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Microorganisms are flushed from the upper digestive tract by saliva and from the lower urinary tract by urine pain treatment for pleurisy imdur 20 mg order otc. Mucus, tears, and saliva also contain lysozyme, an enzyme that destroys bacteria by dissolving their cell walls. Beneath the epithelia of the skin and mucous membranes is a layer of areolar tissue. It is normally difficult for microorganisms to migrate through this sticky tissue gel. Some pathogens overcome this obstacle, however, by producing an enzyme called hyaluronidase, which breaks it down to a thinner consistency that is more easily penetrated. Hyaluronidase occurs in some snake venoms and bacterial toxins and is produced by some parasitic protozoans to facilitate their invasion of the connective tissues. When a neutrophil detects bacteria in the immediate area, its lysosomes migrate to the cell surface and degranulate, or discharge their enzymes into the tissue fluid. Here, the enzymes catalyze a reaction called the respiratory burst: the neutrophil rapidly absorbs oxygen and reduces it to superoxide anions (O2·), which react with H+ to form hydrogen peroxide (H2O2). Superoxide, hydrogen peroxide, and hypochlorite are highly toxic; they form a chemical killing zone around the neutrophil that destroys far more bacteria than the neutrophil can destroy by phagocytosis alone. These potent oxidizing agents can also damage connective tissues and sometimes contribute to rheumatoid arthritis. Eosinophils are found especially in the mucous membranes, standing guard against parasites, allergens (allergy-causing antigens), and other foes. They congregate especially at sites of allergy, inflammation, or parasitic infection. They help to kill parasites such as tapeworms and roundworms, which are too big to phagocytize, by producing superoxide, hydrogen peroxide, and various toxic proteins including a neurotoxin. Finally, they secrete enzymes that degrade and limit the action of histamine and other inflammatory chemicals that, unchecked, could cause tissue damage. Basophils secrete chemicals that aid the mobility and action of other leukocytes: leukotrienes that activate and attract neutrophils and eosinophils; the vasodilator histamine, which increases blood flow and speeds the delivery of leukocytes to the area; and the anticoagulant heparin, which inhibits the formation of blood clots that would impede leukocyte mobility. These substances are also produced by mast cells, a type of connective tissue cell similar to basophils. Eosinophils promote basophil and mast cell action by stimulating them to release these secretions. Lymphocytes all look more or less alike in blood films, but there are several functional types. Certain lymphocytes called helper T cells function in both innate and adaptive immunity. Monocytes are leukocytes that emigrate from the blood into the connective tissues and transform into macrophages. They suffer frequent cuts, nicks, and scrapes and are daily breached even by such mundane activities as shaving and brushing our teeth. Leukocytes and macrophages play especially important roles in both innate and adaptive immunity and, therefore, in both the second and third lines of defense. Leukocytes the five types of leukocytes are illustrated and described in table 18. We will now examine their contributions to resistance and immunity in more detail. Neutrophils spend most of their lives wandering in the connective tissues killing bacteria. One of their methods is simple phagocytosis and digestion-engulfing microorganisms with their pseudopods and destroying them with lysosomal enzymes (see figs. The other is a more complex process that produces a cloud of bactericidal chemicals. Some phagocytes are wandering cells that actively seek pathogens, whereas reticular cells and others are fixed in place and phagocytize only those pathogens that come to them-although they are strategically positioned for this to occur. Macrophages are widely distributed in the loose connective tissues, but there are also specialized forms with more specific localities: microglia in the central nervous system, alveolar macrophages in the lungs, and stellate macrophages in the liver, for example. We have already considered several at the skin surface, and now turn our attention to two families of blood-borne antimicrobial proteins. Interferons When certain cells (especially leukocytes) are infected with viruses, they secrete proteins called interferons. These are of little benefit to the cell that secretes them, but are like its "dying words" that alert neighboring cells and protect them from becoming infected. They bind to surface receptors on those cells and activate second-messenger systems within. This induces the synthesis of dozens of antiviral proteins that defend a cell by such means as breaking down viral genes and preventing viral replication. Like the cascade of blood-clotting reactions, each step generates an enzyme that catalyzes the production of many more molecules at the next step; each step is an amplifying process, so many molecules of product result from a small beginning. In the classical pathway, the cascade is called complement fixation, since it results in the attachment of a chain of complement proteins to the antibody. The alternative and lectin pathways require no antibodies and thus belong to our innate immunity. In the alternative pathway, C3b binds directly to targets such as human tumor cells, viruses, bacteria, and yeasts. This, too, triggers a reaction cascade-this time with an autocatalytic effect in which C3b leads to the accelerated splitting of more C3 and production of even more C3b. In the lectin pathway, a lectin binds to certain sugars of a microbial cell surface and sets off yet another reaction cascade leading to C3b production. As we can see, the splitting of C3 into C3a and C3b is an intersection where all three pathways converge. These two C3 fragments then produce, directly or indirectly, the end results of the complement system: 1.
