diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4clLpYzRVWg_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4clLpYzRVWg_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..c28edfbda4505f8b7c0a2f06308b5035da0762c9
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4clLpYzRVWg_postprocess.srt
@@ -0,0 +1,1836 @@
+1
+00:00:08,590 --> 00:00:10,190
+الطب والعافية و المنافسة
+
+2
+00:00:12,870 --> 00:00:20,930
+المرة الماضى اتكلمنا مقدمة حول علاقة ال tomb
+
+3
+00:00:20,930 --> 00:00:24,270
+hardness المختلفة بعضها البعض و كيف ممكن ال fluids
+
+4
+00:00:24,270 --> 00:00:29,230
+ينتخب من مكان الى مكان و الشروط اللى بتصير اليوم
+
+5
+00:00:29,230 --> 00:00:33,330
+مادام اتكلمنا عن ال osmotic pressure و ال
+
+6
+00:00:33,330 --> 00:00:36,470
+osmolality و ال osmolarity و كيف هو الدور الرئيسي
+
+7
+00:00:36,470 --> 00:00:40,910
+لانتقال ال fluids و ال water من مكان الى مكان
+
+8
+00:00:41,920 --> 00:00:49,100
+خلّينا نشوف كيف هذه المسائل نتعامل معها تعريفاتها
+
+9
+00:00:49,100 --> 00:00:52,660
+و قضايا الحسابية تبعتها اعتقد انه خدتوا في توجيه
+
+10
+00:00:52,660 --> 00:00:57,640
+انتوا اشي من هالنوع و زمولارتي جبت نحسبهم هتكون
+
+11
+00:00:57,640 --> 00:01:01,420
+سهلة ان شاء الله هي معقدة شوية لإنها حسابات رياضية
+
+12
+00:01:01,420 --> 00:01:07,140
+و بعرف الدكاتر محبوش الحسابات لكن خلّينا ن .. نبصر
+
+13
+00:01:07,140 --> 00:01:12,360
+في الأموربداية هنتكلم على ال osmosis what is
+
+14
+00:01:12,360 --> 00:01:17,380
+osmosis؟ osmosis is the net diffusion of water
+
+15
+00:01:17,380 --> 00:01:21,680
+across a selectively permeable membrane from a
+
+16
+00:01:21,680 --> 00:01:27,280
+region of highwater concentration to region of low
+
+17
+00:01:27,280 --> 00:01:33,180
+water concentration همم؟ اذا هنا ال water بيطبق ال
+
+18
+00:01:33,180 --> 00:01:40,900
+physical laws of diffusion عبر ال .. across the a
+
+19
+00:01:40,900 --> 00:01:46,740
+concentration gradientبمعنى اخر انه عندنا الميه
+
+20
+00:01:46,740 --> 00:01:52,920
+الاكثر تركيزا يعني الاقل solute تركيزا والميه
+
+21
+00:01:52,920 --> 00:02:00,540
+الاقل water concentration اذا بتكون more water
+
+22
+00:02:00,540 --> 00:02:05,760
+concentration طيب اذا متكلم عن انتقال الميه من
+
+23
+00:02:05,760 --> 00:02:06,820
+مكان with high
+
+24
+00:02:09,970 --> 00:02:16,190
+water concentration يعني low solute concentration
+
+25
+00:02:16,190 --> 00:02:20,190
+إلى higher solute concentration ال solute
+
+26
+00:02:20,190 --> 00:02:24,830
+concentration هذا كلمة
+
+27
+00:02:24,830 --> 00:02:33,930
+عامة بدنا نعرفها و نعرف كيف نتعامل معاها طيب
+
+28
+00:02:36,160 --> 00:02:40,300
+وشروط ال osmolality او ال osmosis عرفناه و the
+
+29
+00:02:40,300 --> 00:02:44,400
+rate of osmosis the rate of diffusion per a per
+
+30
+00:02:44,400 --> 00:02:49,100
+time unit تمام لذا the rate of diffusion of water
+
+31
+00:02:49,100 --> 00:02:53,570
+is called the rate of osmosisrelation between
+
+32
+00:02:53,570 --> 00:03:01,550
+moles and osmoles عشان نعرف هال
+
+33
+00:03:01,550 --> 00:03:06,570
+concentration of solutes في داخل الميه اللي من
+
+34
+00:03:06,570 --> 00:03:13,480
+خلالهابتتحكم حركة ال fluids من داخل الخلية إلى
+
+35
+00:03:13,480 --> 00:03:19,160
+الخريشة أو بالعكس إذا نحتاج إلى تعريف التعريفات
+
+36
+00:03:19,160 --> 00:03:26,250
+ساعدنا في الموضوع التعريف الأول أنهقولنا هناك حاجة
+
+37
+00:03:26,250 --> 00:03:30,850
+تسمى osmols osmols تعبّر عن osmolarity أو الـ
+
+38
+00:03:30,850 --> 00:03:36,290
+osmotic pressure بعد فترة هنتقل التعريف لهذا وال
+
+39
+00:03:36,290 --> 00:03:44,870
+Osmols تساوي وجود particles of one mole وعشان نكون
+
+40
+00:03:44,870 --> 00:03:51,130
+دقيقين إذا كان هذا ال substance monovalent إذا
+
+41
+00:03:51,130 --> 00:03:59,190
+كانت مكوّنةمن عنصر واحد او تتحلل بشكل اديني ايه
+
+42
+00:03:59,190 --> 00:04:03,830
+one type one .. one .. one particles each mole
+
+43
+00:04:03,830 --> 00:04:10,590
+gives just .. each substance give one molecule the
+
+44
+00:04:10,590 --> 00:04:14,770
+molecule will stay as it is molecule زي ما نقولوا
+
+45
+00:04:14,770 --> 00:04:20,670
+glucose بيضل glucose moleculesإذا لما يكون في عندي
+
+46
+00:04:20,670 --> 00:04:26,270
+انا one mole of glucose مايكون عندي one oz mole of
+
+47
+00:04:26,270 --> 00:04:31,830
+glucose، تمام؟ فقولنا إذا خياساتنا إذا كان عندي
+
+48
+00:04:31,830 --> 00:04:37,520
+انا one mole of glucose in one liter of waterبنقول
+
+49
+00:04:37,520 --> 00:04:43,160
+عندنا one osmole of glucose in one liter of ايه؟
+
+50
+00:04:43,160 --> 00:04:46,780
+of water لكن لو كان عندنا sodium chloride مثلا
+
+51
+00:04:46,780 --> 00:04:53,660
+هنلاقي انه كل one molecule بتديني two active ions
+
+52
+00:04:53,660 --> 00:04:57,260
+اذا بتديني two active osmotically active particles
+
+53
+00:04:57,260 --> 00:05:02,920
+ليه just one فإذا صار عندى one molecule one mole
+
+54
+00:05:02,920 --> 00:05:06,450
+of sodium chlorideeach molecule is divided into
+
+55
+00:05:06,450 --> 00:05:11,970
+two molecules one sodium and one chloride اذا عندي
+
+56
+00:05:11,970 --> 00:05:16,090
+two active particles في الحالة هذه ال one osmol
+
+57
+00:05:16,090 --> 00:05:22,870
+one mol .. the one mol gives two osmols per liter
+
+58
+00:05:22,870 --> 00:05:26,970
+for example يعني اذا حسبتنا احنا هي هتكون per
+
+59
+00:05:26,970 --> 00:05:33,790
+literإذا one mole ممكن تديني two osmoles، إن كان
+
+60
+00:05:33,790 --> 00:05:39,450
+ال substance dissociating into three particles زي
+
+61
+00:05:39,450 --> 00:05:44,950
+مثلا ال .. ال .. اللي هو ايه؟ Sodium sulfate،
+
+62
+00:05:44,950 --> 00:05:48,930
+اتنين Sodium وواحد Sulfate مثلا، هتديني وها كده،
+
+63
+00:05:48,930 --> 00:05:53,150
+هتديني تلاتة و .. نحسبهاإذا الـ total number of
+
+64
+00:05:53,150 --> 00:05:56,490
+particles in a solution is measured in osmoles،
+
+65
+00:05:56,490 --> 00:06:00,750
+one osmole equal to one mole، تعرفين ال particles
+
+66
+00:06:00,750 --> 00:06:06,410
+في ال one mole تساوي 6.02 في ا عشر أوس تلاتة
+
+67
+00:06:06,410 --> 00:06:11,130
+وعشرين، therefore the solution containing one mole
+
+68
+00:06:11,130 --> 00:06:13,870
+of glucose in each liter has a concentration of
+
+69
+00:06:13,870 --> 00:06:21,620
+one osmole per literواتكلمنا عن ال ايه ال sodium
+
+70
+00:06:21,620 --> 00:06:27,020
+chloride واتكلمنا عن ال sodium sulfate طيب thus
+
+71
+00:06:27,020 --> 00:06:31,320
+the term osmol refers to the number of osmotically
+
+72
+00:06:31,320 --> 00:06:35,080
+active particles osmotically active particles in a
+
+73
+00:06:35,080 --> 00:06:38,320
+solution rather than the molar concentration of
+
+74
+00:06:38,320 --> 00:06:39,300
+the solution
+
+75
+00:06:43,010 --> 00:06:49,130
+طيب ال osmole per liter قياس كبير في شغلنا في ال
+
+76
+00:06:49,130 --> 00:06:53,770
+biology مانلاقيش osmole per liter فاستخدمنا ال
+
+77
+00:06:53,770 --> 00:07:02,070
+milli osmole per liter لحيث انه يكون أرقامنا أرقام
+
+78
+00:07:02,070 --> 00:07:05,430
+معجولة ماتبجعش point something كل مرة بتصير عندى
+
+79
+00:07:05,430 --> 00:07:08,850
+ايه أسهل الأرقام تبعت ال biology فال milli osmole
+
+80
+00:07:08,850 --> 00:07:14,480
+يساوي طبعا ايش واحدة الألف من osmoleبيجي تعريف الـ
+
+81
+00:07:14,480 --> 00:07:20,000
+osmolality and osmolarity osmolality تعني انه احنا
+
+82
+00:07:20,000 --> 00:07:26,000
+منجيس الحسابات هذه ال .. ال .. ال .. ال .. ال ..
+
+83
+00:07:26,000 --> 00:07:26,080
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+84
+00:07:26,080 --> 00:07:26,160
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+85
+00:07:26,160 --> 00:07:26,560
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+86
+00:07:26,560 --> 00:07:26,840
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+87
+00:07:26,840 --> 00:07:27,720
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+88
+00:07:27,720 --> 00:07:28,160
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+89
+00:07:28,160 --> 00:07:28,660
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+90
+00:07:28,660 --> 00:07:30,940
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+91
+00:07:30,940 --> 00:07:30,960
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+92
+00:07:30,960 --> 00:07:31,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+93
+00:07:31,220 --> 00:07:35,740
+ال ..
+
+94
+00:07:35,740 --> 00:07:41,620
+ال .. ال ..
+
+95
+00:07:44,450 --> 00:07:46,950
+فلذلك اعتبر اخدنا تعبير تاني اللي هو الـ
+
+96
+00:07:46,950 --> 00:07:50,270
+osmolarity which means the osmotically active
+
+97
+00:07:50,270 --> 00:07:53,590
+substance
+
+98
+00:07:53,590 --> 00:07:59,990
+in one liter more than one kilogram اذا ال
+
+99
+00:07:59,990 --> 00:08:02,990
+osmolarity بتتعامل مع ال liter و ال osmolarity
+
+100
+00:08:02,990 --> 00:08:10,190
+بتتعامل مع kilogram of water إلى حد ما هو ال one
+
+101
+00:08:10,190 --> 00:08:17,110
+literفي تركيبات نفسها one kilogram تقريبا لإنه
+
+102
+00:08:17,110 --> 00:08:21,030
+اتكلمش على water بحت هي عشان نقول ال water في صفات
+
+103
+00:08:21,030 --> 00:08:26,210
+معينة بتاعة أرقام معينة one kilogram equals one
+
+104
+00:08:26,210 --> 00:08:30,350
+ايه؟ one liter لكن بدرجة حرارة الجسم سبعة وتلاتين
+
+105
+00:08:30,350 --> 00:08:35,210
+وفي وجود بواد أخرى إضافية صار عند الكتافة اتغيرت
+
+106
+00:08:35,210 --> 00:08:39,050
+وصار الوزن ال liter هو واش كيلو جرام احنا تجاوزان
+
+107
+00:08:39,050 --> 00:08:42,940
+في فروقات بسيطة ومن احتبال ايه؟انه .. فلذلك
+
+108
+00:08:42,940 --> 00:08:47,340
+معاملاتنا في ال biology في ال physiology متعامل مع
+
+109
+00:08:47,340 --> 00:08:50,460
+ال osmolarity more than .. than ايه ال osmolarity
+
+110
+00:08:50,460 --> 00:08:57,220
+because we are dealing with solutes in volume not
+
+111
+00:08:57,220 --> 00:09:02,680
+in weight therefore
+
+112
+00:09:02,680 --> 00:09:08,720
+most
+
+113
+00:09:08,720 --> 00:09:15,600
+of the calculationsهو ازمولاريه اكتر من ازمولاريه
+
+114
+00:09:15,600 --> 00:09:19,780
+اكتر من ازمولاريه اكتر من ازمولاريه اكتر من
+
+115
+00:09:19,780 --> 00:09:21,100
+ازمولاريه اكتر من ازمولاريه اكتر من ازمولاريه اكتر
+
+116
+00:09:21,100 --> 00:09:22,360
+من ازمولاريه اكتر من ازمولاريه اكتر من ازمولاريه
+
+117
+00:09:22,360 --> 00:09:23,920
+اكتر من ازمولاريه اكتر من ازمولاريه اكتر من
+
+118
+00:09:23,920 --> 00:09:26,320
+ازمولاريه اكتر من ازمولاريه اكتر من ازمولاريه اكتر
+
+119
+00:09:26,320 --> 00:09:30,480
+من ازمولاريه
+
+120
+00:09:30,480 --> 00:09:34,820
+اكتر من ازمولاريه اكتر من ازمولاريه اكتر من
+
+121
+00:09:34,820 --> 00:09:35,860
+ازمولاري
+
+122
+00:09:46,230 --> 00:09:51,930
+لو اعملنا some sort of pressure طبعا هذا ال
+
+123
+00:09:51,930 --> 00:09:56,570
+movement of water it has its own power if we can
+
+124
+00:09:56,570 --> 00:09:59,850
+stop that diffusion by some sort of physical
+
+125
+00:09:59,850 --> 00:10:02,970
+pressure هذا ال physical pressure
+
+126
+00:10:05,740 --> 00:10:09,820
+اللي لازم to stop diffusion is called the osmotic
+
+127
+00:10:09,820 --> 00:10:12,280
+pressure اذا ال osmotic pressure is physical
+
+128
+00:10:12,280 --> 00:10:17,260
+pressure used to stop the osmosis اذا ال osmosis
+
+129
+00:10:17,260 --> 00:10:22,100
+ال osmolar concentration يسوي osmotic pressure
+
+130
+00:10:22,100 --> 00:10:27,040
+معين تمام اذا كيف نحسب احنا ال osmotic pressure
+
+131
+00:10:27,040 --> 00:10:27,880
+هذا
+
+132
+00:10:38,230 --> 00:10:43,230
+الدرجة الصحيحة اللي تحتاجها لإيقاف أزموزية اسمها
+
+133
+00:10:43,230 --> 00:10:47,990
+درجة ازموزية ازموزية ازموزية ازموزية ازموزية
+
+134
+00:10:47,990 --> 00:10:54,270
+ازموزية ازموزية ازموزية ازموزية ازموزية ازموزية
+
+135
+00:10:54,270 --> 00:10:54,290
+ازموزية ازموزية ازموزية ازموزية ازموزية ازموزية
+
+136
+00:10:54,290 --> 00:10:59,390
+ازموزية ازموزية ازموزية ازموزية ازموزية ازموزية
+
+137
+00:10:59,390 --> 00:11:06,600
+ازموزيةكيف احنا ممكن نحول ال ازمولاريتي هذه كيف
+
+138
+00:11:06,600 --> 00:11:10,560
+نحسب ال ازمولاريتي الموجودة كده تساوي osmotic
+
+139
+00:11:10,560 --> 00:11:14,640
+pressure تمام؟ ممكن احنا نحط في المعمل تجربة و
+
+140
+00:11:14,640 --> 00:11:19,780
+نعمل ال pressure و نزيده و نقيس بسهولة لكن ممكن
+
+141
+00:11:19,780 --> 00:11:29,400
+نستخدم احنا قانون van't hoofs لتحويل الحساب الايه
+
+142
+00:11:34,740 --> 00:11:36,880
+البراشر الموجود يساوي ال concentration of the
+
+143
+00:11:36,880 --> 00:11:42,480
+solutes البراشر المطلوب يساوي ال concentration of
+
+144
+00:11:42,480 --> 00:11:44,880
+the solutes البراشر الموجود يساوي ال concentration
+
+145
+00:11:44,880 --> 00:11:44,920
+of the solutes البراشر المطلوب يساوي ال
+
+146
+00:11:44,920 --> 00:11:45,060
+ال concentration of the solutes البراشر المطلوب
+
+147
+00:11:45,060 --> 00:11:45,360
+solutes البراشر المطلوب يساوي ال concentration of
+
+148
+00:11:45,360 --> 00:11:46,200
+the solutes البراشر المطلوب يساوي ال concentration
+
+149
+00:11:46,200 --> 00:11:47,340
+of the solutes البراشر المطلوب يساوي ال
+
+150
+00:11:47,340 --> 00:11:48,660
+concentration of the solutes البراشر المطلوب يساوي
+
+151
+00:11:48,660 --> 00:11:51,620
+ال concentration of the solutes البراشر المطلوب يس
+
+152
+00:11:51,990 --> 00:11:59,370
+و R is the ideal gas constant و T is the absolute
+
+153
+00:11:59,370 --> 00:12:09,610
+temperature تمام بسهولة نحسب الحسبة هذه نجد ان كل
+
+154
+00:12:09,610 --> 00:12:15,010
+أزمال يساوي
+
+155
+00:12:15,010 --> 00:12:22,440
+تسعة عشر الف و تلاتمية ملي مترإذاً كل أزمال بيحتاج
+
+156
+00:12:22,440 --> 00:12:27,900
+إلى تسعتاش ألف تلاتمية ملي متر ميركوري to stop its
+
+157
+00:12:27,900 --> 00:12:33,960
+effect of diffusion تمام؟ إذاً one ozmal needs
+
+158
+00:12:33,960 --> 00:12:39,640
+تسعتاش ألف تلاتمية ملي متر ميركوري pressureفي
+
+159
+00:12:39,640 --> 00:12:42,640
+الحالة هذه احنا بتكلم عن ال Osmol طب الميلي Osmol
+
+160
+00:12:42,640 --> 00:12:46,580
+انا راح اقول لك شغلنا كله على ميلي Osmol هيساو 19
+
+161
+00:12:46,580 --> 00:12:51,600
+.3 ميلي متر Mercury اذا لما يكون انا عندى احسب
+
+162
+00:12:51,600 --> 00:12:54,920
+حسبة Osmol ال concentration لشيء معين بدي اعرف
+
+163
+00:12:54,920 --> 00:12:59,080
+Osmotic pressure بقدره فيه كل ميلي Osmol في الرقم
+
+164
+00:12:59,080 --> 00:13:07,250
+اللي احنا 19.3 مش هيكطيب calculation of the
+
+165
+00:13:07,250 --> 00:13:11,570
+osmolarity and osmotic pressure of a solution احنا
+
+166
+00:13:11,570 --> 00:13:15,310
+عندنا اشهر solution عندنا ايش هو ال sodium
+
+167
+00:13:15,310 --> 00:13:18,810
+chloride عندنا تلاتة .. اتنين solutions مستخدمهم
+
+168
+00:13:18,810 --> 00:13:25,410
+باستمرار كل يوم انتوا هتستخدموهم normal saline و
+
+169
+00:13:25,410 --> 00:13:31,330
+بالانجليزي salineاحنا بنقوله saline هيك، saline
+
+170
+00:13:31,330 --> 00:13:33,750
+بالإنقليزي ماعرفش ال American بيرفضواها saline
+
+171
+00:13:33,750 --> 00:13:38,270
+زينا ولا .. زي ال English saline ولا saline ولا
+
+172
+00:13:38,270 --> 00:13:42,270
+إيش بيرفضوا ال American هدول لسانهم ألوج شوية لكن
+
+173
+00:13:42,270 --> 00:13:45,430
+بالإنقليزي بيقولوش saline زي ما احنا بعمييتنا
+
+174
+00:13:45,430 --> 00:13:49,830
+الإنقليزية بنقول، لأ بنقول saline، saline إذا
+
+175
+00:13:49,830 --> 00:13:53,790
+point nine percent sodium chloride بنسميه normal
+
+176
+00:13:53,790 --> 00:14:00,160
+saline، normal saline أو salineبمعنى ان
+
+177
+00:14:00,160 --> 00:14:05,820
+الاصبوتكالي اكتفت تبعته الاصبوتك اكتفتي equal to
+
+178
+00:14:05,820 --> 00:14:10,000
+the body osmotic activity اللى هى قولنا احنا
+
+179
+00:14:10,000 --> 00:14:14,930
+اصبوتك اكتفتى فى ال plasmaانترستيشن فلويد و ال
+
+180
+00:14:14,930 --> 00:14:19,470
+ايه؟ و ال .. انتستيشن فلويد ده same لازم الليلة
+
+181
+00:14:19,470 --> 00:14:22,730
+تبتطلعجي علشان، اذا انا بود ادخل مادة عندى، احطها
+
+182
+00:14:22,730 --> 00:14:26,130
+من برا، ادخلها على الموضوع، بهمني انا ايه؟ انا ما
+
+183
+00:14:26,130 --> 00:14:28,590
+.. انا مابحبطش الدنيا يعنى، ايه لازم انا .. ايه
+
+184
+00:14:28,590 --> 00:14:32,010
+لازم انا قاصد ادخل شئ؟ فاللي احنا بستخدم clinical
+
+185
+00:14:32,010 --> 00:14:37,180
+كل يوم، بندخلي اما normal saline point nine0.9%
+
+186
+00:14:37,180 --> 00:14:41,160
+Sodium Chloride 0.9% يعني per hundred milliliter
+
+187
+00:14:41,160 --> 00:14:45,840
+تساوي nine grams per liter عشان او مسميها five
+
+188
+00:14:45,840 --> 00:14:49,400
+percent glucose اذا انا مستخدم glucose خمسة في
+
+189
+00:14:49,400 --> 00:14:53,900
+المية يساوي isotonic في الحالة هذه الأزمولية تبعته
+
+190
+00:14:53,900 --> 00:14:58,320
+تساوي الأزمولية تبعت ال body fluids اذا هدول كل
+
+191
+00:14:58,320 --> 00:15:02,770
+يوم بقى استخدمهم انا طب نحسبأحساباتهم نشوف ايش
+
+192
+00:15:02,770 --> 00:15:06,730
+اللي بيصير بالظبط ال point nine بيقولنا تساوي نيني
+
+193
+00:15:06,730 --> 00:15:09,850
+جرام per liter مش هيك ال ninety gram per liter
+
+194
+00:15:09,850 --> 00:15:15,210
+هدول جديش تساوي ال smalls الوزن ال molecular
+
+195
+00:15:15,210 --> 00:15:18,970
+weight عندي انا fifty eight point five تمام اذا
+
+196
+00:15:18,970 --> 00:15:26,800
+عندي القسعة gram per liter على الالـ 58.5 هديني
+
+197
+00:15:26,800 --> 00:15:34,760
+point one five four point one five four mole per
+
+198
+00:15:34,760 --> 00:15:40,000
+liter لما اترجمه ل osmoles معناه بدي اضرب ايه؟ في
+
+199
+00:15:40,000 --> 00:15:42,680
+اتنين معناه بيصير عنده three point .. three
+
+200
+00:15:42,680 --> 00:15:47,980
+hundred point ايه؟ three hundred eight point .. مش
+
+201
+00:15:47,980 --> 00:15:54,680
+هيك مية و اربعة و خمسين بدي تلت مية و تمانية0.308
+
+202
+00:15:54,680 --> 00:16:04,760
+oz per liter احنا بيقولنا
+
+203
+00:16:04,760 --> 00:16:08,340
+ال dissociation فاكرين ال coefficient انه مش كل ال
+
+204
+00:16:08,340 --> 00:16:11,740
+fluids مش كل ال substances بيصيرها complete
+
+205
+00:16:11,740 --> 00:16:15,510
+dissociationفي اينا dissociation coefficient لها
+
+206
+00:16:15,510 --> 00:16:18,250
+فهنا ال sodium chloride قولنا ninety three percent
+
+207
+00:16:18,250 --> 00:16:21,310
+dissociation coefficient لو ضربنا هذا فيها ده
+
+208
+00:16:21,310 --> 00:16:25,910
+بتطلع حقيقة احنا عندنا ال osmolality مش تلاتمية او
+
+209
+00:16:25,910 --> 00:16:32,710
+تمانية بتطلع متين ستة او تمانين هذه ايه لو عدلناها
+
+210
+00:16:32,710 --> 00:16:35,800
+بالتعديل اللي احنا قولنا عليهو حقيقة لو انتوا بكرا
+
+211
+00:16:35,800 --> 00:16:39,140
+يعني أنا مدرسة في sociology كنت بظن انها تلاتمية
+
+212
+00:16:39,140 --> 00:16:42,940
+او تلاتمية و كسر لما ركبت المحلول بإيدي و حطيته
+
+213
+00:16:42,940 --> 00:16:47,540
+على ال osmometerفي جهاز اسمه ازمومتر محط المادة
+
+214
+00:16:47,540 --> 00:16:51,080
+فيه بيدينا بردين ال ايه الرقم بالظبط اتفاجأت انه
+
+215
+00:16:51,080 --> 00:16:57,680
+دايما ترقعدت وزدتوا 286 287 فقط ليش لأنه بيصيرش
+
+216
+00:16:57,680 --> 00:17:00,460
+complete dissociation ل ايه لل Sodium Chloride
+
+217
+00:17:00,460 --> 00:17:08,600
+عندنا dissociation coefficient أقل من ال 100% هذا
+
+218
+00:17:08,600 --> 00:17:13,080
+الان ال Osmols عرفناها تلت مية و تمانية ملي أسمل
+
+219
+00:17:13,080 --> 00:17:18,550
+بليترطب هذا جدّيش يساوي جدّيش يساوي osmotic
+
+220
+00:17:18,550 --> 00:17:23,390
+pressure هنضرب كل milli osmol انه nineteen point
+
+221
+00:17:23,390 --> 00:17:27,910
+three مش كده هنضرب هدي في هدي بيطلعلي ايه خمس تلات
+
+222
+00:17:27,910 --> 00:17:32,830
+تسعمية اربع اربعين millimeter mercury اذا ال
+
+223
+00:17:32,830 --> 00:17:36,330
+osmotic pressure لل body fluids المختلفة اللي هي
+
+224
+00:17:36,330 --> 00:17:39,990
+ال osmolar تبعتها حوالي التلاتمية وشوية حوالي خمس
+
+225
+00:17:39,990 --> 00:17:44,920
+تلات تسعمية اربع اربعين لو عدلنا الرقم هينزل شويةو
+
+226
+00:17:44,920 --> 00:17:53,120
+حاجة ناجية يساوي خمس آلاف أربعمية و كسر تمام؟ ليش؟
+
+227
+00:17:53,120 --> 00:17:55,760
+لأن هو مش على أصبت ال coefficient قبل كده
+
+228
+00:18:00,330 --> 00:18:04,950
+المواد هذه بصداد ديستوشيشن كامل وكل مادة لها
+
+229
+00:18:04,950 --> 00:18:08,290
+ديستوشيشن coefficient مختلف أو كوزيموتر
+
+230
+00:18:08,290 --> 00:18:16,450
+coefficient مختلف فلذلك بنحسب ال real effect
+
+231
+00:18:16,450 --> 00:18:21,140
+بيبقاشبالحسبة نظرية لأ بنضرف في factor ينعدل
+
+232
+00:18:21,140 --> 00:18:24,820
+النسبة هنا بنضرف في تلاتة وتسعين في المية تطلع
+
+233
+00:18:24,820 --> 00:18:27,760
+متين ستة و تمانين ميلي اوزمول در ليتر اذا ال
+
+234
+00:18:27,760 --> 00:18:32,700
+ازموليتي of the normal cell line تساوي كده؟ متين
+
+235
+00:18:32,700 --> 00:18:39,360
+ستة و تمانين اللي هي الآن هنشوف ال ازموليتي of the
+
+236
+00:18:39,360 --> 00:18:41,820
+body fluids in general هنلاقيها نفس الرقم تقريبا
+
+237
+00:18:41,820 --> 00:18:50,500
+تمام لإن هو تركيب الجسمبارضه هنعدل ال dissociation
+
+238
+00:18:50,500 --> 00:18:55,320
+او الزبوط ال coefficient هنلاقيها وصلة 282 281 نفس
+
+239
+00:18:55,320 --> 00:19:00,060
+الأرقام لو طلنا هنا هنقول ان ال plasma الأزمولية
+
+240
+00:19:00,060 --> 00:19:05,900
+تبعتها 300 و 1 هذه أرقام حسابية بحتة
+
+241
+00:19:08,660 --> 00:19:19,760
+الانترستيشال فلويل 300 ميلي امبارح لازمة البروتين
+
+242
+00:19:20,850 --> 00:19:25,070
+فبتطلع اعلى شوية صغيرة من ال a من الاخرين و ال
+
+243
+00:19:25,070 --> 00:19:28,810
+intracellular بتطلع زي تقريبا برجع تاني البروتين
+
+244
+00:19:28,810 --> 00:19:32,270
+بيعلى فيها فبتطلع جريبة من ال plasma انت لا ترسيش
+
+245
+00:19:32,270 --> 00:19:35,870
+الأجال واحدة فيهم لما نعمل correction نضرب كل
+
+246
+00:19:35,870 --> 00:19:41,150
+واحدة في الفترة تبعها بيطلع عندى 282 plasma و 281
+
+247
+00:19:41,150 --> 00:19:45,010
+ال intracellular fluid و 281 ال a intracellular
+
+248
+00:19:45,010 --> 00:19:48,470
+fluid اذا ال total
+
+249
+00:19:51,930 --> 00:19:55,710
+الـ total osmotic pressure at 37 degrees
+
+250
+00:19:55,710 --> 00:19:59,770
+centigrade هنا بطلع خمس تلاف أربعمية و تلاتة و
+
+251
+00:19:59,770 --> 00:20:02,770
+أربعين هنا خمس تلاف أربعمية و تلاتة و عشرين هذا
+
+252
+00:20:02,770 --> 00:20:06,390
+بعد التعديل اللي قلناه بعد ما نضغط بال factor بطلع
+
+253
+00:20:06,390 --> 00:20:12,030
+حقيقة مش خمس تلاف تسعمية و أربع أربعين لأ أطلع أقل
+
+254
+00:20:12,030 --> 00:20:15,550
+بخمسمية مليمتر ميليمتر ميليمتر ميليمتر ميليمتر not
+
+255
+00:20:15,550 --> 00:20:26,180
+thatالان لما نطلع على ال اكسشار
+
+256
+00:20:26,180 --> 00:20:29,200
+الفلويد من اللي هي جس سوديوم بيمثل تمانية فالمية
+
+257
+00:20:29,200 --> 00:20:34,810
+من الاسموتك الاكترمش كده؟ لإن هو 154 ف Sodium
+
+258
+00:20:34,810 --> 00:20:38,050
+chloride في الآخر بيجسم لحاله جسمين فبتديه لإيه
+
+259
+00:20:38,050 --> 00:20:41,170
+اشي رهيب، يعني تمانين في المية من osmolality of
+
+260
+00:20:41,170 --> 00:20:46,210
+the extracellular fluid بلازمة و interstellar
+
+261
+00:20:46,210 --> 00:20:51,690
+fluid بتتمثل من خلال Sodium لchloride، ال
+
+262
+00:20:51,690 --> 00:20:57,980
+intercellular fluidالنهج هو ان البوتاسيوم يدفعني
+
+263
+00:20:57,980 --> 00:21:05,960
+فقط 50% والاخر 50% يدفعني الفوسفات
+
+264
+00:21:05,960 --> 00:21:11,640
+والبروتين كلهم يشاركوا في الموضوع لكن السوديوم
+
+265
+00:21:11,640 --> 00:21:17,320
+كلورايد ASA نيفكاسه عالي عالي جدا اتكلم عن
+
+266
+00:21:17,320 --> 00:21:21,480
+السوديوم كلورايد concentration في نفس الوقت انا
+
+267
+00:21:21,480 --> 00:21:25,420
+بتكلم عن السوديوم كلورايدأو أسبوطيكالي أكتف
+
+268
+00:21:25,420 --> 00:21:29,400
+سبستانس في البلازم أو في الاتجار الفلويد يعني أنا
+
+269
+00:21:29,400 --> 00:21:32,260
+رقم ال concentration بيدين indication على طول
+
+270
+00:21:32,260 --> 00:21:38,160
+لإيه؟ لل-osmolality مش كده؟ لإنه هو السبب الرئيسي
+
+271
+00:21:38,160 --> 00:21:41,400
+في ال ايه؟ في ال-osmolar activity في ال
+
+272
+00:21:41,400 --> 00:21:45,980
+-extracellular fluid compartment تمام؟ احنا في ال
+
+273
+00:21:45,980 --> 00:21:49,020
+day to day examinations اللي بنعملها ال analysis
+
+274
+00:21:49,020 --> 00:21:53,610
+اللي بنعملها في المستشفىمنجسش كتير ال osmolality
+
+275
+00:21:53,610 --> 00:21:57,370
+لكن بسهولة بنبعت عين الدم و بنقول ايه ال
+
+276
+00:21:57,370 --> 00:22:00,970
+electrolytes Sodium, Potassium, Chloride بديناها
+
+277
+00:22:00,970 --> 00:22:04,410
+بسهولة فلمّا اختار علاج انا Sodium, Chloride خفض
+
+278
+00:22:04,410 --> 00:22:07,650
+معناه انا بتوقع انه ايه ال osmolality نفسها تكون
+
+279
+00:22:07,650 --> 00:22:12,150
+ايه مخافة بنامي 80% من ال osmolality تبع بسبب
+
+280
+00:22:12,150 --> 00:22:12,630
+رجلها
+
+281
+00:22:15,940 --> 00:22:18,840
+إذا هنا الجملة اللي أنا قلتها يبدو .. أنا مش كان
+
+282
+00:22:18,840 --> 00:22:22,880
+جايلها قبل كده، مش هى دور ال proteins اه، هنا
+
+283
+00:22:22,880 --> 00:22:26,220
+بتقول the slight difference between the plasma and
+
+284
+00:22:26,220 --> 00:22:29,780
+interstitial fluid is caused by the osmotic effect
+
+285
+00:22:29,780 --> 00:22:32,860
+of the plasma proteins which maintain about a
+
+286
+00:22:32,860 --> 00:22:37,290
+twenty millimeter mercurygreater pressure in the
+
+287
+00:22:37,290 --> 00:22:41,550
+capillaries than in the cerebellum if الموجود ال
+
+288
+00:22:41,550 --> 00:22:45,830
+high plasma proteins بتأكد لإنه في عندي انا فارق
+
+289
+00:22:45,830 --> 00:22:59,810
+دائما في المنطقة
+
+290
+00:22:59,810 --> 00:23:07,260
+اللي مافيهاش plasma proteinsالان موضوعنا حاول ..
+
+291
+00:23:07,260 --> 00:23:12,040
+اذا في عندنا تعبيرات مختلفة احنا بيقولنا
+
+292
+00:23:12,040 --> 00:23:14,000
+osmolarity ايش معناها، بعدين بيقولنا osmotic
+
+293
+00:23:14,000 --> 00:23:17,380
+pressure، الاتنين لا يعنيوا نفس الشيء، لكن هم ..
+
+294
+00:23:17,380 --> 00:23:22,070
+الاتنين بيعبروا عن شيءلو لا إيش واحد هناك بيعبّر
+
+295
+00:23:22,070 --> 00:23:24,970
+لإن زبوتكالية active substance يعني بيعبّر عن ال
+
+296
+00:23:24,970 --> 00:23:30,490
+pressure اللي لازم لمنع ال diffusion اللي بيسبب
+
+297
+00:23:30,490 --> 00:23:33,050
+زبوتكالية active substance طيب هنا what is
+
+298
+00:23:33,050 --> 00:23:35,710
+isotonic solution, hypotonic solution اي
+
+299
+00:23:35,710 --> 00:23:39,490
+hypertonic solution تمام؟ طيب بقول إن ال isotonic
+
+300
+00:23:39,490 --> 00:23:44,350
+solution عشان نكون احنا دقيقين بنقول إنه في وجود
+
+301
+00:23:44,350 --> 00:23:52,720
+ال semi permeable membrane أوالمنبران موجود حوالي
+
+302
+00:23:52,720 --> 00:23:58,040
+solutes يعني مانفعش أنه ال solutes تتحرك عبر
+
+303
+00:23:58,040 --> 00:24:02,060
+المنبران، بس اتحركت مابصيرش ال .. ماتكلمش عن ال
+
+304
+00:24:02,060 --> 00:24:04,960
+azotonicity احنا في الحالة هذه، ناخد تعبير اخر
+
+305
+00:24:04,960 --> 00:24:09,450
+احسن اللي لكالإيزو دي بس تعني انه في عدي solutes
+
+306
+00:24:09,450 --> 00:24:14,990
+impermeable to the solutes مابتقدرش تعدى، اذا اللي
+
+307
+00:24:14,990 --> 00:24:18,970
+بيعدي بس مين؟ الميه، في الحالة هذه اللي بيقول فيها
+
+308
+00:24:18,970 --> 00:24:23,250
+ان isotonic solution يعني solution لو حاطينا فيه
+
+309
+00:24:23,250 --> 00:24:27,950
+حوالين cells و بنلاقي ال cells size is not swollen
+
+310
+00:24:27,950 --> 00:24:34,990
+or shrink تمام؟ no change in the size of the cells
+
+311
+00:24:35,920 --> 00:24:42,220
+إذا هدا isothermal solution طيب لو حطينا ال cells
+
+312
+00:24:42,220 --> 00:24:47,320
+هادي في high bow في other solution و فيها لاجينا
+
+313
+00:24:47,320 --> 00:24:52,640
+ال cells انتفخت معناها الميه ده اتحركت من ايه؟الى
+
+314
+00:24:52,640 --> 00:24:56,680
+داخل ال cells انتفقت معناه ال osmolality هذه واطية
+
+315
+00:24:56,680 --> 00:25:00,460
+في الحالة هذه
+
+316
+00:25:00,460 --> 00:25:05,220
+ماعلاقته بال cell size مابنقولش عنه iso ..
+
+317
+00:25:05,220 --> 00:25:10,200
+isosmotic لأ بنقول هنا ايه ايزو تو ايزوتونك هنا
+
+318
+00:25:10,200 --> 00:25:11,240
+بنقول hybotonic
+
+319
+00:25:14,560 --> 00:25:22,140
+هيبرتونكس سوليوشن يعني انه ينتج من البرتونكس
+
+320
+00:25:22,140 --> 00:25:27,120
+الهيبرتونكس
+
+321
+00:25:27,120 --> 00:25:28,950
+الهيبرتونكس الهيبرتونكس الهيبرتونكسمن الداخل فتسحب
+
+322
+00:25:28,950 --> 00:25:32,630
+الميه من داخل ال cells اذا ال tonicity انا بتكلم
+
+323
+00:25:32,630 --> 00:25:38,370
+hypertonic او isotonic اقصد علاقة ال solutions هذه
+
+324
+00:25:38,370 --> 00:25:42,970
+بال cell size اللي موجودة في داخلها هل هتزيد حجمها
+
+325
+00:25:42,970 --> 00:25:50,150
+او لا لكن تخيلوا لو احنا بنتكلم عن osmolality of a
+
+326
+00:25:50,150 --> 00:25:57,340
+solution that is caused by permeablepermeant
+
+327
+00:25:57,340 --> 00:26:03,560
+solutes الممبرايل ماهواش مبرايل مايبقى لهم عنده
+
+328
+00:26:03,560 --> 00:26:09,060
+permeant solutes يعني المياه تتحرك و ال solutes
+
+329
+00:26:09,060 --> 00:26:12,860
+تتحرك تمام في الحالة هذه زي اليوريا مثلا اذا احنا
+
+330
+00:26:12,860 --> 00:26:17,780
+عاملين ال osmolality او حاطين solution يوريا و
+
+331
+00:26:17,780 --> 00:26:23,620
+isosmotic تمام عندي تلاتمية ميلي ازمول of يوريا in
+
+332
+00:26:23,620 --> 00:26:30,850
+water تمامو حطينا cells فى داخلها او عملنا hyper
+
+333
+00:26:30,850 --> 00:26:33,430
+ملاش ال ISO ال ISO مش هتخرج كتير، hyper او hypo
+
+334
+00:26:33,430 --> 00:26:38,630
+هيصير اختلاف في ال size temporary لإن الميه بسرعة
+
+335
+00:26:38,630 --> 00:26:42,190
+انتقلت لكن شوية صغيرة ال .. ال .. ال urea برضه
+
+336
+00:26:42,190 --> 00:26:45,870
+هتنتقل من ال higher concentration لل إيه لل lower
+
+337
+00:26:45,870 --> 00:26:50,270
+concentration ففي الحالة هذه ال solid بتنتقل و ال
+
+338
+00:26:50,270 --> 00:26:53,880
+water بتنتقل و فى الآخر بترجع كل إشي لإيهلأ طبعا
+
+339
+00:26:53,880 --> 00:27:00,640
+في الحالة هذه انا بدي اجيس osmolality
+
+340
+00:27:00,640 --> 00:27:05,180
+او osmolality لمواد permeant عبر ال semipermeable
+
+341
+00:27:05,180 --> 00:27:09,580
+brain مابنقدرش نقول isotonic و hypertonic و
+
+342
+00:27:09,580 --> 00:27:14,360
+hypotonic ليش؟ لإن الشرط ان يكون عندى ال solute
+
+343
+00:27:14,360 --> 00:27:18,240
+impermeable تمام؟ و لإنه بيصير shrinkage و بيظل
+
+344
+00:27:18,240 --> 00:27:23,070
+عليه بيصير swelling و بيظل عليهلكن في حالتنا
+
+345
+00:27:23,070 --> 00:27:27,450
+التانية اتكلمنا عنها لأ افضل اتكلم عن ازمولز جدش
+
+346
+00:27:27,450 --> 00:27:32,350
+ال ازمولز هذه هذا ال solution لانه عندنا solution
+
+347
+00:27:32,350 --> 00:27:36,390
+هالجد فيه ازمولز ازمولاريتي اذا مستخدم التعبير
+
+348
+00:27:36,390 --> 00:27:41,570
+التاني hyper-osmolar عند اي ايزوزموتك، hypo
+
+349
+00:27:41,570 --> 00:27:47,950
+-osmotic او hyper-osmotic يعني ازمولاريتي تبعتهلما
+
+350
+00:27:47,950 --> 00:27:52,970
+قصناها متساوية مع ال cell او مش متساوية بغض النظر
+
+351
+00:27:52,970 --> 00:27:59,610
+ايش تأثيره على ال cell size the term hyperosmotic
+
+352
+00:27:59,610 --> 00:28:02,510
+and hyperosmotic refer to solutions that have
+
+353
+00:28:02,510 --> 00:28:04,010
+higher or lower osmolarity
+
+354
+00:28:13,370 --> 00:28:18,250
+الشيء الأعلى هو المصادر المتحررة مثل الوريا يمكن
+
+355
+00:28:18,250 --> 00:28:21,090
+أن يسبب فيها تغيير ترانزيني في مقاومة الفلوت بين
+
+356
+00:28:21,090 --> 00:28:24,670
+الانتراثوريول وانتراثوريول الفلوت ولكن في وقت كافي
+
+357
+00:28:24,670 --> 00:28:31,190
+المقاومة من هذه المصادر تصبح في الانتراثوريول
+
+358
+00:28:31,190 --> 00:28:34,930
+وانتراثوريول الفلوت في الانتراثوريول الفلوت في
+
+359
+00:28:34,930 --> 00:28:36,690
+الانتراثوريول الفلوت في الانتراثوريول الفلوت في
+
+360
+00:28:36,690 --> 00:28:39,780
+الانتراثوريول الفلوت في الانتراثوريول الفلوتأو
+
+361
+00:28:39,780 --> 00:28:42,700
+ازموتك ايكوليبريان بين الانترسيبيل و الانترسيبيل
+
+362
+00:28:42,700 --> 00:28:48,100
+فلوويتز is rapidly obtained هذه مسألة ذكرناها
+
+363
+00:28:48,100 --> 00:28:52,580
+لانها clinical انا ماتكلم عن
+
+364
+00:29:03,670 --> 00:29:08,070
+ملاحظ احنا في ثواني بيصير الانتقال يعني
+
+365
+00:29:08,070 --> 00:29:12,250
+equilibrium of water concentration يعني ال osmosis
+
+366
+00:29:12,250 --> 00:29:17,070
+osmolar equilibrium بيصير في in terms of seconds
+
+367
+00:29:17,070 --> 00:29:22,840
+okay in terms of seconds maximum in minutesإذا لما
+
+368
+00:29:22,840 --> 00:29:25,440
+كنت أنا بعمل تجربة أو أشوف .. أحط شيء على شيء عشان
+
+369
+00:29:25,440 --> 00:29:32,320
+تفورا ال .. ال .. هذه التجربة اللي حققش غريب جدا،
+
+370
+00:29:32,320 --> 00:29:37,380
+يعني الواحد برضه اتعلم في حياته، كنا بنتصيد سمك
+
+371
+00:29:37,380 --> 00:29:42,060
+على البحر بالسنارة، تمام؟ و بنستخدم دود معين
+
+372
+00:29:42,060 --> 00:29:46,860
+للصيد، تمام؟ الدود أحيانا مالاجيش الدود المطلوب
+
+373
+00:29:46,860 --> 00:29:50,700
+للصيد، مالاجي دود رفيعفنختاره و نختاره و ما ننصرش
+
+374
+00:29:50,700 --> 00:29:53,400
+و نروح فاللي جيت اختيار جاعت قال لي لا لا هو اللي
+
+375
+00:29:53,400 --> 00:29:56,060
+اللي مابتعال تعال هات ميه من اين الميه بتشرب منها
+
+376
+00:29:56,060 --> 00:29:59,040
+قلت لي هاي الجزازة قاللي هات تتفترز الميه لحظة
+
+377
+00:29:59,040 --> 00:30:02,800
+حطينا شوية ميه و بعدين قاللي حط الدود هذا رفيع
+
+378
+00:30:02,800 --> 00:30:07,580
+المشنافع في الميه هذه و كلها بتتفخ صارف على ايه؟
+
+379
+00:30:07,580 --> 00:30:11,260
+بس في النار بسهولة فانا انت بقول سبحان الله لإن
+
+380
+00:30:11,260 --> 00:30:15,100
+هذا الدود احنا ماخدينه البحر يعني seals of
+
+381
+00:30:15,100 --> 00:30:19,920
+polarityفلمّا حطيناها في hypotonic solution،
+
+382
+00:30:19,920 --> 00:30:22,620
+hyposmolar solution، على طول انتقلت الناقلة ال
+
+383
+00:30:22,620 --> 00:30:29,360
+cells وانتفقت الدودة واستخدمناها بسهولة بس لعلمكوا
+
+384
+00:30:29,360 --> 00:30:32,640
+المواصفات الدودة بتتغير والسمكة بتبطل تجي علي
+
+385
+00:30:32,640 --> 00:30:37,340
+أجرائي لإن بتستخدمي العشام فبجلل تركيزنا العشام
+
+386
+00:30:37,340 --> 00:30:41,200
+فبتطور يعني إذا كنت سيده تاني روح دور عدو صحي
+
+387
+00:30:41,200 --> 00:30:47,120
+أحسنكوا بس الفكرة أن استخدام نهاجةيعني اختيار
+
+388
+00:30:47,120 --> 00:30:51,260
+حكالي عنها انا ادركت معناها لكن هو مش ماخد وانو مش
+
+389
+00:30:51,260 --> 00:30:55,760
+عامل هيك لكن ه .. طبعا في ثواني و انا واجب بحط له
+
+390
+00:30:55,760 --> 00:31:01,540
+.. طيب انا عندي dehydration و عندي جفاف في الخلايا
+
+391
+00:31:01,540 --> 00:31:05,500
+و كده وبقول اه في ثواني شربت ميه؟ كدهش بدي لما
+
+392
+00:31:05,500 --> 00:31:09,420
+الميه اللي انا شربتها؟عشان يصيلها absorption
+
+393
+00:31:09,420 --> 00:31:14,080
+وتتدشر في الجسم ويرجع ال diffusion complete من
+
+394
+00:31:14,080 --> 00:31:18,000
+ساعة باشرة لما يصير equilibrium، هذا بده حوالي نص
+
+395
+00:31:18,000 --> 00:31:21,400
+ساعة، تمام؟ it usually takes about thirty minutes
+
+396
+00:31:21,400 --> 00:31:24,920
+to achieve osmotic equilibrium everywhere in the
+
+397
+00:31:24,920 --> 00:31:28,630
+body after drinking waterإذا في شرب الميه صحيح إذا
+
+398
+00:31:28,630 --> 00:31:32,150
+كنا أشاجون بعض في ثواني بيصير امتقال في ثواني
+
+399
+00:31:32,150 --> 00:31:36,410
+الإكوليب اللي بيصلوا لكن لما نتكلم عن شرب الميه ثم
+
+400
+00:31:36,410 --> 00:31:40,250
+انتشار الميه في كل الجسم و يصير إكوليب في الجسم
+
+401
+00:31:40,250 --> 00:31:47,790
+بيدها نص ساعة volume and osmolality of
+
+402
+00:31:47,790 --> 00:31:51,550
+extracellular and intracellular fluid in abnormal
+
+403
+00:31:51,550 --> 00:31:59,420
+states تمام؟ إذا في عندنا حلقةاللي بيصير فيها
+
+404
+00:31:59,420 --> 00:32:04,480
+عندنا ال osmolarity و ال water content و الدنيا
+
+405
+00:32:04,480 --> 00:32:09,720
+كلها بتغير واحد fasting، واحد عنده أسهل،
+
+406
+00:32:09,720 --> 00:32:13,400
+dehydrating، dehydrated persons يعني الأطفال بيصير
+
+407
+00:32:13,400 --> 00:32:19,120
+فيهم أسهل، واحد vomiting، واحد عنده burn، محروم و
+
+408
+00:32:19,120 --> 00:32:25,300
+دايما oozingفبنخش في terminology جديد هنا some of
+
+409
+00:32:25,300 --> 00:32:28,920
+the different factors that can cause extracellular
+
+410
+00:32:28,920 --> 00:32:32,920
+and intracellular volumes to change markedly are
+
+411
+00:32:32,920 --> 00:32:38,980
+ingestion of water اشرب ميه كتير اغير ال .. لما
+
+412
+00:32:38,980 --> 00:32:43,340
+يصير عندى ال dehydration او واحد انا بديل وجهة ال
+
+413
+00:32:43,340 --> 00:32:50,460
+fluids IVانترافينوس تمام انترافينوس بديله fluids
+
+414
+00:32:50,460 --> 00:32:57,780
+هنا هنلاقي انه انا ادخل قاعد بقيراتي ان ايه اغير
+
+415
+00:32:57,780 --> 00:33:02,960
+ال fluids اللي موجودة انا حريص و افهم ايش اللي انا
+
+416
+00:33:02,960 --> 00:33:03,780
+بعمله
+
+417
+00:33:06,830 --> 00:33:10,250
+كيف نحسب بالظبط ايش اللي احنا قد نعمله loss of
+
+418
+00:33:10,250 --> 00:33:12,050
+large amounts of fluid from the just intestinal
+
+419
+00:33:12,050 --> 00:33:14,850
+tract and loss of abnormal amounts of fluid by
+
+420
+00:33:14,850 --> 00:33:18,310
+sweating or through the kidneys هدفلهم وسائل
+
+421
+00:33:18,310 --> 00:33:21,390
+مختلفة لإيه لتغيير ال hydration status of the body
+
+422
+00:33:21,390 --> 00:33:26,050
+one can calculate both the changes in
+
+423
+00:33:26,050 --> 00:33:29,030
+intracellular and extracellular fluid volumeand
+
+424
+00:33:29,030 --> 00:33:33,510
+the types of therapy that should be instituted if
+
+425
+00:33:33,510 --> 00:33:36,370
+the following basic principles are kept in mind
+
+426
+00:33:36,370 --> 00:33:40,830
+تمام؟ اذا انا بدي اتعامل محالات dehydration او
+
+427
+00:33:40,830 --> 00:33:44,470
+over hydration بيصير عندنا over hydration ندى
+
+428
+00:33:44,470 --> 00:33:48,010
+fluids و احنا مش ماخدين بالنا تمام؟ و ندى ال
+
+429
+00:33:48,010 --> 00:33:53,330
+fluids و فاتحين المحلول على الآخر و ال plasma
+
+430
+00:33:53,330 --> 00:33:59,010
+volume صار طبيعي و احنا لسه بنعطي صارالضغط بدأ
+
+431
+00:33:59,010 --> 00:34:05,130
+يعلق تمام؟ والمشاكل ال over hydration بدأت تشكل
+
+432
+00:34:05,130 --> 00:34:08,710
+خطر عليها تمام؟ وانا مش ماخد بالي، اذا انا لازم
+
+433
+00:34:08,710 --> 00:34:12,710
+اعرف لما اتعامل مع ال fluids هذه لانه يكون في بالي
+
+434
+00:34:12,710 --> 00:34:17,830
+قواعد عامة، القواعد هذه قولنا ان water moves
+
+435
+00:34:17,830 --> 00:34:21,530
+rapidly across the membranesTherefore, the
+
+436
+00:34:21,530 --> 00:34:24,870
+osmolarities of the anticephalic and anticephalic
+
+437
+00:34:24,870 --> 00:34:27,310
+fluids remain almost exactly equal
+
+438
+00:34:43,010 --> 00:34:46,650
+لل .. لل .. انا غير عن الشرب لو بدي IV بدي plus
+
+439
+00:34:46,650 --> 00:34:51,110
+minutes لكن لو انا بدي اشرب و جاسم تستيناتركتري
+
+440
+00:34:51,110 --> 00:34:55,570
+absorption بتاخد ايه؟ وجدت طويلة cell membranes
+
+441
+00:34:55,570 --> 00:34:59,690
+are almost completely impenetrable to many solutes
+
+442
+00:34:59,690 --> 00:35:03,710
+therefore the number of osmols in the
+
+443
+00:35:03,710 --> 00:35:05,830
+extracellular and intracellular fluids generally
+
+444
+00:35:05,830 --> 00:35:11,740
+remains constant يعني انا بتكلم عن دخالة محلولIv
+
+445
+00:35:11,740 --> 00:35:16,060
+للبلازمة ومنه للinterstitial fluid بتكلم انا عن
+
+446
+00:35:16,060 --> 00:35:20,900
+حركة الميه الاوزمواز اللى حطيتها بتتغيرش بتظل فى
+
+447
+00:35:20,900 --> 00:35:24,960
+ال compartment هذى لكن الاوزمواطيك البراشرانوهان
+
+448
+00:35:24,960 --> 00:35:28,860
+بتتعادل فالميه بتروح لكن الاوزمواز اللى حطيتها
+
+449
+00:35:28,860 --> 00:35:35,180
+بتظل ثابتة وهى بتحكم كم تاخد ميه او كم تعطى ميه ان
+
+450
+00:35:35,180 --> 00:35:38,140
+اذا انا حطيت fluids hypotonic تمام
+
+451
+00:35:40,640 --> 00:35:43,560
+الحجم المي اللى حطيته و ال Osmoles اللى حطيتها انا
+
+452
+00:35:43,560 --> 00:35:47,760
+فيها بتخلط مع ال Accessory Fluid تقديني خلطة جديدة
+
+453
+00:35:47,760 --> 00:35:51,180
+فيها ال Accessory Fluid Osmolarity أوتر من اللازم
+
+454
+00:35:51,180 --> 00:35:55,420
+تمام مجموعة ال Osmoles هتظل هي هي لكن المي هتتقل
+
+455
+00:35:55,420 --> 00:35:58,360
+لمين لان انت Cellular و في الحالة هذا الاساسي
+
+456
+00:35:58,360 --> 00:36:02,200
+حيوطة شوية ال Osmotic Pressure تبعها بحيث يتساوى
+
+457
+00:36:02,200 --> 00:36:06,600
+مع مين اه لكن ال Osmoles لو حطينا hypertonic
+
+458
+00:36:06,600 --> 00:36:14,230
+solution و هنحسبها مع بعضهنلاقي ان الماء
+
+459
+00:36:14,230 --> 00:36:18,110
+هتتقل هنا او هنا فخلنا نحسب مع بعض الحسبة هذه
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4clLpYzRVWg_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4clLpYzRVWg_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..daa36acc5f2f114cbf7088532d1b7207f49ffad4
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4clLpYzRVWg_raw.json
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احنا عندنا ال osmolality مش تلاتمية او تمانية بتطلع متين ستة او تمانين هذه ايه لو عدلناها بالتعديل اللي احنا قولنا عليه", "tokens": [41185, 1975, 1829, 8315, 44446, 399, 17619, 5296, 11296, 6156, 3224, 8315, 2423, 20265, 35434, 12174, 12610, 8315, 25063, 1045, 3043, 44446, 399, 17619, 45164, 48812, 25513, 8315, 23758, 8978, 11296, 11778, 3224, 39894, 9566, 1211, 3615, 11331, 38436, 28671, 1975, 5016, 8315, 43242, 8315, 2423, 3003, 76, 401, 1860, 37893, 6055, 1211, 9307, 2304, 10632, 1975, 2407, 46811, 7649, 10632, 39894, 9566, 1211, 3615, 44650, 9957, 8608, 2655, 3660, 1975, 2407, 46811, 7649, 9957, 29538, 1975, 1829, 3224, 45164, 6225, 3215, 1211, 8315, 11296, 20666, 2655, 3615, 16254, 1211, 13672, 1829, 1975, 5016, 8315, 12174, 12610, 8315, 47356], "avg_logprob": -0.2537500137090683, "compression_ratio": 1.75, "no_speech_prob": 1.1920928955078125e-07, "words": [{"start": 973.25, "end": 973.41, "word": "في", "probability": 0.458740234375}, {"start": 973.41, "end": 973.75, "word": " 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"probability": 0.7867431640625}, {"start": 984.79, "end": 985.13, "word": " مش", "probability": 0.99267578125}, {"start": 985.13, "end": 985.79, "word": " تلاتمية", "probability": 0.8359375}, {"start": 985.79, "end": 985.91, "word": " او", "probability": 0.789306640625}, {"start": 985.91, "end": 986.37, "word": " تمانية", "probability": 0.98486328125}, {"start": 986.37, "end": 987.17, "word": " بتطلع", "probability": 0.8980712890625}, {"start": 987.17, "end": 987.69, "word": " متين", "probability": 0.803466796875}, {"start": 987.69, "end": 988.95, "word": " ستة", "probability": 0.8331705729166666}, {"start": 988.95, "end": 989.03, "word": " او", "probability": 0.944580078125}, {"start": 989.03, "end": 989.55, "word": " تمانين", "probability": 0.9835611979166666}, {"start": 989.55, "end": 991.47, "word": " هذه", "probability": 0.3642578125}, {"start": 991.47, "end": 991.73, "word": " ايه", "probability": 0.9737955729166666}, {"start": 991.73, "end": 991.97, "word": " لو", "probability": 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1681.67, "end": 1682.25, "word": " that", "probability": 0.935546875}, {"start": 1682.25, "end": 1682.51, "word": " have", "probability": 0.95751953125}, {"start": 1682.51, "end": 1682.87, "word": " higher", "probability": 0.7841796875}, {"start": 1682.87, "end": 1683.07, "word": " or", "probability": 0.9296875}, {"start": 1683.07, "end": 1683.29, "word": " lower", "probability": 0.86083984375}, {"start": 1683.29, "end": 1684.01, "word": " osmolarity", "probability": 0.92333984375}], "temperature": 1.0}, {"id": 72, "seek": 171845, "start": 1693.37, "end": 1718.45, "text": "الشيء الأعلى هو المصادر المتحررة مثل الوريا يمكن أن يسبب فيها تغيير ترانزيني في مقاومة الفلوت بين الانتراثوريول وانتراثوريول الفلوت ولكن في وقت كافي المقاومة من هذه المصادر تصبح في الانتراثوريول وانتراثوريول الفلوت في الانتراثوريول الفلوت في الانتراثوريول الفلوت في الانتراثوريول الفلوت في الانتراثوريول الفلوت في الانتراثوريول الفلوت", "tokens": [6027, 8592, 1829, 38207, 16247, 3615, 23942, 31439, 9673, 9381, 18513, 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Osmoles هتظل هي هي لكن المي هتتقل لمين لان انت Cellular و في الحالة هذا الاساسي حيوطة شوية ال Osmotic Pressure تبعها بحيث يتساوى مع مين اه لكن ال Osmoles لو حطينا hypertonic solution و هنحسبها مع بعض", "tokens": [6027, 5016, 7435, 2304, 9673, 1829, 13672, 7578, 11331, 9566, 36081, 3224, 4032, 2423, 8875, 76, 7456, 13672, 7578, 11331, 9566, 36081, 11296, 1975, 8315, 8978, 11296, 39894, 9778, 1211, 9566, 20449, 2423, 17166, 827, 33612, 327, 6055, 28543, 9957, 1829, 16490, 1211, 9566, 3660, 10874, 16254, 41891, 8978, 11296, 2423, 17166, 827, 33612, 327, 8875, 76, 15276, 507, 34051, 2655, 2288, 9154, 13672, 31377, 2304, 46811, 10943, 3714, 7435, 2304, 2407, 27884, 2423, 8875, 76, 7456, 8032, 2655, 19913, 1211, 39896, 39896, 44381, 9673, 1829, 8032, 2655, 2655, 4587, 1211, 32767, 9957, 5296, 7649, 16472, 2655, 28859, 1040, 4032, 8978, 21542, 6027, 3660, 23758, 2423, 32277, 32277, 1829, 11331, 1829, 2407, 9566, 3660, 13412, 2407, 10632, 2423, 8875, 76, 9411, 6776, 540, 6055, 3555, 3615, 11296, 4724, 5016, 1829, 12984, 7251, 2655, 3794, 995, 2407, 7578, 20449, 3714, 9957, 1975, 3224, 44381, 2423, 8875, 76, 7456, 45164, 11331, 9566, 1829, 8315, 9848, 1756, 299, 3827, 4032, 8032, 1863, 5016, 35457, 11296, 20449, 45030, 11242], "avg_logprob": -0.2821912625467921, "compression_ratio": 1.8524590163934427, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 2140.64, "end": 2141.4, "word": "الحجم", "probability": 0.65203857421875}, {"start": 2141.4, "end": 2141.64, "word": " المي", "probability": 0.6453857421875}, {"start": 2141.64, "end": 2141.76, "word": " اللى", "probability": 0.63525390625}, {"start": 2141.76, "end": 2142.28, "word": " حطيته", "probability": 0.8935546875}, {"start": 2142.28, "end": 2142.44, "word": " و", "probability": 0.4345703125}, {"start": 2142.44, "end": 2142.44, "word": " ال", "probability": 0.71044921875}, {"start": 2142.44, "end": 2142.78, "word": " Osmoles", "probability": 0.3824055989583333}, {"start": 2142.78, "end": 2142.88, "word": " اللى", "probability": 0.986328125}, {"start": 2142.88, "end": 2143.34, "word": " حطيتها", "probability": 0.971923828125}, {"start": 2143.34, "end": 2143.56, "word": " انا", "probability": 0.65576171875}, {"start": 2143.56, "end": 2143.9, "word": " فيها", "probability": 0.921875}, {"start": 2143.9, "end": 2145.1, "word": " بتخلط", "probability": 0.9053955078125}, {"start": 2145.1, "end": 2145.28, "word": " مع", "probability": 0.9853515625}, {"start": 2145.28, "end": 2145.38, "word": " ال", "probability": 0.92236328125}, {"start": 2145.38, "end": 2145.7, "word": " Accessory", "probability": 0.47125244140625}, {"start": 2145.7, "end": 2146.08, "word": " Fluid", "probability": 0.85400390625}, {"start": 2146.08, "end": 2146.88, "word": " تقديني", "probability": 0.60247802734375}, {"start": 2146.88, "end": 2147.32, "word": " خلطة", "probability": 0.9117431640625}, {"start": 2147.32, "end": 2147.76, "word": " جديدة", "probability": 0.9611002604166666}, {"start": 2147.76, "end": 2148.5, "word": " فيها", "probability": 0.910888671875}, {"start": 2148.5, "end": 2148.72, "word": " ال", "probability": 0.64013671875}, {"start": 2148.72, "end": 2149.16, "word": " Accessory", "probability": 0.845703125}, {"start": 2149.16, "end": 2149.6, "word": " Fluid", "probability": 0.971923828125}, {"start": 2149.6, "end": 2150.24, "word": " Osmolarity", "probability": 0.73199462890625}, {"start": 2150.24, "end": 2150.64, "word": " أوتر", "probability": 0.7540690104166666}, {"start": 2150.64, "end": 2150.74, "word": " من", "probability": 0.90087890625}, {"start": 2150.74, "end": 2151.18, "word": " اللازم", "probability": 0.8815104166666666}, {"start": 2151.18, "end": 2151.98, "word": " تمام", "probability": 0.729248046875}, {"start": 2151.98, "end": 2153.08, "word": " مجموعة", "probability": 0.85859375}, {"start": 2153.08, "end": 2153.2, "word": " ال", "probability": 0.7783203125}, {"start": 2153.2, "end": 2153.62, "word": " Osmoles", "probability": 0.9044596354166666}, {"start": 2153.62, "end": 2154.02, "word": " هتظل", "probability": 0.7974853515625}, {"start": 2154.02, "end": 2154.16, "word": " هي", "probability": 0.7392578125}, {"start": 2154.16, "end": 2154.36, "word": " هي", "probability": 0.9541015625}, {"start": 2154.36, "end": 2154.64, "word": " لكن", "probability": 0.89892578125}, {"start": 2154.64, "end": 2154.9, "word": " المي", "probability": 0.93603515625}, {"start": 2154.9, "end": 2155.42, "word": " هتتقل", "probability": 0.860546875}, {"start": 2155.42, "end": 2155.78, "word": " لمين", "probability": 0.76123046875}, {"start": 2155.78, "end": 2156.5, "word": " لان", "probability": 0.52978515625}, {"start": 2156.5, "end": 2156.58, "word": " انت", "probability": 0.921630859375}, {"start": 2156.58, "end": 2157.3, "word": " Cellular", "probability": 0.8828125}, {"start": 2157.3, "end": 2157.54, "word": " و", "probability": 0.84619140625}, {"start": 2157.54, "end": 2157.62, "word": " في", "probability": 0.460205078125}, {"start": 2157.62, "end": 2157.88, "word": " الحالة", "probability": 0.95751953125}, {"start": 2157.88, "end": 2158.1, "word": " هذا", "probability": 0.18701171875}, {"start": 2158.1, "end": 2158.36, "word": " الاساسي", "probability": 0.451812744140625}, {"start": 2158.36, "end": 2158.76, "word": " حيوطة", "probability": 0.633447265625}, {"start": 2158.76, "end": 2159.18, "word": " شوية", "probability": 0.9129231770833334}, {"start": 2159.18, "end": 2160.06, "word": " ال", "probability": 0.80859375}, {"start": 2160.06, "end": 2160.66, "word": " Osmotic", "probability": 0.806640625}, {"start": 2160.66, "end": 2161.04, "word": " Pressure", "probability": 0.7349853515625}, {"start": 2161.04, "end": 2161.44, "word": " تبعها", "probability": 0.805419921875}, {"start": 2161.44, "end": 2161.7, "word": " بحيث", "probability": 0.9488525390625}, {"start": 2161.7, "end": 2162.2, "word": " يتساوى", "probability": 0.9181315104166666}, {"start": 2162.2, "end": 2162.36, "word": " مع", "probability": 0.98828125}, {"start": 2162.36, "end": 2162.66, "word": " مين", "probability": 0.97607421875}, {"start": 2162.66, "end": 2163.98, "word": " اه", "probability": 0.6956787109375}, {"start": 2163.98, "end": 2164.46, "word": " لكن", "probability": 0.80029296875}, {"start": 2164.46, "end": 2164.8, "word": " ال", "probability": 0.91357421875}, {"start": 2164.8, "end": 2165.26, "word": " Osmoles", "probability": 0.9036458333333334}, {"start": 2165.26, "end": 2165.64, "word": " لو", "probability": 0.88330078125}, {"start": 2165.64, "end": 2166.02, "word": " حطينا", "probability": 0.9095458984375}, {"start": 2166.02, "end": 2166.6, "word": " hypertonic", "probability": 0.6943359375}, {"start": 2166.6, "end": 2167.0, "word": " solution", "probability": 0.94970703125}, {"start": 2167.0, "end": 2167.12, "word": " و", "probability": 0.45361328125}, {"start": 2167.12, "end": 2167.58, "word": " هنحسبها", "probability": 0.91982421875}, {"start": 2167.58, "end": 2167.82, "word": " مع", "probability": 0.1455078125}, {"start": 2167.82, "end": 2168.24, "word": " بعض", "probability": 0.988037109375}], "temperature": 1.0}, {"id": 91, "seek": 217811, "start": 2169.15, "end": 2178.11, "text": "هنلاقي ان الماء هتتقل هنا او هنا فخلنا نحسب مع بعض الحسبة هذه", "tokens": [3224, 1863, 15040, 38436, 16472, 9673, 16606, 8032, 2655, 2655, 4587, 1211, 34105, 1975, 2407, 34105, 6156, 9778, 1211, 8315, 8717, 5016, 35457, 20449, 45030, 11242, 21542, 35457, 3660, 29538], "avg_logprob": -0.6723790399489864, "compression_ratio": 1.2790697674418605, "no_speech_prob": 0.0, "words": [{"start": 2169.15, "end": 2169.79, "word": "هنلاقي", "probability": 0.67083740234375}, {"start": 2169.79, "end": 2170.07, "word": " ان", "probability": 0.5078125}, {"start": 2170.07, "end": 2174.23, "word": " الماء", "probability": 0.207489013671875}, {"start": 2174.23, "end": 2174.83, "word": " هتتقل", "probability": 0.58114013671875}, {"start": 2174.83, "end": 2174.91, "word": " هنا", "probability": 0.153076171875}, {"start": 2174.91, "end": 2175.13, "word": " او", "probability": 0.77587890625}, {"start": 2175.13, "end": 2175.45, "word": " هنا", "probability": 0.9794921875}, {"start": 2175.45, "end": 2176.13, "word": " فخلنا", "probability": 0.3102264404296875}, {"start": 2176.13, "end": 2176.37, "word": " نحسب", "probability": 0.9713541666666666}, {"start": 2176.37, "end": 2176.51, "word": " مع", "probability": 0.64111328125}, {"start": 2176.51, "end": 2177.19, "word": " بعض", "probability": 0.964599609375}, {"start": 2177.19, "end": 2177.81, "word": " الحسبة", "probability": 0.8678385416666666}, {"start": 2177.81, "end": 2178.11, "word": " هذه", "probability": 0.576171875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2181.30575, "duration_after_vad": 2125.586249999993}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk.srt
new file mode 100644
index 0000000000000000000000000000000000000000..96bb1bd050f53788ddb62ee871e8b8f5524d18d9
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk.srt
@@ -0,0 +1,2662 @@
+1
+00:00:05,040 --> 00:00:13,860
+اليوم احنا هنكمل اللي هو how urine is formed in
+
+2
+00:00:13,860 --> 00:00:19,560
+the kidney. زي ما احنا عارفين احنا ال urine بيبدأ ب
+
+3
+00:00:19,560 --> 00:00:24,500
+filtration عبر ال glomerulus. مستمر glomerulus
+
+4
+00:00:24,500 --> 00:00:28,040
+filtration. بعدين بيصير في عملية reabsorption
+
+5
+00:00:28,040 --> 00:00:32,600
+tubular reabsorption. و هدول الإثنين عمليتين هما ال
+
+6
+00:00:32,600 --> 00:00:39,290
+major procedures. بالحقهم بروسيس أخرى أصغر شوية، أقل
+
+7
+00:00:39,290 --> 00:00:45,990
+شوية كمان، وهي ال secretion. عملية ال filtration
+
+8
+00:00:45,990 --> 00:00:51,350
+زائد ال reabsorption زائد ال secretion بتديني ال
+
+9
+00:00:51,350 --> 00:00:56,410
+final quantity of urine.
+
+10
+00:00:56,410 --> 00:01:04,820
+يعتمد. اتكلمنا في آخر نقطة في ال reabsorption، أنه في
+
+11
+00:01:04,820 --> 00:01:08,260
+ال proximal convoluted tubule بيصير عملية
+
+12
+00:01:08,260 --> 00:01:12,120
+secretions كمان. وقلنا ال secretions هذه ممكن تكون
+
+13
+00:01:12,120 --> 00:01:21,940
+active secretion عبر ال counter transport، يعني
+
+14
+00:01:21,940 --> 00:01:25,300
+secondary active. الحالة هذه بيكون اللي هو لما
+
+15
+00:01:25,300 --> 00:01:29,420
+قلنا ال reabsorption of بيكربونات من خلال ال
+
+16
+00:01:29,420 --> 00:01:33,300
+counter transport of ايه؟ of هيدروجين. الفاظها هذه
+
+17
+00:01:33,300 --> 00:01:36,560
+لأن عندنا بعد شوية صغيرة هنقارن ما بين هذه ال
+
+18
+00:01:36,560 --> 00:01:41,000
+process of hydrogen secretion مع other processes of
+
+19
+00:01:41,000 --> 00:01:45,300
+hydrogen secretion، active hydrogen secretion في ال
+
+20
+00:01:45,300 --> 00:01:49,400
+distal tubule، في ال intercalated cells of the
+
+21
+00:01:49,400 --> 00:01:53,120
+distal tubules. في عملية أخرى من ال hydrogen
+
+22
+00:01:53,120 --> 00:01:58,120
+secretion بتتم من خلالها برضه reabsorption of
+
+23
+00:01:58,120 --> 00:02:01,380
+بوتاسيوم، أو mainly reabsorption of الكربونات، أو
+
+24
+00:02:01,380 --> 00:02:04,580
+just for regulation of hydrogen concentration.
+
+25
+00:02:04,580 --> 00:02:09,660
+هنلاحظ
+
+26
+00:02:09,660 --> 00:02:14,600
+هنلاحظ أن هذا ال process secondary active. الثاني هتكون
+
+27
+00:02:14,600 --> 00:02:21,060
+an active process by hydrogen ATPase. تمام. أنا بس
+
+28
+00:02:21,060 --> 00:02:24,980
+بحضركم للفكرة أن دائماً بيصير مقارنة ما بين ال
+
+29
+00:02:24,980 --> 00:02:27,720
+process اللي بيصير في ال distal tubule و ال process
+
+30
+00:02:27,720 --> 00:02:34,820
+اللي بيصير في ال proximal tubule، بما يخص ال hydrogen
+
+31
+00:02:34,820 --> 00:02:37,420
+secretion and bicarbonate reabsorption.
+
+32
+00:02:42,320 --> 00:02:49,200
+عندنا ال p-aminohippuric acid، واحد من ال organic
+
+33
+00:02:49,200 --> 00:02:53,720
+acids. اللي هو ازاي ال organic acids اللي اتكلمنا
+
+34
+00:02:53,720 --> 00:02:57,780
+عنها من شوية أو آخر مرة في الدرس الفات، أنه عندنا
+
+35
+00:02:57,780 --> 00:03:01,440
+active process، active secretion لل organic acids.
+
+36
+00:03:01,440 --> 00:03:06,240
+وقلنا بالذات للبنسلين لأنه عامل عندنا مشكلة، و لل
+
+37
+00:03:06,240 --> 00:03:09,820
+salicylic acid اللي هو الأسبيرين، لأنه بيقدر إلى
+
+38
+00:03:09,820 --> 00:03:16,150
+أن يكون rapid. و من
+
+39
+00:03:16,150 --> 00:03:21,170
+هنا
+
+40
+00:03:21,170 --> 00:03:27,290
+تم عملية ربط بين البنسلين
+
+41
+00:03:27,290 --> 00:03:30,690
+جي، بنسلين جي، بنسلين جي، بنسلين جي، بنسلين
+
+42
+00:03:30,690 --> 00:03:36,840
+جي، بنسلين جي،  binding protein بحيث أنه
+
+43
+00:03:36,840 --> 00:03:42,400
+يبطل يصبح عملية easy filtration and easy excretion
+
+44
+00:03:42,400 --> 00:03:47,180
+and easy secretion. فصار عملية إبطاء من ال
+
+45
+00:03:47,180 --> 00:03:52,960
+executing process.
+
+46
+00:03:52,960 --> 00:03:57,480
+إبطائها شوية، و قد إلى أن في الآخر عندنا نطلع long
+
+47
+00:03:57,480 --> 00:04:00,800
+acting penicillin، long acting penicillin. ممكن
+
+48
+00:04:00,800 --> 00:04:07,280
+نتناقض كل شهر مرة، كل شهر مرة، نديله مواصفات معينة
+
+49
+00:04:07,280 --> 00:04:12,310
+نمنع ايه؟ خروجه عن طريق الكلى. في مادة هنا بتهمني
+
+50
+00:04:12,310 --> 00:04:18,850
+في الموضوع هذا. المادة مش لها يعني clinical effect
+
+51
+00:04:18,850 --> 00:04:23,330
+زي ال penicillin. و دور ال secretion تبعه و أهميته
+
+52
+00:04:23,330 --> 00:04:27,170
+و ال salicylic acid و كذا، لكن لها أهمية بأن هذه
+
+53
+00:04:27,170 --> 00:04:30,590
+المادة اسمها p-aminohippuric acid. هذه المادة أنا
+
+54
+00:04:30,590 --> 00:04:35,240
+بستخدمها في قياس ال plasma renal plasma flow، بلازما
+
+55
+00:04:35,240 --> 00:04:39,660
+فلو في الكلية. ليش بستخدمها؟ لأن هذه المادة
+
+56
+00:04:39,660 --> 00:04:43,700
+تقريباً تسعين في المئة منها، أو نعتبرها حالياً مئة
+
+57
+00:04:43,700 --> 00:04:50,180
+المئة منها is executed just by one flow inside the
+
+58
+00:04:50,180 --> 00:04:54,840
+kidney. متى ما دخلت الكلية معناها أنه بتطلع بلا إشارة
+
+59
+00:04:54,840 --> 00:04:58,800
+ال venous site أصلاً حكيت لكم عليها، ال venous site بيكون
+
+60
+00:04:58,800 --> 00:05:03,000
+فارغ. فبكدا بقدر أنا أقول أن المادة اللي طلعت في
+
+61
+00:05:03,000 --> 00:05:07,380
+اليورين هي نفسها المادة اللي دخلت الكلية عبر
+
+62
+00:05:07,380 --> 00:05:11,300
+البلازما. لأن البلازما اتصفّت منها، بقدر أحسب
+
+63
+00:05:11,300 --> 00:05:15,320
+البلازما flow. بعد ما أعدّلها بالـ 90%، يعني بضيف الـ 10
+
+64
+00:05:15,320 --> 00:05:19,160
+% ومنها ال hematocrit بقدر أعرف ال renal blood
+
+65
+00:05:19,160 --> 00:05:19,860
+flow.
+
+66
+00:05:27,700 --> 00:05:31,140
+الآن دخلنا على... خلصنا ال proximal و ال distal
+
+67
+00:05:31,140 --> 00:05:36,220
+تقريباً كنا شرحنا معظم الأشياء اللي بتصير فيها و
+
+68
+00:05:36,220 --> 00:05:40,020
+أوضحنا على الكاميرا أن أنا نجحت بتاعة ال course. الآن
+
+69
+00:05:40,020 --> 00:05:43,800
+هننزل لل loop of Henle. ال loop of Henle في the
+
+70
+00:05:43,800 --> 00:05:46,700
+descending loop of Henle و في ascending loop of
+
+71
+00:05:46,700 --> 00:05:51,700
+Henle. الديسيندنجلوب أوف هنلي نوع واحد، ثين ديسيندنج
+
+72
+00:05:51,700 --> 00:05:59,660
+لوب أوف هنلي. ما هو جزء ثين وجزء نوع واحد، ثين ديسيندنج
+
+73
+00:05:59,660 --> 00:06:07,230
+لوب أوف هنلي هذا permeable to water، ويعني semi
+
+74
+00:06:07,230 --> 00:06:11,270
+permeable to other solutes. يعني في إمكانية للحركة
+
+75
+00:06:11,270 --> 00:06:14,690
+من خلاله، الأشياء اللي فيه ممكن تطلع لبرا. يعني لو
+
+76
+00:06:14,690 --> 00:06:18,030
+ال interstitium برا ال interstitium اللي نازل فيه
+
+77
+00:06:18,030 --> 00:06:21,410
+ال loop of Henle هي concentrated. هيقدر الميه
+
+78
+00:06:21,410 --> 00:06:28,950
+freely هتتحرك إلى ايه؟ إلى الخارج. هذا ال loop
+
+79
+00:06:28,950 --> 00:06:34,190
+تمام؟ هذا بالنسبة لل descending loop. ال ascending
+
+80
+00:06:34,190 --> 00:06:39,410
+loop برضه فيه جزء تقريباً نص أو أقل من نص شوية، ثين
+
+81
+00:06:39,410 --> 00:06:45,870
+و هذا عكس ال descending loop، impermeable to water
+
+82
+00:06:45,870 --> 00:06:53,610
+and it is impermeable to urea or nearly
+
+83
+00:06:53,610 --> 00:06:57,310
+impermeable to other solutes. يعني ما هو ال
+
+84
+00:06:57,310 --> 00:07:01,990
+permeability للسوليتس الأخرى limited. المهم أنها it
+
+85
+00:07:01,990 --> 00:07:05,030
+is impermeable to water. حيأتي بعدها اللي هو thick
+
+86
+00:07:05,030 --> 00:07:09,330
+ascending limb. ال thick ascending limb هذا أهم جزء
+
+87
+00:07:09,330 --> 00:07:13,850
+في ال loop of Henle من ناحية أنه انعكاسه على كل
+
+88
+00:07:13,850 --> 00:07:18,350
+شغل الكلية، انعكاس كبير. انعكاسه على كل... الآن ال
+
+89
+00:07:18,350 --> 00:07:22,110
+filtrate اللي داخل ال loop of Henle، ال filtrate
+
+90
+00:07:22,110 --> 00:07:25,490
+اللي داخل ال loop of Henle بيصل ال distal tubule
+
+91
+00:07:26,700 --> 00:07:30,820
+بيصل ال thick ascending limb. بيصل ال thick
+
+92
+00:07:30,820 --> 00:07:36,240
+ascending limb. fishy
+
+93
+00:07:36,240 --> 00:07:46,280
+mouse. اه؟ يا ريت والله أنا بيريحني إذا ال... ال
+
+94
+00:07:46,280 --> 00:07:52,690
+thick ascending limb هذا، ميزته أنه حيصير في عندنا
+
+95
+00:07:52,690 --> 00:07:59,610
+عملية active reabsorption for
+
+96
+00:07:59,610 --> 00:08:03,770
+solutes and it is impermeable to water. يعني لما
+
+97
+00:08:03,770 --> 00:08:08,110
+ناخد ال solutes ويصير عندنا hypotonicity في داخل
+
+98
+00:08:08,110 --> 00:08:12,750
+ال filtrate، ال water will not be able to follow
+
+99
+00:08:12,750 --> 00:08:15,170
+the solutes. مش ده ال professor ما كان في ال
+
+100
+00:08:15,170 --> 00:08:19,990
+distal؟ راح السوديوم، الكلوريد، تلحقها الميه. هنا في
+
+101
+00:08:19,990 --> 00:08:24,550
+الحالة هذه حيصير absorption لل solutes كميات كبيرة
+
+102
+00:08:24,550 --> 00:08:31,230
+تمام، بحيث أن الميه can not enter the thick
+
+103
+00:08:31,230 --> 00:08:36,590
+ascending limb cells. إذا it is impermeable to water، it
+
+104
+00:08:36,590 --> 00:08:40,610
+is impermeable to urea. تمام؟ إذا اليوريا و ال water
+
+105
+00:08:40,610 --> 00:08:44,430
+هيدالهم ماشيين في ال filtrate. إذا عندها لما أنا
+
+106
+00:08:44,430 --> 00:08:46,910
+يصير reabsorption لكمية كبيرة من ال solutes
+
+107
+00:08:46,910 --> 00:08:53,110
+حيصير عندي ال tubular filtrate يخلص مهمته في ال
+
+108
+00:08:53,110 --> 00:08:56,690
+thick ascending limb. هنلاقي صار أخذنا ال solutes و
+
+109
+00:08:56,690 --> 00:09:01,090
+أُزيل ال water، هيكون hypo osmotic. إذا عن hypo
+
+110
+00:09:01,090 --> 00:09:05,170
+osmotic حقيقة.
+
+111
+00:09:05,170 --> 00:09:08,650
+ال thick ascending limb هذا، في هذا ال function
+
+112
+00:09:08,650 --> 00:09:14,330
+تبعه، يُصاحب الجزء الأول من ال proximal من ال
+
+113
+00:09:14,330 --> 00:09:17,230
+distal convoluted، ال distal convoluted هنقسمه
+
+114
+00:09:17,230 --> 00:09:22,070
+إلى قسمين: early part و distal part. تمام؟ يفصل
+
+115
+00:09:22,070 --> 00:09:25,350
+الجهتين، ال thick ascending limb عن ال early part
+
+116
+00:09:25,350 --> 00:09:27,950
+of the distal convoluted tubule اللي هو
+
+117
+00:09:27,950 --> 00:09:31,270
+الجوكستاجلوميرولار apparatus. مش كده؟ إذا في عند
+
+118
+00:09:31,270 --> 00:09:33,270
+جوكستاجلوميرولار apparatus بيجي بعده thick ascending
+
+119
+00:09:33,270 --> 00:09:37,530
+limb مباشرة. وبعده بشوية بيبدأ ال... ال distal
+
+120
+00:09:37,530 --> 00:09:40,210
+tubule. هذه الجزئية اللي بعدها شوية صغيرة اللي هي ال
+
+121
+00:09:40,210 --> 00:09:43,690
+early distal tubule، ال early distal convoluted
+
+122
+00:09:43,690 --> 00:09:49,230
+tubule. ال function تبعها مشابه، مصاحب، مكمل لـ thick
+
+123
+00:09:49,230 --> 00:09:54,390
+ascending limb. تمام. نفس الشيء، الفرق بينهم ميكانيزم
+
+124
+00:09:54,390 --> 00:09:58,270
+هنتكلم عن ميكانيزم. لأن ال transporter بيختلف، ال
+
+125
+00:09:58,270 --> 00:10:01,210
+transporter اللي شغال هنا، يساعد تدخل
+
+126
+00:10:01,210 --> 00:10:04,490
+الأشياء هنا في ال thick ascending، بيختلف عن اللي
+
+127
+00:10:04,490 --> 00:10:08,550
+بعده. لكن المحصلة أن كمية كبيرة من ال solutes هتنسحب
+
+128
+00:10:08,550 --> 00:10:14,590
+إلى داخل ال ايه؟ إلى داخل ال interstitium. هتدخل ال
+
+129
+00:10:14,590 --> 00:10:18,350
+cells و هتدخل ال interstitium. و لن يلحق بها ايه؟
+
+130
+00:10:18,350 --> 00:10:22,860
+water ولا urea. هتضل ال water و ال urea داخل. إذا
+
+131
+00:10:22,860 --> 00:10:28,360
+هذه الجزئية، هذه الجزئية اللي هو بتنتهي بال early
+
+132
+00:10:28,360 --> 00:10:31,300
+part of the thick ascending limb عملت absorption
+
+133
+00:10:31,300 --> 00:10:36,800
+of solutes كمية كبيرة. بتنتهي أنه عندي ال tubular
+
+134
+00:10:36,800 --> 00:10:42,300
+filtrate، osmolality دائماً بتنتهي بـ 100 ملي أزمول.
+
+135
+00:10:42,300 --> 00:10:45,780
+إذا ال thick ascending، ال... ال... ال distal
+
+136
+00:10:45,780 --> 00:10:50,300
+convoluted tubule، ال late part، ال second part
+
+137
+00:10:50,300 --> 00:10:53,760
+تبع ال distal convoluted tubule بيسلّم دائماً ال
+
+138
+00:10:53,760 --> 00:10:59,120
+tubular filtrate بتركيز 100 ملي أزمول. تمام؟ إذا
+
+139
+00:10:59,120 --> 00:11:02,320
+الجزء اشتغل، بيغيّر في الـ 100 ملي أزمول، زيادة أو
+
+140
+00:11:02,320 --> 00:11:07,220
+نقصانها. ممكن أن تنقص كمان خمسين، ممكن تصل لخمسين،
+
+141
+00:11:07,220 --> 00:11:09,620
+لأن ال thick ascending limb، ال... ال... ال...
+
+142
+00:11:09,620 --> 00:11:12,640
+distal convoluted tubule. هذه الجزء اللي باقي، عنده
+
+143
+00:11:12,640 --> 00:11:18,290
+إمكانية أنه يعمل more dilution. بس هذا under control
+
+144
+00:11:18,290 --> 00:11:23,770
+حسب حاجة الجسم. وممكن مايعملش أي dilution. المياه
+
+145
+00:11:23,770 --> 00:11:27,850
+دي تبقى ماشية لحد ما تنزل ال interstitium عبر ال
+
+146
+00:11:27,850 --> 00:11:31,530
+collecting duct. وهناك يصير عمل التركيز عالي، ونصل
+
+147
+00:11:31,530 --> 00:11:34,990
+الكمية اللي الرقم يقولنا عليه،  في منطقة الكلية العليا
+
+148
+00:11:34,990 --> 00:11:41,750
+في التركيز تصل لأيه؟ لألف ومئتين أو 1400. إذا ال
+
+149
+00:11:41,750 --> 00:11:46,300
+distal tubule الآن بيصلها. ال Distal Convoluted
+
+150
+00:11:46,300 --> 00:11:53,740
+Tubule يصل إلى ال Tubular Filtrate Hypoosmotic، ال
+
+151
+00:11:53,740 --> 00:11:58,380
+Early Part اللي يكمل شغل ال Thick Ascending Limb
+
+152
+00:11:58,380 --> 00:12:03,260
+ينهي إلى 100 ملي أسمول. لذلك الجزء الثاني من ال
+
+153
+00:12:03,260 --> 00:12:07,140
+Distal Convoluted Tubule اللي هو هذا، يعمل elective
+
+154
+00:12:07,140 --> 00:12:11,700
+حسب حاجة الجسم. ممكن آخذ صوديوم، ممكن لا آخذ. ممكن
+
+155
+00:12:11,700 --> 00:12:17,440
+آخذ ميه، ممكن ما آخذش. تمام. النص الثاني هذا لو أخذ
+
+156
+00:12:17,440 --> 00:12:21,980
+صوديوم، ما أخذش ميه على أقصى قدرة له، يستطيع أنه يسلم
+
+157
+00:12:21,980 --> 00:12:25,980
+ال collecting duct، يسلم ال collecting... ال... ال
+
+158
+00:12:25,980 --> 00:12:28,720
+...ال... ال collecting duct، ال medullary
+
+159
+00:12:28,720 --> 00:12:33,260
+collecting duct، يسلمها أوزمولالية
+
+160
+00:12:33,260 --> 00:12:37,720
+ب just خمسين ملي أوزمول. أنا ليش قلت ال medullary
+
+161
+00:12:37,720 --> 00:12:43,670
+collecting duct؟ لأن حقيقة ال collecting duct، ال
+
+162
+00:12:43,670 --> 00:12:48,130
+cortical و ال distal، second part of the distal
+
+163
+00:12:48,130 --> 00:12:50,710
+convoluted tubule بيشتغلوا نفس الشغل. يعني لما نتكلم
+
+164
+00:12:50,710 --> 00:12:53,210
+عن ال... ال distal convoluted tubule، ال second part
+
+165
+00:12:53,210 --> 00:12:57,110
+ال late part هي و ال connecting tubule و ال
+
+166
+00:12:57,110 --> 00:13:00,030
+cortical collecting، نفس الشيء اللي
+
+167
+00:13:00,030 --> 00:13:03,370
+بيصير هنا، هنا، هنا. يعني لحد ما نصل لـ medullary
+
+168
+00:13:03,370 --> 00:13:06,660
+collecting duct. و نفس المواصفات. بعد medullary
+
+169
+00:13:06,660 --> 00:13:09,520
+collecting duct بيصير ايش؟ عندنا تيوبيول أخرى
+
+170
+00:13:09,520 --> 00:13:13,220
+ومواصفات أخرى. تمام؟ إذا هنا عندي elective
+
+171
+00:13:13,220 --> 00:13:17,660
+reabsorption أو secretion لصوديوم، أو secretion
+
+172
+00:13:17,660 --> 00:13:22,300
+لبوتاسيوم. حسب مين؟ حسب حاجة الجسم. بتبدأ من ال late
+
+173
+00:13:22,300 --> 00:13:26,580
+distal tubule، connecting tubule و cortical
+
+174
+00:13:26,580 --> 00:13:30,240
+collecting tubule. هدول كلهم بيشتغلوا ايه؟ ال
+
+175
+00:13:30,240 --> 00:13:33,360
+anatomy تبعهم. هتكلم إن ال anatomy هذا متميز، زي
+
+176
+00:13:33,360 --> 00:13:37,230
+بقى كله. عندي ال anatomy، وعندي ال principal cells و
+
+177
+00:13:37,230 --> 00:13:40,650
+intercalated cells. ليهم كلهم function، ليهم كلهم زي
+
+178
+00:13:40,650 --> 00:13:46,650
+بعض. إذا هدول جزئية واحدة، اللي هي ال late distal
+
+179
+00:13:46,650 --> 00:13:49,770
+زائد ال connecting زائد ال cortical connecting
+
+180
+00:13:49,770 --> 00:13:53,030
+هدول جزئية واحدة anatomically و functionally
+
+181
+00:13:53,030 --> 00:13:57,190
+و physiologically اللي بيشتغل نفس الشيء. تمام؟ إذا في
+
+182
+00:13:57,190 --> 00:14:00,030
+الحالة
+
+223
+00:17:17,470 --> 00:17:21,610
+يدخل ويعلى تركيزه
+
+224
+00:17:24,270 --> 00:17:27,250
+في علمنا الـ chloride channels على الـ basolateral
+
+225
+00:17:27,250 --> 00:17:36,610
+membrane تساعد على الانتشار من الخلايا إلى  الinterstitium
+
+226
+00:17:36,610 --> 00:17:44,050
+من تركيز أعلى في داخل الcells إلى الـ interstitium
+
+227
+00:17:44,050 --> 00:17:49,010
+حيث التركيز الأقل ماشي؟ طب البوتاسيوم هذا مغلبكم
+
+228
+00:17:49,010 --> 00:17:52,130
+البوتاسيوم هذا البوتاسيوم دخل، تركيزه عالي
+
+229
+00:17:52,130 --> 00:17:56,280
+concentration داخل الـ cytoplasm ومن الـ basolateral
+
+230
+00:17:56,280 --> 00:17:59,900
+membrane يعني الـ carrier system دخل البوتاسيوم والـ
+
+231
+00:17:59,900 --> 00:18:04,040
+.. الـ .. الـ atrial system دخل البوتاسيوم هيعمل
+
+232
+00:18:04,040 --> 00:18:08,700
+بوتاسيوم كتير في داخل ايه؟ مش مش .. ايه؟ اتفضلي
+
+233
+00:18:08,700 --> 00:18:12,980
+مشكلة لأنه .. لأن البوتاسيوم كان freely moved حسب
+
+234
+00:18:12,980 --> 00:18:15,420
+الـ concentration gradient يعني اللي دخل الـ cell
+
+235
+00:18:15,420 --> 00:18:18,540
+بيعمل back diffusion للـ interstitium أو بيعمل back
+
+236
+00:18:18,540 --> 00:18:22,260
+efflux .. diffusion لمين؟ بتفرغش معاه البوتاسيوم
+
+237
+00:18:22,260 --> 00:18:28,410
+بالذات كان ايه؟ بسهولة يقوم بعمل back-diffusion في
+
+238
+00:18:28,410 --> 00:18:33,670
+البرنامج الهان وهان طبعا أن الـ intercellular
+
+239
+00:18:33,670 --> 00:18:38,670
+route هان ما يتوجعش زي الآخر إنه هيعدي منه ايش إنه
+
+240
+00:18:38,670 --> 00:18:42,070
+water، إنه غير مميز للماء هذول الـ intercellular route
+
+241
+00:18:42,070 --> 00:18:46,210
+مميز للماء لكن بيعدي منه
+
+242
+00:18:49,020 --> 00:18:52,080
+السوديوم كما قلنا ممكن يقعد في الـ paracellular route إذا
+
+243
+00:18:52,080 --> 00:18:55,920
+كان الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+244
+00:18:55,920 --> 00:19:00,320
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+245
+00:19:00,320 --> 00:19:01,000
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+246
+00:19:01,000 --> 00:19:01,660
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+247
+00:19:01,660 --> 00:19:01,920
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+248
+00:19:01,920 --> 00:19:07,780
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+249
+00:19:07,780 --> 00:19:11,300
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+250
+00:19:11,300 --> 00:19:12,320
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+251
+00:19:12,320 --> 00:19:14,600
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+252
+00:19:14,600 --> 00:19:15,360
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+253
+00:19:15,360 --> 00:19:15,740
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+254
+00:19:17,290 --> 00:19:19,630
+المهم في الموضوع حاليًا أن في عندي magnesium
+
+255
+00:19:20,220 --> 00:19:28,320
+والكالسيوم يدخل هذه الجزئية ويحدث تجارب
+
+256
+00:19:28,320 --> 00:19:32,580
+تجريبية من خلال الانتقالات التجاربية هنا بيصير في
+
+257
+00:19:32,580 --> 00:19:38,720
+عندي transport للمغنيسيوم وللكالسيوم كبالضبط اللي هو
+
+258
+00:19:38,720 --> 00:19:41,920
+active transport والـ passive transport اللي هو
+
+259
+00:19:41,920 --> 00:19:46,300
+.. بس بيصير عندي نسبة reabsorption عالية لهذين الـ
+
+260
+00:19:46,300 --> 00:19:49,480
+ions المغنيسيوم والكالسيوم في هذه المنطقة، وسنـ
+
+261
+00:19:49,480 --> 00:19:51,880
+نتكلم إن شاء الله .. سنتكلم بعد ذلك عن
+
+262
+00:19:51,880 --> 00:19:55,060
+البروتينات .. سنتكلم بالتفصيل عن هذا الموضوع ..
+
+263
+00:19:55,060 --> 00:19:59,440
+تمام؟ لكن حاليًا، نحن نقول بتبقى عندي  entrance أو
+
+264
+00:19:59,440 --> 00:20:03,940
+reabsorption للمغنيسيوم و الكلوريد في الـ thick
+
+265
+00:20:03,940 --> 00:20:08,300
+ascending limb المغنيسيوم و الكالسيوم في الـ thick
+
+266
+00:20:08,300 --> 00:20:13,340
+ascending limb عبر الـ paracellular route .. تمام؟ طيب
+
+267
+00:20:14,260 --> 00:20:18,900
+لماذا؟ في تفسير، يعني أنه بيصير عندي
+
+268
+00:20:18,900 --> 00:20:22,800
+electronegativity
+
+269
+00:20:22,800 --> 00:20:28,920
+في داخل الـ interstitium مقابل الـ A مقابل more
+
+270
+00:20:28,920 --> 00:20:33,740
+positive filtrate بيؤدي إلى أن المغنزيوم والكلسيوم
+
+271
+00:20:33,740 --> 00:20:39,870
+يندفعان إلى الداخل، لأن الصوديوم ممكن يصير له back
+
+272
+00:20:39,870 --> 00:20:42,950
+diffusion، يؤدي إلى أن الصوديوم والبوتاسيوم يصير له
+
+273
+00:20:42,950 --> 00:20:45,990
+back diffusion، يصير الـ electronegativity موجودة
+
+274
+00:20:45,990 --> 00:20:48,870
+يؤدي إلى مثل أي مسألة بسيطة، المهم في الموضوع أنه
+
+275
+00:20:48,870 --> 00:20:53,910
+بيصير ايه؟ المغنيسيوم و الكالسيوم بيقدروا يعدوا، يصير لهم
+
+276
+00:20:53,910 --> 00:20:57,230
+reabsorption عبر ايه؟ الـ paracellular junction في
+
+277
+00:20:57,230 --> 00:21:00,850
+الطبقة الصاعدة، إذاً هنا عندنا الـ carrier هذا الـ carrier
+
+278
+00:21:00,850 --> 00:21:05,270
+مميز، النقطة الأولى أنه مميز، بعد ذلك سنتكلم عن الـ
+
+279
+00:21:05,270 --> 00:21:10,290
+early distal tubule، سنلاقي أنّه Sodium Chloride فقط، يعني
+
+280
+00:21:10,290 --> 00:21:14,290
+Sodium بخش، جبال الـ chloride،  ليست Sodium Chloride
+
+281
+00:21:14,290 --> 00:21:18,590
+بوتاسيوم، وهنا البوتاسيوم هو داخل وعوض طلع، يعني
+
+282
+00:21:18,590 --> 00:21:23,930
+قيمته غير كبيرة، فإذاً الـ carrier بعده، سنلاقي بس للـ
+
+283
+00:21:23,930 --> 00:21:29,450
+Sodium والـ chloride، هذه النقطة الأولى، أن طبيعة
+
+284
+00:21:29,450 --> 00:21:30,890
+الـ carrier، النقطة الثانية
+
+285
+00:21:34,320 --> 00:21:38,760
+النقطة الثانية المهمة في الموضوع أنّه clinically
+
+286
+00:21:38,760 --> 00:21:42,080
+سنَتكلّم في المستقبل عن شيء اسمه loop
+
+287
+00:21:42,080 --> 00:21:46,440
+diuretics، سنتكلم عن ايه؟ diuretics اللي هي مدرات
+
+288
+00:21:46,440 --> 00:21:51,360
+البول، مدرات البول بأنواعها، 500 ديورتكس، من ضمنها نوع
+
+289
+00:21:51,360 --> 00:21:54,680
+اسمه loop diuretics، يعني الـ diuretic اللي بيشتغل
+
+290
+00:21:54,680 --> 00:21:59,420
+من خلال عمله على الـ loop، يعني بمعنى أنه يُعطل
+
+291
+00:21:59,420 --> 00:22:03,320
+الـ transporter، هذا الـ Transporter الأقوى
+
+292
+00:22:03,320 --> 00:22:06,480
+Transporter في دراساته حتى الآن، One Sodium, One
+
+293
+00:22:06,480 --> 00:22:10,640
+Potassium, اثنين Chloride عبره، لو عطلناه، بيظل في
+
+294
+00:22:10,640 --> 00:22:13,460
+داخل الـ tubule Sodium كثير و Chloride كثير و
+
+295
+00:22:13,460 --> 00:22:17,220
+Potassium كثير، مش كده؟ هذول هم طالعين، بياخذوا
+
+296
+00:22:17,220 --> 00:22:22,990
+معهم ماء، مش هيك؟ لأن الايونات ستسحب معها ماء، تركيزها في
+
+297
+00:22:22,990 --> 00:22:25,910
+الداخل، لذلك الـ loop diuretics are strong
+
+298
+00:22:25,910 --> 00:22:32,430
+diuretics، بيشتغلوا، ولما بيشتغلوا بيبقى لهم rapid
+
+299
+00:22:32,430 --> 00:22:37,510
+onset و short duration، بيشتغلوا كمية كبيرة جدًا من
+
+300
+00:22:37,510 --> 00:22:43,190
+الماء خلال ثلاث أو أربع ساعات، The loop diuretics في
+
+301
+00:22:47,030 --> 00:22:51,230
+المستقبل ستستخدمونهم أنتم، لكن قلت لكم عيبهم أنه
+
+302
+00:22:51,230 --> 00:22:55,210
+سيشتغل بسرعة وسيُخرج كمية كبيرة، لذلك بياخذ
+
+303
+00:22:55,210 --> 00:22:57,890
+من يستخدم loop diuretics لا يذهب للعمل، عليه البقاء في
+
+304
+00:22:57,890 --> 00:23:02,390
+المنزل، لأنه سيذهب إلى الحمام ثلاث أو أربع أو خمس أو ست ساعات، هو رايح جاي
+
+305
+00:23:02,390 --> 00:23:07,090
+على الحمام، لذلك لا يذهب للعمل، بينما
+
+306
+00:23:07,090 --> 00:23:11,210
+أنّ النوع الثاني سأتكلم عنه بعد ذلك، Thiazide
+
+307
+00:23:11,210 --> 00:23:12,930
+diuretics، سيشتغل على الـ
+
+308
+00:23:16,410 --> 00:23:22,090
+سيشتغل على الـ sodium chloride carrier system، أضعف
+
+309
+00:23:22,090 --> 00:23:26,070
+كثيرًا من هذا الـ system، ولذلك له longer duration
+
+310
+00:23:26,070 --> 00:23:31,490
+أظن الكلام واضح، الكلام واضح أم لا يا بُناتي؟
+
+311
+00:23:31,490 --> 00:23:37,510
+واضح، بعد ذلك، سنَجِد transporter مختلف، أضعف، لذلك
+
+312
+00:23:37,510 --> 00:23:44,320
+نعمل له inhibition، ونمنع الـ sodium من الخروج في
+
+313
+00:23:44,320 --> 00:23:49,080
+transporter الضعيف، سنَجِد
+
+314
+00:23:49,080 --> 00:23:52,660
+أنّه الفرصة عندي أنا أن آخذ milder diuretic
+
+315
+00:23:52,660 --> 00:23:58,220
+diuretic أخف قليلًا، وله longer duration، لذلك
+
+316
+00:23:58,220 --> 00:24:02,660
+أقل ضررًا قليلًا، لأنه في النهاية، النتيجة واحدة، واحد
+
+317
+00:24:02,660 --> 00:24:09,760
+عمل عملًا كبيرًا في مسافة صغيرة، وواحد عمل عملًا كبيرًا في
+
+318
+00:24:09,760 --> 00:24:13,460
+مسافة طويلة، هو يبين أنه بطيء، لكن المدة الطويلة هذه
+
+319
+00:24:13,460 --> 00:24:22,120
+أعطته ايه؟ أعطته ميزة جيدة، إذاً في عندنا الـ system
+
+320
+00:24:22,120 --> 00:24:27,720
+الذي تكلمنا عنه، نرجع ثانية إلى الأعلى، لأنّ الصورة
+
+321
+00:24:27,720 --> 00:24:34,240
+أهميتها، دعونا نمشي شيئًا فشيئًا، طيب، إذاً الـ loop
+
+322
+00:24:34,240 --> 00:24:38,760
+فينجزئناه إلى جزئين، وقلنا أنّه في جزء من الأنبوب
+
+323
+00:24:38,760 --> 00:24:40,900
+يسمى ascending limb
+
+324
+00:24:47,040 --> 00:24:54,020
+و قلنا أنه عندنا الـ sodium one sodium two chloride
+
+325
+00:24:54,020 --> 00:25:00,560
+and one potassium، كـ transporter system، وحكينا أنه
+
+326
+00:25:00,560 --> 00:25:06,940
+عندنا الـ inhibitors التي تعمل blocking له
+
+327
+00:25:06,940 --> 00:25:10,760
+الـ transporter system، تمام؟ competitive inhibition له
+
+328
+00:25:10,760 --> 00:25:15,820
+فيمنع الـ sodium من الارتباط به، competitive
+
+329
+00:25:15,820 --> 00:25:21,320
+inhibition، فيصير عندي أنا ايه؟ اللي هو الـ effect of
+
+330
+00:25:21,320 --> 00:25:24,440
+loop diuretics، الـ loop diuretics، أشهرها اللي هو الـ
+
+331
+00:25:24,440 --> 00:25:28,520
+furosemide، اللي بنقول عليه ايه؟ لاسيكس، كلمة
+
+332
+00:25:28,520 --> 00:25:31,860
+diuretics، زي ما أحيانًا ننسى كلمة diuretics، نتذكر
+
+333
+00:25:31,860 --> 00:25:37,040
+كلمة ايه؟ لاسيكس، لاسيكس هو furosemide، الـ furosemide
+
+334
+00:25:37,040 --> 00:25:40,880
+هذا loop diuretic، معناه أنه strong diuretic، معناه
+
+335
+00:25:40,880 --> 00:25:47,520
+أنه ايه؟ strong diuretic، working for a few hours
+
+336
+00:25:47,520 --> 00:25:56,220
+in big intensity، في عندنا الفوروسيميد الأشهر، وعندنا
+
+337
+00:25:56,220 --> 00:26:04,160
+البومتانيد أقل شهرة، بيوميتانايد أقل شهرة أيضًا
+
+338
+00:26:04,160 --> 00:26:09,800
+لكن مشهور جدًا، الفوروسيميد، الفوروسيميد اللي هو لاسيكس
+
+339
+00:26:09,800 --> 00:26:15,000
+لاسيكس، فوروسيميد، احفظوها من اليوم، وأنّه على الـ route
+
+340
+00:26:15,000 --> 00:26:19,080
+على الـ path of the route، سيدخل المغنيسيوم، الكلوريد
+
+341
+00:26:19,080 --> 00:26:25,360
+أيضًا المغنيسيوم و الكالسيوم بالإضافة للصوديوم، لأن
+
+342
+00:26:25,360 --> 00:26:28,620
+الصوديوم والبوتاسيوم، بالفعل، من البداية، في الـ
+
+343
+00:26:28,620 --> 00:26:33,540
+proximal، كان يمر freely through the tight junction
+
+344
+00:26:33,540 --> 00:26:36,460
+هنا
+
+345
+00:26:42,500 --> 00:26:49,200
+الـ .. طيب .. إذا أكدنا هنا على أنه impermeable to
+
+346
+00:26:49,200 --> 00:26:56,740
+water، هذه الرسمة الخاصة بنا، وهذه الـ .. طيب .. okay
+
+347
+00:26:56,740 --> 00:27:01,660
+early distal tubule، فإذاً في حاجة ثانية ممكن ما
+
+348
+00:27:01,660 --> 00:27:05,900
+ذكرناها، نحن بخصوص الـ sodium hydrogen
+
+349
+00:27:09,800 --> 00:27:12,580
+الصوديوم هيدروجين، هنا ممكن نذكره في الجزء الذي
+
+350
+00:27:12,580 --> 00:27:15,880
+بعده، لما عندي أنا هان صوديوم هيدروجين counter
+
+351
+00:27:15,880 --> 00:27:19,660
+transport، أيضًا، وهذا يساعدني في الـ reabsorption of
+
+352
+00:27:19,660 --> 00:27:23,260
+ايه؟ of البيكربونات، سيكون التفاصيل في الجزء الذي
+
+353
+00:27:23,260 --> 00:27:26,480
+بعده أكثر، عندي صوديوم هيدروجين counter transport
+
+354
+00:27:26,480 --> 00:27:32,360
+في الـ early
+
+355
+00:27:32,360 --> 00:27:36,480
+distal tubule، يقولون أن الـ early distal tubule are
+
+356
+00:27:36,480 --> 00:27:41,730
+two parts، early والـ late، ايه اللي يفصل بينهم؟ ايه اللي يفصل بينهم؟
+
+357
+00:27:41,730 --> 00:27:45,930
+الـ thick ascending limb، الفرق اللي يفصل بينهم هو الـ
+
+358
+00:27:45,930 --> 00:27:50,850
+juxtaglomerular apparatus، طيب
+
+359
+00:27:50,850 --> 00:27:59,950
+الـ thick ascending limb تُخرج الفلترات
+
+360
+00:27:59,950 --> 00:28:06,580
+ساحبة منه كمية كبيرة من ايه؟ من الـ solutes، ويكمل
+
+361
+00:28:06,580 --> 00:28:08,840
+عليه هذا الجزء، هذا الجزء يُسمى diluting
+
+362
+00:28:08,840 --> 00:28:12,060
+segment، ليس فقط الـ early thick ascending limb، الـ
+
+363
+00:28:12,060 --> 00:28:17,200
+early distal tubule، تمام؟ الـ early distal tubule
+
+364
+00:28:17,200 --> 00:28:20,720
+مثل الـ thick ascending limb، هذا يُسمى diluting
+
+365
+00:28:20,720 --> 00:28:25,580
+segment، هذا الجزء الذي يعمل ايه؟ dilution، تمام؟
+
+366
+00:28:25,580 --> 00:28:30,830
+لأن قبل ذلك كان isosmotic، لكن يخرج من هذه المنطقة
+
+367
+00:28:30,830 --> 00:28:36,010
+من الـ thick ascending limb diluted، ويخرج من الـ
+
+368
+00:28:36,010 --> 00:28:40,350
+early distal أيضًا more diluted، فهذا الجزء يُسمى
+
+369
+00:28:40,350 --> 00:28:46,750
+ايه؟ diluting segment، approximately 5% of the
+
+370
+00:28:46,750 --> 00:28:49,150
+filtered load of sodium is reabsorbed here
+
+371
+00:28:49,150 --> 00:28:52,390
+لم نتكلم عن اسم الـ thick ascending limb، 25% of
+
+372
+00:28:52,390 --> 00:28:56,750
+the filtered sodium is reabsorbed في الـ thick
+
+373
+00:28:56,750 --> 00:29:00,560
+ascending limb، إذن، الخمسة والعشرون في الطبقة الصاعدة
+
+374
+00:29:00,560 --> 00:29:05,080
+وخمسة في الـ early distal، أصبح لدينا ثلاثون وخمسة
+
+375
+00:29:05,080 --> 00:29:09,900
+وستون في الـ  في الـ proximal، أصبح لدينا ايه؟ تسعون
+
+376
+00:29:09,900 --> 00:29:14,340
+فالمئة في هذه المناطق الثلاث، تسعون بالمئة، نحن
+
+377
+00:29:14,340 --> 00:29:17,580
+الصوديوم  عادةً لن يترك  reabsorption في الظروف
+
+378
+00:29:17,580 --> 00:29:20,660
+العادية، تسعة وتسعون بالمئة  سيترك  reabsorption
+
+379
+00:29:20,660 --> 00:29:24,480
+لكن في ظروف غير عادية، سنرى اختلافًا في النسبة
+
+380
+00:29:28,870 --> 00:29:32,030
+The sodium chloride cotransporter system
+
+381
+00:29:32,030 --> 00:29:36,450
+الـ basolateral system، الـ sodium و البوتاسيوم يتبع
+
+382
+00:29:36,450 --> 00:29:42,850
+الـ بنفس النظام، ما يتغيرش في كل الخلايا التي تتغير أن
+
+383
+00:29:42,850 --> 00:29:46,930
+هالـ sodium اللي داخل سيحرك الـ carrier system، ايه
+
+384
+00:29:46,930 --> 00:29:50,550
+الـ carrier system اللي موجود، هل موجود sodium و
+
+385
+00:29:50,550 --> 00:29:53,950
+Potassium و Chloride أم sodium و Chloride فقط، كان
+
+386
+00:29:53,950 --> 00:29:59,080
+موجود Sodium و Chloride فقط، الصوديوم الكلوريد co-
+
+387
+00:29:59,080 --> 00:30:02,980
+transporter، يتحرك الصوديوم الكلوريد من الـ
+
+388
+00:30:02,980 --> 00:30:08,140
+tubular lumen إلى الـ cell، تتعامل مع الصوديوم يعني
+
+389
+00:30:08,140 --> 00:30:11,220
+يدخل صوديوم و كلوريد، وليس صوديوم و بوتاسيوم و
+
+390
+00:30:11,220 --> 00:30:15,400
+اثنين كلوريد، وستجد الصورة الخاصة بنا، إذاً هنا الـ
+
+391
+00:30:15,400 --> 00:30:19,460
+carrier system، هو الصوديوم يدخل، ويدخل معه من؟
+
+392
+00:30:19,460 --> 00:30:23,060
+الكلوريد أيضًا، والكلوريد، تركيزه بيزيد
+
+393
+00:30:23,060 --> 00:30:27,460
+فالـ chloride channels هذه الموجودة تساعد في الـ
+
+394
+00:30:27,460 --> 00:30:30,940
+passive diffusion of chloride from inside the
+
+395
+00:30:30,940 --> 00:30:41
+
+445
+00:34:25,890 --> 00:34:30,480
+يا إما secretion of potassium يعني ممكن مرات إحنا
+
+446
+00:34:30,480 --> 00:34:32,520
+محتاجين البوتاسيوم، هو البوتاسيوم في الـ principle
+
+447
+00:34:32,520 --> 00:34:35,400
+cells، البوتاسيوم في الـ principle cells لكن
+
+448
+00:34:35,400 --> 00:34:38,000
+الهيدروجين هذا اللي secreted ممكن يكون مقابل
+
+449
+00:34:38,000 --> 00:34:41,500
+reabsorption of البوتاسيوم، لذا هنا بيصير عندي
+
+450
+00:34:41,500 --> 00:34:47,780
+secretion of هيدروجين، عندي هيدروجين ATPase، هنا عندي
+
+451
+00:34:47,780 --> 00:34:53,320
+pumping system، نوع ثالث مختلف تمامًا، عندي الـ carrier
+
+452
+00:34:53,320 --> 00:34:59,080
+system، هنا الـ pumping system يعني مش موجود على الـ
+
+453
+00:34:59,080 --> 00:35:03,460
+بيزولاترال ممبران، هذي عندي pumping system موجود
+
+454
+00:35:03,460 --> 00:35:09,320
+على الـ brush border واسمه hydrogen ATPase في الـ
+
+455
+00:35:09,320 --> 00:35:13,600
+intercalated cells، في حالة ما يكون في عندي
+
+456
+00:35:13,600 --> 00:35:16,780
+hydrogen...hydrogen ion concentration عالي في
+
+457
+00:35:16,780 --> 00:35:20,620
+داخل الجسم، بتتخلص منه، هذا مش فاعل في حالة ما يكون
+
+458
+00:35:20,620 --> 00:35:25,270
+إنّه بنخرج الهيدروجين وندخل بيكربونات أكثر، هذا الـ
+
+459
+00:35:25,270 --> 00:35:29,970
+system بيشتغل، هذا الـ system active، primary active
+
+460
+00:35:29,970 --> 00:35:33,490
+مش secondary active، primary active system for
+
+461
+00:35:33,490 --> 00:35:37,930
+secretion of إيه؟ of hydrogen، لذلك لما نقارنه بالـ
+
+462
+00:35:37,930 --> 00:35:43,050
+counter transport في الـ secondary active system
+
+463
+00:35:43,050 --> 00:35:46,050
+اللي موجود في الـ proximal tubule، اللي هنلاقي
+
+464
+00:35:46,050 --> 00:35:51,180
+الفرق إيه؟ الفرق ضخم، هنا يستطيع هذا الـ system إنّه
+
+465
+00:35:51,180 --> 00:35:58,280
+يشتغل secretion بوتاسيوم بوتاسيوم
+
+466
+00:35:58,280 --> 00:36:01,980
+بوتاسيوم
+
+467
+00:36:01,980 --> 00:36:08,560
+بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم
+
+468
+00:36:08,560 --> 00:36:09,560
+بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم
+
+469
+00:36:09,560 --> 00:36:10,380
+بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم
+
+470
+00:36:10,380 --> 00:36:16,300
+بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم
+
+471
+00:36:16,300 --> 00:36:16,360
+بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم
+
+472
+00:36:16,360 --> 00:36:18,170
+بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم بوتاسيوم هنا ممكن
+
+473
+00:36:18,170 --> 00:36:22,070
+يكون الفرق الـ concentration ألف ضعف و still
+
+474
+00:36:22,070 --> 00:36:26,490
+pumping hydrogen to the...to the filtrate to be
+
+475
+00:36:26,490 --> 00:36:30,110
+secreted to the...to the urine، في حين أن الـ
+
+476
+00:36:30,110 --> 00:36:32,890
+proximal tubule الـ pumping system، الـ secondary
+
+477
+00:36:32,890 --> 00:36:37,970
+active system فيه بيقدر يشتغل against أربعة إلى
+
+478
+00:36:37,970 --> 00:36:41,470
+عشرة أضعاف الـ...الـ...الـ plasma concentration
+
+479
+00:36:41,470 --> 00:36:46,840
+تمام؟ إذًا الـ...الـ...الـ pumping system هنا هو
+
+480
+00:36:46,840 --> 00:36:51,440
+بيشتغل against one thousand difference
+
+481
+00:36:51,440 --> 00:36:55,540
+concentration of hydrogen، الثاني من أربعة إلى عشرة
+
+482
+00:36:55,540 --> 00:37:01,200
+لذلك هو هذا الـ main buffering system، هنا موجود الـ
+
+483
+00:37:01,200 --> 00:37:05,080
+main system that controls the pH، هنا لإنه يستطيع
+
+484
+00:37:05,080 --> 00:37:10,220
+إنّه يطلع كميات غير عادية من الهيدروجين، تمام؟ هذا في
+
+485
+00:37:10,220 --> 00:37:14,180
+الـ intercalated cells، أما الـ principal cells فهي
+
+486
+00:37:14,180 --> 00:37:17,960
+بتعمل reabsorption of sodium to secrete بوتاسيوم
+
+487
+00:37:17,960 --> 00:37:22,100
+مصممة لتسكيريت بوتاسيوم، لأنه طبيعة أكلنا، ربنا خلقنا
+
+488
+00:37:22,100 --> 00:37:26,520
+الأكل فيه بوتاسيوم زيادة، تمام؟ فدائمًا في system
+
+489
+00:37:26,520 --> 00:37:30,660
+موجود عندي إنّي أتخلص من البوتاسيوم الزيادة، إلا إذا
+
+490
+00:37:30,660 --> 00:37:34,880
+كان في عندي دواء معين، مرض معين على البوتاسيوم
+
+491
+00:37:41,730 --> 00:37:47,210
+السيستم الأنترجلية، السلسلة تبقى تبقى تبقى تبقى
+
+492
+00:37:47,210 --> 00:37:57,950
+تبقى تبقى تبقى تبقى تبقى
+
+493
+00:37:57,950 --> 00:38:01,910
+تبقى تبقى تبقى
+
+494
+00:38:04,520 --> 00:38:09,440
+البرينسيبل سيلز، تمام؟ الـ ATPase system هذا موجود على
+
+495
+00:38:09,440 --> 00:38:13,700
+الـ basolateral membrane، ماشي؟ وفي المقابل وفي
+
+496
+00:38:13,700 --> 00:38:18,200
+عندي sodium channels و potassium في sodium
+
+497
+00:38:18,200 --> 00:38:21,820
+channels و potassium channels، هذا إيش بنتكلم؟ عامين
+
+498
+00:38:21,820 --> 00:38:30,080
+إحنا على...على الـ...الـ late distal convoluted tubule، إحنا
+
+499
+00:38:30,080 --> 00:38:33,940
+اتكلمنا عن نظامين من الـ diuretics، مظبوط؟ loop diuretics
+
+500
+00:38:33,940 --> 00:38:37,680
+و thiazide diuretics، thiazide الـ system موجود في الـ late
+
+501
+00:38:37,680 --> 00:38:43,040
+distal، إحنا نتكلم عن الـ late distal اللي يمثل
+
+502
+00:38:43,040 --> 00:38:46,740
+الـ late distal، الـ connecting و الـ cortical
+
+503
+00:38:46,740 --> 00:38:50,160
+connecting، مظبوط؟ الـ system هنا فيه موجود عبارة عن
+
+504
+00:38:50,160 --> 00:38:54,160
+إيش؟ عندي صوديوم و بوتاسيوم، Na+/K+ pumping system
+
+505
+00:38:54,160 --> 00:38:58,320
+وعندي potassium channels وعندي إيه؟ sodium channels
+
+506
+00:38:58,320 --> 00:39:01,960
+هدول الـ channels، هدول بيفتحوا according to the
+
+507
+00:39:01,960 --> 00:39:08,950
+needs، مش...مش...مش...بدخله عن طريق carrier system
+
+508
+00:39:08,950 --> 00:39:12,230
+زي ما اتكلمنا عنه، لأ، هدول channels موجودة بتفتح و
+
+509
+00:39:12,230 --> 00:39:15,690
+بتسكر حسب الحاجة، إذا في عندي والله ألدوستيرون كثير
+
+510
+00:39:15,690 --> 00:39:19,030
+عندي ألدوستيرون كثير، معناه هدول الـ system فاتح
+
+511
+00:39:19,030 --> 00:39:22,890
+تمام؟ إذا فش عندي ألدوستيرون كثير، هدول الـ system
+
+512
+00:39:22,890 --> 00:39:28,210
+إيه؟ مسكر، ألدوستيرون هجيب نفسي لكِ الأول مرة هنا
+
+513
+00:39:28,210 --> 00:39:35,940
+نتكلم، إذا عندي أنا هنا الـ ألدوستيرون، وجوده بينشط لي الـ
+
+514
+00:39:35,940 --> 00:39:41,260
+Na+/K+ ATPase system، هنا إذا الألدوستيرون من أعماله الرئيسية
+
+515
+00:39:41,260 --> 00:39:47,660
+it activates the Na+/K+ ATPase pumping system in the
+
+516
+00:39:47,660 --> 00:39:52,220
+late part of the distal tubule
+
+517
+00:39:52,220 --> 00:39:55,160
+in the late part of the distal tubule، نقول second
+
+518
+00:39:55,160 --> 00:39:59,310
+part أو late part، the same، كلمة الـ system هذا يزيد
+
+519
+00:39:59,310 --> 00:40:03,270
+شغله، كلمة الـ sodium concentration هذا جاب كلمة
+
+520
+00:40:03,270 --> 00:40:09,810
+influx of sodium، زاد، طب تصوروا إنّي جبت system
+
+521
+00:40:09,810 --> 00:40:14,410
+to block the aldosterone effect، آه، إذا أنا عملت
+
+522
+00:40:14,410 --> 00:40:18,210
+blocking للـ aldosterone effect، anti-aldosterone
+
+523
+00:40:18,210 --> 00:40:22,110
+drugs، هاد الـ anti-aldosterone drugs it will
+
+524
+00:40:22,110 --> 00:40:30,060
+compete here, prevent what will decrease the system
+
+525
+00:40:30,060 --> 00:40:37,920
+activity، وهذا هيقدر إلى أن الـ sodium influx هيقل و
+
+526
+00:40:37,920 --> 00:40:45,240
+الـ potassium secretion هيقل، مش هيك معايا أنتو
+
+527
+00:40:45,240 --> 00:40:53,110
+لحظة، هذا الـ system اللي هو الـ diuretics، هنا
+
+528
+00:40:53,110 --> 00:40:55,770
+يسميها إيه؟ الـ diuretics، هنا الـ diuretics، هنا
+
+529
+00:40:55,770 --> 00:40:57,550
+الـ diuretics، هنا الـ diuretics، هنا الـ diuretics، هنا
+
+530
+00:40:57,550 --> 00:41:00,630
+الـ diuretics، هنا الـ diuretics، هنا الـ diuretics، هنا
+
+531
+00:41:00,630 --> 00:41:02,330
+الـ diuretics، هنا الـ diuretics، هنا الـ diuretics، هنا
+
+532
+00:41:02,330 --> 00:41:04,890
+الـ diuretics، هنا الـ diuretics، هنا الـ diuretics، هنا
+
+533
+00:41:04,890 --> 00:41:06,950
+الـ diuretics، هنا الـ diuretics، هنا الـ diuretics، هنا
+
+534
+00:41:06,950 --> 00:41:08,790
+الـ diuretics، هنا الـ diuretics، هنا الـ diuretics، هنا
+
+535
+00:41:08,790 --> 00:41:19,210
+الـ diuretics، هنا الـ diuretics، هنا الـ diuretics
+
+536
+00:41:19,210 --> 00:41:23,520
+هنا، تلاحظوا إيش ميزة؟ إنّه إذا وقفت الـ system هذا
+
+537
+00:41:23,520 --> 00:41:28,680
+بأمنع دخول الـ sodium، معناه في sodium أكثر بيطلع
+
+538
+00:41:28,680 --> 00:41:32,460
+مع إيه؟ مع الـ urine، مش هيك؟ معناه في sodium و
+
+539
+00:41:32,460 --> 00:41:36,140
+water أكثر، معناه diuretic effect، مش هيك؟ لكن في
+
+540
+00:41:36,140 --> 00:41:40,530
+نفس الوقت منع الـ secretion of potassium، لأن هدول الـ
+
+541
+00:41:40,530 --> 00:41:44,410
+principal cells are mainly secretors of potassium
+
+542
+00:41:44,410 --> 00:41:47,650
+فلما أمنع الـ secretion of potassium أنا بحافظ على
+
+543
+00:41:47,650 --> 00:41:54,210
+الـ potassium وين؟ في داخل الجسم، إذًا هذا الـ system
+
+544
+00:41:54,210 --> 00:41:58,550
+الـ aldosterone antagonist، الـ system الوحيد اللي هو
+
+545
+00:41:58,550 --> 00:42:03,240
+retaining potassium، تمام؟ يعني مش هو هو اللي
+
+546
+00:42:03,240 --> 00:42:06,060
+بنتكلم عنه، هذا الـ...الـ diuretics مش على الـ...على الـ
+
+547
+00:42:06,060 --> 00:42:10,700
+late distal، هم returning إيه؟ بوتاسيوم، بيحافظوا
+
+548
+00:42:10,700 --> 00:42:13,100
+على الـ...مش زي الـ other diuretics، الـ other
+
+549
+00:42:13,100 --> 00:42:16,020
+diuretics هم اللي راح تستخدموهم أنتم وهيكون من
+
+550
+00:42:16,020 --> 00:42:20,300
+ضمن الوصفات اللي تكتبوها، آه، potassium chloride
+
+551
+00:42:20,300 --> 00:42:25,170
+tablets، بوتاسيوم كلوريد تابلتز بتاعتها مباشرة
+
+552
+00:42:25,170 --> 00:42:29,410
+بوتاسيوم كلوريد تابلتز تاعتها مباشرة، بوتاسيوم
+
+553
+00:42:29,410 --> 00:42:30,910
+كلوريد تابلتز تاعتها مباشرة، بوتاسيوم كلوريد
+
+554
+00:42:30,910 --> 00:42:32,430
+تابلتز تاعتها مباشرة، بوتاسيوم كلوريد تابلتز
+
+555
+00:42:32,430 --> 00:42:33,490
+تاعتها مباشرة، بوتاسيوم كلوريد تابلتز تاعتها
+
+556
+00:42:33,490 --> 00:42:34,330
+مباشرة، بوتاسيوم كلوريد تابلتز تاعتها مباشرة
+
+557
+00:42:34,330 --> 00:42:34,610
+بوتاسيوم كلوريد تابلتز تاعتها مباشرة، بوتاسيوم
+
+558
+00:42:34,610 --> 00:42:38,610
+كلوريد تابلتز تاعتها مباشرة، بوتاسيوم كلوريد
+
+559
+00:42:38,610 --> 00:42:42,520
+تابلتز، تمام؟ بس بتمنع الـ absorption of sodium أو
+
+560
+00:42:42,520 --> 00:42:46,460
+بتمنع الـ absorption of بوتاسيوم، بتمنع الجسم من
+
+561
+00:42:46,460 --> 00:42:50,440
+البوتاسيوم، عندنا مشكلة كبيرة إذا...لإن الـ plasma
+
+562
+00:42:50,440 --> 00:42:54,760
+level of بوتاسيوم اللي فيها قليل، فإذا أنا نقصته بيصير
+
+563
+00:42:54,760 --> 00:42:58,560
+عندي hypokalemia، الـ hypokalemia بتأثر على العضلات
+
+564
+00:42:58,560 --> 00:43:02,860
+القلبية، بتأثر على القلب، تمام؟ فبتعمل لي مشاكل، فلذلك أنا
+
+565
+00:43:02,860 --> 00:43:06,340
+بيدحافظ على البوتاسيوم على مستوى الـ A في الـ extracellular
+
+566
+00:43:06,340 --> 00:43:10,740
+fluid في الـ interstitium، من هنا يوجد نوعين من
+
+567
+00:43:10,740 --> 00:43:16,000
+diuretics، نوع من الـ diuretics بيطلع الجسم من
+
+568
+00:43:16,000 --> 00:43:19,060
+البوتاسيوم، بيخرج الـ صوديوم والبوتاسيوم مع بعض في
+
+569
+00:43:19,060 --> 00:43:24,840
+اليورين، ونوع ثاني لأ، نوع ثاني بيمنع الـ secretion
+
+570
+00:43:24,840 --> 00:43:32,060
+من الـ...من البوتاسيوم، البوتاسيوم، يحفظ الـ diuretics
+
+571
+00:43:33,800 --> 00:43:38,500
+بتعمل preservation للبوتاسيوم، لذلك هذا النوع الـ
+
+572
+00:43:38,500 --> 00:43:42,880
+aldosterone antagonist بيشتغل على الـ distal tubule
+
+573
+00:43:42,880 --> 00:43:47,760
+ليه الـ distal؟ وفي الحالة هذه هو بيمنع الـ
+
+574
+00:43:47,760 --> 00:43:49,680
+secretion من البوتاسيوم، بيخلي البوتاسيوم...يعني
+
+575
+00:43:49,680 --> 00:43:53,300
+لما أنا بكتب هذا النوع ما بكتب معه بوتاسيوم،
+
+576
+00:43:53,300 --> 00:43:57,640
+ما بلزمّنّيش، تمام؟ هذا النوع أنا ما بلزمّنّيش إنّه يكون فيه
+
+577
+00:43:57,640 --> 00:43:57,920
+إيش
+
+578
+00:44:04,870 --> 00:44:10,650
+عشان أعوّض اللي بدي أفقدّه فيه، بمحتاجة، إذا هذا الـ
+
+579
+00:44:10,650 --> 00:44:12,150
+Aldosterone Antagonist Effect
+
+580
+00:44:17,090 --> 00:44:22,050
+يدخل الصوديوم وبيتقسم تحت تأثير الـ system الـ
+
+581
+00:44:22,050 --> 00:44:27,170
+ألدوستيرون عالي، هذا الـ system بيشتغل، معلش، هذا الـ
+
+582
+00:44:27,170 --> 00:44:31,210
+system بتوقّف، وإذا الـ system توقف ما فيش صوديوم
+
+583
+00:44:31,210 --> 00:44:35,090
+هيدخل، الصوديوم هيدخل إيه؟ طالع برا، لذا هذه
+
+584
+00:44:35,090 --> 00:44:38,650
+الجزئية تشتغل، بتدخل الصوديوم، بتدخل وبتتقسم أو
+
+585
+00:44:38,650 --> 00:44:41,870
+بتدخل الصوديوم وبتطلع وبتتقسم حسب إيه؟ حسب حاجة
+
+586
+00:44:41,870 --> 00:44:48,230
+الجسم، هذا الـ principal إيه؟ cells، طيب عندي هنا الـ
+
+587
+00:44:48,230 --> 00:44:51,150
+cells، هذه زي ما قلنا إنّ فيها Na+/K+ ATPase system، بتنشّط و
+
+588
+00:44:51,150 --> 00:44:54,730
+بتشتغل، وقلنا هنا فيها عندنا potassium channels و
+
+589
+00:44:54,730 --> 00:45:00,050
+إيش؟ و sodium channels، لما بتدخل الـ sodium، آه، لما
+
+590
+00:45:00,050 --> 00:45:08,150
+بدخل الـ sodium، الـ system هذا بيشتغل، لما الـ sodium
+
+591
+00:45:08,150 --> 00:45:12,310
+يدخل، الـ system، الـ Na+/K+ ATPase system بيبقى شغال، لإنّه هو
+
+592
+00:45:12,310 --> 00:45:17,110
+بيبقى اللي بيطلع الـ sodium ويدخل بوتاسيوم، لكن إذا
+
+593
+00:45:17,110 --> 00:45:21,530
+أنا الـ sodium سكرت الـ channel تبعه وبطّل الـ sodium
+
+594
+00:45:21,530 --> 00:45:25,890
+يدخل من الـ tubule، من الـ tubular filtrate، بطّل
+
+595
+00:45:25,890 --> 00:45:28,750
+الصوديوم يدخل لداخل الـ what؟ هدول الـ cells اللي هم
+
+596
+00:45:28,750 --> 00:45:33,490
+الـ late distal tubules، بسبب إنّي سكرت الـ channel
+
+597
+00:45:33,490 --> 00:45:37,930
+sodium channel blockers، بيسمّوهم إيش؟ sodium channel
+
+598
+00:45:37,930 --> 00:45:41,410
+blockers، إذا أنا سكرت الـ channel هذه، الصوديوم
+
+599
+00:45:41,410 --> 00:45:45,880
+ما لحقش داخل الـ cells، نتيجة لطرد الصوديوم إلى خارج
+
+600
+00:45:45,880 --> 00:45:50,700
+الـ cells عن طريق الـ system، تمام؟ هذا الـ system
+
+601
+00:45:50,700 --> 00:45:54,080
+بيطرد الصوديوم لبرا أو بياخذ من الـ cytoplasm، في
+
+602
+00:45:54,080 --> 00:45:56,620
+المقابل بدخل من الـ channel، سكرنا الـ channel
+
+603
+00:45:56,620 --> 00:46:00,120
+الصوديوم، بطّل يدخل لمين؟ لداخل الـ cells، الـ pumping
+
+604
+00:46:00,120 --> 00:46:04,820
+system هيوقف، عشان...هو عشان يدخل بوتاسيوم محتاج
+
+605
+00:46:04,820 --> 00:46:08,480
+يطلع Sodium، ما فيش Sodium بيطلع، معناه ما فيش
+
+606
+00:46:08,480 --> 00:46:12,620
+بوتاسيوم بيدخل، معناه ما فيش hyper-concentration of
+
+607
+00:46:12,620 --> 00:46:15,420
+...of بوتاسيوم، يعني معناه الـ...الـ...البوتاسيوم كان
+
+608
+00:46:15,420 --> 00:46:19,420
+موجود، لكن الـ...الـ cytoplasmic concentration of
+
+609
+00:46:19,420 --> 00:46:24,360
+...of بوتاسيوم انخفض بسبب إنّه إيش؟ الـ pumping
+
+610
+00:46:24,360 --> 00:46:28,100
+system توقف عن العمل، طبعًا هو هيطلع البوتاسيوم يطلع و
+
+611
+00:46:28,100 --> 00:46:31,160
+يطلع حين يتساوى، وبعدين ما فيش شيء جديد يدخل، لما...
+
+612
+00:46:31,160 --> 00:46:35,100
+لما الـ sodium بطّل يدخل، بطّل الـ potassium من إيه؟ من
+
+613
+00:46:35,100 --> 00:46:38,540
+الـ interstitium يدخل لداخل الـ cells، تمام؟ إذا هنا
+
+614
+00:46:38,540 --> 00:46:42,000
+غريبة جدًا إنّ الـ sodium channel blockers، هدول الـ
+
+615
+00:46:42,000 --> 00:46:44,420
+sodium channel blockers preserving الـ potassium
+
+616
+00:46:44,420 --> 00:46:48,540
+concentration
+
+667
+00:50:09,540 --> 00:50:13,960
+concentration في الـ tubule ألف ضعف الـ .. الـ .. الـ
+
+668
+00:50:13,960 --> 00:50:17,180
+interstitial system أو الـلى بلازم برضه بضلاش
+
+669
+00:50:17,180 --> 00:50:22,540
+يطلعها لأن هو شغلته هيدروجين معناها اللى بتحكم في
+
+670
+00:50:22,540 --> 00:50:28,500
+الهيدروجين، بالإعطاء بتحكم في الـ bicarbonate الآخر
+
+671
+00:50:28,500 --> 00:50:32,720
+لأن هدول عكس بعض، عشان أنا أحسن الـ pH، بدي أغير الـ
+
+672
+00:50:32,720 --> 00:50:35,660
+hydrogen في مقابل الـ bicarbonate أو الـ carbonate
+
+673
+00:50:35,660 --> 00:50:39,420
+في مقابله، يعني اتنين عكس بعض، تمام؟ عندي acidity
+
+674
+00:50:39,420 --> 00:50:41,780
+عالية، بيطلع الـ hydrogen أكثر، و آخد الـ bicarbonate
+
+675
+00:50:41,780 --> 00:50:45,760
+أكثر، عندي لأ، ماثرتي مش عالية، فيه ميل لـالكلوميا
+
+676
+00:50:45,760 --> 00:50:50,700
+تمام؟ فبروح أنا ما أطلعش الـ bicarbonate، بصير أعمل
+
+677
+00:50:50,700 --> 00:50:56,210
+عملت إيه؟ reabsorption لميل للبوتاسيوم لحاله قبل
+
+678
+00:50:56,210 --> 00:51:07,950
+كده اتكلمنا عن الـ
+
+679
+00:51:07,950 --> 00:51:12,950
+counter transport، الهيدروجين هذا يتفاعل مع
+
+680
+00:51:12,950 --> 00:51:16,650
+البيكربونات حول كربون ديوكسيد، وميّة، و
+
+681
+00:51:16,650 --> 00:51:19,630
+كربون ديوكسيد كان بي reabsorb، فكده نعمل
+
+682
+00:51:19,630 --> 00:51:23,800
+reabsorption للبيكربونات، متكلم عنه، كنا luminal
+
+683
+00:51:23,800 --> 00:51:27,920
+process، هو فيه لما يدخل داخل الـ cells، بيصير العكس
+
+684
+00:51:27,920 --> 00:51:33,440
+بتحلل، برجع لـ .. لـ .. لـ carbonic acid من جديد، والـ
+
+685
+00:51:33,440 --> 00:51:37,720
+carbonic acid بتحلل تحت تأثير طبعا الـ .. الـ
+
+686
+00:51:37,720 --> 00:51:41,280
+carbonic anhydrase إلى bicarbonate و water، و
+
+687
+00:51:41,280 --> 00:51:45,360
+hydrogen، الـ hydrogen يعني استخدامه في الـ secretion
+
+688
+00:51:45,360 --> 00:51:47,980
+في الـ counter transport تماما، والـ bicarbonate
+
+689
+00:51:47,980 --> 00:51:51,730
+enters the إيه؟ the blood، مش كده؟ وبكده بيكون أنا
+
+690
+00:51:51,730 --> 00:51:54,950
+جابت الـ bicarbonate من هنا لهنا، عبر مين؟ mediated
+
+691
+00:51:54,950 --> 00:52:00,910
+by مين؟ by hydrogen ions، هنا نفس الـ system في داخل
+
+692
+00:52:00,910 --> 00:52:04,270
+الـ cells، نفس الـ system في داخل الـ cells، إنه أنا
+
+693
+00:52:04,270 --> 00:52:09,270
+لما عندي الـ hydrogen تكون من الـ system هذا اللي
+
+694
+00:52:09,270 --> 00:52:11,850
+هو carbon dioxide، زي اللي هو طبعا من الـ carbonic
+
+695
+00:52:11,850 --> 00:52:15,810
+acid، طبعا activated by carbonic anhydrase، هذه
+
+696
+00:52:15,810 --> 00:52:19,950
+اتحلل الـ bicarbonate، إيه؟ والهيدروجين، الهيدروجين
+
+697
+00:52:19,950 --> 00:52:24,410
+يستخدم في الـ secretion، والـ bicarbonate إيه؟ is
+
+698
+00:52:24,410 --> 00:52:31,430
+reabsorbed again، تمام؟ هنا نعمل
+
+699
+00:52:31,430 --> 00:52:36,090
+pumping لمين؟ للهيدروجين لبرا، لاحظوا هنا الـ system
+
+700
+00:52:36,090 --> 00:52:38,230
+الأولى، اتكلمنا عنه في الـ production of the  بيكربونيت
+
+701
+00:52:38,230 --> 00:52:41,410
+كان بيهتم إنه في إيش؟ في الـ يوم، البيكربونيت أدخله
+
+702
+00:52:41,410 --> 00:52:45,390
+ولا ما أدخلوش، عبر الـ hydrogen ions، لأن إحنا بنتكلم
+
+703
+00:52:45,390 --> 00:52:49,270
+قاعدين إن إحنا بندخل أو بنطلع carbon dioxide حسب
+
+704
+00:52:49,270 --> 00:52:57,050
+حاجتنا، في كده نرحل الـ hydrogen، لإنه عندي أنا، عندي
+
+705
+00:52:57,050 --> 00:53:02,530
+موجود في داخل الجسم هيدروجين أيون، كمية كبيرة، بدأ
+
+706
+00:53:02,530 --> 00:53:05,510
+أتخلص منها، بدي أعمل لها secretion، فبحتاج إنه
+
+707
+00:53:05,510 --> 00:53:07,610
+يدخل الـ carbon dioxide عليا من الـ interstitium
+
+708
+00:53:07,610 --> 00:53:12,990
+تمام؟ وفي الـ interstitium هنا أنا بعمل عملية
+
+709
+00:53:12,990 --> 00:53:17,110
+تحويله بالـ carbonic anhydrase إلى carbonic acid، و
+
+710
+00:53:17,110 --> 00:53:19,930
+الـ carbonic acid باخد منه hydrogen وبارميه برا
+
+711
+00:53:19,930 --> 00:53:23,850
+تمام؟ إذًا نستخدم الـ carbon dioxide في أن أحلل
+
+712
+00:53:23,850 --> 00:53:30,530
+الميّة إلى .. إلى hydrogen طلع برا، و OH اتحد مع مين؟
+
+713
+00:53:30,530 --> 00:53:33,390
+في المحصلة يعني، مع الـ carbon dioxide يعمل لي
+
+714
+00:53:33,390 --> 00:53:37,370
+بيكربونات، كده بكون أنا أخدت hydrogen ions من الميّة
+
+715
+00:53:37,370 --> 00:53:40,510
+وسابقاً سبت الـ OH ions في الميّة، كده بكون أنا بخلص
+
+716
+00:53:40,510 --> 00:53:46,020
+الجسم من الـ hydrogen ions، دبعتها، إذًا هنا
+
+717
+00:53:46,020 --> 00:53:50,040
+نتكلم على هذه الـ intercalated cells، وقلنا إنها
+
+718
+00:53:50,040 --> 00:53:58,540
+mainly .. mainly .. mainly بيصير هنا
+
+719
+00:53:58,540 --> 00:54:07,370
+الـ .. both late and early، السلاسل المتعارفة من هذه
+
+720
+00:54:07,370 --> 00:54:12,990
+الـ مناطق النيفرون تحفز حيوانات الهيدروجين عن طريق
+
+721
+00:54:12,990 --> 00:54:17,790
+ميكانيزم ATBA، الهيدروجين هذا الـ process مختلف عن
+
+722
+00:54:17,790 --> 00:54:22,190
+تحفز حيوانات الهيدروجين عن طريق الـ proximal tubule
+
+723
+00:54:22,190 --> 00:54:26,690
+لأنه قادر على تحفز حيوانات الهيدروجين عن طريق
+
+724
+00:54:26,690 --> 00:54:34,140
+ميكانيزم الهيدروجين، كمية 1000 إلى 1 بالنسبة
+
+725
+00:54:34,140 --> 00:54:37,700
+للمقارنة الصغيرة، من أربعة إلى عشرة ضد واحدة
+
+726
+00:54:37,700 --> 00:54:42,600
+لحيوانات الهيدروجينية التي يمكن تحقيقها باستخدام
+
+727
+00:54:42,600 --> 00:54:45,840
+الاستخدام الثانوية في الـ proximal tubule. لذلك،
+
+728
+00:54:45,840 --> 00:54:49,820
+تلعب الخلايا الانتركاليتد دورًا أساسيًا في التحكم
+
+729
+00:54:49,820 --> 00:54:55,340
+الأساسي في المواد الجسمية. برضه بدنا نقول أن
+
+730
+00:54:55,340 --> 00:55:01,580
+البيرميابيليتي للسوديوم والماء هنا في المنطقة هذه
+
+731
+00:55:01,580 --> 00:55:07,160
+تعتمد على availability of aldosterone أو
+
+732
+00:55:07,160 --> 00:55:08,280
+ال antidiuretic hormone
+
+733
+00:55:11,450 --> 00:55:17,310
+هرمون اسمه كان اسمه زمان vasopressin، vasopressin
+
+734
+00:55:17,310 --> 00:55:20,870
+لأنه لما يعلى كثير بيصير vasoactive، بيعمل
+
+735
+00:55:20,870 --> 00:55:24,610
+vasoconstriction، لكن هو الـ dose تبعته قليلة في
+
+736
+00:55:24,610 --> 00:55:29,810
+physiological levels، قليلة، بيحافظ على إنه بس يمنع
+
+737
+00:55:29,810 --> 00:55:34,810
+الميّة أن تـ be excreted من الـ nephron، لكن لو الميّة اللي
+
+738
+00:55:34,810 --> 00:55:38,710
+excreted من الـ nephron مش excreted، وبرضه عندي hypo
+
+739
+00:55:39,190 --> 00:55:42,710
+volemia، البلازما برضه، آه، فالـ aldosterone الهرمون
+
+740
+00:55:42,710 --> 00:55:46,230
+بيعلى أكثر، وبساعد في إنه يساعد الـ blood pressure
+
+741
+00:55:46,230 --> 00:55:50,450
+يستعاد من خلال الـ vaso-spasms، طبعا هذا الـ system
+
+742
+00:55:50,450 --> 00:55:53,730
+كله، الـ aldosterone، والـ antidiuretic hormone، و
+
+743
+00:55:53,730 --> 00:55:57,090
+الـ angiotensin 2، والـ renin system، هذا كلهم شغلتهم
+
+744
+00:55:57,090 --> 00:56:01,240
+يحافظوا على مين؟ يحافظوا على الـ blood pressure، يحافظ
+
+745
+00:56:01,240 --> 00:56:04,180
+على مين؟ الشغل الأساسي تبعهم يحافظ على الـ blood
+
+746
+00:56:04,180 --> 00:56:07,000
+pressure، الـ blood pressure بتحافظ على أن ازيد
+
+747
+00:56:07,000 --> 00:56:14,280
+الميّة اللي فيه بمنعها من التسرب عبر الكلية، تمام؟
+
+748
+00:56:14,280 --> 00:56:18,280
+أو ازيد الـ contraction of blood vessels، لأن ازدت
+
+749
+00:56:18,280 --> 00:56:21,840
+الـ vasoconstriction ميعلى الضغط، إذا ازدت الـ volume اللي
+
+750
+00:56:21,840 --> 00:56:26,140
+في داخل جسمه، ميعلى الضغط، مش كده؟ طيب
+
+751
+00:56:28,970 --> 00:56:33,770
+Medullary Collecting Duct، الجزء الأخير من
+
+752
+00:56:33,770 --> 00:56:40,010
+الموضوع، إحنا وصلنا لأن لما .. طبعاً إحنا في الفصل
+
+753
+00:56:40,010 --> 00:56:44,950
+الجاى بنتكلم عن الأرقام، بس لأن لما إنه الـ .. الـ
+
+754
+00:56:44,950 --> 00:56:46,230
+thickening lab اشتغلت
+
+755
+00:56:48,750 --> 00:56:53,370
+الجزئية اللي هتوصل المدلة لدك تعتمد على الـ
+
+756
+00:56:53,370 --> 00:56:59,090
+functions اللي موجودة في الـ medullary collecting duct
+
+757
+00:56:59,090 --> 00:57:07,670
+الـ medullary collecting duct هذه، ممكن تحول الـ filtrate هذا
+
+758
+00:57:07,670 --> 00:57:11,750
+إلى more diluted، إذا عملنا more reabsorption of
+
+759
+00:57:11,750 --> 00:57:17,280
+sodium، و less reabsorption of water، أو ترجعه إلى
+
+760
+00:57:17,280 --> 00:57:21,380
+maximum بتاعته لـ isosmotic، maximum بتاعته لإيش؟
+
+761
+00:57:21,380 --> 00:57:26,900
+لـ isosmotic، تمام؟ لإنه الـ cortical interstitium
+
+762
+00:57:26,900 --> 00:57:30,520
+تركيزه جدّاً isosmotic، تلت مية الـ cortical
+
+763
+00:57:30,520 --> 00:57:34,380
+interstitium، فلذلك أنا بدي أسحب مياه، بسحبها لحد من
+
+764
+00:57:34,380 --> 00:57:36,880
+الـ cells تصير مساوية للـ interstitium اللي حواليها
+
+765
+00:57:36,880 --> 00:57:40,580
+عشان يصير الـ balance، مش هيك؟ إذًا أنا بيطلع من عندي
+
+766
+00:57:40,580 --> 00:57:49,490
+يا إما hypotonic، يا إما إيه؟ isosmotic، إذا الـ
+
+767
+00:57:49,490 --> 00:57:51,850
+الـ .. الـ .. الـ .. الـ thick ascending limb بتسلم
+
+768
+00:57:51,850 --> 00:57:56,290
+الـ .. الـ distal، الـ hypotonic solution، الـ hypotonic
+
+769
+00:57:56,290 --> 00:57:58,730
+solution هذا، ميته من الأزمة ممكن يزيد الـ
+
+770
+00:57:58,730 --> 00:58:02,910
+hypotonicity أكثر، تمام؟ اللي هو الـ distal اللي هي
+
+771
+00:58:02,910 --> 00:58:07,210
+الـ distal، لكن ما أقدرش يخليه hyper osmotic، الـ hyper osmotic
+
+772
+00:58:07,210 --> 00:58:13,190
+هذا شغل مين؟ المضلة، بصيرش hyper osmotic إلا إذا دخل
+
+773
+00:58:13,190 --> 00:58:17,170
+إيه؟ المضلة، لكن إحنا الـ thick ascending limb، والله
+
+774
+00:58:17,170 --> 00:58:21,310
+الوضع طبعاً طبيعي، لابد نزود ولا بد نجلل، ووضعنا
+
+775
+00:58:21,310 --> 00:58:24,050
+كويسة ونشرب كويسة، ونأكل كويسة، وما فيش عندنا حالة
+
+776
+00:58:24,050 --> 00:58:29,010
+dehydration ولا over hydration ولا إشي، تمام؟ في
+
+777
+00:58:29,010 --> 00:58:31,270
+الحالة دي، الـ thick ascending .. الـ .. الـ .. الـ
+
+778
+00:58:31,270 --> 00:58:34,610
+الـ distal convoluted tubule بتشتغل بشكل طبيعي في العادة
+
+779
+00:58:34,610 --> 00:58:40,450
+بيوصل الـ filtrate إلى الـ medullary collecting duct
+
+780
+00:58:40,450 --> 00:58:48,250
+isosmotic، طبعاً، لكن لو كان محتاج ميّة أكثر، لو عندي
+
+781
+00:58:48,250 --> 00:58:55,090
+ميّة أكثر، آه، بوصله آه، لو محتاج صوديوم أكثر، بوصله
+
+782
+00:58:55,090 --> 00:58:59,430
+hypotonic أكثر، هذه منطقة الـ regulation، طبعاً أنت
+
+783
+00:58:59,430 --> 00:59:05,260
+بتحكم فيها، بيزيدوا بيقلوا، والـ aldosterone بتحكم فيها
+
+784
+00:59:05,260 --> 00:59:09,240
+وحسب النتيجة بسهولة بنقدر نتوقع إيش بتحصل، تمام؟
+
+785
+00:59:09,240 --> 00:59:13,380
+لكن الـ thick ascending limb بيطلع الـ .. الـ distal
+
+786
+00:59:13,380 --> 00:59:16,460
+tubule بيطلع منها fluid إلى الـ .. إلى الـ medullary
+
+787
+00:59:16,460 --> 00:59:20,200
+collecting duct، hypertonic، بيصل maximum isosmotic،
+
+788
+00:59:20,200 --> 00:59:25,850
+تمام؟ لكن ممكن يصل severe hypotonic، وتحافظ عليه
+
+789
+00:59:25,850 --> 00:59:30,650
+المـدلة، إذا أنا بوصل أن أوصل لـ 50 وبدأ أطلع
+
+790
+00:59:30,650 --> 00:59:35,530
+بيتلاشى دور الـ medulla، لأن في الحالة هذه ممكن يطلع
+
+791
+00:59:35,530 --> 00:59:40,170
+من الـ distal tubule الـ hypotonic filtrate، ويظل
+
+792
+00:59:40,170 --> 00:59:44,050
+ماشي للـ medullary collecting duct، ما عملت شغلة، لأن هي اللي
+
+793
+00:59:44,050 --> 00:59:47,640
+بتقدر تعمل dilution، تدخل المضلة أي تدخل المضلة
+
+794
+00:59:47,640 --> 00:59:49,920
+تعمل more concentration، فإذا أنا بدي أعمل
+
+795
+00:59:49,920 --> 00:59:54,700
+dilution كثير، المضلة إيش؟ بتدخلش، تمام؟ لأنه هلاحظ
+
+796
+00:59:54,700 --> 01:00:00,700
+أنا إنه عشان الميّة تـ تـخش من المضلة، medullary duct، medullary
+
+797
+01:00:00,700 --> 01:00:04,980
+إيه؟ duct، إلى داخل الـ cells تبع المضلة، إلى الـ
+
+798
+01:00:04,980 --> 01:00:09,840
+interstitium، تحتاج إلى water carriers، water pores،
+
+799
+01:00:09,840 --> 01:00:13,580
+water channels، إذا فتحت الـ water channels، ممكن
+
+800
+01:00:13,580 --> 01:00:16,840
+الميّة تبدأ تطلع، ويصبح more concentration، صحيح
+
+801
+01:00:16,840 --> 01:00:22,140
+diluted urine، وصحيح اللي حواليها الـ interstitium
+
+802
+01:00:22,140 --> 01:00:28,140
+isosmotic، تمام؟ هو hyper osmotic، لكنه isosmotic، لكن
+
+803
+01:00:28,140 --> 01:00:32,640
+الميّة مش قادرة تطلع منه، لأن الـ water channels إيه؟
+
+804
+01:00:32,640 --> 01:00:39,710
+مسكرة، واضح؟ واضح الكلام ولا لأ؟ إذًا إحنا الـ distal
+
+805
+01:00:39,710 --> 01:00:40,330
+tubule
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a2a54ba5c76053f0065f8ecc0b43b63854146c75
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk_postprocess.srt
@@ -0,0 +1,3220 @@
+1
+00:00:05,040 --> 00:00:13,860
+اليوم احنا هنكمل اللي هو how urine is formed in
+
+2
+00:00:13,860 --> 00:00:19,560
+the kidney زي ما احنا عارفين احنا ال urine بيبدأ ب
+
+3
+00:00:19,560 --> 00:00:24,500
+filtration عبر ال glomerulus مستمير glomerulus
+
+4
+00:00:24,500 --> 00:00:28,040
+filtration بعدين بيصير في عملية reabsorption
+
+5
+00:00:28,040 --> 00:00:32,600
+tubular reabsorption و هدول التنتين عمليتين هم ال
+
+6
+00:00:32,600 --> 00:00:39,290
+major proceduresبالحقهم بروسوس اخرى اصغر شوية اقل
+
+7
+00:00:39,290 --> 00:00:45,990
+شوية كمان وهي ال secretion فعملية ال filtration
+
+8
+00:00:45,990 --> 00:00:51,350
+زائد ال reabsorption زائد ال secretion بتديني ال
+
+9
+00:00:51,350 --> 00:00:56,410
+final quality of urine final quantity of urine
+
+10
+00:00:56,410 --> 00:01:04,820
+يعتمد اتكلمنا في اخر نقطة في ال reabsorption انهفي
+
+11
+00:01:04,820 --> 00:01:08,260
+الـ proximal convolutal tubule بيصير عملية
+
+12
+00:01:08,260 --> 00:01:12,120
+secretions كمان وقولنا ال secretions هذه ممكن تكون
+
+13
+00:01:12,120 --> 00:01:21,940
+active secretion عبر ال counter transport يعني
+
+14
+00:01:21,940 --> 00:01:25,300
+secondary active الحالة هذه بيكون اللي هو لما
+
+15
+00:01:25,300 --> 00:01:29,420
+قولنا ال reabsorption of بيكربونات من خلال ال
+
+16
+00:01:29,420 --> 00:01:33,300
+counter transport of ايه؟ of هيدروجينالفظوه هادى
+
+17
+00:01:33,300 --> 00:01:36,560
+لان عندنا بعد شوية صغيرة هنقارن ما بين هادى ال
+
+18
+00:01:36,560 --> 00:01:41,000
+process of hydrogen secretion مع other process of
+
+19
+00:01:41,000 --> 00:01:45,300
+hydrogen secretion active hydrogen secretion في ال
+
+20
+00:01:45,300 --> 00:01:49,400
+distal tubuleفي الـ intercalated cells of the
+
+21
+00:01:49,400 --> 00:01:53,120
+distal tubules فى عملية أخرى من الـ hydrogen
+
+22
+00:01:53,120 --> 00:01:58,120
+secretion بتم من خلالها برضه reabsorption of
+
+23
+00:01:58,120 --> 00:02:01,380
+بوتاسيوم أو mainly reabsorption of الكربونات أو
+
+24
+00:02:01,380 --> 00:02:04,580
+just for regulation of hydrogen concentration
+
+25
+00:02:04,580 --> 00:02:09,660
+حنلاحظ
+
+26
+00:02:09,660 --> 00:02:14,600
+هن أن هذا ال process secondary activeالتانى هتكون
+
+27
+00:02:14,600 --> 00:02:21,060
+an active process by hydrogen atbas تمام انا بس
+
+28
+00:02:21,060 --> 00:02:24,980
+بحضركم الفكرة ان دايما بيصير مقارنة ما بين ال
+
+29
+00:02:24,980 --> 00:02:27,720
+process اللي بيصير في ال distal tube و ال process
+
+30
+00:02:27,720 --> 00:02:34,820
+اللي بيصير في ال proximal tube بما يخص ال hydrogen
+
+31
+00:02:34,820 --> 00:02:37,420
+secretion and bicarbonate reabsorption
+
+32
+00:02:42,320 --> 00:02:49,200
+عنا ال Paraminohepuric acid واحد من ال organic
+
+33
+00:02:49,200 --> 00:02:53,720
+acids اللى هو ازاي ال organic acids اللى اتكلمنا
+
+34
+00:02:53,720 --> 00:02:57,780
+عنها من شوية او اخر مرة في الدرس الفات انه عنا
+
+35
+00:02:57,780 --> 00:03:01,440
+active process active secretion لل organic acids
+
+36
+00:03:01,440 --> 00:03:06,240
+وقولنا بالذات للبنسيلين لإنه عاملانا مشكلة و ل ال
+
+37
+00:03:06,240 --> 00:03:09,820
+salicylic acid اللى هو الأسبيرين لإنه بيقدر إلى
+
+38
+00:03:09,820 --> 00:03:16,150
+انه rapidو من
+
+39
+00:03:16,150 --> 00:03:21,170
+هنا
+
+40
+00:03:21,170 --> 00:03:27,290
+تم عملية ربط بنسالين بنسالين
+
+41
+00:03:27,290 --> 00:03:30,690
+جي بنسالين جي بنسالين جي بنسالين جي بنسالين جي
+
+42
+00:03:30,690 --> 00:03:36,840
+بنسالين جي بنسالين جيلـ binding protein بحيث انه
+
+43
+00:03:36,840 --> 00:03:42,400
+يبطل يصبح عملية easy filtration and easy excretion
+
+44
+00:03:42,400 --> 00:03:47,180
+and easy secretion فصار عملية انأخر من ال
+
+45
+00:03:47,180 --> 00:03:52,960
+executing process
+
+46
+00:03:52,960 --> 00:03:57,480
+انأخرها شوية و قد الى ان في الآخر عنا نطلع long
+
+47
+00:03:57,480 --> 00:04:00,800
+acting penicillin long acting penicillin ممكن
+
+48
+00:04:00,800 --> 00:04:07,280
+تناقض كل شهر مرةكل شهر مرة اديناله مواصفات معينة
+
+49
+00:04:07,280 --> 00:04:12,310
+نمنع ايه؟ خروجه عن طريق الكلابفي مادة هنا بتهمني
+
+50
+00:04:12,310 --> 00:04:18,850
+في الموضوع هذا المادة مش لها يعني clinical effect
+
+51
+00:04:18,850 --> 00:04:23,330
+زي ال penicillin و دور ال secretion تبعه و أهميته
+
+52
+00:04:23,330 --> 00:04:27,170
+و ال salicylic acid و كذا لكن لها أهمية بأن هذه
+
+53
+00:04:27,170 --> 00:04:30,590
+المادة اسمها paraminohiberic acid هذه المادة أنا
+
+54
+00:04:30,590 --> 00:04:35,240
+بستخدمها في قياس ال plasma renal plasma flowبلازما
+
+55
+00:04:35,240 --> 00:04:39,660
+فلو فيها الكيليا ليش بستخدمها؟ لأن هذه المادة
+
+56
+00:04:39,660 --> 00:04:43,700
+تقريبا تسعين في المية منها او نعتبرها حاليا مية
+
+57
+00:04:43,700 --> 00:04:50,180
+المية منها is executed just by one flow inside the
+
+58
+00:04:50,180 --> 00:04:54,840
+kidneyمتى ما دخلت الكيلية معناها انه بتطلع بلاجة
+
+59
+00:04:54,840 --> 00:04:58,800
+ال venosite اصلا حكيتكوا عليها ال venosite بيكون
+
+60
+00:04:58,800 --> 00:05:03,000
+فضي فبكدا بقدر انا اقول انه المادة اللي طلعت في
+
+61
+00:05:03,000 --> 00:05:07,380
+اليورينها دلساوي المادة اللي دخلت الكيلية عبر
+
+62
+00:05:07,380 --> 00:05:11,300
+البلازمة لإنها البلازمة اتصفت منها بقدر احسب
+
+63
+00:05:11,300 --> 00:05:15,320
+البلازمة flow بعد ما اعدلها بال 90% يعني بضف ال 10
+
+64
+00:05:15,320 --> 00:05:19,160
+% ومنها ال hematocrit بقدر اعرف ال renal blood
+
+65
+00:05:19,160 --> 00:05:19,860
+flow
+
+66
+00:05:27,700 --> 00:05:31,140
+الان دخلنا على .. خلصنا ال brochure و ال tribune
+
+67
+00:05:31,140 --> 00:05:36,220
+تقريبا كنا شرحنا معظم الأشياء اللي بتصير فيها و
+
+68
+00:05:36,220 --> 00:05:40,020
+اضحى على الكاميرا ان انا نجح بتاعة ال course الان
+
+69
+00:05:40,020 --> 00:05:43,800
+هننزل لل loop of Henle ال loop of Henle في the
+
+70
+00:05:43,800 --> 00:05:46,700
+descending loop of Henle و في ascending loop of
+
+71
+00:05:46,700 --> 00:05:51,700
+Henleالدسيندين جلوبوفينلي نوع واحد ثين دسيندين
+
+72
+00:05:51,700 --> 00:05:59,660
+جلوبوفينلي ما هو جزء ثين وجزء نوع واحد ثين دسيندين
+
+73
+00:05:59,660 --> 00:06:07,230
+جلوبوفينلي هذا permeable to waterو يعني semi
+
+74
+00:06:07,230 --> 00:06:11,270
+permeable to other solutes يعني في إمكانية للحركة
+
+75
+00:06:11,270 --> 00:06:14,690
+من خلاله الأشياء اللي فيها ممكن تطلع لبرا يعني لو
+
+76
+00:06:14,690 --> 00:06:18,030
+ال intersection برا ال intersection اللي نازل فيه
+
+77
+00:06:18,030 --> 00:06:21,410
+ال loop of Henle هي concentrated هيقدر الميه
+
+78
+00:06:21,410 --> 00:06:28,950
+freely هتتحرك إلى إيه؟ إلى الخارج هذا ال loop
+
+79
+00:06:28,950 --> 00:06:34,190
+تمام؟ هذا بالنسبة لل descending loopالـ ascending
+
+80
+00:06:34,190 --> 00:06:39,410
+loop برضه فيه جزء تقريبا نص أو أقل من نص شوية تن
+
+81
+00:06:39,410 --> 00:06:45,870
+وهذا عكس ال descending loop impermeable to water
+
+82
+00:06:45,870 --> 00:06:53,610
+and it is impermeable to urea or nearly
+
+83
+00:06:53,610 --> 00:06:57,310
+impermeable to other solutes يعني ما هو ال
+
+84
+00:06:57,310 --> 00:07:01,990
+permeability للسوليس الأخرى limited المهم أنهاit
+
+85
+00:07:01,990 --> 00:07:05,030
+is impermeable to water حيشي بعدها اللي هو thick
+
+86
+00:07:05,030 --> 00:07:09,330
+ascending limb ال thick ascending limb هذا أهم جزء
+
+87
+00:07:09,330 --> 00:07:13,850
+في ال loop of Henle من ناحية انه انعكاسه على كل
+
+88
+00:07:13,850 --> 00:07:18,350
+شغل الكليه انعكاس كبير انعكاسه على كل ..الان ال
+
+89
+00:07:18,350 --> 00:07:22,110
+filtrate اللي داخل ال loop of Henle ال filtrate
+
+90
+00:07:22,110 --> 00:07:25,490
+اللي داخل ال loop of Henle بيصل ال distal tubule
+
+91
+00:07:26,700 --> 00:07:30,820
+بيصل ال thick ascending limb بيصل ال thick
+
+92
+00:07:30,820 --> 00:07:36,240
+ascending limb fishy
+
+93
+00:07:36,240 --> 00:07:46,280
+mouse اه؟ يا ريت والله انا بيريحني اذا ال .. ال
+
+94
+00:07:46,280 --> 00:07:52,690
+thick ascending limb هذا ميزتهإنه حيصير في عندنا
+
+95
+00:07:52,690 --> 00:07:59,610
+عملية active reabsorption for
+
+96
+00:07:59,610 --> 00:08:03,770
+solutes and it is impermeable to water يعني لما
+
+97
+00:08:03,770 --> 00:08:08,110
+ناخد ال solutes و يصير عندنا hypotonicity فى داخل
+
+98
+00:08:08,110 --> 00:08:12,750
+ال filtrate ال water will not be able to follow
+
+99
+00:08:12,750 --> 00:08:15,170
+the solutes مش ده ال professor ما كان في ال
+
+100
+00:08:15,170 --> 00:08:19,990
+tribune راح السوديو مليفروريد تلحقها الميههنا في
+
+101
+00:08:19,990 --> 00:08:24,550
+الحالة هذه هيصير absorption لل solutes كميات كبيرة
+
+102
+00:08:24,550 --> 00:08:31,230
+تمام بحيث انه الميه can not enter the thick
+
+103
+00:08:31,230 --> 00:08:36,590
+aciniglam cells اذا it is impermeable to water it
+
+104
+00:08:36,590 --> 00:08:40,610
+is impermeable to ureaتمام؟ اذا اليوريا و ال water
+
+105
+00:08:40,610 --> 00:08:44,430
+هيدالهم ماشيين في ال filtrate اذا عندها لما انا
+
+106
+00:08:44,430 --> 00:08:46,910
+يصير reabsorption لما كمية كبيرة من ال solutes
+
+107
+00:08:46,910 --> 00:08:53,110
+هيصير عندي ال tubular filtrate يخلص مهمته في ال
+
+108
+00:08:53,110 --> 00:08:56,690
+thick ascending limb هنلاقي صحر أخدنا ال solutes و
+
+109
+00:08:56,690 --> 00:09:01,090
+أضالة ال water هيكون hypo osmotic اذا عن hypo
+
+110
+00:09:01,090 --> 00:09:05,170
+osmotic حقيقة
+
+111
+00:09:05,170 --> 00:09:08,650
+ال thick ascending limb هذافي هذا الـ function
+
+112
+00:09:08,650 --> 00:09:14,330
+تبعه يُصاحب الجزء الأول من الـ proximal من الـ
+
+113
+00:09:14,330 --> 00:09:17,230
+distal convolutable الـ distal convolutable هنقسمه
+
+114
+00:09:17,230 --> 00:09:22,070
+إلى قسمين Early part وDistal part تمام؟بيفصل
+
+115
+00:09:22,070 --> 00:09:25,350
+الجهتين الـ thick ascending limb عن الـ early part
+
+116
+00:09:25,350 --> 00:09:27,950
+of the distal convective tubule اللي هو
+
+117
+00:09:27,950 --> 00:09:31,270
+الجفساجروميلر الاباراتس مش كده؟ إذا في عند
+
+118
+00:09:31,270 --> 00:09:33,270
+جفساجروميلر الاباراتس بيجي بعدها ثقة ascending
+
+119
+00:09:33,270 --> 00:09:37,530
+limb مباشرة وبعده بشوية بيبدأ ال .. ال distal
+
+120
+00:09:37,530 --> 00:09:40,210
+tubule هذه الجزية اللي بعدها شوية صغيرة اللي هي ال
+
+121
+00:09:40,210 --> 00:09:43,690
+early distal tubule ال early distal convective
+
+122
+00:09:43,690 --> 00:09:49,230
+tubule ال function تبعها مشابه مصاحب مكمل لثقة
+
+123
+00:09:49,230 --> 00:09:54,390
+ascending limbتمام نفس الشيء الفرق بينهم ميكانيزم
+
+124
+00:09:54,390 --> 00:09:58,270
+هنتكلم عن ميكانيزم لإن ال transporter بيخلف ال
+
+125
+00:09:58,270 --> 00:10:01,210
+transporter اللي شكالة على اليوم الأساعد تدخل
+
+126
+00:10:01,210 --> 00:10:04,490
+الأشياء هان في ال thick as it in بيخلف عن اللي
+
+127
+00:10:04,490 --> 00:10:08,550
+بعده لكن محص لإن كمية كبيرة من ال solutes هتنسحب
+
+128
+00:10:08,550 --> 00:10:14,590
+إلى داخل ال إيه إلى داخل ال interstitium هتدخل ال
+
+129
+00:10:14,590 --> 00:10:18,350
+cells و هتدخل ال interstitium و لن يلحق بيها ايه
+
+130
+00:10:18,350 --> 00:10:22,860
+water ولا ureaهضل ال water و اللي رافت داخل، اذا
+
+131
+00:10:22,860 --> 00:10:28,360
+هذا الجزئية هذه الجزئية اللي هو بتنتهي بال early
+
+132
+00:10:28,360 --> 00:10:31,300
+part of the thick ascending limb عملت absorption
+
+133
+00:10:31,300 --> 00:10:36,800
+of solutes كمية كبيرة بتنتهي انه عندي ال tubular
+
+134
+00:10:36,800 --> 00:10:42,300
+filtrate, osmolality دايما بتنتهي ب100 ميلي أزمال،
+
+135
+00:10:42,300 --> 00:10:45,780
+اذا ال thick ascending ال .. ال .. ال distal
+
+136
+00:10:45,780 --> 00:10:50,300
+convoluted tubuleالـ late part، الـ second part
+
+137
+00:10:50,300 --> 00:10:53,760
+تبع الـ distal convoluted tubule بيسلم دائماً ال
+
+138
+00:10:53,760 --> 00:10:59,120
+tubular filtrate بتركيز 100 ميلي أزمول، تمام؟ إذا
+
+139
+00:10:59,120 --> 00:11:02,320
+البعض أشتغل، بيغير في الـ 100 ميلي أزمول، زيارة أو
+
+140
+00:11:02,320 --> 00:11:07,220
+نقصانة، ممكن أن نقصها كمان خمسين، ممكن تصل لخمسين،
+
+141
+00:11:07,220 --> 00:11:09,620
+لأن الـ thick ascending limb، ال .. ال .. ال ..
+
+142
+00:11:09,620 --> 00:11:12,640
+distal convoluted tubule هذه الجزء اللي ضايل، عنده
+
+143
+00:11:12,640 --> 00:11:18,290
+إمكانية أنه يعمل more dilutionبس هذا under control
+
+144
+00:11:18,290 --> 00:11:23,770
+حسب حاجة الجسم و ممكن مايعملش اي dilution المياه
+
+145
+00:11:23,770 --> 00:11:27,850
+دي تبقى ماشية لحد ما تنزل ال Interstitium عبر ال
+
+146
+00:11:27,850 --> 00:11:31,530
+collecting duct و هناك يصير عمل التركيز عالي و نصل
+
+147
+00:11:31,530 --> 00:11:34,990
+الكمية اللي الرقم يقولنا عليه خضرة الكلية العليا
+
+148
+00:11:34,990 --> 00:11:41,750
+في التركيزة تصل لأيه؟ لألف و متين او 1400 اذا ال
+
+149
+00:11:41,750 --> 00:11:46,300
+distal tubule الان بيصلهاالـ Distal Convoluted
+
+150
+00:11:46,300 --> 00:11:53,740
+Bulb يصل إلى الـ Tubular Filtrate Hypoosmotic الـ
+
+151
+00:11:53,740 --> 00:11:58,380
+Early Bar اللي يكمل شغل الـ Thick Ascending Limb
+
+152
+00:11:58,380 --> 00:12:03,260
+ينهي إلى 100 ملي أسمه، لذلك الجزء التاني من الـ
+
+153
+00:12:03,260 --> 00:12:07,140
+Distal Convoluted Bulb اللي هو هذا يعمل Elective
+
+154
+00:12:07,140 --> 00:12:11,700
+حسب عيش الجسم، ممكن أخد صوديوم، ممكن لا أخدممكن
+
+155
+00:12:11,700 --> 00:12:17,440
+اخد ميه ممكن مااخدش تمام النص التاني هذا لو اخد
+
+156
+00:12:17,440 --> 00:12:21,980
+صوديوم ماخدش ميه على اقصى قدرة له يستطيع انه يسلم
+
+157
+00:12:21,980 --> 00:12:25,980
+ال collecting duct يسلم ال collecting .. ال .. ال
+
+158
+00:12:25,980 --> 00:12:28,720
+.. ال .. ال collecting duct ال medullary
+
+159
+00:12:28,720 --> 00:12:33,260
+collecting duct يسلمها اوزمولاليه
+
+160
+00:12:33,260 --> 00:12:37,720
+ب just خمسين ملي اوزمول انا ليش قلت ال medullary
+
+161
+00:12:37,720 --> 00:12:43,670
+collecting ductلأن حقيقة الـ collecting duct الـ
+
+162
+00:12:43,670 --> 00:12:48,130
+cortical و الـ dorsal second part of the dorsal
+
+163
+00:12:48,130 --> 00:12:50,710
+capillary tubule بيشتغلوا نفس الشغل يعني لما نتكلم
+
+164
+00:12:50,710 --> 00:12:53,210
+عن ال .. ال dorsal capillary tubule ال second part
+
+165
+00:12:53,210 --> 00:12:57,110
+ال lat part هي و ال connecting tubule و ال
+
+166
+00:12:57,110 --> 00:13:00,030
+collecting cortical collecting نفس الشيء اللي
+
+167
+00:13:00,030 --> 00:13:03,370
+بيصير هان هان هان يعني لحد ما نصل لمدالة ل
+
+168
+00:13:03,370 --> 00:13:06,660
+collecting duct و نفس المواصفاتبعد مدالة
+
+169
+00:13:06,660 --> 00:13:09,520
+reconnecting duct بيصير ايش؟ عندنا تيبيول اخرى
+
+170
+00:13:09,520 --> 00:13:13,220
+ومواصفات اخرى تمام؟ اذا هنا عندي elective
+
+171
+00:13:13,220 --> 00:13:17,660
+reabsorption او secretion لصوديوم او secretion
+
+172
+00:13:17,660 --> 00:13:22,300
+لبوتاسيوم حسب مين حسب حاجة الجسم بتبدأ من ال late
+
+173
+00:13:22,300 --> 00:13:26,580
+distal tubule connecting tubule و cortical
+
+174
+00:13:26,580 --> 00:13:30,240
+connecting tubule هدول كلهم بيشتغلوا ايه؟ ال
+
+175
+00:13:30,240 --> 00:13:33,360
+anatomy تبعهم هتكلمها ان ال anatomy هادا متميز زي
+
+176
+00:13:33,360 --> 00:13:37,230
+بقى كلهمعندي ال Anatomy وعندي ال principal cells و
+
+177
+00:13:37,230 --> 00:13:40,650
+Intercalated cells يلهم كلهم function يلهم كلهم زي
+
+178
+00:13:40,650 --> 00:13:46,650
+بعض إذا هدول جزئية واحدة اللي هي ال late distal
+
+179
+00:13:46,650 --> 00:13:49,770
+زائد ال connecting زائد ال cortical connecting
+
+180
+00:13:49,770 --> 00:13:53,030
+هدول جزئية واحدة anatomically وfunctionally
+
+181
+00:13:53,030 --> 00:13:57,190
+physiological اللي بيشتغل نفس الشيء، تمام؟ إذا في
+
+182
+00:13:57,190 --> 00:14:00,030
+الحالة هذه نرجع تاني أتكلم عن مين؟ إذا انا عارف ان
+
+183
+00:14:00,030 --> 00:14:01,670
+احنا لديه فروقات منهم ال thick and thin
+
+184
+00:14:01,670 --> 00:14:02,630
+equilibrium هدققش بعمله
+
+185
+00:14:05,330 --> 00:14:08,250
+الـ thick ascending limb بيعمل reabsorption of
+
+186
+00:14:08,250 --> 00:14:11,810
+صوديوم، كلورايت، بوتاسيوم، كالسيوم، بايكربونيت،
+
+187
+00:14:11,810 --> 00:14:16,690
+ماجنيزيوم و ممكن يعمل secretion of هيدروجين و
+
+188
+00:14:16,690 --> 00:14:19,470
+الهيدروجين اللي بيصيرله secretion يعني في مقابل
+
+189
+00:14:19,470 --> 00:14:23,810
+ايه ال reabsorption of بايكربونيت، تمام؟
+
+190
+00:14:32,140 --> 00:14:38,040
+هذه خلية من خلايا الـ thick ascending limb هنجي
+
+191
+00:14:38,040 --> 00:14:41,260
+على ال بيزو لاترال ممبراين على ال بيزو لاترال
+
+192
+00:14:41,260 --> 00:14:49,260
+ممبراين على ال برسلر روتس على ال بيزو لاترال
+
+193
+00:14:49,260 --> 00:14:50,820
+ممبراين
+
+194
+00:14:54,090 --> 00:14:57,890
+بوردر هلاجي اللي هو Sodium-Potassium-ATPS Bombing
+
+195
+00:14:57,890 --> 00:15:04,110
+System تمام؟ مكثف شديد اللي بيختلف هان ان هذا ال
+
+196
+00:15:04,110 --> 00:15:09,850
+bombing system يصاحب special type of .. of ..
+
+197
+00:15:09,850 --> 00:15:15,730
+Transporter System ال career system هان مختلف عن
+
+198
+00:15:15,730 --> 00:15:20,090
+اي مكان في ال .. في الكلية تمام؟ هنا عندنا Sodium
+
+199
+00:15:20,090 --> 00:15:23,540
+-Potassium-Chlorideوش يسموه Sodium Potassium
+
+200
+00:15:23,540 --> 00:15:29,400
+Etabase لأ Sodium Potassium Sodium Chloride
+
+201
+00:15:29,400 --> 00:15:32,360
+Potassium Sodium Potassium Chloride System of
+
+202
+00:15:32,360 --> 00:15:40,560
+Carrier بيحمل واحد Sodium و بيحمل واحد Potassium و
+
+203
+00:15:40,560 --> 00:15:44,140
+اتنين Chloride تمام؟ هذا System Carrier System هذا
+
+204
+00:15:44,140 --> 00:15:48,900
+مهم جدا طيب احنا قلنا هنا Sodium Potassium Etabase
+
+205
+00:15:49,450 --> 00:15:54,070
+الإنزايم على ال بيزولاترا من ال brain يسحب صوديوم
+
+206
+00:15:54,070 --> 00:15:59,390
+إلى الخارج و يدخل بوتاسيوم إلى الداخل بعد ذلك يكون
+
+207
+00:15:59,390 --> 00:16:03,830
+لدي تركيز الصوديوم داخل ال cells و أعطي و هذا ال
+
+208
+00:16:03,830 --> 00:16:11,130
+driving force لإن الصوديوم يدخل
+
+209
+00:16:11,130 --> 00:16:13,530
+إلى داخل ال cells
+
+210
+00:16:16,640 --> 00:16:19,140
+فهذا اللي بيشغل ال AI لكن ال carrier هذا اللي
+
+211
+00:16:19,140 --> 00:16:24,860
+بيشتغل بياخد معاه Sodium downhill لكن ال potassium
+
+212
+00:16:24,860 --> 00:16:27,700
+اللي تبيه ال system ايش عاملهان؟ زود ال potassium
+
+213
+00:16:27,700 --> 00:16:32,380
+كل سنتيشن تدخل ال cell، مش هيك؟ و ال carrier
+
+214
+00:16:32,380 --> 00:16:36,160
+system هذا هيدخل Sodium، هيدخل معاه مين؟بوتاسيوم
+
+215
+00:16:36,160 --> 00:16:39,620
+against concentration against gradient إذا
+
+216
+00:16:39,620 --> 00:16:43,600
+البوتاسيوم هنا واضح إنه بدخل ايه بس لإنه active
+
+217
+00:16:43,600 --> 00:16:47,500
+transport system تفرقش معاه بدخل البوتاسيوم
+
+218
+00:16:47,500 --> 00:16:52,220
+against concentration وفي مقابلهم بدخل معاه اتنين
+
+219
+00:16:52,220 --> 00:16:57,540
+كلورايد واضح إذا بدخل اتنين كلورايد وبدخل واحد
+
+220
+00:16:57,540 --> 00:16:59,640
+صوديوم وواحد بوتاسيوم الصوديوم downhill
+
+221
+00:17:03,030 --> 00:17:09,890
+السيطو بلازم الكونستراتيشن
+
+222
+00:17:09,890 --> 00:17:17,470
+من السوديوم هو أقل بسبب نظام الانفجار فالكلورايد
+
+223
+00:17:17,470 --> 00:17:21,610
+يدخل ويعلى تركيزه
+
+224
+00:17:24,270 --> 00:17:27,250
+في علمنا الـ chloride channels على الـ basolateral
+
+225
+00:17:27,250 --> 00:17:36,610
+membrane تساعد على الانترالستيشن في الانترالستيشن
+
+226
+00:17:36,610 --> 00:17:44,050
+من تركيز أعلى في داخل الcells إلى الانترالستيشن
+
+227
+00:17:44,050 --> 00:17:49,010
+حيث التركيز الأقل ماشي؟ طب البوتاسيوم هذا مغلبكوا
+
+228
+00:17:49,010 --> 00:17:52,130
+البوتاسيوم هذا البوتاسيوم دخل عالي ال
+
+229
+00:17:52,130 --> 00:17:56,280
+concentration داخل الcytoplasmو من ال basolateral
+
+230
+00:17:56,280 --> 00:17:59,900
+membrane يعني ال career system دخل البوتاسيوم و ال
+
+231
+00:17:59,900 --> 00:18:04,040
+.. ال .. ال atrial system دخل البوتاسيوم هيعمل
+
+232
+00:18:04,040 --> 00:18:08,700
+بوتاسيوم كتير في داخل ايه؟ مش مش .. ايه اتفضلي مش
+
+233
+00:18:08,700 --> 00:18:12,980
+مشكلة لإنه .. لإن البوتاسيوم كان freely moved حسب
+
+234
+00:18:12,980 --> 00:18:15,420
+ال concentration ال gradient يعني اللي دخل ال cell
+
+235
+00:18:15,420 --> 00:18:18,540
+بيعمل back diffusion لل interstitium او بيعمل back
+
+236
+00:18:18,540 --> 00:18:22,260
+effusion .. diffusion لمين؟ بتفرجش معاه البوتاسيوم
+
+237
+00:18:22,260 --> 00:18:28,410
+بالذات كان ايه؟بسهولة تقوم بعمل back-diffusion في
+
+238
+00:18:28,410 --> 00:18:33,670
+البرنامج الهان وهان طبعا ان الانترال
+
+239
+00:18:33,670 --> 00:18:38,670
+روت هان مايتوجعش زي الآخر انه هيعدي منه ايش انه
+
+240
+00:18:38,670 --> 00:18:42,070
+water انه غير مميز للماء هذول الانترال روت هان
+
+241
+00:18:42,070 --> 00:18:46,210
+مميز للماء لكن بيعدي منهم
+
+242
+00:18:49,020 --> 00:18:52,080
+السوديوم كما قلنا ممكن يقعد في البرسيلة الروت إذا
+
+243
+00:18:52,080 --> 00:18:55,920
+كان ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+244
+00:18:55,920 --> 00:19:00,320
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+245
+00:19:00,320 --> 00:19:01,000
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+246
+00:19:01,000 --> 00:19:01,660
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+247
+00:19:01,660 --> 00:19:01,920
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+248
+00:19:01,920 --> 00:19:07,780
+.. ال .. ال .. ال .. ال .. ال .. ال ..
+
+249
+00:19:07,780 --> 00:19:11,300
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+250
+00:19:11,300 --> 00:19:12,320
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+251
+00:19:12,320 --> 00:19:14,600
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+252
+00:19:14,600 --> 00:19:15,360
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+253
+00:19:15,360 --> 00:19:15,740
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+254
+00:19:17,290 --> 00:19:19,630
+المهم في الموضوع حاليًا أن في عندي magnesium
+
+255
+00:19:20,220 --> 00:19:28,320
+والكالسيوم يدخل هذه الجزيرة ويقع تجارب
+
+256
+00:19:28,320 --> 00:19:32,580
+التجارب من خلال الانتجارات التجاربية هنا بيصير في
+
+257
+00:19:32,580 --> 00:19:38,720
+عندى transport للمجنيزيم ولكالسيوم كبالظبط اللي هو
+
+258
+00:19:38,720 --> 00:19:41,920
+active transport اللي هو passive transport اللي هو
+
+259
+00:19:41,920 --> 00:19:46,300
+.. بس بيصير عندى نسبة reabsorption عالية لهدول ال
+
+260
+00:19:46,300 --> 00:19:49,480
+ions المجنيزيم والكالسيوم في هالمنطقة الحاليةو
+
+261
+00:19:49,480 --> 00:19:51,880
+هنتكلم ان شاء الله .. هنتكلم بعد كده عن
+
+262
+00:19:51,880 --> 00:19:55,060
+البراتيرويد .. هنتكلم بالتفصيل عن هذا الموضوع ..
+
+263
+00:19:55,060 --> 00:19:59,440
+تمام؟ لكن حاليا احنا بيقول بتبقى عند انترانس او
+
+264
+00:19:59,440 --> 00:20:03,940
+reabsorption لالمجنيزيوم و الكلورايد في الـ thick
+
+265
+00:20:03,940 --> 00:20:08,300
+ascending limb المجنيزيوم و الكلسيوم في ال thick
+
+266
+00:20:08,300 --> 00:20:13,340
+ascending limb عبر البراسيلولار روت .. تمام؟ طيب
+
+267
+00:20:14,260 --> 00:20:18,900
+ليش؟ في تفسير يعني أنه بيصير عندي
+
+268
+00:20:18,900 --> 00:20:22,800
+electronegativity
+
+269
+00:20:22,800 --> 00:20:28,920
+في داخل الinterstitium مقابل الـA مقابل more
+
+270
+00:20:28,920 --> 00:20:33,740
+positive filtrate بيقدّي إلى أن المجنزة والكرسي
+
+271
+00:20:33,740 --> 00:20:39,870
+ميندفعه إلى الداخللأن السوديو ممكن يصير له back
+
+272
+00:20:39,870 --> 00:20:42,950
+diffusion يؤدي إلى ان الفرج و البوتاسيوم يصير له
+
+273
+00:20:42,950 --> 00:20:45,990
+back diffusion يصير ال electronegativity موجودة
+
+274
+00:20:45,990 --> 00:20:48,870
+يؤدي إلى مثل اي مسألة بسيطة المهم في الموضوع انه
+
+275
+00:20:48,870 --> 00:20:53,910
+بيصير ايه مجنيزيوم و كالسيوم بيقدروا يعدوا يصيرهم
+
+276
+00:20:53,910 --> 00:20:57,230
+reabsorption عبر ايه ال parasolary junction في
+
+277
+00:20:57,230 --> 00:21:00,850
+التكأس النجلمة اذا هنا عندنا ال career هذا career
+
+278
+00:21:00,850 --> 00:21:05,270
+مميزالنقطة الأولى انه مميز بعد كده هنتكلم عن الـ
+
+279
+00:21:05,270 --> 00:21:10,290
+Early Distil هنلاقي انه Sodium Chloride فقط يعني
+
+280
+00:21:10,290 --> 00:21:14,290
+Sodium بخش جبال ال chloride مش Sodium Chloride
+
+281
+00:21:14,290 --> 00:21:18,590
+بوتاسيوم و هنا بوتاسيوم هو داخل و عوض طلع يعني
+
+282
+00:21:18,590 --> 00:21:23,930
+قيمته مش كبيرة فإذا ال career البعده هنلاقي بس لل
+
+283
+00:21:23,930 --> 00:21:29,450
+Sodium و ال chloride هذا النقطة الأولى انه طبيعة
+
+284
+00:21:29,450 --> 00:21:30,890
+ال career النقطة التانية
+
+285
+00:21:34,320 --> 00:21:38,760
+النقطة التانية المهمة في الموضوع انه clinically
+
+286
+00:21:38,760 --> 00:21:42,080
+احنا هتكلم على في المستقبل حاجة اسمها loop
+
+287
+00:21:42,080 --> 00:21:46,440
+diuretics هتكلم على ايه؟ diuretics اللي هي مدرات
+
+288
+00:21:46,440 --> 00:21:51,360
+البول مدرات البول بانواع 500 ديورتيكس من ضمنها نوع
+
+289
+00:21:51,360 --> 00:21:54,680
+اسمه loop diuretics يعني ال diuretic اللي بيشتغل
+
+290
+00:21:54,680 --> 00:21:59,420
+من خلال شغله على ال loop يعني بمعنى انه بعطل لها
+
+291
+00:21:59,420 --> 00:22:03,320
+ال transporter هذاالـ Transporter اللي بتقوي أقوى
+
+292
+00:22:03,320 --> 00:22:06,480
+Transporter في دراساتها حتى الآن One Sodium, One
+
+293
+00:22:06,480 --> 00:22:10,640
+Potassium, اتنين Chloride عبره، لو عطلها، بيظل في
+
+294
+00:22:10,640 --> 00:22:13,460
+داخل الـ Tribule Sodium كتير و Chloride كتير و
+
+295
+00:22:13,460 --> 00:22:17,220
+Potassium كتير، مش كده؟ هدول هم طالعين، بياخدوا
+
+296
+00:22:17,220 --> 00:22:22,990
+معاهم ميّه، مش هيك؟ لإن الإسقلالية هتعلقهنا هتحتي
+
+297
+00:22:22,990 --> 00:22:25,910
+على الأصغار اللي هيسحبوا معاهم مياه تركيزهم في
+
+298
+00:22:25,910 --> 00:22:32,430
+الداخل فلذلك ال loop diuretics are strong
+
+299
+00:22:32,430 --> 00:22:37,510
+diuretics بيشتغلوا لما بيشتغلوا بيبقى لهم rapid
+
+300
+00:22:37,510 --> 00:22:43,190
+onset و short duration بيشتغلوا كمية كبيرة جدا من
+
+301
+00:22:43,190 --> 00:22:47,030
+المياه خلال تلت اربع ساعاتThe loop diuretics في
+
+302
+00:22:47,030 --> 00:22:51,230
+المستقبل هستخدمهم انتوا لكن قلتلكم عيبهم انه
+
+303
+00:22:51,230 --> 00:22:55,210
+هيشتغلوا بسرعة و هيشتغلوا كمية كبيرة لذلك بياخد
+
+304
+00:22:55,210 --> 00:22:57,890
+loop diuretics بينفعش يروح على الشغل لازم يقعد في
+
+305
+00:22:57,890 --> 00:23:02,390
+الظهر لأنه هياخد تلت اربع خمس ست ساعات هو رايح جاي
+
+306
+00:23:02,390 --> 00:23:07,090
+عوين على الحمام فبينفعش ايه يروح على الشغل في حين
+
+307
+00:23:07,090 --> 00:23:11,210
+انه النوع التاني هتكلم عليه بعد كده Thiazide
+
+308
+00:23:11,210 --> 00:23:12,930
+diuretics اللي هيشتغل على ال
+
+309
+00:23:16,410 --> 00:23:22,090
+هيشغل على ال sodium chloride carrier system اضعف
+
+310
+00:23:22,090 --> 00:23:26,070
+كتير من هذا ال system فهذا بياخد longer duration
+
+311
+00:23:26,070 --> 00:23:31,490
+عصنا مشروع الكلام ايه؟ الكلام واضح ولا لا يا بناه؟
+
+312
+00:23:31,490 --> 00:23:37,510
+واضح بعد كده هنجد transporter مختلف اضعف فلذلك
+
+313
+00:23:37,510 --> 00:23:44,320
+نعمله inhibition ونمنع ال sodiumانه يطلع في
+
+314
+00:23:44,320 --> 00:23:49,080
+transporter ضعيف هلاجي
+
+315
+00:23:49,080 --> 00:23:52,660
+انه الفرصة عندى انا ان باخد milder diuretic
+
+316
+00:23:52,660 --> 00:23:58,220
+diuretic أخف شوية و بياخد longer variation فهذا
+
+317
+00:23:58,220 --> 00:24:02,660
+قلطف شوية لإن في الآخر المحصلة النهائية واحدة واحد
+
+318
+00:24:02,660 --> 00:24:09,760
+عمل شغل كبير في مسافة صغيرة و واحد عمل شغل كبير في
+
+319
+00:24:09,760 --> 00:24:13,460
+مسافة طويلة هو بيان انه بطيءلكن المدة الطويلة دي
+
+320
+00:24:13,460 --> 00:24:22,120
+ادته ايه ادته كام كويسة اذا في عندها ال system
+
+321
+00:24:22,120 --> 00:24:27,720
+اللى اتكلمنا عنه نرجع تانى فوق عشان احنا الصورة
+
+322
+00:24:27,720 --> 00:24:34,240
+اهتمينا فيها خلينا نمشي شوية شوية طيب اذا ال logo
+
+323
+00:24:34,240 --> 00:24:38,760
+فينلي جسمناه لجسمين وقولنا انه في جزء من الدستور
+
+324
+00:24:38,760 --> 00:24:40,900
+بيالحق مثلك ascending limb
+
+325
+00:24:47,040 --> 00:24:54,020
+و قلنا إنه عندنا ال sodium one sodium two chloride
+
+326
+00:24:54,020 --> 00:25:00,560
+and one potassium كترانسبورتر system و حكينا إنه
+
+327
+00:25:00,560 --> 00:25:06,940
+عندنا ال inhibition اللي بيعملوا blocking لها
+
+328
+00:25:06,940 --> 00:25:10,760
+الترانسبورتر systemتمام competitive inhibition له
+
+329
+00:25:10,760 --> 00:25:15,820
+فبيمنعه انه ال sodium اللي بتركب عليه competitive
+
+330
+00:25:15,820 --> 00:25:21,320
+inhibition فبصير عندي انا ايه اللي هو ال effect of
+
+331
+00:25:21,320 --> 00:25:24,440
+loop diuretics ال loop diuretics اشهرهم اللي هو ال
+
+332
+00:25:24,440 --> 00:25:28,520
+furosemide اللي بنقوله احنا ايه لازكس كلمة
+
+333
+00:25:28,520 --> 00:25:31,860
+diuretics زي ما مرات بننسى كلمة diuretics بنذكر
+
+334
+00:25:31,860 --> 00:25:37,040
+كلمة ايه لازكس لازكس هو furosemide ال furosemide
+
+335
+00:25:37,040 --> 00:25:40,880
+هذا loop diureticمعناه انه strong diuretic معناه
+
+336
+00:25:40,880 --> 00:25:47,520
+انه ايه strong diuretic working اه for a few hours
+
+337
+00:25:47,520 --> 00:25:56,220
+in big intensity في عند الفيرزامايد الأشهر وعند
+
+338
+00:25:56,220 --> 00:26:04,160
+الاتاكرينك أسد أقل شهرة بيوميتانايد أقل شهرة أيضا
+
+339
+00:26:04,160 --> 00:26:09,800
+بس مشهور جدا منفوريزامايد فوريزامايد اللي هو ليش
+
+340
+00:26:09,800 --> 00:26:15,000
+لزكس فوريزامايد تحفظوها من اليوم و ان على ال route
+
+341
+00:26:15,000 --> 00:26:19,080
+على ال path of the route هيدخلي مجنيزيوم كلورايد
+
+342
+00:26:19,080 --> 00:26:25,360
+ايضا مجنيزيوم و كالسيوم بالاضافة للسوديوم لان
+
+343
+00:26:25,360 --> 00:26:28,620
+السوديوم و البوتاسيوم already هم من اول في ال
+
+344
+00:26:28,620 --> 00:26:33,540
+proximal كان باس freely through the tide junction
+
+345
+00:26:33,540 --> 00:26:36,460
+هنا
+
+346
+00:26:42,500 --> 00:26:49,200
+الـ .. طيب .. إذا أكدنا هنا على أنه impermeable to
+
+347
+00:26:49,200 --> 00:26:56,740
+water هذه الرسمة تبعتنا و هذه ال .. طيب .. okay
+
+348
+00:26:56,740 --> 00:27:01,660
+early distal tubule فإذا في حاجة تانية ممكن ما
+
+349
+00:27:01,660 --> 00:27:05,900
+ذكرناش احنا بخصوص ال sodium hydrogen
+
+350
+00:27:09,800 --> 00:27:12,580
+السوديوم هيدروجين هنا ممكن نزرقه في الجزء اللي
+
+351
+00:27:12,580 --> 00:27:15,880
+بعده لما عندي أنا هان سوديوم هيدروجين counter
+
+352
+00:27:15,880 --> 00:27:19,660
+transport برضه وهذا بيساعدني في ال reabsorption of
+
+353
+00:27:19,660 --> 00:27:23,260
+ايه؟ of بيكربونات هيكون التفاصيل في الجزء اللي
+
+354
+00:27:23,260 --> 00:27:26,480
+بعيدها اكتر عندي سوديوم هيدروجين counter transport
+
+355
+00:27:26,480 --> 00:27:32,360
+او ايرلي
+
+356
+00:27:32,360 --> 00:27:36,480
+ديسترال تيبيول يقولون ان ايرلي ديسترال تيبيول are
+
+357
+00:27:36,480 --> 00:27:41,730
+two parts ايرلي والدطيب ايه اللى تضام الى مين الى
+
+358
+00:27:41,730 --> 00:27:45,930
+ال thick ascending limb الفرق اللى يفصل بينهم ال
+
+359
+00:27:45,930 --> 00:27:50,850
+jacksaglomerular apparatus طيب
+
+360
+00:27:50,850 --> 00:27:59,950
+ال thick ascending limb بتطلعلي الفلتات
+
+361
+00:27:59,950 --> 00:28:06,580
+ساحبة منه كمية كبيرة من ايه من ال solutesو بيكمل
+
+362
+00:28:06,580 --> 00:28:08,840
+عليه هذا ال part هذا ال part بيسمي احنا diluting
+
+363
+00:28:08,840 --> 00:28:12,060
+segment مش بس ال early thick ascending limb ال
+
+364
+00:28:12,060 --> 00:28:17,200
+early distal tubule تمام؟ ال early distal tubule
+
+365
+00:28:17,200 --> 00:28:20,720
+زي ال thick ascending limb هذا بيسمي ال diluting
+
+366
+00:28:20,720 --> 00:28:25,580
+segment هذا الجزء اللي بيعمل ايه؟ dilution تمام؟
+
+367
+00:28:25,580 --> 00:28:30,830
+لان قبل كده كان isosmoticلكن بيطلع من هذا المنطقة
+
+368
+00:28:30,830 --> 00:28:36,010
+من ال thick ascending limb diluted وبيطلع من ال
+
+369
+00:28:36,010 --> 00:28:40,350
+early distal برضه more diluted فهذا الجزء بيسمي
+
+370
+00:28:40,350 --> 00:28:46,750
+ايه ال diluting segment approximately 5% of the
+
+371
+00:28:46,750 --> 00:28:49,150
+filtered load of sodium is reabsorbed here
+
+372
+00:28:49,150 --> 00:28:52,390
+ماتكلمناش عن اسم ال thick ascending limb 25% of
+
+373
+00:28:52,390 --> 00:28:56,750
+the filtered sodium is reabsorbed في ال thick
+
+374
+00:28:56,750 --> 00:29:00,560
+ascending limbإذا الخمسة و عشرين في التجاسس النجلم
+
+375
+00:29:00,560 --> 00:29:05,080
+و خمسة في ال early distant صار عنده تلاتين و خمسة
+
+376
+00:29:05,080 --> 00:29:09,900
+و ستين في ال a في ال proximal صار عنده ايه تسعين
+
+377
+00:29:09,900 --> 00:29:14,340
+فالمية في التلات مناطق هدول تسعين فالمية احنا
+
+378
+00:29:14,340 --> 00:29:17,580
+الصوتي مجدش هيسيب له reabsorption في الأوضاع
+
+379
+00:29:17,580 --> 00:29:20,660
+العادية تسعة وتسعين فالمية هيسيب له reabsorption
+
+380
+00:29:20,660 --> 00:29:24,480
+لكن في أوضاع غير عادية هنلاقي اختلفة النسبة
+
+381
+00:29:28,870 --> 00:29:32,030
+The sodium chloride cotransporter system
+
+382
+00:29:32,030 --> 00:29:36,450
+البيزولاترال سيستم ال sodium و البوتاسيوم يتبع
+
+383
+00:29:36,450 --> 00:29:42,850
+بابنج سيستم هو ماتغيرش في كل الكيليا اللي بتغير ان
+
+384
+00:29:42,850 --> 00:29:46,930
+هال Sodium اللي داخل هيحرك ال carrier system ايه
+
+385
+00:29:46,930 --> 00:29:50,550
+ال carrier system اللي موجود هل موجود Sodium و
+
+386
+00:29:50,550 --> 00:29:53,950
+Potassium وChloride ولا Sodium وChloride لحاله كان
+
+387
+00:29:53,950 --> 00:29:59,080
+موجود Sodium وChloride لحالهالسوديوم الكلورايد بو
+
+388
+00:29:59,080 --> 00:30:02,980
+ترانس بورتر يتحرك السوديوم الكلورايد من الـ
+
+389
+00:30:02,980 --> 00:30:08,140
+tubular lumen إلى الـ cell تتعامل مع السوديوم يعني
+
+390
+00:30:08,140 --> 00:30:11,220
+يدخل سوديوم و كلورايد و ليس سوديوم و كتاسيوم و
+
+391
+00:30:11,220 --> 00:30:15,400
+اتنين كلورايد وهيلاقى الصورة تبعكنا اذا ان هان ال
+
+392
+00:30:15,400 --> 00:30:19,460
+carrier system هو السوديوم داخل ويدخل داخل مع مين؟
+
+393
+00:30:19,460 --> 00:30:23,060
+الكلورايد كمان و الكلورايد هان كنتش تبعها بيزيد
+
+394
+00:30:23,060 --> 00:30:27,460
+فالالـ chloride channels هذه الموجودة بتساعد في ال
+
+395
+00:30:27,460 --> 00:30:30,940
+passive diffusion of chloride from inside the
+
+396
+00:30:30,940 --> 00:30:41,960
+cytoplasm to the interstitial fluid هنا
+
+397
+00:30:41,960 --> 00:30:47,740
+قولنا هذا ال carrier system is blocked by a
+
+398
+00:30:47,740 --> 00:30:52,380
+thiazide diuretics بيسميها أيش؟ thiazide diuretics
+
+399
+00:30:53,240 --> 00:30:57,540
+يعملوا على الـ Sodium Chloride Carrier System في
+
+400
+00:30:57,540 --> 00:31:01,200
+الـ Early Distal Conveyor Tribune الـ Loop
+
+401
+00:31:01,200 --> 00:31:05,480
+Diuretics تعمل على الـ Sodium Motassium Chloride
+
+402
+00:31:05,480 --> 00:31:08,260
+Carrier System اللي موجود وين؟ في الـ Thick
+
+403
+00:31:08,260 --> 00:31:11,060
+Ascending Limb و لو ان اسمه Loop Diuretic لكن
+
+404
+00:31:11,060 --> 00:31:14,420
+موجود وين اللي موجود؟ في الـ Thick Ascending Limb
+
+405
+00:31:14,420 --> 00:31:17,820
+of the Loop
+
+406
+00:31:17,820 --> 00:31:21,840
+of Hindley تمام؟ يعني مش في كل ال Loop في ال Thick
+
+407
+00:31:21,840 --> 00:31:27,330
+Ascending Limbعلي انت جانب ايد هناك اه انا مارا
+
+408
+00:31:27,330 --> 00:31:32,090
+هناك كويس؟ قدامي هناك عشان ايه؟ وانتوا ميقنطة
+
+409
+00:31:32,090 --> 00:31:35,850
+مجموعة هذه انتوا شايفين ال mail صار هيك اه فهذه
+
+410
+00:31:35,850 --> 00:31:39,630
+المجموعة تحاول انها تكون هم الله يساعدهم كلهم مش
+
+411
+00:31:39,630 --> 00:31:45,510
+اليوم و المره الجاية طيب ليه ال distal تقول هنا
+
+412
+00:31:45,510 --> 00:31:52,090
+عاد خلصنا العمل الشاق تمام؟ احد بدرب الدورية لكن
+
+413
+00:31:52,090 --> 00:31:55,870
+واحد حاطل شي على رجلوبقوله اعمل هذه اعمل هذه اعمل
+
+414
+00:31:55,870 --> 00:32:00,530
+هذه صحيح ان بضرب الطريقة ويتعبلكن اللى جاله هو
+
+415
+00:32:00,530 --> 00:32:03,570
+اللى هرتب الأمور لو سمنا فيها على الطريق اضرب اكسر
+
+416
+00:32:03,570 --> 00:32:06,750
+الدنيا مش هعمل حاجة لكن اللى جاله انت عليك الجزئية
+
+417
+00:32:06,750 --> 00:32:09,090
+هذه وانت عليك الجزئية هذه وانت عليك الجزئية هذه
+
+418
+00:32:09,090 --> 00:32:12,630
+تمام القيادة هي المسؤولة و لو انه مانفسدش بإيه
+
+419
+00:32:12,630 --> 00:32:17,130
+بإيديها مش كده ففي عندنا كام ضخم بتنفل ايه في
+
+420
+00:32:17,130 --> 00:32:21,630
+الجزء الأول يعني الان بيجي الجزئية المرتبة ان احنا
+
+421
+00:32:21,630 --> 00:32:26,410
+طيب ان انت طلبية تبعت الجسم كده اش بتصادم من اديله
+
+422
+00:32:26,410 --> 00:32:34,150
+او من جللهطلبيات الجسم كده بده، هذا المنطقة ماهياش
+
+423
+00:32:34,150 --> 00:32:37,970
+impermeable to water، لأ impermeable to water، لكن
+
+424
+00:32:37,970 --> 00:32:41,270
+under control، under anti-dietary hormone ماهياش
+
+425
+00:32:41,270 --> 00:32:45,290
+impermeable to .. impermeable أو imperiable to
+
+426
+00:32:45,290 --> 00:32:49,970
+ايه؟ to .. to solute، سوديوم، بوتاسيوم، غيره،
+
+427
+00:32:49,970 --> 00:32:52,800
+impermeable لها، لكن و underUnder .. اه
+
+428
+00:32:52,800 --> 00:32:57,260
+Aldosterone تمام؟ اذا في وجود Aldosterone نسمح
+
+429
+00:32:57,260 --> 00:33:04,320
+ندخل ايه؟ Sodium كتر Aldosterone كتر اكتر جالي من
+
+430
+00:33:04,320 --> 00:33:07,560
+جالي من داخل اجالي Under the common the same و هذه
+
+431
+00:33:07,560 --> 00:33:12,620
+الجزية قلتلكم تنتهي وين؟ تنتهي في ال .. مع نهاية
+
+432
+00:33:12,620 --> 00:33:18,980
+ال cortical collecting ducts او tribules تمام؟ لما
+
+433
+00:33:18,980 --> 00:33:24,160
+ندخل المضلة بيختلفهذه الجزئية تتكون من نوعية من ال
+
+434
+00:33:24,160 --> 00:33:32,940
+sales نوع من ال sales متخصص في شئ و نوع تاني متخصص
+
+435
+00:33:32,940 --> 00:33:37,440
+فقط في شئ آخر إذا كان عندك two types of sales
+
+436
+00:33:37,440 --> 00:33:41,820
+working هنا ال early distal attribute
+
+437
+00:33:45,890 --> 00:33:52,090
+اللي هو يتبع مين قولنا هذا الصورة يتبع تجهز سنجلمة
+
+438
+00:33:52,090 --> 00:33:56,230
+أما الـ latest التبيول هذه فعندي two types of
+
+439
+00:33:56,230 --> 00:34:03,090
+cells تمام عندي intercalated cells وفي عندي
+
+440
+00:34:03,090 --> 00:34:06,590
+principal cells هذي ال principal cells اللي هي شكل
+
+441
+00:34:06,590 --> 00:34:11,450
+معين mitochondria بشكل معين وفي intercalated cells
+
+442
+00:34:11,450 --> 00:34:16,230
+محشورة بينها الintercalated cells شغلتهاإنه تعمل
+
+443
+00:34:16,230 --> 00:34:20,990
+secretion of hydrogen في مقابل طبعا ال sodium pre
+
+444
+00:34:20,990 --> 00:34:25,890
+absorption يا إما تعمل secretion of hydrogen تمام؟
+
+445
+00:34:25,890 --> 00:34:30,480
+يا إما secretion of potassiumيعني ممكن مرات احنا
+
+446
+00:34:30,480 --> 00:34:32,520
+محتاجين البوتاسيوم هو البوتاسيوم في ال principle
+
+447
+00:34:32,520 --> 00:34:35,400
+cells البوتاسيوم في ال principle cells لكن
+
+448
+00:34:35,400 --> 00:34:38,000
+الهيدروجين هذا اللي secreted ممكن يكون مقابل
+
+449
+00:34:38,000 --> 00:34:41,500
+reabsorption of البوتاسيوم لذا هنا بيصير عندي
+
+450
+00:34:41,500 --> 00:34:47,780
+secretion of هيدروجين عندي هيدروجين ATPS هان عندي
+
+451
+00:34:47,780 --> 00:34:53,320
+bombing system نوع تالت مختلف تمام عندي ال carrier
+
+452
+00:34:53,320 --> 00:34:59,080
+system هانوالـ pumping system يعني مش موجود على ال
+
+453
+00:34:59,080 --> 00:35:03,460
+بيزولاترال ممبران هذي عندى pumping system موجود
+
+454
+00:35:03,460 --> 00:35:09,320
+على ال brush border واسمه hydrogen atps في ال
+
+455
+00:35:09,320 --> 00:35:13,600
+intercalated cells في حالة ما يكون في عندى
+
+456
+00:35:13,600 --> 00:35:16,780
+hydrogen .. hydrogen ion concentration عالي في
+
+457
+00:35:16,780 --> 00:35:20,620
+داخل الجسم بتتخلص منه هذا مش فاعل في حالة ما يكون
+
+458
+00:35:20,620 --> 00:35:25,270
+انهبنخرج الهيدروجين و ندخل بيكربونات اكتر هذا ال
+
+459
+00:35:25,270 --> 00:35:29,970
+system بيشتغل هذا ال system active primary active
+
+460
+00:35:29,970 --> 00:35:33,490
+مش secondary active primary active system for
+
+461
+00:35:33,490 --> 00:35:37,930
+secretion of ايه؟ of hydrogen لذلك لما نقارنه بال
+
+462
+00:35:37,930 --> 00:35:43,050
+counter transport في ال secondary active system
+
+463
+00:35:43,050 --> 00:35:46,050
+اللي موجود في ال proximal contribute اللي هنلاقي
+
+464
+00:35:46,050 --> 00:35:51,180
+الفارق ايه؟الفرق ضخم هان يستطيع هذا ال system انه
+
+465
+00:35:51,180 --> 00:35:58,280
+يشتغل secretion بتاسيوم بتاسيوم
+
+466
+00:35:58,280 --> 00:36:01,980
+بتاسيوم
+
+467
+00:36:01,980 --> 00:36:08,560
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+468
+00:36:08,560 --> 00:36:09,560
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+469
+00:36:09,560 --> 00:36:10,380
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+470
+00:36:10,380 --> 00:36:16,300
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+471
+00:36:16,300 --> 00:36:16,360
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+472
+00:36:16,360 --> 00:36:18,170
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيبس هنا ممكن
+
+473
+00:36:18,170 --> 00:36:22,070
+يكون الفرق الـ concentration ألف ضعيف و still
+
+474
+00:36:22,070 --> 00:36:26,490
+pumping hydrogen to the .. to the filtrate to be
+
+475
+00:36:26,490 --> 00:36:30,110
+secreted to the .. to the urine في حين أن الـ
+
+476
+00:36:30,110 --> 00:36:32,890
+proximal contribute ال bombing system ال second
+
+477
+00:36:32,890 --> 00:36:37,970
+reactive system فيه بيقدر يشتغل against أربع إلى
+
+478
+00:36:37,970 --> 00:36:41,470
+عشر أضعاف ال .. ال .. ال plasma concentration
+
+479
+00:36:41,470 --> 00:36:46,840
+تمام؟ إذا ال .. ال .. ال bombing system هناهو
+
+480
+00:36:46,840 --> 00:36:51,440
+بيشتغل against one thousand difference
+
+481
+00:36:51,440 --> 00:36:55,540
+concentration of hydrogen التاني من أربع إلى عشرة
+
+482
+00:36:55,540 --> 00:37:01,200
+لذلك هو هذا ال main buffering system هنا موجود ال
+
+483
+00:37:01,200 --> 00:37:05,080
+main system that controls the pH هنا لإنه يستطيع
+
+484
+00:37:05,080 --> 00:37:10,220
+انه يطلع كميات غير عادية من الهيدروجين تمام هذا في
+
+485
+00:37:10,220 --> 00:37:14,180
+ال Intercalate systemأما الـ principal cells فهي
+
+486
+00:37:14,180 --> 00:37:17,960
+بتعمل reabsorption of sodium to secrete بوتاسيوم
+
+487
+00:37:17,960 --> 00:37:22,100
+مصممة لتسكريت بوتاسيوم لأنه طبيعة أكلنا ربنا خلقنا
+
+488
+00:37:22,100 --> 00:37:26,520
+الأكل فيه بوتاسيوم ازيادة تمام فدائما في system
+
+489
+00:37:26,520 --> 00:37:30,660
+موجود عندى ان اتخلص من البوتاسيوم ازيادة الا اذا
+
+490
+00:37:30,660 --> 00:37:34,880
+كان في عندى دوة معين مرض معين على البوتاسيوم
+
+491
+00:37:41,730 --> 00:37:47,210
+السيستم الانترجلية السلسلة تبقى تبقى تبقى تبقى
+
+492
+00:37:47,210 --> 00:37:57,950
+تبقى تبقى تبقى تبقى تبقى
+
+493
+00:37:57,950 --> 00:38:01,910
+تبقى تبقى تبقى
+
+494
+00:38:04,520 --> 00:38:09,440
+البرنسيبل سيلز تمام ال atps system هذا موجود على
+
+495
+00:38:09,440 --> 00:38:13,700
+ال basolateral membrane ماشي و في المقابل و في
+
+496
+00:38:13,700 --> 00:38:18,200
+عندى sodium channels و potassium في sodium
+
+497
+00:38:18,200 --> 00:38:21,820
+channels و potassium channels هذا ايش بنتكلم عامين
+
+498
+00:38:21,820 --> 00:38:30,080
+احنا على على ال ال late distal convertible احنا
+
+499
+00:38:30,080 --> 00:38:33,940
+اتكلمنا عن نظامين من ال diuretics مظبوطلوب ديوتكس
+
+500
+00:38:33,940 --> 00:38:37,680
+وتيزايد ديوتكس تيزايد ال system موجود في ال air
+
+501
+00:38:37,680 --> 00:38:43,040
+ليه؟ ديستال نحن نتكلم عن الليت ديستال اللي يمثل
+
+502
+00:38:43,040 --> 00:38:46,740
+الليت ديستال ال connecting و ال cortical
+
+503
+00:38:46,740 --> 00:38:50,160
+connecting، مظبوط؟ السيستم هنا فيه موجود عبارة عن
+
+504
+00:38:50,160 --> 00:38:54,160
+ايش؟ عندي سوديوم و بوتاسيوم اتباع بومبينج سيستم
+
+505
+00:38:54,160 --> 00:38:58,320
+وعندي بوتاسيوم channels وعندي ايه؟ سوديوم channels
+
+506
+00:38:58,320 --> 00:39:01,960
+هدول ال channels هدول بيفتحوا according to the
+
+507
+00:39:01,960 --> 00:39:08,950
+needsمش .. مش .. مش .. بدخله عن طريق career system
+
+508
+00:39:08,950 --> 00:39:12,230
+زي ما اتكلمنا عنه لأ هدول channels موجودة بتفتح و
+
+509
+00:39:12,230 --> 00:39:15,690
+بتسكر حسب الحاجة إذا فى عندي والله ألدستيرون كتير
+
+510
+00:39:15,690 --> 00:39:19,030
+عندي ألدستيرون كتير معناه هدول ال system فاتح
+
+511
+00:39:19,030 --> 00:39:22,890
+تمام؟ إذا فش عندي ألدستيرون كتير هدال ال system
+
+512
+00:39:22,890 --> 00:39:28,210
+إيه؟ مسكر ألدستيرون هجيب نفسي لك الأول مرة هنا
+
+513
+00:39:28,210 --> 00:39:35,940
+نتكلم إذا عندي أنا هان الالدستيرون وجودهبينشطلي ال
+
+514
+00:39:35,940 --> 00:39:41,260
+atb system هان اذا القلدسترون من اعماله الرئيسية
+
+515
+00:39:41,260 --> 00:39:47,660
+it activates the atbs system bombing system in the
+
+516
+00:39:47,660 --> 00:39:52,220
+secondary in the second part of the distal tubule
+
+517
+00:39:52,220 --> 00:39:55,160
+in the late part of the distal tubule نقول second
+
+518
+00:39:55,160 --> 00:39:59,310
+part او late part the sameكلمه ال system هاد ازاد
+
+519
+00:39:59,310 --> 00:40:03,270
+شغله كلمه ال sodium concentration هاد جال كلمه
+
+520
+00:40:03,270 --> 00:40:09,810
+influx of sodium زاد طب تصوروا ان انا جبت system
+
+521
+00:40:09,810 --> 00:40:14,410
+to block the aldosterone effect اه اذا انا عملت
+
+522
+00:40:14,410 --> 00:40:18,210
+blocking لل aldosterone effect Anti aldosterone
+
+523
+00:40:18,210 --> 00:40:22,110
+drugs هاد ال anti aldosterone drugs it will
+
+524
+00:40:22,110 --> 00:40:30,060
+compete hereprevent what will decrease the system
+
+525
+00:40:30,060 --> 00:40:37,920
+activity وهذا هيقدر إلى ان ال sodium influx هيجل و
+
+526
+00:40:37,920 --> 00:40:45,240
+ال potassium secretion هيجل مش هيك معايا انتوا
+
+527
+00:40:45,240 --> 00:40:53,110
+لحظة هذا ال system اللي هو الالديوريتيكس هان
+
+528
+00:40:53,110 --> 00:40:55,770
+يسميها ايه الديوريتيكس هان الديوريتيكس هان
+
+529
+00:40:55,770 --> 00:40:57,550
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+530
+00:40:57,550 --> 00:41:00,630
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+531
+00:41:00,630 --> 00:41:02,330
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+532
+00:41:02,330 --> 00:41:04,890
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+533
+00:41:04,890 --> 00:41:06,950
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+534
+00:41:06,950 --> 00:41:08,790
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+535
+00:41:08,790 --> 00:41:19,210
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس
+
+536
+00:41:19,210 --> 00:41:23,520
+هان التلاحظوا إيش ميصة؟ إنه إذا وقفت ال system هذا
+
+537
+00:41:23,520 --> 00:41:28,680
+بأمنع دخول ال sodium، معناه في sodium أكتر بيطلع
+
+538
+00:41:28,680 --> 00:41:32,460
+مع إيه؟ مع ال urine، مش هيك؟ معناها في sodium و
+
+539
+00:41:32,460 --> 00:41:36,140
+water أكتر، معناه diuretic effect، مش هيك؟ لكن في
+
+540
+00:41:36,140 --> 00:41:40,530
+نفس الوجد منع ال secretion of potassiumلأن هدول ال
+
+541
+00:41:40,530 --> 00:41:44,410
+principle cells are mainly secretors of potassium
+
+542
+00:41:44,410 --> 00:41:47,650
+فلمّا أمنع ال secretion of potassium أنا بحافظ على
+
+543
+00:41:47,650 --> 00:41:54,210
+ال potassium وين؟ فى داخل الجسم، إذن هذا ال system
+
+544
+00:41:54,210 --> 00:41:58,550
+ال endosterol antagonist ال system الوحيد اللى هو
+
+545
+00:41:58,550 --> 00:42:03,240
+retaining potassium، تمام؟يعني مش هو هو اللي
+
+546
+00:42:03,240 --> 00:42:06,060
+بنتكلم عنه هذا ال .. ال diuretics مش ع ال .. ع ال
+
+547
+00:42:06,060 --> 00:42:10,700
+late distal هم returning ايه؟ بوتاسيوم بيحافظوا
+
+548
+00:42:10,700 --> 00:42:13,100
+على ال .. مش زي ال other diuretics ال other
+
+549
+00:42:13,100 --> 00:42:16,020
+diuretics هم اللي راح تستخدموهم انتوا و هيكون من
+
+550
+00:42:16,020 --> 00:42:20,300
+ضمن الرشيدة اللي تكتبوهم اه calcium chloride
+
+551
+00:42:20,300 --> 00:42:25,170
+tabletsبوتاسيوم كلورايد تابلتز بتاعتها مباشرة
+
+552
+00:42:25,170 --> 00:42:29,410
+بوتاسيوم كلورايد تابلتز تاعتها مباشرة بوتاسيوم
+
+553
+00:42:29,410 --> 00:42:30,910
+كلورايد تابلتز تاعتها مباشرة بوتاسيوم كلورايد
+
+554
+00:42:30,910 --> 00:42:32,430
+تابلتز تاعتها مباشرة بوتاسيوم كلورايد تابلتز
+
+555
+00:42:32,430 --> 00:42:33,490
+تاعتها مباشرة بوتاسيوم كلورايد تابلتز تاعتها
+
+556
+00:42:33,490 --> 00:42:34,330
+مباشرة بوتاسيوم كلورايد تابلتز تاعتها مباشرة
+
+557
+00:42:34,330 --> 00:42:34,610
+بوتاسيوم كلورايد تابلتز تاعتها مباشرة بوتاسيوم
+
+558
+00:42:34,610 --> 00:42:38,610
+كلورايد تابلتز تاعتها مباشرة بوتاسيوم كلورايد
+
+559
+00:42:38,610 --> 00:42:42,520
+تابلتز تامش بس بتمنع ال absorption of sodium او
+
+560
+00:42:42,520 --> 00:42:46,460
+بتمنع ال absorption of بوتاسيوم تمنع الجسم من
+
+561
+00:42:46,460 --> 00:42:50,440
+البوتاسيوم عند مشكلة كبيرة اذا .. لإن ال plasma
+
+562
+00:42:50,440 --> 00:42:54,760
+لصوب بوتاسيوم اللي فيها جليل فإذا انا خلصته فبيصير
+
+563
+00:42:54,760 --> 00:42:58,560
+عندي hypokalemia ال hypokalemia تأثر على العصابة
+
+564
+00:42:58,560 --> 00:43:02,860
+تثبت مني على الجلب تمام؟ فبتعمللي مشاكل فلذلك انا
+
+565
+00:43:02,860 --> 00:43:06,340
+بيدحافظ على البوتاسيومعلى مستوى الـ A في الـ Extra
+
+566
+00:43:06,340 --> 00:43:10,740
+Ceramic Fluid في الـ Interstitium من هنا يوجد 2
+
+567
+00:43:10,740 --> 00:43:16,000
+نوع من الديارتيكس نوع الديارتيكس يدبليط الجسم من
+
+568
+00:43:16,000 --> 00:43:19,060
+البوتاسيوم يخرج السوديوم و البوتاسيوم مع بعض في
+
+569
+00:43:19,060 --> 00:43:24,840
+اليوريد ونوع تاني لأ نوع تاني بيمنع الـ A السكريشن
+
+570
+00:43:24,840 --> 00:43:32,060
+من الـ A من البوتاسيوم البوتاسيوم يحفظ الديارتيكس
+
+571
+00:43:33,800 --> 00:43:38,500
+بتعمل برسيرفشن للبوتاسيوم لذلك هذا النوع ال
+
+572
+00:43:38,500 --> 00:43:42,880
+aldosterone antagonist بيشتغل على ال distal tubule
+
+573
+00:43:42,880 --> 00:43:47,760
+ليه ال distal؟ و في الحالة هذه هو بيمنع ال
+
+574
+00:43:47,760 --> 00:43:49,680
+secretion من البوتاسيوم بيخلّي البوتاسيوم .. يعني
+
+575
+00:43:49,680 --> 00:43:53,300
+لما أنا بكتب هذا النوع بكتبش معاه بوتاسيوم،
+
+576
+00:43:53,300 --> 00:43:57,640
+بلزمنيش، تمام؟ هذا النوع أنا بلزمنيش أنه يكون فيه
+
+577
+00:43:57,640 --> 00:43:57,920
+إيش
+
+578
+00:44:04,870 --> 00:44:10,650
+عشان أعوض اللي بدي أفجده فيها بمحتاجة إذا هذا الـ
+
+579
+00:44:10,650 --> 00:44:12,150
+Aldosterone Antagonist Effect
+
+580
+00:44:17,090 --> 00:44:22,050
+يدخل السوديوم وبتقسم تحت تأثير ال system ال
+
+581
+00:44:22,050 --> 00:44:27,170
+الدوسترون عالي هذا ال system بيشتغل ماعليش هذا ال
+
+582
+00:44:27,170 --> 00:44:31,210
+system بتوقف وإذا ال system توقف مافيش سوديوم
+
+583
+00:44:31,210 --> 00:44:35,090
+هيدخل السوديوم هيدال إيه؟ طالع لبرا، لذا هذه
+
+584
+00:44:35,090 --> 00:44:38,650
+الجزئية تشتغل بتدخل السوديوم، بتدخل وبتقسم أو
+
+585
+00:44:38,650 --> 00:44:41,870
+بتدخل السوديوم وبتطلع وبتقسم حسب إيه؟ حسب حاجة
+
+586
+00:44:41,870 --> 00:44:48,230
+الجسم هذا ال principle إيه؟ cellsطيب عندي هان ال
+
+587
+00:44:48,230 --> 00:44:51,150
+cells هذي زي ما قلنا ان فيها atba system بتنشط و
+
+588
+00:44:51,150 --> 00:44:54,730
+بتجلل و قلنا هان فيها عندنا potassium channels و
+
+589
+00:44:54,730 --> 00:45:00,050
+ايش و sodium channels لما بتدخل ال sodium اه لما
+
+590
+00:45:00,050 --> 00:45:08,150
+بدخل ال sodium ال system هذا بيشتغل لما ال sodium
+
+591
+00:45:08,150 --> 00:45:12,310
+يدخل ال system ال atba system بيبقى شغال لإن هو
+
+592
+00:45:12,310 --> 00:45:17,110
+بيبقى اللي طلع ال sodiumو يدخل بوتاسيوم لكن اذا
+
+593
+00:45:17,110 --> 00:45:21,530
+انا السوديوم سكرت ال channel تبعته و بطل السوديوم
+
+594
+00:45:21,530 --> 00:45:25,890
+يدخل من ال tubule من ال tubular filtrate بطل
+
+595
+00:45:25,890 --> 00:45:28,750
+السوديوم يدخل لداخل ال what هدول ال cells اللي هم
+
+596
+00:45:28,750 --> 00:45:33,490
+ال late distal tubules بسبب ان انا سكرت ال channel
+
+597
+00:45:33,490 --> 00:45:37,930
+Sodium channel blockers بيسموهم ايش Sodium channel
+
+598
+00:45:37,930 --> 00:45:41,410
+blockers اذا انا سكرت ال channel هذه السوديوم
+
+599
+00:45:41,410 --> 00:45:45,880
+مالحقش داخل ال cellsنتيجة لطرد الصوديوم إلى خارج
+
+600
+00:45:45,880 --> 00:45:50,700
+ال cells عن طريق ال system تمام؟ هذا ال system
+
+601
+00:45:50,700 --> 00:45:54,080
+بيطرد الصوديوم لبرا أو بياخد من ال cytoplasm في
+
+602
+00:45:54,080 --> 00:45:56,620
+المقابل بدخل من ال channel سكرنا ال channel
+
+603
+00:45:56,620 --> 00:46:00,120
+الصوديوم بطل يدخل لمين؟ لداخل ال cells ال bombing
+
+604
+00:46:00,120 --> 00:46:04,820
+system هيتوقععشان .. هو عشان يدخل بوتاسيوم محتاج
+
+605
+00:46:04,820 --> 00:46:08,480
+يطلع Sodium مافيش Sodium بيطلع معناه مافيش
+
+606
+00:46:08,480 --> 00:46:12,620
+بوتاسيوم بيدخل معناه مافيش hyper concentration of
+
+607
+00:46:12,620 --> 00:46:15,420
+.. of بوتاسيوم يعني معناه ال .. ال .. بوتاسيوم كان
+
+608
+00:46:15,420 --> 00:46:19,420
+المفتوحة لكن ال .. ال cytoplasmic concentration of
+
+609
+00:46:19,420 --> 00:46:24,360
+.. of بوتاسيوم انخفض بسبب انه ايش ال pumping
+
+610
+00:46:24,360 --> 00:46:28,100
+system توقف عن عمل طبعا هو هيطلع البوتاسيوم يطلع و
+
+611
+00:46:28,100 --> 00:46:31,160
+يطلع حين متساوى و بعدين مافيش اشي جديد يدخللما ..
