Synucleinopathies are neurodegenerative diseases characterised by the abnormal accumulation of aggregates of alpha-synuclein protein in neurons, nerve fibres or glial cells. There are three main types of synucleinopathy: Parkinson's disease, dementia with Lewy bodies, multiple system atrophy. Other rare disorders, such as various neuroaxonal dystrophies have α-synuclein pathologies; the synucleinopathies have shared features of parkinsonism, impaired cognition, sleep disorders, visual hallucinations. Synucleinopathies can sometimes overlap with tauopathies because of interaction between the synuclein and tau proteins. REM sleep behavior disorder is a parasomnia in which individuals with RBD lose the paralysis of muscles, normal during rapid eye movement sleep, act out their dreams or have other abnormal movements or vocalizations. Abnormal sleep behaviors may appear decades before any other symptoms as an early sign of a synucleinopathy. On autopsy, 94 to 98% of individuals with polysomnography-confirmed RBD are found to have a synucleinopathy—most DLB or PD.
Other symptoms of the specific synucleinopathy manifest within 15 years of the diagnosis of RBD, but may emerge up to 50 years after RBD diagnosis. Alpha-synuclein deposits can affect blood vessels. All people with synucleinopathies have cardiovascular dysfunction, although most are asymptomatic. From chewing to defecation, alpha-synuclein deposits affect every level of gastrointestinal function. Symptoms include upper gastrointestinal tract dysfunction such as delayed gastric emptying or lower gastorintestinal dysfunction, such as constipation and prolonged stool transit time. Urinary retention, waking at night to urinate, increased urinary frequency and urgency, over- or underactive bladder are common in people with synucleinopathies. Sexual dysfunction appears early in synucleinopathies, may include erectile dysfunction, difficulties achieving orgasm or ejaculating. Persons with PD are less caught up in their visual hallucinations than those with DLB. There is a lower incidence of tremor at rest in DLB than in PD, signs of parkinsonism in DLB are more symmetrical.
In MSA, autonomic dysfunction appears earlier and is more severe, is accompanied by uncoordinated movements, while visual hallucinations and fluctuating cognition are less common than in DLB. Urinary difficulties are one of the earliest symptoms with MSA, are severe. Proteopathy Lewy body
Compression stockings are a specialized hosiery designed to help prevent the occurrence of, guard against further progression of, venous disorders such as edema and thrombosis. Compression stockings are elastic garments worn around the leg; this reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, relieves heavy and aching legs. Knee-high compression stockings are used not only to help increase circulation, but to help prevent the formation of blood clots in the lower legs, they aid in the treatment of ulcers of the lower legs. Unlike traditional dress or athletic stockings and socks, compression stockings use stronger elastics to create significant pressure on the legs and feet. Compression stockings are tightest at the ankles and become less constrictive toward the knees and thighs. By compressing the surface veins and muscles, they force circulating blood through narrower channels.
As a result, the arterial pressure is increased, which causes more blood to return to the heart and less blood to pool in the feet. There are two types of compression stockings and anti-embolism. Treatment is prescribed by a physician to relieve all manifestations of chronic venous disease and prevent venous troubles. Compression stockings are recommended under the following conditions: Edema is a condition where the opposing forces that occur in the small blood vessels and capillaries cause a net ultrafiltration of plasma water into the soft tissues. Chronic peripheral venous insufficiency is when the veins cannot pump deoxygenated blood back to the heart. Varicose veins are saccular and distended veins which can expand and may cause painful venous inflammation. Once developed, they will not disappear on their own; the formation of varicose veins is an externally visible sign of venous weakness. Deep vein thrombosis occurs when blood flow decreases, causing blood to pool in the legs and leading to blood clot formation.
Evidence does not suggest a benefit in post thrombotic syndrome rates following DVT. Compression stockings are beneficial in reducing symptomless deep vein thrombosis among airline passengers flying for 7 hours or more. Pharmacological and mechanical measures are used to prevent venous thromboembolism in clinical practice. For cases in which the bleeding risk is high and pharmacologic measures are contraindicated, the use of mechanical prophylaxis is recommended. Graduated compression stockings can prevent VTE in hospitalized patients by applying different pressure to the leg; the meta-analysis of general surgical patients revealed that graduated compression stockings decreased their risk of developing VTE by 68% compared to placebo. Nineteen randomized controlled trials analyzed the effectiveness of graduated compression stockings alone or with other additional prophylaxis in prevention of deep vein thrombosis; these trials included 1681 patients after general surgery, orthopedic surgery, medical patients.
