Articles and Clinical Views for Exams

Articulations-General Features Clinical View (P 256) Costochondritis

Costochondritis: =inflammation/irritation of costochondral joints result in: localized chest pain -often mistaken for myocardial infarction (heart attack) cause: - usually unknown - repeated minor trauma to chest (forceful repeated coughing during respiratory infection/overexertion during exercise - bacterial/viral infection of joints - backpackers who dont use chest brace NOT MEDICAL EMERGENCY Treatment: -Nonsteroidal anti-inflammatory drugs (ex aspirin) -rest Symptoms disappear w/in several weeks if treated correctly (Costochondral joints: immobile joints between ribs and its costal cartilage)

Cartilage and Bone Connective Tissue: Clinical View (P 154) OSTEITIS DEFORMANS

-Osteitis Deformans (paget disease of bone) Results from: -a disrutption in the balance between osteoclast and osteoblast function characterized by: -excessive bone resorption (excessive osteoclast activity) followed by excessive bone deposition (excessive osteoblast activity) Osteoclasts are 5x larger than normal (may contain 20 more nuceli--3-5 is normal) --reabsorb bone at higher rate Osteobasts deposit additional bone due to higher rate of reabsorption from osteoclasts --new bone=poorly formed and structurally unstable (susceptible to deformation and fractures) Common locations: -pelvis -skull -vertebrae -femur (thigh bone) -tibia (leg bone) Initial symptoms: -bone deformity -pain Later on symptoms: -lower limb bone may bow skull becomes -thicker and enlarged

Cartilage and Bone Connective Tissue: Article: "Why Is He Limping?"

-strong bones=aqequate nutrition and exercise during childhood and adolescence -calcium accumulates in bone matrix over time--skeleton hardens MID 20's= bones are as dense as they're ever going to be WOMEN: osteoporosis is more common in women 20% cases osteoporosis=MEN MEN: when bones go brittle, cause is usually something other than osteoporosis steroids: can hasten bone loss if taken for prolonged period Hormon disorders: can affect bone metabolism, certain diseases of bowel that disrupt guts ability to absorb calcium, and kidney disorders that can thin the bones Pt felt like hip was broken a week after it started hurting in a prison he was visiting. pt only ate brussel sprouts (had orange skin from carotene), almonds, and water--(had been doing this for years) Diet was deprived of calcium, so body stole the mineral from his bones and delivered it to the bloodstream to support critical functions throughout the body. calcium deficiency led to multiple vertebral compression fractures. pt didn't want to change his eating habits to fix it doctor didn't push past pts wants, offered care and support 1 year later: much worse hip pain. X-ray showed femur (thighbone)-LARGEST BONE IN BODY- fractured near the top by the hip spontaneously because of lack of calcium. he'd been walking around for a week with a broken hip. pt agreed for surgery. started to eat other foods. 3 months later: rehabilitation showed that he didn't even need a cane. gained 6 lbs. pt fixed his diet and improved greatly

Integumentary system: Clinical view (p125) DERMATOGLYPHICS

.Dermatoglyphics: study of friction ridge patterns (finger-prints) Friction ridges --formed by 4th month of fetal development --unique to each person identical twins have diff. friction ridges There are gender differences for friction ridges --MEN have more whorls --FEMALES have more arches Regional populations exibit characteristic patterns Medical conditions come w/certain patterns --DOWN SYNDROME: tend to have a single palmar crease (Simian crease) --schizophrenia, alzheimer disease, rubells, forms of cancer, heart disease =other conditions w/specific patterns research indicates that fingerprint patterns are indicators of conditions (patterns dont change after birth) Researchers hope to use dermatoglyphic patterns to diagnose diseases

Integumentary System Clinical view (p 124) UV RADIATION, SUNSCREENS, and SUNLESS TANNERS

.Suns 3 forms of UV radiation: 1)UVA (ultraviolet A) ---Wavelength ranges 320-400nm ---reach surface of earth/effect skin color ---"tanning rays" but can still cause burning ---causes skin cancer 2) UVB (Ultraviolet B) ---wavelength ranges 290-320nm ---reach surface of earth/effect skin color ---"burning rays" --causes skin cancer 3) UVC (ultraviolet C) ---wavelength ranges 100-280nm. ---dont reach surface of earth/absorbed by upper atmosphere. Visible light wavelength ranges 400nm for deepest violet. NO such thing a healthy suntan. Sunscreen: lotion. materials absorb/block UVA/UVB. if used correctly will help protect light/dark skin Steps of sunscreen: 1) appy to all exposed body parts-reapply after getting wet 2) must have high enough SPF SPF (Sun protection Factor:) a number found by exposing subjects to a light spectrum. ---amount of light inducing redness in sunscreen protected skin, divided by the amount of light that induces redness in unprotected skin=equals the SPF NEVER assume sunscreen will protect you completely from harmful rays of the sun Sunless tanners: create tan/bronzed skin w/out UV light exposure. ---Most effective contain: Dihydroxyactone (DHA) as an active ingredient (apply to epidermis, DHA interacts w/amino acids in cells to produce darkened color change--only superficial cells are effected so color change is temporary 5-7 days) --W/out DHA=not as effective ---most sunless tanners dont have sunscreen=no protection. If used, also use sunscreen

Integumentary System: Table 5.4 (p 139) SKIN CANCER

.TYPES: 1) Basal cell Carcinoma: --most common skin cancer --least dangerous (rarely metastasizes) --originates in stratum basale

Integumentary System: Article "Trucker accumulates skin damage on the left side of his face after 28 years on the road" https://www.cbsnews.com/news/trucker-accumulates-skin-damage-on-left-side-of-his-face-after-28-years-on-the-road/

.Too much ultraviolet radiation from the sun has been tied to premature aging, more wrinkles and a raised risk for potentially deadly skin cancer. This unidentified 69-year-old trucker (pictured above) who has been on the road for 28 years has accumulated lots of exposure to ultraviolet A (UVA) radiation. The man's condition is called unilateral dermatoheliosis and the man's skin has been gradually thickening over the past 25 years. UVA rays transmit through clouds and window glass to penetrate the skin's layers, and have been tied to aging and wrinkles. chronic UVA exposure can result in thickening of the skin's top layers, the epidermis and stratum corneum, as well as destruction of the skin's elastic fibers. The truck driver took the brunt of the damage on the left side of his face because of his many hours behind the wheel. Experts had thought only ultraviolet B radiation (UVB), which cause sunburn, were the main cause of skin cancer but recent research suggests UVA rays can damage DNA in the skin's deepest layers, increasing risk they become cancerous Doctors eventually recommended to this man sun protection, vitamin A creams called topical retinoids and frequent screenings for skin cancer. To protect yourself against UV radiation, the CDC says to seek shade, especially during midday hours, wear protective clothing, wear a hat with a wide brim to shade the face and head and use sun screen that protects against both UVA and UVB rays

Integumentary System: Clinical view (p 131) NAIL DISORDERS

.changes in SHAPE<STRUCTURE<APPEARANCE of nails=clinically significant change may indicate disease affecting metabolism throughout body state of nails can indicate a persons overall health Nails=subject to some disorders 1) Brittle nails: --cause: overexposure to water/chemicals --prone to: vertical splitting/separation of nail plate layers @ free edge --treatment: keep moisturized-limit water exposure/chemicals=alleviate brittle nails 2) ingrown nail: --def: edge of nail digs into skin around it --1st characterized by: pain/inflammation @ site --untreated: cause infection --possible cause: overly tight shoes/ improper trimming of nails 3) Onychomycosis: --def: fungal infection that occurs when nails are constantly exposed to warmth/moisture --start: fungus grows under nail --eventually causes yellow discoloration/thickened nail/brittle and cracked edges. --damage: permanent damage to nail and potential spread of infection --treatment: oral fungal meds for long periods of time to eradicate infection (6-12 weeks, 1 yr) 4) Yellow nail syndrome: --Def: growth and thickening of nail stops or slows completely --when slow growth, nail becomes yellow/green --cause: may be sign of respiratory disease (chronic bronchitis) 5) spoon nails: --Def: outer surface of nails are concave --sign of: iron deficiency --Treatment: treat iron deficiency to alleviate nail condition 6) Beau's lines: --horizontal lines across nail --Indicate: temporary interference w/nail growth @ time this portion of nail was formed --Cause: injury to nail or severe illness. sometimes by chronic malnutrition 7) Vertical Ridging: --common --doesn't indicate serious medical problem --occurs more when you get older

Articulations-General Features Article: Fit Young Pitchers See Elbow Repair as Cure-All http://www.nytimes.com/2007/07/20/sports/baseball/20surgery.html?_r=1&ref=baseball&pagewanted=print

17 year old pitcher was examined for knee surgery. pt and father asked if reconstructive elbow surgery on healthy elbow, would help pt gain speed on his fastball Tommy John Surgery -named after former major league pitcher who had this surgery -had success rate of 80-85 percent -prolonged careers of hundreds of major leaguers -1 in 7 pitchers in the major leagues this season had the surgery Orthopedics say there are troubling aspects to procedure: -becoming more commonplace among teenage pitchers who are injuring arms through overuse -surgery's reliability has misconceptions that a healthy arm can be enlivened by the surgery/procedure will increase an injured pitchers velocity, making him better than ever The success of surgery, and myths, are prompting young pitchers w/small injuries to get the Tommy John Surgery -some hope for scholarships or multimillion dollar professional contracts Orthopedists say: -there is no evidence that elbow surgery had been performed on completely healthy arm -no ethical doctor would perform such an unnecessary procedure PARENTS SEEM MORE EAGER FOR THE SURGERY ON SONS SORE ELBOWS THAN ANY OTHER JOINT TOMMY JOHN SURGERY: -reconstruction of ulnar collateral ligament in the elbow (stretched/frayed/torn from throwing motion) -harvest tendon from forearm/below knee -weave new tendon in fig 8 pattern through tunnels that have been drilled in the ulna and humerus bones DOWNSIDES: -may require 2 years recovery -infection, fractures, nerve irritation, numbness possible -20% pitchers dont return Some think the surgery is a CURE ALL Tommy John surgery relieves pain but does not provide an increased ability over a healthy natural ligament to transfer energy from the body to the ball, doctors said. Pitchers may be comparing postoperative speed with the velocity from their injured arms, young pitchers may begin to throw harder as they mature, and pitchers often improve their mechanics during rehabilitation while also working to make their bodies stronger. And, of course, repaired arms are pain-free and rested.

Heart Clinical view (p659) "Heart sounds and heart murmurs"

2 normal sounds associated w/each heartbeat: -"lubb-dupp" sound LUBB sound=S1 sound -represents closing of atrioventricular valves Dupp sound=S2 sound -represents closing of semilunar valves the place where sounds from the valves can be heard best does not correspond w/the location of the vlave 1) aortic semilunar valve best heard: second intercostal space to the right of the sternum 2) Pulmonary semilunar valve best heard: second intercostal space to the left of the sternum 3) right AV valve best heard: inferior left sternal border in 5th intercostal space 4) left AV valve best heard: near apex of heart (level of 5th intercostal space, 9cm from midline of sternum) HEART MURMUR: =abnormal heart sound =1st indication of heart valve problems -some aren't a big deal, but all should be evaluated result of: -turbulence of blood as it passes through the heart -valvular leakage -decreased valve flexibility -misshapen valve 2 types of heart murmurs 1) valvular insufficiency: 2) valvular stenosis Valvular insufficiency -aka valvular incompetence -1 or more cardiac veins leaks bc valves dont close tight enough -caused by: inflammation/disease that cause free edges of the valve cusps to become scarred/constricted -causes: blood to regurgitate back through the valve, heart enlargement Valvular stenosis: =scarring of valve cusps, become rigid/partly fused, cannot completely open -valve=narrow, resists the flow of blood, decreases chamber output -what happens to affected chamber: undergoes hypertrophy and dilates (dangerous) -CAUSE OF IT: rheumatic heart disease (may follow streptococcal infection of the throat look at pg for pic of locations of individual heart valves

Appendicular Skeleton-Pectoral Girdle and Upper Limbs: Article: "Zion Harvey: A Year After Double Hand Transplant 9-Year-Old 'Can Do More Than I Imagined'" https://www.nbcnews.com/health/health-news/zion-harvey-year-after-double-hand-transplant-9-year-old-n636646

9 year old Zion Harvey -threw 1st pitch @ baltimore orioles game against texas rangers July 2015 ZION= FIRST CHILD TO EVER HAVE DOUBLE HAND TRANSPLANT Zion -lost both hands and legs due to infection -damaged kidneys -ideal candidate due to kidney transplant and immune supressing drugs -drugs gave him better chance at not rejecting transplanted hands Rehab -long -almost rejected new hands @ one point -brian had to relearn how to use new hnads -after few weeks after surgery, played with toys and baked cookies w/whisk Now he can: -throw football -play baseball -do a handstand

Cartilage and Bone Connective Tissue: Clinical View: (p 163) ACHONDROPLASTIC DWARFISM

Achondroplastic Dwarfism: -most common form of Achondroplasia ---characterized by abnormal conversion of hyaline cartilage to bone Achondroplastic Dwarfism: =long bones of limbs stop growing in childhood, where other bones continue to grow normally symptoms: -shortness in stature but has a large head -forehead = prominent -nose is flat @ bridge -bowed legs -lordoisis (exaggerated curvature of lumbar spine) Stature is affected, BUT intelligence/ life span are not affected results from: -failure of chondrocytes in 2/3 zones of epiphyseal plate to multiply and enlarge leads to: -inadequate endochondral ossification other results from: -a spontaneous mutation during DNA replication and is autosomal dominant ---this means unaffected and affected parents can have children w/the disorder

Muscle tissue and Organization: Article: "attention athletes, coaches, parents!" http://www.thesuntimes.com/article/20111123/NEWS/311239983/0/SEARCH

Acute Exertional Rhabdomyolysis (AER) -16 year old got it -can lead to kidney failure -very serious conditional -can occur in anyone who engages in physical activity -specifically affects function of skeletal muscle and transforms whole muscle cell membrane DEF: degeneration of skeletal muscle caused by excessive, unaccustomed exercise process: -Minor muscle damage: this is normal during or after exercise --if in accelerated form, can become AER -function of skeletal muscle altered -intercellular components within muscle are released into bloodstream (potassium, myoglobin, creatine kinase) -myoglobin concentration in blood stream is @ elevated level -Myoglobin carried to urine -potassium and calcium is also leaked into blood stream ---interfering with heartbeat/muscle spasms untreated: -excess myoglobin in urine will collect in kidney, lead to renal failure symptoms: -muscle pain/weakness/swelling -myoglobinuira (myoglobin in urine)(dark colored like cola drink urine) -increased levels of muscle enzymes in blood -bilateral pain with swelling in one or more limbs best treatment: education and prevention -increase the intensity of exercise @ pace that allows muscle tissue to properly recover -health professionals need to instruct proper exercise technique -drinking water is important -acclimatization, diet, fluid intake should be discussed -16 year old was on morphine bc the pain Diagnosis and treatment of AER begins with: proper recognition from health professionals (athletic trainers, strength and conditioning specialists, personal trainers, coaches) If caught early, can make full recovery (why prevention is important) Treatment: -hydration, rest, pain meds Janice Norris=author -made a point that sports/athletics is important, but people try to live up to sterotypes and injure themselves -education should be just as important but for some reason, if a teacher is fired it doesn't raise that many questions, but if a coach is fired, everyone is interested She said we need to look at our obsession with sports and put them in proper perspective Grandson with AER: got it from wrestling

Brain: Clinical view Pg 531 Alzheimer disease: the long goodbye

Alzheimer Disease (AD): -Leading cause of dementia (general loss of cognitive abilities--memory, language, decision making skills) -clinically apparent: in 70's or later Early onset Alzheimer disease: -individual develops symptoms before age 65 AD diagnosis often delayed due to confusion with other forms of cognitive impairment Symptoms: slow, progressive loss of higher intellectual functions-changes in mood and behavior--language deterioration, impaired visuospatial skills-indifferent attitude-poor judgement Motor function stays intact "THE LONG GOODBYE" -known as this bc progresses over months/years -robs ppl of their memory, personality, capacity to speak Prevention: -stimulate your brain (mental decline often appears related to altered or decreased numbers of synapses between neurons) -The way to brain vitality is BRAIN ACTIVITY ---walk, play games, attend play/lecture, garden, work puzzles, read and write, community group participation CAUSE: -unknown -genetics/environment play role Postmorten examinations of brain w/AD show: -marked/generalized cerebral atrophy -brain tissue have decreased number of cerebral cortical neurons (in temporal and frontal lobes) -neurons that remain have abnormal aggregations and protein fibers (NEUROFIBRILLARY TANGLE) -AMYLOID PRECURSOR PROTEIN (APP) (abnormal protein): occurs in brain/walls of cerebral arterioles -Hippocampus (memory processor), affected -biochemical alterations seen (decreased level of neurotransmitter acetylcholine in cerebrum NO CURE FOR AD MEDICATIONS help alleviate symptoms/slow progress RISK: difficulty or loss in identifying common smells (Lemon/cinnamon)=linked w/increased risk of getting AD --loss of smell one of first signs of developing disease (brain regions that deal with smell are first to get neurofibrillary tangles of AD) AD Brain scan shows: LARGE VENTRICLES, wide spaces between gyri

