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UNIT Ⅰ Introduction to Physiology: The Cell and General Physiology2

CHAPTER 1 Functional Organization of the Human Body and Control of the Internal Environment2

Cells as the Living Units of the Body2

Extracellular Fluid—The Internal Environment2

Homeostatic Mechanisms of the Major Functional Systems3

Homeostasis3

Extracellular Fluid Transport System—The Circulatory System3

Origin of Nutrients in the Extracellular Fluid3

Control Systems of the Body4

Reproduction4

Regulation of Body Functions4

Removal of Metabolic End Products4

Examples of Control Mechanisms5

Characteristics of Control Systems6

Summary—Automaticity of the Body7

CHAPTER 2 The Cell and Its Function9

Organization of the Cell9

Physical Structure of the Cell10

Membranous Structures of the Cell10

Cytoplasm and Its Organelles12

Nucleus14

Nucleoli and Formation of Ribosomes15

Comparison of the Animal Cell with Precellular Forms of Life15

Nuclear Membrane15

Functional Systems of the Cell16

Ingestion by the Cell—Endocytosis16

Digestion of Pinocytic and Phagocytic Foreign Substances in the Cell—Function of the Lysosomes17

Synthesis and Formation of Cellular Structures by the Endoplasmic Reticulum and the Golgi Apparatus18

Extraction of Energy from Nutrients—Function of the Mitochondria19

Locomotion of Cells21

CHAPTER 3 Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction24

The Genes24

Genetic Code25

The DNA Code Is Transferred to an RNA Code—The Process of Transcription25

Synthesis of RNA26

Assembly of the RNA Molecule from Activated Nucleotides Using the DNA Strand as a Template—The Process of Transcription27

Messenger RNA—The Codons27

Transfer RNA—The Anticodons27

Ribosomal RNA28

Formation of Proteins on the Ribosomes—The Process of Translation29

Synthesis of Other Substances in the Cell30

Control of Genetic Function and Biochemical Activity in Cells30

Genetic Regulation30

Control of Intracellular Function by Enzyme Regulation32

The DNA-Genetic System Also Controls Cell Reproduction32

Cell Reproduction Begins with Replication of the DNA33

Cell Mitosis34

Chromosomes and Their Replication34

Control of Cell Growth and Cell Reproduction35

Cell Differentiation35

Cancer36

UNIT Ⅱ Membrane Physiology, Nerve, and Muscle40

CHAPTER 4 Transport of Substances Through the Cell Membrane40

The Lipid Barrier of the Cell Membrane and Cell Membrane Transport Proteins40

Diffusion40

Diffusion Through the Cell Membrane41

Diffusion Through Protein Channels and Gating of These Channels42

Facilitated Diffusion43

Factors That Affect Net Rate of Diffusion44

Osmosis Across Selectively Permeable Membranes— Net Diffusion of Water45

Active Transport47

Primary Active Transport47

Secondary Active Transport—Co-transport and Counter-transport49

Active Transport Through Cellular Sheets49

CHAPTER 5 Membrane Potentials and Action Potentials52

Basic Physics of Membrane Potentials52

Membrane Potentials Caused by Diffusion52

Measuring the Membrane Potential53

Resting Membrane Potential of Nerves54

Origin of the Normal Resting Membrane Potential54

Nerve Action Potential55

Voltage-Gated Sodium and Potassium Channels56

Summary of the Events That Cause the Action Potential58

Roles of Other Ions During the Action Potential59

Initiation of the Action Potential59

Propagation of the Action Potential59

Re-establishing Sodium and Potassium Ionic Gradients After Action Potentials Are Completed—Importance of Energy Metabolism60

Plateau in Some Action Potentials61

Rhythmicity of Some Excitable Tissues—Repetitive Discharge61

Special Aspects of Signal Transmission in Nerve Trunks62

Excitation—The Process of Eliciting the Action Potential63

Recording Membrane Potentials and Action Potentials64

Refractory Period After an Action Potential During Which a New Stimulus Can not Be Elicited64

Inhibition of Excitability— Stabilizers and Local Anesthetics64

CHAPTER 6 Contraction of Skeletal Muscle67

Physiologic Anatomy of Skeletal Muscle67

The Skeletal Muscle Fiber67

General Mechanism of Muscle Contraction68

Molecular Mechanism of Muscle Contraction70

Molecular Characteristics of the Contractile Filaments70

Efeet of Actin and Myosin Filament Overlap on Tension Developed by the Contracting Muscle72

Relation of Velocity of Contraction to Load73

Characteristics of Whole Muscle Contraction74

Sources of Energy for Muscle Contraction74

Work Output During Muscle Contraction74

Energetics of Muscle Contraction74

Mechanics of Skeletal Muscle Contraction76

Remodeling of Muscle to Match Function77

Rigor Mortis78

CHAPTER 7 Excitation of Skeletal Muscle: A. Neuromuscular Transmission and B. Excitation-Contraction Coupling80

Transmission of Impulses from Nerves to Skeletal Muscle Fibers: The Neuromuscular Junction80

Secretion by Acetylcholine by the Nerve Terminals80

Molecular Biology of Acetylcholine Formation and Release82

Muscle Action Potential83

Myasthenia Gravis83

Drugs That Affect Transmission at the Neuromuscular Junction83

Spread of the Action Potential to the Interior of the Muscle Fiber by Way of a Transverse Tubule System84

Excitation-Contraction Coupling84

Transverse Tubule—Sarcoplasmic Reticulum System84

Release of Calcium Ions by the Sarcoplasmic Reticulum85

CHAPTER 8 Contraction and Excitation of Smooth Muscle87

Contraction of Smooth Muscle87

Types of Smooth Muscle87

Contractile Mechanism in Smooth Muscle87

Regulation of Contraction by Calcium Ions89

Neuromuscular Junctions of Smooth Muscle90

Membrane Potentials and Action Potentials in Smooth Muscle90

Neural and Hormonal Control of Smooth Muscle Contraction90

Effect of Local Tissue Factors and Hormones to Cause Smooth Muscle Contraction Without Action Potentials92

Source of Calcium Ions That Cause Contraction:(1)Through the Cell Membrane and (2)from the Sarcoplasmic Reticulum93

UNIT Ⅲ The Heart96

CHAPTER 9 Heart Muscle; The Heart as a Pump96

Physiology of Cardiac Muscle96

Physiologic Anatomy of Cardiac Muscle96

Action Potentials in Cardiac Muscle97

The Cardiac Cycle99

Diastole and Systole99

Function of the Ventricles as Pumps100

Emptying of the Ventricles During Systole100

Function of the Atria as Primer Pumps100

Relationship of the Electrocardiogram to the Cardiac Cycle100

Function of the Valves101

The Aortic Pressure Curve101

Relationship of the Heart Sounds to Heart Pumping102

Work Output of the Heart102

Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart103

Regulation of Heart Pumping103

Intrinsic Regulation of Heart Pumping—The Frank-Starling Mechanism103

Effect of Potassium and Calcium Ions on Heart Function106

Effect of Temperature on Heart Function106

Sinus Node (Sinoatrial Node)107

Specialized Excitatory and Conductive System of the Heart107

CHAPTER 10 Rhythmical Excitation of the Heart107

Internodal Pathways and Transmission of the Cardiac Impulse Through the Atria109

Atrioventricular Node, and Delay of Impulse Conduction from the Atria to the Ventricles109

