System diseases 1
A.A. 2023/2024
Obiettivi formativi
The System Diseases 1 course takes the students into clinical medicine with the study of the "Diseases of the Kidney and Urinary System" (Nephrology) and the "Diseases of the Heart and Vessels" (Cardiology). Such studies will be dealt on a comprehensive basis, i.e. including Diagnostic Imaging, Pathology, Clinical Biochemistry and Microbiology, in relation to the diseases of the organ.
CARDIOVASCULAR DISEASES
This module will focus on some relevant aspects of cardiology, which shall be discussed with a predominantly pathophysiological approach. A more clinical and therapy oriented approach will be in place at 5th year, in the exam of Translational Cariovascular Medicine and Surgery.
NEPHROLOGY
The purpose of this module is to provide essential knowledge of the kidney role in maintaining the body homeostasis, both in patients with renal diseases and in patients with other conditions, such as arterial hypertension and diabetes mellitus, in which kidneys play a pivotal role in the genesis and the response of the organism to the disease process. The module offers the unique opportunity to systematically explore specific renal disorders, like the glomerulopathies, and an introduction to very relevant clinical syndromes, such as acute and chronic kidney disease.
Course Relevance: The knowledge of signs and symptoms (semeiotics) in nephrology and the ability to identify the clinical presentation of renal diseases represent an essential part of the medical heritage and practice. It is of utmost importance in the everyday clinical and surgical practice, if we consider the high incidence of both acute (mostly in surgical setting) and chronic kidney injury (mostly in internal medicine). Also, the ability to detect the first signs and symptoms of a specific renal disease is crucial for an early nephrology referral. Despite the intended field of specialization in medicine, we believe that this module is very important both for the future physician and the future surgeon.
MICROBIOLOGY
The main purpose of the module is the understanding of the role of microorganisms, as etiological agents or cofactors, in the pathogenesis of myocardial/cardiac (cardiology module) and urinary tract diseases nephrology module).
Every lecture will focus on four main aspects: the epidemiology of the involved microorganisms, the mechanisms of pathogenesis employed by the microorganisms, the diagnostic approaches for the detection of the microorganisms, and, when available, the antimicrobial therapies.
PATHOLOGY
The first part of the course will focus on the definition of Anatomic Pathology and on its contribution in modern medicine. The organization of the work flow at a Pathology Department, with particular focus on its three major sections (histology, cytology and autopsy) will be described, together with the structure and the contents of a modern pathological report. Principles, applications and clinical implications of some ancillary techniques of the anatomic pathology such as immunohistochemistry and molecular pathology will also be considered in detail.
The second part of the course will deal with the anatomic pathology of the heart. In particular, lectures will be focused on the pathogenetic mechanisms, morphologic changes, evolution and complications of the diseases involving the most important structures of the heart (myocardium, endocardium and valves, pericardium) and the blood vessels.
DIAGNOSTIC IMAGING
The module is focused on explaining the different interactions between iodizing and non iodizing radiation and matter in order to obtain diagnostic images (i.e. x rays, sonography and magnetic resonance imaging) and the use of radiopharmaceuticals in Nuclear Medicine. The course is also designed to highlight the different diagnostic capabilities of imaging techniques in detecting and characterizing pathologic conditions in the cardiovascular and urinary systems.
In particular, the course will focus on conditions such as ischemic heart disease, valvular heart disease, urinary tract stones, infections and tumors.
CARDIOVASCULAR DISEASES
This module will focus on some relevant aspects of cardiology, which shall be discussed with a predominantly pathophysiological approach. A more clinical and therapy oriented approach will be in place at 5th year, in the exam of Translational Cariovascular Medicine and Surgery.
NEPHROLOGY
The purpose of this module is to provide essential knowledge of the kidney role in maintaining the body homeostasis, both in patients with renal diseases and in patients with other conditions, such as arterial hypertension and diabetes mellitus, in which kidneys play a pivotal role in the genesis and the response of the organism to the disease process. The module offers the unique opportunity to systematically explore specific renal disorders, like the glomerulopathies, and an introduction to very relevant clinical syndromes, such as acute and chronic kidney disease.
Course Relevance: The knowledge of signs and symptoms (semeiotics) in nephrology and the ability to identify the clinical presentation of renal diseases represent an essential part of the medical heritage and practice. It is of utmost importance in the everyday clinical and surgical practice, if we consider the high incidence of both acute (mostly in surgical setting) and chronic kidney injury (mostly in internal medicine). Also, the ability to detect the first signs and symptoms of a specific renal disease is crucial for an early nephrology referral. Despite the intended field of specialization in medicine, we believe that this module is very important both for the future physician and the future surgeon.
MICROBIOLOGY
The main purpose of the module is the understanding of the role of microorganisms, as etiological agents or cofactors, in the pathogenesis of myocardial/cardiac (cardiology module) and urinary tract diseases nephrology module).
Every lecture will focus on four main aspects: the epidemiology of the involved microorganisms, the mechanisms of pathogenesis employed by the microorganisms, the diagnostic approaches for the detection of the microorganisms, and, when available, the antimicrobial therapies.
PATHOLOGY
The first part of the course will focus on the definition of Anatomic Pathology and on its contribution in modern medicine. The organization of the work flow at a Pathology Department, with particular focus on its three major sections (histology, cytology and autopsy) will be described, together with the structure and the contents of a modern pathological report. Principles, applications and clinical implications of some ancillary techniques of the anatomic pathology such as immunohistochemistry and molecular pathology will also be considered in detail.
The second part of the course will deal with the anatomic pathology of the heart. In particular, lectures will be focused on the pathogenetic mechanisms, morphologic changes, evolution and complications of the diseases involving the most important structures of the heart (myocardium, endocardium and valves, pericardium) and the blood vessels.
DIAGNOSTIC IMAGING
The module is focused on explaining the different interactions between iodizing and non iodizing radiation and matter in order to obtain diagnostic images (i.e. x rays, sonography and magnetic resonance imaging) and the use of radiopharmaceuticals in Nuclear Medicine. The course is also designed to highlight the different diagnostic capabilities of imaging techniques in detecting and characterizing pathologic conditions in the cardiovascular and urinary systems.
In particular, the course will focus on conditions such as ischemic heart disease, valvular heart disease, urinary tract stones, infections and tumors.
Risultati apprendimento attesi
1) Adaptation of cellular growth and differentiation Mechanisms of cellular injury and cell death (necrosis, apoptosis, autophagy, pyroptosis, necroptosis) Reactive oxygen species (ROS): types, source, effects Balance between ROS and antioxidants in human health and unbalance in human disease Intracellular accumulations of endogenous and exogenous substances Molecular and cellular aspects of protein misfolding and mechanisms of protein-folding diseases The stem cell and the concept of pluripotency Main properties of embryonic and adult stem cells The hematopoietic stem cell as a paradigm of adult stem cells Reprogrammed cells and induced pluripotency Somatic cell reprogramming by nuclear transfer ("therapeutic cloning") Hallmarks of aging Genetic and biochemical changes in aging Cellular senescence Stem cell exhaustion Altered intercellular communication Sources, biochemical functions, and health benefits of energy-releasing and energy-converting vitamins (B1, B2, B3, B5, B6, B7), and deficiency-related diseases Sources, biochemical functions, and health benefits of hematopoietic vitamins (B9, B12), vitamin C, and deficiency-related diseases Lipid-soluble vitamins (A, D, E, K), and deficiency/excess-related diseases
2) Effect of mutations on protein function Mechanism linking mutations to disease Same gene, different phenotypes; different genes, same phenotype Mutation not affecting coding gene sequences Molecular basis of reduced penetrance in human inherited diseases Identification of genetic risk factors in complex diseases Common versus rare variant hypothesis in neurodegenerative disorders Lessons from studying monogenic disease for common disease: the genetics of Alzheimer disease and mellitus diabetes Epigenetic mechanisms Epigenetic modifications and environment Role of epigenetics in human diseases Mechanisms of action of miRNA and lncRNA Role of miRNA and lncRNA in human diseases Genetic variation and drug response Genetic variation and personalized medicine
3) Microbiota in health and disease Basics of bacterial cell structure Properties of bacterial cell walls (Gram staining, structure of peptidoglycan, LPS structure and role in human pathogenesis, target sites for antibiotics) The genetic makeup of bacteria Mechanisms of bacterial virulence: secretory, membrane-associated, and cytosolic factors. Structure, regulation, expression and their contribution to pathogenesis and immune evasion. The eukaryotic nature of fungi and their classification The fungal relationships with humans: basic pathogenic mechanisms for opportunistic and invasive infections. Structure, morphology, genome organization and virulence factors of parasites Pathogenesis of Giardia, Trichomonas, Plasmodii, and intestinal nematodes Structure, morphology, genome organization and evolution theories of viruses Classification of the viruses infecting humans Replication's strategies Mechanisms of viral pathogenesis Determinants of communicable diseases
4) Structures, genome organization, replication properties and pathogenesis of clinical relevant human picornaviruses. Structures, genome organization, replication properties and pathogenesis of clinical relevant human flaviviruses. Structures, genome organization, replication properties and pathogenesis of the human viruses belonging to the viral families: togaviridae, coronaviridae, rhabdoviridae Structures, genome organization, replication properties and pathogenesis of the viruses belonging to the viral families: orthomixoviridae, paramixoviridae, and pneumoviridae. Structures, genome organization, replication properties and pathogenesis of the viruses belonging to the viral families: filoviridae, arenaviridae, bunyaviridae. Structures, genome organization, replication and pathogenesis of the major viruses causing hepatitis. Structures, genome organization, replication and pathogenesis of the major viruses causing hepatitis (II). Structures, genome organization, replication properties and pathogenesis of the human herpesviruses. Structures, genome organization, replication properties and pathogenesis of the viruses belonging to the viral families: parvoviridae, adenoviridae, papillomaviridae. Structures, genome organization, replication properties and pathogenesis of the human polyomaviruses. Structures, genome organization, and replication properties of HIV. Pathogenesis of HIV. Structures, genome organization, replication properties and pathogenesis of the human delta retroviruses (HTLV-I and II). Structures and pathogenesis of the prions.
