The process of voiding urine, known as micturition, involves the urinary bladder filling with urine and then emptying through contraction of the detrusor muscle and relaxation of the internal and external urethral sphincters. This is mediated by a micturition reflex initiated by stretch receptors in the bladder wall and regulated by spinal and brain centers. Voluntary control of micturition is achieved through inhibition or facilitation of the reflex by higher brain centers.
this presentation comprises of everything about the process of defecation and the defecation reflex and the nerve supply involved.
also discusses about the types of defecation reflexes and deals about them seperately in detail.
The basics of autoregulation of Gloemrular filtration rate. This ppt deals with basic renal physiology, tubuloglomerular feedback, myogenic reflex, juxtaglomerular apparatus and renin angiotensin aldosterone system in brief. P.S.- The ppt has animations so kindly view in slide/presentation mode
this presentation comprises of everything about the process of defecation and the defecation reflex and the nerve supply involved.
also discusses about the types of defecation reflexes and deals about them seperately in detail.
The basics of autoregulation of Gloemrular filtration rate. This ppt deals with basic renal physiology, tubuloglomerular feedback, myogenic reflex, juxtaglomerular apparatus and renin angiotensin aldosterone system in brief. P.S.- The ppt has animations so kindly view in slide/presentation mode
Micturition (The Guyton and Hall physiology)Maryam Fida
The process by which the urinary bladder empties when it becomes filled.
It is a reflex process
ANATOMY OF URINARY BLADDER BODY = in which urine is collected
NECK = funnel shaped extension and connecting with the urethra.
URETHRAL SPHINCTER.
1. INTERNAL URETHRAL SPHINCTER.
made up of detrusor muscle
2. EXTERNAL URETHRAL SPHINCTER.
made up of skeletal muscle fiber.
EXTERNAL URETHRAL SPHINCTER is responsible for voluntary control of micturition
The walls of the ureter contain smooth musle and are innervated by both sympathetic and parasympathetic nerves.
Parasympathetic stimulation increases peristaltic contraction .
Sympathetic stimulation inhibited MICTURITION REFLEX Filling of urinary bladder 300 – 400 ml
|
stimulation of sensory stretch receptors
present on the wall of bladder
|
Afferent impulses pass via pelvic nerve
|
reaches the sacral segments of spinal cord
|
synapses with postganglionic neuron
|
Efferent impulses via pelvic nerve
causes contraction of detrusor muscle
and relaxation of internal sphincter
|
flow of urine in to urethra and
stimulation of stretch receptors present
in urethra
|
it send afferent impulses via pelvic nerve
|
Inhibition of pudendal nerve
|
Relaxation of external sphincter
|
voiding of urine
Once a micturition begins ,, it is a “self regenerative “.
THAT IS,
the initial contraction of bladder
further activates the receptors to
causes still further increase in sensory
impulses from the bladder and urethra.
These impulses in turn further increases in reflex contraction of bladder.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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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.
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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2. Micturition
• Urinary bladder is temporary reservoir for urine
• When bladder become full & surroundings are
favorable for voiding urine ,subject passes urine
• The process of voiding urine is known as
micturition
3. Anatomy
• The urinary bladder is a smooth muscle chamber
composed of two main parts:
– (1) the body, the major part, collects urine
– (2) the neck, a funnel-shaped extension of the body,
passing inferiorly and anteriorly into the urogenital
triangle and connecting with the urethra
4. Body
Trigone (on the
posterior wall)
Neck
Smooth muscle of
the bladder
(detrusor muscle)
is arranged in
spiral, longitudinal
and circular
bundles. The
muscle bundles
pass on either side
of the urethra are
called the
internal
urethral
spincter. External urethral spincter
5. The bladder neck (posterior urethra) is 2 to 3 centimeters
long, and its wall is composed of detrusor muscle
interlaced with a large amount of elastic tissue. The
muscle in this area is called the internal sphincter.
6. • Beyond the posterior urethra, the urethra
passes through the urogenital diaphragm,
which contains a layer of muscle called the
external sphincter of the bladder.
7. Filling of the bladder
When urine collects in
the renal pelvis, the
pressure in the pelvis
increases. This increase
in the pressure initiates a
peristaltic contraction
beginning in the pelvis
and spreading downward
along the ureter to force
urine toward the bladder.
Peristaltic waves occur
1-5 times/minute
The walls of
ureters
contain
smooth
muscle
arranged in
spiral,
longitudinal
and circular
bundles.
8. The ureters pass obliquely through the detrusor
muscle and it passes little further underneath the
bladder mucosa. This oblique passage tends to
keep the ureters closed except during peristaltic
waves, preventing reflux of urine from the bladder.
9. In some people, the distance that the ureter courses
through the bladder mucosa is less than normal, so
that contraction of the bladder during micturition does
not always lead to complete occlusion of the ureter.
As a result some of the urine in the bladder is
propelled backward into the ureter. This is called
„Vesicoureteral reflux‟.
