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  • Q1:What is timbre what is jungle what is wood what is forest differentiate between forest and swampSee Answer
  • Q2:Instructions :- Experiment: Lipid Extraction using Soxhlet apparatus. Only write the “discussion” part of the given experiment. Discussion (25%): Interpretation of results and relevant comments should be explicitly placed under this heading. Consideration should be given to potential sources of errors in data and parameters influencing the results, how specific parameters impacted the outcome, and an evaluation of the reliability, accuracy, and consistency of the results with existing literature. Provide examples and draw comparisons with analogous experiments. References (5%): The reference list is a required compilation of all the literature sources, including books, journals, proceedings, and web pages, utilized in preparing the report. Word limit: min 500 excluding references Instructions: Plagiarism free Solutions generated from any AI platform is strictly Prohibited Referencing and formatting Style APA Need Typed Solutions only./n111 LIPID EXTRACTION Zuhal Bitiş - Hilal Oğan - Esma Caner - Kaan Karakuş - Yiğit Adaoğlu - Buket Yazıcı TABLE OF CONTENTS 01 02 INTRODUCTION 03 MATERIALS METHODS AIM 04 RESULTS 05 REFERENCES INTRODUCTION Separation Lipid extraction from wet biomass Soxhlet CH. Bligh and Dyer Organic Solvent evaporation phase HD Folch phase et al. Hara and Radin Green solvents Lipids are essential biomolecules that perform multiple functions in cells, such as structural components of cell membranes, energy storage molecules and signaling molecules. Lipid extraction is a common technique in biochemistry involving the separation of lipids from biological samples. Lipid extraction is usually performed with solvents such as ethanol, methanol, chloroform and hexane. Lipids hexane Chemical Formula: C6H 14 Molecular Weight: 86.18 ? Why Hexane ❑ One of the most well-known methods for the isolation of lipids is solvent extraction, which involves combining polar and non-polar solvents. ❑ For large-scale lipid extractions, hexane is the most often used non-polar, volatile solvent because of its many technical and financial benefits, most notably its low cost and great lipid (non-polar) selectivity. The volatility is also closely associated with the boiling point of the substance. Materials with a low boiling point evaporate more easily, making them more volatile. Because of this, we chose hexane with a boiling point of 68,7 ℃ instead of ethanol has a boiling point of about 78 ° C. ❑ It mainly extracts neutral lipids such as Monoacyl glycerols, Diacyl glycerols, Triacyl glycerols, free fatty acids, cholesterol, and cholesterol-derivatives. Cholesterol derivatives 1. Rose et. al. Journal of Agriculture and Food Research, 101072, 2024 2. Mat Husin et. al. Preparative biochemistry & biotechnology, 54(2), 159-174, 2024 ? Why Hexane Hexane's main Applications in the Extraction of Food Products and Ingredients. ❑ Hexane is a petrochemical solvent widely used in the crushing industry for the extraction of vegetable oils but also for the production of flavors and fragrances, natural extracts, drugs, and nutraceuticals Quantity Raw material Extraction sectors Products Applications Feed Bulk meals Defatted Feed ingredients Feed millers Premix Food meals Oilseeds: 650 kT soybean, rapeseed, Crushing industry: Plant-based proteins sunflower, corn germ, etc. vegetable oil extraction Meat Alternatives Infant nutrition Edible oils Processed foods Colours Biofuels Biodiesel Technical Paints and inks Refined oils Crude oils Methyl esters Specialty oilseeds: Specialty oils sesame, wheat germ, primrose, rice bran, perilla, etc. Specialty oils extraction Oils ingredients and derivatives uses 450 kT Beauty Perfumery Cosmetics Medicinal plants, algae, flowers, micro-organisms, etc. Natural extracts production Natural extracts Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9655691/ AIM OF THIS EXPERIMENT To extract and quantify lipid from chips. By drying the sample, extracting it and then measuring the amount of oil obtained, the lipid content of potato chips will be determined. This method can be used in product quality control and nutritional composition analysis in the food industry. O NS 29/32 "500ml BORO 34 BORU CAM MATERIALS · 20 gr Chips · 250 ml of hexane · Cellulose thimble · Soxhlet apparatus · Extraction chamber · Graduated cylinder · Heater XIX · Mortar · Rotary evaporator · Bottom flask · Boiling chips · Oven · Balance · Gloves Soxhlet Apparatus The setup includes a part that extraction chamber, the thimble, siphon mechanism. When the heating mantle warms the solvent in the round-bottom flask, it turns into vapor. This vapor rises and turns back into liquid in the condenser, dripping onto the sample to dissolve the target compound. As more liquid collects, it fills the Soxhlet well, causing the siphon to send it back to the flask with the dissolved compound. This repeating process extracts efficiently without needing constant watching. Cold water out > Condenser Cold water in Soxhlet Vapor > Siphon tube Round bottom flask Hard ceramic surface - Metal can- To power controller Heating element- inside cạn 10% o ROTARY EVAPORATOR Condenser Motor Vacuum pump Vacuum tube Receiving C Water bath flask - Stand- Rotary evaporators function by utilizing the principle that solvents have different boiling points, which decrease under reduced pressure. This method facilitates faster and more efficient solvent removal compared to atmospheric pressure evaporation, enhancing time efficiency and productivity in labs. METHODS 1. Weigh 20 grams of chips sample. Grind it. 2. Place the sample and the bottom flask into over. Dry the sample for 30 minutes. Weigh the sample. 3. Calculate the moisture gradient. 4. Add 2 boiling chips to the bottom flask and weight it. Note it 5. Weigh 10 grams of chips from the dried sample. 1 0 O Condenser 1. Add 250 ml of hexane to the bottom flask. 2. Place the 10 grams of sample to the cellulose thimble. 3. Set the soxhlet apparatus. Place the sample inside the extraction chamber. Plug the heater. 4. After 3 cycles, unplug the heater. 5. Use the rotary evaporator to remove hexane from the fat extraction on the bottom flask. Extraction chamber Thimble Siphon arm Vapor Extraction solvent Boiling flask 6. Weigh the bottom flask with the extracted fat. CALCULATING THE MOISTURE GRADIENT Wet Weight - Dry Weight Wet Weight Green STHEC FILM STHEC FILA Greek . sartorius 25290 it sartorius RELLENELAMINE After Drying 250 78 g Tare M-power BE CAREFUL THAT THE WATTLE BALANCE ISIN THE HEADLE DO NOT MOVE THE BALANCE FROM THE PLACE IN ORDER NOT VI TO BECOME UNS MILE BE CAREFUL THAT THE WATER /ALANCE BIN THE MADLE M-power -0.212 grams DO NOT MOVE THE BALANCE FROM THE PLACE IN ORDER NOT AT TO BECOME LINS TAGLI % MOIST: 0.0084 Fat Determination Fat% = [(wt of ext. flask + extracted fat) - (wt of ext. flask)] × 100 wt of sample Green ES FILM Green HEC FILA ALII VE SATIM NULLANE JMRE - sartorius BORY CAM 500ml 10.000 g Tare Taw F M-power -sartorius BA LARAILS, THAT THE WATLÝ JALANCE 15 LA THEE. NQUER DO NOT MOVE THE BALANCE FROM THE PLACE IN ORDER NOT LI TO BECOME UNSTABLE 196.758 M-power sartorius WE CAREFUL WANT THE WATLE AALANES 18 HTYA. HEARLA. DO NOT MOVE THE BALANCE FROM THE PLACE IN CADER NOT YT YO WECOME UNSALE 202.3 11 Mi-power BE CAREFUL THAT THE WATER AMUNNEL IS IS THE ANDRE DO NOT MOVE THE BALANCE FROM THE PLACE IN ORDER NOTAT TO BECOME UNS ME 202.311-196.758/10 *100 = 55.53% 5.55 grams of fat was obtained from 10 grams sample O O C REFERENCES 1. Rose, A., Showman, C., Shen, C., Jaczynski, J., & Matak, K. (2024). Effect of organic solvent on the extraction of lipids from krill powders using a one-step extraction process. Journal of Agriculture and Food Research, 101072. 2. Mat Husin, M. A., Mohd Yasin, N. H., Takriff, M. S., & Jamar, N. H. (2024). A review on pretreatment methods for lipid extraction from microalgae biomass. Preparative biochemistry & biotechnology, 54(2), 159-174. O O C REFERENCES 3. Ultrasonics, H. (2024, March 21). Soxhlet Extraction - What is it? How does it work? Hielscher Ultrasonics. https://www.hielscher.com/soxhlet-extraction-setup-and-function.htm 4.Wikipedia contributors. (2024, May 5). Soxhlet extractor. Wikipedia. https://en.wikipedia.org/wiki/Soxhlet extractor 5.Elgie, K. (2023, April 6). What is a Rotary Evaporator? Asynt. https://www.asynt.com/blog/what-is-a-rotary-evaporator/ 0 THANK YOU FOR LISTENING OSee Answer
