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There is overwhelming evidence discount super levitra 80 mg with visa erectile dysfunction pills from india, however generic 80 mg super levitra fast delivery erectile dysfunction 20 years old, that training can substantially mitigate declines in strength and endurance with advancing age purchase super levitra 80mg with amex impotence 22 year old. Changes in functional capacity, as well as protection against heart disease and diabetes, do increase longevity in active persons. However, it remains controversial whether chronic exercise enhances lifespan or whether exercise boosts the immune system, prevents insomnia, or enhances mood. In obese patients, chronic exercise preferentially increases caloric expenditures over increased appetite. Obesity increases the risk for hypertension, heart disease, and diabetes and is characterized, at a descriptive level, as an excess of caloric intake over energy expenditure. Because exercise enhances energy expenditure, increasing physical activity is a mainstay of treatment for obesity. For exceptionally active people, exercise expenditure can exceed 3,000 kcal/d, added to the basal energy expenditure, which for a 55-kg woman averages about 1,400 kcal/d. At high levels of activity, appetite and food intake match caloric expenditure, though the biologic factors that allow this precise balance have never been defined. In obese patients, modest increases in physical activity increase energy expenditure more than food intake, so progressive weight loss can be instituted if exercise can be regularized. This method of weight control is superior to dieting alone, because substantial caloric restriction (>500 kcal/d) results in both a lowered basal metabolic rate and a substantial loss of fat-free body mass. Exercise has other, more subtle, positive effects on the energy balance equation as well. A single exercise episode may increase basal energy expenditure for several hours and may increase the thermal effect of feeding. The greatest practical problem remains compliance with even the most precise exercise “prescription”; patient dropout rates from even short-term programs typically exceed 50%. Although skeletal muscle is omnivorous, its work intensity and duration, training status, inherent metabolic capacities, and substrate availability determine its energy sources. Even maximal efforts lasting 5 to 10 seconds require little or no glycolytic or oxidative energy production. The carbohydrate provided to glycolysis comes from stored, intramuscular glycogen or blood-borne glucose. Exhaustion from work in this intensity range (50% to 90% of the ) is associated with carbohydrate depletion. Accordingly, factors that increase carbohydrate availability improve fatigue resistance. These include prior high dietary carbohydrate, cellular training adaptations that increase the enzymatic potential for fatty acid oxidation (thereby sparing carbohydrate stores), and oral carbohydrate intake during exercise. Hypoglycemia rarely occurs during even the most prolonged or intense physical activity. When it does, it is usually in association with the depletion of muscle and hepatic stores and a failure to supplement carbohydrate orally. Exercise suppresses insulin secretion by increasing sympathetic tone at the pancreatic islets. Despite acutely falling levels of circulating insulin, both non–insulin-dependent and insulin-dependent muscle glucose uptake, increase during exercise. Exercise recruits glucose transporters from their intracellular storage sites to the plasma membrane of active skeletal muscle cells. Because exercise increases insulin sensitivity, patients with type 1 diabetes (insulin dependent) require less insulin when activity increases. However, this positive result can be treacherous because exercise can accelerate hypoglycemia and increase the risk of insulin coma. Chronic exercise, through its reduction of insulin requirements, up- regulates insulin receptors. This effect appears to be a result less of training than simply of a repeated acute stimulus. The effect is full-blown after 2 to 3 days of regular physical activity and can be lost as quickly. Consequently, healthy active people show strikingly greater insulin sensitivity than do their sedentary counterparts (Fig. In addition, up-regulation of insulin receptors and reduced insulin release after chronic exercise are ideal therapy in type 2 diabetes (non–insulin-dependent), a disease characterized by high insulin secretion and low receptor sensitivity. In those with type 2 diabetes, a single episode of exercise results in substantial glucose transporter translocation to the plasma membrane in skeletal muscle. Repeated exercise significantly decreases both