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Next blood pressure chart log template buy nebivolol paypal, both specific and azurophilic granules fuse with the phagosome and release their contents blood pressure chart by age nhs buy genuine nebivolol line, forming a phagolysosome hypertension 5 year old buy nebivolol american express. The enzymatic contents of the granules are responsible for killing and digesting the microorganism. The entire digestive process occurs within the phagolysosome, which protects the cell from self-injury. The digested material is either exocytosed into the extracellular space or stored as residual bodies within the neutrophil. Therefore, fever is a consequence of acute reaction to invading pathogens that cause a massive neutrophilic response. Phagocytosed bacteria are killed within phagolysosomes by the toxic reactive oxygen intermediates produced during respiratory burst. Extended pseudopods of the neutrophil engulf the antigen and internalize it to form a phagosome. Specific and azurophilic granules fuse with the phagosome membrane, and the lysosomal hydrolases of the azurophilic granules digest the foreign material. They include free radicals such as oxygen and hydroxyl radicals that are used in immobilizing and killing live bacteria within the phagolysosomes. By definition, free radicals possess an unpaired electron within their chemical structure, which makes them highly reactive and therefore capable of damaging intracellular molecules, including lipids, proteins, and nucleic acids. The process by which microorganisms are killed within neutrophils is termed oxygen-dependent intracellular killing. Some of the hypochloride may spontaneously break down to yield toxic singlet oxygen (1O2) and chloride ions (Cl). This schematic diagram shows a phagolysosome that contains already phagocytosed bacterium. This complex transports excess electrons across the membrane of the phagolysosome, where they interact with molecular oxygen to generate free superoxide anions. Another enzyme superoxide dismutase converts superoxide anions to singlet oxygen and hydrogen peroxide, which further reacts with superoxide anions to produce bactericidal hydroxyl radicals and more singlet oxygen molecules. Hypochlorous acid is further metabolized to a highly toxic hypochlorite (bleach) and chlorine. Some of the hypochloride may spontaneously break down to yield toxic singlet oxygen and chloride ions. All molecules produced during oxygen bursts in neutrophils (associated with red arrows) are highly effective in killing ingested bacteria. Phagocytosed bacteria can also be killed by a diverse arsenal of oxygen-independent killing mechanisms utilizing bacteriolytic enzymes and antimicrobial peptides. Inflammation and wound healing also involve monocytes, lymphocytes, eosinophils, basophils, and fibroblasts. These oxygenindependent killing mechanisms are directed toward the bacterial cell membrane, causing its breakdown and leakage. Neutrophils contain particularly large amounts of cationic antimicrobial proteins such as defensins and antimicrobial peptides called cathelicidins. Similar to lysozymes and cathepsins stored in the specific granules, these cationic antimicrobial proteins break down the bacterial wall. In addition, lysosomal hydrolytic enzymes that digest bacterial proteins and lactoferrins that chelate iron from nutritional bacterial pathways contribute to the destruction of the invading bacteria. Neutrophils from patients with defects in oxygen-dependent pathways, such as those with chronic granulomatous disease (see Folder 10. However, because of the low efficiency of these processes, individuals with these defects are more susceptible to serious infections. After intracellular digestion by the neutrophil, the remnants of degraded material are stored in residual bodies or exocytosed. Most neutrophils die in this process; the accumulation of dead bacteria and dead neutrophils constitutes the thick exudate called pus. At the site of tissue injury, they transform into macrophages that phagocytose cell and tissue debris, fibrin, remaining bacteria, and dead neutrophils. Normal wound healing depends on the participation of macrophages in the inflammatory response; they become the major cell type in the inflammatory site after the neutrophils are spent. At the same time that the macrophages become active at the site of inflammation, fibroblasts near the site and undifferentiated mesenchymal cells in the adventitia of small vessels at the site begin to divide and differentiate into fibroblasts and myofibroblasts that then secrete the fibers and ground substance of the healing wound. Lymphocytes, eosinophils, and basophils also play a role in inflammation, but they are more involved in the immunologic aspects of the process (see Chapter 14, Lymphatic System).

