1. 1-1 Chapter 1 Lecture Outline Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

2. 1-2 Major Themes of Anatomy and Physiology Form and Function Origins of Biomedical Science Scientific Method Organism Organ system Organ Tissue Cell Organelle Macromolecule Molecule Atom Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.7

3. 1-3 Human Origins and Adaptations Human Structure Human Function Language of Medicine Major Themes of Anatomy and Physiology 2 Organism Organ system Organ Tissue Cell Organelle Macromolecule Molecule Atom Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.7

4. 1-4 Anatomy - The Study of Form Examining structure of the Human Body –inspection –palpation –auscultation –percussion Cadaver dissection –cutting and separation of tissues to reveal their relationships Comparative anatomy –study of more than one species in order to examine structural similarities and differences, and analyze evolutionary trends

5. 1-5 Exploratory Surgery –open body and take a look inside Medical imaging –viewing the inside of the body without surgery –Radiology – branch of medicine concerned with imaging Gross Anatomy –study of structures that can be seen with the naked eye Cytology –study of structure and function of cells Histology (microscopic anatomy) –examination of cells with microscope Ultrastructure –the molecular detail seen in electron microscope Histopathology –microscopic examination of tissues for signs of disease Anatomy - The Study of Form

6. 1-6 Physiology - The Study of Function Subdisciplines –neurophysiology (physiology of nervous system) –endocrinology (physiology of hormones) –pathophysiology (mechanisms of disease) Comparative Physiology –limitations on human experimentation –study of different species to learn about bodily function animal surgery animal drug tests –basis for the development of new drugs and medical procedures

7. 1-7 Greek and Roman Legacy Physicians in Mesopotamia and Egypt –3000 years ago used herbal drugs, salts and physical therapy Hippocrates - Greek physician –“father of medicine” –established a code of ethics (Hippocratic Oath) –urged physicians to seek natural causes of disease rather than attributing them to acts of the gods and demons

8. 1-8 Aristotle –one of the first philosophers to write about anatomy and physiology –believed that diseases had either supernatural causes or physical causes called supernatural causes of disease theologi called natural causes for disease physiologi this gave rise to the terms: physician and physiology –believed that complex structures are built from simpler parts Greek and Roman Legacy

9. 1-9 Claudius Galen – physician to the Roman gladiators – did animal dissections since use of cadavers banned in his time –saw science as a method of discovery not just a body of facts taken on faith –wrote book advising followers to trust their own observation more than the teaching of dogma of the “ancient masters” Greek and Roman Legacy

10. 1-10 Birth of Modern Medicine Christian culture of Europe in Middle Ages –science severely repressed –taught medicine primarily as dogmatic commentary on Galen and Aristotle –crude medical illustrations In Jewish and Muslim cultures free inquiry was less inhibited Jewish physician Maimonides (Moses ben Maimon) –wrote 10 influential medical texts – was physician to Egyptian sultan, Saladin Avicenna (Ibn Sina) from Muslim world –“the Galen of Islam” –combined Galen and Aristotle findings with original discoveries –wrote The Canon of Medicine, used in medical schools for 500 years

11. 1-11 Birth of Modern Medicine around the 16 th century Andreas Vesalius –taught anatomy in Italy –Catholic Church relaxed restrictions on dissection of cadavers and permitting autopsies –barbering and surgery were considered ‘kindred arts of the knife’ –performed his own dissections rather than the barber-surgeons –published first atlas of anatomy, Di Humani Corporis Fabrica (On the Structure of the Human Body) in 1543 William Harvey –early physiologist…contributions represent the birth of experimental physiology –remembered for early studies on blood circulation –realized blood flows out from heart and back to it again –published book De Motu Cordis (On the Motion of the Heart) in 1628 –Michael Servetus, along with Harvey, were the first Western scientists to realize that blood must circulate continuously around the body, from the heart to other organs, and back to the heart again

12. 1-12 Early Medical Illustrations Figure 1.3 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Art Resource© SPL/Photo Researchers, Inc. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.2