responses, demonstrating increased insulin sensitivity. Although the ceiling for oxygen uptake during work gradually falls with age, the ability to train toward an age-appropriate ceiling is as intact at age 70 years as it is at age 20 years (Fig. In fact, a highly active 70-year-old person, otherwise healthy, will typically display an absolute exercise capacity greater than that of a sedentary 20- year-old person. Aging affects all the links in the chain of oxygen transport and use, so aging-induced declines in lung elasticity, lung diffusing capacity, cardiac output, and muscle metabolic potential take place in concert. Consequently, the physiologic mechanisms underlying fatigue are similar at all ages. Endurance-trained subjects possess greater maximal oxygen uptake than sedentary subjects, regardless of age. Regular dynamic exercise, compared with inactivity, increases longevity in rats and humans. In descriptive terms, the effects of exercise are modest; all-cause mortality is reduced but only in amounts sufficient to increase longevity by 1 to 2 years. Although physical activity increases cellular oxidative stress, it simultaneously increases antioxidant capacity. Food-restricted rats experience increased lifespan and exhibit elevated spontaneous activity levels, but the role exercise may play in the apparent delay of aging in these animals remains unclear. In protein–calorie malnutrition, the catabolism of protein for energy lowers immunoglobulin levels and compromises the body’s resistance to infection. Clearly, in this circumstance, exercise merely speeds the starvation process by increasing daily caloric expenditure and would be expected to diminish the immune response further. Nazi labor camps of the early 1940s became death camps, partly by severe food restrictions and incessant demands for physical work-a combination guaranteed to cause starvation. If nutrition is adequate, it is less clear whether adopting an active versus a sedentary lifestyle alters immune responsivity. In healthy subjects, an acute episode of exercise briefly increases blood leukocyte concentration and transiently enhances neutrophil production of microbicidal reactive oxygen species and natural killer cell activity. In contrast to moderate or intermittent physical activity, prolonged and very intense exertions are associated with numerous changes in the immune system that reflect physiologic stress and suppression.

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The pathway of blood fow through the chambers of the hean is indicated in Figure 1-4 purchase super levitra 80mg with amex erectile dysfunction nutrition. Venous blood returns from the systemic organs to the right atrium via the superior and inferior venae cavae purchase super levitra 80 mg visa impotence 60 years old. This "venous" blood is defcient in oxygen because it has just passed through systemic organs that all etract oxyen from blood fr their metabolism buy super levitra with paypal erectile dysfunction in middle age. It then passes through the ticpid valve into the rigt ventricle and from there it is pumped through the pulmonic valve into the pulmo­ nary circulation via the pulmonary arteries. Within the capillaries of the lung, blood is "reoxynated" by eposure t oxygen-rich inspired air. Oxygenated pul­ monary venous blood flows in pulmonary veins to the lef atrium and passes thrugh the mital valve into the left ventricle. From there it is pumped through the artc valve into the aorta to be distributed to the systemic organs. Although the gross anatomy of the right heart pump is somewhat difr­ ent frm that of the left hean pump, the pumping principles are identical. Each pump consists of a ventricle, which is a cosed chamber surrounde by a muscular wall, as illustrated in Figure 1-S. The valves are structurally designed t allow Ho in only one direction and pasivel open and dose in response to the diretion of the pressure diferences across them. Ventricular pumping action occurs because the volume of the intraventricular chamber i cyclically changed by rhythmic and synchronized contraction and relaxation of the individual cardiac muscle cells that lie in a circumfrential orientation within the ventricular wall. When the ventricular muscle cells are contracting, they generate a circum­ ferential tension in the ventricular walls that causes the pressure within the chamber to increase. As soon as the ventricular pressure exceeds the pressure in the pulmonary artery (right pump) or aorta (left pump), blood is forced out of the chamber through the outlet valve, as shown in Figure 1-5. This phase of the cardiac cycle during which the ventricular muscle cells are contracting is called systole. The outlet valve is closed during diastole because