08068 - Applied Physiology (AK-A)

Learning outcomes

Upon completion of the course, the student understands the fundamental functional aspects of the body's activity in order of increasing complexity, outlined by the following succession of integration levels: molecular, cellular, organ, and system, as well as their overall integration. Specifically, the student understands the normal functioning of the human body concerning the following systems: Cardiovascular- Renal – Respiratory – Digestive – Nervous.

Course contents

Somatosensory sensibility

Organization of somatic sensation pathways of the body and face. Thalamic and cortical somatosensory areas. Primary and associative cortices. Morphofunctional organization of the cerebral cortex. Pain: nociceptive and neuropathic pain; hyperalgesia; referred pain. Peripheral modulation and central control of pain.

Electroencephalography (LABORATORY PRACTICALS of APPLIED PHYSIOLOGY)

Principles of electroencephalography. The cortical rhythms in the different wake-sleep states.

Control of Movement

The common final pathway: the motoneuron. Organization of descending motor pathways. Function of the lateral system and medial system pathways. Cortical sensorimotor integration. Cortical and brainstem control of movement. Regulation of movement: cerebellum (morphofunctional organization, afferents, and efferents); basal ganglia (morphofunctional organization, direct and indirect pathways).

Behavioral states and their circadian organization

Behavioral states of wakefulness and sleep. Circadian organization of wake-sleep states. The suprachiasmatic nucleus. Organization and regulation of the wake-sleep cycle. Physiological functions during sleep. Cerebral metabolism and circulation in different behavioral states.

Autonomic Nervous System

Morphofunctional organization of the autonomic nervous system: sympathetic, parasympathetic and enteric divisions. Action of the sympathetic and parasympathetic systems on the main organs. Adrenal medulla. Central control of the autonomic function. Micturition. Thermogenetic and thermolytic mechanisms. Skin circulation.

Digestive system: oral and gastric functions

Morphofunctional organization of the esophagus and stomach. Cephalic, oral, esophageal and gastric phases of motor, secretory and absorptive processes.

Digestive system: intestinal functions

Morphofunctional organization of the intestine. Intervention of the small intestine and colon in motor, secretory and absorptive processes. Pancreatic and biliary secretions.

Functional organization of the vascular system

Elasticity and function of large arteries. Application of Laplace's law to blood vessels. Central and peripheral arterial pulse. Function of the arterioles. Regulation of capillary flow. Role of the endothelium and smooth muscle in the regulation of blood flow. Function of the lymphatic vessels. Function of the venous vessels.

Integrated control of the cardiovascular system

Central venous pressure. Integrated control of the cardiovascular system: curves of cardiac function, curves of vascular function. Relating cardiac function curves to vascular function curves.

Blood pressure and its regulation

Reflex regulation of arterial blood pressure: localization, structure and functional characteristics of the aortic and carotid baroreceptors; cardiac and vasomotor reflexes elicited by aortic and carotid baroreceptors. Vasomotor reflexes elicited by cardiac receptors. The renin-angiotensin-aldosterone system in blood pressure regulation.

Determination of blood pressure (LABORATORY PRACTICALS of APPLIED PHYSIOLOGY)

Measurement of blood pressure by the conventional sphygmomanometry of Riva-Rocci.

Stroke Volume

Genesis and propagation of the cardiac impulse. Electromechanical coupling during the cardiac cycle. Movement of valves, changes in pressure and volume of atria and ventricles during the cardiac cycle. Duration of different phases of the cardiac cycle. Origin of heart sounds.

Cardiac Output

Stroke volume and cardiac output. Determination of the cardiac output by means of the Principle of Fick and the indicator dilution method. Pressure-volume relationship in the left ventricle. Heterometric (Frank-Starling mechanism) and homeometric (increased heart rate, response to the increase in diastolic pressure) intrinsic regulation of myocardial mechanical activity. Extrinsic regulation (nervous and humoral) of the electrical and mechanical myocardial activity. Indices of myocardial contractility.

Cardiac metabolism

Changes in coronary blood flow during the cardiac cycle. Nervous and humoral regulation of the coronary circulation. Cardiac metabolism. Work of the heart. Application of Laplace's law to the heart.

Electrocardiogram (LABORATORY PRACTICALS of APPLIED PHYSIOLOGY)

Physics of electrocardiography: volume conduction, equivalent electric dipole and electric field vector. Recording techniques of cardiac electrical activity: bipolar leads, monopolar augmented and precordial leads. Instantaneous mean vector and genesis of the waveforms in bipolar leads. Calculation of mean cardiac vector (ventricular electrical axis).

Dynamic respiratory mechanics

Functions of the respiratory tract. Action of the respiratory muscles. Pleural pressure. Changes in the alveolar and pleural pressure, in air flow during a respiratory cycle. Dynamic respiratory mechanics: flow and resistance in the airways; maximal expiratory flows; flow-volume diagrams; dynamic airways compression.

