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Instructor’s Manual ® for the Laboratory Manual This online manual is housed within the instructor Online Learning Center discount lady era 100mg otc women's health center of jackson wy. It provides answers to the lab report questions 100mg lady era with mastercard women's health center fishersville va, PageOut is McGraw-Hill’s exclusive tool for creating your own as well as overviews on how to present each laboratory exercise, website for your anatomy course. It requires no knowledge of materials lists, and additional topics for discussion. Transparencies This set of transparency acetates includes 200 full-color illustra- In addition to the materials specifically designed to accom- tions from the text that have been chosen for their value in rein- pany Human Anatomy, McGraw-Hill offers the following supple- forcing lecture presentations. Visual Resource Library Regional Human Anatomy: A Laboratory Workbook For Accessed through the instructor site at the Online Learning Use With Models and Prosections by Frederick E. Grine, Center and also available on CD-ROM, the Visual Resource Li- State University of New York—Stony Brook. Organized with a brary contains labeled and unlabeled versions of the key illustra- regional approach to human anatomy, this workbook utilizes tions and photos from the book, as well as all tables. You can coloring and labeling activities to simplify the learning of quickly preview images and incorporate them into PowerPoint or anatomy. Brief text descriptions of key anatomical structures other presentation programs to create your own multimedia pre- are grouped with detailed illustrations that can be colored and sentations. You can also remove and replace labels to suit your labeled to reinforce the material presented. Instructor’s Manual Anatomy and Physiology Laboratory Manual-Fetal Pig by Accessed via the Online Learning Center, the instructor’s manual Terry R. Prince provides in- color photos of the dissected fetal pig with corresponding labeled structional support in the use of the textbook. This online multimedia program contains vivid, high- emphasizes learning through the process of color association. The program helps The Coloring Guide provides a thorough review of anatomical students easily identify and review the corresponding struc- and physiological concepts. A set of two interactive CD- ROMs that cover each body system and demonstrate clinical ACKNOWLEDGMENTS concepts, histology, and physiology with animated three- Preparing a new edition of a text is a formidable task that in- dimensional and other images. And in the case of this text, even family members were Paolini, San Diego State University. My sincere gratitude is extended to faculty and stu- full-color, high-resolution light micrograph images and 35 scan- dents who have used previous editions of this text and have ning electron micrograph images of selected tissue sections typi- taken the time to suggest ways to improve it. Each image has labels thinking of others who will be using the text in the future, and at that can be clicked on or off, has full explanatory legends, offers the same time, ensuring a future for the text. Ronald Galli, colleagues at Weber State University, who were especially supportive of my efforts in preparing this edition. Feedback from conscientious students is espe- logical processes that are narrated and animated in vibrant cially useful and appreciated. Several physicians contributed clinical input to this edi- Life Science Animations (LSA) videotape series contains 53 tion. Prince animations on five VHS videocassettes: Chemistry, the Cell, and Karianne N. Prince for their contributions of additional and Energetics; Cell Division, Heredity, Genetics, Reproduc- Clinical Practicums and the accompanying radiographic images. A father’s request to three of his sons resulted in Another available videotape is Physiological Concepts of Life additional clinical input. Van De Graaff for their generous suggestions and genuine interest in Atlas to Human Anatomy by Dennis Strete, McLennan what their dad does. This atlas Crawley has continued to be supportive of my writing endeavors. This atlas in the previous editions and a number of new ones for this edi- is a guide to the structure and function of human skeletal tion. The illustrations help students locate muscles and Watts, Department of Radiology at the Utah Valley Regional understand their actions. Medical Center, provided many of the radiographic images used Laboratory Atlas of Anatomy and Physiology, third edition, in the previous editions of this text and some new ones for this by Eder et al. Thanks are also extended to Don Kincaid and Rebecca skeletal anatomy, human muscular anatomy, dissections, and Gray of Ohio State University, who dissected and photographed reference tables.