After the diameter of the future Haversian system is established hypertension jnc 8 summary buy discount nebivolol on line, osteoblasts begin to fill the canal by depositing the organic matrix of bone (osteoid) on its walls in successive lamellae heart attack 80 blockage cheap nebivolol generic. As the successive lamellae of bone are deposited arrhythmia bigeminy purchase nebivolol amex, from the periphery inward, the canal ultimately attains the relatively narrow diameter of the adult osteonal canal. They undergo a progressive secondary mineralization that continues (up to a point) area of bone even after the osteon has been fully formed. The younger bone profile (before remodeling) is shown on the right; the older (after remodeling) on the left. Superimposed on the left side of the figure is the shape of the bone (left half only) as it appeared at an earlier time. To grow in length and retain the general shape of the particular bone, bone resorption occurs on some surfaces, and bone deposition occurs on other surfaces, as indicated in the diagram. The process in which new osteons are formed is referred to as internal remodeling. During the development of new osteons, osteoclasts bore a tunnel, the resorption cavity, through compact bone. Mineralization occurs in the extracellular matrix of bone, cartilage, and in the dentin, cementum, and enamel of teeth. The matrices of all of these structures except enamel contain collagen fibrils and ground substance. Mineralization is initiated at the same time within the collagen fibrils and in the ground substance surrounding them. In enamel, mineralization occurs within the extracellular matrix secreted by the enamel organ. Despite the extracellular location of biologic mineralization and the fact that physicochemical factors are basic to the process, biologic mineralization is a cell-regulated event. Formation of new osteons in compact bone initially involves the creation of a tunnel-like space, the resorption cavity, by osteoclast activity. When osteoclasts have produced an appropriately sized cylindrical tunnel by resorption of compact bone, blood vessels and their surrounding connective tissue occupy the tunnel. As the tunnel is occupied, new bone deposition on its wall begins almost immediately. These two aspects of cellular activity-namely, osteoclast resorption and osteoblast synthesis- constitute a bone-remodeling unit. A bone-remodeling unit consists of two distinct parts: an advancing cutting cone (also called a resorption canal) and a closing cone. The tip of the cutting cone consists of advancing osteoclasts closely followed by an advancing capillary loop and pericytes. It also contains numerous dividing cells that give rise to osteoblasts, additional pericytes, and endothelial cells. The cutting cone formed by osteoclasts is responsible for boring the tunnel or resorption cavity through the compact bone. Its action is initiated within the compact bone at the far left of the diagram (in the area corresponding to section a). The cutting cone moves along osteons, in the direction indicated by the arrow, to the area corresponding to section d. Section d shows the cross-section through the cutting cone lined by osteoclasts (green cells). The resorption cavity is the site where the future osteon is formed by the action of the closing cone, which consists of osteoblasts (purple cells). These cells begin to deposit the osteoid on the walls of the canal in successive lamellae. Note the deposition of the osteoid deep to the osteoblasts seen in sections b and c and, in sections a and b, the presence of the mineralized bone. As successive lamellae of bone are deposited, the canal ultimately attains the relatively narrow diameter of the mature Haversian canal lined by the endosteal cells (pink cells), like those shown in section a. The growth-reversal line that appears at the outer limits of a newly formed osteon represents a border between the resorption activity of the cutting cone and the bony matrix not remodeled by this activity. The osteoblast-derived matrix vesicles are the essential factors in controlling the initial site of mineral deposition in osteoid.

They allow for the exchange of ions blood pressure chart dot order nebivolol 2.5mg line, regulatory molecules blood pressure meaning discount nebivolol 2.5mg without prescription, and small metabolites between cells heart attack jack smack u blue order nebivolol on line. The basement membrane serves as an attachment site of epithelia to connective tissue, compartmentalizes connective tissue, filters substances that pass to and from the epithelium, provides a scaffold during tissue regeneration, and is involved in cell signaling. Focal adhesions are integrin-based, dynamic anchoring junctions that anchor actin filaments to the basement membrane. Their fast formation and dismantling provide the molecular bases for cell migration. Hemidesmosomes are integrin-based, stable anchoring junctions that anchor the intermediate filaments to the basement membrane via intercellular plaques. Exocrine glands secrete their products directly onto a surface or through epithelial ducts that may modify their secretion (concentrating, removing, or adding substances). Exocrine glands are classified as either mucous glands, which produce mucous secretions or serous glands, which produce protein-rich watery secretions. Cells of exocrine glands have three mechanisms of secretion: merocrine (in which secretory product is released by exocytosis), apocrine (in which secretory product is released in vesicles containing a thin layer of cytoplasm), and holocrine (in which secretory product is accompanied by cell debris from the dying secretory cell). They