Unit SCIENCES OF HUMAN PATHOLOGY

CLINICAL ANALYSIS

Code	A001517
CFU	2
Teacher	Alfredo Villa
Teachers	Alfredo Villa
Hours	24 ore - Alfredo Villa
Learning activities	Caratterizzante
Area	Scienze e tecniche di laboratorio biomedico
Academic discipline	BIO/12
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	EMOGASANALISIS THE LABORATORY IN THE EVALUATION OF FLOGOSYS LABORATORY IN THE EVALUTATION OF RENAL FUNCTIONALITY CEPHALORACHIDIAN LIQUID SPECIFIC PROTEIN
Reference texts	MEDICINA DI LABORATORIO (G. Federici) Mc Graw Hill 3rd edition Power Point presentations used during clasees will be available to students and, upon demand, scientific articles providing further detailed information on specific topics.
Educational objectives	Students will have to acquire cultural and techincal basis of clinical phatology and of organization of the laboratory and of computerized administration in the medical and sanitary field.Ability to apply knowledge and understanding: knowledge acquired should allow them to apply the analysis procedures to obtain and manage laboratory data in order to discern parameters that can be useful to prevent, diagnose and treat illnesses, knowing how do deal with systems of communication, filing and digital management of laboratory data. of judgement: ability to autonomously take decisions on the reliability of obtained results and on the technical consistency of the methods applied.Communication skills: ability to relate with different sanitary professionalities working in the laboratory in order to correctly communicate the data and take part in the direct of computerized informative process towards clinicians and clients.Ability to carry out deper study: ability to gather, organize and interpret correctly technical information obtained through methods of biomedical analysis.
Prerequisites	Knowledge of anatomy, physiology, biochemistry, statistics
Teaching methods	Frontal instruction Pathways, materials and/or assessment methodologies consistent with the needs of students with disabilities and/or DSA are provided
Other information	Student reception is by appointment by writing to the following contact details: Prof. Alfredo Villa email: alfredo.villa@ospedale.perugia.it
Learning verification modality	The verification of learning involves a written examination with comprehensive anwer to two questions
Extended program	TUMORAL MARKERS Definition, significance, clinical use, role in the laboratory. Main tumoral markers. EMOGASANALISI Principles di fisiopatologia, equilibrio acido.base idroelettrolitico gas exchanges Main emogasanalasys parameters and their significance THE LABORATORY IN THE VALUATION OF STATO FLOGISTICO Pathophysiological concepts of inflammation grading laboratory markers of acute and chronic inflammation. Technical analysis. Sepsy THE LABORATORY IN THE EVALUTATION OF RENAL FUNCTIONALITY Notions of renal pathophysiology, clinical diagnosis laboratory of the glomerulus and tubulopathies The laboratory in acute and chronic renal failure. MARKERS OF MYOCARDIAL DAMAGE Elements of pathophysiology, historical markers, myoglobin, troponin and CK mass. laboratory diagnostic pathways in the study and evaluation of myocardial damage. CEPHALORACHIDIAN LIQUID Notes of physiology and physiopathology. 1st 2nd and 3rd level analysis. Operating framework for the main neurological diseases. PROTEIN DIAGNOSTIC Proteins and their functions, methods determination and clinica significance with special reference to plasma cell dyscrasias