It drops farther to 40 mm Hg when the blood gives up O2 to respiring tissues pacific pain treatment victoria bc cheap imdur on line, and remains at this level until the blood is reoxygenated back in the lungs. Comparison of these curves shows that for a given Po2, hemoglobin gives up more oxygen at warmer temperatures. Lymph and tissue fluid would accumulate, especially in the lower regions of the body. The principal birthplace of lymphocytes is the red bone marrow; T lymphocytes migrate from there to the thymus. The thymus and spleen do not receive or filter any incoming lymph; only lymph nodes do this. Anergy is a loss of lymphocyte activity, whereas autoimmune diseases result from misdirected activity. Plasma cells are antibody-synthesizing cells of the connective tissues that develop from B cells; they are not found in the blood plasma. They also fire during expiration (although at a lower rate) to exert a braking action on the diaphragm. We inhale all the gases of the atmosphere, whether the body uses them or not; there is no way to separate one gas from another as we inhale. The relatively large inlet to the glomerulus and its small outlet result in high blood pressure in the glomerulus. Phosphate concentration is less critical than that of other electrolytes and can safely vary over a relatively broad range. Increased sodium reabsorption increases urinary H+ excretion and lowers the urine pH. More water than salt is lost in true dehydration, so the body fluids become hypertonic. There is one renal corpuscle per nephron and many nephrons drain into each collecting duct, so renal corpuscles substantially outnumber collecting ducts. Dilation of the efferent arteriole reduces resistance and thus lowers the glomerular blood pressure and filtration rate. Dietary fats are absorbed into the lacteals of the small intestine, then would have to travel the following route, at a minimum, to reach the liver: intestinal trunk thoracic duct left subclavian vein heart aorta celiac trunk common hepatic artery hepatic artery proper hepatic arteries liver. The external anal sphincter is composed of skeletal muscle and therefore controlled by the somatic nervous system. A nutrient is a dietary substance that is absorbed into the tissues and becomes part of the body; water meets this criterion and is considered a nutrient. Excessive protein intake generates excess nitrogenous waste and can cause renal damage. The ileal papilla regulates the passage of residue from the ileum of the small intestine into the cecum of the large intestine. Secretin stimulates the liver and pancreas to secrete bicarbonate and inhibits gastric secretion. Water, glucose, and other nutrients pass between cells, through the tight junctions. Building Your Medical Vocabulary (Answers may vary; these are acceptable examples. Female fetal development results from a low testosterone level, not from estrogen. Sperm have no testosterone receptors; testosterone binds to androgen-binding protein in the seminiferous tubules. There is no such phenomenon as male menopause, and sperm production normally continues throughout old age. Erection is the result of parasympathetic stimulation of the blood vessels of the erectile tissues. The ability to fertilize an egg increases in the first 10 hours as sperm become capacitated. Early cell divisions occur while the conceptus is still in the uterine tube, about 2 days before arrival in the uterus. The individual is considered an embryo then; it is not a fetus until all of the major organs have formed. The kidneys exhibit one of the greatest degrees of senescence, shrinking 60% to 80% by age 90. The foramen ovale is a shunt in the heart by which blood bypasses the lungs; the shunt that bypasses the liver is the ductus venosus. Blood in the umbilical vein is returning from the placenta, where it has picked up oxygen and thus has a high Po2. Telomerase is a telomere-repairing enzyme that prolongs cell life, as in stem cells and cancer cells. Only the ovum and cumulus oophorus cells enter the uterine tube, not the whole follicle. Such girls often have lower than average body fat and delayed menarche because of this. Many eggs and follicles undergo atresia during childhood, so their number is greatly reduced by the age of puberty. Up to two dozen follicles mature to the secondary follicle stage in each cycle, but usually only one of them ovulates. For many biological purposes, however, we deal with smaller quantities such as milligrams per deciliter (mg/dL).
