The approximate timing of classes

The purposes of the class:

· Formation of knowledge of the main issues of the theme

·  Development of skills for experimental work with animals, for functional studies

· Formation of communicative skills for group work

· Formation of law competence of preclinical research

Tasks of study:
• To learn the content, structure, tasks of pathophysiology as an academic discipline, the basic concepts of general nosology
• To learn the basic terms of nosology (glossary)
• To form communicative skills in group work (skills in proving the point of view, leadership qualities) during the blitz game
• To learn the basic orders for preclinical studies (Order of the MH number 697 of 12 November 2009 "On approval of rules for conducting biomedical experiments, (non-clinical) and clinical studies." Order of the Committee for Technical Regulation and Metrology of the Ministry of Industry and Trade of the Republic of Kazakhstan dated December 29, 2006 № 575. State Standard of the Republic of Kazakhstan Good Laboratory Practice.

 Questions for the theme

1. Subject of pathological physiology. A place and role of pathophysiology in medical education, its connections with other sciences.

2. The main purposes of pathological physiology.Methods of pathological physiology. The role of pathophysiological experiment, advantages and lacks of modelling of pathological processes in animals.

3. Moral - ethical aspects of work with laboratory animals.

4. The basic concepts of the general nosology: health, disease, predisease, pathological reaction, pathological process, pathological state.

5. Criteria of disease. The Main principles of disease classification.

6. Stages of disease, their characteristic.

7. Periods of dying, the characteristic. Pathohysiological base of resuscitation (reanimation). Postreanimatory disease, concept, pathogenesis.

Methods of teaching

Discussion the major issues under the supervision of a teacher, a demonstration of multimedia presentation "Ethics of preclinical studies", work in small groups - blitz game, identifying of predisease with load tests (Martine, Shtange, Gençhe)

Methods of control

Oral questioning, checking conclusions of experiment, testing

The approximate timing of classes

№	Steps of the class	Time (min)
1	Organizational part. Roll Call, reading the goals and objectives of the class, distribution of demonstration material	5
2	Discussion the questions  № № 1-3	25
3	Blitz-game	20
4	Break	10
5	Discussion the questions  №№ 4 -7	25
6	Test	15
7	Summarizing the classroom work, assessment of competencies	10

Practice work

The task № 1.

The blitz – game «Definition of correct sequence of the basic stages патофизиологического experiment».

Technique: Each student determines correct sequence of stages of pathophysiological experiment as figures in the column «individual decision». After performance of this task students make groups with three students and collectively discuss results, coming to common opinion, and mark correct sequence of stages of experiment in the column «group decision». Then the teacher gives the correct answer. After that work above mistakes begins. Individual and group mistakes are counted up.

 

Stage of experiment	Individual decision	Individual mistake	Right answer	Group decision	Group mistake
Determination of the purposes and aims of experiment
Making the plan of the experiment
Statistical analysis of the received data
Choice of adequate model and techniques of research
The analysis of results of research and conclusions
Research of pathological process
Modeling of pathological process
Experimental therapy
Creation of idea of experiment
Theoretical preparation of the researcher

Glossary

Pathophysiology (from Greek words): pathos - illness, suffering; physis - nature, function; logos - study
Pathophysiology is the science about the functions of a sick organism.

Pathophysiology is scientific study of disease - its nature, cause, mechanisms and effects. It is the science about general laws of pathological processes and diseases. It studies "why" and "how" disease occurs and develops.

Патофизиология (от греч. Pathos - болезнь, physis – природа, функция, logos - учение) – наука о функциях больного организма.

Патофизиология изучает общие закономерности возникновения, развития и исходов болезней.

Патофизиология (грекше Pathos – ауру, дерт, physis – табиғат, қызмет, logos - ғылым) – ауруға шалдыққан организмнің қызметі туралы ғылым.

Патофизиология аурулардың пайда болуы, дамуы және аяқталуының негізгі заңдылықтарын зерттейді.

Purposes of pathophysiology

· Study the questions of general etiology

· Study the questions of pathogenesis

· Investigation methods of experimental therapy

· Formation of medical mode of thinking

Задачи патофизиологии

· Изучение вопросов общей этиологии

· Изучение вопросов патогенеза

· Разработка методов экспериментальной терапии

· Формирование врачебного мышления

Патофизиологи яның міндеттері

· Жалпы этиология сұрақтарын зерттеу

· Патогенез сұрақтарын зерттеу

· Экспериментік емдеу тәсілдерін өңдеу

· Дәрігерлік ойлауды қалыптастыру

 

The main method of pathophysiology – is pathophysiological experiment.

The main feature of pathophysiological experiment is modelling of human illness at animals.

 

Основной метод патофизиологии – патофизиологический эксперимент.

Особенность патофизиологического эксперимента: моделирование болезней человека у животных.

Патофизиологияның негізгі тәсілі – патофизиологиялық эксперимент.

Патофизиологиялық эксперименттің ерекшелігі: адам ауруларын жануарларда үлгілеу.