Type 2 diabetes secretion of both insulin and glucagon pancreatic beta cells (A) Has a strong genetic component to from the pancreas? A 55-year-old man was diagnosed with least likely see in a person with long- into skeletal muscle type 1 diabetes at the age of 8 buy generic lady era 100 mg on line breast cancer zero stage. Insulin signaling and (D) Ketoacidosis (D) After a 3-day fast the regulation of glucose and lipid me- 7 purchase lady era 100 mg online pregnancy urinary tract infection. J Clin Invest (D) Somatostatin regulating the trafficking and plasma 1999;103:931–943. The insulin-glucagon ratio would be membrane fusion of GLUT4-contain- Wilson JD, Foster DW, Kronenberg HM, expected to be lowest ing intracellular vesicles. CHAPTER Endocrine Regulation of Calcium, Phosphate, and Bone Metabolism 3636 Daniel E. CHAPTER OUTLINEAN OVERVIEW OF CALCIUM AND PHOSPHORUS INREGULATION OF PLASMA CALCIUM AND THE BODY PHOSPHATE CONCENTRATIONSMECHANISMS OF CALCIUM AND PHOSPHATEABNORMALITIES OF BONE MINERAL HOMEOSTASIS METABOLISM KEY CONCEPTS 1. When plasma calcium levels fall below normal, sponta- vital role in calcium and phosphate homeostasis, and acts neous action potentials can be generated in nerves, lead- on bones, kidneys, and intestine to raise the plasma cal- ing to tetany of muscles, which, if severe, can result in cium concentration and lower the plasma phosphate con- death. Vitamin D is converted to the active hormone 1,25-dihy- ized form, about 10% is bound to small anions, and about droxycholecalciferol by sequential hydroxylation reactions 40% is bound to plasma proteins. The majority of ingested calcium is not absorbed by the GI cium concentration. Calcitonin, a polypeptide hormone produced by the thyroid phate is almost completely absorbed by the GI tract and glands, tends to lower the plasma calcium concentration, leaves the body mostly via the urine. Osteoporosis, osteomalacia and rickets, and Paget’s disease lated by a decrease in plasma-ionized calcium. Tclosely regulated of all physiological parameters in the Phosphorus also plays important roles in the body. Such stringent regulation in a biological system usually implies that the parameter plays an important role Calcium Plays Key Roles in Nerve and Muscle in one or more critical processes. Excitation, Muscle Contraction, Enzyme Function, Phosphate also plays a variety of important roles in the and Bone Mineral Balance body, although its concentration is not as tightly regulated Calcium affects nerve and muscle excitability, neurotrans- as that of calcium. Many of the factors involved in regulat- mitter release from axon terminals, and excitation-contrac- ing calcium also affect phosphate. It serves as a second or third messenger in several intracellular signal transduction path- ways. Some enzymes use calcium as a cofactor, including AN OVERVIEW OF CALCIUM AND some in the blood-clotting cascade. PHOSPHORUS IN THE BODY Of all these roles, the one that demands the most care- Calcium plays a key role in many physiologically important ful regulation of plasma calcium is the effect of calcium on processes. A chronic increase in plasma calcium can of nerve membranes, which influences the ease with which 634 CHAPTER 36 Endocrine Regulation of Calcium, Phosphate, and Bone Metabolism 635 action potentials are triggered. Low plasma calcium can lead to the generation of spontaneous action potentials in TABLE 36. When motor neurons are affected, tetany of the muscles of the motor unit may occur; this condition is Percentage of Total Body Content called hypocalcemic tetany. Latent tetany may be revealed Constituent Present in Bone in certain diagnostically important signs. Trousseau’s sign Calcium 99 is a characteristic spasm of the muscles of the forearm that Phosphate 86 causes flexion of the wrist and thumb and extension of the Carbonate 80 fingers. It may occur spontaneously or be elicited by infla- Magnesium 50 tion of a blood pressure cuff placed on the upper arm. Sodium 35 Chvostek’s sign is a unilateral spasm of the facial muscles Water 9 that can be elicited by tapping the facial nerve at the point where it crosses the angle of the jaw. Calcium and Phosphorus Are Present Phosphate Participates in pH Buffering and Is a in the Plasma in Several Forms Major Constituent of Macromolecules and Bones In humans, the normal plasma calcium concentration is 9. Plasma calcium exists in three forms: ion- important metabolic processes.

