PHYSIOLOGY, GENERAL PATHOLOGY AND MEDICAL STATISTICS

Integrated educational activity

Course Sheet

Course code:

TRM12A5

Academic Year of enrolment:

2020

Year of supply:

2020/2021

Degree:

Course of 1st Cycle Degree in IMAGING AND RADIOTHERAPY TECHNIQUES

Moduls:

PHYSIOLOGY - 2 credits
GENERAL PATHOLOGY - 3 credits
BIOSTATISTICS - 2 credits
CLINICAL PATHOLOGY - 1 credits

Location:

CHIETI

Credits:

Programme Year:

Cycle:

Second semester

Hours of classroom activity:

Prerequisites:

PHYSIOLOGY
Physiology is an integrative discipline that - to be successfully followed and learned in class
(and successfully studied for passing the exam) requires that the student has acquired basic knowledge of Chemistry, Biochemistry, Physics, Histology, and Anatomy.
For the aforementioned reasons - before being admitted to the exam of Human Physiology - the student must have passed the exam of Human Anatomy.

CLINICAL PATHOLOGY
Knowledge of biochemistry
GENERAL PATHOLOGY:
Requirements
To the whole understanding of the disciplines is required: sufficient knowledge of histology, anatomy, biochemistry.
STATISTICS
The proposed program will also allow students who have not previously matured
Disciplinary knowledge to achieve the training objectives indicated. There are therefore no prerequisites, but we recommend a knowledge of the notions of mathematics present in all high school programs.

To take the exam of the Integrated Course it is necessary to have passed the exam of the IC. of Systematic and Topographical Human Anatomy.

Objectives

PHYSIOLOGY
Physiology is an integrative discipline that studies the functioning of life processes at many levels of complexity: from cells, to organs and apparatuses, to whole organisms, up to the populations of a species. The objective of this course is to provide the theoretical bases that will allow students to understand the cellular mechanisms that underlie the functioning of the major apparatuses that constitute the human organism.
EXPECTED LEARNING OUTCOMES

• Knowledge and understanding
The student during the examination must:
i) present and discuss exhaustively the questions using an appropriate language to describe the concepts of Physiology;
ii) prove comprehension of the mechanisms underlying cell and organ functions;
iii) show communication skills of the concepts learned;
iv) draw schematically the structures, diagrams and graphics requested (see program);

• Applying knowledge
The student must prove to be able to apply learned Physiology concepts integrated with those of previous courses.

• Soft skills
i) Making judgments
The student must prove to be able to show independent judgments of the concepts learned.
ii) Communications skills
The student must be able to have communication skills of the concepts learned
iii) Learning skills
The student, through the Physiology course, must acquire the theoretical bases necessary to independently undertake further studies.
CLINICAL PATHOLOGY: The objectives that the course aims are:
a) acquire the basic elements in the clinical diagnosis of the main diseases;
b) acquire the elements that allow us to prepare diagnostic frameworks
through the study of bio-cellular and biochemical parameters of the organism;
c) acquiring the principles of molecular investigation applied to predictive medicine in main degenerative and tumor syndromes.

GENERAL PATHOLOGY
LEARNING OBJECTIVES
The teaching of General Pathology contributes to the realization of the educational objective of the Study Programme in Medical Radiology Techniques, for Imaging and Radiotherapy (Article 3 of the REGULATION - Specific training objectives and expected skills. "TRAINING PATTERN 1st year - Finalized in provide a good knowledge of the essential theoretical disciplines that derive from the basic sciences, in the perspective of their subsequent professional application.") providing the student with the scientific basis necessary for the identification not only of pathologies but also of preventive and therapeutic approaches suitable for the protection of individual and community health. In particular, the conceptualization of the disease will be emphasized as a deviation of the general laws aimed at maintaining the state of health.

EXPECTED LEARNING OUTCOMES
• Knowledge and understanding
At the end of the course the student will be able to:
to the different levels of complexity (molecules, cells, tissues, organism), the etiopathogenetic factors underlying the structural and functional alterations found in the pathological processes, as well as the damage response mechanisms and the related disorders.

• Applying knowledge and understanding
The student must also be able to apply the knowledge acquired from the course, integrated with those deriving from previous courses, to the understanding of the pathophysiology of the main human pathologies.
The student will be able to deal with the clinical problem in a rational way both in the diagnostic-therapeutic approach and in the preventive one.
Transversal skills (Soft skills):
¬Making judgments
The student will be able to collect and interpret data useful for defining judgments in an autonomous way.