In these instances pain medication for dogs with renal failure buy 40 mg imdur amex, the strangulation device only constricts the region located directly beneath the chin and/or the front and lateral areas of the neck. Frequency/occurrence Throughout the world, hanging is one of the most common methods of suicide and is favoured by men. Accidents are comparatively rare [19,80] and primarily involve incidents of autoerotic asphyxiation. Near-hanging to enhance sexual stimulation is evidently almost always practised by men [2]. Accidents in which subjects fall or slip from a height and find themselves in a hanging position from which they are unable to escape by their own efforts are extremely rare [20,21]. For example, there have been cases of small children falling onto low, taut ropes resulting in death by hanging [22]. Extremely rare cases have been reported of homicidal hangings as foul play [23,24]. In a very small number of cases, the victim was killed by another method and strung up in a hanging position in order to simulate a suicide for the purpose of concealing the crime. Classification of the circumstances Essentially, there are two distinct situations in which the body may be found, namely incomplete and complete hanging. Strangulation devices For the most part, ligature materials with a circular cross section are used. Ligatures that do not have a circular cross section include belts, straps or, more rarely, even chains. These types of object may produce characteristic indentations within the mark of the ligature. Occasionally, hanging is carried out using items of clothing, bed linen or towels. Occasionally, victims are also found in other positions, including sitting, crouching, kneeling or lying down. In approximately 70 per cent of all suicides by hanging, the body has direct contact of some kind with the surface below [27]. A long drop is used in executions, known as judicial hangings, when the condemned prisoner falls down through a trapdoor and then hangs freely. In drops of more than 1 metre into the tightening noose, fractures of the second cervical vertebra are common in adults. There have been several reports of suicides plunging from a height with the noose around their necks. Depending on the height of the drop, the body weight and the elasticity of the ligature material, this can result in decapitation [32,33]. In suicide hanging, a climbing aid will always be found in the immediate vicinity of the deceased, otherwise there can be no explanation for the free suspension. In practice it is irrelevant whether the knot is located in the middle or on the side behind the ears, since the more lateral position evidently only serves to promote the formation of petechiae [31]. In some cases, they may merely be present in the conjunctiva and/or in the skin of the eyelids. In extreme cases, the congestion syndrome produced by incomplete hanging may resemble the appearance of a ligature strangulation [34]; thus, a differentiation is problematic at best or may even prove impossible. This develops as a result of abrasion or compression of the skin by the strangulation device, which usually has a rough surface. With time, the furrow dries out, taking on a brownish hue like other skin abrasions. As abrasions and desiccations may develop postmortem, the ligature mark in itself does not constitute a criterion for vital hanging [35,37]. If a large amount of material is used or if Ligature mark soft padding is placed under the noose, the ligature mark may merely be an impression of the folds of the cloth, or there may be no mark at all. The various ligature marks in deaths by hanging rarely present associated soft tissue haematomas [27]. In suicide hangings, the marks usually run above or around the thyroid cartilage, in cases of suicidal complete hanging, the figure is even more than 70 per cent [27]. Where the ligature encircles the neck, it will be possible to establish or reconstruct the highest point in nearly every case. In closed nooses, the highest point, also known as the point of suspension, is mostly at the site of the knot. In order to determine the highest point, it may be advantageous to measure the distance between the mark and the lower edge of the auricles. Very often, the ligature furrow is most prominent opposite the point of suspension. If the noose slips upwards during the hanging, this may cause several parallel markings and broad abrasion zones that slope upwards. A band of red skin, observed occasionally above the ligature furrow only, is an incontrovertible postmortem finding. This is a result of the blood draining from the head and pooling around the ligature. This phenomenon occurs notably in bodies that have remained undiscovered for some time [35]. Peri-ligature injuries such as skin blisters, ecchymoses or abrasions are not findings that could justify the vital origin of the ligature mark [36]. Therefore, this finding should not be accorded any relevant significance in evaluating the circumstances. They cannot be distinguished from abrasions that may have been caused by cutting down or transporting the body. Decapitation Thin, strong ligature materials such as plastic cables or wires contribute to this rare occurrence.