secrete their products (hormones) into the bloodstream to reach a specific receptor on distant target cells. The replace- ment cells are produced by mitotic division of adult stem cells residing in different sites (niches) in various epithelia. The cells that make up a given epithelium are arranged in close apposition with one another and typically are located at what may be described as the free surfaces of the body. Such free surfaces include the exterior of the body, the outer surface of many internal organs, and the lining of body cavities, tubes, and ducts. Epithelium is classified on the basis of the arrangement of the cells that it contains and their shape. The shape of the cells is typically described as squamous if the cell is wider than it is tall, cuboidal if its height and width are approximately the same, or columnar if the cell is taller than it is wide. This micrograph shows the surface epithelium of the mesovarium covered by mesothelium, a name given to the simple squamous epithelium that lines the internal cavities of the body. The inset reveals at higher magnification the nuclei (N) of the mesothelial cells. By this method, the boundaries of the surface mesothelial cells are delineated as black lines by the precipitated silver. Note that the cells are in close apposition to one another and that they have a polygonal shape. The inset reveals several mesothelial cells, each of which exhibits a nucleus (N) that has a round or oval profile. Because of the squamous shape of the mesothelial cells, the nuclei are not spherical but rather are disc-like. The duct cell nuclei (N) tend to be spherical, a feature consistent with the cuboidal shape of the cell. The interior of the corpuscle contains Simple cuboidal epithelium, pancreas, human, H&E, 700. This photomicrograph shows the epithelium of the smallest conducting bronchioles of the lung. These are small cells with relatively little cytoplasm, thus the nuclei appear close to one another. The inset shows a higher magnification of a hepatic cell and reveals an unusual feature in that several surfaces of these cells possess a groove representing the free surface of the cell. Where the groove of one cell faces a groove of the adjacent cell, a small canal-like structure, the canaliculus (C), is formed. This micrograph reveals cords of hepatocytes (H), simple cuboidal cells that make up the liver parenchyma. They are characteristic of organ systems primarily concerned with transport, absorption, and secretion, such as the intestine, the vascular system, the digestive glands and other exocrine glands, and the kidney. Stratified epithelia have more than one layer and are typical of surfaces that are subject to frictional stress, such as skin, oral mucosa and esophagus, and vagina. In the circle is a welloriented acinus, a functional group of secretory cells, each of which is pyramidal in shape. The free surface of the cells and the lumen are located in the center of the circle.

Enteroceptors react to stimuli from within the body- for example blood pressure medication lotrel cheap nebivolol 5 mg on line, the degree of filling or stretch of the alimentary canal arteria coronaria derecha purchase nebivolol master card, bladder pulse pressure graph buy cheap nebivolol 5mg on-line, and blood vessels. Proprioceptors, which also react to stimuli from within the body, provide sensation of body position and muscle tone and movement. This ending is found in epithelia, in connective tissue, and in close association with hair follicles. Most sensory nerve endings acquire connective tissue capsules or sheaths of varying complexity. Sensory nerve endings with connective tissue sheaths are called encapsulated endings. Muscle spindles are encapsulated sensory endings located in skeletal muscle; they are described in Chapter 11, Muscle Tissue (page 329). Functionally related Golgi tendon organs are encapsulated tension receptors found at musculotendinous junctions. It is a typical dense connective tissue that surrounds the fascicles formed by the perineurium (Plate 28, page 396). The blood vessels that supply the nerves travel in the epineurium, and their branches penetrate into the nerve and travel within the perineurium. Tissue at the level of the endoneurium is poorly vascularized; metabolic exchange of substrates and wastes in this tissue depends on diffusion from and to the blood vessels through the perineurial sheath. Afferent (Sensory) Receptors Afferent receptors are specialized structures located at the distal tips of the peripheral processes of sensory neurons. These effectors are the functional units in the organs that respond to regulation by nerve tissue. However, visceral motor neurons are frequently accompanied by visceral sensory (afferent) neurons that transmit pain and reflexes from visceral effectors. These pseudounipolar neurons have the same arrangement as other sensory neurons-that is, their cell bodies are located in sensory ganglia, and they possess long peripheral and central axons, as described above. Moreover, each presynaptic neuron makes synaptic contact with more than one postsynaptic neuron. Postsynaptic sympathetic fibers supply smooth muscles (as in blood vessels) or glandular epithelium (as in sweat glands). In this example, the splanchnic nerve joins with the celiac ganglion, where most of the synapses of the two-neuron chain occur. Sympathetic and Parasympathetic Divisions of the Autonomic Nervous System the presynaptic neurons of the sympathetic division are located in the thoracic and upper lumbar portions of the spinal cord. The presynaptic neurons send axons from the thoracic and upper lumbar spinal cord to the vertebral and paravertebral ganglia. The