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Human Physiology
NM Muthayya
SECTION I: CELL PHYSIOLOGY
1:
Cell Physiology
CELL AND CELL ORGANELLES
Cell organelles (Little Organs) (Intracellular Inclusions)
Membrane Bound Cell Organelles in the Cytoplasm
Non-membranous Structures
Endoplasmic Reticulum
Functions
The Golgi Apparatus
Non-membranous Structures
STRUCTURE OF CELL MEMBRANE
INTERCELLULAR JUNCTIONS (Fig. I-5)
Types
MEMBRANE TRANSPORT
MODES OF TRANSPORT ACROSS THE CELL MEMBRANE (Figs I-6,7,8)
Factors influencing Na+- K+ Pump
GENETICS IN PHYSIOLOGY
Introduction
The Location of Chromosomes and Genes
Control of Gene Expression (Figs I-10, 11, 12)
The Protein Synthesis
The DNA and cell reproduction
Role of centriole of the cytoplasm in cell division
THE INTERNAL ENVIRONMENT AND HOMEOSTASIS
2:
Resting Membrane Potential and Action Potential
RESTING MEMBRANE POTENTIAL AND ACTION POTENTIAL (FIGS I-14,15)
Excitation and Action Potentials
Intracellular Recording and Extracellular Recording
RESTING MEMBRANE POTENTIAL AND ACTION POTENTIAL SHAPE AND PHASES
Ionic Basis of Action Potential
GATING MECHANISMS AND THEIR RELATIONSHIP TO DIFFERENT PHASES OF ACTION POTENTIAL
Upstroke
Relative Refractory Periods (Fig. I-20)
Features
Role of other Ions on Action Potential
Accommodation
3:
Physiology of Cell Receptors
RECEPTORS
GENERAL ASPECTS
Receptor Structure
Post-binding events
Transcription
Down Regulation and Up Regulation
CYCLIC AMP
G PROTEINS (FIG. I-23)
INOSITOL TRIPHOSPHATE (IP3) AND DIACYLGLYCEROL (DAG)
Cell Function and Calcium
Clinical Aspects
RECEPTORS COUPLED WITH G-PROTEINS
Neurotransmitters
Tachykinins
Other Peptides
Summary of the Mechanisms by which the first Messengers Bring about Changes in the Cell:
Apoptosis
The details of genetic control of apoptosis
Cancer
SECTION II: MUSCLE
1:
Muscle
INTRODUCTION
Types
VOLUNTARY MUSCLE
Chemical Composition of the Muscle
STRUCTURE OF THE VOLUNTARY MUSCLE
Sarcotubular System
Electron Microscopic Observation
PROTEINS OF THE CONTRACTILE FILAMENTS
Thin Filament
Actin
The Tropomyosin Strands
Troponin
Myosin (Figs II-6,7)
Isoforms of Muscle proteins and their significance
MOLECULAR BASIS OFMUSCLE CONTRACTION
EXCITATION CONTRACTION COUPLING
Ryanodine Receptors
Resting Tension
Generation of Tension or Force
2:
Neuromuscular Transmission
NEUROMUSCULAR JUNCTION—STRUCTURE
MECHANISM OF NEUROMUSCULAR TRANSMISSION
MINIATURE - END PLATE POTENTIAL (MEPP)
MYASTHENIA GRAVIS
Causes
NEUROMUSCULAR BLOCKING AGENTS
Other Substances Blocking Neuromuscular Transmission
Antagonists of Neuromuscular Blocking Agents
THE NERVE SUPPLY TO THE SKELETALMUSCLES AND MOTOR UNIT
Section of the Motor Nerves
3:
Properties of Skeletal Muscle
PROPERTIES OF SKELETAL MUSCLE
EXCITABILITY OR IRRITABILITY
Stimuli may be of various kinds
Induced Current
Excitability will depend upon
Rheobase
CONTRACTILITY
Isotonic contraction
Simple Muscle Curve (Fig. II-17)
Causes of Latent Period
CHANGES OCCURRING DURING MUSCLE CONTRACTION
Mechanical Changes
FACTORS WHICH INFLUENCE CONTRACTILITY
Strength of the stimulus. (Quantal summation).
Effects of two successive stimuli (Fig. II-18)
Effects of repeated stimuli (when more than two stimuli are applied)
Genesis of Tetanus (Fig. II-19)
Fatigue (Fig. II-20)
Causes of fatigue in an isolated muscle
Effect of after Load and Load on Muscle Contraction (Fig. II-21) or
Effect of Initial Length on Muscle Contraction
Effect of Temperature on Muscle Contraction
Action of Chemical Substances on Muscle Contraction
ELECTRICAL CHANGES IN SKELETAL MUSCLE
Resting Membrane Potential
Action Potential (Fig. II-23)
Current of Injury and Monophasic Potential
THERMAL CHANGES
Heat - Production During Muscle Contraction
Initial heat (I)
CHEMISTRY OF MUSCLE CONTRACTION (DETAILS IN BIOCHEMISTRY)
Energy release from ATP
RIGOR MORTIS
Post-Mortem Rigidity
The Order of Appearance
Effects of Exercise on Voluntary Muscle
Effects of Hormones on the Muscle
ELECTROMYOGRAPHY (EMG)
Clinical Aspects
The Normal Electrical Reaction of Muscle and Nerve
The Reaction of Degeneration
Development and Regeneration of Skeletal Muscle
4:
Smooth Muscle
SMOOTH MUSCLE TYPES
STRUCTURE (FIG. II-25)
SMOOTH MUSCLE CONTRACTION
The events occurring during contraction and relaxation of smooth muscle
Difference between Skeletal and Smooth Muscle Contractions
Neuromuscular Endings in the Smooth Muscle
SECTION III: BLOOD
1:
Blood, Plasma and Plasma Proteins
FUNCTIONS OF BLOOD
1. Respiratory function
2. Nutrition
3. Excretory Functions
4. Protective function
5. Transport function
6. Homeostatic function
7. Regulation of Body Temperature
PHYSICAL PROPERTIES OF BLOOD
Colour
Specific Gravity (SG)
Viscosity
Osmotic Pressure
Reaction of the Blood
COMPOSITION OF BLOOD
PLASMA PROTEINS
I. Plasma Proteolytic Systems
II. Plasma Protease Inhibitors
III. Carrier Proteins
METHODS OF SEPARATION OF PLASMA PROTEINS
1. By Precipitation by Salts
2. Cohn's Fractional Precipitation Method
Synthesis of Plasma Proteins
Factors Influencing Plasma Protein Synthesis
High protein diet
FUNCTIONS OF PLASMA PROTEINS
In Coagulation
Maintenance of Osmotic Pressure
Maintenance of pH and Electrolyte Balance
Transport Function
Protective function
Nutritive function
Genetic Information
Distribution of Plasma Proteins
CLINICAL ASPECTS
Variation in Plasma Proteins
Acute Phase Proteins
Plasma Proteins in Disease
2:
The Red Blood Cells or Erythrocytes
RED BLOOD CELLS—DESCRIPTION AND STRUCTURE
The Structure and Composition of the Red Cell
Normal Red Cell Count
PHYSIOLOGICAL VARIATIONS IN THE NUMBER OF RED CELLS
Increase in the Number of Red Cells
A. High altitudes:
B. Muscular Exercise and Certain Emotional States
C. High Environmental Temperature also Causes Liberation of Blood from Splenic Reservoir
Reduction in the Number of RBC
Pathological Conditions in which there is increase in RBC
Origin of Red Cells
Life Span and Fate of RBCs
Functions of the Red Cells
SOME FEATURES OF RBC SHOWN OUTSIDE THE CIRCULATION
Rouleaux Formation
Erythrocyte Sedimentation Rate (ESR) or Suspension Stability
The Sedimentation Rate will Depend Upon
METHODS
Wintrobe's Method
Westergren Method
Haemolysis
HAEMOLYTIC AGENTS
Hypotonic Saline
Chemical Substances
RED CELL METABOLISM
HAEMOGLOBIN
Iron Protoporphyrin IX
Molecular Weight
Haemoglobin Formation in the Body
Heme Synthesis
Types of Human Haemoglobin
Localisation
Haemoglobin Concentration
Absolute Corpuscular Values
Oxygen Combining Capacity of Hb
Functions of Hb
HAEMOGLOBIN DERIVATIVES
Methhaemoglobin
Haematin
Haemin
Haemochromogens
CLINICAL ASPECTS
Anaemias
Classification
Compensatory mechanisms in response to anaemia
Increase in cardiac output
Increase in O2 dissociation
Redistribution of blood flow
Polycythemia
Diseases due to Abnormal Hb. - Haemoglobinopathies
Iron Metabolism—In brief (Details in Biochemistry)