¬ Communication skills
The student will be able to communicate information to specialist interlocutors and not.
¬ Learning skills
The student, through the methodological criterion that the study of the General Pathology provides, will be able to develop the skills necessary to undertake further studies with a good degree of autonomy.

STATISTICS
GENERAL TARGET
At the end of the course students should be able:
To use epidemiological and bio-statistical tools for a better understanding of biomedical information and for improving medical decision making.
INTERMEDIATE TARGETS
At the end of the course students should be able to:

Organize collected data;
• Construct and interpret graphs;
• Describe the differences between the different measuring scales;
• To calculate the most common indices of central trend and variability of the data;
• Analyze frequency distribution curves;
• Use some inferential statistical techniques.
Autonomy of Judgement: At the end of the course students should be able to reading articles related to topics related to the CdS with significant content of biostatistics.

Communication skills: At the end of the course students should be able to use the technical language of medical statistics

Contents

PHYSIOLOGY
1. Introduction to Physiology.
2. Neuron Physiology and generation of electrical signals.
3. Skeletal and Smooth Muscle: structure and function.
4. Physiology of the Cardiovascular System.
6. Physiology of the Respiratory System.
7. Physiology of Kidney and the Hydro-electrolytic Balance.
CLINICAL PATHOLOGY:
The course of Clinical Pathology intends to clarify the different elements that contribute to study the physiology and pathophysiology of organs and tissues with reference to
biocellular and biochemical parameters that measure the main pathological conditions. The discipline is also interested in the application of disease prediction markers in
oncological, cardiovascular and neurological fields.
GENERAL PATHOLOGY
Knowledge of physical, chemical, biological and genetic causes responsible for the occurrence of human diseases.
Knowledge of the fundamental cellular and molecular pathogenesis mechanisms of diseases: genetic alterations, mechanisms of inflammation, degeneration processes, changes in cell proliferation.
Knowledge of the pathophysiological and molecular alterations responsible of functional modifications of organs and systems.

STATISTICS
The course aims to provide the basic knowledge of medical statistics for the analysis of biomedical data and the interpretation of the phenomena analysed.

Extended Syllabus

PHYSIOLOGY
1. Introduction to Physiology.
1.1 Definition of Physiology and its areas of interest; concept of internal and external environment for the cell and for the organism; concept of homeostasis.
1.2 General characteristics of plasma membranes; fluid mosaic model; integral and associated membrane proteins; receptors and transport proteins; difference between carriers and channels.
1.3 The movement of substances through membranes and epithelia; concept of simple or mediated diffusion through membranes; active transport; concept of uniport, symport, and antiport: the examples of Na+/K+ pump and of the Na + -glucose symport; transport by vesicles: exocytosis, endocytosis and transcytosis.

2. Neuron physiology and generation of electrical signals.
2.1 Distribution of solutes in the different liquid compartments of the organism (schematic drawing); resting membrane potential; equilibrium potentials of Na+ and K+.
2.2 Basic structure of the neuron (schematic drawing of its different parts); glial cells; myelin sheath; axonal transport.
2.3 Resting membrane potential of neurons; changes in membrane potential and generation of signals; concept of depolarization and hyperpolarization; the generation of graduated potentials (graph); concept of subthreshold and suprathreshold potential (graph); spatial and temporal summation of graduated potentials; action potential (graph); absolute and relative refractory periods (graph); saltatory conduction.
2.4 Communication between neurons: chemical synapses (schematic drawing of its different parts) and electrical synapses; mechanisms of release and inactivation of neurotransmitters in chemical synapses; concept of convergence and divergence of the signal; concept of stimulus intensity: how the discharge frequency/pattern of neuron influence the release of the neuro-transmitters.

