Lecture teaching plan

Department of Anatomy & Neurobiology Central South University July 2007 Content Lecture 1 Introduction to Human Anatomy and Osteology........................... ............................3 Lecture 2 Introduction to Arthrology............................................ .......................................7 Lecture 3 Skeletal Muscle Tissue................................................ .......................................10 Lecture 4 Introduction to Splanchnology: Digestive and respiratory systems...... ......................13 Lecture 5 Introduction to Reproductive and Urinary System....................... ...........................22 Lecture 6 Angiology ............................................................ ............................................27 Lecture 7 Blood vessels, artery, vein and Lymphatic systems..................... ............................31 Lecture 8 General and Special Sensory organs.................................... .................................36 Lecture 9 Introduction of Nerve System Spinal Nerves.............................. ..........................45 Lecture 10 Cranial Nerves....................................................... ..........................................50 Lecture 11 Spinal Cord.......................................................... ...........................................53 Lecture 12 Brain Stem........................................................... ...........................................60 Lecture 13 Diencephalon and Cerebellum.......................................... .................................66 Lecture 14 Telecephalon......................................................... ..........................................72 Lecture 15 Nervous Pathways..................................................... .......................................76 Lecture 1 Introduction to Human Anatomy and Osteology ________________________________________ I.CONTENTSIntroduction to human antomy and osteology II. OBJECTSMedical students III. TIME2 hours

IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the important role of human Anatomy in clinical medicine 2. To master the common terms of anatomy 3. To understand the recent progress in anatomy scientific research 4. To manage the classification of bones 5. To manage the structure and function of bones VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. Common terms of anatomy and how to study human Anatomy 2. Anatomical Position, terms of direction, variation and malformation 3. Structure and function of bones 4. Anatomical base of regeneration and recovery of bones The difficult issues for teaching Development of bones VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Concept of human anatomy: the study of human Anatomy is a kind of science co nsiders the structure and organs which make up human body. Human Anatomy is one of the fundamental subjects in medical study, and one third of the medical termi nology used by medical worker come from anatomy (5) B. The regions and systems of human body (15) 1. Regions: head, neck, chest, abdomen, back, pelvic cavity and perineum, upper limbs and lower limbs. 2. Systems: locomotor system, alimentary system, respiratory system, urinary sys tem, reproductive system, circulatory system, sensory system, nervous system and endocrine system. C. Common terms of anatomy: (30) 1. Standard posture of Anatomy or Anatomical Position: demonstrate this positio n, standing upright, feet together, facing forward, arms at your sides with palm s facing forward. Furthermore, as terms of direction, right and left are also us ed according to anatomical position instead of the right and left sides of the o bserver 2. Planes: three kinds of planes a. Sagittal planes are these planes parallel to median plane and can divide human body into left and right parts. The median plane is a vertical antero-pos terior plane which pass through the center of trunk. b. Coronal planes divide human body into anterior parts, and they are somet imes named frontal planes. c. Horizontal planes divide human body into superior and inferior parts, an d can also be called transverse planes. Each of these htree planes is at right a ngle to the other two planes. 3. Axis: vertical axis, sagittal axis, coronal axis. a. Vertical axis is vertical with ground and parallels to long axis of body b. Sagittal axis is vertical with long axis of human body in the direction of anterior and posterior to ground c. Coronal axis is vertical with long axis of body in the direction of left and right and parallel to ground 4. Terms of direction: a. Anterior (Ventral): the location of this part near the front of the bod y b. Posterior (dorsal): location near the back of the body c. Superior: the upper part of a structure or body d. Inferior: the lower part of a structure or body e. Medial or lateral: structure nearer or farther from the median plane f. Internal and external: nearer or farther from the center of a body cavi ty or hollow viscera g. Superficial and deep: the relative depth from the surface of body

h. Proximal and distal: nearer or farther from the attached end of the lim b. D. Classification of bones (10) 1. Bone number: 206 2. Bones are divided into three parts: the bones of skull (including 6 auditory ossicle), bones of the trunk (these 2 parts are axial bones), and bones of the limbs (the appendicular bones). 3. According to their shape, four kinds of bones are classified. Those are long , short, flat and irregular bones. a. Long bones: each long bone consist of a shaft or body and two ends or ex tremities b. Short bones: the short bones are roughly in cuboid shape. They distribut e in wrist and foot including the carpal and tarsal bones c. Flat bones: the flat bones consist of two plates of compact bone with sp ongy bone and marrow between them d. Irregular bones: the irregular bones are greatly varied in shape, carry out different functions, and can not be classified in the preceding. E. Structure of bones (20) 1. Periosteum: consists of two layers: fibrous layer and vascular layer 2. Bone marrow: Yellow marrow and red marrow 3. Bone substance: Compact bone and spongy bone F. Chemical composition and physical properties of bones (10) 1. Chemical composition of bones: The organic material (the main one is collage n) forms 30~40 percent and inorganic material , mineral salts (The main one is c alcium phosphate), 60~70 percent of the dry weight of the bone. 2. Chemical features of bones in different stage a. In infant and child-----------organic components percentage=inorganic co mponents percentage-----------their bones are solf and are easy to be reformed b. In old people----------inorganic components percentage are comparatively more----------lead to aged bones brittle and fracture easily G. The development of bones (10) Intramembranous and intracartilaginous ossifications 1. Intramembranous ossification: forms inside a membrane from an ossification c enter and grow peripherally. Examples are cranial bones, mandible and clavicle. 2. Endochondral ossification: bones modeled first in hyaline cartilage. Blood v essels invade perichondrium and cause mineral precipitation forming a bone colla r around the diaphysis. Lack of diffusion of nutrient supply leads to breakdown of cartilage center giving rise to the medullary cavity. Ossification centers fo rm in the epiphyses leaving a cartilage band at the epiphyseal plate. Bone growt h in length occurs as the reserve cartilage reproduces, the chondrocytes enlarge and become more active metabolically, thus causing mineral to precipitate. Even tually the cartilage reserve itself ossifies creating the epiphyseal line indica ting the end of bone growth Increase in girth occurs as osteoclasts remodel bon e from the medullary cavity and osteoblasts add bone to the outside.. Most bone s are formed in this manner. 3. Bone remodeling occurs through out ones lifetime and is done by osteoblasts a nd osteoclasts.

Lecture 2 Introduction to Arthrology ________________________________________ I.CONTENTSIntroduction to arthrology II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building

VI. THE TEACHING GOAL 1. To manage the classification of synovial joints 2. To master the structure of synovial joints 3. To master the accessory of synovial joints 4. To manage the movement of joints 5. To manage the type of synovial joints VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. Structure of synovial joints 2. Structure of synovial joints 3. Accessory structure of synovial joints 4. The relationship between classification of synovial joints and joint mov ement The difficult issues for teaching Movement of joints VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Direct joint (Synarthrose) are classified into fibrous joint, cartilage join t and bony joints based on the type of material uniting the articulation bones. No movement possible (6) B. Indirect joints (Diarthroses): Freely moveable 1. General structure of joints: (30) a. Articular surface: they are usually covered by the hyaline cartilage. It is very smooth but uneven in the thickness b. Articular capsule: it is attached to the periphery of the articular surface and adjacent bone surface. It encloses the joint cavity and is composed of two l ayers: the fibrous membrane and the synovial membrane c. Articular cavity: it is a closed cavity formed by the synovial membrane and the articular cartilage 2. Accessory structure of synovial joints: (14) a. Ligament b. Cartilage in synovial joints (articular labrum and articular disk) c. Fold and bursa of synovial membrane C. Movement of joints: Articular movements are usually groups as three pairs of antagonistic movement based on three orthogonal axes, which a joint may has. Th e movements of each individual joints are decided by shape of articular surfaces , size of attached area of 2 articulated bones, thickness and articular capsule, as well as number and intension of its ligaments. (25) 1. Gliding (slipping) movement: one surface moves back and forth or side to sid e over another surface without angular or rotary movements 2. Flexion: movement out of anatomical position in the sagittal plane, bending your knee 3. Extension: movement restoring anatomical position in the sagittal plane 4. Abduction: movement out of anatomical position in the frontal plane "carried away" 5. Adduction: movement in the frontal plane restoring anatomical position, "add ing to" the body 6. Medial and lateral rotations: turning around its own long axis, turning your head to the side 7. Circumduction: pivoting around the origin of a limb, describing circles in t he air, a combination of adduction, abduction, flexion and extension 8. Special movement: a. Eversion: tipping the sole of the foot outward, laterally b. Dorsiflexion: tipping the foot upward c. Plantar flexion: tipping the toes downward, extending the ankle d. Lateral flexion: bending the spine to the side e. Protraction: movement anteriorly in the horizontal plane - jutting out y our jaw f. Retraction: the reverse of protraction

g. Opposition: movement of the thumb only toward the fingers. To grasp h. Elevation: movement superiorly, shrugging shoulders i. Depression: restoring position after elevation j. Pronation: rotation inward (palm down) k. Supination: rotation outward (palm up) D. Classification of articulation (10) 1. Uniaxial joint: a. Hinge joint: elbow and ankle b. Pivot joint: atlantaoxial and proximal radioulnar joints 2. Biaxial joint: a. Ellipsoid joint: radiocarpal joint b. Saddle joint: pollicial carpometacarpal joint 3. Multiaxial joint: a. Ball and socket joint: shoulder and hip joint b. Plane joint: sternoclavicular joint E. Knee joint: Very poor fit of articular surface, several adaptations to stabi lize joint (15) 1. Strong capsule ligaments: medial and lateral collateral 2. Menisci: Cartilage pads to enhance fit between condyles and head of tibia 3. Intercondylar eminence: provides some lateral stabilization 4. Anterior and posterior cruciate ligaments provide a screw-home effect which t ightens with extension of the joint, limit anterior/posterior motion. 5. Popliteal ligaments: reinforce back of the knee Lecture 3 Skeletal Muscle Tissue ________________________________________ I. CONTENTSSkeletal muscle tissue II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master muscle group 2. To master the origin, insertion, distribution and function of the major skel etal muscles 3. To master the coordination among different types of muscles , including the prime mover, synergist, antagonist and fixator. VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching Muscle group The difficult issues for teaching The coordination among different types of muscles , including the prime mover, synergist, antagonist and fixator. VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. The Names and structure of muscles(10) 1. Names of muscles often the name will help you remember location or action a. Direction of fibers - rectus, oblique, transverse, etc. b. Size - magnus, minor, longus, etc. c. Position- abdominus, femoris, pectoralis, dorsalis, subscapularis, etc. d. Action - adductor, flexor, tensor, extensor, supinator, etc. e. Origin and/or insertion -sternocleidomastoideus, stylohyoid, glossopharyngea l, ileocostalis, zygomaticus, etc. f. Specific features (imagined or otherwise)- serratus, sartorius, semitendinos us, buccinator 2 Structural arrangement a. Muscle wrapped in epimysium b. Fascicles wrapped in perimysium c. Muscle fibers (cells) wrapped in endomysium e. Myofibrils

