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In contrast erectile dysfunction treatment diabetes discount levitra jelly 20 mg buy, increased ventilation raises the local blood Po2 and this stimulates vasodilation, increasing blood flow to that region to take advantage of the oxygen availability (right side of same figure). These reactions of the pulmonary arteries are opposite from the reactions of systemic arteries, which dilate in response to hypoxia. Furthermore, changes in the blood flow to a region of a lung stimulate bronchoconstriction or dilation, adjusting ventilation so that air is directed to the best-perfused parts of the lung (fig. Gas Transport Gas transport is the process of carrying gases from the alveoli to the systemic tissues and vice versa. Trace the partial pressure of oxygen from inspired air to expired air and explain each change in Po2 along the way. Each heme can bind 1 O2 to the iron atom at its center; thus, one hemoglobin molecule can carry up to 4 O2. When hemoglobin is 100% saturated, every molecule of it carries 4 O2; if it is 75% saturated, there is an average of 3 O 2 per hemoglobin molecule; if it is 50% saturated, there is an average of 2 O2 per hemoglobin; and so forth. The poisonous effect of carbon monoxide stems from its competition for the O2 binding site (see Deeper Insight 22. The rate of loading depends on the steepness of the gradient from alveolar air to the venous blood arriving at the alveolar capillaries. Compared with the oxygen gradient at sea level (blue line), the gradient is less steep at high elevation (red line) because the Po2 of the atmosphere is lower. In a hyperbaric chamber with 100% oxygen, the gradient from air to blood is very steep (green line), and oxygen loading is correspondingly rapid. The relationship between hemoglobin saturation and ambient Po2 is shown by the oxyhemoglobin dissociation curve (fig. At low Po2, the curve rises slowly; then there is a rapid increase in oxygen loading as Po2 rises farther. When the first heme group binds O2, hemoglobin changes shape in a way that facilitates uptake of the second O2 by another heme group. This, in turn, promotes the uptake of the third and then the fourth O2-hence the rapidly rising midportion of the curve. At high Po2 levels, the curve levels off because the hemoglobin approaches 100% saturation and cannot load much more oxygen. This colorless, odorless gas occurs in cigarette smoke, engine exhaust, and fumes from furnaces and space heaters. Constriction of bronchioles Decreased airflow (b) Ventilation adjusted to changes in perfusion Increased airflow Dilation of bronchioles Carbon Dioxide Carbon dioxide is transported in three forms: carbonic acid, carbamino compounds, and dissolved gas. As it passes through the alveolar capillaries where the Po2 is high, hemoglobin becomes saturated with oxygen. As it passes through the systemic capillaries where the Po2 is low, it typically gives up about 22% of its oxygen (color bar at top of graph).

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The Broca and Wernicke areas for language abilities are found in only one hemisphere erectile dysfunction questions to ask levitra jelly 20 mg buy with amex, usually the left. Auditory signals are received by the primary posterior parietal lobe (concerned with spatial perception), and much of the inferior temporal lobe, where we recognize faces and other familiar objects. The auditory association area occupies areas of temporal lobe inferior to the primary auditory cortex and deep within the lateral sulcus. This is where we become capable of recognizing spoken words, a familiar piece of music, or a voice on the telephone. Signals from the inner ear for equilibrium project mainly to the cerebellum and several brainstem nuclei concerned with head and eye movements and visceral functions. Some fibers of this system, however, are routed through the thalamus to areas of association cortex in the roof of the lateral sulcus and near the lower end of the central sulcus. Gustatory (taste) signals are received by the primary gustatory cortex in the inferior end of the postcentral gyrus of the parietal lobe (discussed shortly) and an anterior region of the insula. Olfactory (smell) signals are received by the primary olfactory cortex in the medial surface of the temporal lobe and inferior surface of the frontal lobe. The orbitofrontal cortex mentioned earlier serves as a multimodal association area for both taste and smell, and is thus highly important in our enjoyment or rejection of various foods and drinks. As the diagram shows, receptors in the lower limb project to superior and medial parts of the gyrus, and receptors in the face project to the inferior and lateral parts. Thus, the hands and face are represented by a much larger region of somatosensory cortex than the trunk is. Motor Control the intention to contract a skeletal muscle begins in the motor association (premotor) area of the frontal lobes (fig. This is where we plan our behavior-where neurons compile a program for the degree and sequence of muscle contractions required for an action such as dancing, typing, or speaking. The program is then transmitted to neurons of the precentral gyrus (primary motor area), which is the most posterior gyrus of the frontal lobe, immediately anterior to the central sulcus (fig. Neurons here send signals to the brainstem and spinal cord, which ultimately results in muscle contractions. The neurons for toe movements, for example, are deep in the longitudinal fissure on the medial side of the gyrus. The summit of the gyrus controls the trunk, shoulder, and arm, and the inferolateral region controls the facial muscles. Like the sensory homunculus, it has a distorted look because the amount of cortex devoted to a given body region is proportional to the number of muscles and motor units in that region, not to the size of the region. The amount of cerebral tissue dedicated to the hands, face, and tongue reflects the importance of fine motor control in speech, facial expression, and use of the hands. The General Senses the general (somatosensory, somesthetic,51 or somatic) senses are distributed over the entire body and employ relatively simple receptors.

