PHISIOLOGY AND BIOCHEMISTRY

Integrated educational activity

Course Sheet

Course code:

OST12A44

Academic Year of enrolment:

2022

Year of supply:

2022/2023

Degree:

Course of 1st Cycle Degree in MIDWIFERY

Moduls:

HUMAN PHYSIOLOGY - 2 credits
BIOCHEMISTRY - 2 credits

Location:

Credits:

Programme Year:

Cycle:

Second semester

Hours of classroom activity:

Prerequisites:

According to learning regulations, Obstetrics students to take the integrated examination of Physiology and Biochemistry, must have passed the integrated examinations of Physics, Statistics and Computer Science and Biology, Anatomy and Histology.

Objectives

BIOCHEMISTRY is the science that studies the molecules that make up living matter and in particular the incessant transformations (metabolism) to which living matter is subjected and the energy transformations that accompany the molecular ones. It is the branch of chemistry that studies the complex chemical reactions that give rise to life.
The aim of the course is to provide the student with the theoretical basis for understanding:
- the laws of chemistry and the properties of the main inorganic and organic compounds of biological interest,
- the relationship between structure and function of macromolecules of biomedical relevance;
- of the most important human biochemical processes for correct cellular functionality and in particular energy metabolism.

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. 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. Particular attention will be devoted to the nervous, musculoskeletal, cardiovascular, respiratory, and urinary systems.
Expected Learning Outcomes

The student during the oral examination must:
- present and discuss exhaustively the questions selected;
- prove comprehension of the mechanisms underlying cell and organ functions;
- draw schematically the structures, diagrams and graphics requested (see program);
- show communication skills of the concepts learned.
- use an appropriate language to describe the concepts of Physiology.

Contents

BIOCHEMISTRY: 1.
1. Elements of Chemistry and
2. Elements of Organic Chemistry
3. Stucture and function of Biomolecules
4. Enzymes
5. Bioenergetics and Metabolism of Biomolecules
6. Metabolism of carbohydrates, lipids and proteins

FISIOLOGY:
1. Introduction to Physiology (3 hours).
2. Neuron Physiology and generation of electrical signals (4 hours).
3. Skeletal and Smooth Muscle: structure and function (6 hours).
4. Physiology of the Cardiovascular System (5 hours).
5. Physiology of the Respiratory System (4 hours).
6. Physiology of Kidney (6 hours).

Insights:
a. Reflex control of blood pressure and ventilation (1 hour).
b. Blood: plasma composition and corpusclate components (1 hour).

Extended Syllabus

PART I: Introduction to Chemistry
Description of Matter:
The Atom. Isotopes and Atomic Masses. Introduction to the Periodic Table. Atomic Orbitals and Their Energies. Chemical Bonding: An Overview of Chemical Bonding. Ionic Bonding. Lewis Electron Dot Symbols. Lewis Structures and Covalent Bonding. Properties of Covalent Bonds, Polar Covalent Bonds. Ionic and hydrogen bonds.

Energy Changes in Chemical Reactions and Chemical Thermodynamics:
Thermodynamics and Work. The First and The Second Law of Thermodynamics. Enthalpy and Entropy Free Energy. Spontaneity and Equilibrium. Thermodynamics and Life.
Enzymes: classification, kinetics, and control

Molecules, Ions and Chemical Formulas:
Chemical Compounds. Acids and Bases and Ionic Compounds. The Chemical Equilibrium: Concept of Chemical Equilibrium. The Equilibrium Constant. Factors That Affect Equilibrium. Solution Concentrations. Acid–Base Reactions. A Qualitative Description of Acid–Base Equilibriums. Molecular Structure and Acid–Base Strength. Acid–Base Reaction.

Reactions in Aqueous Solution:
Aqueous Solutions. The Autoionization of Water. Solubility and pH.

Elements of Organic Chemistry:
General Overview of Carbon Compounds. Alkanes, Alkenes, Alkynes, Benzene. Overview of Functional Groups: Alcohols, Ethers and Phenols. Aldehydes and Ketones. Amines and Heterocycles.