f. Myofilaments Myosin thick myofilament Actin thin myofilament g. The mysium wrappings collectively form the tendon at the end of the muscle B The origin, insertion, distribution and function of the major skeletal muscle s (30) 1. The distribution of the skeletal muscles:Skeletal muscles mainly distribute around the joints. They functions only by contraction or shortening and are help ful for the posture maintenance, movement by pulling on bones, heat production a nd guard orifices. 2. The coordination among different types of muscles during the movements of jo ints According to the functions of muscles during the joint movement, skeleta l muscles are divided into prime mover, synergist, antagonist and fixator. The d etailis as the following. a. Prime Mover (Agonist) produces desired action. b. Synergist assists prime mover. c. Antagonist- opposes action of prime mover, restores original position d. Fixator fix the near joints and help the prime mover complete the desire d action. e. In conclusion, the coordination among different types of muscles is comp leted only under the common control of nervous system; and the function of a mus cle changes with the desired actions. C the supplementary structure of muscles (25) 1. The superficial fascia: It is formed by connective tissue. It is found immed iately beneath the cutis, covering almost the entire body. It is a layer of loos e connective tissue containing fat in varying quantity. The superficial fascia v aries in thickness in different individuals and different parts of the body. 2. Deep fascia: It is a dense, inelastic fibrous membrane, forming a strong inv estment, which not only binds down collectively the muscles in each region, buta lso gives a separate sheath to each, as well as to the vessels and nerves. 3. Tendinous sheath: A double layered synovial sheath, in which the tendon runs , is usually located in the band and foot. The mesotendon forms the continuity b etween the inner and outer synovial layers and carries blood vessels to the tend on. D. The highlights during the study of muscles(30). 1. In order to comprehend a muscle, for example the biceps brachii, more attent ions should be paid on the following. a. The nerves innervating the muscle ( musculocutaneous nerve) b. The origin and insertion of the muscle (The long head of the biceps originat es by a tendon crossing the shoulder joint. The short head arises from the corac oid process. The insertis the tuberosity of radius and the fascia of forearm.) c. The type and movement of the joint stepped over by the muscle( flexes elbow joint and supinates forearm) d. How does the muscle step over the joint What is the Antagon Lecture 4 Introduction to Splanchnology Digestive and respiratory systems ________________________________________ I. CONTENTSIntroduction to splanchnology, Digestive and Respiratory systems II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the concept Viscera 2. To understand the general structure of the Viscera 3. To be familiar with the Reference Lines of the Thorax and abdomin 4. To master the composition and function of the digestive and respiratory syst

ems 5. To master the morphology, location, characteristics and clinic implications of some parts of the digestive and respiratory systems VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. The conceptional overview and superficial location of the viscrea 2. The constitution and function of the digestive and respiratory system. The difficult issues for teaching The features of the tublar and parenchymatous organ VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. The conception of the viscera 40 1. Composition: The Alimentary, respiratory, urinary and genital systems and me mbrances of pleura and peritoneum 2. Function: To fulfil the metabolism and Maintain the life of the species B. The general Structure of Viscera: Two principal constituents: The tubular vi scus and parenchymatous organ 1. The tubular viscus a. Mucosa (mucous membrane secretes enzymes and mucus); b. Submucosa (loose connective tissue houses blood and lymph vessels); c. Muscularis (two layers of smooth muscle - for peristalsis); d. Serosa or adventitia (serous membrane secretes serous fluid to prevent stick ing 2. The Parenchymatous organ: a. Fibrous capsule and -secreting epithelial substance b. Hilum/porta structure: the hilum of the lung and kidney, the porta hepatis C. Reference Lines of thorax and abdominal Region 1. The lines of thorax a. The anterior median line b. The sternal line c. The midclavicular line d. The parasternal line e. The anterior axillary line f. Posterior anxillary line g. The midaxillary line h. The scapular line i. The posterior median lin 2. The Lines of abdominal region a. The upper horizontal line or Transpyloric line inferior costal marg in b. The lower horizontal line or Transtubercle line tubercles of iliac crests c. Left and right vertical lines throught the midpoint of inguinal ligm ent. D. Digestive system 1. The components and division a. Superiord digestive tube: Mouth, Pharynx, Esophagus and Stomach b. Inferior digestive tube: Small intestinea and Large intestine c. Digestive gland: Major salivary glands, Liver and Pancreas 2. Functions of the digestive system a. Ingestion b. Mechanical processing c. Digestion d. Secretion e. Absorption f. Excretion 3. Oral Cavity a. Vestibule - between lips, cheeks and gums and teeth b. Oral cavity proper laterally and frontally, alveolar arches, posterioly, ist

hmus of faces. c. Hard and soft palates - form roof of mouth Palatoglossal arch - posterior edges of palate Palatopharyngeal arch - encloses fauces f. Tongue Skeletal muscle Taste buds on the tongue provide the sense of taste Skeletal muscle in the tongue allows it to move g. Salivary glands - three pairs Parotid - lateral side of face, anterior to ear, drain by parotid duct to vestib ule near 2nd upper molar Sublingual glands - in floor of mouth - drain near lingual frenulum Submandibular glands - medial surface of mandible, drain posterior to lower mol ars All produce mucous and salivary amylase, lubricates and cleans mouth and teeth These glands send saliva to the mouth for digestion of starch to maltose h. Teeth Types of teeth Incisors - front cutting teeth Cuspids - conical, tearing teeth Bicuspids - two roots, crushing, grinding teeth Molars - 3 or more roots, crushing and grinding Dental succession Deciduous (baby, milk) teeth - 20, replaced by permanent teeth - 32 teeth Function- mastication - chewing i. Pharynx A musculomembranous tube where the air passage and food passage cross Location: behind the nasal cavities, the moth and the the larynx, from the base of the skull to the level of the sixth cervical vertebrae Division: Nasopharynx, Oropharynx and Laryngopharynx Function: Swallowing ----buccal phase - compresses bolus against hard palate, elevates soft palate, tongue retracts -----pharyngeal phase - bolus touches posterior pharyngeal wall, epiglottis tips backward, bolus enters esophagus j. Esophagus (around 25 cm) Location- lower border of C6 to vertebral body of T11 Devision and constrictors- Cervical part, thoracic and abdominal parts; ---- at the site of beginning, 15cm to the incisior ---- at the Cross site with left bronchus, 25cm to the incisio ---- at the site passing through diaphragm, 40 cm to the incisions Function-Peristalsis begins in the esophagus; this collapsed tube moves the bolus of food downward after swallowing occurs The sphincter, a structure at entrance of the esophagus to the stomach prevents food from backing up into the esophagus. k. Stomach Location- left hypochondraic region and epigastric region Regions ---- lesser curvature - medial surface ---- greater curvature - lateral surface ---- cardia - end under the heart ---- fundus - bulge above the esophageal opening ---- body - largest region ----pylorus - J curve, inferior end, terminates in ---- pyloric sphincter to small intestine ---- rugae - interior folds ----greater omentum - enfolds stomach Function-to store food, churn and mix food with gastric juices containing hydroc hloric acid and pepsin for the digestion of protein to peptides. l. Small Intestine-6 meters

Divisions ---- duodenum, short (12 inches), fixed shape & position ---- jejunum - 1st half of rest of small intestine --- ileum 2nd half of small intestine, primarily absorptive ---- ileocecal valve slit valve into the large intestine or colon Specializations of regions ---- duodenum:Superior part-duodenal bulb- superior duodenal flexure; Descendin g part- longitudinal fold of duodenum duodenal papilla - opening of hepatopancre atic duct duodenal ampulla - entry chamber for above duct; Horizontal part-infer ior duodenal flexure; Ascending part-duodenojejunal flexure -suspensory muscle of duodenum ---- jejunum-digestion: secrets intestinal juice 12L/d, pH 7.6 -absorption: glucose, amino acid, glycerin. -solitary lymphatic follicles ---- ileum-Aggregated lymphatic follicles(Peyers patches) j. Large Intestine (Colon)- 1.5 m long Structural Characteristics ---- Colic bands ---- Haustra of colon ---- Epiploic appendices Regions ---- cecum - pocket at proximal end with ---- appendix - lymphoid tissue, suspended by mesoappendix ---- ascending colon - on right, right colic flexure ---- transverse colon - horizontal portion ----descending colon - left side, between left colic flexure and ---- sigmoid colon - S bend near terminal end ---- rectum -ampulla of rectum -sacral flexure -perineal flexure -transverse folds (left, right and left, 11, 9 an7 cm to anus respectively ) ---- anal canal - anal columns -anal valves -anal sinuses -dentate (anocutaneous) line -anal pecten -white line -ending at the anus - which has internal involuntary sphincter external voluntary sphincter ---- function -absorbing water -eliminating as feces -fermenting cellulose -synthesizing vitamin E. The Respiratory System 1. Components and division of Respiratory System a. Respiratory system: upper respiratory tract and lower respiratory tract b. Upper respiratory tract: Nose and nasal cavity, Pharynx and Larynx c. Lower respiratory tract: Trachea Brochi, Bronchial tree and Lung 2. Functions a. Gas exchange area between air and blood b. Moves air breathing c. Warms, moistens, and cleans air d. Speech & other respiratory sounds e. Assists in regulating blood volume and composition

f. Protects against pathogens 3. Upper respiratory tract a. Nose external and internal nares cavity or vestibule turbinates or conchae nasal septum-ethmoid & vomer meatuses - superior, middle, and inferior . b. Pharynx - shared passageway for respiratory and digestive systems nasopharynx -that part above the uvula and posterior to the internal nares oropharynx that portion which can be seen in a mirror when the mouth is wide ope n laryngopharynx between the hyoid & the esophagus 4. Lower respiratory tract a. Larynx-C4-C6 vertebral levels, attached to hyoid cartilages ---- cricoid cartilage ---- thyroid cartilage ---- epiglottis ----two arytenoid cartilages ---- two corniculate cartilages ---- two cuneiform cartilages ligaments ---- intrinsic - bind cartilages together ---- extrinsic - tie larynx to hyoid and trachea sound production ---- vestibular (false) vocal folds - protective , superior ---- true vocal folds (cords) - sound production Vocal folds/cords = vocal ligaments covered by mucosa glottis openings between vestibular & vocal folds into trachea b. Trachea- passageway to lungs, incomplete cartilage rings - completed by trac healis(16-21 C-shaped hyaline cartilage rings) c. Bronchus bifurcation at carina around the fourth thoracic vertebra, complete cartilage rings: a sagittal semilunar ridge, used as a guide to the brochi fo r brpnchoscope. primary - first branches - enter lungs at hilus secondary, tertiary , etc. bronchi terminal bronchioles alveolar ducts alveolus / alveolar sacs d. Lungs - paired lobes: left - 2 lobes - superior and inferior; right - 3 lobes- superior, middle and inferior left has cardiac notch surfaces: costal - faces ribs; mediastinal - faces heart; diaphragmatic - faces diaphragm e. Pulmonary Bronchi - bronchial tree - cartilage plates secondary ( lobar) branches - serve lobes tertiary ( segmental) bronchi - serve segments-pulmonary segment: a segmental br onchi and its govern lung tissue, there are 10 such segments in each lung. terminal bronchioles - smooth muscle, no cartilage, dilate or constrict respiratory bronchioles - within lobule alveolar ducts - supply air to alveolar sacs Lecture 5 Introduction to Reproductive and Urinary System ________________________________________ I. CONTENTSIntroduction to reproductive and urinary system