paravertebral ganglia in the sympathetic trunk contain the cell bodies of the postsynaptic effector neurons of the sympathetic division. The presynaptic neurons of the parasympathetic division are located in the brain stem and sacral spinal cord. The presynaptic parasympathetic neurons send axons from the brain stem-that is, the midbrain, pons, and medulla, and the sacral segments of the spinal cord (S2 through S4)- to visceral ganglia. For example, sympathetic stimulation increases the rate of cardiac muscle contractions, whereas parasympathetic stimulation reduces the rate. This functional similarity is partly explained by the developmental relationships between the cells of the adrenal medulla and postsynaptic sympathetic neurons. A major difference is that the sympathetic neurons deliver the agent directly to the effector, whereas the cells of the adrenal medulla deliver the agent indirectly through the bloodstream. These presynaptic fibers communicate with postsynaptic neurons in two locations, the paravertebral and prevertebral ganglia. Paravertebral ganglia are linked together and form two sympathetic trunks on each side of the vertebral column (drawn as a single column on the side of the spinal cord). Prevertebral ganglia are associated with the main branches of the abdominal aorta (yellow ovals). The presynaptic fibers traveling with cranial nerve X and those from sacral segments (S2 to S4) have their synapses with postsynaptic neurons in the wall of visceral organs (terminal ganglia). Note that a two-neuron chain carries impulses to all viscera except the adrenal medulla. It controls motility (contractions of the gut wall), exocrine and endocrine secretions, and blood flow through the gastrointestinal tract; it also regulates immunologic and inflammatory processes. This diagram shows the organization of the enteric system in the wall of the small intestine.

The lower micrograph is from an adult and has been stained to reveal the elastic component of the vessel wall blood pressure normal teenager buy nebivolol 5mg online. The intima (I) is very lightly stained hypertension headaches discount nebivolol 5mg online, in this case blood pressure medication cause hair loss buy nebivolol without a prescription, due to the paucity of elastic material. The media (M) is heavily stained due to the presence of large amounts of elastic laminae. The adventitia (A) contains in addition to the dense connective tissue a moderate amount of elastic fibers. The inset shows the intima at higher magnification and includes part of the media. The specimen shown here has been stained to distinguish collagen from elastic material. The media (M) contains numerous elastic lamellae that appear as the black wavy lines. Careful examination of the media reveals nuclei of smooth muscle cells dispersed between the elastic lamellae. This micrograph shows the outer portion of the media (M) with its elastic lamellae. The outer portion of the adventitia contains numerous elastic fibers which appear as the black, dot-like structures. These elastic fibers are arranged in a circumferential pattern, thus when sectioned, they appear as black, dot-like structures. Thus, as the arterial tree is traced further from the heart, the elastic tissue is considerably reduced and smooth muscle becomes the predominant component of the tunica media. The muscular arteries are characterized, however, by a refractile internal elastic membrane separating the tunica intima from the tunica media and, usually, by an external elastic membrane separating the tunica media from the tunica adventitia. Muscular arteries, or arteries of medium caliber, constitute the majority of the named arteries in the body. The veins have the same three layers in their walls, but the tunica media is thinner than in the accompanying artery, and the tunica adventitia is the predominant layer in the wall. In this photomicrograph, the lumen of the artery is at the left and the lumen of the vein is at the right. The collagen bundles of the loose connective tissue beneath the tunica adventitia are larger than those of the adventitia, and there are fewer cells in this portion of the specimen. Arterioles have an endothelial lining and smooth muscle in the wall, but the smooth muscle is limited in thickness to one or two cells. There may or may not be an internal elastic membrane, according to the size of the vessel. In the normal relationship between an arteriole and a capillary network, contraction of the smooth muscle of the arteriole wall reduces or shuts off the blood going to the capillaries. A precapillary sphincter is formed by a slight thickening of the smooth muscle at the origin of a capillary bed from an arteriole. Nerve impulses and hormonal stimulation can cause the muscle cells to contract, directing blood into capillary beds where it is most needed. The arteriole on the left is identified as a large arteriole, based on the presence of two discrete layers of smooth muscle cells that form the tunica media of the vessel. The nuclei of the muscle cells appear in longitudinal profile as a result of the circumferential arrangement of the cells. The endothelial cell nuclei of the vessel appear as small round profiles surrounding the lumen. These cells are elongate and oriented with their long axis in the direction of flow. The arteriole on the right is a very small arteriole, having only a single layer of smooth muscle. The endothelial cell nuclei appear as the small round profiles at the luminal surface. A venule is seen in proximity to the larger arteriole, and a cross-section of peripheral nerve (N) is seen in proximity to the smaller arteriole.

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