Embryology human integrated

CONTENT

Chapter 1

CELLULAR REGULATION AND SIGNALING

Felipe Ruiz Botero, Wilmar Saldarriaga Gil,

Claudia Valencia

Introduction. . . . . . . . . . . . . . . . . . 19

Gene transcription. 20

Genes. . . . . . . . . . . . . . . . . . . . . 21

Transcription factors. 24

Helix-Loop-Helix Transcription Factors. . . . . . 25

Methylation. . . . . . . . . . . . . . . . . . 26

Other regulators. 27

Molecular induction of organ formation. . . . . . 28

Cell signaling. . 28

Paracrine signaling factors . . . . . . . . . . . . 30

Other paracrine molecules. . . . . . . . . . . . 31

Chapter 2

SPERMATOGENESIS

Felipe Ruiz Botero, Wilmar Saldarriaga Gil

Introduction . . 35

Anatomy. . 35

Sertoli cells. . 38

Leydig cells. 40

Testosterone synthesis. . . . . . . . . . . . . . 41

Spermatogenesis. 41

Spermiogenesis. . . . . . . . . . . . . . . . . 44

Medical integration . . . . . . . . . . . . . . . 46

Spermatozoon. . . . . . . . . . . . . . . . . 47

Accessory glands. . . . . . . . . . . . . . . . 48

Seminal vesicles. . 48

Prostate. . . . . . . . . . . . . . . . . . . . 48

Bulbourethral glands. 48

Annex. . 50

Chapter 3

FEMALE MENSTRUAL CYCLE

Wilmar Saldarriaga Gil, Claudia Valencia Peña

Hormonal cycle. . 52

Ovarian cycle. . 56

Folliculogenesis. . 56

Recruitment, selection and dominance. . . . . . . 59

Follicular rupture. . . . . . . . . . . . . . . . 63

Oogenesis and ovum. . . . . . . . . . . . . . . 64

Corpus luteum. . . . . . . . . . . . . . . . . 68

Endometrial cycle. . . . . . . . . . . . . . . . 70

Proliferative phase. . . . . . . . . . . . . . . . 70

Secretory phase. . . . . . . . . . . . . . . . . 73

Menstrual phase. . . . . . . . . . . . . . . . . 75

Integration into obstetrics. . . . . . . . . . . . 76

Chapter 4

FERTILIZATION

Wilmar Saldarriaga Gil, Julián Andrés Ramírez Cheyne

Attraction of the sperm. . . . . . . . . . . . . . 82

Gametes in mammals. . . . . . . . . . . . . . 82

Displacement and capacitation. . . . . . . . . . 84

Hyperactivation and chemotaxis. . . . . . . . . . 85

Gametes union and recognition in mammals . . . . 87

Induction of mammals acrosomal reaction by

ZP glycoproteins. . . . . . . . . . . . . . . . 88

Passage through zona pellucida. . . . . . . . . . 89

Cell membrane fusion of the ovum and sperm. . . . 89

Prevention of polyspermy. . . . . . . . . . . . . 90

Calcium as a initiator of the cortical granules

reaction. . . . . . . . . . . . . . . . . . . . . . 95

Activation of the zygote metabolism. . . . . . . . . . 95

Early responses. . . . . . . . . . . . . . . . . . . 98

Late responses. . . . . . . . . . . . . . . . . . . 99

Fusion of the genetic material in mammals and rearrangement of the cytoplasm of the ovum. . . . . . 99