II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the introduction of male reproductive system 2. To master the internal male reproductive system 3. To master the external male reproductive system 4. To master the introduction of female reproductive system 5. To master the internal female reproductive system 6. To understand the external male reproductive system 7. To master the mammae in female VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. Internal male reproductive system 2. Internal female reproductive system The difficult issues for teaching 1. Male urethra 2. Uterus 3. Kidney 4. Urinary bladder VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Introduction of urinary system (10) 1. Urinary system consists of kidney, ureters, urinary bladder and urethra 2. Function of urinary system: removal of metabolic wastes, maintenance of a ba lanced internal environment of the body and the secretion of endocrines B. Kidney (30) 1. External features of kidneys: lateral border, medial border, renal hilum, re nal sinus 2. Location of kidneys: the kidneys lie on the posterior abdominal wall one on each side of the vertibral column with its long axis almost parallel to long axi s 3. Covering of kidneys a. Fibrous capsule: a firm, strong fibrous capsule that can be stripped easily from a normal but can not from a diseased kidney b. Adipose capsule: adipose capsule is outside the fibrous capsule and continue s with the adipose tissue within the renal sinus. c. Renal fascia: renal fascia comes from the extraperitoneal tissue. The renal fascia is divided into anterior and posterior layers to enclose the kidneys and suprarenal glands. 4. Structure of kidneys: a. Renal cortex: it lies immediately beneath the fibrous capsule, arch over the bases of the pyramids b. Renal columns: the parts from renal cortex dipping in between the pyrami ds are named the renal columns c. Renal medulla: it is deep to cortex, it consists of a number of pale str iated, conical masses, termed the renal pyramids d. Renal pyramid: the bases of pyramids are directed toward the periphery o f the kidney, while their apices coverage towards the renal sinus e. Renal papillae: two or three apices of renal pyramids converge in one re nal papillae f. Papillae foramina: the foramina on apices of renal papillae are called t he papillary foramina g. Minor renal calices is indented in a cup-shaped fashion, receiving from one to three papillae h. Major renal calices: two or three minor renal calices converge into one major renal calice. They join into renal pelvis i. Renal pevis: renal pelvis is flat to continue with the ureter at the lev

el of the inferior extremity of the kidney 5. Blood supply and segmentation of kidneys C. Urinary bladder (10) 1. External features: a. Apex of bladder b. Fundus of bladder c. Body of bladder d. Neck of baldder 2. Internal features: a. Trigone of bladder: area at base bounded by openings of ureters and uret hra, without muscle, stabilized from contraction b. Interureteric fold: rugae, permit expansion 3. Location of urinary bladder 4. Histological structure of wall of urinary bladder: a. Serous layer b. Muscular layer c. Submucous layer d. Mucous layer D. Introduction of male reproductive system: male reproductive system is compos ed of internal and external reproductive organs. (10) 1. Internal reproductive organs: testis, epididymis, ductus deferens, ejaculator y duct, accessory glands and male urethra 2. External reproductive organs: scrotum and penis E. Testes (20) 1. The features of testes: oval-shaped organs, being housed in the scrotum. 2. The structure of testes: the testes are covered by tunica albuginea. Lobules of testis---------Convoluted seminiferous tubules---------Straight semin iferous tubules---------Rete testis---------Efferent ductules of testis F Male urethra: It extends from the internal orifice of urethra in the urinary bladder to external orifice at the end of the penis, it is 17~20 cm long. (20) 1. Three parts: a. Prostatic part: it is about 2.5 cm in length with the largest calibre b. Membranous part: it is 1~2 cm in length, and is the shortest, least dila table and narrowest part of thr urethra c. Cavernous part: it is contained in the cavernous body of urethra, about 15 cm in length. 2. Three narrows: a. Internal orifice b. Membrane part c. External orifice 3. Three dilation: a. Prostatic part b. Bulbous part c. Navicular fossa of urethra 4. Two curvatures: a. Prepubic curvature b. Subpubic curvature G. Introduction of female reproductive system (10) 1. Internal reproductive organs: ovaries, uterine tube, uterus and vagina. 2. External reproductive organs: mons pubis, greater lips of pudendum, less er lips of pudendum, vaginal vestibule, hymen, bulb of vestibule, greater vestib ular glands (Bartholins glands) H. Ovaries: (15) 1. Primary organs, produce gametes 2. Suspended by ovarian ligament and suspensory ligament 3. Structure: contain germinal epithelium: superficial to tunica albuginea I. Uterus: It is a single organ, with thick muscular wall, in which the fertili zed ovum becomes embedded and the developing organism grows until its birth. (25) 1. Parts of uterus:

a. Fundus of uterus: bulges above openings of uterine tubes b. Cervix of uterus: portion projecting into vagina, contains cervical cana l, internal orifice - into uterus from canal and external orifice - from canal t o vagina c. Body of uterus 2. Position of uterus: a. Anteversion b. Anteflexion 3. Relationship between uterus and peritoneum: a. Uterovesicle pounch b. Rectouterine pouch 4. Supports of uterus: a. Broad ligaments: base of uterus to lateral walls of pelvis b. Round ligament: lateral edges to inguinal region c. Uterosacral ligament: from lateral edges to sacrum d. Cardinal ligament: extend below the base of the broad ligaments between the pelvic wall and the cervix of uterus

Lecture 6 Angiology ________________________________________ I. CONTENTS Cardiovascular System-Introduction and Heart II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the knowledge about the location, external anatomy of the heart 2. To understand the the routes of the blood flow in the heart and the role of the valves 3. To understand the The conducting system andblood supply of the heart VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching The external anatomy of the heart The difficult issues for teaching The internal anatomy of the heart VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Introduction to Angiology 1. Concept and compositionCardiovascular system and Lymphatic system 2. Function: Transportation of substances a. Maintance of the balance of inernalenvironment b. Protection through immuno-cells and cytokins 3. Introduction tothe Cardiovascular SystemComponents and functions: Hear, arter y, vein and capillary. B. Heart 1. Location, external anatomy and neibouring structures of the heart a. Location in pericardial space inside mediastinum inside thoracic cavity which is the superior portion of the ventral cavity in center of chest deep to sternum, apex tipped toward the left; base superior b. Superficial anatomy four hollow chambers

--- right & left (superior) atria with (de)attached auricles --- right & left (inferior) ventricles base of heart is top with major vessels attached --- superior and inferior venae cavae enter right atrium --- pulmonary veins return to left atrium --- pectinate muscles - interior of atria ---interatrial septum - wall between atria apex is inferior point of heart, usually somewhat left of center atrioventricular sulci lie between atria & ventricles - sites of coronary arter ies and veins from which distributing arteries arise. Anterior/posterior interventricular sulcus separates right and left ventricles 2. The morphology of the heart chambers a. atria, thin walled, pectinate muscle internally Right atrium: Four orifices, Fossa ovalis, Koch Triangle, Aortic eminence b. atria separated by an interatrial septum c. ventricles thick walled with trabeculae carneae & papillary muscles right c hamber is thinner walled than left d. ventricles separated by an interventricular septum Right ventrucle: suparventricular crest, the inflow tract, the outflow tract Moderator band e. atria and ventricles separated by atrioventricular valves tricuspid on the right bicuspid (mitral) on the left valve complex: cuspid ring, valves, chordae tendineae, papillary muscles f. valves are restrained by chordae tendinae which are in turn attached to papil lary muscles Function: to prevent backflow of blood into/through heart 3. Blood flow pattern through the heart a. Blood enters right atrium b. Passes tricuspid valve into right ventricle c. Leaves by way of pulmonary trunk into lungs to be oxygenated d. Passes pulmonary valves on the way to lungs e. Returns from the lung by way of pulmonary veins into the left a trium f. Left atrium past bicuspid valve into left ventricle g. Leaves left ventricle past aortic valve into aorta h. Distributed to rest of the body 4. The Conduction System of Heart: Special tissue sets the pace a. Sinoatrial node b. Atrioventricular node c. Atrioventricular bundle d. Bundle branches e. Purkinje fibers 5. The Vessels of Heart a. Blood in the heart chambers does not nourish the myocardium b. The heart has its own nourishing circulatory system c. Coronary arteries arising from left and right arterial coronary sinus respec tively d. Cardiac veins e. Blood empties into the right atrium via the coronary sinus 6. The Pericardium a. Fibrous pericardium Parietal layer b. Serous pericardium Pericardial cavity Visceral layer C. The Conditions required to Maintain the Heart Normal Function

Lecture 7 Blood vessels, artery, vein and Lymphatic systems ________________________________________ I. CONTENTSArtery, Vein and Lymphatic System II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the conception of artery and veins and their distribution pattern 2. To master the passwas of the thoracic duct and right lmphatic tract and their draining territory. 3. To master the lymphatic drainage of the mammary gland and uterus VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching The courses of the theoracic and right lymphatic ducts and their draining territ ory. The difficult issues for teaching The lymphatic drainage of the mammary gland and uterus VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Introduction 1. Definition and structural features and function of arterial system: Arteries are vessels that carry blood from heart to tissues 2. Types a. Elastic arteries - largest, conducting arteries lead directly from heart, su bject to high pressures b. Muscular arteries - distributing arteries- lots of muscle, medium sized c. Arterioles- small arteries -incomplete tunica media, control local blood flo w d. Capillary -only endothelium-variably permeable 3. Definition and function of vein: the vessels that convey the blood to the he art. 4. The features of veins: milar to arteries, but minimal smooth muscle a. Tica externa - adventia, see arteries b. nica media thinner than in arteries, less elastic c. nica interna - intima - endothelium d. One way valves in extremities, assist blood return by muscle "milking" e. Lumen is larger than in corresponding arteries f. Venules small diameter g. Sinus or sinusoid = no smooth muscle or elastic tissue in walls h. Venous reserve or reservoir - see above B. Hepatic portal vein and the tributaries 1. Composition: superior mesenteric and splenic veins 2. Tributaries a. Superior mesenteric vein b. Splenic vein c. Inferior mesenteric vein d. Left gastric vein e. Right gastric vein f. Cystic vein - Paraumbilical v 3. Function: Collects the blood from the abdominal part of the digestive canal, except the anal canal, and from the pancreas, the spleen and the gallbladder, t hen delivers this blood to the liver 4. Characteristics a. There are two sets of capillaries b. No valves in the portal vein and its tributaries

a. b. c. d. C. 1. a. b. c. d. 2. a. b. c. d. 3. a. b. c. 4. a.

