Public Interest Law Initiative


W. Chris. Freewill Baptist Bible College.

Ice application directly to the skin may cause burns cheap feldene 20mg fast delivery rheumatoid arthritis progression, so a barrier should be used and a wet towel is most effective 20mg feldene with visa arthritis osteoporosis diet. Repeated ice applications are most effective in reducing muscle temperature while allowing the skin to recover between applications. It is painful, swollen and bruised but she can stand although she walks with a limp. You are happy that there is not a bone injury but she is very keen to recover and return to sport as soon as possible. The trainer has a cold spray, another player offers a chemical ice pack, and the club has ice available in the freezer. You are asked to advise on the best form of treatment, how often and for how long, and you would, of course, be concerned not to cause further injury. Sample examination questions Multiple choice questions (answers on p 561) 1 A Ice should be applied directly to the skin B Ice should be used for 45 minutes C Coolant sprays are as effective as ice 52 The role of ice in soft tissue injury management D Ice burns occur with cold sprays E Ice may cause neurological impairment 2 A Ice does not affect muscle strength B A dry towel should be used as a barrier C Melting iced water guarantees a temperature of 0°C D Chemical cold packs are always at 0°C E Ice should not be applied until at least 48 hours after injury 3 A Ice is as effective in a deep muscle injury as a superficial injury B Subcutaneous fat does not affect cold conduction C Ice therapy is always harmless D Repeated application for 10 minutes is most effective E Ice therapy need be used only in the first six hours Essay questions 1 What is the most effective form of cold therapy following an acute soft tissue injury? Physical rehabilitation of the injured athlete, 2nd ed. ACSMs guidelines for the Team Physician Philadelphia: Lea and Febiger, 1991. Color atlas and text of Sports Medicine in childhood and adolescence. Textbook of disorders and injuries of the musculoskeletal system. The epidemiology of sports and exercise related injury in the United Kingdom. Attendances at a casualty department for sport related injuries. Sports injuries and the accident and emergency department – ten years on. The sports’ clinic: a one-year review of new referrals. London, Heinemann: 1931, Vol 4, Chap 5, pp 165, Chap 7, pp 201. Massage with ice (cryokinetics) in the treatment of painful conditions of the musculoskeletal system. Teaching evidence-based medical care: description and evaluation. An improved clinical protocol for ankle cryotherapy. An investigation of the use of infrared telethermography to determine skin temperature changes in the human ankle during cryotherapy. The effect of icing with the Pro-Stim Edema Management System on cutaneous cooling. Ankle and thigh skin surface temperature changes with repeated ice pack application. Does ice immersion influence ankle joint position sense? Physical modalities in the treatment of tendon injuries. Effects of ice packs on tissue temperatures at various depths before and after quadriceps hematoma: studies using sheep. The effect of local cooling on postfracture swelling. Cryotherapy influence on post traumatic limb oedema. Ice treatment of injured ligaments: an experimental model. The effect of contusion and cryotherapy on skeletal muscle microcirculation. Results of intramuscular temperature changes at various levels after the application of ice. The effects of ice and compression wraps on intramuscular temperatures at various depths. Effect of cold submersion on intramuscular temperature of the gastrocnemius muscle.

