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By L. Einar. Kent State University.

Each of the components of the electron transfer chain is oxidized inactivates cytochrome oxidase order 2 mg detrol with mastercard, interacts as it accepts an electron, and then reduced as it passes the electrons to the next mem- with CoQ, affects ion pumps, and inhibits ber of the chain. From NADH, electrons are transferred sequentially through ATP synthase, resulting in decreased ATP NADH dehydrogenase (complex I), CoQ (coenzyme Q), the cytochrome b-c1 com- levels and mildly swollen mitochondria. It plex (complex III), cytochrome c, and finally cytochrome c oxidase (complex IV). It transports electrons from complex I to complex III and is an heart function indirectly through other intrinsic part of the proton pumps for each of these complexes. The terminal complex, cytochrome c oxidase, Cytosolic side contains the binding site for O2. As O2 accepts electrons from the chain, it is reduced nH+ to H2O. THE ELECTROCHEMICAL POTENTIAL GRADIENT ∆ψ motive ∆pH force At each of the three large membrane-spanning complexes in the chain, electron –––––––– H+ transfer is accompanied by proton pumping across the membrane. There is an energy drop of approximately 16 kcal in reduction potential as electrons pass through each of these complexes, which provides the energy required to move pro- nH+ tons against a concentration gradient. The membrane is impermeable to protons, so Matrix side they cannot diffuse through the lipid bilayer back into the matrix. Thus, in actively respiring mitochondria, the intermembrane space and cytosol may be approxi- Fig. Proton motive force (electrochemi- cal gradient) across the inner mitochondrial mately 0. The proton motive force consists of The transmembrane movement of protons generates an electrochemical gra- a membrane potential, , and a proton gradi- dient with two components: the membrane potential (the external face of the ent, denoted by pH for the difference in pH membrane is charged positive relative to the matrix side) and the proton gradient across the membrane. The electrochemical (the inter membrane space has a higher proton concentration and is therefore potential is called the proton motive force more acidic than the matrix) (Fig.

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Glycogen synthase generic 4 mg detrol fast delivery, when not covalently modified is active, and can be designated glycogen synthase a or glycogen synthase I (the I stands for independent of modifiers for activity). When glycogen synthase is covalently modified, it is inactive, in the form of glycogen synthase b or glyco- gen synthase D (for dependent on a modifier for activity). REGULATION OF LIVER GLYCOGEN METABOLISM BY INSULIN AND GLUCAGON Insulin and glucagon regulate liver glycogen metabolism by changing the phosphory- lation state of glycogen phosphorylase in the degradative pathway and glycogen syn- thase in the biosynthetic pathway. An increase of glucagon and decrease of insulin during the fasting state initiates a cAMP-directed phosphorylation cascade, which results in the phosphorylation of glycogen phosphorylase to an active enzyme, and the A ATP P Glycogen phosphorylase b Glycogen phosphorylase a (inactive) (active) B ATP P Glycogen synthase I (or a) Glycogen synthase D (or b) (active) (inactive) Fig. The conversion of active and inactive forms of glycogen phosphorylase (A) and glycogen synthase (B). Note how the nomenclature changes depending on the phosphoryla- tion and activity state of the enzyme. CHAPTER 28 / FORMATION AND DEGRADATION OF GLYCOGEN 519 phosphorylation of glycogen synthase to an inactive enzyme (Fig. As a conse- With a deficiency of debrancher quence, glycogen degradation is stimulated, and glycogen synthesis is inhibited. GLUCAGON ACTIVATES A PHOSPHORYLATION CASCADE THAT degraded in vivo only to within 4 residues of CONVERTS GLYCOGEN PHOSPHORYLASE b TO GLYCOGEN the branchpoint. When the glycogen sam- PHOSPHORYLASE a ples were treated with the commercial preparation containing normal enzymes, Glucagon regulates glycogen metabolism through its intracellular second mes- one glucose residue was released for each senger cAMP and protein kinase A (see Chapter 26). However, in the patient’s cell membrane receptor, transmits a signal through G proteins that activates glycogen sample, with the short outer adenylate cyclase, causing cAMP levels to increase (see Fig. The catalytic subunits of protein kinase A are activated by the dissocia- -1,6 branch.

