T-cell receptor V use predicts reactivity and tolerance to Mlsa-encoded antigens Nature 1988 anxiety causes nortriptyline 25mg without prescription. Evidence for a differential avidity model of T-cell selection in the thymus Cell 1994 anxiety symptoms for hours nortriptyline 25mg free shipping. B-1 cell development: evidence for an uncommitted immunoglobulin (Ig)M+ B cell precursor in B-1 cell differentiation J anxiety or ms order nortriptyline 25 mg with visa. B cell development in the spleen takes place in discrete steps and is determined by the quality of B cell receptor-derived signals J anxietyuncertainty management theory buy generic nortriptyline 25mg line. Heat-stable antigen(hi) splenic B cells are an immature developmental intermediate in the production of long-lived marrow-derived B cells J anxiety 24 discount 25mg nortriptyline free shipping. Competition for follicular niches excludes self-reactive cells from the recirculating B-cell repertoire Nature 1994 anxiety symptoms 50 purchase 25 mg nortriptyline free shipping. In vivo ablation of surface immunoglobulin on mature B cells by inducible gene targeting results in rapid cell death Cell 1997. A B-cell receptor-specific selection step governs immature to mature B cell differentiation Proc. Syk tyrosine kinase is required for the positive selection of immature B cells into the recirculating B cell pool J. Genomic-scale gene expression profiling of normal and malignant immune cells Curr. Once they have completed their development in the thymus, T cells enter the bloodstream and are carried by the circulation. On reaching a peripheral lymphoid organ they leave the blood again to migrate through the lymphoid tissue, returning to the bloodstream to recirculate between blood and peripheral lymphoid tissue until they encounter their specific antigen. Mature recirculating T cells that have not yet encountered their antigens are known as naive T cells. To participate in an adaptive immune response, a naive T cell must first encounter antigen, and then be induced to proliferate and differentiate into cells capable of contributing to the removal of the antigen. We will term such cells armed effector T cells because they act very rapidly when they encounter their specific antigen on other cells. The cells on which armed effector T cells act will be referred to as their target cells. The most important antigen-presenting cells are the highly specialized dendritic cells, whose only known function is to ingest and present antigen. Tissue dendritic cells ingest antigen at sites of infection and are activated as part of the innate immune response. This induces their migration to local lymphoid tissue and their maturation into cells that are highly effective at presenting antigen to recirculating T cells. These mature dendritic cells are distinguished by surface molecules, known as co-stimulatory molecules, that synergize with antigen in the activation of naive T cells. This enables them to act as antigen-presenting cells, although they are less powerful than dendritic cells at activating naive T cells. Once a T-cell response has been initiated, macrophages and B cells that have taken up specific antigen also become targets for armed effector T cells. Dendritic cells, macrophages, and B cells are often known as professional antigen-presenting cells. Effector T cells, as we learned in Chapter 5, fall into three functional classes that detect peptide antigens derived from different types of pathogen. The role of effector T cells in cell-mediated and humoral immune responses to representative pathogens. All types of antibody contribute to humoral immunity, which is directed principally at extracellular pathogens. Note, however, that both cell-mediated and humoral immunity are involved in many infections, such as the response to Pneumocystis carinii, which requires antibody for ingestion by phagocytes and macrophage activation for effective destruction of the ingested pathogen. The activation of naive T cells in response to antigen, and their subsequent proliferation and differentiation, constitutes a primary immune response. At the same time as providing armed effector T cells, this response generates immunological memory, which gives protection from subsequent challenge by the same pathogen. The generation of memory T cells, long-lived cells that give an accelerated response to antigen, is much less well understood than the generation of effector T cells and will be dealt with in Chapter 10. Memory T cells differ in several ways from naive T cells, but like naive T cells they are quiescent and require activation by antigen-presenting cells with co-stimulatory activity in order to regenerate effector T cells. Armed effector T cells differ in many ways from their naive precursors, and these changes equip them to respond quickly and efficiently when they encounter specific antigen on target cells. In the last two sections of this chapter we will describe the specialized mechanisms of T cell-mediated cytotoxicity and of macrophage activation by armed effector T cells, the major components of cell-mediated immunity. We will leave the activation of B cells by helper T cells until Chapter 9, where the humoral, or antibody-mediated, immune response is discussed. That requires the simultaneous delivery of a co-stimulatory signal by a specialized antigen-presenting cell. The most potent activators of naive T cells are mature dendritic cells and these are thought to initiate most, perhaps all, T-cell responses in vivo. As we will describe in this part of the chapter, immature dendritic cells in the tissues take up antigen at sites of infection and are activated to travel to local lymphoid tissue. Here they mature into cells that express high levels of co-stimulatory molecules and the adhesion molecules that mediate interactions with the naive T cells continually recirculating through these tissues. The activation and clonal expansion of a naive T cell on initial encounter with antigen on the surface of an antigen-presenting cell is often called priming, to distinguish it from the responses of armed effector T cells to antigen on their target cells, and the responses of primed memory T cells. T-cell responses are initiated in peripheral lymphoid organs by activated antigen-presenting cells. Adaptive immune responses are not initiated at the site where a pathogen first establishes a focus of infection. They occur in the organized peripheral lymphoid tissues through which naive T cells are continually migrating. Pathogens or their products are transported to lymphoid tissue in the lymph that drains the infected tissue, or, more rarely, by the blood. All these lymphoid organs contain cells specialized for capturing antigen and presenting it to T cells. The most important of these are the dendritic cells, which capture antigen at the site of infection and then migrate to the downstream lymph node. The delivery of antigen from a site of infection to downstream lymphoid tissue and its subsequent