Spine [1,3]

Cervical
Thoracic
Sacrococcygeal

Nuchal [1,2]

Pontine
Medullary
Cerebellar

Cranial [1,1]

Extracranial
Cranial
Intracranial

Pelvic [2,3]

Ureteric-Cystic-Urethral
Ovaro-Utero-Cervical // Testicular
Inguinal-Anal-Perineal

Abdominal [2,2]

Hepatic
Gastric
Intestinal

Thoracal [2,1]

Pleural
Mediastinal
Esophageal

Endocrine, Paracrine, RES [3,3]

Thyroid/Parathyroid/Thymus-Skeletal
Renal/Adrenal/Spleen-Lymphnode
Gastral/Intestinal/Testicul-Ovarian

Pituitary [3,2]

Anterior Lobe
Middle Lobe
Posterior Lobe

Hypothalamus [3,1]

Pre-optic, Supra-chiasmatic, ???
Paraventricular, Dorsoventricular, ???
Etc.

Physiologically Active Proteins [4,3]

Protein Kinase A
Protein Kinase C
?

Phospholipid Bilayer [4,2]

Acyl/Acid/Fat
Glycerol
Activating/Phosphorylating/Enzyme

Matrix Proteins [4,1]

Structure -> embryology + shape + integrity
Function -> Th1 activation + Gene Activation + Elasticity
Cytology -> Differentiation + Metaplasia + Neoplasia

Biological Membranes [5,3]

Vacuoles
Mitochondria
Other

Reticulum [5,2]

Smooth -> Steroid Synthesis
Rough -> Protein Synthesis
Specialized -> Secretion

Endoplasm [5,1]

rDNA, rRNA, mrRNA -> Ribosomal Protein
Ribosomes, Protein, Packaging -> Endoplasmic Reticulum
HMP(*NAs), TCA/Glycolysis(Synthesis), ATP/NADPH/H+ -> Membranes

Nucleolus [6,3]

rDNA
rRNA
mRNA

Nucleoplasm [6,2]

Nucleus [6,1]

Nucleus
Nucleoplasm
Nucleolus

Mitogenesis* [7,3]

Mitosis/Apoptosis
Myofibrills
Specialized Fibrils

Kinetaxis* [7,2]

Kinesis
Chemotaxis
Membrane Architecture/Integrity

Filaments [7,1]

Structure
Function
Cytology

Protein [8,3]

Intracellular -> Chromosome, DNA op., Enzyme
Membrane -> Signalling, Transporter, ID
Extracellular -> Para-Endocrine/Immune, Enzymatic, Structural

Peptide [8,2]

Functional Peptide
Primary Structure
Folding into Protein

Polypeptide [8,1]

Pro-peptide
Non-functional
Cytoplasmic Processing

tRNA [9,3]

Acceptor Arm (5`->PO4-, 3`CCA->tRNA enzyme)
Anticodon:3`->5`
TΨC (Pseudo Uridine)

mRNA [9,2]

3-Base-Sequences
Initiation: Kozak seq/3 pairs up AUG/Ribosomal binding
Stop: AUG + post-transcription addition of repeat AAA-AAA

DNA [9,1]

Promoters (CAAT & TATA)
Exons
Introns

Medicine in a Nutshell

Diagnosis

D[1:3,1:3]
D[4:6,1:3]
D[7:9,1:3]

Etiology

Cause = 3-D Concept
1`-> 2``-> 3``` Dimensions
Cell -> Embryo -> Anatomy

Orders of Causality

1st Order -> Cellular
2nd Order -> Embryological
3rd Order -> Anatomical

Biological Information Systems

Fibrils->Exocytosis->Degradation; Ca,Neuroendocrine,Sum-of-Effects
Polypep->Peptide->Protein; Hydroxylation,Carboxylation,Sulfonation
DNA->mRNA->tRNA; Acylation,Methylation,Conjugation

Beta Islet

Glucose + Glut-2 -> TCA -> ATP
ATP -> K+ channels -> Voltage gated Ca++ channels
Ca++ & cAMP -> Insulin Vesicles -> Exocytosis

Jaundice

RES: Heme -> Bilverdin -> Bilirubin
Hepatocyte: Bilirubin -> UDP-Glucuronide -> Bilirubin-Glucuronide
Intestine: Bilirubin-Glucuronide -> Urobilinogen -> Liver/Stool/Kidney

Mevalonate Pathway

DMAPP + IPP
GPP
Squalene

Glycolysis

Fructose-1-Phosphate
Mannose-6-Phosphate
Glucose-6-Phosphate

Keto-Acids

Alpha -> 1 Carbon away -> Pyruvic Acid
Beta -> 2 Carbons away -> Acetoacetic Acid
Gamma -> 3 Carbons away -> Levulinic Acid

Delete*

Alanine
Pyruvate
Acetyl CoA

Art

DNA
Introns
Exons

TNF-alpha

+ Inflammation
- Tumorigenesis
- Viral Replication

Stress

HBA1c
Glycemia
Insulin Resistance

Insulin Resistance

Aberrant Serine & Threonine Phosphorylation
TNF
Catecholamines, Glycogen, Glucocorticoids