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Explain how the body can shift the flow of blood from one organ system to another erectile dysfunction more causes risk factors buy levitra jelly canada. Chemicals given off by the capillary blood to the perivascular tissues include oxygen, glucose and other nutrients, antibodies, and hormones. Chemicals taken up by the capillaries include carbon dioxide and other wastes, and many of the same substances as they give off: glucose and fatty acids released from storage in the liver and adipose tissue; calcium and other minerals released from bone; antibodies secreted by immune cells; and hormones secreted by the endocrine glands. Thus, many of these chemicals have a two-way traffic between the blood and connective tissue, leaving the capillaries at one point and entering at another. Along with all these solutes, there is substantial movement of water into and out of the bloodstream across the capillary walls. Significant exchange also occurs across the walls of the venules, but capillaries are the more important exchange site because they so greatly outnumber the venules. The mechanisms of capillary exchange are difficult to study quantitatively because it is hard to measure pressure and flow in such small vessels. Few capillaries of the human body are accessible to direct, noninvasive observation, but those of the fingernail bed and eponychium (cuticle) at the base of the nails can be observed with a stereomicroscope and have been the basis for a number of studies. The mechanisms of movement through the capillary wall are diffusion, transcytosis, filtration, and reabsorption. Glucose and oxygen, being more concentrated in the systemic blood than in the tissue fluid, diffuse out of the blood. Carbon dioxide and other wastes, being more concentrated in the tissue fluid, diffuse into the blood. Substances insoluble in lipids, such as glucose and electrolytes, must pass through membrane channels, filtration pores, or intercellular clefts. Oncotic pressure tends to draw water into the capillary by osmosis, opposing hydrostatic pressure. Materials move through the capillary wall via filtration pores (in fenestrated capillaries only), by transcytosis, by diffusion through the endothelial cells, and via intercellular clefts. This probably accounts for only a small fraction of solute exchange across the capillary wall, but fatty acids, albumin, and some hormones such as insulin move across the endothelium by this mechanism. Typically, fluid filters out of the arterial end of a capillary and osmotically reenters it at the venous end. This fluid delivers materials to the cells and rinses away their metabolic wastes.

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At the same time erectile dysfunction for women levitra jelly 20 mg low cost, hyperemia delivers oxygen, amino acids, and other necessities of protein synthesis, while the heat of inflamed tissue increases metabolic rate and the speed of mitosis and tissue repair. It is an important alarm signal that calls our attention to the injury and makes us limit the use of a body part so it has a chance to rest and heal. Earlier it was stated that innate immunity employs protective proteins, protective cells, and protective processes. The remainder of this chapter is concerned with adaptive immunity (the third line of defense). Adaptive immunity is now defined by three characteristics that distinguish it from the three that were itemized earlier (local, nonspecific, and lacking memory) for innate immunity: 1. When an adaptive response is mounted against a particular threat such as a bacterial infection, it acts throughout the body to defeat that pathogen wherever it may be found. Immunity to one disease such as chickenpox does not confer immunity to others such as tetanus. When reexposed to the same pathogen, the body reacts so quickly that there is no noticeable illness. The reaction time for inflammation and other innate defenses, by contrast, is just as long for later exposures as for the initial one. Forms of Adaptive Immunity In the late 1800s, it was discovered that immunity can be transferred from one animal to another by way of the blood serum. Thus, biologists came to recognize two types of adaptive immunity, called cellular and humoral immunity, although the two interact extensively and often respond to the same pathogen. Cellular (cell-mediated) immunity employs lymphocytes that directly attack and destroy foreign cells or diseased host cells. It is a means of ridding the body of pathogens that reside inside human cells, where they are inaccessible to antibodies: intracellular viruses, bacteria, yeasts, and protozoans, for example. Cellular immunity also acts against parasitic worms, cancer cells, and cells of transplanted tissues and organs. The expression humoral refers to antibodies dissolved in the body fluids ("humors"). Humoral immunity is effective against extracellular viruses, bacteria, yeasts, protozoans, and molecular (noncellular) pathogens such as toxins, venoms, and allergens. In the unnatural event of a mismatched blood transfusion, it also destroys foreign erythrocytes. Note that humoral immunity works mainly against the extracellular stages of infectious microorganisms.

