Largest part of hind brain.
Called “ silent area/Little Brain ”
Weight- 150 gms.
Cerebellar cortex is a large folded sheet, each fold is called Folium.
Connected to brain stem by 3 pairs of peduncles- Superior (Brachium conjunctiva), Middle (Brachium Pontis) & Inferior (Restiform body) peduncle.
Largest part of hind brain.
Called “ silent area/Little Brain ”
Weight- 150 gms.
Cerebellar cortex is a large folded sheet, each fold is called Folium.
Connected to brain stem by 3 pairs of peduncles- Superior (Brachium conjunctiva), Middle (Brachium Pontis) & Inferior (Restiform body) peduncle.
BRAINSTEM
The Brainstem lies at the base of the brain and the top of the spinal cord.
The brainstem is located in the posterior cranial fossa.
The brainstem is the structure that connects the cerebrum of the brain to the spinal cord and cerebellum.
Provides a pathway for tracts running between higher and lower neural centers.
Divided into 3 major divisions:
midbrain,
pons, and
medulla oblongata.
It is responsible for many vital functions of life, such as breathing, consciousness, blood pressure, heart rate, and sleep.
It contains many critical collections of white and grey matter.
The grey matter within the brainstem consists of nerve cell bodies and form many important brainstem nuclei. Ten of the twelve cranial nerves arise from their cranial nerve nuclei in the brainstem.
The white matter tracts of the brainstem include axons of nerves traversing their course to different structures. These tracts travel both to the brain (afferent) and from the brain (efferent) such as the somatosensory pathways and the corticospinal tracts, respectively.
Mid Brain
The midbrain is continuous with the cerebral hemisphere.
The upper posterior (i.e. rear) portion of the midbrain is called the tectum, which means "roof."
The surface of the tectum is covered with four bumps representing two paired structures: the superior and inferior colliculi.
The superior colliculi are involved in eye movements and visual processing, while the inferior colliculi are involved in auditory processing.
Another important nucleus, the substantia nigra, is located here.
The substantia nigra is rich in dopamine neurons and is considered part of the basal ganglia.
Pons
An important pathway for tracts that run from the cerebrum down to the medulla and spinal cord, as well as for tracts that travel up into the brain.
It also forms important connections with the cerebellum via fibre bundles known as the cerebellar peduncles.
Posteriorly, the pons and medulla are separated from the cerebellum by the fourth ventricle.
Home to several nuclei for cranial nerves.
Medulla
The point where the brainstem connects to the spinal cord.
Contains a nucleus called the nucleus of the solitary tract that is crucial for our survival (receives information about blood flow, along with information about levels of oxygen and carbon dioxide in the blood, from the heart and major blood vessels).
When this information suggests a discordance with bodily needs (e.g. blood pressure is too low), there are reflexive actions initiated in the nucleus of the solitary tract to bring things back to within the desired range.
Blood Supply
The brain stem receives its blood supply exclusively from the posterior circulation, including the vertebrae and basilar artery.
The medulla receives its blood supply from the vertebral via medial and lateral perforating arteries.
The pons and midbrain receive their blood from the basilar via the medial and lateral perforating arteries.
Thalamus-Anatomy,Physiology,Applied aspectsRanadhi Das
Thalamus is a very important relay station.
All general and special sensory impulses (except smell) & afferent impulses from RAS are integrated here.
Thalamus however is the center of pain and protopathic sensations.
It has other non sensory functions as well, like motor control, sleep, wakefulness.
It is the largest structure deriving from the embryonic diencephalon, the posterior part of the forebrain situated between the midbrain and the cerebrum.
The thalamus is part of a nuclear complex structured of 4 parts, the hypothalamus, epithalamus, prethalamus (formerly called ventral thalamus) and dorsal thalamus.
BRAINSTEM
The Brainstem lies at the base of the brain and the top of the spinal cord.
The brainstem is located in the posterior cranial fossa.
The brainstem is the structure that connects the cerebrum of the brain to the spinal cord and cerebellum.