  • Q3:The Human Endocrine & Nervous Systems Assignment Questions Complete all of questions to demonstrate your knowledge and understanding of the nervous and endocrine systems. All answers must be fully in your own words and direct quotation from your sources is not permitted. You are encouraged to use labelled diagrams, either hand drawn or fully cited from secondary sources, where appropriate. You must include a references and bibliography for the full assignment with the final question. Question 1 (AC1.1) The nervous system is responsible for three main things; sensory input, information processing, and motor output, and has two main parts: . The central nervous system which is made up of the brain and spinal cord. · The peripheral nervous system which is made up of nerves that branch off from the spinal cord and extend to all parts of the body. a) Identify the key parts of the brain using a diagram to help you. You then need to describe the function of each of those parts. b) Use a diagram to help you identify the different parts of the peripheral nervous system. You then need to describe the functions of the spinal cord and peripheral nervous system. Your answer to this question must not exceed 300 words. Question 2 (AC1.2) There are two main responses to stimuli: conscious actions and reflex actions. a) Use a diagram to identify the component parts of the reflex arc. b) Explain how each part of the reflex arc works together to produce a reflex action. Use an example of a reflex action to fully explain your ideas. Your answer to this question must not exceed 300 words. Question 3 (AC1.3) The peripheral nervous system is a complex network of neurons with gaps between called synapses. Information is passed along the axons of the neurons as electrical impulses. a) Explain the how a nerve impulse propagates along the axon of a neuron. b) Explain how the electrical impulse can be transmitted across the synaptic gap. Your answer to this question must not exceed 400 words. Question 4 (AC2.1 & 2.2) The nervous system sends electrical impulses that travel very rapidly and tends to result in short term effects, such as a muscle contraction. The endocrine system is responsible for much slower signals that tend to have a much longer lasting effect on the body. a) Discuss how the endocrine system sends signals around the body, where the signals originate from, where they are targeted and explain why these signals take much longer than nerve impulses. The major glands, hormones and target tissues can be included in a table which needs to be accompanied by a brief discussion of how the endocrine system works. b) Explain how the activity of these endocrine glands are regulated. Your answer to this question must not exceed 400 words. Question 5 (AC3.1) The endocrine and nervous systems work together to help us maintain our bodies in a constant state. We can only thrive if our core body temperature and blood glucose concentration are stable within a relatively narrow range. We sometimes need to react quickly to arising situations to mitigate harm to ourselves. a) Discuss the negative feedback loop that allows us to maintain a stable core body temperature around 36.5ºC. You may use a diagram to help you if you wish. b) Discuss the negative feedback loop that allows us to maintain a mean blood glucose concentration of around 5.5 mmol/L (100 mg/dL). You may use a diagram to help you if you wish. c) Discuss the purpose of the 'fight or flight' response and how our nervous system and endocrine system work together to affect this response. Your answer to this question must not exceed 600 words.See Answer
  • Q4:Part I: General questions on 3D structure modeling. Go to http://predictioncenter.org/ What is CASP? When did CASP 14 finish? Go to (https://predictioncenter.org/casp13/index.cgi) and click on CASP13 in numbers (https://www.predictioncenter.org/casp13/numbers.cgi) How many targets were released in each category? How many groups participated? Go to http://www.cathdb.info/ What is CATH? Go to the search bar and enter “2YPI.” What enzyme is this? To what superfamily does it belong? Click on the superfamily. How many unique PDBs are in this superfamily? Go to http://scop.mrc-lmb.cam.ac.uk/scop/ What is SCOP and how is it different from CATH? Search SCOP for pdb 2YPI. What is the Fold for this protein? How many different superfamilies does this fold contain? Part III: AlphaFold2 For our exercises, we have been looking at CASP13. Now we will take a look at CASP14 to learn about a particularly important new result. (https://predictioncenter.org/casp14/zscores_final.cgi). A new method called AlphaFold2 shattered the competition by predicting the most accurate protein tertiary structures ever reported. Use the various links on https://predictioncenter.org/casp14/index.cgi to answer the following questions: Who came in second? What was their average z-score? How did this compare to Alpha Fold? Use https://predictioncenter.org/casp14/results.cgi?view=tb-sel to compare the runner-up to AlphaFold2. Select AlphaFold2 and the runner-up on the left, all targets on the right, and click show results. Click the little arrows in the RMSD column to sort by RMSD (smallest to largest). What is the smallest RMSD achieved by AlphaFold2 and what was the smallest RMSD for the runner-up? How many of the first entries sorted by RMSD belong to AlphaFold2? AlphaFold2 used a new artificial intelligence algorithm recently developed for learning human language. It is the first application of this type of AI to a bioinformatics problem that has demonstrated this extraordinary level of success. In terms of our ability to predict the structure of proteins, AlphaFold2 is indeed a breakthrough. Use the following papers as starting points to learn more about AlphaFold2 and answer the questions that follow. https://www.nature.com/articles/d41586-021-02265-4 https://www.nature.com/articles/s41586-021-03819-2 https://www.nature.com/articles/s41592-021-01365-3 AlphaFold2 invents a neural network block they call an evoformer. What type of neural network is the evoformer based on? What are some of the well-known applications for this network? What types of information are used to train AlphaFold2? AlphaFold2 has an average GDT_TS score of 92. Why is this so impressive? What are some of the key limitations of AlphaFold2? Some have said that AlphaFold2 represents such a tremendous breakthrough that “the protein folding problem is solved”. Is this true? Why or why not? How does WSME-Linker improve on AlphaFold2? Instructions: Need to answer all the questions above Word requirement – minimum 500 Plagiarism free Solutions generated from any AI platform is strictly Prohibited Solution to be formatted in APA and use appropriate references with in-text citationsSee Answer
  • Q5:Part I: Learning about Data Mining 1. What is "knowledge discovery?” 2. What is "directed knowledge discovery?" 3. Please give an example of directed knowledge discovery. 4. What is "undirected knowledge discovery?" 5. Please give an example of undirected knowledge discovery. 6. Go to http://www.inderscience.com/jhome.php?jcode=ijdmb What is the objective of IJDMB? Please list three topics covered in this journal. 7. Go to Application of Data Mining in Bioinformatics What are the two high-level tasks of data mining? What is the goal of unsupervised learning? Please list three applications of data mining in bioinformatics Why is data mining ideally suited to bioinformatics? Please list three problems that hamper data mining in bioinformatics 8. Go to http://www.kdnuggets.com/solutions/bioinformatics.html Pick 3 links listed on the "bioinformatics solutions" page and tell me what they do. 9. Go to Golden.com List of bioinformatics companies Pick 3 companies listed at this site and tell us what they do. 10. Go to http://www.ebiotics.com/ What does ebiotics do (in general, one sentence answer)? Click on “Services.” What do they create for bioinformatics? What are three things they can do for Algorithm Modelling? 11. Go to Salary and Career Info for Bioinformatics Specialists According to PayScale.com what are the median wages for biotechnology research scientists with bioinformatics knowledge (be sure to read the paragraph)? What are the education requirements for jobs in bioinformatics? What is the career outlook for bioinformaticists? Instructions: Need to answer all the questions above Word requirement – minimum 500 Plagiarism free Solutions generated from any AI platform is strictly Prohibited Solution to be formatted in APA and use appropriate references with in-text citationsSee Answer