5) Classification, pathogenetic mechanisms and diagnostic aspects of most clinically relevant bacteria. Staphylococcus, Streptococcus, Enterococcus. Corynebacterium diphtheriae. Listeria monocytogenes, Legionella pneumophila, Chlamydiae, Neisseriae. Haemophilus influenzae. Bordetella pertussis. Campylobacter, Helicobacter pylori, Vibrio cholerae, Pseudomonas aeruginosa, Acinetobacter. Clostridia and bacilli Mycobacteria Fungi (Candida, Cryptococcus, Aspergillus, dermatophytes, Blastomyces, Coccidioides, Histoplasma, Pneumocystis). The burden of nosocomial infections Anti-microbial resistance Superbugs (MRSA, VRE, KPC)
6) The hematopoietic niche and hematopoietic stem cells Hematopoietic lineages and cytokines The normal and altered blood counts Biological and physical barriers of innate immunity Cardinal signs of acute inflammation Blood flow alterations and vascular permeability The endothelium as a reactive biological structure Mast cells, phagocytes and NK cells Molecular mediators active on vessels Molecular mediators active on leukocytes Primary inflammatory cytokines Eicosanoids Cell adhesion: adhesion molecules and cell migration, the chemokine system Pathogen-Associated Molecular Patterns (PAMPs) and Pathogen Recognition Receptors (PRRs) Danger-Associated Molecular Patterns (DAMPs) and their receptors The TLR system Intracellular PRR Opsonic receptors Genetic defects in pathogen recognition Complement system: Activation pathways, functions, regulatory mechanisms, genetic defects in the complement system Mechanisms of cell-mediated cytotoxicity: phagocytosis and degranulation Oxygen-dependent mechanisms, oxygen independent mechanisms, opsonic agents Genetic defects in pathogen killing mechanisms Energy for immunity Metabolic signatures and profiles of key immune cells Metabolic control of immune responses Neutrophils metabolism and bioenergetics of anti-microbial action Metabolism of macrophages Metabolic shifts in macrophage activation and polarization Negative regulators of the inflammatory response The hypothalamic-pituitary-adrenal axis Anti-inflammatory cytokines and eicosanoids Stem cells and growth factors in tissue renewal Multistep process of tissue repair, fibrosis, anomalies in wound healing Distinct types of chronic inflammation Cellular and molecular effectors of chronic inflammation Macrophage polarization in chronic inflammatory responses Systemic inflammation: Fever, leukocytosis, acute phase proteins
7) Key features of acquired immunity: specificity, memory, tolerance The lymphoid system Primary and secondary lymphoid tissues, lymphatic vessels The antigen: source, structure, processing Thymus-dependent and thymus-independent antigens Structure and function of Major Histocompatibility Complex I and II MHC-I and MHC-II loci organization Superantigens Professional and non-professional antigen presenting cells Dendritic cells origin and subsets Dendritic cells maturation and migration Costimulatory molecules Intrathymic development Positive and negative selection of T lymphocytes TCR structure and repertoire generation Central and peripheral tolerance The TCR/CD3 signalling complex and transduction pathways Helper and cytotoxic T lymphocytes BCR signalling and B cell activation Antibody classes: structure and functions Isotype switch Antibody classes in primary and secondary immune responses Affinity maturation T helper subsets and polarized immune responses Differentiation and signalling in T helper cells Immune response polarization in pathology T cell / macrophage crosstalk in chronic inflammatory responses Impact on effector cells Immune granulomata: an immune perspective Regulatory T cells Myeloid regulatory cells Metabolic differences between innate and adaptive immunity Metabolism of specific T cell lineages T cell metabolism changes during immune response Vaccines and their development
8) Recognition of viral infection by the immune system Effector mechanisms against viral infections Viral strategies for evading antiviral immune responses Recognition of intracellular infection by the immune system Microbial strategies for evading immune responses The mucosal immune system Mucosal immunity and commensal microorganisms Mucosal immunity to pathogenic microbes General issues on hypersensitivity reactions Type I hypersensitivity Type II hypersensitivity Type III hypersensitivity Type IV hypersensitivity The multifactorial pathogenesis of autoimmune diseases Failure mechanisms of the central and peripheral tolerance Effector mechanisms of autoimmune reactions Immune mechanisms of the most common autoimmune diseases Differential features of autoimmune vs autoinflammatory diseases Immune deficiency caused by defects in innate immunity Immune deficiency caused by defects in B and T maturation Iatrogenic immunodeficiencies HIV infection and immune response Acquired immune deficiency syndrome (AIDS) pathogenesis Animal models to assess HIV-1 infection and AIDS pathogenesis Immunological basis of allograft rejection Major and minor histocompatibility antigens Molecular basis of direct and indirect allorecognition Mechanisms of hyperacute, acute and chronic rejection graft-versus-host disease Age-related changes in the innate immune system Age-related changes in the adaptive immune system Impact of immunosenescence on diseases and vaccination Tissue immunometabolism: relationships in the gastrointestinal tract, liver, and adipose tissue Relationships between systemic metabolism and immunity Vitamins in the control of immunity Obesity as a multifactorial disease Immunological implications of obesity
9) Definition of cancer and epidemiology Tumor nomenclature, TNM classification Differentiation and cell grading, rate of growth Local invasion Metastasis, pathways of spread Oncogenic signaling and tumor microenvironment as drivers of cancer metabolism Tumor sensing and metabolic adaptations to hypoxia and nutrient deprivation Signals and targets of metabolic reprogramming in cancer cells Advantages and liabilities of tumor cell metabolism Genes in which mutations cause cancer: oncogenes, tumor suppressor genes (gatekeepers and caretakers genes) Type of genetic alterations responsible for initiating cancer Activating or gain of function mutations Ectopic or heterochronic mutations Chromosome translocations Loss of function mutations Genomic instability and tumor progression Activated oncogenes in hereditary cancer syndrome: MEN2 Gatekeeper tumor suppressor genes in AD cancer syndromes The two-hit origin of cancer: the hereditary and sporadic forms of retinoblastoma The Li-Fraumeni syndrome Caretaker gene in autosomal dominant cancer syndromes BRCA1 and BRCA2 mutations in familial breast cancer Familial colon cancer Counselling and germline mutation testing The hallmarks of cancer The cancer-associated genes involved in the hallmarks of cancer Genomic instability and multistep carcinogenesis Cancer stem cells UV and ionizing radiations Chemical carcinogenesis: initiation, promotion and progression Metabolic activation of chemical compounds in vivo Factors that control chemical carcinogenesis Genotoxic and non-genotoxic effects of carcinogens Oncogenic DNA and RNA viruses Genetic mechanisms underlying the oncogenic process Host interaction with oncogenic viruses Pathogenic role of viruses into the oncogenic process Role of bacteria into the oncogenic process: the H. pylori case The immunosurveillance hypothesis Determinants of tumor antigenicity Defensive mechanisms against tumors Mechanisms of cancer immune evasion Cancer immunoediting Principles of cancer immunotherapy Epidemiologic evidence Myeloid-derived suppressor cells Tumor-associated macrophages and neutrophils Mechanisms of angiogenesis and vasculogenesis Endothelial progenitors and other pro-angiogenetic bone marrow-derived cells Angiogenetic cytokines and their receptors Common and distinctive features of blood and lymphatic vessels Role of angiogenesis to tumor survival and growth The role of the tumor microenvironment Cancer-related anorexia and cachexia Metabolic mechanisms of neoplastic cachexia Molecular mediators of neoplastic cachexia Tumor factors contributing to cancer cachexia Clinical characteristics of neoplastic cachexia Paraneoplastic syndromes
10) Platelets Primary and secondary hemostasis and coagulation cascade Fibrinolytic system Mechanisms of atherosclerotic plaque generation: risk factors, clinical manifestations and complications Thrombus formation and evolution Thromboembolism and immunothrombosis Pathogenesis and stages of shock Disseminated intravascular coagulopathy Biology of the red blood cell and classification of anemias BLOCK 11 iPCs-technology as a tool to investigate pathogenesis and therapy of human diseases Modern translational approaches in immunologic disorders Bio-informatics approaches in the diagnosis of a new primary immune deficiencies Regulatory agencies and policies of physicians facing new challenges and technologies Flow cytometry in diagnosis and therapy of hematologic malignancies Bone marrow reconstitution.
