Anatomy and physiology of the brain and spinal cord
The brain is a spongy organ made up of nerve and supportive tissues. It is
located in the head and is protected by a bony covering called the skull. The base, or lower part, of the brain is connected to the spinal cord. Together, the brain and spinal cord are known as the central nervous system (CNS). The spinal cord contains nerves that send information to and from the brain. The CNS works with the peripheral nervous system (PNS). The PNS is made up of nerves that branch out from the spinal cord to relay messages from the brain to different parts of the body. Together, the CNS and PNS allow a person to walk, talk, throw a ball and so on. Structure and function of the brain The brain is the bodys control centre. It constantly receives and interprets nerve signals from the body and responds based on this information. Different parts of the brain control movement, speech, emotions, consciousness and internal body functions, such as heart rate, breathing and body temperature. The brain has 3 main parts: cerebrum, cerebellum and brain stem.
Cerebrum The cerebrum is the largest part of the brain. It is divided into 2 parts (halves) called the left and right cerebral hemispheres. The 2 hemispheres are connected by a bridge of nerve fibres called the corpus callosum. The right half of the cerebrum (right hemisphere) controls the left side of the body. The left half of the cerebrum (left hemisphere) controls the right side of the body.
The outer surface of the cerebrum is called the cerebral cortex or grey matter. It is the area of the brain where nerve cells make connections, called synapses, that control brain activity. The inner area of the cerebrum contains the insulated (myelinated) bodies of the nerve cells (axons) that relay information between the brain and spinal cord. This inner area is called the white matter because the insulation around the axons gives it a whitish appearance.
The cerebrum is further divided into 4 sections called lobes. These include the frontal (front), parietal (top), temporal (side) and occipital (back) lobes.
Each lobe has different functions: The frontal lobe controls movement, speech, behaviour, memory, emotions and intellectual functioning, such as thought processes, reasoning, problem solving, decision making and planning. The parietal lobe controls sensations, such as touch, pressure, pain and temperature. It also controls spatial orientation (understanding of size, shape and direction). The temporal lobe controls hearing, memory and emotions. The left temporal lobe also controls speech.The occipital lobe controls vision.
Cerebellum The cerebellum is the next largest part of the brain. It is located under the cerebrum at the back of the brain. It is divided into 2 parts or hemispheres and has grey and white matter, much like the cerebrum. The cerebellum is responsible for: movement, posture, balance, reflexes, complex actions (walking, talking), collecting sensory information from the body
Brain stem The brain stem is a bundle of nerve tissue at the base of the brain. It connects the cerebrum to the spinal cord and sends messages between different parts of the body and the brain.The brain stem has 3 areas: midbrain, pons, medulla oblongata. The brain stem controls breathing, body temperature, blood pressure, heart rate, hunger and thirst. Cranial nerves emerge from the brainstem. These nerves control facial sensation, eye movement, hearing, swallowing, taste and speech. Other important parts of the brain Cerebrospinal fluid (CSF) The cerebrospinal fluid (CSF) is a clear, watery liquid that surrounds, cushions and protects the brain and spinal cord. The CSF also carries nutrients from the blood to, and removes waste products from, the brain. It circulates through chambers called ventricles and over the surface of the brain and spinal cord. The brain controls the level of CSF in the body. Meninges The brain and spinal cord are covered and protected by 3 thin layers of tissue (membranes) called the meninges: dura mater thickest outer layer, arachnoid layer middle, thin membrane, pia mater inner, thin membrane.