They concluded that graduated compression stockings are effective in deep vein thrombosis prophylaxis in post-surgical patients. Combining graduated compression stockings with other mechanical and pharmacological measures can increase the effectiveness of VTE prophylaxis by 60%. However, another study performed in France involved 407 ICU patients and showed no difference in the effectiveness of the VTE prevention for patients who used compression stockings alone or in combination with intermittent pneumatic devices. Lymphedema occurs when a body part swells due to an abnormal accumulation of lymph fluid, occurring when there is interference with the normal drainage of lymph fluid back into the blood swelling the arm, neck or abdomen. Phlebitis is the term used when inflammation and clotting occurs in a vein, most a leg vein, due to infection, inflammation, or trauma. People with varicose veins are more affected. Inflammation occurs causing the thrombus to adhere to the vein wall and risking clogging a superficial vein.
Lipodermatosclerosis is the term used to refer to the inflammation of subcutaneous fat, a form of panniculitis. Hormones released during pregnancy and the expanding uterus can affect leg veins; the use of elastic compression stockings can reduce volumetric variations during standing hours. The use of stockings for the entire day is more effective than just half the day or not using compression stockings at all. Many physicians and vein specialists recommend wearing compression stockings after varicose vein stripping, but studies show that wearing an elastic compression stocking has no additional benefit after the application of elastic bandaging for three days in post-operative care following the stripping of the great saphenous vein as assessed by control of limb, pain and return to work. Caution should be used in those with advanced peripheral obstructive arterial disease, heart failure, septic phlebitis, oozing dermatitis and advanced peripheral neuropathy in regard to wearing compression stockings.
In the clinical setting the applying of the antiembolism stockings is performed by physicians and other trained personnel. First the proper size stocking is determined by measuring the legs. Aseptic technique is not necessary; the person is placed in the supine position in bed for fifteen minutes prior
The spinal cord is a long, tubular structure made up of nervous tissue, that extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column. It encloses the central canal of the spinal cord; the brain and spinal cord together make up the central nervous system. In humans, the spinal cord begins at the occipital bone where it passes through the foramen magnum, meets and enters the spinal canal at the beginning of the cervical vertebrae; the spinal cord extends down to between the second lumbar vertebrae where it ends. The enclosing bony vertebral column protects the shorter spinal cord, it is around 45 cm in men and around 43 cm long in women. The spinal cord has a varying width, ranging from 13 mm thick in the cervical and lumbar regions to 6.4 mm thick in the thoracic area. The spinal cord functions in the transmission of nerve signals from the motor cortex to the body, from the afferent fibers of the sensory neurons to the sensory cortex, it is a center for coordinating many reflexes and contains reflex arcs that can independently control reflexes.
It is the location of groups of spinal interneurons that make up the neural circuits known as central pattern generators. These circuits are responsible for controlling motor instructions for rhythmic movements such as walking; the spinal cord is the main pathway for information connecting the brain and peripheral nervous system. Much shorter than its protecting spinal column, the human spinal cord originates in the brainstem, passes through the foramen magnum, continues through to the conus medullaris near the second lumbar vertebra before terminating in a fibrous extension known as the filum terminale, it is about 45 cm long in men and around 43 cm in women, ovoid-shaped, is enlarged in the cervical and lumbar regions. The cervical enlargement, stretching from the C5 to T1 vertebrae, is where sensory input comes from and motor output goes to the arms and trunk; the lumbar enlargement, located between L1 and S3, handles sensory input and motor output coming from and going to the legs. The spinal cord is continuous with the caudal portion of the medulla, running from the base of the skull to the body of the first lumbar vertebra.
It does not run the full length of the vertebral column in adults. It is made of 31 segments from which branch one pair of sensory nerve roots and one pair of motor nerve roots; the nerve roots merge into bilaterally symmetrical pairs of spinal nerves. The peripheral nervous system is made up of these spinal roots and ganglia; the dorsal roots are afferent fascicles, receiving sensory information from the skin and visceral organs to be relayed to the brain. The roots terminate in dorsal root ganglia, which are composed of the cell bodies of the corresponding neurons. Ventral roots consist of efferent fibers that arise from motor neurons whose cell bodies are found in the ventral gray horns of the spinal cord; the spinal cord are protected by three layers of tissue or membranes called meninges, that surround the canal. The dura mater is the outermost layer, it forms a tough protective coating. Between the dura mater and the surrounding bone of the vertebrae is a space called the epidural space; the epidural space is filled with adipose tissue, it contains a network of blood vessels.