3. Skeletal and Smooth Muscle: structure and function.
5.1 The three types of muscle in our body: skeletal, cardiac and smooth; general structure of skeletal muscle fibers: myofibrils, sarcomeres, and membrane systems.
5.2 The excitation-contraction (EC) coupling
mechanism and the transduction of the electrical into a chemical signal; transversal tubules and sarcoplasmic reticulum; the voltage sensor (DHPR); the Ca2+-release channel of the sarcoplasmic reticulum (RYR); the triad or calcium release unit (schematic drawing of its different parts); differences between skeletal and cardiac EC coupling.
5.3 The sarcomere (schematic drawing of the organization of filaments, lines, and bands); the main sarcomeric proteins: contractile, regulatory and accessory; role of troponin and tropomyosin in the activation of the contraction; myosin head cycle; tension-length regulation curve of the sarcomere (graph).
5.4 Classification of muscle fibers based on metabolism and speed of contraction structural and functional differences between slow, intermediate and fast fibers; classification of fibers in red and white; concept of motor unit and motor unit recruitment;
5.5 Relationship between electrical and mechanical events; simple twitch (graph), summation mechanism (graph), incomplete and complete tetanus (graphs); definition of fatigue (graph); isometric and isotonic contractions (and role of elastic and
contractile components).
5.6 General characteristics of smooth muscle cells; organization of thick and thin myofilaments; molecular mechanisms of contraction; molecular mechanisms of contraction: role of calmodulin and phosphorylation of the myosin light chain.

4. Physiology of the Cardiovascular System.
6.1 Introduction to the cardiovascular system: anatomy and general functions.
6.2 The heart (schematic drawing): pacemaker and contractile tissues; contractile myocardial cells and intercalated disks (schematic drawing); the conduction system (schematic drawing of its various components); the action potential of pacemaker cells (graph); the action potential of contractile cells (graph); the electrocardiogram (graph); the cardiac cycle explained with the 5 phases; the cardiac cycle explained with the pressure-volume curve of the left ventricle (graph); cardiac output (formula); Frank-Starling's law (graph) and the importance of venus return.
6.3 Large and small circulation; arterial pressure and its measurement (concept of systolic and diastolic pressure); mean arterial pressure and factors affecting it; structure contractile components).
5.6 General characteristics of smooth muscle cells; organization of thick and thin myofilaments; molecular mechanisms of contraction; molecular mechanisms of contraction: role of calmodulin and phosphorylation of the myosin light chain.

4. Physiology of the Cardiovascular System.
6.1 Introduction to the cardiovascular system: anatomy and general functions.
6.2 The heart (schematic drawing): pacemaker and contractile tissues; contractile myocardial cells and intercalated disks (schematic drawing); the conduction system (schematic drawing of its various components); the action potential of pacemaker cells (graph); the action potential of contractile cells (graph); the electrocardiogram (graph); the cardiac cycle explained with the 5 phases; the cardiac cycle explained with the pressure-volume curve of the left ventricle (graph); cardiac output (formula); Frank-Starling's law (graph) and the importance of venus return.
6.3 Large and small circulation; arterial pressure and its measurement (concept of systolic and diastolic pressure); mean arterial pressure and factors affecting it; structure blood vessels: differences between arteries and veins; the role of arteries and veins in helping the heart to pump blood; regulation of arterial pressure and baroceptors reflex (schematic drawing of its functioning).

5. Physiology of the Respiratory System.
7.1 Introduction to the respiratory system: anatomy and general functions; the reasons for an internalized respiratory system; upper and lower airways; structure of the lung and alveoli; the pleurae and their role in ventilation; inspiratory and expiratory muscles; concepts of lung compliance and elasticity; concept of instability of the alveoli; the four phases of external respiration.
7.2 Ventilation (inhalation and exhalation) and air exchange between external space and lungs; the laws of gases; muscles involved in ventilation at rest and under stress; ventilation mechanics; spirometry and measurement of pulmonary volumes and capacities (graph); concept of pulmonary and alveolar ventilation (formulas); gas exchange between alveoli and blood; hyperventilation and hypoventilation curve (graph).
7.3 Transport of gasses in the blood and gas exchange blood-tissues; transport of O2; hemoglobin/ O2 dissociation curve (graph);
effects of pH (Bohr effect) and temperature on the hemoglobin/ O2 dissociation curve; blood transport of CO2 and its effect on blood pH.
7.4 Reflex control of breathing (schematic drawing of its functioning); respiratory centers of medulla oblongata and pons Varolii; dorsal and ventral respiratory groups; central and peripheral chemoreceptors.

