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Refer to chapter 10 to deter- tracts on one side buy 3.03 mg yasmin with mastercard birth control for women in forties, the head rotates and extends to one side cheap 3.03 mg yasmin mastercard birth control 5 years mirena. The Contracted together, the splenius capitis muscles extend the muscles of the neck are illustrated in figures 9. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 255 FIGURE 9. When the two semi- upper five thoracic vertebrae and inserts on the mastoid spinalis capitis muscles contract together, they extend the head process of the temporal bone (fig. This muscle extends at the neck, along with the splenius capitis muscle. If one of the the head at the neck, bends it to one side, or rotates it muscles acts alone, the head is rotated to the side. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 256 Unit 4 Support and Movement FIGURE 9. Suprahyoid Muscles The sternohyoid muscle originates on the manubrium of the sternum and inserts on the hyoid bone. It depresses the hyoid The group of suprahyoid muscles located above the hyoid bone as it contracts. The digastric is a two-bellied muscle of double origin that When this muscle contracts, the larynx is pulled downward. The anterior origin is on the mandible The short thyrohyoid muscle extends from the thyroid car- at the point of the chin, and the posterior origin is near the mas- tilage to the hyoid bone. It elevates the larynx and lowers the toid process of the temporal bone. The long, thin omohyoid muscle originates on the superior The mylohyoid muscle forms the floor of the mouth. It acts to de- originates on the inferior border of the mandible and inserts on press the hyoid bone. It aids swallowing The coordinated movements of the hyoid bone and the larynx by forcing food toward the back of the mouth. The hyoid bone does not articulate with any other bone, yet it has eight paired muscles attached to it. Two involve The slender stylohyoid muscle extends from the styloid tongue movement, one lowers the jaw, one elevates the floor of the process of the skull to the hyoid bone, which it elevates as it con- mouth, and four depress the hyoid bone or elevate the thyroid carti- tracts. Thus an indirect action of this muscle is to elevate the lage of the larynx. Infrahyoid Muscles Muscles of Respiration The thin, straplike infrahyoid muscles are located below the The muscles of respiration are skeletal muscles that continually hyoid bone. They are individually named on the basis of their contract rhythmically, usually involuntarily. Breathing, or pul- origin and insertion and include the sternohyoid, sternothyroid, monary ventilation, is divided into two phases: inspiration (inhala- thyrohyoid, and omohyoid muscles (fig. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 257 FIGURE 9. Digastric Inferior border of mandible and Hyoid bone Opens mouth; elevates hyoid Trigeminal n. Sternohyoid Manubrium Body of hyoid bone Depresses hyoid bone Spinal nn. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 258 Unit 4 Support and Movement FIGURE 9. During normal, relaxed inspiration, the contracting muscles Muscles of the Abdominal Wall are the diaphragm, the external intercostal muscles, and the interchondral portion of the internal intercostal muscles The anterolateral abdominal wall is composed of four pairs of (fig. A downward contraction of the dome-shaped di- flat, sheetlike muscles: the external abdominal oblique, internal ab- aphragm causes a vertical increase in thoracic dimension. A si- dominal oblique, transversus abdominis, and rectus abdominis mus- multaneous contraction of the external intercostals and the cles (fig.

Muscular System © The McGraw−Hill Anatomy discount yasmin 3.03mg mastercard birth control pills, Sixth Edition Companies purchase 3.03 mg yasmin otc birth control pills 7 days, 2001 Chapter 9 Muscular System 291 FIGURE 9. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 292 Unit 4 Support and Movement FIGURE 9. Source: From Hollingsworth JW, Hashizuma A, Jabbn S: Correlations Between Tests of Aging in Hiroshima Subjects: An Attempt to Define Physiologic Age. She also notes pain in the area order a CT scan (L = lumbar vertebrae; P = of her left hip and left lower quadrant of her psoas major muscle). On physical exam, she has a QUESTIONS PP L mild fever and slight tenderness on the left 1. What is the fluid collection indicated side of her abdomen, and you note that by the arrow on the CT scan? Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 293 CLINICAL PRACTICUM 9. Why is the knee held in a slightly superiorly displaced, and the knee is ex- flexed position? Most hernias occur in the normally injection into a heavily muscled area to muscle. The most common shinsplints Tenderness and pain on the four common hernia types: site is the buttock. Motor neurons conduct nerve impulses to and the maintenance of posture and body the more movable attachment. Muscle bundles, called impulses away from the muscle fiber to all muscle tissue are irritability, fasciculi, are covered by perimysium. Muscles muscles include those that act on the that oppose or reverse the actions of other girdles and those that move the segments muscles are antagonists. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 294 Unit 4 Support and Movement Skeletal Muscle Fibers and Types of (d) The A bands stay the same length Naming of Muscles (pp. Each skeletal muscle fiber is a and thin) do not shorten during of shape, location, attachment, multinucleated, striated cell. Most muscles are paired; that is, the right membrane called a sarcolemma. The neuromuscular junction is the area a Z line, and the subunit between two consisting of the motor end plate and the Muscles of the Axial Skeleton Z lines is called the sarcomere. They are summarized in the thin (actin) myofilaments over and and the muscle fibers it innervates. An eyebrow is drawn toward the midline the quadriceps femoris muscle may act on (a) one motor unit per muscle fiber. Which of the following is not used as a (c) the nasalis (d) the vastus lateralis means of naming muscles? A flexor of the shoulder joint is flexes the ankle joint and inverts the foot (b) action (a) the pectoralis major. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 295 Essay Questions 10. Give three examples of synergistic muscle 17–year-old male lost function of his right multinucleated. Describe the special characteristics of identify the antagonistic muscle group happen to the function of the affected muscle tissue that are essential for muscle for each. Define fascia, aponeurosis, and compartments of the muscles of the muscles relative to the shoulder, elbow, retinaculum. Based on function, describe exercises that the muscle fibers and fasciculi within fossa. Describe the structures that are would strengthen the following muscles: muscle. Firmly press your fingers on the front, (c) the triceps, (d) the pronator teres, disadvantages of pennate-fibered muscles?

