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Most of the muscles that move the Trapezius Posterior of neck and Raises shoulder and pulls it hand and fingers originate from the ra- upper back order 100 mg viagra jelly fast delivery, to clavicle back; extends head dius and the ulna (see Fig proven 100 mg viagra jelly. Some and scapula Latissimus dorsi Middle and lower back, Extends and adducts arm of them insert on the carpal bones of to humerus behind back the wrist, whereas others have long Pectoralis major Superior, anterior chest, Flexes and adducts arm tendons that cross the wrist and insert to humerus across chest; pulls shoulder on bones of the hand and the fingers. Muscles that Deltoid Covers shoulder joint, to Abducts arm produce finger movements are the sev- lateral humerus eral flexor digitorum (dij-e-TO-rum) Biceps brachii Anterior arm along Flexes forearm at the elbow and the extensor digitorum muscles. Muscles of the Trunk The muscles of the trunk include the The shoulder joint allows for a very wide range of muscles involved in breathing, the thin muscle layers of movement. The four muscles are the supraspinatus, in- Muscles of Respiration The most important muscle fraspinatus, teres minor, and subscapularis, known to- involved in the act of breathing is the diaphragm. In dome-shaped muscle forms the partition between the certain activities, such as swinging a golf club, playing thoracic cavity superiorly and the abdominal cavity infe- tennis, or pitching a baseball, the muscles of the rotator riorly (Fig. Contraction along the humerus, is the muscle you usually display of the intercostal muscles serves to elevate the ribs, thus when you want to “flex your muscles” to show your enlarging the thoracic cavity from side to side and from strength (Fig. Another flexor of the forearm at the elbow is the bra- chioradialis (bra-ke-o-ra-de-A-lis), a prominent muscle Checkpoint 8-13 What muscle is most important in breathing? Muscles of the Abdomen and Pelvis The wall of The triceps brachii, located on the posterior of the the abdomen has three layers of muscle that extend from arm, inserts on the olecranon of the ulna (Fig. They are the ex- 166 ✦ CHAPTER EIGHT ternal oblique on the outside, the in- ternal oblique in the middle, and the Biceps Triceps brachii transversus abdominis, the inner- brachii most. The connective tissue from Brachioradialis these muscles extends forward and en- closes the vertical rectus abdominis of Extensor carpi the anterior abdominal wall. The fibers radialis longus of these muscles, as well as their con- nective tissue extensions (aponeu- Brachioradialis Extensor carpi radialis brevis roses), run in different directions, re- sembling the layers in plywood and Flexor carpi Flexor carpi resulting in a strong abdominal wall. Deep Muscles of the Back The deep muscles of the back, which act on Intercostal Left lung the vertebral column itself, are thick muscles vertical masses that lie under the trapezius and latissimus dorsi. Muscles of the Lower Extremities The muscles in the lower extremities, among the longest and strongest mus- cles in the body, are specialized for lo- comotion and balance. Rectus External Muscles that Move the Thigh abdominis oblique and Leg The gluteus maximus (Linea alba) Internal (GLU-te-us MAK-sim-us), which oblique forms much of the fleshy part of the (Umbilicus) Transversus buttock, is relatively large in humans abdominis because of its support function when a (Abdominal aponeurosis) person is standing in the erect position (Fig.

Inter- tapping tapping intervals during arm (black bars) and leg (white bars) anesthesia in a representative patient buy 100 mg viagra jelly. Note that finger-tapping intervals were shorter with hand deafferen- tation order 100 mg viagra jelly with mastercard, denoting improved tapping speed that outlasted the time of anesthesia (modified from Floel et al. This type of intervention may have potential implications for the developing rehabilitative treatments for disability after a stroke, the main cause of adult long-term disability. In summary, deafferentation of one body part representation elicits reorganiza- tional changes in the sensorimotor cortex not only of the contralateral but also the ipsilateral hemisphere11,161 that are associated with behavioral gains. SOMATOSENSORY STIMULATION Somatosensory input is required for proper motor control in healthy volunteers7,31 and patients with brain lesions. In humans, peripheral nerve stimulation has a similar influence on motor cortical function. Stimulation of the ulnar nerve at the wrist for two hours resulted in increased motor cortical excitability in the ulnar nerve-innervated muscle abductor digiti minimi65 consistent with previous find- ings. Similarly, stimulation of pharyngeal areas results in increased excitability of the pharyngeal motor cortical representation. These changes evoked by somatosensory stimulation on motor cortical function raised the hypothesis of the possible use of this intervention in patients with weakness secondary to stroke. This inter- vention resulted in a mild improvement in pinch force relative to a control intervention. Interestingly, the magnitude of improvement correlated with the intensity of the electrical stimulation. Two of these patients spontaneously reported that they could hold objects, write and play cards more easily for approximately 24 h. EFFECTS OF CORTICAL STIMULATION ON MOTOR CORTICAL FUNCTION AND CORTICAL PLASTICITY In animal models, cortical stimulation of a body part representation in the motor cortex results in increased motor maps targeting that particular body part. In healthy human volunteers, application of cortical stimulation techniques also modulates cortical excitabil- ity. These features make this technique potentially an appealing tool to purposefully modulate cortical function.