6. Physiology of Kidney and the Hydro-electrolytic Balance.
8.1 Introduction to the urinary system: urinary tract and kidney; main function of the kidneys; cortex and medulla regions; the nephron: tubular and vascular elements; the structure of the renal corpuscle.
8.2 The nephron: the four basic processes (filtration, reabsorption, secretion, excretion); concepts of filtration fraction; and filtration pressure; self-regulation of glomerular filtration rate: myogenic response and tubulo-glomerular feedback; reabsorption (ex .: sodium, glucose, urea).
8.3 Hydro-electrolyte balance: water balance and role of the kidney in its regulation;
vasopressin or antidiuretic hormone; countercurrent exchange in the medulla of the kidney.
CLINICAL PATHOLOGY
The program is divided into the following points:
a) acquisition of the basic elements related to the pathophysiology of blood and blood
components. Clinical evaluation of anemias and study of related parameters. Analysis
clinics of leukemias and lymphomas and staging.
b) Pathophysiology of haemostasis. Analysis of the components of the coagulation cascade.
Clinical evaluations of coagulative-deficient states. Deficiency of the factors and their
role in hemorrhagic states.
c) Parameters of immunological investigation.
Diagnostic-clinical evaluation
inflammation and the role of cellular components. Immunophenotyping and his
application in the principals of immunodeficiency and neoplastic induction.
Study of autoimmunity and description of the main autoimmune syndromes: disease
celiac disease, reactive pathologies of the gastro-enteric system (M. of Chron, rectocolitis
ulcerative), Sijogren's syndrome, SLE, rheumatoid arthritis, scleroderma
d) Tumor serological markers. Analysis of the molecular alterations of the main ones
genes in the pathogenic processes of tumors. Pathogenesis of gastro-enteric tumors.
Predictive Medicine principles and study of prediction markers for the main ones
family oncological syndromes: breast and ovary cancer, HNPCC, tumors
Hereditary thyroid, retinoblastoma, Li-Fraumeni syndrome
e) Principles of pharmacogenetics and pharmacogenomics. Prediction of the answer
therapeutic in tumors. Presentation of the main application protocols
molecular-diagnostic in the chemotherapeutic orientation
GENERAL PATHOLOGY
Concept of illness and morbid status. Etiologys and pathogenesis. Intrinsic and extrinsic causes of disease. Physical, chemical and viral agents as a cause of illness.
• Inflammation: definition and general characteristics. Acute flogosis: chemical mediators and cells involved; the formation of the exudate; various types of exudate. Phagocytosis. Chronic flogosis.
Thermoregulation. Thermogenesis and heat-dispersion. Non-febrile hyperthermia and hypothermia. Fever: etiopathogenesis of fever; the course of the fever; types of fever; metabolic alterations in fever.
Pathophysiology of the blood. Anaemia: general processes and classification.
Oncology: concepts of hyperplasia, hypertrophy, metaplasia, dysplasia, anaplasia, neoplasia. Benign and malignant tumours. Histogenetic classification of benign and malignant human tumours. Metastasis. The process of carcinogenesis. Concepts of n of neoplasms.
carcinogenicity from chemical, physical and viral agents. Stages of carcinogenesis: initiation, promotion and progression. Oncogenes and oncosuppressors and their role in tumours.

STATISTICS
• Purposes and methods of statistical analysis; Statistical characters and classification.
• Data synthesis Tools: absolute, relative, cumulated frequencies; Arrangement and organization of data in tables; Frequency distributions.
• Main graphical representations: orthograms, circular field diagrams, histograms, frequency polygons, scatter diagrams.
• Central trend indices: Arithmetic mean and its properties, mode and median, Terzili, quartiles and percentiles.
• Variability indices: range, deviance, variance, standard deviation and coefficient of variation. Box-Plot.
• Frequency distribution curves. Symmetry indices.
• Normal distribution, standardized normal distribution.
• Confidence interval for an arithmetic mean and for a proportion.
• Concept of statistical hypothesis testing.
• Relationship between two qualitative characters: the Chi-squared test as a measure of association between two qualitative variables, the chi-squared with the correction of Yates for the continuity, the exact Fisher test.
• Student T-test for independent samples and student T-test for paired samples.
• Relationship between two quantitative characters: regression analysis and correlation analysis
• Critical reading of articles related to topics related to the CdS with significant content of biostatistics

Recommended Bibliography

PHYSIOLOGY
The student will find and study the topics covered in class (listed in detail in the extended program, see below) in several books of Human Physiology available on the market. Following some of the text books among which the student could choose:
1. Human Physiology (or Physiology): an integrated approach. Author: Dee Unglaub Silverthorn.
2. Human Physiology: from cells to systems. Author: Lauralee Sherwood.
3. Fundamentals of Human Physiology. Author: Lauralee Sherwood.
4. Physiology; author. Author: Cindy L. Stanfield.
5. Vander Physiology. Authors: Eric P. Widmaier, Hershel Raff, Kevin T. Strang.