Rapid Transmission in the Ventricular Purkinje System109

Transmission of the Cardiac Impulse in the Ventricular Muscle110

Summary of the Spread of the Cardiac Impulse Through the Heart110

Control of Excitation and Conduction in the Heart111

The Sinus Node as the Pacemaker of the Heart111

Role of the Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle111

Control of Heart Rhythmicity and Impulse Conduction by the Cardiac Nerves: The Sympathetic and Parasympathetic Nerves112

Depolarization Waves Versus Repolarization Waves114

Characteristics of the Normal Electrocardiogram114

CHAPTER 11 The Normal Electrocardiogram114

Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram115

Voltage and Time Calibration of the Electrocardiogram115

Methods for Recording Electrocardiograms116

Pen Recorder116

Flow of Current Around the Heart During the Cardiac Cycle116

Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle116

Flow of Electrical Currents in the Chest Around the Heart116

Electrocardiographic Leads117

Three Bipolar Limb Leads117

Chest Leads (Precordial Leads)118

Augumented Unipolar Limb Leads119

Principles of Vectorial Analysis of Electrocardiograms120

Use of Vectors to Represent Electrical Potentials120

Denoting the Direction of a Vector in Terms of Degrees120

Axis of Each of the Standard Bipolar Leads and for Each Unipolar Limb Lead120

CHAPTER 12 Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis120

Vectorial Analysis of Potentials Recorded in Different Leads121

Vectorial Analysis of the Normal Electrocardiogram122

Vectors That Occur at Successive Intervals During Depolarization of the Ventricles—The QRS Complex122

Electrocardiogram During Repolarization—The T Wave123

Depolarization of the Atria—The P Wave124

Vectorcardiogram124

Abnormal Ventricular Conditions That Cause Axis Deviation125

Mean Electrical Axis of the Ventricular QRS—And Its Significance125

Determining the Electrical Axis from Standard Lead Electrocardiograms125

Conditions That Cause Abnormal Voltages of the QRS Complex127

Increased Voltage in the Standard Bipolar Limb Leads127

Decreased Voltage of the Electrocardiogram127

Prolonged and Bizarre Patterns of the QRS Complex128

Prolonged QRS Complex as a Result of Cardiac Hypertrophy or Dilatation128

Prolonged QRS Complex Resulting from Purkinje System Blocks128

Conditions That Cause Bizarre QRS Complexes128

Current of Injury128

Effect of Current of Injury on the QRS Complex128

The J Point—The Zero Reference Potential for Analyzing Current of Injury129

Coronary Ischemia as a Cause of Current of Injury130

Abnormalities in the T Wave132

Effect of Slow Conduction of the Depolarization Wave on the Characteristics of the T Wave132

Prolonged Depolarization in Portions of the Ventricular Muscle as a Cause of Abnormalities in the T Wave132

CHAPTER 13 Cardiac Arrhythmias and Their Electrocardiographic Interpretation134

Abnormal Sinus Rhythms134

Tachycardia134

Bradycardia134

Sinus Arrhythmia134

Atrioventricular Block135

Sinoatrial Block135

Abnormal Rhythms That Result from Impulse Conduction Block135

Incomplete Intraventricular Block—Electrical Alternans136

Premature Contractions136

Premature Atrial Contractions137

A-V Nodal or A-V Bundle Premature Contractions137

Premature Ventricular Contractions137

Paroxysmal Tachycardia138

Atrial Paroxysmal Tachycardia138

Ventricular Paroxysmal Tachycardia138

Ventricular Fibrillation138

Phenomenon of Re-entry— Circus Movements as the Basis for Ventricular Fibrillation139

Atrial Fibrillation141

Atrial Flutter142

Cardiac Arrest142

UNIT Ⅳ The Circulation144

CHAPTER 14 Overview of the Circulation; Medical Physics of Pressure, Flow, and Resistance144

Physical Characteristics of the Circulation144

Basic Theory of Circulatory Function146

Interrelationships Among Pressure, Flow, and Resistance146

Blood Flow147

Blood Pressure148

Resistance to Blood Flow149

Effects of Pressure on Vascular Resistance and Tissue Blood Flow151

CHAPTER 15 Vascular Distensibility, and Functions of the Arterial and Venous Systems152

Vascular Distensibility152

Vascular Compliance (or Capacitance)152

Volume-Pressure Curves of the Arterial and Venous Circulations152

Delayed Compliance (Stress-Relaxation) of Vessels153

Arterial Pressure Pulsations153

Transmission of Pressure Pulses to the Peripheral Arteries154

Clinical Methods for Measuring Systolic and Diastolic Pressures155

Veins and Their Functions156

Venous Pressures—Right Atrial Pressure (Central Venous Pressure) and Peripheral Venous Pressures156

Blood Reservoir Function of the Veins160

Structure of the Microcirculation and Capillary System162

CHAPTER 16 The Microcirculation and the Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph Flow162

Flow of Blood in the Capillaries—Vasomotion163

Average Function of the Capillary System163

Exchange of Nutrients and Other Substances Between the Blood and Interstitial Fluid164

Diffusion Through the Capillary Membrane164

The Interstitium and Interstitial Fluid165

Proteins in the Plasma and Interstitial Fluid Are Especially Important in Controlling Plasma and Interstitial Fluid Volumes166

Capillary Pressure166

Interstitial Fluid Pressure167

Plasma Colloid Osmotic Pressure168

Exchange of Fluid Volume Through the Capillary Membrane169

Interstitial Fluid Colloid Osmotic Pressure169

Starling Equilibrium for Capillary Exchange170

Lymphatic System170

Lymph Channels of the Body170

Formation of Lymph171

Rate of Lymph Flow172

Role of the Lymphatic System in Controlling Interstitial Fluid Protein Concentration, Interstitial Fluid Volume, and Interstitial Fluid Pressure173

CHAPTER 17 Local Control of Blood Flow by the Tissues; and Humoral Regulation175

Local Control of Blood Flow in Response to Tissue Needs175

Mechanisms of Blood Flow Control175

Acute Control of Local Blood Flow176

Long-Term Blood Flow Regulation179

Development of Collateral Circulation—A Phenomenon of Long-Term Local Blood Flow Regulation180

Vasoconstrictor Agents181

Vasodilator Agents181

Humoral Regulation of the Circulation181

Effects of Ions and Other Chemical Factors on Vascular Control182

CHAPTER 18 Nervous Regulation of the Circulation, and Rapid Control of Arterial Pressure184

Nervous Regulation of the Circulation184

Autonomic Nervous System184

Role of the Nervous System for Rapid Control of Arterial Pressure187

Increase in Arterial Pressure During Muscle Exercise and Other Types of Stress188

Reflex Mechanisms for Maintaining Normal Arterial Pressure188

Central Nervous System Ischemic Response—Control of Arterial Pressure by the Brain s Vasomotor Center in Response to Diminished Brain Blood Flow191

Role of the Skeletal Nerves and Skeletal Muscles in Increasing Cardiac Output and Arterial Pressure192

Special Features of Nervous Control of Arterial Pressure192

Respiratory Waves in the Arterial Pressure193

Arterial Pressure Vasomotor Waves—Oscillation of the Pressure Reflex Control Systems193

CHAPTER 19 Dominant Role of the Kidney in Long-Term Regulation of Arterial Pressure and in Hypertension: The Integrated System for Pressure Control195

The Renal-Body Fluid System for Arterial Pressure Control195

Quantitation of Pressure Diuresis as a Basis for Arterial Pressure Control195

Hypertension (High Blood Pressure): This Is Often Caused by Excess Extracellular Fluid Volume199

The Renin-Angiotensin System: Its Role in Pressure Control and in Hypertension201