PART II: STRUCTURE AND FUNCTION OF BIOMOLECULES

- Carbohydrate: General aspects and classification. Monosaccharides, Disaccharides and Polysaccharides.
- Lipids: General aspects and classification. Fatty Acids, Triglycerides, Phospholipids, Sterols and Cholesterol.
- Proteins: Amino Acids, Peptides, and Proteins. Covalent structures and three-dimensional structures of proteins. Protein Folding and Dynamics. Hemoglobin and Mioblobin. Protein Function
Pathological Hemoglobin.

Nucleic Acids: structure, fuction and general aspects. Nucleotides and Nucleosides

PART III: METABOLISM
Introduction to Metabolism:
- Carbohydrate metabolism I: major metabolic pathways and their control. Glycolysis. Citric Acid Cycle. Electron Transport and Oxidative Phosphorylation. Carbohydrate metabolism II: special pathways and glycoconjugates. Glycogen Metabolism, Gluconeogenesis and the Pentose Phosphate Pathway.
- Lipid Metabolism: utilization and storage of energy in lipid form. Pathways of metabolism of special lipids: β-oxidation and ketogenesis.
- Protein Metabolism: Amino acid metabolism and Urea cycle.

PHYSIOLOGY
1. Introduction to Physiology (3 hours).
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 symport and antiport: the examples of Na+/K+ pump and of the Na + -glucose symport.

2. Neuron physiology and generation of electrical signals (4 hours)
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 Introduction to the nervous system: 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; neuromuscular junction (schematic drawing of its different parts).

3. Skeletal and Smooth muscle: structure and function (6 hours).
3.1 The three types of muscle in our body: skeletal, cardiac and smooth; general skeletal muscle fiber structure: myofibrils, sarcomers, and membrane systems.
3.2 Coupling-excitation contraction in striated muscles: transverse tubules and sarcoplasmic reticulum; voltage sensor (DHPR); sarcoplasmic reticulum Ca2+ release channel (Ryr); triads or calcium release units (schematic drawing of its different parts)
3.3 The sarcomer (schematic design of the organization of filaments, lines, and bands); the main proteins of the sarcomer: contractile, regulatory and accessory; role of troponin and tropomyosin in the activation of contraction; cycle of the head of myosin.
3.4 Classification of muscle fibres according to metabolism and contraction rate; classification into red and white fibres; structural and functional differences between slow, intermediate and fast fibres; concept of motor unit and recruitment; relationship between electrical events and mechanical events; simple shock (graph), summation (graph), incomplete and complete tetanus (graphs); definition of fatigue (graph).
3.5 General characteristics of smooth muscle cells; organisation of thick and thin myofibres in smooth cells; molecular mechanisms of contraction; mechanisms of contraction: role of calmodulin and phosphorylation of the light chain of myosin.

4. Physiology of the Cardiovascular System (5 hours).
4.1 Introduction to the cardiovascular system: anatomy and general functions.
4.2 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); modulation of heart rate by the autonomic nervous system.
4.3 Large and small circulation; arterial pressure and its measurement (concept of systolic and diastolic pressure); mean arterial pressure and factors affecting it; structure of 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 baroceptor reflex (schematic drawing of its functioning).

5. Physiology of the Respiratory System (4 hours).
5.1 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; the four phases of external respiration.
5.2 Ventilation (inhalation and exhalation) gas exchange between alveoli and blood; 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); and air exchange between external space and lungs.
5.3 Transport of gasses in the blood and gas exchange blood-tissues; transport of O2; hemoglobin/ O2 dissociation curve (graph); blood transport of CO2 and its effect on blood pH.

6. Physiology of the kidney (6 hours).
6.1 Introduction to the urinary system: urinary tract and kidney; main functions of the kidneys; cortex and medullary; nephron: tubular elements and vascular elements (schematic drawing of its different parts); structure of the renal corpuscle (schematic drawing).
6.2 The nephron: the four fundamental processes (filtration, resorption, secretion, excretion); filtration fraction; filtration pressure; autoregulation of glomerular filtration rate (graph): myogenic response and tubular-glomerular feedback; resorption (e.g.: sodium, glucose, urea).
6.3 The hydro-electrolytic balance: water balance and role of the kidney in its regulation; vasopressin or antidiuretic hormone; counter-current exchange in the medullary of the kidney (schematic drawing of its functioning); sodium and potassium balance and renin-angiotensin-aldosterone via; behavioural mechanisms in the hydro-electrolytic balance: thirst, appetite for salt, behaviour of avoiding heat.