Muscle tissue and Organization: Clinical view pg 305 "Anabolic steroids and performance enhancing compounds"

Anabolic Steroids: synthetic substances that mimic the actions of natural testosterone -over 100 compounds have been developed -require prescription for legal use in US medical uses: -treatment of delayed puberty -impotence -wasting condition associated with HIV infection popular in athletes/performance enhancers because: -stimulate the manufacture of muscle proteins Stimulation of excessive muscle development requires: -LARGE doses of anabolic steroids Devastating side effects: -come from extended anabolic steroid use -increased risk of heart disease/stroke -kidney damage -agressive behavior -liver tumors -testicular atrophy -acne -personality aberrations Female users: -often experience menstrual irregularities -growth of facial hair -atrophy of uterus/mammary glands -sterility Injections: -must be injected -disease transferred from sharing of needles (AIDS/Hepatitis) USE AS PERFORMANCE ENHANCERS=BANNED Athletes also use: -hormones (growth hormone-insulin like growth factor 1) to increase muscle performance -creatine -branched chain amino acids -ephedrine (linked to death-banned by FDA in US) ---research suggests: they shouldnt be used to increase muscle size and power

Vessels and circulation #1 Clinical view (p709) Aneurysms

Aneurysm: =localized, abnormal dilation of a blood vessel -can form in any type of vessel -MOST COMMON in arteries, especially AORTA (due to higher blood pressure on the arterial side of the circulation) -after initiated by a weakness in the wall of the vessel, an aneurysm tends to increase in size over weeks/months until it ruptures 1) Abdominal aortic aneurysm: -most often cause of atherosclerosis -where developed? between level of renal arteries/point near where aorta bifurcates into common iliac arteries -Emergency? ruptured aorta is surgical emergency. few survive. -how is an abdominal aortic aneurysm detected? during physical exam as pulsating abdominal mass. -xray/ultrasound confirm diagnosis/determine what? size of aneurysm -treatment: stent graft inserted through incision in femoral artery. positioned using xray guidance. expanded to reinforce the weakened/dilated area of aortic wall. (NOT ALWAYS LEAD TO COMPLETE CURE) 2) Berry aneurysm (aka cerebral/saccular aneurysm) =weak area in cerebral blood vessels that balloons out and fills w/blood -named why? it is a saclike outpocketing of cerebral blood vessels, appears berry shaped -located where? most along arteries that form cerebral arterial circle -rupture? all have potential to rupture/cause brain bleeding -can lead to what if ruptures? hemorrhagic stroke, subarachnoid hemorrhage, nerve damage, death -result form? congenital defects, high blood pressure, atherosclerosis, head trauma, infection -what results in symptoms? large aneurysm that steadily presses on tissue/nerves -symptoms: pain above eye, dilated pupils, vision changes -when ruptures experiences? severe headache, double vision, nausea, vomiting, stiff neck, loss of consciousness -emergency? YES. if it ruptures -treatment: sutures, clamps, materials to repair ruptured site

Articulations-Selected Articulations in Depth Clinical View (P282) Arthritis

Arthritis: -group of inflammatory/degenerative diseases of joints that occur in various forms -Symptoms of all forms: --swelling of joint --pain --stiffness ARTHRITIS=MOST PREVALENT CRIPPLING DISEASE IN US. Common forms: 1) Gouty Arthritis 2) Osteoarthritis (OA) 3)Rheumatoid Arthritis 1) Gouty Arthritis -typically in MIDDLE AGED or OLDER individuals -more common in MALES -called "gout" results in: increased level of uric acid in the blood -abnormal level causes urate crystals to accumulate in blood, synovial fluid, and synovial membranes Body's response: joint pain Usually starts: -with an attack on a single joint (often BIG TOE) later progresses: -to other joints Causes: -immobilization of joints bc fusion between articular surfaces of bones Relief: -NSAIDS are used to alleviate symptoms/reduce inflammation 2) Osteoarthritis (OA) -aka "degenerative arthritis" -MOST COMMON TYPE OF ARTHRITIS -aka "wear and tear arthritis" bc its prevalence in weight bearing joints/association w/old adults Process: -articular cartilage breaks down first - bone rubs against bone, causes abrasions on the bony surfaces (eburnation) -movements @ joint is painful/stiff due to lack of articular cartilage -ENTIRE joint is affected Joints commonly affected: 1) weight bearing joints are most affected: - hips - knees - feet - cervical/lumbar regions of spine 2) shoulders 3) interphalangeal joints Seen in: older individuals (yet athletes are seeing it as well due to repetitive stress of joints) Treatment: NSAIDs alleviate symptoms 3) Rheumatoid Arthritis (RA) -typically seen in YOUNGER and MIDDLE AGED adults -more prevalent in WOMEN -a "Autoimmune disorder" --body's immune system targets its own tissues for attack Symptoms: -pain, swelling of joints, muscle weakness, osteoporosis, problems w/heart and blood vessels Results from: -follows infection by certain bacteria//viruses that have surface molecules similar to molecules normally present in joints -when body's immune system is stimulated to attack the foreign materials, it also destroys its own joint tissue, initating autoimmune disorder Process: -starts w/synovial membrane inflammation -fluid /white blood cells leak from small blood vessels into joint cavity --causes increase in synovial fluid volume -joint swells, inflamed synovial membrane thickens -eventually, articular cartilage/underlying bone become eroded -scar tissue forms/ossifies/bone ends fuse together (process of anklyosis) -bone is immobilized Treatment: -2 types of medications are often distributed -faster acting first line medications: --include NSAIDs and corticosteroids --relieve joint pain -Slower, longer acting, second line medications: --methotrexate and hydroxycholorquine --help put disease into remission/slow down destruction of joint

Articulations-General Features Clinical View (P 257) Cracking knuckles

Cracking knuckles: -Stretch/pull on synovial joint -joint volume expands -pressure on fluid w/in joint decrease -partial vacuum exists w/in joint result: -gases dissoved in fluid become less soluble -form bubbles (process of CAVITATION) When joint stretched to certain point: -pressure in joint drops lower -bubbles in fluid burst -cracking/popping sound due to burst of bubbles RECOVERY: 20-30 minutes for gases to dissolve back into the synovial fluid -cannot crack knuckles again until the gases dissolve DOES NOT CAUSE ARTHRITIS

Vessels and circulation #1: Clinical view (P702) Atherosclerosis

Atherosclerosis: -progressive disease of elastic/muscular arteries -characterized by: atheroma (atheromatous plaque) ---leads to thickening of tunica intima/narrowing of arterial lumen -linked to 50% all deaths in US -leading cause of morbidity/mortality in other countries 1) Etiology of atherosclerosis: -cause of atherosclerosis=not understood Response to injury hypothesis: (process) -injury (common repeated) to endothelium of arterial wall results in inflammatory reaction, which leads to development of atheroma -injury caused by: infection, trauma to vessel, hypertension -injured endothelium becomes permeable, encourages leukocytes/platelets to adhere to the lesion/initiate inflammatory response -LDL (low density lipoprotein) and VLDL's enter tunica intima, combine w/oxygen, and remain stuck to vessel wall -oxidation of lipoprotein attracts monocytes, which also adhere to endothelium wall -monocytes digest lipids and develop FOAM CELLS -smooth muscle cells from tunica media migrate into atheroma and proliferate -further enlargement of atheroma -atherosclerotic plaques narrow the lumen of the blood vessel -restricted blood flow to region the artery supplies 2) Risk factors for atherosclerosis -Hypercholesterolemia: increased amount of cholesterol in the blood ----runs in families ---- positively associated w/rate of development/severity of atherosclerosis -males affected more than females -symptomatic atherosclerosis increases w/age -smoking/hypertension cause vascular injury, increases the risk 3) treatment/prevention of atherosclerosis: a= if artery is occluded (blocked) in 1 or a few areas, used Angioplasty treatment: angioplasty process -insert balloon-tip catheter into an artery -positions catheter at the site where lumen is narrowed -balloon is inflated, expanding the narrowed area -stent placed at site to ensure it stays open 1)an uninflated balloon and compressed stent are passed through a catheter to the area of the artery that is obstructed 2) balloon inflates, which expands the stent and inserts it in place and also compresses the atheroma 3) the stent typically remains in the vessel as the balloon is deflated and the catheter is withdrawn b=if you have an occluded coronary artery, use Coronary bypass surgery Coronary bypass surgery process: -vein (great saphenous vein) or artery (internal thoracic artery) detached from original location -vein/artery grafted from aorta to coronary artery system -bypass the areas w/atherosclerotic narrowing c=best treatment, is prevention Prevention option: -maintain healthy diet -watch cholesterol level -no smoking -monitor blood pressure -seek treatment if you have hypertension

Brain: article New alzheimer's treatment fully restores memory function http://www.sciencealert.com/new-alzheimer-s-treatment-fully-restores-memory-function

Australian researchers found non-invasive ultrasound technology that clears brain of neurotoxic amyloid plaques (which are responsible for memory loss/decline in cognitive function in alzheimer's pts) Alzheimer's disease=result of a build up of 2 types of lesions: 1) amyloid plaques -sit between neurons/end up as dense clusters of beta-amyloid molecules (sticky protein clumps/forms plaques) 2)Neurofibrillary tangles -found inside brian -caused by defective tau proteins that clummp into thick insoluble mass -causes small filaments (microtubules) to get twisted -this disrupts transportaion of essential materials Currently NO vaccine/preventative measure for alzhimer's disease --Affects 50 million people worldwide Team from University of Queensland have come up with a solution to remove build up of defective beta-amyloid proteins from the brain Technique of team: +us ultrasound called "focused therapeutic" ultrasound +non invasively beams sound waves into brain tissue +sound waves gently open blood brain barrier/stimulate microglial cells to activate(clear toxic betaamyloid clumps) Tested on Mice -75% fully restored memory function -0 damage to surrounding brain tissue -mice had improved performance on memory tasks Exciting bc dont have to use drug Therapeutics Team is planning to start trials with higher animal models -hope human trials underway in 2017

Brain: Clinical view Pg. 455 Autism Spectrum Disorder

Autism Spectrum Disorder (ASD): -AKA autism -disorder of neural development -affects 1 in 88 children in US -recognized in early childhood--diagnosis difficult until older -Phrase is used to describe similar disorders (autistic disorder, childhood disintegrative disorder, and asperger syndrome) -varies in severity (why called Spectrum) CHARACTERIZED BY: -some form of social and communication difficulties eX) delays in language acquisition/completely nonverbal EX) social interaction is difficult (from inability to reciprocate interest during convo to being withdrawn into childs "own word" EX) intelligence varies (from severe cognitive delay to possessing savant-like skills in focused areas like math or music -highly sensitive to stimuli (loud noises/unfamiliar people) -struggle adjusting to changes in routine MELTDOWNS: -meltdowns or tantrums occur due to discomfort to overstimulation or frustration in inability to communicate Behaviors: -repetitive motions (hand flapping or rocking) -resistance to changes in routine (wear same shirt or eat same meal each day) -inability to engage in pretend play -inability to gauge feelings of others -intense interest in particular activity or subject Causes: -stems from inabilty of brain to process info between neurons -specific cause of condition not well understood -genetic factors may be involved (autism affects 4x more MALES than females, often manifests in siblings) -biochemical and environmental factors # cases has increased singe 1980's -may be because ability to detect disorder has increased 1988 FRAUD paper: -claimed measles, mumps, and rubella (MMR) vaccine was linked to an increased risk of developing autism. -paper manipulated data, study was fawed -author lost his medical license for professional misconduct Recent studies: -show no link between vaccines and developing autism -PPl still believe the fraud paper, and vaccinations rates have declined-diseases increased TREATMENT: -speech and behavioral therapy -holistic approaches (diets, supplements, experimental procedures) Some develop skills and live independently, others will not Independence predictors for adulthood are seen by their level of intelligence and ability to communicate

Axial Skeleton--Vertebral Column and Thoracic Cage: Article: "Sacrifice 101: A Scientist Offers How-To; Aztecs had Technique for Ripping Out Hearts." The Salt Lake Tribune. https://search-proquest-com.dist.lib.usu.edu/docview/288830997

Aztec priests performed human sacrifices by ripping out the hearts of living victims w/knives and bare hands Pyramid-like tempe w/sacrificial altar used they used horizontal cuts side to side before grabbing heart. --quicker than vertical cut down breastbone --incision from navel to tip of sternum would spill organs (not good deptiction) Broad horizontal cut across sternum would kill victims quickly priests reach in and take out heart INCISION USED: bilateral transverse thorcotomy --not used by surgeons today ONCE DEAD the sacrificed were: -dismembered -defleshed -decapitated WHY perform sacrifices: -bc myths held there had been 4 previous worlds, all of which ended in disaster -they were living in the 5th world and knew it would also finish in catastrophe -ONLY way to maintain energy of the world is by human sacrifice

Cartilage and Bone Connective Tissue: Clinical View: (P164) BONE SCANS

Bone scans= tests that detect bone pathologies sooner than standard xrays exposed to less radiation compared to xray 1) patient injected intravenously w/small amount of radioactive tracer that is absorbed by bone. 2) scanning camera detects and measures radation emitted form bone 3) info converted to diagram/photograph --normal bone tissue=gray --Hot spots= indicate increased metabolism (dark area) -cold spots= indicate decreased metabolism. (light area) Abnormalities detected: -fractures -decalcification of bone -osteomyelitis -degenerative bone disease -osteitis deformas -see whether cancer has metastasized bone -identify bone infections -monitor progress of bone grafts and degenerative bone disorders -evaluate unexplained bone pain/fracture -monitor response to therapy of a cancer that has spread to bone

Brain: Clinical view Pg468 Brain disorders

Brain disorders: characterized by malfunction in: -sensory gathering -motor expression -combination of the two Types: -headache -cerebral palsy -encephalitis -epilepsy -huntington disease -parkinson disease HEADACHE -occur even when brain is pain insensitive -NOT brain disorder (but accompany other diseases or brain disorders) Extreme causes: - pressure produced by tumors, hemorrhage, meningitis, inflamed nerve roots Typical causes: -emotional stress, increased blood pressure, food allergies (cause blood vessel diameter to change) MIGRAINE headache -severe, recurring headaches -affect usually one side of the head CEREBRAL PALSY: -group of neuromuscular disorders resulting from damage to infants brain before-during-right after birth -intellectual impairment and speech difficulty may occur -3 forms involve impairment of skeletal motor activity to some degree 1) ATHETOID: characterized by slow, involuntary, writhing hand movements 2) ATAXIC: Marked by lack of muscular coordination 3) SPASTIC: exhibits increased muscular tone ENCEPHALITIS: -acute inflammatory disease of brain -usually due to viral infection -Symptoms: drowsiness, fever, headache, neck pain, coma, paralysis -DEATH may occur EPILEPSY: -Characterized by: recurring attacks of motor, sensory, or psychological malfunction (with or without unconsciousness or convulsive movements) -During seizure: neurons in brain fire at unpredictable times (even without stimulus) -EPILEPSY referrs to: group of symptoms with many cases EX) some epileptic events may be GRAND MAL seizures (affecting motor areas of brain and cause severe spasms and loss of consciousness) EX) some exibit PETIT MAL seizures (affect sensory areas-dont have convulsions or prolonged unconsciousness) HUNTINGTON DISEASE: -autosomal dominant hereditary disease -affects cerebral nuclei Causes: rapid, jerky, involuntary movements (start in face--over months and years go to arms and legs -progressive intellectual deterioration -personality changes, memory loss, irritability ONSET AGE 35-40 FATAL within 10-20 years PARKINSON DISEASE: -slow progressing neurologic condition -affects muscle movement and balance EXHIBIT: -stiff posture, expressionless face, slow voluntary movements, resting tremor (hands), shuffling gait CAUSED BY: deficiency of neurotransmitter dopamine---results from decreased dopamine production by degenerating neurons in substantia nigra Dopamine deficiency : prevents brain cells from performing their usual inhibitory functions within the cerebral nuclei WHEN SYMPTOMS DEVELOP: person has lost 80-90 % of cells that make dopamine TREATMENT: medications enhancing amount of dopamine in remaining cells of substantia nigra -meds to treat symptoms

Appendicular Skeleton-Pelvic Girdle and Lower Limbs Clinical View (P 246) Pathologies of the Foot

Bunion: -localized swelling at first metatarsophalangeal joint -causes: toe to point toward 2nd tow instead of anterior direction -caused by: wearing shoes that are too tight -One of the MOST COMMON foot problems Pes Cavus: -"clawfoot" -excessively high longitudinal arches -joints between metatarsals/proximal phalanges are overly extended -joints between different phalanges are bent so they appear clawed Pes Planus: -"flat feet" -medial longitudinal arch is flattened -entire sole touches ground -caused by: excessive weight, postural abnormalities, weakened supporting tissue -normally: arches may flatten throughout day if standing, proper rest return arches to normal shape Talipes Equinovarus: -"Congenital clubfoot" -Caused by: not enough room inwomb -feet permanently inverted (soles twisted medially) -ankles are plantar flexed (soles twisted posteriorly) (like pt is trying to stand tip toe) Metatarsal Stress Fracture: -caused by: repetitive pressure or stress on foot -small crack develop in outer surface of bone -RUNNERS prone to injury bc repetitive stress on feet

