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Cigarette smoking triggers an inappropriate release of peroxide by alveolar macrophages weight loss supplements over 50 order 60mg xenical with amex, resulting in damage to weight loss pills stacker 3 buy 60mg xenical visa normal respiratory and connective tissues weight loss jackson tn generic xenical 60 mg otc. Phagocytosis by macrophages is greatly depressed in smokers weight loss after menopause purchase xenical 60 mg overnight delivery, and the cells show twice the normal volume with a marked reduction in surfaceto-volume ratios. The outer (parietal) layer lines the inner surface of the thoracic wall; the inner (visceral) layer covers the surface of the lungs. The space between the two layers is under negative pressure, and the two layers are separated only by a thin film of fluid. As the thoracic wall moves out to increase the size of the thoracic cage, the parietal pleura is taken along, passively. The combined effects of surface tension and negative pressure result in the visceral pleura being drawn outward also. Since the visceral pleura is firmly attached to the lungs, they are expanded, the air pressure within the lungs decreases, and air flows into the lungs. Expiration of air occurs as the result of elastic recoil of the lungs when the thoracic wall relaxes. In addition to the intrinsic glands within the wall of the digestive tract proper, there are associated glands that lie outside the tract but that are connected to it by ducts. At the vermilion border, the lip is covered by a nonkeratinized, translucent, stratified squamous epithelium that lacks hair follicles and glands. Its lamina propria projects into the overlying epithelium to form numerous tall connective tissue papillae that contain abundant capillaries. The combination of tall vascular papillae and translucent epithelium accounts for the red hue of this part of the lip. The red portion is continuous with the oral mucosa internally and with thin skin externally. The inner surface of the lip is lined by nonkeratinized (wet) stratified squamous epithelium that overlies a compact lamina propria with numerous connective tissue papillae. Between the oral mucosa and the skin are the skeletal muscle fibers of the orbicularis oris muscle. Coarse fibers of connective tissue in the submucosa connect the mucosa to the adjacent muscle. The ducts of numerous mixed mucoserous labial glands in the submucosa empty onto the internal surface of the lip and provide fluid and lubrication for this region. They can be identified as small bumps when the tongue is pressed firmly against the interior of the lip. The innermost tissue layer of the digestive tract is called a mucous membrane or mucosa and consists of a lining epithelium and an underlying layer of fine, interlacing connective tissue fibers that form the lamina propria. A muscular component of the mucosa, the muscularis mucosae, is found only in the tubular portion of the tract. Immediately beneath the mucosa is a layer of connective tissue consisting of coarse, loosely woven collagen fibers and scattered elastic fibers. This layer is the submucosa, which houses larger blood vessels and nerves and provides the mucosa with considerable mobility. Where it is absent, the mucosa is immobile and firmly attached to surrounding structures. In the tubular portion of the tract, a thick layer of smooth muscle, the muscularis externa, forms an outer supporting wall that in turn is surrounded either by connective tissue, an adventitia, or a layer of connective tissue covered by mesothelium called a serosa. Cheek, Palate, and Gingiva A similar mucous membrane lines the interior of the cheek, soft palate, floor of the mouth, and underside of the tongue. The mucosa of the cheek and soft palate, like that of the lips, is attached to underlying skeletal muscle fibers by coarse connective tissue elements of the submucosa, allowing considerable mobility to the oral mucosa in these regions. Mucoserous glands, adipose tissue, larger blood vessels, and nerves are present in the submucosa. The cheek and soft palate contain a core of skeletal muscle, the buccinator and palatine muscles, respectively. Oral Cavity the irregularly shaped oral cavity consists of the lips, cheeks, tongue, gingiva, teeth, and palate. The mucosa consists of a stratified squamous epithelium and a rather dense lamina propria.