Insulin Receptor Substrates (IRS)

Glucose Uptake
Glycogen, Lipid, Protein Synthesis
Cell Growth & DNA Synthesis

Psychotic Depression

Dysthymia
Major Depression
Psychotic Depression

Post Partum Psychosis

Maternal Blues, 2 days
Postpartum Depression, 2 weeks
Postpartum Psychosis, 2 months

Schizophrenia

Brief Psychotic Episode, < 1 month
Schizophreniform Disorder, <6 months
Schizophrenia, +6 months

Arousal

Brain Stem
Raphe Nucleus
Serotonin

Bioethics

Autonomy
Beneficence
Non-Maleficence

Dopaminergic Systems

Mesolimbic/Mesocortical -> Behavior -> Schizophrenia
Nigrostriatal -> Movement -> Parkinsons
Tuberoinfundibular -> Hyperprolactinemia

Creativity->God->Artist->Beauty->Bayes->Tuber

Reproduction->Woman->Medium->Integritas->A Posteriori->Onion
Gestation->1 week->Resistance->Consontia->Likelihoods->Layers
Conception->Man->Idea->Claritas->A Priori->Core

Tasks

1. judgements of choice require an assessment of sums
2. averages are intuitively accessible so performance is flawed
3. inferences are biased in the direction of the average

Plaguarized Prospect Theory

perception -> sensory -> emotion -> religion -> inundation
intuition -> memory -> motion -> science -> paralysis
reasoning -> intellection -> devotion -> art -> models

Mutant Beta-Globulin

Hemolysis
Vasoocclusive Symptoms
Infections

Neurone Death

1-Day: Loss of Nissl's; 2+Days: Neutrophils; 3+Days: Macrophages
1-Week: Gliosis, Vasc Prolif ; 2-Weeks:Glial Scar ; N-Weeks: Etc.
1-Month: 1 Week. Liquefaction Necrosis; 1 Month. Cystic Area; 1 Year

Accounting for Interperson Differences

Variability (Genetic, Epigenetic & Environmental)
Uncertainty (Parameter & Decision)
Heterogeneity (Groupings)

Propiomelanocortin (POMC)

Beta-Endorphins -> Opiod System | Cushings
ACTH -> Stress Axis | Small (Oat) Cell Ca
MSH -> Cosmic Stress? :) | Pregnancy

Glial Cells

Astrocytes -> Neuroectoderm -> Matrix
Oligodendrocytes -> Neuroectoderm -> Myelination
Microglia -> Monocytes -> Phagocytosis

Renal Calculi: Pareto Distribution

Oxalate-80%
Ammonium-15%
Uric-5%

Plasma Membrane->Arachidonic Acid->Eicosanoids

COX: [PGD2/PGE2/PGF2]=vd+ed, PGI2=vd+pd, TXA2=vc+pa
5-LOX: 5-HETE/LTB4=chtx, LTC4/D4/E4=vc+bs+vp
12-LOX: LXA4/B4=vd+in.chtx+monocyte adh

Gallstone (Cholesterol Precipitation)

Cholesterol
Bile Acids
Phosphatidylcholine

Human Multidrug Resistance (MDR1) Gene

Transmembrane
ATP-dependent efflux (and influx?) pump
MDR1

ACE Inhibitors (1st line in Combined ...)

Anatomical -> Inhibit Remodeling of Damaged Myocardium
Pathological -> Prevent Deterioration of Ventricular Function
Etiological -> Reduce Blood Pressure

Anti-Metabolites (Analogues)

Folic acid: Trimethoprim, Methotrexate & Pyrimethamine
Purines:
Pyrimidines:

ARV's

ARV-1 -> Host Cell Kinase -> Nucleotide Analogue
ARV-2 -> Viral Kinase -> Host Cell Kinase
Host Cell Kinases -> Nucleotide Analogue -> DNA Polymerization

Cancer Rx in a Nutshell

Target: Nucleotides, Polymerases, Nucleases
Cell Cycle: G1-Pu/Py Sy (40%)/S-DNA Syn (39%)/G2-Proof Rd (19%)
Loner: Spindles, M-Mitosis (2%), Vinca Alkaloids (i.e. Neurotoxic!)

Trigeminal Neuralgia (Tic Douloureux)

Face
Demyelination
Posterior Cerebellar Artery Occlusion

Insulin Resistance

Fibrates, None, TZD's
PPAR-gamma
PPAR-(alpha, beta/delta, gamma): 12q12-13.1, 6p21.2-21.1, 3p25

Rx of vWD

Endothelium
vWF release
Desmopressin (DDAVP): synthetic analogue [analogue of vasopressin]

HBV associated HCC

{HBeAg + Time} - [Entecavir/LMV] = HCC

HBV Infection

ALT/AST/GGT, Albumin/Bilirubin/Estrogens
HBeAg -> HBcAg -> HBsAg
HBeAb, HBcAb, HBsAb

IL28B gene -> INF-3

A Major Factor in Host Immune Clearance of HCV
Encodes the type III interferon IFN-3
SNP (rs12979860) 3 kilobases upstream of the IL28B gene