MARIAN DIAMOND: Good morning.
How is everybody this morning?
Lots of smiley faces, I see.
You slept well, did you?
Sort of.
I thought I'd review
just a little bit
about osteoarthritis,
because it's
so common that you should be--
you have it.
Yeah, so one in
the front row has.
Osteoarthritis.
Let me get my white chalk.
I was doing blue
and gold for you,
but I think I'll go back to--
Versus rheumatoid arthritis.
We said this is most common.
And we have destruction of
the articular cartilage here.
And it is triggered initially
by trauma or by injury--
they are the same
thing, but some people
aren't familiar with
the term trauma.
Traumatize, trauma,
or injury induces.
And I wanted to make that
clear because we learned
that with rheumatoid
arthritis, this is
the fault in the immune system.
And it's caused by emotional
stress quite different
from trauma, different system.
And this one then
starts with inflammation
of the synovial fluid--
synovial membrane.
Synovial membrane, which causes
an increase in synovial fluid.
So that's where we
get the swelling.
And here with the destruction
of our articular cartilage,
we get extreme pain
and immobility.
And the same goes for
the rheumatoid arthritis.
There is a reduction in the
viscosity of the synovial fluid
in osteoarthritis.
Reduction in viscosity
of synovial fluid here.
What's viscosity?
It's the stickiness
of the fluid.
But I wanted to
make those clear,
because we were
building up to that
as you were learning
your joints before we
continue on with our
next subject, which
will be cartilage.
We've dealt with-- does
everybody have this?
Nobody said anything
so I'll take it.
So that's-- look at cartilage.
Oh, let's look at
osteoporosis first.
One more with bone degeneration.
Osteoporosis.
Osteoporosis.
So this is loss of bone mass .
It's more frequent
in females and males.
More frequent in
females than males.
And it's more frequent
in whites that in blacks.
Now you can begin
to think why we
should have those differences.
How do we prevent it?
What's number one?
Pardon?
STUDENT: Calcium.
MARIAN DIAMOND: Calcium
is important, yes.
Prevent with calcium
and exercise.
We're just going to--
by the time we finish
with this course,
we're all going to be
convinced that we all need
an hour of exercise every day.
Good exercise to keep it right.
STUDENT: Right.
MARIAN DIAMOND: Good.
All right, osteoporosis.
Let's go on now to cartilage.
You could have much more if
you want, but basic one hour.
All right, cartilage.
We have shown that bone is a
connective tissue with cells,
and fibers, and a
calcified matrix,
and lots of blood vessels.
Now when we look at cartilage.
Cartilage is a connective
tissue with cells,
with fibers, but with
a firm, pliable matrix.
Firm, pliable matrix.
What did we say about
its blood vessels?
No blood vessels.
So how does it
get its nutrients?
By diffusion.
So what we want to
look at first here
to get an idea of the
kinds of fibers that will
be in the cartilage matrix--
got this?
No.
We have a matrix.
We saw that the matrix for
bone was a hydroxyapatite.
What is your matrix
for cartilage?
It's a glycosaminoglycans.
See you can see a sugar,
protein, sugar compound.
And it can have
fibers, several fibers.
One type will be call to action
fibers, collagenous fibers.
They have the protein
collagen. Protein collagen.
Collagen is exceedingly strong.
These fibers are strong.
In fact, it's been
reported that they're
as strong as a steel fiber
the same dimension, stronger.
Strong or stronger than a
steel fiber of same dimension.
They also have a cross linking
what helps with their strength.
So these fibers,
collagenous fibers,
are embedded in the matrix,
but we have elastic fibers
in some matrices.
They have a protein elastin.
Protein elastin.
So we can see that it
can stretch and recoil
different from our
collagenous fibers.
Stretch and recoil.
So with these
basic constituents,
let's look at different
kinds of cartilage.
Kinds and locations.
One we've already mentioned--
hyaline cartilage.
Hyaline.
And it will have a
glassy, shiny appearance.
You've all seen it if you've
looked in the butcher shop
when they have joints
in there for soup bones,
and you see that white
shiny substances they
show the breakage of the bone.
That's hyaline cartilage,
because you saw it.
Now, where do we find it?
Location.
Well, we've given the
articular surface of the joint.
Our costal cartilage, which
are attaching our ribs
to the sternum, that's
hyaline cartilage.
Whoops-- sorry,
costal cartilage.
Costal-- thinking
the next thing.
Costal cartilage-- no,
yes, that's what I want.