Components of the Renin-Angiotensin System201

Types of Hypertension in Which Angiotensin Is Involved: Hypertension Caused by a Renin-Secreting Tumor or by Infusion of Angiotensin Ⅱ203

Other Types of Hypertension Caused by Combinations of Volume-Loading and Vasoconstriction205

“Essential Hypertension” in Human Beings205

Summary of the Integrated, Multifaceted System for Arterial Pressure Regulation207

CHAPTER 20 Cardiac Output, Venous Return, and Their Regulation210

Normal Values for Cardiac Output at Rest and During Activity210

Control of Cardiac Output by Venous Return—Role of the Frank-Starling Mechanism of the Heart210

Cardiac Output Regulation Is the Sum of Blood Flow Regulation in All the Local Tissues of the Body—Tissue Metabolism Regulates Most Local Blood Flow211

The Heart Has Limits for the Cardiac Output That It Can Achieve212

What Is the Role of the Nervous System in Controlling Cardiac Output?212

Pathologically High and Pathologically Low Cardiac Outputs213

High Cardiac Output Is Almost Always Caused by Reduced Total Peripheral Resistance213

Low Cardiac Output214

A More Quantitative Analysis of Cardiac Output Regulation214

Venous Return Curves215

Cardiac Output Curves Used in Quantitative Analysis215

Analysis of Cardiac Output and Right Atrial Pressure, Using Simultaneous Cardiac Output and Venous Return Curves218

Methods for Measuring Cardiac Output220

Pulsatile Output of the Heart as Measured by an Electromagnetic or Ultrasonic Flowmeter220

Measurement of Cardiac Output by the Oxygen Fick Method220

Indicator Dilution Method221

CHAPTER 21 Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart Disease223

Blood Flow in Skeletal Muscle and Its Regulation During Exercise223

Rate of Blood Flow Through the Muscles223

Control of Blood Flow Through the Skeletal Muscles223

Circulatory Readjustments During Exercise224

Normal Coronary Blood Flow226

Coronary Circulation226

Physiologic Anatomy of the Coronary Blood Supply226

Control of Coronary Blood Flow227

Special Features of Cardiac Muscle Metabolism228

Ischemie Heart Disease229

Causes of Death After Acute Coronary Occlusion230

Stages of Recovery from Acute Myocardial Infarction231

Function of the Heart After Recovery from Myocardial Infarction232

Pain in Coronary Disease232

Surgical Treatment of Coronary Disease233

Acute Effects of Moderate Cardiac Failure235

Dynamics of the Circulation in Cardiac Failure235

CHAPTER 22 Cardiac Failure235

Chronic Stage of Failure-Fluid Retention Helps to Compensate Cardiac Output236

Summary of the Changes That Occur After Acute Cardiac Failure— Compensated Heart Failure237

Dynamics of Severe Cardiac Failure—Decompensated Heart Failure237

Unilateral Left Heart Failure239

Low-Output Cardiac Failure—Cardiogenic Shock239

Edema in Patients with Cardiac Failure239

Cardiac Reserve241

Appendix241

Quantitative Graphical Method for Analysis of Cardiac Failure241

Normal Heart Sounds245

Heart Sounds245

CHAPTER 23 Heart Valves and Heart Sounds; Dynamics of Valvular and Congenital Heart Defects245

Valvular Lesions247

Abnormal Circulatory Dynamics in Valvular Heart Disease248

Dynamics of the Circulation in Aortic Stenosis and Aortic Regurgitation248

Dynamics of Mitral Stenosis and Mitral Regurgitation248

Circulatory Dynamics During Exercise in Patients with Valvular Lesions249

Abnormal Circulatory Dynamics in Congenital Heart Defects249

Patent Ductus Arteriosus—A Left-to-Right Shunt249

Tetralogy of Fallot—A Right-to-Left Shunt251

Causes of Congenital Anomalies251

Use of Extracorporeal Circulation During Cardiac Surgery251

Hypertrophy of the Heart in Valvular and Congenital Heart Disease252

CHAPTER 24 Circulatory Shock and Physiology of Its Treatment253

Physiologic Causes of Shock253

Circulatory Shock Caused by Decreased Cardiac Output253

Circulatory Shock That Occurs Without Diminished Cardiac Output253

What Happens to the Arterial Pressure in Circulatory Shock?253

Tissue Deterioration Is the End Stage of Circulatory Shock, Whatever the Cause253

Stages of Shock254

Shock Caused by Hypovolemia—Hemorrhagic Shock254

Relationship of Bleeding Volume to Cardiac Output and Arterial Pressure254

Progressive and Nonprogressive Hemorrhagic Shock255

Irreversible Shock258

Anaphylactic Shock and Histamine Shock259

Neurogenic Shock—Increased Vascular Capacity259

Hypovolemic Shock Caused by Plasma Loss259

Hypovolemic Shock Caused by Trauma259

Septic Shock260

Physiology of Treatment in Shock260

Replacement Therapy260

Treatment of Shock with Sympathomimetic Drugs—Sometimes Useful, Sometimes Not261

Other Therapy261

Circulatory Arrest261

Effect of Circulatory Arrest on the Brain261

Daily loss of Body Water264

Daily Intake of Water264

Fluid Intake and Output Are Balanced During Steady-State Conditions264

CHAPTER 25 The Body Fluid Compartments: Extracellular and Intracellular Fluids; Interstitial Fluid and Edema264

UNIT Ⅴ The Kidneys and Body Fluids264

Body Fluid Compartments265

Intracellular Fluid Compartment265

Extracellular Fluid Compartment266

Blood Volume266

Constituents of Extracellular and Intracellular Fluids266

Ionic Compositions of Plasma and Interstitial Fluid Are Similar266

Important Constituents of the Intracellular Fluid267

Determination of Volumes of Specitic Body Fluid Compartments268

Measurement of Fluid Volumes in the Different Body Fluid Compartments; the Indicator-Dilution Principle268

Basic Principles of Osmosis and Osmotic Pressure269

Regulation of Fluid Exchange and Osmotic Equilibria Between Intracellular and Extracellular Fluid269

Osmotic Equilibrium Is Maintained Between Intracellular and Extracellular Fluids271

Volumes and Osmolalities of Extracellular and Intracellular Fluid in Abnormal States272

Effect of Adding Saline Solution to the Extracellular Fluid272

Glucose and Other Solutions Administered for Nutritive Purposes273

Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia273

Edema: Excess Fluid in the Tissues274

Intracellular Edema274

Extracellular Edema274

Causes of Hypernatremia: Water Loss or Excess Sodium274

Causes of Hyponatremia: Excess Water or loss of Sodium274

Safety Factors That Normally Prevent Edema276

Fluids in the Potential Spaces of the Body277

CHAPTER 26 Urine Formation by the Kidneys: I. Glomerular Filtration, Renal Blood Flow, and Their Control279

Multiple Functions of the Kidneys in Homeostasis279

Physiologic Anatomy of the Kidneys280

General Organization of the Kidneys and Urinary Tract280

Renal Blood Supply281

The Nephron Is the Functional Unit of the Kidney281

Urine Formation Results from Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion282

