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This continued remodeling causes hypertrophic scar formation medications you cant drink alcohol purchase paroxetine 20mg line, resulting in excessive connective tissue contracture treatment ind purchase paroxetine 10mg with visa. Extensive numbers of myofibroblasts are found in most contractive diseases of connective tissue (fibromatoses). If scar tissue grows beyond boundaries of the original wound and does not regress, it is called a keloid. This immunofluorescence image shows wild-type 3T3 fibroblasts cultured on the collagen lattice. Note that some cells have completed their differentiation, and others are in the early stages. The most commonly affected areas near the crease of the hand close to the base of the ring and small fingers form contracted fibrous cords, which are infiltrated by an extensive number of myofibroblasts. Most patients report problems when they try to place the affected hand on the flat surface. In more severe cases, the fingers are permanently flexed and interfere with everyday activities such as washing hands or placing the hand into a pocket. Mast cells initially circulate in the peripheral blood as agranular cells of monocytic appearance. Some functionally important phagocytic cells are not derived directly from monocytes. For example, microglia are small, stellate cells located primarily along capillaries of the central nervous system that function as phagocytic cells. Also, fibroblasts of the subepithelial sheath of the lamina propria of the intestine and uterine endometrium have been shown to differentiate into cells with morphologic, enzymatic, and functional characteristics of connective tissue macrophages. These cells are able to phagocytose avidly vital dyes such as trypan blue and India ink, which makes them visible and easy to identify in the light microscope. Mast cells can also be activated by the IgE-independent mechanism during complement protein activation. Two types of human mast cells have been identified based on morphologic and biochemical properties. Most mast cells in the connective tissue of the skin, intestinal submucosa, and breast and axillary lymph nodes contain cytoplasmic granules with a lattice-like internal structure. In contrast, mast cells in the lungs and intestinal mucosa have granules with a scroll-like internal structure. Mast cells are especially numerous in the connective tissues of skin and mucous membranes but are not present in the brain and spinal cord. On the basis of its anticoagulant properties, heparin is useful for treatment of thrombosis. Tryptase is selectively concentrated in the secretory granules of human mast cells (but not basophils). It is released by mast cells together with histamine and serves as a marker of mast cell activation. The secretions of eosinophils counteract the effects of the histamine and leukotrienes. Similar to histamine, leukotrienes trigger prolonged constriction of smooth muscle in the pulmonary airways, causing bronchospasm. The bronchoconstrictive effects of leukotrienes develop more slowly and last much longer than the effects of histamine. Bronchospasm caused by leukotrienes can be prevented by leukotriene receptor antagonists (blockers) but not by antihistaminic agents. The leukotriene receptor antagonists are among the most prescribed drugs for the management of asthma; they are used for both treatment and prevention of acute asthma attacks. It increases expression of adhesion molecules in endothelial cells and has antitumor effects. Mast cells are also present in the capsules of organs and the connective tissue that surrounds the blood vessels of internal organs. Although the meninges (sheets of connective tissue that surround the brain and spinal cord) contain mast cells, the connective tissue around the small blood vessels within the brain and spinal cord is devoid of mast cells. The absence of mast cells protects the brain and spinal cord from the potentially disruptive effects of the edema of allergic reactions. Mast cells are also numerous in the thymus and, to a lesser degree, in other lymphatic organs, but they are not present in the spleen. Most mast cell secretory products (mediators of inflammation) are stored in granules and are released at the time of mast cell activation.