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A renal stone may obstruct the ureter and the ureter contains another longitudinal layer to the outside greatly increase the frequency of peristaltic waves in an attempt to of the circular layer order 100mg lady era free shipping women's health center at uic. The pain from a lodged urinary stone is extreme and urine through the ureter discount lady era 100mg without a prescription women's health big book of 15 minute workouts pdf download. A lodged urinary stone also by the presence of urine in the renal pelvis, and their fre- causes a sympathetic ureterorenal reflex that results in constriction of renal arterioles, thus reducing the production of urine in the kidney quency is determined by the volume of urine. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 19 Urinary System 685 Ureter Uterus Symphysis pubis Urinary bladder Symphysis pubis Rectum Rectum Vagina Urethra (a) (b) FIGURE 19. In the male (a), the urinary bladder is located between the symphysis pubis and the rectum. In the female (b), the urinary bladder is located between the symphysis pubis and the uterus and upper portion of the vagina. In a female, the volume capacity of the urinary bladder is diminished during the last trimester of pregnancy, when the greatly enlarged uterus exerts constant pressure on the urinary bladder. Urinary Bladder The urinary bladder is a saccular organ for storage of urine. It is located just posterior to the symphysis pubis, anterior to the rec- tum (fig. In females, the urinary bladder is in contact with the uterus and vagina. The shape of the urinary bladder is determined by the vol- ume of urine it contains. An empty urinary bladder is pyramidal; as it fills, it becomes ovoid and bulges upward into the abdominal cavity. The median umbilical ligament, a fibrous remnant of the embryonic urachus (see Developmental Exposition, pp. The base of the urinary bladder receives the ureters, and the urethra exits at the inferior angle, or apex. The region surrounding the urethral opening is known as the neck of the urinary bladder. The internal trigone lacks rugae; it is therefore smooth in appearance and remains rel- atively fixed in position as the urinary bladder changes shape trigone: L. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 686 Unit 6 Maintenance of the Body Urinary bladder Urinary bladder Urethra Prostatic part of urethra Membranous part of urethra Bulbourethral gland (b) Corpus cavernosum penis Spongy part of urethra (a) FIGURE 19. It consists of a prostatic part that passes through the prostate, a membranous part that passes through the urogenital diaphragm, and a spongy part that passes through the penis. Urinary System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 19 Urinary System 687 The second layer of the urinary bladder, the submucosa, The urethra of the male serves both the urinary and repro- functions to support the mucosa. At the neck of the urinary bladder, can be identified in the male urethra: the prostatic part, the the detrusor muscle is modified to form the superior (called the membranous part, and the spongy part (fig. It appears only on the superior surface of the urinary the neck of the urinary bladder. The portion of the urethra re- bladder and is actually a continuation of the parietal peritoneum. The external urethral sphincter muscle The autonomic nerves serving the urinary bladder are de- is located in this portion. Sympathetic innervation arises from The spongy part of the urethra is the longest portion (15 the last thoracic and first and second lumbar spinal nerves to cm), extending from the outer edge of the urogenital diaphragm serve the trigone, urethral openings, and blood vessels of the uri- to the external urethral orifice on the glans penis. Parasympathetic innervation arises from the sec- surrounded by erectile tissue as it passes through the corpus spon- ond, third, and fourth sacral nerves to serve the detrusor muscle. The ducts of the bulbourethral glands (Cow- The sensory receptors of the urinary bladder respond to disten- per’s glands) of the reproductive system attach to the spongy part sion and relay impulses to the central nervous system via the of the urethra near the urogenital diaphragm. The urinary bladder becomes infected easily, and because a woman’s urethra is so much shorter than a man’s, women are Micturition particularly susceptible to urinary bladder infections. It is a infection that involves the renal pelvis is called pyelitis; if it continues complex function that requires a stimulus from the urinary blad- into the nephrons, it is known as pyelonephritis. To reduce the risk of der and a combination of involuntary and voluntary nerve im- these infections, a young girl should be taught to wipe her anal re- gion in a posterior direction, away from the urethral orifice, after a pulses to the appropriate muscular structures of the urinary bowel movement. In young children, micturition is a simple reflex action that occurs when the urinary bladder becomes sufficiently distended. Urethra Voluntary control of micturition is normally developed by the time a child is 2 or 3 years old.