5. The anastomoses between the hepatic portal and vena cava systems The esophageal venous plexus The rectal venous plexus The peri-umbilical venous plexus The connections to external/internal vertebral plexus The Lymphatic System Composition and Function Fluid Lymphoid tissues Vessels Lymphoid organs Vessels The lymphatic capillaries The lymphatic vessels The lymphatic trunks(9) The lymphatic ducts(2) The Collateral Circulation of Lymph Anastomoses between lymphatic vessels Formation of new anastomoses induced by injury or inflamation Metastasis of tumour Thymus and spleen Thymus lies above heart, posterior to sternum involutes with age divided into lobules cortex and medulla - as above for nodes thymus- blood barrier - protects maturing cells from immune attack epithelial cells (Hassall s corpuscles) - produce thymic hormones c. Spleen largest lymphoid organ hilus - as lymph nodes capsule - collagen and elastin red pulp - contains RBCs white pulp- lymphatic nodules trabecular vessels - supply white pulp and its sinusoids 5. The Lymphatic Duct a. The thoracic duct: starts at Cisterna chyli formed by the union of the right lumbar, left lumbar and intestinal trunks, at the root of the neck it receives the left jugular, subclavian and bronchomediastinal trunks, then empty its conte nt into the left venous angles. b. The right lymphatic duct: formed by the union of the right jugular, right su bclavian and right bronchomediastinal trunks, about 1 cm long, and ends by openi ng into the junction of the right subclanian and internal jugular vein(the right venous angle) 6. Lymphatic drainage of the mammary gland a. Lateral and superior lateral b. Interal and superior part c. Medial part d. Inferior-medial e. Deep part

Lecture 8 General and Special Sensory organs ________________________________________ I. CONTENTSSensory organs, visual organ, vestibulocochlear organ II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. Define receptor and sense organ 2. List and describe the accessory structures of the eye and the structural com ponents of the eye. 3. Discuss image formation by describing refraction, accommodation and constric tion of the pupil and describe how photoreceptors and photopigments function in vision. 4. Describe the anatomical features of the ear. 5. Explain how the vestibular apparatus enables the brain to interpret the body ,s position and movements VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. The structure of the eyeball 2. The extraocular muscles 3. The tympanic cavity The difficult issues for teaching The structure of inner ear VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Receptors (5) 1. All sensory receptors are transducers of some sort, that is, they change an incoming stimulus of pressure, vibration, light, etc., into electro-chemical neu ron impulses. Each is specific in that it can transduce only certain types of st imuli into neuron action potentials. 2. Perception - conscious awareness of a sensation 3. Sense organs as transducers a. Chemoreceptors b. Mechanoreceptors c. Thermoreceptors d Nociceptors 4. Interpretation of Sensory Information a. Receptive field - that region monitored by a receptor cell b. Labeled line - route between receptor and appropriate cortical area c. Sensory coding - all the qualities of the action potential patterns characte ristic of that sense

d. Tonic receptors - continuously monitor stimuli e. Phasic receptors - monitor and report changes in stimulus 5. Central Process ing and 5. Adaptation a. Adaptation - loss of sensitivity after exposure to a stimulus. b. Peripheral adaptation - result of sensor fatigue , receptor becomes less sen sitive to stimulus 6. Sensory Limitations a. There are many stimuli for which we do not have receptors b. Stimuli may be out of range for the appropriate receptors - uv light for exa mple c. Our awareness depends on interpretation which may be inexact. B. General Senses (5) 1. Exteroceptors - detect the external environment (temperature, pressure, ligh t, etc.) 2. Interoceptors provide information about internal conditions, most often tens ion or stretch in smooth muscle or tendons. a. Nociceptor stimulation results in pain. heat, mechanical stress and chemical s can all c ause pain by stimulating different classes of receptors. b. Thermoreceptors - detect heat or absence thereof, phasic, same pathways as p ain c. Mechanoreceptors - stimulated by anything moving or physical perturbation. d. Chemoreceptors - respond to specific chemicals either in solution (taste) or volatilized (smell) or internally in monitoring blood composition. Internal che moreceptors monitor blood composition - Na+, pH, osmolarity, etc. Sensory organs are very highly developed and specialized organs that are an exte nsion of the central nervous system, with a sole function to take in information and relate it to the brain. C The visual apparatus: Eye (45) The eyes are the two organs of sight. They are located in the front upper part o f the skull and consist of structures that focus an image onto the retina at the back of the eye which is a network of nerves that convert this image into elect rical impulses to be recorded in a region of the brain. 1, The eyeball a. The wall of eyeball Superficial structures: cushioned by fat pads Fibrous tunic - tough outer layer sclera - white part of fibrous tunic cornea - transparent avascular anterior part limbus - boundary between the above vascular tunic (uvea) choroid - heavily vascular iris with pupil hole, circular sphincter muscles and radial dilator muscles ciliary body - muscles attached to suspensory ligament, regulates focus of lens nervous tunic retina outer pigmented layer inner layer -photoreceptors rods black/white vision, motion detection cones color vision, intense light horizontal cells - modulate between rods and cones and bipolar cells bipolar cells - synapse with rods and cones ganglion cells - synapse with bipolar cells amacrine cells - synapse with both bipolar and ganglion cells ora serrata - anterior edge of retina macula lutea fovea centralis - all cones, best vision optic disc blind spot, where optic nerve exits eye optic nerve b. The contents of the eyeball the lens the vitreous body

the aqueous humor c. The Transmission of Light Rays When light enters the eye, it must first pass through 4 transparent media before they can reach the photoreceptors for proper stimulation. The light rays initia lly pass through the cornea before they pass through the aqueous humor, then the lens, and finally the vitreous humor. The cornea and the lens are considered so lid transparent media, created by avascular protein fibers which are packed rema rkably close together. The out layer of the cornea is covered by an extra thin t ransparent membrane which is really a continuation of the conjunctiva. The aqueo us humor is a fluid media and the vitreous humor is a mix, creating a jelly like media that remains transparent. d. Lens Accommodation Lens accommodation refers to the lens ability to alter its shape in order to refi ne the refraction. Ciliary muscle contract, which enables adjustments of the len s shape. This helps to bring the image into a clear image for the retina. The bi convex lens of the eye is makes various adjustments for any image which is viewe d from less than 20 feet away. When the smooth muscle fibers of the ciliary body contract, the lens relaxes and thickens in response to the relaxation of the su spensory ligament. This creates a thicker lens which in turn creates a more conv ex lens, necessary for the viewing of objects close to the eye. 2. Accessory Structures of the eyeball a. Eyelids palpebrae b. Conjunctiva - mucous membrane lining eyelids c. Lacrimal apparatus lacrimal gland - superior and lateral to eye lacrimal puncta - holes near nose to drain tears lacrimal canaliculi- drain tears to nasolacrimal ducts - empties to nasal cavity d. Extrinsic Muscles of The Eye 3. Visual Pathways Optic Chiasma - optic nerves partially cross in sphenoid (right side of the fiel d of each eye combining and going to the lateral geniculate (knee) on the right, those from the left to the left, of the thalamus which then relays the data to the visual centers. ) Cortical Integration The visual cortex must combine and integrate the incoming information into a com posite which is perceived as depth. (This is a remarkable feat when one consider s that the image is tiny, curved, inverted, the two images slightly out of frame , and each missing a large portion at opposite edges of the field and having a h ole in the image.) The Brain Stem and Visual Processing a. Optic nerve to midbrain or bypass to hypothalamus b. Motor commands control eye movements c. Hypothalamus to epithalamus - affect diurnal rhythms d. Collaterals to visual cortex D, The auditory and vestibular apparatus(45) Hearing involves structures that are formed in the inner ear, the middle ear, an d the outer ear. The inner ear contains structures specifically related to balan ce and equilibrium. The ear is an organ designed to serve two purposes, hearing and establishing and maintaining equilibrium. The ear houses two different types of receptors, one which is stimulated by sound waves and the other which respon ds to the stimulation delivered by head movement. Both types of receptors send t heir impulses through the vestibulocochlear nerve to the brain, where the inform ation is then interpreted. 1. Outer ear The auricle, which is also known as the pinna, and the external acoustic canal c omprise the outer ear. The external acoustic meatus is created by the combinatio n of the fleshy tube which lays inside the bony tube. Easily discernable with th e naked eye, the pinna can be detected along the outside of the head, and is var ied mildly in shape and size from individual to individual. A basic structural f

rame of cartilage is then covered with a stretchy connective tissue, and finally covered with skin. The ridge of the pinna is known as the helix. The fleshy low er section that flexes and hangs free is known as the earlobe, and is the only s ection of the out ear that is free of the cartilage framework. The auricle is he ld to the head with ligaments, as well as a combination of muscles which lack st rength or high definition. These muscles are attached to the outer ear along the superior, anterior, and posterior segments of the ear. The auricle receives the necessary blood supply via posterior auricular artery a nd the occipital artery. These are extensions which branch off from the external carotid artery and the superficial temporal artery. The pinna is designed struc turally to help encourage sound waves to enter the ear, with its mild funneling style it acts somewhat like a sound wave scoop. The external acoustic canal meas ures approximately 1 inch in length and appears to hold the shape of a near S. T he canal itself has a slight incline, extending upward toward the tympanic membr ane. The canal is lined with sebaceous glands and fine, thin hairs that nearly c ircle the entrance, which helps to keep foreign objects from entering the ear ca nal. The tympanic membrane measures only about 1 centimeter in diameter. It is quite thin despite its double layering, and is really a dividing element designed by e pithelial cells. It segregates the external acoustic canal from the middle ear. The outer concave layer is designed out of stratified squamous epithelium while the inner convex layer is designed of low columnar epithelium. A firm connective tissue layer rests in between the epithelial layers. 2. Middle ear The tympanic membrane serves as a segregating point between the middle ear and t he external acoustic canal of the outer ear. This creates an air filled chamber known as the tympanic cavity, where the middle ear is is laterally compressed. I t can be located in the petrous part of the temporal bone. The middle ear and th e inner ear are segregated by a bony structure known as the vestibular window an d the cochlear window. The vestibular window is ovular while the cochlear window is circular. The tympanic cavity hosts two openings. Connecting the tympanic cavity with the mastoidal air cells, which reside in the mastoid process of the temporal bone, is the epitympanic recess. In order to eq ualize the air pressure on both sides of the tympanic cavity, the Eustachian tub e, also known as the auditory tube, serves as the connecting piece between the t ympanic cavity and the nasopharnyx. Reaching out across the tympanic cavity, the re are three auditory ossicles which reach the vestibular window. These are the smallest bones within the human body. From smallest to largest these bones are n amed the malleus, the incus, and the stapes. Ligaments maintain the position the se tiny bones hold within the structure of the ear The tympanic membrane echoes the sound required to vibrate these tiny bones, whi ch transmit sound waves detected via vibration of these bones. The sound waves c arried on the vibrations reach the vestibular window. From the vestibular window , these vibrations reach a fluid filled cavity deep within the inner ear, stimul ates the receptors, which transmits sound waves into the brain which is recogniz ed as sound. The ossicles serve as a systematic lever amplifier to deliver the n ecessary sound waves. The sound waves are once again subjected to amplification as they leave the larger tympanic cavity and enter the smaller vestibular window . This system allow for amplification of about 20 times the starting volume. 3. Inner ear The inner ear is called a labyrinth. The labyrinth itself is comprised of a bone shell known as the bony labyrinth, which is designed to offer protection for th e membranous labyrinth it encompasses. There is a space in between theses two la byrinths which is filled with fluid known as perilymph. Perilymph is a secreted fluid, constantly supplied by the cells which line the bony canal. A second flui d can be found within the structure of the tubular maze inside the membranous la byrinth. This fluid is known as endolymph. Both fluids are equipped to help disc ern vibrations to assist in the process of hearing as well as help the body main tain a sense of balance and equilibrium. There are three structural cavities wit hin the bony labyrinth, the vestibule, the semicircular canals, and the cochlea.

