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The maculae adherentes reinforce the fascia adherens and are also found in the lateral components pain swallowing treatment discount mobic 15mg without prescription. The gap junctions are found only in the lateral component of the intercalated disc. This electron micrograph reveals portions of two cardiac muscle cells joined by an intercalated disc. The line of junction between the two cells takes an irregular, step-like course, making a number of nearly right-angle turns. These include the transverse components (fascia adherens and maculae adherentes) and lateral components (gap junctions and maculae adherentes). The fascia adherens of the intercalated disc corresponds to the zonula adherens of epithelial tissues. This particular specimen is in a highly contracted state, and consequently, the I band is practically obscured. The intercalated discs of monkey myocardial cells and Purkinje fibers as revealed by scanning electron microscopy. The fascia adherens serves as the site at which the thin filaments in the terminal sarcomere anchor onto the plasma membrane. In this way, the fascia adherens · is functionally similar to the epithelial zonula adherens, where actin filaments of the terminal web are also anchored. Maculae adherentes help prevent the cells from pulling apart under the strain of regular repetitive contractions. They reinforce the fascia adherens and are found in both the transverse and lateral components of the intercalated discs. Gap junctions provide ionic continuity between adjacent cardiac muscle cells, thus allowing informational macromolecules to pass from cell to cell. This exchange permits cardiac muscle fibers to behave as a syncytium while retaining cellular integrity and individuality. The position of the gap junctions on the lateral surfaces of the intercalated disc protects them from the forces generated during contraction. The external lamina adheres to the invaginated plasma membrane of the T tubule as it penetrates into the cytoplasm of the muscle cell. The T tubules are larger and more numerous in cardiac ventricular muscle than in skeletal muscle. Passage of Ca2 from the lumen of the T tubule to the sarcoplasm of a cardiac muscle cell is essential to initiate the contraction cycle. Muscle Tissue highly specialized conducting fibers called Purkinje fibers that generate and rapidly transmit the contractile impulse to various parts of the myocardium in a precise sequence. Cells in Purkinje fibers differ from cardiac muscle cells in that they are larger and their myofibrils are located mostly at the periphery of the cell. The cytoplasm between the nucleus and the peripherally located myofibrils stains poorly due to the large amount of glycogen present in this part of the cell. Occasionally, T tubules can be found and their frequency depends on the size of the heart. Sympathetic stimulation accelerates the heartbeat by increasing the frequency of impulses to the cardiac conducting cells. Parasympathetic stimulation slows down the heartbeat by decreasing the frequency of the impulses. The impulses carried by these nerves do not initiate contraction but only modify the rate of intrinsic cardiac muscle contraction by their effect at the nodes. The structure and functions of the conducting system of the heart are described in Chapter 13, Cardiovascular System. The events leading to contraction of cardiac muscle can be summarized as a series of steps. Contraction of a cardiac muscle fiber initiates when the cell membrane depolarization traveling along Purkinje fibers reaches its destination in cardiac myocytes. General depolarization spreads over the plasma membrane of the muscle cell causing the opening of voltage-gated Na channels. Thus, in the first stage of the cardiac muscle contraction cycle, Ca2 from the lumen of the T tubule is transported to the sarcoplasm of cardiac muscle cell, which then opens gated Ca2 -release channels in adjacent terminal sacs of the sarcoplasmic reticulum. Gated Ca2 -release channels in cardiac muscle sarcoplasmic reticulum are composed of RyR2 isoform of ryanodine receptors, which is the primary isoform in the cardiac muscle. This calcium-triggered calcium release mechanism causes a rapid release of additional Ca2 that initiates subsequent steps of the contraction cycle, which are identical to those in skeletal muscle.