arterial pressure is greater than intraventricular pressure. After the period of diastolic flling, the systolic phase of a new cardiac cycle is initiated. Contraction of each cell is triggered when an electrical excitatory impulse (action potential) sweeps over its membrane. Proper coordination of the contractile activity of the individual cardiac muscle cells is achieved primarily by the conduction of action potentials from one cell to the next via gap junctions that connect all cells of the heart into a functional syncytium (ie, acting as one synchronous unit). In addition, muscle cells in certain areas of the heart are specifcally adapted to control the frequency of cardiac excitation, the pathway of conduction, and the rate of the impulse propagation through various regions of the heart. The major components of this specialized excitation and conduction system are shown in Figure 1-6. The Purkinje fbers are specialized for rapid conduction and ensure that all ventricular cells contract at nearly the same instant. The rest of the conduc­ tion system ensures that all the rest of the cells in the heart follow along in proper lockstep for efcient pumping action. When active, these sympathetic nerves release norepinephrine (nor­ adrenaline) on cardiac cells. Norepinephrine interacts with �1-adrenergic receptors on cardiac muscle cells to increase the heart rate, increase the action potential con­ duction velocity, and increase the force of contraction and rates of contraction and relaxation. When active, these parasympathetic nerves release acetlcholine on cardiac muscle cells. Parasympathetic nerves may also act to decrease the force of contraction of atrial (not ventricular) muscle cells. Usually, an increase in parasympathetic nerve activity is accom­ panied by a decrease in sympathetic nerve activity, and vice versa. As a consequence, and as illustrated in Figure 1-7, stroke volume increases nearly in proportion to increases in end­ diastolic volume. The primary consequence is that stroke volume (and therefore cardiac output) is strongly influenced by cardiac fill­ ing during diastole. Therefore, we shall later pay particular attention to the factors that afect cardiac flling and how they participate in the normal regulation of cardiac output. Requirements for Effective Operation For effective effcient ventricular pumping action, the heart must be functioning properly in fve basic respects: 1. The contractions of individual cardiac muscle cells must occur at regular inter- vals and be synchronized (not arrhythmic). In the subsequent chapters, we will study in detail how these requirements are met in the normal heart. As illustrated in Figure 1-8, the major vessel classifications are arteries, arterioles, capilaries, venules, and veins. These consecutive vascular segments are distinguished from one another by differences in their physical dimensions, morphological characteristics, and function. One thing that all these vessels have in common is that they are lined with a contiguous single layer of endothelial cells. In fact, this is true for the entire circulatory system including the heart chambers and even the valve leaflets. Vessel Characteristics Some representative physical characteristics of these major vessel types are shown in Figure 1-8. The total cross-sectional area through which blood fows at any particular level in the vascular system is equal to the sum of the cross-sectional areas of all the individual vessels arranged in parallel at that level. The number and total cross-sectional area values presented in Figure 1-8 are estimates for the entire systemic circulation. Arteries are thick-walled vessels that contain, in addition to some smooth muscle, a large component of elastin and collagen fbers. Primarily because of the elastin fbers, which can stretch to twice their unloaded length, arteries can expand to accept and temporarily store some of the blood ejected by the heart during systole and then, by passive recoil, supply this blood to the organs downstream during diastole. The aorta is the largest artery and has an internal {luminal) diameter of approximately 25 mm. Arterial diameter decreases with each consecutive branching, and the smallest arteries have diameters of approxi­ mately 0. The consecutive arterial branching pattern causes an exponential increase in arterial numbers. Thus, although individual vessels get progressively smaller, the total cross-sectional area available for blood fow within the arte­ rial system increases to several fold that in the aorta. Arteries are often referred to as conduit vessels because they have relatively low and unchanging resistance to fow. In propor­ tion to lumen size, arterioles have much thicker walls with more smooth muscle and less elastic material than do arteries.