2) Effect of mutations on protein function Mechanism linking mutations to disease Same gene, different phenotypes; different genes, same phenotype Mutation not affecting coding gene sequences Molecular basis of reduced penetrance in human inherited diseases Identification of genetic risk factors in complex diseases Common versus rare variant hypothesis in neurodegenerative disorders Lessons from studying monogenic disease for common disease: the genetics of Alzheimer disease and mellitus diabetes Epigenetic mechanisms Epigenetic modifications and environment Role of epigenetics in human diseases Mechanisms of action of miRNA and lncRNA Role of miRNA and lncRNA in human diseases Genetic variation and drug response Genetic variation and personalized medicine
3) Microbiota in health and disease Basics of bacterial cell structure Properties of bacterial cell walls (Gram staining, structure of peptidoglycan, LPS structure and role in human pathogenesis, target sites for antibiotics) The genetic makeup of bacteria Mechanisms of bacterial virulence: secretory, membrane-associated, and cytosolic factors. Structure, regulation, expression and their contribution to pathogenesis and immune evasion. The eukaryotic nature of fungi and their classification The fungal relationships with humans: basic pathogenic mechanisms for opportunistic and invasive infections. Structure, morphology, genome organization and virulence factors of parasites Pathogenesis of Giardia, Trichomonas, Plasmodii, and intestinal nematodes Structure, morphology, genome organization and evolution theories of viruses Classification of the viruses infecting humans Replication's strategies Mechanisms of viral pathogenesis Determinants of communicable diseases
4) Structures, genome organization, replication properties and pathogenesis of clinical relevant human picornaviruses. Structures, genome organization, replication properties and pathogenesis of clinical relevant human flaviviruses. Structures, genome organization, replication properties and pathogenesis of the human viruses belonging to the viral families: togaviridae, coronaviridae, rhabdoviridae Structures, genome organization, replication properties and pathogenesis of the viruses belonging to the viral families: orthomixoviridae, paramixoviridae, and pneumoviridae. Structures, genome organization, replication properties and pathogenesis of the viruses belonging to the viral families: filoviridae, arenaviridae, bunyaviridae. Structures, genome organization, replication and pathogenesis of the major viruses causing hepatitis. Structures, genome organization, replication and pathogenesis of the major viruses causing hepatitis (II). Structures, genome organization, replication properties and pathogenesis of the human herpesviruses. Structures, genome organization, replication properties and pathogenesis of the viruses belonging to the viral families: parvoviridae, adenoviridae, papillomaviridae. Structures, genome organization, replication properties and pathogenesis of the human polyomaviruses. Structures, genome organization, and replication properties of HIV. Pathogenesis of HIV. Structures, genome organization, replication properties and pathogenesis of the human delta retroviruses (HTLV-I and II). Structures and pathogenesis of the prions.
5) Classification, pathogenetic mechanisms and diagnostic aspects of most clinically relevant bacteria. Staphylococcus, Streptococcus, Enterococcus. Corynebacterium diphtheriae. Listeria monocytogenes, Legionella pneumophila, Chlamydiae, Neisseriae. Haemophilus influenzae. Bordetella pertussis. Campylobacter, Helicobacter pylori, Vibrio cholerae, Pseudomonas aeruginosa, Acinetobacter. Clostridia and bacilli Mycobacteria Fungi (Candida, Cryptococcus, Aspergillus, dermatophytes, Blastomyces, Coccidioides, Histoplasma, Pneumocystis). The burden of nosocomial infections Anti-microbial resistance Superbugs (MRSA, VRE, KPC)
6) The hematopoietic niche and hematopoietic stem cells Hematopoietic lineages and cytokines The normal and altered blood counts Biological and physical barriers of innate immunity Cardinal signs of acute inflammation Blood flow alterations and vascular permeability The endothelium as a reactive biological structure Mast cells, phagocytes and NK cells Molecular mediators active on vessels Molecular mediators active on leukocytes Primary inflammatory cytokines Eicosanoids Cell adhesion: adhesion molecules and cell migration, the chemokine system Pathogen-Associated Molecular Patterns (PAMPs) and Pathogen Recognition Receptors (PRRs) Danger-Associated Molecular Patterns (DAMPs) and their receptors The TLR system Intracellular PRR Opsonic receptors Genetic defects in pathogen recognition Complement system: Activation pathways, functions, regulatory mechanisms, genetic defects in the complement system Mechanisms of cell-mediated cytotoxicity: phagocytosis and degranulation Oxygen-dependent mechanisms, oxygen independent mechanisms, opsonic agents Genetic defects in pathogen killing mechanisms Energy for immunity Metabolic signatures and profiles of key immune cells Metabolic control of immune responses Neutrophils metabolism and bioenergetics of anti-microbial action Metabolism of macrophages Metabolic shifts in macrophage activation and polarization Negative regulators of the inflammatory response The hypothalamic-pituitary-adrenal axis Anti-inflammatory cytokines and eicosanoids Stem cells and growth factors in tissue renewal Multistep process of tissue repair, fibrosis, anomalies in wound healing Distinct types of chronic inflammation Cellular and molecular effectors of chronic inflammation Macrophage polarization in chronic inflammatory responses Systemic inflammation: Fever, leukocytosis, acute phase proteins
7) Key features of acquired immunity: specificity, memory, tolerance The lymphoid system Primary and secondary lymphoid tissues, lymphatic vessels The antigen: source, structure, processing Thymus-dependent and thymus-independent antigens Structure and function of Major Histocompatibility Complex I and II MHC-I and MHC-II loci organization Superantigens Professional and non-professional antigen presenting cells Dendritic cells origin and subsets Dendritic cells maturation and migration Costimulatory molecules Intrathymic development Positive and negative selection of T lymphocytes TCR structure and repertoire generation Central and peripheral tolerance The TCR/CD3 signalling complex and transduction pathways Helper and cytotoxic T lymphocytes BCR signalling and B cell activation Antibody classes: structure and functions Isotype switch Antibody classes in primary and secondary immune responses Affinity maturation T helper subsets and polarized immune responses Differentiation and signalling in T helper cells Immune response polarization in pathology T cell / macrophage crosstalk in chronic inflammatory responses Impact on effector cells Immune granulomata: an immune perspective Regulatory T cells Myeloid regulatory cells Metabolic differences between innate and adaptive immunity Metabolism of specific T cell lineages T cell metabolism changes during immune response Vaccines and their development
8) Recognition of viral infection by the immune system Effector mechanisms against viral infections Viral strategies for evading antiviral immune responses Recognition of intracellular infection by the immune system Microbial strategies for evading immune responses The mucosal immune system Mucosal immunity and commensal microorganisms Mucosal immunity to pathogenic microbes General issues on hypersensitivity reactions Type I hypersensitivity Type II hypersensitivity Type III hypersensitivity Type IV hypersensitivity The multifactorial pathogenesis of autoimmune diseases Failure mechanisms of the central and peripheral tolerance Effector mechanisms of autoimmune reactions Immune mechanisms of the most common autoimmune diseases Differential features of autoimmune vs autoinflammatory diseases Immune deficiency caused by defects in innate immunity Immune deficiency caused by defects in B and T maturation Iatrogenic immunodeficiencies HIV infection and immune response Acquired immune deficiency syndrome (AIDS) pathogenesis Animal models to assess HIV-1 infection and AIDS pathogenesis Immunological basis of allograft rejection Major and minor histocompatibility antigens Molecular basis of direct and indirect allorecognition Mechanisms of hyperacute, acute and chronic rejection graft-versus-host disease Age-related changes in the innate immune system Age-related changes in the adaptive immune system Impact of immunosenescence on diseases and vaccination Tissue immunometabolism: relationships in the gastrointestinal tract, liver, and adipose tissue Relationships between systemic metabolism and immunity Vitamins in the control of immunity Obesity as a multifactorial disease Immunological implications of obesity
