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Some muscles have more than one origin buy 200mg lamictal amex, but the principle is the same−the origin act to anchor or 121 Human Anatomy and Physiology hold the muscle so that the force of contraction causes the insertion to move 25 mg lamictal overnight delivery. The insertion of the triceps brachii is on the ulna and contraction results in extension of the forearm. Of all the muscles contracting simultaneously, the one mainly responsible for producing a particular movement is called the prime mover for that movement. When those antagonist muscles contract, they produce a movement opposite to that of those prime movers and their synergist muscles. Naming skeletal muscles Most of the skeletal muscles are named according to one or more of the following basis: 1. Direction of muscle fibres relative to the midline of the body or longitudinal axis of a structure Rectus means the fibres run parallel to the midline of the body or longitudinal axis of a structure. Example, rectus abdominis 122 Human Anatomy and Physiology Transverse means the fibres run perpendicular to the midline longitudinal axis of a structure. Example, transverse abdominis Oblique means the fibres run diagonally to the midline longitudinal axis of a structure. Location−structure to which a muscle is found closely related Example: Frontal, a muscle near the frontal bone Tibialis anterior, a muscle near the front of tibia 3. Origin and insertion−sites where muscles originates and inserts 123 Human Anatomy and Physiology Example, sternocleidomastoid−originates on sternum and clavicle and inserts on mastoid process of temporal bone. Example, obturator externus 124 Human Anatomy and Physiology Principal skeletal muscles Although there are over 700 individual skeletal muscles in the human body, an appreciation and understanding of skeletal muscles can be accomplished by concentrating on the large superficial muscles and muscle groups. Refer to Figures 6-4 and 6-5 as you study the attachments and action of these muscles, and try to figure out why each has the name that it does. Head and neck muscles Muscle Origin Insertion Action Muscles of facial expression Occipitofrontalis Occipital bone Skin of eye brow Elevates eye brows orbicularis oculi Maxilla & frontal Skin around the Closes eye eye Orbicularis oris Maxilla & Skin around the Closes lip mandible lips Buccinator Mandible & Corner of mouth Flattens cheeks maxilla Zygomaticus Zygomatic bone Corner of mouth Elevates corner of muscles mouth Levator labii Maxilla Upper lip Elevates upper lip superioris Corrugator Frontal bone Skin of eye brow Lowers and draws supercilli together eye brows Depressor anguli Mandible Lower lip near Depresses corner oris corner of mouth of the mouth 125 Human Anatomy and Physiology Muscles of Temporal region Mandible Closes jaw mastication on Temporalis side of the skull Massetor Zygomatich arch Mandible Closes jaw Muscles that Occipital bone Scapula and Extends head move the head and Clavicle and neck rapezius vertebrae Sternocleidomas Sternum & Mastoid process Rotates head toid clavicle of temporal bone and flexes neck Table 6-2. Trunk muscles Muscle Origin Insertion Action Muscles that move the vertebral column Erector spinae Ilium, sacrum, Superior vertebrae Extend, abduct, and vertebrae Ribs rotate vertebrae Deep back Vertebrae Vertebrae Extend, abduct, and muscles rotate vertebrae Rectus Pubis Xiphoid process of Flexes vertebrae; abdominis ste- compress abdomen rnum & lower ribs External Rib cage Iliac crest & facia Flexes & rotates abdominal of vertebral column; oblique rectus abdominis compress abdomen Internal Iliac crest and Lower ribs and Flexes & rotates abdominal vertebrae facia of vertebral column; oblique rectus abdominis compress abdomen Transversus Ribcage, Xiphoid process of Compress abdomen abdominis vertebrae and sternum, facia of iliac crest rectus, abdominis and pubis 126 Human Anatomy and Physiology Table 6-3. Upper limb muscles Muscle Origin Insertion Action Muscles that move the