CSF flows in the space between the arachnoid layer and the pia mater. This space is called the subarachnoid space. The tentorium is a flap made of a fold in the meninges. It separates the cerebrum from the cerebellum. The supratentorial area of the brain is the area above the tentorium. It contains the cerebrum, the first and second (lateral) ventricles, the third ventricle, and glands and structures in the centre of the brain. The infratentorial area is located at the back of the brain below the tentorium. It contains the cerebellum and brain stem. This area is also called the posterior fossa. Corpus callosum. The corpus callosum is a bundle of nerve fibres between the 2 cerebral hemispheres. It connects and allows communication between both hemispheres. Thalamus. The thalamus is a structure in the middle of the brain that has 2 lobes or sections. It acts as a relay station for almost all information that comes and goes between the brain and the rest of the nervous system in the body. Hypothalamus. The hypothalamus is a small structure in the middle of the brain below the thalamus. It plays a part in controlling body temperature, hormone secretion, blood pressure, emotions, appetite, and sleep patterns. Pituitary gland. The pituitary gland is a small, pea-sized organ in the centre of the brain. It is attached to the hypothalamus and makes a number of different hormones that affect other glands of the bodys endocrine system. It receives messages from the hypothalamus and releases hormones that control the thyroid and adrenal gland, as well as growth and physical and sexual development. Ventricles. The ventricles are fluid-filled spaces (cavities) within the brain. There are 4 ventricles: The first and second ventricles are in the cerebral hemispheres. They are called lateral ventricles. The third ventricle is in the centre of the brain, surrounded by the thalamus and hypothalamus. The fourth ventricle is at the back of the brain between the brain stem and the cerebellum. The ventricles are connected to each other by a series of tubes. The fluid in the ventricles is cerebrospinal fluid (CSF). The CSF flows through the ventricles, around the brain in the space between the layers of the meninges (subarachnoid space) and down the spinal cord. Pineal gland. The pineal gland is a very small gland in the third ventricle of the brain. It produces the hormone melatonin, which influences sleeping and waking patterns and sexual development. Choroid plexus. The choroid plexus is a small organ in the ventricles that makes CSF. Cranial nerves. There are 12 pairs of cranial nerves that perform specific functions in the head and neck area. The first pair starts in the cerebrum, while the other 11 pairs start in the brain stem. Cranial nerves are indicated by number (Roman numeral) or name.
Cranial nerves and their functions Number Name Function I olfactory smell II optic vision and light detection by the pupil III oculomotor eye movement upward, downward or inward narrowing and widening of the pupil lifting of the eyelid IV trochlear eye movement downward and inward V trigeminal facial sensation chewing VI abducens outward eye movement VII facial facial expression closing of the eyelid taste in the front part of the tongue VIII acoustic hearing balance IX glossopharyngeal swallowing gag reflex speech X vagus swallowing gag reflex speech (vocal cords) control of muscles in internal organs XI accessory neck turning shoulder shrugging XII hypoglossal tongue movement
Blood-brain barrier. The blood-brain barrier is a specialized system of blood vessels and enzymes that protect the brain from chemicals or toxins produced by bacteria. It helps maintain a constant environment for the brain. The blood-brain barrier is made up of very small blood vessels (capillaries) that are lined with thin, flat endothelial cells. In other parts of the body, endothelial cells have small spaces between them that allow substances to move in and out of the capillary so they can reach other cells and tissues. In the brain, the endothelial cells are packed tightly together so substances cannot pass out of the bloodstream into the brain. The enzymes also restrict the types of substances that can be carried from the bloodstream into the brain. Some substances can pass through the blood-brain barrier, such as very small molecules and molecules that can be dissolved in fat (are lipid soluble).
Types of cells in the brain The brain is made up of neurons and glial cells. Neurons, these cells carry the signals that make the nervous system work. They cannot be replaced or repaired if they are damaged. Glial cells (neuroglial cells), these cells support, feed and protect the neurons. The different types of glial cells are: astrocytes, oligodendrocytes, ependymal cells, microglial cells
Structure and function of the spine The spine is made up of vertebrae, sacrum and coccyx bony sections that house and protect the spinal cord (commonly called the spine). The vertebral body is the biggest part of a vertebra. It is the front part of the vertebra, which means it faces into the body. Spinal cord is a column of nerves inside the protective vertebrae that runs from the brain to the bottom of the spine. Disc is a layer of cartilage between each vertebra that cushions and protects the vertebrae and spinal cord.
The spine is divided into 5 sections, the cervical the vertebrae from the base of the skull to the lowest part of the neck, thoracic the vertebrae from the shoulders to mid- back, lumbar the vertebrae from mid-back to the hips, sacrum the vertebrae at the base of the spine. The vertebrae in this section are fused and do not flex. Coccyx the tail bone at the end of the spine. The vertebrae in this section are fused and do not flex. Spinal nerves. The spine relays messages between the body and the brain. These nerve messages control body functions like movement, bladder and bowel control and breathing. Each vertebra has a pair of spinal nerves that receive messages from the body (sensory impulses) and send messages to the body (motor impulses). The spinal nerves are numbered from the cervical spine to the sacral spine.