The necessary organs for hearing and maintaining balance are embedded and suppo rted within these three regions a. Vestibule b. Semicircular canals c. Cochlea d. Receptor Function in the Inner Ear cochlea modiolus central hub of cochlea cochlear duct sandwiched between vestibular duct and tympanic duct Organ of Corti basilar membrane on which sit hair cells with stereocilia tectorial membrane above the hair cells sound causes hair cells to bounce and touch the tectorial membrane causing trans duction. 4. Pathways for Vestibular Sensationvestibular branch of cranial nerve VIII a. Synapses in pons / medulla oblongata b. Relays information to vestibular apparatus of cerebellum c. Relays information to cerebral cortex d. Sends commands to motor nuclei in brain stem and spinal cord 5. Auditory Pathways a. Afferent neurons in cochlear branch of cranial nerve VIII. b. These synapse to neurons relayed to opposite side of midbrain c. Auditory reflexes occur from here, axons synapse to thalamus d. Projection fibers to auditory cortex from thalamus

Lecture 9 Introduction of Nerve System Spinal Nerves ________________________________________ I. CONTENTSIntroduction of nerve system, spinal nerves II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. Identify the major structures and functions of the nervous system in the mai ntenance of homeostasis. 2. Describe the components and subdivisions of the central and peripheral nervo us systems. 3. Compare the histological characteristics of neuroglia and neurons. 4. Describe the major functions of neuroglia and neurons 5. Describe grey matter and white matter, and give examples of each. 6. Describe how spinal nerves are connected to the spinal cord. 7. Describe the components, connective tissue coverings and branching of a spin al nerve.

8. Define the term plexus, and describe the anatomical importance of a plexus. VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. the major structures and functions of the nervous system in the maintenance of homeostasis.l 2. The nerve plexuses. The difficult issues for teaching The branches of spinal nerves VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Basic Divisions of nervous system (10) The brain and spinal cord are considered the central nervous system or CNS and the rest is referred to as the peripheral nervous system or PNS 1. Sensory (afferent) portion - includes a. Special senses - eyes, ears, etc. b. General somatic senses - skin senses c. Visceral senses - internal senses 2. Motor (efferent) portion - includes a. Somatic motor - skeletal muscle control b. Autonomic (visceral) motor - smooth, cardiac muscle and glands sympathetic division parasympathetic division 3. Brain and spinal cord - integration and interpretation B. Nervous Tissue (20) 1. Neurons a. Cell body or soma contains the usual organelles including Nissl Bodies AKA c hromatophilic substance which are the same as ribosomes. b. Dendrites (tree branches) fibers attached to the cell body which are receptive to neurotransmitters from other neurons. Transmit toward the cell body. c. Axon hillock where cell body tapers to axon. Significant because an action p otential originates here. d. Axon single fiber from cell body which transmits an action potential and te rminates in: e. Telodendrites (branches at a distance) contain vesicles with neurotransmitte rs. 2. Synapse a. Presynaptic neuron b. Postsynaptic neuron 3. Neural Structure a. Unipolar - having one fiber attached to the cell body. These will be functi onally sensory b. Bipolar have two fibers attached to the cell body these will also be functio nally sensory in the eye , ear and nose. c. Multipolar have numerous fibers attached to the cell body. These are motor o r associative in function. 4. Neural Function a. Sensory or afferent- partly in PNS, partly in CNS, usually unipolar b. Associative or interneurons only in the CNS and only multipolar, connect bet ween other neurons. c. Motor or efferent always multipolar, partly in PNS and partly in CNS. 5. Supporting Cells Glia (literally glue) are supporting and nourishing/protective cells which retain the ability to reproduce (and therefore are often the source of brain tumors). a. Astrocytes isolate and protect neurons, form the Brain-Blood Barrier or BBB. , form a framework to support and guide neuron growth, and do various repairs ne eded. b. Oligodendrocytes provide a myelin sheathing around neurons in the CNS. c. Microglia - act as macrophages and destroy cellular debris and pathogens.

d. Ependymal cells form the roofs of ventricles in the brain and are responsibl e for forming cerebrospinal fluid CSF e. Satellite cells supportive, nutritive and isolating f. Schwann cells form myelin sheathing in the PNS. The myelin sheath is critic al for fast transmission of the action potential C. Nerve (5) 1. A cable-like collection of neurons a. Endoneurium b. Fascicles c. Perineurium d. Epineurium D. General concepts - organization (5) 1. White = myelinated axons, both nerves (PNS) and tracts (CNS) 2. Gray = non-myelinated material, dendrites, synapses and cell bodies as well as nonmyelinated axons. In CNS nucleus; in PNS - ganglia 3. Collections of cell bodies - ganglion in PNS, center or nucleus in CNS 4. Bundles of axons - tracts in CNS, nerves in PNS 5. Pathways - linkages of centers and tracts E. Neural Regeneration (10) 1. Very limited capability for regeneration, especially in CNS. 2. Successful only if Schwann cells participate releasing growth factors and se tting path for r egeneration. F Spinal Nerves (50) 1. 31 pairs of spinal nerves named after the inferior vertebra a. 8 cervical b. 12 thoracic c. 5 lumbar d. 5 sacral 2. Organization of each spinal nerve a. Coverings similar to muscles epineurium - wraps entire nerve perineurium - wraps fascicles of tracts endoneurium - wraps individual axons b . Organization root inside vertebral canal: dorsal sensory root with a ganglion; ventral motor mixed spinal nerve rami: dorsal mixed; ventral mixed spinal nerve; white ramus communicans motor ANS; gray ramus communicans motor ANS 3. Plexus braid of ventral rami of cervical, thoracic, lumbar or sacral spinal nerves a. cervical: phrenic nerve - innervates diaphragm b. brachial trunks - superior, middle, and inferior cords - lateral, medial, and posterior i. musculocutaneous nerve - innervates biceps and brachialis muscles ii. median nerve - innervates lateral flexors iii. ulnar nerve - innervates medial flexors iv. axillary nerve - innervates deltoid muscle v. radial nerve - innervates forearm extensors c. lumbar genitofemoral nerve lateral femoral cutaneous nerve femoral nerve d. sacral: lumbosacral trunk sciatic nerve pudendal nerve common peroneal nerve

\ Lecture 10 Cranial Nerves ________________________________________ I. CONTENTSPeripheral nervous system----cranial nerves II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. List the 12 cranial nerves by name and number; 2. Identify where each cranial nerve originates and terminates; 3. State the functions of each cranial nerve. VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching Each cranial nerve originates , terminates and function The difficult issues for teaching The Structure and Function of the Cranial Nerves III. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. The introduction of cranial nerves (10) The cranial nerves are responsible for transmission of information to and from t he brain. There are twelve pairs of these nerves, and they traverse the along th e inferior surface of the brain. They exit through the foramina in the skull and innervate the receptive areas, such as the surrounding areas of the head, ne ck, and even the visceral organs within the trunk of the body. B. Cranial nerves: 12 pairs arise from brainstem (90 ) 1. Mnemonic out on our table top are fruits, very green veggies and hamburgers. I Olfactory sensory smell ( by way of cribiform plate of ethmoid) II Optic sensory vision ( by way of optic foramen) III Oculomotor motor runs eye muscles ( by way of superior orbital fissure) IV Trochlear motor runs superior oblique eye muscle (by way of superior orbital fissure) V Trigeminal mixed, three major branches: Ophthalmic, Maxillary, Mandib ular ( by way of 1. superior orbital fissure, 2. foramen rotundum, 3. foramen ovale) VI Abducens motor, runs lateral rectus eye muscle ( by way of superior orbital fissure) VII Facial mixed sensory and facial expression (by way of internal acoustic canal to stylomastoid foramen) VIII Vestibulocochlear sensory hearing and balance (by way of internal acoustic foramen) IX Glossopharyngeal mixed sensory and& swallowing (by way of jugular foramen) X Vagus mixed, very important in ANS ( by way of jugular foramen) XI Accessory motor, swallowing, trapezius, and skm (by way of jugular foramen) XII Hypoglossal motor, tongue musculature (by way of hypoglossal canal)