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Chylomicrons function in the transport of lipids to the bloodstream chyme semifluid material produced by the gastric digestion of food that results partly from the conversion of large solid particles into smaller particles via the combined peristaltic movements of the stomach and contraction of the pyloric sphincter chymotrypsin one of three endopeptidases present in pancreatic juice that attack peptide bonds with an aromatic carboxyl terminal ciliary ganglion location of synapses between parasympathetic preganglionic and postganglionic neurons of the eye cingulate gyrus area of the cerebral cortex involved in the limbic system circadian rhythm roughly 24-hour cycle in organismal physiologic processes order super levitra without prescription erectile dysfunction drugs levitra. Circadian rhythms are endogenously generated and modulated by external cues such as sunlight and temperature circumventricular organs regions of the central nervous system that do not have a blood–brain barrier and thus can sense signals in the blood cirrhosis chronic liver disease characterized by the replacement of normal liver tissue with fibrous tissue as a result of the transformation of stellate cells into collagen-secreting myofibroblasts order 80mg super levitra amex erectile dysfunction 60. It has a major function of conducting air to the deeper parts of the lung conduction transfer of energy through matter from particle to particle; the transfer and distribution of heat energy from atom to atom within a substance conduction velocity rate of impulse conduction in a peripheral nerve or its various component fibers super levitra 80mg for sale erectile dysfunction questions and answers, generally expressed in meters per second conductive deafness hearing impairment due to sound vibrations being interrupted in the outer or middle ear and not reaching the inner ear and its nerve endings cone cell cell in the retina responsible for color (photopic, chromatic) vision. Cells in the crypts of Lieberkühn secrete isotonic alkaline fluid cumulus granulosa cells granulosa cells surrounding the oocyte in a graafian follicle curare drug that is a competitive inhibitor of acetylcholine at the myoneural junction Cushing reflex sympathetic nerve reflex initiated by an increase in intracranial pressure. It significantly elevates arterial pressure by causing severe, sometimes occlusive, constriction of arterioles in systemic organs. Cystinuria also affects the transporter in the small intestine cytochrome P-450 complex of iron-containing proteins responsible for the oxidation–reduction reactions that transform a nonpolar xenobiotic compound to one that is more polar by introducing one or more polar groups onto the molecule. The reflex puts the body into an oxygen-saving mode to maximize the time that can be spent underwater. The reflex includes bradycardia, peripheral vasoconstriction, and a decreased metabolic rate diving response cardiovascular reflex to immersion of the body or even the face underwater. It is characterized by intense slowing of heart rate and sympathetic peripheral vasoconstriction. Effectors bind to a protein and alter the activity of that protein effector cell executing cell of immune responses; in adaptive immunity: plasma cells, T helper cells, and cytotoxic T cells effector systems musculature, secretory epithelium, and blood–lymphatic vasculature in the digestive tract efferent carrying away from efferent nerve (efferents) nerve fibers carrying impulses away from the central nervous system that cause muscles to contract and glands to secrete (inhibitory efferent nerves) efflux transfer of material from the interior to the exterior of a cell eicosapentaenoic acid omega-3 fatty acid found in fish, essential for the normal development of vision in newborns Einthoven triangle theoretical triangle in the frontal plane of the body created from the interconnected electrodes making up the standard bipolar electrocardiogram lead system ejaculation abrupt discharge of fluid; the expulsion of seminal fluid from the urethra of the penis during orgasm ejection fraction amount of blood ejected in one systole by the left ventricle expressed as a percentage of the left ventricular residual volume; it is used clinically to detect impaired performance of the left ventricle elastase one of three endopeptidases present in pancreatic juice that attacks peptide bonds with a neutral aliphatic carboxyl terminal elastic recoil degree to which stretched material returns to its unstretched position elastic response proportionate and time-independent force response to the extension of a deformable body such as muscle elasticity ability