Scattered smooth muscle cells are present on the atrial side of the valves weight loss pills to lose 50 pounds xenical 120 mg on-line, while on the ventricular side elastic fibers are prominent weight loss zanesville ohio cheap xenical 60mg with visa. Thin tendinous cords called chordae tendineae attach the ventricular sides of the valves to weight loss pills at rite aid generic 120mg xenical with amex projections of cardiac muscle called papillary muscles weight loss 8 weeks discount xenical 60mg on line. Semilunar valves of the pulmonary arteries and aorta are thinner but show the same general histologic structure as the atrioventricular valves. Blood Vessels the blood vessels are variously sized tubes arranged in a circuit, through which blood is delivered from the heart to the tissues and back to the heart from all parts of the body. By this circulatory system, oxygen from the lungs, nutrients from the intestines and liver, and regulatory substances such as hormones are distributed to all the organs and tissues. Waste products also are emptied into the circulation and carried to organs such as the lungs and kidneys for elimination. As in the heart, the walls of blood vessels consist of three major coats or tunics. Differences in the appearance and functions of the various parts of the circulatory system are reflected by structural changes in these tunics or by reduction and even omission of some of the layers. From the lumen outward, the wall of a blood vessel consists of a tunica intima, tunica media, and tunica adventitia. The tunica intima corresponds to and is continuous with the endocardium of the heart. It consists of an endothelium of flattened squamous cells resting on a basal lamina and is supported by a subendothelial connective tissue. The tunica media is the equivalent of the myocardium of the heart and is the layer most variable both in size and structure. Depending on the function of the vessel, this layer contains variable amounts of smooth muscle and elastic tissue. The tunica adventitia also varies in thickness in different parts of the vascular circuit. The atrioventricular valves are attached to the annuli fibrosi, the connective tissue of which extends into each valve to form its core. The valves are covered on both sides by endocardium that is thicker on the ventricular 123 It consists mainly of collagenous connective tissue and corresponds to the epicardium of the heart, but it lacks mesothelial cells. Arteries As the arteries course away from the heart they undergo successive divisions to provide numerous branches whose calibers progressively decrease. The changes in size and the corresponding changes in structure of the vessel wall are continuous, but three classes of arteries can be distinguished: large elastic or conducting arteries, medium-sized muscular or distributing arteries, and small arteries and arterioles. A characteristic feature of the entire arterial side of the blood vasculature system is the prominence of smooth muscle in the tunica media. A major feature of this type of artery is the width of the lumen, which, by comparison, makes the wall of the vessel appear thin. The tunica intima is relatively thick and is lined by a single layer of flattened, polygonal endothelial cells that rest on a complete basal lamina. Adjacent endothelial cells may be interdigitated or overlap and are extensively linked by occluding and communicating (gap) junctions. A proteoglycan layer, the endothelial coat, covers the luminal surface of the cell membrane. On the basal surface, the endothelial cells are separated from the basal lamina by an amorphous matrix. Numerous invaginations or caveolae are present at the luminal and basal surfaces of the plasmalemma, and the cytoplasm contains many small vesicles 50 to 70 nm in diameter. These transcytotic vesicles are thought to form at one surface, detach, and cross to the opposite side, where they fuse with the plasmalemma to discharge their contents. In humans, about one-fourth of the total thickness of the intima is formed by the subendothelial layer, a layer of loose connective tissue that contains elastic fibers and a few smooth muscle cells. In the spaces between the laminae are thin layers of connective tissue that contain collagen fibers and smooth muscle cells arranged circumferentially. The smooth muscle cells are flattened, irregular, and branched and are bound to adjacent elastic laminae by elastic microfibrils and reticular fibers. Smooth muscle cells are the only cells present in the media of elastic arteries and synthesize and maintain the elastic fibers and collagen.

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Milk proteins are elaborated by the granular endoplasmic reticulum and in association with the Golgi body form membranebound vesicles weight loss hair loss order 60 mg xenical otc. These are carried to weight loss pills ratings 120mg xenical visa the apex of the cell slim9 weight loss pills buy discount xenical 60 mg line, where the contents are released by exocytosis weight loss after 40 xenical 60mg lowest price. Lipid arises as cytoplasmic droplets that coalesce to form large spherical globules. Ultimately, they pinch off, surrounded by a thin film of cytoplasm and the detached portion of the plasmalemma. This method of release is a form of apocrine secretion, but only minute amounts of cytoplasm are lost. Immunoglobulins in milk are synthesized by plasma cells in the connective tissue surrounding the alveoli of the mammary glands. The secreted immunoglobulin is taken up by receptor-mediated endocytosis along the basolateral plasmalemma of mammary gland epithelial cells and transported in small vesicles to the cell apex, where it is discharged into the lumen by exocytosis. Passage of milk from alveoli into and through the initial ductal segments is due to the contraction of myoepithelial cells. Average milk production by a woman breastfeeding a single infant is about 1200 ml/day. In addition, immunoglobulins (IgE and IgA), electrolytes (Na+, K+, Cl-), minerals (Ca++, Fe++, Mg++), and other substances occur in milk. Such immunoglobulins are important in the resistance of enteric infections and provide the infant with considerable passive immunity. With weaning, lactation soon ceases, and the glandular tissue returns to its resting state. However, regression is never complete, and not all the alveoli completely disappear. While some structural changes can be observed, the cyclic response of the breast is minor. During pregnancy, the glands are continuously stimulated by estrogen and progesterone from the corpus luteum and placenta. Generally, growth of the ductal system depends on estrogen, but for alveolar development, both progesterone and estrogen are required. To attain the full development in pregnancy, other hormones -somatotropin, prolactin, adrenal corticoids, and human chorionic somatomammotropin - appear to be necessary. At the end of pregnancy (birth), the levels of circulating estrogen and progesterone fall abruptly. In the absence of their inhibition, there is an increased output of prolactin by cells of the adenohypophysis. Prolactin is a powerful lactogenic stimulus, and full lactation is established in a few days after birth. Maintenance of lactation requires continuous secretion of prolactin, which results from a neurohormonal reflex established by suckling. Periodic suckling also causes release of oxytocin from the neurohypophysis, which stimulates contraction of myoepithelial cells, resulting in release of milk from alveoli and into the ducts (milk letdown). Organogenesis Early development of the female reproductive tract is related closely to that of the urinary system and of the male reproductive tract. All arise in the mesoderm of the urogenital ridges within epithelial thickenings on each side of the midline. Initially, the ovaries and testes are indistinguishable and form a primitive, indifferent gonad that does not acquire male or female morphology until the seventh week of development. The first indication of gonads appears at four weeks, when a pair of longitudinal ridges, the gonadal ridges, appear. These are divided into lateral and medial parts and only the medial portion gives rise to the ovary. No germ cells are present in the gonadal ridges until the sixth week of development. The epithelium of the gonadal ridge proliferates, and in places, clumps of cells become thickened to form a number of cellular gonadal cords that penetrate the underlying mesenchyme. The cords at the periphery form a primary ovarian cortex, while centrally; proliferation of mesenchyme establishes a primary medulla.