scapula Trapezius Occipital bone Scapula clavicle holds scapula in place and vertebrae rotates scapula Serratus Ribs Medial border of Rotates scapula and anterior the pulls anteriorly scapula Muscles that move the arm Pectoralis Sternum, ribs, Tubercle of Adducts and flexes major and humerus arm clavicle Lattismus Vertebrae Tubercle of Adducts and extends dorsi humerus arm Deltoid Scapula and Shaft of Abducts, flexes, and clavicle humerus extends arm Teres major Scapula Tubercle of Adducts and extends humerus arm Infraspinalis Scapula Tubercle of Extends arm humerus Muscles that move the forearm Brachilis Shaft of humerus Coracoids Flexes and forearm process of ulna Biceps brachii Coracoids Radial process of tuberosity Supinates scapula Triceps brachii Shaft of humerus Olecranon Extends forearm and lateral border process of ulna of scapula Muscles that move the wrist and fingers 127 Human Anatomy and Physiology Anterior fore Medial Carpals,metacar Flex wrist, fingers and arm epicondyle pals, and thumb; pronate muscles phalanges forearm Posterior Lateral Carpals,metacar Extend wrist, fingers forearm epicondyle pals, and thumb; supinate muscles and phalanges forearm Intrinsic hand Carpals Phalanges Abduct, adduct, flex, muscles metacarpals and extend fingers and thumb Table 6-4. Lower limb muscles Muscle Origin Insertion Action Muscles that move the thigh Iliopsoas Ilium and Trochanter of Flexes thigh vertebrae femur Tensor fascia Anterior superior Lateral condyle Abducts thigh latae iliac of tibia spine Gluteus Ilium, sacrum, Lateral side of Extends and abducts maximus and coccyx femur thigh Gluteus Ilium Trochanter of Abducts thigh medius femur Adducter Pubis Femur Adduct thigh muscles of thigh Muscles that move the leg Quadriceps Anterior superior Tibial tuberosity Extends leg and flexes femoris Rectus iliac thigh femoris spine Vastus lateralis Femur Tibial tuberosity Extends leg Vastus Femur Tibial tuberosity Extends leg medialis 128 Human Anatomy and Physiology Vastus Femur Tibial tuberosity Extends leg intermedius (not shown in illustration) Sartorius Anterior superior Tibia Flexes leg and thigh iliac spine Hamstring Ischium and Fibula Flexes leg and muscles femur extends thigh Biceps femoris Semimembran Ischium Tibia Flexes leg and osus extends thigh Semitendinosu Ischium Tibia Flexes leg and s extends thigh Muscles that move the ankle and toes Tibialis anterior Tibia Tarsal and first Dorsiflexes foot metatarsal Deep anterior Tibia or fibula Phalanges, Extend toes leg muscles metatarsals, tarsals Gastrocnemius Medial and Calcaneus Plantar flexes foot lateral epicondyle of femur Soleus Tibia and fibula Calcaneus Plantar flexes foot Deep posterior Tibia of fibula Phalanges, Evert foot leg muscles metatarsals, tarsals Peroneus Fibula and tibia Tarsals and Evert foot Abduct, muscle Intrinsic Tarsals or metatarsals adduct, flex, and foot muscles metatarsals Phalanges extend toes 129 Human Anatomy and Physiology Figure 6-6 Superficial muscles, anterior (front view) (Source: Carola, R. Name and describe the major actions and innervations of the principal muscles of the head and neck, upper extremities, trunk, and lower extremities. Selected Key Terms The following terms are defined in the glossary: Accommodation Midbrain Acetylcholine Nerve Action potential Nerve impulse Afferent Neucleus Autonomic nervous system Neuron Axon Neurotransmitter Brain stem Ossicle Cerebellum Plexus 134 Human Anatomy and Physiology Cerebral cortex Pons Cerebrum Proprioceptor Choroid Receptor Cochlea Reflex Conjunctiva Refraction Cornea Retina Dendrite Sclera Diencephalons Semicircular canal Effector Spinal cord Efferent Stimulus Epinephrine Synapse Ganglion Thalamus Gray matter Tract Hypothalamus Tympanic membrane Lacrimal Ventricle Medulla oblongata Vestibule Meninges White matter General Function None of the body system is capable of functioning alone. All are interdependent and work together as one unit so that normal conditions within the body may prevail. Control of the body’s billions of cells is accomplished mainly