Tests to Evaluate Body Iron Status
3:
White Blood Cells or Leucocytes
CLASSIFICATION AND MORPHOLOGY
Normal Count
Clinical Aspects
Physiological Increase in WBC
The Origin of Leucocytes
DESCRIPTION OF EACH VARIETY OF WBC Blood cells (FIG. III-1)
The Granulocytes
Leishman's Stain
Neutrophils
Arneth Count or Index
Schilling Index
Increase of Neutrophils - Neutrophilia
Decrease in Neutrophils or Neutropenia
Eosinophils
Functions
Conditions in which Eosinophils increase—Eosinophilia
Functions
Allergic Response
Agranulocytes
The Monocyte and the Macrophage
Functions of Monocytes
Life Span and Fate of Leucocytes
THE FUNCTIONS OF NEUTROPHILS
Neutrophils Response during Inflammation (Fig. III-5)
Respiratory Burst in Neutrophils
Phagocytosis
Many factors modify Phagocytosis
Significance of Phagocytosis
Clinical Aspects
Inflammation and Phagocytosis
Functions of Lymphocytes
LYMPHOCYTES AND IMMUNE MECHANISMS
Thymus
Structure
Cell-Dynamics
Immunological Significance
Immunity
Types of Immunity
Acquired Immunity
The Complement System
Immune Mechanisms
Development of the Human Immune System (See Figure III-7)
Cellular Immunity (Figs III-7,8)
Humoral Immunity
Immunoglobulins
Lymphocyte Family of Cells
Macrophages
Clinical Aspects
Acquired Immunodeficiency Syndrome (AIDS)
Histocompatibility antigen (MHC Complex)
Human Leucocyte Antigen (HLA)
PLATELETS OR THROMBOCYTES
Electron Microscopy Reveals Complex Structure (White and Gerrad, 1982)
Platelets Life
Platelet Metabolism
Platelet Contractile Proteins
Functions of Platelets
Method of Counting
4:
Blood Volume
BODY WATER
Data for a Man Weighing 70 kg
MEASUREMENT OF BODY FLUID COMPARTMENT
Total Body Water (TBW)
BLOOD VOLUME
METHODS FOR ESTIMATION OF BLOOD VOLUME
Direct Method
Drawbacks in this Method
Indirect Methods
1. Carbon Monoxide Method
Calculations
Disadvantages of this Method
2. The Dye-Method
Principle of this Method
Procedure
Disadvantages of this Method
3. The Radioactive Iron Method
Principle
Procedure
Alterations in blood volume
Reduction in Blood Volume
Increase in Blood Volume
EXTRACELLULAR FLUID (ECF)
Plasma (Fig. III-9)
ICF and Interstitial Fluid (Table III-7)
Intracellular Fluid
Interstitial Fluid or Tissue Fluid (Fig. III-10)
Functions of the Tissue Fluid
LYMPHATICS AND THE LYMPH
Structure of the Lymphatic System
Formation of Lymph (Fig. III-11)
Functions of Lymphatic System
Lymphogogues
Conditions which Increase Lymph Flow
REGULATION OF BLOOD VOLUME (BODY FLUIDS REGULATION)
Automatic Control of Blood Volume
Water Balance
Water Intake
Water Loss
Causes of Dehydration
Effects of Dehydration
FLUID INTERCHANGE
Regulation of Osmotic Pressure of ECF
Regulation of ECF volume
Clinical Aspects
Causes of Oedema
5:
Blood Groups
BLOOD GROUPS
DETERMINATION OF BLOOD GROUP OF A GIVEN SAMPLE OF BLOOD (FIG. III-12)
DETERMINATION OF BLOOD GROUP
LANDSTEINER'S CLASSIFICATION OF BLOOD
THE Rh. FACTOR (RHESUS)
HAEMORRHAGE
Delayed Effects
Replacement of Lost Fluid
TRANSFUSION
SHOCK
6:
Haemopoiesis
INTRODUCTION
Significance of the Haemopoiesis
Haemopoiesis
Stem cells and progenitor cells
Blood Forming Organs or Haemopoietic Tissues
Changes Occurring During Haemopoiesis
ERYTHROPOIESIS
Proerythroblast:
Early normoblast (Early erythroblast):
Intermediate normoblast (Late erythroblast):
Late Normoblast (Normoblast):
Factors Influencing Erythropoiesis
GENERAL FACTORS
SPECIFIC FACTORS
Factors Necessary for Haemoglobin Formation
b. Maturation Factor
c. Folic Acid
Role of Folic Acid and Cobalamin in Erythropoiesis
LEUCOPOIESIS, GRANULOPOIESIS
Production of Granulocytes and Monocytes
Myeloblast (Fig. III. 12)
Myelocytes
Materials needed for Leucopoiesis
Factors Influencing Granulopoiesis
Regulation of Granulopoiesis:
Production of Eosinophils, Basophils and Mast cells
Eosinophils:
Basophils and Tissue Mast Cells
THROMBOCYTES OR PLATELETS FORMATION
MONOCYTES OR MACROPHAGES PRODUCTION
Functions of Macrophages
LYMPHOCYTES PRODUCTION
Aplastic Anaemia:
Chronic Myelocytic Leukaemia
SUMMARY OF CONCEPT OF HAEMOPOIESIS
7:
Spleen
THE STRUCTURE OF THE SPLEEN
THE SPLENIC CIRCULATION
Vascular arrangement in the spleen:
Knisely's views are as follows:
2. Filling Phase
3. Storage Phase
4. Emptying Phase
There is agreement with regard to the following points:
Weight of the spleen
FUNCTIONS OF THE SPLEEN
1. Blood Destruction
2. Blood Formation
3. Blood Storage Organ
4. Other Phagocytic Activity of Spleen
Defence Function of the Spleen and Antibody Formation
5. Bilirubin formation
RETICULOENDOTHELIAL SYSTEM (RES)
II. Wandering RE Cells or Free Histiocytes
1. Of the Solid Tissue
2. Of the Blood
Functions
8:
Haemostasis
INTRODUCTION
Formation of Platelet Plug
2. Platelet Activation Changes
Change of Platelet Shape
Aggregation
Secretion of Platelets
The Coagulation of Blood (Clotting)
The Physiological Significance of Coagulation
Mechanisms of Coagulation
MODERN VIEW OF COAGULATION
The coagulation factors are:
Source for Coagulation Factors
Coagulation Factors
STAGES OF COAGULATION
Blood Coagulation Occurs in 3 Stages
Simplified Steps of Coagulation
Intrinsic System
Stage II: Conversion of Prothrombin to thrombin
Stage III: Conversion of Fibrinogen to Fibrin
ENZYME CASCADE HYPOTHESIS
Initiation of Blood Coagulation
Vitamin K
Details of Factors which help to Prevent Coagulation in the intact Normal Circulation (Table III-13)
Liver and Coagulation
FIBRINOLYSIS
Plasmin Inhibitor
Heparin:
ANTICOAGULANTS IN VITRO
Substances that Accelerate Coagulation
CLINICAL ASPECTS
Haemorrhagic Disease
Causes
Causes
Test for haemostasis
Disorders Affecting Haemostatic Plug Formation:
Coagulation Time
BLEEDING TIME
Other tests for Haemostasis
Disseminated intravascular clotting
Causes
Embolism
SECTION IV: DIGESTIVE SYSTEM
1:
Digestive System
INTRODUCTION
Gastrointestinal Secretion
DIGESTION IN THE MOUTH AND SALIVARY GLANDS
Structure of the Salivary Glands (Figs IV-2 and 3)
Innervation of the Salivary Glands (Fig. IV-1)
SALIVA
Composition of the mixed saliva
Inorganic Constituents
Organic Constituents
Functions
CONTROL OF SALIVARY SECRETION
The Unconditioned Reflex
Conditioned or Acquired Reflex
Electrical Changes During Salivary Secretion
Effects of Drugs
Clinical Aspects
Paralytic Secretion
MASTICATION OR CHEWING
Physiology of teeth
DEGLUTITION OR SWALLOWING
The First Stage or Oral Stage
Second Stage or Pharyngeal Stage
Third Stage or Oesophageal Stage
Lower Oesophageal Sphincter (LES)
Receptive Relaxation of the Stomach
2:
Digestion in the Stomach or Gastric Digestion
GASTRIC GLANDS
GASTRIC JUICE AND HCl SECRETION
Hydrochloric Acid Secretion
CONTROL OF GASTRIC SECRETION
Cephalic Phase
Sham Feeding
PAVLOV'S POUCH (Fig. IV-7)
Gastric Phase
Intestinal Phase
MECHANISM OF ACID AND PEPSIN SECRETION
Pepsinogen and Intrinsic Factor Secretion
PEPTIDES AND GASTRIC ACID SECRETION
