Physiology

A.Y. 2020/2021
11
Max ECTS
96
Overall hours
SSD
BIO/09
Language
Italian
Learning objectives
The course aims to provide a deep preparation on the functions of organ systems, as well as their integrated view, as an assumption to the study of diseases affecting the human body. Great attention will be paid to the description of physiological mechanisms at cellular and molecular level as a possible target of pharmacological therapies.
The theoretical and practical knowledge in physiology will be mainly forwarded through a logical, rather than mnemonic, and 'problem solving' approaches and a correct technical terminology that would allows students to effectively talk in the medical-scientific field moving to the following educational path.
Moreover, the course aims to provide an advanced scientific background to implement the professional skills by stimulating health-care informant abilities to general public, so that they can represent a connection among patients, doctors and public health structures, proposing healthy lifestyles as well as providing expertise for the management of pathophysiological and/or physiotherapeutic issues.
Expected learning outcomes
After course completion, the student should have gained basic and advanced skills on the functions of the human body, in an integrated view of the biological mechanisms involved.
The course is also expected to develop in the student:
- abilities as well as disciplinary and methodological skills, which will enable the student to understand the biological aspects of the next professionalizing courses and to face and solve logical problems related to biological needs and their possible alterations;
- cross-sector skills, like study strategies to improve learning abilities;
- adequate communication skills and medical-scientific terminology, to establish a link among patients, doctors and the public health facilities.
Course syllabus and organization

Linea AL

Responsible
Lesson period
year
Educational activities in the first semester.
The lessons will be provided online, via Microsoft Teams platform in synchronous mode, as scheduled online. Information on how to access Microsoft Teams lessons and other instructions will be uploaded to the course's ARIEL website: please, consult it regularly. Students will be promptly informed via ARIEL, in case of activities onsite.
The lessons will be recorded and made available on the website. The course will consist of lectures and exercises on multimedia interactive platforms to encourage the students' participation.
Program and reference material
The program will not change. The teaching material (slides displayed during the lectures and registered lessons) will be made available on the Ariel platform.
Learning assessment procedures and assessment criteria.
The oral examination will be held onsite or online (through Microsoft Teams), according to the directives in force at the time of the exam. The learning assessment procedures and assessment criteria are reported in detail in "learning assessment method".
According to the epidemic evolution and in compliance with health and social distancing rules, a written test will be held at the end of the first semester on the "cellular physiology" program, as detailed in "learning assessment method"
Course syllabus
I SEMESTER. CELLULAR PHYSIOLOGY
This unit addresses the organization and biophysical properties of cells and tissues. Basic concepts in cell and membrane physiology are synthesized through exploring the function of epithelial, neuronal and muscle cells. The following topics will be covered:
1. INTRODUCTION
What is physiology? Main characteristics of a living being. Cells, tissues, organs, organ systems, organism. Liquid compartments composition in the body. Homeostasis.
2. BIOLOGICAL MEMBRANES AND TRANSPORT PHENOMENA
Structure and function of biological membranes. Transport through biological membranes: Simple diffusion and Fick's law. Facilitated diffusion and Michaelis-Menten equation. Ionic channels, Transporters and pumps. Primary active transport: ATPases. Secondary active transport, property and function. Transport mediated by vesicles. Osmosis: osmotic pressure. Complex biological barriers: epithelia
3. MEMBRANE POTENTIAL
Resting membrane potential. Equilibrium potentials. Nernst's law. Goldman-Hodgkin-Katz equation. Electrical analogue of a membrane. Extracellular and intracellular recording techniques.
4. CELL COMMUNICATION I: HORMONAL SIGNALS.
Hormone chemistry, synthesis and secretion. Regulatory mechanisms and mechanisms of action of hormones. Endocrine disruptors
5. CELL COMMUNICATION II: NERVOUS SIGNALS
Neurons and glial cells. The graduate potential and action potential. Generation and propagation of the action potential: ionic and molecular bases. Relative and absolute refractory period. Myelin and saltatory conduction Action potentials in excitable cells.
Synaptic transmission. Electrical and chemical synapses. Neurotransmitters, ionotropic and metabotropic receptors, vesicular and membrane transporters. Excitatory and inhibitory postsynaptic potentials and synaptic integration.
6. PHYSIOLOGY OF THE MUSCLE CELL.
Skeletal muscle: electrical and mechanical phenomena. Neuromuscular junction. Excitation-contraction coupling. Molecular mechanism of contraction. Regulation of muscle contraction. Classification of muscle fibers. Motor unity.
Cardiac musculature. Electrical activity of individual cardiac cells and regulation. Heartbeat origin and excitement propagation. Contractile activity. Heart rate regulation. Smooth muscle. Excitation-contraction coupling in smooth muscle. Mechanism of muscle contraction at the molecular level, differences with the striated muscle. Smooth muscle classification
7. CIRCULATING LIQUIDS
The blood. Plasma: ionic components, protein and non-protein components.
Blood Cells: erythrocytes, leukocytes and platelets. The red blood cell: characteristics, composition, membrane properties and Hamburger phenomenon. Hemoglobin and the transport of O2. The lymph and lymph nodes.

