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Many of them project to the posterior pituitary gland and are involved in lactation and uterine contractions during labor (see Chapter 43) menstruation 35 day cycle buy femara with paypal. With water deprivation breast cancer nike buy genuine femara on-line, the extracellular fluid becomes hyperosmotic pregnancy 7 weeks twins buy femara with american express, which in turn causes the intracellular fluid to become hyperosmotic. The brain contains neurons that serve as osmoreceptors for detection of increases in the osmotic pressure of extracellular fluid (see also Chapter 35). Circumventricular organs surround the cerebral ventricles and lack a blood-brain barrier. Water deprivation also causes a decrease in blood volume, which is sensed by receptors in the low-pressure side of the vasculature, including the right atrium of the heart (see also Chapter 17). Insufficient water intake is usually a greater problem than excessive water intake. Other areas of the hypothalamus, particularly the preoptic region and lateral hypothalamus, help regulate water intake, as do several structures outside the hypothalamus. Other Autonomic Control Structures Several regions of the forebrain other than the hypothalamus also play a role in autonomic control. These regions include the central nucleus of the amygdala and the bed nucleus of the stria terminalis, as well as a number of areas of the cerebral cortex. Information reaches these higher autonomic centers from viscera through an ascending system that involves the nucleus of the solitary tract, the parabrachial nucleus, the periaqueductal gray matter, and the hypothalamus. Descending pathways that help control autonomic activity originate in such structures as the paraventricular nucleus of the hypothalamus, noradrenergic cell group A5, the rostral ventrolateral medulla, and the raphe nuclei and adjacent structures of the ventromedial medulla. One mechanism for such an effect involves the release of corticotropin-releasing factor from the hypothalamus. It has sensory and motor components, and the motor component consists of sympathetic and parasympathetic divisions. The enteric nervous system is often considered as part of the autonomic nervous system but is concerned specifically with control of the gastrointestinal tract. Sympathetic preganglionic neurons are located in the thoracolumbar region of the spinal cord, and sympathetic postganglionic neurons are located in paravertebral and prevertebral ganglia. Parasympathetic preganglionic neurons are located in cranial nerve nuclei or in the sacral portion of the spinal cord. Parasympathetic postganglionic neurons reside in ganglia located in or near the target organs. Most function to activate reflexes; for some, activation also leads to sensations that are experienced consciously. The enteric nervous system includes the myenteric and submucosal plexuses in the wall of the gastrointestinal tract. The myenteric plexus regulates motility, and the submucosal plexus regulates ion and water transport and secretion. Neurotransmitters at the synapses of preganglionic neurons in autonomic ganglia include acetylcholine (acting at both nicotinic and muscarinic receptors) and a number of neuropeptides. Norepinephrine (acting on adrenergic receptors) is the neurotransmitter generally released by sympathetic postganglionic neurons; neuropeptides are also released. Sympathetic postganglionic neurons that supply sweat glands release acetylcholine. Parasympathetic postganglionic neurons release acetylcholine (acting on muscarinic receptors).