CNS PEPTIDES AND GASTRIC ACID SECRETION
Inhibition of Gastric Secretion
Effects of Drugs on Gastric Secretion
GASTRIC DIGESTION AND OTHER FUNCTIONS
Other Functions of the Stomach
Clinical Aspect
Peptic Ulcer (Gastric ulcer and duodenal ulcer)
TESTS FOR GASTRIC FUNCTIONS
GASTRIC MOTILITY
Gastric Motility during Digestion
Gastric Emptying
Abnormal Gastric Movements
VOMITING
3:
Digestion in the Small Intestines
PANCREAS
Structure of the Pancreas
Pancreatic Juice
Composition
PANCREATIC DIGESTION
REGULATION OF PANCREATIC JUICE SECRETION
Nervous Control
Hormonal Control
Tests for Pancreatic Exocrine Function
Faecal Fat Excretion Test
Secretin and Pancreozymin Tests
THE SMALL INTESTINAL JUICE
Structure of the Intestinal Glands (Fig. IV-9)
Villi
COMPOSITION AND FUNCTION
Control of Intestinal Secretion
INTESTINAL DIGESTION
Digestion of Carbohydrates—Summary
Luminal Digestion of Carbohydrates
Membrane Digestion of Carbohydrates
Digestion of Proteins—Summary
Membrane Digestion of Proteins
Digestion of Fats—Summary
Luminal Digestion of Fats
Membrane Digestion of Fats
4:
Digestive Function of the Liver
LIVER
Introduction
Functions of Liver in Brief
Structure of the Liver
Composition of Bile
Bile Salts
Bile Pigments
Origin of bile pigments
Circulation
Clinical Aspect
Other Constituents of Bile
Control of Bile Secretion
GALLBLADDER AND BILE DUCTS
Functions
Filling and Emptying of the Gallbladder
Clinical Aspects
Gallbladder Stones
Cirrhosis
Features
Ascites
Viral Hepatitis
Amoebiasis
5:
Gastrointestinal Hormones
INTRODUCTION AND GENERAL CONSIDERATIONS
Gastrointestinal hormones
Secretin family
Insulin family
Epidermal growth factor family (EGF)
Gastrin family
PP-fold family
Somatostatin family
Tachykinin family
IMPORTANT GI HORMONES AND THEIR FUNCTIONS (TABLES IV-5 AND 6)
Secretin
6:
Intestinal Movements
STRUCTURE OF GASTROINTESTINAL WALL
Enteric Nervous System
The Extrinsic Nerves
Electrical Activity
MOVEMENTS IN THE SMALL INTESTINE
Peristaltic Movements
Movements of the Villi and Valvular Conniventes
Clinical Aspects
Disturbances in Small Intestinal Movements
LARGE INTESTINE (COLON) AND ITS MOVEMENTS
Gases in the Gastrointestinal Tract and Intestinal Bacteria
Immune Bodies Formation in the Intestines
Composition of the Faeces
DEFAECATION
Defaecation reflexes
7:
Intestinal Absorption
METHODS OF STUDY OF INTESTINAL ABSORPTION
ABSORPTION OF CARBOHYDRATES
ABSORPTION OF PROTEINS
ABSORPTION OF FATS
1. Lumen Phase
2. Penetration Phase
3. Intracellular Phase
ABSORPTION OF CHOLESTEROL
ABSORPTION OF WATER AND ELECTROLYTES
ABSORPTION OF VITAMINS
8:
Energy Balance and Regulation of Food Intake
INTRODUCTION
ENERGY BALANCE
BALANCED DIET
Factors Influencing Energy Expenditure
Fats
Carbohydrates
Minerals and ions
HUNGER, APPETITE AND SATIETY
Hunger and Appetite
Theories regarding the origin of sensation of hunger
Peripheral Theory of Hunger
Regulation of Food-Intake
Signals for the Regulating Mechanism
Thermostatic Regulation of Food Intake
Glucostatic Regulation of Food Intake
The Lipostatic Regulation of Food Intake
Regulation of Serum Amino Acids
Hydrostatic and Osmotic Factor in the Regulation of Food Intake
CLINICAL ASPECTS
Role of Hormones and Drugs
Anorexia Nervosa
Obesity
Types of Obesity
Ghrelin Receptor
Ghrelin receptor distribution
Function of Ghrelin
GH-Releasing Activity
Appetite Regulation
Cardiovascular Function
Ghrelin and Insulin Secretion
Regulation of Ghrelin Secretion
Clinical Application of Ghrelin
SECTION V: EXCRETORY SYSTEM
1:
Excretory System
INTRODUCTION
Kidneys
NEPHRON—STRUCTURE
THE RENAL CIRCULATION
Vascular Arrangement in the Juxtamedullary Nephrons
Venous return
Nerve Supply
2:
Urine Formation
INTRODUCTION, HISTORICAL CONCEPTS
GLOMERULAR FILTRATION
Filtration Fraction (FF)
TUBULAR REABSORPTION
TUBULAR SECRETION OR TUBULAR EXCRETION
TUBULAR SYNTHESIS
3:
Kidneys in the Regulation of Acid Base Balance and Osmotic Equilibrium
INTRODUCTION
I. BUFFER SYSTEMS OF BLOOD AND OTHER BODY FLUIDS
II. PULMONARY MECHANISMS
III. RENAL MECHANISMS (FIG. V-7)
ACIDOSIS AND ALKALOSIS
REGULATION OF OSMOTIC PRESSURE OF BODY FLUIDS AND FORMATION OF CONCENTRATED URINE AND DILUTE URINE
Formation of dilute urine or Hypotonic Urine (Fig. V-11b)
Role of urea in the formation of concentrated urine
Diuretics
4:
The Endocrine Function of the Kidneys
RENIN AND JUXTAGLOMERULAR APPARATUS
RENIN
JUXTAGLOMERULAR APPARATUS (FIG. V-12)
Regulation of Renin Secretion and Function (Fig. V-13)
Effects of Angiotensin II
Stimuli for Releasing Renin
ERYTHROPOIETIN
HORMONES ACTING ON KIDNEY
5:
Micturition
URETERS
URINARY BLADDER
FILLING OF THE BLADDER
BARRINGTON REFLEXES
APPLIED ASPECTS OF MICTURITION
TESTS FOR RENAL FUNCTION
6:
Skin
STRUCTURE OF THE SKIN
THE SWEAT GLANDS
SWEAT
Composition
Inorganic Constituents
Organic Constituents
MECHANISM OF SWEAT SECRETION
Innervation
THE HAIRS
Sebaceous Glands
FUNCTIONS OF THE SKIN
REGULATION OF BODY TEMPERATURE
HEAT PRODUCTION (THERMOGENESIS)
Factors of thermogenesis (Heat production)
FACTORS OF THERMOLYSIS (HEAT - LOSS)
HEAT LOSS MECHANISMS
FACTORS OF REGULATION OF BODY TEMPERATURE
THE NERVOUS REGULATION OF BODY T°
a. Reflex Regulation
b. Central Regulation
Afferent Fibres
Efferent Fibres
ENDOCRINE REGULATION OF BODY T°
Thyroid
Adrenal Medulla
Hypophysis
1. At Low Environmental Temperature:
2. At moderate Environmental Temperature:
3. At high Environmental Temperature
CLINICAL ASPECTS
DISTURBANCES OF TEMPERATURE REGULATION
Heat Stroke
HEAT CRAMP OR STOKER'S CRAMP
Fever or Pyrexia or Hyperthermia
SECTION VI: ENDOCRINES
1:
The Endocrines or Ductless Glands
INTRODUCTION: ENDOCRINES GENERAL ASPECTS
Hormone Secreting Tissues in the Body
Function of the Hormones in General
Mode of access to the target cells
General Characteristics
Historical Note
Methods of Estimation of Hormones
General Methods of Estimation of Hormones
1. Column Chromatography
2. Flurimetric analysis
Radioimmunoassay Method (RIA)
Brief Description of the method
3. ELISA method (Enzyme Linked Immunosorent Assay)
METHODS OF STUDY OF ENDOCRINE FUNCTIONS
1. Chemical Extraction
2. Surgical Extirpation
3. Spontaneous Defects
4. Replacement therapy
5. Additive Experiment
Mechanism of Hormones Action
THE PITUITARY GLAND (Fig. VI-4)
The Hypophysis Cerebri
The anterior and posterior pituitary glands
THE ANTERIOR PITUITARY GLAND OR ADENOHYPOPHYSIS
Histology
HYPOTHALAMUS AND THE PITUITARY GLAND
Hypothalamo-pituitary Axis in the Foetus
The Hormones of the Anterior Pituitary Gland
THE GROWTH HORMONE (STH)
The ‘Core’ of the Growth Hormone
Functions of the Growth Hormone
1. On Protein Metabolism
2. On Carbohydrate Metabolism
Inter-relationship of GH and Insulin
3. On Fat metabolism
4. Other metabolic Effects
5. Luteotrophic effect of Growth Hormone
Bioassay
THYROTROPHIC HORMONE OR THYROID STIMULATING HORMONE (TSH)