by two communication systems: the nervous system and the endocrine system. Both systems transmit information from 135 Human Anatomy and Physiology one part of the body to another, but they do it in different ways. The nervous system transmits information very rapidly by nerve impulses conducted from one body area to another. The endocrine system transmits information more slowly by chemicals secreted by ductless glands into blood steam and circulated from glands to other parts of the body. Conditions both within and outside the body are constantly changing; the purpose of the nervous system is to respond to these internal and external changes (known as stimuli) and so cause the body to adapt to new conditions. The nervous system has been compared to a telephone exchange, in that the brain and the spinal cord act as switching centres and the nerve trunks act as cables for carrying messages to and from these centres. Cells of nervous system and their functions The two types of cells found in the nervous system are called neurons or nerve cells and neuroglia, which are specialized connective tissue cells. Dendrites are the processes or projections that transmit impulses to the neuron cell bodies, and axons are the processes that transmit impulses away from the neuron cell bodies. The three types of functional classification of neurons are according to the direction in which they transmit impulses. They do not conduct impulses to all parts of the body but only to two kinds of tissue-muscle and glandular epithelial tissue. Sensory neurons are also called afferent neurons; motor neurons are called efferent neurons, and interneurons are called central or connecting neurons. Myelin sheath is a white, fatty substance formed by Schwann cells that wrap around some axons outside the central nervous system. The fact that axons in the brain and cord have no neurilemma is clinically significant because it plays an essential part in the regeneration of cut and injured axons. Therefore the potential for regeneration in the brain and spinal cord is far less than it is in the peripheral nervous system. Impulse Generation and Conduction The Nerve Impulse The cell membrane of an unstimulated (resting) neuron carries an electric charge.

Te responsibility for the interpretation and use of the material lies with the reader order 200 mg lamictal otc. In no event shall the World Health Organization be liable for damages arising from its use 100mg lamictal visa. Fortunately we can prevent the emergence of drug resistance in virtually all cases if we take enough trouble to ensure that the best drug combinations are prescribed and that the patient takes them as directed. It might be suggested that giving a risky combination of drugs, or even giving a drug alone, will not matter if it is only for a short time. It is true that it may not matter in a number of patients, but in some it can matter very much and may make all the difference between survival and death. Te development of drug resistance may be a tragedy not only for the patient himself but for others. If physicians come to apply thoroughly the present knowledge about preventing drug resistance, this percentage should steadily diminish”. From Chemotherapy of pulmonary tuberculosis, by John Crofton, read to a plenary session at the Annual Meeting of the British Medical Associa- tion, Birmingham, England, 1958 (British Medical Journal, 1959, 5138(1):1610–1614). Dennis Falzon, Wayne van Gemert David Mercer, Dmitry Pashkevich, Valentin Rusovich, and Matteo Zignol managed data. Dennis Falzon, Roman Spataru, Gombogaram Tsogt and Richard Zal- Philippe Glaziou, Charalambos Sismanidis, Wayne van eskis. Philippe Glaziou Erwin Cooreman, Khurshid Alam Hyder and Nani and Charalambos Sismanidis led the revision of esti- Nair. De Arango, Robert del Aguila, Zeidy lae Moraru, Gulnora Murmusaeva, Zdenka Novakova, mata Azofeifa, Dràurio Barreira, Jaime Bravo, Christian Joan O’Donnell, Marie Claire Paty, Elena Pavlenko, Garcia Calavaro, Kenneth G. Castro, Espana Cedeno, Brankica Perovic, Vagan