PHYSIOPATOLOGY OF HAEMOSTASIS

Code	A002537
CFU	1
Teacher	Loredana Bury
Teachers	Loredana Bury
Hours	12 ore - Loredana Bury
Learning activities	Base
Area	Scienze biomediche
Academic discipline	MED/04
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Structure and function of platelets. Congenital hemorrhagic diseases and acquired coagulopathies. Hereditary platelet number disorders, hereditary platelet function disorders and autoimmune thrombocytopenia. Advanced diagnostic tests for the study of platelets. Thrombophilias. Molecular genetic diagnostics of hemorrhagic, platelet and thrombotic diseases.
Reference texts	The teacher will prepare the didactic materials on the basis of the scientific literature available on the specific topics. Accordingly, participation to the teacher's lessons is essential. If the student wants to deepen the subject, a good reference text is "Clinic and therapy of hemorrhagic and thrombotic diseases" authors Giancarlo Castaman and Anna Falanga, Published by Piccin
Educational objectives	The course aims to provide students with the basic knowledge on the pathophisiology and the most advanced diagnostic techniques in the field of hemostasis and thrombosis.
Prerequisites	Preliminary knowledge about the biology and physiology of blood cells
Teaching methods	Didactic activity will be mainly focused on face-to-face lessons using Power Point slides
Other information	The attendance to lessons is warranted in order to allow a good understanding of the arguments in the absence of a single reference textbook. Materials presented during classes will be made available after the lessons.
Learning verification modality	Oral exam
Extended program	- STRUCTURE AND FUNCTION OF PLATELETS (formation of platelets from megakaryocytes, structure of platelets, platelet receptors and platelet activation). - CONGENITAL HEMORRHAGIC DISEASES AND ACQUIRED COAGULOPATHIES (Description of the main hereditary diseases of coagulation and acquired coagulopathies and related diagnostic techniques). - HEREDITARY THROMBOCYTOPENIA, HEREDITARY PLATELET FUNCTION DISORDERS AND AUTOIMMUNE THROMBOCYTOPENIA (Description of the main hereditary platelet disorders and of platelet disorders on an autoimmune basis and excursus on the relative diagnostic techniques). - ADVANCED DIAGNOSTIC TESTS FOR THE STUDY OF PLATELETS (Light transmission aggregometry, lumiaggregometry, flow cytometry, bleeding time, PFA-100, optical and fluorescence microscopy). - THROMBOPHILIAS (what is thrombophilia; coagulation tests and genetic tests for the diagnosis of thrombophilias) - MOLECULAR GENETIC DIAGNOSTICS OF PLATELET AND THROMBOTIC HEMORRHAGIC DISEASES (Classic Sanger sequencing techniques and new next generation sequencing techniques for the diagnosis of hemorrhagic, platelet and thrombotic diseases)