Functions of TSH
THE ADRENOCORTICOTROPHIC HORMONE (ACTH) OR CORTICOTROPHIN
Function of ACTH
Adrenal Effects
Extra Adrenal Effects
Bioassay of ACTH
1. Ascorbic Acid Depletion Test (Sayer's test)
2. The repair test
3. Thorn's test: based upon the reduction of eosinophil count by the glucocorticoids.
GONADOTROPHIC HORMONES (FSH AND LH)
Functions of Gonadotrophic hormones in the female
Luteinizing hormone
Gonadotrophins in the Male (FSH and ICSH)
PROLACTIN (LACTOGENIC HORMONE)
Functions of Prolactin
Control of Secretion of Adenohypophyseal Hormones
Hypothalamic Control
Specific areas of the hypothalamus secreting different releasing hormones (HHH)
Growth Hormone Releasing Factor
TSHRF
CRF
FSH and LH Releasing Factors
Feedback Control of Target Glands (Figs VI-8, 9, 10)
Regulation of Growth Hormone Secretion
Regulation of TSH Secretion
Regulation of ACTH Secretion
1. Nervous Control (Corticotrophin Releasing Factor)
Role of Cytokines on hypothalamopituitary adrenal axis (HPA axis)
2. Feedback mechanism
Regulation of Gonadotrophin Secretion
1. Nervous Control
2. Feedback Mechanism
Regulation of Prolactin Secretion
Chemistry of Hypothalamic Hormones
Mechanism of action: (Kraicer - 1975)
Hypophysectomy
Effects
Growth (Fig. VI-11)
Factors Influencing Growth
CLINICAL ASPECTS
Disorders of Pituitary Function
ACROMEGALY
Features
GIANTISM OR GIGANTISM
Cushing's Disease (Fig. VI-13)
Features
Dwarfism
Pituitary Cacexia (Simmond's disease)
Dystrophia Adiposa-Genitalis
Frohlich's Syndrome
The Adolescent Type
NEUROHYPOPHYSIS (PARS NERVOSA, POST PITUITARY GLAND)
Structure
Hypothalamo - Neurohypophyseal Link
Antidiuretic Hormone (Vasopressin) (ADH)
Oxytocin
FUNCTIONS
Antidiuretic Hormone (Vasopressin)
Regulation of Water Balance of the Body
Mode of action
Vasopressor Effect
Vasopressin receptors
Oxytocin Functions
REGULATION OF SECRETION OF ADH
REGULATION OF OXYTOCIN SECRETION
CLINICAL ASPECTS
2:
The Thyroid Gland
THYROID STRUCTURE (FIG. VI-15)
BLOOD SUPPLY
Nerve Supply
THYROID HORMONES
Biosynthesis and Secretion of Thyroid hormones
Selective Absorption of inorganic iodide
Autoregulation in Thyroid
Mechanism of Iodide trapping and concentration
Oxidation of inorganic iodide to iodine
Formation of Mono and Di-iodotyrosine
Formation of Thyroid hormones
Cyclic Activity of the Thyroid
Storage of Thyroid Hormones
Release of Thyroxine and Tri-iodothyronine from the follicles into the blood
Transport of thyroid hormones in the blood
T3 and T4 Carriers
FUNCTIONS OF THE THYROID GLAND
General Metabolic Effects and Calorigenic Effect
Mechanism of metabolic and calorigenic function
Effects on carbohydrate metabolism
Effect on fat metabolism
Effects on protein metabolism
Functions of growth and maturation
Other Functions
Relation of Catecholamines
Fate of Thyroxine
Control of Thyroid Secretion by TSH
Extrahypothalamic Control
Antithyroid Agents or Goitrogenic Agents
Thiocyanate, Percholate and related anions
Thiocarbamide compounds
Iodides
Natural goitrogens
Other compounds having antithyroid properties:
CLINICAL ASPECTS
Abnormal Functions
Hypothyroidism
Cretinism (Fig. VI - 16)
Myxoedema (Fig. IV-17)
HYPERTHYROIDISM
Causes of Hyperthyroidism
The Main features of Hyperthyroidism
1. Metabolism
2. Special Metabolism
3. Circulatory Effects
5. Eye Signs
Thyroglossal Cyst
3:
The Parathyroid Glands
PARATHYROID HORMONES
1. Parathormone (PTH)
2. Calcitonin and Thyrocalcitonin
Functions of Parathyroids
Parathormone Action (Fig. VI-20)
Calcitonin action
Calcitriol action
The Mechanism of Parathormone Action
Parathormone has a number of other effects
Control of Parathyroid Function
Other Possible Factors that regulate Parathyroidhormone Secretion
Other Factors
VITAMIN - D
Functions of Vitamin D (Calcidiol and Calcitriol)
Body Calcium and its Functions
Absorption and Excretion of Calcium and Phosphate in the Intestines
Excretion of Calcium in Faeces and Urine
Intestinal and Urinary Excretion of Phosphates
Body Calcium Functions
CLINICAL ASPECTS
HYPOPARATHYROIDISM (TETANY)
Important Features of Tetany
Latent Tetany
a. Chvostek's Sign
b. Trousseau's Sign
c. Von Bonsdorff's Sign
d. ERB's Sign
HYPERPARATHYROIDISM
PHYSIOLOGY OF BONE
Bone Formation and Resorption
Functions
Clinical Aspects
Bone Diseases:
Rickets
Osteomalacia
4:
The Adrenal Glands (Suprarenal Glands)
STRUCTURE (Fig. VI-23)
Structure of the Adrenal Cortex
ADRENAL CORTICAL HORMONES
Structure and Classification
I. Oxycorticoids or Glucocorticoids
II. Deoxycorticoids or Mineralocorticoids
III. Sex Steroids
Natural-Adrenal Cortical Hormones
Steroid Biosynthesis (Fig. VI-24)
Sources for Cholesterol
Enzymes involved in the biosynthesis
Enzyme Deficiencies
Transport
FUNCTIONS
Functions of Glucocorticoids
On Carbohydrate metabolism
On Protein metabolism
On Fat metabolism
Other Functions of Glucocorticoids
Anti-inflammatory, Anti-allergic effect of Glucocorticoids
Effects on Cardiac and Skeletal Muscle
Mechanism of Action
Function of Mineralocorticoids
Mechanism of Aldosterone Action
ALDOSTERONE INHIBITORS
Regulation of aldosterone Secretion
Metabolism of Adrenal corticoids
Effects of Adrenalectomy
CLINICAL ASPECTS
Abnormal Functions
Addison's Disease (Fig. VI-25)
CUSHING'S SYNDROME
(Corticometabolic syndrome)
ADRENOGENITAL SYNDROME
(Cortico-Sexual-syndrome)
ALDOSTERONISM
Secondary Aldosteronism
5:
The Adrenal Medulla
STRUCTURE
HORMONES
Adrenaline or Epinephrine
Noradrenaline
Biosynthesis (Demis, Balschko and Welch 1957)
1. Actions of Catecholamines
1. Cardiovascular Effects (Fig. VI-27)
Heart
Blood
II. Plain Muscle
III. Metabolic Effects
Adrenaline on General Metabolism
On Carbohydrate Metabolism
Other effects
Skeletal muscles
Respiration
THE FUNCTIONS/ACTIONS
Emergency Theory of Adrenal Function (Cannon)
Physical Exertion
Emotional States
Exposure to Cold
Tonus Theory of Adrenal Function
Control of Secretion by Adrenal Medulla
Clinical Aspects
Hypersecretion
Clinical Tests
Metabolism of Catecholamines
STRESS
Introduction
Stress and Stressor
Stressors
Course of GAS
The Alarm Reaction
The stage of Resistance or the Stage of Adaptation
The Stage of Exhaustion
Adenohypophysis and GAS
Summary
6:
Endocrine Function of the Pancreas
STRUCTURE OF PANCREATIC ISLETS
HORMONES
Insulin
Standardisation of Insulin
Transport
Synthesis
Biosynthesis of Insulin
FUNCTION OF INSULIN
Effects of Insulin
Adipose Tissue
Functions of Adipose tissue
Role of Insulin in ‘Switching’ between Carbohydrate (CHO) and Lipid Metabolism
Mechanism of Insulin Action and Insulin Receptors (Fig. VI-28)
Insulin effect on glucose transport
Insulin Effect on Ion Transport
Control of Insulin Secretion
1. Glucose level
2. Amino acids
3. Nerve supply
Metabolism
Insulin antagonists
Insulin like Substances in Blood
Hyperglycaemic Agents
Glucagon
Glucagon Secretion Regulation
Insulin - Glucagon Molar Ratio
Somatostatin
Pancreatic Polypeptide
CLINICAL ASPECTS
Hypofunction
Other Causes of Diabetes
Symptoms and Signs of Diabetes Mellitus
Carbohydrate Metabolism in Insulin Deficiency
Fat metabolism in Insulin Deficiency
Protein Metabolism in insulin deficiency
Experimental Diabetes
Complication of Diabetes Mellitus
Diagnostic Tests
3. Glucose Tolerance Test
Hypoglycaemia
Signs and Symptoms
7:
Physiology of Reproduction
SEX DIFFERENTIATION AND SEX DEVELOPMENT
The Sex Chromosomes
Development of the Gonads
Development of Genitalia
Gonads in the foetus
REPRODUCTION IN THE FEMALE
Menstrual Cycle
Changes in the Ovaries During the Progestational or secretory or Luteal Phase
Corpus Luteum
Changes in the Uterine Endometrium During Normal Menstrual Cycle (Fig. VI-36)
The Neuroendocrine Control of the Menstrual Cycle
Other changes during menstrual Cycle (Fig. VI-38)
Effect on Water and Electrolyte Balance
Vaginal Changes
Cervix
Menstrual Disturbances
Mechanisms regulating the functions of corpus luteum
1. Small luteal cells of thecal origin (SLC)
2. Large luteal cells of granulosa cell origin (LLC)
8:
Pregnancy and Lactation
PREGNANCY
Fertilization and Implantation
Development of the Placenta (Fig. VI-39)
Organisation of Placenta
Endocrinology of Pregnancy
Human Chorionic Gonadotrophin (HCG)
HCG and Tests of Pregnancy
Ascheim Zondek Test
Friedmann's Test
Kuppermann Test
Hogben Test (Female Frog Test)
Galli Mainini Test (Male Frog Test)
Immunological Tests
The Principle of Haemoagglutination Inhibition Test
The Steroid Hormones of the Placenta
Placental Oestrogens
Changes in the mother during pregnancy
Amniotic Fluid
Nutrition of the Foetus
Parturition or Delivery of the Baby
MAMMARY GLANDS AND LACTATION
Structure of Mammary Gland
Oestrogen and mammary glands
Progesterone and mammary glands
LACTATION
Initiation of Lactation (Fig. VI-40)
Maintenance of Lactation
Milk Ejection (Fig. VI-41)
Human Milk
Ovarian Hormones—general characteristics
Mechanism of action of oestrogens
Mechanism of action of progesterone
Functions
9:
Physiology of Male Reproduction
TESTES
The Male Sex Gland is Testis
Structure of the Testis (Fig. VI-42)
I. Spermatogenesis
Production of spermatozoa.