of a material when stretched to return to its unstretched position (e. This property differs from plasticity (the capability of being stretched, but not returning to its unstretched position, e. A true black body would have ε = 1, whereas any real object would have ε < 1 emmetropia normal vision, free from refractive errors emphysema chronic lung disorder that leads to abnormally high compliance as a result of distention and eventual rupture of the alveoli with progressive loss of pulmonary elasticity; symptoms include shortness of breath with or without cough, which may lead to impaired heart action end-tidal volume volume of air measured at the end of a tidal volume end-diastolic volume volume within the ventricle at the end of diastole endocannabinoids endogenous ligands for the receptors that mediate the effects of the psychoactive component of marijuana, ∆9-tetrahydrocannabinol endocrine glands glands that secrete their products (hormones) directly into the bloodstream (ductless glands) or release hormones (paracrines) that affect only target cells nearby the release site endocrine pancreas portion of the pancreas that secretes hormones such as insulin, glucagon, and somatostatin into the bloodstream endocrinology branch of physiology concerned with the description and characterization of processes involved in the regulation and integration of cells and organ systems by specialized chemical substances called hormones endocytosis invagination of the plasma membrane to pinch off and internalize substances that are otherwise unable to cross the plasma membrane. Some endocytic mechanisms involve binding of extracellular solute to a specific membrane receptor protein (receptor-mediated endocytosis) endogenous originating or produced within the body endogenous creatinine clearance renal clearance of endogenous (i. It contains anticoagulant factors such as heparin and forms a nonthrombotic surface in arteries. The endothelium also produces growth factors that are thought to be responsible for angiogenesis and intimal repair in blood vessels. It uses two antibodies, one of which is specific to the antigen and the other of which is coupled to an enzyme. Conditions at the base of the esophagus (including minimal connective tissue support and the associated negative intrathoracic pressure of the area) together with the increased demand on these vessels to support an increasing load of blood flow lead to a tendency for these varices to rupture, a condition leading to morbidity in 30% of occurrences essential amino acids amino acids that cannot be synthesized by the liver and, therefore, supplied through dietary consumption. Note that some first messengers, such as Ca2+, can also be second messengers, depending on whether they initiate or amplify the signaling cascade first polar body small haploid cell produced by unequal first meiotic division of the oocyte fixed monocyte–macrophage system cells that remain at a strategic fixed location and when encountering pathogenic material, thus being able to differentiate from monocytes to macrophages to ingest and thereby remove the material from the circulation flap valve term used to describe the effects of contraction of the puborectalis muscle to interfere with the movement of feces or flatus in the direction of the anus; a component of the mechanisms that sustain fecal continence flexion movement that decreases the angle between two moving parts of the body flexor withdrawal reflex complex spinal reflex triggered by cutaneous stimulus resulting in withdrawal of the body part from the stimulus flexors skeletal muscles whose action retracts a limb or body part flow-limited transport transport of materials across the capillaries that is limited not by diffusion but instead by the rate at which the materials can be delivered by blood flow into the capillary network of an organ flow-mediated vasodilation dilation of arteries and arterioles following an increase in blood flow. It is caused by increases in shear stress stimulation of nitric oxide release from the arterial endothelium flow velocity measure of how fast blood moves from one point to the next downstream in the cardiovascular system. It has units of cm/s and is an important determinant of lateral pressure, intimal shear stress, and flow turbulence when blood flows within blood vessels flow–volume curve curve that reflects airflow during forced expiration and forced inspiration fluid mosaic model model conceived by S. Recently, it has been named the glucose-dependent insulinotropic peptide gastric lipase acidic lipase secreted by the gastric chief cells in the fundic mucosa in the stomach with a pH optimum of 3 to 6; acidic lipases do not require bile acid or colipase for optimal enzymatic activity