IMMUNOLOGY AND IMMUNOPATHOLOGY

Code	A001516
CFU	2
Teacher	Emanuela Rosati
Teachers	Emanuela Rosati
Hours	20 ore - Emanuela Rosati
Learning activities	Base
Area	Scienze biomediche
Academic discipline	MED/04
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	ORGANIZATION OF THE IMMUNE SYSTEM: cellular and soluble components of innate and adaptive immunity. INNATE IMMUNITY: pattern recognition receptors for pathogens; effector mechanisms of innate immunity; inflammatory response; Natural Killer cells; the complement system. LYMPHOCYTE DEVELOPMENT: stages of B and T cell maturation; molecular mechanisms involved in the generation of diversity of the B and T cell repertoire. ANTIGEN RECOGNITION BY LYMPHOCYTES: B and T cell receptor and genetic basis of their structure; the major histocompatibility complex; antigen processing and presentation to T lymphocytes. ACTIVATION OF B AND T LYMPHOCYTES: activation phases; effector mechanisms of humoral and cell-mediated immunity. FUNCTIONAL ANATOMY OF THE IMMUNE RESPONSES: induction of immune responses in vivo; pathways and mechanisms of lymphocyte recirculation and homing. IMMUNOLOGIC TOLERANCE: mechanisms of central and peripheral tolerance.
Reference texts	- Abbas A.K., Lichtman A.H., Pillai S. Cellular and Molecular Immunology. 9th Edition, 2018, Edra Editor. - Murphy K., Weaver C. Janeway’ s Immunobiology. 9th Edition, 2019, Piccin Editor.
Educational objectives	At the end of this course, the student should know and understand the physiologic (cellular and molecular) mechanisms that regulate the functions of the immune system and mediate the immune responses. Specifically, the student should know the cells, the tissues, the organs and the molecular structures of the immune system and understand their integrated function in the defence against pathogens.
Prerequisites	To understand and follow the contents of the teaching course, the basic knowledge of Biology, Biochemistry and Genetics is necessary.
Teaching methods	Frontal lessons on all the topics of the Course, with presentation and discussion of slides.
Other information	- Schedule of the lessons and exams: The schedule of the lessons and exams is posted on the Course website http://www.med.unipg.it/tecnlab- Consulting hours and location: -Friday hours 14.00 -16.00, and further dates that will be determined upon specific request of the students. - Building B, 4th Floor, Course in Biomedical Laboratory Techniques, Piazza Lucio Severi, Sant'Andrea delle Fratte, Perugia. For students with disabilities see the website http://www.unipg.it/disabilita-e-dsa
Learning verification modality	Oral exam. It will consist of an interview lasting about 20-25 minutes, with two questions on the entire program of the course. The exam will be aimed at ascertaining the level of knowledge, the property of language, the understanding reached by the student and the ability to integrate and connect the content of the course. The oral exam will also verify the student's ability of communication and speaking with an autonomous language.
Extended program	ORGANIZATION OF THE IMMUNE SYSTEM: Properties and cellular and soluble components of the innate and adaptive immunity. Anatomy and functions of lymphoid organs and tissues. INNATE IMMUNITY: Cellular and soluble components of the innate immune system. Pattern recognition receptors of the innate immune system. Role of innate immunity in local and systemic defense against microbes: effector functions of the innate immune responses. Inflammatory response. Role of innate immunity in stimulating adaptive immune responses. Cellule Natural Killer. THE COMPLEMENT SYSTEM: Components of the complement system. Pathways of complement activation: the classical pathway, the alternative pathway and the lectin pathway. Receptors for complement proteins. Regulation of complement activation. Biological functions of complement proteins. CYTOKINES: General properties and functional classification of cytokines. IMMUNOGLOBULINS (Ig): Molecular structure of Ig. Structural features of the variable regions of Ig and their relationship to antigen binding. Structural features of the constant regions of Ig and their relationship to effector functions. Characteristics of antigen-antibody interactions. Genetic basis of Ig structure: organization of Ig germ-line genes; rearrangement and expression of Ig genes. Molecular mechanisms involved in the generation of antibody diversity. Ig classes and their biological activities. MATURATION OF B LYMPHOCYTES: Stages of B lymphocyte maturation. Molecular mechanisms involved in the generation of diversity of the B cell repertoire. Mechanisms controlling autoreactivity of immature B lymphocytes. Acquisition of functional competence. THE MAJOR HISTOCOMPATIBILITY COMPLEX (MHC): Role of MHC in the immune responses. Organization of class I and class II MHC genes. Structure, function, cellular distribution and regulation of class I and class II MHC molecule expression. Characteristics of peptide-MHC interactions. Structural basis of peptide binding to MHC molecules. ANTIGEN PROCESSING AND PRESENTATION TO T LYMPHOCYTES: Characteristics of antigens recognized by T lymphocytes. The MHC-restricted antigen recognition by T lymphocytes. Role of accessory cells in T cell activation. Processing of extracellular and endogenous protein antigens. Association of processed peptides with MHC molecules and presentation to T lymphocytes. T CELL ANTIGEN RECEPTOR (TCR): Structural and biochemical characteristics of the aß TCR. Role of the aß TCR in the recognition of peptide-MHC complexes. Genetic basis of the aß TCR structure: organization of germ-line genes; rearrangement and expression of genes. Molecular mechanisms involved in the generation of the aß TCR diversity. Proteins of T lymphocyte receptor complex (TCR complex). T cell accessory molecules. MATURATION OF T LYMPHOCYTES: Role of the thymus in T cell maturation. Stages of T lymphocyte maturation. Generation of diversity of the T cell repertoire. Thymic selection processes for MHC-restricted and self-tolerant aß T cells. ACTIVATION OF T LYMPHOCYTES AND EFFECTOR MECHANISMS OF CELL-MEDIATED IMMUNITY: Phases of T cell responses. T cell clonal expansion. Molecular and biochemical events in the signal transduction by the TCR complex. Differentiation of CD4+ T cells into different subsets of helper T (TH) cells, TH1, TH2 and TH17. Role of cytokines in the differentiation and functions of the different T subsets. T cell-mediated activation of macrophages and development of inflammatory response. Differentiation of CD8+ T cells into cytotoxic T lymphocytes (CTL). Effector functions of CTL: mechanisms and mediators involved in CTL-mediated cytotoxicity. B LYMPHOCYTE ACTIVATION AND ANTIBODY PRODUCTION: Characteristics of the B cell antigen receptor (BCR). Antigen recognition by the BCR and phases of B cell activation. Molecular and biochemical events in the signal transduction by BCR complex. Mechanisms of T cell-dependent antiboby response to protein antigens. B lymphocytes as antigen presenting cells. B cell activation by TH lymphocytes. Reactions in the germinal centers: heavy chain class (isotype) switching, affinity maturation and memory B cell generation. Antibody responses to T cell-independent antigens. IMMUNOLOGIC TOLERANCE: Features of self-tolerance. Mechanisms of central and peripheral tolerance.

