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The comprehensive nature of the sixth edition of this text knowledge that is now taken for granted—and with what and its current clinical information enable it to be used as a valu- difficulty—can students appreciate the science of anatomy able reference resource regarding the structure infection z trailer purchase fuqixing 500 mg free shipping, function infection bio war discount 250mg fuqixing free shipping, develop- in its proper proportion antibiotics for acne inflammation cheap fuqixing online. TEXT ORGANIZATION OBJECTIVES The 22 chapters in this text are grouped into seven units that are In preparing and updating a text and its ancillaries (website, labora- identified by colored tabs on the outside page margins. A well-written and inviting text is at the heart of an for studying human anatomy by providing a historical perspective x Van De Graaff: Human Front Matter Preface © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 on how this science has developed over the centuries. Anatomy is LEARNING AIDS an exciting and dynamic science that remains vital as it continues to broaden its scope. It is hoped that this unit will make the Each of the 22 chapters of this text incorporates numerous peda- reader feel a part of the heritage of human anatomy. In short, these aids make the study of human mans as a distinct species are described. Chapter Introductions The beginning page of each chapter contains an outline of the Unit 3: Microscopic Structure of the Body The microscopic chapter contents and a Clinical Case Study pertaining to the aspect of body organization is considered at the cellular and histo- subject matter of the chapter. These hypothetical situations underscore integral aspect of learning about how the body functions. The solu- integumentary system provides the body with external support tion to the case study is presented at the end of the chapter, fol- and protection, and the skeletal system provides internal support lowing the last major section. Movement is pos- sible at the joints of the skeleton as the associated skeletal mus- cles are contracted. Surface anatomy and regional anatomy are Understanding Anatomical Terminology given detailed coverage in chapter 10 of this unit. Atlas-quality Each technical term is set off in boldface or italic type, and is photographs of dissections of human cadavers are included in often followed by a phonetic pronunciation in parentheses, at this chapter. The roots of each term can be identified by referring to the glos- Unit 5: Integration and Coordination This unit includes sary of prefixes and suffixes found on the inside of the front chapters on the nervous system, endocrine system, and sensory cover. The concepts identified and discussed in these chapters footnotes at the bottom of the page on which the term is intro- are concerned with the integration and coordination of body duced. If students know how a term was derived, and if they can functions and the perception of environmental stimuli. All of these systems work together in maintaining a Each chapter is divided into several major sections, each of stable internal environment in which the cells of the body can which is prefaced by a concept statement and a list of learning thrive on a day-to-day basis. A concept statement is a succinct expression of the main idea, or organizing principle, of the information contained Unit 7: Reproduction and Development The male and fe- in a chapter section. The learning objectives indicate the level of male reproductive systems are described in this unit, and the competency needed to understand the concept thoroughly and continuance of the human species through sexual reproduction is be able to apply it in practical situations. Unit 7 provides an overview of the entire sequence of lows discusses the concept in detail, with reference to the objec- human life, including prenatal development and postnatal tives. Knowledge Check questions at the end of each chapter growth, development, and aging. Basic concepts of genetics and section test student understanding of the concept and mastery of inheritance are also explained. Set off from the text narrative are short paragraphs highlighted Each body system chapter contains one or two Clinical by accompanying topic icons. This interesting information is rel- Practicums, placed before the chapter summary. Detailed answers evant to the discussion that precedes it, but more important, it to the Clinical Practicum questions are provided in Appendix B. The five icons represent the following topic categories: Chapter Summaries Clinical information is indicated by a stethoscope. The information contained in these commentaries provides examples of the applied A summary, in outline form, at the end of each chapter reinforces medical nature of the information featured in the topic discussion. These comprehensive summaries serve as a valuable tool in helping students prepare for examinations.