+
+612
+00:46:31,160 --> 00:46:35,100
+لما ال sodium بطل يدخل بطل ال potassium من ايه؟ من
+
+613
+00:46:35,100 --> 00:46:38,540
+ال interstitium يدخل لداخل ال cells تمام؟ اذا هنا
+
+614
+00:46:38,540 --> 00:46:42,000
+غريبة جدا ان ال sodium channel blocker هدول ال
+
+615
+00:46:42,000 --> 00:46:44,420
+sodium channel blocker preserving ال potassium
+
+616
+00:46:44,420 --> 00:46:48,540
+concentration في الدم preventing the ايه؟ the
+
+617
+00:46:48,540 --> 00:46:52,280
+diuretics to excrete potassium اذا ال sodium
+
+618
+00:46:52,280 --> 00:46:55,460
+channel blockers لك انهم ايه؟ preserving ايه؟
+
+619
+00:46:56,170 --> 00:47:04,490
+باستخدام البوتاسيوم لتخلص من الديوريتك بشكل كام
+
+620
+00:47:04,490 --> 00:47:07,570
+بيشتغلوا
+
+621
+00:47:07,570 --> 00:47:15,650
+على الـ late distal واحد منهم اسمه الديوريتك
+
+622
+00:47:16,530 --> 00:47:21,430
+و واحد اسمه sodium channel blockers اذا لما اقول
+
+623
+00:47:21,430 --> 00:47:26,710
+لكوا sodium channel blockers برسيفك كوتاسيوم
+
+624
+00:47:26,710 --> 00:47:30,210
+هتقولوا yes مع ان اسمه لا يحفظ عليك
+
+625
+00:47:33,240 --> 00:47:35,760
+في عندى sodium channel blockers وفي عندى
+
+626
+00:47:35,760 --> 00:47:39,420
+aldosterone antagonists هدول بيشتغلوا اتنين نفس
+
+627
+00:47:39,420 --> 00:47:43,200
+المحصلة لكن واحد بيشتغل هنا وواحد بيشتغل هنا وواحد
+
+628
+00:47:43,200 --> 00:47:48,180
+بيعطل الماكينة وواحد بيسحب الكهربا تمام؟ يا منخرب
+
+629
+00:47:48,180 --> 00:47:52,400
+الماكينة ماتشتغلش اللي هي ال aldosteroneنوقف ال
+
+630
+00:47:52,400 --> 00:47:56,460
+ATM system يعني نقوله ماشي مافيش بنزين البنزين بده
+
+631
+00:47:56,460 --> 00:48:00,160
+يكمل تشغيلها هادي ال influx of Sodium طول ما فيه
+
+632
+00:48:00,160 --> 00:48:02,980
+Sodium داخل طول ما الماكينة شغالة وقفنا ندخل
+
+633
+00:48:02,980 --> 00:48:06,580
+Sodium الماكينة بعد شوية و لو شغالة على الفاضي
+
+634
+00:48:06,580 --> 00:48:10,080
+لإنها بدها عشان تعمل ال function ده معاها بدها كل
+
+635
+00:48:10,080 --> 00:48:14,740
+Sodium بيطلع يدخل محله Potassium او كل اتنين
+
+636
+00:48:14,740 --> 00:48:16,740
+Sodium يدخل Potassium او كل Potassium يدخل
+
+637
+00:48:16,740 --> 00:48:20,900
+Potassium فاكرين ال ATM system يعني ده بيشغل كيف؟
+
+638
+00:48:23,170 --> 00:48:26,490
+تلاتة صدرهم واحد و تلاتة و تلاتة و تلاتة و تلاتة و
+
+639
+00:48:26,490 --> 00:48:27,950
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+640
+00:48:27,950 --> 00:48:28,570
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+641
+00:48:28,570 --> 00:48:33,390
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+642
+00:48:33,390 --> 00:48:40,750
+تلاتة و تلاتة و
+
+643
+00:48:40,750 --> 00:48:44,390
+تلات
+
+644
+00:48:45,360 --> 00:48:48,960
+مش كده؟ اذا ال bombing system بيشغل نظام سابق
+
+645
+00:48:48,960 --> 00:48:52,960
+ماتغيرش تلاتة صوديوم لاتنين ايه؟ بوتاسيوم لكن اللي
+
+646
+00:48:52,960 --> 00:48:58,120
+على اليمن ال border حسب ال career فى career صوديوم
+
+647
+00:48:58,120 --> 00:49:02,840
+وصوديوم لاتنين و هان صوديوم بوتاسيوم مش كده؟ طيب
+
+648
+00:49:02,840 --> 00:49:09,600
+اذا اذا
+
+649
+00:49:09,600 --> 00:49:13,750
+واضحة الان ال potassium sparing diureticsاللي هم
+
+650
+00:49:13,750 --> 00:49:18,470
+عندنا نوعين اه بتقسم Sparing Sparing يعني بتخليها
+
+651
+00:49:18,470 --> 00:49:25,230
+محفوظ Intercalated
+
+652
+00:49:25,230 --> 00:49:28,770
+cells Intercalated
+
+653
+00:49:28,770 --> 00:49:35,570
+cells Intercalated cells زي ما قلنا ميزتها انه
+
+654
+00:49:35,570 --> 00:49:41,310
+لاحظوا عندي هذا ال brush border هذا اليمنى
+
+655
+00:49:41,310 --> 00:49:46,470
+الممبرينهذا الـA الـ luminal الابيكال منبراين ال
+
+656
+00:49:46,470 --> 00:49:52,470
+luminal membrane مظبوط موجود عليه ATPs هيدروجين
+
+657
+00:49:52,470 --> 00:49:57,070
+ATPS system هيدروجين ATPS system مش موجود ال ال ال
+
+658
+00:49:57,070 --> 00:49:58,150
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+659
+00:49:58,150 --> 00:49:59,230
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+660
+00:49:59,230 --> 00:50:00,270
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+661
+00:50:00,270 --> 00:50:00,390
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+662
+00:50:00,390 --> 00:50:00,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+663
+00:50:00,890 --> 00:50:00,950
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+664
+00:50:00,950 --> 00:50:01,780
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال الهذا
+
+665
+00:50:01,780 --> 00:50:06,180
+شغلته بس يتحكم في الهيدروجين وبالدين الهيدروجين زى
+
+666
+00:50:06,180 --> 00:50:09,540
+ما قلنا against high concentrations حتى لو كان ال
+
+667
+00:50:09,540 --> 00:50:13,960
+concentration في ال tubule ألف ضعف ال .. ال .. ال
+
+668
+00:50:13,960 --> 00:50:17,180
+interstitial system أو اللى بلازم برضه بضلاش
+
+669
+00:50:17,180 --> 00:50:22,540
+يطلعها لإن هو شغلته هيدروجين معناها اللى بتحكم في
+
+670
+00:50:22,540 --> 00:50:28,500
+الهيدروجين بالإعطاء بتحكمفي الـ bicarbonate بالاخر
+
+671
+00:50:28,500 --> 00:50:32,720
+لأن هدول عكس بعض عشان انا احسن ال pH بدي اغير ال
+
+672
+00:50:32,720 --> 00:50:35,660
+hydrogen في مقابل ال bicarbonate او ال carbonate
+
+673
+00:50:35,660 --> 00:50:39,420
+في مقابله يعني اتنين عكس بعض تمام؟ عندي acidity
+
+674
+00:50:39,420 --> 00:50:41,780
+عالية بيطلع ال hydrogen اكتر و اخد ال bicarbonate
+
+675
+00:50:41,780 --> 00:50:45,760
+اكتر عندي لأ ماثرتي مش عالية فيه بميل لالكاليميا
+
+676
+00:50:45,760 --> 00:50:50,700
+تمام؟ فبروح انا ماطلعش ال bicarbonate بصير اعمل
+
+677
+00:50:50,700 --> 00:50:56,210
+عملت ايه؟ reabsorption لميل للبوتاسيوم لحالهقبل
+
+678
+00:50:56,210 --> 00:51:07,950
+كده اتكلمنا عن الـ
+
+679
+00:51:07,950 --> 00:51:12,950
+counter transport الهيدروشين هذا يتفاعل مع
+
+680
+00:51:12,950 --> 00:51:16,650
+البيكربونيات حول كربون ديوكسيد وهموق و water و
+
+681
+00:51:16,650 --> 00:51:19,630
+كربون ديوكسيد كان بي reabsorb فكده نعمل
+
+682
+00:51:19,630 --> 00:51:23,800
+reabsorption للبيكربونياتمتكلم عنه كنا luminal
+
+683
+00:51:23,800 --> 00:51:27,920
+process هو فيه لما يدخل داخل ال cells بيصير العكس
+
+684
+00:51:27,920 --> 00:51:33,440
+بتحلل برجع ل .. ل .. ل carbonic acid من جديد و ال
+
+685
+00:51:33,440 --> 00:51:37,720
+carbonic acid بتحلل تحت تأثير طبعا ال .. ال
+
+686
+00:51:37,720 --> 00:51:41,280
+carbonic unhydrate إلى bicarbonate و water و
+
+687
+00:51:41,280 --> 00:51:45,360
+hydrogen ال hydrogen يعني استخدامه في ال secretion
+
+688
+00:51:45,360 --> 00:51:47,980
+في ال counter transport تماما و ال bicarbonate
+
+689
+00:51:47,980 --> 00:51:51,730
+enters the ايه؟ the blood مش كده؟وبكدا بيكون انا
+
+690
+00:51:51,730 --> 00:51:54,950
+جالت ال bio carbonate من هن لهن عبر مين mediated
+
+691
+00:51:54,950 --> 00:52:00,910
+by مين؟ by hydrogen ions هنا نفس ال system في داخل
+
+692
+00:52:00,910 --> 00:52:04,270
+ال cells .. نفس ال system في داخل ال cells انه انا
+
+693
+00:52:04,270 --> 00:52:09,270
+لما عندي ال hydrogen اتكون من ال system هذا اللي
+
+694
+00:52:09,270 --> 00:52:11,850
+هو carbon dioxide زي اللي هو طبعا من ال carbonic
+
+695
+00:52:11,850 --> 00:52:15,810
+acid طبعا activated by carbonic anhydrase هذي
+
+696
+00:52:15,810 --> 00:52:19,950
+اتحلل ال bio carbonate ايه؟و الهيدروجين الهيدروجين
+
+697
+00:52:19,950 --> 00:52:24,410
+يستخدم في السكريشن و ال بايكربونيت ايه؟ is
+
+698
+00:52:24,410 --> 00:52:31,430
+reabsorbed again تمام؟ هنا نعمل
+
+699
+00:52:31,430 --> 00:52:36,090
+pumping لمين؟ للهيدروجين لبرا لاحظوا هنا ال system
+
+700
+00:52:36,090 --> 00:52:38,230
+الأولى اتكلمنا عنه في ال production of the jupiter
+
+701
+00:52:38,230 --> 00:52:41,410
+كان بيهتم انه في ايش في اليوم البيكربونيت ادخله
+
+702
+00:52:41,410 --> 00:52:45,390
+ولا مادخلوش عبر الهيدروجين ايالز لإن احنا بتكلم
+
+703
+00:52:45,390 --> 00:52:49,270
+جاعدين ان احنا مندخل او منطلع carbon dioxideحسب
+
+704
+00:52:49,270 --> 00:52:57,050
+حاجتنا فى كده نرحل الهيدروجين لإنه عندى أنا عندى
+
+705
+00:52:57,050 --> 00:53:02,530
+موجود فى داخل الجسم هيدروجين ايون كمية كبيرة بدأ
+
+706
+00:53:02,530 --> 00:53:05,510
+اتخلص منها بدي أعمل إليها secretion فبحتاج إنه
+
+707
+00:53:05,510 --> 00:53:07,610
+يدخل ال carbon dioxide علي من ال interstitium
+
+708
+00:53:07,610 --> 00:53:12,990
+تمام؟ و فى ال interstitium هان أنا بعمل عملية
+
+709
+00:53:12,990 --> 00:53:17,110
+تحويلهبالـ carbonic anhydrase إلى carbonic acid و
+
+710
+00:53:17,110 --> 00:53:19,930
+ال carbonic acid باخد منه hydrogen و بارميه برا
+
+711
+00:53:19,930 --> 00:53:23,850
+تمام؟ إذا نستخدم ال carbon dioxide في أن أحلل
+
+712
+00:53:23,850 --> 00:53:30,530
+الميه إلى .. إلى hydrogen طلع برا و OH اتحد مع مين
+
+713
+00:53:30,530 --> 00:53:33,390
+في المحصلة يعني مع ال carbon dioxide يعمل لي
+
+714
+00:53:33,390 --> 00:53:37,370
+بيكربونات كده بكون أنا أخدت hydrogen ions من الميه
+
+715
+00:53:37,370 --> 00:53:40,510
+و سابقا سبت ال OH ions في الميه كده بكون أنا بخلص
+
+716
+00:53:40,510 --> 00:53:46,020
+الجسم من الـ A من ال hydrogen ions دبعتهاإذا هنا
+
+717
+00:53:46,020 --> 00:53:50,040
+نتكلم على هذه الـ intercalated cells وقلنا إنها
+
+718
+00:53:50,040 --> 00:53:58,540
+mainly .. mainly .. mainly بيصير هنا
+
+719
+00:53:58,540 --> 00:54:07,370
+ال .. both late andالسلسلات المتعارفة من هذه
+
+720
+00:54:07,370 --> 00:54:12,990
+المجالات النيفرون تحفز حيوانات الهيدروجين عن طريق
+
+721
+00:54:12,990 --> 00:54:17,790
+ميكانيزم ATBA الهيدروجين هذا الprocess مختلف عن
+
+722
+00:54:17,790 --> 00:54:22,190
+تحفز حيوانات الهيدروجين عن طريق البروكسيمال تيبور
+
+723
+00:54:22,190 --> 00:54:26,690
+لأنه قادر على تحفز حيوانات الهيدروجين عن طريق
+
+724
+00:54:26,690 --> 00:54:34,140
+ميكانيزم الهيدروجين كمية 1000 إلى 1بالنسبة
+
+725
+00:54:34,140 --> 00:54:37,700
+للمقارنة الصغيرة من أربعة إلى عشرة ضد واحدة
+
+726
+00:54:37,700 --> 00:54:42,600
+لحيوانات الهيدروجينية التي يمكن تحقيقها باستخدام
+
+727
+00:54:42,600 --> 00:54:45,840
+الاستخدام الثانوية في البروكسيماتريبيول. لذلك،
+
+728
+00:54:45,840 --> 00:54:49,820
+تلعب الأسلحة الانتركالية هي رولة أساسية في التحكم
+
+729
+00:54:49,820 --> 00:54:55,340
+الأساسي على المواد الجسمية. برضه بدنا نقول أن
+
+730
+00:54:55,340 --> 00:55:01,580
+البريمابيلية للسوديوم والماء هنا في المنطقة هذه
+
+731
+00:55:01,580 --> 00:55:07,160
+تعتمد عليهاعلى availability of aldosterone او
+
+732
+00:55:07,160 --> 00:55:08,280
+الانتيداراتيك الحرمون
+
+733
+00:55:11,450 --> 00:55:17,310
+خرمون اسمه كان اسمه زمان vazopressin vazopressin
+
+734
+00:55:17,310 --> 00:55:20,870
+لإنه لما يعلى كتير بيصير vazoactive بيعمل
+
+735
+00:55:20,870 --> 00:55:24,610
+vazoconstriction لكن هو ال dose تبعته جليلة في
+
+736
+00:55:24,610 --> 00:55:29,810
+physiological levels جليلة بيحافظ على إنه بس يمنع
+
+737
+00:55:29,810 --> 00:55:34,810
+الميه أن ت be executed ال neuron لكن لو الميه اللي
+
+738
+00:55:34,810 --> 00:55:38,710
+executed ال neuron مش executed و برضه عندي hypo
+
+739
+00:55:39,190 --> 00:55:42,710
+Volumia البلازمو برضه اه فالاندرويد الكهورمون
+
+740
+00:55:42,710 --> 00:55:46,230
+بيعلى اكتر وبساعد في انه يساعد ال blood pressure
+
+741
+00:55:46,230 --> 00:55:50,450
+يستعاد من خلال ال VASO-A Spasms طبعا هذا ال system
+
+742
+00:55:50,450 --> 00:55:53,730
+كله الالدوستيرون و الاندرويد الكهورمون و
+
+743
+00:55:53,730 --> 00:55:57,090
+الانجوتنسين 2 و الرينانسيستم هذا كلهم شغلتهم
+
+744
+00:55:57,090 --> 00:56:01,240
+يحافظوا ع مين يحافظوا علىالـ blood pressure يحافظ
+
+745
+00:56:01,240 --> 00:56:04,180
+على مين؟ الشغل الأساسي تبعهم يحافظ على الـ blood
+
+746
+00:56:04,180 --> 00:56:07,000
+pressure الـ blood pressure بتحافظ علي ان ازيد
+
+747
+00:56:07,000 --> 00:56:14,280
+الميه اللى فيه بمنحها من التسرب عبر الكيلية تمام؟
+
+748
+00:56:14,280 --> 00:56:18,280
+او ازيد ال contraction of blood vessels لإن ازدت
+
+749
+00:56:18,280 --> 00:56:21,840
+ال vasoplasm ميعلى الدغر اذا ازدت ال volume اللى
+
+750
+00:56:21,840 --> 00:56:26,140
+في داخل جسمه ميعلى الدغر مش كده؟ طيب
+
+751
+00:56:28,970 --> 00:56:33,770
+Medullary Collecting Doctrine الجزء الأخير من
+
+752
+00:56:33,770 --> 00:56:40,010
+الموضوع احنا وصلنا لان لما .. طبعا احنا فى الفصل
+
+753
+00:56:40,010 --> 00:56:44,950
+الجاى بنتكلم عن الأرقام بس لان لما انه ال .. ال
+
+754
+00:56:44,950 --> 00:56:46,230
+thickening lab اشتغلت
+
+755
+00:56:48,750 --> 00:56:53,370
+الجزئية اللى هتصل المدالة لدك تعتمد على ال
+
+756
+00:56:53,370 --> 00:56:59,090
+functions اللى موجودة في ال led circuitry
+
+757
+00:56:59,090 --> 00:57:07,670
+ال led circuitry الها دى ممكن تحول ال filtrate هذا
+
+758
+00:57:07,670 --> 00:57:11,750
+الى more diluted اذا عملنا more reabsorption of
+
+759
+00:57:11,750 --> 00:57:17,280
+sodium و less reabsorption of water او ترجعهالى
+
+760
+00:57:17,280 --> 00:57:21,380
+maximum بترايشه ل isosmotic maximum بترايشه ل إيش
+
+761
+00:57:21,380 --> 00:57:26,900
+ل isosmotic تمام لإنه ال cortical interstitium
+
+762
+00:57:26,900 --> 00:57:30,520
+تركيزه جديش isosmotic تلت مية ال cortical
+
+763
+00:57:30,520 --> 00:57:34,380
+interstitium فلذلك أنا بدي أسحب مياه بسحبها لحد من
+
+764
+00:57:34,380 --> 00:57:36,880
+ال cells تصير مساوية لل interstitium اللي حواليها
+
+765
+00:57:36,880 --> 00:57:40,580
+عشان يصير ال balance مش هات؟ إذا أنا بيطلع من عندي
+
+766
+00:57:40,580 --> 00:57:49,490
+يا إما hypotonic يا إما إيهيا ايزوز بوتيك اذا ال
+
+767
+00:57:49,490 --> 00:57:51,850
+.. ال .. ال .. ال .. ال thick ascending limb بتسلم
+
+768
+00:57:51,850 --> 00:57:56,290
+ال .. ال distal ال hypotonic solution ال hypotonic
+
+769
+00:57:56,290 --> 00:57:58,730
+solution هذا ميت من الأزمة ممكن يزيد ال
+
+770
+00:57:58,730 --> 00:58:02,910
+hypotonicity اكتر تمام اللي هو ال distal اللي هي
+
+771
+00:58:02,910 --> 00:58:07,210
+ال distal لكن مابقدرش يخليه high bar ال high bar
+
+772
+00:58:07,210 --> 00:58:13,190
+هذا شغلت مين المضلةبصيرش hyper osmotic إلا إذا دخل
+
+773
+00:58:13,190 --> 00:58:17,170
+ايه المضلة لكن احنا ال thick ascending limb والله
+
+774
+00:58:17,170 --> 00:58:21,310
+الوضع طبعا طبيعي لابد نزود ولا بد نجلل ووضعنا
+
+775
+00:58:21,310 --> 00:58:24,050
+كويسه ونشرب كويسه ونأكل كويسه ومافيش عندنا حالة
+
+776
+00:58:24,050 --> 00:58:29,010
+dehydration ولا over hydration ولا إشي تمام؟ في
+
+777
+00:58:29,010 --> 00:58:31,270
+الحالة دي ال thick ascending .. ال .. ال .. ال ..
+
+778
+00:58:31,270 --> 00:58:34,610
+ال distal convolution بتشغل بشكل طبيعي في العادة
+
+779
+00:58:34,610 --> 00:58:40,450
+بيوصل ال filtrateالى المدلري collecting duct
+
+780
+00:58:40,450 --> 00:58:48,250
+isosmotic طبعا لكن لو كان محتاج ميه اكتر لو عندى
+
+781
+00:58:48,250 --> 00:58:55,090
+ميه اكتر اه بوصله اه لو محتاج سوديوم اكتر بوصله
+
+782
+00:58:55,090 --> 00:58:59,430
+hypotonic اكتر هذه منطقة ال regulation طبعا انت
+
+783
+00:58:59,430 --> 00:59:05,260
+تحكم فيهابيزيدوا بجل و القلد السترال بتحكم فيها
+
+784
+00:59:05,260 --> 00:59:09,240
+وحسب النتيجة بسهولة بنقدر نتوقع ايش بتحصل، تمام؟
+
+785
+00:59:09,240 --> 00:59:13,380
+لكن الـthick ascending limb بيطلع ال .. الـ distal
+
+786
+00:59:13,380 --> 00:59:16,460
+tubule بيطلعش منها fluid إلى ال .. إلى المدالة
+
+787
+00:59:16,460 --> 00:59:20,200
+recollecting duct hypertonic بيصل ماكسما إيزوتونك،
+
+788
+00:59:20,200 --> 00:59:25,850
+تمام؟ لكن ممكن يصل severe hypotonicو تحافظ عليه
+
+789
+00:59:25,850 --> 00:59:30,650
+الميدالة اذا انا بوصل ان اوصل لخمسين و بدأ اطلع
+
+790
+00:59:30,650 --> 00:59:35,530
+بيتلاشى دور الميدالة لان في الحالة هذه ممكن يطلع
+
+791
+00:59:35,530 --> 00:59:40,170
+من الـ distal tribule الهيبوتينيك فيلتريت و يظل
+
+792
+00:59:40,170 --> 00:59:44,050
+ماشي لل ball الميدالة ماعملتش شفية لأن هي اللي
+
+793
+00:59:44,050 --> 00:59:47,640
+بتقدر تعمل dilutionتدخل المضلة اي تدخل المضلة
+
+794
+00:59:47,640 --> 00:59:49,920
+تعمله more concentration فإذا أنا بدي اعمل
+
+795
+00:59:49,920 --> 00:59:54,700
+dilution كتير المضلة ايش؟ بتدخلش تمام؟ لأنه هلاحظ
+
+796
+00:59:54,700 --> 01:00:00,700
+انا انه عشان الميه اتخش من المضلة مضلة دكت مضلة
+
+797
+01:00:00,700 --> 01:00:04,980
+ايه؟ دكت الى داخل ال cells تبع المضلة الى ال
+
+798
+01:00:04,980 --> 01:00:09,840
+interstitium تحتاج الى watercarriers water pores
+
+799
+01:00:09,840 --> 01:00:13,580
+water channels إذا فتحت ال water channels ممكن
+
+800
+01:00:13,580 --> 01:00:16,840
+الميه تبدأ تطلع و يصبح more concentration صحيح
+
+801
+01:00:16,840 --> 01:00:22,140
+diluted urine و صحيح اللي حواليها ال interstitium
+
+802
+01:00:22,140 --> 01:00:28,140
+ايزوزموتك تمام هو شيبرزموتك لكنه ايزوزموتك لكن
+
+803
+01:00:28,140 --> 01:00:32,640
+الميه مش قادرة تطلع منه لإن ال water channels ايه
+
+804
+01:00:32,640 --> 01:00:39,710
+مسكرةواضح؟ واضح الكلام ولا لا؟ اذا احنا ال digital
+
+805
+01:00:39,710 --> 01:00:40,330
+tribune
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..fcbe312b81d219c17833b1f57261799a2036cb1b
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/4h-Rll8QLkk_raw.srt
@@ -0,0 +1,3256 @@
+1
+00:00:05,040 --> 00:00:13,860
+اليوم احنا هنكمل اللي هو how urine is formed in
+
+2
+00:00:13,860 --> 00:00:19,560
+the kidney زي ما احنا عارفين احنا ال urine بيبدأ ب
+
+3
+00:00:19,560 --> 00:00:24,500
+filtration عبر ال glomerulus مستمير glomerulus
+
+4
+00:00:24,500 --> 00:00:28,040
+filtration بعدين بيصير في عملية reabsorption
+
+5
+00:00:28,040 --> 00:00:32,600
+tubular reabsorption و هدول التنتين عمليتين هم ال
+
+6
+00:00:32,600 --> 00:00:39,290
+major proceduresبالحقهم بروسوس اخرى اصغر شوية اقل
+
+7
+00:00:39,290 --> 00:00:45,990
+شوية كمان وهي ال secretion فعملية ال filtration
+
+8
+00:00:45,990 --> 00:00:51,350
+زائد ال reabsorption زائد ال secretion بتديني ال
+
+9
+00:00:51,350 --> 00:00:56,410
+final quality of urine final quantity of urine
+
+10
+00:00:56,410 --> 00:01:04,820
+يعتمد اتكلمنا في اخر نقطة في ال reabsorption انهفي
+
+11
+00:01:04,820 --> 00:01:08,260
+الـ proximal convolutal tubule بيصير عملية
+
+12
+00:01:08,260 --> 00:01:12,120
+secretions كمان وقولنا ال secretions هذه ممكن تكون
+
+13
+00:01:12,120 --> 00:01:21,940
+active secretion عبر ال counter transport يعني
+
+14
+00:01:21,940 --> 00:01:25,300
+secondary active الحالة هذه بيكون اللي هو لما
+
+15
+00:01:25,300 --> 00:01:29,420
+قولنا ال reabsorption of بيكربونات من خلال ال
+
+16
+00:01:29,420 --> 00:01:33,300
+counter transport of ايه؟ of هيدروجينالفظوه هادى
+
+17
+00:01:33,300 --> 00:01:36,560
+لان عندنا بعد شوية صغيرة هنقارن ما بين هادى ال
+
+18
+00:01:36,560 --> 00:01:41,000
+process of hydrogen secretion مع other process of
+
+19
+00:01:41,000 --> 00:01:45,300
+hydrogen secretion active hydrogen secretion في ال
+
+20
+00:01:45,300 --> 00:01:49,400
+distal tubuleفي الـ intercalated cells of the
+
+21
+00:01:49,400 --> 00:01:53,120
+distal tubules فى عملية أخرى من الـ hydrogen
+
+22
+00:01:53,120 --> 00:01:58,120
+secretion بتم من خلالها برضه reabsorption of
+
+23
+00:01:58,120 --> 00:02:01,380
+بوتاسيوم أو mainly reabsorption of الكربونات أو
+
+24
+00:02:01,380 --> 00:02:04,580
+just for regulation of hydrogen concentration
+
+25
+00:02:04,580 --> 00:02:09,660
+حنلاحظ
+
+26
+00:02:09,660 --> 00:02:14,600
+هن أن هذا ال process secondary activeالتانى هتكون
+
+27
+00:02:14,600 --> 00:02:21,060
+an active process by hydrogen atbas تمام انا بس
+
+28
+00:02:21,060 --> 00:02:24,980
+بحضركم الفكرة ان دايما بيصير مقارنة ما بين ال
+
+29
+00:02:24,980 --> 00:02:27,720
+process اللي بيصير في ال distal tube و ال process
+
+30
+00:02:27,720 --> 00:02:34,820
+اللي بيصير في ال proximal tube بما يخص ال hydrogen
+
+31
+00:02:34,820 --> 00:02:37,420
+secretion and bicarbonate reabsorption
+
+32
+00:02:42,320 --> 00:02:49,200
+عنا ال Paraminohepuric acid واحد من ال organic
+
+33
+00:02:49,200 --> 00:02:53,720
+acids اللى هو ازاي ال organic acids اللى اتكلمنا
+
+34
+00:02:53,720 --> 00:02:57,780
+عنها من شوية او اخر مرة في الدرس الفات انه عنا
+
+35
+00:02:57,780 --> 00:03:01,440
+active process active secretion لل organic acids
+
+36
+00:03:01,440 --> 00:03:06,240
+وقولنا بالذات للبنسيلين لإنه عاملانا مشكلة و ل ال
+
+37
+00:03:06,240 --> 00:03:09,820
+salicylic acid اللى هو الأسبيرين لإنه بيقدر إلى
+
+38
+00:03:09,820 --> 00:03:16,150
+انه rapidو من
+
+39
+00:03:16,150 --> 00:03:21,170
+هنا
+
+40
+00:03:21,170 --> 00:03:27,290
+تم عملية ربط بنسالين بنسالين
+
+41
+00:03:27,290 --> 00:03:30,690
+جي بنسالين جي بنسالين جي بنسالين جي بنسالين جي
+
+42
+00:03:30,690 --> 00:03:36,840
+بنسالين جي بنسالين جيلـ binding protein بحيث انه
+
+43
+00:03:36,840 --> 00:03:42,400
+يبطل يصبح عملية easy filtration and easy excretion
+
+44
+00:03:42,400 --> 00:03:47,180
+and easy secretion فصار عملية انأخر من ال
+
+45
+00:03:47,180 --> 00:03:52,960
+executing process
+
+46
+00:03:52,960 --> 00:03:57,480
+انأخرها شوية و قد الى ان في الآخر عنا نطلع long
+
+47
+00:03:57,480 --> 00:04:00,800
+acting penicillin long acting penicillin ممكن
+
+48
+00:04:00,800 --> 00:04:07,280
+تناقض كل شهر مرةكل شهر مرة اديناله مواصفات معينة
+
+49
+00:04:07,280 --> 00:04:12,310
+نمنع ايه؟ خروجه عن طريق الكلابفي مادة هنا بتهمني
+
+50
+00:04:12,310 --> 00:04:18,850
+في الموضوع هذا المادة مش لها يعني clinical effect
+
+51
+00:04:18,850 --> 00:04:23,330
+زي ال penicillin و دور ال secretion تبعه و أهميته
+
+52
+00:04:23,330 --> 00:04:27,170
+و ال salicylic acid و كذا لكن لها أهمية بأن هذه
+
+53
+00:04:27,170 --> 00:04:30,590
+المادة اسمها paraminohiberic acid هذه المادة أنا
+
+54
+00:04:30,590 --> 00:04:35,240
+بستخدمها في قياس ال plasma renal plasma flowبلازما
+
+55
+00:04:35,240 --> 00:04:39,660
+فلو فيها الكيليا ليش بستخدمها؟ لأن هذه المادة
+
+56
+00:04:39,660 --> 00:04:43,700
+تقريبا تسعين في المية منها او نعتبرها حاليا مية
+
+57
+00:04:43,700 --> 00:04:50,180
+المية منها is executed just by one flow inside the
+
+58
+00:04:50,180 --> 00:04:54,840
+kidneyمتى ما دخلت الكيلية معناها انه بتطلع بلاجة
+
+59
+00:04:54,840 --> 00:04:58,800
+ال venosite اصلا حكيتكوا عليها ال venosite بيكون
+
+60
+00:04:58,800 --> 00:05:03,000
+فضي فبكدا بقدر انا اقول انه المادة اللي طلعت في
+
+61
+00:05:03,000 --> 00:05:07,380
+اليورينها دلساوي المادة اللي دخلت الكيلية عبر
+
+62
+00:05:07,380 --> 00:05:11,300
+البلازمة لإنها البلازمة اتصفت منها بقدر احسب
+
+63
+00:05:11,300 --> 00:05:15,320
+البلازمة flow بعد ما اعدلها بال 90% يعني بضف ال 10
+
+64
+00:05:15,320 --> 00:05:19,160
+% ومنها ال hematocrit بقدر اعرف ال renal blood
+
+65
+00:05:19,160 --> 00:05:19,860
+flow
+
+66
+00:05:27,700 --> 00:05:31,140
+الان دخلنا على .. خلصنا ال brochure و ال tribune
+
+67
+00:05:31,140 --> 00:05:36,220
+تقريبا كنا شرحنا معظم الأشياء اللي بتصير فيها و
+
+68
+00:05:36,220 --> 00:05:40,020
+اضحى على الكاميرا ان انا نجح بتاعة ال course الان
+
+69
+00:05:40,020 --> 00:05:43,800
+هننزل لل loop of Henle ال loop of Henle في the
+
+70
+00:05:43,800 --> 00:05:46,700
+descending loop of Henle و في ascending loop of
+
+71
+00:05:46,700 --> 00:05:51,700
+Henleالدسيندين جلوبوفينلي نوع واحد ثين دسيندين
+
+72
+00:05:51,700 --> 00:05:59,660
+جلوبوفينلي ما هو جزء ثين وجزء نوع واحد ثين دسيندين
+
+73
+00:05:59,660 --> 00:06:07,230
+جلوبوفينلي هذا permeable to waterو يعني semi
+
+74
+00:06:07,230 --> 00:06:11,270
+permeable to other solutes يعني في إمكانية للحركة
+
+75
+00:06:11,270 --> 00:06:14,690
+من خلاله الأشياء اللي فيها ممكن تطلع لبرا يعني لو
+
+76
+00:06:14,690 --> 00:06:18,030
+ال intersection برا ال intersection اللي نازل فيه
+
+77
+00:06:18,030 --> 00:06:21,410
+ال loop of Henle هي concentrated هيقدر الميه
+
+78
+00:06:21,410 --> 00:06:28,950
+freely هتتحرك إلى إيه؟ إلى الخارج هذا ال loop
+
+79
+00:06:28,950 --> 00:06:34,190
+تمام؟ هذا بالنسبة لل descending loopالـ ascending
+
+80
+00:06:34,190 --> 00:06:39,410
+loop برضه فيه جزء تقريبا نص أو أقل من نص شوية تن
+
+81
+00:06:39,410 --> 00:06:45,870
+وهذا عكس ال descending loop impermeable to water
+
+82
+00:06:45,870 --> 00:06:53,610
+and it is impermeable to urea or nearly
+
+83
+00:06:53,610 --> 00:06:57,310
+impermeable to other solutes يعني ما هو ال
+
+84
+00:06:57,310 --> 00:07:01,990
+permeability للسوليس الأخرى limited المهم أنهاit
+
+85
+00:07:01,990 --> 00:07:05,030
+is impermeable to water حيشي بعدها اللي هو thick
+
+86
+00:07:05,030 --> 00:07:09,330
+ascending limb ال thick ascending limb هذا أهم جزء
+
+87
+00:07:09,330 --> 00:07:13,850
+في ال loop of Henle من ناحية انه انعكاسه على كل
+
+88
+00:07:13,850 --> 00:07:18,350
+شغل الكليه انعكاس كبير انعكاسه على كل ..الان ال
+
+89
+00:07:18,350 --> 00:07:22,110
+filtrate اللي داخل ال loop of Henle ال filtrate
+
+90
+00:07:22,110 --> 00:07:25,490
+اللي داخل ال loop of Henle بيصل ال distal tubule
+
+91
+00:07:26,700 --> 00:07:30,820
+بيصل ال thick ascending limb بيصل ال thick
+
+92
+00:07:30,820 --> 00:07:36,240
+ascending limb fishy
+
+93
+00:07:36,240 --> 00:07:46,280
+mouse اه؟ يا ريت والله انا بيريحني اذا ال .. ال
+
+94
+00:07:46,280 --> 00:07:52,690
+thick ascending limb هذا ميزتهإنه حيصير في عندنا
+
+95
+00:07:52,690 --> 00:07:59,610
+عملية active reabsorption for
+
+96
+00:07:59,610 --> 00:08:03,770
+solutes and it is impermeable to water يعني لما
+
+97
+00:08:03,770 --> 00:08:08,110
+ناخد ال solutes و يصير عندنا hypotonicity فى داخل
+
+98
+00:08:08,110 --> 00:08:12,750
+ال filtrate ال water will not be able to follow
+
+99
+00:08:12,750 --> 00:08:15,170
+the solutes مش ده ال professor ما كان في ال
+
+100
+00:08:15,170 --> 00:08:19,990
+tribune راح السوديو مليفروريد تلحقها الميههنا في
+
+101
+00:08:19,990 --> 00:08:24,550
+الحالة هذه هيصير absorption لل solutes كميات كبيرة
+
+102
+00:08:24,550 --> 00:08:31,230
+تمام بحيث انه الميه can not enter the thick
+
+103
+00:08:31,230 --> 00:08:36,590
+aciniglam cells اذا it is impermeable to water it
+
+104
+00:08:36,590 --> 00:08:40,610
+is impermeable to ureaتمام؟ اذا اليوريا و ال water
+
+105
+00:08:40,610 --> 00:08:44,430
+هيدالهم ماشيين في ال filtrate اذا عندها لما انا
+
+106
+00:08:44,430 --> 00:08:46,910
+يصير reabsorption لما كمية كبيرة من ال solutes
+
+107
+00:08:46,910 --> 00:08:53,110
+هيصير عندي ال tubular filtrate يخلص مهمته في ال
+
+108
+00:08:53,110 --> 00:08:56,690
+thick ascending limb هنلاقي صحر أخدنا ال solutes و
+
+109
+00:08:56,690 --> 00:09:01,090
+أضالة ال water هيكون hypo osmotic اذا عن hypo
+
+110
+00:09:01,090 --> 00:09:05,170
+osmotic حقيقة
+
+111
+00:09:05,170 --> 00:09:08,650
+ال thick ascending limb هذافي هذا الـ function
+
+112
+00:09:08,650 --> 00:09:14,330
+تبعه يُصاحب الجزء الأول من الـ proximal من الـ
+
+113
+00:09:14,330 --> 00:09:17,230
+distal convolutable الـ distal convolutable هنقسمه
+
+114
+00:09:17,230 --> 00:09:22,070
+إلى قسمين Early part وDistal part تمام؟بيفصل
+
+115
+00:09:22,070 --> 00:09:25,350
+الجهتين الـ thick ascending limb عن الـ early part
+
+116
+00:09:25,350 --> 00:09:27,950
+of the distal convective tubule اللي هو
+
+117
+00:09:27,950 --> 00:09:31,270
+الجفساجروميلر الاباراتس مش كده؟ إذا في عند
+
+118
+00:09:31,270 --> 00:09:33,270
+جفساجروميلر الاباراتس بيجي بعدها ثقة ascending
+
+119
+00:09:33,270 --> 00:09:37,530
+limb مباشرة وبعده بشوية بيبدأ ال .. ال distal
+
+120
+00:09:37,530 --> 00:09:40,210
+tubule هذه الجزية اللي بعدها شوية صغيرة اللي هي ال
+
+121
+00:09:40,210 --> 00:09:43,690
+early distal tubule ال early distal convective
+
+122
+00:09:43,690 --> 00:09:49,230
+tubule ال function تبعها مشابه مصاحب مكمل لثقة
+
+123
+00:09:49,230 --> 00:09:54,390
+ascending limbتمام نفس الشيء الفرق بينهم ميكانيزم
+
+124
+00:09:54,390 --> 00:09:58,270
+هنتكلم عن ميكانيزم لإن ال transporter بيخلف ال
+
+125
+00:09:58,270 --> 00:10:01,210
+transporter اللي شكالة على اليوم الأساعد تدخل
+
+126
+00:10:01,210 --> 00:10:04,490
+الأشياء هان في ال thick as it in بيخلف عن اللي
+
+127
+00:10:04,490 --> 00:10:08,550
+بعده لكن محص لإن كمية كبيرة من ال solutes هتنسحب
+
+128
+00:10:08,550 --> 00:10:14,590
+إلى داخل ال إيه إلى داخل ال interstitium هتدخل ال
+
+129
+00:10:14,590 --> 00:10:18,350
+cells و هتدخل ال interstitium و لن يلحق بيها ايه
+
+130
+00:10:18,350 --> 00:10:22,860
+water ولا ureaهضل ال water و اللي رافت داخل، اذا
+
+131
+00:10:22,860 --> 00:10:28,360
+هذا الجزئية هذه الجزئية اللي هو بتنتهي بال early
+
+132
+00:10:28,360 --> 00:10:31,300
+part of the thick ascending limb عملت absorption
+
+133
+00:10:31,300 --> 00:10:36,800
+of solutes كمية كبيرة بتنتهي انه عندي ال tubular
+
+134
+00:10:36,800 --> 00:10:42,300
+filtrate, osmolality دايما بتنتهي ب100 ميلي أزمال،
+
+135
+00:10:42,300 --> 00:10:45,780
+اذا ال thick ascending ال .. ال .. ال distal
+
+136
+00:10:45,780 --> 00:10:50,300
+convoluted tubuleالـ late part، الـ second part
+
+137
+00:10:50,300 --> 00:10:53,760
+تبع الـ distal convoluted tubule بيسلم دائماً ال
+
+138
+00:10:53,760 --> 00:10:59,120
+tubular filtrate بتركيز 100 ميلي أزمول، تمام؟ إذا
+
+139
+00:10:59,120 --> 00:11:02,320
+البعض أشتغل، بيغير في الـ 100 ميلي أزمول، زيارة أو
+
+140
+00:11:02,320 --> 00:11:07,220
+نقصانة، ممكن أن نقصها كمان خمسين، ممكن تصل لخمسين،
+
+141
+00:11:07,220 --> 00:11:09,620
+لأن الـ thick ascending limb، ال .. ال .. ال ..
+
+142
+00:11:09,620 --> 00:11:12,640
+distal convoluted tubule هذه الجزء اللي ضايل، عنده
+
+143
+00:11:12,640 --> 00:11:18,290
+إمكانية أنه يعمل more dilutionبس هذا under control
+
+144
+00:11:18,290 --> 00:11:23,770
+حسب حاجة الجسم و ممكن مايعملش اي dilution المياه
+
+145
+00:11:23,770 --> 00:11:27,850
+دي تبقى ماشية لحد ما تنزل ال Interstitium عبر ال
+
+146
+00:11:27,850 --> 00:11:31,530
+collecting duct و هناك يصير عمل التركيز عالي و نصل
+
+147
+00:11:31,530 --> 00:11:34,990
+الكمية اللي الرقم يقولنا عليه خضرة الكلية العليا
+
+148
+00:11:34,990 --> 00:11:41,750
+في التركيزة تصل لأيه؟ لألف و متين او 1400 اذا ال
+
+149
+00:11:41,750 --> 00:11:46,300
+distal tubule الان بيصلهاالـ Distal Convoluted
+
+150
+00:11:46,300 --> 00:11:53,740
+Bulb يصل إلى الـ Tubular Filtrate Hypoosmotic الـ
+
+151
+00:11:53,740 --> 00:11:58,380
+Early Bar اللي يكمل شغل الـ Thick Ascending Limb
+
+152
+00:11:58,380 --> 00:12:03,260
+ينهي إلى 100 ملي أسمه، لذلك الجزء التاني من الـ
+
+153
+00:12:03,260 --> 00:12:07,140
+Distal Convoluted Bulb اللي هو هذا يعمل Elective
+
+154
+00:12:07,140 --> 00:12:11,700
+حسب عيش الجسم، ممكن أخد صوديوم، ممكن لا أخدممكن
+
+155
+00:12:11,700 --> 00:12:17,440
+اخد ميه ممكن مااخدش تمام النص التاني هذا لو اخد
+
+156
+00:12:17,440 --> 00:12:21,980
+صوديوم ماخدش ميه على اقصى قدرة له يستطيع انه يسلم
+
+157
+00:12:21,980 --> 00:12:25,980
+ال collecting duct يسلم ال collecting .. ال .. ال
+
+158
+00:12:25,980 --> 00:12:28,720
+.. ال .. ال collecting duct ال medullary
+
+159
+00:12:28,720 --> 00:12:33,260
+collecting duct يسلمها اوزمولاليه
+
+160
+00:12:33,260 --> 00:12:37,720
+ب just خمسين ملي اوزمول انا ليش قلت ال medullary
+
+161
+00:12:37,720 --> 00:12:43,670
+collecting ductلأن حقيقة الـ collecting duct الـ
+
+162
+00:12:43,670 --> 00:12:48,130
+cortical و الـ dorsal second part of the dorsal
+
+163
+00:12:48,130 --> 00:12:50,710
+capillary tubule بيشتغلوا نفس الشغل يعني لما نتكلم
+
+164
+00:12:50,710 --> 00:12:53,210
+عن ال .. ال dorsal capillary tubule ال second part
+
+165
+00:12:53,210 --> 00:12:57,110
+ال lat part هي و ال connecting tubule و ال
+
+166
+00:12:57,110 --> 00:13:00,030
+collecting cortical collecting نفس الشيء اللي
+
+167
+00:13:00,030 --> 00:13:03,370
+بيصير هان هان هان يعني لحد ما نصل لمدالة ل
+
+168
+00:13:03,370 --> 00:13:06,660
+collecting duct و نفس المواصفاتبعد مدالة
+
+169
+00:13:06,660 --> 00:13:09,520
+reconnecting duct بيصير ايش؟ عندنا تيبيول اخرى
+
+170
+00:13:09,520 --> 00:13:13,220
+ومواصفات اخرى تمام؟ اذا هنا عندي elective
+
+171
+00:13:13,220 --> 00:13:17,660
+reabsorption او secretion لصوديوم او secretion
+
+172
+00:13:17,660 --> 00:13:22,300
+لبوتاسيوم حسب مين حسب حاجة الجسم بتبدأ من ال late
+
+173
+00:13:22,300 --> 00:13:26,580
+distal tubule connecting tubule و cortical
+
+174
+00:13:26,580 --> 00:13:30,240
+connecting tubule هدول كلهم بيشتغلوا ايه؟ ال
+
+175
+00:13:30,240 --> 00:13:33,360
+anatomy تبعهم هتكلمها ان ال anatomy هادا متميز زي
+
+176
+00:13:33,360 --> 00:13:37,230
+بقى كلهمعندي ال Anatomy وعندي ال principal cells و
+
+177
+00:13:37,230 --> 00:13:40,650
+Intercalated cells يلهم كلهم function يلهم كلهم زي
+
+178
+00:13:40,650 --> 00:13:46,650
+بعض إذا هدول جزئية واحدة اللي هي ال late distal
+
+179
+00:13:46,650 --> 00:13:49,770
+زائد ال connecting زائد ال cortical connecting
+
+180
+00:13:49,770 --> 00:13:53,030
+هدول جزئية واحدة anatomically وfunctionally
+
+181
+00:13:53,030 --> 00:13:57,190
+physiological اللي بيشتغل نفس الشيء، تمام؟ إذا في
+
+182
+00:13:57,190 --> 00:14:00,030
+الحالة هذه نرجع تاني أتكلم عن مين؟ إذا انا عارف ان
+
+183
+00:14:00,030 --> 00:14:01,670
+احنا لديه فروقات منهم ال thick and thin
+
+184
+00:14:01,670 --> 00:14:02,630
+equilibrium هدققش بعمله
+
+185
+00:14:05,330 --> 00:14:08,250
+الـ thick ascending limb بيعمل reabsorption of
+
+186
+00:14:08,250 --> 00:14:11,810
+صوديوم، كلورايت، بوتاسيوم، كالسيوم، بايكربونيت،
+
+187
+00:14:11,810 --> 00:14:16,690
+ماجنيزيوم و ممكن يعمل secretion of هيدروجين و
+
+188
+00:14:16,690 --> 00:14:19,470
+الهيدروجين اللي بيصيرله secretion يعني في مقابل
+
+189
+00:14:19,470 --> 00:14:23,810
+ايه ال reabsorption of بايكربونيت، تمام؟
+
+190
+00:14:32,140 --> 00:14:38,040
+هذه خلية من خلايا الـ thick ascending limb هنجي
+
+191
+00:14:38,040 --> 00:14:41,260
+على ال بيزو لاترال ممبراين على ال بيزو لاترال
+
+192
+00:14:41,260 --> 00:14:49,260
+ممبراين على ال برسلر روتس على ال بيزو لاترال
+
+193
+00:14:49,260 --> 00:14:50,820
+ممبراين
+
+194
+00:14:54,090 --> 00:14:57,890
+بوردر هلاجي اللي هو Sodium-Potassium-ATPS Bombing
+
+195
+00:14:57,890 --> 00:15:04,110
+System تمام؟ مكثف شديد اللي بيختلف هان ان هذا ال
+
+196
+00:15:04,110 --> 00:15:09,850
+bombing system يصاحب special type of .. of ..
+
+197
+00:15:09,850 --> 00:15:15,730
+Transporter System ال career system هان مختلف عن
+
+198
+00:15:15,730 --> 00:15:20,090
+اي مكان في ال .. في الكلية تمام؟ هنا عندنا Sodium
+
+199
+00:15:20,090 --> 00:15:23,540
+-Potassium-Chlorideوش يسموه Sodium Potassium
+
+200
+00:15:23,540 --> 00:15:29,400
+Etabase لأ Sodium Potassium Sodium Chloride
+
+201
+00:15:29,400 --> 00:15:32,360
+Potassium Sodium Potassium Chloride System of
+
+202
+00:15:32,360 --> 00:15:40,560
+Carrier بيحمل واحد Sodium و بيحمل واحد Potassium و
+
+203
+00:15:40,560 --> 00:15:44,140
+اتنين Chloride تمام؟ هذا System Carrier System هذا
+
+204
+00:15:44,140 --> 00:15:48,900
+مهم جدا طيب احنا قلنا هنا Sodium Potassium Etabase
+
+205
+00:15:49,450 --> 00:15:54,070
+الإنزايم على ال بيزولاترا من ال brain يسحب صوديوم
+
+206
+00:15:54,070 --> 00:15:59,390
+إلى الخارج و يدخل بوتاسيوم إلى الداخل بعد ذلك يكون
+
+207
+00:15:59,390 --> 00:16:03,830
+لدي تركيز الصوديوم داخل ال cells و أعطي و هذا ال
+
+208
+00:16:03,830 --> 00:16:11,130
+driving force لإن الصوديوم يدخل
+
+209
+00:16:11,130 --> 00:16:13,530
+إلى داخل ال cells
+
+210
+00:16:16,640 --> 00:16:19,140
+فهذا اللي بيشغل ال AI لكن ال carrier هذا اللي
+
+211
+00:16:19,140 --> 00:16:24,860
+بيشتغل بياخد معاه Sodium downhill لكن ال potassium
+
+212
+00:16:24,860 --> 00:16:27,700
+اللي تبيه ال system ايش عاملهان؟ زود ال potassium
+
+213
+00:16:27,700 --> 00:16:32,380
+كل سنتيشن تدخل ال cell، مش هيك؟ و ال carrier
+
+214
+00:16:32,380 --> 00:16:36,160
+system هذا هيدخل Sodium، هيدخل معاه مين؟بوتاسيوم
+
+215
+00:16:36,160 --> 00:16:39,620
+against concentration against gradient إذا
+
+216
+00:16:39,620 --> 00:16:43,600
+البوتاسيوم هنا واضح إنه بدخل ايه بس لإنه active
+
+217
+00:16:43,600 --> 00:16:47,500
+transport system تفرقش معاه بدخل البوتاسيوم
+
+218
+00:16:47,500 --> 00:16:52,220
+against concentration وفي مقابلهم بدخل معاه اتنين
+
+219
+00:16:52,220 --> 00:16:57,540
+كلورايد واضح إذا بدخل اتنين كلورايد وبدخل واحد
+
+220
+00:16:57,540 --> 00:16:59,640
+صوديوم وواحد بوتاسيوم الصوديوم downhill
+
+221
+00:17:03,030 --> 00:17:09,890
+السيطو بلازم الكونستراتيشن
+
+222
+00:17:09,890 --> 00:17:17,470
+من السوديوم هو أقل بسبب نظام الانفجار فالكلورايد
+
+223
+00:17:17,470 --> 00:17:21,610
+يدخل ويعلى تركيزه
+
+224
+00:17:24,270 --> 00:17:27,250
+في علمنا الـ chloride channels على الـ basolateral
+
+225
+00:17:27,250 --> 00:17:36,610
+membrane تساعد على الانترالستيشن في الانترالستيشن
+
+226
+00:17:36,610 --> 00:17:44,050
+من تركيز أعلى في داخل الcells إلى الانترالستيشن
+
+227
+00:17:44,050 --> 00:17:49,010
+حيث التركيز الأقل ماشي؟ طب البوتاسيوم هذا مغلبكوا
+
+228
+00:17:49,010 --> 00:17:52,130
+البوتاسيوم هذا البوتاسيوم دخل عالي ال
+
+229
+00:17:52,130 --> 00:17:56,280
+concentration داخل الcytoplasmو من ال basolateral
+
+230
+00:17:56,280 --> 00:17:59,900
+membrane يعني ال career system دخل البوتاسيوم و ال
+
+231
+00:17:59,900 --> 00:18:04,040
+.. ال .. ال atrial system دخل البوتاسيوم هيعمل
+
+232
+00:18:04,040 --> 00:18:08,700
+بوتاسيوم كتير في داخل ايه؟ مش مش .. ايه اتفضلي مش
+
+233
+00:18:08,700 --> 00:18:12,980
+مشكلة لإنه .. لإن البوتاسيوم كان freely moved حسب
+
+234
+00:18:12,980 --> 00:18:15,420
+ال concentration ال gradient يعني اللي دخل ال cell
+
+235
+00:18:15,420 --> 00:18:18,540
+بيعمل back diffusion لل interstitium او بيعمل back
+
+236
+00:18:18,540 --> 00:18:22,260
+effusion .. diffusion لمين؟ بتفرجش معاه البوتاسيوم
+
+237
+00:18:22,260 --> 00:18:28,410
+بالذات كان ايه؟بسهولة تقوم بعمل back-diffusion في
+
+238
+00:18:28,410 --> 00:18:33,670
+البرنامج الهان وهان طبعا ان الانترال
+
+239
+00:18:33,670 --> 00:18:38,670
+روت هان مايتوجعش زي الآخر انه هيعدي منه ايش انه
+
+240
+00:18:38,670 --> 00:18:42,070
+water انه غير مميز للماء هذول الانترال روت هان
+
+241
+00:18:42,070 --> 00:18:46,210
+مميز للماء لكن بيعدي منهم
+
+242
+00:18:49,020 --> 00:18:52,080
+السوديوم كما قلنا ممكن يقعد في البرسيلة الروت إذا
+
+243
+00:18:52,080 --> 00:18:55,920
+كان ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+244
+00:18:55,920 --> 00:19:00,320
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+245
+00:19:00,320 --> 00:19:01,000
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+246
+00:19:01,000 --> 00:19:01,660
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+247
+00:19:01,660 --> 00:19:01,920
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+248
+00:19:01,920 --> 00:19:07,780
+.. ال .. ال .. ال .. ال .. ال .. ال ..
+
+249
+00:19:07,780 --> 00:19:11,300
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+250
+00:19:11,300 --> 00:19:12,320
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+251
+00:19:12,320 --> 00:19:14,600
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+252
+00:19:14,600 --> 00:19:15,360
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+253
+00:19:15,360 --> 00:19:15,360
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+254
+00:19:15,360 --> 00:19:15,740
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+255
+00:19:17,290 --> 00:19:19,630
+المهم في الموضوع حاليًا أن في عندي magnesium
+
+256
+00:19:20,220 --> 00:19:28,320
+والكالسيوم يدخل هذه الجزيرة ويقع تجارب
+
+257
+00:19:28,320 --> 00:19:32,580
+التجارب من خلال الانتجارات التجاربية هنا بيصير في
+
+258
+00:19:32,580 --> 00:19:38,720
+عندى transport للمجنيزيم ولكالسيوم كبالظبط اللي هو
+
+259
+00:19:38,720 --> 00:19:41,920
+active transport اللي هو passive transport اللي هو
+
+260
+00:19:41,920 --> 00:19:46,300
+.. بس بيصير عندى نسبة reabsorption عالية لهدول ال
+
+261
+00:19:46,300 --> 00:19:49,480
+ions المجنيزيم والكالسيوم في هالمنطقة الحاليةو
+
+262
+00:19:49,480 --> 00:19:51,880
+هنتكلم ان شاء الله .. هنتكلم بعد كده عن
+
+263
+00:19:51,880 --> 00:19:55,060
+البراتيرويد .. هنتكلم بالتفصيل عن هذا الموضوع ..
+
+264
+00:19:55,060 --> 00:19:59,440
+تمام؟ لكن حاليا احنا بيقول بتبقى عند انترانس او
+
+265
+00:19:59,440 --> 00:20:03,940
+reabsorption لالمجنيزيوم و الكلورايد في الـ thick
+
+266
+00:20:03,940 --> 00:20:08,300
+ascending limb المجنيزيوم و الكلسيوم في ال thick
+
+267
+00:20:08,300 --> 00:20:13,340
+ascending limb عبر البراسيلولار روت .. تمام؟ طيب
+
+268
+00:20:14,260 --> 00:20:18,900
+ليش؟ في تفسير يعني أنه بيصير عندي
+
+269
+00:20:18,900 --> 00:20:22,800
+electronegativity
+
+270
+00:20:22,800 --> 00:20:28,920
+في داخل الinterstitium مقابل الـA مقابل more
+
+271
+00:20:28,920 --> 00:20:33,740
+positive filtrate بيقدّي إلى أن المجنزة والكرسي
+
+272
+00:20:33,740 --> 00:20:39,870
+ميندفعه إلى الداخللأن السوديو ممكن يصير له back
+
+273
+00:20:39,870 --> 00:20:42,950
+diffusion يؤدي إلى ان الفرج و البوتاسيوم يصير له
+
+274
+00:20:42,950 --> 00:20:45,990
+back diffusion يصير ال electronegativity موجودة
+
+275
+00:20:45,990 --> 00:20:48,870
+يؤدي إلى مثل اي مسألة بسيطة المهم في الموضوع انه
+
+276
+00:20:48,870 --> 00:20:53,910
+بيصير ايه مجنيزيوم و كالسيوم بيقدروا يعدوا يصيرهم
+
+277
+00:20:53,910 --> 00:20:57,230
+reabsorption عبر ايه ال parasolary junction في
+
+278
+00:20:57,230 --> 00:21:00,850
+التكأس النجلمة اذا هنا عندنا ال career هذا career
+
+279
+00:21:00,850 --> 00:21:05,270
+مميزالنقطة الأولى انه مميز بعد كده هنتكلم عن الـ
+
+280
+00:21:05,270 --> 00:21:10,290
+Early Distil هنلاقي انه Sodium Chloride فقط يعني
+
+281
+00:21:10,290 --> 00:21:14,290
+Sodium بخش جبال ال chloride مش Sodium Chloride
+
+282
+00:21:14,290 --> 00:21:18,590
+بوتاسيوم و هنا بوتاسيوم هو داخل و عوض طلع يعني
+
+283
+00:21:18,590 --> 00:21:23,930
+قيمته مش كبيرة فإذا ال career البعده هنلاقي بس لل
+
+284
+00:21:23,930 --> 00:21:29,450
+Sodium و ال chloride هذا النقطة الأولى انه طبيعة
+
+285
+00:21:29,450 --> 00:21:30,890
+ال career النقطة التانية
+
+286
+00:21:34,320 --> 00:21:38,760
+النقطة التانية المهمة في الموضوع انه clinically
+
+287
+00:21:38,760 --> 00:21:42,080
+احنا هتكلم على في المستقبل حاجة اسمها loop
+
+288
+00:21:42,080 --> 00:21:46,440
+diuretics هتكلم على ايه؟ diuretics اللي هي مدرات
+
+289
+00:21:46,440 --> 00:21:51,360
+البول مدرات البول بانواع 500 ديورتيكس من ضمنها نوع
+
+290
+00:21:51,360 --> 00:21:54,680
+اسمه loop diuretics يعني ال diuretic اللي بيشتغل
+
+291
+00:21:54,680 --> 00:21:59,420
+من خلال شغله على ال loop يعني بمعنى انه بعطل لها
+
+292
+00:21:59,420 --> 00:22:03,320
+ال transporter هذاالـ Transporter اللي بتقوي أقوى
+
+293
+00:22:03,320 --> 00:22:06,480
+Transporter في دراساتها حتى الآن One Sodium, One
+
+294
+00:22:06,480 --> 00:22:10,640
+Potassium, اتنين Chloride عبره، لو عطلها، بيظل في
+
+295
+00:22:10,640 --> 00:22:13,460
+داخل الـ Tribule Sodium كتير و Chloride كتير و
+
+296
+00:22:13,460 --> 00:22:17,220
+Potassium كتير، مش كده؟ هدول هم طالعين، بياخدوا
+
+297
+00:22:17,220 --> 00:22:22,990
+معاهم ميّه، مش هيك؟ لإن الإسقلالية هتعلقهنا هتحتي
+
+298
+00:22:22,990 --> 00:22:25,910
+على الأصغار اللي هيسحبوا معاهم مياه تركيزهم في
+
+299
+00:22:25,910 --> 00:22:32,430
+الداخل فلذلك ال loop diuretics are strong
+
+300
+00:22:32,430 --> 00:22:37,510
+diuretics بيشتغلوا لما بيشتغلوا بيبقى لهم rapid
+
+301
+00:22:37,510 --> 00:22:43,190
+onset و short duration بيشتغلوا كمية كبيرة جدا من
+
+302
+00:22:43,190 --> 00:22:47,030
+المياه خلال تلت اربع ساعاتThe loop diuretics في
+
+303
+00:22:47,030 --> 00:22:51,230
+المستقبل هستخدمهم انتوا لكن قلتلكم عيبهم انه
+
+304
+00:22:51,230 --> 00:22:55,210
+هيشتغلوا بسرعة و هيشتغلوا كمية كبيرة لذلك بياخد
+
+305
+00:22:55,210 --> 00:22:57,890
+loop diuretics بينفعش يروح على الشغل لازم يقعد في
+
+306
+00:22:57,890 --> 00:23:02,390
+الظهر لأنه هياخد تلت اربع خمس ست ساعات هو رايح جاي
+
+307
+00:23:02,390 --> 00:23:07,090
+عوين على الحمام فبينفعش ايه يروح على الشغل في حين
+
+308
+00:23:07,090 --> 00:23:11,210
+انه النوع التاني هتكلم عليه بعد كده Thiazide
+
+309
+00:23:11,210 --> 00:23:12,930
+diuretics اللي هيشتغل على ال
+
+310
+00:23:16,410 --> 00:23:22,090
+هيشغل على ال sodium chloride carrier system اضعف
+
+311
+00:23:22,090 --> 00:23:26,070
+كتير من هذا ال system فهذا بياخد longer duration
+
+312
+00:23:26,070 --> 00:23:31,490
+عصنا مشروع الكلام ايه؟ الكلام واضح ولا لا يا بناه؟
+
+313
+00:23:31,490 --> 00:23:37,510
+واضح بعد كده هنجد transporter مختلف اضعف فلذلك
+
+314
+00:23:37,510 --> 00:23:44,320
+نعمله inhibition ونمنع ال sodiumانه يطلع في
+
+315
+00:23:44,320 --> 00:23:49,080
+transporter ضعيف هلاجي
+
+316
+00:23:49,080 --> 00:23:52,660
+انه الفرصة عندى انا ان باخد milder diuretic
+
+317
+00:23:52,660 --> 00:23:58,220
+diuretic أخف شوية و بياخد longer variation فهذا
+
+318
+00:23:58,220 --> 00:24:02,660
+قلطف شوية لإن في الآخر المحصلة النهائية واحدة واحد
+
+319
+00:24:02,660 --> 00:24:09,760
+عمل شغل كبير في مسافة صغيرة و واحد عمل شغل كبير في
+
+320
+00:24:09,760 --> 00:24:13,460
+مسافة طويلة هو بيان انه بطيءلكن المدة الطويلة دي
+
+321
+00:24:13,460 --> 00:24:22,120
+ادته ايه ادته كام كويسة اذا في عندها ال system
+
+322
+00:24:22,120 --> 00:24:27,720
+اللى اتكلمنا عنه نرجع تانى فوق عشان احنا الصورة
+
+323
+00:24:27,720 --> 00:24:34,240
+اهتمينا فيها خلينا نمشي شوية شوية طيب اذا ال logo
+
+324
+00:24:34,240 --> 00:24:38,760
+فينلي جسمناه لجسمين وقولنا انه في جزء من الدستور
+
+325
+00:24:38,760 --> 00:24:40,900
+بيالحق مثلك ascending limb
+
+326
+00:24:47,040 --> 00:24:54,020
+و قلنا إنه عندنا ال sodium one sodium two chloride
+
+327
+00:24:54,020 --> 00:25:00,560
+and one potassium كترانسبورتر system و حكينا إنه
+
+328
+00:25:00,560 --> 00:25:06,940
+عندنا ال inhibition اللي بيعملوا blocking لها
+
+329
+00:25:06,940 --> 00:25:10,760
+الترانسبورتر systemتمام competitive inhibition له
+
+330
+00:25:10,760 --> 00:25:15,820
+فبيمنعه انه ال sodium اللي بتركب عليه competitive
+
+331
+00:25:15,820 --> 00:25:21,320
+inhibition فبصير عندي انا ايه اللي هو ال effect of
+
+332
+00:25:21,320 --> 00:25:24,440
+loop diuretics ال loop diuretics اشهرهم اللي هو ال
+
+333
+00:25:24,440 --> 00:25:28,520
+furosemide اللي بنقوله احنا ايه لازكس كلمة
+
+334
+00:25:28,520 --> 00:25:31,860
+diuretics زي ما مرات بننسى كلمة diuretics بنذكر
+
+335
+00:25:31,860 --> 00:25:37,040
+كلمة ايه لازكس لازكس هو furosemide ال furosemide
+
+336
+00:25:37,040 --> 00:25:40,880
+هذا loop diureticمعناه انه strong diuretic معناه
+
+337
+00:25:40,880 --> 00:25:47,520
+انه ايه strong diuretic working اه for a few hours
+
+338
+00:25:47,520 --> 00:25:56,220
+in big intensity في عند الفيرزامايد الأشهر وعند
+
+339
+00:25:56,220 --> 00:26:04,160
+الاتاكرينك أسد أقل شهرة بيوميتانايد أقل شهرة أيضا
+
+340
+00:26:04,160 --> 00:26:09,800
+بس مشهور جدا منفوريزامايد فوريزامايد اللي هو ليش
+
+341
+00:26:09,800 --> 00:26:15,000
+لزكس فوريزامايد تحفظوها من اليوم و ان على ال route
+
+342
+00:26:15,000 --> 00:26:19,080
+على ال path of the route هيدخلي مجنيزيوم كلورايد
+
+343
+00:26:19,080 --> 00:26:25,360
+ايضا مجنيزيوم و كالسيوم بالاضافة للسوديوم لان
+
+344
+00:26:25,360 --> 00:26:28,620
+السوديوم و البوتاسيوم already هم من اول في ال
+
+345
+00:26:28,620 --> 00:26:33,540
+proximal كان باس freely through the tide junction
+
+346
+00:26:33,540 --> 00:26:36,460
+هنا
+
+347
+00:26:42,500 --> 00:26:49,200
+الـ .. طيب .. إذا أكدنا هنا على أنه impermeable to
+
+348
+00:26:49,200 --> 00:26:56,740
+water هذه الرسمة تبعتنا و هذه ال .. طيب .. okay
+
+349
+00:26:56,740 --> 00:27:01,660
+early distal tubule فإذا في حاجة تانية ممكن ما
+
+350
+00:27:01,660 --> 00:27:05,900
+ذكرناش احنا بخصوص ال sodium hydrogen
+
+351
+00:27:09,800 --> 00:27:12,580
+السوديوم هيدروجين هنا ممكن نزرقه في الجزء اللي
+
+352
+00:27:12,580 --> 00:27:15,880
+بعده لما عندي أنا هان سوديوم هيدروجين counter
+
+353
+00:27:15,880 --> 00:27:19,660
+transport برضه وهذا بيساعدني في ال reabsorption of
+
+354
+00:27:19,660 --> 00:27:23,260
+ايه؟ of بيكربونات هيكون التفاصيل في الجزء اللي
+
+355
+00:27:23,260 --> 00:27:26,480
+بعيدها اكتر عندي سوديوم هيدروجين counter transport
+
+356
+00:27:26,480 --> 00:27:32,360
+او ايرلي
+
+357
+00:27:32,360 --> 00:27:36,480
+ديسترال تيبيول يقولون ان ايرلي ديسترال تيبيول are
+
+358
+00:27:36,480 --> 00:27:41,730
+two parts ايرلي والدطيب ايه اللى تضام الى مين الى
+
+359
+00:27:41,730 --> 00:27:45,930
+ال thick ascending limb الفرق اللى يفصل بينهم ال
+
+360
+00:27:45,930 --> 00:27:50,850
+jacksaglomerular apparatus طيب
+
+361
+00:27:50,850 --> 00:27:59,950
+ال thick ascending limb بتطلعلي الفلتات
+
+362
+00:27:59,950 --> 00:28:06,580
+ساحبة منه كمية كبيرة من ايه من ال solutesو بيكمل
+
+363
+00:28:06,580 --> 00:28:08,840
+عليه هذا ال part هذا ال part بيسمي احنا diluting
+
+364
+00:28:08,840 --> 00:28:12,060
+segment مش بس ال early thick ascending limb ال
+
+365
+00:28:12,060 --> 00:28:17,200
+early distal tubule تمام؟ ال early distal tubule
+
+366
+00:28:17,200 --> 00:28:20,720
+زي ال thick ascending limb هذا بيسمي ال diluting
+
+367
+00:28:20,720 --> 00:28:25,580
+segment هذا الجزء اللي بيعمل ايه؟ dilution تمام؟
+
+368
+00:28:25,580 --> 00:28:30,830
+لان قبل كده كان isosmoticلكن بيطلع من هذا المنطقة
+
+369
+00:28:30,830 --> 00:28:36,010
+من ال thick ascending limb diluted وبيطلع من ال
+
+370
+00:28:36,010 --> 00:28:40,350
+early distal برضه more diluted فهذا الجزء بيسمي
+
+371
+00:28:40,350 --> 00:28:46,750
+ايه ال diluting segment approximately 5% of the
+
+372
+00:28:46,750 --> 00:28:49,150
+filtered load of sodium is reabsorbed here
+
+373
+00:28:49,150 --> 00:28:52,390
+ماتكلمناش عن اسم ال thick ascending limb 25% of
+
+374
+00:28:52,390 --> 00:28:56,750
+the filtered sodium is reabsorbed في ال thick
+
+375
+00:28:56,750 --> 00:29:00,560
+ascending limbإذا الخمسة و عشرين في التجاسس النجلم
+
+376
+00:29:00,560 --> 00:29:05,080
+و خمسة في ال early distant صار عنده تلاتين و خمسة
+
+377
+00:29:05,080 --> 00:29:09,900
+و ستين في ال a في ال proximal صار عنده ايه تسعين
+
+378
+00:29:09,900 --> 00:29:14,340
+فالمية في التلات مناطق هدول تسعين فالمية احنا
+
+379
+00:29:14,340 --> 00:29:17,580
+الصوتي مجدش هيسيب له reabsorption في الأوضاع
+
+380
+00:29:17,580 --> 00:29:20,660
+العادية تسعة وتسعين فالمية هيسيب له reabsorption
+
+381
+00:29:20,660 --> 00:29:24,480
+لكن في أوضاع غير عادية هنلاقي اختلفة النسبة
+
+382
+00:29:28,870 --> 00:29:32,030
+The sodium chloride cotransporter system
+
+383
+00:29:32,030 --> 00:29:36,450
+البيزولاترال سيستم ال sodium و البوتاسيوم يتبع
+
+384
+00:29:36,450 --> 00:29:42,850
+بابنج سيستم هو ماتغيرش في كل الكيليا اللي بتغير ان
+
+385
+00:29:42,850 --> 00:29:46,930
+هال Sodium اللي داخل هيحرك ال carrier system ايه
+
+386
+00:29:46,930 --> 00:29:50,550
+ال carrier system اللي موجود هل موجود Sodium و
+
+387
+00:29:50,550 --> 00:29:53,950
+Potassium وChloride ولا Sodium وChloride لحاله كان
+
+388
+00:29:53,950 --> 00:29:59,080
+موجود Sodium وChloride لحالهالسوديوم الكلورايد بو
+
+389
+00:29:59,080 --> 00:30:02,980
+ترانس بورتر يتحرك السوديوم الكلورايد من الـ
+
+390
+00:30:02,980 --> 00:30:08,140
+tubular lumen إلى الـ cell تتعامل مع السوديوم يعني
+
+391
+00:30:08,140 --> 00:30:11,220
+يدخل سوديوم و كلورايد و ليس سوديوم و كتاسيوم و
+
+392
+00:30:11,220 --> 00:30:15,400
+اتنين كلورايد وهيلاقى الصورة تبعكنا اذا ان هان ال
+
+393
+00:30:15,400 --> 00:30:19,460
+carrier system هو السوديوم داخل ويدخل داخل مع مين؟
+
+394
+00:30:19,460 --> 00:30:23,060
+الكلورايد كمان و الكلورايد هان كنتش تبعها بيزيد
+
+395
+00:30:23,060 --> 00:30:27,460
+فالالـ chloride channels هذه الموجودة بتساعد في ال
+
+396
+00:30:27,460 --> 00:30:30,940
+passive diffusion of chloride from inside the
+
+397
+00:30:30,940 --> 00:30:41,960
+cytoplasm to the interstitial fluid هنا
+
+398
+00:30:41,960 --> 00:30:47,740
+قولنا هذا ال carrier system is blocked by a
+
+399
+00:30:47,740 --> 00:30:52,380
+thiazide diuretics بيسميها أيش؟ thiazide diuretics
+
+400
+00:30:53,240 --> 00:30:57,540
+يعملوا على الـ Sodium Chloride Carrier System في
+
+401
+00:30:57,540 --> 00:31:01,200
+الـ Early Distal Conveyor Tribune الـ Loop
+
+402
+00:31:01,200 --> 00:31:05,480
+Diuretics تعمل على الـ Sodium Motassium Chloride
+
+403
+00:31:05,480 --> 00:31:08,260
+Carrier System اللي موجود وين؟ في الـ Thick
+
+404
+00:31:08,260 --> 00:31:11,060
+Ascending Limb و لو ان اسمه Loop Diuretic لكن
+
+405
+00:31:11,060 --> 00:31:14,420
+موجود وين اللي موجود؟ في الـ Thick Ascending Limb
+
+406
+00:31:14,420 --> 00:31:17,820
+of the Loop
+
+407
+00:31:17,820 --> 00:31:21,840
+of Hindley تمام؟ يعني مش في كل ال Loop في ال Thick
+
+408
+00:31:21,840 --> 00:31:27,330
+Ascending Limbعلي انت جانب ايد هناك اه انا مارا
+
+409
+00:31:27,330 --> 00:31:32,090
+هناك كويس؟ قدامي هناك عشان ايه؟ وانتوا ميقنطة
+
+410
+00:31:32,090 --> 00:31:35,850
+مجموعة هذه انتوا شايفين ال mail صار هيك اه فهذه
+
+411
+00:31:35,850 --> 00:31:39,630
+المجموعة تحاول انها تكون هم الله يساعدهم كلهم مش
+
+412
+00:31:39,630 --> 00:31:45,510
+اليوم و المره الجاية طيب ليه ال distal تقول هنا
+
+413
+00:31:45,510 --> 00:31:52,090
+عاد خلصنا العمل الشاق تمام؟ احد بدرب الدورية لكن
+
+414
+00:31:52,090 --> 00:31:55,870
+واحد حاطل شي على رجلوبقوله اعمل هذه اعمل هذه اعمل
+
+415
+00:31:55,870 --> 00:32:00,530
+هذه صحيح ان بضرب الطريقة ويتعبلكن اللى جاله هو
+
+416
+00:32:00,530 --> 00:32:03,570
+اللى هرتب الأمور لو سمنا فيها على الطريق اضرب اكسر
+
+417
+00:32:03,570 --> 00:32:06,750
+الدنيا مش هعمل حاجة لكن اللى جاله انت عليك الجزئية
+
+418
+00:32:06,750 --> 00:32:09,090
+هذه وانت عليك الجزئية هذه وانت عليك الجزئية هذه
+
+419
+00:32:09,090 --> 00:32:12,630
+تمام القيادة هي المسؤولة و لو انه مانفسدش بإيه
+
+420
+00:32:12,630 --> 00:32:17,130
+بإيديها مش كده ففي عندنا كام ضخم بتنفل ايه في
+
+421
+00:32:17,130 --> 00:32:21,630
+الجزء الأول يعني الان بيجي الجزئية المرتبة ان احنا
+
+422
+00:32:21,630 --> 00:32:26,410
+طيب ان انت طلبية تبعت الجسم كده اش بتصادم من اديله
+
+423
+00:32:26,410 --> 00:32:34,150
+او من جللهطلبيات الجسم كده بده، هذا المنطقة ماهياش
+
+424
+00:32:34,150 --> 00:32:37,970
+impermeable to water، لأ impermeable to water، لكن
+
+425
+00:32:37,970 --> 00:32:41,270
+under control، under anti-dietary hormone ماهياش
+
+426
+00:32:41,270 --> 00:32:45,290
+impermeable to .. impermeable أو imperiable to
+
+427
+00:32:45,290 --> 00:32:49,970
+ايه؟ to .. to solute، سوديوم، بوتاسيوم، غيره،
+
+428
+00:32:49,970 --> 00:32:52,800
+impermeable لها، لكن و underUnder .. اه
+
+429
+00:32:52,800 --> 00:32:57,260
+Aldosterone تمام؟ اذا في وجود Aldosterone نسمح
+
+430
+00:32:57,260 --> 00:33:04,320
+ندخل ايه؟ Sodium كتر Aldosterone كتر اكتر جالي من
+
+431
+00:33:04,320 --> 00:33:07,560
+جالي من داخل اجالي Under the common the same و هذه
+
+432
+00:33:07,560 --> 00:33:12,620
+الجزية قلتلكم تنتهي وين؟ تنتهي في ال .. مع نهاية
+
+433
+00:33:12,620 --> 00:33:18,980
+ال cortical collecting ducts او tribules تمام؟ لما
+
+434
+00:33:18,980 --> 00:33:24,160
+ندخل المضلة بيختلفهذه الجزئية تتكون من نوعية من ال
+
+435
+00:33:24,160 --> 00:33:32,940
+sales نوع من ال sales متخصص في شئ و نوع تاني متخصص
+
+436
+00:33:32,940 --> 00:33:37,440
+فقط في شئ آخر إذا كان عندك two types of sales
+
+437
+00:33:37,440 --> 00:33:41,820
+working هنا ال early distal attribute
+
+438
+00:33:45,890 --> 00:33:52,090
+اللي هو يتبع مين قولنا هذا الصورة يتبع تجهز سنجلمة
+
+439
+00:33:52,090 --> 00:33:56,230
+أما الـ latest التبيول هذه فعندي two types of
+
+440
+00:33:56,230 --> 00:34:03,090
+cells تمام عندي intercalated cells وفي عندي
+
+441
+00:34:03,090 --> 00:34:06,590
+principal cells هذي ال principal cells اللي هي شكل
+
+442
+00:34:06,590 --> 00:34:11,450
+معين mitochondria بشكل معين وفي intercalated cells
+
+443
+00:34:11,450 --> 00:34:16,230
+محشورة بينها الintercalated cells شغلتهاإنه تعمل
+
+444
+00:34:16,230 --> 00:34:20,990
+secretion of hydrogen في مقابل طبعا ال sodium pre
+
+445
+00:34:20,990 --> 00:34:25,890
+absorption يا إما تعمل secretion of hydrogen تمام؟
+
+446
+00:34:25,890 --> 00:34:30,480
+يا إما secretion of potassiumيعني ممكن مرات احنا
+
+447
+00:34:30,480 --> 00:34:32,520
+محتاجين البوتاسيوم هو البوتاسيوم في ال principle
+
+448
+00:34:32,520 --> 00:34:35,400
+cells البوتاسيوم في ال principle cells لكن
+
+449
+00:34:35,400 --> 00:34:38,000
+الهيدروجين هذا اللي secreted ممكن يكون مقابل
+
+450
+00:34:38,000 --> 00:34:41,500
+reabsorption of البوتاسيوم لذا هنا بيصير عندي
+
+451
+00:34:41,500 --> 00:34:47,780
+secretion of هيدروجين عندي هيدروجين ATPS هان عندي
+
+452
+00:34:47,780 --> 00:34:53,320
+bombing system نوع تالت مختلف تمام عندي ال carrier
+
+453
+00:34:53,320 --> 00:34:59,080
+system هانوالـ pumping system يعني مش موجود على ال
+
+454
+00:34:59,080 --> 00:35:03,460
+بيزولاترال ممبران هذي عندى pumping system موجود
+
+455
+00:35:03,460 --> 00:35:09,320
+على ال brush border واسمه hydrogen atps في ال
+
+456
+00:35:09,320 --> 00:35:13,600
+intercalated cells في حالة ما يكون في عندى
+
+457
+00:35:13,600 --> 00:35:16,780
+hydrogen .. hydrogen ion concentration عالي في
+
+458
+00:35:16,780 --> 00:35:20,620
+داخل الجسم بتتخلص منه هذا مش فاعل في حالة ما يكون
+
+459
+00:35:20,620 --> 00:35:25,270
+انهبنخرج الهيدروجين و ندخل بيكربونات اكتر هذا ال
+
+460
+00:35:25,270 --> 00:35:29,970
+system بيشتغل هذا ال system active primary active
+
+461
+00:35:29,970 --> 00:35:33,490
+مش secondary active primary active system for
+
+462
+00:35:33,490 --> 00:35:37,930
+secretion of ايه؟ of hydrogen لذلك لما نقارنه بال
+
+463
+00:35:37,930 --> 00:35:43,050
+counter transport في ال secondary active system
+
+464
+00:35:43,050 --> 00:35:46,050
+اللي موجود في ال proximal contribute اللي هنلاقي
+
+465
+00:35:46,050 --> 00:35:51,180
+الفارق ايه؟الفرق ضخم هان يستطيع هذا ال system انه
+
+466
+00:35:51,180 --> 00:35:58,280
+يشتغل secretion بتاسيوم بتاسيوم
+
+467
+00:35:58,280 --> 00:36:01,980
+بتاسيوم
+
+468
+00:36:01,980 --> 00:36:08,560
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+469
+00:36:08,560 --> 00:36:09,560
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+470
+00:36:09,560 --> 00:36:10,380
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+471
+00:36:10,380 --> 00:36:16,300
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+472
+00:36:16,300 --> 00:36:16,300
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+473
+00:36:16,300 --> 00:36:16,360
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+474
+00:36:16,360 --> 00:36:16,360
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيوم
+
+475
+00:36:16,360 --> 00:36:18,170
+بتاسيوم بتاسيوم بتاسيوم بتاسيوم بتاسيبس هنا ممكن
+
+476
+00:36:18,170 --> 00:36:22,070
+يكون الفرق الـ concentration ألف ضعيف و still
+
+477
+00:36:22,070 --> 00:36:26,490
+pumping hydrogen to the .. to the filtrate to be
+
+478
+00:36:26,490 --> 00:36:30,110
+secreted to the .. to the urine في حين أن الـ
+
+479
+00:36:30,110 --> 00:36:32,890
+proximal contribute ال bombing system ال second
+
+480
+00:36:32,890 --> 00:36:37,970
+reactive system فيه بيقدر يشتغل against أربع إلى
+
+481
+00:36:37,970 --> 00:36:41,470
+عشر أضعاف ال .. ال .. ال plasma concentration
+
+482
+00:36:41,470 --> 00:36:46,840
+تمام؟ إذا ال .. ال .. ال bombing system هناهو
+
+483
+00:36:46,840 --> 00:36:51,440
+بيشتغل against one thousand difference
+
+484
+00:36:51,440 --> 00:36:55,540
+concentration of hydrogen التاني من أربع إلى عشرة
+
+485
+00:36:55,540 --> 00:37:01,200
+لذلك هو هذا ال main buffering system هنا موجود ال
+
+486
+00:37:01,200 --> 00:37:05,080
+main system that controls the pH هنا لإنه يستطيع
+
+487
+00:37:05,080 --> 00:37:10,220
+انه يطلع كميات غير عادية من الهيدروجين تمام هذا في
+
+488
+00:37:10,220 --> 00:37:14,180
+ال Intercalate systemأما الـ principal cells فهي
+
+489
+00:37:14,180 --> 00:37:17,960
+بتعمل reabsorption of sodium to secrete بوتاسيوم
+
+490
+00:37:17,960 --> 00:37:22,100
+مصممة لتسكريت بوتاسيوم لأنه طبيعة أكلنا ربنا خلقنا
+
+491
+00:37:22,100 --> 00:37:26,520
+الأكل فيه بوتاسيوم ازيادة تمام فدائما في system
+
+492
+00:37:26,520 --> 00:37:30,660
+موجود عندى ان اتخلص من البوتاسيوم ازيادة الا اذا
+
+493
+00:37:30,660 --> 00:37:34,880
+كان في عندى دوة معين مرض معين على البوتاسيوم
+
+494
+00:37:41,730 --> 00:37:47,210
+السيستم الانترجلية السلسلة تبقى تبقى تبقى تبقى
+
+495
+00:37:47,210 --> 00:37:57,950
+تبقى تبقى تبقى تبقى تبقى
+
+496
+00:37:57,950 --> 00:38:01,910
+تبقى تبقى تبقى
+
+497
+00:38:04,520 --> 00:38:09,440
+البرنسيبل سيلز تمام ال atps system هذا موجود على
+
+498
+00:38:09,440 --> 00:38:13,700
+ال basolateral membrane ماشي و في المقابل و في
+
+499
+00:38:13,700 --> 00:38:18,200
+عندى sodium channels و potassium في sodium
+
+500
+00:38:18,200 --> 00:38:21,820
+channels و potassium channels هذا ايش بنتكلم عامين
+
+501
+00:38:21,820 --> 00:38:30,080
+احنا على على ال ال late distal convertible احنا
+
+502
+00:38:30,080 --> 00:38:33,940
+اتكلمنا عن نظامين من ال diuretics مظبوطلوب ديوتكس
+
+503
+00:38:33,940 --> 00:38:37,680
+وتيزايد ديوتكس تيزايد ال system موجود في ال air
+
+504
+00:38:37,680 --> 00:38:43,040
+ليه؟ ديستال نحن نتكلم عن الليت ديستال اللي يمثل
+
+505
+00:38:43,040 --> 00:38:46,740
+الليت ديستال ال connecting و ال cortical
+
+506
+00:38:46,740 --> 00:38:50,160
+connecting، مظبوط؟ السيستم هنا فيه موجود عبارة عن
+
+507
+00:38:50,160 --> 00:38:54,160
+ايش؟ عندي سوديوم و بوتاسيوم اتباع بومبينج سيستم
+
+508
+00:38:54,160 --> 00:38:58,320
+وعندي بوتاسيوم channels وعندي ايه؟ سوديوم channels
+
+509
+00:38:58,320 --> 00:39:01,960
+هدول ال channels هدول بيفتحوا according to the
+
+510
+00:39:01,960 --> 00:39:08,950
+needsمش .. مش .. مش .. بدخله عن طريق career system
+
+511
+00:39:08,950 --> 00:39:12,230
+زي ما اتكلمنا عنه لأ هدول channels موجودة بتفتح و
+
+512
+00:39:12,230 --> 00:39:15,690
+بتسكر حسب الحاجة إذا فى عندي والله ألدستيرون كتير
+
+513
+00:39:15,690 --> 00:39:19,030
+عندي ألدستيرون كتير معناه هدول ال system فاتح
+
+514
+00:39:19,030 --> 00:39:22,890
+تمام؟ إذا فش عندي ألدستيرون كتير هدال ال system
+
+515
+00:39:22,890 --> 00:39:28,210
+إيه؟ مسكر ألدستيرون هجيب نفسي لك الأول مرة هنا
+
+516
+00:39:28,210 --> 00:39:35,940
+نتكلم إذا عندي أنا هان الالدستيرون وجودهبينشطلي ال
+
+517
+00:39:35,940 --> 00:39:41,260
+atb system هان اذا القلدسترون من اعماله الرئيسية
+
+518
+00:39:41,260 --> 00:39:47,660
+it activates the atbs system bombing system in the
+
+519
+00:39:47,660 --> 00:39:52,220
+secondary in the second part of the distal tubule
+
+520
+00:39:52,220 --> 00:39:55,160
+in the late part of the distal tubule نقول second
+
+521
+00:39:55,160 --> 00:39:59,310
+part او late part the sameكلمه ال system هاد ازاد
+
+522
+00:39:59,310 --> 00:40:03,270
+شغله كلمه ال sodium concentration هاد جال كلمه
+
+523
+00:40:03,270 --> 00:40:09,810
+influx of sodium زاد طب تصوروا ان انا جبت system
+
+524
+00:40:09,810 --> 00:40:14,410
+to block the aldosterone effect اه اذا انا عملت
+
+525
+00:40:14,410 --> 00:40:18,210
+blocking لل aldosterone effect Anti aldosterone
+
+526
+00:40:18,210 --> 00:40:22,110
+drugs هاد ال anti aldosterone drugs it will
+
+527
+00:40:22,110 --> 00:40:30,060
+compete hereprevent what will decrease the system
+
+528
+00:40:30,060 --> 00:40:37,920
+activity وهذا هيقدر إلى ان ال sodium influx هيجل و
+
+529
+00:40:37,920 --> 00:40:45,240
+ال potassium secretion هيجل مش هيك معايا انتوا
+
+530
+00:40:45,240 --> 00:40:53,110
+لحظة هذا ال system اللي هو الالديوريتيكس هان
+
+531
+00:40:53,110 --> 00:40:55,770
+يسميها ايه الديوريتيكس هان الديوريتيكس هان
+
+532
+00:40:55,770 --> 00:40:57,550
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+533
+00:40:57,550 --> 00:41:00,630
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+534
+00:41:00,630 --> 00:41:02,330
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+535
+00:41:02,330 --> 00:41:04,890
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+536
+00:41:04,890 --> 00:41:06,950
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+537
+00:41:06,950 --> 00:41:08,790
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس هان
+
+538
+00:41:08,790 --> 00:41:19,210
+الديوريتيكس هان الديوريتيكس هان الديوريتيكس
+
+539
+00:41:19,210 --> 00:41:23,520
+هان التلاحظوا إيش ميصة؟ إنه إذا وقفت ال system هذا
+
+540
+00:41:23,520 --> 00:41:28,680
+بأمنع دخول ال sodium، معناه في sodium أكتر بيطلع
+
+541
+00:41:28,680 --> 00:41:32,460
+مع إيه؟ مع ال urine، مش هيك؟ معناها في sodium و
+
+542
+00:41:32,460 --> 00:41:36,140
+water أكتر، معناه diuretic effect، مش هيك؟ لكن في
+
+543
+00:41:36,140 --> 00:41:40,530
+نفس الوجد منع ال secretion of potassiumلأن هدول ال
+
+544
+00:41:40,530 --> 00:41:44,410
+principle cells are mainly secretors of potassium
+
+545
+00:41:44,410 --> 00:41:47,650
+فلمّا أمنع ال secretion of potassium أنا بحافظ على
+
+546
+00:41:47,650 --> 00:41:54,210
+ال potassium وين؟ فى داخل الجسم، إذن هذا ال system
+
+547
+00:41:54,210 --> 00:41:58,550
+ال endosterol antagonist ال system الوحيد اللى هو
+
+548
+00:41:58,550 --> 00:42:03,240
+retaining potassium، تمام؟يعني مش هو هو اللي
+
+549
+00:42:03,240 --> 00:42:06,060
+بنتكلم عنه هذا ال .. ال diuretics مش ع ال .. ع ال
+
+550
+00:42:06,060 --> 00:42:10,700
+late distal هم returning ايه؟ بوتاسيوم بيحافظوا
+
+551
+00:42:10,700 --> 00:42:13,100
+على ال .. مش زي ال other diuretics ال other
+
+552
+00:42:13,100 --> 00:42:16,020
+diuretics هم اللي راح تستخدموهم انتوا و هيكون من
+
+553
+00:42:16,020 --> 00:42:20,300
+ضمن الرشيدة اللي تكتبوهم اه calcium chloride
+
+554
+00:42:20,300 --> 00:42:25,170
+tabletsبوتاسيوم كلورايد تابلتز بتاعتها مباشرة
+
+555
+00:42:25,170 --> 00:42:29,410
+بوتاسيوم كلورايد تابلتز تاعتها مباشرة بوتاسيوم
+
+556
+00:42:29,410 --> 00:42:30,910
+كلورايد تابلتز تاعتها مباشرة بوتاسيوم كلورايد
+
+557
+00:42:30,910 --> 00:42:32,430
+تابلتز تاعتها مباشرة بوتاسيوم كلورايد تابلتز
+
+558
+00:42:32,430 --> 00:42:33,490
+تاعتها مباشرة بوتاسيوم كلورايد تابلتز تاعتها
+
+559
+00:42:33,490 --> 00:42:34,330
+مباشرة بوتاسيوم كلورايد تابلتز تاعتها مباشرة
+
+560
+00:42:34,330 --> 00:42:34,610
+بوتاسيوم كلورايد تابلتز تاعتها مباشرة بوتاسيوم
+
+561
+00:42:34,610 --> 00:42:38,610
+كلورايد تابلتز تاعتها مباشرة بوتاسيوم كلورايد
+
+562
+00:42:38,610 --> 00:42:42,520
+تابلتز تامش بس بتمنع ال absorption of sodium او
+
+563
+00:42:42,520 --> 00:42:46,460
+بتمنع ال absorption of بوتاسيوم تمنع الجسم من
+
+564
+00:42:46,460 --> 00:42:50,440
+البوتاسيوم عند مشكلة كبيرة اذا .. لإن ال plasma
+
+565
+00:42:50,440 --> 00:42:54,760
+لصوب بوتاسيوم اللي فيها جليل فإذا انا خلصته فبيصير
+
+566
+00:42:54,760 --> 00:42:58,560
+عندي hypokalemia ال hypokalemia تأثر على العصابة
+
+567
+00:42:58,560 --> 00:43:02,860
+تثبت مني على الجلب تمام؟ فبتعمللي مشاكل فلذلك انا
+
+568
+00:43:02,860 --> 00:43:06,340
+بيدحافظ على البوتاسيومعلى مستوى الـ A في الـ Extra
+
+569
+00:43:06,340 --> 00:43:10,740
+Ceramic Fluid في الـ Interstitium من هنا يوجد 2
+
+570
+00:43:10,740 --> 00:43:16,000
+نوع من الديارتيكس نوع الديارتيكس يدبليط الجسم من
+
+571
+00:43:16,000 --> 00:43:19,060
+البوتاسيوم يخرج السوديوم و البوتاسيوم مع بعض في
+
+572
+00:43:19,060 --> 00:43:24,840
+اليوريد ونوع تاني لأ نوع تاني بيمنع الـ A السكريشن
+
+573
+00:43:24,840 --> 00:43:32,060
+من الـ A من البوتاسيوم البوتاسيوم يحفظ الديارتيكس
+
+574
+00:43:33,800 --> 00:43:38,500
+بتعمل برسيرفشن للبوتاسيوم لذلك هذا النوع ال
+
+575
+00:43:38,500 --> 00:43:42,880
+aldosterone antagonist بيشتغل على ال distal tubule
+
+576
+00:43:42,880 --> 00:43:47,760
+ليه ال distal؟ و في الحالة هذه هو بيمنع ال
+
+577
+00:43:47,760 --> 00:43:49,680
+secretion من البوتاسيوم بيخلّي البوتاسيوم .. يعني
+
+578
+00:43:49,680 --> 00:43:53,300
+لما أنا بكتب هذا النوع بكتبش معاه بوتاسيوم،
+
+579
+00:43:53,300 --> 00:43:57,640
+بلزمنيش، تمام؟ هذا النوع أنا بلزمنيش أنه يكون فيه
+
+580
+00:43:57,640 --> 00:43:57,920
+إيش
+
+581
+00:44:04,870 --> 00:44:10,650
+عشان أعوض اللي بدي أفجده فيها بمحتاجة إذا هذا الـ
+
+582
+00:44:10,650 --> 00:44:12,150
+Aldosterone Antagonist Effect
+
+583
+00:44:17,090 --> 00:44:22,050
+يدخل السوديوم وبتقسم تحت تأثير ال system ال
+
+584
+00:44:22,050 --> 00:44:27,170
+الدوسترون عالي هذا ال system بيشتغل ماعليش هذا ال
+
+585
+00:44:27,170 --> 00:44:31,210
+system بتوقف وإذا ال system توقف مافيش سوديوم
+
+586
+00:44:31,210 --> 00:44:35,090
+هيدخل السوديوم هيدال إيه؟ طالع لبرا، لذا هذه
+
+587
+00:44:35,090 --> 00:44:38,650
+الجزئية تشتغل بتدخل السوديوم، بتدخل وبتقسم أو
+
+588
+00:44:38,650 --> 00:44:41,870
+بتدخل السوديوم وبتطلع وبتقسم حسب إيه؟ حسب حاجة
+
+589
+00:44:41,870 --> 00:44:48,230
+الجسم هذا ال principle إيه؟ cellsطيب عندي هان ال
+
+590
+00:44:48,230 --> 00:44:51,150
+cells هذي زي ما قلنا ان فيها atba system بتنشط و
+
+591
+00:44:51,150 --> 00:44:54,730
+بتجلل و قلنا هان فيها عندنا potassium channels و
+
+592
+00:44:54,730 --> 00:45:00,050
+ايش و sodium channels لما بتدخل ال sodium اه لما
+
+593
+00:45:00,050 --> 00:45:08,150
+بدخل ال sodium ال system هذا بيشتغل لما ال sodium
+
+594
+00:45:08,150 --> 00:45:12,310
+يدخل ال system ال atba system بيبقى شغال لإن هو
+
+595
+00:45:12,310 --> 00:45:17,110
+بيبقى اللي طلع ال sodiumو يدخل بوتاسيوم لكن اذا
+
+596
+00:45:17,110 --> 00:45:21,530
+انا السوديوم سكرت ال channel تبعته و بطل السوديوم
+
+597
+00:45:21,530 --> 00:45:25,890
+يدخل من ال tubule من ال tubular filtrate بطل
+
+598
+00:45:25,890 --> 00:45:28,750
+السوديوم يدخل لداخل ال what هدول ال cells اللي هم
+
+599
+00:45:28,750 --> 00:45:33,490
+ال late distal tubules بسبب ان انا سكرت ال channel
+
+600
+00:45:33,490 --> 00:45:37,930
+Sodium channel blockers بيسموهم ايش Sodium channel
+
+601
+00:45:37,930 --> 00:45:41,410
+blockers اذا انا سكرت ال channel هذه السوديوم
+
+602
+00:45:41,410 --> 00:45:45,880
+مالحقش داخل ال cellsنتيجة لطرد الصوديوم إلى خارج
+
+603
+00:45:45,880 --> 00:45:50,700
+ال cells عن طريق ال system تمام؟ هذا ال system
+
+604
+00:45:50,700 --> 00:45:54,080
+بيطرد الصوديوم لبرا أو بياخد من ال cytoplasm في
+
+605
+00:45:54,080 --> 00:45:56,620
+المقابل بدخل من ال channel سكرنا ال channel
+
+606
+00:45:56,620 --> 00:46:00,120
+الصوديوم بطل يدخل لمين؟ لداخل ال cells ال bombing
+
+607
+00:46:00,120 --> 00:46:04,820
+system هيتوقععشان .. هو عشان يدخل بوتاسيوم محتاج
+
+608
+00:46:04,820 --> 00:46:08,480
+يطلع Sodium مافيش Sodium بيطلع معناه مافيش
+
+609
+00:46:08,480 --> 00:46:12,620
+بوتاسيوم بيدخل معناه مافيش hyper concentration of
+
+610
+00:46:12,620 --> 00:46:15,420
+.. of بوتاسيوم يعني معناه ال .. ال .. بوتاسيوم كان
+
+611
+00:46:15,420 --> 00:46:19,420
+المفتوحة لكن ال .. ال cytoplasmic concentration of
+
+612
+00:46:19,420 --> 00:46:24,360
+.. of بوتاسيوم انخفض بسبب انه ايش ال pumping
+
+613
+00:46:24,360 --> 00:46:28,100
+system توقف عن عمل طبعا هو هيطلع البوتاسيوم يطلع و
+
+614
+00:46:28,100 --> 00:46:31,160
+يطلع حين متساوى و بعدين مافيش اشي جديد يدخللما ..
+
+615
+00:46:31,160 --> 00:46:35,100
+لما ال sodium بطل يدخل بطل ال potassium من ايه؟ من
+
+616
+00:46:35,100 --> 00:46:38,540
+ال interstitium يدخل لداخل ال cells تمام؟ اذا هنا
+
+617
+00:46:38,540 --> 00:46:42,000
+غريبة جدا ان ال sodium channel blocker هدول ال
+
+618
+00:46:42,000 --> 00:46:44,420
+sodium channel blocker preserving ال potassium
+
+619
+00:46:44,420 --> 00:46:48,540
+concentration في الدم preventing the ايه؟ the
+
+620
+00:46:48,540 --> 00:46:52,280
+diuretics to excrete potassium اذا ال sodium
+
+621
+00:46:52,280 --> 00:46:55,460
+channel blockers لك انهم ايه؟ preserving ايه؟
+
+622
+00:46:56,170 --> 00:47:04,490
+باستخدام البوتاسيوم لتخلص من الديوريتك بشكل كام
+
+623
+00:47:04,490 --> 00:47:07,570
+بيشتغلوا
+
+624
+00:47:07,570 --> 00:47:15,650
+على الـ late distal واحد منهم اسمه الديوريتك
+
+625
+00:47:16,530 --> 00:47:21,430
+و واحد اسمه sodium channel blockers اذا لما اقول
+
+626
+00:47:21,430 --> 00:47:26,710
+لكوا sodium channel blockers برسيفك كوتاسيوم
+
+627
+00:47:26,710 --> 00:47:30,210
+هتقولوا yes مع ان اسمه لا يحفظ عليك
+
+628
+00:47:33,240 --> 00:47:35,760
+في عندى sodium channel blockers وفي عندى
+
+629
+00:47:35,760 --> 00:47:39,420
+aldosterone antagonists هدول بيشتغلوا اتنين نفس
+
+630
+00:47:39,420 --> 00:47:43,200
+المحصلة لكن واحد بيشتغل هنا وواحد بيشتغل هنا وواحد
+
+631
+00:47:43,200 --> 00:47:48,180
+بيعطل الماكينة وواحد بيسحب الكهربا تمام؟ يا منخرب
+
+632
+00:47:48,180 --> 00:47:52,400
+الماكينة ماتشتغلش اللي هي ال aldosteroneنوقف ال
+
+633
+00:47:52,400 --> 00:47:56,460
+ATM system يعني نقوله ماشي مافيش بنزين البنزين بده
+
+634
+00:47:56,460 --> 00:48:00,160
+يكمل تشغيلها هادي ال influx of Sodium طول ما فيه
+
+635
+00:48:00,160 --> 00:48:02,980
+Sodium داخل طول ما الماكينة شغالة وقفنا ندخل
+
+636
+00:48:02,980 --> 00:48:06,580
+Sodium الماكينة بعد شوية و لو شغالة على الفاضي
+
+637
+00:48:06,580 --> 00:48:10,080
+لإنها بدها عشان تعمل ال function ده معاها بدها كل
+
+638
+00:48:10,080 --> 00:48:14,740
+Sodium بيطلع يدخل محله Potassium او كل اتنين
+
+639
+00:48:14,740 --> 00:48:16,740
+Sodium يدخل Potassium او كل Potassium يدخل
+
+640
+00:48:16,740 --> 00:48:20,900
+Potassium فاكرين ال ATM system يعني ده بيشغل كيف؟
+
+641
+00:48:23,170 --> 00:48:26,490
+تلاتة صدرهم واحد و تلاتة و تلاتة و تلاتة و تلاتة و
+
+642
+00:48:26,490 --> 00:48:27,950
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+643
+00:48:27,950 --> 00:48:28,570
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+644
+00:48:28,570 --> 00:48:33,390
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+645
+00:48:33,390 --> 00:48:33,390
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+646
+00:48:33,390 --> 00:48:33,390
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+647
+00:48:33,390 --> 00:48:33,390
+تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و تلاتة و
+
+648
+00:48:33,390 --> 00:48:40,750
+تلاتة و تلاتة و
+
+649
+00:48:40,750 --> 00:48:44,390
+تلات
+
+650
+00:48:45,360 --> 00:48:48,960
+مش كده؟ اذا ال bombing system بيشغل نظام سابق
+
+651
+00:48:48,960 --> 00:48:52,960
+ماتغيرش تلاتة صوديوم لاتنين ايه؟ بوتاسيوم لكن اللي
+
+652
+00:48:52,960 --> 00:48:58,120
+على اليمن ال border حسب ال career فى career صوديوم
+
+653
+00:48:58,120 --> 00:49:02,840
+وصوديوم لاتنين و هان صوديوم بوتاسيوم مش كده؟ طيب
+
+654
+00:49:02,840 --> 00:49:09,600
+اذا اذا
+
+655
+00:49:09,600 --> 00:49:13,750
+واضحة الان ال potassium sparing diureticsاللي هم
+
+656
+00:49:13,750 --> 00:49:18,470
+عندنا نوعين اه بتقسم Sparing Sparing يعني بتخليها
+
+657
+00:49:18,470 --> 00:49:25,230
+محفوظ Intercalated
+
+658
+00:49:25,230 --> 00:49:28,770
+cells Intercalated
+
+659
+00:49:28,770 --> 00:49:35,570
+cells Intercalated cells زي ما قلنا ميزتها انه
+
+660
+00:49:35,570 --> 00:49:41,310
+لاحظوا عندي هذا ال brush border هذا اليمنى
+
+661
+00:49:41,310 --> 00:49:46,470
+الممبرينهذا الـA الـ luminal الابيكال منبراين ال
+
+662
+00:49:46,470 --> 00:49:52,470
+luminal membrane مظبوط موجود عليه ATPs هيدروجين
+
+663
+00:49:52,470 --> 00:49:57,070
+ATPS system هيدروجين ATPS system مش موجود ال ال ال
+
+664
+00:49:57,070 --> 00:49:58,150
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+665
+00:49:58,150 --> 00:49:59,230
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+666
+00:49:59,230 --> 00:50:00,270
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+667
+00:50:00,270 --> 00:50:00,390
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+668
+00:50:00,390 --> 00:50:00,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+669
+00:50:00,890 --> 00:50:00,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+670
+00:50:00,890 --> 00:50:00,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+671
+00:50:00,890 --> 00:50:00,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+672
+00:50:00,890 --> 00:50:00,950
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+673
+00:50:00,950 --> 00:50:01,780
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال الهذا
+
+674
+00:50:01,780 --> 00:50:06,180
+شغلته بس يتحكم في الهيدروجين وبالدين الهيدروجين زى
+
+675
+00:50:06,180 --> 00:50:09,540
+ما قلنا against high concentrations حتى لو كان ال
+
+676
+00:50:09,540 --> 00:50:13,960
+concentration في ال tubule ألف ضعف ال .. ال .. ال
+
+677
+00:50:13,960 --> 00:50:17,180
+interstitial system أو اللى بلازم برضه بضلاش
+
+678
+00:50:17,180 --> 00:50:22,540
+يطلعها لإن هو شغلته هيدروجين معناها اللى بتحكم في
+
+679
+00:50:22,540 --> 00:50:28,500
+الهيدروجين بالإعطاء بتحكمفي الـ bicarbonate بالاخر
+
+680
+00:50:28,500 --> 00:50:32,720
+لأن هدول عكس بعض عشان انا احسن ال pH بدي اغير ال
+
+681
+00:50:32,720 --> 00:50:35,660
+hydrogen في مقابل ال bicarbonate او ال carbonate
+
+682
+00:50:35,660 --> 00:50:39,420
+في مقابله يعني اتنين عكس بعض تمام؟ عندي acidity
+
+683
+00:50:39,420 --> 00:50:41,780
+عالية بيطلع ال hydrogen اكتر و اخد ال bicarbonate
+
+684
+00:50:41,780 --> 00:50:45,760
+اكتر عندي لأ ماثرتي مش عالية فيه بميل لالكاليميا
+
+685
+00:50:45,760 --> 00:50:50,700
+تمام؟ فبروح انا ماطلعش ال bicarbonate بصير اعمل
+
+686
+00:50:50,700 --> 00:50:56,210
+عملت ايه؟ reabsorption لميل للبوتاسيوم لحالهقبل
+
+687
+00:50:56,210 --> 00:51:07,950
+كده اتكلمنا عن الـ
+
+688
+00:51:07,950 --> 00:51:12,950
+counter transport الهيدروشين هذا يتفاعل مع
+
+689
+00:51:12,950 --> 00:51:16,650
+البيكربونيات حول كربون ديوكسيد وهموق و water و
+
+690
+00:51:16,650 --> 00:51:19,630
+كربون ديوكسيد كان بي reabsorb فكده نعمل
+
+691
+00:51:19,630 --> 00:51:23,800
+reabsorption للبيكربونياتمتكلم عنه كنا luminal
+
+692
+00:51:23,800 --> 00:51:27,920
+process هو فيه لما يدخل داخل ال cells بيصير العكس
+
+693
+00:51:27,920 --> 00:51:33,440
+بتحلل برجع ل .. ل .. ل carbonic acid من جديد و ال
+
+694
+00:51:33,440 --> 00:51:37,720
+carbonic acid بتحلل تحت تأثير طبعا ال .. ال
+
+695
+00:51:37,720 --> 00:51:41,280
+carbonic unhydrate إلى bicarbonate و water و
+
+696
+00:51:41,280 --> 00:51:45,360
+hydrogen ال hydrogen يعني استخدامه في ال secretion
+
+697
+00:51:45,360 --> 00:51:47,980
+في ال counter transport تماما و ال bicarbonate
+
+698
+00:51:47,980 --> 00:51:51,730
+enters the ايه؟ the blood مش كده؟وبكدا بيكون انا
+
+699
+00:51:51,730 --> 00:51:54,950
+جالت ال bio carbonate من هن لهن عبر مين mediated
+
+700
+00:51:54,950 --> 00:52:00,910
+by مين؟ by hydrogen ions هنا نفس ال system في داخل
+
+701
+00:52:00,910 --> 00:52:04,270
+ال cells .. نفس ال system في داخل ال cells انه انا
+
+702
+00:52:04,270 --> 00:52:09,270
+لما عندي ال hydrogen اتكون من ال system هذا اللي
+
+703
+00:52:09,270 --> 00:52:11,850
+هو carbon dioxide زي اللي هو طبعا من ال carbonic
+
+704
+00:52:11,850 --> 00:52:15,810
+acid طبعا activated by carbonic anhydrase هذي
+
+705
+00:52:15,810 --> 00:52:19,950
+اتحلل ال bio carbonate ايه؟و الهيدروجين الهيدروجين
+
+706
+00:52:19,950 --> 00:52:24,410
+يستخدم في السكريشن و ال بايكربونيت ايه؟ is
+
+707
+00:52:24,410 --> 00:52:31,430
+reabsorbed again تمام؟ هنا نعمل
+
+708
+00:52:31,430 --> 00:52:36,090
+pumping لمين؟ للهيدروجين لبرا لاحظوا هنا ال system
+
+709
+00:52:36,090 --> 00:52:38,230
+الأولى اتكلمنا عنه في ال production of the jupiter
+
+710
+00:52:38,230 --> 00:52:41,410
+كان بيهتم انه في ايش في اليوم البيكربونيت ادخله
+
+711
+00:52:41,410 --> 00:52:45,390
+ولا مادخلوش عبر الهيدروجين ايالز لإن احنا بتكلم
+
+712
+00:52:45,390 --> 00:52:49,270
+جاعدين ان احنا مندخل او منطلع carbon dioxideحسب
+
+713
+00:52:49,270 --> 00:52:57,050
+حاجتنا فى كده نرحل الهيدروجين لإنه عندى أنا عندى
+
+714
+00:52:57,050 --> 00:53:02,530
+موجود فى داخل الجسم هيدروجين ايون كمية كبيرة بدأ
+
+715
+00:53:02,530 --> 00:53:05,510
+اتخلص منها بدي أعمل إليها secretion فبحتاج إنه
+
+716
+00:53:05,510 --> 00:53:07,610
+يدخل ال carbon dioxide علي من ال interstitium
+
+717
+00:53:07,610 --> 00:53:12,990
+تمام؟ و فى ال interstitium هان أنا بعمل عملية
+
+718
+00:53:12,990 --> 00:53:17,110
+تحويلهبالـ carbonic anhydrase إلى carbonic acid و
+
+719
+00:53:17,110 --> 00:53:19,930
+ال carbonic acid باخد منه hydrogen و بارميه برا
+
+720
+00:53:19,930 --> 00:53:23,850
+تمام؟ إذا نستخدم ال carbon dioxide في أن أحلل
+
+721
+00:53:23,850 --> 00:53:30,530
+الميه إلى .. إلى hydrogen طلع برا و OH اتحد مع مين
+
+722
+00:53:30,530 --> 00:53:33,390
+في المحصلة يعني مع ال carbon dioxide يعمل لي
+
+723
+00:53:33,390 --> 00:53:37,370
+بيكربونات كده بكون أنا أخدت hydrogen ions من الميه
+
+724
+00:53:37,370 --> 00:53:40,510
+و سابقا سبت ال OH ions في الميه كده بكون أنا بخلص
+
+725
+00:53:40,510 --> 00:53:46,020
+الجسم من الـ A من ال hydrogen ions دبعتهاإذا هنا
+
+726
+00:53:46,020 --> 00:53:50,040
+نتكلم على هذه الـ intercalated cells وقلنا إنها
+
+727
+00:53:50,040 --> 00:53:58,540
+mainly .. mainly .. mainly بيصير هنا
+
+728
+00:53:58,540 --> 00:54:07,370
+ال .. both late andالسلسلات المتعارفة من هذه
+
+729
+00:54:07,370 --> 00:54:12,990
+المجالات النيفرون تحفز حيوانات الهيدروجين عن طريق
+
+730
+00:54:12,990 --> 00:54:17,790
+ميكانيزم ATBA الهيدروجين هذا الprocess مختلف عن
+
+731
+00:54:17,790 --> 00:54:22,190
+تحفز حيوانات الهيدروجين عن طريق البروكسيمال تيبور
+
+732
+00:54:22,190 --> 00:54:26,690
+لأنه قادر على تحفز حيوانات الهيدروجين عن طريق
+
+733
+00:54:26,690 --> 00:54:34,140
+ميكانيزم الهيدروجين كمية 1000 إلى 1بالنسبة
+
+734
+00:54:34,140 --> 00:54:37,700
+للمقارنة الصغيرة من أربعة إلى عشرة ضد واحدة
+
+735
+00:54:37,700 --> 00:54:42,600
+لحيوانات الهيدروجينية التي يمكن تحقيقها باستخدام
+
+736
+00:54:42,600 --> 00:54:45,840
+الاستخدام الثانوية في البروكسيماتريبيول. لذلك،
+
+737
+00:54:45,840 --> 00:54:49,820
+تلعب الأسلحة الانتركالية هي رولة أساسية في التحكم
+
+738
+00:54:49,820 --> 00:54:55,340
+الأساسي على المواد الجسمية. برضه بدنا نقول أن
+
+739
+00:54:55,340 --> 00:55:01,580
+البريمابيلية للسوديوم والماء هنا في المنطقة هذه
+
+740
+00:55:01,580 --> 00:55:07,160
+تعتمد عليهاعلى availability of aldosterone او
+
+741
+00:55:07,160 --> 00:55:08,280
+الانتيداراتيك الحرمون
+
+742
+00:55:11,450 --> 00:55:17,310
+خرمون اسمه كان اسمه زمان vazopressin vazopressin
+
+743
+00:55:17,310 --> 00:55:20,870
+لإنه لما يعلى كتير بيصير vazoactive بيعمل
+
+744
+00:55:20,870 --> 00:55:24,610
+vazoconstriction لكن هو ال dose تبعته جليلة في
+
+745
+00:55:24,610 --> 00:55:29,810
+physiological levels جليلة بيحافظ على إنه بس يمنع
+
+746
+00:55:29,810 --> 00:55:34,810
+الميه أن ت be executed ال neuron لكن لو الميه اللي
+
+747
+00:55:34,810 --> 00:55:38,710
+executed ال neuron مش executed و برضه عندي hypo
+
+748
+00:55:39,190 --> 00:55:42,710
+Volumia البلازمو برضه اه فالاندرويد الكهورمون
+
+749
+00:55:42,710 --> 00:55:46,230
+بيعلى اكتر وبساعد في انه يساعد ال blood pressure
+
+750
+00:55:46,230 --> 00:55:50,450
+يستعاد من خلال ال VASO-A Spasms طبعا هذا ال system
+
+751
+00:55:50,450 --> 00:55:53,730
+كله الالدوستيرون و الاندرويد الكهورمون و
+
+752
+00:55:53,730 --> 00:55:57,090
+الانجوتنسين 2 و الرينانسيستم هذا كلهم شغلتهم
+
+753
+00:55:57,090 --> 00:56:01,240
+يحافظوا ع مين يحافظوا علىالـ blood pressure يحافظ
+
+754
+00:56:01,240 --> 00:56:04,180
+على مين؟ الشغل الأساسي تبعهم يحافظ على الـ blood
+
+755
+00:56:04,180 --> 00:56:07,000
+pressure الـ blood pressure بتحافظ علي ان ازيد
+
+756
+00:56:07,000 --> 00:56:14,280
+الميه اللى فيه بمنحها من التسرب عبر الكيلية تمام؟
+
+757
+00:56:14,280 --> 00:56:18,280
+او ازيد ال contraction of blood vessels لإن ازدت
+
+758
+00:56:18,280 --> 00:56:21,840
+ال vasoplasm ميعلى الدغر اذا ازدت ال volume اللى
+
+759
+00:56:21,840 --> 00:56:26,140
+في داخل جسمه ميعلى الدغر مش كده؟ طيب
+
+760
+00:56:28,970 --> 00:56:33,770
+Medullary Collecting Doctrine الجزء الأخير من
+
+761
+00:56:33,770 --> 00:56:40,010
+الموضوع احنا وصلنا لان لما .. طبعا احنا فى الفصل
+
+762
+00:56:40,010 --> 00:56:44,950
+الجاى بنتكلم عن الأرقام بس لان لما انه ال .. ال
+
+763
+00:56:44,950 --> 00:56:46,230
+thickening lab اشتغلت
+
+764
+00:56:48,750 --> 00:56:53,370
+الجزئية اللى هتصل المدالة لدك تعتمد على ال
+
+765
+00:56:53,370 --> 00:56:59,090
+functions اللى موجودة في ال led circuitry
+
+766
+00:56:59,090 --> 00:57:07,670
+ال led circuitry الها دى ممكن تحول ال filtrate هذا
+
+767
+00:57:07,670 --> 00:57:11,750
+الى more diluted اذا عملنا more reabsorption of
+
+768
+00:57:11,750 --> 00:57:17,280
+sodium و less reabsorption of water او ترجعهالى
+
+769
+00:57:17,280 --> 00:57:21,380
+maximum بترايشه ل isosmotic maximum بترايشه ل إيش
+
+770
+00:57:21,380 --> 00:57:26,900
+ل isosmotic تمام لإنه ال cortical interstitium
+
+771
+00:57:26,900 --> 00:57:30,520
+تركيزه جديش isosmotic تلت مية ال cortical
+
+772
+00:57:30,520 --> 00:57:34,380
+interstitium فلذلك أنا بدي أسحب مياه بسحبها لحد من
+
+773
+00:57:34,380 --> 00:57:36,880
+ال cells تصير مساوية لل interstitium اللي حواليها
+
+774
+00:57:36,880 --> 00:57:40,580
+عشان يصير ال balance مش هات؟ إذا أنا بيطلع من عندي
+
+775
+00:57:40,580 --> 00:57:49,490
+يا إما hypotonic يا إما إيهيا ايزوز بوتيك اذا ال
+
+776
+00:57:49,490 --> 00:57:51,850
+.. ال .. ال .. ال .. ال thick ascending limb بتسلم
+
+777
+00:57:51,850 --> 00:57:56,290
+ال .. ال distal ال hypotonic solution ال hypotonic
+
+778
+00:57:56,290 --> 00:57:58,730
+solution هذا ميت من الأزمة ممكن يزيد ال
+
+779
+00:57:58,730 --> 00:58:02,910
+hypotonicity اكتر تمام اللي هو ال distal اللي هي
+
+780
+00:58:02,910 --> 00:58:07,210
+ال distal لكن مابقدرش يخليه high bar ال high bar
+
+781
+00:58:07,210 --> 00:58:13,190
+هذا شغلت مين المضلةبصيرش hyper osmotic إلا إذا دخل
+
+782
+00:58:13,190 --> 00:58:17,170
+ايه المضلة لكن احنا ال thick ascending limb والله
+
+783
+00:58:17,170 --> 00:58:21,310
+الوضع طبعا طبيعي لابد نزود ولا بد نجلل ووضعنا
+
+784
+00:58:21,310 --> 00:58:24,050
+كويسه ونشرب كويسه ونأكل كويسه ومافيش عندنا حالة
+
+785
+00:58:24,050 --> 00:58:29,010
+dehydration ولا over hydration ولا إشي تمام؟ في
+
+786
+00:58:29,010 --> 00:58:31,270
+الحالة دي ال thick ascending .. ال .. ال .. ال ..
+
+787
+00:58:31,270 --> 00:58:34,610
+ال distal convolution بتشغل بشكل طبيعي في العادة
+
+788
+00:58:34,610 --> 00:58:40,450
+بيوصل ال filtrateالى المدلري collecting duct
+
+789
+00:58:40,450 --> 00:58:48,250
+isosmotic طبعا لكن لو كان محتاج ميه اكتر لو عندى
+
+790
+00:58:48,250 --> 00:58:55,090
+ميه اكتر اه بوصله اه لو محتاج سوديوم اكتر بوصله
+
+791
+00:58:55,090 --> 00:58:59,430
+hypotonic اكتر هذه منطقة ال regulation طبعا انت
+
+792
+00:58:59,430 --> 00:59:05,260
+تحكم فيهابيزيدوا بجل و القلد السترال بتحكم فيها
+
+793
+00:59:05,260 --> 00:59:09,240
+وحسب النتيجة بسهولة بنقدر نتوقع ايش بتحصل، تمام؟
+
+794
+00:59:09,240 --> 00:59:13,380
+لكن الـthick ascending limb بيطلع ال .. الـ distal
+
+795
+00:59:13,380 --> 00:59:16,460
+tubule بيطلعش منها fluid إلى ال .. إلى المدالة
+
+796
+00:59:16,460 --> 00:59:20,200
+recollecting duct hypertonic بيصل ماكسما إيزوتونك،
+
+797
+00:59:20,200 --> 00:59:25,850
+تمام؟ لكن ممكن يصل severe hypotonicو تحافظ عليه
+
+798
+00:59:25,850 --> 00:59:30,650
+الميدالة اذا انا بوصل ان اوصل لخمسين و بدأ اطلع
+
+799
+00:59:30,650 --> 00:59:35,530
+بيتلاشى دور الميدالة لان في الحالة هذه ممكن يطلع
+
+800
+00:59:35,530 --> 00:59:40,170
+من الـ distal tribule الهيبوتينيك فيلتريت و يظل
+
+801
+00:59:40,170 --> 00:59:44,050
+ماشي لل ball الميدالة ماعملتش شفية لأن هي اللي
+
+802
+00:59:44,050 --> 00:59:47,640
+بتقدر تعمل dilutionتدخل المضلة اي تدخل المضلة
+
+803
+00:59:47,640 --> 00:59:49,920
+تعمله more concentration فإذا أنا بدي اعمل
+
+804
+00:59:49,920 --> 00:59:54,700
+dilution كتير المضلة ايش؟ بتدخلش تمام؟ لأنه هلاحظ
+
+805
+00:59:54,700 --> 01:00:00,700
+انا انه عشان الميه اتخش من المضلة مضلة دكت مضلة
+
+806
+01:00:00,700 --> 01:00:04,980
+ايه؟ دكت الى داخل ال cells تبع المضلة الى ال
+
+807
+01:00:04,980 --> 01:00:09,840
+interstitium تحتاج الى watercarriers water pores
+
+808
+01:00:09,840 --> 01:00:13,580
+water channels إذا فتحت ال water channels ممكن
+
+809
+01:00:13,580 --> 01:00:16,840
+الميه تبدأ تطلع و يصبح more concentration صحيح
+
+810
+01:00:16,840 --> 01:00:22,140
+diluted urine و صحيح اللي حواليها ال interstitium
+
+811
+01:00:22,140 --> 01:00:28,140
+ايزوزموتك تمام هو شيبرزموتك لكنه ايزوزموتك لكن
+
+812
+01:00:28,140 --> 01:00:32,640
+الميه مش قادرة تطلع منه لإن ال water channels ايه
+
+813
+01:00:32,640 --> 01:00:39,710
+مسكرةواضح؟ واضح الكلام ولا لا؟ اذا احنا ال digital
+
+814
+01:00:39,710 --> 01:00:40,330
+tribune
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..dfeb5d0b7711ce6695f3ee082d6fb2ce8d3641d8
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_postprocess.srt
@@ -0,0 +1,1948 @@
+1
+00:00:05,820 --> 00:00:09,560
+تلج حسب الظروف المختلفة لما بيدخل على الرئاتين
+
+2
+00:00:09,560 --> 00:00:13,280
+يدخل حسب على ال .. يصير ال alveoli ال دقيقة هادية
+
+3
+00:00:13,280 --> 00:00:17,420
+مايصارش تلج و إلا حيصير جوا cracks و هنخش في إيه؟
+
+4
+00:00:17,420 --> 00:00:20,920
+احنا بس نبرد ثواني كنا رشحنا أو حالتنا حالة
+
+5
+00:00:20,920 --> 00:00:24,680
+فمابالك لو كان المسألة هادى دائما احنا معرضين
+
+6
+00:00:24,680 --> 00:00:28,020
+للهواء الخارجى الرئاتين ال alveoli مش معرضين
+
+7
+00:00:28,020 --> 00:00:32,700
+للهواء الخارجى بيصير عاملين تدفع إذا هدي .. إذا
+
+8
+00:00:32,700 --> 00:00:39,160
+صار عندي حاجتينfilteration وتدفئة warming والتالت
+
+9
+00:00:39,160 --> 00:00:44,640
+humidification الهواء اللي بده يخش بده يكون رطب
+
+10
+00:00:44,640 --> 00:00:51,220
+مايكونش جاف يجففلي الميوكاس اه ويجففلي ال .. ال ..
+
+11
+00:00:51,220 --> 00:00:54,100
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+12
+00:00:54,100 --> 00:00:54,200
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+13
+00:00:54,200 --> 00:00:54,500
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+14
+00:00:54,500 --> 00:00:55,040
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+15
+00:00:55,040 --> 00:00:55,360
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+16
+00:00:55,360 --> 00:00:56,720
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+17
+00:00:56,720 --> 00:01:00,420
+.. ال .. ال .. ال ..
+
+18
+00:01:00,420 --> 00:01:00,660
+ال .. ال
+
+19
+00:01:03,850 --> 00:01:08,450
+cracks وبيصير عندي spread
+
+20
+00:01:08,450 --> 00:01:14,210
+of infection تمام؟ اذا عندي هى تلت حاجات وفي حاجة
+
+21
+00:01:14,210 --> 00:01:18,670
+رابعة كتير مهمة انا لو لا هالريقتين هدول مابقدر
+
+22
+00:01:18,670 --> 00:01:21,790
+اخاطبهم او اتخاطبونى لو لا ال air passages هذه
+
+23
+00:01:21,790 --> 00:01:27,030
+اللى فيها اه حاطين الزمارة فيها كده ال larynx اه
+
+24
+00:01:27,030 --> 00:01:36,910
+وحاطين اللى هى حلق و لسان وشفايفو soft palate و
+
+25
+00:01:36,910 --> 00:01:42,690
+intercostals و abdominal muscles و diaphragm هذا
+
+26
+00:01:42,690 --> 00:01:46,650
+كله طاقم في الآخر بيقدر ال phonation بيقدر ال
+
+27
+00:01:46,650 --> 00:01:51,630
+speech تمام؟ الكلام هذا طبعا إله مركزية بتحكمه و
+
+28
+00:01:51,630 --> 00:01:56,510
+هي الأساس بحيث أن هذا كل الطاقم اللي اتكلمنا عنه
+
+29
+00:01:56,510 --> 00:02:01,030
+من عضلات بتزيد الضغط في داخل الرائعتين إلى vocal
+
+30
+00:02:01,030 --> 00:02:07,420
+cords بتفتح و بتسكربتشد و بترخي بتزيد الهواء و
+
+31
+00:02:07,420 --> 00:02:10,800
+بتجلله عشان يطلع عندي أنغام مختلفة من الصوت
+
+32
+00:02:10,800 --> 00:02:15,860
+phonation عملية انه يطلع صوت رفيع ولا خميل ولا
+
+33
+00:02:15,860 --> 00:02:21,580
+شديد ولا عالي ولا هادي مربوط وين؟ في ال larynx في
+
+34
+00:02:21,580 --> 00:02:26,500
+ال vocal cords بعدين الصوت اللي طلع هذا يتحول إلى
+
+35
+00:02:26,500 --> 00:02:29,960
+أحرفوالحمد لله رب العالمين كلكم بتعرفوا المخارج
+
+36
+00:02:29,960 --> 00:02:33,380
+وكلكم بتعرفوا صفات الحروف وكل حرف كيف بيطلع و اين
+
+37
+00:02:33,380 --> 00:02:38,220
+بنزل هذه المرحلة النهائية تمام اللي هي وانت
+
+38
+00:02:38,220 --> 00:02:42,960
+بتتكلمي لا بتفكر ان حرف ال .. الح يطلع من الحلق
+
+39
+00:02:42,960 --> 00:02:48,420
+ولا يطلع من الخيشوم ولا غيره انت بس بتقول اي حاجة
+
+40
+00:02:48,420 --> 00:02:52,260
+بيطلع لحاله لأن في مركزية في الداخل احنا اول ما
+
+41
+00:02:53,500 --> 00:02:56,720
+بدأنا ننمو و اتعلمنا اسمعنا هذا الكلام من ايه؟ من
+
+42
+00:02:56,720 --> 00:03:01,600
+الأم فبدأنا نقلدها ثم برمجنا دماغ عنا لما نطلع
+
+43
+00:03:01,600 --> 00:03:05,700
+الحرف او الكلمة او الفكرة احنا بنقول الفكرة جاعدين
+
+44
+00:03:05,700 --> 00:03:08,280
+قبل ما .. قبل ما نعرف ايش بنقول، بنقول طالعة
+
+45
+00:03:08,280 --> 00:03:12,620
+لساننا يعني و احنا بنفكر و بنتكلم يعني مش بنفكر و
+
+46
+00:03:12,620 --> 00:03:16,140
+بعدين .. اه هذه في غير لغة الأم بيقرر واحد ايش
+
+47
+00:03:16,140 --> 00:03:19,940
+بيقول و بعدين بيقول لكن في لغة الأم اللي مبرمج انت
+
+48
+00:03:19,940 --> 00:03:26,480
+عليها بتفكريوبتتكلمي في نفس الوجد الفكرة مافيش فرق
+
+49
+00:03:26,480 --> 00:03:31,200
+ما بين انتقال الفكرة الى كلام اى وقت محسوس هو فيه
+
+50
+00:03:31,200 --> 00:03:35,460
+فرق بس الفرق هذا ايه مش محسوس من كتر ماهي الفكرة
+
+51
+00:03:35,460 --> 00:03:39,860
+وانا بكلمك واقعد مستغرب انا كيف ان الكلام قبل ما
+
+52
+00:03:39,860 --> 00:03:42,360
+ايه ماتطلع الفكرة من رأسي مش عارف ايش بده اقول
+
+53
+00:03:42,360 --> 00:03:46,820
+بسمعها سماع في الآخر السرعة السرعة الرهيبة اللى
+
+54
+00:03:46,820 --> 00:03:53,410
+بتنفيها ايه نقل الفكرة من مركز ال الكلام اهمن مركز
+
+55
+00:03:53,410 --> 00:03:57,470
+الفكرة إلى مركز الكلام و مركز الكلام هذا فورا شوف
+
+56
+00:03:57,470 --> 00:04:02,550
+كده سرعة العصاب بحيث انه يزود ضغط الصدر عشان الصوت
+
+57
+00:04:02,550 --> 00:04:09,610
+يعل شوية او يوت شوية او يظل مندفع حجاب الحاجز ضغط
+
+58
+00:04:09,610 --> 00:04:13,010
+باستمرار عشان ال intro thoracic pressure يظل عالي
+
+59
+00:04:13,010 --> 00:04:16,470
+عشان .. و طول ما هو عالي طول ما ان انا ايه فيه هوا
+
+60
+00:04:16,470 --> 00:04:19,930
+مندفع على الخارجو ال vocal cords بتزيدوا و بتجيلوا
+
+61
+00:04:19,930 --> 00:04:24,770
+بحيث انه تدينا الصوت ال pitch اللي انا بدياه ثم
+
+62
+00:04:24,770 --> 00:04:28,650
+بيجي الطاقم الأخير اللي انتوا اتكلمتوا عنه اللي هو
+
+63
+00:04:28,650 --> 00:04:33,470
+طاقم المخارج و ال ايه و الصفات اللي يعمللي الحرف
+
+64
+00:04:33,470 --> 00:04:38,530
+اللي انا في الآخر و علمه أدم الأسماء كلها فأصبح
+
+65
+00:04:38,530 --> 00:04:48,050
+إنسان بيتكلم و بينطق و له قامة معتدلةوله يدين
+
+66
+00:04:48,050 --> 00:04:53,730
+القفزة في الخلق ما بين الإنسان وبين أي مخلوق آخر
+
+67
+00:04:53,730 --> 00:04:59,250
+على وجه الأرض غير الإنسان قفزة ضخمة كبيرة مفترض
+
+68
+00:04:59,250 --> 00:05:03,690
+إنه لو هذا إجا عفويا بالصدفة زي ما قالوا لإلا جينا
+
+69
+00:05:03,690 --> 00:05:07,670
+إشي جريب من الإنسان هيك تسعين المية أو إشي خمسة و
+
+70
+00:05:07,670 --> 00:05:10,130
+تسعين المية أو إشي أسعة و تسعين المية دولة عشان ..
+
+71
+00:05:10,130 --> 00:05:14,370
+بعدين هنلاقي كان إنسان طويل و عريض و بس من غير ..
+
+72
+00:05:14,370 --> 00:05:20,280
+من دماغه و ماكملش تفكيرهأه يعني نلاقي إنسان طويل و
+
+73
+00:05:20,280 --> 00:05:23,880
+عريض بس إيه دي كلها إيه مش أصابع حلوة هيك أه كلها
+
+74
+00:05:23,880 --> 00:05:27,940
+إيه كذا و إيه له دماغ طبعا إيش هيعفي الدماغ اللي
+
+75
+00:05:27,940 --> 00:05:32,520
+بيفكر فيه الإنسان كويس في عدم موجود الأصابع في عدم
+
+76
+00:05:32,520 --> 00:05:38,560
+موجود أشياء كتير أه فبرجع تاني بقول الجسم
+
+77
+00:05:41,460 --> 00:05:44,920
+بنى برضه بالعلامة خلقناها على الاقتصاد فالهوى اللى
+
+78
+00:05:44,920 --> 00:05:49,160
+طالع كمان عاملنا صوت و عاملنا أشياء كلام و عاملنا
+
+79
+00:05:49,160 --> 00:05:54,780
+هو داخل للنفس نفس بس فى نفس الوجهة مدامه فى مكينة
+
+80
+00:05:54,780 --> 00:06:00,160
+ضخ هوى إذا نستخلها برضه في إيجاد ما يسمى بالصوت ما
+
+81
+00:06:00,160 --> 00:06:03,840
+إيجاد .. ماعملاش مكينة تانية للصوت بس تشغل صوت و
+
+82
+00:06:03,840 --> 00:06:09,190
+بعدين هدا يشغل نفس لأ إيجاد هاديمعهد إذا الجهاز
+
+83
+00:06:09,190 --> 00:06:13,770
+التنفسي عندها بيعمل تلت أشياء مهمة واشي الرابع
+
+84
+00:06:13,770 --> 00:06:19,930
+بيخصش التنفس نفسه يعني تلتة بتخص عملية التنفس ال
+
+85
+00:06:19,930 --> 00:06:23,490
+humidification و ال warming و ال filtration بتخص
+
+86
+00:06:23,490 --> 00:06:27,470
+عملية الهواء نفسه لكن الرابع ال foundation وظيفة
+
+87
+00:06:27,470 --> 00:06:30,670
+إضافية يعني مالها الجهاز التنفسي لكن مالهاش علاقة
+
+88
+00:06:30,670 --> 00:06:35,870
+هي إيه بالتنفس يعني الرطوبة بتحمي الفلترة بتحمي
+
+89
+00:06:35,870 --> 00:06:43,990
+التدفئة بتحميلكن الصوت هذا صفة إضافية رابعة إذن
+
+90
+00:06:43,990 --> 00:06:48,550
+الجهاز التنفسي اللي عندى بيبدأ بال nose الأنف وما
+
+91
+00:06:48,550 --> 00:06:52,750
+أدراك ما الأنف الأنف في حاجز أنفي نازل سبتمبر في
+
+92
+00:06:52,750 --> 00:06:58,430
+النص وفي من الجناب طالع what is called كونكا
+
+93
+00:06:58,430 --> 00:07:03,410
+مجموهم كونكى اتنين بالعرض ماشيين هيك عاملين زر
+
+94
+00:07:03,410 --> 00:07:08,300
+رديتر حاجزين في وسط الايه بس بالعرضفي وسط الفراغ
+
+95
+00:07:08,300 --> 00:07:13,600
+الأنفي هذا تشوفي الأنفي نزل سبتم في النص وعندي من
+
+96
+00:07:13,600 --> 00:07:17,520
+الجانب جاي كونكا و كونكا سموها بعد شوية turbulent
+
+97
+00:07:17,520 --> 00:07:23,160
+ليش؟ لإن الكونكا تؤدي إلى turbulence بتلخبط الهواء
+
+98
+00:07:23,160 --> 00:07:26,960
+فقالوا إذا هذي turbulent هي كونكا عظميا لكن
+
+99
+00:07:26,960 --> 00:07:29,860
+functionally سموها turbulent هتكلم معنا بعد شوية
+
+100
+00:07:29,860 --> 00:07:33,180
+وعلى الجانب التاني من النزل إيه؟ اه فإذا عندي
+
+101
+00:07:33,180 --> 00:07:36,230
+أنفين فيه نزل سبتموهان وهان الـ turbinates
+
+102
+00:07:36,230 --> 00:07:39,590
+بيقسمولي الهواء إلى تلت أقسام، الهواء بنزل في ال
+
+103
+00:07:39,590 --> 00:07:43,050
+.. في ال .. في المجلة الوسطانية أو في النص وفوق،
+
+104
+00:07:43,050 --> 00:07:49,890
+تمام؟ إذا صار عندي أنا nasal cavity و nasal ال
+
+105
+00:07:49,890 --> 00:07:56,010
+turbinates و nasal sinusesعندي أنا هذا الهواء اللي
+
+106
+00:07:56,010 --> 00:08:02,090
+داخلها مشبوك في sinuses ال sinuses لهم فائدة في
+
+107
+00:08:02,090 --> 00:08:07,590
+التدفئة و الصوت ال phonation ده مع الصوت لكن ال
+
+108
+00:08:07,590 --> 00:08:13,150
+nasal space هذا اللي الهواء بيخشه عشان يت filter و
+
+109
+00:08:13,150 --> 00:08:18,030
+يتدفى و كده يديش مساحته اتصوروا لجينا عندي مساحة
+
+110
+00:08:18,030 --> 00:08:24,440
+ستمائة centimeter ستمائة ولا اتنين وستين؟عشرة في
+
+111
+00:08:24,440 --> 00:08:30,920
+ستين اه ستمية ستمية وعشرين centimeter مربع مساحة
+
+112
+00:08:30,920 --> 00:08:35,260
+ال surface area اللي الهواء لما بيخش ال nose بيخش
+
+113
+00:08:35,260 --> 00:08:40,180
+فيها تمام المتر المربع عشرة الف centimeter مش هيك
+
+114
+00:08:40,180 --> 00:08:44,820
+احنا بنتكلم عن ستمية ستمية وعشرين يعني حوالي عشرة
+
+115
+00:08:44,820 --> 00:08:49,930
+centimeter عرض مثلا في ستين centimeterهذه تصوروا
+
+116
+00:08:49,930 --> 00:08:54,590
+ان ال nose تبعنا هذا هالجد في surface area إله
+
+117
+00:08:54,590 --> 00:09:02,490
+أهمية كبيرة جدا في تنقية الهواء وتدفئة الهواء و ال
+
+118
+00:09:02,490 --> 00:09:05,850
+humidification
+
+119
+00:09:05,850 --> 00:09:12,330
+و ترطيب الهواء تمام؟ ال nose إله دور و الtrachea
+
+120
+00:09:12,330 --> 00:09:16,070
+إلها دور و الbronchus إلها دور طب خليني أتكلم عن
+
+121
+00:09:16,070 --> 00:09:18,470
+الموضوع هذا بشكل أوسع
+
+122
+00:09:24,350 --> 00:09:28,450
+طيب ال .. خلّينا جايبنا نتكلم عن ال .. خلّا بدأنا
+
+123
+00:09:28,450 --> 00:09:37,190
+فيها نتكلم عنها طب okay نتكلم
+
+124
+00:09:37,190 --> 00:09:40,950
+عنها مدن بدأنا الكلام حولها
+
+125
+00:09:56,950 --> 00:10:00,890
+the normal respiratory functions of the nose إذا
+
+126
+00:10:00,890 --> 00:10:04,110
+بدأ أنا أتكلم عن مين؟ عن ال nose لإن الهو أولا
+
+127
+00:10:04,110 --> 00:10:10,870
+بدخل بقابل ال nose بقابل ال هو الهو داخل لحظه لإن
+
+128
+00:10:10,870 --> 00:10:14,870
+ال هو بدخل كده و بعدين يغير اتجاهه عشان كده فتحات
+
+129
+00:10:14,870 --> 00:10:20,910
+الأنف مش جاية قدام هيك مش بس منظر جمالي هو منظر
+
+130
+00:10:20,910 --> 00:10:23,590
+جمالي جدا إن كانوا تحت بس بعض الناس لاجي
+
+131
+00:10:23,590 --> 00:10:29,810
+المناخيرهمفاتحاك بشكل مزعج أمامك كده شاهد؟ لكن فضل
+
+132
+00:10:29,810 --> 00:10:33,750
+ربنا انه خلالنا .. مش بس منظر جمالي لأ كمان علشان
+
+133
+00:10:33,750 --> 00:10:38,510
+الهواء يغير اتجاهه تمام؟ و ال nose الشغلته
+
+134
+00:10:38,510 --> 00:10:43,050
+الأساسيه الاخبط الهواء اغير اتجاهات في الهواء لإنه
+
+135
+00:10:43,050 --> 00:10:46,450
+كل ما بيغير اتجاهة الهواء كل ما بيشغل ال nose أكتر
+
+136
+00:10:46,450 --> 00:10:50,850
+كيف يعني؟ الغبرة المحمولة في ال .. في الهواء
+
+137
+00:10:50,850 --> 00:10:57,320
+الداخلأحجام مختلفة أحجام مختلفة بالقطع كلها
+
+138
+00:10:57,320 --> 00:11:03,960
+الغبارة وزنها أكتر من وزن ال particles of air لذلك
+
+139
+00:11:03,960 --> 00:11:06,780
+لما الهواء يبقى مندفع بشكل معين وحامل معه ال
+
+140
+00:11:06,780 --> 00:11:10,580
+particles ثم يصير تغيير في اتجاه الهواء بيغير
+
+141
+00:11:10,580 --> 00:11:15,060
+اتجاهه أسرع من بيغيره من ال particles ال particles
+
+142
+00:11:15,060 --> 00:11:17,900
+بتبقى مندفع على أنها كتلة
+
+143
+00:11:20,450 --> 00:11:24,190
+الها كتلة حركة الها عزم .. إيش بيسموه أنتوا العجلة
+
+144
+00:11:24,190 --> 00:11:28,930
+ولا إيش .. في التوجيه كنا زمان ندوس .. إيه؟ تسا ..
+
+145
+00:11:28,930 --> 00:11:32,810
+الها وزن معين بيخليها مدفعة بشكل معين هذا بيقدر إن
+
+146
+00:11:32,810 --> 00:11:36,610
+الهواء بيغير اتجاهه لكن ال .. ال particles هذه
+
+147
+00:11:36,610 --> 00:11:41,350
+بتخبط في الحيط اللي هي إيه؟ اللي واجهتها الحيط
+
+148
+00:11:41,350 --> 00:11:45,030
+اللي واجهتها الـ mucous membrane مخاطب يلزق فيها
+
+149
+00:11:45,030 --> 00:11:49,170
+ال إيه؟ ال particles تمام؟ إذا هو أول ما الهواء
+
+150
+00:11:49,170 --> 00:11:59,180
+بيخشبنجح حاله وغير اتجاهه فبضرب في سجف الانف بضرب
+
+151
+00:11:59,180 --> 00:12:02,240
+في ال turbinates فبتلاقي اتجاهه تشتت في كل اتجاه
+
+152
+00:12:02,240 --> 00:12:07,520
+ال air ال ال ال ال ال ال ال pollution particles
+
+153
+00:12:07,520 --> 00:12:10,620
+هذه الموجودة في الهواء بتبدأ تغير اتجاهها مش مدفعة
+
+154
+00:12:10,620 --> 00:12:14,580
+كلها إلى ال ايه؟ إلى الرئاتين فتتجهى وليش اي شي
+
+155
+00:12:14,580 --> 00:12:18,980
+لفوق ولا تحت ويمين وشمال فبتلتثق في ال mucus
+
+156
+00:12:18,980 --> 00:12:23,980
+membrane المنتشر في كل مكانتمام؟ غير كده في شعر في
+
+157
+00:12:23,980 --> 00:12:27,680
+باب الـ A بالأنف ال big particles هذه بيمسكها
+
+158
+00:12:27,680 --> 00:12:33,760
+الشعر الأصغر بتلزج وين؟ في الميوكاس من براين لحد
+
+159
+00:12:33,760 --> 00:12:39,480
+ال 6 مايكرون بيلزج في ال A يعني بدخلش على التراكية
+
+160
+00:12:39,480 --> 00:12:45,900
+إلى ال particles الحجمها أجل من 6 مايكرون تمام؟
+
+161
+00:12:45,900 --> 00:12:51,630
+لحظوا الهواء مدفع في التراكيةو اذا ادانا اتنين
+
+162
+00:12:51,630 --> 00:12:55,610
+main bronchi و ال main bronchi يدونا شوية
+
+163
+00:12:55,610 --> 00:13:00,230
+bronchioles بعدين كل bronchiole ادى بالدينى كان
+
+164
+00:13:00,230 --> 00:13:05,070
+ضخم جدا من ال .. اللي هو ال terminal bronchiole
+
+165
+00:13:05,070 --> 00:13:10,070
+تمام؟ حاجة و ستين الف terminal bronchiole فهذا
+
+166
+00:13:10,070 --> 00:13:16,290
+بيقدى الى انه ال space اللى الهوى كان ماشي فيه
+
+167
+00:13:16,290 --> 00:13:22,190
+فجأة وسعففجأة الهواء اللي جاء مدفع خف حركته بطء
+
+168
+00:13:22,190 --> 00:13:29,170
+البطء هذا بيقدر إلى أن الأشياء الثقيلة يصلها الـ
+
+169
+00:13:29,170 --> 00:13:33,810
+Gravitational precipitation هتهدي التيار فهذه
+
+170
+00:13:33,810 --> 00:13:38,890
+هتروح هتلزج هتهدأ و هتلزج في ميوكاسبنبرين of
+
+171
+00:13:38,890 --> 00:13:43,870
+البرونكيولز البرونكيولز هذه قطرها حوالي حجم و نص
+
+172
+00:13:43,870 --> 00:13:49,450
+مايكرونواحد و نص micrometer تمام؟ هذه ال terminal
+
+173
+00:13:49,450 --> 00:13:53,570
+واحد و نص micrometer و كل ما اعلينا لفوق شوية
+
+174
+00:13:53,570 --> 00:13:58,470
+بيوسعوا شوية قصدي اقول انا في مرحلة من المراحل انه
+
+175
+00:13:58,470 --> 00:14:03,630
+كمية ال .. ال .. ال broncular space اللي عندي صار
+
+176
+00:14:03,630 --> 00:14:07,790
+اكبر كتير من التركيا و من ال .. من ال broncules
+
+177
+00:14:07,790 --> 00:14:10,730
+فبقدر إلى ان الهواء .. التلاتة هواء بتهدأ في منطقة
+
+178
+00:14:10,730 --> 00:14:15,710
+معينة فبقدر إلى انه مايصلش ال alveoliمايصلش الـ
+
+179
+00:14:15,710 --> 00:14:20,570
+alveoli إلا اللي حجمه أقل من واحد micron يعني اللي
+
+180
+00:14:20,570 --> 00:14:23,430
+بين الخمسة والواحد بيكون لزج في الـ mucous
+
+181
+00:14:23,430 --> 00:14:27,470
+membrane تبع ال إيه؟ ال air passages مش ال .. ال
+
+182
+00:14:27,470 --> 00:14:31,590
+nose ال nose بيكون على ده بيصلش ال alveoli إلا
+
+183
+00:14:31,590 --> 00:14:35,970
+الأشي أقل من واحد إيه؟ micron ال particle تبعه طيب
+
+184
+00:14:35,970 --> 00:14:41,830
+الآن السؤال أنه هذا ال particles اللي واحد micron
+
+185
+00:14:41,830 --> 00:14:47,350
+في أقل من micronإذا هذه هتندفع و تخبط في الـmucous
+
+186
+00:14:47,350 --> 00:14:50,730
+membrane تبع مين؟ تبع الـalveoli و هتخش في
+
+187
+00:14:50,730 --> 00:14:53,950
+الـmucous membrane تبع الـalveoli تمام؟ by
+
+188
+00:14:53,950 --> 00:14:58,450
+diffusion، by إيش ماكان، by .. هذي شغلة
+
+189
+00:14:58,450 --> 00:15:02,770
+الـmacrophages الـalveoli wall، الـalveolar wall
+
+190
+00:15:02,770 --> 00:15:06,750
+فيها قولنا type I إبثيليوم و type II إبثيليوم، إيش
+
+191
+00:15:06,750 --> 00:15:13,340
+type II بصنع؟surfactant، نسيتوها انتوا، surfactant
+
+192
+00:15:13,340 --> 00:15:21,240
+surface acting agent، اه surfactant، طيب في كمان
+
+193
+00:15:21,240 --> 00:15:25,520
+عندي macro phages موجودة بين ال cells هذه بتهاجم
+
+194
+00:15:25,520 --> 00:15:28,420
+الموارد هذه وبتاخدها وبتنظف ال alveoli منها
+
+195
+00:15:28,420 --> 00:15:33,860
+الأشياء اللي أقل من نص مايكرون، في الغالب، خفيفة
+
+196
+00:15:34,110 --> 00:15:38,270
+بتخش و بتطلع مع ال ايه؟ مع الهواء بدون ما ايه يصير
+
+197
+00:15:38,270 --> 00:15:45,690
+لها precipitation لكن ال ال ال ال smoke particles
+
+198
+00:15:45,690 --> 00:15:54,800
+الدخان اه بنلاقيها point three micron تمامبتخش و
+
+199
+00:15:54,800 --> 00:15:58,280
+بتطلع لكن لو وجودها دي كتير تعمل reactions و أشياء
+
+200
+00:15:58,280 --> 00:16:02,200
+بعد كده مزعجة هتكلم عنها ان شاء الله بالتفصيل في
+
+201
+00:16:02,200 --> 00:16:06,000
+لما اتكلم عن الانفزيما اذا عندي انا هنا النوز هذا
+
+202
+00:16:06,000 --> 00:16:11,720
+مش معمول هيك مش بس زي اللوزة عشان ايه ننبسط لأ ما
+
+203
+00:16:11,720 --> 00:16:14,760
+بعد اللوزة اذا اللوزة هذه بتغير اتجاه لذا من هنا
+
+204
+00:16:14,760 --> 00:16:18,840
+عريض و من هنا برفع عشان اتجاه الهواء اللي داخل هيك
+
+205
+00:16:18,840 --> 00:16:22,580
+عود ايه يغير اتجاهه بيصطدم بال terminates
+
+206
+00:16:23,140 --> 00:16:28,320
+Turbulence تربين تربين تربين تربين تربين تربين
+
+207
+00:16:28,320 --> 00:16:31,540
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+208
+00:16:31,540 --> 00:16:36,040
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+209
+00:16:36,040 --> 00:16:38,640
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+210
+00:16:38,640 --> 00:16:40,700
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+211
+00:16:40,700 --> 00:16:45,760
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+212
+00:16:45,760 --> 00:16:50,800
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+213
+00:16:50,800 --> 00:16:51,920
+تربين
+
+214
+00:16:55,220 --> 00:17:03,200
+البرونج فيولز لهم تنقية بشكل تاني ال
+
+215
+00:17:03,200 --> 00:17:15,820
+ال ال ال ال ال ال ال ال
+
+216
+00:17:15,820 --> 00:17:15,880
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+217
+00:17:15,880 --> 00:17:15,940
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+218
+00:17:15,940 --> 00:17:16,140
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+219
+00:17:16,140 --> 00:17:16,320
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+220
+00:17:16,320 --> 00:17:16,340
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+221
+00:17:16,340 --> 00:17:21,250
+ال ال ال ال ال ال ال النفس الحرارة والفهراء
+
+222
+00:17:21,250 --> 00:17:25,650
+والفهراء هي ال difference بس جداش الفهراء يعني
+
+223
+00:17:25,650 --> 00:17:30,230
+بالنسبة لل centigrade جزء
+
+224
+00:17:30,230 --> 00:17:37,590
+منها تمام؟ اذا ال humidification هتلاقي الهواء
+
+225
+00:17:37,590 --> 00:17:43,550
+ترتب ترطيب مشبع اتنين الى تلاتة في المية اقل من
+
+226
+00:17:43,550 --> 00:17:47,910
+التشبع اتنين الى تلاتة في المية اقل من ايه؟highly
+
+227
+00:17:47,910 --> 00:17:51,990
+humidified
+
+228
+00:17:51,990 --> 00:17:55,990
+بالنسبة
+
+229
+00:17:55,990 --> 00:18:00,310
+للـ particles احنا ايه هنتكلم عنها بالتفصيل
+
+230
+00:18:00,310 --> 00:18:05,450
+اتكلمنا
+
+231
+00:18:05,450 --> 00:18:09,930
+عن ال nose و ال size of particles هنا و قولنا انه
+
+232
+00:18:09,930 --> 00:18:15,970
+عندي ال particles الكبيرة ال particles أكتر من 6
+
+233
+00:18:15,970 --> 00:18:20,530
+مايكرونأو يعني أكتر من خمسة لحد الستة خلص منها
+
+234
+00:18:20,530 --> 00:18:24,570
+النوز من البرونكولات المتبقية، الكثير منهم بين
+
+235
+00:18:24,570 --> 00:18:29,870
+واحد إلى خمس ميكرومتر تقع في البرونكولات الصينية
+
+236
+00:18:29,870 --> 00:18:30,490
+الصينية الصينية الصينية صينية صينية صينية صينية
+
+237
+00:18:30,490 --> 00:18:30,810
+صينية صينية صينية صينية صينية صينية صينية صينية
+
+238
+00:18:30,810 --> 00:18:41,830
+صينية صينية صينية صينية صينية صينية صينية
+
+239
+00:18:41,830 --> 00:18:43,050
+صينية صينية صينية صينية صينية صينية صينية صينية
+
+240
+00:18:43,050 --> 00:18:44,990
+صينية صينية صينية صينية صينية صينية صينية صينية
+
+241
+00:18:44,990 --> 00:18:49,090
+صينية صينية صينية صينية صينيةand many armies طيب
+
+242
+00:18:49,090 --> 00:18:54,550
+ماشي vocalization
+
+243
+00:18:54,550 --> 00:18:58,730
+إذا إنه الجزء الأخير إذا كانوا humidification و
+
+244
+00:18:58,730 --> 00:19:07,190
+filtration اتكلمنا عنها و humidification طيب إذا
+
+245
+00:19:07,190 --> 00:19:10,010
+filtration و humidification و warming ال warming
+
+246
+00:19:10,010 --> 00:19:15,510
+موجود بالإضافة لنزل ال space هذاعنا الـ nasal
+
+247
+00:19:15,510 --> 00:19:19,750
+sinuses تستخدم في الـ warming of the air بالإضافة
+
+248
+00:19:19,750 --> 00:19:24,550
+لإنها إلها دور في ال .. في ال .. في ال speech
+
+249
+00:19:24,550 --> 00:19:27,850
+تبعنا ال speech إحنا بنفسنا موحش تاني ال speech
+
+250
+00:19:27,850 --> 00:19:35,770
+عندنا phonation و .. و articulation and resonance
+
+251
+00:19:35,770 --> 00:19:42,410
+phonation اللي هو الصوت اللي بطلع اللي متعلق بصوت
+
+252
+00:19:42,410 --> 00:19:49,430
+شديدرفيع، رخيم، خشن، ماعرفش إيش هذه كلها مسؤولة
+
+253
+00:19:49,430 --> 00:19:53,710
+من؟ الـ vocal cords أما الـ articulation التفصيل
+
+254
+00:19:53,710 --> 00:19:57,690
+والمخارج، اتكلمنا عنها أما عن ال resonance ال
+
+255
+00:19:57,690 --> 00:20:03,090
+resonance إن الهواء يمر في طبل في مناطق تعمل صوت
+
+256
+00:20:03,090 --> 00:20:08,370
+طبل الجيوب الأنفية بتدينه الصوت اللي هو لما أحنا
+
+257
+00:20:08,370 --> 00:20:12,830
+بنبقى مرشحين ومسكرة الجيوب الأنفية من حد ما الواحد
+
+258
+00:20:12,830 --> 00:20:16,180
+يتكلمأول كلمة كيف حالك يا ديمة؟ مالك سلامتك؟ إيش
+
+259
+00:20:16,180 --> 00:20:20,940
+فيه؟ كيف عرفت إنه عندها .. من الصوت عرفت إنه في
+
+260
+00:20:20,940 --> 00:20:24,780
+عندها رشح لإنه بيسكروا ال nasal sinuses فالصوت
+
+261
+00:20:24,780 --> 00:20:29,040
+بتغير تماما فالصوت هذا اللي بيتميز ال resonance زي
+
+262
+00:20:29,040 --> 00:20:31,880
+ما الصوت راح ال resonance الفرغات اللي .. اللي
+
+263
+00:20:31,880 --> 00:20:35,880
+بيمشي فيها الصوت بتدلوا الرنين هذا ال .. ال nasal
+
+264
+00:20:35,880 --> 00:20:39,960
+sinuses ال mouth نفسه إنه في عندى mouth أنا موجود
+
+265
+00:20:40,160 --> 00:20:45,360
+تمام؟ ضخم؟ كبير هيك؟ بدي صوت؟ الريقات .. نفسهم
+
+266
+00:20:45,360 --> 00:20:52,160
+تمام؟ أبحاب بيطلع الصوت منهم .. من الحنجرة و كده
+
+267
+00:20:52,160 --> 00:20:57,520
+هذه الفرق .. مساحات بيمشيها الصوت بتديله رخامة
+
+268
+00:20:57,520 --> 00:21:01,200
+بتديله resonance ال articulation اللي بتعمل من
+
+269
+00:21:01,200 --> 00:21:07,320
+خلال الحلق و ال soft palate و اللبس و ال tongue
+
+270
+00:21:07,320 --> 00:21:12,600
+بتعمل إيه؟ اللي هو مخارجو أحرف و تشكل و تغير و
+
+271
+00:21:12,600 --> 00:21:16,760
+تعمل سواء اما ال phonation نفسه ال vocal cords
+
+272
+00:21:16,760 --> 00:21:21,600
+هدول طبعا ان فيهم اسمهم vocal folds أساسا اسم ايش؟
+
+273
+00:21:21,600 --> 00:21:25,900
+vocal folds لإنه طيهان و طيهان ع ال vocal cords في
+
+274
+00:21:25,900 --> 00:21:28,580
+ال .. في ال lyrics طيه واحدة يعني ان ال vocal
+
+275
+00:21:28,580 --> 00:21:32,970
+cords مش ألف ولا ميةهم تنين لكن انهم مشبوكة منهم
+
+276
+00:21:32,970 --> 00:21:39,570
+مجموعة من ال .. هم شبكين في الغضاريف الحنجرة بس
+
+277
+00:21:39,570 --> 00:21:44,090
+الغضاريف هذه مشبوكة بمجموعة من العضلات بتشد ع
+
+278
+00:21:44,090 --> 00:21:47,590
+vocal cords تمام؟ بيخلي عندي أنا أصوات ال
+
+279
+00:21:47,590 --> 00:21:51,970
+phonation عملية ال phonation اللي بالتم تمام؟ إذا
+
+280
+00:21:51,970 --> 00:21:58,390
+هذا بالنسبة لفوائد أخرى غير تنفسية بالنسبة لمين؟ ل
+
+281
+00:21:58,390 --> 00:21:59,090
+.. ال ..
+
+282
+00:22:02,910 --> 00:22:08,630
+الإجهاز التنفسي ما هو باسمه the functions of the
+
+283
+00:22:08,630 --> 00:22:15,250
+nose نرجع تاني لأشياء انا رطيتها شوية عشان ايه
+
+284
+00:22:15,250 --> 00:22:26,870
+نكمل الموضوع ان احنا غير ربع ساعة اعتقد الان
+
+285
+00:22:26,870 --> 00:22:31,090
+عندي انا هنا respiratory passages عندي اتراكية
+
+286
+00:22:31,520 --> 00:22:37,000
+supported بال .. بال .. ال .. ال cartidges ال C
+
+287
+00:22:37,000 --> 00:22:42,020
+shape او ال U shape cartidges مش كده؟ ال .. كل ما
+
+288
+00:22:42,020 --> 00:22:48,160
+نزلنا لتحت بنصل .. بنصل ل .. بيقل ال cartidges
+
+289
+00:22:48,530 --> 00:22:54,250
+وبيزيد محل ال cartilage more muscular tissue لدرجة
+
+290
+00:22:54,250 --> 00:23:00,530
+انه عندنا في ال ال bronchioles the bronchioles are
+
+291
+00:23:00,530 --> 00:23:04,830
+not present plates the plates are not present اللي
+
+292
+00:23:04,830 --> 00:23:07,330
+هو ال cartilage plates in the bronchioles وماكنش
+
+293
+00:23:07,330 --> 00:23:10,830
+بقدر اقول انا وصلت ل bronchiole لما يكون عندى ايه
+
+294
+00:23:10,830 --> 00:23:14,620
+بطل فيه cartilageأنا جاب ال .. ال bronchiol في
+
+295
+00:23:14,620 --> 00:23:17,580
+عندى bronchi بتصغر ال bronchiol أصلا بس طول ما
+
+296
+00:23:17,580 --> 00:23:20,600
+فيها supported by cartilage ال bronchiol .. بين ال
+
+297
+00:23:20,600 --> 00:23:24,140
+cartilage موجود fibrostitious و muscles لكن لما
+
+298
+00:23:24,140 --> 00:23:27,280
+أخش على ال bronchiols أنا لجيت just fibrostitious
+
+299
+00:23:27,280 --> 00:23:32,020
+و muscles من غير إيه؟ طب كيف يبقى الفاتحة؟ اللي
+
+300
+00:23:32,020 --> 00:23:35,080
+بفتح القلبي الله بفتحها ال negative pressure اللي
+
+301
+00:23:35,080 --> 00:23:38,840
+موجود براها لشددها ال compliance تبع ال .. ال ..
+
+302
+00:23:38,840 --> 00:23:41,940
+ال elasticity تبع ال tissuesتبعت ال lung فتحها
+
+303
+00:23:41,940 --> 00:23:46,920
+شدها muscular
+
+304
+00:23:46,920 --> 00:23:50,820
+wall of the bronchi اتكلمت عنه ال respirator ال
+
+305
+00:23:50,820 --> 00:23:53,800
+bronchioles ال respirator ال bronchioles which are
+
+306
+00:23:53,800 --> 00:23:57,540
+هنا بعد ال bronchioles اتكلمت عنها مافيش فيها
+
+307
+00:23:57,540 --> 00:24:02,100
+كارتش اتجدت ال respirator ال bronchioles فيها ..
+
+308
+00:24:02,100 --> 00:24:07,380
+عندنا ابيثيليام شبيه بال alveolar ابيثيليام لكن
+
+309
+00:24:07,380 --> 00:24:11,280
+مافيش عندي انا ايه فيه muscular tissue كتيرالخاص
+
+310
+00:24:11,280 --> 00:24:16,120
+بنا فيبراس و بعض البرونكيوز البرونكيوز البرونكيوز
+
+311
+00:24:16,120 --> 00:24:20,340
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+312
+00:24:20,340 --> 00:24:21,300
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+313
+00:24:21,300 --> 00:24:23,120
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+314
+00:24:23,120 --> 00:24:23,140
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+315
+00:24:23,140 --> 00:24:23,200
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+316
+00:24:23,200 --> 00:24:23,480
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+317
+00:24:23,480 --> 00:24:31,200
+البرونكيوز البرونكيوز البرونكيوز
+
+318
+00:24:31,200 --> 00:24:31,560
+البر
+
+319
+00:24:34,260 --> 00:24:39,740
+ممكن يكون عندى انا يعني هو المعظم المشاكل ال
+
+320
+00:24:39,740 --> 00:24:42,560
+diseases في الريقتين انهم يعملوا ايه انهم يعملوا
+
+321
+00:24:42,560 --> 00:24:45,800
+destruction او narrowing هتكلم عن الانفيزيام اللى
+
+322
+00:24:45,800 --> 00:24:47,800
+بتعمل destruction وعن ال bronchial asthma اللى
+
+323
+00:24:47,800 --> 00:24:52,920
+بتعمل ايه narrowing اللى عندى اذا الآن صار عندى
+
+324
+00:24:52,920 --> 00:24:57,740
+bronchioles ممكن تنسد فيها mucus يمكن يصير فيها
+
+325
+00:24:57,740 --> 00:25:02,950
+اديمة تديج ممكن muscle spasmيعني تلت حاجات تعمل
+
+326
+00:25:02,950 --> 00:25:06,430
+الـ Narrowing of the A، البرونكال تري، يا إما plug
+
+327
+00:25:06,430 --> 00:25:09,950
+of mucous، الصد، إفرازات، صدّة ال .. ال .. ال
+
+328
+00:25:09,950 --> 00:25:14,630
+human، يا إما إديمة في ال wall، ورميل ال إيه؟ ال
+
+329
+00:25:14,630 --> 00:25:17,630
+.. ال .. ال cartilages الصغيرة أو اللي هو ال
+
+330
+00:25:17,630 --> 00:25:20,270
+terminal البرونكوليزي اللي هي mainly muscular،
+
+331
+00:25:20,270 --> 00:25:24,110
+هتعمل spasm، فهذا بيقديلي إلى ال إيه؟ لذلك ال
+
+332
+00:25:24,110 --> 00:25:26,750
+resistance، احنا وين بنلاقي resistance أكتر إشي؟
+
+333
+00:25:26,750 --> 00:25:34,860
+ال resistance بنلاقيها أكترفي مهاية البرونكاي و
+
+334
+00:25:34,860 --> 00:25:40,540
+أول البرونكيولز مهاية البرونكاي و أول البرونكيولز
+
+335
+00:25:40,540 --> 00:25:44,400
+لإن إذا دخلنا على البرونكيولز إحنا بربر هنلاقي
+
+336
+00:25:44,400 --> 00:25:51,580
+عندنا إيه متسع ضخم إذا
+
+337
+00:25:51,580 --> 00:25:59,900
+الهواء اللي داخل الرئاتين هذا بدخل من نوز واسع إلى
+
+338
+00:26:00,410 --> 00:26:05,530
+لارينكس إلى تركيا إلى برونكاى تتفرع main و
+
+339
+00:26:05,530 --> 00:26:09,050
+branching برونكاى وبعدين بتفقد ال cartilage تبقى
+
+340
+00:26:09,050 --> 00:26:11,670
+حابسي البرونكيول بس بعد ما نخش البرونكيول ال
+
+341
+00:26:11,670 --> 00:26:15,970
+resistance بتروح ليش؟ لإنه صار عندى 65 ألف
+
+342
+00:26:15,970 --> 00:26:21,590
+برونكيول مقابل المجموعة القليلة من ال .. من ال ..
+
+343
+00:26:21,590 --> 00:26:25,130
+البرونكاى فبيقدر إلى ان ال low resistance اللي فات
+
+344
+00:26:25,130 --> 00:26:33,730
+فاتنزل ضغط الهواء المندفع خلّي الهواء يهدوروك انه
+
+345
+00:26:33,730 --> 00:26:37,090
+بيصل .. خلّي الهواء يصل لل .. لل ال alveoli مش
+
+346
+00:26:37,090 --> 00:26:42,710
+مندفع حتى ما يجرح ال ايه ال alveoli هادي اللي أشبه
+
+347
+00:26:42,710 --> 00:26:47,570
+بال .. بال cellophane membrane الرقيق تمام؟ اللي
+
+348
+00:26:47,570 --> 00:26:53,990
+أجل شيء بي .. بيمزعه اذا عندي resistance في
+
+349
+00:26:53,990 --> 00:27:00,010
+المنطقة هذه لكن عندي bronchiolesأضيق واحد و نصف
+
+350
+00:27:00,010 --> 00:27:04,650
+مليمتر broncules وفيها muscles يعني من العملية
+
+351
+00:27:04,650 --> 00:27:07,630
+اللي كلمنا عنها من شوية الضيق هذا بيقدر أي ميكا
+
+352
+00:27:07,630 --> 00:27:13,250
+تسكرها اي spasm يسكرها اذا ممكن يصير عندي ال ال ال
+
+353
+00:27:13,250 --> 00:27:16,670
+ال ال diseases اكتر تيجي من ايه؟ من ال small
+
+354
+00:27:16,670 --> 00:27:19,950
+broncules هذه لأنه بيصير فيها ال spasm بيصير فيها
+
+355
+00:27:19,950 --> 00:27:23,970
+الضيقة ال secretions بتسكرها القديمة ابتحفيها
+
+356
+00:27:23,970 --> 00:27:29,410
+نهائيالـ lungs هذه الـ system هذا فيه nerve
+
+357
+00:27:29,410 --> 00:27:31,790
+supply؟ أه فيه nerve supply في عندى sympathetic؟
+
+358
+00:27:31,790 --> 00:27:35,790
+okay فيه sympathetic على ال outer of the lung لكن
+
+359
+00:27:35,790 --> 00:27:39,270
+inside deep in the .. in the .. deep in the .. in
+
+360
+00:27:39,270 --> 00:27:42,350
+the lung there is no sympathetic stimulation لكن
+
+361
+00:27:42,350 --> 00:27:45,070
+ال non-adrenaline و ال adrenaline بيصلوا لل lung
+
+362
+00:27:45,070 --> 00:27:49,790
+اللي جايين من وين؟ من السبردينة المضلة تمام؟ مش
+
+363
+00:27:49,790 --> 00:27:53,190
+محتاجين أنه ال sympathetic stimulation تيجي by the
+
+364
+00:27:53,190 --> 00:27:56,910
+nerves themselvesلكن ال .. ال chemical اللي بتطلع
+
+365
+00:27:56,910 --> 00:28:02,130
+اللي هو ايه ال chemical transmitter تبعت ال .. ال
+
+366
+00:28:02,130 --> 00:28:06,090
+.. sympathetic nerve system اللي هي ال
+
+367
+00:28:06,090 --> 00:28:08,850
+noradrenaline و norepinephrine و ال epinephrine
+
+368
+00:28:08,850 --> 00:28:13,630
+هدول بيمشوا في الدم بيصلوا يعني اللي هم تأثير فيه
+
+369
+00:28:13,630 --> 00:28:17,350
+receptors موجودة تستجيب لمين ل ال adrenergic
+
+370
+00:28:17,350 --> 00:28:22,060
+stimuliالـ nerve endings أفسها جليلة في داخل ال ..
+
+371
+00:28:22,060 --> 00:28:25,000
+ال .. ال lung لكن في عند ال receptors تستجيب
+
+372
+00:28:25,000 --> 00:28:27,980
+للادرينالين والنورادرينالين السيمباتاتيك ماكنتش
+
+373
+00:28:27,980 --> 00:28:31,620
+بتطلع فوق الطوارئ و فوق الطوارئ أنا محتاج نفس أكتر
+
+374
+00:28:31,620 --> 00:28:35,040
+فالادرينال أكتر فال bronchi بتوسع و ال bronchi
+
+375
+00:28:35,040 --> 00:28:38,760
+بتوسع و النفس بيصير إيه؟ بيصير أكتر أخش نفس و أطلع
+
+376
+00:28:38,760 --> 00:28:42,020
+بيدين السيمباتاتيك استعداد بس مش by its nerve
+
+377
+00:28:42,020 --> 00:28:45,280
+terminal directly لكن عبر مين؟ mainly عبر
+
+378
+00:28:45,280 --> 00:28:49,660
+السبرانين الادرينالين تمام؟ إذا ال simulation ها
+
+379
+00:28:49,910 --> 00:28:51,570
+بيمنع ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+380
+00:28:51,570 --> 00:28:52,130
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+381
+00:28:52,130 --> 00:28:54,730
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+382
+00:28:54,730 --> 00:28:55,370
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+383
+00:28:55,370 --> 00:28:58,550
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+384
+00:28:58,550 --> 00:28:59,050
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+385
+00:28:59,050 --> 00:28:59,990
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+386
+00:28:59,990 --> 00:29:01,470
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+387
+00:29:01,470 --> 00:29:05,090
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+388
+00:29:05,090 --> 00:29:09,990
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+389
+00:29:14,220 --> 00:29:16,560
+عملوا irritation، ال irritation هدا بيعمل
+
+390
+00:29:16,560 --> 00:29:19,220
+inflammatory process، إيديما و plugs و secretions
+
+391
+00:29:19,220 --> 00:29:23,620
+و تسديد و فوق هيك و هيك و هيك، بيتنكد و بتطرب و
+
+392
+00:29:23,620 --> 00:29:26,620
+بيعمل كمان super imposed بيجينا عنده بارا
+
+393
+00:29:26,620 --> 00:29:29,440
+sympathetic stimulation، بيعمل ال spasm كمان لمين؟
+
+394
+00:29:29,440 --> 00:29:32,620
+للمuscles، تمام؟ فال sympathetic .. بارا
+
+395
+00:29:32,620 --> 00:29:35,480
+sympathetic بينكد على الإنسان من ناحية رقتين، لأنه
+
+396
+00:29:35,480 --> 00:29:38,600
+بيعمل ال spasm فوق الهم الأساسي اللي هو ال
+
+397
+00:29:38,600 --> 00:29:41,880
+irritation اللي عملت لل plugs و عملت للإيديما و
+
+398
+00:29:41,880 --> 00:29:47,000
+عملت لمشاكلالبرا السيمباتاتيك منتشر في كل مكان
+
+399
+00:29:47,000 --> 00:29:51,820
+more penetrating لل .. لل .. لل lungs مش زي
+
+400
+00:29:51,820 --> 00:29:57,660
+السيمباتاتيك لكنه تأثيره هنا سلبي عكس ال .. ال GIT
+
+401
+00:29:57,660 --> 00:30:00,300
+اتكلمنا ولا ما .. انا عارف اتكلمنا ولا لأ؟
+
+402
+00:30:00,300 --> 00:30:03,100
+اتكلمناش معاكوا لسه عن ال GIT اه البرا
+
+403
+00:30:03,100 --> 00:30:06,020
+السيمباتاتيك هان بيعمل narrowing و خاصة إذا صار
+
+404
+00:30:06,020 --> 00:30:09,860
+فيه spasm السيمباتاتيك لأبيفتح للريقتين بيجلل
+
+405
+00:30:09,860 --> 00:30:15,240
+الإديمة الموجودة بيمنع ال .. ال .. ال narrowing في
+
+406
+00:30:15,240 --> 00:30:19,360
+ال .. في ال respiratory بيديني more ability to ..
+
+407
+00:30:19,360 --> 00:30:23,080
+to .. to have more air and more oxygen وهذا طبيعي
+
+408
+00:30:23,080 --> 00:30:27,680
+جدا أنه في ال sympathetic تبع الطوارئ أنه يديني ال
+
+409
+00:30:27,680 --> 00:30:34,920
+fuel اللي لازمنا لمين الطوارئ هو ال oxygen ال
+
+410
+00:30:34,920 --> 00:30:38,910
+.. هنا عندناالـ local secretory factors often
+
+411
+00:30:38,910 --> 00:30:42,150
+cause bronchial constriction لما يصير antigen
+
+412
+00:30:42,150 --> 00:30:44,710
+antibody reaction أو irritation by any substance
+
+413
+00:30:44,710 --> 00:30:48,710
+بنلاقي إحنا عندنا فيه mast cells بتتفجر و بتطلعلي
+
+414
+00:30:48,710 --> 00:30:53,210
+هستامين أو slow reactive substance of anaphylaxis
+
+415
+00:30:53,210 --> 00:30:57,250
+هدول المواد الكيميائية بتقدّي إلى الإديمة و إلى ال
+
+416
+00:30:57,250 --> 00:31:00,770
+narrowing و إلى ال spasm و إلى المشاكل اللي بتصير
+
+417
+00:31:00,770 --> 00:31:04,630
+دائما بتصير أيضا irritation للrespiratory tract
+
+418
+00:31:04,890 --> 00:31:08,590
+بتقدي إلى أن ال muscles تنفجر و بتقدي إلى إيه؟
+
+419
+00:31:08,590 --> 00:31:13,610
+خروج الهستامين بيعمللي ال picture of أزمة
+
+420
+00:31:13,610 --> 00:31:18,930
+narrowing و secretions كتيرة تمام؟ و slow reactive
+
+421
+00:31:18,930 --> 00:31:24,230
+substance as well ميوكاس
+
+422
+00:31:24,230 --> 00:31:27,850
+lining of the ال ميوكاس تبع ال bronchial tree
+
+423
+00:31:27,850 --> 00:31:32,210
+موجود في اتجاه الحلق فتحت ال phalanx بتدور في
+
+424
+00:31:32,210 --> 00:31:36,510
+اتجاه ال phalanx بتمشيوفي ال nose بتعمل تجاه عكسي
+
+425
+00:31:36,510 --> 00:31:40,490
+مش كده تصوروا لو اطلح بطاة الماء اللي كان ال mucus
+
+426
+00:31:40,490 --> 00:31:43,870
+كله بتنزل ايه على ال ايه على ال alveoli تسكرها لكن
+
+427
+00:31:43,870 --> 00:31:48,330
+عند ال alveoli كله بتطلع لفوق وعند ال nose بتطلع
+
+428
+00:31:48,330 --> 00:31:54,410
+من نفسي لتحت كله في تهمين في اتجاه بحيث ان احنا
+
+429
+00:31:54,410 --> 00:31:59,390
+جاعدين عدة مرات غيرنا mucus لكن مبلعوا بسهولة من
+
+430
+00:31:59,390 --> 00:32:03,600
+غير ما نحس فيه وانتش احنا ما نحس ان في مشكلةلما
+
+431
+00:32:03,600 --> 00:32:08,440
+يصير ال secretions اكتر من اللازم فبتصير تحس انه
+
+432
+00:32:08,440 --> 00:32:17,720
+فيه mucus بده يطلع او بده او بده طيب
+
+433
+00:32:17,720 --> 00:32:22,340
+ال cough reflex و sneezing اخر اشي بده اقولهم ال
+
+434
+00:32:22,340 --> 00:32:26,080
+coughing مش cough هو cough ال cough reflex vocal
+
+435
+00:32:26,080 --> 00:32:30,060
+cords irritation تحت ال ايه ال vocal cords بيصير
+
+436
+00:32:30,060 --> 00:32:32,660
+ال simulation ل ال afferent nerves of the vagus
+
+437
+00:32:33,740 --> 00:32:37,720
+تمام؟ بيرجعلي إشارة تعملي ال cuff اللي هي عبارة عن
+
+438
+00:32:37,720 --> 00:32:41,460
+إيش؟ عبارة عن أنه أنا أسكر ال .. ال .. ال .. ال ..
+
+439
+00:32:41,460 --> 00:32:44,020
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+440
+00:32:44,020 --> 00:32:46,660
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+441
+00:32:46,660 --> 00:32:46,680
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+442
+00:32:46,680 --> 00:32:46,800
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+443
+00:32:46,800 --> 00:32:47,000
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+444
+00:32:47,000 --> 00:32:47,080
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+445
+00:32:47,080 --> 00:32:47,220
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+446
+00:32:47,220 --> 00:32:47,880
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+447
+00:32:47,880 --> 00:32:48,140
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+448
+00:32:48,140 --> 00:32:48,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+449
+00:32:48,220 --> 00:32:52,750
+ال .. ال .. ال ..الـ intercostal muscles بتشد الـ
+
+450
+00:32:52,750 --> 00:32:57,050
+muscles of expiration بتشد بيعلق عند الضغط في داخل
+
+451
+00:32:57,050 --> 00:33:02,770
+الرئتين بعدين فجأة بيفتح الابوجلوتس كل شي بتطلع
+
+452
+00:33:02,770 --> 00:33:07,770
+على شكل كحة ده نفس مندفع قد يصل سرعته لسبعين ميل
+
+453
+00:33:07,770 --> 00:33:13,510
+في الساعة مندفع جدا تمام؟ سبعين ميل في الساعة
+
+454
+00:33:13,510 --> 00:33:18,950
+بيقدر إلى أنه وأنا بأضغط جاعدكمان ال ميوكاس او
+
+455
+00:33:18,950 --> 00:33:22,270
+الابيثيليام اللى بين ال .. ال cartridge rings
+
+456
+00:33:22,270 --> 00:33:27,850
+الريقتين بتندفع هذه المناطق الى ال human تمام؟ لما
+
+457
+00:33:27,850 --> 00:33:30,470
+تضغط عليها منبرة هي طارية بتخش لجوة هذا بيقدي
+
+458
+00:33:30,470 --> 00:33:33,450
+الأشياء اللى موجودة في ال slit sand اللى مخبية
+
+459
+00:33:33,450 --> 00:33:39,010
+كمان مع ضغط تتسير في اتجاه الهواء بحيث انه اي حاجة
+
+460
+00:33:39,010 --> 00:33:44,430
+غريبة تاخدها ال ايه؟ الاندفاع ال .. الطيار هواوي
+
+461
+00:33:45,270 --> 00:33:49,670
+الـ sneezing الـ irritation بيكون وين؟ في ال .. أه
+
+462
+00:33:49,670 --> 00:33:52,550
+above في ال nose فهذا بيقدر إلى نفس ال picture
+
+463
+00:33:52,550 --> 00:33:59,890
+لكنه عندى كمان ال .. ال .. أثناء بعمل ضغطي على
+
+464
+00:33:59,890 --> 00:34:04,850
+اليوغيولا بتنزل لتحتاللي هو soft palate بينزل لتحت
+
+465
+00:34:04,850 --> 00:34:08,170
+في اتجاه الثوم بيخلي انه الهواء اللي .. اللي اندفع
+
+466
+00:34:08,170 --> 00:34:11,550
+من التراكية ساعت مال إيه بو جلوتس فاتح انه مش يطلع
+
+467
+00:34:11,550 --> 00:34:14,510
+من الثوم يطلع من ال إيه؟ من الأنف لإن هو ده
+
+468
+00:34:14,510 --> 00:34:18,490
+الطريقة فبيقدر إلى تنظيف ال .. الأنف من ال إيه؟ من
+
+469
+00:34:18,490 --> 00:34:24,870
+any foreign material ال .. ال nasal ال reflex تبع
+
+470
+00:34:24,870 --> 00:34:28,970
+ال .. ال .. ال sneezing الafferent تبعه trigeminal
+
+471
+00:34:28,970 --> 00:34:33,220
+ال efferent الفيجل هو هوال .. ال .. ال .. قفنج
+
+472
+00:34:33,220 --> 00:34:37,380
+الأفرن تماميين الفيجل نفسه وال إفران الفيجل
+
+473
+00:34:37,380 --> 00:34:42,680
+الجهتين إذا عندي steps هنا اتنين و نص لتر من
+
+474
+00:34:42,680 --> 00:34:46,960
+الهواء بناخد نفس غميق بعدين بيسكر بعدين بيزيد
+
+475
+00:34:46,960 --> 00:34:50,300
+الضغط بعدين إيه؟ بندفع اتنين و نص لتر rapidly
+
+476
+00:34:50,300 --> 00:34:54,560
+inspired the epiglottis closes أبضومنا ال muscles
+
+477
+00:34:54,560 --> 00:34:57,580
+contract forcefully مش بس هم و كل ال expiratory
+
+478
+00:34:57,580 --> 00:35:02,430
+muscles بتضغط forcefully بعدينfourth the vocal
+
+479
+00:35:02,430 --> 00:35:05,850
+cords and the magrut is suddenly open widely هو
+
+480
+00:35:05,850 --> 00:35:11,550
+ايه؟ بيندفع الهواء بسرعة سبعين الى ميت mile بال
+
+481
+00:35:11,550 --> 00:35:14,310
+ايه؟ mile يعني يضربوا في اتنين point four في one
+
+482
+00:35:14,310 --> 00:35:19,010
+point six ال mile في one point six four اظن فسرعة
+
+483
+00:35:19,010 --> 00:35:24,310
+ايه رهيبة بتنط ال ال متين كيلو متر في الساعة تمام؟
+
+484
+00:35:24,310 --> 00:35:31,120
+وها كذا بنكون احنا ايه؟اتكلمنا عن الفصل الأول
+
+485
+00:35:31,120 --> 00:35:34,120
+خلصنا ال functions المختلفة هذه اللي بيساعدنا في
+
+486
+00:35:34,120 --> 00:35:36,680
+ال respiration و الله يعطيكوا العافية و مين اللي
+
+487
+00:35:36,680 --> 00:35:37,340
+هالسؤال؟
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..067464d31dea40d66b64227b26aa4d9fc0ecd348
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3350, "start": 5.82, "end": 33.5, "text": "تلج حسب الظروف المختلفة لما بيدخل على الرئاتين يدخل حسب على ال .. يصير ال alveoli ال دقيقة هادية مايصارش تلج و إلا حيصير جوا cracks و هنخش في إيه؟ احنا بس نبرد ثواني كنا رشحنا أو حالتنا حالة فمابالك لو كان المسألة هادى دائما احنا معرضين للهواء الخارجى الرئاتين ال alveoli مش معرضين للهواء الخارجى بيصير عاملين تدفع إذا هدي .. إذا صار عندي حاجتين", "tokens": [2655, 1211, 7435, 11331, 35457, 6024, 116, 32887, 5172, 9673, 46456, 46538, 3660, 5296, 15042, 4724, 25708, 9778, 1211, 15844, 34892, 19986, 9307, 9957, 7251, 3215, 9778, 1211, 11331, 35457, 15844, 2423, 4386, 7251, 9381, 13546, 2423, 419, 303, 9384, 2423, 11778, 38436, 28671, 8032, 18513, 10632, 19446, 1829, 9381, 9640, 8592, 6055, 1211, 7435, 4032, 11933, 15040, 11331, 1829, 9381, 13546, 10874, 14407, 21770, 4032, 8032, 1863, 9778, 8592, 8978, 11933, 1829, 3224, 22807, 1975, 5016, 8315, 4724, 3794, 8717, 26890, 3215, 38637, 2407, 7649, 1829, 9122, 8315, 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functions المختلفة هذه اللي بيساعدنا في ال respiration و الله يعطيكوا العافية و مين اللي هالسؤال؟", "tokens": [9307, 4117, 19528, 8315, 18871, 27188, 36520, 16247, 12610, 16490, 1211, 9381, 8315, 2423, 6828, 9673, 46456, 46538, 3660, 29538, 13672, 1829, 4724, 1829, 3794, 995, 22488, 8315, 8978, 2423, 1597, 7611, 4032, 21984, 37495, 9566, 1829, 4117, 14407, 18863, 31845, 10632, 4032, 3714, 9957, 13672, 1829, 8032, 6027, 3794, 33604, 6027, 22807], "avg_logprob": -0.2002314762384803, "compression_ratio": 1.4662162162162162, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 2128.7000000000003, "end": 2129.44, "word": "اتكلمنا", "probability": 0.8660888671875}, {"start": 2129.44, "end": 2129.72, "word": " عن", "probability": 0.9970703125}, {"start": 2129.72, "end": 2130.76, "word": " الفصل", "probability": 0.6689453125}, {"start": 2130.76, "end": 2131.12, "word": " الأول", "probability": 0.908447265625}, {"start": 2131.12, "end": 2131.76, "word": " خلصنا", "probability": 0.9119873046875}, {"start": 2131.76, "end": 2132.18, "word": " ال", "probability": 0.984375}, {"start": 2132.18, "end": 2132.62, "word": " functions", "probability": 0.82080078125}, {"start": 2132.62, "end": 2133.32, "word": " المختلفة", "probability": 0.9910888671875}, {"start": 2133.32, "end": 2133.5, "word": " هذه", "probability": 0.60888671875}, {"start": 2133.5, "end": 2133.6, "word": " اللي", "probability": 0.924560546875}, {"start": 2133.6, "end": 2134.02, "word": " بيساعدنا", "probability": 0.8142903645833334}, {"start": 2134.02, "end": 2134.12, "word": " في", "probability": 0.904296875}, {"start": 2134.12, "end": 2134.14, "word": " ال", "probability": 0.89404296875}, {"start": 2134.14, "end": 2134.72, "word": " respiration", "probability": 0.7054443359375}, {"start": 2134.72, "end": 2135.48, "word": " و", "probability": 0.5478515625}, {"start": 2135.48, "end": 2135.62, "word": " الله", "probability": 0.93310546875}, {"start": 2135.62, "end": 2135.96, "word": " يعطيكوا", "probability": 0.86826171875}, {"start": 2135.96, "end": 2136.34, "word": " العافية", "probability": 0.9658203125}, {"start": 2136.34, "end": 2136.44, "word": " و", "probability": 0.751953125}, {"start": 2136.44, "end": 2136.56, "word": " مين", "probability": 0.82763671875}, {"start": 2136.56, "end": 2136.68, "word": " اللي", "probability": 0.7392578125}, {"start": 2136.68, "end": 2137.34, "word": " هالسؤال؟", "probability": 0.8123575846354166}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2141.08875, "duration_after_vad": 2080.8699999999935}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..87cd3b31738d6b499ecc4fb2c6ed8ed9b364da2a
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/7Y5WSKHPBrE_raw.srt
@@ -0,0 +1,2004 @@
+1
+00:00:05,820 --> 00:00:09,560
+تلج حسب الظروف المختلفة لما بيدخل على الرئاتين
+
+2
+00:00:09,560 --> 00:00:13,280
+يدخل حسب على ال .. يصير ال alveoli ال دقيقة هادية
+
+3
+00:00:13,280 --> 00:00:17,420
+مايصارش تلج و إلا حيصير جوا cracks و هنخش في إيه؟
+
+4
+00:00:17,420 --> 00:00:20,920
+احنا بس نبرد ثواني كنا رشحنا أو حالتنا حالة
+
+5
+00:00:20,920 --> 00:00:24,680
+فمابالك لو كان المسألة هادى دائما احنا معرضين
+
+6
+00:00:24,680 --> 00:00:28,020
+للهواء الخارجى الرئاتين ال alveoli مش معرضين
+
+7
+00:00:28,020 --> 00:00:32,700
+للهواء الخارجى بيصير عاملين تدفع إذا هدي .. إذا
+
+8
+00:00:32,700 --> 00:00:39,160
+صار عندي حاجتينfilteration وتدفئة warming والتالت
+
+9
+00:00:39,160 --> 00:00:44,640
+humidification الهواء اللي بده يخش بده يكون رطب
+
+10
+00:00:44,640 --> 00:00:51,220
+مايكونش جاف يجففلي الميوكاس اه ويجففلي ال .. ال ..
+
+11
+00:00:51,220 --> 00:00:54,100
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+12
+00:00:54,100 --> 00:00:54,200
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+13
+00:00:54,200 --> 00:00:54,500
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+14
+00:00:54,500 --> 00:00:55,040
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+15
+00:00:55,040 --> 00:00:55,360
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+16
+00:00:55,360 --> 00:00:56,720
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+17
+00:00:56,720 --> 00:00:56,720
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+18
+00:00:56,720 --> 00:00:56,720
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+19
+00:00:56,720 --> 00:00:56,720
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+20
+00:00:56,720 --> 00:01:00,420
+.. ال .. ال .. ال ..
+
+21
+00:01:00,420 --> 00:01:00,660
+ال .. ال
+
+22
+00:01:03,850 --> 00:01:08,450
+cracks وبيصير عندي spread
+
+23
+00:01:08,450 --> 00:01:14,210
+of infection تمام؟ اذا عندي هى تلت حاجات وفي حاجة
+
+24
+00:01:14,210 --> 00:01:18,670
+رابعة كتير مهمة انا لو لا هالريقتين هدول مابقدر
+
+25
+00:01:18,670 --> 00:01:21,790
+اخاطبهم او اتخاطبونى لو لا ال air passages هذه
+
+26
+00:01:21,790 --> 00:01:27,030
+اللى فيها اه حاطين الزمارة فيها كده ال larynx اه
+
+27
+00:01:27,030 --> 00:01:36,910
+وحاطين اللى هى حلق و لسان وشفايفو soft palate و
+
+28
+00:01:36,910 --> 00:01:42,690
+intercostals و abdominal muscles و diaphragm هذا
+
+29
+00:01:42,690 --> 00:01:46,650
+كله طاقم في الآخر بيقدر ال phonation بيقدر ال
+
+30
+00:01:46,650 --> 00:01:51,630
+speech تمام؟ الكلام هذا طبعا إله مركزية بتحكمه و
+
+31
+00:01:51,630 --> 00:01:56,510
+هي الأساس بحيث أن هذا كل الطاقم اللي اتكلمنا عنه
+
+32
+00:01:56,510 --> 00:02:01,030
+من عضلات بتزيد الضغط في داخل الرائعتين إلى vocal
+
+33
+00:02:01,030 --> 00:02:07,420
+cords بتفتح و بتسكربتشد و بترخي بتزيد الهواء و
+
+34
+00:02:07,420 --> 00:02:10,800
+بتجلله عشان يطلع عندي أنغام مختلفة من الصوت
+
+35
+00:02:10,800 --> 00:02:15,860
+phonation عملية انه يطلع صوت رفيع ولا خميل ولا
+
+36
+00:02:15,860 --> 00:02:21,580
+شديد ولا عالي ولا هادي مربوط وين؟ في ال larynx في
+
+37
+00:02:21,580 --> 00:02:26,500
+ال vocal cords بعدين الصوت اللي طلع هذا يتحول إلى
+
+38
+00:02:26,500 --> 00:02:29,960
+أحرفوالحمد لله رب العالمين كلكم بتعرفوا المخارج
+
+39
+00:02:29,960 --> 00:02:33,380
+وكلكم بتعرفوا صفات الحروف وكل حرف كيف بيطلع و اين
+
+40
+00:02:33,380 --> 00:02:38,220
+بنزل هذه المرحلة النهائية تمام اللي هي وانت
+
+41
+00:02:38,220 --> 00:02:42,960
+بتتكلمي لا بتفكر ان حرف ال .. الح يطلع من الحلق
+
+42
+00:02:42,960 --> 00:02:48,420
+ولا يطلع من الخيشوم ولا غيره انت بس بتقول اي حاجة
+
+43
+00:02:48,420 --> 00:02:52,260
+بيطلع لحاله لأن في مركزية في الداخل احنا اول ما
+
+44
+00:02:53,500 --> 00:02:56,720
+بدأنا ننمو و اتعلمنا اسمعنا هذا الكلام من ايه؟ من
+
+45
+00:02:56,720 --> 00:03:01,600
+الأم فبدأنا نقلدها ثم برمجنا دماغ عنا لما نطلع
+
+46
+00:03:01,600 --> 00:03:05,700
+الحرف او الكلمة او الفكرة احنا بنقول الفكرة جاعدين
+
+47
+00:03:05,700 --> 00:03:08,280
+قبل ما .. قبل ما نعرف ايش بنقول، بنقول طالعة
+
+48
+00:03:08,280 --> 00:03:12,620
+لساننا يعني و احنا بنفكر و بنتكلم يعني مش بنفكر و
+
+49
+00:03:12,620 --> 00:03:16,140
+بعدين .. اه هذه في غير لغة الأم بيقرر واحد ايش
+
+50
+00:03:16,140 --> 00:03:19,940
+بيقول و بعدين بيقول لكن في لغة الأم اللي مبرمج انت
+
+51
+00:03:19,940 --> 00:03:26,480
+عليها بتفكريوبتتكلمي في نفس الوجد الفكرة مافيش فرق
+
+52
+00:03:26,480 --> 00:03:31,200
+ما بين انتقال الفكرة الى كلام اى وقت محسوس هو فيه
+
+53
+00:03:31,200 --> 00:03:35,460
+فرق بس الفرق هذا ايه مش محسوس من كتر ماهي الفكرة
+
+54
+00:03:35,460 --> 00:03:39,860
+وانا بكلمك واقعد مستغرب انا كيف ان الكلام قبل ما
+
+55
+00:03:39,860 --> 00:03:42,360
+ايه ماتطلع الفكرة من رأسي مش عارف ايش بده اقول
+
+56
+00:03:42,360 --> 00:03:46,820
+بسمعها سماع في الآخر السرعة السرعة الرهيبة اللى
+
+57
+00:03:46,820 --> 00:03:53,410
+بتنفيها ايه نقل الفكرة من مركز ال الكلام اهمن مركز
+
+58
+00:03:53,410 --> 00:03:57,470
+الفكرة إلى مركز الكلام و مركز الكلام هذا فورا شوف
+
+59
+00:03:57,470 --> 00:04:02,550
+كده سرعة العصاب بحيث انه يزود ضغط الصدر عشان الصوت
+
+60
+00:04:02,550 --> 00:04:09,610
+يعل شوية او يوت شوية او يظل مندفع حجاب الحاجز ضغط
+
+61
+00:04:09,610 --> 00:04:13,010
+باستمرار عشان ال intro thoracic pressure يظل عالي
+
+62
+00:04:13,010 --> 00:04:16,470
+عشان .. و طول ما هو عالي طول ما ان انا ايه فيه هوا
+
+63
+00:04:16,470 --> 00:04:19,930
+مندفع على الخارجو ال vocal cords بتزيدوا و بتجيلوا
+
+64
+00:04:19,930 --> 00:04:24,770
+بحيث انه تدينا الصوت ال pitch اللي انا بدياه ثم
+
+65
+00:04:24,770 --> 00:04:28,650
+بيجي الطاقم الأخير اللي انتوا اتكلمتوا عنه اللي هو
+
+66
+00:04:28,650 --> 00:04:33,470
+طاقم المخارج و ال ايه و الصفات اللي يعمللي الحرف
+
+67
+00:04:33,470 --> 00:04:38,530
+اللي انا في الآخر و علمه أدم الأسماء كلها فأصبح
+
+68
+00:04:38,530 --> 00:04:48,050
+إنسان بيتكلم و بينطق و له قامة معتدلةوله يدين
+
+69
+00:04:48,050 --> 00:04:53,730
+القفزة في الخلق ما بين الإنسان وبين أي مخلوق آخر
+
+70
+00:04:53,730 --> 00:04:59,250
+على وجه الأرض غير الإنسان قفزة ضخمة كبيرة مفترض
+
+71
+00:04:59,250 --> 00:05:03,690
+إنه لو هذا إجا عفويا بالصدفة زي ما قالوا لإلا جينا
+
+72
+00:05:03,690 --> 00:05:07,670
+إشي جريب من الإنسان هيك تسعين المية أو إشي خمسة و
+
+73
+00:05:07,670 --> 00:05:10,130
+تسعين المية أو إشي أسعة و تسعين المية دولة عشان ..
+
+74
+00:05:10,130 --> 00:05:14,370
+بعدين هنلاقي كان إنسان طويل و عريض و بس من غير ..
+
+75
+00:05:14,370 --> 00:05:20,280
+من دماغه و ماكملش تفكيرهأه يعني نلاقي إنسان طويل و
+
+76
+00:05:20,280 --> 00:05:23,880
+عريض بس إيه دي كلها إيه مش أصابع حلوة هيك أه كلها
+
+77
+00:05:23,880 --> 00:05:27,940
+إيه كذا و إيه له دماغ طبعا إيش هيعفي الدماغ اللي
+
+78
+00:05:27,940 --> 00:05:32,520
+بيفكر فيه الإنسان كويس في عدم موجود الأصابع في عدم
+
+79
+00:05:32,520 --> 00:05:38,560
+موجود أشياء كتير أه فبرجع تاني بقول الجسم
+
+80
+00:05:41,460 --> 00:05:44,920
+بنى برضه بالعلامة خلقناها على الاقتصاد فالهوى اللى
+
+81
+00:05:44,920 --> 00:05:49,160
+طالع كمان عاملنا صوت و عاملنا أشياء كلام و عاملنا
+
+82
+00:05:49,160 --> 00:05:54,780
+هو داخل للنفس نفس بس فى نفس الوجهة مدامه فى مكينة
+
+83
+00:05:54,780 --> 00:06:00,160
+ضخ هوى إذا نستخلها برضه في إيجاد ما يسمى بالصوت ما
+
+84
+00:06:00,160 --> 00:06:03,840
+إيجاد .. ماعملاش مكينة تانية للصوت بس تشغل صوت و
+
+85
+00:06:03,840 --> 00:06:09,190
+بعدين هدا يشغل نفس لأ إيجاد هاديمعهد إذا الجهاز
+
+86
+00:06:09,190 --> 00:06:13,770
+التنفسي عندها بيعمل تلت أشياء مهمة واشي الرابع
+
+87
+00:06:13,770 --> 00:06:19,930
+بيخصش التنفس نفسه يعني تلتة بتخص عملية التنفس ال
+
+88
+00:06:19,930 --> 00:06:23,490
+humidification و ال warming و ال filtration بتخص
+
+89
+00:06:23,490 --> 00:06:27,470
+عملية الهواء نفسه لكن الرابع ال foundation وظيفة
+
+90
+00:06:27,470 --> 00:06:30,670
+إضافية يعني مالها الجهاز التنفسي لكن مالهاش علاقة
+
+91
+00:06:30,670 --> 00:06:35,870
+هي إيه بالتنفس يعني الرطوبة بتحمي الفلترة بتحمي
+
+92
+00:06:35,870 --> 00:06:43,990
+التدفئة بتحميلكن الصوت هذا صفة إضافية رابعة إذن
+
+93
+00:06:43,990 --> 00:06:48,550
+الجهاز التنفسي اللي عندى بيبدأ بال nose الأنف وما
+
+94
+00:06:48,550 --> 00:06:52,750
+أدراك ما الأنف الأنف في حاجز أنفي نازل سبتمبر في
+
+95
+00:06:52,750 --> 00:06:58,430
+النص وفي من الجناب طالع what is called كونكا
+
+96
+00:06:58,430 --> 00:07:03,410
+مجموهم كونكى اتنين بالعرض ماشيين هيك عاملين زر
+
+97
+00:07:03,410 --> 00:07:08,300
+رديتر حاجزين في وسط الايه بس بالعرضفي وسط الفراغ
+
+98
+00:07:08,300 --> 00:07:13,600
+الأنفي هذا تشوفي الأنفي نزل سبتم في النص وعندي من
+
+99
+00:07:13,600 --> 00:07:17,520
+الجانب جاي كونكا و كونكا سموها بعد شوية turbulent
+
+100
+00:07:17,520 --> 00:07:23,160
+ليش؟ لإن الكونكا تؤدي إلى turbulence بتلخبط الهواء
+
+101
+00:07:23,160 --> 00:07:26,960
+فقالوا إذا هذي turbulent هي كونكا عظميا لكن
+
+102
+00:07:26,960 --> 00:07:29,860
+functionally سموها turbulent هتكلم معنا بعد شوية
+
+103
+00:07:29,860 --> 00:07:33,180
+وعلى الجانب التاني من النزل إيه؟ اه فإذا عندي
+
+104
+00:07:33,180 --> 00:07:36,230
+أنفين فيه نزل سبتموهان وهان الـ turbinates
+
+105
+00:07:36,230 --> 00:07:39,590
+بيقسمولي الهواء إلى تلت أقسام، الهواء بنزل في ال
+
+106
+00:07:39,590 --> 00:07:43,050
+.. في ال .. في المجلة الوسطانية أو في النص وفوق،
+
+107
+00:07:43,050 --> 00:07:49,890
+تمام؟ إذا صار عندي أنا nasal cavity و nasal ال
+
+108
+00:07:49,890 --> 00:07:56,010
+turbinates و nasal sinusesعندي أنا هذا الهواء اللي
+
+109
+00:07:56,010 --> 00:08:02,090
+داخلها مشبوك في sinuses ال sinuses لهم فائدة في
+
+110
+00:08:02,090 --> 00:08:07,590
+التدفئة و الصوت ال phonation ده مع الصوت لكن ال
+
+111
+00:08:07,590 --> 00:08:13,150
+nasal space هذا اللي الهواء بيخشه عشان يت filter و
+
+112
+00:08:13,150 --> 00:08:18,030
+يتدفى و كده يديش مساحته اتصوروا لجينا عندي مساحة
+
+113
+00:08:18,030 --> 00:08:24,440
+ستمائة centimeter ستمائة ولا اتنين وستين؟عشرة في
+
+114
+00:08:24,440 --> 00:08:30,920
+ستين اه ستمية ستمية وعشرين centimeter مربع مساحة
+
+115
+00:08:30,920 --> 00:08:35,260
+ال surface area اللي الهواء لما بيخش ال nose بيخش
+
+116
+00:08:35,260 --> 00:08:40,180
+فيها تمام المتر المربع عشرة الف centimeter مش هيك
+
+117
+00:08:40,180 --> 00:08:44,820
+احنا بنتكلم عن ستمية ستمية وعشرين يعني حوالي عشرة
+
+118
+00:08:44,820 --> 00:08:49,930
+centimeter عرض مثلا في ستين centimeterهذه تصوروا
+
+119
+00:08:49,930 --> 00:08:54,590
+ان ال nose تبعنا هذا هالجد في surface area إله
+
+120
+00:08:54,590 --> 00:09:02,490
+أهمية كبيرة جدا في تنقية الهواء وتدفئة الهواء و ال
+
+121
+00:09:02,490 --> 00:09:05,850
+humidification
+
+122
+00:09:05,850 --> 00:09:12,330
+و ترطيب الهواء تمام؟ ال nose إله دور و الtrachea
+
+123
+00:09:12,330 --> 00:09:16,070
+إلها دور و الbronchus إلها دور طب خليني أتكلم عن
+
+124
+00:09:16,070 --> 00:09:18,470
+الموضوع هذا بشكل أوسع
+
+125
+00:09:24,350 --> 00:09:28,450
+طيب ال .. خلّينا جايبنا نتكلم عن ال .. خلّا بدأنا
+
+126
+00:09:28,450 --> 00:09:37,190
+فيها نتكلم عنها طب okay نتكلم
+
+127
+00:09:37,190 --> 00:09:40,950
+عنها مدن بدأنا الكلام حولها
+
+128
+00:09:56,950 --> 00:10:00,890
+the normal respiratory functions of the nose إذا
+
+129
+00:10:00,890 --> 00:10:04,110
+بدأ أنا أتكلم عن مين؟ عن ال nose لإن الهو أولا
+
+130
+00:10:04,110 --> 00:10:10,870
+بدخل بقابل ال nose بقابل ال هو الهو داخل لحظه لإن
+
+131
+00:10:10,870 --> 00:10:14,870
+ال هو بدخل كده و بعدين يغير اتجاهه عشان كده فتحات
+
+132
+00:10:14,870 --> 00:10:20,910
+الأنف مش جاية قدام هيك مش بس منظر جمالي هو منظر
+
+133
+00:10:20,910 --> 00:10:23,590
+جمالي جدا إن كانوا تحت بس بعض الناس لاجي
+
+134
+00:10:23,590 --> 00:10:29,810
+المناخيرهمفاتحاك بشكل مزعج أمامك كده شاهد؟ لكن فضل
+
+135
+00:10:29,810 --> 00:10:33,750
+ربنا انه خلالنا .. مش بس منظر جمالي لأ كمان علشان
+
+136
+00:10:33,750 --> 00:10:38,510
+الهواء يغير اتجاهه تمام؟ و ال nose الشغلته
+
+137
+00:10:38,510 --> 00:10:43,050
+الأساسيه الاخبط الهواء اغير اتجاهات في الهواء لإنه
+
+138
+00:10:43,050 --> 00:10:46,450
+كل ما بيغير اتجاهة الهواء كل ما بيشغل ال nose أكتر
+
+139
+00:10:46,450 --> 00:10:50,850
+كيف يعني؟ الغبرة المحمولة في ال .. في الهواء
+
+140
+00:10:50,850 --> 00:10:57,320
+الداخلأحجام مختلفة أحجام مختلفة بالقطع كلها
+
+141
+00:10:57,320 --> 00:11:03,960
+الغبارة وزنها أكتر من وزن ال particles of air لذلك
+
+142
+00:11:03,960 --> 00:11:06,780
+لما الهواء يبقى مندفع بشكل معين وحامل معه ال
+
+143
+00:11:06,780 --> 00:11:10,580
+particles ثم يصير تغيير في اتجاه الهواء بيغير
+
+144
+00:11:10,580 --> 00:11:15,060
+اتجاهه أسرع من بيغيره من ال particles ال particles
+
+145
+00:11:15,060 --> 00:11:17,900
+بتبقى مندفع على أنها كتلة
+
+146
+00:11:20,450 --> 00:11:24,190
+الها كتلة حركة الها عزم .. إيش بيسموه أنتوا العجلة
+
+147
+00:11:24,190 --> 00:11:28,930
+ولا إيش .. في التوجيه كنا زمان ندوس .. إيه؟ تسا ..
+
+148
+00:11:28,930 --> 00:11:32,810
+الها وزن معين بيخليها مدفعة بشكل معين هذا بيقدر إن
+
+149
+00:11:32,810 --> 00:11:36,610
+الهواء بيغير اتجاهه لكن ال .. ال particles هذه
+
+150
+00:11:36,610 --> 00:11:41,350
+بتخبط في الحيط اللي هي إيه؟ اللي واجهتها الحيط
+
+151
+00:11:41,350 --> 00:11:45,030
+اللي واجهتها الـ mucous membrane مخاطب يلزق فيها
+
+152
+00:11:45,030 --> 00:11:49,170
+ال إيه؟ ال particles تمام؟ إذا هو أول ما الهواء
+
+153
+00:11:49,170 --> 00:11:59,180
+بيخشبنجح حاله وغير اتجاهه فبضرب في سجف الانف بضرب
+
+154
+00:11:59,180 --> 00:12:02,240
+في ال turbinates فبتلاقي اتجاهه تشتت في كل اتجاه
+
+155
+00:12:02,240 --> 00:12:07,520
+ال air ال ال ال ال ال ال ال pollution particles
+
+156
+00:12:07,520 --> 00:12:10,620
+هذه الموجودة في الهواء بتبدأ تغير اتجاهها مش مدفعة
+
+157
+00:12:10,620 --> 00:12:14,580
+كلها إلى ال ايه؟ إلى الرئاتين فتتجهى وليش اي شي
+
+158
+00:12:14,580 --> 00:12:18,980
+لفوق ولا تحت ويمين وشمال فبتلتثق في ال mucus
+
+159
+00:12:18,980 --> 00:12:23,980
+membrane المنتشر في كل مكانتمام؟ غير كده في شعر في
+
+160
+00:12:23,980 --> 00:12:27,680
+باب الـ A بالأنف ال big particles هذه بيمسكها
+
+161
+00:12:27,680 --> 00:12:33,760
+الشعر الأصغر بتلزج وين؟ في الميوكاس من براين لحد
+
+162
+00:12:33,760 --> 00:12:39,480
+ال 6 مايكرون بيلزج في ال A يعني بدخلش على التراكية
+
+163
+00:12:39,480 --> 00:12:45,900
+إلى ال particles الحجمها أجل من 6 مايكرون تمام؟
+
+164
+00:12:45,900 --> 00:12:51,630
+لحظوا الهواء مدفع في التراكيةو اذا ادانا اتنين
+
+165
+00:12:51,630 --> 00:12:55,610
+main bronchi و ال main bronchi يدونا شوية
+
+166
+00:12:55,610 --> 00:13:00,230
+bronchioles بعدين كل bronchiole ادى بالدينى كان
+
+167
+00:13:00,230 --> 00:13:05,070
+ضخم جدا من ال .. اللي هو ال terminal bronchiole
+
+168
+00:13:05,070 --> 00:13:10,070
+تمام؟ حاجة و ستين الف terminal bronchiole فهذا
+
+169
+00:13:10,070 --> 00:13:16,290
+بيقدى الى انه ال space اللى الهوى كان ماشي فيه
+
+170
+00:13:16,290 --> 00:13:22,190
+فجأة وسعففجأة الهواء اللي جاء مدفع خف حركته بطء
+
+171
+00:13:22,190 --> 00:13:29,170
+البطء هذا بيقدر إلى أن الأشياء الثقيلة يصلها الـ
+
+172
+00:13:29,170 --> 00:13:33,810
+Gravitational precipitation هتهدي التيار فهذه
+
+173
+00:13:33,810 --> 00:13:38,890
+هتروح هتلزج هتهدأ و هتلزج في ميوكاسبنبرين of
+
+174
+00:13:38,890 --> 00:13:43,870
+البرونكيولز البرونكيولز هذه قطرها حوالي حجم و نص
+
+175
+00:13:43,870 --> 00:13:49,450
+مايكرونواحد و نص micrometer تمام؟ هذه ال terminal
+
+176
+00:13:49,450 --> 00:13:53,570
+واحد و نص micrometer و كل ما اعلينا لفوق شوية
+
+177
+00:13:53,570 --> 00:13:58,470
+بيوسعوا شوية قصدي اقول انا في مرحلة من المراحل انه
+
+178
+00:13:58,470 --> 00:14:03,630
+كمية ال .. ال .. ال broncular space اللي عندي صار
+
+179
+00:14:03,630 --> 00:14:07,790
+اكبر كتير من التركيا و من ال .. من ال broncules
+
+180
+00:14:07,790 --> 00:14:10,730
+فبقدر إلى ان الهواء .. التلاتة هواء بتهدأ في منطقة
+
+181
+00:14:10,730 --> 00:14:15,710
+معينة فبقدر إلى انه مايصلش ال alveoliمايصلش الـ
+
+182
+00:14:15,710 --> 00:14:20,570
+alveoli إلا اللي حجمه أقل من واحد micron يعني اللي
+
+183
+00:14:20,570 --> 00:14:23,430
+بين الخمسة والواحد بيكون لزج في الـ mucous
+
+184
+00:14:23,430 --> 00:14:27,470
+membrane تبع ال إيه؟ ال air passages مش ال .. ال
+
+185
+00:14:27,470 --> 00:14:31,590
+nose ال nose بيكون على ده بيصلش ال alveoli إلا
+
+186
+00:14:31,590 --> 00:14:35,970
+الأشي أقل من واحد إيه؟ micron ال particle تبعه طيب
+
+187
+00:14:35,970 --> 00:14:41,830
+الآن السؤال أنه هذا ال particles اللي واحد micron
+
+188
+00:14:41,830 --> 00:14:47,350
+في أقل من micronإذا هذه هتندفع و تخبط في الـmucous
+
+189
+00:14:47,350 --> 00:14:50,730
+membrane تبع مين؟ تبع الـalveoli و هتخش في
+
+190
+00:14:50,730 --> 00:14:53,950
+الـmucous membrane تبع الـalveoli تمام؟ by
+
+191
+00:14:53,950 --> 00:14:58,450
+diffusion، by إيش ماكان، by .. هذي شغلة
+
+192
+00:14:58,450 --> 00:15:02,770
+الـmacrophages الـalveoli wall، الـalveolar wall
+
+193
+00:15:02,770 --> 00:15:06,750
+فيها قولنا type I إبثيليوم و type II إبثيليوم، إيش
+
+194
+00:15:06,750 --> 00:15:13,340
+type II بصنع؟surfactant، نسيتوها انتوا، surfactant
+
+195
+00:15:13,340 --> 00:15:21,240
+surface acting agent، اه surfactant، طيب في كمان
+
+196
+00:15:21,240 --> 00:15:25,520
+عندي macro phages موجودة بين ال cells هذه بتهاجم
+
+197
+00:15:25,520 --> 00:15:28,420
+الموارد هذه وبتاخدها وبتنظف ال alveoli منها
+
+198
+00:15:28,420 --> 00:15:33,860
+الأشياء اللي أقل من نص مايكرون، في الغالب، خفيفة
+
+199
+00:15:34,110 --> 00:15:38,270
+بتخش و بتطلع مع ال ايه؟ مع الهواء بدون ما ايه يصير
+
+200
+00:15:38,270 --> 00:15:45,690
+لها precipitation لكن ال ال ال ال smoke particles
+
+201
+00:15:45,690 --> 00:15:54,800
+الدخان اه بنلاقيها point three micron تمامبتخش و
+
+202
+00:15:54,800 --> 00:15:58,280
+بتطلع لكن لو وجودها دي كتير تعمل reactions و أشياء
+
+203
+00:15:58,280 --> 00:16:02,200
+بعد كده مزعجة هتكلم عنها ان شاء الله بالتفصيل في
+
+204
+00:16:02,200 --> 00:16:06,000
+لما اتكلم عن الانفزيما اذا عندي انا هنا النوز هذا
+
+205
+00:16:06,000 --> 00:16:11,720
+مش معمول هيك مش بس زي اللوزة عشان ايه ننبسط لأ ما
+
+206
+00:16:11,720 --> 00:16:14,760
+بعد اللوزة اذا اللوزة هذه بتغير اتجاه لذا من هنا
+
+207
+00:16:14,760 --> 00:16:18,840
+عريض و من هنا برفع عشان اتجاه الهواء اللي داخل هيك
+
+208
+00:16:18,840 --> 00:16:22,580
+عود ايه يغير اتجاهه بيصطدم بال terminates
+
+209
+00:16:23,140 --> 00:16:28,320
+Turbulence تربين تربين تربين تربين تربين تربين
+
+210
+00:16:28,320 --> 00:16:31,540
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+211
+00:16:31,540 --> 00:16:36,040
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+212
+00:16:36,040 --> 00:16:38,640
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+213
+00:16:38,640 --> 00:16:40,700
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+214
+00:16:40,700 --> 00:16:45,760
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+215
+00:16:45,760 --> 00:16:50,800
+تربين تربين تربين تربين تربين تربين تربين تربين
+
+216
+00:16:50,800 --> 00:16:51,920
+تربين
+
+217
+00:16:55,220 --> 00:17:03,200
+البرونج فيولز لهم تنقية بشكل تاني ال
+
+218
+00:17:03,200 --> 00:17:15,820
+ال ال ال ال ال ال ال ال
+
+219
+00:17:15,820 --> 00:17:15,820
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+220
+00:17:15,820 --> 00:17:15,880
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+221
+00:17:15,880 --> 00:17:15,940
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+222
+00:17:15,940 --> 00:17:16,140
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+223
+00:17:16,140 --> 00:17:16,320
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+224
+00:17:16,320 --> 00:17:16,320
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+225
+00:17:16,320 --> 00:17:16,320
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+226
+00:17:16,320 --> 00:17:16,340
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+227
+00:17:16,340 --> 00:17:16,340
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+228
+00:17:16,340 --> 00:17:16,340
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+229
+00:17:16,340 --> 00:17:16,340
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+230
+00:17:16,340 --> 00:17:21,250
+ال ال ال ال ال ال ال النفس الحرارة والفهراء
+
+231
+00:17:21,250 --> 00:17:25,650
+والفهراء هي ال difference بس جداش الفهراء يعني
+
+232
+00:17:25,650 --> 00:17:30,230
+بالنسبة لل centigrade جزء
+
+233
+00:17:30,230 --> 00:17:37,590
+منها تمام؟ اذا ال humidification هتلاقي الهواء
+
+234
+00:17:37,590 --> 00:17:43,550
+ترتب ترطيب مشبع اتنين الى تلاتة في المية اقل من
+
+235
+00:17:43,550 --> 00:17:47,910
+التشبع اتنين الى تلاتة في المية اقل من ايه؟highly
+
+236
+00:17:47,910 --> 00:17:51,990
+humidified
+
+237
+00:17:51,990 --> 00:17:55,990
+بالنسبة
+
+238
+00:17:55,990 --> 00:18:00,310
+للـ particles احنا ايه هنتكلم عنها بالتفصيل
+
+239
+00:18:00,310 --> 00:18:05,450
+اتكلمنا
+
+240
+00:18:05,450 --> 00:18:09,930
+عن ال nose و ال size of particles هنا و قولنا انه
+
+241
+00:18:09,930 --> 00:18:15,970
+عندي ال particles الكبيرة ال particles أكتر من 6
+
+242
+00:18:15,970 --> 00:18:20,530
+مايكرونأو يعني أكتر من خمسة لحد الستة خلص منها
+
+243
+00:18:20,530 --> 00:18:24,570
+النوز من البرونكولات المتبقية، الكثير منهم بين
+
+244
+00:18:24,570 --> 00:18:29,870
+واحد إلى خمس ميكرومتر تقع في البرونكولات الصينية
+
+245
+00:18:29,870 --> 00:18:30,490
+الصينية الصينية الصينية صينية صينية صينية صينية
+
+246
+00:18:30,490 --> 00:18:30,810
+صينية صينية صينية صينية صينية صينية صينية صينية
+
+247
+00:18:30,810 --> 00:18:41,830
+صينية صينية صينية صينية صينية صينية صينية
+
+248
+00:18:41,830 --> 00:18:43,050
+صينية صينية صينية صينية صينية صينية صينية صينية
+
+249
+00:18:43,050 --> 00:18:44,990
+صينية صينية صينية صينية صينية صينية صينية صينية
+
+250
+00:18:44,990 --> 00:18:44,990
+صينية صينية صينية صينية صينية صينية صينية صينية
+
+251
+00:18:44,990 --> 00:18:49,090
+صينية صينية صينية صينية صينيةand many armies طيب
+
+252
+00:18:49,090 --> 00:18:54,550
+ماشي vocalization
+
+253
+00:18:54,550 --> 00:18:58,730
+إذا إنه الجزء الأخير إذا كانوا humidification و
+
+254
+00:18:58,730 --> 00:19:07,190
+filtration اتكلمنا عنها و humidification طيب إذا
+
+255
+00:19:07,190 --> 00:19:10,010
+filtration و humidification و warming ال warming
+
+256
+00:19:10,010 --> 00:19:15,510
+موجود بالإضافة لنزل ال space هذاعنا الـ nasal
+
+257
+00:19:15,510 --> 00:19:19,750
+sinuses تستخدم في الـ warming of the air بالإضافة
+
+258
+00:19:19,750 --> 00:19:24,550
+لإنها إلها دور في ال .. في ال .. في ال speech
+
+259
+00:19:24,550 --> 00:19:27,850
+تبعنا ال speech إحنا بنفسنا موحش تاني ال speech
+
+260
+00:19:27,850 --> 00:19:35,770
+عندنا phonation و .. و articulation and resonance
+
+261
+00:19:35,770 --> 00:19:42,410
+phonation اللي هو الصوت اللي بطلع اللي متعلق بصوت
+
+262
+00:19:42,410 --> 00:19:49,430
+شديدرفيع، رخيم، خشن، ماعرفش إيش هذه كلها مسؤولة
+
+263
+00:19:49,430 --> 00:19:53,710
+من؟ الـ vocal cords أما الـ articulation التفصيل
+
+264
+00:19:53,710 --> 00:19:57,690
+والمخارج، اتكلمنا عنها أما عن ال resonance ال
+
+265
+00:19:57,690 --> 00:20:03,090
+resonance إن الهواء يمر في طبل في مناطق تعمل صوت
+
+266
+00:20:03,090 --> 00:20:08,370
+طبل الجيوب الأنفية بتدينه الصوت اللي هو لما أحنا
+
+267
+00:20:08,370 --> 00:20:12,830
+بنبقى مرشحين ومسكرة الجيوب الأنفية من حد ما الواحد
+
+268
+00:20:12,830 --> 00:20:16,180
+يتكلمأول كلمة كيف حالك يا ديمة؟ مالك سلامتك؟ إيش
+
+269
+00:20:16,180 --> 00:20:20,940
+فيه؟ كيف عرفت إنه عندها .. من الصوت عرفت إنه في
+
+270
+00:20:20,940 --> 00:20:24,780
+عندها رشح لإنه بيسكروا ال nasal sinuses فالصوت
+
+271
+00:20:24,780 --> 00:20:29,040
+بتغير تماما فالصوت هذا اللي بيتميز ال resonance زي
+
+272
+00:20:29,040 --> 00:20:31,880
+ما الصوت راح ال resonance الفرغات اللي .. اللي
+
+273
+00:20:31,880 --> 00:20:35,880
+بيمشي فيها الصوت بتدلوا الرنين هذا ال .. ال nasal
+
+274
+00:20:35,880 --> 00:20:39,960
+sinuses ال mouth نفسه إنه في عندى mouth أنا موجود
+
+275
+00:20:40,160 --> 00:20:45,360
+تمام؟ ضخم؟ كبير هيك؟ بدي صوت؟ الريقات .. نفسهم
+
+276
+00:20:45,360 --> 00:20:52,160
+تمام؟ أبحاب بيطلع الصوت منهم .. من الحنجرة و كده
+
+277
+00:20:52,160 --> 00:20:57,520
+هذه الفرق .. مساحات بيمشيها الصوت بتديله رخامة
+
+278
+00:20:57,520 --> 00:21:01,200
+بتديله resonance ال articulation اللي بتعمل من
+
+279
+00:21:01,200 --> 00:21:07,320
+خلال الحلق و ال soft palate و اللبس و ال tongue
+
+280
+00:21:07,320 --> 00:21:12,600
+بتعمل إيه؟ اللي هو مخارجو أحرف و تشكل و تغير و
+
+281
+00:21:12,600 --> 00:21:16,760
+تعمل سواء اما ال phonation نفسه ال vocal cords
+
+282
+00:21:16,760 --> 00:21:21,600
+هدول طبعا ان فيهم اسمهم vocal folds أساسا اسم ايش؟
+
+283
+00:21:21,600 --> 00:21:25,900
+vocal folds لإنه طيهان و طيهان ع ال vocal cords في
+
+284
+00:21:25,900 --> 00:21:28,580
+ال .. في ال lyrics طيه واحدة يعني ان ال vocal
+
+285
+00:21:28,580 --> 00:21:32,970
+cords مش ألف ولا ميةهم تنين لكن انهم مشبوكة منهم
+
+286
+00:21:32,970 --> 00:21:39,570
+مجموعة من ال .. هم شبكين في الغضاريف الحنجرة بس
+
+287
+00:21:39,570 --> 00:21:44,090
+الغضاريف هذه مشبوكة بمجموعة من العضلات بتشد ع
+
+288
+00:21:44,090 --> 00:21:47,590
+vocal cords تمام؟ بيخلي عندي أنا أصوات ال
+
+289
+00:21:47,590 --> 00:21:51,970
+phonation عملية ال phonation اللي بالتم تمام؟ إذا
+
+290
+00:21:51,970 --> 00:21:58,390
+هذا بالنسبة لفوائد أخرى غير تنفسية بالنسبة لمين؟ ل
+
+291
+00:21:58,390 --> 00:21:59,090
+.. ال ..