  • Q6:Instructions: Word requirement – 450-500 words Plagiarism free Solutions generated from any AI platform is strictly Prohibited Solution to be formatted in APA and use appropriate references with in-text citationsSee Answer
  • Q7:Support or refute the statement below. Again, this part is open book, open notes. No A.I., though. cite your sources from our book. It is now 2024. There is really no need for anybody to study about the medical importance of plants. Plants can’t really do anything to hurt or help you, medically speaking. They are just pretty to look at. In reality, all ailments can be easily treated with synthetic drugs prescribed by a physician. Instructions: Word requirement – 450-500 words Plagiarism free Solutions generated from any AI platform is strictly Prohibited Solution to be formatted in APA and use appropriate references with in-text citations/nSee Answer
  • Q8:Question Write a short essay (300 words each). Please discuss the CRISPR/Cas systems, their roles in nature, and the ways that they can be used to improve human health Please discuss the roles of DNA-binding proteins in genetic regulation Instructions: Answer all the questions following the instructions. Strictly do not use AI for solving questions. The solution should be free of Plagiarism. Solution to be formatted in APA and use appropriate references with in-text citations in APA.See Answer
  • Q9:Question Write a short essay (300 words each). Please discuss the various types of programmed cell death and how this is accomplished. Please discuss the role of p53 in sensing and repairing DNA damage. Instructions: Answer all the questions following the instructions. Strictly do not use AI for solving questions. The solution should be free of Plagiarism. Solution to be formatted in APA and use appropriate references with in-text citations in APA.See Answer
  • Q10:Question Write a short essay (no more than 350 words) about each. Please compare and contrast transcription in prokaryotes and eukaryotes Please compare and contrast translation in prokaryotes and eukaryotes. Remember that compare and contrast means: tell me what they have in common, and what their key differences are. Instructions: Answer all the questions following the instructions. Strictly do not use AI for solving questions. The solution should be free of Plagiarism. Solution to be formatted in APA and use appropriate references with in-text citations in APA.See Answer
  • Q11:Assignment Need typed answers, use only the lecture notes attached, don’t use outside sources. Questions:- Non effervescent vs effervescent tablets 2. What is a GSL 3. Schedule 2 medicine what can be dispensed by whom, on what prescription, what records you have to do for each type of prescription for CD 4. Look-alike and sound-alike 5. Which CDs are not required for storage 6. Vet Controlled drug validity period 7. What are the POM requirements on Rx 8. Schedule 2 what doesn’t need to go on the POM register 9. Oxycodon 10mg m/r take every 12 hours. What isn’t legally valid about this 10. Abbreviations for CD4 pt2 11. How long are invoices used for and what is validity of a sch4 12. When a Schedule 2 or 3 is at a lower strength or dose so it can be classified differently 13. Requirements on Label for POM and Emergency Supply 14. What forms of Morphine are 12 release 15. Responsible pharmacist requirements 16. Implied vs explicit consent 17. P medicines good practice vs law 18. When can a pharmacist prescribe for someone that they have a close relation to 19. Midwives what can they give? 20. Medical devices vs Medicinal products and the UKCA vs CE. Who oversees it? 21. What can a private prescriber NOT prescribe 22. Name 3 criteria’s on how to take responsibility for a prescription 23. What is PGD and what schedule from 2 and 3 are allowed(and what CANT) 24. DMS STAGES AND actions needed with patient medicines 25. Respiratory part of DMS criteria 26. NMS 27. Two stages of Hypertension Finding Case service and inclusion criteria/ how does it help prevent and something about inclusion with a focus on CVD. Interactions of medication 29. MDA LEGAL ISSUES 30. HOME OFFICE wording scenarios 31. What can you amend and not amend 32. Wants to go on vacation can you give him extra? 33. Has COVID and can’t come is, what is he suppose to do? prescribing standards - pip what can they prescribe and the 5 standards under taking responsibility pgd - what can be prescribed on a PGD/ what’s the legal definition of PGD p medicine - how can they be legally sold/ is it a legal or professional requirement for them to be sold behind the counter/ why are they placed like this dms / nms stages what happens in all of them methadone prescription question - what’s wrong with it .See Answer
  • Q12: TVO ILC Student name: Date: SBI3U Assessment #1 for Feedback and Grade Assessment #1 for Feedback and Grade Level/Mark Percentage of term work /10% Instructions: • • Answer the questions for this assessment on a separate piece of paper. Make sure to note the task and question number you are answering for each. (e.g. Task 1, Question #1, etc. Review the rubric for this assessment located on the last pages before answering the questions for an understanding of how the assessment will be graded. • All terms must be included in mindmap. Copyright © 2021 The Ontario Educational Communications Authority. All rights reserved. TVO ILC SBI3U Assessment #1 for Feedback and Grade Task 1: Short answer - 10 Questions 1. In many viral diseases (such as smallpox, mumps, or influenza), illness occurs shortly after exposure to the virus. In others (such as AIDS), the victim may not show symptoms for many years following the initial exposure. How would you explain the difference between these two situations? 2. Various bacteria are normally present in most of our body systems. These “good” bacteria are essential for maintaining health. Describe two risks and two benefits of using antibacterial creams to cure vaginal infections. 3. State and describe two differences between bacteria and viruses. 4. a) State one reason why viruses are considered to be non-living organisms by some biologists. b) State one reason why viruses are considered to be living organisms by some biologists. 5. a) Which major level of classification contains the most closely related species? b) Which major level of classification contains the largest grouping of species? 6. List and describe three ecological roles of fungi OR three ecological roles of protists. 7. State and describe three characteristics of a body plan. 8. List and describe three reasons for habitat loss caused by humans. 9. Why do endothermic animals have far greater energy requirements than ectotherms? 10. Using the shark anatomy pictures and the key provided, classify the 10 sharks labelled 1- 10 in the following diagram: Copyright © 2021 The Ontario Educational Communications Authority. All rights reserved. TVO ILC Shark species 4 6 2 5 7 SBI3U Assessment #1 for Feedback and Grade 3 8 9 10 Shark Anatomy Use these terms related to shark anatomy to help you work through the key below. Key First dorsal fin Anal fin Pelvic fin Pectoral fin Dorsal surface Copyright © 2021 The Ontario Educational Communications Authority. All rights reserved. -Caudal fin TVO ILC SBI3U Assessment #1 for Feedback and Grade 1a. Body, as seen from the top, shaped like a kite...... 1b. Body, as seen from the top, not shaped like a kite.. 2a. Pelvic fin absent......... 2b. Pelvic fin present.. 3a. Six gill slits...... 3b. Five gill slits.. 4a. One dorsal fin.……………………. 