Filtration, Reabsorption, and Secretion of Different Substances283

Glomerular Capillary Membrane284

GFR Is About 20 Per Cent of the Renal Plasma Flow284

Glomerular Filtration—The First Step In Urine Formation284

Composition of the Glomerular Filtrate284

Determinants of the Glomerular Filtration Rate286

Increased Glomerular Capillary Filtration Coefficient (K1) Increases GFR286

Increased Bowman s Capsule Hydrostatic Pressure Decreases GFR287

Increased Glomerular Capillary Colloid Osmotic Pressure Decreases GFR287

Increased Glomerular Capillary Hydrostatic Pressure Increases GFR287

Renal Blood Flow288

Determinants of Renal Blood Flow288

Hormonal and Autacoid Control of Renal Circulation289

Sympathetic Nervous System Activation Decreases GFR289

Physiologic Control of Glomerular Filtration and Renal Blood Flow289

Blood Flow in the Vasa Recta of the Renal Medulla Is Very Low Compared with Flow in the Renal Cortex289

Autoregulation of GFR and Renal Blood Flow290

Importance of GFR Autoregulation in Preventing Extreme Changes in Renal Excretion291

Role of Tubuloglomerular Feedback in Autoregulation of GFR291

Myogenic Autoregulation of Renal Blood Flow and GFR293

Other Factors That Increase Renal Blood Flow and GFR: High Protein Intake and Increased Blood Glucose293

CHAPTER 27 Urine Formation by the Kidneys: Ⅱ.Tubular Processing of the Glomerular Filtrate295

Reabsorption and Secretion by the Renal Tubules295

Tubular Reabsorption Is Selective and Quantitatively large295

Tubular Reabsorption Includes Passive and Active Mechanisms295

Active Transport296

Passive Water Reabsorption by Osmosis Is Coupled Mainly to Sodium Reabsorption299

Reabsorption of Chloride, Urea, and Other Solutes by Passive Diffusion300

Reabsorption and Secretion Along Different Parts of the Nephron300

Proximal Tubular Reabsorption300

Solute and Water Transport in the Loop of Henle302

Distal Tubule303

late Distal Tubule and Cortical Collecting Tubule303

Medullary Collecting Duct304

Summary of Concentrations of Different Solutes in the Different Tubular Segments304

Regulation of Tubular Reabsorption305

Glomerulotubular Balance—The Ability of the Tubules to Increase Reabsorption Rate in Response to Increased Tubular load305

Peritubular Capillary and Renal Interstitial Fluid Physical Forces306

Effect of Arterial Pressure on Urine Output—The Pressure-Natriuresis and Pressure-Diuresis Mechanisms308

Hormonal Control of Tubular Reabsorption308

Use of Clearance Methods to Quantify Kidney Function309

PAH Clearance Can Be Used to Estimate Renal Plasma Flow311

Filtration Fraction Is Calculated from GFR Divided by Plasma Renal Flow311

Calculation of Tubular Reabsorption or Secretion from Renal Clearances311

CHAPTER 28 Regulation of Extracellular Fluid Osmolarity and Sodium Concentration313

The Kidney Excretes Excess Water by Forming a Dilute Urine313

Antidiuretic Hormone Controls Urine Concentration313

Renal Mechanisms for Excreting a Dilute Urine313

The Countercurrent Mechanism Produces a Hyperosmotic Renal Medullary Interstitium315

Requirements for Excreting a Concentrated Urine—High ADH Levels and Hyperosmotic Renal Medulla315

Obligatory Urine Volume315

The Kidney Conserves Water by Excreting a Concentrated Urine315

Role of the Distal Tubule and Collecting Ducts in Excreting a Concentrated Urine317

Urea Contributes to Hyperosmotic Renal Medullary Interstitium and to a Concentrated Urine318

Countercurrent Exchange in the Vasa Recta Preserves Hyperosmolarity of the Renal Medulla319

Summary of Urine Concentrating Mechanism and Changes in Osmolarity in Different Segments of the Tubules320

Quantifying Renal Urine Concentration and Dilution: Free Water and Osmolar Clearances321

Disorders of Urinary Concentrating Ability322

Control of Extracellular Fluid Osmolarity and Sodium Concentration322

Estimating Plasma Osmolarity from Plasma Sodium Concentration322

ADH Synthesis in Supraoptic and Paraventricular Nuclei of the Hypothalamus and ADH Release from the Posterior Pituitary323

Osmoreceptor-ADH Feedback System323

Cardiovascular Reflex Stimulation of ADH Release by Decreased Arterial Pressure and/or Decreased Blood Volume324

Quantitative Importance of Cardiovascular Reflexes and Osmolarity in Stimulating ADH Secretion324

Other Stimuli for ADH Secretion324

Role of Thirst in Controlling Extracellular Fluid Osmolarity and Sodium Concentration325

Central Nervous System Centers for Thirst325

Stimuli for Thirst325

Threshold for Osmolar Stimulus of Drinking326

Integrated Responses of Osmoreceptor-ADH and Thirst Mechanisms in Controlling Extracellular Fluid Osmolarity and Sodium Concentration326

Role of Angiotensin Ⅱ and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration327

Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume327

Sodium Excretion Is Controlled by Altering Glomerular Filtration or Tubular Sodium Reabsorption Rates329

Sodium Excretion Is Precisely Matched to Intake Under Steady-State Conditions329

CHAPTER 29 Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume; and Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium329

Control Mechanisms for Regulating Sodium and Water Excretion329

Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance330

Pressure Natriuresis and Diuresis Are Key Components of a Renal-Body Fluid Feedback for Regulating Body Fluid Volumes and Arterial Pressure330

Precision of Blood Volume and Extracellular Fluid Volume Regulation331

Distribution of Extracellular Fluid Between the Interstitial Spaces and Vascular System332

Nervous and Hormonal Factors Increase the Effectiveness of Renal-Body Fluid Feedback Control332

Sympathetic Nervous System Control of Renal Excretion: The Arterial Baroreceptor and Low-Pressure Stretch Receptor Reflexes332

Role of Angiotensin Ⅱ in Controlling Renal Excretion333

Role of Aldosterone in Controlling Renal Excretion334

Role of ADH in Controlling Renal Water Excretion334

Conditions That Cause Large Increases in Blood Volume and Extracellular Fluid Volume335

Increased Blood Volume and Extracellular Fluid Volume Caused by Heart Diseases335

Role of Atrial Natriuretic Peptide in Controlling Renal Excretion335

Integrated Responses to Changes in Sodium Intake335

Increased Blood Volume Caused by Increased Capacity of the Circulation336

Conditions That Cause Large Increases in Extracellular Fluid Volume but with Normal Blood Volume336

Nephrotic Syndrome—Loss of Plasma Proteins in the Urine and Sodium Retention by the Kidneys336

Liver Cirrhosis—Decreased Synthesis of Plasma Proteins by the Liver and Sodium Retention by the Kidneys336

Regulation of Potassium Excretion and Potassium Concentration in the Extracellular Fluid336

Regulation of Internal Potassium Distribution337

Overview of Renal Potassium Excretion338

Summary of Factors That Regulate Potassium Secretion: Plasma Potassium Concentration, Aldosterone, Tubular Flow Rate, and Hydrogen Ion339

Potassium Secretion in the Principal Cells of the Late Distal and Cortical Collecting Tubules339

Control of Renal Calcium Excretion and Extracellular Calcium Ion Concentration342

Control of Calcium Excretion by the Kidneys343

Regulation of Renal Phosphate Excretion343

Control of Renal Magnesium Excretion and Extracellular Magnesium Ion Concentration344

CHAPTER 30 Regulation of Acid-Base Balance346

Hydrogen Ion Concentration Is Precisely Regulated346

Acids and Bases—Their Definitions and Meanings346

Defenses Against Changes in Hydrogen Ion Concentration: Buffers, Lungs, and Kidneys347