10. Ureterorenal reflex
The ureters are well supplied with pain nerve
fibers. When a ureter is blocked eg. by a ureteral
stone, there will be intense reflex constriction which
is associated with very severe pain.
These pain impulses cause a sympathetic reflex
back to the kidney to constrict the renal arterioles,
thereby decreasing urinary output from that kidney.
This effect is known as „Ureterorenal reflex‟.
12. Sympathetic nerve supply and Internal urethral sphincter
apparently play no role in micturition. They prevent reflux of
semen into the bladder during ejaculation.
Parasympathetic nerve supply
Sensory fibers in the pelvic nerve carry impulses from stretch
receptors present on the wall of the urinary bladder to the spinal
centre of micturition. Stimulation of parasympathetic efferent
fibers causes contraction of detrusor muscle leading to
emptying of urinary bladder.
Somatic nerve supply
This maintains the tonic contractions of the skeletal muscle
fibers of the external sphincter, so that this sphincter is
contracted always. During micturition this nerve is inhibited,
causing relaxation of the external sphincter and voiding of urine.
13. Innervation
Parasympathetic
Pre-glanglionic S2, S3, S4 unite to form Pelvic nerves
Post-ganglionic onto detrusor muscle & internal sphincter
Sympathetic
Pre-ganglionic L1, L2, L3
Post-ganglionic onto trigone, neck, & internal sphincter
Little to do with bladder contraction
o--------- o------------------------------------------
Ach NE
14. Innervation con’t…
Afferents (sensory nerves)
Pelvic nerve: impulses due to bladder fullness; micturition reflex;
pain impulses
Hypogastric nerve: pain impulses
Pudendal nerve: sensory impulses from urethra
Somatic Efferent (Pudendal nerve)
Impulses originate in S1 and S2; innervate external sphincter
Mediate voluntary control of micturition
16. • Internal sphincter
- detrusor muscle in the bladder neck whose
tone normally keeps the bladder neck and
posterior urethra empty of urine and
therefore prevents
emptying of the bladder until the pressure in
the main part of the bladder exceeds a
critical level
• External sphincter
- layer of voluntary skeletal muscle which
surrounds the urethra as it passes through
the urogenital diaphragm
- under voluntary control and can conciously
prevent urination even when involuntary
controls are attempting to empty the
bladder
17. Micturition Reflex
• As bladder fills sensory stretch receptors
send signals via pelvic nerves to sacral
segments of spinal cord.
• Parasympathetic stimulation of the bladder
smooth muscle via the same pelvic nerves
occurs.
• It is “self-regenerative”, subsides, then re-
generates again until the external
sphincter is relaxed and urination can
occur.
18. What is micturition?
Spinal cord reflex activity.
* facilitated or inhibited by higher centers
* voluntary facilitation or inhibition
19. The relationship between the volume of urine and pressure in
the urinary bladder (intravesical pressure) can be studied by
inserting a double lumen catheter and emptying the bladder.
Then the pressure is recorded by connecting one lumen of the
catheter to a suitable recording instrument while introducing
water or air through the other lumen. The graphical recording of
the pressure changes in the urinary bladder in relation to rise in
the volume of urine collected in it is called cystometrogram.
Cystometry is the technique used to demonstrate this
relationship.
20. Bladder Filling and Micturition
Bladder Filling:
1. Empty bladder: 0 pressure
2. 30 - 50 mls of urine 5 - 10 cm H2O
3. 50 - 300 ml little pressure change
4. With filling, increased
activity of external sphincter
(maintains continence, or control of
excretory functions)
5. > 300 - 400 ml discomfort;
leads to urgency
Start of Micturition:
1. As bladder fills, micturition (bladder)
contractions begin to appear
a. Last from a few seconds to more than
a minute
b. Pressure peaks (micturition waves)
may rise a few cm H2O to more than 100
cm H2O
c. Caused by micturition reflex
21. Cystometrogram
100 200 300 400
Intravesical volume (mL)
Intravesic
al
pressure
(cm of
Water)
80
60
40
20
0
0
Ia
Ib
22. Micturition Con’t…
2. Micturition reflex (does not need the
brain)
a. Filling stimulates sensory stretch
receptors
b. Afferent impulses in Pelvic nerve
c. Signal reflexively sent back to
bladder via efferent parasympathetic
fibers in the Pelvic nerve
d. Detrusor muscle contracts, then
relaxes
2. Micturition reflex - continued
e. As bladder fills, micturition reflex occurs
more frequently, with greater
contraction of bladder wall (positive
feedback loop)
f. Micturition powerful enough then
another signal is sent through
Pudendal nerve to inhibit external
sphincter (internal relaxes passively
when pressure is 20 - 40 cm H2O)
g. Voluntary relaxation of external
sphincter allows for urination
h. Flow thru urethra stimulates
parasympathic system, sustaining
bladder contraction
23. Micturition Reflex
• stretch reflex initiated by filling of the bladder with
urine which results in bladder wall contraction
• mediated by sensory stretch receptors in the
bladder wall,specially by receptors in the posterior
urethra
BLADDER
SPINAL CORD
(sacral segments)
Sensory stretch receptor
Detrusor muscle
PELVIC NERVE
(Sensory Fibers)
PELVIC NERVE
(Parasympathetic
Motor Fibers)
25. Filling of the bladder – partially filled
Reflex contractions
Acute increase in pressure
Contractions relax spontaneously
Pressure falls back to baseline
Bladder continues to fill
Reflex contractions – more frequently and powerful
Filling of the bladder ………..