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A Smooth endoplasmic reticulum (SER) Ribosomes Rough endoplasmic reticulum (RER) B Fig cheap 20mg feldene free shipping arthritis inflamed knee. GOLGI COMPLEX The Golgi complex is involved in modifying proteins produced in the RER and in sorting and distributing these proteins to the lysosomes generic feldene 20mg suppurative arthritis definition, secretory vesicles, or the plasma membrane. It consists of a curved stack of flattened vesicles in the cyto- plasm that is generally divided into three compartments: the cis-Golgi network, which is often convex and faces the nucleus; the medial Golgi stacks; and the trans Golgi network, which often faces the plasma membrane (Fig. Proteins are transported to and from the Golgi in at least three kinds of vesicles: coatomer-coated COP I vesicles, coatomer-coated COP II vesicles, and clathrin- coated vesicles (see Fig. Proteins produced on the RER travel in COP II vesicles to an endoplasmic reticulum-Golgi intermediate compartment (ERGIC), and then to the cis-Golgi network, where they enter the lumen. Here N-linked oligosaccharide chains that were added to proteins in the RER are modified, and O-linked oligosaccharides are added. COP I vesicles recycle material from the Golgi back to the ER and possibly transfer material from the Golgi to other sites. Clathrin Trans-Golgi Medial-Golgi COPI Cis-Golgi COPI COPII ER-golgi Fusion intermediate of COPII compartment vesicles Rough ER Fig. COP II vesicles (coatomer- coated) form in the rough ER and move to the Golgi. COP I vesicles generally go from the trans to the cis Golgi to the ER. Vesicles that go to late endosomes (eventually lysosomes) from the Golgi or the plasma membrane are clathrin-coated. Vesicle transport, as well as transport of organelles and secretory proteins, occurs along microtubules (structures formed from the protein tubulin). CHAPTER 10 / RELATIONSHIP BETWEEN CELL BIOLOGY AND BIOCHEMISTRY 177 Vesicles released from the trans face of the Golgi complex travel to endosomes as clathrin-coated vesicles. COP vesicles are coated with a complex composed of coatomer proteins (COP), an Arf family monomeric G protein that mediates vesicle assembly, and other proteins (Fig. COP I vesicles contain the monomeric G protein Arf (ADP-ribosylating factor), and COP II vesicles contain the monomeric G protein Sar (another member of the Arf family). In both types of vesicles, hydrolysis of GTP causes dissociation of the G-protein and disassembly of the vesicle coat. Glycoproteins or glycolipids once anchored in the membrane of the vesicle remain in the plasma membrane when the vesicular and plasma membranes fuse. Vesicles that have lost their coats are ready to fuse with the target membrane. The monomeric G protein Arf was The vesicle membranes contain proteins called v-SNARES (vesicle-SNARES) named for its contribution to the (see Fig. Each type of v-SNARE is able to recognize and bind to its com- pathogenesis of cholera and not for its normal function in the assembly of plementary t-SNARE (target SNARE) on the target membrane, thus ensuring that COP I vesicles. However, it is also required for the transport of V. Assembly and release vesicles that subsequently merge with lyso- somes (or are transformed into lysosomes), Coatomer where the acidic pH contributes to activation ARF of the toxin. As the toxin is transported through the Golgi and ER, it is further processed and activated. Arf forms a com- plex with the A-toxin that promotes its travel between compartments. The A-toxin is actu- ally an ADP-ribosylase (an enzyme that cleaves NAD and attaches the ADP portion to a protein) (see Chapter 6, Fig. The ADP-ribosylation of pro- GDP ARF Coatomer teins regulating the CFTR chloride channel leads to Dennis Veere’s dehydration and diarrhea. Docking Rab Vesicle Rab NSF v-Snare SNAPs Rab Rab t-Snare Target Fig. Arf with bound GTP assembles a region of the trans-Golgi membrane containing receptors for the protein cargo and coatomers. Several additional proteins are required for fusion of the vesicle with the target membrane, including Rab (another monomeric G protein) and two additional proteins called SNAP (soluble NSF attachment proteins) and NSF (N-ethylmaleimide sensitive factor). The hormone Exocytotic vesicles release proteins into the extracellular space after fusion insulin is synthesized as a prohor- of the vesicular and plasma cell membranes. Exocytotic vesicles containing mone, proinsulin, which is incorpo- hormones also may contain proteases that cleave the prohormone at a specific rated into secretory vesicles. These vesicles site and v-ATPases that acidify the vesicle and activate the protease (similar to contain a protease that is activated by the lysosomes).

