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This term is unfortunate order 50 mg voveran with visa, because the receptors are not “spare” in the sense of being unused order 50mg voveran overnight delivery. While at any one point in time only 5 to 10% of the receptors may be occupied, hormone-receptor interactions are an equilibrium process, and hormones continually dis- sociate and reassociate with their receptors. Therefore, from one point in time to the next, different subsets of the total population of receptors may be occupied, but presum- ably all receptors participate equally in producing the bio- logical response. Physiological or pathophysiological alterations in target Log hormone concentration Log hormone concentration tissue responses to hormones can take one of two general Altered target tissue responses reflected by FIGURE 31. A change in responsiveness is indicated by an ber of receptors for that hormone per cell. This phenomenon increase or decrease in the maximal response of the target is referred to as down-regulation. In the case of peptide hor- tissue and may be the result of one or more factors (Fig. Altered responsiveness can be caused by a change of receptors from the cell surface to intracellular sites usually in the number of functional target cells in a tissue, by a occurs as part of the process of down-regulation. Therefore, change in the number of receptors per cell for the hormone there may be fewer total receptors per cell, and a smaller per- in question or, if receptor function itself is not rate-limiting centage may be available for hormone binding on the cell sur- for hormone action, by a change in the specific rate-limiting face. Although somewhat less prevalent than down-regula- postreceptor step in the hormone action pathway. Changes in rates of receptor synthesis may also con- a right shift indicates decreased sensitivity and a left shift tribute to long-term down- or up-regulation. Changes in sensitivity reflect (1) an alteration in cells can regulate receptor function. Chronic exposure of receptor affinity or, if submaximal concentrations of hor- cells to a hormone may cause the cells to become less re- mone are present, (2) a change in receptor number. Dose- sponsive to subsequent exposure to the hormone by a response curves may also reflect combinations of changes process termed desensitization. If the exposure of cells to in responsiveness and sensitivity in which there is both a a hormone has a desensitizing effect on further action by right or left shift of the curve (a sensitivity change) and a that same hormone, the effect is termed homologous de- change in maximal biological response to a lower or higher sensitization. If the exposure of cells to one hormone has level (a change in responsiveness).

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The most common form is horizontal jerk nystagmus order voveran 50 mg online, in which the eyes repetitively move slowly toward one side and then quickly back purchase voveran 50mg. Vertical nystagmus is always abnormal, signifying a disorder in brainstem function. Pendular nystagmus, in which one eye moves at equal speeds in both directions, commonly is congenital. Doll’s Eye Phenomenon occurs when the head is turned suddenly to one side. This reflex is believed to be brainstem mediated, and any asymmetry or lack of response is believed to reflect significant brainstem dysfunction. The complete neurological examination: What every nurse practitioner should know. This page intentionally left blank Chapter 7 Magnetic Resonance Imaging Objectives: Upon completion of this chapter, the learner will: Describe the role of MRI in the diagnosis and treatment of MS Discuss MRI in relation to disease modifying therapies Cite the use of MRI in MS researchBasic overview of MRI: A. Unlike CAT (computed axial tomography) scans, MRI does not use X-rays to create pictures of the body. The technology uses a complicated array of physics, mathematics, and high-performance computing techniques. An MRI scanner consists of a very large and very strong, but harmless, magnet; the patient lies within the magnet’s field. The scanner generates pictures by analyzing how water molecules react to electrical impulses in this strong magnetic environment. When a person lies in the magnetic field on an MR unit, protons align with the axis of the magnet. When the pulse is turned off, the protons return to their previ- ous states.

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An examination of the internal eyeball with an ophthalmoscope Blood Supply to the Eyeball is frequently part of a routine physical examination generic voveran 50mg. If they appear abnormal (for example order voveran 50 mg, Both the choroid and the retina are richly supplied with blood. Diseases such as arterioscle- eyeball and traverse the choroid to the ciliary body and base of the rosis, diabetes, cataracts, or glaucoma can be detected by examin- iris. Although the ciliary arteries enter the eyeball independently, ing the internal eyeball. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 508 Unit 5 Integration and Coordination TABLE 15. The scleral venous sinus is located at the junction of the cornea and iris. The interior of the eyeball is separated by the lens and its associ- The large posterior cavity is filled with a transparent jelly- ated lens capsule into an anterior cavity and a posterior cavity like vitreous humor. The anterior cavity is subdivided by the iris into ular pressure that maintains the shape of the eyeball and holds an anterior chamber and a posterior chamber (see fig. Unlike aqueous humor, vitreous The anterior chamber is located between the cornea and the iris. Additional vitreous humor forms as a person’s eyes become pensory ligament and lens. Aqueous humor also Puncture wounds to the eyeball are especially dangerous and provides nutrients and oxygen to the avascular lens and cornea. Protective equipment such as goggles, shields, and shatterproof lenses should be used in haz- An estimated 5. If the eye is punctured, the the vascular epithelium of the ciliary body (fig. From its main thing to remember is to leave the object in place if it is still im- site of secretion within the posterior chamber, the aqueous paling the eyeball. Removal may allow the fluids to drain from the humor passes through the pupil into the anterior chamber. From eyeball, causing loss of intraocular pressure, a detached retina, and possibly blindness.

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