 

Nosology – is the study of disease in general (from Greek word nosus – disease):

Нозология – учение о болезни (от греч. nosus-болезнь)

Нозология – ауру туралы жалпы ілім (грекше nosus-ауру).

 

“Health is a state of complete physical, psychological and social well-being, and is not just the absence of illnesses or physical defects” (WHO).

«Здоровье – это состояние полного физического, духовного и социального благополучия, а не только отсутствие болезней или физических дефектов» ВОЗ.

«Денсаулық – бұл аурудың немесе физикалық ақаулардың болмауы ғана емес, физикалық, психикалық және әлеуметтік толық сәттілік жағдай» БДСҰ.

 

“Disease is normal life disturbances under the influence of pathogenic factors, it is characterized by restriction in adaptation to the environment and reduction in work capacity” (I.Petrov)

 «Болезнь – нарушение нормальной жизни организма под влиянием различных повреждающих факторов, характеризующееся ограничением приспособления к окружающей среде и снижением трудоспособности» И.Петров.

Ауру – әртүрлі зақымдаушы агенттің әсерінен қоршаған ортаға бейімделуінің шектелуімен және еңбекке қабілетінің төмендеуімен организмнің қалыпты өмірінің бұзылысы» И.Петров.

 

Predisease is a condition between health and illness.

Предболезнь – состояние между здоровьем и болезнью.

Ауру алды – денсаулық пен ауру арасындағы аралық жағдай.

 

Pathological reaction – (re-against) – is short-term, unusual, inadequate organism’s responce to different factors

Патологическая реакция –(re - против, action - действие) – кратковременная, необычная (неадекватная) реакция организма на какое-либо воздействие

Дерттік серпіліс –(re – қарсы, action - әсер, серпіліс) –

Қандай да бір әсерге организмнің қысқаша, биологиялық мәнсіз және сәйкессіз жауабы

 

Pathological process – is a combination of pathological and protective - adaptive reactions to damage.

Патологический проц есс – сочетание патологических и защитно-приспособительных реакций при повреждении.

Дерттік үрдіс – зақымдану кезінде әрі қорғану бейімделу және әрі зақымдану серпілістерінің жиынтығы

Typical (general) pathological processes

• have the same pathogenesis in different kinds of animals and men (monopathogenesis)

• Have many causes (multicausality)

• develop in different organs and tissues

• have more or less expressed protective - adaptive value

• are formed during evolution

Типовые патологические процессы:

· протекают однотипно у разных видов животных и человека (монопатогенез)

· характерна многопричинность (полиэтиологичность),

· развиваются в разных органах и тканях,

· имеют более или менее выраженное защитно-приспособительное значение,

· выработаны в ходе эволюции.

Біртектес дерттік үрдістер:

· Адам мен әртүрлі жануарларда бірдей деңгейде өтеді,

· Көп себепті (полиэтиологиялы),

· әртүрлі ағзалар мен тіндерде өтеді,

· айқындығы аз немесе жоғары қорғану-бейімделулік маңызы бар,

· эволюцияда барысында түзілген

 

Pathological state is firm departure from the norm, which doesn’t have adaptive value for an organism.

Патологическое состояние – стойкое отклонение от нормы, не имеющее приспособительного значения для организма.

Дерттік жағдай –организм үшін кері биологиялық мәні бар қалыптан тыс тұрақты ауытқу.

 

Reanimation is resuscitation of an organism. It is possible at reversible stages of dying.

Реанимация – оживление организма. Возможна на обратимых этапах умирания.

Реанимация –организмді тірілту. Өлімнің қайтымды сатыларында жүргізуге мүмкіндік бар.

 

Control

Tests

THE LIST OF LITERATURE:

The basic

1. Litvitsky P.F., Pirozhkov S.V., Tezikov E.B. Concise lectures and tests on pathophysiology E-tekstbook. – ГЭОТАР-Медиа, 2007

2. Lectures. Handouts

3. Textbook of pathology. Harsh Mohan 4rd edition, Delhi, 2004, P 3-13.

Additional

4. Патофизиология в схемах и таблицах: Курс лекций: Учебное пособие. Под ред. А.Н.Нурмухамбетова. – Алматы: Кітап, 2004. – С. 12-17.

 

Office hours (2)

Case study

Case № 1

    Patient A., aged 45, arrived for a spa treatment with complaints of weakness and pain in the muscles of the right shin while walking. Five years ago on the basis of vascular disease (endarteritis), he developed dry gangrene of the left foot. It had been amputated. The patient was treated with warm hydrogen sulfide baths. Soon, however, the procedure had to be canceled because of development of inflammation in the veins (phlebitis). In addition, the patient was poorly tolerated to treatment: while taking baths he showed raised blood pressure and headaches.
Questions:
1. Find out the  disease. Define disease, select disease criteria.
2. Find out the pathological reaction, give the definition
3. Find out the pathological processes, give the definition
4. Find out the pathological state, give the definition
         

Case 2

A child of 3 years old complained of sore throat, abdominal pain and headache. Body temperature was 38.5⁰ C, there was a single vomiting. After 12 hours a doctor revealed rash on the cheeks the chest, back, around the underarms and elbows, enlarged hyperemic tonsils, enlarged submandibular lymph nodes. A week ago, the child had contact with sick person with scarlet fever. The doctor diagnosed scarlet fever and prescribed antibiotics.
A week later the rash faded, but the affected skin begin to peel.
1. Call the stages of infectious disease, describe each stage, justify answer.
Case 3

A musician (pianist) injured a finger. Inflammation developed.