Rafaelovich Poghosyan, Cris- Felurimonde Chargles, Mercedez F Esteban Chiotti, tina Popa, Bozidarka Rakocevic, Filomena Rodrigues, Stefano Barbosa Codenotti, Ada S. Martinez Cruz, Xo- Elena Rodríguez-Valín, Karin Rønning, Kazimierz chil Alemàn de Cruz, Celia Martiney de Cuellar, Rich- Roszkowski, Petri Ruutu, Eugeniy Sagalchik, Saidulo ard D’Meza, Angela Diaz, Edward Ellis, Zulema Torres Makhmadalievich Saidaliev, Dmitri Sain, Roland Salm- Gaete, Victor Gallant, Manuel Zuniga Gajardo, E. Bontuyan Jr, Rich- bra, Ali Al-Lawati, Rashid Al-Owaish, Assan Al-Tuhami, ard Brostrom, Susan Bukon, En Hi Cho, Kuok Hei Chou, Abdullatif Alkhal, Saeed Alsaffar, Naima Ben Cheikh, Mao Tan Eang, Marites C. Fabul, Yasumasa Fukushima, Essam Elmoghazy, Mohamad Gaafar, Amal Galai, Anna Marie Celina G. Hashim, Ali Mohammed Heffernan, Nobukatsu Ishikawa, Andrew Kamarepa, Hussain, Lahsen Laasri, Fadia Maamari, Rachid Four- Seiya Kato, Dovdon Khandaasuren, Liza Lopez, Wang ati-Salah Ben Mansou, Issa Ali Al Rahbi, Khaled Abu Lixia, Tam Cheuk Ming, Dorj Otgontsetseg, Cheng Rumman, Mtanios Saade and Mohammed Tabena. Vianzon, Khin Mar Kyi Abubakar, Elmira Djusudbekovna Abdurakhmanova, Win and Byung Hee Yoo. Natavan Alikhanova, Aftandil Shermamatovich Al- Te authors also express their gratitude to Emmanuelle isherov, Odorina Tello Anchuela, Delphine Antoine, Dubout and Lydia Panchenko for their assistance with António Fonseca Antunes, Coll Armanguè, Gordana data management, and Sue Hobbs of minimum graph- Radosavljevic Asic, Margarida Rusudan Aspindze- ics for providing design and layout of the report. Teir lashvili, Andrei Petrovich Astrovko, Venera Bismilda, contributions have been greatly appreciated. We are sincerely " Istituto Superiore di Sanità Dipartimento di Malat- grateful for their support. Tey may have different meanings in the proportion of drug resistance among a sample of other contexts. Te clustering effect is the extent to which documentation is available, there is evidence of such inferences, properly accounting for this clustering history. Territory A legally administered territory, which is a non-sovereign geographical area that has come un- der the authority of another government. It summarizes the bacteria or may develop in the course of a patient’s latest data and provides latest estimates of the global treatment. To date, 12 countries gion (China), Estonia, Latvia, Lithuania and the United States of America. Te funding required in 2015 will be 16 finding concurs with the results contained in “Anti-tu- times higher than the funding that is available in 2010. To settings, diagnostic capacity cannot match the current date, a cumulative total of 58 countries have confirmed needs. Treatment success was lished for 2015 – the diagnosis and treatment of 80% of documented in 60% of patients overall. Anti-Tuberculosis Drug Resistance Surveillance, data Te Supranational Reference Laboratory Network1 on drug resistance have been systematically collected expanded to include three additional laboratories in and analysed from 114 countries worldwide (59% of all 2007–2009 and now comprises 28 laboratories world- countries of the world). Compared with lines: Bangladesh, Belarus, Kyrgyzstan, Pakistan and the 4th report on anti-tuberculosis drug resistance Nigeria. Updated data on trends are available Of 114 countries that provided information between from 37 countries. Te Russian B continuous surveillance data and was therefore not Federation reported both Class A and Class B subna- included in Map 4. Tese high propor- countries that have conducted continuous surveillance tions explain in part the slow progress made in Eastern since the time of publication of the 4th report on anti- European and Central Asian countries in reaching the tuberculosis drug resistance in 2008 (6). Countries not meeting the mortality rates by 2015 compared with their levels of criteria for reporting Class A or Class B data are not in- 1990 (8). Within Class categories, countries are stratified by status as high-income countries or non 1.

