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The eyelids can be closed to keep harmful materials out of the eye cheap renagel 400 mg online, and blinking helps ◗ The free dendrite of a sensory neuron generic renagel 400mg otc, such as the re- to lubricate the eye cheap 800mg renagel with mastercard. A muscle, the levator palpebrae, is at- ceptors for pain tached to the upper eyelid. When this muscle contracts, it ◗ A modified ending, or end-organ, on the dendrite of an keeps the eye open. If the muscle becomes weaker with afferent neuron, such as those for touch and temperature age, the eyelids may droop and interfere with vision, a ◗ A specialized cell associated with an afferent neuron, condition called ptosis. Cells within the ◗ Chemoreceptors, such as receptors for taste and smell, conjunctiva produce mucus that aids in lubricating the detect chemicals in solution. Where the conjunctiva folds back from the eyelid to ◗ Photoreceptors, located in the retina of the eye, respond the anterior of the eye, a sac is formed. With age, the conjunctiva often thins and dries, of these receptors are located in the skin. These include pressure Eyelashes Eyebrow receptors in the skin, receptors that monitor body posi- tion, and the receptors of hearing and equilibrium in the ear, which are activated by the movement of cilia on specialized receptor cells. Any receptor must receive a stimulus of adequate in- Upper eyelid tensity, that is, at least a threshold stimulus, in order to (superior respond and generate a nerve impulse. A special sense is localized Iris Pupil Sclera in a special sense organ; a general sense is widely distrib- (covered with uted throughout the body. Bates’ Guide to Physical Ex- ◗ Hearing from receptors in the internal ear amination and History Taking. Philadelphia: Lippincott ◗ Equilibrium from receptors in the internal ear Williams & Wilkins, 2003. Superior canal Coats of the Eyeball The eyeball has three separate coats, or tunics (Fig. Lacrimal sac The outermost tunic, called the sclera (SKLE-rah), is made Ducts of of tough connective tissue. It is commonly referred to as Nasolacrimal lacrimal duct the white of the eye. It appears white because of the colla- gland gen it contains and because it has no blood vessels to add Opening of color. The second tunic of the eyeball is the choroid (KO-royd). This coat is composed of a delicate network of Figure 11-2 The lacrimal apparatus. The lacrimal (tear) connective tissue interlaced with many blood gland and its associated ducts are shown. The choroid may be compared to the dull black lining of ◗ Tears, produced by the lacrimal (LAK-rih-mal) glands a camera in that it prevents incoming light rays from scat- (Fig. As tears flow across the The blood vessels at the posterior, or fundus, of the eye from the lacrimal gland, located in the upper lateral 11 eye can reveal signs of disease, and visualization of part of the orbit, they carry away small particles that these vessels with an ophthalmoscope (of-THAL- may have entered the eye. The tears then flow into mo-skope) is an important part of a medical examination. An excess of tears causes cells known as rods and cones, which generate the nerve a “runny nose”; a greater overproduction of them re- impulses associated with vision. With age, the lacrimal glands produce less secretion, but tears still may overflow onto the cheek if the nasolacrimal ducts Checkpoint 11-2 What are the names of the tunics of the eye- ball? Pathway of Light Rays and Refraction As light rays pass through the eye to- ward the retina, they travel through a series of transparent, colorless parts de- scribed below and seen in Figure 11-3. On the way, they undergo a process known as refraction, which is the bending of light rays as they pass from one substance to another substance of different density. The eye’s transparent refracting parts are listed here, in order from exterior to interior: ◗ The cornea (KOR-ne-ah) is an ante- Figure 11-3 The eye. Note the three tunics, the refractive parts of the eye (cornea, rior continuation of the sclera, but it aqueous humor, lens, vitreous body), and other structures involved in vision. Next are the rods and cones, referred to frequently as the window of the eye. It bulges the receptor cells of the eye, named for their shape.