Does he have a disease? Justify the answer.

 

THE LIST OF LITERATURE:

The basic

5. Lectures. Handouts

6. Textbook of pathology. Harsh Mohan 3rd edition, Delhi, 1998, P 3-13.

Additional

7. Патофизиология в схемах и таблицах: Курс лекций: Учебное пособие. Под ред. А.Н.Нурмухамбетова. – Алматы: Кітап, 2004. – С. 12-17.

 

Control – conclusions on the tasks

 

2. THEME:

«GENERAL ETIOLOGY AND PATHOGENESIS. EFFECTS  OF LOW BAROMETRIC PRESSURE ON AN ORGANISM»

The purposes of the class:

· Formation of knowledge of the main issues of the theme

· Formation of skills to use the knowledge of the theoretical material for pathogenetic schemes and pathophysiological analysis of clinical cases

· Formation of communicative skills for discussion of the problem

Tasks of study:
• To learn the main issues of the theme
• To develop the skills to use the glossary in three languages for discussion of the theoretical material
• To Learn how to make pathogenetic schemes, to allocate the leading link and  vicious circles
• To  apply the theoretical knowledge in solving of clinical cases

• To form communicative skills for discussion of the theoretical material

 Questions for the theme

1. Etiology, definition. Role of causes and conditions in occurrence of diseases Etiotropic principle of preventive maintenance and treatment of illnesses.

2. Classification of etiological factors and their characteristic. Role of environmental factors and organism’s peculiarities in occurrence of illnesses.

3. Pathogenesis, definition. Primary lesion as an initial factor of pathogenesis. Levels of damage. Cause and effect relations in pathogenesis. The main (leading) pathogenetic factor, "vicious circles", definitions, examples.

4. Effects on an organism of low barometric pressure. Mountain sickness, the main symptoms, pathogenesis.

Methods of teaching

Discussion the major issues under the supervision of a teacher, discussion of video film “Modeling of mountain sickness”, pathogenetic schemes analysis

Methods of control

Oral questioning, checking conclusions of experiment, testing

Practical work of students

Task №1. To receive the model of Mountain sickness, to study its main symptoms (viewing of video film «Modeling of Mountain sickness»)

Technique. A mouse is placed in a hermetically sealed balloon of Komovsky’s apparatus. Examine an initial condition of an animal: behavior, character of breath, color of skin and mucous, with the help of the pump gradually pump out air, watching for a level of barometric pressure on a manometer. Fix character and sequence of changes at the level of barometric pressure 0.8 atm., 0.6 atm., 0.4 atm., 0.2 atm. In occurrence of convulsions immediately let air under the balloon. The received data bring in the table, conclude.

 THE REPORT OF EXPERIMENT.

Level of barometric pressure	The main symptoms
Initial condition
0,8 atm.
0,6 atm.
0,4 atm.
0,2 atm.

Questions
1. What factors affect the mouse in this experiment?

Office hours (2)

Formation of practical skills on the theme «General etiology and pathogenesis. Effects of low barometric pressure on an organism”

The purpose of the office hour:

• Development of practical skills of interpretation of clinical and laboratory data in solving clinical cases

Tasks of study:
• To apply the theoretical knowledge in pathophysiological analysis of cases

The Method of office hour: case study

Case Study

Case 1.
A group of tourists came under heavy rain. A day later, one of them developed pneumonia.

Questions:

1. What causes inflammation of the lungs in a tourist? What was the condition for the occurrence of the disease
2. Define the causes and conditions of the disease
3. Give the characteristics of causes of diseases
4. What is the role of the causes and conditions of illness, give the characteristics of monocauzalizm and  conditionalism

 

Case 2

A Child of 14 years, entered the hospital with tuberculous gonitis (inflammation of the knee joint). Onset of the disease is associated with knee injury. The child is often sick with colds. Living conditions are below average.
Make parsing task of this algorithm:
1. What was the cause of the child's illness? What was the condition of this disease?
2. Define the causes of disease and conditions
3. Describe the causes of the disease
4. What is the role of the causes and conditions in the event of illness, and let characteristics monokauzalizma conditionalism

Case 3

A mouse is put in a small pressure chamber. Then, during 2-3 min air is pumped out of it to decrease the pressure in the chamber down to 170-180 mm Hg. After 0.5-1 min in the hypobaric conditions the mouse shows signs of anxiety: running over, scratching its face. Two or three minutes later clonic and tonic seizures develop; the mouse is lying on its side, urinates; terminal breathing ("gasping") develops. Soon afterwards, breathing stops, and the mouse dies. The overall time of the mouse's life in the hypobaric atmosphere is 3-4 min.

