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When subsequently of the ventricles generating an L is 70% of Lmax (sarcomere length: 1 purchase finast 5 mg overnight delivery hair loss in men engagement. In addition finast 5mg online hair loss cure keith, Incardiacmusclebutnotinskeletalmuscle, a greatly pre-extended muscle (L " Lmax) can the duration of an action potential can change develop only restricted force, because the the force of contraction, which is controlled by number of potentially available actin–myosin the variable influx of Ca2+ into the cell. When extended to The greater the force (load), the lower the 130%ormoreoftheLmax,theextensionforceat velocity of an (isotonic) contraction (see velo- rest becomes a major part of the total muscle city–force diagram, F1). Light loads can muscle length, and ventricular pressure corre- therefore be picked up more quickly than sponds to muscle force;! Thetotalamountofenergy the cytosolic Ca2+ concentration can modify consumed for work and heat is greater in thepressure–volumerelationshipbycausinga isotonic contractions than in isometric ones. Muscle power is the product of force and the Other important functional differences be- shortening velocity: N·m·s–1 = W (! Active and passive components of muscle force (skeletal muscle) 100 Active muscle force Passive resting tension force Relative 0 muscle length 80 90 100 (length at max. Length-force curve for skeletal and cardiac muscle 1 Striated muscle 2 Cardiac muscle Total force Total force 200 200 Active Resting force tension force 100 100 Active Resting force tension force 0 0 65 100 135 80 100 120 Relative muscle length Relative muscle length (length at max. Muscle force (or load) and shortening velocity Maximum velocity (V ) 1 100 max 2 light Power with Fast Load small load Slow large load heavy Time 0 Load = muscle force 69 Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. The second type, multi-unit Smooth muscle (SmM) consists of multiple SmM, contracts primarily due to stimuli from layers of spindle-shaped cells. It is involved in the autonomic nervous system (neurogenic the function of many organs (stomach, in- tonus). This occurs in structures such as the testine, gall bladder, urinary bladder, uterus, arterioles, spermatic ducts, iris, ciliary body, bronchi, eyes, etc. Since where it plays an important role in circulatory these SmM cells generally are not connected control. SmM contains a special type of F- by gap junctions, stimulation remains local- actin-tropomyosin and myosin II filaments ized, as in the motor units of the skeletal (! Furthermore, it has no distinct tubular system Smooth muscle tonus is regulated by the and no sarcomeres (nonstriated). An in- which also provide a mechanical means for creaseintonuswilloccurifanyofthesefactors cell–cell binding of SmM. Smooth muscle can directly or indirectly increases the cytosolic shorten much more than striated muscle. ThemembranepotentialoftheSmMcellsof The Ca2+ influx comes mainly from extracellu- many organs (e. Ca2+ ions bind to cal- frequency (3 to 15 min–1) and amplitude (10 to modulin (CM) (! B3): The Ca2+-CM when they exceed a certain threshold poten- complex activates myosin light chain kinase tial. Tetanus occurs at relatively low spike Ca2+-CM complex also binds with caldesmon frequencies (! Hence, SmM is con- (CDM), which then detaches from the actin– stantly in a state of a more or less strong con- tropomyosincomplex,thusmakingitavailable traction(tonusortone). Phosphorylationof SmMcellsofsomeorganshasaplateausimilar CDM by protein kinase C (PK-C) also seems to to that of the cardiac action potential be able to induce filament sliding (! Factorsthat leadtoareduction oftonus are: There are two types of smooth muscles reduction of the cytosolic Ca2+ concentration (! Smooth muscle fibers according to type of stimulation 1 Single-unit fibers Electrical coupling 2 Multi-unit fibers (gap junctions) Stimulated by autonomic nerve Spontaneous stimulation Local contraction General contraction Stomach, intestine, uterus, blood vessels, etc. Regulation of smooth muscle contraction Depolarization, transmitter, hormones, stretch Intermediate filaments Adhesive plaques Nucleus Myocyte 1 Actin-myosin filaments Ca2+ 2+ 2+ 7 Ca Ca RLC Thickening zones Myosin II [ 2+] 2+ [Ca2+] Ca i Smooth ER Ca –6 i <10–6mol/l 2+ >10 mol/l Caldesmon (Ca stores) (CDM) 2+ 2 Ca CM Calmodulin binding Actin-tropomyosin Low muscle tone 9 ATP Ca2+ CM 4 CDM Ca2+ CM P MLCK 3 8 PK-C P ATP P Release of actin or Phosphatase ADP 5 Phosphorylation PK-C ATP of myosin II CDM P 6 P 71 Contraction: Increased tone Filaments slide Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. The several minutes that Energy Supply for Muscle Contraction pass before this steady state is achieved are Adenosine triphosphate (ATP) is a direct bridged by anaerobic energy production, in- source of chemical energy for muscle contrac- creased O2 extraction from the blood and tion (! However, a muscle depletion of short-term O2 reserves in the cell contains only a limited amount of ATP– muscle (myoglobin). The interim between the only enough to take a sprinter some 10 to 20m two phases is often perceived as the “low or so. Dephosphorylation of creatine phosphate oxygen to the mitochondria during brief arte- 2. The endurance limit, which is some 370W Routes 2 and 3 are relatively slow, so creatine (! When derived from metabolized ATP is immediately the endurance limit is exceeded, steady state transformed to ATP and creatine (Cr) by mito- cannotoccur,theheartratethenrisescontinu- chondrialcreatinekinase(!