In addition to those associated with the papillae medicine 3605 buy discount paroxetine 10 mg on line, taste buds are also present on the glossopalatine arch medicine quinine buy genuine paroxetine line, the soft palate, the posterior surface of the epiglottis, and the posterior wall of the pharynx down to the level of the cricoid cartilage. Bitter, sweet, and umami tastes are detected by a variety of receptor proteins encoded by the two taste receptor genes (T1R and T2R). Each receptor represents a single transmembrane protein coupled to its own G protein. Depolarization of the plasma membrane causes voltage-gated Ca2 channels in neuroepithelial cells to open. In contrast to the bitter taste receptors, they have two protein subunits, T1R2 and T1R3. Umami taste receptors are very similar to sweet receptors; bitter taste receptor T1R2 T1R3 they are also composed of two subunits. The transduction process is identical to that described previously for bitter taste pathways. Monosodium glutamate, added to many foods to enhance their taste (and the main ingredient of soy sauce), stimulates the umami receptors. Sodium ions and hydrogen protons, which are responsible for salty and sour taste, respectively, act directly on ion channels. Digestive System I Signaling mechanisms, in the case of sour and salty tastes, are similar to other signaling mechanisms found in synapses and neuromuscular junctions. This diagram shows the signaling mechanism of bitter, sweet, and umami receptors in the neuroepithelial cells. These cells selectively express only one class of receptor proteins; for simplicity, all three taste receptors are depicted in the apical cell membrane. Signaling mechanism in sour sensation is generated by H protons that primarily block K channels. Salty sensation derives from Na ions that enter the neuroepithelial cells through the amiloride-sensitive Na channels. Intracellular Na causes a depolarization of membrane and activation of additional voltage-sensitive Na and Ca2 channels. Calcium-mediated release of neurotransmitters from synaptic vesicles results in stimulating gustatory nerve fiber. Salty taste that is stimulated by table salt (NaCl) is essentially derived from the taste of the sodium ions. The Na enters the neuroepithelial cells through the specific amiloride-sensitive Na channels (the same that are involved in sour taste transmission). These channels are different from voltage-sensitive Na channels that generate action potentials in nerve or muscle cells. The entry of Na into a receptor cell causes a depolarization of its membrane and activation of additional voltage-sensitive Na channels and voltage-sensitive Ca2 channels. Vascular and glandular innervation is provided by the sympathetic and parasympathetic nerves. These cells belong to postsynaptic parasympathetic neurons and are destined for the minor salivary glands within the tongue. The cell bodies of sympathetic postsynaptic neurons are located in the superior cervical ganglion. Teeth are embedded in and attached to the alveolar processes of the maxilla and mandible. In general, taste buds at the tip of the tongue detect sweet stimuli, those immediately posterolateral to the tip detect salty stimuli, and those more posterolateral detect sour-tasting stimuli. However, studies with thermal stimulation of the tongue have shown that the classic taste maps as described above represent an oversimplified view of the distribution of taste receptors. Sensitivity to all tastes is distributed across the entire tongue, but some areas are indeed more responsive to certain tastes than others. The lingual tonsil consists of accumulations of lymphatic tissue at the base of the tongue. The lingual tonsil contains diffuse lymphatic tissue with lymphatic nodules containing germinal centers. However, the structure of the epithelium may be difficult to distinguish because of the extremely large number of lymphocytes that normally invade it. Between nodules, the lingual epithelium has the characteristics of lining epithelium. Mucous lingual salivary glands may be seen within the lingual tonsil and may extend into the muscle of the base of the tongue.

This spontaneous rhythm of the heart can be altered by nerve impulses from both sympathetic and the parasympathetic nerve supply to the heart originates in the vagus nerve (cranial nerve X) medicine 2410 order 20mg paroxetine. Presynaptic parasympathetic fibers synapse with postsynaptic neurons within the heart medicine 72 paroxetine 10 mg otc. The release of the neurotransmitter acetylcholine from the terminals of these fibers slows the heart rate (an effect known as bradycardia), reduces the force of the heartbeat, and constricts the coronary arteries of the heart. The sympathetic presynaptic fibers that supply the heart originate in the lateral horns at the level of the T1 to T6 segments of the spinal cord. The sympathetic component causes the rate of contraction to increase (an effect known as tachycardia) and increases the force of muscle contraction. Sympathetic stimulation produces dilation of the coronary arteries by inhibiting their constriction. The heart rate and the force of contraction can be regulated by circulating hormones and other substances. Both receptors function in neural reflexes that adjust cardiac output and respiratory rate. These hormones include epinephrine and norepinephrine that reach the heart muscle cells via the coronary circulation. Activation of adrenergic receptors (mainly 1 type) by epinephrine and less efficiently by norepinephrine increases the force of contraction (a positive inotropic effect) and the heart rate (a positive chronotropic effect). Other substances that have positive inotropic and chronotropic effects on the heart include Ca2, thyroid hormones, caffeine, theophylline, and the cardiac glycoside digoxin. Substances that have negative inotropic and chronotropic actions on the heart muscle include adrenergic-receptor antagonists such as propranolol or Ca2 channel blockers. These substances decrease the heart rate and the