Spinal nerves and their functions Number Part of spine Function C1 to C8 (8 pairs) cervical send messages to the back of the head, neck, shoulders, arms, hands and diaphragm T1 to T12 (12 pairs) thoracic send messages to the chest, some back muscles and parts of the abdomen L1 to L5 (5 pairs) lumbar send messages to the lower parts of the abdomen and the back, some of the legs and some parts of the external genital organs S1 to S5 (5 pairs) sacral send messages to the thighs, lower parts of the legs, feet, most of the external genital organs, the groin area, the bladder and the anal sphincter
ANATOMY AND PHYSIOLOGY OF THE LUNG The lungs are located in the chest and are part of the respiratory system. The lungs take up most of the space inside the chest. The lungs are surrounded by the chest wall. The chest wall is made up of the ribs and the muscles between the ribs. The lungs are separated by the mediastinum, which contains the heart and other organs. Below the lungs is the diaphragm, a thin muscle that separates the chest cavity from the abdomen.
Each lung is divided into lobes (sections): The left lung has 2 lobes, the heart sits in a groove (cardiac notch) in the lower lobe. The right lung has 3 lobes and is slightly larger than the left lung.
The trachea (windpipe) is the tube-shaped airway in the neck and chest. It divides into 2 tubes or branches called the main bronchi. One bronchus goes to each lung. The area where each bronchus enters the lung is called the hilum.
The pleura is a thin membrane that covers the lungs and lines the chest wall. It protects and cushions the lungs and produces a fluid that acts like a lubricant so the lungs can move smoothly in the chest cavity. The pleura is made up of 2 layers, the inner (visceral) pleura the layer next to the lung, and the outer (parietal) pleura the layer that lines the chest wall. The area between the 2 layers is called the pleural space.
Each of the main bronchi divides or branches into smaller bronchi (which have small glands and cartilage in their walls). These smaller bronchi eventually divide into even smaller tubes called bronchioles (which have no glands or cartilage). At the end of the bronchioles are millions of tiny sacs called alveoli. Surrounding the alveoli are very tiny blood vessels (capillaries). The bronchi are lined with cells that have very fine hair-like projections called cilia.
The lungs produce a mixture of fats and proteins called lung or pulmonary surfactant. The surfactant coats the surfaces of the alveoli, making it easier for them to expand and deflate with each breath.
Different groups of lymph nodes, which are part of the lymphatic system, drain fluid normally produced in the lung, bronchial nodes lymph nodes around the main bronchi, hilar nodes lymph nodes in the area where the trachea divides into the main bronchi, upper (superior) mediastinal nodes lymph nodes at the top of the mediastinum, subcarinal mediastinal nodes lymph nodes just below the trachea where it divides into the main bronchi, lower (inferior) mediastinal nodes lymph nodes at the bottom of the mediastinum
Function The main functions of the lungs are to transfer oxygen from the air to the blood and to release carbon dioxide from the blood to the air. Air enters the mouth or nose and travels through the trachea (windpipe), bronchi and bronchioles to the alveoli. The exchange of oxygen and carbon dioxide takes place in the alveoli. The alveoli absorb oxygen from the air and pass it into the blood, which circulates the oxygen around the body. Carbon dioxide, which is a waste product of the bodys cells, passes from the blood into the alveoli and is breathed out.
The lungs also play a role in the bodys defences against harmful substances in the air, such as smoke, pollution, bacteria or viruses. These substances can pass through the nose and become trapped in the lungs. The lungs produce a thick, slippery fluid (mucus), which can trap and partly destroy these materials. The cilia move rapidly to push the mucus up through the bronchi, where it is removed by coughing or swallowing.