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Surfactant is readily inactivated by hypoxia menstrual xx order femara with amex, infection breast cancer cakes 2.5mg femara with mastercard, and edema fluid women's health clinic castle hill generic 2.5mg femara, which results in a decrease in lung compliance. In addition to surfactant, another mechanism, interde pendence, contributes to stability of the alveoli. Alveoli, except for those on the pleural surface, are surrounded by other alveoli. The tendency of one alveolus to collapse is opposed by the traction exerted by the surrounding alveoli. Thus collapse of a single alveolus causes stretching and distortion of the surrounding alveoli, which in turn are connected to other alveoli. Small openings (pores of Kohn) in the alveolar walls connect adjacent alveoli, whereas the canals of Lambert connect the terminal airways to adja cent alveoli. The pores of Kohn and the canals of Lambert provide collateral ventilation and prevent alveolar collapse (atelectasis). The pressure across the respiratory system is 0 at points of no airflow (end inspiration and end exhalation). Pressure gradients in the respiratory system are created by the active contraction and subsequent relaxation of the muscles of respiration. Elastic recoil is lost in patients with emphysema, and this loss is associated with an increase in lung compliance, whereas in diseases associated with pulmonary fibrosis, lung compliance is decreased. The surface tensionreducing and antisticking properties of surfactant increase lung compliance, decrease the work of breathing, and help stabilize alveoli of different size. Lung distensibility: the static pressurevolume curve of the lungs and its use in clinical assessment. American Physiological Society Handbook of Physiology: the Respiratory System, vol. Describe how flow limitation occurs at the equal pressure point and the role of dynamic airway compression in flow limitation. Understand how dynamic compliance is different from static compliance and its contribution to work of breathing. Patterns of Airflow There are two major patterns of gas flow in the airways- laminar and turbulent. As the flow rate increases and particularly as the airways divide, the flow stream becomes unsteady and small eddies develop. The pressure-flow characteristics of laminar flow were first described by the French physician Poiseuille and apply to both liquids and air. In straight circular tubes the flow rate (V) is defined by the following equation: Equation 22. It can be seen that driving pressure (P) is proportional to the flow rate (V); thus the greater the pressure, the greater the flow. The flow resistance (R) across a set of tubes is defined as the change in driving pressure (P) divided by the flow rate, or: Equation 22. This equation is for laminar flow and demonstrates that the radius of the tube is the most important determinant of resistance. If the radius of the tube is reduced by half, the resistance will increase 16-fold. If, however, tube length is increased twofold, the resistance will increase only twofold. Stated another way, resistance is inversely proportional to the fourth power of the radius, and it is directly proportional to the length of the tube and to the viscosity of the gas.

Although projections to the heart have been described breast cancer football socks buy generic femara 2.5 mg on line, their function is uncertain women's health center hudson discount femara 2.5mg with amex. The nucleus ambiguus contains two groups of neurons: (1) a dorsal group (branchiomotor) that activates striated muscle in the soft palate pregnancy diarrhea purchase genuine femara online, pharynx, larynx, and esophagus and (2) a ventrolateral group that innervates and slows the heart (see also Chapter 18). The Parasympathetic Nervous System the parasympathetic preganglionic neurons are found in several of the cranial nerve nuclei of brainstem and in the sacral spinal cord (S3-S4) gray matter. Hence, this part of the autonomic nervous system is sometimes called the craniosacral division. Postganglionic parasympathetic cells are located in cranial ganglia, including the ciliary ganglion (preganglionic input is from the Edinger-Westphal nucleus), the pterygopalatine and submandibular ganglia (input is from the superior salivatory nucleus), and the otic ganglion (input is from the inferior salivatory nucleus). The ciliary ganglion innervates the pupillary sphincter and ciliary muscles in the eye. The pterygopalatine ganglion supplies the lacrimal gland, as well as glands in the nasal and oral pharynx. The submandibular ganglion projects to the submandibular and sublingual salivary glands and to glands in the oral cavity. Other parasympathetic postganglionic neurons are located near or in the walls of visceral organs in the thoracic, abdominal, and pelvic cavities. Neurons of the enteric plexus include cells that can also be considered parasympathetic postganglionic neurons. The vagus nerves innervate the heart, lungs, bronchi, liver, pancreas, and gastrointestinal Visceral Afferent Fibers the visceral motor fibers in the autonomic nerves are accompanied by visceral afferent fibers. Most of these afferent fibers supply information that originates from sensory receptors in the viscera. The activity of these sensory receptors only rarely reaches the level of consciousness; however, these receptors initiate the afferent limb of reflex arcs. Both viscerovisceral and viscerosomatic reflexes are elicited by these afferent fibers. Even though these visceral reflexes generally operate at a subconscious level, they are very important for homeostatic regulation and adjustment to external stimuli. The fast-acting neurotransmitters released by visceral afferent fibers are not well documented, although many of these neurons release an excitatory amino acid transmitter such as glutamate. Visceral afferent fibers that can mediate conscious sensation include nociceptors that travel in sympathetic nerves, such as the splanchnic nerves. Visceral pain is caused by excessive distention of hollow viscera, contraction against an obstruction, or ischemia. The origin of visceral pain is often difficult to identify because of the diffuse nature of the pain and its tendency to be referred to somatic structures (see Chapter 7). Visceral nociceptors in sympathetic nerves reach the spinal cord via the sympathetic chain, white rami, 230 S E C T I O N 2 Berne & Levy Physiology and dorsal roots. The terminals of nociceptive afferent fibers project to the dorsal horn and to the region surrounding the central canal. They activate not only local interneurons, which participate in reflex arcs, but also projection cells, which include spinothalamic tract cells that signal pain to the brain. A major visceral nociceptive pathway from the pelvis involves a relay in the gray matter of the lumbosacral spinal cord. These neurons send axons into the fasciculus gracilis that terminate in the nucleus gracilis.