force of cardiac muscle contraction. The central nervous system monitors arterial pressure and heart function through specialized receptors located within the cardiovascular system. The tunica intima, the innermost layer of the vessel, consists of three components: (1) a single layer of squamous epithelial cells, the endothelium; (2) the basal lamina of the endothelial cells (a thin extracellular layer composed chiefly of collagen, proteoglycans, and glycoproteins); and (3) the subendothelial layer, consisting of loose connective tissue. The subendothelial layer of the intima in arteries and arterioles contains a sheet-like layer or lamella of fenestrated elastic material called the internal elastic membrane. Specialized sensory nerve receptors that supply afferent information about blood pressure are located in the walls of large blood vessels near the heart and within the heart itself. The information received from all types of cardiovascular receptors initiates the appropriate physiologic reflexes. These receptors are the carotid and aortic bodies located at the bifurcation of the common carotid arteries and in the aortic arch, respectively. The layers or tunics of the blood vessel walls are labeled in the upper two panels. The arrangement of the microcirculatory bed in certain parts of the body is shown in the lowest panel. The tunica media, or middle layer, consists primarily of circumferentially arranged layers of vascular smooth muscle cells. In arteries, this layer is relatively thick and extends from the internal elastic membrane to the external elastic membrane. The external elastic membrane is a layer of elastin that separates the tunica media from the tunica adventitia. Variable amounts of elastin, reticular fibers, and proteoglycans are interposed between the smooth muscle cells of the tunica media. The sheets or lamellae of elastin are fenestrated and arranged in circular concentric layers. All of the extracellular components of the tunica media are produced by the vascular smooth muscle cells. The tunica adventitia, or outermost connective tissue layer, is composed primarily of longitudinally arranged collagenous tissue and a few elastic fibers. These connective tissue elements gradually merge with the loose connective tissue surrounding the vessels.

In this early stage of development symptoms yellow eyes discount paroxetine 10 mg amex, synovial joints are being formed between developing tarsal bones medicine ketoconazole cream discount 10mg paroxetine mastercard. Note that nonarticulating surfaces of the hyaline cartilage models of tarsal bones are covered by perichondrium, which also contributes to the development of joint capsules. Also, a developing tendon (T) is evident in the indentation of the cartilage seen on the left side of the micrograph. A disc of hyaline cartilage-the epiphyseal plate- separates the more proximally located epiphysis from the funnel-shaped diaphysis located distal to the plate. The articular cartilage on the surface of the epiphysis contributes to the synovial joint and is also composed of hyaline cartilage. The cartilage of the epiphyseal plate disappears when lengthwise growth of the bone is completed, but the articular cartilage remains throughout life. Hyaline cartilage also exists in the adult as the skeletal unit in the trachea, bronchi, larynx, and nose. A firmly attached connective tissue, the perichondrium, surrounds hyaline cartilage. Hyaline cartilage that covers the articular surfaces of movable joints is termed articular cartilage. In general, the the perichondrium is a dense irregular connective tissue composed of cells that are indistinguishable from fibroblasts. In many respects, the perichondrium resembles the capsule that surrounds glands and many organs. When actively growing, the perichondrium appears divided into an inner cellular layer, which gives rise to new cartilage cells, and an outer fibrous layer. This division is not always evident, especially in perichondrium that is not actively producing new cartilage or in very slow-growing cartilage. Also, on the opposite surface, the cartilage contacts the bone, and there is no perichondrium. Articular cartilage is a remnant of the original hyaline cartilage template of the developing bone, and it persists throughout adult life. This diagram shows the organization of the collagen network and chondrocytes in the various zones of articular cartilage. Also, this zone is lighter staining than the matrix of the more superficial zones. Collagen fibrils are less organized and are arranged in a somewhat oblique orientation to the surface. The deep (radial) zone is characterized by small, round chondrocytes that are arranged in short columns perpendicular to the free surface of the cartilage. The collagen fibrils are positioned between columns parallel to the long axis of the bone. The calcified zone is characterized by a calcified matrix with the presence of small chondrocytes. This zone is separated from the deep (radial) zone by a smooth, undulating, heavily calcified line called the tidemark. Above this line, proliferation of chondrocytes within the cartilage lacunae provides the new cells for interstitial growth. In articular cartilage renewal, chondrocytes migrate from this region toward the joint surface. Unlike hyaline cartilage, which calcifies with aging, the matrix of elastic cartilage does not calcify during the aging process. Fibrocartilage is a combination of dense regular connec- tive tissue and hyaline cartilage. These fibers and lamellae are best demonstrated in paraffin sections with special stains such as resorcin-fuchsin and orcein. The elastic material gives the cartilage elastic properties in addition to the resilience and pliability that are characteristic of hyaline cartilage. Elastic cartilage is found in the external ear, the walls of the external acoustic meatus, the auditory (Eustachian) tube, and the epiglottis of the larynx. This specimen was stained with orcein and reveals the elastic fibers, stained brown, within the cartilage matrix.