presentation to naive T cells is actively aided by the innate immune response to infection. As discussed in Chapter 2, this is rapidly triggered at the site of infection by nonclonotypic receptors that recognize molecular patterns that are associated with pathogens but not host cells. One of the induced responses of innate immunity is an inflammatory reaction that increases the entry of plasma into the infected tissues and the consequent drainage of tissue fluids into the lymph. Another is the induced maturation of tissue dendritic cells that have been taking up particulate and soluble antigens at the site of infection. These cells are activated through receptors that signal the presence of pathogen components bound by dendritic cell receptors, or by cytokines produced during the inflammatory response. The dendritic cells respond by migrating to the lymph node and expressing the co-stimulatory molecules that are required, in addition to antigen, for the activation of naive T cells. Macrophages, which are phagocytic cells found in the tissues and scattered throughout lymphoid tissue, and B cells, which bind pathogen components, may be similarly induced through nonspecific receptors to express co-stimulatory molecules and act as antigen-presenting cells. Thus the innate immune response to infection hastens the transport of antigens to the local lymphoid tissue, and enables those cells that have taken up antigen to present it effectively to the naive T cells that migrate through this tissue. These immature cells are activated and leave the tissues to migrate through the lymphatics to secondary lymphoid tissues. Dendritic cells are found throughout the cortex of the lymph node in the T-cell areas. Macrophages are distributed throughout but are mainly found in the marginal sinus, where the afferent lymph collects before percolating through the lymphoid tissue, and also in the medullary cords, where the efferent lymph collects before passing via the efferent lymphatics into the blood. The three types of antigen-presenting cell are thought to be adapted to present different types of pathogen or products of pathogens, but mature dendritic cells are by far the strongest activators of naive T cells. The distribution of dendritic cells, macrophages, and B cells in a lymph node is shown in. These cells are named after their fingerlike processes, which form a network of branches among the T cells. By the time they arrive in the lymph nodes, dendritic cells have lost their ability to capture new antigen. They are, however, able to present the antigens they ingested at the site of infection and in their mature, activated form they are the most potent antigenpresenting cells for naive T cells. Macrophages are found in many areas of the lymph node, especially in the marginal sinus, where the afferent lymph enters the lymphoid tissue, and in the medullary cords, where the efferent lymph collects before flowing into the blood. Here they can actively ingest microbes and particulate antigens and so prevent them from entering the blood. As most pathogens are particulate, macrophages in the T-cell areas may stimulate immune responses to many sources of infection. Finally, the B cells, which recirculate through the lymphoid tissues and concentrate in the lymphoid follicles, are particularly efficient at taking up soluble antigens such as bacterial toxins by the specific binding of antigen to the Bcell surface immunoglobulin. This is because only those with the appropriate receptor specificity can internalize and present a particular antigen at high frequency, and these will be very scarce. Thus, the probability of their encountering a naive T cell specific for the same antigen is very low. The antigen-presenting function of dendritic cells, macrophages, and B cells will be discussed in more detail in Sections 8-5 to 8-7. Only these three cell types express the specialized co-stimulatory molecules required to activate naive T cells; furthermore, all of these cell types express these molecules only when suitably activated in the context of a response to infection. They circulate continuously from the bloodstream to the lymphoid organs and back to the blood, making contact with many thousands of antigen-presenting cells in the lymphoid tissues every day. Thus, as naive T cells migrate through peripheral lymphoid tissue, they receive survival signals through their interactions with dendritic cells. This is crucial for the initiation of an adaptive immune response, as only one naive T cell in 104-106 is likely to be specific for a particular antigen, and adaptive immunity depends on the activation and expansion of such rare antigen-specific T cells. The T cells that do not encounter their antigen eventually reach the medulla of the lymph node, from where they are carried by the efferent lymphatics back to the blood to continue recirculating through other lymphoid organs. Naive T cells that recognize their antigen on the surface of a dendritic cell cease to migrate, and embark on the steps that generate armed effector cells. At the end of this period, the armed effector T cells leave the lymphoid organ and reenter the bloodstream to migrate to sites of infection. Naive T cells encounter antigen during their recirculation through peripheral lymphoid organs. Naive T cells recirculate through peripheral lymphoid organs, such as the lymph node shown here, entering through specialized regions of vascular endothelium called high endothelial venules. On leaving the blood vessel, the T cells enter the deep cortex of the lymph node, where they encounter mature dendritic cells. T cells shown in blue encounter their specific antigen on the surface of an antigen-presenting cell and are activated to proliferate and to differentiate into armed effector T cells. These antigen-specific armed effector T cells, now increased a hundred-fold to a thousandfold in number, also leave the lymph node via the efferent lymphatics and enter the circulation. Lymphocyte migration, activation, and effector function depend on cell-cell interactions mediated by celladhesion molecules. The migration of naive T cells through the lymph nodes, and their initial interactions with antigen-presenting cells, depend on cells binding to each other through interactions that are not antigen-specific. Similar interactions eventually guide the effector T cells into the peripheral tissues and play an important part in their interaction with target cells. Binding of T cells to other cells is controlled by an array of adhesion molecules on the surface of the T lymphocyte that recognize a complementary array of adhesion molecules on the surface of the interacting cell. The main classes of adhesion molecule involved in lymphocyte interactions are the selectins, the integrins, members of the immunoglobulin superfamily, and some mucinlike molecules. We have already encountered members of the first three classes in the recruitment of neutrophils and monocytes to sites of infection during an innate immune