Guidelines for the prevention of catastrophic outcome cheap renagel 800 mg free shipping. Mechanisms and pathophysiology of cerebral concussion best 800 mg renagel. Traumatically induced axonal damage: evidence for enduring changes in axolemmal permeability with associated cytoskeletal change 400mg renagel with mastercard. The neurochemical and metabolic cascade following brain injury: moving from animal models to man. Closed head injury: psychological, social and family consequences. Neurobehavioural Consequences of Closed Head Injury. Clinical and neuropsychological aspects of closed head injury. Delayed recovery of intellectual function following minor head injury. Performance changes during recovery from closed head injury. Paced auditory serial addition task: a measure of recovery from concussion. Duration of post-traumatic amnesia after mild head injury. Memory and information processing capacity after closed head injury. Cumulative and persisting effects of concussion on attention and cognition. Neuropsychological and psychological consequences of minor head injury. Persisting effects of minor head injury observable during hypoxic stress. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. Neurobehavioural outcome following minor head injury: a three centre study. Moderate head injury: completing the clinical spectrum of brain trauma. Mild head injury in sports: neuropsychological sequelae and recovery of function. An objective measure of recovery from concussion in Australian rules footballers. Measurement of intellectual functions in the acute stages of head injury. A psychometric study of identical twins discordant for closed head injury. Acta Psychiatr Neurol Scandi 1958;33(Supplement 22): 1–77. Measurement of reaction time following minor head injury. Reaction time and attention after closed head injury. Differential effects of simple and choice reaction after closed head injury. Return to athletic competition following concussion. Neuropsychological recovery after concussion in Australian rules footballers. Mild head injury effects in rugby: is the game really worth the cost. In: International Neuropsychological Society 16th European Conference; 1993; Madiera, Portugal: International Neuropsychological Society; 1993.

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This variety in receptor types allows a messenger to have different actions in different cells trusted 400mg renagel. CHAPTER 11 / CELL SIGNALING BY CHEMICAL MESSENGERS 199 Table 11 cheap renagel 400mg on-line. ADENYLYL CYCLASE AND CAMP PHOSPHODIESTERASE Dennis Veere was hospitalized for dehydration resulting from cholera cAMP is referred to as a second messenger because changes in its concentration toxin (see Chapter 10) cheap renagel 400 mg otc. Cholera A reflect changes in the concentration of the hormone (the first messenger). When toxin was absorbed into the intestinal a hormone binds and adenylyl cyclase is activated, it synthesizes cAMP from mucosal cells, where it was processed and adenosine triphosphate (ATP). The tor), a small G protein normally involved in concentration of cAMP and other second messengers is kept at very low levels vesicular transport. Cholera A toxin is an in cells by balancing the activity of these two enzymes so that cAMP levels can NAD-glycohydrolase, which cleaves NAD and transfers the ADP ribose portion to other change rapidly when hormone levels change. It ADP-ribosylates the G s subunit centration of cAMP by targeting the phosphodiesterase enzyme rather than of heterotrimeric G proteins, thereby inhibit- adenylyl cyclase. For example, insulin lowers cAMP levels by causing phospho- ing their GTPase activity. It is an allosteric activator of protein kinase cyclase, resulting in increased production of A (see Chapter 9, section III. The CFTR channel is activated, result- phosphorylates a large number of metabolic enzymes, thereby providing a rapid ing in secretion of chloride ion and Na ion response to hormones such as glucagon and epinephrine. The catalytic subunits of into the intestinal lumen. The ion secretion is protein kinase A also enter the nucleus and phosphorylate a gene-specific tran- followed by loss of water, resulting in vomit- scription factor called CREB (cyclic AMP response element-binding protein). In other cell types, cAMP directly activates ligand-gated channels. Some signaling pathways cross from the MAP kinase pathway to phosphorylate CREB, and all het- 3. PHOSPHATIDYLINOSITOL SIGNALING BY HEPTAHELICAL erotrimeric G protein pathways diverge to RECEPTORS include a route to the MAP kinase pathway. Certain heptahelical receptors bind the q isoform of the G subunit (G ), which These types of complex interconnections in q signaling pathways are sometimes called activates the target enzyme phospholipase C (see Fig. IP3 has a binding site in the sarcoplasmic reticulum and the endoplasmic reticulum that stimulates the release of Ca2 (Fig. Ca2 activates enzymes containing the calcium–calmodulin subunit, including a protein kinase. Diacylglycerol, which remains in the membrane, acti- vates protein kinase C, which then propagates the response by phosphorylating target proteins. Changes in Response to Signals Tissues vary in their ability to respond to a message through changes in receptor activity or number. Many receptors contain intracellular phosphorylation sites that alter their ability to transmit signals. Formation and cleavage of the cyclic phosphodiester bond in cAMP. When activated by G s, adenyl cyclase converts ATP to 3 ,5 - cyclic AMP PPi. After a hormone binds to the receptor, the hormone–receptor endocytosis and degradation of complex may be taken into the cell by the process of endocytosis in clathrin- acetylcholine receptors lead to a coated pits (see Chapter 10, Section III. This internalization of receptors decreases the synthesis of new receptors. Thus, downreg- number available on the surface under conditions of constant high hormone lev- ulation of acetylcholine receptors is part of els when more of the receptors are occupied by hormones and results in decreased this disease. SIGNAL TERMINATION Some signals, such as those that modify the metabolic responses of cells or trans- mit neural impulses, need to turn off rapidly when the hormone is no longer being produced. Other signals, such as those that stimulate proliferation, turn off more slowly. In contrast, signals regulating differentiation may persist throughout our lifetime.