II. Endocrine Function
The Spermatogenesis
REGULATION OF TESTICULAR FUNCTION
Control of Spermatogenesis
Role of Sertoli cells on Spermatogenesis
Other Factors Influencing Spermatogenesis
Seminal tract and related glands
Vas deferens
Seminal Vesicles
Prostate
Prostate Specific Antigen (PSA)
Normal blood level below 40 years is 0–4 ng/ml
Normal blood level above 40 years is 0–10 ng/ml
Bulbourethral Glands secrete mucus
Semen or Seminal Fluid
Composition of Human Semen
Endocrine Functions of the Testes
Biosynthesis of testosterone
REGULATION OF LEYDIG CELL FUNCTION
Functions of Testosterone
Male Secondary Sex Characters
Mechanism of Testosterone Action
Physiology of Coitus
Effects of Extirpation of Testes
Hypergonadism
Hypogonadism
FERTILITY CONTROL OR CONTROL OF CONCEPTION
Significance
Family Planning methods
(I) Temporary methods
(a) Method of Coitus Interruptus
(b) Safe Period or the Rhythm method
(c) Mechanical and Chemical methods of Family Planning
(d) The Intrauterine Contraceptive Devices (IUCD)
(e) Oral Contraceptives or Pills
(f) Medical Termination of Pregnancy - by Inducting Abortion
(II) Permanent Methods
10:
The Pineal Gland
THE SECRETIONS OF THE PINEAL GLAND
PINEAL AND CENTRAL NERVOUS SYSTEM
11:
Essential Fatty Acids and Eicosanoids
PROSTAGLANDINS
Action of Prostaglandins
Decrease gastric acid secretion
LEUKOTRIENS
THROMBOXANE
PROSTACYCLIN
12:
Ageing
INTRODUCTION
Ageing
TISSUE CHANGES DURING AGEING
As the ageing progress many changes occur in our
Respiration
Digestive system
Temperature regulation
Defense and waste Disposal
Reproduction and Sexual Function
CNS
CLINICAL ASPECTS
Common Disorders of old age
CAUSES OF DEATH DUE TO AGEING
SECTION VII: CARDIOVASCULAR SYSTEM OR CIRCULATORY SYSTEM
1:
Structure and Properties of Heart Muscle
INTRODUCTION
CARDIAC MUSCLE—STRUCTURE (FIG. VII-1)
Intercalated Discs
Detail of cytoskeleton proteins
CONDUCTION SYSTEM OF HEART
SA Node
Auriculoventricular Node (AV Node)
AV Bundle or Bundle of His and Bundle Branches
The Cardiac Receptors
Angiotensin II receptors
Muscarine receptors
Normal cardiac extracellular matrix (ECM)
PROPERTIES OF THE HEART MUSCLE
I. Excitability and Contractility
Contraction of the Heart Shows Certain Features (Figs VII-3 and 4)
Treppe or Stair Case Effect (Fig. VII-4)
Summation of Subminimal Stimuli
II. Rhythmicity
III. Conductivity
IV. The Refractory Period (Fig. VII - 5) (Hoffman 1969)
ORIGIN AND SPREAD OF THE CARDIAC IMPULSE
Evidences to Show that the SA Node is the Pacemaker
The Spread of the Cardiac Impulse in the Ventricles (Fig. VII-6)
Causes for the Delay
NUTRITION AND METABOLISM OF THE HEART
Oxygen Consumption
Myocardial Metabolism
Heat Production in Heart Muscle
Inorganic Ions and Heart's Activity
Excitation Contraction Coupling and Calcium Cycle in Cardiac Muscle
Clinical Aspects
Norepinephrine and Epinephrine
2:
The Cardiac Cycle
CARDIO DYNAMICS—MAIN EVENTS
HEART VALVES (FIGS VII-10 TO 12)
SEQUENCE OF EVENTS OF CARDIAC CYCLE (FIGS VII-13 AND 14)
CHANGES DURING EACH CARDIAC CYCLE
HEART BEAT - MOVEMENTS-APEX BEAT
Pressure Changes in the Heart
The Principle of Optical Monometry (Fig. VII-15)
Intra Auricular Pressure Changes (Fig. VI-16)
The Intraventricular Pressure Changes (Fig. VII-17)
Aortic Pressure Changes (Fig. VII-17)
Changes in the Ventricular Volume (Fig. VII-16)
Intra Cardiac Catheterisation
Uses
HEART SOUNDS (FIG. VII-18)
Causes of Heart Sounds
I Sound
II Sound
III Sound
IV Sound
Graphic Registration of Heart Sounds Phonocardiogram (Fig. VII-18)
Abnormal Heart Sounds are called Murmurs
3:
Electrical Changes and Electrocardiography
INTRODUCTION—ELECTROCARDIOGRAM (ECG)
ECG LEADS
Bipolar Limb Leads (Standard Limb Leads) (Fig. VII-19)
Unipolar Limb Leads (Fig. VII-20)
Unipolar precordial chest leads: Vc1 or VI to V6 positions in the chest (Fig. VII-21)
Calibration of ECG (Fig. VII-22)
NORMAL ELECTROCARDIOGRAM (ECG) (FIG. VII-23)
Ventricular Complex QRST
P-R interval
The Electrical Axis or Cardiac Vector (Fig. VII-24)
Cardiac Axis Deviation
CLINICAL ASPECTS
Abnormal Patterns of ECG (Figs VII-27 to 29)
Depression and Elevation of ST Segments
Electrical Activity of Individual Cardiac Muscle Fibre (Figs VII30A and B)
Electrical Activity of SA Node and AV Node Cell
ARRHYTHMIAS OR IRREGULARITIES OF HEART BEAT
Mechanisms behind the production of arrhythmias (Figs VII-36 and 37)
Artificial Pacemaker
4:
The Regulation of Heart's Performance
INTRODUCTION
THE HEART RATE
Physiological Variations
CONTROL OF THE HEART RATE
Nervous Mechanism of Regulation of Heart Rate
The Cardiac Centres
The Cardio Inhibitory Centre
The Cardio-accelerator Centre
The Efferent Nerves (Fig. VII-38)
Action of the Vagus
Vagal Tone
Mechanism of Vagal Action
Action of Certain Drugs on Vagal Effects
Vagal Escape
Causes for Vagal Escape
The Sympathetic Nerves of the Heart
The Accelerator Nerves (Fig. VII-38)
Action of the Sympathetics
Mechanism of Action of Sympathetics
The Afferent Pathways and Cardiac Reflexes
1. The Carotid Sinus and Aortic Arch (Fig. VII-40)
(Sinoaortic reflexes)
2. The Carotid and Aortic Bodies
Chemical Regulation of Heart Rate
Other Reflexogenic Areas
3. Reflex from the Great Veins and the Right Auricle
(Auricular Reflex or Bainbridge Reflex or Venous Reflex)
4. Reflex from Other Parts
Direct Effects
II. Chemical substances in the circulating blood which influence heart rate
III. Mechanical Factors
INTRINSIC REGULATION OF CARDIAC PERFORMANCE
The Physiologic importance of the four major determinants of cardiac performance
5:
The Cardiac Output
THE CARDIAC OUTPUT (CO)
The stroke volume normal value is 70–80 ml.
