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Innocent bystander refers to a cell that is fatally injured Immunologic (or immunological) is an adjective referring during an immune response specifc for a different cell type hiv infection rates in kenya starlix 120mg with amex. The tissue cells are not the specifc targets during an immune An immunological reaction is an in vivo or in vitro response response but are killed as innocent bystanders because of of lymphoid cells to an antigen they have never previously their close proximity to the site where nonspecifc factors encountered or to an antigen for which they are already are released near the actual target of the immune response hiv infection rates san francisco cheap generic starlix canada. An immunological reaction may consist Bystander lysis may occur by the Fas/FasL pathway depend- of antibody formation xylitol antiviral generic starlix 120 mg otc, cell-mediated immunity, or immuno- ing on the polarity and kinetics of FasL surface expression logical tolerance. This cytotoxicity immune reactions may mediate either protective immunity or pathway may give rise to bystander lysis of Fas+ target cells. An immunologically competent cell is a lymphocyte, such A microenvironment is an organized, local interaction as a B cell or T cell, that can recognize and respond to a among cells that provides an interactive, dynamic, structural, specifc antigen. The microenvironment may facilitate or regulate cell and molecular interactions An immunologist is a person who makes a special study of through biologically active molecules. In the immune system, they include the thy- Immunology is that branch of biomedical science con- mic cortex and the thymic medulla, which are distinct; the cerned with the response of the organism to immunogenic microenvironment of lymphoid nodules; and a microenviron- (antigenic) challenge, the recognition of self from nonself, ment of B cells in a lymphoid follicle, among others. Microflaments are cellular organelles that comprise a net- work of fbers of about 60 Å in diameter present beneath Immunophysiology refers to the physiologic basis of immu- the membranes of round cells, occupying protrusions of the nologic processes. It may function in cell– important functions of cells belonging to the immune and cell and cell–matrix interactions. It can also bind with high affnity to the neural proteo- An immunologically activated cell is the term for an immu- glycan eurocan. A ligand is any molecule that a receptor genes governing cellular proliferation, differentiation, and recognizes. The sig- present on lymphocyte surfaces enable lymphocytes to recir- naling induced by the ligand binding to the receptor appears culate and home to specifc tissues. Based on x-ray crystallography, the to ligands termed addressins found on endothelial cells in trimeric ligand has three equal faces; a receptor monomer affected vessels. The bringing together of three receptors, thereby orienting Adhesion molecules (Figure 2. B and T lymphocytes Promiscuous binding: A docking site that accepts several that pass through high endothelial venules have lymph different ligands with related affnity manifests promiscuous node homing receptors. In the immune system, adhesion molecules are critical to Cross-linking: A process resulting from the joining of mul- most aspects of leukocyte function, including lymphocyte tiple identical molecules by the union of multivalent ligands recirculation through lymphoid organs, leukocyte recruit- such as antibodies. Cross-linking may occur with both solu- ment into infammatory sites, antigen-specifc recognition, ble and cell-surface structures. Examples include glycoproteins, colla- vessel wall injury is the adhesion of platelets to the injury gens, and proteoglycans. This platelet mass is called cytoskeletal protein moesin is important for the redistribu- a hemostatic plug. The exposed basement membranes at tion of adhesion molecules to the cellular uropod. It is a lympho- dency to break up with new masses reformed immediately cyte transmembrane glycoprotein with a molecular weight of at the original site. There are four repeats of 40 amino also function in tissues such as bone and brain. The principal function of integrins is to link the Amino acid sequences in the intracellular portion of signal- cytoskeleton to extracellular ligands. They also participate transducing cell surface molecules that are sites of tyrosine in wound healing, cell migration, killing of target cells, and phosphorylation and of association with tyrosine kinases and in phagocytosis. Molecules, Cells, and Tissues of the Immune Response 83 Antigen Presenting Cell gastrointestinal mucosa. An extracellular substance, heparan sulfate is present in the lungs, arterial walls, and on numerous cell surfaces. Each that inhibit other signal transduction pathways, thereby nega- type of receptor can impact the signal and ultimate response tively regulating cell activation. An example of a growth factor that has been shown to infuence members of the integrin family of cell Adhesion receptors (Figure 2. The third family of adhesion receptors con- mediated B cell and lymphoma cell adhesion. One is comprised of d-glu- signal transduction pathway can also induce ligand-bind- cosamine and d-glucuronic acid, whereas the other is com- ing activity in functionally inactive αv β3 integrins. The glycoprotein is comprised of a 180-kDa α chain blasts, and endothelial cells of vessels. It facilitates natural killer amino acid extracellular region, a 23-amino acid transmem- cell and cytotoxic T cell interaction with target cells.