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These gastroesophageal reflux disorder generic 5 mg finast free shipping hair loss icd 9, and hypersecretory drugs block the cardiac K channels responsible for the conditions purchase 5mg finast amex hair loss products for women, such as Zollinger-Ellison syndrome. The repolarizing current (IKr) of the action potential (see pharmacodynamics and clinical uses of these drugs are Chapter 16) and therefore prolong the QT interval. Arrhythmias result when these drugs accumulate to toxic levels, such as when their metabolism is impaired, Cromolyn and Nedocromil as in liver disease or following coadministration of Although cromolyn sodium (Intal) and nedocromil drugs that inhibit the CYP3A family of enzymes. Cromolyn sodium and nedocromil sodium are used as The second-generation antihistamines and the first- pulmonary inhalants in the treatment of asthma. Nasal generation alkylamines are most frequently used to (Nasalcrom) and ophthalmic (Opticrom) preparations treat allergic rhinitis. Allergic conjunctivitis and the of cromolyn sodium can be used to reduce the symp- acute form of urticaria are also effectively treated with toms of allergic rhinitis and conjunctivitis. The allergic responses seen in suscepti- tailed information on these compounds may be found in ble individuals after intradermal injections of allergens Chapter 39. However, the New Directions in Antihistamine Therapy H1-antagonists are not drugs of choice in acute anaphy- lactic emergencies or the viral-caused common cold. None of the selective agonists and antagonists of H3- Although the antihistamines are not useful as pri- receptors are available for clinical use. Antagonists of mary agents in the treatment of asthma, a number of H3-mediated inhibition of neurotransmission may have studies have shown that the second-generation com- potential in the treatment of CNS disorders, since ani- pounds are effective as adjunctive therapies in asthmatic mal studies have found that these compounds may en- patients with concomitant rhinitis, urticaria, or dermati- hance learning, ameliorate learning deficits, and de- tis. Diphenhydramine prevent the arrhythmia and cardiac damage that may (Benadryl), dimenhydrinate (Dramamine), cyclizine result from norepinephrine overflow and thus may be (Marezine), and meclizine (Antivert) have anticholiner- useful in the treatment of myocardial infarction. The antigen-mediated release of histamine can ANSWERS (A) Be inhibited by the binding of histamine to H3- 1. Histamine inhibits its own release through an ef- receptors on mast cells fect on H2-receptors on mast cells. Its release is in- (B) Be stimulated by 2-adrenoceptor agonists hibited, not stimulated, by 2-adrenoceptor agonists. Effects mediated by the H1 histamine receptor in- Histamine stimulates sensory nerve endings, result- clude ing in pain and itching. Histamine stimulates gastric acid secretion (B) Induction of hepatic cytochrome P450 enzymes through an effect on H2-receptors of gastric parietal (C) Maintenance of a wakeful state cells. Although certain antihistamines are metabo- (D) Bronchodilation lized by cytochrome P450 enzymes, histamine does (E) Vasoconstriction of arterioles not induce their production. All four types of histamine receptors maintain a wakeful state through an effect on H1- (A) Are found on the surface of mast cells and ba- receptors. Histamine-mediated bronchoconstriction sophils is mediated by H1-receptors, while histamine- (B) Are G protein–coupled mediated vasodilation occurs as a result of stimula- (C) Modulate adenylyl cyclase activity tion of H1- and H2-receptors. Jones takes fexofenadine 60 mg twice a day for ceptors belong to the G protein–coupled receptor seasonal allergies. Only H2-receptors are coupled to sinus infection and receives a prescription for eryth- adenylyl cyclase through the G protein G. Therefore, administering an inhibitor of (A) Exhibit no changes in fexofenadine elimination CYP3A4 would not affect fexofenadine elimination. Although scopolamine effectively combats mo- without risk of torsades de pointes tion sickness, it is an antimuscarinic agent, not an (E) Exhibit moderate anticholinergic effects com- antihistamine. Dimenhydrinate is an antihistamine monly seen with fexofenadine with significant antimuscarinic properties that are 5. Smith has severe motion sickness during air likely to contribute to its anti–motion sickness activ- travel. Chlorpheniramine, fexofenadine, and tripelen- you, his physician, would like to prescribe an anti- namine are antihistamines without significant effi- histamine to prevent motion sickness. Case Study Behavior Changes and the Bladder nisette Doe, a 28-year old woman, went to the 50 mg every 6 to 8 hours. What is a possible Aemergency department with abdominal explanation for the sudden onset of her inability to bloating and inability to void her bladder; she had void her bladder? Doe had or masses in the bladder, urethra, ureters, or not complained of anticholinergic effects prior to kidneys.

Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review Complement Ther Med 2000; 8:97–105 100 discount 5 mg finast otc hair loss in men 30. Use of alternative health therapies by people with multiple sclerosis: an exploratory study 5mg finast visa hair loss pcos. Am J Forensic Med Pathol 1999; 20:354–6 6 Acupuncture and traditional Chinese medicine Yuan-Chi Lin Complementary Therapies in Neurology: An Evidence-Based Approach Edited by Barry S. Oken ISBN 1-84214-200-3 Copyright © 2004 by The Parthenon Publishing Group, London INTRODUCTION The history of traditional Chinese medicine and acupuncture can be traced back 2000 to 3000 years. In Shi Jing (Book of Poems), a collection of verse compiled in the 12th century BC, a number of herbs are mentioned. In Shy Ji (Records of Historian) written 104–91 BC, it is recounted that the technique of pulse taking and acupuncture was developed. Acupuncture is one of the treatment modalities within comprehensive traditional Chinese medicine. Needles of flint, bamboo and bone from the Neolithic period suggest that acupuncture existed long before the discovery of metal. The acupuncture treatment is performed by inserting special hair-thin needles into the skin at specific sites, known as acupuncture points, for desired therapeutic and preventive purposes. Acupuncture can be effective in the treatment of mental as well as physical illnesses. Moxibustion, the burning of moxa (Artemisia vulgaris) over the acupuncture points, can also be used for the treatment of various illnesses. There were other situations, such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome and asthma, in which acupuncture may be useful as an adjunct or an acceptable alternative treatment, or one that might be included in a comprehensive management program. This chapter provides a practical and theoretical Acupuncture and traditional Chinese medicine 135 understanding of traditional Chinese medicine and acupuncture, emphasizing its efficacy in various neurological diseases. The training and licensing requirements for acupuncturists and potential risks of acupuncture are also addressed. TRADITIONAL CHINESE MEDICINE The use of traditional Chinese medicine and acupuncture can be traced back to Neolithic times. Archeological vestiges exist which testify to the antiquity of its practice, although the practice was first passed on as an oral tradition. This work was composed as a dialogue between the Yellow Emperor and his minister, Chi-Po. There are two depictions of sessions within the text, Su Wen (Common Questions) and Ling Shu (Direction of Soul/Spirit). Within traditional Chinese medicine, sharp distinctions are not made between the physical, psychological and synthetic. This contrasts with Western biomedical science, which tends to be reductionistic in its attempts to trace a linear cause-and-effect chain of events to a single identifiable etiology. In the traditional Chinese medicine framework, illness is understood as an overall pattern of a multiple of physical, psychological and environmental factors. The theoretical basis of traditional Chinese medicine stems from a system of metaphysics that focuses on the balance between two opposing forces: Yin and Yang. They can transform into each other, and are natural phenomena that also exist within the body. Yin is present in the qualities of cold, rest, passivity, dark, inward, decrease and female. Yang is associated with hot, activity, activity, light, outward, increase and male (Table 1). Disease is Table 1 Yin and Yang are projected to all levels of the cosmos through a system of correspondences Yin Yang Nature Winter Summer Dark Bright Cold Hot Night Day Moon Sun Rest Activity Earth Heaven Low High Heaviness Lightness Complementary therapies in neurology 136 Body Female Male Lower Upper Interior Exterior Front Back Structure Function Inhibition Stimulation Deficiency Excess Medicine Chronic disease Acute disease Gradual onset Rapid onset Cold Heat Pale Red Moist Thirst Loose stool Constipation characterized by a disharmony or a lack of balance between Yin and Yang. Qi is not easily translatable or defin-able, as a clear distinction between matter and energy is not made in Chinese metaphysics. Qi flows through a complex system of meridians throughout the body, maintaining life and health. These meridians are not defined by physical structures such as blood or lymphatic vessels, but by their function. The body is viewed as a dynamic system of organs connected by the flow of Qi within the meridians. The flow of Qi may be restored by the insertion of several very fine needles into a combination of points from the 365 classical acupuncture points that exist along the meridians. The manual twirling of these needles produces a sore, heavy, or numb sensation known as De Qi (obtaining Qi).

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