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In the past buy discount viagra jelly 100 mg online, the recommended stances that are essential in small amounts for the regu- dietary allowances (RDAs) buy generic viagra jelly 100mg on-line, which are the levels of in- lation of normal metabolism, growth, and function of take of essential nutrients that are considered to be ade- the human body. Not all of the vitamins can be synthe- quate to meet the known nutritional needs of practically sized in the body, and therefore, some vitamins must be all healthy persons, were the primary reference value for obtained from an external source, such as a proper well- vitamins and other nutrients. RDA, EAR, and AI reference standards define nutri- Deficiency diseases can result from insufficient vitamin tional intake adequacy. Since these recommendations are ingestion, irregular absorption, or impaired metabolic given for healthy populations in general and not for indi- use of these nutrients. The ingestion or administration viduals, special problems, such as premature birth, inher- of excessive quantities of vitamins, also known as hy- ited metabolic disorders, infections, chronic disease, and pervitaminosis, may result in toxicity. This chapter focuses on the pharmacological and Separate RDAs have been developed for pregnant and toxicological properties of vitamins. Vitamin supplementation may be re- quired by patients with special conditions and for those who do not consume an appropriate diet. A varied diet containing a wide range of foodstuffs DIETARY REFERENCE STANDARDS provides adequate intake of vitamins for most people, The Food and Nutrition Board of the Institute of and supplementing these amounts will have no benefi- Medicine (IOM) has been developing reference stan- cial effect and may result in the toxicity associated with dards for vitamins and other nutrients called Dietary hypervitaminosis. The DRI also includes the tolerable 777 778 VII DRUGS AFFECTING THE ENDOCRINE SYSTEM upper intake level (UL) of vitamins. Bone development and growth in children as the highest level of intake of a nutrient that will not have also been linked to adequate vitamin A intake. The UL is an important ref- combines with opsin to produce the visual pigment erence standard, especially with the current promotion rhodopsin. A plant pigment, carotene, is a precursor for vitamin DEFICIENCY DISEASES A and is present in highly pigmented vegetables, such as carrots, rutabaga, and red cabbage. Medical personnel who work in affluent areas are un- An early sign of hypovitaminosis A is night blind- likely to see large numbers of people with vitamin defi- ness.

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Many individuals with AS have stra- to detect cases of AS caused by mutations in this gene generic viagra jelly 100mg with amex. Fluorescent in situ hybridization (FISH) FISH studies may be necessary to detect chromo- Prognosis some rearrangements that disrupt the 15q11-q13 region Individuals with AS have significant mental retarda- on the maternal copy of chromosome 15 cheap viagra jelly 100 mg mastercard. The FISH tion and speech impairment that are considered to occur method is a special way of checking for the presence, in all cases. However, they do have capacity to learn and absence, or rearrangement of very small pieces of chro- should receive appropriate educational training. FISH testing can also readily detect AS caused by chromosome deletions, which account for approxi- Young people with AS typically have good physical mately 70% of AS cases. Although life span data are following an abnormal methylation study to determine if not available, the life span of people with AS is expected a chromosome deletion accounts for the abnormal to be normal. The typical hyperactivity in AS may not respond to ORGANIZATION traditional behavior modification strategies. Most families make special accommodations for their child by WEBSITES providing a safe yet confining environment. Jennifer Ann Roggenbuck, MS, CGC GALE ENCYCLOPEDIA OF GENETIC DISORDERS 93 KEY TERMS Ankylosis—Immobility of a joint due to the forma- diagnostic marker for rheumatoid arthritis that is tion of new bone at the site of inflammation. Enthesitis—Inflammation at the place where the lig- Sacroiliac joint—The joint between the triangular aments insert into the bone. HLA-B27—Stands for a specific form of human Sensitivity—The proportion of people with a dis- leukocyte antigen, the proteins involved in immune ease who are correctly diagnosed (test positive system function. Specificity—The proportion of people without a Magnetic resonance imaging (MRI)—A technique disease who are correctly classified as healthy or that employs magnetic fields and radio waves to not having the disease (test negative based on diag- create detailed images of internal body structures nostic criteria). Spondyloarthritis (spondylitis)—Inflammatory dis- ease of the joints of the spine.