II SEMESTER. HUMAN PHYSIOLOGY.
This unit addresses the organization and functioning of organs and systems of normal human body. The regulatory mechanisms and the contributions of each system to the body homeostasis will be emphasized. The functioning of the following systems will be covered:
8. THE NERVOUS SYSTEM
Organization of the central and peripheral nervous system (in brief)
Sensory function. Sensory signals. Transduction and coding of sensory information in sense organs and receptors. Somatosensory perception. The nociception and control of painful stimuli.
View: elements of optics, pupillary reflexes, the retina, photoreceptors and phototransduction, analysis of visual information in cortical circuits.
Hearing: structure of the ear, elements of acoustics, the cochlea, ciliated cells and mechanotransduction, analysis of acustic information in cortical circuits.
Motor function. The simple reflexes. Voluntary movements. Central control of motor activity. Role of the nuclei of the base and cerebellum. Mirror neurons.
Complex functions: learning and memory, molecular mechanisms of learning and memory, sleep and wake, language, emotions.
Integrated Physiology Control of body temperature
9. ENDOCRINE SYSTEM
Hypothalamic-pituitary relationships, hypothalamic hormones, neurohypophysis and anterior pituitary.
The endocrine "axes".
Thyroid hormones: synthesis, secretion, regulation and action
Hormonal control of glucose metabolism: insulin and glucagon.
Hormonal control of Ca2+, K+ and PO4- homeostasis: vitamin D, parathyroid hormone and calcitonin.
Adrenal hormones and stress response
Steroid sex hormones, sexual determination and differentiation.
10. HEART AND CIRCULATION
Cardiac muscle structure. Electrical cycle: origin of the heartbeat and propagation of excitement. Cardiac Mechanical cycle: cardiac pressures and volumes in the different phases of the cardiac cycle. Frank and Starling's law. Systolic and cardiac output. Cardiac output control. The role of the autonomic nervous system. Electrocardiogram.
Blood circulation: arteries, capillaries and venous. Hydrodynamics of blood circulation. Laplace's law, Bernoulli's law and Darcy's law. Blood pressure. Peripheral resistance: central and local control. Microcirculation and osmotic/oncotic pressure. Edema and lymphatic system.
Integrated Physiology Integrated blood pressure control.
11. BREATHING AND TRANSPORT OF RESPIRATORY GASES
Gas properties. Ventilation. Breathing Mechanics. Respiratory muscles. Surfactant. Spirometry and lung volumes. Ventilation and gas exchange.
Oxygen transport: hemoglobin, oxyhemoglobin dissociation curve. CO2 transport. Tissue breathing.
Integrated Physiology: Control of respiration.
12. KIDNEY FUNCTION
Kidney. Nephron. Kidney circulation. Glomerular filtration (FG). Factors influencing FG. Measurement of FG flow. Tubular function. Reabsorption mechanisms. Titration curve for glucose. Tubular secretion. Henle loop. Collector duct. Clearance concept.
13. HYDRO-SALINE INTEGRATION and ACID-BASE BALANCE
Countercurrent multiplication. Hormones action on kidney function. The antidiuretic hormone. Renin-angiotensin-aldosterone system.
Integrated Physiology Integrated control of Na+, K+ concentration.
Integrated Physiology Integrated control of plasma volume and blood pressure
Integrated Physiology Mechanisms of pH control. Buffer systems. Effects of breathing on the acid-base balance. Kidney regulation. Alterations of the acid-base balance: alkalosis and acidosis.
14. GASTROINTESTINAL FUNCTION (in brief)
The digestive system nervous system. Motility of the digestive system: swallowing, peristalsis and segmentation. Salivary, gastric, pancreatic secretions. Liver and bile.
Basis of nutrient digestion and absorption. Water and electrolyte absorption processes.
Integrated Physiology Food behavior.