+
+292
+00:22:02,910 --> 00:22:08,630
+الإجهاز التنفسي ما هو باسمه the functions of the
+
+293
+00:22:08,630 --> 00:22:15,250
+nose نرجع تاني لأشياء انا رطيتها شوية عشان ايه
+
+294
+00:22:15,250 --> 00:22:26,870
+نكمل الموضوع ان احنا غير ربع ساعة اعتقد الان
+
+295
+00:22:26,870 --> 00:22:31,090
+عندي انا هنا respiratory passages عندي اتراكية
+
+296
+00:22:31,520 --> 00:22:37,000
+supported بال .. بال .. ال .. ال cartidges ال C
+
+297
+00:22:37,000 --> 00:22:42,020
+shape او ال U shape cartidges مش كده؟ ال .. كل ما
+
+298
+00:22:42,020 --> 00:22:48,160
+نزلنا لتحت بنصل .. بنصل ل .. بيقل ال cartidges
+
+299
+00:22:48,530 --> 00:22:54,250
+وبيزيد محل ال cartilage more muscular tissue لدرجة
+
+300
+00:22:54,250 --> 00:23:00,530
+انه عندنا في ال ال bronchioles the bronchioles are
+
+301
+00:23:00,530 --> 00:23:04,830
+not present plates the plates are not present اللي
+
+302
+00:23:04,830 --> 00:23:07,330
+هو ال cartilage plates in the bronchioles وماكنش
+
+303
+00:23:07,330 --> 00:23:10,830
+بقدر اقول انا وصلت ل bronchiole لما يكون عندى ايه
+
+304
+00:23:10,830 --> 00:23:14,620
+بطل فيه cartilageأنا جاب ال .. ال bronchiol في
+
+305
+00:23:14,620 --> 00:23:17,580
+عندى bronchi بتصغر ال bronchiol أصلا بس طول ما
+
+306
+00:23:17,580 --> 00:23:20,600
+فيها supported by cartilage ال bronchiol .. بين ال
+
+307
+00:23:20,600 --> 00:23:24,140
+cartilage موجود fibrostitious و muscles لكن لما
+
+308
+00:23:24,140 --> 00:23:27,280
+أخش على ال bronchiols أنا لجيت just fibrostitious
+
+309
+00:23:27,280 --> 00:23:32,020
+و muscles من غير إيه؟ طب كيف يبقى الفاتحة؟ اللي
+
+310
+00:23:32,020 --> 00:23:35,080
+بفتح القلبي الله بفتحها ال negative pressure اللي
+
+311
+00:23:35,080 --> 00:23:38,840
+موجود براها لشددها ال compliance تبع ال .. ال ..
+
+312
+00:23:38,840 --> 00:23:41,940
+ال elasticity تبع ال tissuesتبعت ال lung فتحها
+
+313
+00:23:41,940 --> 00:23:46,920
+شدها muscular
+
+314
+00:23:46,920 --> 00:23:50,820
+wall of the bronchi اتكلمت عنه ال respirator ال
+
+315
+00:23:50,820 --> 00:23:53,800
+bronchioles ال respirator ال bronchioles which are
+
+316
+00:23:53,800 --> 00:23:57,540
+هنا بعد ال bronchioles اتكلمت عنها مافيش فيها
+
+317
+00:23:57,540 --> 00:24:02,100
+كارتش اتجدت ال respirator ال bronchioles فيها ..
+
+318
+00:24:02,100 --> 00:24:07,380
+عندنا ابيثيليام شبيه بال alveolar ابيثيليام لكن
+
+319
+00:24:07,380 --> 00:24:11,280
+مافيش عندي انا ايه فيه muscular tissue كتيرالخاص
+
+320
+00:24:11,280 --> 00:24:16,120
+بنا فيبراس و بعض البرونكيوز البرونكيوز البرونكيوز
+
+321
+00:24:16,120 --> 00:24:20,340
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+322
+00:24:20,340 --> 00:24:21,300
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+323
+00:24:21,300 --> 00:24:23,120
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+324
+00:24:23,120 --> 00:24:23,140
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+325
+00:24:23,140 --> 00:24:23,200
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+326
+00:24:23,200 --> 00:24:23,480
+البرونكيوز البرونكيوز البرونكيوز البرونكيوز
+
+327
+00:24:23,480 --> 00:24:31,200
+البرونكيوز البرونكيوز البرونكيوز
+
+328
+00:24:31,200 --> 00:24:31,560
+البر
+
+329
+00:24:34,260 --> 00:24:39,740
+ممكن يكون عندى انا يعني هو المعظم المشاكل ال
+
+330
+00:24:39,740 --> 00:24:42,560
+diseases في الريقتين انهم يعملوا ايه انهم يعملوا
+
+331
+00:24:42,560 --> 00:24:45,800
+destruction او narrowing هتكلم عن الانفيزيام اللى
+
+332
+00:24:45,800 --> 00:24:47,800
+بتعمل destruction وعن ال bronchial asthma اللى
+
+333
+00:24:47,800 --> 00:24:52,920
+بتعمل ايه narrowing اللى عندى اذا الآن صار عندى
+
+334
+00:24:52,920 --> 00:24:57,740
+bronchioles ممكن تنسد فيها mucus يمكن يصير فيها
+
+335
+00:24:57,740 --> 00:25:02,950
+اديمة تديج ممكن muscle spasmيعني تلت حاجات تعمل
+
+336
+00:25:02,950 --> 00:25:06,430
+الـ Narrowing of the A، البرونكال تري، يا إما plug
+
+337
+00:25:06,430 --> 00:25:09,950
+of mucous، الصد، إفرازات، صدّة ال .. ال .. ال
+
+338
+00:25:09,950 --> 00:25:14,630
+human، يا إما إديمة في ال wall، ورميل ال إيه؟ ال
+
+339
+00:25:14,630 --> 00:25:17,630
+.. ال .. ال cartilages الصغيرة أو اللي هو ال
+
+340
+00:25:17,630 --> 00:25:20,270
+terminal البرونكوليزي اللي هي mainly muscular،
+
+341
+00:25:20,270 --> 00:25:24,110
+هتعمل spasm، فهذا بيقديلي إلى ال إيه؟ لذلك ال
+
+342
+00:25:24,110 --> 00:25:26,750
+resistance، احنا وين بنلاقي resistance أكتر إشي؟
+
+343
+00:25:26,750 --> 00:25:34,860
+ال resistance بنلاقيها أكترفي مهاية البرونكاي و
+
+344
+00:25:34,860 --> 00:25:40,540
+أول البرونكيولز مهاية البرونكاي و أول البرونكيولز
+
+345
+00:25:40,540 --> 00:25:44,400
+لإن إذا دخلنا على البرونكيولز إحنا بربر هنلاقي
+
+346
+00:25:44,400 --> 00:25:51,580
+عندنا إيه متسع ضخم إذا
+
+347
+00:25:51,580 --> 00:25:59,900
+الهواء اللي داخل الرئاتين هذا بدخل من نوز واسع إلى
+
+348
+00:26:00,410 --> 00:26:05,530
+لارينكس إلى تركيا إلى برونكاى تتفرع main و
+
+349
+00:26:05,530 --> 00:26:09,050
+branching برونكاى وبعدين بتفقد ال cartilage تبقى
+
+350
+00:26:09,050 --> 00:26:11,670
+حابسي البرونكيول بس بعد ما نخش البرونكيول ال
+
+351
+00:26:11,670 --> 00:26:15,970
+resistance بتروح ليش؟ لإنه صار عندى 65 ألف
+
+352
+00:26:15,970 --> 00:26:21,590
+برونكيول مقابل المجموعة القليلة من ال .. من ال ..
+
+353
+00:26:21,590 --> 00:26:25,130
+البرونكاى فبيقدر إلى ان ال low resistance اللي فات
+
+354
+00:26:25,130 --> 00:26:33,730
+فاتنزل ضغط الهواء المندفع خلّي الهواء يهدوروك انه
+
+355
+00:26:33,730 --> 00:26:37,090
+بيصل .. خلّي الهواء يصل لل .. لل ال alveoli مش
+
+356
+00:26:37,090 --> 00:26:42,710
+مندفع حتى ما يجرح ال ايه ال alveoli هادي اللي أشبه
+
+357
+00:26:42,710 --> 00:26:47,570
+بال .. بال cellophane membrane الرقيق تمام؟ اللي
+
+358
+00:26:47,570 --> 00:26:53,990
+أجل شيء بي .. بيمزعه اذا عندي resistance في
+
+359
+00:26:53,990 --> 00:27:00,010
+المنطقة هذه لكن عندي bronchiolesأضيق واحد و نصف
+
+360
+00:27:00,010 --> 00:27:04,650
+مليمتر broncules وفيها muscles يعني من العملية
+
+361
+00:27:04,650 --> 00:27:07,630
+اللي كلمنا عنها من شوية الضيق هذا بيقدر أي ميكا
+
+362
+00:27:07,630 --> 00:27:13,250
+تسكرها اي spasm يسكرها اذا ممكن يصير عندي ال ال ال
+
+363
+00:27:13,250 --> 00:27:16,670
+ال ال diseases اكتر تيجي من ايه؟ من ال small
+
+364
+00:27:16,670 --> 00:27:19,950
+broncules هذه لأنه بيصير فيها ال spasm بيصير فيها
+
+365
+00:27:19,950 --> 00:27:23,970
+الضيقة ال secretions بتسكرها القديمة ابتحفيها
+
+366
+00:27:23,970 --> 00:27:29,410
+نهائيالـ lungs هذه الـ system هذا فيه nerve
+
+367
+00:27:29,410 --> 00:27:31,790
+supply؟ أه فيه nerve supply في عندى sympathetic؟
+
+368
+00:27:31,790 --> 00:27:35,790
+okay فيه sympathetic على ال outer of the lung لكن
+
+369
+00:27:35,790 --> 00:27:39,270
+inside deep in the .. in the .. deep in the .. in
+
+370
+00:27:39,270 --> 00:27:42,350
+the lung there is no sympathetic stimulation لكن
+
+371
+00:27:42,350 --> 00:27:45,070
+ال non-adrenaline و ال adrenaline بيصلوا لل lung
+
+372
+00:27:45,070 --> 00:27:49,790
+اللي جايين من وين؟ من السبردينة المضلة تمام؟ مش
+
+373
+00:27:49,790 --> 00:27:53,190
+محتاجين أنه ال sympathetic stimulation تيجي by the
+
+374
+00:27:53,190 --> 00:27:56,910
+nerves themselvesلكن ال .. ال chemical اللي بتطلع
+
+375
+00:27:56,910 --> 00:28:02,130
+اللي هو ايه ال chemical transmitter تبعت ال .. ال
+
+376
+00:28:02,130 --> 00:28:06,090
+.. sympathetic nerve system اللي هي ال
+
+377
+00:28:06,090 --> 00:28:08,850
+noradrenaline و norepinephrine و ال epinephrine
+
+378
+00:28:08,850 --> 00:28:13,630
+هدول بيمشوا في الدم بيصلوا يعني اللي هم تأثير فيه
+
+379
+00:28:13,630 --> 00:28:17,350
+receptors موجودة تستجيب لمين ل ال adrenergic
+
+380
+00:28:17,350 --> 00:28:22,060
+stimuliالـ nerve endings أفسها جليلة في داخل ال ..
+
+381
+00:28:22,060 --> 00:28:25,000
+ال .. ال lung لكن في عند ال receptors تستجيب
+
+382
+00:28:25,000 --> 00:28:27,980
+للادرينالين والنورادرينالين السيمباتاتيك ماكنتش
+
+383
+00:28:27,980 --> 00:28:31,620
+بتطلع فوق الطوارئ و فوق الطوارئ أنا محتاج نفس أكتر
+
+384
+00:28:31,620 --> 00:28:35,040
+فالادرينال أكتر فال bronchi بتوسع و ال bronchi
+
+385
+00:28:35,040 --> 00:28:38,760
+بتوسع و النفس بيصير إيه؟ بيصير أكتر أخش نفس و أطلع
+
+386
+00:28:38,760 --> 00:28:42,020
+بيدين السيمباتاتيك استعداد بس مش by its nerve
+
+387
+00:28:42,020 --> 00:28:45,280
+terminal directly لكن عبر مين؟ mainly عبر
+
+388
+00:28:45,280 --> 00:28:49,660
+السبرانين الادرينالين تمام؟ إذا ال simulation ها
+
+389
+00:28:49,910 --> 00:28:51,570
+بيمنع ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+390
+00:28:51,570 --> 00:28:52,130
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+391
+00:28:52,130 --> 00:28:54,730
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+392
+00:28:54,730 --> 00:28:55,370
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+393
+00:28:55,370 --> 00:28:58,550
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+394
+00:28:58,550 --> 00:28:59,050
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+395
+00:28:59,050 --> 00:28:59,990
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+396
+00:28:59,990 --> 00:29:01,470
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+397
+00:29:01,470 --> 00:29:05,090
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+398
+00:29:05,090 --> 00:29:05,090
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+399
+00:29:05,090 --> 00:29:05,090
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+400
+00:29:05,090 --> 00:29:05,090
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+401
+00:29:05,090 --> 00:29:09,990
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+402
+00:29:09,990 --> 00:29:09,990
+..
+
+403
+00:29:14,220 --> 00:29:16,560
+عملوا irritation، ال irritation هدا بيعمل
+
+404
+00:29:16,560 --> 00:29:19,220
+inflammatory process، إيديما و plugs و secretions
+
+405
+00:29:19,220 --> 00:29:23,620
+و تسديد و فوق هيك و هيك و هيك، بيتنكد و بتطرب و
+
+406
+00:29:23,620 --> 00:29:26,620
+بيعمل كمان super imposed بيجينا عنده بارا
+
+407
+00:29:26,620 --> 00:29:29,440
+sympathetic stimulation، بيعمل ال spasm كمان لمين؟
+
+408
+00:29:29,440 --> 00:29:32,620
+للمuscles، تمام؟ فال sympathetic .. بارا
+
+409
+00:29:32,620 --> 00:29:35,480
+sympathetic بينكد على الإنسان من ناحية رقتين، لأنه
+
+410
+00:29:35,480 --> 00:29:38,600
+بيعمل ال spasm فوق الهم الأساسي اللي هو ال
+
+411
+00:29:38,600 --> 00:29:41,880
+irritation اللي عملت لل plugs و عملت للإيديما و
+
+412
+00:29:41,880 --> 00:29:47,000
+عملت لمشاكلالبرا السيمباتاتيك منتشر في كل مكان
+
+413
+00:29:47,000 --> 00:29:51,820
+more penetrating لل .. لل .. لل lungs مش زي
+
+414
+00:29:51,820 --> 00:29:57,660
+السيمباتاتيك لكنه تأثيره هنا سلبي عكس ال .. ال GIT
+
+415
+00:29:57,660 --> 00:30:00,300
+اتكلمنا ولا ما .. انا عارف اتكلمنا ولا لأ؟
+
+416
+00:30:00,300 --> 00:30:03,100
+اتكلمناش معاكوا لسه عن ال GIT اه البرا
+
+417
+00:30:03,100 --> 00:30:06,020
+السيمباتاتيك هان بيعمل narrowing و خاصة إذا صار
+
+418
+00:30:06,020 --> 00:30:09,860
+فيه spasm السيمباتاتيك لأبيفتح للريقتين بيجلل
+
+419
+00:30:09,860 --> 00:30:15,240
+الإديمة الموجودة بيمنع ال .. ال .. ال narrowing في
+
+420
+00:30:15,240 --> 00:30:19,360
+ال .. في ال respiratory بيديني more ability to ..
+
+421
+00:30:19,360 --> 00:30:23,080
+to .. to have more air and more oxygen وهذا طبيعي
+
+422
+00:30:23,080 --> 00:30:27,680
+جدا أنه في ال sympathetic تبع الطوارئ أنه يديني ال
+
+423
+00:30:27,680 --> 00:30:34,920
+fuel اللي لازمنا لمين الطوارئ هو ال oxygen ال
+
+424
+00:30:34,920 --> 00:30:38,910
+.. هنا عندناالـ local secretory factors often
+
+425
+00:30:38,910 --> 00:30:42,150
+cause bronchial constriction لما يصير antigen
+
+426
+00:30:42,150 --> 00:30:44,710
+antibody reaction أو irritation by any substance
+
+427
+00:30:44,710 --> 00:30:48,710
+بنلاقي إحنا عندنا فيه mast cells بتتفجر و بتطلعلي
+
+428
+00:30:48,710 --> 00:30:53,210
+هستامين أو slow reactive substance of anaphylaxis
+
+429
+00:30:53,210 --> 00:30:57,250
+هدول المواد الكيميائية بتقدّي إلى الإديمة و إلى ال
+
+430
+00:30:57,250 --> 00:31:00,770
+narrowing و إلى ال spasm و إلى المشاكل اللي بتصير
+
+431
+00:31:00,770 --> 00:31:04,630
+دائما بتصير أيضا irritation للrespiratory tract
+
+432
+00:31:04,890 --> 00:31:08,590
+بتقدي إلى أن ال muscles تنفجر و بتقدي إلى إيه؟
+
+433
+00:31:08,590 --> 00:31:13,610
+خروج الهستامين بيعمللي ال picture of أزمة
+
+434
+00:31:13,610 --> 00:31:18,930
+narrowing و secretions كتيرة تمام؟ و slow reactive
+
+435
+00:31:18,930 --> 00:31:24,230
+substance as well ميوكاس
+
+436
+00:31:24,230 --> 00:31:27,850
+lining of the ال ميوكاس تبع ال bronchial tree
+
+437
+00:31:27,850 --> 00:31:32,210
+موجود في اتجاه الحلق فتحت ال phalanx بتدور في
+
+438
+00:31:32,210 --> 00:31:36,510
+اتجاه ال phalanx بتمشيوفي ال nose بتعمل تجاه عكسي
+
+439
+00:31:36,510 --> 00:31:40,490
+مش كده تصوروا لو اطلح بطاة الماء اللي كان ال mucus
+
+440
+00:31:40,490 --> 00:31:43,870
+كله بتنزل ايه على ال ايه على ال alveoli تسكرها لكن
+
+441
+00:31:43,870 --> 00:31:48,330
+عند ال alveoli كله بتطلع لفوق وعند ال nose بتطلع
+
+442
+00:31:48,330 --> 00:31:54,410
+من نفسي لتحت كله في تهمين في اتجاه بحيث ان احنا
+
+443
+00:31:54,410 --> 00:31:59,390
+جاعدين عدة مرات غيرنا mucus لكن مبلعوا بسهولة من
+
+444
+00:31:59,390 --> 00:32:03,600
+غير ما نحس فيه وانتش احنا ما نحس ان في مشكلةلما
+
+445
+00:32:03,600 --> 00:32:08,440
+يصير ال secretions اكتر من اللازم فبتصير تحس انه
+
+446
+00:32:08,440 --> 00:32:17,720
+فيه mucus بده يطلع او بده او بده طيب
+
+447
+00:32:17,720 --> 00:32:22,340
+ال cough reflex و sneezing اخر اشي بده اقولهم ال
+
+448
+00:32:22,340 --> 00:32:26,080
+coughing مش cough هو cough ال cough reflex vocal
+
+449
+00:32:26,080 --> 00:32:30,060
+cords irritation تحت ال ايه ال vocal cords بيصير
+
+450
+00:32:30,060 --> 00:32:32,660
+ال simulation ل ال afferent nerves of the vagus
+
+451
+00:32:33,740 --> 00:32:37,720
+تمام؟ بيرجعلي إشارة تعملي ال cuff اللي هي عبارة عن
+
+452
+00:32:37,720 --> 00:32:41,460
+إيش؟ عبارة عن أنه أنا أسكر ال .. ال .. ال .. ال ..
+
+453
+00:32:41,460 --> 00:32:44,020
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+454
+00:32:44,020 --> 00:32:46,660
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+455
+00:32:46,660 --> 00:32:46,680
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+456
+00:32:46,680 --> 00:32:46,800
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+457
+00:32:46,800 --> 00:32:47,000
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+458
+00:32:47,000 --> 00:32:47,080
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+459
+00:32:47,080 --> 00:32:47,220
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+460
+00:32:47,220 --> 00:32:47,880
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+461
+00:32:47,880 --> 00:32:48,140
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+462
+00:32:48,140 --> 00:32:48,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+463
+00:32:48,220 --> 00:32:52,750
+ال .. ال .. ال ..الـ intercostal muscles بتشد الـ
+
+464
+00:32:52,750 --> 00:32:57,050
+muscles of expiration بتشد بيعلق عند الضغط في داخل
+
+465
+00:32:57,050 --> 00:33:02,770
+الرئتين بعدين فجأة بيفتح الابوجلوتس كل شي بتطلع
+
+466
+00:33:02,770 --> 00:33:07,770
+على شكل كحة ده نفس مندفع قد يصل سرعته لسبعين ميل
+
+467
+00:33:07,770 --> 00:33:13,510
+في الساعة مندفع جدا تمام؟ سبعين ميل في الساعة
+
+468
+00:33:13,510 --> 00:33:18,950
+بيقدر إلى أنه وأنا بأضغط جاعدكمان ال ميوكاس او
+
+469
+00:33:18,950 --> 00:33:22,270
+الابيثيليام اللى بين ال .. ال cartridge rings
+
+470
+00:33:22,270 --> 00:33:27,850
+الريقتين بتندفع هذه المناطق الى ال human تمام؟ لما
+
+471
+00:33:27,850 --> 00:33:30,470
+تضغط عليها منبرة هي طارية بتخش لجوة هذا بيقدي
+
+472
+00:33:30,470 --> 00:33:33,450
+الأشياء اللى موجودة في ال slit sand اللى مخبية
+
+473
+00:33:33,450 --> 00:33:39,010
+كمان مع ضغط تتسير في اتجاه الهواء بحيث انه اي حاجة
+
+474
+00:33:39,010 --> 00:33:44,430
+غريبة تاخدها ال ايه؟ الاندفاع ال .. الطيار هواوي
+
+475
+00:33:45,270 --> 00:33:49,670
+الـ sneezing الـ irritation بيكون وين؟ في ال .. أه
+
+476
+00:33:49,670 --> 00:33:52,550
+above في ال nose فهذا بيقدر إلى نفس ال picture
+
+477
+00:33:52,550 --> 00:33:59,890
+لكنه عندى كمان ال .. ال .. أثناء بعمل ضغطي على
+
+478
+00:33:59,890 --> 00:34:04,850
+اليوغيولا بتنزل لتحتاللي هو soft palate بينزل لتحت
+
+479
+00:34:04,850 --> 00:34:08,170
+في اتجاه الثوم بيخلي انه الهواء اللي .. اللي اندفع
+
+480
+00:34:08,170 --> 00:34:11,550
+من التراكية ساعت مال إيه بو جلوتس فاتح انه مش يطلع
+
+481
+00:34:11,550 --> 00:34:14,510
+من الثوم يطلع من ال إيه؟ من الأنف لإن هو ده
+
+482
+00:34:14,510 --> 00:34:18,490
+الطريقة فبيقدر إلى تنظيف ال .. الأنف من ال إيه؟ من
+
+483
+00:34:18,490 --> 00:34:24,870
+any foreign material ال .. ال nasal ال reflex تبع
+
+484
+00:34:24,870 --> 00:34:28,970
+ال .. ال .. ال sneezing الafferent تبعه trigeminal
+
+485
+00:34:28,970 --> 00:34:33,220
+ال efferent الفيجل هو هوال .. ال .. ال .. قفنج
+
+486
+00:34:33,220 --> 00:34:37,380
+الأفرن تماميين الفيجل نفسه وال إفران الفيجل
+
+487
+00:34:37,380 --> 00:34:42,680
+الجهتين إذا عندي steps هنا اتنين و نص لتر من
+
+488
+00:34:42,680 --> 00:34:46,960
+الهواء بناخد نفس غميق بعدين بيسكر بعدين بيزيد
+
+489
+00:34:46,960 --> 00:34:50,300
+الضغط بعدين إيه؟ بندفع اتنين و نص لتر rapidly
+
+490
+00:34:50,300 --> 00:34:54,560
+inspired the epiglottis closes أبضومنا ال muscles
+
+491
+00:34:54,560 --> 00:34:57,580
+contract forcefully مش بس هم و كل ال expiratory
+
+492
+00:34:57,580 --> 00:35:02,430
+muscles بتضغط forcefully بعدينfourth the vocal
+
+493
+00:35:02,430 --> 00:35:05,850
+cords and the magrut is suddenly open widely هو
+
+494
+00:35:05,850 --> 00:35:11,550
+ايه؟ بيندفع الهواء بسرعة سبعين الى ميت mile بال
+
+495
+00:35:11,550 --> 00:35:14,310
+ايه؟ mile يعني يضربوا في اتنين point four في one
+
+496
+00:35:14,310 --> 00:35:19,010
+point six ال mile في one point six four اظن فسرعة
+
+497
+00:35:19,010 --> 00:35:24,310
+ايه رهيبة بتنط ال ال متين كيلو متر في الساعة تمام؟
+
+498
+00:35:24,310 --> 00:35:31,120
+وها كذا بنكون احنا ايه؟اتكلمنا عن الفصل الأول
+
+499
+00:35:31,120 --> 00:35:34,120
+خلصنا ال functions المختلفة هذه اللي بيساعدنا في
+
+500
+00:35:34,120 --> 00:35:36,680
+ال respiration و الله يعطيكوا العافية و مين اللي
+
+501
+00:35:36,680 --> 00:35:37,340
+هالسؤال؟
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90.srt
new file mode 100644
index 0000000000000000000000000000000000000000..b28893ed9e59fe73c04adfe44a1c06eb2098d758
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90.srt
@@ -0,0 +1,3026 @@
+
+1
+00:00:06,330 --> 00:00:09,990
+يعطيكم العافية اليوم، إن شاء الله، بإذن الله،أتكلم
+
+2
+00:00:09,990 --> 00:00:17,950
+عن موضوع جديد، الذي أعتقد أنه عندكم فكرة كبيرة
+
+3
+00:00:17,950 --> 00:00:23,810
+عنه، وهي قدرة الكلية في التحكم في تركيز
+
+4
+00:00:23,810 --> 00:00:28,560
+الـ blood، قدرتها على  regulation of extracellular
+
+5
+00:00:28,560 --> 00:00:33,460
+fluid osmolarity and sodium concentration.  تكلمنا
+
+6
+00:00:33,460 --> 00:00:37,200
+من أول يوم حكينا فيه عن anatomy of the kidney
+
+7
+00:00:37,200 --> 00:00:40,620
+وقلنا فيه ميضالة، وقلنا الميضالة هذه شغلتها
+
+8
+00:00:40,620 --> 00:00:45,400
+الأساسية هي to concentrate urine، تمام؟ لذا لو
+
+9
+00:00:45,400 --> 00:00:47,320
+أتكلم عن concentration of urine، نقول نحن في
+
+10
+00:00:47,320 --> 00:00:52,220
+عندنا حاجتين مهمتين لنعمل concentration of urine.
+
+11
+00:00:52,220 --> 00:00:55,340
+نحتاج
+
+12
+00:00:55,340 --> 00:01:02,140
+أن يكون عندنا هرمون مضادّ للبول جيد، وموجود، وشغال جيدًا
+
+13
+00:01:02,140 --> 00:01:08,340
+ومطلوب أن يكون عندنا رينال ميدولة بتشتغل كويس، إذن
+
+14
+00:01:08,340 --> 00:01:11,320
+نحن نريد حاجتين: hyperosmotic gradient تبقى
+
+15
+00:01:11,320 --> 00:01:15,840
+موجودة في الميدولة، ومطلوب أن يكون هناك هرمون مضاد للبول
+
+16
+00:01:15,840 --> 00:01:20,860
+موجود لكي يفتح الـ channels للماء لكي تتحرك من الـ
+
+17
+00:01:20,860 --> 00:01:24,580
+tubules إلى داخل الـ interstitium  لكي تعمل الـ
+
+18
+00:01:24,580 --> 00:01:32,240
+concentrated urine. بدايةً، خلينا نتكلم عن الكلية هذه
+
+19
+00:01:32,240 --> 00:01:39,150
+العجيبة التي بإمكانها أن تنتج as little as point
+
+20
+00:01:39,150 --> 00:01:43,910
+five liter of water per day، و as maximum as twenty
+
+21
+00:01:43,910 --> 00:01:49,680
+liters per day. variations ضخمة، وممكن تنتج as low
+
+22
+00:01:49,680 --> 00:01:56,220
+as 50 millimole per liter concentration، و as high
+
+23
+00:01:56,220 --> 00:02:03,880
+as 1400 millimole
+
+24
+00:02:03,880 --> 00:02:07,740
+per liter concentration. إذن، في عندنا variations
+
+25
+00:02:07,740 --> 00:02:13,720
+كبيرة موجودة. مثلًا،
+
+26
+00:02:13,720 --> 00:02:18,600
+لو نحن أخذنا لترًا من الماء وشربناه، ستنتج  ملاجة
+
+27
+00:02:18,600 --> 00:02:22,520
+خلال خمسة وأربعين دقيقة، بيصير لنا maximal
+
+28
+00:02:22,520 --> 00:02:29,560
+diuresis، والكمية التي نحن شربناها خلال ساعة ونصف
+
+29
+00:02:29,560 --> 00:02:35,120
+ساعتين بتكون عوضت.  ما الذي حدث هنا؟
+
+30
+00:02:35,120 --> 00:02:43,320
+drinking water.  حجم البول هنا، تدفق البول
+
+31
+00:02:43,320 --> 00:02:47,150
+rate، ها هنا بدأ بعد خمس دقائق. بدأ هنا، شربنا
+
+32
+00:02:47,150 --> 00:02:51,590
+الماء. شربنا الماء، تمام؟ بعد شوية، ها يطلع إدرار
+
+33
+00:02:51,590 --> 00:02:56,530
+ما هو حجم البول أو معدل التدفق عندي بعد شوية؟
+
+34
+00:02:56,530 --> 00:03:00,410
+بدأ يزيد إلى الحد الأقصى في خمسة وأربعين دقيقة، الحجم
+
+35
+00:03:00,410 --> 00:03:04,170
+يُخلص. ما الذي أخذناه زيادة ثم يهبط.
+
+36
+00:03:04,170 --> 00:03:07,790
+عندي، ها يطلع إدرار.  الـ osmolality تبع الـ blood هبطت
+
+37
+00:03:07,790 --> 00:03:10,810
+لأنه زاد تدفق البول، و osmolality of the
+
+38
+00:03:10,810 --> 00:03:14,540
+plasma.  أ يعني minimal changes and one liter. أيش
+
+39
+00:03:14,540 --> 00:03:18,340
+يُريد أن يعمل في الـ الـ 25 الـ الـ ثلاثة
+
+40
+00:03:18,340 --> 00:03:21,940
+liter  البلازما والعشرين liter  الذي هو ما هو
+
+41
+00:03:21,940 --> 00:03:24,680
+السائل الإضافي؟ سيكون minimal changes، لكن ملاحظ
+
+42
+00:03:24,680 --> 00:03:29,960
+نحن أصلاً عندنا نوع من التخفيف للـ
+
+43
+00:03:29,960 --> 00:03:35,620
+osmolality تبع البلازما، وسنلاحظ أن الـ
+
+44
+00:03:35,620 --> 00:03:39,860
+نحن أخذنا ماء نقيّ، إلى حد ما، سنجد الماء
+
+45
+00:03:39,860 --> 00:03:44,540
+خرج، لكن المحاليل الصلبة الخاصة به لم تتغير، طيب
+
+46
+00:03:44,540 --> 00:03:51,150
+إذن، الكلية لديها القدرة على أن، لو زاد الماء يخرج
+
+47
+00:03:51,150 --> 00:03:54,510
+ماء زيادة، ولو قل الماء يخرج ماء أقلّ. ولو زاد الـ
+
+48
+00:03:54,510 --> 00:03:58,750
+solutes يخرج solutes أكثر، ولو قل الماء يخرج الـ
+
+49
+00:03:58,750 --> 00:04:03,310
+solutes أقلّ. الاثنين غير مرتبطين ببعض، نظام التحكم
+
+50
+00:04:03,310 --> 00:04:06,790
+في الماء يختلف عن نظام التحكم
+
+51
+00:04:06,790 --> 00:04:10,790
+في الـ solutes. أحيانًا الاثنين
+
+52
+00:04:10,790 --> 00:04:14,030
+يشتغلان معًا في حالات الجفاف، حالات
+
+53
+00:04:14,030 --> 00:04:17,070
+النزيف، وانخفاض حجم السائل الإضافي
+
+54
+00:04:17,070 --> 00:04:21,990
+fluid، وأحيانًا كل واحد يعمل على حدة حسب الوضع.
+
+55
+00:04:21,990 --> 00:04:25,810
+تمام؟  من يشرب ماء كثير سيخرج ماء كثير، ومن يأكل
+
+56
+00:04:25,810 --> 00:04:30,030
+طعام صلب كثير، تمام؟ سيخرج مواد صلبة كثيرة.  يعتمد على
+
+57
+00:04:30,030 --> 00:04:35,110
+ما هو، لكن أحيانًا يكونان مرتبطين. هذا الضيف عندنا
+
+58
+00:04:35,110 --> 00:04:41,210
+هذا اسمه الـ hopping mouse. اسمه ماذا؟ The
+
+59
+00:04:41,210 --> 00:04:47,190
+Australian Hopping Mouse.  ترونه هذا؟ هذا كائن
+
+60
+00:04:47,190 --> 00:04:53,290
+صحراوي، بمعنى أن كمية الماء التي يتناولها
+
+61
+00:04:53,290 --> 00:04:57,270
+ضئيلة جدًا، ويعتمد على الماء الأساسي الذي يأتي من
+
+62
+00:04:57,270 --> 00:05:03,050
+metabolism الطعام
+
+63
+00:05:03,050 --> 00:05:07,910
+الخاص به. عملية الـ metabolism تنتج ماء، فيقدر إلى كمية
+
+64
+00:05:07,910 --> 00:05:11,150
+محترمة من الـ metabolism يستغلها.  تعرفون قد ماذا
+
+65
+00:05:11,150 --> 00:05:16,550
+يُمكنه تركيز الـ blood؟ عشرة آلاف ميلي أزمول، عشرة آلاف
+
+66
+00:05:16,550 --> 00:05:23,450
+ميلي أزمول، لأنه حيوان صحراوي، تمام؟ وعكس ذلك، الـ
+
+67
+00:05:23,450 --> 00:05:26,770
+beavers. هذا الـ beaver، هذا الـ الـ beaver
+
+68
+00:05:26,770 --> 00:05:33,890
+المائي، حيوان مائي، تمام؟  تركيز البول الـ
+
+69
+00:05:33,890 --> 00:05:37,330
+الـ الـ الـ urine عنده، تركيز الـ urine، الـ
+
+70
+00:05:37,330 --> 00:05:40,650
+maximum  عنده لا يزيد عن خمسمائة ميلي أزمول، الثاني عشر
+
+71
+00:05:40,650 --> 00:05:45,910
+ثلاثة ملي أزمول. نحن في المنتصف، لأن نحن نستطيع
+
+72
+00:05:45,910 --> 00:05:50,230
+أن نتحرك. نحن لا نعيش في الماء مثله، لا، نحن نعيش في
+
+73
+00:05:50,230 --> 00:05:55,110
+الـ في الـ في اليابسة. نستطيع أن نذهب
+
+74
+00:05:55,110 --> 00:05:59,810
+إلى الماء عندما نحتاج، ونتعرض أحيانًا إلى انقطاع مؤقت
+
+75
+00:05:59,810 --> 00:06:04,970
+للماء، لذلك نعمل تركيز متوسط بين الحالتين هاتين. طيب
+
+76
+00:06:04,970 --> 00:06:10,050
+إذن، نحن لاحظنا من خلال الحيوانات هذه ودرسناها أن
+
+77
+00:06:10,050 --> 00:06:17,370
+كمية تركيز البول تعتمد على طول الميضالة. كلما
+
+78
+00:06:17,370 --> 00:06:23,710
+كانت الميضالة أطول بالنسبة للكلية أكثر، كلما كان
+
+79
+00:06:23,710 --> 00:06:27,800
+عندنا بول مركز أكثر. طبعًا، كلما
+
+80
+00:06:27,800 --> 00:06:34,260
+قصرّت الميضالة، كلما قدرة التركيز للكلية
+
+81
+00:06:34,260 --> 00:06:39,420
+تقلّ. لاحظنا
+
+82
+00:06:39,420 --> 00:06:43,080
+أن الميضالة هذه، عندما يكون هناك تركيز blood،
+
+83
+00:06:43,080 --> 00:06:46,360
+لو أخذنا الـ interstitium الخاص بها وفحصناه سنجد
+
+84
+00:06:46,360 --> 00:06:51,260
+مركزًا، وعندما يخرج بول مخفف، لو أخذنا الـ
+
+85
+00:06:51,260 --> 00:06:55,700
+interstitium هذا وفحصناه سنجد مخففًا، يعني دائمًا
+
+86
+00:06:55,700 --> 00:07:01,100
+النتيجة النهائية لـ osmolality البول،  الـ final
+
+87
+00:07:01,100 --> 00:07:04,300
+osmolality أو التركيز سنجد مثل الـ
+
+88
+00:07:04,300 --> 00:07:09,080
+interstitium osmolality  تبع الميضالة، تمام؟ كما
+
+89
+00:07:09,080 --> 00:07:13,300
+أقول، هناك علاقة مؤكدة في هذا الموضوع.
+
+90
+00:07:16,490 --> 00:07:20,110
+لكن نعرف أن لديّ obligatory urine volume،
+
+91
+00:07:20,110 --> 00:07:24,830
+obligatory urine volume، يعني حجم البول
+
+92
+00:07:24,830 --> 00:07:30,710
+اللازم لإخراج الحد الأدنى لحجم البول
+
+93
+00:07:30,710 --> 00:07:37,170
+اللازم لإخراج  المنتجات الأيضية. طيب، بسم
+
+94
+00:07:37,170 --> 00:07:42,010
+الله الرحمن الرحيم. الآن، سؤالنا الذي دائمًا نسأله،
+
+95
+00:07:42,010 --> 00:07:46,660
+مثل ما يقولون،  يذهبون إلى البحر ويعودون بدون أن
+
+96
+00:07:46,660 --> 00:07:50,880
+يشربوا ماء، طيب. أنا أريد أن أسأل سؤال، أن أفضل
+
+97
+00:07:50,880 --> 00:07:54,880
+الذهاب إلى البحر وشرب ماء عندما يكون عطشان، أم لا
+
+98
+00:07:54,880 --> 00:07:59,260
+يشرب ماء؟ هل ماء البحر صالح للإنسان
+
+99
+00:07:59,260 --> 00:08:05,460
+ليستخدمه؟ لا، من يقول نعم؟ طيب، نحن نتكلم
+
+100
+00:08:05,460 --> 00:08:09,520
+كلام علميّ.  لا نعم ولا لا، هكذا أمثال.  سنقول إن
+
+101
+00:08:09,520 --> 00:08:14,610
+ماء البحر يكون فيه تركيز الأملاح ثلاثة إلى
+
+102
+00:08:14,610 --> 00:08:20,210
+ثلاثة ونصف في المائة، يعني تمثل حوالي ألف ومئتي ملي
+
+103
+00:08:20,210 --> 00:08:27,970
+أزمول بالليتر، تمام؟ ونحن عندنا تركيز الـ الـ
+
+104
+00:08:27,970 --> 00:08:33,810
+blood، أقصى ما يُمكن ألف ومئتان، ألف وأربعمائة، كلها ألف
+
+105
+00:08:33,810 --> 00:08:37,490
+ومئتان. يعني، قلنا لو الشخص شرب لترًا من ماء
+
+106
+00:08:37,490 --> 00:08:42,390
+البحر، مفترض أنه شرب لترًا، ألف ومئتي ملي أزمول فيه.
+
+107
+00:08:43,890 --> 00:08:48,970
+سيخرج لتر من الأملاح الـ الأملاح التي فيه
+
+108
+00:08:48,970 --> 00:08:51,930
+تساوي الـ يعني ألف ومئتان من الأزمول، الـ
+
+109
+00:08:51,930 --> 00:08:55,830
+maximum  الخاص بنا، أليس كذلك؟ لكن ليس هذا هو الواقع الحقيقي،
+
+110
+00:08:55,830 --> 00:08:59,430
+هي الـ الـ الوصفة التي تكلمنا عنها معناها أن
+
+111
+00:08:59,430 --> 00:09:06,170
+الشخص لكي يُخرج لترًا من ماء البحر، يحتاج لترًا من البول، أليس كذلك؟
+
+112
+00:09:06,170 --> 00:09:10,030
+لا، هذا الكلام لو صحيح، يكون الشخص لم يستفد
+
+113
+00:09:11,000 --> 00:09:15,180
+يعني، لا خسر ولا ربح ماء. لكن في الواقع، يخسر.
+
+114
+00:09:15,180 --> 00:09:18,980
+لماذا؟ يخسر، لأني أريد أن أخرج بول مركز
+
+115
+00:09:18,980 --> 00:09:24,340
+بـ ألف ومئتي. تكلمنا المرة الماضية، أو ما
+
+116
+00:09:24,340 --> 00:09:27,600
+تكلمنا، أو بالتأكيد سأتكلم اليوم، لكن تكلمنا المرة
+
+117
+00:09:27,600 --> 00:09:30,760
+الماضية أن التدرج الأسموزي الذي يكون في
+
+118
+00:09:30,760 --> 00:09:35,000
+الميضالة مسؤول عنه ليس فقط الأملاح، الصوديوم،
+
+119
+00:09:35,000 --> 00:09:41,000
+الكلوريد.  مسؤول عنه من أيضًا؟ اليوريا.
+
+120
+00:09:41,000 --> 00:09:45,980
+وقلنا خمسون في المائة منه مسؤولية اليوريا، وخمسون
+
+121
+00:09:45,980 --> 00:09:50,340
+في المائة مسؤولية الأملاح الأخرى. إذن، لأجل أن
+
+122
+00:09:50,340 --> 00:09:53,860
+تصل اليوريا إلى هذه المرحلة في الـ interstitium
+
+123
+00:09:53,860 --> 00:09:57,980
+بتركيز ألف ومئتي، يجب أن يكون لديّ كمية من اليوريا
+
+124
+00:09:57,980 --> 00:10:00,500
+تشارك بستمائة ميلي أزمول، والأملاح الأخرى تشارك
+
+125
+00:10:00,500 --> 00:10:03,320
+بستمائة ميلي أزمول، يعني يجب أن تكون اليوريا لديّ...و
+
+126
+00:10:03,320 --> 00:10:06,060
+ستصل تركيزها لكي تخرج بطريقة بسيطة
+
+127
+00:10:06,060 --> 00:10:09,630
+الانتشار، تخرج من الأنابيب بشكل بسيط
+
+128
+00:10:09,630 --> 00:10:13,730
+بالانتشار، لأنه عندي الهرمون المضادّ للبول يرفع الـ
+
+129
+00:10:13,730 --> 00:10:18,030
+التركيز ويفتح الـ urea transporters،
+
+130
+00:10:18,030 --> 00:10:21,750
+فتقدر اليوريا المركزة في الـ على
+
+131
+00:10:21,750 --> 00:10:24,690
+الكلام،  تبقى شوية صغيرة في الـ في الأنابيب
+
+132
+00:10:24,690 --> 00:10:28,110
+فتقدر إلى أن تعمل الانتشار، تمام؟ ستعمل
+
+133
+00:10:28,110 --> 00:10:30,250
+الانتشار حتى يصل التركيز الخاص باليوريا
+
+134
+00:10:30,250 --> 00:10:33,070
+في الأنابيب مثل الـ interstitium. إذن، يجب أن يكون
+
+135
+00:10:33,070 --> 00:10:38,020
+لديّ التركيز في اليوريا 600 تقريبًا،
+
+136
+00:10:38,020 --> 00:10:42,240
+أليس كذلك؟  في هذه الحالة، الـ 1200 التي تكون و
+
+137
+00:10:42,240 --> 00:10:45,160
+الـ 600 منهم يجب أن يكون ماذا؟ يوريا، لكي أخرج الـ
+
+138
+00:10:45,160 --> 00:10:48,740
+1200، لا أستطيع إخراجها مرة واحدة.  إذا أخرجت الـ 1200،
+
+139
+00:10:48,740 --> 00:10:52,200
+الـ 600 منهم يوريا والـ 600 منهم صوديوم وكلوريد
+
+140
+00:10:52,200 --> 00:10:56,280
+إذن،  أحتاج لإخراج الـ 1200  كم؟ لترين.
+
+141
+00:10:56,280 --> 00:11:00,660
+أنا أكون في هذه الحالة لو لم أشرب؟ أفضل، لأنه
+
+142
+00:11:00,660 --> 00:11:04,700
+أنا، إذا شربت ماء البحر، سأفقد مقابل كل
+
+143
+00:11:04,700 --> 00:11:08,200
+لتر لترًا إضافيًا، أليس كذلك؟  معناه أنني أدخل في
+
+144
+00:11:08,200 --> 00:11:11,980
+جفاف فوق ما هو جفاف أصلاً، وإلا لماذا
+
+145
+00:11:11,980 --> 00:11:16,750
+يُمكنني شرب ماء البحر حتى لو كنت عطشان، هو خطأ، شرب ماء
+
+146
+00:11:16,750 --> 00:11:24,990
+البحر، لكن المثل الذي قلته لا أعتقد أنه خطأ
+
+147
+00:11:24,990 --> 00:11:28,150
+كثيرًا. لماذا؟ لأن البحر في هذه الحالة، باللغة المصرية
+
+148
+00:11:28,150 --> 00:11:32,610
+يعني ماذا؟ يعني...يعني نهر النيل الذي وصل
+
+149
+00:11:32,610 --> 00:11:36,590
+الولاية، وهكذا، لكن حبيت أوضح لكم أن
+
+150
+00:11:36,590 --> 00:11:40,650
+بحرنا، لا، لا نشرب منه في مصر، ليس لأنه ماءه سيء
+
+151
+00:11:40,650 --> 00:11:44,990
+أما هو، إذا شربتم ماء من ماء البحر، ستكون مشكلة، لأنه
+
+152
+00:11:44,990 --> 00:11:49,670
+ستفقد مقابل كل لتر لترًا آخر لإخراج ما هو ماذا؟ الذي
+
+153
+00:11:49,670 --> 00:11:54,690
+شربتَ، لديك، لأنه لكي نخرج البول المركز
+
+154
+00:11:54,690 --> 00:11:59,970
+نحتاج إلى شيء آخر، نحتاج إلى أن يكون الهرمون المضاد للبول
+
+155
+00:11:59,970 --> 00:12:06,930
+مُنظّم، و و  تدرج أسموزيّ عالٍ.  الميضالة الكلوية
+
+156
+00:12:06,930 --> 00:12:07,270
+...
+
+157
+00:12:10,210 --> 00:12:13,790
+الهرمون المضادّ للبول، ذكرنا سيرته، والتدرج الأسموزيّ
+
+158
+00:12:13,790 --> 00:12:18,150
+الميضالة،  ذكرنا سيرتهما، لكن نريد التفاصيل، نريد ماذا؟
+
+159
+00:12:18,150 --> 00:12:22,430
+التفاصيل.  تفاصيل الهرمون المضاد للبول، ذكرنا
+
+160
+00:12:22,430 --> 00:12:25,910
+وتكلمنا عنها تقريبًا بما فيه الكفاية، وقلنا عنه، الـ
+
+161
+00:12:25,910 --> 00:12:29,550
+هرمون المضاد للبول أين يعمل؟ يعمل في الـ distal
+
+162
+00:12:29,550 --> 00:12:34,340
+tubule والـ collecting tubule والـ collecting duct.
+
+163
+00:12:34,340 --> 00:12:37,860
+يعني، من بعد الـ thick ascending limb والـ early
+
+164
+00:12:37,860 --> 00:12:41,040
+part of الـ distal tubule، يصبح لديّ الـ
+
+165
+00:12:41,040 --> 00:12:45,600
+هرمون المضاد للبول.  مكان عمله من هذه النقطة إلى النهاية،
+
+166
+00:12:45,600 --> 00:12:49,480
+تمام؟  إذن، الهرمون المضاد للبول، بوجوده، الـ الـ
+
+167
+00:12:49,480 --> 00:12:52,980
+الـ tubule من هذا الجزء إلى قمة الـ
+
+168
+00:12:52,980 --> 00:12:59,960
+papilla، يستطيع أن يمتص الماء، تمام؟  لكن في عدم
+
+169
+00:12:59,960 --> 00:13:02,860
+وجود الهرمون المضاد للبول، لن يكون لديّ امتصاص
+
+170
+00:13:02,860 --> 00:13:05,040
+للمياه. طبعًا، عندما يكون لديّ عدم
+
+171
+00:13:05,040 --> 00:13:06,820
+امتصاص للماء، لن يكون لديّ بول مركز
+
+172
+00:13:06,820 --> 00:13:14,620
+طبعًا. طيب، لحظة، أريدكم أن تركزوا معي قليلًا.  هكذا نحن
+
+173
+00:13:14
+
+223
+00:15:57,220 --> 00:16:02,900
+..و الـ plasma تمام؟ إذًا الجزئية المهمة في المضلة
+
+224
+00:16:02,900 --> 00:16:06,780
+أنها بتخلي الـ osmolality تعلى أكثر من الـ ايه؟ يعني
+
+225
+00:16:06,780 --> 00:16:10,380
+الجزء الأخير، الثلث الأخير من الـ filtrate اللي باقي
+
+226
+00:16:10,380 --> 00:16:14,480
+هو بيصير له نتحكم فيه و نعمله reabsorption لـ most
+
+227
+00:16:14,480 --> 00:16:18,560
+of it to have concentrated urine، إذًا الـ cortical
+
+228
+00:16:18,560 --> 00:16:24,000
+part له أهمية في الـ concentration لكن الـ medullary part
+
+229
+00:16:24,000 --> 00:16:29,750
+أهميته في ايش؟ أنه بيعمل لي ايش isosmotic urine هو
+
+230
+00:16:29,750 --> 00:16:33,370
+بيعمل لي hyper osmotic urine، إذًا الـ concentrated
+
+231
+00:16:33,370 --> 00:16:36,910
+urine مسئولية المدلة، لكن الـ reabsorption of water
+
+232
+00:16:36,910 --> 00:16:41,030
+في حالة الـ dehydration هي مش بس مسئولية المدلة، الـ
+
+233
+00:16:41,030 --> 00:16:45,430
+cortex بتسحب مية من الـ urine أكثر مما بتسحب ايه
+
+234
+00:16:45,430 --> 00:16:51,130
+تمام؟ ولو الـ flow تبع الـ .. الـ .. الـ filtrate نزل
+
+235
+00:16:51,130 --> 00:16:54,890
+المدلة بكمية كبيرة، بتقدرش المدلة تاخد هذه الكمية
+
+236
+00:16:55,540 --> 00:16:59,500
+لذلك احنا ايه .. لذلك نبدأ من بدري، من early part
+
+237
+00:16:59,500 --> 00:17:03,560
+التحكم في المية عشان يكون عندي enough يعني length
+
+238
+00:17:03,560 --> 00:17:07,780
+عشان ايه؟ أتحكم في الـ reabsorption of big amounts
+
+239
+00:17:07,780 --> 00:17:12,840
+الـ cortical معظم الأشياء .. طيب قلناها أن احنا
+
+240
+00:17:12,840 --> 00:17:17,810
+أن .. إذًا المية بيصير لها reabsorption في الجزء
+
+241
+00:17:17,810 --> 00:17:21,190
+الأخير، هذا كله لأن اسمه ده distal nephron ده
+
+242
+00:17:21,190 --> 00:17:24,490
+distal ايه؟ مش distal tubule، ده distal nephron
+
+243
+00:17:24,490 --> 00:17:27,470
+بيبدأ من الجزء اللي اسمه distal tubule للآخر، اسمه
+
+244
+00:17:27,470 --> 00:17:30,390
+distal nephron، خليني أتكلم عنه، إذًا الـ distal
+
+245
+00:17:30,390 --> 00:17:34,090
+nephron هذا فيه reabsorption of water according to
+
+246
+00:17:34,090 --> 00:17:36,350
+the body needs under the control of antidiuretic
+
+247
+00:17:36,350 --> 00:17:40,350
+hormone، مش هيك؟ وهذا الجزء كله هو permeable to
+
+248
+00:17:40,350 --> 00:17:43,210
+water، إذًا فيه antidiuretic hormone، لكن هل الجزء
+
+249
+00:17:43,210 --> 00:17:49,860
+هذا كله permeable to urea؟ لأ، إذًا الـ .. الـ .. الـ
+
+250
+00:17:49,860 --> 00:17:53,140
+cortical part منه هذا مش .. مش .. not .. not
+
+251
+00:17:53,140 --> 00:17:56,600
+permeable to urea، لكن الـ medullary part permeable
+
+252
+00:17:56,600 --> 00:17:59,660
+to urea، لذلك لما نقول احنا سرعنا reabsorption of
+
+253
+00:17:59,660 --> 00:18:04,460
+water في الـ cortex كان ضخم، مظبوط؟ و الـ urea not
+
+254
+00:18:04,460 --> 00:18:08,820
+reabsorbed، إذًا الـ urea لما تصل المدلة بتكون
+
+255
+00:18:08,820 --> 00:18:14,120
+concentrated، تمام واضح؟ من هنا، من هنا أن في عندي
+
+256
+00:18:14,120 --> 00:18:19,700
+طولتين المية، إذًا اليوريا اتضاعف تركيزها لثلث
+
+257
+00:18:19,700 --> 00:18:23,040
+أضعف، لأنه ايه؟ كانت في طولتين كمية، صارت في .. انسحب
+
+258
+00:18:23,040 --> 00:18:26,920
+منها طولتين صارت في طولة الكمية، إذًا اتضاعف تركيزها
+
+259
+00:18:26,920 --> 00:18:31,850
+ولما تدخل المضلة كمان، تمام؟ لما تدخل المضلة، برضه
+
+260
+00:18:31,850 --> 00:18:35,130
+فيه water reabsorption، بصمت؟ يعني فيه more
+
+261
+00:18:35,130 --> 00:18:40,030
+concentration of urea، لذلك الـ urea هي نازلة،
+
+262
+00:18:40,030 --> 00:18:42,450
+بيصير لها ايه؟ simple diffusion، إذًا الـ .. إذًا الـ
+
+263
+00:18:42,450 --> 00:18:44,770
+urea transformed لنا سفاتين، بيصير لها simple
+
+264
+00:18:44,770 --> 00:18:49,590
+diffusion لمين؟ للمدلة، ومن هنا بتشارك في صناعة
+
+265
+00:18:49,590 --> 00:18:50,370
+hyper osmotic
+
+266
+00:18:53,170 --> 00:18:56,770
+مدلة واضح، إذًا هي fifty percent من الـ osmotic
+
+267
+00:18:56,770 --> 00:19:00,310
+gradient، بسبب مين؟ لما نقول الـ maximum تبعنا تحت
+
+268
+00:19:00,310 --> 00:19:05,470
+الألف وميتين، إذًا ستمية منه من الـ A من اليوريا، واضح؟
+
+269
+00:19:05,840 --> 00:19:10,700
+إذًا الـ antidiuretic hormone مش بس بيساعدني على
+
+270
+00:19:10,700 --> 00:19:14,660
+أنه يعمل absorption of water، كمان بِرَكّز اليوريا
+
+271
+00:19:14,660 --> 00:19:18,220
+أكثر و بيساعد، بيساعدها في الـ diffusion، اتنين
+
+272
+00:19:18,220 --> 00:19:22,540
+برضه زي ما بيفتح الـ الـ water channels، الـ
+
+273
+00:19:22,540 --> 00:19:25,940
+antidiuretic hormone أيضًا بيفتح الـ ايه؟ الـ urea
+
+274
+00:19:25,940 --> 00:19:28,300
+transporters، بيعمل الـ .. الـ .. الـ .. الـ
+
+275
+00:19:28,300 --> 00:19:31,760
+facilitated diffusion هذا عن طريق الـ carrier و
+
+276
+00:19:31,760 --> 00:19:35,680
+بيساعد الـ diffusion، واضح؟ طيب كثير الكلام هذا، إذًا
+
+277
+00:19:35,680 --> 00:19:40,200
+احنا دلوقتي صار عندنا نظرة شاملة عن الـ
+
+278
+00:19:40,200 --> 00:19:43,740
+reabsorption و الـ water و الـ urea اللي بيعملوها، طيب
+
+279
+00:19:43,740 --> 00:19:46,840
+هذا ما يتعلق بالـ antidiuretic hormone و علاقاته
+
+280
+00:19:46,840 --> 00:19:50,920
+التفاصيل اللي إحنا هناخدها أكثر عن الـ osmotic
+
+281
+00:19:50,920 --> 00:19:52,160
+gradient هذا اللي بتكون
+
+282
+00:19:54,930 --> 00:19:58,850
+اتكلمنا عن جزء اليوريا منه وفهمناها، بس في جزء ما
+
+283
+00:19:58,850 --> 00:20:04,510
+فهمناهوش، في الآخر نتكلم عن الـ Urea cycle أو circuit
+
+284
+00:20:04,510 --> 00:20:08,430
+re-circuiting أو recycling of urea، هنتكلم عنها في
+
+285
+00:20:08,430 --> 00:20:11,550
+نهاية الكلام، بس دلوقتي نتكلم عن الـ osmolality
+
+286
+00:20:11,550 --> 00:20:15,350
+gradient هذا، الـ 50%، الأسئلة الأولانية منه تتكون من
+
+287
+00:20:15,350 --> 00:20:23,880
+الصوديوم و الكلوريد و السوليوت و الـ hyper osmolality، طيب
+
+288
+00:20:23,880 --> 00:20:32,420
+السوليوتس هدول .. السوليوتس
+
+289
+00:20:32,420 --> 00:20:40,820
+هدول لما يصلهم دور في الـ osmotic gradient تبع
+
+290
+00:20:40,820 --> 00:20:44,520
+المدلة، معناها بيكون صار عندي أنا ايه؟ في
+
+291
+00:20:44,520 --> 00:20:49,160
+absorption للسوليوتس بكميات أكبر من الـ .. من الـ
+
+292
+00:20:49,160 --> 00:20:54,700
+water عشان أعمل hyper osmotic مضلة، مظبوط؟ يعني
+
+293
+00:20:54,700 --> 00:20:59,760
+بدنا ننتقل من أي جزء؟ بدنا ننتقل، من الـ loop of Henle،
+
+294
+00:20:59,760 --> 00:21:03,980
+يعني مضلة، ايش فيها؟ مضلة فيها loop of Henle، و قلنا
+
+295
+00:21:03,980 --> 00:21:06,800
+فيها thin part و فيها ايش؟ thick part، وقلنا الـ
+
+296
+00:21:06,800 --> 00:21:09,300
+thick part هو ايش؟ reabsorbing solutes in
+
+297
+00:21:09,300 --> 00:21:13,220
+permeable  طبعًا، إذًا الـ thick part هذا هو الجزء
+
+298
+00:21:13,220 --> 00:21:17,710
+الرئيسي المسؤول عن ايش؟ عن أنه يعمل الـ osmotic
+
+299
+00:21:17,710 --> 00:21:22,410
+gradient، الـ solute part منه الـ 50%، تمام؟ إذًا هو
+
+300
+00:21:22,410 --> 00:21:25,310
+المسؤول عن الجزئية هذه هو اللي بيقدر إنه يدخل
+
+301
+00:21:25,310 --> 00:21:29,150
+solutes more than water، إذًا هذا بيقدر .. و أين
+
+302
+00:21:29,150 --> 00:21:32,030
+بيوديها؟ reabsorption للـ interstitium تبع مين؟
+
+303
+00:21:32,030 --> 00:21:37,310
+تبع المدلة، إذًا هذه العملية هي المفتاح الرئيسي
+
+304
+00:21:37,310 --> 00:21:43,440
+لعملية ايه؟ لعملية الـ .. الـ osmotic gradient، بس
+
+305
+00:21:43,440 --> 00:21:47,700
+احنا لاحظنا أن الـ pumping system هذا الموجود، قلنا
+
+306
+00:21:47,700 --> 00:21:52,400
+sodium one two chloride one potassium، مش هيك؟ الـ
+
+307
+00:21:52,400 --> 00:21:56,180
+pumping system هذا بيستطيع أنه يشتغل against ..
+
+308
+00:21:56,180 --> 00:21:58,360
+against gradient، مش كده؟ against concentration
+
+309
+00:21:58,360 --> 00:22:02,360
+gradient، بس أنه maximum، أنه maximum، أنه بيشتغل
+
+310
+00:22:02,360 --> 00:22:07,300
+against two hundred milli osmo difference، يعني
+
+311
+00:22:07,300 --> 00:22:12,260
+بيقدر ياخد من الـ fluid للـ interstitium بحيث أنه
+
+312
+00:22:12,260 --> 00:22:17,320
+يخلي الـ concentration في الـ interstitium أكثر من
+
+313
+00:22:17,320 --> 00:22:24,120
+الـ .. من الـ .. الـ tubule، الـ 200، واضح؟ يعني بيقدرش
+
+314
+00:22:24,120 --> 00:22:28,100
+إذا زاد عن 200 في الـ tubule، فهي بتوقف عن الايه؟ إذا
+
+315
+00:22:28,100 --> 00:22:33,420
+زاد الفرق برا؟ طيب إذًا هنا بدأنا أن نخش على
+
+316
+00:22:33,420 --> 00:22:37,310
+الموضوع، طب لما يكون عندي فرق 200 وأنا عندي داخل الـ
+
+317
+00:22:37,310 --> 00:22:42,950
+fluid الـ .. الـ .. الـ .. الـ .. الـ proximal tubule
+
+318
+00:22:42,950 --> 00:22:47,630
+بتسلم لي fluid isosmotic، مش كده؟ وصل للـ thick
+
+319
+00:22:47,630 --> 00:22:50,150
+ascending limb، في الحالة دي الـ thick ascending
+
+320
+00:22:50,150 --> 00:22:54,010
+limb بيقدر أنه ياخد solutes من جوا من الـ tubule
+
+321
+00:22:54,010 --> 00:22:57,270
+ويرميها للـ interstitium لحد ما يصير الفرق بين هذا
+
+322
+00:22:57,270 --> 00:23:00,870
+و هذا كده 200 من الأزمول، يعني هذا هيصير بدل 300
+
+323
+00:23:00,870 --> 00:23:07,300
+200 وهذا بدل 300، 400، تمام؟ هذه قدرته، لكن احنا
+
+324
+00:23:07,300 --> 00:23:11,020
+بنتكلم دلوقتي عن ايش؟ عن ألف وأربعمية، ألف وميتين
+
+325
+00:23:11,020 --> 00:23:16,120
+concentration gradient، أعلى من هيك بكثير، ايش اللي
+
+326
+00:23:16,120 --> 00:23:20,520
+بيصير؟ آه، بيصير what is called اللي هو الـ counter
+
+327
+00:23:20,520 --> 00:23:24,060
+current multiplier، counter current multiplication
+
+328
+00:23:24,060 --> 00:23:28,680
+counter current multiplication هو الراحل ايه؟
+
+329
+00:23:28,680 --> 00:23:32,200
+التعبير عشان أوريكم إياه، معلش، counter current
+
+330
+00:23:32,200 --> 00:23:32,780
+multiplication
+
+331
+00:23:35,840 --> 00:23:43,460
+الـ counter current multiplication هذا عبارة عن، صح؟
+
+332
+00:23:43,460 --> 00:23:52,280
+أنا باخد الـ solutes من داخل الـ tubule لبرا بكمية
+
+333
+00:23:52,280 --> 00:23:57,300
+معينة، بس هذه المسألة أنا عملتها، عملت مضاعفات في
+
+334
+00:23:57,300 --> 00:24:01,420
+system عندي اسمه counter current multiplier بيخلي
+
+335
+00:24:01,420 --> 00:24:05,630
+الاتنين دول، الفارق، يزيدوا ويزيدوا ويزيدوا
+
+336
+00:24:05,630 --> 00:24:09,610
+لدرجة يعمل لي الـ .. الـ osmotic gradient اللي
+
+337
+00:24:09,610 --> 00:24:15,650
+هو عند الـ .. الـ cortex، isosmotic، تلاتمية، وعند
+
+338
+00:24:15,650 --> 00:24:21,170
+الـ papilla بيطلع لألف وتلاتمية، ألف وأربعمية، كيف
+
+339
+00:24:21,170 --> 00:24:24,050
+بتصير هذه؟ مع أن القدرة تبعنا اتكلمنا عنها محدودة
+
+340
+00:24:24,050 --> 00:24:27,190
+مش هيك؟ طبعًا هو في مشاركة لليوريا، لكن
+
+341
+00:24:29,920 --> 00:24:33,820
+لكن كيف الـ solutes بتعمل استثمار من أزمون الفارق
+
+342
+00:24:33,820 --> 00:24:34,420
+تبعها؟
+
+343
+00:24:51,000 --> 00:24:53,980
+شوفناها، special characteristics of the loop of
+
+344
+00:24:53,980 --> 00:24:57,580
+Henle that cause solutes to be transported أو
+
+345
+00:24:57,580 --> 00:25:04,980
+trapped in the renal medulla
+
+346
+00:25:04,980 --> 00:25:09,100
+حاجة شوية صغيرة، قلنا الـ loop of Henle عليه جزء
+
+347
+00:25:09,100 --> 00:25:13,160
+thin وجزء thick، الجزء الـ thick قلنا impermeable
+
+348
+00:25:13,160 --> 00:25:17,960
+to water، و الـ ascending thin برضه impermeable to
+
+349
+00:25:17,960 --> 00:25:21,770
+water، تمام؟ إذًا الـ thin ascending limb .. الـ
+
+350
+00:25:21,770 --> 00:25:27,390
+ascending limb كله impermeable to water، الـ thick بـ
+
+351
+00:25:27,390 --> 00:25:34,450
+.. can reabsorb solutes actively، big amounts، الـ ..
+
+352
+00:25:34,450 --> 00:25:38,870
+الـ thin ascending، الـ transport عليه minimal، can
+
+353
+00:25:38,870 --> 00:25:42,890
+reabsorb solutes without water، لكنه minimal، الآن
+
+354
+00:25:42,890 --> 00:25:48,000
+الـ thin descending .. الـ thin ايه؟ descending؟ زي
+
+355
+00:25:48,000 --> 00:25:51,200
+الـ thin ascending، permeable to solutes and
+
+356
+00:25:51,200 --> 00:25:53,940
+permeable to water، يعني الـ descending هذا اللي
+
+357
+00:25:53,940 --> 00:25:57,600
+نازل، و الـ ascending الجزء اللي طالع، الـ thin منه
+
+358
+00:25:57,600 --> 00:26:02,160
+هذا permeable to solutes، partially permeable، لكنه
+
+359
+00:26:02,160 --> 00:26:05,160
+descending limb permeable to water، الـ ascending
+
+360
+00:26:05,160 --> 00:26:08,420
+limb thin not permeable to water، وبجيت طبعًا الـ
+
+361
+00:26:08,420 --> 00:26:11,520
+ascending limb not permeable to water، هذه المواصفات
+
+362
+00:26:11,520 --> 00:26:18,630
+تؤدي إلى العملية اللي بتكلم عنها، اللي هي creation
+
+363
+00:26:18,630 --> 00:26:23,130
+of osmotic gradient، يؤدي
+
+364
+00:26:23,130 --> 00:26:30,810
+إلى قدرة الكلية على امتصاص أو إخراج يورين مركز
+
+365
+00:26:30,810 --> 00:26:35,130
+جدا، والأخرين، الانمالي، تمام، الانمالي اتكلمنا عنه
+
+366
+00:26:35,130 --> 00:26:39,730
+عشر ألاف، عشر ألاف، معناها الـ loop of Henle تبعه هذا طويل
+
+367
+00:26:39,730 --> 00:26:43,510
+جدا لدرجة أن الـ multiplication بيظهر زي زي زي زي
+
+368
+00:26:43,510 --> 00:26:46,010
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+369
+00:26:46,010 --> 00:26:50,130
+زي زي زي
+
+370
+00:26:50,130 --> 00:26:50,630
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+371
+00:26:50,630 --> 00:26:53,130
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+372
+00:26:53,130 --> 00:26:55,170
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+373
+00:26:55,170 --> 00:26:55,490
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+374
+00:26:55,490 --> 00:27:04,410
+زي زي زي زي زي زي زي زي زي زي
+
+375
+00:27:04,410 --> 00:27:05,690
+زي ز
+
+376
+00:27:09,700 --> 00:27:14,460
+لو طلعنا هنا، في الوضع الطبيعي، الـ .. الـ .. الصورة
+
+377
+00:27:14,460 --> 00:27:18,300
+نمرة واحد، هذه الـ filter، جامع الـ proximal tubule
+
+378
+00:27:18,300 --> 00:27:28,400
+تركيزه isosmotic، مش كده؟ مفترض
+
+379
+00:27:28,400 --> 00:27:31,700
+يصير .. ايه اللي بيحصل في الـ loop وفين ليه؟ آه، و
+
+380
+00:27:31,700 --> 00:27:36,560
+يطلع الـ .. الـ difference في الجهة هذه، تمام؟ أنه ايش
+
+381
+00:27:36,560 --> 00:27:42,020
+يطلع؟ اللي هو isosmotic، ويكمل المشوار هنا، بيتدخل
+
+382
+00:27:42,020 --> 00:27:46,260
+عندنا الـ thick ascending limb، الـ thick ascending
+
+383
+00:27:46,260 --> 00:27:48,860
+limb بيعمل أنه reabsorption of the filtrate
+
+384
+00:27:48,860 --> 00:27:53,980
+solutes، impermeable to water، فبياخد الـ solutes
+
+385
+00:27:53,980 --> 00:27:57,060
+وبياخدش water، فده الـ diluting segment، احنا okay
+
+386
+00:27:57,060 --> 00:28:00,080
+diluting segment في داخل الـ tubule، لكن بالنسبة للـ
+
+387
+00:28:00,080 --> 00:28:04,100
+الـ interstitium صار concentrating segment، تمام؟
+
+388
+00:28:04,480 --> 00:28:06,780
+بالنسبة للإنترستيشن، مش الـ concentrating segment
+
+389
+00:28:06,780 --> 00:28:10,120
+بالنسبة للتيوبيول، الـ diluting لأنه بياخد solutes
+
+390
+00:28:10,120 --> 00:28:16,340
+بياخدش ايه؟ معاه، عالية، معاه، طيب إذًا يستطيع، يقول لنا
+
+391
+00:28:16,340 --> 00:28:19,420
+يعمل فرق جداش 200 ميلي أزمول، الـ pumping system
+
+392
+00:28:19,420 --> 00:28:23,060
+عنده هذه القدرة، فبنلاحظ هنا لما ياخد من هذه
+
+393
+00:28:23,060 --> 00:28:27,270
+المية، ويطلع المية للـ interstitium بيصل لـ ايه؟ للـ maximum
+
+394
+00:28:27,270 --> 00:28:30,390
+تبعه، لـ saturation level تبع الـ pumping system
+
+395
+00:28:30,390 --> 00:28:34,470
+فبنلاحظ احنا أن هذه العملية بتزيد الـ interstitial
+
+396
+00:28:34,470 --> 00:28:40,650
+fluid osmolality إلى 400 ملي أزمول وبت
+
+445
+00:32:05,690 --> 00:32:09,350
+loop of هنلي إلى الـ interstitium لكن هذا الدافع
+
+446
+00:32:09,350 --> 00:32:12,330
+بيجابِل في الطريق الفازاركته اللي أنا تحيط
+
+447
+00:32:12,330 --> 00:32:18,230
+الفازاركته تحيط بالـ .. بالـ .. بالـ descending tubule
+
+448
+00:32:18,230 --> 00:32:25,050
+بالـ descending limb اه، تصور إنه ديل الفرس تمام
+
+449
+00:32:25,050 --> 00:32:28,070
+الوسطية تبعته هذه الـ .. الـ .. الـ descending
+
+450
+00:32:28,070 --> 00:32:32,510
+loop of هنلي الوسطية تبعته لكن بجيط الشعر اللي حوالين
+
+451
+00:32:32,510 --> 00:32:38,090
+ديل الفرس هذا فزاركته، إذا هو بيطلع جاعد الـ .. الـ
+
+452
+00:32:38,090 --> 00:32:39,150
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+453
+00:32:39,150 --> 00:32:39,450
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+454
+00:32:39,450 --> 00:32:39,890
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+455
+00:32:39,890 --> 00:32:40,410
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+456
+00:32:40,410 --> 00:32:40,710
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+457
+00:32:40,710 --> 00:32:41,510
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+458
+00:32:41,510 --> 00:32:46,750
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+459
+00:32:46,750 --> 00:32:48,770
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+460
+00:32:48,770 --> 00:32:49,590
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+461
+00:32:49,590 --> 00:32:49,610
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+462
+00:32:49,610 --> 00:32:49,650
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+463
+00:32:49,650 --> 00:32:50,350
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+464
+00:32:50,350 --> 00:32:51,310
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+465
+00:32:54,420 --> 00:32:56,880
+في الـ interstitium لأنه لو زادت في الـ interstitium
+
+466
+00:32:56,880 --> 00:33:00,700
+إيش جابتها من ضربوها من عاوز نعمل الـ dilution و
+
+467
+00:33:00,700 --> 00:33:04,800
+بتضرب الفعل هيك لذا الأن صار عندي قدرة على أن أعمل
+
+468
+00:33:04,800 --> 00:33:11,160
+400 في الـ interstitium و أعمل filtrate بعد ما يخرج من الـ
+
+469
+00:33:11,160 --> 00:33:17,850
+proximal tubule و ينزل على الـ loop of هنلي تدخل و لو
+
+470
+00:33:17,850 --> 00:33:22,550
+loop of هنلي تدخل و لو loop of هنلي تدخل و لو loop of هنلي
+
+471
+00:33:22,550 --> 00:33:29,530
+تدخل و لو loop of هنلي تدخل و لو loop of هنلي تدخل و لو
+
+472
+00:33:29,530 --> 00:33:31,230
+loop of هنلي تدخل و لو loop of هنلي تدخل و لو loop of هنلي
+
+473
+00:33:31,230 --> 00:33:31,430
+تدخل و لو loop of هنلي تدخل و لو loop of هنلي تدخل و لو
+
+474
+00:33:31,430 --> 00:33:33,250
+loop of هنلي تدخل و لو loop of هنلي تدخل و لو loop of هنلي
+
+475
+00:33:33,250 --> 00:33:34,810
+تدخل و لو loop of هنلي تدخل و لو loop of هنلي تدخل و لو
+
+476
+00:33:34,810 --> 00:33:45,830
+loop of هنلي تدخل و لو loop of هنلي تدخل و لو loop of هنلي  تهو
+
+477
+00:33:45,830 --> 00:33:49,870
+.. إذا creating osmolality, osmotic gradient و الـ
+
+478
+00:33:49,870 --> 00:33:54,170
+system بيمنع إيه؟ بيعمل maintenance لمين؟ لهذا الـ
+
+479
+00:33:54,170 --> 00:33:56,970
+.. الـ .. الـ concentration gradient تمام؟ طيب،
+
+480
+00:33:56,970 --> 00:34:00,570
+ماشي، إذا مدام وصلنا لهذا المسألة هذه فهمناها، إذا
+
+481
+00:34:00,570 --> 00:34:04,790
+الـ multiplication ماوقفش، إذا هذا وصل لأربعماية،
+
+482
+00:34:04,790 --> 00:34:09,930
+إذا هذا وصل لأربعماية، تمام؟ إذا أنا هنا وصلت هنا
+
+483
+00:34:09,930 --> 00:34:16,130
+لأربعماية، الأربعماية هذه هتتحرك و تطلع فوق، صارت 400
+
+484
+00:34:16,130 --> 00:34:20,420
+أكبر من المائتين، إذا صار 400 أكبر من 400، مش كده؟ هذا عنده
+
+485
+00:34:20,420 --> 00:34:24,260
+القدرة أنه يعمل فرق، فبيقدر يضخها كمان مائة، بيصير الـ
+
+486
+00:34:24,260 --> 00:34:29,100
+intersection 500، هو إيه؟ 300 طبعاً، إذا صار عندي هنا
+
+487
+00:34:29,100 --> 00:34:33,560
+في الـ intersection إيه؟ 500، هيأخذ ماء من الـ
+
+488
+00:34:33,560 --> 00:34:37,920
+descending limb، بيوصل لمين؟ لـ 500، الـ 500 هتنزل للـ
+
+489
+00:34:37,920 --> 00:34:42,840
+ascending، هتصير 500 أكبر من 500، بتدي له كمان إيه؟ 100
+
+490
+00:34:42,840 --> 00:34:47,820
+بيصير هنا 600، وهنا 500، 400، 400، 400، 400، 400، 400
+
+491
+00:34:47,820 --> 00:35:07,460
+400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 400، 4400، 400، 400، 400، 4400، 400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400، 4400
+
+492
+00:35:12,380 --> 00:35:23,380
+هايبر أزموتك، أزموتك، أزموتك، أزموتك، أزموتك
+
+493
+00:35:23,380 --> 00:35:27,100
+أزموتك، أزموتك، أزموتك، أزموتك، أزموتك، أزموتك، أزموتك
+
+494
+00:35:27,100 --> 00:35:27,540
+أزموتك، أزموتك، أزموتك، أزموتك، أزموتك، أزموتك، أزموتك
+
+495
+00:35:27,540 --> 00:35:27,560
+أزموتك، أزموتك، أزموتك، أزموتك، أزموتك، أزموتك، أزموتك
+
+496
+00:35:27,560 --> 00:35:33,180
+أزموتك، أزموتك، أزموتك
+
+497
+00:35:33,180 --> 00:35:38,680
+أزم
+
+498
+00:35:43,060 --> 00:35:46,040
+بالكفاءة، فوق بياخد جزء، وتحت جزء، وتحت جزء، وتحت
+
+499
+00:35:46,040 --> 00:35:48,280
+جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت
+
+500
+00:35:48,280 --> 00:35:50,460
+جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت
+
+501
+00:35:50,460 --> 00:35:51,520
+جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت
+
+502
+00:35:51,520 --> 00:35:51,580
+جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت
+
+503
+00:35:51,580 --> 00:35:51,640
+جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت جزء، وتحت
+
+504
+00:35:51,640 --> 00:36:05,900
+جزء، وتحت جزء، و
+
+505
+00:36:05,900 --> 00:36:10,340
+تحت جزء، الـ distal tubule لما يعديلي من أول وجديد
+
+506
+00:36:10,340 --> 00:36:15,660
+على الـ، على الـ collecting duct وعندي antidiuretic
+
+507
+00:36:15,660 --> 00:36:19,840
+hormone موجود، و الـ water channels مفتوحة، و الـ urea
+
+508
+00:36:19,840 --> 00:36:24,840
+channels مفتوحة، بيصير الـ انتقال من هنا، تمام؟
+
+509
+00:36:24,840 --> 00:36:28,840
+إذا واضحة، إذا احنا طبعاً شوية صغيرة اتكلمنا عن دور
+
+510
+00:36:28,840 --> 00:36:35,220
+الـ antidiuretic hormone في أنه بيعمل دوره في الـ
+
+511
+00:36:35,220 --> 00:36:39,220
+concentration، بس دوره هنا في الـ cortex دوره صحيح
+
+512
+00:36:39,220 --> 00:36:44,500
+جالي اللي بيوصل لـ 300، لكنه حجماً كبيراً، الجزء اللي
+
+513
+00:36:44,500 --> 00:36:47,960
+بيظل صغير، بنزل المضلة و بيصير الـ concentration
+
+514
+00:36:47,960 --> 00:36:50,040
+أعلى من الـ
+
+515
+00:36:51,990 --> 00:36:55,990
+من الـ plasma osmolality تمام، بيصير أعلى لإنه يصير
+
+516
+00:36:55,990 --> 00:37:00,490
+عنده hyperosmotic شسمه، وبعدين بيشارك مين؟
+
+517
+00:37:00,490 --> 00:37:05,990
+بيشارك اليوريا فيها، عندنا هنتكلم عن اليوريا أكتر
+
+518
+00:37:05,990 --> 00:37:09,490
+وأكثر، لإن كيف تعمل الدائرة تبعها لما دخلت جوا، إيش
+
+519
+00:37:09,490 --> 00:37:12,970
+بيصير فيها، هتكلم عنها بعد شوية، إذن واضح الـ
+
+520
+00:37:12,970 --> 00:37:15,990
+counter current multiplier أو multiplication
+
+521
+00:37:15,990 --> 00:37:21,410
+counter current multiplication to hyper osmotic renal medullar
+
+522
+00:37:21,410 --> 00:37:27,450
+infestation and to concentrate urine، قلنا إذا
+
+523
+00:37:27,450 --> 00:37:31,940
+اللي شرب ماء البحر، في حال ما بتطلع concentrated
+
+524
+00:37:31,940 --> 00:37:36,800
+urine لازم يكون من نصفه urea، تمام؟ لإن الـ urea اللي
+
+525
+00:37:36,800 --> 00:37:40,780
+نازلة مشاركة في الـ interstitium، إذا تركيزها هيكون
+
+526
+00:37:40,780 --> 00:37:44,020
+في الـ .. في الـ .. في الـ .. في الـ trials زي الـ إيه؟
+
+527
+00:37:44,020 --> 00:37:46,800
+زي الـ interstitium، إذا بوصل لستمية، و الـ solids
+
+528
+00:37:46,800 --> 00:37:49,640
+الأخرى اللي أنا شربتها بتشارك بستمية، إذا بيدو
+
+529
+00:37:49,640 --> 00:37:53,040
+لترين، قلنا مش هيك؟ إذا هنا الـ urea كيف بتمشي؟
+
+530
+00:37:53,040 --> 00:37:59,480
+الـ urea و كيف بتعمل؟ في رسمة أنا يبدو إني شايلها مش
+
+531
+00:37:59,480 --> 00:38:04,460
+مشكلة، إذا احنا الأن اليوريا قلنا توّي إنه مراحل
+
+532
+00:38:04,460 --> 00:38:09,780
+التعامل معها، الـ proximal tubule بيقدر يمتص 50% من
+
+533
+00:38:09,780 --> 00:38:14,400
+اليوريا، تمام؟ إذا الـ loop اللي بيخش له بس 50% من
+
+534
+00:38:14,400 --> 00:38:18,480
+اليوريا اللي هي AFL-card، بصبوط؟ فاكرين هذه ولا
+
+535
+00:38:18,480 --> 00:38:21,080
+نسيتها أنتم؟ نسيتها يا عبدالله، إذا الـ proximal
+
+536
+00:38:21,080 --> 00:38:24,280
+tubule بيصير بيعمل رقم، يصور اليوريا اللي نازلة
+
+537
+00:38:24,280 --> 00:38:24,620
+الجهة
+
+538
+00:38:27,520 --> 00:38:33,080
+اليوريا اللي نازلة في الـ loop of Henle بتبطل لما
+
+539
+00:38:33,080 --> 00:38:35,440
+تصل الـ thick ascending .. لما تصل الـ ascending
+
+540
+00:38:35,440 --> 00:38:38,720
+limb .. الـ ascending limb impermeable to إيه؟ to
+
+541
+00:38:38,720 --> 00:38:45,300
+يوريا، لأ احنا قلنا الـ distal tubule للاخر
+
+542
+00:38:45,300 --> 00:38:49,770
+impermeable to يوريا، عندي حاجتين، يعني عندي إيه؟
+
+543
+00:38:49,770 --> 00:38:57,170
+حاجتين، عندي thick ascending و .. و .. و .. و .. و
+
+544
+00:38:57,170 --> 00:38:58,390
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+545
+00:38:58,390 --> 00:38:58,410
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+546
+00:38:58,410 --> 00:38:58,450
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+547
+00:38:58,450 --> 00:38:59,170
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+548
+00:38:59,170 --> 00:38:59,970
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+549
+00:38:59,970 --> 00:39:00,590
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+550
+00:39:00,590 --> 00:39:02,950
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+551
+00:39:02,950 --> 00:39:03,010
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+552
+00:39:03,010 --> 00:39:12,850
+.. و .. و .. و .. و .. و
+
+553
+00:39:14,720 --> 00:39:19,280
+إذا عندي أنا يوريا اندفعت، لإنها concentrated في الـ
+
+554
+00:39:19,280 --> 00:39:24,520
+tubular fluid، موجود في المضلة، عندي يوريا مركزة
+
+555
+00:39:24,520 --> 00:39:29,220
+وقلنا كيف تتركز، تندفع من الـ transporters إلى الـ
+
+556
+00:39:29,220 --> 00:39:33,080
+interstitium، اللي هو مفترض أنا لسه اليوريا فيه
+
+557
+00:39:33,080 --> 00:39:36,800
+عادية، زي ما في البلازما، تركيز اليوريا في البلازما
+
+558
+00:39:36,800 --> 00:39:41,760
+20 لـ 40 milligram per liter، يعني osmolality
+
+559
+00:39:41,760 --> 00:39:42,660
+واقعي حوالي
+
+560
+00:39:45,240 --> 00:39:47,680
+المشاركة في الـ .. في الـ .. في الـ general
+
+561
+00:39:47,680 --> 00:39:51,740
+responsibility للدم لا تُذكر للبلازما، تمام؟ إذا
+
+562
+00:39:51,740 --> 00:39:54,560
+عندي highly concentrated يوريا في الـ .. في الـ
+
+563
+00:39:54,560 --> 00:39:59,760
+tubular fluid اللي في المضلة، مش كده؟ و الـ
+
+564
+00:39:59,760 --> 00:40:02,220
+interstitium مش فيه concentration و transporters
+
+565
+00:40:02,220 --> 00:40:05,380
+فارقة، فتدفع الـ .. الـ يوريا إلى إيه؟ إلى الـ
+
+566
+00:40:05,380 --> 00:40:09,180
+interstitium، هتظل تندفع .. تندفع لحد ما إيه يصير
+
+567
+00:40:09,180 --> 00:40:17,420
+الـ concentration متساوي، مظبوط؟ طيب، متساوي وخلص
+
+568
+00:40:17,420 --> 00:40:22,020
+دورها؟ لأ، جا لها دور أكبر، كيف يعني؟ جزء من هذا
+
+569
+00:40:22,020 --> 00:40:26,890
+اللي دخل الـ interstitium هيدخل الـ loop
+
+570
+00:40:26,890 --> 00:40:31,130
+فين؟ ليه؟ هيزيد اليوريا اللي موجودة، احنا قلنا
+
+571
+00:40:31,130 --> 00:40:35,170
+قبل كده، الجسم مبني على اقتصاد، تمام، اليوريا دي
+
+572
+00:40:35,170 --> 00:40:38,510
+ما أطلعهاش أنا، لإنها end product ما بديش إياها، لكن إن
+
+573
+00:40:38,510 --> 00:40:41,390
+ما بدي أعمل concentrated urine، بدي تساعدني في
+
+574
+00:40:41,390 --> 00:40:47,390
+الموضوع، تمام، فبدي أحفظ جزء منها يساعدني في تركيز
+
+575
+00:40:47,390 --> 00:40:52,310
+الـ interstitium، معايا يا بنات؟ معايا مركزين؟ إذا ..
+
+576
+00:40:52,310 --> 00:40:56,350
+إذا مش واضح .. مش واضح، أُعيد تاني الأن الـ .. الـ ..
+
+577
+00:40:56,350 --> 00:40:58,010
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+578
+00:40:58,010 --> 00:40:58,130
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+579
+00:40:58,130 --> 00:40:58,170
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+580
+00:40:58,170 --> 00:40:58,430
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+581
+00:40:58,430 --> 00:40:58,630
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+582
+00:40:58,630 --> 00:40:59,570
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+583
+00:40:59,570 --> 00:40:59,890
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+584
+00:40:59,890 --> 00:41:00,670
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+585
+00:41:00,670 --> 00:41:06,270
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+586
+00:41:06,270 --> 00:41:07,670
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+587
+00:41:07,670 --> 00:41:09,070
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+588
+00:41:09,070 --> 00:41:15,890
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+589
+00:41:15,890 --> 00:41:19,370
+الـ
+
+590
+00:41:19,370 --> 00:41:21,410
+..
+
+591
+00:41:23,070 --> 00:41:26,670
+بيصير في عندي برضه permeable to water، إذا برضه يصحب
+
+592
+00:41:26,670 --> 00:41:31,470
+منه water، إذا كله بيساعد إن الـ urea تزيد تركيزها
+
+593
+00:41:31,470 --> 00:4
+
+667
+00:46:46,940 --> 00:46:50,040
+لي على الـ distal nephron كمية أكثر و إذا سحبنا
+
+668
+00:46:50,040 --> 00:46:54,020
+المياه بعمل تركيز أكثر و بتعمل الـ multiple cache اللي
+
+669
+00:46:54,020 --> 00:46:57,680
+قلنا عليه هذا
+
+670
+00:46:57,680 --> 00:47:01,760
+الجزء
+
+671
+00:47:01,760 --> 00:47:05,580
+counter current exchange in the vasa recta هذا الجزء
+
+672
+00:47:05,580 --> 00:47:09,560
+الثاني اللي أنا حكيت لكم عليها الـ vasa recta بتمشي
+
+673
+00:47:09,560 --> 00:47:15,580
+بطريقة ما تبقى حوالين الـ thin descending loop
+
+674
+00:47:15,580 --> 00:47:19,220
+حوالين الـ loop كله بس هي بالذات بتكون محيطة بمين؟
+
+675
+00:47:19,220 --> 00:47:29,330
+بالـ thin بحيث أن الـ ascending vasa recta
+
+676
+00:47:29,330 --> 00:47:34,500
+ملاصق للـ descending thin loop يعني هنا في
+
+677
+00:47:34,500 --> 00:47:39,200
+عندي counter current ماشيين عكس بعض تمام، إذا بيكون
+
+678
+00:47:39,200 --> 00:47:42,560
+عندي أنا أفرض أنه تلات حاجات هنا، وهنا حاجتين، هذا
+
+679
+00:47:42,560 --> 00:47:45,820
+الوسطانية هذا الـ tubular filtrate، تمام، الـ thin
+
+680
+00:47:45,820 --> 00:47:49,560
+descending loop و هدول الاثنين اللي جنبهم هدول
+
+681
+00:47:49,560 --> 00:47:54,160
+يمثلوا الـ ascending vasa recta و الـ descending
+
+682
+00:47:54,160 --> 00:47:58,380
+vasa recta، إذا الـ vasa recta بتنزل بعيد عن الـ tubule و هي
+
+683
+00:47:58,380 --> 00:48:02,130
+طالعة ملاصقة للـ tubule، لأن شغلها تحمل الماء
+
+684
+00:48:02,130 --> 00:48:06,550
+اللي طالع منه و هي طالعة تمام؟ تحملها و هي طالعة،
+
+685
+00:48:06,550 --> 00:48:08,690
+إذا التركيبة الـ anatomical structure تبع
+
+686
+00:48:08,690 --> 00:48:13,550
+الـ vasa recta معمولة بطريقة إنه يسحب كل الـ إيه؟ لو الـ
+
+687
+00:48:13,550 --> 00:48:16,970
+blood flow زاد في الـ vasa recta هذا بيقدر إلى أنه إيه؟
+
+688
+00:48:16,970 --> 00:48:22,730
+يعمل wash لكل الـ solutes كمان مش بس للـ water، واضح؟ طيب، التفاصيل مش كتير، التفاصيل تبع
+
+689
+00:48:22,730 --> 00:48:27,510
+الـ vasa recta أنتَ تصورتها زي ما أنا قلت لك عليها مش
+
+690
+00:48:27,510 --> 00:48:30,470
+هيك تخيلتوها، كيف أن الـ descending thin loop of
+
+691
+00:48:30,470 --> 00:48:34,950
+Henle محاط بالـ ascending vasa recta و بيعمل عملية
+
+692
+00:48:34,950 --> 00:48:38,950
+اتكلمنا عنها
+
+693
+00:48:38,950 --> 00:48:39,850
+جزء
+
+694
+00:48:45,230 --> 00:48:51,130
+إذا في الـ vasa recta counter current exchanger
+
+695
+00:48:51,130 --> 00:48:59,070
+تمام؟ يا رب يا كريم، إذا عندي هنا هذا الـ vasa
+
+696
+00:48:59,070 --> 00:49:03,930
+recta، هذه الصورة، هذه الـ vasa recta، و كيف أن الـ
+
+697
+00:49:03,930 --> 00:49:07,950
+fluids بتنتقل، المهم، أنا المهم اللي فهمته،
+
+698
+00:49:07,950 --> 00:49:11,410
+أكثر من ما تقولوا التفاصيل لأنها مزعجة شوية
+
+699
+00:49:17,100 --> 00:49:21,540
+الـ vasa recta لا تخلق مدالة عيب الأزمولالية، ولكنها
+
+700
+00:49:21,540 --> 00:49:26,820
+تحفظها من أن تكون محفوظة، الـ vasa recta شغلتها أنها
+
+701
+00:49:26,820 --> 00:49:30,560
+تمنع أن العيب الأزمولالية تذهب، من خلال أنها تسحب
+
+702
+00:49:30,560 --> 00:49:35,720
+المياه أول بأول، تحفظ مدالة عيب الأزمولالية، يمكن أن
+
+703
+00:49:35,720 --> 00:49:37,360
+تقوم بتحفظ مدالة عيب الأزمولالية، تحفظ مدالة عيب
+
+704
+00:49:37,360 --> 00:49:39,120
+الأزمولالية، تحفظ مدالة عيب الأزمولالية، تحفظ مدالة
+
+705
+00:49:39,120 --> 00:49:41,180
+عيب الأزمولالية، تحفظ مدالة عيب الأزمولالية، تحفظ مدالة
+
+706
+00:49:41,180 --> 00:49:47,160
+عيب الأزمولالية، تحفظ مدالة عيب 2% من blood supply
+
+707
+00:49:47,160 --> 00:49:51,140
+يعني 2% من الـ renal blood supply بتروح للمدلة، 98%
+
+708
+00:49:51,140 --> 00:49:55,920
+بتروح للـ cortex، يعني هنا ممكن أزيد لـ 5% maximum
+
+709
+00:49:55,920 --> 00:50:04,020
+لكن لو أنا عندي hypertension
+
+710
+00:50:04,020 --> 00:50:11,670
+شوية، يعني الضغط زاد، يعني الـ efferent arterioles
+
+711
+00:50:11,670 --> 00:50:15,490
+الـ efferent arterioles الضغط زاد، الـ peritubular capillary زاد، والجزء
+
+712
+00:50:15,490 --> 00:50:19,590
+اللي بينزل للـ vasa recta، الضغط زاد معناه
+
+713
+00:50:19,590 --> 00:50:22,150
+بيزيد الـ blood flow في الـ إيه؟ في المدلة، وهذا
+
+714
+00:50:22,150 --> 00:50:28,750
+washing الـ إيه؟ الـ osmotic gradient، إذا
+
+715
+00:50:28,750 --> 00:50:34,820
+certain vasodilators أو Hypertension ممكن يخرب لي
+
+716
+00:50:34,820 --> 00:50:41,000
+الـ osmotic gradient في المدلة و يخرب لي
+
+717
+00:50:41,000 --> 00:50:45,720
+الـ ability تبع الكلية لتركيز البول المركزي
+
+718
+00:50:45,720 --> 00:50:48,820
+لل بول
+
+719
+00:50:48,820 --> 00:50:51,160
+المركزي للبول المركزي للبول المركزي للبول
+
+720
+00:50:51,160 --> 00:50:51,200
+المركزي للبول المركزي للبول المركزي للبول
+
+721
+00:50:51,200 --> 00:50:51,260
+المركزي للبول المركزي للبول المركزي للبول
+
+722
+00:50:51,260 --> 00:50:52,500
+المركزي للبول المركزي للبول المركزي للبول
+
+723
+00:50:52,500 --> 00:50:53,020
+المركزي للبول المركزي للبول المركزي للبول
+
+724
+00:50:53,020 --> 00:50:54,100
+المركزي للبول المركزي للبول المركزي للبول
+
+725
+00:50:54,100 --> 00:50:58,150
+المركزي للبول المركزي للبول المركزي The kidney
+
+726
+00:50:58,150 --> 00:51:01,030
+can, when needed, execute highly concentrated urine
+
+727
+00:51:01,030 --> 00:51:05,110
+that contains little sodium، إذا عندي أنا الآن
+
+728
+00:51:05,110 --> 00:51:10,630
+البول صارت مش قصة إنها بس مشاركة اقتصادية، صارت
+
+729
+00:51:10,630 --> 00:51:14,050
+مشاركة أخرى، أنه أنا ممكن أطلع concentrated urine
+
+730
+00:51:14,050 --> 00:51:16,990
+لأن أنا محتاج المياه لكن برضه أنا محتاج الـ sodium
+
+731
+00:51:16,990 --> 00:51:23,810
+ما بديش أنا إيه أعمل reabsorption، أعمل excretion للـ
+
+732
+00:51:23,810 --> 00:51:28,280
+sodium، بدي كل الـ sodium آخده، تمام؟ في الحالة هذه
+
+733
+00:51:28,280 --> 00:51:35,660
+أنا بقدر أطلع concentrated urine فقط بالـ urea تمام؟
+
+734
+00:51:35,660 --> 00:51:40,420
+لذا إذا أنا كنت محتاج للصوديوم، وممكن يكون عندي
+
+735
+00:51:40,420 --> 00:51:43,760
+أنا concentrated urine طالع، بس اليوريا اللي فيه
+
+736
+00:51:43,760 --> 00:51:46,920
+إيه؟ عملت له concentration، مش محتاجين إن الصوديوم
+
+737
+00:51:46,920 --> 00:51:47,480
+أشاركه
+
+738
+00:51:50,250 --> 00:51:54,210
+إذاً نحتاج أن نشتغل يورين عالي التركيز، يحتوي على
+
+739
+00:51:54,210 --> 00:51:57,810
+قليل من الصوديوم، كلوريد، هيبريزمولارية لليورين
+
+740
+00:51:57,810 --> 00:52:02,970
+في هذه الحالات، هي عبارة عالية عن تركيزات أخرى
+
+741
+00:52:02,970 --> 00:52:10,570
+الصوديوم خاصة، يوريا، كرياتينين، مُحدث
+
+742
+00:52:10,570 --> 00:52:15,050
+مُحدث في حالة كهذه، يعني ما أحتاج أن آخذ الصوديوم
+
+743
+00:52:15,050 --> 00:52:19,540
+كله وأطلع يوريا، في حالة في حالة dehydration
+
+744
+00:52:19,540 --> 00:52:23,280
+شديدة، أنا بدي المياه و بدي الـ sodium بس بديش إيه؟
+
+745
+00:52:23,280 --> 00:52:26,320
+يوريا، فأنا بطلع concentrated urine صحيح لأن أخذت
+
+746
+00:52:26,320 --> 00:52:29,880
+كل المياه وأخذت كل الـ sodium لكن بلاقى الـ
+
+747
+00:52:29,880 --> 00:52:32,340
+concentrated urine طالع إيه؟ بالـ urea، إذا في
+
+748
+00:52:32,340 --> 00:52:37,500
+اليوريا هذه، عشان أنا أحافظ على المياه، بدي hyper
+
+749
+00:52:37,500 --> 00:52:42,240
+osmotic interstitium، مش كده؟ إذا لو كان عندي الـ
+
+750
+00:52:42,240 --> 00:52:49,870
+interstitium في كمية صوديوم كبيرة، معناها الصوديوم
+
+751
+00:52:49,870 --> 00:52:53,230
+اللي بيخش بالـ aldosterone مش هيقدر يخش، لأنه بيخش by
+
+752
+00:52:53,230 --> 00:52:58,030
+diffusion، مش كده؟ الـ aldosterone بيشتغل مع
+
+753
+00:52:58,030 --> 00:53:07,490
+الـ androgen  طبعاً إذا كان في عندي
+
+754
+00:53:07,490 --> 00:53:08,810
+صوديوم
+
+755
+00:53:12,550 --> 00:53:16,650
+إذا أنا ممكن آكل كل الـ sodium اللي من إيه؟ من الـ
+
+756
+00:53:16,650 --> 00:53:21,170
+من الـ tubule وأطلع فقط اللي هو اليوريا، وأطلع
+
+757
+00:53:21,170 --> 00:53:24,390
+فقط اليوريا، معناه أنا بيصير عندي absorption of
+
+758
+00:53:24,390 --> 00:53:27,450
+sodium كمية ضخمة، الـ interstitium بيضل فيه
+
+759
+00:53:27,450 --> 00:53:31,050
+concentrated sodium عشان ما يصيرش equilibrium، بيصير
+
+760
+00:53:31,050 --> 00:53:34,950
+عندي إلى ينزل لـ zero، عشان كل الـ sodium اللي في
+
+761
+00:53:34,950 --> 00:53:39,780
+الـ tubule يندفع للـ interstitium و reabsorbed، بالحظة
+
+762
+00:53:39,780 --> 00:53:43,080
+يعني ممكن أنا أوصل إنه كل العملية هذه تصير
+
+763
+00:53:43,080 --> 00:53:47,580
+بالـ urea وفي الآخر يطلع concentrated urea، طب والـ
+
+764
+00:53:47,580 --> 00:53:50,580
+sodium؟ الـ sodium reabsorbed completely عشان يكونوا
+
+765
+00:53:50,580 --> 00:53:53,920
+reabsorbed completely لازم الـ transition ما يكونش فيه
+
+766
+00:53:53,920 --> 00:53:56,780
+إيه؟ الـ sodium concentration، وإلا هيصير عندي أنا
+
+767
+00:53:56,780 --> 00:54:00,620
+equilibrium لحد ما الـ sodium يكون equilibrium، واضح؟
+
+768
+00:54:00,620 --> 00:54:04,950
+إذا في حالات بنلاقي إنه مش الاثنين مشاركين واحد
+
+769
+00:54:04,950 --> 00:54:09,110
+منهم وممكن العكس يصير، يعني الدقة في عمل الكلية هنا
+
+770
+00:54:09,110 --> 00:54:14,010
+أكبر من الشرح تبعنا، أكبر من الشرح تبعنا، لإنه جد ممكن
+
+771
+00:54:14,010 --> 00:54:16,730
+يطلع يوريا بزيادة أو صوديوم بزيادة أو صوديوم
+
+772
+00:54:16,730 --> 00:54:21,610
+بزيادة أو يوريا أقل أو مياه أكثر وصوديوم أقل أو
+
+773
+00:54:21,610 --> 00:54:26,290
+صوديوم أكثر ومياه أقل، very meticulous process
+
+774
+00:54:26,290 --> 00:54:31,220
+دقيقة جداً، بحيث أنه في الآخر احنا بنشرح عشان تعرفوا
+
+775
+00:54:31,220 --> 00:54:34,320
+بعض الـ procedures اللي بتصير، عشان تستوعبوا كيف الـ
+
+776
+00:54:34,320 --> 00:54:37,830
+control بيصير، لكن الـ control إيه؟ very complicated
+
+777
+00:54:37,830 --> 00:54:40,810
+لأنه بتدخل هنا عوامل كمان، other hormones و other
+
+778
+00:54:40,810 --> 00:54:46,870
+prostaglandins و vasodilators، قصص كبيرة، لكن واضح
+
+779
+00:54:46,870 --> 00:54:51,430
+من الكلام أنه في عندنا جهد كبير و تركيز كبير وعمل
+
+780
+00:54:51,430 --> 00:54:54,550
+كبير بيتم في الكلية بحيث أنها تختار بالضبط اللي
+
+781
+00:54:54,550 --> 00:54:57,850
+بيحتاجه حسب الأوامر اللي جاية من الجسم، احنا بنكمل
+
+782
+00:54:57,850 --> 00:55:02,270
+بنفهم البنية وهي عليها الـ إيه؟ عليها الباقي، هذا
+
+783
+00:55:02,270 --> 00:55:03,090
+النقطة الأولى
+
+784
+00:55:06,120 --> 00:55:08,800
+أنه ممكن أفصل أنا في الـ concentration ما بين الـ
+
+785
+00:55:08,800 --> 00:55:11,140
+sodium واليوريا، ممكن يطلع لي بس اليوريا لحالها
+
+786
+00:55:11,140 --> 00:55:13,900
+concentrated من غير ما يكون فيه sodium، أو ممكن
+
+787
+00:55:13,900 --> 00:55:17,980
+العكس، أو في العكس بيكون mainly sodium وجاية
+
+788
+00:55:17,980 --> 00:55:22,660
+اليوريا، النقطة الثانية اللي بدنا نتكلم عنها، large
+
+789
+00:55:22,660 --> 00:55:25,720
+quantities of diluted urine can be executed
+
+790
+00:55:25,720 --> 00:55:29,280
+without increasing the excretion of sodium، منفصلين
+
+791
+00:55:29,280 --> 00:55:32,620
+يعني لا يعني الـ volume الكبيرة من الـ urine أنه في
+
+792
+00:55:32,620 --> 00:55:37,700
+عندي كمان sodium كتير، لأ، ممكن يكون large volume of
+
+793
+00:55:37,700 --> 00:55:42,920
+diluted urine without
+
+794
+00:55:42,920 --> 00:55:46,420
+increasing the excretion of sodium، بمعنى أنه لما
+
+795
+00:55:46,420 --> 00:55:50,710
+بزيد البول، الـ excretion تبعه، الـ concentration of
+
+796
+00:55:50,710 --> 00:55:55,290
+sodium في الـ بول بتقل، لأنه بتطلع كمية معينة
+
+797
+00:55:55,290 --> 00:55:59,090
+بتطلع، بلاش كمية طلعت إن كان بحجم كبير بول ولا
+
+798
+00:55:59,090 --> 00:56:03,970
+بحجم قليل بول، إذا في هذه العملية excretion of
+
+799
+00:56:03,970 --> 00:56:08,270
+solutes منفصلة تماماً عن الـ water، إذا هي هي حتطلع
+
+800
+00:56:08,270 --> 00:56:11,270
+وكمية المياه اللي بدنا إياها حتطلع، فبيقدر إلى أنه
+
+801
+00:56:11,270 --> 00:56:14,110
+المياه بتطلع، الـ sodium concentration عالي أو واطي
+
+802
+00:56:14,900 --> 00:56:17,700
+ما له علاقة إن الـ volume زاد، يعني الـ water والـ
+
+803
+00:56:17,700 --> 00:56:20,540
+sodium زاد، لأ زي ما
+
+804
+00:56:20,540 --> 00:56:24,320
+قلنا في المثال الأول لما شربنا لتر مياه، جينا
+
+805
+00:56:24,320 --> 00:56:26,940
+المياه كثرت، لكن لقينا إن الـ sodium excretion ما تغيرش
+
+806
+00:56:26,940 --> 00:56:31,780
+لأن الـ concentration تبعه هبط، تمام؟ فالـ
+
+807
+00:56:31,780 --> 00:56:34,600
+concentration هبط و الـ volume of urine زاد فظهرت
+
+808
+00:56:34,600 --> 00:56:41,200
+كمية الـ excreted sodium هو هو، واضح؟ طيب
+
+809
+00:56:41,200 --> 00:56:47,370
+quantifying ingredients, concentration and dilution
+
+810
+00:56:47,370 --> 00:56:58,350
+نعمل عملية حسابية، نشرح
+
+811
+00:56:58,350 --> 00:57:05,750
+الجزء الأخير هنا، عملية osmolality هذه أو الـ urine
+
+812
+00:57:05,750 --> 00:57:11,030
+concentration ممكن نديله عملية قياسية، الـ
+
+813
+00:57:11,030 --> 00:57:15,040
+quantifying of urine concentration and dilution
+
+814
+00:57:15,040 --> 00:57:18,340
+جينا إنه احنا لما اتكلمنا عن الـ clearance في يوم
+
+815
+00:57:18,340 --> 00:57:21,700
+من الأيام، مش هيك؟ قلنا الـ clearance تبع المادة
+
+816
+00:57:21,700 --> 00:57:27,820
+المعينة هو قد ايش أنا بقدر أنظف بلازما من مادة معينة
+
+817
+00:57:27,820 --> 00:57:32,160
+وقلنا الحسبة تبعها سهلة، اه الـ concentration في الـ
+
+818
+00:57:32,160 --> 00:57:35,240
+volume تبع الـ urine في الجسم على الـ concentration
+
+819
+00:57:35,240 --> 00:57:39,400
+في البلازما بيطلع كم سنتي بلازما نظيفة بالضبط، طب
+
+820
+00:57:39,400 --> 00:57:43,320
+أنا ممكن أعمل clearance of osmoles، clearance of
+
+821
+00:57:43,320 --> 00:57:52,110
+إيه؟ أوزمولز، قد ايش أنا طلعت أوزمولز، بقول أنا أزمولية
+
+822
+00:57:52,110 --> 00:57:58,470
+لليورين في الـ volume على أزمولية البلازما، مش هيك؟
+
+823
+00:57:58,470 --> 00:58:06,250
+بقدر أقول أنا قد ايش عملت، نظفت البلازما من كل الـ solutes
+
+824
+00:58:06,250 --> 00:58:09,750
+لأن كل الـ osmotically active solutes أنا بتكلم عنها جاية
+
+825
+00:58:09,750 --> 00:58:13,770
+مضافة منها كلها، إذا ما قد ايش أوزمول طلعوا، هدول
+
+826
+00:58:13,770 --> 00:58:17,570
+الأوزمول الموجودة في كم سنتي، كم مل، إذا في حاجة اسمها
+
+827
+00:58:17,570 --> 00:58:23,610
+clearance of إيه؟ of osmoles، طيب، إذا الآن لما يكون
+
+828
+00:58:23,610 --> 00:58:32,720
+عندي تركيز البول يساوي تركيز البلازما يعني
+
+829
+00:58:32,720 --> 00:58:37,040
+أوزمول هنا، أزمولية هنا، وأزمولية هنا واحد بالضبط
+
+830
+00:58:37,040 --> 00:58:42,820
+معناه الـ clearance of osmoles هذا يساوي الـ urine
+
+831
+00:58:42,820 --> 00:58:47,120
+volume، مش كده؟ لأن الـ urine volume في الـ
+
+832
+00:58:47,120 --> 00:58:49,120
+concentration على الـ concentration بروح الـ
+
+833
+00:58:49,120 --> 00:58:53,100
+concentration هذا مع بعض، لأنه متساويين بيصير الـ إيه؟
+
+834
+00:58:53,100 --> 00:58:56,360
+الـ clearance of osmoles يساوي إيه؟ الـ urine volume
+
+835
+00:58:56,360 --> 00:59:03,670
+طيب، لو كان أنا عندي diluted urine، تمام؟ يعني عندي
+
+836
+00:59:03,670 --> 00:59:07,270
+diluted urine، كمية الأوزمولز اللي موجودة فيه
+
+837
+00:59:07,270 --> 00:59:13,170
+أقل بالنسبة للحجم، تمام؟ عندي حجم مياه كتير، لكن عندي
+
+838
+00:59:13,170 --> 00:59:17,410
+أوزمولز قليلة، أقول volume في الـ concentration
+
+839
+00:59:17,410 --> 00:59:20,990
+للـ urine diluted على الـ concentration في البلازما
+
+840
+00:59:20,990 --> 00:59:28,150
+أعلى، مش هيك؟ في الحالة هذه أنا بطلع بلاقي أنه
+
+841
+00:59:28,150 --> 00:59:36,450
+إيه؟ بضرب الـ volume،
+
+889
+01:03:16,290 --> 01:03:21,010
+من له السؤال؟ جهنم! اطلع منها، ما فيش مانع، اسأليها.
+
+890
+01:03:21,010 --> 01:03:27,640
+السؤال واضح؟ طيب، أحنا قلنا للمسؤول عن عملية الـ
+
+891
+01:03:27,640 --> 01:03:30,740
+concentration of urine لازم يكون عندي حاجتين: عندي
+
+892
+01:03:30,740 --> 01:03:33,500
+antidiuretic hormone مظبوط، وعندي osmotic gradient
+
+893
+01:03:33,500 --> 01:03:37,940
+مظبوط. اتكلمنا احنا بالتفصيل عن الجهتين، لكن هنا
+
+894
+01:03:37,940 --> 01:03:43,040
+بهمنا أنه نجيب سيرة بعض الأشياء المهمة بما يتعلق
+
+895
+01:03:43,040 --> 01:03:47,360
+بالـ antidiuretic hormone. الـ antidiuretic hormone هذا
+
+896
+01:03:47,360 --> 01:03:51,180
+hormone بيطلع من الـ pituitary gland. هندرسه الفصل اللي
+
+897
+01:03:51,180 --> 01:03:54,770
+جاي إن شاء الله. يعني، يدرس الـ ... بتويتري والتفاصيل
+
+898
+01:03:54,770 --> 01:03:57,570
+تبعته. الفصل جايه في الـ endocrine، لكن الـ antidiuretic
+
+899
+01:03:57,570 --> 01:04:02,390
+hormone هذا، إذا صار عندي إشكال، trauma، something،
+
+900
+01:04:02,390 --> 01:04:05,150
+شيء أثر على الـ pituitary gland، ممكن الـ antidiuretic
+
+901
+01:04:05,150 --> 01:04:08,810
+hormone بطل يطلع. فإذا بطل يطلع الـ antidiuretic hormone،
+
+902
+01:04:08,810 --> 01:04:12,710
+حسين عندي diuresis كتير. إن هو بمنع الـ
+
+903
+01:04:12,710 --> 01:04:17,480
+diuresis، بظبط الـ osmolality حسب حاجة الجسم، لكن هو
+
+904
+01:04:17,480 --> 01:04:21,880
+بطل يبقى موجود، فصار الـ fluid اللي بيصل الـ distal
+
+905
+01:04:21,880 --> 01:04:28,300
+tubule يظل إيه؟ يظل كما هو. ليش؟ لأن الـ antidiuretic
+
+906
+01:04:28,300 --> 01:04:31,340
+الهرمون اللي بده ياخد الميزة اللي محتاجينها مش
+
+907
+01:04:31,340 --> 01:04:36,120
+موجود، تمام؟ إذا في عندي كمية كبيرة من الـ urine
+
+908
+01:04:36,120 --> 01:04:40,940
+بتطلع، شبيهة باللي عنده diabetes mellitus، بس الفرق
+
+909
+01:04:40,940 --> 01:04:44,020
+بين هذا وهذا، أحنا فكرناها diabetes، واتفحصناها،
+
+910
+01:04:44,020 --> 01:04:48,540
+لاقينا ما فيش سكر، فقلنا هذا diabetes insipidus. من
+
+911
+01:04:48,540 --> 01:04:53,040
+هنا، اجى اسمه زي السكري، لكنه كاذب، شبه السكر، فإنه
+
+912
+01:04:53,040 --> 01:04:56,780
+بيعطش، وبينشف فمه، وبيتبول كتير. هذه مواصفات إيه
+
+913
+01:04:56,780 --> 01:05:01,900
+السكري: إنه بيتبول كتير، وبيحس أنه إيه؟ عنده جفاف في
+
+914
+01:05:01,900 --> 01:05:05,560
+الحلق، وبيضل يشرب ماء كتير عشان يضيع هذا الإحساس
+
+915
+01:05:05,560 --> 01:05:09,440
+بالجفاف. هذا المرض السكري، البول السكري، أحنا عارفينه،
+
+916
+01:05:09,440 --> 01:05:13,020
+لكن هذا بول كتير، وعامل نفس المواصفات، لكن ما فيش
+
+917
+01:05:13,020 --> 01:05:17,200
+فيه سكر. لذلك، سميّناه diabetes insipidus. الـ diabetes
+
+918
+01:05:17,200 --> 01:05:21,260
+insipidus هذا يقولنا فيه منها نوعين: في عندنا نوع
+
+919
+01:05:21,260 --> 01:05:23,760
+central diabetes insipidus، يعني إصابة من أساسها
+
+920
+01:05:23,760 --> 01:05:27,430
+جاية في الـ pituitary gland، في المركزية، في مركزية
+
+921
+01:05:27,430 --> 01:05:30,990
+الـ antidiuretic hormone، تمام؟ وممكن يكون في نوع
+
+922
+01:05:30,990 --> 01:05:34,290
+مش central، peripheral، يعني المشكلة في الكلية، مش
+
+923
+01:05:34,290 --> 01:05:37,010
+المشكلة في الـ antidiuretic hormone. طبيعي، لكن الكلية
+
+924
+01:05:37,010 --> 01:05:40,030
+مش راضية تستجيب للـ antidiuretic hormone. nephrogenic
+
+925
+01:05:40,030 --> 01:05:44,910
+diabetes insipidus. إذا الـ diabetes insipidus عندنا في
+
+926
+01:05:44,910 --> 01:05:49,430
+نوع منه central type، وnephrogenic type. nephrogenic
+
+927
+01:05:49,430 --> 01:05:56,040
+type يعني عندها إيش بيكون؟ يعني الـ response of the
+
+928
+01:05:56,040 --> 01:05:58,040
+antidiuretic hormone on the kidney is abolished.
+
+929
+01:05:58,040 --> 01:06:03,800
+مش موجود، بسبب أنه عندي الـ ... الـ receptors الموجودة
+
+930
+01:06:03,800 --> 01:06:06,280
+مثلاً، مرضى بيكون فيه مشكلة في الـ receptors، الـ V2
+
+931
+01:06:06,280 --> 01:06:09,580
+receptors، اتكلمنا عنها، اللي في الـ distal tubule، في
+
+932
+01:06:09,580 --> 01:06:15,600
+كل الجسم. ممكن تكون هي إيه؟ المشكلة فيها بتؤدي إلى
+
+933
+01:06:15,600 --> 01:06:19,800
+أنه الـ antidiuretic hormone، إذا في failure of the
+
+934
+01:06:19,800 --> 01:06:24,920
+counter-current mechanism. عندنا الجزئية بتخصنا عن failure of the
+
+935
+01:06:24,920 --> 01:06:28,480
+distal and collecting tubules and collecting ducts
+
+936
+01:06:28,480 --> 01:06:31,620
+to respond to antidiuretic hormone. وهذا ممكن
+
+937
+01:06:31,620 --> 01:06:35,660
+يكون response من أي مكان، أو بيكون عندي أنا ممكن
+
+938
+01:06:35,660 --> 01:06:40,040
+أنا أطلع كمية كبيرة من الـ urine، تمام؟ يكون عندي
+
+939
+01:06:40,040 --> 01:06:44,960
+القدرة على تركيز الـ urine ضعيفة. هذه وين موجودة؟
+
+940
+01:06:44,960 --> 01:06:47,480
+القدرة على تركيز الـ urine؟ في المضلة. يعني، وين من
+
+941
+01:06:47,480 --> 01:06:50,740
+في المضلة؟ في الـ thick ascending limb mainly. إذا ممكن
+
+942
+01:06:50,740 --> 01:06:53,260
+يكون عندي خلل في الـ thick ascending limb، يتّدي إلى
+
+943
+01:06:53,260 --> 01:06:56,720
+nephrogenic diabetes insipidus، أو ممكن يكون الـ
+
+944
+01:06:56,720 --> 01:06:59,620
+diabetes insipidus سببه برضه no response to
+
+945
+01:06:59,620 --> 01:07:02,020
+antidiuretic hormone. إذا عندي الـ diabetes
+
+946
+01:07:02,020 --> 01:07:05,560
+insipidus، ممكن تكون central، وتكون peripheral، لكن
+
+947
+01:07:05,560 --> 01:07:07,780
+في الـ central والـ peripheral، ممكن يكون سببها
+
+948
+01:07:07,780 --> 01:07:11,070
+antidiuretic hormone. وممكن يكون الـ nephrogenic
+
+949
+01:07:11,070 --> 01:07:15,350
+سببها، لأ، مش antidiuretic hormone، سببها إيه؟ Failure of
+
+950
+01:07:15,350 --> 01:07:18,570
+the concentrating mechanism in the ... in the ... in
+
+951
+01:07:18,570 --> 01:07:22,570
+the ... in the thick ascending limb. إذا الـ failure
+
+952
+01:07:22,570 --> 01:07:25,570
+of the counter-current mechanism to form a hyper-
+
+953
+01:07:25,570 --> 01:07:28,810
+osmotic renal medullary interstitium. لأن أحنا قلنا
+
+954
+01:07:28,810 --> 01:07:31,430
+الـ concentration أساسه، interstitium مظبوط، و
+
+955
+01:07:31,430 --> 01:07:34,190
+antidiuretic hormone مظبوط. ممكن يطلع كمية كبيرة من
+
+956
+01:07:34,190 --> 01:07:36,970
+البول، لو ما فيش تركيز. إذا الـ interstitium مش مظبوط،
+
+957
+01:07:36,970 --> 01:07:40,290
+الـ counter-current multiplication تكلمنا عنه قبل كده، أو
+
+958
+01:07:40,290 --> 01:07:43,710
+يكون إيه؟ الـ antidiuretic hormone مش موجود. هذا يسمى
+
+959
+01:07:43,710 --> 01:07:47,910
+nephrogenic، لأنه في نوع ثاني، central، اللي هو إيه؟
+
+960
+01:07:47,910 --> 01:07:54,380
+لما يكون عندي مشكلة في الـ pituitary. ممكن أحنا خلصنا
+
+961
+01:07:54,380 --> 01:07:58,560
+المحاضرة هذه، والـ chapter هذه، حقيقة، لأن جيت الـ
+
+962
+01:07:58,560 --> 01:08:02,600
+chapter هذا تحصيل حاصل، يعني عبارة عن أشياء تُعاد
+
+963
+01:08:02,600 --> 01:08:09,070
+بطريقة ... يمكن، إذا كان معانا وقت أكثر، أشرح لكم الـ
+
+964
+01:08:09,070 --> 01:08:11,870
+third mechanism والكلام هذا، بس في الـ time management هذا
+
+965
+01:08:11,870 --> 01:08:16,890
+بس فيه أشياء كثيرة هذه مش هنشرحها، لإنه في بعدين كده
+
+966
+01:08:16,890 --> 01:08:21,850
+بيصير إيه؟ عيب الـ ... عيب الـ ... الـ guiding أنه ممكن يصير
+
+967
+01:08:21,850 --> 01:08:26,070
+بس يجمع أشياء وكلها انشرحت في مناطق أخرى. مش معقول
+
+968
+01:08:26,070 --> 01:08:30,030
+أنه يضيع لها محاضرة كاملة للتجميع، بس إن الـ third
+
+969
+01:08:30,030 --> 01:08:33,630
+mechanism احتمال أشرحه. تمام، بيضل عندي هنا في
+
+970
+01:08:33,630 --> 01:08:38,710
+الغالب محاضرتين أو ثلاث. لأ، الـ ... الـ kidney تسيب ليّش
+
+971
+01:08:38,710 --> 01:08:43,390
+إن ممكن خلصناها، تمام؟ ليش؟ لإنه في فاصل الـ
+
+972
+01:08:43,390 --> 01:08:46,230
+potassium والـ magnesium regulation، ده مش هتكلم
+
+973
+01:08:46,230 --> 01:08:51,130
+عنه، لإنه موزع بين مواد أخرى، okay. من هنا؟ من اللي
+
+974
+01:08:51,130 --> 01:08:51,770
+سؤال؟
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..0c662bd251b0f8577a4deb1077dd6aff2edad3d5
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_postprocess.srt
@@ -0,0 +1,3896 @@
+1
+00:00:06,330 --> 00:00:09,990
+يعطيكوا العافية اليوم ان شاء الله بإذن الله اتكلم
+
+2
+00:00:09,990 --> 00:00:17,950
+عن موضوع جديد اللي هو اعتقد انه عندكوا فكرة كبيرة
+
+3
+00:00:17,950 --> 00:00:23,810
+عنه اللي هي قدرة ال .. الكلية في التحكم في تركيز
+
+4
+00:00:23,810 --> 00:00:28,560
+ال ball قدرتها على ايه؟regulation of extracellular
+
+5
+00:00:28,560 --> 00:00:33,460
+fluid osmolarity and sodium concentration اتكلمنا
+
+6
+00:00:33,460 --> 00:00:37,200
+من اول يوم حكينا فيه عن anatomy of the kidney
+
+7
+00:00:37,200 --> 00:00:40,620
+وقلنا فيه ميضالة وقلنا الميضالة هادى شغلتها
+
+8
+00:00:40,620 --> 00:00:45,400
+الاساسية ايه to concentrate urine تمام؟ لذا لو
+
+9
+00:00:45,400 --> 00:00:47,320
+اتكلم عن concentration of urine بنقول احنا في
+
+10
+00:00:47,320 --> 00:00:52,220
+عندنا حاجتين مهمين لنعمل concentration of urine
+
+11
+00:00:52,220 --> 00:00:55,340
+محتاجين
+
+12
+00:00:55,340 --> 00:01:02,140
+يكون عندناانتدروتك هرمون كويس وموجود شغالي كويس
+
+13
+00:01:02,140 --> 00:01:08,340
+ومطلوب ان يكون عندنا رينال ميدالة بتشتغل كويس، اذا
+
+14
+00:01:08,340 --> 00:01:11,320
+نحن عايزين حاجتين، hyperosmotic gradient تبقى
+
+15
+00:01:11,320 --> 00:01:15,840
+موجود في الميدالةمطلوب ان يكون هناك انتجر هرمون
+
+16
+00:01:15,840 --> 00:01:20,860
+موجود علشان يفتح ال channels للميه تتحرك من ال
+
+17
+00:01:20,860 --> 00:01:24,580
+tubules الى داخل ال interstitium عشان تعمل ال
+
+18
+00:01:24,580 --> 00:01:32,240
+concentrated urine بداية خلينا نتكلم عن الكلية هذه
+
+19
+00:01:32,240 --> 00:01:39,150
+العجيبة اللى بإمكانها انهتطلع as little as point
+
+20
+00:01:39,150 --> 00:01:43,910
+five liter water per day و as maximum as twenty
+
+21
+00:01:43,910 --> 00:01:49,680
+liters per day، variations ضخمةو ممكن تطلع as low
+
+22
+00:01:49,680 --> 00:01:56,220
+as 50 millismole per liter concentration و as high
+
+23
+00:01:56,220 --> 00:02:03,880
+as 1400 millismole
+
+24
+00:02:03,880 --> 00:02:07,740
+per liter concentration إذا في عنا variations
+
+25
+00:02:07,740 --> 00:02:13,720
+كبيرة موجودة مثلا
+
+26
+00:02:13,720 --> 00:02:18,600
+لو أحنا أخدنا لتر من الماء شربناهانتطلع احنا ملاجة
+
+27
+00:02:18,600 --> 00:02:22,520
+خلال خمسة و أربعين دقيقة بيصير لنا maximal
+
+28
+00:02:22,520 --> 00:02:29,560
+diuresis و الكمية اللي احنا شربناها خلال ساعة و نص
+
+29
+00:02:29,560 --> 00:02:35,120
+ساعتين بتكون عوضت ايه executed اللي أخدنا هنا
+
+30
+00:02:35,120 --> 00:02:43,320
+drinking water ال urine volume هنا ال urine flow
+
+31
+00:02:43,320 --> 00:02:47,150
+rateهلاجيه بدأ بعد خمسة بعد بدأ انا هنا شربنا
+
+32
+00:02:47,150 --> 00:02:51,590
+الميهان شربنا الميهان تمام بعد شوية هاطلع أهلاجي
+
+33
+00:02:51,590 --> 00:02:56,530
+ايه ال urine volume او ال flow rate عندي بعد شوية
+
+34
+00:02:56,530 --> 00:03:00,410
+بدأ يزيد ل ال maximum لخمسة و عمري دقيقة الحجم
+
+35
+00:03:00,410 --> 00:03:04,170
+يخلص ال little اللي أخدناه زيادة ثم بيهبط على هوا
+
+36
+00:03:04,170 --> 00:03:07,790
+عندي هاطلع أهلاجي ال osmolality تبعت ال ball هبطت
+
+37
+00:03:07,790 --> 00:03:10,810
+لإنه زاد ال urine flow و ال osmolality of the
+
+38
+00:03:10,810 --> 00:03:14,540
+plasmaأه يعني minimal changes and one liter ايش
+
+39
+00:03:14,540 --> 00:03:18,340
+بده يعمل في ال .. ال 25 .. ال .. ال .. التلاتة
+
+40
+00:03:18,340 --> 00:03:21,940
+liter البلازما والعشرين liter اللي هو ايه ال
+
+41
+00:03:21,940 --> 00:03:24,680
+accessory fluid هيكون minimal changes بس ملاحظ
+
+42
+00:03:24,680 --> 00:03:29,960
+احنا اصلا عندنا ايه some sort of dilution لل
+
+43
+00:03:29,960 --> 00:03:35,620
+osmolality تبع البلازما و هنلاحظ احنا انه ال ..
+
+44
+00:03:35,620 --> 00:03:39,860
+احنا خدنا ميه بحته مش هيكالى حد ما هنلاقي الميه
+
+45
+00:03:39,860 --> 00:03:44,540
+طلعت بس ال solutes اللوت تبعها و هو مضايقرش طيب
+
+46
+00:03:44,540 --> 00:03:51,150
+اذا عند الكيلياعند القدرة أنه لو زالت الميه تطلع
+
+47
+00:03:51,150 --> 00:03:54,510
+ميه زيادة و لو جالت الميه تطلع ميه أجالى لو زالت
+
+48
+00:03:54,510 --> 00:03:58,750
+ال solus تطلع solus أكتر و لو جالت الميه تطلع
+
+49
+00:03:58,750 --> 00:04:03,310
+solus أجالى التنين مش مرتبطين في بعض ال control
+
+50
+00:04:03,310 --> 00:04:06,790
+system تبع التحكم في الميه مختلف عن ال control
+
+51
+00:04:06,790 --> 00:04:10,790
+system تبع التحكم في ال solus أحيانا التنين
+
+52
+00:04:10,790 --> 00:04:14,030
+بيشتغلوا مع بعض في حالات ال dehydration حالات ال
+
+53
+00:04:14,030 --> 00:04:17,070
+hemorrhage حياتهالـ low volume of the accessory
+
+54
+00:04:17,070 --> 00:04:21,990
+fluid و أحيانا ده بيشرب كل واحد لخاله حسب الوضع
+
+55
+00:04:21,990 --> 00:04:25,810
+تمام؟ واحد بيشرب ميه كتير هيطلع ميه كتير واحد أكل
+
+56
+00:04:25,810 --> 00:04:30,030
+السيخ كتير تمام؟ هيطلع solids كتير مثلا يعتمد على
+
+57
+00:04:30,030 --> 00:04:35,110
+إيه لكن مرة بيكونوا مرتبط البعض هذا الضيف تبعنا
+
+58
+00:04:35,110 --> 00:04:41,210
+هذا اسمه the hopping mouseاه اسمه ايش؟ The
+
+59
+00:04:41,210 --> 00:04:47,190
+Australian Hobbing Mouse شايفينه هذا؟ هذا كائن
+
+60
+00:04:47,190 --> 00:04:53,290
+صحراوي يعني بمعنى انه كمية الميه اللى بتناولها
+
+61
+00:04:53,290 --> 00:04:57,270
+جليلة جدا وبيعتمد على الميه الأساسية اللى بتشوف ال
+
+62
+00:04:57,270 --> 00:05:03,050
+metabolism تبع ال food
+
+63
+00:05:03,050 --> 00:05:07,910
+تبعهعملية ال metabolism بتكون ميه فبيقدر إلى كمية
+
+64
+00:05:07,910 --> 00:05:11,150
+محترمة من ال metabolism بيستغلها بتعرفين قدش اللي
+
+65
+00:05:11,150 --> 00:05:16,550
+بيقدر يركز ال ball هو عشر تلاف ميلي أزمول عشر تلاف
+
+66
+00:05:16,550 --> 00:05:23,450
+ميلي أزمول لإنه خيائن صحران تمام؟ وعكس ذلك ال
+
+67
+00:05:23,450 --> 00:05:26,770
+beavers هذا ال beaver هذا ال .. ال .. ال beaver
+
+68
+00:05:26,770 --> 00:05:33,890
+المائي حيوان مائيتمام ال .. التركيز المياه ال ..
+
+69
+00:05:33,890 --> 00:05:37,330
+ال .. ال .. ال urine عنده التركيز ال urine ال
+
+70
+00:05:37,330 --> 00:05:40,650
+maximum تبعه بزيش عند خمسمية ملي أزمال التاني عشر
+
+71
+00:05:40,650 --> 00:05:45,910
+تلات ملي أزمال بنقعد ده في الوسط لإنه احنا بنقدر
+
+72
+00:05:45,910 --> 00:05:50,230
+نتحرك يعني مش عايشين في الميه زي هذا لأ عايشين في
+
+73
+00:05:50,230 --> 00:05:55,110
+ال .. في ال .. في ال .. يابسة نستطيع إنه ن .. نروح
+
+74
+00:05:55,110 --> 00:05:59,810
+للميه وجد ما بدنا و بنتعرض أحيان ال ..انقطاع مؤقت
+
+75
+00:05:59,810 --> 00:06:04,970
+للميّه لذلك نعمل تركيز متوسط بين الحالتين هدول طيب
+
+76
+00:06:04,970 --> 00:06:10,050
+اذا احنا لاحظنا من خلال الحيوانات هذه ودرستها انه
+
+77
+00:06:10,050 --> 00:06:17,370
+كمية التركيز تبع البول يعتمد على طول المضلة كل ما
+
+78
+00:06:17,370 --> 00:06:23,710
+المضلة كان طولها بالنسبة لكيليا اكتر كل ما كان
+
+79
+00:06:23,710 --> 00:06:27,800
+عندنا more concentrated urine اكترطبعا كلما
+
+80
+00:06:27,800 --> 00:06:34,260
+المضالة قصرت كلما ال concentration ability للكل
+
+81
+00:06:34,260 --> 00:06:39,420
+يهادي تقل لحظنا
+
+82
+00:06:39,420 --> 00:06:43,080
+ان المضالة هادي ساعة ما يكون في عندنا تركيز ball
+
+83
+00:06:43,080 --> 00:06:46,360
+لو أخدنا ال interest station تبعه وجسناه هنلاقي
+
+84
+00:06:46,360 --> 00:06:51,260
+مركزو لما يكون بيطلع diluted urine لو خدنا ال
+
+85
+00:06:51,260 --> 00:06:55,700
+interstitium هذا و جسدنا هنلاقي diluted يعني دايما
+
+86
+00:06:55,700 --> 00:07:01,100
+ال end product تبع ال urine osmolality ال final
+
+87
+00:07:01,100 --> 00:07:04,300
+osmolality او ال concentration هنلاقي مثاول ال
+
+88
+00:07:04,300 --> 00:07:09,080
+interstitium osmolality تبع القلمط الله تمام؟ زي
+
+89
+00:07:09,080 --> 00:07:13,300
+ما اقول ان احنا هناك علاقة و أكيدة في هذا الموضوع
+
+90
+00:07:16,490 --> 00:07:20,110
+لكن بنعرف ان في عندي انا obligatory urine volume
+
+91
+00:07:20,110 --> 00:07:24,830
+obligatory urine volume يعني ال volume of urine
+
+92
+00:07:24,830 --> 00:07:30,710
+that is needed to excrete the minimal urine volume
+
+93
+00:07:30,710 --> 00:07:37,170
+that is needed to excrete the metabolites طيب بسم
+
+94
+00:07:37,170 --> 00:07:42,010
+الله الرحمن الرحيم الآن سؤالنا اللي دايما بنسأل
+
+95
+00:07:42,010 --> 00:07:46,660
+مثل بيقولوا انه ودا على البحرو بيرجعوا بدون ما
+
+96
+00:07:46,660 --> 00:07:50,880
+إيه؟ ما يشربوا مية طيب أنا بدي أسأل سؤال أنه أفضل
+
+97
+00:07:50,880 --> 00:07:54,880
+ودي على البحر و يشربوا مية لما يكون عطشان؟ ولا ما
+
+98
+00:07:54,880 --> 00:07:59,260
+يشربوش مية؟ يعني هل مية البحر هي صالحة لبن آدم
+
+99
+00:07:59,260 --> 00:08:05,460
+يستخدمها؟ لأ، مين بيقول أه؟ طيب، احنا بدنا نتكلم
+
+100
+00:08:05,460 --> 00:08:09,520
+كلام علمي، لأ أه ولا لأ هيك أميتي بدنا نقول إنه
+
+101
+00:08:09,520 --> 00:08:14,610
+مية البحر بيكون فيها تركيز ال ..الاملاح تلاتة الى
+
+102
+00:08:14,610 --> 00:08:20,210
+تلاتة و نص في المية يعني تمثل حوالي الف و متين ملي
+
+103
+00:08:20,210 --> 00:08:27,970
+ازمور بالليتر تمام؟ و احنا عندنا تركيز ال .. ال
+
+104
+00:08:27,970 --> 00:08:33,810
+ball اقصى ما يمكن الف و متين الف و اربعمية كله الف
+
+105
+00:08:33,810 --> 00:08:37,490
+و متين يعني قولنا لو الف الواحد شرب لتر من ميط
+
+106
+00:08:37,490 --> 00:08:42,390
+البحر مفترض انه شرب اللتر الف و متين ملي ازمور فيه
+
+107
+00:08:43,890 --> 00:08:48,970
+هيطلع liter من الأزمال .. ال .. الأزمالات اللي فيه
+
+108
+00:08:48,970 --> 00:08:51,930
+تساوي ال .. يعني أمي ألف و متين من الأزمال، ال
+
+109
+00:08:51,930 --> 00:08:55,830
+maximum تابعنا، مش هيك؟ بس مش هيك الواقع حقيقية،
+
+110
+00:08:55,830 --> 00:08:59,430
+هي ال .. ال .. الوصفة اللي اتكلمنا عنها معناها انه
+
+111
+00:08:59,430 --> 00:09:06,170
+الواحد عشان يطلع liter ميط بحر، بده liter bowl، مش
+
+112
+00:09:06,170 --> 00:09:10,030
+كده؟ لأ، هذا الكلام لو هيك، بكون الواحد باستفادش
+
+113
+00:09:11,000 --> 00:09:15,180
+يعني لا خسر ولا كسب مية لكن واقع الأمر انه بيخسر
+
+114
+00:09:15,180 --> 00:09:18,980
+ليش؟ بيخسر لأنه انا انا بدي اطلع concentrated
+
+115
+00:09:18,980 --> 00:09:24,340
+urine ب ألف و متين اتكلمنا المرة الماضية او ما
+
+116
+00:09:24,340 --> 00:09:27,600
+اتكلمناش او بتأكيد هتكلم اليوم بس اتكلمنا المرة
+
+117
+00:09:27,600 --> 00:09:30,760
+الماضية انه ال osmotic gradient اللي بتكون في
+
+118
+00:09:30,760 --> 00:09:35,000
+المضلة مسؤول عنه مش بس ال solutes ال sodium
+
+119
+00:09:35,000 --> 00:09:41,000
+chloride solutes و ان فيهمسؤول عنه مين كمان الوريا
+
+120
+00:09:41,000 --> 00:09:45,980
+وقلنا خمسين في المية منه مسئولية مين الوريا وخمسين
+
+121
+00:09:45,980 --> 00:09:50,340
+في المية مسئولية ال other solos اذا انا علشان
+
+122
+00:09:50,340 --> 00:09:53,860
+الوريا تصل لهذه المرحلة هذي في ال interest system
+
+123
+00:09:53,860 --> 00:09:57,980
+الف و متين التركيز لازم يكون عندى اناءة الوريا
+
+124
+00:09:57,980 --> 00:10:00,500
+بتشارك بستمية مليون أزمان و ال soli مكنورة بتشارك
+
+125
+00:10:00,500 --> 00:10:03,320
+بستمية مليون أزمان يعني لازم الوريا تكون عندى .. و
+
+126
+00:10:03,320 --> 00:10:06,060
+هتصل تركيزها عشان يبقى تروح by the simple
+
+127
+00:10:06,060 --> 00:10:09,630
+diffusionهي تخرج من التيوبيول بشكل A بشكل بسيط
+
+128
+00:10:09,630 --> 00:10:13,730
+بشكل diffusion لإنه عندي الانترنت كورمون علالي ال
+
+129
+00:10:13,730 --> 00:10:18,030
+concentration وفتح ال .. ال urea transporters
+
+130
+00:10:18,030 --> 00:10:21,750
+فبتقدر ال hyper concentrated urea في ال .. على
+
+131
+00:10:21,750 --> 00:10:24,690
+الكلام أنا بقعد شوية صغيرة في ال .. في التيوبيول
+
+132
+00:10:24,690 --> 00:10:28,110
+بتقدر إلى أنه بتعمل diffusion تمام؟ هتعمل
+
+133
+00:10:28,110 --> 00:10:30,250
+diffusion لحد ما يصيب ال concentration تبع ال urea
+
+134
+00:10:30,250 --> 00:10:33,070
+في التيوبيول زي ال interstitium إذا أنا لازم يكون
+
+135
+00:10:33,070 --> 00:10:38,020
+عندي ال concentration في ال Aاليوريا 600 تقريبا،
+
+136
+00:10:38,020 --> 00:10:42,240
+مش هيك؟ إذا في الحالة هذه أنا ال 1200 اللي بتكون و
+
+137
+00:10:42,240 --> 00:10:45,160
+ال 600 منهم لازم يكون بقى إيه؟ يوريا عشان أطلع ال
+
+138
+00:10:45,160 --> 00:10:48,740
+1200 ماقدرش أطلع لهم مرة واحدة، إذا أطلع ال 1200،
+
+139
+00:10:48,740 --> 00:10:52,200
+ال 600 منهم يوريا و ال 600 منهم Sodium chloride
+
+140
+00:10:52,200 --> 00:10:56,280
+إذا محتاج عشان أطلع ال 1200 أنا إيه لقداش؟ اتنين
+
+141
+00:10:56,280 --> 00:11:00,660
+لتر، أنا بكون في الحالة هذه لو مشربتش؟أحسن لإنه
+
+142
+00:11:00,660 --> 00:11:04,700
+انا إذا سيبت وشرب ميه بحر معناه يظل يفقد مقابل كل
+
+143
+00:11:04,700 --> 00:11:08,200
+لتر لتر إضافي مش هيك معناه أنا بخششه فيه
+
+144
+00:11:08,200 --> 00:11:11,980
+dehydration فوق ما هو already dehydrated وإلا ليش
+
+145
+00:11:11,980 --> 00:11:16,750
+كان ميخ من العتش حتى شرب ميه البحر فهو غلطبشرب ميط
+
+146
+00:11:16,750 --> 00:11:24,990
+البحر لكن المثل اللي قلته انا ماعتقدش ان هو غلط
+
+147
+00:11:24,990 --> 00:11:28,150
+كتير ليش؟ لإن البحر في الحالة هادي باللغة المصرية
+
+148
+00:11:28,150 --> 00:11:32,610
+تعني ايه؟ تعني .. تعني النهر النيل انه وصل
+
+149
+00:11:32,610 --> 00:11:36,590
+الولالولا وكده لكن احنا حاببت ان اوضحلكم ان ع
+
+150
+00:11:36,590 --> 00:11:40,650
+بحرنا لأ مانشربوش في مصر لازم نشربه لإن ميطه حلوة
+
+151
+00:11:40,650 --> 00:11:44,990
+اما هانإذا صار شارب ميه من ميه البحر مشكلة لإنه
+
+152
+00:11:44,990 --> 00:11:49,670
+سيفقد مقابل كل لتر لتر أخر لإخراج اللي إيه اللي
+
+153
+00:11:49,670 --> 00:11:54,690
+سافناه عندك لإنه عشان نطلع ال concentrated urine
+
+154
+00:11:54,690 --> 00:11:59,970
+احنا محتاجين حاجة تانية محتاجين يقولنا أنت ال red
+
+155
+00:11:59,970 --> 00:12:06,930
+hormone مظبوط و إيش و hyper osmotic رينال ميضلة ال
+
+156
+00:12:06,930 --> 00:12:07,270
+..
+
+157
+00:12:10,210 --> 00:12:13,790
+الـ Antidote hormone جيبنا سيرته و ال Osmotic
+
+158
+00:12:13,790 --> 00:12:18,150
+Mandala جيبنا سالتها بس بدنا التفاصيل بدنا ايش؟
+
+159
+00:12:18,150 --> 00:12:22,430
+التفاصيل التفاصيل بتاعة ال Antidote hormone جيبنا
+
+160
+00:12:22,430 --> 00:12:25,910
+اتكلمنا عنها تقريبا بما يعرفين و قولنا عنه ال
+
+161
+00:12:25,910 --> 00:12:29,550
+Antidote hormone اين بيشتغل؟ بيشتغل في ال distal
+
+162
+00:12:29,550 --> 00:12:34,340
+tubule و ال collecting tubuleو الـ collecting duct
+
+163
+00:12:34,340 --> 00:12:37,860
+يعني من بعد الـ thick ascending limb و الـ early
+
+164
+00:12:37,860 --> 00:12:41,040
+part of الـ distal tubule بيصير عندي أنا الـ
+
+165
+00:12:41,040 --> 00:12:45,600
+anterior hormone مكان عمله من هذا النقطة للنهاية،
+
+166
+00:12:45,600 --> 00:12:49,480
+تمام؟ إذا الـ anterior hormone في وجوده ال .. ال
+
+167
+00:12:49,480 --> 00:12:52,980
+.. ال tubule من هذا الجزء إلى ال tip of the
+
+168
+00:12:52,980 --> 00:12:59,960
+papilla يستطيع أنه يabsorb water، تمام؟لكن في عدم
+
+169
+00:12:59,960 --> 00:13:02,860
+وجود الانتجار الكرمون مش هيكون في عندي لا
+
+170
+00:13:02,860 --> 00:13:05,040
+absorption of water طبعا لما يكون في عندي لا
+
+171
+00:13:05,040 --> 00:13:06,820
+absorption of water في الصين عندي concentrated
+
+172
+00:13:06,820 --> 00:13:14,620
+urine طبعا طيب لحظة بدى تركزوا معايا شوية هيك احنا
+
+173
+00:13:14,620 --> 00:13:18,340
+جيبنا سيرة المضلة كتير انها مهمة في ال
+
+174
+00:13:18,340 --> 00:13:23,380
+concentration of urine مش كده لكن بدى اذكركم اشي
+
+175
+00:13:23,380 --> 00:13:28,320
+تاني مهم كتيروهو انه ال thick ascending limb و ال
+
+176
+00:13:28,320 --> 00:13:34,540
+early part of the distal tubule بتسلملي ال late
+
+177
+00:13:34,540 --> 00:13:40,340
+distal tubule و باقي النفرول في tubular fluid
+
+178
+00:13:40,340 --> 00:13:45,260
+تركيزه كده؟ مائة ملي أزمال مين اللي جالس مائة ملي
+
+179
+00:13:45,260 --> 00:13:48,860
+أزمال؟ كويس بكذا معايا انذا هذا diluting segment
+
+180
+00:13:48,860 --> 00:13:55,390
+بياخد solutes و بطلعلي diluted ايه؟ تمام؟لما يكون
+
+181
+00:13:55,390 --> 00:13:58,890
+عندى انا .. لما يكون عندى انا موجود حالة
+
+182
+00:13:58,890 --> 00:14:04,310
+dehydration محتاج الميه والانتردوت الحرمون عالى في
+
+183
+00:14:04,310 --> 00:14:09,230
+الحالة هذه بيبدأ التركيز من اول ال ايه ال .. ال ..
+
+184
+00:14:09,230 --> 00:14:11,730
+ال .. اللي هو من .. من اول ال late distal tubule
+
+185
+00:14:11,730 --> 00:14:15,590
+من هذا النقطة الى نهاية الانتردوت الحرمون شغال الى
+
+186
+00:14:15,590 --> 00:14:18,970
+نهاية ال tubule مش هكذا كل المنطقة هذه تشارك في ال
+
+187
+00:14:18,970 --> 00:14:23,110
+concentrationمظبوط؟ لكن ال .. ال .. ال .. ال .. ال
+
+188
+00:14:23,110 --> 00:14:23,410
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+189
+00:14:23,410 --> 00:14:24,090
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+190
+00:14:24,090 --> 00:14:25,050
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+191
+00:14:25,050 --> 00:14:25,770
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+192
+00:14:25,770 --> 00:14:28,150
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+193
+00:14:28,150 --> 00:14:28,730
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+194
+00:14:28,730 --> 00:14:29,590
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+195
+00:14:29,590 --> 00:14:30,510
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+196
+00:14:30,510 --> 00:14:34,110
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+197
+00:14:34,110 --> 00:14:34,210
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+198
+00:14:34,210 --> 00:14:36,290
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+199
+00:14:36,290 --> 00:14:40,450
+.. ال ..
+
+200
+00:14:40,450 --> 00:14:44,690
+ال
+
+201
+00:14:46,390 --> 00:14:50,610
+سنتولتين ال fluid اللى موجود فى ال filtrate ستة و
+
+202
+00:14:50,610 --> 00:14:53,450
+ستين فى المية منه الآن بيصير reabsorption عشان
+
+203
+00:14:53,450 --> 00:14:59,490
+نوصل لل إيش لل تلت مية، مظبوط؟ إذا قدش ضايل على ال
+
+204
+00:14:59,490 --> 00:15:02,170
+maximum، مابود أطلع كل اللى .. كل اللى نازل لتحت
+
+205
+00:15:02,170 --> 00:15:06,030
+ضايل التلت من ال filtrate إذا ال bulk of
+
+206
+00:15:06,030 --> 00:15:10,510
+reabsorption لما يصير عنده concentration بتموين فى
+
+207
+00:15:10,510 --> 00:15:16,370
+ال cortex ال distal tubule و collecting ductهنا
+
+208
+00:15:16,370 --> 00:15:24,330
+بتحول ال water channels مفتوحة وبتدخل الميه بسيفلي
+
+209
+00:15:24,330 --> 00:15:28,810
+حطسها ل maximum concentration تلاتمية مش كده؟ اذا
+
+210
+00:15:28,810 --> 00:15:34,050
+ال cortical part هذا مهم جدا في ال reabsorption of
+
+211
+00:15:34,050 --> 00:15:36,830
+water في حالة ال .. ال .. ال .. ال .. ال .. ال ..
+
+212
+00:15:36,830 --> 00:15:37,190
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+213
+00:15:37,190 --> 00:15:37,470
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+214
+00:15:37,470 --> 00:15:38,130
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+215
+00:15:38,130 --> 00:15:39,250
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+216
+00:15:39,250 --> 00:15:39,430
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+217
+00:15:39,430 --> 00:15:39,950
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+218
+00:15:39,950 --> 00:15:40,810
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+219
+00:15:40,810 --> 00:15:42,720
+ال .. ال .. ال .. ال .. ال ..لكن الـ urine اللي
+
+220
+00:15:42,720 --> 00:15:45,580
+طالع ما هوش concentrated صار isosmotic
+
+221
+00:15:45,580 --> 00:15:53,380
+ايزوثينيوريا ايزوثينيوريا يعني ال .. ال .. ال
+
+222
+00:15:53,380 --> 00:15:57,220
+osmolality متواحدة بين ال ايه؟ بين ال urine و ال
+
+223
+00:15:57,220 --> 00:16:02,900
+.. و ال plasma تمام؟ اذا الجزئية المهمة في المضالة
+
+224
+00:16:02,900 --> 00:16:06,780
+انه بتخليلي ال osmolality تعلى اكتر من ال ايه؟يعني
+
+225
+00:16:06,780 --> 00:16:10,380
+الجزء الأخير التلت الأخير من ال filtrate اللي ضايل
+
+226
+00:16:10,380 --> 00:16:14,480
+هو بيصيرله نتحكم فيه و نعمله reabsorption ل most
+
+227
+00:16:14,480 --> 00:16:18,560
+of it to have concentrated urine لذن ال cortical
+
+228
+00:16:18,560 --> 00:16:24,000
+part له أهمية في ال concentration لكن المدلري part
+
+229
+00:16:24,000 --> 00:16:29,750
+أهميته في إيش؟ إنه بيعمللي إشي isosmotic urineهو
+
+230
+00:16:29,750 --> 00:16:33,370
+بيعمل لي hyper osmotic urine إذا ال concentrated
+
+231
+00:16:33,370 --> 00:16:36,910
+urine مسئولية المدلة لكن ال reabsorption of water
+
+232
+00:16:36,910 --> 00:16:41,030
+في حالة ال dehydration هي مش بس مسئولية المدلة ال
+
+233
+00:16:41,030 --> 00:16:45,430
+cortex بتسحب ميه من ال urine أكتر ما بتسحب ايه
+
+234
+00:16:45,430 --> 00:16:51,130
+تمام؟ و لو ال flow تبع ال .. ال .. ال filtrate نزل
+
+235
+00:16:51,130 --> 00:16:54,890
+المدلة بكمية كبيرة، بتقدرش المدلة تاخد كمية هذه
+
+236
+00:16:55,540 --> 00:16:59,500
+لذلك احنا ايه .. لذلك نبدأ من بدري من early part
+
+237
+00:16:59,500 --> 00:17:03,560
+التحكم في الميه عشان يكون عندي enough يعني length
+
+238
+00:17:03,560 --> 00:17:07,780
+عشان ايه اتحكم في ال reabsorption of big amounts
+
+239
+00:17:07,780 --> 00:17:12,840
+ال cortical معظم الأشياء .. طيب قولناها ان احنا
+
+240
+00:17:12,840 --> 00:17:17,810
+انه .. اذا الميه بيصيرها reabsorption فيالجزء
+
+241
+00:17:17,810 --> 00:17:21,190
+الأخير هذا كله لإن سميه ده distal nephron ده
+
+242
+00:17:21,190 --> 00:17:24,490
+distal إيه مش distal tubule ده distal nephron
+
+243
+00:17:24,490 --> 00:17:27,470
+بيبدأ من الجزء اللي ليه distal tubule للآخر اسمه
+
+244
+00:17:27,470 --> 00:17:30,390
+distal nephron خليني أتكلم عنه إذا ال distal
+
+245
+00:17:30,390 --> 00:17:34,090
+nephron هذا في reabsorption of water according to
+
+246
+00:17:34,090 --> 00:17:36,350
+the body needs under the control of antidepressant
+
+247
+00:17:36,350 --> 00:17:40,350
+hormone مش هيك؟ وهذا الجزء كله هي to permeable to
+
+248
+00:17:40,350 --> 00:17:43,210
+water إذا في antidepressant hormone لكن هل الجزء
+
+249
+00:17:43,210 --> 00:17:49,860
+هذا كله permeable to urea؟لأ إذا ال .. ال .. ال
+
+250
+00:17:49,860 --> 00:17:53,140
+cortical part منه هذا مش .. مش .. not .. not
+
+251
+00:17:53,140 --> 00:17:56,600
+permeable to urea لكن ال medullary part permeable
+
+252
+00:17:56,600 --> 00:17:59,660
+to urea لذلك لما نقول احنا سرعينا reabsorption of
+
+253
+00:17:59,660 --> 00:18:04,460
+water في ال cortex كان ضخم، مظبوط؟ و ال urea not
+
+254
+00:18:04,460 --> 00:18:08,820
+reabsorbed إذا ال urea لما تصل المدلة بتكون
+
+255
+00:18:08,820 --> 00:18:14,120
+concentrated تمام واضح؟ من هنامن هنا انه في عيدي
+
+256
+00:18:14,120 --> 00:18:19,700
+طولتين الميه اذا اليوريا اتضاعف التركيزها لتلت
+
+257
+00:18:19,700 --> 00:18:23,040
+اضعف لانه ايه كانت في طولت كمية صارت في .. انسحب
+
+258
+00:18:23,040 --> 00:18:26,920
+منها طولتين صارت في طولت الكمية اذا اتضاعف تركيزها
+
+259
+00:18:26,920 --> 00:18:31,850
+و لما تدخل المضلة كمانتمام؟ لما تدخل المضلة، برضه
+
+260
+00:18:31,850 --> 00:18:35,130
+فيه water reabsorption، بصمت؟ يعني فيه more
+
+261
+00:18:35,130 --> 00:18:40,030
+concentration of urea لذلك ال urea هي نازلة،
+
+262
+00:18:40,030 --> 00:18:42,450
+بيصيلها ايه؟ simple diffusion، اذا ال .. اذا ال
+
+263
+00:18:42,450 --> 00:18:44,770
+urea transformed لنا سفاتين، بيصيلها simple
+
+264
+00:18:44,770 --> 00:18:49,590
+diffusion لمين؟ للمضلة، و من هنا بتشارك في صناعة
+
+265
+00:18:49,590 --> 00:18:50,370
+hyper osmotic
+
+266
+00:18:53,170 --> 00:18:56,770
+مدلة واضح اذا هي fifty percent من ال azimuthic
+
+267
+00:18:56,770 --> 00:19:00,310
+gradient بسبب مين لما نقول ال maximum تبعنا تحت
+
+268
+00:19:00,310 --> 00:19:05,470
+الف و متين اذا ستمية منه في Mن ال A من الورية واضح
+
+269
+00:19:05,840 --> 00:19:10,700
+إذن الـ antidiuretic hormone مش بس بيساعدني على
+
+270
+00:19:10,700 --> 00:19:14,660
+إنه يعمل absorption of water كمان بيركز لليوريا
+
+271
+00:19:14,660 --> 00:19:18,220
+أكتر و بيساعد أنه يساعدها في ال diffusion اتنين
+
+272
+00:19:18,220 --> 00:19:22,540
+برضه زي اما بيفتح ال ال water channels ال
+
+273
+00:19:22,540 --> 00:19:25,940
+antidiuretic hormone أيضا بيفتح ال ايه ال urea
+
+274
+00:19:25,940 --> 00:19:28,300
+transporters بيعمل ال .. ال .. ال .. ال
+
+275
+00:19:28,300 --> 00:19:31,760
+facilitated diffusion هذا عن طريق ال carrier و
+
+276
+00:19:31,760 --> 00:19:35,680
+بيساعد ال diffusion واضح؟طيب كتير الكلام هذا إذا
+
+277
+00:19:35,680 --> 00:19:40,200
+إحنا دلوقتي صار عندنا نظرة شاملة عن ال
+
+278
+00:19:40,200 --> 00:19:43,740
+reabsorption و ال water و ال urea اللي بيعملوه طيب
+
+279
+00:19:43,740 --> 00:19:46,840
+هذا ما يتعلق بال antidiotic hormone و علاقاته
+
+280
+00:19:46,840 --> 00:19:50,920
+التفاصيل اللي أنا هناخدها أكتر عن ال osmotic
+
+281
+00:19:50,920 --> 00:19:52,160
+gradient هذا اللي بتكون
+
+282
+00:19:54,930 --> 00:19:58,850
+أتكلمنا عن جزء اليوريا منه وفهمناها بس في جزء ما
+
+283
+00:19:58,850 --> 00:20:04,510
+فهمناهش في الآخر نتكلم عن الـUrea cycle او circuit
+
+284
+00:20:04,510 --> 00:20:08,430
+Re-circuiting او Recycling of urea هنتكلم عنها في
+
+285
+00:20:08,430 --> 00:20:11,550
+نهاية الكلام بس دلوقت نتكلم عن الـosmolality
+
+286
+00:20:11,550 --> 00:20:15,350
+gradient هذا الـ50% الأسئلة الأولانية منه تتكون من
+
+287
+00:20:15,350 --> 00:20:23,880
+السوديوم والكلورايد والسوليوت والهيبر اوزمولاريطيب
+
+288
+00:20:23,880 --> 00:20:32,420
+السوليوس هدول .. السوليوس
+
+289
+00:20:32,420 --> 00:20:40,820
+هدول لما يصلهم دور في الـ osmotic gradient تبع
+
+290
+00:20:40,820 --> 00:20:44,520
+الميدالة معناها بيكون صار عندى انا ايه؟ في
+
+291
+00:20:44,520 --> 00:20:49,160
+absorption للسوليوس بكميات اكبر من ال .. من ال
+
+292
+00:20:49,160 --> 00:20:54,700
+water عشان اعمل hyper osmoticمضلة، مظبوط؟ يعني
+
+293
+00:20:54,700 --> 00:20:59,760
+بدنا ننتقله من أي شزء بدنا ننتقله، من لقو فنلي،
+
+294
+00:20:59,760 --> 00:21:03,980
+يعني مضلة إيش فيها؟ مضلة فيها لقو فنلي، وقولنا
+
+295
+00:21:03,980 --> 00:21:06,800
+فيها ten part و فيها إيش؟ thick part وقولنا ال
+
+296
+00:21:06,800 --> 00:21:09,300
+thick part هو إيش؟ reabsorbing solutes in
+
+297
+00:21:09,300 --> 00:21:13,220
+permeable تواطع، إذا ال thick part هذا هو الجزء
+
+298
+00:21:13,220 --> 00:21:17,710
+الرئيسي المسؤول عن إيش؟عن إنه يعمل الـ osmotic
+
+299
+00:21:17,710 --> 00:21:22,410
+gradient الـ solute part منه الـ 50% تمام؟ إذن هو
+
+300
+00:21:22,410 --> 00:21:25,310
+المسؤول عن الجزية هذه هو اللي بيقدر إنه يدخل
+
+301
+00:21:25,310 --> 00:21:29,150
+solutes more than water إذن هذا بيقدر .. و أين
+
+302
+00:21:29,150 --> 00:21:32,030
+بيوضيها؟ Reabsorption للـ interstitium تبع مين؟
+
+303
+00:21:32,030 --> 00:21:37,310
+تبع المدلة إذن هذه العملية هي المفتاح الرئيسي
+
+304
+00:21:37,310 --> 00:21:43,440
+لعملية إيه؟لعملية ال .. ال osmotic gradient بس
+
+305
+00:21:43,440 --> 00:21:47,700
+احنا لاحظنا ان ال pumping system هذا الموجود قولنا
+
+306
+00:21:47,700 --> 00:21:52,400
+sodium one two chloride one potassium مش هيك ال
+
+307
+00:21:52,400 --> 00:21:56,180
+pumping system هذا بيستطيع انه يشتغل against ..
+
+308
+00:21:56,180 --> 00:21:58,360
+against gradient مش كده against concentration
+
+309
+00:21:58,360 --> 00:22:02,360
+gradient بس انه maximum انه maximum انه بيشتغل
+
+310
+00:22:02,360 --> 00:22:07,300
+against two hundred milli osmo differenceيعني
+
+311
+00:22:07,300 --> 00:22:12,260
+بيقدر ياخد من ال fluid لل interstitium بحيث انه
+
+312
+00:22:12,260 --> 00:22:17,320
+يخلي ال concentration في ال interstitium اكتر من
+
+313
+00:22:17,320 --> 00:22:24,120
+ال .. من ال .. ال tubule ال 200 واضح؟ يعني بيقدرش
+
+314
+00:22:24,120 --> 00:22:28,100
+اذا زاد عن 200 في ال tubule فهي توقف عن الايه؟ اذا
+
+315
+00:22:28,100 --> 00:22:33,420
+زاد الفرق برا؟ طيب اذا هنا بدأنا ان نخش على
+
+316
+00:22:33,420 --> 00:22:37,310
+الموضوع طب لما يكون عندى فرق 200وانا عندى داخل ال
+
+317
+00:22:37,310 --> 00:22:42,950
+fluid ال .. ال .. ال .. ال .. ال proximal tubule
+
+318
+00:22:42,950 --> 00:22:47,630
+بتسلمني fluid isosmotic مش كده؟ وصل لل thick
+
+319
+00:22:47,630 --> 00:22:50,150
+ascending limb فى الحالة دى ال thick ascending
+
+320
+00:22:50,150 --> 00:22:54,010
+limb بيقدر انه ياخد solutes من جوا من ال tubule
+
+321
+00:22:54,010 --> 00:22:57,270
+ويرميها لل interstitium لحد ما يصير الفرق بين هدا
+
+322
+00:22:57,270 --> 00:23:00,870
+و هدا كده 200 من الأزمول يعنى هدا هيصير بدل 300
+
+323
+00:23:00,870 --> 00:23:07,300
+200 وهذا بدل 300 400 تمام؟هذه قدرته لكن احنا
+
+324
+00:23:07,300 --> 00:23:11,020
+بنتكلم دالين عن ايش؟ عن ألف و أربعمية ألف و ميتين
+
+325
+00:23:11,020 --> 00:23:16,120
+concentration gradient أعلى من هيك بكتير ايش اللي
+
+326
+00:23:16,120 --> 00:23:20,520
+بيصير اها بيصير what is called اللي هو ال counter
+
+327
+00:23:20,520 --> 00:23:24,060
+current multiplier counter current multiplication
+
+328
+00:23:24,060 --> 00:23:28,680
+counter current multiplication هو الراحل ايه
+
+329
+00:23:28,680 --> 00:23:32,200
+التعبير عشان اوريكوايا ماعلينا counter current
+
+330
+00:23:32,200 --> 00:23:32,780
+multiplication
+
+331
+00:23:35,840 --> 00:23:43,460
+الـ counter current multiplication هذا عبارة عن صح
+
+332
+00:23:43,460 --> 00:23:52,280
+انا باخد ال solutes من داخل ال tubule لبرا بكمية
+
+333
+00:23:52,280 --> 00:23:57,300
+معينة بس هذه المسألة انا عملها عملت مضاعفات في
+
+334
+00:23:57,300 --> 00:24:01,420
+system عندى اسمه counter current multiplier بيخلي
+
+335
+00:24:01,420 --> 00:24:05,630
+الاتين دول الفارقيظلهم يزيدوا و يزيدوا و يزيدوا
+
+336
+00:24:05,630 --> 00:24:09,610
+لحجم يعمل ليه الاش ال .. ال osmotic gradient اللي
+
+337
+00:24:09,610 --> 00:24:15,650
+هو عند ال .. ال cortex ال isosmotic تلاتمية و عند
+
+338
+00:24:15,650 --> 00:24:21,170
+التب يطلع لاش لألف و تلاتمية ألف و أربعمية كيف
+
+339
+00:24:21,170 --> 00:24:24,050
+بتصير هذه؟ مع أن القدرة تبعتنا اتكلمنا عنها محدودة
+
+340
+00:24:24,050 --> 00:24:27,190
+مش هيك؟ طبعا هو في مشاركة ليورياكية
+
+341
+00:24:29,920 --> 00:24:33,820
+لكن كيف سوليوس بتعمل استثميت من أزمون الفارق
+
+342
+00:24:33,820 --> 00:24:34,420
+تبعونها
+
+343
+00:24:51,000 --> 00:24:53,980
+شوفناها special characteristics of the loop of
+
+344
+00:24:53,980 --> 00:24:57,580
+Henle that cause solutes to be transported او
+
+345
+00:24:57,580 --> 00:25:04,980
+trapped in the renal نرجح
+
+346
+00:25:04,980 --> 00:25:09,100
+حاجة شوية صغيرة قلنا ال loop of Henle علينا جزء
+
+347
+00:25:09,100 --> 00:25:13,160
+thin و جزء thick الجزء ال thick قلنا impermeable
+
+348
+00:25:13,160 --> 00:25:17,960
+to water و ال ascending thin برضه impermeable to
+
+349
+00:25:17,960 --> 00:25:21,770
+waterتمام؟ اذا ال thin ascending limb .. ال
+
+350
+00:25:21,770 --> 00:25:27,390
+ascending limb كله impermeable to water ال thick ب
+
+351
+00:25:27,390 --> 00:25:34,450
+.. can reabsorb solutes actively big amounts ال ..
+
+352
+00:25:34,450 --> 00:25:38,870
+ال thin ascending ال transport عليه minimal can
+
+353
+00:25:38,870 --> 00:25:42,890
+reabsorb solutes without water لكنه minimal الآن
+
+354
+00:25:42,890 --> 00:25:48,000
+ال thin descending .. ال thin ايه descending؟زي
+
+355
+00:25:48,000 --> 00:25:51,200
+الـ thin ascending permeable to solutes and
+
+356
+00:25:51,200 --> 00:25:53,940
+permeable to water يعني ال descending هذا اللي
+
+357
+00:25:53,940 --> 00:25:57,600
+نازل و ال ascending الجزء اللي طالع ال thin منه
+
+358
+00:25:57,600 --> 00:26:02,160
+هذا permeable to solutes partially permeable لكنه
+
+359
+00:26:02,160 --> 00:26:05,160
+descending limb permeable to water ال ascending
+
+360
+00:26:05,160 --> 00:26:08,420
+limb thin not permeable to water و بجيت طبعا ال
+
+361
+00:26:08,420 --> 00:26:11,520
+ascending limb not permeable to water هذه المعصفات
+
+362
+00:26:11,520 --> 00:26:18,630
+تؤدي إلى العملية اللي بتكلم عنها اللي هيCreation
+
+363
+00:26:18,630 --> 00:26:23,130
+of osmotic gradient يؤدي
+
+364
+00:26:23,130 --> 00:26:30,810
+إلى قدرة الكلية على إمتصاص أو إخراج يورين مركزي
+
+365
+00:26:30,810 --> 00:26:35,130
+جدا والأخرين الانمالي تمام الانمالي اتكلمنا عنه
+
+366
+00:26:35,130 --> 00:26:39,730
+عشر تلاف عشر تلاف معناها لوبو فيني تبعه هذاطويل
+
+367
+00:26:39,730 --> 00:26:43,510
+جدا لدرجة ان ال multiplication بيظهر زي زي زي زي
+
+368
+00:26:43,510 --> 00:26:46,010
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+369
+00:26:46,010 --> 00:26:50,130
+زي زي زي
+
+370
+00:26:50,130 --> 00:26:50,630
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+371
+00:26:50,630 --> 00:26:53,130
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+372
+00:26:53,130 --> 00:26:55,170
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+373
+00:26:55,170 --> 00:26:55,490
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+374
+00:26:55,490 --> 00:27:04,410
+زي زي زي زي زي زي زي زي زي زي
+
+375
+00:27:04,410 --> 00:27:05,690
+زي ز
+
+376
+00:27:09,700 --> 00:27:14,460
+لو طلعنا هنا في الوضع الطبيعي ال .. ال .. الصورة
+
+377
+00:27:14,460 --> 00:27:18,300
+نمر واحد هذه ال filter جامع ال proximal tubule
+
+378
+00:27:18,300 --> 00:27:28,400
+تركيزه isosmotic مش كده؟ مفترض
+
+379
+00:27:28,400 --> 00:27:31,700
+يصير .. ايه اللي مشي في ال loop و فين ليه؟ اه و
+
+380
+00:27:31,700 --> 00:27:36,560
+يطلع ال .. ال distance في الجثة هذه تمام؟ انه ايش
+
+381
+00:27:36,560 --> 00:27:42,020
+يطلع؟اللي هو isosmotic ويكمل المشوار هنا بيتدخل
+
+382
+00:27:42,020 --> 00:27:46,260
+عندنا ال thick ascending limb ال thick ascending
+
+383
+00:27:46,260 --> 00:27:48,860
+limb بيعمل انه reabsorption of the filtrate
+
+384
+00:27:48,860 --> 00:27:53,980
+solutes impermeable to water فبياخد ال solutes
+
+385
+00:27:53,980 --> 00:27:57,060
+وبياخدش water فده ال diluting segment احنا okay
+
+386
+00:27:57,060 --> 00:28:00,080
+diluting segment في داخل ال tubule لكن بالنسبة لل
+
+387
+00:28:00,080 --> 00:28:04,100
+ال interstitium صار concentrating segment تمام؟
+
+388
+00:28:04,480 --> 00:28:06,780
+بالنسبة للإنترستيشن مو ال concentrating signal
+
+389
+00:28:06,780 --> 00:28:10,120
+بالنسبة للتيوبيول الـ diluting لإنه بياخد solace
+
+390
+00:28:10,120 --> 00:28:16,340
+بياخدش ايه معايا عالية معايا طيب إذا يستطيع يقولنا
+
+391
+00:28:16,340 --> 00:28:19,420
+يعمل فرد جداش 200 ميلي أزمول ال pumping system
+
+392
+00:28:19,420 --> 00:28:23,060
+عنده هذا القدرة فبنطلع ملاجي هنا لما ياخد من هذه
+
+393
+00:28:23,060 --> 00:28:27,270
+مية و طلع مية للإنترستيشن بيصلل ايه؟للـ maximum
+
+394
+00:28:27,270 --> 00:28:30,390
+تبعه لـ saturation level تبع من ال pumping system
+
+395
+00:28:30,390 --> 00:28:34,470
+فبنلاحظ احنا انه هذه العملية بتزيد ال interstitial
+
+396
+00:28:34,470 --> 00:28:40,650
+fluid osmolality الى 400 ملي ازمول و بتنزلي ال
+
+397
+00:28:40,650 --> 00:28:43,910
+tubular
+
+398
+00:28:43,910 --> 00:28:47,820
+fluid الى 200 ملي ازمولطيب خلاص هاي ال maximum انت
+
+399
+00:28:47,820 --> 00:28:51,360
+بتبقى نجلة؟ لأ لأ في نظام اخر بيساعد هذه الجزئية
+
+400
+00:28:51,360 --> 00:28:59,440
+صحيح هي بتنتج .. بتنتج مثلا بتقدر تصفي .. تصوروا
+
+401
+00:28:59,440 --> 00:29:04,000
+مكينة يعني بتقدر تصفي مثلا عشرين في المية من
+
+402
+00:29:04,000 --> 00:29:07,060
+المادة اللي بحطها فيها لكن بعد ما كده اخد المادة
+
+403
+00:29:07,060 --> 00:29:11,040
+اللي مصففاها دي اللي فجت عشرين مية و ارجح كمان مرة
+
+404
+00:29:11,040 --> 00:29:14,280
+اصف فيها بتفجد كمان عشرين في المية من اللي اشتيت
+
+405
+00:29:14,910 --> 00:29:19,410
+وبعدين باخدها كمان مرة هذا multiplication تمام؟
+
+406
+00:29:19,410 --> 00:29:24,050
+اذا هذا ايه؟ multiplication مضاعفات فبضل انا نفس
+
+407
+00:29:24,050 --> 00:29:28,810
+المادة اللي انا عملت لها هذه القدرة بعود استخدمها
+
+408
+00:29:28,810 --> 00:29:32,170
+كمان مرة هي مش الأصلي فهذا بيقدي الى ايه؟ ال
+
+409
+00:29:32,170 --> 00:29:34,570
+multiplication كيف ال multiplication بتتم هان؟
+
+410
+00:29:34,570 --> 00:29:42,210
+بتتم ان عندي في loop of Henleyعندي واحد fluid ماشي
+
+411
+00:29:42,210 --> 00:29:46,010
+باتجاه عكس التاني، تمام؟ اذا انا في عندي system
+
+412
+00:29:46,010 --> 00:29:49,290
+موجود ماشي واحد عكس التاني، بيقدر ال
+
+413
+00:29:49,290 --> 00:29:53,110
+multiplication هذا، بيقدر ال multiplication هذا،
+
+414
+00:29:53,110 --> 00:29:56,810
+واضح؟ اذا ال system المبني هنا صحي جزئية منه،
+
+415
+00:29:56,810 --> 00:30:00,570
+بتشتغل شغل معين، لكن انا بعيده و بكرر، بقدر هنا
+
+416
+00:30:00,570 --> 00:30:07,390
+ايدنه ايه؟الشيء يزيد مثلًا مثلًا مثلًا مثلًا مثلًا
+
+417
+00:30:07,390 --> 00:30:16,130
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+418
+00:30:16,130 --> 00:30:20,930
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+419
+00:30:20,930 --> 00:30:22,690
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+420
+00:30:22,690 --> 00:30:22,770
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+421
+00:30:22,770 --> 00:30:31,390
+مثلًا مثو ال filtrate 200 طيب لما يصير عندها 400
+
+422
+00:30:31,390 --> 00:30:34,330
+ال interstitium و قولنا it's descending limb
+
+423
+00:30:34,330 --> 00:30:37,770
+permeable to water تمام؟ اذا هت .. automatically
+
+424
+00:30:37,770 --> 00:30:41,430
+ال flow .. ال .. ال tubule هذا ال thin ascending
+
+425
+00:30:41,430 --> 00:30:45,370
+limb .. thin descending limb هو نازل معاه diluted
+
+426
+00:30:45,370 --> 00:30:49,790
+urine هيفقد ميه منه .. diluted fluid هيفقد ميه منه
+
+427
+00:30:49,790 --> 00:30:52,990
+بحيث يصير equilibrium مع مين؟ مع ال interstitium
+
+428
+00:30:55,370 --> 00:31:02,230
+الان هيفقد مية من ال water بحيث انه يصبح تركيزه
+
+429
+00:31:02,230 --> 00:31:07,270
+400 مساوى لمين ال interstitium فيها نتركة صغيرة
+
+430
+00:31:07,270 --> 00:31:10,810
+بدي تفهموها بعدين بس بدي أقولها الجديد الان المية
+
+431
+00:31:10,810 --> 00:31:15,810
+لما تخرج من ال descending limb وتروح لل hyper
+
+432
+00:31:15,810 --> 00:31:19,790
+osmotic interstitium تمام؟ وصارت ال osmolarity
+
+433
+00:31:19,790 --> 00:31:22,730
+متساوية مفترض المية لما تروح ال interstitium تتعمل
+
+434
+00:31:22,730 --> 00:31:28,780
+dilutionوتخرب عليه تمام هان بدخل system آخر اذا
+
+435
+00:31:28,780 --> 00:31:32,240
+احنا عشان نعمل concentration محتاجين انه الناس
+
+436
+00:31:32,240 --> 00:31:34,820
+تعمل concentration و الناس تحافظ عليها ال
+
+437
+00:31:34,820 --> 00:31:38,520
+concentration فال system هذا ال multiplication هذا
+
+438
+00:31:38,520 --> 00:31:42,100
+اللي بيصير بيعمل ال concentration بيجي نظام ال
+
+439
+00:31:42,100 --> 00:31:46,360
+vase recta اللي قلتلت عليه زمان شغلتها تحافظ علي
+
+440
+00:31:46,360 --> 00:31:50,270
+ال ايه؟عال concentration هذا بمعنى ان الفازاركته
+
+441
+00:31:50,270 --> 00:31:53,590
+ماشية بطريقة معينة الميه اللي طالع من ال tube و من
+
+442
+00:31:53,590 --> 00:31:56,030
+ال descending loop قبل ان تصبح ال interstitium
+
+443
+00:31:56,030 --> 00:32:00,790
+بيكون ايه؟ اخدت طيار للخارج اذا بيمنع .. في دافع
+
+444
+00:32:00,790 --> 00:32:05,690
+.. في دافع عندى بيجعل الميه تندفع من ال descending
+
+445
+00:32:05,690 --> 00:32:09,350
+loop of هنلي الى ال interstitium لكن هذا الدافع
+
+446
+00:32:09,350 --> 00:32:12,330
+بيجابل في الطريق الفازاركته اللي انا تحيط
+
+447
+00:32:12,330 --> 00:32:18,230
+الفازاركتهتحيط بال .. بال .. بالdescending tubule
+
+448
+00:32:18,230 --> 00:32:25,050
+بالdescending limb اه تصور انه ديل الفرس تمام
+
+449
+00:32:25,050 --> 00:32:28,070
+الوسطية تبعته هذه ال .. ال .. الdescending
+
+450
+00:32:28,070 --> 00:32:32,510
+lobopenly الوسطية تبعته لكن بجيط الشعر اللي حوالين
+
+451
+00:32:32,510 --> 00:32:38,090
+ديل الفرس هذا فزاركته اذا هو بيطلع جاعد ال ..الـ
+
+452
+00:32:38,090 --> 00:32:39,150
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+453
+00:32:39,150 --> 00:32:39,450
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+454
+00:32:39,450 --> 00:32:39,890
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+455
+00:32:39,890 --> 00:32:40,410
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+456
+00:32:40,410 --> 00:32:40,710
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+457
+00:32:40,710 --> 00:32:41,510
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+458
+00:32:41,510 --> 00:32:46,750
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+459
+00:32:46,750 --> 00:32:48,770
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+460
+00:32:48,770 --> 00:32:49,590
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+461
+00:32:49,590 --> 00:32:49,610
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+462
+00:32:49,610 --> 00:32:49,650
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+463
+00:32:49,650 --> 00:32:50,350
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+464
+00:32:50,350 --> 00:32:51,310
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+465
+00:32:54,420 --> 00:32:56,880
+في الـ Interstitium لأنه لو زلت في ال Interstitium
+
+466
+00:32:56,880 --> 00:33:00,700
+إيش جابت من ضربوها من عاوز نعمل ال dilution و
+
+467
+00:33:00,700 --> 00:33:04,800
+بتضرب الفعل هيك لذا الأن صار عندي قدرة على أن أعمل
+
+468
+00:33:04,800 --> 00:33:11,160
+Interstitium 400 و أعمل filtrate بعد ما يخرج من ال
+
+469
+00:33:11,160 --> 00:33:17,850
+proximal tubule و ينزل على اللو بوف هنلي تدخل و لو
+
+470
+00:33:17,850 --> 00:33:22,550
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي
+
+471
+00:33:22,550 --> 00:33:29,530
+تدخل و لو بوف هنلي تدخل و لو بوف هنلي تدخل و لو
+
+472
+00:33:29,530 --> 00:33:31,230
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي
+
+473
+00:33:31,230 --> 00:33:31,430
+تدخل و لو بوف هنلي تدخل و لو بوف هنلي تدخل و لو
+
+474
+00:33:31,430 --> 00:33:33,250
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي
+
+475
+00:33:33,250 --> 00:33:34,810
+تدخل و لو بوف هنلي تدخل و لو بوف هنلي تدخل و لو
+
+476
+00:33:34,810 --> 00:33:45,830
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي تهو
+
+477
+00:33:45,830 --> 00:33:49,870
+.. اذا creating osmolality, osmotic gradient و ال
+
+478
+00:33:49,870 --> 00:33:54,170
+system بيمنع ايه؟ بيعمل maintenance لمين؟ لهذا ال
+
+479
+00:33:54,170 --> 00:33:56,970
+.. ال .. ال concentration gradient تمام؟ طيب،
+
+480
+00:33:56,970 --> 00:34:00,570
+ماشي، اذا مدام وصلنا لهذا المسألة هذه فهمناها، اذا
+
+481
+00:34:00,570 --> 00:34:04,790
+ال multiplication ماوقفش، اذا هذا وصل لاربعمية،
+
+482
+00:34:04,790 --> 00:34:09,930
+اذا هذا وصل لاربعمية، تمام؟ اذا انا هنا وصلت هنا
+
+483
+00:34:09,930 --> 00:34:16,130
+لالميتين، الاربعمية هذه هتتحرك و تطلع فوقصارت 400
+
+484
+00:34:16,130 --> 00:34:20,420
+اكبار الميهينإذا صار 400 أكبر 400 مش كده هذا عنده
+
+485
+00:34:20,420 --> 00:34:24,260
+القدرة أنه يعمل فرق فبيقدر أضخها كمان مية بيصير ال
+
+486
+00:34:24,260 --> 00:34:29,100
+intersection 500 هو ايه 300 طبعا إذا صار عندي هان
+
+487
+00:34:29,100 --> 00:34:33,560
+في ال intersection ايه 500 هياخد مية من ال
+
+488
+00:34:33,560 --> 00:34:37,920
+descending limb بيوصل لمين ل 500 ال 500 هتنزل لل
+
+489
+00:34:37,920 --> 00:34:42,840
+ascending هصير 500 أكبر 500 بتديله كمان ايه 100
+
+490
+00:34:42,840 --> 00:34:47,820
+بيصير هان 600 و هان 500400 400 400 400 400 400 400
+
+491
+00:34:47,820 --> 00:35:07,460
+400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400440040040040044004004400440044004400440044004400440044004400440044004
+
+492
+00:35:12,380 --> 00:35:23,380
+هيبر ازموتك مدلة ازموتك ازموتك ازموتك ازموتك
+
+493
+00:35:23,380 --> 00:35:27,100
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+494
+00:35:27,100 --> 00:35:27,540
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+495
+00:35:27,540 --> 00:35:27,560
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+496
+00:35:27,560 --> 00:35:33,180
+ازموتك ازموتك ازموتك
+
+497
+00:35:33,180 --> 00:35:38,680
+ازم
+
+498
+00:35:43,060 --> 00:35:46,040
+بالكفاءة فوق بياخد جزء و تحت جزء و تحت جزء و تحت
+
+499
+00:35:46,040 --> 00:35:48,280
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+500
+00:35:48,280 --> 00:35:50,460
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+501
+00:35:50,460 --> 00:35:51,520
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+502
+00:35:51,520 --> 00:35:51,580
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+503
+00:35:51,580 --> 00:35:51,640
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+504
+00:35:51,640 --> 00:36:05,900
+جزء و تحت جزء و
+
+505
+00:36:05,900 --> 00:36:10,340
+تحت جزالـ distal tubule لما يعديلي من أول و جديد
+
+506
+00:36:10,340 --> 00:36:15,660
+على ال a على ال collecting duct وعندي antidiuretic
+
+507
+00:36:15,660 --> 00:36:19,840
+hormone موجود و ال water channels مفتوحة و ال urea
+
+508
+00:36:19,840 --> 00:36:24,840
+channels مفتوحة بيصير ال a الانتقال من هنا تمام؟
+
+509
+00:36:24,840 --> 00:36:28,840
+اذا واضحة اذا احنا طبعا شوية صغيرة اتكلمنا عن دور
+
+510
+00:36:28,840 --> 00:36:35,220
+ال antidiuretic hormone في انهيعمل دوره في ال
+
+511
+00:36:35,220 --> 00:36:39,220
+concentration بس دوره هنا في ال cortex دوره صحيح
+
+512
+00:36:39,220 --> 00:36:44,500
+جالي اللي بيوصل ل 300 لكنه حجما كبير الجزء اللي
+
+513
+00:36:44,500 --> 00:36:47,960
+بيظل صغير بنزل المضلة و بيصير ال concentration
+
+514
+00:36:47,960 --> 00:36:50,040
+أعلى من ال
+
+515
+00:36:51,990 --> 00:36:55,990
+من الـ Plasma Osmolality تمام بيصير أعلى لإنه يصير
+
+516
+00:36:55,990 --> 00:37:00,490
+عنده hyperzotic شسم و بعدين بيقول بيشارك مين
+
+517
+00:37:00,490 --> 00:37:05,990
+بيشارك اليوريا فيها عندنا هنتكلم عن اليوريا أكتر
+
+518
+00:37:05,990 --> 00:37:09,490
+وأكتر لإن كيف تعمل الدائرة تبعها لما دخلت جوا إيش
+
+519
+00:37:09,490 --> 00:37:12,970
+بيصير فيها هتكلم عنها بعد شوية إذن واضح ال
+
+520
+00:37:12,970 --> 00:37:15,990
+multiplication counter current multiplier أو
+
+521
+00:37:15,990 --> 00:37:21,410
+multiplicationto hyper osmotic renal medullar
+
+522
+00:37:21,410 --> 00:37:27,450
+infestation and to concentrate urine قولنا إذا
+
+523
+00:37:27,450 --> 00:37:31,940
+اللي شرب موية البحرفي حال ما بتطلع concentrated
+
+524
+00:37:31,940 --> 00:37:36,800
+urine لازم يكون من نصه urea تمام؟ لإن ال urea اللي
+
+525
+00:37:36,800 --> 00:37:40,780
+نازلة مشاركة في ال interstitium إذا تركيزها هيكون
+
+526
+00:37:40,780 --> 00:37:44,020
+في ال .. في ال .. في ال .. في ال trails زي ال إيه؟
+
+527
+00:37:44,020 --> 00:37:46,800
+زي ال interstitium إذا بصل لستمية و ال solids
+
+528
+00:37:46,800 --> 00:37:49,640
+الأخرى اللي أنا شربتها بتشارك بستمية إذا بيدو
+
+529
+00:37:49,640 --> 00:37:53,040
+اتنين لتر قلنا مش هيك؟ إذا هنا ال urea كيف بتمشي
+
+530
+00:37:53,040 --> 00:37:59,480
+ال urea و كيف بتعملفي رسمة انا يبدو اني شايلها مش
+
+531
+00:37:59,480 --> 00:38:04,460
+مشكلة اذا احنا الان اليوريا قلنا توي انه مراحل
+
+532
+00:38:04,460 --> 00:38:09,780
+التعامل معها ال proximal tubule بيقدر يمتص 50% من
+
+533
+00:38:09,780 --> 00:38:14,400
+اليوريا تمام؟ اذا ال لوبوفين اللي بيخشله بس 50% من
+
+534
+00:38:14,400 --> 00:38:18,480
+اليوريا اللي هي AFL-card، بصبوط؟ فاكرين هذه ولا
+
+535
+00:38:18,480 --> 00:38:21,080
+نسيتها انتوا؟ نسيتها يا عبدالله اذا ال proximal
+
+536
+00:38:21,080 --> 00:38:24,280
+tubule بيصير بيعمل رقم سورفين اليوريا اللي نازلها
+
+537
+00:38:24,280 --> 00:38:24,620
+الجهة
+
+538
+00:38:27,520 --> 00:38:33,080
+اليوريا اللي نازلة في ال loop of Henle بتبطل لما
+
+539
+00:38:33,080 --> 00:38:35,440
+تصل ال thick ascending .. لما تصل ال ascending
+
+540
+00:38:35,440 --> 00:38:38,720
+limb .. ال ascending limb impermeable to ايه؟ to
+
+541
+00:38:38,720 --> 00:38:45,300
+يوريا لأ احنا جولنا ال distal tubule للاخر
+
+542
+00:38:45,300 --> 00:38:49,770
+impermeable to يورياعندي حاجتين، يعني عندي ايه؟
+
+543
+00:38:49,770 --> 00:38:57,170
+حاجتين عندي thick ascending و .. و .. و .. و .. و
+
+544
+00:38:57,170 --> 00:38:58,390
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+545
+00:38:58,390 --> 00:38:58,410
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+546
+00:38:58,410 --> 00:38:58,450
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+547
+00:38:58,450 --> 00:38:59,170
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+548
+00:38:59,170 --> 00:38:59,970
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+549
+00:38:59,970 --> 00:39:00,590
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+550
+00:39:00,590 --> 00:39:02,950
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+551
+00:39:02,950 --> 00:39:03,010
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+552
+00:39:03,010 --> 00:39:12,850
+.. و .. و .. و .. و .. و
+
+553
+00:39:14,720 --> 00:39:19,280
+أذا عندى انا يوريا اندفعت لإنها concentrated في ال
+
+554
+00:39:19,280 --> 00:39:24,520
+tubular fluid موجود في المضلة عندى يوريا مركزة
+
+555
+00:39:24,520 --> 00:39:29,220
+وقولنا كيف اتركزت تندفع من ال transporters إلى ال
+
+556
+00:39:29,220 --> 00:39:33,080
+interstation اللى هو مفترض انا لسه اليوريا فيه
+
+557
+00:39:33,080 --> 00:39:36,800
+عادية زى ما في البلازمه تركيز اليوريا في البلازمه
+
+558
+00:39:36,800 --> 00:39:41,760
+عشرين لاربعين milligram per liter يعني osmolality
+
+559
+00:39:41,760 --> 00:39:42,660
+واقعى حوالى
+
+560
+00:39:45,240 --> 00:39:47,680
+المشاركة في ال .. في ال .. في الgeneral
+
+561
+00:39:47,680 --> 00:39:51,740
+responsibility للدم لا تُذكر للبلازمة تمام؟ إذا
+
+562
+00:39:51,740 --> 00:39:54,560
+عندي hands are concentrated يوريا في ال .. في ال
+
+563
+00:39:54,560 --> 00:39:59,760
+tubular fluid اللي في المضلة مش كده؟ و ال
+
+564
+00:39:59,760 --> 00:40:02,220
+interstitium مش فيه concentration و transporters
+
+565
+00:40:02,220 --> 00:40:05,380
+فارقة فتدفع ال .. ال يوريا إلى إيه؟ إلى ال
+
+566
+00:40:05,380 --> 00:40:09,180
+interstitium هتظل تندفع .. تندفع لحد ما إيه يصير
+
+567
+00:40:09,180 --> 00:40:17,420
+ال concentration متساوي مظبوط؟طيب متساوي و خلص
+
+568
+00:40:17,420 --> 00:40:22,020
+دورها؟ لأ جالك إلها دور أكبر كيف يعني؟ جزء من هذا
+
+569
+00:40:22,020 --> 00:40:26,890
+اللي دخل ال interest station هيدخلهيدخل ال loop
+
+570
+00:40:26,890 --> 00:40:31,130
+فين ليه؟ هيزيد إلى اليوريا اللي موجودة احنا قلنا
+
+571
+00:40:31,130 --> 00:40:35,170
+قبل كده الجسم مبني على اقتصاد تمام اليوريا دي
+
+572
+00:40:35,170 --> 00:40:38,510
+ماتطلعها انا لإنها end product مابديش إياها لكن إن
+
+573
+00:40:38,510 --> 00:40:41,390
+مابدي أعمل concentrated during بدي ساعدني في
+
+574
+00:40:41,390 --> 00:40:47,390
+الموضوع تمام فبدي أحفظ جزء منها يساعدني في تركيز
+
+575
+00:40:47,390 --> 00:40:52,310
+ال interest ratio معايا بنات؟ معايا مركزين؟ إذا ..
+
+576
+00:40:52,310 --> 00:40:56,350
+إذا مش واضح .. مش واضح بعيد تاني الآنال .. ال ..
+
+577
+00:40:56,350 --> 00:40:58,010
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+578
+00:40:58,010 --> 00:40:58,130
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+579
+00:40:58,130 --> 00:40:58,170
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+580
+00:40:58,170 --> 00:40:58,430
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+581
+00:40:58,430 --> 00:40:58,630
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+582
+00:40:58,630 --> 00:40:59,570
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+583
+00:40:59,570 --> 00:40:59,890
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+584
+00:40:59,890 --> 00:41:00,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+585
+00:41:00,670 --> 00:41:06,270
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+586
+00:41:06,270 --> 00:41:07,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+587
+00:41:07,670 --> 00:41:09,070
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+588
+00:41:09,070 --> 00:41:15,890
+ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+589
+00:41:15,890 --> 00:41:19,370
+ال
+
+590
+00:41:19,370 --> 00:41:21,410
+..
+
+591
+00:41:23,070 --> 00:41:26,670
+بصار في عندى برضه permeable to water إذا برضه يصحب
+
+592
+00:41:26,670 --> 00:41:31,470
+منه water إذا كله بيساعد ان ال urea تزيد تركيزها
+
+593
+00:41:31,470 --> 00:41:34,810
+لكن هنا بيروح water و بيروح urea برضه في نفس
+
+594
+00:41:34,810 --> 00:41:37,570
+الكمية بس إذا التركيز اللى دخل من ال cortex و ده
+
+595
+00:41:37,570 --> 00:41:42,490
+اللى هو هو ليش لإنه الآن بدخل ال water و ال .. اه
+
+596
+00:41:42,490 --> 00:41:46,070
+لما دخلنا ال interstitium ال interstitium لجينا a
+
+597
+00:41:46,070 --> 00:41:53,230
+thin loop ال urea فيه مخففة تماملأن انا هنا سحبت
+
+598
+00:41:53,230 --> 00:41:56,770
+كمية مياه إضافية فصار اليوريا مركزة فيستطيع انها
+
+599
+00:41:56,770 --> 00:41:59,670
+اليوريا تدخل الـ thin loop الـ thin loop of Henle
+
+600
+00:41:59,670 --> 00:42:04,010
+إذا كانت descending ولا ايه؟ و لا سنسياً معناها
+
+601
+00:42:04,010 --> 00:42:07,810
+اليوريا اللي في ال loop of Henle كميتها أكبر من
+
+602
+00:42:07,810 --> 00:42:10,790
+اليوريا اللي جاية من ال proximal tubule لإن اللي
+
+603
+00:42:10,790 --> 00:42:15,190
+جاية من ال proximal tubule مضاف عليه كمية ازيادة
+
+604
+00:42:15,190 --> 00:42:20,580
+تمام؟إذاً اللي صار في الـ Tube-ul صار مركز أكتر
+
+605
+00:42:20,580 --> 00:42:24,520
+لإنه أخد شزء من الـ Interstitiumوهذا هيعدي برضه in
+
+606
+00:42:24,520 --> 00:42:29,660
+permeable ويصير تركيز أعلى من التركيز الأولاني لأن
+
+607
+00:42:29,660 --> 00:42:32,360
+كمية من اليوريا اللي سارت في الـ distal nephron
+
+608
+00:42:32,360 --> 00:42:36,140
+سارت الجزء اللي جاء من الـ proximal tubule وجزء
+
+609
+00:42:36,140 --> 00:42:40,720
+تاني رجع لف دخل شعرك في الموضوع تمام فتركيزها عالي
+
+610
+00:42:40,720 --> 00:42:46,100
+أكتر من أول الآن تنزل المدلة Reduct مركزة أكتر من
+
+611
+00:42:46,100 --> 00:42:50,260
+أول معناه تدّي يوريا أكتر لل-interstitium معناه في
+
+612
+00:42:50,260 --> 00:42:55,450
+كمية يوريا أكتر بتخش من الـthin loopمعنى ان الوريا
+
+613
+00:42:55,450 --> 00:43:00,250
+اللى في اللوموفينلي صارت more in quantity عن الأول
+
+614
+00:43:00,250 --> 00:43:03,390
+معنى انها لسهب فبتحمل برضه الوريا multiplication
+
+615
+00:43:03,390 --> 00:43:08,670
+بحيث انها تزيد تركيزها في ال filtrate ومعناها اللى
+
+616
+00:43:08,670 --> 00:43:12,230
+بينتقل من ال filtrate الى ال interest ratioبزيد،
+
+617
+00:43:12,230 --> 00:43:16,370
+إذا هي برضه بتشارك بطريقة إيه؟ بطريقة أخرى، واضح؟
+
+618
+00:43:16,370 --> 00:43:19,610
+بطريقة أخرى ال rule key تبعها إنه في antideric
+
+619
+00:43:19,610 --> 00:43:25,390
+hormone بسمح لمية تخش و بسمحش ل aurea لكن إذا هبط
+
+620
+00:43:25,390 --> 00:43:30,220
+ال antideric hormoneو ال water اللى موجودة ضالة
+
+621
+00:43:30,220 --> 00:43:34,320
+فيها هي ال urea بيصير مش concentrated و بيصير عندى
+
+622
+00:43:34,320 --> 00:43:37,520
+انا ال .. انا losing ال ايه ال .. ال urea
+
+623
+00:43:37,520 --> 00:43:40,840
+concentration ال gradient شوية شوية شوية لإنه بطلت
+
+624
+00:43:40,840 --> 00:43:44,580
+تخش ال interstitium و صارت تنزل و ماهياش
+
+625
+00:43:44,580 --> 00:43:49,280
+concentrated و اقف زى ما انا برضه thick ascending
+
+626
+00:43:49,280 --> 00:43:52,840
+limb ممكن ايه اعمل losing لإذا مافيش عندى
+
+627
+00:43:56,820 --> 00:43:59,720
+مافيش عندى ال aldosterone ال aldosterone مشكلة في
+
+628
+00:43:59,720 --> 00:44:03,900
+ال .. في ال .. في ال distal part هنا حقيقة مش ال
+
+629
+00:44:03,900 --> 00:44:06,900
+aldosterone ال distal part ال aldosterone على ال
+
+630
+00:44:06,900 --> 00:44:10,100
+sodium مالناش علاقة فيه الآن احنا بنتكلم عن ال
+
+631
+00:44:10,100 --> 00:44:14,220
+thick ascending limb اذا ال blood supply للمضلة
+
+632
+00:44:14,220 --> 00:44:21,900
+طبعا ضال جليل طبعا معناه الجكسة مدلري نفلوس مفتحوش
+
+633
+00:44:22,490 --> 00:44:28,690
+والدستال تبعهم يشتغلش ومايعملش ال concentration
+
+634
+00:44:28,690 --> 00:44:33,490
+gradient تمام؟ مايعملش ال concentration gradient
+
+635
+00:44:33,490 --> 00:44:38,290
+اللي هو يعتمد على الجكستا ميدالا رينفرونز إذا قلنا
+
+636
+00:44:38,290 --> 00:44:40,330
+احنا ال concentration gradient هذا بنعمل في
+
+637
+00:44:40,330 --> 00:44:45,290
+الميدالا بسبب مين؟ بسبب الجكستا غلوميرا رينفرونز
+
+638
+00:44:45,290 --> 00:44:50,840
+اللي هي لها long globeبتعمل الحركة هادئة واضح ؟
+
+639
+00:44:50,840 --> 00:44:53,860
+اذا انا اذا وجفت ال thick ascending limb عن العمل
+
+640
+00:44:53,860 --> 00:44:58,260
+بمعنى ان ال glomeruli تبعته كلها انا عملت لها
+
+641
+00:44:58,260 --> 00:45:04,180
+constriction و مابتشتغلش مرتاحة تمام اذا ممكن
+
+642
+00:45:04,180 --> 00:45:08,120
+يتوقف عن العمل هذا الجزئية فببطل في عند ال
+
+643
+00:45:08,120 --> 00:45:11,160
+concentration grade ال concentration grade مبدأ
+
+644
+00:45:11,160 --> 00:45:15,670
+يخفيعني to be washed شوية شوية شوية وفيش ايه a new
+
+645
+00:45:15,670 --> 00:45:18,970
+generation ل concentration gradient في التكأس
+
+646
+00:45:18,970 --> 00:45:22,690
+النجلم فبيختفي لو صار عند ال blood flow زاد مرة
+
+647
+00:45:22,690 --> 00:45:27,360
+واحدة للمضلة زي ما في حالة مثلا hypertensionفي حال
+
+648
+00:45:27,360 --> 00:45:32,300
+ان انا مدى vasodilators تمام الدم اذا انا عملت
+
+649
+00:45:32,300 --> 00:45:37,900
+high blood flow للinterstitium مابقدرش احافظ
+
+650
+00:45:37,900 --> 00:45:40,680
+الinterstitium على ال ايه؟ على ال concentration ال
+
+651
+00:45:40,680 --> 00:45:43,840
+gradient لانه بيجي الدم الكتير بيعملوش لل ايه؟ لل
+
+652
+00:45:43,840 --> 00:45:47,820
+solutes infusion الأخير هذا هتكلم عنه بعدي شوية
+
+653
+00:45:47,820 --> 00:45:52,210
+اكتر بس دلوقتي فهمنا دور ال thick ascending limbو
+
+654
+00:45:52,210 --> 00:45:55,210
+ال multiplication اللي بيعمله و دور اليوريا و ال
+
+655
+00:45:55,210 --> 00:45:59,090
+multiplication اللي بيحصل فيها واضح هذا اهم اشي
+
+656
+00:45:59,090 --> 00:46:05,650
+انا اريكوا تفهموه
+
+657
+00:46:05,650 --> 00:46:10,590
+recirculation of urea اه هذا الجزء اللي كان انا
+
+658
+00:46:10,590 --> 00:46:15,550
+اريكوا تشوفوه هو ماشوفتوش اذا الان قولنا اليوريا
+
+659
+00:46:15,550 --> 00:46:18,970
+في
+
+660
+00:46:18,970 --> 00:46:23,160
+التكاسن في المضارة الاداكت هناhyper concentrated
+
+661
+00:46:23,160 --> 00:46:29,760
+ليش؟ لأنه صار absorption ال water بدونها فهنا
+
+662
+00:46:29,760 --> 00:46:32,780
+بتندفع إلى داخل ال interstitium وفي ال
+
+663
+00:46:32,780 --> 00:46:36,080
+interstitium لإن الفيلتريتها هذا permeable لها
+
+664
+00:46:36,080 --> 00:46:40,560
+الجزئية 10 هذا الجزئية permeable لها و هو في ال
+
+665
+00:46:40,560 --> 00:46:43,420
+interstitium أعلى فبتنتقل إلى ال A فبصير كمية
+
+666
+00:46:43,420 --> 00:46:46,940
+اليوريا اللي صارت في ال tubule أكتر فاللي صار طالع
+
+667
+00:46:46,940 --> 00:46:50,040
+لي على ال distal nephron كمية أكتر و إذا سحبنا
+
+668
+00:46:50,040 --> 00:46:54,020
+الميه بعمل تركيز أكتروبتعمل ال multiple cache اللي
+
+669
+00:46:54,020 --> 00:46:57,680
+قلنا عليه هذا
+
+670
+00:46:57,680 --> 00:47:01,760
+جزء
+
+671
+00:47:01,760 --> 00:47:05,580
+counter can't exchange in the vase recta هذا الجزء
+
+672
+00:47:05,580 --> 00:47:09,560
+التاني اللي انا حكيتلكوا عليها ال vase recta بتمشي
+
+673
+00:47:09,560 --> 00:47:15,580
+بطريقة ما تبقى حوالين ال thin descending loop
+
+674
+00:47:15,580 --> 00:47:19,220
+حوالين ال loop كله بس هي بالذات بتكون محيطا مين
+
+675
+00:47:19,220 --> 00:47:29,330
+بال thin بحيث انهال .. ال .. ال ascending فأزاركتة
+
+676
+00:47:29,330 --> 00:47:34,500
+ملاصق لل .. لل descendingThin loop يعني هنا في
+
+677
+00:47:34,500 --> 00:47:39,200
+عندي counter current ماشيين عكس بعض تمام اذا بيكون
+
+678
+00:47:39,200 --> 00:47:42,560
+عندى انا افترض انه تلت حاجات هنا و هن حاجتين هذا
+
+679
+00:47:42,560 --> 00:47:45,820
+الوسطانية هذا ال tubular filtrate تمام ال thin
+
+680
+00:47:45,820 --> 00:47:49,560
+descending loop و هدول الجتنين اللي جنبهم هدول
+
+681
+00:47:49,560 --> 00:47:54,160
+يمثلوا ال ascending vasecta و برا ال descending
+
+682
+00:47:54,160 --> 00:47:58,380
+vasecta اذا ال vasecta بتنزل بعيد عن ال tubule وهي
+
+683
+00:47:58,380 --> 00:48:02,130
+طالعة ملاصقة لمينلات تفيل ، لأن شغلها تحمل الماء
+
+684
+00:48:02,130 --> 00:48:06,550
+اللي طالع منه و هي طالعة تمام؟ تحملها و هي طالعة،
+
+685
+00:48:06,550 --> 00:48:08,690
+إذا التركيبة الـ anatomical structure تبع
+
+686
+00:48:08,690 --> 00:48:13,550
+الفاذاركتة معمولة بطريقة إنه يسحب كل ال إيه؟ لو ال
+
+687
+00:48:13,550 --> 00:48:16,970
+blood flow زاد بالفاذاركتةهذا بيقدر إلى انه ايه
+
+688
+00:48:16,970 --> 00:48:22,730
+يعمل wash لكل ال solutes كمان مش بس لمين لل ال ال
+
+689
+00:48:22,730 --> 00:48:27,510
+water واضح طيب التفاصيل مش وم كتير التفاصيل تبعت
+
+690
+00:48:27,510 --> 00:48:30,470
+ال vase recta انت تصورتها زي ما انا قلت فياها مش
+
+691
+00:48:30,470 --> 00:48:34,950
+هيك خيلتوها كيف انه ال descending thin loop of
+
+692
+00:48:34,950 --> 00:48:38,950
+Henle محاط بال ascending vase recta وبيعمل عملية
+
+693
+00:48:38,950 --> 00:48:39,850
+اتكلمنا عنها
+
+694
+00:48:45,230 --> 00:48:51,130
+أذا في في ال vasa recta counter current exchanger
+
+695
+00:48:51,130 --> 00:48:59,070
+تمام؟ يا ربي يا كريم .. اذا عندي هان هذا .. vasa
+
+696
+00:48:59,070 --> 00:49:03,930
+recta هذه الصورة هذه ال vasa recta و كيف انه ال
+
+697
+00:49:03,930 --> 00:49:07,950
+fluids بتنتقل المهم .. انا المهم اللي فهمت بيها
+
+698
+00:49:07,950 --> 00:49:11,410
+اكتر من ما تقولوا التفاصيل لأنها مزعجة شوية
+
+699
+00:49:17,100 --> 00:49:21,540
+فازاريكتا لا تخلق مدالة عيب الأزملالية ولكنهم
+
+700
+00:49:21,540 --> 00:49:26,820
+يحفظونها من أن تكون محفوظة فازاريكتا شغلتها أنها
+
+701
+00:49:26,820 --> 00:49:30,560
+تمنع أن العيب الأزملالية تذهب من خلال أنه يسحب
+
+702
+00:49:30,560 --> 00:49:35,720
+المي أول بأول تحفظ مدالة عيب الأزملالية يمكن أن
+
+703
+00:49:35,720 --> 00:49:37,360
+يقوم بتحفظ مدالة عيب الأزملالية تحفظ مدالة عيب
+
+704
+00:49:37,360 --> 00:49:39,120
+الأزملالية تحفظ مدالة عيب الأزملالية تحفظ مدالة
+
+705
+00:49:39,120 --> 00:49:41,180
+عيب الأزملالية تحفظ مدلة عيب الأزملالية تحفظ مدلة
+
+706
+00:49:41,180 --> 00:49:47,160
+عيب الأزملالية تحفظ مدلة عيب2% من blood supply
+
+707
+00:49:47,160 --> 00:49:51,140
+يعني 2% من رين ال blood supply بتروح المضلة 98%
+
+708
+00:49:51,140 --> 00:49:55,920
+بتروح ال cortex يعني هنا ممكن ازيد ل 5% maximum
+
+709
+00:49:55,920 --> 00:50:04,020
+لكن لو انا عندي hypertension
+
+710
+00:50:04,020 --> 00:50:11,670
+شويةيعني الضغط زاد يعني ال efferent filtration ال
+
+711
+00:50:11,670 --> 00:50:15,490
+efferent الضغط زاد الbertier capillary زاد والجزء
+
+712
+00:50:15,490 --> 00:50:19,590
+اللي بنزل لل .. لانفاز عليك تاع اه الضغط زاد معناه
+
+713
+00:50:19,590 --> 00:50:22,150
+بيزيد ال blood flow في ال ايه؟ في المضلة وهذا
+
+714
+00:50:22,150 --> 00:50:28,750
+washing ال ايه؟ ال osmotic gradient اذا
+
+715
+00:50:28,750 --> 00:50:34,820
+certain vasodilatorsأو Hypertension ممكن يخربني
+
+716
+00:50:34,820 --> 00:50:41,000
+الـA أو الـOsmotic Gradient في المدلة ويخربني
+
+717
+00:50:41,000 --> 00:50:45,720
+الـability تبع البيولين لإكسيقراط البيولين المركزي
+
+718
+00:50:45,720 --> 00:50:48,820
+للبيولين
+
+719
+00:50:48,820 --> 00:50:51,160
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+720
+00:50:51,160 --> 00:50:51,200
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+721
+00:50:51,200 --> 00:50:51,260
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+722
+00:50:51,260 --> 00:50:52,500
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+723
+00:50:52,500 --> 00:50:53,020
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+724
+00:50:53,020 --> 00:50:54,100
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+725
+00:50:54,100 --> 00:50:58,150
+المركزي للبيولين المركزي للبيولين المركزThe kidney
+
+726
+00:50:58,150 --> 00:51:01,030
+can when needed execute highly concentrated urine
+
+727
+00:51:01,030 --> 00:51:05,110
+that contains little sodium اذا عندي انا الان
+
+728
+00:51:05,110 --> 00:51:10,630
+الورية صارت مش قصة انها بس مشاركة اقتصادية صارت
+
+729
+00:51:10,630 --> 00:51:14,050
+مشاركة اخرى انه انا ممكن بتطلع concentrated urine
+
+730
+00:51:14,050 --> 00:51:16,990
+لان انا محتاج الميه لكن برضه انا محتاج ال sodium
+
+731
+00:51:16,990 --> 00:51:23,810
+مابديش انا ايه اعمل reabsorption اعمل execution لل
+
+732
+00:51:23,810 --> 00:51:28,280
+sodium بدي كل ال sodium ااخده تمامفي الحالة هذه
+
+733
+00:51:28,280 --> 00:51:35,660
+انا بقدر اطلع concentrated urine فقط بيورية تمام؟
+
+734
+00:51:35,660 --> 00:51:40,420
+لذا اذا انا كنت محتاج الصوديوم و ممكن يكون عندى
+
+735
+00:51:40,420 --> 00:51:43,760
+انا concentrated urine طالع بس اليورية اللى فيه
+
+736
+00:51:43,760 --> 00:51:46,920
+ايه عملاله concentration مش محتاجين ان الصوديوم
+
+737
+00:51:46,920 --> 00:51:47,480
+اشارك
+
+738
+00:51:50,250 --> 00:51:54,210
+إذاً نحتاج أن نشتغل يورين عالي مركزي يحتوي على
+
+739
+00:51:54,210 --> 00:51:57,810
+قليل من الصوديوم الكلوريه الهيبر ازمولاريه لليورين
+
+740
+00:51:57,810 --> 00:52:02,970
+في هذه الحالات هي عبارة عالية عن مركزات أخرى
+
+741
+00:52:02,970 --> 00:52:10,570
+الصوديوم خاصة يورية و كرياتينيه محدث
+
+742
+00:52:10,570 --> 00:52:15,050
+محدث في حالة كهذه يعني لم أحتاج أن أخذ الصوديوم
+
+743
+00:52:15,050 --> 00:52:19,540
+كله و أطلع يورية في حالة الفي حالة dehydration
+
+744
+00:52:19,540 --> 00:52:23,280
+شديدة انا بدي الميه و بدي ال sodium بس بديش ايه؟
+
+745
+00:52:23,280 --> 00:52:26,320
+يوريا فانا بطلع concentrated urine صحيح لإن أخدت
+
+746
+00:52:26,320 --> 00:52:29,880
+كل الميه و أخدت كل ال sodium لكن بلقى ال
+
+747
+00:52:29,880 --> 00:52:32,340
+concentrated urine طالع ايه؟ باليوريا اذا في
+
+748
+00:52:32,340 --> 00:52:37,500
+اليوريا هذه عشان انا احافظ على الميه بدي hyper
+
+749
+00:52:37,500 --> 00:52:42,240
+osmotic interstitium مش كده؟ اذا لو كان عندي ال
+
+750
+00:52:42,240 --> 00:52:49,870
+interstitiumفي كمية صوديوم كبيرة معناها الصوديوم
+
+751
+00:52:49,870 --> 00:52:53,230
+اللى بيخش بالالدوستيرون مش هيقدر تخش لإنه بيخش by
+
+752
+00:52:53,230 --> 00:52:58,030
+diffusion مش كده الالدوستيرون بيشغل مع
+
+753
+00:52:58,030 --> 00:53:07,490
+الاندروجرمون لأكل عبدالسنفرن طبعا إذا كان في عندى
+
+754
+00:53:07,490 --> 00:53:08,810
+صوديوم
+
+755
+00:53:12,550 --> 00:53:16,650
+إذا انا ممكن أأكل كل ال Sodium اللي من ايه من ال
+
+756
+00:53:16,650 --> 00:53:21,170
+.. من ال tubule و اطلع فقط اللي هو اليوريا و اطلع
+
+757
+00:53:21,170 --> 00:53:24,390
+فقط اليوريا معناه انا بيصير عندي absorption of
+
+758
+00:53:24,390 --> 00:53:27,450
+Sodium كمية ضخمة ال interstitium بيضلش فيه
+
+759
+00:53:27,450 --> 00:53:31,050
+concentrated sodium عشان مايصيرش equilibrium بيصير
+
+760
+00:53:31,050 --> 00:53:34,950
+عندي إلى .. ينزل ل zero عشان كل ال Sodium اللي في
+
+761
+00:53:34,950 --> 00:53:39,780
+ال tubule يندفع ال interstitium و reabsorbedبالحظه
+
+762
+00:53:39,780 --> 00:53:43,080
+يعني ممكن انا اوصل انه كل العملية هاد يتصير
+
+763
+00:53:43,080 --> 00:53:47,580
+باليوريا وفي الاخر يطلع concentrated urea طب و ال
+
+764
+00:53:47,580 --> 00:53:50,580
+sodium ال sodium reabsorbed completely عشان يكونوا
+
+765
+00:53:50,580 --> 00:53:53,920
+reabsorbed completely لازم ال transition مايكنش في
+
+766
+00:53:53,920 --> 00:53:56,780
+ايه ال sodium concentration و الا هيصير اندي انا
+
+767
+00:53:56,780 --> 00:54:00,620
+equilibrium لحد ال sodium ماهو equilibrium واضح؟
+
+768
+00:54:00,620 --> 00:54:04,950
+اذا في حالاتمنلاقي انه مش التيران مشاركين واحد
+
+769
+00:54:04,950 --> 00:54:09,110
+منهم وممكن العكس يصير يعني الدقة في عمل الكلية هان
+
+770
+00:54:09,110 --> 00:54:14,010
+اكبر من الشرح تبعنا اكبر من الشرح تبعنا لإنه جدش
+
+771
+00:54:14,010 --> 00:54:16,730
+يطلع يوريا بزيادة او سوديوم بزيادة او سوديوم
+
+772
+00:54:16,730 --> 00:54:21,610
+بزيادة او يوريا اقل او ميه اكتر و سوديوم اقل او
+
+773
+00:54:21,610 --> 00:54:26,290
+سوديوم اكتر و ميه اقل very meticulous process
+
+774
+00:54:26,290 --> 00:54:31,220
+دقيقة جدابحيث انه في الآخر احنا بنشرح عشان تعرفوا
+
+775
+00:54:31,220 --> 00:54:34,320
+بعض ال procedures اللي بتصير عشان تستوعبوا كيف ال
+
+776
+00:54:34,320 --> 00:54:37,830
+control بيصير لكن ال control ايه؟very complicated
+
+777
+00:54:37,830 --> 00:54:40,810
+لأنه بتدخل هنا عيننا كمان other hormones و other
+
+778
+00:54:40,810 --> 00:54:46,870
+prostaglandins و vasodilators قصص كبيرة لكن واضح
+
+779
+00:54:46,870 --> 00:54:51,430
+من الكلام أنه في عندنا جهد كبير و تركيز كبير و عمل
+
+780
+00:54:51,430 --> 00:54:54,550
+كبير بتم في الكلية بحيث أنها تختار بالظبط اللي
+
+781
+00:54:54,550 --> 00:54:57,850
+بتهيأ حسب الأوامر اللي جاي من الجسم احنا بنكمل
+
+782
+00:54:57,850 --> 00:55:02,270
+بنفهم البنيا و هي عليها ال ايه عليها الباقي هذا
+
+783
+00:55:02,270 --> 00:55:03,090
+النقطة الأولانية
+
+784
+00:55:06,120 --> 00:55:08,800
+إنه ممكن افصل انا في ال concentration ما بين ال
+
+785
+00:55:08,800 --> 00:55:11,140
+sodium و اليوريا ممكن يطلع لي بس اليوريا لحالها
+
+786
+00:55:11,140 --> 00:55:13,900
+concentrated من غير ما يكون فيه Sodium او ممكن
+
+787
+00:55:13,900 --> 00:55:17,980
+العكس او في العكس بيكون mainly Sodium و جالي
+
+788
+00:55:17,980 --> 00:55:22,660
+اليورياالنقطة التانية اللي بدنا نتكلم عنها large
+
+789
+00:55:22,660 --> 00:55:25,720
+quantities of diluted urine can be executed
+
+790
+00:55:25,720 --> 00:55:29,280
+without increasing the execution of sodium منفصلين
+
+791
+00:55:29,280 --> 00:55:32,620
+يعني لا يعني ال volume الكبيرة من ال urine انه في
+
+792
+00:55:32,620 --> 00:55:37,700
+عندى كمان sodium كتير لأ ممكن يكون large volume of
+
+793
+00:55:37,700 --> 00:55:42,920
+diluted urine without
+
+794
+00:55:42,920 --> 00:55:46,420
+increasing the execution of sodium بمعنى انه لما
+
+795
+00:55:46,420 --> 00:55:50,710
+بزيد البول ال execution تبعهالـ concentration of
+
+796
+00:55:50,710 --> 00:55:55,290
+sodium في الـ bowl بجليل لأنه بتطلع كمية معينة
+
+797
+00:55:55,290 --> 00:55:59,090
+بتطلع بلاجة كمية طلعت ان كان بحاشب كبير bowl ولا
+
+798
+00:55:59,090 --> 00:56:03,970
+حاشب جليل bowl إذا في هذه عملية execution of
+
+799
+00:56:03,970 --> 00:56:08,270
+solutes منفصلة تماما عن الـ A إذا هي هي هتطلع
+
+800
+00:56:08,270 --> 00:56:11,270
+وكمية الميه اللي بدنا هيه هتطلع فبيقدر إلى أنه
+
+801
+00:56:11,270 --> 00:56:14,110
+الميه بتطلع ال sodium concentration عالي أو واطي
+
+802
+00:56:14,900 --> 00:56:17,700
+مالوش علاقة ان ال volume زاد يعني ال .. ال .. ال
+
+803
+00:56:17,700 --> 00:56:20,540
+.. ال .. ال .. ال water و ال sodium زاد لأ زي ما
+
+804
+00:56:20,540 --> 00:56:24,320
+قلنا في المثال الأولاني لما شربنا لتر ميه لجينا
+
+805
+00:56:24,320 --> 00:56:26,940
+الميه كترة تلاكظ ان ال sodium excretion ماتغيرش
+
+806
+00:56:26,940 --> 00:56:31,780
+لإن ال concentration تبعه هبط تمام فال
+
+807
+00:56:31,780 --> 00:56:34,600
+concentration هبط و ال volume of urine زاد فظهر
+
+808
+00:56:34,600 --> 00:56:41,200
+كمية ال excreted sodium هو هو واضح؟ طيب
+
+809
+00:56:41,200 --> 00:56:47,370
+quantifying ingredientsconcentration and dilution
+
+810
+00:56:47,370 --> 00:56:58,350
+نعمل عملية حسابية نشرح
+
+811
+00:56:58,350 --> 00:57:05,750
+الجزء الأخير هنا عملية osmolality هذي أو ال urine
+
+812
+00:57:05,750 --> 00:57:11,030
+concentration ممكن نديله عملية قياسية ال
+
+813
+00:57:11,030 --> 00:57:15,040
+quantifying of urine concentrationand dilution
+
+814
+00:57:15,040 --> 00:57:18,340
+لجينا انه احنا لما اتكلمنا عن ال clearance في يوم
+
+815
+00:57:18,340 --> 00:57:21,700
+من الأيام مش هيك قلنا ال clearance تبع المادة
+
+816
+00:57:21,700 --> 00:57:27,820
+المعينة هو جديش انا بقدر انظف بلازمة من مادة معينة
+
+817
+00:57:27,820 --> 00:57:32,160
+وقلنا الحسبة تبعتها سهلة اه ال concentration في ال
+
+818
+00:57:32,160 --> 00:57:35,240
+volume تبع ال urine من جسمه على ال concentration
+
+819
+00:57:35,240 --> 00:57:39,400
+في البلازمة بيطلع اكام سانت بلازمة نظيف بظبط طب
+
+820
+00:57:39,400 --> 00:57:43,320
+انا ممكن اعمل clearance of osmoles clearance of
+
+821
+00:57:43,320 --> 00:57:52,110
+ايه؟و ازمولز جداش انا طلعت ازمولز بقول انا ازمولية
+
+822
+00:57:52,110 --> 00:57:58,470
+لليورين في ال volume على ازمولية لبلازمة مش هيك
+
+823
+00:57:58,470 --> 00:58:06,250
+مقدر اقول انا جداش عملت نظفتبلازمة من كل الصليوط
+
+824
+00:58:06,250 --> 00:58:09,750
+لان كل الاصموتيكالي اكتف صليوط انا بتكلم عنها جاعد
+
+825
+00:58:09,750 --> 00:58:13,770
+مضفتها منها كلها اذا ماجدش اصموال طلع هدول
+
+826
+00:58:13,770 --> 00:58:17,570
+الاصموال موجودة في اكم صنطي اكمل اذا حاجة اسمة
+
+827
+00:58:17,570 --> 00:58:23,610
+clearance of ايه of اصموال طيب اذا الان لما يكون
+
+828
+00:58:23,610 --> 00:58:32,720
+عندى تركيز تركيز ال ball يساوي تركيز ال plasmaيعني
+
+829
+00:58:32,720 --> 00:58:37,040
+ازمولز هان ازمولالتي هان و ازمولالتي هان واحد بظبط
+
+830
+00:58:37,040 --> 00:58:42,820
+معناه ال clearance of ازمولز هذا يسوى ال urine
+
+831
+00:58:42,820 --> 00:58:47,120
+volume مش كده لإن ال urine volume في ال
+
+832
+00:58:47,120 --> 00:58:49,120
+concentration على ال concentration بروح ال
+
+833
+00:58:49,120 --> 00:58:53,100
+concentration هذا مع بعض لإنه متساوين بيصير ال ايه
+
+834
+00:58:53,100 --> 00:58:56,360
+ال clearance of ازمولز يسوى ايه ال urine volume
+
+835
+00:58:56,360 --> 00:59:03,670
+طيب لو كان انا عندي diluted urineتمام؟ يعني عندي
+
+836
+00:59:03,670 --> 00:59:07,270
+diluted urine كمية ال ozone moles اللي موجودة فيه
+
+837
+00:59:07,270 --> 00:59:13,170
+أقل بالنسبة للحجم تمام؟ عندي حجم ميه كتير لكن عندي
+
+838
+00:59:13,170 --> 00:59:17,410
+ozone moles جليلة اقول volume في ال concentration
+
+839
+00:59:17,410 --> 00:59:20,990
+لل urine diluted على ال concentration في ال plasma
+
+840
+00:59:20,990 --> 00:59:28,150
+ا ا اعلى مش هيك؟ في الحالة هذه انا بتطلع بلاقي انه
+
+841
+00:59:28,150 --> 00:59:36,450
+ايه بادرب ال volumeفي بضرب ال volume في نسبة أجل
+
+842
+00:59:36,450 --> 00:59:39,410
+من واحد مش كده لإن ال concentration في ال urine
+
+843
+00:59:39,410 --> 00:59:42,770
+diluted و ال concentration في ال plasma أعلى إذا
+
+844
+00:59:42,770 --> 00:59:45,990
+لما أضرب أي حجم في أجل من واحد معناه الكمية تطلع
+
+845
+00:59:45,990 --> 00:59:50,750
+إيه تطلع جليلة مش هيك إذا ال solutes هنا في الحالة
+
+846
+00:59:50,750 --> 00:59:55,210
+هذه ال solutes ال volume ال clearance of solutes
+
+847
+00:59:55,210 --> 00:59:58,790
+ال clearance of esmoles طلع أجل من ال urine إيه
+
+848
+00:59:59,180 --> 01:00:03,100
+volume يعني احنا ضربنا في ال urine volume في كسر،
+
+849
+01:00:03,100 --> 01:00:08,000
+مصبوط؟ فإذا ال volume الأساسي أكبر من ال volume
+
+850
+01:00:08,000 --> 01:00:12,720
+اللي مانضره في كسر، إذا صار في عندي جزء من الميه
+
+851
+01:00:12,720 --> 01:00:17,700
+executed من غير ال .. من غير ال osmoles، مش هيك؟
+
+852
+01:00:17,700 --> 01:00:22,020
+إذا انا .. إذا ال clearance of osmoles يمثل الحجم
+
+853
+01:00:22,020 --> 01:00:26,120
+اللي من ال plasma اللي موجود فيه دول ال osmoles،
+
+854
+01:00:26,120 --> 01:00:29,790
+لكن لما أنا طالع ألاقي حالي ماخدclearance of
+
+855
+01:00:29,790 --> 01:00:35,210
+smalls اتنين سانت اتنين مل وانا بتطلع بول تلاتة مل
+
+856
+01:00:35,210 --> 01:00:38,630
+معناها في عندى سانت تطلع من غير ايه من غير ال
+
+857
+01:00:38,630 --> 01:00:45,610
+solutes مش هيك سمناها free water clearance free
+
+858
+01:00:45,610 --> 01:00:48,630
+water هذا ال free water يعني water عندى cleared
+
+859
+01:00:48,630 --> 01:00:53,430
+طلع من غير ال solutes اذا بنحسب احنا الكمية اللى
+
+860
+01:00:53,430 --> 01:00:57,850
+لازمة تطلع على ال solutes تطلع معاها وفي عندى جزء
+
+861
+01:00:57,850 --> 01:01:03,680
+مياهطلع زيادة، اذا هذا طلعت حرة من غير الـ free
+
+862
+01:01:03,680 --> 01:01:08,020
+water الـ free water هذا لما يكون عندى انا .. اذا
+
+863
+01:01:08,020 --> 01:01:13,040
+كيف بحسبوا الـ free water؟ بحسب ان ال volume تبع
+
+864
+01:01:13,040 --> 01:01:16,660
+ال urine ناجس ال what؟ ال clearance of osmores،
+
+865
+01:01:16,660 --> 01:01:20,640
+كمان؟ اذا والله انا بطلع ده ال urine بطلع كمية من
+
+866
+01:01:20,640 --> 01:01:26,320
+ال pore من الفريق كمية urine without osmores، مش
+
+867
+01:01:26,320 --> 01:01:30,370
+هيك؟إذا نسميه free water excretion بوسيطف هذا
+
+868
+01:01:30,370 --> 01:01:35,390
+تمام؟ إذا أنا طلعت diluted urine لما ال free water
+
+869
+01:01:35,390 --> 01:01:38,530
+يزيد معناه أنا طلعت diluted urine لإن ال osmosis
+
+870
+01:01:38,530 --> 01:01:41,650
+حسبنا هوالذي أنا معناه عملت dilution طب لما أطلع
+
+871
+01:01:41,650 --> 01:01:45,290
+concentrated urine بحسبها بلاج لأ ال concentrated
+
+872
+01:01:45,290 --> 01:01:49,850
+urine أكتر من ال plasma فأنا بضرب جاعة ال volume
+
+873
+01:01:49,850 --> 01:01:55,770
+في كسرأكبر فبيقدر الكمية أكبر معناها بيطلع ال free
+
+874
+01:01:55,770 --> 01:02:02,770
+water جداش negative مش هي لما أقصد ال volume من ..