Spirometry 1 (LABORATORY PRACTICALS of APPLIED PHYSIOLOGY)

Determination of flow-volume curves.

Static respiratory mechanics.

Static respiratory mechanics: pressure-volume curves of the lung, of the chest and of the chest-lung system; compliance; application of the Laplace's law to the lung; contribution of the surface tension to the pulmonary elasticity; role of pulmonary surfactant. Work of breathing.

Spirometry 2 (LABORATORY PRACTICALS of APPLIED PHYSIOLOGY)

Direct and indirect spirometry: measurement of lung volumes and capacities.

Pulmonary gas exchange

Composition of atmospheric and alveolar air. Pulmonary ventilation and alveolar ventilation. Measurement of dead space. Alveolar-capillary barrier. Measurement of pulmonary diffusion capacity. Pulmonary circulation. Ventilation-perfusion ratio: regional differences in ventilation-perfusion ratio; excess of ventilation with respect to perfusion; excess of perfusion with respect to ventilation.

Transport of oxygen and carbon dioxide in the blood

Forms of oxygen transport in the blood. Functional significance of the hemoglobin dissociation curve. Quantitative aspects of the transport of oxygen in the blood. Types of hypoxia. Forms of transport of carbon dioxide in the blood. Functional significance of the curve of transport of carbon dioxide. Quantitative aspects of the transport of carbon dioxide in the blood. Interaction between the transport of oxygen and carbon dioxide.

Control of breathing

Ventilatory responses to changes in the arterial partial pressure of oxygen and carbon dioxide and concentration of hydrogen ion. Function of the peripheral and central chemoreceptors in the regulation of pulmonary ventilation. Interaction between chemical stimuli in the regulation of pulmonary ventilation. Control of breathing by pontine and medullary respiratory centers. Lung receptors and respiratory reflexes.

Functions of the renal glomerulus

Plasma and renal blood flow. Ultrafiltration process. Glomerular ultrafiltration rate: clearance of inulin; plasma creatinine. Filtration fraction. Autoregulation of renal blood flow and glomerular filtration rate.

Functions of the renal tubule

Absorption and secretion in the nephron. Reabsorption of sodium chloride and water. Control of renal potassium homeostasis. Renal clearance.

Regulation of body fluid osmolality

Fluid compartments of the body. Neurohypophyseal secretion of antidiuretic hormone. Renal mechanisms for concentration and dilution of urine. Osmolar clearance and free-water clearance.

Regulation of body fluids volume

Fluid compartments of the body. Effective circulating volume. Regulation of renal excretion of water and sodium chloride. Mechanisms of regulation of extracellular fluid volume: volume receptors; actions of the sympathetic nervous system, the renin-angiotensin-aldosterone system and natriuretic peptides.

Regulation of acid-base balance

Concentration of hydrogen ions in the blood and blood buffer systems. Tubular transport of hydrogen ions and bicarbonate. Formation of ammonium ions. Kidney and respiratory responses to changes in acid-base balance. Primary acid-base alterations: acidosis and alkalosis of respiratory and metabolic origin; compensatory responses to primary acid-base alterations.

Regulation of serum calcium and phosphorus

Effects of parathyroid hormone, vitamin D and calcitonin on the mobilization of the bone matrix and the absorption and excretion of calcium and phosphate. Regulation of the secretion of parathyroid hormone and calcitonin. Endogenous synthesis of vitamin D.

Regulation of energy metabolism

Energy balance and energy stores in the body. Measurement of energy metabolism by means of indirect calorimetry. Structure and functions of adenohypophysis. Nervous and endocrine regulation of energy stores and metabolism (insulin, glucagon, glucocorticoids, epinephrine, leptin, thyroid hormones, growth hormone).

Reproductive glands. Growth

The ovaries: oogenesis and ovulation, corpus luteum formation secretion and actions of estrogen and progesterone; the menstrual cycle. The testes: spermatogenesis, secretion and actions of androgens. Growth hormone and thyroid hormones influences on the development and growth.

Readings/Bibliography

Conti F. (a cura di), Fisiologia Medica, Volumi I e II, Edi-Ermes, Milano, 2025. ISBN 978887051867-2/ 978887051868-9

Koeppen B.M., Stanton B.A. (Eds.), Berne & Levy Physiology, Elsevier, Philadelphia, 2023. ISBN 9780323847902.

Berne R.M., Levy M.N., Koeppen B.M., Stanton B.A. (a cura di), Fisiologia di Berne e Levy, Casa Editrice Ambrosiana, Milano, 2018. ISBN 978-8808480040.