PRACTICAL COURSE
Osmolarity and tonicity, Action potential and synaptic integration.
Principles and techniques of manual blood pressure measurement
Heart function: electrocardiogram
First Aid Guide and Emergency Treatment Instructions - Body Life Support and Defibrillation (fBLSD)
Prerequisites for admission
Students taking this course are expected to have a background in general and organic chemistry, physics and biology
Teaching methods
Frontal and practical lessons, interactive multimedia platforms
Teaching Resources
Text book
- Human Physiology, an integrated approach, aut. D.U. Silverthorn, Pearson
Reference book
- Principles of Human Physiology - Stanfield Cindy L., Pearson
- Human physiology - Berne and Levy, Elsevier
- Principles of Neural Science Textbook by Eric Kandel, James H. Schwartz, and Thomas Jessell, Elsevier,
Teaching materials available on ARIEL web site
https://cperegofal.ariel.ctu.unimi.it/v5/home/Default.aspx
Assessment methods and Criteria
Oral examination to ascertain the candidate's knowledge on the topics covered during the course.
The exam consists of three questions: the first relating to cellular physiology and the other two concerning organs functioning and regulation. The examination is passed if the candidate demonstrates that he/she has acquired and understood the principles of cell and organ functioning and the mechanisms of their homeostatic regulation (not the simple "learning by heart").
For student attending the courses, an on-going evaluation is planned in written form (with open and multiple-choice questions) during the teaching-break (generally February). In case of positive result, at the end of the course, the students will be evaluated by oral examination only on general and integrated physiology. The final grade is the weighted average (5 CFU for cellular physiology and 6 CFU for general physiology) of the two votes. The evaluation is released at the end of the test and submitted to the candidate for acceptance.
The assessment includes a range of: minimum marks (18-23/30) if sufficient preparation is demonstrated; intermediate marks (24-27/30) if the student shows a good knowledge of all the topics covered in the exam; high marks (28-30/30) if the student shows an excellent knowledge of all the topics covered in the exam and excellent communication skills. The student is awarded with the highest mark (30 lode) if he will demonstrate ability to deepen the topics.
BIO/09 - PHYSIOLOGY - University credits: 11
Practicals: 16 hours
Lessons: 80 hours
Professor: Perego Carla

Linea MZ

Responsible
Lesson period
year
Teaching methods

Teaching lasts one year. The lessons of the first semester will be delivered through the Microsoft Teams platform and can be followed synchronously according to the scheduled timetable. If the situation allows it, the lessons of the second part of the year will be held in the classroom.
Similarly, the exercises (seminars and practical training) of the first semester will be administered through tutorials uploaded on the Ariel website while, according to the epidemiological situation, those scheduled in the second semester will be held in the classroom.
Please note that, regardless of the method of delivery, all exercises are mandatory.

Programme and reference material

The programme and reference material of the lectures will not be changed. All supporting teaching materials will always be made available at the Ariel platform.