FACTORS INFLUENCING CARDIAC OUTPUT
1. The Venous Return Depends Upon Number of Factors
2. Force of the Heart Beat
3. The Heart Rate
Physiological Factors Modifying the Cardiac Output
Distribution of the cardiac output minute volume to various organs
METHODS OF DETERMINATION OF CARDIAC OUTPUT
In man only indirect methods are possible
The Fick Principle Direct Method (Adolph Fick 1870) (Fig. VII-42)
The Fick Principle Indirect Method
Dye Method, Using Stewart Principle (Indicator Method)
Method Employing Inhalation of Inert Gases
Physical Methods
Ballistocardiography
Radiographic Method
Echocardiography
6:
The Arterial Blood Pressure
DEFINITIONS
Significance of the Each of the Above
DETERMINANTS OF THE ARTERIAL BP
1. The Cardiac Output (CO)
2. The Peripheral Resistance (PR)
3. Elasticity of the arterial walls (Fig. VII-45)
4. Blood volume
5. Capacity of the vascular bed
METHODS OF RECORDING BLOOD PRESSURE
Palpatory method
Auscultatory method
The Actual Method
Variations in BP under Physiological Conditions
1. Age, Sex and Build
2. Digestion
3. Sleep
4. Emotional Influence
5. Posture
Orthostatic postural hypotension
6. Respiration
REGULATION OF BP (FIG. VII-46)
Four Mechanisms are Recognized for the Regulation of BP
I. Nervous Regulation of Arterial Blood Pressure
a. Sinoaortic Mechanism
b. Sympathetic Increased Activity
c. Ischaemic Response of the CNS
II. Kidney Mechanisms in the Regulation of BP
a. The Extracellular Fluid Volume theory of Renal Regulation of BP
(b) Salt Retention Theory of Renal Regulation of BP
(c) Renin Angiotensin mechanism and
Mechanisms of Sodium Effect to Raise BP
Mechanism of Angiotensin Action
III. The Endocrine Mechanisms
IV. The Capillary Fluid Shift Mechanism
VASOMOTOR CONTROL
The Vasomotor Centre and the Control of Blood Vessels
Brainstem Vasomotor Centre
1. Vasoconstrictor centre
2. Vasodilator centre
Higher Centres for Vascular Control
Cerebral Cortex
The Spinal Cord Centres
Vasomotor Nerves
1. Vasoconstrictor fibres
2. Vasodilator fibres are 3 types
Sympathetic Vasodilator System
Factors Influencing the Vasomotor Centre (Fig. VII-47)
1. Higher Centres
2. Radiation from the Respiratory Centre
4. CO2 tension (PO2)
5. O2 Lack
6. Aff. Impulses from the Skin, Muscles and Viscera
7. Reflexes arising from the Rt. Auricle and Great Veins
Axon Reflex (Fig. VII-47)
The Chemical Regulation of Arterioles
1. O2 and CO2
2. Metabolites
3. Hormones
4. Other Chemical Substances
CLINICAL ASPECTS
Hypertension
Fainting or Syncope
MODE OF ACTION OF ANTIHYPERTENSIVE DRUGS
EICOSANOIDS AND BLOOD PRESSURE
Prostacyclin and Thromboxane A2
Endothelium Derived Relaxing Factor (EDRF) or Nitric Oxide (NO) (Fig. VII-48)
Mechanism of Vasodilation
Other Functions of EDRF
Endothelins
Endothelium Derived Hyperpolarizing Factor (EDHF)
7:
The Physiology of Vascular System
SYSTEMIC CIRCULATION
General outline of the Vascular system
Histological structure of the blood Vessels (Fig. VII-49)
The Capillaries
Veins
Functional Characteristics of Systemic Vessels (Haemodynamics)
Diameter and Cross-Sectional Area
Pressure gradient
Variation in Pressure in different parts of the vascular system (Fig. VIII-51)
Poiseulle Hagen Formula
Law of Laplace (Fig. VII-52)
ARTERIAL PULSE (FIG. VII-53)
The Radial Pulse
Analysis of Pulse Curve
Clinical examination of the pulse will include
Venous Pulse
Record of Venous Pulse (Fig. VII-54)
Microcirculation (Fig. VII-55)
CAPILLARY CIRCULATION
Regulation of blood flow through capillaries
Innervation of the capillaries
Vascular Reactions of the Human Skin
The Triple Response
VENOUS CIRCULATION
Regulation of Blood Flow through Veins
Factors which influence the venous flow
Angiogenesis
The following are inhibitory to angiogenesis
8:
Circulation through Special Regions or Special Circulations
INTRODUCTION
GENERAL CONSIDERATIONS
Methods of Estimation of Volume of Blood Flow
Determination of Circulation Time
The Substances Used for Injection
CORONARY CIRCULATION (FIG. VII-56)
Volume of Coronary Blood Flow
Factors Influencing the Coronary Blood Flow
I. Mechanical or Physical Factors
1. Coronary blood flow during different phases of the cardiac cycle
2. Aortic Blood Pressure
3. The Heart Rate
II Neural and Neurohumoral Factors
III. Myogenic Factor
IV. Metabolic and Chemical Factors
Methods of Measurement
Clinical Aspects
Isoenzymes and Diseases of the Heart (Fig. VII-58)
CEREBRAL CIRCULATION
Physiological Variations of Cerebral Blood Flow
Factors Regulating Cerebral Circulation
I. The effective perfusion pressure.
II. The resistance in the cerebral vessels.
Intracranial Pressure
Viscosity of the Blood
Lumen of the Blood Vessels
Nervous Control
Chemical Control
SKELETAL MUSCLE CIRCULATION
Skeletal Muscle Circulation - Important Features
FOETAL CIRCULATION
Foetal Circulation - Important Features (Fig. VII-59)
Ejection Fraction
Endurance: Physical Conditioning or Training
Cardiac Autocrine Functions
Bradykinin, Prostaglandins E2 and Cytokines
PULMONARY CIRCULATION
Pulmonary Capillary Blood Flow
Regulation of Pulmonary Vessels
Chemical Regulation
Zones in the Vertical Lung
SECTION VIII: RESPIRATION
1:
Respiration
INTRODUCTION
RESPIRATORY ORGANS
Elastic tissue
Muscle
Blood Supply
Nerve Supply
Receptors
Recent Concepts about Receptors in the air Ways and Lungs
Drugs Effect on Bronchioles
The Bronchioles and the Airsacs
Respiratory Bronchioles
Alveolar Duct
Pulmonary Alveoli
SURFACTANT (FIG. VIII-2)
Functions of Surfactant
THE EXPANSION OF THE LUNGS AT BIRTH
INTRAPULMONARY PRESSURE OR ALVEOLAR PRESSURE
THE PLEURA AND THE INTRAPLEURAL PRESSURE (INTRATHORACIC PRESSURE)
Measurement
CLINICAL ASPECTS
Lung Cancer
Cystic Fibrosis
2:
The Respiratory Movements
INTRODUCTION
MUSCLES OF INSPIRATION
MUSCLES OF EXPIRATION
THE ENLARGEMENT OF THE THORACIC CAVITY DURING INSPIRATION (FIG. VIII-5)
Thoracic Lid or Operculum
The Upper Costal Series
The Lower Costal Series and the Diaphragm
The floating ribs and the abdominal muscles
Expiration
3:
The Lung Air
SUBDIVISIONS OF THE LUNG AIR
LUNG VOLUMES (FIG. VIII-7)
LUNG CAPACITIES (FIG. VIII-7)
Factors Influencing Vital Capacity
The Total Lung Capacity
Maximal Voluntary Ventilation (MVV)
Maximum Breathing Capacity (MBC)
THE DEAD SPACE AIR
4:
Gaseous Exchanges and Transport of O2 and CO2
INTRODUCTION
ALVEOLAR AIR
COMPOSITION — VOLUMES in ml %
THE EXCHANGE OF GASES IN THE LUNGS (FIG. VIII-8)
CO2 release and O2 uptake
THE OXYGEN TRANSPORT
OXYGEN CARRIAGE
THE STUDY OF THE O2 CARRIAGE INCLUDES
THE FORMS OF O2 CARRIAGE
The Unloading or Delivery of O2 to the Tissues (Fig. VIII-9)
The O2 Dissociation Curve (Figs VIII-10 and 11)
Modern Methods of Gas Analysis
Discussion of the O2 Dissociation Curves
Causes
2,3 DPG and O2 Dissociation
Clinical Aspects
Oxygen Treatment (Oxygen Inhalation Therapy)
O2Toxicity
CO2 Transport in the Body
The Uptake of CO2 from the Tissues (Fig. VIII-9)
Forms of CO2 Transport in the Blood
1. Carbonic Acid
Carbonic Anhydrase (Roughton)
2. Carriage of CO2 as Bicarbonates
Function of Bicarbonates
3. Carriage of CO2 as Carbamino Compounds
THE RELEASE OF CO2 FROM THE BLOOD IN THE LUNGS AND ITS EXPULSION FROM THE LUNGS IN THE EXPIRED AIR
CO2 Dissociation Curve
Observation
5:
The Control of Respiration
INTRODUCTION
I. Neural or Nervous mechanisms of respiration
II. Automatic control of respiration
Historical Background
MEDULLARY RESPIRATORY CENTRES
Localisation of Respiratory Centres
PITTS Theory of rhythmic breathing
The Pneumotaxic centre and rhythmic breathing (Fig. VIII-18)
Regulation of Respiration (Fig. VIII-20)
I. Nervous Control of Respiration
a. Voluntary Control
Factors influencing Respiratory Centres
Structure of Carotid body and aortic body chemoreceptors
Mechanism of carotid and aortic body chemoreceptors function
II Chemical regulation of Respiration
CO and breathing
Oxygen and breathing
H+ Concentration and Breathing
6:
Anoxia (or) Hypoxia
HYPOXIA
Types of Hypoxic
Effects of hypoxia
On CNS
Respiratory System
Mountain Sickness
Acclimatization
AVIATION, HIGH ALTITUDE AND SPACE PHYSIOLOGY
6. Stress
Caisson Disease or Decompression Sickness
Asphyxia
CYANOSIS
MODIFICATION OF RESPIRATION
DISTURBANCE OF RESPIRATION (FIG. VIII-24)
ARTIFICIAL RESPIRATION
Two Methods
7:
Pulmonary function Tests
PULMONARY FUNCTION TESTS
Limitation and Usefulness
I. Ventilation
II Diffusion
III. Pulmonary blood flow
IV. Mechanics of Breathing
Elastic Resistance or Lung Compliance
The Pressure—Volume Curve (Fig. VIII-26)
Non-elastic Resistance
Airway Resistance
Timed Vital Capacity (TVC) or Forced Vital Capacity
Mid Expiratory Time (MET)
Maximum Mid Expiratory Flow Rate (MMEFR)
Maximum Expiratory Pressure (MEP)
NON-RESPIRATORY FUNCTIONS OF THE LUNG
1. Filtration Function of the Lung
2. Coagulation and Lungs
3. Protease transport system
4. Alteration of Hormones Level
Synthesized and used in the Lungs - Surfactant
Synthesized or Stored and Released into the Blood
Partially removed from the Blood
Activated in the lungs
5. Lungs and Lipid Metabolism
6. Protective function
7. Excretory function
8. PH Regulation
9. Temperature Regulation
10. Defence Mechanisms
EXERCISE PHYSIOLOGY
Cardiovascular System Changes
Changes in the Respiratory System
Metabolic Changes
Endocrine Changes
Other Changes
“Second Wind”
SECTION IX: NERVOUS SYSTEM
1:
Nervous System Neuron, Neuroglia and Nerve Fibre
INTRODUCTION
Development of the Nervous System
Subdivisions of the Nervous System
THE NEURON AND ITS STRUCTURE (FIG. IX-1)
Types of Neurons
Neuroglia (Fig. IX-3)
Electrophysiology of Neuroglia
Neuroglia are three types.
