This presentation looks at intraoperative monitoring of auditory evoked potential, somato sensory evoked potential and motor evoked potential, procedure, pitfalls and utility.
This presentation looks at intraoperative monitoring of auditory evoked potential, somato sensory evoked potential and motor evoked potential, procedure, pitfalls and utility.
oxygen requrement cmr and cerebral circulationBRAJENDRA VERMA
this titel for knowlage abt cerebral blood flow and effect for intrensic and extensic factor for control the ICP and CBF..this topic cover all about cerebral blood circulation and cmro2
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. • CBF = CPP/CVR
– CVR = Cerebral vascular resistance
• Under normal physiologic conditions,
– blood flow is regulated in the brain through changes in vascular
resistance.
– n = Blood viscosity
– L= vessel length
– r= radius of vessel
• CVR
– subject to dynamic changes in the contractile state of vascular
smooth muscle (VSM),
– most at the principal cerebral resistance vessels
• those that arise perpendicularly from the pial arteries on the brain surface
before penetrating the parenchyma.
• However, up to 50% of total CVR arises from smaller pial arteries (150 to
200 μm in diameter) and arteries of the circle of Willis.
3. Viscosity
• critical to cerebral perfusion in pathologic states of low blood flow.
• low blood flow may be due to
– is a decrease in arterial perfusion pressure or
– an increase in vascular resistance,
• Low blood flow decrease in shear stress causes an elevation in
the hematocrit. increased viscosity further retardation in blood
flow, vicious circle.
4. CBF AND ICP RELATIONS
• CBF and ICP are
– related by the Monro-Kellie doctrine, states that
• “Because the intracranial space is fixed and its principal
components,
• The brain parenchyma, blood, and CSF, are nearly incompressible,
• any change in the volume of one component must lead to a
reciprocal change in volume of the other components or ICP must
rise.”
– Cerebral blood volume (CBV) takes up a significant
proportion of intracranial volume.
• At any point in time, changes in CBV
– are determined by changes in arterial inflow relative to venous drainage
and are therefore reliant on CBF.
– So CBF has important role in management of ICP
5. REGULATION OF CBF
• On entering the brain parenchyma, cerebral arteries lose this ganglionic nerve
supply and instead acquire “intrinsic” innervation from parenchymal neurons.
– The best characterized intrinsic neural pathways that project to cortical blood vessels are those
from
• the nucleus basalis, locus caeruleus, and raphe nucleus.
– With electrical or chemical stimulation of these areas, increase or decrease in cortical CBF occur.
• There are three principal components in the regulation of CBF.
1. AUTOREGULATION
– changes in perfusion pressure are capable of producing marked changes in
CVR.
2. cerebral blood vessels changes in caliber in response to
– variations within certain ranges of partial pressure of carbon dioxide (PCO2)
and, to a lesser extent, partial pressure of oxygen (PO2).
3. Flow-metabolism coupling,
– the activity of the brain is linked to blood flow
– wherein changes in cerebral metabolism resulting from neural stimulation are
tied or “coupled” to corresponding changes in CBF.
6. VASOMEDIATORS
• NO
– Vasodilator
• EICOSANOIDS
– vasoconstrictors such as
• prostaglandin F2α and
• thromboxane A2,
– vasodilators such as:
• prostaglandin I2 (prostacyclin) and prostaglandin E2.
• ENDOTHELIUM DERIVED HYPER-POLARIZING FACTOR (EDHF)
– Complement NO in vasodilation
• ENDOTHELIN
• ADENOSINE
– Vasodilatation
– Neuroprotective in ischemia
• K+ Ions
– Perivasular conc. 3 to 15 mmol/L vasodilation
– >15 mmol/L vasoconstrictor
• H+ Ions
– vasodilatation
8. • Def:
– The brain maintains its regional and total blood flow (and therefore perfusion) at a fairly constant rate
over a wide range of systemic blood pressure by a vasomotor phenomenon known as cerebral
autoregulation.
• In normal individuals, CPP varies directly with MAP because ICP is constant.
• the brain is
– protected from fluctuations in perfusion over a MAP range of 60 to 150 mm Hg
– Beyond this limit CPP passively follows MAP.
• It is important to note that the limits of autoregulation
– are by no means invariable.
• For example,
– they may be right-shifted in
• chronic hypertension (associated with increased sympathetic tone) and in
– Left shifted in
• increased renin release; conversely, a left shift may be observed in sleep,
• “physiologic hypotension” in athletes,
• “pathologic hypotension” associated with hemorrhage, and the presence of angiotensin-converting enzyme
inhibitors,
• prolonged hypoxemia, or
• hypercapnia.
– disturbed in
• acute, severe hypotension or hypertension and
– Profoundly impaired or even abolished in
• severe cerebral ischemia,
• Arteriovenous malformation beds, or
• brain injury and
• after aneurysmal subarachnoid hemorrhage.
• The changes induced by autoregulation
– pial arteries indicate a time course ranging from 5 to 10 seconds.
9. • The precise mechanism not known.
