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The Purkinje fibers have a fast inherent conduction rate order avanafil 200mg amex, and the electrical impulse reaches all of the ventricular muscle cells in about 75 ms (see Figure 19 buy generic avanafil 50mg on-line. Since the electrical stimulus begins at the apex buy avanafil 100 mg with visa, the contraction also begins at the apex and travels toward the base of the heart generic 200 mg avanafil overnight delivery, similar to squeezing a tube of toothpaste from the bottom. Membrane Potentials and Ion Movement in Cardiac Conductive Cells + Action potentials are considerably different between cardiac conductive cells and cardiac contractive cells. Conductive cells contain a series of sodium ion channels that allow a normal and slow influx of sodium ions that causes the membrane potential to rise slowly from an initial value of −60 mV up to about –40 mV. The resulting movement of sodium ions creates spontaneous depolarization (or prepotential depolarization). At this point, the calcium ion channels close and K channels open, allowing outflux of + + K and resulting in repolarization. When the membrane potential reaches approximately −60 mV, the K channels close and + Na channels open, and the prepotential phase begins again. The prepotential accounts for the membrane reaching threshold and initiates the spontaneous depolarization and contraction of the cell. This phenomenon accounts for the long refractory periods required for the cardiac muscle cells to pump blood effectively before they are capable of firing for a second time. These cardiac myocytes normally do not initiate their own electrical potential but rather wait for an impulse to reach them. Contractile cells demonstrate a much more stable resting phase than conductive cells at approximately −80 mV for cells in the atria and −90 mV for cells in the ventricles. Despite this initial difference, the other components of their action potentials are virtually identical. In both cases, when stimulated by an action potential, voltage-gated channels rapidly open, beginning the positive-feedback mechanism of depolarization. This rapid influx of positively charged ions raises the membrane potential to approximately +30 mV, at which point the sodium channels close. Depolarization is followed by the plateau phase, in which membrane potential declines relatively 2+ 2+ + slowly. This is due in large part to the opening of the slow Ca channels, allowing Ca to enter the cell while few K + channels are open, allowing K to exit the cell. Once the 2+ + + membrane potential reaches approximately zero, the Ca channels close and K channels open, allowing K to exit the cell. At this point, membrane potential drops until it reaches resting levels once more and the cycle repeats. The absolute refractory period for cardiac contractile muscle lasts approximately 200 ms, and the relative refractory period lasts approximately 50 ms, for a total of 250 ms. This extended period is critical, since the heart muscle must contract to pump blood effectively and the contraction must follow the electrical events. Without extended refractory periods, premature contractions would occur in the heart and would not be compatible with life. The extended refractory period allows the cell to fully contract before another electrical event can occur. Their influx through slow calcium channels accounts for the prolonged plateau phase and absolute refractory period that enable cardiac muscle to function properly. Calcium ions also combine with the regulatory protein troponin in the troponin-tropomyosin complex; this complex removes the inhibition that prevents the heads of the myosin molecules from forming cross bridges with the active sites on actin that provide the power stroke of contraction. The bundle branches would have an inherent rate of 20–30 impulses per minute, and the Purkinje fibers would fire at 15–20 impulses per minute. While a few exceptionally trained aerobic athletes demonstrate resting heart rates in the range of 30–40 beats per minute (the lowest recorded figure is 28 beats per minute for Miguel Indurain, a cyclist), for most individuals, rates lower than 50 beats per minute would indicate a condition called bradycardia. Depending upon the specific individual, as rates fall much below this level, the heart would be unable to maintain adequate flow of blood to vital tissues, initially resulting in decreasing loss of function across the systems, unconsciousness, and ultimately death. Electrocardiogram By careful placement of surface electrodes on the body, it is possible to record the complex, compound electrical signal of the heart. The term “lead” may be used to refer to the cable from the electrode to the electrical recorder, but it typically describes the voltage difference between two of the electrodes. The 12-lead electrocardiograph uses 10 electrodes placed in standard locations on the patient’s skin (Figure 19. In continuous ambulatory electrocardiographs, the patient wears a small, portable, battery-operated device known as a Holter monitor, or simply a Holter, that continuously monitors heart electrical activity, typically for a period of 24 hours during the patient’s normal routine.

