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\"This newly revised fourth edition of The Concise Book of Muscles is a comprehensive guide to the major muscle groups. Fully illustrated with more than 500 drawings, and easy to use, this compact reference provides a complete profile for each muscle, clearly showing its origin, insertion, nerve supply, and action, the movements that use it, and, where appropriate, exercises that stretch and strengthen it. The book's distinctive quick-reference format shows students exactly how to locate and identify specific muscles, highlighting those that are heavily used and therefore subject to injury in a variety of sports and activities. Each muscle chapter now includes an overview of the gross anatomy of the body area to show bony landmarks, cross-sections of muscle layers, and points of attachment as well as a quick reference table and an overview of the nerve pathways that are most relevant. The book also includes a new chapter on the pelvic floor muscles--of particular interest to those studying or practicing yoga and Pilates--as well as a 20\"x35\" detachable muscle wall chart. \"--Amazon.com.

Background Optimal analgesia following laparoscopic colorectal resection is yet to be determined; however, recent studies have questioned the role of postoperative epidural anaesthesia, suggesting other analgesic modalities may be preferable. The aim of this randomised controlled trial was to assess the effect of transversus abdominis plane (TAP) blocks on opioid requirements in patients undergoing laparoscopic colorectal resection. Methods After appropriate trial registration ( www.clinicaltrials.gov NCT 00830089) and local medical ethics review board approval (REC 09/H0407/10), all adult patients who were to undergo laparoscopic colorectal surgery at a single centre were randomised into the intervention group receiving bilateral TAP blocks or the control group (no TAP block). The blocks were administered prior to surgery after the induction of a standardised anaesthetic by an anaesthetist otherwise uninvolved with the case. The patient, theatre anaesthetist, surgeon, and ward staff were blinded to treatment allocation. All patients received postoperative analgesia of paracetamol and morphine as a patient-controlled analgesia (PCA). Cumulative opioid consumption and pain scores were recorded at 2, 4, 6, and 24 h postoperatively and compared between the groups as were clinical outcomes and length of stay. Results The intervention (TAP block) group ( n  = 33) and the control group ( n  = 35) were comparable with respect to characteristics, specimen pathology, and type of procedure. The TAP block group’s median cumulative morphine usage (40 mg [IQR = 25–63]) was significantly less than that of the control group (60 mg [IQR = 39–81]). Pain scores and median length of stay (LOS) were similar between the two groups. Conclusion Preoperative TAP blocks in patients undergoing laparoscopic colorectal resection reduced opioid use in the first postoperative day in this study.

The act of defaecation, although a ubiquitous human experience, requires the coordinated actions of the anorectum and colon, pelvic floor musculature, and the enteric, peripheral and central nervous systems. Defaecation is best appreciated through the description of four phases, which are, temporally and physiologically, reasonably discrete. However, given the complexity of this process, it is unsurprising that disorders of defaecation are both common and problematic; almost everyone will experience constipation at some time in their life and many will develop faecal incontinence. A detailed understanding of the normal physiology of defaecation and continence is critical to inform management of disorders of defaecation. During the past decade, there have been major advances in the investigative tools used to assess colonic and anorectal function. This Review details the current understanding of defaecation and continence. This includes an overview of the relevant anatomy and physiology, a description of the four phases of defaecation, and factors influencing defaecation (demographics, stool frequency/consistency, psychobehavioural factors, posture, circadian rhythm, dietary intake and medications). A summary of the known pathophysiology of defaecation disorders including constipation, faecal incontinence and irritable bowel syndrome is also included, as well as considerations for further research in this field. Defaecation is a coordinated process that requires a morphologically intact gastrointestinal tract and the integration of multiple physiological systems (neuromuscular, hormonal and cognitive). This Review describes the physiology of human defaecation and continence, providing insights into the pathophysiology of defaecation and evacuation disorders. Key points Defaecation is a fundamental physiological process resulting in the evacuation of faeces; it is dependent on the coordination of neural, muscular, hormonal and cognitive systems. Several factors influence defaecation, including gastrointestinal transit, stool volume and/or consistency, and dietary intake. Defaecation can be described in terms of four reasonably discrete temporal phases: basal phase, pre-expulsive phase, expulsive phase and end phase. The latest imaging and technological advances (such as high-resolution colonic and anorectal manometry, cine-MRI and magnetic resonance defaecography and wireless capsules) have improved our knowledge of defaecatory mechanisms. Knowledge of the physiology of normal defaecation could inform management of common disorders of defaecation such as constipation and faecal incontinence; however, future research needs are highlighted in this article.

Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patients with moderate hypertension. We investigated whether an alternative technology using endovascular ultrasound renal denervation reduces ambulatory blood pressure in patients with hypertension in the absence of antihypertensive medications. RADIANCE-HTN SOLO was a multicentre, international, single-blind, randomised, sham-controlled trial done at 21 centres in the USA and 18 in Europe. Patients with combined systolic–diastolic hypertension aged 18–75 years were eligible if they had ambulatory blood pressure greater than or equal to 135/85 mm Hg and less than 170/105 mm Hg after a 4-week discontinuation of up to two antihypertensive medications and had suitable renal artery anatomy. Patients were randomised (1:1) to undergo renal denervation with the Paradise system (ReCor Medical, Palo Alto, CA, USA) or a sham procedure consisting of renal angiography only. The randomisation sequence was computer generated and stratified by centres with randomised blocks of four or six and permutation of treatments within each block. Patients and outcome assessors were blinded to randomisation. The primary effectiveness endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Patients were to remain off antihypertensive medications throughout the 2 months of follow-up unless specified blood pressure criteria were exceeded. Major adverse events included all-cause mortality, renal failure, an embolic event with end-organ damage, renal artery or other major vascular complications requiring intervention, or admission to hospital for hypertensive crisis within 30 days and new renal artery stenosis within 6 months. This study is registered with ClinicalTrials.gov, number NCT02649426. Between March 28, 2016, and Dec 28, 2017, 803 patients were screened for eligibility and 146 were randomised to undergo renal denervation (n=74) or a sham procedure (n=72). The reduction in daytime ambulatory systolic blood pressure was greater with renal denervation (−8·5 mm Hg, SD 9·3) than with the sham procedure (−2·2 mm Hg, SD 10·0; baseline-adjusted difference between groups: −6·3 mm Hg, 95% CI −9·4 to −3·1, p=0·0001). No major adverse events were reported in either group. Compared with a sham procedure, endovascular ultrasound renal denervation reduced ambulatory blood pressure at 2 months in patients with combined systolic–diastolic hypertension in the absence of medications. ReCor Medical.