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D Offen purchase 20 mg feldene with mastercard rheumatoid arthritis in neck symptoms, PM Beart order feldene 20 mg without prescription arthritis medication arcoxia, NS Cheung, CJ Pascoe, A Hochman, S Gorodin, E Melamed, R Bernard, O Bernard. Transgenic mice expressing human Bcl-2 in their neurons are resistant to 6-hydroxydopamine and 1-methyl-4-phenyl- 1,2,3,6-tetrahydropyridine neurotoxicity. L Yang, RT Matthews, JB Schulz, T Klockgether, AW Liao, JC Martinou, JB Penney, Jr. Caspase inhibition protects nigral neurons against 6-OHDA-induced retrograde degeneration. BS Jeon, NG Kholodilov, TF Oo, SY Kim, KJ Tomaselli, A Srinivasan, L Stefanis, RE Burke. Activation of caspase-3 in developmental models of programmed cell death in neurons of the substantia nigra. N Takai, H Nakanishi, K Tanabe, T Nishioku, T Sugiyama, M Fujiwara, K Yamamoto. Involvement of caspase-like proteinases in apoptosis of neuronal PC12 cells and primary cultured microglia induced by 6-hydroxydopamine. RC Dodel, Y Du, KR Bales, Z Ling, PM Carvey, SM Paul. Caspase-3-like proteases and 6-hydroxydopamine induced neuronal cell death. H Turmel, A Hartmann, K Parain, A Douhou, A Srinivasan, Y Agid, EC Hirsch. Caspase-3 activation in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mice. M Mogi, A Togari, T Kondo, Y Mizuno, O Komure, S Kuno, H Ichinose, T Nagatsu. Caspase activities and tumor necrosis factor receptor R1 (p55) level are elevated in the substantia nigra from parkinsonian brain. A Hartmann, S Hunot, PP Michel, MP Muriel, S Vyas, BA Faucheux, A Mouatt-Prigent, H Turmel, A Srinivasan, M Ruberg, GI Evan, Y Agid, EC Hirsch. Caspase-3: a vulnerability factor and final effector in apoptotic death of dopaminergic neurons in Parkinson’s disease. A Hartmann, JD Troadec, S Hunot, K Kikly, BA Faucheux, A Mouatt- Prigent, M Ruberg, Y Agid, EC Hirsch. Caspase-8 is an effector in apoptotic death of dopaminergic neurons in Parkinson’s disease, but pathway inhibition results in neuronal necrosis. P Anglade, S Vyas, F Javoy-Agid, MT Herrero, PP Michel, J Marquez, A Mouatt-Prigent, M Ruberg, EC Hirsch, Y Agid. Apoptosis and autophagy in nigral neurons of patients with Parkinson’s disease. Histochemical detection of apoptosis in Parkinson’s disease. A Hartmann, A Mouatt-Prigent, BA Faucheux, Y Agid, EC Hirsch. FADD: a link between TNF family receptors and caspases in Parkinson’s disease. Lyons University of Kansas Medical Center, Kansas City, Kansas, U. Stereotactic surgeries for movement disorders were introduced in the 1950s (1,2) but were not widely accepted due to significant morbidity, mortality, and limited knowledge in target selection for symptomatic benefit. In the late 1950s and early 1960s there was an increase in the number of stereotactic surgeries performed. With advances in pharmacological therapy, particularly the availability of levodopa, these surgeries were rarely performed until the late 1980s. Currently, based on the recognition of the limitations of drug treatments for Parkinson’s disease (PD) and a better understanding of the physiology and circuitry of the basal ganglia, there has been a marked increase in surgical therapies for PD. In addition, advances in surgical techniques, neuroimaging, and improved electrophysiological recordings allow stereotactic procedures to be done more accurately, leading to reduced morbidity. Over the last decade, deep brain stimulation (DBS) is increasingly replacing lesion surgery as the preferred procedure. DBS in PD is associated with three targets: the ventral intermediate nucleus (VIM) of Copyright 2003 by Marcel Dekker, Inc.