Integumentary System: Clinical View ( p136) BURNS

CAUSE of Burns: --heat --radiation --harmful chemicals --sunlight --electrical shock PRIMARY THREAT to life from burns: --fluid loss --infection --effects of burned, dead tissue BURNS=MAJOR CAUSE OF ACCIDENTAL DEATH CLASSIFICATION of burns by: --depth of tissue involvement 1st/2nd degree burns= partial-thickness burns 3rd degree burns= Ful thickness burns FIRST DEGREE: SUPERFICIAL --only involve epidermis --characterized by: redness, pain, slight edema --healing time: 3-5 days --typically no scarring EX) mild sunburn. --treatment: put burned area in cold water or apply cool, wet compressions--cover burn w/sterile nonadhesive bandages SECOND DEGREE: PARTIAL THICKNESS --Involve epidermis and part of dermis --skin appears (tan, red, white) --blisters/pain --Healing time: 2-4 weeks --slight scarring may occur EX) severe sunburn where skin has blisters/scalding from hot liquids or chemicals --treatment: similar to 1st degree. --don't break blisters (infection may occur) --don't apply ointment bc causes retained heat --limbs should be elevated to prevent swelling THIRD DEGREE: FULL THICKNESS --Involve epidermis, dermis, hypodermis (often destroyed) --Cause: corrosive chemicals/fire/prolonged contact w/hot water --concern: dehydration bc skin is lost and water cant be retained in that area --Treatment: must treat dehydration or could die. antibiotics bc high infection rate. differ on burn --many require hospitalization --SKIN GRAFT: piece of skin transported from one part of the body to the other to cover destroyed area --Skin graft needed bc dermis and vasculature are destroyed --Skin graft prevents: infection/ dehydration? minimize abnormal connective tissue fibrosis/disfigurement SEVERITY of burn determined by: --degree of burn --age of patient --general size of burn --location of burn EX) burn on face requires more treatment than similar burn on extremity RULE OF NINES: --used to estimate surface area of burn --major body areas account for some factor of 9% of total body surface area EX) ADULTS: --anterior/posterior parts of head/neck=9% each --each upper limb=9% --each lower limb=18% (including butt) --anterior trunk=18% --posterior trunk=18% Perineun=1% estimating surface area is critical for proper: --fluid replacement (greater area=greater amount fluid lost) Burns are severe/critical if one of these are met: 1)over 25% body has 2nd degree 2) over 10% body has 3rd degree 3) 3rd degree burns present on hands/feet/face/perineum TREATMENTS used for burns: -in general: --managing fluid loss --relieving swelling --pain management --remove dead tissue/foreign material --control infection --increase caloric intake -Swelling occurs when blood capillaries become permeable and fluid collects in localized tissues (causes exacerbation to the overall fluid loss in the circulation) -ESCHARATOMY: severe swelling cases, this is performed. Incision made in dermis to lesson constriction caused by swelling -pain meds: alleviate discomfort from burn/swelling -antibiotics: limit infection -Severe burns: become hypermetabolic, and demand for nutrition increases. --pt given additional caloric intake, (2-3x more than normal sometimes) --often supplementary nutrition through feeding tubes or IV's

Integumentary System Article "Kids' Sun Exposure May be Key to Deadly Cancer" http://www.nbcnews.com/id/19173898/ns/health-cancer/t/kids-sun-exposure-may-be-key-deadly-cancer/#.WmO4xMeGw6g

CHILDHOOD EXPOSURE COUNTS: overall sun exposure in childhood, not just burns, is a big key to who later develops deadly skin cancer. NEED TO BLOCK UVA TOO: The Food and Drug Administration wants sunscreens to be rated not just for how well they block the ultraviolet-B rays that cause sunburn — today's SPF rankings —BUT for how well they protect against deeper-penetrating ultraviolet-A rays that are linked to cancer and wrinkles. GOOD WAY TO SHEILD KIDS: Check the weather forecast for the day's "UV index" in your town, to learn when to stay indoors or in the shade. --UV levels vary from state to state, even day to day, because of things like altitude, cloud cover and ozone. MELANOMA=MOST DEADLY SKIN CANCER --usually seen in 40-50's, --lately seen in young kids CHECK UV EXPOSURE: Patients with the most common known melanoma mutations, called BRAF mutations, also had the highest UV exposure by age 20. Interestingly, they also had the most moles, another important melanoma risk factor. WHY MORE OF A RISK? young, rapidly growing skin may be particularly vulnerable to damaging UV rays, especially as moles are developing, Thomas says. Or maybe early childhood sun exposure spurs moles to develop in the first place. association with BRAF disappeared at age 30. Another melanoma subtype, characterized by mutations in a gene called NRAS, is strongly linked to UV exposure by age 50 SUNSCREEN PROBLEM: Until recently, sunscreens have filtered out mostly UVB rays that cause sunburns, not UVA rays, meaning people who depended only on sunscreen to prevent skin cancer may have gotten a false sense of security BROAD SPECTRUM: many sunscreen promise broad spectrum against UVA rays--but government doesn't have testing requirements for UVA protection yet --term "broad spectrum" doesn't mean anything. anyone can use it. FDA PROPOSAL: -keep SPF for UVB -Add SPF for UVA ADVICE: -use enough sunscreen --child: tablespoon-full --adult: full shot glass -super high SPF will counter thin-coat problem -if has Helioplex=provide longer lasting UVA protection (or Mexoryl in moisturizer) -apply 30 min before going in sun -limit exposure during peak UV hours (10am-4pm) UVA benefits: needed by body to create vitamin D

Heart Article "vital signs: plumbing the depths" Ultrasound uncovers lethal choke hold on the heart ON canvas

Pericardium - double layer around high -tough fibrous sac -visceral pericardium: adheres to heart -Parietal pericardium: encloses heart -low friction space for beating Pericarditis: -results from virus,

Heart clinical view (P666) "cardiac Arrhythmia"

Cardiac Arrhythmia: =aka dysrhythmia =abnormality in rate, regularity, or sequence of the cardiac cycle Types: 1) atrial flutter 2) atrial fibrillation 3) premature ventricular contractions (PVC's) 4) ventricular fibrillation 1) atrial flutter: -atria beat at 200-400x per minute -abnormal muscle impulses flow through the atrial conduction system -stimulates the atrial musculature/AV node over and over 2) atrial fibrillation -muscle impulses are more chaotic than atrial flutter -lead to irregular heart rate -ventricles respond by increasing and decreasing contraction activities -leads to serious disturbances in the cardiac rhythm 3) premature ventricular contractions (PVC's) -result from stress, stimulants (caffeine), sleep deprivation -occur singly or in rapid bursts -due to abnormal impulses initiated w/in AV node or Ventricular conduction system --EVERYONE experiences occasional PVC -not detrimental unless occur in great numbers -most go unnoticed PERCEIVED AS: heart "skipping a beat" and "jumping" in the chest 4) ventricular fibrillation: -disorganized, rapid, repetitious movement of ventricular muscel -replaces normal contraction -contractions of heart in fibrillation=uncoordinated -heart does not pump blood, blood circulation stops -----cessation of cardiac activity = CARDIAC ARREST -----CPR (cardiopulmonary resuscitation) used to continue circulation of blood during cardiac arrest -----AED (automated external defibrillator) or paddle electrodes are used to attempt resynchronization of cardiac muscle cell electrical activity

Axial muscles Clinical view pg 341 Paralysis of the diaphragm

Cause of diaphragm paralysis and loss of diaphragmatic innervation: -injury to critical parts of brain, spinal cord, phrenic nerves Symptoms: -diaphragm paralyzed -cannot contract diaphragm -no air is exchanged in lungs -pt cannot breath -DEATH IS INEVITABLE unless artificial breathing measures are implemented MOST COMMON CAUSE: spinal cord injury @ or superior to the 4th cervical vertebra (motor neurons that innervate diaphragm located here) INfection with poliovirus: -destorys brain and spinal cord motor neurons -used to be main cause of paralysis Breathing devices: -modern ventilator -older methods: polio pt placed in an iron lung: chamber where air pressure around pt is decreased to facilitate inhalation, and increase to facilitate exhalation ---weeks/months of time spent in device ---position: lying prone, only head extending from tubular apparatus

Brain: Clinical view Pg 520 Cerebrovascular accident

Cerebrovascular Accident (CVA or STROKE) caused by: -reduced blood supply to part of brain due to blocked or damaged arterial blood vessel EX)Thrombus=blood clot within the blood vessel -if forms @ narrowed region of cerebral artery, can completely block lumen of artery ex)Embolus =blood clot formed someplace else -may break free, travel through vascular system, become lodged in cerebral blood vessel ex) Serious stroke form results from: weakened blood vessel in brain ruptures and hemorrhages--leading to unconsciousness and death Symptoms: -loss of hearing -blurry vision -weak/slight numbness -headache -dizziness -walking difficulties -regional sensory loss, motor loss, or both (depending on location of blockage) EX)pt suddenly as speech dificulties and loss of motor control of right arm--CVA affecting left hemisphere precentral gyrus in region of motor homunculus upper limb and motor speech area RESULTS: -tissue in brain dies (if blockage lasts longer than 10 minutes) -completely paralyzed/without sensation over half their body (if massive stroke) RISK: -increases with age -influenced by family history, race, and gender (risk ppl advised to take agent inhibiting platelet aggregation :aspirin)

Appendicular Skeleton-Pectoral Girdle and Upper Limbs: Clinical View (P221) CLAVICLE FRACTURE

Clavicle: -fracture easily bc its S shape does not allow it to resist stress -sternoclavicular joint is very strong (if stress is placed on clavicle and joint, clavicle will fracture before joint is damaged CAUSE: Direct blow to middle part of clavicle fall on lateral border of shoulder use of arms to brace against forward fall Severe stress to midregion of bone usually results in ANTERIOR fracture: --bc clavicle has anterior and posterior curve along its length between medial and lateral edges POSTERIOR fracture: -more serious bc bone splinters can penetrate SUBCLAVIAN ARTERY/VEIN --lie immediately posterior/inferior to clavicle --primary blood vessels supplying upper limb

Axial Skeleton--Skull: Clinical View (p 196) CLEFT LIP and CLEFT PALATE

Cleft Lip: -incomplete fusion of upper jaw components of developing embryo -results in split upper lip (extending from mouth to side of one nostril) -may be unilateral (occurring on one side only) or bilateral (both sides) -appears in 1 per 1000 births ***MORE COMMON IN MALES -both genetic/environmental factors contribute (etiology of cleft lip is multifactorial-same w/palate) Cleft palate: -congential fissure in midline of palate -results when left and right bones fuse incompletely/not at all -severe cases: -kids experience swallowing/feeding problems bc food can travel from oral to nasal cavity -appears in 1 per 2500 births **MORE COMMON IN FEMALES -both genetic/environmental factors contribute Sometimes cleft palate occurs in conjunction of cleft lip

Appendicular Skeleton-Pectoral Girdle and Upper Limbs: Clinical View (P230) COLLES FRACTURE

Colles Fracture: -fracture of distal radius HOW: -typically occurs when person extends hand while trying to break a fall -force of fall on outstretched hand fractures distal radius -Distal radius is displaced: POSTERIORLY Interosseous membrane: -force can transmit to interosseous membrane to the ulna and result in distal ulna fracture COMMON IN ADULTS -especially elderly ppl w/osteoporosis SYMPTOMS: -pain/swelling proximal to wrist -weakness in affected hand LOOKS LIKE SILVER FORK -bc displacement of broken segment -wrist bent at angle similar to dinner fork

Axial muscles Clinical view pg 336 Congenital Muscular Torticollis

Congenital Muscular Torticollis (CMT) -aka wryneck -newborn presents shortened/tightened sternocleidomastoid muscle (persisting into childhood) -result of: trauma from difficult brith or prenatal position of fetus -trauma causes: hematoma and fibrosing of muscle tissue, -increases among newborns who are kept in infant seats for extended periods of time outside of the car. -often tilt heads to affected side and chins to unaffected side -child favors head position when sleeping--plagiocephaly (flattened head) often accompanies it Treatment: stretching affected muscle several times a day, changin sleeping positions, make child use affected side more frequently. --BOTOX (botulinum toxin type A), is also used bc it impairs contraction of affected muscle, combined with strethching Sternocleidomastoid release surgery reccommended it case doesnt respond to treatment: --cut muscle from at lease one attachment point, repositioned, reattached (botox injected) Recovery of surgery: neck brace and physical therapy

Articulations-Selected Articulations in Depth Clinical View (P 272) Shoulder Joint Dislocations

Dislocation: -a joint injury, where articulating bones have separated COMMON SITE IS THE SHOULDER -more common @ acromioclavicular joint/Genohumeral joint 1) SHOULDER SEPARATION -dislocation of acromioclavicular joint -acromion appear prominent/pointed -2 steps/step off results from: hard blow to joint/fall onto shoulder symptoms: tenderness, edema (swelling) in area of joint, pain when arm is abducted more than 90 degrees (bc in this position significant movement occurs between the separated bone surfaces Treatment: range from rest to surgery (depends on severity 2) GLENOHUMERAL JOINT DISLOCATION: -very common bc joint is very mobile and unstable -"squared off" and flattened appearance --bc humeral head is dislocated anteriorly and inferiorly to glenohumeral joint capsule Results from: when a fully abducted humerus is struck hard ex) quarterback is hit as he is about to release football ex) person falls on outstretched hand initial blow pushes humerus into inferior part of articular capsule and tears it as the humerus dislocates Once humeral head is not held in place by capsule, anterior thorax (chest) muscles pull superiorly and medially on the humeral head, causing it to lie inferior to coracoid process MOST COMMON TO MOVE ANTERIOR/INFERIOR of joint Treatment: -popping humerus back into glenoid cavity -severe: surgical repair

Brain: Clinical view Pg. 466 Effects of alcohol and drugs on the cerebellum

Disorders of the cerebellum: characterized by: -impaired skeletal muscle function -uncoordinated, jerky movements (ATAXIA) -loss of equilibrium that presents as uncoordinated walking DRUGS and ALCOHOL can temporarily and permanently impair cerebellar function: ex) drink too much alcohol, have characteristics of impaired cerebellum, used in sobriety tests performed by the police Effects of alcohol: 1)Disturbance of gait: rarely walks in straight line, appears to sway and stagger. falls and bumps into objects due to temporary cerebellar disturbance 2)Loss of balance and posture: when attempt to stand on one foot, intoxicated person tips and falls over 3) INability to detect proprioceptive information: INtoxicated person, when told to close eyes and touch nose, will miss the mark--due to reduced ability to sense proprioceptive info, compounded by uncoordination of skeletal muscles

Axial Skeleton--Vertebral Column and Thoracic Cage: Clinical view (p205): SPINAL CURVATURE ABNORMALITIES

Distortion of normal spinal curvature caused by: -poor posture -disease -congenital defects in structure of vertebrae -weakness/paralysis of muscles of the trunk 3 main spinal curvature deformities: 1) Kyphosis 2) Lordosis 3) Scoliosis Kyphosis: -exaggerated thoracic curvature (directed posteriorly) -"hunchback" RESULT FROM: -osteoporosis -vertebral compression fracture affecting anterior region of vertebral column -osteomalacia (adult bones demineralize) -heavy weight lifting during adolescence -abnormal vertebral growth -chronic contractions in muscles that insert on vertebrae Lordosis: -exaggerated lumbar curvature -"swayback" -protrusion of abdomen and buttocks -lumbar go more anteriorly RESULTS FROM: -similar to kyphosis -added abdominal weight -pregnancy -obesity Scoliosis: =MOST COMMON SPINAL CURVATURE DEFORMITY -abnormal lateral curvature RESULTS FROM: -during development when vertebral arch and body fail to form/form incompletely on one side of the vertebrae -unilateral muscular paralysis/spasm of back TREATED: -mild: in adolescence wearing back brace -severe: surgical intervention

Axial muscles Clinical view pg 348 Episiotomy

Episiotomy: surgical incision made in perineal skin/soft tissues between vagina/anus during childbirth to prevent tearing of the mother's tissues/minimize fetal injury long believed: clean surgical incision heals more rapidly and effectively than laceration/tear-has come into question Serious perineal lacerations, infection, and bleeding=more common in women who have had this surgery Benefits seen in only LIMITED deliveries Professional organizations (3): recommend: -against routine use of episiotomy Talk to healthcare provider before to see if you need to have one before having birth

Axial Skeleton--Vertebral Column and Thoracic Cage: Article: "Folic Acid During Pregnancy Reduces Risk of Language Delay" http://www.highlighthealth.com/pediatrics/folic-acid-during-pregnancy-reduces-risk-of-language-delay/