4b. Two dorsal fins..... ..go to 12 ..go to 2 ..Pristiophoridae ..go to 3 ..Hexanchidae .go to 4 .Scyliorhinidae 5a. Mouth located at front of snout... .go to 5 Rhincodontidae go to 6 5b. Mouth located on underside of head.... 6a. Head expanded, with eyes located at end of expansion………………………….. ..Sphrynidea 6b. Head not expanded....... 7a. Top half of caudal fin same as bottom half.. 7b. Top half of caudal fin different than bottom half 8a. First dorsal fin extremely short... 8b. First dorsal fin regular length……………….. 9a. Caudal fin extremely long.. 9b. Caudal fin regular length...... 10a. A long point on end of snout… 10b. Snout without long point... 11a. Anal fin absent...... 11b. Anal fin present.... 12a. Small dorsal fin present near tip of tail.. 12b. No dorsal fin near tip of tail….. 13a. Front of animal with two horn-like appendages...... 13b. No horn-like appendages...... .go to 7 ....Isuridae .go to 8 .Pseuodotriakidae .go to 9 ..Alopiidae ..go to 10 ..Scapanorhynchidae go to 11 .Squalidae .Carcharhinidae .Rajidae .go to 13 .Mobulidae .Dasyatidae Copyright © 2021 The Ontario Educational Communications Authority. All rights reserved. TVO ILC SBI3U Assessment #1 for Feedback and Grade Task 2: Mind Map Recall an earlier activity where you created a mind map of the kingdom Animalia. It may have looked something like this one: Kingdom Animalia Invertebrates Simple Invertebrates phylum phylum Porifera Cnidaria (no backbone) Worm-like Invertebrates phylum Nematoda phylum phylum Complex Joint-legged Invertebrates phylum Invertebrates phylum Mollusca Echinodermata Platyhelminthes Annelida phylum Porifera Vertebrates (backbone) phylum Chordata class Arachnida class Crustacea class Insecta class Diplopoda class Chilopoda class Agnatha class Osteichthyes class Amphibia class Reptilia class Aves class Mammalia Now, it is time to put together all the information you learned about the different kingdoms into one concept map. All terms must be included. You may create this concept map however you like. You may use pen and paper or you may choose to use a computer program/digital tool. Another option would be to use index cards to write the terms on them and then organize them on a flat surface and take a picture to submit when complete. This could be done with "sticky notes" on a wall too. There are lots of terms and you must consider how they will be organized together. Notice how, in the example above, the categories or 'groupings' that were not official scientific classifications (for example, simple invertebrates, worm-like invertebrates, complex invertebrates, joint-legged invertebrates, invertebrates, and vertebrates) do not have kingdom, phylum, or class in front of them. They are just classifications that scientists use to help them understand the living world. In your concept map, make sure you can tell which classifications are official phyla and which ones are just groupings scientists make to help their understanding. The reason this is done is because there are so many phyla in each kingdom. In your concept map, aim to incorporate and make connections between all the terms as provided in the table below. Include characteristics and common features in your concept map. Organizing all of this will be difficult, but stick with it. It will help to get the big picture of all the material and terms you have learned throughout this unit. Copyright © 2021 The Ontario Educational Communications Authority. All rights reserved.See Answer
  • Q13: Research The biophysics of the ion channel recordings of stomata under salt stress theory and experimental application. Content about: Stomata ion channel recordings. salt concentration stress the importance of this topic for plants to grow in arid climates. what ion channels are effective in biophysicals according to them? biophysical theory and measurement. experimental technique (experimentation) the model from the Wang paper and from the Hedrich paper as they both involve ion channel recordings. 13 pages at least, references pictures and others do not account. 1.5 line space Times new Roman 12 points. an outline should be in a separate file with references. Supplementary Materials: Comprising Materials and Methods, figures, and tables; should be in a separate file. One Sentence Summary: no more than 110 characters. introductory paragraph, a thesis statement. Abstract: no more 115 words, and organized in this structure: An opening sentence that sets the question that you address and is comprehensible to the general reader, background content specific to this study, results, and a concluding sentence. It should be a single paragraph. References: Followed by a numbered list only a single reference list should be provided for the main text and supplemental information. please add the pictures from the articles I have attachedSee Answer
  • Q14: Semester 2, Skill 3 Part A: The Eye 1. Testing your distance visual acuity with the Snellen Chart 1. Stand 6 meters away from the chart. (For this purpose, a Snellen chart is displayed on the wall and a line is marked on the floor with a tape at a distance of 6 meters from it.) 2. Close one eye and read the lines on the chart from the top until you can no longer read the letters clearly. 3. Read off the visual acuity number on the side of the chart. Record this as a fraction, the first number being the distance from the chart in meters or feet e.g. 6/9 or 20/30 4. Repeat for the other eye, then for both eyes open together Left eye Right eye Both eyes Fraction in feet Fraction in meters 2. Using The Ophthalmoscope The ophthalmoscope is a lighted instrument used to examine the interior of the eye, including the lens, retina and optic nerve. It consists of a concave mirror and a battery- powered light (contained within the handle). The operator looks through a single monocular eyepiece into the patient's eye. The ophthalmoscope is equipped with a rotating disc of lenses to permit the eye to be examined at different depths and magnifications. This may be enhanced by drugs that dilate the pupil and enlarge the opening into the structures within the eye. Brow rest Practitioner side of the ophthalmoscope Diopter dial Viewing window Dioptre power display On/off switch GEEKYMEDICS.COM 1. Familiarise yourself with the ophthalmoscope. Check that you know how to switch it on and that the light is working. Set the value to 0 to begin (stronger lenses will be needed to inspect other parts of the eye). Use the head model with diagnostic eye trainer to practice using the ophthalmoscope. 2. Gently place your free hand on the model's head. Use your right eye to examine their right eye, and your left eye to examine their left eye. Look towards the subject's face through the aperture of the ophthalmoscope, steadying it against the side of your nose. Move the instrument around until the spot of light falls on the eye. Move your head with the ophthalmoscope (as a single unit) sideways until you see a red glow (the red reflex) from the pupil of the eye. Gradually move towards the subject until the fundus is seen (you will need to be close to the subject). You can then try to see other features by moving the dial to change focus. 3. Make observations using the head model provided. Aim to identify key features of the normal eye, then change the view to observe some different disease conditions (by changing the number on the model's controls) and make observations of notable differences. 