Buffering of Hydrogen Ions in the Body Fluids347

Quantitative Dynamics of the Bicarbonate Buffer System348

The Bicarbonate Buffer System348

The Phosphate Buffer System350

Proteins: Important Intracellular Buffers350

Isohydric Principle: All Buffers in a Common Solution Are in Equilibrium with the Same Hydrogen Ion Concentration350

Respiratory Regulation of Acid-Base Balance351

Pulmonary Expiration of CO2 Balances Metabolic Formation of CO2351

Increasing Alveolar Ventilation Decreases Extracellular Fluid Hydrogen Ion Concentration and Raises pH351

Increased Hydrogen Ion Concentration Stimulates Alveolar Ventilation351

Renal Control of Acid-Base Balance352

Secretion of Hydrogen Ions and Reabsorption of Bicarbonate Ions by the Renal Tubule353

Hydrogen Ions Are Secreted by Secondary Active Transport in the Early Tubular Segments353

Filtered Bicarbonate Ions Are Reabsorbed by Interaction with Hydrogen Ions in the Tubules354

Combination of Excess Hydrogen Ions With Phosphate and Ammonia Buffers in the Tubule—A Mechanism for Generating New Bicarbonate Ions355

Primary Active Secretion of Hydrogen Ions in the Intercalated Cells of Late Distal and Collecting Tubules355

The Phosphate Buffer System Carries Excess Hydrogen Ions into the Urine and Generates New Bicarbonate356

Excretion of Excess Hydrogen Ions and Generation of New Bicarbonate by the Ammonia Buffer System356

Quantifying Renal Acid-Base Excretion357

Regulation of Renal Tubular Hydrogen Ion Secretion357

Renal Correction of Acidosis—Increased Excretion of Hydrogen Ions and Addition of Bicarbonate Ions to the Extracellular Fluid358

Acidosis Decreases the Ratio of HCO3-/H+ in Renal Tubular Fluid358

Respiratory Alkalosis Results from Increased Ventilation and Decreased PCO2359

Respiratory Acidosis Is Caused by Decreased Ventilation and Increased PCO2359

Clinical Causes of Acid-Base Disorders359

Alkalosis Increases the Ratio of HCO3-/H+ in Renal Tubular Fluid359

Renal Correction of Alkalosis—Decreased Tubular Secretion of Hydrogen Ions and Increased Excretion of Bicarbonate Ions359

Metabolic Acidosis Results from Decreased Extracellular Fluid Bicarbonate Concentration360

Metabolic Alkalosis Is Caused by Increased Extracellular Fluid Bicarbonate Concentration360

Treatment of Acidosis or Alkalosis360

Clinical Measurements and Analysis of Acid-Base Disorders361

Complex Acid-Base Disorders and the Use of the Acid-Base Nomogram for Diagnosis361

Use of Anion Gap to Diagnose Acid-Base Disorders362

Innervation of the Bladder364

Physiologic Anatomy and Nervous Connections of the Bladder364

Transport of Urine from the Kidney Through the Ureters and Into the Bladder364

CHAPTER 31 Micturition, Diuretics, and Kidney Diseases364

Micturition364

Filling of the Bladder and Bladder Wall Tone; The Cystometrogram365

Micturition Reflex366

Facilitation or Inhibition of Micturition by the Brain366

Abnormalities of Micturition366

Diuretics and Their Mechanisms of Action367

Osmotic Diuretics Decrease Water Reabsorption by Increasing Osmotic Pressure of Tubular Fluid367

Carbonic Anhydrase Inhibitors Block Sodium-Bicarbonate Reabsorption in the Proximal Tubules368

Diuretics That Block Sodium Channels in the Collecting Tubules Decrease Sodium Reabsorption368

Competitive Inhibitors of Aldosterone Decrease Sodium Reabsorption from and Potassium Secretion into the Cortical Collecting Tubule368

Thiazide Diuretics Inhibit Sodium-Chloride Reabsorption in the Early Distal Tubule368

Loop Diuretics Decrease Active Sodium-Chloride-Potassium Reabsorption in the Thick Ascending Loop of Henle368

Kidney Diseases369

Acute Renal Failure369

Prerenal Acute Renal Failure Caused by Decreased Blood Flow to the Kidney369

Intrarenal Acute Renal Failure Caused by Abnormalities Within the Kidney369

Postrenal Acute Renal Failure Caused by Abnormalities of the Lower Urinary Tract370

Physiologic Effects of Acute Renal Failure370

Chronic Renal Failure: An Irreversible Decrease in the Number of Functional Nephrons371

Vicious Circle of Chronic Renal Failure Leading to End-Stage Renal Disease371

Injury to the Renal Vasculature as a Cause of Chronic Renal Failure371

Injury to the Glomeruli as a Cause of Chronic Renal Failure—Glomerulonephritis372

Nephrotic Syndrome—Excretion of Protein in the Urine Because of Increased Glomerular Permeability373

Abnormal Nephron Function in Chronic Renal Failure373

Injury to the Renal Interstitium as a Cause of Chronic Renal Failure—Pyelonephritis373

Effects of Renal Failure on the Body Fluids—Uremia375

Hypertension and Kidney Disease376

Specific Tubular Disorders377

Treatment of Renal Failure by Dialysis With an Artificial Kidney377

UNIT Ⅵ Blood Cells, Immunity, and Blood Clotting382

CHAPTER 32 Red Blood Cells, Anemia, and Polycythemia382

Red Blood Cells (Erythrocytes)382

Production of Red Blood Cells382

Formation of Hemoglobin386

Iron Metabolism387

Destruction of Red Blood Cells389

The Anemias389

Effects of Anemia on the Circulatory System390

Polycythemia390

Effect of Polycythemia on the Circulatory System390

CHAPTER 33 Resistance of the Body to Infection: Ⅰ. Leukocytes, Granulocytes, the Monocyte-Macrophage System, and Inflammation392

Leukocytes (White Blood Cells)392

General Characteristics of Leukocytes392

Genesis of the White Blood Cells392

Life Span of the White Blood Cells393

Defense Properties of Neutrophils and Macrophages393

Phagocytosis394

Monocyte-Macrophage System (Reticuloendothelial System)395

Inflammation and Role of Neutrophils and Macrophages397

Inflammation397

Macrophage and Neutrophil Responses During Inflammation397

Eosinophils399

Basophils399

Leukopenia399

The Leukemias400

Effects of Leukemia on the Body400

Both Types of Acquired Immunity Are Initiated by Antigens402

Basic Types of Acquired Immunity402

Acquired Immunity402

Innate Immunity402

CHAPTER 34 Resistance of the Body to Infection: Ⅱ. Immunity and Allergy402

Lymphocytes Are the Basis of Acquired Immunity403

Preprocessing of the T and B Lymphocytes403

T Lymphocytes and B-Lymphocyte Antibodies React Highly Specifically Against Specific Antigens—Role of Lymphocyte Clones404

Origin of the Many Clones of Lymphocytes405

Specific Attributes of the B-Lymphocyte System—Humoral Immunity and the Antibodies405

Special Attributes of the T-Lymphocyte System—Activated T Cells and Cell-Mediated Immunity408

Several Types of T Cells and Their Different Functions409

Tolerance of the Acquired Immunity System to One s Own Tissues—Role of Preprocessing in the Thymus and Bone Marrow410