Questions:

Case 5

A pressure chamber is filled with a mixture of gases consisting of 95% N₂ and of 5% O₂. Barometric pressure inside the chamber is maintained equal to normal atmospheric pressure. A mouse is put in the chamber. A thin jet of the same gas mixture is being passed through the chamber. Partial pressure of O₂ in this gas mixture is about 37 mm Hg. After staying in the chamber for 10-15 min the mouse develops seizures and then dies.

Considering the results of all 3 experiments, answer the following questions:

The purposes of the class:

· Formation of knowledge of the main issues of the theme

· Formation of skills to use the knowledge of the theoretical material for pathogenetic schemes and pathophysiological analysis of clinical cases

· Formation of communicative skills for discussion of the problem

Tasks of study:
• To learn the main issues of the theme
• To develop the skills to use the glossary in three languages for discussion of the theoretical material
• To Learn how to make pathogenetic schemes, to allocate the leading link and  vicious circles
• To apply the theoretical knowledge in solving of clinical cases

• To form communicative skills for discussion of the theoretical material

 Questions for the theme

1. Reactivity and resistance of an organism, definition.

2. Forms of organism response to pathogenic factor.

3. Types of reactivity and their characteristic. The factors determining reactivity (heredity, constitution, age, sex, function of nervous, endocrine systems, etc.).

4. Constitution of organism, definition. Classification of constitutional types on Sigout, Krechmer E., Pavlov I.P., Chernorutsky M.V., Bogomolez A.A. The role of organism’s constitution in reactivity.

5. The role of age in reactivity. Features of reactivity of children's and senile age.

6. The role of sex in reactivity. Features of reactivity of male and female organism.

Methods of teaching

Discussion the major issues under the supervision of a teacher, discussion of video film “The Role of age, function of CNS, species reactivity in resistance to hypoxy”.

Methods of control

Oral questioning, checking conclusions on experiment, testing

Practical work of students

The task № 1.

To value a role of species in reactivity.

Technique: A mouse and a frog are placed into tha ballone of Komovsky’s apparatus. Pay attention to behaviour of animals, character of breath, color of skin and mucous. Gradually reducing barometric pressure, mark distinction in manifestations of high-altitude disease at animals. The received data analyze.

 

The task №2.

To find out the role of age in reactivity.

Technique: An adult mouse (weight 18-20г.) and a newborn mouse are placed into the balloone of Komovsky’s apparatus. Pay attention to behaviour of animals, character of breath, color of skin and mucous. With the help of the pump gradually pump out air. Watch development of high-altitude illness in both animals. Conclude about the role of age in reaction of animals to low oxygen content.

 

The task №3.

To find out the role of CNS function in reactivity.

Technique: Three adult mice are taken in experiment. Inject 1 % solution of Hexanal (0,5 ml per 100g of weight) subcutaneously to one of, 10 % solution of caffeine (0,5 ml per 100g of weight) to another. The third mouse is the control. 5-6 minutes after injections all mice are placed into the balloone of Komovsky’s apparatus. Repeat a course of the previous experiments, pay attention to a difference in behaviour of animals. Analyze the received data.

 

The task №4.

To study the role of environmental factors in reactivity of an organism.

Technique: Take three mice. One mouse is cooled in the refrigerating chamber for 20 minutes, another is placed to thermostat at temperature of 40⁰С for 10 minutes. The third mouse is the control. All mice are placed into the balloone of Komovsky’s apparatus. Model high-altitude illness. Pay attention to a difference in behavior of animals, conclude.

The report

Animals	Course experience	Behavior	Character of breath	Color of skin and mucous	The form of response
Frog	Initial condition High-altitude illness
The mouse № 1 (control)	Initial condition High-altitude illness
The mouse № 2 (newborn)	Initial condition High-altitude illness
The mouse № 3 (narcosis)	Initial condition High-altitude illness
The mouse № 4 (caffeine)	Initial condition High-altitude illness
The mouse № 5 (hyperthermia)	Initial condition High-altitude illness
The mouse № 6 (hypothermia)	Initial condition High-altitude illness

       

Glossary:

Reactivity i s  a certain organism’s response to environmental factors (N.N.Sirotinin).

Reactivity is organism’s property as a whole to respond to environmental factors by changing its  life (A.D.Ado).

Реактивность ( Re – против; action - действие ) - это свойство организма отвечать определенным образом на воздействие факторов окружающей среды (Н.Н.Сиротинин).

Реактивность- это свойство организма как целого отвечать изменением жизнедеятельности на воздействие окружающей среды (А.Д.Адо).

Реактивтілік ( Re – қарсы; action - әсер ) - сыртқы ортаның әсерлеріне организмнің белгілі бір жолмен жауап қайтару қасиеті (Н.Н.Сиротинин).