FOLIC ACID -taken before and during pregnancy WHY? prevents neural tube defect (defects to brain and spinal cord) ***significantly reduces risk of severe language delay in children at 3 years of age (found by study in journal of american medical association) WHY IS FOLIC ACID THE MOST CRITiCAL PRENATAL SUPPLEMENT? --many women dont consume enough in food --deficiences can lead to serious developmental problems ----neural tube defect (spina bifida) ***a vitamin that ensures NORMAL FETAL DEVELOPMENT Research in Norwegion institue of public health: -Tracked use of folic acid and other supplements in 40000 women *women who took no folic acid were significantly more likely to have children with severe language delay FOLIC ACID=B VITAMIN -vitamin B9 FOLIC ACID FORMS: -most common in supplements -derivative chemical, FOLATE, found in foods and used by body --folate not used in supplements bc not as stable Folates -coenzymes (molecule assisting enzyme operation) -critical participants in reactions in the body that involve amino acids and nucleic acids Enzyme: protein that speeds up chemical reactions NEURAL TUBE DEVELOPS: during the 3rd week post conception (5th week of pregnancy) --most important to take folic acid EARLY in pregnancy all women in childbearing years should take 4mg folic acid daily This NORWEGIAN study is the first to scienticically evaluate whether folic acid supplementation continues to have an impact on neural development beyond formation of neural tube study shows that: folic acid likley continues to play important developmental roles beyond the end of the 5th week in pregnancy Wise to continue folic acid supplementation throughout pregnancy in order to maximize its potential benefits to fetal development

Axial muscles Clinical view pg 326 Idiopathic facial nerve paralysis (bell palsy)

Facial nerve (CN VII) paralysis: unilateral paralysis of the muscles of facial expression -cause unknown -AKA Idiopathic Facial Nerve paralysis -AKA Bell Palsy associate with: -herpes simplex 1 viral infection -exposure to cold temperatures -commonly seen in ppl who sleep with one side of their head facing an open window -late stages of lyme disease develop bilateral facial nerve paralysis Process: -nerve becomes inflamed and compressed within the narrow stylomastoid foramen (facial nerve travels in) -muscles on same side of face paralyzed as result Treatment: -alleviate symptoms -prednisone (steroid) used to reduce inflammation and swelling of nerve -with herpes, antiviral medication given -with lymes disease, antibiotics given recovery: mysterious -over 50% of all pts experience complete spontaneous recovery within 30 days of first symptoms -others takes longer or never goes away EX) when smiling, drooping left side of mouth-lack of elevation of eyebrow

Appendicular muscles Clinical view pg 367 Carpal tunnel syndrome

Flexor retinaculum extends from medial to lateral carpal bones Carpal tunnel: space between carpal bones and the flexor retinaculum -narrow tunnel -long muscle tendons extend to the fingers from the forearm (through this tunnel) -median curve runs through it (innervates skin on lateral region of hand/muscles moving thumb Carpal Tunnel Syndrome: -any compression to median nerve or tendons common cause: inflammation of any component in carpal tunnel EX)swollen tendons from overuse eX) workers who repeatedly flex fingers or wrist ex)typists/computer programmers FEMALES in last trimester develop due to increased water retention--leads to compression characterized by: -pain -paresthesia (feeling of "pins and needles") ---more extensive sensory loss/motor loss in muscles of hand supplied by median nerve severe cases: -muscles of thumb atrophy as nerve supply is diminished (median nerve supplies muscles of thumb) Treatment: -support hand in splint -anti-inflammatory drugs -surgery Chronic cases: -if dont respond to mild treatment, SURGERY (incise flexor reticulum-open carpal tunnel-relieve pressure)

Brain: Clinical view Pg 467 Frontal Lobotomy

Frontal lobotomy: -a "Cure" for people who were violent and profoundly disturbed years ago, when no medical treatments were available for the severely mentally ill Basic procedure: -introduce a cutting instrument into frontal cortex, through small hole drilled into skull in region of medial canthus of each eye -instrument, long and spatula like blade, moved back and forth -severs frontal cortical connections from rest of the brain THOUSANDS performed in late 1930's -early 50's JAPAN -performed on children who had done bad in school US -offered to prisoners in exchange for early parole Late 40's, -studies showed mental conditions of 1/3 pts actually improved due to lobotomy -2/3 stayed same or became worse -meds were developed to treat depression/psychiatric problems (getting rid of reason to use this) stopped using in 1950's, many states and foreign countries have laws forbidding it

Appendicular Skeleton-Pelvic Girdle and Lower Limbs Clinical View (P 113) Gangrene

Gangrene: =necrosis (death) of soft tissues of a body part due to diminished or obstructed arterial blood supply to that region Commonly affected areas: -limbs -fingers -toes Complication of DIABETICS -often suffer from diminished blood flow to upper/lower limbs Forms of Gangrene: 1) Intestinal gangrene 2)Dry Gangrene 3) Wet gangrene 4) Gas gangrene Intestinal Gangrene: -occurs following obstruction of blood supply to intestines -if intestine dont have sufficient blood, tissue undergoes necrosis/gangrene -if untreated, leads to DEATH Dry Gangrene: -involved body part is desiccated, sharply demarcated, and shrivled -due to constricted blood vessels as result of exposure to EXTREME COLD -complication of: frostbite/variety of cardiovascular diseases that restrict blood flow -primarily to HANDS and FEET Wet Gangrene: -caused by bacterial infection of tissues that have lost their blood and oxygen supply -cells in dying tissue rupture and release fluid -wet environment causes bacteria to flourish -produce foul-smelling pus -common bacteria involved: --streptococcus, staphylococcus, enterobacter, klebsiella -must be treated QUICKLY w/antibiotics and removal of necrotic tissue Gas Gangrene: -Often mistaken for wet gangrene -bacteria involved=Clostridium -usually affects MUSCLE tissue -bacteria invade necrotic tissue, release of gases form tissue produce gas bubbles -bubbles make crackling sound in tissue if pt moves Symptoms: -fever, pain, edema (swelling) -occur within 72 hours of intial trauma to region Treatment -similar to wet gangrene treatment

Brain: Clinical view Pg. 446 Epidural and subdural hematomas

Hematoma: a pooling of blood outside of a vessel Epidural Hematoma: Process: -ruptured artery -pool of blood forms in epidural space of brain -adjacent brain tissue becomes distorted and compressed as hematoma grows in size Treatment: -Accumulated blood removed by surgically drilling hole into skull, suction out blood, ligating (tye off) the bleeding vessel May result in: -Severe neurologic injury/death occurs if bleeding does not stop Cause: -severe blow to the head Subdural hematoma: =hemmorrhage occurring in subdural space (between dura mater and arachnoid mater) Process: -ruptured veins -blood pools in space/compresses brain -occur slower than epidural hematoma Treatment: -similar to epidural hematoma CAUSE: -fast or violent rotational motion of the head PICUTURES: epidural=bigger area of red subdural: skinny line of red

Axial muscles Clinical view pg 346 Hernias

Hernia: condition where portion of viscera protrudes through weakened point of muscular wall of abdominopelvic cavity Serious medical problem: if herniated portion of intestine swells, becoming traped. -blood flow to trapped area diminish, portion dies -LIFE THREATENING if not treated correctly (condition:Strangulated intestinal hernia) 2 common types: 1)inguinal hernia 2) Femoral hernias A) inguinal hernia: -MOST COMMON hernia type -Inguinal region of abdominal wall is one of weakest areas -Inguinal canal within region allows passage of spermatic cord in males, and the round ligament in females ---this area or the superficial inguinal ring is often a sight of RUPTURE of SEPARATION of the abdominal wall -MALES more likely than females bc larger canal/ring for spermatic cord EX) strain to lift heavy object-rising pressure in abdominopelvic cavity-force created to push segment of small intestine into canal 2 Types of inguinal hernia: 1)Direct inguinal hernia 2) indirect inguinal hernia 1)Direct inguinal hernia: -loop of small intestine prtrudes through superficial inguinal ring, but not through whole length of canal -creates bulge in lower anterior abdominal wall -seen in: Middle aged males w/poorly developed abdominal muscles/protruding abdomens 2) Indirect inguinal hernia: -herniation through entire inguinal canal, sometimes to scrotum -Seen in: younger males or male children w/congenital anomal "patent process vaginalis" (embryonic path taken by testis into the scrotum fails to regress) B)Femoral hernia: -Occurs in upper thigh (inferior to inguinal ligament) -originates in: femoral triangle region ---medial portion=weak, prone to stress injury (allow loop of small intestine to protrude) -seen in: WOMEN more common (bc have greater width of femoral triangle, leading to wider hip span)

Axial Skeleton--Vertebral Column and Thoracic Cage: Clinical view (P207): HERNIATED DISKS

Herniated disk: -gelatinous nucleus pulposus protrudes into or through the anulus fibrosis -produces "bulging" of dist posterolaterally into vertebral canal, pinching spinal cord/nerves of spinal cord Most common: -cervical and lumbar intervertebral discs -bc vertebral column has lots of mobility in these regions/ lumbar region bears increased weight cervical herniated disc: -cause neck pain and down upper limb (bc nerves that supply upper limb are in this region of spinal cord) -cause muscle weakness in upper limb Lumbar herniated disc: -frequently causes LOWER back pain -if pinches nerve fibers, pain felt down entire lower limb (known as SCIATICA) Treatments for herniated disc: 1) wait to see if disc heals on its own 2) non steroidal anti-inflammatory durgs --ibuprofen, steroid drugs, physical therapy 3) MICRODISCECTOMY --microsurgical technique, removing herniated portion of dic --done when conservative treatments fail 4) DISCECTOMY --more invasive technique --laminae of nearby vertebrae/back muscles are incised before removing herniated portions of disc 5) artificial discs made of synthetic material have been developed to replace herniated discs

Brain: article: Multiple concussions raise teen athletes health risks http://health.usnews.com/health-news/family-health/brain-and- behavior/articles/2011/01/29/multiple-concussions-raise-teen-athletes-health-risks

High school athletes with 2+ concussions could have early symptoms of "post-concussion syndrome" Study: +look at rates of symptoms of: 1) 260 athletes w/1 previous concussion 2) 105 with 2+ previous concussions 3) 251 w/no history of concussion +no concussions occurring 4 months prior to study Results: +rates of concussion-related symptoms were higher among athletes w/previous concussions +very true for those with 2+ concussions Adj for other factors, and found: -compared with athletes w/no concussion or 1 previous concussion, Athletes with 2+ previous concussions=more likely to have a cluster of 3 symptoms: 1) intellectual symptoms/cognitive symptoms -memory problems or feeling "mentally foggy" 2) physical symptoms -headaches -problems with balance -feel dizzy 3)Sleep symptoms: -sleeping more/less than they normally would No differences among 3 tested groups with Emotional symptoms -irritability/sadness the 3 symptoms seen are similar to those seen in retired professional athletes with history of concussion EX) autopsy of 18 year old high school athlete showed evidence of degenerative brain disese --linked to having 2+ concussions while playing pro sports FINDINGS=CAUTION to: +parents, coaches, sports medicine personnel (supervising high school/young athletes with history of concussion) FINDINGS=SUPPORT: +recent surge in advocacy on state/federal governmental levels to ESTABLISH YOUTH CONCUSSION MANAGEMENT PROGRAMS ++++this would better regulate the rules of youth sports

Brain: Clinical view Pg. 448 Hydrocephalus

Hydrocephalus: -AKA "Water on the brain" -Pathologic condition of excessive CSF Leads to: brain distortion Most results from: Obstruction in CSF flow, restricts reabsorption into venous blood OR some intrinsic problem w/the arachnoid villi themselves CHILDREN: -if develops before cranial sutures fuse, head enlarges -Result: neurologic damage After Cranial sutures fuse: -brain compresses within fixed cranium -ventricles expland -Result: permanent brain damage Severe case Treatment: -insert a Ventriculoperitoneal (VP) shunt ---drains excess CSF from ventricles to abdominopelvic cavity ---used for past 30 years ---infection/blockage may occur

Cranial nerves Clinical view (p614) Hypophysectomy

Hypophysectomy: =surgical removal of the pituitary gland rarely performed today done in years past purpose: -treat advanced breast/prostate cancer why? -they depend on hormone stimulation for their growth -pituitary removal effectively shuts off the hormone source to the tumors today: -there are medications to block hormone stimulation for those cancers instead TODAYS purpose of hypophysectomy: -performed for tumors in the pituitary gland Pituitary tumors casue: -changes in vision, bc optic chiasm is draped around anterior pituitary preferred route for hypophysectomy: -through nasal cavity/sphenoidal sinus -directly into sella turcica -requires small instruments -allows complete removal w/minimum trauma

Appendicular muscles Article: Ice or heat for sports injury? http://sportsmedicine.about.com/cs/rehab/a/heatorcold.htm

Ice packs/heat pads=one of most commonly used treatments in orthopedics Ice treatment: +helps minimize swelling, which controls pain +used commonly in acute injuries and chronic conditions: 1) ACUTE INJURIES -use when you have swelling on an injury within the last 48 hours - commonly used for: ankle sprain CHRONIC CONDITIONS: ex) overuse injuries in athletes -ice injured area AFTER activity to help control inflammation -never ice before activity Heat treatment: +used for chronic conditions +helps relax/loosen tissues/stimulate blood flow to area + use heating pad, or hot wet towel +avoid burns by using moderate heat +never leave on while sleeping or for extended periods of time CHRONIC CONDITIONS ex)overuse injury -use before activity, never after CHRONIC CONDITIONS: +heat before +ice after

Appendicular muscles Clinical view pg 365 Lateral epicondylitis (tennis elbow)

Lateral epicondylitis (TENNIS ELBOW) results from: trauma or overuse of common extensor tendon of posterior forearm muscles --repeated forceful contraction of forearm extensors (muscles used to extend hand at wrist) --EX) pull a heavy object form overhead shelf, shoveling snow, hitting a backhand shot in tennis pain from: lateral epicondyle of humerus (attachment site of extensor tendon)

Brain: Clinical view Pg 530 Pathologic states of unconciousness

Level of consciousness state varies throughout the day. -wide awake, alert, deep sleep Prior to sleep=person gets Lethargic (normal level of alertness is associated with inclination to SLEEP) When asleep=unconscious (but not pathologically unconscious) Pathologic unconscious conditions: 1)fainting/syncope 2)stupor 3)coma 4)persisent vegetative state (PSV) 1)Fainting/Syncope -brief loss of consciousness -signals inadequate cerebral blood flow due to low blood pressure -may follow hemorrhage/sudden emotional stress 2) Stupor -moderately deep level of unconsciousness -person can only be aroused by extreme repeated and painful stimuli -associated with: metabolic disorders (low blood sugar, diseases of liver/kidney/CVA, brain trauma, drug use) 3) Coma =deep and profound state of unconsciousness -person not aroused with repeated or painful stimuli -person is alive, unable to respond to environment -Result from: severe head injury or CVA, marked metabolic failure, very low blood sugar, drug use -cause should be identified to gauge depth of coma -physician perform detailed neurologic exam 4)Persistent Vegetative state (PVS): -person has lost thinking ability/awareness of environment -noncognitive brain functions continue (brainstem monitoring heart rate, breathing, sleep wake cycle) -unable to speak/dont respond to commands -some spontaneous movements (move eyes, grimacing, crying, laughing)

Spinal cord and spinal nerves: Clinical view (p487) Lumbar puncture (spinal tap)

Lumbar puncture AKA spinal tap =clinical procedure to obtain CSF (to determine it infection/disorder of CNS is present) process: -needle inserted through skin, back muscles, and ligamentum flavum (between vertebrae) -needle pass through epidural space, dura mater, arachnoid mater -needle enter subarachnoid space -obtain about 2-9 milliliters of CSF Adult spinal cord typically ENDs at level L1, vertebra, --lumbar puncture must be performed inferior to L1 to ensure the spinal cord is not pierced by the needed Lumbar puncture typically enters at: -level of L3 and L4 -level of L4 and L5 How to locate correct location: -physician palpates highest point of iliac creasts (same horizontal level as spinous process of the L4 vertebra -insert needle directly above or below spinous process of L4 when vertebral column is flexed

Axial Skeleton--Vertebral Column and Thoracic Cage: Article: "Meet the baby who was born twice" https://www.cnn.com/2016/10/20/health/baby-born-twice-fetal-surgery/index.html

Margaret Boemer got ultrasound 16 weeks into pregnancy baby had sacrococcygeal teratoma: -tumor develops before birth, grows from baby's coccyx -most common tumor seen in newborn (still rare though) _FOUND MORE OFTEN IN GIRLS THAN BOYS -occurs in 1 of 35000 births mother originally had twins, but lost one previously problems: -cause blood flow problem -tumor trys to grow by sucking blood flow from baby (becomes competition) -can kill child if tumor wins 23 weeks: shutting heart down into cardiac failure -emergency fetal surgery (tumor was larger than fetus) -had to make large incision due to large tumor -fetus was completely out of mother, amniotic fluid fell out -cut tumor off Mother on bed rest for the rest of her pregnancy -baby was healthy after born -had to remove bits of tumor after baby was born, that wasn't reached in surgery Risk: fetus could be born immediately after utero surgery, or die