Semimembranous tendon mediated avulsion fracture of the posteromedial tibial plateau hiv infection first 24 hours cheap 120mg starlix mastercard. Computed tomography hiv infection rates berlin buy starlix american express, coronal and sagittal reformatted views symptoms of hiv infection include buy cheap starlix 120mg on line, with three-dimensional reconstruction views of right knee demonstrating a displaced and rotated posteromedial tibial plateau fracture fragment. Semimembranous tendon mediated avulsion fracture of the posteromedial tibial plateau. The short arrow points to the retracted coiled tendon of the distal muscle unit in the posteromedial aspect of the proximal tibia. A high frequency linear ultrasound transducer is placed over the medial semimembranosus insertion joint in the oblique longitudinal plane with the superior portion of the ultrasound transducer turned about 20 degrees toward the patella (Fig. A survey scan is taken which demonstrates the characteristic appearance of the medial joint space with the hyperechoic medial margins of the femur and the tibia with the thick hyperechoic filaments of the medial collateral ligament overlying the triangular-shaped medial meniscus (Fig. The medial meniscus is visualized as a triangular-shaped hyperechoic structure resting between the bony medial margins of the femur and tibia (Fig. Just inferior to the joint space is the hypoechoic rounded tendon of the semimembranosus muscle at its tibial insertion. After the semimembranosus tendon is identified, the tendon and distal musculotendinous unit is evaluated for tendinosis, tendinitis, tear, and rupture (Fig. Correct longitudinal position for ultrasound transducer for ultrasound evaluation of the distal semimembransosus musculotendinous unit. Ultrasound image of the knee joint demonstrating the medial border of the proximal femur. Longitudinal ultrasound image demonstrating the triangular-shaped medial meniscus nestled between the medial borders of the femur and tibia. Just inferior to the joint space is the hypoechoic rounded tendon of the semimembranosus muscle at its tibial insertion. The tendon is focally swollen and hypoechoic with loss of the normal fibrillary architecture due to tendinosis (arrow). Tears of the gastrocnemius muscle can also coexist with semimembranosus insertion syndrome and bursitis in the presence of trauma to the medial knee (Fig. The medial collateral ligament is crossed at its lower part by the tendons of the sartorius, gracilis, and semitendinosus muscles. The pes anserine bursa is between these tendons and the medial collateral ligament and is subject to inflammation if the ligament or tendons are traumatized (Fig. The anatomy of the medial collateral ligament and its relationship with the other musculotendinous units of the medial knee. Longitudinal ultrasound image of the medial knee joint demonstrating the pes anserine bursa lying beneath the pes anserine tendon. The ligament is susceptible to strain at the joint line or avulsion at its origin or insertion. The medial collateral ligament is frequently injured from falls with the leg in valgus and externally rotated, typically during snow skiing accidents or as the result of tackles in American football (Fig. The pain of medial collateral ligament damage is localized to the medial knee and is made worse with passive valgus and external rotation of the knee. Activity, especially involving flexion and external rotation of the knee, will exacerbate the pain. Sleep disturbance is common in patients suffering from trauma to the medial collateral ligament of the knee. Coexistent bursitis, tendinitis, arthritis, or internal derangement of the knee may confuse the clinical picture after trauma to the knee joint making clinical diagnosis difficult (Fig. The medial collateral ligament is frequently injured by low tackles in American football and in snow skiing accidents. Longitudinal ultrasound image demonstrating tearing of the anterior horn of the medial meniscus. Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing.
