The document discusses mechanosensation and the somatosensory system. It describes the basic organization, including labeled lines for different sensory functions. It outlines the peripheral mechanosensory elements like various receptor types, their locations and functions. It details the pathways for mechanosensation from the post-cranial body and face, including the dorsal column medial lemniscus system and trigeminal lemniscus pathway. It also discusses proprioception, muscle spindles, golgi tendon organs, and areas of the cortex involved in somatosensory processing.
BACK AND AUTONOMIC NERVOUS SYSTEM
EMBRYOLOGY
GROSS ANATOMY
PIA MATER, ARACHNOID, DURA MATER
ANATOMIC NERVOUS SYSTEM. SYMPATHETIC NERVOUS SYSTEM AND PARASYMPATHETIC NERVOUS SYSTEM.
BACK AND AUTONOMIC NERVOUS SYSTEM
EMBRYOLOGY
GROSS ANATOMY
PIA MATER, ARACHNOID, DURA MATER
ANATOMIC NERVOUS SYSTEM. SYMPATHETIC NERVOUS SYSTEM AND PARASYMPATHETIC NERVOUS SYSTEM.
09.22.08: Histology of the Peripheral Nervous SystemOpen.Michigan
Slideshow is from the University of Michigan Medical School's M1 Cells and Tissues Sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1CellsTissues
09.22.08: Histology of the Peripheral Nervous SystemOpen.Michigan
Slideshow is from the University of Michigan Medical School's M1 Cells and Tissues Sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1CellsTissues
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
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
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Functions of somatosensory system
shape and texture of objects that interact with our skin
prevention of possible injury
monitoring of the forces that are acting upon the body
proprioception (self awareness)
3. Basic organisation of somatosensory system
labeled lines (labeled line system)
mechanosensation; pain and temperature
two pairs of pathways (pair of pathways for the back of
the head and body; pair of pathways for the face)
4. Peripheral mechanosensory elements
Dorsal root ganglion cells are pseudomonopolar cells.
Axon bifurcates and grows in two directions: one direction grows out to the
body and other grows out to the spinal cord.
Peripheral process of pseudomonopolar cell is connected with specialised
receptor ending.
The mechanosensory central process of the pseudomonopolar axon enters the
dorsal root and makes a sharp upward bend and enters the dorsal column of
white matter.
The pain and temperature central process of pseudomonopolar axon enters the
dorsal horn and makes a synaptic connection.
6. Peripheral mechanosensory elements
Sensory
function
Receptor type Afferent axon type Axon diameter
(μm)
Conduction
velocity (m/s)
Proprioception Muscle spindle Ia, II (myelinated) 13-20 80-120
Touch Merkel, Meissner,
Pacinian, Ruffini
cells
Aβ (myelinated) 6-12 35-75
Pain,
temperature
Free nerve endings Aδ (myelinated) 1-5 5-30
Pain,
temperature,
itch
Free nerve endings
(unmyelinated)
C (unmyelinated) 0,2-1,5 0,5-2
7. Mechanosensation
Meissner corpuscle and Merkel-cell neurite complex are
responsible for light touch sensation.
Ruffini corpuscle is sensitive to stretch.
Pacinian corpuscles (encapsulated with many Schwann
cell lamellae) are sensitive to vibration
8. Afferent systems and their properties
Properties Small receptor field Large receptor field
Merkel Meissner Pacinian Ruffini
Location Tip of epidermal
sweat ridges
Dermal papillae (close to
skin surface)
Dermis and deeper tissues Dermis
Axon
diameter
7-11 μm 6-12 μm 6-12 μm 6-12 μm
Conduction
velocity
40-65 m/s 35-70 m/s 35-70 m/s 35-70 m/s
Sensory
function
Form and texture
perception
Motion detection, grip
control
Perception of distant
events through transmitted
vibrations, tool use
Tangential force,
hand shape, motion
direction
Effective
stimuli
Edges, points, corners,
curvature
Skin motion Vibration Skin stretch
Receptive
field area
9 mm2 22 m2 Entire finger or hand 60 mm2
Innervation
densitiy
100/cm 2 150/cm 2 20/cm2 10/cm2
Spatial
acuity
0,5 mm 3 mm 10+ mm 7+ mm
9. Muscle spindle, proprioception
It is formed by specialized muscle fibres and certain types of receptor endings
that innervate those specialized muscle fibres.
Muscle fibres within muscle spindle are called intrafusal muscle fibres.
Intrafusal muscle fibres have collection of nuclei that are bundled near the
centre of spindle shape.
Those muscle fibres have their contractile elements extending away from the
central region out to pole of the muscle spindle.
Group Ia afferent axons innervate the central region of muscle spindle and
group II afferent axons end in a flower spray ending on the contractile
elements.
11. Golgi tendon organ
Group Ib afferent axons innervate the junction of
the muscle fiber and the tendon.
Golgi tendon organ is sensitive on the muscle
force, while the muscle spindle is sensitive to
muscle stretching.
13. Ventral posterior complex of the thalamus
It is divided into two main nuclei:
•ventral posterior lateral nucleus
(somatosensory pair of pathways from
posterior part of the head and body)
•ventral posterior medial nucleus
(somatosensory pair of pathways from face)
15. Primary somatosensory cortex (S1) somatotopy
Areas 1, 2, 3a and 3b (Broadmann´s areas).
Representation of contralateral somatosensation of foot is in the area
of paracentral lobule.