The endothelial cells rest on a continuous layer of fine collagen fibers weight loss 90 diet discount xenical 60mg visa, separated from it by a basement membrane weight loss over 60 cheap xenical 60 mg on line. Deep to weight loss pills korea purchase 60 mg xenical with mastercard it is a thick layer of denser connective tissue that forms the bulk of the endocardium and contains elastic fibers and some smooth muscle cells weight loss yoga for beginners 60mg xenical sale. Loose connective tissue constituting the subendocardial layer binds the endocardium to the underlying heart muscle and contains collagen fibers, elastic fibers, and blood vessels. In the ventricles it also contains the specialized cardiac muscle fibers of the conducting system. The myocardium is a very vascular tissue with a capillary density estimated to be about 2800 capillaries per mm2 as compared to skeletal muscle which has a capillary density of about 350 per mm2. The capillaries completely surround individual cardiac myocytes and are held in close apposition to them by the enveloping delicate connective tissue that occurs between individual muscle cells. The myocardial capillaries are normally all open to perfusion unlike those of other tissues in which a certain percentage are close to perfusion. In these other tissues as activity increases so does the number of capillaries open to perfusion. The myocardium is arranged in layers that form complex spirals about the atria and ventricles. In the atria, bundles of cardiac muscle form a latticework and locally are prominent as the pectinate muscles, while in the ventricles, isolated bundles of cardiac muscle form the trabeculae carnea. In the atria, the cardiac muscle cells are smaller and contain a number of dense granules not seen elsewhere in the heart. They are most numerous in the right atrium and release the secretory granules when stretched. Heart the heart is a modified blood vessel that serves as a double pump and consists of four chambers. On the right side, the atrium receives blood from the body and the ventricle propels it to the lungs. The left atrium receives blood from the lungs and passes it to the left ventricle, from which it is distributed throughout the body. The wall of the heart consists of an inner lining layer, a middle muscular layer, and an external layer of connective tissue. It consists of a single layer of polygonal squamous (endothelial) cells with oval or rounded nuclei. Tight (occluding) junctions unite the closely apposed cells, and gap junctions permit the cells to communicate with one another. Atrial natriuretic factor acts on the kidneys causing vasoconstriction of the afferent arteriole which increases both glomerular filtration pressure and filtration rate. These actions result in increased sodium chloride excretion (natriuresis) in a large volume of dilute urine. Elastic fibers are scarce in the ventricular myocardium but are plentiful in the atria, where they form an interlacing network between muscle fibers. The elastic fibers of the myocardium become continuous with those of the endocardium and the outer layer of the heart (epicardium). Cardiac muscle cells contract spontaneously (selfexcitation) in response to intrinsically generated action potentials which are then passed to neighboring cardiac myocytes via gap (communicating) junctions. The action potentials are generated by ion fluxes mediated by ion channels in the plasmalemma and T-tubule system of the cardiac muscle cell. The prolonged plateau of the action potential observed during the contraction of cardiac myocytes lasts up to 15 times longer than that observed in skeletal muscle cells. The action potential, as in skeletal muscle, is caused in part by the sudden opening of large numbers of fast sodium ion channels that allow sodium ions to enter the cardiac myocytes. These ion channels remain open only for a few 10,000th of a second and then close. In skeletal muscle, repolarization then occurs and the action potential is over within 10,000th of a second. In cardiac muscle, the action potential is caused by the opening of two types of ion channels: (1) the fast sodium ion channels as in skeletal muscle and (2) slow calcium channels (calcium-sodium channels). When open both calcium and sodium ions enter the cardiac myocyte and maintain the prolonged period of depolarization resulting in the elongated plateau of the action potential. The permeability of the plasmalemma to potassium ions also decreases during this period as a result of the calcium influx and prevents an early return of the action potential to a resting level as occurs in skeletal muscle.

References:

• https://www.differentiatedservicedelivery.org/Portals/0/adam/Content/i58JJqqeREehR20m2O88hA/File/ethiopia_art_guidelines_2017.pdf
• https://www.cdc.gov/lyme/resources/TickborneDiseases.pdf
• https://www.ecronicon.com/ecmi/pdf/ECMI-14-00450.pdf
• https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lhsc-cardiovascular-market-new-realities-medtech.pdf
• https://www.nasponline.org/Documents/Resources%20and%20Publications/Handouts/Families%20and%20Educators/Early_Childhood_Disabilities_and_Special_Education.pdf