9) Definition of cancer and epidemiology Tumor nomenclature, TNM classification Differentiation and cell grading, rate of growth Local invasion Metastasis, pathways of spread Oncogenic signaling and tumor microenvironment as drivers of cancer metabolism Tumor sensing and metabolic adaptations to hypoxia and nutrient deprivation Signals and targets of metabolic reprogramming in cancer cells Advantages and liabilities of tumor cell metabolism Genes in which mutations cause cancer: oncogenes, tumor suppressor genes (gatekeepers and caretakers genes) Type of genetic alterations responsible for initiating cancer Activating or gain of function mutations Ectopic or heterochronic mutations Chromosome translocations Loss of function mutations Genomic instability and tumor progression Activated oncogenes in hereditary cancer syndrome: MEN2 Gatekeeper tumor suppressor genes in AD cancer syndromes The two-hit origin of cancer: the hereditary and sporadic forms of retinoblastoma The Li-Fraumeni syndrome Caretaker gene in autosomal dominant cancer syndromes BRCA1 and BRCA2 mutations in familial breast cancer Familial colon cancer Counselling and germline mutation testing The hallmarks of cancer The cancer-associated genes involved in the hallmarks of cancer Genomic instability and multistep carcinogenesis Cancer stem cells UV and ionizing radiations Chemical carcinogenesis: initiation, promotion and progression Metabolic activation of chemical compounds in vivo Factors that control chemical carcinogenesis Genotoxic and non-genotoxic effects of carcinogens Oncogenic DNA and RNA viruses Genetic mechanisms underlying the oncogenic process Host interaction with oncogenic viruses Pathogenic role of viruses into the oncogenic process Role of bacteria into the oncogenic process: the H. pylori case The immunosurveillance hypothesis Determinants of tumor antigenicity Defensive mechanisms against tumors Mechanisms of cancer immune evasion Cancer immunoediting Principles of cancer immunotherapy Epidemiologic evidence Myeloid-derived suppressor cells Tumor-associated macrophages and neutrophils Mechanisms of angiogenesis and vasculogenesis Endothelial progenitors and other pro-angiogenetic bone marrow-derived cells Angiogenetic cytokines and their receptors Common and distinctive features of blood and lymphatic vessels Role of angiogenesis to tumor survival and growth The role of the tumor microenvironment Cancer-related anorexia and cachexia Metabolic mechanisms of neoplastic cachexia Molecular mediators of neoplastic cachexia Tumor factors contributing to cancer cachexia Clinical characteristics of neoplastic cachexia Paraneoplastic syndromes
10) Platelets Primary and secondary hemostasis and coagulation cascade Fibrinolytic system Mechanisms of atherosclerotic plaque generation: risk factors, clinical manifestations and complications Thrombus formation and evolution Thromboembolism and immunothrombosis Pathogenesis and stages of shock Disseminated intravascular coagulopathy Biology of the red blood cell and classification of anemias BLOCK 11 iPCs-technology as a tool to investigate pathogenesis and therapy of human diseases Modern translational approaches in immunologic disorders Bio-informatics approaches in the diagnosis of a new primary immune deficiencies Regulatory agencies and policies of physicians facing new challenges and technologies Flow cytometry in diagnosis and therapy of hematologic malignancies Bone marrow reconstitution.
Periodo: Primo semestre
Modalità di valutazione: Esame
Giudizio di valutazione: voto verbalizzato in trentesimi
Corso singolo
Questo insegnamento non può essere seguito come corso singolo. Puoi trovare gli insegnamenti disponibili consultando il catalogo corsi singoli.
Programma e organizzazione didattica
Edizione unica
Responsabile
Prerequisiti
To take the System Diseases 1 exam, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Modalità di verifica dell’apprendimento e criteri di valutazione
Student assessment is based on a combination of written and oral examinations. The written exam is a multiple choice test focused on the topics of the modules: Clinical Biochemistry, Microbiology, Pathology. Only students who successfully pass the written tests of all subjects (threshold 7/10) are allowed to take the oral examination, focused on the modules: DIAGNOSTIC IMAGING, Cardiovascular Diseases, NEPHROLOGY.
The oral examination must be passed in the same session as the written examination. Examinations on two consecutive days are seldom possible depending upon the availability of teachers or rooms. The students must undergo both written and oral examination on the same day. If the student does not pass successfully the oral examination, the positive result at the written test is valid only within the same session.
The final mark is the weighted average of the marks obtained in the oral examinations.
Attendance is required to be allowed to take the exam. Unexcused absence is tolerated up to 34% of the course activities. University policy regarding excused illness is followed.
Registration to the exam through SIFA is mandatory.
The oral examination must be passed in the same session as the written examination. Examinations on two consecutive days are seldom possible depending upon the availability of teachers or rooms. The students must undergo both written and oral examination on the same day. If the student does not pass successfully the oral examination, the positive result at the written test is valid only within the same session.
The final mark is the weighted average of the marks obtained in the oral examinations.
Attendance is required to be allowed to take the exam. Unexcused absence is tolerated up to 34% of the course activities. University policy regarding excused illness is followed.
Registration to the exam through SIFA is mandatory.
Cardiovascular diseases
Programma
BLOCK 1
Topic 1 - CARDIOLOGY. Cardiovascular risk
Understand the approaches used to identify the genetic predisposition and environmental factors to cardiovascular diseases
To be able to define monogenic vs. multifactorial cardiovascular diseases: description of examples
Understand the clinical impact of risk stratification
Evaluation of the role as cardiovascular risk factors of race and economical condition
Topic 2 - CARDIOLOGY. Grading the severity of cardiovascular diseases
Perform a medical interview and a general examination of the cardiac patient
Recognize cardiac sounds and the severity of the cardiovascular disease
Capability to define the severity of heart failure
Topic 3 - NEPHROLOGY. Management of the patient with renal disease
How to identify renal syndromes from the patient's clinical presentation (nephrotic syndrome, nephritic syndrome, positive uranalysis examination, rapidly progressive renal failure, chronic kidney disease) and through specific laboratory investigations, including microscopic urinary sediment analysis
How to measure kidney function (glomerular filtration rate, tubular and endocrine renal function)
The renal biopsy
Topic 4 - DIAGNOSTIC IMAGING. Ionizing and non-iodizing radiation used in diagnostic imaging
Understand the different radiation used in medical imaging
Describe interactions of different radiations with matter
Describe the possible harmful effects of ionizing radiations
Topic 4b - DIAGNOSTIC IMAGING: Nuclear Medicine
Understand the basic principles of nuclear image formation
Understand the use of radiopharmaceuticals in diagnostic imaging and therapy
Describe the role of hybrid imaging
Topic 5 - DIAGNOSTIC IMAGING. Sonography
Describe interaction of mechanical waves with tissues
Describe monographic probes and image genesis for diagnostic purposes
Describe image patterns of different anatomic and pathologic structures
Topic 6 - PATHOLOGY. Introduction to Anatomic Pathology part I
Define goals and roles of Anatomic and Surgical Pathology in the modern medicine
Describe activities and the work flow at the Pathology Department: histology
Focus on the structure and contents of the pathology report (histological diagnosis, grading, staging, prognostic and predictive parameters)
Topic 7 - PATHOLOGY - Introduction to Anatomic Pathology part II
Describe activities and the work flow at the Pathology Department: cytology and autopsies
Cytology: Aspitation cytology and exfoliative cytology (pros and cons)
Autopsies: Who, why and when
Topic 8 - PATHOLOGY. Ancillary techniques in Anatomic Pathology
Describe principles, applications and clinical implication of immunohistochemistry
Describe principles, applications and clinical implication of molecular pathology (PCR-based techniques, FISH)
Topic 9 - CLINICAL BIOCHEMISTRY. Specimen collection and storage; point of care testing and automation
Recognize the importance of correct blood collection in managing total patient care
Describe what the correct specimen for the requested test is
Differentiate between whole blood, plasma and serum
Describe the collection of serum samples
Describe the collection of the urine sample
Describe the collection of CSF
Illustrate the stability of biological samples
Understand and illustrate the core lab and the point of care testing
Topic 10 - CLINICAL BIOCHEMISTRY. The quality control in clinical laboratory
Define the relevance of quality control
Define the type and rate of error in laboratory medicine
Define methods for the analytical quality control
Define accuracy and precision in laboratory medicine
Define the analytical goal for precision
Define the biological variability and reference intervals
Topic 11 - CLINICAL BIOCHEMISTRY. Biobanks and their importance in clinical and scientific fields related to biomedical research
Define a biobank and define a private collection highlighting the differences
Define the relevance of biobanks in clinical research
The role of the informed consent.
Define the different types of collected specimen.
Define the possible clinical and scientific use of different specimen
Define the relevance of right operating procedures of specimen collection
Topic 12 - CLINICAL BIOCHEMISTRY. Preanalytical variables affecting the Integrity of human biospecimens in laboratory tests and in biobanking
Define preanalytical variables
Define the role of preanalytical variables in laboratory tests
Define the impact of preanalytical variables in NGS and mass spectrometry analytical procedures
Define the impact of preanalytical variables in clinical studies.