and make up 30% of lipid hydrolysis occurring during digestion in the human adult, with gastric lipase contributing the most of the two acidic lipases gastric mucosa mucous membrane layer of the stomach wall (one of four layers) containing the glands and the gastric pits; it is ~1 mm thick and its surface is smooth, soft, and velvety; it consists of epithelium, lamina propria, and the muscularis mucosae gastric phase one of three phases that stimulates acid secretion resulting from the ingestion of food. Acid secretion during the gastric phase is mainly a result of gastric distention and the digested peptides in the gastric lumen. The enzyme acts on the α-1,4-glycosidic linkage yielding glucose polymers glycogen synthase enzyme that catalyzes the transfer of glucose from uridine diphosphate–glucose to glycogen glycogenesis occurring mainly in the liver, the process by which glycogen is synthesized from circulating glucose, lactate, and pyruvate after ingestion of a meal glycogenolysis process by which glycogen is broken down to glucose 6-phosphate and then to glucose for subsequent release into circulation. The reaction is specific to the liver glycolipid lipid molecule that contains one or more monosaccharide units glycolysis adenosine triphosphate–generating metabolic process of most cells in which carbohydrates are converted to pyruvic acid glycolytic pathway (or glycolysis) series of cytoplasmic chemical reactions that break down glucose molecules and produce adenosine triphosphate for energy-requiring cellular processes glycoprotein protein that contains one or more monosaccharide units goblet cells cells that serve to secrete various mucins (mucoproteins) found in intestinal secretions goiter enlarged thyroid gland Goldman equation value of the membrane potential when all the permeable ions are accounted for. Oxygen causes a downward shift of the carbon dioxide equilibrium curve hallucination perception in the absence of a stimulus hamartoma nonneoplastic congenital malformation composed of a heterotropic mass of nerve tissue usually located on the floor of the third ventricle or attached to the tuber cinereum hapten nonimmunogenic antibody-binding molecule, unless linked to a carrier molecule haptoglobin large glycoprotein (molecular weight of 100,000 Da) that binds free hemoglobin in blood, forming a hemoglobin–haptoglobin complex, which is rapidly removed from circulation by the liver, thereby conserving iron in the body Hartnup disease extremely rare genetic disorder of amino acid carriers. It is composed of two upper chambers, a right and left atrium, and two larger, lower chambers called the right and left ventricles. The right atrium receives blood from the peripheral veins and delivers it through the tricuspid valve to the right ventricle. The right ventricle pumps blood through the pulmonic valve into the pulmonary circulation. Blood returning from the pulmonary circulation arrives in the left atrium, where it is pumped through the mitral valve into the left ventricle. This chamber pumps blood through the aortic valve into the aorta and thus into the systemic circulation. In this arrangement, the right and left sides of the heart are actually two pumps arranged in series heart murmur sound heard over the chest with a stethoscope that results from turbulent flow in the heart, aorta, or pulmonary circulation, usually resulting from stenotic or incompetent heart valves heart rate number of times the normal heart contracts in 1 minute; in a healthy individual, this rate can range between 50 and 180 contractions per minute heartburn episodic retrosternal burning heat exhaustion most common heat-related illness, involving mild to moderate dysfunction of temperature control associated with elevated ambient temperatures and/or strenuous exercise resulting in dehydration and salt depletion. It may rapidly progress to heatstroke when the body’s thermoregulatory mechanisms become overwhelmed and fail heat storage difference between heat production and net heat loss heat syncope body temperature above 40°C (104°F) with fainting or weakness but without mental confusion; results from circulatory failure as a result of peripheral venous pooling, with a consequent decrease in venous return. Heat syncope is caused by mild overheating with inadequate water or salt heatstroke extreme hyperthermia, typically above 100. Heatstroke traditionally is divided into exertional and classic varieties, which are defined by the underlying etiology but are clinically indistinguishable heel stick procedure in which a newborn baby’s heel is pricked and then a small amount of the blood is collected, usually with a narrow-gauge (“capillary”) glass tube or a filter paper hem(at)/o referring to blood hematocrit (Hct or Ht) percentage of whole blood that is composed of erythrocytes hematologist blood specialist hematopoiesis generation of blood cells hematopoietins subclass of cytokines regulating hematopoiesis heme oxygenase microsomal enzyme responsible for the release of iron from heme. Iron then enters the cellular free iron pool and can be stored as ferritin or released into the bloodstream hemochromatosis condition caused by iron overload that is characterized by excessive amounts of hemosiderin in the hepatocytes, rendering them defective and unable to perform many normal, essential functions. The excess iron is stored in the organs, especially the liver, heart, and pancreas, causing damage to these organs and leading to life-threatening illnesses such as cancer, heart complications, and liver disease hemocytometer chamber for manual blood cell counts hemodialysis procedure usually done three times a week (4 to 6 hours per session) in a medical facility or at home in which kidney-failure patient’s blood is pumped through an artificial kidney machine; the blood is separated from a balanced salt solution by a cellophane-like membrane, and small molecules can diffuse across this membrane; excess fluid can be removed by applying pressure to the blood and filtering it hemodynamics study of the physics of the containment and movement of blood in the cardiovascular system hemoglobin (Hb) oxygen-transporting protein of erythrocytes hemoglobinopathies diseases caused by mutated hemoglobin hemolysis bursting (lysis) of red blood cells leading to the release of hemoglobin hemolytic anemia anemia caused by destruction of erythrocytes that exceeds their generation hemopexin protein synthesized by the liver that is involved in the transport of free heme in the blood. High-altitude cerebral edema is the result of rapid accent to high altitude (5,280 ft above sea level or higher) and is caused by hypoxemia. Initial symptoms include headaches, insomnia, nausea, dizziness, and loss of coordination. The edema is caused by hypoxic-induced pulmonary arterial vasoconstriction and occurs from short-term exposures to altitudes in excess of 2,000 m above sea level (6,560 ft). The intercalated ducts are connected to the striated duct, which eventually empties into the excretory duct intercostal muscles muscles between the ribs that are involved in forced expiration interdigestive state fasting state in the upper gastrointestinal that begins with the absorption of all nutrients, which is characterized by the migrating motor complex behavioral pattern interferons class of natural proteins produced by the cells of the immune system in response to challenges by foreign agents such as viruses, bacteria, parasites, and tumor cells. Interferons belong to the large class of glycoproteins known as cytokines interganglionic fiber tracts bundles of nerve fibers connecting adjacent ganglia of the enteric nervous system interleukin cytokine made by one leukocyte and acting on another interleukin-1 cytokine secreted by macrophages, monocytes, and dendritic cells as part of the inflammatory response to infection. It enables transmigration of leukocytes to sites of infection and resets the hypothalamic thermoregulatory center, leading to an increased body temperature (fever), thereby acting as an endogenous pyrogen interleukin-6 proinflammatory cytokine secreted by T cells and macrophages to stimulate immune response to trauma, especially burns or other tissue damage leading to inflammation. During the intestinal phase, protein digestion products in the duodenum stimulate gastric acid secretion through the action of the circulating amino acids on the parietal cells. During the inflammatory process, these cells have the ability to transform into myofibroblasts, which secrete collagen into the space of Disse and regulate sinusoidal portal pressure by contracting or relaxing. Ito cells may be involved in the pathologic fibrosis of the liver; also known as stellate cells J receptors unmyelinated C-fiber nerves that are located adjacent to alveoli that are stimulated by stretch; also referred to as juxtapulmonary capillary receptors or C-fiber endings junctional complex functional unit in muscle comprising both dihydropyridine and ryanodine receptors juxtaglomerular apparatus structure in the kidney consisting of macula densa, extraglomerular mesangial cells, and granular cells, located where the end of the thick ascending limb touches afferent and efferent arterioles of its parent glomerulus juxtamedullary nephron nephron with its glomerulus deep in the cortex, next to the medulla, and having long loops of Henle juxtapulmonary capillary receptors see J receptors kallidin see lysyl-bradykinin kallikrein serine protease released by the