Overall quadriceps pain treatment cheap 7.5mg mobic amex, the elastic fibers of the dermis have a three-dimensional interlacing configuration, thus the variety of forms. This is a whole mount specimen of mesentery prepared to show the connective tissue elements and differentially stained to reveal elastic fibers. The elastic fibers (E) appear as thin, long, crisscrossing and branching threads without discernible beginnings or endings and with a somewhat irregular course. Again, the collagen fibers (C) are contrasted by their eosin staining and appear as long, straight profiles that are considerably thicker than the elastic fibers. Elastic material also occurs in sheets or lamellae rather than string-like fibers. This figure shows the wall of an elastic artery (pulmonary artery) that was stained to show the elastic material. Each of the wavy lines is a lamella of elastic material that is organized in the form of a fenestrated sheet or membrane. The empty-appearing spaces between elastic layers contain collagen fibers and smooth muscle cells, but they remain essentially unstained. In the muscular layer of blood vessel, both elastin and collagen are secreted by the smooth muscle cells. Tissues of the body containing large amounts of elastic material are limited in distribution to the walls of elastic arteries and some ligaments that are associated with the spinal column. Three types of cartilage that differ in appearance and mechanical properties are distinguished on the basis of characteristics of their matrix: · · · Hyaline cartilage is characterized by matrix containing Cartilage is an avascular tissue that consists of chondrocytes and an extensive extracellular matrix. More than 95% of cartilage volume consists of extracellular matrix, which is a functional element of this tissue. The extracellular matrix in cartilage is solid and firm but also somewhat pliable, which accounts for its resilience. Because there is no vascular network within cartilage, the composition of the extracellular matrix is crucial to the survival of the chondrocytes. Close interactions are seen between two classes of structural molecules that possess contrasting biophysical characteristics: the meshwork of tension-resisting collagen fibrils and the large amounts of heavily hydrated proteoglycan aggregates. The latter, being extremely weak in shear, makes the cartilage well adapted to bear weight, especially at points of movement such as synovial joints. Because it maintains this property even while growing, cartilage is a key tissue in the development of the fetal skeleton and in most growing bones. Elastic cartilage is characterized by elastic fibers and elastic lamellae in addition to the matrix material of hyaline cartilage. Fibrocartilage is characterized by abundant type I collagen fibers as well as the matrix material of hyaline cartilage. The matrix of hyaline cartilage appears glassy in the living state: hence, the name hyaline [Gr. Hyaline cartilage is not a simple, inert, homogeneous substance but a complex living tissue. It provides a low-friction surface, participates in lubricating synovial joints, and distributes applied forces to the underlying bone. Although its capacity for repair is limited, under normal circumstances, it shows no evidence of abrasive wear over a lifetime. An exception is articular cartilage, which, in many individuals, breaks down with age (Folder 7. Cartilage contains 60% to 80% of the wet weight of intercellular water, which is bound by proteoglycan aggregates. This photomicrograph of a routine H&E preparation of hyaline cartilage shows its general features. Note the extensive extracellular matrix that separates a sparse population of chondrocytes. Hyaline cartilage matrix is produced by chondrocytes and contains three major classes of molecules. Four types of collagen participate in the formation of a three-dimensional meshwork of the relatively thin (20-nm diameter) and short matrix fibrils. The pathogenesis of osteoarthritis is unknown, but it is related to aging and injury of articular cartilage.

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They may contract in a wave-like manner knee joint pain treatment mobic 7.5mg order line, producing peristaltic movements such as those in the gastrointestinal tract and the male genital tract, or contraction may occur along the entire muscle, producing extrusive movements. Smooth muscle exhibits a spontaneous contractile activity in the absence of nerve stimuli. An increase in the Ca2 level concentration within the cytosol is necessary to initiate smooth muscle contraction. This increase is achieved either by initial depolarization of the cell membrane or hormonal stimulation of cell surface receptors. The intracellular Ca2 binds to calmodulin (four Ca2 per one molecule of calmodulin) to form the Ca2 ­calmodulin complex. When phosphorylated, the myosin changes its conformation from inactive (folded) to active (unfolded), which can then assemble into side-polar filaments. The actin-binding site on the myosin head is activated, allowing it to attach to actin filament. Dephosphorylation of smooth muscle myosin molecules by phosphatase promotes disassembly of myosin filaments. Thus, smooth muscle contraction may also be initiated by certain hormones secreted from the posterior pituitary gland. In addition, smooth muscle cells may be stimulated or inhibited by hormones secreted by the adrenal medulla. Also, oxytocin is a potent stimulator of smooth muscle contraction, and its release by the posterior pituitary plays an essential role in uterine contraction during parturition. Many peptide secretions of enteroendocrine cells also stimulate or inhibit smooth muscle contraction, particularly in the alimentary canal and its associated organs. Nerve terminals in smooth muscle are observed only in the connective tissue adjacent to the muscle cells. Renewal, Repair, and Differentiation Smooth muscle cells are capable of dividing to maintain or increase their number. Nerve fibers pass through the connective tissue within the bundles of smooth muscle cells; enlargements in the passing nerve fiber, or bouton en passant (see page 362), occur adjacent to the muscle cells to be innervated. However, the neuromuscular site is not comparable to the neuromuscular junction of striated muscle. Rather, a considerable distance, usually 10 to 20 m (in some locations, up to 200 m), may separate the nerve terminal and the smooth muscle. The neurotransmitter released by the nerve terminal must diffuse across this distance to reach the muscle. Not all smooth muscle cells are exposed directly to the neurotransmitter, however. As discussed above, smooth muscle cells make contact with neighboring cells by gap junctions. As in cardiac muscle, contraction is propagated from cell to cell via gap junctions, thus producing coordinated activity within a smooth muscle bundle or layer. The gap junction between two smooth muscle cells was originally designated a nexus, a term still in use. Except at the gap junctions, smooth muscle cells are surrounded by an external lamina. In some locations, Smooth muscle cells may respond to injury by undergoing mitosis. Smooth muscle in the uterus proliferates during the normal menstrual cycle and during pregnancy; both activities are under hormonal control. The smooth muscle cells of blood vessels also divide regularly in the adult, presumably to replace damaged or senile cells; the smooth muscle of the muscularis externa of the stomach and colon regularly replicates and may even slowly thicken during life. New smooth muscle cells have been shown to differentiate from undifferentiated mesenchymal stem cells in the adventitia of blood vessels. Differentiation of smooth muscle progenitor cells is regulated by a variety of intracellular and environmental stimuli, and developing muscles exhibit a wide range of different phenotypes at different stages of their development. To date, no transcription factors have been identified that are characteristic for the smooth muscle cell lineage. Smooth muscle cells have also been shown to develop from the division and differentiation of endothelial cells and pericytes during the repair process after vascular injury.

