rate has been recorded as high as 50%. Many children have been brought into remission after a second stem cell transplant.After bone marrow transplant, the relapse rate for children with JMML may be as high as 50%. Relapse often occurs within a few months after transplant and the risk of relapse drops considerably at the one-year point after transplant. A significant number of JMML patients do achieve complete remission and long-term cure after a second bone marrow transplant, so this additional therapy should always be considered for children who relapse. Frequency
JMML accounts for 1–2% of childhood leukemias each year; in the United States, an estimated 25-50 new cases are diagnosed each year, which also equates to about 3 cases per million children. There is no known environmental cause for JMML. Since about 10% of patients are diagnosed before 3 months of age, it is thought that JMML is a congenital condition in these infants

History
Juvenile myelomonocytic leukemia (JMML) is a myelodysplastic and myeloproliferative disorder. The diagnostic criteria were originally laid down by Neimeyer et al. in 1997 and 1998 and were incorporated in the WHO classification in 2008. See also
List of cutaneous conditions
Hematologic disease
List of cancer types

References


== External links ==