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The Endocrine System: Glands and Hormones 000 Unit V Circulation and Body Defense 000 13 purchase 4mg detrol amex. Body Defenses, Immunity, and Vaccines 000 Unit VI Energy: Supply and Use 000 18. The Urinary System 000 Unit VII Perpetuation of Life 000 23. Heredity and Hereditary Diseases 000 Glossary 000 Glossary of Word Parts 000 Appendices 000 Index 000 xix Contents Unit I Movement That Requires Cellular Energy How Osmosis Affects Cells THE BODY AS A WHOLE 000 Cell Aging 000 1 rganization of the Human Body 000 Cells and Cancer 000 Studies of the Human Body 000 Cancer Risk Factors 000 Levels of Organization 000 Body Systems 000 4 T issues, Glands, and Membranes 000 Metabolism and Its Regulation 000 Tissue Classification 000 Homeostasis 000 Epithelial Tissue 000 The Effects of Aging 000 Structure of Epithelial Tissue 000 Directions in the Body 000 Special Functions of Epithelial Tissue 000 Directional Terms 000 Glands 000 Planes of Division 000 Connective Tissue 000 Body Cavities 000 Soft Connective Tissue 000 Dorsal Cavity 000 Fibrous Connective Tissue 000 Ventral Cavity 000 Hard Connective Tissue 000 The Metric System 000 Muscle Tissue 000 Units of Length 000 Nervous Tissue 000 Units of Weight 000 The Neuron 000 Units of Volume 000 Neuroglia 000 Temperature 000 Membranes 000 Epithelial Membranes 000 2 Chemistry, Matter, and Life 000 Connective Tissue Membranes 000 Elements 000 Membranes and Disease 000 Atoms 000 Benign and Malignant Tumors 000 Molecules and Compounds 000 Benign Tumors 000 The Importance of Water 000 Malignant Tumors 000 Symptoms of Cancer 000 Mixtures: Solutions and Suspensions Diagnosis of Cancer 000 Chemical Bonds 000 Tissues and Aging 000 Ionic Bonds 000 Covalent Bonds 000 Compounds: Acids, Bases and Salts 000 The pH Scale 000 Buffers 000 Unit II Isotopes and Radioactivity 000 Use of Radioactive Isotopes 000 DISEASE AND THE FIRST LINE OF DEFENSE 000 Chemistry of Living Matter 000 Organic Compounds 000 5 Disease and Disease-Producing Organisms 000 Categories of Disease 000 Predisposing Causes of Disease 000 3 ells and Their Functions 000 The Study of Disease 000 The Role of Cells 000 Disease Terminology 000 Microscopes 000 Treatment and Prevention of Disease 000 Cell Structure 000 Complementary and Alternative Medicine 000 Plasma Membrane 000 Prevention of Disease 000 The Nucleus 000 Infectious Disease 000 The Cytoplasm 000 Modes of Transmission 000 Surface Organelles 000 Microbiology- The Study of Microorganisms 000 Cellular Diversity 000 Normal Flora 000 Protein Synthesis 000 Bacteria 000 Nucleic acids- DNA and RNA Viruses 000 Cell Division 000 Fungi 000 Stages of Mitosis 000 Protozoa 000 Movement of Substances Across the Plasma Parasitic Worms 000 Membrane 000 Roundworms 000 Movement That Does Not Require Cellular Energy 000 Flatworms 000 xxi xxii CONTENTS Microbial Control 000 Tumors 000 Microbes and Public Health 000 Infection 000 Aseptic Methods 000 Structural Disorders 000 Infection Control Techniques 000 Fractures 000 Antimicrobial Agents 000 Skeletal Changes in the Aging 000 Laboratory Identification of Pathogens 000 The Joints 000 Bacterial Isolations and Tests 000 More About Synovial Joints 000 Staining Techniques 000 Disorders of Joints 000 Other Methods of Identification 000 8 The Muscular System 000 6 The Skin in Health and Disease 000 Types of Muscle 000 Structure of the Skin 000 Smooth Muscle 000 Epidermis 000 Cardiac Muscle 000 Dermis 000 Skeletal Muscle 000 Subcutaneous Layer 000 The Muscular System 000 Accessory Structures of the Skin 000 Structure of a Muscle 000 Sebaceous (Oil) Glands 000 Muscle Cells in Action 000 Sudoriferous (Sweat) Glands 000 Energy Sources 000 Hair 000 Effects of Exercise 000 Nails 000 Types of Muscle Contractions 000 Functions of the Skin 000 The Mechanics of Muscle Movement 000 Protection Against Infection 000 Muscles Work Together 000 Protection Against Dehydration 000 Levers and Body Mechanics 000 Regulation of Body Temperature 000 Skeletal Muscle Groups 000 Collection of Sensory Information 000 Muscles of the Head 000 Other Activities of the Skin 000 Muscles of the Neck 000 Observation of the Skin 000 Muscles of the Upper Extremities 000 Color 000 Muscles of the Trunk 000 