Topic 13 - CARDIOLOGY. Resting ECG
Understanding of the cellular and molecular mechanisms involved in the electrical activity of the heart; the anatomy and physiology of the conduction system; and the electrical vectors throughout the cardiac cycle
Understanding the philosophy behind ECG
Understanding the normal ECG and learning to recognize the characteristic appearances of, and the explanation for, the ECG in the main pathological conditions
Topic 14 - CARDIOLOGY. Arrhythmias
Understanding the epidemiology, pathophysiology, diagnosis and clinical features of arrhythmias and conduction disturbances
Understanding of the classification and definition of bradycardias, tachycardias, supraventricular arrhythmias (including atrial fibrillation and flutter) and ventricular arrhythmias
Topic 15 - DIAGNOSTIC IMAGING. Computed Tomography - CT
Describe the technical aspects of a CT scanner
Describe the different acquisitions protocols (axial acquisition, volumetric acquisition, High Resolution acquisition)
Describe image-processing capabilities (multiplanar reconstructions, MIP, Virtual reality reconstructions)
Describe the use of contrast media
Topic 16 - CARDIOLOGY. Heart-lung interaction
Discuss of the pathophysiology of lung-heart interactions
Discuss of the clinical and physiological modifications that occur during exercise
Evaluate exercise tolerance and differentiate between cardiovascular and pulmonary aetiology of exercise intolerance
Discuss the difference between cardiac and lung dyspnea
Topic 17 - CARDIOLOGY. O2 consumption
Discuss of Wasserman plots, CPET parameters and their correlation with prognosis
Discuss the use of VO2 to determine heart failure prognosis
Discuss exercise ventilator efficiency for cardiac, pulmonary and cardiopulmonary diseases
Topic 18 - DIAGNOSTIC IMAGING. Magnetic Resonance Imaging - MRI
Describe the technical aspects of a MRI scanner
Describe the different acquisitions protocols (T1w, T2w, Fat Sat, DWI. Contrast enhanced)
Topic 19 - PATHOLOGY. Atherosclerosis and Ischemic heart disease
Describe the pathogenesis, morphologic changes and the evolution of the atherosclerotic plaque
Define aneurysms and aortic dissection
Describe the pathogenesis of myocardial infarction (MI), macroscopic and microscopic changes and their temporal evolution; morphologic changes of the MI after reperfusion; the complications of MI
Define Sudden Cardiac Death in adults and describe its causes
Topic 20 - PATHOLOGY. Non neoplastic and neoplastic diseases of great vessels and heart.
Define aneurysms and aortic dissection
Define vasculitis
Describe neoplastic lesions of the vessels and heart
Topic 21 - CARDIOLOGY. Ischemic heart disease
Understand myocardial ischemia: from pathophysiology to the clinical spectrum (angina, myocardial infarction)
Comprehend the diagnostic tools for assessing myocardial ischemia
Define the basis of the therapeutic approaches
Topic 22 - DIAGNOSTIC IMAGING. Nuclear Cardiology. Imaging of ischemia and cardiac function
Describe the role of nuclear medicine in the evaluation of ischemic heart disease and cardiac function
Topic 23 - PATHOLOGY. Pathology of the endocardium, myocardium and cardiac valves
Define pathogenesis and morphologic changes of endocarditis
Define pathogenesis of cardiomyopathies and their morphologic changes (dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy)
Define pathogenesis and morphologic changes in myocarditis
Define Rheumatic Fever and rheumatic heart disease
Define valvular heart diseases (calcific valvular degeneration and valve prolapse)
Topic 24 - CARDIOLOGY. Valvular heart disease
Learning the definition of mitral valve diseases
Learning the definition of aortic valve diseases
Learning the definition of tricuspid valve diseases
Learning the definition of pulmonary valve diseases
Hemodynamics of valvular heart diseases
Topic 25 - CARDIOLOGY. Pericarditis and endocarditis
Myocarditis and pericarditis: understanding of the mechanisms underlying the disease, the pathophysiology of the disease and diagnostic and therapeutic approaches
Endocarditis: understanding of the epidemiology, aetiopathogenesis, pathophysiology, diagnosis and therapeutic approaches
Topic 26 - DIAGNOSTIC IMAGING. Cardiac imaging
Describe the capabilities and clinical applications of cardiac sonography
Describe the capabilities and clinical applications of cardiac CT
Topic 27 - DIAGNOSTIC IMAGING. Cardiovascular imaging
Describe the capabilities and clinical applications of cardiac MRI
Describe the different imaging aspects of cardiac failure, ischemic heart disease
Myocarditis and pericarditis
Topic 28 - DIAGNOSTIC IMAGING. Cardiovascular imaging
Clinical cases
Topic 29 - CARDIOLOGY. Heart failure part 1
Understanding the evolution of concept of HF
Understanding of the epidemiology and prognosis of heart failure with reduced and preserved ejection fraction
Understand the definition of heart failure and recognize the different underlying causes and the precipitating factors of heart failure
Understanding of the pathophysiology of heart failure and systolic and diastolic dysfunction
Topic 30 - CARDIOLOGY. Heart failure part 2
To be able to evaluate the prognosis of the heart failure patient
To be able to manage acute and chronic HF
Understanding of the role of exercise training programmes in HF patients
Understand the complications of HF
Understanding the therapy approach of HF
Topic 31 - MICROBIOLOGY. Viruses and myocardial diseases
Understand the role of viruses in inducing myocardial diseases
To learn the epidemiology and pathogenesis of virus-induced myocarditis and pericarditis
To be able to define the diagnostic approach and the laboratory monitoring or viral cardiac diseases
Topic 32 - MICROBIOLOGY. Bacteria and cardiac diseases
Understand the epidemiology and etiology bacterial cardiac diseases
Understand the pathogenesis of bacterial cardiac diseases
To be able to define the diagnostic approach, and to learn basic aspects of antimicrobial therapy
Topic 33 - MICROBIOLOGY. The role of microbes in atherosclerosis and other chronic cardiac diseases
Understand the main epidemiological aspects of microbes possibly involved in chronic cardiovascular diseases
Understand the pathogenesis of microbe - related chronic cardiovascular diseases
Topic 34 - CARDIOLOGY. Pulmonary hypertension
Understanding of the pathophysiological classification of pulmonary hypertension and the type of investigations used for diagnosing pulmonary hypertension and recognizing the etiology
Understanding of the medical, surgical and interventional management of pulmonary hypertension
Topic 35 - CLINICAL BIOCHEMISTRY. Cardiac monitoring in clinical laboratory and biological fluids profiling: a new challenge in clinical laboratory
Describe an ideal marker
Discuss their kinetic of release, sensitivity and specificity
Define biochemical markers for AMI
Discuss the use of troponin in AMI management and define its limitations
Define future markers
Define why biological fluids should be profiled
Describe the most innovative technologies for profiling biological fluids
Discuss the significance and relevance of profiling results
Topic 36 - NEPHROLOGY. The body fluid imbalance and the pathophysiology of the edema
Evaluation of hypovolemia and volume overload in patients with normal and altered renal function
Clinical management and diagnostic algorithm of hyponatremia and hypernatremia
Clinical management and diagnostic algorithm of hypokalemia and hyperkalemia
Clinical management and diagnostic algorithm of acid-base disorders
Topic 37 - NEPHROLOGY. Glomerular disorders
Clinical presentation and management of most frequent primary and secondary glomerulonephritis, microscopic urinary sediment analysis, follow up of chronic glomerulonephritis
Topic 38 - MICROBIOLOGY. Microbes and urinary tract infection
Understand the epidemiology of urinary upper and lower urinary tract infection (UTI)
Understand the etiology and pathogenesis of bacterial and viral UTI
To be able to define the diagnostic approach, from the sample collection to the laboratory result evaluation
Topic 39 - NEPHROLOGY. Management of patients with tubulo-interstitial nephritis
Common etiologies, clinical presentation, diagnostic algorithm for both acute nephritis and chronic interstitial nephritis
Topic 40 - NEPHROLOGY. Approach to patients with urinary tract and renal infection
Common etiologies and clinical presentation of cystitis, acute and chronic pyelonephritis, reflux nephropathy, CAKUT syndrome
Topic 41 - CARDIOLOGY. Congenital heart diseases
Discuss the anatomy of the heart, veins and great vessels, their major congenital malformations and the principles of nomenclature
Discuss the physiology of the foetal and transitional circulations; aetiology of congenital heart disease, including the developmental anatomy of the heart and vasculature