Lecture 11 Spinal Cord ________________________________________ I. CONTENTSCentral nervous system----spinal cord II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the internal architecture of the spinal gray matter and white matt er. 2. To master the position, fibre connection and function of the tract in the sp inal white matter. VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. The internal structure and function of the spinal gray matter. 2. The external surface of spinal cord. The difficult issues for teaching Fibres connection of the lateral gray horn VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. Introduction of development of central nervous system (5) 1. Neural ectoderm----neural plate----neural groove/neural fold----neural tube/ neural crests a. Neural tube-------central nervous system b. Neural crests--------peripheral nervous system *** emphasis the inductional role of notchord 2. The rsotral part of neural tube----primary brain vesicles-----secondary brai n vesicles----the six part of brain, the caudal part of neural tube-----spinal c ord B. The derivation of spinal cord (10): The evolution of the caudal part of neural tube: 1. Ependymal layer 2. Mantle layer a. Alar plate----dorsal part-----sensory neuronal body of gray matter

b. Basal plate----ventral part-----motor neuranal body of gray matter c. Sulcus limitans-----longitudinal groove which demacrates alar plate from basal plate 3. Marginal layer------white matter C. Position and shape of spinal cord, spinal nerves and segments (20) The spinal cord is primarily made up of gray matter and is housed within the spi nal column. Its purpose it to communicate from various parts of the body to the brain. The peripherally located tracts of white matter are responsible for sendi ng the various impulses to and from the brain. The spinal cord runs the length o f the thorax and is continuous with the brain via the skulls foramen magnum. Extending up the inferior side, near the foramen magnum that belongs to the occi pital bone, the spinal cord runs up to the same level of the first vertebrate. I t looks like an ovular cross section due to its mildly flattened posteroventral shape. From a posterior viewpoint, the two rather obvious enlargements can be de termined. Between the third cervical vertebrate and the second thoracic vertebra te the cervical enlargement can be detected. The upper extremities receive the n erve supply from this area of the spinal cord. In between the thoracic vertebrat es number 9 and 12, the lumbar enlargement can be detected. The lower extremitie s are served via this area. In an adult human body, the spinal cord does not pro trude beyond the first vertebrate, L1, due to the slower fetal development of th e spinal cord. The vertebral column extends a bit further. The conus medullaris refers to the end of the spinal cord, where it tapers into its termination. A st rand of mostly fiber material which is comprised nearly entirely out of pia mate r is referred to as the filum terminale. The filum terminale runs along the infe rior side from the conus medullaris even with L1 to the coccyx. There are 31 segments that create the spinal cord. Each segment radiates one pai r of spinal nerves which protrude from the spinal cord via the intervertebral fo ramina.There are two distinct grooves that partially segregate the spinal cord i nto a general right and left side. These grooves are referred to as the anterior median fissure and the posterior median sulcus. The three diverse meninges that help to protect the brain also have their place in protecting the spinal cord, as does the cerebrospinal fluid. The highly vascular pia mater helps to supply t he cells with much needed blood nutrients and oxygen. 1. Bilateral symmetry 2. Cervical and lumbar enlargements - associated with more cell bodies for moto r control of limbs 3. Anterior fissures 4. Posterior sulcus 5. Central canal, containing CSF 6. Superficial white (myelinated) tracts/columns a. Anterior and lateral descending b. Posterior and lateral ascending 7. Interior gray horns: cell bodies, dendrites and synapses 8. 31 pairs of spinal nerves named after the inferior vertebra a. 8 cervical b. 12 thoracic c. 5 lumbar d. 5 sacral 9. Conus medullaris - inferior end of spinal cord proper 10. Cauda equina - individual spinal nerves within spinal canal 11. Filum terminale - filamentous end of meninges, "tie-down" D. Internal structure of spinal cord 1. grey matter (20) The majority of the spinal cord is created by the gray matter, which is centrall y located and aptly surrounded by white matter. The gray matter is composed of a combination of neuroglia, nerve cell bodies, and unmyelinated association neuro ns. When looking at the core of gray matter, it appears to create the letter H. Horn s, which are projections of gray matter throughout the spinal cord, are appropri ately determined by the direction of their projection. Thus, the paired horns wh

ich extend posteriorly are known as the posterior horns, and the anterior horns are those which project anteriorly. The shorter pair of lateral horns protrude t o the sides. In the thoracic and lumbar areas, the lateral horns can be discerne d, but typically not in other regions. The paired lateral horns are conjoined ac ross the middle of the spinal cord by a transverse rod of gray matter. This is k nown as the gray commissure. The central canal lies withing the gray commissure. The gray commissure is also continuous with the brains ventricles and is protect ed by cerebrospinal fluid. a. Posterior gray horns - somatic and visceral sensory nuclei b. Anterior gray horns - somatic motor control c. Lateral gray horns - visceral motor control d. Gray commissures - axons carrying information from side to side e. Neuronal architecture of spinal gray matter----the laminae of Rexed the rela tionship of laminae I to X and the neuclei of spinal gray matter 2. White matter (15) Within the columns of white matter, there are ascending and descending tracts fo r the nerve impulses to travel along, delivering their messages either to the br ain or to the body structure. There are six of these white matter columns within the spinal cord. They are called funiculli, and are named appropriately for the ir relationship with the relative position. Between the anterior gray horns, the anterior funiculi are positioned on either side of the anterior median fissure. Likewise, the posterior funiculi are positioned between the posterior horns of gray matter. These are on either side of the posterior median sulcus. In between the gray matter that creates the anterior and posterior horns, the posterior fu niculi are positioned. Ascending and descending tracts line the individual funiculi. The nerve fibers t hat line the tracts are myelinated and have been named by they original location or their location of termination, as the fibers within these tracts either rema in on the same side they began or they cross over either within the medulla oblo ngata or the spinal cord. Decussation is the term deemed for the crossing over o f the nerves. The descending tracts are also named for their location of origin. a. Positions Posterior white column Anterior white column Lateral white column Anterior white commissure b. Functions: ascending tracts - sensory toward brain fasciculus gracilis and cuneatus: derived from neurons located in the dorsal root ganglion, which are concerned with discriminative qualities o f sensation, including the ability to recognize changes readily in the positions of tactile stimuli applied to the skin. spinothalamic tract: cross axons of opposite half cord, mostly originates from laminae V, conducts impulses concerned with tactile, thermal, a nd painful sensations. spinocerebellar tract: ventral and dorsal part, convey sensory (mainly proprioceptive) information from one side of the body to the same side of the cerebellum. --- descending tracts - motor from brain lateral corticospinal tract: consists of axons of neurons in the cor tex of the contralateral frontal and parietal lobe, terminates mainly in laminae VII-IX and establish synaptic connections with motor neurons. corticospinal trac ts descend directly and continuously without any synaptic interruption. The cell bodies that create the fibers for these tracts are derived from precentral gyru s of the frontal lobe. At least 85% of the fibers from the corticospinal tracts decussitate. The crossing fibers then create the lateral corticospinal tracts. T he remaining 15% of the fibers which do not decussitate create the anterior cort icospinal tracts. The process of nerve fibers which cross over contributes to th e right brain, left brain notion. Many of the skeletal and other voluntary actio ns that happen on the right side of the body are directed by the left side of th

e brain, and vice verse. rubrospinal tract: crossed pathway, tectospinal tract: E. Reflexes and symptom injured of spinal cord (15) The spinal cord is also involved in spinal reflexes. Dedicated nerve pathways de termine the reflex directly from the spinal cord thus eliminating the extra time and distance required for voluntary actions to receive their information. This means that reflexes are often faster than voluntary action. Reflexive action can contribute to various body needs including the heart, breathing, coughing, snee zing, motor reflexes, blood pressure, vomiting, hiccupping, and digestion. Reflexes fast, stereotypical, inborn, protective actions 1. Occur at spinal cord or brainstem levels 2. Do NOT require cerebral processing but can be modified by cerebral control 3. May be either monosynaptic or polysynaptic but either is relatively simple 4. May be either somatic or visceral 5. All require a. Stimulus at receptor b. Sensory information relay c. Processing at CNS level d. Activation of motor response e. Response of peripheral effector 6. Examples a. Patellar b. Stretch reflex F. The regeneration of central nervous system (15) 1. Obstacles of regeneration of central nervous system a. Cell body response: atrophy and/or death b. Cyst/cavitation c. Glia scar 2. Growth inhibitory environments of central nervous system a. MAG---- Myelin-associated glycoprotein b. NOGO c. CSPG--- Chondroitin Sulfate Proteoglycans 3. Some experiment progress of SCI group in our department

Lecture 12 Brain Stem ________________________________________ I. CONTENTSCentral nervous system----brain stem II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term

V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the orgnization and surface shape of brain stem. 2. To master the position and the cross-connection of the fourth ventricle. 3. To master the regional distribution of gray matter and white matter on trans verse section of brain stem. VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. The relationship between nuclei of brain stem and cranial nerves. 2. The regional distribution of gray matter and white matter on transverse sect ion of brain stem. The difficult issues for teaching Functional zone of nuclei of cranial nerves VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. The derivation of brain stem (10) 1. Neural tube----primary brain vesicles-----secondary brain vesicles myelencephalon----medulla oblongata metencephalon-----pons and cerebellum mesencephalon-----midbrain 2. The evolution of the external surface and internal structure of brain stem, f or example----the enlargement and formation of the fourth ventricle. Within both the metencephalon and the myelencephalon, the mesencephalic aqueduct broadens, becoming the fourth ventricle of the brain. B. The position and surface shape of brain stem (10) 1. Medulla oblongata It rests on the basilar portion of the occipital bone and is concealed from abov e by the cerebellum. When viewing from the external side, the medulla oblongata resembles very closely the spinal cord, with the exception of the pyramids. a. Pyramids - decussation or crossing b. Olive c. Gracile tubercle d. Cuneate tubercle e. Inferior cerebellar peduncle 2. Pons It rests upon the dorsum sellae of the sphenoid bone and the adjacent basil ar part of the occipital bone, the dorsal surface of the pons is also hidden by the cerebellum. The pons looks like a circular bulge lying on the inferior surfa ce of the brain. a. Middle cerebellar peduncle b. Basilar sulcus c. Superior cerebellar peduncle d. Anterior medullary velum 3. Midbrain It is the shortest part of the brain stem. It connects the pons and cerebell um with the cerebrum. The midbrain, houses the mesencephalic aqueduct which is r esponsible for the unification of the third and fourth ventricles. a. Cerebral peduncle b. Interpeduncular fossa c. Posterior perforated substance d. Superior colliculus e. Inferior colliculus 4. Fourth ventricle---- make / contain cerebrospinal fluid (CSF) In the brain stem, positioned between the pons and the cerebellum, is the fo urth ventricle. Adjoining the third and fourth ventricle is the mesencephalic aq ueduct, which traverses the midbrain to complete the link. One of the responsibl ilities of the fourth ventricle is communication with the spinal cords central ca nal. The fourth ventricle allows the release of cerebrospinal fluid via subarach noid space. Three foramina assist in this process, the median aperture, the medi