Allergies in the So-Called Allergic Person, Who Has Excess IgE Antibodies411

Allergy Caused by Activated T Cells: Delayed-Reaction Allergy411

Immunization411

Passive Immunity411

Allergy and Hypersensitivity411

CHAPTER 35 Blood Groups; Transfusion; Tissue and Organ Transplantation413

Antigenicity Causes Immune Reactions of Blood413

O-A-B Blood Groups413

A and B Antigens—Agglutinogens413

Agglutinins413

Agglutination Process in Transfusion Reactions414

Blood Typing414

Rh Immune Response415

Rh Blood Types415

Transfusion Reactions Resulting from Mismatched Blood Types416

Transplantation of Tissues and Organs416

Attempts to Overcome the Immune Reaction to Transplanted Tissue417

CHAPTER 36 Hemostasis and Blood Coagulation419

Events in Hemostasis419

Vascular Constriction419

Formation of the Platelet Plug419

Blood Coagulation in the Ruptured Vessel420

Conversion of Fibrinogen to Fibrin—Formation of the Clot421

Conversion of Prothrombin to Thrombin421

Fibrous Organization or Dissolution of the Blood Clot421

Mechanism of Blood Coagulation421

Vicious Circle of Clot Formation422

Initiation of Coagulation: Formation of Prothrombin Activator422

Prevention of Blood Clotting in the Normal Vascular System—The Intravascular Anticoagulants425

Lysis of Blood Clots—Plasmin425

Conditions That Cause Excessive Bleeding in Human Beings426

Decreased Prothrombin, Factor Ⅶ, Factor Ⅸ, and Factor Ⅹ Caused by Vitamin K Deficiency426

Hemophilia426

Thrombocytopenia426

Disseminated Intravascular Coagulation427

Thromboembolic Conditions in the Human Being427

Femoral Venous Thrombosis and Massive Pulmonary Embolism427

Anticoagulants for Clinical Use428

Heparin as an Intravenous Anticoagulant428

Coumarins as Anticoagulants428

Prevention of Blood Coagulation Outside the Body428

Blood Coagulation Tests428

Bleeding Time428

Clotting Time428

Prothrombin Time429

Muscles That Cause Lung Expansion and Contraction432

Mechanics of Pulmonary Ventilation432

Movement of Air In and Out of the Lungs—and the Pressures That Cause the Movement432

CHAPTER 37 Pulmonary Ventilation432

UNIT Ⅶ Respiration432

Effect of the Thoracic Cage on Lung Expansibility435

Work of Breathing435

Pulmonary Volumes and Capacities436

Recording Changes in Pulmonary Volume—Spirometry436

Abbreviations and Symbols Used in Pulmonary Function Studies437

Determination of Functional Residual Capacity, Residual Volume, and Total Lung Capacity—Helium Dilution Method437

Minute Respiratory Volume Equals Respiratory Rate Times Tidal Volume438

Alveolar Ventilation438

Rate of Alveolar Ventilation439

Dead Space and Its Effect on Alveolar Ventilation439

Functions of the Respiratory Passageways440

Trachea, Bronchi, and Bronchioles440

Normal Respiratory Functions of the Nose441

Vocalization442

CHAPTER 38 Pulmonary Circulation; Pulmonary Edema; Pleural Fluid444

Physiologic Anatomy of the Pulmonary Circulatory System444

Pressures in the Pulmonary System444

Blood Volume of the Lungs445

Blood Flow Through the Lungs and Its Distribution445

Effect of Hydrostatic Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow446

Zones 1, 2, and 3 of Pulmonary Blood Flow446

Function of the Pulmonary Circulation When the Left Atrial Pressure Rises as a Result of Left-Sided Heart Failure447

Effect of Increased Cardiac Output on the Pulmonary Circulation During Heavy Exercise447

Capillary Exchange of Fluid in the Lungs, and Pulmonary Interstitial Fluid Dynamics448

Pulmonary Capillary Dynamics448

Pulmonary Edema449

Fluids in the Pleural Cavity450

CHAPTER 39 Physical Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory Membrane452

Physics of Gas Diffusion and Gas Partial Pressures452

Molecular Basis of Gas Diffusion452

Gas Pressures in a Mixture of Gases— Partial Pressures of Individual Gases452

Pressures of Gases Dissolved in Water and Tissues452

Vapor Pressure of Water453

Diffusion of Gases Through Fluids—Pressure Difference Causes Net Diffusion453

Rate at Which Alveolar Air Is Renewed by Atmospheric Air454

Diffusion of Gases Through Tissues454

Composition of Alveolar Air—Its Relation to Atmospheric Air454

Oxygen Concentration and Partial Pressure in the Alveoli455

CO2 Concentration and Partial Pressure in the Alveoli455

Expired Air456

Diffusion of Gases Through the Respiratory Membrane456

Factors That Affect the Rate of Gas Diffusion Through the Respiratory Membrane457

Diffusing Capacity of the Respiratory Membrane458

Effect of the Ventilation-Perfusion Ratio on Alveolar Gas Concentration460

PO2-PCO2, VA/Q Diagram460

Abnormalities of Ventilation-Perfusion Ratio461

Concept of Physiologic Dead Space (When VA/Q Is Creater Than Normal)461

Concept of Physiologic Shunt (When VA/Q Is Below Normal)461

CHAPTER 40 Transport of Oxygen and Carbon Dioxide in the Blood and Body Fluids463

Pressures of Oxygen and Carbon Dioxide in the Lungs, Blood, and Tissues463

Uptake of Oxygen by the Pulmonary Blood463

Transport of Oxygen in the Arterial Blood464

Diffusion of Oxygen from the Peripheral Capillaries into the Tissue Fluid464

Diffusion of Oxygen from the Peripheral Tissue Capillaries to the Tissue Cells465

Diffusion of Carbon Dioxide from the Peripheral Tissue Cells into the Tissue Capillaries and from the Pulmonary Capillaries into the Alveoli465

Transport of Oxygen in the Blood466

Reversible Combination of Oxygen with Hemoglobin466

Effect of Hemoglobin to Buffer the Tissue Po2467

Factors That Shift the Oxygen-Hemoglobin Dissociation Curve—Their Importance for Oxygen Transport468

Metabolic Use of Oxygen by the Cells469

Transport of Oxygen in the Dissolved State469

Combination of Hemoglobin with Carbon Monoxide—Displacement of Oxygen469

Transport of Carbon Dioxide in the Blood470

Chemical Forms in Which Carbon Dioxide Is Transported470

Transport of Carbon Dioxide in the Form of Bicarbonate Ion470

Carbon Dioxide Dissociation Curve471

When Oxygen Binds with Hemoglobin, Carbon Dioxide Is Released—The Haldane Effect—to Increase CO2 Transport471

Change in Blood Acidity During Carbon Dioxide Transport472

Respiratory Exchange Ratio472

Dorsal Respiratory Group of Neurons—Its Control of Inspiration and of Respiratory Rhythm474

Respiratory Center474

CHAPTER 41 Regulation of Respiration474

The Pneumotaxic Center Limits the Duration of Inspiration and Increases the Respiratory Rate475

Ventral Respiratory Group of Neurons Functions in Both Inspiration and Expiration475

Possibility of an Apneustic Center in the Lower Pons475

Lung Inflation Signals Limit Inspiration—The Hering-Breuer Inflation Reflex475

Control of Overall Respiratory Center Activity476

Chemical Control of Respiration476

Direct Chemical Control of Respiratory Center Activity by Carbon Dioxide and Hydrogen Ions476

Peripheral Chemoreceptor System for Control of Respiratory Activity—Role of Oxygen in Respiratory Control477