+
+875
+01:02:02,770 --> 01:02:12,470
+إذا إذا طلعت ال water ال free water إذا إذا طلعت
+
+876
+01:02:12,470 --> 01:02:20,080
+ال free water positive معناها أنا عنديdiluted
+
+877
+01:02:20,080 --> 01:02:23,700
+urine و اذا طالع نيجاتيف يعني انتي خصها diluted
+
+878
+01:02:23,700 --> 01:02:26,420
+urine، واضح؟ اذا ال free .. ال free water هذا
+
+879
+01:02:26,420 --> 01:02:29,380
+مافيش حاجة اسمها free water هو، لكنه اشي قياسي
+
+880
+01:02:29,380 --> 01:02:33,040
+احنا بنعمله، قولنا لو حسبنا ال osmoles هذه كدهش
+
+881
+01:02:33,040 --> 01:02:35,400
+بتكون في milliliter .. في .. في milliliter plasma
+
+882
+01:02:35,950 --> 01:02:39,930
+طب و لو يورين طلع أكتر معناها في طلع جزئية من ال
+
+883
+01:02:39,930 --> 01:02:42,370
+.. من ال water طلعت من غير صوديوم ولا من غير شسمه
+
+884
+01:02:42,370 --> 01:02:46,390
+يعني كان قدرته على يعمل dilution و لو العكس بيقول
+
+885
+01:02:46,390 --> 01:03:01,110
+اه قدرته على انه يعمل concentration disorders
+
+886
+01:03:01,110 --> 01:03:03,170
+in urine concentration
+
+887
+01:03:08,650 --> 01:03:12,870
+الان ال quantitative ability اتكلمنا عنها و
+
+888
+01:03:12,870 --> 01:03:16,290
+فهمناها اعتقد اننا فهمناها فهمناها فهمناها فانا
+
+889
+01:03:16,290 --> 01:03:21,010
+مين الها السؤال جهنم اطلع منها مافيش مانع اسأليها
+
+890
+01:03:21,010 --> 01:03:27,640
+السؤال واضح؟ طيبأحنا قلنا للمسؤول عن عملية ال
+
+891
+01:03:27,640 --> 01:03:30,740
+concentration of urine لازم يكون عندي حاجتين عندي
+
+892
+01:03:30,740 --> 01:03:33,500
+antidiotic hormone مظبوط وعندي osmotic gradient
+
+893
+01:03:33,500 --> 01:03:37,940
+مظبوط اتكلمنا احنا بالتفصيل عن الجهتين لكن هنا
+
+894
+01:03:37,940 --> 01:03:43,040
+بهمنا انه نجيب سيرة بعض الأشياء المهمة بما يتعلق
+
+895
+01:03:43,040 --> 01:03:47,360
+بال antidiotic hormone ال antidiotic hormone هذا
+
+896
+01:03:47,360 --> 01:03:51,180
+hormone بيطلع من البصير بتويترين هندرسه الفصل اللي
+
+897
+01:03:51,180 --> 01:03:54,770
+جاي ان شاء اللهيعني يدرس ال .. بتويتري و التفاصيل
+
+898
+01:03:54,770 --> 01:03:57,570
+تبعتها الفصل جاها في ال endocrine لكن ال antidote
+
+899
+01:03:57,570 --> 01:04:02,390
+hormone هذا إذا صار عندى إشكال trauma something
+
+900
+01:04:02,390 --> 01:04:05,150
+إشي أثر على البصير بتويتري ممكن ال antidote
+
+901
+01:04:05,150 --> 01:04:08,810
+hormone بطل يطلح فإذا بطل يطلع ال antidote hormone
+
+902
+01:04:08,810 --> 01:04:12,710
+حسين عندى diuresis بقول كتير إن هو بمنع ال
+
+903
+01:04:12,710 --> 01:04:17,480
+diuresis بظبط ال osmolality حسب حاجة الجسملكن هو
+
+904
+01:04:17,480 --> 01:04:21,880
+بطل يبقى موجود فصار ال fluid اللى بيصل ال distal
+
+905
+01:04:21,880 --> 01:04:28,300
+tubule يظل ايه؟ يظل كما هو، ليش؟ لأن اندرويد
+
+906
+01:04:28,300 --> 01:04:31,340
+الغرمون اللى بده ياخد المميزة اللى محتاجينها مش
+
+907
+01:04:31,340 --> 01:04:36,120
+موجود، تمام؟ اذا فى عندى كمية كبيرة من ال bowl
+
+908
+01:04:36,120 --> 01:04:40,940
+بتطلع شبيهة باللي عنده diabetes melatusبس الفرق
+
+909
+01:04:40,940 --> 01:04:44,020
+بين هدا و هدا احنا فكرناها diabetes و اتفحصناها
+
+910
+01:04:44,020 --> 01:04:48,540
+لاجئنا مافيش سُكر فقلنا هدا diabetes insipidus من
+
+911
+01:04:48,540 --> 01:04:53,040
+هنا اجى اسمه زى السُكري لكنه كاذب شبه السُكر فإنه
+
+912
+01:04:53,040 --> 01:04:56,780
+بيعطش و بنشفريق و بتبول كتير هذه مواصفات ايه
+
+913
+01:04:56,780 --> 01:05:01,900
+السُكر انه بتبول كتير و بيحس انه ايه عنده جفاف في
+
+914
+01:05:01,900 --> 01:05:05,560
+الحلق و بيضل يشرب ميه كتير عشان يضيع هذا الاحساس
+
+915
+01:05:05,560 --> 01:05:09,440
+بالجفاففهذا المرض السكري ال بول السكر احنا عارفينه
+
+916
+01:05:09,440 --> 01:05:13,020
+لكن هذا بول كتير و عامل نفس المواصفات لكن مافيش
+
+917
+01:05:13,020 --> 01:05:17,200
+فيه سكر لذلك سمنها diabetes insipidus ال diabetes
+
+918
+01:05:17,200 --> 01:05:21,260
+insipidus هذا يقولنا في منها نوعين في عندنا نوع
+
+919
+01:05:21,260 --> 01:05:23,760
+central diabetes insipidus يعني إصابة من أساسها
+
+920
+01:05:23,760 --> 01:05:27,430
+جايةفي الـ Pituitary gland في المركزية في مركزية
+
+921
+01:05:27,430 --> 01:05:30,990
+الـ Antidiotic hormone تمام؟ وممكن يكونوا في نوع
+
+922
+01:05:30,990 --> 01:05:34,290
+مش Central peripheral يعني المشكلة في الكيلية مش
+
+923
+01:05:34,290 --> 01:05:37,010
+المشكلة في ال Antidiotic hormone طبيعي لكن الكيلية
+
+924
+01:05:37,010 --> 01:05:40,030
+مش رادية تستجيب لل Antidiotic hormone نفروجينيك
+
+925
+01:05:40,030 --> 01:05:44,910
+ديابتس انسبيدس اذا ال diabetes insipidus عندنا في
+
+926
+01:05:44,910 --> 01:05:49,430
+نوع منه Central type ونفروجينيك type النفروجينيك
+
+927
+01:05:49,430 --> 01:05:56,040
+type يعني عندها إيش هيكون؟يعني ال response of the
+
+928
+01:05:56,040 --> 01:05:58,040
+antidiarrheal hormone on the kidney is abolished
+
+929
+01:05:58,040 --> 01:06:03,800
+مش موجود بسبب انه عندي ال .. ال receptors الموجودة
+
+930
+01:06:03,800 --> 01:06:06,280
+مثلا مرضى بيكون فيه مشكلة في ال receptors ال V2
+
+931
+01:06:06,280 --> 01:06:09,580
+ريسبتورز اتكلمنا عنها اللي في ال distal tubule في
+
+932
+01:06:09,580 --> 01:06:15,600
+كل الجسم ممكن تكون هي ايه المشكلة فيها بتأدي إلى
+
+933
+01:06:15,600 --> 01:06:19,800
+انه ال antidiarrheal hormone اذا في failure of the
+
+934
+01:06:19,800 --> 01:06:24,920
+counterعندنا الجزيرة بتخصنا عن failure of the
+
+935
+01:06:24,920 --> 01:06:28,480
+distal and collecting tubules and collecting ducts
+
+936
+01:06:28,480 --> 01:06:31,620
+to respond to another diuretic hormone وهذا ممكن
+
+937
+01:06:31,620 --> 01:06:35,660
+يكون response من أي مكان او بيكون عندى انا ممكن
+
+938
+01:06:35,660 --> 01:06:40,040
+انا اطلع كمية كبيرة من ال ball تماميكون عندى
+
+939
+01:06:40,040 --> 01:06:44,960
+القدرة على تركيز ال bone راحة هدى وين موجودة
+
+940
+01:06:44,960 --> 01:06:47,480
+القدرة على تركيز ال bone؟ في المضالة يعني وين من
+
+941
+01:06:47,480 --> 01:06:50,740
+في المضالة؟ في التكأس ending limb mainly إذا ممكن
+
+942
+01:06:50,740 --> 01:06:53,260
+يكون عندى خلل في التكأس ending limb يتقدي إلى
+
+943
+01:06:53,260 --> 01:06:56,720
+nephrogenic diabetes insipidus أو ممكن يكون ال
+
+944
+01:06:56,720 --> 01:06:59,620
+diabetes insipidus سببه برضه no response to
+
+945
+01:06:59,620 --> 01:07:02,020
+antidepressure hormone إذا عندى ال diabetes
+
+946
+01:07:02,020 --> 01:07:05,560
+insipidus ممكن تكون central وتكون peripheral لكن
+
+947
+01:07:05,560 --> 01:07:07,780
+في ال central و ال peripheral ممكن يكون سببها
+
+948
+01:07:07,780 --> 01:07:11,070
+antidepressure hormoneوممكن يكون الـ Mephrogenic
+
+949
+01:07:11,070 --> 01:07:15,350
+سببها لأ مش أندريدو كرموان، سببها إيه؟ Failure of
+
+950
+01:07:15,350 --> 01:07:18,570
+the concentrating mechanism in the .. in the .. in
+
+951
+01:07:18,570 --> 01:07:22,570
+the .. in the thick ascending limb إذا الـ failure
+
+952
+01:07:22,570 --> 01:07:25,570
+of the counter current mechanism to form a hyper
+
+953
+01:07:25,570 --> 01:07:28,810
+osmotic and remodellary interstitium لإن احنا قلنا
+
+954
+01:07:28,810 --> 01:07:31,430
+الـ concentration أساسه، interstitium مظبوط و
+
+955
+01:07:31,430 --> 01:07:34,190
+أندريدو كرموان مظبوطفممكن يطلع كمية كبيرة من
+
+956
+01:07:34,190 --> 01:07:36,970
+البولو لو مافيش تركيز إذا ال intersection مش مظبوط
+
+957
+01:07:36,970 --> 01:07:40,290
+مالكاونتر كارنت مالتيبليكيش تكلمنا عنه طاربا أو
+
+958
+01:07:40,290 --> 01:07:43,710
+يكون إيه ال Antidermal hormone مش موجود هذا مستعمل
+
+959
+01:07:43,710 --> 01:07:47,910
+إفريجينيك لإنه في أن نوع تاني central اللي هو إيه
+
+960
+01:07:47,910 --> 01:07:54,380
+لما يكون عندي مشكلة في الطيب هيك ممكن احنا خلصنا
+
+961
+01:07:54,380 --> 01:07:58,560
+المحاضرة هذه و ال chapter هذه حقيقة لإن بجيت ال
+
+962
+01:07:58,560 --> 01:08:02,600
+chapter هذا تحصيل حاصل يعني عبارة عن أشياء تعاد
+
+963
+01:08:02,600 --> 01:08:09,070
+بطريقة ..يمكن إذا كان معانا فرق أكتر أشرحلكوا ال
+
+964
+01:08:09,070 --> 01:08:11,870
+third mechanism و الكلام هذا بس في ال manager هذا
+
+965
+01:08:11,870 --> 01:08:16,890
+بس في أشياء كتيرة هذي مش هنشرحها لإنه في بعدين كده
+
+966
+01:08:16,890 --> 01:08:21,850
+بصير عيب ال .. عيب ال .. ال guidon أنه ممكن يصير
+
+967
+01:08:21,850 --> 01:08:26,070
+بس يجمع أشياء و كلها انشرحت في مناطق أخرى مش معقول
+
+968
+01:08:26,070 --> 01:08:30,030
+أنه يضيعلها محاضرة كاملة للتجميع بس إن ال third
+
+969
+01:08:30,030 --> 01:08:33,630
+mechanism احتمال أشرحه تمام بيضال عيني هنا في
+
+970
+01:08:33,630 --> 01:08:38,710
+الغالب محاضرتين أو تلاتةلأ ال .. ال kidney تسيبليش
+
+971
+01:08:38,710 --> 01:08:43,390
+ان ممكن خلصناها تمام؟ ليش؟ لإنه في فاصل ال
+
+972
+01:08:43,390 --> 01:08:46,230
+potassium و ال magnesium regulation ده مش هتكلم
+
+973
+01:08:46,230 --> 01:08:51,130
+عنه لإنه موزع بين مواد أخرى okay من هات؟ مين اللي
+
+974
+01:08:51,130 --> 01:08:51,770
+سؤال؟
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..67f9e867a901bc22d5dddda0b910fd8b8ffa478b
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_raw.json
@@ -0,0 +1 @@
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"word": " urine", "probability": 0.876953125}, {"start": 86.5, "end": 88.9, "word": " بداية", "probability": 0.7950032552083334}, {"start": 88.9, "end": 89.34, "word": " خلينا", "probability": 0.5782063802083334}, {"start": 89.34, "end": 89.66, "word": " نتكلم", "probability": 0.9539794921875}, {"start": 89.66, "end": 90.18, "word": " عن", "probability": 0.98095703125}, {"start": 90.18, "end": 91.96, "word": " الكلية", "probability": 0.5785319010416666}, {"start": 91.96, "end": 92.24, "word": " هذه", "probability": 0.439697265625}, {"start": 92.24, "end": 92.82, "word": " العجيبة", "probability": 0.9833984375}, {"start": 92.82, "end": 93.86, "word": " اللى", "probability": 0.788818359375}, {"start": 93.86, "end": 94.62, "word": " بإمكانها", "probability": 0.823388671875}, {"start": 94.62, "end": 95.18, "word": " انه", "probability": 0.862060546875}], "temperature": 1.0}, {"id": 5, "seek": 10681, "start": 95.83, "end": 106.81, "text": "تطلع as little as point five liter water per day و as maximum as twenty liters per day، variations ضخمة", "tokens": [2655, 9566, 1211, 3615, 382, 707, 382, 935, 1732, 2733, 1281, 680, 786, 4032, 382, 6674, 382, 7699, 32323, 680, 786, 12399, 17840, 48812, 9778, 46007], "avg_logprob": -0.18098957781438474, "compression_ratio": 1.1414141414141414, "no_speech_prob": 0.0, "words": [{"start": 95.83, "end": 97.01, "word": "تطلع", "probability": 0.8270263671875}, {"start": 97.01, "end": 97.97, "word": " as", "probability": 0.90576171875}, {"start": 97.97, "end": 98.21, "word": " little", "probability": 0.83544921875}, {"start": 98.21, "end": 98.67, "word": " as", "probability": 0.9814453125}, {"start": 98.67, "end": 99.15, "word": " point", "probability": 0.65966796875}, {"start": 99.15, "end": 99.55, "word": " five", "probability": 0.86181640625}, {"start": 99.55, "end": 100.01, "word": " liter", "probability": 0.55908203125}, {"start": 100.01, "end": 100.99, "word": " water", "probability": 0.86328125}, {"start": 100.99, "end": 101.27, "word": " per", "probability": 0.64404296875}, {"start": 101.27, "end": 101.59, "word": " day", "probability": 0.96923828125}, {"start": 101.59, "end": 102.31, "word": " و", "probability": 0.89208984375}, {"start": 102.31, "end": 102.53, "word": " as", "probability": 0.8876953125}, {"start": 102.53, "end": 103.05, "word": " maximum", "probability": 0.955078125}, {"start": 103.05, "end": 103.49, "word": " as", "probability": 0.97412109375}, {"start": 103.49, "end": 103.91, "word": " twenty", "probability": 0.82763671875}, {"start": 103.91, "end": 104.43, "word": " liters", "probability": 0.8544921875}, {"start": 104.43, "end": 104.69, "word": " per", "probability": 0.9697265625}, {"start": 104.69, "end": 105.75, "word": " day،", "probability": 0.736328125}, {"start": 105.75, "end": 106.31, "word": " variations", "probability": 0.78369140625}, {"start": 106.31, "end": 106.81, "word": " ضخمة", "probability": 0.9720052083333334}], "temperature": 1.0}, {"id": 6, "seek": 13702, "start": 107.42, "end": 137.02, "text": "و ممكن تطلع as low as 50 millismole per liter concentration و as high as 1400 millismole per liter concentration إذا في عنا variations كبيرة موجودة مثلا لو أحنا أخدنا لتر من الماء شربناها", "tokens": [2407, 3714, 43020, 6055, 9566, 1211, 3615, 382, 2295, 382, 2625, 1728, 271, 3280, 306, 680, 2733, 9856, 4032, 382, 1090, 382, 46795, 1728, 271, 3280, 306, 680, 2733, 9856, 11933, 15730, 8978, 6225, 8315, 17840, 9122, 3555, 48923, 3714, 29245, 23328, 3660, 50113, 15040, 45164, 5551, 5016, 8315, 5551, 9778, 3215, 8315, 5296, 2655, 2288, 9154, 9673, 16606, 13412, 25513, 8315, 11296], "avg_logprob": -0.23791504092514515, "compression_ratio": 1.441860465116279, "no_speech_prob": 0.0, "words": [{"start": 107.42, "end": 107.64, "word": "و", "probability": 0.65234375}, {"start": 107.64, "end": 107.98, "word": " ممكن", "probability": 0.865478515625}, {"start": 107.98, "end": 108.7, "word": " تطلع", "probability": 0.791748046875}, {"start": 108.7, "end": 109.36, 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0.77490234375}, {"start": 118.2, "end": 123.88, "word": " millismole", "probability": 0.82177734375}, {"start": 123.88, "end": 124.36, "word": " per", "probability": 0.943359375}, {"start": 124.36, "end": 124.74, "word": " liter", "probability": 0.916015625}, {"start": 124.74, "end": 126.54, "word": " concentration", "probability": 0.8916015625}, {"start": 126.54, "end": 126.88, "word": " إذا", "probability": 0.6807861328125}, {"start": 126.88, "end": 127.04, "word": " في", "probability": 0.81982421875}, {"start": 127.04, "end": 127.24, "word": " عنا", "probability": 0.684814453125}, {"start": 127.24, "end": 127.74, "word": " variations", "probability": 0.8232421875}, {"start": 127.74, "end": 128.26, "word": " كبيرة", "probability": 0.9889322916666666}, {"start": 128.26, "end": 129.58, "word": " موجودة", "probability": 0.984619140625}, {"start": 129.58, "end": 133.72, "word": " مثلا", "probability": 0.822998046875}, {"start": 133.72, "end": 133.94, "word": " لو", "probability": 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"لذلك احنا ايه .. لذلك نبدأ من بدري من early part التحكم في الميه عشان يكون عندي enough يعني length عشان ايه اتحكم في ال reabsorption of big amounts ال cortical معظم الأشياء .. طيب قولناها ان احنا انه .. اذا الميه بيصيرها reabsorption في", "tokens": [1211, 8848, 23275, 1975, 5016, 8315, 1975, 1829, 3224, 4386, 5296, 8848, 23275, 8717, 44510, 10721, 9154, 47525, 16572, 9154, 2440, 644, 16712, 5016, 24793, 8978, 9673, 1829, 3224, 6225, 8592, 7649, 7251, 30544, 18871, 16254, 1547, 37495, 22653, 4641, 6225, 8592, 7649, 1975, 1829, 3224, 1975, 2655, 5016, 24793, 8978, 2423, 319, 17243, 284, 1695, 295, 955, 11663, 2423, 11278, 804, 20449, 19913, 2304, 16247, 8592, 1829, 16606, 4386, 23032, 1829, 3555, 12174, 12610, 8315, 11296, 16472, 1975, 5016, 8315, 16472, 3224, 4386, 1975, 15730, 9673, 1829, 3224, 4724, 1829, 9381, 13546, 11296, 319, 17243, 284, 1695, 8978], "avg_logprob": -0.21156249493360518, "compression_ratio": 1.6376146788990826, "no_speech_prob": 0.0, "words": [{"start": 1015.54, 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بدل", "probability": 0.978759765625}, {"start": 1382.75, "end": 1383.21, "word": " 300", "probability": 0.94921875}, {"start": 1383.21, "end": 1383.67, "word": " 400", "probability": 0.86865234375}, {"start": 1383.67, "end": 1385.27, "word": " تمام؟", "probability": 0.8660481770833334}], "temperature": 1.0}, {"id": 56, "seek": 141278, "start": 1385.42, "end": 1412.78, "text": "هذه قدرته لكن احنا بنتكلم دالين عن ايش؟ عن ألف و أربعمية ألف و ميتين concentration gradient أعلى من هيك بكتير ايش اللي بيصير اها بيصير what is called اللي هو ال counter current multiplier counter current multiplication counter current multiplication هو الراحل ايه التعبير عشان اوريكوايا ماعلينا counter current multiplication", "tokens": [3224, 24192, 12174, 3215, 43500, 3224, 44381, 1975, 5016, 8315, 4724, 29399, 4117, 19528, 11778, 6027, 9957, 18871, 1975, 1829, 8592, 22807, 18871, 5551, 46538, 4032, 5551, 25513, 25957, 10632, 5551, 46538, 4032, 3714, 36081, 9957, 9856, 16235, 5551, 3615, 23942, 9154, 39896, 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من داخل ال tubule لبرا بكمية معينة بس هذه المسألة انا عملها عملت مضاعفات في system عندى اسمه counter current multiplier بيخلي الاتين دول الفارق", "tokens": [6027, 39184, 5682, 2190, 27290, 23758, 6225, 3555, 9640, 3660, 18871, 20328, 5016, 1975, 8315, 4724, 47283, 3215, 2423, 1404, 1819, 9154, 11778, 47283, 1211, 2423, 10809, 2271, 5296, 3555, 23557, 4724, 24793, 10632, 20449, 9957, 3660, 4724, 3794, 29538, 9673, 3794, 10721, 37977, 1975, 8315, 6225, 42213, 11296, 6225, 42213, 2655, 3714, 11242, 45761, 5172, 9307, 8978, 1185, 43242, 7578, 24525, 2304, 3224, 5682, 2190, 44106, 4724, 1829, 9778, 20292, 2423, 9307, 9957, 11778, 12610, 27188, 9640, 4587], "avg_logprob": -0.2847656235098839, "compression_ratio": 1.5970149253731343, "no_speech_prob": 0.0, "words": [{"start": 1415.84, "end": 1417.04, "word": "الـ", "probability": 0.38885498046875}, {"start": 1417.04, "end": 1417.24, "word": " counter", "probability": 0.6962890625}, {"start": 1417.24, "end": 1417.56, "word": " current", 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331846, "start": 3306.12, "end": 3318.46, "text": "إنه ممكن افصل انا في ال concentration ما بين ال sodium و اليوريا ممكن يطلع لي بس اليوريا لحالها concentrated من غير ما يكون فيه Sodium او ممكن العكس او في العكس بيكون mainly Sodium و جالي اليوريا", "tokens": [28814, 1863, 3224, 3714, 43020, 1975, 5172, 36520, 1975, 8315, 8978, 2423, 9856, 19446, 49374, 2423, 20265, 4032, 45595, 13063, 25528, 3714, 43020, 7251, 9566, 1211, 3615, 32239, 4724, 3794, 45595, 13063, 25528, 5296, 5016, 6027, 11296, 21321, 9154, 32771, 13546, 19446, 7251, 30544, 8978, 3224, 42059, 2197, 1975, 2407, 3714, 43020, 18863, 4117, 3794, 1975, 2407, 8978, 18863, 4117, 3794, 4724, 1829, 30544, 8704, 42059, 2197, 4032, 10874, 6027, 1829, 45595, 13063, 25528], "avg_logprob": -0.2583333190282186, "compression_ratio": 1.7674418604651163, "no_speech_prob": 1.7881393432617188e-07, "words": [{"start": 3306.12, "end": 3306.64, "word": "إنه", "probability": 0.4403483072916667}, {"start": 3306.64, "end": 3306.9, "word": " ممكن", 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4096.89, "end": 4097.25, "word": " بصير", "probability": 0.8170572916666666}, {"start": 4097.25, "end": 4097.53, "word": " عيب", "probability": 0.9925130208333334}, {"start": 4097.53, "end": 4097.95, "word": " ال", "probability": 0.86279296875}, {"start": 4097.95, "end": 4098.49, "word": " ..", "probability": 0.826171875}, {"start": 4098.49, "end": 4098.89, "word": " عيب", "probability": 0.9879557291666666}, {"start": 4098.89, "end": 4099.69, "word": " ال", "probability": 0.96630859375}, {"start": 4099.69, "end": 4099.69, "word": " ..", "probability": 0.86669921875}, {"start": 4099.69, "end": 4099.99, "word": " ال", "probability": 0.83984375}, {"start": 4099.99, "end": 4100.47, "word": " guidon", "probability": 0.44189453125}, {"start": 4100.47, "end": 4101.11, "word": " أنه", "probability": 0.6923828125}, {"start": 4101.11, "end": 4101.37, "word": " ممكن", "probability": 0.9072265625}, {"start": 4101.37, "end": 4101.85, "word": " يصير", "probability": 0.9793294270833334}, {"start": 4101.85, "end": 4102.59, "word": " بس", "probability": 0.878662109375}, {"start": 4102.59, "end": 4103.07, "word": " يجمع", "probability": 0.978271484375}, {"start": 4103.07, "end": 4103.61, "word": " أشياء", "probability": 0.9918212890625}, {"start": 4103.61, "end": 4103.87, "word": " و", "probability": 0.4296875}, {"start": 4103.87, "end": 4104.09, "word": " كلها", "probability": 0.95703125}, {"start": 4104.09, "end": 4104.51, "word": " انشرحت", "probability": 0.7174479166666666}, {"start": 4104.51, "end": 4104.63, "word": " في", "probability": 0.9482421875}, {"start": 4104.63, "end": 4104.97, "word": " مناطق", "probability": 0.9168294270833334}, {"start": 4104.97, "end": 4105.41, "word": " أخرى", "probability": 0.9864908854166666}, {"start": 4105.41, "end": 4105.79, "word": " مش", "probability": 0.93994140625}, {"start": 4105.79, "end": 4106.07, "word": " معقول", "probability": 0.75927734375}, {"start": 4106.07, "end": 4106.25, "word": " أنه", "probability": 0.3782958984375}, {"start": 4106.25, "end": 4106.89, "word": " يضيعلها", "probability": 0.851171875}, {"start": 4106.89, "end": 4107.79, "word": " محاضرة", "probability": 0.979248046875}, {"start": 4107.79, "end": 4108.29, "word": " كاملة", "probability": 0.990234375}, {"start": 4108.29, "end": 4108.99, "word": " للتجميع", "probability": 0.90126953125}, {"start": 4108.99, "end": 4109.57, "word": " بس", "probability": 0.99072265625}, {"start": 4109.57, "end": 4109.69, "word": " إن", "probability": 0.5517578125}, {"start": 4109.69, "end": 4109.79, "word": " ال", "probability": 0.970703125}, {"start": 4109.79, "end": 4110.03, "word": " third", "probability": 0.9482421875}, {"start": 4110.03, "end": 4110.47, "word": " mechanism", "probability": 0.96826171875}, {"start": 4110.47, "end": 4110.89, "word": " احتمال", "probability": 0.79425048828125}, {"start": 4110.89, "end": 4111.45, "word": " أشرحه", "probability": 0.9637451171875}, {"start": 4111.45, "end": 4112.75, "word": " تمام", "probability": 0.795166015625}, {"start": 4112.75, "end": 4113.05, "word": " بيضال", "probability": 0.56524658203125}, {"start": 4113.05, "end": 4113.25, "word": " عيني", "probability": 0.4640299479166667}, {"start": 4113.25, "end": 4113.47, "word": " هنا", "probability": 0.78173828125}, {"start": 4113.47, "end": 4113.63, "word": " في", "probability": 0.91796875}, {"start": 4113.63, "end": 4114.13, "word": " الغالب", "probability": 0.97509765625}, {"start": 4114.13, "end": 4114.77, "word": " محاضرتين", "probability": 0.9615234375}, {"start": 4114.77, "end": 4114.89, "word": " أو", "probability": 0.859375}, {"start": 4114.89, "end": 4115.37, "word": " تلاتة", "probability": 0.98681640625}], "temperature": 1.0}, {"id": 166, "seek": 413177, "start": 4115.73, "end": 4131.77, "text": "لأ ال .. ال kidney تسيبليش ان ممكن خلصناها تمام؟ ليش؟ لإنه في فاصل ال potassium و ال magnesium regulation ده مش هتكلم عنه لإنه موزع بين مواد أخرى okay من هات؟ مين اللي سؤال؟", "tokens": [1211, 10721, 2423, 4386, 2423, 19000, 6055, 3794, 1829, 3555, 20292, 8592, 16472, 3714, 43020, 16490, 1211, 9381, 8315, 11296, 46811, 10943, 22807, 32239, 8592, 22807, 5296, 28814, 1863, 3224, 8978, 6156, 33546, 1211, 2423, 29547, 4032, 2423, 32950, 15062, 11778, 3224, 37893, 8032, 2655, 4117, 19528, 18871, 3224, 5296, 28814, 1863, 3224, 3714, 2407, 11622, 3615, 49374, 3714, 14407, 3215, 5551, 34740, 7578, 1392, 9154, 8032, 9307, 22807, 3714, 9957, 13672, 1829, 8608, 33604, 6027, 22807], "avg_logprob": -0.29827723441979825, "compression_ratio": 1.439153439153439, "no_speech_prob": 1.7881393432617188e-07, "words": [{"start": 4115.73, "end": 4116.15, "word": "لأ", "probability": 0.861328125}, {"start": 4116.15, "end": 4116.47, "word": " ال", "probability": 0.91015625}, {"start": 4116.47, "end": 4117.35, "word": " ..", "probability": 0.82958984375}, {"start": 4117.35, "end": 4117.67, "word": " ال", "probability": 0.8154296875}, {"start": 4117.67, "end": 4118.13, "word": " kidney", "probability": 0.60400390625}, {"start": 4118.13, "end": 4118.71, "word": " تسيبليش", "probability": 0.5408732096354166}, {"start": 4118.71, "end": 4118.73, "word": " ان", "probability": 0.155517578125}, {"start": 4118.73, "end": 4118.85, "word": " ممكن", "probability": 0.836181640625}, {"start": 4118.85, "end": 4119.53, "word": " خلصناها", "probability": 0.846484375}, {"start": 4119.53, "end": 4120.81, "word": " تمام؟", "probability": 0.77880859375}, {"start": 4120.81, "end": 4121.37, "word": " ليش؟", "probability": 0.9293619791666666}, {"start": 4121.37, "end": 4121.73, "word": " لإنه", "probability": 0.851318359375}, {"start": 4121.73, "end": 4122.21, "word": " في", "probability": 0.85986328125}, {"start": 4122.21, "end": 4122.75, "word": " فاصل", "probability": 0.7061360677083334}, {"start": 4122.75, "end": 4123.39, "word": " ال", "probability": 0.8701171875}, {"start": 4123.39, "end": 4123.95, "word": " potassium", "probability": 0.91455078125}, {"start": 4123.95, "end": 4124.11, "word": " و", "probability": 0.89111328125}, {"start": 4124.11, "end": 4124.15, "word": " ال", "probability": 0.5556640625}, {"start": 4124.15, "end": 4124.53, "word": " magnesium", "probability": 0.9423828125}, {"start": 4124.53, "end": 4125.47, "word": " regulation", "probability": 0.60498046875}, {"start": 4125.47, "end": 4125.79, "word": " ده", "probability": 0.79345703125}, {"start": 4125.79, "end": 4125.93, "word": " مش", "probability": 0.98095703125}, {"start": 4125.93, "end": 4126.23, "word": " هتكلم", "probability": 0.966552734375}, {"start": 4126.23, "end": 4126.65, "word": " عنه", "probability": 0.98291015625}, {"start": 4126.65, "end": 4127.69, "word": " لإنه", "probability": 0.9681396484375}, {"start": 4127.69, "end": 4128.21, "word": " موزع", "probability": 0.97509765625}, {"start": 4128.21, "end": 4128.43, "word": " بين", "probability": 0.6376953125}, {"start": 4128.43, "end": 4128.71, "word": " مواد", "probability": 0.9451497395833334}, {"start": 4128.71, "end": 4129.27, "word": " أخرى", "probability": 0.9651692708333334}, {"start": 4129.27, "end": 4130.01, "word": " okay", "probability": 0.458251953125}, {"start": 4130.01, "end": 4130.23, "word": " من", "probability": 0.33544921875}, {"start": 4130.23, "end": 4130.77, "word": " هات؟", "probability": 0.6321614583333334}, {"start": 4130.77, "end": 4131.03, "word": " مين", "probability": 0.791748046875}, {"start": 4131.03, "end": 4131.13, "word": " اللي", "probability": 0.53564453125}, {"start": 4131.13, "end": 4131.77, "word": " سؤال؟", "probability": 0.857421875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 4134.4755, "duration_after_vad": 4035.853749999984}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..f2a4d3ee3fd2ce3a803789af5f38ff82ef94ceeb
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/8XlimcYeX90_raw.srt
@@ -0,0 +1,3940 @@
+1
+00:00:06,330 --> 00:00:09,990
+يعطيكوا العافية اليوم ان شاء الله بإذن الله اتكلم
+
+2
+00:00:09,990 --> 00:00:17,950
+عن موضوع جديد اللي هو اعتقد انه عندكوا فكرة كبيرة
+
+3
+00:00:17,950 --> 00:00:23,810
+عنه اللي هي قدرة ال .. الكلية في التحكم في تركيز
+
+4
+00:00:23,810 --> 00:00:28,560
+ال ball قدرتها على ايه؟regulation of extracellular
+
+5
+00:00:28,560 --> 00:00:33,460
+fluid osmolarity and sodium concentration اتكلمنا
+
+6
+00:00:33,460 --> 00:00:37,200
+من اول يوم حكينا فيه عن anatomy of the kidney
+
+7
+00:00:37,200 --> 00:00:40,620
+وقلنا فيه ميضالة وقلنا الميضالة هادى شغلتها
+
+8
+00:00:40,620 --> 00:00:45,400
+الاساسية ايه to concentrate urine تمام؟ لذا لو
+
+9
+00:00:45,400 --> 00:00:47,320
+اتكلم عن concentration of urine بنقول احنا في
+
+10
+00:00:47,320 --> 00:00:52,220
+عندنا حاجتين مهمين لنعمل concentration of urine
+
+11
+00:00:52,220 --> 00:00:55,340
+محتاجين
+
+12
+00:00:55,340 --> 00:01:02,140
+يكون عندناانتدروتك هرمون كويس وموجود شغالي كويس
+
+13
+00:01:02,140 --> 00:01:08,340
+ومطلوب ان يكون عندنا رينال ميدالة بتشتغل كويس، اذا
+
+14
+00:01:08,340 --> 00:01:11,320
+نحن عايزين حاجتين، hyperosmotic gradient تبقى
+
+15
+00:01:11,320 --> 00:01:15,840
+موجود في الميدالةمطلوب ان يكون هناك انتجر هرمون
+
+16
+00:01:15,840 --> 00:01:20,860
+موجود علشان يفتح ال channels للميه تتحرك من ال
+
+17
+00:01:20,860 --> 00:01:24,580
+tubules الى داخل ال interstitium عشان تعمل ال
+
+18
+00:01:24,580 --> 00:01:32,240
+concentrated urine بداية خلينا نتكلم عن الكلية هذه
+
+19
+00:01:32,240 --> 00:01:39,150
+العجيبة اللى بإمكانها انهتطلع as little as point
+
+20
+00:01:39,150 --> 00:01:43,910
+five liter water per day و as maximum as twenty
+
+21
+00:01:43,910 --> 00:01:49,680
+liters per day، variations ضخمةو ممكن تطلع as low
+
+22
+00:01:49,680 --> 00:01:56,220
+as 50 millismole per liter concentration و as high
+
+23
+00:01:56,220 --> 00:02:03,880
+as 1400 millismole
+
+24
+00:02:03,880 --> 00:02:07,740
+per liter concentration إذا في عنا variations
+
+25
+00:02:07,740 --> 00:02:13,720
+كبيرة موجودة مثلا
+
+26
+00:02:13,720 --> 00:02:18,600
+لو أحنا أخدنا لتر من الماء شربناهانتطلع احنا ملاجة
+
+27
+00:02:18,600 --> 00:02:22,520
+خلال خمسة و أربعين دقيقة بيصير لنا maximal
+
+28
+00:02:22,520 --> 00:02:29,560
+diuresis و الكمية اللي احنا شربناها خلال ساعة و نص
+
+29
+00:02:29,560 --> 00:02:35,120
+ساعتين بتكون عوضت ايه executed اللي أخدنا هنا
+
+30
+00:02:35,120 --> 00:02:43,320
+drinking water ال urine volume هنا ال urine flow
+
+31
+00:02:43,320 --> 00:02:47,150
+rateهلاجيه بدأ بعد خمسة بعد بدأ انا هنا شربنا
+
+32
+00:02:47,150 --> 00:02:51,590
+الميهان شربنا الميهان تمام بعد شوية هاطلع أهلاجي
+
+33
+00:02:51,590 --> 00:02:56,530
+ايه ال urine volume او ال flow rate عندي بعد شوية
+
+34
+00:02:56,530 --> 00:03:00,410
+بدأ يزيد ل ال maximum لخمسة و عمري دقيقة الحجم
+
+35
+00:03:00,410 --> 00:03:04,170
+يخلص ال little اللي أخدناه زيادة ثم بيهبط على هوا
+
+36
+00:03:04,170 --> 00:03:07,790
+عندي هاطلع أهلاجي ال osmolality تبعت ال ball هبطت
+
+37
+00:03:07,790 --> 00:03:10,810
+لإنه زاد ال urine flow و ال osmolality of the
+
+38
+00:03:10,810 --> 00:03:14,540
+plasmaأه يعني minimal changes and one liter ايش
+
+39
+00:03:14,540 --> 00:03:18,340
+بده يعمل في ال .. ال 25 .. ال .. ال .. التلاتة
+
+40
+00:03:18,340 --> 00:03:21,940
+liter البلازما والعشرين liter اللي هو ايه ال
+
+41
+00:03:21,940 --> 00:03:24,680
+accessory fluid هيكون minimal changes بس ملاحظ
+
+42
+00:03:24,680 --> 00:03:29,960
+احنا اصلا عندنا ايه some sort of dilution لل
+
+43
+00:03:29,960 --> 00:03:35,620
+osmolality تبع البلازما و هنلاحظ احنا انه ال ..
+
+44
+00:03:35,620 --> 00:03:39,860
+احنا خدنا ميه بحته مش هيكالى حد ما هنلاقي الميه
+
+45
+00:03:39,860 --> 00:03:44,540
+طلعت بس ال solutes اللوت تبعها و هو مضايقرش طيب
+
+46
+00:03:44,540 --> 00:03:51,150
+اذا عند الكيلياعند القدرة أنه لو زالت الميه تطلع
+
+47
+00:03:51,150 --> 00:03:54,510
+ميه زيادة و لو جالت الميه تطلع ميه أجالى لو زالت
+
+48
+00:03:54,510 --> 00:03:58,750
+ال solus تطلع solus أكتر و لو جالت الميه تطلع
+
+49
+00:03:58,750 --> 00:04:03,310
+solus أجالى التنين مش مرتبطين في بعض ال control
+
+50
+00:04:03,310 --> 00:04:06,790
+system تبع التحكم في الميه مختلف عن ال control
+
+51
+00:04:06,790 --> 00:04:10,790
+system تبع التحكم في ال solus أحيانا التنين
+
+52
+00:04:10,790 --> 00:04:14,030
+بيشتغلوا مع بعض في حالات ال dehydration حالات ال
+
+53
+00:04:14,030 --> 00:04:17,070
+hemorrhage حياتهالـ low volume of the accessory
+
+54
+00:04:17,070 --> 00:04:21,990
+fluid و أحيانا ده بيشرب كل واحد لخاله حسب الوضع
+
+55
+00:04:21,990 --> 00:04:25,810
+تمام؟ واحد بيشرب ميه كتير هيطلع ميه كتير واحد أكل
+
+56
+00:04:25,810 --> 00:04:30,030
+السيخ كتير تمام؟ هيطلع solids كتير مثلا يعتمد على
+
+57
+00:04:30,030 --> 00:04:35,110
+إيه لكن مرة بيكونوا مرتبط البعض هذا الضيف تبعنا
+
+58
+00:04:35,110 --> 00:04:41,210
+هذا اسمه the hopping mouseاه اسمه ايش؟ The
+
+59
+00:04:41,210 --> 00:04:47,190
+Australian Hobbing Mouse شايفينه هذا؟ هذا كائن
+
+60
+00:04:47,190 --> 00:04:53,290
+صحراوي يعني بمعنى انه كمية الميه اللى بتناولها
+
+61
+00:04:53,290 --> 00:04:57,270
+جليلة جدا وبيعتمد على الميه الأساسية اللى بتشوف ال
+
+62
+00:04:57,270 --> 00:05:03,050
+metabolism تبع ال food
+
+63
+00:05:03,050 --> 00:05:07,910
+تبعهعملية ال metabolism بتكون ميه فبيقدر إلى كمية
+
+64
+00:05:07,910 --> 00:05:11,150
+محترمة من ال metabolism بيستغلها بتعرفين قدش اللي
+
+65
+00:05:11,150 --> 00:05:16,550
+بيقدر يركز ال ball هو عشر تلاف ميلي أزمول عشر تلاف
+
+66
+00:05:16,550 --> 00:05:23,450
+ميلي أزمول لإنه خيائن صحران تمام؟ وعكس ذلك ال
+
+67
+00:05:23,450 --> 00:05:26,770
+beavers هذا ال beaver هذا ال .. ال .. ال beaver
+
+68
+00:05:26,770 --> 00:05:33,890
+المائي حيوان مائيتمام ال .. التركيز المياه ال ..
+
+69
+00:05:33,890 --> 00:05:37,330
+ال .. ال .. ال urine عنده التركيز ال urine ال
+
+70
+00:05:37,330 --> 00:05:40,650
+maximum تبعه بزيش عند خمسمية ملي أزمال التاني عشر
+
+71
+00:05:40,650 --> 00:05:45,910
+تلات ملي أزمال بنقعد ده في الوسط لإنه احنا بنقدر
+
+72
+00:05:45,910 --> 00:05:50,230
+نتحرك يعني مش عايشين في الميه زي هذا لأ عايشين في
+
+73
+00:05:50,230 --> 00:05:55,110
+ال .. في ال .. في ال .. يابسة نستطيع إنه ن .. نروح
+
+74
+00:05:55,110 --> 00:05:59,810
+للميه وجد ما بدنا و بنتعرض أحيان ال ..انقطاع مؤقت
+
+75
+00:05:59,810 --> 00:06:04,970
+للميّه لذلك نعمل تركيز متوسط بين الحالتين هدول طيب
+
+76
+00:06:04,970 --> 00:06:10,050
+اذا احنا لاحظنا من خلال الحيوانات هذه ودرستها انه
+
+77
+00:06:10,050 --> 00:06:17,370
+كمية التركيز تبع البول يعتمد على طول المضلة كل ما
+
+78
+00:06:17,370 --> 00:06:23,710
+المضلة كان طولها بالنسبة لكيليا اكتر كل ما كان
+
+79
+00:06:23,710 --> 00:06:27,800
+عندنا more concentrated urine اكترطبعا كلما
+
+80
+00:06:27,800 --> 00:06:34,260
+المضالة قصرت كلما ال concentration ability للكل
+
+81
+00:06:34,260 --> 00:06:39,420
+يهادي تقل لحظنا
+
+82
+00:06:39,420 --> 00:06:43,080
+ان المضالة هادي ساعة ما يكون في عندنا تركيز ball
+
+83
+00:06:43,080 --> 00:06:46,360
+لو أخدنا ال interest station تبعه وجسناه هنلاقي
+
+84
+00:06:46,360 --> 00:06:51,260
+مركزو لما يكون بيطلع diluted urine لو خدنا ال
+
+85
+00:06:51,260 --> 00:06:55,700
+interstitium هذا و جسدنا هنلاقي diluted يعني دايما
+
+86
+00:06:55,700 --> 00:07:01,100
+ال end product تبع ال urine osmolality ال final
+
+87
+00:07:01,100 --> 00:07:04,300
+osmolality او ال concentration هنلاقي مثاول ال
+
+88
+00:07:04,300 --> 00:07:09,080
+interstitium osmolality تبع القلمط الله تمام؟ زي
+
+89
+00:07:09,080 --> 00:07:13,300
+ما اقول ان احنا هناك علاقة و أكيدة في هذا الموضوع
+
+90
+00:07:16,490 --> 00:07:20,110
+لكن بنعرف ان في عندي انا obligatory urine volume
+
+91
+00:07:20,110 --> 00:07:24,830
+obligatory urine volume يعني ال volume of urine
+
+92
+00:07:24,830 --> 00:07:30,710
+that is needed to excrete the minimal urine volume
+
+93
+00:07:30,710 --> 00:07:37,170
+that is needed to excrete the metabolites طيب بسم
+
+94
+00:07:37,170 --> 00:07:42,010
+الله الرحمن الرحيم الآن سؤالنا اللي دايما بنسأل
+
+95
+00:07:42,010 --> 00:07:46,660
+مثل بيقولوا انه ودا على البحرو بيرجعوا بدون ما
+
+96
+00:07:46,660 --> 00:07:50,880
+إيه؟ ما يشربوا مية طيب أنا بدي أسأل سؤال أنه أفضل
+
+97
+00:07:50,880 --> 00:07:54,880
+ودي على البحر و يشربوا مية لما يكون عطشان؟ ولا ما
+
+98
+00:07:54,880 --> 00:07:59,260
+يشربوش مية؟ يعني هل مية البحر هي صالحة لبن آدم
+
+99
+00:07:59,260 --> 00:08:05,460
+يستخدمها؟ لأ، مين بيقول أه؟ طيب، احنا بدنا نتكلم
+
+100
+00:08:05,460 --> 00:08:09,520
+كلام علمي، لأ أه ولا لأ هيك أميتي بدنا نقول إنه
+
+101
+00:08:09,520 --> 00:08:14,610
+مية البحر بيكون فيها تركيز ال ..الاملاح تلاتة الى
+
+102
+00:08:14,610 --> 00:08:20,210
+تلاتة و نص في المية يعني تمثل حوالي الف و متين ملي
+
+103
+00:08:20,210 --> 00:08:27,970
+ازمور بالليتر تمام؟ و احنا عندنا تركيز ال .. ال
+
+104
+00:08:27,970 --> 00:08:33,810
+ball اقصى ما يمكن الف و متين الف و اربعمية كله الف
+
+105
+00:08:33,810 --> 00:08:37,490
+و متين يعني قولنا لو الف الواحد شرب لتر من ميط
+
+106
+00:08:37,490 --> 00:08:42,390
+البحر مفترض انه شرب اللتر الف و متين ملي ازمور فيه
+
+107
+00:08:43,890 --> 00:08:48,970
+هيطلع liter من الأزمال .. ال .. الأزمالات اللي فيه
+
+108
+00:08:48,970 --> 00:08:51,930
+تساوي ال .. يعني أمي ألف و متين من الأزمال، ال
+
+109
+00:08:51,930 --> 00:08:55,830
+maximum تابعنا، مش هيك؟ بس مش هيك الواقع حقيقية،
+
+110
+00:08:55,830 --> 00:08:59,430
+هي ال .. ال .. الوصفة اللي اتكلمنا عنها معناها انه
+
+111
+00:08:59,430 --> 00:09:06,170
+الواحد عشان يطلع liter ميط بحر، بده liter bowl، مش
+
+112
+00:09:06,170 --> 00:09:10,030
+كده؟ لأ، هذا الكلام لو هيك، بكون الواحد باستفادش
+
+113
+00:09:11,000 --> 00:09:15,180
+يعني لا خسر ولا كسب مية لكن واقع الأمر انه بيخسر
+
+114
+00:09:15,180 --> 00:09:18,980
+ليش؟ بيخسر لأنه انا انا بدي اطلع concentrated
+
+115
+00:09:18,980 --> 00:09:24,340
+urine ب ألف و متين اتكلمنا المرة الماضية او ما
+
+116
+00:09:24,340 --> 00:09:27,600
+اتكلمناش او بتأكيد هتكلم اليوم بس اتكلمنا المرة
+
+117
+00:09:27,600 --> 00:09:30,760
+الماضية انه ال osmotic gradient اللي بتكون في
+
+118
+00:09:30,760 --> 00:09:35,000
+المضلة مسؤول عنه مش بس ال solutes ال sodium
+
+119
+00:09:35,000 --> 00:09:41,000
+chloride solutes و ان فيهمسؤول عنه مين كمان الوريا
+
+120
+00:09:41,000 --> 00:09:45,980
+وقلنا خمسين في المية منه مسئولية مين الوريا وخمسين
+
+121
+00:09:45,980 --> 00:09:50,340
+في المية مسئولية ال other solos اذا انا علشان
+
+122
+00:09:50,340 --> 00:09:53,860
+الوريا تصل لهذه المرحلة هذي في ال interest system
+
+123
+00:09:53,860 --> 00:09:57,980
+الف و متين التركيز لازم يكون عندى اناءة الوريا
+
+124
+00:09:57,980 --> 00:10:00,500
+بتشارك بستمية مليون أزمان و ال soli مكنورة بتشارك
+
+125
+00:10:00,500 --> 00:10:03,320
+بستمية مليون أزمان يعني لازم الوريا تكون عندى .. و
+
+126
+00:10:03,320 --> 00:10:06,060
+هتصل تركيزها عشان يبقى تروح by the simple
+
+127
+00:10:06,060 --> 00:10:09,630
+diffusionهي تخرج من التيوبيول بشكل A بشكل بسيط
+
+128
+00:10:09,630 --> 00:10:13,730
+بشكل diffusion لإنه عندي الانترنت كورمون علالي ال
+
+129
+00:10:13,730 --> 00:10:18,030
+concentration وفتح ال .. ال urea transporters
+
+130
+00:10:18,030 --> 00:10:21,750
+فبتقدر ال hyper concentrated urea في ال .. على
+
+131
+00:10:21,750 --> 00:10:24,690
+الكلام أنا بقعد شوية صغيرة في ال .. في التيوبيول
+
+132
+00:10:24,690 --> 00:10:28,110
+بتقدر إلى أنه بتعمل diffusion تمام؟ هتعمل
+
+133
+00:10:28,110 --> 00:10:30,250
+diffusion لحد ما يصيب ال concentration تبع ال urea
+
+134
+00:10:30,250 --> 00:10:33,070
+في التيوبيول زي ال interstitium إذا أنا لازم يكون
+
+135
+00:10:33,070 --> 00:10:38,020
+عندي ال concentration في ال Aاليوريا 600 تقريبا،
+
+136
+00:10:38,020 --> 00:10:42,240
+مش هيك؟ إذا في الحالة هذه أنا ال 1200 اللي بتكون و
+
+137
+00:10:42,240 --> 00:10:45,160
+ال 600 منهم لازم يكون بقى إيه؟ يوريا عشان أطلع ال
+
+138
+00:10:45,160 --> 00:10:48,740
+1200 ماقدرش أطلع لهم مرة واحدة، إذا أطلع ال 1200،
+
+139
+00:10:48,740 --> 00:10:52,200
+ال 600 منهم يوريا و ال 600 منهم Sodium chloride
+
+140
+00:10:52,200 --> 00:10:56,280
+إذا محتاج عشان أطلع ال 1200 أنا إيه لقداش؟ اتنين
+
+141
+00:10:56,280 --> 00:11:00,660
+لتر، أنا بكون في الحالة هذه لو مشربتش؟أحسن لإنه
+
+142
+00:11:00,660 --> 00:11:04,700
+انا إذا سيبت وشرب ميه بحر معناه يظل يفقد مقابل كل
+
+143
+00:11:04,700 --> 00:11:08,200
+لتر لتر إضافي مش هيك معناه أنا بخششه فيه
+
+144
+00:11:08,200 --> 00:11:11,980
+dehydration فوق ما هو already dehydrated وإلا ليش
+
+145
+00:11:11,980 --> 00:11:16,750
+كان ميخ من العتش حتى شرب ميه البحر فهو غلطبشرب ميط
+
+146
+00:11:16,750 --> 00:11:24,990
+البحر لكن المثل اللي قلته انا ماعتقدش ان هو غلط
+
+147
+00:11:24,990 --> 00:11:28,150
+كتير ليش؟ لإن البحر في الحالة هادي باللغة المصرية
+
+148
+00:11:28,150 --> 00:11:32,610
+تعني ايه؟ تعني .. تعني النهر النيل انه وصل
+
+149
+00:11:32,610 --> 00:11:36,590
+الولالولا وكده لكن احنا حاببت ان اوضحلكم ان ع
+
+150
+00:11:36,590 --> 00:11:40,650
+بحرنا لأ مانشربوش في مصر لازم نشربه لإن ميطه حلوة
+
+151
+00:11:40,650 --> 00:11:44,990
+اما هانإذا صار شارب ميه من ميه البحر مشكلة لإنه
+
+152
+00:11:44,990 --> 00:11:49,670
+سيفقد مقابل كل لتر لتر أخر لإخراج اللي إيه اللي
+
+153
+00:11:49,670 --> 00:11:54,690
+سافناه عندك لإنه عشان نطلع ال concentrated urine
+
+154
+00:11:54,690 --> 00:11:59,970
+احنا محتاجين حاجة تانية محتاجين يقولنا أنت ال red
+
+155
+00:11:59,970 --> 00:12:06,930
+hormone مظبوط و إيش و hyper osmotic رينال ميضلة ال
+
+156
+00:12:06,930 --> 00:12:07,270
+..
+
+157
+00:12:10,210 --> 00:12:13,790
+الـ Antidote hormone جيبنا سيرته و ال Osmotic
+
+158
+00:12:13,790 --> 00:12:18,150
+Mandala جيبنا سالتها بس بدنا التفاصيل بدنا ايش؟
+
+159
+00:12:18,150 --> 00:12:22,430
+التفاصيل التفاصيل بتاعة ال Antidote hormone جيبنا
+
+160
+00:12:22,430 --> 00:12:25,910
+اتكلمنا عنها تقريبا بما يعرفين و قولنا عنه ال
+
+161
+00:12:25,910 --> 00:12:29,550
+Antidote hormone اين بيشتغل؟ بيشتغل في ال distal
+
+162
+00:12:29,550 --> 00:12:34,340
+tubule و ال collecting tubuleو الـ collecting duct
+
+163
+00:12:34,340 --> 00:12:37,860
+يعني من بعد الـ thick ascending limb و الـ early
+
+164
+00:12:37,860 --> 00:12:41,040
+part of الـ distal tubule بيصير عندي أنا الـ
+
+165
+00:12:41,040 --> 00:12:45,600
+anterior hormone مكان عمله من هذا النقطة للنهاية،
+
+166
+00:12:45,600 --> 00:12:49,480
+تمام؟ إذا الـ anterior hormone في وجوده ال .. ال
+
+167
+00:12:49,480 --> 00:12:52,980
+.. ال tubule من هذا الجزء إلى ال tip of the
+
+168
+00:12:52,980 --> 00:12:59,960
+papilla يستطيع أنه يabsorb water، تمام؟لكن في عدم
+
+169
+00:12:59,960 --> 00:13:02,860
+وجود الانتجار الكرمون مش هيكون في عندي لا
+
+170
+00:13:02,860 --> 00:13:05,040
+absorption of water طبعا لما يكون في عندي لا
+
+171
+00:13:05,040 --> 00:13:06,820
+absorption of water في الصين عندي concentrated
+
+172
+00:13:06,820 --> 00:13:14,620
+urine طبعا طيب لحظة بدى تركزوا معايا شوية هيك احنا
+
+173
+00:13:14,620 --> 00:13:18,340
+جيبنا سيرة المضلة كتير انها مهمة في ال
+
+174
+00:13:18,340 --> 00:13:23,380
+concentration of urine مش كده لكن بدى اذكركم اشي
+
+175
+00:13:23,380 --> 00:13:28,320
+تاني مهم كتيروهو انه ال thick ascending limb و ال
+
+176
+00:13:28,320 --> 00:13:34,540
+early part of the distal tubule بتسلملي ال late
+
+177
+00:13:34,540 --> 00:13:40,340
+distal tubule و باقي النفرول في tubular fluid
+
+178
+00:13:40,340 --> 00:13:45,260
+تركيزه كده؟ مائة ملي أزمال مين اللي جالس مائة ملي
+
+179
+00:13:45,260 --> 00:13:48,860
+أزمال؟ كويس بكذا معايا انذا هذا diluting segment
+
+180
+00:13:48,860 --> 00:13:55,390
+بياخد solutes و بطلعلي diluted ايه؟ تمام؟لما يكون
+
+181
+00:13:55,390 --> 00:13:58,890
+عندى انا .. لما يكون عندى انا موجود حالة
+
+182
+00:13:58,890 --> 00:14:04,310
+dehydration محتاج الميه والانتردوت الحرمون عالى في
+
+183
+00:14:04,310 --> 00:14:09,230
+الحالة هذه بيبدأ التركيز من اول ال ايه ال .. ال ..
+
+184
+00:14:09,230 --> 00:14:11,730
+ال .. اللي هو من .. من اول ال late distal tubule
+
+185
+00:14:11,730 --> 00:14:15,590
+من هذا النقطة الى نهاية الانتردوت الحرمون شغال الى
+
+186
+00:14:15,590 --> 00:14:18,970
+نهاية ال tubule مش هكذا كل المنطقة هذه تشارك في ال
+
+187
+00:14:18,970 --> 00:14:23,110
+concentrationمظبوط؟ لكن ال .. ال .. ال .. ال .. ال
+
+188
+00:14:23,110 --> 00:14:23,410
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+189
+00:14:23,410 --> 00:14:24,090
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+190
+00:14:24,090 --> 00:14:25,050
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+191
+00:14:25,050 --> 00:14:25,770
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+192
+00:14:25,770 --> 00:14:28,150
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+193
+00:14:28,150 --> 00:14:28,730
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+194
+00:14:28,730 --> 00:14:29,590
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+195
+00:14:29,590 --> 00:14:30,510
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+196
+00:14:30,510 --> 00:14:34,110
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+197
+00:14:34,110 --> 00:14:34,110
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+198
+00:14:34,110 --> 00:14:34,210
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+199
+00:14:34,210 --> 00:14:36,290
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+200
+00:14:36,290 --> 00:14:40,450
+.. ال ..
+
+201
+00:14:40,450 --> 00:14:44,690
+ال
+
+202
+00:14:46,390 --> 00:14:50,610
+سنتولتين ال fluid اللى موجود فى ال filtrate ستة و
+
+203
+00:14:50,610 --> 00:14:53,450
+ستين فى المية منه الآن بيصير reabsorption عشان
+
+204
+00:14:53,450 --> 00:14:59,490
+نوصل لل إيش لل تلت مية، مظبوط؟ إذا قدش ضايل على ال
+
+205
+00:14:59,490 --> 00:15:02,170
+maximum، مابود أطلع كل اللى .. كل اللى نازل لتحت
+
+206
+00:15:02,170 --> 00:15:06,030
+ضايل التلت من ال filtrate إذا ال bulk of
+
+207
+00:15:06,030 --> 00:15:10,510
+reabsorption لما يصير عنده concentration بتموين فى
+
+208
+00:15:10,510 --> 00:15:16,370
+ال cortex ال distal tubule و collecting ductهنا
+
+209
+00:15:16,370 --> 00:15:24,330
+بتحول ال water channels مفتوحة وبتدخل الميه بسيفلي
+
+210
+00:15:24,330 --> 00:15:28,810
+حطسها ل maximum concentration تلاتمية مش كده؟ اذا
+
+211
+00:15:28,810 --> 00:15:34,050
+ال cortical part هذا مهم جدا في ال reabsorption of
+
+212
+00:15:34,050 --> 00:15:36,830
+water في حالة ال .. ال .. ال .. ال .. ال .. ال ..
+
+213
+00:15:36,830 --> 00:15:37,190
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+214
+00:15:37,190 --> 00:15:37,470
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+215
+00:15:37,470 --> 00:15:38,130
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+216
+00:15:38,130 --> 00:15:39,250
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+217
+00:15:39,250 --> 00:15:39,430
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+218
+00:15:39,430 --> 00:15:39,950
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+219
+00:15:39,950 --> 00:15:40,810
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+220
+00:15:40,810 --> 00:15:40,810
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+221
+00:15:40,810 --> 00:15:42,720
+ال .. ال .. ال .. ال .. ال ..لكن الـ urine اللي
+
+222
+00:15:42,720 --> 00:15:45,580
+طالع ما هوش concentrated صار isosmotic
+
+223
+00:15:45,580 --> 00:15:53,380
+ايزوثينيوريا ايزوثينيوريا يعني ال .. ال .. ال
+
+224
+00:15:53,380 --> 00:15:57,220
+osmolality متواحدة بين ال ايه؟ بين ال urine و ال
+
+225
+00:15:57,220 --> 00:16:02,900
+.. و ال plasma تمام؟ اذا الجزئية المهمة في المضالة
+
+226
+00:16:02,900 --> 00:16:06,780
+انه بتخليلي ال osmolality تعلى اكتر من ال ايه؟يعني
+
+227
+00:16:06,780 --> 00:16:10,380
+الجزء الأخير التلت الأخير من ال filtrate اللي ضايل
+
+228
+00:16:10,380 --> 00:16:14,480
+هو بيصيرله نتحكم فيه و نعمله reabsorption ل most
+
+229
+00:16:14,480 --> 00:16:18,560
+of it to have concentrated urine لذن ال cortical
+
+230
+00:16:18,560 --> 00:16:24,000
+part له أهمية في ال concentration لكن المدلري part
+
+231
+00:16:24,000 --> 00:16:29,750
+أهميته في إيش؟ إنه بيعمللي إشي isosmotic urineهو
+
+232
+00:16:29,750 --> 00:16:33,370
+بيعمل لي hyper osmotic urine إذا ال concentrated
+
+233
+00:16:33,370 --> 00:16:36,910
+urine مسئولية المدلة لكن ال reabsorption of water
+
+234
+00:16:36,910 --> 00:16:41,030
+في حالة ال dehydration هي مش بس مسئولية المدلة ال
+
+235
+00:16:41,030 --> 00:16:45,430
+cortex بتسحب ميه من ال urine أكتر ما بتسحب ايه
+
+236
+00:16:45,430 --> 00:16:51,130
+تمام؟ و لو ال flow تبع ال .. ال .. ال filtrate نزل
+
+237
+00:16:51,130 --> 00:16:54,890
+المدلة بكمية كبيرة، بتقدرش المدلة تاخد كمية هذه
+
+238
+00:16:55,540 --> 00:16:59,500
+لذلك احنا ايه .. لذلك نبدأ من بدري من early part
+
+239
+00:16:59,500 --> 00:17:03,560
+التحكم في الميه عشان يكون عندي enough يعني length
+
+240
+00:17:03,560 --> 00:17:07,780
+عشان ايه اتحكم في ال reabsorption of big amounts
+
+241
+00:17:07,780 --> 00:17:12,840
+ال cortical معظم الأشياء .. طيب قولناها ان احنا
+
+242
+00:17:12,840 --> 00:17:17,810
+انه .. اذا الميه بيصيرها reabsorption فيالجزء
+
+243
+00:17:17,810 --> 00:17:21,190
+الأخير هذا كله لإن سميه ده distal nephron ده
+
+244
+00:17:21,190 --> 00:17:24,490
+distal إيه مش distal tubule ده distal nephron
+
+245
+00:17:24,490 --> 00:17:27,470
+بيبدأ من الجزء اللي ليه distal tubule للآخر اسمه
+
+246
+00:17:27,470 --> 00:17:30,390
+distal nephron خليني أتكلم عنه إذا ال distal
+
+247
+00:17:30,390 --> 00:17:34,090
+nephron هذا في reabsorption of water according to
+
+248
+00:17:34,090 --> 00:17:36,350
+the body needs under the control of antidepressant
+
+249
+00:17:36,350 --> 00:17:40,350
+hormone مش هيك؟ وهذا الجزء كله هي to permeable to
+
+250
+00:17:40,350 --> 00:17:43,210
+water إذا في antidepressant hormone لكن هل الجزء
+
+251
+00:17:43,210 --> 00:17:49,860
+هذا كله permeable to urea؟لأ إذا ال .. ال .. ال
+
+252
+00:17:49,860 --> 00:17:53,140
+cortical part منه هذا مش .. مش .. not .. not
+
+253
+00:17:53,140 --> 00:17:56,600
+permeable to urea لكن ال medullary part permeable
+
+254
+00:17:56,600 --> 00:17:59,660
+to urea لذلك لما نقول احنا سرعينا reabsorption of
+
+255
+00:17:59,660 --> 00:18:04,460
+water في ال cortex كان ضخم، مظبوط؟ و ال urea not
+
+256
+00:18:04,460 --> 00:18:08,820
+reabsorbed إذا ال urea لما تصل المدلة بتكون
+
+257
+00:18:08,820 --> 00:18:14,120
+concentrated تمام واضح؟ من هنامن هنا انه في عيدي
+
+258
+00:18:14,120 --> 00:18:19,700
+طولتين الميه اذا اليوريا اتضاعف التركيزها لتلت
+
+259
+00:18:19,700 --> 00:18:23,040
+اضعف لانه ايه كانت في طولت كمية صارت في .. انسحب
+
+260
+00:18:23,040 --> 00:18:26,920
+منها طولتين صارت في طولت الكمية اذا اتضاعف تركيزها
+
+261
+00:18:26,920 --> 00:18:31,850
+و لما تدخل المضلة كمانتمام؟ لما تدخل المضلة، برضه
+
+262
+00:18:31,850 --> 00:18:35,130
+فيه water reabsorption، بصمت؟ يعني فيه more
+
+263
+00:18:35,130 --> 00:18:40,030
+concentration of urea لذلك ال urea هي نازلة،
+
+264
+00:18:40,030 --> 00:18:42,450
+بيصيلها ايه؟ simple diffusion، اذا ال .. اذا ال
+
+265
+00:18:42,450 --> 00:18:44,770
+urea transformed لنا سفاتين، بيصيلها simple
+
+266
+00:18:44,770 --> 00:18:49,590
+diffusion لمين؟ للمضلة، و من هنا بتشارك في صناعة
+
+267
+00:18:49,590 --> 00:18:50,370
+hyper osmotic
+
+268
+00:18:53,170 --> 00:18:56,770
+مدلة واضح اذا هي fifty percent من ال azimuthic
+
+269
+00:18:56,770 --> 00:19:00,310
+gradient بسبب مين لما نقول ال maximum تبعنا تحت
+
+270
+00:19:00,310 --> 00:19:05,470
+الف و متين اذا ستمية منه في Mن ال A من الورية واضح
+
+271
+00:19:05,840 --> 00:19:10,700
+إذن الـ antidiuretic hormone مش بس بيساعدني على
+
+272
+00:19:10,700 --> 00:19:14,660
+إنه يعمل absorption of water كمان بيركز لليوريا
+
+273
+00:19:14,660 --> 00:19:18,220
+أكتر و بيساعد أنه يساعدها في ال diffusion اتنين
+
+274
+00:19:18,220 --> 00:19:22,540
+برضه زي اما بيفتح ال ال water channels ال
+
+275
+00:19:22,540 --> 00:19:25,940
+antidiuretic hormone أيضا بيفتح ال ايه ال urea
+
+276
+00:19:25,940 --> 00:19:28,300
+transporters بيعمل ال .. ال .. ال .. ال
+
+277
+00:19:28,300 --> 00:19:31,760
+facilitated diffusion هذا عن طريق ال carrier و
+
+278
+00:19:31,760 --> 00:19:35,680
+بيساعد ال diffusion واضح؟طيب كتير الكلام هذا إذا
+
+279
+00:19:35,680 --> 00:19:40,200
+إحنا دلوقتي صار عندنا نظرة شاملة عن ال
+
+280
+00:19:40,200 --> 00:19:43,740
+reabsorption و ال water و ال urea اللي بيعملوه طيب
+
+281
+00:19:43,740 --> 00:19:46,840
+هذا ما يتعلق بال antidiotic hormone و علاقاته
+
+282
+00:19:46,840 --> 00:19:50,920
+التفاصيل اللي أنا هناخدها أكتر عن ال osmotic
+
+283
+00:19:50,920 --> 00:19:52,160
+gradient هذا اللي بتكون
+
+284
+00:19:54,930 --> 00:19:58,850
+أتكلمنا عن جزء اليوريا منه وفهمناها بس في جزء ما
+
+285
+00:19:58,850 --> 00:20:04,510
+فهمناهش في الآخر نتكلم عن الـUrea cycle او circuit
+
+286
+00:20:04,510 --> 00:20:08,430
+Re-circuiting او Recycling of urea هنتكلم عنها في
+
+287
+00:20:08,430 --> 00:20:11,550
+نهاية الكلام بس دلوقت نتكلم عن الـosmolality
+
+288
+00:20:11,550 --> 00:20:15,350
+gradient هذا الـ50% الأسئلة الأولانية منه تتكون من
+
+289
+00:20:15,350 --> 00:20:23,880
+السوديوم والكلورايد والسوليوت والهيبر اوزمولاريطيب
+
+290
+00:20:23,880 --> 00:20:32,420
+السوليوس هدول .. السوليوس
+
+291
+00:20:32,420 --> 00:20:40,820
+هدول لما يصلهم دور في الـ osmotic gradient تبع
+
+292
+00:20:40,820 --> 00:20:44,520
+الميدالة معناها بيكون صار عندى انا ايه؟ في
+
+293
+00:20:44,520 --> 00:20:49,160
+absorption للسوليوس بكميات اكبر من ال .. من ال
+
+294
+00:20:49,160 --> 00:20:54,700
+water عشان اعمل hyper osmoticمضلة، مظبوط؟ يعني
+
+295
+00:20:54,700 --> 00:20:59,760
+بدنا ننتقله من أي شزء بدنا ننتقله، من لقو فنلي،
+
+296
+00:20:59,760 --> 00:21:03,980
+يعني مضلة إيش فيها؟ مضلة فيها لقو فنلي، وقولنا
+
+297
+00:21:03,980 --> 00:21:06,800
+فيها ten part و فيها إيش؟ thick part وقولنا ال
+
+298
+00:21:06,800 --> 00:21:09,300
+thick part هو إيش؟ reabsorbing solutes in
+
+299
+00:21:09,300 --> 00:21:13,220
+permeable تواطع، إذا ال thick part هذا هو الجزء
+
+300
+00:21:13,220 --> 00:21:17,710
+الرئيسي المسؤول عن إيش؟عن إنه يعمل الـ osmotic
+
+301
+00:21:17,710 --> 00:21:22,410
+gradient الـ solute part منه الـ 50% تمام؟ إذن هو
+
+302
+00:21:22,410 --> 00:21:25,310
+المسؤول عن الجزية هذه هو اللي بيقدر إنه يدخل
+
+303
+00:21:25,310 --> 00:21:29,150
+solutes more than water إذن هذا بيقدر .. و أين
+
+304
+00:21:29,150 --> 00:21:32,030
+بيوضيها؟ Reabsorption للـ interstitium تبع مين؟
+
+305
+00:21:32,030 --> 00:21:37,310
+تبع المدلة إذن هذه العملية هي المفتاح الرئيسي
+
+306
+00:21:37,310 --> 00:21:43,440
+لعملية إيه؟لعملية ال .. ال osmotic gradient بس
+
+307
+00:21:43,440 --> 00:21:47,700
+احنا لاحظنا ان ال pumping system هذا الموجود قولنا
+
+308
+00:21:47,700 --> 00:21:52,400
+sodium one two chloride one potassium مش هيك ال
+
+309
+00:21:52,400 --> 00:21:56,180
+pumping system هذا بيستطيع انه يشتغل against ..
+
+310
+00:21:56,180 --> 00:21:58,360
+against gradient مش كده against concentration
+
+311
+00:21:58,360 --> 00:22:02,360
+gradient بس انه maximum انه maximum انه بيشتغل
+
+312
+00:22:02,360 --> 00:22:07,300
+against two hundred milli osmo differenceيعني
+
+313
+00:22:07,300 --> 00:22:12,260
+بيقدر ياخد من ال fluid لل interstitium بحيث انه
+
+314
+00:22:12,260 --> 00:22:17,320
+يخلي ال concentration في ال interstitium اكتر من
+
+315
+00:22:17,320 --> 00:22:24,120
+ال .. من ال .. ال tubule ال 200 واضح؟ يعني بيقدرش
+
+316
+00:22:24,120 --> 00:22:28,100
+اذا زاد عن 200 في ال tubule فهي توقف عن الايه؟ اذا
+
+317
+00:22:28,100 --> 00:22:33,420
+زاد الفرق برا؟ طيب اذا هنا بدأنا ان نخش على
+
+318
+00:22:33,420 --> 00:22:37,310
+الموضوع طب لما يكون عندى فرق 200وانا عندى داخل ال
+
+319
+00:22:37,310 --> 00:22:42,950
+fluid ال .. ال .. ال .. ال .. ال proximal tubule
+
+320
+00:22:42,950 --> 00:22:47,630
+بتسلمني fluid isosmotic مش كده؟ وصل لل thick
+
+321
+00:22:47,630 --> 00:22:50,150
+ascending limb فى الحالة دى ال thick ascending
+
+322
+00:22:50,150 --> 00:22:54,010
+limb بيقدر انه ياخد solutes من جوا من ال tubule
+
+323
+00:22:54,010 --> 00:22:57,270
+ويرميها لل interstitium لحد ما يصير الفرق بين هدا
+
+324
+00:22:57,270 --> 00:23:00,870
+و هدا كده 200 من الأزمول يعنى هدا هيصير بدل 300
+
+325
+00:23:00,870 --> 00:23:07,300
+200 وهذا بدل 300 400 تمام؟هذه قدرته لكن احنا
+
+326
+00:23:07,300 --> 00:23:11,020
+بنتكلم دالين عن ايش؟ عن ألف و أربعمية ألف و ميتين
+
+327
+00:23:11,020 --> 00:23:16,120
+concentration gradient أعلى من هيك بكتير ايش اللي
+
+328
+00:23:16,120 --> 00:23:20,520
+بيصير اها بيصير what is called اللي هو ال counter
+
+329
+00:23:20,520 --> 00:23:24,060
+current multiplier counter current multiplication
+
+330
+00:23:24,060 --> 00:23:28,680
+counter current multiplication هو الراحل ايه
+
+331
+00:23:28,680 --> 00:23:32,200
+التعبير عشان اوريكوايا ماعلينا counter current
+
+332
+00:23:32,200 --> 00:23:32,780
+multiplication
+
+333
+00:23:35,840 --> 00:23:43,460
+الـ counter current multiplication هذا عبارة عن صح
+
+334
+00:23:43,460 --> 00:23:52,280
+انا باخد ال solutes من داخل ال tubule لبرا بكمية
+
+335
+00:23:52,280 --> 00:23:57,300
+معينة بس هذه المسألة انا عملها عملت مضاعفات في
+
+336
+00:23:57,300 --> 00:24:01,420
+system عندى اسمه counter current multiplier بيخلي
+
+337
+00:24:01,420 --> 00:24:05,630
+الاتين دول الفارقيظلهم يزيدوا و يزيدوا و يزيدوا
+
+338
+00:24:05,630 --> 00:24:09,610
+لحجم يعمل ليه الاش ال .. ال osmotic gradient اللي
+
+339
+00:24:09,610 --> 00:24:15,650
+هو عند ال .. ال cortex ال isosmotic تلاتمية و عند
+
+340
+00:24:15,650 --> 00:24:21,170
+التب يطلع لاش لألف و تلاتمية ألف و أربعمية كيف
+
+341
+00:24:21,170 --> 00:24:24,050
+بتصير هذه؟ مع أن القدرة تبعتنا اتكلمنا عنها محدودة
+
+342
+00:24:24,050 --> 00:24:27,190
+مش هيك؟ طبعا هو في مشاركة ليورياكية
+
+343
+00:24:29,920 --> 00:24:33,820
+لكن كيف سوليوس بتعمل استثميت من أزمون الفارق
+
+344
+00:24:33,820 --> 00:24:34,420
+تبعونها
+
+345
+00:24:51,000 --> 00:24:53,980
+شوفناها special characteristics of the loop of
+
+346
+00:24:53,980 --> 00:24:57,580
+Henle that cause solutes to be transported او
+
+347
+00:24:57,580 --> 00:25:04,980
+trapped in the renal نرجح
+
+348
+00:25:04,980 --> 00:25:09,100
+حاجة شوية صغيرة قلنا ال loop of Henle علينا جزء
+
+349
+00:25:09,100 --> 00:25:13,160
+thin و جزء thick الجزء ال thick قلنا impermeable
+
+350
+00:25:13,160 --> 00:25:17,960
+to water و ال ascending thin برضه impermeable to
+
+351
+00:25:17,960 --> 00:25:21,770
+waterتمام؟ اذا ال thin ascending limb .. ال
+
+352
+00:25:21,770 --> 00:25:27,390
+ascending limb كله impermeable to water ال thick ب
+
+353
+00:25:27,390 --> 00:25:34,450
+.. can reabsorb solutes actively big amounts ال ..
+
+354
+00:25:34,450 --> 00:25:38,870
+ال thin ascending ال transport عليه minimal can
+
+355
+00:25:38,870 --> 00:25:42,890
+reabsorb solutes without water لكنه minimal الآن
+
+356
+00:25:42,890 --> 00:25:48,000
+ال thin descending .. ال thin ايه descending؟زي
+
+357
+00:25:48,000 --> 00:25:51,200
+الـ thin ascending permeable to solutes and
+
+358
+00:25:51,200 --> 00:25:53,940
+permeable to water يعني ال descending هذا اللي
+
+359
+00:25:53,940 --> 00:25:57,600
+نازل و ال ascending الجزء اللي طالع ال thin منه
+
+360
+00:25:57,600 --> 00:26:02,160
+هذا permeable to solutes partially permeable لكنه
+
+361
+00:26:02,160 --> 00:26:05,160
+descending limb permeable to water ال ascending
+
+362
+00:26:05,160 --> 00:26:08,420
+limb thin not permeable to water و بجيت طبعا ال
+
+363
+00:26:08,420 --> 00:26:11,520
+ascending limb not permeable to water هذه المعصفات
+
+364
+00:26:11,520 --> 00:26:18,630
+تؤدي إلى العملية اللي بتكلم عنها اللي هيCreation
+
+365
+00:26:18,630 --> 00:26:23,130
+of osmotic gradient يؤدي
+
+366
+00:26:23,130 --> 00:26:30,810
+إلى قدرة الكلية على إمتصاص أو إخراج يورين مركزي
+
+367
+00:26:30,810 --> 00:26:35,130
+جدا والأخرين الانمالي تمام الانمالي اتكلمنا عنه
+
+368
+00:26:35,130 --> 00:26:39,730
+عشر تلاف عشر تلاف معناها لوبو فيني تبعه هذاطويل
+
+369
+00:26:39,730 --> 00:26:43,510
+جدا لدرجة ان ال multiplication بيظهر زي زي زي زي
+
+370
+00:26:43,510 --> 00:26:46,010
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+371
+00:26:46,010 --> 00:26:50,130
+زي زي زي
+
+372
+00:26:50,130 --> 00:26:50,630
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+373
+00:26:50,630 --> 00:26:53,130
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+374
+00:26:53,130 --> 00:26:55,170
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+375
+00:26:55,170 --> 00:26:55,490
+زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي زي
+
+376
+00:26:55,490 --> 00:27:04,410
+زي زي زي زي زي زي زي زي زي زي
+
+377
+00:27:04,410 --> 00:27:05,690
+زي ز
+
+378
+00:27:09,700 --> 00:27:14,460
+لو طلعنا هنا في الوضع الطبيعي ال .. ال .. الصورة
+
+379
+00:27:14,460 --> 00:27:18,300
+نمر واحد هذه ال filter جامع ال proximal tubule
+
+380
+00:27:18,300 --> 00:27:28,400
+تركيزه isosmotic مش كده؟ مفترض
+
+381
+00:27:28,400 --> 00:27:31,700
+يصير .. ايه اللي مشي في ال loop و فين ليه؟ اه و
+
+382
+00:27:31,700 --> 00:27:36,560
+يطلع ال .. ال distance في الجثة هذه تمام؟ انه ايش
+
+383
+00:27:36,560 --> 00:27:42,020
+يطلع؟اللي هو isosmotic ويكمل المشوار هنا بيتدخل
+
+384
+00:27:42,020 --> 00:27:46,260
+عندنا ال thick ascending limb ال thick ascending
+
+385
+00:27:46,260 --> 00:27:48,860
+limb بيعمل انه reabsorption of the filtrate
+
+386
+00:27:48,860 --> 00:27:53,980
+solutes impermeable to water فبياخد ال solutes
+
+387
+00:27:53,980 --> 00:27:57,060
+وبياخدش water فده ال diluting segment احنا okay
+
+388
+00:27:57,060 --> 00:28:00,080
+diluting segment في داخل ال tubule لكن بالنسبة لل
+
+389
+00:28:00,080 --> 00:28:04,100
+ال interstitium صار concentrating segment تمام؟
+
+390
+00:28:04,480 --> 00:28:06,780
+بالنسبة للإنترستيشن مو ال concentrating signal
+
+391
+00:28:06,780 --> 00:28:10,120
+بالنسبة للتيوبيول الـ diluting لإنه بياخد solace
+
+392
+00:28:10,120 --> 00:28:16,340
+بياخدش ايه معايا عالية معايا طيب إذا يستطيع يقولنا
+
+393
+00:28:16,340 --> 00:28:19,420
+يعمل فرد جداش 200 ميلي أزمول ال pumping system
+
+394
+00:28:19,420 --> 00:28:23,060
+عنده هذا القدرة فبنطلع ملاجي هنا لما ياخد من هذه
+
+395
+00:28:23,060 --> 00:28:27,270
+مية و طلع مية للإنترستيشن بيصلل ايه؟للـ maximum
+
+396
+00:28:27,270 --> 00:28:30,390
+تبعه لـ saturation level تبع من ال pumping system
+
+397
+00:28:30,390 --> 00:28:34,470
+فبنلاحظ احنا انه هذه العملية بتزيد ال interstitial
+
+398
+00:28:34,470 --> 00:28:40,650
+fluid osmolality الى 400 ملي ازمول و بتنزلي ال
+
+399
+00:28:40,650 --> 00:28:43,910
+tubular
+
+400
+00:28:43,910 --> 00:28:47,820
+fluid الى 200 ملي ازمولطيب خلاص هاي ال maximum انت
+
+401
+00:28:47,820 --> 00:28:51,360
+بتبقى نجلة؟ لأ لأ في نظام اخر بيساعد هذه الجزئية
+
+402
+00:28:51,360 --> 00:28:59,440
+صحيح هي بتنتج .. بتنتج مثلا بتقدر تصفي .. تصوروا
+
+403
+00:28:59,440 --> 00:29:04,000
+مكينة يعني بتقدر تصفي مثلا عشرين في المية من
+
+404
+00:29:04,000 --> 00:29:07,060
+المادة اللي بحطها فيها لكن بعد ما كده اخد المادة
+
+405
+00:29:07,060 --> 00:29:11,040
+اللي مصففاها دي اللي فجت عشرين مية و ارجح كمان مرة
+
+406
+00:29:11,040 --> 00:29:14,280
+اصف فيها بتفجد كمان عشرين في المية من اللي اشتيت
+
+407
+00:29:14,910 --> 00:29:19,410
+وبعدين باخدها كمان مرة هذا multiplication تمام؟
+
+408
+00:29:19,410 --> 00:29:24,050
+اذا هذا ايه؟ multiplication مضاعفات فبضل انا نفس
+
+409
+00:29:24,050 --> 00:29:28,810
+المادة اللي انا عملت لها هذه القدرة بعود استخدمها
+
+410
+00:29:28,810 --> 00:29:32,170
+كمان مرة هي مش الأصلي فهذا بيقدي الى ايه؟ ال
+
+411
+00:29:32,170 --> 00:29:34,570
+multiplication كيف ال multiplication بتتم هان؟
+
+412
+00:29:34,570 --> 00:29:42,210
+بتتم ان عندي في loop of Henleyعندي واحد fluid ماشي
+
+413
+00:29:42,210 --> 00:29:46,010
+باتجاه عكس التاني، تمام؟ اذا انا في عندي system
+
+414
+00:29:46,010 --> 00:29:49,290
+موجود ماشي واحد عكس التاني، بيقدر ال
+
+415
+00:29:49,290 --> 00:29:53,110
+multiplication هذا، بيقدر ال multiplication هذا،
+
+416
+00:29:53,110 --> 00:29:56,810
+واضح؟ اذا ال system المبني هنا صحي جزئية منه،
+
+417
+00:29:56,810 --> 00:30:00,570
+بتشتغل شغل معين، لكن انا بعيده و بكرر، بقدر هنا
+
+418
+00:30:00,570 --> 00:30:07,390
+ايدنه ايه؟الشيء يزيد مثلًا مثلًا مثلًا مثلًا مثلًا
+
+419
+00:30:07,390 --> 00:30:16,130
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+420
+00:30:16,130 --> 00:30:20,930
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+421
+00:30:20,930 --> 00:30:22,690
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+422
+00:30:22,690 --> 00:30:22,690
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+423
+00:30:22,690 --> 00:30:22,690
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+424
+00:30:22,690 --> 00:30:22,770
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+425
+00:30:22,770 --> 00:30:31,390
+مثلًا مثو ال filtrate 200 طيب لما يصير عندها 400
+
+426
+00:30:31,390 --> 00:30:34,330
+ال interstitium و قولنا it's descending limb
+
+427
+00:30:34,330 --> 00:30:37,770
+permeable to water تمام؟ اذا هت .. automatically
+
+428
+00:30:37,770 --> 00:30:41,430
+ال flow .. ال .. ال tubule هذا ال thin ascending
+
+429
+00:30:41,430 --> 00:30:45,370
+limb .. thin descending limb هو نازل معاه diluted
+
+430
+00:30:45,370 --> 00:30:49,790
+urine هيفقد ميه منه .. diluted fluid هيفقد ميه منه
+
+431
+00:30:49,790 --> 00:30:52,990
+بحيث يصير equilibrium مع مين؟ مع ال interstitium
+
+432
+00:30:55,370 --> 00:31:02,230
+الان هيفقد مية من ال water بحيث انه يصبح تركيزه
+
+433
+00:31:02,230 --> 00:31:07,270
+400 مساوى لمين ال interstitium فيها نتركة صغيرة
+
+434
+00:31:07,270 --> 00:31:10,810
+بدي تفهموها بعدين بس بدي أقولها الجديد الان المية
+
+435
+00:31:10,810 --> 00:31:15,810
+لما تخرج من ال descending limb وتروح لل hyper
+
+436
+00:31:15,810 --> 00:31:19,790
+osmotic interstitium تمام؟ وصارت ال osmolarity
+
+437
+00:31:19,790 --> 00:31:22,730
+متساوية مفترض المية لما تروح ال interstitium تتعمل
+
+438
+00:31:22,730 --> 00:31:28,780
+dilutionوتخرب عليه تمام هان بدخل system آخر اذا
+
+439
+00:31:28,780 --> 00:31:32,240
+احنا عشان نعمل concentration محتاجين انه الناس
+
+440
+00:31:32,240 --> 00:31:34,820
+تعمل concentration و الناس تحافظ عليها ال
+
+441
+00:31:34,820 --> 00:31:38,520
+concentration فال system هذا ال multiplication هذا
+
+442
+00:31:38,520 --> 00:31:42,100
+اللي بيصير بيعمل ال concentration بيجي نظام ال
+
+443
+00:31:42,100 --> 00:31:46,360
+vase recta اللي قلتلت عليه زمان شغلتها تحافظ علي
+
+444
+00:31:46,360 --> 00:31:50,270
+ال ايه؟عال concentration هذا بمعنى ان الفازاركته
+
+445
+00:31:50,270 --> 00:31:53,590
+ماشية بطريقة معينة الميه اللي طالع من ال tube و من
+
+446
+00:31:53,590 --> 00:31:56,030
+ال descending loop قبل ان تصبح ال interstitium
+
+447
+00:31:56,030 --> 00:32:00,790
+بيكون ايه؟ اخدت طيار للخارج اذا بيمنع .. في دافع
+
+448
+00:32:00,790 --> 00:32:05,690
+.. في دافع عندى بيجعل الميه تندفع من ال descending
+
+449
+00:32:05,690 --> 00:32:09,350
+loop of هنلي الى ال interstitium لكن هذا الدافع
+
+450
+00:32:09,350 --> 00:32:12,330
+بيجابل في الطريق الفازاركته اللي انا تحيط
+
+451
+00:32:12,330 --> 00:32:18,230
+الفازاركتهتحيط بال .. بال .. بالdescending tubule
+
+452
+00:32:18,230 --> 00:32:25,050
+بالdescending limb اه تصور انه ديل الفرس تمام
+
+453
+00:32:25,050 --> 00:32:28,070
+الوسطية تبعته هذه ال .. ال .. الdescending
+
+454
+00:32:28,070 --> 00:32:32,510
+lobopenly الوسطية تبعته لكن بجيط الشعر اللي حوالين
+
+455
+00:32:32,510 --> 00:32:38,090
+ديل الفرس هذا فزاركته اذا هو بيطلع جاعد ال ..الـ
+
+456
+00:32:38,090 --> 00:32:39,150
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+457
+00:32:39,150 --> 00:32:39,450
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+458
+00:32:39,450 --> 00:32:39,890
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+459
+00:32:39,890 --> 00:32:40,410
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+460
+00:32:40,410 --> 00:32:40,710
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+461
+00:32:40,710 --> 00:32:41,510
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+462
+00:32:41,510 --> 00:32:46,750
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+463
+00:32:46,750 --> 00:32:48,770
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+464
+00:32:48,770 --> 00:32:49,590
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+465
+00:32:49,590 --> 00:32:49,610
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+466
+00:32:49,610 --> 00:32:49,650
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+467
+00:32:49,650 --> 00:32:50,350
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+468
+00:32:50,350 --> 00:32:51,310
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+469
+00:32:51,310 --> 00:32:51,310
+ال
+
+470
+00:32:54,420 --> 00:32:56,880
+في الـ Interstitium لأنه لو زلت في ال Interstitium
+
+471
+00:32:56,880 --> 00:33:00,700
+إيش جابت من ضربوها من عاوز نعمل ال dilution و
+
+472
+00:33:00,700 --> 00:33:04,800
+بتضرب الفعل هيك لذا الأن صار عندي قدرة على أن أعمل
+
+473
+00:33:04,800 --> 00:33:11,160
+Interstitium 400 و أعمل filtrate بعد ما يخرج من ال
+
+474
+00:33:11,160 --> 00:33:17,850
+proximal tubule و ينزل على اللو بوف هنلي تدخل و لو
+
+475
+00:33:17,850 --> 00:33:22,550
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي
+
+476
+00:33:22,550 --> 00:33:29,530
+تدخل و لو بوف هنلي تدخل و لو بوف هنلي تدخل و لو
+
+477
+00:33:29,530 --> 00:33:31,230
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي
+
+478
+00:33:31,230 --> 00:33:31,430
+تدخل و لو بوف هنلي تدخل و لو بوف هنلي تدخل و لو
+
+479
+00:33:31,430 --> 00:33:33,250
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي
+
+480
+00:33:33,250 --> 00:33:34,810
+تدخل و لو بوف هنلي تدخل و لو بوف هنلي تدخل و لو
+
+481
+00:33:34,810 --> 00:33:45,830
+بوف هنلي تدخل و لو بوف هنلي تدخل و لو بوف هنلي تهو
+
+482
+00:33:45,830 --> 00:33:49,870
+.. اذا creating osmolality, osmotic gradient و ال
+
+483
+00:33:49,870 --> 00:33:54,170
+system بيمنع ايه؟ بيعمل maintenance لمين؟ لهذا ال
+
+484
+00:33:54,170 --> 00:33:56,970
+.. ال .. ال concentration gradient تمام؟ طيب،
+
+485
+00:33:56,970 --> 00:34:00,570
+ماشي، اذا مدام وصلنا لهذا المسألة هذه فهمناها، اذا
+
+486
+00:34:00,570 --> 00:34:04,790
+ال multiplication ماوقفش، اذا هذا وصل لاربعمية،
+
+487
+00:34:04,790 --> 00:34:09,930
+اذا هذا وصل لاربعمية، تمام؟ اذا انا هنا وصلت هنا
+
+488
+00:34:09,930 --> 00:34:16,130
+لالميتين، الاربعمية هذه هتتحرك و تطلع فوقصارت 400
+
+489
+00:34:16,130 --> 00:34:20,420
+اكبار الميهينإذا صار 400 أكبر 400 مش كده هذا عنده
+
+490
+00:34:20,420 --> 00:34:24,260
+القدرة أنه يعمل فرق فبيقدر أضخها كمان مية بيصير ال
+
+491
+00:34:24,260 --> 00:34:29,100
+intersection 500 هو ايه 300 طبعا إذا صار عندي هان
+
+492
+00:34:29,100 --> 00:34:33,560
+في ال intersection ايه 500 هياخد مية من ال
+
+493
+00:34:33,560 --> 00:34:37,920
+descending limb بيوصل لمين ل 500 ال 500 هتنزل لل
+
+494
+00:34:37,920 --> 00:34:42,840
+ascending هصير 500 أكبر 500 بتديله كمان ايه 100
+
+495
+00:34:42,840 --> 00:34:47,820
+بيصير هان 600 و هان 500400 400 400 400 400 400 400
+
+496
+00:34:47,820 --> 00:34:47,820
+400 400 400
+
+497
+00:34:47,820 --> 00:35:07,460
+400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400400440040040040044004004400440044004400440044004400440044004400440044004
+
+498
+00:35:12,380 --> 00:35:23,380
+هيبر ازموتك مدلة ازموتك ازموتك ازموتك ازموتك
+
+499
+00:35:23,380 --> 00:35:27,100
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+500
+00:35:27,100 --> 00:35:27,540
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+501
+00:35:27,540 --> 00:35:27,540
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+502
+00:35:27,540 --> 00:35:27,560
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+503
+00:35:27,560 --> 00:35:27,560
+ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك ازموتك
+
+504
+00:35:27,560 --> 00:35:33,180
+ازموتك ازموتك ازموتك
+
+505
+00:35:33,180 --> 00:35:38,680
+ازم
+
+506
+00:35:43,060 --> 00:35:46,040
+بالكفاءة فوق بياخد جزء و تحت جزء و تحت جزء و تحت
+
+507
+00:35:46,040 --> 00:35:48,280
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+508
+00:35:48,280 --> 00:35:50,460
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+509
+00:35:50,460 --> 00:35:51,520
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+510
+00:35:51,520 --> 00:35:51,520
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+511
+00:35:51,520 --> 00:35:51,580
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+512
+00:35:51,580 --> 00:35:51,640
+جزء و تحت جزء و تحت جزء و تحت جزء و تحت جزء و تحت
+
+513
+00:35:51,640 --> 00:36:05,900
+جزء و تحت جزء و
+
+514
+00:36:05,900 --> 00:36:10,340
+تحت جزالـ distal tubule لما يعديلي من أول و جديد
+
+515
+00:36:10,340 --> 00:36:15,660
+على ال a على ال collecting duct وعندي antidiuretic
+
+516
+00:36:15,660 --> 00:36:19,840
+hormone موجود و ال water channels مفتوحة و ال urea
+
+517
+00:36:19,840 --> 00:36:24,840
+channels مفتوحة بيصير ال a الانتقال من هنا تمام؟
+
+518
+00:36:24,840 --> 00:36:28,840
+اذا واضحة اذا احنا طبعا شوية صغيرة اتكلمنا عن دور
+
+519
+00:36:28,840 --> 00:36:35,220
+ال antidiuretic hormone في انهيعمل دوره في ال
+
+520
+00:36:35,220 --> 00:36:39,220
+concentration بس دوره هنا في ال cortex دوره صحيح
+
+521
+00:36:39,220 --> 00:36:44,500
+جالي اللي بيوصل ل 300 لكنه حجما كبير الجزء اللي
+
+522
+00:36:44,500 --> 00:36:47,960
+بيظل صغير بنزل المضلة و بيصير ال concentration
+
+523
+00:36:47,960 --> 00:36:50,040
+أعلى من ال
+
+524
+00:36:51,990 --> 00:36:55,990
+من الـ Plasma Osmolality تمام بيصير أعلى لإنه يصير
+
+525
+00:36:55,990 --> 00:37:00,490
+عنده hyperzotic شسم و بعدين بيقول بيشارك مين
+
+526
+00:37:00,490 --> 00:37:05,990
+بيشارك اليوريا فيها عندنا هنتكلم عن اليوريا أكتر
+
+527
+00:37:05,990 --> 00:37:09,490
+وأكتر لإن كيف تعمل الدائرة تبعها لما دخلت جوا إيش
+
+528
+00:37:09,490 --> 00:37:12,970
+بيصير فيها هتكلم عنها بعد شوية إذن واضح ال
+
+529
+00:37:12,970 --> 00:37:15,990
+multiplication counter current multiplier أو
+
+530
+00:37:15,990 --> 00:37:21,410
+multiplicationto hyper osmotic renal medullar
+
+531
+00:37:21,410 --> 00:37:27,450
+infestation and to concentrate urine قولنا إذا
+
+532
+00:37:27,450 --> 00:37:31,940
+اللي شرب موية البحرفي حال ما بتطلع concentrated
+
+533
+00:37:31,940 --> 00:37:36,800
+urine لازم يكون من نصه urea تمام؟ لإن ال urea اللي
+
+534
+00:37:36,800 --> 00:37:40,780
+نازلة مشاركة في ال interstitium إذا تركيزها هيكون
+
+535
+00:37:40,780 --> 00:37:44,020
+في ال .. في ال .. في ال .. في ال trails زي ال إيه؟
+
+536
+00:37:44,020 --> 00:37:46,800
+زي ال interstitium إذا بصل لستمية و ال solids
+
+537
+00:37:46,800 --> 00:37:49,640
+الأخرى اللي أنا شربتها بتشارك بستمية إذا بيدو
+
+538
+00:37:49,640 --> 00:37:53,040
+اتنين لتر قلنا مش هيك؟ إذا هنا ال urea كيف بتمشي
+
+539
+00:37:53,040 --> 00:37:59,480
+ال urea و كيف بتعملفي رسمة انا يبدو اني شايلها مش
+
+540
+00:37:59,480 --> 00:38:04,460
+مشكلة اذا احنا الان اليوريا قلنا توي انه مراحل
+
+541
+00:38:04,460 --> 00:38:09,780
+التعامل معها ال proximal tubule بيقدر يمتص 50% من
+
+542
+00:38:09,780 --> 00:38:14,400
+اليوريا تمام؟ اذا ال لوبوفين اللي بيخشله بس 50% من
+
+543
+00:38:14,400 --> 00:38:18,480
+اليوريا اللي هي AFL-card، بصبوط؟ فاكرين هذه ولا
+
+544
+00:38:18,480 --> 00:38:21,080
+نسيتها انتوا؟ نسيتها يا عبدالله اذا ال proximal
+
+545
+00:38:21,080 --> 00:38:24,280
+tubule بيصير بيعمل رقم سورفين اليوريا اللي نازلها
+
+546
+00:38:24,280 --> 00:38:24,620
+الجهة
+
+547
+00:38:27,520 --> 00:38:33,080
+اليوريا اللي نازلة في ال loop of Henle بتبطل لما
+
+548
+00:38:33,080 --> 00:38:35,440
+تصل ال thick ascending .. لما تصل ال ascending
+
+549
+00:38:35,440 --> 00:38:38,720
+limb .. ال ascending limb impermeable to ايه؟ to
+
+550
+00:38:38,720 --> 00:38:45,300
+يوريا لأ احنا جولنا ال distal tubule للاخر
+
+551
+00:38:45,300 --> 00:38:49,770
+impermeable to يورياعندي حاجتين، يعني عندي ايه؟
+
+552
+00:38:49,770 --> 00:38:57,170
+حاجتين عندي thick ascending و .. و .. و .. و .. و
+
+553
+00:38:57,170 --> 00:38:58,390
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+554
+00:38:58,390 --> 00:38:58,410
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+555
+00:38:58,410 --> 00:38:58,410
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+556
+00:38:58,410 --> 00:38:58,450
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+557
+00:38:58,450 --> 00:38:59,170
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+558
+00:38:59,170 --> 00:38:59,970
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+559
+00:38:59,970 --> 00:39:00,590
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+560
+00:39:00,590 --> 00:39:02,950
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+561
+00:39:02,950 --> 00:39:03,010
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+562
+00:39:03,010 --> 00:39:12,850
+.. و .. و .. و .. و .. و
+
+563
+00:39:14,720 --> 00:39:19,280
+أذا عندى انا يوريا اندفعت لإنها concentrated في ال
+
+564
+00:39:19,280 --> 00:39:24,520
+tubular fluid موجود في المضلة عندى يوريا مركزة
+
+565
+00:39:24,520 --> 00:39:29,220
+وقولنا كيف اتركزت تندفع من ال transporters إلى ال
+
+566
+00:39:29,220 --> 00:39:33,080
+interstation اللى هو مفترض انا لسه اليوريا فيه
+
+567
+00:39:33,080 --> 00:39:36,800
+عادية زى ما في البلازمه تركيز اليوريا في البلازمه
+
+568
+00:39:36,800 --> 00:39:41,760
+عشرين لاربعين milligram per liter يعني osmolality
+
+569
+00:39:41,760 --> 00:39:42,660
+واقعى حوالى
+
+570
+00:39:45,240 --> 00:39:47,680
+المشاركة في ال .. في ال .. في الgeneral
+
+571
+00:39:47,680 --> 00:39:51,740
+responsibility للدم لا تُذكر للبلازمة تمام؟ إذا
+
+572
+00:39:51,740 --> 00:39:54,560
+عندي hands are concentrated يوريا في ال .. في ال
+
+573
+00:39:54,560 --> 00:39:59,760
+tubular fluid اللي في المضلة مش كده؟ و ال
+
+574
+00:39:59,760 --> 00:40:02,220
+interstitium مش فيه concentration و transporters
+
+575
+00:40:02,220 --> 00:40:05,380
+فارقة فتدفع ال .. ال يوريا إلى إيه؟ إلى ال
+
+576
+00:40:05,380 --> 00:40:09,180
+interstitium هتظل تندفع .. تندفع لحد ما إيه يصير
+
+577
+00:40:09,180 --> 00:40:17,420
+ال concentration متساوي مظبوط؟طيب متساوي و خلص
+
+578
+00:40:17,420 --> 00:40:22,020
+دورها؟ لأ جالك إلها دور أكبر كيف يعني؟ جزء من هذا
+
+579
+00:40:22,020 --> 00:40:26,890
+اللي دخل ال interest station هيدخلهيدخل ال loop
+
+580
+00:40:26,890 --> 00:40:31,130
+فين ليه؟ هيزيد إلى اليوريا اللي موجودة احنا قلنا
+
+581
+00:40:31,130 --> 00:40:35,170
+قبل كده الجسم مبني على اقتصاد تمام اليوريا دي
+
+582
+00:40:35,170 --> 00:40:38,510
+ماتطلعها انا لإنها end product مابديش إياها لكن إن
+
+583
+00:40:38,510 --> 00:40:41,390
+مابدي أعمل concentrated during بدي ساعدني في
+
+584
+00:40:41,390 --> 00:40:47,390
+الموضوع تمام فبدي أحفظ جزء منها يساعدني في تركيز
+
+585
+00:40:47,390 --> 00:40:52,310
+ال interest ratio معايا بنات؟ معايا مركزين؟ إذا ..
+
+586
+00:40:52,310 --> 00:40:56,350
+إذا مش واضح .. مش واضح بعيد تاني الآنال .. ال ..
+
+587
+00:40:56,350 --> 00:40:58,010
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+588
+00:40:58,010 --> 00:40:58,130
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+589
+00:40:58,130 --> 00:40:58,170
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+590
+00:40:58,170 --> 00:40:58,430
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+591
+00:40:58,430 --> 00:40:58,630
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+592
+00:40:58,630 --> 00:40:59,570
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+593
+00:40:59,570 --> 00:40:59,570
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+594
+00:40:59,570 --> 00:40:59,890
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+595
+00:40:59,890 --> 00:41:00,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+596
+00:41:00,670 --> 00:41:06,270
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+597
+00:41:06,270 --> 00:41:07,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+598
+00:41:07,670 --> 00:41:09,070
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+599
+00:41:09,070 --> 00:41:15,890
+ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+600
+00:41:15,890 --> 00:41:19,370
+ال
+
+601
+00:41:19,370 --> 00:41:21,410
+..
+
+602
+00:41:23,070 --> 00:41:26,670
+بصار في عندى برضه permeable to water إذا برضه يصحب
+
+603
+00:41:26,670 --> 00:41:31,470
+منه water إذا كله بيساعد ان ال urea تزيد تركيزها
+
+604
+00:41:31,470 --> 00:41:34,810
+لكن هنا بيروح water و بيروح urea برضه في نفس
+
+605
+00:41:34,810 --> 00:41:37,570
+الكمية بس إذا التركيز اللى دخل من ال cortex و ده
+
+606
+00:41:37,570 --> 00:41:42,490
+اللى هو هو ليش لإنه الآن بدخل ال water و ال .. اه
+
+607
+00:41:42,490 --> 00:41:46,070
+لما دخلنا ال interstitium ال interstitium لجينا a
+
+608
+00:41:46,070 --> 00:41:53,230
+thin loop ال urea فيه مخففة تماملأن انا هنا سحبت
+
+609
+00:41:53,230 --> 00:41:56,770
+كمية مياه إضافية فصار اليوريا مركزة فيستطيع انها
+
+610
+00:41:56,770 --> 00:41:59,670
+اليوريا تدخل الـ thin loop الـ thin loop of Henle
+
+611
+00:41:59,670 --> 00:42:04,010
+إذا كانت descending ولا ايه؟ و لا سنسياً معناها
+
+612
+00:42:04,010 --> 00:42:07,810
+اليوريا اللي في ال loop of Henle كميتها أكبر من
+
+613
+00:42:07,810 --> 00:42:10,790
+اليوريا اللي جاية من ال proximal tubule لإن اللي
+
+614
+00:42:10,790 --> 00:42:15,190
+جاية من ال proximal tubule مضاف عليه كمية ازيادة
+
+615
+00:42:15,190 --> 00:42:20,580
+تمام؟إذاً اللي صار في الـ Tube-ul صار مركز أكتر
+
+616
+00:42:20,580 --> 00:42:24,520
+لإنه أخد شزء من الـ Interstitiumوهذا هيعدي برضه in
+
+617
+00:42:24,520 --> 00:42:29,660
+permeable ويصير تركيز أعلى من التركيز الأولاني لأن
+
+618
+00:42:29,660 --> 00:42:32,360
+كمية من اليوريا اللي سارت في الـ distal nephron
+
+619
+00:42:32,360 --> 00:42:36,140
+سارت الجزء اللي جاء من الـ proximal tubule وجزء
+
+620
+00:42:36,140 --> 00:42:40,720
+تاني رجع لف دخل شعرك في الموضوع تمام فتركيزها عالي
+
+621
+00:42:40,720 --> 00:42:46,100
+أكتر من أول الآن تنزل المدلة Reduct مركزة أكتر من
+
+622
+00:42:46,100 --> 00:42:50,260
+أول معناه تدّي يوريا أكتر لل-interstitium معناه في
+
+623
+00:42:50,260 --> 00:42:55,450
+كمية يوريا أكتر بتخش من الـthin loopمعنى ان الوريا
+
+624
+00:42:55,450 --> 00:43:00,250
+اللى في اللوموفينلي صارت more in quantity عن الأول
+
+625
+00:43:00,250 --> 00:43:03,390
+معنى انها لسهب فبتحمل برضه الوريا multiplication
+
+626
+00:43:03,390 --> 00:43:08,670
+بحيث انها تزيد تركيزها في ال filtrate ومعناها اللى
+
+627
+00:43:08,670 --> 00:43:12,230
+بينتقل من ال filtrate الى ال interest ratioبزيد،
+
+628
+00:43:12,230 --> 00:43:16,370
+إذا هي برضه بتشارك بطريقة إيه؟ بطريقة أخرى، واضح؟
+
+629
+00:43:16,370 --> 00:43:19,610
+بطريقة أخرى ال rule key تبعها إنه في antideric
+
+630
+00:43:19,610 --> 00:43:25,390
+hormone بسمح لمية تخش و بسمحش ل aurea لكن إذا هبط
+
+631
+00:43:25,390 --> 00:43:30,220
+ال antideric hormoneو ال water اللى موجودة ضالة
+
+632
+00:43:30,220 --> 00:43:34,320
+فيها هي ال urea بيصير مش concentrated و بيصير عندى
+
+633
+00:43:34,320 --> 00:43:37,520
+انا ال .. انا losing ال ايه ال .. ال urea
+
+634
+00:43:37,520 --> 00:43:40,840
+concentration ال gradient شوية شوية شوية لإنه بطلت
+
+635
+00:43:40,840 --> 00:43:44,580
+تخش ال interstitium و صارت تنزل و ماهياش
+
+636
+00:43:44,580 --> 00:43:49,280
+concentrated و اقف زى ما انا برضه thick ascending
+
+637
+00:43:49,280 --> 00:43:52,840
+limb ممكن ايه اعمل losing لإذا مافيش عندى
+
+638
+00:43:56,820 --> 00:43:59,720
+مافيش عندى ال aldosterone ال aldosterone مشكلة في
+
+639
+00:43:59,720 --> 00:44:03,900
+ال .. في ال .. في ال distal part هنا حقيقة مش ال
+
+640
+00:44:03,900 --> 00:44:06,900
+aldosterone ال distal part ال aldosterone على ال
+
+641
+00:44:06,900 --> 00:44:10,100
+sodium مالناش علاقة فيه الآن احنا بنتكلم عن ال
+
+642
+00:44:10,100 --> 00:44:14,220
+thick ascending limb اذا ال blood supply للمضلة
+
+643
+00:44:14,220 --> 00:44:21,900
+طبعا ضال جليل طبعا معناه الجكسة مدلري نفلوس مفتحوش
+
+644
+00:44:22,490 --> 00:44:28,690
+والدستال تبعهم يشتغلش ومايعملش ال concentration
+
+645
+00:44:28,690 --> 00:44:33,490
+gradient تمام؟ مايعملش ال concentration gradient
+
+646
+00:44:33,490 --> 00:44:38,290
+اللي هو يعتمد على الجكستا ميدالا رينفرونز إذا قلنا
+
+647
+00:44:38,290 --> 00:44:40,330
+احنا ال concentration gradient هذا بنعمل في
+
+648
+00:44:40,330 --> 00:44:45,290
+الميدالا بسبب مين؟ بسبب الجكستا غلوميرا رينفرونز
+
+649
+00:44:45,290 --> 00:44:50,840
+اللي هي لها long globeبتعمل الحركة هادئة واضح ؟
+
+650
+00:44:50,840 --> 00:44:53,860
+اذا انا اذا وجفت ال thick ascending limb عن العمل
+
+651
+00:44:53,860 --> 00:44:58,260
+بمعنى ان ال glomeruli تبعته كلها انا عملت لها
+
+652
+00:44:58,260 --> 00:45:04,180
+constriction و مابتشتغلش مرتاحة تمام اذا ممكن
+
+653
+00:45:04,180 --> 00:45:08,120
+يتوقف عن العمل هذا الجزئية فببطل في عند ال
+
+654
+00:45:08,120 --> 00:45:11,160
+concentration grade ال concentration grade مبدأ
+
+655
+00:45:11,160 --> 00:45:15,670
+يخفيعني to be washed شوية شوية شوية وفيش ايه a new
+
+656
+00:45:15,670 --> 00:45:18,970
+generation ل concentration gradient في التكأس
+
+657
+00:45:18,970 --> 00:45:22,690
+النجلم فبيختفي لو صار عند ال blood flow زاد مرة
+
+658
+00:45:22,690 --> 00:45:27,360
+واحدة للمضلة زي ما في حالة مثلا hypertensionفي حال
+
+659
+00:45:27,360 --> 00:45:32,300
+ان انا مدى vasodilators تمام الدم اذا انا عملت
+
+660
+00:45:32,300 --> 00:45:37,900
+high blood flow للinterstitium مابقدرش احافظ
+
+661
+00:45:37,900 --> 00:45:40,680
+الinterstitium على ال ايه؟ على ال concentration ال
+
+662
+00:45:40,680 --> 00:45:43,840
+gradient لانه بيجي الدم الكتير بيعملوش لل ايه؟ لل
+
+663
+00:45:43,840 --> 00:45:47,820
+solutes infusion الأخير هذا هتكلم عنه بعدي شوية
+
+664
+00:45:47,820 --> 00:45:52,210
+اكتر بس دلوقتي فهمنا دور ال thick ascending limbو
+
+665
+00:45:52,210 --> 00:45:55,210
+ال multiplication اللي بيعمله و دور اليوريا و ال
+
+666
+00:45:55,210 --> 00:45:59,090
+multiplication اللي بيحصل فيها واضح هذا اهم اشي
+
+667
+00:45:59,090 --> 00:46:05,650
+انا اريكوا تفهموه
+
+668
+00:46:05,650 --> 00:46:10,590
+recirculation of urea اه هذا الجزء اللي كان انا
+
+669
+00:46:10,590 --> 00:46:15,550
+اريكوا تشوفوه هو ماشوفتوش اذا الان قولنا اليوريا
+
+670
+00:46:15,550 --> 00:46:18,970
+في
+
+671
+00:46:18,970 --> 00:46:23,160
+التكاسن في المضارة الاداكت هناhyper concentrated
+
+672
+00:46:23,160 --> 00:46:29,760
+ليش؟ لأنه صار absorption ال water بدونها فهنا
+
+673
+00:46:29,760 --> 00:46:32,780
+بتندفع إلى داخل ال interstitium وفي ال
+
+674
+00:46:32,780 --> 00:46:36,080
+interstitium لإن الفيلتريتها هذا permeable لها
+
+675
+00:46:36,080 --> 00:46:40,560
+الجزئية 10 هذا الجزئية permeable لها و هو في ال
+
+676
+00:46:40,560 --> 00:46:43,420
+interstitium أعلى فبتنتقل إلى ال A فبصير كمية
+
+677
+00:46:43,420 --> 00:46:46,940
+اليوريا اللي صارت في ال tubule أكتر فاللي صار طالع
+
+678
+00:46:46,940 --> 00:46:50,040
+لي على ال distal nephron كمية أكتر و إذا سحبنا
+
+679
+00:46:50,040 --> 00:46:54,020
+الميه بعمل تركيز أكتروبتعمل ال multiple cache اللي
+
+680
+00:46:54,020 --> 00:46:57,680
+قلنا عليه هذا
+
+681
+00:46:57,680 --> 00:47:01,760
+جزء
+
+682
+00:47:01,760 --> 00:47:05,580
+counter can't exchange in the vase recta هذا الجزء
+
+683
+00:47:05,580 --> 00:47:09,560
+التاني اللي انا حكيتلكوا عليها ال vase recta بتمشي
+
+684
+00:47:09,560 --> 00:47:15,580
+بطريقة ما تبقى حوالين ال thin descending loop
+
+685
+00:47:15,580 --> 00:47:19,220
+حوالين ال loop كله بس هي بالذات بتكون محيطا مين
+
+686
+00:47:19,220 --> 00:47:29,330
+بال thin بحيث انهال .. ال .. ال ascending فأزاركتة
+
+687
+00:47:29,330 --> 00:47:34,500
+ملاصق لل .. لل descendingThin loop يعني هنا في
+
+688
+00:47:34,500 --> 00:47:39,200
+عندي counter current ماشيين عكس بعض تمام اذا بيكون
+
+689
+00:47:39,200 --> 00:47:42,560
+عندى انا افترض انه تلت حاجات هنا و هن حاجتين هذا
+
+690
+00:47:42,560 --> 00:47:45,820
+الوسطانية هذا ال tubular filtrate تمام ال thin
+
+691
+00:47:45,820 --> 00:47:49,560
+descending loop و هدول الجتنين اللي جنبهم هدول
+
+692
+00:47:49,560 --> 00:47:54,160
+يمثلوا ال ascending vasecta و برا ال descending
+
+693
+00:47:54,160 --> 00:47:58,380
+vasecta اذا ال vasecta بتنزل بعيد عن ال tubule وهي
+
+694
+00:47:58,380 --> 00:48:02,130
+طالعة ملاصقة لمينلات تفيل ، لأن شغلها تحمل الماء
+
+695
+00:48:02,130 --> 00:48:06,550
+اللي طالع منه و هي طالعة تمام؟ تحملها و هي طالعة،
+
+696
+00:48:06,550 --> 00:48:08,690
+إذا التركيبة الـ anatomical structure تبع
+
+697
+00:48:08,690 --> 00:48:13,550
+الفاذاركتة معمولة بطريقة إنه يسحب كل ال إيه؟ لو ال
+
+698
+00:48:13,550 --> 00:48:16,970
+blood flow زاد بالفاذاركتةهذا بيقدر إلى انه ايه
+
+699
+00:48:16,970 --> 00:48:22,730
+يعمل wash لكل ال solutes كمان مش بس لمين لل ال ال
+
+700
+00:48:22,730 --> 00:48:27,510
+water واضح طيب التفاصيل مش وم كتير التفاصيل تبعت
+
+701
+00:48:27,510 --> 00:48:30,470
+ال vase recta انت تصورتها زي ما انا قلت فياها مش
+
+702
+00:48:30,470 --> 00:48:34,950
+هيك خيلتوها كيف انه ال descending thin loop of
+
+703
+00:48:34,950 --> 00:48:38,950
+Henle محاط بال ascending vase recta وبيعمل عملية
+
+704
+00:48:38,950 --> 00:48:39,850
+اتكلمنا عنها
+
+705
+00:48:45,230 --> 00:48:51,130
+أذا في في ال vasa recta counter current exchanger
+
+706
+00:48:51,130 --> 00:48:59,070
+تمام؟ يا ربي يا كريم .. اذا عندي هان هذا .. vasa
+
+707
+00:48:59,070 --> 00:49:03,930
+recta هذه الصورة هذه ال vasa recta و كيف انه ال
+
+708
+00:49:03,930 --> 00:49:07,950
+fluids بتنتقل المهم .. انا المهم اللي فهمت بيها
+
+709
+00:49:07,950 --> 00:49:11,410
+اكتر من ما تقولوا التفاصيل لأنها مزعجة شوية
+
+710
+00:49:17,100 --> 00:49:21,540
+فازاريكتا لا تخلق مدالة عيب الأزملالية ولكنهم
+
+711
+00:49:21,540 --> 00:49:26,820
+يحفظونها من أن تكون محفوظة فازاريكتا شغلتها أنها
+
+712
+00:49:26,820 --> 00:49:30,560
+تمنع أن العيب الأزملالية تذهب من خلال أنه يسحب
+
+713
+00:49:30,560 --> 00:49:35,720
+المي أول بأول تحفظ مدالة عيب الأزملالية يمكن أن
+
+714
+00:49:35,720 --> 00:49:37,360
+يقوم بتحفظ مدالة عيب الأزملالية تحفظ مدالة عيب
+
+715
+00:49:37,360 --> 00:49:39,120
+الأزملالية تحفظ مدالة عيب الأزملالية تحفظ مدالة
+
+716
+00:49:39,120 --> 00:49:41,180
+عيب الأزملالية تحفظ مدلة عيب الأزملالية تحفظ مدلة
+
+717
+00:49:41,180 --> 00:49:47,160
+عيب الأزملالية تحفظ مدلة عيب2% من blood supply
+
+718
+00:49:47,160 --> 00:49:51,140
+يعني 2% من رين ال blood supply بتروح المضلة 98%
+
+719
+00:49:51,140 --> 00:49:55,920
+بتروح ال cortex يعني هنا ممكن ازيد ل 5% maximum
+
+720
+00:49:55,920 --> 00:50:04,020
+لكن لو انا عندي hypertension
+
+721
+00:50:04,020 --> 00:50:11,670
+شويةيعني الضغط زاد يعني ال efferent filtration ال
+
+722
+00:50:11,670 --> 00:50:15,490
+efferent الضغط زاد الbertier capillary زاد والجزء
+
+723
+00:50:15,490 --> 00:50:19,590
+اللي بنزل لل .. لانفاز عليك تاع اه الضغط زاد معناه
+
+724
+00:50:19,590 --> 00:50:22,150
+بيزيد ال blood flow في ال ايه؟ في المضلة وهذا
+
+725
+00:50:22,150 --> 00:50:28,750
+washing ال ايه؟ ال osmotic gradient اذا
+
+726
+00:50:28,750 --> 00:50:34,820
+certain vasodilatorsأو Hypertension ممكن يخربني
+
+727
+00:50:34,820 --> 00:50:41,000
+الـA أو الـOsmotic Gradient في المدلة ويخربني
+
+728
+00:50:41,000 --> 00:50:45,720
+الـability تبع البيولين لإكسيقراط البيولين المركزي
+
+729
+00:50:45,720 --> 00:50:48,820
+للبيولين
+
+730
+00:50:48,820 --> 00:50:51,160
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+731
+00:50:51,160 --> 00:50:51,200
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+732
+00:50:51,200 --> 00:50:51,260
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+733
+00:50:51,260 --> 00:50:52,500
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+734
+00:50:52,500 --> 00:50:53,020
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+735
+00:50:53,020 --> 00:50:54,100
+المركزي للبيولين المركزي للبيولين المركزي للبيولين
+
+736
+00:50:54,100 --> 00:50:58,150
+المركزي للبيولين المركزي للبيولين المركزThe kidney
+
+737
+00:50:58,150 --> 00:51:01,030
+can when needed execute highly concentrated urine
+
+738
+00:51:01,030 --> 00:51:05,110
+that contains little sodium اذا عندي انا الان
+
+739
+00:51:05,110 --> 00:51:10,630
+الورية صارت مش قصة انها بس مشاركة اقتصادية صارت
+
+740
+00:51:10,630 --> 00:51:14,050
+مشاركة اخرى انه انا ممكن بتطلع concentrated urine
+
+741
+00:51:14,050 --> 00:51:16,990
+لان انا محتاج الميه لكن برضه انا محتاج ال sodium
+
+742
+00:51:16,990 --> 00:51:23,810
+مابديش انا ايه اعمل reabsorption اعمل execution لل
+
+743
+00:51:23,810 --> 00:51:28,280
+sodium بدي كل ال sodium ااخده تمامفي الحالة هذه
+
+744
+00:51:28,280 --> 00:51:35,660
+انا بقدر اطلع concentrated urine فقط بيورية تمام؟
+
+745
+00:51:35,660 --> 00:51:40,420
+لذا اذا انا كنت محتاج الصوديوم و ممكن يكون عندى
+
+746
+00:51:40,420 --> 00:51:43,760
+انا concentrated urine طالع بس اليورية اللى فيه
+
+747
+00:51:43,760 --> 00:51:46,920
+ايه عملاله concentration مش محتاجين ان الصوديوم
+
+748
+00:51:46,920 --> 00:51:47,480
+اشارك
+
+749
+00:51:50,250 --> 00:51:54,210
+إذاً نحتاج أن نشتغل يورين عالي مركزي يحتوي على
+
+750
+00:51:54,210 --> 00:51:57,810
+قليل من الصوديوم الكلوريه الهيبر ازمولاريه لليورين
+
+751
+00:51:57,810 --> 00:52:02,970
+في هذه الحالات هي عبارة عالية عن مركزات أخرى
+
+752
+00:52:02,970 --> 00:52:10,570
+الصوديوم خاصة يورية و كرياتينيه محدث
+
+753
+00:52:10,570 --> 00:52:15,050
+محدث في حالة كهذه يعني لم أحتاج أن أخذ الصوديوم
+
+754
+00:52:15,050 --> 00:52:19,540
+كله و أطلع يورية في حالة الفي حالة dehydration
+
+755
+00:52:19,540 --> 00:52:23,280
+شديدة انا بدي الميه و بدي ال sodium بس بديش ايه؟
+
+756
+00:52:23,280 --> 00:52:26,320
+يوريا فانا بطلع concentrated urine صحيح لإن أخدت
+
+757
+00:52:26,320 --> 00:52:29,880
+كل الميه و أخدت كل ال sodium لكن بلقى ال
+
+758
+00:52:29,880 --> 00:52:32,340
+concentrated urine طالع ايه؟ باليوريا اذا في
+
+759
+00:52:32,340 --> 00:52:37,500
+اليوريا هذه عشان انا احافظ على الميه بدي hyper
+
+760
+00:52:37,500 --> 00:52:42,240
+osmotic interstitium مش كده؟ اذا لو كان عندي ال
+
+761
+00:52:42,240 --> 00:52:49,870
+interstitiumفي كمية صوديوم كبيرة معناها الصوديوم
+
+762
+00:52:49,870 --> 00:52:53,230
+اللى بيخش بالالدوستيرون مش هيقدر تخش لإنه بيخش by
+
+763
+00:52:53,230 --> 00:52:58,030
+diffusion مش كده الالدوستيرون بيشغل مع
+
+764
+00:52:58,030 --> 00:53:07,490
+الاندروجرمون لأكل عبدالسنفرن طبعا إذا كان في عندى
+
+765
+00:53:07,490 --> 00:53:08,810
+صوديوم
+
+766
+00:53:12,550 --> 00:53:16,650
+إذا انا ممكن أأكل كل ال Sodium اللي من ايه من ال
+
+767
+00:53:16,650 --> 00:53:21,170
+.. من ال tubule و اطلع فقط اللي هو اليوريا و اطلع
+
+768
+00:53:21,170 --> 00:53:24,390
+فقط اليوريا معناه انا بيصير عندي absorption of
+
+769
+00:53:24,390 --> 00:53:27,450
+Sodium كمية ضخمة ال interstitium بيضلش فيه
+
+770
+00:53:27,450 --> 00:53:31,050
+concentrated sodium عشان مايصيرش equilibrium بيصير
+
+771
+00:53:31,050 --> 00:53:34,950
+عندي إلى .. ينزل ل zero عشان كل ال Sodium اللي في
+
+772
+00:53:34,950 --> 00:53:39,780
+ال tubule يندفع ال interstitium و reabsorbedبالحظه
+
+773
+00:53:39,780 --> 00:53:43,080
+يعني ممكن انا اوصل انه كل العملية هاد يتصير
+
+774
+00:53:43,080 --> 00:53:47,580
+باليوريا وفي الاخر يطلع concentrated urea طب و ال
+
+775
+00:53:47,580 --> 00:53:50,580
+sodium ال sodium reabsorbed completely عشان يكونوا
+
+776
+00:53:50,580 --> 00:53:53,920
+reabsorbed completely لازم ال transition مايكنش في
+
+777
+00:53:53,920 --> 00:53:56,780
+ايه ال sodium concentration و الا هيصير اندي انا
+
+778
+00:53:56,780 --> 00:54:00,620
+equilibrium لحد ال sodium ماهو equilibrium واضح؟
+
+779
+00:54:00,620 --> 00:54:04,950
+اذا في حالاتمنلاقي انه مش التيران مشاركين واحد
+
+780
+00:54:04,950 --> 00:54:09,110
+منهم وممكن العكس يصير يعني الدقة في عمل الكلية هان
+
+781
+00:54:09,110 --> 00:54:14,010
+اكبر من الشرح تبعنا اكبر من الشرح تبعنا لإنه جدش
+
+782
+00:54:14,010 --> 00:54:16,730
+يطلع يوريا بزيادة او سوديوم بزيادة او سوديوم
+
+783
+00:54:16,730 --> 00:54:21,610
+بزيادة او يوريا اقل او ميه اكتر و سوديوم اقل او
+
+784
+00:54:21,610 --> 00:54:26,290
+سوديوم اكتر و ميه اقل very meticulous process
+
+785
+00:54:26,290 --> 00:54:31,220
+دقيقة جدابحيث انه في الآخر احنا بنشرح عشان تعرفوا
+
+786
+00:54:31,220 --> 00:54:34,320
+بعض ال procedures اللي بتصير عشان تستوعبوا كيف ال
+
+787
+00:54:34,320 --> 00:54:37,830
+control بيصير لكن ال control ايه؟very complicated
+
+788
+00:54:37,830 --> 00:54:40,810
+لأنه بتدخل هنا عيننا كمان other hormones و other
+
+789
+00:54:40,810 --> 00:54:46,870
+prostaglandins و vasodilators قصص كبيرة لكن واضح
+
+790
+00:54:46,870 --> 00:54:51,430
+من الكلام أنه في عندنا جهد كبير و تركيز كبير و عمل
+
+791
+00:54:51,430 --> 00:54:54,550
+كبير بتم في الكلية بحيث أنها تختار بالظبط اللي
+
+792
+00:54:54,550 --> 00:54:57,850
+بتهيأ حسب الأوامر اللي جاي من الجسم احنا بنكمل
+
+793
+00:54:57,850 --> 00:55:02,270
+بنفهم البنيا و هي عليها ال ايه عليها الباقي هذا
+
+794
+00:55:02,270 --> 00:55:03,090
+النقطة الأولانية
+
+795
+00:55:06,120 --> 00:55:08,800
+إنه ممكن افصل انا في ال concentration ما بين ال
+
+796
+00:55:08,800 --> 00:55:11,140
+sodium و اليوريا ممكن يطلع لي بس اليوريا لحالها
+
+797
+00:55:11,140 --> 00:55:13,900
+concentrated من غير ما يكون فيه Sodium او ممكن
+
+798
+00:55:13,900 --> 00:55:17,980
+العكس او في العكس بيكون mainly Sodium و جالي
+
+799
+00:55:17,980 --> 00:55:22,660
+اليورياالنقطة التانية اللي بدنا نتكلم عنها large
+
+800
+00:55:22,660 --> 00:55:25,720
+quantities of diluted urine can be executed
+
+801
+00:55:25,720 --> 00:55:29,280
+without increasing the execution of sodium منفصلين
+
+802
+00:55:29,280 --> 00:55:32,620
+يعني لا يعني ال volume الكبيرة من ال urine انه في
+
+803
+00:55:32,620 --> 00:55:37,700
+عندى كمان sodium كتير لأ ممكن يكون large volume of
+
+804
+00:55:37,700 --> 00:55:42,920
+diluted urine without
+
+805
+00:55:42,920 --> 00:55:46,420
+increasing the execution of sodium بمعنى انه لما
+
+806
+00:55:46,420 --> 00:55:50,710
+بزيد البول ال execution تبعهالـ concentration of
+
+807
+00:55:50,710 --> 00:55:55,290
+sodium في الـ bowl بجليل لأنه بتطلع كمية معينة
+
+808
+00:55:55,290 --> 00:55:59,090
+بتطلع بلاجة كمية طلعت ان كان بحاشب كبير bowl ولا
+
+809
+00:55:59,090 --> 00:56:03,970
+حاشب جليل bowl إذا في هذه عملية execution of
+
+810
+00:56:03,970 --> 00:56:08,270
+solutes منفصلة تماما عن الـ A إذا هي هي هتطلع
+
+811
+00:56:08,270 --> 00:56:11,270
+وكمية الميه اللي بدنا هيه هتطلع فبيقدر إلى أنه
+
+812
+00:56:11,270 --> 00:56:14,110
+الميه بتطلع ال sodium concentration عالي أو واطي
+
+813
+00:56:14,900 --> 00:56:17,700
+مالوش علاقة ان ال volume زاد يعني ال .. ال .. ال
+
+814
+00:56:17,700 --> 00:56:20,540
+.. ال .. ال .. ال water و ال sodium زاد لأ زي ما
+
+815
+00:56:20,540 --> 00:56:24,320
+قلنا في المثال الأولاني لما شربنا لتر ميه لجينا
+
+816
+00:56:24,320 --> 00:56:26,940
+الميه كترة تلاكظ ان ال sodium excretion ماتغيرش
+
+817
+00:56:26,940 --> 00:56:31,780
+لإن ال concentration تبعه هبط تمام فال
+
+818
+00:56:31,780 --> 00:56:34,600
+concentration هبط و ال volume of urine زاد فظهر
+
+819
+00:56:34,600 --> 00:56:41,200
+كمية ال excreted sodium هو هو واضح؟ طيب
+
+820
+00:56:41,200 --> 00:56:47,370
+quantifying ingredientsconcentration and dilution
+
+821
+00:56:47,370 --> 00:56:58,350
+نعمل عملية حسابية نشرح
+
+822
+00:56:58,350 --> 00:57:05,750
+الجزء الأخير هنا عملية osmolality هذي أو ال urine
+
+823
+00:57:05,750 --> 00:57:11,030
+concentration ممكن نديله عملية قياسية ال
+
+824
+00:57:11,030 --> 00:57:15,040
+quantifying of urine concentrationand dilution
+
+825
+00:57:15,040 --> 00:57:18,340
+لجينا انه احنا لما اتكلمنا عن ال clearance في يوم
+
+826
+00:57:18,340 --> 00:57:21,700
+من الأيام مش هيك قلنا ال clearance تبع المادة
+
+827
+00:57:21,700 --> 00:57:27,820
+المعينة هو جديش انا بقدر انظف بلازمة من مادة معينة
+
+828
+00:57:27,820 --> 00:57:32,160
+وقلنا الحسبة تبعتها سهلة اه ال concentration في ال
+
+829
+00:57:32,160 --> 00:57:35,240
+volume تبع ال urine من جسمه على ال concentration
+
+830
+00:57:35,240 --> 00:57:39,400
+في البلازمة بيطلع اكام سانت بلازمة نظيف بظبط طب
+
+831
+00:57:39,400 --> 00:57:43,320
+انا ممكن اعمل clearance of osmoles clearance of
+
+832
+00:57:43,320 --> 00:57:52,110
+ايه؟و ازمولز جداش انا طلعت ازمولز بقول انا ازمولية
+
+833
+00:57:52,110 --> 00:57:58,470
+لليورين في ال volume على ازمولية لبلازمة مش هيك
+
+834
+00:57:58,470 --> 00:58:06,250
+مقدر اقول انا جداش عملت نظفتبلازمة من كل الصليوط
+
+835
+00:58:06,250 --> 00:58:09,750
+لان كل الاصموتيكالي اكتف صليوط انا بتكلم عنها جاعد
+
+836
+00:58:09,750 --> 00:58:13,770
+مضفتها منها كلها اذا ماجدش اصموال طلع هدول
+
+837
+00:58:13,770 --> 00:58:17,570
+الاصموال موجودة في اكم صنطي اكمل اذا حاجة اسمة
+
+838
+00:58:17,570 --> 00:58:23,610
+clearance of ايه of اصموال طيب اذا الان لما يكون
+
+839
+00:58:23,610 --> 00:58:32,720
+عندى تركيز تركيز ال ball يساوي تركيز ال plasmaيعني
+
+840
+00:58:32,720 --> 00:58:37,040
+ازمولز هان ازمولالتي هان و ازمولالتي هان واحد بظبط
+
+841
+00:58:37,040 --> 00:58:42,820
+معناه ال clearance of ازمولز هذا يسوى ال urine
+
+842
+00:58:42,820 --> 00:58:47,120
+volume مش كده لإن ال urine volume في ال
+
+843
+00:58:47,120 --> 00:58:49,120
+concentration على ال concentration بروح ال
+
+844
+00:58:49,120 --> 00:58:53,100
+concentration هذا مع بعض لإنه متساوين بيصير ال ايه
+
+845
+00:58:53,100 --> 00:58:56,360
+ال clearance of ازمولز يسوى ايه ال urine volume
+
+846
+00:58:56,360 --> 00:59:03,670
+طيب لو كان انا عندي diluted urineتمام؟ يعني عندي
+
+847
+00:59:03,670 --> 00:59:07,270
+diluted urine كمية ال ozone moles اللي موجودة فيه
+
+848
+00:59:07,270 --> 00:59:13,170
+أقل بالنسبة للحجم تمام؟ عندي حجم ميه كتير لكن عندي
+
+849
+00:59:13,170 --> 00:59:17,410
+ozone moles جليلة اقول volume في ال concentration
+
+850
+00:59:17,410 --> 00:59:20,990
+لل urine diluted على ال concentration في ال plasma
+
+851
+00:59:20,990 --> 00:59:28,150
+ا ا اعلى مش هيك؟ في الحالة هذه انا بتطلع بلاقي انه
+
+852
+00:59:28,150 --> 00:59:36,450
+ايه بادرب ال volumeفي بضرب ال volume في نسبة أجل
+
+853
+00:59:36,450 --> 00:59:39,410
+من واحد مش كده لإن ال concentration في ال urine
+
+854
+00:59:39,410 --> 00:59:42,770
+diluted و ال concentration في ال plasma أعلى إذا
+
+855
+00:59:42,770 --> 00:59:45,990
+لما أضرب أي حجم في أجل من واحد معناه الكمية تطلع
+
+856
+00:59:45,990 --> 00:59:50,750
+إيه تطلع جليلة مش هيك إذا ال solutes هنا في الحالة
+
+857
+00:59:50,750 --> 00:59:55,210
+هذه ال solutes ال volume ال clearance of solutes
+
+858
+00:59:55,210 --> 00:59:58,790
+ال clearance of esmoles طلع أجل من ال urine إيه
+
+859
+00:59:59,180 --> 01:00:03,100
+volume يعني احنا ضربنا في ال urine volume في كسر،
+
+860
+01:00:03,100 --> 01:00:08,000
+مصبوط؟ فإذا ال volume الأساسي أكبر من ال volume
+
+861
+01:00:08,000 --> 01:00:12,720
+اللي مانضره في كسر، إذا صار في عندي جزء من الميه
+
+862
+01:00:12,720 --> 01:00:17,700
+executed من غير ال .. من غير ال osmoles، مش هيك؟
+
+863
+01:00:17,700 --> 01:00:22,020
+إذا انا .. إذا ال clearance of osmoles يمثل الحجم
+
+864
+01:00:22,020 --> 01:00:26,120
+اللي من ال plasma اللي موجود فيه دول ال osmoles،
+
+865
+01:00:26,120 --> 01:00:29,790
+لكن لما أنا طالع ألاقي حالي ماخدclearance of
+
+866
+01:00:29,790 --> 01:00:35,210
+smalls اتنين سانت اتنين مل وانا بتطلع بول تلاتة مل
+
+867
+01:00:35,210 --> 01:00:38,630
+معناها في عندى سانت تطلع من غير ايه من غير ال
+
+868
+01:00:38,630 --> 01:00:45,610
+solutes مش هيك سمناها free water clearance free
+
+869
+01:00:45,610 --> 01:00:48,630
+water هذا ال free water يعني water عندى cleared
+
+870
+01:00:48,630 --> 01:00:53,430
+طلع من غير ال solutes اذا بنحسب احنا الكمية اللى
+
+871
+01:00:53,430 --> 01:00:57,850
+لازمة تطلع على ال solutes تطلع معاها وفي عندى جزء
+
+872
+01:00:57,850 --> 01:01:03,680
+مياهطلع زيادة، اذا هذا طلعت حرة من غير الـ free
+
+873
+01:01:03,680 --> 01:01:08,020
+water الـ free water هذا لما يكون عندى انا .. اذا
+
+874
+01:01:08,020 --> 01:01:13,040
+كيف بحسبوا الـ free water؟ بحسب ان ال volume تبع
+
+875
+01:01:13,040 --> 01:01:16,660
+ال urine ناجس ال what؟ ال clearance of osmores،
+
+876
+01:01:16,660 --> 01:01:20,640
+كمان؟ اذا والله انا بطلع ده ال urine بطلع كمية من
+
+877
+01:01:20,640 --> 01:01:26,320
+ال pore من الفريق كمية urine without osmores، مش
+
+878
+01:01:26,320 --> 01:01:30,370
+هيك؟إذا نسميه free water excretion بوسيطف هذا
+
+879
+01:01:30,370 --> 01:01:35,390
+تمام؟ إذا أنا طلعت diluted urine لما ال free water
+
+880
+01:01:35,390 --> 01:01:38,530
+يزيد معناه أنا طلعت diluted urine لإن ال osmosis
+
+881
+01:01:38,530 --> 01:01:41,650
+حسبنا هوالذي أنا معناه عملت dilution طب لما أطلع
+
+882
+01:01:41,650 --> 01:01:45,290
+concentrated urine بحسبها بلاج لأ ال concentrated
+
+883
+01:01:45,290 --> 01:01:49,850
+urine أكتر من ال plasma فأنا بضرب جاعة ال volume
+
+884
+01:01:49,850 --> 01:01:55,770
+في كسرأكبر فبيقدر الكمية أكبر معناها بيطلع ال free
+
+885
+01:01:55,770 --> 01:02:02,770
+water جداش negative مش هي لما أقصد ال volume من ..
+
+886
+01:02:02,770 --> 01:02:12,470
+إذا إذا طلعت ال water ال free water إذا إذا طلعت
+
+887
+01:02:12,470 --> 01:02:20,080
+ال free water positive معناها أنا عنديdiluted
+
+888
+01:02:20,080 --> 01:02:23,700
+urine و اذا طالع نيجاتيف يعني انتي خصها diluted
+
+889
+01:02:23,700 --> 01:02:26,420
+urine، واضح؟ اذا ال free .. ال free water هذا
+
+890
+01:02:26,420 --> 01:02:29,380
+مافيش حاجة اسمها free water هو، لكنه اشي قياسي
+
+891
+01:02:29,380 --> 01:02:33,040
+احنا بنعمله، قولنا لو حسبنا ال osmoles هذه كدهش
+
+892
+01:02:33,040 --> 01:02:35,400
+بتكون في milliliter .. في .. في milliliter plasma
+
+893
+01:02:35,950 --> 01:02:39,930
+طب و لو يورين طلع أكتر معناها في طلع جزئية من ال
+
+894
+01:02:39,930 --> 01:02:42,370
+.. من ال water طلعت من غير صوديوم ولا من غير شسمه
+
+895
+01:02:42,370 --> 01:02:46,390
+يعني كان قدرته على يعمل dilution و لو العكس بيقول
+
+896
+01:02:46,390 --> 01:03:01,110
+اه قدرته على انه يعمل concentration disorders
+
+897
+01:03:01,110 --> 01:03:03,170
+in urine concentration
+
+898
+01:03:08,650 --> 01:03:12,870
+الان ال quantitative ability اتكلمنا عنها و
+
+899
+01:03:12,870 --> 01:03:16,290
+فهمناها اعتقد اننا فهمناها فهمناها فهمناها فانا
+
+900
+01:03:16,290 --> 01:03:21,010
+مين الها السؤال جهنم اطلع منها مافيش مانع اسأليها
+
+901
+01:03:21,010 --> 01:03:27,640
+السؤال واضح؟ طيبأحنا قلنا للمسؤول عن عملية ال
+
+902
+01:03:27,640 --> 01:03:30,740
+concentration of urine لازم يكون عندي حاجتين عندي
+
+903
+01:03:30,740 --> 01:03:33,500
+antidiotic hormone مظبوط وعندي osmotic gradient
+
+904
+01:03:33,500 --> 01:03:37,940
+مظبوط اتكلمنا احنا بالتفصيل عن الجهتين لكن هنا
+
+905
+01:03:37,940 --> 01:03:43,040
+بهمنا انه نجيب سيرة بعض الأشياء المهمة بما يتعلق
+
+906
+01:03:43,040 --> 01:03:47,360
+بال antidiotic hormone ال antidiotic hormone هذا
+
+907
+01:03:47,360 --> 01:03:51,180
+hormone بيطلع من البصير بتويترين هندرسه الفصل اللي
+
+908
+01:03:51,180 --> 01:03:54,770
+جاي ان شاء اللهيعني يدرس ال .. بتويتري و التفاصيل
+
+909
+01:03:54,770 --> 01:03:57,570
+تبعتها الفصل جاها في ال endocrine لكن ال antidote
+
+910
+01:03:57,570 --> 01:04:02,390
+hormone هذا إذا صار عندى إشكال trauma something
+
+911
+01:04:02,390 --> 01:04:05,150
+إشي أثر على البصير بتويتري ممكن ال antidote
+
+912
+01:04:05,150 --> 01:04:08,810
+hormone بطل يطلح فإذا بطل يطلع ال antidote hormone
+
+913
+01:04:08,810 --> 01:04:12,710
+حسين عندى diuresis بقول كتير إن هو بمنع ال
+
+914
+01:04:12,710 --> 01:04:17,480
+diuresis بظبط ال osmolality حسب حاجة الجسملكن هو
+
+915
+01:04:17,480 --> 01:04:21,880
+بطل يبقى موجود فصار ال fluid اللى بيصل ال distal
+
+916
+01:04:21,880 --> 01:04:28,300
+tubule يظل ايه؟ يظل كما هو، ليش؟ لأن اندرويد
+
+917
+01:04:28,300 --> 01:04:31,340
+الغرمون اللى بده ياخد المميزة اللى محتاجينها مش
+
+918
+01:04:31,340 --> 01:04:36,120
+موجود، تمام؟ اذا فى عندى كمية كبيرة من ال bowl
+
+919
+01:04:36,120 --> 01:04:40,940
+بتطلع شبيهة باللي عنده diabetes melatusبس الفرق
+
+920
+01:04:40,940 --> 01:04:44,020
+بين هدا و هدا احنا فكرناها diabetes و اتفحصناها
+
+921
+01:04:44,020 --> 01:04:48,540
+لاجئنا مافيش سُكر فقلنا هدا diabetes insipidus من
+
+922
+01:04:48,540 --> 01:04:53,040
+هنا اجى اسمه زى السُكري لكنه كاذب شبه السُكر فإنه
+
+923
+01:04:53,040 --> 01:04:56,780
+بيعطش و بنشفريق و بتبول كتير هذه مواصفات ايه
+
+924
+01:04:56,780 --> 01:05:01,900
+السُكر انه بتبول كتير و بيحس انه ايه عنده جفاف في
+
+925
+01:05:01,900 --> 01:05:05,560
+الحلق و بيضل يشرب ميه كتير عشان يضيع هذا الاحساس
+
+926
+01:05:05,560 --> 01:05:09,440
+بالجفاففهذا المرض السكري ال بول السكر احنا عارفينه
+
+927
+01:05:09,440 --> 01:05:13,020
+لكن هذا بول كتير و عامل نفس المواصفات لكن مافيش
+
+928
+01:05:13,020 --> 01:05:17,200
+فيه سكر لذلك سمنها diabetes insipidus ال diabetes
+
+929
+01:05:17,200 --> 01:05:21,260
+insipidus هذا يقولنا في منها نوعين في عندنا نوع
+
+930
+01:05:21,260 --> 01:05:23,760
+central diabetes insipidus يعني إصابة من أساسها
+
+931
+01:05:23,760 --> 01:05:27,430
+جايةفي الـ Pituitary gland في المركزية في مركزية
+
+932
+01:05:27,430 --> 01:05:30,990
+الـ Antidiotic hormone تمام؟ وممكن يكونوا في نوع
+
+933
+01:05:30,990 --> 01:05:34,290
+مش Central peripheral يعني المشكلة في الكيلية مش
+
+934
+01:05:34,290 --> 01:05:37,010
+المشكلة في ال Antidiotic hormone طبيعي لكن الكيلية
+
+935
+01:05:37,010 --> 01:05:40,030
+مش رادية تستجيب لل Antidiotic hormone نفروجينيك
+
+936
+01:05:40,030 --> 01:05:44,910
+ديابتس انسبيدس اذا ال diabetes insipidus عندنا في
+
+937
+01:05:44,910 --> 01:05:49,430
+نوع منه Central type ونفروجينيك type النفروجينيك
+
+938
+01:05:49,430 --> 01:05:56,040
+type يعني عندها إيش هيكون؟يعني ال response of the
+
+939
+01:05:56,040 --> 01:05:58,040
+antidiarrheal hormone on the kidney is abolished
+
+940
+01:05:58,040 --> 01:06:03,800
+مش موجود بسبب انه عندي ال .. ال receptors الموجودة
+
+941
+01:06:03,800 --> 01:06:06,280
+مثلا مرضى بيكون فيه مشكلة في ال receptors ال V2
+
+942
+01:06:06,280 --> 01:06:09,580
+ريسبتورز اتكلمنا عنها اللي في ال distal tubule في
+
+943
+01:06:09,580 --> 01:06:15,600
+كل الجسم ممكن تكون هي ايه المشكلة فيها بتأدي إلى
+
+944
+01:06:15,600 --> 01:06:19,800
+انه ال antidiarrheal hormone اذا في failure of the
+
+945
+01:06:19,800 --> 01:06:24,920
+counterعندنا الجزيرة بتخصنا عن failure of the
+
+946
+01:06:24,920 --> 01:06:28,480
+distal and collecting tubules and collecting ducts
+
+947
+01:06:28,480 --> 01:06:31,620
+to respond to another diuretic hormone وهذا ممكن
+
+948
+01:06:31,620 --> 01:06:35,660
+يكون response من أي مكان او بيكون عندى انا ممكن
+
+949
+01:06:35,660 --> 01:06:40,040
+انا اطلع كمية كبيرة من ال ball تماميكون عندى
+
+950
+01:06:40,040 --> 01:06:44,960
+القدرة على تركيز ال bone راحة هدى وين موجودة
+
+951
+01:06:44,960 --> 01:06:47,480
+القدرة على تركيز ال bone؟ في المضالة يعني وين من
+
+952
+01:06:47,480 --> 01:06:50,740
+في المضالة؟ في التكأس ending limb mainly إذا ممكن
+
+953
+01:06:50,740 --> 01:06:53,260
+يكون عندى خلل في التكأس ending limb يتقدي إلى
+
+954
+01:06:53,260 --> 01:06:56,720
+nephrogenic diabetes insipidus أو ممكن يكون ال
+
+955
+01:06:56,720 --> 01:06:59,620
+diabetes insipidus سببه برضه no response to
+
+956
+01:06:59,620 --> 01:07:02,020
+antidepressure hormone إذا عندى ال diabetes
+
+957
+01:07:02,020 --> 01:07:05,560
+insipidus ممكن تكون central وتكون peripheral لكن
+
+958
+01:07:05,560 --> 01:07:07,780
+في ال central و ال peripheral ممكن يكون سببها
+
+959
+01:07:07,780 --> 01:07:11,070
+antidepressure hormoneوممكن يكون الـ Mephrogenic
+
+960
+01:07:11,070 --> 01:07:15,350
+سببها لأ مش أندريدو كرموان، سببها إيه؟ Failure of
+
+961
+01:07:15,350 --> 01:07:18,570
+the concentrating mechanism in the .. in the .. in
+
+962
+01:07:18,570 --> 01:07:22,570
+the .. in the thick ascending limb إذا الـ failure
+
+963
+01:07:22,570 --> 01:07:25,570
+of the counter current mechanism to form a hyper
+
+964
+01:07:25,570 --> 01:07:28,810
+osmotic and remodellary interstitium لإن احنا قلنا
+
+965
+01:07:28,810 --> 01:07:31,430
+الـ concentration أساسه، interstitium مظبوط و
+
+966
+01:07:31,430 --> 01:07:34,190
+أندريدو كرموان مظبوطفممكن يطلع كمية كبيرة من
+
+967
+01:07:34,190 --> 01:07:36,970
+البولو لو مافيش تركيز إذا ال intersection مش مظبوط
+
+968
+01:07:36,970 --> 01:07:40,290
+مالكاونتر كارنت مالتيبليكيش تكلمنا عنه طاربا أو
+
+969
+01:07:40,290 --> 01:07:43,710
+يكون إيه ال Antidermal hormone مش موجود هذا مستعمل
+
+970
+01:07:43,710 --> 01:07:47,910
+إفريجينيك لإنه في أن نوع تاني central اللي هو إيه
+
+971
+01:07:47,910 --> 01:07:54,380
+لما يكون عندي مشكلة في الطيب هيك ممكن احنا خلصنا
+
+972
+01:07:54,380 --> 01:07:58,560
+المحاضرة هذه و ال chapter هذه حقيقة لإن بجيت ال
+
+973
+01:07:58,560 --> 01:08:02,600
+chapter هذا تحصيل حاصل يعني عبارة عن أشياء تعاد
+
+974
+01:08:02,600 --> 01:08:09,070
+بطريقة ..يمكن إذا كان معانا فرق أكتر أشرحلكوا ال
+
+975
+01:08:09,070 --> 01:08:11,870
+third mechanism و الكلام هذا بس في ال manager هذا
+
+976
+01:08:11,870 --> 01:08:16,890
+بس في أشياء كتيرة هذي مش هنشرحها لإنه في بعدين كده
+
+977
+01:08:16,890 --> 01:08:21,850
+بصير عيب ال .. عيب ال .. ال guidon أنه ممكن يصير
+
+978
+01:08:21,850 --> 01:08:26,070
+بس يجمع أشياء و كلها انشرحت في مناطق أخرى مش معقول
+
+979
+01:08:26,070 --> 01:08:30,030
+أنه يضيعلها محاضرة كاملة للتجميع بس إن ال third
+
+980
+01:08:30,030 --> 01:08:33,630
+mechanism احتمال أشرحه تمام بيضال عيني هنا في
+
+981
+01:08:33,630 --> 01:08:38,710
+الغالب محاضرتين أو تلاتةلأ ال .. ال kidney تسيبليش
+
+982
+01:08:38,710 --> 01:08:43,390
+ان ممكن خلصناها تمام؟ ليش؟ لإنه في فاصل ال
+
+983
+01:08:43,390 --> 01:08:46,230
+potassium و ال magnesium regulation ده مش هتكلم
+
+984
+01:08:46,230 --> 01:08:51,130
+عنه لإنه موزع بين مواد أخرى okay من هات؟ مين اللي
+
+985
+01:08:51,130 --> 01:08:51,770
+سؤال؟
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e0d88cf64d997c35056c4694df5cd4ef3323037f
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_postprocess.srt
@@ -0,0 +1,2164 @@
+1
+00:00:05,200 --> 00:00:10,600
+في أنواع منها بتنتهي بسرعة وبنرجع طبيعي وفي أنواع
+
+2
+00:00:10,600 --> 00:00:14,380
+progressive هي دخلة بدنا فيها بس لا تنتهي
+
+3
+00:00:14,380 --> 00:00:18,080
+autoimmune disease بيظل يخرب ويخرب ويخرب ويخرب كده
+
+4
+00:00:18,080 --> 00:00:23,320
+لكن في أنواع لأ هذه بتقعد فترة بسيطة وبعدين self
+
+5
+00:00:23,320 --> 00:00:27,200
+regenerative وبترجع طبيعي إذا عندي intrarenal
+
+6
+00:00:27,200 --> 00:00:33,390
+acute renal failurecaused by glomerulonephritis في
+
+7
+00:00:33,390 --> 00:00:36,170
+الـ glomerulus أو tubular necrosis as a cause of
+
+8
+00:00:36,170 --> 00:00:38,950
+acute renal failure يعني إذا إشي بدرب ال
+
+9
+00:00:38,950 --> 00:00:43,470
+glomerulus أو ال tubule تمام بيدخلني في acute
+
+10
+00:00:43,470 --> 00:00:46,210
+renal failure ممكن يدخلني في chronic renal failure
+
+11
+00:00:46,210 --> 00:00:52,930
+واضح؟ عندي post renal causes abnormalities of the
+
+12
+00:00:52,930 --> 00:01:02,390
+lower urinary tract تمام؟ هدول إيه؟ في الغالبعندي
+
+13
+00:01:02,390 --> 00:01:09,050
+مشكلة في التوصيل يعني عندي مشكلة مشهورة احنا بين
+
+14
+00:01:09,050 --> 00:01:13,610
+الrenal pelvis و الureter تمام ان يكون في عندي زي
+
+15
+00:01:13,610 --> 00:01:18,450
+الakalasia or the esophagus إذا فاكرين بتعرفوها في
+
+16
+00:01:18,450 --> 00:01:24,370
+جزئية اتصالمفقودة الـ nervous connection ممكن تكون
+
+17
+00:01:24,370 --> 00:01:28,370
+مفقودة و تقدي الى ان البلدار ال .. ال .. ال .. ال
+
+18
+00:01:28,370 --> 00:01:31,770
+.. ال .. بلوز of the kidney is full and no urine
+
+19
+00:01:31,770 --> 00:01:35,270
+can be transmitted to the ureter ليش؟ لأن
+
+20
+00:01:35,270 --> 00:01:40,810
+البريستالز لسه وقفت هان بي بيلفك يعني بي يو ال
+
+21
+00:01:40,810 --> 00:01:45,770
+ureter بي يو جي بيسميها ال بيلف يوريتريك جونكشن
+
+22
+00:01:46,290 --> 00:01:49,770
+abnormality او disease او كده مشهورة وكتيرة هذه
+
+23
+00:01:49,770 --> 00:01:53,690
+انه هان يبقى في عنده مشكلة الكلش هجزا الفل و ال
+
+24
+00:01:53,690 --> 00:01:57,750
+blood زي الفل لكن هان يتوقف ال ايه فبيزيد الضغط و
+
+25
+00:01:57,750 --> 00:02:01,050
+بيبدأ يخرب يخرب يخرب لإن الضغط اللي زاد في داخل ال
+
+26
+00:02:01,050 --> 00:02:05,350
+pelvis بينعكس ع مين؟ ع ال kidney tissue انها اسلها
+
+27
+00:02:05,350 --> 00:02:09,490
+dilatation و تخريب ببدأ بتخريب المضلة و بينتهي
+
+28
+00:02:09,490 --> 00:02:14,390
+بتخريب كل ال inferenceإذا عندي .. طبعا ممكن يكون
+
+29
+00:02:14,390 --> 00:02:19,010
+عندي king في ال ureter بعض الناس عندهم الكيلية
+
+30
+00:02:19,010 --> 00:02:24,810
+معلجة بطريقة drop kidney .. dropped kidney ..
+
+31
+00:02:24,810 --> 00:02:28,570
+dropping فيها لإن ال tissues اللي حواليها حملها ال
+
+32
+00:02:28,570 --> 00:02:34,180
+fatty tissue دي ساحت من ضعف من عدم أكل من ..أه
+
+33
+00:02:34,180 --> 00:02:37,220
+ودرجة ان المعدة ال .. ال .. ال .. ال .. ال .. ال
+
+34
+00:02:37,220 --> 00:02:40,800
+.. ال kid سجطت من محلها فعملت kinking وين؟ في
+
+35
+00:02:40,800 --> 00:02:43,400
+اليوريتا فبنعمل obstruction mechanical obstruction
+
+36
+00:02:43,400 --> 00:02:48,040
+بس وسببه مش فيش obstruction لكن هو الحبل الطويل
+
+37
+00:02:48,040 --> 00:02:54,770
+انت وانت عاجزته فال .. ال ..و ممكن يكون عندي حصاوي
+
+38
+00:02:54,770 --> 00:02:59,370
+مزمنة مسكرة ureter تؤدي إلى انه back pressure و
+
+39
+00:02:59,370 --> 00:03:03,230
+nephrosis و او اخر و ممكن يكون اشي تاني فيبروزس
+
+40
+00:03:03,230 --> 00:03:08,550
+جاي من مكان اخر المهم في post-renal يعني مشاكل
+
+41
+00:03:08,550 --> 00:03:13,130
+تبدأ من ال ureter و نازل او من ال pelvis of the
+
+42
+00:03:13,130 --> 00:03:15,830
+kidney مش من التشوذ نفسها من ال pelvis of the
+
+43
+00:03:15,830 --> 00:03:21,470
+kidney تمام؟ ال .. اذا في عندي acute renal failure
+
+44
+00:03:22,350 --> 00:03:25,350
+الو pre-renal causes و intra-renal causes و post
+
+45
+00:03:25,350 --> 00:03:28,710
+-renal causes ال causes كتيرة كتيرة و التفاصيل
+
+46
+00:03:28,710 --> 00:03:31,730
+كتير حتدوسها ان شاء الله في البطنة بس بهمني ان انا
+
+47
+00:03:31,730 --> 00:03:35,310
+تعرف التوزيع هذي كويس؟ الان لو صار acute-renal
+
+48
+00:03:35,310 --> 00:03:39,750
+الفاعل يعني ايش بتتوقع يصير؟ كل ال functions اللي
+
+49
+00:03:39,750 --> 00:03:43,670
+اتكلمنا عنها مش هتتصلح تمام؟ اذا في عندي waste
+
+50
+00:03:43,670 --> 00:03:48,390
+product مش هتطلع و
+
+51
+00:03:48,390 --> 00:03:55,030
+عندي electrolytes مش هتتصلحو ال acid base و ال
+
+52
+00:03:55,030 --> 00:03:58,450
+potassium مع ال ether as قلنا و بالاضافة لأنه
+
+53
+00:03:58,450 --> 00:04:08,340
+vitamin Dاللي مش هتكون vitamin D3 بالإضافة للأخيات
+
+54
+00:04:08,340 --> 00:04:12,840
+الطبالتين إذا في عندي مجموعة من الأشياء مختصة بال
+
+55
+00:04:12,840 --> 00:04:16,080
+kidney function proper و ال hormones اللي هي أساس
+
+56
+00:04:16,080 --> 00:04:19,600
+ال kidney بتطلعها كل هذا مش إيه مش هيشتغل يتعطل
+
+57
+00:04:19,600 --> 00:04:23,880
+تمام؟ نتخيل الوضع طبعا احنا قبل كده أصلا ولا ..
+
+58
+00:04:23,880 --> 00:04:28,000
+نتخيل و هيك نشوف التسلسل الدرامي اللي هيحصل لو صار
+
+59
+00:04:28,000 --> 00:04:32,520
+انه عندي acute renal failureA major physiologic
+
+60
+00:04:32,520 --> 00:04:36,280
+effect of acute renal failure is retention of
+
+61
+00:04:36,280 --> 00:04:42,600
+water with products and electrolytes ممكن أضيف
+
+62
+00:04:42,600 --> 00:04:45,520
+عليها جملة أنها and and and failure of production
+
+63
+00:04:45,520 --> 00:04:50,140
+of D3 and إلكروبيوتين بيصير جملة كاملة على المسألة
+
+64
+00:04:50,140 --> 00:04:54,780
+هنا ذكر هذه وذكر تفاصيلها و بعدين ذكر ال D3 و
+
+65
+00:04:54,780 --> 00:04:56,120
+الهيموبيوتين في الآخر
+
+66
+00:04:59,070 --> 00:05:03,410
+risk and lead to water and salt overload اللي
+
+67
+00:05:03,410 --> 00:05:07,390
+باخده مقدرش اطلع، بيصير عندي ايه؟ water ازيادة و
+
+68
+00:05:07,390 --> 00:05:09,910
+electrolyte overload ازيادة، بيقدرلى hypertension
+
+69
+00:05:09,910 --> 00:05:12,950
+و hypertension و مصايبة كتيرة، على الكلية و على
+
+70
+00:05:12,950 --> 00:05:18,170
+غير الكلية، تمام؟ اذا بيعمللي ال overload بيعمللي
+
+71
+00:05:18,170 --> 00:05:22,710
+اديمة و hypertension، اديمة everywhere، و هذه
+
+72
+00:05:22,710 --> 00:05:27,250
+خطيرةبالذات عرقتين انا بدي هوا و المناطق هذه
+
+73
+00:05:27,250 --> 00:05:30,110
+القديمة بيصيح في المنطقة فيه هوا بتتعب على طول
+
+74
+00:05:30,110 --> 00:05:34,150
+بيحس اللي عنده generalized قديمة generalized أنا
+
+75
+00:05:34,150 --> 00:05:38,030
+ساركة بيقولها زي ال generalized قديمة طفت الميه في
+
+76
+00:05:38,030 --> 00:05:41,670
+كل مكان حتى ال potential spaces اللي قولنا عليهم
+
+77
+00:05:41,670 --> 00:05:46,310
+البلورة و الماء كلها انتلت و لما تصل لبلورة و
+
+78
+00:05:46,310 --> 00:05:50,730
+تلاقي جنبها ال alveoli فاضية تبدأ ايه تهجم عليها
+
+79
+00:05:50,730 --> 00:05:54,530
+تعبي فيها شوية شويةفإدّيهم الجنازة إدّيهم
+
+80
+00:05:54,530 --> 00:05:58,430
+hypertension هذا من ال overload Excessive
+
+81
+00:05:58,430 --> 00:06:01,130
+retention of potassium احنا قولنا البوتاسيوم لما
+
+82
+00:06:01,130 --> 00:06:04,850
+ربنا خرج الكيلية ربنا عارف احنا إيش بناكل وإن في
+
+83
+00:06:04,850 --> 00:06:07,410
+بوتاسيوم زيادة دايما فدايما في عندنا secretion of
+
+84
+00:06:07,410 --> 00:06:10,270
+potassium برا برا برا لإن ال intracellular
+
+85
+00:06:10,270 --> 00:06:13,030
+البوتاسيوم العالي اللي احنا بناكله هذا مش لازمنا
+
+86
+00:06:13,030 --> 00:06:16,990
+احنا تمام ف excessive retention of potassium
+
+87
+00:06:16,990 --> 00:06:23,930
+howeverهو أكثر أضرار أكتر لشباب بخطأ الأكيوترينية
+
+88
+00:06:23,930 --> 00:06:28,330
+لأن أزمة بلزمة بوتاسيوم بكسنتراشين بكسنتراشين
+
+89
+00:06:28,330 --> 00:06:29,350
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+90
+00:06:29,350 --> 00:06:32,530
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+91
+00:06:32,530 --> 00:06:33,230
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+92
+00:06:33,230 --> 00:06:33,390
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+93
+00:06:33,390 --> 00:06:35,090
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+94
+00:06:35,090 --> 00:06:42,630
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتر
+
+95
+00:06:43,820 --> 00:06:49,080
+بسبب أن الكدنز لا يستطيع إكسيكليز حيدروجين أيونات
+
+96
+00:06:49,080 --> 00:06:54,440
+كافية ندخل في ايه؟ طبعا احنا الأكل طبيعي
+
+97
+00:06:54,440 --> 00:06:58,760
+متابوريزمنا بيطلعلي أساتز أساتز ماطلع تخلصنا منها
+
+98
+00:06:58,760 --> 00:07:03,680
+تمام؟ هنخش في hyper-acidemia مش كده؟ هنخش في hypo
+
+99
+00:07:05,970 --> 00:07:13,170
+سوف ندخل في الـ metabolic acidosis وهذا يساعد
+
+100
+00:07:13,170 --> 00:07:17,750
+أيضًا الـ hyperkalemia which itself can be lethal
+
+101
+00:07:17,750 --> 00:07:21,850
+or can aggravate hyperkalemia يعني الـ metabolic
+
+102
+00:07:21,850 --> 00:07:25,830
+acidosis في حد ذاته fatal disease وكمان بندخل
+
+103
+00:07:25,830 --> 00:07:30,890
+دائمًا معاكتين مع بعض نجد الـ acidosis و ال
+
+104
+00:07:30,890 --> 00:07:40,910
+hyperkalemia مع بعضفي أكثر حالات أساسية تتوقف
+
+105
+00:07:40,910 --> 00:07:44,930
+الكيليا عن إفراز البول المشكلة هي الجثة ستبقى كل
+
+106
+00:07:44,930 --> 00:07:49,450
+ما تأكله في جسمك ليس كذلك؟ ليس هناك سيستم التحكم
+
+107
+00:07:49,450 --> 00:07:53,650
+الشخص سيموت في 8 إلى 14 أيام إذا لم يتم إعادة عمل
+
+108
+00:07:53,650 --> 00:07:57,570
+كدني أو
+
+109
+00:07:57,570 --> 00:08:01,630
+إذا لم يتم استخدام كدني إصلاحي لإنهاء
+
+110
+00:08:05,160 --> 00:08:09,360
+body electrolytes and waste products and water إذا
+
+111
+00:08:09,360 --> 00:08:13,720
+ما تدخلنا خلال 8 إلى 14 يوم it can be killing
+
+112
+00:08:13,720 --> 00:08:21,320
+chronic renal failure ما
+
+113
+00:08:21,320 --> 00:08:25,000
+دخلنا في irreversible disease ال acute بتكلم عنه
+
+114
+00:08:25,000 --> 00:08:28,280
+لإنه في الغالب reversible لكن في acute بتحول ل
+
+115
+00:08:28,280 --> 00:08:31,370
+chronic بيبدأ acute بتحول ل chronicهدول ال
+
+116
+00:08:31,370 --> 00:08:41,650
+intrarenal causes diseases ال chronic هدى هو
+
+117
+00:08:41,650 --> 00:08:46,890
+اللى بدخلنا فى المشاكل الكبيرة تبع الكلية طبعا طب
+
+118
+00:08:46,890 --> 00:08:49,110
+وقتش بنقدر نقول ال chronic failure ال chronic
+
+119
+00:08:49,110 --> 00:08:53,930
+failure معناه عدد ال nephrons جال ال nephrons اللى
+
+120
+00:08:53,930 --> 00:08:58,610
+بتشتغل بيهبط و بيهبط و بيهبط و بيهبط اذا عدد ال
+
+121
+00:08:58,610 --> 00:09:02,060
+nephrons اللى شغالة بيجللو اجتيش طبيب ده يظهر عنا
+
+122
+00:09:02,060 --> 00:09:09,020
+احنا في انا chronic failure إذا .. إذا عدد ال
+
+123
+00:09:09,020 --> 00:09:14,120
+nephrons نزل أجل من الربع يعني لو خمسة و سبعين في
+
+124
+00:09:14,120 --> 00:09:16,940
+المية من ال nephrons راح و عندي خمسة و عشر في
+
+125
+00:09:16,940 --> 00:09:21,380
+المية و أنا مشيت على حياة طبيعية من غير ما أخد
+
+126
+00:09:21,380 --> 00:09:24,780
+أملحة كتير و من غير ما أعمل أشياء غير عادية تكفيني
+
+127
+00:09:25,540 --> 00:09:30,340
+تمام؟ لكن إذا بدأ يجيل عن 25% عدد النفرونز حتى
+
+128
+00:09:30,340 --> 00:09:33,840
+الأكل الطبيعي و الوضع الطبيعي بيكفنش طبعا ال
+
+129
+00:09:33,840 --> 00:09:36,800
+chronic disease في العادة بي .. بيخرب .. بيخرب ..
+
+130
+00:09:36,800 --> 00:09:40,400
+بيخرب عشان كده بنصل لحاجة اسمها end stage بنصل
+
+131
+00:09:40,400 --> 00:09:43,620
+لحاجة اسمها إيه؟ end stage ماقدرش أعمل غسل بقى
+
+132
+00:09:43,620 --> 00:09:46,920
+أكتر من هيك أو ماقدرش أعمل أصبر أكتر من هيك يعني
+
+133
+00:09:46,920 --> 00:09:50,060
+مش .. ماقدرش أصبر عليه لازم أدخله في إيه؟ في غسل
+
+134
+00:09:50,060 --> 00:09:53,280
+أو أدخله في .. يعني بدي أدخل ب artificial
+
+135
+00:09:53,280 --> 00:09:58,670
+somethingبدي أغسل يا إما artificially يا إما أعمله
+
+136
+00:09:58,670 --> 00:10:01,630
+كيلية جديدة أعمله knuckle كيلية in this stage
+
+137
+00:10:01,630 --> 00:10:06,170
+بقدرش أصبر لإنه بدأت ال .. أزوتيميا اللي بيصير
+
+138
+00:10:06,170 --> 00:10:08,670
+عنده ال nitrogen products تعلى اليوريا و
+
+139
+00:10:08,670 --> 00:10:12,850
+الكرياتينين و .. اه تعلى تعلى تعلى صارت في .. يعني
+
+140
+00:10:12,850 --> 00:10:17,470
+ايه ايه ايه صارت hazardous to his life واضح؟
+
+141
+00:10:17,470 --> 00:10:21,530
+بتدخله في كومة، بتدخله في .. تمام؟ إذا عندي مرحلة
+
+142
+00:10:21,530 --> 00:10:26,330
+وعينة ب .. لازم أدخلالـ .. الـ chronic neural
+
+143
+00:10:26,330 --> 00:10:33,010
+failure نقدر نقول بتبدأ تدخلني في end stage و تبدأ
+
+144
+00:10:33,010 --> 00:10:37,810
+تدخلني في خطورة بعد ما 75% من ال .. من ال nephrons
+
+145
+00:10:37,810 --> 00:10:42,110
+يروح في الحالة هذه صرت أنا جاعد بقت دهور مافيش
+
+146
+00:10:42,110 --> 00:10:45,690
+عندي شوية nephrons اللي يشكلوني طبيعي أنا ببدأ
+
+147
+00:10:45,690 --> 00:10:51,590
+اتدهور لأصل لمرحلة انه لابد من عمل شيءفي الحقيقة،
+
+148
+00:10:51,590 --> 00:10:57,610
+تقريبًا، تقريبًا،
+
+149
+00:10:57,610 --> 00:11:03,230
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+150
+00:11:03,230 --> 00:11:03,430
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+151
+00:11:03,430 --> 00:11:03,510
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+152
+00:11:03,510 --> 00:11:05,490
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+153
+00:11:05,490 --> 00:11:17,150
+تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+154
+00:11:17,150 --> 00:11:22,280
+تقto chronic renal failure the end result is
+
+155
+00:11:22,280 --> 00:11:25,880
+essentially the same هم كلهم هينصبوا في نهاية
+
+156
+00:11:25,880 --> 00:11:29,540
+واحدة a decrease in the number of functioning
+
+157
+00:11:29,540 --> 00:11:33,360
+nephrons طبعا في الآخر هينخلوا يعني أنا عدد
+
+158
+00:11:33,360 --> 00:11:38,440
+النفلوز الشغال خربوا هم في مكان ما لحد ما خربوا ال
+
+159
+00:11:38,440 --> 00:11:42,640
+glomerulus كلها لحد ما خربوا ال tubule كله النفر
+
+160
+00:11:42,640 --> 00:11:48,190
+كله أثبت للشغالو هكذا من نفرون لنفرون لحد ما العدد
+
+161
+00:11:48,190 --> 00:11:51,690
+الكلي ينقص اه معناها المشكلة المشكلة اذا في ال
+
+162
+00:11:51,690 --> 00:11:55,450
+chronic انه نضرب عدد النفرون عشان كده جل
+
+163
+00:11:55,450 --> 00:12:01,490
+الكرياتينين blood level مؤشر لجديش عند انا نفرون
+
+164
+00:12:01,490 --> 00:12:06,790
+كل ما زاد جال عددها كل ما الكرياتينين فانا من خلال
+
+165
+00:12:06,790 --> 00:12:09,550
+الكرياتينين level بقدر اعرف جديش ضارب في الكل يعني
+
+166
+00:12:10,100 --> 00:12:15,380
+تمام؟ إذا أضاعف الكرياتينين نص النفرنز راح يظل نص
+
+167
+00:12:15,380 --> 00:12:19,200
+إذا أربع أضاعف أنا عندي بس ربع النفرنز شغال مش
+
+168
+00:12:19,200 --> 00:12:23,980
+كده؟ لكن بيضال يعلى لمرحلة انه خلاص بطل سريع
+
+169
+00:12:23,980 --> 00:12:28,000
+لبسرعة بعدين لإن النفرنز ال daily needs تبعتي مش
+
+170
+00:12:28,000 --> 00:12:33,340
+مكفية انه نحافظ عليها في عندنا what's called
+
+171
+00:12:33,340 --> 00:12:35,720
+vicious circle of chronic renal failure يعني ال
+
+172
+00:12:35,720 --> 00:12:41,100
+chronic renal failureبيروح بيخرّب الكلية أكتر تمام
+
+173
+00:12:41,100 --> 00:12:42,860
+و بيزيد ال renal فرق الكورونا الكورونا الكورونا
+
+174
+00:12:42,860 --> 00:12:43,100
+الكورونا الكورونا الكورونا الكورونا الكورونا
+
+175
+00:12:43,100 --> 00:12:45,140
+الكورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+176
+00:12:45,140 --> 00:12:50,840
+كورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+177
+00:12:50,840 --> 00:12:52,760
+كورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+178
+00:12:52,760 --> 00:12:56,980
+كورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+179
+00:12:56,980 --> 00:13:02,820
+كورونا كورونا كورونا كورونا كورونا
+
+180
+00:13:02,820 --> 00:13:08,100
+كورو
+
+181
+00:13:09,790 --> 00:13:12,970
+primary kidney disease ادى الى decrease في ال
+
+182
+00:13:12,970 --> 00:13:17,330
+number of nephrons الى chronic renal failure اول
+
+183
+00:13:17,330 --> 00:13:18,830
+وقت مضى الى chronic renal failure يعني decrease
+
+184
+00:13:18,830 --> 00:13:24,770
+number of functioning nephrons هذا بيقدى الى hyper
+
+185
+00:13:24,770 --> 00:13:28,350
+tension لان قولنا هيزيد ال volume و ال
+
+186
+00:13:28,350 --> 00:13:33,630
+electrolytes يدولى الى ايه؟hypertension ارتيونا
+
+187
+00:13:33,630 --> 00:13:39,410
+البشريانة وفي عندها يصير reflex hypertrophy في
+
+188
+00:13:39,410 --> 00:13:45,910
+النفره لان احنا قلنا لو شيلنا كيلية مثلا الكيلية
+
+189
+00:13:45,910 --> 00:13:50,870
+التانية بتقدي نفس الغرض مش كده لكن الكيلية التانية
+
+190
+00:13:50,870 --> 00:13:54,490
+صار عليها يبقى كيليتين هلج ال filtration تبعها زاد
+
+191
+00:13:54,490 --> 00:13:59,600
+عشان يقدي نفس الغرضو هلاجي انا عندي ال blood
+
+192
+00:13:59,600 --> 00:14:02,800
+pressure ال blood vessels سبعتها dilated عشان
+
+193
+00:14:02,800 --> 00:14:06,080
+تديني نفس ال ايه يعني بيصير عندي hypertrophy في
+
+194
+00:14:06,080 --> 00:14:10,860
+مين؟ في الكيلية او في ال nephrons هذه العملية انا
+
+195
+00:14:10,860 --> 00:14:13,520
+سألت المرأة الفاتة إلكوا ولا لمين؟ لأ لما أنا
+
+196
+00:14:13,520 --> 00:14:18,540
+التالتة اشقلنا كيليتين تمام؟ قلنا كيليتين علشان
+
+197
+00:14:18,540 --> 00:14:21,180
+الضغط اللي ييجي على الكيلية الواحدة يبقى مناسب
+
+198
+00:14:21,180 --> 00:14:24,280
+إلها لإن لو ضغط الكيليتين إجي على كيلية واحدة
+
+199
+00:14:24,280 --> 00:14:28,610
+فبيخرّبهالذلك احنا كنا منذ زمان نظن ان نقل الكيلة
+
+200
+00:14:28,610 --> 00:14:33,950
+عملية آمنة لأ حقيقة مش آمنة لحالها لأ ليش لإن
+
+201
+00:14:33,950 --> 00:14:38,190
+الدغط اللي بيزيد مع الكيلة الكيلة الواحدة اللي
+
+202
+00:14:38,190 --> 00:14:41,750
+ضالت ان انا اتبرعت بكيلة وضالت عندك كيلة هيزيد
+
+203
+00:14:41,750 --> 00:14:44,290
+عندي انا الدم اللي ذاكر على الكيلة تبعتي هيزير
+
+204
+00:14:44,290 --> 00:14:50,270
+اكتر و ال filtration هيكون اكتر و ال tube will
+
+205
+00:14:50,270 --> 00:14:56,340
+هتتمدد اكتر هذه العملية متقدرش تظل foreverتمام؟
+
+206
+00:14:56,340 --> 00:14:59,680
+بتخرّب عندي .. بيصير عندي sclerosis في ال .. في ال
+
+207
+00:14:59,680 --> 00:15:02,240
+blood vessels اللي dilated ده اللي داخلة لل ..
+
+208
+00:15:02,240 --> 00:15:06,460
+للكيلية و بيبدأ أصير عندي failure في نفس الكيلية
+
+209
+00:15:06,460 --> 00:15:10,520
+اللي أنا عايش .. اللي ضالت عندي واضح؟ يعني الآن
+
+210
+00:15:10,520 --> 00:15:14,780
+إذا عندي renal failure إذا عندي renal failure
+
+211
+00:15:14,780 --> 00:15:18,460
+هيعمللي بعض ال changes بتخرّب الأكتر و أكتر و أكتر
+
+212
+00:15:18,460 --> 00:15:22,620
+شبيهة بالمثل اللي قلنا عليها من شوية عندي ال blood
+
+213
+00:15:22,620 --> 00:15:25,720
+pressure هيزيدand the hypertrophy and
+
+214
+00:15:25,720 --> 00:15:30,480
+vasodilatation of the surviving nephrons التنين
+
+215
+00:15:30,480 --> 00:15:34,440
+هذول هيزودولي الـ glomerular pressure و هيزودولي
+
+216
+00:15:34,440 --> 00:15:36,240
+ال filtration
+
+217
+00:15:41,780 --> 00:15:45,860
+طيب، هذا هيقدر إلى sclerosis، glomerul sclerosis،
+
+218
+00:15:45,860 --> 00:15:48,680
+ال glomerulus جلنا blood vessel، مش كده؟
+
+219
+00:15:48,680 --> 00:15:51,740
+capillaries، blood pressure زاد في ال .. في ال
+
+220
+00:15:51,740 --> 00:15:56,440
+glomerulus، هسير فيها sclerosis، هدد تسكر، اه،
+
+221
+00:15:56,440 --> 00:16:00,340
+بطل، قادرة، تشتغل، sclerosis بيزيد، بيزيد، بيزيد
+
+222
+00:16:00,340 --> 00:16:05,120
+لحجم ال glomerulus، إيه عشان؟بتنتهي ال glomerular
+
+223
+00:16:05,120 --> 00:16:09,080
+sclerosis هذا ضيع ال glomeruli جلللي أكتر عدد من
+
+224
+00:16:09,080 --> 00:16:12,660
+ال nephrons و هكذا تمام؟ إذا ما بخش في vicious
+
+225
+00:16:12,660 --> 00:16:17,100
+circle من .. بيصير عندي تسارع في ال renal failure
+
+226
+00:16:17,100 --> 00:16:20,420
+إذا ال renal failure عند level معين .. ال renal
+
+227
+00:16:20,420 --> 00:16:23,180
+failure عند level معين بيقدر إلى أن ال nephrons
+
+228
+00:16:23,180 --> 00:16:28,450
+اللي ضايلة بيتقوم بواجب عن الآخرينتمام؟ فبصير
+
+229
+00:16:28,450 --> 00:16:32,030
+hypertrophy بالاضافة لل renal failure نفسه بيعمللي
+
+230
+00:16:32,030 --> 00:16:37,130
+hypertension فصار عندي hypertension بيخرّب بطريقة
+
+231
+00:16:37,130 --> 00:16:41,690
+ما و hypertrophy في ال nephrons و ال .. بيخرّب
+
+232
+00:16:41,690 --> 00:16:46,630
+بطريقة أخرى فبصير عندي أنا ال disease الأصلي خرّب
+
+233
+00:16:46,630 --> 00:16:49,630
+في الكيلية و الكيلية صارت ساعت و تخرب نفسها و ال
+
+234
+00:16:49,630 --> 00:16:52,490
+disease الأصلي موجود و ال disease الأصلي إيش؟
+
+235
+00:16:52,490 --> 00:16:56,780
+موجود طيبلو هنا .. هذه انا حابب ان انتوا تفهموها
+
+236
+00:16:56,780 --> 00:17:02,060
+بالتفصيل studies in laboratory animals have shown
+
+237
+00:17:02,060 --> 00:17:05,740
+that surgical removal of a large portion of the
+
+238
+00:17:05,740 --> 00:17:09,360
+kidney مش راضي اقول kidney و نخلي kidney اخافوا
+
+239
+00:17:09,360 --> 00:17:13,420
+عنه الناس بتتشجعش لل transplant يعني اعتبروا انه
+
+240
+00:17:13,420 --> 00:17:20,110
+شيلنا جزء من الكل يعنيأولاً تعمل تغييرات مستقل في
+
+241
+00:17:20,110 --> 00:17:24,010
+النيفرون المتبقى اللي يجعل البلد تتفرق و تتفرق في
+
+242
+00:17:24,010 --> 00:17:27,650
+الـGFR و تتفرق في الـUrine output في النيفرون
+
+243
+00:17:27,650 --> 00:17:32,510
+المتبقى و بعد شوية ملاك بالظبط البول اللي بيطلع من
+
+244
+00:17:32,510 --> 00:17:35,390
+كيلية واحدة يسوى اللي كان يطلع من كيلية اتانية و
+
+245
+00:17:35,390 --> 00:17:39,150
+ال chemistry تبع ال blood هو و هو ماتغيرش تمام؟
+
+246
+00:17:39,150 --> 00:17:42,570
+اذا الكيلية هذه صار عليها مضاعف احنا في أولها مش
+
+247
+00:17:42,570 --> 00:17:48,570
+حاسينه ولا هي حساه بس بعد شويةهنا نتكلم عن عملية
+
+248
+00:17:48,570 --> 00:17:51,010
+plus نقصان النفرونز وليس هناك عملية original
+
+249
+00:17:51,010 --> 00:17:54,370
+disease نحن عملنا surgical removal وشوفنا ايش صار
+
+250
+00:17:54,370 --> 00:17:58,470
+فنتخيل انه عندى كمان في disease اخر ومش عمل
+
+251
+00:17:58,470 --> 00:18:02,300
+surgical removal خرب جزء من النفرونزإذن لما تظل
+
+252
+00:18:02,300 --> 00:18:05,080
+شويه difference لحالها هتعمل visual circuit
+
+253
+00:18:05,080 --> 00:18:08,640
+destruction of more and more and more rapid طيب
+
+254
+00:18:08,640 --> 00:18:11,460
+the exact mechanism responsible for these changes
+
+255
+00:18:11,460 --> 00:18:15,480
+are not well understood but involve hypertrophy as
+
+256
+00:18:15,480 --> 00:18:18,480
+well as functional changes that decrease vascular
+
+257
+00:18:18,480 --> 00:18:20,980
+resistance and tubular reabsorption in the
+
+258
+00:18:20,980 --> 00:18:24,630
+surviving nephron تمام؟التغييرات التقليدية تسمح
+
+259
+00:18:24,630 --> 00:18:29,830
+لشخص يتعذب عن عمومات عادية من الماء والسلوك حتى
+
+260
+00:18:29,830 --> 00:18:32,150
+وإن عمومات عمومات عمومات عمومات عمومات عمومات
+
+261
+00:18:32,150 --> 00:18:32,530
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+262
+00:18:32,530 --> 00:18:36,850
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+263
+00:18:36,850 --> 00:18:37,270
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+264
+00:18:37,270 --> 00:18:41,990
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+265
+00:18:41,990 --> 00:18:45,690
+عمومات
+
+266
+00:18:45,690 --> 00:18:51,090
+عمو
+
+267
+00:18:51,230 --> 00:18:56,550
+إن أمنع ال blood pressure دي علاقة لكن هذا بيحلش
+
+268
+00:18:56,550 --> 00:18:59,270
+كل المشكلة بس بيحلش جزء كبير من المشكلة اللي هو
+
+269
+00:18:59,270 --> 00:19:03,090
+أنا أعطي ال angiotensin converting enzyme
+
+270
+00:19:03,090 --> 00:19:07,850
+inhibitors تمام؟ هذا بيخليلي ال blood pressure
+
+271
+00:19:07,850 --> 00:19:11,850
+اللي ناتج بداية عن ال renin اللي طلع و ال
+
+272
+00:19:11,850 --> 00:19:15,650
+angiotensin تولدت كوّن أنه هذا ألغي أنا عشان أمنع
+
+273
+00:19:15,650 --> 00:19:18,290
+ال blood pressure الناتج عن الكيليا ال
+
+274
+00:19:18,290 --> 00:19:20,990
+hypertension ناتج عن الكيليا mainly هيكون عبر مين؟
+
+275
+00:19:21,220 --> 00:19:31,000
+عبر ال renin system مش هيك ال theology .. هذه
+
+276
+00:19:31,000 --> 00:19:35,880
+انا برضه مخليها مهمة جدا ال theology of the ايه؟
+
+277
+00:19:35,880 --> 00:19:41,840
+of the chronic renal فارعةفي عام 1980، جلوميل
+
+278
+00:19:41,840 --> 00:19:47,000
+الارفريتس في جميع أنواعها كانت مؤمنة بأنها هي
+
+279
+00:19:47,000 --> 00:19:49,900
+السبب العام لإدارة الحصول على الـ End Stage Kidney
+
+280
+00:19:49,900 --> 00:19:53,040
+Disease كنا زمان نظن أن الجلوميل الارفريتس هي
+
+281
+00:19:53,040 --> 00:19:58,520
+المشكلة الرئيسية في الـ chronic kidney failure End
+
+282
+00:19:58,520 --> 00:20:02,650
+Stage Kidney Disease هو chronic kidneyin recent
+
+283
+00:20:02,650 --> 00:20:05,830
+years تبين إلي إنه أنا في حاجتين مهمين مش بس
+
+284
+00:20:05,830 --> 00:20:08,650
+الجوان الفريتس ال blood pressure و ال diabetes
+
+285
+00:20:08,650 --> 00:20:12,550
+السكر اللي موجود في العالم هو اللي بيخرب الكلية
+
+286
+00:20:12,550 --> 00:20:17,650
+اتنين الضغط اللي بيصير مع ال obesity الضغط بيخرب
+
+287
+00:20:17,650 --> 00:20:20,890
+الكلية هو قالك الضغط مارموض مع ال obesity قالك لأ
+
+288
+00:20:20,890 --> 00:20:23,450
+ما هو ال diabetes و ال obesity و الضغط ايه واحدة
+
+289
+00:20:23,450 --> 00:20:28,330
+واحدة قالك في حاجة اسمها metabolic syndrome واحد
+
+290
+00:20:28,330 --> 00:20:30,890
+سمن السكر عليه
+
+291
+00:20:34,120 --> 00:20:38,880
+الضغط عليه دخلنا في مشكلة metabolic syndrome تمام؟
+
+292
+00:20:38,880 --> 00:20:42,020
+طب لو اتصلح اه بيرجع السكر و بيرجع كلش تمام يعني
+
+293
+00:20:42,020 --> 00:20:46,040
+معظم السكر 75% من السكر في العالم سكر ناتج عن
+
+294
+00:20:46,040 --> 00:20:50,320
+obesity يعني لو صلحت ال obesity بتصلح اه metabolic
+
+295
+00:20:50,320 --> 00:20:53,560
+syndrome نسميها شوفوا اجروا عنه metabolic syndrome
+
+296
+00:20:53,560 --> 00:20:57,830
+جيد لإن هو مرض العصر اليومفي السنوات الماضية،
+
+297
+00:20:57,830 --> 00:21:01,890
+زيابتس مليتس والهيبرتنشين أصبحوا مسموحين كسبب
+
+298
+00:21:01,890 --> 00:21:03,690
+أساسية الحصول على الحصول على الحصول على الحصول على
+
+299
+00:21:03,690 --> 00:21:05,150
+الحصول على الحصول على الحصول على الحصول على الحصول
+
+300
+00:21:05,150 --> 00:21:06,210
+على الحصول على الحصول على الحصول على الحصول على
+
+301
+00:21:06,210 --> 00:21:06,310
+الحصول على الحصول على الحصول على الحصول على الحصول
+
+302
+00:21:06,310 --> 00:21:08,390
+على الحصول على الحصول على الحصول على الحصول على
+
+303
+00:21:08,390 --> 00:21:09,890
+الحصول على الحصول على الحصول على الحصول
+
+304
+00:21:12,560 --> 00:21:15,720
+Excessive weight gain appears to be the most
+
+305
+00:21:15,720 --> 00:21:19,000
+important risk factor for the two main causes of
+
+306
+00:21:19,000 --> 00:21:23,060
+indigestion Obesity هي اللي بتعمل السكر بيزيد معها
+
+307
+00:21:23,060 --> 00:21:26,440
+وهي اللي بتعلق الضغط لإن مع ال obesity ال
+
+308
+00:21:26,440 --> 00:21:29,780
+atherosclerosis بيزيد و بيزيد الضغط لإن كلهم
+
+309
+00:21:29,780 --> 00:21:32,680
+مربوطين إيه؟ إذا ال obesity الآن رسك كبير موجود
+
+310
+00:21:32,680 --> 00:21:36,660
+للعالم إذا تخلصنا منه حامينا الكيليا بطريقة ما
+
+311
+00:21:36,660 --> 00:21:42,690
+What is nephrotic syndrome؟أنا جبتلكم في الكلام في
+
+312
+00:21:42,690 --> 00:21:46,330
+أسنان الحديث حاجة عن الـ nephrotic syndrome تمام؟
+
+313
+00:21:46,330 --> 00:21:50,170
+اليوم كنا بنتكلم عنه بتوسع أكتر nephrotic syndrome
+
+314
+00:21:50,170 --> 00:21:56,590
+هو حالة من الحالات مش مرتبطة كتير بال .. بال
+
+315
+00:21:56,590 --> 00:22:00,850
+electrolytes و ال .. اه في diseases مربوطة بال
+
+316
+00:22:00,850 --> 00:22:04,410
+electrolytes و غيره اي .. اي acute renal failure
+
+317
+00:22:04,410 --> 00:22:07,570
+يعني بيعمل overload لل electrolytes و لل water و
+
+318
+00:22:07,570 --> 00:22:12,060
+كده ال kidney function failedلكن هذه حالة تانية بس
+
+319
+00:22:12,060 --> 00:22:16,140
+الكيليا بتهري ببروتين سمينها nephrotic syndrome
+
+320
+00:22:16,140 --> 00:22:19,660
+يعني الكيليا بس ايش بتهري ببروتين يعني ال
+
+321
+00:22:19,660 --> 00:22:26,860
+glomerulus filtration is more permeable to بروتين
+
+322
+00:22:26,860 --> 00:22:30,080
+than it should be فبيقدّي إلى أن فيه proteins
+
+323
+00:22:30,080 --> 00:22:33,140
+بتطلع من الجسم باستمرار بعد شوية هيصير عندك
+
+324
+00:22:33,140 --> 00:22:38,830
+hypoprotonemia الhypoprotonemia هذهلما تصير بتقدي
+
+325
+00:22:38,830 --> 00:22:43,630
+إلى generalized اديمة ليش؟ لأن الـ colloidal
+
+326
+00:22:43,630 --> 00:22:47,910
+pressure اللي من الـ plasma proteins هو الأساس في
+
+327
+00:22:47,910 --> 00:22:50,890
+السعادة في الميه اللي بتطلع من ال tissues فإذا
+
+328
+00:22:50,890 --> 00:22:56,230
+هبطت هذه إذا هبطت معناها ال filtration اللي بيصير
+
+329
+00:22:56,230 --> 00:23:01,370
+بيقبلوش reabsorption ع مستوى الجسم كله فبيقدي إلى
+
+330
+00:23:01,370 --> 00:23:06,150
+إن الاديمة بتبتد تتكون في كل الجسم شوية شوية شوية
+
+331
+00:23:07,740 --> 00:23:14,440
+طيب ال .. ال .. ال hypoproteinemia احنا عندناها
+
+332
+00:23:14,440 --> 00:23:21,840
+ناتج عن ال .. ال .. ال .. ال protonuria هرمون
+
+333
+00:23:21,840 --> 00:23:25,980
+albuminuria albumin أو بروتين تلقى في البون تشابه
+
+334
+00:23:25,980 --> 00:23:29,640
+ال hypo .. ال hypoproteinemia هذه البروتين الوطن
+
+335
+00:23:29,640 --> 00:23:34,170
+في الدم تشابه حالة الايه؟الـ liver failure لإن ال
+
+336
+00:23:34,170 --> 00:23:37,550
+liver failure مش بيهرب البروتين بيمنع تكوين
+
+337
+00:23:37,550 --> 00:23:41,030
+البروتين ال liver is the main source of protein
+
+338
+00:23:41,030 --> 00:23:45,910
+synthesis فلما ال liver يصير في عندي .. إذا في
+
+339
+00:23:45,910 --> 00:23:50,590
+عندي في حالات ال .. ال hepatic edema يكون عندي
+
+340
+00:23:50,590 --> 00:23:55,490
+liver disease بيقدر إلى تقليل تصنيع البروتين و ال
+
+341
+00:23:55,490 --> 00:23:58,990
+nephrotic syndrome عندي kidney disease بيقدر إلى
+
+342
+00:23:58,990 --> 00:24:03,400
+تهريب البروتينالنتجة في الآخر انه hypoproteinemia
+
+343
+00:24:03,400 --> 00:24:06,180
+يعني انا مالاج hypoproteinemia بدي ادور على liver
+
+344
+00:24:06,180 --> 00:24:09,500
+function و ادور على ال kidney function اشوف النتجة
+
+345
+00:24:09,500 --> 00:24:12,280
+من وين هذه تمام اذا جيت قلبه من كتير في ال ball
+
+346
+00:24:12,280 --> 00:24:15,720
+باطمن انه احنا ايه ال liver بخير ان لجينا ال ball
+
+347
+00:24:15,720 --> 00:24:19,000
+كويس و مافيش فيه protein معناها مشكلة كبيرة عندها
+
+348
+00:24:19,000 --> 00:24:23,820
+تصير حاليا ايضا صار في عنا liver transplantation
+
+349
+00:24:23,820 --> 00:24:29,160
+احنا انا بتكلم لازلت عن مرحلتي اناانه كان ال liver
+
+350
+00:24:29,160 --> 00:24:31,560
+transplantation مش موجود، بس موجود ايه؟ ال kid
+
+351
+00:24:31,560 --> 00:24:36,740
+transplantation، ملحوقة، بتغير، نزرع، مش كده؟ لكن
+
+352
+00:24:36,740 --> 00:24:40,040
+ال liver ضرب، لأ اليوم ب .. ايه؟ بنزرع ال liver
+
+353
+00:24:40,040 --> 00:24:44,020
+بنجحالـ liver اليوم بين زراع بين إجاح أنا حقيقة
+
+354
+00:24:44,020 --> 00:24:48,620
+القسم اللي كنت بشتغل فيه في .. اتدربت فيه في Leeds
+
+355
+00:24:48,620 --> 00:24:55,580
+شوية روحت على ال transplantation department
+
+356
+00:24:55,580 --> 00:24:58,420
+في St. James's hospital فلجيتهم بايدين ال liver
+
+357
+00:24:58,420 --> 00:25:01,260
+صرت أضحك و أفكر فيهم و سنة و سنة أضحك عليهم فانتوا
+
+358
+00:25:01,260 --> 00:25:04,900
+بس بضايق وقتهم على الفاضي لكن حاليا الآن تبين أنه
+
+359
+00:25:04,900 --> 00:25:08,540
+بالفعل في liver transplantation و ناجح
+
+360
+00:25:11,440 --> 00:25:14,820
+المرحلة الحالية سنة انا مش خايف برضه من ال liver
+
+361
+00:25:14,820 --> 00:25:19,420
+لإن في عندي liver transplantation مع أنه أصعب ومش
+
+362
+00:25:19,420 --> 00:25:22,980
+أسهل ومشكلة كبيرة لكن الله يبعد عننا ال liver و ال
+
+363
+00:25:22,980 --> 00:25:26,140
+renal disease لكن ال hypoproteinemia قد تعني liver
+
+364
+00:25:26,140 --> 00:25:32,440
+وقد تعني kidney تمام؟ اذا هنا في ال .. ال
+
+365
+00:25:32,440 --> 00:25:36,820
+nephrotic syndrome عندي picture معينة وهي فقدان
+
+366
+00:25:38,200 --> 00:25:41,780
+protein mainly albumin في البول يؤدي مع ال long
+
+367
+00:25:41,780 --> 00:25:45,280
+-time إلى الhypoprotein هنا في عنا خطأ بيصير بين
+
+368
+00:25:45,280 --> 00:25:49,740
+الناس العام بيقولوا في زولال في البول وكلمة زولال
+
+369
+00:25:49,740 --> 00:25:53,800
+في البول هذه تفهم بطريقة غريبة وبيعرفوا الناس ان
+
+370
+00:25:53,800 --> 00:25:57,570
+في زولال في البيتفبقولك لأ فى زولال فى ال bowl
+
+371
+00:25:57,570 --> 00:26:01,570
+فانا ماكولش بيض لإن فى زولال بلس إذا أكلت زولال
+
+372
+00:26:01,570 --> 00:26:05,430
+البيض أكلت زولال معناه بيصير عندى زولال فى لشسهم
+
+373
+00:26:05,430 --> 00:26:09,950
+مش عارفين إنهم زولال ال protein أنا فاخده بيحتاج
+
+374
+00:26:09,950 --> 00:26:13,790
+أنا عشان أعوضه إلى high protein diet بدي protein
+
+375
+00:26:13,790 --> 00:26:17,970
+diet عالى بحيث أن أقدر أعوض هذا فهم بيقولك لأ أنا
+
+376
+00:26:17,970 --> 00:26:20,690
+عندى زولال فى ال .. بديش أكل زولال بديش أكل بيض
+
+377
+00:26:20,690 --> 00:26:23,870
+طبعا المفهوم خاطئ لمفهوم الزولال زولال تعني
+
+378
+00:26:23,870 --> 00:26:29,440
+protein مش كدهالنقطتين الأخرتين اللي بدي أجيب
+
+379
+00:26:29,440 --> 00:26:32,380
+سيرتهم هو أنه ال anemia اللي في ال chronic kidney
+
+380
+00:26:32,380 --> 00:26:36,880
+failure و جيبنا سيرتها من ال hemobiosis ال
+
+381
+00:26:36,880 --> 00:26:40,660
+hemobiotin زي ما بيصير failure لكل ال function
+
+382
+00:26:40,660 --> 00:26:44,540
+اللي تاكدني من ضمنها بيصير عندى decrease in
+
+383
+00:26:44,540 --> 00:26:49,920
+production of the hemobiotin أو ال erythrobiotinو
+
+384
+00:26:49,920 --> 00:26:53,940
+هذا بيقدر الى مع arena of failure بيقدر الى ايش
+
+385
+00:26:53,940 --> 00:26:58,040
+الى anemia , severe anemia حقيقة ال anemia بتشكل
+
+386
+00:26:58,040 --> 00:27:01,940
+بحاجتين ان اليوريميا اللى موجودة اليوريميا في
+
+387
+00:27:01,940 --> 00:27:05,160
+حالتها هتخرب الجلب و هتخرب البنك الرئيسي و هتخرب
+
+388
+00:27:05,160 --> 00:27:08,220
+ال liver و هتخرب كل شيء اليوريميا كونها arena of
+
+389
+00:27:08,220 --> 00:27:12,930
+failure حالة اليوريميا هتخرب أشياء كتيرةلكن من
+
+390
+00:27:12,930 --> 00:27:16,110
+ضمنها انه مش بس بتخرب البون بارو المارو و مابتطلعش
+
+391
+00:27:16,110 --> 00:27:18,630
+ابتطر بيطين عشان يساعد البون بارو في ايه لذلك
+
+392
+00:27:18,630 --> 00:27:22,050
+بيصير عنده severe anemia early في الحالات هذه طبعا
+
+393
+00:27:22,050 --> 00:27:25,690
+الحمد لله رب العالمين من عشرين عشرين سنة فاتت
+
+394
+00:27:25,690 --> 00:27:30,030
+اكتشفوا او اكتر شويةاكتشفوا ال synthetic
+
+395
+00:27:30,030 --> 00:27:33,290
+erythropoietin سموه hemobiotin تمام؟ وهذه الجرعة
+
+396
+00:27:33,290 --> 00:27:37,410
+بتنعطيها للناس اللي عندهم renal failure تمام؟ اللي
+
+397
+00:27:37,410 --> 00:27:39,670
+بيعملوا غسل كيلة كانوا بنعطيه لهم ال
+
+398
+00:27:39,670 --> 00:27:42,050
+erythropoietin لحد ما يصير ناجل كيلة بعد ناجل
+
+399
+00:27:42,050 --> 00:27:45,530
+الكيلة خلاص بتصنع ال erythropoietin لحاله لكن طول
+
+400
+00:27:45,530 --> 00:27:50,390
+ما هم بينتظروا ال severe anemia اللي بيغسل severe
+
+401
+00:27:50,390 --> 00:27:55,370
+anemia لهذا اللي بيغسل صارت عندي قادر انه انا
+
+402
+00:27:55,370 --> 00:28:00,200
+اعوضهابإني أديله إيراترو بايوتين فبصير ال bomber
+
+403
+00:28:00,200 --> 00:28:04,900
+يصلح لحاله اللي بيغسل كده بيخرّب RBCs من خلال ال
+
+404
+00:28:04,900 --> 00:28:08,660
+machine اللي أنا بستخدمها و بيخرّب
+
+405
+00:28:11,550 --> 00:28:15,930
+هو بيخرّب تصنيع لإن ال irritability انجل، فإذا ال
+
+406
+00:28:15,930 --> 00:28:19,430
+irritability انجل فالتصنيع جالين و التكسير كتير،
+
+407
+00:28:19,430 --> 00:28:24,510
+اللي داخل أجليه و اللي طالع كتير، لإن أنا داخل
+
+408
+00:28:24,510 --> 00:28:29,010
+artificial machine بكسر mechanical destruction of
+
+409
+00:28:29,010 --> 00:28:34,330
+bloodof RBCs فمحتاج انه ايه؟ اعوضها فوجود
+
+410
+00:28:34,330 --> 00:28:38,010
+الارتروبيوتين الجديد الهيموبيوتين يصبح يد جرعة كل
+
+411
+00:28:38,010 --> 00:28:42,030
+شهر للناس وهذا يقدر إلى انه يتصلح الدم لحاله وهذا
+
+412
+00:28:42,030 --> 00:28:44,870
+عمل قفزة كتير في الناس اللي بيعملوا غسل الكلة
+
+413
+00:28:44,870 --> 00:28:52,310
+تمام؟الأستيو ماليشيا .. الأستيو ماليشيا قولنا بسبب
+
+414
+00:28:52,310 --> 00:28:55,590
+مين؟ ال vitamin D3 و بيجلل ال reabsorption في ال
+
+415
+00:28:55,590 --> 00:28:59,550
+intestinal اه ال intestinal absorption of كالسيوم
+
+416
+00:28:59,550 --> 00:29:02,830
+بيجلل طبعا ال .. ال .. ال .. مابقولش ال
+
+417
+00:29:02,830 --> 00:29:04,730
+reabsorption في الكلية لإن الكلية أساسا هي
+
+418
+00:29:04,730 --> 00:29:09,510
+failing، تمام؟طيب تريتمنت واحد عنده رينال فاليار
+
+419
+00:29:09,510 --> 00:29:12,430
+كرويكينال فاليار و بدنا نعمله علاج بدنا نعمله يا
+
+420
+00:29:12,430 --> 00:29:16,750
+اما artificial kidney يا اما transplantation
+
+421
+00:29:16,750 --> 00:29:20,030
+kidney مش كده بدنا ندخله في واحدة من الاتنين تانية
+
+422
+00:29:20,030 --> 00:29:23,910
+ال artificial kidney قد تكون peritoneal dialysis
+
+423
+00:29:23,910 --> 00:29:29,990
+قد تكون CAPD continuous ambulatory peritoneal
+
+424
+00:29:29,990 --> 00:29:37,160
+dialysis و hemodialysis تمام طبعااللي هيكون احنا
+
+425
+00:29:37,160 --> 00:29:41,340
+زمان كنا نعمل virtual dialysis بعدين اتطورت لهيمو
+
+426
+00:29:41,340 --> 00:29:45,160
+dialysis بعدين رجعنا المفروض التسلسل يكون واحد
+
+427
+00:29:45,160 --> 00:29:51,080
+تلاتة اتنين رجعنا لل CIPD ليش؟ لإنه ال
+
+428
+00:29:51,080 --> 00:29:56,640
+hemodialysis جثة كبيرة بديجي مرة مرة مرتين في
+
+429
+00:29:56,640 --> 00:30:00,620
+الأسبوع هيجي يومين في الأسبوع على المستشفي يعمل
+
+430
+00:30:00,620 --> 00:30:03,550
+dialysisاليوم اللي جابلي ال dialysis بيكون تعبان
+
+431
+00:30:03,550 --> 00:30:06,030
+عشان كده محتاج dialysis واليوم اللي بعمله فيه ال
+
+432
+00:30:06,030 --> 00:30:08,430
+dialysis بيكون تعبان لإنه طالع من ال dialysis يعني
+
+433
+00:30:08,430 --> 00:30:11,750
+في الأسبوع بيعيش مصحصح يومين أو تلاتة وبعد الأسبوع
+
+434
+00:30:11,750 --> 00:30:16,650
+بيكون ايه؟ بيكون تعبان تمام؟ فقالوا لأ بداش نعمل
+
+435
+00:30:16,650 --> 00:30:20,030
+احنا hemodialysis في أوجه محددة بدنا نعمل
+
+436
+00:30:20,030 --> 00:30:26,250
+continuous ambulatory peritoneal dialysis نديله ال
+
+437
+00:30:26,250 --> 00:30:30,050
+dialysate medium نعمله احنا peritoneal cannula
+
+438
+00:30:32,320 --> 00:30:34,540
+بنعمله canner في البريتون هو شو البريتون ال
+
+439
+00:30:34,540 --> 00:30:39,460
+dialysis اني أحط مواد نظيفة هو البريتون نفسه by
+
+440
+00:30:39,460 --> 00:30:45,220
+diffusion لإنه تركيز المواد السيئة ال electrolytes
+
+441
+00:30:45,220 --> 00:30:50,540
+الزيادة و ال waste products زيادة موجودة في الدم
+
+442
+00:30:50,540 --> 00:30:53,980
+أكتر لكن ال dialyzer اللي بحطه أنا شبيه بال extra
+
+443
+00:30:53,980 --> 00:30:58,260
+cereal fluid standardفكل الزيادة اللى بتيجي فيه
+
+444
+00:30:58,260 --> 00:31:01,980
+تمام؟ من دخله البروتريال دياليسيز من دخله نستنى
+
+445
+00:31:01,980 --> 00:31:05,880
+ساعتين تلاتة اربعة و بعدين نشفطه و نحط غيره تمام؟
+
+446
+00:31:05,880 --> 00:31:09,200
+و هكذا فبطلع طبعا حامل إلكتروناسيز زيادة حامل
+
+447
+00:31:09,200 --> 00:31:12,580
+بوتاسيب زيادة حامل يوريا زيادة حامل كرياتينين
+
+448
+00:31:12,580 --> 00:31:16,540
+زيادة حامل أشياء كتير زيادة مش هيك؟ فبنضل ان احنا
+
+449
+00:31:16,540 --> 00:31:19,800
+هذا البروتريال دياليسيز العادي لما عملنا
+
+450
+00:31:19,800 --> 00:31:24,740
+Hemodialysisعند كلام عنها بعد شوية لجيناها قفزة
+
+451
+00:31:24,740 --> 00:31:27,700
+كبيرة لإن بحتاجش أنا مدة طويلة في ال dialysis إزاي
+
+452
+00:31:27,700 --> 00:31:31,320
+البروتينيال بستخدم بسرعة بتتم العملية تلت أربع
+
+453
+00:31:31,320 --> 00:31:34,520
+ساعات و بقوله اروح روح و بيضل عليها تلت أربع أيام
+
+454
+00:31:34,520 --> 00:31:38,340
+كويس تمام؟ بعدين قولنا طب هذا مسكين حياته انعدمت
+
+455
+00:31:38,340 --> 00:31:41,140
+بطل يشتغل لإن صار يومين أو تلت عندى في المستشفى
+
+456
+00:31:41,140 --> 00:31:45,880
+قولنا نعمل continuous ambulatory peritoneal
+
+457
+00:31:45,880 --> 00:31:50,900
+dialysis CAPD هاديحقيقة بيضل في شغله و بيضل الروح
+
+458
+00:31:50,900 --> 00:31:54,000
+ييجي و بيضل يعمل غسل 24 ساعة زي ما الكلة في
+
+459
+00:31:54,000 --> 00:31:56,880
+الطبيعة بتعمل 24 ساعة يعني البروتينال دهاليسيس
+
+460
+00:31:56,880 --> 00:31:59,780
+واجدش احنا بطلنا منه لإنه بده يروح المستشفى يعمل
+
+461
+00:31:59,780 --> 00:32:03,040
+بروتينال دهاليسيس و هذا بطيء و بده يقعد كل يوم كل
+
+462
+00:32:03,040 --> 00:32:07,320
+يوم في المستشفىلكن هي مدارس سريع فعمل فرق في .. في
+
+463
+00:32:07,320 --> 00:32:09,840
+.. في .. في .. في .. في فكرة ال artificial kidney
+
+464
+00:32:09,840 --> 00:32:14,400
+هي مدارس لكن ال CIPD للناس الكورانيك سنة نديهم
+
+465
+00:32:14,400 --> 00:32:18,820
+احنا كرتونة المحلين و نعلمه اش يعمل نعملنا له
+
+466
+00:32:18,820 --> 00:32:23,560
+canula بريتريا ال canula تمام؟ عملية جراحية و ال
+
+467
+00:32:23,560 --> 00:32:26,920
+canula موجودة و طالع منها تيوب على جامب و بنقولله
+
+468
+00:32:26,920 --> 00:32:35,630
+انت الصبح بدك تفطر اشبط محلول وعلجهفى الـ A is the
+
+469
+00:32:35,630 --> 00:32:39,250
+stand اللى جنبك بتخلص الفطور بيكون محلول خلص لفه
+
+470
+00:32:39,250 --> 00:32:43,630
+اه و سكره و خطه فى جيبك و روح لشغلك بدك تتغدى
+
+471
+00:32:43,630 --> 00:32:46,670
+الظهر lunch time ساعة واحدة بتنزل محلوله على الأرض
+
+472
+00:32:46,670 --> 00:32:52,250
+كان كل اللى انت حاطيته برجع لمين للكيس اربطه ارميه
+
+473
+00:32:52,250 --> 00:32:55,370
+و خط محلول غيره وعلجه بتكمل غداء بيكون ال A
+
+474
+00:32:55,370 --> 00:33:00,070
+المحلول الجديد دخل ال abdomen تمام على العشاء
+
+475
+00:33:00,070 --> 00:33:04,680
+بتغير التالتisn't continuous عيب البريتونيا
+
+476
+00:33:04,680 --> 00:33:08,500
+دياليسيز اللي كان بطيق و بدك تعمله متواصل في
+
+477
+00:33:08,500 --> 00:33:11,680
+مستشفى لأ يعمله في الدار لحاله طبعا هدودها ناس
+
+478
+00:33:11,680 --> 00:33:14,480
+متعلمين و بيه أراقية و نظيفة عشان مايصيرش
+
+479
+00:33:14,480 --> 00:33:18,760
+بريتونيتس عشان مايصيرش infection منعلمه كيف يعمل
+
+480
+00:33:18,760 --> 00:33:22,260
+ال .. ال .. ال .. ال aseptic techniques كلها بحيث
+
+481
+00:33:22,260 --> 00:33:25,460
+أنه بيصير لحاله بيرجع لحياته الطبيعية لحد ال
+
+482
+00:33:25,460 --> 00:33:25,780
+strategically
+
+483
+00:33:31,760 --> 00:33:36,080
+طبعا ال dialysis هذه مكلفة جدا المحليين اللي
+
+484
+00:33:36,080 --> 00:33:40,260
+مستخدمها للغسل لإنها دقيقة في تكوينها تبتبجى غالية
+
+485
+00:33:40,260 --> 00:33:42,860
+مع ان تركيبه ولا إشي يعني صادم و بتقسم و شوية
+
+486
+00:33:42,860 --> 00:33:48,840
+album و كده مش غالية كتير إلا إن ال what is
+
+487
+00:33:48,840 --> 00:33:54,480
+hemodialysis hemodialysis عبارة عن إن أعمل
+
+488
+00:33:57,020 --> 00:34:02,140
+مكان يحتاج فيه الدم مع ال dialyzate اللي أنا بحطه
+
+489
+00:34:02,140 --> 00:34:07,740
+زي البريتون ال membrane لكن ال membrane هدا حاجز
+
+490
+00:34:07,740 --> 00:34:12,020
+بينهم عندى cellophane cellophane membrane حاجز ما
+
+491
+00:34:12,020 --> 00:34:18,280
+بين ال dialyzate و ال blood تمام؟ اذا عندنا فيها
+
+492
+00:34:18,280 --> 00:34:21,720
+cellophane الدم ماشي فيها و حواليها فيه ال
+
+493
+00:34:21,720 --> 00:34:25,120
+dialyzate تمام؟ و هم اتنين ماشيين في اتجاه واحد
+
+494
+00:34:25,850 --> 00:34:29,590
+الدم ماشي هان هيك و ال dialyzer ماشي هيك تاني ماشي
+
+495
+00:34:29,590 --> 00:34:32,170
+في flow في اتجاه واحد طبعا احنا زي ما انتوا شايفين
+
+496
+00:34:32,170 --> 00:34:39,430
+هان بناخد الدم من الشريان و بنرجعه للوريد هذه
+
+497
+00:34:39,430 --> 00:34:42,630
+المكينة تبعت ال dialyzer .. dialysis هي ال
+
+498
+00:34:42,630 --> 00:34:49,210
+dialysis هان تمام ال dialyzer هذا عندي دائرة فيها
+
+499
+00:34:49,210 --> 00:34:55,570
+ال dialyzer بيدخل بطريقة معينة بإجبال الدمهان
+
+500
+00:34:55,570 --> 00:34:58,170
+بيبقى ال flow تبع الدم وهان تبع ال flow دالي زيت
+
+501
+00:34:58,170 --> 00:35:01,350
+ال by diffusion ال simple diffusion الأشياء الأعلى
+
+502
+00:35:01,350 --> 00:35:04,950
+بتخش عن طريق السلوفين إلى الأشياء طبعا واضح أنه في
+
+503
+00:35:04,950 --> 00:35:09,990
+دالي زيت هان في عندي album عندي extra serif fluid
+
+504
+00:35:09,990 --> 00:35:14,290
+composition عشان بس اللي زيد عن هذه التركيبة هو
+
+505
+00:35:14,290 --> 00:35:18,890
+اللي هنتقل إلى إيه إلى إلى إلى ال دالي زيت اللي
+
+506
+00:35:18,890 --> 00:35:24,940
+يصل لل level هادا يثبت على هيعشان ادي فوق فترة
+
+507
+00:35:24,940 --> 00:35:28,160
+اطول للتانين يقبعوا البعض عشان يبقى انتقال انتقال
+
+508
+00:35:28,160 --> 00:35:32,160
+انتقال لحد بيصلوا ايه ل balance تمام ساعد العملية
+
+509
+00:35:32,160 --> 00:35:35,860
+هذه انه انا اعمل طيب ال dialyze هذا بده ادخله ال
+
+510
+00:35:35,860 --> 00:35:39,320
+system هذا بده ادخله under pressure يعني مش بس
+
+511
+00:35:39,320 --> 00:35:42,280
+simple diffusion وعملت شوية pressure زي ما الجالب
+
+512
+00:35:42,280 --> 00:35:45,380
+بيعمل pressure عشان يصير filtration في الكيليا
+
+513
+00:35:45,380 --> 00:35:48,720
+اعملنا شوية pressure ع ال dialyze هذه فصار عندي
+
+514
+00:35:49,420 --> 00:35:53,200
+عندي صار mass transport مش بس ايه بال diffusion
+
+515
+00:35:53,200 --> 00:35:57,200
+البسيط، الضغط اللي أنا عامله كان أسرع في انتقال
+
+516
+00:35:57,200 --> 00:35:57,720
+المواد
+
+517
+00:36:00,550 --> 00:36:03,510
+طبعا الماكينة هذه اللي دخلت هنا هتكسر دم زي ما
+
+518
+00:36:03,510 --> 00:36:09,110
+قلتلكم ال cellophane membrane هذا ممكن يتبزع و
+
+519
+00:36:09,110 --> 00:36:11,370
+فجأة الدم يخش على ال dialyzer و يتوقف خارج ال
+
+520
+00:36:11,370 --> 00:36:15,790
+filter هذا كله هو عبارة عن طبقات من ال cellophane
+
+521
+00:36:15,790 --> 00:36:20,310
+دائرة كده طبقات من ال cellophane او دائرة او كيف
+
+522
+00:36:20,310 --> 00:36:23,830
+ما يكون سيلندر لكن طبقات مختلفة واحدة ماخش فيها دم
+
+523
+00:36:23,830 --> 00:36:25,950
+واحدة ماخش فيها dialyzer واحدة ماخش فيها دم واحدة
+
+524
+00:36:25,950 --> 00:36:33,230
+ماخش فيها dialyzerمش بس في طيار واحد لأ طيارات
+
+525
+00:36:33,230 --> 00:36:38,250
+كتيرة داخلة يعني مش عكس بعض لكن بالتبادل لكن بمشوف
+
+526
+00:36:38,250 --> 00:36:42,090
+اتجاه واحد الدم ماشي هيك و الدالزيت ماشي معاه عشان
+
+527
+00:36:42,090 --> 00:36:44,990
+يضلوا جبال بعض لحد ما يصير ال balance ال
+
+528
+00:36:44,990 --> 00:36:49,510
+equilibrium بين الاتنين تمام؟ وهكذا اذا هذه اللي
+
+529
+00:36:49,510 --> 00:36:52,930
+هي مدالسة فهذه فكرته الرئيسية اضفنا عليه كلمة ال
+
+530
+00:36:52,930 --> 00:36:57,420
+ايه انه اخر شئ to preventEcoagulation مضيف هيبرين
+
+531
+00:36:57,420 --> 00:36:59,760
+طبعا هذا هيبرينية اللي بيكون اللي انا بده اشتغل
+
+532
+00:36:59,760 --> 00:37:02,200
+عليه و ايه اللي هيصير ال clothing في داكل اللي هيش
+
+533
+00:37:02,200 --> 00:37:07,580
+اسمه بعمل تقريبا مترين و نص مساحة ال .. ال .. ال
+
+534
+00:37:07,580 --> 00:37:10,700
+.. ال surface area اللي بيصير فيها التبادل بسبب ..