acinar cells that acts on endogenous peptides present in body fluid to release lysyl-bradykinin (kallidin), which causes dilation of the blood vessels supplying the salivary glands Kallmann syndrome syndrome characterized by a congenital absence of gonadotropin-releasing hormone in the hypothalamus (causing, in women, primary amenorrhea and anovulation and, in men, failure of puberty) in combination with a congenitally absent sense of smell ketoacidosis condition found in diabetics that is characterized by large amounts of β-hydroxybutyric acid in the blood ketogenesis process by which ketone bodies are produced as a result of fatty acid breakdown ketones acidic substances produced when the body uses fat, instead of sugar, for energy ketosis condition observed in diabetic patients and during periods of prolonged starvation that is marked by highly elevated levels of circulating ketone bodies 17-ketosteroids excretable metabolite formed by lysis of the carbon 20 to 21 side chain of 21-carbon steroids kilocalorie unit of measurement for energy that approximates the heat energy needed to increase the temperature of 1 kg of water by 1°C, equivalent to the dietary “calorie” kinesin microtubule-associated protein involved in anterograde axonal transport of organelles and vesicles (from the minus to the plus ends of the microtubules) via the hydrolysis of adenosine triphosphate kininogen endogenous peptide present in body fluid that releases lysyl-bradykinin (kallidin) kinins mediator of the inflammatory response kinocilium nonmotile cilium-like structure on each hair cell of the human ear involved in converting mechanical movement of endolymph into electrical signals Klinefelter syndrome congenital abnormality of men in which there is one X chromosome too many; men with this condition are usually sterile Korotkoff sounds sounds made by the first spurts of blood escaping from a compressed artery as the compression is slowly released. They are detected by stethoscope in the measurement of arterial pressure by sphygmomanometer and used as the indicator of peak systolic pressure Krebs cycle series of mitochondrial chemical reactions that produces adenosine triphosphate in the presence of O2, a process called oxidative phosphorylation Kupffer cells one of the types of cells lining hepatic sinusoids; resident macrophages of the “fixed monocyte–macrophage system” that act in the removal of unwanted material (bacteria, viral particles, etc. Larger vessels contain one-way valves directed away from the tissues and toward the heart. It opens into the left ventricle during diastole but closes off the left atrium when the left ventricle contracts mitral valve prolapse condition whereby either the mitral valve bulges or the leaflets open backward into the pulmonary vein during systole. In the latter case, blood flows back into the pulmonary circulation from the left ventricle during systole mittelschmerz (German for “middle pain”) lower abdominal and pelvic pain that occurs roughly midway through a woman’s menstrual cycle, associated with ovulation; pain can appear suddenly and usually subsides within hours mixed acid–base disturbance simultaneous presence of two or more primary acid–base disturbances mixed contractions skeletal muscle contractions that begin isometrically and become isotonic as force becomes sufficient to lift the afterload mixed micelles substance that aids in rendering lipid digestion products water soluble. Mixed micelles diffuse across the unstirred water layer and deliver lipid digestion products to the enterocytes for absorption mixing motility pattern motility pattern of the digestive state M-mode echocardiography ultrasound image of the heart used to examine motion of the ventricular walls, changes in chamber size, and valve motion during the cardiac cycle modulator peptide released at a synapse that modifies the response of a coreleased transmitter interacting with its own receptor in the synapse molecular switch intracellular protein that can transition between “on” and “off” states in response to a cellular stimuli (e. Mucins lubricate the mucosal surface and protect it from mechanical damage by solid food particles. Mucins may also provide a physical barrier in the small intestine against the entry of microorganisms into the mucosa mucous cells cells that line the entire surface of the gastric mucosa and the openings of the cardiac, pyloric, and oxyntic glands; secrete mucus and bicarbonate to protect the gastric surface from the acidic environment of the stomach mucous gel layer layer covering the surface of the gastric mucosa that traps bicarbonate and neutralizes acid, thus preventing damage to the mucosal cells mucous neck cells one of several types of cells in the oxyntic glands.