Teaching methods

The teaching of the Integrated Course (C.I.) of Physiology is divided into three parts: Cellular Physiology (first semester, 2nd year), Apparatuses Physiology and Applied Physiology (second semester, 2nd year). The teaching activities of the Physiology course aim to provide students with the fundamental principles of cellular physiology and the general mechanisms governing the functioning of the human body. The final exam is a single examination held at the end of the second semester. The teaching of Physiology of Organ Systems consists of 13 CFU (ECTS), corresponding to 110.5 hours of traditional lectures and 52 hours of distance/supplementary teaching with mandatory attendance for both. These requirements must be met according to the modalities defined by the Degree Program and approved by the Department of Medical and Surgical Sciences. This course runs parallel to the 1 CFU (17 hours) Applied Physiology course, which partly includes practical demonstrations for large groups of students and practical exercises for small groups of students. The teaching load is shared among Prof. Berteotti (9 CFU), Prof. Bosco (3 CFU), and Prof. Martelli (1 CFU), who cover the different topics of the syllabus in a coordinated and integrated manner, while the Applied Physiology course is taught by Prof. Hitrec and Prof. Luppi. Due to the type of activities and teaching methods adopted, participation in laboratory activities requires prior completion of modules 1 and 2 of safety training in study environments via e-learning. Information regarding this training is available at: https://elearning-sicurezza.unibo.it/ . The examination syllabus is covered in its entirety during the course. The iconographic material shown during lectures is mainly taken from the recommended textbooks; otherwise, the source is cited. The teaching activity aims to provide an integrated understanding of the functions of the main systems of the human body and the mechanisms that regulate its homeostasis. Lectures are organized to encourage connections between the different topics of the course and an integrated understanding of physiological processes. Traditional teaching activity is based on classroom lectures, while online teaching activity consists of iconographic and multimedia material commented by the professors, which is made available to students through the University's Virtual platform (https://virtuale.unibo.it/ ). The iconographic material presented in class is mainly taken from the recommended textbooks; when different sources are used, they are appropriately cited.

Assessment methods

The teaching of the Integrated Course (C.I.) of Physiology is divided into three parts: Cellular Physiology (first semester, 2nd year), Apparatuses Physiology and Applied Physiology (second semester, 2nd year). The final exam is a single examination held at the end of the second semester. At the end of the Cellular Physiology course, students can take an intermediate test consisting of 44 true/false questions. The score is calculated by awarding 1 point for each correct answer, −0.6 points for each incorrect answer, and 0 points for each unanswered question. The score obtained is converted into a mark out of 30. The test is considered passed with a grade of 18/30 or higher. Students who accept the grade achieved in the intermediate test will take the final oral exam exclusively on the topics of Apparatuses Physiology and Applied Physiology. The oral exam is based on a balanced topic drawing procedure and involves different professors for the various parts of the syllabus. Students who have passed the midterm exam answer two questions concerning Systems Physiology and Applied Physiology. Students who have not taken the midterm exam must also answer a third question relating to Cellular Physiology. Each question is graded on a scale from 18/30 to 30 cum laude. The final grade corresponds to the average of the scores obtained in the individual questions. Failing even a single question means failing the exam. The evaluation takes into account: the accuracy and completeness of the acquired knowledge; the ability to integrate the different topics of the discipline; the capacity for physiological reasoning and making connections between different biological systems; the appropriate use of scientific terminology; and the clarity and precision of the presentation. A broad and in-depth preparation, combined with the ability to make independent connections between various topics and a full mastery of scientific language, is awarded the highest scores. A predominantly rote-learned preparation, with limited analytical and integration skills, leads to intermediate grades. Gaps in knowledge, difficulty in using specific terminology, and a limited ability to navigate the covered topics will result in barely passing or failing grades. Regarding the use of generative Artificial Intelligence in assessment tests, its use is not permitted, and any use constitutes a violation of academic integrity. Students with Specific Learning Disabilities (SLD/DSA) or temporary or permanent disabilities are invited to contact the dedicated University service ( https://site.unibo.it/studenti-con-disabilita-e-dsa/it ) in a timely manner to agree on any test adaptations, in compliance with the learning objectives of the course.

Teaching tools

Traditional lectures are supported and integrated by multimedia presentations and properly annotated digital teaching materials, which together constitute the distance/supplementary teaching. The practical activities of Applied Physiology involve the use of instrumentation dedicated to the assessment of the main physiological functions, including spirometers for the analysis of respiratory volumes and flows, electrocardiographs, sphygmomanometers for measuring arterial blood pressure, oximetry assessment systems, electroencephalography equipment, and polysomnographic recording systems. The iconographic and textual material used during the course is restricted to students enrolled in the course via authentication with their institutional University credentials through the University of Bologna's Virtual platform (https://virtuale.unibo.it/ ), which therefore serves as a supporting tool for individual study and in-depth learning of the topics.

Office hours

See the website of Marco Luppi