+
+535
+00:37:10,700 --> 00:37:14,480
+بما انه كلنا طيوب هالجد لكن زي ما قلتلكم عدة طبجات
+
+536
+00:37:14,480 --> 00:37:20,000
+عدة طبجات و كل .. طبجة هيك و طبجة هيك طبجةتمام؟
+
+537
+00:37:20,000 --> 00:37:22,280
+بالاضافة لإن إذا زدنا ال pressure إحنا في المنطقة
+
+538
+00:37:22,280 --> 00:37:26,900
+هذه بيصير عندنا bulk flow filtration لإنه صار ال
+
+539
+00:37:26,900 --> 00:37:30,280
+pressure عالي فبقدر إلى better filtration هيك
+
+540
+00:37:30,280 --> 00:37:33,100
+بنكون خلصنا الكلمة المحاضرة اللي جاية معناها نتكلم
+
+541
+00:37:33,100 --> 00:37:34,420
+عن ال respiratory tract
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..2170fa339f2205a3b1be9e2509379d089167a239
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2872, "start": 5.2, "end": 28.72, "text": "في أنواع منها بتنتهي بسرعة وبنرجع طبيعي وفي أنواع progressive هي دخلة بدنا فيها بس لا تنتهي autoimmune disease بيظل يخرب ويخرب ويخرب ويخرب كده لكن في أنواع لأ هذه بتقعد فترة بسيطة وبعدين self regenerative وبترجع طبيعي إذا عندي intrarenal acute renal failure", "tokens": [41185, 14739, 14407, 3615, 9154, 11296, 39894, 29399, 3224, 1829, 4724, 3794, 2288, 27884, 46599, 1863, 47341, 3615, 23032, 21292, 3615, 1829, 4032, 41185, 14739, 14407, 3615, 16131, 39896, 11778, 9778, 37977, 47525, 8315, 8978, 11296, 4724, 3794, 20193, 6055, 29399, 3224, 1829, 8399, 49031, 4752, 4724, 1829, 19913, 1211, 7251, 34740, 3555, 4032, 1829, 34740, 3555, 4032, 1829, 34740, 3555, 4032, 1829, 34740, 3555, 9122, 3215, 3224, 44381, 8978, 14739, 14407, 3615, 5296, 10721, 29538, 39894, 4587, 22488, 6156, 2655, 25720, 4724, 3794, 1829, 9566, 3660, 46599, 22488, 9957, 2698, 26358, 1166, 46599, 2655, 47341, 3615, 23032, 21292, 3615, 1829, 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..8c86c79d7d2bfe8bede2bf35c6ea559579896430
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/DLc3ThIXOiw_raw.srt
@@ -0,0 +1,2172 @@
+1
+00:00:05,200 --> 00:00:10,600
+في أنواع منها بتنتهي بسرعة وبنرجع طبيعي وفي أنواع
+
+2
+00:00:10,600 --> 00:00:14,380
+progressive هي دخلة بدنا فيها بس لا تنتهي
+
+3
+00:00:14,380 --> 00:00:18,080
+autoimmune disease بيظل يخرب ويخرب ويخرب ويخرب كده
+
+4
+00:00:18,080 --> 00:00:23,320
+لكن في أنواع لأ هذه بتقعد فترة بسيطة وبعدين self
+
+5
+00:00:23,320 --> 00:00:27,200
+regenerative وبترجع طبيعي إذا عندي intrarenal
+
+6
+00:00:27,200 --> 00:00:33,390
+acute renal failurecaused by glomerulonephritis في
+
+7
+00:00:33,390 --> 00:00:36,170
+الـ glomerulus أو tubular necrosis as a cause of
+
+8
+00:00:36,170 --> 00:00:38,950
+acute renal failure يعني إذا إشي بدرب ال
+
+9
+00:00:38,950 --> 00:00:43,470
+glomerulus أو ال tubule تمام بيدخلني في acute
+
+10
+00:00:43,470 --> 00:00:46,210
+renal failure ممكن يدخلني في chronic renal failure
+
+11
+00:00:46,210 --> 00:00:52,930
+واضح؟ عندي post renal causes abnormalities of the
+
+12
+00:00:52,930 --> 00:01:02,390
+lower urinary tract تمام؟ هدول إيه؟ في الغالبعندي
+
+13
+00:01:02,390 --> 00:01:09,050
+مشكلة في التوصيل يعني عندي مشكلة مشهورة احنا بين
+
+14
+00:01:09,050 --> 00:01:13,610
+الrenal pelvis و الureter تمام ان يكون في عندي زي
+
+15
+00:01:13,610 --> 00:01:18,450
+الakalasia or the esophagus إذا فاكرين بتعرفوها في
+
+16
+00:01:18,450 --> 00:01:24,370
+جزئية اتصالمفقودة الـ nervous connection ممكن تكون
+
+17
+00:01:24,370 --> 00:01:28,370
+مفقودة و تقدي الى ان البلدار ال .. ال .. ال .. ال
+
+18
+00:01:28,370 --> 00:01:31,770
+.. ال .. بلوز of the kidney is full and no urine
+
+19
+00:01:31,770 --> 00:01:35,270
+can be transmitted to the ureter ليش؟ لأن
+
+20
+00:01:35,270 --> 00:01:40,810
+البريستالز لسه وقفت هان بي بيلفك يعني بي يو ال
+
+21
+00:01:40,810 --> 00:01:45,770
+ureter بي يو جي بيسميها ال بيلف يوريتريك جونكشن
+
+22
+00:01:46,290 --> 00:01:49,770
+abnormality او disease او كده مشهورة وكتيرة هذه
+
+23
+00:01:49,770 --> 00:01:53,690
+انه هان يبقى في عنده مشكلة الكلش هجزا الفل و ال
+
+24
+00:01:53,690 --> 00:01:57,750
+blood زي الفل لكن هان يتوقف ال ايه فبيزيد الضغط و
+
+25
+00:01:57,750 --> 00:02:01,050
+بيبدأ يخرب يخرب يخرب لإن الضغط اللي زاد في داخل ال
+
+26
+00:02:01,050 --> 00:02:05,350
+pelvis بينعكس ع مين؟ ع ال kidney tissue انها اسلها
+
+27
+00:02:05,350 --> 00:02:09,490
+dilatation و تخريب ببدأ بتخريب المضلة و بينتهي
+
+28
+00:02:09,490 --> 00:02:14,390
+بتخريب كل ال inferenceإذا عندي .. طبعا ممكن يكون
+
+29
+00:02:14,390 --> 00:02:19,010
+عندي king في ال ureter بعض الناس عندهم الكيلية
+
+30
+00:02:19,010 --> 00:02:24,810
+معلجة بطريقة drop kidney .. dropped kidney ..
+
+31
+00:02:24,810 --> 00:02:28,570
+dropping فيها لإن ال tissues اللي حواليها حملها ال
+
+32
+00:02:28,570 --> 00:02:34,180
+fatty tissue دي ساحت من ضعف من عدم أكل من ..أه
+
+33
+00:02:34,180 --> 00:02:37,220
+ودرجة ان المعدة ال .. ال .. ال .. ال .. ال .. ال
+
+34
+00:02:37,220 --> 00:02:40,800
+.. ال kid سجطت من محلها فعملت kinking وين؟ في
+
+35
+00:02:40,800 --> 00:02:43,400
+اليوريتا فبنعمل obstruction mechanical obstruction
+
+36
+00:02:43,400 --> 00:02:48,040
+بس وسببه مش فيش obstruction لكن هو الحبل الطويل
+
+37
+00:02:48,040 --> 00:02:54,770
+انت وانت عاجزته فال .. ال ..و ممكن يكون عندي حصاوي
+
+38
+00:02:54,770 --> 00:02:59,370
+مزمنة مسكرة ureter تؤدي إلى انه back pressure و
+
+39
+00:02:59,370 --> 00:03:03,230
+nephrosis و او اخر و ممكن يكون اشي تاني فيبروزس
+
+40
+00:03:03,230 --> 00:03:08,550
+جاي من مكان اخر المهم في post-renal يعني مشاكل
+
+41
+00:03:08,550 --> 00:03:13,130
+تبدأ من ال ureter و نازل او من ال pelvis of the
+
+42
+00:03:13,130 --> 00:03:15,830
+kidney مش من التشوذ نفسها من ال pelvis of the
+
+43
+00:03:15,830 --> 00:03:21,470
+kidney تمام؟ ال .. اذا في عندي acute renal failure
+
+44
+00:03:22,350 --> 00:03:25,350
+الو pre-renal causes و intra-renal causes و post
+
+45
+00:03:25,350 --> 00:03:28,710
+-renal causes ال causes كتيرة كتيرة و التفاصيل
+
+46
+00:03:28,710 --> 00:03:31,730
+كتير حتدوسها ان شاء الله في البطنة بس بهمني ان انا
+
+47
+00:03:31,730 --> 00:03:35,310
+تعرف التوزيع هذي كويس؟ الان لو صار acute-renal
+
+48
+00:03:35,310 --> 00:03:39,750
+الفاعل يعني ايش بتتوقع يصير؟ كل ال functions اللي
+
+49
+00:03:39,750 --> 00:03:43,670
+اتكلمنا عنها مش هتتصلح تمام؟ اذا في عندي waste
+
+50
+00:03:43,670 --> 00:03:48,390
+product مش هتطلع و
+
+51
+00:03:48,390 --> 00:03:55,030
+عندي electrolytes مش هتتصلحو ال acid base و ال
+
+52
+00:03:55,030 --> 00:03:58,450
+potassium مع ال ether as قلنا و بالاضافة لأنه
+
+53
+00:03:58,450 --> 00:04:08,340
+vitamin Dاللي مش هتكون vitamin D3 بالإضافة للأخيات
+
+54
+00:04:08,340 --> 00:04:12,840
+الطبالتين إذا في عندي مجموعة من الأشياء مختصة بال
+
+55
+00:04:12,840 --> 00:04:16,080
+kidney function proper و ال hormones اللي هي أساس
+
+56
+00:04:16,080 --> 00:04:19,600
+ال kidney بتطلعها كل هذا مش إيه مش هيشتغل يتعطل
+
+57
+00:04:19,600 --> 00:04:23,880
+تمام؟ نتخيل الوضع طبعا احنا قبل كده أصلا ولا ..
+
+58
+00:04:23,880 --> 00:04:28,000
+نتخيل و هيك نشوف التسلسل الدرامي اللي هيحصل لو صار
+
+59
+00:04:28,000 --> 00:04:32,520
+انه عندي acute renal failureA major physiologic
+
+60
+00:04:32,520 --> 00:04:36,280
+effect of acute renal failure is retention of
+
+61
+00:04:36,280 --> 00:04:42,600
+water with products and electrolytes ممكن أضيف
+
+62
+00:04:42,600 --> 00:04:45,520
+عليها جملة أنها and and and failure of production
+
+63
+00:04:45,520 --> 00:04:50,140
+of D3 and إلكروبيوتين بيصير جملة كاملة على المسألة
+
+64
+00:04:50,140 --> 00:04:54,780
+هنا ذكر هذه وذكر تفاصيلها و بعدين ذكر ال D3 و
+
+65
+00:04:54,780 --> 00:04:56,120
+الهيموبيوتين في الآخر
+
+66
+00:04:59,070 --> 00:05:03,410
+risk and lead to water and salt overload اللي
+
+67
+00:05:03,410 --> 00:05:07,390
+باخده مقدرش اطلع، بيصير عندي ايه؟ water ازيادة و
+
+68
+00:05:07,390 --> 00:05:09,910
+electrolyte overload ازيادة، بيقدرلى hypertension
+
+69
+00:05:09,910 --> 00:05:12,950
+و hypertension و مصايبة كتيرة، على الكلية و على
+
+70
+00:05:12,950 --> 00:05:18,170
+غير الكلية، تمام؟ اذا بيعمللي ال overload بيعمللي
+
+71
+00:05:18,170 --> 00:05:22,710
+اديمة و hypertension، اديمة everywhere، و هذه
+
+72
+00:05:22,710 --> 00:05:27,250
+خطيرةبالذات عرقتين انا بدي هوا و المناطق هذه
+
+73
+00:05:27,250 --> 00:05:30,110
+القديمة بيصيح في المنطقة فيه هوا بتتعب على طول
+
+74
+00:05:30,110 --> 00:05:34,150
+بيحس اللي عنده generalized قديمة generalized أنا
+
+75
+00:05:34,150 --> 00:05:38,030
+ساركة بيقولها زي ال generalized قديمة طفت الميه في
+
+76
+00:05:38,030 --> 00:05:41,670
+كل مكان حتى ال potential spaces اللي قولنا عليهم
+
+77
+00:05:41,670 --> 00:05:46,310
+البلورة و الماء كلها انتلت و لما تصل لبلورة و
+
+78
+00:05:46,310 --> 00:05:50,730
+تلاقي جنبها ال alveoli فاضية تبدأ ايه تهجم عليها
+
+79
+00:05:50,730 --> 00:05:54,530
+تعبي فيها شوية شويةفإدّيهم الجنازة إدّيهم
+
+80
+00:05:54,530 --> 00:05:58,430
+hypertension هذا من ال overload Excessive
+
+81
+00:05:58,430 --> 00:06:01,130
+retention of potassium احنا قولنا البوتاسيوم لما
+
+82
+00:06:01,130 --> 00:06:04,850
+ربنا خرج الكيلية ربنا عارف احنا إيش بناكل وإن في
+
+83
+00:06:04,850 --> 00:06:07,410
+بوتاسيوم زيادة دايما فدايما في عندنا secretion of
+
+84
+00:06:07,410 --> 00:06:10,270
+potassium برا برا برا لإن ال intracellular
+
+85
+00:06:10,270 --> 00:06:13,030
+البوتاسيوم العالي اللي احنا بناكله هذا مش لازمنا
+
+86
+00:06:13,030 --> 00:06:16,990
+احنا تمام ف excessive retention of potassium
+
+87
+00:06:16,990 --> 00:06:23,930
+howeverهو أكثر أضرار أكتر لشباب بخطأ الأكيوترينية
+
+88
+00:06:23,930 --> 00:06:28,330
+لأن أزمة بلزمة بوتاسيوم بكسنتراشين بكسنتراشين
+
+89
+00:06:28,330 --> 00:06:29,350
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+90
+00:06:29,350 --> 00:06:32,530
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+91
+00:06:32,530 --> 00:06:33,230
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+92
+00:06:33,230 --> 00:06:33,390
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+93
+00:06:33,390 --> 00:06:35,090
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتراشين
+
+94
+00:06:35,090 --> 00:06:42,630
+بكسنتراشين بكسنتراشين بكسنتراشين بكسنتر
+
+95
+00:06:43,820 --> 00:06:49,080
+بسبب أن الكدنز لا يستطيع إكسيكليز حيدروجين أيونات
+
+96
+00:06:49,080 --> 00:06:54,440
+كافية ندخل في ايه؟ طبعا احنا الأكل طبيعي
+
+97
+00:06:54,440 --> 00:06:58,760
+متابوريزمنا بيطلعلي أساتز أساتز ماطلع تخلصنا منها
+
+98
+00:06:58,760 --> 00:07:03,680
+تمام؟ هنخش في hyper-acidemia مش كده؟ هنخش في hypo
+
+99
+00:07:05,970 --> 00:07:13,170
+سوف ندخل في الـ metabolic acidosis وهذا يساعد
+
+100
+00:07:13,170 --> 00:07:17,750
+أيضًا الـ hyperkalemia which itself can be lethal
+
+101
+00:07:17,750 --> 00:07:21,850
+or can aggravate hyperkalemia يعني الـ metabolic
+
+102
+00:07:21,850 --> 00:07:25,830
+acidosis في حد ذاته fatal disease وكمان بندخل
+
+103
+00:07:25,830 --> 00:07:30,890
+دائمًا معاكتين مع بعض نجد الـ acidosis و ال
+
+104
+00:07:30,890 --> 00:07:40,910
+hyperkalemia مع بعضفي أكثر حالات أساسية تتوقف
+
+105
+00:07:40,910 --> 00:07:44,930
+الكيليا عن إفراز البول المشكلة هي الجثة ستبقى كل
+
+106
+00:07:44,930 --> 00:07:49,450
+ما تأكله في جسمك ليس كذلك؟ ليس هناك سيستم التحكم
+
+107
+00:07:49,450 --> 00:07:53,650
+الشخص سيموت في 8 إلى 14 أيام إذا لم يتم إعادة عمل
+
+108
+00:07:53,650 --> 00:07:57,570
+كدني أو
+
+109
+00:07:57,570 --> 00:08:01,630
+إذا لم يتم استخدام كدني إصلاحي لإنهاء
+
+110
+00:08:05,160 --> 00:08:09,360
+body electrolytes and waste products and water إذا
+
+111
+00:08:09,360 --> 00:08:13,720
+ما تدخلنا خلال 8 إلى 14 يوم it can be killing
+
+112
+00:08:13,720 --> 00:08:21,320
+chronic renal failure ما
+
+113
+00:08:21,320 --> 00:08:25,000
+دخلنا في irreversible disease ال acute بتكلم عنه
+
+114
+00:08:25,000 --> 00:08:28,280
+لإنه في الغالب reversible لكن في acute بتحول ل
+
+115
+00:08:28,280 --> 00:08:31,370
+chronic بيبدأ acute بتحول ل chronicهدول ال
+
+116
+00:08:31,370 --> 00:08:41,650
+intrarenal causes diseases ال chronic هدى هو
+
+117
+00:08:41,650 --> 00:08:46,890
+اللى بدخلنا فى المشاكل الكبيرة تبع الكلية طبعا طب
+
+118
+00:08:46,890 --> 00:08:49,110
+وقتش بنقدر نقول ال chronic failure ال chronic
+
+119
+00:08:49,110 --> 00:08:53,930
+failure معناه عدد ال nephrons جال ال nephrons اللى
+
+120
+00:08:53,930 --> 00:08:58,610
+بتشتغل بيهبط و بيهبط و بيهبط و بيهبط اذا عدد ال
+
+121
+00:08:58,610 --> 00:09:02,060
+nephrons اللى شغالة بيجللو اجتيش طبيب ده يظهر عنا
+
+122
+00:09:02,060 --> 00:09:09,020
+احنا في انا chronic failure إذا .. إذا عدد ال
+
+123
+00:09:09,020 --> 00:09:14,120
+nephrons نزل أجل من الربع يعني لو خمسة و سبعين في
+
+124
+00:09:14,120 --> 00:09:16,940
+المية من ال nephrons راح و عندي خمسة و عشر في
+
+125
+00:09:16,940 --> 00:09:21,380
+المية و أنا مشيت على حياة طبيعية من غير ما أخد
+
+126
+00:09:21,380 --> 00:09:24,780
+أملحة كتير و من غير ما أعمل أشياء غير عادية تكفيني
+
+127
+00:09:25,540 --> 00:09:30,340
+تمام؟ لكن إذا بدأ يجيل عن 25% عدد النفرونز حتى
+
+128
+00:09:30,340 --> 00:09:33,840
+الأكل الطبيعي و الوضع الطبيعي بيكفنش طبعا ال
+
+129
+00:09:33,840 --> 00:09:36,800
+chronic disease في العادة بي .. بيخرب .. بيخرب ..
+
+130
+00:09:36,800 --> 00:09:40,400
+بيخرب عشان كده بنصل لحاجة اسمها end stage بنصل
+
+131
+00:09:40,400 --> 00:09:43,620
+لحاجة اسمها إيه؟ end stage ماقدرش أعمل غسل بقى
+
+132
+00:09:43,620 --> 00:09:46,920
+أكتر من هيك أو ماقدرش أعمل أصبر أكتر من هيك يعني
+
+133
+00:09:46,920 --> 00:09:50,060
+مش .. ماقدرش أصبر عليه لازم أدخله في إيه؟ في غسل
+
+134
+00:09:50,060 --> 00:09:53,280
+أو أدخله في .. يعني بدي أدخل ب artificial
+
+135
+00:09:53,280 --> 00:09:58,670
+somethingبدي أغسل يا إما artificially يا إما أعمله
+
+136
+00:09:58,670 --> 00:10:01,630
+كيلية جديدة أعمله knuckle كيلية in this stage
+
+137
+00:10:01,630 --> 00:10:06,170
+بقدرش أصبر لإنه بدأت ال .. أزوتيميا اللي بيصير
+
+138
+00:10:06,170 --> 00:10:08,670
+عنده ال nitrogen products تعلى اليوريا و
+
+139
+00:10:08,670 --> 00:10:12,850
+الكرياتينين و .. اه تعلى تعلى تعلى صارت في .. يعني
+
+140
+00:10:12,850 --> 00:10:17,470
+ايه ايه ايه صارت hazardous to his life واضح؟
+
+141
+00:10:17,470 --> 00:10:21,530
+بتدخله في كومة، بتدخله في .. تمام؟ إذا عندي مرحلة
+
+142
+00:10:21,530 --> 00:10:26,330
+وعينة ب .. لازم أدخلالـ .. الـ chronic neural
+
+143
+00:10:26,330 --> 00:10:33,010
+failure نقدر نقول بتبدأ تدخلني في end stage و تبدأ
+
+144
+00:10:33,010 --> 00:10:37,810
+تدخلني في خطورة بعد ما 75% من ال .. من ال nephrons
+
+145
+00:10:37,810 --> 00:10:42,110
+يروح في الحالة هذه صرت أنا جاعد بقت دهور مافيش
+
+146
+00:10:42,110 --> 00:10:45,690
+عندي شوية nephrons اللي يشكلوني طبيعي أنا ببدأ
+
+147
+00:10:45,690 --> 00:10:51,590
+اتدهور لأصل لمرحلة انه لابد من عمل شيءفي الحقيقة،
+
+148
+00:10:51,590 --> 00:10:57,610
+تقريبًا، تقريبًا،
+
+149
+00:10:57,610 --> 00:11:03,230
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+150
+00:11:03,230 --> 00:11:03,430
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+151
+00:11:03,430 --> 00:11:03,430
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+152
+00:11:03,430 --> 00:11:03,510
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+153
+00:11:03,510 --> 00:11:05,490
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+154
+00:11:05,490 --> 00:11:17,150
+تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+155
+00:11:17,150 --> 00:11:22,280
+تقto chronic renal failure the end result is
+
+156
+00:11:22,280 --> 00:11:25,880
+essentially the same هم كلهم هينصبوا في نهاية
+
+157
+00:11:25,880 --> 00:11:29,540
+واحدة a decrease in the number of functioning
+
+158
+00:11:29,540 --> 00:11:33,360
+nephrons طبعا في الآخر هينخلوا يعني أنا عدد
+
+159
+00:11:33,360 --> 00:11:38,440
+النفلوز الشغال خربوا هم في مكان ما لحد ما خربوا ال
+
+160
+00:11:38,440 --> 00:11:42,640
+glomerulus كلها لحد ما خربوا ال tubule كله النفر
+
+161
+00:11:42,640 --> 00:11:48,190
+كله أثبت للشغالو هكذا من نفرون لنفرون لحد ما العدد
+
+162
+00:11:48,190 --> 00:11:51,690
+الكلي ينقص اه معناها المشكلة المشكلة اذا في ال
+
+163
+00:11:51,690 --> 00:11:55,450
+chronic انه نضرب عدد النفرون عشان كده جل
+
+164
+00:11:55,450 --> 00:12:01,490
+الكرياتينين blood level مؤشر لجديش عند انا نفرون
+
+165
+00:12:01,490 --> 00:12:06,790
+كل ما زاد جال عددها كل ما الكرياتينين فانا من خلال
+
+166
+00:12:06,790 --> 00:12:09,550
+الكرياتينين level بقدر اعرف جديش ضارب في الكل يعني
+
+167
+00:12:10,100 --> 00:12:15,380
+تمام؟ إذا أضاعف الكرياتينين نص النفرنز راح يظل نص
+
+168
+00:12:15,380 --> 00:12:19,200
+إذا أربع أضاعف أنا عندي بس ربع النفرنز شغال مش
+
+169
+00:12:19,200 --> 00:12:23,980
+كده؟ لكن بيضال يعلى لمرحلة انه خلاص بطل سريع
+
+170
+00:12:23,980 --> 00:12:28,000
+لبسرعة بعدين لإن النفرنز ال daily needs تبعتي مش
+
+171
+00:12:28,000 --> 00:12:33,340
+مكفية انه نحافظ عليها في عندنا what's called
+
+172
+00:12:33,340 --> 00:12:35,720
+vicious circle of chronic renal failure يعني ال
+
+173
+00:12:35,720 --> 00:12:41,100
+chronic renal failureبيروح بيخرّب الكلية أكتر تمام
+
+174
+00:12:41,100 --> 00:12:42,860
+و بيزيد ال renal فرق الكورونا الكورونا الكورونا
+
+175
+00:12:42,860 --> 00:12:43,100
+الكورونا الكورونا الكورونا الكورونا الكورونا
+
+176
+00:12:43,100 --> 00:12:45,140
+الكورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+177
+00:12:45,140 --> 00:12:50,840
+كورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+178
+00:12:50,840 --> 00:12:52,760
+كورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+179
+00:12:52,760 --> 00:12:52,760
+كورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+180
+00:12:52,760 --> 00:12:56,980
+كورونا كورونا كورونا كورونا كورونا كورونا كورونا
+
+181
+00:12:56,980 --> 00:13:02,820
+كورونا كورونا كورونا كورونا كورونا
+
+182
+00:13:02,820 --> 00:13:08,100
+كورو
+
+183
+00:13:09,790 --> 00:13:12,970
+primary kidney disease ادى الى decrease في ال
+
+184
+00:13:12,970 --> 00:13:17,330
+number of nephrons الى chronic renal failure اول
+
+185
+00:13:17,330 --> 00:13:18,830
+وقت مضى الى chronic renal failure يعني decrease
+
+186
+00:13:18,830 --> 00:13:24,770
+number of functioning nephrons هذا بيقدى الى hyper
+
+187
+00:13:24,770 --> 00:13:28,350
+tension لان قولنا هيزيد ال volume و ال
+
+188
+00:13:28,350 --> 00:13:33,630
+electrolytes يدولى الى ايه؟hypertension ارتيونا
+
+189
+00:13:33,630 --> 00:13:39,410
+البشريانة وفي عندها يصير reflex hypertrophy في
+
+190
+00:13:39,410 --> 00:13:45,910
+النفره لان احنا قلنا لو شيلنا كيلية مثلا الكيلية
+
+191
+00:13:45,910 --> 00:13:50,870
+التانية بتقدي نفس الغرض مش كده لكن الكيلية التانية
+
+192
+00:13:50,870 --> 00:13:54,490
+صار عليها يبقى كيليتين هلج ال filtration تبعها زاد
+
+193
+00:13:54,490 --> 00:13:59,600
+عشان يقدي نفس الغرضو هلاجي انا عندي ال blood
+
+194
+00:13:59,600 --> 00:14:02,800
+pressure ال blood vessels سبعتها dilated عشان
+
+195
+00:14:02,800 --> 00:14:06,080
+تديني نفس ال ايه يعني بيصير عندي hypertrophy في
+
+196
+00:14:06,080 --> 00:14:10,860
+مين؟ في الكيلية او في ال nephrons هذه العملية انا
+
+197
+00:14:10,860 --> 00:14:13,520
+سألت المرأة الفاتة إلكوا ولا لمين؟ لأ لما أنا
+
+198
+00:14:13,520 --> 00:14:18,540
+التالتة اشقلنا كيليتين تمام؟ قلنا كيليتين علشان
+
+199
+00:14:18,540 --> 00:14:21,180
+الضغط اللي ييجي على الكيلية الواحدة يبقى مناسب
+
+200
+00:14:21,180 --> 00:14:24,280
+إلها لإن لو ضغط الكيليتين إجي على كيلية واحدة
+
+201
+00:14:24,280 --> 00:14:28,610
+فبيخرّبهالذلك احنا كنا منذ زمان نظن ان نقل الكيلة
+
+202
+00:14:28,610 --> 00:14:33,950
+عملية آمنة لأ حقيقة مش آمنة لحالها لأ ليش لإن
+
+203
+00:14:33,950 --> 00:14:38,190
+الدغط اللي بيزيد مع الكيلة الكيلة الواحدة اللي
+
+204
+00:14:38,190 --> 00:14:41,750
+ضالت ان انا اتبرعت بكيلة وضالت عندك كيلة هيزيد
+
+205
+00:14:41,750 --> 00:14:44,290
+عندي انا الدم اللي ذاكر على الكيلة تبعتي هيزير
+
+206
+00:14:44,290 --> 00:14:50,270
+اكتر و ال filtration هيكون اكتر و ال tube will
+
+207
+00:14:50,270 --> 00:14:56,340
+هتتمدد اكتر هذه العملية متقدرش تظل foreverتمام؟
+
+208
+00:14:56,340 --> 00:14:59,680
+بتخرّب عندي .. بيصير عندي sclerosis في ال .. في ال
+
+209
+00:14:59,680 --> 00:15:02,240
+blood vessels اللي dilated ده اللي داخلة لل ..
+
+210
+00:15:02,240 --> 00:15:06,460
+للكيلية و بيبدأ أصير عندي failure في نفس الكيلية
+
+211
+00:15:06,460 --> 00:15:10,520
+اللي أنا عايش .. اللي ضالت عندي واضح؟ يعني الآن
+
+212
+00:15:10,520 --> 00:15:14,780
+إذا عندي renal failure إذا عندي renal failure
+
+213
+00:15:14,780 --> 00:15:18,460
+هيعمللي بعض ال changes بتخرّب الأكتر و أكتر و أكتر
+
+214
+00:15:18,460 --> 00:15:22,620
+شبيهة بالمثل اللي قلنا عليها من شوية عندي ال blood
+
+215
+00:15:22,620 --> 00:15:25,720
+pressure هيزيدand the hypertrophy and
+
+216
+00:15:25,720 --> 00:15:30,480
+vasodilatation of the surviving nephrons التنين
+
+217
+00:15:30,480 --> 00:15:34,440
+هذول هيزودولي الـ glomerular pressure و هيزودولي
+
+218
+00:15:34,440 --> 00:15:36,240
+ال filtration
+
+219
+00:15:41,780 --> 00:15:45,860
+طيب، هذا هيقدر إلى sclerosis، glomerul sclerosis،
+
+220
+00:15:45,860 --> 00:15:48,680
+ال glomerulus جلنا blood vessel، مش كده؟
+
+221
+00:15:48,680 --> 00:15:51,740
+capillaries، blood pressure زاد في ال .. في ال
+
+222
+00:15:51,740 --> 00:15:56,440
+glomerulus، هسير فيها sclerosis، هدد تسكر، اه،
+
+223
+00:15:56,440 --> 00:16:00,340
+بطل، قادرة، تشتغل، sclerosis بيزيد، بيزيد، بيزيد
+
+224
+00:16:00,340 --> 00:16:05,120
+لحجم ال glomerulus، إيه عشان؟بتنتهي ال glomerular
+
+225
+00:16:05,120 --> 00:16:09,080
+sclerosis هذا ضيع ال glomeruli جلللي أكتر عدد من
+
+226
+00:16:09,080 --> 00:16:12,660
+ال nephrons و هكذا تمام؟ إذا ما بخش في vicious
+
+227
+00:16:12,660 --> 00:16:17,100
+circle من .. بيصير عندي تسارع في ال renal failure
+
+228
+00:16:17,100 --> 00:16:20,420
+إذا ال renal failure عند level معين .. ال renal
+
+229
+00:16:20,420 --> 00:16:23,180
+failure عند level معين بيقدر إلى أن ال nephrons
+
+230
+00:16:23,180 --> 00:16:28,450
+اللي ضايلة بيتقوم بواجب عن الآخرينتمام؟ فبصير
+
+231
+00:16:28,450 --> 00:16:32,030
+hypertrophy بالاضافة لل renal failure نفسه بيعمللي
+
+232
+00:16:32,030 --> 00:16:37,130
+hypertension فصار عندي hypertension بيخرّب بطريقة
+
+233
+00:16:37,130 --> 00:16:41,690
+ما و hypertrophy في ال nephrons و ال .. بيخرّب
+
+234
+00:16:41,690 --> 00:16:46,630
+بطريقة أخرى فبصير عندي أنا ال disease الأصلي خرّب
+
+235
+00:16:46,630 --> 00:16:49,630
+في الكيلية و الكيلية صارت ساعت و تخرب نفسها و ال
+
+236
+00:16:49,630 --> 00:16:52,490
+disease الأصلي موجود و ال disease الأصلي إيش؟
+
+237
+00:16:52,490 --> 00:16:56,780
+موجود طيبلو هنا .. هذه انا حابب ان انتوا تفهموها
+
+238
+00:16:56,780 --> 00:17:02,060
+بالتفصيل studies in laboratory animals have shown
+
+239
+00:17:02,060 --> 00:17:05,740
+that surgical removal of a large portion of the
+
+240
+00:17:05,740 --> 00:17:09,360
+kidney مش راضي اقول kidney و نخلي kidney اخافوا
+
+241
+00:17:09,360 --> 00:17:13,420
+عنه الناس بتتشجعش لل transplant يعني اعتبروا انه
+
+242
+00:17:13,420 --> 00:17:20,110
+شيلنا جزء من الكل يعنيأولاً تعمل تغييرات مستقل في
+
+243
+00:17:20,110 --> 00:17:24,010
+النيفرون المتبقى اللي يجعل البلد تتفرق و تتفرق في
+
+244
+00:17:24,010 --> 00:17:27,650
+الـGFR و تتفرق في الـUrine output في النيفرون
+
+245
+00:17:27,650 --> 00:17:32,510
+المتبقى و بعد شوية ملاك بالظبط البول اللي بيطلع من
+
+246
+00:17:32,510 --> 00:17:35,390
+كيلية واحدة يسوى اللي كان يطلع من كيلية اتانية و
+
+247
+00:17:35,390 --> 00:17:39,150
+ال chemistry تبع ال blood هو و هو ماتغيرش تمام؟
+
+248
+00:17:39,150 --> 00:17:42,570
+اذا الكيلية هذه صار عليها مضاعف احنا في أولها مش
+
+249
+00:17:42,570 --> 00:17:48,570
+حاسينه ولا هي حساه بس بعد شويةهنا نتكلم عن عملية
+
+250
+00:17:48,570 --> 00:17:51,010
+plus نقصان النفرونز وليس هناك عملية original
+
+251
+00:17:51,010 --> 00:17:54,370
+disease نحن عملنا surgical removal وشوفنا ايش صار
+
+252
+00:17:54,370 --> 00:17:58,470
+فنتخيل انه عندى كمان في disease اخر ومش عمل
+
+253
+00:17:58,470 --> 00:18:02,300
+surgical removal خرب جزء من النفرونزإذن لما تظل
+
+254
+00:18:02,300 --> 00:18:05,080
+شويه difference لحالها هتعمل visual circuit
+
+255
+00:18:05,080 --> 00:18:08,640
+destruction of more and more and more rapid طيب
+
+256
+00:18:08,640 --> 00:18:11,460
+the exact mechanism responsible for these changes
+
+257
+00:18:11,460 --> 00:18:15,480
+are not well understood but involve hypertrophy as
+
+258
+00:18:15,480 --> 00:18:18,480
+well as functional changes that decrease vascular
+
+259
+00:18:18,480 --> 00:18:20,980
+resistance and tubular reabsorption in the
+
+260
+00:18:20,980 --> 00:18:24,630
+surviving nephron تمام؟التغييرات التقليدية تسمح
+
+261
+00:18:24,630 --> 00:18:29,830
+لشخص يتعذب عن عمومات عادية من الماء والسلوك حتى
+
+262
+00:18:29,830 --> 00:18:32,150
+وإن عمومات عمومات عمومات عمومات عمومات عمومات
+
+263
+00:18:32,150 --> 00:18:32,530
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+264
+00:18:32,530 --> 00:18:36,850
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+265
+00:18:36,850 --> 00:18:37,270
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+266
+00:18:37,270 --> 00:18:41,990
+عمومات عمومات عمومات عمومات عمومات عمومات عمومات
+
+267
+00:18:41,990 --> 00:18:45,690
+عمومات
+
+268
+00:18:45,690 --> 00:18:51,090
+عمو
+
+269
+00:18:51,230 --> 00:18:56,550
+إن أمنع ال blood pressure دي علاقة لكن هذا بيحلش
+
+270
+00:18:56,550 --> 00:18:59,270
+كل المشكلة بس بيحلش جزء كبير من المشكلة اللي هو
+
+271
+00:18:59,270 --> 00:19:03,090
+أنا أعطي ال angiotensin converting enzyme
+
+272
+00:19:03,090 --> 00:19:07,850
+inhibitors تمام؟ هذا بيخليلي ال blood pressure
+
+273
+00:19:07,850 --> 00:19:11,850
+اللي ناتج بداية عن ال renin اللي طلع و ال
+
+274
+00:19:11,850 --> 00:19:15,650
+angiotensin تولدت كوّن أنه هذا ألغي أنا عشان أمنع
+
+275
+00:19:15,650 --> 00:19:18,290
+ال blood pressure الناتج عن الكيليا ال
+
+276
+00:19:18,290 --> 00:19:20,990
+hypertension ناتج عن الكيليا mainly هيكون عبر مين؟
+
+277
+00:19:21,220 --> 00:19:31,000
+عبر ال renin system مش هيك ال theology .. هذه
+
+278
+00:19:31,000 --> 00:19:35,880
+انا برضه مخليها مهمة جدا ال theology of the ايه؟
+
+279
+00:19:35,880 --> 00:19:41,840
+of the chronic renal فارعةفي عام 1980، جلوميل
+
+280
+00:19:41,840 --> 00:19:47,000
+الارفريتس في جميع أنواعها كانت مؤمنة بأنها هي
+
+281
+00:19:47,000 --> 00:19:49,900
+السبب العام لإدارة الحصول على الـ End Stage Kidney
+
+282
+00:19:49,900 --> 00:19:53,040
+Disease كنا زمان نظن أن الجلوميل الارفريتس هي
+
+283
+00:19:53,040 --> 00:19:58,520
+المشكلة الرئيسية في الـ chronic kidney failure End
+
+284
+00:19:58,520 --> 00:20:02,650
+Stage Kidney Disease هو chronic kidneyin recent
+
+285
+00:20:02,650 --> 00:20:05,830
+years تبين إلي إنه أنا في حاجتين مهمين مش بس
+
+286
+00:20:05,830 --> 00:20:08,650
+الجوان الفريتس ال blood pressure و ال diabetes
+
+287
+00:20:08,650 --> 00:20:12,550
+السكر اللي موجود في العالم هو اللي بيخرب الكلية
+
+288
+00:20:12,550 --> 00:20:17,650
+اتنين الضغط اللي بيصير مع ال obesity الضغط بيخرب
+
+289
+00:20:17,650 --> 00:20:20,890
+الكلية هو قالك الضغط مارموض مع ال obesity قالك لأ
+
+290
+00:20:20,890 --> 00:20:23,450
+ما هو ال diabetes و ال obesity و الضغط ايه واحدة
+
+291
+00:20:23,450 --> 00:20:28,330
+واحدة قالك في حاجة اسمها metabolic syndrome واحد
+
+292
+00:20:28,330 --> 00:20:30,890
+سمن السكر عليه
+
+293
+00:20:34,120 --> 00:20:38,880
+الضغط عليه دخلنا في مشكلة metabolic syndrome تمام؟
+
+294
+00:20:38,880 --> 00:20:42,020
+طب لو اتصلح اه بيرجع السكر و بيرجع كلش تمام يعني
+
+295
+00:20:42,020 --> 00:20:46,040
+معظم السكر 75% من السكر في العالم سكر ناتج عن
+
+296
+00:20:46,040 --> 00:20:50,320
+obesity يعني لو صلحت ال obesity بتصلح اه metabolic
+
+297
+00:20:50,320 --> 00:20:53,560
+syndrome نسميها شوفوا اجروا عنه metabolic syndrome
+
+298
+00:20:53,560 --> 00:20:57,830
+جيد لإن هو مرض العصر اليومفي السنوات الماضية،
+
+299
+00:20:57,830 --> 00:21:01,890
+زيابتس مليتس والهيبرتنشين أصبحوا مسموحين كسبب
+
+300
+00:21:01,890 --> 00:21:03,690
+أساسية الحصول على الحصول على الحصول على الحصول على
+
+301
+00:21:03,690 --> 00:21:05,150
+الحصول على الحصول على الحصول على الحصول على الحصول
+
+302
+00:21:05,150 --> 00:21:06,210
+على الحصول على الحصول على الحصول على الحصول على
+
+303
+00:21:06,210 --> 00:21:06,310
+الحصول على الحصول على الحصول على الحصول على الحصول
+
+304
+00:21:06,310 --> 00:21:08,390
+على الحصول على الحصول على الحصول على الحصول على
+
+305
+00:21:08,390 --> 00:21:09,890
+الحصول على الحصول على الحصول على الحصول
+
+306
+00:21:12,560 --> 00:21:15,720
+Excessive weight gain appears to be the most
+
+307
+00:21:15,720 --> 00:21:19,000
+important risk factor for the two main causes of
+
+308
+00:21:19,000 --> 00:21:23,060
+indigestion Obesity هي اللي بتعمل السكر بيزيد معها
+
+309
+00:21:23,060 --> 00:21:26,440
+وهي اللي بتعلق الضغط لإن مع ال obesity ال
+
+310
+00:21:26,440 --> 00:21:29,780
+atherosclerosis بيزيد و بيزيد الضغط لإن كلهم
+
+311
+00:21:29,780 --> 00:21:32,680
+مربوطين إيه؟ إذا ال obesity الآن رسك كبير موجود
+
+312
+00:21:32,680 --> 00:21:36,660
+للعالم إذا تخلصنا منه حامينا الكيليا بطريقة ما
+
+313
+00:21:36,660 --> 00:21:42,690
+What is nephrotic syndrome؟أنا جبتلكم في الكلام في
+
+314
+00:21:42,690 --> 00:21:46,330
+أسنان الحديث حاجة عن الـ nephrotic syndrome تمام؟
+
+315
+00:21:46,330 --> 00:21:50,170
+اليوم كنا بنتكلم عنه بتوسع أكتر nephrotic syndrome
+
+316
+00:21:50,170 --> 00:21:56,590
+هو حالة من الحالات مش مرتبطة كتير بال .. بال
+
+317
+00:21:56,590 --> 00:22:00,850
+electrolytes و ال .. اه في diseases مربوطة بال
+
+318
+00:22:00,850 --> 00:22:04,410
+electrolytes و غيره اي .. اي acute renal failure
+
+319
+00:22:04,410 --> 00:22:07,570
+يعني بيعمل overload لل electrolytes و لل water و
+
+320
+00:22:07,570 --> 00:22:12,060
+كده ال kidney function failedلكن هذه حالة تانية بس
+
+321
+00:22:12,060 --> 00:22:16,140
+الكيليا بتهري ببروتين سمينها nephrotic syndrome
+
+322
+00:22:16,140 --> 00:22:19,660
+يعني الكيليا بس ايش بتهري ببروتين يعني ال
+
+323
+00:22:19,660 --> 00:22:26,860
+glomerulus filtration is more permeable to بروتين
+
+324
+00:22:26,860 --> 00:22:30,080
+than it should be فبيقدّي إلى أن فيه proteins
+
+325
+00:22:30,080 --> 00:22:33,140
+بتطلع من الجسم باستمرار بعد شوية هيصير عندك
+
+326
+00:22:33,140 --> 00:22:38,830
+hypoprotonemia الhypoprotonemia هذهلما تصير بتقدي
+
+327
+00:22:38,830 --> 00:22:43,630
+إلى generalized اديمة ليش؟ لأن الـ colloidal
+
+328
+00:22:43,630 --> 00:22:47,910
+pressure اللي من الـ plasma proteins هو الأساس في
+
+329
+00:22:47,910 --> 00:22:50,890
+السعادة في الميه اللي بتطلع من ال tissues فإذا
+
+330
+00:22:50,890 --> 00:22:56,230
+هبطت هذه إذا هبطت معناها ال filtration اللي بيصير
+
+331
+00:22:56,230 --> 00:23:01,370
+بيقبلوش reabsorption ع مستوى الجسم كله فبيقدي إلى
+
+332
+00:23:01,370 --> 00:23:06,150
+إن الاديمة بتبتد تتكون في كل الجسم شوية شوية شوية
+
+333
+00:23:07,740 --> 00:23:14,440
+طيب ال .. ال .. ال hypoproteinemia احنا عندناها
+
+334
+00:23:14,440 --> 00:23:21,840
+ناتج عن ال .. ال .. ال .. ال protonuria هرمون
+
+335
+00:23:21,840 --> 00:23:25,980
+albuminuria albumin أو بروتين تلقى في البون تشابه
+
+336
+00:23:25,980 --> 00:23:29,640
+ال hypo .. ال hypoproteinemia هذه البروتين الوطن
+
+337
+00:23:29,640 --> 00:23:34,170
+في الدم تشابه حالة الايه؟الـ liver failure لإن ال
+
+338
+00:23:34,170 --> 00:23:37,550
+liver failure مش بيهرب البروتين بيمنع تكوين
+
+339
+00:23:37,550 --> 00:23:41,030
+البروتين ال liver is the main source of protein
+
+340
+00:23:41,030 --> 00:23:45,910
+synthesis فلما ال liver يصير في عندي .. إذا في
+
+341
+00:23:45,910 --> 00:23:50,590
+عندي في حالات ال .. ال hepatic edema يكون عندي
+
+342
+00:23:50,590 --> 00:23:55,490
+liver disease بيقدر إلى تقليل تصنيع البروتين و ال
+
+343
+00:23:55,490 --> 00:23:58,990
+nephrotic syndrome عندي kidney disease بيقدر إلى
+
+344
+00:23:58,990 --> 00:24:03,400
+تهريب البروتينالنتجة في الآخر انه hypoproteinemia
+
+345
+00:24:03,400 --> 00:24:06,180
+يعني انا مالاج hypoproteinemia بدي ادور على liver
+
+346
+00:24:06,180 --> 00:24:09,500
+function و ادور على ال kidney function اشوف النتجة
+
+347
+00:24:09,500 --> 00:24:12,280
+من وين هذه تمام اذا جيت قلبه من كتير في ال ball
+
+348
+00:24:12,280 --> 00:24:15,720
+باطمن انه احنا ايه ال liver بخير ان لجينا ال ball
+
+349
+00:24:15,720 --> 00:24:19,000
+كويس و مافيش فيه protein معناها مشكلة كبيرة عندها
+
+350
+00:24:19,000 --> 00:24:23,820
+تصير حاليا ايضا صار في عنا liver transplantation
+
+351
+00:24:23,820 --> 00:24:29,160
+احنا انا بتكلم لازلت عن مرحلتي اناانه كان ال liver
+
+352
+00:24:29,160 --> 00:24:31,560
+transplantation مش موجود، بس موجود ايه؟ ال kid
+
+353
+00:24:31,560 --> 00:24:36,740
+transplantation، ملحوقة، بتغير، نزرع، مش كده؟ لكن
+
+354
+00:24:36,740 --> 00:24:40,040
+ال liver ضرب، لأ اليوم ب .. ايه؟ بنزرع ال liver
+
+355
+00:24:40,040 --> 00:24:44,020
+بنجحالـ liver اليوم بين زراع بين إجاح أنا حقيقة
+
+356
+00:24:44,020 --> 00:24:48,620
+القسم اللي كنت بشتغل فيه في .. اتدربت فيه في Leeds
+
+357
+00:24:48,620 --> 00:24:55,580
+شوية روحت على ال transplantation department
+
+358
+00:24:55,580 --> 00:24:58,420
+في St. James's hospital فلجيتهم بايدين ال liver
+
+359
+00:24:58,420 --> 00:25:01,260
+صرت أضحك و أفكر فيهم و سنة و سنة أضحك عليهم فانتوا
+
+360
+00:25:01,260 --> 00:25:04,900
+بس بضايق وقتهم على الفاضي لكن حاليا الآن تبين أنه
+
+361
+00:25:04,900 --> 00:25:08,540
+بالفعل في liver transplantation و ناجح
+
+362
+00:25:11,440 --> 00:25:14,820
+المرحلة الحالية سنة انا مش خايف برضه من ال liver
+
+363
+00:25:14,820 --> 00:25:19,420
+لإن في عندي liver transplantation مع أنه أصعب ومش
+
+364
+00:25:19,420 --> 00:25:22,980
+أسهل ومشكلة كبيرة لكن الله يبعد عننا ال liver و ال
+
+365
+00:25:22,980 --> 00:25:26,140
+renal disease لكن ال hypoproteinemia قد تعني liver
+
+366
+00:25:26,140 --> 00:25:32,440
+وقد تعني kidney تمام؟ اذا هنا في ال .. ال
+
+367
+00:25:32,440 --> 00:25:36,820
+nephrotic syndrome عندي picture معينة وهي فقدان
+
+368
+00:25:38,200 --> 00:25:41,780
+protein mainly albumin في البول يؤدي مع ال long
+
+369
+00:25:41,780 --> 00:25:45,280
+-time إلى الhypoprotein هنا في عنا خطأ بيصير بين
+
+370
+00:25:45,280 --> 00:25:49,740
+الناس العام بيقولوا في زولال في البول وكلمة زولال
+
+371
+00:25:49,740 --> 00:25:53,800
+في البول هذه تفهم بطريقة غريبة وبيعرفوا الناس ان
+
+372
+00:25:53,800 --> 00:25:57,570
+في زولال في البيتفبقولك لأ فى زولال فى ال bowl
+
+373
+00:25:57,570 --> 00:26:01,570
+فانا ماكولش بيض لإن فى زولال بلس إذا أكلت زولال
+
+374
+00:26:01,570 --> 00:26:05,430
+البيض أكلت زولال معناه بيصير عندى زولال فى لشسهم
+
+375
+00:26:05,430 --> 00:26:09,950
+مش عارفين إنهم زولال ال protein أنا فاخده بيحتاج
+
+376
+00:26:09,950 --> 00:26:13,790
+أنا عشان أعوضه إلى high protein diet بدي protein
+
+377
+00:26:13,790 --> 00:26:17,970
+diet عالى بحيث أن أقدر أعوض هذا فهم بيقولك لأ أنا
+
+378
+00:26:17,970 --> 00:26:20,690
+عندى زولال فى ال .. بديش أكل زولال بديش أكل بيض
+
+379
+00:26:20,690 --> 00:26:23,870
+طبعا المفهوم خاطئ لمفهوم الزولال زولال تعني
+
+380
+00:26:23,870 --> 00:26:29,440
+protein مش كدهالنقطتين الأخرتين اللي بدي أجيب
+
+381
+00:26:29,440 --> 00:26:32,380
+سيرتهم هو أنه ال anemia اللي في ال chronic kidney
+
+382
+00:26:32,380 --> 00:26:36,880
+failure و جيبنا سيرتها من ال hemobiosis ال
+
+383
+00:26:36,880 --> 00:26:40,660
+hemobiotin زي ما بيصير failure لكل ال function
+
+384
+00:26:40,660 --> 00:26:44,540
+اللي تاكدني من ضمنها بيصير عندى decrease in
+
+385
+00:26:44,540 --> 00:26:49,920
+production of the hemobiotin أو ال erythrobiotinو
+
+386
+00:26:49,920 --> 00:26:53,940
+هذا بيقدر الى مع arena of failure بيقدر الى ايش
+
+387
+00:26:53,940 --> 00:26:58,040
+الى anemia , severe anemia حقيقة ال anemia بتشكل
+
+388
+00:26:58,040 --> 00:27:01,940
+بحاجتين ان اليوريميا اللى موجودة اليوريميا في
+
+389
+00:27:01,940 --> 00:27:05,160
+حالتها هتخرب الجلب و هتخرب البنك الرئيسي و هتخرب
+
+390
+00:27:05,160 --> 00:27:08,220
+ال liver و هتخرب كل شيء اليوريميا كونها arena of
+
+391
+00:27:08,220 --> 00:27:12,930
+failure حالة اليوريميا هتخرب أشياء كتيرةلكن من
+
+392
+00:27:12,930 --> 00:27:16,110
+ضمنها انه مش بس بتخرب البون بارو المارو و مابتطلعش
+
+393
+00:27:16,110 --> 00:27:18,630
+ابتطر بيطين عشان يساعد البون بارو في ايه لذلك
+
+394
+00:27:18,630 --> 00:27:22,050
+بيصير عنده severe anemia early في الحالات هذه طبعا
+
+395
+00:27:22,050 --> 00:27:25,690
+الحمد لله رب العالمين من عشرين عشرين سنة فاتت
+
+396
+00:27:25,690 --> 00:27:30,030
+اكتشفوا او اكتر شويةاكتشفوا ال synthetic
+
+397
+00:27:30,030 --> 00:27:33,290
+erythropoietin سموه hemobiotin تمام؟ وهذه الجرعة
+
+398
+00:27:33,290 --> 00:27:37,410
+بتنعطيها للناس اللي عندهم renal failure تمام؟ اللي
+
+399
+00:27:37,410 --> 00:27:39,670
+بيعملوا غسل كيلة كانوا بنعطيه لهم ال
+
+400
+00:27:39,670 --> 00:27:42,050
+erythropoietin لحد ما يصير ناجل كيلة بعد ناجل
+
+401
+00:27:42,050 --> 00:27:45,530
+الكيلة خلاص بتصنع ال erythropoietin لحاله لكن طول
+
+402
+00:27:45,530 --> 00:27:50,390
+ما هم بينتظروا ال severe anemia اللي بيغسل severe
+
+403
+00:27:50,390 --> 00:27:55,370
+anemia لهذا اللي بيغسل صارت عندي قادر انه انا
+
+404
+00:27:55,370 --> 00:28:00,200
+اعوضهابإني أديله إيراترو بايوتين فبصير ال bomber
+
+405
+00:28:00,200 --> 00:28:04,900
+يصلح لحاله اللي بيغسل كده بيخرّب RBCs من خلال ال
+
+406
+00:28:04,900 --> 00:28:08,660
+machine اللي أنا بستخدمها و بيخرّب
+
+407
+00:28:11,550 --> 00:28:15,930
+هو بيخرّب تصنيع لإن ال irritability انجل، فإذا ال
+
+408
+00:28:15,930 --> 00:28:19,430
+irritability انجل فالتصنيع جالين و التكسير كتير،
+
+409
+00:28:19,430 --> 00:28:24,510
+اللي داخل أجليه و اللي طالع كتير، لإن أنا داخل
+
+410
+00:28:24,510 --> 00:28:29,010
+artificial machine بكسر mechanical destruction of
+
+411
+00:28:29,010 --> 00:28:34,330
+bloodof RBCs فمحتاج انه ايه؟ اعوضها فوجود
+
+412
+00:28:34,330 --> 00:28:38,010
+الارتروبيوتين الجديد الهيموبيوتين يصبح يد جرعة كل
+
+413
+00:28:38,010 --> 00:28:42,030
+شهر للناس وهذا يقدر إلى انه يتصلح الدم لحاله وهذا
+
+414
+00:28:42,030 --> 00:28:44,870
+عمل قفزة كتير في الناس اللي بيعملوا غسل الكلة
+
+415
+00:28:44,870 --> 00:28:52,310
+تمام؟الأستيو ماليشيا .. الأستيو ماليشيا قولنا بسبب
+
+416
+00:28:52,310 --> 00:28:55,590
+مين؟ ال vitamin D3 و بيجلل ال reabsorption في ال
+
+417
+00:28:55,590 --> 00:28:59,550
+intestinal اه ال intestinal absorption of كالسيوم
+
+418
+00:28:59,550 --> 00:29:02,830
+بيجلل طبعا ال .. ال .. ال .. مابقولش ال
+
+419
+00:29:02,830 --> 00:29:04,730
+reabsorption في الكلية لإن الكلية أساسا هي
+
+420
+00:29:04,730 --> 00:29:09,510
+failing، تمام؟طيب تريتمنت واحد عنده رينال فاليار
+
+421
+00:29:09,510 --> 00:29:12,430
+كرويكينال فاليار و بدنا نعمله علاج بدنا نعمله يا
+
+422
+00:29:12,430 --> 00:29:16,750
+اما artificial kidney يا اما transplantation
+
+423
+00:29:16,750 --> 00:29:20,030
+kidney مش كده بدنا ندخله في واحدة من الاتنين تانية
+
+424
+00:29:20,030 --> 00:29:23,910
+ال artificial kidney قد تكون peritoneal dialysis
+
+425
+00:29:23,910 --> 00:29:29,990
+قد تكون CAPD continuous ambulatory peritoneal
+
+426
+00:29:29,990 --> 00:29:37,160
+dialysis و hemodialysis تمام طبعااللي هيكون احنا
+
+427
+00:29:37,160 --> 00:29:41,340
+زمان كنا نعمل virtual dialysis بعدين اتطورت لهيمو
+
+428
+00:29:41,340 --> 00:29:45,160
+dialysis بعدين رجعنا المفروض التسلسل يكون واحد
+
+429
+00:29:45,160 --> 00:29:51,080
+تلاتة اتنين رجعنا لل CIPD ليش؟ لإنه ال
+
+430
+00:29:51,080 --> 00:29:56,640
+hemodialysis جثة كبيرة بديجي مرة مرة مرتين في
+
+431
+00:29:56,640 --> 00:30:00,620
+الأسبوع هيجي يومين في الأسبوع على المستشفي يعمل
+
+432
+00:30:00,620 --> 00:30:03,550
+dialysisاليوم اللي جابلي ال dialysis بيكون تعبان
+
+433
+00:30:03,550 --> 00:30:06,030
+عشان كده محتاج dialysis واليوم اللي بعمله فيه ال
+
+434
+00:30:06,030 --> 00:30:08,430
+dialysis بيكون تعبان لإنه طالع من ال dialysis يعني
+
+435
+00:30:08,430 --> 00:30:11,750
+في الأسبوع بيعيش مصحصح يومين أو تلاتة وبعد الأسبوع
+
+436
+00:30:11,750 --> 00:30:16,650
+بيكون ايه؟ بيكون تعبان تمام؟ فقالوا لأ بداش نعمل
+
+437
+00:30:16,650 --> 00:30:20,030
+احنا hemodialysis في أوجه محددة بدنا نعمل
+
+438
+00:30:20,030 --> 00:30:26,250
+continuous ambulatory peritoneal dialysis نديله ال
+
+439
+00:30:26,250 --> 00:30:30,050
+dialysate medium نعمله احنا peritoneal cannula
+
+440
+00:30:32,320 --> 00:30:34,540
+بنعمله canner في البريتون هو شو البريتون ال
+
+441
+00:30:34,540 --> 00:30:39,460
+dialysis اني أحط مواد نظيفة هو البريتون نفسه by
+
+442
+00:30:39,460 --> 00:30:45,220
+diffusion لإنه تركيز المواد السيئة ال electrolytes
+
+443
+00:30:45,220 --> 00:30:50,540
+الزيادة و ال waste products زيادة موجودة في الدم
+
+444
+00:30:50,540 --> 00:30:53,980
+أكتر لكن ال dialyzer اللي بحطه أنا شبيه بال extra
+
+445
+00:30:53,980 --> 00:30:58,260
+cereal fluid standardفكل الزيادة اللى بتيجي فيه
+
+446
+00:30:58,260 --> 00:31:01,980
+تمام؟ من دخله البروتريال دياليسيز من دخله نستنى
+
+447
+00:31:01,980 --> 00:31:05,880
+ساعتين تلاتة اربعة و بعدين نشفطه و نحط غيره تمام؟
+
+448
+00:31:05,880 --> 00:31:09,200
+و هكذا فبطلع طبعا حامل إلكتروناسيز زيادة حامل
+
+449
+00:31:09,200 --> 00:31:12,580
+بوتاسيب زيادة حامل يوريا زيادة حامل كرياتينين
+
+450
+00:31:12,580 --> 00:31:16,540
+زيادة حامل أشياء كتير زيادة مش هيك؟ فبنضل ان احنا
+
+451
+00:31:16,540 --> 00:31:19,800
+هذا البروتريال دياليسيز العادي لما عملنا
+
+452
+00:31:19,800 --> 00:31:24,740
+Hemodialysisعند كلام عنها بعد شوية لجيناها قفزة
+
+453
+00:31:24,740 --> 00:31:27,700
+كبيرة لإن بحتاجش أنا مدة طويلة في ال dialysis إزاي
+
+454
+00:31:27,700 --> 00:31:31,320
+البروتينيال بستخدم بسرعة بتتم العملية تلت أربع
+
+455
+00:31:31,320 --> 00:31:34,520
+ساعات و بقوله اروح روح و بيضل عليها تلت أربع أيام
+
+456
+00:31:34,520 --> 00:31:38,340
+كويس تمام؟ بعدين قولنا طب هذا مسكين حياته انعدمت
+
+457
+00:31:38,340 --> 00:31:41,140
+بطل يشتغل لإن صار يومين أو تلت عندى في المستشفى
+
+458
+00:31:41,140 --> 00:31:45,880
+قولنا نعمل continuous ambulatory peritoneal
+
+459
+00:31:45,880 --> 00:31:50,900
+dialysis CAPD هاديحقيقة بيضل في شغله و بيضل الروح
+
+460
+00:31:50,900 --> 00:31:54,000
+ييجي و بيضل يعمل غسل 24 ساعة زي ما الكلة في
+
+461
+00:31:54,000 --> 00:31:56,880
+الطبيعة بتعمل 24 ساعة يعني البروتينال دهاليسيس
+
+462
+00:31:56,880 --> 00:31:59,780
+واجدش احنا بطلنا منه لإنه بده يروح المستشفى يعمل
+
+463
+00:31:59,780 --> 00:32:03,040
+بروتينال دهاليسيس و هذا بطيء و بده يقعد كل يوم كل
+
+464
+00:32:03,040 --> 00:32:07,320
+يوم في المستشفىلكن هي مدارس سريع فعمل فرق في .. في
+
+465
+00:32:07,320 --> 00:32:09,840
+.. في .. في .. في .. في فكرة ال artificial kidney
+
+466
+00:32:09,840 --> 00:32:14,400
+هي مدارس لكن ال CIPD للناس الكورانيك سنة نديهم
+
+467
+00:32:14,400 --> 00:32:18,820
+احنا كرتونة المحلين و نعلمه اش يعمل نعملنا له
+
+468
+00:32:18,820 --> 00:32:23,560
+canula بريتريا ال canula تمام؟ عملية جراحية و ال
+
+469
+00:32:23,560 --> 00:32:26,920
+canula موجودة و طالع منها تيوب على جامب و بنقولله
+
+470
+00:32:26,920 --> 00:32:35,630
+انت الصبح بدك تفطر اشبط محلول وعلجهفى الـ A is the
+
+471
+00:32:35,630 --> 00:32:39,250
+stand اللى جنبك بتخلص الفطور بيكون محلول خلص لفه
+
+472
+00:32:39,250 --> 00:32:43,630
+اه و سكره و خطه فى جيبك و روح لشغلك بدك تتغدى
+
+473
+00:32:43,630 --> 00:32:46,670
+الظهر lunch time ساعة واحدة بتنزل محلوله على الأرض
+
+474
+00:32:46,670 --> 00:32:52,250
+كان كل اللى انت حاطيته برجع لمين للكيس اربطه ارميه
+
+475
+00:32:52,250 --> 00:32:55,370
+و خط محلول غيره وعلجه بتكمل غداء بيكون ال A
+
+476
+00:32:55,370 --> 00:33:00,070
+المحلول الجديد دخل ال abdomen تمام على العشاء
+
+477
+00:33:00,070 --> 00:33:04,680
+بتغير التالتisn't continuous عيب البريتونيا
+
+478
+00:33:04,680 --> 00:33:08,500
+دياليسيز اللي كان بطيق و بدك تعمله متواصل في
+
+479
+00:33:08,500 --> 00:33:11,680
+مستشفى لأ يعمله في الدار لحاله طبعا هدودها ناس
+
+480
+00:33:11,680 --> 00:33:14,480
+متعلمين و بيه أراقية و نظيفة عشان مايصيرش
+
+481
+00:33:14,480 --> 00:33:18,760
+بريتونيتس عشان مايصيرش infection منعلمه كيف يعمل
+
+482
+00:33:18,760 --> 00:33:22,260
+ال .. ال .. ال .. ال aseptic techniques كلها بحيث
+
+483
+00:33:22,260 --> 00:33:25,460
+أنه بيصير لحاله بيرجع لحياته الطبيعية لحد ال
+
+484
+00:33:25,460 --> 00:33:25,780
+strategically
+
+485
+00:33:31,760 --> 00:33:36,080
+طبعا ال dialysis هذه مكلفة جدا المحليين اللي
+
+486
+00:33:36,080 --> 00:33:40,260
+مستخدمها للغسل لإنها دقيقة في تكوينها تبتبجى غالية
+
+487
+00:33:40,260 --> 00:33:42,860
+مع ان تركيبه ولا إشي يعني صادم و بتقسم و شوية
+
+488
+00:33:42,860 --> 00:33:48,840
+album و كده مش غالية كتير إلا إن ال what is
+
+489
+00:33:48,840 --> 00:33:54,480
+hemodialysis hemodialysis عبارة عن إن أعمل
+
+490
+00:33:57,020 --> 00:34:02,140
+مكان يحتاج فيه الدم مع ال dialyzate اللي أنا بحطه
+
+491
+00:34:02,140 --> 00:34:07,740
+زي البريتون ال membrane لكن ال membrane هدا حاجز
+
+492
+00:34:07,740 --> 00:34:12,020
+بينهم عندى cellophane cellophane membrane حاجز ما
+
+493
+00:34:12,020 --> 00:34:18,280
+بين ال dialyzate و ال blood تمام؟ اذا عندنا فيها
+
+494
+00:34:18,280 --> 00:34:21,720
+cellophane الدم ماشي فيها و حواليها فيه ال
+
+495
+00:34:21,720 --> 00:34:25,120
+dialyzate تمام؟ و هم اتنين ماشيين في اتجاه واحد
+
+496
+00:34:25,850 --> 00:34:29,590
+الدم ماشي هان هيك و ال dialyzer ماشي هيك تاني ماشي
+
+497
+00:34:29,590 --> 00:34:32,170
+في flow في اتجاه واحد طبعا احنا زي ما انتوا شايفين
+
+498
+00:34:32,170 --> 00:34:39,430
+هان بناخد الدم من الشريان و بنرجعه للوريد هذه
+
+499
+00:34:39,430 --> 00:34:42,630
+المكينة تبعت ال dialyzer .. dialysis هي ال
+
+500
+00:34:42,630 --> 00:34:49,210
+dialysis هان تمام ال dialyzer هذا عندي دائرة فيها
+
+501
+00:34:49,210 --> 00:34:55,570
+ال dialyzer بيدخل بطريقة معينة بإجبال الدمهان
+
+502
+00:34:55,570 --> 00:34:58,170
+بيبقى ال flow تبع الدم وهان تبع ال flow دالي زيت
+
+503
+00:34:58,170 --> 00:35:01,350
+ال by diffusion ال simple diffusion الأشياء الأعلى
+
+504
+00:35:01,350 --> 00:35:04,950
+بتخش عن طريق السلوفين إلى الأشياء طبعا واضح أنه في
+
+505
+00:35:04,950 --> 00:35:09,990
+دالي زيت هان في عندي album عندي extra serif fluid
+
+506
+00:35:09,990 --> 00:35:14,290
+composition عشان بس اللي زيد عن هذه التركيبة هو
+
+507
+00:35:14,290 --> 00:35:18,890
+اللي هنتقل إلى إيه إلى إلى إلى ال دالي زيت اللي
+
+508
+00:35:18,890 --> 00:35:24,940
+يصل لل level هادا يثبت على هيعشان ادي فوق فترة
+
+509
+00:35:24,940 --> 00:35:28,160
+اطول للتانين يقبعوا البعض عشان يبقى انتقال انتقال
+
+510
+00:35:28,160 --> 00:35:32,160
+انتقال لحد بيصلوا ايه ل balance تمام ساعد العملية
+
+511
+00:35:32,160 --> 00:35:35,860
+هذه انه انا اعمل طيب ال dialyze هذا بده ادخله ال
+
+512
+00:35:35,860 --> 00:35:39,320
+system هذا بده ادخله under pressure يعني مش بس
+
+513
+00:35:39,320 --> 00:35:42,280
+simple diffusion وعملت شوية pressure زي ما الجالب
+
+514
+00:35:42,280 --> 00:35:45,380
+بيعمل pressure عشان يصير filtration في الكيليا
+
+515
+00:35:45,380 --> 00:35:48,720
+اعملنا شوية pressure ع ال dialyze هذه فصار عندي
+
+516
+00:35:49,420 --> 00:35:53,200
+عندي صار mass transport مش بس ايه بال diffusion
+
+517
+00:35:53,200 --> 00:35:57,200
+البسيط، الضغط اللي أنا عامله كان أسرع في انتقال
+
+518
+00:35:57,200 --> 00:35:57,720
+المواد
+
+519
+00:36:00,550 --> 00:36:03,510
+طبعا الماكينة هذه اللي دخلت هنا هتكسر دم زي ما
+
+520
+00:36:03,510 --> 00:36:09,110
+قلتلكم ال cellophane membrane هذا ممكن يتبزع و
+
+521
+00:36:09,110 --> 00:36:11,370
+فجأة الدم يخش على ال dialyzer و يتوقف خارج ال
+
+522
+00:36:11,370 --> 00:36:15,790
+filter هذا كله هو عبارة عن طبقات من ال cellophane
+
+523
+00:36:15,790 --> 00:36:20,310
+دائرة كده طبقات من ال cellophane او دائرة او كيف
+
+524
+00:36:20,310 --> 00:36:23,830
+ما يكون سيلندر لكن طبقات مختلفة واحدة ماخش فيها دم
+
+525
+00:36:23,830 --> 00:36:25,950
+واحدة ماخش فيها dialyzer واحدة ماخش فيها دم واحدة
+
+526
+00:36:25,950 --> 00:36:33,230
+ماخش فيها dialyzerمش بس في طيار واحد لأ طيارات
+
+527
+00:36:33,230 --> 00:36:38,250
+كتيرة داخلة يعني مش عكس بعض لكن بالتبادل لكن بمشوف
+
+528
+00:36:38,250 --> 00:36:42,090
+اتجاه واحد الدم ماشي هيك و الدالزيت ماشي معاه عشان
+
+529
+00:36:42,090 --> 00:36:44,990
+يضلوا جبال بعض لحد ما يصير ال balance ال
+
+530
+00:36:44,990 --> 00:36:49,510
+equilibrium بين الاتنين تمام؟ وهكذا اذا هذه اللي
+
+531
+00:36:49,510 --> 00:36:52,930
+هي مدالسة فهذه فكرته الرئيسية اضفنا عليه كلمة ال
+
+532
+00:36:52,930 --> 00:36:57,420
+ايه انه اخر شئ to preventEcoagulation مضيف هيبرين
+
+533
+00:36:57,420 --> 00:36:59,760
+طبعا هذا هيبرينية اللي بيكون اللي انا بده اشتغل
+
+534
+00:36:59,760 --> 00:37:02,200
+عليه و ايه اللي هيصير ال clothing في داكل اللي هيش
+
+535
+00:37:02,200 --> 00:37:07,580
+اسمه بعمل تقريبا مترين و نص مساحة ال .. ال .. ال
+
+536
+00:37:07,580 --> 00:37:10,700
+.. ال surface area اللي بيصير فيها التبادل بسبب ..
+
+537
+00:37:10,700 --> 00:37:14,480
+بما انه كلنا طيوب هالجد لكن زي ما قلتلكم عدة طبجات
+
+538
+00:37:14,480 --> 00:37:20,000
+عدة طبجات و كل .. طبجة هيك و طبجة هيك طبجةتمام؟
+
+539
+00:37:20,000 --> 00:37:22,280
+بالاضافة لإن إذا زدنا ال pressure إحنا في المنطقة
+
+540
+00:37:22,280 --> 00:37:26,900
+هذه بيصير عندنا bulk flow filtration لإنه صار ال
+
+541
+00:37:26,900 --> 00:37:30,280
+pressure عالي فبقدر إلى better filtration هيك
+
+542
+00:37:30,280 --> 00:37:33,100
+بنكون خلصنا الكلمة المحاضرة اللي جاية معناها نتكلم
+
+543
+00:37:33,100 --> 00:37:34,420
+عن ال respiratory tract
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo.srt
new file mode 100644
index 0000000000000000000000000000000000000000..748bbdf8f670e1a3738bc23b0b04b75adf063ffa
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo.srt
@@ -0,0 +1,1381 @@
+1
+00:00:05,860 --> 00:00:09,840
+تمام؟ يعني قبل transport maximum ما نصله احنا فيه
+
+2
+00:00:09,840 --> 00:00:13,520
+جزء بيكون بيطلع لسه في الـ ball ليش؟ لأن مش كل الـ
+
+3
+00:00:13,520 --> 00:00:18,340
+nephrons يلهم نفس الـ transport maximum لما أتكلم
+
+4
+00:00:18,340 --> 00:00:22,120
+عن مستوى الـ nephron على مستوى الـ nephron كل
+
+5
+00:00:22,120 --> 00:00:26,650
+nephron له transport maximum مختلف عن التاني تمام
+
+6
+00:00:26,650 --> 00:00:30,750
+واحد طاقة كبيرة، واحد طاقة صغيرة. فإني لما وصلت
+
+7
+00:00:30,750 --> 00:00:36,850
+لمرحلة 200 مثلا ملي جرام سكر في الدم، تمام. بعض الـ
+
+8
+00:00:36,850 --> 00:00:41,970
+نيفرونز صارت تأخذ جزء من هذا السكر، والجزء الثاني
+
+9
+00:00:41,970 --> 00:00:45,010
+ما بتقدرش تاخده، لكن بعض الـ نيفرونز عندها طاقة
+
+10
+00:00:45,010 --> 00:00:49,520
+لازالت تاخذه. فـ minimal sugar هيبدأ يظهر عندي لو
+
+11
+00:00:49,520 --> 00:00:54,460
+زدنا السكر أكثر في الدم، لو زاد أكثر وصار الـ
+
+12
+00:00:54,460 --> 00:00:58,380
+filtration سكر أكثر، معناها في عندي في other
+
+13
+00:00:58,380 --> 00:01:03,400
+nephrons برضه هتصل لـ maximum تبعها، وهيصير أكثر
+
+14
+00:01:03,400 --> 00:01:08,200
+urine أكثر، إيش يطلع؟ سكر أكثر يطلع في الـ ball، لكن
+
+15
+00:01:08,200 --> 00:01:15,300
+صار برضه الامتصاص بيزيد، إذا لحد ما نصل أن
+
+16
+00:01:15,300 --> 00:01:21,260
+الامتصاص في كل الـ nephrons وصل لـ maximum. أي زيادة
+
+17
+00:01:21,260 --> 00:01:26,800
+في الـ sugar load، كل زيادة عن level معين، كل
+
+18
+00:01:26,800 --> 00:01:30,580
+زيادة بتطلع في البول، معينة، جزء من الزيادة بيطلع و
+
+19
+00:01:30,580 --> 00:01:34,880
+جزء reabsorbed لأنه different abilities of the ..
+
+20
+00:01:34,880 --> 00:01:38,820
+آه، لكن عند معي .. آه، إذا الفترة هذه اللي بنصل فيها
+
+21
+00:01:38,820 --> 00:01:43,660
+كل زيادة في الـ load executed بنسميها، أوصلنا هذا
+
+22
+00:01:43,660 --> 00:01:49,570
+اسمه، الكمية اللي صار لها reabsorption. آه هذه
+
+23
+00:01:49,570 --> 00:01:52,770
+transport maximum. وبعد الكمية يعني لما يكون عندي
+
+24
+00:01:52,770 --> 00:01:59,790
+load معين، الـ load الـ 375 مثلا milligram per minute
+
+25
+00:01:59,790 --> 00:02:03,430
+في الكلية الواحدة، في الكليتين، can be reabsorbed
+
+26
+00:02:03,430 --> 00:02:07,890
+الـ filtered أكثر من 375 milligram، كله بيطلع، تمام.
+
+27
+00:02:07,890 --> 00:02:13,690
+لكن لما يكون احنا ما نيش بنقول أن ما هو السكر بدأ
+
+28
+00:02:13,690 --> 00:02:18,360
+يبيّن من بدري، لسه من أول nephron إنفشل في أنه يأخذ كل
+
+29
+00:02:18,360 --> 00:02:22,620
+ما جاء من الـ load، بدأ يبين السكر في الـ bowl، هذه
+
+30
+00:02:22,620 --> 00:02:25,560
+مسمى مثلا threshold level، إذا في عندي threshold
+
+31
+00:02:25,560 --> 00:02:28,600
+level أو في عندي transport maximum، الـ threshold
+
+32
+00:02:28,600 --> 00:02:32,780
+level، أول level بيبدأ السكر يظهر فيه في الـ ايه؟ في
+
+33
+00:02:32,780 --> 00:02:41,600
+الـ bowl. بمعنى أنه بتديني شكل أقل نفرون قادر على ايه؟
+
+34
+00:02:41,600 --> 00:02:45,700
+يصل the lowest transport maximum in one نفرون
+
+35
+00:02:45,700 --> 00:02:48,660
+النفرون اللي يقولوا the lowest transport maximum
+
+36
+00:02:48,660 --> 00:02:53,320
+تشبع، والزائد بده يظهر، لكن الآخرين لسه يستطيعوا
+
+37
+00:02:53,320 --> 00:02:58,460
+يأخذوا سكر زائد. لما نسأل عن level، أنه كل الزيادة في
+
+38
+00:02:58,460 --> 00:03:02,080
+الـ load بصير لبرا، معناها وصلنا لـ transport maximum
+
+39
+00:03:02,080 --> 00:03:06,480
+وهذا الفرق بين الـ ايه؟ التاني. مش هيك؟ لو طلعنا على
+
+40
+00:03:06,480 --> 00:03:13,170
+الصورة هذه، تبعت السكر. بنقول هنا الطبيعي أن السكر
+
+41
+00:03:13,170 --> 00:03:22,430
+الـ load تبعنا، مثلا عندنا مية، خمسماية ملي السكر، من
+
+42
+00:03:22,430 --> 00:03:27,870
+سبعين لـ مية وعشرين، لمية وعشرة، حسب القراءات، يعني
+
+43
+00:03:27,870 --> 00:03:34,110
+متوسط مية ملي جرام per cent. معناها في مية وخمسة
+
+44
+00:03:34,110 --> 00:03:39,550
+وعشرين، معناها ايه؟ بيطلع 125 milligram per minute
+
+45
+00:03:39,550 --> 00:03:44,750
+احنا عندنا مية التركيز، يعني one milligram per
+
+46
+00:03:44,750 --> 00:03:48,230
+milliliter، وـ filtration بيصير عندي 125 milliliter
+
+47
+00:03:48,230 --> 00:03:51,670
+per minute، مش كده؟ معناها أن عندي 125 milligram
+
+48
+00:03:51,670 --> 00:03:57,950
+طبيعي في الـ ايه؟ في الدقيقة. is the glucose load to
+
+49
+00:03:57,950 --> 00:04:01,710
+the tubules can be reabsorbed easily، كله
+
+50
+00:04:01,710 --> 00:04:06,080
+reabsorbed، ولا نفرون بيفلت، تمام. لذلك أنا بأبحث، بأقول
+
+51
+00:04:06,080 --> 00:04:11,680
+في الطبيعي، بلاقي no sugar، no sugar، تمام. طيب، لو زاد
+
+52
+00:04:11,680 --> 00:04:15,440
+السكر تركيزه، من مية، مية وعشرة، مية وعشرين، مية
+
+53
+00:04:15,440 --> 00:04:18,120
+وثلاثين، مية وأربعين، برضه completely absorbed
+
+54
+00:04:18,120 --> 00:04:23,660
+يعني الخط الأحمر هذا الـ .. الـ filtered load، الخط
+
+55
+00:04:23,660 --> 00:04:29,380
+الأحمر، الـ filtered load، الـ .. الخط الأزرق، بتكلم عن
+
+56
+00:04:29,380 --> 00:04:35,470
+ايه؟ الـ reabsorption، كل اللي filtered، reabsorbed
+
+57
+00:04:35,470 --> 00:04:40,170
+تمام، وموازيين، ما فيش مع بعض، لكن عند مرحلة معينة الـ
+
+58
+00:04:40,170 --> 00:04:45,290
+filtration بيصير أكثر، فبيبدأ الـ الـ reabsorption
+
+59
+00:04:45,290 --> 00:04:51,790
+يتوقف عند level معين، تمام. وبعدين لاحظوا الـ curve
+
+60
+00:04:51,790 --> 00:05:00,920
+هذا، هون هذا هنا، الـ threshold، بدأ بعض الـ اللي الـ
+
+61
+00:05:00,920 --> 00:05:03,600
+sugar .. الـ sugar يبين في الـ bowl، إذا هنا وصلنا الـ
+
+62
+00:05:03,600 --> 00:05:08,000
+threshold level، threshold of، أي أول level
+
+63
+00:05:08,000 --> 00:05:12,820
+concentration of plasma sugar اللي بيبدأ يظهر فيه
+
+64
+00:05:12,820 --> 00:05:15,920
+sugar في الـ bowl، هنا ايه؟ بيبدأ عندي هنا الـ
+
+65
+00:05:15,920 --> 00:05:19,960
+threshold level، اللي هو عندي هنا، بيطلع حوالي مئتين
+
+66
+00:05:19,960 --> 00:05:24,860
+وشوية، آه، أو مئتين و آه، تمام؟ إذا في الـ .. هنا في
+
+67
+00:05:24,860 --> 00:05:28,520
+المنطقة هذه، بيبدأ الـ .. الـ reabsorption ما يكونش
+
+68
+00:05:28,520 --> 00:05:32,420
+لكل الـ load، لإنه بعض الـ nephrons failed، وبيبدأ
+
+69
+00:05:32,420 --> 00:05:35,960
+يظهر، هاي الـ excreted، الأخضر هذا، الـ bowl، يظهر فيه
+
+70
+00:05:35,960 --> 00:05:39,840
+ندفة ندفة ندفة ندفة، تمام. الـ bowl، بعدين بيصير
+
+71
+00:05:39,840 --> 00:05:43,100
+الزيادة في الـ excretion موازية للزيادة في الـ load
+
+72
+00:05:43,100 --> 00:05:47,860
+لأنه كل اللي loaded زيادة، آه، بعد level معين، يعني
+
+73
+00:05:47,860 --> 00:05:50,940
+بعد ما يصير عندي الـ concentration تقريبا
+
+74
+00:05:50,940 --> 00:05:56,970
+ثلاثمية، بصير عندي كل زيادة عن ثلاثمية في الدم، يعني
+
+75
+00:05:56,970 --> 00:06:00,690
+جديش بيكون في الـ .. في الـ .. في الـ load، ثلاثمية و
+
+76
+00:06:00,690 --> 00:06:04,730
+خمس وسبعين، مش في مية وخمس وعشرين، بنضرب، كل مية لها
+
+77
+00:06:04,730 --> 00:06:08,510
+مية وخمس وعشرين، فالثلاثمية sugar هي ثلاثمية وخمس
+
+78
+00:06:08,510 --> 00:06:11,550
+ وسبعين، ثلاثمية وخمس وسبعين. بعد الـ load، ثلاثمية و
+
+79
+00:06:11,550 --> 00:06:16,310
+خمس وسبعين، كل الزيادة بيكون عندي كل الـ tube in
+
+80
+00:06:16,310 --> 00:06:20,770
+reference وصلت للـ maximum تبعها، فبيصير عندي الـ
+
+81
+00:06:20,770 --> 00:06:27,170
+extra load is clear as an extra sugar in the urine
+
+82
+00:06:27,170 --> 00:06:31,210
+تمام، في الفترة، الـ curve هذه بتديني الفرق ما بين الـ
+
+83
+00:06:31,210 --> 00:06:35,190
+threshold، minimal threshold، لحد ما نصل لـ maximum
+
+84
+00:06:35,190 --> 00:06:43,820
+transport. بعدها واضح الـ curve هذا، okay. طيب، إذا في
+
+85
+00:06:43,820 --> 00:06:48,080
+عندنا الـ transport maximum لبعض المواد اللي يلهم
+
+86
+00:06:48,080 --> 00:06:52,020
+الـ transport maximum، هدول معناها عبارة عن المواد
+
+87
+00:06:52,020 --> 00:06:55,460
+يعتمدوا في الـ absorption هم على إيش؟ على الـ carrier
+
+88
+00:06:55,460 --> 00:06:59,040
+system. لأن الـ carrier system can be saturated، can
+
+89
+00:06:59,040 --> 00:07:04,280
+be saturated، يتشبع. كل زيادة عن قدرته، خلاص، أنا
+
+90
+00:07:04,280 --> 00:07:08,860
+ما إليش أنا هيك، طاقتي أكثر من هيك، مع السلامة إلى
+
+91
+00:07:08,860 --> 00:07:13,160
+الخارج. لكن واضح أن احنا عندنا في الطبيعي أن الـ
+
+92
+00:07:13,160 --> 00:07:21,180
+load can be reabsorbed completely، مش هيك؟ طيب،
+
+93
+00:07:21,180 --> 00:07:25,220
+دربنا
+
+94
+00:07:25,220 --> 00:07:28,360
+مثال، إذا بالسكر، وهذا أهم مثال لنا في الدراسة اللي
+
+95
+00:07:28,360 --> 00:07:32,240
+بعتناها، أهم مثال السكر، لأن diabetes mellitus، أهم
+
+96
+00:07:32,240 --> 00:07:37,410
+مرض في العالم. ليش أهم مرض في العالم؟ لإنه الـ
+
+97
+00:07:37,410 --> 00:07:41,990
+occupancy في المستشفيات، معظمها مربوط بالـ diabetes
+
+98
+00:07:41,990 --> 00:07:46,270
+mellitus، في كل الأقسام، كل الأمراض بتزيد، والمشاكل
+
+99
+00:07:46,270 --> 00:07:51,150
+بتزيد بسبب وجود ايه؟ الـ diabetes. فجدا مهم جدا احنا
+
+100
+00:07:51,150 --> 00:07:55,730
+نفهم الـ diabetes، لإنه هيصاحبنا في شغلنا، في أي تخصص
+
+101
+00:07:55,730 --> 00:07:59,290
+من التخصصات، هنلاقي جاعد عندي ايه؟ diabetes mellitus
+
+102
+00:08:03,700 --> 00:08:06,260
+إذا، however، when the plasma concentration of
+
+103
+00:08:06,260 --> 00:08:12,060
+glucose rises above 200 milligram percent، بيبدأ
+
+104
+00:08:12,060 --> 00:08:17,980
+عندي ايه؟ increasing the filtered load to 250، a
+
+105
+00:08:17,980 --> 00:08:21,680
+small amount of glucose begins to appear in urine
+
+106
+00:08:21,680 --> 00:08:26,820
+لذلك الـ 200 هذا يعتبر ايه؟ الـ threshold. إذا هذا الـ
+
+107
+00:08:26,820 --> 00:08:30,240
+level، this point is termed the threshold for
+
+108
+00:08:30,240 --> 00:08:34,660
+glucose. بعد تركيز السكر 200، بيبدأ يظهر في الـ bowl
+
+109
+00:08:34,660 --> 00:08:39,260
+لأن هذا الـ level تبع البلازما sugar يسمى threshold
+
+110
+00:08:39,260 --> 00:08:45,040
+level. Note that this appearance of glucose in
+
+111
+00:08:45,040 --> 00:08:48,940
+urine occurs before the transport maximum is
+
+112
+00:08:48,940 --> 00:08:53,140
+reached. وقلنا ليش،
+
+113
+00:08:53,140 --> 00:08:58,260
+إذا الـ transport maximum هذا مش بس على السكر، على كل
+
+114
+00:08:58,260 --> 00:09:00,340
+المواد اللي بتستخدم ايه؟ carrier system
+
+115
+00:09:00,340 --> 00:09:04,060
+facilitated diffusion. فمثلا عندي للجلوكوز الـ
+
+116
+00:09:04,060 --> 00:09:06,540
+transport maximum تبعه ثلاثمية وخمس وسبعين
+
+117
+00:09:06,540 --> 00:09:11,100
+milligram per minute، طبعا نحسب للـ two kidneys، مش هيك؟
+
+118
+00:09:11,100 --> 00:09:15,000
+زي ما بيقول مية وخمس وعشرين ملي لتر per minute، GFR،
+
+119
+00:09:15,000 --> 00:09:19,380
+glomerular filtration rate for the two kidneys، آه
+
+120
+00:09:19,380 --> 00:09:22,020
+for the two kidneys، ومية وخمس وعشرين ملي لتر per
+
+121
+00:09:22,020 --> 00:09:29,020
+what؟ per minute. الفوسفات الكذا، كل واحدة الها level
+
+122
+00:09:29,020 --> 00:09:33,800
+معين، إذا اتخطى الباقي هيبقى ايه؟ to be excreted
+
+123
+00:09:33,800 --> 00:09:38,000
+الـ maximum threshold تبعنا، الـ maximum load تبعنا،
+
+124
+00:09:38,000 --> 00:09:41,080
+الـ maximum transport maximum تبعنا، ده هو، أكثر من
+
+125
+00:09:41,080 --> 00:09:45,520
+هيك. طبعا عشان نعرف كده إيش نزل، بدنا نقول في عندنا
+
+126
+00:09:45,520 --> 00:09:50,300
+الـ GFR، في الـ plasma concentration، مش كده؟ احنا
+
+127
+00:09:50,300 --> 00:09:54,040
+قلنا الـ .. الـ filtrate الـ concentration تبعه
+
+128
+00:09:54,040 --> 00:09:59,140
+يساوي الـ plasma، ما عدا المواد اللي ماسكة في الـ
+
+129
+00:09:59,140 --> 00:10:05,150
+proteins. فالـ free level، الـ free calcium، والـ
+
+130
+00:10:05,150 --> 00:10:09,930
+free كذا، تساوي الـ نفس الـ .. بس الـ total، في جزء منه
+
+131
+00:10:09,930 --> 00:10:13,470
+ممسوك بـ proteins، برا الحسبة، تمام؟ لإنه لأ لأ يصير ..
+
+132
+00:10:13,470 --> 00:10:16,670
+بيصير لوش absorption، كله اللي ممسوك بالدم، زي الـ
+
+133
+00:10:16,670 --> 00:10:20,750
+proteins. لكن الـ free form، الأشكال اللي هي الـ free
+
+134
+00:10:20,750 --> 00:10:25,590
+نفس الـ concentration، تقريبا 80% منها، زي البلازما، زي
+
+135
+00:10:25,590 --> 00:10:27,570
+الـ water is filtered
+
+136
+00:10:30,930 --> 00:10:34,870
+هتلاحظوا أن الـ urea هنا، اللي مفترض أنها وسط الـ
+
+137
+00:10:34,870 --> 00:10:39,070
+product، مش هيك؟ اللي لها transport maximum، يعني
+
+138
+00:10:39,070 --> 00:10:42,450
+can be reabsorbed، okay، can be reabsorbed، اللي
+
+139
+00:10:42,450 --> 00:10:46,570
+لها، هندرس احنا حاجة اسمها urea circulation، هندرس
+
+140
+00:10:46,570 --> 00:10:49,450
+حاجة اسمها ايه؟ urea circulation in the ايه؟ in
+
+141
+00:10:49,450 --> 00:10:52,050
+the kidney، والـ urea circulation هذه في الـ kidney
+
+142
+00:10:52,050 --> 00:10:56,610
+مهمة، احنا اتكلمنا عن المضلة of the kidney، وقلنا
+
+143
+00:10:56,610 --> 00:11:00,840
+المضلة ايه دورها أساسي؟ آه، الـ solutes اللي
+
+144
+00:11:00,840 --> 00:11:04,400
+بنستخدمها للـ concentration، الـ solutes، والموليكوليا، و
+
+145
+00:11:04,400 --> 00:11:09,120
+اليوريا، تمام؟ إذا اليوريا تساعدنا في ايه؟ إنها
+
+146
+00:11:09,120 --> 00:11:12,140
+مدام احنا رميناها، رميناها، موجودة، موجودة، قبل ما
+
+147
+00:11:12,140 --> 00:11:17,020
+نرميها، بنستخدمها في ايه؟ في circle، circuit، تعمل لي
+
+148
+00:11:17,020 --> 00:11:19,860
+concentration، تساعدني في الـ reabsorption of water
+
+149
+00:11:19,860 --> 00:11:23,880
+تمام، وبتعاود ايه؟ جزء منها بيطلع، وجزء منها بيرجع
+
+150
+00:11:23,880 --> 00:11:28,540
+بتضل تعمل circle، بستخدمها في ايه؟ يعني إيش مستهلكة
+
+151
+00:11:28,540 --> 00:11:32,260
+هنا الاقتصاد في بناء الجسم، هنلاحظه وين ما كان، يعني
+
+152
+00:11:32,260 --> 00:11:36,000
+إيش مستهلك وما رميناه، طب ما نخليه ايه؟ نستخدمه قبل
+
+153
+00:11:36,000 --> 00:11:39,500
+ما نرميه، نستخدمه في الـ ايه؟ في الـ interstitial
+
+154
+00:11:39,500 --> 00:11:43,500
+osmolality gradient، اليوريا بتشارك في نصه تقريبا
+
+155
+00:11:45,530 --> 00:11:49,090
+هذا الـ maximum transport for reabsorption، وفي عند
+
+156
+00:11:49,090 --> 00:11:53,670
+transport ايه؟ لـ secretion، يعني زي ما بعمل transport
+
+157
+00:11:53,670 --> 00:12:00,250
+يعني المعبر له قدرة تتشبع، إن كان بده يدخل أو يطلع
+
+158
+00:12:00,250 --> 00:12:04,450
+في اتجاهين، مش كده؟ ففي عند، نفس الكلام، بعض المواد
+
+159
+00:12:04,450 --> 00:12:09,410
+اللي هم secreted from the blood to the infiltrate
+
+160
+00:12:09,410 --> 00:12:13,920
+to be secreted، برضه يلهم tubular maximum، طبعا
+
+161
+00:12:13,920 --> 00:12:16,800
+نقولهم tubular maximum، أكثر من هيك ما نلاقيش الـ ..
+
+162
+00:12:16,800 --> 00:12:21,240
+الـ .. الـ .. الـ filtrate قادر، يعني يحمل، لإنه تشبع
+
+163
+00:12:21,240 --> 00:12:25,520
+ولو إنه زاد التركيز في الدم عن هيك، إلا إنه الكمية
+
+164
+00:12:25,520 --> 00:12:28,700
+الـ maximum بتقدر تخش الـ filtrate، تخش الـ .. الـ
+
+165
+00:12:28,700 --> 00:12:33,820
+tubule، محدودة، منها الكرياتينين، ومنها
+
+166
+00:12:33,820 --> 00:12:35,120
+الـ p-aminohippuric acid
+
+167
+00:12:38,000 --> 00:12:42,200
+البرامينوهيبيوريك أسيد هذه مادة احنا هنشتغل ..
+
+168
+00:12:42,200 --> 00:12:48,680
+هنذكرها كتير، ليش؟ لإنه هي تقريبا اللي داخل في الـ
+
+169
+00:12:48,680 --> 00:12:53,680
+renal blood، اللي في الـ venous blood، تقريبا صفر
+
+170
+00:12:53,680 --> 00:13:00,440
+يعني أن هذه المادة كلها excreted من جولة واحدة، لما
+
+171
+00:13:00,440 --> 00:13:04,760
+تدخل الدم، بتطلع صفر، بتدخل الكلية، يعني من الدم
+
+172
+00:13:04,760 --> 00:13:09,080
+دخلت الكلية، اللي طالع مرة صفر، هو مش صفر، عشان يكون
+
+173
+00:13:09,080 --> 
+
+223
+00:17:00,370 --> 00:17:03,990
+طلعت بقدر أعرف الـ GFR إذا الكرياتينين مادة
+
+224
+00:17:03,990 --> 00:17:07,430
+بستخدمها احنا في معرفة الـ glomer filtration
+
+225
+00:17:07,430 --> 00:17:13,610
+rate تمام، وفي المستقبل هقول لكم الكرياتينين الـ
+
+226
+00:17:13,610 --> 00:17:18,400
+blood level تبعها في حد ذاته بتعطيني فكرة عن الـ GFR
+
+227
+00:17:18,400 --> 00:17:20,860
+من غير ما أعمل الحسبة اللي موجودة عليها، نشوف إيش
+
+228
+00:17:20,860 --> 00:17:23,560
+في الـ urine وإيش في الـ excretion اللي موجودة
+
+229
+00:17:23,560 --> 00:17:27,660
+على الحسبة ثانية طبعا، لأنه طول ما الـ GFR يعني لأنه
+
+230
+00:17:27,660 --> 00:17:30,740
+الـ excretion تبعها بيعتمد أساسا على الـ filtration
+
+231
+00:17:30,740 --> 00:17:35,440
+طبعا، إذا لما يجيلي الـ filtration الـ level تبع
+
+232
+00:17:35,440 --> 00:17:40,980
+الكرياتينين بيعلن، صار الجسم هو، بتخلص الجسم من
+
+233
+00:17:40,980 --> 00:17:45,310
+الكرياتينين فقط بالـ filtration، إذا الـ filtration
+
+234
+00:17:45,310 --> 00:17:49,910
+كميتها قلت، إذا الـ excretion أو التخلص من هذا الـ
+
+235
+00:17:49,910 --> 00:17:53,750
+waste product من الدم انخفض، معناها الكرياتينين في
+
+236
+00:17:53,750 --> 00:17:59,070
+الدم مش هيزيد فيه، هيعلن، مش هيزيد؟ إذا كل ما فيه شوية
+
+237
+00:17:59,070 --> 00:18:04,750
+كرياتينين بعرف إن الـ GFR قلت، إذا في علاقة عكسية
+
+238
+00:18:04,750 --> 00:18:08,850
+ما بين الكرياتينين والـ GFR، إذا أنا بس لو شفت الـ
+
+239
+00:18:08,850 --> 00:18:14,010
+plasma كرياتينين بقول إيش أخبار الـ GFR؟ لما
+
+240
+00:18:14,010 --> 00:18:17,910
+يصير الكرياتينين ضعف ما كان، الـ GFR نزلت للنصف، لما
+
+241
+00:18:17,910 --> 00:18:22,110
+يصير الـ GFR الكرياتينين ثلاثة أضعاف، معناها لا دي ولا
+
+242
+00:18:22,110 --> 00:18:27,450
+ثلاثة مرتبطة، هادي في هادي، هنتكلم عنها بالتفصيل later
+
+243
+00:18:27,450 --> 00:18:32,030
+on، لكنه بداية، إذا فهمنا  الاثنين الـ secreted هدول
+
+244
+00:18:32,030 --> 00:18:37,330
+واحدة بتستخدم للكلى، الـ blood flow، واحدة الـ glomer
+
+245
+00:18:37,330 --> 00:18:42,190
+filtration rate، إذا الـ flow rate والـ filtration
+
+246
+00:18:42,190 --> 00:18:48,310
+rate، كرياتينين وإنولين
+
+247
+00:18:48,310 --> 00:18:52,890
+هدول إيش؟ للـ GFR، الإنولين مشكلته إنه مادة خارجية
+
+248
+00:18:52,890 --> 00:18:57,230
+أنا بدي أعطيها، مشكلته إيش؟ إنه مادة polysaccharide
+
+249
+00:18:57,230 --> 00:19:01,110
+الـ إنولين، بس يبقى ده بدي أديها أنا في الدم وأصبر
+
+250
+00:19:01,110 --> 00:19:05,450
+عليها، وبعدين أجيبها في الدم، في الـ plasma، وأجيبها
+
+251
+00:19:05,450 --> 00:19:09,150
+في الـ urine وأعمل الحسبة المعروفة، تمام؟ عم بطلع الـ
+
+252
+00:19:09,150 --> 00:19:12,590
+filtration rate، لأنها just filtered not reabsorbed
+
+253
+00:19:12,590 --> 00:19:16,030
+and not secreted، هو إيش؟ هي أي مادة بنستخدمها
+
+254
+00:19:16,030 --> 00:19:20,690
+لمعرفة الـ GFR لازم تكون بس filtered، لا هي
+
+255
+00:19:20,690 --> 00:19:23,830
+reabsorbed ولا هي secreted، معناها الكمية تمثل الـ
+
+256
+00:19:23,830 --> 00:19:27,340
+filtered volume، بحسب الحسبة، الإنولين عيبها إن أنا
+
+257
+00:19:27,340 --> 00:19:31,020
+بدي أديها للمريض وأحسب الحسبة، لكن الـ creatinine
+
+258
+00:19:31,020 --> 00:19:35,120
+ميزتها، ولو إنها فيها شوية factors، مشكلة اللي
+
+259
+00:19:35,120 --> 00:19:38,920
+بيستخدم الـ secretion، لكنها ميزتها إن أنا باخد عينة
+
+260
+00:19:38,920 --> 00:19:44,360
+مباشرة، ما بديش أنا أعمل جهد مع المريض وأعطيه وأجيب
+
+261
+00:19:44,360 --> 00:19:47,240
+وأجيب وأروح وأتى، لأ، باخد blood sample وخلاص
+
+262
+00:19:47,240 --> 00:19:54,650
+بقوله روح، روح، تمام؟ بس الإنولين أدق، الكرياتينين أسهل
+
+263
+00:19:54,650 --> 00:19:59,710
+طبعا، أما الـ para-amino hippuric acid  لأ، الـ filtrate
+
+264
+00:19:59,710 --> 00:20:04,570
+وباقي الدم، إذا بستخدمه في الـ plasma flow rate، يعني
+
+265
+00:20:04,570 --> 00:20:07,630
+الـ blood flow rate في الكلى، بقدر أحسبها، renal
+
+266
+00:20:07,630 --> 00:20:13,110
+blood flow، بقدر أحسبه من الـ para-amino hippuric acid
+
+267
+00:20:13,110 --> 00:20:16,350
+substances
+
+268
+00:20:16,350 --> 00:20:20,230
+that are actively transported and do not exhibit
+
+269
+00:20:20,230 --> 00:20:31,210
+a transport maximum، فهنا نتكلم عن مواد active
+
+270
+00:20:31,210 --> 00:20:35,550
+transport، و secondary active transport، مش كده؟ لكن
+
+271
+00:20:35,550 --> 00:20:38,810
+في مواد عندي actively transported وملهاش transport
+
+272
+00:20:38,810 --> 00:20:47,680
+maximum، زي الصوديوم، ليش ما لهوش transport maximum؟ لأنه
+
+273
+00:20:47,680 --> 00:20:52,600
+الـ pumping system تبعه أكبر من أي تركيز ممكن يجي
+
+274
+00:20:52,600 --> 00:20:58,460
+على الـ brush border، على الـ membrane، على الفلترات، تمام؟
+
+275
+00:20:58,460 --> 00:21:04,760
+إذا الـ pumping system ضخم، إذا أي كمية بتيجي في
+
+276
+00:21:04,760 --> 00:21:09,660
+وجود الـ brush border بيعمل لي عشرين ضعف لإيش؟ الـ
+
+277
+00:21:09,660 --> 00:21:16,320
+surface area، الـ transport surface بيزيد عشرين ضعف
+
+278
+00:21:18,260 --> 00:21:23,720
+بالإضافة لوجود الـ carrier system، تمام؟ بالإضافة
+
+279
+00:21:23,720 --> 00:21:27,360
+لوجود إنه عندي كمية الـ ... الـ ... الـ ... الـ
+
+280
+00:21:27,360 --> 00:21:32,280
+basolateral membrane transport أكثر من كمية الـ
+
+281
+00:21:32,280 --> 00:21:35,580
+الـ ... الـ ... الـ transport على الـ ... على الـ brush
+
+282
+00:21:35,580 --> 00:21:41,610
+border، مش كده؟ على الـ brush border، عندي الكمية
+
+283
+00:21:41,610 --> 00:21:44,510
+التركيز الموجودة، يعني الكمية اللي في الفلترات أنا
+
+284
+00:21:44,510 --> 00:21:46,830
+بأطردها على الـ basolateral membrane أكبر منها بكثير
+
+285
+00:21:46,830 --> 00:21:50,590
+أضعاف أضعاف، فمهما أزيد الـ concentration of sodium
+
+286
+00:21:50,590 --> 00:21:53,270
+في الـ proximal convoluted tubule تستطيع إنها إيش؟
+
+287
+00:21:53,270 --> 00:21:56,890
+تعملها reabsorption، طب في الوضع الطبيعي أنا بوصل
+
+288
+00:21:56,890 --> 00:22:01,650
+لمرحلة إن أنا استهلكت كل الـ sodium اللي موجود وين؟
+
+289
+00:22:01,650 --> 00:22:06,670
+في الـ ... في الـ ... في الفلترات، لأن الـ basolateral
+
+290
+00:22:06,670 --> 00:22:10,970
+membrane pumping system ضخم، بيضخ من داخل الـ cells
+
+291
+00:22:10,970 --> 00:22:15,070
+إلى الـ interstitial fluid، تمام؟ سحبنا كل إيش؟ طب والـ
+
+292
+00:22:15,070 --> 00:22:18,910
+sodium، والـ glucose، والـ amino acid اللي موجودة
+
+293
+00:22:18,910 --> 00:22:23,630
+بدون sodium ثاني، عشان عن طريقه بتـ ... إذا ما فيش
+
+294
+00:22:23,630 --> 00:22:26,870
+sodium، الـ carrier system مش هيشتغل، يعني الـ glucose
+
+295
+00:22:26,870 --> 00:22:31,190
+والـ amino acid وغيرها بيضالوا خارج، تمام؟ فعندنا هنا
+
+296
+00:22:31,190 --> 00:22:37,100
+المسألة محلولة، إنه بيصير عندي back leak، يعني الـ
+
+297
+00:22:37,100 --> 00:22:39,860
+concentration ... الـ concentrated sodium اللي في الـ
+
+298
+00:22:39,860 --> 00:22:44,600
+interstitium لما يقل كتير، الـ ... الـ ... الـ filtered
+
+299
+00:22:44,600 --> 00:22:50,210
+concentration of sodium، فبرجع أساعده، لأن هذا شغله
+
+300
+00:22:50,210 --> 00:22:55,450
+يدخل، مش أنا شغلي أتخلص من الـ sodium، لأ، شغلي أساسا
+
+301
+00:22:55,450 --> 00:23:00,290
+الـ sodium أستخدمه في إيش؟ في نقل الأشياء، فلذلك
+
+302
+00:23:00,290 --> 00:23:05,370
+بعد ما أنقل وأخلص، برجع جزء منه، عشان إيش؟ عشان يظل
+
+303
+00:23:05,370 --> 00:23:09,090
+عندي high concentration في الـ ... في الـ lumen، و
+
+304
+00:23:09,090 --> 00:23:14,150
+يندفع في نقل الـ sodium، وفي نقل الـ glucose، والـ
+
+305
+00:23:14,150 --> 00:23:17,890
+amino acid، و others بنفس الكفاءة، تمام؟ إذا عندي
+
+306
+00:23:17,890 --> 00:23:23,860
+أنا basolateral membrane transport system عالي، هذا
+
+307
+00:23:23,860 --> 00:23:29,220
+بيقدر إنه أي كمية، أنا بساعدها إني بأديها من
+
+308
+00:23:29,220 --> 00:23:32,360
+اللي أنا طلعته، وبرجع ثاني back leak عبر الـ tight
+
+309
+00:23:32,360 --> 00:23:36,480
+junction، عشان إيش؟ بيصير إن الـ interstitial fluid
+
+310
+00:23:36,480 --> 00:23:41,260
+عالي الـ concentration، والـ tubular fluid  قليل
+
+311
+00:23:41,260 --> 00:23:43,440
+الـ osmotic، لما الـ tight junction ما شاء الله عليها
+
+312
+00:23:43,440 --> 00:23:48,960
+مسموحة، تحت السلك بسهولة بتعدي، فبرجع بحيث يظل حافظ
+
+313
+00:23:48,960 --> 00:23:50,180
+على الـ
+
+314
+00:23:52,800 --> 00:23:56,840
+الـ ... الـ ... الـ facilitated diffusion، عشان يحافظ
+
+315
+00:23:56,840 --> 00:24:03,260
+على إنه ... فلذلك هذا النوع من إيش؟ من الـ ... من
+
+316
+00:24:03,260 --> 00:24:08,540
+الـ ... الـ active transport بدون إيش؟ بدون transport
+
+317
+00:24:08,540 --> 00:24:12,460
+maximum، بالصوديوم وين؟ في الـ proximal convoluted
+
+318
+00:24:12,460 --> 00:24:17,420
+tubule، في الـ distal convoluted tubule مش موجود such
+
+319
+00:24:17,420 --> 00:24:24,620
+tight junction لأ، ولا موجود such leaky membrane لأ،
+
+320
+00:24:24,620 --> 00:24:29,660
+لأ، باخد صوديوم بالعيار، باخد صوديوم بالعيار، الكمية
+
+321
+00:24:29,660 --> 00:24:33,040
+اللي أنا عايزها، لأن ممكن يكون أنا مش عايز يكون
+
+322
+00:24:33,040 --> 00:24:38,140
+الضغط عندي عالي ومحتاج أهرب شوية صوديوم لبرا، فاللي
+
+323
+00:24:38,140 --> 00:24:41,420
+بوصل للـ distal tubule يمثل حوالي عشرين في المية،
+
+324
+00:24:41,420 --> 00:24:50,310
+تمام، عشرين أو أقل، عندي خمسة وسبعين، خمسة وسبعين بالمية وعشرين
+
+325
+00:24:50,310 --> 00:24:55,030
+يعني في نسب مختلفة، هذا ممكن أنا أتخلص إيش؟ أتخلص
+
+326
+00:24:55,030 --> 00:25:00,190
+منه، أو آخده كله حسب حاجة الجسم، حسب الـ control
+
+327
+00:25:00,190 --> 00:25:03,810
+system اللي احنا هنتكلم عنه، الـ aldosterone،
+
+328
+00:25:03,990 --> 00:25:10,810
+antidiuretic hormone، و other hormones
+
+329
+00:25:10,810 --> 00:25:17,990
+that control العملية في الـ distal tubule، substances
+
+330
+00:25:17,990 --> 00:25:23,130
+that are actively transported but do not exhibit a
+
+331
+00:25:23,130 --> 00:25:24,410
+transport maximum
+
+332
+00:25:55,830 --> 00:25:59,030
+substances that do not exhibit a transport maximum
+
+333
+00:25:59,030 --> 00:26:04,930
+الأشياء اللي هي بيصير لها passive diffusion، passive
+
+334
+00:26:04,930 --> 00:26:09,010
+transport، مالهاش carrier system، يعني إلها طريق آخر
+
+335
+00:26:09,010 --> 00:26:13,010
+عبر channels أخرى، من غير carrier system، لأن carrier
+
+336
+00:26:13,010 --> 00:26:16,530
+system بيصير له إيش؟ بيصير له saturation، بيصير له إيش؟
+
+337
+00:26:16,530 --> 00:26:21,530
+تشبع، لكن أنا بعدي عبر الـ ... الـ carrier system
+
+338
+00:26:21,530 --> 00:26:28,690
+فبيصير عندي أنا three factors، بعدي جودة ما موجود، جودة
+
+339
+00:26:28,690 --> 00:26:34,330
+في عندي تركيز، بعدي جودة، في عندي الـ surface area
+
+340
+00:26:34,330 --> 00:26:38,550
+بعدي جودة، في الـ permeability تبعات الـ membrane بعدي
+
+341
+00:26:38,550 --> 00:26:42,590
+جودة، أنا وقفت جبال الـ membrane، بعدي، إذا كنت ماشي
+
+342
+00:26:42,590 --> 00:26:45,530
+سريع، الكمية هتعدي إيش؟ جزيئات، إذا أنا exposed
+
+343
+00:26:45,530 --> 00:26:50,970
+لمدة أطول، تمام؟ لذلك يسموها الـ gradient time
+
+344
+00:26:50,970 --> 00:26:56,650
+transport، مش ... مش not exhibiting transport
+
+345
+00:26:56,650 --> 00:27:01,940
+maximum، the transport is at gradient time transport
+
+346
+00:27:01,940 --> 00:27:06,160
+قد إيش فيه تركيز، فارق بينها وبين هان، عشان أنا ببدأ أعمل
+
+347
+00:27:06,160 --> 00:27:09,790
+diffusion، وقد إيش الـ time اللي أنا بقضيه جبال الـ flow
+
+348
+00:27:09,790 --> 00:27:13,430
+تبع الـ tubular fluid، الـ flow سريع ولا بطيء، الـ flow
+
+349
+00:27:13,430 --> 00:27:17,330
+بطيء، هيعطي كمية، فرصة كبيرة إن أنا أعمل transport، الـ
+
+350
+00:27:17,330 --> 00:27:23,150
+flow سريع، يهرب قبل المنطقة هذه، تمام؟ إذا هدول
+
+351
+00:27:23,150 --> 00:27:27,850
+الـ passively transported substances are not
+
+352
+00:27:27,850 --> 00:27:31,530
+limited by a transport maximum
+
+353
+00:27:38,410 --> 00:27:43,310
+الكميات اللي بسيطة تدخل تدخل تدخل تدخل تدخل تدخل
+
+354
+00:27:43,310 --> 00:27:51,350
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+355
+00:27:51,350 --> 00:27:51,490
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+356
+00:27:51,490 --> 00:27:52,010
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+357
+00:27:52,010 --> 00:27:52,050
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+358
+00:27:52,050 --> 00:27:59,210
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+359
+00:27:59,210 --> 00:28:07,930
+ت
+
+360
+00:28:08,290 --> 00:28:11,530
+مش كده، الصوديوم في الـ proximal tubule لكن
+
+361
+00:28:11,530 --> 00:28:14,590
+الصوديوم في الـ distal tubule، الـ tight junction
+
+362
+00:28:14,590 --> 00:28:24,010
+في الـ distal tubule is tight، هنا leaking، وتكلمنا
+
+363
+00:28:24,010 --> 00:28:29,290
+عنها احنا، ليش هذول مختلفين؟ عشان الـ basolateral system
+
+364
+00:28:29,290 --> 00:28:33,230
+عشان الـ back leak أساسا بيعطيه، واحنا محتاجين
+
+365
+00:28:33,230 --> 00:28:36,610
+نرجع أساسا بنخلص كل اللي موجود وبنعطيه كمان و
+
+366
+00:28:36,610 --> 00:28:41,510
+برضه إيش؟ قادرين عليه، تمام؟ الـ brush border والـ
+
+367
+00:28:41,510 --> 00:28:50,870
+surface area وكذا، كل إيش؟ ضخم، passive
+
+368
+00:28:52,170 --> 00:28:56,430
+Water reabsorption by osmosis is coupled mainly by
+
+369
+00:28:56,430 --> 00:29:01,910
+sodium reabsorption، طيب، الآن تكلمنا عن الـ sodium،
+
+370
+00:29:01,910 --> 00:29:06,990
+الـ active transport، والـ glucose، إيش أخبار المية؟
+
+371
+00:29:06,990 --> 00:29:13,550
+المية تعتمد في انتقالها على الـ osmolality، sodium
+
+372
+00:29:13,550 --> 00:29:19,130
+كتير دخل إلى داخل الـ cells، وليه جوا، الـ chloride، و
+
+373
+00:29:19,130 --> 00:29:25,640
+كمان دخل الـ glucose، وكل الأشياء اللي reabsorbed في
+
+374
+00:29:25,640 --> 00:29:29,740
+الـ tubule، في الـ proximal tubule، كلها عملت لي high
+
+375
+00:29:29,740 --> 00:29:37,560
+concentration of water، عمل لي low osmolality في
+
+376
+00:29:37,560 --> 00:29:41,700
+داخل الـ lumen، و high osmolality في الـ cells، والـ
+
+377
+00:29:41,700 --> 00:29:45,660
+interstitium، لذلك المياه automatically بتلحق من الـ
+
+378
+00:29:45,660 --> 00:29:47,660
+hyper osmotic solutions
+
+379
+00:29:50,880 --> 00:29:54,060
+بتعدي على الـ cells، إذا كان الـ route of entry
+
+380
+00:29:54,060 --> 00:29:57,280
+transcellular، أو بتعدي على الـ tight junction، إذا
+
+381
+00:29:57,280 --> 00:30:02,050
+كان الـ route of entry عبر الـ A، وإذا كان عبرت الـ
+
+382
+00:30:02,050 --> 00:30:05,110
+cells، لكن الـ pumping system بسرعة بيركزها أكثر من الـ
+
+383
+00:30:05,110 --> 00:30:09,150
+cells، في داخل الـ lumen بتاع الـ junction، هتعدي من هنا
+
+384
+00:30:09,150 --> 00:30:12,310
+يعني الـ water هنا is following the sodium and
+
+385
+00:30:12,310 --> 00:30:17,230
+chloride، تركيزها متوازن، يعني 75% من الـ sodium يمتص
+
+386
+00:30:17,230 --> 00:30:21,030
+في الـ lumen في الـ proximal، و75% من المية يمتص في الـ lumen
+
+387
+00:30:21,030 --> 00:30:24,850
+في الـ proximal، عشان osmolality، لأن الـ main
+
+388
+00:30:25,060 --> 00:30:29,420
+الكاتيون اللي بيحدد اسمها لك هو الصوديوم طبعا، فلذلك
+
+389
+00:30:29,420 --> 00:30:33,560
+اتنين ماشيين مع بعض، لكن الـ route of entry both من
+
+390
+00:30:33,560 --> 00:30:44,420
+إيش؟ transcellular، و paracellular، a
+
+391
+00:30:44,420 --> 00:30:47,160
+large part of the osmotic flow of water at tight
+
+392
+00:30:47,160 --> 00:30:53,000
+junctions، اه، في هنا حاجة اسمها solvent drag، والمية
+
+393
+00:30:53,000 --> 00:30:57,330
+مندفعة إلى داخل الـ tight junctions، بسبب إن الـ sodium
+
+394
+00:30:57,330 --> 00:31:02,750
+concentration جوا عالي، ليش؟ لأن اللي تم إدخاله عبر
+
+395
+00:3
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..2480b37a9f95dd5a369996802e84061a0b52bd58
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2274, "start": 5.86, "end": 22.74, "text": "تمام؟ يعني قبل transport maximum ما نصله احنا فيه جزء بيكون بيطلع لسه في ال ball ليش؟ لإن مش كل ال nephrons يلهم نفس ال transport maximum لما اتكلم عن مستوى ال nephron على مستوى ال nephron كل nephron إله", "tokens": [39237, 10943, 22807, 37495, 22653, 12174, 36150, 5495, 6674, 19446, 8717, 36520, 3224, 1975, 5016, 8315, 8978, 3224, 10874, 11622, 38207, 4724, 1829, 30544, 4724, 1829, 9566, 1211, 3615, 5296, 3794, 3224, 8978, 2423, 2594, 32239, 8592, 22807, 5296, 28814, 1863, 37893, 28242, 2423, 408, 950, 13270, 7251, 1211, 16095, 8717, 36178, 2423, 5495, 6674, 5296, 15042, 1975, 2655, 4117, 19528, 18871, 3714, 14851, 2407, 7578, 2423, 408, 950, 2044, 15844, 3714, 14851, 2407, 7578, 2423, 408, 950, 2044, 28242, 408, 950, 2044, 11933, 43761], "avg_logprob": -0.23746366244415903, "compression_ratio": 1.6685082872928176, "no_speech_prob": 0.0, "words": [{"start": 5.860000000000003, "end": 6.48, "word": "تمام؟", 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1244.65, "end": 1245.11, "word": " maximum", "probability": 0.96630859375}], "temperature": 1.0}, {"id": 50, "seek": 127632, "start": 1246.82, "end": 1276.32, "text": "لإنه ال bombing system تبعه أكبر من أي تركيز ممكن يجي على ال bezel أترا ال membrane على الفلترات تمام؟ إذا ال bombing system ضخم إذا أي كمية بتيجي في وجود brush border بيعمللي عشرين ضعف لإيه ال surface area ال transport surface بيزيد عشرين ضعف", "tokens": [1211, 28814, 1863, 3224, 2423, 31292, 1185, 6055, 3555, 3615, 3224, 5551, 4117, 26890, 9154, 36632, 6055, 31747, 1829, 11622, 3714, 43020, 7251, 7435, 1829, 15844, 2423, 37179, 5551, 2655, 23557, 2423, 19651, 15844, 27188, 1211, 2655, 2288, 9307, 46811, 10943, 22807, 11933, 15730, 2423, 31292, 1185, 48812, 9778, 2304, 11933, 15730, 36632, 9122, 2304, 10632, 39894, 1829, 7435, 1829, 8978, 49610, 23328, 5287, 7838, 4724, 1829, 25957, 1211, 20292, 6225, 46309, 9957, 48812, 3615, 5172, 5296, 28814, 1829, 3224, 2423, 3753, 1859, 2423, 5495, 3753, 4724, 1829, 11622, 25708, 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1267.78, "word": " عشرين", "probability": 0.9471028645833334}, {"start": 1267.78, "end": 1268.12, "word": " ضعف", "probability": 0.9812825520833334}, {"start": 1268.12, "end": 1268.56, "word": " لإيه", "probability": 0.618560791015625}, {"start": 1268.56, "end": 1269.66, "word": " ال", "probability": 0.83203125}, {"start": 1269.66, "end": 1271.54, "word": " surface", "probability": 0.69140625}, {"start": 1271.54, "end": 1272.02, "word": " area", "probability": 0.7802734375}, {"start": 1272.02, "end": 1272.54, "word": " ال", "probability": 0.46630859375}, {"start": 1272.54, "end": 1273.08, "word": " transport", "probability": 0.9501953125}, {"start": 1273.08, "end": 1274.2, "word": " surface", "probability": 0.89404296875}, {"start": 1274.2, "end": 1275.36, "word": " بيزيد", "probability": 0.96875}, {"start": 1275.36, "end": 1275.94, "word": " عشرين", "probability": 0.9684244791666666}, {"start": 1275.94, "end": 1276.32, "word": " ضعف", "probability": 0.9947916666666666}], "temperature": 1.0}, {"id": 51, "seek": 129980, "start": 1278.26, "end": 1299.8, "text": "بالاضافة لو وجود ال career system تمام؟ بالاضافة لو وجود انه عندى كمية ال .. ال .. ال .. ال basolateral membrane transport اكتر من كمية ال ايه ال .. ال .. ال transport على ال .. على ال brush border مش كده؟ على ال brush border", "tokens": [3555, 6027, 46958, 31845, 3660, 45164, 49610, 23328, 2423, 3988, 1185, 46811, 10943, 22807, 20666, 46958, 31845, 3660, 45164, 49610, 23328, 16472, 3224, 43242, 7578, 9122, 2304, 10632, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 987, 401, 17274, 19651, 5495, 1975, 4117, 2655, 2288, 9154, 9122, 2304, 10632, 2423, 1975, 1829, 3224, 2423, 4386, 2423, 4386, 2423, 5495, 15844, 2423, 4386, 15844, 2423, 5287, 7838, 37893, 9122, 3215, 3224, 22807, 15844, 2423, 5287, 7838], "avg_logprob": -0.19354166984558105, "compression_ratio": 1.888235294117647, "no_speech_prob": 1.1920928955078125e-07, "words": [{"start": 1278.26, "end": 1279.14, "word": "بالاضافة", "probability": 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0.9930013020833334}, {"start": 1285.64, "end": 1285.96, "word": " ال", "probability": 0.98388671875}, {"start": 1285.96, "end": 1286.44, "word": " ..", "probability": 0.48876953125}, {"start": 1286.44, "end": 1287.04, "word": " ال", "probability": 0.974609375}, {"start": 1287.04, "end": 1287.04, "word": " ..", "probability": 0.9140625}, {"start": 1287.04, "end": 1287.22, "word": " ال", "probability": 0.978515625}, {"start": 1287.22, "end": 1287.22, "word": " ..", "probability": 0.50830078125}, {"start": 1287.22, "end": 1287.36, "word": " ال", "probability": 0.962890625}, {"start": 1287.36, "end": 1287.94, "word": " basolateral", "probability": 0.6609700520833334}, {"start": 1287.94, "end": 1288.22, "word": " membrane", "probability": 0.7724609375}, {"start": 1288.22, "end": 1288.8, "word": " transport", "probability": 0.703125}, {"start": 1288.8, "end": 1290.28, "word": " اكتر", "probability": 0.887939453125}, {"start": 1290.28, "end": 1290.96, "word": " من", "probability": 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1973.7, "end": 1975.9, "word": " distal", "probability": 0.516448974609375}, {"start": 1975.9, "end": 1976.24, "word": " communicative", "probability": 0.4037882486979167}, {"start": 1976.24, "end": 1976.6, "word": " pool", "probability": 0.1429443359375}, {"start": 1976.6, "end": 1977.74, "word": " بيصلنا", "probability": 0.8369140625}, {"start": 1977.74, "end": 1978.9, "word": " hypotonic", "probability": 0.6092122395833334}, {"start": 1978.9, "end": 1980.52, "word": " hypoosmalen", "probability": 0.595263671875}, {"start": 1980.52, "end": 1981.62, "word": " بيصل", "probability": 0.9552408854166666}, {"start": 1981.62, "end": 1981.84, "word": " ل", "probability": 0.87060546875}, {"start": 1981.84, "end": 1982.4, "word": " 100", "probability": 0.38623046875}, {"start": 1982.4, "end": 1982.86, "word": " ملي", "probability": 0.5379638671875}, {"start": 1982.86, "end": 1985.46, "word": " ملي", "probability": 0.5523681640625}, {"start": 1985.46, "end": 1985.92, "word": " أزمال", "probability": 0.697998046875}, {"start": 1985.92, "end": 1986.12, "word": " ال", "probability": 0.88671875}, {"start": 1986.12, "end": 1986.7, "word": " concentration", "probability": 0.85693359375}, {"start": 1986.7, "end": 1987.4, "word": " تبعه", "probability": 0.8599853515625}, {"start": 1987.4, "end": 1988.1, "word": " cosmolality", "probability": 0.5995890299479166}, {"start": 1988.1, "end": 1989.04, "word": " هنا", "probability": 0.95556640625}, {"start": 1989.04, "end": 1989.68, "word": " تصل", "probability": 0.730712890625}, {"start": 1989.68, "end": 1989.8, "word": " ل", "probability": 0.461669921875}, {"start": 1989.8, "end": 1990.04, "word": " 100", "probability": 0.677734375}, {"start": 1990.04, "end": 1992.72, "word": " واضح؟", "probability": 0.75640869140625}, {"start": 1992.72, "end": 1993.22, "word": " طيب", "probability": 0.9698893229166666}, {"start": 1993.22, "end": 1993.78, "word": " إذا", "probability": 0.6468505859375}, {"start": 1993.78, "end": 1995.74, "word": 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..4e12d1d1fd0c6da8c28cfc67b9737c18dadba041
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/H9CaLQN3GBo_raw.srt
@@ -0,0 +1,1732 @@
+1
+00:00:05,860 --> 00:00:09,840
+تمام؟ يعني قبل transport maximum ما نصله احنا فيه
+
+2
+00:00:09,840 --> 00:00:13,520
+جزء بيكون بيطلع لسه في ال ball ليش؟ لإن مش كل ال
+
+3
+00:00:13,520 --> 00:00:18,340
+nephrons يلهم نفس ال transport maximum لما اتكلم
+
+4
+00:00:18,340 --> 00:00:22,120
+عن مستوى ال nephron على مستوى ال nephron كل
+
+5
+00:00:22,120 --> 00:00:26,650
+nephron إلهtransport maximum مختلف عن التاني تمام
+
+6
+00:00:26,650 --> 00:00:30,750
+واحد طاقة كبيرة واحد طاقة صغيرة فانا لما وصلت
+
+7
+00:00:30,750 --> 00:00:36,850
+لمرحلة 200 مثلا ملي جرام سكر في الدم تمام بعض ال
+
+8
+00:00:36,850 --> 00:00:41,970
+نيفرونز صارت تاخد جزء من هذا السكر والجزء التاني
+
+9
+00:00:41,970 --> 00:00:45,010
+مابتقدرش تاخده لكن بعض ال نيفرونز عندها طاقة
+
+10
+00:00:45,010 --> 00:00:49,520
+لازالت تاخده ف minimal sugar هيبدأ يظهر عندىلو
+
+11
+00:00:49,520 --> 00:00:54,460
+زودنا السكر اكتر في الدم لو زاد اكتر وصار ال
+
+12
+00:00:54,460 --> 00:00:58,380
+filtration سكر اكتر معناها في عندى في other
+
+13
+00:00:58,380 --> 00:01:03,400
+nephrons برضه هتصل ل maximum تبعها وهيصير اكتر
+
+14
+00:01:03,400 --> 00:01:08,200
+urine اكتر ايش يطلع سكر اكتر يطلع في ال ball لكن
+
+15
+00:01:08,200 --> 00:01:15,300
+صار برضه الامتصاص بيزيد اذا لحد ما نصل انه
+
+16
+00:01:15,300 --> 00:01:21,260
+الامتصاص في كل ال nephrons وصل ل maximumأي زيادة
+
+17
+00:01:21,260 --> 00:01:26,800
+في ال load sugar load كل زيادة عن level معين كل
+
+18
+00:01:26,800 --> 00:01:30,580
+زيادة بتطلع في مفاترة معينة جزء من الزيادة بيطلع و
+
+19
+00:01:30,580 --> 00:01:34,880
+جزء reabsorbed لإنه different abilities of the ..
+
+20
+00:01:34,880 --> 00:01:38,820
+اه لكن عند معي .. اه اذا الفترة هذه اللي بنصل فيها
+
+21
+00:01:38,820 --> 00:01:43,660
+كل زيادة في ال load executed بنسميها أوصلنا هذا
+
+22
+00:01:43,660 --> 00:01:49,570
+اسمه الكمية اللي صارلها reabsorptionأه هذه
+
+23
+00:01:49,570 --> 00:01:52,770
+transport maximum وبعد الكمية يعني لما يكون عندى
+
+24
+00:01:52,770 --> 00:01:59,790
+load معين ال load ال 375 مثلا milligram per minute
+
+25
+00:01:59,790 --> 00:02:03,430
+في الكيلية الواحدة في الكيليتين can be reabsorbed
+
+26
+00:02:03,430 --> 00:02:07,890
+ال filtered أكتر من 375 milligram كله بطلع تمام
+
+27
+00:02:07,890 --> 00:02:13,690
+لكن لما يكون احنا مانيشي بنقول ان ما هو السكر بدأ
+
+28
+00:02:13,690 --> 00:02:18,360
+يبين من بدريو لسه من أول نفره انفشل في انه ياخد كل
+
+29
+00:02:18,360 --> 00:02:22,620
+ما جاء من ال load بدأ يبين السكر في ال bowl هذي
+
+30
+00:02:22,620 --> 00:02:25,560
+مسمى مثلا threshold level، اذا في عندي threshold
+
+31
+00:02:25,560 --> 00:02:28,600
+level أو في عندي transport maximum، ال threshold
+
+32
+00:02:28,600 --> 00:02:32,780
+level أول level بيبدأ السكر يظهر فيه في ال ايه؟ في
+
+33
+00:02:32,780 --> 00:02:41,600
+ال bowlبمعنى انه بتديني شكل اقل نفرون قادر على ايه
+
+34
+00:02:41,600 --> 00:02:45,700
+يصل the lowest transport maximum in one نفرون
+
+35
+00:02:45,700 --> 00:02:48,660
+النفرون اللي يقولوا the lowest transport maximum
+
+36
+00:02:48,660 --> 00:02:53,320
+تشبع والزايد بده يظهر لكن الآخرين لسه يستطيعوا
+
+37
+00:02:53,320 --> 00:02:58,460
+ياخدوا سكر زايد لما نسألل level انه كل الزيادة في
+
+38
+00:02:58,460 --> 00:03:02,080
+ال load بصير لبرا معناه وصلنا ل transport maximum
+
+39
+00:03:02,080 --> 00:03:06,480
+وهذا الفرق بين الايه التاني مش هيك لو طلعنا على
+
+40
+00:03:06,480 --> 00:03:13,170
+الصورة هذه تبعت السكربنقول هان الطبيعي انه السكر
+
+41
+00:03:13,170 --> 00:03:22,430
+ال load تبعنا مثلا عندنا مية خمسة ميت ملي السكر من
+
+42
+00:03:22,430 --> 00:03:27,870
+سبعين لمية و عشرين لمية و عشرة حسب القراءات يعني
+
+43
+00:03:27,870 --> 00:03:34,110
+متوسط ميت ميلي جرام per cent معناها في مية و خمسة
+
+44
+00:03:34,110 --> 00:03:39,550
+و عشرين معناها ايه؟بطلع 125 milligram per minute
+
+45
+00:03:39,550 --> 00:03:44,750
+احنا عندنا مية التركيز يعني one milligram per
+
+46
+00:03:44,750 --> 00:03:48,230
+milliliter و filtration بيصير عندى 125 milliliter
+
+47
+00:03:48,230 --> 00:03:51,670
+per minute مش كده معناه ان عندى 125 milligram
+
+48
+00:03:51,670 --> 00:03:57,950
+طبيعي في ال ايه في الدقيقة is the glucose load to
+
+49
+00:03:57,950 --> 00:04:01,710
+the tubules can be reabsorbed easily كله
+
+50
+00:04:01,710 --> 00:04:06,080
+reabsorbed ولا نفرن بفلتتمام لذلك انا ببحث البقل
+
+51
+00:04:06,080 --> 00:04:11,680
+في الطبيعي بلاقي no sugar no sugar تمام طيب لو زاد
+
+52
+00:04:11,680 --> 00:04:15,440
+السكر تركيزه من مية، مية و عشرة، مية و عشرين، مية
+
+53
+00:04:15,440 --> 00:04:18,120
+و تلاتين، مية و أربعين برضه completely absorbed
+
+54
+00:04:18,120 --> 00:04:23,660
+يعني الخط الأحمر هذا ال .. ال filtered load الخط
+
+55
+00:04:23,660 --> 00:04:29,380
+الأحمر ال filtered load ال .. الخط الأزرق بتكلم عن
+
+56
+00:04:29,380 --> 00:04:35,470
+ايه؟الـ Reabsorption كل اللي filtered Reabsorbed
+
+57
+00:04:35,470 --> 00:04:40,170
+تمام و موازيماش مع بعض لكن عند مرحلة معينة ال
+
+58
+00:04:40,170 --> 00:04:45,290
+filtration بيصير أكتر فبيبدأ ال ال Reabsorption
+
+59
+00:04:45,290 --> 00:04:51,790
+يتوقف عند level معين تمام و بعدين لاحظوا ال curve
+
+60
+00:04:51,790 --> 00:05:00,920
+هذا الجوز هذا هنا ال threshold بدأ بعض الاللي ال
+
+61
+00:05:00,920 --> 00:05:03,600
+sugar .. ال sugar يبين في ال bone إذا هنا وصلنا ال
+
+62
+00:05:03,600 --> 00:05:08,000
+threshold level threshold of أي أول level
+
+63
+00:05:08,000 --> 00:05:12,820
+concentration of plasma sugar اللي بيبدأ يظهر فيه
+
+64
+00:05:12,820 --> 00:05:15,920
+sugar في ال bone هنا إيه؟ بيبدأ عندي hand ال
+
+65
+00:05:15,920 --> 00:05:19,960
+threshold level اللي هو عندي hand بيطلع حوالي متين
+
+66
+00:05:19,960 --> 00:05:24,860
+و شوية اه أو متين و اه تمام؟إذا في ال .. هنا في
+
+67
+00:05:24,860 --> 00:05:28,520
+المنطقة هذه بيبدأ ال .. ال reabsorption مايكونش
+
+68
+00:05:28,520 --> 00:05:32,420
+لكل ال load لإنه بعض ال nephrons failed و بيبدأ
+
+69
+00:05:32,420 --> 00:05:35,960
+يظهر هاي ال executor الأخضر هذا ال ball يظهر فيه
+
+70
+00:05:35,960 --> 00:05:39,840
+ندفة ندفة ندفة ندفة تمام ال ball بعدين بيصير
+
+71
+00:05:39,840 --> 00:05:43,100
+الزيادة في ال execution موازية للزيادة في ال load
+
+72
+00:05:43,100 --> 00:05:47,860
+لإنه كل اللي loaded زيادة اه بعد level معين يعني
+
+73
+00:05:47,860 --> 00:05:50,940
+بعد انا مايصير عندي ال concentration تقريبا
+
+74
+00:05:50,940 --> 00:05:56,970
+تلاتميةبصير عندى كل زيارة عن تلاتمية في الدم يعني
+
+75
+00:05:56,970 --> 00:06:00,690
+جديش بيكون في ال .. في ال .. في ال load تلاتمية و
+
+76
+00:06:00,690 --> 00:06:04,730
+خمس سبعين مش في مية و خمس عشرين بنضره كل مية لها
+
+77
+00:06:04,730 --> 00:06:08,510
+مية و خمس عشرين فالتلاتمية sugar هي تلاتمية و خمس
+
+78
+00:06:08,510 --> 00:06:11,550
+سبعين تلاتمية و خمس سبعين بعد ال load تلاتمية و
+
+79
+00:06:11,550 --> 00:06:16,310
+خمس سبعينكل الزيادة بكون عندى كل ال tube in
+
+80
+00:06:16,310 --> 00:06:20,770
+reference وصلت لل maximum تبعها فبصير عندى ال
+
+81
+00:06:20,770 --> 00:06:27,170
+extra load is clear as an extra sugar in the urine
+
+82
+00:06:27,170 --> 00:06:31,210
+تمام فى الفترة ال curve هذه بتدينى الفرق ما بين ال
+
+83
+00:06:31,210 --> 00:06:35,190
+threshold minimal threshold لحد ما نصل ل maximum
+
+84
+00:06:35,190 --> 00:06:43,820
+transport بعدها واضح ال curve هذا okay طيبإذا في
+
+85
+00:06:43,820 --> 00:06:48,080
+عندها ال transport maximum لبعض المواد اللي يلهم
+
+86
+00:06:48,080 --> 00:06:52,020
+ال transport maximum هدول معناها عبارة عن المواد
+
+87
+00:06:52,020 --> 00:06:55,460
+يعتمدوا في ال absorption هم على إيش؟ على ال career
+
+88
+00:06:55,460 --> 00:06:59,040
+system لإن ال career system can be saturated can
+
+89
+00:06:59,040 --> 00:07:04,280
+be saturated يتشبع كل زيادة عن قدرته خلاص أنا
+
+90
+00:07:04,280 --> 00:07:08,860
+ماليش أنا هيك طاجتي أكتر من هيك مع السلامة إلى
+
+91
+00:07:08,860 --> 00:07:13,160
+الخارجلكن واضح انه احنا عندنا في الطبيعي ان ال
+
+92
+00:07:13,160 --> 00:07:21,180
+load can be reabsorbed completely مش هيك؟ طيب
+
+93
+00:07:21,180 --> 00:07:25,220
+دربنا
+
+94
+00:07:25,220 --> 00:07:28,360
+مثل اذا بالسكر و هذا اهم مثل لنا في الدراسة اللي
+
+95
+00:07:28,360 --> 00:07:32,240
+بعتناها اهم مثل السكر لان diabetes mellitus اهم
+
+96
+00:07:32,240 --> 00:07:37,410
+مرض في العالمليش أهم مرض في العالم لإنه ال
+
+97
+00:07:37,410 --> 00:07:41,990
+occupancy في المستشفيات معظمها مربوطة بال diabetes
+
+98
+00:07:41,990 --> 00:07:46,270
+mellitus في كل الأقسام كل الأمراض بتزيد و المشاكل
+
+99
+00:07:46,270 --> 00:07:51,150
+بتزيد بسبب وجود ايه ال diabetes فجدا مهم جدا احنا
+
+100
+00:07:51,150 --> 00:07:55,730
+نفهم ال diabetes لإنه هيصاحبنا في شغلنا في اي تخصص
+
+101
+00:07:55,730 --> 00:07:59,290
+من التخصصات هنلاقي جاعد عندي ايه diabetes mellitus
+
+102
+00:08:03,700 --> 00:08:06,260
+إذا however when the plasma concentration of
+
+103
+00:08:06,260 --> 00:08:12,060
+glucose rises above 200 milligram percent بيبدأ
+
+104
+00:08:12,060 --> 00:08:17,980
+عندى ايه increasing the filtered load to 250 a
+
+105
+00:08:17,980 --> 00:08:21,680
+small amount of glucose begins to appear in urine
+
+106
+00:08:21,680 --> 00:08:26,820
+لذلك ال 200 هذا يعتبر ايه ال threshold إذا هذا ال
+
+107
+00:08:26,820 --> 00:08:30,240
+level this point is termed the threshold for
+
+108
+00:08:30,240 --> 00:08:34,660
+glucose بعد تركيز السكر 200ببدأ يظهر في ال ball
+
+109
+00:08:34,660 --> 00:08:39,260
+لأن هذا ال level تبع البلازم شجر يسمى treasure
+
+110
+00:08:39,260 --> 00:08:45,040
+level Note that this appearance of glucose in
+
+111
+00:08:45,040 --> 00:08:48,940
+urine occurs before the transport maximum is
+
+112
+00:08:48,940 --> 00:08:53,140
+reached وقلنا ليش،
+
+113
+00:08:53,140 --> 00:08:58,260
+اذا ال transport maximum هذا مش بس على السكرع كل
+
+114
+00:08:58,260 --> 00:09:00,340
+المواد اللي بتستخدم ايه؟ carrier system
+
+115
+00:09:00,340 --> 00:09:04,060
+facilitated diffusion فمثلا عندي لجلوكوز ال
+
+116
+00:09:04,060 --> 00:09:06,540
+transport maximum تبعه تلت مية و خمسة و سبعين
+
+117
+00:09:06,540 --> 00:09:11,100
+milligram per minute طبعا احسب لتو kidneys مش هيك؟
+
+118
+00:09:11,100 --> 00:09:15,000
+زي ما بيقول مية و خمس عشر ميلي لتر per minute GFR،
+
+119
+00:09:15,000 --> 00:09:19,380
+glomeral filtration rate for the two kidneys اه
+
+120
+00:09:19,380 --> 00:09:22,020
+for the two kidneys ومية و خمس عشر ميلي لتر per
+
+121
+00:09:22,020 --> 00:09:29,020
+what؟ per minuteالفوسفات الكذا كل واحدة إلها level
+
+122
+00:09:29,020 --> 00:09:33,800
+معين إذا اتخططوا الباقي هيبقى إيه؟ to be executed
+
+123
+00:09:33,800 --> 00:09:38,000
+ال maximum threshold تبعنا، ال maximum load تبعنا،
+
+124
+00:09:38,000 --> 00:09:41,080
+ال maximum transport maximum تبعنا، ده هو، أكتر من
+
+125
+00:09:41,080 --> 00:09:45,520
+هيك طبعا عشان نعرف كده إيش نزل، بدنا نقول في عندنا
+
+126
+00:09:45,520 --> 00:09:50,300
+ال GFR في ال plasma concentrationمش كده؟ احنا
+
+127
+00:09:50,300 --> 00:09:54,040
+قولنا ال .. ال filtrate ال concentration تبعه
+
+128
+00:09:54,040 --> 00:09:59,140
+يساوي ال plasma ما عدا المواد اللي ماسكة في ال
+
+129
+00:09:59,140 --> 00:10:05,150
+proteinsفال ال free level ال free calcium و ال
+
+130
+00:10:05,150 --> 00:10:09,930
+free كذا تساوي ال نفس ال .. بس ال total في جزء منه
+
+131
+00:10:09,930 --> 00:10:13,470
+ممسوك بروتينز برا الحسبة تمام؟ لإنه لأ لأ يصير ..
+
+132
+00:10:13,470 --> 00:10:16,670
+بيصير لوش absorption كله اللي ممسوك بالدم زي ال
+
+133
+00:10:16,670 --> 00:10:20,750
+proteins لكن ال free form ال أشكال اللي هي ال free
+
+134
+00:10:20,750 --> 00:10:25,590
+نفس ال concentration تقري 80% منها زي البلازمة زي
+
+135
+00:10:25,590 --> 00:10:27,570
+ال water is filtered
+
+136
+00:10:30,930 --> 00:10:34,870
+هتلاحظوا إن الـ urea هان اللي مفترض أنها وسط ال
+
+137
+00:10:34,870 --> 00:10:39,070
+product مش هيك، اللي لها transport maximum يعني
+
+138
+00:10:39,070 --> 00:10:42,450
+can be reabsorbed okay can be reabsorbed، اللي
+
+139
+00:10:42,450 --> 00:10:46,570
+لها، هندرس احنا حاجة اسمها urea circulation، هندرس
+
+140
+00:10:46,570 --> 00:10:49,450
+حاجة اسمها ايه؟ urea circulation in the ايه؟ in
+
+141
+00:10:49,450 --> 00:10:52,050
+the kidney والـ urea circulation هذه في ال kidney
+
+142
+00:10:52,050 --> 00:10:56,610
+مهمة، احنا اتكلمنا عن المضلة of the kidney وقلنا
+
+143
+00:10:56,610 --> 00:11:00,840
+المضلة إيه دورها أساسي؟اها ال solutes اللى
+
+144
+00:11:00,840 --> 00:11:04,400
+بنستخدمها لل concentration السودو موليكولوجيا و
+
+145
+00:11:04,400 --> 00:11:09,120
+اليوريا تمام؟ اذا اليوريا تساعدنا في ايه؟ انها
+
+146
+00:11:09,120 --> 00:11:12,140
+مدام احنا رميناها رميناها موجودة موجودة قبل ما
+
+147
+00:11:12,140 --> 00:11:17,020
+نرميها بنستخدمها في ايه؟في circle circuit تعمللي
+
+148
+00:11:17,020 --> 00:11:19,860
+concentration تساعدني في ال reabsorption of water
+
+149
+00:11:19,860 --> 00:11:23,880
+تمام وبتعاود ايه جزء منها بيطلع و جزء منها بيرجع
+
+150
+00:11:23,880 --> 00:11:28,540
+بتضل تعمل circle بستخدمها في ايه يعني ايش مستهلكة
+
+151
+00:11:28,540 --> 00:11:32,260
+هنا الاقتصاد في بناء الجسم هنلاحظه وين ما كان يعني
+
+152
+00:11:32,260 --> 00:11:36,000
+ايش مستهلك و مارمين طب ما تخليني ايه استخدمه قبل
+
+153
+00:11:36,000 --> 00:11:39,500
+ما ارميه بستخدمه في ال ايه في ال interstitial
+
+154
+00:11:39,500 --> 00:11:43,500
+osmolality gradient اليوريا بتشارك في نصه تقريبا
+
+155
+00:11:45,530 --> 00:11:49,090
+هذا ال maximum transport for reabsorption وفي عند
+
+156
+00:11:49,090 --> 00:11:53,670
+transport ايه لsecretion يعني زي ما بعمل transport
+
+157
+00:11:53,670 --> 00:12:00,250
+يعني المعبر له قدرة تتشبع ان كان بده يدخل او يطلع
+
+158
+00:12:00,250 --> 00:12:04,450
+في اتجاهين مش كده ففي عند نفس الكلام بعض المواد
+
+159
+00:12:04,450 --> 00:12:09,410
+اللي هم secreted from the blood to the infiltrate
+
+160
+00:12:09,410 --> 00:12:13,920
+to be secreted برضه يلهم tubular maximumطبعا
+
+161
+00:12:13,920 --> 00:12:16,800
+نقولهم tubular maximum أكتر من هيك مانلاقيش ال ..
+
+162
+00:12:16,800 --> 00:12:21,240
+ال .. ال .. ال filtrate جادر يعني يحمل لإنه اتشبع
+
+163
+00:12:21,240 --> 00:12:25,520
+ولو إنه زاد التركيز في الدم عن هيك إلا إنه الكمية
+
+164
+00:12:25,520 --> 00:12:28,700
+ال maximum بتقدر تخش ال filtrate تخش ال .. ال
+
+165
+00:12:28,700 --> 00:12:33,820
+tubule محدودة منها الكرياتينين و منها
+
+166
+00:12:33,820 --> 00:12:35,120
+الparaminohiboric acid
+
+167
+00:12:38,000 --> 00:12:42,200
+البرامينوهيبيونكاسيد هذه مادة احنا هننشتغل ..
+
+168
+00:12:42,200 --> 00:12:48,680
+هنذكرها كتير ليش؟ لإن هي تقريبا اللي داخل في ال
+
+169
+00:12:48,680 --> 00:12:53,680
+renal blood اللي في ال venous blood تقريبا سفر
+
+170
+00:12:53,680 --> 00:13:00,440
+يعني ان هذه المادة كلها executed من جولة واحدة لما
+
+171
+00:13:00,440 --> 00:13:04,760
+تدخل الدم بتطلع صفر بتدخل الكيلية يعني من الدم
+
+172
+00:13:04,760 --> 00:13:09,080
+دخلت الكيليةاللي طالع مرة صفر هو مش صفر عشان يكون
+
+173
+00:13:09,080 --> 00:13:12,740
+عشر المية طالع نخصم العشر المية شوش كده نحطها في
+
+174
+00:13:12,740 --> 00:13:19,240
+الحساب فإذا معظمها is executed تمام؟ إذا معناها
+
+175
+00:13:19,240 --> 00:13:23,000
+هذي جزء filtered عشرين المية معناها عندي كمية
+
+176
+00:13:23,000 --> 00:13:28,640
+كبيرة إيش secreted مش هيك؟ مستحيل إشي أنا أقدر
+
+177
+00:13:28,640 --> 00:13:33,480
+أتخلص منه كاملا بالإيش بال filtration ليش؟ لأن ال
+
+178
+00:13:33,480 --> 00:13:38,470
+filtration يمثل إيش؟فقط خمس الكميات إذا ال plasma
+
+179
+00:13:38,470 --> 00:13:43,250
+حاملة كمان تمانين في المية من ال .. من ال .. من
+
+180
+00:13:43,250 --> 00:13:47,010
+المادة ضالت في ال plasma عشرين في المية filtered
+
+181
+00:13:47,010 --> 00:13:50,010
+إذا في عندى تمانين في المية ضايلة وين لما أنا
+
+182
+00:13:50,010 --> 00:13:54,110
+أتخلص من كل المادة معناها أنه لازم يكون صار لها
+
+183
+00:13:54,110 --> 00:13:59,030
+secretion مستحيل ان filtration طبيعته لا هتستطيع
+
+184
+00:13:59,030 --> 00:14:02,070
+أنه يطلع كل إشي إذا هذا البرامج ما أنها pure acid
+
+185
+00:14:02,690 --> 00:14:10,230
+معناها انها كمية كبيرة منها secreted معناها يعني
+
+186
+00:14:10,230 --> 00:14:15,310
+معظم اللي دخل الدم secreted مع ال ball معناها لو
+
+187
+00:14:15,310 --> 00:14:19,490
+حسبت الكمية هذه هذه المادة بالذات مقدر من خلالها
+
+188
+00:14:19,490 --> 00:14:23,110
+اعرف الرينا ال blood flow الرينا ال blood flow
+
+189
+00:14:23,110 --> 00:14:29,350
+لإنه هي اللي طلع هو كل المحمول في الدم في ال
+
+190
+00:14:29,350 --> 00:14:34,150
+plasma اقصد اذا عرفناالكمية هذه كل اللى طلع هو
+
+191
+00:14:34,150 --> 00:14:36,930
+اللى دخل البلازمة وعرفنا ال concentration تبعه
+
+192
+00:14:36,930 --> 00:14:41,470
+وبعرف ايه عرف حجم البلازمة مش هيك ومن حجم البلازمة
+
+193
+00:14:41,470 --> 00:14:44,990
+بضرف ال hematocrit او واحد ناجس hematocrit بعرف ال
+
+194
+00:14:44,990 --> 00:14:49,270
+ايه ال total blood volume اذا ال renal blood flow
+
+195
+00:14:49,270 --> 00:14:56,270
+هذه بده مادة زى برقة من الhyperic acid تدخش ال
+
+196
+00:14:56,270 --> 00:15:01,260
+renal arteryماتطلعش كلها executed بحسب جداش
+
+197
+00:15:01,260 --> 00:15:06,960
+executed معناها هادي مش بس انها filtered filtered
+
+198
+00:15:06,960 --> 00:15:11,200
+و secreted معناها الكمية اللي طلعت هادي تمثلي كل
+
+199
+00:15:11,200 --> 00:15:19,690
+اللي دخل بال plasma يعني تمثلمش الفلتر الفلترات
+
+200
+00:15:19,690 --> 00:15:24,690
+تمثل ال flow تمثل البلازمة كلها لإن جزء filtered
+
+201
+00:15:24,690 --> 00:15:29,050
+جزء secreted تمام من خلالها إذا بقدر أعرف أحسب مش
+
+202
+00:15:29,050 --> 00:15:33,290
+الفلترات بعرف الأيه؟ البلازمة flow ومن البلازمة
+
+203
+00:15:33,290 --> 00:15:36,290
+flow بعرف الأيه؟ ال blood flow
+
+204
+00:15:38,330 --> 00:15:41,610
+إذا بعرف تركيزها في الدم بعرف كده تطلع في ال ball
+
+205
+00:15:41,610 --> 00:15:46,150
+بأجسم هذه على هذه بتطلع لي إيش ال volume of plasma
+
+206
+00:15:46,150 --> 00:15:49,710
+اللي عدى اللي كانت الكمية هذه فيه طبعا هذه الكمية
+
+207
+00:15:49,710 --> 00:15:53,650
+احنا في الآخر بنضرب إنها 90% نعمل تعديل هذه مش في
+
+208
+00:15:53,650 --> 00:15:59,950
+100% 90% إذا هذا يمثل 90% من ال plasma بنضيف عليها
+
+209
+00:15:59,950 --> 00:16:05,350
+10% بتطلع كمية ال plasma إيه كاملة و بنضرب في
+
+210
+00:16:05,350 --> 00:16:09,090
+معرفة ال chemical grade بنطلع إيهال .. ال .. ال
+
+211
+00:16:09,090 --> 00:16:12,190
+blood volume مثلا البهارة أمامي هي بيوريك أسد مادة
+
+212
+00:16:12,190 --> 00:16:17,750
+organic material معظم المواد اللي هو secreted
+
+213
+00:16:17,750 --> 00:16:22,450
+organic acids and organic material تمام؟ بيصيروا
+
+214
+00:16:22,450 --> 00:16:27,690
+.. الكرياتينين كمية اللي بيصيرها secretion minimal
+
+215
+00:16:27,690 --> 00:16:34,520
+لذلك بيقول عنه هو فقط الكرياتينين is filteredI'm
+
+216
+00:16:34,520 --> 00:16:38,460
+not reabsorbed or secreted فى minimal secretion
+
+217
+00:16:38,460 --> 00:16:41,120
+مانحطها فى الحساب عكس البرامج انها بيوريك أسد
+
+218
+00:16:41,120 --> 00:16:44,900
+تمام؟ يزن الكمية اللى انا بتطلع فى ال ball بخصم
+
+219
+00:16:44,900 --> 00:16:48,620
+منها الكمية اللى ايه اللى هو اللى هي secreted
+
+220
+00:16:48,620 --> 00:16:51,080
+بتصير الكمية اللى عندى اللى ضايلة هي بس ال
+
+221
+00:16:51,080 --> 00:16:56,930
+filtrateو من خلال حسبة التركيز في الدم اللى كان
+
+222
+00:16:56,930 --> 00:17:00,370
+تنفسى التركيز فى ال filtrate و جنب الكمية اللى
+
+223
+00:17:00,370 --> 00:17:03,990
+طلعت بقدر اعرف ال GFR إذا الكرياتينين مادة
+
+224
+00:17:03,990 --> 00:17:07,430
+بستخدمها احنا فى معرفة ال ايه الglomer filtration
+
+225
+00:17:07,430 --> 00:17:13,610
+rate تمام و فى المستقبل هقولكوا الكرياتينين ال
+
+226
+00:17:13,610 --> 00:17:18,400
+blood level تبعها فى حد ذاتهبتديني فكرة عن الـ GFR
+
+227
+00:17:18,400 --> 00:17:20,860
+من غير ما أعمل الحسبة اللي موجودة عليها نشوف إيش
+
+228
+00:17:20,860 --> 00:17:23,560
+في ال urine و إيش في إيش ال executor اللي موجودة
+
+229
+00:17:23,560 --> 00:17:27,660
+علي الحسبة تانية طبعا لإن طول ما ال GFR يعني لإنه
+
+230
+00:17:27,660 --> 00:17:30,740
+ال execution تبعها بيعتمد أساسا على ال filtration
+
+231
+00:17:30,740 --> 00:17:35,440
+طبعا إذا لما يجيلي ال filtration ال level تبع
+
+232
+00:17:35,440 --> 00:17:40,980
+الكرياتينين بيعلن صار الجسم هو بتخلص الجسم من
+
+233
+00:17:40,980 --> 00:17:45,310
+الكرياتينين فقط بال filtrationإذا ال filtration
+
+234
+00:17:45,310 --> 00:17:49,910
+كميت و جلت إذا ال exclusion أو التخلص من هذا ال
+
+235
+00:17:49,910 --> 00:17:53,750
+waste product من الدم انخفط معناها الكرياتيني في
+
+236
+00:17:53,750 --> 00:17:59,070
+الدم مش هسير فيه هيعلن مش هيك؟ إذا كل ما عليه شوية
+
+237
+00:17:59,070 --> 00:18:04,750
+الكرياتينين بعرف إن ال GFR وطيت إذا في علاقة ترضية
+
+238
+00:18:04,750 --> 00:18:08,850
+ما بين الكرياتينين و ال GFR إذا أنا بس لو شفت ال
+
+239
+00:18:08,850 --> 00:18:14,010
+plasma كرياتينين بقول إيش أخباري الأيه؟الـ GFR لما
+
+240
+00:18:14,010 --> 00:18:17,910
+ناجي الكريتينين اضعف مانها الـ GFR نزلت للنصف لما
+
+241
+00:18:17,910 --> 00:18:22,110
+ناجي الـ GFR الكريتينين تلت اضعاف معناها لا دي ولا
+
+242
+00:18:22,110 --> 00:18:27,450
+تلت مرتبط هادي في هادي هنتكلم عنها بالتفصيل later
+
+243
+00:18:27,450 --> 00:18:32,030
+on لكنه بداية اذا نفهمنا التنتين ال secreted هدول
+
+244
+00:18:32,030 --> 00:18:37,330
+واحدة بتستخدم للرينا ال blood flow واحدة ال glomer
+
+245
+00:18:37,330 --> 00:18:42,190
+filtration rate اذا ال flow rate والfiltration
+
+246
+00:18:42,190 --> 00:18:48,310
+rate كرياتينين وانيولين
+
+247
+00:18:48,310 --> 00:18:52,890
+هدولة ايش لل GFR الانيولين مشكلته انه مادة خارجيه
+
+248
+00:18:52,890 --> 00:18:57,230
+انا بدي اعطيها مشكلته ايش انه مادة polysaccharide
+
+249
+00:18:57,230 --> 00:19:01,110
+الانيولينبس يبقى ده بدي أديها أنا في الدم و أصبر
+
+250
+00:19:01,110 --> 00:19:05,450
+عليها و بعدين أجيسها في الدم في ال plasma و أجيسها
+
+251
+00:19:05,450 --> 00:19:09,150
+في ال ball و أعمل الحسبة المعروفة تمام؟ عم بطلع ال
+
+252
+00:19:09,150 --> 00:19:12,590
+filtration rate لإنها just filtered not reabsorbed
+
+253
+00:19:12,590 --> 00:19:16,030
+and not resecrated هو الأيه؟ هي أي مادة بنستخدمها
+
+254
+00:19:16,030 --> 00:19:20,690
+لمعرفة ال GFR لازم تكون بس filtered لا هي
+
+255
+00:19:20,690 --> 00:19:23,830
+reabsorbed ولا هي secreted معناها الكمية تمثل ال
+
+256
+00:19:23,830 --> 00:19:27,340
+filtered volume بحسب الحسبةالانويلين عيبها ان انا
+
+257
+00:19:27,340 --> 00:19:31,020
+بدي اديها للعيان و احسب الحسبة لكن ال criteria
+
+258
+00:19:31,020 --> 00:19:35,120
+ميزتها ولو انها فيها شوية factor مشكلة اللي
+
+259
+00:19:35,120 --> 00:19:38,920
+بيستخدم ال secretion لكنها ميزتها ان انا باخد عينة
+
+260
+00:19:38,920 --> 00:19:44,360
+مباشرة مديش انا اعمل جثة مع العيان و طاقم و اعطي و
+
+261
+00:19:44,360 --> 00:19:47,240
+جيس و روح و تعالى لأ باخد blood sample و خلاص
+
+262
+00:19:47,240 --> 00:19:54,650
+بقوله روح روح تمام؟بس الانويلين أدق كرياتينين أسهل
+
+263
+00:19:54,650 --> 00:19:59,710
+طبعا أما البرقة مينوهيبيرك أسد لأ ال filtrate
+
+264
+00:19:59,710 --> 00:20:04,570
+وباقي الدم إذا بستخدمه في ال plasma flow rate يعني
+
+265
+00:20:04,570 --> 00:20:07,630
+ال blood flow rate في الآخر بقدر أحسبها رينال
+
+266
+00:20:07,630 --> 00:20:13,110
+blood flow بقدر أحسبه من البرقة مينوهيبيرك أسد
+
+267
+00:20:13,110 --> 00:20:16,350
+substances
+
+268
+00:20:16,350 --> 00:20:20,230
+that are actively transportedand do not exhibit
+
+269
+00:20:20,230 --> 00:20:31,210
+transport maximum فهنا نتكلم عن مواد active
+
+270
+00:20:31,210 --> 00:20:35,550
+transport و secondary active transport مش كده لكن
+
+271
+00:20:35,550 --> 00:20:38,810
+في مواد عندى actively transported وملهش transport
+
+272
+00:20:38,810 --> 00:20:47,680
+maximum زى الصدر ليش مالوش transport maximumلإنه
+
+273
+00:20:47,680 --> 00:20:52,600
+ال bombing system تبعه أكبر من أي تركيز ممكن يجي
+
+274
+00:20:52,600 --> 00:20:58,460
+على ال bezel أترا ال membrane على الفلترات تمام؟
+
+275
+00:20:58,460 --> 00:21:04,760
+إذا ال bombing system ضخم إذا أي كمية بتيجي في
+
+276
+00:21:04,760 --> 00:21:09,660
+وجود brush border بيعمللي عشرين ضعف لإيه ال
+
+277
+00:21:09,660 --> 00:21:16,320
+surface area ال transport surface بيزيد عشرين ضعف
+
+278
+00:21:18,260 --> 00:21:23,720
+بالاضافة لو وجود ال career system تمام؟ بالاضافة
+
+279
+00:21:23,720 --> 00:21:27,360
+لو وجود انه عندى كمية ال .. ال .. ال .. ال
+
+280
+00:21:27,360 --> 00:21:32,280
+basolateral membrane transport اكتر من كمية ال ايه
+
+281
+00:21:32,280 --> 00:21:35,580
+ال .. ال .. ال transport على ال .. على ال brush
+
+282
+00:21:35,580 --> 00:21:41,610
+border مش كده؟ على ال brush borderعند الكمية
+
+283
+00:21:41,610 --> 00:21:44,510
+التركيز الموجودة يعني الكمية اللي في الفلترات انا
+
+284
+00:21:44,510 --> 00:21:46,830
+باطرد على ال basolateral membrane اكبر منها بكتير
+
+285
+00:21:46,830 --> 00:21:50,590
+اضعاف اضعاف فمهما ازود ال concentration of sodium
+
+286
+00:21:50,590 --> 00:21:53,270
+في ال proximal convolutal tubule تستطيع انها ايش
+
+287
+00:21:53,270 --> 00:21:56,890
+تعملها reabsorption طب في الوضع الطبيعي انا بصل
+
+288
+00:21:56,890 --> 00:22:01,650
+لمرحلة ان انا استهلاكت كل ال sodium اللي موجود وين
+
+289
+00:22:01,650 --> 00:22:06,670
+في ال .. في ال .. في الفلترات لإن ال basolateral
+
+290
+00:22:06,670 --> 00:22:10,970
+membrane pumping system ضخمبضخ من الداخل ال cells
+
+291
+00:22:10,970 --> 00:22:15,070
+لإيه ال terrestrial fluid تمام سحبنا كل الايه طب و
+
+292
+00:22:15,070 --> 00:22:18,910
+ال sodium و ال glucose و ال amino acid اللي موجودة
+
+293
+00:22:18,910 --> 00:22:23,630
+بيدها sodium تاني عشان عن طريقه بت .. إذا فيش
+
+294
+00:22:23,630 --> 00:22:26,870
+sodium ال career system مش هيشتغل يعني ال glucose
+
+295
+00:22:26,870 --> 00:22:31,190
+و ال amino acid و غيرها بيضالهم خارج تمام فعنا هنا
+
+296
+00:22:31,190 --> 00:22:37,100
+المسألة محلولة انه بيصيح عندي back leakيعني ال
+
+297
+00:22:37,100 --> 00:22:39,860
+concentration .. ال concentrated sodium اللي في ال
+
+298
+00:22:39,860 --> 00:22:44,600
+interstitium لما اقل كتير ال .. ال .. ال filtered
+
+299
+00:22:44,600 --> 00:22:50,210
+concentration of sodiumفبرجع أساعده لإن هذا شغلته
+
+300
+00:22:50,210 --> 00:22:55,450
+يدخل مش أنا شغلت أتخلص من ال sodium لأ شغلتي أساسا
+
+301
+00:22:55,450 --> 00:23:00,290
+ال sodium أستخدمه في إيه؟ في نقل الأشياء ف لذلك
+
+302
+00:23:00,290 --> 00:23:05,370
+بعد ما أنقل و أخلص برجع جزء منه عشان إيه؟ عشان يظل
+
+303
+00:23:05,370 --> 00:23:09,090
+في عندي high concentration في ال .. في ال traitو
+
+304
+00:23:09,090 --> 00:23:14,150
+يندفع في نقل ال sodium و في نقل ال glucose و ال
+
+305
+00:23:14,150 --> 00:23:17,890
+amino acid و others بنفس الكفاءة، تمام؟ اذا عندي
+
+306
+00:23:17,890 --> 00:23:23,860
+انا bisolateral membrane transport system عاليهذا
+
+307
+00:23:23,860 --> 00:23:29,220
+بيقدر الى انه اي كمية بل انا بساعدها اني بديها من
+
+308
+00:23:29,220 --> 00:23:32,360
+اللي انا طلعته و برجع تاني back leak عبر ال tide
+
+309
+00:23:32,360 --> 00:23:36,480
+junction عشان ايه ال بيصير ان انترستيشن ال fluid
+
+310
+00:23:36,480 --> 00:23:41,260
+عالي ال concentration و ال tubular fluid جالف
+
+311
+00:23:41,260 --> 00:23:43,440
+فاطوماتيكا لما ال tide junction ما شاء الله عليها
+
+312
+00:23:43,440 --> 00:23:48,960
+مسموح تحت السلك بسهولة بتعدى فبرجع بحيث يضلي حافظ
+
+313
+00:23:48,960 --> 00:23:50,180
+على ال
+
+314
+00:23:52,800 --> 00:23:56,840
+ال .. ال .. ال facilitated diffusion عشان يحافظ
+
+315
+00:23:56,840 --> 00:24:03,260
+على انه .. فلذلك هذا النوع من الايه؟ من ال .. من
+
+316
+00:24:03,260 --> 00:24:08,540
+ال .. ال active transport بدون ايش؟ بدون transport
+
+317
+00:24:08,540 --> 00:24:12,460
+maximum بالصوديوم وين؟ في ال proximal convolutal
+
+318
+00:24:12,460 --> 00:24:17,420
+pool في الdistal convolutal pool مش موجود such
+
+319
+00:24:17,420 --> 00:24:24,620
+tight junction لأ ولا موجود such leakymembrane لأ
+
+320
+00:24:24,620 --> 00:24:29,660
+لأ باخد صوديوم بالعيار باخد صوديوم بالعيار الكمية
+
+321
+00:24:29,660 --> 00:24:33,040
+اللي أنا عايزها لإن ممكن يكون أنا مش عايز يكون
+
+322
+00:24:33,040 --> 00:24:38,140
+الضغط عندي عليه ومحتاج أهرب شوية صوديوم لبرا فاللي
+
+323
+00:24:38,140 --> 00:24:41,420
+بصل ال diesel tubule يمثل حوالي عشرين في المية
+
+324
+00:24:41,420 --> 00:24:50,310
+تمام عشرين أو أقل عندي خمسة وسبعينخمسة لمية وعشرين
+
+325
+00:24:50,310 --> 00:24:55,030
+يعني في نسب مختلفة هذا ممكن انا اتخلص ايه اتخلص
+
+326
+00:24:55,030 --> 00:25:00,190
+منه او اخده كله حسب حاجة الجسم حسب ال control
+
+327
+00:25:00,190 --> 00:25:03,810
+system اللي احنا هنتكلم عنه ال دوستيرون,
+
+328
+00:25:03,990 --> 00:25:10,810
+antidiotic hormone و other hormones
+
+329
+00:25:10,810 --> 00:25:17,990
+that control العملية في ال distal tubulesubstances
+
+330
+00:25:17,990 --> 00:25:23,130
+that are actively transported but do not exhibit a
+
+331
+00:25:23,130 --> 00:25:24,410
+transport maximum
+
+332
+00:25:55,830 --> 00:25:59,030
+substances that do not exhibit a transport maximum
+
+333
+00:25:59,030 --> 00:26:04,930
+الاشياء اللي هي بيصيرها passive diffusion passive
+
+334
+00:26:04,930 --> 00:26:09,010
+transport مالهاش career system يعني إلها طريق آخر
+
+335
+00:26:09,010 --> 00:26:13,010
+عبر channels أخرى من غير career system لإن career
+
+336
+00:26:13,010 --> 00:26:16,530
+system بيصيرله إيش؟بصيرله saturation، بصيرله ايه؟
+
+337
+00:26:16,530 --> 00:26:21,530
+تشبح، لكن أنا بعديش عبر ال .. ال career system
+
+338
+00:26:21,530 --> 00:26:28,690
+فبصير عندي انا three entrants، بعدي جد ما موجودجدش
+
+339
+00:26:28,690 --> 00:26:34,330
+في عندى تركيز بعدي جدش في عندى ال surface area
+
+340
+00:26:34,330 --> 00:26:38,550
+بعدي جدش في ال permeability تبعات ال membrane بعدي
+
+341
+00:26:38,550 --> 00:26:42,590
+جدش انا وقفت جبال ال membrane بعدي إذا كنت ماشي
+
+342
+00:26:42,590 --> 00:26:45,530
+سريع الكاميرا هتعدي إيه؟ جليلا إذا أنا exposed
+
+343
+00:26:45,530 --> 00:26:50,970
+لمدة أطول تمام لذلك يسموها ال gradient time
+
+344
+00:26:50,970 --> 00:26:56,650
+transport مش .. مش not exhibiting transport
+
+345
+00:26:56,650 --> 00:27:01,940
+maximumthe transport is at gradient time transport
+
+346
+00:27:01,940 --> 00:27:06,160
+قدش فيه تركيز فارق بينها نهان عشان انا بدأ اعمل
+
+347
+00:27:06,160 --> 00:27:09,790
+diffusionوقدش ال time اللى انا جاعتى جبال ال flow
+
+348
+00:27:09,790 --> 00:27:13,430
+تبع ال tubular fluid ال flow سريع ولا بطيق ال flow
+
+349
+00:27:13,430 --> 00:27:17,330
+بطيق هقد كمية فرصة كبيرة ان انا اعمل transport ال
+
+350
+00:27:17,330 --> 00:27:23,150
+flow سريع يهرب إلى بعد المنطقة هذه تمام؟ اذا هدول
+
+351
+00:27:23,150 --> 00:27:27,850
+ال passively transported substances are not
+
+352
+00:27:27,850 --> 00:27:31,530
+limited by transport maximum
+
+353
+00:27:38,410 --> 00:27:43,310
+الشركات اللي بسيطة تدخل تدخل تدخل تدخل تدخل تدخل
+
+354
+00:27:43,310 --> 00:27:51,350
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+355
+00:27:51,350 --> 00:27:51,490
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+356
+00:27:51,490 --> 00:27:52,010
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+357
+00:27:52,010 --> 00:27:52,050
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+358
+00:27:52,050 --> 00:27:59,210
+تدخل تدخل تدخل تدخل تدخل تدخل تدخل
+
+359
+00:27:59,210 --> 00:28:07,930
+ت
+
+360
+00:28:08,290 --> 00:28:11,530
+مش كده الصوديوم في الـ proximal tubule لكن
+
+361
+00:28:11,530 --> 00:28:14,590
+الصوديوم في الـ distal tubule الـ tight junction
+
+362
+00:28:14,590 --> 00:28:24,010
+في ال distal tubule is tight هنا leaking وتكلمنا
+
+363
+00:28:24,010 --> 00:28:29,290
+عنها احنا ليش هذهمختلفة عشان ال basolateral system
+
+364
+00:28:29,290 --> 00:28:33,230
+عشان ال back leak أساسا بيعطيها و احنا محتاجين
+
+365
+00:28:33,230 --> 00:28:36,610
+ويرجع أساسا بنخلص كل اللي موجود و بنعطيه كمان و
+
+366
+00:28:36,610 --> 00:28:41,510
+برضه ايه جادرين عليه تمام ال brush border و ال
+
+367
+00:28:41,510 --> 00:28:50,870
+surface area و كذا كل ال ايه ضخم passive
+
+368
+00:28:52,170 --> 00:28:56,430
+Water reabsorption by osmosis is coupled mainly by
+
+369
+00:28:56,430 --> 00:29:01,910
+Sodium reabsorption طيب الآن اتكلمنا عن ال Sodium
+
+370
+00:29:01,910 --> 00:29:06,990
+الactive transport و ال glucose ايش اخبار الميه
+
+371
+00:29:06,990 --> 00:29:13,550
+الميه تعتمد في انتقالها على ال osmolality Sodium
+
+372
+00:29:13,550 --> 00:29:19,130
+كتير دخل الى داخل ال cells و ليه جوا ال chloride و
+
+373
+00:29:19,130 --> 00:29:25,640
+كمان دخل ال glucoseو كل الأشياء اللي reabsorbed في
+
+374
+00:29:25,640 --> 00:29:29,740
+ال tubule في ال proximal tubule كلها عملتلي high
+
+375
+00:29:29,740 --> 00:29:37,560
+concentration of water عمللي low osmolality في
+
+376
+00:29:37,560 --> 00:29:41,700
+داخل الاه و high osmolality في ال cells و ال
+
+377
+00:29:41,700 --> 00:29:45,660
+interstitium لذلك المياه automatically بتلحق من ال
+
+378
+00:29:45,660 --> 00:29:47,660
+hyper osmotic solutions
+
+379
+00:29:50,880 --> 00:29:54,060
+بتعدي على ال cells إذا كان ال root of entry
+
+380
+00:29:54,060 --> 00:29:57,280
+transcendental أو بتعدي على ال tie junction إذا
+
+381
+00:29:57,280 --> 00:30:02,050
+كان ال aRoot of Entry عبر الـ A وإذا كان عبرت ال
+
+382
+00:30:02,050 --> 00:30:05,110
+cells لكن ال pumping system بسرعة ركزها أكتر من ال
+
+383
+00:30:05,110 --> 00:30:09,150
+cells في داخل ال A بتاع ال junction هتعدي من هنا
+
+384
+00:30:09,150 --> 00:30:12,310
+يعني ال water هنا is following the sodium and
+
+385
+00:30:12,310 --> 00:30:17,230
+chloride تركيزها متوازن يعني 75% من ال sodium يمتص
+
+386
+00:30:17,230 --> 00:30:21,030
+في ال A في ال proximal و 75% من الميه يمتص في ال A
+
+387
+00:30:21,030 --> 00:30:24,850
+في ال proximal عشان cosmolality لإن ال main
+
+388
+00:30:25,060 --> 00:30:29,420
+الكاتيون اللي بيحدد اسمه لك هو الصوديوم طبعا فلذلك
+
+389
+00:30:29,420 --> 00:30:33,560
+اتنين ماشيين مع بعض لكن ال route of entry both من
+
+390
+00:30:33,560 --> 00:30:44,420
+ايه؟ Transcellular و Paracellular a
+
+391
+00:30:44,420 --> 00:30:47,160
+large part of the osmotic flow of water at tide
+
+392
+00:30:47,160 --> 00:30:53,000
+junctions اه في هنا حاجة اسمة solvent drag والميه
+
+393
+00:30:53,000 --> 00:30:57,330
+مندفعةالى داخل ال tide junctions بسبب ان ال sodium
+
+394
+00:30:57,330 --> 00:31:02,750
+concentration جوا عالى ليش؟ لأن اللي تم ادخاله عبر
+
+395
+00:31:02,750 --> 00:31:08,250
+ال عبر ال basolateral membrane عبر ال brush border
+
+396
+00:31:08,250 --> 00:31:11,250
+انتقل عبر ال basolateral membrane بالإيه؟ بال
+
+397
+00:31:11,250 --> 00:31:13,350
+pumping system وبسرعة إلى ال interstitium و ال
+
+398
+00:31:13,350 --> 00:31:15,770
+interstitium تركيز السوديوم عالي فيه فال
+
+399
+00:31:15,770 --> 00:31:17,750
+osmolality عالي في ال interstitium أكتر من ال
+
+400
+00:31:17,750 --> 00:31:21,170
+filtrate بكتير فال water اندفعت إلى إيه؟ عبر ال
+
+401
+00:31:21,170 --> 00:31:23,650
+tide junctions بتاخد معاها بعض الأشياء اللي دايبة
+
+402
+00:31:23,650 --> 00:31:29,050
+فيهابسميها solvent drag هي مدفعة وتاخد معها بعض ال
+
+403
+00:31:29,050 --> 00:31:32,270
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+404
+00:31:32,270 --> 00:31:32,370
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+405
+00:31:32,370 --> 00:31:32,950
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+406
+00:31:32,950 --> 00:31:33,650
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+407
+00:31:33,650 --> 00:31:35,230
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+408
+00:31:35,230 --> 00:31:35,470
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+409
+00:31:35,470 --> 00:31:36,630
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+410
+00:31:36,630 --> 00:31:36,630
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+411
+00:31:36,630 --> 00:31:37,670
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+412
+00:31:37,670 --> 00:31:37,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+413
+00:31:37,670 --> 00:31:38,850
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+414
+00:31:38,850 --> 00:31:42,310
+ال .. ال .. ال ..
+
+415
+00:31:42,310 --> 00:31:45,830
+ال .. ال .. ال .. ال .. ال .. ال ..
+
+416
+00:31:51,700 --> 00:31:55,700
+water permeability is always high and water is
+
+417
+00:31:55,700 --> 00:32:01,240
+reabsorbed as rapidly as the solutes in the
+
+418
+00:32:01,240 --> 00:32:04,640
+ascending loop of Henle كويس هادى الان بتكلم عن
+
+419
+00:32:04,640 --> 00:32:10,260
+الميه in general في ال proximal it follows ال ايه
+
+420
+00:32:10,260 --> 00:32:14,360
+ال sodium يعني حسب كده ال solutes reabsorbed و كده
+
+421
+00:32:14,360 --> 00:32:20,020
+الميه reabsorbed by diffusion simple diffusion ال
+
+422
+00:32:20,020 --> 00:32:25,050
+loop of Henlein the ascending loop of henley هذا
+
+423
+00:32:25,050 --> 00:32:28,230
+اللي بيهمنا في الموضوع ال descending permeable to
+
+424
+00:32:28,230 --> 00:32:33,730
+water لكن او اول ال thin ascending لكن ال thick
+
+425
+00:32:33,730 --> 00:32:37,790
+ascending هو الأهم is impermeable to water it is
+
+426
+00:32:37,790 --> 00:32:42,310
+permeable to solutes من هنا المنطج هادي في thick
+
+427
+00:32:42,310 --> 00:32:46,990
+ascending limb الميه ممنوعة تمتص وهي بيمتص كمية
+
+428
+00:32:46,990 --> 00:32:51,020
+ضخمة من ال solutesوبيطلع عندنا ال filtrate هان بعد
+
+429
+00:32:51,020 --> 00:32:55,900
+ال thick ascending limb لأول ال distal
+
+430
+00:32:55,900 --> 00:33:00,520
+communicative pool بيصلنا hypotonic hypoosmalen
+
+431
+00:33:00,520 --> 00:33:07,400
+بيصل ل 100 ملي ملي أزمال ال concentration تبعه
+
+432
+00:33:07,400 --> 00:33:16,180
+cosmolality هنا تصل ل 100 واضح؟ طيب إذا ال water
+
+433
+00:33:16,180 --> 00:33:21,460
+في الproximal إلها إشي في ال thick ascending limb
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c.srt
new file mode 100644
index 0000000000000000000000000000000000000000..8e88575f271db226dbca7099db62b0ba47b12e3d
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c.srt
@@ -0,0 +1,1558 @@
+1
+00:00:13,870 --> 00:00:18,030
+الـ blood volume إذا قلنا عنه أنه هان نقدر نعتبره
+
+2
+00:00:18,030 --> 00:00:21,730
+compartment خاصة لأنه موجود في إيه؟ في blood
+
+3
+00:00:21,730 --> 00:00:26,910
+vessels شملها، فيه منه solid و منه fluid وهذا 40
+
+4
+00:00:26,910 --> 00:00:32,910
+إلى 60 the
+
+5
+00:00:32,910 --> 00:00:36,950
+average blood volume  كبلد كبلد مش ك .. كبلازمة
+
+6
+00:00:36,950 --> 00:00:44,000
+يمثل 7% من وزن الجسم، 7% من إيه؟ من وزن الجسم لكن ال
+
+7
+00:00:44,000 --> 00:00:48,700
+plasma  الحالها كده؟ ال plasma خمس المية، خمس
+
+8
+00:00:48,700 --> 00:00:54,300
+المية، معناه بس ال plasma مع ال إيه؟ ال plasma مع
+
+9
+00:00:54,300 --> 00:00:57,340
+ال red blood cells و ال other cells يمثلوا إيه؟
+
+10
+00:00:57,340 --> 00:01:02,220
+يمثلوا سبعة المية، حوالي خمس لتر، حوالي خمس
+
+11
+00:01:02,220 --> 00:01:05,860
+لتر، طيب
+
+12
+00:01:05,860 --> 00:01:09,320
+hematocrit
+
+13
+00:01:09,320 --> 00:01:13,580
+اتكلمنا عنها، بس نقطة مهمة في الهيماتوكريت ملاحظة
+
+14
+00:01:13,580 --> 00:01:18,180
+المكتوب بالأحمر هنا، إحنا لما فصلنا بال
+
+15
+00:01:18,180 --> 00:01:23,040
+centrifugation، ال centrifuge عملنا خلينا ال red
+
+16
+00:01:23,040 --> 00:01:29,120
+blood cells تنطرد خارجيًا، لأنه أثقل، اه، و البلازما
+
+17
+00:01:29,120 --> 00:01:33,240
+بتضال برا، صار عندي packed red blood cells مضغوطة
+
+18
+00:01:33,240 --> 00:01:37,860
+هذا لا يعني أنها حقيقةً صار البلازما كلها طلعت برا
+
+19
+00:01:37,860 --> 00:01:41,460
+عندي 3 إلى 4% من البلازما بتضال محشورة بين ال
+
+20
+00:01:41,460 --> 00:01:47,100
+إيه؟ بين red blood cells، لذلك لما بدنا إحنا نتكلم
+
+21
+00:01:47,100 --> 00:01:54,710
+عن الـ hematocrit، حقيقةً هي الهيماتوكريت بيطلع بس
+
+22
+00:01:54,710 --> 00:01:56,830
+ستة وتسعين في المية منها هو الـ blood red cells
+
+23
+00:01:56,830 --> 00:02:01,070
+لإن فيه أربعة في المية بتضل لمن؟ للبلازما، لكن
+
+24
+00:02:01,070 --> 00:02:04,570
+الهيماتوكريت اللي بنقرأها إحنا بنعتمد عليها خلاص
+
+25
+00:02:04,570 --> 00:02:07,950
+هي إيه؟ الهيماتوكريت بنعامل معاها، بس للعلم أن فيه
+
+26
+00:02:07,950 --> 00:02:11,330
+جزء من البلازما بيكون إيه؟ ضايل بينها، أما
+
+27
+00:02:11,330 --> 00:02:13,750
+الهيماتوكريت المقروءة خلاص أن إحنا بنقرأ
+
+28
+00:02:13,750 --> 00:02:19,450
+بالهيماتوكريت tube و بنسجلها، لكن للعلم أنها ليست 40
+
+29
+00:02:19,450 --> 00:02:26,730
+% حقيقيًا بالظبط، هي أقل من 40%، لأنه عندي 3 أو 4 %
+
+30
+00:02:26,730 --> 00:02:32,610
+موجودة plasma بينهم، ومدى إن نتكلم عن الـ hematocrit
+
+31
+00:02:32,610 --> 00:02:35,390
+اللي علاقة بالـ RBC's، هي الحالات اللي فيها أنيميا
+
+32
+00:02:35,390 --> 00:02:40,810
+معناها الـ hematocrit فيها هتنخفض، هتهبط، معناها لو
+
+33
+00:02:40,810 --> 00:02:43,730
+عندنا حالات polycythaemia، red blood cells زاد ال
+
+34
+00:02:43,730 --> 00:02:47,690
+hematocrit، هيزيد، مش كده بس، الاستخدام الأكثر هو الـ
+
+35
+00:02:47,690 --> 00:02:49,950
+hematocrit مش عشان أعرف إذا فيه أنيميا ولا فيه
+
+36
+00:02:49,950 --> 00:02:55,730
+polycythaemia، الاستخدام الأكثر أن أعرف الـ
+
+37
+00:02:55,730 --> 00:02:58,910
+dehydration status، يعني أجدش فيه plasma هو الأهم
+
+38
+00:02:58,910 --> 00:03:02,310
+أن أجدش فيه red blood cells، لأن الـ red blood cells
+
+39
+00:03:02,310 --> 00:03:06,110
+الموجودة ثابتة، لكن اللي بيطلع و بينزل عندي الـ plasma
+
+40
+00:03:07,240 --> 00:03:11,720
+لذلك لو واحدة جت فقدت كمية كبيرة من الدم و صار
+
+41
+00:03:11,720 --> 00:03:16,700
+عندها hypotension و أغمى عليها أو حالة حالة، و
+
+42
+00:03:16,700 --> 00:03:19,240
+أخدتها من عينة الدم، لو حصل إني ماتت وجيت تبقى
+
+43
+00:03:19,240 --> 00:03:24,240
+حاجة إيش هنلاقيها؟ طبيعي، لكن اديها فترة كافية و تبدأ
+
+44
+00:03:24,240 --> 00:03:28,480
+الـ fluids تنتقل من الـ interstitial fluid لـ
+
+45
+00:03:28,480 --> 00:03:31,560
+البلازما، بمعنى آخر لو كان .. في .. في مجال أنها
+
+46
+00:03:31,560 --> 00:03:34,900
+تبقى عايشة، يعني لو كان عندنا severe bleeding، لو
+
+47
+00:03:34,900 --> 00:03:38,060
+كان الـ bleeding moderate أو minimal، تمام، الجسم
+
+48
+00:03:38,060 --> 00:03:41,480
+بيبدأ يعوض نفسه بنفسه، أن بعض الـ fluids هتطلع من الـ
+
+49
+00:03:41,480 --> 00:03:44,380
+interstitial fluid لـ البلازما، و الفقدان هذا اللي
+
+50
+00:03:44,380 --> 00:03:48,220
+بيصير في الـ interstitial fluid بتعوض من مين؟ من الـ
+
+51
+00:03:48,220 --> 00:03:52,640
+intracellular، لأن بيصير على طول نزاحة، كلّه بيزيح في
+
+52
+00:03:52,640 --> 00:03:55,990
+هذا الاتجاه، بحيث يصير في الآخر equilibrium، الـ
+
+53
+00:03:55,990 --> 00:03:58,050
+equilibrium هي اللي هتحدد إيه اللي بيحكمه بعد
+
+54
+00:03:58,050 --> 00:04:00,970
+شويا، هتحدد إيه اللي بيحكمه، لكن لو فقدنا الـ
+
+55
+00:04:00,970 --> 00:04:06,110
+plasma pressure، فيها fluids يعني هتمشي هكذا، اه، لو
+
+56
+00:04:06,110 --> 00:04:10,290
+زاد الـ plasma هتمشي باتجاه هذا، بس مش هتسرع كتير
+
+57
+00:04:10,290 --> 00:04:14,980
+باتجاه هذا، لأن كلّه هتدخل و تشيل الزيادة، تمام؟ لكن
+
+58
+00:04:14,980 --> 00:04:20,400
+في حالات الطوارئ لما إحنا بنفقد نزيف دم بسرعة
+
+59
+00:04:20,400 --> 00:04:24,160
+طبعًا اللي بسرعة بيموت، ما الحاجة الجسم يعوض حاله،
+
+60
+00:04:24,160 --> 00:04:28,840
+لكن لو كان gradual و minimal و كده فبنلاقي أنه
+
+61
+00:04:28,840 --> 00:04:33,880
+خلال ساعات، خلال ساعات بيكون الجسم عوض الضغط من
+
+62
+00:04:33,880 --> 00:04:38,390
+أول وجهته على، إلى شيء قابل للحياة، إلى شيء معقول
+
+63
+00:04:38,390 --> 00:04:42,070
+لأنه جزء من الـ hydrostatic pressure، جزء من الـ
+
+64
+00:04:42,070 --> 00:04:46,390
+tissue fluid هينتقل إلى الـ plasma، و هذا الجزء
+
+65
+00:04:46,390 --> 00:04:52,150
+اللي فقد هيعوض جزء منه من .. بحيث في الآخر عندي ..
+
+66
+00:04:52,150 --> 00:05:00,110
+بحيث في الآخر عندي أنا إيش؟ أنه عندي نوع من
+
+67
+00:05:00,110 --> 00:05:04,120
+التوازن بين التلاتة compartments هذه، هنتكلم إيش
+
+68
+00:05:04,120 --> 00:05:07,560
+اللي بيحكمهم، إذا الوضع الأساسي اللي أنا بتكلم عنه
+
+69
+00:05:07,560 --> 00:05:14,700
+في الـ .. في الـ hematocrit، الفقدان البسيط، الطفيف
+
+70
+00:05:14,700 --> 00:05:18,880
+تمام، الفقدان الطفيف هذا بيدل إن الحالة هادئة، يعني
+
+71
+00:05:18,880 --> 00:05:23,160
+لو إحنا صبرنا على الست اللي نزفت في هادئة بعد شوية
+
+72
+00:05:23,160 --> 00:05:28,140
+هنتطلع هنلاقي عندها الـ hematocrit انخفض كتير، ليش؟
+
+73
+00:05:28,140 --> 00:05:34,080
+لأن الدم اللي طلع اتعوض بـ .. بـ fluids، إذا فقدنا
+
+74
+00:05:34,080 --> 00:05:38,160
+إحنا في الأول بلازما و RBC's، لكن في التعويض كان
+
+75
+00:05:38,160 --> 00:05:42,920
+إيه؟ بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+76
+00:05:42,920 --> 00:05:43,220
+بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+77
+00:05:43,220 --> 00:05:43,240
+بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+78
+00:05:43,240 --> 00:05:48,460
+بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+79
+00:05:48,460 --> 00:06:01,260
+بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+80
+00:06:01,870 --> 00:06:04,150
+تمام، في فقدان كبير، سريع
+
+81
+00:06:20,300 --> 00:06:27,060
+الهيماتوكريت مهمة في حالات dehydration، خاصة
+
+82
+00:06:27,060 --> 00:06:31,100
+في وجود الأزمات، يجب أن تُراقب الـ dehydration في وجود
+
+83
+00:06:33,910 --> 00:06:40,150
+إسهال، في وجود أنا بدي أقعد المريض fluids، أنا بدي
+
+84
+00:06:40,150 --> 00:06:44,090
+fluids، لوين أديله fluids، لو إجتهدنا ممكن أنا الـ
+
+85
+00:06:44,090 --> 00:06:47,930
+fluids يبقى الـ over hydration و أموته من كتر ما
+
+86
+00:06:47,930 --> 00:06:51,470
+نديتُه، قلبه مش قادر يتصرف في الـ fluids، صار
+
+87
+00:06:51,470 --> 00:06:56,610
+عليه عبء زيادة، تمام، برضه هذه الـ hematocrit من
+
+88
+00:06:56,610 --> 00:07:01,910
+فترة لفترة، قرايتها بتدلني أنا كيف وضعي في الـ fluids
+
+89
+00:07:01,910 --> 00:07:04,810
+اللي بعطيها، بعطي fluids مناسب، و لا بدي أكثر و لا
+
+90
+00:07:04,810 --> 00:07:07,410
+أقل، ممكن، اه والله أنا مَ بِعطي و مُغالِب حالي، و فيه
+
+91
+00:07:07,410 --> 00:07:10,190
+الأكل أنا مش بِعطي شيء، تمام، يعني الآن أنا محتاج
+
+92
+00:07:10,190 --> 00:07:14,250
+أكثر، فالـ hematocrit بتعكس دائمًا الـ hydration
+
+93
+00:07:14,250 --> 00:07:18,930
+status، الـ fluids أكثر ما بتعكس اللي هي الـ RBC's
+
+94
+00:07:18,930 --> 00:07:23,790
+الـ compartments
+
+95
+00:07:23,790 --> 00:07:30,480
+هذه، فيه اللي لها composition إلى حد ما من
+
+96
+00:07:30,480 --> 00:07:36,260
+compartment لكم compartment مختلف، وبعدين
+
+97
+00:07:36,260 --> 00:07:40,040
+هندرس اللي هو إيش اللي بضبط كل compartment
+
+98
+00:07:40,040 --> 00:07:47,080
+خصوصياته، بعدها، إذا أول شيء هنتكلم عن الـ accessory
+
+99
+00:07:47,080 --> 00:07:50,360
+fluid، لو طلعنا هذا الجزء، يمثل accessory fluid
+
+100
+00:07:50,360 --> 00:07:55,960
+نلاحظ أن الـ main كاتيون فيه إيش؟ Sodium، اه، و الـ main
+
+101
+00:07:55,960 --> 00:07:58,040
+anion Chloride
+
+102
+00:08:00,010 --> 00:08:04,010
+مع الكلوريد فيه بايكربونات، لكن الكلوريد هو الـ
+
+103
+00:08:04,010 --> 00:08:08,230
+main، لكن الصوديوم هو صوديوم و بس، وقليل من
+
+104
+00:08:08,230 --> 00:08:14,950
+البوتاسيوم، تمام، وقليل من الـ كالسيوم، أما الـ
+
+105
+00:08:14,950 --> 00:08:17,270
+intracellular compartment، الـ composition أيون الـ
+
+106
+00:08:17,270 --> 00:08:21,670
+composition تبعها، الـ main كاتيون هو البوتاسيوم، و
+
+107
+00:08:21,670 --> 00:08:27,510
+عندي قليل من الـ إيه؟ عكس الـ اه، وقليل من المغنيسيوم
+
+108
+00:08:27,510 --> 00:08:28,870
+لكن الـ main أنيون
+
+109
+00:08:34,560 --> 00:08:40,400
+البيكربونات، جليلة، و الكلوريد جليلة، في عندي non
+
+110
+00:08:40,400 --> 00:08:45,860
+ionic composition للبلازما، تمام، هو الـ ionic
+
+111
+00:08:45,860 --> 00:08:50,480
+composition إحنا مهتمين فيه، لأنه زي ما قلت لكم هو
+
+112
+00:08:50,480 --> 00:08:56,290
+الواسطة لأشياء كتير مهمة، التركيب هذا أن الصوديوم
+
+113
+00:08:56,290 --> 00:09:00,470
+يكون عالي، والبوتاسيوم كذا، تركيبة الخلايا، والـ
+
+114
+00:09:00,470 --> 00:09:07,050
+gates تبع الخلايا، و انتقال المواد من خارج الخلية
+
+115
+00:09:07,050 --> 00:09:11,370
+إلى داخل الخلية أو بالعكس، مرتبط بالشيء الرئيسي اللي
+
+116
+00:09:11,370 --> 00:09:15,570
+اللي بيديرهم الصوديوم و البوتاسيوم، الـ carriers اللي
+
+117
+00:09:15,570 --> 00:09:19,130
+بتنقل الأشياء من جوا ولا برا، بحكمها أنك تخش ولا
+
+118
+00:09:19,130 --> 00:09:23,470
+تطلع، الصوديوم والبوتاسيوم، تمام؟ لذلك هذول كتير
+
+119
+00:09:23,470 --> 00:09:27,470
+مهمين، لكن هم مهمين عشان يخدموا غيرهم، غيرهم اللي هو
+
+120
+00:09:27,470 --> 00:09:33,750
+السكر و الـ lipids، لأن جسمنا بيعيش بشكل رئيسي على
+
+121
+00:09:33,750 --> 00:09:37,910
+الـ lipids مش على السكر، لكن أهم شيء فينا بيعيش على
+
+122
+00:09:37,910 --> 00:09:42,590
+السكر، فكل شيء مهم، إن دماغنا بيعيش على السكر، عضلاتنا
+
+123
+00:09:42,590 --> 00:09:48,930
+لكن كمية الطاقة اللي بفقدها بالعضلات و القلب أكثر
+
+124
+00:09:48,930 --> 00:09:52,210
+كتير من كمية الطاقة اللي بفقدها بالـ brain، لكن الـ
+
+125
+00:09:52,210 --> 00:09:57,790
+brain يعني هو إيه؟ هو المهم، تمام؟ فلذلك المعادلة
+
+126
+00:09:57,790 --> 00:10:01,710
+بين الأهمية والكمية، الـ quality والـ quantity، يعني
+
+127
+00:10:01,710 --> 00:10:06,110
+بتضل اتنين مهمين، فعندنا هنا عندنا phospholipids
+
+128
+00:10:06,110 --> 00:10:13,190
+موجودة كمية كبيرة في داخل الـ plasma، محمولة عشان
+
+129
+00:10:13,190 --> 00:10:16,090
+تنتقل من الـ liver إلى different parts of the body
+
+130
+00:10:18,430 --> 00:10:21,230
+الـ cholesterol اللي هو اللي بيمثل كمية كبيرة من اللي
+
+131
+00:10:21,230 --> 00:10:26,350
+إيه؟ من الـ lipids عندنا، الـ neutral fats عندنا، الـ
+
+132
+00:10:26,350 --> 00:10:30,150
+glucose، عندنا الـ waste products الأخرى in general
+
+133
+00:10:30,150 --> 00:10:34,750
+التركيزات
+
+134
+00:10:34,750 --> 00:10:38,550
+يعني إحنا زي ما بنقول إحنا عندنا الـ concentration
+
+135
+00:10:38,550 --> 00:10:41,550
+of sodium في الـ extraction of fluid حوالي 142
+
+136
+00:10:41,550 --> 00:10:50,550
+milliequivalent كذلك أو milliosmoles كذلك البوتاسيوم
+
+137
+00:10:50,550 --> 00:10:54,450
+داخل الـ cells بنلاقي حوالي المية نفس الرقم تقريبًا
+
+138
+00:10:54,450 --> 00:11:00,250
+أنا 142، أنا 140، هنا في البلازما، البوتاسيوم 4.2
+
+139
+00:11:00,250 --> 00:11:03,470
+الصوديوم
+
+140
+00:11:03,470 --> 00:11:14,310
+في داخل الـ cells هيكون منخفض كتير، ليش؟ 140، أن هو و
+
+141
+00:11:14,310 --> 00:11:19,700
+هكذا هنلاقي الفروقات ما بينهم، هذه لنا برضه فيها كلام
+
+142
+00:11:19,700 --> 00:11:25,640
+المهم النهائي أن عندي أنا intracellular
+
+143
+00:11:25,640 --> 00:11:29,020
+compartment و extracellular compartment بينهم cell
+
+144
+00:11:29,020 --> 00:11:35,480
+membrane اللي بيحكم الحركة بين هذا وهذا، الـ
+
+145
+00:11:35,480 --> 00:11:42,280
+osmolality، طبعًا إذا لو أنا فقدت مية من الـ
+
+146
+00:11:42,280 --> 00:11:47,380
+accessory fluid، الـ osmolality إيش بيصير فيها؟ تعلى
+
+147
+00:11:48,520 --> 00:11:54,580
+فبيصير عندي أنا ازمولارية عالية، فقدت fluid، الـ ionic
+
+148
+00:11:54,580 --> 00:11:59,500
+composition زاد، ازمولارية عالية، في حين أن الـ
+
+149
+00:11:59,500 --> 00:12:03,020
+interstitial ما حدش كلامها، فـ automatically المية
+
+150
+00:12:03,020 --> 00:12:09,240
+هتنتقل من الأزمولارية العالية للواطئة
+
+151
+00:12:09,240 --> 00:12:16,400
+للـ عالية، المية من المنطقه الـ higher water
+
+152
+00:12:16,400 --> 00:12:19,840
+concentration للـ less water concentration، بمعنى
+
+153
+00:12:19,840 --> 00:12:24,380
+أنه من الـ osmolality الواطئة للـ osmolality العالية
+
+154
+00:12:24,380 --> 00:12:29,560
+تمام؟ إذا إحنا طبيعة القانون تبعنا، القانون الطبيعي
+
+155
+00:12:29,560 --> 00:12:33,600
+اللي بيحكم انتقال المواد من الأعلى إلى الأوطأ
+
+156
+00:12:33,600 --> 00:12:38,740
+الأوطأ، الـ osmolality هنا معرفة أنه عندي أنا لأنه
+
+157
+00:12:38,740 --> 00:12:42,140
+من case، الـ osmolality بالـ ionic composition، فكل ما
+
+158
+00:12:42,140 --> 00:12:46,020
+زاد الـ ionic concentration، كل ما الأزمولارية زادت، لكن
+
+159
+00:12:46,020 --> 00:12:50,200
+لما نتكلم عن انتقال، هو انتقال سريع للمية من المنطقة
+
+160
+00:12:50,200 --> 00:12:55,900
+الأكثر إلى المنطقة الأقل، تمام، بمعنى أنه اللي هي
+
+161
+00:12:55,900 --> 00:12:59,360
+المية، المنطقة اللي فيها ionic أقل إلى المنطقة اللي
+
+162
+00:12:59,360 --> 00:13:03,440
+فيها ionic أكثر، سهل لو إحنا فهمناها كلنا، مش كده؟
+
+163
+00:13:03,440 --> 00:13:07,780
+إذا لما إحنا نفكر شوية، سوائل من الـ from the
+
+164
+00:13:07,780 --> 00:13:11,400
+interstitial fluid، معناها بتبدأ عندي أنا سواء تتحرك
+
+165
+00:13:11,400 --> 00:13:16,860
+من وين؟ من الـ intracellular fluid، لحين ما إيه يصير
+
+166
+00:13:16,860 --> 00:13:21,120
+equilibrium، في الحالة هذه الـ intracellular fluid
+
+167
+00:13:21,120 --> 00:13:27,520
+concentration زاد لأنه فقد مية، يعني الأزمولارية بدل ما
+
+168
+00:13:27,520 --> 00:13:31,360
+كانت حوالي تلاتمية في داخل الـ cells وتلاتمية في
+
+169
+00:13:31,360 --> 00:13:34,780
+الـ interstitial، لما الـ interstitial فقد مية وصار
+
+170
+00:13:34,780 --> 00:13:40,950
+تلاتمية وعشرة، هذا بده يفضل شوية من ميته وتعالى
+
+171
+00:13:40,950 --> 00:13:43,850
+القسمة تبعته وينزلها تلاتمية وخمسة، وهذا بيصير
+
+172
+00:13:43,850 --> 00:13:46,590
+تلاتمية وخمسة تقريبًا، يعني in general، إلى حساب أنا
+
+173
+00:13:46,590 --> 00:13:51,830
+حاسبه كذا، لأن الـ volumes مش واحدة، يعني،
+
+223
+00:16:57,140 --> 00:17:03,860
+الاسمولاليتي في كلهم في  الإنترستيشيل والبلازما
+
+224
+00:17:03,860 --> 00:17:06,260
+والإنْتْراسيلولار واحدة
+
+225
+00:17:28,920 --> 00:17:32,720
+Ionic composition of the plasma and interstitial
+
+226
+00:17:32,720 --> 00:17:33,400
+fluid
+
+227
+00:17:38,840 --> 00:17:48,560
+referring again to important
+
+228
+00:17:48,560 --> 00:18:02,740
+constituents of the intracellular fluid كلمت
+
+229
+00:18:02,740 --> 00:18:03,060
+عنها
+
+230
+00:18:05,940 --> 00:18:11,260
+fluids in the different compartments طبعًا عندنا
+
+231
+00:18:11,260 --> 00:18:17,240
+fluid  موتر موجود في كل مكان، طيب جدًا، احنا كيف عرفنا
+
+232
+00:18:17,240 --> 00:18:25,220
+أن هذا 40% وهذا 15% وهذا 5%، والـ blood أن الـ
+
+233
+00:18:25,220 --> 00:18:29,460
+plasma الجد، والشسم الجد، طبعًا عرفناهم باستخدام
+
+234
+00:18:29,460 --> 00:18:35,220
+indicators،  فيها substances خاصة بتفيدنا في
+
+235
+00:18:35,220 --> 00:18:38,800
+القياس، indicator substances، هذه الـ indicator
+
+236
+00:18:38,800 --> 00:18:43,460
+substances أنا ممكن أستخدمها بحيث أن تتعرفني على
+
+237
+00:18:43,460 --> 00:18:48,340
+الأحجام المختلفة، النظرية الأساسية فيها dilution
+
+238
+00:18:48,340 --> 00:18:52,720
+theory، مش مسميها الـ dilution theory، يعني مادة
+
+239
+00:18:52,720 --> 00:19:00,060
+مركزة، عرف حجمها وعرف تركيزها تمام، خففتها وبقدر
+
+240
+00:19:00,060 --> 00:19:03,380
+أعرف تخفيف التركيز، المخففة للمادة المخففة
+
+241
+00:19:03,380 --> 00:19:08,220
+أوتوماتيكيًا أنا بأعرف الـ volume، مش كده؟ إذًا الحجم
+
+242
+00:19:08,220 --> 00:19:13,540
+الصغير في التركيز العالي يساوي التركيز الواطي في
+
+243
+00:19:13,540 --> 00:19:16,660
+الحجم الكبير، احنا عرفنا التركيز الواطي، أن أنا بكل
+
+244
+00:19:16,660 --> 00:19:19,660
+بساطة بأخذ عينة من المكان اللي بدي إياه، وأعرف
+
+245
+00:19:19,660 --> 00:19:23,880
+التركيز الجديد جدًّا، تمام؟ من التركيز الجديد هذا
+
+246
+00:19:23,880 --> 00:19:26,740
+بقدر أضرب هذا في هذا يساوي هذا في هذا، بطلع الكمية
+
+247
+00:19:26,740 --> 00:19:33,140
+هذه، الـ dilution، طبعًا عشان أعمل هذه العملية لازم
+
+248
+00:19:33,140 --> 00:19:37,260
+أعطي فرصة للمادة المركزة اللي أعطيتها، لازم أديها
+
+249
+00:19:37,260 --> 00:19:39,380
+فرصة كافية أن تكون إيه؟ صارت عندها
+
+250
+00:19:42,230 --> 00:19:46,510
+أخذت فترة كافية لتوزيع متكافئ، يعني قدرت هذه
+
+251
+00:19:46,510 --> 00:19:49,050
+المادة تتوزع في كل الـ compartment اللي أنا بدي إيه؟
+
+252
+00:19:49,050 --> 00:19:52,270
+اللي أنا أعطيتها، بدي أجيسها، أديها فترة كافية
+
+253
+00:19:52,270 --> 00:19:56,970
+ثلاثين إلى ستين دقيقة، توزعت في الفترة هذه، إيش
+
+254
+00:19:56,970 --> 00:19:59,850
+فقدنا عن طريق الـ urine أو الـ stool أو كده، بدي
+
+255
+00:19:59,850 --> 00:20:03,190
+أقسمهم، بدي أشيلهم من الـ إيه؟ من الكمية الرئيسية
+
+256
+00:20:03,190 --> 00:20:07,030
+لأن بأعرف الـ ball  بأجري فيه التركيز الجديد في الـ
+
+257
+00:20:07,030 --> 00:20:10,240
+volume اللي اتوزع فيه، بأعرف الـ volume، is a dilution
+
+258
+00:20:10,240 --> 00:20:15,500
+theory، بيحتاج إلى.. إلى إيه؟ إلى principle، إلى..
+
+259
+00:20:15,500 --> 00:20:19,920
+إلى indicator substance، تمام؟ وبأستخدم الـ dilution
+
+260
+00:20:19,920 --> 00:20:24,160
+principle من خلاله بقدر أعرف كل شيء، مثلًا بدنا نعرف
+
+261
+00:20:24,160 --> 00:20:29,480
+الـ total body fluids، الـ total body water، طب بدي
+
+262
+00:20:29,480 --> 00:20:34,990
+indicator، معناها أنه ينتشر في كل الـ compartments، مش
+
+263
+00:20:34,990 --> 00:20:37,990
+هيك؟ بدي أعرف الـ total، أنا يعني، بدي أعرف الـ
+
+264
+00:20:37,990 --> 00:20:40,690
+intracellular والـ extracellular والبلازما
+
+265
+00:20:40,690 --> 00:20:44,370
+intracellular  وinterstellar والبلازما، كدهش، تمام؟
+
+266
+00:20:44,370 --> 00:20:48,030
+بدي حاجة تنتشر في كل.. أش في عندي مادة ممكن تنتشر
+
+267
+00:20:48,030 --> 00:20:53,850
+في كل الأشياء هذه؟ الماء، الماء هي بتستطيع أن
+
+268
+00:20:53,850 --> 00:20:57,410
+إيه؟ تنتقل، طب أنا كده بدي أميز الماء اللي أنا حطيتها
+
+269
+00:20:57,410 --> 00:21:02,890
+عن مجمل الماء، بأخليها radioactive، يعني الـ hydrogen
+
+270
+00:21:02,890 --> 00:21:08,330
+اللي فيها، بدل ما هو ماء معمولة من هيدروجين عادي، بحط
+
+271
+00:21:08,330 --> 00:21:14,090
+هيدروجين radioactive، تريتيوم، أو بحط الـ heavy water
+
+272
+00:21:14,090 --> 00:21:21,090
+اللي هو H2، مش.. ها، تريتيوم H3، تريتيوم وده
+
+273
+00:21:21,090 --> 00:21:25,270
+ديوتيريوم، آه، إذًا عندي H3 وH2، بقدر بأخدّهم
+
+274
+00:21:25,270 --> 00:21:31,240
+radioactive، يعني بقدر أ.. أنا بالمناسبة اشتغلت
+
+275
+00:21:31,240 --> 00:21:35,020
+فيهم كتير، هدول اللي بتريتهم هذه اشتغلت فيه كتير، و
+
+276
+00:21:35,020 --> 00:21:37,340
+يا ما شربته وأنا مش ماخذ بالي، وبقى أنا بأجيس، وبقى
+
+277
+00:21:37,340 --> 00:21:40,580
+بقى أعمل ما بتسويه الله، لسه أتعرف، لكن الصح أني كنت
+
+278
+00:21:40,580 --> 00:21:45,460
+أستخدم mouth pipette لأن أدق الـ.. الـ.. الـ.. الـ
+
+279
+00:21:45,460 --> 00:21:48,200
+automatic pipette مش.. مش.. مش دقيقة كتير، كانت
+
+280
+00:21:48,200 --> 00:21:51,920
+فكثير من الأحيان ألاجي الـ rubber tube اللي بدي
+
+281
+00:21:51,920 --> 00:21:56,960
+أشفط منها مليانة، ويكشل، ما علينا، الله اللي بستّر
+
+282
+00:21:56,960 --> 00:22:00,260
+يعني هو الـ.. الـ.. الأشياء إلها مخاطر، يعني لو الـ
+
+283
+00:22:00,260 --> 00:22:04,700
+safety، يعني الـ guides اللي واحد بيستخدمها، لكن
+
+284
+00:22:04,700 --> 00:22:07,680
+بيصير أحيانًا يعني، مرات كنت مروح متناكة، أحس أني
+
+285
+00:22:07,680 --> 00:22:11,100
+أخذت كمية كبيرة من إيه؟ من الإشعاع، لكن الله اللي
+
+286
+00:22:11,100 --> 00:22:17,420
+بستر إن شاء الله، فالـ Tritium هذا H3، ممكن نأخذ، و
+
+287
+00:22:17,420 --> 00:22:23,040
+بيطلع radiations، تمام؟ الـ radiations هذه بأجيسها في
+
+288
+00:22:23,040 --> 00:22:26,980
+counter، في counter خاص بها، الـ radiations هذه
+
+289
+00:22:27,420 --> 00:22:32,260
+التريتيوم بيطلع بيتا ردياشن، فلذلك نضع بيتا counter
+
+290
+00:22:32,260 --> 00:22:36,420
+تمام، الـ beta counter هذا نستطيع أن نضع المادة اللي
+
+291
+00:22:36,420 --> 00:22:43,020
+نريد أن نستخدمها، نضعها، نجيس ردياشن تبعها جدًّا، و
+
+292
+00:22:43,020 --> 00:22:47,320
+بعدين نضع المواد بعد ما توزعت جدًّا، الردياشن فيها
+
+293
+00:22:47,320 --> 00:22:55,010
+الردياشن يمثل التركيز، فردياشن في volume يساوي الـ
+
+294
+00:22:55,010 --> 00:23:02,190
+radiation في volume، مش كده؟ نفس الشيء، ومن هنا
+
+295
+00:23:02,190 --> 00:23:04,770
+بنقدر نحسب الحسبة، إذًا لما نتكلم عن total body
+
+296
+00:23:04,770 --> 00:23:08,830
+water، بنتكلم عن الماء لأنها الوحيدة، اللي مش الوحيدة
+
+297
+00:23:08,830 --> 00:23:12,710
+يعني هي من الأشياء اللي بتقدر تنتشر في كل مكان، لكن
+
+298
+00:23:12,710 --> 00:23:16,010
+عشان أعرف كمية الماء، أنا بأعملها إيه؟ radioactive water
+
+299
+00:23:16,010 --> 00:23:19,110
+radioactive، ما بأعملش قياس من الـ concentration لكن
+
+300
+00:23:19,110 --> 00:23:22,780
+بأعملها إيه؟ بأعملها count، count للـ radiation تبع الـ
+
+301
+00:23:22,780 --> 00:23:25,060
+activity، radiation activity تبعها من الـ count
+
+302
+00:23:25,060 --> 00:23:29,660
+بأعرفها، تمام؟ بديها injection وبقى أصبر فترة أنها
+
+303
+00:23:29,660 --> 00:23:34,000
+تكون توزعت evenly، بالتساوي في كل الجسم، وبعدين بقعد
+
+304
+00:23:34,000 --> 00:23:39,770
+بأخذ عينة من البلازما، وبجيس العين هذه، كده التركيز
+
+305
+00:23:39,770 --> 00:23:44,950
+فيها، طبعًا إذًا التركيز في الـ volume مع التركيز في
+
+306
+00:23:44,950 --> 00:23:48,790
+الـ body water، الـ body water بطلع بسهولة، بنعرف إذًا
+
+307
+00:23:48,790 --> 00:23:55,410
+الـ body water من إيه؟ خلال غير الـ.. غير الـ water
+
+308
+00:23:55,410 --> 00:23:59,210
+في عندنا مادة ثانية اسمها antipyrene، تستطيع برضه
+
+309
+00:23:59,210 --> 00:24:01,430
+هذه المادة أن
+
+310
+00:24:03,870 --> 00:24:10,610
+أنها تستخدم لقياس الـ water، الـ total body water
+
+311
+00:24:10,610 --> 00:24:14,410
+تمام؟ لما بدي أستخدم أن أجيس الـ extracellular، إذًا
+
+312
+00:24:14,410 --> 00:24:23,190
+أنا جيست الـ total، بدي أجيس الـ intracellular، ما بقدرش
+
+313
+00:24:23,190 --> 00:24:27,690
+أجيس الـ intracellular direct، ما بقدرش أجيس الـ
+
+314
+00:24:27,690 --> 00:24:33,470
+intracellular direct، لأ، لازم أجيسها indirect، يعني
+
+315
+00:24:33,470 --> 00:24:37,770
+بجيس الـ total، بعدين الـ extracellular، والفرق هيكون
+
+316
+00:24:37,770 --> 00:24:42,730
+الـ extracellular مهمّة.. أهميتها في أنها بجيسها
+
+317
+00:24:42,730 --> 00:24:46,370
+هي نفسها، وبيساعدني في قياس مين؟ الـ intracellular
+
+318
+00:24:46,370 --> 00:24:50,530
+الـ extracellular water هذه، لما بدي أنا أجيسها، بدي
+
+319
+00:24:50,530 --> 00:24:54,890
+حاجة اللي بتيجي فيها أو بتطلعش للـ intracellular
+
+320
+00:24:54,890 --> 00:24:58,690
+بتظل موزعة بالتساوي بس في الإيه؟ في الـ
+
+321
+00:24:58,690 --> 00:25:03,710
+extracellular، تمام؟ الماء الأولانية، الـ radioactive
+
+322
+00:25:03,710 --> 00:25:07,650
+water، استخدمناها تنتشر في كل مكان، بدنا نعلق توتر
+
+323
+00:25:07,650 --> 00:25:10,990
+لكن أنا بدي بس الـ extracellular compartment
+
+324
+00:25:10,990 --> 00:25:15,170
+مهناها، إيش أكثر إيش موجود، إيش الـ أش اللي بيجي بس في
+
+325
+00:25:15,170 --> 00:25:18,090
+الـ extracellular compartment وما بيطلعش منه؟ الـ sodium
+
+326
+00:25:18,090 --> 00:25:21,250
+الـ sodium لو تركناه فترة، هو بيصل الـ intra
+
+327
+00:25:21,250 --> 00:25:26,030
+cellular، لكن في فترة معينة بيكون انتشر بسهولة في الـ
+
+328
+00:25:26,030 --> 00:25:28,330
+extracellular بدون ما يوصل الـ إيه؟ الـ intra
+
+329
+00:25:28,330 --> 00:25:33,160
+cellular، إلى حد ما، هو مش دقيق، لذلك قلنا هو هذا
+
+330
+00:25:33,160 --> 00:25:37,140
+sodium space، مش الـ extracellular fluid، combined
+
+331
+00:25:37,140 --> 00:25:41,920
+space، سميناه sodium space لأنه أخذ كل الـ
+
+332
+00:25:41,920 --> 00:25:47,740
+extracellular صحيح، زائد دخل شوية نَفَد عِمين، ففي جزء
+
+333
+00:25:47,740 --> 00:25:51,980
+من التركيز راح للـ intracellular، معناه صار
+
+334
+00:25:51,980 --> 00:25:59,140
+الحجم أكبر من اللازم، طبعًا لإنه صار عندي تركيز أكبر
+
+335
+00:26:00,310 --> 00:26:03,770
+فبيكبر لي الحجم، لأن جزء منه دخل للـ إنترا سيلولار
+
+336
+00:26:03,770 --> 00:26:08,510
+فلذلك هو التركيز اللي زاد مش لإنه الـ extra
+
+337
+00:26:08,510 --> 00:26:11,890
+cellular كبيرة، لإنه أخذ جزء من الـ extracellular، و
+
+338
+00:26:11,890 --> 00:26:15,950
+جزء من الـ intracellular، تمام؟ ففي الحسبة تبعيتي بطلع
+
+339
+00:26:15,950 --> 00:26:20,030
+بنحسب الجزء اللي إيه؟ الـ intracellular، مش كده؟ لإنه
+
+340
+00:26:20,030 --> 00:26:23,870
+أنا عندي اللي دخله محسوب، الـ sodium، الـ radioactive
+
+341
+00:26:23,870 --> 00:26:27,800
+sodium اللي دخله أنا محسوب، اللي دخل extracellular
+
+342
+00:26:27,800 --> 00:26:32,720
+أعطاني تركيز معين، شرد منه كمان شوية، فخف الإيه؟ لما
+
+343
+00:26:32,720 --> 00:26:37,800
+خف أنا التركيز، معناه الـ volume هيزيد طبعًا، إذًا بديني
+
+344
+00:26:37,800 --> 00:26:42,580
+حجم أكبر من اللازم، فسميناه extracellular، أو أدق
+
+345
+00:26:42,580 --> 00:26:46,660
+اسمها الـ extracellular space، sodium space، طبعًا، و
+
+346
+00:26:46,660 --> 00:26:53,510
+هكذا مع مين؟ مع الـ inulin مثلًا، طبعًا هو موجود فقط في
+
+347
+00:26:53,510 --> 00:26:56,810
+الاكستراسيلار فلويد، لكن بيدخل شوية منه للإيه؟
+
+348
+00:26:56,810 --> 00:27:02,190
+للإنترا، فبنعتبره inulin space، لكن إلى حد ما من
+
+349
+00:27:02,190 --> 00:27:06,610
+قراءة هذا وهذا وهذا، إلى حد ما بنعرف الاكستراسيلار
+
+350
+00:27:06,610 --> 00:27:10,670
+جدًّا، عندنا برضه radioactive أيوثالميت، و
+
+351
+00:27:10,670 --> 00:27:14,310
+radioactive ثيوثالفيت، هدول برضه من خلالهم نقدر
+
+352
+00:27:14,310 --> 00:27:20,990
+نعمل الـ calculations تبعّتنا، الإنْتْراسيلولار فلويد، إذًا نخصم
+
+353
+00:27:20,990 --> 00:27:27,390
+الـ total من إيه؟ نخصم الـ plasma، طيب بدي أنا أحسب الـ
+
+354
+00:27:27,390 --> 00:27:32,210
+plasma، الـ plasma بدي مادة تدخل في blood vessels
+
+355
+00:27:32,210 --> 00:27:37,310
+وما تطلعش، إيش هتكون هذه؟ proteins، مش كده؟ proteins
+
+356
+00:27:37,310 --> 00:27:42,050
+بحط albumin، radioactive albumin، بحكي radioactive
+
+357
+00:27:42,050 --> 00:27:48,190
+albumin، وبعدين بأعمله إيه؟ قياس، تمام؟ بأعمله قياس
+
+358
+00:27:48,800 --> 00:27:53,840
+أو بقدر أعرف من خلالها الـ plasma volume، طب دي الـ
+
+359
+00:27:53,840 --> 00:27:58,520
+blood volume، الـ blood volume من خلال الـ plasma
+
+360
+00:27:58,520 --> 00:28:03,940
+volume زائد زائد hematocrit، زائد hematocrit، إذًا من
+
+361
+00:28:03,940 --> 00:28:06,840
+خلال معرفة الـ hematocrit والـ plasma volume
+
+362
+00:28:06,840 --> 00:28:10,580
+أوتوماتيكيًا بقدر أعرف كمان الدم، blood volume اللي هو
+
+363
+00:28:10,580 --> 00:28:14,360
+الـ RBC volume، أو بأعرف الـ total من خلال الحسبة
+
+364
+00:28:14,360 --> 00:28:16,940
+الصغيرة هذه كمان، إذًا
+
+365
+00:28:18,690 --> 00:28:22,770
+هذا الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ
+
+366
+00:28:22,770 --> 00:28:23,230
+.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ
+
+367
+00:28:23,230 --> 00:28:23,730
+الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ
+
+368
+00:28:23,730 --> 00:28:27,990
+.. الـ.. الـ.. الـ..
+
+369
+00:28:27,990 --> 00:28:31,590
+الـ..
+
+370
+00:28:31,590 --> 00:28:31,670
+الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ
+
+371
+00:28:31,670 --> 00:28:31,730
+.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ..
+
+372
+00:28:31,730 --> 00:28:31,830
+الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ
+
+373
+00:28:31,830 --> 00:28:31,870
+.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ..
+
+374
+00:28:31,870 --> 00:28:31,950
+الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ
+
+375
+00:28:31,950 --> 00:28:32,030
+.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ.. الـ..
+
+376
+00:28:32,030 --> 00:28:44,390
+.. الـ.. الـ.. الـ.. الـ.. الـ..