Реактивтілік – сыртқы орта ықпалдарының әсерлеріне организмнің, оның жекелеген ағзалары мен жүйелерінің тіршілігін өзгертіп жауап қайтару қасиеті немесе қабілеті (А.Д.Адо)

Normergy is the adequate organism’s response to pathogenic factors

Нормергия- это адекватный ответ организма на воздействие раздражителя

Нормергия – әдеттегі тітіркендіргішке организмнің қалыпты жауабы, мұнда нормергиялық жауап серпілісі туралы айтылады

Pathergy is inadequate response to pathogenic factors

Hyperergy is more intensive reaction then normal (high reflexes, allergic reactions, child reactivity)

Hypoergy is low reaction of physiological systems to surroundings (asymptomatic diseases), reactivity of a senile organism)

Anergy is absence of organism’s response (coma, shock, narcosis)

Disergy    is inverted response, opposite to normal (vasodilation to cold, expansion of a pupil to light)

Патергия - неадекватная ответная реакция:

· гиперергия- бурные физиологические реакции, значительно превышающие необходимый уровень реагирования (реактивность детского организма)

· гипергия - слабые реакции физиологических систем, недостаточные для полноценного ответа организма на повреждающее воздействие (вялое течение болезней с неясными, стертыми признаками) (реактивность старческого организма)

· анергия - отсутствие ответных реакций (носительство, отсутствие реакций в состоянии комы, при наркозе)

· дизергия - извращенные ответные реакции (расширение сосудов на действие низкой температуры, расширение зрачка на свет)

  Патергия - қалыптан тыс жауап:

· гиперергия– реактивтіліктің жоғарылауы

· гипергия – органихм реактивтілігінің төмендеуі (аурулар сылбыр, белгілері айқын болмай өтеді) (қарттардың реактивтілігі)

· анергия - реактивтіліктің мүлде болмауы (өзі ауырмай микробтардың тасымалдаушылары болады, терең кома, сілейме, наркоз жағдайларындағы)

· дизергия - қалыптан тыс, бұрмаланған жауап (төмен температураға тамырлардың кеңеюі, жарыққа көз қарашығының кеңеюі)

Organism’s resistance is resistance against pathogenic factors.

Резистентность организма - устойчивость организма против болезнетворных воздействий (resisteo-сопротивление).

Организм төзімділігі – ауру туындататын ықпалдарға организмнің тұрақтылығы (resisteo-қарсы тұру)

 

Species reactivity - is a complex protective reactions of different species of animals to surroundings, general type of reactivity (ex. migration of birds, hibernation of mammal, species immunity)

Виды реактивности

Видовая - наиболее общий вид реактивности, особенности реагирования целого вида (миграция птиц, зимняя спячка млекопитающих, видовой иммунитет)

Түрлік – реактивтіліктің жалпы түрі, бүкіл бір түрдің жауап қайтару ерекшелігі (құстардың мекенін ауыстыруы, сүтқоректілердің қысқы ұйқысы, түрлік иммунитет)

 

Group reactivity is the response of several individuals within the species (ex. sex, age, constitution, race, group of blood)

Групповая - особенности реагирования отдельных групп индивидуумов в пределах вида (пол, возраст, конституция, расовая принадлежность, группа крови и др.)

  Топтық - түрдің ішіндегі кейбір топтардың жауап қайтару ерекшелігі (жыныс, жас, конституция, нәсілдік ерекшелік, қан топтары, ж.б.)

 

Individual reactivityis an individual's particular response unique to each person

Индивидуальная - особенности реагирования индивидуума, определяет уникальность индивидуума

Даралық - еке тұлғалардың реактивтілігі, әр адам қайталанбайтын тұлға екендігін көрсетеді

 

Physiological reactivity is adequate organism’s response

Pathological reactivity is inadequate organism’s response

Физиологическая реактивность - адекватные реакции организма

Патологическая реактивность - неадекватные реакции организма

Реактивтілік физиологиялық  ( организмнің қалыпты жауабы)

Патологиялық (организмнің қалыптан тыс жауабы) болып бөлінеді.

 

Specific (immunological) reactivity is organism’s response to antigens

Специфическая, иммунологическая реактивность – ответная реакция на антиген

Арнайыланған немесе иммунологиялық реактивтілік – антигеннің әсеріне антидене

Constitution (from Lat. Constitutio - state property) – is a set of morphological and functional characteristics of the body, forming the state of its reactivity, formed on the basis of inherited and acquired properties.

Конституция (от лат. constitutio – состояние, свойство) - это совокупность морфологических и функциональных особенностей организма, формирующих состояние его реактивности, сложившихся на основе наследственных и приобретенных свойств.

Дене бітімі (лат. constitutio – жағдай, қасиет) – тұқым қуалаушылықтың және жүре пайда болған қасиеттер негізінде қалыптасқан, жеке тұлғалардың құрылымдық, функциялық және жандүниелік ерекшеліктерінің жиынтығы.