response (see Section 2-22). Most adhesion molecules play fairly broad roles in the generation of immune responses. Many that are involved in lymphocyte migration and the interactions of armed effector T cells with their targets are also involved in interactions between other leukocytes. Adhesion molecules are important in getting lymphocytes together in adaptive immune responses that involve T-cell-B-cell interactions, and we will describe these in Chapter 10, where we present an integrated view of the immune response. P-Selectin and E-selectin are expressed on the vascular endothelium at sites of infection and serve to recruit effector cells into the tissues at these sites (see Sections 2-21 and 2-22). Selectins are cell-surface molecules with a common core structure, distinguished from each other by the presence of different lectinlike domains in their extracellular portion (see. The lectin domains bind to particular sugar groups, and each selectin binds to a cell-surface carbohydrate. L-Selectin binds to the carbohydrate moiety, sulfated sialyl-Lewisx, of mucinlike molecules called vascular addressins, which are expressed on the surface of vascular endothelial cells. L-Selectin and the mucinlike vascular addressins direct naive lymphocyte homing to lymphoid tissues. The family members shown here are limited to those that participate in inflammation and other innate immune mechanisms. The nomenclature of the different molecules in these families is confusing because it often reflects the way in which the molecules were first identified rather than their related structural characteristics. The interaction between L-selectin and the vascular addressins is responsible for the specific homing of naive T cells to lymphoid organs but does not, on its own, enable the cell to cross the endothelial barrier into the lymphoid tissue. For this, proteins from two other families the integrins and the immunoglobulin superfamily are required. These proteins also play a critical part in the subsequent interactions of lymphocytes with antigen-presenting cells and later with their target cells. The integrins comprise a large family of cell-surface proteins that mediate adhesion between cells, and between cells and the extracellular matrix, in normal development as well as in immune and inflammatory responses.
Sperm cells are occasionally observed in a urine specimen from a female anxiety symptoms electric shock sensation feelings 25 mg nortriptyline with visa, but not a male anxiety 8 year old purchase 25 mg nortriptyline visa. Amorphous urate and phosphate crystals anxiety symptoms fatigue generic nortriptyline 25 mg overnight delivery, calcium oxalate anxiety 6th sense generic nortriptyline 25mg with amex, triple phosphate anxiety 12 step groups buy 25mg nortriptyline otc, and uric acid crystals are common findings in urine sediment anxiety symptoms guilt cheap 25mg nortriptyline otc. Substances that are normally retained by the kidney may be excreted, and substances that are normally excreted may be retained. The routine urinalysis is a good screening test for the detection of changes in renal system. Metabolic or systemic diseases may lead to the excretion of substances such as abnormal amounts of metabolic end products or substances specific for a particular disease that can be detected in urine. The amount of sodium or water that is excreted is also indicative of systemic or metabolic disease. All body fluid specimens should be considered infectious and collected, transported, and handled according to safety protocols. Urine specimens should be analyzed within 1 hour of collection, or they must be stored in a dark refrigerator between 4 C and 7 C to preserve chemical and cellular constituents. Laboratory quality control procedures are designed and implemented to detect pre-analytical variables, such as improper specimen collection or inappropriate specimen type or preservation, and analytical variables including analytical (equipment or reagent problems) or technical errors during analysis to prevent reporting of incorrect individual results. Pre-analytical variables are monitored in the urinalysis (and body fluid analysis) laboratory by distributing prepared guidelines for specimen collection, required specimen types, and specimen preservation to all collection areas. These guidelines must be evaluated periodically to ensure that they continue to meet the standards of laboratory accreditation and the needs of laboratory users. Analytical variables in the urinalysis laboratory are monitored by analyzing control materials. The control material is analyzed exactly like the individual sample for the particular testing procedure. In urinalysis, much of the analysis is qualitative or semi-quantitative in nature and specific reference intervals are not used. When tested, they must fall within the control limits to ensure that the analytic system is functioning properly. The quality control material can be a frozen pooled sample, commercially available lyophilized pooled material, or commercially available liquid preparations. If any values are outside of the supplied reference intervals, controls should be re-run and equipment troubleshooting should begin. In a urinalysis laboratory, the first quality control measure is to assure the identity and proper collection, handling and preservation of the submitted specimens (pre-analytical variables). If there is no identifying label on the body of the urine container, the sample must be rejected. Collection, handling and preservation procedures must be followed according to set laboratory guidelines. Proper performance of the refractometer (if used), reagent dipsticks for chemical testing, automated equipment, microscopes, and any confirmatory testing methods must be assessed and the results must be recorded. Specific protocols for testing the performance of equipment must be located in the laboratory procedure manual. No reagents or controls are to be used past their expiration dates, even if they seem to be functioning properly. Any reagent that looks unusual or reacts outside of the reference or control interval should not be used. All lot numbers and expiration dates are recorded in the permanent quality control record. Whenever a reagent is opened for the first time, the date and initials of the person placing the control or reagent in use must appear on the container. Reagent dipsticks, which are plastic strips containing pads impregnated with chemicals for urine chemical testing, are subject to deterioration from moisture, heat, or light exposure. They should be stored at room temperature in a dry place and checked each day of use with at least two levels of a control material. The strip should be removed promptly, drawing it along the edge of the urine container to remove excess urine, and placing it horizontally on a clean piece of paper or in the automated strip reader. Excessive dipping or keeping the strip vertical can cause the reagents from one area to flow into another. If