CARDIOVASCULAR SYSTEM The cardiovascular system consists of the heart, blood vessels, and the approximately 5 liters of blood that the blood vessels transport. Responsible for transporting oxygen, nutrients, hormones, and cellular waste products throughout the body, the cardiovascular system is powered by the bodys hardest-working organ the heart, which is only about the size of a closed fist. Even at rest, the average heart easily pumps over 5 liters of blood throughout the body every minute. CARDIOVASCULAR SYSTEM ANATOMY The Heart The heart is a muscular pumping organ located medial to the lungs along the bodys midline in the thoracic region. The bottom tip of the heart, known as its apex, is turned to the left, so that about 2/3 of the heart is located on the bodys left side with the other 1/3 on right. The top of the heart, known as the hearts base, connects to the great blood vessels of the body: the aorta, vena cava, pulmonary trunk, and pulmonary veins. Circulatory Loops There are 2 primary circulatory loops in the human body: the pulmonary circulation loopand the systemic circulation loop. Pulmonary circulation transports deoxygenated blood from the right side of the heart to the lungs, where the blood picks up oxygen and returns to the left side of the heart. The pumping chambers of the heart that support the pulmonary circulation loop are the right atrium and right ventricle. Systemic circulation carries highly oxygenated blood from the left side of the heart to all of the tissues of the body (with the exception of the heart and lungs). Systemic circulation removes wastes from body tissues and returns deoxygenated blood to the right side of the heart. The left atrium and left ventricle of the heart are the pumping chambers for the systemic circulation loop. Blood Vessels Blood vessels are the bodys highways that allow blood to flow quickly and efficiently from the heart to every region of the body and back again. The size of blood vessels corresponds with the amount of blood that passes through the vessel. All blood vessels contain a hollow area called the lumen through which blood is able to flow. Around the lumen is the wall of the vessel, which may be thin in the case of capillaries or very thick in the case of arteries. All blood vessels are lined with a thin layer of simple squamous epithelium known as the endothelium that keeps blood cells inside of the blood vessels and prevents clots from forming. The endothelium lines the entire circulatory system, all the way to the interior of the heart, where it is called the endocardium. There are three major types of blood vessels: arteries, capillaries and veins. Blood vessels are often named after either the region of the body through which they carry blood or for nearby structures. For example, the brachiocephalic artery carries blood into the brachial (arm) and cephalic (head) regions. One of its branches, the subclavian artery, runs under the clavicle; hence the name subclavian. The subclavian artery runs into the axillary region where it becomes known as the axillary artery. Arteries and Arterioles: Arteries are blood vessels that carry blood away from the heart. Blood carried by arteries is usually highly oxygenated, having just left the lungs on its way to the bodys tissues. The pulmonary trunk and arteries of the pulmonary circulation loop provide an exception to this rule these arteries carry deoxygenated blood from the heart to the lungs to be oxygenated.
Arteries face high levels of blood pressure as they carry blood being pushed from the heart under great force. To withstand this pressure, the walls of the arteries are thicker, more elastic, and more muscular than those of other vessels. The largest arteries of the body contain a high percentage of elastic tissue that allows them to stretch and accommodate the pressure of the heart.
Smaller arteries are more muscular in the structure of their walls. The smooth muscles of the arterial walls of these smaller arteries contract or expand to regulate the flow of blood through their lumen. In this way, the body controls how much blood flows to different parts of the body under varying circumstances. The regulation of blood flow also affects blood pressure, as smaller arteries give blood less area to flow through and therefore increases the pressure of the blood on arterial walls.
Arterioles are narrower arteries that branch off from the ends of arteries and carry blood to capillaries. They face much lower blood pressures than arteries due to their greater number, decreased blood volume, and distance from the direct pressure of the heart. Thus arteriole walls are much thinner than those of arteries. Arterioles, like arteries, are able to use smooth muscle to control their aperture and regulate blood flow and blood pressure. Capillaries: Capillaries are the smallest and thinnest of the blood vessels in the body and also the most common. They can be found running throughout almost every tissue of the body and border the edges of the bodys avascular tissues. Capillaries connect to arterioles on one end and venules on the other.
Capillaries carry blood very close to the cells of the tissues of the body in order to exchange gases, nutrients, and waste products. The walls of capillaries consist of only a thin layer of endothelium so that there is the minimum amount of structure possible between the blood and the tissues. The endothelium acts as a filter to keep blood cells inside of the vessels while allowing liquids, dissolved gases, and other chemicals to diffuse along their concentration gradients into or out of tissues.
Precapillary sphincters are bands of smooth muscle found at the arteriole ends of capillaries. These sphincters regulate blood flow into the capillaries. Since there is a limited supply of blood, and not all tissues have the same energy and oxygen requirements, the precapillary sphincters reduce blood flow to inactive tissues and allow free flow into active tissues. Veins and Venules: Veins are the large return vessels of the body and act as the blood return counterparts of arteries. Because the arteries, arterioles, and capillaries absorb most of the force of the hearts contractions, veins and venules are subjected to very low blood pressures. This lack of pressure allows the walls of veins to be much thinner, less elastic, and less muscular than the walls of arteries.