Functions attributed to Glia
NERVE FIBRES
The Structure of the Myelinated Nerve Fibre (Fig. IX-1)
Numerical Classification of Afferent fibres
PHYSIOLOGICAL PROPERTIES OF THE NERVE FIBRE
Accommodation
Excitation: Action Potential (Fig. IX-7)
THE NERVE IMPULSE AND CONDUCTION OF NERVE IMPULSES
The Membrane Theory of Nerve Conduction (Fig. IX-11)
Cable Properties of the Nerve Fibre and Saltatory Conduction (Fig. IX-12)
Orthodromic and Antidromic Conduction
Synthesis of Proteins and Neurotransmitters
Nerve Growth Factor (NGF)
Neurotrophins or Nerve Growth Factors
NERVE DEGENERATION AND REGENERATION
Changes in the Nerve Cell Body
The Normal Electrical Reaction of the nerve or muscle and Electrotonus
Reaction of Degeneration
Neuronal Metabolism
2:
Somatic Sensation
CLASSIFICATION OF RECEPTOR ORGANS AND SENSATIONS
Deep Sensations are:
CUTANEOUS RECEPTORS (FIG. IX-14): GENERAL STRUCTURE
General Structure
Light Touch or Tactile Receptors
Touch or tactile sensation
Tactile Localisation
Tactile Discrimination (Two point sensibility)
THE PROPRIOCEPTORS
Muscle Spindles and Stretch Reflex or Myotatic Reflex (Fig. IX-16)
PROPERTIES OF RECEPTORS
Properties of Receptors:
3:
Synapse, Synaptic Transmission and Neurotransmitters
SYNAPSE—STRUCTURE—TYPES
Synapse
Axodendritic synapses
Axosomatic synapses
Axoaxonic synapses.
Role of Calcium in the Release of Neurotransmitters
Mechanism of Excitation and Inhibition on the post-synaptic Neuron
PROPERTIES OF SYNAPTIC TRANSMISSION
Properties
Facilitation or Repetitive Discharge
Synaptic Inhibition (Fig. IX-19)
NEUROTRANSMITTERS
General Characteristics
Neurotransmitters and Neurohumours
Acetylcholine
Functions
Biogenic Amines Norepinephrine, Epinephrine and Dopamine:
Monoaminergic System (Fig. IX-21)
Biosynthesis (Refer Fig. VI-2)
Functions of Noradrenergic Neurons
Dopamine
Functions
Serotonin
Functions
Lysergic Acid Diethylamide (LSD)
Gamma - Aminobutyric acid and Other Amino acids
Functions
Functions
Opioid Peptides - Encephalins, Endorphins and Dynorphins
Functions
Excitatory Amino Acids Glutamates and Aspartates
Applied Aspects
4:
Reflex Action
THE REFLEX FUNCTIONS OF THE NERVOUS SYSTEM
REFLEX ACTION—COMPONENTS
Peripheral Nerves
DORSAL NERVE ROOTS AND DERMATOME
Effects of Section of Dorsal Root
PROPERTIES OF REFLEX ACTION
Occlusion (Fig. IX-25A)
Subliminal Fringe (Fig. IX-25B)
Recruitment (irradiation)
After Discharge
Rebound
Reflex Inhibition, Reciprocal Innervation and Crossed Extension Reflex
STRETCH REFLEXES OR MYOTATIC REFLEXES
Muscle Tone
WITHDRAWAL REFLEXES OR FLEXOR REFLEXES
LENGTHENING REACTION OR INVERSE MYOTATIC REFLEX
5:
Spinal Cord
SPINAL CORD GRAY MATTER
The Cell Groups in the Posterior Gray Horn
Cells Groups:
WHITE MATTER OF THE SPINAL CORD
THE TRACTS IN THE SPINAL CORD
Mode of Entry of Fibres Carrying Different Sensations
Ascending Tracts in the Spinal Cord (Afferent Tracts)
1. Dorsolateral Fasciculus: (Lissauer's tract)
2. The Lateral Spinothalamic Tract (Fig. IX-32)
Location in the Spinal Cord
3. The Ventral Spinothalamic Tract (Fig. IX-33)
4. The Dorsal Spinocerebellar Tract Figure IX-34
5. The Ventral Spinocerebellar Tract (Fig. IX-34)
6. Posterior Column Tracts or Fasciculus Gracilis and Cuneatus or Tract of Goll and Burdach (Fig. IX-33)
7. Spinotectal Tract
8. Spino Olivary Tract
Sensory Pathways in the Brainstem
Medial lemniscus
Trigeminal lemniscus
The Lateral lemniscus
Descending Tracts of the Spinal Cord (Efferent tracts or Motor tracts)
Corticospinal tracts or Pyramidal tracts (Fig. IX-35)
Origin and Course
1. Ventral and Lateral Vestibulospinal Tracts
2. Reticulospinal Tracts
3. Rubrospinal Tract
4. Tecto Spinal Tract
5. Olivospinal Tact (Tract of Helweg)
COMPLETE TRANSVERSE SECTION OF THE SPINAL CORD
Effect of complete transverse section of the spinal cord (Paraplegia)
These effects appear in three stages
Stage of Spinal Shock
Stage of Reflex Activity (Mass reflex)
Stage of Reflex Failure
HEMISECTION OF THE SPINAL CORD
Effects of Hemisection of the Spinal Cord (or) Brown Sequard Syndrome (Fig. IX-37)
Clinical Aspects
6:
Sensory Functions
RECEPTOR ORGANS FOR VARIOUS SENSATIONS
AFFERENT INPUT AND FIRST ORDER NEURONS
MODE OF ENTRY OF SENSORY AFFERENTS AND SECOND ORDER NEURONS
Somatic afferents
Sensory Pathways in the Spinal Cord and Brainstem
DORSAL COLUMN (OR POSTERIOR)OF ASCENDING SYSTEM
ANTEROLATERAL SPINOTHALAMIC SYSTEM
Anterior or Ventral Spinothalamic Tract
Lateral Spino Thalamic Tract
RELAY OF AFFERENT SENSATION IN THE THALAMUS
NEUROPHYSIOLOGY OF PAIN
Landmarks
Receptors for Pain
Relays in the Spinal Cord
The Ascending tracts carrying pain
Modulation of pain impulses at the spinal cord (Fig. IX-39)
Pain Pathways in the Spinal Cord
Lateral Spinothalamic Tract (LST)
The Paleospinothalamic Tract or Spinoreticulothalamic Tract
Thalamus and Cerebral Cortex in Pain Perception
Descending Control Systems (Fig. IX-41)
Endogenous Peptides and Pain
Nociception
VISCERAL PAIN AND REFERRED PAIN
Referred Pain
Mechanism of Referred Pain
Dermatomal rule
Facilitation and Subliminal Fringe Effects (Fig. IX-42B)
Hyperalgesia—means increased sensitivity to pain.
7:
The Cerebral Cortex
STRUCTURE OF CEREBRAL CORTEX
Methods of Localisation of Cortical Functions
II. Methods of Ablation and Extirpation
III. Strychnine Neuronography
IV. Using the Method of Tracing Wallarian Degeneration
V. By Observing the effects of the diseases of the nervous system
FUNCTIONAL AREAS IN THE CORTEX
FUNCTIONAL AREAS IN THE FRONTAL LOBE (4,4S,6,8,44)
Supplementary Motor Area (Fig. IX-47)
FUNCTIONAL AREAS IN THE PREFRONTAL LOBE
Prefrontal lobe or orbito forntal region
Connections of Prefrontal lobe (Figs IX-48 and 49A to C)
Afferent Connections
Efferent Connections (Fig. IX-49B)
Intracortical Connections (Fig. IX-49C)
Functions
Clinical aspects
FUNCTIONAL AREAS IN THE PARIETAL LOBE
The Parietal Lobe
Connections
Clinical aspects
Types of Clinical Neglect Syndromes
FUNCTIONAL AREAS IN THE OCCIPITAL LOBE
Occipital lobe
FUNCTIONAL AREAS IN THE TEMPORAL LOBE
Temporal lobe
Other functions
Clinical Aspects
Memory loss
8:
Limbic System
COMPONENTS OF LIMBIC SYSTEM
Fibre tracts forming limbic circuits:
LIMBIC CIRCUITS
Three fundamental behaviours:
Nervous mechanisms governing behaviour:
Olfaction and Social behaviour
Taste and limbic structures
Importance of Reward and Punishment in behaviour:
Integration of three modes of behaviour:
FUNCTIONS OF THE LIMBIC SYSTEM (SUMMARY)
9:
Motor Mechanisms: Pyramidal and Extrapyramidal Systems
CLASSIFICATION OF VOLUNTARY MUSCLES
General Aspects
Organisation of Lower motor neurons in the ventral horn of spinal gray matter
Organisation of Spinal Inter neurons
UPPER MOTOR NEURONS OF THE DESCENDING PATHWAYS
Somatic Motor Activity
Lower Motor Neurons
Upper Motor Neurons
PYRAMIDAL SYSTEM
EXTRAPYRAMIDAL SYSTEM (EPS)—BASAL GANGLIA
Components of EPS
Extrapyramidal Projection from the Cortex
Basal Ganglia
Connections (Fig. IX-59)
FUNCTIONS
CLINICAL ASPECTS
Mechanism of tremor
Chorea and Athetosis
Significance of Dopamine.