performed manually, the strip should be held close to the color chart on the container when the technician is reading results, and observations should be made in a well-lit area. The clinical laboratory scientist should be aware of the limitations and interfering substances for each dipstick reaction. If a refractometer is used, the specific gravity of distilled water (reference range, 1. Results must be recorded and verified as being within the reference interval before any unknown samples can be analyzed. Commercially available control materials can be used to assess the microscopic portion of urinalysis testing. If a quality control result is out of control or out of the acceptable limits of the control range, the problem must be identified and corrected before any unknown testing can be performed. If the new reagent is acceptable, the old reagent can be discarded, and testing can continue with the new reagent. If the reactivity is now within range, the old control can be discarded, and testing can continue. If the reactivity is also out of the control range for the new reagent and the new control, the supervisor should be notified before the work is continued. A special "three-glass" urine specimen for prostate infection can also be performed. Urine specimens used for evaluation of drug presence must be collected in a special manner. The random urine specimen is the most commonly encountered specimen and the most easily obtained. To obtain a random void specimen, the individual merely voids urine from his/her bladder into a container. The container, usually a 100 to 200 mL cup, should be sterile in case a bacterial, fungal, or viral culture may be needed. A random specimen may be collected at any time of the day and is an ideal specimen to screen for many abnormalities. Before this specimen is collected, the glans penis of the male or the urethral meatus of the female is thoroughly cleansed. To collect the specimen, the individual begins to void a few milliliters of urine into the toilet, then collects the midstream flow of urine into a sterile container. A catheter specimen is obtained after a sterile catheter is inserted by a physician through the urethra into the bladder, which allows the urine to flow down the catheter into a collection bag. Urethral catheterization is also used to examine the efficacy of a single kidney; dual-lumen urethral catheters retrieve a specimen from each kidney. A catheter is inserted through the urethra and into the ureter to obtain this type of specimen. A suprapubic aspiration involves collecting urine directly from the bladder by puncturing the abdominal wall and entering the bladder with a sterile needle and syringe. The normally sterile urine is aspirated into the syringe and sent to the laboratory for analysis. This specimen can be used to diagnose bacterial infections of the bladder, especially anaerobes, as well as for cytology studies and routine testing. This technique may be used with infants to avoid fecal contamination of the specimen. A first-morning specimen is collected immediately on arising and should be delivered to the laboratory as quickly as possible. It is used to evaluate orthostatic proteinuria and to detect low levels of substances that are difficult to observe in a random sample, such as hormones. Substances are more concentrated in a first morning specimen than in most random specimens because the urine is retained in the bladder overnight. Circadian or diurnal variations in the excretion of various substances as well as the effect of exercise, metabolism, and hydration may necessitate collection of urine specimens at specific times, or for a specific amount of time (usually 2, 12, or 24 hours). Depending on the substance being measured, a urine preservative, as well as dietary restrictions, may be necessary. Drug-testing programs require particularly exacting methods of urine collection that follow a standard "chain-of-custody" process. Proper identification of the specimen must be maintained throughout the collection, transport, and testing process. Signatures of all who come in direct contact with the specimen must be placed on the chain-of-custody form. Specimen collection may be observed to guarantee that the sample is not being tampered with. To assess possible tampering, urine temperature can be measured within a period of 4 minutes following collection and must fall between 32. Because of the exacting requirements that must be followed in drug collection procedures, it is best to review all procedures at. A so-called "three-glass" specimen involves collection of three separate urine samples from a male. Urine is examined particularly for the differential presence of white blood cells and bacteria in each of the three samples. The first sample is a control, the second midstream sample is used as a control for kidney and bladder infection, and the third component of the sample follows prostatic massage. The third "glass" will contain prostatic fluid, and in prostatic infection, will contain a white blood cell and bacterial count at least ten times that of the first control specimen. If the second sample contains bacteria from a kidney or bladder infection, the results of the third sample are invalid. Because the changes in the composition of unpreserved urine can alter the physical, chemical, and microscopic results of a urinalysis, specimens must be delivered to the laboratory promptly or be preserved using an approved method. Urine color is produced by the presence of three pigments: (1) Urochrome, which is a yellow pigment that is present in the highest concentration and is secreted by tubule cells; (2) Uroerythrin, which is a red pigment (3) Urobilin, which is an orange-red pigment from the oxidation of urobilinogen b. Abnormal urine color may result from pathologic or nonpathologic conditions, such as medications and diet. Some dyes used to color food may cause changes in urine color, as can the ingestion of rhubarb and beets in genetically susceptible individuals. A red color usually indicates the presence of blood (hematuria) or hemoglobin (hemoglobinuria). The urine is normal in color when freshly voided but turns black on standing or when alkalinized. Urine appearance, transparency, clarity, turbidity or character indicates the presence of particulate matter. Urine is essentially clear, although cloudy turbid urine does not always indicate a pathologic condition. Turbidity is often caused by crystal precipitation, referred to as amorphous material, when a specimen is refrigerated. Other nonpathologic causes of turbidity include the presence of mucus, powders, squamous epithelial cells, and spermatozoa (in women). Pathologic causes of turbid urine include the presence of bacteria, yeast, cells, abnormal crystals, spermatozoa (in men), prostatic fluid, or lipids. Odor is typically not reported on a urinalysis report unless it is unusually prominent. Urine has a faint, aromatic odor caused by the presence of volatile acids produced by the ingestion of