Anatomy, biology, physiology and basic pathology of the nail organ

The nail is the largest skin appendage. It grows continuously through life in a non-cyclical manner; its growth is not hormone-dependent. The nail of the middle finger of the dominant hand grows fastest with approximately 0.1 mm/day, whereas the big toe nail grows only 0.03-0.05 mm/d. The nails' size and shape vary characteristically from finger to finger and from toe to toe, for which the size and shape of the bone of the terminal phalanx is responsible. The nail apparatus consists of both epithelial and connective tissue components. The matrix epithelium is responsible for the production of the nail plate whereas the nail bed epithelium mediates firm attachment. The hyponychium is a specialized structure sealing the subungual space and allowing the nail plate to physiologically detach from the nail bed. The proximal nail fold covers most of the matrix. Its free end forms the cuticle which seals the nail pocket or cul-de-sac. The dermis of the matrix and nail bed is specialized with a morphogenetic potency. The proximal and lateral nail folds form a frame on three sides giving the nail stability and allowing it to grow out. The nail protects the distal phalanx, is an extremely versatile tool for defense and dexterity and increases the sensitivity of the tip of the finger. Nail apparatus, finger tip, tendons and ligaments of the distal interphalangeal joint form a functional unit and cannot be seen independently. The nail organ has only a certain number of reaction patterns that differ in many respects from hairy and palmoplantar skin.

Acute mental stress and hemostasis: When physiology becomes vascular harm

Stress-induced activation of the sympathoadrenal medullary system activates both the coagulation and fibrinolysis system resulting in net hypercoagulability. The evolutionary interpretation of this physiology is that stress-hypercoagulability protects a healthy organism from excess bleeding should injury occur in fight-or-flight situations. In turn, acute mental stress, negative emotions and psychological trauma also are triggering factors of atherothrombotic events and possibly of venous thromboembolism. Individuals with pre-existent atherosclerosis and impaired endothelial anticoagulant function are the most vulnerable to experience onset of acute coronary events within two hours of intense emotions. A range of sociodemographic and psychosocial factors (e.g., chronic stress and negative affect) might critically intensify and prolong stress-induced hypercoagulability. In contrast, several pharmacological compounds, dietary flavanoids, and positive affect mitigate the acute prothrombotic stress response. Studies are needed to investigate whether attenuation of stress-hypercoagulability through medications and biobehavioral interventions reduce the risk of thrombotic incidents in at-risk populations.

The great fluid debate: saline or so-called "balanced" salt solutions?

BACKGROUND Intravenous fluids are commonly prescribed in childhood. 0.9 % saline is the most-used fluid in pediatrics as resuscitation or maintenance solution. Experimental studies and observations in adults suggest that 0.9 % saline is a poor candidate for fluid resuscitation. Although anesthesiologists, intensive care specialists, perioperative physicians and nephrologists have been the most active in this debate, this issue deserves some physiopathological considerations also among pediatricians. RESULTS As compared with so-called "balanced" salt crystalloids such as lactated Ringer, administration of large volumes of 0.9 % saline has been associated with following deleterious effects: tendency to hyperchloremic metabolic acidosis (called dilution acidosis); acute kidney injury with reduced urine output and salt retention; damaged vascular permeability and stiffness, increase in proinflammatory mediators; detrimental effect on coagulation with tendency to blood loss; detrimental gastrointestinal perfusion and function; possible uneasiness at the bedside resulting in unnecessary administration of more fluids. Nevertheless, there is no firm evidence that these adverse effects are clinically relevant. CONCLUSIONS Intravenous fluid therapy is a medicine like insulin, chemotherapy or antibiotics. Prescribing fluids should fit the child's history and condition, consider the right dose at the right rate as well as the electrolyte levels and other laboratory variables. It is unlikely that a single type of fluid will be suitable for all pediatric patients. "Balanced" salt crystalloids, although more expensive, should be preferred for volume resuscitation, maintenance and perioperatively. Lactated Ringer appears unsuitable for patients at risk for brain edema and for those with overt or latent chloride-deficiency. Finally, in pediatrics there is a need for new fluids to be developed on the basis of a better understanding of the physiology and to be tested in well-designed trials.

Radioisotopes in medicine and human physiology : a selected list of references /

This bibliography contains 2862 references on uses of radioisotopes in diagnostic medicine, therapeutic medicine, clinical research, human physiology, general medical research and immunology. The references were taken from the 1948-1956 open literature. A list of the journals from which the references were selected and an author index are included.

Adolescence, its social psychology; with an introduction to recent findings from the fields of anthropology, physiology, medicine, psychometrics and sociometry.

"An Evergreen book."

First lessons in botany and vegetable physiology : illustrated by over 360 wood engravings from original drawings by Isaac Sprague : to which is added a copious glossary, or dictionary of botanical terms /

Mode of access: Internet.

A manual of physiology, a textbook for students of medicine / by Gerald F. Yeo.

Mode of access: Internet.

The American vegetable practice, or, A new and improved guide to health. : Designed for the use of families. : In six parts. Part I. Concise view of the human body, with engraved and wood-cut illustrations. Part II. Glance at the old school practice of physic. Part III. Vegetable materia medica, with colored illustrations. Part IV. Compounds. Part V. Practice of medicine, based upon what are deemed correct physiological and pathological principles. Part VI. Guide for women, containing a simplified treatise on childbirth, with a description of the diseases peculiar to females and infants. /

Errata and advertisement for "New England Depot. D.L. Hale" at end of v. 2.

Lexicon pharmaceuticum, or a Pharmaceutical dictionary : comprehending the pharmacopoeias of London, Edinburgh, and Dublin, with a variety of other useful information relative to medicine and pharmacy, designed expressly for the use of students /

Mode of access: Internet.

A general natural history or, new and accurate descriptions of the animals, vegetables, and minerals, of the different parts of the world : with their virtues and uses ... in medicine and mechanics : ... including the history of the materia medica, pictoria, and tinctoria, of the present and earlier ages : as also observations ... with a great number of figures, elegantly engraved /

Mode of access: Internet.