al opening, and the lateral apertures. a. Choroid plexus --with network of capillaries b. Ependymal cells line the ventricles- glia which selectively take blood compo nents to form CSF c. Rhomboid fossa: median sulcus, medial eminence, sulcus limitans, medullary s triate, locus ceruleus, facial colliculus, hypoglossal triangle, vagal triangle, vestibular area. C. Internal structure of brain stem 1. Nuclei of cranial nerves (30) a. General somatic motor nucleus oculomotor nucleus --------III oculomotor nerve trochlear nucleus------------IV trochlear nerve abducens nucleus-----------VI abducent nerve hypoglossal nucleus-------XII hypoglossal nerve b. Special visceral motor nucleus motor nucleus of trigeminal nerve-----V trigeminal nerve facial nucleus---------------VII facial nerve nucleus ambiguus----------IX glossopharyngeal nerve, X vagus nerve, XI accessory nerve accessory nucleus-----------XI accessory nerve c. General visceral motor nucleus accessory nucleus of oculomotor nerve--------III oculomotor nerve superior salivatory nucleus------------- VII facial nerve inferior salivatory nucleus------------- IX glossopharyngeal nerve dorsal nucleus of vagus nerve--------- X vagus nerve d. General visceral sensory nucleus nucleus of solitary tract----------- IX glossopharyngeal nerve, X vagus nerve e. Special visceral sensory nucleus nucleus of solitary tract----------- VII facial nerve, IX glossopharyngeal nerv e, X vagus nerve f. Genenral somatic sensory nucleus mesencephalic nucleus of trigeminal nerve-----V trigeminal nerve pontine nucleus of trigeminal nerve-----V trigeminal nerve spinal nucleus of trigeminal nerve-----V trigeminal nerve g. Special somatic sensory nucleus cochlear nucleus-----------------VIII vestibulocochlear nerve vestibular nucleus--------------- VIII vestibulocochlear nerve 2. Nuclei of non-cranial nerves (10) a. Nucleus gracilis - relay sensory information to thalamus b. Nucleus cuneatus - as above c. Olivary nuclei - relay to cerebellum from all other regions d. Nuclei which relay cerebellar information through cerebral peduncles e. Corpora quadrigemina f. Superior colliculus - processes visual information g. Inferior colliculus - relays auditory information to thalamus h. Tectum - roof of fourth ventricle i. Red nucleus - involuntary muscle activity for posture, etc j. Substantia nigra -regulates motor output 3. Conductive tracts (20) 4. Reticular formation (5) A highly complex network involving nuclei and nerve fibers in the brain stem is known as reticular formation. The network also helps to create the reticular activating system that brings the cerebrum. The network known as reticular form ation is spread throughout the spinal cord, the midbrain, the pons, the thalamus , and the hypothalamus. The majority of structures within the brain sends and ac cepts fibers which ascend and descend throughout the reticular formation. Unless they receive interference from other portions within the brain, the nuclei of t he reticular formation send continuous impulses throughout the entire formation. The reticular activating system is responsible for the chronic state of alertne ss of the cerebrum. It also selectively monitors the type and amount of sensory

perception received by the cerebrum. The additional responsibility of the reticu lar formation is to send impulses which allow the cerebellum to coordinate conti nuous and smooth motor skeletal muscle motion. D. The transverse sections of brain stem (10) 1. The transverse section at the level of the pyramidal decussation 2. The transverse section at the level of decussation of the lemnisci 3. The transverse section at the level of mid-olivary 4. The transverse section at the level of facial colliculus 5. The transverse section at the level of trigeminal nerve 6. The transverse section at the level of the inferior colliculus 7. The transverse section at the level of the superior colliculus E. Diagnostic localization of brain stem (5) 1. Medial medullary syndrome-----alternating hypoglossal hemiplegia 2. Lateral medullary syndrome------Wallenberg syndrome 3. Basal pontine syndrome----------alternating abducent hemiplegia 4. Peduncular syndrome------------alternating oculomotor hemiplegia/Weber syndr ome

Lecture 13 Diencephalon and Cerebellum ________________________________________ I. CONTENTSCentral nervous system----diencephalon and cerebellum II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the position and subdevision of the cerebellum, the position and c linical significance of the tosil of cerebellum. 2. To master the position and the continous of the third ventricle. 3. To master the subdivision of the diencephalon and the composition of each pa rt thalamus. 4. To master components and function of the specific thalamic relay nuclei. VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE

The focused issues for teaching 1. The subdivision and function of cerebellum. 2. The subdivision of the diencephalon and the composition of each part thalamu s. 3. The components and function of the specific thalamic relay nuclei. The difficult issues for teaching 1. The fibre connection and function of cerebellum. 2. The components of dorsal thalamus. 3. The fibre connection of hypothalamus. VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. The derivation of cerebellum and diencephalon (5) 1. Neural tube----primary brain vesicles-----secondary brain vesicles diencephalon----thalamus, epithalamus, hypothalamus, subthalamus 2. The evolution of the external surface and internal structure of diencephalon, for example----the development of alar plate. B. Position and shape of cerebellum (10) Taking up the inferior and posterior aspect of the cranial cavity, the cerebellu m is the second largest structure attributed to the brain. Positioned within the metencephalon, it is segregated via the transverse fissure from the overlying c erebrum. The transverse fissure accepts a segment of the meninges known as the t entorium cerebelli. The cerebellum is created by two hemispheres and one area of central constrictio n known as the vermis. Protruding between the hemispheres is the falx cerebelli, which is part of the meninges. 1. Hemispheres, separated by vermis 2. Lobes - 2 each hemisphere, separated by primary fissure a. Anterior b. Posterior c. Small flocculomotor - anterior and inferior to major lobes d. Tonsil of cerebellum C. Internal structure of cerebellum (25) The outer layer of the cerebellum is like that of the cerebrum, a slight layer o f gray matter. This gray matter layer is known as the cerebellar cortex. The whi te matter beneath this outer layer is much thicker. Parallel and slight folia is created by the convolutions of the gray matter of the cerebellum. When looking at the brain from a saggital viewpoint, the arbor vitae can be clearly distingui shed, looking like a network of white thin matter branching off in all direction s. 1. Cortex -gray surface with a. Folia - fine ridges b. Sulcus - grooves between the ridges c. Purkinje cells , axons of which become2. Arbor vitae (white matter) in center 3. Cerebellar nuclei - synapsing of sensory information for motion The nerve bundles, which are created by three equally paired groups of nerves, i n known as the cerebellum peduncle. The peduncle is a supportive structure that assists in laying the groundwork for the cerebellums communication with the rest of the brain. 4. Superior cerebellar peduncles - link to cerebrum, diencephalon and mesenceph alon. The nerves of the bundle, or more specifically the fibers of the bundle, b egin their existence from the specialized dentate nuclei that is housed by the c erebellum. Passing through the red nucleus to the thalamus and then continuing o n to the motor areas of the cerebral cortex, the cerebrum is then able to receiv e the appropriate feedback and communications via impulses. 5. Middle cerebellar peduncles - connect to motor and sensory centers of pons. Voluntary movement impulses are sent via middle cerebellar peduncles, originatin g in the cerebrum and traveling through the pons and on to the cerebellum. 6. Inferior cerebellar peduncles - link to medulla, carry ascending and descend

ing tracts. Inferior cerebellar peduncles are responsible for adjoining the cere bellum with the medulla oblongata as well as the spinal cord. Equipped with inco ming vestibular fibers and proprioceptive fibers, as well as outgoing motor fibe rs, the basic responsibility of the inferior cerebellar peduncles is to transmit the information necessary to obtain coordinated skeletal muscular contraction, which created body movement. D. Function and symptom injured of cerebellum (5) Voluntary skeletal muscle movement impulses begin in the cerebral cortex and are them transmitted in coordinated efforts by the cerebellum. The cerebellum is re ally quite busy continuously transmitting impulses to specif Voluntary skeletal muscle movement impulses begin in the cerebral cortex and are them transmitted i n coordinated ic motor units in order to maintain muscular tone and posture. The proprioceptors send the cerebellum impulses for interpretation from the muscles , joints, tendons, and special sense organs as these improve learned fine motor development. A proprioceptor is a specialized sensory nerve ending designed to b e susceptible to variations in muscular or tendon tone and tightness. 1. Postural muscles control ( by way of red nucleus) 2. Fine control and coordination of voluntary and involuntary movements E. Position and shape of diencephalon (15) As a second subdivision of the forebrain, the diencephalon is neighbored by the cerebral hemispheres of the telencephalon. The thin cavity running along the mid line within the diencephalon is known as the third ventricle. The vital structur es within the diencephalon control various functions and are required for basic survival. 1. Espithalamus Along the posterior section of the diencephalon lies the epithalamus. This cause s the formation of a fine roof over the third ventricle. The thin roof is then l ined with the vascular choroid plexus which is responsible for the production of cerebrospinal fluid. Named for its appearance, which is similar to that of a pi ne cone, the pineal gland is a small tissue mass which projects outwards from th e posterior section of the epithalamus. While scientific studies have yet to con firm all of its functions, it is thought that this has a neuroendocrine function . Positioned inferior to the lineal gland, the posterior commissure is a tract o f commissural fibers which are responsible for the connection of the midbrains ri ght and left colliculi. pineal gland - produces melatonin, sets diurnal cycles 2. Dorsal thalamus Approximately 4/5 of the diencephalon is made up of the thalamus. Its app earance is a large ovular mass of gray matter. Though it appears as one organ, i n reality the thalamus is paired. The thalamus in its entirety lies directly bel ow the lateral ventricle, with each half extending into the appropriate hemisphe re. a. Two lobes - third ventricle between these b. Massa intermedia - connecting strand 3. Hypothalamus Just below the thalamus lies the hypothalamus. This would be the furthermo st inferior section of the diencephalon. Forming a section of the lateral walls as well as the floor of the third ventricle, the hypothalamus houses numerous ma sses of nuclei which is interconnected to various places along the central nervo us system. a. Just superior to optic chiasma b. Infundibulum - connects to pituitary gland c. Tuber cinereum- between infundibulum and mamillary bodies, gray matter, cont rols pituitary d. Median eminence- part of tuber cinereum 4. Metathalamus 5. Subthalamus F. Internal structure and function of cerebellum 1. Thalamus (25) The thalamus is responsible for the internal relay center for sensory interpr

etation between the brain and the sensory receptors, with the exception of those related to smell. Intensely specialized areas of nuclei relay the necessary imp ulses which enter the brain directly to the exact location within the cerebral c ortex. a. Anterior nuclei- part of limbic system, information relay b. Medial nuclei- conscious awareness of emotional state, integrate sensory inf ormation, relay to frontal lobes c. Ventral nuclei- relay information to and from central nuclei and cerebral co rtex ventral posterior - relays sensory information ventral lateral - relays somatic information to and from primary motor cortex d. Posterior nuclei pulvinar- integrates sensory information to association areas lateral geniculate- relays visual information medial geniculate- relay auditory information to association areas e. Lateral nuclei - feedback, integrates emotional with sensory information The thalamus is capable of a small amount of sensory interpretation. The cerebra l cortex is responsible for refined tactile interpretation as well as the respon se to painful stimuli. The crude interpretation possible in the thalamus is not sufficient for the necessary enhanced tactile interpretation. The thalamus is re sponsible for a crude and immature interpretation of sensory awareness such as i ntense pain. It most likely contributes to the bodys reaction to intense and imme diate pain while the brains cerebral cortex has time to take over to fine tuned r eactions to pain. Psychological shock that often accompanies phenomenal pain is contributed by via the thalamus. 2. Hypothalamus (15) The hypothalamus is quite small yet is still able to perform vital f unctions which are responsible for the regulation (both directly and indirectly) of visceral organs. The hypothalalmus is also responsible for emotional and ins tinctual reactive processes. a. Control of involuntary somatic motor activites, expressions of emotional states b. Control of autonomic nervous system c. Coordination of nervous and endocrine systems d. Secretion of hormones- ADH (from supraoptic nuclei) and oxytocin (from parav entricular nuclei) e. Produces emotional and basic drives- hunger, thirst, sex, anger, etc. f. Coordinates voluntary and autonomic activity g. Regulates body temperature h. Controls diurnal rhythms