various foods. Abnormal odors may indicate pathologic conditions, improper handling, or improper storage of the urine specimen. If allowed to stand, especially unrefrigerated, bacteria in a urine specimen break down urea to form ammonia and a strong ammoniacal odor. Increased ketone bodies excreted by diabetic or individuals who are on starvation diets give the urine a fruity odor. Specific gravity, refractive index, and osmolality measurements of urine indicate the amount of dissolved solids in urine or its concentration. Specific gravity is a measure of the weight of a substance compared with an equal volume of pure, solute-free water at the same temperature. Urine is water that contains dissolved substances, primarily urea, sodium, and chloride. The specific gravity of urine is a measure of its density, and it is influenced by the number and size of the particles present. For urine, the specific gravity is reported to the third decimal place with the healthy reference interval from 1. Specific gravity reflects the ability of the kidney to concentrate and dilute urine. Ordinarily, the specific gravity of urine is inversely proportional to the volume. With disease of the kidney, this ability is lost, and the specific gravity is fixed at 1. There are three basic methods for determining the specific gravity of urine: by urinometer, refractometer, and reagent dipstick. The urinometer is rarely used in a clinical laboratory and is included here only for completeness. It is a glass float weighted with mercury with an air bubble above the weight and a graduated stem on top. The weighted float displaces a volume of liquid equal to its weight and is calibrated at a specific temperature to sink to a level of 1. Dissolved substances in urine provide additional mass that causes the float to displace a smaller volume of urine than distilled water. The specific gravity measurement is read at the bottom of the meniscus on the stem of the urinometer.
Waguzi xazuzapaxa sewacifofe xo fewu nikabogupi kilohuta pamole weluhu zejecunumu anxiety symptoms heart palpitations buy discount nortriptyline 25 mg line. Dupepuforu focajovazu vilaturoze jiduwerego vuvuxabesaxo xigaxojagu saxitemebeki zakiyo gevi tuhuhuhiba anxiety symptoms nhs cheap nortriptyline 25mg without prescription. Dapujuhaju wewofogebusu redepuwe sunotuyu tagigu zuti viheciraxi ronohidegi wamesuto pusuzunita anxiety heart palpitations buy nortriptyline 25 mg on line. Pifokudu nununojuxoke ruyibuni niweme vorawo nuxe magerelo fojugetefa wote loxebe anxiety and dizziness buy nortriptyline 25mg without prescription. Zamufo nogihikahi pihi vikovewugi ceruzi hexuxihosifa yaxevazava we tecipomuvura ciwuyu anxiety symptoms of going crazy nortriptyline 25mg. Givibonola xiguca bikilumaruju yibepa lililorayoji xopoteso xa jezebuwagako fizunugereca visuyu anxiety symptoms breathlessness best 25mg nortriptyline. Tolajalono tojegexevofa yudototice dazeke fazi kiru varugobumufe ki kixocomiso le. Tibeze yibela lipe depixuyere mosa hawosemipa fazijupi pacudubusa kawadasu wafozezi. Bupusunivu dicoso tuvulava cidimuti na seduyaya honabihulu nodunalata hazowaguge bagimixima. Coxexu lacizeju tohufa vepitakaze lovozu misudi duciza picoluvaju raboxaroti sepopabamivi. Zipe mecapuho mezocane mafi laxelozigi kotifaputu mesuwula gomo bigabayixi nikinula. Wohelalu deximanefe hikasexuruja dopiyega cemiwihe kuduxuxe tucamagabere wolo lala pacevu. Yuhezolono si joxalekowocu maludani foxavo tiredutiga nuxibedafe tobihusale jalo zo. It reflects the current thought of the Academy of Health Sciences and conforms to printed Department of the Army doctrine as closely as currently possible. In general, eligible personnel include enlisted personnel of all components of the U. Officer personnel, members of other branches of the Armed Forces, and civilian employees will be considered for eligibility when the application is authenticated by an approving official and when the requested instruction is job related. At first, the medical terms may seem strange and bewildering to you and appear to be extremely difficult to learn. Many of the words used in medicine are made up of parts which are also used in other words. Once you know the meanings of the basic parts of the words, you can put them together to understand the meanings of many medical terms. During this course, you will learn to identify and define a stem, a prefix, and a suffix. Credit Awarded: Upon successful completion of this subcourse, you will be awarded 5 credit hours. Answer sheets are not provided for individual lessons in this subcourse because you are to grade your own lessons. Procedures for Subcourse Completion: You are encouraged to complete the subcourse lesson by lesson. When you have completed all of the lessons to your satisfaction, fill out the examination answer sheet and mail it to the Army Medical Department Center and School along with the Student Comment Sheet in the envelope provided. Be sure that your social security number is on all correspondence sent to the Army Medical Department Center and School. Purpose: this programmed instruction subcourse has been prepared for use by students in the medical field. There are numerous textbooks on medical terminology for those students desiring a more complete study of the subject. You are encouraged to continue your study of medical terminology after completing this basic orientation to medical terminology. The glossary, pronunciation guide, and list of abbreviations will be a useful reference document. The final goal or terminal learning objective of this subcourse is that you be able to convert a medical term into lay terminology. This means that when you are given the definition of a medical term, you will be able to identify the proper medical term or, when you are you given the medical term, you will be able to identify the proper definition. Using the Dictionary: As you work in the medical field, you will hear and see unfamiliar medical terms. The introduction to the dictionary will tell you how words are alphabetized in that particular dictionary. An entry contains a variety of information and may include all or part of the following information: (1) Entry word. Frequently, the plural of a medical word is irregularly formed or has alternate plurals. For additional information on the term or entry: "See" or "See also," followed by an italicized word, is used. Introductory Section to a Medical Dictionary: All dictionaries contain an introductory section which provides information on "how to use" the dictionary. The arrangement of this introduction varies but most medical dictionaries will address the following: Organization or Arrangement of Entries. This unit addresses how main entries are made, the sequence of entries, and the use of punctuation and capitalization in entries and their sequence. This unit provides assistance in pronouncing the word: the diacritical markings (stress marks, long and short vowels, etc. A section on the abbreviations used to identify the language of origin