13. 1-13 Robert Hooke –made many improvements to the compound microscope -2 lenses- ocular lens (eyepiece) and objective lens (near specimen) invented specimen stage, illuminator, coarse and fine focus controls his microscopes magnified only 30X first to see and named ‘cells’ –published first comprehensive book of microscopy (Micrographia) in 1665 Antony van Leeuwenhoek –invented a simple (single-lens) microscope with great magnification to look at fabrics (200X) –published his observations of blood, lake water, sperm, bacteria from tooth scrapings and many other things Birth of Modern Medicine

14. 1-14 Carl Zeiss & Ernst Abbe –greatly improved compound microscopes –added condenser and superior optics eliminated blurry edges (spherical aberration) and rainbow-like distortions (chromatic aberration ) Matthias Schleiden and Theodor Schwann –with improved microscopes, examination of a wide variety of specimens followed –concluded that “all organisms were composed of cells” –first tenet of Cell Theory considered as the most important breakthrough in biomedical history all functions of the body are interpreted as effects of cellular activity Birth of Modern Medicine

15. 1-15 Early Compound Microscopes The first cells seen were plant cell walls in a section of dried cork. Figure 1.4 (a) (b) Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. a: Courtesy of the Armed Forces Institute of Pathology; b: © Corbis–Bettmann

16. 1-16 Living in a Revolution Modern biomedical science –technological enhancements advances in Medical Imaging have enhanced our diagnostic ability and life-support strategies Genetic Revolution human genome is finished gene therapy is being used to treat disease Early pioneers were important –established scientific way of thinking –replaced superstition with natural laws

17. 1-17 Scientific Method Francis Bacon, in England, and Rene Descartes, in France –philosophers who invented new habits of scientific thought –sought systematic way of seeking similarities, differences, and trends in nature and drawing useful generalizations from observable facts Governments of England and France –established academies of science -- still exist today Science and scientific methods –set standards for truth

18. 1-18 Inductive Method Described by Francis Bacon –making numerous observations until one becomes confident in drawing generalizations and predictions from them –knowledge of anatomy obtained by this method Proof in science –reliable observations –tested and confirmed repeatedly –not falsified by any credible observation In science, all truth is tentative –“proof beyond a reasonable doubt ”

19. 1-19 Hypothetico-Deductive Method more physiological knowledge gained by this method investigator asks a question formulates a hypothesis- an educated speculation or possible answer to the question –characteristics of a good hypothesis consistent with what is already known testable and possibly falsifiable with evidence Falsifiability – if we claim something is scientifically true, we must be able to specify what evidence it would take to prove it wrong Hypothesis - to suggest a method for answering questions - are written as ‘If-Then’ statements

20. 1-20 Experimental Design Sample size –number of subjects used in a study –controls for chance events and individual variation Controls –control group and treatment group –comparison of treated and untreated individuals Psychosomatic Effects –effects of the subject’s state of mind on his or her physiology –use of placebo in control group

21. 1-21 Experimenter bias –prevented with double-blind study Statistical testing –provides statements of probability –difference between control and test subjects was not random variation –results due to the variable being tested Proper Experimental Design

22. 1-22 Peer Review Critical evaluation by other experts in the field –done prior to funding or publication –done by using verification and repeatability of results Ensures honesty, objectivity and quality in science

23. 1-23 Facts, Laws and Theories Scientific fact –information that can be independently verified by a trained person Law of nature –generalization about the predictable way matter and energy behave results from inductive reasoning and repeated observations written as verbal statements or mathematical formulae Theory –an explanatory statement or set of statements derived from facts, laws, and confirmed hypotheses summarizes what we know suggests direction for further study

24. 1-24 Human Origins & Adaptations Charles Darwin –On the Origin of Species by Means of Natural Selection (1859) – ‘book that shook the world’ –The Descent of Man (1871) – human evolution Theory of natural selection –how species originate and change through time –changed view of “our origin, our nature and our place in the universe” –increases understanding of human form and function