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Thyroid hormone also promotes alertness and quicker reflexes; growth hormone secretion; growth of the bones erectile dysfunction doctor edmonton order levitra jelly 20 mg, skin, hair, nails, and teeth; and development of the fetal nervous system. The thyroid gland also contains nests of parafollicular cells, also called clear (C) cells, at the periphery of the follicles. They respond to rising levels of blood calcium by secreting the hormone calcitonin. Calcitonin antagonizes parathyroid hormone (discussed shortly) and stimulates osteoblast activity, thus promoting calcium deposition and bone formation. It is important mainly 16 in children, having relatively little effect in adults (see "Calcium Homeostasis" in section 7. The Parathyroid Glands the parathyroid glands are ovoid glands, usually four in number, partially embedded in the posterior surface of the thyroid. Each is about 3 to 8 mm long and 2 to 5 mm wide, and is separated from the thyroid follicles by a thin fibrous capsule and adipose tissue (fig. Often, they occur in other locations ranging from as high as the hyoid bone to as low as the aortic arch, and about 5% of people have more than four parathyroids. Calcium homeostasis is so crucial to neuromuscular and cardiovascular function that a person can die within just a few days if the parathyroids are removed without instituting hormone replacement therapy. This often happened to patients shortly following thyroid surgery before surgeons realized the existence and function of the tiny, nearly hidden parathyroids. The Adrenal Glands the adrenal17 (suprarenal) glands sit like a cap on the superior pole of each kidney (fig. The adult adrenal gland measures about 5 cm vertically, 3 cm wide, and 1 cm from anterior to posterior. It weighs about 8 to 10 g in the newborn, but loses half of this weight by the age of 2 years, mainly because of involution of its outer layer, the adrenal cortex. Like the pituitary, the adrenal gland forms by the merger of two fetal glands with different origins and functions. Surrounding it is a much thicker adrenal cortex, constituting 80% to 90% of the gland and having a yellowish color due to its high concentration of cholesterol and other lipids. The name glomerulosa ("full of little balls") refers to the arrangement of its cells in round clusters. Here the cells are arranged in parallel cords (fascicles), separated by blood capillaries, perpendicular to the gland surface. The cells are called spongiocytes because of a foamy appearance imparted by an abundance of cytoplasmic lipid droplets. Like the preceding layer, the zona reticularis also secretes glucocorticoids and androgens. Aldosterone is the most significant mineralocorticoid, and is produced only by the zona glomerulosa. In brief, blood pressure sensors (baroreceptors) in major arteries near the heart detect falling blood pressure and activate a sympathetic reflex. Water is retained with it by osmosis, so aldosterone helps to maintain blood volume and pressure.