Lecture 14 Telecephalon ________________________________________ I. CONTENTSCentral nervous system---- the telecephalon II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. To master the shape, lobes and major gyri of cerebral hemispheres 2. To master the important internal structures in the cerebral hemispheres 3. To master the functional localization of the cerebral cortex. 4. To master the location and subdivision of the internal capsule and its fiber

connections VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. The location and subdivision of the internal capsule and its fiber connectio ns 2. The clinic situation after injure of internal capsule, 3. The shape, internal structures and functions of the cerebral cortex The difficult issues for teaching Spatial relationship among callositas, anterior commissure and cerebral trigone . VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A. The derivation and evolution of telencephalon (15) The nervous system develops from the neural tube . by the fourth week, the n eural tube exhibits three anterior dilations , or primary vesicles, called the f orebrain. By the fifth week, the neural tube undergoes further flexion and subdi vides into five secondary vescles. The forebrain divides into two of them, the t elencephalon and diencephalon. The anterior has a pair of lateral outgrowths tha t later become the cerebral hemispheres. B. The surface shape and lobes of cerebrum (10) 1. The gyri and sulci: They result from the different development speed of cere bral cortex. 2. The lobes named for covering bones a. Frontal b. Parietal c. Temporal d. Occipital e. Insula - hidden deep to temporal lobe 3. The internal structures of cerebrum (70) a. The histology of the cerebral cortex Archicortex Archaeocortex neocortex (about 90% of the human cerebral cortex) The neocortex is subdivided into six layers: molecular layer external granular layer pyramidal cell layer(), internal granular layer(), ganglionic layer() d spindle cell layer(). Layer is the thickest in sensory regions and layer in mot or regions. All axons that leave the cortex and enter the white matter arise fro m layers , , and . b. Brodmanns map The cerebral cortex has been divided into cytoarchitectural areas, based on the differences in the thickness of individual layer, neuronal morphology in the lay er, the details of nerve fiber lamination , and clinicopathologic studies & anim al experiments. Brodmanns map, consists of approximately 52 areas, remains the mo st widely used map of cortical cytoarchitectural areas. Each area is in charge o f the processing of certain final imput. Yet the exact regions still are impreci se. Detailly, motor area (primary motor cortex) (4 and 6 areas) somesthetic area (primary sensory cortex) (3,1and 2 areas) The common features between A and B: crossing (control the opposite side) inverted graph except the head the size of the cortical area for a particular part of the body is determined by the functional importance of the part and its need for sensitivity. visual area auditory area the language areas: motor speech area, auditory speech area, writin g area and visual speech area. c. The internal structure of cerebrum

lateral ventricle They are roughly C-shaped cavities lined by ependymal epithelium one in each cer ebral hemisphere, and filled with cerebrospinal fluid. Each lateral ventricle co nsists of a body in the region of the parietal lobe from which anterior, posteri or and inferior horns extend into the frontal, occipital and temporal lobes, res pectively. the lateral ventricles communicate with the third ventricle through t he interventricular foramen. Cerebral nuclei- gray matter internal to the cerebral cortex, part of the extrap yramidal system Caudate nucleus- deep to lateral ventricles, maintains the pattern and rhythm of a movement amygdaloid nucelus- almond shaped, near tail of caudate nucleus, part of limbic system (emotional brain) claustrum- between insula and diencephalon, focuses visual attention lentiform nucleus - bean shaped made up of -putamen - with claustrum globus pallidus- with claustrum and putamen, controls and adjusts muscle tone Corpus striatum -encloses both lentiform and caudate nuclei White tracts internally commissure tracts connect corresponding gyri of the two hemispheres a. Copus callosum Association tracts connect one gyrus to another in the same hemisphere Projection tracts connect more or less vertically, form internal capsule Internal capsule consists of an anterior limb, a genu and a posterior limb. When it is injured, the individual can show symptoms such as voluntary motor par alysis, impairment of general sensation on the opposite side of the body and bli ndness in the opposite visual field. Limbic system functions emotional brain, links conscious and unconscious functions Components- limbic lobe made up of- cingualte gyrus, dentate gyrus, parahippocam pal gyrus, hippocampus, fornix, mamillary bodies, and anterior nucleus

Lecture 15 Nervous Pathways ________________________________________ I. CONTENTSCentral nervous system---- the nervous pathways II. OBJECTSMedical students III. TIME2 hours IV. THE SEMESTER1st term V. PLACEMultimedia classroom, Teaching building VI. THE TEACHING GOAL 1. Master the pyramidal system 2. Master the visual pathway and pupillary reflexes pathway. 3. Master the deep sensory( proprioceptive) pathways and the superficial se nsory pathways VII. THE FOCUSED AND DIFFICULT ISSUES OF THE LECTURE The focused issues for teaching 1. The origin, insertion and functions of the lateral spinothalamic tract, anterior spinothalamic tract, fasciculus gracilis, fasciculus cuneatus, pyramidal tractand optic radiation 2. The pyramidal system, visual pathway, pupillary reflexes pathway, propri oceptive pathways and superficial sensory pathways 3. The relationship between the peripheral nervous system and central ner vous system. The difficult issues for teaching Different Clinic symptoms between the supranuclear paralysis and infranuclear paralysis.

VIII. THE WAY OF TEACHINGLecture IX. THE INSTRUMENTS FOR TEACHINGMultimedia X. LECTURE OUTLINE A the concept of conductive pathway (10) Conductive pathway is the route formed by the chains of neurons, through which s ensory awareness reaches the cerebral cortex and a motor response is initiated. 1. Ascending pathways a. Conscious deep sensory pathway of trunk and limbs (10) the concept of conscious deep sensory components: the first neurons( located in the spinal ganglia) The second neurons (located in gracile and cuneate nuclei) The third neurons (located in ventroposterior lateral nucleus of the thalmus ) features: no decussation in the spinal cord; decussation through the internal ar cuate fibers in the medulla oblongata the symptoms after lesions of the pathway: Interruption of pathways by lesions b elow the level of the decussation of medial lemniscus causes hemiplegia on the a ffected side of the body, including the loss of all the sensations conducted by the path. An interruption by a lesion above the level of the decussation produce s hemiplegia on the opposite side of the body, including the loss of all the sen sations conducted by the path. 2. Superficial sensory pathways of trunk and limbs (15) a. The concept of Superficial sensory b. Components: the first neurons( located in the spinal ganglia) The second neurons (located in the nucleus proprius of the spinal posterior horn ) The third neurons (located in ventroposterior lateral nucleus of the thalamus) c. Features: Decussation through the anterior white commissure in the spinal cord Run upward within one or two segments during the decussation in the spinal cord d. The symptoms after lesions of the pathway: Interruption of pathways by lesions below the level of the anterior white commis sure of spinal cord causes hemiplegia on the affected side of the body, includin g the loss of all the sensations conducted by the path. An interruption by a lesion above the level of the anterior white commissure of spinal cord produces hemiplegia on the opposite side of the body, including the loss of all the sensations conducted by the path. 3. The visual pathway and pupillary reflexes (15) a. The concept of pupillary light reflex b. Components of visual pathway : the first neurons(the bipolar cells in the re tina) The second neurons (the ganglion cell in the retina) The third neurons (located in lateral geniculate body) c. Features of visual pathway: the optic chiasma. Within the chiasma a partial decussation occurs with the fib ers from the temporal halves of the retina remaining uncrosses. the relationship between visual field and the fibers in of optic nerve and the o ptic chiasma---- decussation. d. Components of pupillary light reflex pathway : the first neurons(the bipolar cells in the retina) The second neurons (the ganglion cell in the retina) The third neurons (located in pretectal area) The fourth neurons(located in accessory nucleus of oculomotor nerv e in both sides) The fifth neurons (located in ciliary ganglion and its target is the sphincter o f the iris) e. The symptoms after lesions of visual pathway Bitemporal hemianopia, blindness in the temporal halves o f the fields of both eyes, result from interruption of the fibers crossing in th e optic chiasma and is sometimes caused by pituitary tumors. Blindness in the na

sal half of the field of vision can be produced in one eye by damage to the uncr ossed fibers of the corresponding side of the chiasma. Lesions in the right side of the optic tract, optic radiation or optic center produce blindness in the ri ght halves of both visual fields. f. The symptoms after lesions of pupillary light reflex pathway Light shone on the retina of one eye whose optic nerve is injured, does not cause both pupils to constrict, but light shone on the healthy one cause both pupils to constrict. The pupil on the side of which the oculomot or nerve is damaged, does not constrict when light is shone on either pupil. B. Descending pathways (90) 1. Pyramidal system. a. The function of pyramidal system control the voluntary movement of the skeletal muscles b. Components: The upper motor neurons( located in the precentral gyrus and paracentral lobule) The lower motor neurons (located in the cranial motor nuclei and anterior horn o f spinal horn) c. Features: The corticonuclear tract terminates most of the bilateral cranial motor nuclei e xcept the hypoglossal nucleus and the inferior part of the facial nucleus. the h ypoglossal nucleus and the inferior part of the facial nucleus receive the fiber s only from the contralateral corticonuclear tract. Most fibers of the corticospinal tract cross to the opposite side to form the py ramidal decussation in the caudal part of the medulla oblongata; its small part fibers directly descend and dont cross the middle line of the medulla oblongata. d. The symptoms after lesions of the pathway: The damage of the upper motor neurons result in the spra nuclear paralysis(hard paralysis), which show the loss of motor functions withou t atrophy and tonicity of the affected muscles. The damage of the lower motor ne urons result in the infranuclear paralysis (flaccid paralysis), which show the l oss of motor functions and atrophy of associated muscles. 2. extrapyramidal system. a. The concept of extrapyramidal system It is a common name for the descending pathways except the pyramidal system. The main functions of the extrapyramidal system in man are to regulate the tonicity of the muscles, coordinate the musclar activities, maintain the nor mal body posture and produce habitual and rhythmic movements. b. Components of visual pathway : the cortico-pallidal system the corticoponto-cerebellar system :