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The cells of origin of the medullary reticulospinal tract receive input from the corticospinal tract and the rubrospinal 303 cHapter the tectospinal tract arises from neurones in the intermediate and deep layers of the superior colliculus of the midbrain gastritis peptic ulcers symptoms buy generic gasex 100caps online. They make polysynaptic connections with motor neurones serving muscles in the neck gastritis diet ëóíòèê buy gasex once a day, facilitating those that innervate contralateral muscles and inhibiting those that innervate ipsilateral ones. In animals, unilateral electrical stimulation of the superior colliculus causes turning of the head to the contralateral side, an effect mainly mediated through the tectospinal tract. Descending in the ventral funiculus and ventral part of the lateral funiculus of the cord, these axons terminate on phrenic motor neurones supplying the diaphragm and thoracic motor neurones that innervate intercostal muscles. A pathway with somewhat similar course and terminations to that of the solitariospinal tract originates from the nucleus retroambiguus. Both pathways subserve respiratory activities by driving inspiratory muscles, and some descending axons from the nucleus retroambiguus facilitate expiratory motor neurones. There is clinical evidence that bilateral ventrolateral cordotomy at high cervical levels abolishes rhythmic ventilatory movements. Nucleus of superior olive Medial vestibular nucleus Inferior vestibular nucleus Restiform body Medulla Medial lemniscus Pyramid Medial lemniscus 3 Hypothalamospinal fibres Medulla Accessory nerve Ventral grey column Motor decussation Hypothalamospinal fibres exist in animals. They arise from the paraventricular nucleus and other areas of the hypothalamus, and descend ipsilaterally, mainly in the dorsolateral region of the cord, to be distributed to sympathetic and parasympathetic preganglionic neurones in the intermediolateral column. Fibres from the paraventricular nucleus show oxytocin and vasopressin immunoreactivity. Descending fibres from the dopaminergic cell group (A11) situated in the caudal hypothalamus innervate sympathetic preganglionic neurones and neurones in the dorsal horn. That similar pathways exist in humans may be inferred from ipsilateral sympathetic deficits. The reticulospinal tracts normally function in a coordinated, balanced fashion to control muscle tone. However, if the descending control from higher centres is lost, such as occurs after a stroke in the internal capsule, then the natural excitability of the pontine reticulospinal tract, combined with the activity of the vestibulospinal tracts, causes the antigravity muscles to become hypertonic and hyperreflexic (spasticity) (Guyton and Hall 2006). They project rostrally to many forebrain areas and caudally to the spinal cord, and appear to be concerned with the modulation of sensory transmission, and the control of autonomic and somatic motor neuronal activities. Coeruleospinal projections originate from noradrenergic cell groups A4 and A6 in the locus coeruleus complex in the pons and descend via the ventrolateral white matter to innervate all cord segments bilaterally. They also project extensively to preganglionic parasympathetic neurones in the sacral cord. Descending noradrenergic fibres, which arise from the lateral tegmental cell groups A5 and A7 of the pons, travel in the dorsolateral white matter. Descending fibres from adrenergic cell groups C1 and C3 of the medulla oblongata have been traced into the ventral funiculus of the cord and are extensively distributed to the intermediolateral column. Dopaminergic fibres projecting to the spinal cord travel in the hypothalamospinal pathway. The raphe nuclei pallidus (B1), obscurus (B2) and magnus (B3) in the brainstem give rise to two serotoninergic descending bundles. The lateral raphe spinal bundle, from B3 neurones, is concerned with the control of nociception. Some descending serotoninergic fibres project to sympathetic preganglionic neurones and are concerned with the central control of cardiovascular function. Propriospinal pathways Propriospinal pathways (fasciculi proprii) consist of the ascending and descending fibres of intrinsic spinal neurones. They contact other neurones within the same segment and/or in more distant segments of the spinal cord and so subserve intrasegmental and intersegmental integration and coordination. Descending pathways end on specific subgroups of propriospinal neurones and these, in turn, relay to motor neurones and other spinal neurones. The system mediates all those automatic functions that Interstitiospinal tract 304 the interstitiospinal tract arises from neurones in the interstitial nucleus (of Cajal) and the immediate surrounding area, and descends via the medial longitudinal fasciculus into the ventral funiculus of the spinal cord. They establish some monosynaptic connections with motor neurones supplying neck muscles, but their main connections are disynaptic with motor neurones supplying limb muscles. Some propriospinal axons are very short and span only one segment, while others run the entire length of the cord. The shortest axons lie immediately adjacent to the grey matter and the longer ones are situated more peripherally. Propriospinal neurones can be categorized according to the length of their axons as long, intermediate or short neurones.