Composite Effects of Pco2, pH, and Po2 on Alveolar Ventilation479

Regulation of Respiration During Exercise479

Other Factors That Affect Respiration481

Periodic Breathing482

CHAPTER 42 Respiratory Insufficiency—Pathophysiology, Diagnosis, Oxygen Therapy484

Useful Methods for Studying Respiratory Abnormalities484

Study of Blood Gases and Blood pH484

Measurement of Maximum Expiratory Flow485

Forced Expiratory Vital Capacity and Forced Expiratory Volume486

Physiologic Peculiarities of Specific Pulmonary Abnormalities486

Chronic Pulmonary Emphysema486

Pneumonia488

Atelectasis488

Asthma489

Tuberculosis489

Oxygen Therapy in Different Types of Hypoxia490

Hypoxia and Oxygen Therapy490

Hypercapnia491

Cyanosis491

Dyspnea491

Artificial Respiration492

UNIT Ⅷ Aviation, Space, and Deep-Sea Diving Physiology496

CHAPTER 43 Aviation, High-Altitude, and Space Physiology496

Effects of Low Oxygen Pressure on the Body496

Alveolar PO2 at Different Elevations496

Effect of Breathing Pure Oxygen on Alveolar PO2 at Different Altitudes496

Acclimatization to Low PO2497

Acute Effects of Hypoxia497

Natural Acclimatization of Native Human Beings Living at High Altitudes498

Work Capacity at High Altitudes—The Effect of Acclimatization499

Chronic Mountain Sickness499

Acute Mountain Sickness and High-Altitude Pulmonary Edema499

Effects of Acceleratory Forces on the Body in Aviation and Space Physiology500

Centrifugal Acceleratory Forces500

Effects of Linear Acceleratory Forces on the Body501

Artificial Climate in the Sealed Spacecraft502

Weightlessness in Space502

Effect of High Partial Pressures of Gases on the Body504

Oxygen Toxicity at High Pressures504

CHAPTER 44 Physiology of Deep-Sea Diving and Other Hyperbaric Conditions504

Decompression of the Diver After Exposure to High Pressures506

Scuba (Self-Contained Underwater Breathing Apparatus)Diving508

Special Physiologic Problems in Submarines508

Hyperbaric Oxygen Therapy509

UNIT Ⅸ The Nervous System: A. General Principles and Sensory Physiology512

CHAPTER 45 Organization of the Nervous System; Basic Functions of Synapses and Transmitter Substances512

General Design of the Nervous System512

The Central Nervous System Neuron—The Basic Functional Unit512

Sensory Division of the Nervous System—Sensory Receptors512

Motor Division—The Effectors512

Processing of Information— Integrative Function of the Nervous System513

Storage of Information—Memory514

Major Levels of Central Nervous System Function514

Spinal Cord Level514

Lower Brain or Subcortical Level514

Higher Brain or Cortical Level515

Comparison of the Nervous System With an Electronic Computer515

Central Nervous System Synapses515

Types of Synapses—Chemical and Electrical515

Physiologic Anatomy of the Synapse516

Chemical Substances That Function as Synaptic Transmitters519

Electrical Events During Neuronal Excitation521

Electrical Events in Neuronal Inhibition522

Special Functions of Dendrites in Exciting Neurons524

Relation of State of Excitation of the Neuron to Rate of Firing525

Some Special Characteristics of Synaptic Transmission525

CHAPTER 46 Sensory Receptors; Neuronal Circuits for Processing Information528

Types of Sensory Receptors and the Sensory Stimuli They Detect528

Differential Sensitivity of Receptors528

Transduction of Sensory Stimuli Into Nerve Impulses529

Local Electrical Currents at Nerve Endings—Receptor Potentials529

Adaptation of Receptors531

Nerve Fibers That Transmit Different Types of Signals and Their Physiologic Classification532

Transmission and Processing of Signals in Neuronal Pools533

Transmission of Signals of Different Intensity in Nerve Tracts—Spatial and Temporal Summation533

Relaying of Signals Through Neuronal Pools534

Prolongation of a Signal by a Neuronal Pool— Afterdischarge536

Instability and Stability of Neuronal Circuits538

Inhibitory Circuits as a Mechanism for Stabilizing Nervous System Function538

Synaptic Fatigue as a Means of Stabilizing the Nervous System538

CHAPTER 47 Somatic Sensations: Ⅰ. General Organization; the Tactile and Position Senses540

Classification of Somatic Senses540

Detection and Transmission of Tactile Sensations540

Detection of Vibration541

Anatomy of the Dorsal Column-Medial Lemniscal System542

Transmission in the Dorsal Column-Medial Lemniscal System542

Anterolateral System542

Sensory Pathways for Transmitting Somatic Signals into the Central Nervous System542

Tickling and Itch542

Dorsal Column-Medial Lemniscal System542

Somatosensory Cortex544

Somatosensory Association Areas546

Overall Characteristics of Signal Transmission and Analysis in the Dorsal Column-Medial Lemniscal System546

Interpretation of Sensory Stimulus Intensity548

Judgment of Stimulus Intensity548

Position Senses548

Transmission of Less Critical Sensory Signals in the Anterolateral Pathway549

Anatomy of the Anterolateral Pathway549

Cortical Control of Sensory Sensitivity— Corticofugal Signals550

Some Special Aspects of Somatosensory Function550

Function of the Thalamus in Somatic Sensation550

Segmental Fields of Sensation—The Dermatomes551

CHAPTER 48 Somatic Sensations: Ⅱ. Pain, Headache, and Thermal Sensations552

Types of Pain and Their Qualities—Fast Pain and Slow Pain552

Pain Receptors and Their Stimulation552

Rate of Tissue Damage as a Stimulus for Pain553

Dual Transmission of Pain Signals into the Central Nervous System553

Dual Pain Pathways in the Cord and Brain Stem—The Neospinothalamic Tract and the Paleospinothalamic Tract554

Pain Suppression ( Analgesia ) System in the Brain and Spinal Cord555

The Brain s Opiate System—The Endorphins and Enkephalins556

Causes of True Visceral Pain557

Visceral Pain557

Inhibition of Pain Transmission by Tactile Sensory Signals557

Referred Pain557

Treatment of Pain by Electrical Stimulation557

Parietal Pain Caused by Visceral Damage558

Localization of Visceral Pain—The Visceral and the Parietal Pain Transmission Pathways558

Some Clinical Abnormalities of Pain and Other Somatic Sensations559

Hyperalgesia559

Thalamic Syndrome559

Herpes Zoster (Shingles)559

Tic Douloureux559

Headache of Intracranial Origin560

Headache560

Brown-Sequard Syndrome560

Extracranial Types of Headache561

Thermal Sensations561

Thermal Receptors and Their Excitation561

Transmission of Thermal Signals in the Nervous System562

UNIT Ⅹ The Nervous System: B. The Special Senses566

CHAPTER 49 The Eye: Ⅰ. Optics of Vision566

Physical Principles of Optics566

Refraction of Light566

Application of Refractive Principles to Lenses566

Focal Length of a Lens567

Formation of an Image by a Convex Lens568

Measurement of the Refractive Power of a Lens—The Diopter569

Optics of the Eye569

The Eye as a Camera569

Mechanism of Accommodation570

Pupillary Diameter571

Errors of Refraction571

Visual Acuity573

Determination of Distance of an Object from the Eye—Depth Perception574

Ophthalmoscope574

Formation of Aqueous Humor by the Ciliary Body575

Fluid System of the Eye—Intraocular Fluid575

Outflow of Aqueous Humor from the Eye576

Intraocular Pressure576

CHAPTER 50 The Eye: Ⅱ. Receptor and Neural Function of the Retina578

Anatomy and Function of the Structural Elements of the Retina578

Photochemistry of Vision579

Rhodopsin-Retinal Visual Cycle, and Excitation of the Rods580

Automatic Regulation of Retinal Sensitivity—Light and Dark Adaptation582

Color Vision584

Tricolor Mechanism of Color Detection584

Color Blindness584

Neural Circuitry of the Retina586

Neural Function of the Retina586

Ganglion Cells588

Excitation of the Ganglion Cells588

CHAPTER 51 The Eye: Ⅲ. Central Neurophysiology of Vision591

Visual Pathways591

Function of the Dorsal Lateral Geniculate Nucleus591

Organization and Function of the Visual Cortex592

Layered Structure of the Primary Visual Cortex593

Two Major Pathways for Analysis of Visual Information—(1) The Fast Position and Motion Pathway; (2) The Accurate Color Pathway594