Lesions 000 Muscles of the Lower Extremities 000 Burns 000 Effects of Aging on Muscles 000 Tissue Repair 000 Muscular Disorders 000 Effects of Aging on the Integumentary System 000 Diseases of Muscles 000 Care of the Skin 000 Disorders of Associated Structures 000 Skin Disorders 000 Dermatitis 000 Psoriasis 000 Cancer 000 Unit IV Acne and Other Skin Infections 000 Alopecia (Baldness) 000 COORDINATION AND CONTROL 000 Allergy and Other Immune Disorders 000 9 The Nervous System: The Spinal Cord and Pressure Ulcers 000 Spinal Nerves 000 Role of the Nervous System 000 Structural Divisions 000 Functional Divisions 000 Unit III Neurons and Their Functions 000 Structure of a Neuron 000 MOVEMENT AND SUPPORT 000 Types of Neurons 000 7 The Skeleton: Bones and Joints 000 Nerves and Tracts 000 Bones 000 Neuroglia 000 Bone Structure 000 The Nervous System at Work 000 Bone Growth and Repair 000 The Nerve Impulse 000 Bone Markings 000 The Synapse 000 Bones of the Axial Skeleton 000 The Spinal Cord 000 Framework of the Skull 000 Structure of the Spinal Cord 000 Framework of the Trunk 000 The Reflex Arc 000 Bones of the Appendicular Skeleton 000 Medical Procedures Involving the Spinal Cord 000 The Upper Division of the Appendicular Skeleton 000 Diseases and Other Disorders of the Spinal Cord 000 The Lower Division of the Appendicular Skeleton 000 The Spinal Nerves 000 Disorders of Bone 000 Branches of the Spinal Nerves 000 Metabolic Disorders 000 Disorders of the Spinal Nerves 000 CONTENTS xxiii The Autonomic Nervous System (ANS) 000 12 The Endocrine System: Glands and Divisions of the Autonomic Nervous System 000 Hormones 000 Functions of the Autonomic Nervous System 000 Hormones 000 Hormone Chemistry 000 10 The Nervous System: The Brain and Cranial Hormone Regulation 000 The Endocrine Glands and Their Hormones 000 Nerves 000 The Pituitary 000 The Brain 000 The Thyroid Gland 000 Protective Structures of the Brain and Spinal Cord 000 The Parathyroid Glands 000 Cerebrospinal Fluid 000 The Adrenal Glands 000 The Cerebral Hemispheres 000 The Pancreas and Its Hormones 000 Functions of the Cerebral Cortex 000 The Sex Glands 000 Communication Areas 000 The Thymus Gland 000 Memory and the Learning Process 000 The Pineal Gland 000 The Diencephalon 000 Other Hormone-Producing Tissues 000 The Limbic System 000 Prostaglandins 000 The Brain Stem 000 Hormones and Treatment 000 The Midbrain 000 Hormones and Stress 000 The Pons 000 Aging and the Endocrine System 000 The Medulla Oblongata 000 The Cerebellum 000 Brain Studies 000 The Electroencephalograph 000 Unit V Disorders of the Brain and Associated Structures 000 Hydrocephalus 000 CIRCULATION AND BODY DEFENSE 000 Stroke and Other Brain Disorders 000 13 The Blood 000 Injury 000 Functions of the Blood 000 Degenerative Diseases 000 Transportation 000 Cranial Nerves 000 Regulation 000 Names and Functions of the Cranial Nerves 000 Protection 000 Disorders Involving the Cranial Nerves 000 Blood Constituents 000 Aging of the Nervous System 000 Blood Plasma 000 The Formed Elements 000 Hemostasis 000 11 The Sensory System 000 Blood Clotting 000 The Senses 000 Blood Types 000 Sensory Receptors 000 The ABO Blood Type Group 000 Special and General Senses 000 The Rh Factor 000 The Eye and Vision 000 Uses of Blood and Blood Components 000 Coats of the Eyeball 000 Whole Blood Transfusions 000 Pathway of Light Rays and Refraction 000 Use of Blood Components 000 Function of the Retina 000 Blood Disorders 000 Muscles of the Eye 000 Anemia 000 Nerve Supply to the Eye 000 Leukemia 000 Errors of Refraction and other Eye Disorders 000 Clotting Disorders 000 The Ear 000 Blood Studies 000 The Outer Ear 000 The Hematocrit 000 The Middle Ear and Ossicles 000 Hemoglobin Tests 000 The Inner Ear 000 Blood Cell Counts 000 Otitis and Other Disorders of the Ear 000 The Blood Slide (Smear) 000 Other Special Sense Organs 000 Blood Chemistry Tests 000 Sense of Taste 000 Coagulation Studies 000 Sense of Smell 000 Bone Marrow Biopsy 000 The General Senses 000 Sense of Touch 000 14 The Heart and Heart Disease 000 Sense of Pressure 000 Circulation and the Heart 000 Sense of Temperature 000 Location of the heart 000 Sense of Position 000 Structure of the Heart 000 Sense of Pain 000 The Pericardium 000 Sensory Adaptation 