Chapter 5

FIRST AND SECOND WEEKS OF HUMAN DEVELOPMENT

Wilmar Saldarriaga Gil, Julián Andrés Ramírez Cheyne

Cleavage. . . . . . . . . . . . . . . . . . . .105

Blatocyst formation. . . . . . . . . . . . . . 108

Integration into obstetrics. . . . . . . . . . . 108

Day 8. . . . . . . . . . . . . . . . . . . . 109

Days 9 and 10 . . . . . . . . . . . . . . . . 110

Days 11 and 12. . . . . . . . . . . . . . . . 111

Days 13 and 14. . . . . . . . . . . . . . . . 114

Integration into obstetrics. . . . . . . . . . . 114

Chapter 6

IMPLANTATION. . . . . . . . . . . . . . . . .117

Wilmar Saldarriaga Gil

Preparation of the conceptus . . . . . . . . . . 118

Preparation of the endometrium. . . . . . . . . .118

Apposition, adhesion and invasion. . . . . . . . .119

Immunology of implantation. . . . . . . . . . 121

Hormonal and paracrine regulation of implantation.122

Integration to obstetrics. . . . . . . . . . . . 124

Insufficiency of the corpus luteum. . . . . . . . .126

Chapter 7

THIRD WEEK OF HUMAN DEVELOPMENT. . . .129

Wilmar Saldarriaga Gil, Laura Camila Molina Barrera, Carolina Isaza de Lourido

Notochord formation. . . . . . . . . . . . . 134

Establishment of the axis of the body. . . . . . . .138

Cell migration during gastrulation. . . . . . . . .141

Embryonic disc development. . . . . . . . . . 143

Chorionic villi formation. . . . . . . . . . . . .143

Chapter 8

FOURTH WEEK OF DEVELOPMENT

Wilmar Saldarriaga Gil, Laura Camila Molina Barrera, Carolina Isaza de Lourido

Embryonic folding. . . . . . . . . . . . . . . .150

Sagittal plane folding: cephalic and caudal folds . . .150

Cephalic folding. . . . . . . . . . . . . . . . .152

Caudal folding. . . . . . . . . . . . . . . . 154

Transverse folding. . . . . . . . . . . . . . . .156

Neurulation. . . . . . . . . . . . . . . . . 158

Integration to neural tube defects, skull and spine. 162

Molecular regulation of the neural induction integration . . . . . . . . . . . . . . . . . . .165

Neural crest formation. . . . . . . . . . . . . .166

Neurocristophaties. . . . . . . . . . . . . . .169

Mesoderm germ layer derivates. . . . . . . . . 170

Paraxial mesoderm: somites. . . . . . . . . . . .170

Molecular regulation of the somites formation integration. . . . . . . . . . . . . . . . . . .172

Somite differentiation . . . . . . . . . . . . . 172

Molecular regulation of somite differentiation

integration. . . . . . . . . . . . . . . . . . .175

Intermediate mesoderm: urogenital system. . . . 176

Lateral plate mesoderm: somatic and splanchnic. . .176

The heart starts beating. . . . . . . . . . . . . .178

Integration with the molecular induction of

blood vessels. . . . . . . . . . . . . . . . . 178

Pharyngeal arches. . . . . . . . . . . . . . . .180

Development of the endomermic germ layer. . . . .182

Integration with the molecular induction of the endoderm. . . . . . . . . . . . . . . . . . 184

Congenital defects of the endodermic derivates integration . . . . . . . . . . . . . . . . . . .184

Aspect of the embryo on the fourth week. . . . . .184

Chapter 9

FIFTH TO THE EIGHTH WEEK OF DEVELOPMENT

Wilmar Saldarriaga Gil, Julián Andrés Ramírez Cheyne, Claudia Valencia Peña

Fifth week of development. . . . . . . . . . . 189

Sixth week of development. . . . . . . . . . . 190

Seventh week of development. . . . . . . . . . .192

Eight week of development. . . . . . . . . . . 193

Ultrasound scopes in the embryonic period until the last day of the eight week by conception date. . . . .196

Chapter 10

FETAL AND NEONATAL PHYSIOLOGY

Wilmar Saldarriaga Gil, Carolina Isaza de Lourido,

Julián Andres Ramirez Cheyne

Biology of fetal growth . . . . . . . . . . . . . .201

Fetal growth is determined by primary genetic and epigenetic factors . . . . . . . . . . . . . . . .202