Discuss the pathophysiology, natural history and complications of: valve and outflow tract lesions; septal defects; patent ductus arteriosus; Eisenmenger syndrome; coarctation of the aorta; Ebsteins's anomaly; aortic and pulmonary artery malformations; venous anomalies; transposition of the great arteries (complete and congenitally corrected); tetralogy of Fallot; congenital malformations of coronary arteries; cyanotic congenital heart disease and secondary erythrocytosis; and pulmonary hypertension in congenital heart disease
Evaluate adolescent and adult patients with simple congenital heart defects (grown-up congenital heart disease - GUCH), including those who have undergone cardiac surgery
Describe and recognize physical signs of congenital heart disease and its complications
Topic 42 - NEPHROLOGY. Acute kidney injury / acute renal failure
Common etiologies and clinical presentation of acute kidney injury in the hospital and community settings
Differential diagnosis of the various clinical presentations (pre-renal, parenchymal, obstructive renal injury)
Topic 43 - NEPHROLOGY. Chronic kidney disease - CKD
Common etiologies and clinical presentation of CKD
Systemic consequences of CKD, based on loss of physiologic functions of the kidneys
Endocrine abnormalities linked to CKD. Introduction to the artificial kidney
Topic 44 - NEPHROLOGY. Introduction to artificial kidney
Topic 45 - NEPHROLOGY. Renal vascular diseases
Vascular injury to the kidney
Hypertensive vascular disease
Topic 46 - DIAGNOSTIC IMAGING. Kidney imaging
Describe imaging aspects of acute renal failure
Describe imaging aspects of chronic renal failure
Understand imaging of nephrovascular hypertension
Topic 47 - DIAGNOSTIC IMAGING. Nuclear Medicine. Imaging of renal function
Understand the role of radiopharmaceutical in the evaluation of renal function
Topic 48 - NEPHROLOGY. Case studies
Four hours of non-formal teaching will be devoted to case studies, where students will be challenged to understand and explain pathophysiological mechanisms of kidney diseases based on a simulated clinical case and on information derived from published articles
Topic 49 - DIAGNOSTIC IMAGING. Kidney imaging
Describe imaging aspects of urinary tract stones and infections
Describe diagnostic imaging in renal and urinary tract tumors
Topic 50 - DIAGNOSTIC IMAGING. Kidney imaging
Clinical cases discussion
Topic 51 - NEPHROLOGY. Principles of renal transplantation
How to get on the transplant waiting list, selection of the recipients, management of the waiting list, different types of donors, early and late complications of renal transplantation
Topic 52 - MICROBIOLOGY. Infectious agents and renal transplant
Understand the role of infectious agents in the outcome of renal transplant
Understand the pathogenesis of viral induced organ rejection
To be able to define the diagnostic approach and the laboratory monitoring or viral replication
Topic 53 - NEPHROLOGY. Management of patients with diabetes
When to suspect a renal involvement and how to detect an early diabetic nephropathy (signs, symptoms and specific laboratory investigations)
The stages of diabetic nephropathy: microalbuminuria, nephrotic syndrome, renal failure and uremia
Treatment and follow-up of diabetic patients
Topic 54 - CINICAL BIOCHEMISTRY. Diabetes diagnosis and monitoring in laboratory medicine
Diabetic nephropathy micro and macro albuminuria
Define renal clearance
Urine analyses
Glycated proteins assessment
Define additional tests
Topic 55 - NEPHROLOGY. Management of patients with hereditary nephropathies
When to suspect a hereditary nephropathy and how to conduct a clinical interview in such conditions (autosomic dominant polycystic kidney disease, Alport Syndrome, benign familial hematuria, Fabry disease)
Inherited renal tubular disorders : Bartter, Gitelman, RTA etc
When to suspect a hereditary nephropathy and how to conduct a clinical interview in such conditions (autosomic dominant polycystic kidney disease, Alport Syndrome, benign familial hematuria, Fabry disease)
Topic 56 - MICROBIOLOGY. Urinary tract infection and microbe associate renal diseases
To learn basic aspects of antimicrobial therapy
Understand the impact of viruses and other agents in acute and chronic renal diseases
To learn the role of infectious agents in kidney, prostate and urinary tract cancer
Topic 57 - PATHOLOGY. Non neoplastic diseases of the kidney
Glomerular diseases: pathogenesis and mechanisms of progression; diseases associated with nephritic and nephrotic syndromes.
Tubular and Interstitial Diseases
Vascular Disease
Topic 58 - NEPHROLOGY. Analysis of the urinary sediment
To learn how to recognize diseases based on the characteristics of the urine composition and microscopic analysis
Topic 59 - PATHOLOGY. Transplantation pathology.
Topic 1 - CARDIOLOGY. Cardiovascular risk
Understand the approaches used to identify the genetic predisposition and environmental factors to cardiovascular diseases
To be able to define monogenic vs. multifactorial cardiovascular diseases: description of examples
Understand the clinical impact of risk stratification
Evaluation of the role as cardiovascular risk factors of race and economical condition
Topic 2 - CARDIOLOGY. Grading the severity of cardiovascular diseases
Perform a medical interview and a general examination of the cardiac patient
Recognize cardiac sounds and the severity of the cardiovascular disease
Capability to define the severity of heart failure
Topic 3 - NEPHROLOGY. Management of the patient with renal disease
How to identify renal syndromes from the patient's clinical presentation (nephrotic syndrome, nephritic syndrome, positive uranalysis examination, rapidly progressive renal failure, chronic kidney disease) and through specific laboratory investigations, including microscopic urinary sediment analysis
How to measure kidney function (glomerular filtration rate, tubular and endocrine renal function)
The renal biopsy
Topic 4 - DIAGNOSTIC IMAGING. Ionizing and non-iodizing radiation used in diagnostic imaging
Understand the different radiation used in medical imaging
Describe interactions of different radiations with matter
Describe the possible harmful effects of ionizing radiations
Topic 4b - DIAGNOSTIC IMAGING: Nuclear Medicine
Understand the basic principles of nuclear image formation
Understand the use of radiopharmaceuticals in diagnostic imaging and therapy
Describe the role of hybrid imaging
Topic 5 - DIAGNOSTIC IMAGING. Sonography
Describe interaction of mechanical waves with tissues
Describe monographic probes and image genesis for diagnostic purposes
Describe image patterns of different anatomic and pathologic structures
Topic 6 - PATHOLOGY. Introduction to Anatomic Pathology part I
Define goals and roles of Anatomic and Surgical Pathology in the modern medicine
Describe activities and the work flow at the Pathology Department: histology
Focus on the structure and contents of the pathology report (histological diagnosis, grading, staging, prognostic and predictive parameters)
Topic 7 - PATHOLOGY - Introduction to Anatomic Pathology part II
Describe activities and the work flow at the Pathology Department: cytology and autopsies
Cytology: Aspitation cytology and exfoliative cytology (pros and cons)
Autopsies: Who, why and when
Topic 8 - PATHOLOGY. Ancillary techniques in Anatomic Pathology
Describe principles, applications and clinical implication of immunohistochemistry
Describe principles, applications and clinical implication of molecular pathology (PCR-based techniques, FISH)
Topic 9 - CLINICAL BIOCHEMISTRY. Specimen collection and storage; point of care testing and automation
Recognize the importance of correct blood collection in managing total patient care
Describe what the correct specimen for the requested test is
Differentiate between whole blood, plasma and serum
Describe the collection of serum samples
Describe the collection of the urine sample
Describe the collection of CSF
Illustrate the stability of biological samples
Understand and illustrate the core lab and the point of care testing
Topic 10 - CLINICAL BIOCHEMISTRY. The quality control in clinical laboratory
Define the relevance of quality control
Define the type and rate of error in laboratory medicine
Define methods for the analytical quality control
Define accuracy and precision in laboratory medicine
Define the analytical goal for precision
Define the biological variability and reference intervals
Topic 11 - CLINICAL BIOCHEMISTRY. Biobanks and their importance in clinical and scientific fields related to biomedical research
Define a biobank and define a private collection highlighting the differences
Define the relevance of biobanks in clinical research
The role of the informed consent.
Define the different types of collected specimen.
Define the possible clinical and scientific use of different specimen
Define the relevance of right operating procedures of specimen collection
Topic 12 - CLINICAL BIOCHEMISTRY. Preanalytical variables affecting the Integrity of human biospecimens in laboratory tests and in biobanking
Define preanalytical variables
Define the role of preanalytical variables in laboratory tests
Define the impact of preanalytical variables in NGS and mass spectrometry analytical procedures
Define the impact of preanalytical variables in clinical studies.