Costal cartilage.
All right, we have the
embryonic skeleton.
Your skeleton was once
all hyaline cartilage.
Embryonic skeleton.
And then our respiratory system.
It's important that our
respiratory system stays
open at all times, so
you need the difference
between your nose
and your mouth.
You can close your mouth,
who can close its nose
without using your fingers?
You need hyaline cartilage
to keep that open
for you to survive.
So we're going to
see hyaline cartilage
in the respiratory system.
We'll put the names
here, but we'll
discuss them in detail when
we have the respiratory system
later.
So under respiratory
system, then we'd
have the nose hyaline
cartilage to give support.
As we go back, we'll have
the larynx, the trachea--
these are all part of getting
the air down to your lungs--
the bronchi.
All of these are held
open by hyaline cartilage.
That gives examples of
where they're found.
The next cartilage then
would be elastic cartilage.
So the matrix will
have elastic fibers.
Where are we going to
find elastic cartilage?
Why do we need a different kind?
So location--
what's an easy one?
STUDENT: Epiglottis.
MARIAN DIAMOND: That's
not an easy one,
you can't touch your epiglottis.
STUDENT: Outer ear.
MARIAN DIAMOND: Outer ear, sure.
Wrinkle up your ear.
Wrinkle it up.
See what happens
when you let go.
Fortunately, it goes back
in shape, doesn't it?
Did it?
That's because you have
elastic fibers there.
So the external ear
has elastic cartilage.
The Eustachian tube
has elastic cartilage.
The Eustachian tube--
you have to wait
until I get through that
sentence so I can go on,
but I know you're eager,
so if that's fine.
What is a Eustachian tube?
It connects your nasal pharynx.
You say, where in the world
is your nasal pharynx?
We'll learn about
it when we learn
that the passage way for
air, but right now, it's
going to be a name.
It's posterior to
your nasal cavity.
So if you go inside your nose,
nasal cavity, back further
is the nasal pharynx.
So the Eustachian tube connects
the nasal pharynx with what?
Why do you yawn when
you're landing on a plane?
To equalize pressure.
What are you trying to
equalize pressure on?
Your tympanic
membrane, your eardrum.
But to get that
air in there, you
have to get into the middle ear.
So that Eustachian tube is
connecting the nasal pharynx
with the middle ear, and learn
about it more as we go on,
but putting it
together where you're
going to find elastic
cartilage to make this tube.
And the next one, somebody
mentioned moment ago
is the epiglottis.
The epiglottis.
Have you ever heard
of epiglottis?
What does epi mean?
Upon, good.
You're going to run into
that root lots of times.
So it's going to be
upon the vocal chords.
With your vocal
chords, air has to pass
through these membranes.
And that area between
those membranes
is called the glottis.
So I'm just going to give it
to you, now we'll get it later,
but the glottis is the
opening between vocal chords.
For me to be
talking now, air has
to pass through my vocal chords.
And this epiglottis,
and just a quick sketch,
is, again, elastic cartilage.
Now if this is my
larynx, and down here I
have folds of membrane,
which are my vocal cords,
this is ultra simple, but
I'll have this sort of leaf
of elastic cartilage here.
This is the epiglottis's.
So when you have food in your
mouth, and it's coming down,
and it wants to get over
here into your esophagus,
you don't want it to come
down into your windpipe,
or larynx, so the epiglottis
comes down as a lid,
and that forces the food to
go down into the esophagus.
So epiglottis in
a very simple way.
Now, how are you going
to remember these?
Elastic cartilage
begins with what?
An e.
External ear begins with what?
Eustachian tube begins with?
We are learning.
And our epiglottis?
This is one thing students never
forget are the three places
for elastic cartilage, right?
What's the third
type of cartilage?
You've had it.
STUDENT: Fibrocartilage.
MARIAN DIAMOND: Fibrocartilage.
Yes, thank you.
Some are learning to speak.
Fibrocartilage is
our third type,
and we've reviewed this at
least three times before.
So we know that we have
lots gelatinous fibers
in the matrix of
fibrocartilage, thus its name.
And where do we find it?
What are our examples?
Gave you two of them.
Intervertebral disc and-- you
didn't say it loud enough.
STUDENT: Pubic symphonies.
MARIAN DIAMOND: Pubic
symphonies, certainly.
Intervertebral discs
and the pubic symphysis.
What does synthesis mean?
You don't remember.
What's it doing?
Bringing together.
It's together where the two
pubic bones come together.