Methods of learning verification and evaluation criteria

The examinations scheduled until January will take place in oral form using the Microsoft Teams platform. In this case, the duration of the test will be approximately 15-20 minutes and will mainly focus on ascertaining the student's ability to apply the knowledge acquired to physiological problems. Also the possible official in-progress check, at the beginning of the second semester, will be agreed according to the epidemiological emergency.
Course syllabus
PART I: CELL PHYSIOLOGY
The biological membranes
- Transports across the biological membranes
- Osmosis and osmotic pressure, oncotic pressure
- Diffusion
- Facilitated diffusion
- Active transports
The physiological buffer system
- Henderson-Hasselbach equation and the isohydric principle
- Chemical (bicarbonate, phosphate) and protein buffers
- Involvement of lung and kidneys in the pH regulation
The blood
- The body fluids
- The blood and its components.
- The corpuscular elements of the blood
- Red blood cells and hemoglobin
- Platelets and blood coagulation
- The white blood cells and the immune system
- The blood groups and Rh factors
Conduction of nerve signals
- Cells of the nervous system: neurons and glia
- membrane potentials and action potentials
- Nernst and Goldman-Hodgkin-Katz equations
- Transmission of the nerve impulse
- Synaptic transmission.
- Neurotransmitters and their membrane receptors
- Postreceptor signal pathways
- Role of calcium in the synaptic transmission
- Excitatory and inhibitory postsynaptic potentials
Physiology of the Muscle cell
- Classification of muscles: skeletal muscle, cardiac muscle, smooth muscle
- Structure of the skeletal muscle: the sarcomere
- The neuromuscular plate and muscle contraction
- Mechanisms involved in the contraction (cross-bridge cycling)
- Role of the ATP and calcium
- Types of muscle contraction: the cardiac and smooth muscle
- Biophysics of the muscle contraction

PART II: GENERAL PHYSIOLOGY AND PHYSIOLOGY OF INTEGRATED SYSTEMS (PIS)

Nervous System
- Physiology of normal skin
- The sensory perception
- Sensory receptors and signal transmission
- Progression of the sensory signals
- Special sensory organs: olfactive, gustative, auditory, vestibular and visual perception.
- Somatosensory and somatomotory connection
- Sensory cortex and motor cortex
- Autonomous nervous system and the control of the activity of the inner organs
- Central control of the motor activity (the example of Parkinson's disease)
- Spinal reflex and the local control of the motor activity
- Advanced levels of integration of the movements and posture: role of the inner ear, the basal ganglia, the reticular formation, the cerebellum and the cerebral cortex
- Higher functions of the cerebral cortex: learning and memory
- Elaboration of the thought, words and images
- The sleep; sleep-waking rhythms and sleep disturbance
- The limbic system, the behaviors and the relationships
PIS - Control of body temperature
PIS - Nociception and the control of the painful stimuli
The Endocrine System
- Neuroendocrinology: the hypotalamo-pituitary relationship, hypothalamic hormones, hormones of the neurohypophisis and of the anterior pituitary
- The "endocrine axes": hypotalamo-pituitary-thyroid, hypotalamo-pituitary -adrenal, hypotalamo-pituitary-gonadal axes
- Fertilization and pregnancy, sex determination and sexual differentiation, delivery and breast-feeding.
- Control of the body growth: the growth hormone of the growth factors
- Hormonal control of the glucose metabolism: insulin and glucagone.
- Hormonal control of the calcium and phosphate homeostasis: vitamin D, parathyroid hormone and calcitonin.
PIS - Nervous and hormonal control of the sexual and reproductive behavior
Cardiovascular system
- Heart and cardiac cycle
- Structure of the cardiac muscle
- Conduction system and the contraction in the heart.
- Variation of intracardiac pressures along the various phases of the cardiac cycle
- Frank-Starling law of the heart
- The electrocardiogram (ECG)
- Cardiac output and blood flow
- The relationship among flow, pressure and resistance.
- Laplace's law; the Bernoulli and Darcy law.
- Blood circulation: arteries, capillary and venous systems.
- Osmotic/oncotic pressure and edema
- Special districts of the blood circulation: muscles, coronary arteries, cerebrospinal fluid and lymphatic system
- Control of the circulation and of the arterial blood pressure
- Local control of the circulation. Central control and vasomotor centers.
The respiratory system
- Mechanical respiratory and pulmonary volumes
- Alveolar pulmonary gas exchange
- Transport of respiratory gases in the blood
- Role of red blood cells and of hemoglobin
- Dissociation curve of oxyhemoglobin and carboxyhemoglobin
- The chloride shift
- CO2 elimination
- Local and central control of the respiratory activity: role of the pH, CO2 and oxygen
- The bulbar respiratory centers
Renal function
- Glomerular filtration.
- Evaluation of the glomerular filtration pressure: role of the plasma proteins and of the arterial and Bowman's capsule pressure.
- The plasma clearance. Determination of the clearance of a substance and analysis of the renal function.
- Determination of the glomerular filtration rate, of the plasmatic flow and of the renal blood flow.
- Exchanges of substances along several tracts of renal tubule.
- The proximal renal tubule.
- The Henle's loop, the vasa recta, the counter current multiplier and the counter current exchanger
- The distal renal tubule and the urea cycle.
- Reabsorption of water and electrolytes: role of ADH and aldosterone.
- The urine acidification of urines.
- The control of the renal activity.
- The renin-angiotensin system and the long-term control of the arterial pressure.
PIS - Nervous and hormonal control of the drinking behavior
The digestive system
- Mechanical and nervous control of the activity of the digestive system
- Physiological aspects of swallowing
- Introduction to digestive processes of carbohydrates, fats, and proteins
- Introduction to the absorption of the alimentary nutrients, water and ions
- The function of the liver and of the gallbladder