Neuronal Patterns of Stimulation During Analysis of the Visual Image594

Fields of Vision; Perimetry595

Effect of Removing the Primary Visual Cortex595

Detection of Color595

Eye Movements and Their Control596

Fixation Movements of the Eyes596

Fusion of the Visual Images from the Two Eyes598

Autonomic Control of Accommodation and Pupillary Aperture599

Control of Accommodation (Focusing the Eyes)599

Control of Pupillary Diameter600

CHAPTER 52 The Sense of Hearing602

Tympanic Membrane and the Ossicular System602

Conduction of Sound from the Tympanic Membrane to the Cochlea602

Functional Anatomy of the Cochlea603

The Cochlea603

Transmission of Sound Through Bone603

Transmission of Sound Waves in the Cochlea—The Traveling Wave604

Function of the Organ of Corti605

Determination of Sound Frequency—The Place Principle607

Determination of Loudness607

Central Auditory Mechanisms608

Auditory Pathways608

Function of the Cerebral Cortex in Hearing609

Determination of the Direction from Which Sound Comes610

Hearing Abnormalities611

Types of Deafness611

Centrifugal Signals from the Central Nervous System to Lower Auditory Centers611

CHAPTER 53 The Chemical Senses—Taste and Smell613

Sense of Taste613

Primary Sensations of Taste613

Taste Bud and Its Function614

Transmission of Taste Signals into the Central Nervous System615

Taste Preference and Control of the Diet616

Sense of Smell616

Olfactory Membrane616

Stimulation of the Olfactory Cells617

Transmission of Smell Signals into the Central Nervous System618

Organization of the Spinal Cord for Motor Functions622

CHAPTER 54 Motor Functions of the Spinal Cord; The Cord Reflexes622

UNIT Ⅺ The Nervous System: C. Motor and Integrative Neurophysiology622

Muscle Sensory Receptors—Muscle Spindles and Golgi Tendon Organs—and Their Roles in Muscle Control624

Receptor Function of the Muscle Spindle624

Muscle Stretch Reflex625

Role of the Muscle Spindle in Voluntary Motor Activity626

Clinical Applications of the Stretch Reflex627

Golgi Tendon Reflex628

Function of the Muscle Spindles and Golgi Tendon Organs in Conjunction with Motor Control from Higher Levels of the Brain628

Flexor Reflex and the Withdrawal Reflexes629

Reflexes of Posture and Locomotion630

Postural and Locomotive Reflexes of the Cord630

Reciprocal Inhibition and Reciprocal Innervation630

Crossed Extensor Reflex630

Scratch Reflex631

Spinal Cord Reflexes That Cause Muscle Spasm632

Autonomic Reflexes in the Spinal Cord632

Spinal Cord Transection and Spinal Shock632

CHAPTER 55 Cortical and Brain Stem Control of Motor Function634

The Motor Cortex and Corticospinal Tract634

Primary Motor Cortex634

Premotor Area634

Some Specialized Areas of Motor Control Found in the Human Motor Cortex635

Supplementary Motor Area635

Transmission of Signals from the Motor Cortex to the Muscles636

Incoming Fiber Pathways to the Motor Cortex637

The Red Nucleus Serves as an Alternative Pathway for Transmitting Cortical Signals to the Spinal Cord637

Extrapyramidal System638

Excitation of the Spinal Cord Motor Control Areas by the Primary Motor Cortex and the Red Nucleus638

Role of the Brain Stem in Controlling Motor Function640

Support of the Body Against Gravity—Roles of the Reticular and Vestibular Nuclei640

Vestibular Sensations and the Maintenance of Equilibrium641

Vestibular Apparatus641

Function of the Utricle and Saccule in the Maintenance of Static Equilibrium643

Detection of Head Rotation by the Semicircular Ducts644

Vestibular Mechanisms for Stabilizing the Eyes645

Other Factors Concerned with Equilibrium645

Functions of Brain Stem Nuclei in Controlling Subconscious, Stereotyped Movements646

CHAPTER 56 The Cerebellum, the Basal Ganglia, and Overall Motor Control647

The Cerebellum and Its Motor Functions647

Anatomical Functional Areas of the Cerebellum647

Neuronal Circuit of the Cerebellum648

Function of the Cerebellum in Overall Motor Control652

Clinical Abnormalities of the Cerebellum655

The Basal Ganglia—Their Motor Functions656

Function of the Basal Ganglia in Executing Patterns of Motor Activity—The Putamen Circuit657

Role of the Basal Ganglia for Cognitive Control of Sequences of Motor Patterns—The Caudate Circuit657

Function of the Basal Ganglia to Change the Timing and to Scale the Intensity of Movements658

Functions of Specific Neurotransmitter Substances in the Basal Ganglial System659

Clinical Syndromes Resulting from Damage to the Basal Ganglia659

Integration of the Many Parts of the Total Motor Control System660

Spinal Level660

Hindbrain Level660

Motor Cortex Level660

What Drives Us to Action?661

CHAPTER 57 The Cerebral Cortex; Intellectual Functions of the Brain; and Learning and Memory663

Physiologic Anatomy of the Cerebral Cortex663

Functions of Specific Cortical Areas663

Association Areas665

Comprehensive Interpretative Function Of the Posterior Superior Temporal Lobe— Wernicke s Area (a General Interpretative Area)666

Functions of the Parieto-occipitotemporal Cortex in the Nondominant Hemisphere668

Higher Intellectual Functions of the Prefrontal Association Area668

Function of the Brain in Communication—Language Input and Language Output669

Function of the Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories. Training, and Other Information Between the Two Cerebral Hemispheres671

Thoughts, Consciousness, and Memory671

Memory—Roles of Synaptic Facilitation and Synaptic Inhibition672

Short-Term Memory673

Intermediate Long-Term Memory673

Long-Term Memory674

Consolidation of Memory675

Control of Cerebral Activity by Continuous Excitatory Signals from the Brain Stem678

Activating-Driving Systems of the Brain678

CHAPTER 58 Behavioral and Motivational Mechanisms of the Brain—The Limbic System and the Hypothalamus678

Neurohormonal Control of Brain Activity679

The Limbic System681

Functional Anatomy of the Limbic System: the Key Position of the Hypothalamus681

The Hypothalamus, a Major Control Headquarters for the Limbic System682

Vegetative and Endocrine Control Functions of the Hypothalamus682

Behavioral Functions of the Hypothalamus and Associated Limbic Structures684

Reward and Punishment Function of the Limbic System684

Importance of Reward and