All right, that gives you an
introduction to cartilage.
But as you get older,
and you begin to lose it,
you'll appreciate
your cartilage.
So now, how did your bones
change from when you were born
and you're nothing more
than a foot and a half long?
And where are you now?
5' 10", or 5' 8", or 5' 4".
What allowed your bones
to make you grow that way?
Terribly important process.
Has anybody had the
process in other classes,
the formation of bones?
Well, I think it's
you should have it
because it is very
important and you just
take it for granted you have all
this architectural change going
on inside you, and you
pay no attention to it.
So we just want bone formation.
There are two types.
One, intramembranous.
Intramembranous.
And intra, just as
the name implies,
it develops in the connective
tissue membrane in the embryo.
Develops in the CT
membrane and embryo.
And what do we call this
embryonic connective tissue?
Mesenchyme.
Mesenchyme.
Mesenchyme.
That's embryonic CT.
So this method of bone
formation is evolutionarily new.
So, what bone do you think
are the last to develop
because the structure
in it is relatively
new within our evolution?
Cerebral cortex, right?
So the bones of the calvarium
develop in connective tissue.
So our example here
would be the calvarium.
Then the other type
of bone formation
is called endocondral.
What is the-- where is
the root for condral?
What does it mean?
STUDENT: Cartilage.
MARIAN DIAMOND: Cartilage, yes.
So this is our other
form of bone formation.
Endocondral bone formation.
So cartilage, with
this type, we first
have a complete cartilage
model of your skeleton.
You have a cartilage
model cytoskeleton.
And you have to remove
that cartilage model
to lay down bone.
So remove cartilage
model to lay down bone.
So, is has bone formed
by calcifying cartilage?
No.
And yet, almost every
advertisement you see
tells you that bone is
calcified cartilage.
I want all 700 of you to know
definitely that bone is not
calcified cartilage.
You've gotten rid
of the cartilage,
and you lay down bone.
Very important.
It's amazing how the
advertisers never pick that up.
So we've got to see how
this is going to happen.
So we want to see
some cartilage model.
We can just take any
model, but we'll start.
This will represent
our cartilage model.
What kind of cartilage is it?
STUDENT: Hyaline.
MARIAN DIAMOND: Hyaline.
Process of elimination.
You know it's not
going to be elastic,
and you know it's not fibro.
Everything else is hyaline.
So a lot of learning is
process of elimination.
So this is our cartilage model.
And in our cartilage
model, we're
going to have what are
called ossification centers.
Centers where bone is
going to start forming.
Ossification centers.
And we'll mark those with an
X. We're going to put one here,
one here, and one here.
So these are
ossification centers
where we're going to remove
the cartilage first and start
laying down bone.
It's very systematic,
because you
don't want to remove
cartilage haphazardly
or your model will
collapse, and you
won't have any structure
to the developing embryo.
So we call the end of our
cartilage model, the epiphysis.
This epiphysis.
This is an epiphysis.
Who knows what we call
the shaft of the bone?
STUDENT: Diaphysis.
MARIAN DIAMOND: The
diaphysis, right.
Diaphysis.
So we'll have first
then the breakdown
of cartilage in our
ossification centers,
and then lay down bone.
So you'll have a
process that's going on
from here, for example.
We'll break down
the cartilage, bone
is formed, break down more
cartilage, more bone, more
bone, and so forth.
So we're going in
this direction here.
And what we'll see
then is that you'll
have two parts of your bone
that will retain cartilage.
Two areas retain
hyaline cartilage.
We're not going to
remove the whole model.
Who can tell me what one of
them that you have in your body
right now?
Where is your hyaline
cartilage in your bone?
Sure, the joint.
The articular cartilage.
That's hyaline cartilage,
that's retained.
So, articular cartilage.
So we can put it on,
once this is becoming
a model, a bone, all
of that, we're going
to retain hyaline cartilage.
Now whereas the other place
that we have hyaline cartilage?
What's called the epiphyseal
ACL disk epiphyseal disc.
Epiphyseal disc.
And where it?
It's going to be right in
here between the epiphysis
and the diaphysis.
We will retain hyaline
cartilage there for a time.
Why is the epiphyseal
disc so important?
Because this is where the
growth of your long bones
is occurring.
This is where growth
of long bones occurs.
Now, how does that happen?
We have this little model here.
It's now born except
for the cartilage.
So to grow in this direction
or in this direction,
we're going to remove
cartilage on this side
and add cartilage on this side.
So we'll move up.