Placental growth occurs in periods of fast

fetal growth. . . . . . . . . . . . . . . . . . .203

Insulin, insulin like growth factors and thyroxine stimulate fetal growth. . . . . . . . . . . . . 204

Insulin like growth factors. . . . . . . . . . . 205

Epidermal growth factor (EGF). . . . . . . . . 205

Thyroid hormones. . . . . . . . . . . . . . . .206

Peptide hormones. . . . . . . . . . . . . . . .206

Growth restriction . . . . . . . . . . . . . . 206

Development and maturation of the

respiratory system. . . . . . . . . . . . . . . .209

Neonatal respiratory distress syndrome . . . . . .212

Fetal respiratory movements . . . . . . . . . . 213

Fetal circulation . . . . . . . . . . . . . . . 213

Placenta . . . . . . . . . . . . . . . . . . . .214

Ductus venosus. . . . . . . . . . . . . . . . .214

Foramen ovale . . . . . . . . . . . . . . . . 214

Ductus arteriosus . . . . . . . . . . . . . . . .216

Fetal asphyxia . . . . . . . . . . . . . . . . 216

Respiratory adaptations at birth . . . . . . . . . .217

Elimination of the placental circulation. . . . . . .218

Neonatal physiology . . . . . . . . . . . . . . .219

The newborn mobilizes glucose and fatty acids

shortly after birth. . . . . . . . . . . . . . . 219

Chapter 11

PLACENTA AND FETAL MEMBRANES

Wilmar Saldarriaga Gil, Julián Andres Ramirez Cheyne

Placenta . . . . . . . . . . . . . . . . . . . .223

Obstetrics correlation. . . . . . . . . . . . . 230

Placental Structure . . . . . . . . . . . . . . 230

Full term placenta . . . . . . . . . . . . . . . .232

Placental circulation . . . . . . . . . . . . . . .232

Fetal placental circulation . . . . . . . . . . . 232

Maternal placental circulation . . . . . . . . . 233

Placental membrane. . . . . . . . . . . . . . .234

Roles of the placenta . . . . . . . . . . . . . . .234

Umbilical cord . . . . . . . . . . . . . . . . 238

Amnion. . . . . . . . . . . . . . . . . . . 238

Amniotic fluid. . . . . . . . . . . . . . . . 239

Yolk sac. . . . . . . . . . . . . . . . . . . 241

Multiple pregnancy. . . . . . . . . . . . . . 241

Twins and fetal membranes. . . . . . . . . . . .241

Monozygotic twins. . . . . . . . . . . . . . 242

Dizygotic twins. . . . . . . . . . . . . . . . 243

Integration into obstetrics. . . . . . . . . . . 245

Chapter 12

CONGENITAL ANOMALIES

Julián Andres Ramirez Cheyne, Carolina Isaza,

Wilmar Saldarriaga Gil

Classification of congenital anomalies. . . . . . 248

Chapter 13

PRENATAL DIAGNOSIS AND CONSIDERATIONS ON THE NEWBORN AND PEDIATRIC PATIENT WITH CONGENITAL ANOMALIES

Julián Ramírez Cheyne, Carolina Isaza,

Wilmar Saldarriaga

Prenatal diagnosis . . . . . . . . . . . . . . . .255

Pregnancy classification according to the risk of congenital anomalies . . . . . . . . . . . . . 256

Screening for congenital anomalies and

chromosome abnormalities.. . . . . . . . . . . .257

High risk patients. . . . . . . . . . . . . . . 260

Invasive procedures. . . . . . . . . . . . . . 261

Newborn and pediatric patient with congenital anomalies: A clinical approach. . . . . . . . . 263

Anamnesis. . . . . . . . . . . . . . . . . . .263

Physical examination. . . . . . . . . . . . . . .263

Interpretation of findings. . . . . . . . . . . . .264

GLOSSARY. . . . . . . . . . . . . . . . . . . .269

INDEX. . . . . . . . . . . . . . . . . . . . . .281