10:
The Cerebellum
FUNCTIONAL CLASSIFICATION (INGVAR) (FIG. IX-63)
STRUCTURE (FIG. IX-64)
THE CONNECTIONS OF THE CEREBELLUM
Connections through the inferior cerebellar peduncle
Afferent Tracts
Efferent Tracts
Connections through the middle cerebellar peduncles
Connections through superior cerebellar peduncles
The Efferent Connections
Afferent Tracts
Closed Circuits
To Summarise
FUNCTIONS
Archicerebellum
Paleocerebellum
Neocerebellum
CLINICAL ASPECTS
11:
Muscle Tone/Posture and Equilibrium
STRETCH REFLEX OR MYOTATIC REFLEX (FIG IX-72)
POSTURAL REFLEXES
Spinal Animal
Decerebrate Animal
Thalamic Animal
EQUILIBRIUM OR VESTIBULAR MECHANISMS
The Role of the Vestibular System in posture and movements
Vestibular Apparatus (Fig. IX-74)
The Semicircular Canals
The Utricle and Saccule (Otolith Organs)
Innervation of the Vestibular Apparatus
Central Projections of the Vestibular System (Fig. IX-76)
Medial Longitudinal fasciculus (Fig. IX-77)
Vestibulo-ocular reflex (VOR) (Fig. IX-78)
Other Vestibular Control Systems
Spino Vestibulo - Spinal reflexes [SVS]
Tonic Neck Reflexes
CLINICAL ASPECTS
12:
Thalamus and Hypothalamus
THE MAIN NUCLEAR MASSES IN THE THALAMUS
1. Nuclei of the Medial Mass and Connections
2. Nuclei of the Lateral Mass
4. The Intra Laminar Nucleus
5. Pulvinar
6. Medial Geniculate Body
Lateral Geniculate Body
FUNCTIONS OF THALAMUS
Functions
Clinical Aspects
HYPOTHALAMUS
Introduction
HYPOTHALAMIC NUCLEI
1. The Anterior group Includes (Fig. IX-82)
II. Middle group
III. Posterior group
HYPOTHALAMIC CONNECTIONS
Afferent Connections (Fig. IX-83)
Efferent Tracts
FUNCTIONS OF THE HYPOTHALAMUS
Control of Autonomic Nervous System
Regulation of Body Temperature
Regulation of Food Intake
INTEGRATION OF ENDOCRINE AUTONOMIC AND SOMATIC EFFERENTS BY HYPOTHALAMUS
Regulation of Endocrine functions
Hypothalamus and Sleep and Wakefulness
Emotional changes
Sex Behaviour
Regulation of Gastric Acid Secretion
CLINICAL ASPECTS
13:
Reticular Formation, Sleep and EEG
INTRODUCTION
RETICULAR FORMATION—COMPONENTS
The Central Reticular Core
Ascending Components
Descending Components
FUNCTIONS OF THE RETICULAR FORMATION
NEUROPHYSIOLOGY OF SLEEP
Introduction
Theories and Mechanism of Sleep
Genesis of Slow Wave Sleep
Genesis of REM Sleep
Clinical Aspects
Disturbance of Consciousness
ELECTRO ENCEPHALOGRAM (EEG)
The Physiological basis of EEG, Consciousness and Sleep
Desynchronization
Synchronisation
Applied Aspects
EEG PATTERNS DURING DIFFERENT SLEEP PERIODS
14:
Autonomic Nervous System (ANS)
ORGANISATION OF THE AUTONOMIC NERVOUS SYSTEM
Sacral Division
Transmission in Parasympathetic Nerve
Transmission in Sympathetic Nerves
Regulation of Autonomic Functions
ANS Synaptic Transmission
Ganglionic Transmission in ANS
Postganglionic Transmission in ANS
Excitatory Effects are Produced via M1 Receptors
Inhibitory Effects are Produced via M2 Receptors
Postganglionic Transmission in the Sympathetic Division of ANS
Clinical Aspects
Horner's Syndrome
Raynaud's Disease
Hirschsprung's Disease
15:
Neurophysiology of Speech, Learning and Memory
INTRODUCTION
Speech, Learning and Memory are Higher Functions
CORTICAL AREAS AND ORGANISATION OF SPEECH
EXECUTION OF SPEECH AND WRITING
Dominant Hemisphere and Representational Hemisphere
Corpus Callosum and Anterior Commissure
CLINICAL ASPECTS - APHASIA
CONDITIONED REFLEXES, LEARNING AND MEMORY
Introduction
Criteria for Conditioning
Properties of Conditioned reflexes
Mechanisms of Reinforcement
Types of Conditioning
Anatomical, physiological and subjective relationship between drive and reinforcement
LEARNING
Memory is the retention and storage of that information
Neural Plasticity
Neural Plasticity and Learning
Posttetanic Potentiation (Short Term Potentiation)
Habituation
Sensitization
Long term Potentiation (LTP)
MEMORY
16:
Cerebrospinal Fluid
INTRODUCTION
CEREBROSPINAL FLUID (CSF)
Circulation of CSF
Composition
Intracranial tension
Functions of CSF
Analysis of CSF
Clinical Aspects
Lumbar Puncture
Uses of Lumbar Puncture
Hydrocephalus
BLOOD BRAIN BARRIER (BBB)
Blood Brain Barrier and different substances
Usefulness of the Blood Brain Barrier
SECTION X: SPECIAL SENSES
1:
Ear
EAR
THE COCHLEA
1. The Rods of Corti and the Tunnel of Corti
SOUND TRANSMISSION AND AUDITORY PATHWAY
Mechanism of Hearing (Figs X-4A and B)
Middle Ear and Impedance Matching
AUDITORY PATHWAY (FIG. X-5)
Central Mechanisms of Hearing
Superior Olivary Nucleus (SON) or Superior Olivary Complex
Inferior Colliculus
Medial Geniculate Body (MGB)
The Auditory Cortex
Descending Auditory Pathways
PITCH PERCEPTION BY THE COCHLEA
Frequency Analysis or Pitch Perception by the Cochlea
(Theorise of Hearing)
Tonotopic Organisation of the Basilar Membrane (Figs X-6 and 7)
Theories of Hearing or Pitch perception
Helmholtz (1893) Resonance Theory (Harp or piano theory)
Rutherford (1880) Telephone Theory
Wever and Bray (1949) Resonance Volley theory
Von Bekesy's travelling wave theory (Figs X-7 and 8)
Electrical Activity in the Cochlea (Fig. X-9)
1. Endocochlear Potential
2. Cochlear microphonics (CM) or Wever and Bray phenomenon
Clinical Aspects
Tests of Auditory Function
2:
Eye
EYE
Anatomical Considerations
OPTICAL SYSTEM OF THE EYE AND IMAGE FORMATION
The Aqueous Humour
Formation (Duke Elder)
Functions
Lens
Composition
Functions
Light and Refraction
Eye Defects (Refractive Errors) (Figs X-12 and 13)
Astigmatism
Presbyopia
RETINA
Receptors (Fig. X-16) Rods and Cones
The Wavelengths of Spectral Colours
Functional Organisation or Functional Neural Circuits in the Retina (Fig. X-18)
Horizontal Cells
Bipolar Cells
Receptive Fields in the Retina
Surround or Lateral Inhibition
Role of retina in the visual processing
Genesis of Photoreceptor Potentials in the Retina
Photoreceptor cells and phototransduction
Photosensitive substances of the retinal receptors
Cone Pigments
Resynthesis of cGMP
Phototransduction in rods and cones
Photoreceptor potentials in retina and genesis of action potentials
Retinal Synaptic mediators are many:
The Visual Pathway (Fig. X-23)
Effects of Lesions of Optical Pathway (Fig. X-24)
Clinical aspects
Central Connections of the Retina
Organisation in the Lateral Geniculate Nucleus (LGN) (For postgraduates)
Non-retinal Input and Functional Gating of LGN
Organisation in the Visual Cortex (Fig. X-25)
Orientation Columns and Ocular Dominance Columns
Extrastriate Visual Areas
Dark Adaptation
Light Adaptation
COLOUR VISION
Complementary Colours
Theories of Colour Vision
1. Young-Helmholtz Trichromatic theory
2. Hartridge's Polychromatic theory (1949)
3. Granit's Theory (Dominator-Modullator Theory)
4. Herring's Theory of Opposite Colours
Clinical Aspects
Colour Blindness
Defects of Colour Vision are tested by
IRIS, ACCOMMODATION AND PUPILLARY REFLEXES
Pupillary reflexes
Argyll Robertson Pupil
Functions of Iris
ACCOMMODATION
Accommodation for Distant Vision
Pupillary Constrictor Pathway (Light reflex) (Fig. X-26)
Pupillary Constrictor Pathway for light reflex
Pupillary Constrictor Pathway during accommodation for near vision
Pupillary dilator Pathway during dark adaptation
The Lacrimal Gland and Tears
Secretion of Tear
Eye muscles and Eyeball movements
Nerve Supply
Visual Field
Binocular Vision
Flicker
The Vision is Tested by Using Snellen's Chart and for Illiterates using E types.
3:
Taste
TASTE
Distribution of taste buds
The Receptors and Afferents
TASTE PATHWAY
FACTORS INFLUENCING TASTE
4:
Smell or Olfaction
SMELL OR OLFACTION
CLASSIFICATION OF ODOURS
Factors Influencing Olfactory Function (Macrides, 1976)
OLFACTORY PATHWAY
Sensory processing in the olfactory bulb
Central Mechanisms of Olfaction
Olfactory tubercle
Pyriform Lobe
Amygdaloid Complex and Ventromedial Nucleus of Hypothalamus
Clinical Aspects
INDEX
TOC
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