PATHOLOGY AND GENERAL PHYSIOPATHOLOGY

Code	A001515
CFU	3
Teacher	Teresa Zelante
Teachers	Teresa Zelante
Hours	40 ore - Teresa Zelante
Learning activities	Base
Area	Scienze biomediche
Academic discipline	MED/04
Type of study-unit	Obbligatorio (Required)
Language of instruction	ITALIAN
Contents	Intrinsic and Extrinsic Causes of Disease. Regressive and Progressive processes. Oncology. Classification of the tumors. Carcinogenesis. Oncogenes and Tumor Suppressor Genes. Invasive cancer and metastasis. Acute and Chronic inflammation. Physiopathology of: the blood; of the heart and the blood vessel; of the liver; of the kidney; of endocrine system; Alteration of the thermoregulation.
Reference texts	Le basi della patologia generale Ganghi M. 2020 Patologia generale Parola M., 2020
Educational objectives	The course of General Pathology includes the study of the structural changes which come about in the organism and cause diseases and the changes at molecular, cellular, tissues and organs. In particular the teaching course is aimed at the comprehension by the student: a) the causes (etiology) exogenic, endogenic which result in structural and functional alterations in the organs; b) the molecular and cellular mechanisms (pathogenesis) by which the etiologic agents induce the damage; c) the processes by which the organism responds to the damage, in order to reestablish the previous integral conditions (or a new condition of equilibrium). The course of General Physiopathology includes the study of the structural changes which come about in the organism and cause diseases and the changes at molecular, cellular, tissues and organs.
Prerequisites	To understand and follow the contents of the teaching course, the knowledge of Biology, Anatomy, Biochemistry and Physiology is necessary.
Teaching methods	Lectures on the topics of the module. Lessons are provided in the didactic laboratory regarding tests performed in pathology and immunology.
Learning verification modality	Oral examination: is a discussion (of 30 minutes on average), aimed at ascertaining the level of knowledge, the property of language, the understanding reached by the student and the ability to integrate and connect the content of the course followed. The exam is integrated with immunology
Extended program	Intrinsic causes of disease Genetic Pathology -Monogenic autosomic and heterochromosomic diseases. Extrinsic Causes of Disease -Physical agents. Non ionizing and ionizing radiation. Low and high temperature: freezing and burn. Low and high pressure. -Chemical and Environmental agents. Environment pollution. Drugs. Regressive processes -Physiological and pathological Atrophy. -Intracellular regressive processes.Vacuolar, hydropic and turbid degenerations. Hyaline and Mucoid degenerations. Steatosis. -Extracellular regressive processes. Amiloidosis. Hyaline, Fibrinoid and Mucoid degenerations. -Cell death. Necrosis. Gangrene. Outcome of necrotic process. Autolysis post-mortem. Apoptosis. Progressive processes. -Physiological and pathological hypertrophy and hyperplasia. - - Regenerative process in labile, stable and perennial cells. Liver regeneration. Reconstitution process. Molecular Oncology -Classification of the tumors. Characteristics of normal and transformed cell. Metaplasia, Dysplasia, Anaplasia. Benignant and Malignant tumors. Histological classification and morphological features of human tumors. -In "situ" carcinoma. - Epidemiology of tumor. Carcinogenesis: chemical, physical (U.V. and ionizing radiations), viral, environmental. -Co-carcinogenesis, mechanism of transformation. -Molecular basis of the transformed cell. Pathogenetic mechanisms. Oncogenes and Tumor Suppressor Genes. Control of DNA replication. Mutations. Hereditary tumor diseases. Karyotype and chromosomal alteration in tumor. -Role of the apoptosis control in the tumor growth.. -Molecular pathology in DNA repair. Mismatch repair. Excision repair. Xeroderma Pigmetosum. -Angiogenesis in cancer. -Concept of invasive cancer. Metastasis and stage of the cancer. Molecular mechanisms of the metastasis. Metastasis routes. Inflammation -General characteristic and definition of inflammation. Recognition mechanisms of pathogens. Distinctive characters between acute and chronic phlogosis. -Acute exudative phlogosis (Angiophlogosis) The inflammation phases. Plasmatic and tissutal mediators of inflammation. The exudation: different types of exudate. Acute phase proteins. Acute phase cells. The diapedesis, the chemotaxis, and phagocytosis. Different types of acute inflammation: serous, serous-fibrinous, fibrinous, catarrhal, purulent, hemorrhagic, necrotic- hemorrhagic and allergic. -Chronic phlogosis. The cells of chronic inflammation. -Chronic inflammation: granulomatosis and interstitial. Structure of granuloma: tuberculoma, syphiloma, rheumatic nodule and foreign body granuloma. -Outcome of inflammatory process. The repair processes and granulation tissue. PHISIOPATHOLOGY Physiopathology of the blood -Blood: composition, hemopoiesis. -Alteration of the blood mass. The erytrocytes: Polycythemia and erythremia. Hemoglobinopathy. Anaemia. Physiopathology of the heart and the blood vessel -Congenital and acquired heart defects. Endocarditis and valvulopathy. Ischemic heart disease. Heart attack. Myocardiopathy. Heart failure. -Pathogenesis of atherosclerosis and its complications. -Shock: cause of shock, evolution and phases, compensatory mechanisms. Edema. Physiopathology of respiratory apparatus -Pathogenesis of respiratory failure. -Bronchial asthma. -Obstructive pulmonary disease. Physiopathology of the liver -Liver primitive pathology. Inflammatory and degenerative processes. Hepatitis, Cirrhosis. -Jaundice. -Liver failure. Physiopathology of the kidney - Renal failure. Physiopathology of endocrine system -Thyroid: hypo- and hyper-thyroidism. Thyroid goiter. Thyroiditis. -Endocrine pancreas. Diabetes Mellitus: etiopathogenetic and metabolic aspects, complications. Alteration of the thermoregulation -Fever, Hypothermia and Hyperthermia