3. If you feel comfortable using the Ophthalmoscope, practice on a real human eye. Ask your partner to sit comfortably and stare at a distant object behind you, keeping their eye open. Stand or sit in front of your partner and try to examine their eye in the same way as you did on the model trainer. Make a note of any features you manage to see. Examination of the Fundus The fundus consists of the optic disc, retina, retina vessels, maculae lutea. You may need a weak diverging lens (-2D to -4D) to focus on the optic disc and macula. Examination of other parts of the eye You will need to use converging (+ve) lenses to focus on structures anterior to the fundus. e.g. vitreous humour +4D - +8D Lens +10D Iris +15D Aqueous humour +14D+18D fovea optic nerve Cornea +20D Human retina Part B: The Ear 1. Audiometry An Audiometer is an electrical instrument used for measuring a subjects hearing. Auditory responses are monitored at different frequencies over a range of amplitudes. You will be using a screening audiometer to measure threshold in decibels at different frequencies. To produce an audiogram: a) Connect the left (blue) and right (red) jack plugs to the headphones and the jack plug (black) of the persons response button into the corresponding coloured and labelled sockets (4, 5, & 6) on the back of the panel. b) Connect the power cable to the mains input (2) on the back of the panel and to the mains supply. Turn the switch ON at the socket. The green ON indicator should light up on the front panel. Press the Right/Yes button. c) Sit the subject with his/her back to the audiometer. The subject should be told to press the response button upon hearing the tone and release it when the tone is no longer heard. d) The headset should be fitted with the RED earpiece on the RIGHT ear e) Select the "LEFT" ear position first on the earphone selector. Select 1 kHz (1000Hz) on the frequency selector and select 30 dB on the attenuator level. f) Press the "PRESENT” button for 2 secs, the green "present" button will light up. If the tone is heard, the subject should respond by pressing the response button (if there is a hearing impairment, the tone will not be heard). The attenuator level should be increased in steps of 5 dB until the tone is heard. Always release the “PRESENT” button before changing frequency or attenuation g) Once the initial threshold has been established, the attenuator level should be decreased in 10 dB steps until the tone is no longer heard and then increased in 5dB steps for the hearing threshold level to be checked h) The threshold of hearing is the lowest level at which a subject can identify the tone when it is re-introduced. Thresholds should be measure in sequences of 500Hz, 250Hz, 1, 2, 4, 6 and 8 kHz) i) Plot the threshold dB on the audiogram chart provided, for left ear thresholds mark using a small cross and for right ear use a small circle j) Repeat for the other ear 2. Parts of the ear Observe the model of the ear and try to identify the structures in the diagram below. Then, look at your partner's ear and try to identify the same structures. Finally, use the model to examine the structure of the inner ear before proceeding to the next section. Make note of your observations for your skills report. Triangular fossa Crus of helix Tragus Helix Scaphoid fossa -Crura of antihelix Concha cava Antihelix Lobule Antitragus 3. Observations with Otoscope An otoscope is an instrument which is used to look into the ear canal. The ear speculum (a cone-shaped viewing piece of the otoscope) is slowly inserted into the ear canal while looking into the otoscope. A light beam extends beyond the viewing tip of the speculum. The otoscope is gently moved to different angles to view the canal walls and eardrum. The normal eardrum appears pinkish-grey in colour and is approximately circular in shape. The first of the three small bones that transmit sound vibrations to the hearing mechanism (the cochlea) lies against the far side of the drum and can be seen through it in the upper part, like the clock handles in approximately the 12 o'clock position. Otoscope Eardrum Michael Saunders FRCS You will be called in small groups to view your own eardrum with the otoscope attached to a camera/imager. 4. Observation with Ear Diagnostic Trainer Familiarise yourself with the otoscope using the model head trainer. To safely use the otoscope: a) Gently lift the pinna (lobe) of the subject's ear upwards and backwards b) Hold the otoscope between the thumb and forefinger (like a pencil) with the back of the hand resting gently but firmly against the subject's cheek. This prevents you from pushing the otoscope too far in and harming the ear. c) The otoscope should then move in unison with the subjects head if moved. The whole tympanic membrane cannot be seen one time so the examiner will need to adjust his/her line of vision and the position of the speculum to observe a view of the whole membrane d) Observe the healthy eardrum first, then change the number on the model head to make observations of some other conditions If you feel confident to do so, look at your partner's ear with the otoscope. You should both be seated to do this. USE A CLEAN SPECULUM FOR EACH EXAMINATION. 5. Observe the Models of the teeth. A model of the teeth and mouth has been provided. Examine the model and make observations for your written lab report.See Answer
  • Q15: GENE4003 SEM-1 2024 GENE4003: WORKSHEET TOPICS SET 3 AND 4 1. In Drosophila melanogaster, loss of Bicoid (bcd) results in an embryo with two tails. The bcd mutation is recessive and exhibits a maternal effect. In the cross shown below, what will be the genotypes AND phenotypes of the resulting embryos, and in what ratios? Explain your answer. bcd-/bcd (female) X bcd+/bcd (male) 2. The diagram below illustrates the normal expression of three different groups of genes (A, B, and C) within four different whorls of a developing flower. Normally, whorl 1 produces sepals, whorl 2 produces petals, whorl 3 produces stamens, and whorl 4 produces carpels. Furthermore, expression of class A genes inhibits class C genes, and expression of class C inhibits class A. B A C Whorl 1 (Sepals) 2 3 4 (Petals) (Stamens) (Carpels) What kind of mutation would produce sepals in whorls 1 and 4 and petals in whorls 2 and 3? Explain your answer. 3. "Cells of multicellular organisms become increasingly specialised as they head towards their ultimate cell fate." What kinds of experiments support this statement, and how do their results support it? 4. Describe the epigenetic changes that occur in cells during development and the role they play in differentiation of cell types within a multicellular organism. 5. Fill in the blanks in the following text about early Drosophila development with appropriate words or phrases. During oogenesis, (1)_ is synthesized in the (2)_ and transported to the pole of the egg. After fertilization, _(4)_ forms a concentration gradient that is highest at the (5) pole and lowest at the _(6)_ pole. This graded distribution of (4)_ acts as a providing (8)_ to the embryo. - In the early stages of development, (10) _ is (4)_ (4)_ activates target genes that direct the formation of the (9) axis. One of the activated target genes of _(4) _ is (10)_, which is expressed in a gradient that (11) the gradient of (4) In mutants that lack _(4)_ not sufficiently (12), and the embryo develops _(14)_ the expression of _(10), which in turn embryo. (13). This suggests that helps to specify the (15) of the 1 GENE4003 SEM-1 2024 6. You are a researcher trying to understand the epigenetic mechanisms of queen bee development. Which of the following experimental manipulations would probably not lead to the development of a queen bee? a) Feeding royal jelly to a female honeybee larva b) Feeding decitabine, a DNA methyltransferase inhibitor, to a female larva c) Injecting Dnmt3 siRNA into a female honeybee larva d) Activation of a DNA cytosine deaminase enzyme in a female larva e) Feeding royal jelly to an adult worker honeybee. 7. The composite image below shows three strains of Arabidopsis thaliana. In the diploid state, A. thaliana has two homologous sets of five chromosomes (2n = 10). a) Derive the chromosome equations for the diploid, tetraploid and octaploid strains, assuming autopolyploidy. b) Using the image, describe the relationship between ploidy, leaf size (A) and cell size (B) in this species. c) What conclusions can you draw about potential for improving crop yield by increasing ploidy levels? A C The first foliage leaf 1 mm C Diploid Tetraploid Octaploid B 0.1 mm 8. Explain how DNA methylation is passed on to daughter cells. 9. Explain how bisulfite sequencing helps researchers to detect methylated cytosines. 2 GENE4003 SEM-1 2024 10. The platypus is one of the few extant monotremes, a group of egg-laying mammals that is sister to placental mammals that bear live young. Humans and mice have two genes (Hoxa 7 and Hoxb7) with close homology to the homeobox gene Ultrabithorax in Drosophila melanogaster. A researcher interested in the function of Hox genes in the platypus is comparing two hypothetical gene phylogenies of Ubx homologues from humans, mice, platypus and Drosophila. These are shown below and labelled as Phylogeny A and Phylogeny B. Phylogeny A Hoxa7 (human) Phylogeny B Hoxa7 (human) Hoxa7 (mouse) Hoxa7 (mouse) Hoxb7 (human) Hoxa7 (platypus) Hoxb7 (mouse) Hoxb7 (human) Hoxa7 (platypus) Hoxb7 (mouse) Hoxb7 (platypus) Hoxb7 (platypus) Ubx (Drosophila) Ubx (Drosophila) a) In terms of the relative timing of putative gene duplication events during the evolution of mammals, describe how these two phylogenies differ. Your answer should identify the number of gene duplications and in what lineages they are predicted to have occurred, and should refer to orthologues and paralogues. b) Which phylogeny is most parsimonious, and why? 3See Answer