They receive most of the terminals of proprioceptive primary afferents gastritis diagnosis code purchase 100caps gasex amex, profuse corticospinal projections from the motor and sensory cortex gastritis symptoms ppt buy gasex now, and input from subcortical levels, suggesting their involvement in the regulation of movement. Both have a mixed cell population but the former contains many prominent well-staining somata interlaced by numerous bundles of transverse, dorsoventral and longitudinal fibres. It has a densely staining medial third of small, densely packed neurones and a lateral two-thirds containing larger, more loosely packed, triangular or stellate somata. This region is known as the intermediate zone and within the thoracic cord includes the lateral horn. Its neurones display a heterogeneous mixture of sizes and shapes from small to moderately large. The relative positions of these columnar groups and their extent through spinal segments are indicated. The axons from these interneurones influence motor neurone activity bilaterally, perhaps directly but more probably by excitation of small motor neurones supplying efferent fibres to muscle spindles. The large motor neurones supply motor end-plates of extrafusal muscle fibres in striated muscle. The former have a lower rate of firing and lower conduction velocity, and tend to innervate type S muscle units. The smaller motor neurones give rise to small-diameter efferent axons (fusimotor fibres), which innervate the intrafusal muscle fibres in muscle spindles. Lamina X surrounds the central canal and consists of the dorsal and ventral grey commissures. Radial and vertical cells are predominantly glutamatergic and presumed to be excitatory, and central cells include both inhibitory and excitatory subsets. In the brainstem, the regions inducing such effects correspond to a number of midbrain and rhombencephalic nuclei, which, with their connections, constitute an endogenous analgesic Section 3 Dorsal horn the dorsal horn is a major zone of termination of primary afferent fibres, which enter the spinal cord through the dorsal roots of spinal nerves. Dorsal root fibres contain numerous molecules, which are either known, or suspected, to fulfil a neurotransmitter or neuromodulator role. Dorsal root afferents carry exteroceptive, proprioceptive and interoceptive information. Most, if not all, primary afferent fibres divide into ascending and descending branches on entering the cord. These then travel for variable distances in the tract of Lissauer, near the surface of the cord, and send collaterals into the subjacent grey matter. The lamina marginalis (lamina I) is a thin lamina of neurones at the dorsolateral tip of the dorsal horn, deep to the tract of Lissauer. The substantia gelatinosa receives afferents via the dorsal roots, and its neurones give rise to fibres that form the contralateral spinothalamic tract. It can usually be identified from the eighth cervical to the third or fourth lumbar segments. Neurones of the posterior thoracic nucleus vary in size but most are large, especially in the lower thoracic and lumbar segments. Some send axons into the dorsal spinocerebellar tracts and others are interneurones. Note that the excitatory activation circuits have a ventral-to-dorsal organization. The projection neurones in lamina I also receive direct nociceptive C and A input. These dorsally directed circuits are the route through which both noxious and innocuous primary afferent input can engage the projection neurones of lamina I. The excitatory circuits in the superficial dorsal horn are subject to profound inhibitory controls (red). The latter in turn exert inhibitory control of a variety of excitatory interneurones, including vertical (V) and central (C) cells. In the midbrain, these regions are the periaqueductal grey matter, dorsal raphe nucleus and part of the cuneiform nucleus.

In certain pathological conditions gastritis treatment guidelines cheap gasex american express, muscle cells (and macrophages) undergo fatty degeneration and participate in the formation of atheromatous plaques gastritis upper left abdominal pain generic gasex 100caps online. Fine, incomplete elastic lamellae are interspersed between smooth muscle cells of the tunica media. Other fibrous components such as fibronectin, and amorphous proteoglycans and glycosaminoglycans, are present in the interstitial space. More extensive fusion produces lamellae of elastic material, which, though usually perforated and thus incomplete, separate the layers of muscle cells. The internal elastic lamina is a conspicuous elastic lamella in arteries, between intima and media, which allows the vessel to recoil after distension. Fenestrations in the elastic lamina, which may also be split in thickness, allow materials to diffuse between intima and media. Collagen is abundant in the adventitia, where type I collagen fibres form large bundles that increase in size from the junction with the media to the outer limit of the vessel wall. In veins, collagen is the main component of the vessel wall and accounts for more than half its mass. In general terms, collagen and elastic fibres in the media run parallel to , or at a small angle to , the axes of the muscle cells, and they are therefore arranged mainly circumferentially. In contrast, the predominant arrangement of collagen fibres in the adventitia is longitudinal. This arrangement imposes constraints on length change in large vessels under pressure. The outer sheath of type I collagen in the adventitia therefore has a structurally supportive role. In a distended vessel, the elastic fibres store energy and, by recoiling, help to restore the resting length and calibre. The extracellular material of the media, including collagen and elastin, is produced by the muscle cells. In the adventitia, collagen is synthesized and secreted by fibroblasts, as in other connective tissues. During postnatal development, while vessels increase in diameter and wall thickness, there is an increase in elastin and collagen content. Subsequent changes in vessel structure, seen during ageing, include an increase in the ratio of collagen to elastin, with a reduction in vessel elasticity. Adventitia the adventitia is formed of general connective tissue, varying in the thickness and density of its collagen fibre bundles. Vasa vasorum In smaller vessels, the nourishment of the tissues of the vessel wall is provided by diffusion from the blood circulating in the vessel itself. The wall thickness at which simple diffusion from the lumen becomes insufficient is 1 mm. These originate from, and drain into, peripheral branches of the vessel they supply. They ramify within the adventitia and, in the largest of arteries, penetrate the outermost part of the media. The larger veins are also supplied by vasa vasorum but these may penetrate the wall more deeply, perhaps because of the lower oxygen tension. Nervi vasorum Blood vessels are innervated by efferent autonomic fibres that regulate the state of contraction of the musculature (muscular tone) and thus the diameter of the vessels, particularly the resistance arteries and arterioles. Perivascular nerves branch and anastomose within the adventitia of an artery, forming a meshwork around it. Nerves are occasionally found within the outermost layers of the media in some of the large muscular arteries. Nervi vasorum are small bundles of axons, which are almost invariably unmyelinated and typically varicose. The density of innervation varies in different vessels and in different areas of the body; it is usually sparser in veins and larger lymphatic vessels.