+
+377
+00:28:49,200 --> 00:28:55,580
+في طريقة أخرى لقياس البلازما، مش أن أجيس
+
+378
+00:28:55,580 --> 00:29:01,540
+البلازما عن طريق الـ blood، أقصد مش أجيس الـ blood عن
+
+379
+00:29:01,540 --> 00:29:05,400
+طريق أن أجيس البلازما وأعمل بالـ hematocrit، لأ
+
+380
+00:29:05,400 --> 00:29:08,140
+بأعمل dilution theory مباشرة، لكمبارتمنت اسمه blood
+
+381
+00:29:08,140 --> 00:29:13,100
+تمام؟ كمبارتمنت اسمه blood، بأعمله dilution theory
+
+382
+00:29:13,100 --> 00:29:18,800
+عادي، أحط كمية، تمام؟ وهذه الكمية بحيث أنها ما تطلعش
+
+383
+00:29:18,800 --> 00:29:23,020
+من الـ blood vessels، ما تطلعش، تمام؟ وبعدين بشوف
+
+384
+00:29:23,020 --> 00:29:27,440
+تركيزها في الـ blood، وبعدين بقى أضرب الـ theory
+
+385
+00:29:27,440 --> 00:29:30,360
+عادي، ده ليش الـ theory، تركيز في كده يساوي تركيز في
+
+386
+00:29:30,360 --> 00:29:36,400
+كده، تمام؟ في الحالة هذه بدي أحط أنا red blood cells
+
+387
+00:29:36,400 --> 00:29:39,640
+labelled with radioactive material، red blood cells
+
+388
+00:29:39,640 --> 00:29:46,390
+حطيت كمية معينة، activity معينة في الـ blood، بعد 10
+
+389
+00:29:46,390 --> 00:29:50,910
+دقائق، آخذ عينة، سامبل من الـ blood، الـ RBC ما بتطلعش
+
+390
+00:29:50,910 --> 00:29:54,730
+ما بتطلعش
+
+391
+00:29:54,730 --> 00:
+
+445
+00:33:51,250 --> 00:33:53,190
+عندي fluids دخلت الـ interstitial fluid بالـ
+
+446
+00:33:53,190 --> 00:33:55,990
+hydrostatic pressure و الـ oncotic pressure مش جادة
+
+447
+00:33:55,990 --> 00:33:59,800
+رجعها، فبيصير عندي إِدِمَة فالناس اللي عندهم الـ
+
+448
+00:33:59,800 --> 00:34:03,560
+proteinuria، الناس اللي عندهم nephrotic syndrome
+
+449
+00:34:03,560 --> 00:34:09,920
+بيجيُون منفخين، ليش منفخين؟ لأن هبط البروتين في الدم
+
+450
+00:34:09,920 --> 00:34:16,020
+فبِش أدى عندي إِلى أنَّ الـ fluids هربت واستقرت في
+
+451
+00:34:16,020 --> 00:34:20,600
+الـ ... مش جادرة، إذا أنا بدي أحلها باني بدي أعطيهم
+
+452
+00:34:20,600 --> 00:34:26,300
+infusion human albumin، بدي أعطيهم في الدم مباشرة human
+
+453
+00:34:26,300 --> 00:34:29,670
+albumin عشان يزودوا الـ albumin في الدم، تمام؟ عشان
+
+454
+00:34:29,670 --> 00:34:33,450
+إيه؟ أعود أسحب الـ ... الـ fluids اللي هربت للانسجة
+
+455
+00:34:33,450 --> 00:34:37,350
+عشان أُضَيِّع الـ ... القديمة، بس سبب الهروب الأساسي هو
+
+456
+00:34:37,350 --> 00:34:46,150
+مين؟ الكلية، هربت، ممكن يكون عند الـ liver ضعف، بطّل
+
+457
+00:34:46,150 --> 00:34:52,430
+يصنع، مش كده؟ فلو كان عندي أنا liver failure، بيقل
+
+458
+00:34:52,430 --> 00:34:56,110
+تصنيع البروتينات، البروتينات في الـ plasma بتقل
+
+459
+00:34:56,110 --> 00:35:03,510
+تمام؟ لو عندي تهريب مباشر من الكلية، البروتينات في
+
+460
+00:35:03,510 --> 00:35:08,990
+البلازما بتقل، هدول الإثنين بيؤدِّيان إلى أنَّ عندي
+
+461
+00:35:08,990 --> 00:35:13,470
+بيؤدِّي إلى أنَّ الـ oncotic pressure اللي موجود في الـ
+
+462
+00:35:13,470 --> 00:35:17,370
+capillaries اللي بيرجع الـ fluids بيقل، و بتؤدي إلى
+
+463
+00:35:17,370 --> 00:35:24,530
+إِدِمَة، الـ interstitial fluid بيزيد الـ ... الـ ... الـ ...
+
+464
+00:35:24,530 --> 00:35:24,950
+الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ
+
+465
+00:35:24,950 --> 00:35:25,130
+.. الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ...
+
+466
+00:35:25,130 --> 00:35:25,350
+الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ
+
+467
+00:35:25,350 --> 00:35:27,270
+.. الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ...
+
+468
+00:35:27,270 --> 00:35:27,450
+الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ
+
+469
+00:35:27,450 --> 00:35:31,110
+.. الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ...
+
+470
+00:35:31,110 --> 00:35:31,390
+الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ
+
+471
+00:35:31,390 --> 00:35:36,470
+.. الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ...
+
+472
+00:35:36,470 --> 00:35:38,390
+الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ ... الـ
+
+473
+00:35:38,390 --> 00:35:43,870
+الـ ... الـ ... الـ ... الـ ... الـ ...
+
+474
+00:35:43,870 --> 00:35:49,190
+الـ ... الـ ...
+
+475
+00:35:51,710 --> 00:35:54,350
+الكلمة زلال هذه الغريبة العجيبة اللي موجودة بين
+
+476
+00:35:54,350 --> 00:35:57,970
+الناس، آه عنده زلال، ما يأكلش زلال لإنه عنده زلال، طب
+
+477
+00:35:57,970 --> 00:36:02,870
+وايش يعني؟ بنعوّضه، أخسرنا، بنعوّضه، إذا ممكن نعوّضه إحنا
+
+478
+00:36:02,870 --> 00:36:08,310
+الـ protein اللي ... اللي راح عبر الكلية، يِعْني إنَّه
+
+479
+00:36:08,310 --> 00:36:11,610
+بناخد مباشرة، أو بنديله high protein diet، إيش
+
+480
+00:36:11,610 --> 00:36:17,000
+بنعطيه المريض high protein عشان نقول للكبد، خُذ اللي
+
+481
+00:36:17,000 --> 00:36:22,120
+بَاقي فيه من الـ amino acids، وصنّع كميات أكبر من
+
+482
+00:36:22,120 --> 00:36:26,360
+البروتين إلى داخل الـ ... إلى البلازما، حتى تحمي الجسم
+
+483
+00:36:26,360 --> 00:36:32,160
+عندنا الـ cell membrane بين الـ fluid و الـ ... بيحكم
+
+484
+00:36:32,160 --> 00:36:35,320
+الـ osmotic pressure، الـ sodium و الـ potassium
+
+485
+00:36:35,320 --> 00:36:39,140
+concentration هان، وهان اللي عاملين الـ osmolality
+
+486
+00:36:39,140 --> 00:36:44,310
+تمام؟ osmolality زادت، بيجذب ماء هان، ثم بتروح
+
+487
+00:36:44,310 --> 00:36:49,790
+ماء لمين؟ للجهة الثانية، والـ factors هذه، إذا
+
+488
+00:36:49,790 --> 00:36:53,270
+المرة الجاية هتكلم عن principles of osmosis and
+
+489
+00:36:53,270 --> 00:36:56,470
+osmotic pressure، وكيف بنحسبها، يلا يعطيكم العفو
+
+490
+00:36:56,470 --> 00:37:00,390
+مين له سؤال؟ إحنا ضايل ست دقائق، ولو إنَّه
+
+491
+00:37:00,390 --> 00:37:04,150
+الناس خاطر مرة، إحنا معاكم، وجيت لسه، مين له سؤال يا
+
+492
+00:37:04,150 --> 00:37:07,610
+بنات؟ يلا يعطيكم العفو
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..0e802899d87bbb516bfa8d11149beaf3db37aee4
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c_postprocess.srt
@@ -0,0 +1,1968 @@
+1
+00:00:13,870 --> 00:00:18,030
+الـ blood volume إذا قلنا عنه أنه هان نقدر نعتبره
+
+2
+00:00:18,030 --> 00:00:21,730
+compartment خاصة لإن هو موجود في إيه؟ في blood
+
+3
+00:00:21,730 --> 00:00:26,910
+vessels شملها، في منه solid و منه fluid وهذا 40
+
+4
+00:00:26,910 --> 00:00:32,910
+إلى 60 the
+
+5
+00:00:32,910 --> 00:00:36,950
+average blood volume البلد كبلد مش ك .. كبلازمة
+
+6
+00:00:36,950 --> 00:00:44,000
+يمثل 7% من وزن الجسم 7% من إيه؟ من وزن الجسملكن ال
+
+7
+00:00:44,000 --> 00:00:48,700
+plasma الحالها كده؟ ال plasma خمس المية، خمس
+
+8
+00:00:48,700 --> 00:00:54,300
+المية، معناه بس ال plasma مع ال ايه؟ ال plasma مع
+
+9
+00:00:54,300 --> 00:00:57,340
+ال red blood cells و ال other cells يمثلوا ايه؟
+
+10
+00:00:57,340 --> 00:01:02,220
+يمثلوا سبعة المية، حوالي خمس لتر، حوالي خمس
+
+11
+00:01:02,220 --> 00:01:05,860
+لتر،طيب
+
+12
+00:01:05,860 --> 00:01:09,320
+hematocrit
+
+13
+00:01:09,320 --> 00:01:13,580
+اتكلمنا عنهابس نقطة مهمة في الماتوكريات ملاحظة
+
+14
+00:01:13,580 --> 00:01:18,180
+المكتوب بالأحمر هنا احنا لما فصلنا بال
+
+15
+00:01:18,180 --> 00:01:23,040
+centrifugation ال centrifuge عملنا خلينا ال red
+
+16
+00:01:23,040 --> 00:01:29,120
+blood cells تنطرد خارجياو لأنه أثقل اه و البلازمه
+
+17
+00:01:29,120 --> 00:01:33,240
+بتضال برا صار عندى packed red blood cells مضغوطة
+
+18
+00:01:33,240 --> 00:01:37,860
+هذا لا يعني انها حقيقة صار البلازمه كلها طلعت برا
+
+19
+00:01:37,860 --> 00:01:41,460
+عندى 3 الى 4 عامية من البلازمه بتضال محشورة بين ال
+
+20
+00:01:41,460 --> 00:01:47,100
+ايه بين red blood cells لذلك لما بدنا احنا نتكلم
+
+21
+00:01:47,100 --> 00:01:54,710
+عن ال ال hematocrit حقيقةهي الهيموتوكريته بيطلع بس
+
+22
+00:01:54,710 --> 00:01:56,830
+ستة و تسعين في المية منها هو ال blood red cells
+
+23
+00:01:56,830 --> 00:02:01,070
+لإن في أربع عالمية بتنظف لمن؟ للبلازمة لكن
+
+24
+00:02:01,070 --> 00:02:04,570
+الهيموتوكريته اللي بنقرأها احنا بنعتمد عليها خلاص
+
+25
+00:02:04,570 --> 00:02:07,950
+هي ايه؟ هيموتوكريته بتعامل معاها بس للعلم ان في
+
+26
+00:02:07,950 --> 00:02:11,330
+جنون من البلازمة بيكون ايه؟ ضايل بينها اما
+
+27
+00:02:11,330 --> 00:02:13,750
+الهيموتوكريته المقروقة خلاص ان احنا بنقرأ
+
+28
+00:02:13,750 --> 00:02:19,450
+بالهيموتوكريته tubeومنسجلها لكن بيعلم أنها ليست 40
+
+29
+00:02:19,450 --> 00:02:26,730
+% حقيقيا بالظبط هي أقل من 40% لأنه في عندى 3400
+
+30
+00:02:26,730 --> 00:02:32,610
+موجودة plasma بينهم ومدى ان نتكلم عن ال hematocrit
+
+31
+00:02:32,610 --> 00:02:35,390
+اللي علاقة بال RBC's هي حاجات اللي فيها أنيميا
+
+32
+00:02:35,390 --> 00:02:40,810
+معناها ال hematocrit فيها هتنخفضهتهبط معناها لو
+
+33
+00:02:40,810 --> 00:02:43,730
+عندنا حالات polycyzemia red blood cells زاد ال
+
+34
+00:02:43,730 --> 00:02:47,690
+hematocrit حد زيت مش كده بس الاستخدام الاكتر هو ال
+
+35
+00:02:47,690 --> 00:02:49,950
+hematocrit مش عشان اعرف اذا في انيميا ولا في
+
+36
+00:02:49,950 --> 00:02:55,730
+polycyzemia الاستخدام الاكتر ان اعرف ال
+
+37
+00:02:55,730 --> 00:02:58,910
+dehydration status يعني اجدش فيه plasma هو الاهم
+
+38
+00:02:58,910 --> 00:03:02,310
+ان اجدش فيه red blood cells لان ال red blood cells
+
+39
+00:03:02,310 --> 00:03:06,110
+الموجودة ثابتة لكن اللي بطلع و بنزل عندى ال plasma
+
+40
+00:03:07,240 --> 00:03:11,720
+لذلك لو واحدة وجيت فقدت كمية كبيرة من الدم و صار
+
+41
+00:03:11,720 --> 00:03:16,700
+عندها hypotension و أغمى عليها أو حالة حالة و
+
+42
+00:03:16,700 --> 00:03:19,240
+أخدتها من عين الدم لو فحصل اني ماتت و جيت تبقى
+
+43
+00:03:19,240 --> 00:03:24,240
+حاجة ايش هنلاجيه؟ طبيعي لكن اديها فترة كافيةو تبدأ
+
+44
+00:03:24,240 --> 00:03:28,480
+ال fluids تنتقل من ال interstitial fluid ل
+
+45
+00:03:28,480 --> 00:03:31,560
+البلازما بمعنى اخر لو كان .. في .. في مجال انها
+
+46
+00:03:31,560 --> 00:03:34,900
+تبقى عايشة يعني لو كانش عندنا severe bleeding لو
+
+47
+00:03:34,900 --> 00:03:38,060
+كان ال bleeding moderate او minimal تمام الجسم
+
+48
+00:03:38,060 --> 00:03:41,480
+بيبدأ يعود نفسه بنفسه ان بعض ال fluids هتطلع من ال
+
+49
+00:03:41,480 --> 00:03:44,380
+interstitial fluid ل البلازما و الفقدان هذا اللي
+
+50
+00:03:44,380 --> 00:03:48,220
+بيصير في ال interstitial fluid بتعود من مين؟ من ال
+
+51
+00:03:48,220 --> 00:03:52,640
+intracellular لان بيصير على طول نزاحة كله بيزيح في
+
+52
+00:03:52,640 --> 00:03:55,990
+هاتجاهبحيث يصير في الآخر equilibrium ال
+
+53
+00:03:55,990 --> 00:03:58,050
+equilibrium هي اللي هتتكلم ايه اللي بيحكمه بعد
+
+54
+00:03:58,050 --> 00:04:00,970
+شوارع صغير هتتكلم ايه اللي بيحكمه لكن لو فقدنا ال
+
+55
+00:04:00,970 --> 00:04:06,110
+plasma pressure فيها fluids يعني هتمشي هكذا اه لو
+
+56
+00:04:06,110 --> 00:04:10,290
+زاد ال plasma هتمشي باتجاه هذا بس مش هتصرح كتير
+
+57
+00:04:10,290 --> 00:04:14,980
+باتجاه هذا لان كله هتدخل و تشيل الزيادة تمام؟لكن
+
+58
+00:04:14,980 --> 00:04:20,400
+في حالات الطوارئ لما احنا بنفقد نزيف دمء بسرعة
+
+59
+00:04:20,400 --> 00:04:24,160
+طبعا اللي بسرعة بيموت، مالحاجش الجسم يعوض حاله،
+
+60
+00:04:24,160 --> 00:04:28,840
+لكن لو كان gradual و minimal و كده فبنلاقي انه
+
+61
+00:04:28,840 --> 00:04:33,880
+خلال ساعات .. خلال ساعات بكون الجسم عوض الضغط من
+
+62
+00:04:33,880 --> 00:04:38,390
+أول وجهته على .. إلى اشي قابل للحياةإلى إشي معقول
+
+63
+00:04:38,390 --> 00:04:42,070
+لإنه جزء من ال hydrostatic pressure جزء من ال
+
+64
+00:04:42,070 --> 00:04:46,390
+transition fluid هينتخر إلى ال plasma و هذا الجزء
+
+65
+00:04:46,390 --> 00:04:52,150
+اللي فقد هيعوض جزء منه من .. بحيث في الآخر عندي ..
+
+66
+00:04:52,150 --> 00:05:00,110
+بحيث في الآخر عندي أنا إيش؟ إنه في عندي نوع من
+
+67
+00:05:00,110 --> 00:05:04,120
+التوازن بين التلاتة compartments هذههنتكلم إيش
+
+68
+00:05:04,120 --> 00:05:07,560
+اللي بيحكمهم إذا الوضع الأساسي اللي أنا بتكلم عنه
+
+69
+00:05:07,560 --> 00:05:14,700
+في ال .. في ال hematocrite الفقدان البسيط البطيق
+
+70
+00:05:14,700 --> 00:05:18,880
+تمام الفقدان البطيق هذا بتدين إن الحالة هادى يعني
+
+71
+00:05:18,880 --> 00:05:23,160
+لو أحنا صبرنا على الست اللي نزفها في هادى بعد شوية
+
+72
+00:05:23,160 --> 00:05:28,140
+هنتطلع هنلاجى عندها ال hematocrite انخفض كتير ليش؟
+
+73
+00:05:28,140 --> 00:05:34,080
+لإن الدم اللي طلع اتعود ب .. ب fluidsإذا فقدنا
+
+74
+00:05:34,080 --> 00:05:38,160
+إحنا في الأول بلازمة و RBC's لكن في التعويض كان
+
+75
+00:05:38,160 --> 00:05:42,920
+إيه؟ بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+76
+00:05:42,920 --> 00:05:43,220
+بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+77
+00:05:43,220 --> 00:05:43,240
+بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+78
+00:05:43,240 --> 00:05:48,460
+بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+79
+00:05:48,460 --> 00:06:01,260
+بس بس بس بس بس بس بس بس بس بس بس بس بس بس
+
+80
+00:06:01,870 --> 00:06:04,150
+تمام في فقدان كبير سريع
+
+81
+00:06:20,300 --> 00:06:27,060
+الهيماتوكريت مهمة في حالات الهيدراشيا للبطل خاصة
+
+82
+00:06:27,060 --> 00:06:31,100
+في وجود الأزمات يجب أن تراقب الهيدراشيا في وجود
+
+83
+00:06:33,910 --> 00:06:40,150
+ديارية في وجود انا بدي قاعد المريض fluids انا بدي
+
+84
+00:06:40,150 --> 00:06:44,090
+fluids لوين اديله fluids لو اجتاش ممكن انا ال
+
+85
+00:06:44,090 --> 00:06:47,930
+fluids يبقى ال over hydration و اموته من كتر ما
+
+86
+00:06:47,930 --> 00:06:51,470
+نديته قنقته الجلب مش قادر يتصرف في ال fluids صار
+
+87
+00:06:51,470 --> 00:06:56,610
+عليه عبء ازيادة تمام برضه هذه ال hematocrit من
+
+88
+00:06:56,610 --> 00:07:01,910
+فترة لفترة قرايتها بالدين انا كيف وضعيفي ال fluids
+
+89
+00:07:01,910 --> 00:07:04,810
+اللى بعطيها بعطى fluids مناسب و لا بدى اكتر و لا
+
+90
+00:07:04,810 --> 00:07:07,410
+اقل ممكن اه والله انا ميعطى و مغالب حالي و في
+
+91
+00:07:07,410 --> 00:07:10,190
+الأكل انا مش بيعطي اشي تمام يعني الان انا محتاج
+
+92
+00:07:10,190 --> 00:07:14,250
+اكتر فال hematocrit بتراكب دايما ال hydration
+
+93
+00:07:14,250 --> 00:07:18,930
+status ال fluids اكتر ما بتراكب اللي هي ال RBC's
+
+94
+00:07:18,930 --> 00:07:23,790
+ال compartments
+
+95
+00:07:23,790 --> 00:07:30,480
+هذه فيه اللي لها compositionالى حد ما من
+
+96
+00:07:30,480 --> 00:07:36,260
+compartment لكمpartment مختلف وبعدين
+
+97
+00:07:36,260 --> 00:07:40,040
+هندرس اللي هو ايش اللي بضبط كل compartment
+
+98
+00:07:40,040 --> 00:07:47,080
+خصوصيتها بعدها اذا اول شي هنتكلم عن ال accessory
+
+99
+00:07:47,080 --> 00:07:50,360
+fluid لو طلعنا هذا الجزء يمثل accessory fluid
+
+100
+00:07:50,360 --> 00:07:55,960
+نلاحظ ان ال main كتابة فيه ايش Sodium اه و ال main
+
+101
+00:07:55,960 --> 00:07:58,040
+anion Fluoride
+
+102
+00:08:00,010 --> 00:08:04,010
+مع الكلوريد فيه باي كربونات لكن الكلوريد هو ال
+
+103
+00:08:04,010 --> 00:08:08,230
+main لكن الصوديوم هو صوديوم و بس و قليل من
+
+104
+00:08:08,230 --> 00:08:14,950
+البوتاسيوم تمام و قليل من ال كالسيوم اما ال
+
+105
+00:08:14,950 --> 00:08:17,270
+infrastructure compartment ال composition ايون ال
+
+106
+00:08:17,270 --> 00:08:21,670
+composition تبعها ال main كتايون هو البوتاسيوم و
+
+107
+00:08:21,670 --> 00:08:27,510
+عندي قليل من ال ايه عكس ال اه و قليل من المغنيسيوم
+
+108
+00:08:27,510 --> 00:08:28,870
+لكن ال main انايون
+
+109
+00:08:34,560 --> 00:08:40,400
+البيكربونات جليلة والكلورايتز جليلة في عندى non
+
+110
+00:08:40,400 --> 00:08:45,860
+ionic composition للبلازما تمام هو ال ionic
+
+111
+00:08:45,860 --> 00:08:50,480
+composition احنا مهتمين فيه لانه زى ما قلتلكم هو
+
+112
+00:08:50,480 --> 00:08:56,290
+الواسطةلأشياء كتير مهمة التركيب هذا ان الصوديوم
+
+113
+00:08:56,290 --> 00:09:00,470
+يكون عالي والبوتاسيوم كذا تركيبة الخلايا و ال
+
+114
+00:09:00,470 --> 00:09:07,050
+gates تبع الخلايا وانتقال المواد من خارج الخلية
+
+115
+00:09:07,050 --> 00:09:11,370
+إلى داخل الخلية او بالعكس مرتبط بالشيالين تبعوننا
+
+116
+00:09:11,370 --> 00:09:15,570
+اللي بيديرهم الصوديوم والبوتاسيوم ال carriers اللي
+
+117
+00:09:15,570 --> 00:09:19,130
+بتنقل الأشياء من جوا ولا برا بحكومها انك تخش ولا
+
+118
+00:09:19,130 --> 00:09:23,470
+تطلع الصوديوم والبوتاسيوم تمام؟ لذلكهذول كتير
+
+119
+00:09:23,470 --> 00:09:27,470
+مهمين لكن هم مهمين عشان يخدموا غيرهم غيرهم اللي هو
+
+120
+00:09:27,470 --> 00:09:33,750
+السكر و ال lipids لإن جسمنا بيعيش بشكل رئيسي على
+
+121
+00:09:33,750 --> 00:09:37,910
+ال lipids مش على السكر لكن أهم فينا بيعيش على
+
+122
+00:09:37,910 --> 00:09:42,590
+السكر فكل مهم إن دماغنا بيعيش على السكر عضلاتنا
+
+123
+00:09:42,590 --> 00:09:48,930
+لكن كمية الطاقة اللي بفقدها بالعضلات و الجلب أكتر
+
+124
+00:09:48,930 --> 00:09:52,210
+كتير من كمية الطاقة اللي بفقدها بال brainلكن ال
+
+125
+00:09:52,210 --> 00:09:57,790
+brain يعني هو ايه؟ هو المهم تمام؟ فلذلك المعادلة
+
+126
+00:09:57,790 --> 00:10:01,710
+بين الأهمية و الكمية ال quality و ال quantity يعني
+
+127
+00:10:01,710 --> 00:10:06,110
+بتظل اتنين مهمين فعنا هنا عندنا phospholipids
+
+128
+00:10:06,110 --> 00:10:13,190
+موجودة كمية كبيرة في داخل ال plasma محمولة عشان
+
+129
+00:10:13,190 --> 00:10:16,090
+تنتقل من ال liver الى different parts of the body
+
+130
+00:10:18,430 --> 00:10:21,230
+الكلستيرول اللى هو اللى يمثل كمية كبيرة من اللى
+
+131
+00:10:21,230 --> 00:10:26,350
+ايه من ال limits عندنا ال neutral fats عندنا ال
+
+132
+00:10:26,350 --> 00:10:30,150
+glucose عندنا ال waste products الأخرى in general
+
+133
+00:10:30,150 --> 00:10:34,750
+التركيزات
+
+134
+00:10:34,750 --> 00:10:38,550
+يعني احنا زى ما بنقول احنا عندنا ال concentration
+
+135
+00:10:38,550 --> 00:10:41,550
+of sodium في ال extraction of fluid حوالي 142
+
+136
+00:10:41,550 --> 00:10:50,550
+milliequivalent كذلك او millieosmolكذلك البوتاسيوم
+
+137
+00:10:50,550 --> 00:10:54,450
+داخل ال cells بنلاقي حوالي المية نفس الرقم تقريبا
+
+138
+00:10:54,450 --> 00:11:00,250
+انا 142 انا 140 هان في البلازم البوتاسيوم 4.2
+
+139
+00:11:00,250 --> 00:11:03,470
+الصوديوم
+
+140
+00:11:03,470 --> 00:11:14,310
+في داخل ال cells هيكون منخفض كتير ليش 14 ان هو و
+
+141
+00:11:14,310 --> 00:11:19,700
+هكذا هنلاقي الفروقات ما بينوهذه لنا برضه فيها كلام
+
+142
+00:11:19,700 --> 00:11:25,640
+المعدل النهائي ان عندي انا intracellular
+
+143
+00:11:25,640 --> 00:11:29,020
+compartment و extracellular compartment بينهم cell
+
+144
+00:11:29,020 --> 00:11:35,480
+membrane اللى بيحكم الحركة بين هذا و هذا ال
+
+145
+00:11:35,480 --> 00:11:42,280
+osmolality طبعا اذا لو انا فقدت ميه من ال
+
+146
+00:11:42,280 --> 00:11:47,380
+accessory fluid ال osmolality ايش بيصير فيها تعلى
+
+147
+00:11:48,520 --> 00:11:54,580
+فبصير عندى انا ازمولارية عالية فقدت fluid ال ionic
+
+148
+00:11:54,580 --> 00:11:59,500
+composition زاد ازمولارية عالية في حين انه ال
+
+149
+00:11:59,500 --> 00:12:03,020
+interstellar ماحدش كلامها ف automatically الميه
+
+150
+00:12:03,020 --> 00:12:09,240
+هتنتقل من ازمولارية العالية الواطية
+
+151
+00:12:09,240 --> 00:12:16,400
+الى العالية الميه من المن ال higher water
+
+152
+00:12:16,400 --> 00:12:19,840
+concentration لل less water concentration بمعنى
+
+153
+00:12:19,840 --> 00:12:24,380
+انه من ال osmolality الواطية لل osmolality العالية
+
+154
+00:12:24,380 --> 00:12:29,560
+تمام؟ اذا احنا طبيعة القانون تبعنا القانون الطبيعي
+
+155
+00:12:29,560 --> 00:12:33,600
+اللي بيحكم انتقال المواد من الأعلى إلى الأعلى
+
+156
+00:12:33,600 --> 00:12:38,740
+الأوطى ال osmolality هنا متعرفة انه عندي انا لإنه
+
+157
+00:12:38,740 --> 00:12:42,140
+من case ال osmolality بال ionic compositionفكل ما
+
+158
+00:12:42,140 --> 00:12:46,020
+زاد ال ionic concentration كل ما ازمه نزل زادت لكن
+
+159
+00:12:46,020 --> 00:12:50,200
+لما نتكلم عن انتقال هو انتقال سهر الميه من المنطقة
+
+160
+00:12:50,200 --> 00:12:55,900
+الأكتر إلى المنطقة الأقل تمام بمعنى انه اللي هي
+
+161
+00:12:55,900 --> 00:12:59,360
+الميه المنطقة اللي فيها ionic أقل إلى المنطقة اللي
+
+162
+00:12:59,360 --> 00:13:03,440
+فيها ionic أكتر سهل لو احنا فاهمينا كلنا مش كده
+
+163
+00:13:03,440 --> 00:13:07,780
+اذا لما احنا نفكر شوية سوائل من ال from the
+
+164
+00:13:07,780 --> 00:13:11,400
+interstitial fluidمعناها بتبدأ عندى انا سواء اتحرك
+
+165
+00:13:11,400 --> 00:13:16,860
+من وين من ال intracellular fluid لحين ما ايه يصير
+
+166
+00:13:16,860 --> 00:13:21,120
+equilibrium في الحالة هذه ال intracellular fluid
+
+167
+00:13:21,120 --> 00:13:27,520
+concentration زاد لانه فقد مية يعني ازمولية بدل ما
+
+168
+00:13:27,520 --> 00:13:31,360
+كانت حوالي تلاتمية في داخل ال cells و تلاتمية في
+
+169
+00:13:31,360 --> 00:13:34,780
+ال interstitial لما ال interstitial فقد مية و صار
+
+170
+00:13:34,780 --> 00:13:40,950
+تلاتمية و عشرة هذا بدهيفكر شوية من ميته وتعالى
+
+171
+00:13:40,950 --> 00:13:43,850
+القزمانة تبعته وينزلها تلات مية وخمسة وهذا بيصير
+
+172
+00:13:43,850 --> 00:13:46,590
+تلات مية وخمسة تقريبا يعني in general إلى حساب انا
+
+173
+00:13:46,590 --> 00:13:51,830
+حاسبه كذا لإن ال volumes مش واحدة يعني اه اذا
+
+174
+00:13:51,830 --> 00:13:55,830
+بيصير equilibrium إذا ال intracerebral fluid و ال
+
+175
+00:13:55,830 --> 00:13:58,690
+extracerebral fluid و ال interstitial يحكمهم في
+
+176
+00:13:58,690 --> 00:14:02,870
+انتقال الميه من hand ل hand اشوة
+
+177
+00:14:05,560 --> 00:14:11,800
+small solute osmolality of the small solute في حين
+
+178
+00:14:11,800 --> 00:14:18,260
+انه من ال fluid للبلازمة بيحكمنا ايش بيقولنا
+
+179
+00:14:18,260 --> 00:14:18,920
+حاجتين
+
+180
+00:14:22,820 --> 00:14:26,600
+بتقدي الى ان الفلوسة بتقل هان او هان الاتنين
+
+181
+00:14:26,600 --> 00:14:31,320
+بيشتغلوا عكس بعض بحيث ان هذا بيزود ال filtration و
+
+182
+00:14:31,320 --> 00:14:34,380
+هذا بيمنع ال filtration بحيث يصير دائما بينهم ايه
+
+183
+00:14:34,380 --> 00:14:39,240
+اكوليبريام لل hydrostatic و ال oncotic pressure
+
+184
+00:14:39,240 --> 00:14:41,880
+يصلوا الى مرحلة متوازن
+
+185
+00:14:48,670 --> 00:14:55,250
+المختلفة المهمة بين هاتين الانتجارات هي تركيز
+
+186
+00:14:55,250 --> 00:14:58,470
+البروتين في البلازمه اذا احنا بتتكلم عن مين نقعد
+
+187
+00:14:58,470 --> 00:15:02,630
+عن ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن ال
+
+188
+00:15:02,630 --> 00:15:02,670
+.. عن ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن
+
+189
+00:15:02,670 --> 00:15:02,710
+ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن ال ..
+
+190
+00:15:02,710 --> 00:15:02,750
+عن ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن ال
+
+191
+00:15:02,750 --> 00:15:02,790
+ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن ال ..
+
+192
+00:15:02,790 --> 00:15:02,970
+.. عن ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن
+
+193
+00:15:02,970 --> 00:15:03,290
+ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن ال ..
+
+194
+00:15:03,290 --> 00:15:03,350
+عن ال .. عن ال .. عن ال .. عن ال .. عن ال .. عن ال
+
+195
+00:15:03,350 --> 00:15:11,550
+.. عن ال ..
+
+196
+00:15:11,550 --> 00:15:13,330
+عن ال ..
+
+197
+00:15:16,670 --> 00:15:21,250
+يقول مادان في more protein عندي معناها فيها more
+
+198
+00:15:21,250 --> 00:15:26,810
+cations لإن ال protein هذا more negative فبيقدر
+
+199
+00:15:26,810 --> 00:15:33,140
+يمسك يتواتش to more cationsفبنلاحظ احنا ولو انه
+
+200
+00:15:33,140 --> 00:15:36,860
+صار equilibrium لكن ال equilibrium بي .. مش بالظبط
+
+201
+00:15:36,860 --> 00:15:40,440
+كيف يعني لما تكون عندك semi permeable membrane و
+
+202
+00:15:40,440 --> 00:15:43,980
+في جهة منهم في more protein هنلاقي انه صار في
+
+203
+00:15:43,980 --> 00:15:46,880
+الجهة هذه صحيح ال concentration في الآخر ال
+
+204
+00:15:46,880 --> 00:15:53,050
+cosmolality واحدة ال cosmolality واحدة لكنهيقدى
+
+205
+00:15:53,050 --> 00:15:56,990
+الى انه في هذه المنطقة more cations وفي هذه
+
+206
+00:15:56,990 --> 00:16:01,730
+المنطقة more anions بسبب وجود ال ال ال ال ال ال ال
+
+207
+00:16:01,730 --> 00:16:02,090
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+208
+00:16:02,090 --> 00:16:05,110
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+209
+00:16:05,110 --> 00:16:06,310
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+210
+00:16:06,310 --> 00:16:06,490
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+211
+00:16:06,490 --> 00:16:06,550
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+212
+00:16:06,550 --> 00:16:07,750
+ال ال ال ال ال ال ال ال ال التنقل من
+
+213
+00:16:15,360 --> 00:16:18,660
+ملاها تنتقل فبديوا ينتقلوا لها ال positive مش هي
+
+214
+00:16:18,660 --> 00:16:21,580
+تروح تتساوى بالجهة التانية يعني مش هي اللي بتنتقل
+
+215
+00:16:21,580 --> 00:16:24,220
+للجهة الأخرى من ال membrane انها بتقدرش فبديوا
+
+216
+00:16:24,220 --> 00:16:27,960
+يضطروا ان الجهة تمسك more cations فهذا بيقدر إلى
+
+217
+00:16:27,960 --> 00:16:31,400
+انه دايما في وجود ال proteins في جهة من جهات ال
+
+218
+00:16:31,400 --> 00:16:34,800
+membranes انها تكون عندنا ال equilibrium في الآخر
+
+219
+00:16:34,800 --> 00:16:41,700
+okay في ناحية ال a لكن بيضل ال ال
+
+220
+00:16:41,700 --> 00:16:47,900
+الالكاتيونيك الاكترولايت
+
+221
+00:16:47,900 --> 00:16:52,920
+تتجمع في جهة الشسم في حين ان الانيونز تتجمع في
+
+222
+00:16:52,920 --> 00:16:57,140
+الجهة المعيدة عن البروتيز هنا هنلاحظ احنا ان
+
+223
+00:16:57,140 --> 00:17:03,860
+الاسمولاليتي في كلهم في الانترستيشيل والبلازما
+
+224
+00:17:03,860 --> 00:17:06,260
+والانتراسيلولار واحدة
+
+225
+00:17:28,920 --> 00:17:32,720
+Ionic composition of the plasma and interstitial
+
+226
+00:17:32,720 --> 00:17:33,400
+fluid
+
+227
+00:17:38,840 --> 00:17:48,560
+referring again to important
+
+228
+00:17:48,560 --> 00:18:02,740
+constituents of the intracellular fluid كلمت
+
+229
+00:18:02,740 --> 00:18:03,060
+عنها
+
+230
+00:18:05,940 --> 00:18:11,260
+fluids in the different compartments طبعا عندنا
+
+231
+00:18:11,260 --> 00:18:17,240
+fluid موتر موجود في كل مكان طيب جد احنا كيف عرفنا
+
+232
+00:18:17,240 --> 00:18:25,220
+ان هذا 40% و هذا 15% و هذا 5% و ال blood ان ال
+
+233
+00:18:25,220 --> 00:18:29,460
+plasma الجد و الشسم الجد طبعا عرفناهم باستخدام
+
+234
+00:18:29,460 --> 00:18:35,220
+indicatorsفي انها substances خاصة بتفيدنا في
+
+235
+00:18:35,220 --> 00:18:38,800
+القياس indicator substances هذه ال indicator
+
+236
+00:18:38,800 --> 00:18:43,460
+substances انا ممكن استخدمها بحيث ان اتعرفني على
+
+237
+00:18:43,460 --> 00:18:48,340
+الأحجام المختلفة النظرية الأساسية فيها dilution
+
+238
+00:18:48,340 --> 00:18:52,720
+theory مش مسميها ال dilution theory يعني مادة
+
+239
+00:18:52,720 --> 00:19:00,060
+مركزة عرف انا حجمها وعرف تركيزها تمام خففتهاو بقدر
+
+240
+00:19:00,060 --> 00:19:03,380
+اعرف تخفيف التركيز المخففة للمادة المخففة
+
+241
+00:19:03,380 --> 00:19:08,220
+اوتوماتيا انا باعرف ال volume مش كده اذا الحجم
+
+242
+00:19:08,220 --> 00:19:13,540
+الصغير في التركيز العالي يساوي التركيز الواطي في
+
+243
+00:19:13,540 --> 00:19:16,660
+الحجم الكبير احنا عارفنا التركيز الواطي ان انا بكل
+
+244
+00:19:16,660 --> 00:19:19,660
+بساطة باخد عينة من المكان اللي بديها و باعرف
+
+245
+00:19:19,660 --> 00:19:23,880
+التركيز الجديد جداش تمام من التركيز الجديد هذا
+
+246
+00:19:23,880 --> 00:19:26,740
+بقدر اضغط هدا في هدا يساوي هدا في هدا بطلع الكمية
+
+247
+00:19:26,740 --> 00:19:33,140
+هذه ال dilutionطبعا علشان اعمل هذه العملية لازم
+
+248
+00:19:33,140 --> 00:19:37,260
+ادي فرصة للمادة المركزة اللي اعطيتها لازم اديها
+
+249
+00:19:37,260 --> 00:19:39,380
+فرصة كافية انها تكون ايه صارت عندها
+
+250
+00:19:42,230 --> 00:19:46,510
+أخدت فترة كافية لتوزيع المتكافئ يعني جدرت هذه
+
+251
+00:19:46,510 --> 00:19:49,050
+المادة تتوزع في كل ال compartment اللي انا بدي ايه
+
+252
+00:19:49,050 --> 00:19:52,270
+اللي انا اعطيتها بدي اجيسها اديتها فترة كافية
+
+253
+00:19:52,270 --> 00:19:56,970
+تلاتين الى ستين دقيقة توزعت في الفترة هذه ايش
+
+254
+00:19:56,970 --> 00:19:59,850
+فقدنا عن طريق ال urine او ال stool او كده بدي
+
+255
+00:19:59,850 --> 00:20:03,190
+اقسمهم بدي اشيلهم من ال ايه؟ من الكمية الرئيسية
+
+256
+00:20:03,190 --> 00:20:07,030
+لان بعرف ال ball بجري فيه التركيز لجديد في ال
+
+257
+00:20:07,030 --> 00:20:10,240
+volume اللي اتوزع فيه بعرف ال volumeis a dilution
+
+258
+00:20:10,240 --> 00:20:15,500
+theory بيحتاج الى .. الى ايه الى principle الى ..
+
+259
+00:20:15,500 --> 00:20:19,920
+الى indicator substance تمام وبستخدم ال dilution
+
+260
+00:20:19,920 --> 00:20:24,160
+principle من خلاله بقدر اعرف كل شيء مثلا بدنا نعرف
+
+261
+00:20:24,160 --> 00:20:29,480
+ال total body fluids ال total body water طب بدي
+
+262
+00:20:29,480 --> 00:20:34,990
+indicator معناها انه ينتشر في كل ال compartmentsمش
+
+263
+00:20:34,990 --> 00:20:37,990
+هيك؟ بده اعرف ال total انا يعني بده اعرف ال
+
+264
+00:20:37,990 --> 00:20:40,690
+intracellular و ال extracellular و البلازمه
+
+265
+00:20:40,690 --> 00:20:44,370
+intracellular و interstellar و البلازمه كدهش تمام؟
+
+266
+00:20:44,370 --> 00:20:48,030
+بدي حاجة تنتشر في كل .. اش في عندي مادة ممكن تنتشر
+
+267
+00:20:48,030 --> 00:20:53,850
+في كل الأشياء هذه؟ الميه الميه هي بتستطيع انها
+
+268
+00:20:53,850 --> 00:20:57,410
+ايه؟ تنتقل طب انا كده بدي اميز ميه اللي انا حطيتها
+
+269
+00:20:57,410 --> 00:21:02,890
+من مجل ميه بخليها radioactive يعني ال hydrogen
+
+270
+00:21:02,890 --> 00:21:08,330
+اللي فيهابدل ما هو ميه معموله من هيدروجين عادي بحط
+
+271
+00:21:08,330 --> 00:21:14,090
+هيدروجين radioactive تريتيوم او بحط ال heavy water
+
+272
+00:21:14,090 --> 00:21:21,090
+اللي هو H2 مش .. ها تريتيوم H3 تريتيوم وده
+
+273
+00:21:21,090 --> 00:21:25,270
+Deuterium اه اذا عندي H3 وH2 بقدر بحدهم
+
+274
+00:21:25,270 --> 00:21:31,240
+radioactive يعني بقدر ا ..انا بالمناسبة اشتغلت
+
+275
+00:21:31,240 --> 00:21:35,020
+فيهم كتير هدول اللي بتريتهم هذي اشتغلت فيه كتير و
+
+276
+00:21:35,020 --> 00:21:37,340
+يا ما شربته و انا مش ماخد بالي و بقى انا بجيس و
+
+277
+00:21:37,340 --> 00:21:40,580
+بقى اعمل ما بتسوي الله لسه اتعرف لكن الصح اني كنت
+
+278
+00:21:40,580 --> 00:21:45,460
+استخدم mouth pipette لإن ادق ال .. ال .. ال .. ال
+
+279
+00:21:45,460 --> 00:21:48,200
+automatic pipette مش .. مش .. مش دقيقة كتير كانت
+
+280
+00:21:48,200 --> 00:21:51,920
+فكتير من الأحيان ألاجي ال rubber tube اللي بدي
+
+281
+00:21:51,920 --> 00:21:56,960
+أشفط منها مليانا و يكشل ما علينا الله اللي بستور
+
+282
+00:21:56,960 --> 00:22:00,260
+يعني هو ال .. ال .. الاشياء إلها مخاطريعني لو ال
+
+283
+00:22:00,260 --> 00:22:04,700
+safety يعني ال guides اللي واحد بيستخدمها لكن
+
+284
+00:22:04,700 --> 00:22:07,680
+بيصير أحيانا يعني المرات كنت مروح متناكدة أحس أني
+
+285
+00:22:07,680 --> 00:22:11,100
+أخدت كمية كبيرة من إيه من الإشعاع لكن الله اللي
+
+286
+00:22:11,100 --> 00:22:17,420
+بصر ان شاء الله فال Tritium هذا H3 ممكن ناخد و
+
+287
+00:22:17,420 --> 00:22:23,040
+بيطلع radiations تمام ال radiations هذه بيجيسها في
+
+288
+00:22:23,040 --> 00:22:26,980
+counter في counter خاص بها ال radiations هذه
+
+289
+00:22:27,420 --> 00:22:32,260
+الريتيوم بيطلع بيتا ردياشن فلذلك نضع بيتا counter
+
+290
+00:22:32,260 --> 00:22:36,420
+تمام البيتا counter هذا نستطيع ان نضع المادة اللي
+
+291
+00:22:36,420 --> 00:22:43,020
+نريد ان نستخدمها نضعها نجيس ردياشن تبعها جداش و
+
+292
+00:22:43,020 --> 00:22:47,320
+بعدين نضع المواد بعد ما توزعت جداش الردياشن فيها
+
+293
+00:22:47,320 --> 00:22:55,010
+الردياشن يمثل التركيز فردياشن في volumeيساوي ال
+
+294
+00:22:55,010 --> 00:23:02,190
+radiation في volume مش كده نفس الجثة و من هنا
+
+295
+00:23:02,190 --> 00:23:04,770
+بنقدر نحسب الحسابة اذا لما نتكلم عن total body
+
+296
+00:23:04,770 --> 00:23:08,830
+water بنتكلم عن ميه لإنها الوحيدة اللي مش الوحيدة
+
+297
+00:23:08,830 --> 00:23:12,710
+يعني هي من الأشياء اللي يقدر ينتشر من كل مكان لكن
+
+298
+00:23:12,710 --> 00:23:16,010
+عشان اعرف ميتي انا بتعملها ايه radioactive water
+
+299
+00:23:16,010 --> 00:23:19,110
+radioactive بعملش هشتر من ال concentration لكن
+
+300
+00:23:19,110 --> 00:23:22,780
+بعملها ايهبعملها count count لل radiation تبع ال
+
+301
+00:23:22,780 --> 00:23:25,060
+activity radiation activity تبعتها من ال count
+
+302
+00:23:25,060 --> 00:23:29,660
+بعرفها تمام بديها injection و بقى أصبر فترة أنها
+
+303
+00:23:29,660 --> 00:23:34,000
+تكون توزعة evenly بالتساوي في كل الجسم وبعدين بقعد
+
+304
+00:23:34,000 --> 00:23:39,770
+واخد عيلة من البلازمةوبجيس العين هذه كده التركيز
+
+305
+00:23:39,770 --> 00:23:44,950
+فيها طبعا اذا التركيز في ال volume مع التركيز في
+
+306
+00:23:44,950 --> 00:23:48,790
+ال body water ال body water بطلع بسهولة بنعرف اذا
+
+307
+00:23:48,790 --> 00:23:55,410
+ال body water من ايه خلال غير ال .. غير ال water
+
+308
+00:23:55,410 --> 00:23:59,210
+في عندنا مادة تانية اسمها antipyrene تستطيع برضه
+
+309
+00:23:59,210 --> 00:24:01,430
+هذه المادة انها
+
+310
+00:24:03,870 --> 00:24:10,610
+انها تستخدم لقياس ال water ال total body water
+
+311
+00:24:10,610 --> 00:24:14,410
+تمام لما بدي استخدم ان اجيس ال extra cellular اذا
+
+312
+00:24:14,410 --> 00:24:23,190
+انا جيست ال total بدي اجيس ال intracellular بقدرش
+
+313
+00:24:23,190 --> 00:24:27,690
+اجيس ال intracellular direct بقدرش اجيس ال
+
+314
+00:24:27,690 --> 00:24:33,470
+intracellular direct لأ لازم اجيسها indirectيعني
+
+315
+00:24:33,470 --> 00:24:37,770
+بجيس ال total بعدين ال extracellular و الفرج هيكون
+
+316
+00:24:37,770 --> 00:24:42,730
+ال extracellular is مهم .. أهميتها في أنها بجيسها
+
+317
+00:24:42,730 --> 00:24:46,370
+هي نفسها و بيساعدني في قياس مين ال intracellular
+
+318
+00:24:46,370 --> 00:24:50,530
+ال extracellular water هذه لما بدي أنا أجيسها بدي
+
+319
+00:24:50,530 --> 00:24:54,890
+حاجة اللي بتيجي فيها أو بتطلعش لل intracellular
+
+320
+00:24:54,890 --> 00:24:58,690
+بتظل موزعة بالتساوي بس في الايه؟ في ال
+
+321
+00:24:58,690 --> 00:25:03,710
+extracellular تمام؟ الميه الأولانيةالراديو اكتر
+
+322
+00:25:03,710 --> 00:25:07,650
+ووتر استخدمناها تنتشر فى كل مكان بدنا يعلق توتر
+
+323
+00:25:07,650 --> 00:25:10,990
+لكن انا بدي بس ال extra cellular compartment
+
+324
+00:25:10,990 --> 00:25:15,170
+مهناها ايش اكتر اش موجود ايش الاش اللى بيجي بس فى
+
+325
+00:25:15,170 --> 00:25:18,090
+ال extra cellular compartment وبطلعش منه ال sodium
+
+326
+00:25:18,090 --> 00:25:21,250
+ال sodium لو تركناه فترة احنا بيصل ال intra
+
+327
+00:25:21,250 --> 00:25:26,030
+cellular لكن فى فترة معينة بيكون اتشر بسهولة فى ال
+
+328
+00:25:26,030 --> 00:25:28,330
+extra cellular بدون ما يصل ال ايه ال intra
+
+329
+00:25:28,330 --> 00:25:33,160
+cellular إلى حد ما هو مش دقيقلذلك قلنا هو هذا
+
+330
+00:25:33,160 --> 00:25:37,140
+sodium space مش ال extracellular fluid combined
+
+331
+00:25:37,140 --> 00:25:41,920
+space سبناه sodium space لأنه أخد كل ال
+
+332
+00:25:41,920 --> 00:25:47,740
+extracellular صحيح زائد دخلي شوية نفد عمين ففي جزء
+
+333
+00:25:47,740 --> 00:25:51,980
+من التركيز سبعه راح لل intracellular معناه صار
+
+334
+00:25:51,980 --> 00:25:59,140
+الحسمة أجل من اللازم طبعا لإنه صار عندي تركيز أجل
+
+335
+00:26:00,310 --> 00:26:03,770
+فبيكبرلي الحجم لما انه جزء من وشرة الانترا سيلولار
+
+336
+00:26:03,770 --> 00:26:08,510
+فلذلك هو التركيزه اللي خاف مش لإنه ال extra
+
+337
+00:26:08,510 --> 00:26:11,890
+cellular كبيرة لإنه أخد جزء من ال extra cellular و
+
+338
+00:26:11,890 --> 00:26:15,950
+جزء من ال intracellular تمام ففي الحسبة تبعتي بطلع
+
+339
+00:26:15,950 --> 00:26:20,030
+بنحسب الجزء اللي ايه ال intracellular مش كده لإنه
+
+340
+00:26:20,030 --> 00:26:23,870
+انا عندي اللي دخلته محسب ال sodium ال radioactive
+
+341
+00:26:23,870 --> 00:26:27,800
+sodium اللي دخلته انا محسباللي دخل extracellular
+
+342
+00:26:27,800 --> 00:26:32,720
+اداني تركيز معين شرد منه كمان شوية فخف ال ايه لما
+
+343
+00:26:32,720 --> 00:26:37,800
+خف انا التركيز معناه ال volume هزيد طبعا اذا بديني
+
+344
+00:26:37,800 --> 00:26:42,580
+حجم اكبر من اللازم فسمينا extracellular او ادق
+
+345
+00:26:42,580 --> 00:26:46,660
+اتها ال extracellular space sodium space طبعا و
+
+346
+00:26:46,660 --> 00:26:53,510
+هكذا مع مين مع ال inulin مثلاطبعا هو حسنا فقط في
+
+347
+00:26:53,510 --> 00:26:56,810
+الاكساسيلرال فلويد لكن بحرب شوية منه للإيه
+
+348
+00:26:56,810 --> 00:27:02,190
+للإنترال فبنحتبره in unispace لكن إلى حد ما من
+
+349
+00:27:02,190 --> 00:27:06,610
+قراءة هذا و هذا و هذا إلى حد ما بنعرف الاكساسيلرال
+
+350
+00:27:06,610 --> 00:27:10,670
+جديش عندنا برضه radioactive أيوثالميت و
+
+351
+00:27:10,670 --> 00:27:14,310
+radioactive ثيوثالفيت هدول برضه من خلالهم نقدر
+
+352
+00:27:14,310 --> 00:27:20,990
+نعمل ال calculations تبعتناالإنترال فلويد إذا مخصم
+
+353
+00:27:20,990 --> 00:27:27,390
+ال total من إيه؟ نخص ال plasma طيب بدي أنا أحسب ال
+
+354
+00:27:27,390 --> 00:27:32,210
+plasma ال plasma بدي مادة تخش في blood vessels
+
+355
+00:27:32,210 --> 00:27:37,310
+ماتطلعش إيش هتكون هذه؟ proteins مش كده؟ proteins
+
+356
+00:27:37,310 --> 00:27:42,050
+بحط albumin radioactive albumin بحكي radioactive
+
+357
+00:27:42,050 --> 00:27:48,190
+albumin وبعدين بعمله إيه؟ إقياس تمام؟ بعمله إقياس
+
+358
+00:27:48,800 --> 00:27:53,840
+أو بقدر اعرف من خلالها ال plasma volume طب دي ال
+
+359
+00:27:53,840 --> 00:27:58,520
+blood volume ال blood volume من خلال ال plasma
+
+360
+00:27:58,520 --> 00:28:03,940
+volume زائد زائد hematocrit زائد hematocrit اذا من
+
+361
+00:28:03,940 --> 00:28:06,840
+خلال معرفة ال hematocrit و ال plasma volume
+
+362
+00:28:06,840 --> 00:28:10,580
+اتوماتيكي بقدر اعرف كمان الدم blood volume اللي هو
+
+363
+00:28:10,580 --> 00:28:14,360
+ال RBC volume او بعرف ال total من خلال الحسبة
+
+364
+00:28:14,360 --> 00:28:16,940
+الصغيرة هذه كمان اذا
+
+365
+00:28:18,690 --> 00:28:22,770
+هذا ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+366
+00:28:22,770 --> 00:28:23,230
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+367
+00:28:23,230 --> 00:28:23,730
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+368
+00:28:23,730 --> 00:28:27,990
+.. ال .. ال .. ال ..
+
+369
+00:28:27,990 --> 00:28:31,590
+ال ..
+
+370
+00:28:31,590 --> 00:28:31,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+371
+00:28:31,670 --> 00:28:31,730
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+372
+00:28:31,730 --> 00:28:31,830
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+373
+00:28:31,830 --> 00:28:31,870
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+374
+00:28:31,870 --> 00:28:31,950
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+375
+00:28:31,950 --> 00:28:32,030
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+376
+00:28:32,030 --> 00:28:44,390
+.. ال .. ال .. ال .. ال .. ال ..
+
+377
+00:28:49,200 --> 00:28:55,580
+في عد وصيلة أخرى لقياس البلازما مش ان اجيس
+
+378
+00:28:55,580 --> 00:29:01,540
+البلازما عن طريق ال blood اقصد مش اجيس ال blood عن
+
+379
+00:29:01,540 --> 00:29:05,400
+طريق ان اجيس البلازما و اعمل بال hematocrit لأ
+
+380
+00:29:05,400 --> 00:29:08,140
+بعمل dilution theory مباشرة لكمبارتمنت اسمه blood
+
+381
+00:29:08,140 --> 00:29:13,100
+تمام؟ كمبارتمنت اسمه blood بدعمله dilution theory
+
+382
+00:29:13,100 --> 00:29:18,800
+عادي احط كميةتمام و هذه الكمية بحيث انها ماتطلعش
+
+383
+00:29:18,800 --> 00:29:23,020
+من ال blood vessels ماتطلعش تمام و بعدين بشوف
+
+384
+00:29:23,020 --> 00:29:27,440
+تركيزها في ال blood و بعدين بقى اضرب ال theory
+
+385
+00:29:27,440 --> 00:29:30,360
+عادى ده ليش ال theory تركيز في كده يساوي تركيز في
+
+386
+00:29:30,360 --> 00:29:36,400
+كده تمام في الحالة هذه بدي احط انا red blood cells
+
+387
+00:29:36,400 --> 00:29:39,640
+labelled with radioactive material red blood cells
+
+388
+00:29:39,640 --> 00:29:46,390
+حطيت كمية معينة activity معينةفى ال blood بعد 10
+
+389
+00:29:46,390 --> 00:29:50,910
+دقائق اي عين سامبل من ال blood ال RBC مابتطلعش
+
+390
+00:29:50,910 --> 00:29:54,730
+مابتطلعش
+
+391
+00:29:54,730 --> 00:29:58,970
+فبعد شوية بشوف كده ال radio activity تبع سانتر
+
+392
+00:29:58,970 --> 00:30:04,690
+اعتقد احنا هنا خلصنا لها لأ خلنا هنا لسه هنا الجزء
+
+393
+00:30:04,690 --> 00:30:10,330
+الأخير بدنا عشر دقائق بقى نولع نص مش هيك okay طيب
+
+394
+00:30:10,330 --> 00:30:13,470
+احنا ان شاء الله الجزء الأخر احنا اتكلمنا عنه بس
+
+395
+00:30:13,470 --> 00:30:19,190
+بنعيده تانىطيب ال .. ال .. انتقال من مكان لمكان مش
+
+396
+00:30:19,190 --> 00:30:22,370
+هيك؟ اتكلمنا انه ال .. ال .. ما بين ال
+
+397
+00:30:22,370 --> 00:30:25,130
+intracellular و ال extracellular لزمة ال membrane
+
+398
+00:30:25,130 --> 00:30:29,450
+يحكمهم .. يحكم انتقال ال fluids من هان لهان اللي
+
+399
+00:30:29,450 --> 00:30:35,470
+هو ايه؟ اللي هو ال osmosis ال osmotic pressure ال
+
+400
+00:30:35,470 --> 00:30:39,640
+osmolality تبعت هادي و هاديوهذه هنتكلم عليها كلام
+
+401
+00:30:39,640 --> 00:30:43,200
+كتير حقيقة بعد المحاضرة اللى جاية هنتكلم كلام كتير
+
+402
+00:30:43,200 --> 00:30:47,140
+حول المسألة هذه لو ضفنا احنا fluid حطنا احنا كل
+
+403
+00:30:47,140 --> 00:30:50,520
+يوم بنضيف بنحط الناس محليل مظبوط المحلوق اللى بحطه
+
+404
+00:30:50,520 --> 00:30:55,700
+انا هذا ايش بتتوقع بعد كده يعمل لوين بيصل ايش اثر
+
+405
+00:30:55,700 --> 00:30:59,380
+على اخر الخط اللى هو ال intracellular زادوا جللوا
+
+406
+00:30:59,380 --> 00:31:03,220
+عملوا سوى اه فى عندى anaerobic pressure او عندى
+
+407
+00:31:03,220 --> 00:31:10,200
+electrolyte concentrationطبعا وعندى يعني عكس بعد
+
+408
+00:31:10,200 --> 00:31:12,660
+كده على blood pressure يعني محط محطه fluid جاعد
+
+409
+00:31:12,660 --> 00:31:15,980
+انا بسوّد البلازمة volume معناه انا بسوّد جاعد ايه
+
+410
+00:31:15,980 --> 00:31:19,220
+ال blood pressure مش هيك لإن ال blood pressure
+
+411
+00:31:19,220 --> 00:31:23,100
+يقولنا volume مع مين مع blood vessel العلاقة بين
+
+412
+00:31:23,100 --> 00:31:26,680
+التانين يسوى لإيه ال blood pressure هذا زاد بزاد
+
+413
+00:31:26,680 --> 00:31:29,140
+blood pressure هذا وسع بزاد blood pressure هذا ضيق
+
+414
+00:31:29,140 --> 00:31:30,540
+بزيد blood pressure راية كذا
+
+415
+00:31:36,330 --> 00:31:39,110
+a frequent problem in treating seriously ill
+
+416
+00:31:39,110 --> 00:31:43,990
+patients is maintaining adequate fluids in one or
+
+417
+00:31:43,990 --> 00:31:45,590
+both of the intestinal and excretional
+
+418
+00:31:45,590 --> 00:31:48,390
+compartments تمام جدا، لذلك و أنا متعامل مع
+
+419
+00:31:48,390 --> 00:31:53,990
+المسألة هذه، بدأ أبقى عارف أنا إيش بشتغل قاعدة،
+
+420
+00:31:53,990 --> 00:31:58,390
+إذن يقولون هذا بيحكم الكابليري من brain و القواعد
+
+421
+00:31:58,390 --> 00:32:02,430
+اللي بتحكمه من pressure و من osmotic أو from
+
+422
+00:32:02,430 --> 00:32:07,360
+oncotic pressure يعنيواحد عنده ال proteins بتهرب
+
+423
+00:32:07,360 --> 00:32:13,220
+من الجسم واحد عنده نفروتيك سندروم الكلية صارت
+
+424
+00:32:13,220 --> 00:32:18,600
+اتهرب لبروتينات صار عندي مشكلة في النفرون النفرون
+
+425
+00:32:18,600 --> 00:32:24,820
+بطل يطلع بس ل fluids و معها بروتين البروتين هذا مش
+
+426
+00:32:24,820 --> 00:32:29,820
+مصمم النفرون يعيد امتصاصه لأن هو أصلا حجمه كبير ال
+
+427
+00:32:29,820 --> 00:32:35,470
+amino acids و ال small proteins بترجعلكن البيومين
+
+428
+00:32:35,470 --> 00:32:39,770
+يطلع او اصغر من البيومين شوية بحيث انه مش small
+
+429
+00:32:39,770 --> 00:32:45,730
+proteins اكبر بتطلع و بتظل طالع تمام فمتفاجأت في
+
+430
+00:32:45,730 --> 00:32:49,590
+ال urine و احنا بنفحص انه عندنا كمية البيومين او
+
+431
+00:32:49,590 --> 00:32:53,450
+كمية البروتينات طالعة كبيرة نسميها proteinuria ايش
+
+432
+00:32:53,450 --> 00:32:57,850
+نسميها proteinuria او البيومينوريا حسب هو اللي طلع
+
+433
+00:32:57,850 --> 00:33:02,380
+البيومين ولا نوع تانياه الأغلب هو البيومين فبنقول
+
+434
+00:33:02,380 --> 00:33:07,080
+البيومينوريا لإن أصغر البروتينات في الدم البيومين
+
+435
+00:33:07,080 --> 00:33:11,740
+البجين الفيبرينيون وغيره ايه أكبر منه فهو الأصغر
+
+436
+00:33:11,740 --> 00:33:15,240
+فهو لما بيطلع الدم بيطلع أول واحد إذا عندي
+
+437
+00:33:15,240 --> 00:33:19,300
+البيومينوريا البروتينوريا الناس بيسموها زلال عنده
+
+438
+00:33:19,300 --> 00:33:23,700
+زلال في ال إيه؟ في ال bowl كان عنده زلال في ال
+
+439
+00:33:23,700 --> 00:33:27,620
+bowl مايأكلش بيض لإن البيض فيه زلال غلط
+
+440
+00:33:29,090 --> 00:33:33,450
+60 غلط انا بفقد ال protein جاعد من الدم في ال bowl
+
+441
+00:33:33,450 --> 00:33:37,490
+اش هيصير ال .. اش هيصير في ال ايه؟ في ال protein
+
+442
+00:33:37,490 --> 00:33:43,150
+في الدم؟ هيجل مش كده؟ ال oncotic pressure اللي
+
+443
+00:33:43,150 --> 00:33:46,990
+برجع ال fluids من ال interstitial fluid بعد ما ال
+
+444
+00:33:46,990 --> 00:33:51,250
+hydrostatic pressure يهبط صارت كميته اقل صار في
+
+445
+00:33:51,250 --> 00:33:53,190
+عندي fluids دخلت ال interstitial fluid بال
+
+446
+00:33:53,190 --> 00:33:55,990
+hydrostatic pressure و ال oncotic pressure مش جادة
+
+447
+00:33:55,990 --> 00:33:59,800
+رجعهافبصير عندي إديمة فالناس اللي عندهم ال
+
+448
+00:33:59,800 --> 00:34:03,560
+proteinuria الناس اللي عندهم nephrotic syndrome
+
+449
+00:34:03,560 --> 00:34:09,920
+بيجيون منفخين ليش منفخين؟لأن هبط البروتين في الدم
+
+450
+00:34:09,920 --> 00:34:16,020
+فبش أدى عندى ايه الى انه ال fluids هربت واستقرت في
+
+451
+00:34:16,020 --> 00:34:20,600
+الايه مش جادرال اذا انا بدى احلها باني بديهم
+
+452
+00:34:20,600 --> 00:34:26,300
+infusion human albumin بديهم في الدم مباشرة human
+
+453
+00:34:26,300 --> 00:34:29,670
+albumin عشان يزودوا ال album في الدمتمام؟ عشان
+
+454
+00:34:29,670 --> 00:34:33,450
+ايه؟ اعود اسحب ال .. ال fluids اللي هربت للانسج
+
+455
+00:34:33,450 --> 00:34:37,350
+عشان اضيع ال .. القديمة بس سبب الهروب الأساسي هو
+
+456
+00:34:37,350 --> 00:34:46,150
+مين؟ الكلية هربت ممكن يكون عند ال liver ضعف بطل
+
+457
+00:34:46,150 --> 00:34:52,430
+يصنع مش كده؟ فلو كان عندي انا liver failure بجل
+
+458
+00:34:52,430 --> 00:34:56,110
+تصنيع البروتينات البروتينات في ال plasma بتجل
+
+459
+00:34:56,110 --> 00:35:03,510
+تمام؟لو عندى تهريب مباشر من الكيليا البروتينات فى
+
+460
+00:35:03,510 --> 00:35:08,990
+البلازما بتجل هدول الاتنين بيقدوا الى انه عندي
+
+461
+00:35:08,990 --> 00:35:13,470
+يقدى الى انه ال oncotic pressure اللى موجود فى ال
+
+462
+00:35:13,470 --> 00:35:17,370
+capillaries اللى بيرجع ال fluids بيجل و بتقدى لها
+
+463
+00:35:17,370 --> 00:35:24,530
+أديمة ال interstitial fluid بيزيدال .. ال .. ال ..
+
+464
+00:35:24,530 --> 00:35:24,950
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+465
+00:35:24,950 --> 00:35:25,130
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+466
+00:35:25,130 --> 00:35:25,350
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+467
+00:35:25,350 --> 00:35:27,270
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+468
+00:35:27,270 --> 00:35:27,450
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+469
+00:35:27,450 --> 00:35:31,110
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+470
+00:35:31,110 --> 00:35:31,390
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+471
+00:35:31,390 --> 00:35:36,470
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+472
+00:35:36,470 --> 00:35:38,390
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+473
+00:35:38,390 --> 00:35:43,870
+ال .. ال .. ال .. ال .. ال ..
+
+474
+00:35:43,870 --> 00:35:49,190
+ال .. ال ..
+
+475
+00:35:51,710 --> 00:35:54,350
+الكلمة زلال هذه الغريبة العجيبة اللى موجودة بين
+
+476
+00:35:54,350 --> 00:35:57,970
+الناس اه عنده زلال مايأكلش زلال لإنه عنده زلال طب
+
+477
+00:35:57,970 --> 00:36:02,870
+واش يعني بنعوضه اخسرنا بنعوضه اذا ممكن نعوضه احنا
+
+478
+00:36:02,870 --> 00:36:08,310
+ال protein اللى اللى راح عبر الكيليا يئما انه
+
+479
+00:36:08,310 --> 00:36:11,610
+بناخد مباشرة او بنديله high protein diet ايش
+
+480
+00:36:11,610 --> 00:36:17,000
+بنعطيله العيان high proteinعشان نقول للملح خد اللي
+
+481
+00:36:17,000 --> 00:36:22,120
+بد فيه من ال amino acids و صنعك كميات اكبر من
+
+482
+00:36:22,120 --> 00:36:26,360
+البروتين الى داخل ال A الى البلازم حتى تحمي الجسم
+
+483
+00:36:26,360 --> 00:36:32,160
+عندنا ال cell membrane بين ال fluid و ال A بيحكم
+
+484
+00:36:32,160 --> 00:36:35,320
+ال osmotic pressure ال sodium و ال potassium
+
+485
+00:36:35,320 --> 00:36:39,140
+concentration هان و هان اللي عاملين ال osmolality
+
+486
+00:36:39,140 --> 00:36:44,310
+تمام؟ osmolality زادت بيصحب ميه هان ثم هتجلدبتروح
+
+487
+00:36:44,310 --> 00:36:49,790
+ميه لمين؟ ل الجهة التانية وال factors هذه اذا
+
+488
+00:36:49,790 --> 00:36:53,270
+المرة الجاية هتكلم عن principles of osmosis and
+
+489
+00:36:53,270 --> 00:36:56,470
+osmotic pressure وكيف بنحسبها يلا يعطيكوا العفو
+
+490
+00:36:56,470 --> 00:37:00,390
+مين هالسؤال يك معانا احنا ضايل ست دقايق ولو انه
+
+491
+00:37:00,390 --> 00:37:04,150
+الناس خاطر مرة احنا معانا وجيت لسه مين هالسؤال يا
+
+492
+00:37:04,150 --> 00:37:07,610
+بنات؟ يلا يعطيكوا العفو
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..07057379afb27287a15655863958963fbd7abdf6
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/Hcx1Ai8Xk6c_raw.json
@@ -0,0 +1 @@
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-0.24878875968992248, "compression_ratio": 1.7983870967741935, "no_speech_prob": 0.0, "words": [{"start": 2203.87, "end": 2204.31, "word": "بتروح", "probability": 0.8172607421875}, {"start": 2204.31, "end": 2204.65, "word": " ميه", "probability": 0.630615234375}, {"start": 2204.65, "end": 2205.61, "word": " لمين؟", "probability": 0.6312662760416666}, {"start": 2205.61, "end": 2205.75, "word": " ل", "probability": 0.77685546875}, {"start": 2205.75, "end": 2207.63, "word": " الجهة", "probability": 0.7622884114583334}, {"start": 2207.63, "end": 2208.15, "word": " التانية", "probability": 0.984375}, {"start": 2208.15, "end": 2208.79, "word": " وال", "probability": 0.541015625}, {"start": 2208.79, "end": 2209.17, "word": " factors", "probability": 0.830078125}, {"start": 2209.17, "end": 2209.53, "word": " هذه", "probability": 0.61669921875}, {"start": 2209.53, "end": 2209.79, "word": " اذا", "probability": 0.61865234375}, {"start": 2209.79, "end": 2210.45, "word": " المرة", "probability": 0.93017578125}, {"start": 2210.45, "end": 2210.79, "word": " الجاية", "probability": 0.66943359375}, {"start": 2210.79, "end": 2211.21, "word": " هتكلم", "probability": 0.8583984375}, {"start": 2211.21, "end": 2211.53, "word": " عن", "probability": 0.98779296875}, {"start": 2211.53, "end": 2212.05, "word": " principles", "probability": 0.34521484375}, {"start": 2212.05, "end": 2212.49, "word": " of", "probability": 0.970703125}, {"start": 2212.49, "end": 2213.09, "word": " osmosis", "probability": 0.951171875}, {"start": 2213.09, "end": 2213.27, "word": " and", "probability": 0.53955078125}, {"start": 2213.27, "end": 2213.61, "word": " osmotic", "probability": 0.9230143229166666}, {"start": 2213.61, "end": 2213.99, "word": " pressure", "probability": 0.95458984375}, {"start": 2213.99, "end": 2214.71, "word": " وكيف", "probability": 0.9344075520833334}, {"start": 2214.71, "end": 2215.39, "word": " بنحسبها", "probability": 0.9139404296875}, {"start": 2215.39, "end": 2215.95, "word": " يلا", "probability": 0.536376953125}, {"start": 2215.95, "end": 2216.31, "word": " يعطيكوا", "probability": 0.949609375}, {"start": 2216.31, "end": 2216.47, "word": " العفو", "probability": 0.7532552083333334}, {"start": 2216.47, "end": 2216.69, "word": " مين", "probability": 0.6995849609375}, {"start": 2216.69, "end": 2217.07, "word": " هالسؤال", "probability": 0.8140625}, {"start": 2217.07, "end": 2217.21, "word": " يك", "probability": 0.35101318359375}, {"start": 2217.21, "end": 2217.51, "word": " معانا", "probability": 0.8522135416666666}, {"start": 2217.51, "end": 2217.75, "word": " احنا", "probability": 0.89111328125}, {"start": 2217.75, "end": 2218.11, "word": " ضايل", "probability": 0.8815104166666666}, {"start": 2218.11, "end": 2218.59, "word": " ست", "probability": 0.83984375}, {"start": 2218.59, "end": 2219.83, "word": " دقايق", "probability": 0.78070068359375}, {"start": 2219.83, "end": 2220.21, "word": " ولو", "probability": 0.650390625}, {"start": 2220.21, "end": 2220.39, "word": " انه", "probability": 0.5985107421875}, {"start": 2220.39, "end": 2220.61, "word": " الناس", "probability": 0.7671712239583334}, {"start": 2220.61, "end": 2220.95, "word": " خاطر", "probability": 0.5891927083333334}, {"start": 2220.95, "end": 2221.19, "word": " مرة", "probability": 0.6019287109375}, {"start": 2221.19, "end": 2221.41, "word": " احنا", "probability": 0.9713541666666666}, {"start": 2221.41, "end": 2221.65, "word": " معانا", "probability": 0.9816080729166666}, {"start": 2221.65, "end": 2221.91, "word": " وجيت", "probability": 0.52685546875}, {"start": 2221.91, "end": 2222.67, "word": " لسه", "probability": 0.96875}, {"start": 2222.67, "end": 2223.71, "word": " مين", "probability": 0.91259765625}, {"start": 2223.71, "end": 2224.09, "word": " هالسؤال", "probability": 0.99189453125}, {"start": 2224.09, "end": 2224.15, "word": " يا", "probability": 0.9521484375}, {"start": 2224.15, "end": 2225.29, "word": " بنات؟", "probability": 0.8199462890625}, {"start": 2225.29, "end": 2226.97, "word": " يلا", "probability": 0.871337890625}, {"start": 2226.97, "end": 2227.31, "word": " يعطيكوا", "probability": 0.9791015625}, {"start": 2227.31, "end": 2227.61, "word": " العفو", "probability": 0.9767252604166666}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2228.44225, "duration_after_vad": 2166.174999999993}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/KuCzOB_w3GQ_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/KuCzOB_w3GQ_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..1b477cbd1eec2bc52f29f435da8f0df3b404feec
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/KuCzOB_w3GQ_postprocess.srt
@@ -0,0 +1,2828 @@
+1
+00:00:04,980 --> 00:00:09,360
+absorption of solutes and water in the proximal
+
+2
+00:00:09,360 --> 00:00:12,860
+and lobohinly as a result of increased filtration
+
+3
+00:00:12,860 --> 00:00:18,300
+rate هذا مسمى ايه؟ اللي هو ال glomerulotubular
+
+4
+00:00:18,300 --> 00:00:24,860
+balance وهذا
+
+5
+00:00:24,860 --> 00:00:30,360
+ال balance موجود ك factor اتكلمنا عنه مختلف عن ال
+
+6
+00:00:30,360 --> 00:00:35,940
+hormones ومختلف عن ايه؟ ال neural controlفهو يعني
+
+7
+00:00:35,940 --> 00:00:41,160
+بمعنى آخر لو كان عندي isolated kidney model حيصير
+
+8
+00:00:41,160 --> 00:00:45,980
+لو شيلنا الكلية من الجسم لا متصلة بأعصاب ولا
+
+9
+00:00:45,980 --> 00:00:51,760
+علاقلها هرمونات وخطنا لها ضغوط مختلفة عشان نظبط ال
+
+10
+00:00:51,760 --> 00:00:56,360
+GFR وزاد ال filtration هلاجئ انه في glomerular
+
+11
+00:00:56,360 --> 00:01:00,160
+balance موجود لذلك انا قلتلكم اذا عندنا ال
+
+12
+00:01:00,160 --> 00:01:03,400
+glomerular balance هي factor اتنين عندنا hormonal
+
+13
+00:01:03,400 --> 00:01:07,450
+control تلاتةإذن هذا مفصل عنهم، مش موالوش على
+
+14
+00:01:07,450 --> 00:01:11,250
+خلايا بالورمون ولا بالإيه، it is an autogenous
+
+15
+00:01:11,250 --> 00:01:19,530
+property موجودة في داخل النفرون أو الكلية، the
+
+16
+00:01:19,530 --> 00:01:20,050
+importance
+
+17
+00:01:49,030 --> 00:01:50,930
+بالنسبة للنسبة للنسبة للنسبة للنسبة للنسبة للنسبة
+
+18
+00:01:50,930 --> 00:01:50,970
+للنسبة للنسبة للنسبة للنسبة للنسبة للنسبة للنسبة
+
+19
+00:01:50,970 --> 00:01:54,060
+للنسبةو يطلع البدوية معناه الكلية بارفية to fail
+
+20
+00:01:54,060 --> 00:01:57,420
+إذا
+
+21
+00:01:57,420 --> 00:02:00,440
+الـ Gramatical balance acts as a second line of
+
+22
+00:02:00,440 --> 00:02:03,820
+defense to buffer the effects of spontaneous
+
+23
+00:02:03,820 --> 00:02:08,040
+changes in GFR on urine output إذا ال first line
+
+24
+00:02:08,040 --> 00:02:11,720
+of defense مين؟ ال auto regression مش كده؟ right
+
+25
+00:02:11,720 --> 00:02:18,950
+effect of arterial pressure in urineoutput هنا
+
+26
+00:02:18,950 --> 00:02:22,870
+مدام كده احنا جيبنا سيرة ال pressure لو اتكلم عن
+
+27
+00:02:22,870 --> 00:02:25,890
+ال auto regulation وقلنا لكوا okay بيصير auto
+
+28
+00:02:25,890 --> 00:02:31,150
+regulation بس برضه بيزيد شوية ال load اذا هنا بعد
+
+29
+00:02:31,150 --> 00:02:33,590
+ما صار مسكون الموضوعين موضوع ال auto regulation
+
+30
+00:02:33,590 --> 00:02:37,790
+وموضوع ال glomerular balance طب خليني اتكلم عن ال
+
+31
+00:02:37,790 --> 00:02:40,570
+pressure ال pressure زي ما قلنا لو صار variations
+
+32
+00:02:40,570 --> 00:02:44,650
+كبيرة ال auto regulation بيقدر يعني إلى حد ما
+
+33
+00:02:44,650 --> 00:02:48,680
+يعدمهاوكأنها مش موجودة لكن هيظل minimal effect
+
+34
+00:02:48,680 --> 00:02:52,940
+إليه بتقدي إلى what is called pressure diuresis
+
+35
+00:02:52,940 --> 00:02:57,220
+and pressure natriuresis ال volume of urine زاد
+
+36
+00:02:57,220 --> 00:03:02,960
+فبنسميها pressure diuresis diuretics اللي بتدر
+
+37
+00:03:02,960 --> 00:03:07,440
+البول، diuresis إدرار البول الزايد لذلك بقول كلمة
+
+38
+00:03:07,440 --> 00:03:12,870
+diuretics احنا وعنا diuresisو لدينا البراشر ناتريو
+
+39
+00:03:12,870 --> 00:03:16,630
+يوريسس ناتريوم اللي هو من الصوديوم ناتريو يوريسس
+
+40
+00:03:16,630 --> 00:03:22,030
+يعني الصوديوم اللي بيطلع في ال مول كتر و اتكلمنا
+
+41
+00:03:22,030 --> 00:03:24,970
+عن ال variations of pressure اللي ممكن في الآخر
+
+42
+00:03:24,970 --> 00:03:34,140
+يتحكم فيها الجسم بسبب ايه؟طب ليش بيصير ال .. ال ..
+
+43
+00:03:34,140 --> 00:03:36,580
+هذا ال increase؟ the slight increase in GFR that
+
+44
+00:03:36,580 --> 00:03:40,580
+does or care contributes in part to the effect of
+
+45
+00:03:40,580 --> 00:03:45,220
+increased arterial pressure on urine output طيب،
+
+46
+00:03:45,220 --> 00:03:49,080
+اذا جزء .. ليش ال .. ليش .. ليش .. لما ال pressure
+
+47
+00:03:49,080 --> 00:03:53,540
+يزيد و ال auto regulation و ال tumor .. tumor
+
+48
+00:03:53,540 --> 00:03:57,160
+balance او .. اه .. او tumor tubular balance
+
+49
+00:03:57,160 --> 00:03:59,780
+الجهتيناللي بتجيب ال glomeral هو ال auto
+
+50
+00:03:59,780 --> 00:04:03,280
+-regulation، ال glomeral balance هو اللي اتكلمنا
+
+51
+00:04:03,280 --> 00:04:07,820
+عنه الآن، ليش بزيد؟ لأنه ال GFR بتزيد، ولو انه
+
+52
+00:04:07,820 --> 00:04:12,620
+اتحكمنا في معظم ال changes، لكن انه في جزء ايه،
+
+53
+00:04:12,620 --> 00:04:17,680
+حيبقى له، اتنين احنا لما يزيد ال pressure، لما
+
+54
+00:04:17,680 --> 00:04:20,500
+يزيد ال pressure، ايش بيصير في ال renin
+
+55
+00:04:20,500 --> 00:04:25,760
+-angiotensin system؟يحبط مش كده؟ هو الـ Renal
+
+56
+00:04:25,760 --> 00:04:30,020
+Agitation System يستنفر لما اتضغط يوتع لكن لما
+
+57
+00:04:30,020 --> 00:04:33,800
+اتضغطي على بيصير suppression فال agitation هادته
+
+58
+00:04:33,800 --> 00:04:38,860
+بكل مواصفاته المهمة لل reabsorption راح هتكلم عنه
+
+59
+00:04:38,860 --> 00:04:42,220
+انه مواصفات مش مضاد vessels كمان كمان بيزود ال
+
+60
+00:04:42,220 --> 00:04:48,000
+ايه؟ ال tubular reabsorption تمام؟تلاتة لما يزيد
+
+61
+00:04:48,000 --> 00:04:53,640
+ال pressure عندنا، تمام؟ هيزيد كمان ال pressure في
+
+62
+00:04:53,640 --> 00:04:57,660
+ال peritubular capillaries، اذا عندي factor في ال
+
+63
+00:04:57,660 --> 00:05:03,480
+reabsorption، اه؟ خلى
+
+64
+00:05:03,480 --> 00:05:05,680
+ال reabsorption يجل، ان ال hydrostatic pressure
+
+65
+00:05:05,680 --> 00:05:12,210
+ايش؟هيزيد هناك بمعنى آخر a second effect of
+
+66
+00:05:12,210 --> 00:05:15,510
+increasing the air pressure that raises urine
+
+67
+00:05:15,510 --> 00:05:19,490
+output is that it decreases the percentage of
+
+68
+00:05:19,490 --> 00:05:23,150
+filtered load of sodium and water that is
+
+69
+00:05:23,150 --> 00:05:26,570
+reabsorbed by the tubule يعني ال pressure نفسه
+
+70
+00:05:26,570 --> 00:05:27,930
+بيخلى ال reabsorption
+
+71
+00:05:30,120 --> 00:05:34,340
+process اتجل لما يزيد ال pressure بمعنى ليش؟ لإن
+
+72
+00:05:34,340 --> 00:05:41,260
+عندي ال hydrostatic pressure زاد
+
+73
+00:05:42,410 --> 00:05:47,250
+فحنا قولنا ال reabsorption عملية معاكسة بالظبط
+
+74
+00:05:47,250 --> 00:05:51,370
+عملية ال filtration عشان كده احنا مادرسلاش لحالها
+
+75
+00:05:51,370 --> 00:05:55,450
+لإن درستها لو درست واحد لاجوها بالظبط مملة لإن عكس
+
+76
+00:05:55,450 --> 00:06:00,010
+ال filtration لذلك اما بيزيد ال hydrostatic
+
+77
+00:06:00,010 --> 00:06:03,350
+pressure بيجلل ال reabsorption لإن في ال
+
+78
+00:06:03,350 --> 00:06:06,370
+reabsorption هلاجي factor ال hydrostatic pressure
+
+79
+00:06:06,370 --> 00:06:11,140
+صار زيادةالاتنين عندى انا لما ال pressure .. لما
+
+80
+00:06:11,140 --> 00:06:17,060
+ال pressure يعلى و ال filtration ال flow rate
+
+81
+00:06:17,060 --> 00:06:22,320
+بيزيد ده اتطلع انا بلاجى انه كمية ال GFR لل flow
+
+82
+00:06:22,320 --> 00:06:27,240
+rate جلت كمان بمعنى انه ال uncritical pressure
+
+83
+00:06:27,240 --> 00:06:32,450
+برضه ايش مش هيعلى كتيرهيضل ايه؟ واطعى، اذا ان كنت
+
+84
+00:06:32,450 --> 00:06:35,350
+برشهر واطعى وحبسك برشهر عالى، اذا عملت ال
+
+85
+00:06:35,350 --> 00:06:38,330
+reabsorption نفسها كلها ايه؟ هتقطع، اذا ال
+
+86
+00:06:38,330 --> 00:06:42,630
+pressure بيعمل لها اللي هو بيخلي ال filter ال
+
+87
+00:06:42,630 --> 00:06:46,670
+percentage of filtered load of the sodium and
+
+88
+00:06:46,670 --> 00:06:51,090
+water that is reabsorbed بيخليها ايه؟ decreased،
+
+89
+00:06:51,090 --> 00:06:53,510
+اذا decreased is the percentage of the filtered
+
+90
+00:06:53,510 --> 00:06:57,770
+load that is reabsorbedبمعنى ان ال process بتاعة
+
+91
+00:06:57,770 --> 00:07:02,050
+ال reabsorption تتمثل فى أنكوترك براشر و في
+
+92
+00:07:02,050 --> 00:07:05,930
+الهيدروسالكبراشر هتقدى الى انه تلقالب بطريقة تمنع
+
+93
+00:07:05,930 --> 00:07:11,830
+ال more reabsorption اذا بغضب بزيد ال GFR بنلاقي
+
+94
+00:07:11,830 --> 00:07:18,990
+slight increase بزيدأتنين ملاحظة ان ال process الـ
+
+95
+00:07:18,990 --> 00:07:24,050
+reabsorption بتجيل بسبب ال mechanics تبعتها ال
+
+96
+00:07:24,050 --> 00:07:29,630
+pressure رخبطها طلعت أقول ان تأثير الانجوتنسين two
+
+97
+00:07:29,630 --> 00:07:35,400
+انه حبط ان الانجوتنسين twoin general بيجلل ال
+
+98
+00:07:35,400 --> 00:07:38,580
+reabsorption لحاله بدون اي مواصفات اخرى لو حطناها
+
+99
+00:07:38,580 --> 00:07:41,480
+بدون اي تأثير اخر بس ع ال tribunal هنلاقي ازاد ال
+
+100
+00:07:41,480 --> 00:07:44,720
+reabsorption او جلد تمام هنتكلم عنه عدو بالتفصيل
+
+101
+00:07:44,720 --> 00:07:47,120
+لو اتكلم عن ال hormonات بس انا ماتكلمش على ال
+
+102
+00:07:47,120 --> 00:07:51,220
+hormonات جاندي انا بتكلم على ال pressure ايش بيقود
+
+103
+00:07:51,220 --> 00:07:54,220
+العملية اللي يقودها ال blood pressure لو عليا تمام
+
+104
+00:07:54,220 --> 00:07:56,940
+من ضمن الناس اللي بيأثر عليهم اللي هو ال renin
+
+105
+00:07:56,940 --> 00:07:59,020
+-angiotensis system اذا قلنا
+
+106
+00:08:03,840 --> 00:08:07,520
+بجلل الانجوتنسين 2 طيب الانجوتنسين 2 itself
+
+107
+00:08:07,520 --> 00:08:11,640
+increases Sodium reabsorption by tubules لما يجل
+
+108
+00:08:11,640 --> 00:08:15,320
+بيجل ال reabsorption و الانجوتنسين 2 stimulates
+
+109
+00:08:15,320 --> 00:08:20,300
+الألدوستران الألدوستران بيعمل ايه بيزود ال
+
+110
+00:08:20,300 --> 00:08:25,800
+reabsorption للصوديوم إذا الانجوتنسين 2 هيأثر
+
+111
+00:08:25,800 --> 00:08:29,440
+مباشرة على ال tubule بيجلل ال reabsorption و عبر
+
+112
+00:08:29,440 --> 00:08:35,990
+انه بيعملالبرادبشار برنين سيستيم لما بيهبط لإن
+
+113
+00:08:35,990 --> 00:08:38,890
+الانجليتانسين 2 هذا من ال main stimulants
+
+114
+00:08:38,890 --> 00:08:43,190
+للالدوستيرون لما ندرس ان شاء الله في ال endocrine
+
+115
+00:08:43,190 --> 00:08:48,010
+لما ندرس الالدوستيرون هنلاقي what are the main
+
+116
+00:08:49,280 --> 00:08:55,860
+فاكتوريات الالدوستيرون هي بوتاسيوم و أنجوتانسين 2
+
+117
+00:08:55,860 --> 00:09:00,980
+فلما انجوتانسين 2 يحبط الالدوستيرون يحبط
+
+118
+00:09:00,980 --> 00:09:06,180
+الانجوتانسين
+
+119
+00:09:07,930 --> 00:09:12,310
+بيشتغل على تلت مستويات احنا دخلنا في وسط الشغل
+
+120
+00:09:12,310 --> 00:09:16,190
+جيبنا جثة دياريسي عشان نفهمه شيلوه من اللي ايه
+
+121
+00:09:16,190 --> 00:09:18,830
+اللي اتفرضوا ان احنا متكلماش عنه لان اذا احنا
+
+122
+00:09:18,830 --> 00:09:25,410
+متكلم عن مين جاعدين على ال factors that regulate
+
+123
+00:09:25,410 --> 00:09:32,600
+reabsorption قولنا tubuloglomero tubular balanceو
+
+124
+00:09:32,600 --> 00:09:36,420
+بعدين hormonal factors التاني ايش في النص عشان
+
+125
+00:09:36,420 --> 00:09:40,800
+الان وضعه نفهمه كويس ان ال .. اذا ال factor التاني
+
+126
+00:09:40,800 --> 00:09:45,380
+اللي بيأثر ع مين؟ على reabsorption ال hormones ال
+
+127
+00:09:45,380 --> 00:09:48,480
+hormones عندنا ال aldosterone بيأثر على ال
+
+128
+00:09:48,480 --> 00:09:52,920
+reabsorption طبعا بيأثر وين؟ mainly على اللي
+
+129
+00:09:52,920 --> 00:09:58,020
+الدستال مصبوط ويله تأثير بسيط على ال collecting
+
+130
+00:09:58,020 --> 00:10:05,310
+ductهي collecting tubule and duct collecting
+
+131
+00:10:05,310 --> 00:10:09,670
+tubule هذه معاها الجزية اللي من ال a اللي ديستال
+
+132
+00:10:09,670 --> 00:10:13,190
+الانجوتينسينتو
+
+133
+00:10:13,190 --> 00:10:19,090
+بيشتغل على ال proximal الانجوتينسينتو بيشتغل على
+
+134
+00:10:19,090 --> 00:10:24,710
+ال proximal اتك اسننق لمفهن ال tubule وcollecting
+
+135
+00:10:24,710 --> 00:10:28,910
+tubule الانتداديوهرمون
+
+136
+00:10:29,320 --> 00:10:33,500
+أشتغلت ديستال تيبيول و أشتغلت ديستال تيبيول و
+
+137
+00:10:33,500 --> 00:10:34,720
+أشتغلت ديستال تيبيول و أشتغلت ديستال تيبيول و
+
+138
+00:10:34,720 --> 00:10:36,880
+أشتغلت ديستال تيبيول و أشتغلت ديستال تيبيول و
+
+139
+00:10:36,880 --> 00:10:39,300
+أشتغلت ديستال تيبيول و أشتغلت ديستال تيبيول و
+
+140
+00:10:39,300 --> 00:10:40,820
+أشتغلت ديستال تيبيول و أشتغلت ديستال تيبيول و
+
+141
+00:10:40,820 --> 00:10:44,640
+أشتغلت ديستال تيبيول و أشتغلت ديستال تيبيول و
+
+142
+00:10:44,640 --> 00:10:48,380
+أشتغلت ديستال تيبيول و أشتغلت ديستال تيبيول و
+
+143
+00:10:48,380 --> 00:10:53,920
+أشتغلت ديستال تيبيول
+
+144
+00:10:56,330 --> 00:10:59,910
+بتكلم عن the hormonal control over your absorption
+
+145
+00:10:59,910 --> 00:11:06,450
+نكتب دي ليهم خمسة Aldosterone 1,2,2 مش كده
+
+146
+00:11:06,450 --> 00:11:11,630
+Antidiuretic hormone هذا الشيء الجديد اللي بتوم
+
+147
+00:11:11,630 --> 00:11:15,170
+أجيب نفسي قبل كده هنشرحه ان شاء الله اللي هو
+
+148
+00:11:15,170 --> 00:11:21,030
+Atrial Natriuretic Peptide ALP و ال Parathyroid
+
+149
+00:11:21,600 --> 00:11:25,760
+البراثيرويد متحكم بس متعلق على اللي إلها اللي هو
+
+150
+00:11:25,760 --> 00:11:30,260
+الكالسيوم و الفوسفات و شوية مجنسية طبعا
+
+151
+00:11:30,260 --> 00:11:35,080
+البراثيرويد الاترينترويوتركبيبتايد لأ مهتم لإن هذا
+
+152
+00:11:35,080 --> 00:11:38,300
+بيطلع من الاتريام من القلب من ال right atrium
+
+153
+00:11:38,300 --> 00:11:43,560
+بيجيس جديش عنده fluids لما يزيد ال Venus return
+
+154
+00:11:43,560 --> 00:11:47,020
+يعني ال extra cellular fluid compartment زادت و
+
+155
+00:11:47,020 --> 00:11:52,500
+البلازمةوليوم زاد معناه الفلولز اللي بتصل ال right
+
+156
+00:11:52,500 --> 00:11:57,200
+atrium كترت فهو بيصير more dilatation فبنبهي يا
+
+157
+00:11:57,200 --> 00:12:01,400
+جماعة أنتوا أنا ال issue كترأه؟ فبيبعت للكل إشارة
+
+158
+00:12:01,400 --> 00:12:06,840
+لما يكتر إفرازه أنه يخففي من ال reabsorption تمام؟
+
+159
+00:12:06,840 --> 00:12:10,540
+هنا لما يعلق بيجي ل reabsorption و لما يوتع بيعلق
+
+160
+00:12:10,540 --> 00:12:13,460
+ل reabsorption بيشتغل بعملية عكسية لأنه بيطلع هو
+
+161
+00:12:13,460 --> 00:12:18,240
+stimulated by increased volume مش زي ال
+
+162
+00:12:18,240 --> 00:12:23,000
+aldosterone و التانينه بيشتغل العكس، هو ممكن هديجي
+
+163
+00:12:23,000 --> 00:12:27,360
+أسئلة فيه ليش؟ لأنه عكس ال aldosterone و علاقته
+
+164
+00:12:27,360 --> 00:12:31,620
+بال excess fluid volume عكسية، يعني إذا زادت بيزيد
+
+165
+00:12:31,620 --> 00:12:36,560
+و بجلد شغل الكيلية، التانين إذا زادت بيجل و إذا
+
+166
+00:12:36,560 --> 00:12:40,120
+جلت بيزيد و بيزود شغل الكيلية، تمام؟ ال absorptive
+
+167
+00:12:40,120 --> 00:12:44,490
+ميكانيزم اللي بيتكلم عنهاالالدوستيرون يزيد عبارة
+
+168
+00:12:44,490 --> 00:12:45,570
+عن عبارة عن عبارة عن عبارة عن عبارة عن عبارة عن
+
+169
+00:12:45,570 --> 00:12:46,510
+عبارة عن عبارة عن عبارة عن عبارة عن عبارة عن عبارة
+
+170
+00:12:46,510 --> 00:12:46,850
+عن عبارة عن عبارة عن عبارة عن عبارة عن عبارة عن
+
+171
+00:12:46,850 --> 00:12:52,510
+عبارة عن عبارة عن عبارة عن عبارة عن عبارة عن عبارة
+
+172
+00:12:52,510 --> 00:12:57,010
+عن عبارة عن عبارة
+
+173
+00:12:57,010 --> 00:12:58,290
+عن عبارة عن عبارة عن عبارة عن عبارة عن عبارة عن
+
+174
+00:12:58,290 --> 00:12:58,370
+عبارة عن عبارة عن عبارة عن عبارة عن عبارة عن عبارة
+
+175
+00:12:58,370 --> 00:12:59,010
+عن عبارة عن عبارة عن عبارة عن عبارة عن عبارة عن
+
+176
+00:12:59,010 --> 00:13:07,690
+عبارة عن عبارة
+
+177
+00:13:07,980 --> 00:13:11,540
+بلازمة potassium concentration لذا البوتاسيوم لما
+
+178
+00:13:11,540 --> 00:13:17,620
+ازيد هي تمام بتعمل بتطلع الادوسترون عشان نتخلص منه
+
+179
+00:13:17,620 --> 00:13:21,900
+بس في مقابل التخلص منه احنا بنبنطس ايه؟ Sodium مش
+
+180
+00:13:21,900 --> 00:13:26,580
+كده؟ لذلك يقولون اول factor احنا في ال ايه؟ في
+
+181
+00:13:26,580 --> 00:13:28,680
+التحكم في الادوسترون ال potassium concentration
+
+182
+00:13:28,680 --> 00:13:34,300
+اتنين ايه؟ اللي هو ال .. ال angiotensin two
+
+183
+00:13:35,470 --> 00:13:39,910
+والتالتة بيجي .. يعني ال potassium ال تالت بيقول
+
+184
+00:13:39,910 --> 00:13:48,510
+انه لو جلل او زاد ال sodium بيلاقي انه صار ايه؟
+
+185
+00:13:48,510 --> 00:13:52,590
+suppression ل ال aldosterone لحظة تشعروا ان زاد ال
+
+186
+00:13:52,590 --> 00:13:56,850
+sodium ال concentration زاد بيلاقي ايه؟ ال
+
+187
+00:13:56,850 --> 00:14:01,210
+aldosterone level بيجل يعني ال sodium عامل تالت بس
+
+188
+00:14:01,210 --> 00:14:06,670
+مش as strong as ده ايه؟ potassium السمينسهو فيه
+
+189
+00:14:06,670 --> 00:14:14,490
+فاكتور رابع تتذكروا ساعتها تمام ال SETH كفاكتور
+
+190
+00:14:14,490 --> 00:14:17,310
+رابع ماعلينا إذا في عندي أنا ال aldosterone هنا
+
+191
+00:14:17,310 --> 00:14:23,510
+إذا زاد البوتاسيوم mainly stimulated هو بيقدر إلى
+
+192
+00:14:23,510 --> 00:14:26,490
+إنه يزود ال reabsorption of sodium and secretion
+
+193
+00:14:26,490 --> 00:14:33,850
+معظم معظم of the excreted potassium is secreted
+
+194
+00:14:35,070 --> 00:14:38,790
+معظم البوتاسيوم اللي بيصير له excretion بيبقى جامع
+
+195
+00:14:38,790 --> 00:14:42,130
+ال filtrate بيبقى جامع ال digital tribute بيصير له
+
+196
+00:14:42,130 --> 00:14:47,710
+secretion تمام؟ اذا المعظم .. most of the excreted
+
+197
+00:14:47,710 --> 00:14:52,530
+potassium is secreted واضح؟ عشان كتير احنا اللي
+
+198
+00:14:52,530 --> 00:14:56,030
+اخلط من كلمة excretion و secretion ال excretion ال
+
+199
+00:14:56,030 --> 00:14:59,630
+final result لكن ال secretion ال process بتنفي
+
+200
+00:14:59,630 --> 00:15:03,530
+ايه؟ في ال .. في ال .. نفر
+
+201
+00:15:06,160 --> 00:15:12,800
+الميكانيزم انه ال primary انه ال aldosterone بيشغل
+
+202
+00:15:12,800 --> 00:15:15,540
+على الطبق اللي قلنا عليه ال principle cells لإن في
+
+203
+00:15:15,540 --> 00:15:20,060
+ال intercalated بيشغلش عليها ال aldosterone كيف ال
+
+204
+00:15:20,060 --> 00:15:23,620
+aldosterone increases reabsorption of sodium and
+
+205
+00:15:23,620 --> 00:15:30,620
+secretion of ايه؟ of بوتاسيم اصلا حكينا قلنا ال
+
+206
+00:15:30,620 --> 00:15:36,900
+ايش ال atbsبومبينج سيستم في الـ distal tubule هذه
+
+207
+00:15:36,900 --> 00:15:41,140
+Simulated by aldosterone، مش كده؟ قولنا أزالت
+
+208
+00:15:41,140 --> 00:15:46,420
+بجلد، جلد بجلد، وهذه
+
+209
+00:15:46,420 --> 00:15:50,920
+احنا عارفينها وانا خليت النقطة المذكورة نشرحها، مش
+
+210
+00:15:50,920 --> 00:15:53,700
+عشان اقول النقطة هذه، لإن شرحناها بالتفصيل، لأ
+
+211
+00:15:53,700 --> 00:15:58,480
+عشان في نقطتين أخرتين أو نقطة مهمة هنا، ان ال
+
+212
+00:15:58,480 --> 00:16:02,660
+aldosterone also increases the sodium permeability
+
+213
+00:16:04,350 --> 00:16:06,690
+of the luminal side of the membrane يعني
+
+214
+00:16:06,690 --> 00:16:09,430
+الالدوسيرون مش بس بيزود ال bombing system على
+
+215
+00:16:09,430 --> 00:16:14,690
+بيزولاتر الممبران تمام لأ كمان بيزود ال sodium
+
+216
+00:16:14,690 --> 00:16:19,710
+hydrogen exchange
+
+217
+00:16:19,710 --> 00:16:25,610
+mechanism هنا عبر الالـ Brush Board عبر الـ Apical
+
+218
+00:16:25,610 --> 00:16:29,250
+Membrane إذا القلدستيرون بيزود ال Sodium
+
+219
+00:16:29,250 --> 00:16:35,130
+Reabsorption صار على ال Principal Cells وعلى ال
+
+220
+00:16:35,130 --> 00:16:37,130
+Intercalated Cells لكن ال Intercalated Cell هي
+
+221
+00:16:37,130 --> 00:16:41,890
+اللي ايه؟ بتطلع ال Hydrogen مش كده؟ طيب مش بس في
+
+222
+00:16:41,890 --> 00:16:45,290
+ال Distal كمان في اللي ايه؟ في ال Proximal لأن
+
+223
+00:16:45,290 --> 00:16:49,130
+القلدستيرون له علاقة بال .. بال Hydrogen Sodium
+
+224
+00:16:49,760 --> 00:16:54,720
+اللي هو مقاومة الترانسبورت هذا لما نأخد صوديوم و
+
+225
+00:16:54,720 --> 00:16:58,040
+نطلق حيدروجين تمام الهيسين ألدسترون بيشتغل على
+
+226
+00:16:58,040 --> 00:17:01,180
+اتباين بومبينج سيستم و بيعمل استموليشن و بيزود
+
+227
+00:17:01,180 --> 00:17:07,420
+برضه الابيكال بوردر بيرميابيليتي for صوديوم
+
+228
+00:17:07,420 --> 00:17:09,380
+reabsorption and secretion of hydrogen
+
+229
+00:17:15,500 --> 00:17:21,240
+إذا الالدوستيرون مهم كمعالجة تركيز التركيز التركيز
+
+230
+00:17:21,240 --> 00:17:22,260
+التركيز التركيز التركيز التركيز التركيز التركيز
+
+231
+00:17:22,260 --> 00:17:25,940
+التركيز التركيز التركيز التركيز التركيز التركيز
+
+232
+00:17:25,940 --> 00:17:33,040
+التركيز التركيز التركيز التركيز التركيز التركيز
+
+233
+00:17:33,040 --> 00:17:34,920
+التركيز التركيز التركيز التركيز التركيز التركيز
+
+234
+00:17:34,920 --> 00:17:35,160
+التركيز التركيز التركيز التركيز التركيز التركيز
+
+235
+00:17:35,160 --> 00:17:43,540
+التركيز التركيز التركيز التركيز التركيز التركيز
+
+236
+00:17:43,540 --> 00:17:49,570
+التركيارتفاعه او هبوته اخطر من ايه؟ من ال sodium
+
+237
+00:17:49,570 --> 00:17:53,630
+ارتفاع او هبوته ليش؟ لأن فورا انا ال plasma و ال
+
+238
+00:17:53,630 --> 00:18:00,330
+potassium هنا هيصل ال nerve endings هيصل ال heart
+
+239
+00:18:00,330 --> 00:18:04,270
+ال heart قبل ال nerve endings لأن ال nerve endings
+
+240
+00:18:04,270 --> 00:18:07,210
+ممكن تكون فى ال interstitium لكن ال heart بيصلوا
+
+241
+00:18:07,210 --> 00:18:11,590
+ال plasma تمام؟ اذا احنا اتصلنا ال potassium يزل
+
+242
+00:18:11,590 --> 00:18:16,780
+شوية على ال ايه؟ على ال heart بيتوقف عملهالتوقف
+
+243
+00:18:16,780 --> 00:18:22,740
+عمله و نرجع و احنا على لما بدنا نتخلص او لو ..
+
+244
+00:18:22,740 --> 00:18:25,960
+بلاش كلمة هذه احنا مستجرين قاعدين ال .. ال
+
+245
+00:18:25,960 --> 00:18:33,120
+potassium chloride لما نعطيه لل .. لأي حد فيه خطر
+
+246
+00:18:33,120 --> 00:18:37,840
+شديد تمام؟ لما ندل الأطفال rehydration fluids بدنا
+
+247
+00:18:37,840 --> 00:18:41,620
+ندل جدا لل potassium جديش احنا معطيين لإنه احنا
+
+248
+00:18:41,620 --> 00:18:50,470
+ايه؟ ممكن نكونkilling fluids قاعدين في حالات ال
+
+249
+00:18:50,470 --> 00:18:55,750
+IVF حكيته قصدي قبل كده؟ اه في حالات ال IVF اللي هو
+
+250
+00:18:55,750 --> 00:19:00,810
+أطفالي أنابيب لما بيصير أحيانا انه بيصير عندى خمس
+
+251
+00:19:00,810 --> 00:19:06,210
+ست أجنة موجودين سبعة تمانية موجودين في الرحمطبعا
+
+252
+00:19:06,210 --> 00:19:10,410
+خطأ أن المركز أساسا مش لازم يدّي يرجّع أجننا أكتر
+
+253
+00:19:10,410 --> 00:19:14,130
+من تلاتة لأن إذا رجعنا أجننا أكتر من تلاتة لرحيم
+
+254
+00:19:14,130 --> 00:19:18,010
+فرصة أنه يصير عندى multiple pregnancies عالية
+
+255
+00:19:18,010 --> 00:19:22,710
+معناها فرصة أنه يصير early delivery عالية يعني
+
+256
+00:19:22,710 --> 00:19:26,190
+هتولد الست في أول السادس أو أول السابع وفي وعدم
+
+257
+00:19:26,190 --> 00:19:29,730
+وجود إمكانيات حضانة عالية بيقدّي لهم كلهم في الأخر
+
+258
+00:19:29,730 --> 00:19:34,430
+مفرحنة لما إجوالكن هنزعل لإنهم هيروحوا بدري فى أول
+
+259
+00:19:34,430 --> 00:19:38,030
+السابع كلهم من ولده وكلهم فى الحضانة كويسين لكن
+
+260
+00:19:38,030 --> 00:19:41,530
+يوم يوم تخ تخ تخ تخ السبعة ماتوا أو الكمسة ماتوا
+
+261
+00:19:41,530 --> 00:19:47,550
+ليش؟ لإنه فشت إمكانية كبيرة عالية هو صعب على الطفل
+
+262
+00:19:47,550 --> 00:19:52,010
+إنه ينولد برا من .. من .. يطلع من رحم أمه فى أشهر
+
+263
+00:19:52,010 --> 00:19:56,270
+مبكرة okay فى الدولات المتقدمة فى حضانة ممتعة زى
+
+264
+00:19:56,270 --> 00:19:58,930
+ما ممكن اتعودهم هذا الكلام بس هذا مش موشف فى كل
+
+265
+00:19:58,930 --> 00:20:04,290
+مكان لإنه مكلف جداالحل ان نعمل reduction of the
+
+266
+00:20:04,290 --> 00:20:08,490
+number of embryos لما نلاقي خمسة اجنة في الرحم
+
+267
+00:20:08,490 --> 00:20:13,770
+موجودين وهذا هيهدد خطر المجموع كله، هيكون خطر على
+
+268
+00:20:13,770 --> 00:20:17,090
+حياة كل المجموع، مش واحد اتنين هيموتوا والباجينة،
+
+269
+00:20:17,090 --> 00:20:20,910
+لأ، هيكلهم ينزلوا بدريوكلهم فبيعمل عملية reduction
+
+270
+00:20:20,910 --> 00:20:25,050
+للإيه لعدد الأجنة بيشيلوا واحد او اتنين بحيث
+
+271
+00:20:25,050 --> 00:20:29,390
+يخففوا من حمل الرحم عشان يقدروا يصلوا للشهر التامن
+
+272
+00:20:29,390 --> 00:20:33,190
+او التاسع فبيعملهم ejection of potassium chloride
+
+273
+00:20:33,190 --> 00:20:37,070
+بيحشوا بقبرة هيك على الجنين وبيحجن الجنين
+
+274
+00:20:37,070 --> 00:20:40,710
+potassium chloride بيعلى ال potassium بيوقف القلب
+
+275
+00:20:40,710 --> 00:20:45,530
+فورا تمام؟ وبيتوقف الجنين عن الايه فبيظل في فرق
+
+276
+00:20:45,530 --> 00:20:54,190
+لإيه لاختههذا بالنسبة للإيه؟ للبوتاسيوم خطير لذلك
+
+277
+00:20:54,190 --> 00:20:58,090
+القلد الصيران تمام بيهتم في البوتاسيوم البوتاسيومي
+
+278
+00:20:58,090 --> 00:21:02,110
+أكتر منه و أخطر البوتاسيوم البوتاسيوم إيه؟ أخطر و
+
+279
+00:21:02,110 --> 00:21:05,770
+بنتكلم عن أربعة من ال equivalent أربعة لو صارت
+
+280
+00:21:05,770 --> 00:21:08,790
+خمسة أو ستة و نخش في خطر في حين أنك بتكلم صدر مية
+
+281
+00:21:08,790 --> 00:21:11,230
+و دون و خمسين يا أخي تصير مية و ستين إيش بده يصير؟
+
+282
+00:21:11,530 --> 00:21:16,870
+هذا شوية expansion of the volume بتزيد شوية ضغط
+
+283
+00:21:16,870 --> 00:21:20,590
+لكن البوتنازيو متعاملش مع ضغط متعامل مع ايه؟
+
+284
+00:21:20,590 --> 00:21:23,270
+تكسيسية ال heart و لا ال neuromuscular junctions
+
+285
+00:21:23,270 --> 00:21:28,390
+المقطة التانية اللي هو ال angiotensin 2 إذا
+
+286
+00:21:28,390 --> 00:21:32,770
+الألدوسترون له تأثير احد الكلام عن ال hormonal
+
+287
+00:21:32,770 --> 00:21:35,630
+part تمام؟ قبل كده اتكلمنا عن الايه؟
+
+288
+00:21:42,010 --> 00:21:48,690
+الانجوتانسين 2 هو ربما الانجوتانسين 2 هو
+
+289
+00:21:48,690 --> 00:21:50,990
+الانجوتانسين 2 هو الانجوتانسين 2 هو الانجوتانسين 2
+
+290
+00:21:50,990 --> 00:21:52,570
+هو الانجوتانسين 2 هو الانجوتانسين 2 هو
+
+291
+00:21:52,570 --> 00:21:53,630
+الانجوتانسين 2 هو الانجوتانسين 2 هو الانجوتانسين 2
+
+292
+00:21:53,630 --> 00:21:56,170
+هو الانجوتانسين 2 هو الانجوتانسين 2 هو
+
+293
+00:21:56,170 --> 00:22:01,170
+الانجوتانسين 2 هو الانجوتانسين 2 هو الانجوتان
+
+294
+00:22:01,820 --> 00:22:07,740
+الالدوستيرون الانجليزي تنسى انه يعمل expansion
+
+295
+00:22:07,740 --> 00:22:12,200
+يزغط الضغط فهو بيعمل expansion لل body fluids
+
+296
+00:22:12,200 --> 00:22:15,940
+بمعنى ان ال sodium retaining يعني بيحافظ على
+
+297
+00:22:15,940 --> 00:22:19,240
+السوديوم يعني بيعمل ايه سوديوم وميه يعني expansion
+
+298
+00:22:19,240 --> 00:22:23,780
+تمام هو اقوى واحد لانه بيشتغل مباشر بنفسه وعبر
+
+299
+00:22:23,780 --> 00:22:27,640
+زملاته اللي هم الالدوستيرون اللي يستنجد فيهم تمام
+
+300
+00:22:28,920 --> 00:22:33,660
+المصادر المزيد من الاشيوتينسين تساعد في إعادة
+
+301
+00:22:33,660 --> 00:22:36,880
+إعادة مدرسة الدم وأكثر من مدرسة الهيروليوم للطبيعي
+
+302
+00:22:36,880 --> 00:22:38,880
+بإعادة مدارسة المدرسة الهيروليوم للطبيعي بإعادة
+
+303
+00:22:38,880 --> 00:22:39,460
+مدارسة المدرسة الهيروليوم للطبيعي بإعادة مدارسة
+
+304
+00:22:39,460 --> 00:22:40,280
+المدارسة الهيروليوم للطبيعي بإعادة مدارسة المدارسة
+
+305
+00:22:40,280 --> 00:22:41,160
+الهيروليوم للطبيعي بإعادة مدارسة المدارسة
+
+306
+00:22:41,160 --> 00:22:43,600
+الهيروليوم للطبيعي بإعادة مدارسة الهيروليوم
+
+307
+00:22:43,600 --> 00:22:50,800
+للطبيعي بإعادة مدارسة الهيروليوم للطبعا اذا انزلت
+
+308
+00:22:50,800 --> 00:22:55,180
+انسان تروه فبيشتغل بتلات نقاط على انه يحافظ على ال
+
+309
+00:22:55,180 --> 00:22:58,420
+sodium وال water منها اللي قلنا عليها الالد السرار
+
+310
+00:22:58,420 --> 00:23:01,360
+مش كده هاي انزلت استمرت في الالد السرار اللي احنا
+
+311
+00:23:01,360 --> 00:23:07,470
+عارفينها اتنين منها اللي هو التحكمفي الـ efferent
+
+312
+00:23:07,470 --> 00:23:12,110
+arteriole تمام؟ إذا الـ angiotensin 2 زود ال
+
+313
+00:23:12,110 --> 00:23:15,350
+construction معي لل efferent بيزود ال filtration
+
+314
+00:23:15,350 --> 00:23:21,350
+مش كده؟ بيزود ال filtration و بي .. و بي .. هذا
+
+315
+00:23:21,350 --> 00:23:23,410
+علاقته بال filtration خلاص الكلام عن ال
+
+316
+00:23:23,410 --> 00:23:27,450
+reabsorption ال angiotensin 2 لما يزيد بيزود ال
+
+317
+00:23:27,450 --> 00:23:30,910
+reabsorption في ال different parts of the
+
+318
+00:23:33,760 --> 00:23:37,160
+هذه النقطة التالتة خلّيني أدخل عليها عشت نفسي الـ
+
+319
+00:23:37,160 --> 00:23:39,960
+Direct Stimulus Sodium Reabsorption in the
+
+320
+00:23:39,960 --> 00:23:42,780
+proximal tubule, the lobophilic and the distal
+
+321
+00:23:42,780 --> 00:23:44,780
+tubule and the collective tubule يعني في الـ
+
+322
+00:23:44,780 --> 00:23:48,680
+different parts of the نفرون Reabsorption of
+
+323
+00:23:48,680 --> 00:23:53,600
+Sodium و Sodium طبعا يليل ال water في الغالبالـ
+
+324
+00:23:53,600 --> 00:23:57,460
+different bars is stimulated to reabsorb more
+
+325
+00:23:57,460 --> 00:24:02,460
+sodium ولمّا يجيل ال aldosterone بيجيل نفس الكلام
+
+326
+00:24:02,460 --> 00:24:04,860
+ال reabsorption إذا ال different bars is
+
+327
+00:24:04,860 --> 00:24:07,400
+stimulated to reabsorb more sodium if the
+
+328
+00:24:07,400 --> 00:24:11,120
+angiotensin 2 increases تمام؟ إذا لما ال
+
+329
+00:24:11,120 --> 00:24:15,960
+angiotensin 2 يزيد بيزيد ال reabsorption
+
+330
+00:24:15,960 --> 00:24:20,450
+everywhere مش بميكانيزم معينةمباشرة مباشرة مباشرة
+
+331
+00:24:20,450 --> 00:24:25,210
+مباشرة مباشرة direct effect مباشرة
+
+332
+00:24:25,210 --> 00:24:25,350
+مباشرة direct effect مباشرة مباشرة direct effect
+
+333
+00:24:25,350 --> 00:24:27,390
+مباشرة مباشرة direct effect مباشرة مباشرة direct
+
+334
+00:24:27,390 --> 00:24:30,370
+effect مباشرة مباشرة direct effect مباشرة مباشرة
+
+335
+00:24:30,370 --> 00:24:31,310
+direct effect مباشرة direct effect مباشرة direct
+
+336
+00:24:31,310 --> 00:24:32,270
+effect مباشرة direct effect مباشرة direct effect
+
+337
+00:24:32,270 --> 00:24:36,130
+مباشرة direct effect مباشرة
+
+338
+00:24:36,130 --> 00:24:41,350
+direct effect مباشرة direct effect مباشرة direct
+
+339
+00:24:41,350 --> 00:24:42,290
+effect مباشرة direct effect مباشرة direct effect
+
+340
+00:24:42,290 --> 00:24:42,350
+مباشرة direct effect مباشرة direct effect مباشرة
+
+341
+00:24:42,350 --> 00:24:42,570
+direct effect مباشرة direct effect مباشرة direct
+
+342
+00:24:42,570 --> 00:24:46,150
+effect مباشرة direct effect مباشرة
+
+343
+00:24:49,680 --> 00:24:54,800
+النقطة التانية اللى سبناها احنا هان بدها تفاصيل ان
+
+344
+00:24:54,800 --> 00:25:00,940
+الانجليكاس تشتغل الارتريالات الافرنطية اللى تشتغل
+
+345
+00:25:00,940 --> 00:25:02,200
+الارتريالات الافرنطية الافرنطية الافرنطية
+
+346
+00:25:02,200 --> 00:25:02,580
+الافرنطية الافرنطية الافرنطية الافرنطية الافرنطية
+
+347
+00:25:02,580 --> 00:25:10,100
+الافرنطية الافرنطية
+
+348
+00:25:10,100 --> 00:25:15,040
+الافرنطية الافرنطية الافرنطية الافرنطية الافرنطية
+
+349
+00:25:15,040 --> 00:25:15,160
+الافرنطية الافرنطية الافرنطية الافرنطية الافرنطية
+
+350
+00:25:15,160 --> 00:25:15,240
+الافرنطية الافرنطية الافرنطية الافرنطية الافرنطية
+
+351
+00:25:15,240 --> 00:25:20,130
+الافرنطية الافرنطية الممكن يكون مش mild اكتر شوية
+
+352
+00:25:20,130 --> 00:25:27,970
+هذا يكون اكتر شوية تمام بيزود ال filtration مش كده
+
+353
+00:25:27,970 --> 00:25:31,030
+معناها اللي .. اللي .. اللي .. اللي .. اللي .. ال
+
+354
+00:25:31,030 --> 00:25:31,850
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+355
+00:25:31,850 --> 00:25:31,990
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+356
+00:25:31,990 --> 00:25:32,070
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+357
+00:25:32,070 --> 00:25:32,310
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+358
+00:25:32,310 --> 00:25:32,850
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+359
+00:25:32,850 --> 00:25:33,150
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+360
+00:25:33,150 --> 00:25:34,390
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+361
+00:25:34,390 --> 00:25:35,150
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+362
+00:25:35,150 --> 00:25:41,250
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+363
+00:25:45,730 --> 00:25:50,910
+طب هذا النقطة الأولى أولا إفرانت الارتريوالر تقوم
+
+364
+00:25:50,910 --> 00:25:54,050
+بتقليم كبيرة البروتيوبلا تقوم بتقليم كبيرة
+
+365
+00:25:54,050 --> 00:25:55,170
+البروتيوبلا تقوم بتقليم كبيرة البروتيوبلا تقوم
+
+366
+00:25:55,170 --> 00:25:56,270
+بتقليم كبيرة البروتيوبلا تقوم بتقليم كبيرة
+
+367
+00:25:56,270 --> 00:25:57,790
+البروتيوبلا تقوم بتقليم كبيرة البروتيوبلا تقوم
+
+368
+00:25:57,790 --> 00:26:03,690
+بتقليم كبيرة البروتيوبلا تقليم كبيرة البروتيوبلا
+
+369
+00:26:03,690 --> 00:26:07,590
+تقليم كبيرة البروتيوبلا تقليم كبيرة البروتيوبلا
+
+370
+00:26:07,590 --> 00:26:10,430
+تقليم كبيرة البروتيوبلا تقليم كبيرة البروتيوبلا
+
+371
+00:26:10,430 --> 00:26:13,590
+تقليم كبيرة البروتيوبلا تقليم كبيرة البروت
+
+372
+00:26:14,610 --> 00:26:17,030
+reabsorption على ال level تبع ال vertebral
+
+373
+00:26:17,030 --> 00:26:20,810
+capillaries انه كله ده ال factor احنا هان لما يزيد
+
+374
+00:26:20,810 --> 00:26:26,830
+ال filtration بمعنى انه ال filtration زاد مش مش ل
+
+375
+00:26:26,830 --> 00:26:33,510
+.. لإن ال flow rate جال تمام ال flow rate جال احنا
+
+376
+00:26:33,510 --> 00:26:37,110
+عندنا العلاقة
+
+377
+00:26:37,110 --> 00:26:42,330
+ما بين ال filtration fraction يساوي ال GFR على ال
+
+378
+00:26:42,330 --> 00:26:47,560
+Aعالى Renal Flow فلما عندنا Renal Blood Flow Renal
+
+379
+00:26:47,560 --> 00:26:51,440
+Plasma Flow يجل تمام معناه ال filtration ايش؟
+
+380
+00:26:51,440 --> 00:26:57,580
+بيزيد معناها ال colloidal ال colloidal بيعلق لأنه
+
+381
+00:26:57,580 --> 00:27:02,380
+زاد ال filtration مش كده؟ زاد ال filtration بمعنى
+
+382
+00:27:02,380 --> 00:27:07,710
+أخر أبسط من العلاقة اللي هي معقدة هذهإنه لما الاشي
+
+383
+00:27:07,710 --> 00:27:14,030
+بمشي بطيق ال time for filtration increases طب كمية
+
+384
+00:27:14,030 --> 00:27:18,290
+الماء اللي هتروح لإنه صار exposed لل surface of
+
+385
+00:27:18,290 --> 00:27:22,050
+filtration أطول هيصير more concentrated، هيصير
+
+386
+00:27:22,050 --> 00:27:24,690
+عندى more colloidal، هيصير more reabsorption عبر
+
+387
+00:27:24,690 --> 00:27:27,650
+ال colloidal، تمام؟ إذا في الحالة هذه أنا عندى
+
+388
+00:27:27,650 --> 00:27:32,560
+بشتغل ال android instant 2على الـ Hashtag بيشتغل
+
+389
+00:27:32,560 --> 00:27:35,720
+انه بيزود الـ Colloidal في البريتيوبيلر و بيجلل ال
+
+390
+00:27:35,720 --> 00:27:38,580
+hydrostatic في البريتيوبيلر فال two factors هدول
+
+391
+00:27:38,580 --> 00:27:41,180
+بيساعدولي على ال reabsorption لما يجلل ال
+
+392
+00:27:41,180 --> 00:27:43,340
+hydrostatic pressure لإنه صار under constriction
+
+393
+00:27:43,340 --> 00:27:45,440
+تمام جلل ال hydrostatic pressure بيزيد ال
+
+394
+00:27:45,440 --> 00:27:48,800
+reabsorption لما يزيد colloidal pressure بيزيد ال
+
+395
+00:27:48,800 --> 00:27:52,200
+ايه reabsorption اصلا انتوا اتكلمنا عن ايش عكس ذلك
+
+396
+00:27:52,200 --> 00:27:56,180
+لما ال blood pressure بيزيد قولنامش كده؟ بيزيد ال
+
+397
+00:27:56,180 --> 00:27:59,000
+peritubular capillary بشر بيجيل ال ايه؟ ال
+
+398
+00:27:59,000 --> 00:28:04,500
+reabsorption طيب، اذا ال angiotensin 2 simulates
+
+399
+00:28:04,500 --> 00:28:08,660
+aldosterone ال angiotensin 2 constricts different
+
+400
+00:28:08,660 --> 00:28:12,180
+arteriole which has two effects on the peritubular
+
+401
+00:28:12,180 --> 00:28:16,720
+capillary dynamics الميكانيزم، لكن المحصلة ان هذه
+
+402
+00:28:16,720 --> 00:28:20,880
+العملية بتأدي ل more reabsorption عبر الهيدروسينات
+
+403
+00:28:20,880 --> 00:28:26,590
+بشر و عبر ال ايه؟ ال colloidal بشروالتالتة قولنا
+
+404
+00:28:26,590 --> 00:28:30,670
+لأ الو direct properties على ال all parts of the
+
+405
+00:28:30,670 --> 00:28:34,190
+nephron to increase reabsorption إذا الانجوتينسين
+
+406
+00:28:34,190 --> 00:28:37,810
+تسيموليه ال sodium transport across both the
+
+407
+00:28:37,810 --> 00:28:40,430
+luminal and the bisilateral
+
+408
+00:28:43,940 --> 00:28:48,440
+فهمناها ال reabsorptive forces بس ال basolateral
+
+409
+00:28:48,440 --> 00:28:54,360
+وين؟ ال aldosterone مش كده؟ ماشي مال aldosterone
+
+410
+00:28:54,360 --> 00:28:59,000
+هو انا شو ت listen toه قولنا اول اوال effect تبعه
+
+411
+00:28:59,000 --> 00:29:01,580
+انه زود ال aldosterone فال aldosterone هيزود ال
+
+412
+00:29:01,580 --> 00:29:05,760
+ايه؟ ال bombing system و هيزود برضه ال communal
+
+413
+00:29:05,760 --> 00:29:11,490
+transport mechanism مش كده؟واحد من إفعالات
+
+414
+00:29:11,490 --> 00:29:17,670
+الانجوتينسين 2 هو .. واحد من إفعالات الانجوتينسين
+
+415
+00:29:17,670 --> 00:29:20,970
+2 هو تسيمولات صوديوم بوتاسيوم في محطة البريزولات
+
+416
+00:29:20,970 --> 00:29:23,370
+البريزولات البريزولات البريزولات البريزولات
+
+417
+00:29:23,370 --> 00:29:23,490
+البريزولات البريزولات البريزولات البريزولات
+
+418
+00:29:23,490 --> 00:29:24,050
+البريزولات البريزولات البريزولات البريزولات
+
+419
+00:29:24,050 --> 00:29:24,730
+البريزولات البريزولات البريزولات البريزولات
+
+420
+00:29:24,730 --> 00:29:28,150
+البريزولات البريزولات البريزولات البريزولات
+
+421
+00:29:28,150 --> 00:29:31,310
+البريزولات البريزولات البريزولات البريزولات
+
+422
+00:29:31,310 --> 00:29:34,890
+البريزولات البريزولات البريزولات البر
+
+423
+00:29:38,140 --> 00:29:44,240
+هذا الانجدنسين تبعه
+
+424
+00:29:44,240 --> 00:29:51,020
+الالدستيرون من ضمن الميكانيزمات اللي بشتغل عليها
+
+425
+00:30:11,010 --> 00:30:17,550
+هذا بالنسبة للهرمون التاني أنجليتنسين 2إذا اتكلمنا
+
+426
+00:30:17,550 --> 00:30:21,050
+عن الادوسترون و انجدنز الـ2 و الـ antidiuretic
+
+427
+00:30:21,050 --> 00:30:25,150
+hormone هنا محتاجين احنا نعمل شوية تفاصيل عنه لإنه
+
+428
+00:30:25,150 --> 00:30:28,930
+جيبنا سيرته كتير و ما اتكلمناش عن التفاصيل تمام؟
+
+429
+00:30:28,930 --> 00:30:31,990
+الـ antidiuretic hormone increases water
+
+430
+00:30:31,990 --> 00:30:35,990
+reabsorption كيف؟
+
+431
+00:30:35,990 --> 00:30:41,470
+و أين؟يزيد ال water reabsorption في ال distal
+
+432
+00:30:41,470 --> 00:30:44,450
+nephron و ال collecting ده يعني من بعد ال
+
+433
+00:30:44,450 --> 00:30:47,730
+juxtapose من ال apparatus بشوية صغيرة ال early و
+
+434
+00:30:47,730 --> 00:30:51,470
+ال late من سيبها لإنهم بقى ما بيبطوا water لكن ال
+
+435
+00:30:51,470 --> 00:30:57,050
+late distal ال connecting و ال collecting و ال
+
+436
+00:30:57,050 --> 00:31:02,530
+مدلة reductive هدول كلهم under the effect of Aإذا
+
+437
+00:31:02,530 --> 00:31:05,030
+ال digital tribute, collectible tribute و
+
+438
+00:31:05,030 --> 00:31:08,110
+collecting duct هن كلهم affected بعض ال
+
+439
+00:31:08,110 --> 00:31:13,830
+antihormones وزيادة ال antihormones هان بيزيد ال
+
+440
+00:31:13,830 --> 00:31:19,370
+reabsorption كيف بيزيد ال reabsorption هان؟ طيب
+
+441
+00:31:19,370 --> 00:31:22,870
+لما نتكلم احنا ال reabsorption نتكلم تحت .. خلينا
+
+442
+00:31:22,870 --> 00:31:26,410
+نتكلم تحت على ال collecting duct على ال collecting
+
+443
+00:31:26,410 --> 00:31:29,590
+duct في ال collecting duct الميكانيزم ان احنا
+
+444
+00:31:29,590 --> 00:31:35,820
+بنفتحالـ water channels هنتكلم عنها بعد شوية لما
+
+445
+00:31:35,820 --> 00:31:39,160
+نفتح ال water channels الميه تخش للإيه؟ لل
+
+446
+00:31:39,160 --> 00:31:45,140
+collecting duct epithelia وبعدين لما احنا بنبقى
+
+447
+00:31:45,140 --> 00:31:47,620
+متص ميه في الحالة هذه بنعمل concentration لل urine
+
+448
+00:31:47,620 --> 00:31:54,120
+بيكون hyperosmotic مين؟ هي hyperosmotic مضلة مش
+
+449
+00:31:54,120 --> 00:31:59,120
+كده؟ في عندي concentration gradient مدام في عندنا
+
+450
+00:31:59,120 --> 00:32:03,490
+reabsorptionof water by antiretic hormone معناها
+
+451
+00:32:03,490 --> 00:32:06,710
+فى عندى osmotic gradient اتكون بتكلم عن الجزء
+
+452
+00:32:06,710 --> 00:32:09,050
+الأخر احنا ال collecting duct ال collecting duct
+
+453
+00:32:09,050 --> 00:32:13,590
+طبعا اين موجودة هي فى المضلة مش كده فى المضلة ال
+
+454
+00:32:13,590 --> 00:32:17,010
+collecting duct فى المضلة إذا فتحت ال water
+
+455
+00:32:17,010 --> 00:32:18,130
+channels
+
+456
+00:32:20,740 --> 00:32:24,700
+واناجينا ان الـ hyper osmotic medulla بتشفط ال
+
+457
+00:32:24,700 --> 00:32:28,780
+water من وين من الابيثيليا هتدفع ال water من ال
+
+458
+00:32:28,780 --> 00:32:32,760
+filtrate من ال tubular fluid إلى داخل ال cells
+
+459
+00:32:32,760 --> 00:32:37,580
+هتنتقل واضح الميكانيزم اذا عبر ال osmosis اللي
+
+460
+00:32:37,580 --> 00:32:42,440
+موجود في ال interstitium طيب لفوق شوية في ال
+
+461
+00:32:42,440 --> 00:32:47,900
+collecting tubule cortical في ال distal tubule
+
+462
+00:32:47,900 --> 00:32:54,860
+corticalتمام؟ الميكانيزم هذا بتنفع؟ طب احنا هنا
+
+463
+00:32:54,860 --> 00:33:00,180
+ماتقولوش تسرعوش انا بتغلطكوا طب احنا عندنا هنا
+
+464
+00:33:00,180 --> 00:33:04,160
+اعتمد ال reabsorption of water على وجود ال
+
+465
+00:33:04,160 --> 00:33:08,480
+interstitium concentrated مش كده؟ طيب في ال .. في
+
+466
+00:33:08,480 --> 00:33:11,140
+ال .. في ال cortex ال interstitium ماهواش
+
+467
+00:33:11,140 --> 00:33:15,220
+concentrated مظبوط؟ طب okay فتحنا ال channels
+
+468
+00:33:15,220 --> 00:33:19,350
+الميه كيف هتعدل ال ايه؟عندها تشغل الميكانيزم ان
+
+469
+00:33:19,350 --> 00:33:22,790
+الانتردو كهرمون بس فتحت channels جالك ال water
+
+470
+00:33:22,790 --> 00:33:25,570
+يقبل permeability انت احتمل على انتردو كهرمون في
+
+471
+00:33:25,570 --> 00:33:28,890
+ال distal tubule و في ال collecting cortical
+
+472
+00:33:28,890 --> 00:33:32,930
+collecting يحتمل عميل على انتردو كهرمون و ال
+
+473
+00:33:32,930 --> 00:33:35,790
+collecting duct يحتمل على انتردو كهرمون في ال
+
+474
+00:33:35,790 --> 00:33:39,130
+collecting duct الانتردو كهرمون فتحت channels و
+
+475
+00:33:39,130 --> 00:33:43,610
+لجينا ايه اندفاع رهيب لإنترستيشن لإن انترستيشن في
+
+476
+00:33:43,610 --> 00:33:46,610
+الحالة يعني بيكون ايه اه في concentrated interest
+
+477
+00:33:47,630 --> 00:33:51,150
+بس الكورتيكس مافيش concentrated interstitial جداش
+
+478
+00:33:51,150 --> 00:33:56,950
+ال .. ال .. ال osmolality في الكورتيكس بيكون بيكون
+
+479
+00:33:56,950 --> 00:34:03,110
+as osmotic جداش يعني تلت مية حوالي تلت مية طب جداش
+
+480
+00:34:03,110 --> 00:34:05,490
+ال .. ال .. ال tubular filtrate osmolality في
+
+481
+00:34:05,490 --> 00:34:10,470
+الحالة هذه بيكون في
+
+482
+00:34:10,470 --> 00:34:15,570
+ال distal tubule في ليه ال distal tubule تمام في
+
+483
+00:34:15,570 --> 00:34:19,190
+..الـ Early Distal Tribule في الـ Thick Ascending
+
+484
+00:34:19,190 --> 00:34:22,410
+Limb نهايته الفلترات كم يكون فيه عند الـ
+
+485
+00:34:22,410 --> 00:34:27,250
+Osmolality تبعته لما سق مية إذن لازال في فرق كبير
+
+486
+00:34:27,250 --> 00:34:32,810
+في ال Osmolality بين الفلترات و ال cortex لأنه
+
+487
+00:34:32,810 --> 00:34:35,210
+احنا جونا في ال Thick Ascending Limb سحبنا ال
+
+488
+00:34:35,210 --> 00:34:40,670
+Solids وصلنا لديستالالـ early part برضه مستحيل
+
+489
+00:34:40,670 --> 00:34:44,750
+للماء للماء لكن احنا قاعدين مسحب solutes فتفلترات
+
+490
+00:34:44,750 --> 00:34:48,970
+جو معادي صار ايه؟ diluted في الحالة هذه اذا سمحت
+
+491
+00:34:48,970 --> 00:34:53,590
+للماء ال channel هنا تفتح اوتوماتيكالي هتقدر الميه
+
+492
+00:34:53,590 --> 00:34:56,790
+تطلع و تصل ال ال interstitium لان ال interstitium
+
+493
+00:34:56,790 --> 00:35:04,650
+هي 300 طبعا؟ اذا نقولنا احنا لو الفلترات هذا في
+
+494
+00:35:04,650 --> 00:35:09,890
+عندي concentrating mechanismsوالفيلتريات ده يؤثر
+
+495
+00:35:09,890 --> 00:35:13,490
+علي انترنت الحرمون ال maximum بتطلع من ال cortex
+
+496
+00:35:13,490 --> 00:35:18,390
+للمضالة 300 ال cortex ماعندوش قدر يعمل تأثير اكتر
+
+497
+00:35:18,390 --> 00:35:22,050
+من ايه يزود قسمه ل 300 لإن ال intersection تبعه
+
+498
+00:35:22,050 --> 00:35:28,410
+على 300 مش كده فلذلك هو بيقدر يتحول من 100 انه
+
+499
+00:35:28,410 --> 00:35:34,170
+يديني تلتين الميه يتروح فبتعالى بتجيل الميه لتلت
+
+500
+00:35:34,170 --> 00:35:38,280
+بيسبرج على 300 تمامإذا في الحالة هذه الـ Antidote
+
+501
+00:35:38,280 --> 00:35:40,860
+hormone ميكانيزم of action effective في ال cortex
+
+502
+00:35:40,860 --> 00:35:43,260
+لإن أنا بتكلم عن infiltrate مش .. مش .. مش
+
+503
+00:35:43,260 --> 00:35:46,420
+isosmotic بتكلم عن infiltrate إذا ال maximum
+
+504
+00:35:46,420 --> 00:35:51,220
+بيصلّي ال filtrate هذا بنزل للمضلة مش ممكن ينزل ..
+
+505
+00:35:51,220 --> 00:35:54,340
+يطلع أكتر من 300 ليش؟ لإن قدرة ال cortex هناك 300
+
+506
+00:35:54,340 --> 00:35:58,920
+ومعناها إن أنا بقدر أسلمه في حالات شديدة اللي
+
+507
+00:35:58,920 --> 00:36:02,460
+محتاج فيها ميّه كتير بقدر أسلمه بس لل
+
+508
+00:36:02,460 --> 00:36:07,700
+Interestation للمضلة Reductبقدر اسلمه فيلتريت او
+
+509
+00:36:07,700 --> 00:36:11,180
+tubular fluid تركيزه جداش تلاتمية من الاغزمه ال
+
+510
+00:36:11,180 --> 00:36:13,500
+maximum بعدين هنا عندنا بيجي ال high bar
+
+511
+00:36:13,500 --> 00:36:17,040
+concentration بيصير هان لإن المضالة بتبقى مش على
+
+512
+00:36:17,040 --> 00:36:21,040
+ال ازموتك بتبقى high bar ايه ازموتك بتقدر تاخد جد
+
+513
+00:36:21,040 --> 00:36:28,180
+ما بدها حسب ال maximum تبعها جداش لأ في المضالة ال
+
+514
+00:36:28,180 --> 00:36:31,640
+maximum تبع تركيزها اللي بتقدر تعمله لل ball يعني
+
+515
+00:36:31,640 --> 00:36:36,740
+انت راسيه جداشلأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ
+
+516
+00:36:36,740 --> 00:36:36,760
+لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ
+
+517
+00:36:36,760 --> 00:36:37,200
+لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ
+
+518
+00:36:37,200 --> 00:36:47,140
+لأ
+
+519
+00:36:47,140 --> 00:36:51,020
+لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ
+
+520
+00:36:51,020 --> 00:36:51,460
+لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ
+
+521
+00:36:51,460 --> 00:36:57,380
+لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ لأ
+
+522
+00:36:57,380 --> 00:37:03,020
+لأ لأ
+
+523
+00:37:03,250 --> 00:37:07,850
+الـ water channels فاتحة والـ interstitium جاهز كل
+
+524
+00:37:07,850 --> 00:37:11,910
+ما بنزل بشفط منه شوية فبيزيد ال concentration فال
+
+525
+00:37:11,910 --> 00:37:14,710
+tubular filtrate في الأخر ال drop اللي هتنزل في ال
+
+526
+00:37:14,710 --> 00:37:19,050
+pelvis of the kidney هتكون تركيزها زي تركيز الايه
+
+527
+00:37:19,050 --> 00:37:23,370
+ال interstitium واضح الكلام؟ واضح؟ مين اللي كان
+
+528
+00:37:23,370 --> 00:37:29,270
+أحسن؟ واضح؟ تمام؟ واضحين كله؟ تمام يلا طيب إذا
+
+529
+00:37:29,270 --> 00:37:34,870
+الميكانزم واحدة في ال proximalفي ال .. في ال
+
+530
+00:37:34,870 --> 00:37:38,290
+cortical و في ال ايه؟ ليش ال cortical اشتغلت فيه
+
+531
+00:37:38,290 --> 00:37:43,130
+بس افتح البواب؟ لأنه في عندي hypo osmotic tubular
+
+532
+00:37:43,130 --> 00:37:48,450
+fluid فإذا لو فتحناله المجال انه يطلع ال cortex
+
+533
+00:37:48,450 --> 00:37:53,090
+صار عندي انا في فرق منهم ايه؟ كبير طيب كيف
+
+534
+00:37:53,090 --> 00:37:55,670
+الميكانيزم هذي بتصير؟ قولتلكم ميكانيزم انه تفتح
+
+535
+00:37:55,670 --> 00:37:59,090
+الوضع ال channels ولا ما تفتحش بعدين ال osmolality
+
+536
+00:37:59,090 --> 00:38:02,080
+اللي في ال intercession هو اللي بيكمل المشواريعني
+
+537
+00:38:02,080 --> 00:38:07,380
+لدينا ما يسمى V2 ريسيبتورز موجودين من الـ late
+
+538
+00:38:07,380 --> 00:38:14,260
+distal لنهاية ال collecting duct V2 يعني هدول هم
+
+539
+00:38:14,260 --> 00:38:17,680
+اللي simulating ال water pools أو water channels
+
+540
+00:38:17,680 --> 00:38:25,630
+ال aqua pouringأكوا بورين V2 ريسبتور هذي الانتجار
+
+541
+00:38:25,630 --> 00:38:29,810
+الحرموني تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل
+
+542
+00:38:29,810 --> 00:38:30,750
+تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل
+
+543
+00:38:30,750 --> 00:38:30,790
+تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل
+
+544
+00:38:30,790 --> 00:38:31,530
+تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل
+
+545
+00:38:31,530 --> 00:38:33,530
+تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل
+
+546
+00:38:33,530 --> 00:38:36,030
+تعمل تعمل تعمل تعمل تعمل تعمل تعمل تعمل
+
+547
+00:38:43,470 --> 00:38:47,170
+اللي هم certain type of proteins موجودة في ال ..
+
+548
+00:38:47,170 --> 00:38:51,610
+في ال cytoplasm وممكن يكون إذا ال simulation بسيط
+
+549
+00:38:51,610 --> 00:38:55,010
+نستخدم ال aquaporin الموجود في ال cytoplasm يعني
+
+550
+00:38:55,010 --> 00:38:57,850
+تحت ال membrane تحت ال apical membrane موجود عندنا
+
+551
+00:38:57,850 --> 00:39:02,970
+vesiclesتحتوي على proteins خاصة إذا الانترنت هرمون
+
+552
+00:39:02,970 --> 00:39:06,430
+هذا عمل stimulation فال proteins بتروح بتتلتصق بال
+
+553
+00:39:06,430 --> 00:39:09,510
+إيه بال membrane تمام ثم بيصيبلها extra ..
+
+554
+00:39:09,510 --> 00:39:15,430
+extravasation أو exocytosis فبتطلع على ال membrane
+
+555
+00:39:15,430 --> 00:39:19,250
+border و بتعمل water channels إذا الانترنت هرمون
+
+556
+00:39:19,250 --> 00:39:22,570
+جال جزء منهم هينضب جال جزء منهم .. جال اللي على
+
+557
+00:39:22,570 --> 00:39:26,070
+الآخر هيروح و اختفو بيصير الميه كلها تمام بتطلع
+
+558
+00:39:26,070 --> 00:39:32,750
+براإذا هو بفتح channels أو بجللها أو بكترها تمام؟
+
+559
+00:39:32,750 --> 00:39:37,750
+وشافت هو هو بس أنا بزود فتحات التسريب أو بجللها
+
+560
+00:39:37,750 --> 00:39:41,730
+حسب ما أنا إيش بديه، تركيزة فعندي ال V2 ريسبتورز
+
+561
+00:39:41,730 --> 00:39:45,170
+increasing ال mechanism هذا ال cellular mechanism
+
+562
+00:39:45,170 --> 00:39:47,390
+بتقدر إلى إن simultaneous movement of
+
+563
+00:39:47,390 --> 00:39:50,430
+intracellular protein called aquaporin أكوه إيش
+
+564
+00:39:50,430 --> 00:39:55,050
+يعني أكوه؟ لذلك أكوه التوعن ميه هدول
+
+565
+00:39:59,580 --> 00:40:04,180
+Aquaporin 2 في عندي 3 و 4 ال aquaporin 2 هدول اللي
+
+566
+00:40:04,180 --> 00:40:07,360
+هم موجود على ال brush border ال apical border اللي
+
+567
+00:40:07,360 --> 00:40:13,260
+الأولى بتكون المون بتحكم فيهم ال aquaporin او aqua
+
+568
+00:40:13,260 --> 00:40:18,830
+3 و 4 موجودة على ال basolateralمعلومش علاقة بالـ A
+
+569
+00:40:18,830 --> 00:40:21,550
+بالـ Antidote hormone بس هم فاتحين ال channels
+
+570
+00:40:21,550 --> 00:40:25,450
+بحيث انه يساعد على ال A تدخل ال interstitium لكن
+
+571
+00:40:25,450 --> 00:40:27,590
+هو مش under control of the A of the antidote
+
+572
+00:40:27,590 --> 00:40:30,790
+hormone اللي under control of the antidote hormone
+
+573
+00:40:30,790 --> 00:40:34,230
+اللي هو على ال A ال apical membrane بيفتح بتطلع
+
+574
+00:40:34,230 --> 00:40:39,030
+الميه بيروحه الميه بتضالها ايه؟ لتحصي الدخول
+
+575
+00:40:39,030 --> 00:40:42,750
+الكلية من جديد إلى ال interstitium بتضالها to the
+
+576
+00:40:42,750 --> 00:40:43,030
+out
+
+577
+00:40:46,650 --> 00:40:51,530
+الموليكيولات تجمع و تفوز مع ممبرا للسلب من خلال
+
+578
+00:40:51,530 --> 00:40:57,610
+اكزوسيتوزيس لتصوير قطع الماء التي تسمح لتفوز الماء
+
+579
+00:40:57,610 --> 00:41:00,990
+بسرعة من خلال السلبيات هناك اخرين اكوابورين تلاتة
+
+580
+00:41:00,990 --> 00:41:03,970
+او اربعة مش موجودين و مش عندنا هنا مش موجودين على
+
+581
+00:41:03,970 --> 00:41:07,130
+ال بيزولاترال والاكرانيك انكريز بيعمل ليه اكثر
+
+582
+00:41:07,130 --> 00:41:13,370
+تجارب تجارب اكوابورين عشان التضالع العملية تصبح
+
+583
+00:41:13,370 --> 00:41:16,720
+أسرع و أكبرعندما يتخلص الجزء من الاندرويد الحرموني
+
+584
+00:41:16,720 --> 00:41:20,800
+عندما يتخلص الجزء من الاندرويد الحرموني عندما
+
+585
+00:41:20,800 --> 00:41:22,620
+يتخلص الجزء من الاندرويد الحرموني عندما يتخلص
+
+586
+00:41:22,620 --> 00:41:25,660
+الجزء من الاندرويد الحرموني عندما يتخلص الجزء من
+
+587
+00:41:25,660 --> 00:41:27,440
+الاندرويد الحرموني عندما يتخلص الجزء من الاندرويد
+
+588
+00:41:27,440 --> 00:41:27,620
+يتخلص الجزء من الاندرويد الحرموني عندما يتخلص
+
+589
+00:41:27,620 --> 00:41:29,060
+الجزء من الاندرويد الحرموني عندما يتخلص الجزء من
+
+590
+00:41:29,060 --> 00:41:32,880
+الانالـ Antidocrine هعود ندرسه تاني في الـ
+
+591
+00:41:32,880 --> 00:41:37,060
+Endocrine ونتكلم لو .. مش على مستوى الكل يعني
+
+592
+00:41:37,060 --> 00:41:40,880
+هنتكلم عنه هنتكلم عنه على مستوى ال .. ب Twitter
+
+593
+00:41:40,880 --> 00:41:44,440
+gland تمام؟ لإنه ممكن يزيد و ممكن يجلد و إيش أسباب
+
+594
+00:41:44,440 --> 00:41:49,940
+اللي بيخلي يزيد ك diseases مش ك physiological
+
+595
+00:41:49,940 --> 00:41:57,000
+controlling system أه؟ لأ التالت هذا أو الرابع
+
+596
+00:41:57,980 --> 00:42:00,940
+أتكلمنا عن الانتريد الكرمون التالت هنتكلم عن
+
+597
+00:42:00,940 --> 00:42:02,100
+الرابع الانتريد الكرمون التالت الالدوسترون
+
+598
+00:42:02,100 --> 00:42:05,840
+الهيوتينسين تو الانتريد الكرمون التالت الانتريد
+
+599
+00:42:05,840 --> 00:42:06,940
+الكرمون التالت الانتريد الكرمون التالت الانتريد
+
+600
+00:42:06,940 --> 00:42:08,180
+الكرمون التالت الانتريد الكرمون التالت الانتريد
+
+601
+00:42:08,180 --> 00:42:10,620
+الكرمون التالت الانتريد الكرمون التالت الانتريد
+
+602
+00:42:10,620 --> 00:42:10,960
+الكرمون التالت الانتريد الكرمون التالت الانتريد
+
+603
+00:42:10,960 --> 00:42:14,580
+الكرمون التالت الانتريد الكرمون التالت الانتريد
+
+604
+00:42:14,580 --> 00:42:17,600
+الكرمون التالت الانتريد الكرمون التالت الانتريد
+
+605
+00:42:17,600 --> 00:42:25,520
+الكرمون التالت الان
+
+606
+00:42:26,740 --> 00:42:31,760
+أقل ال volume البصل بيقل لكن بيشغل الكيليا بطريقة
+
+607
+00:42:31,760 --> 00:42:35,980
+عكسية لإن هو لما يزيد ال volume بده يقلله طيب ال
+
+608
+00:42:35,980 --> 00:42:43,180
+mechanism of action تبعه وين وين شغله هو increase
+
+609
+00:42:43,180 --> 00:42:46,680
+levels of this peptide in turn inhibit the
+
+610
+00:42:46,680 --> 00:42:49,340
+reabsorption of sodium and water by the renal
+
+611
+00:42:49,340 --> 00:42:52,860
+tubules especially in the collecting duct لذا
+
+612
+00:42:52,860 --> 00:42:56,550
+بيشغل على الجزء الأخرتمام؟ mainly على الجزر أخر
+
+613
+00:42:56,550 --> 00:42:59,410
+لكن هو على ال tubule كله بيجلل ال reabsorption
+
+614
+00:42:59,410 --> 00:43:02,290
+اللي هو ذاتي و بيزود ال reabsorption اللي هو إيه
+
+615
+00:43:02,290 --> 00:43:05,970
+جالب بس ال main action تبقى على مين؟ ال collecting
+
+616
+00:43:05,970 --> 00:43:11,790
+duct Parathyroid هرمون، هذا إيه علاقة بالمين؟ بال
+
+617
+00:43:11,790 --> 00:43:18,130
+.. بال calcium و الفوسفات و قليل من إيه؟ ال
+
+618
+00:43:18,130 --> 00:43:22,150
+magnesium ال calcium بيشتغل في ال calcium ع ال
+
+619
+00:43:22,150 --> 00:43:26,080
+distal tubuleبزود ال reabsorption في كالسوم وين؟
+
+620
+00:43:26,080 --> 00:43:29,260
+في ال distal tubule لما يزيد برهيرويد البرهيرويد
+
+621
+00:43:29,260 --> 00:43:32,480
+هي هرمون شكلته الرئيسيه اللي بيحفظوها شكلته
+
+622
+00:43:32,480 --> 00:43:36,520
+الرئيسيه المحافظه على مستوى الكالسو في الدم ماليش
+
+623
+00:43:36,520 --> 00:43:40,600
+بيفهمش اللي هي و هو قوي تمام؟ هو هو ايه؟ هرمون قوي
+
+624
+00:43:40,600 --> 00:43:44,460
+ان جلل كالسو في الدم بن جنب بده يعليه من أول جهزة
+
+625
+00:43:44,460 --> 00:43:47,320
+كما كان فبياخد من العظم وبياخد من ال intestine
+
+626
+00:43:47,320 --> 00:43:51,640
+وبياخد من هنا ممنعه بده يعليهفهو هرمون قوي، شغلته
+
+627
+00:43:51,640 --> 00:43:55,340
+يحافظ على مين؟ مش شغلته يبني عظيمة، لأ لأ مالوش
+
+628
+00:43:55,340 --> 00:43:59,140
+علاقة بينها العظيم هو، هو بيكسر العظيم، شغلته
+
+629
+00:43:59,140 --> 00:44:02,820
+يحافظ على إيه؟ الكالسيوم كدا، لكن إذا دوتوله
+
+630
+00:44:02,820 --> 00:44:05,820
+كالسيوم كافي، بهدا، بهدا و بسكت، و الكالسيوم يزيد،
+
+631
+00:44:05,820 --> 00:44:09,400
+انا بروح للعظيمةلكن إيه النقص يا أقولكوا؟ النقص
+
+632
+00:44:09,400 --> 00:44:13,300
+براتيرويد بنهش في العضم، بيكسّه، تمام؟ اللي يسحب
+
+633
+00:44:13,300 --> 00:44:16,520
+ال .. اللي إيه؟ ال calcium المطلوب بيحس بلازمة
+
+634
+00:44:16,520 --> 00:44:20,400
+level of calcium ده اللي إيه؟ طبيعية، ليش؟ لإن ال
+
+635
+00:44:20,400 --> 00:44:24,460
+calcium level زي ال potassium، خطير لإيه؟ ل .. ل
+
+636
+00:44:24,460 --> 00:44:27,520
+.. ل .. ل .. ل .. ل .. ل .. لل cardiac بالذات،
+
+637
+00:44:27,520 --> 00:44:30,220
+okay لل muscles كلها، نرفع ال muscles كله، لكن ال
+
+638
+00:44:30,220 --> 00:44:34,670
+cardiac برضه toxicity لل heart بتزيدإذا نبدو حافظ
+
+639
+00:44:34,670 --> 00:44:38,830
+على level هذا لإنه هذا مش بس احنا محتاجينه الدم ال
+
+640
+00:44:38,830 --> 00:44:42,430
+plasma لأ لإن في ناس أخرين متعقدين معاهم إنه نضبط
+
+641
+00:44:42,430 --> 00:44:46,410
+الأمور و إلا إيه تختل البلد كلها ضرب المفاعل شسمه
+
+642
+00:44:46,410 --> 00:44:49,930
+هيخرب الدنيا كلها مش بس هيخرب الكهربا هيموت الناس
+
+643
+00:44:49,930 --> 00:44:52,710
+الإشعال طلع مش إنه فيش كهربا طبعا إن شاء الله
+
+644
+00:44:52,710 --> 00:44:56,070
+مافيه كهربا من نام على الشمعةلكن لأ الآن الإشعاع
+
+645
+00:44:56,070 --> 00:44:59,510
+اللي طلع مال الدنيا هذا مش خطر اليابان لحالها، خطر
+
+646
+00:44:59,510 --> 00:45:03,710
+على كل مكان كالسيوم ازاد .. الجسم لا يسمح بالإيه
+
+647
+00:45:03,710 --> 00:45:07,730
+بإنه إشي يطلع out of control عطول فيه ميكانيزمات
+
+648
+00:45:07,730 --> 00:45:10,610
+دائما الإشي .. مش ميكانيزم واحد، بيوجد كذا
+
+649
+00:45:10,610 --> 00:45:13,230
+ميكانيزم زي ما أنتوا شايفين ال regulation كام تم،
+
+650
+00:45:13,230 --> 00:45:19,460
+مش كده؟ إشي بيضعب يأكد إشي، اه؟ sympatheticبيطلع
+
+651
+00:45:19,460 --> 00:45:21,200
+ال renin و ال renin بيطلع ال angiotensin 2 و ال
+
+652
+00:45:21,200 --> 00:45:24,700
+angiotensin 2 بيطلع ال .. ال .. ال aldosterone و
+
+653
+00:45:24,700 --> 00:45:27,620
+ال .. ال .. و ال aldosterone بيطلع ال antihormone
+
+654
+00:45:27,620 --> 00:45:33,200
+system كامل لو واحد منه فشل الباقي بيكمل ف
+
+655
+00:45:33,200 --> 00:45:36,540
+multiple control systems ازاي نتكلم ال control من
+
+656
+00:45:36,540 --> 00:45:39,340
+ال .. ال autogenic one اللي هو ال .. ال
+
+657
+00:45:39,340 --> 00:45:43,780
+glomerotubular balance بعدين ال hormones بعدين ال
+
+658
+00:45:43,780 --> 00:45:47,150
+.. فمتداخلةو هاد ال physiology ال homeostasis
+
+659
+00:45:47,150 --> 00:45:50,910
+مانظبطش .. احنا مش عايشين سباحة للا لو ان .. يعني
+
+660
+00:45:50,910 --> 00:45:55,310
+عشان تشوف كدهش انه الحياة .. ال .. ال aldosterone
+
+661
+00:45:55,310 --> 00:45:57,810
+و ال .. ال .. و ال aldosterone بتطلع علامة ال
+
+662
+00:45:57,810 --> 00:46:04,410
+hormone لو واحد منه فشل ال باقي بيكمل ف multiple
+
+663
+00:46:04,410 --> 00:46:08,110
+control systems لزم تتكلم ال control قلنا ال .. ال
+
+664
+00:46:08,110 --> 00:46:10,790
+autogenic one اللي هو ال .. ال glomerotubular
+
+665
+00:46:10,790 --> 00:46:16,770
+balance بعدين ال hormones بعدين الفمتداخلك و هذا
+
+666
+00:46:16,770 --> 00:46:19,290
+ال physiology ال homeostasis مانظبطش احنا مش
+
+667
+00:46:19,290 --> 00:46:23,090
+عايشين سباحة لا لأ لو ان يعني عشان تشوفوا كدهش انه
+
+668
+00:46:23,090 --> 00:46:26,610
+الحياة ال aldosterone و ال .. و ال aldosterone
+
+669
+00:46:26,610 --> 00:46:31,370
+بطلّي علامة ال hormone ا system كامل لو واحد منه
+
+670
+00:46:31,370 --> 00:46:35,290
+فشل الباقي بيكمل ف multiple control systems اذا
+
+671
+00:46:35,290 --> 00:46:38,570
+انت بتتكلم ال control قلنا ال autogenic one اللي
+
+672
+00:46:38,570 --> 00:46:42,910
+هو ال glomerotubular balance بعدين ال hormones
+
+673
+00:46:42,910 --> 00:46:46,870
+بعدين الفمتداخلك و هذا ال physiology ال
+
+674
+00:46:46,870 --> 00:46:50,850
+homeostasis مانظبطش احنا مش عايشين سباحة لأ لإن
+
+675
+00:46:50,850 --> 00:46:54,010
+يعني عشان تشوفوا كدهش انه الحياة هي .. ال
+
+676
+00:46:54,010 --> 00:46:57,310
+aldosterone و ال .. و ال aldosterone بطلّي علاج لل
+
+677
+00:46:57,310 --> 00:47:02,750
+hormone system كامل لو واحد منه فشل ال باقي بيكمل
+
+678
+00:47:02,750 --> 00:47:06,230
+ف multiple control systems اذا انا بتتكلم ال
+
+679
+00:47:06,230 --> 00:47:09,670
+control قلنا ال autogenic one اللي هو ال .. ال
+
+680
+00:47:09,670 --> 00:47:14,090
+glomerotubular balance بعدين ال hormones بعدين ال
+
+681
+00:47:14,090 --> 00:47:17,480
+..فمتداخلك و هاد ال physiology ال homeostasis
+
+682
+00:47:17,480 --> 00:47:21,640
+مانظبطش احنا مش عايشين سباحة لأ لأ لو يعني عشان
+
+683
+00:47:21,640 --> 00:47:23,060
+تشوفوا كدهش انه الحياة
+
+684
+00:47:23,060 --> 00:47:41,680
+هالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهال
+
+685
+00:47:44,410 --> 00:47:47,130
+و هذا ال physiology ال homeostasis مانظبطش .. احنا
+
+686
+00:47:47,130 --> 00:47:50,450
+مش عايشين سباحة لا لأ لو ان .. يعني عشان تشوفوا
+
+687
+00:47:50,450 --> 00:47:53,490
+كدهش انه الحياة .. و ال .. و ال .. و ال .. و ال ..
+
+688
+00:47:53,490 --> 00:47:53,950
+و ال .. و ال .. و ال .. و ال .. و ال .. و ال .. و
+
+689
+00:47:53,950 --> 00:47:54,290
+ال .. و ال .. و ال .. و ال .. و ال .. و ال .. و ال
+
+690
+00:47:54,290 --> 00:47:54,570
+ال .. و ال .. و ال .. و ال .. و ال .. و ال .. و ال
+
+691
+00:47:54,570 --> 00:47:55,850
+.. و ال .. و ال .. و ال .. و ال .. و ال .. و ال ..
+
+692
+00:47:55,850 --> 00:47:56,410
+و ال .. و ال .. و ال .. و ال .. و ال .. و ال .. و
+
+693
+00:47:56,410 --> 00:47:59,230
+ال .. و ال .. و ال .. و ال .. و ال .. و ال .. و ال
+
+694
+00:47:59,230 --> 00:48:08,810
+.. و ال .. و ال .. و
+
+695
+00:48:13,130 --> 00:48:15,830
+و هذا ال physiology ال homeostasis مانزبطش .. احنا
+
+696
+00:48:15,830 --> 00:48:19,170
+مش عايشين سباق لأ لأ لو ان .. يعني عشان تشوفوا
+
+697
+00:48:19,170 --> 00:48:24,370
+كدهش انه الحياة .. system كامل لو واحد منه فشل
+
+698
+00:48:24,370 --> 00:48:28,070
+الباقي بيكمل ف multiple control systems اذا انا
+
+699
+00:48:28,070 --> 00:48:32,250
+بتتكلم ال control قلنا ال autogenic one اللي هو ال
+
+700
+00:48:32,250 --> 00:48:36,750
+glomerotubular balance بعدين ال hormones بعدين ال
+
+701
+00:48:36,750 --> 00:48:40,090
+.. فمتداخلة و هذا ال physiology ال homeostasis
+
+702
+00:48:40,090 --> 00:48:43,920
+مانزبطش .. احنا مش عايشين سباق لأ لألو ان .. يعني
+
+703
+00:48:43,920 --> 00:48:47,100
+عشان تشوف و جدش انه على الحياة هاجم ال hormones
+
+704
+00:48:47,100 --> 00:48:51,620
+فمتداخلك و هذا ال physiological ال homeostasis
+
+705
+00:48:51,620 --> 00:48:55,120
+مانظبطش .. احنا مش عايشين سباق له لا .. لو ان ..
+
+706
+00:48:55,120 --> 00:48:57,420
+يعني عشان تشوف و جدش انه على الحياة هاجم ال
+
+707
+00:48:57,420 --> 00:48:57,660
+hormones
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/KuCzOB_w3GQ_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/KuCzOB_w3GQ_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..049ad7fd9bd1a9cebe27cb3e3f882ab6508bf15e
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/KuCzOB_w3GQ_raw.json
@@ -0,0 +1 @@
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regulation بس برضه بيزيد شوية ال load اذا هنا بعد ما صار مسكون الموضوعين موضوع ال auto regulation وموضوع ال glomerular balance طب خليني اتكلم عن ال pressure ال pressure زي ما قلنا لو صار variations كبيرة ال auto regulation بيقدر يعني إلى حد ما يعدمها", "tokens": [346, 2582, 34105, 3714, 3215, 10943, 9122, 3215, 3224, 1975, 5016, 8315, 10874, 1829, 3555, 8315, 8608, 48923, 2423, 3321, 45164, 1975, 2655, 4117, 19528, 18871, 2423, 8399, 15062, 4032, 4587, 1211, 8315, 5296, 4117, 14407, 1392, 4724, 1829, 9381, 13546, 8399, 15062, 4724, 3794, 4724, 43042, 3224, 4724, 1829, 11622, 25708, 13412, 2407, 10632, 2423, 3677, 1975, 15730, 34105, 39182, 19446, 20328, 9640, 47524, 30544, 9673, 2407, 11242, 45367, 9957, 3714, 2407, 11242, 45367, 2423, 8399, 15062, 4032, 2304, 2407, 11242, 45367, 2423, 1563, 14301, 1040, 4772, 23032, 3555, 16490, 1211, 9957, 1829, 1975, 2655, 4117, 19528, 18871, 2423, 3321, 2423, 3321, 30767, 1829, 19446, 12174, 1211, 8315, 45164, 20328, 9640, 17840, 9122, 3555, 48923, 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" اما", "probability": 0.5692138671875}, {"start": 358.23, "end": 358.89, "word": " بيزيد", "probability": 0.84185791015625}, {"start": 358.89, "end": 359.55, "word": " ال", "probability": 0.98388671875}, {"start": 359.55, "end": 360.01, "word": " hydrostatic", "probability": 0.8250325520833334}, {"start": 360.01, "end": 360.31, "word": " pressure", "probability": 0.9521484375}, {"start": 360.31, "end": 360.83, "word": " بيجلل", "probability": 0.8826171875}, {"start": 360.83, "end": 361.21, "word": " ال", "probability": 0.378662109375}, {"start": 361.21, "end": 362.81, "word": " reabsorption", "probability": 0.8582763671875}, {"start": 362.81, "end": 363.07, "word": " لإن", "probability": 0.8759765625}, {"start": 363.07, "end": 363.25, "word": " في", "probability": 0.62060546875}, {"start": 363.25, "end": 363.35, "word": " ال", "probability": 0.96044921875}, {"start": 363.35, "end": 364.63, "word": " reabsorption", "probability": 0.86334228515625}, {"start": 364.63, "end": 365.09, "word": " هلاجي", "probability": 0.6748046875}, {"start": 365.09, "end": 365.41, "word": " factor", "probability": 0.6708984375}, {"start": 365.41, "end": 365.55, "word": " ال", "probability": 0.75634765625}, {"start": 365.55, "end": 365.99, "word": " hydrostatic", "probability": 0.9119466145833334}, {"start": 365.99, "end": 366.37, "word": " pressure", "probability": 0.96435546875}, {"start": 366.37, "end": 366.97, "word": " صار", "probability": 0.87548828125}, {"start": 366.97, "end": 367.73, "word": " زيادة", "probability": 0.883056640625}], "temperature": 1.0}, {"id": 16, "seek": 38968, "start": 368.14, "end": 389.68, "text": "الاتنين عندى انا لما ال pressure .. لما ال pressure يعلى و ال filtration ال flow rate بيزيد ده اتطلع انا بلاجى انه كمية ال GFR لل flow rate جلت كمان بمعنى انه ال uncritical pressure برضه ايش مش هيعلى كتير", "tokens": [6027, 9307, 1863, 9957, 43242, 7578, 1975, 8315, 5296, 15042, 2423, 3321, 4386, 5296, 15042, 2423, 3321, 7251, 30241, 7578, 4032, 2423, 43623, 2423, 3095, 3314, 4724, 1829, 11622, 25708, 11778, 3224, 1975, 2655, 9566, 1211, 3615, 1975, 8315, 4724, 15040, 7435, 7578, 16472, 3224, 9122, 2304, 10632, 2423, 460, 34658, 24976, 3095, 3314, 10874, 1211, 2655, 9122, 2304, 7649, 4724, 2304, 3615, 1863, 7578, 16472, 3224, 2423, 6219, 3210, 804, 3321, 4724, 43042, 3224, 1975, 1829, 8592, 37893, 39896, 30241, 7578, 9122, 2655, 13546], "avg_logprob": -0.22819766818090928, "compression_ratio": 1.6203208556149733, "no_speech_prob": 0.0, "words": [{"start": 368.14, "end": 368.8, "word": "الاتنين", "probability": 0.756591796875}, {"start": 368.8, "end": 369.58, "word": " عندى", "probability": 0.824462890625}, {"start": 369.58, "end": 369.76, "word": " انا", "probability": 0.889404296875}, {"start": 369.76, "end": 370.1, "word": " لما", "probability": 0.9384765625}, {"start": 370.1, "end": 370.42, "word": " ال", "probability": 0.97607421875}, {"start": 370.42, "end": 370.74, "word": " pressure", "probability": 0.8427734375}, {"start": 370.74, "end": 370.84, "word": " ..", "probability": 0.40478515625}, {"start": 370.84, "end": 371.14, "word": " لما", "probability": 0.973876953125}, {"start": 371.14, "end": 371.32, "word": " ال", "probability": 0.994140625}, {"start": 371.32, "end": 371.58, "word": " pressure", "probability": 0.98291015625}, {"start": 371.58, "end": 372.08, "word": " يعلى", "probability": 0.6778971354166666}, {"start": 372.08, "end": 373.22, "word": " و", "probability": 0.91552734375}, {"start": 373.22, "end": 373.9, "word": " ال", "probability": 0.89208984375}, {"start": 373.9, "end": 374.76, "word": " filtration", "probability": 0.95703125}, {"start": 374.76, "end": 376.56, "word": " ال", "probability": 0.385009765625}, {"start": 376.56, "end": 376.88, "word": " flow", "probability": 0.82666015625}, {"start": 376.88, "end": 377.06, "word": " rate", "probability": 0.96875}, {"start": 377.06, "end": 377.7, "word": " بيزيد", "probability": 0.85833740234375}, {"start": 377.7, "end": 378.42, "word": " ده", "probability": 0.69775390625}, {"start": 378.42, "end": 378.82, "word": " اتطلع", "probability": 0.77255859375}, {"start": 378.82, "end": 379.0, "word": " انا", "probability": 0.830078125}, {"start": 379.0, "end": 379.5, "word": " بلاجى", "probability": 0.74951171875}, {"start": 379.5, "end": 379.9, "word": " انه", "probability": 0.906005859375}, {"start": 379.9, "end": 380.62, "word": " كمية", "probability": 0.9957682291666666}, {"start": 380.62, "end": 380.82, "word": " ال", "probability": 0.8955078125}, {"start": 380.82, "end": 381.44, "word": " GFR", "probability": 0.81298828125}, {"start": 381.44, "end": 381.78, "word": " لل", "probability": 0.341552734375}, {"start": 381.78, "end": 382.32, "word": " flow", "probability": 0.9306640625}, {"start": 382.32, "end": 382.6, "word": " rate", "probability": 0.96533203125}, {"start": 382.6, "end": 384.06, "word": " جلت", "probability": 0.9318033854166666}, {"start": 384.06, "end": 385.42, "word": " كمان", "probability": 0.7320149739583334}, {"start": 385.42, "end": 386.18, "word": " بمعنى", "probability": 0.93857421875}, {"start": 386.18, "end": 386.44, "word": " انه", "probability": 0.79345703125}, {"start": 386.44, "end": 386.56, "word": " ال", "probability": 0.80712890625}, {"start": 386.56, "end": 386.92, "word": " uncritical", "probability": 0.4726155598958333}, {"start": 386.92, "end": 387.24, "word": " pressure", "probability": 0.96826171875}, {"start": 387.24, "end": 387.6, "word": " برضه", "probability": 0.9889322916666666}, {"start": 387.6, "end": 387.92, "word": " ايش", "probability": 0.7088216145833334}, {"start": 387.92, "end": 388.92, "word": " مش", "probability": 0.91064453125}, {"start": 388.92, "end": 389.32, "word": " هيعلى", "probability": 0.91796875}, {"start": 389.32, "end": 389.68, "word": " كتير", "probability": 0.98291015625}], "temperature": 1.0}, {"id": 17, "seek": 41479, "start": 390.15, "end": 414.79, "text": "هيضل ايه؟ واطعى، اذا ان كنت برشهر واطعى وحبسك برشهر عالى، اذا عملت ال reabsorption نفسها كلها ايه؟ هتقطع، اذا ال pressure بيعمل لها اللي هو بيخلي ال filter ال percentage of filtered load of the sodium and water that is reabsorbed بيخليها ايه؟ decreased، اذا decreased is the percentage of the filtered load that is reabsorbed", "tokens": [3224, 1829, 11242, 1211, 1975, 1829, 3224, 22807, 4032, 41193, 3615, 7578, 12399, 1975, 15730, 16472, 9122, 29399, 4724, 2288, 8592, 3224, 2288, 4032, 41193, 3615, 7578, 4032, 5016, 3555, 3794, 4117, 4724, 2288, 8592, 3224, 2288, 6225, 6027, 7578, 12399, 1975, 15730, 6225, 42213, 2655, 2423, 319, 17243, 284, 1695, 8717, 36178, 11296, 28242, 11296, 1975, 1829, 3224, 22807, 8032, 2655, 4587, 9566, 3615, 12399, 1975, 15730, 2423, 3321, 4724, 1829, 25957, 1211, 5296, 11296, 13672, 1829, 31439, 4724, 1829, 9778, 20292, 2423, 6608, 2423, 9668, 295, 37111, 3677, 295, 264, 20265, 293, 1281, 300, 307, 319, 17243, 284, 2883, 4724, 1829, 9778, 20292, 11296, 1975, 1829, 3224, 22807, 24436, 12399, 1975, 15730, 24436, 307, 264, 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{"start": 394.07, "end": 394.83, "word": " عالى،", "probability": 0.7880859375}, {"start": 394.83, "end": 394.99, "word": " اذا", "probability": 0.83740234375}, {"start": 394.99, "end": 395.27, "word": " عملت", "probability": 0.8232421875}, {"start": 395.27, "end": 395.35, "word": " ال", "probability": 0.93017578125}, {"start": 395.35, "end": 395.87, "word": " reabsorption", "probability": 0.74005126953125}, {"start": 395.87, "end": 396.23, "word": " نفسها", "probability": 0.7939453125}, {"start": 396.23, "end": 396.49, "word": " كلها", "probability": 0.98193359375}, {"start": 396.49, "end": 397.07, "word": " ايه؟", "probability": 0.93701171875}, {"start": 397.07, "end": 398.03, "word": " هتقطع،", "probability": 0.6531982421875}, {"start": 398.03, "end": 398.21, "word": " اذا", "probability": 0.9423828125}, {"start": 398.21, "end": 398.33, "word": " ال", "probability": 0.95703125}, {"start": 398.33, "end": 398.65, "word": " pressure", "probability": 0.328857421875}, {"start": 398.65, 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"word": " of", "probability": 0.904296875}, {"start": 405.97, "end": 406.15, "word": " the", "probability": 0.732421875}, {"start": 406.15, "end": 406.43, "word": " sodium", "probability": 0.79638671875}, {"start": 406.43, "end": 406.67, "word": " and", "probability": 0.88818359375}, {"start": 406.67, "end": 407.09, "word": " water", "probability": 0.90771484375}, {"start": 407.09, "end": 407.63, "word": " that", "probability": 0.82421875}, {"start": 407.63, "end": 407.83, "word": " is", "probability": 0.95654296875}, {"start": 407.83, "end": 408.93, "word": " reabsorbed", "probability": 0.9415283203125}, {"start": 408.93, "end": 409.51, "word": " بيخليها", "probability": 0.91611328125}, {"start": 409.51, "end": 409.79, "word": " ايه؟", "probability": 0.70367431640625}, {"start": 409.79, "end": 411.09, "word": " decreased،", "probability": 0.6455078125}, {"start": 411.09, "end": 411.39, "word": " اذا", "probability": 0.71826171875}, {"start": 411.39, "end": 411.89, "word": " decreased", "probability": 0.1685791015625}, {"start": 411.89, "end": 412.09, "word": " is", "probability": 0.336181640625}, {"start": 412.09, "end": 412.23, "word": " the", "probability": 0.90087890625}, {"start": 412.23, "end": 412.87, "word": " percentage", "probability": 0.86328125}, {"start": 412.87, "end": 413.05, "word": " of", "probability": 0.9755859375}, {"start": 413.05, "end": 413.19, "word": " the", "probability": 0.62451171875}, {"start": 413.19, "end": 413.51, "word": " filtered", "probability": 0.64453125}, {"start": 413.51, "end": 413.79, "word": " load", "probability": 0.92578125}, {"start": 413.79, "end": 414.01, "word": " that", "probability": 0.93798828125}, {"start": 414.01, "end": 414.19, "word": " is", "probability": 0.955078125}, {"start": 414.19, "end": 414.79, "word": " reabsorbed", "probability": 0.963134765625}], "temperature": 1.0}, {"id": 18, "seek": 43559, "start": 415.27, "end": 435.59, "text": "بمعنى ان ال process بتاعة ال reabsorption تتمثل فى أنكوترك براشر و في الهيدروسالكبراشر هتقدى الى انه تلقالب بطريقة تمنع ال more reabsorption اذا بغضب بزيد ال GFR بنلاقي slight increase بزيد", "tokens": [3555, 2304, 3615, 1863, 7578, 16472, 2423, 1399, 39894, 995, 27884, 2423, 319, 17243, 284, 1695, 6055, 39237, 12984, 1211, 6156, 7578, 14739, 4117, 35473, 2288, 4117, 4724, 2288, 33599, 2288, 4032, 8978, 2423, 3224, 25708, 2288, 41779, 6027, 4117, 26890, 33599, 2288, 8032, 2655, 28543, 7578, 2423, 7578, 16472, 3224, 6055, 1211, 4587, 6027, 3555, 4724, 9566, 16572, 28671, 6055, 27842, 3615, 2423, 544, 319, 17243, 284, 1695, 1975, 15730, 4724, 17082, 11242, 3555, 4724, 11622, 25708, 2423, 460, 34658, 44945, 15040, 38436, 4036, 3488, 4724, 11622, 25708], "avg_logprob": -0.3986111044883728, "compression_ratio": 1.5364583333333333, "no_speech_prob": 0.0, "words": [{"start": 415.27, "end": 415.85, "word": "بمعنى", "probability": 0.851953125}, {"start": 415.85, "end": 416.17, "word": " ان", "probability": 0.57763671875}, {"start": 416.17, "end": 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"word": " هتقدى", "probability": 0.53155517578125}, {"start": 423.67, "end": 423.87, "word": " الى", "probability": 0.6846923828125}, {"start": 423.87, "end": 424.31, "word": " انه", "probability": 0.7587890625}, {"start": 424.31, "end": 424.97, "word": " تلقالب", "probability": 0.73173828125}, {"start": 424.97, "end": 425.39, "word": " بطريقة", "probability": 0.96923828125}, {"start": 425.39, "end": 425.93, "word": " تمنع", "probability": 0.86279296875}, {"start": 425.93, "end": 426.57, "word": " ال", "probability": 0.8173828125}, {"start": 426.57, "end": 426.93, "word": " more", "probability": 0.58984375}, {"start": 426.93, "end": 427.69, "word": " reabsorption", "probability": 0.946044921875}, {"start": 427.69, "end": 428.47, "word": " اذا", "probability": 0.558349609375}, {"start": 428.47, "end": 429.65, "word": " بغضب", "probability": 0.5723876953125}, {"start": 429.65, "end": 430.09, "word": " بزيد", "probability": 0.589111328125}, {"start": 430.09, "end": 430.21, "word": " ال", 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new file mode 100644
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@@ -0,0 +1 @@
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353253, "start": 3520.73, "end": 3532.53, "text": "لس blood pressure و can a construct when we have a more blood pressure a phenomenon هنا ايش بيقولها ايه another mechanism", "tokens": [1211, 3794, 3390, 3321, 4032, 393, 257, 7690, 562, 321, 362, 257, 544, 3390, 3321, 257, 14029, 34105, 1975, 1829, 8592, 4724, 1829, 39648, 11296, 1975, 1829, 3224, 1071, 7513], "avg_logprob": -0.4803427380900229, "compression_ratio": 1.2280701754385965, "no_speech_prob": 0.0, "words": [{"start": 3520.73, "end": 3521.29, "word": "لس", "probability": 0.2636871337890625}, {"start": 3521.29, "end": 3521.47, "word": " blood", "probability": 0.1722412109375}, {"start": 3521.47, "end": 3521.89, "word": " pressure", "probability": 0.94482421875}, {"start": 3521.89, "end": 3522.31, "word": " و", "probability": 0.69189453125}, {"start": 3522.31, "end": 3522.57, "word": " can", "probability": 0.376708984375}, {"start": 3522.57, "end": 3523.03, "word": " a", "probability": 0.37255859375}, {"start": 3523.03, "end": 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0.93896484375}, {"start": 3727.67, "end": 3727.95, "word": " عندي", "probability": 0.945556640625}, {"start": 3727.95, "end": 3728.23, "word": " more", "probability": 0.931640625}, {"start": 3728.23, "end": 3729.25, "word": " ايه؟", "probability": 0.73583984375}, {"start": 3729.25, "end": 3729.59, "word": " more", "probability": 0.85009765625}, {"start": 3729.59, "end": 3730.63, "word": " GFR", "probability": 0.9296875}], "temperature": 1.0}, {"id": 151, "seek": 376033, "start": 3731.31, "end": 3760.33, "text": "الـ proximal معناه more reabsorption لمن؟ للwater لأن الاتنين بيمشوا بنفس ال barrel to each other فلما يجل الصوديوم لأنه زاد ال reabsorption تبعه بسبب انه زاد عندي ال amino acids او ال glucose فبيقدر إلى ان ال delivery بيجل بيصير عندي more response narrowing لل ال efferent بزيد ال GFR تمام؟ و بيصير عندي more ايه؟ more GFR", "tokens": [6027, 39184, 21932, 304, 20449, 8315, 3224, 544, 319, 17243, 284, 1695, 5296, 27842, 22807, 24976, 8002, 5296, 33456, 2423, 9307, 1863, 9957, 4724, 1829, 2304, 8592, 14407, 44945, 36178, 2423, 13257, 281, 1184, 661, 6156, 1211, 15042, 7251, 7435, 1211, 31767, 2407, 16254, 20498, 5296, 33456, 3224, 30767, 18513, 2423, 319, 17243, 284, 1695, 6055, 3555, 3615, 3224, 4724, 35457, 3555, 16472, 3224, 30767, 18513, 18871, 16254, 2423, 24674, 21667, 1975, 2407, 2423, 23997, 6156, 21292, 4587, 3215, 2288, 30731, 16472, 2423, 8982, 4724, 1829, 7435, 1211, 4724, 1829, 9381, 13546, 18871, 16254, 544, 4134, 9432, 278, 24976, 2423, 1244, 260, 317, 4724, 11622, 25708, 2423, 460, 34658, 46811, 10943, 22807, 4032, 4724, 1829, 9381, 13546, 18871, 16254, 544, 1975, 1829, 3224, 22807, 544, 460, 34658], "avg_logprob": -0.2856445428915322, "compression_ratio": 1.6559139784946237, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 3731.31, "end": 3731.57, "word": "الـ", "probability": 0.23736572265625}, {"start": 3731.57, "end": 3732.23, "word": " proximal", "probability": 0.79345703125}, {"start": 3732.23, "end": 3732.79, "word": " معناه", "probability": 0.796875}, {"start": 3732.79, "end": 3732.93, "word": " more", "probability": 0.564453125}, {"start": 3732.93, "end": 3733.45, "word": " reabsorption", "probability": 0.8502197265625}, {"start": 3733.45, "end": 3734.21, "word": " لمن؟", "probability": 0.5621744791666666}, {"start": 3734.21, "end": 3734.77, "word": " للwater", "probability": 0.5614013671875}, {"start": 3734.77, "end": 3735.27, "word": " لأن", "probability": 0.721923828125}, {"start": 3735.27, "end": 3735.57, "word": " الاتنين", "probability": 0.68170166015625}, {"start": 3735.57, "end": 3735.91, "word": " بيمشوا", "probability": 0.771337890625}, {"start": 3735.91, "end": 3736.17, "word": " بنفس", "probability": 0.966552734375}, {"start": 3736.17, "end": 3736.29, "word": " ال", "probability": 0.84912109375}, {"start": 3736.29, "end": 3736.59, "word": " barrel", "probability": 0.63916015625}, {"start": 3736.59, "end": 3736.87, "word": " to", "probability": 0.3193359375}, {"start": 3736.87, "end": 3737.01, "word": " each", "probability": 0.9755859375}, {"start": 3737.01, "end": 3737.23, "word": " other", "probability": 0.77001953125}, {"start": 3737.23, "end": 3737.95, "word": " فلما", "probability": 0.7709147135416666}, {"start": 3737.95, "end": 3738.25, "word": " يجل", "probability": 0.9191080729166666}, {"start": 3738.25, "end": 3738.79, "word": " الصوديوم", "probability": 0.7822265625}, {"start": 3738.79, "end": 3739.69, "word": " لأنه", "probability": 0.8543294270833334}, {"start": 3739.69, "end": 3740.17, "word": " زاد", "probability": 0.981689453125}, {"start": 3740.17, "end": 3740.49, "word": " ال", "probability": 0.9501953125}, {"start": 3740.49, "end": 3741.01, "word": " reabsorption", "probability": 0.9140625}, {"start": 3741.01, "end": 3741.37, "word": " تبعه", "probability": 0.91748046875}, {"start": 3741.37, "end": 3741.79, "word": " بسبب", "probability": 0.9822591145833334}, {"start": 3741.79, "end": 3742.07, "word": " انه", "probability": 0.7110595703125}, {"start": 3742.07, "end": 3742.33, "word": " زاد", "probability": 0.853271484375}, {"start": 3742.33, "end": 3742.55, "word": " عندي", "probability": 0.89306640625}, {"start": 3742.55, "end": 3742.63, "word": " ال", "probability": 0.95849609375}, {"start": 3742.63, "end": 3742.83, "word": " amino", "probability": 0.857421875}, {"start": 3742.83, "end": 3743.23, "word": " acids", "probability": 0.74072265625}, {"start": 3743.23, "end": 3744.03, "word": " او", "probability": 0.7900390625}, {"start": 3744.03, "end": 3744.31, "word": " ال", "probability": 0.6904296875}, {"start": 3744.31, "end": 3744.91, "word": " glucose", "probability": 0.66796875}, {"start": 3744.91, "end": 3745.77, "word": " فبيقدر", "probability": 0.7189453125}, {"start": 3745.77, "end": 3745.91, "word": " إلى", "probability": 0.2342529296875}, {"start": 3745.91, "end": 3746.05, "word": " ان", "probability": 0.82373046875}, {"start": 3746.05, "end": 3746.15, "word": " ال", "probability": 0.7958984375}, {"start": 3746.15, "end": 3746.47, "word": " delivery", "probability": 0.87353515625}, {"start": 3746.47, "end": 3746.95, "word": " بيجل", "probability": 0.9007568359375}, {"start": 3746.95, "end": 3747.47, "word": " بيصير", "probability": 0.875244140625}, {"start": 3747.47, "end": 3747.79, "word": " عندي", "probability": 0.922119140625}, {"start": 3747.79, "end": 3748.63, "word": " more", "probability": 0.94580078125}, {"start": 3748.63, "end": 3749.45, "word": " response", "probability": 0.9296875}, {"start": 3749.45, "end": 3750.89, "word": " narrowing", "probability": 0.72412109375}, {"start": 3750.89, "end": 3751.21, "word": " لل", "probability": 0.75927734375}, {"start": 3751.21, "end": 3752.09, "word": " ال", "probability": 0.075439453125}, {"start": 3752.09, "end": 3752.51, "word": " efferent", "probability": 0.6558430989583334}, {"start": 3752.51, "end": 3752.87, "word": " بزيد", "probability": 0.7828776041666666}, {"start": 3752.87, "end": 3752.99, "word": " ال", "probability": 0.7841796875}, {"start": 3752.99, "end": 3753.55, "word": " GFR", "probability": 0.89111328125}, {"start": 3753.55, "end": 3755.39, "word": " تمام؟", "probability": 0.8225911458333334}, {"start": 3755.39, "end": 3757.01, "word": " و", "probability": 0.80712890625}, {"start": 3757.01, "end": 3757.47, "word": " بيصير", "probability": 0.9619140625}, {"start": 3757.47, "end": 3757.75, "word": " عندي", "probability": 0.9482421875}, {"start": 3757.75, "end": 3758.05, "word": " more", "probability": 0.9482421875}, {"start": 3758.05, "end": 3759.05, "word": " ايه؟", "probability": 0.7427978515625}, {"start": 3759.05, "end": 3759.39, "word": " more", "probability": 0.91845703125}, {"start": 3759.39, "end": 3760.33, "word": " GFR", "probability": 0.940185546875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 3760.37875, "duration_after_vad": 3668.9756249999796}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/LKlxenVpS-o_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/LKlxenVpS-o_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6d885aa31e750539a1bf722cd0689b99104702d8
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/LKlxenVpS-o_raw.srt
@@ -0,0 +1,3524 @@
+1
+00:00:05,410 --> 00:00:13,110
+هنكمل الحديث حول الرينا
+
+2
+00:00:13,110 --> 00:00:18,750
+ال blood flow بس مش من وجهة نظر ال structure من
+
+3
+00:00:18,750 --> 00:00:22,250
+وجهة نظر ال function القيم الأساسية لرينا ال blood
+
+4
+00:00:22,250 --> 00:00:28,590
+flow اللي هو يديني flow كافي ل good filtration
+
+5
+00:00:28,590 --> 00:00:32,870
+تمام؟ اذا هناك ارتباط كبير ما بين الرينا ال blood
+
+6
+00:00:32,870 --> 00:00:38,680
+flowو بين ال glomerular filtration rate تمام هنا
+
+7
+00:00:38,680 --> 00:00:48,680
+هنطلع نلاقي انه الكيليا على غير العادة الكيليا
+
+8
+00:00:48,680 --> 00:00:57,500
+على غير العادة فيها blood flow blood
+
+9
+00:00:57,500 --> 00:01:02,900
+flow عالي يعني 22% اكتر من الخمس تقريبامن ال
+
+10
+00:01:02,900 --> 00:01:07,500
+cardiac output بيكون
+
+11
+00:01:07,500 --> 00:01:11,300
+بيصل الكيلية طبعا اذا اكتر من خمس ال cardiac
+
+12
+00:01:11,300 --> 00:01:16,000
+output بيخش الكيلية هنلاحظ احنا طبعا كمية كبيرة
+
+13
+00:01:16,000 --> 00:01:21,440
+بالنسبة لوزن الكيلية الكيلية تمثل من الجسم point
+
+14
+00:01:21,440 --> 00:01:25,960
+four percent لا تمثل يعني twenty percent او twenty
+
+15
+00:01:25,960 --> 00:01:29,640
+two percent زي ما ال product supply بالنسبة لل
+
+16
+00:01:29,640 --> 00:01:35,620
+cardiac outputإذا هناك زيادة غير عادية في ال blood
+
+17
+00:01:35,620 --> 00:01:40,720
+supply للكلية و هذا من خلال احنا طبعا مدرسته و
+
+18
+00:01:40,720 --> 00:01:43,760
+اللي هندرسه بعد كده بنعرف ان الكلية اللي عمل ال
+
+19
+00:01:43,760 --> 00:01:47,620
+blood supply الرئيسي إليها عشان يعمل ال filtration
+
+20
+00:01:47,620 --> 00:01:51,420
+و ال function تبعها مش عشان ال nutrition ل ال
+
+21
+00:01:51,420 --> 00:01:55,220
+kidney tissuesيعني مش ال kid nutritious metabolism
+
+22
+00:01:55,220 --> 00:02:01,020
+او kidney cells metabolism او kidney cells
+
+23
+00:02:01,020 --> 00:02:06,460
+nutrition هو الأساس انما هناك function التمثل في
+
+24
+00:02:06,460 --> 00:02:13,180
+filtration وabsorption و secretion هذا بيخلي ال
+
+25
+00:02:13,180 --> 00:02:16,480
+renal blood flow يكون عالي حتى نقدر نتخلص من waste
+
+26
+00:02:16,480 --> 00:02:25,390
+products لو طلعنا علىمقارنة بال brain مقارنة بال
+
+27
+00:02:25,390 --> 00:02:28,070
+brain هنلاقي أنه ال blood supply
+
+28
+00:02:36,530 --> 00:02:42,150
+ال blood supply ل الكلية سبع أضعاف ال blood supply
+
+29
+00:02:42,150 --> 00:02:48,070
+ل ال brain في حين أن الكلية في العادة تستهلك فقط
+
+30
+00:02:48,070 --> 00:02:51,990
+ضعف استهلاك ال brain من ال oxygen، لذا في عندي خمس
+
+31
+00:02:51,990 --> 00:02:57,830
+أضعاف فارق لإيش هدول جايين، مش جايين علشان يدوني
+
+32
+00:02:57,830 --> 00:03:02,550
+nutrition، انما جايين علشان ايه؟ to be filtered
+
+33
+00:03:02,550 --> 00:03:06,420
+and clearedمجموعة كبيرة من الوزن اللي تمتلقها
+
+34
+00:03:06,420 --> 00:03:10,960
+الكدنية مرتبطة بقيمة مرتبطة مرتبطة مرتبطة مرتبطة
+
+35
+00:03:10,960 --> 00:03:12,020
+مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة
+
+36
+00:03:12,020 --> 00:03:14,060
+مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة
+
+37
+00:03:14,060 --> 00:03:17,240
+مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة
+
+38
+00:03:17,240 --> 00:03:20,040
+مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة
+
+39
+00:03:20,040 --> 00:03:31,820
+مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة مرتبطة
+
+40
+00:03:31,820 --> 00:03:37,550
+مطبعا الفيلتر اللى للصوديوم هو زى ما حكينا
+
+41
+00:03:37,550 --> 00:03:42,970
+الكاتايون اللى هو عن طريقه بتتم التعامل مع ال
+
+42
+00:03:42,970 --> 00:03:49,040
+cellular transport mechanismsعن طريقه بيتم إدخال
+
+43
+00:03:49,040 --> 00:03:54,260
+الميه بعده يعني تليه الميه وعن طريقه بيدخل ورا ال
+
+44
+00:03:54,260 --> 00:03:58,560
+.. ال .. ال glucose و ال amino acids و معظم ال
+
+45
+00:03:58,560 --> 00:04:01,520
+nutrients الأخرى اللي احنا عايزينها بيكون ال
+
+46
+00:04:01,520 --> 00:04:05,200
+sodium carriers، transporter، ميكانيزم تعتمد على
+
+47
+00:04:05,200 --> 00:04:11,210
+ال sodium هي الأساس في انتقالهالذلك السوديوم مؤشر
+
+48
+00:04:11,210 --> 00:04:14,370
+على كم فيه activity في داخل الـA في داخل
+
+49
+00:04:14,370 --> 00:04:18,530
+الـtubules طبعا بيصير ال filtration و بيصير معظمه
+
+50
+00:04:18,530 --> 00:04:22,430
+99% من السوديوم is reabsorbed طبعا ال reabsorption
+
+51
+00:04:22,430 --> 00:04:26,270
+تبعه بيقدر مع ال functions الأخرى لذلك هناك علاقة
+
+52
+00:04:26,270 --> 00:04:29,910
+مقترضية ما بين الـA السوديوم reabsorption و ال
+
+53
+00:04:29,910 --> 00:04:34,090
+oxygen consumption لو نزلنا السوديوم reabsorption
+
+54
+00:04:34,090 --> 00:04:38,500
+إلى الصفربمعنى انه نزلنا ال filtration rate الى
+
+55
+00:04:38,500 --> 00:04:47,640
+الصفر تمام بأي تكنيك معين هلاحظ انه انه بينخفض ال
+
+56
+00:04:47,640 --> 00:04:52,180
+oxygen consumption انخفاض كبير تمام بيبقى فقط
+
+57
+00:04:52,180 --> 00:04:59,580
+الاستهلاك 5 الربع 25% من ال oxygen consumption
+
+58
+00:04:59,580 --> 00:05:04,900
+بيستمر تلت أرباع الاستهلاك بيختفيبالنسبة للخلايا
+
+59
+00:05:04,900 --> 00:05:12,500
+الاساسية للخلايا الاساسية هي استخدام 25% من
+
+60
+00:05:12,500 --> 00:05:19,800
+الدكتورين و 75% استخدام البربوس الاخر للخلايا
+
+61
+00:05:19,800 --> 00:05:25,600
+تمام بيتمثل عبر طبعا ال sodium زي اللي كتتم 75%
+
+62
+00:05:25,600 --> 00:05:29,260
+منها هذه تتناسب ترضي مع ال sodium زي ما انتوا
+
+63
+00:05:29,260 --> 00:05:34,650
+شايفينها عندي أنا الجزئية هذه basicسابتة بزيدش ولا
+
+64
+00:05:34,650 --> 00:05:38,530
+بتقل لكن إذا زودنا ال sodium reabsorption من اللي
+
+65
+00:05:38,530 --> 00:05:42,110
+بزيد مع ال oxygen consumption إذا ال sodium
+
+66
+00:05:42,110 --> 00:05:45,830
+reabsorption و ال oxygen consumption مرتبطين مع
+
+67
+00:05:45,830 --> 00:05:50,590
+بعض و من البعض determination of renal blood flow
+
+68
+00:05:50,590 --> 00:06:01,070
+is determined by أي اي
+
+69
+00:06:08,860 --> 00:06:13,120
+blood flow في أي مكان كيلية او غير كيلية بتعتمد
+
+70
+00:06:13,120 --> 00:06:17,620
+على ال pressure gradients الفارق بين ال arterial و
+
+71
+00:06:17,620 --> 00:06:21,220
+ال venous ال pressure gradients بين الطرفين هذا
+
+72
+00:06:21,220 --> 00:06:24,140
+اللي بتخلي الاشي يندفع لإن هن في ضغط عالي و هن ضغط
+
+73
+00:06:24,140 --> 00:06:28,780
+واطي يندفع و resistance فى الطريق مش كده هتدوس ان
+
+74
+00:06:28,780 --> 00:06:31,420
+شاء الله فى الفصل الجاى ال circulation بتاخد
+
+75
+00:06:31,420 --> 00:06:35,250
+تفاصيل عنهاو اتلاقوا ان عندي أنا ايه عشان ال flow
+
+76
+00:06:35,250 --> 00:06:39,930
+هذا بيتحكم في ال pressure gradient بين الطرفين
+
+77
+00:06:39,930 --> 00:06:43,870
+blood vessels بالاضافة لل resistance الموجودة، اذا
+
+78
+00:06:43,870 --> 00:06:50,970
+العلاقة بين هذا وهذا هو بيمثل اللي ايه اللي بيحدد
+
+79
+00:06:50,970 --> 00:06:58,090
+ليه ال flow كيف بدي يكون، اذا نتكلم عن ال the
+
+80
+00:06:58,090 --> 00:07:02,420
+renal heart pressure is aboutequal to the systemic
+
+81
+00:07:02,420 --> 00:07:07,880
+pressure، تمام؟ إذا عندي blood pressure ال
+
+82
+00:07:07,880 --> 00:07:12,720
+arterial يعني شبيه بال .. بال arterial .. بال ..
+
+83
+00:07:12,720 --> 00:07:16,220
+بال aortic blood pressure لإن هو طالع من الأورطة
+
+84
+00:07:16,220 --> 00:07:20,110
+على طولالـ Venus من تلاتة إلى أربعة مليمتر ميركورد
+
+85
+00:07:20,110 --> 00:07:24,990
+فتطلع ان هنكون فرق بين حوالي مية و عشرة او المتوسط
+
+86
+00:07:24,990 --> 00:07:28,870
+مية و قلنا مية و عشرية تمانين على متوسطها مية مية
+
+87
+00:07:28,870 --> 00:07:32,790
+ناجس تلاتة إلى أربعة يعني في عندي ايه في فرق ضغط
+
+88
+00:07:32,790 --> 00:07:37,250
+pressure gradient عالي موجود بيقدر ال good flow
+
+89
+00:07:37,250 --> 00:07:40,330
+اللي اتكلمنا عنه طيب بالنسبة لل
+
+90
+00:07:43,790 --> 00:07:46,550
+resistance اذا انا اقول انها علاقة ما بين ال .. ال
+
+91
+00:07:46,550 --> 00:07:49,250
+arterial pressure و ال virus pressure اللي هو ال
+
+92
+00:07:49,250 --> 00:07:52,550
+pressure gradient هو ال .. ال resistance ال
+
+93
+00:07:52,550 --> 00:07:57,270
+resistance وين ما تمشي ال blood flow في اي blood
+
+94
+00:07:57,270 --> 00:08:01,010
+vessel فيه resistanceطبعا طول ما ال blood ماشي فيه
+
+95
+00:08:01,010 --> 00:08:06,350
+محجوز ب blood vessel ومش قادر يتحرك لورا هيك فيه
+
+96
+00:08:06,350 --> 00:08:10,250
+resistance ال resistance هذه بتزيد في بعض الأماكن
+
+97
+00:08:10,250 --> 00:08:12,910
+كل ما دياج ال blood pressure ال vessel blood
+
+98
+00:08:12,910 --> 00:08:16,730
+vessel كل ما ال resistance بتزيد لذلك بيلاقي ان ال
+
+99
+00:08:16,730 --> 00:08:20,990
+resistance في التمركز بداة في ال intra lobularو ال
+
+100
+00:08:20,990 --> 00:08:23,350
+a front و ال a front ال a front و ال a front
+
+101
+00:08:23,350 --> 00:08:28,170
+هنتكلم عنهم بعد كده بتفصيل لإنه في عندي مواد أو
+
+102
+00:08:28,170 --> 00:08:31,730
+أشياء بتخلي ال a front to be dilated أو to be
+
+103
+00:08:31,730 --> 00:08:35,990
+constricted معناها بيزود ال GFR و العكس صحيح إذا
+
+104
+00:08:35,990 --> 00:08:41,890
+صار في ال a front vasoconstriction بيزود ال GFR أو
+
+105
+00:08:41,890 --> 00:08:46,550
+vasodilatation بيجلل ال GFR لكن بدنا نلاحظ إنه أي
+
+106
+00:08:46,550 --> 00:08:48,930
+vasoconstriction إن كان في ال a front ولا في ال a
+
+107
+00:08:48,930 --> 00:08:53,220
+front في الآخر هيعمل ليههينزل ال blood flow تمام
+
+108
+00:08:53,220 --> 00:08:56,320
+لإن كل ما زالت ال blood flow ال resistance بزيد
+
+109
+00:08:56,320 --> 00:09:01,000
+بجل ال blood flow مش كده فلذلك احنا الجزء انه بجل
+
+110
+00:09:01,000 --> 00:09:05,740
+ال blood flow لدرجة بحيث مايأثرش على ال filtration
+
+111
+00:09:05,740 --> 00:09:11,880
+ماشي الحال لكن إذا الجل ب blood flow تمام ال
+
+112
+00:09:11,880 --> 00:09:16,160
+mechanism هتزيادة يعني ال ال ال ال ال ال GFR
+
+113
+00:09:16,160 --> 00:09:20,000
+automatically هتنزلتمام؟ اذا في عندنا كلام حول
+
+114
+00:09:20,000 --> 00:09:23,460
+احنا بالذات بال .. بالنسبة لمن؟ لل .. افرد ال
+
+115
+00:09:23,460 --> 00:09:26,520
+arteriole قولنا اذا صارله vasoconstriction mild
+
+116
+00:09:26,520 --> 00:09:31,740
+بيزود ال GFR تمام؟ لكن اذا كان ال vasoconstriction
+
+117
+00:09:31,740 --> 00:09:35,680
+severe بيجلل ال GFR لإن صار ال blood flow كله ايش
+
+118
+00:09:35,680 --> 00:09:40,040
+منخفض و ال GF .. و ال blood flow ال GFR تعتمد
+
+119
+00:09:40,040 --> 00:09:42,780
+اعتماد كله على ايه؟ على ال blood flow
+
+120
+00:09:48,260 --> 00:09:53,540
+هنا هنلاحظ حاجة غريبة جدا في الكلية تمام هنلاحظ
+
+121
+00:09:53,540 --> 00:09:59,480
+حاجة غريبة في الكلية انه فيها حاجة بيسميها auto
+
+122
+00:09:59,480 --> 00:10:04,540
+regulation auto regulation في حاجة اسمها ايش؟ auto
+
+123
+00:10:04,540 --> 00:10:07,760
+regulation بالنسبالي احنا ال blood vessels بتكلم
+
+124
+00:10:07,760 --> 00:10:18,910
+عن ال blood supply في auto regulation لل لل GFRهو
+
+125
+00:10:18,910 --> 00:10:22,350
+في auto regulation انا اتكلم عن ال blood flow ال
+
+126
+00:10:22,350 --> 00:10:29,050
+blood flow هذا اللي بيعمل GFR عالية ان زاد ال
+
+127
+00:10:29,050 --> 00:10:33,450
+blood pressure لحد معين لحوالي مية و ستين
+
+128
+00:10:33,450 --> 00:10:38,510
+millimeter mercury او نزل لحد سبعين millimeter
+
+129
+00:10:38,510 --> 00:10:41,990
+mercury هنلاحظ ان ال GFR متغيرش متغيرش
+
+130
+00:10:41,990 --> 00:10:46,230
+significantly متغيرش بسيط يعني في عندي range واسع
+
+131
+00:10:46,230 --> 00:10:50,270
+من ال blood pressureتمام اللى هو بيقدر ال blood
+
+132
+00:10:50,270 --> 00:10:53,110
+flow العالى احنا قولنا ال blood flow بالفرق بين ال
+
+133
+00:10:53,110 --> 00:10:55,510
+arteria و ال venous لان ال arteria عالى و ال
+
+134
+00:10:55,510 --> 00:10:58,050
+venous ماتأثرش معناها ال flow بيزيد و ال
+
+135
+00:10:58,050 --> 00:11:03,470
+resistance ماتأثرتش تمام؟ اذا في عندي انا range
+
+136
+00:11:03,470 --> 00:11:08,570
+عالى من ال variations و يضل الكل يعامل auto
+
+137
+00:11:08,570 --> 00:11:14,910
+regulation لنفسها بحيث انه مايزلش ال ايه ال ..ال
+
+138
+00:11:14,910 --> 00:11:19,450
+filtration rate و ال excretion significantly بيصير
+
+139
+00:11:19,450 --> 00:11:24,030
+في حقيقة هتتعلموها اسمها pressure diuresis و
+
+140
+00:11:24,030 --> 00:11:27,690
+pressure natriuresis بمعنى زيادة ال pressure هيزود
+
+141
+00:11:27,690 --> 00:11:31,550
+ال excretion
+
+142
+00:11:31,550 --> 00:11:35,570
+of urine و هيزود ال excretion of sodium nature
+
+143
+00:11:35,570 --> 00:11:43,190
+diuresis او pressure diuresisلكن الـ changes مش
+
+144
+00:11:43,190 --> 00:11:48,010
+متناسبة مع الزيادة يعني زيادة ال blood pressure
+
+145
+00:11:48,010 --> 00:11:51,670
+زيادة ال .. اللي هتتناسب مع جديش طلع ال sodium
+
+146
+00:11:51,670 --> 00:11:55,910
+زيادة أو طلع جديش urine زيادة لإنه في auto
+
+147
+00:11:55,910 --> 00:11:59,430
+regulation و ال auto regulation هادي عملية
+
+148
+00:11:59,430 --> 00:12:04,730
+intrinsic في داخل الكلية تمام؟ بتعتمد أساسا على
+
+149
+00:12:04,730 --> 00:12:10,780
+what is called maculadinsa ال maculadinsa هاديفي
+
+150
+00:12:10,780 --> 00:12:15,260
+بداية الـ distal tubule هنشرحها بعد شوية حساسة
+
+151
+00:12:15,260 --> 00:12:20,180
+لقداشي بيوصلها Sodium بيوصلها Sodium كتير بتقول أن
+
+152
+00:12:20,180 --> 00:12:23,360
+Sodium هذا أكبر من قدرة ال distal tubule to deal
+
+153
+00:12:23,360 --> 00:12:26,780
+with أكتر من قدرة ال distal tubule متعامل معاه
+
+154
+00:12:26,780 --> 00:12:32,040
+فلذلك بتبعت إشارة ل أفرند سكربدياجي شوية بجالي ال
+
+155
+00:12:32,040 --> 00:12:36,180
+GFR برغم ان ال pressure عالي برا صار مائة و سبعين
+
+156
+00:12:36,180 --> 00:12:40,820
+لكن اللي ده ال afferent سكر دياجي ليش؟ لإنه بده
+
+157
+00:12:40,820 --> 00:12:46,100
+ينزل ال GFR لإيش يتناسب مع ال nephron function و
+
+158
+00:12:46,100 --> 00:12:51,000
+العكس صحيح لو ال ال ال sodium delivered to the
+
+159
+00:12:51,000 --> 00:12:55,500
+distal tribule عند الميكروفينس حس انه ال sodium
+
+160
+00:12:55,500 --> 00:13:03,700
+delivery جال تروح تدي إشارة لمين؟لأفرند و لإفران
+
+161
+00:13:03,700 --> 00:13:09,860
+لأن عملية زيادة ال GFR أو نقصانها التانيين بتحكموا
+
+162
+00:13:09,860 --> 00:13:13,920
+فيه بطريقة عكسية صحيح لكن التانيين بتحكموا فيه
+
+163
+00:13:13,920 --> 00:13:18,320
+فبتدى إشارة أن اللي جاينا صوديوم يجليل زودولى شوية
+
+164
+00:13:18,320 --> 00:13:23,420
+فلو نزلنا سبعين اربناشر برضه ايه بنلاقي ال GFR
+
+165
+00:13:23,420 --> 00:13:27,820
+مناسبة لإنها تدى function طبيعى بحيث انه يصل
+
+166
+00:13:27,820 --> 00:13:31,910
+الصوديوم طبيعى لمينهذه العملية تسمى auto
+
+167
+00:13:31,910 --> 00:13:35,450
+regulation هندرسها برضه بتفصيل شوية اليوم في نفس
+
+168
+00:13:35,450 --> 00:13:40,670
+المحاضرة هذه هنلاحظ
+
+169
+00:13:40,670 --> 00:13:45,070
+في جثة ال blood flow انه ال blood supply او blood
+
+170
+00:13:45,070 --> 00:13:50,670
+flow in the vasecta لا يمثل من ال blood flow في
+
+171
+00:13:50,670 --> 00:13:53,230
+الrenal blood flow ال total اكتر من واحد الاتنين
+
+172
+00:13:53,230 --> 00:13:58,710
+في المية تمام؟ ليش؟ لأن احنا قلتلكم انا في الأساس
+
+173
+00:13:59,190 --> 00:14:03,550
+ان الفازاركتا والجكستام الدولار نيفرونز شغلتهم
+
+174
+00:14:03,550 --> 00:14:07,850
+الأساسية مش انهم ت filtrate and excrete ال wasp
+
+175
+00:14:07,850 --> 00:14:11,910
+products و الكلام هذا شغلتهم الأساسية انهم محتاجين
+
+176
+00:14:11,910 --> 00:14:14,550
+concentrated urine ولا لا فالفترات اللي بدنا فيها
+
+177
+00:14:14,550 --> 00:14:17,390
+concentrated urine بيشتغلوا الفترات اللي مابدناش
+
+178
+00:14:17,390 --> 00:14:20,330
+concentrated urine بيشتغلوش لذلك ال blood supply
+
+179
+00:14:20,330 --> 00:14:23,750
+اللي هم بيزيد و بيقل و ال osmotic gradient اللي هم
+
+180
+00:14:23,750 --> 00:14:30,410
+بيكونوهفي المضلة بيتكون و بيختفي بيزيد و بيقل حسب
+
+181
+00:14:30,410 --> 00:14:35,290
+حاجات الجسم لذلك ال بذركة اللي هي تمثل blood
+
+182
+00:14:35,290 --> 00:14:43,370
+supply لل .. لل .. دي ال mainly للجفص المضلة
+
+183
+00:14:43,370 --> 00:14:48,810
+للنفرونز هنلاقي فيها blood supply محدود the
+
+184
+00:14:48,810 --> 00:14:52,640
+control of the glomeral filtrationتكلمنا من
+
+185
+00:14:52,640 --> 00:14:56,320
+المحاضرة الفاترة تقولنا ال glomeral filtration
+
+186
+00:14:56,320 --> 00:15:01,920
+يعتمد على two types of brushes مش كده متصارعين ال
+
+187
+00:15:01,920 --> 00:15:07,420
+hydrostatic على جانبينال bo .. ال capillary wall
+
+188
+00:15:07,420 --> 00:15:11,800
+of the glomerulus و اسمه .. و colloidal على برق
+
+189
+00:15:11,800 --> 00:15:16,660
+الجهتين مش كده؟ و الفرج ما بينهم مديني محصلة كده
+
+190
+00:15:16,660 --> 00:15:21,700
+يصير filtration طيب إذا عندي هدول ال two factors
+
+191
+00:15:21,700 --> 00:15:28,660
+hydrostatic pressure و ال colloidal pressureطيب
+
+192
+00:15:28,660 --> 00:15:32,580
+إذا في عندى colloidal pressure بدو يندرس لحال و
+
+193
+00:15:32,580 --> 00:15:35,960
+hydrostatic pressure بدو يندرس لحال ال hydrostatic
+
+194
+00:15:35,960 --> 00:15:43,680
+pressure هذا اللي جاي عبر ال رينا القاطري ال
+
+195
+00:15:43,680 --> 00:15:46,760
+hydrostatic pressure بيتقل إلى أن يصل ال afferent
+
+196
+00:15:46,760 --> 00:15:50,180
+تمام إيش ال factors اللي بتزود ال hydrostatic
+
+197
+00:15:50,180 --> 00:15:52,960
+pressure اللي في المقابل هيزود ال filtration مش
+
+198
+00:15:52,960 --> 00:15:57,710
+كده ال auto regulation mechanisms هتتحكم فيهلكن في
+
+199
+00:15:57,710 --> 00:16:02,630
+جزء مش هينطبطه يعني في minimal factor هضل موجود
+
+200
+00:16:02,630 --> 00:16:05,550
+بعدين لو زاد pressure عن 170 هصير عندى severe
+
+201
+00:16:05,550 --> 00:16:09,390
+diuresis pressure diuresis و لو جال عن 70 معناها
+
+202
+00:16:09,390 --> 00:16:14,030
+انه هيصير really blood flow هي drop كويس و ال GFR
+
+203
+00:16:14,030 --> 00:16:18,310
+نفسه هيصير في high drop و ال excretion of urine
+
+204
+00:16:18,310 --> 00:16:22,690
+will be dropped و ال function of the kidney اذا هو
+
+205
+00:16:22,690 --> 00:16:28,370
+ال dropهنلاحظ ان الـ hydrostatic pressure هذا او
+
+206
+00:16:28,370 --> 00:16:35,350
+influenced by three factors ياما nervous factors و
+
+207
+00:16:35,350 --> 00:16:39,350
+هين mainly sympathetic innervation ياما hormonal
+
+208
+00:16:39,350 --> 00:16:44,650
+factors ان كانت hormones systemic او hormones
+
+209
+00:16:44,650 --> 00:16:49,370
+local تسمى autocoids فهنلاحظ اكتر substance that
+
+210
+00:16:49,370 --> 00:16:57,000
+affects the blood vesselsالـ microcirculation تعمل
+
+211
+00:16:57,000 --> 00:16:58,420
+بشكل موجود بشكل موجود بشكل موجود بشكل موجود بشكل
+
+212
+00:16:58,420 --> 00:17:00,600
+موجود بشكل موجود بشكل موجود بشكل موجود بشكل موجود
+
+213
+00:17:00,600 --> 00:17:02,420
+بشكل موجود بشكل موجود بشكل موجود بشكل موجود بشكل
+
+214
+00:17:02,420 --> 00:17:02,960
+موجود بشكل موجود بشكل موجود بشكل موجود بشكل موجود
+
+215
+00:17:02,960 --> 00:17:03,100
+بشكل موجود بشكل موجود بشكل موجود بشكل موجود بشكل
+
+216
+00:17:03,100 --> 00:17:05,520
+موجود بشكل موجود بشكل موجود بشكل موجود بشكل موجود
+
+217
+00:17:05,520 --> 00:17:07,020
+بشكل موجود بشكل موجود بشكل موجود بشكل موجود بشكل
+
+218
+00:17:07,020 --> 00:17:17,940
+موجود بشكل موجود بشكل موجود بشكل
+
+219
+00:17:17,940 --> 00:17:22,500
+موجود بشكل
+
+220
+00:17:22,500 --> 00:17:25,800
+موجالـ auto regulation بيزود ال hydrostatic
+
+221
+00:17:25,800 --> 00:17:29,040
+pressure و بيجلله إذا صار vazoconstriction على
+
+222
+00:17:29,040 --> 00:17:31,500
+الafferent بيجلل ال hydrostatic pressure اللي هو
+
+223
+00:17:31,500 --> 00:17:34,600
+ال active ال active hydrostatic pressure اللي
+
+224
+00:17:34,600 --> 00:17:38,540
+بيشتغل و بعمل filtration إذا صح قبل الafferent ال
+
+225
+00:17:38,540 --> 00:17:41,360
+pressure عالي لكن بعد الafferent فصار
+
+226
+00:17:41,360 --> 00:17:45,820
+vazoconstriction جلمتمام؟ اذا عندي ال .. ال auto
+
+227
+00:17:45,820 --> 00:17:48,880
+regulation احنا دروسها برضه بالتفصيل اذا في تلات
+
+228
+00:17:48,880 --> 00:17:52,500
+نقطة مهمة sympathetic و hormones و ايه؟ طب ال
+
+229
+00:17:52,500 --> 00:17:56,300
+sympathetic ايه الشغله؟ sympathetic nervous system
+
+230
+00:17:56,300 --> 00:18:03,380
+activation decreases GFR وهذا حقيقة كتير مهم كيف
+
+231
+00:18:03,380 --> 00:18:07,160
+يعني؟ يعني انا حكيتلك قبل كده انه في عندنا درجات
+
+232
+00:18:07,160 --> 00:18:14,080
+من ال ..من ال sympathetic stimulation او يعني لما
+
+233
+00:18:14,080 --> 00:18:16,840
+يصير عندى انا حالات طوارئ تستدعي ال sympathetic
+
+234
+00:18:16,840 --> 00:18:21,640
+stimulation رد فعل الجسم بيختلف بيبدأ بال
+
+235
+00:18:21,640 --> 00:18:26,120
+splanchnic area بجلد دم فيها عشان ال sympathetic
+
+236
+00:18:27,160 --> 00:18:30,920
+عشان لما يصير عندى hemorrhage مثلا تمام ال
+
+237
+00:18:30,920 --> 00:18:34,580
+sympathetic stimulation بيقدر الى ان ال area of
+
+238
+00:18:34,580 --> 00:18:37,480
+vasoconstriction ال blood supply اللى جاى لمنطقة
+
+239
+00:18:37,480 --> 00:18:41,400
+الأمعاق و حول ال area of vasoconstriction بيصير
+
+240
+00:18:41,400 --> 00:18:45,480
+لها vasoconstriction حتى ال veins الرئيسية ال
+
+241
+00:18:45,480 --> 00:18:47,840
+portal vein غيره بيصير لها vasoconstriction عشان
+
+242
+00:18:47,840 --> 00:18:51,930
+يضخوا دم لل ايه لل general circulationبعدها او
+
+243
+00:18:51,930 --> 00:18:55,890
+معاها ال skin blood supply برضه بيختفي بيصير كله
+
+244
+00:18:55,890 --> 00:18:59,890
+ايه لل general circulation بعدها الكيلية تفقد ال
+
+245
+00:18:59,890 --> 00:19:02,930
+blood supply تبعها اللي بيكون عندي severe
+
+246
+00:19:02,930 --> 00:19:06,190
+sympathetic stimulation بيصير severe spasm لرينا
+
+247
+00:19:06,190 --> 00:19:12,130
+ال blood vessels بتقدر ال blood flowبيدخلهاش تمام؟
+
+248
+00:19:12,130 --> 00:19:15,730
+لذا هذه مش ال day-to-day regulation يعني ال blood
+
+249
+00:19:15,730 --> 00:19:19,350
+pressure عالي شوية ال baroreceptors انتبهوا و
+
+250
+00:19:19,350 --> 00:19:24,410
+جالوا ل ال vasoactive center جالي ال ال ال ال ال
+
+251
+00:19:24,410 --> 00:19:27,230
+ال tone او زود ال tone للتحكم في ال blood pressure
+
+252
+00:19:27,230 --> 00:19:31,270
+يعني مش الأشياء ال ال day-to-day changes emergency
+
+253
+00:19:31,270 --> 00:19:34,330
+acute changes بتقدر إلى severe stimulation of
+
+254
+00:19:34,330 --> 00:19:37,930
+sympathetic nervous system بتقدر إلى انه يجل
+
+255
+00:19:37,930 --> 00:19:43,550
+الايه؟الـrenal blood flow وقد يكون خطير لدرجة انه
+
+256
+00:19:43,550 --> 00:19:49,050
+ممكن يدخل الكدليا في ischemia كبيرة مدة طويلة وهذه
+
+257
+00:19:49,050 --> 00:19:53,530
+تؤدي الى acute renal failure تمام؟ قد تكون short
+
+258
+00:19:53,530 --> 00:19:57,030
+duration acute renal failure reversible وقد تكون
+
+259
+00:19:57,030 --> 00:20:01,650
+severe ischemia او تؤدي في الآخر الى chronic renal
+
+260
+00:20:01,650 --> 00:20:05,430
+failure ونحتاج الى ان كل هذه كلها خلاص اتعطلت
+
+261
+00:20:05,430 --> 00:20:06,710
+وبدها تبديل
+
+262
+00:20:10,170 --> 00:20:15,030
+اكتفاء قوي من مدرسين شخصيات الحرارة يمكن أن يصنع
+
+263
+00:20:15,030 --> 00:20:17,290
+الحرارات الحرارية ويقلل مدارس الحرارة الحرارية
+
+264
+00:20:17,290 --> 00:20:22,690
+مدارس حرارة الحرارة الحرارية مدارس
+
+265
+00:20:22,690 --> 00:20:23,310
+حرارة الحرارة الحرارية مدارس حرارة الحرارة
+
+266
+00:20:23,310 --> 00:20:23,950
+الحرارية مدارس حرارة الحرارة الحرارية مدارس حرارة
+
+267
+00:20:23,950 --> 00:20:23,950
+الحرارة الحرارية مدارس حرارة الحرارة الحرارية
+
+268
+00:20:23,950 --> 00:20:24,290
+مدارس حرارة الحرارة الحرارية مدارس حرارة الحرارة
+
+269
+00:20:24,290 --> 00:20:28,290
+الحرارية مدارس حرارة الحرارة الحرارة الحرارية
+
+270
+00:20:28,290 --> 00:20:39,230
+مدارس حرارة الحرارة الحرارة الحرارة الحر
+
+271
+00:20:39,420 --> 00:20:43,400
+في وقت الطوارئ تمام لما to be stimulated over
+
+272
+00:20:43,400 --> 00:20:47,760
+stimulation الكلية بتاخد نصيب من الموضوع هذا ال
+
+273
+00:20:47,760 --> 00:20:53,060
+autocoids و ال hormones عندنا هربونات نقول نور
+
+274
+00:20:53,060 --> 00:20:57,440
+ابنفرين و ابنفرين ما هم ال sympathetic مش كده هم
+
+275
+00:20:57,440 --> 00:21:00,720
+ال sympathetic نور ابنفرين و ابنفرين ان كان اجا
+
+276
+00:21:00,720 --> 00:21:04,380
+مباشر عبر ال nerve او اجا من خلال ال suprarenal
+
+277
+00:21:04,380 --> 00:21:08,850
+medulla وصل الكلية هيقدي الى vasoconstrictionو
+
+278
+00:21:08,850 --> 00:21:13,030
+يجللوا ال a ال ال ال gfa ال blue mirror filtration
+
+279
+00:21:13,030 --> 00:21:19,170
+rate ال endothelin هذا vasoactive substance بتشتغل
+
+280
+00:21:19,170 --> 00:21:22,990
+زي ال non-epinephrine و زي ال epinephrine و هذه
+
+281
+00:21:22,990 --> 00:21:27,880
+عبارة عن مادة في الغالب موجودة في الجسمفي كل blood
+
+282
+00:21:27,880 --> 00:21:31,860
+vessels إذا صار injured لل blood vessels بتعمل
+
+283
+00:21:31,860 --> 00:21:36,260
+some sort of reaction عشان تمنع ال bleeding some
+
+284
+00:21:36,260 --> 00:21:39,460
+sort of homeostasis أو هنا hemostasis ال
+
+285
+00:21:39,460 --> 00:21:41,820
+homeostasis طبعا ال blood vessels هنا بيبقى intact
+
+286
+00:21:41,820 --> 00:21:47,080
+فبتعمل hemostasis الدم يبقى مايصيرش نظيف كبير
+
+287
+00:21:47,080 --> 00:21:51,630
+فبتعمل vasospasm لل injured vesselحتى تمنع انه ايه
+
+288
+00:21:51,630 --> 00:21:55,670
+يصير منه bleeding اندوثيلين اذا تطلع مادة من
+
+289
+00:21:55,670 --> 00:21:59,090
+الاندوثيليم تبع blood vessels when it is injured
+
+290
+00:21:59,090 --> 00:22:02,530
+when the endothelium is ايه injured by any injury
+
+291
+00:22:02,530 --> 00:22:11,770
+هاي الاندوثيلين بنلاحظ أحيانا بعض الحالات اللي
+
+292
+00:22:11,770 --> 00:22:15,690
+فيها trauma generalized trauma لل blood vessels
+
+293
+00:22:15,690 --> 00:22:17,630
+toxemia of pregnancy
+
+294
+00:22:21,260 --> 00:22:26,040
+حالات ال acute and chronic renal failure يوريميا
+
+295
+00:22:26,040 --> 00:22:32,020
+يعني renal failure حالات بيصير فيها من لحظ ال
+
+296
+00:22:32,020 --> 00:22:34,240
+endothelin ال blood level ل ال endothelin كمان
+
+297
+00:22:34,240 --> 00:22:38,740
+عالي لإنه صار انا عندي systemic problem في ال
+
+298
+00:22:38,740 --> 00:22:44,260
+toxicity of pregnancy بتسمهم الحملبعض الستات بعد
+
+299
+00:22:44,260 --> 00:22:49,640
+الشهر السابع مثلا بنلاقي ضغطهم عليه كتير، ضغطهم
+
+300
+00:22:49,640 --> 00:22:52,880
+أثناء الحمل، طبعا الضغط العالي بيعمل injury لمين؟
+
+301
+00:22:53,440 --> 00:22:57,640
+لل blood vessels المشكلة انه ازعلي لانه بيعمل
+
+302
+00:22:57,640 --> 00:23:02,060
+chronic destruction لل ايه؟ لل blood vessels ففي
+
+303
+00:23:02,060 --> 00:23:05,860
+هذه الحالات اللي فيها injury تكسيمي او كده بنلاحظ
+
+304
+00:23:05,860 --> 00:23:08,960
+ان ال endothelin هذا من اللي جالي شوية بس قلنالكم
+
+305
+00:23:08,960 --> 00:23:12,500
+هو vasoactive كويس ازعلي هيعمل vasospasm ويجلل
+
+306
+00:23:12,500 --> 00:23:17,720
+الrenal flow ويجلل ال GFR وهو مشكلة يعني شغلاته
+
+307
+00:23:17,720 --> 00:23:24,710
+الرئيسية في غالب hemostasis هنا في الحالة ديطيب
+
+308
+00:23:24,710 --> 00:23:27,230
+هذا بالنسبة لمن؟ ال non-epinephrine و ال
+
+309
+00:23:27,230 --> 00:23:30,870
+epinephrine و ال endotheline ال angiotensin 2
+
+310
+00:23:30,870 --> 00:23:35,950
+constricts afferent arteriole اذا هاي تلتة هرموز
+
+311
+00:23:35,950 --> 00:23:40,570
+الرابع هتكلم عن angiotensin 2 تمام الخامس هتكلم عن
+
+312
+00:23:40,570 --> 00:23:44,870
+prostaglandins هتكلم
+
+313
+00:23:44,870 --> 00:23:49,970
+عن prostaglandins و بعدين السادس او الخامس و
+
+314
+00:23:49,970 --> 00:23:54,490
+السادس ال nitric oxide لانه vasodilatorطيب نتكلم
+
+315
+00:23:54,490 --> 00:24:00,170
+عميقين على الانجيوتنسين 2 الانجيوتنسين 2 أساسا
+
+316
+00:24:00,170 --> 00:24:08,250
+ناتج عن ان في عندي رنن .. رنن stimulated فطلع في
+
+317
+00:24:08,250 --> 00:24:13,750
+الدم هذا ال .. رنن بيأثر على what is called
+
+318
+00:24:13,750 --> 00:24:18,830
+انجيوتنسينوجين هذا الانجيوتنسينوجين بروتين بيطلع
+
+319
+00:24:18,830 --> 00:24:24,750
+من ال liver تمام؟بيجي الرنن اللي طالع من الكلية من
+
+320
+00:24:24,750 --> 00:24:28,090
+وين من الكلية؟ من الجكسة جلوميرول الاباراتوس حد
+
+321
+00:24:28,090 --> 00:24:32,670
+جيت حنتكلم عنه الجكسة جلوميرولة الجهاز اللي عند ال
+
+322
+00:24:32,670 --> 00:24:36,090
+glomerulus اللي يتكون من مياكي لدنسة اللي اتكلمنا
+
+323
+00:24:36,090 --> 00:24:41,370
+عن اتوي وجكسة جلوميرول السلز هدول مع بعض يطلعولي
+
+324
+00:24:41,370 --> 00:24:44,890
+رنن الرنن بيروح to the circulation
+
+325
+00:24:54,960 --> 00:24:59,740
+الأنجوتينسينوين هدا هو مشهد السيركوليشن هلاقي
+
+326
+00:24:59,740 --> 00:25:01,900
+الانزايم الانجوتينسينوين هدا هو مشهد السيركوليشن
+
+327
+00:25:01,900 --> 00:25:02,780
+هلاقي الانزايم الانجوتينسينوين هدا هو مشهد
+
+328
+00:25:02,780 --> 00:25:04,800
+السيركوليشن هلاقي الانزايم الانجوتينسينوين هدا هو
+
+329
+00:25:04,800 --> 00:25:07,240
+مشهد السيركوليشن هلاقي الانزايم الانجوتنسينوين هدا
+
+330
+00:25:07,240 --> 00:25:08,300
+هو مشهد السيركوليشن هلاقي الانزايم الانجوتنسينوين
+
+331
+00:25:08,300 --> 00:25:13,020
+هدا هو مشهد السيركوليشن هلاقي الانزايم
+
+332
+00:25:13,020 --> 00:25:14,880
+الانجوتنسينوين هدا هو مشهد السيركوليشن هلاقي
+
+333
+00:25:14,880 --> 00:25:17,910
+الانزايم الانجوتنسينوين هدا هو مشهتمام
+
+334
+00:25:17,910 --> 00:25:21,410
+الانجريوتنسين 2 قلتلك قبل كده هو the most active
+
+335
+00:25:21,410 --> 00:25:25,690
+vasoactive substance in the body الانجريوتنسين 2
+
+336
+00:25:25,690 --> 00:25:31,550
+هذا له function local وله function general إذا
+
+337
+00:25:31,550 --> 00:25:37,030
+وجدت ماعندي أنا ال blood supply يجيل في الكيليا
+
+338
+00:25:37,030 --> 00:25:40,230
+بنبح
+
+339
+00:25:40,230 --> 00:25:43,710
+ال renin-angiotensin system بنسميه renin
+
+340
+00:25:43,710 --> 00:25:44,870
+-angiotensin system
+
+341
+00:25:47,740 --> 00:25:50,700
+إذا ال .. هذا ال system يعني ال androgen system
+
+342
+00:25:50,700 --> 00:25:55,400
+كتير مهم و الكيلية فيه مش بتطبط نفسها بس كمان
+
+343
+00:25:55,400 --> 00:26:02,920
+بتطبط فيه ايه ال systemic blood flow ليش؟ لإن وجود
+
+344
+00:26:02,920 --> 00:26:07,580
+دم مواصل الكيلية واطي معناه الدم برا كمان ايه واطي
+
+345
+00:26:07,580 --> 00:26:12,100
+تستنفر ال system اللي بيعمل عملية ايه محافظة على
+
+346
+00:26:12,100 --> 00:26:18,610
+ال ..الـ blood pressure بتمثل في الانجوتنس انتوهات
+
+347
+00:26:18,610 --> 00:26:22,070
+لما بيطلع من خلال ال renin انجوتنس ال system بروح
+
+348
+00:26:22,070 --> 00:26:25,250
+بستنفرلي كمان ال antidiuretic hormone بستنفرلي ال
+
+349
+00:26:25,250 --> 00:26:29,110
+aldosterone كل الأشياء اللي بتحافظ على ايه؟ على
+
+350
+00:26:29,110 --> 00:26:34,570
+ضغط يعلىو fluids to be retained in the body، ممنوع
+
+351
+00:26:34,570 --> 00:26:37,310
+ال fluids تطلع برا، تمام، فال antidote hormone
+
+352
+00:26:37,310 --> 00:26:40,750
+بتطلع بزيادة، ممنوع ال fluids تطلع برا، فال
+
+353
+00:26:40,750 --> 00:26:44,050
+aldosterone بتطلع و في ال vasoactive substance
+
+354
+00:26:44,050 --> 00:26:47,010
+الangiotensin 2 بتعمل vasoconstriction، كده بنعلّي
+
+355
+00:26:47,010 --> 00:26:51,350
+الضغط، بنحسن الضغط، في حالات الطوارئلكن إله شغلانة
+
+356
+00:26:51,350 --> 00:26:54,430
+تانية الـ angiotensin 2 locally عشان يخلّي ال
+
+357
+00:26:54,430 --> 00:26:59,790
+kidney function طبيعي فرنن لما بيطلع بتكون
+
+358
+00:26:59,790 --> 00:27:01,790
+angiotensin 2، ال angiotensin 2 يقولنا إيه إيش
+
+359
+00:27:01,790 --> 00:27:05,730
+بيشتغل؟ بيشتغل على إيه؟ على ال .. على ال E front
+
+360
+00:27:05,730 --> 00:27:09,910
+بالذات، بيشتغل ع مين؟ على ال E front بالذات، بيقدر
+
+361
+00:27:09,910 --> 00:27:13,170
+إلى vasoconstriction في ال E front تمام؟ إيش بيقدر
+
+362
+00:27:13,170 --> 00:27:15,130
+هذا؟ إنه يزود ال GFR
+
+363
+00:27:17,860 --> 00:27:22,560
+لما يجل طبعا هو ممكن زي ما جلنا بيعمل general
+
+364
+00:27:22,560 --> 00:27:25,840
+circulation phase constriction مش كده؟إذا
+
+365
+00:27:25,840 --> 00:27:29,000
+الانجليتانسين 2 كان عاملة عاملة عاملة عاملة عاملة
+
+366
+00:27:29,000 --> 00:27:32,380
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+367
+00:27:32,380 --> 00:27:37,360
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+368
+00:27:37,360 --> 00:27:37,420
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+369
+00:27:37,420 --> 00:27:40,400
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+370
+00:27:40,400 --> 00:27:40,400
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+371
+00:27:40,400 --> 00:27:40,400
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+372
+00:27:40,400 --> 00:27:40,400
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+373
+00:27:40,400 --> 00:27:40,400
+عاملة عاملة عاملة عاملة عاملة عاملة عاملة عاملة
+
+374
+00:27:40,400 --> 00:27:49,540
+عاملة عام
+
+375
+00:27:50,080 --> 00:27:54,700
+ع ال mainly ع ال efferent لكن ممكن إيش لو قولنا
+
+376
+00:27:54,700 --> 00:28:01,780
+إنه ال sodium اللي بيصل المكولادينسا كتير يعني ال
+
+377
+00:28:01,780 --> 00:28:05,240
+GFR كتير ممكن يعملي تأثير مباشر ع مين؟ ع ال
+
+378
+00:28:05,240 --> 00:28:09,100
+afferent كمان كمان بيعملي vasoconstriction ع ال
+
+379
+00:28:09,100 --> 00:28:15,790
+afferent عشان يجللالشي اسمه او اذا بيقدر يعمل هنا
+
+380
+00:28:15,790 --> 00:28:19,130
+construction يجلل ال filtration وهنا يعمل
+
+381
+00:28:19,130 --> 00:28:22,770
+vasodilatation يجلل ال filtration تمام؟ اذا على ال
+
+382
+00:28:22,770 --> 00:28:25,150
+a front vasodilatation بيجلل ال filtration على ال
+
+383
+00:28:25,150 --> 00:28:28,730
+a front vasodilatation بيجلل ال filtration والعكس
+
+384
+00:28:28,730 --> 00:28:29,950
+صحيح
+
+385
+00:28:37,790 --> 00:28:41,570
+هنتكلم عنه كثير في كل رحلتنا مع الكلية عن
+
+386
+00:28:41,570 --> 00:28:46,870
+جيبستيريا تانجويتانزيتو في كل مكان وشغلته اللي هو
+
+387
+00:28:46,870 --> 00:28:49,930
+systemic و local الوكال بيشتغل mainly على ال
+
+388
+00:28:49,930 --> 00:28:52,970
+إيفراند وإله ميكانيزم هتكلم عنها بعد شوية
+
+389
+00:28:52,970 --> 00:29:00,190
+endothelial derived nitric oxide nitric oxide one
+
+390
+00:29:00,190 --> 00:29:05,510
+of the auto coils او hormones that is vasodilator
+
+391
+00:29:06,910 --> 00:29:10,410
+تمام؟ Vasodilators و هدول مش بس في الكيلية موجود
+
+392
+00:29:10,410 --> 00:29:15,870
+everywhere ال .. ال nitrous .. ال nitric oxide و
+
+393
+00:29:15,870 --> 00:29:18,690
+هو إذا سمعتوا أنتوا في ال Viagra اللي متكلم عنها
+
+394
+00:29:18,690 --> 00:29:25,970
+اللي هو أساسهاعشان تجعل الـ Nitric Oxide موجود
+
+395
+00:29:25,970 --> 00:29:32,910
+بشكل متواصل، نمنع تكسيره نفق الـ Sildraphil اللي
+
+396
+00:29:32,910 --> 00:29:36,910
+هو الـ Viagra اللي نقول عنها هذه بتمنع تكسير الـ
+
+397
+00:29:36,910 --> 00:29:39,990
+Nitric Oxide فهذه المادة الـ Vasodilator بتاخد مدة
+
+398
+00:29:39,990 --> 00:29:45,350
+طويلةوجودها فبيقدّي الى انه nervous stimulation
+
+399
+00:29:45,350 --> 00:29:49,610
+اللي بيطلع ال nitrous nitric oxide انه طلع nitric
+
+400
+00:29:49,610 --> 00:29:53,970
+oxide وما تكسرش فبتجمع فبتجمع فبتجمع فبصير ال
+
+401
+00:29:53,970 --> 00:30:00,090
+vasoactive dose عالية فبتعمل من هنا لما بعض الناس
+
+402
+00:30:00,090 --> 00:30:05,250
+بياخدوا Viagra بيصير معهم صداع شديدتمام لإنه بيبقى
+
+403
+00:30:05,250 --> 00:30:10,970
+عندى انا generalized vasodilatation في اكتر من
+
+404
+00:30:10,970 --> 00:30:14,490
+مكان مش بس في الأماكن اللى احنا بدناياها coronary
+
+405
+00:30:14,490 --> 00:30:18,690
+او penile او كده فبيصير عنده صداع في ال in
+
+406
+00:30:18,690 --> 00:30:22,710
+cerebral arteries بتعمل صداع عشان بتعمل
+
+407
+00:30:22,710 --> 00:30:29,010
+vasodilatation بتقدر الى انه تعمله صداع شديد هذا
+
+408
+00:30:29,010 --> 00:30:33,690
+بالنسبة لمين نيتريك اكسايدبنوجد في داخل الكيلية
+
+409
+00:30:33,690 --> 00:30:37,970
+وفي كل الأنسجة وهذا من الأشياء اللي ايه إذا زاد
+
+410
+00:30:37,970 --> 00:30:39,810
+بيزود ال filtration rate وإذا جالد بيزود ال
+
+411
+00:30:39,810 --> 00:30:40,970
+filtration rate وإذا جالد بيزود ال filtration rate
+
+412
+00:30:40,970 --> 00:30:41,910
+وإذا جالد بيزود ال filtration rate وإذا جالد بيزود
+
+413
+00:30:41,910 --> 00:30:43,290
+ال filtration rate وإذا جالد بيزود ال filtration
+
+414
+00:30:43,290 --> 00:30:43,510
+rate وإذا جالد بيزود ال filtration rate وإذا جالد
+
+415
+00:30:43,510 --> 00:30:43,510
+بيزود ال filtration rate وإذا جالد بيزود ال
+
+416
+00:30:43,510 --> 00:30:43,510
+filtration rate وإذا جالد بيزود ال filtration rate
+
+417
+00:30:43,510 --> 00:30:43,770
+وإذا جالد بيزود ال filtration rate وإذا جالد بيزود
+
+418
+00:30:43,770 --> 00:30:45,610
+ال filtration rate وإذا جالد بيزود ال filtration
+
+419
+00:30:45,610 --> 00:30:51,270
+rate وإذا جالد بيزود ال filtration rate وإذا جالد
+
+420
+00:30:51,270 --> 00:30:55,400
+بيزود ال filtration rateتمام؟ عندنا مجموعة ال E
+
+421
+00:30:55,400 --> 00:31:00,560
+-prostaglandins و ال I-prostaglandins مجموعة كبيرة
+
+422
+00:31:00,560 --> 00:31:04,360
+حقيقة منها عندنا ال E2 و ال I2 هدول ايه؟
+
+423
+00:31:04,360 --> 00:31:09,300
+Vasodilators هدول ايه؟ Vasodilators مع البرادكينين
+
+424
+00:31:09,300 --> 00:31:16,420
+بيشتغلوا ال prostaglandins تشغل locally في المناطق
+
+425
+00:31:16,420 --> 00:31:22,760
+على الال .. ال .. ال arterials الجبل الكابيلاريز
+
+426
+00:31:22,760 --> 00:31:25,960
+الجبل الكابيلاريز الجبل الكابيلاريز الجبل
+
+427
+00:31:25,960 --> 00:31:28,060
+الكابيلاريز الجبل الكابيلاريز الجبل الكابيلاريز
+
+428
+00:31:28,060 --> 00:31:28,500
+الجبل الكابيلاريز الجبل الكابيلاريز الجبل
+
+429
+00:31:28,500 --> 00:31:28,700
+الكابيلاريز الجبل الكابيلاريز الجبل الكابيلاريز
+
+430
+00:31:28,700 --> 00:31:31,920
+الجبل الكابيلاريز الجبل الكابيلاريز الجبل
+
+431
+00:31:31,920 --> 00:31:33,300
+الكابيلاريز الجبل الكابيلاريز الجبل الكابيلاريز
+
+432
+00:31:33,300 --> 00:31:35,720
+الجبل الكابيلاريز الجبل الكابيلاريز الجبل
+
+433
+00:31:35,720 --> 00:31:35,720
+الكابيلاريز الجبل الكابيلاريز الجبل الكابيلاريز
+
+434
+00:31:35,720 --> 00:31:35,720
+الجبل الكابيلاريز الجبل الكابيلاريز الجبل
+
+435
+00:31:35,720 --> 00:31:35,740
+الكابيلاريز الجبل الكابيلاريز الجبل الكابيلاريز
+
+436
+00:31:35,740 --> 00:31:42,100
+الجبل الكابيلاريز الجلل .. ال .. ال tissue لال
+
+437
+00:31:42,100 --> 00:31:46,080
+oxygen لما ال metabolites زيد و ال oxygen يجلف
+
+438
+00:31:46,080 --> 00:31:50,200
+فبتطلع بصة glandes تفتح ال pre capillary pre bed
+
+439
+00:31:50,200 --> 00:31:55,960
+sphincter فبصير ال ايه ال blood supply لها ال
+
+440
+00:31:55,960 --> 00:32:02,720
+capillary bed هذا بزيد عن ال .. عن اول اذا قلتلكم
+
+441
+00:32:02,720 --> 00:32:06,520
+انا 10% من ال capillary beds فاتحة at a timeتمام
+
+442
+00:32:06,520 --> 00:32:10,260
+فبيتحكم فيها وقت إيش تفتح و وقت إيش تسكر من ضمن
+
+443
+00:32:10,260 --> 00:32:12,360
+الأشياء اللي بتحكم فيها اللي هم ال إيه ال
+
+444
+00:32:12,360 --> 00:32:15,580
+prostaglandins ال prostaglandins موجودين local في
+
+445
+00:32:15,580 --> 00:32:18,420
+كل مكان و ممكن يطلعوا و ينزلوا و يعملوا function
+
+446
+00:32:18,420 --> 00:32:22,880
+محدد يعني و بتكسروا بسرعة مافيش عندهم مجال انه
+
+447
+00:32:22,880 --> 00:32:27,020
+يخشوا الدم اه و في الدم ايه ينتشروا و يشتغلوا هان
+
+448
+00:32:27,020 --> 00:32:30,460
+و هان لذلك هم بتكونوا و بتكسروا بسرعة فبيشتغلوا
+
+449
+00:32:30,460 --> 00:32:33,660
+local إذا طلعوا بعيدوا عن مكانهم بيكونوا ايه خلاص
+
+450
+00:32:33,660 --> 00:32:39,190
+بتكسروا بياخدوش وقت طويلunder stressful conditions
+
+451
+00:32:39,190 --> 00:32:42,090
+such as volume depletion or after surgery
+
+452
+00:32:42,090 --> 00:32:44,690
+administration of non-steroidal anti-inflammatory
+
+453
+00:32:44,690 --> 00:32:50,090
+agents هذه مهمة تمام هذه مهمة في الأوجات اللي فيها
+
+454
+00:32:50,090 --> 00:32:53,690
+طالعة prostaglandins و vasodilators و احنا
+
+455
+00:32:53,690 --> 00:32:57,190
+محتاجينهاتمام عشان تحمل كلية عشان تعمل good blood
+
+456
+00:32:57,190 --> 00:33:01,150
+supply تعمل good perfusion لل blood لل .. لل
+
+457
+00:33:01,150 --> 00:33:05,170
+tissues of blood تمام with blood اروح انا استخدم
+
+458
+00:33:05,170 --> 00:33:10,550
+أشياء ضد ال .. ال .. ال prostaglandins تمام هو
+
+459
+00:33:10,550 --> 00:33:15,430
+احنا الacamol اللي بستخدمه كل يوم كيف بشتغل تمام
+
+460
+00:33:15,430 --> 00:33:21,480
+الacamol هو antiprostaglandin تماماحنا عموما ال
+
+461
+00:33:21,480 --> 00:33:24,980
+analgesics أو ال anti-inflammatory drugs اللي
+
+462
+00:33:24,980 --> 00:33:30,000
+منتجهم لجسمين جسم بنسميهم anti-steroidal وجسم
+
+463
+00:33:30,000 --> 00:33:33,900
+بنسميهم non-steroidal anti-inflammatory إذا في
+
+464
+00:33:33,900 --> 00:33:37,460
+عندي non-steroidal anti-inflammatory هدول بيشتغلوا
+
+465
+00:33:37,460 --> 00:33:40,810
+على إيه؟ بيشتغلوا على ال prostaglandinsتمام؟ إذا
+
+466
+00:33:40,810 --> 00:33:43,970
+في عندى ال drugs شائع عندنا كتير, anti
+
+467
+00:33:43,970 --> 00:33:46,970
+inflammatory drugs, analgesics, هذه بتشغل على إيه؟
+
+468
+00:33:46,970 --> 00:33:50,450
+إنها تعمل suppression لل إيه؟ Prostaglandins فإذا
+
+469
+00:33:50,450 --> 00:33:53,470
+أنا استخدمتها هذه الأشياء ال anti inflammatory في
+
+470
+00:33:53,470 --> 00:33:57,130
+أوقات أنا محتاج ال prostaglandins تمام؟ هذا ممكن
+
+471
+00:33:57,130 --> 00:34:00,310
+أعمل أنا severe ischemia أو severe damage لمين؟ لل
+
+472
+00:34:00,310 --> 00:34:06,610
+kidney functionع فكرة اليوم من السبب الرئيسي لل
+
+473
+00:34:06,610 --> 00:34:08,910
+renal failure .. لل renal failure acute او
+
+474
+00:34:08,910 --> 00:34:12,170
+chronic، بالذات ال chronic هو ال anti-inflammatory
+
+475
+00:34:12,170 --> 00:34:17,350
+drugs، يعني اليوم في عالم المتحضر هذا اللي ركبي
+
+476
+00:34:17,350 --> 00:34:20,840
+بجعني بدل اخدكل أنواع ال a ال anti-rheumatics و ال
+
+477
+00:34:20,840 --> 00:34:24,320
+anti-inflammatory هدول بيقدروا إلى اني عندى drop
+
+478
+00:34:24,320 --> 00:34:27,920
+في ال a في ال prostaglandins في الكلية بالذات
+
+479
+00:34:27,920 --> 00:34:30,820
+بتقدر إلى a vasoconstriction و destruction و
+
+480
+00:34:30,820 --> 00:34:34,380
+damage continuous damage لمين للكلية بتنتهي بكل
+
+481
+00:34:34,380 --> 00:34:38,440
+الكلينة الفالية احنا فكنا من الركب دخلنا على ال a
+
+482
+00:34:38,440 --> 00:34:44,250
+ع الكلية انواع اهوانانه كما هو لذلك في بعض الستات
+
+483
+00:34:44,250 --> 00:34:48,250
+اللي جوا او الرجال .. الستات بالذات مضمنين أدوية
+
+484
+00:34:48,250 --> 00:34:52,870
+اه لأ بدهم يوازنوا شوية وجهة بهمش يعني okay يعني
+
+485
+00:34:52,870 --> 00:34:56,870
+انا مش لازم .. مش هارجع شباب هم نفسي مارجع شباب مش
+
+486
+00:34:56,870 --> 00:35:03,010
+هنرجع شباب لكن ناخد energy معقولة لكن مش severe
+
+487
+00:35:03,010 --> 00:35:06,590
+doses و continuous و daily و اه لإن هنخش في مشكلة
+
+488
+00:35:06,590 --> 00:35:12,720
+أكبر منهابالنسبة للمواضيع المضغوطة مثل بوليوم
+
+489
+00:35:12,720 --> 00:35:16,020
+ديبليشن، عنا bleeding، عنا dehydration، عنا كذا
+
+490
+00:35:16,020 --> 00:35:20,160
+The administration of non-steroidal anti
+
+491
+00:35:20,160 --> 00:35:22,140
+-inflammatory agents اللي هم بيشتغلوا الـ non
+
+492
+00:35:22,140 --> 00:35:25,060
+-steroidal على الـ antiprostaglandin such as
+
+493
+00:35:25,060 --> 00:35:29,020
+aspirin that inhibit prostaglandin synthesis may
+
+494
+00:35:29,020 --> 00:35:35,480
+cause significant reduction in GFR الـ auto
+
+495
+00:35:35,480 --> 00:35:40,580
+regulationof GFR and adrenal blood flow انا بدأت
+
+496
+00:35:40,580 --> 00:35:46,760
+اتكلم عنه لكن احنا بيهمنا انه ال auto regulation
+
+497
+00:35:46,760 --> 00:35:49,880
+نتكلم
+
+498
+00:35:49,880 --> 00:35:53,560
+لو اتكلم عنه نتكلم عن ال juxtaglomerular
+
+499
+00:35:53,560 --> 00:35:58,640
+juxtaglomerular apparatus juxtaglomerular
+
+500
+00:35:58,640 --> 00:36:03,360
+apparatus بتكون من two components
+
+501
+00:36:06,230 --> 00:36:11,750
+عندى انا highly pigmented
+
+502
+00:36:11,750 --> 00:36:15,310
+cells
+
+503
+00:36:15,310 --> 00:36:21,030
+different in shape from the surrounding it is
+
+504
+00:36:21,030 --> 00:36:24,750
+columnar و the surrounding cuboidal تمام؟
+
+505
+00:36:24,750 --> 00:36:28,590
+condensed و the color is بليك بليك هنا في المنطقة
+
+506
+00:36:28,590 --> 00:36:35,230
+غامجة شوية عن الباقي macula densaمكيول يعني بقعة
+
+507
+00:36:35,230 --> 00:36:41,730
+دنس غامق مكثر مكولا دنسا ملاحظ في هالمنطقة دي في
+
+508
+00:36:41,730 --> 00:36:44,050
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+509
+00:36:44,050 --> 00:36:44,350
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+510
+00:36:44,350 --> 00:36:44,350
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+511
+00:36:44,350 --> 00:36:44,350
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+512
+00:36:44,350 --> 00:36:44,350
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+513
+00:36:44,350 --> 00:36:44,490
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+514
+00:36:44,490 --> 00:36:44,970
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+515
+00:36:44,970 --> 00:36:46,390
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+516
+00:36:46,390 --> 00:36:46,550
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+517
+00:36:46,550 --> 00:36:46,970
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+518
+00:36:46,970 --> 00:36:56,330
+في ال .. في ال .. في ال .. في ال .. في ال ..