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A receptor is a type of recognition protein that can selectively bind a specific molecule outside the cell buy lamictal 25mg lowest price, and this binding induces a chemical reaction within the cell buy lamictal 50 mg fast delivery. One example of a receptor-ligand interaction is the receptors on nerve cells that bind neurotransmitters, such as dopamine. When a dopamine molecule binds to a dopamine receptor protein, a channel within the transmembrane protein opens to allow certain ions to flow into the cell. A glycoprotein is a protein that has carbohydrate molecules attached, which extend into the extracellular matrix. The carbohydrates that extend from membrane proteins and even from some membrane lipids collectively form the glycocalyx. The glycocalyx is a fuzzy-appearing coating around the cell formed from glycoproteins and other carbohydrates attached to the cell membrane. For example, it may have molecules that allow the cell to bind to another cell, it may contain receptors for hormones, or it might have enzymes to break down nutrients. They give each of the individual’s trillions of cells the “identity” of belonging in the person’s body. This identity is the primary way that a person’s immune defense cells “know” not to attack the person’s own body cells, but it also is the reason organs donated by another person might be rejected. Peripheral proteins are typically found on the inner or outer surface of the lipid bilayer but can also be attached to the internal or external surface of an integral protein. Some peripheral proteins on the surface of intestinal cells, for example, act as digestive enzymes to break down nutrients to sizes that can pass through the cells and into the bloodstream. Transport across the Cell Membrane One of the great wonders of the cell membrane is its ability to regulate the concentration of substances inside the cell. A membrane that has selective permeability allows only substances meeting certain criteria to pass through it unaided. In the case of the cell membrane, only relatively small, nonpolar materials can move through the lipid bilayer (remember, the lipid tails of the This OpenStax book is available for free at http://cnx. However, water-soluble materials—like glucose, amino acids, and electrolytes—need some assistance to cross the membrane because they are repelled by the hydrophobic tails of the phospholipid bilayer. All substances that move through the membrane do so by one of two general methods, which are categorized based on whether or not energy is required. Passive transport is the movement of substances across the membrane without the expenditure of cellular energy. Passive Transport In order to understand how substances move passively across a cell membrane, it is necessary to understand concentration gradients and diffusion. Molecules (or ions) will spread/diffuse from where they are more concentrated to where they are less concentrated until they are equally distributed in that space. If a bottle of perfume were sprayed, the scent molecules would naturally diffuse from the spot where they left the bottle to all corners of the bathroom, and this diffusion would go on until no more concentration gradient remains. In both cases, if the room is warmer or the tea hotter, diffusion occurs even faster as the molecules are bumping into each ° other and spreading out faster than at cooler temperatures. Whenever a substance exists in greater concentration on one side of a semipermeable membrane, such as the cell membranes, any substance that can move down its concentration gradient across the membrane will do so. Neither of these examples requires any energy on the part of the cell, and therefore they use passive transport to move across the membrane. Because cells rapidly use up oxygen during metabolism, there is typically a lower concentration of O inside the cell than outside. As a result, oxygen2 will diffuse from the interstitial fluid directly through the lipid bilayer of the membrane and into the cytoplasm within the cell. This mechanism of molecules moving across a cell membrane from the side where they are more concentrated to the side where they are less concentrated is a form of passive transport called simple diffusion (Figure 3. Charged atoms or molecules of any size cannot cross the cell membrane via simple diffusion as the charges are repelled by the hydrophobic tails in the interior of the phospholipid bilayer. Solutes dissolved in water on either side of the cell membrane will tend to diffuse down their concentration gradients, but because most substances cannot pass freely through the lipid bilayer of the cell membrane, their movement is restricted to protein channels and specialized transport mechanisms in the membrane. Facilitated diffusion is the diffusion process used for those substances that cannot cross the lipid bilayer due to their size, charge, and/or polarity (Figure 3. Although glucose can be more concentrated outside of a cell, it cannot cross the lipid bilayer via simple diffusion because it is both large and polar. To resolve this, a specialized carrier protein called the glucose transporter will transfer glucose molecules into the cell to facilitate its inward diffusion. Channel proteins are less selective than carrier proteins, and usually mildly discriminate between their cargo based on size and charge. Their diffusion is facilitated by membrane proteins that + form sodium channels (or “pores”), so that Na ions can move down their concentration gradient from outside the cells to inside the cells. There are many other solutes that must undergo facilitated diffusion to move into a cell, such as amino acids, or to move out of a cell, such as wastes.