25. 1-25 Evolution, Selection, and Adaptation Evolution –change in genetic composition of population of organisms development of bacterial resistance to antibiotics appearance of new strains of AIDS virus Natural Selection –some individuals within a species have hereditary advantage over their competitors better camouflage disease resistance ability to attract mates –produce more offspring and advantage passed on –Selection Pressures – natural forces that promote the reproductive success of some individuals more than others

26. 1-26 Evolution, Selection, and Adaptation Adaptations – features of an organism’s anatomy, physiology, or behavior that have evolved in response to these selection pressures and enable the organism to cope with the challenges of its environment. –Model – animal species selected for research on a particular problem

27. 1-27 Animal Relations Closest relative - chimpanzee –difference of only 1.6% in DNA structure –chimpanzees and gorillas differ by 2.3% Study of evolutionary relationships –help us chose animals for biomedical research (the animal model) –rats and mice used extensively due to issues involved with using chimpanzees

28. 1-28 Vestiges of Human Evolution Vestigial Organs – remnants of organs that apparently were better developed and more functional in the ancestors of a species, and now serve little or no purpose –piloerector muscle –auricularis muscles

29. 1-29 Life in the Trees Primates – order of mammals to which humans, monkeys, and apes belong Earliest Primates –squirrel-sized, arboreal, insect-eating African mammals –moved to trees due to safety, food supply and lack of competition Adaptations for arboreal (treetop) life style –mobile shoulders –opposable thumbs made hands prehensile to grasp branches and encircle them with the thumb and finger –forward-facing eyes (stereoscopic vision) depth perception for leaping and catching prey –color vision distinguish ripe fruit and young, less toxic foliage –larger brains and good memory remember food sources and improved social organization

30. 1-30 Walking Upright African forest became grassland 4-5 million years ago –producing more predators and less protection Bipedalism - standing and walking on 2 legs –helps spot predators, carry food or infants Adaptations for bipedalism –skeletal and muscular modifications –increased brain volume –family life and social changes

31. 1-31 Australopithecus – oldest bipedal primate Homo genus (appeared 2.5 million years ago) taller, larger brain volume, probable speech, tool-making Homo erectus (appeared 1.8 million years ago) –migrated from Africa to parts Asia Other Homo species discovered recently still matter of considerable debate Homo sapiens originated in Africa 200,000 years ago –sole surviving hominid species Evolutionary (darwinian) medicine traces some of our diseases and imperfections to our past Walking Upright

32. 1-32 Hierarchy of Complexity Organism is composed of organ systems Organ Systems composed of organs Organs composed of tissues Tissues composed of cells Cells composed of organelles Organelles composed of molecules Molecules composed of atoms Organism Organ system Organ Tissue Cell Organelle Macromolecule Molecule Atom Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.7

33. Hierarchy of Complexity Organism – a single, complete individual Organ System – human body made of 11 organ systems Organ – structure composed of two or more tissue types that work together to carry out a particular function Tissue – a mass of similar cells and cell products that form discrete region of an organ and performs a specific function Cells – the smallest units of an organism that carry out all the basic functions of life –Cytology – the study of cells and organelles Organelles – microscopic structures in a cell that carry out its individual functions Molecules – make up organelles and other cellular components –macromolecules – proteins, carbohydrates, fats, DNA Atoms – the smallest particles with unique chemical identities 1-33

34. Hierarchy of Complexity Reductionism – theory that a large, complex system such as the human body can be understood by studying its simpler components –first espoused by Aristotle –highly productive approach –essential to scientific thinking Holism – there are ‘emergent properties’ of the whole organism that cannot be predicted from the properties of the separate parts –humans are more than the sum of their parts –complementary theory to reductionism 1-34