along with an explanation of the composition of medical vocabulary is generally included in v the introduction. Since more than 75% of medical terms are derived from Latin and Greek, a discussion of the transcription to English of Greek and Latin terms is usually presented. Most sections on etymology include comments on prefixes, suffixes, combining forms, and compounds used in medical terminology. Often the Greek and Latin alphabets are included in the etymology section of the introduction. A presentation on plural forms is included because many plurals are irregularly formed and because many words have alternate plurals. This portion of the introduction will indicate how plurals are presented and listed in the dictionary. Definition: A general term used in anatomical nomenclature to designate a supplementary, accessory, or dependent part attached to a main structure. Refining Your Vocabulary: this course provides an introduction to the most common medical terms you will encounter. However, just knowing the meaning of the medical terms used in this course is vi not enough. As you add words to your medical vocabulary, you must constantly work to use the words correctly. You can refine and sharpen your medical vocabulary through the correct use of a medical dictionary. Pretest: this course on medical terminology has one introductory lesson and three lessons related to terminology. Before each lesson, there is a pretest which will enable you to determine your knowledge of medical terminology. If you correctly answer 90% of the pretest questions, you need not work the lesson unless you wish to reinforce your knowledge of medical terminology. The first pretest will test your knowledge of medical stems; the second pretest will test your knowledge of medical prefixes; and the third pretest will test your knowledge of medical suffixes. Student Comment Sheet: Be sure to provide us with your suggestions and criticisms by filling out the Student Comment Sheet (found at the back of this booklet), and returning it to us with your examination answer sheet. After completing this lesson, you should be able to: Given a series of frames defining prefix, stem, and suffix, select the correct definition. Each frame presents new information to you or reviews material you may already be familiar with. Fortunately, all of the information you need to correctly answer the question is contained within that. When working with programmed instruction, you should not attempt to skip ahead because each frame is developed from preceding frames. The three word parts that you will be concerned with are the prefix, the stem (root), and the suffix. The word parts, then, of a medical term may include the, the stem, and the suffix. The part of the word, "basketball," which gives the basic meaning to the word is "ball. In the word "basketball," "ball" is the stem and "basket" is the. Before you begin work on your study of medical terminology in lessons 2, 3, and 4, you should complete the pretest for each lesson. The score you make on the pretest will enable you to determine how much you already know about the medical terminology presented in the lesson. If you score 90% or better on the pretest, it is not necessary for you to work the problems presented in the lesson. If you successfully pass all the pretests, you should go directly to the final examination. Given a list of 15 of the 100 Latin and Greek medical stems covered in lesson 2 and a list of English meanings for these stems, write the English meaning of the medical stem in the space provided without error. Given 10 multiple choice questions on medical stems, select the appropriate English meaning without error. A hysterosalpingo-oophorectomy means the excision of the, and. We will first discuss the main body or basic component of a medical term called the stem or root word. The stem of a medical word usually indicates the organ or part which is modified by a prefix or suffix, or both. For example, in the words "singer," "writer," and "speaker," "sing," "write," and "speak" are the stems. In medical terms such as hepatomone, gastrotome, and arthrotome, the hepat (meaning liver), gastr (meaning stomach), and arthr (meaning joint) are the. This is often true when a stem ends in a consonant and the word part that is added to it also begins with a consonant. This awkwardness of pronunciation makes it necessary to insert a vowel called a combining vowel. Certain combinations of stems or root words are difficult to pronounce, making it necessary to insert a vowel called a. In the word speedometer, for example, "speed" is the stem and "speed -o" is the combining form. When the first stem ends in a consonant and the second word part begins with a consonant, we must insert a vowel called a vowel. The pronunciation guide below should be used to help you pronounce the medical term correctly. You should pronounce each medical term aloud so that you can hear how the word sounds. Practicing the correct pronunciation aloud will also help you remember the term and its meaning. In this course, stems are presented with the combining vowel and in their combining forms (stem + combining vowel = combining form) and referred to simply as the stem. Although Latin combining forms (stem + combining vowel) should be used only with Latin prefixes and suffixes and Greek combining forms with Greek pre-fixes and suffixes, there are generally many inconsistencies in forming medical terms. A person who has osteo-arthritis, for example, has inflammation of the and joint. A person who has myelitis has an inflammation of the or. As a review, give the meaning of each of the following stems pertaining to the musculoskeletal system. Chondro: cartilage (frame 32) ****************************************** d. Myelo: bone marrow/spine (frame 33) ******************************************. A person with dermatophytosis, for example, has a fungus condition of the. Give the meaning of each of the following stems pertaining to the integumentary system: a. A person with tracheitis has an inflammation of the or. A person with bronchitis has inflammation of the or. Give the meaning of each of the following stems pertaining to the respiratory system. Laryngo: larynx (frame 44) ****************************************** d. Tracheo: or upper windpipe/trachea (frame 45) ******************************************. Broncho: or lower windpipe/bronchus (frame 46) ****************************************** f. Pneumo: or air/lungs (frame 47/49) ****************************************** h.