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Homologous chromosomes contain genes for the same characteristic at the same locus generic 100 mg lady era with mastercard menstrual girls. One allele of each pair originates from the female parent and the other from the male purchase lady era 100mg overnight delivery breast cancer website. The shape of a person’s ears, for example, is determined by the kind of allele re- ceived from each parent and how the alleles interact with one another. Alleles are always located on the same spot (called a locus) on homologous chromosomes (Fig. For any particular pair of alleles in a person, the two alleles are either identical or not identical. Two par- If the alleles for a particular trait are homozygous, the char- ents with unattached (free) earlobes can have a child with attached earlobes. If the alleles for a particular trait are heterozygous, phenotypes of the individuals would be free earlobes resulting from however, the allele that expresses itself and the way in which the the presence of a dominant allele in each genotype. A person who genes for that trait interact will determine the phenotype. The inherited two recessive alleles for earlobes would have the geno- allele that expresses itself is called the dominant allele, the one type ee and would have attached earlobes. The various combinations of Thus, three genotypes are possible when gene pairing in- dominant and recessive alleles are responsible for a person’s volves dominant and recessive alleles. Only In describing genotypes, it is traditional to use letter symbols two phenotypes are possible, however, because the dominant al- to refer to the alleles of an organism. The dominant alleles are sym- lele is expressed in both the homozygous dominant (EE) and bolized by uppercase letters, and the recessive alleles are symbolized the heterozygous (Ee) individuals. Thus, the genotype of a person who is homozygous for pressed only in the homozygous recessive (ee) condition. Refer to free earlobes as a result of a dominant allele is symbolized EE; a figure 22. In both of these instances, the trait may be expressed in a child of parents who are heterozygous. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance 784 Unit 7 Reproduction and Development Phenotypes of the parents dark hair dark hair free free earlobes earlobes FIGURE 22. Any of the combinations of genes that have a D and chart, and the female gametes (ova) at the top, as in figure 22. Three of the possible combinations The four spaces on the chart represent the possible combinations have two alleles for attached earlobes (ee) and at least one allele for of male and female gametes that could form zygotes. Three of the combina- bility of an offspring having a particular genotype is 1 in 4 (. These are indicated with a for homozygous dominant and homozygous recessive and 1 in 2 square (I). The remaining possibility has the genotype eedd for at- tached earlobes and light hair. Normal color vision (designated C) are followed from parents to offspring is referred to as a dihybrid dominates. The term hybrid refers to an offspring de- depends entirely on the X chromosomes. The genotype possibili- scended from parents who have different genotypes. The al- C c X X Normal female carrying the recessive allele lele for red-green color blindness, for example, is determined by a c c X X Color-blind female In order for a female to be red-green color-blind, she must have the recessive allele on both of her X chromosomes. Her fa- Punnett square: from Reginald Crundall Punnett, English geneticist, 1875–1967 ther would have to be red-green colorblind and her mother Van De Graaff: Human VII. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance Chapter 22 Developmental Anatomy, Postnatal Growth, and Inheritance 785 would have to be a carrier for this condition. A male with only concern for developmental anatomy are such topics as ectopic one such allele on his X chromosome, however, will show the pregnancies, so-called test-tube babies, multiple pregnancy, fetal characteristic. Because a male receives his X chromosome from monitoring, and congenital defects.