• Proposed mechanisms include:
1. Intrinsic changes in VSM tone (myogenic hypothesis),
2. The release of a variety of vasoactive substances from the
endothelium (endothelial hypothesis) or
3. Periadventitial nerves (neurogenic hypothesis) in response to
changes in transmural pressure, and
4. the effect of circulating or local metabolites (metabolic
hypothesis).
• argues against a significant involvement of “metabolic”
– First : microdialysis measurements of the metabolites, normally do not change
in response to alteration in CPP.
– Second: the time course of autoregulation may be too rapid to
depend on the generation of metabolic products.
– Third : the autoregulatory response has been observed in isolated,
perfused vessels in vitro (i.e., not subject to the influences of neuroglial
metabolism).
10. MYOGENIC HYPOTHESIS
• Denotes key role to the inherent response of VSM to mechanical
stimulation.
– an increase in intraluminal pressure leads to increased
contraction,
– whereas a decrease in pressure leads to decreased contraction.
• VSM integrins
– serves as mechanotransducers through their physical associations
with the extracellular matrix, cytoskeleton,
– These peptides containing integrin-specific amino acid signaling
regulates VSM [Ca2+]i, the primary trigger for contraction, by
altering L-type Ca2+ current.
11. ENDOTHELIAL HYPOTHESIS
• An increase in flow rate and shear stress without
an increase in transmural pressure can induce
vasodilation
– most likely through the endothelial release of NO.
• It has been said that endothelium-dependent
arteriolar contractions can be demonstrated in
response to
– increased transmural pressure.
• Due to depression of EDRF release or an
• increase in EDCF release (or both).
12. NEUROGENIC HYPOTHESIS
• Denotes the resistance of cerebral blood vessels
– to release of neurotransmitters from perivascular nerve
fibers.
• The sources of cerebrovascular innervation may be
either
– extrinsic (i.e., from remote neurons) or
– intrinsic (i.e., involving local neurons)
• Nerve stimulation studies have demonstrated a
– functional correlation between electrical stimulation of
isolated arteries (even those subject to mechanical de-
endothelialization) and altered vasomotor tone.
13.
14. REGULATION OF CBF BY GASES
• 1. CO2
• Most important for physiological chemoregulation.
• PaCO2
– exerts profound effects on CBF,
– particularly across the physiologic range of 30 to 50 mm Hg
• hypercapnia (increased PaCO2) is found to cause
– cerebral vasodilation,
• whereas hypocapnia causes
– Cerebral vasoconstriction
• In fact, inhalation of 5% to 7% CO2 is associated with an
– almost exponential increase in CBF of 50% to 100%,
– thus rendering CO2 one of the most potent vasodilatory influences on the
cerebral circulation.
• When alterations in PCO2 have been sustained for 3 to 5 hours,
– there is an adaptive return of CBF toward baseline levels.
15.
16. • It is most likely that extracellular acidosis is the major
determinant of hypercapnic hyperemia.
– rather than intracellular acidosis or molecular CO2 itself.
• When PaCO2 increases molecular CO2 diffuses across the BBB
Perivascular PCO2 rises astrocytes convert the CO2 to HCO3− and
H+ via carbonic anhydrase increasing the extracellular or
perivascular concentration of H+ (i.e., there is a fall in local pH).
• There is no consensus on the mechanism or mechanisms linking
changes in extracellular pH to cerebral VSM tone
– Suggested explanations for the inconsistent data in adults are that NO may
have a permissive role in facilitating the action of other mediators
– or that multiple redundant pathways may interact in CO2 induced
vasodilation.
17. PaO2
• Important determinant of CVR and hence CBF.
• Increased Pao2 elicit CVR decrease CBF.
• Conversely, a fall in PaO2 vasodilation increased CBF.
• Response of CBF to PaO2 is a threshold phenomenon that is evident only
– when PaO2 falls below the normal physiologic range
• Hypoxia inhibits sarcoplasmic Ca2+ uptake stimulates the
production of EDRF (over EDCF) increases VSM relaxation
• Hypoxia also causes :
– alterations in cellular metabolism that lead to increased generation and
release of the vasoactive tissue factors K+, H+, and adenosine.
• Hypoxia-
– induces stimulation of oxygen-sensing neurons in the rostral
ventrolateral medulla may increase CBF via neurogenic vasodilation.
• Hypoxia
– If severe (PaO2 < 35 mmHg)
• Induces NO signaling and causes vasodilatation.
18.
19. CEREBRAL NEUROVASCULAR COUPLING
• Through research,
– Found that astrocytic end feet serving as individual vasoregulatory
units through neurotransmitter-evoked Ca2+-dependent signaling events.
• It has been demonstrated that arteriolar vasodilation occurs in a
time frame similar to the rise in astrocytic [Ca2+]i.
• Low PaO2
– astrocyte [Ca2+]i is elevated astrocyte glycolysis is maximized
extracellular accumulation of lactate and adenosine decreases
uptake of the vasorelaxant PGE2 from the ECS and block
astrocyte-mediated constriction,both of which facilitate
vasodilation.
• An additional hypothesis is that Ca2+ currents in astrocytic end-feet,
termed “transients” and not present in the soma of the cell, are
responsible for some aspects of neurovascular coupling.