Appendicular muscles Clinical view pg 380 Thigh muscle injuries

Muscles in lower limb=prone to injury --especially if physically active Thigh muscle injuries: 1) groin pull 2) Strained/pulled hamstrings Groin pull: -caused by: tearing, stretching, straining proximal attachments of medial muscles of the thigh__the adductor muscles of the leg and/or the iliopsoas muscle -results most frequently by: activities that involve rapid accelerations EX) football, baseball, tennis, running, soccer Strained or pulled hamstrings: -Common in ATHLETES who perform quick starts/stops, run very fast, sustain sudden lateral or medial stress on the knee joint ---the violent muscular exertion required to do these running feats can cause tendinous origins of hamstrings to be avulsed (torn away) from their attachment on the ischial tuberosity -BICEPS FEMORIS: susceptible to this stress injury -Things that may occur with hamstring damage: contusions (bruising), blood vessel rupture, pain, hematoma formation (accumulation of blood in soft tissue), tearing of muscle fibers -Prevention: Athletes warm up and perform stretching exercises before running

Appendicular muscles Clinical view pg 388 Shin splints and compartment syndrome

Musculature is surrounded by deep fascia (tough and unyeilding-wraps around muscle like support hose-groups muscles into compartments) Compartments of the leg (anterior, lateral, posterior)=subdivided by fascia SHIN SPLINTS: (shin splint syndrome) =soreness or pain along the length of the tibia, usually inferior Causes: -stress fracture of tibia -tendonitis involving muscles of anterior compartment muscles of the leg (often tibialis anterior muscle -inflammation of periosteum (called periostitis) Occur in: -Runners/joggers who are new to sport or poorly conditioned -runners who run on hard surfaces (concrete/asphalt), -wear running shoes that dont properly support foot HEalth care professionals consider shin splints to be: compartment syndrome of anterior compartment of the leg Compartment syndrome: =condition where blood vessels in a limb compartment become compressed (resulting from inflammation, swelling secondary to muscle strain, contusion, overuse) EX)person who suddenly starts an intensive exercise regimen -Severe compartment syndrome: occur due to trauma to limb compartment (bone fracture/rupture blood vessel) Because deep Fascia is tight/cannot stretch: --swelling from muscles/accumulating fluid/blood increases pressure in the compartment --circulatory supply/nerves of compartment become compressed and compromised ---reduced blood flow =ISCHEMIA ---ISCHEMIA leads to HYPOXIA ___HYPOXIA=lack of oxygen within the compartment If blood flow not restored, -DEATH of nerves within 2 hours --may regenerate after compratment syndrome has been resolved -DEATH of skeletal muscle within 6 hours ---lost cells irreversible Mild cases treated: -immobilize and rest affected limb Severe cases treated: -fascia incised (cute) to relieve pressure/decompress affected compartment

Nervous tissue: Clinical article Pg 431 Neural tube defects

Neural Tube Defects (NTD's): -serious developmental deformities of the brain, spinal cord, and meninges 2 Basis categories: 1)Anencephaly 2)spina bifida --both from localized failure of developing neural tube to close ANENCEPHALY: -Substantial or complete absence of a brain/bones making up the cranium -rarely live longer than a few hours following birth -RARE, easily detected with prenatal ultrasound --thus, can alert parents of the condition SPINA BIFIDA: -More common than anencephaly -caudal poriton of neural tube (lumbar or sacral region), fails to close 1)Spina bifida Cystica (myelomeningocele) -most common and severe form -almost no vertebral arch forms -posterior aspect of spinal cord is unprotected -Large cystic structure in back, filled with Cerebrospinal fluid and covered by skin and meninges TREATMENT: -surgery to close defect --reduces risk of infection/preserves existing spinal cord function FUNCTIONAL EFFECTS: -determined by anatomic level of spinal cord involvement EARLY INTERVENTION: -most children with spina bifida cystica live into adulthood if early medical intervention 2) spina bifida Occulta: (tuft of hair) -less serious -much more common than cystica -pts are asymptomatic-detected incidentally during xray CHARACTERIZED BY: -partial defect on vertebral arch (involving lamina and spinous process ESTIMATES OF INCIDENT: -range to 17% of population in xray studies REDUCTION OF NEURAL TUBE DEFECTS: -cannot be eliminated, but greatly reduced -increase intake of Vitamin B12 and B vitamin "FOLIC ACID" by pregnant women --associated with decreased incidence --both critical to DNA formation/necessary for cellular division/tissue differentation PRegnant women: -encouraged to take prenatal vitamins with high levels of these chemicals Food industry: begun fortifying breads/greains with folate

Muscle tissue and Organization: Clinical view pg 315 "Neuromuscular Diseases"

Neuromuscular disease: -disease or damage affecting somatic motor neurons, neuromuscular junctions, or muscle fibers--result in abnormal muscle functions (aka neuromuscular disease) 1) fibromyalgia 2) muscular dystrophy 3)Duchenne Muscular Dystrophy (DMD) 4)Myasthenia gravis (MG) 5)Myofascial Pain Syndrome (MPS) Fibromyalgia: -syndrome of chronic severe pain involving muscles and skeleton -accompanied by: fatigue, morning stiffness, psychological depression -cause: NO SINGLE CAUSE determined -Contributing factors: alterations in brain neurotransmitters, stress, anxiety, sleep disturbances, endocrine abnormalities -Pain: whole body, specifically neck and lowerback -1-2% population has this -WOMEN affected more than men -Treatment:medication and self care Muscular dystrophy: -collective term for several hereditary diseases (skeletal musceles degenerate, lose strength, gradually replaced by adipose and fibrous connective tissue) -new connective tissues impedes blood circulation--further accelarates muscle degenerations Duchenne Musclular Dystrophy (DMD): -MOST COMMON form of the illness -results from: expression of sex linked recessive allele -MEN usually always the ones affected -occurs in 1 in 3500 births -muscular difficulties apparent in early childhood -symptoms: hard time walking, falls frequently, hard time standing up -places affected: HIPs first, lowerlimbs, then abdomen and spinal muscles -causes: muscle atrophy, shortening of muscles, postural abnormalities (scoliosis) -INCURABLE disease -confined to wheelchair by adolescence -rarely lives beyond 30 years -death=usually by respiratory and heart complications future treatment of DMD: -advances in gene therapy research may find help -use altered virus carrying gene for dystrophin (protien needed for muscle function missing in pts) -used on mice successfully -if injected to every muscle, could be a new performance enhancement drug for athletes (gene-DOPING concern could arise) Myasthenia Gravis (MG): -autoimmune disease -i in 10,000 people -primarily WOMEN aged 20-40 -antibodies attack neuromuscular junctions, binding ach receptors together into clustuers. Abnormally clustered ACH receptors are removed from muscle fiber sarcolemma by endocytosis, diminishing number of receptors on muscle fibers -result: decreased abilitly to stimulate muscle--rapid fatigue/muscle weakness --Eye and facial muscles attacked first--double vision and drooping eyelids--followed by swallowing problems, limb weakness, low physical stamina -Life span: some live normal life span, others die quickly from paralysis of respiratory muscles -treatment: cholinesterase inhibitors, immunosuppressive drugs, thymectomy (remove thymus gland, abnormal in pts) ---1) prevent ach destruction by acetylcholinerterase--allowing prolonged stimulation of remaining ach receptors in muscle fiber membrane. ---2)decrease production of antibodies against ach receptors, slow attack on neuromuscular junction Myofascial Pain Syndrome (MPS): -common disorder -associated with excessive use of postural muscles -Pain: results when bands of muscle fibers tighten and twitch after overlying skin is stimulated. (trigger point stimulation) . -trigger point stimulation widely recognized feature of MPS -Trigger points may cause automonic nervous system changes --results in: flushing of skin, sweating, "goose bumps" -does not cause fatigue and morning stiffness -50% people, ages 30and 60 may be affected Treatment: massaging, muscle stretching, nonsteroidal anti-inflammatory drugs

Nervous tissue: Clinical article Pg414 Neuroplasticity

Neuroplasticity: -ability of nervous system to remodel itself in response to internal and external factors or pressures Old assumption: -once brain developed, few changes occur Research shows: -Brain changes to respond to environmental factors some changes strengthen existing connections: -learning, mental rehearsal, musical training some changes allow for new connections to be made to compensate for functional loss in other areas of the brain: --rehabilitation after concussion or stroke Process of neuroplasticity include: -Neurogenesis (development of new neurons/glial cells) -enhancing/strengthening connections through dendrite, axon, and synapse formation -decreasing connections through dendrite, axon, and synapse loss Factors associated with INCREASES in neurogenesis/enhancement -have engaging and enriching environment, exercise, learning Neurogenesis occurs reactively after injury DECREASE neurogenisis factors: -depression, chronis stress, illness

Appendicular Skeleton-Pelvic Girdle and Lower Limbs Article: "Bone Fractures: Treatment and Risks." R. Lipkin. Science http://www.jstor.org.dist.lib.usu.edu/stable/3978912?seq=1#page_scan_tab_contents

New treatment to hasten healing of fracture: 1) realign damaged bone/inject soft paste -physician place thin tube into damaged area -mix up special paste -inject paste into wound 2)wait 10 minutes for paste to solidify -.it crystallizes largely as a mineral that occurs naturally in the human skeleton 3) after 12 hours, paste is hard as normal bone 4) body treats new material as if it were bone -grows new blood vessels into it -remodleing the crystals to match natural bone structure Paste: -hardens in place and accelerates bone replacement -believed most useful in treating fractures of the: --hip --wrist --shin --joints --vertebrae Time and money: -hip fracture healing in hospital shortened to 7 (from 12) -29,000 for surgery -20,000 to hospitalize -will save lots of money Testing: -Holland physicians use the new material to treat fractures -US is having a trial w/324 pts WHO AT RISK: -Women w/mothers that had hip fractures have TWICE the avg risk of having the same injury (off study) -Tall women -women who had broken any other bone over age 50 -women w/overactive thyroid gland -certain drugs -too little exercise, too much caffeine -gaining weight after age 25 reduces risk -losing weight after age 25 increases risk PREVENTION: -stay active -quit smoking -women cut caffeine intake -avoid meds that raise risk -take estrogen replacement therapy to increase bone density 1 in 6 North American white women age 50 or older suffer a hip fracture 6% comparable men suffer hip fracture

Axial Skeleton--Skull: Clinical View (P183): CRANIOSYNOSTOSIS and PLAGIOCEPHALY

Normally: -sutures of skull allow cranium to grow/expand during childhood -adulthood, when cranial growth stopped, sutures fuse Craniosynostosis: -premature fusion or closing of one or more of the cranial sutures -occurs early in life or in utero -skull shape is affected -if no surgery, individual grows up w/unusual craniofacial shape Sagittal synostosis: -sagittal suture fuses prematurely -result: --skull cannot grow/expand laterally as brain grows --skull grows in anterior/posterior fashion Develops: -elongated, narrow skull shape (Scaphecephaly or Dolicocephaly) Coronal Synostosis: -premature fusion of coronal future result: -skull is abnormally short and wide WHY: -genetics -teratogens (drug/agent causes birth defects) -environmental factors RESULT: -no complications other than unusual skull shape -if complications---may have increased intracranial pressure ----leads to headaches/seizures, optic nerve compression, intellectual disability (due to restricted brain growth Plagiocephaly: -term for asymmetric head shape -one part of skull (normally frontal or occiptial), has oblique flattening cause: -unilateral coronal craniosynostosis or asymmetric lambdoid synostosis -normal deformational factors (sleeping on same side of head) Plagiocephaly has risen: -since 1990's -primarily due to national institute of child health and human development safe to sleep campaign -campaign encourages parents to place children on backs to sleep (instead of stomach), to reduce SIDS Mild forms of Plagiocephaly corrected by: -wearing corrective helmet Severe forms of plagiocephaly corrected by: -surgery

Axial Skeleton--Skull: Article: "A Lifetime of Pain Hard-to-Diagnose TMJ Disorder Causes Myriad Ills" The Salt Lake Tribune" https://search-proquest-com.dist.lib.usu.edu/docview/288707225

Oral/facial surgeon James A Daves Jr. Of Tallahassee Fla. about 80% TMJ dysfunction sufferers are women side effects: 1) migraines 2) loss of hearing 3) blurred vision 4) depression 5) backaches 6) facial pain 7) vary from small CLICK of jaw to need of surgery 8)fatigue 9) noise when chewing 10) sharp pain when yawn or bite on hard object one of most difficult to diagnose maladies some ppl think it's "Phantom pain" -a neurotic, midlife crisis, woman thing TMJ dysfunction, Crooked jaws, TMD: Best described as: Joint stress due to uneven bite Davis says there is a biblical term "gnashing of teeth" that is a leading cause of the problem causes: 1)blows to head/face 2) mental stress 3) structural deformities Jaw joint dysfunction is linked to a long list of common head and body ailments Montgomery dentist says 25% pts have TMJ. only in the last 15-20 years have they had success in treating it SUFFERERS: Usually middle aged white women (but can be anyone) --can be aged as young as 4 to 70 years HARD TO DIAGNOSE: bc starts as soft tissue injury, but worsens over time. additional systems and organs become involved and symptoms seem to have no relationship with the TMJ joint of where it started. EARLY ON -pain may come and go TREATMENTS -may be effective for only a short time (ex 6 months) PSYCHIASTRIST: some ppl think they should see psychiatrist instead of doctor--may be sent there due to dr. not knowing TMJ symptoms Jane hart had TMJ dysfunction. --uppper and lower jaw did not fit properly -jawbone moved slightly out of line to make them fit --put strain on TMJ and all muscles around it Jane treatment --alignment fixed w/simple bite plate --fit over teeth like football outhpiece --allowed muscles to relax and jaw to move into natural position -SHE GOT HER BITE BACK !! TMJ --most complicated joint in body --hinged at two points SOLUTION: --fix malocclusion (bad bite) =basic orthopedic adj like a bite plate THE GREAT IMPOSTER: --TMJ joint is known as this bc it mimicks nerve related ailments !ST STEP IN TREATMENT --look at pt history, examine offending joint --ask questions about pain 2 --try bite splint --if doesnt work move to medications. BRACE: solved 75% headaches on first night -repositioned jaw -allowed facial and chewing muscles to work rihgt --neck and shoulders relaxed --nerves 'disappeared' LASTING RESULTS: -require behavior modification -diet -stress reduction techniques WITHOUT DRUGS: -can be treated w/ice pack and anesthetics, manipulation of head, neck and jaw joints, physical therapy, exercises MONTGOMERY STATS: 8 in 10 pts symptoms disapppear 1 in 10 need surgery 10th person may not figure out

Cartilage and Bone Connective Tissue: Clinical View: (P 168) OSTEOPOROSIS

Osteoporosis means "porous bones" =disease that results in decreased bone mass and microarchitectural changes that lead to weakened bones that are prone to fracture LOST: -bone matrix -calcium (specifically in metabolically active spongy bone ) AGE: -greatest in elderly -MOST COMMON: Caucasian women (closely linked to age and onset of menopause) INCREASES RISK: -smoking WHY POSTMENOPAUSAL WOMEN: -at risk bc 1) women have less bone mass than men 2) women begin losing bone mass earlier and faster in life 3) postmenopausal women no longer produce significant amounts of estrogen, which helps protect against osteoporosis (stimulates bone growth) MUCH LESS SEVERE IN MEN FRACTURES: -increased risk -locations: --wrist (distal end of radius-colles fracture) --hip (@ neck of femur) --vertebral column (weight bearing regions that lose spongy bone is more easily compressed, leading to loss of height and compression fractures of vertebral bodies) w/normal amount of stress BEST CURE: =preention what to do: -maintain good nutrition/physical activity=adequate one density and allow for normal, age related loss later in life CALCIUM SUPPLEMENT: -help maintain bone health w/help of vitamin D BUT wont stimulate new bone growth MEDICAL TREATMENTS: 1) slowing rate of bone loss (w/certain drugs--interfere w/osteoclast function and retard the removal of bone during remodeling--but risk of Osteonecrosis (bone death) of jaw and other bone abnormalities--dont take drugs longer than 5 years ) 2) attempt to stimulate new bone growth

Heart Article "a gasping heart: cardiac quirk may worsen sleep apnea, invite altitude sickness" http://www.thefreelibrary.com/A+gasping+heart%3A+cardiac+quirk+may+worsen+sleep+apnea,+ invite...-a0162103267