The skin is our largest sensory organ, transmitting pain, temperature, itch, and touch information to the central nervous system. Touch sensations are conveyed by distinct combinations of mechanosensory end organs and the low-threshold mechanoreceptors (LTMRs) that innervate them. Here we explore the various structures underlying the diverse functions of cutaneous LTMR end organs. Beyond anchoring of LTMRs to the surrounding dermis and epidermis, recent evidence suggests that the non-neuronal components of end organs play an active role in signaling to LTMRs and may physically gate force-sensitive channels in these receptors. Combined with LTMR intrinsic properties, the balance of these factors comprises the response properties of mechanosensory neurons and, thus, the neural encoding of touch.

BackgroundDespite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose.MethodsWe dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained.ResultsThe nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose.ConclusionThe pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.

Adipose tissues communicate with the central nervous system to maintain whole-body energy homeostasis. The mainstream view is that circulating hormones secreted by the fat convey the metabolic state to the brain, which integrates peripheral information and regulates adipocyte function through noradrenergic sympathetic output 1 . Moreover, somatosensory neurons of the dorsal root ganglia innervate adipose tissue 2 . However, the lack of genetic tools to selectively target these neurons has limited understanding of their physiological importance. Here we developed viral, genetic and imaging strategies to manipulate sensory nerves in an organ-specific manner in mice. This enabled us to visualize the entire axonal projection of dorsal root ganglia from the soma to subcutaneous adipocytes, establishing the anatomical underpinnings of adipose sensory innervation. Functionally, selective sensory ablation in adipose tissue enhanced the lipogenic and thermogenetic transcriptional programs, resulting in an enlarged fat pad, enrichment of beige adipocytes and elevated body temperature under thermoneutral conditions. The sensory-ablation-induced phenotypes required intact sympathetic function. We postulate that beige-fat-innervating sensory neurons modulate adipocyte function by acting as a brake on the sympathetic system. These results reveal an important role of the innervation by dorsal root ganglia of adipose tissues, and could enable future studies to examine the role of sensory innervation of disparate interoceptive systems. Beige-fat-innervating sensory neurons modulate adipocyte function by acting as a brake on the sympathetic system.

This tutorial focuses on the sense of touch within the context of a fully active human observer. It is intended for graduate students and researchers outside the discipline who seek an introduction to the rapidly evolving field of human haptics. The tutorial begins with a review of peripheral sensory receptors in skin, muscles, tendons, and joints. We then describe an extensive body of research on “what” and “where” channels, the former dealing with haptic perception of objects, surfaces, and their properties, and the latter with perception of spatial layout on the skin and in external space relative to the perceiver. We conclude with a brief discussion of other significant issues in the field, including vision-touch interactions, affective touch, neural plasticity, and applications.

Engineering replacement organs is the next frontier in therapeutic technologies. Yet, the integration of innervation—critical for organ development, function, and homeostasis—remains underexplored. This review highlights the role of neural inputs in regulating critical organs including pancreas, liver, salivary gland, and spleen. We examine organ-specific neuroanatomy and emerging strategies to incorporate neuronal-axonal networks in engineered organs, drawing from innovations in scaffold design, multi-cell culture techniques, neural engineering, and biofabrication. Finally, we discuss tools for evaluating innervation across in vitro, preclinical, and clinical settings, advocating for innervation as a core design element in next-generation artificial organs. As tissue engineering has developed it has become apparent that multiple inputs are needed to fully replicate tissues, neuronal-axonal networks are an important part of this. In this review, the authors explore the advances in biomanufacturing and multi cell techniques aiming to generate tissues with integrated neuronal networks.

The autonomic nervous system orchestrates the functions of the brain and body through the sympathetic and parasympathetic pathways 1 . However, our understanding of the autonomic system, especially the sympathetic system, at the cellular and molecular levels is severely limited. Here we show topological representations of individual visceral organs in the major abdominal sympathetic ganglion complex. Using multi-modal transcriptomic analyses, we identified molecularly distinct sympathetic populations in the coeliac–superior mesenteric ganglia (CG–SMG). Of note, individual CG–SMG populations exhibit selective and mutually exclusive axonal projections to visceral organs, targeting either the gastrointestinal tract or secretory areas including the pancreas and bile tract. This combinatorial innervation pattern suggests functional segregation between different CG–SMG populations. Indeed, our neural perturbation experiments demonstrated that one class of neurons regulates gastrointestinal transit, and another class of neurons controls digestion and glucagon secretion independent of gut motility. These results reveal the molecularly diverse sympathetic system and suggest modular regulation of visceral organ functions by sympathetic populations. Multi-modal transcriptomic analyses of the sympathetic nervous system reveal organ-specific neural innervation and modular regulation of visceral functions.