 THE LIST OF LITERATURE:

The basic

1. Litvitsky P.F., Pirozhkov S.V., Tezikov E.B. Concise lectures and tests on pathophysiology E-tekstbook. – ГЭОТАР-Медиа, 2007

2. Lectures, handouts.

Control –test

Office hours (2)

Formation of practical skills on the theme «The role of reactivity of an organism in pathology”

The purpose of the office hour:

• Development of practical skills of interpretation of clinical and laboratory data in solving clinical cases

Tasks of study:
• To apply the theoretical knowledge in pathophysiological analysis of cases

The Method of office hour: case study
                                                                   Case Study

Case 1

Three mice are used in the following experiment. Mouse 1 is put in the water basin where water is heated up to 30^oC. Five minutes later mouse 2 is put in the same basin. Ten seconds later both mice are taken out of the water and put in the pressure chamber. The third mouse (intact) is also put in the same chamber. The air is pumped out as in the experiment N 1 to bring the barometric pressure in the chamber down to 170-180 mm Hg. The intact mouse dies after 3-4 min of staying in the hypobaric conditions. Mouse 2 dies after 6-7 min, and the mouse 1 survives 15 min of hypoxia. At this point the experiment is stopped. When mouse 1 is taken out no signs of pathology are observed.

Questions:

Case 2

Three mice are used in the following experiment. Mouse N 1 is narcotized by a subcutaneous injection of morphine. This mouse is used in the experiment after it loses righting reflex indicating deep sleep. Mouse 2 is administered a central nervous system stimulator phenamine. Mouse 3 serves as control. All three mice are put in the pressure chamber, and the air is pumped out as in experiment N 1. Mouse 2 dies during the 1-2 min of its staying in the chamber, mouse 3 - during the 4th min; and mouse 3 survives 15 min in hypobaric conditions. At this point the last mouse is taken out of the chamber and examined after it has taken up. It shows no signs of pathology.

Questions:

Case 4

N., a healthy woman, whose father suffered from hemophilia A and mother was healthy, went to a genetic counseling unit. She was anxious about the risk of hemophilia to her grandsons. Her husband, as well as her son and two daughters were healthy.

Questions:

The purposes of the class:

· Formation of knowledge of the main issues of the theme

· Formation of skills of experimental work

· Formation of communicative skills for discussion of the problem

Tasks of study:
• To learn the main issues of the theme
• To develop the skills to use the glossary in three languages for discussion of the theoretical material
• To Learn how to make pathogenetic schemes
• To apply the theoretical knowledge in solving of clinical cases

• To form communicative skills for discussion of the theoretical material
Questions for the theme

1. The notion of cell injury. Causes of cell injury. The factors determining resistance of cells to damage.

2. Types of cell injury, the characteristic. Stages of acute and chronic cell injury. Reversible and irreversible ischemic/hypoxic cell injury.

3. Specific and nonspecific (ionic imbalance, reduction of energy supply, changes of рН, membrane potential, sorption ability) manifestations of cell injury, mechanisms of development.

4. General mechanisms of cell injury: Pathogenesis of cellular membrane damage (activation of lipid peroxidation, phospholipases, osmotic and immune damage). Derangements of the energy supply and utilization, Ionic and water dysbalance.

5. Adaptive mechanisms operating during cell injury.

Methods of teaching

Discussion the major issues under the supervision of a teacher, discussion of videos and results of the experiment.

Methods of control

Oral questioning, checking conclusions on experiment, testing

Practical work of students

The task №1. Study the effect of high temperature on osmotic resistance of rabbit’s erythrocytes.

Technique: 0.5 ml of blood from a regional vein of an ear of the healthy rabbit was taken into a test tube. 0.02 ml of blood  were placed into 4 test tubes, with 5 ml of NaCl solution of 0.3 %, 0.45 %, 0.65 %, 0.85 %).

The rest blood was incubated within 5 minutes in a water bath with water temperature of 50⁰С. After that, 0,02 ml of the heated blood was  placed into other 4 test tubes with the same concentrations of NaCl. After 10-15 minutes of exposure intensity of the color is visually compared. Analyze the results of an experiment using the table, make the conclusion.
The protocol of the experiment

Series of experiment	Concentration of solutions of NaCl
	0,3 %	0,45 %	0,65 %	0,85 %
1. Control	++	+	-	-
2. Experiment	+++	++	+	-

 

The task № 2. Analyze  the effects of ethanol on rabbit’s erythrocytes.

Technique:  5 ml. Ringer's solution is placed into 5 centrifuge tubes. Then  the ingredients according to the protocol specified in the table below are added. 

Tube 1 (control)	Tube  2	Tube 3	Tube 4	Tube 5
5 ml. Ringer's solution + 0,02 ml blood	5 ml. Ringer's solution + 0,5 ml 30% Н2О2 + 0,02 ml blood	5 ml. Ringer's solution + a few grains of powder detergent + 0,02ml blood	5 ml. Ringer's solution + 0,5 мл 0,1N HCl + 0,02 ml blood	5 ml. 0,5% solution of NaCl   + 0,02 ml blood
Without hemolysis	Hemolysis	hemolysis	hemolysis	hemolysis

Glossary

Cell injury is cellular structure and function damages which persists after the removal of the damaging agent

Повреждение клетки это нарушение структуры и функции клетки, сохраняющееся после удаления повреждающего агента

Жасушаның зақымдануы – бұл жасушаның құрылымы мен қызметінің зақымдаушы жайттың әсерінен кейін дамитын бұзылыс

Glycocalyx is thin cell cover, formed by glycoproteins and glycolipids functioning as charged molecular sieve. Destruction of Glycocalyx leads to decrease in resistance to cell injury. Гликокалекс – тонкая пленка, покрывающая клеточные поверхности, образована полисахаридными цепями, гликопротеидами, гликолипидами, функционирует как заряженное молекулярное сито. Нарушение образования гликокалекса уменьшает устойчивость клетки к повреждению.