  • Q16:Directions: Write a well-developed academic essay (2½- 3 pgs., 500 words minimum) than analyzes and reports on the views of your classmates on the topic of genomics and genomic sequencing. The essay must include: ⚫ at least 5 paragraphs 。 with an introduction (with a thesis statement that indicates the content and organization of the essay) • 3 well-developed body paragraphs (the first body paragraph presents your background of genomic sequencing,; the second body paragraph addresses circumstances under which your classmates were most likely to agree on the use of genomic sequencing, and the third body paragraph addresses circumstances and issues that were the most divisive among your classmates on the subject of genomic sequencing) o a conclusion paragraph, in which you summarize your classmates' general outlook for the future of genomics and genomic sequencing. • at least one paraphrased source with an APA in-text citation from either reading 3 or 4 in Making Connections 4, Unit 2, that supports a point in your essay ⚫the APA reference citation under the title "List of References" at the end of the essay.See Answer
  • Q17:/n 30 dquid Chapter Objectives After reading this chapter, you will be able to: List the anatomic alterations of the lungs associated with nimyasthenia gravis. • Describe the etiology and epidemiology of myasthenia gravis. • Discuss the screening for and diagnosis of myasthenia Myasthenia Gravis gravis. • List the cardiopulmonary clinical manifestations associated with myasthenia gravis. • Describe the general management of myasthenia gravis. • Describe the clinical strategies and rationales of the SOAPS presented in the case study. • Define key terms and complete self-assessment questions on the Evolve website. Key Terms Acetylcholine (ACh) Acetylcholinesterase Inhibitors Anticholinesterase Inhibitors Binding ACHR Antibodies Test Chronic Immunotherapies CMAP Amplitude Decremental Response Diplopia Anatomic Alterations of the Lungs Associated With Myasthenia Gravis Myasthenia gravis is the most common chronic disorder of the neuromuscular junction. The disorder interferes with the chemical transmission of acetylcholine (ACh) between the axonal terminal and the receptor sites of voluntary muscles (Fig. 30.1). The hallmark clinical feature of myasthenia gravis is fluctuating skeletal muscle weakness, often with true muscle fatigue. The fatigue and weakness usually improve after rest. There are two clinical types of myasthenia gravis: ocular and generalized. In ocular myasthenia gravis, the muscle weakness is limited to the eyelids and extraocular muscles. In generalized myasthenia gravis, the muscle weakness involves a variable combination of (1) muscles of the mouth and throat responsible for speech and swallowing Neck extensor and flexor muscles are commonly affected, (called bulbar muscles), (2) limbs, and (3) respiratory muscles. producing "dropped head syndrome." The facial muscles are often involved, causing the patient to appear expressionless. Generalized myasthenia gravis may or may not involve Edrophonium (Tensilon) Test Electromyography Generalized Myasthenia Gravis Ice Pack Test Immunoglobulin G (IgG) Antibodies Inadvertent Right Mainstem Bronchial Intubation Intravenous Immune Globulin (IVIG) Muscle-Specific Receptor Tyrosine Kinase (MUSK) Myasthenic Crisis Mycophenolate Mofetil Neuromuscular Junction Ocular Myasthenia Gravis Ophthalmoparesis Ophthalmoplegia Plasmapheresis Ptosis Pyridostigmine (Mestinon) Rapid Immunotherapies Repetitive Nerve Stimulation (RNS) Seronegative Myasthenia Gravis Seropositive Myasthenia Gravis Single-Fiber Electromyography (SFEMG) Symptomatic Treatment Thymectomy Thymoma the ocular muscles. Because the disorder affects only the myoneural (motor) junction, sensory function is not lost. The abnormal weakness may be confined to an isolated group of muscles (e.g., the drooping of one or both eyelids), or it may manifest as a generalized weakness that in severe cases includes the diaphragm. When the diaphragm is involved, ventilatory failure can develop, producing myasthenic crisis. In these cases, mechanical ventilation is required. If the patient is not properly managed (e.g., via the Airway Clearance Therapy Protocol, Protocol 10.2; Ventilator Initiation and Management Protocol, Protocol 11.1; and Ventilator Weaning Protocol, Protocol 11.2), mucus accumulation with airway obstruction, alveolar consolidation, and atelectasis may develop. The major pathologic or structural changes of the lungs associated with a poorly managed myasthenic crisis are as follows: . Mucus accumulation Airway obstruction Alveolar consolidation Atelectasis . ● 445 AT ACh MNF OR AB MRS ME FIGURE 30.1 Myasthenia gravis, a disorder of the neuromuscular junction that interferes with the chemical transmission of acetylcholine. AB, antibody; ACh, acetylcholine; AT, axonal terminal; D, dendrite; MF, muscle fiber; MNF, myelinated nerve fiber; MRS, muscle receptor site; V, vesicle. Note that the antibodies have a physical structure similar to that of ACh, which permits them to connect to (and block ACh from) the muscle receptor sites. Inset: atelectasis, a common secondary anatomic alteration of the lungs. Etiology and Epidemiology The cause of myasthenia gravis appears to be related to ACh receptor (AChR) antibodies (immunoglobulin G [IgG] antibodies) that block the nerve impulse transmissions at the neuromuscular junction. Patients who have detectable antibodies to the AChR, or to muscle-specific receptor tyrosine kinase (MuSK), are said to have seropositive myasthenia gravis, whereas those lacking both ACHR and MuSK antibodies on standard assays are said to have seronegative myasthenia gravis. About 50% of patients with only ocular myasthenia gravis are seropositive. About 90% of cases of generalized myasthenia gravis are seropositive. It is believed that the IgG antibodies disrupt the chemical transmission of ACh at the neuromuscular junction by (1) blocking the ACh from the receptor sites of the muscular cell, (2) accelerating the breakdown of ACh, and (3) destroying the receptor sites (see Fig. 30.1). Receptor-binding antibodies are present in 85% to 90% of persons with myasthenia gravis. Although the specific events that activate the formation of the antibodies remain unclear, the thymus gland is often abnormal; it is generally presumed that the antibodies arise within the thymus or in related tissue. According to the Myasthenia Gravis Foundation of America, there are between 36,000 to 60,000 cases of myasthenia gravis in the United States (20 per 100,000 population). The disease usually has a peak age of onset in females of 15 to 35 years, compared with 40 to 70 years in males. The clinical manifestations associated with myasthenia gravis are often provoked by emotional upset, physical stress, exposure to extreme temperature changes, febrile illness, and pregnancy. Death caused by myasthenia gravis is possible, especially during the first few years after onset. Screening and Diagnosis Screening methods and tests used to diagnose myasthenia gravis include (1) clinical presentation and history, (2) bedside tests, (3) immunologic studies, (4) electrodiagnostic studies, and (5) evaluation of conditions associated with myasthenia gravis. inical Presentation and History The hallmark of myasthenia gravis is chronic muscle fatigue. The muscles become progressively weaker during periods of activity and improve after periods of rest. Signs and symptoms include facial muscle weakness; ptosis (drooping of one or both eyelids); diplopia (double vision); ophthalmoplegia (paralysis or weakness of one or more of the muscles the control eye movement); difficulty in breathing, speaking chewing, and swallowing; unstable gait; and weakness in arms, hands, fingers, legs, and neck brought on by repetitive motions. The muscles that control the eyes, eyelids, face, and throat are especially susceptible and are usually affected first The respiratory muscles of the diaphragm and chest wall can become weak and impair the patient's ventilation. Impairment in deep breathing and coughing predisposes the patient to retain bronchial secretions, atelectasis, and pneumonia. The signs and symptoms of myasthenia gravis during the early stages are often elusive. The onset can be subtle, intermittent or sudden and rapid. The patient may (1) demonstrate normal health for weeks or months at a time, (2) show signs of weakness only late in the day or evening, or (3) develop a sudden and transient generalized weakness that includes the diaphragm Because of this last characteristic, ventilatory failure is always a sinister possibility. In most cases, the first noticeable symptom is weakness of the eye muscles (droopy eyelids) and a change in the patient's facial expressions. As the disorder becomes more generalized, weakness develops in the arms and legs. The muscle weakness is usually more pronounced in the proximal parts of the extremities. The patient has difficulty in climbing stairs, lifting objects, maintaining balance, and walking. In severe cases, the weakness of the upper limbs may be such that the hand cannot be lifted to the mouth. Muscle atrophy or pain is rare Tendon reflexes almost always remain intact. Bedside Diagnostic Tests Ice Pack Test The ice pack test is a very simple, safe, and reliable procedure for diagnosing myasthenia gravis in patients who have ptosis (droopy eye). In addition, the ice pack test does not require special medications or expensive equipment and is free of adverse effects. The test consists of the application of an ice pack to the patient's symptomatic eye for 3 to 5 minutes (Fig 30.2). The test is considered positive for myasthenia gravis when there is improvement of the ptosis (an increase of at least 2 mm in the palpebral fissure from before the test to after). only when ptosis is present. Even though the symptoms A major disadvantage of the ice pack test is that it is u associated with diplopia (double vision) also may improve with the ice pack test, the reliability of the ice pack to patients with diplopia without ptosis is usually questionable because the patient's personal impression of the diplopia is s useful ang insiden baxis in fatigue. riods of mptoms one or oplegia es that de studies, asthenia eaking, Less in etitive e, and d first. ll can ment ent to early ttent, -rmal ness and agm. ys a tom e in ore scle arts irs, ses, nd re. re is -e of e S t A FIGURE 30.2 Ice pack test. (A) Myasthenia gravis in a patient who has ptosis (droopy left eye). (B) Same patient after 5-minute application of an ice pack. Note that the patient's left eye lid is no longer droopy. subjective. Therefore, caution should be exercised in patients with isolated diplopia without visible ptosis. The ice pack test may be especially useful in patients in whom the edrophonium that is contraindicated by either cardiac status or age. Edrophonium (Tensilon) Test The Immunologic Studies Serologic tests to detect the presence of circulating acetylcholine receptor antibodies (AChR-Abs) is the first step in the laboratory confirmation of myasthenia. There are three AChR-Ab assays: binding, blocking, and modulating. The binding ACHR antibodies test is highly specific for myasthenia gravis (80% to 90%). Most experts use the term AChR-Abs as synonymous with the binding antibodies. In some patients, assays for blocking and modulating antibodies also may be helpful. Blocking AChR-Abs are found in about 50% of patients with generalized myasthenia gravis. Assays for modulating AChR-Abs increase the diagnostic sensitivity by about 5% when combined with the binding studies. When AChR-Abs are negative, an assay for the antibodies to MuSK proteins should be performed. Electrodiagnostic Studies repetitive nerve stimulation (RNS) and single-fiber electromyography (SFEMG) tests are important diagnostic supplements to the immunologic studies. The RNS study is the most frequently used electrodiagnostic test for myasthenia gravis. The RNS study is performed by electrically stimulating the motor nerve of selected muscles 6 to 10 times at low rates (2 or 3 Hz). In the normal muscle, there is no change in the compound muscle action potential (CMAP) amplitude. In patients with myasthenia gravis, there may be a progressive decline in the CMAP amplitude within the first four to five stimuli-called a decremental response. The RNS is considered positive when the decrement is greater than 10%. The edrophonium (Tensilon) test is used in patients with unneedle electrode allows simultaneous recording of the action The SFEMG is the most sensitive diagnostic test for myasthenia gravis, although it is technically more difficult. A specialized ophthalmoparesis. Edrophonium, a short- or obvious ptosis acting drug, blocks cholinesterase from breaking down ACh after it has been released from the terminal axon. This action increases the myoneural concentration of ACh, which in turn offsets the influx of antibodies at the neuromuscular When muscular weakness is caused by myasthenia junction. gravis, a dramatic transitory improvement in muscle function (lasting about 10 minutes) is seen after the administration of edrophonium. A disadvantage of the edrophonium test is that it can be complicated by cholinergic side effects that include cardiac arrhythmias and cardiopulmonary arrest. Cardiac monitoring, or avoiding this test altogether, is suggested in the elderly or those with a history of arrhythmia or heart disease. Although the sensitivity of the Tensilon test for the diagnosis of myasthenia gravis is in the 80% to 90% range, it is associated with many false-negative and false-positive results. potential of two muscle fibers innervated by the same motor axon. The variability in time between the two action potentials is called jitter. In patients with myasthenia gravis, the jitter is increased. The SFEMG is positive in more than 95% of patients with generalized myasthenia gravis. The sensitivity of the SFEMG ranges between 85% and 95% in ocular myasthenia gravis. Evaluation of Conditions Associated With Myasthenia Gravis Thymic Tumors and Other Malignancies Thymic abnormalities are often seen in patients with myasthenia gravis. Computed tomography (CT) or magnetic resonance imaging (MRI) scans may be used to identify an abnormal thymus gland or the presence of a thymoma (a usually benign tumor of the thymus gland that may be associated with myasthenia gravis). A thymectomy has been shown to reduce symptoms of myasthenia gravis. In fact, a thymectomy may be recommended even when there is no tumor. The removal of the thymus seems to improve the condition in many patients. Differential Diagnosis Studies to rule out other disease in the differential diagnosis of myasthenia gravis are indicated in some patients. For example, in cases with ocular or bulbar symptoms, an MRI of the brain is indicated. CT scanning or ultrasound of the orbits is helpful in the differential diagnosis of ocular myasthenia and thyroid ophthalmopathy. A lumbar puncture may be helpful in ruling out lymphomatous or carcinomatous meningitis in some cases. Blood tests should include thyroid function tests. In patients who have symptoms associated with a rheumatologic disorder, assays for antinuclear antibodies and rheumatoid factor should be performed. Pulmonary Function Testing Pulmonary function testing may be performed to help evaluate the patient's ventilatory status and the possibility of ventilatory failure-that is, a myasthenic crisis. Serial testing is advised. Table 30.1 provides a widely accepted clinical classification system of myasthenia gravis, which was developed by the Myasthenia Gravis Foundation of America. CHAPTER 30 Myasthenia Gravis 447 TABLE 30.1 Clinical Classifications of Myasthenia Gravis Class I Class II