35. 1-35 Anatomical Variation No two humans are exactly alike –70% most common structure –30% anatomically variant –variable number of organs missing muscles, extra vertebrae, renal arteries –variation in organ locations (situs solitus, situs inversus, dextrocardia, situs perversus) Figure 1.8 Variations in branches of the aorta Normal Pelvic kidneyHorseshoe kidney Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

36. 1-36 Characteristics of Life Organization Cellular composition Metabolism –anabolism, catabolism and excretion Responsiveness and movement –stimuli Homeostasis Development –differentiation and growth Reproduction Evolution –mutations

37. 1-37 Physiological Variation Sex, age, diet, weight, physical activity Typical physiological values –reference man 22 years old, 154 lbs, light physical activity consumes 2800 kcal/day –reference woman same as man except 128 lbs and 2000 kcal/day Overmedication of elderly

38. 1-38 Homeostasis Homeostasis – the body’s ability to detect change, activate mechanisms that oppose it, and thereby maintain relatively stable internal conditions Claude Bernard (1813-78) –constant internal conditions regardless of external conditions internal body temperature ranges from 97 to 99 degrees despite variations in external temperature Walter Cannon (1871-1945) –coined the term ‘Homeostasis’ –state of the body fluctuates (dynamic equilibrium) within limited range around a set point –Negative feedback keeps variable close to the set point Loss of homeostatic control causes illness or death

39. 1-39 Negative Feedback Loop Body senses a change and activates mechanisms to reverse it - dynamic equilibrium (a) 3 4 5 6 1 2 Room temperature falls to 66°F (19°C) Room cools down Thermostat activates furnace Thermostat shuts off furnace Room temperature rises to 70°F (21°C) Heat output Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. C 10°15°20°25° F 50°60°70°80° C 10°15°20°25° F 50°60°70°80° Figure 1.9a

40. 1-40 Negative Feedback, Set Point Room temperature does not stay at set point of 68 degrees -- it only averages 68 degrees (b) Room temperature (°F) Time Furnace turned off at 70°F Set point 68°F Furnace turned on at 66°F Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 75 70 65 60 Figure 1.9b

41. 1-41 Negative Feedback in Human Thermoregulation Brain senses change in blood temperature –if to warm, vessels dilate (vasodilation) in the skin and sweating begins (heat losing mechanisms) –if too cold, vessels in the skin constrict (vasoconstriction) and shivering begins (heat gaining mechanism) Time Sweating Set point Vasoconstriction Vasodilation 36.5°C (97.7°F) 37.0°C (98.6°F) 37.5°C (99.5°F) Shivering Core body temperature Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.10

42. 1-42 Negative Feedback Control of Blood Pressure Sitting up in bed causes a drop in blood pressure in the head and upper thorax Baroreceptors in the arteries near the heart alert the cardiac center in the brainstem Cardiac center sends nerve signals that increase the heart rate and return the blood pressure to normal Failure of this to feedback loop may produce dizziness in the elderly

43. 1-43 Control of Blood Pressure Blood drains from upper body, creating homeostatic imbalance Baroreceptors above heart respond to drop in blood pressure Baroreceptors send signals to cardiac center of brainstem Blood pressure rises to normal; homeostasis is restored Person rises from bed Cardiac center accelerates heartbeat Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.11

44. 1-44 3 Components of a Feedback Loop Receptor - senses change in the body Integrating (Control) Center - control center that processes the sensory information, ‘makes a decision’, and directs the response Effector – carries out the final corrective action to restore homeostasis

45. 1-45 Positive Feedback Loops Self-amplifying cycle –leads to greater change in the same direction –feedback loop is repeated – change produces more change Normal way of producing rapid changes –occurs with childbirth, blood clotting, protein digestion, fever, and generation of nerve signals Head of fetus pushes against cervix 2 3 4 1 Oxytocin stimulates uterine contractions and pushes fetus toward cervix Nerve impulses from cervix Transmitted to brain Brain stimulates pituitary gland to secrete oxytocin Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.12