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There is a dense plexus of somatostatin-immunoreactive fibres in the molecular layer of the dentate gyrus and also in the stratum lacunosum-moleculare of the hippocampus gastritis diet ðàäèî order cheapest gasex and gasex. The polymorphic layer of the dentate gyrus gastritis diet áèòâà generic 100 caps gasex, stratum oriens of the hippocampus and the deep layers of the entorhinal cortex all contain somatostatin-immunoreactive neurones. The medial septal complex and the supramammillary area of the posterior hypothalamus are the two major sources of subcortical afferents to the hippocampal formation. There are also projections from the amygdaloid complex and claustrum (to the subicular complex and entorhinal cortex), as well as monoaminergic projections from the ventral tegmental area, the mesencephalic raphe nuclei and the locus coeruleus. The noradrenergic and serotoninergic projections reach all hippocampal fields but are especially dense in the dentate gyrus. All divisions of the anterior thalamic nuclear complex and associated lateral dorsal nucleus project to the hippocampal formation, predominantly to the subicular complex. Some midline thalamic nuclei, particularly the parataenial, central medial and reuniens nuclei, project especially to the entorhinal cortex. The entorhinal cortex is divisible into six layers and is quite distinct from other neocortical regions. They form small bumps on the surface of the brain that can be seen by the naked eye (verrucae hippocampi) and provide an indication of the boundaries of the entorhinal cortex. Its cells continue around the angular bundle (subcortical white matter deep to the subicular complex made up largely of perforant path axons) to lie beneath the pre- and parasubiculum. The entorhinal cortex has reciprocal connections with the hippocampus and neocortical regions. It projects to the perirhinal and temporal polar cortices and the caudal parahippocampal and cingulate gyri. Evidence from clinical and animal studies suggests that the entorhinal cortex plays an essential role within a frontotemporal cortical memory network (Takehara-Nishiuchi 2014). Below this, the septal region is made up of four main nuclear groups: dorsal, ventral, medial and caudal. The dorsal group is essentially the dorsal septal nucleus, the ventral group consists of the lateral septal nucleus, the medial group contains the medial septal nucleus and the nucleus of the diagonal band of Broca, and the caudal group contains the fimbrial and triangular septal nuclei. The major afferents to the region terminate primarily in the lateral septal nucleus. The lateral septum receives a rich monoaminergic innervation, including noradrenergic afferents from the locus coeruleus and medullary cell groups (A1, A2), serotoninergic afferents from the midbrain raphe nuclei, and dopaminergic afferents from the ventral tegmental area (A10). Efferents from the lateral septum project to the medial and lateral preoptic areas, anterior hypothalamus, supramammillary and midbrain ventral tegmental area, via the medial forebrain bundle, and to the medial habenular nucleus and some midline thalamic nuclei via the stria medullaris thalami. The projections from the habenula via the fasciculus retroflexus to the interpeduncular nucleus and adjacent ventral tegmental area in the midbrain provide a route through which forebrain limbic structures influence midbrain nuclear groups. Efferents from the medial septal and vertical limb nuclei of the diagonal band travel via the dorsal fornix, fimbria, supracallosal striae and a ventral route through the amygdaloid complex. Subicular complex the subicular complex is generally subdivided into subiculum, presubiculum and parasubiculum. The subiculum consists of a superficial molecular layer containing apical dendrites of subicular pyramidal cells, a pyramidal cell layer and a deep polymorphic layer. The presubiculum, lying medial to the subiculum, is distinguished by a densely packed superficial layer of pyramidal cells and forms the boundary between the subicular complex and the entorhinal cortex. The cell layers deep to the parasubiculum are indistinguishable from the deep layers of the entorhinal cortex. The major subcortical projections of the hippocampal formation, to the septal nucleus, lateral and medial mammillary nuclei, nucleus accumbens, anterior thalamus and entorhinal cortex, all arise from pyramidal neurones of the subicular complex. The presubiculum, in particular, projects to the anterior thalamic nuclear complex (anteromedial, anteroventral and laterodorsal nuclei). Collectively, the nuclei form the ventral, superior and medial walls of the tip of the inferior horn of the lateral ventricle. The amygdala is partly continuous above with the inferomedial margin of the claustrum. Fibres of the external capsule and substriatal grey matter, including the cholinergic magnocellular nucleus basalis of Meynert, partially separate it from the putamen and globus pallidus.