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Vigorous fest by the significant incidence of diabetes mellitus (25%) and impaired glucose tol- exercise discount renagel 800 mg on line, stage III–IV sleep discount renagel 800 mg online, psychological erance (33%) in patients with acromegaly buy cheap renagel 800 mg on-line, such as Sam Atotrope. Yet, under normal and physical stress, and levodopa, clonidine, circumstances, physiologic concentrations of GH (as well as cortisol and thyroid hor- and estrogens also increase GH release. This “proinsular” effect is strate the autonomous hypersecretion of GH probably intended to act as a “brake” to dampen any potentially excessive “contrain- involves giving the patient an oral glucose sular” effects that increments in GH and the other counterregulatory hormones exert. A sudden rise in blood glucose sup- presses serum GH to 2 ng/mL or less in nor- mal subjects, but not in patients with active acromegaly. BIOCHEMICAL COMMENTS If one attempts to demonstrate auto- nomous hypersecretion of GH in a patient Most hormones are present in body fluids in picomolar to nanomolar suspected of having acromegaly, therefore, amounts, requiring highly sensitive assays to determine their concentration in before drawing the blood for both the basal the blood or urine. Radioimmunoassays (RIAs), developed in the 1960s, use (pre-glucose load) serum GH level and the an antibody, generated in animals, against a specific antigen (the hormone to be meas- post-glucose load serum GH level, one must ured). Determining the concentration of the hormone in the sample involves incubat- be certain that the patient has not eaten for ing the plasma or urine sample with the antibody and then quantifying the level of anti- 6–8 hours, has not done vigorous exercise for at least 4 hours, remains fully awake dur- gen–antibody complex formed during the incubation by one of several techniques. A standard curve is prepared, using a set amount of the antibody and vari- GH secretion for at least 1 week. In addition to Under these carefully controlled circum- a known concentration of the unlabeled hormone, each tube contains the same stances, if both the basal and postsuppres- small, carefully measured amount of radiolabeled hormone. The labeled hormone sion serum levels of the suspect hormone and the unlabeled hormone compete for binding to the antibody. The higher the are elevated, one can conclude that amount of unlabeled hormone in the sample, the less radiolabeled hormone is autonomous hypersecretion is probably bound. At this point, localization proce- patient’s blood or urine, containing the unlabeled hormone to be measured, is incu- dures (such as an MRI of the pituitary gland in an acromegalic suspect) are performed to bated with the immobilized antibody in the presence of the same small, carefully further confirm the diagnosis. The amount of radiolabeled hormone bound to the antibody is determined, and the standard curve is used to quantitate the amount of unlabeled hormone in the patient sample. CHAPTER 43 / ACTIONS OF HORMONES THAT REGULATE FUEL METABOLISM 803 The same principle is used in immunoradiometric assays (IRMAs), but with this technique the antibody, rather than the antigen to be measured, is radiola- beled. The first antibody, attached to a 30 solid support matrix such as a plastic culture dish, binds the hormone to be assayed. The sandwich technique can be improved even further if the second antibody is Fig. Standard curve for a radioim- attached to an enzyme, such as alkaline phosphatase. A constant amount of radioactive an added colorless substrate into a colored product, or a nonfluorescent substrate T4 is added to a series of tubes, each of which into a highly fluorescent product. These changes can be quantitated if the degree of contains a different amount of nonradioactive change in color or fluorescence is proportional to the amount of hormone present in T4. The amount of radioactive hormone that 9 binds to an antibody specific for the hormone the patient sample. Less than a nanogram (10 g) of a protein can be measured by is measured and plotted against the nonra- such an enzyme-linked immunosorbent assay (ELISA). When more nonradioactive T4 is present in the tube, less radioactive T4 binds to the antibody. Fat metabolism and diabetes: 2003 American Diabetes Association Postgraduate Course. Role of cortisol in the pathogenesis of deficient counterregulation after antecedent hypoglycemia in normal humans. Lipid-induced insulin resistance in human muscle is associated with changes in diacylglycerol, protein kinase C, and I kappa B-. Effect of epinephrine on muscle glycogenolysis and insulin- stimulated muscle glycogen synthesis in humans. In: Larsen PF, Kronenberg HM, Melmed S, Polon- sky KS, eds. Effect of 6-week course of glucagon-like peptide one on glycemic conrol, insulin sensitivity, and beta cell function in type 2 diabetes. As a third-year medical student, you examine your first patient.

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