Note hiv infection hindi purchase starlix 120 mg amex, in segmental contractions hiv infection youth discount starlix 120 mg mastercard, food is grinded and thoroughly mixed between two propulsive segments hiv infection rate atlanta cheap 120 mg starlix with visa. Electrophysiology of Intestinal Smooth Muscles migrating myoelectric complex, contraction of the muscu- laris mucosa, villus contractions, and movements due to the frequency of slow wave is maximum in small intestine intestinal reflexes. The frequency is highest in duode- num (about 15 per minute) and decreases slowly toward Segmentation ileum where it is about 8–10 per minute. Slow waves are not always accompanied by bursts This is the most common variety of movement of the small of action potential spikes. It is characterized by closely spaced contraction of the absence (no spike), contraction is weaker or absent circular muscle layer. The rate of segmental contraction is same as the fre- that they are localized to a short segment of the intes- quency of slow waves. Therefore, contraction is also localized to the num, 15/min in jejunum, and 12/min in ileum. Two nearby propulsive segments force the chyme mines the strength of muscle contraction, depends on toward each other into the receiving segment (Fig. They also bring the fresh chyme into the contact with the enteric neurons and the circulating hormones. Therefore, segmentation movements are also called thetic stimulation inhibits intestinal contractility. Bringing the chyme in contact with the absorptive tions of circular smooth muscles of the small intestine. In fact, peristaltic wave spreads These functions are achieved by various small intesti- in both directions. The motilities are segmentation, peristalsis, (oral spread) dies out after a short distance, and wave 414 Section 5: Gastrointestinal System 3. On the other hand administration of laxative for exam- ple castor oil produces the reverse effect. Laxatives increase intestinal motility, and therefore, shorten the transit time of the intestinal content. This increases the delivery of chyme and water into the colon that A causes diarrhea. Other Motilities Migrating Myoelectric Motor Complex In the interdigestive phase, the pattern of motility of small intestine changes. There are bursts of intense electrical and contractile B activity, once in about every 90 minutes. These contractions alter the patterns of the mucosal Antiperistalsis results in vomiting. Such contractions help in mixing the luminal contents Short range peristalsis also occurs in the intestine, but less and also in bringing the fresh chyme in contact with frequently. Short range peristalsis along with segmentation con- traction decreases the net rate of propulsion of chyme Villus Contraction in forward direction. This allows the chyme to stay more time in intestine to called villus contraction. This is typically seen in upper part of the small intes- Clinical Significance tine. Administration of codeine decreases the motility of the central lacteals of the villi. The decreased motility also prolongs the transit Intestinal Reflexes time for the intestinal contents so that more water and nutrients are reabsorbed. Therefore, this also There are two reflexes observed in the intestine: intestino- decreases the volume of stool. Ileocecal sphincter is also controlled by extrinsic nerve When a part of the intestine is over-distended, the rest fibers. This is called intestinointestinal by vagal stimulation as seen in gastroileal reflex. When the intestine is injured, excessively handled or mis- This increases entry of contents of ileum into the colon handled, the smooth muscles of the intestine are inhib- through ileocecal sphincter. This helps in propagation in the small intestine (6–8 hours later) followed by of ring of contraction in aboral direction.
History of Immunology 71 of immunology; and to contribute to the advancement of immunology in all its aspects hiv infected person symptoms purchase starlix pills in toronto. Cruse four stages hiv infection purchase genuine starlix line, who introduced Professor 1839 Francois Magendie antiviral y retroviral purchase starlix no prescription, Lectures on the Blood, Heidelberger, Dr. He found both 1884 Elie Metchnikoff described phagocytosis, a heat-stable and a heat-labile component, studied the phenomenon in starfsh larvae antibody and alexine (complement: Ehrlich) and Daphnia J. Leclef, immunization greatly increased phagocytosis 1885 Paul Ehrlich’s book on the need of the Precipitins organism for oxygen, frst reference to his side-chain theory, Das Sauerstoff- 1896 Max von Grüber and Henry Durham dis- Bedurfniss des Organismus covered agglutination of the typhoid bacil- lus, by the serum of typhoid patient 1886 D. Salmon and Theobald Smith found Fernand Widal used the same reaction in that dead virus could produce immunity reverse, testing sera of patients against against the living virus known bacteria to identify typhoid, the Louis Pasteur described method of prevent- Grüber–Widal test ing rabies 1897 Ehrlich developed a method for standardiz- 1887 F. Löffer, a frst history of bacteriology, ing the antitoxin used in treatment of diph- incomplete theria, one of the founding discoveries of immunochemistry 1888 George Nuttall, demonstration of the bac- R. Kraus showed that bacterial culture fl- tericidal power of the blood of certain trate could produce an antibody which animals formed precipitate when added to the fl- Emile Roux and A. The precipitin reac- a bacterium-free fltrate of the diphtheria tion could be demonstrated