Topic 13 - CARDIOLOGY. Resting ECG
Understanding of the cellular and molecular mechanisms involved in the electrical activity of the heart; the anatomy and physiology of the conduction system; and the electrical vectors throughout the cardiac cycle
Understanding the philosophy behind ECG
Understanding the normal ECG and learning to recognize the characteristic appearances of, and the explanation for, the ECG in the main pathological conditions
Topic 14 - CARDIOLOGY. Arrhythmias
Understanding the epidemiology, pathophysiology, diagnosis and clinical features of arrhythmias and conduction disturbances
Understanding of the classification and definition of bradycardias, tachycardias, supraventricular arrhythmias (including atrial fibrillation and flutter) and ventricular arrhythmias
Topic 15 - DIAGNOSTIC IMAGING. Computed Tomography - CT
Describe the technical aspects of a CT scanner
Describe the different acquisitions protocols (axial acquisition, volumetric acquisition, High Resolution acquisition)
Describe image-processing capabilities (multiplanar reconstructions, MIP, Virtual reality reconstructions)
Describe the use of contrast media
Topic 16 - CARDIOLOGY. Heart-lung interaction
Discuss of the pathophysiology of lung-heart interactions
Discuss of the clinical and physiological modifications that occur during exercise
Evaluate exercise tolerance and differentiate between cardiovascular and pulmonary aetiology of exercise intolerance
Discuss the difference between cardiac and lung dyspnea
Topic 17 - CARDIOLOGY. O2 consumption
Discuss of Wasserman plots, CPET parameters and their correlation with prognosis
Discuss the use of VO2 to determine heart failure prognosis
Discuss exercise ventilator efficiency for cardiac, pulmonary and cardiopulmonary diseases
Topic 18 - DIAGNOSTIC IMAGING. Magnetic Resonance Imaging - MRI
Describe the technical aspects of a MRI scanner
Describe the different acquisitions protocols (T1w, T2w, Fat Sat, DWI. Contrast enhanced)
Topic 19 - PATHOLOGY. Atherosclerosis and Ischemic heart disease
Describe the pathogenesis, morphologic changes and the evolution of the atherosclerotic plaque
Define aneurysms and aortic dissection
Describe the pathogenesis of myocardial infarction (MI), macroscopic and microscopic changes and their temporal evolution; morphologic changes of the MI after reperfusion; the complications of MI
Define Sudden Cardiac Death in adults and describe its causes
Topic 20 - PATHOLOGY. Non neoplastic and neoplastic diseases of great vessels and heart.
Define aneurysms and aortic dissection
Define vasculitis
Describe neoplastic lesions of the vessels and heart
Topic 21 - CARDIOLOGY. Ischemic heart disease
Understand myocardial ischemia: from pathophysiology to the clinical spectrum (angina, myocardial infarction)
Comprehend the diagnostic tools for assessing myocardial ischemia
Define the basis of the therapeutic approaches
Topic 22 - DIAGNOSTIC IMAGING. Nuclear Cardiology. Imaging of ischemia and cardiac function
Describe the role of nuclear medicine in the evaluation of ischemic heart disease and cardiac function
Topic 23 - PATHOLOGY. Pathology of the endocardium, myocardium and cardiac valves
Define pathogenesis and morphologic changes of endocarditis
Define pathogenesis of cardiomyopathies and their morphologic changes (dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy)
Define pathogenesis and morphologic changes in myocarditis
Define Rheumatic Fever and rheumatic heart disease
Define valvular heart diseases (calcific valvular degeneration and valve prolapse)
Topic 24 - CARDIOLOGY. Valvular heart disease
Learning the definition of mitral valve diseases
Learning the definition of aortic valve diseases
Learning the definition of tricuspid valve diseases
Learning the definition of pulmonary valve diseases
Hemodynamics of valvular heart diseases
Topic 25 - CARDIOLOGY. Pericarditis and endocarditis
Myocarditis and pericarditis: understanding of the mechanisms underlying the disease, the pathophysiology of the disease and diagnostic and therapeutic approaches
Endocarditis: understanding of the epidemiology, aetiopathogenesis, pathophysiology, diagnosis and therapeutic approaches
Topic 26 - DIAGNOSTIC IMAGING. Cardiac imaging
Describe the capabilities and clinical applications of cardiac sonography
Describe the capabilities and clinical applications of cardiac CT
Topic 27 - DIAGNOSTIC IMAGING. Cardiovascular imaging
Describe the capabilities and clinical applications of cardiac MRI
Describe the different imaging aspects of cardiac failure, ischemic heart disease
Myocarditis and pericarditis
Topic 28 - DIAGNOSTIC IMAGING. Cardiovascular imaging
Clinical cases
Topic 29 - CARDIOLOGY. Heart failure part 1
Understanding the evolution of concept of HF
Understanding of the epidemiology and prognosis of heart failure with reduced and preserved ejection fraction
Understand the definition of heart failure and recognize the different underlying causes and the precipitating factors of heart failure
Understanding of the pathophysiology of heart failure and systolic and diastolic dysfunction
Topic 30 - CARDIOLOGY. Heart failure part 2
To be able to evaluate the prognosis of the heart failure patient
To be able to manage acute and chronic HF
Understanding of the role of exercise training programmes in HF patients
Understand the complications of HF
Understanding the therapy approach of HF
Topic 31 - MICROBIOLOGY. Viruses and myocardial diseases
Understand the role of viruses in inducing myocardial diseases
To learn the epidemiology and pathogenesis of virus-induced myocarditis and pericarditis
To be able to define the diagnostic approach and the laboratory monitoring or viral cardiac diseases
Topic 32 - MICROBIOLOGY. Bacteria and cardiac diseases
Understand the epidemiology and etiology bacterial cardiac diseases
Understand the pathogenesis of bacterial cardiac diseases
To be able to define the diagnostic approach, and to learn basic aspects of antimicrobial therapy
Topic 33 - MICROBIOLOGY. The role of microbes in atherosclerosis and other chronic cardiac diseases
Understand the main epidemiological aspects of microbes possibly involved in chronic cardiovascular diseases
Understand the pathogenesis of microbe - related chronic cardiovascular diseases
Topic 34 - CARDIOLOGY. Pulmonary hypertension
Understanding of the pathophysiological classification of pulmonary hypertension and the type of investigations used for diagnosing pulmonary hypertension and recognizing the etiology
Understanding of the medical, surgical and interventional management of pulmonary hypertension
Topic 35 - CLINICAL BIOCHEMISTRY. Cardiac monitoring in clinical laboratory and biological fluids profiling: a new challenge in clinical laboratory
Describe an ideal marker
Discuss their kinetic of release, sensitivity and specificity
Define biochemical markers for AMI
Discuss the use of troponin in AMI management and define its limitations
Define future markers
Define why biological fluids should be profiled
Describe the most innovative technologies for profiling biological fluids
Discuss the significance and relevance of profiling results
Topic 36 - NEPHROLOGY. The body fluid imbalance and the pathophysiology of the edema
Evaluation of hypovolemia and volume overload in patients with normal and altered renal function
Clinical management and diagnostic algorithm of hyponatremia and hypernatremia
Clinical management and diagnostic algorithm of hypokalemia and hyperkalemia
Clinical management and diagnostic algorithm of acid-base disorders
Topic 37 - NEPHROLOGY. Glomerular disorders
Clinical presentation and management of most frequent primary and secondary glomerulonephritis, microscopic urinary sediment analysis, follow up of chronic glomerulonephritis
Topic 38 - MICROBIOLOGY. Microbes and urinary tract infection
Understand the epidemiology of urinary upper and lower urinary tract infection (UTI)
Understand the etiology and pathogenesis of bacterial and viral UTI
To be able to define the diagnostic approach, from the sample collection to the laboratory result evaluation
Topic 39 - NEPHROLOGY. Management of patients with tubulo-interstitial nephritis
Common etiologies, clinical presentation, diagnostic algorithm for both acute nephritis and chronic interstitial nephritis
Topic 40 - NEPHROLOGY. Approach to patients with urinary tract and renal infection
Common etiologies and clinical presentation of cystitis, acute and chronic pyelonephritis, reflux nephropathy, CAKUT syndrome
Topic 41 - CARDIOLOGY. Congenital heart diseases
Discuss the anatomy of the heart, veins and great vessels, their major congenital malformations and the principles of nomenclature
Discuss the physiology of the foetal and transitional circulations; aetiology of congenital heart disease, including the developmental anatomy of the heart and vasculature
Discuss the pathophysiology, natural history and complications of: valve and outflow tract lesions; septal defects; patent ductus arteriosus; Eisenmenger syndrome; coarctation of the aorta; Ebsteins's anomaly; aortic and pulmonary artery malformations; venous anomalies; transposition of the great arteries (complete and congenitally corrected); tetralogy of Fallot; congenital malformations of coronary arteries; cyanotic congenital heart disease and secondary erythrocytosis; and pulmonary hypertension in congenital heart disease