26. Spinal centres of micturition which are present in scral and lumbar
segments are regulated by higher centres in the brain stem (Facilitatory
area in the pontine region and inhibitory area in the mid brain). The
threshold for the voiding reflex is adjusted by the activity of facilitatory
and inhibitory centres.
When the micturition is facilitated, perineal muscles and external urethral
sphincter are relaxed, the detrusor muscle contracts and urine passes out
through the urethra. During micturition, the flow of urine is facilitated by
increase in the abdominal pressure due to voluntary contractions of
abdominal muscles.
After urination, the female urethra empties by gravity. Urine remaining in
the urethra of the male is expelled by several contractions of the
bulbocavernosus muscle.
27. Stimulates
contraction of
detrusor muscle
Nerve endings
sensitive to
stretch
Spinal cord
Simple reflex control of micturition seen in infants.
The ability of voluntary control (inhibition) develops
at the age of 2 – 3 years.
28. Facilitation or Inhibition of
Micturition by the Brain
• The micturition reflex is a completely autonomic spinal cord reflex,
but it can be inhibited or facilitated by centers in the brain.
• These centers include
– (1) strong facilitative and inhibitory centers in the brain stem,
located mainly in the pons, and
– (2) several centers located in the cerebral cortex that are mainly
inhibitory but can become excitatory
29. • The micturition reflex is the basic cause of micturition,
but the higher centers normally exert final control of
micturition as follows:
– 1. The higher centers keep the micturition reflex
partially inhibited, except when micturition is desired.
– 2. The higher centers can prevent micturition, even if
the micturition reflex occurs, by continual tonic
contraction of the external urethral sphincter until a
convenient time presents itself.
– 3. When it is time to urinate, the cortical centers can
facilitate the sacral micturition centers to help initiate
a micturition reflex and at the same time inhibit the
external urethral sphincter so that urination can occur.
32. Voluntary Control of Micturition
1. Micturition reflex can be inhibited by:
a. Pons
b. Cerebral cortex
2. Voluntary contraction of external bladder sphincter means emptying can be delayed
even if a micturition reflex occurs (can go and stop voluntarily)
3. Voluntary emptying:
a. Contraction of abdominal muscles causes ↑ pressure in bladder
micturition reflex and inhibition of external sphincter
b. Voluntary relaxation of external sphincter
Problems:
Atonic Bladder
- destruction of sensory fibers
Traumatic spinal cord injury
Overflow incontinence.
Automatic Bladder
- spinal cord injury above sacral region
Micturition reflex is intact but
uncontrolled
33. Micturition Abnormalities
• Atonic Bladder - destruction of
sensory fibers
–Traumatic spinal cord injury
–Overflow incontinence.
• Automatic Bladder - spinal cord
injury above sacral region
–Micturition reflex is intact but
uncontrolled
34. Abnormalities of micturition
1.Atonic bladder
This is due to destruction of sensory nerve fibers from
urinary from the bladder. When the dorsal sacral roots are
interrupted by diseases of the dorsal roots such as tabes
dorsalis or when there is crush injury to sacral segments of
spinal cord, person looses bladder control (abolition of
reflex contractions of the bladder). Bladder muscle looses
the tone (hypotonic) and becomes flaccid). Bladder fills to
the capacity and overflows few drops at a time through the
urethra (overflow incontinence or overflow dribbling).
35. 2. Automatic bladder (Spastic neurogenic
bladder)
During spinal shock after complete transection of spinal
cord above sacral centres of micturition, the urinary
bladder looses its tone and becomes flaccid and
unresponsive. So, the bladder is completely filled, and later
urine overflows by dribbling. After the spinal shock has
passed, the voiding reflex returns although there is no
voluntary and higher centre control.
Whenever, the bladder is filled with some amount of urine,
there is automatic evacuation of the bladder.
36. 3. Uninhibited neurogenic bladder
Due to a lesion in some parts of brain stem
(interrupting most of the inhibitory signals), there is
continuous excitation of
spinal micturition centres by the higher centres. There
is uncontrollable micturition. Even a small quantity of urine
collected in bladder will elicit the micturition reflex
increasing the frequency of micturition.
37. Nocturnal micturition (Bed wetting)
This is normal in infants and children below 3 years. It
occurs due to incomplete myelination of motor nerve fibers
of the bladder resulting loss of voluntary control of
micturition .