The cases of polymyositis tients with polymyositis experience muscle tenderness or associated with cancer (a paraneoplastic syndrome) are aching pain; a similar proportion of patients have some in- thought to be due to the altered immune status or tumor volvement of the heart muscle virus c buy 250 mg fuqixing otc. Several other disorders may present symptoms similar Primary idiopathic polymyositis cases comprise ap- to polymyositis; these include neurological or neuromus- proximately one third of the inflammatory myopathies virus zeus buy 100mg fuqixing amex. Early third of polymyositis cases are associated with a closely re- stages of muscular dystrophy may mimic polymyositis virus killer discount fuqixing 500 mg amex, al- lated condition called dermatomyositis, symptoms of though the overall courses of the diseases differ consider- which include a mild heliotrope (light purple) rash around ably; the decline in function is much more rapid in un- the eyes and nose and other parts of the body, such as treated polymyositis. Nail bed abnormalities may also be produce symptoms of the disease, depending on the present. Still other cases (approximately 8%) are associ- severity of the infection. A large number of commonly ated with cancer present in the lung, breast, ovary, or gas- used drugs may produce the typical symptoms of muscle trointestinal tract. This association occurs mostly in older pain and weakness, and a careful drug history may sug- patients. Finally, about one fifth of polymyositis cases are gest a specific cause. In cases in which dermatomyositis is associated with other connective tissue disorders, such as combined with the typical symptoms of polymyositis, the rheumatoid arthritis and lupus erythematosus. Careful follow-up (by Polymyositis is thought to be primarily an autoim- direct muscle strength testing and measurement of serum mune disease. Muscle histology shows infiltration by in- CK levels) is necessary to determine the ongoing effective- flammatory cells such as lymphocytes, macrophages, ness of treatment. Muscle tissue destruction, which is al- may become inactive, but relapses can occur, and other most always present, occurs by phagocytosis. The route treatment approaches, such as the use of cytotoxic drugs, of infiltration often follows the vascular supply. Long-term physical therapy and assis- may be elevated serum levels of enzymes normally pres- tive devices are required when drug therapy is not suffi- ent in muscle, such as creatine kinase (CK). It is accomplished by the interaction of Explains Muscle Contraction the globular heads of the myosin molecules (crossbridges, which project from the thick filaments) with binding sites The structure of skeletal muscle provides important clues to on the actin filaments. The width of the A bands force and shortening are produced and where the chemical (thick-filament areas) in striated muscle remains constant, energy stored in the muscle is transformed into mechanical regardless of the length of the entire muscle fiber, while the energy. The total shortening of each sarcomere is only width of the I bands (thin-filament areas) varies directly about 1 m, but a muscle contains many thousands of sar- with the length of the fiber. These represent ma- the effect of multiplying all the small sarcomere length terial extending into the A band from the I bands. The lengths of the thin and thick myofilaments comere is small (a few hundred micronewtons), but, again, remain constant despite changes in fiber length. When the muscle is stretched be- thin filaments telescope into the array of thick filaments. This limits the CHAPTER 8 Contractile Properties of Muscle Cells 145 I I Over this small region, further interdigitation does not lead A A A to an increase in the number of attached crossbridges and the force remains constant. At shorter lengths, additional geometric and physical factors play a role in myofilament interactions. Since mus- cle is a “telescoping” system, there is a physical limit to the Least overlap amount of shortening. As thin myofilaments penetrate the I I A band from opposite sides, they begin to meet in the mid- dle and interfere with each other (1.

Now the SK channels cannot open antibiotics z pack generic 500mg fuqixing overnight delivery, even though intracellular [Ca2‡] still Ca rises (Fig antibiotics for dogs at tractor supply cheap 500mg fuqixing otc. This allows the action potential discharge to continue throughout the length of the depolarising current injection (Fig antibiotics for uti penicillin purchase fuqixing 500mg without prescription. Thus, the SKCa channels induce an adaptation of the action potential discharge to a maintained stimulus: this adaptation is lost when the SKCa channels are prevented from opening. When the opening of M-channels is inhibited by muscarine, this adaptation is again lost. Also note that muscarine has actually depolarised the cell Ð the level of membrane potential before injecting the current pulse has changed. This is because a few M-channels are open at the resting potential and actually contribute to the resting potential. As mentioned above, M-channels and KCa channels co-exist in many neurons. However, in practice, their effects are slightly different, depending on the pattern of stimulation, and in fact the two currents act synergistically Ð i. SK and M channels are not the only K‡ channels regulated by transmitters. As Ca noted above, transmitters can also close, or open, other K‡ channels that do not directly regulate excitability but instead determine the resting potential of the neuron, and hence depolarise or hyperpolarise the neuron. Ca2‡ CHANNELS: PLATEAU POTENTIALS AND PACEMAKING As pointed out above, although the principal function of voltage-gated Ca2‡ channels is to provide the charge of Ca2‡ necessary for transmitter release, Ca2‡ channels are also present on the