CLINICAL PATHOLOGY
G. Federici et al. Medicina di Laboratorio. McGraw Hill
GENERAL PATHOLOGY
-J. Anne Marie Maier, Massimo Mariotti “Elementi di Patologia generale e Fisiopatologia”, McGraw Hill, Milano.
-G.M. Pontieri “Patologia e Fisiopatologia Generale” per i corsi di laurea in Professioni Sanitarie Piccin, Padova.

-Teaching material provided by the teacher with express recommendation to the students to use it only as an aid/guide to the preparation of the exam. It is recalled, in fact, that the use of the recommended General Pathology books (exclusive choice of the student) is essential for a correct, useful and easier preparation of the subject. Students are required to perform all the topics indicated in the program even if not included in the teaching material. Finally, students are warned against the use of photocopies of educational material (presumed printouts of the lessons) ABUSIVELY sold at the copy shops.
STATISTICS
Copy of the slides used during the lessons and bibliographic material available on-line on the site www.biostatistica.unich.it
• J Fowler, P Jarvis, M Chevannes. STATISTICA PER LE PROFESSIONI SANITARIE. EdiSES

Teaching Methods

PHYSIOLOGY
Teaching is structured in 21 hours of frontal teaching, divided into 7 lessons of 3 hours each according to the educational calendar. The frontal teaching will be supported by the projection of slides (prepared by the teacher) and movie-animations related to the topics covered.

CLINICAL PATHOLOGY: Frontal lessons

GENERAL PATHOLOGY
The course will be held through interactive lectures with the aid of iconographic material in Power Point files for a total of 3 CFU corresponding to a total of 30 hours. Individual work on a topic chosen by the student in the context of the contents developed during the lectures and part of the program.
STATISTICS
The teaching is structured in 20 hours of frontal didactics, each lesson will be divided into two parts. A first part in which will be presented the topic of the lesson and in a second part in which will be proposed by the teacher of the exercises that allow to verify the practical application of the topics treated in a theoretical way.

Evaluation methods

Verification of learning:

The students level of preparation will be verified through an exam that will focus exclusively on topics covered in the lectures (listed in detail in the extended program, see below).

The exam will consist of a written and an oral test to be held on the same day. If the exams will not be completed in one day due to excessive numbers of students, the exam will be completed the first available day.
The exam will be considered passed only if both tests are passed in their entirety. Written test: each student will be given the written test related to each discipline of the IC. (see the syllabus of the single module for more details) in the following order: Physiology, Clinical Pathology, General Pathology, Medical Statistics.
Oral exam: the student who has passed the written test related to each discipline of the IC. can access the oral exam (see the syllabus of the single module for more details).
The final grade of the C.I. will be the result of the weighted average on the number of CFU of the final marks obtained in the individual modules.

More specifically:
1. the vote of the single module is multiplied by its value in CFU;
2. all the results obtained are added;
3. the credits of the C.I. (8 CFU);
4. divide the result obtained from the calculation in point 2. for the result obtained from the calculation referred to in point 3.
Example: Physiology: 2 CFU, 30/30 General Pathology: 3 CFU, 22/30 Clinical Pathology: 1 CFU, 30/30 Medical Statistics: 2 CFU, 30 cum laude.

The weighted average is calculated as follows: (30 * 2) + (22 * 3) + (30 * 1) + (31 * 2) /8=27.25/30.
To round off the final vote of the IC. is: 27/30.
Rounding rules: the final vote will be rounded down if the decimal place is less than or equal to 4.
In case the exam should be held at a distance on the Microsoft Teams platform the exam will consist only in the oral exam.

Contacts/More Information

Students will be received by the teacher by appointment to be agreed by e-mail to the address:
marta.dinicola@unich.it
gabriella.mincione@unich.it
simona.boncompagni@unich.it
elena.toniato@unich.it The publicity of the timetable of the lessons and of the didactic programs is assured by the website of the Study Programme and of the University. The exam session is ensured by the application ESSE3 and by the personal student webpage.
Prof.ssa G. Mincione
Tel. 0871/3554117
E-mail: gabriella.mincione@unich.it
Office hours: take an appointment through e-mail.

Università degli Studi
"G. d'Annunzio"

Chieti - Pescara

Aree