We can do it--
--simply this way.
Just take the disc out.
So here we have a disc.
And we're going to be
removing, the cartilage
is regenerating on this side.
But on this side, it's dividing.
So removed here, increased here.
So our disc retains
its dimension,
but it's moving up like this.
You get the principle
how it keeps it own?
The disc stays the same width.
Very important principle
for you to understand
the growth of bones.
But in late teens, you stop
increasing the dimension
and you just remove.
So late teens, early 20s, no
new little cartilage formed,
only destroyed.
So you'll have the
diaphysis will just
meet with the epiphysis,
and there's no disc left.
So the bone growth has stopped.
The literature says
somewhere for girls
it stops about 18 years of age,
and for boys stops about 20.
But we know with different
bones stop at different times,
but that's sort of a general
average as to where this stops.
But it gives the
process and you can
see how vulnerable these areas
are to us when we're growing.
What happens how--
we don't even care.
You do all these
crazy things and see
what would happen if you
disrupted epiphyseal disc,
but that didn't
happen in any of you.
You just went right along right.
So it's a very important
part of your body.
Now let's look at the
structural and functional unit
of our compact bone.
Bone is dynamic as you can see.
Structural and functional
unit of compact bone.
So let's just take to
start with to build up,
what we mean by compact bone.
Here's our bone now.
And compact bone is
found on the outside.
Compact matrix are
all close together.
So this equals compact bone.
And inside, we have
bone with lots of spaces
in between called spongy bone.
It's really aligned
very beautifully
with force stresses.
When the infant begins
to walk, these line up
to give the best resistance.
So internally, we
have spongy bone.
What is between the bone here?
Use the correct term.
What kind of tissue?
Pardon?
No.
We can wait.
There was a lady at
Stanford who did a study
on why students don't answer.
We don't wait long enough.
So I can wait here.
I've given it to you.
What's inside your bones?
What's happening?
Sure, but what do we call
it tissue scientifically?
We gave you the name.
What kind of tissue?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND:
You're getting there.
You've got half the word.
Hemopoietic tissue, right.
Do you remember it?
Hemopoietic tissue.
It's important we
repeat, repeat, repeat.
Maybe we should
just say it once,
and maybe you'd remember it.
Hemopoietic tissue,
what is it doing?
STUDENT: Making blood.
MARIAN DIAMOND: It's
making blood cells, yes.
Blood cell production.
Remember we talked about where
you could get bone marrow.
Somebody asked me that Sunday.
They were going to have to give
bone marrow transplant, where
I did take it.
I said, you want to
take it in the sternum,
you want to take it in
the crest of your ileum.
Crest of your ileum, there
was no doubt in their minds.
So this is the basic structure.
What we're building up here
is to what is compact bone,
because we're going to look at
the structural and functional
unit of compact bone.
So what we want to do just
to give the principle of how
the blood supply is
coming in, my staff
has brought us all this
beautiful new chalk,
so we have such choices today.
It's wonderful.
So we have a blood
vessel coming in.
It's going to enter
the compact bone
and then parallel the surface.
This is absolutely simplistic,
but this is roughly
what we want to illustrate.
We brought in here
a blood vessel.
And it runs parallel to surface.
So I'm going to
take a cross section
through my compact bone.
I want to show you the
structural unit then
of our compact long.
(SNEEZING) Blessings.
So this is our cross
section, so we're
going to see a blood vessel.
We've taken it in cross section.
Cross section of compact bone.
And we're going to be
developing a haversian system.
Haversian system.
Your compact bone has
millions of haversian systems.
Millions in shaft of bone.
We're taking one as a
structural and functional unit,
and we're first going to see a
haversian canal with an artery.
Haversian canal.
It actually has an
artery and nerves.
And surrounding it, then,
will be these concentric rings
of compact bone.
These are concentric
rings of bone.
What do they call them?
Lamellae.
Lamellae.
No, you tried.
I appreciate it.
You had the spelling.
Lamellae.
And within this lamellae
will be a little cavities.
Look like little lakes
to early anatomists--
just put in a few.
These are lacunae.
Lacunae.
And lacunae have what inside?
STUDENT: Osteocytes.
MARIAN DIAMOND: Osteocytes.
Good for you.
Osteocytes.
So this is where we have
our bone maintaining cells.
The osteocytes are in
here in the lacunae.
Thank you.
So we've put osteocytes here.
They're going to
maintain the bone.
And then we have to
get nutrients to them,
so we have to have little canals
through the lamellae of bone
to reach these lacunae.