somata and dendrites of most neurons. These include two classes of Ca2‡ channel not involved in transmitter release Ð dihydropyridine-sensitive high-threshold L-type channels, homologous to the cardiac Ca2‡ channels responsible for ventricular contraction and some pacemaking activity; and low-threshold, rapidly-inactivating T- type Ca2‡ channels. First, their opening during somato-dendritic action potentials provides the source of the increased intracellular [Ca2‡] required to open Ca2‡-activated K‡ channels Ð BK channels, to accelerate spike repolarisation, and SK channels, to induce spike-train adaptation and limit repetitive firing. The BK channels are activated (primarily) following entry of Ca2‡ through L-type channels; the source of Ca2‡ for SK channel activation varies with different neurons, and may be either through L-type or N-type channels. Second, as in the ventricular muscle fibres of the heart, opening of L-type channels can generate sustained plateau potentials following the initial Na2‡-mediated action potential Ð for example, in the rhythmically firing neurons of the inferior olive (Fig. At resting potentials 4760 mV, these channels are inactivated and hence non-conducting (a voltage-sensitive closure process resembling Na‡ channel inactivation). Under these conditions, the relay neurons show sustained rhythmic firing when tonically depolarised. However, if the neurons are first hyper- polarised, T-channel inactivation is removed. This in turn induces a rapid 46 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION Figure 2. The Ca2‡ entry activates K Ca channels, to produce a long-lasting (several hundred ms) after-hyperpolarisation. Hence, as the Ca2‡ is extruded and the K current declines, the low-threshold T-type Ca2‡ channels open, and the cell depolarises to Ca reach the threshold for the Na‡ channel, giving a new action potential, and so on. The burst is arrested first because the Na‡ channels inactivate, and then because the T-type Ca2‡ channels inactivate. Both inactivation processes are removed when the cell hyperpolarises back again, so becoming available for another burst. As a result, the cells change their firing pattern from tonic firing to burst-firing simply dependent on membrane potential.

Regarding the blood draining into the catheter antibiotic spectrum buy fuqixing now, trace and explain its course of flow antibiotics vs antibacterial buy cheap fuqixing 250 mg line. Begin at a point in the ab- FIGURE: The placement of a urinary dominal aorta infection 2010 order fuqixing cheap, and end the course with drainage into the catheter. Assuming that the surgeon catheter is a common procedure for patients would be prompted to remove the kidney in order to quickly control hemorrhage, what possible who have abdominal trauma or abdominal anatomical variant should she keep in mind? A laboratory assessment (urinalysis) of the collected urine may help reveal the Hints: Study the positions of the kidneys within the abdominal cavity and note the location of extent of the trauma or a patient’s progress in the supportive and protective serous membrane. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 676 Unit 6 Maintenance of the Body INTRODUCTION TO THE URINARY SYSTEM The urinary system maintains the composition and properties of the body fluid that establishes the internal environment of the Inferior body cells. The end product of the urinary system is urine, which vena cava is voided from the body during micturition. Objective 2 Identify the arteries that transport blood to the urinary system for filtration. Abdominal aorta The urinary system, along with the respiratory, digestive, and in- tegumentary systems, excretes substances from the body. For this Ureter reason, these systems are occasionally referred to as excretory sys- tems. In the process of cellular metabolism, nutrients taken in by the digestive system and oxygen from inhaled air are used to syn- thesize a variety of substances while providing energy needed for body maintenance. Metabolic processes, however, produce cellu- lar wastes that must be eliminated if homeostasis is to be main- Urinary bladder tained. Just as the essential nutrients are transported to the cells by the blood, the cellular wastes are removed through the circu- Urethra latory system to the appropriate excretory system. Carbon diox- ide is eliminated through the respiratory system; excessive water, salts, nitrogenous wastes, and even excessive metabolic heat are removed through the integumentary system; and various diges- tive wastes are eliminated through the digestive system. Electrolytes are compounds that neys, two ureters, urinary bladder, and urethra. Electrolyte balance is achieved when the number of electrolytes entering the body equals the number leaving. Hydrogen ions, for example, are maintained in precise concentration so that an acid-base, or pH, Knowledge Check balance exists in the body. Drawing on your knowledge of the functions of the urinary A second major function of the urinary system is the excre- system, list the basic substances that compose normal urine. Explain the role of the renal vessels in maintaining home- elimination of toxic wastes that may result from bacterial action ostasis. Approximately how much blood is processed in the and the removal of various drugs that have been taken into the kidneys each minute? All of these functions are accomplished through the forma- tion of urine by the kidneys. The urinary system consists of two kidneys, two ureters, the urinary bladder, and the urethra (fig. Tubules in the kidneys KIDNEYS are intertwined with vascular networks of the circulatory system The kidney consists of an outer renal cortex and an inner renal to enable the production of urine. After the urine is formed, it is medulla that contains the renal pyramids.

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