000 Special Features of the Myocardium 000 xxiv CONTENTS Divisions of the Heart 000 The Reticuloendothelial System 000 Blood Supply to the Myocardium 000 Disorders of the Lymphatic System and Lymphoid Function of the Heart 000 Tissue 000 Cardiac Output 000 Lymphedema 000 The Heart’s Conduction System 000 Lymphadenopathy 000 Control of the Heart Rate 000 Splenomegaly 000 Heart Sounds 000 Lymphoma 000 Heart Disease 000 Classifications of Heart Disease 000 17 Body Defenses, Immunity, and Vaccines 000 Congenital Heart Disease 000 Why Do Infections Occur? All are interdependent and work together as one tem are as follows (Fig. The nervous system serves as the chief coordinat- and spinal cord. Conditions both within and ◗ The peripheral (per-IF-er-al) nervous system (PNS) is outside the body are constantly changing. The nervous made up of all the nerves outside the CNS. It includes system must detect and respond to these changes all the cranial nerves that carry impulses to and from (known as stimuli) so that the body can adapt itself to the brain and all the spinal nerves that carry messages new conditions. The nervous system has been com- to and from the spinal cord. Functional Divisions Although all parts of the nervous system work in co- ordination, portions may be grouped together on the Functionally, the nervous system is divided according to basis of either structure or function. Any tissue or organ that carries out a command from the nerv- ous system is called an effector, all of Posterior view which are muscles or glands. The somatic nervous system is controlled voluntarily (by conscious Brain Cranial nerves will), and all its effectors are skeletal Central muscles (described in Chapter 8). The nervous system involuntary division of the nervous sys- Spinal tem is called the autonomic nervous cord system (ANS), making reference to its automatic activity. It is also called the visceral nervous system because it Peripheral nervous controls smooth muscle, cardiac mus- system cle, and glands, much of which make up the soft body organs, the viscera. The ANS is further subdivided into a sympathetic nervous system and a parasympathetic nervous system based on organization and how each affects specific organs.

Although the behavioral benefits of adrenal medullary tissue transplantation in animals were modest 1 mg detrol amex, early human investigations focused on transplantation of adrenal medulla cells. Direct stereotactic implantation of autologous adrenal medullary tissue into the caudate (29) and putamen (30) failed to show long-term changes. Revising the surgical procedure by placing the adrenal grafts into the intraventricular surface of the right caudate, Madrazo et al. Preopera- tively, Patient 1 was wheelchair-bound and had bilateral rigidity, bradykinesia, resting tremor, and speech impairment. At 5 months postsurgery, he was reported to be speaking more clearly, ambulating and performing routine activities independently, and had less tremor and virtually no rigidity or akinesia on either side. Improvement persisted, and at 10 months, the patient visited the clinic independently, was playing soccer Copyright 2003 by Marcel Dekker, Inc. Likewise, Patient 2, who was severely disabled prior to transplantation, exhibited impressive improvement at 3 months postsurgery, as he had no tremor, was ambulating independently, and was speaking clearly with almost normal facial expression (31). Both patients were able to discontinue antiparkinsonian medications postoperatively. Unfortunately, these results were not repli- cated by subsequent studies using the same techniques (32–34). Evaluation at 6 months postsurgery revealed that the mean duration of on time increased from 48 to 75%, on time without dyskinesias increased from 27 to 59%, and off time decreased from 53 to 25%. Off Unified Parkinson’s Disease Rating Scale (UPDRS) Activities of Daily Living (ADL) and Schwab and England scores showed significant improvement during off time. Off UPDRS motor subscale scores showed a trend toward improvement, while off Hoehn and Yahr scores did not change. Overall, the benefits observed in this study were quite modest compared to those of Madrazo et al.

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