Patent Foramen Ovale (PFO) -foramen ovale (between atria of heart) fails to fuse when baby takes its first breath -flaps of tissue may open and allow deoxygenated blood from right side of heart, to left side of heart -flaps open if: too much pressure in heart's upper right chamber -continuously opening the PFO forcefully may enlarge the hole (due to apnea) linked to: -stroke -migraine -decompression illness -injury in scuba divers contributes to: 1) rapid drop in blood oxygens content 2) sleep apnea 3) high-altitude pulmonary edema in mountaineers who ascend too quickly Closing/sealing the foramen ovale: -seal to prevent recurrent decompression illness or stroke -possibly help w/migraines -may get rid of oxygen desaturation problem in sleep apnea patients Continuous Positive airway pressure , CPAP -treatment for ppl w/apnea and PFO -Pt wears mask when sleeping -machine continuously forces air through mask to prop open sleepers airways Problem w/CPAP -ppl dont like wearing a mask when they sleep 2 year trial w/CPAP - on pts w/apnea and PFO -lessened severity of apnea -shrank holes in pts hearts A) SLEEP APNEA: -occurs when upper airways collapse during sleep -breathing ceases for 10 seconds -person unconsciously strains to inhale -pressure changes in and around the HEART -force open a PFO Cause: -oxygen desaturation: large/rapid drop in blood-oxygen concentration EXPERIMENT: why: see if PFO's contribute to oxygen desaturation Process: -monitor blood-oxygen concentrations during night w/apnea patients -use sound waves @ heart to assess blood flow patterns (show how much blood through PFO) RESULTS: -9/15 ppl who experienced oxygen desaturation frequently, had PFO -2/15 who experienced it rarely, had PFO B) HIGH-ALTITUDE PULMONARY EDEMA (life-threatening condition, fluid collect in lungs) -rapid ascent of mountaineers -air breathed gets thinner -blood pressure in lungs increases to compensate for the bloods low oxygen content -Edema in lungs -fluid block gas exchange -leads to Respiratory failure Reversing high-altitude pulmonary edema: -prevent permanent harm -return promptly to lower elevation EXPERIMENT: -35 mountaineers hiked to elevation 1,100 meters above sea level -1 day later, reached research station in italian alps (4559 m- high peak) -16 have had high-altitude pulmonary edema -8 experience it again -increase to altitude of 2,500 m or higher can cause edema -test each volunteer twice for PFO/size of opening -lead ill ppl dwon to lower elevations (once normal oxygen concentrations in the air, they heal) Results: -PFO 4x as common in volunteers who had previously had high-altitude pulmonary edema -@ top of peak: PFO present in 69% former group, 16% latter group -blood oxygen saturation @ high elevation was much lower in edema-prone volunteers ---particularly low in PFO patients -6/8 edema prone group had PFO and developed pulmonary edema FINDINGS SUGGEST: -connection between having PFO and being prone to high-altitude pulmonary edema Climbers who have experienced edema should be tested for PFO Research is now conducting trial to test whether sealing divers PFO reduce risk of recurrent illness

Heart: Clinical view (P653) "Pericarditits"

Pericarditis: -inflammation of the pericardium caused by: -virus/bacteria/fungi inflammation causes: -increase permeability of capillaries -capillaries become "leaky" -fluid accumulates in the pericardial cavity -potential space of pericardial cavity becomes REAL as it fills w/fluid severe cases -excess fluid limits hearts movement -keeps heart chambers from filling w/adequate blood -heart is unable to pump blood -lead to emergency of CARDIAC TAMPONADE and possibly heart failure/death how to diagnose: -Friction rub --crackling or scraping sound heard w/stethoscope -sound caused by movement of inflamed pericardial layers against each other

Appendicular muscles Clinical view pg 388 plantar fasciitis

Plantar Fasciitis: -inflammation caused by chronic irritation of plantar aponeurosis (fascia) Most often inflammation is greatest @ attachment of the plantar aponeurosis of the CALCANEUS bone Frequently caused by: -overexertion that stresses plantar fascia Factors: -related to age (--loss of elasticity in aponeurosis that occurs with aging) -weight bearing activities (--lifting heavy objects, jogging, walking) -excessive body weight -improperly fitting shoes -poor biomechanics (--wear high heeled shoes, flat feet) Most common cause of heel pain in runners --due to this being a consequence of repetitively pounding the feet on the ground

Cartilage and Bone Connective Tissue: Clinical View: (p 164) RICKETS

Rickets: Caused by: vitamin D deficiency in childhood Characterized By; -overproduction and deficient calcification of osteoid. -disturbances in growth - hypocalcemia (abnormally low level of calcium in blood) -tetany (cramps/muscle twitches bc low calcium) accompanied with: -irritability -listlessness -generalized muscle weakness FRACTURES OFTEN OCCUR symptoms: -lack of vitamin D leads to digestive tract being unable to absorb calcium and phosphorus (minerals needed for the hardening of the osteoid during the formation of bone) results in: -poorly ossified bones -bones exibit flexibility -aquire bowlegged appearance bc weight increases and bones in their legs bend During industrial revolution, rickets increased bc children worked in indoor factories (lack of vitamin D from sun and from diet) continues to occur in -developing nations -some urban areas of US (kids spend time inside, dont drink enough milk bc like soft drinks) EASILY PREVENTABLE but MAKING COMBACK IN US due to: 1) poor dietary and lifestyle habits among nations youth

Muscle tissue and Organization: Clinical view pg 302 "Rigor Mortis"

Rigor mortis: -physiological state in which all skeletal muscles lock into a contracted position, and deceased individual becomes rigid -continues for 15-24 hours process: 1)ATP levels in skeletal muscle fibers are exhausted (a few hours after heart stops beating) 2)prevention of myosin head detachment from actin 3)Sarcoplasmic reticulum loses ability to recall calcium ions from sarcoplasm 4)calcium ions are present in sarcoplasm and leak into sarcoplasmic reticulum 5)triggers sustained contraction in the fiber 6) atp not available, crossbriges between thick and thin filaments cannot detach 7) skeletal muscles lock into contracted position, person is rigid Disappears because: -lysomal enzymes released within muscle fibers -causes autolysis (breakdown and self destruction) of myofibrils -muscle tissue breaks down -muscles of dead person become flaccid (relaxed) Used for: -forensic pathologists to establish time of death --environmental conditions taken into consideration ex) warmer body resolve rigor mortis quickler than normal temp body--elevated temp increases rate of processes in rigor mortis forensic pathologists must know ---- to establish time of death: -ambient (existing) temperature -general conditions where body was found Death interval, body temp and stiffness chart in book

Articulations-General Features Article: Triple Knock Out: Disastrous Surgical Enthusiasm https://books.google.com/books?id=LGVhw-nGxEEC&printsec=frontcover&source=gbs_ge_summary_r&hl=en#v=onepage&q&f=false

Robert Liston: can amputate leg in 2.5 minutes surgery was a matter of more haste less pain anesthesia unknown blood stained boards -swooning, sweating, strapped down patient -had pt time him to free both hands, clasped bloody knife between his teeth Invented see-through isinglass sticking plaster, the artery forceps, and a leg splint using in WWII liked operating successfully on tenements of the grassmarket and lawnmarket on pts who were discharged as hopelessly incurable performed the first operation under anaesthesis in europe. -leg hit sawdust in the bucket after 2.5 minutes -talent for surgical velocity was outdated 4th most famous case: removal in 4 minutes of a 45 lb scrotal tumour, whose owner had to carry it round in a wheelbarrow 3rd most famous case: tumor in small boys neck a straightforward abcess of skin? or aneurism of carotid artery? Liston lanced the rare aneurism from the neck, arterial blood was split and the boy died. artery kept at university college hospital pathology museum 2 most famous case: amputated leg in 2.5 minutes, accidentally cut the testicles in his excitement 1 most famous cause: amputated leg under 2.5 minutes -pt died after from hospital gangrene -also amputated fingers of young assistant (also died from hospital gangrene) -also slashed through the coat tails of a surgical spectator--dropped dead from fright that it had pierced his vitals THIS WAS THE ONLY OPERATION W/ 300 percent mortality

Appendicular muscles Clinical view pg 359 Rotator cuff injuries

Rotator cuff injury: Result of: trauma or disease in any part of rotator cuff muscles/tendons --extensive /repetitive use of muscles cause tearing of muscle fibers or rupture of tendon attachments Supraspinatus muscle injury=MOST COMMON --bc the tendon of this muscle can become impinged(pinched) inferior to acromion when using the muscle --COMMON IN BASEBALL PLAYERS ---bc repetitive shoulder movements while pitching/throwing the pall --Painters experience it: due to repetitive overhead upper limb movements involved with their work Treatment: -depends on severity of injury -use of NSAID's, corticosteroid shots, physical therapy Severe injuries require SURGICAL repair some never regain full athletic use of injured shoulder

Appendicular Skeleton-Pelvic Girdle and Lower Limbs Article: Vital signs: The Sneaky Pain that fooled 6 experts" by Anna Reisman, Discover Magazine http://uoflama.blogspot.com/2009/09/vital-signs-sneaky-pain-that-fooled-6.html

Russell McCoy: shot soda can into garbage -pain laced in left hip -couldnt run a few weeks later 2 months after incident: 1 DOCTOR other doctor thought it was "referred pain" --pain in one body area that the result of a problem in another --due to strained lower back muscles causes hip pain --pt took antiinflammatory meds and stretching for his lower back for one week gained 10 lbs couldnt exercise/sleep well hip aches when on side --xray of hip: -showed no arthritis or fracture MRI of lower back: -showed small disk bulge seeming unrelated to pain 2 DOCTOR: pushed on greater trochanter --pt experienced pain Main Symptom: -sore spot on hip when pressed (typical for trochanteric bursitis (inflammation of greater trochanter bursa) --bursa is irritated by overuse, pressure around it cause pain Treatment of NEW DOCTOR: -treat inflammation w/cortisone injection -wanted another opinion ORTHOPEIC SURGEION (3rd doctor) -thought symptoms originated inl lower back -went to physical therapist who said the back had nothing to do with it PHYSICAL THERAPIST (4th) -said he strained a muscle in his hip CHIROPRACTOR (5th) -worked on hip and back and saw no improvement 2 DOCTOR: -4 months later -gained much weight -did the injectoin -injection numbs area, steroid kicks in, in 2 days -Injection did not work 6 months after injury RHEUMATOLOGIST (joint specialist) -anesthetic w/cortisone injected into ball and socket of hip joint -failed to relieve pain DISK BULGE: -common in ppl with and without pain NEUROSURGERY: -had appt in 2 months -waited, and went to physical therapist for cane and hip exercises JANUARY: -wasnt limping -no cane REASON: -has a short leg -physical therapist measured legs (right is half inch shorter) -given heel lift, and has been good ever since LEG LENGTH DISCREPANCY (LLD) =common =70% have slight difference in lengths of legs =most cases are undetected 2 types of LLD 1) Structural discrepancies: ----actual difference in length of bones ----result of fracture, hip replacement surgery 2) functional discrepancies ----Caused by muscel weakness/stiffness of pelvis, ankle,foot ----legs are same size but function as if one is longer PT: had lifelong length discrepancy that never hurt until hurt hip -pain changed how he walked, and then the discrepancy mattered -LLD small engough that it never caused limp until injury SOLES OF SHOES: if right leg is shorter, you walk on the outer part of that foot, to extend the leg -left side, to make feel shorter, you flatten the foot COMMON METHOD TO CK FOR SSD: -run tape measure from point on pelvis to ankle bone -do several times -average numbers FUNCTIONAL CK: measure from belly button to each ankle bone some ppl will get xrays to ck measurement, others dont think its worth the radiation HELPS: -small LLD heel lift/insert from a sneaker --doesnt alwasy work bc pain can be originating from somewhere else

Spinal cord and spinal nerves: Clinical view (P505) Sacral plexus nerve injuries

Sacral plexus: -some branches are subject to injury ex) a poorly placed gluteal intramuscular injection can injure the superior/inferior gluteal nerves or sciatic nerve ex) herniated intervertebral disc may impinge on nerve branches of the sciatic nerve Sciatica: -injury to the sciatic nerve characterized by: -extreme pain down posterior leg/thigh -does not go away until injury on sciatic nerve is remedied EX) repair herniated disc alleviate compression on sciatic nerve, helping pain subside Injury to common fibular nerve due to: -fracture of neck of the fibula -compression from a leg cast that is too tight ex) compression of nerve compromises it and its branches ( superficial/deep fibular) ---paralyzes the anterior and lateral leg muscles --person is unable to dorsiflex and evert the foot sign of common fibular nerve injury: -FOOT DROP --person tries to take a step, there is a lack of innervation of the anterior/lateral leg muscles --foot falls into the plantar flexed position -person cannot dorsiflex the foot to walk normally -person compensates by flexing hip to lift affected area and keep from tripping/stubbing toes

Nervous tissue: Article: Study: new growth in adult brain possible http://dist.lib.usu.edu/login?url=http://proquest.umi.com/pqdweb?did=53833600&sid=3&Fmt=3 &clientId=1652&RQT=309&VName=PQD

Scientists learn how EXPERIENCE can reshape/reorganize your brain +as adult and child Brian is not fixed at puberty +good news for ppl with injury, stroke, disease Regeneration/growing new cells in brain +help ppl with damage to CNS +eventually ppl will possibly be able to cure someone who is paralyzed +practiced on Mice, and have been able to regenerate severed nerve fibers +damaged nerve cells have been growing back in monkeys MRI of london taxi drivers: + shows adaptability of adult brain +hippocampus became enlarged during the 2 years it took to learn their way around complicated metropolis +longer they drove, more hippocampus expanded Hippocampus +stores mental maps of places and directions +center of "spatial navigation system"-answers questions of where am i, how do i get there? +center has special "place cells" and "direction cells" (shown in MRI when person tries to find their way BLIND PEOPLE +who raid braille w/fingertip +enlarge part of brain that receives sensation from that finger PROFESSIONAL MUSICIANS: +develop extra capacity in brains auditory region These normal activites change volume of gray matter, so we may be able to do so with ppl with brain injury/disease +animal experiments show part of brain that deals with hearing can be rewired to take on task of seeing Downside to adult molding: +stress, injury, disease, aging, can reduce number of healthy brain cells/weaken memory Victims of POST TRAUMATIC STRESS DISORDER: +have major atrophy (shrinking) of hippocampus DEPRESSED women: +hippocampus 10% smaller than healthy woman New evidence that mature brain is malleable offers hope for future treatments +preliminary trials are under way for parkinsons disease/huntingtons disease/epilepsy/stroke pts ++will transplant new cells into their brains

Nervous tissue: Article: Russian man volunteers for first human head transplant http://www.cbsnews.com/news/russian-man-volunteers-for-first-human-head-transplant/

Sergio Canavero planned to perform first human head transplant in 2017 Pt: russian man (valery spiridonov) +in wheelchair +limbs shriveled +movements limitied to feeding himself, typing, controlling wheelchair with joystick Pts Disease: Werdnig-hoffman disease (rare /fatal genetic disorder) +breaks down muscles +kills nerve cells in brain /spinal cord that help body move many are against the transplant-think surgeon should be charged with murder if it doesn't work Surgery plans have been tested on mice successfully Needed suitable donor: +must be brain dead-young male patient Once permission for donor: Process: +surgeons set body up for decapitation +other surgical team cool body to 50 degrees Fahrenheit (delay tissue death in brain for about an hour) +use transparent diamond blade to remove both pts heads/sever spinal cord +custom crane used to shift Spirindonov's head onto donor body's neck +2 ends of spinal cord fused together with chemical (Polyethylene glycol--shown to promote regrowth of cells that make up the spinal cord) +muscles/blood supply from donor body joined with spiridonov's head +kept in coma for 3-4 weeks to prevent movement as he healed +implanted electrodes used to stimulate spinal cord/strengthen new nerve connections Require: 80 surgeons/millions of dollars +would have a 90%+ chance of success many disagree with the surgery: +unethical +bad science +not simple to transplant the whole self with pts mind, personality, and consciousness (body is a real part in formation of human self--person will have huge difficulties to have a new body--strong implications on human identity) +if spiridonov had the new body, his children would have the genetic makeup of the donor's(will donor's family have rights to the offspring?) +the uncertain surgery would take away vital donor organs that could have been used for someone else (heart/liver) to save their lives If approved, procedure would probably take place in CHINA/another countly outside of europe or the united stated It would not be approved in the western world

Nervous tissue: Article: Don't lose your head: doctor ready to perform first human head transplant https://www.yahoo.com/news/could-2017-first-head-transplant-010722047.html

Sergio Canavero=neurosurgeon +first introduced the idea of a head transplant in 2013 Head transplant: +2 part procedure +composed of Heaven (head anastomosis venture) and Gemini (spinal cord fusion) +36 hours, 150 people (doctors, nurses, technicians, psychologies, virtual reality engineers), $20 million dollars 1st person who signed on to be 1st pt=Valery Spiridonov (31): with rare muscular atrophy disorder (werdnig-hoffman disese) (he is russian) Process: 1) 2 surgical teams working @ same time +one on living pt +one on donor's body __must be brain dead/selected based on height, build, and immunotype 2)pts anesthetized/hooked to breathing machines/electrodes to look at brain and heart activity 3)living pt have his head nearly frozen (temporarily brain dead ) 4) physicians drain blood from living pt/flush it w/surgery solution 5) tubes looped around major arteries/veins to stop blood flow(later removed once new body is attached) 6) cut both spinal cords (with 200,000 dollar blade) 7)all arteries/veins reconnected 8) new blood flow will rewarm living pts head 9) spinal cord segments fused/severed muscles/skin sewn back together Should be walking within 3-6 months after procedure Pt is willing to risk death to escape his current condition ++procedure is slated to take place late next year