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However generic lady era 100mg on line menopause and fatigue, proliferation of receptors is the normal response to a deficit in transmitter release and so the opposite change buy cheap lady era 100mg online womens health of augusta, downregulation of b-adrenoceptors by antidepressants, would follow an increase in the concentration of synaptic noradrenaline. This would be consistent with both their proposed mechanism of action and the monoamine theory for depression. Nonetheless, there are many reasons to be confident that b-adrenoceptor desensitisa- tion does not explain the therapeutic effects of antidepressants. First, with the development of more selective ligands for use in radioligand binding studies, it became evident that b-adrenoceptor downregulation can occur after only 2±3 days of drug treatment (Heal et al. Second, maprotiline, most of the SSRIs, and even some of the newer TCAs have no effect on b-adrenoceptor binding or function. Third, and the greatest problem of all, citalopram increases the b-adrenoceptor-mediated cAMP response without changing receptor density. Evidently, we must lookelsewhere to find an explanation for the neurobiology of depression and its treatment. SEROTONERGIC TARGETS There is a good deal of evidence that the therapeutic effects of antidepressants could involve adaptive changes in 5-HT1A receptors. Postsynaptic 5-HT1A receptor responses became implicated because the hyperpolarisation of hippocampal CA3 pyramidal neurons that follows ionophoretic administration of 5-HT was found to be increased after chronic treatment with most (but not all) antidepressants (Chaput, de Montigny and Blier 1991). Others suggested that antidepressants attenuate postsynaptic 5-HT1A responses because the hypothermia, evoked by their activation, is diminished by antidepressants (Martin et al. More recently, a series of studies using microdialysis in vivo has suggested that long- latency changes in presynaptic 5-HT1A receptors could underlie the therapeutic lag in antidepressant treatment. The suggested explanation for this regional difference was that the accumulation of extracellular 5-HT in the Raphe nuclei, caused by the SSRIs blocking its reuptake, activates somatodendritic 5-HT1A receptors and so inhibits the firing of serotonergic neurons. This results in reduced impulse flow to their terminals so that extracellular 5-HT does not increase there despite blockade of its reuptake (Fig. In these conditions there is little tonic activation of somatodendritic 5-HT1A autoreceptors. At nerve terminals 5-HT1B receptors control the 5-HT synthesis and release in a local manner. This leads to neuronal hyperpolarisation, reduction of the discharge rate and reduction of 5-HT release by forebrain terminals. The reduced 5-HT1A function enables serotonergic neurons to recover cell firing and terminal release. Under these conditions, the SSRI-induced blockade of the 5-HT transporter in forebrain nerve terminals results in extracellular 5-HT increases larger than those observed after a single treatment with SSRIs. This was confirmed by the finding that SSRIs did increase the concentration of extracellular 5-HT in the cortex and failed to reduce neuronal firing rate if the 5-HT1A receptor antagonist, WAY 100635, was co-administered, either systemically or by infusion directly into the dorsal Raphe nucleus. Presumably this is because the prolonged elevation of extracellular 5-HT around the neurons in the Raphe causes progressive desensitisation of the somatodendritic 5-HT1A receptors. At this point, inhibition of their firing does not occur and so more 5-HT is released in the cortex (see Hervas et al. If long-latency 5-HT1A receptor downregulation explains the antidepressant thera- peutic lag, then 5-HT1A receptor antagonists might reduce the delay in treatment response. This prediction has been tested in the clinic using combined treatment with paroxetine and the mixed b-adrenoceptor/5-HT1A antagonist, pindolol and the majority of studies report a successful outcome (see Hervas et al. However, it remains uncertain whether this effect of pindolol is due to its actions at presynaptic 5-HT1A receptors. If, as suggested earlier, postsynaptic 5-HT1A receptors are involved in the therapeutic effects of antidepressants, then co-administration of a 5-HT1A receptor antagonist of this receptor might well diminish any antidepressant effect. Pindolol is said to avoid this problem by its selective antagonism of presynaptic, but not postsynaptic, 5-HT1A receptors, but this is controversial. A related strategy would be to inactivate the 5-HT1B/1D autoreceptors which are found on serotonergic nerve terminals and so prevent feedbackinhibition of 5-HT release in the terminal field. These drugs would not prevent the impact of indirect activation of 5-HT1A receptors, and the reduced neuronal firing, by SSRIs (described above), but they would augment 5-HT release in the terminal field once the presynaptic 5-HT1A receptors have desensitised. Selective 5-HT1B/1D antagonists have been developed only recently but will doubtless soon be tested in humans.

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