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For example buy yasmin 3.03 mg with visa birth control for women 007, GH is thought to be one of the physiological factors that counteract and purchase 3.03mg yasmin visa birth control expiration, thus, modulate some of the actions of insulin on the liver and peripheral tissues. Human GH GH mRNA is a globular 22 kDa protein consisting of a single chain of Gi cAMP PKA P proteins 191 amino acid residues with two intrachain disulfide bridges. Human GH has considerable structural similarity AC to human PRL and placental lactogen. ATP Growth hormone is produced in somatotrophs of the an- Gs terior pituitary. It is synthesized in the rough ER as a larger prohormone consisting of an N-terminal signal peptide and Ca2 GH GHRH the 191-amino acid hormone. The signal peptide is then cleaved from the prohormone, and the hormone traverses Secretory the Golgi apparatus and is packaged in secretory granules. As a result, the normal rate of GH production depends on GH these hormones. For example, a thyroid hormone deficient individual is also GH-deficient. This important action of The actions of GHRH and somatostatin on FIGURE 32. GHRH binds to membrane receptors that are coupled to adenylyl cyclase (AC) by stimula- Regulation of GH Secretion by GHRH and Somatostatin. Cyclic AMP (cAMP) rises in the cell and ac- The secretion of GH is regulated by two opposing hypo- tivates protein kinase A (PKA), which then phosphorylates pro- teins (P proteins) involved in stimulating GH secretion and the thalamic releasing hormones. Ca is also involved in the ac- tion and somatostatin inhibits GH secretion by inhibiting tion of GHRH on GH secretion. The rate of GH secretion is deter- phosphatidylinositol pathway in GHRH action is not shown. So- mined by the net effect of these counteracting hormones matostatin (SRIF) binds to membrane receptors that are coupled on somatotrophs. When GHRH predominates, GH secre- to adenylyl cyclase by inhibitory G proteins (G ). When somatostatin predominates, GH hibits the ability of GHRH to stimulate adenylyl cyclase, block- secretion is inhibited. CHAPTER 32 The Hypothalamus and the Pituitary Gland 591 drolysis of membrane PIP2in the somatotroph. The impor- tance of this phospholipid pathway for the stimulation of Hypothalamus GH secretion by GHRH is not established. Although made by neurosecretory neurons in GHRH SRIF various parts of the hypothalamus, somatostatin neurons are especially abundant in the anterior periventricular re- gion (i. The axons of these cells terminate on the capillary networks giving rise to the Somatotroph hypophyseal portal circulation, where they release somato- statin into the blood. Somatostatin binds to receptors in the plasma mem- GH branes of somatotrophs. These receptors, like those for GHRH, are also coupled to adenylyl cyclase, but they are coupled by an inhibitory G protein (see Fig. The GH target binding of somatostatin to its receptor decreases adenylyl cells cyclase activity, reducing intracellular cAMP. Somatostatin 2 binding to its receptor also lowers intracellular Ca , re- ducing GH secretion. When the somatroph is exposed to both somatostatin and GHRH, the effects of somatostatin IGF-I 2 are dominant and intracellular cAMP and Ca are re- duced. GH is not consid- shown in red, inhibit GHRH secretion and action on the soma- ered a traditional trophic hormone; however, it does stim- totroph, causing a decrease in GH secretion. The feedback loops ulate the production of a trophic hormone called insulin- ( ), shown in gray, stimulate somatostatin secretion, causing a like growth factor I (IGF-I). IGF-I was originally called somatomedin C or soma- totropin-mediating hormone because of its role in promot- fect of these actions is the inhibition of GH secretion. Somatomedin C was renamed IGF-I because of stimulating IGF-I production, GH inhibits its own secre- its structural similarity to proinsulin. This mechanism is analogous to the way ACTH and Insulin-like growth factor II (IGF-II), an additional TSH regulate their own secretion through the respective growth factor induced by GH, is structurally similar to IGF- negative-feedback effects of the glucocorticoid and thyroid I and has many of the same metabolic and mitogenic ac- hormones. However, IGF-I appears to be the more important somatostatin, GH, and IGF-I comprises the hypothalamic- mediator of GH action. Because of its structural similarity to Feedback Effects of GH on Its Own Secretion.