46. 1-46 Harmful Positive Feedback Loop Fever > 104 degrees F –metabolic rate increases –body produces heat even faster –body temperature continues to rise –further increasing metabolic rate Cycle continues to reinforce itself Becomes fatal at 113 degrees F

47. 1-47 Anatomical Terminology Standard International Anatomical Terminology –Terminologia Anatomica was codified in 1998 by professional associations of anatomists About 90% of medical terms from 1,200 Greek and Latin roots Naming confusion during the Renaissance –same structures with different names in different countries –structures named after people (eponyms) 1895 Nomina Anatomica (NA) –rejected all eponyms –each structure given a unique Latin name to be used worldwide

48. 1-48 Analyzing Medical Terms Terminology based on word elements –lexicon of 400 word elements on the inside the back cover of textbook Scientific terms –one root (stem) with core meaning –combining vowels join roots into a word –prefix modifies core meaning of root word –suffix modifies core meaning of root word Acronyms formed from first letter, or first few letters of series of words –Calmodulin comes from the phrase - calcium modulating protein

49. 1-49 Useful Tables in Textbook

50. 1-50 Plural, Adjectival, and Possessive Forms Plural forms not always easy –ovary – ovaries, cortex – cortices, corpus – corpora, epididymis – epididymides Adjectival form of same word –brachium denotes ‘arm’- digits – fingers and toes –brachii denotes ‘of the arm’- digiti – of a single finger or toe - digitorum – of multiple fingers or toes 3 examples of positive, comparative, and superlative degrees of comparison English – large, larger, and largest Latin - magnus means large, major means larger of 2, while maximus is largest of 3 being compared Adjectives often follow the noun in a name foramen magnum or pectoralis major

51. 1-51 Importance of Precision Be precise in your terms Spell correctly Health Care professions demand the same type of precision People’s lives will be in your hands

52. 1-52 Review of Major Themes Cell Theory –All structure and function result from the activity of cells Homeostasis –The purpose of most normal physiology is to maintain stable conditions within the body Evolution –The human body is a product of evolution Hierarchy of Structure –Human structure can be viewed as a series of levels of complexity Unity of Form and Function –Form and function complement each other; physiology cannot be divorced from anatomy

53. 1-53 Medical Imaging Radiography (x rays) –William Roentgen - 1885 –penetrate tissues to darken photographic film beneath the body –dense tissue appears white –over half of all medical imaging –until 1960’s, it was the only method widely available

54. 1-54 Medical Imaging Radiopaque substances –injected or swallowed –fills hollow structures blood vessels intestinal tract (b) Cerebral angiogram Custom Medical Stock Photo, Inc. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Figure 1.13b

55. 1-55 Medical Imaging Computed Tomography (CT scan) –formerly called a CAT scan –low-intensity X rays and computer analysis slice type image increased sharpness of image Figure 1.13c (c) Computed tomographic (CT) scan © CNR/Phototake Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

56. 1-56 Medical Imaging - Nuclear Medicine Positron Emission Tomography (PET scan) –assesses metabolic state of tissue –distinguished tissues most active at a given moment –mechanics inject radioactively labeled glucose –positrons and electrons collide –gamma rays given off –detected by sensor –analyzed by computer –image color shows which tissues were using the most glucose at that moment –damaged tissues appear dark

57. 1-57 Medical Imaging Magnetic Resonance Imaging (MRI) –slice type image –superior quality to CT scan –best for soft tissue –mechanics alignment & realignment of hydrogen atoms with magnetic field & radio waves varying levels of energy given off used by computer to produce an image (e) Magnetic resonance image (MRI) Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. © Monte S. Buchsbaum, Mt. Sinai School of Medicine, New York, NY Figure 1.13e

58. 1-58 Medical Imaging Sonography –second oldest & second most widely used –mechanics high-frequency sound waves echo back from internal organs –avoids harmful x rays obstetrics image not very sharp Figure 1.14 (a) (b) © Alexander Tsiaras/Photo Researchers, Inc.; (inset): Ken Saladin Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.