Evaluate adolescent and adult patients with simple congenital heart defects (grown-up congenital heart disease - GUCH), including those who have undergone cardiac surgery
Describe and recognize physical signs of congenital heart disease and its complications
Topic 42 - NEPHROLOGY. Acute kidney injury / acute renal failure
Common etiologies and clinical presentation of acute kidney injury in the hospital and community settings
Differential diagnosis of the various clinical presentations (pre-renal, parenchymal, obstructive renal injury)
Topic 43 - NEPHROLOGY. Chronic kidney disease - CKD
Common etiologies and clinical presentation of CKD
Systemic consequences of CKD, based on loss of physiologic functions of the kidneys
Endocrine abnormalities linked to CKD. Introduction to the artificial kidney
Topic 44 - NEPHROLOGY. Introduction to artificial kidney
Topic 45 - NEPHROLOGY. Renal vascular diseases
Vascular injury to the kidney
Hypertensive vascular disease
Topic 46 - DIAGNOSTIC IMAGING. Kidney imaging
Describe imaging aspects of acute renal failure
Describe imaging aspects of chronic renal failure
Understand imaging of nephrovascular hypertension
Topic 47 - DIAGNOSTIC IMAGING. Nuclear Medicine. Imaging of renal function
Understand the role of radiopharmaceutical in the evaluation of renal function
Topic 48 - NEPHROLOGY. Case studies
Four hours of non-formal teaching will be devoted to case studies, where students will be challenged to understand and explain pathophysiological mechanisms of kidney diseases based on a simulated clinical case and on information derived from published articles
Topic 49 - DIAGNOSTIC IMAGING. Kidney imaging
Describe imaging aspects of urinary tract stones and infections
Describe diagnostic imaging in renal and urinary tract tumors
Topic 50 - DIAGNOSTIC IMAGING. Kidney imaging
Clinical cases discussion
Topic 51 - NEPHROLOGY. Principles of renal transplantation
How to get on the transplant waiting list, selection of the recipients, management of the waiting list, different types of donors, early and late complications of renal transplantation
Topic 52 - MICROBIOLOGY. Infectious agents and renal transplant
Understand the role of infectious agents in the outcome of renal transplant
Understand the pathogenesis of viral induced organ rejection
To be able to define the diagnostic approach and the laboratory monitoring or viral replication
Topic 53 - NEPHROLOGY. Management of patients with diabetes
When to suspect a renal involvement and how to detect an early diabetic nephropathy (signs, symptoms and specific laboratory investigations)
The stages of diabetic nephropathy: microalbuminuria, nephrotic syndrome, renal failure and uremia
Treatment and follow-up of diabetic patients
Topic 54 - CINICAL BIOCHEMISTRY. Diabetes diagnosis and monitoring in laboratory medicine
Diabetic nephropathy micro and macro albuminuria
Define renal clearance
Urine analyses
Glycated proteins assessment
Define additional tests
Topic 55 - NEPHROLOGY. Management of patients with hereditary nephropathies
When to suspect a hereditary nephropathy and how to conduct a clinical interview in such conditions (autosomic dominant polycystic kidney disease, Alport Syndrome, benign familial hematuria, Fabry disease)
Inherited renal tubular disorders : Bartter, Gitelman, RTA etc
When to suspect a hereditary nephropathy and how to conduct a clinical interview in such conditions (autosomic dominant polycystic kidney disease, Alport Syndrome, benign familial hematuria, Fabry disease)
Topic 56 - MICROBIOLOGY. Urinary tract infection and microbe associate renal diseases
To learn basic aspects of antimicrobial therapy
Understand the impact of viruses and other agents in acute and chronic renal diseases
To learn the role of infectious agents in kidney, prostate and urinary tract cancer
Topic 57 - PATHOLOGY. Non neoplastic diseases of the kidney
Glomerular diseases: pathogenesis and mechanisms of progression; diseases associated with nephritic and nephrotic syndromes.
Tubular and Interstitial Diseases
Vascular Disease
Topic 58 - NEPHROLOGY. Analysis of the urinary sediment
To learn how to recognize diseases based on the characteristics of the urine composition and microscopic analysis
Topic 59 - PATHOLOGY. Transplantation pathology.
Metodi didattici
Synchronous learning: lectures, Clinical cases, Seminars, Grand Rounds, Case studies and Laboratory skills.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Materiale di riferimento
Harrison's Principles of Internal Medicine, 20th Edition, McGraw Hill, 2018 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
Goldman's Cecil Medicine L. Goldman, A. I. Schafer, 25th ed., Elsevier, 2015
Making Sense of Exercise Texting, R. B. Schoene, H. T. Robertson, CRC Press, 2019
Bates' Guide to Physical Examination and History Taking, Lynn S. Bickley
Goldman's Cecil Medicine L. Goldman, A. I. Schafer, 25th ed., Elsevier, 2015
Making Sense of Exercise Texting, R. B. Schoene, H. T. Robertson, CRC Press, 2019
Bates' Guide to Physical Examination and History Taking, Lynn S. Bickley
Nephrology
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Cardiovascular Diseases.
Metodi didattici
Synchronous learning: lectures, Clinical cases, Seminars, Grand Rounds, Case studies and Laboratory skills.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Materiale di riferimento
NEPHROLOGY textbooks and resources:
Edinburgh Renal Education Pages Textbook. Free textbook available at http://www.edrep.org/pages/textbook.php
Robert W. Schrier. Manual of NEPHROLOGY. Wolters Kluwer Health, 2014
JOVE Clinical Skills - Digital library of the University of Milano
Edinburgh Renal Education Pages Textbook. Free textbook available at http://www.edrep.org/pages/textbook.php
Robert W. Schrier. Manual of NEPHROLOGY. Wolters Kluwer Health, 2014
JOVE Clinical Skills - Digital library of the University of Milano
Pathology
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Cardiovascular Diseases.
Metodi didattici
Synchronous learning: lectures, Clinical cases, Seminars, Grand Rounds, Case studies and Laboratory skills.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Materiale di riferimento
Robbins and Cotran. Pathologic Basis Of Disease (9th Edition)
Radiology
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Cardiovascular Diseases.
Metodi didattici
Synchronous learning: lectures, Clinical cases, Seminars, Grand Rounds, Case studies and Laboratory skills.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Materiale di riferimento
Essential of Radiology. F. A. Mettler. 3rd Edition. Elsevier Saunders. (e book)
Core Radiology. J. Mandell. Cambrige University Press. (ebook)
Core Radiology. J. Mandell. Cambrige University Press. (ebook)
Microbiology
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Cardiovascular Diseases.
Metodi didattici
Synchronous learning: lectures, Clinical cases, Seminars, Grand Rounds, Case studies and Laboratory skills.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Materiale di riferimento
Medical Microbiology, 8th edition. P. Murray, K Rosenthal, A. Pfaller Elsevier
Clinical Biochemistry
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Cardiovascular Diseases.
Metodi didattici
Synchronous learning: lectures, Clinical cases, Seminars, Grand Rounds, Case studies and Laboratory skills.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific Ariel platform.
Materiale di riferimento
Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. Burtis & Bruns, 7th Edition, Elsevier
Moduli o unità didattiche
Cardiovascular diseases
MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE - CFU: 2
Lezioni: 16 ore
: 8 ore
: 8 ore
Docente:
Agostoni Piergiuseppe
Clinical Biochemistry
BIO/12 - BIOCHIMICA CLINICA E BIOLOGIA MOLECOLARE CLINICA - CFU: 1
Lezioni: 8 ore
: 4 ore
: 4 ore
Docente:
Gelfi Cecilia
Microbiology
MED/07 - MICROBIOLOGIA E MICROBIOLOGIA CLINICA - CFU: 1
Lezioni: 8 ore
: 4 ore
: 4 ore
Docente:
Alteri Claudia
Nephrology
MED/14 - NEFROLOGIA - CFU: 4
Lezioni: 32 ore
: 16 ore
: 16 ore
Pathology
MED/08 - ANATOMIA PATOLOGICA - CFU: 1
Lezioni: 8 ore
: 4 ore
: 4 ore
Docenti:
Fusco Nicola, Kuhn Elisabetta
Radiology
MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA - CFU: 2
Lezioni: 18 ore
: 6 ore
: 6 ore
Docente/i
Ricevimento:
previo appuntamento da concordare via e-mail
Ricevimento:
Disponibile su Teams ed in presenza; giorno ed ora sono da concordare con il docente via email.
Teams or in presence
Ricevimento:
Da concordare telefonicamente o tramite posta elettronica
Centro Diagnostico Italiano, Via Saint Bon 20, Milano
Ricevimento:
previo appuntamento da concordare via e-mail
U.O. Nefrologia e Dialisi, Ospedale Sacco oppure Ospedale Fatebenefratelli
Ricevimento:
Lunedì dalle 10 alle 13
LITA
Ricevimento:
Previo appuntamento da concordare via e-mail
IRCCS Policlinico San Donato - Settore didattico - Corpo F - Piano 1
Ricevimento:
Martedì e Giovedì ore 12 previo appuntamento