Class lla Class llb Class III Class Illa Class Illb Class IV Class IVa 017 Class IVb ● Class V Any ocular muscle weakness; may have weakness of eye closure; all other muscle strength is normal Mild weakness affecting other ocular muscles; may also have ocular muscle weakness of any severity Predominantly affecting limb, axial muscles, or both; may also have lesser involvement of oropharyngeal muscles Predominantly affecting oropharyngeal, respiratory muscles, or both; may also have lesser or equal involvement of limb, axial muscles, or both Moderate weakness affecting other ocular muscles; may also have ocular muscle weakness of any severity Predominantly affecting limb, axial muscles, or both; may also have lesser involvement of oropharyngeal muscles Predominantly affecting oropharyngeal, respiratory muscles, or both; may also have lesser or equal involvement of limb, axial muscles, or both Severe weakness affecting other ocular muscles; may also have ocular muscle weakness of any severity Predominantly affecting limb, axial muscles, or both; may also have lesser involvement of oropharyngeal muscles ITO AN Predominantly affecting oropharyngeal, respiratory muscles, or both; may also have lesser or equal involvement of limb, axial muscles, or both; use of a feeding tube without intubation Defined by the need for intubation, with or without mechanical ventilation, except when used during routine postoperative management From Jaretzki A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology. 2000;55(1):16-23. H OVERVIEW of the Cardiopulmonary Clinical Manifestations Associated With Myasthenia Gravis The following clinical manifestations result from the pathologic mechanisms caused (or activated) by atelectasis (see Fig. 10.7), alveolar consolidation (see Fig. 10.8), and excessive bronchial secretions (see Fig. 10.11)-the major anatomic alterations of the lungs associated with myasthenia gravis, which may occur when the patient is not properly managed via the Airway Clearance Therapy Protocol, Protocol 10.2; Ventilator Initiation and Management Protocol, Protocol 11.1; and Ventilator Weaning Protocol, Protocol 11.2 (see Fig. 30.1).1 CLINICAL DATA OBTAINED AT THE PATIENT'S BEDSIDE The Physical Examination Respiratory Rate Varies with the degree of respiratory muscle paralysis Apnea (in severe cases) Cyanosis (in severe cases) Chest Assessment Findings • Diminished breath sounds • Crackles 'It should be noted that the clinical manifestations associated with myasthenia gravis may occur over hours or days, depending on how quickly the paralysis progresses. CLINICAL DATA OBTAINED FROM LABORATORY TESTS AND SPECIAL PROCEDURES Pulmonary Function Test Findings2 (Restrictive Lung Pathology) FORCED EXPIRATORY VOLUME AND FLOW RATE FINDINGS FEF25%-75% FVC FEVT FEV₁/FVC ratio ↓ Nor T Nor FEF 50% Nor↓ VT 5→ → Nor VC FEF 20 200-1200 LUNG VOLUME AND CAPACITY FINDINGS IRV ↓ Nort ERV ↓ PEFR Nort FRC ↓ RV 1 IC TLC ↓ 1 MAXIMUM INSPIRATORY PRESSURE (MIP) MVV Nord RV/TLC ratio N 2Progressive worsening of these values is key to anticipating the onset of ventilatory failure. Arterial Blood Gases MODERATE TO SEVERE MYASTHENIA GRAVIS Acute Ventilatory Failure With Hypoxemia3 (Acute Respiratory Acidosis) PaCO₂ HCO34 pH4 ↓ ↑ ↑ (but normal) S Qs/QT ↑ . PaO2 SaO₂ or SpO2 ↓ ↓ Oxygenation Indices5 DO₂6 VO₂ C(a-V)O2 O₂ER N N ↓ General Management of Myasthenia Gravis In the past, many patients with myasthenia gravis died within the first few years of diagnosis of the disease. Today, several therapeutic measures provide most patients with marked relief of symptoms and allow them to live a normal life. Close respiratory monitoring with frequent measurements of the patient's forced vital capacity (FVC), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), blood pressure, oxygen saturation, and, when indicated, arterial blood gases (ABGs) should be performed. Mechanical ventilation should be initiated when the clinical data demonstrate impending or acute ventilatory failure. Good clinical indicators of impending acute ventilatory SVO₂ Pon 25 of 92 ↑ see Fig. 5.3 and Table 5.5 and related discussion for the acute pH, PaCO2, and HCO changes associated with acute ventilatory failure. When tissue hypoxia is severe enough to produce lactic acid, the pH and HCO3 values will be lower than expected for a particular PaCO₂ level. Ola-v)0₂, Arterial-venous oxygen difference; DO2, total oxygen delivery; O₂ER, oxygen extraction ratio; Qs/QT, pulmonary shunt fraction; SVO₂, mixed venous oxygen saturation: VO₂, oxygen consumption. The DO₂ may be normal in patients who have compensated to the decreased oxygenation status with (1) an increased cardiac output, (2) an increased hemoglobin level, or (3) a combination of both. When the DO₂ is normal, the OER is usually normal. cm failure include the following: FVC less than 20 mL/kg of . MIP below -30 cm H₂O-In other words, the patient is unable to generate a maximum inspiratory pressure 30 H₂O would confirm severe muscle weakness and, importantly, that acute ventilatory failure is likely. MEP less than 40 cm H₂O PaCO₂ greater than 45 mm Hg pH less than 7.35. gravis are inhibitors.. The four basic therapy modalities used to treat myasthenia e (1) symptomatic treatment (acetylcholinesterase (2) immunotherapies (e.g., chronic glucocorticoids and other immunosuppressive drugs), (3) rapid immunotherapies (plasma exchange and intravenous immune globulins [IVIG]), and (4) thymectomy. cal Manifestations Associated RADIOLOGIC FINDINGS Chest Radiograph • Normal, or • Increased opacity (when atelectasis or consolidation are present) If the ventilatory failure associated with myasthenia gravis is properly managed (e.g., via the Airway Clearance Therapy Protocol, Protocol 10.2; Ventilator Initiation and Management Protocol, Protocol 11.1; and Ventilator Weaning Protocol, Protocol 11.2), the chest radiograph should appear normal. However, if the patient is not properly managed, mucus accumulation, alveolar consolidation, and atelectasis may develop-as part of the myasthenic crisis. In these cases, the chest radiograph may show an increased density of the lung segments affected. Other Gastric aspiration pneumonia is also a complication of patients with myasthenia gravis while being mechanically ventilated. Symptomatic Treatment: Acetylcholinesterase Inhibitors Acetylcholinesterase inhibitors are recommended as the first line of treatment for symptomatic myasthenia gravis. Pyridostigmine (Mestinon) is usually the first choice. Pyridostigmine inhibits the function of acetylcholinesterase. This action increases the concentration of ACh to compete with the circulating anti- ACh antibodies, which interfere with the ability of ACh to stimulate the muscle receptors. Although the anticholinesterase inhibitors are effective in mild cases of myasthenia gravis, they are not completely effective in severe cases. Chronic Immunotherapies Most patients with myasthenia gravis need some form of immunotherapy in addition to an acetylcholinesterase inhibitor (see previous section). It is recommended that immunotherapy be administered to patients who remain acetylcholinesterase significantly symptomatic while on an inhibitor or who become symptomatic after a temporary response to an acetylcholinesterase inhibitor. Common immunotherapy agents include glucocorticoids, azathioprine, mycophenolate mofetil, and cyclosporine. Immunotherapy agents are usually used for more severe cases. The patient's strength often improves strikingly with steroids. Patients receiving long-term steroid therapy, however, may develop serious complications such as diabetes, cataracts, steroid myopathy, gastrointestinal bleeding, infections, aseptic necrosis of the bone, osteoporosis, and psychoses. CHAPTER 30 Myasthenia Gravis 449See Answer
  • Q18:5). Map the one autapomorphic character onto the branch leading to the single species that has a derived character state. These types of characters provide no grouping information.See Answer

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    • How long will it take to get biology homework Answers?

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    Why do students need the help of an expert in biology?

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