Expansive representation for contralateral hand is in the S-shape area
of the central sulcus.
The face is conveyed by inputs from the ventral posterior medial
nucleus of the thalamus which terminates in the inferior segment of
the postcentral gyrus, below the S-shape bend of the central sulcus.
17. Cortical magnification
How much more does cortical
circuits magnify the
representation of the body that
is related to the density of
peripheral receptors and the
density of neurons at all the
antecendent stations in the
somatic sensory pathway.
18. Primary somatosensory cortex (S1) somatotopy
Area 3a is concerned with proprioceptors (muscle spindle, golgi tendon
organ, joint receptors) and proprioception.
Area 3b is concerned with cutaneous receptors.
Area 1 is going to respond to complex stimuli activating multiple skin
surfaces.
Area 2 is concerned with the shapes of objects that we encounter.
19. Secondary somatosensory cortex
Secondary somatosensory cortex is in the inferior and
posterior aspect of the parietal lobe and recieves inputs
from primary somatosensory cortex.
Informations are then passed to amygdala and
hippocampus (creation of memories).
All areas project to secondary somatosensory cortex, but
area 2 also projects to parietal areas 5 and 7 (orientation
relative to the environment).
22. Two pairs of somatosensory
pathways
Post-cranial body:
posterior part of the head
and body below the head
Dorsal column
medial lemniscal
system:
mechanical stimuli
Anterolateral
system: pain and
temperature
Face and anterior portion
of the head
Pathway through
the principal
sensory trigeminal
complex nucleus:
mechanical stimuli
Pathways through
the spinal
trigeminal
complex nucleus:
pain and
temperature
23. Dorsal column medial lemniscus system, mechanosensation
from the post-cranial body
First order neuron is dorsal root ganglion neuron in the spinal cord.
Central process enters the dorsal column in the white matter and runs
the longitudinal length of the spinal cord.
Dorsal column nuclei in the dorsal part of tegmentum of medulla
oblongata: synapses for the second order neuron.
Axons of the second order neuron cross the midline.
Third order neuron is in the ventral posterior lateral nucleus of the
thalamus.
24. First order
neuron:
dorsal root
ganglion
neuron
Dorsal column
of the spinal cord
Second
order
neuron:
dorsal
column
nuclei in the
tegmentum
of medulla
Crossing the midline
Third order
neurons:
ventral
posterior
lateral nucleus
of the
thalamus
Dorsal column medial lemniscus system: mechanosensation from the post-cranial body.
www.bioon.com
Second order neurons
are in cuneate nucleus
and gracile nucleus.
Internal arcuate fibers are crossing
the midline.
After
crossing
the
midline,
fibres
continue
as medial
lemniscus.
Postcentral
gyrus
Fibers from gracile tract
(lower extremity) project to the
paracentral lobule.
Fibers from cuneate tract (upper
extremity) project to the middle
of the postcentral gyrus.
25. Trigeminal lemniscus pathway or V-lemniscus,
mechanosensation from the face
First order neuron is the ganglion cell in the trigeminal ganglion.
Axons enter the brainstem through the trigeminal nerve.
Second order neuron is in the principal sensory trigeminal complex nucleus.
Second order axon crosses the midline and ascends the remaining divisions of the brain
stem, the upper pons and the midbrain and enters the ventral posterior complex of the
thalamic nuclei.
This pathway is trigeminal lemniscus and it is near the medial edge of the medial
lemniscus.
Third order neuron is in the ventral posterior medial nucleus.
Third order neuron projects to the inferior one third of the postcentral gyrus.
26. Trigeminal lemniscus pathway: mechanosensation from face and anterior portion of the head.
First order
neuron:
trigeminal
ganglion
Second
order
neuron:
principal
sensory
trigeminal
complex
nucleus Axons cross the midline.
Axons
continue
ascending
as
trigeminal
lemniscus.
Third order
neuron:
ventral
posterior
medial
thalamic
nucleus.
Inferior one third of
postcentral gyrus
27. Cerebellum
It helps to facilitate agile movements of the body and agile movements of
thoughts.
The cerebellum gets inputs from the cortex about what we are trying to do.
The cerebellum gets feedback from our sensory systems about what we are
actually doing.
If there is a problem, the cerebellum will generate an error signal that is sent
back into our motor system for an adjustment (correction can be made).
28. Spinocerebellar pathways: dorsal spinocerebellar tract
Receptor is for example proprioceptor in skin of the foot.
The first order neuron is in the dorsal root ganglion of the spinal cord.
First order axon enters the dorsal column and ascends to the thoracic
spinal cord (from lower extremity).
Clarke´s nucleus is in the intermediate gray matter of the thoracic
spinal cord: synapse occurs with first order axon.
Clarke´s nucleus extends throughout the thoracic spinal cord and then
to the upper lumbar levels of the spinal cord.
29. Spinocerebellar pathways: dorsal spinocerebellar tract
Clarke´s nucleus gives rise to a second order axon that ascends in the dorsal
lateral white matter of the spinal cord.
This is dorsal spinocerebellar tract.
The dorsal spinocerebellar tract ascends to the cerebellum via the inferior
cerebellar peduncle.
This is the pathway for lower extremity.
30. Spinocerebellar pathway for upper extremity
From the upper extremity, first order axons ascend in
the dorsal column.
From the dorsal column fibres interact with external
cuneate nucleus in medulla oblongata
From external cuneate nucleus second order axons
project to the cerebellum.