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It is a mechanism for secreting large polar molecules best 50 mg lamictal, such as protein molecules and enzymes that cannot cross the plasma membrane buy 25mg lamictal. The Vesicular contents are highly specific and are released only upon receipt of appropriate signals. It enables the cell to add specific components to the plasma membrane, such as carrier, channels, or receptors depending on the cell’s need The rate of endocytosis and exocytosis is maintained in balance to maintain a constant membrane surface area and cell volume. More than 100% of the plasma membrane may be used in an hour to wrap internalized vesicles in a cell actively involved in endocytosis, needing rapid replacement of surface membrane by exocytosis. In some cases of endocytosis, receptor sites on the surface membrane recognize and bind with specific molecule in the environment of the cell. Antibodies attach to the bacteria forming a coat that can be recognized by the specific receptor sites in the plasma membrane of the phagocytic leukocyte. A specific neural or hormonal stimuli initiates opening of calcium channels in the membranes of secretory cell. Calcium influx increases cytosolic calcium levels triggering fusion of the exocytic vescicle with plasma membrane and subsequent release of its secretory products. The process of exocytosis 32 Caveolae Role in membrane transport and signal transduction: the outer surface of the plasma membrane is not smooth; it has tiny, cave-like indentations known as caveolae (tiny caves). Coordination of diverse activities to maintain homeostasis requires the cells to communicate with each other. The most intimate communication is through gap junctions, which are minute tunnels that bridge the cytoplasm of nearby cells. Gaps are important in permitting spread of electrical signals from one cell to the next in cardiac and smooth muscle. The presence of signaling molecules on the surface membrane of some cells gives them ability to directly link up and interact with certain other cells in a special way. Thus phagocytic cells recognize and selectively destroy only undesirable cell, such as invading microbes while sparing the body’s own cell. Intercellular chemical messenger is the commonest means by which cells communicate with each other. These chemicals messengers are paracrines, neurotransmitters, hormones, and neurohormones. Various ways of cell-to-cell communicaton 34 Signal Transduction Binding on chemical messenger to membrane receptors brings about a wide range of responses in different cells through only a few similar pathways used. Dispersed within the outer surface on the plasma membrane of cell (muscle/ nerve/ gland) are specialized protein receptors that bind with the selected chemical messenger - neurotransmitter, hormone, or neuro-hormone, that are delivered by the blood or a neurotransmitter released from the neuron. The chemical messenger binds with receptor triggering a sequence of intracellular events that ultimately influence/control a particular cellular activity important in the maintenance of homeostasis, such as membrane transport, secretion, metabolism, or contraction. There are wide ranging responses, but there are mainly two ways by which binding of the receptor with extracellular chemical messenger bring about the desired effects. By opening or closing of specific channels in the membrane regulating a particular ion to move in or move out of the cell, or 2. By transferring the signal to an intracellular chemical messenger (the second messenger), which is turn triggers a preprogrammed series of biochemical events within the cell. Neural transmission or communication at synaptic junction using neuro- transmitters. The first chemical messenger binds with receptor on the surface membrane and then issue their orders - “pass it on “process. The first messenger binds to a membrane receptor, that combination serves as a signal for activation of an intracellular second messenger that ultimately relays the order through a series of biochemical intermediaries to specific intracellular proteins that carry out the dictated response, such as changes in cellular metabolism or secretary activities. This mechanism utilized is similar the variability in response depends on the specialization of the cell. Biological control systems have their own complexities and the enormous range and time scale over which they operate. The physiology of the various body systems is inseparable from homeostatic control mechanisms. Many step intracellular chemical events that amplifies a single irritating event is amplified thousands of times. In nervous system, millions of neurons may be involved in as simple act as walking up stairs. Some intracellular regulatory processes operate at the size scale of individual molecules or ions. On the other hand, of the time and size, the development plan of the human body by the endocrine system involves billions of cells, fulfilled on a time scale of decades. Shows consistency of internal environment of the cell Some terms Used in Control System A “System” is a set of components related in such a way as to work as a unit. A “control System” is so arranged as to regulate itself or another system Some terms used in control systems A”system” is a set of components related is such a way as to work as a unit. A “control system” is so arranged as to regulate itself or another system 42 An “input” is the stimulus applied to a control system from a source outside the system so a to produce a specified response from the control system. An “open loop” control system is one in which the control action depends on (is a function of) output. A “negative feedback” system is one in which the control action is a function of output in such a way that the output inhibits the control system A “positive feedback system” is a closed loop control system in which the output accelerates the control system.

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