[Program for not attending students with reference to descriptor 1 and 2]:
Program

PART I: CELL PHYSIOLOGY
The biological membranes
- Transports across the biological membranes
- Osmosis and osmotic pressure, oncotic pressure
- Diffusion
- Facilitated diffusion
- Active transports
The physiological buffer system
- Henderson-Hasselbach equation and the isohydric principle
- Chemical (bicarbonate, phosphate) and protein buffers
- Involvement of lung and kidneys in the pH regulation
The blood
- The body fluids
- The blood and its components.
- The corpuscular elements of the blood
- Red blood cells and hemoglobin
- Platelets and blood coagulation
- The white blood cells and the immune system
- The blood groups and Rh factors
Conduction of nerve signals
- Cells of the nervous system: neurons and glia
- membrane potentials and action potentials
- Nernst and Goldman-Hodgkin-Katz equations
- Transmission of the nerve impulse
- Synaptic transmission.
- Neurotransmitters and their membrane receptors
- Postreceptor signal pathways
- Role of calcium in the synaptic transmission
- Excitatory and inhibitory postsynaptic potentials
Physiology of the Muscle cell
- Classification of muscles: skeletal muscle, cardiac muscle, smooth muscle
- Structure of the skeletal muscle: the sarcomere
- The neuromuscular plate and muscle contraction
- Mechanisms involved in the contraction (cross-bridge cycling)
- Role of the ATP and calcium
- Types of muscle contraction: the cardiac and smooth muscle
- Biophysics of the muscle contraction

PART II: GENERAL PHYSIOLOGY AND PHYSIOLOGY OF INTEGRATED SYSTEMS (PIS)