Provides a pathway for tracts running between higher and lower neural centers.
Divided into 3 major divisions:
midbrain,
pons, and
medulla oblongata.
It is responsible for many vital functions of life, such as breathing, consciousness, blood pressure, heart rate, and sleep.
It contains many critical collections of white and grey matter.
The grey matter within the brainstem consists of nerve cell bodies and form many important brainstem nuclei. Ten of the twelve cranial nerves arise from their cranial nerve nuclei in the brainstem.
The white matter tracts of the brainstem include axons of nerves traversing their course to different structures. These tracts travel both to the brain (afferent) and from the brain (efferent) such as the somatosensory pathways and the corticospinal tracts, respectively.
Mid Brain
The midbrain is continuous with the cerebral hemisphere.
The upper posterior (i.e. rear) portion of the midbrain is called the tectum, which means "roof."
The surface of the tectum is covered with four bumps representing two paired structures: the superior and inferior colliculi.
The superior colliculi are involved in eye movements and visual processing, while the inferior colliculi are involved in auditory processing.
Another important nucleus, the substantia nigra, is located here.
The substantia nigra is rich in dopamine neurons and is considered part of the basal ganglia.
Pons
An important pathway for tracts that run from the cerebrum down to the medulla and spinal cord, as well as for tracts that travel up into the brain.
It also forms important connections with the cerebellum via fibre bundles known as the cerebellar peduncles.
Posteriorly, the pons and medulla are separated from the cerebellum by the fourth ventricle.
Home to several nuclei for cranial nerves.
Medulla
The point where the brainstem connects to the spinal cord.
Contains a nucleus called the nucleus of the solitary tract that is crucial for our survival (receives information about blood flow, along with information about levels of oxygen and carbon dioxide in the blood, from the heart and major blood vessels).
When this information suggests a discordance with bodily needs (e.g. blood pressure is too low), there are reflexive actions initiated in the nucleus of the solitary tract to bring things back to within the desired range.
Blood Supply
The brain stem receives its blood supply exclusively from the posterior circulation, including the vertebrae and basilar artery.
The medulla receives its blood supply from the vertebral via medial and lateral perforating arteries.
The pons and midbrain receive their blood from the basilar via the medial and lateral perforating arteries.
Thalamus-Anatomy,Physiology,Applied aspectsRanadhi Das
Thalamus is a very important relay station.
All general and special sensory impulses (except smell) & afferent impulses from RAS are integrated here.
Thalamus however is the center of pain and protopathic sensations.
It has other non sensory functions as well, like motor control, sleep, wakefulness.
It is the largest structure deriving from the embryonic diencephalon, the posterior part of the forebrain situated between the midbrain and the cerebrum.
The thalamus is part of a nuclear complex structured of 4 parts, the hypothalamus, epithalamus, prethalamus (formerly called ventral thalamus) and dorsal thalamus.
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.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. INTRODUCTION
Basal ganglia - Another accessory
motor system.
Function- in association with the
cerebral cortex & corticospinal motor
control system.
Input- From the Cerebral Cortex.
Output- Back to the Cortex.
3. BASAL GANGLIA
Collection of masses of gray matter
situated within each cerebral hemisphere.
They are paired & located between
thalamus and white matter.
Consist of 5 pairs of nuclei: These are
Caudate nucleus
Putamen
Globus pallidus
Substantia nigra
Subthalamic nucleus.
12. PUTAMEN CIRCUIT
Inputs -mainly from those parts of
brain adjacent to primary motor cortex.
Output- mainly go back to the Primary
motor cortex or closely associated
premotor & supplementary cortex.
13. Abnormal Functions in Putamen
Circuit
Athetosis – spontaneous & writhing
movements of a hand, an arm, the
neck or the face. It is due to lesion in
Globus pallidus.
Hemiballismus- lesion in the
Subthalamus leads to sudden flailing
movements of an entire limb.