Гликокалекс – молекулярлық сүзгі қызметін атқарушы, гликолипидті, гликопротеидті, полисахаридті тізбектен тұратын жасушаның беткей қабатын көмкеруші жұқа қабық.   

 

Cell cycle.: G 0 (gap 0) phase - resting phase, G1 - is the preparation for DNA synthesis, S (synthetic) phase - is DNA synthesis, G2 ph. – preparation for mitosis, M - mitosis

Фазы жизненного цикла клетки: G₀  ®  G₁ ® S ® G₂  ® M

G₀ - состояние покоя клетки; G₁- пресинтетическая фаза, подготовка к синтезу ДНК; S - синтез ДНК; G_{2 -} премитотическая фаза, подготовка к митозу, M – митоз. К различным воздействиям клетка по-разному чувствительна в разные фазы цикла.

Жасушаның тіршілік айналым кезеңдері: G₀ ®  G₁ ® S ® G₂  ® M

G₀ - жасушаның тыныштық жағдайы; G₁- синтез алды кезең, ДНК синтезіне дайындық кезең; S – ДНК синтезі; G_{2 –} митоз алдындағы кезең, митозға дайындық кезең, M – митоз. Жасушаның әртүрлі ықпалдарға айналым кезеңдеріне әртүрлі сезімталдығы байланысты.

           

Acute cell injury occurs when pathogenic agents are intensive, their action is of short duration

Острое повреждение клетки развивается когда достаточно интенсивный этиологический фактор действует непродолжительное время

Жасушаны ң ж іт і за қымдануы – зақымдаушы жайт қысқа уақытта қатты әсер еткенде дамиды

Chronic cell injury occurs when pathogenic agents are less intensive but their action is prolonged

Хроническое повреждение клетки развивается когда этиологический фактор малой интенсивности действует продолжительно,

Жасушаның созылмалы зақымдануы – қарқыны аз зақымдаушы жайт ұзақ уақыт әсер еткенде дамиды.

 

Direct (primary) cell injury is due to direct effects of etiological factors

Indirect (secondary) cell injury is the result of the primary injury. It is due to mediators of damage.

Partial damage occurs when there is injury to a part of the cell, as a rule, it is reversible, ie. cell recovers its structure and function

Total damage is irreversible.

Прямое повреждение клетки (первичное) - непосредственное повреждение клетки этиологическим фактором.

Жасушаның тікелей зақымдануы (біріншілік) – жасушаның этиологиялық жайттың әсеріне байланысты зақымдануы

Опосредованное повреждение клетки (вторичное) - является следствием первичного, развивается под действием БАВ - медиаторов повреждения

Жасушаның тікелей емес қосымшы зақымдануы (екіншілік) – біріншілік себепкер ықпалдың салдарынан пайда болатын белсенді биологиялық заттардың әсерінен дамиды.

Парциальное повреждение клетки – повреждается только часть клетки, как правило, оно бывает обратимым, т.е. клетка восстанавливает свою структуру и функцию

Жасушаның үлестік зақымдануы – жасушаның тек бір бөлігінің зақымдануы, әдетте ол қайтымды болады, жасуша өзінің құрылымы мен қызметін қалпына келтіреді   

  

Specific lesions are due to specific action of the etiologic factor (cyanide inactivates cytochrome

oxidase in mitochondria, high temperature leads to protein coagulation).

Nonspecific lesions are present in every injured cell (increased membrane

 permeability, inhibition of enzyme activity, inhibition of membrane pumps, ionic imbalance,

disorders of energy supply, intracellular acidosis)

Специфические проявления повреждения обусловлены специфическим действием этиологического фактора (цианиды блокируют цитохромоксидазу; высокая температура вызывает коагуляцию белков)

Зақымданудың спецификалық көрінісі - этиологиялық жайттың тікелей арнайы әсер етуінен (цианидтер цитохромоксидазаны тежейді; жоғарғы температура нәруыздың коагуляциясын шақырады) дамиды.

Неспецифические проявления повреждения сопровождают любое повреждение клеток (повышение проницаемости мембран, угнетение активности транспортных ферментов, мембранных насосов, нарушение рецепторного аппарата клеток, нарушение функционирования ионных каналов, нарушение ионного состава клетки, нарушение энергообразования, внутриклеточный ацидоз).

Жасушаның арнайы емес көрінісі жасушаның кез келген зақымдануында (мембрана өткізгіштігінің жоғарылауымен, ферменттердің белсенді тасымалдануының бөгелуінің, сүзгіш мембранасының, жасуша аппаратының рецепторлы бұзылысымен, иондық каналдық қызметінің және жасушаның иондық құрамының, энергиямен қамтамасыз етілуінің бұзылысымен, жасушаішілік ацидоз) байқалады.