Syndromes

• Increased sensitivity to cold temperature
• Bone deformities
• Tremors
• Reflux nephropathy (a condition in which urine flows backward from the bladder to the kidney)
• There is severe head or face bleeding
• Wounds that do not heal
• Washing of the skin (irrigation) -- perhaps every few hours for several days
• Vascular rings
• Feelings of worthlessness, self-hate, and guilt

Perineurium is the specialized connective tissue surrounding a nerve fascicle that contributes to the formation of the blood­nerve barrier chronic pain syndrome treatment guidelines generic mobic 15 mg buy on line. Surrounding the nerve bundle is a sheath of unique connective tissue cells that constitutes the perineurium. The perineurium serves as a metabolically active diffusion barrier that contributes to the formation of a blood­nerve barrier. In a manner similar to the properties exhibited by the endothelial cells of brain capillaries forming the blood­brain barrier (see page 388), perineurial cells possess receptors, transporters, and enzymes that provide for the active transport of substances. The perineurium may be one or more cell layers thick, depending on the nerve diameter. The cells are contractile and contain an appreciable number of actin filaments, a characteristic of smooth muscle cells and other contractile cells. Moreover, when there are two or more perineurial cell layers (as many as five or six layers may be present in larger nerves), collagen fibrils are present between the perineurial cell layers, but fibroblasts are absent. Tight junctions provide the basis for the blood­nerve barrier and are present between the cells located within the same layer of the perineurium. In effect, the arrangement of these cells as a barrier-the presence of tight junctions and external (basal) lamina material-liken them to an epithelioid tissue. On the other hand, their contractile nature and their apparent ability to produce collagen fibrils also liken them to smooth muscle cells and fibroblasts. The limited number of connective tissue cell types within the endoneurium (page 380) undoubtedly reflects the protective role that the perineurium plays. This absence of immune cells (other than the mast cells and macrophages) is accounted for by the protective barrier created by the perineurial cells. Typically, only fibroblasts, a small number of resident macrophages, and occasional mast cells are present within the nerve compartment. Epineurium consists of dense irregular connective tissue that surrounds and binds nerve fascicles into a common bundle. Enteroceptors react to stimuli from within the body- for example, the degree of filling or stretch of the alimentary canal, bladder, and blood vessels. Proprioceptors, which also react to stimuli from within the body, provide sensation of body position and muscle tone and movement. This ending is found in epithelia, in connective tissue, and in close association with hair follicles. Most sensory nerve endings acquire connective tissue capsules or sheaths of varying complexity. Sensory nerve endings with connective tissue sheaths are called encapsulated endings. Muscle spindles are encapsulated sensory endings located in skeletal muscle; they are described in Chapter 11, Muscle Tissue (page 329). Functionally related Golgi tendon organs are encapsulated tension receptors found at musculotendinous junctions. It is a typical dense connective tissue that surrounds the fascicles formed by the perineurium (Plate 28, page 396). The blood vessels that supply the nerves travel in the epineurium, and their branches penetrate into the nerve and travel within the perineurium. Afferent (Sensory) Receptors Afferent receptors are specialized structures located at the distal tips of the peripheral processes of sensory neurons. These effectors are the functional units in the organs that respond to regulation by nerve tissue. However, visceral motor neurons are frequently accompanied by visceral sensory (afferent) neurons that transmit pain and reflexes from visceral effectors. These pseudounipolar neurons have the same arrangement as other sensory neurons-that is, their cell bodies are located in sensory ganglia, and they possess long peripheral and central axons, as described above. Moreover, each presynaptic neuron makes synaptic contact with more than one postsynaptic neuron. Postsynaptic sympathetic fibers supply smooth muscles (as in blood vessels) or glandular epithelium (as in sweat glands). In this example, the splanchnic nerve joins with the celiac ganglion, where most of the synapses of the two-neuron chain occur. Sympathetic and Parasympathetic Divisions of the Autonomic Nervous System the presynaptic neurons of the sympathetic division are located in the thoracic and upper lumbar portions of the spinal cord. The presynaptic neurons send axons from the thoracic and upper lumbar spinal cord to the vertebral and paravertebral ganglia.