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It may seem counterintuitive that something that depolarizes the membrane can still be considered inhibitory women's health controversial issues cheap femara line, but if it decreases the probability of spiking women's health center of houston cheap femara 2.5mg, then it is indeed inhibitory (a further explanation is given in the Synaptic Integration section) menopause 37 buy femara without a prescription. Many factors determine synaptic strength, including the 94 S E C T I O N 2 Berne & Levy Physiology size and number of synaptic contacts between two cells, its activity level and past history, and the probability of vesicle fusion for the synapse. This summation process is at the core of synaptic integration, which is taken up in the next section. Synapses with high (>1) safety factors exist, however, and the neuromuscular junction is one prominent example. A high safety factor makes sense for the neuromuscular junction because each muscle cell is contacted by only a single motor neuron, and if that motor neuron is firing, the nervous system has basically made the decision to contract that muscle. To understand this concept fully, we must first recall that action potentials are typically generated at the initial segment of the cell because it has the highest density of voltage-gated Na+ channels and therefore the lowest threshold for initiation of a spike. Thus, it is the summed amplitudes of the synaptic potentials at this point, the initial segment, that is critical for the decision to spike. Responsesevoked by synapses that are electrically distant from each other (1 and 3). D, Sublinear summation of two synapses located near each other becauseofshunting(2and4). Spatial summation refers to the fact that synaptic potentials generated by different synapses can interact. Instead, if both axons fire within a short enough time of each other, their effect can be additive, as shown in. That is, when synapse 2 is active, channels are opened in the cell membrane, which means that it is more leaky. An alternative way to look at this effect is to view each synapse as a device that tries to bring the membrane potential to its own equilibrium potential. Thus far the interaction of synaptic potentials has been presented under the assumption that the postsynaptic cell membrane is passive. However, it is clear that the dendrites and somas of most, if not all, neurons contain active elements. Another example is Ca++-activated K+ channels that are present in the dendrites of some neurons. As a final example, there are some Ca++ channels that underlie a lowthreshold Ca++ spike. Modulation of Synaptic Activity Integration of synaptic input by a postsynaptic neuron, as described in the previous section, represents one aspect of the dynamic nature of synaptic transmission. A second aspect is that the strength of individual synapses can vary as a function of their use or activity. Activation of a synapse typically produces a response in the postsynaptic cell. Certain patterns of synaptic activation, however, result in changes in the response to subsequent activation of the synapse. Paired-Pulse Facilitation When a presynaptic axon is stimulated twice in rapid succession, it is often found that the postsynaptic potential evoked by the second stimulus are larger in amplitude than the one evoked by the first. Notethat facilitationfailedtooccuratthelowestfrequencyofstimulation(1/sec)andthatthedegreeoffacilitation increased with increasing frequency of stimulation in the range of frequency used. Rather, the repeated stimulation leads to an increased number of quanta of transmitter being released.

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