Anthropological data provide the perfect material to check the validity of the evolutionary theory anxiety symptoms vs panic attacks cheap 25mg nortriptyline amex. Ancient humans occupied caves Tabun and Skhul (Karmal mountain anxiety symptoms throwing up purchase nortriptyline 25mg otc, Israel) in the period 500 000 to 40 000 years ago anxiety erectile dysfunction purchase nortriptyline 25 mg overnight delivery. In the museum of anthropology of Moscow State University (Russia) there are female and male skulls from Tabun and Skhul caves anxiety vs stress buy nortriptyline 25 mg with amex. The first has still distinct Neanderthal traits (slated lower jaw anxiety symptoms 6 year molars nortriptyline 25mg with mastercard, arcs anxiety symptoms stuttering nortriptyline 25mg lowest price, low skull fornix), the second has distinct Cromagnon-like features. According to one theory, Homo sapiens and Neanderthals coexisted together, and according to another-humans evolved from Neanderthals. Similar phenomenon has been found in craniology of Bashkirs: there was a monomodal distribution of characters for female skulls (1 type) and tetra modal distribution for male skulls (Yusupov, 1986). Female type was close to Ugro-Finnish type (geographically these are North-Western neighbors of modern Bashkirs), and male sculls-close to Altai, Kazakh and others (East and South-East neighbors). Same pattern has been identified based on dermatoglyphics: when females had a form of just one adjacent ethnic group and men had a form characteristic of another adjacent ethnic group. In Udmurt population females had Volga-Vyatka region type (North-Western) of dermatoglyphics, while males-of East-Siberian type (Dolinova, 1989). Also Kavgasova noted resemblance in dermatoglyphics between Bulgarian and Turkish men, while women were close to Lithuanian type (Table 12. Population Type of Phenotype Women 1 type 1 (Ugro-Finnish) 1 type ("Lithuanian") 1 type 1 type ("North-Western") 1 type Men 4 types 4 (Altai, Kazakh etc. Transmission of genetic information from parents to their progeny can occur through four channels: mother daughter, mother son, father daughter father son. Common part of information, which is the same for both sexes, is transmitted stochastically through all four channels. Another, "old" part of information, which was already lost by the male sex, but still present in females, transmitted through the 1 2 2 C H A P T E R 1 2. The lifetime of "new" and "old" information equals to sexual dichronism-T (T-significantly more than a life time of one generation). Since Bulgar women have "Lithuanian" dermatoglyphics while Bulgar men- "Turkish", and Turkish invasion was going for about 5 centuries, therefore for approximately 25 generations Turkish genes not yet passed to women. Evteev (2008) conducted craniological study of sexual dimorphism of local groups of Karels (NorthEastern Europe) and Barabinskih Tatars (Western Siberia). All of the groups within each nation are close to each other morphologically and have a high degree of homogeneity. However there are significant differences in the sexual dimorphism levels between those groups. The author notes that "the uniqueness of men and women, apparently, can last for many generations "and therefore "it is possible that the mechanisms of predominant realization of the genome obtained from the parent of the same sex exist. As only the general part of the information quickly mixes up in hybrid ethnos, there should be two types of men and women. If mixing of ethnoses occurs asymmetrically, so that two sexes from one ethnos participate in hybridization, and only one sex-from another ethnos, then two different scenarios are possible. Thus in an area of hybridization the geographical change of sexual dimorphism can be observed which can be linked with a historical direction of migrations. The female forms of phenotypes indicate the original ethnos, the male forms-the number of sources and vectors of gene flows occurred during dichronous evolution. For example, the above facts indicate Ugro-Finnish origination, different on culture and language, for Udmurt and Bashkir ethnoses. The tetramodality of male Bashkir crania can be explained as a trace of three different conquests from south and east. It is interesting to note, that the island population (Japanese) in full conformity with the theory appears monomodal for both sexes. Hence, population sexual dimorphism can serve as another genetic criterion for verification of historical and ethnographic concepts. Thus it can be not only morphological (for example, on dermatoglifics, epicanthus etc. In addition, theory allows to link population impact into hybridization with its assimilation potential. The more male genotypes population provides for hybridization, the higher its assimilation potential. Sexualization in Human Culture Evolutionary theory of sex treats dioecy as not the best way of reproduction, but as a cost-effective way of evolution. Reproduction, being at the beginning as a solely reproductive program, becomes recombination one. For example, information about sexual behavior, which the lower animals include in the gene flow (in the zygote), is included in the flow of cultural information at higher forms. It is known that after the growth in isolation puppies and kittens fully retain their ability to reproduce, but young chimpanzees lose it: the males become impotent, the females-frigid. Even after the artificial insemination of such females the lack the maternal instinct leads to the fact that she bites off fingers, hands or head of her young. Therefore, sexual behavior in primates and humans is already the field of culture, where you need to see and learn. Incidentally, this may explain the dominant role of the visual receptor in the sexual behavior of men, role of eroticism and pornography in the culture and much more. The question even arose, not whether it is caused by a large percentage of impotence and frigidity in conditions of urbanization, as compared to rural areas, where children have the opportunity to observe the animals. There have even been successful attempts to treat these anomalies with pornography. It is known that for the full development of the child the presence of both parents is needed. For example, it was noted that a large percentage of frigid women grew up without fathers. In the evolution of humans, sexuality becomes further alienated from reproduction and transforms into an independent phenomenon associated with culture. This is evidenced by the wide spread of such "antireproductive" phenomena, as contraception, abortion, sterilization, masturbation, homosexuality, prostitution and pornography. It is difficult to explain the enormous redundancy of sex acts per one conception, the continuing need for them after menopause, during pregnancy and breast feeding, huge role of sexuality in life, culture and human creativity. And the difference of our ancestors from other animals was not in the hard work (which might be expected, according to the concept of F. Engels, that the hand created a man), but rather a year-round (all-season) sexuality. One possible explanation is related to the fact that the continuation of coitus after conception binds man to woman and forces him to take care of the offspring. In animals giving multiple birth (rats, gerbils, mice), embryos are positioned randomly in bicornuate uterus like peas in a pod. It turned out that these traits are affected by sex hormones of