<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 39-year-old male presents with muscle weakness in his upper and lower extremities. The patient has also noticed some trouble with swallowing. On physical exam, signs of hyperreflexia, spasticity, fasciculations, and muscle atrophy are present in an asymmetric fashion. Tongue fasciculations are also present. No sensory loss is noted. The patient does not report any abnormality with his bowel or bladder function. What will most likely be found on muscle biopsy?? A: Mitochondrial proliferation leading to ragged appearance in Gomori trichrome stain, B: Perimysial CD4 infiltration and perifascicular atrophy, C: CD8 infiltrating within the fascicle, D: Denervation and reinnervation of the muscle, E: Larval cysts,  <response>: This is a clinical vignette describing a patient with progressive muscle weakness and signs of upper motor neuron disease on exam, including hyperreflexia, spasticity, and fasciculations. The asymmetric presentation and presence of tongue fasciculations point towards a diagnosis of amyotrophic lateral sclerosis ALS. ALS is characterized by degeneration of both upper and lower motor neurons. On muscle biopsy in ALS, we would expect to see evidence of denervation and reinnervation as motor neurons die off and the muscle fibers try to compensate. D: Denervation and reinnervation of the muscle 