The arachnoid mater, the middle protective layer, is named for its spiderweb-like appearance. The space between the arachnoid and the underlying pia mater is called the subarachnoid space; the subarachnoid space contains cerebrospinal fluid, which can be sampled with a lumbar puncture, or "spinal tap" procedure. The delicate pia mater, the innermost protective layer, is associated with the surface of the spinal cord; the cord is stabilized within the dura mater by the connecting denticulate ligaments, which extend from the enveloping pia mater laterally between the dorsal and ventral roots. The dural sac ends at the vertebral level of the second sacral vertebra. In cross-section, the peripheral region of the cord contains neuronal white matter tracts containing sensory and motor axons. Internal to this peripheral region is the grey matter, which contains the nerve cell bodies arranged in the three grey columns that give the region its butterfly-shape; this central region surrounds the central canal, an extension of the fourth ventricle and contains cerebrospinal fluid.
The spinal cord is elliptical in cross section, being compressed dorsolaterally. Two prominent grooves, or sulci, run along its length; the posterior median sulcus is the groove in the dorsal side, the anterior median fissure is the groove in the ventral side. The human spinal cord is divided into segments. Six to eight motor nerve rootlets branch out of right and left ventro lateral sulci in a orderly manner. Nerve rootlets combine to form nerve roots. Sensory nerve rootlets form off right and left dorsal lateral sulci and form sensory nerve roots; the ventral and dorsal roots combine to form one on each side of the spinal cord. Spinal nerves, with the exception of C1 and C2, form inside the intervertebral foramen; these rootlets form the demarcation between the peripheral nervous systems. The grey column, in the center of the cord, is shaped like a butterfly and consists of cell bodies of interneurons, motor neurons, neuroglia cells and unmyelinated axons; the anterior and posterior grey column present as projections of the grey matter and are known as the horns of the spinal cord.
Together, the gr
Pathology is the study of the causes and effects of disease or injury. The word pathology refers to the study of disease in general, incorporating a wide range of bioscience research fields and medical practices. However, when used in the context of modern medical treatment, the term is used in a more narrow fashion to refer to processes and tests which fall within the contemporary medical field of "general pathology," an area which includes a number of distinct but inter-related medical specialties that diagnose disease through analysis of tissue and body fluid samples. Idiomatically, "a pathology" may refer to the predicted or actual progression of particular diseases, the affix path is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist; as a field of general inquiry and research, pathology addresses four components of disease: cause, mechanisms of development, structural alterations of cells, the consequences of changes.
In common medical practice, general pathology is concerned with analyzing known clinical abnormalities that are markers or precursors for both infectious and non-infectious disease and is conducted by experts in one of two major specialties, anatomical pathology and clinical pathology. Further divisions in specialty exist on the basis of the involved sample types and physiological systems, as well as on the basis of the focus of the examination. Pathology is a significant field in medical research; the study of pathology, including the detailed examination of the body, including dissection and inquiry into specific maladies, dates back to antiquity. Rudimentary understanding of many conditions was present in most early societies and is attested to in the records of the earliest historical societies, including those of the Middle East and China. By the Hellenic period of ancient Greece, a concerted causal study of disease was underway, with many notable early physicians having developed methods of diagnosis and prognosis for a number of diseases.
The medical practices of the Romans and those of the Byzantines continued from these Greek roots, but, as with many areas of scientific inquiry, growth in understanding of medicine stagnated some after the Classical Era, but continued to develop throughout numerous cultures. Notably, many advances were made in the medieval era of Islam, during which numerous texts of complex pathologies were developed based on the Greek tradition. So, growth in complex understanding of disease languished until knowledge and experimentation again began to proliferate in the Renaissance and Baroque eras, following the resurgence of the empirical method at new centers of scholarship. By the 17th century, the study of microscopy was underway and examination of tissues had led British Royal Society member Robert Hooke to coin the word "cell", setting the stage for germ theory. Modern pathology began to develop as a distinct field of inquiry during the 19th Century through natural philosophers and physicians that studied disease and the informal study of what they termed “pathological anatomy” or “morbid anatomy”.
However, pathology as a formal area of specialty was not developed until the late 19th and early 20th centuries, with the advent of detailed study of microbiology. In the 19th century, physicians had begun to understand that disease-causing pathogens, or "germs" existed and were capable of reproduction and multiplication, replacing earlier beliefs in humors or spiritual agents, that had dominated for much of the previous 1,500 years in European medicine. With the new understanding of causative agents, physicians began to compare the characteristics of one germ’s symptoms as they developed within an affected individual to another germ’s characteristics and symptoms; this realization led to the foundational understanding that diseases are able to replicate themselves, that they can have many profound and varied effects on the human host. To determine causes of diseases, medical experts used the most common and accepted assumptions or symptoms of their times, a general principal of approach that persists into modern medicine.