14. Abnormal Functions in Putamen
Circuit
Chorea – Multiple small lesions in the
putamen leads to flicking movements
in the hands, face, & other parts of the
body called Chorea.
Parkinson’s Disease- lesions of
Substantia nigra leads to a common &
extremely severe disease of rigidity,
akinesia & tremors.
15.
16.
17. Caudate Circuit- Cognitive
Control
Cognition – Thinking process of the
brain using sensory input to the brain
plus information already stored in
memory.
Most of our motor actions occurs as a
consequence of thoughts generated in
the mind, a process called cognitive
control of motor activity.
Caudate nucleus plays a major role in
this cognitive control of motor activity.
18. Caudate Circuit- Cognitive
Control
The neural connections b/w caudate
nucleus & corticospinal motor control
system are different from those of
putamen circuit.
As Caudate nucleus extends into all
the lobes of the cerebrum, beginning
anteriorly in the frontal lobes, then
passing posteriorly through the
parietal & occipital lobes & finally
curving again like the letter “C” into the
Temporal lobes.
19. Caudate Circuit- Cognitive
Control
Inputs- Associated areas of the
cerebral cortex overlying the caudate
nucleus, areas that integrate diff types
of sensory & motor information into
usable thought patterns.
After the signals pass from the
cerebral cortex to the caudate
nucleus, they are next transmitted to
the internal Globus pallidus, then to
the relay nuclei of the VA & VL
thalamus.
20. Caudate Circuit- Cognitive
Control
Output- And from thalamus back to the
Prefrontal, Premotor & supplementary
motor areas of the cerebral cortex but
with none of the signals passing directly
to the primary motor cortex.
Instead the returning signals go to those
accessory motor regions in the premotor
& supp. motor areas that are concerned
with putting together sequential patterns
of movt. Lasting 5 or more seconds
instead of exciting individual muscle
movt. Eg. Person seeing a lion
21. Functions of Basal Ganglia
2 imp. capability of the brain in
controlling movements are
1) To determine how rapidly the movt. is
to be performed. i.e timing of
movement.
2) To control how large the movt. will
be? Scaling of movement.
For ex: writing a letter “a”.
22. Functions of Basal Ganglia
In patients with severe lesions of basal
ganglia these timing & scaling
functions are poor.
In this also basal ganglia works
inconsistent with the cerebral cortex.
Posterior parietal cortex is the locus of
spatial coordinates for motor control of
all parts of the body.
Lesion of this area leads to Agnosia.
Inability to perceive objects through
normally functioning sensory
23. Functions of Basal Ganglia
Personal neglect syndrome.
Caudate circuit of the basal ganglia
systems functions mainly with
association areas of the cerebral
cortex such as the posterior parietal
cortex, so timing and scaling of movt.
are functions of this caudate
cognitive motor control circuit.
25. Functions of Specific
Neurotransmitter substances
1)Dopamine pathways from the
Substantia nigra to the Caudate nucleus
& Putamen.
2)Gamma aminobutyric acid(GABA)
pathways from the caudate nucleus &
putamen to Globus pallidus & Substantia
nigra.
3)Acetylcholine pathway from the Cortex
to the Caudate nu & Putamen.
4)Multiple general pathways from the
brain stem that secrete NE, Serotonin,
26. Functions of Specific
Neurotransmitter
4)Multiple general pathways from the
brain stem that secrete NE, Serotonin,
Enkephalin etc.
5) Glutamate pathways- That provide
most of the Excitatory signals that
balances the large inhibitory signals.
GABA- Inhibitory negative feedback
loops.
Dopamine- Inhibitory neurotransmitter
in most parts of the brain.
29. PARKINSON’S DISEASE
It is a clinical syndrome resulting from
damage to the Basal Ganglia.
Paralysis agitans results from
widespread destruction of that portion
of Substantia nigra(the pars
compacta) that sends dopamine-
secreting nerve fibers to the caudate
nucleus & putamen & is characterized
by rigidity, tremors & akinesia.