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Breast milk has laxative properties that help expel meconium from the intestines and clear bilirubin through the excretion of bile avanafil 200 mg online. Some degree of jaundice is normal in newborns buy avanafil 200mg low cost, but a high level of bilirubin—which is neurotoxic—can cause brain damage cheap avanafil 200mg without prescription. Newborns buy discount avanafil 50mg on-line, who do not yet have a fully functional blood–brain barrier, are highly vulnerable to the bilirubin circulating in the blood. Indeed, hyperbilirubinemia, a high level of circulating bilirubin, is the most common condition requiring medical attention in newborns. Each of these chromosomes carries hundreds or even thousands of genes, each of which codes for the assembly of a particular protein—that is, genes are “expressed” as proteins. The characteristics that the genes express, whether they are physical, behavioral, or biochemical, are a person’s phenotype. Homologous chromosomes—those that make up a complementary pair—have genes for the same characteristics in the same location on the chromosome. Because one copy of a gene, an allele, is inherited from each parent, the alleles in these complementary pairs may vary. A child may inherit the allele encoding for dimples on the chromosome from the father and the allele that encodes for smooth skin (no dimples) on the chromosome from the mother. The banding patterns are nearly identical for the two chromosomes within each pair, indicating the same organization of genes. The expression of an allele can be dominant, for which the activity of this gene will mask the expression of a nondominant, or recessive, allele. In some cases, both alleles are expressed at the same time in a form of expression known as codominance. Moreover, although any one person can only have two alleles corresponding to a given gene, more than two alleles commonly exist in a population. Over 100 years of theoretical and experimental genetics studies, and the more recent sequencing and annotation of the human genome, have helped scientists to develop a better understanding of how an individual’s genotype is expressed as their phenotype. This body of knowledge can help scientists and medical professionals to predict, or at least estimate, some of the features that an offspring will inherit by examining the genotypes or phenotypes of the parents. One important application of this knowledge is to identify an individual’s risk for certain heritable genetic disorders. However, most diseases have a multigenic pattern of inheritance and can also be affected by the environment, so examining the genotypes or phenotypes of a person’s parents will provide only limited information about the risk of inheriting a disease. Only for a handful of single-gene disorders can genetic testing allow clinicians to calculate the probability with which a child born to the two parents tested may inherit a specific disease. Mendel’s Theory of Inheritance Our contemporary understanding of genetics rests on the work of a nineteenth-century monk. Working in the mid-1800s, long before anyone knew about genes or chromosomes, Gregor Mendel discovered that garden peas transmit their physical characteristics to subsequent generations in a discrete and predictable fashion. When he mated, or crossed, two pure- breeding pea plants that differed by a certain characteristic, the first-generation offspring all looked like one of the parents. For instance, when he crossed tall and dwarf pure-breeding pea plants, all of the offspring were tall. Mendel called tallness dominant because it was expressed in offspring when it was present in a purebred parent. He called dwarfism recessive 1356 Chapter 28 | Development and Inheritance because it was masked in the offspring if one of the purebred parents possessed the dominant characteristic. Mendel performed thousands of crosses in pea plants with differing traits for a variety of characteristics. And he repeatedly came up with the same results—among the traits he studied, one was always dominant, and the other was always recessive. By crossing the second-generation offspring of purebred parents with each other, he showed that the latter was true: recessive traits reappeared in third-generation plants in a ratio of 3:1 (three offspring having the dominant trait and one having the recessive trait). Mendel then proposed that characteristics such as height were determined by heritable “factors” that were transmitted, one from each parent, and inherited in pairs by offspring. In the language of genetics, Mendel’s theory applied to humans says that if an individual receives two dominant alleles, one from each parent, the individual’s phenotype will express the dominant trait. If an individual receives two recessive alleles, then the recessive trait will be expressed in the phenotype. Individuals who have two identical alleles for a given gene, whether dominant or recessive, are said to be homozygous for that gene (homo- = “same”).

Because the myelomeningocele form of spina bifida involves more extensive damage to the nervous tissue order 200mg avanafil otc, neurological damage may persist buy 200mg avanafil visa, but symptoms can often be handled buy 200mg avanafil free shipping. Complications of the spinal cord may present later in life generic 50mg avanafil amex, but overall life expectancy is not reduced. The caption for the video describes it as “less gray matter,” which is another way of saying “more white matter. The spinal cord is a single structure, whereas the adult brain is described in terms of four major regions: the cerebrum, the diencephalon, the brain stem, and the cerebellum. The coordination of reflexes depends on the integration of sensory and motor pathways in the spinal cord. The Cerebrum The iconic gray mantle of the human brain, which appears to make up most of the mass of the brain, is the cerebrum (Figure 13. The wrinkled portion is the cerebral cortex, and the rest of the structure is beneath that outer covering. Deep within the cerebrum, the white matter of the corpus callosum provides the major pathway for communication between the two hemispheres of the cerebral cortex. Many of the higher neurological functions, such as memory, emotion, and consciousness, are the result of cerebral function. The cerebrum of the most primitive vertebrates is not much more than the connection for the sense of smell. In mammals, the cerebrum comprises the outer gray matter that is the cortex (from the Latin word meaning “bark of a tree”) and several deep nuclei that belong to three important functional groups. The basal nuclei are responsible for cognitive processing, the most important function being that associated with planning movements. The limbic cortex is the region of the cerebral cortex that is part of the limbic system, a collection of structures involved in emotion, memory, and behavior. This thin, extensive region of wrinkled gray matter is responsible for the higher functions of the nervous system. A gyrus (plural = gyri) is the ridge of one of those wrinkles, and a sulcus (plural = sulci) is the groove between two gyri. The head is limited by the size of the birth canal, and the brain must fit inside the cranial cavity of the skull. If the gray matter of the cortex were peeled off of the cerebrum and laid out flat, its surface area would be roughly equal to one square meter. During embryonic development, as the telencephalon expands within the skull, the brain goes through a regular course of growth that results in everyone’s brain having a similar pattern of folds. Superior to the lateral sulcus are the parietal lobe and frontal lobe, which are separated from each other by the central sulcus. The posterior region of the cortex is the occipital lobe, which has no obvious anatomical border between it and the parietal or temporal lobes on the lateral surface of the brain. From the medial surface, an obvious landmark separating the parietal and occipital lobes is called the parieto- occipital sulcus. The fact that there is no obvious anatomical border between these lobes is consistent with the functions of these regions being interrelated. Different regions of the cerebral cortex can be associated with particular functions, a concept known as localization of function. In the early 1900s, a German neuroscientist named Korbinian Brodmann performed an extensive study of the microscopic anatomy—the cytoarchitecture—of the cerebral cortex and divided the cortex into 52 separate regions on the basis of the histology of the cortex. His work resulted in a system of classification known as Brodmann’s areas, which is still used today to describe the anatomical distinctions within the cortex (Figure 13. The results from Brodmann’s work on the anatomy align very well with the functional differences within the cortex. The temporal lobe is associated with primary auditory sensation, known as Brodmann’s areas 41 and 42 in the superior temporal lobe. Because regions of the temporal lobe are part of the limbic system, memory is an important function associated with that lobe.

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