Insights (2 hours)
a. Reflex control of blood pressure and ventilation (1 hour): aortic and carotid baroreceptors; bulbar cardiovascular control center; autonomous efferent pathways: targets and effect of sympathetic and parasympathetic regulation; baroceptive reflex (schematic drawing of its operation); central and peripheral chemoceptors; bulbary control centres and ventilation bridges; efferent pathways to the ventilator muscles.
b. Blood; composition of plasma; corpusculated component: red blood cells, white blood cells and platelets; concept of hematocrit; hematopoiesis; hemostasis and coagulation.

Recommended Bibliography

The student will find and study the topics covered in class (listed in detail in the extended program) in several books of Biochemistry and Human Physiology available on the market. Below some of the textbooks among which the student could choose:

BIOCHEMISTRY:
"Chimica e Biochimica" (lauree brevi), M.Samaja-R.Paroni. PICCIN Editore
Nelson & Cox - Introduzione alla biochimica di Lenhinger – Zanichelli

PHYSIOLOGY:
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.

Teaching Methods

Both courses are structured in 30 hours of frontal teaching each, divided into 15 lessons of 2 hours each according to the teaching calendar. The frontal teaching will be supported by the projection of slides (prepared by the teacher) and movie-animations related to the topics covered.
Attendance is mandatory and verified by collection of signatures in each lesson. The students to be admitted at the exam must have attended a minimum of 70% of classes.

Evaluation methods

Verification of learning:

The student 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).

BIOCHEMISTRY: oral exam
The exam method is an oral test designed to verify the results of the expected learning, in accordance with the educational and specific objectives of the course. The oral examination is placed at the end of the course, after having achieved the attendance to the same, according to a schedule established and published on the University web page at the beginning of the academic year. The outcome of the test is evaluated as the result of learning the specific and training objectives, such as knowledge and understanding, capacity for logical integration and application. At the end of the test the teacher will form an opinion expressed in terms of Italian grades and their correspondent European Credit Transfer System grade (In Italian Universities grades are given on the basis of 30 points).

1) Rating 30 - 30 cum laude (corresponding to ECTS grade A): Excellent knowledge and understanding of the subjects, ability to reason and logical integration of the acquired knowledge. If the student, who has achieved this evaluation, demonstrates autonomy of judgment, high communication skills and autonomous learning skills, a laude can be added by the commision.
2) Rating 27 - 29 (corresponding to ECTS grade B): Good knowledge and understanding of the topics with some non-serious inaccuracies and with a good capacity for logical integration and judgment.
3) Rating: 23 - 26 (corresponding to ECTS grade C): Discrete knowledge and understanding of the topics and, despite some gaps in the ability to integrate and apply knowledge.
4) Rating 20 - 22 (corresponding to ECTS grade D): Knowledge and understanding of the arguments fully sufficient, although there are clear gaps, which are reflected in a reduced capacity for integration, logic and application.
5) Rating 18 - 19 (corresponding to ECTS grade E): Knowledge and understanding of the topics with serious and evident gaps, with limited integrative and applicative skills, but which also allow the passing of the exam.

PHYSIOLOGY
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 students will be examined in the order in which they signed-in for the exam in web site.
The written exam will last 20 minutes and will consist in 10 questions with multiple choice of answer (with only one correct answer). The total points of the written test will be 30 (3 points for each correct answer, 0 points for each wrong answer). To access the oral exam the student must have answered correctly to 6 questions out of 10. The relative weight of the written test will be 1/2 of the Physiology exam and ¼ of the entire exam (which includes also 2 CFU of Biochemistry and 1 CFU of History of Medicine).
The oral exam will be based on pre-formulated questions (published and accessible to the students before the exam) that will be drawn by the student at the time of the test. Each student will draw a maximum of 2 2 oral questions and must reach a sufficient score (18/30) in each of the 2 questions. The relative weight of the oral examination will be 1/2 of the Physiology exam and ¼ of the entire exam (which includes also 2 CFU of Biochemistry and 1 CFU of History of Medicine).
The final mark of the exam will be determined by the mathematical average between 2 scores: 1 from the written test, and 1 from the oral examination.

Contacts/More Information

Meeting the teacher will require scheduling an appointment by e-mail:

- erminia.carletti@unich.it
- feliciano.protasi@unich.it

Università degli Studi
"G. d'Annunzio"

Chieti - Pescara

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