Nervous tissue: Clinical article Pg 429 Nervous system disorders

Serious diseases that attack portions of nervous system: 1) Amyotrophic Lateral Sclerosis (ALS) (LOU GEHRIG DISEASE) -well known -motor neuron disease -progresses quickly -eventually fatal AFFECTS: -neurons in brain/spinal cord--leading to progressinve degeneration of somatic motor system SYMPTOMS: -Weakened/atrophied muscles in hands and forearms -Speech impariment -breathing difficulties -chewing/swallowing problems---lead to choking or drooling DOES NOT AFFECT: -sensory abilites (hearing, sight, smell) TREATMENT: -do effective treatment or cure exists -Disease in FATAL OCCURS IN MALES MORE OFTEN -90% cases occur in families with no previous history of disease -10% cases are inherited and called "familial" --Familial=more members of same family affected-can be accout=nted by chance) --Inherited form=LOCALIZED TO GENE ON CHROMOSOME 21 2) Multiple sclerosis (MS) -progressive demyelination of neurons in CNS -destruction of oligodendrocytes -disabling -progresses slowly -most pts lead to productive lives during periods of remission -symptoms are diverse bc almost any myelinated site in the brain or spinal cord could be affected RESULT: conduction of nerve impulses is disrupted (leads to impaired sensory perception and motor coordination SYMPTOMS: -Scarring (sclerosis)--from repeatedinflammatory events at myelinated sites -function can be permanently lost --vision problems -muscle weakness and spasm -urinary infections -bladder incontinence -mood changes (drastic) PEOPLE -adults between ages 18-40 -5x more prevalent in WHITES than in blacks CAUSE: -body's immune system attacks its own CNS, making MS an Autoimmune disorder TREATMENT: -depends of stage and severity -steroids for acute symptoms -interferons (natural proteins produced by immune system) for prolonged therapy ---studies show one form of it lowers activity of immune cells, reducing number and severity of attacks 3) Parkinson disease: -AKA parkinsonism or "shaky palsy" -slowly progressive disorder -affects muscle movement and balance Characterized by: -stiff posture -tremors -reduced spontaneity of facial expressions Results from: -Loss of cells that produce the neurotransmitter dopamine in a specific region of the brainstem Guillain-Barre Syndrome (GBS) -inflammation causes loss of myelin from peripheral nerves and spinal nerve roots -appears to be immune mediated condition Characterized by: -Muscle weakness that begins in distal limbs -rapidly advances to involve proximal muscles (ascending paralysis) Proceded by: -acute, flulike illness RARE circumstance: -follow immunization Treatment: -steroids provide little improvement -most people recover almost all neurologic function on their own w/little medical intervention Multifocal Motor Neuropathy (MMN): -immune-mediated motor Neuropathy -similar to GBS but less severe -demyelinating condition -progresses slowly -presents with asymmetric weakness, degrees of muscular atrophy of forearm and hand -the body's own antibodies eat away at the myelin sheaths around motor neurons MEN affected more often Ususally symptoms BEFORE 45 years clinical signs: -resemble motor neuron disease (ALS)--makes diagnosis hard--accurate diagnosis is NECESSARY Treatment: -intravenous immunoglobulin (IVIG) to slow production of antibodies --successful in most cases

Appendicular muscles Clinical view pg 355 Paralysis of the serrates anterior muscle (winged scapula)

Serrates Anterior muscle: -primary protractor of scapula -pull on scapula is counterbalanced by posterior thoracic muscles -recieves innervation from long thoracic nerve (traveling inferiorly along anterolateral chest wall) --nerve can be damaged or cut during surgical removal of breast (radical mastectomy)--causes paralysis of serratus anterior msucle Cause of paralysis: Long thoracic nerve cut or damaged symptoms: -posterior thoracic muscles unopposed How to tell if you have it: -put arms anteriorly on wall -push -scapula on injured side will poke posteriorly like a birds wing (winged scapula) -scapula on unaffected side remain close to thoracic wall (normal position) Paralysis of serrates anterior muscle AKA "winged scapula"

Spinal cord and spinal nerves: Clinical view (P490) Shingles

Shingles: -reactivation of childhood chickenpox infection who experienced it? -some adults -after age 50 what can trigger it? -psychological stress -infections (cold/flu) -sunburn during initial infection: -chickenpox virus leaves skin and invades the posterior root ganglia -virus remains latent until late adulthood when it is reactivated/proliferates When reactivated into shingles, the virus travels: -through the sensory axons to a dermatome process: -rash/blisters along the dermatome -intense burning/tingling pain treatment: -antiviral meds reduce severity/duration of symptoms -old adults can get vaccine for shingles, which prevent/reduce severity of the disease

Cartilage and Bone Connective Tissue: Article: "Smokers Suffer Impaired Bone Healing" K. A. Fackelmann."

Smoking harms the body's ability to heal skin wounds. **Smoking slows bone growth -Orthopedic surgeion studied 29 men/women who had osteomyelitis Osteomyelitis: (bacteria infection of bone/bone marrow-may appear after bone fracture) Nine nonsmokers nine exsmokers 11 smokers all had surgery cutting through skin/tissue-remove infected tibia (shin bone) Ilizarov apparatus (round device) w/wires fastening to tibia's-given to pts after surgery tension spurs one end of the tibia to regenerate--bone heals nonsmokers: formed new bone w/in 2 months of operation smokers: minimal bone growth in 2 months Normal activities resumed w/in 8-18 months -smokers: spent more time recuperating (average 2.98 months to manufacture 1cm of new bone) -nonsmokers: (5cm bone gap-10 months recuperation -smokers (5cm bone gap-15 months recuperation) exsmokers: 2.72 months to grow 1cm bone -ppl who quit before surgery recover much faster than if they keep smoking Nicotine plays a key role in poor bone healing. -cigarette smoke can reduce amount of oxygen reaching body tissue (probs through nicotine) --lack of oxygen impairs ability to make collagen (protein used to form new bone) additional research must be done to know how drastic smoking during surgery affects those who have just broken an arm (not taking a whole chunk out.)

Integumentary System: Clinical view (p122) TATOOS

Tattoo: permanent image by injecting dye into the dermis dye remains in dermis due to lack of mitotic activity scar tissue surrounds dye granules--which are too large for dendritic cells to invest--they become a permanent part of the dermis layer Removal of tattoo: usually impossible to completely remove --scarring may occur old methods of tattoo removal: 1) excision (cutting out tattoo 2) dermabrasion (sanding down tattooed skin) 3) cryosurgery (freezing area of tattooed skin before its removal) 4) lasers (used to break down tattoo pigments Newer tattoo links have been introduced that allow for easier removal

Nervous tissue: Article: The brain: the Dark Matter of the Human Brain http://discovermagazine.com/2009/sep/19-dark-matter-of-the-human-brain

Some common words we use are mistakes +influenza from word meaning "influence" (allusion to the influence stars were believed to have on our heath) +explorers looking for india named inhabitants "indios/indians" Some words within the brain are mistakes: +cells in brain that aren't neurons, called "glia" meaning "glue" (thought to be passive/supportive, instead have much bigger role and are 10x more than neurons) GLIA: -multitaskers -guide brains development/sustain it throughout our lives -listen to neighbors, speak chemical language of their own (experiments suggest its part of neurological convo that takes place as we learn and form new memories) One thing to blame false impression about glia=electricity +luigi Galvani touched electrified metal to nerve on frog, causing it to twitch +physicians tried to find "animal spirits" that moved the body +it was only lightning Later scientists started to understand how the signals worked: +a branch @ one end of neuron is stimulated-electrical pulse goes to body-other branches may send separate pulses @ same time +@ main body of neuron conveys pulses to axon, which splits into numerous branches, which almost touch other neurons -Synaptic cleft=space between two neurons +signal-sending neuron pumps chemicals into space, signal-receiving neuron take some of them===triggers new electric pulse ALL neurons: +have axons, synapses, ability to produce electric signals Scientists founds cells without neuronal abilities: +electrodes did not produce electric impulses +named "glia" and treated as "passive inhabitants of the brain" Other scientists: +did not accept glia to be "passive" +santiago ramon and Cajal came up with theory that: 1) neurons are the fundamental units of the brain 2) glia "may remain unsolved for many years to come" =a mystery Mystery of glia is partially solved: +they come in several forms: 1) radial glia: serve as a scaffolding in embryonic brain (neurons climb these pole-like cells to reach final location) (turn into astrocytes after they have finshed helping neurons move around the developing brain) 2) microglia: brains immune system (search for debris form dead/injured cells) (prune away extra branches on neurons/fine-tune their connections) 3)Schwann cells/oligodendrocytes: (insulate cells and speed up impulses) (foster new synapses between neurons) 4) astrocytes: -most abundent of all glial cells/most abundent cell in the brain -can wrap rays around more than 1million synapses -fuse to each other (build channels where molecules can go from cell to cell) -have receptors that snap some neurotransmitters -can react to neurotransmitters (cells produce waves of charged calcium ions) -release powerful neurotransmitters (glutamate/adenosine) Glutamate/adenosine process: +astrocyte produces glutamate/adenosine (neurotransmitters) +glutamate excites neurons so they are more likely to respond from signal from other neuron +Adenosine blunt a neurons sensitivity Calcium process: +Calcium: come from sealed packets scattered through atrocytes +stimulate astrocyte, cells open calcium packets when sense neurotransmitters, +triggers other cells to open their calcium packets +then stash the calcium atons back into packets +released again when stimulated (wave of activity spreads among astrocytes) Astrocytes have some of the requirements for processing information the way neurons do: (Pieces of figuring out Astrocytes) 1) can sense incoming signals 2) can respond with calcium waves 3)produce outputs (neurotransmitters/calcium waves that spread to other astrocytes) 4) 2 different responses in an astrocytes ++2 different stimulus signals can produce 2 different patterns of calcium waves ++when given both different signals @ once, created whole new response (similar to neurons and computers) If astrocytes really do process information, it is speculated that astrocytes have their own computing (compared to neurons) +they act like an analog network +encode info in slowly rising and falling waves of calcium +scientist suggests it could be responsible for our creative and imaginative existence as humans Currently can observe Astrocytes in living animals: +study mounted microscopes on skulls of mich +inject molecules into mice that glow when bind to free calcium +whenever mouse moves leg, small burst of calcium waves +astrocytes have flared up (can last several seconds) Astrocytes vital for SYNAPSES: +neurons that grew with astrocytes formed 10x more synapses compared to neurons growing without astrocytes ++activity of the synapses are 100x greater (test if astrocytes help in our ability to learn--gave chicks colored beads to peck at. Red=bitter. would eat one time and then not go for red again. When injected with drug that prevent astrocytes from synthesized glutamate, birds couldnt remember the bad taste and would peck again) Skeptics are out there: +study that stopped calcium packets being released in mice +mice were indistinguishable from ordinary ones CONCLUSION: +we barely understand what our brain is doing, that is marvelous +1930's astronomers said all the things they could see through their telescopes make up a small fraction of the universe. +what is not seen= known as "dark matter" We all carry some "dark matter" within our brains

Articulations-Selected Articulations in Depth Article: The Nine-Month Arthritis "cure" http://www.jstor.org.dist.lib.usu.edu/stable/3977384?seq=1#page_scan_tab_contents

Some women w/rhematoid arthritis claimed their joint pain/swelling vanished during pregnancy WHY: -tested hormonal changes but failed to account for the "cure" -appears to result from genetic differences between mother and fetus (new study found) TERI ROW: -pain faded during 3rd child -2 months after giving birth, came back Nelson: -woman who started looking into this -was it possible that moms immune system has something to do with it? (affected during pregnancy) Arthritis: Joint, inflammation -refer to a host of joint diseases (osteoarthritis) Rheumatoid arthritis: -autoimmune disease that often strikes in midlife -belief that: --in certain genetically susceptible people, the immune cells remain hyperactive long after the infectious agent has been cleared from the body -now these immune cells attack synovial joints Side effects: -soreness stiffness fatigue permanent crippling of afflicted joints -eventually cause destruction of synovial membrane (lining inside joint) , the cartilage that cushions that bone ends, and bone itself -inflammtion of body's blood vessels/lining of heart and lungs Nelson did study: -analysis revealed significant improvement / remission of joint disease in 34 cases (12 remained active in pregnancy-11 not enough data) -studied genetic material from mother/offspring -looked at genes a part of the human leukocyte antigen system -compare mother genes w/childs to see which HLA genes kid gets from mother HLA profile -there will be differences between child and mother when joint pain ceases HLA genes: -carry blueprint for manufacturing HLA proteins (sit on surface of immune cells)--lymphocytes -enable immune system to differentiate between body's own cells and foreign cells (such as childs cells) -HLA profile of a person is like a fingerprint GENETIC DIFFERENCES: between maternal and fetal HLA genes lead to temporary remission of arthritis symptoms -when mom/child have different HLA types, mothers immune system may turn down its activity to allow fetus to develop undisturbed in the womb-same time immune system scales back its attack on the mothers joints OR -mothers immune system notes potential danger for genetically different fetus-manufactures a substance that quiets the immune response Today to treat disorder: aspirin nonsteroidal antiinflammatory drugs powerful corticosteroids Hench's 1938 report: -dint solve pregnancy mystery -lead to discovery of cortisone, hormone produced by adrenal glands, that give great relief to patients with rheumatoid arthritis

Nervous tissue: Clinical article Pg 425 treating spinal cord injuries

Spinal cord injuries leave many individuals unable to walk or paralyed from neck down Old Assumption: people with spinal injury at neck level are doomed to die, because of inadequate stimulation of diaphragm/respiratory failure New Assumption: -aggressive/early treatment of spinal cord injuries save lives Research treatment options show minimal promise: 1) electrical stimulation simultaneously with intensive rehabilitation therapy: strengthens function 2)Enzyme therapy: reduces scar tissue to allow axonal growth 3) cell therapies(stem cell and olfactory cells): try to create a "bridge" of nervous tissue that spans the injured area 4) gene therapy: to "turn on" genes to grow axons These studies are preliminary, havent undergone clinical trials, or just starting to still waiting to see findings

Articulations-Selected Articulations in Depth Clinical View (P281) Ankle Sprains

Sprain: =a stretching or tearing of ligaments, without fracture or dislocation of joint Ankle Sprain: results from: foot twisting, due to Overinversion --fibers of lateral ligaments are either stretched (in mild sprains) or torn (in severe sprains) --produces localized swelling/tenderness anteroinferior to lateral malleolus Overeversion sprains: -rarely occur due to strength of deltoid ligament -if occur: Pott fracture may result Ligaments: made of dense regular connective tissue (poorly vascularized)-take long time to heal So, ankle sprains take a long time to heal, and are prone to reinjury

Cranial nerves Clinical view (p330) Strabismus

Strabismus: -when eyes are improperly aligned -means eyes aren't working synchronously to transmit a stereoscopic view to the brain Process: -each eye sends a slightly different image to the brain -brain becomes confused -brain ignores one of the images -ignored eyes becomes weaker and weaker over time results in: -lazy eye if lazy eye is uncorrected: -Strabismic amblyopia: lazy eye loses visual acuity causes: -birth injuries -diseases localized to the ye or its bony orbit -improper attachment of the extrinsic eye muscles -heredity 2 forms: 1) external strabismus 2) internal strabismus 1) external strabismus: -occurs when oculomotor nerve (CN III) is injured -affected eye moves laterally while @ rest -cannot move medially and inferiorly 2) internal strabismus: -abducens nerve (CN VI) is injured -affected eye moves medially, but cant move laterally

Axial muscles Clinical view pg 330 Strabismus

Strabismus: eyes are improperly aligned -eyes not working synchronously to transmit a stereoscopic view to the brain -each eye sends different image, brain becomes confused and ignores one of the images -ignored eye becomes weaker over time...leads to LAZY EYE -if Lazy eye is uncorrected, it loses visual acuity (Strabismic Amblyopia) Causes: -birth injuries -diseases localized to the eye or its bony orbit -improper attachment of extrinsic eye muscles -heredity 2 forms of strabismus: 1)External Strabismus 2) internal strabismus External strabismus: occurs when Oculomotor nerve (CN II) is injured -affected eye moves laterally at rest (cannot move medially or inferiorly) Internal strabismus: Occurs when abducens nerve (CNVI) is injured -affected eye moves medially (cannot move laterally)

Articulations-General Features Article: Does running actually ruin your knees? https://www.huffingtonpost.com/entry/does-running-actually-ruin-your-knees_us_5890bca6e4b02772c4e96c3f

Study shows: -running decreases inflammation in knees of 6 ppl -running may be more beneficial to joints than harmful Running puts force on knee, but knee is made to load STUDY: -very small -extract synovial fluid (indicator for inflammation) from knee cartilage -knee cartilage may be meant to absorb shock that running causes Most research shows running not causing knee arthritis BUT -there's a standard degenerative process of joints as ppl age -running can cause damage to knees of ppl who've already experienced trauma to knee cartilage SET UP FOR ARTHRITIS= -damage cartilage in knee -skiing, torn meniscus, blown out ACL -regularly run and overuse knee =set up for arthritis WHAT TO DO: -if surgery/trauma to knee cartilage rehabilitate -pick up on low impact sport when recovered --swimming, cycling if knees are in good shape: running shouldn't cause damage Runners' knee: standard overuse of the knee common source of pain