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Because the interstitial fluid in the medulla is hyperosmotic pain treatment center seattle wa 7.5 mg mobic visa, water exits this nephron segment by osmosis, causing the luminal content of Na and Cl to become progressively more concentrated. The cells of this limb do not actively transport ions; thus, the increased tubular fluid osmolality that occurs in this nephron segment is caused in large part by the passive movement of water into the peritubular connective tissue. The thin ascending limb of the loop of Henle is highly permeable to Na and Cl due to the presence of Na /K /2Cl cotransporters in the apical plasma cell membranes. Counter ions, in this case, Na (the majority) and K, follow passively to maintain electrochemical neutrality. The hyperosmolarity of the interstitium is directly related to the transport activity of the cells in this nephron segment. This diagram shows the various types of epithelia and the region where they are found in the thin limb of the short and long loops of Henle. The diagrams of the epithelium do not include nuclear regions of the epithelial cells. For this reason, the thin ascending limb is sometimes referred to as the diluting segment of the nephron. In addition, epithelial cells lining the thick ascending limb produce an 85 kDa protein called uromodulin (Tamm-Horsfall protein) that influences NaCl reabsorption and urinary concentration ability. Uromodulin also modulates cell adhesion and signal transduction by interacting with various cytokines. It also inhibits the aggregation of calcium oxalate crystals (preventing kidney stone formation) and provides a defense against urinary tract infection. In individuals with inflammatory kidney diseases, a precipitated uromodulin is detected in urine in the form of urinary casts (see Folder 20. The distal straight tubule (thick ascending limb), as previously noted, is part of the ascending limb of the loop of Henle and includes both medullary and cortical portions, with the latter located in the medullary rays. The distal straight tubule, like the ascending thin limb, transports ions from the tubular lumen to the interstitium. The apical cell membrane in this segment has electroneutral transporters (synporters) that allow Cl, Na, and K to enter the cell from the lumen. Some K ions leak back into the tubular fluid through K channels, causing the tubular lumen to be positively charged with respect to the interstitium. This positive gradient provides the driving force for the reabsorption of many other ions such as Ca2 and Mg2. Note that this significant movement of ions occurs without the movement of water through the wall of the distal straight tubule, resulting in separation of water from its solutes. In routine histologic preparations, the large cuboidal cells of the distal straight tubule stain lightly with eosin, and the lateral margins of the cells are indistinct (Plate 77, page 736). The nucleus is located in the apical portion of the cell and sometimes, especially in the straight segment, causes the cell to bulge into the lumen. As in the proximal tubule cell, the mitochondria account for the appearance of basal striations in the light microscope. The cells of the distal convoluted tubule resemble those of the distal straight tubule (thick ascending limb) but are considerably taller and lack a well-developed brush border. Similar to the distal straight tubule, the epithelium in the distal convoluted tubule is also relatively impermeable to water. The early part of the distal convoluted tubule is the primary site for parathyroid hormone­regulated Ca2 reabsorption. This short tubule is responsible for: Distal Convoluted Tubule the structure and function of the distal convoluted tubule depends on the delivery and uptake of Na. It begins at a variable distance beyond the macula densa and extends to the connecting tubule, which connects the nephron with the cortical collecting duct. Connecting tubules of the subcapsular nephrons join directly to the cortical collecting duct, whereas the connecting tubules from the midcortical and juxtamedullary nephrons merge with other connecting tubules first to form an arched connecting tubule before uniting with the cortical collecting duct. The epithelium of this segment undergoes a gradual transition from the distal convoluted tubule to the collecting duct and consists of intermingling cells from both regions. Both morphologic and physiologic studies demonstrated that connecting tubules play an important role in K secretion (most likely attributed to the presence of the principal cells), which is in part regulated by mineralocorticoids secreted by the adrenal cortex. The cortical collecting ducts have flattened cells, somewhat squamous to cuboidal in shape.

References

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• Meschia, M., Pifarotti, P., Bernasconi, F., Magatti, F., Riva, D., Kocjancic, E. Tension-free vaginal tape: analysis of risk factors for failures. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:419-422.