CLINICAL PATHOLOGY TECHNIQUES

Code	A001518
CFU	2
Teacher	Cristina Tortoioli
Teachers	Cristina Tortoioli
Hours	24 ore - Cristina Tortoioli
Learning activities	Caratterizzante
Area	Scienze e tecniche di laboratorio biomedico
Academic discipline	MED/46
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	1) Techniques of Hematology 2) physiology of haemostasis
Reference texts	Text, slides and recommended study materials provided by the teacher
Educational objectives	The teaching represents the acquisition of methods for determining the blood count with 2nd generation automated and manual systems. The acquisition of the basic principles of haemostasis physiology and the main diagnostic screening tests of primary haemostasis. The main knowledge acquired will be basic theoretical elements important for the subsequent understanding of the techniques they will perform in the theoretical-practical training in the laboratories they will attend and useful for their profession practiced in hematology and coagulation laboratories
Prerequisites	preliminary knowledge about the cell biology and physiology of blood cells.
Teaching methods	the course is organized as follows: - classroom lessons on all the topics of the course with the help of slides
Other information	To be agreed prior telephone contact Place of work: LABORATORIO MISEM Building C floor 2 Square Lucio Severi 1/8 S.Sisto Phone N. 075/5783588
Learning verification modality	evaluation through examination with written verification, consisting of two questions with open reponses
Extended program	1) HEMATOLOGICAL TECHNIQUES 1st part: (qualitative surveys): evaluation of the blood smear (MGG staining), evaluation of erythrocyte, leukocyte and platelet morphology. Leukocyte formula. HEMATOLOGICAL TECHNIQUES 2nd part (quantitative surveys): Counting of cellular components of blood by method: - direct: via burker chamber - - indirect / automated: through hematology analyzers (Coulter and VCS technology) -Hematocrit (meaning) - Red cell constants (CHM-CHCM-VGM) 2) HEMOSTASIS - FIBRINOLYSIS - haemocoagulation process: vascular phase - platelet phase - plasma coagulation phase (intrinsic path, extrinsic path) haemostatic control - - Fibrinolytic process 3) SCREENING TEST OF PRIMARY and SECONDARY HEMOSTASIS: - platelet count bleeding time and Closure time. -PT-Ratio-INR -Aptt-Fibrinogen.