with a variety of bacillus culture contained the exotoxin protein and complex polysaccharides Killed vaccines First antigen and antibody 1898 Bordet published paper on bacterial hemo- lysis, bringing it to the attention of many 1889 Hans Buchner demonstrated that the bacte- investigators ricidal power of defbrinated serum was in Side-chain theory cell-free serum and was lost on heating the Intracellular growth of virus serum to 55°C for 1 h A. Roger observed clumping 1900 Karl Landsteiner mentioned the agglutina- of bacterial suspension by immune serum tion of red blood cells of healthy human blood from another individual, perhaps due 1890 Emil von Behring and Shibasaburo Kitasato to inborn differences, in a footnote published papers describing the use of anti- Blood groups toxins against diphtheria and tetanus in P. Morgenroth studied blood therapy, passive transfer of immunity of six goats, fnding that there are clumping Koch announced the preparation of “tuber- reactions between some, not published until culin” prematurely at the 10th International 1901, the horror autotoxicus theory Congress of Medicine in Berlin Hypersensitivity 1901 J. Gengou developed the Antitoxins complement fxation test, basis of many laboratory tests 1891 Ehrlich studied the plant toxins ricin and Emil von Behring awarded Nobel Prize in abrin and raised antibodies to them Medicine for diphtheria, tetanus antitoxin sera Max Neisser and R. Lubowski demonstrated 1892 Filterability of virus complement deviation History of Immunology 73 Complement fxation 1908 Paul Ehrlich, Elie Metchnikoff, Nobel Prize Yellow fever transmission for work on immunity 1902 Jan Danysz studied the Danysz phenom- 1909 Inbred mice enon, different results from mixing anti- toxin–toxin in equal parts or the antitoxin 1910 John Auer and Paul Lewis; S. Meltzer added in two doses, resulting in continued identifed the physiological reaction in ana- toxicity phylaxis, recognized that asthma was a phe- August von Wassermann, studies on hemo- nomenon of anaphylaxis lysin, cytotoxin, and precipitin L. Uhlenhuth, tissue-specifc antigens, muscle recognition of bird egg albumin William H. Douglas anaphylaxis studied opsonization reactions (coined Viruses cultured from opsono: I prepare food for). A bridge between the cellular and humoral theories 1913 Ludvig Hektoen proved that x-rays sup- George Nuttall’s Blood Immunity and pressed the antibody response Blood Relationships published. Precipitin American Association of Immunologists reactions used to demonstrate blood rela- founded tionships among various animals F. Pick described 1914 Frederick Twort announced the transmissi- altered protein antigens, frst hapten study ble lysis of bacteria by viruses, frst mention Fred Neufeld, bacteriotropins named and of bacteriophage described Svante Arrhenius delivered a series of lec- 1915 G. Sanarelli observed what was later called tures in Berkeley, later to be published in the Shwartzman reaction book Immunochemistry, term coined by him Bacterophage discovered 1905 Clemens von Pirquet and Bela Schick pub- 1916 Landsteiner began study on haptens, carri- lished text on serum sickness of children ers, and antibody specifcity receiving serum therapy. Steinhardt gave term ied reagin; allergy to fsh was passively anti-anaphylaxis to the desensitization of transmitted, Prausnitz–Küstner test animals sensitized to an antigen Bacterial lysogeny 74 Atlas of Immunology, Third Edition 1922 Alexander Fleming described lysozyme 1936 Gorer identifed the frst histocompatibility Michael Heildelberger and O. Williamson of the Mayo Clinic response described the pathology of transplant rejection Hans Zinsser identifed immediate and 1939 Philip Levine and R. Schoenheit wrote on of reaction delayed hypersensitivity to simple protein Variable folding theory antigens injected into tubercles, forerunner of the adjuvant 1941 George Hirst discovered virus hemagglu- Alexander Fleming, penicillin described tination; also independently discovered by William Taliaferro’s monograph on immu- McClelland and Hare nity to parasitic infections F. Burnet, Freeman, Jackson, and Lush pro- posed an early theory of antibody formation 1930 Friedrich Breinl and Felix Haurowitz, the template theory of antibody formation 1942 Jules Freund, Freund’s complete adjuvant Direct template theory which enhanced antibody response to anti- gen and directed response to development of 1931 Thomsen’s description of the panaggluti- delayed hypersensitivity nation reaction named for him in human A. Creech used fuores- erythrocytes cein labeling, immunofuorescence as a tool Virus culture on embryo for research Virus size measured Lloyd D. Kendall 1944 Peter Medawar proved that the mecha- isolated pure antibodies, performed quanti- nism of tissue transplant rejection was tative precipitin reactions immunological P. Hudack, antibody Acquired immunological tolerance produced by cells of lymph nodes 1945 R. Jerne developed the natural selec- Ehrich, the role of the lymphocyte in anti- tion theory of antibody production body formation Cattle chimeras 1956 Ernest Witebsky and Noel Rose, induction Recombination in phage of autoimmune thyroiditis in animals Discovery of human immunodefciencies 1946 Jacques Oudin, precipitin reaction in gels 1957 Roitt and Doniach, et al. Jaap dis- antibody in gels cussed the bursa of Fabricius in antibody Antibodies in plasma cells production, B cells Alick Isaacs and Jean Lindenmann, discov- ery of interferon 1949 Astrid Fagraeus, thesis on the correlation L.
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