 

Necrosis is irreversible damage to cells, due to the action of pathogenic agents, is the result of destructive enzyme activity with the development of two competing processes: the enzymatic digestion of the cell (colliquation (liquefaction) necrosis) and protein denaturation (coagulation necrosis)

  Некроз – необратимое повреждение клетки, развивается под действием повреждающих факторов, является результатом разрушающего действия ферментов с развитием

двух конкурирующих процессов: ферментативное переваривание клетки (колликвационный, разжижающий некроз) и денатурация белков (коагуляционный некроз)

Некроз - жасушаның қайтымсыз зақымдануы, зақымдаушы жайттардың ықпалынан дамитын екі бәсекелес үрдістің, ферменттердің бүліндіргіш әсерінің нәтижесінде дамитын: жасушаның ферментативті қорытылуы (колликвациялы, сұйылтушы некроз) және нәруыздыңденатурациясы (коагуляциялық некроз).

 

Paranecrosis is notable, but reversible changes in the cell: cytoplasm clouding and vacuolization, the the appearance of coarse sediments, increased permeability for different dyes.

Паранекроз - заметные, но обратимые изменения в клетке: помутнение цитоплазмы, вакуолизация, появление грубодисперсных осадков, увеличение проникновения в клетку различных красителей.

Паранекроз – жасушаның қайтымды өзгерісі: цитоплазманың бұлыңғырлануы, вакуолизациясы, ірі дисперсті тұнбалардың пайда болуы, жасушаға әртүрлі бояғыштардың сорылуының жоғарылауы.

 

Necrobiosis – is the state "between life and death" (from necros - dead and bios - live), changes in the cell prior to its death. Necrobiotic cell may return to its original state after elimination of the reasons that caused necrobiosis.

Некробиоз - состояние «между жизнью и смертью» (от necros - мертвый и bios - живой); изменения в клетке, предшествующие ее смерти. При некробиозе в отличие от некроза возможно возвращение клетки в исходное состояние после устранения причины, вызвавшей некробиоз.

Некробиоз - «өлім мен өмір арасы» жағдайындағы (necros – өлі және bios - тірі); жасушаның өліміне әкелетін өзгерісі. Некробиоздың некроздан айырмашылығы некробиоз тудырған себептердің әсерінен кейін жасушаның бастапқы жағдайына қайта келу мүмкіндігі.

 

Apoptosis is genetically programmed cell death; controlled process of cellular self-destruction.

Апоптоз - генетически запрограммированная гибель клетки, контролируемый процесс самоуничтожения клетки.

Апоптоз – жасушаның алдын-ала бағдарланған гендік ақпаратың қадағалауы бойынша тіршілігін жоюы.

 

Apoptotic bodies – are extracellular fragments of the nucleus, surrounded by membranes. They are the results of apoptotic destruction of cells

Апоптотические (апоптозные) тельца - внеклеточные фрагменты ядра, окруженные мембраной, на которые распадается клетка при апоптозе

Апоптотикалық (апоптоздық) денешік – ядроның жасушасыртылық фрагменті, мембранамен қоршалған, апоптоз кезінде жасушаның ыдырауының салдары. 

1) Receptor mechanism of apoptosis realization. Is carried out with the help of " receptors of death»  (Fas, TNF-RI, TNF-RII, DR-3, DR-5, etc.)

2) Mitochondrial mechanism of apoptosis is due to increase in permeability of mitochondrial membranes and release of cytochrome C, apoptosis-inducing factor (AIF) and other proapoptotic proteins into the cytoplasm with further activation of caspase 3.

 

3) P53- mediated mechanism of apoptosis. Protein p53 induces the transcription of apoptogenic factors (Bax, Fas-receptor, DR-5, etc.)

4) Perforin- granzyme mechanism of apoptosis. Characteristic of T-killer cells that release perforin. Perforin forms channels in the cytoplasmic cell membranes through which the cell receives secreted by T-killers granzymes - proteolytic enzymes that activate caspase 3.

1. Рецепторный механизм реализации апоптоза. Осуществляется с помощью «рецепторов смерти» (Fas, TNF-RI, TNF-RII, DR-3, DR-5 и др.)

Апоптозды іске асырудың рецепторлы механизмі. «Өлім рецепторы» көмегімен қамтылады.

2. Митохондриальный механизм реализации апоптоза. При повышении проницаемости мембран митохондрий и выхода в цитоплазму цитохрома С (Cyt С), апоптозиндуцирующего фактора (AIF) и других проапоптических белков с дальнейшей активацией каспазы 3

Апоптозды іске асырудың м итохондриаль ды механизм і. Митохондрий мембранасының жоғары өткізгіштігі кезінде цитоплазмаға апопотозды сергітетін фактор (AIF) цитохром С шығарылуын (Cyt С), және апоптозды күшейтетін нәруыздар каспаза 3 белсенділін арттырады.