These are canals for blood.
What do you call them so you
don't have to say little canal?
Canaliculi.
Canaliculi.
Canaliculi.
So that gives you what we
call a haversian system.
As I said, there are millions
of these in your compact bones.
And you'll have a vessel
coming through perpendicular
to the surface is a
blood vessel, in what's
called a Volkmann's canal.
I've seen that on boards, so
I know it's important for you.
And it's bringing the blood
into your haversian systems.
Let's look at slides.
Didn't he dim the lights?
Yes.
I'll wait for you.
First slide, please.
All right.
This is cartilage.
This is hyaline cartilage
with the cells in the matrix.
This is part of, your
respiratory system.
You'll learn to identify it.
Next one.
Next one, please?
Next one.
What kind of cartilage
do you think this is?
Look at all the fibers.
This is the elastic cartilage.
You can stain and
pick up the fibers.
What's the next one?
And this is fibrocartilage
in a intervertebral joint.
Look at this.
Isn't that beautiful section?
Next one.
Next one.
I know we're late.
Here's our compact bone, cross
section, and the spongy bone,
but you can see how
the bone aligns up
to give maximum strength
as one begins to walk.
And the next one.
And this will show some
epiphyseal discs here.
So this is a hand of a
three-year-old child.
Ossification is in progress.
It's an X-ray of the hand.
These haven't even
begun down here,
but it shows your
epiphyseal plates.
They're active in your phalanges
and in your metacarpels.
And the next one.
And this is a section of a
cartilage model in the embryo.
The cartilage is beginning
to dissolve in the middle.
It's pretty stable here, but
this is the ossification center
in the center of the diaphysis.
And the next one.
And now you can see that
cartilage is left here.
It's all dissolved out.
Bone is being formed,
the dark blue.
This is cartilage that is
beginning to disintegrate.
This is healthy
cartilage, so the process
is moving up here, moving
up here from the center
of the diaphysis.
And the next one.
Real activity forming at
the ossification center
in the middle of the diaphysis.
Lots of bone coming in.
Next one.
And these then are what we
call spicules or trabeculae
of bone in the spongy bone.
So we've got lots of
marrow forming, cells here.
But the ones I
wanted to show you
we didn't get to
that we'll mention
next time our osteoclasts.
We have osteoblasts,
which lay the bone down.
We osteocytes, which
maintain the bone.
And we have osteoclasts,
which destroy the bone.
So every time you
need some calcium,
they'll come and dissolve
the bone and release calcium.
You get too much calcium out
there, more bone is laid down.
Constantly your bones
are being remodeled.
Osteoclasts are a product
of white blood cells.
There are macrophages.
Big eaters.
They eat the bone.
Next one.
And here's another
enlargement of an osteoclasts.
Do you know what
hormone activates it?
parathormone.
We'll get that later.
When you need more
calcium out in the blood
for your muscles
and your nerves,
osteoclasts release it
from the bone next one.
And this shows you're
epiphyseal discs.
See how clear it is?
Your ossification center going
on up here in the epiphysis.
It's cleared out, your
whole marrow cavity here.
But this will retain
dividing on this side,
dissolving on this side.
So that disc remains
the same dimension.
As it moves up, it's got to go
feed to make your long bones.
Next one.
And this is a beautiful slide.
This was done here
way back in the '40s.
Here's the epiphyseal
disc, epiphysis, here's
the patella showing
the knee joint.
Just beautiful.
I've never seen one in any
collection as good as that.
And the next one.
And this shows your
haversian systems.
Here you have the lamellae.
Here you have the
lacunae the astrocyte.
Here's the artery
going up and down.
And here's a Volkmann's
canal coming in perpendicular
to the surface.
Volkmann's canal feeds
into the artery that
is within the haversian canal.
Lamellae, lacunae.
But see, you have
millions of, these
and they're in different stages
because some of the osteoclasts
have destroyed them.
It's that a beautiful.
That's what you look like
inside the shaft of your bones.
And the next one.
And that's a favorite.
That was done here.
I've never seen a
replication of this.
Here's your haversian canal.
Here are your lacunae.
But see, they're empty here.
That's why they thought
they're little legs.
Because when you
do the preparation,
the cell falls out.
Here you are a little
canalicui, [INAUDIBLE],,
bringing nutrients from the
center out to the bony cells.
But that's going on
down in your tibia now,
in your fibula, any bone you
mentioned of a long bone.
And the next one.
That's it.