Veins rely on gravity, inertia, and the force of skeletal muscle contractions to help push blood back to the heart. To facilitate the movement of blood, some veins contain many one-way valves that prevent blood from flowing away from the heart. As skeletal muscles in the body contract, they squeeze nearby veins and push blood through valves closer to the heart.
When the muscle relaxes, the valve traps the blood until another contraction pushes the blood closer to the heart. Venules are similar to arterioles as they are small vessels that connect capillaries, but unlike arterioles, venules connect to veins instead of arteries. Venules pick up blood from many capillaries and deposit it into larger veins for transport back to the heart. Coronary Circulation The heart has its own set of blood vessels that provide the myocardium with the oxygen and nutrients necessary to pump blood throughout the body. The left and right coronary arteries branch off from the aorta and provide blood to the left and right sides of the heart. The coronary sinus is a vein on the posterior side of the heart that returns deoxygenated blood from the myocardium to the vena cava. Hepatic Portal Circulation The veins of the stomach and intestines perform a unique function: instead of carrying blood directly back to the heart, they carry blood to the liver through the hepatic portal vein. Blood leaving the digestive organs is rich in nutrients and other chemicals absorbed from food. The liver removes toxins, stores sugars, and processes the products of digestion before they reach the other body tissues. Blood from the liver then returns to the heart through the inferior vena cava. Blood The average human body contains about 4 to 5 liters of blood. As a liquid connective tissue, it transports many substances through the body and helps to maintain homeostasis of nutrients, wastes, and gases. Blood is made up of red blood cells, white blood cells, platelets, and liquid plasma. Red Blood Cells: Red blood cells, also known as erythrocytes, are by far the most common type of blood cell and make up about 45% of blood volume. Erythrocytes are produced inside of red bone marrow from stem cells at the astonishing rate of about 2 million cells every second. The shape of erythrocytes is biconcavedisks with a concave curve on both sides of the disk so that the center of an erythrocyte is its thinnest part. The unique shape of erythrocytes gives these cells a high surface area to volume ratio and allows them to fold to fit into thin capillaries. Immature erythrocytes have a nucleus that is ejected from the cell when it reaches maturity to provide it with its unique shape and flexibility. The lack of a nucleus means that red blood cells contain no DNA and are not able to repair themselves once damaged.
Erythrocytes transport oxygen in the blood through the red pigment hemoglobin. Hemoglobin contains iron and proteins joined to greatly increase the oxygen carrying capacity of erythrocytes. The high surface area to volume ratio of erythrocytes allows oxygen to be easily transferred into the cell in the lungs and out of the cell in the capillaries of the systemic tissues. White Blood Cells: White blood cells, also known as leukocytes, make up a very small percentage of the total number of cells in the bloodstream, but have important functions in the bodys immune system. There are two major classes of white blood cells: granular leukocytes and agranular leukocytes.
Granular Leukocytes: The three types of granular leukocytes are neutrophils, eosinophils, and basophils. Each type of granular leukocyte is classified by the presence of chemical-filled vesicles in their cytoplasm that give them their function. Neutrophils contain digestive enzymes that neutralize bacteria that invade the body. Eosinophils contain digestive enzymes specialized for digesting viruses that have been bound to by antibodies in the blood. Basophils release histamine to intensify allergic reactions and help protect the body from parasites. Agranular Leukocytes: The two major classes of agranular leukocytes are lymphocytes and monocytes. Lymphocytes include T cells and natural killer cells that fight off viral infections and B cells that produce antibodies against infections by pathogens. Monocytes develop into cells called macrophages that engulf and ingest pathogens and the dead cells from wounds or infections. Platelets : Also known as thrombocytes, platelets are small cell fragments responsible for the clotting of blood and the formation of scabs. Platelets form in the red bone marrow from large megakaryocyte cells that periodically rupture and release thousands of pieces of membrane that become the platelets. Platelets do not contain a nucleus and only survive in the body for up to a week before macrophages capture and digest them. Plasma: Plasma is the non-cellular or liquid portion of the blood that makes up about 55% of the bloods volume. Plasma is a mixture of water, proteins, and dissolved substances. Around 90% of plasma is made of water, although the exact percentage varies depending upon the hydration levels of the individual. Theproteins within plasma include antibodies and albumins. Antibodies are part of the immune system and bind to antigens on the surface of pathogens that infect the