Modern medicine was advanced by further developments of the microscope to analyze tissues, to which Rudolf Virchow gave a significant contribution, leading to a slew of research developments. By the late 1920s to early 1930s pathology was deemed a medical specialty. Combined with developments in the understanding of general physiology, by the beginning of the 20th century, the study of pathology had begun to split into a number of rarefied fields and resulting in the development of large number of modern specialties within pathology and related disciplines of diagnostic medicine; the term pathology comes from the Ancient Greek roots of pathos, meaning "experience" or "suffering" and -logia, "study of". The modern practice of pathology is divided into a number of subdisciplines within the discrete but interconnected aims of biological research and medical practice. Biomedical research into disease incorporates the
Autonomic nervous system
The autonomic nervous system the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, thus influences the function of internal organs. The autonomic nervous system is a control system that acts unconsciously and regulates bodily functions such as the heart rate, respiratory rate, pupillary response and sexual arousal; this system is the primary mechanism in control of the fight-or-flight response. Within the brain, the autonomic nervous system is regulated by the hypothalamus. Autonomic functions include control of respiration, cardiac regulation, vasomotor activity, certain reflex actions such as coughing, sneezing and vomiting; those are subdivided into other areas and are linked to ANS subsystems and nervous systems external to the brain. The hypothalamus, just above the brain stem, acts as an integrator for autonomic functions, receiving ANS regulatory input from the limbic system to do so; the autonomic nervous system has three branches: the sympathetic nervous system, the parasympathetic nervous system and the enteric nervous system.
Some textbooks do not include the enteric nervous system as part of this system. The sympathetic nervous system is considered the "fight or flight" system, while the parasympathetic nervous system is considered the "rest and digest" or "feed and breed" system. In many cases, both of these systems have "opposite" actions where one system activates a physiological response and the other inhibits it. An older simplification of the sympathetic and parasympathetic nervous systems as "excitatory" and "inhibitory" was overturned due to the many exceptions found. A more modern characterization is that the sympathetic nervous system is a "quick response mobilizing system" and the parasympathetic is a "more activated dampening system", but this has exceptions, such as in sexual arousal and orgasm, wherein both play a role. There are excitatory synapses between neurons. A third subsystem of neurons that have been named non-noradrenergic, non-cholinergic transmitters have been described and found to be integral in autonomic function, in particular in the gut and the lungs.
Although the ANS is known as the visceral nervous system, the ANS is only connected with the motor side. Most autonomous functions are involuntary but they can work in conjunction with the somatic nervous system which provides voluntary control; the autonomic nervous system is divided into the sympathetic nervous system and parasympathetic nervous system. The sympathetic division emerges from the spinal cord in the thoracic and lumbar areas, terminating around L2-3; the parasympathetic division has craniosacral “outflow”, meaning that the neurons begin at the cranial nerves and sacral spinal cord. The autonomic nervous system is unique in; the preganglionic, or first, neuron will begin at the “outflow” and will synapse at the postganglionic, or second, neuron's cell body. The postganglionic neuron will synapse at the target organ; the sympathetic nervous system consists of cells with bodies in the lateral grey column from T1 to L2/3. These cell bodies are "GVE" are the preganglionic neurons. There are several locations upon which preganglionic neurons can synapse for their postganglionic neurons: Paravertebral ganglia of the sympathetic chain cervical ganglia thoracic ganglia and rostral lumbar ganglia caudal lumbar ganglia and sacral gangliaPrevertebral ganglia Chromaffin cells of the adrenal medulla These ganglia provide the postganglionic neurons from which innervation of target organs follows.
Examples of splanchnic nerves are: Cervical cardiac nerves & thoracic visceral nerves, which synapse in the sympathetic chain Thoracic splanchnic nerves, which synapse in the prevertebral ganglia Lumbar splanchnic nerves, which synapse in the prevertebral ganglia Sacral splanchnic nerves, which synapse in the inferior hypogastric plexusThese all contain afferent nerves as well, known as GVA neurons. The parasympathetic nervous system consists of cells with bodies in one of two locations: the brainstem or the sacral spinal cord; these are the preganglionic neurons, which synapse with postganglionic neurons in these locations: Parasympathetic ganglia of the head: Ciliary, Submandibular and Otic In or near the wall of an organ innervated by the Vagus or Sacral nerves These ganglia provide the postganglionic neurons from which innervations of target organs follows. Examples are: The postganglionic parasympathetic splanchnic nerves The vagus nerve, which passes through the thorax and abdominal regions innervating, among other organs, the heart, lungs and stomach The sensory arm is composed of primary visceral sensory neurons found in the peripheral nervous system, in cranial sensory ganglia: the geniculate and nodose ganglia, appen