Articulations-Selected Articulations in Depth Clinical View (P 273) Subluxation of the Head of the Radius

Subluxation =incomplete dislocation, where contact between bony joint surfaces is altered, but still in partial contact Subluxation of head of the radius =head of radius is pulled out of the anular ligament "pulled elbow, nursemaids elbow, slipped elbow" OCCURS COMMONLY/ALMOST EXCLUSIVELY IN CHILDREN -younger than 5 -bc childs anular ligament is thin/head of radius is not fully formed Results from: -individual pulls suddenly on child's pronated forearm Treatment: -simple -Pediatrician applies posteriorly placed pressure to head of radius while slowly supinating and extending childs forearm -this movement screws radial head back into the anular ligament -most cases, manual treatment brings relief

Muscle tissue and Organization: Clinical view pg 291 "Tendinitis"

Tendinitis: Inflammation of tendon or synovial sheath around tendon results from: 1)overuse/repetitive use of tendon ex)too much typing-synovial sheaths around finger tendons enflame-swelling/pain 2)age related changes --age related is not well understood --aging causes tendons to lose elasticity/ability to glide smoothly 3)autoimmune condition--rheumatoid arthritis --body reacts against his or her own body 4) inflammatory process of joints can injure synovial sheaths as well Treatment: 1) rest, icing, nonsteroidal anti-inflammatory agents 2) stretching and strengthening exercises on the muscles in the affected area is beneficial 3) physical therapy using measured exercise program

A First Look At Anatomy: Article "Why Does His Belly Hurt?" By: Cohen, Mark http://web.b.ebscohost.com/ehost/detail/detail?vid=0&sid=fc9e109d-4f7e-485a-93c5-a2c7be511f4e%40sessionmgr120&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=15672866&db=aph

The abdomen has always been a source of great mystery. It doesn't offer a lot of clues when something is wrong Whether the problem is simple indigestion or a potentially life-threatening catastrophe, all the belly seems to know is how to hurt Even the etymology of the word abdomen is mysterious. Babies can't tell me where their pain is, but a young man can One important clue is geography: Is the pain in the upper right, the lower left, or around the belly button? Every location generates its own list of possibilities, each with its characteristic history and physical findings. Most people are aware, for example, that pain in the lower right abdomen could mean appendicitis. What they may not know is that there is one precise spot on the abdomen, McBurney's point, that is typically extremely painful in acute appendicitis. If I push on that spot and the patient yells or winces, he's on his way to the surgeon upper left quadrant, I was somewhat concerned because that is not a common location for pain from appendicitis. The spleen and part of the colon are in the upper left quadrant. Farther back, behind the peritoneum (the membrane that surrounds the abdominal cavity like a thin glistening sac) are the left kidney and adrenal gland and the tail of the pancreas. I asked more questions. My patient had a cold a few days ago and was still coughing a little, but he wasn't having any difficulty breathing. He hadn't been vomiting, he had no constipation or diarrhea, and he hadn't had anything unusual to eat or drink in the past few days. He was generally healthy and in good shape, I think your young guy may have an injury to his spleen" he said. "He told me that he got hit on the left side in football practice the day before yesterday. He could have a small laceration that's leaking blood. I'm going to send him for a CT scan." I hadn't asked about any history of trauma to the area. (spleen) Surgeons are attuned to that, of course, but I should have considered that possibility. It was a reminder that every patient is an opportunity to learn--and to relearn. "His spleen is OK ... but did you know he has pneumonia?" I stared at the image. The fluid in the left lower lobe of the patient's lung stood out in stark white contrast to the normal black, air-filled lung tissue around it. Just as the workshops on corporate success exhort people to "think outside the box," my teachers had always reminded us to "think outside the belly" when dealing with abdominal pain. our abdomen can hurt when you have strep throat, an infected hip, or pneumonia. The young athlete's infection was close enough to the lower surface of his left lung to cause local inflammation of the diaphragm and the peritoneum, thus causing belly pain. When I listened to the patient's chest again, I could hear, very faintly, the crackles over his left lower lung field that signal pneumonia. Those crackling sounds result from a buildup of fluid. When microorganisms spread deep into the lungs, they reach the alveoli, the tiny air-filled sacs where oxygen is absorbed into the capillaries of the lung. Part of the immune reaction to the infection is the secretion of fluid around the infected area. But if the infection gets out of hand and spreads to large portions of the lung, the fluid buildup starves the blood of oxygen. The abdomen is a place of mystery, of things hidden away. And sometimes the things hidden are not what we suspect.

Muscle tissue and Organization: Clinical view pg 300 "muscular paralysis and neurotoxins"

Toxins interfere with neuromuscular junction processes-result in muscular paralysis. 2 resulting conditions: 1)Tetanus 2)Botulism Tetanus: LIFE THREATENING -form of spastic paralysis caused by toxin produced by anaerobic bacterium "clostridium tetani" -toxin blocks release of inhibitory neurotransmitter (glycine) in the spinal cord -result in: overstimulation of muscles and excessive muscle contraction C. Tetani: -very common in soils/veggie matter -effective if introduced to a wound -absorbed into blood and circulates nervous system where it initiates tetanic (spasmodic muscle contractions -condition is LIFE THREATENING --immunize ourselves against it --should get gots every 10 years Botulism: POTENTIALLY FATAL -muscular paralysis -caused by toxin produced by bacterium "clostridium botulinum" -toxin prevents release of acetylcholine (ACh) at neuromuscular junctions -leads to muscular paralysis C. Botulinum: -anaerobe common in environment/produce toxin Most botulinum poisoning cases result from: 1) ingesting the toxin in canned foods that were not processed at temperatures high enough to kill the spores 2) ingestion of unpasteurized honey by infants in first year can introduce botulinum into gastrointestinal tract BOTOX: botulinum toxin type A -approved by FDA -temporarily diminishes wrinkles -used clinically to help reduce overcontraction of muscle associated with certain disorders -one of the most important treatments for spasticity -most effective 1-2 weeks after injections, spasticity reduced up to 3-6 months (repeat every 3 months)

Brain: Clinical view Pg. 447 Traumatic Brain injuries: Concussion and contusion

Traumatic Brain Injury: TBI -acute brain damage -occurs from accident or trauma Types: 1) concussion 2) contusion 3)Second impact syndrom (SIS) CONCUSSION: -most common TBI type Characterized by: -temporary, abrupt loss of consciousness after blow to head/sudden stop of moving head -headache -drowsiness -lack of concentration -confusion -amnesia Multiple concussions: -have cumulative effect -person loses small amount of mental ability with each episode -related to long-term personality changes, depression, intellectual decline Athletes prone to concussions: -football/soccer players -greater risk for detrimental changes Coaches/athletic trainers -should be educated to be more cautious if its expected CONTUSION: =bruised brain due to trauma that causes blood to leak from small vessels into subarachnoid space Detected by: -computed tomography (CT) scan of head CHaracteristics: -person immediately loses consciousness (no longer than 5 minutes) -respiration abnormalities -decreased blood presssure SECOND IMPACT SYNDROME (SIS): -RARE and SERIOUS -individual experiences second brain inury prior to the resolution of first injury -develops severe brain swelling/possible death ESSENTIAL: -Original TBI completely heals before individual resumes behavior that puts at risk for another brain injury TBI: -severe TBI and repetitive TBIs cause long-term cognitive deficits and motor impairment Treatment; -physical, occupational , speech therapy to regain functions Research shows: -pts with therapeutic PROGESTERONE made greater and faster recovery than those without it --reproductive hormone, also helps nervous system healing

Nervous tissue: Clinical article Pg 420 tumors of the CNS

Tumor: Neoplasms resulting from unregulated cell growth Primary tumor: tumor that originates within the organ where it is found Primary CNS tumors: -originate in supporting tissues within brain/spinal cord that can undergo mitosis (glial cells /meninges--protective membranes of CNS) ---mature neurons dont divide and cannot give rise to tumors Gliomas: -Glial cell tumors -relatively benign slow growing or Malignant --Malignant=capable of metastasizing (spreading) to other areas of body Secondary tumor: neoplasm originated at one sight--spread to another organ EX)lung cancer metastasizes to nervous system and from additional tumors

Axial Skeleton--Skull: Article: "U. researchers discover how to reverse cleft palate for mice still in uterus" https://www.ksl.com/?sid=45927732

University of Utah researches reverse cleft palate of mice in womb--all tested unborn mice had successful surgeries and had no side effects NOW: Only available option=surgery, many times more than 1 due to complications CLEFT PALATE: sides of roof of mouth dont joint together during fetal development AFFECTS: 1 in 1574 infants in US PREVALENCE: 3rd highest out of 22 common categories of birth defects (on CDC) HOW: -used drug on gene WNT -PAX 9 gene is critical for palate fusion (sustan activity of WNT gene) -when PAX 9 is absent, fusion blocked by 2 inhinbitied genes SIDE EFFECTS: -way you swallow -speak -inhale -society puts stigma on nonnormal looking ppt SETBACK: cleft palate not always due to single gene misbehaving --treatment needs to come after identifying reason for malformation treatment lacks to effect other deftec​ts related to absent PAX 9 gene PAX 9 deficiency causes defects to: hind limb parathyroid gland thymus gland hard palate mice often died to complications even after injection BUT mothers who recieved injection through tail too, had no side effects INITIALLY: D'SOUZA found this by studying Wnt and PAX 9 genes in formation of teeth

Vessels and circulation #2 Clinical view (p684) Varicose veins

Varicose veins: =dilated, tortuous (many curves or twists) veins -valves in veins are nonfunctional, causing blood to pool in one area, and vein to swell and bulge most common in: superficial veins of lower limbs result of: genetic predisposition, aging, stress on venous system that inhibits venous return (standing for long time, obesity, pregnancy) Treatment: -elevate affected body part -compression stockings(promote blood movement in lower limbs) -Sclerotherapy: irritant is injected into small varicose veins to make them scar and seal off ---need multiple sessions before optimal results are seen Large varicose vein treatment: surgical procedure (phlebectomy) --stripping or vein removal Hemorrhoids: -varicose veins in the anorectal region -occur due to increased intra-abdominal pressure ex) person strains to have bowel movement ex) person in labor during childbirth

Heart Clinical view (P662) "Angina pectoris and myocardial infarction"

causes of angina pectoris and myocardial infarction: 1) atherosclerosis -aka coronary artery disease -narrowed coronary artery, occluded w/plaque 2) coronary spasm -sudden narrowing of vessels -caused by smooth muscle contraction in their wall 3) overall=unhealthy coronary arteries, not able to supply sufficient blood flow to heart wall Angina pectoris: -poorly localized pain sensation in left side of chest, left arm, shoulder, jaw and back -location vary, especially in women results form: -strenuous activity, when workloads demands on heart exceed the ability of the narrowed coronary vessels to supply blood pain from angina pectoris: -usually referred along the sympathetic pathways (T1-T5 spinal cord segments) EX) individual may have pain in chest region or down left arm=T1 dermatome -pain stops shortly after exertion stops, normal blood flow of heart is restored treatment: -medication causing temporary vascular dilation -long term therapy depends on severity of narrowing/spasming Myocardial infarction (MI): -Infarction=death of tissue due to lack of blood supply -MI: aka Heart attack process -sudden and complete occlusion of a coronary artery -region of myocardium deprived of oxygen -some of the tissue in that area may die (necrosis=tissue death) Pain: -sudden development of excruciating/crushing substernal chest pain -pain radiates into left arm/left side of neck -weakness, shortness of breath, nausea, vomiting, anxiety, marked sweating WOMEN: overcome w/incredible fatigue and flulike symptoms, may be misdiagnosed Mature cardiac muscle cells: have little to know capacity to undergo mitosis --if die, scar tissue forms to fill the gap --if large amount dies, person will die a few hours/days bc heart is WEAKENED

Articulations-Selected Articulations in Depth Clinical View (P 277) Knee Ligament and Cartilage Injuries

knee=highly vulnerable to injury among ATHLETES Ligamentous injuries to knee=COMMON -bc knee if reinforced by tendons and ligaments only 1) Tibial collateral ligament: -frequently injured when leg is forcibly abducted at the knee (if persons knee is hit from lateral side) -if injured, may injure medial meniscus bc its attached to the tibial collateral ligament 2) Fibular collateral ligament: -occur if medial side of knee is struck -results in hyperadduction of leg at the knee -fairly rare injury, bc medial blows to knee=not common 3) Anterior cruciate ligament (ACL) -injured when leg is hyperextended ex) runners foot hits a hole -ACL is weak compared to other knee ligaments, MORE PRONE TO INJURY Testing for ACL injury: (Anterior Drawer Test) -physician tugs on tibia -too much forward movement indicates ACL tear 4) Posterior Cruciate Ligament: -injury occurs if leg hyperflexed/tibia driven posteriorly on the femur -RARE injury bc this ligament is strong Testing for PCL injury: (Posterior Drawer Test) -physician pushes posteriorly on tibia -too much posterior movement indicted PCL tear 5) Menisci of knee: -PRONE TO INJURY -Result from: blows to knee/general overuse of joint -composed of fibrocartilage, cannot regenerate, must be treated w/surgery 6) Unhappy Triad of injuries =refers to a TRIPLE injury of tibial and collateral ligament, medial meniscus, and anterior cruciate ligament -MOST COMMON TYPE OF FOOTBALL INJURY -Results from: player is illegally "clipped" by lateral blow to knee, leg is forcibly abducted/laterally rotated --if blow is severe enough, the tibial collateral ligament tears, followed by tearing of medial meniscus (bc connected) --force that tears these two is transferred to ACL (tears bc weak) Treatment of ligamentous knee injuries -depends on severity/type of injury -conservative treatment: immobilize knee to rest joint -Surgical treatment: repair torn ligaments or replace ligaments w/graft from another tendon/ligament (quadricepts tendon) Knee sugeries: -now performed w/arthroscopy Arthoscopy: type of conservative surgical treatment -incision is made in knee -arthroscope is inserted in knee -allows surgeon to see area w/out large incisions Arthroscope: instrument w/camera and light source

Cranial nerves Article: Conduit to the brain: particles enter the nervous system via the nose http://www.phschool.com/science/science_news/articles/conduit_to_the_brain.html

minute airborne particles can enter the brain through the nose -inhale particle -shimmy up nerve bundle that governs smell (olfactory nerve) -infiltrate central nervous system This pathway bypasses the natural firewall between brain tissue and the main circulatory system -blood brain barrier Benefit and downwfall 1) delivery vehicle for treatments/drugs that cannot make it past the blood brain barrier 2) bad matter from human activities may cause neurological problems (in addition to harm to heart and lungs) --burning diesel fuel PPL have thought particles in the nose can circumvent the blood brain barrier since the 1900's, but little evidence backed up the claim Experiment 1) 12 rats in chamber w/airborne particles (Carbon-13) 2) @ 1,3,5,7 days after exposure, scientists removed/observed animals lungs and brain Results: 1)Animals 1 day exposure had 1.39 micrograms in tissue 2) animals 1 day exposure had.35 micrograms in the brain olfactory bulbs 3) excess in lungs declined over 1 week --immune system will remove all small foreign debris from lungs 4) excess in olfactory bulbs increased over 1 week --particles can become permanently lodged in the brain --could permit particles to accumulate w/toxic consequences 5) other brain areas had excess carbon, was not consistent over the week Greatest concern: 1) combustion by-products --ppl experience lifelong exposure of this 2) ppl will most likely inhale dangerous mundane pollutants NOT ultrafine engineered materials ---High tech materials (carbon nanotubes) should also be investigated for neurotoxic effects The "paucity of toxicological data" on engineered nanoparticles mandates a "focus on safety testing" HOPE: -exploit the new findings to deliver drugs DIRECTLY to the brain EX) nanoparticles containing therapeutic compounds be inhaled as treatment to Parkinson's disease

Axial Skeleton--Skull: Article: "Folic Acid May Prevent Cleft Lip and Palate, Medical News Today" https://www.medicalnewstoday.com/releases/61799.php

women who take folic acid supplements early in their pregnancy can reduce their baby's chances of being born with a facial cleft. NIEHS fount .4 mg of folic acid daily reduced by 1/3 baby's rest of cleft lip (with or without cleft palate) Folic acid=B vitamin found in: -leafy veggies, citrus fruits, beans, whole grains, vitamin supplement, flour daily recommendation for folate is .4mg or 400 micrograms reduces: neural tube defects (ex=spina bifida) possibly facial clefts 1 in 750 babies have cleft lip or palate STUDY done in: -nroway -population study -highest rates of facial clefts in europe -doesnt fortify food w/folic acid -questionaire asked health questions to mother -many ppl contributed to study 22% cleft lip cases in norway could have been prevented if took .4mg folic acid daily