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The ganglion contains the somas of neurons that carry sensory signals to the spinal cord erectile dysfunction uncircumcised levitra jelly 20 mg purchase without prescription. The corticospinal tracts carry sensory signals from the spinal cord to the cerebral cortex. The dermatomes are nonoverlapping regions of skin innervated by different spinal nerves. Ipsilateral reflex arcs are monosynaptic whereas contralateral arcs are polysynaptic. Emergency medical technicians properly immobilize her neck and transport her to a hospital, but she dies 5 minutes after arrival. An autopsy shows multiple fractures of vertebrae C1, C6, and C7 and extensive damage to the spinal cord. A bullet grazed his vertebral column, and bone fragments severed the left half of his spinal cord at segments T8 through T10. Since the accident, Wallace has had a condition called dissociated sensory loss, in which he feels no sensations of deep touch or limb position on the left side of his body below the injury, and no sensations of pain or heat from the right side. Explain what spinal tract(s) the injury has affected and why these sensory losses are on opposite sides of the body. The attacker stabs him on the medial side of the right gluteal fold and Anthony collapses. He loses all use of his right limb, being unable to extend his hip, flex his knee, or move his foot. Raise your left foot from the floor without losing contact with the wall at any point. When a patient needs a tendon graft, surgeons sometimes use the tendon of the palmaris longus, a relatively dispensable muscle of the forearm. There have been cases in which a surgeon mistakenly removed a section of this nerve instead of the tendon. The brainstem contains extensions of the spinal cord tracts, so you will find it helpful to know those or refer back to table 13. To best understand the cranial nerves, you should be familiar with the general structure of nerves and ganglia, afferent and efferent nerve fibers, and the distinction between sensory, motor, and mixed nerves (see "General Anatomy of Nerves and Ganglia" in section 13. The human brain has a high opinion of itself, often claiming to be the most complex object in the known universe. It has a mystique that intrigues modern biologists and psychologists even as it did the philosophers of antiquity. Aristotle thought it was just a radiator for cooling the blood, but generations earlier, Hippocrates had expressed a more accurate view. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant. With its hundreds of neural pools and trillions of synapses, the brain performs sophisticated tasks beyond our present understanding.

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Thrusting of the penis in the vagina tugs on the labia minora and erectile dysfunction drug related levitra jelly 20 mg buy on-line, by extension, pulls on the prepuce and stimulates the clitoris. The clitoris may also be stimulated by pressure between the pubic symphyses of the partners. The breasts also become congested and swollen during the excitement phase, and the nipples become erect. Female sexual response, the physiological changes that occur during intercourse, may be viewed in terms of the four phases identified by Masters and Johnson and discussed in section 27. The neurological and vascular controls of the female response are essentially the same as in the male and need not be repeated here. Orgasm Late in plateau, many women experience involuntary pelvic thrusting, followed by 1 to 2 seconds of "suspension" or "stillness" preceding orgasm. Orgasm is commonly described as an intense sensation spreading from the clitoris through the pelvis, sometimes with pelvic throbbing and a spreading sense of warmth. The uterus exhibits peristaltic waves of contraction, which may help to draw semen from the vagina. The anal and urethral sphincters constrict, and the paraurethral glands, homologous to the prostate, sometimes expel copious fluid similar to prostatic fluid ("female ejaculation"). Tachycardia and hyperventilation occur; the breasts enlarge still more and the areolae often become engorged; and in many women, a reddish, rashlike flush appears on the lower abdomen, chest, neck, and face. Excitement and Plateau Excitement is marked by myotonia; vasocongestion; and increased heart rate, blood pressure, and respiratory rate. Although vasocongestion works by the same mechanism in both sexes, its effects are quite different in females. The labia majora redden and enlarge, then flatten and spread away from the vaginal orifice. The lower one-third of the vagina constricts to form a narrow passage called the orgasmic platform, owing partly to vasocongestion of the vestibular bulbs. The narrower canal and the vaginal rugae (friction ridges) enhance stimulation and help induce orgasm in both partners. Increased blood flow in the vaginal wall turns it purple and produces a serous fluid, the vaginal transudate, that seeps through the wall into the canal. Along with secretions of the greater vestibular glands, this moistens the vestibule and provides lubrication. The uterus, which normally tilts forward over the urinary bladder, stands more erect during excitement and the cervix withdraws from the vagina. Although the vagina is the female copulatory organ, the clitoris is more comparable to the penis in structure, physiology, and importance as the primary focus of sexual stimulation. It has a high concentration of sensory nerve endings, which, by contrast, are relatively scanty in the vagina.

Shawn, 39 years: The greatest incidence is among males from 16 to 30 years old, because of their high-risk behaviors.

Mufassa, 56 years: The urinary system consists of six principal organs: two kidneys, two ureters, the urinary bladder, and the urethra.

Kor-Shach, 49 years: Heart block is a failure of any part of the cardiac conduction system to conduct signals, usually as the result of disease and degeneration of conduction system fibers.

Grubuz, 25 years: Among other functions, this mechanism is crucial to penile erection (see Deeper Insight 27.