+
+519
+00:37:00,160 --> 00:37:04,220
+إذا في عندي hand كمان changes موجودة في ال wall of
+
+520
+00:37:04,220 --> 00:37:10,940
+the afferent and efferent هلاجي انه ال ال ال
+
+521
+00:37:10,940 --> 00:37:18,380
+smooth muscles fibers اللي supporting ال الالـ
+
+522
+00:37:18,380 --> 00:37:21,240
+afferent والـ afferent في المنطقة هذه بتغيروا لشكل
+
+523
+00:37:21,240 --> 00:37:25,220
+تاني لخلايا من نوع آخر تمام؟ خلايا ماللاحظ احنا
+
+524
+00:37:25,220 --> 00:37:28,860
+فيها انها عندنا فيها golgi apparatus كتير يعني
+
+525
+00:37:28,860 --> 00:37:33,720
+secretary function لها بالذات هدول ال main cells
+
+526
+00:37:33,720 --> 00:37:35,380
+that secretes renin in the kidney
+
+527
+00:37:35,380 --> 00:37:41,120
+الجكستاجلوميرولاباريتاس طبعا لاحظوا انتوا الآنالـ
+
+528
+00:37:41,120 --> 00:37:44,780
+.. انه ال .. ال .. ال .. الـ distal tubule بدايتها
+
+529
+00:37:44,780 --> 00:37:49,060
+جنب ال a front و ال a front لذلك لما نقول انه لما
+
+530
+00:37:49,060 --> 00:37:54,700
+يصل ال sodium زيادة لأ ال distal بتمنع .. بتتنبه
+
+531
+00:37:54,700 --> 00:37:57,460
+ال a front و ال a front انه لأ اللي زي عندي زاد او
+
+532
+00:37:57,460 --> 00:38:02,080
+جال عشان يعمل auto regulation ما هم ملاصقين لها مش
+
+533
+00:38:02,080 --> 00:38:06,680
+بعاد عنها واضح؟ من هنا التركيبة هذه بتخلي الإشارة
+
+534
+00:38:06,680 --> 00:38:12,020
+سريعة ما بين ال .. ال ..ال .. ال .. ال .. ال .. ال
+
+535
+00:38:12,020 --> 00:38:12,020
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+536
+00:38:12,020 --> 00:38:12,360
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+537
+00:38:12,360 --> 00:38:12,520
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+538
+00:38:12,520 --> 00:38:13,780
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+539
+00:38:13,780 --> 00:38:14,620
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+540
+00:38:14,620 --> 00:38:19,780
+ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+541
+00:38:19,780 --> 00:38:22,320
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+542
+00:38:22,320 --> 00:38:23,020
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+543
+00:38:23,020 --> 00:38:23,020
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+544
+00:38:23,020 --> 00:38:23,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+545
+00:38:23,220 --> 00:38:24,280
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+546
+00:38:24,280 --> 00:38:24,280
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+547
+00:38:24,280 --> 00:38:29,200
+ال .. ال .. ال .. ال .. ال ..
+
+548
+00:38:29,200 --> 00:38:38,480
+ال .. ال ..
+
+549
+00:38:39,370 --> 00:38:45,490
+الـ auto regulation هو الجزء المهم هنا نسميه
+
+550
+00:38:45,490 --> 00:38:49,190
+tubular glomerular feedback tubular glomerular
+
+551
+00:38:49,190 --> 00:38:52,610
+feedback اللي احنا تاوم شرحته اسمه tubular
+
+552
+00:38:52,610 --> 00:38:56,830
+glomerular لان auto regulation نوعين glomerular
+
+553
+00:38:56,830 --> 00:39:02,670
+tubular و tubular glomerular هذا tubular
+
+554
+00:39:02,670 --> 00:39:06,290
+glomerular feedback أو tubular glomerular auto
+
+555
+00:39:06,290 --> 00:39:10,460
+regulationهذه واحدة و glomerular و tubular balance
+
+556
+00:39:10,460 --> 00:39:14,280
+هذا نوع تاني ال glomerular tubular balance ان لو
+
+557
+00:39:14,280 --> 00:39:20,100
+زاد ال filtration ال gfr glomerulus glomerulo نبدأ
+
+558
+00:39:20,100 --> 00:39:23,320
+من بداية اسم ال glomerulus اذا زاد glomerulus
+
+559
+00:39:23,320 --> 00:39:26,840
+function و ال filtration اتوماتيكالي بزيد ال
+
+560
+00:39:26,840 --> 00:39:30,840
+tubular function الوريه absorption ل level معين
+
+561
+00:39:30,840 --> 00:39:34,440
+يعني بينهم balance تمام؟ هذا يتعلق بال filtration
+
+562
+00:39:34,440 --> 00:39:39,560
+يتعلق بال ايه؟بال reabsorption هنا auto regulation
+
+563
+00:39:39,560 --> 00:39:44,900
+لل GFR عبر التحكم في blood vessels من هنا الكلام
+
+564
+00:39:44,900 --> 00:39:50,260
+حول ال control of blood flow فعندي auto regulation
+
+565
+00:39:50,260 --> 00:39:55,360
+لل blood supply لل glomerulus من خلال ال tubular
+
+566
+00:39:55,360 --> 00:39:59,140
+function فال tubule is a z function ال function
+
+567
+00:39:59,140 --> 00:40:04,280
+اللي اللي ال load عليها أوجل بتنبهالأفراند
+
+568
+00:40:04,280 --> 00:40:10,420
+والإفراند ارتيريوزي تيوبيلو جلوميرلر اوتو
+
+569
+00:40:10,420 --> 00:40:14,480
+ريجوليشن او feedback تاني جلوميرلر تيوبيلر balance
+
+570
+00:40:14,480 --> 00:40:18,320
+يبدأ من حياته الاسم الأولاني
+
+571
+00:40:23,740 --> 00:40:26,900
+هذا الفيديوهات يسيطر على نفسه على نفسه على نفسه
+
+572
+00:40:26,900 --> 00:40:28,720
+على نفسه على نفسه على نفسه على نفسه على نفسه على
+
+573
+00:40:28,720 --> 00:40:34,260
+نفسه على نفسه على نفسه على نفسه على نفسه على نفسه
+
+574
+00:40:34,260 --> 00:40:35,460
+على نفسه على نفسه على نفسه على نفسه على نفسه على
+
+575
+00:40:35,460 --> 00:40:37,880
+نفسه على نفسه على نفسه على نفسه على نفسه على نفسه
+
+576
+00:40:37,880 --> 00:40:39,240
+على نفسه على نفسه على نفسه على نفسه على نفسه على
+
+577
+00:40:39,240 --> 00:40:42,640
+نفسه على نفسه على نفسه على نفسه على نفسه على نفسه
+
+578
+00:40:42,640 --> 00:40:43,400
+على نفسه على نفسه على نفسه على نفسه على نفسه على
+
+579
+00:40:43,400 --> 00:40:43,400
+نفسه على نفسه على نفسه على نفسه على نفسه على نفسه
+
+580
+00:40:43,400 --> 00:40:47,280
+على نفسه على نفسه على نفسه على نفسه على نفسه على
+
+581
+00:40:47,280 --> 00:40:50,330
+نفسis out regulated at the expense of it إذا هي
+
+582
+00:40:50,330 --> 00:40:57,750
+عبارة عن إيه تحكم في ال tubular function بحيث ال
+
+583
+00:40:57,750 --> 00:41:02,590
+tubular function يكون ال load اللي عليه جد ال
+
+584
+00:41:02,590 --> 00:41:06,970
+function تبعه تمام؟ مالفعش أنا أدى احنا الأن
+
+585
+00:41:06,970 --> 00:41:12,210
+هنلاحظ أنه ال proximal tubule تشتغل شغل كبير لبه
+
+586
+00:41:12,210 --> 00:41:16,210
+في اللي بيشتغل شغلك تبقى كبيرالـ fine regulation
+
+587
+00:41:16,210 --> 00:41:21,050
+للـ distal tubule الـ distal tubule بتشتغل 5% من
+
+588
+00:41:21,050 --> 00:41:25,590
+ال reabsorption لل Sodium او لل water او اكتر او
+
+589
+00:41:25,590 --> 00:41:31,350
+اقل محدودة 20% maximum لكن لما تديها load اكبر
+
+590
+00:41:31,350 --> 00:41:35,090
+منها ده مابتقدرش تتعامل معاه تمام فإذا ال load هي
+
+591
+00:41:35,090 --> 00:41:40,750
+شغلتها تضبط الأمور بدقةفإذا زاد ال load عن قدرتها
+
+592
+00:41:40,750 --> 00:41:43,810
+اتوماتيكا اللي بيصير ال simulation لل ايه لل
+
+593
+00:41:43,810 --> 00:41:48,330
+autoregulator ميكانزم يجلل ال GFR عشان اللي يصلها
+
+594
+00:41:48,330 --> 00:41:56,570
+في الآخر تبقى منضبط حسب قدرتها واضح؟ طيب إذا عندنا
+
+595
+00:41:56,570 --> 00:42:02,130
+two components هنا نتعامل مع ماكولا دنسا و أفراند
+
+596
+00:42:02,130 --> 00:42:05,650
+و إفراند جانب بعض هي جاعدة بينهم عندنا ال أفراند
+
+597
+00:42:05,650 --> 00:42:09,200
+أرتيويلر feedback mechanismوهذا لما يزيد ال load
+
+598
+00:42:09,200 --> 00:42:13,620
+بتعمل simulation لل .. لل .. لل .. لل running يعمل
+
+599
+00:42:13,620 --> 00:42:17,460
+visa constriction لل afferent تمام؟ ولو جل ال load
+
+600
+00:42:17,460 --> 00:42:21,880
+بتعمل ايه؟ بيجل ال .. ال .. ال .. ال .. ال
+
+601
+00:42:21,880 --> 00:42:27,680
+construction يعني فهذا التأثير على ال afferent ال
+
+602
+00:42:27,680 --> 00:42:33,790
+afferent إذا صار على عكسهذه الميكانيزمات تعتمد على
+
+603
+00:42:33,790 --> 00:42:39,050
+اتجارات خاصة جكساجلوميلار جكساجلوميلار
+
+604
+00:42:39,050 --> 00:42:42,110
+جكساجلوميلار جكساجلوميلار جكساجلوميلار
+
+605
+00:42:42,110 --> 00:42:43,430
+جكساجلوميلار جكساجلوميلار جكساجلوميلار
+
+606
+00:42:43,430 --> 00:42:43,550
+جكساجلوميلار جكساجلوميلار جكساجلوميلار
+
+607
+00:42:43,550 --> 00:42:43,670
+جكساجلوميلار جكساجلوميلار جكساجلوميلار
+
+608
+00:42:43,670 --> 00:42:46,970
+جكساجلوميلار جكساجلوميلار
+
+609
+00:42:46,970 --> 00:42:49,330
+جكساجلوميلار جكساجلوميلار جكساجلوميلار
+
+610
+00:42:49,330 --> 00:42:53,330
+جكساجلوميلار جكساجلوميلار جكساجلوميلار
+
+611
+00:42:53,330 --> 00:42:57,790
+جكساجلوميلار
+
+612
+00:42:57,790 --> 00:43:09,000
+جكساجلوميلار جكساجلوميلار جتمام؟ إذا جل ال sodium
+
+613
+00:43:09,000 --> 00:43:14,440
+chloride اللى واصل لمكولا دينسا تمام؟ إذا جل بتقدي
+
+614
+00:43:14,440 --> 00:43:19,420
+إلى انه ايه؟ decrease of the sodium chloride which
+
+615
+00:43:19,420 --> 00:43:24,660
+causes dilatation of the afferent arteriole
+
+616
+00:43:24,660 --> 00:43:29,780
+هذا مباشر مش عبر الرنن هذا التأثير احنا مش عارفينه
+
+617
+00:43:29,780 --> 00:43:33,830
+كيف بيصيرتأثير ال renin أساسا و ال angiotensin 2
+
+618
+00:43:33,830 --> 00:43:38,410
+على ال efferent لكن ملاحظ احنا انه بيصير direct
+
+619
+00:43:38,410 --> 00:43:44,890
+ميكانيزم معينة انه يصير vazospasm لل efferent عشان
+
+620
+00:43:44,890 --> 00:43:49,310
+يجلي ال GFR إذا كان ال delivery ساد وإذا ال
+
+621
+00:43:49,310 --> 00:43:53,750
+delivery جال بيصير release و بيصير vazodilatation
+
+622
+00:43:53,750 --> 00:43:58,050
+و ال flow بيزيد هذا بالنسبة لمن؟ لل efferentهو هذه
+
+623
+00:43:58,050 --> 00:44:01,110
+المسألة في خلاف هو ال afferent بتأثر و لا بتأثرش
+
+624
+00:44:01,110 --> 00:44:05,270
+لإنه متأكدين إحنا إنه ال renin angiotensism شغال
+
+625
+00:44:05,270 --> 00:44:08,870
+على ال afferent لكن ال afferent إيش دوره؟في
+
+626
+00:44:08,870 --> 00:44:13,610
+ميكانيزم معينة توازي ال .. تساعد ال ايه ال effect
+
+627
+00:44:13,610 --> 00:44:18,450
+على ال افران تساعدها بمعنى اذا هان صار dilatation
+
+628
+00:44:18,450 --> 00:44:22,330
+هان بيصير ايه construction و اذا صار هان
+
+629
+00:44:22,330 --> 00:44:26,970
+construction ممكن هان يصير ايه dilatation بحيث
+
+630
+00:44:26,970 --> 00:44:30,990
+الجهتين بدهم يشتغلوا في اتجاه تزويد ال GFR او
+
+631
+00:44:30,990 --> 00:44:33,970
+الجهتين يشتغلوا في اتجاه تجليل ال GFR
+
+632
+00:44:37,430 --> 00:44:42,070
+المكونات دينسا تسلسل بسبب تغيير في تحضير الوزن
+
+633
+00:44:42,070 --> 00:44:48,490
+للتيبيوت الديستالي برضه هنا خلاف حول هو ال ال ال
+
+634
+00:44:48,490 --> 00:44:49,150
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+635
+00:44:49,150 --> 00:44:50,090
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+636
+00:44:50,090 --> 00:44:50,570
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+637
+00:44:50,570 --> 00:44:51,930
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+638
+00:44:51,930 --> 00:44:53,610
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+639
+00:44:53,610 --> 00:44:54,430
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+640
+00:44:54,430 --> 00:44:54,430
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+641
+00:44:54,430 --> 00:44:54,430
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+642
+00:44:54,430 --> 00:44:54,430
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+643
+00:44:54,430 --> 00:44:56,970
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+644
+00:45:01,820 --> 00:45:04,940
+ولا لأ في load عند زيادة في flow زيادة tubular
+
+645
+00:45:04,940 --> 00:45:10,300
+flow و Sodiumزيادة فبرضه فيها خلاص مش مهم كتير
+
+646
+00:45:10,300 --> 00:45:15,560
+المهم فيه sensation sensory effect هال
+
+647
+00:45:15,560 --> 00:45:19,920
+الماكولادينسا بتنتبه لما يزيد عنده ال sodium load
+
+648
+00:45:19,920 --> 00:45:24,860
+تمام ان كان concentration ولا sodium مش م
+
+649
+00:45:24,860 --> 00:45:28,180
+concentrated لكنه معاه flow عالي بيقدر إلى انه
+
+650
+00:45:28,180 --> 00:45:32,060
+sensation experimental studies suggest that
+
+651
+00:45:32,060 --> 00:45:38,080
+decreased GFRوهو ما يجعل الـ flow rate لدسترد
+
+652
+00:45:38,080 --> 00:45:41,900
+تيبول يتخلص من الـ GFR وهو ما يجعل ال flow rate
+
+653
+00:45:41,900 --> 00:45:43,240
+لدسترد تيبول يتخلص من الـ GFR وهو ما يجعل ال flow
+
+654
+00:45:43,240 --> 00:45:44,400
+rate لدسترد تيبول يتخلص من الـ GFR وهو ما يجعل ال
+
+655
+00:45:44,400 --> 00:45:46,240
+flow rate لدسترد تيبول يتخلص من الـ GFR وهو ما
+
+656
+00:45:46,240 --> 00:45:47,140
+يجعل ال flow rate لدسترد تيبول يتخلص من الـ GFR
+
+657
+00:45:47,140 --> 00:45:49,600
+وهو ما يجعل ال flow rate لدسترد تيبول يتخلص من الـ
+
+658
+00:45:49,600 --> 00:45:51,480
+GFR وهو ما يجعل ال flow rate لدسترد تيبول يتخلص من
+
+659
+00:45:51,480 --> 00:45:54,140
+الـ GFR وهو ما يجعل ال flow rate لدسترد تيبول
+
+660
+00:45:54,140 --> 00:45:55,880
+يتخلص من الـ
+
+661
+00:46:05,140 --> 00:46:08,820
+إذا الماكيلودين سهر جت ال signal اللي لها two
+
+662
+00:46:08,820 --> 00:46:12,300
+effects افكت على الافراند مش عارفين كده بالظبط بس
+
+663
+00:46:12,300 --> 00:46:16,420
+افكت على ال افراند اللي هو عن طريق الدمان it
+
+664
+00:46:16,420 --> 00:46:20,660
+decreases the resistance of the blood flow لما جلس
+
+665
+00:46:20,660 --> 00:46:24,100
+ال sodium delivery للدستة اللي احنا بنتكلم بيحصل
+
+666
+00:46:24,100 --> 00:46:27,700
+ال stimulation it decreases the resistance to the
+
+667
+00:46:27,700 --> 00:46:30,100
+blood flow in the afferant arteriole which raises
+
+668
+00:46:30,100 --> 00:46:32,980
+glomeral endostatic pressure and helps return of
+
+669
+00:46:32,980 --> 00:46:39,820
+GFR تمام؟ماجولناش كيف ماجولناش كيف لكن اللي بنقول
+
+670
+00:46:39,820 --> 00:46:42,800
+عنها كيف it increases renin release from the
+
+671
+00:46:42,800 --> 00:46:46,640
+juxtaglomerular cells of the afferent and efferent
+
+672
+00:46:46,640 --> 00:46:51,000
+arterioles which are major storage sites for renin
+
+673
+00:46:51,000 --> 00:46:53,840
+و renin هذا بيعمل انجوتنسين one زي ما أكدلكم
+
+674
+00:46:53,840 --> 00:46:57,720
+finally the angiotensin two constricts the
+
+675
+00:46:57,720 --> 00:47:00,520
+efferent arterioles thereby increasing the
+
+676
+00:47:00,520 --> 00:47:01,300
+glomerular
+
+677
+00:47:04,500 --> 00:47:09,040
+and resulting and returning GFR towards normal
+
+678
+00:47:09,040 --> 00:47:15,580
+طبعا إذا إضافة إنه لو الأشي قررنا نقول دوره كمان
+
+679
+00:47:15,580 --> 00:47:20,260
+على ال general circulation الرسم هذي تدينا دور ال
+
+680
+00:47:20,260 --> 00:47:29,500
+arterial pressure لو جال لو
+
+681
+00:47:29,500 --> 00:47:33,060
+جال ال arterial pressure بيقدّي إلى إنه ال GFR
+
+682
+00:47:33,060 --> 00:47:39,840
+بيجلالدليفري للماكولادينسا بيجيل تمام بيقده الى
+
+683
+00:47:39,840 --> 00:47:46,240
+حاجتين الافرند بيعمله vasoconstriction تمام افرند
+
+684
+00:47:46,240 --> 00:47:49,860
+ارتيويلاريزيستانس ريزيستانس بتزيه بتجيل تبتصر
+
+685
+00:47:49,860 --> 00:47:55,850
+vasodilatation تمام بيزود ال GFRوالطرف التاني على
+
+686
+00:47:55,850 --> 00:48:00,230
+الـ afferent بيزود ال renin angiotensin 2 بيزود ال
+
+687
+00:48:00,230 --> 00:48:04,130
+afferent resistance بتقل ال afferent resistance
+
+688
+00:48:04,130 --> 00:48:09,170
+بتزيد بتزيد فبيصير عند ال GFR من الطرفين بزيد هذا
+
+689
+00:48:09,170 --> 00:48:13,320
+ال resistance زادتبمعنى انه فازل كونستريكشن صار
+
+690
+00:48:13,320 --> 00:48:16,840
+وهذا ال resistance جلت مثلا عندنا فازل relation
+
+691
+00:48:16,840 --> 00:48:22,120
+بيصير فبيقدر تنين لان ال GFR بتزيد تمام و بيرجع ال
+
+692
+00:48:22,120 --> 00:48:25,280
+pressure ال glomerular pressure إلى A إلى طبيعته
+
+693
+00:48:25,280 --> 00:48:31,600
+من خلال زيادة resistance في ال a front و نقصان
+
+694
+00:48:31,600 --> 00:48:34,440
+resistance في ال a في ال a front هذه بتنقص من
+
+695
+00:48:34,440 --> 00:48:38,260
+ناحية ال a front و بتزيد من ناحية ال a front بتقدر
+
+696
+00:48:38,260 --> 00:48:46,270
+إلى aللزيادة هنا تقدي إلى ان ال flow rate الجي اف
+
+697
+00:48:46,270 --> 00:48:55,030
+ار يزيد طيب اذا
+
+698
+00:48:55,030 --> 00:49:00,210
+هنا عنده اتوا ميكانزم اتكلمنا عنهم when both these
+
+699
+00:49:00,210 --> 00:49:03,410
+mechanisms are functioning together the GFR
+
+700
+00:49:03,410 --> 00:49:09,830
+changes onlyThe GFR changes only few percentage
+
+701
+00:49:09,830 --> 00:49:14,430
+points تغير اللي حيصير في ال GFR جليل معناه ال
+
+702
+00:49:14,430 --> 00:49:18,890
+function مش ايه هيتغير هيرجع طبيعي واضح؟ لذلك قلنا
+
+703
+00:49:18,890 --> 00:49:24,130
+عليه من أول انه بين سبعين ومية و سبتين بيصير
+
+704
+00:49:24,130 --> 00:49:29,470
+تغيرات محسسش فرق كبير فيها ليش؟ لإن عندي زاد ال
+
+705
+00:49:29,470 --> 00:49:36,800
+pressure زاد ال GFR ال auto regulation بتمو لما
+
+706
+00:49:36,800 --> 00:49:41,540
+اقل كذلك ال auto regulation بتتم لكن بتظل
+
+707
+00:49:41,540 --> 00:49:45,980
+percentage واضحة ان في عندى لما ازيد الضغط في
+
+708
+00:49:45,980 --> 00:49:51,700
+percentage واضحة جليلة صحيح لكن بيزيد ال ال ال ال
+
+709
+00:49:51,700 --> 00:49:56,400
+urine و ال sodium excretion بعض الناس بيعرف ضغطه
+
+710
+00:49:56,400 --> 00:50:01,140
+زاد او مازدش من خلال ال urine على طول فورا زاد ال
+
+711
+00:50:01,140 --> 00:50:04,930
+urine قالوا دكتور الحق عندى الضغط زادمش عارف اكيد
+
+712
+00:50:04,930 --> 00:50:10,510
+بول زاد افحص بتلاقيه عالم الفعل بلوكيج
+
+713
+00:50:10,510 --> 00:50:15,510
+of agitation to formation further reduces GFR
+
+714
+00:50:15,510 --> 00:50:21,510
+during hyper hyperperfusion لما احنا يكون عندنا
+
+715
+00:50:21,510 --> 00:50:25,970
+blood pressure عالي اليوم من ال من ال من ال bugs
+
+716
+00:50:25,970 --> 00:50:30,920
+الرئيسية اللي بنعطيها انه ال converting enzymeاللي
+
+717
+00:50:30,920 --> 00:50:34,280
+بيمنع اللي اللي بيحول أنجوتنسين 2 إلى أنجوتنسين 1
+
+718
+00:50:34,280 --> 00:50:41,260
+بنعمله inhibition ACE inhibitors ACE inhibitors
+
+719
+00:50:41,260 --> 00:50:44,980
+أنجوتنسين converting enzyme inhibitors إذا عملنا
+
+720
+00:50:44,980 --> 00:50:47,620
+انه inhibition لل converting enzyme معناه
+
+721
+00:50:47,620 --> 00:50:52,120
+أنجوتنسين 1 بتكون لكن أنجوتنسين 2 متكون أنجوتنسين
+
+722
+00:50:52,120 --> 00:50:55,540
+1 mild vasoconstrictor أنجوتنسين 2 very severe
+
+723
+00:50:55,540 --> 00:50:57,140
+very strong vasoconstrictor
+
+724
+00:51:00,770 --> 00:51:04,750
+هذه ال drugs بنديها لنا الناس كل يوم و ماخدش بقى
+
+725
+00:51:04,750 --> 00:51:10,590
+انا مينميزش كتير تمام احيانا
+
+726
+00:51:10,590 --> 00:51:17,130
+احيانا ال drugs هذه ممنوع نستخدمها كيف يعني؟ يعني
+
+727
+00:51:17,130 --> 00:51:23,930
+انا لما الدغط بيعلى عندى بدي اصبط الدغط طب لما
+
+728
+00:51:23,930 --> 00:51:28,670
+يكون الدغط مصدره من الكلية انه الكلية انتبهت و
+
+729
+00:51:28,670 --> 00:51:32,760
+طلعت rentingتمام؟ عشان تتعالج الضغط عشان تتعرف
+
+730
+00:51:32,760 --> 00:51:38,800
+تشتغل فانت تيش تقولها انجوتنسين 2 اللي انت طلعتيه
+
+731
+00:51:38,800 --> 00:51:40,940
+عشان تتعرف تشتغل اللي بدّيش هي معناه ال kidney
+
+732
+00:51:40,940 --> 00:51:45,100
+function ايش هتسير فيه تصوروا هالحالة عندك من ضمن
+
+733
+00:51:45,100 --> 00:51:50,260
+الحالات اللي بتعمل طبعا in general اي scheme يالا
+
+734
+00:51:50,260 --> 00:51:54,060
+الكلية بتقدر الرنين يعلى ممكن تعمل hyper tension
+
+735
+00:51:54,060 --> 00:52:01,550
+يعني الضغط بتقسمه نوعين من الدكاترةدكاترة الكلة و
+
+736
+00:52:01,550 --> 00:52:06,390
+دكاترة القلب ليش؟ لأن هذا ممكن يكون سبب الرئيسي في
+
+737
+00:52:06,390 --> 00:52:09,610
+معظم الحالات القلب و تبع الكلة برضه بيقول انا ممكن
+
+738
+00:52:09,610 --> 00:52:13,610
+يكون من عندي شايل ايه اضغطت فالتانيين بتقسموا تبع
+
+739
+00:52:13,610 --> 00:52:19,370
+الكلة في حالة خاصة اسمها arena arti stenosis arena
+
+740
+00:52:19,370 --> 00:52:26,510
+arti stenosis في عندي ولد مولود بإن الشريان تبع
+
+741
+00:52:26,510 --> 00:52:34,030
+الكلةضيق لما الكلية يكون في شرينها ضيق الدم اللى
+
+742
+00:52:34,030 --> 00:52:38,890
+واصل الكائش بيكون جليل الكلية بتعرفش انه هي بس
+
+743
+00:52:38,890 --> 00:52:44,210
+عليها جليل بتفكر انه ايه كل الجسم الدم فيه مش واصل
+
+744
+00:52:44,210 --> 00:52:48,090
+انها شغلتها تحس الدم و تطبطه من ضمن شغلة الكلية
+
+745
+00:52:48,090 --> 00:52:51,630
+انها تطبط الدم فالدم وصلها جليل بتطلع رينه نجراي
+
+746
+00:52:51,630 --> 00:52:58,910
+الدق برا كويس فبتقدر انه ايه يعلىلما بيقلى برا ال
+
+747
+00:52:58,910 --> 00:53:02,910
+.. ال stenosis اللى موجود فى الارض بيصير يدخل ..
+
+748
+00:53:02,910 --> 00:53:09,230
+يخش فيه flow أكتر فبيصلها دم كويس فبتشتغل تمام؟
+
+749
+00:53:09,230 --> 00:53:12,570
+اذا هى زورت الضغط، الضغط، الضغط حتى المنطقة الديجة
+
+750
+00:53:12,570 --> 00:53:16,390
+صار فيها ضغط عالى فنزل ال flow أكتر فأدى إلى ان هى
+
+751
+00:53:16,390 --> 00:53:21,490
+تحس ان هى قدك معايا صلحت الضغطاللي وصلها بس هى
+
+752
+00:53:21,490 --> 00:53:26,290
+خربت الضغط اللى ايه اللى فى الجسم كله احنا بنروح
+
+753
+00:53:26,290 --> 00:53:29,310
+نخرب اكتر و اكتر مش ماخدين بالنا ان هدى الحالة
+
+754
+00:53:29,310 --> 00:53:33,110
+بالذات حالة ريان الاردستينوزيس بنقول بسيط اديلها
+
+755
+00:53:33,110 --> 00:53:35,930
+ايه angiotensin 2 converting enzyme inhibitors
+
+756
+00:53:35,930 --> 00:53:39,490
+بندي inhibitors تمام angiotensin 2 ايش بيصير فيه
+
+757
+00:53:40,190 --> 00:53:43,770
+الكل يبقى بتصرخ عني وأنا بصرخ .. بصرخ أيه أو أعطيه
+
+758
+00:53:43,770 --> 00:53:47,010
+فبتأدي في الآخر أنه الأدوية اللي أنا بديها أجوى من
+
+759
+00:53:47,010 --> 00:53:50,190
+أيه من ال renin و ال .. ال responses لإن أنا بدي
+
+760
+00:53:50,190 --> 00:53:53,850
+خلاص أي renin يطلع أعمله inhibition مش هكمل شغله
+
+761
+00:53:53,850 --> 00:53:57,350
+مش inhibition لل renin .. renin لل .. عشان تنسمته
+
+762
+00:53:58,410 --> 00:54:00,290
+فأيانا ان بطلجات بيطلع في الأكل انا بعمل
+
+763
+00:54:00,290 --> 00:54:02,950
+inhalation ل الانجوتنسين تقولي اللي حصل اللي حصل
+
+764
+00:54:02,950 --> 00:54:06,470
+ان هي و الكلية لها طاقة محددة تصل لمرحلة مابتقدرش
+
+765
+00:54:06,470 --> 00:54:09,330
+تطلع اكتر من هي و انا ببساطة مدي دوز يعمل
+
+766
+00:54:09,330 --> 00:54:13,230
+inhalation عشان اوطي الضغط معناها برجع الرينا ال R
+
+767
+00:54:13,230 --> 00:54:17,970
+-testosis بيقدر الى انه ال blood flow للكلية اياش
+
+768
+00:54:17,970 --> 00:54:22,250
+واطي بيخش في رينا ال ischemia و كل ال kidney
+
+769
+00:54:22,250 --> 00:54:26,420
+function بتهبطتمام؟ مالاجي صار خشنة في حالة uremia
+
+770
+00:54:26,420 --> 00:54:31,580
+شوية شوية شوية، تمام؟ ففي عند ال .. ال .. ال .. ال
+
+771
+00:54:31,580 --> 00:54:33,500
+.. ال .. هدو .. هدى الحالة، هدى ال converting
+
+772
+00:54:33,500 --> 00:54:37,000
+enzyme، ال inhibitors هدى، في بعض الحالات مش لازم
+
+773
+00:54:37,000 --> 00:54:40,130
+أستخدمها، بدي أستخدم لعب تاني من ال إيه؟من ال
+
+774
+00:54:40,130 --> 00:54:45,370
+inhibitors من ال drugs that is lowering blood
+
+775
+00:54:45,370 --> 00:54:48,430
+pressure عشان أدي فرصة ل أنجوتينسين 2 تدل شغال
+
+776
+00:54:48,430 --> 00:54:53,390
+عشان يقدي لإيه good function لإنه تأثيره مش بس على
+
+777
+00:54:53,390 --> 00:54:58,650
+ال renal blood flow كمان ال GFR لإن أنجوتينسين 2
+
+778
+00:54:58,650 --> 00:55:02,640
+أثرلي على ال efferentلأنه okay الدم شاى جليل لكن
+
+779
+00:55:02,640 --> 00:55:06,060
+هي عملت شوية construction قدت إلى أنه ال .. ال ..
+
+780
+00:55:06,060 --> 00:55:10,100
+ال .. ال GFR يتحسن فانا لما قعدت من كمان تأثير على
+
+781
+00:55:10,100 --> 00:55:13,860
+ال efferent لما قعدت من تأثير على ال efferent صار
+
+782
+00:55:13,860 --> 00:55:16,500
+الدم جليل و أنا مش بدي فوز على ال efferent يصلح
+
+783
+00:55:16,500 --> 00:55:23,580
+حاله فبيقدر إلى low GFR و lowfunctioning kidney
+
+784
+00:55:23,580 --> 00:55:28,580
+والوريه بتاعها والكلية تانية نبيعها والالكتروليس
+
+785
+00:55:28,580 --> 00:55:32,380
+الأخرى و ال trace كل ال function تبع الكلية بيوضع
+
+786
+00:55:34,110 --> 00:55:37,590
+فهذه حالة معينة من حالات الرينا ال hypoperfusion
+
+787
+00:55:37,590 --> 00:55:40,230
+هو رينا الارتسينوزيس لازم ناخد بالنا منها لأنه
+
+788
+00:55:40,230 --> 00:55:44,130
+بكرا ال clinical احنا هنشوف الاشياء ده و نمارسه و
+
+789
+00:55:44,130 --> 00:55:47,530
+ننتبهله اه ليش بالله ال angiotensin 2 ع طول من حد
+
+790
+00:55:47,530 --> 00:55:51,690
+ما استخدمت ال angiotensin 2 inhibitors ع طول
+
+791
+00:55:51,690 --> 00:55:55,770
+اليورية عليته و هتشوفوها باضح تمام دكاتر الجلب بحب
+
+792
+00:55:55,770 --> 00:55:59,810
+يعطوه هذا دكاتر كده بحبوش يعطوه ال inhibitors
+
+793
+00:56:04,820 --> 00:56:18,980
+الكلب مبسوط فورا
+
+794
+00:56:18,980 --> 00:56:27,280
+لأن هو بالنسبة له محبوش بيخبطله شغل الكلبطيب اذا
+
+795
+00:56:27,280 --> 00:56:31,300
+.. لكن في حالات ال congestive heart failure per se
+
+796
+00:56:31,300 --> 00:56:35,160
+ال .. ال convert .. ال convert انظمي كويس ندي احنا
+
+797
+00:56:35,160 --> 00:56:39,520
+لحالات ال .. ال .. ال chronic heart failure
+
+798
+00:56:39,520 --> 00:56:42,360
+congestive heart failure نديله مياهم ياخدوا
+
+799
+00:56:42,360 --> 00:56:47,840
+جرعواطي على طول تمام؟ جرعواطية على طول لكن انتوا
+
+800
+00:56:47,840 --> 00:56:54,200
+الآن فهمتوا الصراع بين ايه؟ الجهتين طيب
+
+801
+00:56:54,200 --> 00:57:00,660
+هذا بالنسبة لإيه؟الـ Autoregulation
+
+802
+00:57:00,660 --> 00:57:09,620
+عبارة عن الـ Tubular Glomerular Feedback Mechanism
+
+803
+00:57:09,620 --> 00:57:12,000
+Autoregulation في حاجة تانية في ال Autoregulation
+
+804
+00:57:12,000 --> 00:57:18,100
+في حاجة يسموها Myogenic Autoregulation بمعنى إنه
+
+805
+00:57:18,100 --> 00:57:24,340
+إذا اتضغط عليفي مكان ما تمام بروح بيصير response
+
+806
+00:57:24,340 --> 00:57:28,540
+reflex spasm للبسل هذا يعني البسل اللي الضغط عليه
+
+807
+00:57:28,540 --> 00:57:31,720
+يوسعه بيروح ايه بيصير some sort of
+
+808
+00:57:31,720 --> 00:57:37,120
+vasoconstriction reflex spasm انه يعاود ادياج عشان
+
+809
+00:57:37,120 --> 00:57:40,640
+يجلل ايه ال flow لما الضغط عليه راح الجل اصار
+
+810
+00:57:40,640 --> 00:57:47,660
+vasoconstriction لما الضغط جل يعاود بفتح عشان يدفع
+
+811
+00:57:47,660 --> 00:57:52,690
+more flowتمام؟ جالك اه هو عندك لما بيه على الضغط
+
+812
+00:57:52,690 --> 00:57:58,130
+بيقدّي إلى some sort of calcium entrance to the
+
+813
+00:57:58,130 --> 00:58:01,970
+cells بتقدّي لإيه؟ Spasm في ال smooth muscles
+
+814
+00:58:01,970 --> 00:58:05,790
+بتقدّي ل vasoconstriction إلى كده تمام؟ طبعا هي
+
+815
+00:58:05,790 --> 00:58:09,270
+يعني هو بيصير في auto regulation بس مابيش auto
+
+816
+00:58:09,270 --> 00:58:13,680
+regulation بيحس في الآخر اتحكميعني يكون يكفي لإنه
+
+817
+00:58:13,680 --> 00:58:18,200
+يضبط ال blood flow معناه مافيش عندنا مشكلة إذا ضغط
+
+818
+00:58:18,200 --> 00:58:20,700
+طبيعي لأ بيروح بيعمل vasoconstriction بيعود يظبط
+
+819
+00:58:20,700 --> 00:58:25,820
+حاله بحاله يعني في موجود إشي بس يعني its effect is
+
+820
+00:58:25,820 --> 00:58:31,120
+not so prominent تمام؟ هذا ال myogenic theory
+
+821
+00:58:31,120 --> 00:58:35,280
+myogenic auto regulation ال myo يعني muscle اه؟
+
+822
+00:58:35,280 --> 00:58:39,680
+myogenic يعني muscular فال muscles can relax لما
+
+823
+00:58:39,680 --> 00:58:44,270
+يكون في عندنالس blood pressure و can a construct
+
+824
+00:58:44,270 --> 00:58:49,670
+when we have a more blood pressure a phenomenon
+
+825
+00:58:49,670 --> 00:58:52,530
+هنا ايش بيقولها ايه another mechanism
+
+826
+00:59:07,700 --> 00:59:14,880
+النظرية التابعتها ان كالسيوم تدخل ايوان والسيلز
+
+827
+00:59:14,880 --> 00:59:16,200
+تؤدي الى ال
+
+828
+00:59:22,830 --> 00:59:25,890
+التالتة او احنا قلنا ال auto regulation reflex هذا
+
+829
+00:59:25,890 --> 00:59:29,750
+ال feedback وقلنا ال myogenic theory وقلنا في نوع
+
+830
+00:59:29,750 --> 00:59:34,750
+اخر كلام في الفصل هذا اللي هو ال dietary ال
+
+831
+00:59:34,750 --> 00:59:40,530
+dietary regulation لاحظنا انه اللي بياكل نسبة
+
+832
+00:59:40,530 --> 00:59:45,470
+بروتين عالي ال blood flow بزيد و اللي عنده السكر
+
+833
+00:59:45,470 --> 00:59:50,570
+عالي ال blood flow بزيد و ال GFR و ال blood flow
+
+834
+00:59:50,570 --> 01:00:00,350
+ليش؟يقولك ما هو ال ال GFR العادية حاملة كمية amino
+
+835
+01:00:00,350 --> 01:00:06,010
+acids عالية يعني أنا ماأكل بروتين كتير طبعا كل أكل
+
+836
+01:00:06,010 --> 01:00:13,770
+انا بروتينات اذا أنا بخير و بحب اللحون و بحب أنجي
+
+837
+01:00:13,770 --> 01:00:17,930
+أشياء من المنطقة زي الناس عادي مش مماجون فال amino
+
+838
+01:00:17,930 --> 01:00:20,970
+acids عندي اللي بتصل الدم بتصل اللي بيصلها
+
+839
+01:00:20,970 --> 01:00:25,540
+filtrationالأمينو أسس بيصير فيلتراشيون حيكون عندي
+
+840
+01:00:25,540 --> 01:00:30,500
+عبق على الصوديوم يدخلها داخل ال tubes من هو عن
+
+841
+01:00:30,500 --> 01:00:34,320
+طريق ال reabsorption للأمينو أسس عبر مين؟ عبر ال
+
+842
+01:00:34,320 --> 01:00:37,380
+sodium channels عبر ال sodium carriers facilitated
+
+843
+01:00:37,380 --> 01:00:42,280
+diffusion، transport، facilitated transport فعبر
+
+844
+01:00:42,280 --> 01:00:44,560
+الصوديوم، فبيصير more reabsorption من الصوديوم
+
+845
+01:00:44,560 --> 01:00:48,920
+الصوديوم اللي بيصل الماكولاتينسابقل لإن احنا
+
+846
+01:00:48,920 --> 01:00:52,940
+استخدمنا Sodium أكتر في ال reabsorption، مش هيك؟
+
+847
+01:00:52,940 --> 01:00:56,360
+هاد ال theory هيك بتقول انه يعني ال reabsorption
+
+848
+01:00:56,360 --> 01:00:59,960
+اللي بيزيد لل mine acids و للشجر نفس الكلام، لل
+
+849
+01:00:59,960 --> 01:01:03,280
+glucose، لما يزيد ال blood glucose، برضه ال
+
+850
+01:01:03,280 --> 01:01:07,120
+glucose يعني تنتهي من نفس التفسيرإنه عندي صار الـ
+
+851
+01:01:07,120 --> 01:01:10,740
+Reabsorption ميكانيزم زادت إن كان لإنه ال amino
+
+852
+01:01:10,740 --> 01:01:15,360
+acids زاد أو السكر زاد فال Sodium Reabsorption في
+
+853
+01:01:15,360 --> 01:01:18,460
+ال proximal بزيد ال Sodium اللي بيصل ال distal
+
+854
+01:01:18,460 --> 01:01:21,980
+للماكرودينسا بجل بيقدي إلى إنه إيه يعمل auto
+
+855
+01:01:21,980 --> 01:01:25,890
+regulation إنه زود ال GFRليش؟ لأنه الـ GFR هنا
+
+856
+01:01:25,890 --> 01:01:30,190
+قلنا معتمدين احنا ال Sodium ال Sodium ال ال ال ال
+
+857
+01:01:30,190 --> 01:01:30,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+858
+01:01:30,890 --> 01:01:31,370
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+859
+01:01:31,370 --> 01:01:32,630
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+860
+01:01:32,630 --> 01:01:33,510
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+861
+01:01:33,510 --> 01:01:34,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+862
+01:01:34,890 --> 01:01:36,530
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+863
+01:01:36,530 --> 01:01:36,530
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+864
+01:01:36,530 --> 01:01:36,810
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+865
+01:01:36,810 --> 01:01:36,810
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+866
+01:01:36,810 --> 01:01:36,810
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+867
+01:01:36,810 --> 01:01:38,330
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+868
+01:01:38,330 --> 01:01:42,530
+ال
+
+869
+01:01:42,530 --> 01:01:46,930
+ال ال ال الللوتر لان الاتنين بيمشوا بنفس البرالين
+
+870
+01:01:46,930 --> 01:01:50,690
+في اتنين فلما يجل الصوديوم لانه زاد ال
+
+871
+01:01:50,690 --> 01:01:53,410
+reabsorption تبعه بسبب انه زاد عندي ال amino acids
+
+872
+01:01:53,410 --> 01:01:57,670
+او ال glucose فبيقدر ان ال delivery بيجل بيصير
+
+873
+01:01:57,670 --> 01:02:03,190
+عندي more response narrowing لل efferent بزيد ال
+
+874
+01:02:03,190 --> 01:02:11,570
+GFR تمام؟ و بيصير عندي more ايه؟ more GFRالـ
+
+875
+01:02:11,570 --> 01:02:15,270
+proximal معناه more reabsorption لمن؟ للwater لأن
+
+876
+01:02:15,270 --> 01:02:17,950
+الاتنين بيمشوا بنفس ال barrel to each other فلما
+
+877
+01:02:17,950 --> 01:02:21,790
+يجل الصوديوم لأنه زاد ال reabsorption تبعه بسبب
+
+878
+01:02:21,790 --> 01:02:25,770
+انه زاد عندي ال amino acids او ال glucose فبيقدر
+
+879
+01:02:25,770 --> 01:02:29,450
+إلى ان ال delivery بيجل بيصير عندي more response
+
+880
+01:02:29,450 --> 01:02:37,470
+narrowing لل ال efferent بزيد ال GFR تمام؟ و بيصير
+
+881
+01:02:37,470 --> 01:02:40,330
+عندي more ايه؟ more GFR
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU.srt
new file mode 100644
index 0000000000000000000000000000000000000000..8eaf478ed95e1a18206acd7b17dfa3157b0716a2
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU.srt
@@ -0,0 +1,851 @@
+1
+00:00:05,010 --> 00:00:10,330
+بتوصلني إلى filter rate ممكن يكون isosmotic أو
+
+2
+00:00:10,330 --> 00:00:17,910
+hypotonic ممكن يوصله تمام، لكن المضلة دورها تشتغل و
+
+3
+00:00:17,910 --> 00:00:20,690
+تفتح أو تعمل إذا كان أنا بيدخل more concentration
+
+4
+00:00:20,690 --> 00:00:26,250
+لكن ممكن أنا ألغي تمامًا دور المضلة بأن الـ water
+
+5
+00:00:26,250 --> 00:00:30,430
+channels اللي مفترض نتكلم عنها من شوية هي و الـ
+
+6
+00:00:30,430 --> 00:00:33,840
+urea channels تفتح وتؤدي إلى أن هذا أو ذاك يدخل أو
+
+7
+00:00:33,840 --> 00:00:38,540
+كذا ممكن تسكت الـ water channels هذه الـ water اللي
+
+8
+00:00:38,540 --> 00:00:42,640
+جاية من الـ distal tubule متظل طالعة ما فيش أحد
+
+9
+00:00:42,640 --> 00:00:45,660
+يقول لها: "إنتِ مظبوط؟" وهذا تحت تأثير الـ
+
+10
+00:00:45,660 --> 00:00:48,980
+antidiuretic hormone إذا كان أنا محتاج ماء أكثر،
+
+11
+00:00:48,980 --> 00:00:53,480
+الـ antidiuretic hormone بيفتح الـ water channels،
+
+12
+00:00:53,480 --> 00:00:56,840
+وإذا أنا مش محتاج ماء أكثر، مش محتاج .. آه بدي ..
+
+13
+00:00:56,840 --> 00:01:01,800
+بدي إيه؟ أعمل excretion لكميات كبيرة، عندي over
+
+14
+00:01:01,800 --> 00:01:04,960
+hydration، تمام؟ فبروُح، بيُلغِي الـ antidiuretic
+
+15
+00:01:04,960 --> 00:01:08,880
+hormone وبيسكر الـ .. الـ channels وبيخلي الـ .. الـ
+
+16
+00:01:08,880 --> 00:01:10,960
+dilute دول يطلع للخارج
+
+17
+00:01:13,520 --> 00:01:21,540
+لأ، مش خلاص، احنا الـ distal convoluted tubule زائد
+
+18
+00:01:21,540 --> 00:01:25,600
+الـ system المشارك لها اللي هو الـ connecting و الـ
+
+19
+00:01:25,600 --> 00:01:30,100
+collecting tubules هدول بيقدروا يدوني diluted
+
+20
+00:01:30,100 --> 00:01:34,080
+urine أقصى ما يمكن، وإذا أنا بدي diluted urine
+
+21
+00:01:34,080 --> 00:01:37,340
+بعطل عمل الـ collecting duct
+
+22
+00:01:39,970 --> 00:01:44,550
+الـ collecting duct هذه الـ collecting duct
+
+23
+00:01:44,550 --> 00:01:49,430
+هذه الـ collecting duct بعطل عملها تمام؟ وأنا إذا
+
+24
+00:01:49,430 --> 00:01:54,090
+.. إذا .. إذا هي لها دور مهم كثير في إنها تخلّي الـ
+
+25
+00:01:54,090 --> 00:01:58,610
+urine diluted ولا هي تبقى تخلّي concentrated، هذه
+
+26
+00:01:58,610 --> 00:02:02,030
+اللي هتكلم عنها الآن، إذا في عندي أنا الـ collecting
+
+27
+00:02:02,030 --> 00:02:04,050
+duct
+
+28
+00:02:06,410 --> 00:02:12,350
+ممكن هنا الـ collecting ducts بشغلها محدود،
+
+29
+00:02:12,350 --> 00:02:17,150
+لأن كمية اللي وصلت الـ distal tubule محدودة، مش كده؟
+
+30
+00:02:17,150 --> 00:02:20,770
+فلذلك إيش ما تشتغل، هيكون معظم الأشياء راحت منها، فـ
+
+31
+00:02:20,770 --> 00:02:24,090
+maximum تشتغل 10% تمكُن تعمل reabsorption
+
+32
+00:02:24,090 --> 00:02:27,510
+للصوديوم أو البوتاسيوم، احنا قلنا لحد الـ thick
+
+33
+00:02:27,510 --> 00:02:33,090
+ascending limb نهايته احنا أخدنا 90%، 5
+
+34
+00:02:33,090 --> 00:02:40,180
+و25 و5 و60% ايش صاروا هدول؟ 90%
+
+35
+00:02:40,180 --> 00:02:43,640
+بالـ thick و الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+36
+00:02:43,640 --> 00:02:44,960
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+37
+00:02:44,960 --> 00:02:45,980
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+38
+00:02:45,980 --> 00:02:47,440
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+39
+00:02:47,440 --> 00:02:47,460
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+40
+00:02:47,460 --> 00:02:47,760
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+41
+00:02:47,760 --> 00:02:48,100
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+42
+00:02:48,100 --> 00:02:48,260
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+43
+00:02:48,260 --> 00:02:48,600
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+44
+00:02:48,600 --> 00:02:55,060
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+45
+00:02:55,060 --> 00:03:01,660
+الـ .. الـ .. الـ .. الـ .. الـ
+
+46
+00:03:06,640 --> 00:03:12,320
+الـ duct هاد الـ duct عبارة عن cuboidal cells، تمام،
+
+47
+00:03:12,320 --> 00:03:17,560
+الepithelium تبعها cuboidal، مش columnar، وهدي
+
+48
+00:03:17,560 --> 00:03:23,800
+اللي بيشتغل على الـ distal، ليه الـ distal بيشتغل عليها؟
+
+49
+00:03:23,800 --> 00:03:27,460
+يعني برضه under control، هي إذا في antidiuretic hormone
+
+50
+00:03:27,460 --> 00:03:33,440
+موجود، زي ما بيأثر على الـ .. الـ .. الـ .. الـ distal الـ
+
+51
+00:03:33,440 --> 00:03:38,190
+convoluted بيأثر عليها، إذا كان عندي الـ aldosterone
+
+52
+00:03:38,190 --> 00:03:42,910
+موجود، تمام؟ زي ما بيأثر عليها على الـ distal
+
+53
+00:03:42,910 --> 00:03:45,570
+convoluted tubule، بيأثر عليها، إيش الفرق بينها
+
+54
+00:03:45,570 --> 00:03:49,590
+وديه؟ الـ urea permeability، هديه برمي ملتوي
+
+55
+00:03:49,590 --> 00:03:54,350
+اليوريا، الـ distal thick ascending limb، برمي ملتوي
+
+56
+00:03:54,350 --> 00:04:00,550
+اليوريا، تمام؟ إذا لاحظوا الـ distal convoluted
+
+57
+00:04:00,550 --> 00:04:05,890
+برمي ملتوي اليوريا، معناها، واحنا بنسحب ماء، وجالسين، و
+
+58
+00:04:05,890 --> 00:04:10,310
+صوديوم من الـ thick ascending limb، من الـ distal
+
+59
+00:04:10,310 --> 00:04:13,610
+convoluted بنسحب ماء وصوديوم under the effect of
+
+60
+00:04:13,610 --> 00:04:16,750
+antidiuretic hormone و under the effect of
+
+61
+00:04:16,750 --> 00:04:22,870
+aldosterone، اليوريا جالكت عالية، تمام؟ لأن هي إيه؟
+
+62
+00:04:22,870 --> 00:04:26,750
+not reabsorbed في الـ distal convoluted، فلذلك إذا
+
+63
+00:04:26,750 --> 00:04:30,710
+خدنا ماء، هي علت، آه، إذا ماخدناش ماء أبدًا، التركيز
+
+64
+00:04:30,710 --> 00:04:35,290
+هيكون عالي، تمام؟ إذا بيصير reabsorption لا الـ water
+
+65
+00:04:35,290 --> 00:04:38,690
+لحالها، اليوريا بتبقى to be concentrated، تمام؟ إذا
+
+66
+00:04:38,690 --> 00:04:42,090
+اليوريا concentrated هنا، واليوريا كانت برضه not
+
+67
+00:04:42,090 --> 00:04:45,690
+reabsorbed by the thick ascending limb ولا بالـ
+
+68
+00:04:45,690 --> 00:04:48,950
+distal tubule، إذا هنا بنصل اليوريا جاهزة بتركيزها،
+
+69
+00:04:48,950 --> 00:04:52,510
+بتركيزها، واضح؟ إذا الآن هتدخل
+
+70
+00:04:52,510 --> 00:04:58,810
+الـ filtrate مع أحوال مختلفة من الـ sodium و الـ water،
+
+71
+00:04:58,810 --> 00:05:03,180
+لكنه بالقطع اليوريا عالية، إذا اليوريا
+
+72
+00:05:03,180 --> 00:05:06,940
+الداخلة بالقطع عالية، لكن الـ sodium حسب الـ
+
+73
+00:05:06,940 --> 00:05:10,940
+aldosterone كيف كان وضعه، الـ water حسب الـ
+
+74
+00:05:10,940 --> 00:05:14,440
+antidiuretic كيف وضعها، وهذه هكمل المسيرة، لكن
+
+75
+00:05:14,440 --> 00:05:18,960
+اليوريا بالقطع هي إيش؟ عالية، هنا في عندنا .. في
+
+76
+00:05:18,960 --> 00:05:23,540
+عندنا هنا في الـ .. الـ medullary duct، يوريا
+
+77
+00:05:23,540 --> 00:05:27,920
+transporters، واليوريا transporters هدول بيشتغلوا
+
+78
+00:05:27,920 --> 00:05:32,240
+أحيانًا ومش أحيانًا، الغريب أن هم اليوريا transporters مش
+
+79
+00:05:32,240 --> 00:05:35,360
+غريبة يعني إذا فهمناها، علاجها مش غريبة، بيزيدوا و
+
+80
+00:05:35,360 --> 00:05:38,800
+بيجيلوا حسب antidiuretic hormone، تمام؟ بيزيدوا و
+
+81
+00:05:38,800 --> 00:05:42,560
+بيجيلوا حسب إيه؟ الـ antidiuretic hormone، ليش؟ جالك ازعل
+
+82
+00:05:42,560 --> 00:05:46,710
+الـ antidiuretic hormone، يعني أنا بدي ماء أكثر، طب أنا
+
+83
+00:05:46,710 --> 00:05:51,030
+كمان بدي أسحب من الـ medulla ماء أكثر، عبر مين؟ الـ
+
+84
+00:05:51,030 --> 00:05:54,930
+hyperosmolality of the interstitium، مش كده؟ إذا
+
+85
+00:05:54,930 --> 00:05:58,430
+الآن واحنا داخلين الـ antidiuretic hormone عالي،
+
+86
+00:05:58,430 --> 00:06:03,560
+فاتح لي الـ water channels، الماء دخل إلى الـ
+
+87
+00:06:03,560 --> 00:06:08,400
+tubular cells إلى الـ collecting duct cells
+
+88
+00:06:08,400 --> 00:06:13,220
+ومنها تندفع إلى الـ hyperosmotic interstitium، مش
+
+89
+00:06:13,220 --> 00:06:19,040
+كده؟ فبنِسحب الماء منها من الـ filtrate، احنا لما بنسحب
+
+90
+00:06:19,040 --> 00:06:21,740
+الماء من الـ filtrate، سحبناها under the effect of، يعني
+
+91
+00:06:21,740 --> 00:06:26,480
+of the hyperosmotic interstitium، اليوريا لها حاجة
+
+92
+00:06:26,480 --> 00:06:32,810
+اسمها urea cycle، تشارك تقريبًا 50% من
+
+93
+00:06:32,810 --> 00:06:35,390
+الـ hyperosmolality اللي بتكون في الـ interstitium،
+
+94
+00:06:35,390 --> 00:06:40,510
+تشارك في مين؟ اليوريا، لذلك لما أنا أبدأ أعمل more
+
+95
+00:06:40,510 --> 00:06:43,490
+absorption of water، يعني محتاج إلى more
+
+96
+00:06:43,490 --> 00:06:47,650
+hyperosmolality medullary،
+
+97
+00:06:47,650 --> 00:06:50,910
+محتاج أدخل اليوريا عشان تشاركني في إيه؟ في بناء
+
+98
+00:06:50,910 --> 00:06:55,810
+مين؟ الـ medullary interstitium، الـ medullary إيه؟
+
+99
+00:06:55,810 --> 00:07:00,260
+osmotic gradient، إذا لمّا بدّي ماء، بدّي معها تدخل
+
+100
+00:07:00,260 --> 00:07:02,460
+الـ urea عشان تساعدني في إيه؟ تساعدني في امتصاص
+
+101
+00:07:02,460 --> 00:07:07,900
+الماء، وإذا بدّيش ماء، تمام، إذا بدّيش الـ urea، في
+
+102
+00:07:07,900 --> 00:07:10,960
+الحالة هذه، الـ urea channels والـ water channels
+
+103
+00:07:10,960 --> 00:07:14,860
+under defect of مين؟ of antidiuretic hormone، في الـ medulla
+
+104
+00:07:14,860 --> 00:07:17,810
+إذا هنا الـ medullary duct، الـ antidiuretic
+
+105
+00:07:17,810 --> 00:07:21,430
+hormone بيزيد الـ urea channels، بيفتحها، وبيزيد الـ
+
+106
+00:07:21,430 --> 00:07:25,430
+water channels، بيفتحها، لأنه بدي ماء، بدي urea تدخل
+
+107
+00:07:25,430 --> 00:07:28,450
+وتشارك في الـ hyperosmolality gradient اللي
+
+108
+00:07:28,450 --> 00:07:32,800
+هيتكوّن في الـ interstitium، بدّيش ماء، بسكر الـ
+
+109
+00:07:32,800 --> 00:07:35,220
+channels، لأن مش محتاجة، يلا الله يسهل
+
+110
+00:07:35,220 --> 00:07:38,640
+عليها، مع السلامة، تمام؟ إذا أنا بستخدمها partially
+
+111
+00:07:38,640 --> 00:07:41,860
+عشان أساعد .. وعادة بترجع، بتطلع، يعني هي دائرة
+
+112
+00:07:41,860 --> 00:07:45,260
+صغيرة، لكنها دائرة صغيرة هي ساعدتني في امتصاص إيه؟
+
+113
+00:07:45,260 --> 00:07:49,240
+ماء وتركيز عالِ عشان أنا أساعد على إن آخذ أكبر
+
+114
+00:07:49,240 --> 00:07:56,230
+كمية من إيه؟ من الماء، إذا هذه الـ duct بيشتغل عليها
+
+115
+00:07:56,230 --> 00:08:00,490
+الـ antidiuretic hormone وبيشتغل عليها الـ aldosterone،
+
+116
+00:08:00,490 --> 00:08:04,650
+طيب، الـ antidiuretic hormone حقيقة هنا عندنا مهم، كيف
+
+117
+00:08:04,650 --> 00:08:09,590
+بيشتغل عليها؟ الـ antidiuretic hormone بيشتغل عن طريق الـ
+
+118
+00:08:09,590 --> 00:08:16,370
+nucleus، عن طريق الـ .. الـ .. الـ genome تبع الـ
+
+119
+00:08:19,870 --> 00:08:24,010
+الـ aquaporins، هذا ما نسميه، aquaporins، بروتينات معينة
+
+120
+00:08:24,010 --> 00:08:27,570
+بتتكون عن طريق الـ system، لأنه بروتين، بتتكون بنفس
+
+121
+00:08:27,570 --> 00:08:30,810
+الطريقة بتتكون فيها البروتينات، وبتبقى موجودة تحت الـ
+
+122
+00:08:30,810 --> 00:08:34,230
+basement membrane، تحت الـ basement membrane، تحت الـ
+
+123
+00:08:34,230 --> 00:08:36,410
+apical membrane، تحت الـ .. هنا ما فيش brush border
+
+124
+00:08:36,410 --> 00:08:40,090
+لأن الـ collecting duct smooth surface، ما فيش
+
+125
+00:08:40,090 --> 00:08:43,230
+فيه إيه؟ brush border، الكمية اللي جاية قليلة، فمش
+
+126
+00:08:43,230 --> 00:08:49,550
+محتاجة إلى surface كبير، هنا عندي أنا what is called
+
+127
+00:08:49,550 --> 00:08:54,230
+.. أظن فيها رسمها .. مش عارف، لأ، ما عنديش رسمها، ممكن
+
+128
+00:08:54,230 --> 00:09:00,350
+رسمها ده في مكان ثاني، طيب،
+
+129
+00:09:00,350 --> 00:09:03,630
+في عندي أنا الـ proteins بتتكون وبتتحط في الـ
+
+130
+00:09:03,630 --> 00:09:07,040
+vesicles تحت الـ apical membrane، إذا كان عندك هرمون
+
+131
+00:09:07,040 --> 00:09:15,240
+بزيادة، فبتطلع، بيصير لها، بيصير لها exocytosis، بتطلع
+
+132
+00:09:15,240 --> 00:09:21,420
+لبرا، تمام؟ فبتتجد في الـ cell membrane، في الـ apical
+
+133
+00:09:21,420 --> 00:09:26,200
+membrane، وبتعمل what is called aquaporins، يعني أن
+
+134
+00:09:26,200 --> 00:09:30,740
+الـ aquaporins حقيقتها هي كذا نوع، هنا إيه؟ الـ
+
+135
+00:09:30,740 --> 00:09:33,260
+aquaporins هذه .. الـ aquaporins نوع واحد متأثرة في
+
+136
+00:09:33,260 --> 00:09:36,650
+الـ urea transporters، كذا نوع، هنا في الحالة هذه الـ
+
+137
+00:09:36,650 --> 00:09:40,190
+apical membrane بتكون الـ aquaporins، بتسمح للماء يدخل،
+
+138
+00:09:40,190 --> 00:09:45,830
+كل ما زاد الماء أكثر، كل ما الـ aquaporins طلعت
+
+139
+00:09:45,830 --> 00:09:48,950
+الـ vesicles هذه للـ cell membrane، واتكونت أكثر وطلعت
+
+140
+00:09:48,950 --> 00:09:52,270
+أكثر وساعدت في area absorption of more water اللي
+
+141
+00:09:52,270 --> 00:09:56,130
+داخل الـ cells، طبعًا كيف بندفع للداخل الـ cells؟ عند
+
+142
+00:09:56,130 --> 00:09:59,130
+.. لما يكون في .. عند aquaporins موجودة وعندي hyper
+
+143
+00:09:59,130 --> 00:10:01,950
+osmotic interstitium، الـ interstitium اللي بيسحب
+
+144
+00:10:01,950 --> 00:10:05,530
+الماء من مين؟ من الـ medullary cells، فبيخليها
+
+145
+00:10:05,530 --> 00:10:09,130
+concentrated، احنا بيخلي الماء تندفع من داخل الـ
+
+146
+00:10:09,130 --> 00:10:12,290
+tubule إلى .. إلى الـ cells إلى الـ interstitium،
+
+147
+00:10:12,290 --> 00:10:15,950
+فبنعمل .. لكن أساس الموضوع، إذا الـ pores فاتحة، يعني
+
+148
+00:10:15,950 --> 00:10:18,770
+الـ aquaporins موجودة، يعني الـ proteins والـ system
+
+149
+00:10:18,770 --> 00:10:22,790
+يعني antidiuretic hormone موجود، تمام؟ إذا كان الـ hormone
+
+150
+00:10:22,790 --> 00:10:27,510
+مش موجود، بيصير أو هيبقى جزء من الـ pores هذه بيصير لهم
+
+151
+00:10:27,510 --> 00:10:31,830
+endocytosis، تدخل إلى الداخل، تمام، وبتظل موجودة
+
+152
+00:10:31,830 --> 00:10:36,950
+في داخل الـ cells، مش معرضة للـ tubule، تمنع الـ water
+
+153
+00:10:36,950 --> 00:10:43,010
+channels إنها تشتغل وتمنع اندفاع الماء، تمام؟ نفس
+
+154
+00:10:43,010 --> 00:10:44,110
+التأثير تبع الـ ..
+
+155
+00:10:47,490 --> 00:10:50,810
+هذه الـ aquaporins موجودة على الـ basolateral
+
+156
+00:10:50,810 --> 00:10:52,670
+membrane ولا على الـ apical membrane،
+
+157
+00:11:15,520 --> 00:11:19,880
+بعد شوية هتكلم بتفصيل عن الـ aquaporins والـ ureaporins
+
+158
+00:11:19,880 --> 00:11:23,160
+الـ transporters، بس خليني هتكلم الآن، الـ antidiuretic hormone
+
+159
+00:11:23,160 --> 00:11:28,380
+permeability of the medullary collecting duct to
+
+160
+00:11:28,380 --> 00:11:32,190
+water is controlled by the antidiuretic hormone، unlike
+
+161
+00:11:32,190 --> 00:11:34,030
+the cortical collecting tubule، the medullary
+
+162
+00:11:34,030 --> 00:11:38,430
+collecting duct is permeable to water، برضه اليوريا
+
+163
+00:11:38,430 --> 00:11:44,750
+حسب موجود عندك هرمون كثير ولا لأ، لأن اليوريا
+
+164
+00:11:44,750 --> 00:11:48,290
+transporters موجودة أكثر ولا أقل، لكنه زي نظام
+
+165
+00:11:48,290 --> 00:11:52,410
+الـ elective، يعني the medullary collecting duct
+
+166
+00:11:52,410 --> 00:11:54,190
+is capable of secreting hydrogen
+
+167
+00:11:58,140 --> 00:12:01,100
+الجملتين اللي أنا بدي أحطهم حقيقة في جملة فوق
+
+168
+00:12:01,100 --> 00:12:04,660
+وجملة تحت، إن الـ medullary collecting duct is
+
+169
+00:12:04,660 --> 00:12:08,200
+capable of secreting hydrogen ions against a large
+
+170
+00:12:08,200 --> 00:12:12,000
+concentration gradient، as also occurs in the
+
+171
+00:12:12,000 --> 00:12:15,920
+cortical collecting tubule، يعني عندنا هنا في
+
+172
+00:12:15,920 --> 00:12:21,180
+hydrogen،  الـ secretion system زي اللي موجود في الـ distal
+
+173
+00:12:21,180 --> 00:12:27,010
+tubule، موجود في الـ intercalated cells، الـ hydrogen ions، الـ system
+
+174
+00:12:27,010 --> 00:12:29
+
+223
+00:15:55,470 --> 00:16:03,560
+هذه؟ طيب ماشي، الـ inulin مادة صناعية، وبدي أعطيها و
+
+224
+00:16:03,560 --> 00:16:06,340
+بدي أعطيها لكنها more accurate than the others و
+
+225
+00:16:06,340 --> 00:16:12,800
+احنا مستخدمينها في معاينة قياس الأشياء في التجارب
+
+226
+00:16:12,800 --> 00:16:16,900
+تبعتنا الـ inulin من جيس الـ inulin، قداش في الـ
+
+227
+00:16:16,900 --> 00:16:21,660
+filtrate وقداش في الـ plasma، تمام؟ حيث يرتفع نسبة
+
+228
+00:16:21,660 --> 00:16:25,420
+الـ inulin في الـ filtrate على الـ plasma، مش كده؟
+
+229
+00:16:25,420 --> 00:16:29,480
+معناها صار concentration، يعني مش هيكالانيولين
+
+230
+00:16:29,480 --> 00:16:33,540
+تركيزه في الـ plasma واحد، وفي الفيلتريت صارت
+
+231
+00:16:33,540 --> 00:16:39,320
+اتنين، معناه أنا في عندي ايه؟ في عندي نص المية امتصت
+
+232
+00:16:39,320 --> 00:16:43,780
+عشان كده الانيولين اللي لا يمتص ارتفع، صارت ضعيف
+
+233
+00:16:43,780 --> 00:16:49,320
+نزلنا كمان لتحت شوية، لاجينا الانيولين زاد تلت
+
+234
+00:16:49,320 --> 00:16:53,670
+أضعاف، معناه تلت المية باقي، وتلتين راحوا كمية
+
+235
+00:16:53,670 --> 00:16:57,750
+الماء الموجودة أتركزت ثلاثة أضعاف المادة، مش كده؟
+
+236
+00:16:57,750 --> 00:17:01,990
+يعني احنا بنستخدمه في التجارب تبعتنا حتى نعرف من
+
+237
+00:17:01,990 --> 00:17:05,610
+منطقة لمنطقة في الـ... في الـ... في النفرون ايش
+
+238
+00:17:05,610 --> 00:17:09,630
+بيصير للمية، قداش reabsorbed من خلال علاقة التركيز
+
+239
+00:17:09,630 --> 00:17:13,510
+على الانولين مع تركيز مين؟ مع تركيز البلازما، بيقول
+
+240
+00:17:13,510 --> 00:17:16,030
+اه والله، هنا الانولين زاد، هو لا يمتص ولا... ولا
+
+241
+00:17:16,030 --> 00:17:19,690
+secreted، زاد لأنه المية راحت، قداش راحت مية وقداش صار
+
+242
+00:17:19,690 --> 00:17:24,960
+تركيز، تمام؟ كل ما بيزيد ميّه الـ reabsorption كل ما
+
+243
+00:17:24,960 --> 00:17:29,460
+بيزيد التركيز... مش قصة كبيرة، بس احنا من خلالها
+
+244
+00:17:29,460 --> 00:17:34,380
+بنلاحظها انه في الـ collecting tubules، ساحة خالص
+
+245
+00:17:34,380 --> 00:17:40,900
+بنلاقي انه احنا تركيز الانيولين بيصير 125 ضعف، بمعنى
+
+246
+00:17:40,900 --> 00:17:47,770
+انه احنا فقدنا عندنا واحد من 125 من المية الأساسية
+
+247
+00:17:47,770 --> 00:17:50,730
+عشان كده نتركز لإيه؟ في الحالة اللي بيقول اه ما هو
+
+248
+00:17:50,730 --> 00:17:55,450
+احنا عندنا ايش الـ... الـ filtrate والـ... جميع الفيلتريت هو
+
+249
+00:17:55,450 --> 00:18:02,830
+125، تمام؟ لما يرفع الـ... الـ... الـ urine الـ... الـ...
+
+250
+00:18:02,830 --> 00:18:06,310
+الـ... الـ inulin concentration في الـ urine إلى 125
+
+251
+00:18:06,310 --> 00:18:10,190
+ضعف، تمام؟ معناه ان الـ answer عندنا مية واحد على 125
+
+252
+00:18:10,190 --> 00:18:13,860
+من الأساسية، المية الأساسية هي اللي filtered. The
+
+253
+00:18:13,860 --> 00:18:17,960
+math معلنة، مش قصة كبيرة، قصة سهلة كتير، بس بتفهمنا
+
+254
+00:18:17,960 --> 00:18:20,900
+احنا كيف قسنا الـ water concentration under
+
+255
+00:18:20,900 --> 00:18:23,860
+absorptive mechanisms في الـ different parts of the
+
+256
+00:18:23,860 --> 00:18:27,360
+nephron من خلال العلاقة ما بين الـ... الـ... الـ
+
+257
+00:18:27,360 --> 00:18:30,100
+inulin concentration و الـ plasma concentration، كل
+
+258
+00:18:30,100 --> 00:18:32,240
+ما بيزيد، كل ما بنعرف ايش اسمه، المرة اللي جاية ان
+
+259
+00:18:32,240 --> 00:18:35,680
+شاء الله نتكلم عن الـ regulation system في الـ ايه؟
+
+260
+00:18:35,680 --> 00:18:43,450
+الـ nephron، مين هي؟ السؤال يا بنات؟ اه، اعطيكم
+
+261
+00:18:43,450 --> 00:18:46,130
+العافية، احنا ضايقين، معانا دقيقة، يعني بتسأل
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..b2c2e57e06898f978634afabf15b1f87efde7f46
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU_postprocess.srt
@@ -0,0 +1,1044 @@
+1
+00:00:05,010 --> 00:00:10,330
+بتوصللي الى filter rate ممكن يكون isosmotic او
+
+2
+00:00:10,330 --> 00:00:17,910
+hypotonic ممكن يوصله تمام لكن المضلة دورها تشتغل و
+
+3
+00:00:17,910 --> 00:00:20,690
+تفتح او تعمل اذا كان انا بيدعمل more concentration
+
+4
+00:00:20,690 --> 00:00:26,250
+لكن ممكن انا ألغي تماما دور المضلة بان ال water
+
+5
+00:00:26,250 --> 00:00:30,430
+channels اللي مفترض نتكلم عنها من شوية هي و ال
+
+6
+00:00:30,430 --> 00:00:33,840
+urea channels تفتحوتأدي إلى أن هذا أو هذا يدخل أو
+
+7
+00:00:33,840 --> 00:00:38,540
+كذا ممكن تسكت ال water channels هذه ال water اللي
+
+8
+00:00:38,540 --> 00:00:42,640
+جاية من ال distal tubule متظل طالعة مافيش حد
+
+9
+00:00:42,640 --> 00:00:45,660
+يقولها واني انت مظبوط؟ وهذا تحت تأثير ال
+
+10
+00:00:45,660 --> 00:00:48,980
+antiderivative hormoneإذا كان أنا محتاج ميه أكتر،
+
+11
+00:00:48,980 --> 00:00:53,480
+الـ Antioxidant hormone بيفتح ال water channels،
+
+12
+00:00:53,480 --> 00:00:56,840
+وإذا أنا مش محتاج ميه أكتر، مش محتاج .. أه بدي ..
+
+13
+00:00:56,840 --> 00:01:01,800
+بدي إيه؟ أعمل execution لكميات كبيرة، عندي over
+
+14
+00:01:01,800 --> 00:01:04,960
+hydration، تمام؟ فبروح، بيلضغي ال Antioxidant
+
+15
+00:01:04,960 --> 00:01:08,880
+hormone و بسكر ال .. ال channels و بخلي ال .. ال
+
+16
+00:01:08,880 --> 00:01:10,960
+dilute دول يطلع للخارج
+
+17
+00:01:13,520 --> 00:01:21,540
+لأ مش خلاص احنا الـ distal convoluted tubule زائد
+
+18
+00:01:21,540 --> 00:01:25,600
+ال system المشارك إلها اللي هو ال connecting و ال
+
+19
+00:01:25,600 --> 00:01:30,100
+collecting tubules هدول بيقدروا يدوني diluted
+
+20
+00:01:30,100 --> 00:01:34,080
+urine أقصى ما يمكن و إذا أنا بدي diluted urine
+
+21
+00:01:34,080 --> 00:01:37,340
+بعطل عمل ال collecting مضلة
+
+22
+00:01:39,970 --> 00:01:44,550
+المدلّري دكت هذه الـ collecting duct المدلّري دكت
+
+23
+00:01:44,550 --> 00:01:49,430
+هذه الـ security duct بعطل عملها تمام؟ و أنا إذا
+
+24
+00:01:49,430 --> 00:01:54,090
+.. إذا .. إذا هي لها دور مهم كتير في إنها تخلّي ال
+
+25
+00:01:54,090 --> 00:01:58,610
+urine diluted ولا هي تبقى تخلّي concentrated هذه
+
+26
+00:01:58,610 --> 00:02:02,030
+اللي هتكلم عنها الآن إذا في عندى أنا المدلّري
+
+27
+00:02:02,030 --> 00:02:04,050
+collecting duct
+
+28
+00:02:06,410 --> 00:02:12,350
+ممكن هان المدارس اللي collecting ducks بشغلهامحدود
+
+29
+00:02:12,350 --> 00:02:17,150
+لان كمية اللى وصلت ال دستر تيوبيول محدود مش كده
+
+30
+00:02:17,150 --> 00:02:20,770
+فلذلك ايش ما تشتغل هيكون معظم الأشياء راحت منها ف
+
+31
+00:02:20,770 --> 00:02:24,090
+maximum تشتغل عشرة فالمية تمك در تعمل reabsorption
+
+32
+00:02:24,090 --> 00:02:27,510
+للصوديوم او البوتاسيوم احنا قولنا لحد ال thick
+
+33
+00:02:27,510 --> 00:02:33,090
+ascending limb نهايته احنا أخدنا تسعين المية خمسة
+
+34
+00:02:33,090 --> 00:02:40,180
+وخمسة وعشرين وخمسة وستينياديش صاروا هدول؟ تسعين
+
+35
+00:02:40,180 --> 00:02:43,640
+بال تكت و ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+36
+00:02:43,640 --> 00:02:44,960
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+37
+00:02:44,960 --> 00:02:45,980
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+38
+00:02:45,980 --> 00:02:47,440
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+39
+00:02:47,440 --> 00:02:47,460
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+40
+00:02:47,460 --> 00:02:47,760
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+41
+00:02:47,760 --> 00:02:48,100
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+42
+00:02:48,100 --> 00:02:48,260
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+43
+00:02:48,260 --> 00:02:48,600
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+44
+00:02:48,600 --> 00:02:55,060
+.. ال .. ال .. ال .. ال .. ال .. ال ..
+
+45
+00:02:55,060 --> 00:03:01,660
+ال .. ال .. ال .. ال .. ال
+
+46
+00:03:06,640 --> 00:03:12,320
+الدكت هاد الدكت عبارة عن cuboidal cells تمام
+
+47
+00:03:12,320 --> 00:03:17,560
+الابيثيليوم تبعها cuboidal مواشي كولامنار وهدى
+
+48
+00:03:17,560 --> 00:03:23,800
+اللى بيشتغل على ال دستال ليه الدستال بيشتغل عليها
+
+49
+00:03:23,800 --> 00:03:27,460
+يعني برضه under control هى إذا فى أنتدرت حرمول
+
+50
+00:03:27,460 --> 00:03:33,440
+موجود زى ما أثر على ال .. ال .. ال .. الدستال ال
+
+51
+00:03:33,440 --> 00:03:38,190
+convoluted بيأثر عليهاإذا كان عندى الـ Aldosterone
+
+52
+00:03:38,190 --> 00:03:42,910
+موجود تمام؟ زى ما بيأثر عليها على الـDistal
+
+53
+00:03:42,910 --> 00:03:45,570
+convoluted tubule بيأثر عليها إيش الفرق بينها
+
+54
+00:03:45,570 --> 00:03:49,590
+دوهادى؟ الـUrea permeability هدى برمى ملتوى
+
+55
+00:03:49,590 --> 00:03:54,350
+اليوريا الـDistal thick ascending limb مبرمى ملتوى
+
+56
+00:03:54,350 --> 00:04:00,550
+اليوريا تمام؟ إذا لاحظوا الـDistal convoluted
+
+57
+00:04:00,550 --> 00:04:05,890
+مبرمى ملتوى اليوريا معناهاو احنا نسحب ميه جاعدين و
+
+58
+00:04:05,890 --> 00:04:10,310
+سوديوم من ال thick ascending limb من ال distal
+
+59
+00:04:10,310 --> 00:04:13,610
+convertibule نسحب ميه و سوديوم under the effect of
+
+60
+00:04:13,610 --> 00:04:16,750
+antidepressant hormone و under the effect of
+
+61
+00:04:16,750 --> 00:04:22,870
+aldosterone اليوريا جالكت اعلى تمام؟ لإن هي ايه؟
+
+62
+00:04:22,870 --> 00:04:26,750
+not reabsorbed في ال distal convertibule فلذلك اذا
+
+63
+00:04:26,750 --> 00:04:30,710
+خدنا ميه هي عليت اه اذا ماخدناش ميه ابدا التركيز
+
+64
+00:04:30,710 --> 00:04:35,290
+هو هوتمام؟ إذا بيصير reabsorption لا ال water
+
+65
+00:04:35,290 --> 00:04:38,690
+لحالها اليوريا بتبقى to be concentrated تمام؟ إذا
+
+66
+00:04:38,690 --> 00:04:42,090
+اليوريا concentrated هنا و اليوريا كانت برضه not
+
+67
+00:04:42,090 --> 00:04:45,690
+reabsorbed by the thick ascending limb ولا بال
+
+68
+00:04:45,690 --> 00:04:48,950
+distal tubule إذا هنا بنصل اليوريا جاهدة بيه على
+
+69
+00:04:48,950 --> 00:04:52,510
+تركيزها بيه على تركيزها واضح؟ إذا الآن هتدخل
+
+70
+00:04:52,510 --> 00:04:58,810
+الفلترات مع أحوال مختلفة من ال sodium و ال water
+
+71
+00:04:58,810 --> 00:05:03,180
+لكنه بالقطع اليوريا عياشةعالية، اذا اليوريا
+
+72
+00:05:03,180 --> 00:05:06,940
+هالداخلة بالقطع عالية، لكن ال sodium حسب ال
+
+73
+00:05:06,940 --> 00:05:10,940
+aldosterone كيف كان وضعه، ال water حسب ال
+
+74
+00:05:10,940 --> 00:05:14,440
+antioxidant كيف وضعها، وهذه هكمل المسيرة، لكن
+
+75
+00:05:14,440 --> 00:05:18,960
+اليوريا بالقطع هي ايش؟ عالية، هنا في عندنا .. في
+
+76
+00:05:18,960 --> 00:05:23,540
+عندنا هنا في ال .. ال medullary duct يوريا
+
+77
+00:05:23,540 --> 00:05:27,920
+transportersو الوريا ترانسبورتر هدول بيشتغلوا
+
+78
+00:05:27,920 --> 00:05:32,240
+أحيان و مش أحيان الغريب أن هم الوريا ترانسبورتر مش
+
+79
+00:05:32,240 --> 00:05:35,360
+غريبة يعني إذا فهمناها علاجها مش غريبة بيزيدوا و
+
+80
+00:05:35,360 --> 00:05:38,800
+بيجيلوا حسب الانترداد الكرمان تمام؟ بيزيدوا و
+
+81
+00:05:38,800 --> 00:05:42,560
+بيجيلوا حسب إيه؟ الانترداد الكرمان ليش؟ جالك ازعل
+
+82
+00:05:42,560 --> 00:05:46,710
+الانترداد الكرمانيعني انا بدي مياه اكتر، طب انا
+
+83
+00:05:46,710 --> 00:05:51,030
+كمان بدي اسحب من المدلّر دا مياه اكتر، عبر مين؟ ال
+
+84
+00:05:51,030 --> 00:05:54,930
+hyper osmolality of the interstitium، مش كده؟ اذا
+
+85
+00:05:54,930 --> 00:05:58,430
+الان و احنا دخلين ال antidiabetic hormone عالي
+
+86
+00:05:58,430 --> 00:06:03,560
+فاتحلي ال water channelsالماية دخلت إلى الـ
+
+87
+00:06:03,560 --> 00:06:08,400
+tubular الـ cells إلى الـ collecting duct cells
+
+88
+00:06:08,400 --> 00:06:13,220
+ومنها تندفع إلى الـ hyperosmotic interstitium مش
+
+89
+00:06:13,220 --> 00:06:19,040
+كده فبنسحب الميا منها من الفلترات احنا لما بنسحب
+
+90
+00:06:19,040 --> 00:06:21,740
+الميا من الفلترات سحبناها under the effect of mean
+
+91
+00:06:21,740 --> 00:06:26,480
+of the hyperosmotic interstitium اليوريا لها حاجة
+
+92
+00:06:26,480 --> 00:06:32,810
+اسمها يوريا cycleتشارك تقريباً خمسين في المية من
+
+93
+00:06:32,810 --> 00:06:35,390
+الـ hyperosmolality اللي بتكون في الـ interstitial
+
+94
+00:06:35,390 --> 00:06:40,510
+تشارك في مين اليوريا لذلك لما انا بدأ اعمل more
+
+95
+00:06:40,510 --> 00:06:43,490
+absorption of water يعني محتاج إلى more
+
+96
+00:06:43,490 --> 00:06:47,650
+hyperosmotic مضالة
+
+97
+00:06:47,650 --> 00:06:50,910
+محتاج ادخل اليوريا عشان شاركني في ايه؟ في بناء
+
+98
+00:06:50,910 --> 00:06:55,810
+المين الـ interstitial مضالة الـ interstitial ايه؟
+
+99
+00:06:55,810 --> 00:07:00,260
+osmotic gradientإذا لمّا بدّي ميّه، بدّي معها تدخل
+
+100
+00:07:00,260 --> 00:07:02,460
+الـUrea عشان تساعدني في إيه؟ تساعدني في امتصاص
+
+101
+00:07:02,460 --> 00:07:07,900
+الميّه وإذا بدّيش ميّه تمام، إذا بدّيش الـUrea في
+
+102
+00:07:07,900 --> 00:07:10,960
+الحالة هذه الـUrea channels و ال water channels
+
+103
+00:07:10,960 --> 00:07:14,860
+under defect of مين؟ of antidote hormone في المدلة
+
+104
+00:07:14,860 --> 00:07:17,810
+Reductإذا هنا الـ Medullary Duct الـ Antiduct
+
+105
+00:07:17,810 --> 00:07:21,430
+hormone بيزيد الـ urea channels بيفتحها و بيزيد ال
+
+106
+00:07:21,430 --> 00:07:25,430
+water channels بيفتحها لأنه بدي ميه بدي urea تدخل
+
+107
+00:07:25,430 --> 00:07:28,450
+و تتشعد في الـ hyperosmolality gradient اللي
+
+108
+00:07:28,450 --> 00:07:32,800
+هيتكوّن في الـ interstitium بديش ميهبسكر ال
+
+109
+00:07:32,800 --> 00:07:35,220
+channels لان مش محتاجة لانتصار .. يلا الله يسهل
+
+110
+00:07:35,220 --> 00:07:38,640
+عليها مع السلامة، تمام؟ إذا أنا بستخدمها partially
+
+111
+00:07:38,640 --> 00:07:41,860
+عشان أساعد .. وعادة بترجع، بتطلع، يعني هي دائرة
+
+112
+00:07:41,860 --> 00:07:45,260
+صغيرة، لكنها دائرة صغيرة هي ساعدتني في امتصاص إيه؟
+
+113
+00:07:45,260 --> 00:07:49,240
+ميه و تركيز ball عشان أنا أساعد على إن أاخد أكبر
+
+114
+00:07:49,240 --> 00:07:56,230
+كمية من إيه؟ من الميهإذا هذه الـ duct بيشتغل عليها
+
+115
+00:07:56,230 --> 00:08:00,490
+الـ Antidote hormone وبيشتغل عليها ال Aldosterone
+
+116
+00:08:00,490 --> 00:08:04,650
+طيب ال Antidote hormone حقيقة هان عنا مهم كيف
+
+117
+00:08:04,650 --> 00:08:09,590
+بيشتغل عليها ال Antidote hormone بيشتغل عن طريق ال
+
+118
+00:08:09,590 --> 00:08:16,370
+nucleus عن طريق ال ال ال genome تبع ال
+
+119
+00:08:19,870 --> 00:08:24,010
+الاكوا بورز هذا ما نسميها الاكوا بورز بروتيز معينة
+
+120
+00:08:24,010 --> 00:08:27,570
+بتتكون عن طريق ال system لأنه بروتين بتتكون بنفس
+
+121
+00:08:27,570 --> 00:08:30,810
+الطريقة بتتكون فيها البروتيز وبتبقى موجودة تحت ال
+
+122
+00:08:30,810 --> 00:08:34,230
+basement membrane تحت اليمنى ال membrane تحت ال
+
+123
+00:08:34,230 --> 00:08:36,410
+apical membrane تحت ال .. هنا مافيش brush border
+
+124
+00:08:36,410 --> 00:08:40,090
+لأن ال collecting duct smooth ايه surface مافيش
+
+125
+00:08:40,090 --> 00:08:43,230
+فيه ايه brush border الكمية اللي جاية جليلة فمش
+
+126
+00:08:43,230 --> 00:08:49,550
+محتاجة إلى surface كبيرهنا عندي انا what is called
+
+127
+00:08:49,550 --> 00:08:54,230
+.. اظن فيها رسمها .. مش عارف لأ مالعش رسمها ممكن
+
+128
+00:08:54,230 --> 00:09:00,350
+رسمها ده في مكان تاني طيب،
+
+129
+00:09:00,350 --> 00:09:03,630
+في عندي انا ال proteins بتتكون و بتحط في ال
+
+130
+00:09:03,630 --> 00:09:07,040
+physicals تحت ال apical membraneإذا كان عندك هرمون
+
+131
+00:09:07,040 --> 00:09:15,240
+بزيادة فبتطلع بيصير لها بيصير لها exocytosis بتطلع
+
+132
+00:09:15,240 --> 00:09:21,420
+لبرا تمام؟ فبتجد في ال cell membrane في ال apical
+
+133
+00:09:21,420 --> 00:09:26,200
+membrane و بتعمل what is called aquapores يعني أن
+
+134
+00:09:26,200 --> 00:09:30,740
+ال aquapores حقيقتها هي كذا نوع هنا ايه؟ ال
+
+135
+00:09:30,740 --> 00:09:33,260
+aquapores هذه .. ال aquapores نوع واحد متأثرة في
+
+136
+00:09:33,260 --> 00:09:36,650
+اليوريا ترانس بورتاس كذا نوعهنا في الحالة هذه الـ
+
+137
+00:09:36,650 --> 00:09:40,190
+apical membrane بتكون الأكوا بورز بتسمح للميه تدخل
+
+138
+00:09:40,190 --> 00:09:45,830
+كل ما زاد الميه أكتر كل ما الأكوا بورز طلعت
+
+139
+00:09:45,830 --> 00:09:48,950
+الفيسيكلز هذه للcell membrane و اتكونت أكتر و طلعت
+
+140
+00:09:48,950 --> 00:09:52,270
+أكتر و ساعدت في area absorption of more water اللي
+
+141
+00:09:52,270 --> 00:09:56,130
+داخل ال cellsطبعاً كيف بندفع لداخل الـ cells عند
+
+142
+00:09:56,130 --> 00:09:59,130
+.. لما يكون في .. عند اكوا بورز موجودة وعندي hyper
+
+143
+00:09:59,130 --> 00:10:01,950
+osmotic interstitium الـ interstitium اللي بيسحب
+
+144
+00:10:01,950 --> 00:10:05,530
+الميه من مين؟ من الـ medullary cells فبيخليها
+
+145
+00:10:05,530 --> 00:10:09,130
+concentrated احنا بيخلي الميه تندفع من داخل ال
+
+146
+00:10:09,130 --> 00:10:12,290
+tubule إلى .. إلى ال cells إلى ال interstitium
+
+147
+00:10:12,290 --> 00:10:15,950
+فبنعمل .. لكن أساس الموضوع إذا ال بورز فاتحة يعني
+
+148
+00:10:15,950 --> 00:10:18,770
+ال أكوا بورز موجودة يعني ال proteins و ال system
+
+149
+00:10:18,770 --> 00:10:22,790
+يعني أنتدوم الفيرمون موجود تمام؟إذا كانت الكربون
+
+150
+00:10:22,790 --> 00:10:27,510
+مش موجود بيصيح أو هبق جزء من ال بورز هذه بيصيرهم
+
+151
+00:10:27,510 --> 00:10:31,830
+endocytosis تدخل إلى الداخل تمام و بتظلها موجودة
+
+152
+00:10:31,830 --> 00:10:36,950
+في داخل ال cells مش معرضة لل tubule تمنع ال water
+
+153
+00:10:36,950 --> 00:10:43,010
+channels أنها تشتغل و تمنع اندفع الميه تمام؟ نفس
+
+154
+00:10:43,010 --> 00:10:44,110
+التأثير تبع ال ..
+
+155
+00:10:47,490 --> 00:10:50,810
+هذه الأكبر بورزون موجودة على الـ Basal Laser
+
+156
+00:10:50,810 --> 00:10:52,670
+Lateral Membrane ولا على الـ Apical Membrane
+
+157
+00:11:15,520 --> 00:11:19,880
+بعد شوية هتكلم بتفصيل عن ال اكوابورز واليوريابورز
+
+158
+00:11:19,880 --> 00:11:23,160
+ال transporters بس خليني هتكلم ان الانترنت الهرمون
+
+159
+00:11:23,160 --> 00:11:28,380
+برميبيريتي of the medulla recollecting duct to
+
+160
+00:11:28,380 --> 00:11:32,190
+water is controlled by the enteric hormoneUnlike
+
+161
+00:11:32,190 --> 00:11:34,030
+the cortical collecting tube, the medullary
+
+162
+00:11:34,030 --> 00:11:38,430
+collecting duct is permeable to water برضه تيوريا
+
+163
+00:11:38,430 --> 00:11:44,750
+حسب موجود عندك كرمون كتير ولا لأ لإن الهيرا
+
+164
+00:11:44,750 --> 00:11:48,290
+ترانسبورتر موجودة أكتر ولا أجل لكنه زي نظام
+
+165
+00:11:48,290 --> 00:11:52,410
+الـElectively يعني The medullary collecting duct
+
+166
+00:11:52,410 --> 00:11:54,190
+is capable of secreting hydrogen
+
+167
+00:11:58,140 --> 00:12:01,100
+الجملتين اللي انا بدي احطهم حقيقة في جملة فوق
+
+168
+00:12:01,100 --> 00:12:04,660
+وجملة تحت ان الـmedullary collecting duct is
+
+169
+00:12:04,660 --> 00:12:08,200
+capable of secreting hydrogen ions against a large
+
+170
+00:12:08,200 --> 00:12:12,000
+concentration gradient as also occurs in the
+
+171
+00:12:12,000 --> 00:12:15,920
+cortical collecting tubule يعني عندنا هنا في
+
+172
+00:12:15,920 --> 00:12:21,180
+hydrogen التبييز system زي اللي موجود في الدسترال
+
+173
+00:12:21,180 --> 00:12:27,010
+تبيول موجود في الـA خص ال hydrogen ionsالـ system
+
+174
+00:12:27,010 --> 00:12:29,510
+لازال موجود بيصل للاخر يعني من الـ distal tube
+
+175
+00:12:29,510 --> 00:12:32,710
+يقول فيه هيدروجين .. زي الـ intercalated موجود
+
+176
+00:12:32,710 --> 00:12:36,650
+برضه ايه على ال base المنبرين برضه الهيدروجين يبقى
+
+177
+00:12:36,650 --> 00:12:39,930
+بيه ال system و بيعمل secretion of .. thus the
+
+178
+00:12:39,930 --> 00:12:44,430
+medullary collecting duct also plays a key role in
+
+179
+00:12:44,430 --> 00:12:47,210
+regulating acid base balance إذا ال acid base
+
+180
+00:12:47,210 --> 00:12:49,310
+balance موجود في ال intercalated cells إن كانت في
+
+181
+00:12:49,310 --> 00:12:53,450
+ال distal convoluted أو كانت في ال .. مدلري ..
+
+182
+00:12:53,450 --> 00:12:55,830
+ducts okay؟ طيب
+
+183
+00:12:59,540 --> 00:13:07,580
+هذا ايش بعد الانيولين هنا ال الانيولين اتكلمنا عنه
+
+184
+00:13:07,580 --> 00:13:11,300
+اعتقد قبل كده لما اتكلمنا عن الكرياتينين اقول ان
+
+185
+00:13:11,300 --> 00:13:17,780
+الكرياتينين is filtered nearly not secreted or
+
+186
+00:13:17,780 --> 00:13:21,780
+reabsorbed طب كده هو الكرياتينين اللي نزل برا في
+
+187
+00:13:21,780 --> 00:13:25,080
+اليولين يمثل ال filtered one في الحالة دي بقدر انا
+
+188
+00:13:25,080 --> 00:13:28,770
+احسبجدّاش filtered من خلال حساب التنبعات العلقة
+
+189
+00:13:28,770 --> 00:13:33,370
+البسيطة بقدر اعرف الـGFR مش كده الانيولين more
+
+190
+00:13:33,370 --> 00:13:37,250
+accurateلأن في عندى نسبة من الكرياتينين can cross
+
+191
+00:13:37,250 --> 00:13:41,250
+the .. the .. the .. البروكسونالكورتيوبيول can be
+
+192
+00:13:41,250 --> 00:13:43,870
+reabsorbed or secreted نسبة reabsorbed ونسبة
+
+193
+00:13:43,870 --> 00:13:47,010
+secreted لكن هنا عندى الانيولين is a
+
+194
+00:13:47,010 --> 00:13:50,810
+polysaccharide that is filtered not reabsorbed or
+
+195
+00:13:50,810 --> 00:13:54,750
+secreted تمام؟ إذن هو more accurate لمسألة الـA بس
+
+196
+00:13:54,750 --> 00:13:59,230
+عيبه إنه بدى يقعد بإيدي بدى يقعد بإيدي الكرياتينين
+
+197
+00:13:59,230 --> 00:14:02,770
+لأ موجودوالكرياتينين في حد ذاته زي ما قلتلكم قبل
+
+198
+00:14:02,770 --> 00:14:05,850
+كده أنه بس أعرف كده ال level تبع الكرياتينين أقرب
+
+199
+00:14:05,850 --> 00:14:12,790
+ال normal عكس ذلك بيكون صار على ال filtration لأنه
+
+200
+00:14:12,790 --> 00:14:18,310
+إذا الكرياتينين طبيعي إذا ال GFR طبيعي إذا
+
+201
+00:14:18,310 --> 00:14:22,000
+الكرياتينين عليهمعناها الـ GFR هو اللي بيطلع
+
+202
+00:14:22,000 --> 00:14:25,740
+الكرياتينين جالب معناها جزء من الكرياتينين مش قادر
+
+203
+00:14:25,740 --> 00:14:28,180
+يطلع لإن ال execution of الكرياتينين is mainly by
+
+204
+00:14:28,180 --> 00:14:31,820
+مين؟ by GFR إذا أنا اتطلعت وجدت الكرياتينين عالي
+
+205
+00:14:31,820 --> 00:14:36,220
+تمام؟ معناها الـ GFR هو اللي إيه؟ اللي انخفض مش
+
+206
+00:14:36,220 --> 00:14:42,560
+كده؟ طيب الـ GFR الكرياتينين عالي لضعف معناها الـ
+
+207
+00:14:42,560 --> 00:14:47,500
+GFR انخفض للنص تمام؟ ليش؟ لإن أنا بدي في الآخر
+
+208
+00:14:47,500 --> 00:14:52,830
+الكليةوماكنتش بيثبت الكيلية تانية في الدم بيثبت
+
+209
+00:14:52,830 --> 00:14:58,510
+لما يكون ال input اللي جاي يساوي ال output تمام
+
+210
+00:14:58,510 --> 00:15:05,810
+فاحنا الكيلية صراحة ضعفت لكن ال execution of كيلية
+
+211
+00:15:05,810 --> 00:15:09,820
+تانية ماتغيرشExecration كمية اللي بتطلع ماتغيرتش
+
+212
+00:15:09,820 --> 00:15:14,420
+ليش؟ لأنه صحيح الـGFR قوط شوية صار يطلع نص الكمية
+
+213
+00:15:14,420 --> 00:15:17,820
+فارتفع الكرياتينين اللي اتضاعف صار لما اقول
+
+214
+00:15:17,820 --> 00:15:23,360
+الكرياتينين اتضاعف في الـGFR النص يساوي واحد مش
+
+215
+00:15:23,360 --> 00:15:27,860
+كده؟ رجع إلى أصله يعني الكرياتينين كل ما ارتفع كل
+
+216
+00:15:27,860 --> 00:15:32,070
+ما بدليلهم الـGFR هبطلوا لأن في بينهم توازنبيظل
+
+217
+00:15:32,070 --> 00:15:34,850
+يرتفع ويرتفع ويرتفع لما يثبت له level معين ال
+
+218
+00:15:34,850 --> 00:15:40,070
+level هذا بيثبت عنده لما يكون اللي جاي من الجسم
+
+219
+00:15:40,070 --> 00:15:46,050
+يساوي اللي بده يطلع تمام فلما ال GFR يهبط إلى النص
+
+220
+00:15:46,050 --> 00:15:49,390
+الكريتينين بتضعف إلى الضعف في الحالة هذه الكمية
+
+221
+00:15:49,390 --> 00:15:52,850
+اللي بتطلع تساوي الكمية الأولانية يعني تساوي
+
+222
+00:15:52,850 --> 00:15:55,470
+الكمية اللي produced by the body قلتها قبل كده أنا
+
+223
+00:15:55,470 --> 00:16:03,560
+هذه؟ طيب ماشي ال inulinمادة صناعية و بدي أعطيها و
+
+224
+00:16:03,560 --> 00:16:06,340
+بدي أعطيها لكنها more accurate than ال others و
+
+225
+00:16:06,340 --> 00:16:12,800
+احنا مستخدمها في معاينة قياس الأشياء في التجارب
+
+226
+00:16:12,800 --> 00:16:16,900
+تبعتنا ال inulin من جيس ال inulin جديش في ال
+
+227
+00:16:16,900 --> 00:16:21,660
+filtrate و جديش في ال plasma تمام حيث يرتفع نسبة
+
+228
+00:16:21,660 --> 00:16:25,420
+ال inulin في ال filtrate على ال plasma مش كده
+
+229
+00:16:25,420 --> 00:16:29,480
+معناها صار concentration يعني مش هيكالانيولين
+
+230
+00:16:29,480 --> 00:16:33,540
+تركيزه في الـ plasma واحد وفي الفيلتريات صارت
+
+231
+00:16:33,540 --> 00:16:39,320
+اتنين معناه انا في عندى ايه في عندى نص الميه امتصت
+
+232
+00:16:39,320 --> 00:16:43,780
+عشان كده الانيولين اللى لايمتص ارتفع صارت ضعيف
+
+233
+00:16:43,780 --> 00:16:49,320
+انزلنا كمان لتحت شوية لاجينا الانيولين زاد تلت
+
+234
+00:16:49,320 --> 00:16:53,670
+اضعاف معناه تلت الميه ميه باقي وتلتين راحالكمية
+
+235
+00:16:53,670 --> 00:16:57,750
+الماء الموجودة اتركزت تلات أطعاف المادة مش كده
+
+236
+00:16:57,750 --> 00:17:01,990
+يعني احنا بستخدمه في التجارب تبعتنا حتى نعرف من
+
+237
+00:17:01,990 --> 00:17:05,610
+منطقة لمنطقة في ال .. في ال .. في النفرون ايش
+
+238
+00:17:05,610 --> 00:17:09,630
+بيصير للميه جدش reabsorbed من خلال علاقة التركيز
+
+239
+00:17:09,630 --> 00:17:13,510
+على الانولين مع تركيز مين مع تركيز البلازمة بيقول
+
+240
+00:17:13,510 --> 00:17:16,030
+اه والله هنا الانولين زاد هو لا يمتص ولا .. ولا
+
+241
+00:17:16,030 --> 00:17:19,690
+secreted زاد لأنه الميه راحت جدش راح ميه وجدش صار
+
+242
+00:17:19,690 --> 00:17:24,960
+تركيز تمام؟كل ما بيزيد ميّه الـ Reabsorption كل ما
+
+243
+00:17:24,960 --> 00:17:29,460
+بيزيد التركيز .. مش قصة كبيرة بس احنا من خلالها
+
+244
+00:17:29,460 --> 00:17:34,380
+بنلاحظها انه في الـ Collecting Tubules ساحة خالص
+
+245
+00:17:34,380 --> 00:17:40,900
+بنلاقي انه احنا تركيز الانيولين بصير 125 ضعف بمعنى
+
+246
+00:17:40,900 --> 00:17:47,770
+انه احنا فقدناعندنا واحد من 125 من الميه الأساسية
+
+247
+00:17:47,770 --> 00:17:50,730
+عشان كده نتركز لإيه في الحالة اللي بيقول أه ما هو
+
+248
+00:17:50,730 --> 00:17:55,450
+احنا عندنا إيش ال .. ال filtrate والجميع فلتريت هو
+
+249
+00:17:55,450 --> 00:18:02,830
+125 تمام لما يرفع ال .. ال .. ال urine ال .. ال ..
+
+250
+00:18:02,830 --> 00:18:06,310
+ال .. ال enulin concentration في الصنطي إلى 125
+
+251
+00:18:06,310 --> 00:18:10,190
+ضعف تمام معناه ان ال answer عند ميه واحد على 125
+
+252
+00:18:10,190 --> 00:18:13,860
+من الأساسية الميه الأساسية هي اللي filteredThe
+
+253
+00:18:13,860 --> 00:18:17,960
+math معلنة مش قصة كبيرة قصة سهلة كتير بس بتفهمنا
+
+254
+00:18:17,960 --> 00:18:20,900
+احنا كيف جسنا ال water concentration under
+
+255
+00:18:20,900 --> 00:18:23,860
+absorptive mechanisms في ال different parts of the
+
+256
+00:18:23,860 --> 00:18:27,360
+nephron من خلال العلاقة ما بين ال .. ال .. ال
+
+257
+00:18:27,360 --> 00:18:30,100
+annual concentration و ال plasma concentration كل
+
+258
+00:18:30,100 --> 00:18:32,240
+ما بيزيد كل ما بنعرف اش اسمه المرة اللي جاية ان
+
+259
+00:18:32,240 --> 00:18:35,680
+شاء الله نتكلم عن ال regulation system في ال ايه؟
+
+260
+00:18:35,680 --> 00:18:43,450
+ال nephron مين هي السؤال يا بنات؟ اهيعطيكوا
+
+261
+00:18:43,450 --> 00:18:46,130
+العافية احنا ضايقين معانا دقيق يعني بتسأل
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..57ecd188083f1c4dbe8bed89eb9b585ee23fca8c
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/QehUZID3MAU_raw.srt
@@ -0,0 +1,1052 @@
+1
+00:00:05,010 --> 00:00:10,330
+بتوصللي الى filter rate ممكن يكون isosmotic او
+
+2
+00:00:10,330 --> 00:00:17,910
+hypotonic ممكن يوصله تمام لكن المضلة دورها تشتغل و
+
+3
+00:00:17,910 --> 00:00:20,690
+تفتح او تعمل اذا كان انا بيدعمل more concentration
+
+4
+00:00:20,690 --> 00:00:26,250
+لكن ممكن انا ألغي تماما دور المضلة بان ال water
+
+5
+00:00:26,250 --> 00:00:30,430
+channels اللي مفترض نتكلم عنها من شوية هي و ال
+
+6
+00:00:30,430 --> 00:00:33,840
+urea channels تفتحوتأدي إلى أن هذا أو هذا يدخل أو
+
+7
+00:00:33,840 --> 00:00:38,540
+كذا ممكن تسكت ال water channels هذه ال water اللي
+
+8
+00:00:38,540 --> 00:00:42,640
+جاية من ال distal tubule متظل طالعة مافيش حد
+
+9
+00:00:42,640 --> 00:00:45,660
+يقولها واني انت مظبوط؟ وهذا تحت تأثير ال
+
+10
+00:00:45,660 --> 00:00:48,980
+antiderivative hormoneإذا كان أنا محتاج ميه أكتر،
+
+11
+00:00:48,980 --> 00:00:53,480
+الـ Antioxidant hormone بيفتح ال water channels،
+
+12
+00:00:53,480 --> 00:00:56,840
+وإذا أنا مش محتاج ميه أكتر، مش محتاج .. أه بدي ..
+
+13
+00:00:56,840 --> 00:01:01,800
+بدي إيه؟ أعمل execution لكميات كبيرة، عندي over
+
+14
+00:01:01,800 --> 00:01:04,960
+hydration، تمام؟ فبروح، بيلضغي ال Antioxidant
+
+15
+00:01:04,960 --> 00:01:08,880
+hormone و بسكر ال .. ال channels و بخلي ال .. ال
+
+16
+00:01:08,880 --> 00:01:10,960
+dilute دول يطلع للخارج
+
+17
+00:01:13,520 --> 00:01:21,540
+لأ مش خلاص احنا الـ distal convoluted tubule زائد
+
+18
+00:01:21,540 --> 00:01:25,600
+ال system المشارك إلها اللي هو ال connecting و ال
+
+19
+00:01:25,600 --> 00:01:30,100
+collecting tubules هدول بيقدروا يدوني diluted
+
+20
+00:01:30,100 --> 00:01:34,080
+urine أقصى ما يمكن و إذا أنا بدي diluted urine
+
+21
+00:01:34,080 --> 00:01:37,340
+بعطل عمل ال collecting مضلة
+
+22
+00:01:39,970 --> 00:01:44,550
+المدلّري دكت هذه الـ collecting duct المدلّري دكت
+
+23
+00:01:44,550 --> 00:01:49,430
+هذه الـ security duct بعطل عملها تمام؟ و أنا إذا
+
+24
+00:01:49,430 --> 00:01:54,090
+.. إذا .. إذا هي لها دور مهم كتير في إنها تخلّي ال
+
+25
+00:01:54,090 --> 00:01:58,610
+urine diluted ولا هي تبقى تخلّي concentrated هذه
+
+26
+00:01:58,610 --> 00:02:02,030
+اللي هتكلم عنها الآن إذا في عندى أنا المدلّري
+
+27
+00:02:02,030 --> 00:02:04,050
+collecting duct
+
+28
+00:02:06,410 --> 00:02:12,350
+ممكن هان المدارس اللي collecting ducks بشغلهامحدود
+
+29
+00:02:12,350 --> 00:02:17,150
+لان كمية اللى وصلت ال دستر تيوبيول محدود مش كده
+
+30
+00:02:17,150 --> 00:02:20,770
+فلذلك ايش ما تشتغل هيكون معظم الأشياء راحت منها ف
+
+31
+00:02:20,770 --> 00:02:24,090
+maximum تشتغل عشرة فالمية تمك در تعمل reabsorption
+
+32
+00:02:24,090 --> 00:02:27,510
+للصوديوم او البوتاسيوم احنا قولنا لحد ال thick
+
+33
+00:02:27,510 --> 00:02:33,090
+ascending limb نهايته احنا أخدنا تسعين المية خمسة
+
+34
+00:02:33,090 --> 00:02:40,180
+وخمسة وعشرين وخمسة وستينياديش صاروا هدول؟ تسعين
+
+35
+00:02:40,180 --> 00:02:43,640
+بال تكت و ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+36
+00:02:43,640 --> 00:02:44,960
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+37
+00:02:44,960 --> 00:02:45,980
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+38
+00:02:45,980 --> 00:02:47,440
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+39
+00:02:47,440 --> 00:02:47,460
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+40
+00:02:47,460 --> 00:02:47,760
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+41
+00:02:47,760 --> 00:02:48,100
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+42
+00:02:48,100 --> 00:02:48,260
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+43
+00:02:48,260 --> 00:02:48,600
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+44
+00:02:48,600 --> 00:02:55,060
+.. ال .. ال .. ال .. ال .. ال .. ال ..
+
+45
+00:02:55,060 --> 00:02:55,060
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+46
+00:02:55,060 --> 00:02:55,060
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+47
+00:02:55,060 --> 00:03:01,660
+ال .. ال .. ال .. ال .. ال
+
+48
+00:03:06,640 --> 00:03:12,320
+الدكت هاد الدكت عبارة عن cuboidal cells تمام
+
+49
+00:03:12,320 --> 00:03:17,560
+الابيثيليوم تبعها cuboidal مواشي كولامنار وهدى
+
+50
+00:03:17,560 --> 00:03:23,800
+اللى بيشتغل على ال دستال ليه الدستال بيشتغل عليها
+
+51
+00:03:23,800 --> 00:03:27,460
+يعني برضه under control هى إذا فى أنتدرت حرمول
+
+52
+00:03:27,460 --> 00:03:33,440
+موجود زى ما أثر على ال .. ال .. ال .. الدستال ال
+
+53
+00:03:33,440 --> 00:03:38,190
+convoluted بيأثر عليهاإذا كان عندى الـ Aldosterone
+
+54
+00:03:38,190 --> 00:03:42,910
+موجود تمام؟ زى ما بيأثر عليها على الـDistal
+
+55
+00:03:42,910 --> 00:03:45,570
+convoluted tubule بيأثر عليها إيش الفرق بينها
+
+56
+00:03:45,570 --> 00:03:49,590
+دوهادى؟ الـUrea permeability هدى برمى ملتوى
+
+57
+00:03:49,590 --> 00:03:54,350
+اليوريا الـDistal thick ascending limb مبرمى ملتوى
+
+58
+00:03:54,350 --> 00:04:00,550
+اليوريا تمام؟ إذا لاحظوا الـDistal convoluted
+
+59
+00:04:00,550 --> 00:04:05,890
+مبرمى ملتوى اليوريا معناهاو احنا نسحب ميه جاعدين و
+
+60
+00:04:05,890 --> 00:04:10,310
+سوديوم من ال thick ascending limb من ال distal
+
+61
+00:04:10,310 --> 00:04:13,610
+convertibule نسحب ميه و سوديوم under the effect of
+
+62
+00:04:13,610 --> 00:04:16,750
+antidepressant hormone و under the effect of
+
+63
+00:04:16,750 --> 00:04:22,870
+aldosterone اليوريا جالكت اعلى تمام؟ لإن هي ايه؟
+
+64
+00:04:22,870 --> 00:04:26,750
+not reabsorbed في ال distal convertibule فلذلك اذا
+
+65
+00:04:26,750 --> 00:04:30,710
+خدنا ميه هي عليت اه اذا ماخدناش ميه ابدا التركيز
+
+66
+00:04:30,710 --> 00:04:35,290
+هو هوتمام؟ إذا بيصير reabsorption لا ال water
+
+67
+00:04:35,290 --> 00:04:38,690
+لحالها اليوريا بتبقى to be concentrated تمام؟ إذا
+
+68
+00:04:38,690 --> 00:04:42,090
+اليوريا concentrated هنا و اليوريا كانت برضه not
+
+69
+00:04:42,090 --> 00:04:45,690
+reabsorbed by the thick ascending limb ولا بال
+
+70
+00:04:45,690 --> 00:04:48,950
+distal tubule إذا هنا بنصل اليوريا جاهدة بيه على
+
+71
+00:04:48,950 --> 00:04:52,510
+تركيزها بيه على تركيزها واضح؟ إذا الآن هتدخل
+
+72
+00:04:52,510 --> 00:04:58,810
+الفلترات مع أحوال مختلفة من ال sodium و ال water
+
+73
+00:04:58,810 --> 00:05:03,180
+لكنه بالقطع اليوريا عياشةعالية، اذا اليوريا
+
+74
+00:05:03,180 --> 00:05:06,940
+هالداخلة بالقطع عالية، لكن ال sodium حسب ال
+
+75
+00:05:06,940 --> 00:05:10,940
+aldosterone كيف كان وضعه، ال water حسب ال
+
+76
+00:05:10,940 --> 00:05:14,440
+antioxidant كيف وضعها، وهذه هكمل المسيرة، لكن
+
+77
+00:05:14,440 --> 00:05:18,960
+اليوريا بالقطع هي ايش؟ عالية، هنا في عندنا .. في
+
+78
+00:05:18,960 --> 00:05:23,540
+عندنا هنا في ال .. ال medullary duct يوريا
+
+79
+00:05:23,540 --> 00:05:27,920
+transportersو الوريا ترانسبورتر هدول بيشتغلوا
+
+80
+00:05:27,920 --> 00:05:32,240
+أحيان و مش أحيان الغريب أن هم الوريا ترانسبورتر مش
+
+81
+00:05:32,240 --> 00:05:35,360
+غريبة يعني إذا فهمناها علاجها مش غريبة بيزيدوا و
+
+82
+00:05:35,360 --> 00:05:38,800
+بيجيلوا حسب الانترداد الكرمان تمام؟ بيزيدوا و
+
+83
+00:05:38,800 --> 00:05:42,560
+بيجيلوا حسب إيه؟ الانترداد الكرمان ليش؟ جالك ازعل
+
+84
+00:05:42,560 --> 00:05:46,710
+الانترداد الكرمانيعني انا بدي مياه اكتر، طب انا
+
+85
+00:05:46,710 --> 00:05:51,030
+كمان بدي اسحب من المدلّر دا مياه اكتر، عبر مين؟ ال
+
+86
+00:05:51,030 --> 00:05:54,930
+hyper osmolality of the interstitium، مش كده؟ اذا
+
+87
+00:05:54,930 --> 00:05:58,430
+الان و احنا دخلين ال antidiabetic hormone عالي
+
+88
+00:05:58,430 --> 00:06:03,560
+فاتحلي ال water channelsالماية دخلت إلى الـ
+
+89
+00:06:03,560 --> 00:06:08,400
+tubular الـ cells إلى الـ collecting duct cells
+
+90
+00:06:08,400 --> 00:06:13,220
+ومنها تندفع إلى الـ hyperosmotic interstitium مش
+
+91
+00:06:13,220 --> 00:06:19,040
+كده فبنسحب الميا منها من الفلترات احنا لما بنسحب
+
+92
+00:06:19,040 --> 00:06:21,740
+الميا من الفلترات سحبناها under the effect of mean
+
+93
+00:06:21,740 --> 00:06:26,480
+of the hyperosmotic interstitium اليوريا لها حاجة
+
+94
+00:06:26,480 --> 00:06:32,810
+اسمها يوريا cycleتشارك تقريباً خمسين في المية من
+
+95
+00:06:32,810 --> 00:06:35,390
+الـ hyperosmolality اللي بتكون في الـ interstitial
+
+96
+00:06:35,390 --> 00:06:40,510
+تشارك في مين اليوريا لذلك لما انا بدأ اعمل more
+
+97
+00:06:40,510 --> 00:06:43,490
+absorption of water يعني محتاج إلى more
+
+98
+00:06:43,490 --> 00:06:47,650
+hyperosmotic مضالة
+
+99
+00:06:47,650 --> 00:06:50,910
+محتاج ادخل اليوريا عشان شاركني في ايه؟ في بناء
+
+100
+00:06:50,910 --> 00:06:55,810
+المين الـ interstitial مضالة الـ interstitial ايه؟
+
+101
+00:06:55,810 --> 00:07:00,260
+osmotic gradientإذا لمّا بدّي ميّه، بدّي معها تدخل
+
+102
+00:07:00,260 --> 00:07:02,460
+الـUrea عشان تساعدني في إيه؟ تساعدني في امتصاص
+
+103
+00:07:02,460 --> 00:07:07,900
+الميّه وإذا بدّيش ميّه تمام، إذا بدّيش الـUrea في
+
+104
+00:07:07,900 --> 00:07:10,960
+الحالة هذه الـUrea channels و ال water channels
+
+105
+00:07:10,960 --> 00:07:14,860
+under defect of مين؟ of antidote hormone في المدلة
+
+106
+00:07:14,860 --> 00:07:17,810
+Reductإذا هنا الـ Medullary Duct الـ Antiduct
+
+107
+00:07:17,810 --> 00:07:21,430
+hormone بيزيد الـ urea channels بيفتحها و بيزيد ال
+
+108
+00:07:21,430 --> 00:07:25,430
+water channels بيفتحها لأنه بدي ميه بدي urea تدخل
+
+109
+00:07:25,430 --> 00:07:28,450
+و تتشعد في الـ hyperosmolality gradient اللي
+
+110
+00:07:28,450 --> 00:07:32,800
+هيتكوّن في الـ interstitium بديش ميهبسكر ال
+
+111
+00:07:32,800 --> 00:07:35,220
+channels لان مش محتاجة لانتصار .. يلا الله يسهل
+
+112
+00:07:35,220 --> 00:07:38,640
+عليها مع السلامة، تمام؟ إذا أنا بستخدمها partially
+
+113
+00:07:38,640 --> 00:07:41,860
+عشان أساعد .. وعادة بترجع، بتطلع، يعني هي دائرة
+
+114
+00:07:41,860 --> 00:07:45,260
+صغيرة، لكنها دائرة صغيرة هي ساعدتني في امتصاص إيه؟
+
+115
+00:07:45,260 --> 00:07:49,240
+ميه و تركيز ball عشان أنا أساعد على إن أاخد أكبر
+
+116
+00:07:49,240 --> 00:07:56,230
+كمية من إيه؟ من الميهإذا هذه الـ duct بيشتغل عليها
+
+117
+00:07:56,230 --> 00:08:00,490
+الـ Antidote hormone وبيشتغل عليها ال Aldosterone
+
+118
+00:08:00,490 --> 00:08:04,650
+طيب ال Antidote hormone حقيقة هان عنا مهم كيف
+
+119
+00:08:04,650 --> 00:08:09,590
+بيشتغل عليها ال Antidote hormone بيشتغل عن طريق ال
+
+120
+00:08:09,590 --> 00:08:16,370
+nucleus عن طريق ال ال ال genome تبع ال
+
+121
+00:08:19,870 --> 00:08:24,010
+الاكوا بورز هذا ما نسميها الاكوا بورز بروتيز معينة
+
+122
+00:08:24,010 --> 00:08:27,570
+بتتكون عن طريق ال system لأنه بروتين بتتكون بنفس
+
+123
+00:08:27,570 --> 00:08:30,810
+الطريقة بتتكون فيها البروتيز وبتبقى موجودة تحت ال
+
+124
+00:08:30,810 --> 00:08:34,230
+basement membrane تحت اليمنى ال membrane تحت ال
+
+125
+00:08:34,230 --> 00:08:36,410
+apical membrane تحت ال .. هنا مافيش brush border
+
+126
+00:08:36,410 --> 00:08:40,090
+لأن ال collecting duct smooth ايه surface مافيش
+
+127
+00:08:40,090 --> 00:08:43,230
+فيه ايه brush border الكمية اللي جاية جليلة فمش
+
+128
+00:08:43,230 --> 00:08:49,550
+محتاجة إلى surface كبيرهنا عندي انا what is called
+
+129
+00:08:49,550 --> 00:08:54,230
+.. اظن فيها رسمها .. مش عارف لأ مالعش رسمها ممكن
+
+130
+00:08:54,230 --> 00:09:00,350
+رسمها ده في مكان تاني طيب،
+
+131
+00:09:00,350 --> 00:09:03,630
+في عندي انا ال proteins بتتكون و بتحط في ال
+
+132
+00:09:03,630 --> 00:09:07,040
+physicals تحت ال apical membraneإذا كان عندك هرمون
+
+133
+00:09:07,040 --> 00:09:15,240
+بزيادة فبتطلع بيصير لها بيصير لها exocytosis بتطلع
+
+134
+00:09:15,240 --> 00:09:21,420
+لبرا تمام؟ فبتجد في ال cell membrane في ال apical
+
+135
+00:09:21,420 --> 00:09:26,200
+membrane و بتعمل what is called aquapores يعني أن
+
+136
+00:09:26,200 --> 00:09:30,740
+ال aquapores حقيقتها هي كذا نوع هنا ايه؟ ال
+
+137
+00:09:30,740 --> 00:09:33,260
+aquapores هذه .. ال aquapores نوع واحد متأثرة في
+
+138
+00:09:33,260 --> 00:09:36,650
+اليوريا ترانس بورتاس كذا نوعهنا في الحالة هذه الـ
+
+139
+00:09:36,650 --> 00:09:40,190
+apical membrane بتكون الأكوا بورز بتسمح للميه تدخل
+
+140
+00:09:40,190 --> 00:09:45,830
+كل ما زاد الميه أكتر كل ما الأكوا بورز طلعت
+
+141
+00:09:45,830 --> 00:09:48,950
+الفيسيكلز هذه للcell membrane و اتكونت أكتر و طلعت
+
+142
+00:09:48,950 --> 00:09:52,270
+أكتر و ساعدت في area absorption of more water اللي
+
+143
+00:09:52,270 --> 00:09:56,130
+داخل ال cellsطبعاً كيف بندفع لداخل الـ cells عند
+
+144
+00:09:56,130 --> 00:09:59,130
+.. لما يكون في .. عند اكوا بورز موجودة وعندي hyper
+
+145
+00:09:59,130 --> 00:10:01,950
+osmotic interstitium الـ interstitium اللي بيسحب
+
+146
+00:10:01,950 --> 00:10:05,530
+الميه من مين؟ من الـ medullary cells فبيخليها
+
+147
+00:10:05,530 --> 00:10:09,130
+concentrated احنا بيخلي الميه تندفع من داخل ال
+
+148
+00:10:09,130 --> 00:10:12,290
+tubule إلى .. إلى ال cells إلى ال interstitium
+
+149
+00:10:12,290 --> 00:10:15,950
+فبنعمل .. لكن أساس الموضوع إذا ال بورز فاتحة يعني
+
+150
+00:10:15,950 --> 00:10:18,770
+ال أكوا بورز موجودة يعني ال proteins و ال system
+
+151
+00:10:18,770 --> 00:10:22,790
+يعني أنتدوم الفيرمون موجود تمام؟إذا كانت الكربون
+
+152
+00:10:22,790 --> 00:10:27,510
+مش موجود بيصيح أو هبق جزء من ال بورز هذه بيصيرهم
+
+153
+00:10:27,510 --> 00:10:31,830
+endocytosis تدخل إلى الداخل تمام و بتظلها موجودة
+
+154
+00:10:31,830 --> 00:10:36,950
+في داخل ال cells مش معرضة لل tubule تمنع ال water
+
+155
+00:10:36,950 --> 00:10:43,010
+channels أنها تشتغل و تمنع اندفع الميه تمام؟ نفس
+
+156
+00:10:43,010 --> 00:10:44,110
+التأثير تبع ال ..
+
+157
+00:10:47,490 --> 00:10:50,810
+هذه الأكبر بورزون موجودة على الـ Basal Laser
+
+158
+00:10:50,810 --> 00:10:52,670
+Lateral Membrane ولا على الـ Apical Membrane
+
+159
+00:11:15,520 --> 00:11:19,880
+بعد شوية هتكلم بتفصيل عن ال اكوابورز واليوريابورز
+
+160
+00:11:19,880 --> 00:11:23,160
+ال transporters بس خليني هتكلم ان الانترنت الهرمون
+
+161
+00:11:23,160 --> 00:11:28,380
+برميبيريتي of the medulla recollecting duct to
+
+162
+00:11:28,380 --> 00:11:32,190
+water is controlled by the enteric hormoneUnlike
+
+163
+00:11:32,190 --> 00:11:34,030
+the cortical collecting tube, the medullary
+
+164
+00:11:34,030 --> 00:11:38,430
+collecting duct is permeable to water برضه تيوريا
+
+165
+00:11:38,430 --> 00:11:44,750
+حسب موجود عندك كرمون كتير ولا لأ لإن الهيرا
+
+166
+00:11:44,750 --> 00:11:48,290
+ترانسبورتر موجودة أكتر ولا أجل لكنه زي نظام
+
+167
+00:11:48,290 --> 00:11:52,410
+الـElectively يعني The medullary collecting duct
+
+168
+00:11:52,410 --> 00:11:54,190
+is capable of secreting hydrogen
+
+169
+00:11:58,140 --> 00:12:01,100
+الجملتين اللي انا بدي احطهم حقيقة في جملة فوق
+
+170
+00:12:01,100 --> 00:12:04,660
+وجملة تحت ان الـmedullary collecting duct is
+
+171
+00:12:04,660 --> 00:12:08,200
+capable of secreting hydrogen ions against a large
+
+172
+00:12:08,200 --> 00:12:12,000
+concentration gradient as also occurs in the
+
+173
+00:12:12,000 --> 00:12:15,920
+cortical collecting tubule يعني عندنا هنا في
+
+174
+00:12:15,920 --> 00:12:21,180
+hydrogen التبييز system زي اللي موجود في الدسترال
+
+175
+00:12:21,180 --> 00:12:27,010
+تبيول موجود في الـA خص ال hydrogen ionsالـ system
+
+176
+00:12:27,010 --> 00:12:29,510
+لازال موجود بيصل للاخر يعني من الـ distal tube
+
+177
+00:12:29,510 --> 00:12:32,710
+يقول فيه هيدروجين .. زي الـ intercalated موجود
+
+178
+00:12:32,710 --> 00:12:36,650
+برضه ايه على ال base المنبرين برضه الهيدروجين يبقى
+
+179
+00:12:36,650 --> 00:12:39,930
+بيه ال system و بيعمل secretion of .. thus the
+
+180
+00:12:39,930 --> 00:12:44,430
+medullary collecting duct also plays a key role in
+
+181
+00:12:44,430 --> 00:12:47,210
+regulating acid base balance إذا ال acid base
+
+182
+00:12:47,210 --> 00:12:49,310
+balance موجود في ال intercalated cells إن كانت في
+
+183
+00:12:49,310 --> 00:12:53,450
+ال distal convoluted أو كانت في ال .. مدلري ..
+
+184
+00:12:53,450 --> 00:12:55,830
+ducts okay؟ طيب
+
+185
+00:12:59,540 --> 00:13:07,580
+هذا ايش بعد الانيولين هنا ال الانيولين اتكلمنا عنه
+
+186
+00:13:07,580 --> 00:13:11,300
+اعتقد قبل كده لما اتكلمنا عن الكرياتينين اقول ان
+
+187
+00:13:11,300 --> 00:13:17,780
+الكرياتينين is filtered nearly not secreted or
+
+188
+00:13:17,780 --> 00:13:21,780
+reabsorbed طب كده هو الكرياتينين اللي نزل برا في
+
+189
+00:13:21,780 --> 00:13:25,080
+اليولين يمثل ال filtered one في الحالة دي بقدر انا
+
+190
+00:13:25,080 --> 00:13:28,770
+احسبجدّاش filtered من خلال حساب التنبعات العلقة
+
+191
+00:13:28,770 --> 00:13:33,370
+البسيطة بقدر اعرف الـGFR مش كده الانيولين more
+
+192
+00:13:33,370 --> 00:13:37,250
+accurateلأن في عندى نسبة من الكرياتينين can cross
+
+193
+00:13:37,250 --> 00:13:41,250
+the .. the .. the .. البروكسونالكورتيوبيول can be
+
+194
+00:13:41,250 --> 00:13:43,870
+reabsorbed or secreted نسبة reabsorbed ونسبة
+
+195
+00:13:43,870 --> 00:13:47,010
+secreted لكن هنا عندى الانيولين is a
+
+196
+00:13:47,010 --> 00:13:50,810
+polysaccharide that is filtered not reabsorbed or
+
+197
+00:13:50,810 --> 00:13:54,750
+secreted تمام؟ إذن هو more accurate لمسألة الـA بس
+
+198
+00:13:54,750 --> 00:13:59,230
+عيبه إنه بدى يقعد بإيدي بدى يقعد بإيدي الكرياتينين
+
+199
+00:13:59,230 --> 00:14:02,770
+لأ موجودوالكرياتينين في حد ذاته زي ما قلتلكم قبل
+
+200
+00:14:02,770 --> 00:14:05,850
+كده أنه بس أعرف كده ال level تبع الكرياتينين أقرب
+
+201
+00:14:05,850 --> 00:14:12,790
+ال normal عكس ذلك بيكون صار على ال filtration لأنه
+
+202
+00:14:12,790 --> 00:14:18,310
+إذا الكرياتينين طبيعي إذا ال GFR طبيعي إذا
+
+203
+00:14:18,310 --> 00:14:22,000
+الكرياتينين عليهمعناها الـ GFR هو اللي بيطلع
+
+204
+00:14:22,000 --> 00:14:25,740
+الكرياتينين جالب معناها جزء من الكرياتينين مش قادر
+
+205
+00:14:25,740 --> 00:14:28,180
+يطلع لإن ال execution of الكرياتينين is mainly by
+
+206
+00:14:28,180 --> 00:14:31,820
+مين؟ by GFR إذا أنا اتطلعت وجدت الكرياتينين عالي
+
+207
+00:14:31,820 --> 00:14:36,220
+تمام؟ معناها الـ GFR هو اللي إيه؟ اللي انخفض مش
+
+208
+00:14:36,220 --> 00:14:42,560
+كده؟ طيب الـ GFR الكرياتينين عالي لضعف معناها الـ
+
+209
+00:14:42,560 --> 00:14:47,500
+GFR انخفض للنص تمام؟ ليش؟ لإن أنا بدي في الآخر
+
+210
+00:14:47,500 --> 00:14:52,830
+الكليةوماكنتش بيثبت الكيلية تانية في الدم بيثبت
+
+211
+00:14:52,830 --> 00:14:58,510
+لما يكون ال input اللي جاي يساوي ال output تمام
+
+212
+00:14:58,510 --> 00:15:05,810
+فاحنا الكيلية صراحة ضعفت لكن ال execution of كيلية
+
+213
+00:15:05,810 --> 00:15:09,820
+تانية ماتغيرشExecration كمية اللي بتطلع ماتغيرتش
+
+214
+00:15:09,820 --> 00:15:14,420
+ليش؟ لأنه صحيح الـGFR قوط شوية صار يطلع نص الكمية
+
+215
+00:15:14,420 --> 00:15:17,820
+فارتفع الكرياتينين اللي اتضاعف صار لما اقول
+
+216
+00:15:17,820 --> 00:15:23,360
+الكرياتينين اتضاعف في الـGFR النص يساوي واحد مش
+
+217
+00:15:23,360 --> 00:15:27,860
+كده؟ رجع إلى أصله يعني الكرياتينين كل ما ارتفع كل
+
+218
+00:15:27,860 --> 00:15:32,070
+ما بدليلهم الـGFR هبطلوا لأن في بينهم توازنبيظل
+
+219
+00:15:32,070 --> 00:15:34,850
+يرتفع ويرتفع ويرتفع لما يثبت له level معين ال
+
+220
+00:15:34,850 --> 00:15:40,070
+level هذا بيثبت عنده لما يكون اللي جاي من الجسم
+
+221
+00:15:40,070 --> 00:15:46,050
+يساوي اللي بده يطلع تمام فلما ال GFR يهبط إلى النص
+
+222
+00:15:46,050 --> 00:15:49,390
+الكريتينين بتضعف إلى الضعف في الحالة هذه الكمية
+
+223
+00:15:49,390 --> 00:15:52,850
+اللي بتطلع تساوي الكمية الأولانية يعني تساوي
+
+224
+00:15:52,850 --> 00:15:55,470
+الكمية اللي produced by the body قلتها قبل كده أنا
+
+225
+00:15:55,470 --> 00:16:03,560
+هذه؟ طيب ماشي ال inulinمادة صناعية و بدي أعطيها و
+
+226
+00:16:03,560 --> 00:16:06,340
+بدي أعطيها لكنها more accurate than ال others و
+
+227
+00:16:06,340 --> 00:16:12,800
+احنا مستخدمها في معاينة قياس الأشياء في التجارب
+
+228
+00:16:12,800 --> 00:16:16,900
+تبعتنا ال inulin من جيس ال inulin جديش في ال
+
+229
+00:16:16,900 --> 00:16:21,660
+filtrate و جديش في ال plasma تمام حيث يرتفع نسبة
+
+230
+00:16:21,660 --> 00:16:25,420
+ال inulin في ال filtrate على ال plasma مش كده
+
+231
+00:16:25,420 --> 00:16:29,480
+معناها صار concentration يعني مش هيكالانيولين
+
+232
+00:16:29,480 --> 00:16:33,540
+تركيزه في الـ plasma واحد وفي الفيلتريات صارت
+
+233
+00:16:33,540 --> 00:16:39,320
+اتنين معناه انا في عندى ايه في عندى نص الميه امتصت
+
+234
+00:16:39,320 --> 00:16:43,780
+عشان كده الانيولين اللى لايمتص ارتفع صارت ضعيف
+
+235
+00:16:43,780 --> 00:16:49,320
+انزلنا كمان لتحت شوية لاجينا الانيولين زاد تلت
+
+236
+00:16:49,320 --> 00:16:53,670
+اضعاف معناه تلت الميه ميه باقي وتلتين راحالكمية
+
+237
+00:16:53,670 --> 00:16:57,750
+الماء الموجودة اتركزت تلات أطعاف المادة مش كده
+
+238
+00:16:57,750 --> 00:17:01,990
+يعني احنا بستخدمه في التجارب تبعتنا حتى نعرف من
+
+239
+00:17:01,990 --> 00:17:05,610
+منطقة لمنطقة في ال .. في ال .. في النفرون ايش
+
+240
+00:17:05,610 --> 00:17:09,630
+بيصير للميه جدش reabsorbed من خلال علاقة التركيز
+
+241
+00:17:09,630 --> 00:17:13,510
+على الانولين مع تركيز مين مع تركيز البلازمة بيقول
+
+242
+00:17:13,510 --> 00:17:16,030
+اه والله هنا الانولين زاد هو لا يمتص ولا .. ولا
+
+243
+00:17:16,030 --> 00:17:19,690
+secreted زاد لأنه الميه راحت جدش راح ميه وجدش صار
+
+244
+00:17:19,690 --> 00:17:24,960
+تركيز تمام؟كل ما بيزيد ميّه الـ Reabsorption كل ما
+
+245
+00:17:24,960 --> 00:17:29,460
+بيزيد التركيز .. مش قصة كبيرة بس احنا من خلالها
+
+246
+00:17:29,460 --> 00:17:34,380
+بنلاحظها انه في الـ Collecting Tubules ساحة خالص
+
+247
+00:17:34,380 --> 00:17:40,900
+بنلاقي انه احنا تركيز الانيولين بصير 125 ضعف بمعنى
+
+248
+00:17:40,900 --> 00:17:47,770
+انه احنا فقدناعندنا واحد من 125 من الميه الأساسية
+
+249
+00:17:47,770 --> 00:17:50,730
+عشان كده نتركز لإيه في الحالة اللي بيقول أه ما هو
+
+250
+00:17:50,730 --> 00:17:55,450
+احنا عندنا إيش ال .. ال filtrate والجميع فلتريت هو
+
+251
+00:17:55,450 --> 00:18:02,830
+125 تمام لما يرفع ال .. ال .. ال urine ال .. ال ..
+
+252
+00:18:02,830 --> 00:18:06,310
+ال .. ال enulin concentration في الصنطي إلى 125
+
+253
+00:18:06,310 --> 00:18:10,190
+ضعف تمام معناه ان ال answer عند ميه واحد على 125
+
+254
+00:18:10,190 --> 00:18:13,860
+من الأساسية الميه الأساسية هي اللي filteredThe
+
+255
+00:18:13,860 --> 00:18:17,960
+math معلنة مش قصة كبيرة قصة سهلة كتير بس بتفهمنا
+
+256
+00:18:17,960 --> 00:18:20,900
+احنا كيف جسنا ال water concentration under
+
+257
+00:18:20,900 --> 00:18:23,860
+absorptive mechanisms في ال different parts of the
+
+258
+00:18:23,860 --> 00:18:27,360
+nephron من خلال العلاقة ما بين ال .. ال .. ال
+
+259
+00:18:27,360 --> 00:18:30,100
+annual concentration و ال plasma concentration كل
+
+260
+00:18:30,100 --> 00:18:32,240
+ما بيزيد كل ما بنعرف اش اسمه المرة اللي جاية ان
+
+261
+00:18:32,240 --> 00:18:35,680
+شاء الله نتكلم عن ال regulation system في ال ايه؟
+
+262
+00:18:35,680 --> 00:18:43,450
+ال nephron مين هي السؤال يا بنات؟ اهيعطيكوا
+
+263
+00:18:43,450 --> 00:18:46,130
+العافية احنا ضايقين معانا دقيق يعني بتسأل
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM.srt
new file mode 100644
index 0000000000000000000000000000000000000000..0178a56f4aff2d3fa1f86e8ecd9f57726f52e51d
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM.srt
@@ -0,0 +1,1517 @@
+1
+00:00:07,290 --> 00:00:11,010
+يعني كل واحد centimeter pressure بيعمل .. بيزيد ال
+
+2
+00:00:11,010 --> 00:00:15,270
+volume  تبع الـ lung 62 بيزودهم كلهم مع بعض الـ
+
+3
+00:00:15,270 --> 00:00:18,310
+volume اللي بيزيد 200 milliliter لإنه الـ 2.5
+
+4
+00:00:18,310 --> 00:00:22,770
+بيزودولي 500 milliliter تمام؟ يعني لو نفخنا الـ
+
+5
+00:00:22,770 --> 00:00:27,110
+ايه؟ الـ lung نفخ  الدقة اللي أنا بدي إياها هي .. بدي إياها هي
+
+6
+00:00:27,110 --> 00:00:31,140
+أن أديتها هي ساحب أو أديتها هي اللي هو هو ده same الـ
+
+7
+00:00:31,140 --> 00:00:34,320
+lung كالـ lung تمام؟ بلاقي كل ضغط بيزيد و أنا بزيد
+
+8
+00:00:34,320 --> 00:00:38,500
+هي زي البلون بنفخ شوية بزيد الضغط بنفخ بزيد
+
+9
+00:00:38,500 --> 00:00:40,520
+الضغط أكثر بنفخ أكثر بزيد الضغط أكثر بنفخ أكثر
+
+10
+00:00:40,520 --> 00:00:47,460
+مش كده؟ لما أزيد لـ اثنين بلاقيها انتفخت إيه؟ إلى
+
+11
+00:00:47,460 --> 00:00:52,080
+واحد إلى اثنين اثنين مليليتر بتزيد وحكي كذا تمام؟ إذا
+
+12
+00:00:52,080 --> 00:00:56,300
+الـ compliance each one pressure unit increases the
+
+13
+00:00:56,300 --> 00:01:01,110
+lung volume إلى إيه؟ اثنين مليليتر واضح؟ هذا الـ ايه
+
+14
+00:01:01,110 --> 00:01:07,750
+الـ compliance الـ compliance هذا عملنا له
+
+15
+00:01:07,750 --> 00:01:13,970
+احنا إيه عملنا له curve هيك the compliance diagram
+
+16
+00:01:13,970 --> 00:01:19,130
+of the lung هذا إيه الـ compliance كيف يعني و أنا
+
+17
+00:01:19,130 --> 00:01:23,670
+بنفخ فيه في الـ lung الـ lung بتزيد خلينا نبدأ من
+
+18
+00:01:23,670 --> 00:01:28,160
+هنا تمام أو أنا بشفط في الـ intrapleural pressure الـ
+
+19
+00:01:28,160 --> 00:01:33,740
+lung volume  بيزيد فلو احنا حطينا من level معين
+
+20
+00:01:33,740 --> 00:01:39,000
+مثلا منها الـ minus four مثلا و
+
+21
+00:01:39,000 --> 00:01:43,540
+زودنا أربعة point one أربعة point two أربعة point
+
+22
+00:01:43,540 --> 00:01:48,460
+three درجة درجة درجة درجة و كل درجة حطيناها بعد ما
+
+23
+00:01:48,460 --> 00:01:53,600
+زودنا الـ intramuscular زودناها جلّنا يعني .. أسودنا
+
+24
+00:01:53,600 --> 00:01:56,800
+الـ negativity أقصد يعني جَلّنا البُشر جوا في داخل
+
+25
+00:01:56,800 --> 00:02:00,200
+البلورة و صبرنا نشوف لون بيصلي الـ volume يعني
+
+26
+00:02:00,200 --> 00:02:03,860
+نديها عشر ثواني عشان إيه تعمل equilibrium اه زاد
+
+27
+00:02:03,860 --> 00:02:06,640
+الـ volume هالجدر على اثنين زاد الـ volume على ثلاثة
+
+28
+00:02:06,640 --> 00:02:10,800
+زاد هالجدر أربعة أو اه بزي بنجس بنجس بنجس الضغط
+
+29
+00:02:10,800 --> 00:02:14,680
+فعملت الـ curve هذا أنا إذا كان بيسمي inspiratory
+
+30
+00:02:14,680 --> 00:02:20,300
+compliance curve أو diagram أديان الشكل هذا تمام؟
+
+31
+00:02:20,580 --> 00:02:25,780
+إذا عندي لحظة إنه من بعد الخمسة و يصير عندي إيه لحد
+
+32
+00:02:25,780 --> 00:02:32,020
+ما أسرع الـ .. الـ رد الفعل لذلك الـ .. الـ .. الـ
+
+33
+00:02:32,020 --> 00:02:35,740
+pulmonary tissues هذه الـ .. الـ .. الـ lung tissues و
+
+34
+00:02:35,740 --> 00:02:38,720
+الـ pleural pressure اللي في داخلها ثابتة على minus
+
+35
+00:02:38,720 --> 00:02:43,380
+five لإنه قبل الـ minus five تبقى رد الفعل بطيء
+
+36
+00:02:43,380 --> 00:02:46,960
+يعني بدي أنا قوة أكبر عشان أنجز dilatation
+
+37
+00:02:46,960 --> 00:02:51,220
+inflation بسيط لكن بعد الخمسة إيه لحد ما صار إيه
+
+38
+00:02:51,220 --> 00:02:56,560
+واقف و جوف قبلها بطيء يعني أنا هاخد force أكبر
+
+39
+00:02:56,560 --> 00:03:02,800
+أعمل force أكبر عشان أنا أجيب نتائج أقل لذلك جئنا
+
+40
+00:03:02,800 --> 00:03:05,880
+minus five هي الـ إيه الـ intrapleural pressure بحيث
+
+41
+00:03:05,880 --> 00:03:10,040
+بعد الـ minus five أجل زيادة تديني أحسن أحسن
+
+42
+00:03:10,040 --> 00:03:13,380
+inflation تمام؟ لاحظوا الكيرف ده ليش ماخد الشكل
+
+43
+00:03:13,380 --> 00:03:16,240
+هذا لذلك احنا جئنا النَجُوء في الداخل البلورة
+
+44
+00:03:16,240 --> 00:03:21,540
+minus five ليش؟ لأن الـ minus five هذه أدتني ردود
+
+45
+00:03:21,540 --> 00:03:28,340
+فعل أفضل كثيرا من ما تكون أجل من هيك minus five هنا
+
+46
+00:03:28,340 --> 00:03:32,500
+الدراسة معمولة لحد ستة و بعدين رجعنا احنا نرجع من
+
+47
+00:03:32,500 --> 00:03:35,560
+أول و جديد جئنا غريبة جدا في الموضوع أن في معظم
+
+48
+00:03:35,560 --> 00:03:39,860
+الأشياء لما نعمل احنا issue و نعكسه برجع نفس الخط
+
+49
+00:03:39,860 --> 00:03:44,860
+لأ الـ lines برجعش نفس الخط الـ inspiratory curve
+
+50
+00:03:44,860 --> 00:03:49,440
+compliance بشكل و الـ expiratory compliance ماخد
+
+51
+00:03:49,440 --> 00:03:54,110
+إيه شكل آخر برضه هان اللي بيجل شوية شوية شوية في
+
+52
+00:03:54,110 --> 00:03:59,910
+أولها وبعد الخمسة تمام؟ بعد الخمسة بينزل أسرع
+
+53
+00:03:59,910 --> 00:04:03,550
+تمام؟ اللي هي مصلهاش احنا في العادية هذه الخمسة في
+
+54
+00:04:03,550 --> 00:04:08,150
+الطبيعة عندنا فده لذلك إيه؟ بيكون عندنا الـ
+
+55
+00:04:08,150 --> 00:04:13,270
+expiration بطيء بياخد مدة أطول تمام؟ و الـ
+
+56
+00:04:13,270 --> 00:04:18,040
+expiration الـ expiration بياخد .. بيكون أسرع ما
+
+57
+00:04:18,040 --> 00:04:23,780
+علينا هو ده الإطار العجيب فيه الغريب فيه أنه الـ two
+
+58
+00:04:23,780 --> 00:04:30,040
+curves أن هم عكس بعض مش بتطبقوا ما بتطبقوا تمام؟
+
+59
+00:04:30,040 --> 00:04:36,580
+لما أبدأ أنا أَجِلّ الـ pressure هان ما برجعش الـ curve
+
+60
+00:04:36,580 --> 00:04:41,520
+من أول و جديد هان لأ الـ volume بجل أجل من ما كان
+
+61
+00:04:41,520 --> 00:04:46,180
+طلع طلع بسرعة لكن هو بجل بجل أجل أجل أجل أجل أجل
+
+62
+00:04:46,180 --> 00:04:46,800
+أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل
+
+63
+00:04:46,800 --> 00:04:50,160
+أجل أجل أجل أجل أجل أجل أجل أجَل بسبب إيه؟ بسبب أن
+
+64
+00:04:50,160 --> 00:04:57,460
+الـ recoil هذا بياخد وقت أنا بنزل الـ .. تمام؟ لما
+
+65
+00:04:57,460 --> 00:05:00,740
+سحبته أنا active سحبته بسرعة رجعته بس هو برجع
+
+66
+00:05:00,740 --> 00:05:05,440
+بقوته برجع بالـ structure تبعه المهم هذا هو الـ curve
+
+67
+00:05:05,440 --> 00:05:10,520
+تبعه inspiratory و expiratory curve هذا هنستخدمه من
+
+68
+00:05:10,520 --> 00:05:13,480
+حاجة واحدة يعني إيش قيمته كتيرة؟ هذا الـ compliance
+
+69
+00:05:13,480 --> 00:05:20,150
+curve تبع الايه؟ تبع الـ lung في الطبيعي هنستفيد منه
+
+70
+00:05:20,150 --> 00:05:24,550
+في معرفة أهمية حاجة اسمها surfactant و الـ surface
+
+71
+00:05:24,550 --> 00:05:28,310
+tension و الكلام هذا تمام؟ من هنا احنا الـ curve
+
+72
+00:05:28,310 --> 00:05:33,790
+هذا أثر له تطبيق في الدراسة تبع الـ lung بفهمنا إشي
+
+73
+00:05:33,790 --> 00:05:37,750
+معين هنستفيد منه بعد شوية في حد ذاته هو إيش قيمته؟
+
+74
+00:05:37,750 --> 00:05:41,050
+أنه الـ inspiratory ماشي بالشكل هذا و الـ expiratory
+
+75
+00:05:41,050 --> 00:05:44,580
+ماشي بالشكل هذا؟ مش هيفيدنا كثيرا يعني مش هيفيدنا
+
+76
+00:05:44,580 --> 00:05:48,480
+كثيرا المفهوم الـ curve هذا لكنه بعد شوية هنفهم
+
+77
+00:05:48,480 --> 00:06:02,000
+القصة طيب
+
+78
+00:06:02,000 --> 00:06:06,260
+the elastic forces of the lungs can be divided into
+
+79
+00:06:06,260 --> 00:06:11,160
+two parts يعني
+
+80
+00:06:11,160 --> 00:06:15,140
+عندي أنا elastic forces بمعنى أنها بتمنع الـ
+
+81
+00:06:15,140 --> 00:06:20,480
+expansion و بتساعد على إيش الـ recoil مش كده الـ
+
+82
+00:06:20,480 --> 00:06:24,240
+elastic forces الموجودة إيش قيمتها هنا بتقاوم الـ
+
+83
+00:06:24,240 --> 00:06:29,280
+expansion تمام الـ elastic بتحاول تمنع الـ expansion
+
+84
+00:06:29,280 --> 00:06:36,300
+آه و لما أنا بقى أسيبها بتعود إيه بترجع زي ما كانت
+
+85
+00:06:36,300 --> 00:06:41,970
+هذه ناتجة عن طبيعة تركيب الـ lung tissues و هذا احنا
+
+86
+00:06:41,970 --> 00:06:45,790
+كلنا عارفينه و متوقعينه لكن إشي اللي بغريب على
+
+87
+00:06:45,790 --> 00:06:48,690
+الدراسة و غريب علينا احنا في مفهومنا الآن و احنا
+
+88
+00:06:48,690 --> 00:06:53,150
+بندرس أن الـ alveoli هذه lined by a film of water
+
+89
+00:06:53,150 --> 00:06:59,130
+a film of a fluid الـ alveolus هذه رطبة ففي عندي
+
+90
+00:06:59,130 --> 00:07:05,930
+film of fluid هذا عامل surface tension هتعمل إيش؟
+
+91
+00:07:05,930 --> 00:07:09,450
+surface tension هَلْجِيت نقطة المطر نقطة المية؟ ليش
+
+92
+00:07:09,450 --> 00:07:13,610
+همعملها نقطة؟ ليش مش مفروضة تنزل؟ ليش مش مفروضة؟
+
+93
+00:07:13,610 --> 00:07:17,010
+النقطة المحتوطة على الجزاز المطر ليش تنزل؟ نقطة
+
+94
+00:07:17,010 --> 00:07:19,950
+نقطة نقطة نقطة ليش أول ما تنزل على المية على
+
+95
+00:07:19,950 --> 00:07:26,630
+الجزاز تنفردش؟ ليش؟ لأنه في surface tension بين الـ
+
+96
+00:07:26,630 --> 00:07:30,250
+molecules of water هذه بتخليهم يمسكوا بعض و يعملوا
+
+97
+00:07:30,250 --> 00:07:35,250
+يشدوا بعض attractive forces تخلي أنّه .. أنّه المية
+
+98
+00:07:35,250 --> 00:07:39,690
+تتمسك في بعض البعض فلما تتمسك في بعض البعض بتعمل
+
+99
+00:07:39,690 --> 00:07:45,230
+surface tension مسكها بتعمل شكل دائرة مش كده الـ
+
+100
+00:07:45,230 --> 00:07:50,250
+film of water هذا في الـ .. في الـ alveolus بيميل أنه
+
+101
+00:07:51,140 --> 00:07:54,540
+يشد المية لبعض على بعض و يعمل drop من أول وجهته
+
+102
+00:07:54,540 --> 00:08:00,240
+و يخلي المية تسكر و ترجع drop لكن الـ lung الـ
+
+103
+00:08:00,240 --> 00:08:06,080
+alveolus مفتوحة تمام فهو دائما شدّ لجوه إذا في عند
+
+104
+00:08:06,080 --> 00:08:08,720
+surface tension من الـ film of water اللي بيبطن الـ
+
+105
+00:08:08,720 --> 00:08:14,540
+alveoli وهذه قصة كبيرة هنتكلم عنها و هنتكلم عن خطورتها و
+
+106
+00:08:14,540 --> 00:08:17,790
+عن مشاكلها اللي بتصير clinically تمام؟ يعني في
+
+107
+00:08:17,790 --> 00:08:22,890
+أطفال بيولدوا و بعد فترة بسيطة بيموتوا فقط لأن الـ
+
+108
+00:08:22,890 --> 00:08:27,890
+surface tension هذا اللي جوا كثير تبع المية ليش؟
+
+109
+00:08:27,890 --> 00:08:30,850
+قال آه في مادة اسمها surfactant مفترض أنها تكون في
+
+110
+00:08:30,850 --> 00:08:35,270
+داخل السائل هذا تقلل من الـ surface tension تبعه
+
+111
+00:08:35,270 --> 00:08:40,290
+آه و تخليه أخف شوية و تخلي الطفل آه يقدر يفتح الـ
+
+112
+00:08:40,290 --> 00:08:44,290
+lung الـ alveoli بسهولة لكن لما يكون عندي أنا الـ
+
+113
+00:08:44,290 --> 00:08:47,630
+recoil قوي شديد بسبب الـ surface tension اللي فقد
+
+114
+00:08:47,630 --> 00:08:52,350
+مادة معينة بيقدر الـ طفل بمليون عافية يفتح صدره
+
+115
+00:08:52,350 --> 00:08:55,670
+يدخل الهواء إلى الـ alveoli لأنه في عنده recoil
+
+116
+00:08:55,670 --> 00:08:59,730
+pressures عالي تمام فهذا بيقدر أنه يرحق خلال فترة
+
+117
+00:08:59,730 --> 00:09:02,950
+بسيطة عضلاته تتوقف عن العمل تعمد أو بيموت
+
+118
+00:09:02,950 --> 00:09:09,100
+respiratory distress syndrome Newborn respiratory
+
+119
+00:09:09,100 --> 00:09:14,640
+distress syndrome تمام؟ بيقولوا آه والله الرائعتين
+
+120
+00:09:14,640 --> 00:09:19,640
+تبعتهم هذه الحِمَة ما بتنفخش الرائعتين مش راديتين
+
+121
+00:09:19,640 --> 00:09:23,720
+ما بتنفخش بس جدعة لحمة لأ هي مش جدعة لحمة هي مُكاملة
+
+122
+00:09:23,720 --> 00:09:31,330
+لكنه الـ recoil تبع المية لجوه الـ surface شدها لبعض
+
+123
+00:09:31,330 --> 00:09:35,950
+و سكر الـ alveoli عشان تفتحها هيك بدنا pressure
+
+124
+00:09:35,950 --> 00:09:39,570
+عالي على العضلات من برا عشان يقدر يفتح الـ .. الـ
+
+125
+00:09:39,570 --> 00:09:48,030
+recoil تبع الـ lung نقدر نشده تمام؟ له قوة معينة و
+
+126
+00:09:48,030 --> 00:09:51,270
+الـ surface tension له قوة معينة لكن في الطبيعي
+
+127
+00:09:51,270 --> 00:09:54,550
+عندنا أن الـ surface tension هي ده تبع الـ .. الـ ..
+
+128
+00:09:54,550 --> 00:09:57,390
+الـ .. الـ film of water أو film .. film of fluid
+
+129
+00:09:57,390 --> 00:10:01,390
+اللي lining الـ alveoli جَرّبنا خَلّج أن هي مش مية بحتة
+
+130
+00:10:01,390 --> 00:10:06,110
+ولا extra fluid بحتة لأ خَلّج أن في مادة أخرى تقلل
+
+131
+00:10:06,110 --> 00:10:11,390
+surface .. surface tension تخف بحيث أنه يقدر أنه
+
+132
+00:10:11,390 --> 00:10:14,250
+عامل مساعد الـ recoil بس مش عامل كمية كبيرة اللي
+
+133
+00:10:14,250 --> 00:10:17,170
+إيه اللي يمنع الـ expansion واضح؟
+
+134
+00:10:19,480 --> 00:10:22,460
+لذلك بتكلم عن الـ recoil هذه عندي حاجتين الـ
+
+135
+00:10:22,460 --> 00:10:27,280
+elasticity نفسها بتخلي الـ الـ الـ الـ الـ الـ الـ الـ
+
+136
+00:10:27,280 --> 00:10:27,680
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+137
+00:10:27,680 --> 00:10:28,340
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+138
+00:10:28,340 --> 00:10:28,620
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+139
+00:10:28,620 --> 00:10:31,100
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+140
+00:10:31,100 --> 00:10:33,140
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+141
+00:10:33,140 --> 00:10:36,920
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+142
+00:10:36,920 --> 00:10:40,260
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+143
+00:10:40,260 --> 00:10:40,480
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+144
+00:11:05,370 --> 00:11:09,810
+the elastic forces of the lung are determined
+
+145
+00:11:09,810 --> 00:11:16,180
+mainly الـ lung نفسه بتتحدد بالتركيبة تبع الـ lung
+
+146
+00:11:16,180 --> 00:11:21,480
+tissue اللي هو عندي elastin and collagen و
+
+147
+00:11:21,480 --> 00:11:26,520
+هدول زي ما قلنا kinged بطريقة معينة بحيث أنه ممكن
+
+148
+00:11:26,520 --> 00:11:28,900
+ينفردوا بس بميل أن هم يرجعوا يعملوا king king
+
+149
+00:11:28,900 --> 00:11:32,460
+فأنت لما هتعمل أي force بتفردهم لما تسيبهم يعودوا
+
+150
+00:11:32,460 --> 00:11:38,480
+إيه من جديد بس هذه اللي هي الموضوع الخطير تبعنا الـ
+
+151
+00:11:38,480 --> 00:11:42,500
+elastic forces that caused by surface tension are
+
+152
+00:11:42,500 --> 00:11:46,520
+much more complex مش فيها البساطة هذه تمام؟ فهمنا
+
+153
+00:11:46,520 --> 00:11:50,380
+احنا الفكرة تبعنا فهمنا الفكرة تبعنا و عشان نشوف
+
+154
+00:11:50,380 --> 00:11:55,240
+احنا الـ surface tension هذا قد إيش أهميته قد إيش
+
+155
+00:11:55,240 --> 00:12:00,900
+أهميته نحاول نشوف الـ compliance تبع الـ lung ما هو
+
+156
+00:12:00,900 --> 00:12:03,300
+الآن اللي بيقاوم الـ compliance اللي بيحدد الـ
+
+157
+00:12:03,300 --> 00:12:06,700
+compliance قد إيش بيقاوم الـ inflation الـ recoil
+
+158
+00:12:06,700 --> 00:12:13,080
+forces الـ recoil forces قلنا صارت مجسمة جسمين الـ
+
+159
+00:12:13,080 --> 00:12:18,520
+structured tissues و الفيلم و بعدها طيب الآن ..
+
+160
+00:12:18,520 --> 00:12:24,560
+الآن أنا هل الـ compliance هذا كل واحدة من الـ
+
+161
+00:12:24,560 --> 00:12:29,010
+forces هذه كده بتأثر فيه؟ تمام؟ أنا لو الـ
+
+162
+00:12:29,010 --> 00:12:32,010
+compliance تبع الـ tissues الـ elasticity أقل شوية
+
+163
+00:12:32,010 --> 00:12:33,270
+كان النفخة تبع
+
+164
+00:12:33,270 --> 00:12:55,350
+ووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووو
+
+165
+00:12:55,590 --> 00:12:59,610
+بدي أحاول أن ألغي واحد منهم عشان أشوف الواحد لحاله
+
+166
+00:12:59,610 --> 00:13:04,550
+كيف تأثيره بكده بقدر أميز إذا الـ curve الرئيسي هذا
+
+167
+00:13:04,550 --> 00:13:12,070
+تمام؟ شايفين كم مربط؟ بالراحة بيشتغل الآن لو أنا
+
+168
+00:13:12,070 --> 00:13:18,130
+حاولت أشيل الـ surface tension factor كيف ممكن
+
+169
+00:13:18,130 --> 00:13:23,750
+أشيله؟ بدي أجيب lung و بعدين بدي أنغس الـ surface
+
+170
+00:13:23,750 --> 00:13:29,230
+tension، أعبيها saline، أعبيها مية، أعبيها مية،
+
+171
+00:13:29,23
+
+223
+00:17:21,360 --> 00:17:29,820
+tissue forces، واضح؟ واضح، طيب. The fluid air
+
+224
+00:17:29,820 --> 00:17:32,920
+surface tension and elastic forces of the lungs also
+
+225
+00:17:32,920 --> 00:17:36,600
+increase tremendously when the substance called
+
+226
+00:17:36,600 --> 00:17:41,100
+surfactant is not present. احنا فهمنا القصة هذه، أن
+
+227
+00:17:41,100 --> 00:17:48,820
+هو مهم، أن هو إيه؟ مهم، وفي الطبيعي، لما نيجي نقول أن هو يمثل
+
+228
+00:17:48,820 --> 00:17:53,200
+2:1 بالنسبة لـ lung tissues recoil
+
+229
+00:17:53,200 --> 00:17:59,620
+forces. تمام. بتزيد المشكلة أكبر لو الـ water هذا، الـ
+
+230
+00:17:59,620 --> 00:18:05,380
+fluid اللي lining ال alveoli تركيبته اختلفت، وصار
+
+231
+00:18:05,380 --> 00:18:08,760
+له surface tension أكبر. ليش؟ هو الـ surface tension
+
+232
+00:18:08,760 --> 00:18:13,360
+أو الـ recoil forces هذه لما تتغير مثلاً، مختلف.. اه.
+
+233
+00:18:13,360 --> 00:18:17,480
+جالك مثال، في عندي أنا مواد مختلفة، كل مادة لها
+
+234
+00:18:17,480 --> 00:18:23,280
+إيه؟ لها surface tension مختلفة عن الثانية، من
+
+235
+00:18:23,280 --> 00:18:23,820
+راحت.
+
+236
+00:18:28,310 --> 00:18:34,470
+طيب، إذا في مادة اسمها إيه؟ surfactant. إذا كانت مش
+
+237
+00:18:34,470 --> 00:18:39,190
+موجودة، هيديلي إيه؟ مشاكل كتيرة. الـ surfactant هذه
+
+238
+00:18:39,190 --> 00:18:49,810
+مادة surface acting agent. surfactant يعني هي اسمها
+
+239
+00:18:49,810 --> 00:18:58,000
+مش اسم إنجليزي حقيقي. هو مركب، اسم مركب من إيه؟ من زي
+
+240
+00:18:58,000 --> 00:19:04,020
+فيات، سيارة فيات! مركب، تركيب زي دواء نيوستاتين اللي
+
+241
+00:19:04,020 --> 00:19:09,100
+احنا بنستخدمه للـ fungus. مركب تركيب نيوستاتين، New York
+
+242
+00:19:09,100 --> 00:19:16,080
+State. نيوستاتين، عشان هو دواء يعني، فيات، Fabrica
+
+243
+00:19:16,080 --> 00:19:22,400
+Italiano. ما أعرفش إيش، وهذه surfactant، surface
+
+244
+00:19:22,400 --> 00:19:30,780
+acting agent. تمام؟ طيب، يعني هذه المادة لما تنخلط
+
+245
+00:19:30,780 --> 00:19:36,640
+بالماء، تمام، بتقلل الـ surface tension. بتقلل الـ
+
+246
+00:19:36,640 --> 00:19:41,400
+surface tension. بتقلل
+
+247
+00:19:41,400 --> 00:19:44,900
+الـ surface tension. بتقلل الـ surface tension. بتقلل
+
+248
+00:19:44,900 --> 00:19:45,360
+الـ surface tension. بتقلل الـ surface tension. بتقلل
+
+249
+00:19:45,360 --> 00:19:45,420
+الـ surface tension. بتقلل الـ surface tension. بتقلل
+
+250
+00:19:45,420 --> 00:19:45,500
+الـ surface tension. بتقلل الـ surface tension. بتقلل
+
+251
+00:19:45,500 --> 00:19:45,540
+الـ surface tension. بتقلل الـ surface tension. بتقلل
+
+252
+00:19:45,540 --> 00:19:51,940
+الـ surface tension. بتقلل الـ surface
+
+253
+00:19:51,940 --> 00:20:00,260
+tension. بتقلل الـ surface. فيها أنو two types of
+
+254
+00:20:00,260 --> 00:20:07,260
+cells. الـ الـ الـ flat alveolar cells، اللي هو بيسميها
+
+255
+00:20:07,260 --> 00:20:12,740
+احنا alveolar cell type one، وفي عندي alveolar cell
+
+256
+00:20:12,740 --> 00:20:16,060
+إضافية، تمثل خمسة، الـ إيه؟ twenty percent of the cells
+
+257
+00:20:16,060 --> 00:20:21,840
+alveolar cell type two. الـ type two، هادي شغلتها بس
+
+258
+00:20:21,840 --> 00:20:26,500
+تعمل secretion لمين؟ لـ surfactant. الـ type one لأ، هي
+
+259
+00:20:26,500 --> 00:20:30,240
+اللي بيصير عن طريقها التبادل الغازات، زي اللي كان
+
+260
+00:20:30,240 --> 00:20:34,400
+thin، زي الـ endothelium تبع مين؟ تبع الـ capillaries تبع
+
+261
+00:20:34,400 --> 00:20:48,580
+الشعيرات الدموية. مش كده؟ طيب، surfactant
+
+262
+00:20:48,580 --> 00:20:53,260
+and its effect. surfactant is a surface active
+
+263
+00:20:53,260 --> 00:21:00,020
+agent في الماء، وهو يعني أنه يقلل كثيرًا، حرارة
+
+264
+00:21:00,020 --> 00:21:04,980
+الماء، من الماء. إنه مُفرَز من الخلايا الخاصة اللي
+
+265
+00:21:04,980 --> 00:21:09,200
+اتكلمنا عنها. هذه الخلايا هي خلايا جرانولارية،
+
+266
+00:21:09,200 --> 00:21:14,240
+جرانولارية، يعني تحتوي على حبيبات، يعني فيه فيه
+
+267
+00:21:14,240 --> 00:21:18,770
+production، فيه شيء يُصنع جوا، تمام؟ أنا قلت عشرين
+
+268
+00:21:18,770 --> 00:21:21,670
+المائة، أنا غلطان، عشرة المائة، يمثل عشرة المائة من
+
+269
+00:21:21,670 --> 00:21:26,650
+الايه؟ من الـ .. الـ alveolar cells. these cells are
+
+270
+00:21:26,650 --> 00:21:30,610
+granular، containing lipid inclusions that are
+
+271
+00:21:30,610 --> 00:21:36,350
+secreted into the surfactant into the alveoli. إذا
+
+272
+00:21:36,350 --> 00:21:41,820
+احنا فهمنا أن الـ surfactant الآن، secreted by the
+
+273
+00:21:41,820 --> 00:21:47,860
+type 2 alveolar cells، اللي تمثل 10% من الـ alveolar
+
+274
+00:21:47,860 --> 00:21:52,200
+cells. هذا عبارة عن مادة دهنية. مادة دهنية، لذلك
+
+275
+00:21:52,200 --> 00:21:58,080
+اتكلمنا عن، احنا، granular vesicles
+
+276
+00:21:58,080 --> 00:22:01,920
+containing lipid inclusions. في داخلها، يعني هذه
+
+277
+00:22:01,920 --> 00:22:05,140
+lipid. إلى حد ما. طيب، من إيش متكون المادة هذه؟ تطلع
+
+278
+00:22:05,140 --> 00:22:10,750
+تتكون من several phospholipids، وبعض البروتين، و
+
+279
+00:22:10,750 --> 00:22:14,790
+أيونات فوسفو
+
+280
+00:22:14,790 --> 00:22:19,110
+ليبيد. أهمها الـ فوسفوليبيد اللي هو dipalmitoyl
+
+281
+00:22:19,110 --> 00:22:24,770
+phosphatidylcholine.  dipalmitoyl
+
+282
+00:22:24,770 --> 00:22:31,170
+phosphatidylcholine. وعندنا البروتين اسمه surfactant
+
+283
+00:22:31,170 --> 00:22:35,950
+apoprotein، وعندنا calcium ions. ثلاثة مع بعض، هدول
+
+284
+00:22:35,950 --> 00:22:43,900
+تمام، بيجوا كمادة بتدخل ما بين الـ water molecules، و
+
+285
+00:22:43,900 --> 00:22:49,200
+بتؤدي إلى أن تبعدها عن بعض. كل ما زادت النسبة هذه،
+
+286
+00:22:49,200 --> 00:22:52,360
+كل ما زاد تأثيرها أكثر. كل ما قلت، كل ما.. اه؟
+
+287
+00:22:52,360 --> 00:22:55,900
+يعني هذه النسبة.. نسبة معينة، مختلطة، مخلوطة بحيث
+
+288
+00:22:55,900 --> 00:22:57,840
+أنها ما تمنعش الـ surface tension تبع الـ water
+
+289
+00:22:57,840 --> 00:23:02,610
+completely، لكنها إيه؟ بتقلله، بتضعفه. التأثير، هي كأنها
+
+290
+00:23:02,610 --> 00:23:06,550
+بيصير أن جزء يبقى موجود في الـ Phospholipid، دايب
+
+291
+00:23:06,550 --> 00:23:10,670
+في الماء، وجزء مش دايب في الماء. فهذا بيؤدي إلى أن
+
+292
+00:23:10,670 --> 00:23:13,990
+يحدث interruptions لـ water molecules. مش متماسكة مع بعض
+
+293
+00:23:13,990 --> 00:23:16,610
+البعض، في فراغات ما بين الـ molecules. مش كل الـ
+
+294
+00:23:16,610 --> 00:23:22,030
+molecules ماسكة في بعضها البعض. تمام؟
+
+295
+00:23:22,030 --> 00:23:25,870
+in
+
+296
+00:23:25,870 --> 00:23:28,670
+quantitative terms, the surface tension of
+
+297
+00:23:28,670 --> 00:23:32,240
+different water fluids is approximately the
+
+298
+00:23:32,240 --> 00:23:36,140
+following. إذا لم أتكلم عن أرقام، خليني أتكلم عن
+
+299
+00:23:36,140 --> 00:23:39,800
+الـ surface tension تبع المواد المختلفة، الـ pure
+
+300
+00:23:39,800 --> 00:23:44,200
+water، لجنة الـ surface tension تبعه 72 dynes per
+
+301
+00:23:44,200 --> 00:23:49,060
+centimeter. الـ normal fluid lining the alveoli، من
+
+302
+00:23:49,060 --> 00:23:51,980
+غير surfactant، لو شلنا.. جبنا تركيبة الـ fluid
+
+303
+00:23:51,980 --> 00:23:54,920
+اللي هو شبيه الـ extra serum fluid، وشيلنا منه
+
+304
+00:23:54,920 --> 00:23:59,200
+surfactant، هنلاقي أن الـ surface tension تبعه
+
+305
+00:23:59,200 --> 00:24:04,680
+50 داين/سنتيمتر، لكن بالـ surfactant بينزل إلى
+
+306
+00:24:04,680 --> 00:24:10,000
+تُقْلَم 5 إلى 30 داين/سنتيمتر، حسب أنا قد إيش حاطة
+
+307
+00:24:10,000 --> 00:24:14,380
+surfactant. تمام؟ ممكن ينزل الـ surfactant نهائيًا،
+
+308
+00:24:14,380 --> 00:24:20,080
+ممكن يكون يعني متوسط 50% إلى 1/12
+
+309
+00:24:20,080 --> 00:24:22,420
+من الـ.. من الـ surfactant. يعني ممكن يلغي الـ
+
+310
+00:24:22,420 --> 00:24:27,940
+surfactant تبع المادة هذه، نص الكمية فقط، تبقى
+
+311
+00:24:27,940 --> 00:24:28,860
+surfactant.
+
+312
+00:24:31,980 --> 00:24:36,140
+أو لو زادت الـ surfactant، ينزل لـ 5، لو 1/12
+
+313
+00:24:36,140 --> 00:24:39,220
+من الـ إيه؟ من الـ original surface tension تبع
+
+314
+00:24:39,220 --> 00:24:42,720
+هذه المادة. تمام؟ يبقى كده هذه المادة كتير مهمة.
+
+315
+00:24:44,050 --> 00:24:48,930
+معناها بيصير عندي 12 ضعف، أو 8 أضعاف، أو 10
+
+316
+00:24:48,930 --> 00:24:53,690
+أضعاف، أو على الأقل ضعفين، الـ a الـ surface
+
+317
+00:24:53,690 --> 00:24:58,350
+tension تبع الـ lungs. معناها أنا بدي force أقوى في
+
+318
+00:24:58,350 --> 00:25:01,590
+عملية أن أفتح الـ lungs عشان أرجع الـ compliance
+
+319
+00:25:01,590 --> 00:25:05,970
+للعملية الأولى. بدي قوة أكبر، إذا زاد الـ surface
+
+320
+00:25:05,970 --> 00:25:09,570
+tension، هذا بدي قوة أكبر عشان أفتح الـ a، ومن هنا
+
+321
+00:25:09,570 --> 00:25:16,450
+المشكلة بتصير عندي لما ينولد ولد صغير فاقد هذه الـ
+
+322
+00:25:16,450 --> 00:25:23,130
+إيه؟ الـ.. فاقد هذه الـ property، هذه surfactant
+
+323
+00:25:23,130 --> 00:25:27,410
+secretion. تمام؟ مشكلة كبيرة في الآخر، إذا ما أديتوش
+
+324
+00:25:27,410 --> 00:25:31,220
+أنا surfactant، ودي very expensive material. إذا ما
+
+325
+00:25:31,220 --> 00:25:35,100
+أديتوا أنا surfactant بإيدي، هيموت فورًا. وإذا أديتوا
+
+326
+00:25:35,100 --> 00:25:38,800
+أنا surfactant، وأنا غنية، زي واحدة من سنتين، يعني
+
+327
+00:25:38,800 --> 00:25:41,400
+كانت عندها المشكلة هذه، لكن أهلها أغنية، ودوها على
+
+328
+00:25:41,400 --> 00:25:44,680
+إسرائيل، وأخدت surfactant، وظلت عايشة عليها لسنين،
+
+329
+00:25:44,680 --> 00:25:51,840
+اتنين عشرة، ماتت لأن بعد كده مش قادرة أنها تواصل الحياة
+
+330
+00:25:51,840 --> 00:25:56,180
+الطبيعية. بدأت الـ lungs تتغير شوية شوية شوية شوية.
+
+331
+00:25:56,180 --> 00:25:59,820
+لو وصلت لمرحلة أن صار عندي respiratory
+
+332
+00:25:59,820 --> 00:26:04,310
+insufficiency. تمام؟ طيب، خليني نرجع تاني، نشوف إحنا من
+
+333
+00:26:04,310 --> 00:26:09,050
+جبت سيرة ولد صغير، لأن هو اللي بينه ولد، والـ
+
+334
+00:26:09,050 --> 00:26:12,010
+surfactant مفقود منه. طيب، وإذا الولد premature،
+
+335
+00:26:12,010 --> 00:26:14,890
+بدري، في العادة الـ surfactant ما يكونش إلا في الأشهر
+
+336
+00:26:14,890 --> 00:26:17,790
+الأخيرة. فإذا ده الولد premature، ممكن أحطه في
+
+337
+00:26:17,790 --> 00:26:20,630
+الحضانة فترة، لحد ما الـ surfactant يرجع يتكون، و
+
+338
+00:26:20,630 --> 00:26:24,010
+بقولهم يلا، الله يسهل عليكم. هذا إذا ما دخلش في إيه؟
+
+339
+00:26:24,010 --> 00:26:26,970
+الـ respiratory infection، لأن هذا اللي بيصير عندنا
+
+340
+00:26:26,970 --> 00:26:30,170
+قبل ما يتكون الـ surfactant، بيكون دخل في إيه؟ في..
+
+341
+00:26:30,170 --> 00:26:32,790
+في.. في.. في severe acute pulmonary infection،
+
+342
+00:26:32,790 --> 00:26:36,470
+بيموت الولد. لكن نفترض إنه إحنا في مستشفى محترمة،
+
+343
+00:26:36,470 --> 00:26:41,310
+وعندنا حضانة ممتازة، ما فيش cross infection في
+
+344
+00:26:41,310 --> 00:26:44,520
+الحالة هذه. لو صبرنا عليه أسبوعين، ثلاثة، الـ
+
+345
+00:26:44,520 --> 00:26:47,420
+premature، الولد بدري، قبل ما يعود الـ surfactant
+
+346
+00:26:47,420 --> 00:26:50,200
+هيرجع يتكون، وهيرجع على سبيل المثال، الـ sister، روح،
+
+347
+00:26:50,200 --> 00:26:53,080
+ونقوله مع السلامة. لكن بعض الناس عندهم congenital
+
+348
+00:26:53,080 --> 00:26:57,240
+absence of that surfactant. تاني مشكلة كبيرة. طيب،
+
+349
+00:26:57,240 --> 00:27:00,500
+أنا هنا إيه؟ عن إيش بدأت أتكلم فوق؟ قعدت رجعت، بدأت أقول
+
+350
+00:27:00,500 --> 00:27:06,120
+أن في عامل تاني في الطفل يخلي المشكلة أكبر. كيف
+
+351
+00:27:06,120 --> 00:27:09,240
+يعني؟ يعني احنا okay، قلنا الـ surfactant، عدم وجوده
+
+352
+00:27:09,240 --> 00:27:12,120
+مشكلة للطفل، ووجوده
+
+353
+00:27:15,620 --> 00:27:19,600
+إذا عندي أنا عدم وجود الـ surfactant، المشكلة، لكن
+
+354
+00:27:19,600 --> 00:27:23,440
+عدم وجوده كمان في الطفل، المشكلة بيصير مضاعفة. ليش؟
+
+355
+00:27:23,440 --> 00:27:27,460
+طيب، نشوف احنا الـ surface tension هذا كيف بنحسبه، و
+
+356
+00:27:27,460 --> 00:27:31,480
+كيف بتكون. تمام؟
+
+357
+00:27:31,480 --> 00:27:35,860
+لما نيجي نقول أن عشان أعرف الـ pressure اللي بتكون من الـ
+
+358
+00:27:35,860 --> 00:27:40,860
+surface tension، بيعتمد على الـ diameter تبع الـ الـ الـ
+
+359
+00:27:40,860 --> 00:27:42,660
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+360
+00:27:42,660 --> 00:27:44,760
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+361
+00:27:44,760 --> 00:27:46,000
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+362
+00:27:46,000 --> 00:27:48,620
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+363
+00:27:48,620 --> 00:27:50,580
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+364
+00:27:50,580 --> 00:27:58,720
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+365
+00:27:58,720 --> 00:27:58,760
+الـ الـ الـ الـ الـ الـ
+
+366
+00:28:04,980 --> 00:28:08,600
+في الـ.. في، احنا الكبار، الـ radius of our alveoli
+
+367
+00:28:08,600 --> 00:28:13,980
+حوالي 100 ميكرون، الصغار حوالي 50، تمام؟ فلذلك
+
+368
+00:28:13,980 --> 00:28:18,920
+أنا هنا لما بقسم على 100، بظهر الـ surface tension
+
+369
+00:28:18,920 --> 00:28:23,560
+هذا الموجود، لكن لما بقسم على 50، بيصير عندي
+
+370
+00:28:23,560 --> 00:28:28,140
+ضعف الكمية، الـ surface tension، ضعف الـ pressure،
+
+371
+00:28:28,140 --> 00:28:32,010
+لذلك الطفل الصغير عنده radius صغير، وهو عدم وجود
+
+372
+00:28:32,010 --> 00:28:35,490
+surfactant، فبيؤدي إلى أن الـ pressure الموجود هيكون
+
+373
+00:28:35,490 --> 00:28:38,770
+عالي جدًا، لأن الـ surface tension ما اتغيرش، فقدر منه
+
+374
+00:28:38,770 --> 00:28:43,950
+الـ surfactant زاد، وعندي diameter صغير، زاد لضعف
+
+375
+00:28:43,950 --> 00:28:48,450
+أكثر وأكثر. مش كده؟ طيب، إذا هنا الخطورة في الأطفال،
+
+376
+00:28:48,450 --> 00:28:53,510
+أن الـ pressure اللي بتكون، هذه بتكون في الـ alveoli
+
+377
+00:28:53,510 --> 00:28:59,270
+small، smaller، half the size، half the radius of the
+
+378
+00:29:01,870 --> 00:29:05,110
+of the adult. فبيؤدي إلى أنه بيديني more pressure.
+
+379
+00:29:05,110 --> 00:29:10,210
+بحسب الحسبة اللي متكونة، for the average size
+
+380
+00:29:10,210 --> 00:29:15,250
+alveolus، with the radius of about micrometer، and
+
+381
+00:29:15,250 --> 00:29:18,370
+the line with normal surfactant. this calculates to
+
+382
+00:29:18,370 --> 00:29:22,130
+be about four centimeters of water pressure. حوالي
+
+383
+00:29:22,130 --> 00:29:26,550
+3 مم، ميكرومتر. لكن في الطفل، هنلاقي بيوصل
+
+384
+00:29:26,550 --> 00:29:30,970
+لـ 7 سم.  في وجه الـ surfactant. إذا كانت الـ alveoli
+
+385
+00:29:30,970 --> 00:29:34,770
+مرتبطة بماء طبيعي، بدون أي مدفع. المدفع المدفع المدفع
+
+386
+00:29:34,770 --> 00:29:36,670
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+387
+00:29:36,670 --> 00:29:38,950
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+388
+00:29:38,950 --> 00:29:39,310
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+389
+00:29:39,310 --> 00:29:41,290
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+390
+00:29:41,290 --> 00:29:42,090
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+391
+00:29:42,090 --> 00:29:45,110
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+392
+00:29:45,110 --> 00:29:55,610
+المدفع المدفع المدفع المدفع المدفع
+
+393
+00:29:59,770 --> 00:30:02,
+
+445
+00:34:00,030 --> 00:34:04,070
+تشيس وول توراكس وول تمام؟ إذا صار عندي فيه ثلاثة
+
+446
+00:34:04,070 --> 00:34:08,590
+أنواع من الـ resistance عندها the work of
+
+447
+00:34:08,590 --> 00:34:11,190
+inspiration can be divided into three fractions
+
+448
+00:34:11,190 --> 00:34:15,870
+اللي أنا عشان أبذل الجهد عشان أتنفس بستخدم .. بشغل
+
+449
+00:34:15,870 --> 00:34:20,970
+ثلاث حاجات، الهواء اللي هو داخل داخل في أنابيب رفيعة
+
+450
+00:34:20,970 --> 00:34:25,760
+إلها مقاومة، مش كده؟ الأنسجة اللي أنا بأزيحها، انسوا
+
+451
+00:34:25,760 --> 00:34:29,580
+أنها elastic، الأنسجة بدي أزيحها هيك وأظل
+
+452
+00:34:29,580 --> 00:34:32,860
+محلها، مش مشكلة، يعني أنا حاجة إيه أزيح تاني كده
+
+453
+00:34:32,860 --> 00:34:36,940
+ما رجعتش، ما فيش إيه ركود، بس أنا زيحتها، هذا بده
+
+454
+00:34:36,940 --> 00:34:41,140
+جهود، مش كده؟ وكمان وأنا بأزيحها بتقومني، صار فيه
+
+455
+00:34:41,140 --> 00:34:46,160
+جهود ثالثة تمام؟ إذا أنا بأزيحها، الأنسجة إلها، وإلها،
+
+456
+00:34:46,160 --> 00:34:50,130
+وإلها work، جهود، بدأت أكبرها، اتفاجأنا أنها مش راضية
+
+457
+00:34:50,130 --> 00:34:53,630
+فيه كمان elasticity، الهوزن والهي elasticity، لذلك
+
+458
+00:34:53,630 --> 00:34:59,030
+الـ work هنا بيتوزع على الـ resistance الثلاثة اللي
+
+459
+00:34:59,030 --> 00:35:03,110
+هو resistance of the airways، الـ tissue resistance
+
+460
+00:35:03,110 --> 00:35:07,810
+work، الـ tissue لحاله، لإن أنا بأزيحه، أبعده تمام
+
+461
+00:35:07,810 --> 00:35:12,370
+الثلاثة، الـ recoil، الهواء، الـ elasticity، elastic the
+
+462
+00:35:12,370 --> 00:35:16,370
+compliance work or elastic work، تمام، إذا عندي أنا
+
+463
+00:35:16,370 --> 00:35:22,360
+الـ work اللي بستخدمه، بستخدمه لثلاث مناطق، ثلاث حاجات
+
+464
+00:35:22,360 --> 00:35:25,420
+اللي هو دخول الهواء، بيندفع في الـ air passages وهو
+
+465
+00:35:25,420 --> 00:35:31,140
+أقل resistance، الأنسجة اللي أنا بأزيحها هذه برضه
+
+466
+00:35:31,140 --> 00:35:34,400
+أقل resistance، الـ elastic forces اللي هي الـ
+
+467
+00:35:34,400 --> 00:35:38,280
+compliance work، هذا أكبر، بنلاحظ احنا أنه during
+
+468
+00:35:38,280 --> 00:35:41,260
+normal، هذا آخر شيء بدي أقوله، during normal quiet
+
+469
+00:35:41,260 --> 00:35:46,920
+respiration، 3%-5% من الطاقة المستخدمة يتم استخدامها
+
+470
+00:35:46,920 --> 00:35:47,640
+لإدخال الهواء
+
+471
+00:35:56,270 --> 00:36:00,230
+أنا بعمل مجهود، بدي أتنفس أكثر، أنا كمية الطاقة
+
+472
+00:36:00,230 --> 00:36:02,170
+اللي صارت بستخدمها أكثر، لإن أنا جاهدة بعمل مجهود
+
+473
+00:36:02,170 --> 00:36:05,450
+كبير، بطلع بلاقي صارت أنا محتاجة إلى خمسين، قد يكون
+
+474
+00:36:05,450 --> 00:36:09,510
+خمسين ضعف الطاقة اللي بستخدمها في الـ إيه؟ في وضع
+
+475
+00:36:09,510 --> 00:36:13,990
+الراحة، يعني التنفس في وضع مجهود بيده يستخدم إيه
+
+476
+00:36:13,990 --> 00:36:17,030
+طاقة أكبر، والتنفس في وضع مرتاح بيستخدم طاقة
+
+477
+00:36:17,030 --> 00:36:22,420
+بسيطة، مش كده؟ المرة اللي جاية هأتكلم عن الـ
+
+478
+00:36:22,420 --> 00:36:25,340
+pulmonary volumes and capacities، اللي أعتقد أن
+
+479
+00:36:25,340 --> 00:36:29,360
+أنتوا أخذتوها في المعمل، أشياء كثيرة عنها، هتسهل علينا
+
+480
+00:36:29,360 --> 00:36:33,160
+المهمة، إن شاء الله، نقدر نخلص الفصل اللي جاي في
+
+481
+00:36:33,160 --> 00:36:35,060
+المحاضرة اللي جاية، الله يعطيكم العافية وبركة الله
+
+482
+00:36:35,060 --> 00:36:36,060
+فيكم من له سؤال؟
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..fec351c97896fe8e8eca5d4a1ddef51e733a37e8
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_postprocess.srt
@@ -0,0 +1,1928 @@
+1
+00:00:07,290 --> 00:00:11,010
+يعني كل واحد centimeter pressure بيعمل .. بيزود ال
+
+2
+00:00:11,010 --> 00:00:15,270
+volume تبع ال lung 62 بيزودهم كلهم مع بعض ال
+
+3
+00:00:15,270 --> 00:00:18,310
+volume اللي بيزيد 200 milliliter لإنه ال 2.5
+
+4
+00:00:18,310 --> 00:00:22,770
+بيزودولي 500 milliliter تمام؟ يعني لو نفخنا ال
+
+5
+00:00:22,770 --> 00:00:27,110
+ايه؟ ال lung نفخ الدقت اللي انا بديه هي .. بديه هي
+
+6
+00:00:27,110 --> 00:00:31,140
+ان اديت هي ساحب او اديت هي اللي هو هو ده sameالـ
+
+7
+00:00:31,140 --> 00:00:34,320
+lung كالlung تمام؟ بلاقي كل ضغط بزيد و أنا بتزيد
+
+8
+00:00:34,320 --> 00:00:38,500
+هي زي البلون بنفخت شوية بزيد الضغط بنتفخ بزيد
+
+9
+00:00:38,500 --> 00:00:40,520
+الضغط أكتر بنتفخت أكتر بزيد الضغط أكتر بنتفخت أكتر
+
+10
+00:00:40,520 --> 00:00:47,460
+مش كده؟ لما أزيد ل متين بلاقيها انتفخت إيه؟ إلى
+
+11
+00:00:47,460 --> 00:00:52,080
+واحد إلى متين متين مليليتر بتزيد وحك كذا تمام؟ إذا
+
+12
+00:00:52,080 --> 00:00:56,300
+ال compliance each one pressure unit increases the
+
+13
+00:00:56,300 --> 00:01:01,110
+lung volume إلى إيه؟ متين مليليتر واضح؟هذا ال ايه
+
+14
+00:01:01,110 --> 00:01:07,750
+ال compliance ال compliance هذا عملناله
+
+15
+00:01:07,750 --> 00:01:13,970
+احنا ايه عملناله curve هيك the compliance diagram
+
+16
+00:01:13,970 --> 00:01:19,130
+of the lung هذا ايه ال compliance كيف يعني و انا
+
+17
+00:01:19,130 --> 00:01:23,670
+بنفخ فيه في ال lung ال lung بتزيد خلينا نبدأ من
+
+18
+00:01:23,670 --> 00:01:28,160
+هنا تمام او انا بشفط في ال intrabral pressureالـ
+
+19
+00:01:28,160 --> 00:01:33,740
+lung volume a بيزيد فلو احنا حطينا من level معين
+
+20
+00:01:33,740 --> 00:01:39,000
+مثلا منها ال minus four مثلا و
+
+21
+00:01:39,000 --> 00:01:43,540
+زودنا اربعة point one اربعة point two اربعة point
+
+22
+00:01:43,540 --> 00:01:48,460
+three درجة درجة درجة درجة و كل درجة حطيناها بعد ما
+
+23
+00:01:48,460 --> 00:01:53,600
+زودنا ال intramuscular زودناهاجللنا يعني .. أسودنا
+
+24
+00:01:53,600 --> 00:01:56,800
+ال negativity أقصد يعني جللنا البشر جوا في داخل
+
+25
+00:01:56,800 --> 00:02:00,200
+البلورة و صبرنا نشوف لون بيصلي ال volume يعني
+
+26
+00:02:00,200 --> 00:02:03,860
+نديها عشر ثواني عشان ايه تعمل equilibrium اه زاد
+
+27
+00:02:03,860 --> 00:02:06,640
+ال volume هالجدر على اتنين زاد ال volume على تلاتة
+
+28
+00:02:06,640 --> 00:02:10,800
+زاد هالجدر اربعة او اه بزي بنجس بنجس بنجس الضغط
+
+29
+00:02:10,800 --> 00:02:14,680
+فعملت ال curve هذا انا اذا كان بيسمي inspiratory
+
+30
+00:02:14,680 --> 00:02:20,300
+compliance curve او diagram اديان الشكل هذا تمام؟
+
+31
+00:02:20,580 --> 00:02:25,780
+إذا عندي لحظة إنه من بعد الخمسةو يصير عندى إيه لحد
+
+32
+00:02:25,780 --> 00:02:32,020
+ما أسرع ال .. الرد الفعل لذلك ال .. ال .. ال
+
+33
+00:02:32,020 --> 00:02:35,740
+plural tissues هذه ال .. ال .. ال lung tissues و
+
+34
+00:02:35,740 --> 00:02:38,720
+ال plural pressure اللى فى داخلها ثابتة على minus
+
+35
+00:02:38,720 --> 00:02:43,380
+five لإنه قبل ال minus five تبقى رد الفعل بطيق
+
+36
+00:02:43,380 --> 00:02:46,960
+يعني بدي أنا قوة أكبر عشان أنجز dilatation
+
+37
+00:02:46,960 --> 00:02:51,220
+inflation بسيط لكن بعد الخمسة إيه لحد ما صار إيه
+
+38
+00:02:51,220 --> 00:02:56,560
+واقف و جوف قبلها مبتوحيعني انا هاخد force أكبر
+
+39
+00:02:56,560 --> 00:03:02,800
+اعمل force أكبر عشان انا اجيب نتائج أقل لذلك لجينا
+
+40
+00:03:02,800 --> 00:03:05,880
+minus five هي ال إيه ال intrablur pressure بحيث
+
+41
+00:03:05,880 --> 00:03:10,040
+بعد ال minus five أجل زيادة تديني أحسن أحسن
+
+42
+00:03:10,040 --> 00:03:13,380
+inflation تمام؟ لاحظوا الكلفة ده ليش ماخد الشكل
+
+43
+00:03:13,380 --> 00:03:16,240
+هذا لذلك احنا لجينا النوجوء في الداخل البلورة
+
+44
+00:03:16,240 --> 00:03:21,540
+minus five ليش؟ لإن ال minus five هذه أدتني ردود
+
+45
+00:03:21,540 --> 00:03:28,340
+فعل أفضل كتير من ما تكون أجل من هيكminus five هنا
+
+46
+00:03:28,340 --> 00:03:32,500
+الدراسة معمولة لحد ستة و بعدين رجعنا احنا نرجع من
+
+47
+00:03:32,500 --> 00:03:35,560
+اول و جديد لجينا غريبة جدا في الموضوع ان في معظم
+
+48
+00:03:35,560 --> 00:03:39,860
+الأشياء لما نعمل احنا issue و نعكسه برجع نفس الخط
+
+49
+00:03:39,860 --> 00:03:44,860
+لأ ال lines برجعش نفس الخط ال inspiratory curve
+
+50
+00:03:44,860 --> 00:03:49,440
+compliance بشكل و ال exploratory compliance ماخد
+
+51
+00:03:49,440 --> 00:03:54,110
+ايه شكل اخر برضه هاناللي بيجل شوية شوية شوية في
+
+52
+00:03:54,110 --> 00:03:59,910
+أولها وبعد الخمسة تمام؟ بعد الخمسة بينزل أسرع
+
+53
+00:03:59,910 --> 00:04:03,550
+تمام؟ اللي هي مصلهاش احنا في العادية هذه الخمسة في
+
+54
+00:04:03,550 --> 00:04:08,150
+الطبيعة عندنا فده ذلك ايه؟ بيكون عندنا ال
+
+55
+00:04:08,150 --> 00:04:13,270
+expiration بطيق بياخد منده أطول تمام؟ و ال
+
+56
+00:04:13,270 --> 00:04:18,040
+expiration ال expiration بياخد .. بيكون أسرعما
+
+57
+00:04:18,040 --> 00:04:23,780
+علينا هو ده افرام العجيب فيه الغريب فيه انه ال two
+
+58
+00:04:23,780 --> 00:04:30,040
+curves ان هم عكس بعض مش بتطبقوش ما بتطبقوا تمام؟
+
+59
+00:04:30,040 --> 00:04:36,580
+لما ابدأ انا اجلل ال pressure هان مابرجعش ال curve
+
+60
+00:04:36,580 --> 00:04:41,520
+من أول و جديد هان لأ ال volume بجل أجل من ما كان
+
+61
+00:04:41,520 --> 00:04:46,180
+طلع طلع بسرعة لكن هو بجل بجل أجل أجل أجل أجل أجل
+
+62
+00:04:46,180 --> 00:04:46,800
+أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل
+
+63
+00:04:46,800 --> 00:04:50,160
+أجل أجل أجل أجل أجل أجل أجل أجلبسبب ايه؟ بسبب ان
+
+64
+00:04:50,160 --> 00:04:57,460
+ال recoil هذا بياخد وقت انا بنزل ال .. تمام؟ لما
+
+65
+00:04:57,460 --> 00:05:00,740
+سحبته انا active سحبته بسرعة رجعته بس هو برجع
+
+66
+00:05:00,740 --> 00:05:05,440
+بقوته برجع بال structure تبعه المهم هذا هو ال care
+
+67
+00:05:05,440 --> 00:05:10,520
+تبعه inspiratory و expiratory care هذا هنستخدمه من
+
+68
+00:05:10,520 --> 00:05:13,480
+حاجة واحدة يعني ايش قيمته كتيرة؟ هذا ال compliance
+
+69
+00:05:13,480 --> 00:05:20,150
+care تبع الايه؟طبع ال lung في الطبيعي هنستفيد منه
+
+70
+00:05:20,150 --> 00:05:24,550
+في معرفة أهمية حاجة اسمها surfactant و ال surface
+
+71
+00:05:24,550 --> 00:05:28,310
+tension و الكلام هذا تمام؟ من هنا احنا ال curve
+
+72
+00:05:28,310 --> 00:05:33,790
+هذا أثرله تطبيق في الدراسة تبع ال lung بفهمنا إشي
+
+73
+00:05:33,790 --> 00:05:37,750
+معين هنستفيد منه بعد شوية في حد ذاته هو إيش قيمته؟
+
+74
+00:05:37,750 --> 00:05:41,050
+إنه ال inspiratory ماشي بالشكل هذا و ال expiratory
+
+75
+00:05:41,050 --> 00:05:44,580
+ماشي بالشكل هذا؟مش هيفيدنا كتير يعني مش هيفيدنا
+
+76
+00:05:44,580 --> 00:05:48,480
+كتير المفهوم ال curve هذا لكنه بعد شوية هنفهم
+
+77
+00:05:48,480 --> 00:06:02,000
+القصة طيب
+
+78
+00:06:02,000 --> 00:06:06,260
+ال elastic forces of the lungs can be divided into
+
+79
+00:06:06,260 --> 00:06:11,160
+two parts يعني
+
+80
+00:06:11,160 --> 00:06:15,140
+عندي اناelastic forces بمعنى انها بتمنع ال
+
+81
+00:06:15,140 --> 00:06:20,480
+expansion و بتساعد على ايش ال recoil مش كده ال
+
+82
+00:06:20,480 --> 00:06:24,240
+elastic forces الموجودة ايش قيمتها هنا بتقاوم ال
+
+83
+00:06:24,240 --> 00:06:29,280
+expansion تمام ال elastic بتحاول تمنع ال expansion
+
+84
+00:06:29,280 --> 00:06:36,300
+اه و لما انا بقى أسيبها بتعود ايه بترجع زي ما كانت
+
+85
+00:06:36,300 --> 00:06:41,970
+هذه ناتجة عن طبيعة تركيب ال lung tissuesوهذا احنا
+
+86
+00:06:41,970 --> 00:06:45,790
+كلنا عارفينه ومتوقعينه لكن اشي اللي بغريب على
+
+87
+00:06:45,790 --> 00:06:48,690
+الدراسة وغريب علينا احنا في مفهومنا الآن واحنا
+
+88
+00:06:48,690 --> 00:06:53,150
+بندرس ان ال alveoli هادي lined by a film of water
+
+89
+00:06:53,150 --> 00:06:59,130
+a film of a fluid ال alveolus هادي رطبة ففي عندي
+
+90
+00:06:59,130 --> 00:07:05,930
+film of fluid هذا عامل surface tensionهتعمل إيش؟
+
+91
+00:07:05,930 --> 00:07:09,450
+surface tension هلجيت نقطة المطر نقطة الميه؟ ليش
+
+92
+00:07:09,450 --> 00:07:13,610
+همعمولها نقطة؟ ليش مش مفروضة تنزل؟ ليش مش مفروضة؟
+
+93
+00:07:13,610 --> 00:07:17,010
+النقطة المحتوطة على الجزاز المطر ليش تنزل؟ نقطة
+
+94
+00:07:17,010 --> 00:07:19,950
+نقطة نقطة نقطة ليش أول ما تنزل على الميه على
+
+95
+00:07:19,950 --> 00:07:26,630
+الجزاز تنفردش؟ ليش؟ لأنه في surface tensionبين الـ
+
+96
+00:07:26,630 --> 00:07:30,250
+molecules of water هذه بتخلهم يمسكوا بعض و يعملوا
+
+97
+00:07:30,250 --> 00:07:35,250
+يشدوا بعض attractive forces تخلي انه .. انه الميه
+
+98
+00:07:35,250 --> 00:07:39,690
+تتمسك في بعض البعض فلما تتمسك في بعض البعض بتعملي
+
+99
+00:07:39,690 --> 00:07:45,230
+surface tension مسكها بتعملي شكل دائرة مش كده ال
+
+100
+00:07:45,230 --> 00:07:50,250
+film of water هذا في ال .. في الalveolus بيميل انه
+
+101
+00:07:51,140 --> 00:07:54,540
+يشد الميه لبعض علي البعض و يعمل drop من أول وجهته
+
+102
+00:07:54,540 --> 00:08:00,240
+و يخلي الميه تسكر و ترجع drop لكن ال lung ال
+
+103
+00:08:00,240 --> 00:08:06,080
+alveolus مفتوحة تمام فهو دايما شدد لجوه إذا في عند
+
+104
+00:08:06,080 --> 00:08:08,720
+surface tension من ال film of water اللي بيبطن ال
+
+105
+00:08:08,720 --> 00:08:14,540
+a وهذه قصة كبيرة هنتكلم عنها و هنتكلم عن خطورتها و
+
+106
+00:08:14,540 --> 00:08:17,790
+عن مشاكلها اللي بتصير clinicallyتمام؟ يعني في
+
+107
+00:08:17,790 --> 00:08:22,890
+أطفال بيولدوا و بعد فترة بسيطة بيموتوا فقط لإن ال
+
+108
+00:08:22,890 --> 00:08:27,890
+surface tension هذا اللي جوا كتير تبع الميه ليش؟
+
+109
+00:08:27,890 --> 00:08:30,850
+قال اه في مادة اسمها surfactant مفترض انها تكون في
+
+110
+00:08:30,850 --> 00:08:35,270
+داخل السائل هذا اتجلل من ال surface tension تبعه
+
+111
+00:08:35,270 --> 00:08:40,290
+اه و تخليه أخف شوية و تخلي الطفلأه يقدر يفتح ال
+
+112
+00:08:40,290 --> 00:08:44,290
+lung ال alveoli بسهولة لكن لما يكون عندى انا ال
+
+113
+00:08:44,290 --> 00:08:47,630
+recoil هارى شديد بسبب ال self-extension اللى فقد
+
+114
+00:08:47,630 --> 00:08:52,350
+مادة معينة بيقدر ال طفل بمليون عافية يفتح صدره
+
+115
+00:08:52,350 --> 00:08:55,670
+يدخل الهوا الى ال alveoli لأنه في عنده recoil
+
+116
+00:08:55,670 --> 00:08:59,730
+pressures عالى تمام فهذا بيقدر انه يرحق خلال فترة
+
+117
+00:08:59,730 --> 00:09:02,950
+بسيطة عضلاته تتوقف عن العمل تعمد أو بيموت
+
+118
+00:09:02,950 --> 00:09:09,100
+respiratory distress syndromeNewborn respiratory
+
+119
+00:09:09,100 --> 00:09:14,640
+distress syndrome تمام؟ بيقولوا اه والله الرائعتين
+
+120
+00:09:14,640 --> 00:09:19,640
+تبعتهم هذه اللحمة مابتنفخش الرائعتين مش راديتين
+
+121
+00:09:19,640 --> 00:09:23,720
+مابتنفخش بس جدعة لحمة لأ هي مش جدعة لحمة هي مكاملة
+
+122
+00:09:23,720 --> 00:09:31,330
+لكنهالـ recoil تبع الميه لجوه ال surface شدها لبعض
+
+123
+00:09:31,330 --> 00:09:35,950
+و سكر ال alveoli عشان تفتحها هيك بدنا pressure
+
+124
+00:09:35,950 --> 00:09:39,570
+عالي على العضلات من برا عشان يقدر يفتح ال .. ال
+
+125
+00:09:39,570 --> 00:09:48,030
+recoil تبع ال lung نقدر نشده تمام؟ إله قوة معينةو
+
+126
+00:09:48,030 --> 00:09:51,270
+ال surface tension له قوة معينة لكن في الطبيعي
+
+127
+00:09:51,270 --> 00:09:54,550
+عندنا ان ال surface tension هي ده تبع ال .. ال ..