ZOOMING IN Which spinal nerves carry impulses from the skin of ance of vesicles (fluid-filled skin le- the toes? The drainage from these vesicles contains highly contagious liquid order 20 mg feldene overnight delivery arthritis in lower back management. The neuralgic pains may persist into the spinal cord through the spinal nerves order feldene 20mg with visa arthritis foot pain. This infection may also surface can be mapped into distinct regions that are sup- involve the first branch of the fifth cranial nerve and plied by a single spinal nerve. Each of these regions is cause pain in the eyeball and surrounding tissues. This information can be used Guillain-Barré syndrome (ge-YAN bar-RA) is classi- to identify the spinal nerve or spinal segment that is in- fied as a polyneuropathy (pol-e-nu-ROP-a-the)—that is, a volved in an injury. In some areas, the dermatomes are disorder involving many nerves. Some dermatomes may share a cle weakness due to loss of myelin, with numbness and nerve supply with neighboring regions. For this reason, it paralysis, which may involve the breathing muscles. The cause of Guillain-Barré syndrome is not known, but it often fol- lows an infection, usually a viral infection. It may result Checkpoint 9-13 How many pairs of spinal nerves are there? Most people recover completely from the disease with time, but recovery may take months or even years. Disorders of the Spinal Nerves Box 9-2, Careers in Occupational Therapy, describes Peripheral neuritis (nu-RI-tis), or peripheral neuropathy, is professions related to care of people with nervous system the degeneration of nerves supplying the distal areas of the injuries. THE NERVOUS SYSTEM: THE SPINAL CORD AND SPINAL NERVES 193 Box 9-2 • Health Professions Careers in Occupational TherapyCareers in Occupational Therapy ccupational therapy (OT) helps people with physical or from injury or compensate for permanent disability. Treatment Omental disability achieve independence at home and at may include teaching activities ranging from work tasks to work by teaching them “skills for living. OT assistants are responsible for implementing the treat- ◗ Recovering from traumas such as fractures, amputations, ment plan and reporting results back to the therapist, who may burns, spinal cord injury, stroke, and heart attack. To perform these duties, OTs and assistants ◗ With chronic conditions such as arthritis, multiple sclerosis, need a thorough understanding of anatomy and physiology. Most OTs in the United States have bachelor’s or master’s de- ◗ With developmental disabilities such as Down syndrome, grees and must pass a national licensing exam. Assistants typi- cally train in a 2-year program and also take a licensing exam. As OTs work as part of multidisciplinary teams, which include the population continues to age and the need for rehabilitative physicians, nurses, physical therapists, speech pathologists, and therapy increases, job prospects remain good. They assess their clients’ capabilities and develop mation about OT careers, contact the American Occupational individualized treatment programs that help clients recover Therapy Association. These preganglionic fibers arise from ried on automatically; whenever a change occurs that the spinal cord at the level of the first thoracic spinal nerve calls for a regulatory adjustment, it is made without con- down to the level of the second lumbar spinal nerve. All autonomic pathways which extend to the glands and involuntary muscle tissues. The two neurons synapse in gan- thetic chains, two cordlike strands of ganglia that extend glia that serve as relay stations along the way. The first along either side of the spinal column from the lower neuron, the preganglionic neuron, extends from the neck to the upper abdominal region. The second neuron, the post- 16 shows only one side for each division of the ANS. This differs from the voluntary (somatic) nervous abdominal and pelvic cavities synapse in three single col- system, in which each motor nerve fiber extends all the lateral ganglia farther from the spinal cord. These are the: way from the spinal cord to the skeletal muscle with no intervening synapse. Some of the autonomic fibers are ◗ Celiac ganglion, which sends fibers mainly to the di- within the spinal nerves; some are within the cranial gestive organs nerves (see Chapter 10). The diagram shows only one side of the body for each division. ZOOMING IN Which division of the autonomic nervous system has ganglia closer to the effector organ?

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