body. Albumins help maintain the bodys osmotic balance by providing an isotonic solution for the cells of the body. Many different substances can be found dissolved in the plasma, including glucose, oxygen, carbon dioxide, electrolytes, nutrients, and cellular waste products. The plasma functions as a transportation medium for these substances as they move throughout the body. Cardiovascular System Physiology Functions of the Cardiovascular System The cardiovascular system has three major functions: transportation of materials, protection from pathogens, and regulation of the bodys homeostasis. Transportation: The cardiovascular system transports blood to almost all of the bodys tissues. The blood delivers essential nutrients and oxygen and removes wastes and carbon dioxide to be processed or removed from the body. Hormones are transported throughout the body via the bloods liquid plasma. Protection: The cardiovascular system protects the body through its white blood cells. White blood cells clean up cellular debris and fight pathogens that have entered the body. Platelets and red blood cells form scabs to seal wounds and prevent pathogens from entering the body and liquids from leaking out. Blood also carries antibodies that provide specific immunity to pathogens that the body has previously been exposed to or has been vaccinated against. Regulation: The cardiovascular system is instrumental in the bodys ability to maintain homeostatic control of several internal conditions. Blood vessels help maintain a stable body temperature by controlling the blood flow to the surface of the skin. Blood vessels near the skins surface open during times of overheating to allow hot blood to dump its heat into the bodys surroundings. In the case of hypothermia, these blood vessels constrict to keep blood flowing only to vital organs in the bodys core. Blood also helps balance the bodys pH due to the presence of bicarbonate ions, which act as a buffer solution. Finally, the albumins in blood plasma help to balance the osmotic concentration of the bodys cells by maintaining an isotonic environment. The Circulatory Pump The heart is a four-chambered double pump, where each side (left and right) operates as a separate pump. The left and right sides of the heart are separated by a muscular wall of tissue known as the septum of the heart. The right side of the heart receives deoxygenated blood from the systemic veins and pumps it to the lungs for oxygenation. The left side of the heart receives oxygenated blood from the lungs and pumps it through the systemic arteries to the tissues of the body. Each heartbeat results in the simultaneous pumping of both sides of the heart, making the heart a very efficient pump. Regulation of Blood Pressure Several functions of the cardiovascular system can control blood pressure. Certain hormones along with autonomic nerve signals from the brain affect the rate and strength of heart contractions. Greater contractile force and heart rate lead to an increase in blood pressure. Blood vessels can also affect blood pressure. Vasoconstriction decreases the diameter of an artery by contracting the smooth muscle in the arterial wall. The sympathetic (fight or flight) division of the autonomic nervous system causes vasoconstriction, which leads to increases in blood pressure and decreases in blood flow in the constricted region. Vasodilation is the expansion of an artery as the smooth muscle in the arterial wall relaxes after the fight-or-flight response wears off or under the effect of certain hormones or chemicals in the blood. The volume of blood in the body also affects blood pressure. A higher volume of blood in the body raises blood pressure by increasing the amount of blood pumped by each heartbeat. Thicker, more viscous blood from clotting disorders can also raise blood pressure. Hemostasis Hemostasis, or the clotting of blood and formation of scabs, is managed by the platelets of the blood. Platelets normally remain inactive in the blood until they reach damaged tissue or leak out of the blood vessels through a wound. Once active, platelets change into a spiny ball shape and become very sticky in order to latch on to damaged tissues. Platelets next release chemical clotting factors and begin to produce the protein fibrin to act as structure for the blood clot. Platelets also begin sticking together to form a platelet plug. The platelet plug will serve as a temporary seal to keep blood in the vessel and foreign material out of the vessel until the cells of the blood vessel can repair the damage to the vessel wall.
Author Praveen Buddiga, MD Physician, Allergy, Asthma and Immunology, Baz Allergy, Asthma and Sinus Center, Fresno, California
Praveen Buddiga, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American College of Allergy, Asthma and Immunology
Disclosure: Meda Honoraria Speaking and teaching; Teva Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching Coauthor(s) Archana Bangalore Research Coordinator and Volunteer, Alta Family Health Clinic; Volunteer, Fresno Women's Care
Disclosure: Nothing to disclose. Chief Editor Thomas R Gest, PhD Professor of Anatomy, Department of Pathology and Cell Biology, University of South Florida College of Medicine
Disclosure: Lippincott Williams & Wilkins Royalty Other