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For those who wish to know more buy generic yasmin 3.03mg on line birth control pills used to treat endometriosis, the references in the chapters can be a useful guide buy 3.03mg yasmin birth control 5 year implant. In preparing the work, the contributors were able to profit from the experience and insights collected and reported by many leading clinical researchers in the field. What are the key objectives, the challenges, and the corresponding options for study design? What should the architecture of diagnostic research look like to provide us with an appropriate research strategy, yielding the clinical information we are looking for, with a minimum burden for study patients and an efficient use of resources? Second, important design features for studying the accuracy and clinical impact of diagnostic tests and procedures are dealt with in more detail, addressing the cross-sectional study, the randomised trial, and the before–after study. In addition, it is shown that the impact of diagnostic tests varies with different clinical settings and target populations, and indications are given as how to ensure that estimates of test accuracy will travel and be transferable to other settings. Also, for clinical diagnostic studies, an overview of the most important data-analytic issues is presented, from simple two by two tables to multiple logistic regression analysis. Nowadays, for both clinical investigators and readers of research articles, it is not enough to understand the methodology of original clinical studies. They must also know more about the techniques to summarise and synthesise results from various clinical studies on a similar topic. Guidelines for diagnostic systematic reviews and meta-analysis are therefore presented. Learning from accumulated clinical experience and the application of diagnostic knowledge in practice has much in common with retrieving and selecting information from clinical databases. Accordingly, diagnostic decision support using information and communication technology (ICT) is addressed as an increasingly important domain for clinical practice, research, and education. Furthermore, as clinical research results can only be successfully incorporated into diagnostic decision making if the way clinicians tend to solve medical problems is taken into account, an overview of the domain of clinical problem solving is given. Eventually, we have to recognise that improving test use in daily care needs more than clinical research, and presenting guidelines and other supportive materials. Therefore, the strategy of successful implementation – which has become a field of study in itself – is also covered. In order to allow each chapter to keep a logical structure in itself, a number of topics have x PREFACE been dealt with more than once, albeit to a varying extent. Instead of seeing this as a problem, we think that it may be informative for readers to see important issues considered from different perspectives. Parallel to the preparation of this book, an initiative to reach international agreement of standards for reporting diagnostic accuracy (STARD) was taken and elaborated. This development can be expected to make a significant contribution to improving the quality of published literature on the value of diagnostic tests. We are happy that members of the group of initiators of STARD have contributed to this book as the authors of chapters 4 and 6, and are looking forward to seeing these standards having an impact. The field of diagnostic research is developing strongly and an increasing number of talented clinical investigators are working in (the methodology of ) diagnostic research. In view of this dynamic field, we welcome comments from readers and suggestions for possible improvements. The contributors wish to thank Richard Smith from the BMJ, who has so positively welcomed the initiative for this book, Trish Groves from the BMJ who gave very useful feedback on the proposed outline and stimulated us to work it out, and Mary Banks from BMJ Books, who has provided support and encouragement from the beginning and monitored the progress of the book until the work was done. This is reflected in a substantial expansion of research on diagnostic tests. For example, the number of such publications we found in MEDLINE increased from about 2000 in the period 1966–1970 to about 17 000 in the period 1996–2000. However, the evaluation of diagnostic techniques is far from being as advanced as the evaluation of therapies. At present, unlike the situation with regard to drugs, there are no formal requirements that a diagnostic test must meet in order to be accepted or retained as a routine part of health care. This is related to another point: in spite of useful early initiatives1,2 the methodology for evaluation of diagnostics is not much crystallised, in contrast to the deeply rooted consensus regarding the principles of the randomised controlled trial on therapeutic effectiveness1,3 and the broad agreement on aetiologic study designs. Rather than being limited to a particular body system, diagnostic evaluation studies frequently start from a complaint, a clinical problem, or certain tests. The first crucial medical intervention in an episode of illness is diagnostic, labelling symptoms and complaints as illness, and indicating possible disease and its prognosis. Effective and efficient therapy – including reassurance, “watchful waiting” and supporting patient self- efficacy – depends to a large extent on an accurate interpretation of (early) symptoms and the outcome of the diagnostic process.

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