Nervous System
- Physiology of normal skin
- The sensory perception
- Sensory receptors and signal transmission
- Progression of the sensory signals
- Special sensory organs: olfactive, gustative, auditory, vestibular and visual perception.
- Somatosensory and somatomotory connection
- Sensory cortex and motor cortex
- Autonomous nervous system and the control of the activity of the inner organs
- Central control of the motor activity (the example of Parkinson's disease)
- Spinal reflex and the local control of the motor activity
- Advanced levels of integration of the movements and posture: role of the inner ear, the basal ganglia, the reticular formation, the cerebellum and the cerebral cortex
- Higher functions of the cerebral cortex: learning and memory
- Elaboration of the thought, words and images
- The sleep; sleep-waking rhythms and sleep disturbance
- The limbic system, the behaviors and the relationships
PIS - Control of body temperature
PIS - Nociception and the control of the painful stimuli
The Endocrine System
- Neuroendocrinology: the hypotalamo-pituitary relationship, hypothalamic hormones, hormones of the neurohypophisis and of the anterior pituitary
- The "endocrine axes": hypotalamo-pituitary-thyroid, hypotalamo-pituitary -adrenal, hypotalamo-pituitary-gonadal axes
- Fertilization and pregnancy, sex determination and sexual differentiation, delivery and breast-feeding.
- Control of the body growth: the growth hormone of the growth factors
- Hormonal control of the glucose metabolism: insulin and glucagone.
- Hormonal control of the calcium and phosphate homeostasis: vitamin D, parathyroid hormone and calcitonin.
PIS - Nervous and hormonal control of the sexual and reproductive behavior
Cardiovascular system
- Heart and cardiac cycle
- Structure of the cardiac muscle
- Conduction system and the contraction in the heart.
- Variation of intracardiac pressures along the various phases of the cardiac cycle
- Frank-Starling law of the heart
- The electrocardiogram (ECG)
- Cardiac output and blood flow
- The relationship among flow, pressure and resistance.
- Laplace's law; the Bernoulli and Darcy law.
- Blood circulation: arteries, capillary and venous systems.
- Osmotic/oncotic pressure and edema
- Special districts of the blood circulation: muscles, coronary arteries, cerebrospinal fluid and lymphatic system
- Control of the circulation and of the arterial blood pressure
- Local control of the circulation. Central control and vasomotor centers.
The respiratory system
- Mechanical respiratory and pulmonary volumes
- Alveolar pulmonary gas exchange
- Transport of respiratory gases in the blood
- Role of red blood cells and of hemoglobin
- Dissociation curve of oxyhemoglobin and carboxyhemoglobin
- The chloride shift
- CO2 elimination
- Local and central control of the respiratory activity: role of the pH, CO2 and oxygen
- The bulbar respiratory centers
Renal function
- Glomerular filtration.
- Evaluation of the glomerular filtration pressure: role of the plasma proteins and of the arterial and Bowman's capsule pressure.
- The plasma clearance. Determination of the clearance of a substance and analysis of the renal function.
- Determination of the glomerular filtration rate, of the plasmatic flow and of the renal blood flow.
- Exchanges of substances along several tracts of renal tubule.
- The proximal renal tubule.
- The Henle's loop, the vasa recta, the counter current multiplier and the counter current exchanger
- The distal renal tubule and the urea cycle.
- Reabsorption of water and electrolytes: role of ADH and aldosterone.
- The urine acidification of urines.
- The control of the renal activity.
- The renin-angiotensin system and the long-term control of the arterial pressure.
PIS - Nervous and hormonal control of the drinking behavior
The digestive system
- Mechanical and nervous control of the activity of the digestive system
- Physiological aspects of swallowing
- Introduction to digestive processes of carbohydrates, fats, and proteins
- Introduction to the absorption of the alimentary nutrients, water and ions
- The function of the liver and of the gallbladder
Prerequisites for admission
Major knowledges of math, physics, general biology, anatomy and general chemistry are required for course attendance. Admission to the examination requires passing the propaedeutic courses.
Teaching methods
In-class lessons and exercises (seminars and practical training),
in-progress multimedia checks.
Teaching Resources
ARIEL website for the course (slides, articles, videos etc.)
http://rmaggif.ariel.ctu.unimi.it/v1/home/Default.aspx

REFERENCE TEXTBOOK (includes e-book)
Carbone, Aicardi, Maggi FISIOLOGIA: Dalle Molecole ai Sistemi Integrati, EdiSES

OTHER SUGGESTED TEXTBOOK (english language, alphabetical order)

Berne & Levy, Physiology, Elsevier
Barman, Barrett, Boitano and Brooks, Ganong's Review of Medical Physiology, Mc Graw Hill
Germann & Stanfield, Human Physiology, Pearson
Guyton & Hall, Medical Physiology, Elsevier
Rhoades e Pflanzer, Human Physiology, Saunders
Rhoades & Tanner, Medical Physiology, Wolters Kluwer
Sherwood, Human Physiology: From Cells to Systems, Brooks/Cole
Silverthorn Human Physiology: An Integrated Approach, Pearson
Assessment methods and Criteria
The examination consists of an interview on the topics included in the course programme.
It will be organized in one first question concerning cell Physiology programme (to be successfully passed) followed by 2-3 questions on general Physiology.
It will be agreed annually with the students a possible official in-progress check, at the end of the first semester, by means of a multiple-choice written test, with optional acceptance of the result expressed in thirtieths. This test will include the cellular Physiology program and, if passed successfully, it will replace the first question of the final interview.
BIO/09 - PHYSIOLOGY - University credits: 11
Practicals: 16 hours
Lessons: 80 hours
Professor: Maggi Roberto
Professor(s)
Reception:
Tuesday, a notice would be appreciated.
Via G. Balzaretti, 9 - floor 4°