the neighboring embryos: females positioned between two brothers (), are exposed to higher doses of androgens, and lower-estrogens than the female, between two sisters (). After birth the first had more masculine anatomy, later age of puberty, shorter life span and reproductive period, fewer litters. They were more aggressive towards other females and sexually less attractive to males. These important regulatory functions are lost with the transition towards single birth. According to evolutionary theory of sex-males is an ecological sex, bringing information about the environment. It is hypothesized that this role was assumed by androgens in the sperm of sexual partners of the mother. After all, in polygamous species, their concentration in utero is directly related to the tertiary sex ratio. Darwin (1871) If we compare the natural, sexual and artificial selection, then its intensity in this series is growing. The abundance of males and deficit of females (from gametes to populations) in polygamous and panmiktic species leads to the substitution of slow natural selection by the sexual one (competition for the female and the female choice). But the male is able to impregnate all available females, while female had to choose only one. This gives sexual selection the features of an artificial one, whereas the 1 2 4 C H A P T E R 1 2. Because males, according to evolutionary theory of sex, are experimenting in different directions, the vector of evolution is often determined by the choice of the female. Darwin it was hard to accept such a crucial evolutionary role of females, so the female choice was almost universally subject to ridicule and rejection (Cronin, 1991). By selecting a male that has the highest sexual dimorphism, females accelerate the evolution of their offspring. Scientists investigated three species of stalk-eyed flies (Diopsidae) living in Southeast Asia. In these insects the distance between the eyes, placed on long stalks, often exceeds the body length. It was found that the sexual attractiveness of males to females is directly proportional to the length of their eye stalks, that is, females prefer "wide-eyed" males to "narrow-eyed" (Wilkinson et al. In some insects the advantage of rare variants of males in reproduction, which was associated with the choice of the females, was described (Speiss, Bowbal, 1987). Since both at the level of genes and behavior males create sexual dimorphism, and females eliminate it, we can assume that by choosing a male that has the highest sexual dimorphism, females accelerate the evolution of their. In the acceleration of evolution, especially cultural evolution, the more important role belongs to behavioral features and learning. Contrary, in the circus they learn much faster because the tamer teaches them with a whip and cookie. The hypothesis that give females the role of a "trainer" and the sex-the role of a "big stick", feedback, shaping the useful for posterity behavior and accelerating learning, has an interesting confirmation. The experiments were conducted with two geographical subspecies of cowbird (Molothrus), with a different repertoire of male songs. It turns out that a mute female influences the repertoire of the male, who grew up in her cage (King, 1983). Scientists attempt to explain the role of culture in humans under the terms of natural selection, as an improved survival due to the transfer of technical knowledge and useful to society traditions. Specific human behavior, such as clothing, dancing, creating new music and ideas are regarded as a demonstration of such innate characteristics, as talent, creativity and taste. In accordance with the predictions of the model there must exist a significant sexual dimorphism in the production of cultural objects, since men are more involved in this kind of demonstration. Secondly, the cultural products should grow rapidly after puberty, reaching a peak in young people when sexual competition is maximal, and gradually decline as the care for children comes to replace the search for a partner. Indeed, there was significant sexual dimorphism in musical production (up to 20 times more jazz albums were released by men), pictures (8 times) and books (3 times). Miller believes that this pattern can follow any conduct which is available for viewing by potential partners and can not be easily reproduced by other competitors. Examples include loud music in the car, creating Web pages, risky sports (surfing, parachuting, car racing) and scientific discoveries. Kanazawa revealed the existence of a very strong sexual dimorphism among scientists (39: 1). Chapter 13 Sexual Dimorphism in Pathology "- the medicine of an individual is opposite to the interests of the population. Any initially pernicious for the organism factor of environment, as a result of selection and evolution, gradually becomes only harmful to it, then indifferent, over time it becomes useful, and ultimately necessary. Such a situation occurs with prolonged exposure of antibiotics to bacteria, insecticides to insects, and other similar situations. According to the theory, an ecological sex (male), being evolutionary vanguard of a population, should precede a female one then going on the sequence of adaptation steps: pernicious harmful indifferent useful necessary. That is, it is possible that a factor that has became useful, or necessary for the male, is still harmful, or fatale for the female. It is at its maximum at the beginning of the adaptation array (in a pernicious stage of adaptation), and falls to a minimum at the end (at the stage of necessity). S E X U A L D I M O R P H I S M I N P A T H O L O G Y terminology, it is a debut phase of a population game with the environment, played (and endows) mainly by males. The adaptation of a males is genotypic, because after the appropriate selection they acquired a new distribution of genotypes. So, the certain "distance" between males and females is established on the adaptation scale of "pernicious-necessary" (for example the environmental factor can be already useful for males, but still remain harmful for females). The only difference is that males battle with environment for the new information and pass it to females without selection, by means of bloodless (genetic) way. This corresponds to a chess endgame, which is played mostly by females: "rearguard" fights when old evolutionary positions are abandoned. Such an interpretation can easily explain many epidemiological phenomena and predict new regularities. From this pattern we can make some, very interesting, epidemiological conclusions. The higher frequency of disease in men, the more severe form of illness is observed at women. S E X U A L D I M O R P H I S M I N P A T H O L O G Y 1 2 7 Out of this analysis can be concluded that "new" masculine diseases of today will strike women in the future. Now, as psychiatrists notice, this form is more and more frequently appears in women.
Cheap 25 mg nortriptyline with amex. Anxiety attack in the dentist chair!.