+
+128
+00:09:54,550 --> 00:09:57,390
+ال .. ال film of water او film .. film of fluid
+
+129
+00:09:57,390 --> 00:10:01,390
+اللي lining ال alveoli جربنا خلاج ان هي مش ميا بحت
+
+130
+00:10:01,390 --> 00:10:06,110
+ولا extra fluid بحت لأ خلاج ان في مادة اخرى يتخلص
+
+131
+00:10:06,110 --> 00:10:11,390
+surface .. surface tension يخف بحيث انه يقدر انه
+
+132
+00:10:11,390 --> 00:10:14,250
+عامل مساعد ال recoil بس مش عامل كمية كبيرة اللي
+
+133
+00:10:14,250 --> 00:10:17,170
+ايه اللي يمنع ال expansion واضح؟
+
+134
+00:10:19,480 --> 00:10:22,460
+لذلك بتكلم عن ال recoil هذه عندى حاجتين ال
+
+135
+00:10:22,460 --> 00:10:27,280
+elasticity نفسها بتخلى ال ال ال ال ال ال ال ال ال
+
+136
+00:10:27,280 --> 00:10:27,680
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+137
+00:10:27,680 --> 00:10:28,340
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+138
+00:10:28,340 --> 00:10:28,620
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+139
+00:10:28,620 --> 00:10:31,100
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+140
+00:10:31,100 --> 00:10:33,140
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+141
+00:10:33,140 --> 00:10:36,920
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+142
+00:10:36,920 --> 00:10:40,260
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+143
+00:10:40,260 --> 00:10:40,480
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+144
+00:11:05,370 --> 00:11:09,810
+the elastic forces of the lung are determined
+
+145
+00:11:09,810 --> 00:11:16,180
+mainly ال lung نفسه بتتحددبالتركيبة تبعت ال long
+
+146
+00:11:16,180 --> 00:11:21,480
+tissue اللي هو عندى elastin and collagen و
+
+147
+00:11:21,480 --> 00:11:26,520
+هدول زى ما قولنا kinged بطريقة معينة بحيث انه ممكن
+
+148
+00:11:26,520 --> 00:11:28,900
+ينفردوا بس بميله ان هم يرجعوا يعملوا king king
+
+149
+00:11:28,900 --> 00:11:32,460
+فانت لما هتعمل اي force بتفردهم لما تسيبهم يعودوا
+
+150
+00:11:32,460 --> 00:11:38,480
+ايه من جديد بس هذه اللي هي الموضوع الخطير تبعنا ال
+
+151
+00:11:38,480 --> 00:11:42,500
+elastic forces that caused by self-extensionare
+
+152
+00:11:42,500 --> 00:11:46,520
+much more complex مش فيها البساطة هذه تمام؟ افهمنا
+
+153
+00:11:46,520 --> 00:11:50,380
+احنا الفكرة تبعتنا افهمنا الفكرة تبعتنا وعشان نشوف
+
+154
+00:11:50,380 --> 00:11:55,240
+احنا ال surface tension هذا جداش أهميته جداش
+
+155
+00:11:55,240 --> 00:12:00,900
+أهميته نحاول نشوف ال compliance تبع ال lung ما هو
+
+156
+00:12:00,900 --> 00:12:03,300
+الآن اللي بيقاوم ال compliance اللي بيحدد ال
+
+157
+00:12:03,300 --> 00:12:06,700
+compliance جداش بيقاوم ال inflation ال recoil
+
+158
+00:12:06,700 --> 00:12:13,080
+forces ال recoil forces قلنا صارت مجسمة جسمينالـ
+
+159
+00:12:13,080 --> 00:12:18,520
+Structured tissues و الفيلم و بعدها طيب الآن ..
+
+160
+00:12:18,520 --> 00:12:24,560
+الآن أنا هل ال compliance هذا كل واحدة من ال
+
+161
+00:12:24,560 --> 00:12:29,010
+forces هذه كده بتأثر فيه؟تمام؟ انا لو ال
+
+162
+00:12:29,010 --> 00:12:32,010
+compliance تبع ال tissues ال elasticity اقل شوية
+
+163
+00:12:32,010 --> 00:12:33,270
+كان النفخة تبعت
+
+164
+00:12:33,270 --> 00:12:55,350
+ووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووو
+
+165
+00:12:55,590 --> 00:12:59,610
+بدي أحاول أن ألغي واحد منهم عشان أشوف الواحد لحاله
+
+166
+00:12:59,610 --> 00:13:04,550
+كيف تأثيره بكده بقدر أميز إذا ال curve الرئيسي هذا
+
+167
+00:13:04,550 --> 00:13:12,070
+تمام؟ شايفين كم مربطح؟ بالراحة بيشتغل الآن لو أنا
+
+168
+00:13:12,070 --> 00:13:18,130
+حاولت أشيل ال surface tension factor كيف ممكن
+
+169
+00:13:18,130 --> 00:13:23,750
+أشيله؟ بدي أجيب lungو بعدين بدي أنغس ال surface
+
+170
+00:13:23,750 --> 00:13:29,230
+tension، أعبيها saline، أعبيها ميه، أعبيها ميه،
+
+171
+00:13:29,230 --> 00:13:32,930
+تمام؟ يعني زي بلون مليان إيه الآن، ميه، أنا صارت
+
+172
+00:13:32,930 --> 00:13:36,950
+أنفخه الآن مش بالإيه، بالهوا، بدي أنفخه بالميه،
+
+173
+00:13:36,950 --> 00:13:41,210
+تمام؟ و بدي أنفس الميه اللي فيه عشان أعمل negative
+
+174
+00:13:41,210 --> 00:13:44,830
+pressure، أشوف ال record تبعه كده أو أدخل ميه عشان
+
+175
+00:13:44,830 --> 00:13:49,400
+إيه أعمل نفعيعني بدي أشيل ال factor تبع ال surface
+
+176
+00:13:49,400 --> 00:13:52,540
+tension هذا لإن صار كله مليان ميّه مافيش surface
+
+177
+00:13:52,540 --> 00:13:57,040
+tension يحاول يشد ال .. الأكسارات كلها من ال .. ال
+
+178
+00:13:57,040 --> 00:14:01,280
+violas للتراكية كلها مليانة ميّه تمام؟ و أدرس ال
+
+179
+00:14:01,280 --> 00:14:07,760
+compliance تبعها بلاقي أنه أنا أي brochure بعمله و
+
+180
+00:14:07,760 --> 00:14:12,420
+بنفخه على طول غير ما فيها هوا لما حطيت فيها ميّه
+
+181
+00:14:12,420 --> 00:14:13,960
+ادتني ال curve القاتى
+
+182
+00:14:16,710 --> 00:14:21,870
+من أول ما أنا بدأت أنقس الضغط في البلورة أو في
+
+183
+00:14:21,870 --> 00:14:25,490
+الضغط اللي أنا بنفخه، إنه في ميا يعني، مش في هوا،
+
+184
+00:14:25,490 --> 00:14:28,490
+بزيد الضغط داخلي، يا عن طريق التركيه، بدخل ميا
+
+185
+00:14:28,490 --> 00:14:32,630
+زيادة، يا بجل ال pressure من برا، عشان كل ال إيه،
+
+186
+00:14:32,630 --> 00:14:36,750
+تشوف ال compliance كأي تجربة ال compliance، بلاقي
+
+187
+00:14:36,750 --> 00:14:39,790
+إنه أنا وصلت لل maximum تبعي، ال نص لتري اللي أنا
+
+188
+00:14:39,790 --> 00:14:45,490
+بزيده، في force بسيطة، تمام؟إذا في عندى elastic
+
+189
+00:14:45,490 --> 00:14:50,510
+force كانت بتقاوم راحت اختفت إذا صار ان الان الان
+
+190
+00:14:50,510 --> 00:14:56,330
+عندى ال elastic tissue recoil forces فقط طبعا طيب
+
+191
+00:14:56,330 --> 00:15:01,130
+لو رجعنا المجموعة من أول و جديد التانين يعني رجعنا
+
+192
+00:15:01,130 --> 00:15:05,010
+للهواء نفس ال force استخدمناها point one ماشيناها
+
+193
+00:15:05,010 --> 00:15:09,670
+كده و نشوف ال ايه الفرق بين هذا و هذا طبعا ال two
+
+194
+00:15:09,670 --> 00:15:13,730
+curves هدولمش واحد شغال هنا و واحد شغال هنا
+
+195
+00:15:13,730 --> 00:15:17,630
+الاتنين مش شغالين على نفس الضغوط لكن هذا ال curve
+
+196
+00:15:17,630 --> 00:15:23,830
+نشتغل عليه واضح؟ يعني الاتنين مخلطين تحت الظروف
+
+197
+00:15:23,830 --> 00:15:31,810
+لكن هذا شكله اختلف عن هذا هذا أخد وجد أطول و أنا
+
+198
+00:15:31,810 --> 00:15:39,590
+بعمل التجربة أخد وجد أطول من minus five إلى minus
+
+199
+00:15:39,590 --> 00:15:45,090
+eight تقريباأو أقل شوية سبعة و نصها لما أدانا نص
+
+200
+00:15:45,090 --> 00:15:49,990
+لتر اللي هو هاي النص لتر ال volume expansion في
+
+201
+00:15:49,990 --> 00:15:57,370
+حين انه لما ضيعت ال هادي ماخدش عندي طولة القوة اذا
+
+202
+00:15:57,370 --> 00:16:05,930
+لجينا احنا ان ال recoil forces لحالها تمام بتاخد
+
+203
+00:16:06,500 --> 00:16:10,440
+نفس الانفلاشن بطولة القوة المطلوبة في حين انه في
+
+204
+00:16:10,440 --> 00:16:15,260
+وجود ال surface tension احتجنا احنا ايه تلت اضعاف
+
+205
+00:16:15,260 --> 00:16:20,840
+القوة الاولانية تمام اذا when the lungs are filled
+
+206
+00:16:20,840 --> 00:16:23,720
+with air there is an interface between the
+
+207
+00:16:23,720 --> 00:16:26,580
+alveolar one and the other in the case of saline
+
+208
+00:16:26,580 --> 00:16:29,960
+solution filled lungs there is no air fluid
+
+209
+00:16:29,960 --> 00:16:33,000
+interface therefore the surface tension effect is
+
+210
+00:16:33,000 --> 00:16:37,550
+not present only the elastic forcesتلاحظ ان
+
+211
+00:16:37,550 --> 00:16:41,970
+المدرسات الترانسبلورية اللي تحتاجها لتفتح الهواء
+
+212
+00:16:41,970 --> 00:16:45,530
+اللي تحتاجها لتفتح الهواء اللي تحتاجها لتفتح
+
+213
+00:16:45,530 --> 00:16:47,270
+الهواء اللي تحتاجها لتفتح الهواء اللي تحتاجها
+
+214
+00:16:47,270 --> 00:16:49,930
+لتفتح الهواء اللي تحتاجها لتفتح الهواء اللي
+
+215
+00:16:49,930 --> 00:16:52,490
+تحتاجها لتفتح الهواء اللي تحتاجها لتفتح الهواء
+
+216
+00:16:52,490 --> 00:16:54,510
+اللي تحتاجها لتفتح الهواء اللي تحتاجها لتفتح
+
+217
+00:16:54,510 --> 00:16:55,310
+الهواء اللي تحتاجها لتفتح الهواء اللي تحتاجها
+
+218
+00:16:55,310 --> 00:16:59,890
+لتفتح الهواء اللي تحتاجها لتفتح الهواء اللي
+
+219
+00:16:59,890 --> 00:16:59,970
+تحتاجها لتفتح
+
+220
+00:17:06,760 --> 00:17:11,740
+صار دوره ضعف ال elastic forces، تمام؟ يعني
+
+221
+00:17:11,740 --> 00:17:16,540
+creating recoil capacity أعلى بمرتين من ال tissues
+
+222
+00:17:16,540 --> 00:17:21,360
+تبع ال .. ال .. ال .. ال .. ال elastic recoil
+
+223
+00:17:21,360 --> 00:17:29,820
+tissues forces، واضح؟ واضح، طيبThe fluid air
+
+224
+00:17:29,820 --> 00:17:32,920
+surface tension elastic forces of the lungs also
+
+225
+00:17:32,920 --> 00:17:36,600
+increase tremendously when the substance called
+
+226
+00:17:36,600 --> 00:17:41,100
+surfactant is not present احنا فهمنا القصة هذه ان
+
+227
+00:17:41,100 --> 00:17:48,820
+هو مهم ان هو ايه مهم و في الطبيعي لجينا ان هو يمثل
+
+228
+00:17:48,820 --> 00:17:53,200
+اتنين الى واحد بالنسبة لل lung tissues recoil
+
+229
+00:17:53,200 --> 00:17:59,620
+forces تمام بتزيد المشكلة اكبرلو ال water هذا ال
+
+230
+00:17:59,620 --> 00:18:05,380
+fluid اللي lining ال alveoli تركيبته اختلفت وصار
+
+231
+00:18:05,380 --> 00:18:08,760
+له surface tension اكبر ليش هو ال surface tension
+
+232
+00:18:08,760 --> 00:18:13,360
+او ال recoil forces هذه لما اتلقى مثلا مختلف .. اه
+
+233
+00:18:13,360 --> 00:18:17,480
+جالك تعال في عندى انا مواد مختلفة كل مادة إلها
+
+234
+00:18:17,480 --> 00:18:23,280
+ايه؟ إلها surface tension مختلفة عن التانية من
+
+235
+00:18:23,280 --> 00:18:23,820
+راحت
+
+236
+00:18:28,310 --> 00:18:34,470
+طيب، إذا في مادة اسمها إيه؟ surfactant إذا كانت مش
+
+237
+00:18:34,470 --> 00:18:39,190
+موجودة هيقديلي إيها مشاكل كتيرة ال surfactant هذه
+
+238
+00:18:39,190 --> 00:18:49,810
+مادة surface acting agent surfactant يعني هي اسمها
+
+239
+00:18:49,810 --> 00:18:58,000
+مش اسم انجليزي حقيقي هو مركب اسم مركب من إيه؟ منزي
+
+240
+00:18:58,000 --> 00:19:04,020
+فيات سيارة فيات مركبة تركيب زي دوة نستاتين اللي
+
+241
+00:19:04,020 --> 00:19:09,100
+احنا بستخدمه لل fungus مركب تركيب نستاتين New York
+
+242
+00:19:09,100 --> 00:19:16,080
+State نستاتين عشان انه دوة يعني فيات Fabrica
+
+243
+00:19:16,080 --> 00:19:22,400
+Italiano ماعرفش ايش و هذه surfactant surface
+
+244
+00:19:22,400 --> 00:19:30,780
+acting agent تمام؟طيب يعني هذه المادة لما تنخلط
+
+245
+00:19:30,780 --> 00:19:36,640
+بالميه تمام بتجلل ال surface tension بتجلل ال
+
+246
+00:19:36,640 --> 00:19:41,400
+surface tension بتجلل
+
+247
+00:19:41,400 --> 00:19:44,900
+ال surface tension بتجلل ال surface tension بتجلل
+
+248
+00:19:44,900 --> 00:19:45,360
+ال surface tension بتجلل ال surface tension بتجلل
+
+249
+00:19:45,360 --> 00:19:45,420
+ال surface tension بتجلل ال surface tension بتجلل
+
+250
+00:19:45,420 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+251
+00:19:45,500 --> 00:19:45,540
+ال surface tension بتجلل ال surface tension بتجلل
+
+252
+00:19:45,540 --> 00:19:51,940
+ال surface tension بتجلل ال surface
+
+253
+00:19:51,940 --> 00:20:00,260
+tension بتجلل ال surfacewall فيها انو two types of
+
+254
+00:20:00,260 --> 00:20:07,260
+cells ال ال ال flat alveolar cells اللي هو بيسميها
+
+255
+00:20:07,260 --> 00:20:12,740
+احنا alveolar cell type one وفي عندي alveolar cell
+
+256
+00:20:12,740 --> 00:20:16,060
+اضافية تمثل خمس ال ايه twenty percent of the cells
+
+257
+00:20:16,060 --> 00:20:21,840
+alveolar cell type two ال type two هادى شغلتها بس
+
+258
+00:20:21,840 --> 00:20:26,500
+تعمل secretion لمين ل surfactantالـ type one لأ هى
+
+259
+00:20:26,500 --> 00:20:30,240
+اللى بيصير عن طريقها التبادل الغازات لزى اللى كان
+
+260
+00:20:30,240 --> 00:20:34,400
+thin زى ال endothelium تبع مين؟ تبع الكابيريز تبع
+
+261
+00:20:34,400 --> 00:20:48,580
+الشعارات الدموية مش كده؟ طيب surfactant
+
+262
+00:20:48,580 --> 00:20:53,260
+and its effect surfactant is a surface active
+
+263
+00:20:53,260 --> 00:21:00,020
+agentفي الماء، وهو يعني أنه يقلل كثيرًا حرارة
+
+264
+00:21:00,020 --> 00:21:04,980
+المياه من الماء إنه محفظ من الخلايا الخاصة اللي
+
+265
+00:21:04,980 --> 00:21:09,200
+اتكلمنا عنها هذه الخلايا هم خلايا جرانولارية،
+
+266
+00:21:09,200 --> 00:21:14,240
+جرانولارية يعني تحتوي على سيارات يعني فيه فيه
+
+267
+00:21:14,240 --> 00:21:18,770
+production فيه إشي يصنع جوا، تمام؟أنا قلت عشر
+
+268
+00:21:18,770 --> 00:21:21,670
+المية، أنا غلطان، عشرة المية يمثل عشرة المية من
+
+269
+00:21:21,670 --> 00:21:26,650
+الايه؟ من ال .. ال alveolar cells these cells are
+
+270
+00:21:26,650 --> 00:21:30,610
+granular containing lipid inclusions that are
+
+271
+00:21:30,610 --> 00:21:36,350
+secreted in the surfactant into the alveoli اذا
+
+272
+00:21:36,350 --> 00:21:41,820
+احنا افهمنا ان ال surfactant الآنsecreted by the
+
+273
+00:21:41,820 --> 00:21:47,860
+type 2 alveolar cells اللي تمثل 10% من ال alveolar
+
+274
+00:21:47,860 --> 00:21:52,200
+cells هذا عبارة عن مادة دهنية مادة دهنية لذلك
+
+275
+00:21:52,200 --> 00:21:58,080
+اتكلمنا عن احنا granular vesicles
+
+276
+00:21:58,080 --> 00:22:01,920
+containing lipid inclusions في داخلها يعني هذه
+
+277
+00:22:01,920 --> 00:22:05,140
+lipid إلى حد ما طب من ايش متكون المادة هذه تطلع
+
+278
+00:22:05,140 --> 00:22:10,750
+تتكون من several phospholipidsو بعض البروتين و
+
+279
+00:22:10,750 --> 00:22:14,790
+ايون فاسفو
+
+280
+00:22:14,790 --> 00:22:19,110
+ليبيد اهمها ال فاسفو ليبيد اللي هو داي بلمي تايلو
+
+281
+00:22:19,110 --> 00:22:24,770
+بلمي بلمي تايل فاسفتي دايل كلين داي بلمي تايل
+
+282
+00:22:24,770 --> 00:22:31,170
+فاسفتي دايل كلين وعنا البروتين اسمه surfactant
+
+283
+00:22:31,170 --> 00:22:35,950
+apoprotein وعنا calcium ions تلاتة مع بعض هدول
+
+284
+00:22:35,950 --> 00:22:43,900
+تمام بيجوا كمادةبتدخل ما بين ال water molecules و
+
+285
+00:22:43,900 --> 00:22:49,200
+بتقدي إلى انه تبعدها عن بعض كل ما زادت النسبة هذه
+
+286
+00:22:49,200 --> 00:22:52,360
+كل ما زادت تأثيرها اكتر كل ما جلت كل ما .. اه؟
+
+287
+00:22:52,360 --> 00:22:55,900
+يعني هذا النسبة .. نسبة معينة مختوطة مخلوطة بحيث
+
+288
+00:22:55,900 --> 00:22:57,840
+انه ماتمنعش ال surface tension تبع ال water
+
+289
+00:22:57,840 --> 00:23:02,610
+completely لكنها ايه؟ بتجلله، بتضعفهالتأثير هي كاي
+
+290
+00:23:02,610 --> 00:23:06,550
+بيصير انها جزء تبقى موجود في الـ Phospholipid دايب
+
+291
+00:23:06,550 --> 00:23:10,670
+في الميه و جزء مش دايب في الميه فهذا بيقدر إلى انه
+
+292
+00:23:10,670 --> 00:23:13,990
+interruptions لل water molecules مش متماسكة مع بعض
+
+293
+00:23:13,990 --> 00:23:16,610
+البعض في فراغات ما بين ال molecules مش كل ال
+
+294
+00:23:16,610 --> 00:23:22,030
+molecules ماسكة في بعضها البعض تمام؟
+
+295
+00:23:22,030 --> 00:23:25,870
+in
+
+296
+00:23:25,870 --> 00:23:28,670
+quantitative terms the surface tension of
+
+297
+00:23:28,670 --> 00:23:32,240
+differentWater Fluids is approximately the
+
+298
+00:23:32,240 --> 00:23:36,140
+following، إذا لم أتكلم عن أرقام، خلّيني أتكلم عن
+
+299
+00:23:36,140 --> 00:23:39,800
+ال surface tension تبع المواد المختلفة، ال pure
+
+300
+00:23:39,800 --> 00:23:44,200
+water لجنة ال surface tension تبعه 72 dynes per
+
+301
+00:23:44,200 --> 00:23:49,060
+centimeterالـ Normal Fluid lining the alveoli من
+
+302
+00:23:49,060 --> 00:23:51,980
+غير surfactant لو شيلنا .. جيبنا تركيبة ال fluid
+
+303
+00:23:51,980 --> 00:23:54,920
+اللي هو شميب ال extra serum fluid و شيلنا منه
+
+304
+00:23:54,920 --> 00:23:59,200
+surfactant هنلاقي انه ال surface tension تبعه
+
+305
+00:23:59,200 --> 00:24:04,680
+خمسين نين بال سنتيمتر لكن بال surfactant بينزل إلى
+
+306
+00:24:04,680 --> 00:24:10,000
+تلقمخمسة إلى تلاتين دقائق حسب انا جديش حاطة
+
+307
+00:24:10,000 --> 00:24:14,380
+surfactant تمام؟ ممكن ينزل ال surfactant نهائي
+
+308
+00:24:14,380 --> 00:24:20,080
+ممكن يكون يعني متوسط خمسين في المية الى واحدة على
+
+309
+00:24:20,080 --> 00:24:22,420
+اتناش من ال .. من ال surfactant يعني ممكن يلغي ال
+
+310
+00:24:22,420 --> 00:24:27,940
+surfactant تبع المادة هذه نص الكبية فقط تبقى
+
+311
+00:24:27,940 --> 00:24:28,860
+surfactant
+
+312
+00:24:31,980 --> 00:24:36,140
+أو لو زادت ال surfactant انزل لخمسة لو واحد على
+
+313
+00:24:36,140 --> 00:24:39,220
+اتناش من ال ايه من ال original surface tension تبع
+
+314
+00:24:39,220 --> 00:24:42,720
+هذه المادة تمام؟ يبقى كدا هذه المادة كتير مهمة
+
+315
+00:24:44,050 --> 00:24:48,930
+معناها بيصير عندى اتن عشر ضعف او تمان اضعاف او عشر
+
+316
+00:24:48,930 --> 00:24:53,690
+اضعاف او على الأقل ضعف .. ضعفين ال a ال surface
+
+317
+00:24:53,690 --> 00:24:58,350
+tension تبع ال lungs معناها انا بدي force اقوى في
+
+318
+00:24:58,350 --> 00:25:01,590
+عملية ان افتح ال lungs عشان ارجع ال compliance
+
+319
+00:25:01,590 --> 00:25:05,970
+للعملية الاولانية بدي قوة اكبر اذا زاد ال surface
+
+320
+00:25:05,970 --> 00:25:09,570
+tension هذا بدي قوة اكبر عشان افتح ال a و من هنا
+
+321
+00:25:09,570 --> 00:25:16,450
+المشكلة بتصير عندى لما ينولد ولد صغيرفاقد هذه ال
+
+322
+00:25:16,450 --> 00:25:23,130
+ايه؟ ال .. فاقد هذه ال property، هذه surfactant
+
+323
+00:25:23,130 --> 00:25:27,410
+secretion تمام؟ مشكلة كبيرة في الآخر إذا ما أدتوش
+
+324
+00:25:27,410 --> 00:25:31,220
+أنا surfactant و دي very expensive materialإذا ما
+
+325
+00:25:31,220 --> 00:25:35,100
+ددتش أنا surfactant بإيدي، هيموت فورا وإذا ددتوا
+
+326
+00:25:35,100 --> 00:25:38,800
+أنا surfactant وانا غانى زي واحدة من سنتين يعني
+
+327
+00:25:38,800 --> 00:25:41,400
+كانت عندها المشكلة هذه لكن أهلها أغنية ودوها ع
+
+328
+00:25:41,400 --> 00:25:44,680
+اسرائيل واخدت surfactant وضلت عايشة عليها لسن
+
+329
+00:25:44,680 --> 00:25:51,840
+اتناش ماتت لإن بعد كده مش جادرة انها تواصل الحياة
+
+330
+00:25:51,840 --> 00:25:56,180
+الطبيعية بدأت ال lungs تتغير شوية شوية شوية شوية
+
+331
+00:25:56,180 --> 00:25:59,820
+لو وصلت لمرحلة انه صار عندى respiratory
+
+332
+00:25:59,820 --> 00:26:04,310
+insufficiencyتمام؟ طب خليني نرجع تاني نشمعنا من
+
+333
+00:26:04,310 --> 00:26:09,050
+جيب سيرة ولد صغير لإن هو اللي بنه ولد و ال
+
+334
+00:26:09,050 --> 00:26:12,010
+surfactant مفقود منه طيب و إذا الولد premature
+
+335
+00:26:12,010 --> 00:26:14,890
+بدري في العادة ال surfactant متكونش إلا في الأشهر
+
+336
+00:26:14,890 --> 00:26:17,790
+الأخيرة فإذا ده الولد premature ممكن أحطه في
+
+337
+00:26:17,790 --> 00:26:20,630
+الحضانة فترة لحد ما ال surfactant يرجع يتكون و
+
+338
+00:26:20,630 --> 00:26:24,010
+بقولهم يلا الله أسهل عليكمهذا إذا ما دخلش في إيه
+
+339
+00:26:24,010 --> 00:26:26,970
+ال respiratory infection لإنه هذا اللي بيصير عندنا
+
+340
+00:26:26,970 --> 00:26:30,170
+قبل ما يتكون ال surfactant بيكون دخل في إيه في ..
+
+341
+00:26:30,170 --> 00:26:32,790
+في .. في .. في severe acute pulmonary infection
+
+342
+00:26:32,790 --> 00:26:36,470
+بيموت الولد لكن نفترض إنه إحنا في مستشفى محترمة
+
+343
+00:26:36,470 --> 00:26:41,310
+وعنا حضانة ممتازة مافيش في cross infection في
+
+344
+00:26:41,310 --> 00:26:44,520
+الحالة هذه لو صبرنا عليه أسبوعين تلاتةالـ
+
+345
+00:26:44,520 --> 00:26:47,420
+premature الولد بدري قبل ما عادوا ال surfactant
+
+346
+00:26:47,420 --> 00:26:50,200
+هيرجع يتكون و هيرجع على سبيل المثال ال sister روح
+
+347
+00:26:50,200 --> 00:26:53,080
+و نقوله مع السلامة لكن بعض الناس عندهم congenital
+
+348
+00:26:53,080 --> 00:26:57,240
+absence of that surfactant تاني مشكلة كبيرة طيب
+
+349
+00:26:57,240 --> 00:27:00,500
+انا هنا ايه عن ايش بدأ اتكلم فوق قعد رجعت بدأ اقول
+
+350
+00:27:00,500 --> 00:27:06,120
+انه في عامل تاني في الطفل يخلي المشكلة أكبر كيف
+
+351
+00:27:06,120 --> 00:27:09,240
+يعني؟ يعني احنا okay قولنا ال surfactant عدم وجوده
+
+352
+00:27:09,240 --> 00:27:12,120
+مشكلة للطفل و وجوده
+
+353
+00:27:15,620 --> 00:27:19,600
+إذا عندي انا عدم وجود ال surfactant المشكلة لكن
+
+354
+00:27:19,600 --> 00:27:23,440
+عدم وجوده كمان في الطفل المشكلة بيصير مضعفة ليش؟
+
+355
+00:27:23,440 --> 00:27:27,460
+طيب نشوف احنا ال surface tension هذا كيف بنحسب و
+
+356
+00:27:27,460 --> 00:27:31,480
+كيف بتكون تمام؟
+
+357
+00:27:31,480 --> 00:27:35,860
+لجينا انه عشان اعرف ال pressure اللي بتكون من ال
+
+358
+00:27:35,860 --> 00:27:40,860
+surface tensionبيعتمد على ال diameter تبع ال ال ال
+
+359
+00:27:40,860 --> 00:27:42,660
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+360
+00:27:42,660 --> 00:27:44,760
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+361
+00:27:44,760 --> 00:27:46,000
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+362
+00:27:46,000 --> 00:27:48,620
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+363
+00:27:48,620 --> 00:27:50,580
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+364
+00:27:50,580 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+365
+00:27:58,720 --> 00:27:58,760
+ال ال ال ال ال ال ال
+
+366
+00:28:04,980 --> 00:28:08,600
+في ال .. في احنا الكبار ال radius of our alveoli
+
+367
+00:28:08,600 --> 00:28:13,980
+حوالي ميت مايكرون، الصغار حوالي خمسين، تمام؟ فلذلك
+
+368
+00:28:13,980 --> 00:28:18,920
+انا هنا لما باقسم على مية بظخر ال self-extension
+
+369
+00:28:18,920 --> 00:28:23,560
+هذا الموجود، لكن لما اقسم على خمسين، بيصير عندي
+
+370
+00:28:23,560 --> 00:28:28,140
+ضعف الكمية ال self-extension، ضعف ال pressure،
+
+371
+00:28:28,140 --> 00:28:32,010
+لذلك الطفل الصغير عنده radius صغيرهو عدم موجود
+
+372
+00:28:32,010 --> 00:28:35,490
+surfactant فبيقدر إلى ان ال pressure الموجود هيكون
+
+373
+00:28:35,490 --> 00:28:38,770
+عالي جدا لان ال surface tension ما اتغيرش فقدر منه
+
+374
+00:28:38,770 --> 00:28:43,950
+ال surfactant زاد و عندي diameter صغير زاد لضعف
+
+375
+00:28:43,950 --> 00:28:48,450
+اكتر و اكتر مش كده؟ طيب اذا هنا الخطورة في الأطفال
+
+376
+00:28:48,450 --> 00:28:53,510
+ان ال pressure اللي بتكون هذا بتكون في الفيولاي
+
+377
+00:28:53,510 --> 00:28:59,270
+small smaller half the size half the radius of the
+
+378
+00:29:01,870 --> 00:29:05,110
+of the adult فبيقدّي الى انه بيديني more pressure
+
+379
+00:29:05,110 --> 00:29:10,210
+بحسب الحصفة اللي متكونها for the average size
+
+380
+00:29:10,210 --> 00:29:15,250
+alveolus with the radius of about micrometer and
+
+381
+00:29:15,250 --> 00:29:18,370
+the line with normal surfactant this calculates to
+
+382
+00:29:18,370 --> 00:29:22,130
+be about four centimeters of water pressure حوالى
+
+383
+00:29:22,130 --> 00:29:26,550
+تلاتة مليمتر ميكرومية لكن في الطفل هنلاقي بيوصل
+
+384
+00:29:26,550 --> 00:29:30,970
+لطمنتعش انا في وجه ال surfactantإذا كانت الفيولاية
+
+385
+00:29:30,970 --> 00:29:34,770
+مرتبطة بماء طبيعي بدون أي مدفع المدفع المدفع
+
+386
+00:29:34,770 --> 00:29:36,670
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+387
+00:29:36,670 --> 00:29:38,950
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+388
+00:29:38,950 --> 00:29:39,310
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+389
+00:29:39,310 --> 00:29:41,290
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+390
+00:29:41,290 --> 00:29:42,090
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+391
+00:29:42,090 --> 00:29:45,110
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+392
+00:29:45,110 --> 00:29:55,610
+المدفع المدفع المدفع المدفع المدفع
+
+393
+00:29:59,770 --> 00:30:02,210
+أذن من هنا بيصير عنده مشكلة كبيرة في كيف ان اقدر
+
+394
+00:30:02,210 --> 00:30:06,490
+افتح ال alveoli هادي و ان اقدر ان اشد ال ال ال ال
+
+395
+00:30:06,490 --> 00:30:09,590
+ال lungs تفتح عشان تفتح ال alveoli مع pressure
+
+396
+00:30:09,590 --> 00:30:12,790
+البسيط اللي انا بعمله محتاج لبشر بشر كبير
+
+397
+00:30:12,790 --> 00:30:17,510
+contraction كتير muscle power كتيرة work كتير يؤدي
+
+398
+00:30:17,510 --> 00:30:21,950
+بعد شوية لطفل صغير لسه مولود الى fatigue و failure
+
+399
+00:30:21,950 --> 00:30:24,530
+و suffocation حين اخنج ويموت
+
+400
+00:30:32,540 --> 00:30:35,640
+respiratory stress syndrome اتكلمنا عنه effect of
+
+401
+00:30:35,640 --> 00:30:40,680
+the thoracic cage on lung expansibility طيب الان
+
+402
+00:30:40,680 --> 00:30:43,620
+احنا اتكلمنا عن .. مهم دقيقة ان شاء الله مش هانطول
+
+403
+00:30:43,620 --> 00:30:48,620
+اتكلمنا عن ال lung ك lung لحالها تمام؟ لكن تنسوش
+
+404
+00:30:48,620 --> 00:30:53,120
+ان ال lung هذه موجودة و انا بدي انفخ اعمل force
+
+405
+00:30:53,120 --> 00:30:58,340
+انفخ مش بانفخ بس ال .. ال .. ال lung و كمان بفتح
+
+406
+00:30:58,340 --> 00:31:03,310
+ال cage يعني انا ال recoil تبع ال lungهو بزوج ال
+
+407
+00:31:03,310 --> 00:31:08,910
+what ال wall ثورسك لبرا اذا عندي انا حقيقية حاجتين
+
+408
+00:31:08,910 --> 00:31:13,710
+عشان اخلي ال alveoli تفتح بدي ال tissues هذه اقاوم
+
+409
+00:31:13,710 --> 00:31:18,930
+ال recoil تبعها و بدي احمل ال chest wall احملها
+
+410
+00:31:18,930 --> 00:31:24,170
+لبرا بدي اقاوم برضه what تبعها اللي نازل ده يطلع
+
+411
+00:31:24,170 --> 00:31:27,150
+على ال lungs بدي افتحها لبرا العضايا بتشغل لبرا مش
+
+412
+00:31:27,150 --> 00:31:32,960
+كده فعندي انا لو استخدمتالـ compliance factor هذا
+
+413
+00:31:32,960 --> 00:31:36,620
+وقلنا تعالى نشوف ال compliance لأن ال lung في ال
+
+414
+00:31:36,620 --> 00:31:41,680
+chest واحد خدرناهنائم و Paralyzed و نفخنا و دينا
+
+415
+00:31:41,680 --> 00:31:45,140
+ضغط للريقتين نشوف ال compliance لجينا في وجود
+
+416
+00:31:45,140 --> 00:31:49,820
+الريقتين بتديني كل واحد centimeter water الى مية و
+
+417
+00:31:49,820 --> 00:31:55,040
+عشرة milliliter expansion في حين انه لو استخدمنا
+
+418
+00:31:55,040 --> 00:31:57,880
+ال lung لحالها بنفس ال force بتديني ايه؟ خمس مية
+
+419
+00:31:57,880 --> 00:32:01,860
+بتديني متين لصنتى واحد الصنتى الواحد بتديني ايه؟
+
+420
+00:32:01,860 --> 00:32:08,680
+متين اذا ال lung thoracic cage preparation تمام
+
+421
+00:32:09,430 --> 00:32:14,730
+بيديني محتاج ضعف القوة عشان دي نفس الهدف يعني ال
+
+422
+00:32:14,730 --> 00:32:19,230
+one millimeter centimeter water بيديني فقط نص ال
+
+423
+00:32:19,230 --> 00:32:23,210
+expansion المتوقع من ال lung لحالها تمام؟ اذا انا
+
+424
+00:32:23,210 --> 00:32:25,850
+صار في عندى هنا الان في ال normal عندى two factors
+
+425
+00:32:25,850 --> 00:32:28,350
+اذا هنا بتكلم عن بعد كده
+
+426
+00:32:33,850 --> 00:32:38,270
+لإنفلاط هذا النظام البلموني تقريبًا مرتين كم مضايا
+
+427
+00:32:38,270 --> 00:32:43,490
+محتاجة لإنفلاط نفس الجلد وحالتها تمام؟ إذا بدى
+
+428
+00:32:43,490 --> 00:32:48,030
+أعمل ال lungs لحالهم من غير ما أستخدم ال
+
+429
+00:32:48,030 --> 00:32:53,390
+preparation كله ال lung و ال chest و نفسه بدي ضعف
+
+430
+00:32:53,390 --> 00:32:56,510
+القوة أستخدمها عشان أصل لنفس ال inflation.
+
+431
+00:32:57,070 --> 00:33:00,070
+therefore compliance of the combined lung thorax
+
+432
+00:33:00,070 --> 00:33:04,410
+system is almost exactlyone half that of the lungs
+
+433
+00:33:04,410 --> 00:33:09,990
+alone يعني 110 إلى 200 تقريبا نص الكمية
+
+434
+00:33:09,990 --> 00:33:14,930
+furthermore when the lungs are expanded to high
+
+435
+00:33:14,930 --> 00:33:18,970
+volumes or compressed to low volumes هذا في آخر ال
+
+436
+00:33:18,970 --> 00:33:24,110
+expansion أو في آخر ال recoil بتدخل عند عوام
+
+437
+00:33:24,110 --> 00:33:28,530
+الأخرى إضافية يعني ال resistance بيزيد لإن ال
+
+438
+00:33:28,530 --> 00:33:32,480
+chest له limit معينأخر جزء بيصير ال compliance أقل
+
+439
+00:33:32,480 --> 00:33:36,200
+كتير وفي أخر مرحلة من الinflation من ال recoil
+
+440
+00:33:36,200 --> 00:33:39,660
+برضه بيصير ال resistance كتيرة مش مهم كتير هذا
+
+441
+00:33:39,660 --> 00:33:44,820
+الكلام لكن احنا فهمنا الآن انه عندي انا جهود بدي
+
+442
+00:33:44,820 --> 00:33:49,980
+ابدله علشان اقاوم ال recoil هذا الان الجهود مش بس
+
+443
+00:33:49,980 --> 00:33:54,640
+long لحالها اللي هيتمثل تشوف و surface tension
+
+444
+00:33:54,640 --> 00:34:00,030
+وكمان عندي ال recoil elastic forces تمعت من؟تبعت ل
+
+445
+00:34:00,030 --> 00:34:04,070
+تشيس وول توراكس وول تمام؟ إذا صار عندى فيه تلت
+
+446
+00:34:04,070 --> 00:34:08,590
+أنواع من ال resistance عندها the work of
+
+447
+00:34:08,590 --> 00:34:11,190
+inspiration can be divided into three fractions
+
+448
+00:34:11,190 --> 00:34:15,870
+اللي أنا عشان أبدو الجهد عشان أتنفس بستخدم .. بشغل
+
+449
+00:34:15,870 --> 00:34:20,970
+تلت حاجات الهوة اللي هو داخل داخل في أنابيب ارفيعة
+
+450
+00:34:20,970 --> 00:34:25,760
+إلها مقاومة مش كده؟التيشيوز اللي أنا بزيحها انسوا
+
+451
+00:34:25,760 --> 00:34:29,580
+انها elastic التيشيوز بخت بدي أزيحها هيك و أظل
+
+452
+00:34:29,580 --> 00:34:32,860
+محلها مش مشكلة يعني انا حاجة ايه ازيح تاني كده
+
+453
+00:34:32,860 --> 00:34:36,940
+مارجعتش مافيش إيه ركايل بس انا زيحتي إلها هذا بده
+
+454
+00:34:36,940 --> 00:34:41,140
+جهود مش كده و كمان و أنا بزيحها بتقومني صار فيه
+
+455
+00:34:41,140 --> 00:34:46,160
+جهود تالت تمام؟ إذا أنا بزيحها كتيشو إلها و إلها و
+
+456
+00:34:46,160 --> 00:34:50,130
+إلها work جهود بدأت أكترهى اتفاجأنا انها مش راضية
+
+457
+00:34:50,130 --> 00:34:53,630
+فى كمان elasticity الهوزن و الهي elasticity لذلك
+
+458
+00:34:53,630 --> 00:34:59,030
+ال work هنا بيتوزع على ال resistance التلاتة اللى
+
+459
+00:34:59,030 --> 00:35:03,110
+هو resistance of the airways ال tissue resistance
+
+460
+00:35:03,110 --> 00:35:07,810
+work ال tissue لحاله لإن أنا بزيعه أبعده تمام
+
+461
+00:35:07,810 --> 00:35:12,370
+التلاتة اله recoil اله اله elasticity elastic the
+
+462
+00:35:12,370 --> 00:35:16,370
+compliance work or elastic work تمام اذا عندي انا
+
+463
+00:35:16,370 --> 00:35:22,360
+ال work اللى بستخدمهبستخدمه لتلت مناطق تلت حاجات
+
+464
+00:35:22,360 --> 00:35:25,420
+اللي هو دخول الهواء بيندفع في ال air passages وهو
+
+465
+00:35:25,420 --> 00:35:31,140
+اقل resistance ال tissues اللي انا بزيحها هذي برضه
+
+466
+00:35:31,140 --> 00:35:34,400
+اقل resistance ال elastic forces اللي هي ال
+
+467
+00:35:34,400 --> 00:35:38,280
+compliance work هذا اكبر بنلاحظ احنا انه during
+
+468
+00:35:38,280 --> 00:35:41,260
+normal هذا اخر اشي بده اقوله during normal quiet
+
+469
+00:35:41,260 --> 00:35:46,920
+respiration3%-5% من الطاقة المستخدمة يتم استخدامها
+
+470
+00:35:46,920 --> 00:35:47,640
+لإيقاف الهواء
+
+471
+00:35:56,270 --> 00:36:00,230
+أنا بعمل مجهود، بدي تنفس أكتر، أنا كمية الطاقة
+
+472
+00:36:00,230 --> 00:36:02,170
+اللي صارت بستخدمها أكتر، لإن أنا جاعة بعمل مجهود
+
+473
+00:36:02,170 --> 00:36:05,450
+كبير، بطلع بلاقي صارت أنا محتاج إلى خمسين، قد يكون
+
+474
+00:36:05,450 --> 00:36:09,510
+خمسين ضعف الطاقة اللي بستخدمها في ال إيه؟ في وضع
+
+475
+00:36:09,510 --> 00:36:13,990
+الراحة، يعني التنفس في وضع مجهود بيده يستخدم إيه
+
+476
+00:36:13,990 --> 00:36:17,030
+طاقة أكبر، و التنفس في وضع مرتاح بيستخدم طاقة
+
+477
+00:36:17,030 --> 00:36:22,420
+بسيطة، مش كده؟المرة اللى جاية ماتكلم عن ال
+
+478
+00:36:22,420 --> 00:36:25,340
+بالمونري volumes and capacities اللى أعتقد ان
+
+479
+00:36:25,340 --> 00:36:29,360
+انتوا أخدته في المعمل أشياء كتير عنها هتسهل علينا
+
+480
+00:36:29,360 --> 00:36:33,160
+المهمة ان شاء الله نقدر نخلص الفصل اللى جاى في
+
+481
+00:36:33,160 --> 00:36:35,060
+المحاضرة اللى جاية الله يعطيكوا العافية وبركة الله
+
+482
+00:36:35,060 --> 00:36:36,060
+فيكم من اللي له سؤال؟
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..8d38a40c3cce3c2e9206a3db5457e5b6e635757b
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3033, "start": 7.29, "end": 30.33, "text": "يعني كل واحد centimeter pressure بيعمل .. بيزود ال volume تبع ال lung 62 بيزودهم كلهم مع بعض ال volume اللي بيزيد 200 milliliter لإنه ال 2.5 بيزودولي 500 milliliter تمام؟ يعني لو نفخنا ال ايه؟ ال lung نفخ الدقت اللي انا بديه هي .. بديه هي ان اديت هي ساحب او اديت هي اللي هو هو ده same", "tokens": [40228, 22653, 28242, 36764, 24401, 31914, 3321, 4724, 1829, 25957, 1211, 4386, 4724, 1829, 11622, 23328, 2423, 5523, 6055, 3555, 3615, 2423, 16730, 24536, 4724, 1829, 11622, 23328, 16095, 28242, 16095, 20449, 45030, 11242, 2423, 5523, 13672, 1829, 4724, 1829, 11622, 25708, 2331, 1728, 388, 1681, 5296, 28814, 1863, 3224, 2423, 568, 13, 20, 4724, 1829, 11622, 23328, 12610, 1829, 5923, 1728, 388, 1681, 46811, 10943, 22807, 37495, 22653, 45164, 8717, 5172, 9778, 8315, 2423, 1975, 1829, 3224, 22807, 2423, 16730, 8717, 5172, 9778, 32748, 38149, 13672, 1829, 1975, 8315, 4724, 16254, 3224, 39896, 4386, 4724, 16254, 3224, 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"temperature": 1.0}, {"id": 2, "seek": 6004, "start": 30.86, "end": 60.04, "text": "الـ lung كالlung تمام؟ بلاقي كل ضغط بزيد و أنا بتزيد هي زي البلون بنفخت شوية بزيد الضغط بنتفخ بزيد الضغط أكتر بنتفخت أكتر بزيد الضغط أكتر بنتفخت أكتر مش كده؟ لما أزيد ل متين بلاقيها انتفخت إيه؟ إلى واحد إلى متين متين مليليتر بتزيد وحك كذا تمام؟ إذا ال compliance each one pressure unit increases the lung volume إلى إيه؟ متين مليليتر واضح؟", "tokens": [6027, 39184, 16730, 9122, 6027, 17850, 46811, 10943, 22807, 4724, 15040, 38436, 28242, 48812, 17082, 9566, 4724, 11622, 25708, 4032, 41850, 39894, 11622, 25708, 39896, 30767, 1829, 29739, 1211, 11536, 44945, 5172, 46456, 13412, 2407, 10632, 4724, 11622, 25708, 6024, 114, 17082, 9566, 44945, 2655, 5172, 9778, 4724, 11622, 25708, 6024, 114, 17082, 9566, 5551, 4117, 2655, 2288, 44945, 2655, 5172, 46456, 5551, 4117, 2655, 2288, 4724, 11622, 25708, 6024, 114, 17082, 9566, 5551, 4117, 2655, 2288, 44945, 2655, 5172, 46456, 5551, 4117, 2655, 2288, 37893, 9122, 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تمام؟ ممكن ينزل ال surfactant نهائي ممكن يكون يعني متوسط خمسين في المية الى واحدة على اتناش من ال .. من ال surfactant يعني ممكن يلغي ال surfactant تبع المادة هذه نص الكبية فقط تبقى surfactant", "tokens": [9778, 2304, 3794, 3660, 30731, 6055, 1211, 9307, 9957, 11778, 4587, 16373, 4587, 11331, 35457, 1975, 8315, 10874, 16254, 8592, 11331, 41193, 3660, 9684, 578, 394, 46811, 10943, 22807, 3714, 43020, 7251, 1863, 11622, 1211, 2423, 9684, 578, 394, 8717, 3224, 16373, 1829, 3714, 43020, 7251, 30544, 37495, 22653, 44650, 41779, 9566, 16490, 2304, 3794, 9957, 8978, 9673, 10632, 2423, 7578, 36764, 24401, 3660, 15844, 1975, 2655, 1863, 33599, 9154, 2423, 4386, 9154, 2423, 9684, 578, 394, 37495, 22653, 3714, 43020, 7251, 1211, 17082, 1829, 2423, 9684, 578, 394, 6055, 3555, 3615, 9673, 18513, 3660, 29538, 8717, 9381, 33251, 3555, 10632, 6156, 47432, 6055, 3555, 4587, 7578, 9684, 578, 394], "avg_logprob": -0.2722409823993305, "compression_ratio": 1.8476190476190477, "no_speech_prob": 0.0, "words": 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0.9224853515625}, {"start": 2188.22, "end": 2188.46, "word": " كتير", "probability": 0.9251302083333334}, {"start": 2188.46, "end": 2188.68, "word": " عنها", "probability": 0.6556396484375}, {"start": 2188.68, "end": 2189.06, "word": " هتسهل", "probability": 0.904296875}, {"start": 2189.06, "end": 2189.36, "word": " علينا", "probability": 0.97265625}, {"start": 2189.36, "end": 2190.04, "word": " المهمة", "probability": 0.9803059895833334}, {"start": 2190.04, "end": 2190.32, "word": " ان", "probability": 0.89013671875}, {"start": 2190.32, "end": 2190.5, "word": " شاء", "probability": 0.97705078125}, {"start": 2190.5, "end": 2190.54, "word": " الله", "probability": 0.9326171875}, {"start": 2190.54, "end": 2190.8, "word": " نقدر", "probability": 0.9578450520833334}, {"start": 2190.8, "end": 2191.32, "word": " نخلص", "probability": 0.9874267578125}, {"start": 2191.32, "end": 2191.76, "word": " الفصل", "probability": 0.947021484375}, {"start": 2191.76, "end": 2192.0, "word": " اللى", 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..0cc89da81e4c9680722a236915f3036b8acace7b
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/S6nMQgmZvWM_raw.srt
@@ -0,0 +1,2000 @@
+1
+00:00:07,290 --> 00:00:11,010
+يعني كل واحد centimeter pressure بيعمل .. بيزود ال
+
+2
+00:00:11,010 --> 00:00:15,270
+volume تبع ال lung 62 بيزودهم كلهم مع بعض ال
+
+3
+00:00:15,270 --> 00:00:18,310
+volume اللي بيزيد 200 milliliter لإنه ال 2.5
+
+4
+00:00:18,310 --> 00:00:22,770
+بيزودولي 500 milliliter تمام؟ يعني لو نفخنا ال
+
+5
+00:00:22,770 --> 00:00:27,110
+ايه؟ ال lung نفخ الدقت اللي انا بديه هي .. بديه هي
+
+6
+00:00:27,110 --> 00:00:31,140
+ان اديت هي ساحب او اديت هي اللي هو هو ده sameالـ
+
+7
+00:00:31,140 --> 00:00:34,320
+lung كالlung تمام؟ بلاقي كل ضغط بزيد و أنا بتزيد
+
+8
+00:00:34,320 --> 00:00:38,500
+هي زي البلون بنفخت شوية بزيد الضغط بنتفخ بزيد
+
+9
+00:00:38,500 --> 00:00:40,520
+الضغط أكتر بنتفخت أكتر بزيد الضغط أكتر بنتفخت أكتر
+
+10
+00:00:40,520 --> 00:00:47,460
+مش كده؟ لما أزيد ل متين بلاقيها انتفخت إيه؟ إلى
+
+11
+00:00:47,460 --> 00:00:52,080
+واحد إلى متين متين مليليتر بتزيد وحك كذا تمام؟ إذا
+
+12
+00:00:52,080 --> 00:00:56,300
+ال compliance each one pressure unit increases the
+
+13
+00:00:56,300 --> 00:01:01,110
+lung volume إلى إيه؟ متين مليليتر واضح؟هذا ال ايه
+
+14
+00:01:01,110 --> 00:01:07,750
+ال compliance ال compliance هذا عملناله
+
+15
+00:01:07,750 --> 00:01:13,970
+احنا ايه عملناله curve هيك the compliance diagram
+
+16
+00:01:13,970 --> 00:01:19,130
+of the lung هذا ايه ال compliance كيف يعني و انا
+
+17
+00:01:19,130 --> 00:01:23,670
+بنفخ فيه في ال lung ال lung بتزيد خلينا نبدأ من
+
+18
+00:01:23,670 --> 00:01:28,160
+هنا تمام او انا بشفط في ال intrabral pressureالـ
+
+19
+00:01:28,160 --> 00:01:33,740
+lung volume a بيزيد فلو احنا حطينا من level معين
+
+20
+00:01:33,740 --> 00:01:39,000
+مثلا منها ال minus four مثلا و
+
+21
+00:01:39,000 --> 00:01:43,540
+زودنا اربعة point one اربعة point two اربعة point
+
+22
+00:01:43,540 --> 00:01:48,460
+three درجة درجة درجة درجة و كل درجة حطيناها بعد ما
+
+23
+00:01:48,460 --> 00:01:53,600
+زودنا ال intramuscular زودناهاجللنا يعني .. أسودنا
+
+24
+00:01:53,600 --> 00:01:56,800
+ال negativity أقصد يعني جللنا البشر جوا في داخل
+
+25
+00:01:56,800 --> 00:02:00,200
+البلورة و صبرنا نشوف لون بيصلي ال volume يعني
+
+26
+00:02:00,200 --> 00:02:03,860
+نديها عشر ثواني عشان ايه تعمل equilibrium اه زاد
+
+27
+00:02:03,860 --> 00:02:06,640
+ال volume هالجدر على اتنين زاد ال volume على تلاتة
+
+28
+00:02:06,640 --> 00:02:10,800
+زاد هالجدر اربعة او اه بزي بنجس بنجس بنجس الضغط
+
+29
+00:02:10,800 --> 00:02:14,680
+فعملت ال curve هذا انا اذا كان بيسمي inspiratory
+
+30
+00:02:14,680 --> 00:02:20,300
+compliance curve او diagram اديان الشكل هذا تمام؟
+
+31
+00:02:20,580 --> 00:02:25,780
+إذا عندي لحظة إنه من بعد الخمسةو يصير عندى إيه لحد
+
+32
+00:02:25,780 --> 00:02:32,020
+ما أسرع ال .. الرد الفعل لذلك ال .. ال .. ال
+
+33
+00:02:32,020 --> 00:02:35,740
+plural tissues هذه ال .. ال .. ال lung tissues و
+
+34
+00:02:35,740 --> 00:02:38,720
+ال plural pressure اللى فى داخلها ثابتة على minus
+
+35
+00:02:38,720 --> 00:02:43,380
+five لإنه قبل ال minus five تبقى رد الفعل بطيق
+
+36
+00:02:43,380 --> 00:02:46,960
+يعني بدي أنا قوة أكبر عشان أنجز dilatation
+
+37
+00:02:46,960 --> 00:02:51,220
+inflation بسيط لكن بعد الخمسة إيه لحد ما صار إيه
+
+38
+00:02:51,220 --> 00:02:56,560
+واقف و جوف قبلها مبتوحيعني انا هاخد force أكبر
+
+39
+00:02:56,560 --> 00:03:02,800
+اعمل force أكبر عشان انا اجيب نتائج أقل لذلك لجينا
+
+40
+00:03:02,800 --> 00:03:05,880
+minus five هي ال إيه ال intrablur pressure بحيث
+
+41
+00:03:05,880 --> 00:03:10,040
+بعد ال minus five أجل زيادة تديني أحسن أحسن
+
+42
+00:03:10,040 --> 00:03:13,380
+inflation تمام؟ لاحظوا الكلفة ده ليش ماخد الشكل
+
+43
+00:03:13,380 --> 00:03:16,240
+هذا لذلك احنا لجينا النوجوء في الداخل البلورة
+
+44
+00:03:16,240 --> 00:03:21,540
+minus five ليش؟ لإن ال minus five هذه أدتني ردود
+
+45
+00:03:21,540 --> 00:03:28,340
+فعل أفضل كتير من ما تكون أجل من هيكminus five هنا
+
+46
+00:03:28,340 --> 00:03:32,500
+الدراسة معمولة لحد ستة و بعدين رجعنا احنا نرجع من
+
+47
+00:03:32,500 --> 00:03:35,560
+اول و جديد لجينا غريبة جدا في الموضوع ان في معظم
+
+48
+00:03:35,560 --> 00:03:39,860
+الأشياء لما نعمل احنا issue و نعكسه برجع نفس الخط
+
+49
+00:03:39,860 --> 00:03:44,860
+لأ ال lines برجعش نفس الخط ال inspiratory curve
+
+50
+00:03:44,860 --> 00:03:49,440
+compliance بشكل و ال exploratory compliance ماخد
+
+51
+00:03:49,440 --> 00:03:54,110
+ايه شكل اخر برضه هاناللي بيجل شوية شوية شوية في
+
+52
+00:03:54,110 --> 00:03:59,910
+أولها وبعد الخمسة تمام؟ بعد الخمسة بينزل أسرع
+
+53
+00:03:59,910 --> 00:04:03,550
+تمام؟ اللي هي مصلهاش احنا في العادية هذه الخمسة في
+
+54
+00:04:03,550 --> 00:04:08,150
+الطبيعة عندنا فده ذلك ايه؟ بيكون عندنا ال
+
+55
+00:04:08,150 --> 00:04:13,270
+expiration بطيق بياخد منده أطول تمام؟ و ال
+
+56
+00:04:13,270 --> 00:04:18,040
+expiration ال expiration بياخد .. بيكون أسرعما
+
+57
+00:04:18,040 --> 00:04:23,780
+علينا هو ده افرام العجيب فيه الغريب فيه انه ال two
+
+58
+00:04:23,780 --> 00:04:30,040
+curves ان هم عكس بعض مش بتطبقوش ما بتطبقوا تمام؟
+
+59
+00:04:30,040 --> 00:04:36,580
+لما ابدأ انا اجلل ال pressure هان مابرجعش ال curve
+
+60
+00:04:36,580 --> 00:04:41,520
+من أول و جديد هان لأ ال volume بجل أجل من ما كان
+
+61
+00:04:41,520 --> 00:04:46,180
+طلع طلع بسرعة لكن هو بجل بجل أجل أجل أجل أجل أجل
+
+62
+00:04:46,180 --> 00:04:46,800
+أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل
+
+63
+00:04:46,800 --> 00:04:46,800
+أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل أجل
+
+64
+00:04:46,800 --> 00:04:50,160
+أجل أجل أجل أجل أجل أجل أجل أجلبسبب ايه؟ بسبب ان
+
+65
+00:04:50,160 --> 00:04:57,460
+ال recoil هذا بياخد وقت انا بنزل ال .. تمام؟ لما
+
+66
+00:04:57,460 --> 00:05:00,740
+سحبته انا active سحبته بسرعة رجعته بس هو برجع
+
+67
+00:05:00,740 --> 00:05:05,440
+بقوته برجع بال structure تبعه المهم هذا هو ال care
+
+68
+00:05:05,440 --> 00:05:10,520
+تبعه inspiratory و expiratory care هذا هنستخدمه من
+
+69
+00:05:10,520 --> 00:05:13,480
+حاجة واحدة يعني ايش قيمته كتيرة؟ هذا ال compliance
+
+70
+00:05:13,480 --> 00:05:20,150
+care تبع الايه؟طبع ال lung في الطبيعي هنستفيد منه
+
+71
+00:05:20,150 --> 00:05:24,550
+في معرفة أهمية حاجة اسمها surfactant و ال surface
+
+72
+00:05:24,550 --> 00:05:28,310
+tension و الكلام هذا تمام؟ من هنا احنا ال curve
+
+73
+00:05:28,310 --> 00:05:33,790
+هذا أثرله تطبيق في الدراسة تبع ال lung بفهمنا إشي
+
+74
+00:05:33,790 --> 00:05:37,750
+معين هنستفيد منه بعد شوية في حد ذاته هو إيش قيمته؟
+
+75
+00:05:37,750 --> 00:05:41,050
+إنه ال inspiratory ماشي بالشكل هذا و ال expiratory
+
+76
+00:05:41,050 --> 00:05:44,580
+ماشي بالشكل هذا؟مش هيفيدنا كتير يعني مش هيفيدنا
+
+77
+00:05:44,580 --> 00:05:48,480
+كتير المفهوم ال curve هذا لكنه بعد شوية هنفهم
+
+78
+00:05:48,480 --> 00:06:02,000
+القصة طيب
+
+79
+00:06:02,000 --> 00:06:06,260
+ال elastic forces of the lungs can be divided into
+
+80
+00:06:06,260 --> 00:06:11,160
+two parts يعني
+
+81
+00:06:11,160 --> 00:06:15,140
+عندي اناelastic forces بمعنى انها بتمنع ال
+
+82
+00:06:15,140 --> 00:06:20,480
+expansion و بتساعد على ايش ال recoil مش كده ال
+
+83
+00:06:20,480 --> 00:06:24,240
+elastic forces الموجودة ايش قيمتها هنا بتقاوم ال
+
+84
+00:06:24,240 --> 00:06:29,280
+expansion تمام ال elastic بتحاول تمنع ال expansion
+
+85
+00:06:29,280 --> 00:06:36,300
+اه و لما انا بقى أسيبها بتعود ايه بترجع زي ما كانت
+
+86
+00:06:36,300 --> 00:06:41,970
+هذه ناتجة عن طبيعة تركيب ال lung tissuesوهذا احنا
+
+87
+00:06:41,970 --> 00:06:45,790
+كلنا عارفينه ومتوقعينه لكن اشي اللي بغريب على
+
+88
+00:06:45,790 --> 00:06:48,690
+الدراسة وغريب علينا احنا في مفهومنا الآن واحنا
+
+89
+00:06:48,690 --> 00:06:53,150
+بندرس ان ال alveoli هادي lined by a film of water
+
+90
+00:06:53,150 --> 00:06:59,130
+a film of a fluid ال alveolus هادي رطبة ففي عندي
+
+91
+00:06:59,130 --> 00:07:05,930
+film of fluid هذا عامل surface tensionهتعمل إيش؟
+
+92
+00:07:05,930 --> 00:07:09,450
+surface tension هلجيت نقطة المطر نقطة الميه؟ ليش
+
+93
+00:07:09,450 --> 00:07:13,610
+همعمولها نقطة؟ ليش مش مفروضة تنزل؟ ليش مش مفروضة؟
+
+94
+00:07:13,610 --> 00:07:17,010
+النقطة المحتوطة على الجزاز المطر ليش تنزل؟ نقطة
+
+95
+00:07:17,010 --> 00:07:19,950
+نقطة نقطة نقطة ليش أول ما تنزل على الميه على
+
+96
+00:07:19,950 --> 00:07:26,630
+الجزاز تنفردش؟ ليش؟ لأنه في surface tensionبين الـ
+
+97
+00:07:26,630 --> 00:07:30,250
+molecules of water هذه بتخلهم يمسكوا بعض و يعملوا
+
+98
+00:07:30,250 --> 00:07:35,250
+يشدوا بعض attractive forces تخلي انه .. انه الميه
+
+99
+00:07:35,250 --> 00:07:39,690
+تتمسك في بعض البعض فلما تتمسك في بعض البعض بتعملي
+
+100
+00:07:39,690 --> 00:07:45,230
+surface tension مسكها بتعملي شكل دائرة مش كده ال
+
+101
+00:07:45,230 --> 00:07:50,250
+film of water هذا في ال .. في الalveolus بيميل انه
+
+102
+00:07:51,140 --> 00:07:54,540
+يشد الميه لبعض علي البعض و يعمل drop من أول وجهته
+
+103
+00:07:54,540 --> 00:08:00,240
+و يخلي الميه تسكر و ترجع drop لكن ال lung ال
+
+104
+00:08:00,240 --> 00:08:06,080
+alveolus مفتوحة تمام فهو دايما شدد لجوه إذا في عند
+
+105
+00:08:06,080 --> 00:08:08,720
+surface tension من ال film of water اللي بيبطن ال
+
+106
+00:08:08,720 --> 00:08:14,540
+a وهذه قصة كبيرة هنتكلم عنها و هنتكلم عن خطورتها و
+
+107
+00:08:14,540 --> 00:08:17,790
+عن مشاكلها اللي بتصير clinicallyتمام؟ يعني في
+
+108
+00:08:17,790 --> 00:08:22,890
+أطفال بيولدوا و بعد فترة بسيطة بيموتوا فقط لإن ال
+
+109
+00:08:22,890 --> 00:08:27,890
+surface tension هذا اللي جوا كتير تبع الميه ليش؟
+
+110
+00:08:27,890 --> 00:08:30,850
+قال اه في مادة اسمها surfactant مفترض انها تكون في
+
+111
+00:08:30,850 --> 00:08:35,270
+داخل السائل هذا اتجلل من ال surface tension تبعه
+
+112
+00:08:35,270 --> 00:08:40,290
+اه و تخليه أخف شوية و تخلي الطفلأه يقدر يفتح ال
+
+113
+00:08:40,290 --> 00:08:44,290
+lung ال alveoli بسهولة لكن لما يكون عندى انا ال
+
+114
+00:08:44,290 --> 00:08:47,630
+recoil هارى شديد بسبب ال self-extension اللى فقد
+
+115
+00:08:47,630 --> 00:08:52,350
+مادة معينة بيقدر ال طفل بمليون عافية يفتح صدره
+
+116
+00:08:52,350 --> 00:08:55,670
+يدخل الهوا الى ال alveoli لأنه في عنده recoil
+
+117
+00:08:55,670 --> 00:08:59,730
+pressures عالى تمام فهذا بيقدر انه يرحق خلال فترة
+
+118
+00:08:59,730 --> 00:09:02,950
+بسيطة عضلاته تتوقف عن العمل تعمد أو بيموت
+
+119
+00:09:02,950 --> 00:09:09,100
+respiratory distress syndromeNewborn respiratory
+
+120
+00:09:09,100 --> 00:09:14,640
+distress syndrome تمام؟ بيقولوا اه والله الرائعتين
+
+121
+00:09:14,640 --> 00:09:19,640
+تبعتهم هذه اللحمة مابتنفخش الرائعتين مش راديتين
+
+122
+00:09:19,640 --> 00:09:23,720
+مابتنفخش بس جدعة لحمة لأ هي مش جدعة لحمة هي مكاملة
+
+123
+00:09:23,720 --> 00:09:31,330
+لكنهالـ recoil تبع الميه لجوه ال surface شدها لبعض
+
+124
+00:09:31,330 --> 00:09:35,950
+و سكر ال alveoli عشان تفتحها هيك بدنا pressure
+
+125
+00:09:35,950 --> 00:09:39,570
+عالي على العضلات من برا عشان يقدر يفتح ال .. ال
+
+126
+00:09:39,570 --> 00:09:48,030
+recoil تبع ال lung نقدر نشده تمام؟ إله قوة معينةو
+
+127
+00:09:48,030 --> 00:09:51,270
+ال surface tension له قوة معينة لكن في الطبيعي
+
+128
+00:09:51,270 --> 00:09:54,550
+عندنا ان ال surface tension هي ده تبع ال .. ال ..
+
+129
+00:09:54,550 --> 00:09:57,390
+ال .. ال film of water او film .. film of fluid
+
+130
+00:09:57,390 --> 00:10:01,390
+اللي lining ال alveoli جربنا خلاج ان هي مش ميا بحت
+
+131
+00:10:01,390 --> 00:10:06,110
+ولا extra fluid بحت لأ خلاج ان في مادة اخرى يتخلص
+
+132
+00:10:06,110 --> 00:10:11,390
+surface .. surface tension يخف بحيث انه يقدر انه
+
+133
+00:10:11,390 --> 00:10:14,250
+عامل مساعد ال recoil بس مش عامل كمية كبيرة اللي
+
+134
+00:10:14,250 --> 00:10:17,170
+ايه اللي يمنع ال expansion واضح؟
+
+135
+00:10:19,480 --> 00:10:22,460
+لذلك بتكلم عن ال recoil هذه عندى حاجتين ال
+
+136
+00:10:22,460 --> 00:10:27,280
+elasticity نفسها بتخلى ال ال ال ال ال ال ال ال ال
+
+137
+00:10:27,280 --> 00:10:27,680
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+138
+00:10:27,680 --> 00:10:28,340
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+139
+00:10:28,340 --> 00:10:28,620
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+140
+00:10:28,620 --> 00:10:31,100
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+141
+00:10:31,100 --> 00:10:33,140
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+142
+00:10:33,140 --> 00:10:36,920
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+143
+00:10:36,920 --> 00:10:40,260
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+144
+00:10:40,260 --> 00:10:40,480
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+145
+00:10:40,480 --> 00:10:40,480
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+146
+00:10:40,480 --> 00:10:40,480
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+147
+00:10:40,480 --> 00:10:40,480
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+148
+00:10:40,480 --> 00:10:40,480
+ال ال ال ال
+
+149
+00:11:05,370 --> 00:11:09,810
+the elastic forces of the lung are determined
+
+150
+00:11:09,810 --> 00:11:16,180
+mainly ال lung نفسه بتتحددبالتركيبة تبعت ال long
+
+151
+00:11:16,180 --> 00:11:21,480
+tissue اللي هو عندى elastin and collagen و
+
+152
+00:11:21,480 --> 00:11:26,520
+هدول زى ما قولنا kinged بطريقة معينة بحيث انه ممكن
+
+153
+00:11:26,520 --> 00:11:28,900
+ينفردوا بس بميله ان هم يرجعوا يعملوا king king
+
+154
+00:11:28,900 --> 00:11:32,460
+فانت لما هتعمل اي force بتفردهم لما تسيبهم يعودوا
+
+155
+00:11:32,460 --> 00:11:38,480
+ايه من جديد بس هذه اللي هي الموضوع الخطير تبعنا ال
+
+156
+00:11:38,480 --> 00:11:42,500
+elastic forces that caused by self-extensionare
+
+157
+00:11:42,500 --> 00:11:46,520
+much more complex مش فيها البساطة هذه تمام؟ افهمنا
+
+158
+00:11:46,520 --> 00:11:50,380
+احنا الفكرة تبعتنا افهمنا الفكرة تبعتنا وعشان نشوف
+
+159
+00:11:50,380 --> 00:11:55,240
+احنا ال surface tension هذا جداش أهميته جداش
+
+160
+00:11:55,240 --> 00:12:00,900
+أهميته نحاول نشوف ال compliance تبع ال lung ما هو
+
+161
+00:12:00,900 --> 00:12:03,300
+الآن اللي بيقاوم ال compliance اللي بيحدد ال
+
+162
+00:12:03,300 --> 00:12:06,700
+compliance جداش بيقاوم ال inflation ال recoil
+
+163
+00:12:06,700 --> 00:12:13,080
+forces ال recoil forces قلنا صارت مجسمة جسمينالـ
+
+164
+00:12:13,080 --> 00:12:18,520
+Structured tissues و الفيلم و بعدها طيب الآن ..
+
+165
+00:12:18,520 --> 00:12:24,560
+الآن أنا هل ال compliance هذا كل واحدة من ال
+
+166
+00:12:24,560 --> 00:12:29,010
+forces هذه كده بتأثر فيه؟تمام؟ انا لو ال
+
+167
+00:12:29,010 --> 00:12:32,010
+compliance تبع ال tissues ال elasticity اقل شوية
+
+168
+00:12:32,010 --> 00:12:33,270
+كان النفخة تبعت
+
+169
+00:12:33,270 --> 00:12:55,350
+ووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووو
+
+170
+00:12:55,590 --> 00:12:59,610
+بدي أحاول أن ألغي واحد منهم عشان أشوف الواحد لحاله
+
+171
+00:12:59,610 --> 00:13:04,550
+كيف تأثيره بكده بقدر أميز إذا ال curve الرئيسي هذا
+
+172
+00:13:04,550 --> 00:13:12,070
+تمام؟ شايفين كم مربطح؟ بالراحة بيشتغل الآن لو أنا
+
+173
+00:13:12,070 --> 00:13:18,130
+حاولت أشيل ال surface tension factor كيف ممكن
+
+174
+00:13:18,130 --> 00:13:23,750
+أشيله؟ بدي أجيب lungو بعدين بدي أنغس ال surface
+
+175
+00:13:23,750 --> 00:13:29,230
+tension، أعبيها saline، أعبيها ميه، أعبيها ميه،
+
+176
+00:13:29,230 --> 00:13:32,930
+تمام؟ يعني زي بلون مليان إيه الآن، ميه، أنا صارت
+
+177
+00:13:32,930 --> 00:13:36,950
+أنفخه الآن مش بالإيه، بالهوا، بدي أنفخه بالميه،
+
+178
+00:13:36,950 --> 00:13:41,210
+تمام؟ و بدي أنفس الميه اللي فيه عشان أعمل negative
+
+179
+00:13:41,210 --> 00:13:44,830
+pressure، أشوف ال record تبعه كده أو أدخل ميه عشان
+
+180
+00:13:44,830 --> 00:13:49,400
+إيه أعمل نفعيعني بدي أشيل ال factor تبع ال surface
+
+181
+00:13:49,400 --> 00:13:52,540
+tension هذا لإن صار كله مليان ميّه مافيش surface
+
+182
+00:13:52,540 --> 00:13:57,040
+tension يحاول يشد ال .. الأكسارات كلها من ال .. ال
+
+183
+00:13:57,040 --> 00:14:01,280
+violas للتراكية كلها مليانة ميّه تمام؟ و أدرس ال
+
+184
+00:14:01,280 --> 00:14:07,760
+compliance تبعها بلاقي أنه أنا أي brochure بعمله و
+
+185
+00:14:07,760 --> 00:14:12,420
+بنفخه على طول غير ما فيها هوا لما حطيت فيها ميّه
+
+186
+00:14:12,420 --> 00:14:13,960
+ادتني ال curve القاتى
+
+187
+00:14:16,710 --> 00:14:21,870
+من أول ما أنا بدأت أنقس الضغط في البلورة أو في
+
+188
+00:14:21,870 --> 00:14:25,490
+الضغط اللي أنا بنفخه، إنه في ميا يعني، مش في هوا،
+
+189
+00:14:25,490 --> 00:14:28,490
+بزيد الضغط داخلي، يا عن طريق التركيه، بدخل ميا
+
+190
+00:14:28,490 --> 00:14:32,630
+زيادة، يا بجل ال pressure من برا، عشان كل ال إيه،
+
+191
+00:14:32,630 --> 00:14:36,750
+تشوف ال compliance كأي تجربة ال compliance، بلاقي
+
+192
+00:14:36,750 --> 00:14:39,790
+إنه أنا وصلت لل maximum تبعي، ال نص لتري اللي أنا
+
+193
+00:14:39,790 --> 00:14:45,490
+بزيده، في force بسيطة، تمام؟إذا في عندى elastic
+
+194
+00:14:45,490 --> 00:14:50,510
+force كانت بتقاوم راحت اختفت إذا صار ان الان الان
+
+195
+00:14:50,510 --> 00:14:56,330
+عندى ال elastic tissue recoil forces فقط طبعا طيب
+
+196
+00:14:56,330 --> 00:15:01,130
+لو رجعنا المجموعة من أول و جديد التانين يعني رجعنا
+
+197
+00:15:01,130 --> 00:15:05,010
+للهواء نفس ال force استخدمناها point one ماشيناها
+
+198
+00:15:05,010 --> 00:15:09,670
+كده و نشوف ال ايه الفرق بين هذا و هذا طبعا ال two
+
+199
+00:15:09,670 --> 00:15:13,730
+curves هدولمش واحد شغال هنا و واحد شغال هنا
+
+200
+00:15:13,730 --> 00:15:17,630
+الاتنين مش شغالين على نفس الضغوط لكن هذا ال curve
+
+201
+00:15:17,630 --> 00:15:23,830
+نشتغل عليه واضح؟ يعني الاتنين مخلطين تحت الظروف
+
+202
+00:15:23,830 --> 00:15:31,810
+لكن هذا شكله اختلف عن هذا هذا أخد وجد أطول و أنا
+
+203
+00:15:31,810 --> 00:15:39,590
+بعمل التجربة أخد وجد أطول من minus five إلى minus
+
+204
+00:15:39,590 --> 00:15:45,090
+eight تقريباأو أقل شوية سبعة و نصها لما أدانا نص
+
+205
+00:15:45,090 --> 00:15:49,990
+لتر اللي هو هاي النص لتر ال volume expansion في
+
+206
+00:15:49,990 --> 00:15:57,370
+حين انه لما ضيعت ال هادي ماخدش عندي طولة القوة اذا
+
+207
+00:15:57,370 --> 00:16:05,930
+لجينا احنا ان ال recoil forces لحالها تمام بتاخد
+
+208
+00:16:06,500 --> 00:16:10,440
+نفس الانفلاشن بطولة القوة المطلوبة في حين انه في
+
+209
+00:16:10,440 --> 00:16:15,260
+وجود ال surface tension احتجنا احنا ايه تلت اضعاف
+
+210
+00:16:15,260 --> 00:16:20,840
+القوة الاولانية تمام اذا when the lungs are filled
+
+211
+00:16:20,840 --> 00:16:23,720
+with air there is an interface between the
+
+212
+00:16:23,720 --> 00:16:26,580
+alveolar one and the other in the case of saline
+
+213
+00:16:26,580 --> 00:16:29,960
+solution filled lungs there is no air fluid
+
+214
+00:16:29,960 --> 00:16:33,000
+interface therefore the surface tension effect is
+
+215
+00:16:33,000 --> 00:16:37,550
+not present only the elastic forcesتلاحظ ان
+
+216
+00:16:37,550 --> 00:16:41,970
+المدرسات الترانسبلورية اللي تحتاجها لتفتح الهواء
+
+217
+00:16:41,970 --> 00:16:45,530
+اللي تحتاجها لتفتح الهواء اللي تحتاجها لتفتح
+
+218
+00:16:45,530 --> 00:16:47,270
+الهواء اللي تحتاجها لتفتح الهواء اللي تحتاجها
+
+219
+00:16:47,270 --> 00:16:49,930
+لتفتح الهواء اللي تحتاجها لتفتح الهواء اللي
+
+220
+00:16:49,930 --> 00:16:52,490
+تحتاجها لتفتح الهواء اللي تحتاجها لتفتح الهواء
+
+221
+00:16:52,490 --> 00:16:54,510
+اللي تحتاجها لتفتح الهواء اللي تحتاجها لتفتح
+
+222
+00:16:54,510 --> 00:16:55,310
+الهواء اللي تحتاجها لتفتح الهواء اللي تحتاجها
+
+223
+00:16:55,310 --> 00:16:59,890
+لتفتح الهواء اللي تحتاجها لتفتح الهواء اللي
+
+224
+00:16:59,890 --> 00:16:59,970
+تحتاجها لتفتح
+
+225
+00:17:06,760 --> 00:17:11,740
+صار دوره ضعف ال elastic forces، تمام؟ يعني
+
+226
+00:17:11,740 --> 00:17:16,540
+creating recoil capacity أعلى بمرتين من ال tissues
+
+227
+00:17:16,540 --> 00:17:21,360
+تبع ال .. ال .. ال .. ال .. ال elastic recoil
+
+228
+00:17:21,360 --> 00:17:29,820
+tissues forces، واضح؟ واضح، طيبThe fluid air
+
+229
+00:17:29,820 --> 00:17:32,920
+surface tension elastic forces of the lungs also
+
+230
+00:17:32,920 --> 00:17:36,600
+increase tremendously when the substance called
+
+231
+00:17:36,600 --> 00:17:41,100
+surfactant is not present احنا فهمنا القصة هذه ان
+
+232
+00:17:41,100 --> 00:17:48,820
+هو مهم ان هو ايه مهم و في الطبيعي لجينا ان هو يمثل
+
+233
+00:17:48,820 --> 00:17:53,200
+اتنين الى واحد بالنسبة لل lung tissues recoil
+
+234
+00:17:53,200 --> 00:17:59,620
+forces تمام بتزيد المشكلة اكبرلو ال water هذا ال
+
+235
+00:17:59,620 --> 00:18:05,380
+fluid اللي lining ال alveoli تركيبته اختلفت وصار
+
+236
+00:18:05,380 --> 00:18:08,760
+له surface tension اكبر ليش هو ال surface tension
+
+237
+00:18:08,760 --> 00:18:13,360
+او ال recoil forces هذه لما اتلقى مثلا مختلف .. اه
+
+238
+00:18:13,360 --> 00:18:17,480
+جالك تعال في عندى انا مواد مختلفة كل مادة إلها
+
+239
+00:18:17,480 --> 00:18:23,280
+ايه؟ إلها surface tension مختلفة عن التانية من
+
+240
+00:18:23,280 --> 00:18:23,820
+راحت
+
+241
+00:18:28,310 --> 00:18:34,470
+طيب، إذا في مادة اسمها إيه؟ surfactant إذا كانت مش
+
+242
+00:18:34,470 --> 00:18:39,190
+موجودة هيقديلي إيها مشاكل كتيرة ال surfactant هذه
+
+243
+00:18:39,190 --> 00:18:49,810
+مادة surface acting agent surfactant يعني هي اسمها
+
+244
+00:18:49,810 --> 00:18:58,000
+مش اسم انجليزي حقيقي هو مركب اسم مركب من إيه؟ منزي
+
+245
+00:18:58,000 --> 00:19:04,020
+فيات سيارة فيات مركبة تركيب زي دوة نستاتين اللي
+
+246
+00:19:04,020 --> 00:19:09,100
+احنا بستخدمه لل fungus مركب تركيب نستاتين New York
+
+247
+00:19:09,100 --> 00:19:16,080
+State نستاتين عشان انه دوة يعني فيات Fabrica
+
+248
+00:19:16,080 --> 00:19:22,400
+Italiano ماعرفش ايش و هذه surfactant surface
+
+249
+00:19:22,400 --> 00:19:30,780
+acting agent تمام؟طيب يعني هذه المادة لما تنخلط
+
+250
+00:19:30,780 --> 00:19:36,640
+بالميه تمام بتجلل ال surface tension بتجلل ال
+
+251
+00:19:36,640 --> 00:19:41,400
+surface tension بتجلل
+
+252
+00:19:41,400 --> 00:19:44,900
+ال surface tension بتجلل ال surface tension بتجلل
+
+253
+00:19:44,900 --> 00:19:45,360
+ال surface tension بتجلل ال surface tension بتجلل
+
+254
+00:19:45,360 --> 00:19:45,420
+ال surface tension بتجلل ال surface tension بتجلل
+
+255
+00:19:45,420 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+256
+00:19:45,500 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+257
+00:19:45,500 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+258
+00:19:45,500 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+259
+00:19:45,500 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+260
+00:19:45,500 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+261
+00:19:45,500 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+262
+00:19:45,500 --> 00:19:45,500
+ال surface tension بتجلل ال surface tension بتجلل
+
+263
+00:19:45,500 --> 00:19:45,540
+ال surface tension بتجلل ال surface tension بتجلل
+
+264
+00:19:45,540 --> 00:19:51,940
+ال surface tension بتجلل ال surface
+
+265
+00:19:51,940 --> 00:20:00,260
+tension بتجلل ال surfacewall فيها انو two types of
+
+266
+00:20:00,260 --> 00:20:07,260
+cells ال ال ال flat alveolar cells اللي هو بيسميها
+
+267
+00:20:07,260 --> 00:20:12,740
+احنا alveolar cell type one وفي عندي alveolar cell
+
+268
+00:20:12,740 --> 00:20:16,060
+اضافية تمثل خمس ال ايه twenty percent of the cells
+
+269
+00:20:16,060 --> 00:20:21,840
+alveolar cell type two ال type two هادى شغلتها بس
+
+270
+00:20:21,840 --> 00:20:26,500
+تعمل secretion لمين ل surfactantالـ type one لأ هى
+
+271
+00:20:26,500 --> 00:20:30,240
+اللى بيصير عن طريقها التبادل الغازات لزى اللى كان
+
+272
+00:20:30,240 --> 00:20:34,400
+thin زى ال endothelium تبع مين؟ تبع الكابيريز تبع
+
+273
+00:20:34,400 --> 00:20:48,580
+الشعارات الدموية مش كده؟ طيب surfactant
+
+274
+00:20:48,580 --> 00:20:53,260
+and its effect surfactant is a surface active
+
+275
+00:20:53,260 --> 00:21:00,020
+agentفي الماء، وهو يعني أنه يقلل كثيرًا حرارة
+
+276
+00:21:00,020 --> 00:21:04,980
+المياه من الماء إنه محفظ من الخلايا الخاصة اللي
+
+277
+00:21:04,980 --> 00:21:09,200
+اتكلمنا عنها هذه الخلايا هم خلايا جرانولارية،
+
+278
+00:21:09,200 --> 00:21:14,240
+جرانولارية يعني تحتوي على سيارات يعني فيه فيه
+
+279
+00:21:14,240 --> 00:21:18,770
+production فيه إشي يصنع جوا، تمام؟أنا قلت عشر
+
+280
+00:21:18,770 --> 00:21:21,670
+المية، أنا غلطان، عشرة المية يمثل عشرة المية من
+
+281
+00:21:21,670 --> 00:21:26,650
+الايه؟ من ال .. ال alveolar cells these cells are
+
+282
+00:21:26,650 --> 00:21:30,610
+granular containing lipid inclusions that are
+
+283
+00:21:30,610 --> 00:21:36,350
+secreted in the surfactant into the alveoli اذا
+
+284
+00:21:36,350 --> 00:21:41,820
+احنا افهمنا ان ال surfactant الآنsecreted by the
+
+285
+00:21:41,820 --> 00:21:47,860
+type 2 alveolar cells اللي تمثل 10% من ال alveolar
+
+286
+00:21:47,860 --> 00:21:52,200
+cells هذا عبارة عن مادة دهنية مادة دهنية لذلك
+
+287
+00:21:52,200 --> 00:21:58,080
+اتكلمنا عن احنا granular vesicles
+
+288
+00:21:58,080 --> 00:22:01,920
+containing lipid inclusions في داخلها يعني هذه
+
+289
+00:22:01,920 --> 00:22:05,140
+lipid إلى حد ما طب من ايش متكون المادة هذه تطلع
+
+290
+00:22:05,140 --> 00:22:10,750
+تتكون من several phospholipidsو بعض البروتين و
+
+291
+00:22:10,750 --> 00:22:14,790
+ايون فاسفو
+
+292
+00:22:14,790 --> 00:22:19,110
+ليبيد اهمها ال فاسفو ليبيد اللي هو داي بلمي تايلو
+
+293
+00:22:19,110 --> 00:22:24,770
+بلمي بلمي تايل فاسفتي دايل كلين داي بلمي تايل
+
+294
+00:22:24,770 --> 00:22:31,170
+فاسفتي دايل كلين وعنا البروتين اسمه surfactant
+
+295
+00:22:31,170 --> 00:22:35,950
+apoprotein وعنا calcium ions تلاتة مع بعض هدول
+
+296
+00:22:35,950 --> 00:22:43,900
+تمام بيجوا كمادةبتدخل ما بين ال water molecules و
+
+297
+00:22:43,900 --> 00:22:49,200
+بتقدي إلى انه تبعدها عن بعض كل ما زادت النسبة هذه
+
+298
+00:22:49,200 --> 00:22:52,360
+كل ما زادت تأثيرها اكتر كل ما جلت كل ما .. اه؟
+
+299
+00:22:52,360 --> 00:22:55,900
+يعني هذا النسبة .. نسبة معينة مختوطة مخلوطة بحيث
+
+300
+00:22:55,900 --> 00:22:57,840
+انه ماتمنعش ال surface tension تبع ال water
+
+301
+00:22:57,840 --> 00:23:02,610
+completely لكنها ايه؟ بتجلله، بتضعفهالتأثير هي كاي
+
+302
+00:23:02,610 --> 00:23:06,550
+بيصير انها جزء تبقى موجود في الـ Phospholipid دايب
+
+303
+00:23:06,550 --> 00:23:10,670
+في الميه و جزء مش دايب في الميه فهذا بيقدر إلى انه
+
+304
+00:23:10,670 --> 00:23:13,990
+interruptions لل water molecules مش متماسكة مع بعض
+
+305
+00:23:13,990 --> 00:23:16,610
+البعض في فراغات ما بين ال molecules مش كل ال
+
+306
+00:23:16,610 --> 00:23:22,030
+molecules ماسكة في بعضها البعض تمام؟
+
+307
+00:23:22,030 --> 00:23:25,870
+in
+
+308
+00:23:25,870 --> 00:23:28,670
+quantitative terms the surface tension of
+
+309
+00:23:28,670 --> 00:23:32,240
+differentWater Fluids is approximately the
+
+310
+00:23:32,240 --> 00:23:36,140
+following، إذا لم أتكلم عن أرقام، خلّيني أتكلم عن
+
+311
+00:23:36,140 --> 00:23:39,800
+ال surface tension تبع المواد المختلفة، ال pure
+
+312
+00:23:39,800 --> 00:23:44,200
+water لجنة ال surface tension تبعه 72 dynes per
+
+313
+00:23:44,200 --> 00:23:49,060
+centimeterالـ Normal Fluid lining the alveoli من
+
+314
+00:23:49,060 --> 00:23:51,980
+غير surfactant لو شيلنا .. جيبنا تركيبة ال fluid
+
+315
+00:23:51,980 --> 00:23:54,920
+اللي هو شميب ال extra serum fluid و شيلنا منه
+
+316
+00:23:54,920 --> 00:23:59,200
+surfactant هنلاقي انه ال surface tension تبعه
+
+317
+00:23:59,200 --> 00:24:04,680
+خمسين نين بال سنتيمتر لكن بال surfactant بينزل إلى
+
+318
+00:24:04,680 --> 00:24:10,000
+تلقمخمسة إلى تلاتين دقائق حسب انا جديش حاطة
+
+319
+00:24:10,000 --> 00:24:14,380
+surfactant تمام؟ ممكن ينزل ال surfactant نهائي
+
+320
+00:24:14,380 --> 00:24:20,080
+ممكن يكون يعني متوسط خمسين في المية الى واحدة على
+
+321
+00:24:20,080 --> 00:24:22,420
+اتناش من ال .. من ال surfactant يعني ممكن يلغي ال
+
+322
+00:24:22,420 --> 00:24:27,940
+surfactant تبع المادة هذه نص الكبية فقط تبقى
+
+323
+00:24:27,940 --> 00:24:28,860
+surfactant
+
+324
+00:24:31,980 --> 00:24:36,140
+أو لو زادت ال surfactant انزل لخمسة لو واحد على
+
+325
+00:24:36,140 --> 00:24:39,220
+اتناش من ال ايه من ال original surface tension تبع
+
+326
+00:24:39,220 --> 00:24:42,720
+هذه المادة تمام؟ يبقى كدا هذه المادة كتير مهمة
+
+327
+00:24:44,050 --> 00:24:48,930
+معناها بيصير عندى اتن عشر ضعف او تمان اضعاف او عشر
+
+328
+00:24:48,930 --> 00:24:53,690
+اضعاف او على الأقل ضعف .. ضعفين ال a ال surface
+
+329
+00:24:53,690 --> 00:24:58,350
+tension تبع ال lungs معناها انا بدي force اقوى في
+
+330
+00:24:58,350 --> 00:25:01,590
+عملية ان افتح ال lungs عشان ارجع ال compliance
+
+331
+00:25:01,590 --> 00:25:05,970
+للعملية الاولانية بدي قوة اكبر اذا زاد ال surface
+
+332
+00:25:05,970 --> 00:25:09,570
+tension هذا بدي قوة اكبر عشان افتح ال a و من هنا
+
+333
+00:25:09,570 --> 00:25:16,450
+المشكلة بتصير عندى لما ينولد ولد صغيرفاقد هذه ال
+
+334
+00:25:16,450 --> 00:25:23,130
+ايه؟ ال .. فاقد هذه ال property، هذه surfactant
+
+335
+00:25:23,130 --> 00:25:27,410
+secretion تمام؟ مشكلة كبيرة في الآخر إذا ما أدتوش
+
+336
+00:25:27,410 --> 00:25:31,220
+أنا surfactant و دي very expensive materialإذا ما
+
+337
+00:25:31,220 --> 00:25:35,100
+ددتش أنا surfactant بإيدي، هيموت فورا وإذا ددتوا
+
+338
+00:25:35,100 --> 00:25:38,800
+أنا surfactant وانا غانى زي واحدة من سنتين يعني
+
+339
+00:25:38,800 --> 00:25:41,400
+كانت عندها المشكلة هذه لكن أهلها أغنية ودوها ع
+
+340
+00:25:41,400 --> 00:25:44,680
+اسرائيل واخدت surfactant وضلت عايشة عليها لسن
+
+341
+00:25:44,680 --> 00:25:51,840
+اتناش ماتت لإن بعد كده مش جادرة انها تواصل الحياة
+
+342
+00:25:51,840 --> 00:25:56,180
+الطبيعية بدأت ال lungs تتغير شوية شوية شوية شوية
+
+343
+00:25:56,180 --> 00:25:59,820
+لو وصلت لمرحلة انه صار عندى respiratory
+
+344
+00:25:59,820 --> 00:26:04,310
+insufficiencyتمام؟ طب خليني نرجع تاني نشمعنا من
+
+345
+00:26:04,310 --> 00:26:09,050
+جيب سيرة ولد صغير لإن هو اللي بنه ولد و ال
+
+346
+00:26:09,050 --> 00:26:12,010
+surfactant مفقود منه طيب و إذا الولد premature
+
+347
+00:26:12,010 --> 00:26:14,890
+بدري في العادة ال surfactant متكونش إلا في الأشهر
+
+348
+00:26:14,890 --> 00:26:17,790
+الأخيرة فإذا ده الولد premature ممكن أحطه في
+
+349
+00:26:17,790 --> 00:26:20,630
+الحضانة فترة لحد ما ال surfactant يرجع يتكون و
+
+350
+00:26:20,630 --> 00:26:24,010
+بقولهم يلا الله أسهل عليكمهذا إذا ما دخلش في إيه
+
+351
+00:26:24,010 --> 00:26:26,970
+ال respiratory infection لإنه هذا اللي بيصير عندنا
+
+352
+00:26:26,970 --> 00:26:30,170
+قبل ما يتكون ال surfactant بيكون دخل في إيه في ..
+
+353
+00:26:30,170 --> 00:26:32,790
+في .. في .. في severe acute pulmonary infection
+
+354
+00:26:32,790 --> 00:26:36,470
+بيموت الولد لكن نفترض إنه إحنا في مستشفى محترمة
+
+355
+00:26:36,470 --> 00:26:41,310
+وعنا حضانة ممتازة مافيش في cross infection في
+
+356
+00:26:41,310 --> 00:26:44,520
+الحالة هذه لو صبرنا عليه أسبوعين تلاتةالـ
+
+357
+00:26:44,520 --> 00:26:47,420
+premature الولد بدري قبل ما عادوا ال surfactant
+
+358
+00:26:47,420 --> 00:26:50,200
+هيرجع يتكون و هيرجع على سبيل المثال ال sister روح
+
+359
+00:26:50,200 --> 00:26:53,080
+و نقوله مع السلامة لكن بعض الناس عندهم congenital
+
+360
+00:26:53,080 --> 00:26:57,240
+absence of that surfactant تاني مشكلة كبيرة طيب
+
+361
+00:26:57,240 --> 00:27:00,500
+انا هنا ايه عن ايش بدأ اتكلم فوق قعد رجعت بدأ اقول
+
+362
+00:27:00,500 --> 00:27:06,120
+انه في عامل تاني في الطفل يخلي المشكلة أكبر كيف
+
+363
+00:27:06,120 --> 00:27:09,240
+يعني؟ يعني احنا okay قولنا ال surfactant عدم وجوده
+
+364
+00:27:09,240 --> 00:27:12,120
+مشكلة للطفل و وجوده
+
+365
+00:27:15,620 --> 00:27:19,600
+إذا عندي انا عدم وجود ال surfactant المشكلة لكن
+
+366
+00:27:19,600 --> 00:27:23,440
+عدم وجوده كمان في الطفل المشكلة بيصير مضعفة ليش؟
+
+367
+00:27:23,440 --> 00:27:27,460
+طيب نشوف احنا ال surface tension هذا كيف بنحسب و
+
+368
+00:27:27,460 --> 00:27:31,480
+كيف بتكون تمام؟
+
+369
+00:27:31,480 --> 00:27:35,860
+لجينا انه عشان اعرف ال pressure اللي بتكون من ال
+
+370
+00:27:35,860 --> 00:27:40,860
+surface tensionبيعتمد على ال diameter تبع ال ال ال
+
+371
+00:27:40,860 --> 00:27:42,660
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+372
+00:27:42,660 --> 00:27:44,760
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+373
+00:27:44,760 --> 00:27:46,000
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+374
+00:27:46,000 --> 00:27:48,620
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+375
+00:27:48,620 --> 00:27:50,580
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+376
+00:27:50,580 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+377
+00:27:58,720 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+378
+00:27:58,720 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+379
+00:27:58,720 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+380
+00:27:58,720 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+381
+00:27:58,720 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+382
+00:27:58,720 --> 00:27:58,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+383
+00:27:58,720 --> 00:27:58,760
+ال ال ال ال ال ال ال
+
+384
+00:28:04,980 --> 00:28:08,600
+في ال .. في احنا الكبار ال radius of our alveoli
+
+385
+00:28:08,600 --> 00:28:13,980
+حوالي ميت مايكرون، الصغار حوالي خمسين، تمام؟ فلذلك
+
+386
+00:28:13,980 --> 00:28:18,920
+انا هنا لما باقسم على مية بظخر ال self-extension
+
+387
+00:28:18,920 --> 00:28:23,560
+هذا الموجود، لكن لما اقسم على خمسين، بيصير عندي
+
+388
+00:28:23,560 --> 00:28:28,140
+ضعف الكمية ال self-extension، ضعف ال pressure،
+
+389
+00:28:28,140 --> 00:28:32,010
+لذلك الطفل الصغير عنده radius صغيرهو عدم موجود
+
+390
+00:28:32,010 --> 00:28:35,490
+surfactant فبيقدر إلى ان ال pressure الموجود هيكون
+
+391
+00:28:35,490 --> 00:28:38,770
+عالي جدا لان ال surface tension ما اتغيرش فقدر منه
+
+392
+00:28:38,770 --> 00:28:43,950
+ال surfactant زاد و عندي diameter صغير زاد لضعف
+
+393
+00:28:43,950 --> 00:28:48,450
+اكتر و اكتر مش كده؟ طيب اذا هنا الخطورة في الأطفال
+
+394
+00:28:48,450 --> 00:28:53,510
+ان ال pressure اللي بتكون هذا بتكون في الفيولاي
+
+395
+00:28:53,510 --> 00:28:59,270
+small smaller half the size half the radius of the
+
+396
+00:29:01,870 --> 00:29:05,110
+of the adult فبيقدّي الى انه بيديني more pressure
+
+397
+00:29:05,110 --> 00:29:10,210
+بحسب الحصفة اللي متكونها for the average size
+
+398
+00:29:10,210 --> 00:29:15,250
+alveolus with the radius of about micrometer and
+
+399
+00:29:15,250 --> 00:29:18,370
+the line with normal surfactant this calculates to
+
+400
+00:29:18,370 --> 00:29:22,130
+be about four centimeters of water pressure حوالى
+
+401
+00:29:22,130 --> 00:29:26,550
+تلاتة مليمتر ميكرومية لكن في الطفل هنلاقي بيوصل
+
+402
+00:29:26,550 --> 00:29:30,970
+لطمنتعش انا في وجه ال surfactantإذا كانت الفيولاية
+
+403
+00:29:30,970 --> 00:29:34,770
+مرتبطة بماء طبيعي بدون أي مدفع المدفع المدفع
+
+404
+00:29:34,770 --> 00:29:36,670
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+405
+00:29:36,670 --> 00:29:38,950
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+406
+00:29:38,950 --> 00:29:39,310
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+407
+00:29:39,310 --> 00:29:41,290
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+408
+00:29:41,290 --> 00:29:42,090
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+409
+00:29:42,090 --> 00:29:45,110
+المدفع المدفع المدفع المدفع المدفع المدفع المدفع
+
+410
+00:29:45,110 --> 00:29:55,610
+المدفع المدفع المدفع المدفع المدفع
+
+411
+00:29:59,770 --> 00:30:02,210
+أذن من هنا بيصير عنده مشكلة كبيرة في كيف ان اقدر
+
+412
+00:30:02,210 --> 00:30:06,490
+افتح ال alveoli هادي و ان اقدر ان اشد ال ال ال ال
+
+413
+00:30:06,490 --> 00:30:09,590
+ال lungs تفتح عشان تفتح ال alveoli مع pressure
+
+414
+00:30:09,590 --> 00:30:12,790
+البسيط اللي انا بعمله محتاج لبشر بشر كبير
+
+415
+00:30:12,790 --> 00:30:17,510
+contraction كتير muscle power كتيرة work كتير يؤدي
+
+416
+00:30:17,510 --> 00:30:21,950
+بعد شوية لطفل صغير لسه مولود الى fatigue و failure
+
+417
+00:30:21,950 --> 00:30:24,530
+و suffocation حين اخنج ويموت
+
+418
+00:30:32,540 --> 00:30:35,640
+respiratory stress syndrome اتكلمنا عنه effect of
+
+419
+00:30:35,640 --> 00:30:40,680
+the thoracic cage on lung expansibility طيب الان
+
+420
+00:30:40,680 --> 00:30:43,620
+احنا اتكلمنا عن .. مهم دقيقة ان شاء الله مش هانطول
+
+421
+00:30:43,620 --> 00:30:48,620
+اتكلمنا عن ال lung ك lung لحالها تمام؟ لكن تنسوش
+
+422
+00:30:48,620 --> 00:30:53,120
+ان ال lung هذه موجودة و انا بدي انفخ اعمل force
+
+423
+00:30:53,120 --> 00:30:58,340
+انفخ مش بانفخ بس ال .. ال .. ال lung و كمان بفتح
+
+424
+00:30:58,340 --> 00:31:03,310
+ال cage يعني انا ال recoil تبع ال lungهو بزوج ال
+
+425
+00:31:03,310 --> 00:31:08,910
+what ال wall ثورسك لبرا اذا عندي انا حقيقية حاجتين
+
+426
+00:31:08,910 --> 00:31:13,710
+عشان اخلي ال alveoli تفتح بدي ال tissues هذه اقاوم
+
+427
+00:31:13,710 --> 00:31:18,930
+ال recoil تبعها و بدي احمل ال chest wall احملها
+
+428
+00:31:18,930 --> 00:31:24,170
+لبرا بدي اقاوم برضه what تبعها اللي نازل ده يطلع
+
+429
+00:31:24,170 --> 00:31:27,150
+على ال lungs بدي افتحها لبرا العضايا بتشغل لبرا مش
+
+430
+00:31:27,150 --> 00:31:32,960
+كده فعندي انا لو استخدمتالـ compliance factor هذا
+
+431
+00:31:32,960 --> 00:31:36,620
+وقلنا تعالى نشوف ال compliance لأن ال lung في ال
+
+432
+00:31:36,620 --> 00:31:41,680
+chest واحد خدرناهنائم و Paralyzed و نفخنا و دينا
+
+433
+00:31:41,680 --> 00:31:45,140
+ضغط للريقتين نشوف ال compliance لجينا في وجود
+
+434
+00:31:45,140 --> 00:31:49,820
+الريقتين بتديني كل واحد centimeter water الى مية و
+
+435
+00:31:49,820 --> 00:31:55,040
+عشرة milliliter expansion في حين انه لو استخدمنا
+
+436
+00:31:55,040 --> 00:31:57,880
+ال lung لحالها بنفس ال force بتديني ايه؟ خمس مية
+
+437
+00:31:57,880 --> 00:32:01,860
+بتديني متين لصنتى واحد الصنتى الواحد بتديني ايه؟
+
+438
+00:32:01,860 --> 00:32:08,680
+متين اذا ال lung thoracic cage preparation تمام
+
+439
+00:32:09,430 --> 00:32:14,730
+بيديني محتاج ضعف القوة عشان دي نفس الهدف يعني ال
+
+440
+00:32:14,730 --> 00:32:19,230
+one millimeter centimeter water بيديني فقط نص ال
+
+441
+00:32:19,230 --> 00:32:23,210
+expansion المتوقع من ال lung لحالها تمام؟ اذا انا
+
+442
+00:32:23,210 --> 00:32:25,850
+صار في عندى هنا الان في ال normal عندى two factors
+
+443
+00:32:25,850 --> 00:32:28,350
+اذا هنا بتكلم عن بعد كده
+
+444
+00:32:33,850 --> 00:32:38,270
+لإنفلاط هذا النظام البلموني تقريبًا مرتين كم مضايا
+
+445
+00:32:38,270 --> 00:32:43,490
+محتاجة لإنفلاط نفس الجلد وحالتها تمام؟ إذا بدى
+
+446
+00:32:43,490 --> 00:32:48,030
+أعمل ال lungs لحالهم من غير ما أستخدم ال
+
+447
+00:32:48,030 --> 00:32:53,390
+preparation كله ال lung و ال chest و نفسه بدي ضعف
+
+448
+00:32:53,390 --> 00:32:56,510
+القوة أستخدمها عشان أصل لنفس ال inflation.
+
+449
+00:32:57,070 --> 00:33:00,070
+therefore compliance of the combined lung thorax
+
+450
+00:33:00,070 --> 00:33:04,410
+system is almost exactlyone half that of the lungs
+
+451
+00:33:04,410 --> 00:33:09,990
+alone يعني 110 إلى 200 تقريبا نص الكمية
+
+452
+00:33:09,990 --> 00:33:14,930
+furthermore when the lungs are expanded to high
+
+453
+00:33:14,930 --> 00:33:18,970
+volumes or compressed to low volumes هذا في آخر ال
+
+454
+00:33:18,970 --> 00:33:24,110
+expansion أو في آخر ال recoil بتدخل عند عوام
+
+455
+00:33:24,110 --> 00:33:28,530
+الأخرى إضافية يعني ال resistance بيزيد لإن ال
+
+456
+00:33:28,530 --> 00:33:32,480
+chest له limit معينأخر جزء بيصير ال compliance أقل
+
+457
+00:33:32,480 --> 00:33:36,200
+كتير وفي أخر مرحلة من الinflation من ال recoil
+
+458
+00:33:36,200 --> 00:33:39,660
+برضه بيصير ال resistance كتيرة مش مهم كتير هذا
+
+459
+00:33:39,660 --> 00:33:44,820
+الكلام لكن احنا فهمنا الآن انه عندي انا جهود بدي
+
+460
+00:33:44,820 --> 00:33:49,980
+ابدله علشان اقاوم ال recoil هذا الان الجهود مش بس
+
+461
+00:33:49,980 --> 00:33:54,640
+long لحالها اللي هيتمثل تشوف و surface tension
+
+462
+00:33:54,640 --> 00:34:00,030
+وكمان عندي ال recoil elastic forces تمعت من؟تبعت ل
+
+463
+00:34:00,030 --> 00:34:04,070
+تشيس وول توراكس وول تمام؟ إذا صار عندى فيه تلت
+
+464
+00:34:04,070 --> 00:34:08,590
+أنواع من ال resistance عندها the work of
+
+465
+00:34:08,590 --> 00:34:11,190
+inspiration can be divided into three fractions
+
+466
+00:34:11,190 --> 00:34:15,870
+اللي أنا عشان أبدو الجهد عشان أتنفس بستخدم .. بشغل
+
+467
+00:34:15,870 --> 00:34:20,970
+تلت حاجات الهوة اللي هو داخل داخل في أنابيب ارفيعة
+
+468
+00:34:20,970 --> 00:34:25,760
+إلها مقاومة مش كده؟التيشيوز اللي أنا بزيحها انسوا
+
+469
+00:34:25,760 --> 00:34:29,580
+انها elastic التيشيوز بخت بدي أزيحها هيك و أظل
+
+470
+00:34:29,580 --> 00:34:32,860
+محلها مش مشكلة يعني انا حاجة ايه ازيح تاني كده
+
+471
+00:34:32,860 --> 00:34:36,940
+مارجعتش مافيش إيه ركايل بس انا زيحتي إلها هذا بده
+
+472
+00:34:36,940 --> 00:34:41,140
+جهود مش كده و كمان و أنا بزيحها بتقومني صار فيه
+
+473
+00:34:41,140 --> 00:34:46,160
+جهود تالت تمام؟ إذا أنا بزيحها كتيشو إلها و إلها و
+
+474
+00:34:46,160 --> 00:34:50,130
+إلها work جهود بدأت أكترهى اتفاجأنا انها مش راضية
+
+475
+00:34:50,130 --> 00:34:53,630
+فى كمان elasticity الهوزن و الهي elasticity لذلك
+
+476
+00:34:53,630 --> 00:34:59,030
+ال work هنا بيتوزع على ال resistance التلاتة اللى
+
+477
+00:34:59,030 --> 00:35:03,110
+هو resistance of the airways ال tissue resistance
+
+478
+00:35:03,110 --> 00:35:07,810
+work ال tissue لحاله لإن أنا بزيعه أبعده تمام
+
+479
+00:35:07,810 --> 00:35:12,370
+التلاتة اله recoil اله اله elasticity elastic the
+
+480
+00:35:12,370 --> 00:35:16,370
+compliance work or elastic work تمام اذا عندي انا
+
+481
+00:35:16,370 --> 00:35:22,360
+ال work اللى بستخدمهبستخدمه لتلت مناطق تلت حاجات
+
+482
+00:35:22,360 --> 00:35:25,420
+اللي هو دخول الهواء بيندفع في ال air passages وهو
+
+483
+00:35:25,420 --> 00:35:31,140
+اقل resistance ال tissues اللي انا بزيحها هذي برضه
+
+484
+00:35:31,140 --> 00:35:34,400
+اقل resistance ال elastic forces اللي هي ال
+
+485
+00:35:34,400 --> 00:35:38,280
+compliance work هذا اكبر بنلاحظ احنا انه during
+
+486
+00:35:38,280 --> 00:35:41,260
+normal هذا اخر اشي بده اقوله during normal quiet
+
+487
+00:35:41,260 --> 00:35:46,920
+respiration3%-5% من الطاقة المستخدمة يتم استخدامها
+
+488
+00:35:46,920 --> 00:35:47,640
+لإيقاف الهواء
+
+489
+00:35:56,270 --> 00:36:00,230
+أنا بعمل مجهود، بدي تنفس أكتر، أنا كمية الطاقة
+
+490
+00:36:00,230 --> 00:36:02,170
+اللي صارت بستخدمها أكتر، لإن أنا جاعة بعمل مجهود
+
+491
+00:36:02,170 --> 00:36:05,450
+كبير، بطلع بلاقي صارت أنا محتاج إلى خمسين، قد يكون
+
+492
+00:36:05,450 --> 00:36:09,510
+خمسين ضعف الطاقة اللي بستخدمها في ال إيه؟ في وضع
+
+493
+00:36:09,510 --> 00:36:13,990
+الراحة، يعني التنفس في وضع مجهود بيده يستخدم إيه
+
+494
+00:36:13,990 --> 00:36:17,030
+طاقة أكبر، و التنفس في وضع مرتاح بيستخدم طاقة
+
+495
+00:36:17,030 --> 00:36:22,420
+بسيطة، مش كده؟المرة اللى جاية ماتكلم عن ال
+
+496
+00:36:22,420 --> 00:36:25,340
+بالمونري volumes and capacities اللى أعتقد ان
+
+497
+00:36:25,340 --> 00:36:29,360
+انتوا أخدته في المعمل أشياء كتير عنها هتسهل علينا
+
+498
+00:36:29,360 --> 00:36:33,160
+المهمة ان شاء الله نقدر نخلص الفصل اللى جاى في
+
+499
+00:36:33,160 --> 00:36:35,060
+المحاضرة اللى جاية الله يعطيكوا العافية وبركة الله
+
+500
+00:36:35,060 --> 00:36:36,060
+فيكم من اللي له سؤال؟
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/WVvcKoQB710_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/WVvcKoQB710_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..85c98f9e5bb59d9cef1f6b6f0e6e035a1cb3d323
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/WVvcKoQB710_raw.json
@@ -0,0 +1 @@
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"الـ tissues المختلفة هذه الـ functions المختلفة اللي بتنعملها دي بدها energy بدها supplements مختلفة ففي عندنا another system of blood which is called the bronchial arteries, bronchial vessels هذي supplying the tissues of the lung إذا هذي جاية من الأورطة من ال system circulation يعني حملة أكسجينة للبلد", "tokens": [6027, 39184, 27353, 9673, 46456, 46538, 3660, 29538, 2423, 39184, 6828, 9673, 46456, 46538, 3660, 13672, 1829, 39894, 1863, 25957, 1211, 11296, 11778, 1829, 47525, 11296, 2281, 47525, 11296, 26645, 3714, 46456, 46538, 3660, 6156, 41185, 43242, 8315, 1071, 1185, 295, 3390, 597, 307, 1219, 264, 16586, 339, 831, 44801, 11, 16586, 339, 831, 20117, 8032, 8848, 1829, 46815, 264, 27353, 295, 264, 16730, 11933, 15730, 8032, 8848, 1829, 10874, 995, 10632, 9154, 16247, 13063, 9566, 3660, 9154, 2423, 1185, 23168, 37495, 22653, 11331, 2304, 37977, 5551, 4117, 3794, 7435, 9957, 3660, 24976, 3555, 1211, 3215], "avg_logprob": -0.24484535590889528, "compression_ratio": 1.6141732283464567, 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في ال atrium بيضل داخل ع مين؟ ع ال ventricle لكن إذا انتلا ال ventricle و إذا طف فاللي بيطف بيصير في ال atrium في ال atrium بيروح بدخهم لل إيه؟ لل .. فلذلك الضغط دايما فيه منخفض منخفض جدا", "tokens": [10721, 34740, 10874, 11622, 19986, 10632, 39894, 2655, 5016, 2407, 8592, 8978, 2423, 412, 13015, 6156, 26890, 2407, 5016, 2423, 412, 13015, 39894, 17082, 9566, 11296, 11933, 11242, 31845, 1829, 49429, 31439, 32748, 2304, 39894, 5016, 2407, 8592, 39894, 5016, 2407, 8592, 8592, 8978, 2423, 412, 13015, 4724, 1829, 11242, 1211, 11778, 47283, 1211, 6225, 3714, 9957, 22807, 6225, 2423, 6931, 1341, 306, 44381, 11933, 15730, 16472, 2655, 15040, 2423, 6931, 1341, 306, 4032, 11933, 15730, 23032, 5172, 6156, 6027, 20292, 4724, 1829, 9566, 5172, 4724, 1829, 9381, 13546, 8978, 2423, 412, 13015, 8978, 2423, 412, 13015, 4724, 1829, 32887, 5016, 47525, 9778, 16095, 24976, 11933, 1829, 3224, 22807, 24976, 4386, 6156, 1211, 8848, 23275, 6024, 114, 17082, 9566, 11778, 47302, 15042, 8978, 3224, 9154, 9778, 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Balmonary Artery من الـ Highland في الوسط بين ال base .. بين ال base و ال .. و ال .. و ال apex و ال .. اه في عندي تلاتين centimeter تلاتين centimeter ارتفاع ال a ارتفاع ال long تلاتين centimeter فبين ال base و ال .. عندنا ال vertical diameter هنا", "tokens": [6027, 39184, 13140, 46386, 1587, 12733, 9154, 2423, 39184, 5229, 1661, 8978, 2423, 41779, 9566, 49374, 2423, 3096, 4386, 49374, 2423, 3096, 4032, 2423, 4386, 4032, 2423, 4386, 4032, 2423, 48115, 4032, 2423, 4386, 1975, 3224, 8978, 18871, 16254, 6055, 1211, 9307, 9957, 31914, 6055, 1211, 9307, 9957, 31914, 1975, 43500, 5172, 45761, 2423, 257, 1975, 43500, 5172, 45761, 2423, 938, 6055, 1211, 9307, 9957, 31914, 6156, 3555, 9957, 2423, 3096, 4032, 2423, 4386, 43242, 8315, 2423, 9429, 14196, 34105], "avg_logprob": -0.23707562022738987, "compression_ratio": 2.0470588235294116, "no_speech_prob": 0.0, "words": [{"start": 2010.27, "end": 2010.61, "word": "الـ", "probability": 0.68505859375}, {"start": 2010.61, "end": 2011.01, "word": " 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واضح؟ طيب إذا في الحالة هذه إحنا بنقدر نتكلم عن تلاتة models تلاتة models سميناها zone one, zone two, zone three احنا حقيقة أهم .. أصح من .. من zone model لإن ال zone معناها في منطقة معينة", "tokens": [1211, 33456, 12174, 36150, 9122, 3215, 3224, 20328, 9640, 4386, 20328, 9640, 8978, 3714, 14851, 2407, 7578, 2423, 39184, 1975, 1829, 3224, 22807, 2423, 1917, 6156, 21292, 9381, 13546, 43242, 8315, 13826, 5704, 9122, 45865, 3794, 3660, 4032, 46958, 5016, 22807, 23032, 1829, 3555, 11933, 15730, 8978, 21542, 6027, 3660, 29538, 11933, 5016, 8315, 44945, 28543, 2288, 8717, 2655, 4117, 19528, 18871, 6055, 1211, 9307, 3660, 5245, 6055, 1211, 9307, 3660, 5245, 8608, 2304, 1829, 8315, 11296, 6668, 472, 11, 6668, 732, 11, 6668, 1045, 1975, 5016, 8315, 11331, 38436, 28671, 5551, 16095, 4386, 5551, 9381, 5016, 9154, 4386, 9154, 6668, 2316, 5296, 28814, 1863, 2423, 6668, 20449, 8315, 11296, 8978, 9154, 9566, 28671, 20449, 9957, 3660], "avg_logprob": -0.22788665835130012, "compression_ratio": 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{"start": 4107.92, "end": 4108.34, "word": " عليه", "probability": 0.6165364583333334}, {"start": 4108.34, "end": 4108.86, "word": " لدرجة", "probability": 0.93359375}, {"start": 4108.86, "end": 4109.0, "word": " ان", "probability": 0.3876953125}, {"start": 4109.0, "end": 4109.16, "word": " ال", "probability": 0.63330078125}, {"start": 4109.16, "end": 4109.6, "word": " filtration", "probability": 0.92529296875}, {"start": 4109.6, "end": 4109.8, "word": " اللى", "probability": 0.87255859375}, {"start": 4109.8, "end": 4110.22, "word": " بتتم", "probability": 0.81298828125}, {"start": 4110.22, "end": 4111.1, "word": " جلبت", "probability": 0.98486328125}, {"start": 4111.1, "end": 4111.64, "word": " المعادلة", "probability": 0.990966796875}, {"start": 4111.64, "end": 4112.14, "word": " تبعت", "probability": 0.82080078125}, {"start": 4112.14, "end": 4112.7, "word": " ال", "probability": 0.94384765625}, {"start": 4112.7, "end": 4113.24, "word": " equilibrium", "probability": 0.98291015625}, {"start": 4113.24, "end": 4113.72, "word": " تبع", "probability": 0.9425455729166666}, {"start": 4113.72, "end": 4113.9, "word": " ال", "probability": 0.9697265625}, {"start": 4113.9, "end": 4114.26, "word": " ال", "probability": 0.32666015625}, {"start": 4114.26, "end": 4114.92, "word": " interstitial", "probability": 0.7801513671875}, {"start": 4114.92, "end": 4115.36, "word": " fluid", "probability": 0.8974609375}, {"start": 4115.36, "end": 4116.08, "word": " كنا", "probability": 0.85498046875}, {"start": 4116.08, "end": 4116.22, "word": " في", "probability": 0.830078125}, {"start": 4116.22, "end": 4116.74, "word": " equilibrium", "probability": 0.9423828125}, {"start": 4116.74, "end": 4117.12, "word": " اللى", "probability": 0.976806640625}, {"start": 4117.12, "end": 4117.48, "word": " بطلع", "probability": 0.793212890625}, {"start": 4117.48, "end": 4118.08, "word": " بنشفط", "probability": 0.8616943359375}, {"start": 4118.08, "end": 4118.86, "word": " لكن", "probability": 0.72998046875}, {"start": 4118.86, "end": 4119.22, "word": " لعبارة", "probability": 0.756689453125}, {"start": 4119.22, "end": 4119.86, "word": " التلاتين", "probability": 0.896240234375}, {"start": 4119.86, "end": 4120.52, "word": " لازم", "probability": 0.9895833333333334}, {"start": 4120.52, "end": 4120.78, "word": " يظل", "probability": 0.7989908854166666}, {"start": 4120.78, "end": 4121.32, "word": " بقايا", "probability": 0.9619140625}, {"start": 4121.32, "end": 4122.08, "word": " fluid", "probability": 0.8056640625}, {"start": 4122.08, "end": 4123.02, "word": " اللى", "probability": 0.975830078125}, {"start": 4123.02, "end": 4123.32, "word": " بيظل", "probability": 0.91357421875}, {"start": 4123.32, "end": 4123.42, "word": " فى", "probability": 0.783203125}, {"start": 4123.42, "end": 4123.46, "word": " ال", "probability": 0.98876953125}, {"start": 4123.46, "end": 4123.94, "word": " interstitial", "probability": 0.907958984375}, {"start": 4123.94, "end": 4124.48, "word": " space", "probability": 0.947265625}, {"start": 4124.48, "end": 4125.2, "word": " هيصبح", "probability": 0.8343098958333334}, {"start": 4125.2, "end": 4125.68, "word": " لمين", "probability": 0.79443359375}, {"start": 4125.68, "end": 4127.66, "word": " للalveoli", "probability": 0.69976806640625}, {"start": 4127.66, "end": 4128.44, "word": " للalveolar", "probability": 0.879638671875}, {"start": 4128.44, "end": 4128.9, "word": " space", "probability": 0.958984375}], "temperature": 1.0}, {"id": 150, "seek": 415539, "start": 4129.11, "end": 4155.39, "text": "و هتبتعملي بالمونري قديمة بحيث أنه ال alveoli تبدأ إيه؟ الطف فيها ال .. خليني نجف لحد هنا عشان إيه؟ ال بالمونري capillary dynamics إنه نحسب بالظبط ال brushes هذه الموجودة في الطبيعي كيف مش عاملة قديمة و كوكتيش بتعمل قديمة ان شاء الله المرة اللي جاية بإذن الله تعالى يعطيكوا العافية بنات، مين هي السؤال؟", "tokens": [2407, 8032, 2655, 3555, 2655, 25957, 20292, 20666, 2304, 11536, 16572, 12174, 16254, 46007, 4724, 5016, 1829, 12984, 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0.6640625}, {"start": 4129.33, "end": 4130.03, "word": " هتبتعملي", "probability": 0.6641845703125}, {"start": 4130.03, "end": 4130.61, "word": " بالمونري", "probability": 0.584259033203125}, {"start": 4130.61, "end": 4131.09, "word": " قديمة", "probability": 0.8572591145833334}, {"start": 4131.09, "end": 4131.65, "word": " بحيث", "probability": 0.97119140625}, {"start": 4131.65, "end": 4131.97, "word": " أنه", "probability": 0.6187744140625}, {"start": 4131.97, "end": 4132.21, "word": " ال", "probability": 0.97509765625}, {"start": 4132.21, "end": 4132.61, "word": " alveoli", "probability": 0.6819661458333334}, {"start": 4132.61, "end": 4132.97, "word": " تبدأ", "probability": 0.9085286458333334}, {"start": 4132.97, "end": 4133.51, "word": " إيه؟", "probability": 0.75445556640625}, {"start": 4133.51, "end": 4133.97, "word": " الطف", "probability": 0.75390625}, {"start": 4133.97, "end": 4134.59, "word": " فيها", "probability": 0.97412109375}, {"start": 4134.59, "end": 4135.65, "word": 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/WVvcKoQB710_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/WVvcKoQB710_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d002d495882ecd714804a26be21feca12eece54a
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/WVvcKoQB710_raw.srt
@@ -0,0 +1,3552 @@
+1
+00:00:06,290 --> 00:00:10,990
+اليوم بنتكلم عن الجزئية
+
+2
+00:00:10,990 --> 00:00:14,350
+التانية من عملية ال respiration أو عملية ال
+
+3
+00:00:14,350 --> 00:00:17,770
+ventilation عملية ال ventilation عملية ميكانيكية
+
+4
+00:00:17,770 --> 00:00:22,930
+بتوصل الهواء إلى ال alveoli عشان يدخلوا على الدم
+
+5
+00:00:22,930 --> 00:00:26,650
+مش هيك عشان يدخل ال oxygen إلى الدم اليوم بندرس
+
+6
+00:00:26,650 --> 00:00:30,570
+الدم هذا اللي بيحيط بال إيه؟ بال alveoli و بدخل
+
+7
+00:00:30,570 --> 00:00:34,590
+الرئتينإيش مواصفاته؟ إيش صفاته؟ لإنه احنا العملية
+
+8
+00:00:34,590 --> 00:00:40,570
+بين هوا في جانب و دم في جانب الهوا بيحرقوا الرقتين
+
+9
+00:00:40,570 --> 00:00:44,450
+و ال chest و ال muscles و الدنيا كلها درسنا ال
+
+10
+00:00:44,450 --> 00:00:47,670
+mechanics سبعتها و اليوم هدوس الدم هذا اللي بدخل
+
+11
+00:00:47,670 --> 00:00:53,650
+عندنا على الحيط بال alveoli عشان يحمل ال oxygen و
+
+12
+00:00:53,650 --> 00:00:58,590
+يطالع بنطمن عليه قبل ما يحمل لحظة يكون إيه مقصر
+
+13
+00:00:58,590 --> 00:01:02,190
+ولا ماعندوش القدرة كاملة على حمل هذه ال إيهالأمانة
+
+14
+00:01:02,190 --> 00:01:08,330
+وهي أمانة حملة ال oxygen إلى ال
+
+15
+00:01:08,330 --> 00:01:21,930
+different tissues of the body مش هيك؟ طيب، الآن ال
+
+16
+00:01:21,930 --> 00:01:27,050
+blood vessels of the lung
+
+17
+00:01:28,120 --> 00:01:33,080
+are two types او two sources we have two sources
+
+18
+00:01:33,080 --> 00:01:38,420
+for blood supply of the lung ال source الأساسي
+
+19
+00:01:38,420 --> 00:01:40,960
+اللي بنتكلم عنه احنا هان بنتكلم عن ال palmonary
+
+20
+00:01:40,960 --> 00:01:48,400
+artery اللي طالع من ال right ventricle طالع بنقسم
+
+21
+00:01:48,400 --> 00:01:52,140
+إلى right and left palmonary arteriesو اول ما يدخل
+
+22
+00:01:52,140 --> 00:01:58,260
+ال lung بنقسم الى branches بسرعة من branch ل
+
+23
+00:01:58,260 --> 00:02:01,660
+branch لحد مثلا ال capillary network ال capillary
+
+24
+00:02:01,660 --> 00:02:10,080
+network هذه اللي موجودة في ال two lungs لو فرضناها
+
+25
+00:02:10,080 --> 00:02:15,400
+كده مساحة ال surface area تبعها بنلاقيها يمكن
+
+26
+00:02:15,400 --> 00:02:19,880
+بتعمل بتغطي الصلة اللي احنا فيها سبعين متر مربعة
+
+27
+00:02:20,700 --> 00:02:28,480
+سبعين متر مربع يعني ال surface of gas exchange بتم
+
+28
+00:02:28,480 --> 00:02:34,560
+على exchange على سبعين متر مربع مساحة مش ضخم طبعا
+
+29
+00:02:34,560 --> 00:02:37,720
+لو
+
+30
+00:02:37,720 --> 00:02:43,300
+نعرف أن السبعين متر مربع هدول بيكون فيهم سبعين ملي
+
+31
+00:02:43,300 --> 00:02:47,800
+لتر ومدن بس يعني ال capillaries الحجم السبعين متر
+
+32
+00:02:47,800 --> 00:02:57,090
+مربعبيكون فيها في الوقت الواحد اللي هو سبعين ملي
+
+33
+00:02:57,090 --> 00:03:02,470
+لتر دم اتصوروا جداش هيكون الدم مفروض و جداش ال
+
+34
+00:03:02,470 --> 00:03:08,650
+exchange بيكون سهل، تمام؟ اذا عندنا احنا ال
+
+35
+00:03:08,650 --> 00:03:13,010
+balmonary are فيه و بنقسم و بيديني capillaries و
+
+36
+00:03:13,010 --> 00:03:18,790
+برجع على شكل ايش؟ على شكل balmonary فيهveins لإنه
+
+37
+00:03:18,790 --> 00:03:24,210
+أربعة veins بتخش اللي ايه ال lift atrium مش كده
+
+38
+00:03:24,210 --> 00:03:31,590
+اذا طب ال source التاني ال source هذا واضح ان ال
+
+39
+00:03:31,590 --> 00:03:34,810
+source بتدخل الدم عشان to be oxygenated و يطلع لكن
+
+40
+00:03:34,810 --> 00:03:38,470
+ال lung as a tissue as an organ it should has its
+
+41
+00:03:38,470 --> 00:03:44,110
+own blood supply for nutrition مش كدهالـ tissues
+
+42
+00:03:44,110 --> 00:03:47,150
+المختلفة هذه الـ functions المختلفة اللي بتنعملها
+
+43
+00:03:47,150 --> 00:03:54,750
+دي بدها energy بدها supplements مختلفة ففي عندنا
+
+44
+00:03:54,750 --> 00:03:58,130
+another system of blood which is called the
+
+45
+00:03:58,130 --> 00:04:03,030
+bronchial arteries, bronchial vessels هذي
+
+46
+00:04:03,030 --> 00:04:09,110
+supplying the tissues of the lung إذا هذي جاية من
+
+47
+00:04:09,110 --> 00:04:12,930
+الأورطة من ال system circulation يعني حملة أكسجينة
+
+48
+00:04:12,930 --> 00:04:17,500
+للبلدو بتروح لل lung as any organ تمام؟ بتروح
+
+49
+00:04:17,500 --> 00:04:21,220
+تعمله supply و بترجع بس بنفس ال .. ال venous
+
+50
+00:04:21,220 --> 00:04:24,920
+drainage بترجع بال .. بال pulmonary veins يعني في
+
+51
+00:04:24,920 --> 00:04:28,320
+عندي pulmonary .. bronchial vessels .. arteries بس
+
+52
+00:04:28,320 --> 00:04:33,580
+مافيش عندي bronchial إيش؟ veins لذلك عندي إيه؟
+
+53
+00:04:33,580 --> 00:04:37,490
+bronchialArtist مافيش bronchial veins لإن ال veins
+
+54
+00:04:37,490 --> 00:04:43,190
+تبعتنا هنا بتشبك مع مين يعني بترجع مع ال .. مع ال
+
+55
+00:04:43,190 --> 00:04:46,950
+pulmonary veins مافي bronchial veins بتخش في
+
+56
+00:04:46,950 --> 00:04:51,630
+pulmonary veins ع طول يعني مابترجعش ال .. ال .. ال
+
+57
+00:04:51,630 --> 00:04:54,590
+venous system لحاله لأ بترجع مع ال pulmonary veins
+
+58
+00:04:54,590 --> 00:04:59,670
+معناها احنا اذا واضح من الكلام هذا ان ال blood
+
+59
+00:04:59,670 --> 00:05:05,040
+supply ال pulmonary blood supplyيعني الـ pulmonary
+
+60
+00:05:05,040 --> 00:05:10,360
+arteries الدم تبعهم بيرجع في ال pulmonary veins و
+
+61
+00:05:10,360 --> 00:05:15,240
+ال pulmonary veins فيه كمان مع attributors أخرى
+
+62
+00:05:15,240 --> 00:05:19,800
+يعني ال pulmonary veins حاملين دم أكتر من مين؟ من
+
+63
+00:05:19,800 --> 00:05:22,300
+ال pulmonary arteries مش كده؟ يعني ال pulmonary
+
+64
+00:05:22,300 --> 00:05:25,960
+veins حاملين نفس ال pulmonary artery blood supply
+
+65
+00:05:25,960 --> 00:05:30,640
+زائد ال إيه؟ ال ال bronchial vessels اللي هي
+
+66
+00:05:30,640 --> 00:05:35,440
+جايبها لإيه؟which is about two percent of the a of
+
+67
+00:05:35,440 --> 00:05:41,020
+the pulmonary of
+
+68
+00:05:41,020 --> 00:05:46,640
+the cardiac output تمام يعني
+
+69
+00:05:46,640 --> 00:05:48,980
+ال one to two percent of the of the cardiac output
+
+70
+00:05:48,980 --> 00:05:52,740
+بيوصل حوالي خمسة المية يعني خمسة تسعين يعني خمسة
+
+71
+00:05:52,740 --> 00:05:56,320
+في المية من ال ال Venus return جاي من bronchial
+
+72
+00:05:56,320 --> 00:05:56,860
+origin
+
+73
+00:06:05,380 --> 00:06:11,900
+هذا بالنسبة لل blood supply ال lymphatics ال
+
+74
+00:06:11,900 --> 00:06:18,920
+lymphatics تبعت ال lungs تدخل إلى ال lungs من ال
+
+75
+00:06:18,920 --> 00:06:24,480
+hilum of the lung بتتفرع زي ال ايه ال bronchiality
+
+76
+00:06:24,480 --> 00:06:31,740
+و بتعمل بتنتهي بال interstitialSpaces,
+
+77
+00:06:31,740 --> 00:06:37,080
+interstitial fluid اللي هو in between the A and
+
+78
+00:06:37,080 --> 00:06:41,100
+the alveoli تمام؟ و بتعمل absorption و بتعمل
+
+79
+00:06:41,100 --> 00:06:43,720
+negative pressure في داخل ال A في داخل ال
+
+80
+00:06:43,720 --> 00:06:47,500
+interstitium هان لإن بتعمل عملية shaft لل A و هاد
+
+81
+00:06:47,500 --> 00:06:52,060
+كتير كتير مهمة بس هنتكلم عنها في آخر المحاضرةإذا
+
+82
+00:06:52,060 --> 00:06:57,780
+عندنا ال lungs both right and left mainly برجعوا
+
+83
+00:06:57,780 --> 00:07:01,740
+في ال thoracic duct ال right side في حين أن ال
+
+84
+00:07:01,740 --> 00:07:06,000
+other parts of the body in the a left thoracic
+
+85
+00:07:06,000 --> 00:07:14,120
+duct عملهم
+
+86
+00:07:14,120 --> 00:07:18,920
+زي أي إيه lymphatics أخرى بياخدوا ال extra fluid و
+
+87
+00:07:18,920 --> 00:07:22,220
+بياخدوا ال extra proteinsو creating negative
+
+88
+00:07:22,220 --> 00:07:25,740
+pressure pressure
+
+89
+00:07:25,740 --> 00:07:32,480
+in the pulmonary system احنا خليني نطلع الحين ال
+
+90
+00:07:32,480 --> 00:07:35,460
+normal systemic circulation عندنا ال aortic
+
+91
+00:07:35,460 --> 00:07:42,860
+pressure تمام عندنا ال systole و عندنا ال diastole
+
+92
+00:07:42,860 --> 00:07:48,260
+عندنا ال systole و عندنا ايه ال diastole و عندنا
+
+93
+00:07:48,260 --> 00:07:54,500
+النطوق هذاان فوق هذا سببه انه أثناء ال system اللي
+
+94
+00:07:54,500 --> 00:08:00,200
+ما ينتهي الضغط بيعلق تمام بيضال فاتح ال ال aortic
+
+95
+00:08:00,200 --> 00:08:04,600
+valves و لما الضغط يوتى ال contraction ينتهي و
+
+96
+00:08:04,600 --> 00:08:08,980
+الضغط يوتى فابوه بتضغط بسرعة و بيرجع ال valves ورا
+
+97
+00:08:08,980 --> 00:08:14,280
+فابوه بتهبط سريع لإنه مش بس صار يمشي الدمالمدافع
+
+98
+00:08:14,280 --> 00:08:17,500
+للأمام كمان في لحظة و لحظة برجع على ورا شوية
+
+99
+00:08:17,500 --> 00:08:23,340
+فبيعمل انخفاض واضح بعدين برجع A يعني هذه تمثل ال
+
+100
+00:08:23,340 --> 00:08:27,440
+closure of the ايه of the aortic valve ساعة ما
+
+101
+00:08:27,440 --> 00:08:31,460
+يسكر برجع الدم معاها شوية فبيلاقي مسكر بتضل الضغط
+
+102
+00:08:31,460 --> 00:08:36,480
+يتنقص بعد ذلك شوية شوية نفس الكلام هنا لو طلعنا
+
+103
+00:08:36,480 --> 00:08:41,960
+الأسود هذا الخط الأسود هذا يمثل ال right
+
+104
+00:08:41,960 --> 00:08:48,490
+ventricular pressureالتانى هنا يمثل هذه الجهة تمثل
+
+105
+00:08:48,490 --> 00:08:53,890
+ال lift ventricular pressure مش كده ثم هنا بيغلق
+
+106
+00:08:53,890 --> 00:08:58,810
+ال valve و هنا بيكمل as aorta لإن هو فاتح ال
+
+107
+00:08:58,810 --> 00:09:02,950
+pressure هنا و هنا واحد لما ال aortic valve يفتح
+
+108
+00:09:02,950 --> 00:09:07,230
+معناها ال pressure في داخل ال ventricle و داخل ال
+
+109
+00:09:07,230 --> 00:09:13,070
+aorta the same لإنه فتحه صار ضخ واحدفهنا تشوف الخط
+
+110
+00:09:13,070 --> 00:09:17,090
+الأسود هنا ال right ventricular pressure بيعلى
+
+111
+00:09:17,090 --> 00:09:22,670
+تمام و بعدين بنزل للصفر بيعلى للآخر و بنزل للصفر
+
+112
+00:09:22,670 --> 00:09:27,770
+تمام بيعلى لخمسة و عشرين اذا ال systolic pressure
+
+113
+00:09:27,770 --> 00:09:31,070
+في ال ventricular side بيعلى لخمس و عشرين
+
+114
+00:09:31,070 --> 00:09:36,450
+millimeter mercury و بعدين بيصير relaxation تمام و
+
+115
+00:09:36,450 --> 00:09:43,020
+بسكر ال بالمونري valvesهو بيظل يهبط لانه relax ال
+
+116
+00:09:43,020 --> 00:09:46,940
+right ventricle بيظل يهبط للصفر، اذا الخط هذا اللي
+
+117
+00:09:46,940 --> 00:09:50,920
+ماشي هنا اللي هو عادي اللي هو ال ال ال ال
+
+118
+00:09:50,920 --> 00:09:53,860
+intraventricular pressures in the in the in the
+
+119
+00:09:53,860 --> 00:09:58,040
+right side of the heart لكن هنا عندنا ال pressure
+
+120
+00:09:58,040 --> 00:10:01,300
+هو بيقعد في ال right ventricle بيفتح في المنطقه
+
+121
+00:10:01,300 --> 00:10:06,570
+هذه الالتقاه الأحمر هنا بيفتح الال .. ال ..
+
+122
+00:10:06,570 --> 00:10:12,230
+البلمونارى valves بفتحها و بضخ الدم طبعا مقتش
+
+123
+00:10:12,230 --> 00:10:14,530
+بفتحها لما الضغط في الداخل يصير يساوي الضغط اللى
+
+124
+00:10:14,530 --> 00:10:19,170
+في ايه اللى في ال .. في الارتز و يزيد عليه فبفتح
+
+125
+00:10:19,170 --> 00:10:22,690
+ال valves و بصير اتجاه الدم الى ايه ال بالمونارى
+
+126
+00:10:22,690 --> 00:10:25,870
+ارتز و بيضل يعلى يعلى ال بالمونارى ارتز ال
+
+127
+00:10:25,870 --> 00:10:33,440
+pressure in equal to theto the right ventricular
+
+128
+00:10:33,440 --> 00:10:36,160
+pressure التانين بيصيروا ايه pressure واحد تمام
+
+129
+00:10:36,160 --> 00:10:39,220
+لكن لما يتخفض ال pressure في داخل ال ventricle
+
+130
+00:10:39,220 --> 00:10:42,600
+توقف السيستول توقف ال contraction و بيعمل
+
+131
+00:10:42,600 --> 00:10:46,140
+relaxation بروح الدنبل و يرجع على ال ventricle
+
+132
+00:10:46,140 --> 00:10:50,660
+تمام فبروح بيسكر ال ايه ال valve فبيظل الضغط جم
+
+133
+00:10:50,660 --> 00:10:54,800
+مرتفع و بيعود ينزل شوي شوي او هكذا اذا برضه هذا ال
+
+134
+00:10:54,800 --> 00:11:00,600
+network هذا اللي هنا هذا اغلاق ال بالمونري valve
+
+135
+00:11:01,140 --> 00:11:04,040
+إذا في الحالة هذه ال .. ال .. ال pressure بنزل
+
+136
+00:11:04,040 --> 00:11:08,000
+بهبط .. ب .. لإنه سكر ال valve بنزل ببطء شوية شوية
+
+137
+00:11:08,000 --> 00:11:11,800
+اتضغط في الايه؟ في البلمونary artery في حين إنه
+
+138
+00:11:11,800 --> 00:11:14,680
+بهبط في داخل الفندق اللي كانت فاصلة مع بعضها هذا
+
+139
+00:11:14,680 --> 00:11:18,780
+هبط للآخر و هذا سكر دال ضغطه ايه؟ بنسبوت شوية شوية
+
+140
+00:11:18,780 --> 00:11:24,600
+هنلاحظ يعني إنه ال .. ال systolic blood pressure
+
+141
+00:11:24,600 --> 00:11:27,240
+في البلمونary artery يسوى خمسة عشرين مليمتر
+
+142
+00:11:27,240 --> 00:11:31,650
+mercury و ال diastolic بنزل لإيه؟ لسبعةمليميتر
+
+143
+00:11:31,650 --> 00:11:35,030
+ميركورين لكن في ال .. في داخل ال ventricل نفسه
+
+144
+00:11:35,030 --> 00:11:41,450
+طبعا منزل ال صفر مش هيك لإنه خلاص relaxation و
+
+145
+00:11:41,450 --> 00:11:45,290
+هكذا بتبقى الدائرة هتتمشي بالشكل هذا الأرقام هذه
+
+146
+00:11:45,290 --> 00:11:51,150
+كتير مهمة لإنه بعد كده هنفهم مسائل
+
+147
+00:11:51,150 --> 00:11:55,150
+كتير متعلقة بالرقامين هدول اللي هو إيه من خمسة
+
+148
+00:11:55,150 --> 00:12:00,410
+عشرين ل تمانية ال main arterial blood pressure
+
+149
+00:12:02,210 --> 00:12:09,170
+المتوسط نعتبره خمسة عشر مليمتر mercury نعتبره
+
+150
+00:12:09,170 --> 00:12:16,730
+خمسة عشر مليمتر mercury okay طيب اذا هنا مشكلة انه
+
+151
+00:12:16,730 --> 00:12:21,670
+بهمنا نعرف طيب ال .. ال capillary pressure ال
+
+152
+00:12:21,670 --> 00:12:27,230
+pressure في ال capillaries جديش جالك
+
+153
+00:12:27,230 --> 00:12:35,820
+انه بما انهالـ pulmonary artery ممكن نصله ممكن
+
+154
+00:12:35,820 --> 00:12:40,580
+ندخل catheter تصل ل ايه ال right atrium right
+
+155
+00:12:40,580 --> 00:12:46,840
+ventricle right pulmonary artery و بتخش علي
+
+156
+00:12:46,840 --> 00:12:52,160
+branches و بتظل ماشية لما تصل any smaller and
+
+157
+00:12:52,160 --> 00:12:55,760
+smaller and smaller than a sludge than stuck in a
+
+158
+00:12:55,760 --> 00:13:00,930
+capillary it will occludewedging in a capillary
+
+159
+00:13:00,930 --> 00:13:07,610
+ومن جيس ساعت الضغط هناك سموه ايه؟ سموها the wedge
+
+160
+00:13:07,610 --> 00:13:15,490
+brusher بلمونة لوجه ايه؟ برشر تمام؟ البلمونة لوجه
+
+161
+00:13:15,490 --> 00:13:21,090
+برشر هذا لجو حوالي
+
+162
+00:13:21,090 --> 00:13:28,010
+خمسة مليمتر ميركوليد
+
+163
+00:13:28,010 --> 00:13:28,970
+تمام؟
+
+164
+00:13:31,240 --> 00:13:35,740
+طيب و الدم بينتقل من ال capillaries بيظل ماشي الى
+
+165
+00:13:35,740 --> 00:13:40,380
+ال left atrium مش هيك؟ اذا مدام الدم انتقل من ال
+
+166
+00:13:40,380 --> 00:13:44,000
+capillaries ل left atrium مستحيل ان ال left atrium
+
+167
+00:13:44,000 --> 00:13:46,740
+يكون ضغطه اعلى من ال capillaries لازم يكون ايه؟
+
+168
+00:13:46,740 --> 00:13:51,300
+اوطة لإن لو منه اعلى كان انعكست الدائرة مش هيك؟
+
+169
+00:13:51,300 --> 00:13:55,960
+اذا دائما القواعد ال physical laws بتقول ان الاشي
+
+170
+00:13:55,960 --> 00:14:00,320
+بنتقل من الأعلىالى ال .. في كل شيء من ضمنها الضغط
+
+171
+00:14:00,320 --> 00:14:06,000
+فإذا معناها هنا ال atrium لو قصنا احنا ال .. ال ..
+
+172
+00:14:06,000 --> 00:14:09,460
+البلمونة الكابيلاريسية اللي وجيناها الوجه حوالي
+
+173
+00:14:09,460 --> 00:14:15,280
+خمسة و ال left atrium معناها لازم يكون منخفض عن
+
+174
+00:14:15,280 --> 00:14:21,600
+ايه عن هيك لازم يكون ايش منخفض عن كده إذا هنا ال
+
+175
+00:14:21,600 --> 00:14:25,380
+left atrium أول ما بيعمل relaxation يبقى تقريبا
+
+176
+00:14:25,380 --> 00:14:29,640
+صفربيندفع الدم بيبني .. بيبني واحد اتنين تلاتة
+
+177
+00:14:29,640 --> 00:14:33,020
+اربعة في الآخر لازم يكون اقل من خمسة قبل ما يعمل
+
+178
+00:14:33,020 --> 00:14:36,340
+ال .. ال contraction ال final contraction to push
+
+179
+00:14:36,340 --> 00:14:40,280
+the rim .. the remaining blood in the atrium هو
+
+180
+00:14:40,280 --> 00:14:45,320
+لما بيفتح ال atrium بيجمع دم بيفتح ال .. ال .. ال
+
+181
+00:14:45,320 --> 00:14:50,080
+bicuspid ال mitral valve فبيبقى الدم بيخش مباشرة
+
+182
+00:14:50,080 --> 00:14:53,740
+من ال atrium لل ايه بتجمعش اخر جزئية لما انت ال
+
+183
+00:14:53,740 --> 00:14:59,320
+ventricleأخر جزئية بتتحوش في ال atrium فبروح ال
+
+184
+00:14:59,320 --> 00:15:03,880
+atrium بتغطها إضافي ولا هو الدم بتحوش بتحوشش في ال
+
+185
+00:15:03,880 --> 00:15:07,740
+atrium بيضل داخل ع مين؟ ع ال ventricle لكن إذا
+
+186
+00:15:07,740 --> 00:15:11,660
+انتلا ال ventricle و إذا طف فاللي بيطف بيصير في ال
+
+187
+00:15:11,660 --> 00:15:14,380
+atrium في ال atrium بيروح بدخهم لل إيه؟ لل ..
+
+188
+00:15:14,380 --> 00:15:17,080
+فلذلك الضغط دايما فيه منخفض منخفض جدا
+
+189
+00:15:20,160 --> 00:15:22,980
+the mean pulmonary capillary pressure is about
+
+190
+00:15:22,980 --> 00:15:27,200
+seven millimeter mercury احنا قلنا هنا من خمستاشر
+
+191
+00:15:27,200 --> 00:15:31,720
+من خمس عشر إلى تمانية مش كده طيب اذا هنا احنا قلنا
+
+192
+00:15:31,720 --> 00:15:38,380
+متوسط ال pulmonary capillary pressure about seven
+
+193
+00:15:38,380 --> 00:15:42,400
+millimeter mercury ال lift atrial and pulmonary
+
+194
+00:15:42,400 --> 00:15:47,220
+venous pressure لاجينا دائما قلنا من واحد إلى
+
+195
+00:15:47,220 --> 00:15:50,780
+اتنين ممكن يصل الى خمسةإذا أوصل لخمسة معناها اللي
+
+196
+00:15:50,780 --> 00:15:54,040
+فوق لازم يكون دائما أعلى من انه ممكن يصل لسبعة ال
+
+197
+00:15:54,040 --> 00:15:59,480
+capillary pressure مش
+
+198
+00:15:59,480 --> 00:16:02,260
+وهم احنا كيف وصلنا للمسألة هذه المهم احنا بهمنا
+
+199
+00:16:02,260 --> 00:16:06,440
+الأرقام في الآخر عشان هي اللي هتساعدنا في ال ايه
+
+200
+00:16:06,440 --> 00:16:14,980
+في الحساب طيب blood
+
+201
+00:16:14,980 --> 00:16:22,750
+volume of the lungsالان احنا ال blood بيطلع من ال
+
+202
+00:16:22,750 --> 00:16:29,030
+right artery من ال pulmonary artery الى ال blood
+
+203
+00:16:29,030 --> 00:16:34,310
+الى ال lungs و بعدين بيطلع فى ال pulmonary veins
+
+204
+00:16:34,310 --> 00:16:40,570
+طيب بين ال artery و ال vein لما دخلنا ال lung
+
+205
+00:16:40,570 --> 00:16:46,630
+نفسها قداش في عندي أنا موجود دم فى اللحظة الواحدة
+
+206
+00:16:47,690 --> 00:16:50,510
+تمام؟ في اللحظة الواحدة موجودة حوالي اربعمائة
+
+207
+00:16:50,510 --> 00:16:56,170
+وخمسين ملي لتر دم في ال two lungs منهم سبعين ملي
+
+208
+00:16:56,170 --> 00:17:01,630
+لتر موجودة في ال capillaries والباقي مناصفة جزء في
+
+209
+00:17:01,630 --> 00:17:05,170
+ال arterial side وجزء في ال venous side ال
+
+210
+00:17:05,170 --> 00:17:09,990
+branches الأكبر تمام؟ مثلا ال lungs فيهم حوالي
+
+211
+00:17:09,990 --> 00:17:13,890
+اربعمائة وخمسين ملي لتر لكن هدول قابلين انهم
+
+212
+00:17:13,890 --> 00:17:20,840
+يزيدوامقابلين انهم ينجسوا يعني في في ال lung
+
+213
+00:17:20,840 --> 00:17:26,340
+القدرة على انها تستوعب اكتر شوية او تعطي الجسم
+
+214
+00:17:26,340 --> 00:17:29,200
+اكتر شوية حسب حاجته يعني في حالة ما يكون فيه
+
+215
+00:17:29,200 --> 00:17:32,420
+hemorrhage بيصير انه عندنا vasospasm لحد الماء و
+
+216
+00:17:32,420 --> 00:17:35,480
+بزوج more blood to the ايه؟ to the systemic
+
+217
+00:17:35,480 --> 00:17:38,800
+circulation to save the body و لو صار عندى انا
+
+218
+00:17:38,800 --> 00:17:42,550
+mitral stenosis او كان some sort ofdelay in
+
+219
+00:17:42,550 --> 00:17:47,210
+evacuation هنلاقي انه عندي انا ال .. ال .. ال ..
+
+220
+00:17:47,210 --> 00:17:51,630
+ال .. ايه ال lung مستعدة تستوعب دم اكتر لحدود
+
+221
+00:17:51,630 --> 00:17:56,270
+معينة بعدين بيصير عندنا مشكلة لكن عندنا في
+
+222
+00:17:56,270 --> 00:18:00,570
+compliance معين انه يستوعب زيادة يستوعب اقل بدون
+
+223
+00:18:00,570 --> 00:18:04,170
+اي مشاكل بدون اي تغييرلكن عند level معين هنلاقي
+
+224
+00:18:04,170 --> 00:18:08,090
+انه الضغط اللي زاد او الكمية اللي زادت زولت الضغط
+
+225
+00:18:08,090 --> 00:18:12,050
+وعملتلي مشاكل هنتكلم عنها بالتفصيل بعد شوية لكنه
+
+226
+00:18:12,050 --> 00:18:14,590
+in general في physiological changes كبيرة هان
+
+227
+00:18:14,590 --> 00:18:24,750
+بإمكانها انها تستوعب more اذا هنا the lungs as
+
+228
+00:18:24,750 --> 00:18:29,490
+blood reservoir اذا ان هي ال lungs مش بس بتعملي
+
+229
+00:18:29,490 --> 00:18:34,190
+عمليةاللي هو تبدو الغازات وبتعمل نوع من التخزين
+
+230
+00:18:34,190 --> 00:18:40,330
+بالزيادة والنقصة مش هيك لذلك احنا لما مثلا ننفخ
+
+231
+00:18:40,330 --> 00:18:47,330
+بلون بالجوي طبعا الضغط اللي في داخلنا في داخل
+
+232
+00:18:47,330 --> 00:18:50,990
+الرئتين بيقل كتير مش كده الدم اللي بيصير في
+
+233
+00:18:50,990 --> 00:18:56,780
+الرئتين بهرب منها بيصير دم أقل طبعالكن في حالات
+
+234
+00:18:56,780 --> 00:19:00,100
+قلتلكم ما يكون في عندي تطلع هنا إيش الرقم المكتوب
+
+235
+00:19:00,100 --> 00:19:04,620
+can be express يعني ممكن يصير عندي بس بدل 450 بس
+
+236
+00:19:04,620 --> 00:19:10,720
+200 يعني 250 ممكن إيش ينضغطه لخارج الرقتين و لو
+
+237
+00:19:10,720 --> 00:19:13,980
+صار عندي hemorrhage نفس الكلام بيصير عندي إمكانية
+
+238
+00:19:13,980 --> 00:19:18,520
+أنه يندفع بعض الدم من ال lungs إلى ال system of
+
+239
+00:19:18,520 --> 00:19:24,480
+circulation حتى يعمل عمل التعويضوالعكس صحيح في
+
+240
+00:19:24,480 --> 00:19:28,240
+حالة ما أصبح عندى اي congestion بسبب ما قولنا ال
+
+241
+00:19:28,240 --> 00:19:32,880
+valvular disease في ال left side ممكن يستوعب شوية
+
+242
+00:19:32,880 --> 00:19:39,680
+دم زيادة بدون اي مشاكل shift of blood between the
+
+243
+00:19:39,680 --> 00:19:43,960
+pulmonary and systemic circulation as a result of
+
+244
+00:19:43,960 --> 00:19:47,640
+cardiac pathology هذا الكلام اللى احنا بكلمه فيه
+
+245
+00:19:47,640 --> 00:19:51,420
+انه failure of left side of the heartor increase
+
+246
+00:19:51,420 --> 00:19:55,240
+resistance of to blood flow يعني الضغط زاد
+
+247
+00:19:55,240 --> 00:19:58,700
+resistance ل blood flow زاد فالضغط بزيد او صار
+
+248
+00:19:58,700 --> 00:20:03,400
+عندى المشكلة مش فى البلمونة مش فى ال .. ال aorta
+
+249
+00:20:03,400 --> 00:20:07,360
+المشكلة في .. بين ال .. ال atria و ال ventricle
+
+250
+00:20:07,360 --> 00:20:12,280
+يعني اقرب لمين لل lung يعني وين ما يكون فى مقاومة
+
+251
+00:20:12,280 --> 00:20:16,860
+لدخول الدم اين ما كان هينعكس هذا على مين؟ على ال
+
+252
+00:20:16,860 --> 00:20:21,510
+lungs تمام؟فبيبدأ ال brusher في ال lungs يعلى يعلى
+
+253
+00:20:21,510 --> 00:20:28,490
+يعلى مش هيك لمرحلة ممكن يزيد الضغط كتير ويبدأ
+
+254
+00:20:28,490 --> 00:20:33,930
+يعملي كمان بلمونري قديمة يعني ال venous blood ال
+
+255
+00:20:33,930 --> 00:20:38,290
+venous brusher صار كتير صار ال filtration أكتر من
+
+256
+00:20:38,290 --> 00:20:43,790
+قدرة اللي ايه ال absorption أو ال lymphatic system
+
+257
+00:20:44,560 --> 00:20:49,440
+فبصير عندي fluids متخلفة فبتعمللي ايه بالمنا دي ما
+
+258
+00:20:49,440 --> 00:20:51,800
+هو المشكلة لإن بالمنا دي ما مش بس هتخش في ال
+
+259
+00:20:51,800 --> 00:20:55,380
+interstitium هتلاقي عندي فراغات مساحات هوائية
+
+260
+00:20:55,380 --> 00:20:59,600
+موجودة هتعبيها هصير عندي انا مشكلة في ال ايه؟ في
+
+261
+00:20:59,600 --> 00:21:03,420
+التنفس هو السؤال الكبير اللي احنا بنظل بنسأل حالنا
+
+262
+00:21:03,420 --> 00:21:07,620
+كيف انه هالفراغات الهوائية دي موجودة و حواليها
+
+263
+00:21:07,620 --> 00:21:13,060
+interstitial fluid و مابغرجش كيف ال fluid اللي في
+
+264
+00:21:13,060 --> 00:21:16,480
+ال interstitiumبيظل في الـ interstitium و اللي
+
+265
+00:21:16,480 --> 00:21:20,940
+بيفاصل بينه وبين الفرقات الهوائية ال alveolar wall
+
+266
+00:21:20,940 --> 00:21:26,000
+very thin very delicate، مظبوط؟ طب ليش مابنتخلش ال
+
+267
+00:21:26,000 --> 00:21:31,040
+fluids من ال interstitium لل alveolar spaces؟
+
+268
+00:21:31,040 --> 00:21:36,220
+تمام؟ علشان كلام هنقولكوه في الآخر، لسه موصلنهاش،
+
+269
+00:21:36,220 --> 00:21:37,220
+لكن هذه المسألة
+
+270
+00:21:40,100 --> 00:21:43,460
+اللي لو صار عندى انا انه صار mitral stenosis ال ..
+
+271
+00:21:43,460 --> 00:21:46,560
+ال mitral valve اللى هو بين ال .. ال .. ال atrium
+
+272
+00:21:46,560 --> 00:21:51,600
+ال lift و ال .. و ال left ventricle ضيق لسبب ما
+
+273
+00:21:51,600 --> 00:21:58,400
+اسباب فبيقدر إلى أنه ينهي نحجز الدم إلى ايه؟ إلى
+
+274
+00:21:58,400 --> 00:22:03,220
+.. إلى .. إلى انه يبقى مدة أطول و كمية أكبر منين
+
+275
+00:22:03,220 --> 00:22:06,860
+في ال .. في ال pulmonary circulationSometimes
+
+276
+00:22:06,860 --> 00:22:09,460
+increasing the pulmonary blood volume as much as
+
+277
+00:22:09,460 --> 00:22:12,760
+one hundred percent، يعني بيصير ضعيف، يعني بدل ما
+
+278
+00:22:12,760 --> 00:22:16,400
+هو أربعمائة و خمسين مليلتر ممكن يصل لإيه؟ لتسعمائة
+
+279
+00:22:16,400 --> 00:22:21,520
+مليلتر، واضح؟And
+
+280
+00:22:21,520 --> 00:22:24,020
+causing large increases in pulmonary vascular
+
+281
+00:22:24,020 --> 00:22:26,520
+pressures، إذا ال blood pressure في داخل الـA
+
+282
+00:22:26,520 --> 00:22:27,060
+حيزيد
+
+283
+00:22:31,180 --> 00:22:36,240
+بالعكس أن عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد
+
+284
+00:22:36,240 --> 00:22:37,520
+عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد
+
+285
+00:22:37,520 --> 00:22:37,580
+عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد
+
+286
+00:22:37,580 --> 00:22:38,620
+عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد
+
+287
+00:22:38,620 --> 00:22:38,620
+عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد عدد
+
+288
+00:22:38,620 --> 00:22:42,680
+عدد عدد عدد عدد عدد عدد عدد عدد عدد
+
+289
+00:22:42,680 --> 00:22:49,920
+عدد عدد عدد عدد
+
+290
+00:22:49,920 --> 00:22:54,720
+عدد
+
+291
+00:22:54,720 --> 00:23:00,080
+عد
+
+292
+00:23:00,290 --> 00:23:05,510
+يصيب تماما أضعاف يعني مش هتفرق كتير لكنه العكس
+
+293
+00:23:05,510 --> 00:23:11,570
+صحيح يعني أي تغيير في ال system circulation بيأثر
+
+294
+00:23:11,570 --> 00:23:15,990
+في ال ايه؟ بيأثر في ال بالمونة ال circulation لأنه
+
+295
+00:23:15,990 --> 00:23:22,170
+البالمونة ال circulation محدودة blood flow through
+
+296
+00:23:22,170 --> 00:23:27,710
+the lungs and its distribution blood
+
+297
+00:23:27,710 --> 00:23:32,600
+flow through the lungsUnder most conditions, the
+
+298
+00:23:32,600 --> 00:23:38,900
+pulmonary vessels act as passive distensible tubes
+
+299
+00:23:38,900 --> 00:23:42,620
+that enlarge with increasing pressure and narrow
+
+300
+00:23:42,620 --> 00:23:46,660
+with decreasing pressure حلو؟ يعني عندها القدرة ال
+
+301
+00:23:46,660 --> 00:23:51,040
+blood vessels انها زي اي blood vessels انت تتسع
+
+302
+00:23:51,040 --> 00:23:55,360
+اذا زاد الحجم و تندق اذا جال الحجم بحيث انه تحافظ
+
+303
+00:23:55,360 --> 00:24:00,950
+على ضغط معين يظل دافع الالدم إلى ال .. إلى الـ
+
+304
+00:24:00,950 --> 00:24:07,350
+heart for adequate aeration of the blood to occur
+
+305
+00:24:07,350 --> 00:24:11,530
+it is important for the blood to distribute to
+
+306
+00:24:11,530 --> 00:24:14,830
+those segments of the lungs that has good aeration
+
+307
+00:24:14,830 --> 00:24:20,370
+يعني الدم هو رايح لذئتين المفروض يروح للمناطق اللي
+
+308
+00:24:20,370 --> 00:24:24,850
+التهوية فيها جيدة و المناطق اللي متهوية فيها مش
+
+309
+00:24:24,850 --> 00:24:29,840
+جيدة مفترض ماروحلهاش لإنههيضيع بس جهد وقال فاضي
+
+310
+00:24:29,840 --> 00:24:34,260
+هيروح ياخد هوا بلا جيش و بيضل ايه؟ بيضل ماشي طب و
+
+311
+00:24:34,260 --> 00:24:38,960
+في مناطق ممكن يكون فيها تهوية مش جايدة؟ اه under
+
+312
+00:24:38,960 --> 00:24:44,380
+certain diseases ممكن يكون عندي مناطق فيها تهوية
+
+313
+00:24:44,380 --> 00:24:49,600
+مش جايدة و under physiological conditions بعض
+
+314
+00:24:49,600 --> 00:24:53,300
+المناطق التهوية فيها جايدة أحيانا و مش جايدة
+
+315
+00:24:53,300 --> 00:24:59,520
+أحيانا طب أنا هتكلم عنهاالنقطة الأولى في المحافظة
+
+316
+00:24:59,520 --> 00:25:03,500
+على أن ال .. الهوى .. أن الدم يتوجه للمناطق اللي م
+
+317
+00:25:03,500 --> 00:25:08,340
+.. اللي لها تهوية جيدة أنه فيها عندنا ملاحظة غريبة
+
+318
+00:25:08,340 --> 00:25:12,180
+أنه إحنا مانلاحظ أن المنطقة اللي مافيش فيها تهوية
+
+319
+00:25:12,180 --> 00:25:15,200
+جيدة بيصير vase-base من الكابيلة اللي زي اللي
+
+320
+00:25:15,200 --> 00:25:19,680
+حوالها مافيش فيها دم بيصير shift لل blood إلى
+
+321
+00:25:19,680 --> 00:25:25,300
+المناطق اللي ايه with good reaction تمام؟عندي
+
+322
+00:25:25,300 --> 00:25:31,580
+automatic control of pulmonary blood flow حسب ال
+
+323
+00:25:31,580 --> 00:25:35,800
+ايه؟ ال oxygen concentration in the alveoli لما ال
+
+324
+00:25:35,800 --> 00:25:38,200
+oxygen concentration in the alveoli ينزل يعني
+
+325
+00:25:38,200 --> 00:25:41,880
+مافيش عندنا good aeration للمنطقة هذه مالاجي صار
+
+326
+00:25:41,880 --> 00:25:48,520
+عندي vazospasm when
+
+327
+00:25:48,520 --> 00:25:50,840
+the concentration of oxygen in the air of the
+
+328
+00:25:50,840 --> 00:25:54,820
+alveoli decreases below normalespecially when it
+
+329
+00:25:54,820 --> 00:25:59,980
+is it falls below 70%
+
+330
+00:25:59,980 --> 00:26:05,100
+of the normal يعني below 73 millimeter mercury the
+
+331
+00:26:05,100 --> 00:26:09,720
+adjacent blood vessels constrict with the vascular
+
+332
+00:26:09,720 --> 00:26:13,200
+resistance increasing more than 5 folds at
+
+333
+00:26:13,200 --> 00:26:17,940
+extremely low oxygen levels إذا الأكسجين هبط احنا
+
+334
+00:26:17,940 --> 00:26:21,780
+في العادة الأكسجين partial pressure تبعه في داخل
+
+335
+00:26:21,780 --> 00:26:27,550
+الalveoli 104مية وأربعة لما ينزل سبعين في المية
+
+336
+00:26:27,550 --> 00:26:31,810
+يعني يصير تلاتة وسبعين millimeter mercury ينزل
+
+337
+00:26:31,810 --> 00:26:35,190
+السبعين في المية من قيمته الأساسية تمام؟ تلاتة
+
+338
+00:26:35,190 --> 00:26:39,890
+وسبعين millimeter mercury بيبدأ ال .. ال .. ال ..
+
+339
+00:26:39,890 --> 00:26:43,750
+صار ال .. ال .. الصار ال oxygen اللي اللي موجودة
+
+340
+00:26:43,750 --> 00:26:46,850
+في ال .. في ال .. في ال alveoli تقريبا شبيه بال
+
+341
+00:26:46,850 --> 00:26:51,210
+oxygen اللي راجع مع ال إيه؟ مع ال blood تمام؟ يعني
+
+342
+00:26:51,210 --> 00:26:55,620
+بيحس أنه مقدرش ياخد منهيعني صار عنده ال oxygen
+
+343
+00:26:55,620 --> 00:26:58,100
+الموجود في ال alveoli هذا مش اكتر من ال oxygen
+
+344
+00:26:58,100 --> 00:27:01,880
+اللي ايه اللي موجود في ال blood ال blood هو راجع
+
+345
+00:27:01,880 --> 00:27:06,660
+في ال venous side برجعش ال oxygen في صفر ال
+
+346
+00:27:06,660 --> 00:27:10,940
+partial pressure of oxygen مابترجع لصفر تمام بيكون
+
+347
+00:27:10,940 --> 00:27:19,440
+ايه تقريبا 70% لازال موجود تمام اذا هنا اذا نقص ال
+
+348
+00:27:19,440 --> 00:27:23,800
+oxygen في ال alveoliبشكل substantial بالنسبة للدم
+
+349
+00:27:23,800 --> 00:27:27,360
+اللي راجع يعني مش هيفيده كتير فمن اللي جيه حول
+
+350
+00:27:27,360 --> 00:27:30,820
+اتجاهه من المناطق هذه اللي فيها bad aeration الى
+
+351
+00:27:30,820 --> 00:27:34,660
+مناطق هي فيها good aeration تمام؟ the adjacent
+
+352
+00:27:34,660 --> 00:27:37,520
+blood vessels constrict with the vascular
+
+353
+00:27:37,520 --> 00:27:44,060
+resistance increases the opposite observed
+
+354
+00:27:44,060 --> 00:27:47,600
+in systemic vessels عكس هيك بنشوفه في ال systemic
+
+355
+00:27:47,600 --> 00:27:52,120
+vesselsلما يزيد عندي .. يجيلي ال oxygen في ال
+
+356
+00:27:52,120 --> 00:27:56,940
+blood vessels بيصير vasodilatation عشان يدخل دم
+
+357
+00:27:56,940 --> 00:28:01,900
+جديد يغسل و .. لكن سبحانه لا إله إلا هو هنا ال
+
+358
+00:28:01,900 --> 00:28:04,960
+function اختلف عن هناك هناك function أخر ال oxygen
+
+359
+00:28:04,960 --> 00:28:08,580
+فأنا ال oxygen الجليل بديش يعني لكن هنا ال
+
+360
+00:28:08,580 --> 00:28:10,460
+function بدي أدي ال oxygen لما ألاقي ال oxygen
+
+361
+00:28:10,460 --> 00:28:13,500
+جليل أربع مفتاح عشان أديله ايه؟ أديله دم أكتر و
+
+362
+00:28:13,500 --> 00:28:18,580
+oxygen أكتر مش كده؟ وهذا بيخلي أنه الدم اللي واصل
+
+363
+00:28:18,580 --> 00:28:22,200
+ال tissuesزي ما قلنا مش متواصل مش continuous،
+
+364
+00:28:22,200 --> 00:28:26,760
+intermittent الأكسجين جال، بفتح، بعبّى، أصبح كويس،
+
+365
+00:28:26,760 --> 00:28:29,940
+بعمل، بعمل فزش، فبقى زمن جديد، كذلك قلت لكم كبلاري
+
+366
+00:28:29,940 --> 00:28:34,720
+بيتز، مش كلها فاتحة، in one time، اه، ten percent
+
+367
+00:28:34,720 --> 00:28:40,440
+only opens at a time، بتبادلوا، بحيث أنه، ففي ال
+
+368
+00:28:40,440 --> 00:28:44,100
+system of circulation وجود ال ischemia، وجود ال
+
+369
+00:28:44,100 --> 00:28:50,130
+high boxy-oxid، بيقدّي إلى أنه يصيرهنا وجود
+
+370
+00:28:50,130 --> 00:28:53,310
+الهيبوكسيا في المنطقة بتقدي إلى إيه؟ إن الأكسجين
+
+371
+00:28:53,310 --> 00:28:55,950
+تأثيره عكسي بيعمل vazospasm مش ايه؟ مش
+
+372
+00:28:55,950 --> 00:28:58,470
+vazodilatation تفسيرها إنه في عندنا
+
+373
+00:28:58,470 --> 00:29:02,110
+vazoconstrictor substances might be secreted by
+
+374
+00:29:02,110 --> 00:29:05,690
+the alveolar epithelial cells when it is hypoxic
+
+375
+00:29:05,690 --> 00:29:10,250
+تمام؟ بتقدي إلى إنه هو لو أنتوا تلاحظوا جدش
+
+376
+00:29:10,250 --> 00:29:17,750
+العلاقة ما بين ال ال alveolar wall و ال capillary
+
+377
+00:29:19,250 --> 00:29:22,330
+الـ capillaries أنا بدي أقول جاعي مش capillaries
+
+378
+00:29:22,330 --> 00:29:25,450
+حقيقي أنا بقول capillary sheet لإن ال capillaries
+
+379
+00:29:25,450 --> 00:29:30,590
+اللي بتغلف ال ال alveoli ملتسقة مع بعضها البعض
+
+380
+00:29:30,590 --> 00:29:34,950
+لدرجة انه ماتشوفش فرق بينهم و كأنهم sheet لذلك هي
+
+381
+00:29:34,950 --> 00:29:37,750
+عاملة capillary sheet و ده بدخل في ال sheet هات هو
+
+382
+00:29:37,750 --> 00:29:42,110
+the scanning the scanner بدخل و المنطقة هو بيخش
+
+383
+00:29:42,110 --> 00:29:47,410
+عليه على ال venous side عطول تمام فالعلاقة بينهم
+
+384
+00:29:47,410 --> 00:29:51,210
+علاقة بخمة و كبيرةومافيش فراغات بينهم ملتصقين مع
+
+385
+00:29:51,210 --> 00:29:55,250
+بعضهم البعض و ال capillary ديق جدا لدرجة انه ال
+
+386
+00:29:55,250 --> 00:29:58,270
+capillary اللي ماشي هذا الدم اللي ماشي في ال
+
+387
+00:29:58,270 --> 00:30:00,930
+capillary يدوب ال diameter تبع ال capillary ال
+
+388
+00:30:00,930 --> 00:30:04,830
+diameter of A أجال من ال diameter of RBCs بذلك
+
+389
+00:30:04,830 --> 00:30:07,230
+بتبقى ال RBCs محشورة في داخلها في ال capillary
+
+390
+00:30:07,230 --> 00:30:13,210
+بمعنى انه هي مش انه بدو ينتقل ال oxygen لل plasma
+
+391
+00:30:13,210 --> 00:30:18,190
+و من ال plasma لل ايه لل RBCsيعني بينهم واسع، لأ،
+
+392
+00:30:18,190 --> 00:30:22,990
+ملتصقة، لل .. لل .. للـ hemoglobin مباشرة، لل ..
+
+393
+00:30:22,990 --> 00:30:26,410
+لل blood cells مباشرة، و هذا ندرسه ساعة و نتكلم عن
+
+394
+00:30:26,410 --> 00:30:31,710
+انتقال اللي .. لذلك هنا بنلاقي العلاقة بينهم على
+
+395
+00:30:31,710 --> 00:30:35,730
+طول بينتبه للhypoxia أو بيصير vasoplasm بمنع هذا
+
+396
+00:30:35,730 --> 00:30:37,850
+ال blood اللي انه عدي في المنطقة هذه لإنه مش
+
+397
+00:30:37,850 --> 00:30:38,610
+هيستفيد منها
+
+398
+00:30:41,400 --> 00:30:43,440
+هذا الانفعال من الهواء القليل على مقاومة البلمونار
+
+399
+00:30:43,440 --> 00:30:48,020
+الفاسكالية لديه فعالة مهمة مهمة مهمة مهمة مهمة
+
+400
+00:30:48,020 --> 00:30:49,040
+مهمة مهمة مهمة مهمة مهمة مهمة مهمة مهمة مهمة مهمة
+
+401
+00:30:49,040 --> 00:30:49,560
+مهمة مهمة مهمة مهمة مهمة مهمة مهمة مهمة مهمة مهمة
+
+402
+00:30:49,560 --> 00:30:53,780
+مهمة مهمة مهمة مهمة
+
+403
+00:31:11,920 --> 00:31:18,720
+تأثير ال effect of hydrostatic pressure gradients
+
+404
+00:31:18,720 --> 00:31:23,820
+in the lungs on regional pulmonary blood flow
+
+405
+00:31:23,820 --> 00:31:29,660
+blood
+
+406
+00:31:29,660 --> 00:31:33,940
+pressure in الفقه طيب اذا الان ال lung هذه اللى
+
+407
+00:31:33,940 --> 00:31:39,420
+متكلم عنها احنا من شوية صغيرة انا قلتلكم ال blood
+
+408
+00:31:41,540 --> 00:31:46,240
+flow فيها مش كله the same بعض المناطق ممكن يكون
+
+409
+00:31:46,240 --> 00:31:54,100
+فيها without لسبب الأسباب blood supply وبعض
+
+410
+00:31:54,100 --> 00:31:58,440
+المناطق ممكن يكون فيها blood supply أحيانا في
+
+411
+00:31:58,440 --> 00:32:01,460
+physiological conditions أحيانا ال blood موجود و
+
+412
+00:32:01,460 --> 00:32:06,020
+أحيانا مش موجود تمام؟ الآن احنا اتكلم عن نقطة مهمة
+
+413
+00:32:06,020 --> 00:32:11,200
+في المسألةال .. ال .. ال blood vessels و ال blood
+
+414
+00:32:11,200 --> 00:32:16,720
+supply لل lungs تمام؟ احنا الضغط تبع الجلب تبع
+
+415
+00:32:16,720 --> 00:32:21,120
+الأور تجدش ع مستوى الجلب مية و عشرين على تمانين
+
+416
+00:32:21,120 --> 00:32:25,560
+يعني ال systol مية و عشرين و لما ينزل ينزل ينزل
+
+417
+00:32:25,560 --> 00:32:27,540
+الجبل ما يصل ال تمانين بيكون إيه جالس ال systol
+
+418
+00:32:27,540 --> 00:32:31,340
+الجديد بيبدأ يعلق يعني ال diastol تمانين أخر إيه؟
+
+419
+00:32:31,690 --> 00:32:37,630
+أخر انقفاض من خفضه طيب
+
+420
+00:32:37,630 --> 00:32:43,850
+لو طلعنا فوق في اتجاه الرأس و احنا واقفين صار عندى
+
+421
+00:32:43,850 --> 00:32:49,310
+انه الدم بدى ماشي anti gravity طبعا معناها و انا
+
+422
+00:32:49,310 --> 00:32:54,890
+بعلى فوق الضغط بخفف لإنه بدى يسند فالقوة اللى عندى
+
+423
+00:32:54,890 --> 00:32:59,450
+فهي عبدغل في حين انه انا نازل معايا ال gravity مش
+
+424
+00:32:59,450 --> 00:33:06,530
+كده يعني في ال footمن اللاجئ انه الضغط can be as
+
+425
+00:33:06,530 --> 00:33:09,850
+much as ninety millimeter greater than the cardiac
+
+426
+00:33:09,850 --> 00:33:13,890
+pressure than the heart تمام اذا انا هيدوستك
+
+427
+00:33:13,890 --> 00:33:19,050
+pressure في المناطق اللي تحت ال heart حقيقة اعلى
+
+428
+00:33:19,050 --> 00:33:23,570
+من ال heart نفسه من المستوى على ال heart و المناطق
+
+429
+00:33:23,570 --> 00:33:29,790
+اللي فوق اقل تمام ال lung بيخشها
+
+430
+00:33:30,270 --> 00:33:35,230
+الـ Balmonary Artery من الـ Highland في الوسط بين
+
+431
+00:33:35,230 --> 00:33:43,550
+ال base .. بين ال base و ال .. و ال .. و ال apex و
+
+432
+00:33:43,550 --> 00:33:50,890
+ال .. اه في عندي تلاتين centimeter تلاتين
+
+433
+00:33:50,890 --> 00:33:55,470
+centimeter ارتفاع ال a ارتفاع ال long تلاتين
+
+434
+00:33:55,470 --> 00:33:58,350
+centimeter فبين ال base و ال .. عندنا ال vertical
+
+435
+00:33:58,350 --> 00:34:03,040
+diameter هناتلاتين centimeter التلاتين centimeter
+
+436
+00:34:03,040 --> 00:34:09,200
+هذا بلغة الضغط مفترض يكون فيه فارق بينهم تلاتة و
+
+437
+00:34:09,200 --> 00:34:14,360
+عشرين millimeter mercury كفروقات
+
+438
+00:34:14,360 --> 00:34:21,220
+ارتفاع بمعنى اخر ان ال highland داخلها مفترض ال
+
+439
+00:34:21,220 --> 00:34:25,020
+zero يعني اللي هو المية و عشرين ال cardiac يعني
+
+440
+00:34:25,020 --> 00:34:32,680
+مفترض فوق ال apex عندي انابينقص خمس عشر ملي متر
+
+441
+00:34:32,680 --> 00:34:38,520
+mercury يعني بلاقي ال blood blood فوق مية و ..
+
+442
+00:34:38,520 --> 00:34:41,740
+عندنا خمسة و عشرين قلنا خمسة و عشرين ملي متر
+
+443
+00:34:41,740 --> 00:34:47,520
+mercury ناقص خمس عشر بيصير عشرة ع ال apex of the
+
+444
+00:34:47,520 --> 00:34:51,080
+lung عند ال blood pressure ال .. ال .. ال .. ال
+
+445
+00:34:51,080 --> 00:34:54,200
+main blood pressure مش هيك؟ لأ مش ال main هاد، هاد
+
+446
+00:34:54,200 --> 00:34:56,780
+خمسة و عشرين خسر .. خسرنا من خمسة و عشرين من ال
+
+447
+00:34:56,780 --> 00:35:01,620
+systolic إذا ال systolic جدش هيكون؟خمس .. خمس و
+
+448
+00:35:01,620 --> 00:35:07,320
+عشر ناجس .. ناجس خمس تاشر عشرة احنا قولنا ال .. ال
+
+449
+00:35:07,320 --> 00:35:12,060
+.. بلمونة بلاتبشر خمس و عشر علي تمانية معناها في
+
+450
+00:35:12,060 --> 00:35:17,460
+ال diastole جدش هيكون البلاتبشر فوق مين مسحسح
+
+451
+00:35:17,460 --> 00:35:23,660
+معايا؟ اه؟ سالب اتنين سالب اتنين مش كده؟ لإن عندي
+
+452
+00:35:23,660 --> 00:35:29,880
+انا تمانية و هي بصير عندي .. بنزل ..بدي انزل ..
+
+453
+00:35:29,880 --> 00:35:32,060
+انا ساعدت بسبع عامة انت you are right you are
+
+454
+00:35:32,060 --> 00:35:36,440
+right تمام اذا من خمسة و عشرين احنا قولنا سيستول
+
+455
+00:35:36,440 --> 00:35:41,140
+بنزل لتمانية في ال diastole الفرق عندنا في خمستاشر
+
+456
+00:35:41,140 --> 00:35:45,400
+اذا لما ينزل ل تمانية عندى minus seven هيكون اذا
+
+457
+00:35:45,400 --> 00:35:50,220
+في ال .. في ال .. لاحظ ال abical area هيكون فيه
+
+458
+00:35:50,220 --> 00:35:55,180
+عندنا سيستول عشرة و diastole minus seven واضح؟
+
+459
+00:35:55,180 --> 00:36:01,540
+ننزل تحت على الآخر على ال baseهيكون عندى ال .. ال
+
+460
+00:36:01,540 --> 00:36:04,640
+.. ال sister خمسة و عشرين جداش احنا جولنا الفرق
+
+461
+00:36:04,640 --> 00:36:07,400
+بين فوق و تحت تلاتة و عشرين يعني هيظل عندى جداش
+
+462
+00:36:07,400 --> 00:36:14,540
+تمانية مش كده ال apex نجسط لل apex خمستاشر و لل
+
+463
+00:36:14,540 --> 00:36:18,720
+base هنزيد من ال heart level ل ال base هنزيد
+
+464
+00:36:18,720 --> 00:36:22,680
+تمانية عشان يصيروا تلاتة و عشرين اذا خمسة و عشرين
+
+465
+00:36:22,680 --> 00:36:29,160
+و تمانية خمسة و عشرين و تمانية جداشتلاتة و تلاتين
+
+466
+00:36:29,160 --> 00:36:33,520
+و تمانية و تمانية ستة عشرة يعني في الستول و
+
+467
+00:36:33,520 --> 00:36:37,140
+الدياستول عند blood pressure هنا ايه؟ عالي في هناك
+
+468
+00:36:37,140 --> 00:36:43,600
+في الستول خمسة عشرة في الدياستول minus seven هذا
+
+469
+00:36:43,600 --> 00:36:51,140
+بيقدر إلى ان ال blood supply مقارنة مقارنة بالblur
+
+470
+00:36:51,140 --> 00:36:55,980
+pressure ال tissue pressure ال tissues هذه لها لها
+
+471
+00:36:55,980 --> 00:37:00,470
+ايه؟collapsing pressure مش كده؟ ال collapsing
+
+472
+00:37:00,470 --> 00:37:08,690
+pressure بتبقى حق plus ten plus ten
+
+473
+00:37:08,690 --> 00:37:15,650
+ولا أجلي شوية الرسمة مش ذاكرها القليل فهذا بيقدر
+
+474
+00:37:15,650 --> 00:37:19,550
+إلى أنه لما يكون عندى انا ten و
+
+475
+00:37:26,010 --> 00:37:30,530
+و ال tissues ال
+
+476
+00:37:30,530 --> 00:37:36,070
+tissues pressure which is positive pressure هي ده
+
+477
+00:37:36,070 --> 00:37:42,850
+ضغط بيقدّي إلى انه for example اه when a person is
+
+478
+00:37:42,850 --> 00:37:45,170
+in the upright position the pulmonary arterial
+
+479
+00:37:45,170 --> 00:37:48,490
+pressure at the lung apex is about fifteen
+
+480
+00:37:48,490 --> 00:37:51,290
+millimeter mercury less than the pressure at the
+
+481
+00:37:51,290 --> 00:37:54,440
+level of the heartبالتالي، مركز الابيكال سيستوليكي
+
+482
+00:37:54,440 --> 00:37:59,300
+هو 10 مليمتر ميركوري فقط في مستوى الهارد ماينوس
+
+483
+00:37:59,300 --> 00:38:04,020
+فيفتين بيساوي ايه؟ هذا المركز الابيكالي 10 مليمتر
+
+484
+00:38:04,020 --> 00:38:10,400
+ميركوري هو أكتر من مستوى الفيولر
+
+485
+00:38:10,400 --> 00:38:15,080
+ايه؟ اه، اذا الفيولر ايه؟ بين ال .. بين ال
+
+486
+00:38:15,080 --> 00:38:19,320
+inspiration و ال expiration بيصل لإيش؟لزيرو مش هيك
+
+487
+00:38:19,320 --> 00:38:24,460
+اذا انا بكون عندى عشرة فوق الزيرو بعمل انا ال
+
+488
+00:38:24,460 --> 00:38:28,280
+blood ال blood flow بكون كويس ال capillary
+
+489
+00:38:28,280 --> 00:38:31,680
+pressure ال ال perfusion ال arti .. ال systolic
+
+490
+00:38:31,680 --> 00:38:36,240
+pressure بصل لعشرة معناه بيعمل good perfusion تمام
+
+491
+00:38:36,240 --> 00:38:40,440
+لكن لو كان انا عندى ال ال ال pressure minus seven
+
+492
+00:38:40,440 --> 00:38:46,460
+وعندي ال tissues pressure zeroيعني zero يعني plus
+
+493
+00:38:46,460 --> 00:38:49,120
+بالنسباله plus seven بالنسبالى ال minus seven مش
+
+494
+00:38:49,120 --> 00:38:52,360
+كده الفرق سبعة هذه هقدر ان ال tissues هتضغط على ال
+
+495
+00:38:52,360 --> 00:38:56,620
+capillaries و تمنع ال perfusion بمعنى انه عندى بعض
+
+496
+00:38:56,620 --> 00:39:00,700
+المناطق هذه ال apical area و احنا واقفين أثناء ال
+
+497
+00:39:00,700 --> 00:39:03,500
+systole بيعدى فيها الدم في ال capillaries و أثناء
+
+498
+00:39:03,500 --> 00:39:09,920
+ال diastole بيتوقف مش كده واضح طيب نرجع عشان نطة
+
+499
+00:39:09,920 --> 00:39:13,950
+عشان نطة هذه المرة واحدة نرجع نتكلم حد حدإذا ال
+
+500
+00:39:13,950 --> 00:39:18,490
+hydrostatic pressure يعني عندنا
+
+501
+00:39:18,490 --> 00:39:22,170
+بيختلف
+
+502
+00:39:22,170 --> 00:39:29,690
+حسب ال level تبع ال lung و حسب احنا و كيف وضعنا
+
+503
+00:39:29,690 --> 00:39:33,610
+احنا و احنا واقفين بتكلم ال apex عن ال base تلاتين
+
+504
+00:39:33,610 --> 00:39:36,550
+سانتي بفرق تلاتين و عشرين millimeter mercury فوق
+
+505
+00:39:36,550 --> 00:39:42,970
+ال heart level عندي فرقخمس عشر millimeter mercury
+
+506
+00:39:42,970 --> 00:39:48,650
+وتحتها بالنقصان وتحتها تمانية بالزيادة تمام؟ يعني
+
+507
+00:39:48,650 --> 00:39:53,610
+نعتبر ال tissues pressure zero فلما أكون عندي عشرة
+
+508
+00:39:53,610 --> 00:39:56,630
+مقابل يعني ال capillary blood بدي يدخل ال
+
+509
+00:39:56,630 --> 00:40:00,050
+perfusion بيعدّي في ال capillaries الضغط اللي جاي
+
+510
+00:40:00,050 --> 00:40:05,930
+عندي عشرة مقابل صفر بعدّي لكن لما أكون عندي ناجس
+
+511
+00:40:05,930 --> 00:40:11,300
+سبعة مقابل صفر بقى توقففتجينا هنا ايه؟ مشكلة في ال
+
+512
+00:40:11,300 --> 00:40:15,500
+perfusion في حين انه ال basal side دايما ايه؟ has
+
+513
+00:40:15,500 --> 00:40:19,040
+good perfusion لإنه بيتنقل بين تلاتة و تلاتين و
+
+514
+00:40:19,040 --> 00:40:22,200
+ايش و ستة عشر يعني دايما احنا ايه؟ بخير في ال base
+
+515
+00:40:22,200 --> 00:40:27,960
+لكن لو غيرنا وضعنا احنا و نمنا مش واقفين و جوف،
+
+516
+00:40:27,960 --> 00:40:32,420
+اذا نمنا الفرق بين ال ال ال two levels مش تلاتين
+
+517
+00:40:32,420 --> 00:40:35,820
+سانتي، اشي بسيط، بنلاقي ال perfusion صار على ال
+
+518
+00:40:35,820 --> 00:40:39,220
+apical side كويسلأن قبل كده صار .. صار في مستوى
+
+519
+00:40:39,220 --> 00:40:43,200
+الـ ايه؟ ال heart فبيصير عندنا perfusion كويسة
+
+520
+00:40:43,200 --> 00:40:48,580
+واضح؟ طيب إذا في الحالة هذه إحنا بنقدر نتكلم عن
+
+521
+00:40:48,580 --> 00:40:53,720
+تلاتة models تلاتة models سميناها zone one, zone
+
+522
+00:40:53,720 --> 00:40:58,740
+two, zone three احنا حقيقة أهم .. أصح من .. من
+
+523
+00:40:58,740 --> 00:41:03,440
+zone model لإن ال zone معناها في منطقة معينةفيها
+
+524
+00:41:03,440 --> 00:41:06,340
+اللي بدنا نقوله ومنطقة تانية فيها اش تانية ومنطقة
+
+525
+00:41:06,340 --> 00:41:09,580
+تالتة فيها اش تالت في الطبيعة التلاتة مش موجودين
+
+526
+00:41:09,580 --> 00:41:14,580
+موجود جزء منهم ومجزء لأ بس هي ك model نتكلم وبعدين
+
+527
+00:41:14,580 --> 00:41:18,340
+بنطبقه ع مين بنطبق ال model هذا على ال lung نشوف
+
+528
+00:41:18,340 --> 00:41:22,700
+ال lung إيش بنطبق عليها تمام؟ عندنا model واحد أو
+
+529
+00:41:22,700 --> 00:41:28,680
+بنسميه zone واحد فيه القرطيرة البشر أعلى من ال
+
+530
+00:41:28,680 --> 00:41:36,060
+إيه؟من ال .. فيها ال arterial pressure بيقدر يعمل
+
+531
+00:41:36,060 --> 00:41:40,480
+perfusion لل capillaries during systole ومستطيعش
+
+532
+00:41:40,480 --> 00:41:46,500
+يعمل during الايه؟ during .. ده .. هذا اللي هو
+
+533
+00:41:46,500 --> 00:41:50,880
+نمرة اتنين نمرة .. نمرة الأولى انه ال .. الviolar
+
+534
+00:41:50,880 --> 00:41:54,440
+pressure أعلى من ال capillary pressure فدائما عندي
+
+535
+00:41:54,440 --> 00:42:00,010
+no flow zoneتمام؟ إذا كان ال pressure عندي في ال
+
+536
+00:42:00,010 --> 00:42:03,350
+systole و في ال diastole أعلى من ال capillary
+
+537
+00:42:03,350 --> 00:42:06,490
+pressure أعلى من ال .. من ال .. من ال blood
+
+538
+00:42:06,490 --> 00:42:09,970
+pressure blood perfusion pressure في المنطقة هذه
+
+539
+00:42:09,970 --> 00:42:13,890
+معناها دائما ال capillary is إيه؟ included يعني
+
+540
+00:42:13,890 --> 00:42:19,170
+هذه no flow .. no flow zone تمام؟ لكن الموديل
+
+541
+00:42:19,170 --> 00:42:23,910
+التاني أنه يكون لأ يعني هو أعلى شوية ال pressure
+
+542
+00:42:23,910 --> 00:42:26,230
+بحيث أنه في ال systole بيصير أعلى من ال
+
+543
+00:42:26,230 --> 00:42:31,010
+interstitialpressure of the alveolar tissue وفي ال
+
+544
+00:42:31,010 --> 00:42:33,950
+diastole لما بهبط بصير أجالة هذه سمينها zone two
+
+545
+00:42:33,950 --> 00:42:37,770
+بمعنى أنه في ال systole فاتح و كويس و في ال
+
+546
+00:42:37,770 --> 00:42:40,590
+diastole يعود إيش ال young إذا هذه ال zone
+
+547
+00:42:40,590 --> 00:42:43,650
+الأولانية ال pressure عندي الخارجي أعلى من ال
+
+548
+00:42:43,650 --> 00:42:46,670
+pressure اللي داك ال capillaries فمسكرة كل الأوجات
+
+549
+00:42:46,670 --> 00:42:50,850
+هنا لأ وجد مفتوح وجد مسكر حسب في ال system اللي
+
+550
+00:42:50,850 --> 00:42:54,390
+بيعلق بدخل في ال diastole اللي بهبط النوع التالت
+
+551
+00:42:56,110 --> 00:42:59,190
+السيستول و ده solid ضغط أعلى من ال alveolar
+
+552
+00:42:59,190 --> 00:43:03,670
+pressure فبيقدي إلى انه ايه انه ال ال ال ال
+
+553
+00:43:03,670 --> 00:43:09,650
+continuous blood flow تمام واضح انه هذه المنطقة زي
+
+554
+00:43:09,650 --> 00:43:14,530
+ال basal zone three موجودة زي zone three موجودة
+
+555
+00:43:14,530 --> 00:43:22,110
+كأنها basal و هذه واضح انهاالأبكال لإن السيستوليك
+
+556
+00:43:22,110 --> 00:43:26,050
+بيخلّي ال perfusion اتم intermittent perfusion او
+
+557
+00:43:26,050 --> 00:43:29,990
+في ال diastole ايه بيروح هذه مش موجودة عندنا في
+
+558
+00:43:29,990 --> 00:43:32,950
+physiological conditions مش موجودة لكن under
+
+559
+00:43:32,950 --> 00:43:36,930
+certain pathological conditions ممكن تكون موجودة
+
+560
+00:43:36,930 --> 00:43:40,750
+ممكن under ايه certain pathological conditions
+
+561
+00:43:40,750 --> 00:43:45,550
+تصير ايش هذه تصير موجودة تمام لما سيدي heart
+
+562
+00:43:45,550 --> 00:43:50,870
+failure pressure ينزل اكترفبيقدّي لوهار السيستول
+
+563
+00:43:50,870 --> 00:43:55,510
+حتى بطل يكفي لفتح ال .. ال apical area عندي
+
+564
+00:43:55,510 --> 00:44:00,550
+hemorrhage blood pressure وطي تمام؟ فبيقدّي إلى
+
+565
+00:44:00,550 --> 00:44:03,830
+هذه المسألة يعني في عندي حالات pathological
+
+566
+00:44:03,830 --> 00:44:12,470
+بتوصللي zone two إلى zone one تمام؟ لكنها في
+
+567
+00:44:12,470 --> 00:44:16,490
+الطبيعي zone one هذه مش موجودة لأ يعنيهيعدى على
+
+568
+00:44:16,490 --> 00:44:20,330
+الأقل أثناء ال stall اللى هي في الأعلى منطقة طبعا
+
+569
+00:44:20,330 --> 00:44:24,310
+انا لما انام ال area ال zone two بتتحول ل zone
+
+570
+00:44:24,310 --> 00:44:30,610
+three لإن ال perfusion بيصير أحسن مش زود طيب من
+
+571
+00:44:30,610 --> 00:44:37,730
+وين بنبدأ zone three هذه من وين بنبدأ بدنا level
+
+572
+00:44:37,730 --> 00:44:43,230
+معين يكون ال pressure فيه صار في ال diastole أكتر
+
+573
+00:44:43,230 --> 00:44:47,750
+من zeroفي الدياستول صار ايه؟ اكتر من zero بحيث انه
+
+574
+00:44:47,750 --> 00:44:52,490
+احنا عندنا ال zero اللي هو اللي بيمنع الضغط فانا
+
+575
+00:44:52,490 --> 00:44:56,090
+اذا minus من ال zero هيكون ال capillaries
+
+576
+00:44:56,090 --> 00:45:01,330
+compressed كمان في الدياستول، تمام؟ لكن اذا كان
+
+577
+00:45:01,330 --> 00:45:06,170
+انا وصلت لمنطقة ان ال diastolic pressure يصير اعلى
+
+578
+00:45:06,170 --> 00:45:09,610
+نتره صغيرة من ال zero معناها بيفتح ال blood
+
+579
+00:45:09,610 --> 00:45:13,850
+vessels و بعدي، واضح؟ومنها دي بلاجيها، احنا قولنا
+
+580
+00:45:13,850 --> 00:45:18,310
+في عندنا تلاتين سانتي فوق ال .. بين التنين، مش
+
+581
+00:45:18,310 --> 00:45:27,810
+كده؟ قولنا عندنا خمستاشر سانتي تقريبا فوق ال ..
+
+582
+00:45:27,810 --> 00:45:29,910
+التلاتين سانتي، ومن هما دول؟
+
+583
+00:45:39,300 --> 00:45:44,980
+الـ hydrostatic pressure عندنا هان تسعين .. اه
+
+584
+00:45:44,980 --> 00:45:51,580
+تلاتين سانتي الفرق بينهم خمس عشر تقريبا
+
+585
+00:45:51,580 --> 00:45:57,300
+احنا عندنا التلاتين هذه كلها في عندنا حوالي اكتر
+
+586
+00:45:57,300 --> 00:46:02,140
+من خمس عشر سانتي اكتر من النص من التلاتين اكتر من
+
+587
+00:46:02,140 --> 00:46:07,550
+النص فوق ال .. ال .. ال blood level of the heartو
+
+588
+00:46:07,550 --> 00:46:11,510
+أقل من النص تحت ال level of the heart لإن
+
+589
+00:46:11,510 --> 00:46:16,130
+الخمستعشر تلاتين يمثل تلاتة و عشرين إذا عند
+
+590
+00:46:16,130 --> 00:46:21,490
+الخمستعشر تاخد تقريبا تمانتاشر سانتي تمانتاشر و
+
+591
+00:46:21,490 --> 00:46:26,070
+تمانتاشر و جديش لما تصير تلاتين و اتناشر مش كده
+
+592
+00:46:26,070 --> 00:46:34,420
+حوالي هيك الآن إيش اللي بيصير اللي بيصير أنهكل ما
+
+593
+00:46:34,420 --> 00:46:38,260
+نزلنا شوية كل ما ال diastolic pressure اتحسن وضعه
+
+594
+00:46:38,260 --> 00:46:41,940
+مش هيك ال systolic احنا عارفينه من فوق بنفع يعني
+
+595
+00:46:41,940 --> 00:46:45,440
+اعلى منطقة ال systole بيعدى ال .. ال capillary
+
+596
+00:46:45,440 --> 00:46:49,220
+pressure بيعدى فيها ال perfusion will even during
+
+597
+00:46:49,220 --> 00:46:53,160
+a .. in the highest area لكن كل ما نزلنا كل ما ال
+
+598
+00:46:53,160 --> 00:46:56,100
+diastolic بيبدأ يتحسن بيبدأ عندى يصير good
+
+599
+00:46:56,100 --> 00:47:00,800
+perfusion above ال heart level بعشرة سانتي
+
+600
+00:47:03,470 --> 00:47:07,430
+heart level في ال lungs 10 centimeter above the
+
+601
+00:47:07,430 --> 00:47:13,990
+heart level it will be zone 3 it will be a zone 3
+
+602
+00:47:13,990 --> 00:47:19,750
+لإن هنا حيصير عندي perfusion continuous systolic
+
+603
+00:47:19,750 --> 00:47:27,310
+and diastolic واضح طيب إذا هنا عندي ايه ال
+
+604
+00:47:33,550 --> 00:47:41,430
+زون عاما الانسان لديه فقط زون 2 و3 زون 2 يعني
+
+605
+00:47:41,430 --> 00:47:51,070
+انترمت فلو في الـ apex وزون 3 فلو مستمر في جميع
+
+606
+00:47:51,070 --> 00:47:57,550
+المناطق الأسفل او بالظبط تن سنتمتر اعلى مستوى
+
+607
+00:47:57,550 --> 00:48:07,640
+القلوب مثلا هذا المثلهنا ايش قولنا طيب
+
+608
+00:48:07,640 --> 00:48:12,260
+اذا zone two blood flow begins in the normal lungs
+
+609
+00:48:12,260 --> 00:48:16,560
+about ten centimeters above the mid level of the
+
+610
+00:48:16,560 --> 00:48:21,360
+heart and extends from there to the top of the
+
+611
+00:48:21,360 --> 00:48:26,920
+lung يعني تحت العشرة سانتي تمام بيكون عندى zone
+
+612
+00:48:26,920 --> 00:48:31,720
+three zone two بتبدأ من above the heart levelبعشرة
+
+613
+00:48:31,720 --> 00:48:36,300
+سنتين تمام؟
+
+614
+00:48:36,300 --> 00:48:38,940
+in the lower regions of the lung from about ten
+
+615
+00:48:38,940 --> 00:48:41,620
+centimeters above the level of the heart all the
+
+616
+00:48:41,620 --> 00:48:43,680
+way down to the bottom of the lungs the pulmonary
+
+617
+00:48:43,680 --> 00:48:46,260
+arterial pressure during both systole and diastole
+
+618
+00:48:46,260 --> 00:48:52,360
+remains greater than zero تمام؟ في الحالة هذي
+
+619
+00:48:52,360 --> 00:48:55,100
+بيصير عندى continuous perfusion يعني zone three
+
+620
+00:48:55,100 --> 00:49:02,950
+واضحة ال zones؟ واضحة الفكرة فيها؟ اه؟ طيب تمامطيب
+
+621
+00:49:02,950 --> 00:49:05,450
+وقت إيش بيصير zone one عندى؟ احنا إيش درسناها؟
+
+622
+00:49:05,450 --> 00:49:09,370
+عشانها بتصير under pathological conditions إذا إيش
+
+623
+00:49:09,370 --> 00:49:14,570
+بيتطلب عشان يصير عندى zone one؟ يا إما الضغط ..
+
+624
+00:49:14,570 --> 00:49:21,050
+الضغط تبع ال blood pressure يقل أكتر بحيث ال
+
+625
+00:49:21,050 --> 00:49:27,150
+system يبطل يكفي يا إما ال alveolar pressure بحيث
+
+626
+00:49:27,150 --> 00:49:32,410
+يصير يقاوم ال إيه؟ طيبزن وان بلد فلو وهو بلد فلو
+
+627
+00:49:32,410 --> 00:49:38,350
+في لا وقت لا بلد فلو في اي وقت خلال عمل كاريكسايكل
+
+628
+00:49:38,350 --> 00:49:41,670
+يحدث عندما ايضا البلمونيوسيستوليكي ارتيار براشر
+
+629
+00:49:41,670 --> 00:49:47,810
+مرتفع أو الفيرور براشر مرتفع تمام؟ على سبيل المثال
+
+630
+00:49:47,810 --> 00:49:53,430
+إذا كان شخص مبارك يتخلص من بوزر براشر احنا بنعمله
+
+631
+00:49:53,430 --> 00:49:57,150
+تخلص من ايه؟ في عنده مشكلة في الرئتين عنده
+
+632
+00:49:57,150 --> 00:50:02,220
+انفيزيمةأو bronchial asthma و مدينه مدينه positive
+
+633
+00:50:02,220 --> 00:50:06,460
+pressure ventilation يعني احنا مدينه ضغط فالضغط
+
+634
+00:50:06,460 --> 00:50:10,460
+هذا بيقدر إلى ان ال alveolar pressure بطل zero
+
+635
+00:50:10,460 --> 00:50:16,940
+تمام احنا عندنا مشكلة في ال membranes الاكسجين مش
+
+636
+00:50:16,940 --> 00:50:22,100
+قادر يصل بكمية كافية لمين للدم فمديله positive
+
+637
+00:50:22,100 --> 00:50:25,740
+pressure ventilation positive pressure فبيقدر ال
+
+638
+00:50:25,740 --> 00:50:29,100
+pressure جوا ايه زادالزيادة في ال brusher هذا
+
+639
+00:50:29,100 --> 00:50:32,520
+بتخليلي بعض مناطق ال apical part اذا كان قاعد ا
+
+640
+00:50:32,520 --> 00:50:37,140
+bright انه توصل لإيش لزيادة ال physical يعني هذه
+
+641
+00:50:37,140 --> 00:50:40,420
+during therapy انه انا بزود ال brusher في ال
+
+642
+00:50:40,420 --> 00:50:45,180
+alveoli عشان اوصل oxygen اكتر لمين عشان يزود ال
+
+643
+00:50:45,180 --> 00:50:48,180
+brusher انا انتوا هتشوفوا انه ال brusher brusher
+
+644
+00:50:48,180 --> 00:50:51,220
+تبع ال oxygen و تبع ال carbon dioxide و تبع ال
+
+645
+00:50:51,220 --> 00:50:55,000
+nitrogen بياخد نصيبه من ال brusher حسب ال brusher
+
+646
+00:50:55,000 --> 00:50:58,410
+الكل اللي هو ال atmospheric brusherلما ازود انا ال
+
+647
+00:50:58,410 --> 00:51:00,470
+positive pressure ازود ال atmospheric pressure
+
+648
+00:51:00,470 --> 00:51:05,410
+اللي هو الصناعي اللي انا عامله صار مش ستمية و
+
+649
+00:51:05,410 --> 00:51:09,290
+سبعين مليمتر mercury صار عندى ايه positive
+
+650
+00:51:09,290 --> 00:51:11,970
+pressure انا عامله اكتر من هيك كتير صار partial
+
+651
+00:51:11,970 --> 00:51:16,650
+pressure بتاع الكسجين اعلى فبيقدر الانتقاله الى ال
+
+652
+00:51:16,650 --> 00:51:20,630
+blood اسرع فزي زود ال pressure انا بزود ال في
+
+653
+00:51:20,630 --> 00:51:27,130
+الحالة هذه مشكلة انه صار عندى بعض المنطقةtwo هذه
+
+654
+00:51:27,130 --> 00:51:32,010
+الابيكال تحول إلى zone one أو العكس إذا صار عندك
+
+655
+00:51:32,010 --> 00:51:35,890
+مشكلة في ال blood flow زي ما يحصل في حالات ال
+
+656
+00:51:35,890 --> 00:51:42,690
+hemorrhage وحالات blood pressure أنه يحبط effect
+
+657
+00:51:42,690 --> 00:51:45,710
+of x اه لأ انا اتكمل او حاجة another instance
+
+658
+00:51:45,710 --> 00:51:49,490
+another instance in which zone one blood flow
+
+659
+00:51:49,490 --> 00:51:53,030
+occurs is in an upright person whose blood
+
+660
+00:51:53,030 --> 00:51:57,600
+pressure is exceedingly lowas might occur in
+
+661
+00:51:57,600 --> 00:52:00,840
+severe blood loss اذا .. اذا يا pressure بزيد تبع
+
+662
+00:52:00,840 --> 00:52:05,340
+ال alveoli يا اما ال pressure تبع ال blood بيجل في
+
+663
+00:52:05,340 --> 00:52:08,660
+الحالة هذه ممكن كمان في ال systole مايصيرش فيه
+
+664
+00:52:08,660 --> 00:52:13,740
+flow نتحول ل zone one الان لو صار عندي exercise
+
+665
+00:52:13,740 --> 00:52:20,140
+انا لو صار عندي exercise في ال exercise انا محتاج
+
+666
+00:52:20,140 --> 00:52:25,060
+اكسجين اكتر مش هاي؟ محتاج عشان يصير اكسجين اكتر
+
+667
+00:52:25,600 --> 00:52:31,960
+الدم يخش ال lungs أكتر والهواء يخش ال lungs أكتر
+
+668
+00:52:31,960 --> 00:52:37,960
+مش كده؟ طيب the increase in flow in the top of the
+
+669
+00:52:37,960 --> 00:52:43,520
+lung may be .. اه هذا في عندنا curve هان لأ مش هذا
+
+670
+00:52:43,520 --> 00:52:49,240
+ال curve ال curve اللي هنا هيك وين
+
+671
+00:52:49,240 --> 00:52:54,220
+هو؟ هدول two curves مش عارف إيش أنا أحطه هناطيب
+
+672
+00:52:54,220 --> 00:52:59,780
+إذا هنا عندنا ال under exercise بنطلع بنلاقي أنه
+
+673
+00:52:59,780 --> 00:53:07,860
+ال blood ال perfusion of blood بزيد بزيد ل level
+
+674
+00:53:07,860 --> 00:53:15,180
+عالي كتير تمام؟ هاي ال exercise وهي ال normal at
+
+675
+00:53:15,180 --> 00:53:19,040
+rest هنا ال apical و هنا ال base
+
+676
+00:53:22,280 --> 00:53:29,360
+بنلاحظ في ال apex بتزيد حوالي سبعة تمان أضعف لإنه
+
+677
+00:53:29,360 --> 00:53:35,040
+كمية جليدة وزادة تقول هنا
+
+678
+00:53:35,040 --> 00:53:41,300
+بتزيد من هنا
+
+679
+00:53:41,300 --> 00:53:45,120
+لإنه عالية الكمية كبيرة أساسا في ال base الزيادة
+
+680
+00:53:45,120 --> 00:53:50,900
+هي هي حقيقة زيادة بينال .. ال perfusion قبل و بعد
+
+681
+00:53:50,900 --> 00:53:54,720
+هو هو لكن هنا لأن البداية صغيرة فهنا قولنا سبعمائة
+
+682
+00:53:54,720 --> 00:53:59,000
+لتمانين ضعف في حين أنه هانميجول زرت ضعف فقط يعني
+
+683
+00:53:59,000 --> 00:54:03,400
+ال .. under exercise ال basal perfusion بزيد الضعف
+
+684
+00:54:03,400 --> 00:54:06,420
+لكن .. لأنه أساسا ال blood .. ال perfusion تبعه
+
+685
+00:54:06,420 --> 00:54:09,880
+كويس فلما زاد زاد كمان شوية صارت ضعف لكن ال apical
+
+686
+00:54:09,880 --> 00:54:12,580
+اللي هو كان ال .. ال .. ال perfusion تبعه واطي
+
+687
+00:54:12,580 --> 00:54:18,050
+فلما بزيد بزيدبكمية ايه؟ واضحة لذلك نقول ايه؟
+
+688
+00:54:18,050 --> 00:54:21,710
+سبعمية الى تمانمية في المية يعني سبعة تمان اضعاف
+
+689
+00:54:21,710 --> 00:54:27,810
+زيادة صارت عندى في حالة الايه؟ اذا the increase in
+
+690
+00:54:27,810 --> 00:54:30,470
+flow in the top of the lung may be سبعمية الى
+
+691
+00:54:30,470 --> 00:54:34,590
+تمانمية percent whereas the increase in the lower
+
+692
+00:54:34,590 --> 00:54:39,010
+part من متين الى تلاتمية او اكتر شوية the reason
+
+693
+00:54:39,010 --> 00:54:41,990
+for these differences is that the pulmonary
+
+694
+00:54:41,990 --> 00:54:47,370
+vascular pressureraise enough during exercise to
+
+695
+00:54:47,370 --> 00:54:51,850
+convert the lung apices from zone two to zone
+
+696
+00:54:51,850 --> 00:54:56,890
+three اذا في اندر exercise ال perfusion الزيادة
+
+697
+00:54:56,890 --> 00:55:01,330
+هذا قد إلى ان بجد blood pressure قد إلى ان ال
+
+698
+00:55:01,330 --> 00:55:08,390
+apical area صارت مشاركة دائمة في عملية ال gas
+
+699
+00:55:08,390 --> 00:55:13,620
+transport مش بس أثناء الستول و نص الوقتهو مش نص
+
+700
+00:55:13,620 --> 00:55:16,760
+الوجد ده ال soul أطوى من ال ايه اس ال soul يعني
+
+701
+00:55:16,760 --> 00:55:20,960
+أكتر من نص الوجد نايمة و أجل من نص الوجد بتعمل ايه
+
+702
+00:55:20,960 --> 00:55:26,620
+بتساعد لكن بدون ال exercise ال blood فى داخل
+
+703
+00:55:26,620 --> 00:55:32,900
+الرئتين بزيد عشر أضعاف و ال oxygenation فى داخل
+
+704
+00:55:32,900 --> 00:55:38,920
+الرئتين بزيد عشر أضعاف لاحظوا فى عندي أنا زيادة فى
+
+705
+00:55:38,920 --> 00:55:45,550
+الدم اللى داخل كان كبيروزيادة في ايه؟ في الهوى
+
+706
+00:55:45,550 --> 00:55:49,990
+اللي داخل تمام؟ هنعرف التفاصيل تبعها و احنا ماشيين
+
+707
+00:55:49,990 --> 00:55:54,510
+في الطريق اذا عندي انا في الحالة هالي في ال
+
+708
+00:55:54,510 --> 00:55:59,070
+exercise بيزيد عندي ال efficiency تمامتي ال apical
+
+709
+00:55:59,070 --> 00:56:02,810
+area اتحول من zone two ل ايه؟ ل zone three ليه؟ طب
+
+710
+00:56:02,810 --> 00:56:07,090
+هو ايش بيصير بالظبط أثناء ال exercise أثناء ال
+
+711
+00:56:07,090 --> 00:56:11,090
+exercise ملاحظ انه بعض ال capillaries اللي كانت مش
+
+712
+00:56:11,090 --> 00:56:39,940
+شغالة بتشتغلit will
+
+713
+00:56:39,940 --> 00:56:44,270
+dilate moreزي ان صار عندى زيادة في عدد الكابيلاريز
+
+714
+00:56:44,270 --> 00:56:49,070
+توسع في كل الكابيلاريز تلاتة مع ال exercise كمان
+
+715
+00:56:49,070 --> 00:56:53,970
+ال brochure اللى جاي بزيد اذا فين تلت عوامل بتخلى
+
+716
+00:56:53,970 --> 00:56:59,150
+انه ال perfusion of blood during exercise انه يزيد
+
+717
+00:56:59,150 --> 00:57:06,150
+تلت اضعاف يزيد قداش increasesمن تلاتة من أربعة إلى
+
+718
+00:57:06,150 --> 00:57:09,890
+سبعة أبعاث في مجال مجال مجال مجال مجال مجال مجال
+
+719
+00:57:09,890 --> 00:57:10,930
+مجال مجال مجال مجال مجال مجال مجال مجال مجال مجال
+
+720
+00:57:10,930 --> 00:57:12,210
+مجال مجال مجال مجال مجال مجال مجال مجال مجال مجال
+
+721
+00:57:24,730 --> 00:57:28,930
+sometimes increases تلت أضعاف انه يزيد عدد ال
+
+722
+00:57:28,930 --> 00:57:32,710
+capillaries اللي يفتح بيزيدلي الحجم تبع ال
+
+723
+00:57:32,710 --> 00:57:38,330
+capillaries تلت أضعاف ويزيد عندي مش عدد ال
+
+724
+00:57:38,330 --> 00:57:41,770
+capillaries اللي فتحت حجم كل ال capillaries كمان
+
+725
+00:57:41,770 --> 00:57:46,950
+ضعفين و اللي بيظل عندي خمس أضعاف زيادة و الفرق في
+
+726
+00:57:46,950 --> 00:57:50,050
+ال blood pressure اللي بيزيد بيخليلي سبع أضعاف
+
+727
+00:57:50,050 --> 00:57:56,230
+تقريبا سبع أضعاف زيادة في الفي الـ perfusion in
+
+728
+00:57:56,230 --> 00:57:59,910
+the normal person the first two changes decrease
+
+729
+00:57:59,910 --> 00:58:02,610
+pulmonary vascular resistance لما يزيد عدد ال
+
+730
+00:58:02,610 --> 00:58:06,830
+capillaries ويزيد the lotation of the capillaries
+
+731
+00:58:06,830 --> 00:58:09,910
+the diameter of the capillaries في وضع طبيعي هيقبط
+
+732
+00:58:09,910 --> 00:58:14,950
+الضغط عندى لكن في وضع exercise الضغط بيعلى فاللي
+
+733
+00:58:14,950 --> 00:58:20,030
+نقص الضغط مع زيادة الضغط بيرجع إلى إيه إلى إلى حد
+
+734
+00:58:20,030 --> 00:58:23,940
+ما ضغط طبيعىيعني الـ vasodilatation للـ
+
+735
+00:58:23,940 --> 00:58:26,600
+capillaries و ال increase of number of dilated
+
+736
+00:58:26,600 --> 00:58:29,800
+capillaries يعني بيهدى الضغط لإنه صار عندى المساحة
+
+737
+00:58:29,800 --> 00:58:33,280
+اللى لدى الدم اكتر من ايه اكتر من اول فمعناها
+
+738
+00:58:33,280 --> 00:58:37,980
+الضغط ايه يعني ال resistance جل لإنه صار ال ال ال
+
+739
+00:58:37,980 --> 00:58:43,560
+ال ال ال ال ال ال space لل blood هذا اللى موجود
+
+740
+00:58:43,560 --> 00:58:47,840
+فيه واسع ف resistance جلت فبهبط الضغط لكن وقتش هذا
+
+741
+00:58:47,840 --> 00:58:51,400
+بيجل في الوقت اللى عندى زاد الضغط alreadyالـ
+
+742
+00:58:51,400 --> 00:58:54,700
+cardiac output بيزيد في ال exercise ال heart rate
+
+743
+00:58:54,700 --> 00:58:57,500
+بيزيد و ال stroke volume بيزيد ال cardiac output
+
+744
+00:58:57,500 --> 00:59:03,200
+بيزيد تمام فبيقدر إلى أنه يرجع الضغط إلى حد ما زي
+
+745
+00:59:03,200 --> 00:59:08,760
+أول و أعلى شوية الأعلى شوية بتخلي عندي انا ايه انه
+
+746
+00:59:08,760 --> 00:59:15,300
+مش بس رجعت الضغط لوضعه كمان بيديني more perfusion
+
+747
+00:59:15,300 --> 00:59:21,270
+أسرع من أول كمان طيب اذا عندها زادعملت exercise
+
+748
+00:59:21,270 --> 00:59:28,130
+زودتلي blood flow
+
+749
+00:59:28,130 --> 00:59:36,210
+الى سبع أضعاف نظرنا
+
+750
+00:59:36,210 --> 00:59:40,490
+الى ال curve المرحلة هادة هلاحظ انه و لو انه صار
+
+751
+00:59:40,490 --> 00:59:44,760
+عندى زيادة في ال curve outputduring exercise
+
+752
+00:59:44,760 --> 00:59:47,940
+كبيرة، اربعة، تمانية، اتنين، اتنين، اتنين، اتنين،
+
+753
+00:59:47,940 --> 00:59:48,920
+اتنين، اتنين، اتنين، اتنين، اتنين، اتنين، اتنين،
+
+754
+00:59:48,920 --> 00:59:50,340
+اتنين، اتنين، اتنين، اتنين، اتنين، اتنين، اتنين،
+
+755
+00:59:50,340 --> 00:59:52,100
+اتنين، اتنين، اتنين، اتنين، اتنين، اتنين، اتنين،
+
+756
+00:59:52,100 --> 00:59:55,260
+اتنين،
+
+757
+00:59:55,260 --> 01:00:01,640
+اتنين، اتنين، اتنين، اتنين، اتنين، اتنين، اتنين،
+
+758
+01:00:01,640 --> 01:00:03,140
+اتنين، اتنين، اتنين، اتنين، اتنين، اتنين، اتنين،
+
+759
+01:00:03,140 --> 01:00:10,780
+اتنين، اتنينالـ A الـ capillary number of open
+
+760
+01:00:10,780 --> 01:00:13,100
+capillaries وبيزيد عند ال diameter of the A the
+
+761
+01:00:13,100 --> 01:00:17,800
+whole capillaries طيب هنا بيقدّي .. بيقدّي إلى
+
+762
+01:00:17,800 --> 01:00:20,980
+إيش؟
+
+763
+01:00:20,980 --> 01:00:27,000
+بيقدّي إلى إنه the ability of the lungs to
+
+764
+01:00:27,000 --> 01:00:31,000
+accommodate greatly increased blood flow during
+
+765
+01:00:31,000 --> 01:00:34,140
+exercise without increasing pulmonary arterial
+
+766
+01:00:34,140 --> 01:00:39,920
+pressureconserve هذا بيقدر إلى انه الضغط ماعليش
+
+767
+01:00:39,920 --> 01:00:44,260
+فانا ب .. اريح الجلب ال right side ده اللي بضخ
+
+768
+01:00:44,260 --> 01:00:49,720
+against pressure و لو انه زاد ال blood flow اللي
+
+769
+01:00:49,720 --> 01:00:54,700
+انه ال heart إلى حد ما اللي جا ال pressure اللي
+
+770
+01:00:54,700 --> 01:00:59,680
+أمامه ماتغيرش فبصير بشتغل ايه with less energy
+
+771
+01:00:59,680 --> 01:01:06,500
+than expected تمام؟ اتنينهذا بيقدّي .. also
+
+772
+01:01:06,500 --> 01:01:08,820
+prevents a significant rise in pulmonary capillary
+
+773
+01:01:08,820 --> 01:01:13,640
+pressure يعني ال capillary pressure لما وطي بسبب
+
+774
+01:01:13,640 --> 01:01:17,420
+ال vasodilation was increased number قد انه ريح ال
+
+775
+01:01:17,420 --> 01:01:21,340
+right side of the heart لإنه beating against
+
+776
+01:01:21,340 --> 01:01:25,520
+normal pressure اتنين ماحللش ال pressure في ال
+
+777
+01:01:25,520 --> 01:01:30,040
+lungs بشكل يعملي مشكلة ارتفاع الضغط انه ممكن يعملي
+
+778
+01:01:30,040 --> 01:01:36,300
+edema of the lungs تمام؟ممكن اعمل edema of the
+
+779
+01:01:36,300 --> 01:01:40,540
+lungs طبعا اذا عالي الضغط كتير ممكن نكمل نعمل
+
+780
+01:01:40,540 --> 01:01:44,600
+right side heart failure يعني مشكلة ذلك الضغط إلى
+
+781
+01:01:44,600 --> 01:01:49,650
+حد ما شغلت الال .. ال .. ال .. ال .. ال .. ال ..
+
+782
+01:01:49,650 --> 01:01:49,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+783
+01:01:49,670 --> 01:01:49,790
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+784
+01:01:49,790 --> 01:01:50,450
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+785
+01:01:50,450 --> 01:01:50,910
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+786
+01:01:50,910 --> 01:01:51,550
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+787
+01:01:51,550 --> 01:01:54,530
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+788
+01:01:54,530 --> 01:02:00,710
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+789
+01:02:00,710 --> 01:02:00,990
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+790
+01:02:00,990 --> 01:02:01,050
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+791
+01:02:01,050 --> 01:02:01,050
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+792
+01:02:01,050 --> 01:02:02,950
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+793
+01:02:02,950 --> 01:02:02,950
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+794
+01:02:02,950 --> 01:02:07,550
+ال .. ال ..
+
+795
+01:02:07,550 --> 01:02:14,570
+ال .. ال ..
+
+796
+01:02:14,810 --> 01:02:18,430
+level معين قدرة ال reabsorption باللمفاتيكس بتكون
+
+797
+01:02:18,430 --> 01:02:24,090
+ايه اجل مش متخطاها مانا بنعمل ايش بالمونري اديمة
+
+798
+01:02:24,090 --> 01:02:26,710
+بالاضافة للضغط العالي مش بس بيعمل ال بالمونري
+
+799
+01:02:26,710 --> 01:02:30,010
+اديمة و لو طول ممكن تدخلني في ايه في right side
+
+800
+01:02:30,010 --> 01:02:34,750
+هال failure إذا الرجال مرتاح بخشش في failure لإنه
+
+801
+01:02:34,750 --> 01:02:38,150
+الضغط ماعليش هو ده شغال كويس و الاديمة مش موجودة
+
+802
+01:02:38,150 --> 01:02:40,510
+function of the
+
+803
+01:02:44,950 --> 01:02:49,270
+circulation when the left atrial pressure rises as
+
+804
+01:02:49,270 --> 01:02:51,030
+a result of left sided heart failure دخلنا في left
+
+805
+01:02:51,030 --> 01:02:54,790
+sided heart failure الان ايش كيف هيعكس هذا على مين
+
+806
+01:02:54,790 --> 01:03:02,430
+على ال lungs تمام ايش كيف هيعكس على ال lungs و هان
+
+807
+01:03:02,430 --> 01:03:07,430
+حقيقة منشوف احنا العظمة اللي من خلالها هذه ال
+
+808
+01:03:07,430 --> 01:03:12,600
+lungs كيف مبنية واضح هنشوفال .. ال .. ال lift
+
+809
+01:03:12,600 --> 01:03:16,580
+atrium في العهد اقولنا اضطغط تبعه و احد اتنين من
+
+810
+01:03:16,580 --> 01:03:21,280
+عيلي في اخر مرة احنا بيصل ايه لخمسة تمام؟ بيزرش عن
+
+811
+01:03:21,280 --> 01:03:28,580
+ستة يعني مش كده even during the most strenuous
+
+812
+01:03:28,580 --> 01:03:30,980
+exercise بيزرش .. بيزرش ال lift .. ايه ال atrium
+
+813
+01:03:30,980 --> 01:03:39,440
+البراشر عن مين؟ عن ستة ال changes هذهفي العادة
+
+814
+01:03:39,440 --> 01:03:42,220
+بتنعكس على ال .. على ال capillaries و بتعملش اي
+
+815
+01:03:42,220 --> 01:03:46,660
+مشاكل يعني لما الستة لستة عندها under exercise
+
+816
+01:03:46,660 --> 01:03:50,260
+الجهة التانية بتصل ل تمانية، تسعة، عشر، في فرج
+
+817
+01:03:50,260 --> 01:03:54,480
+اتنين بينهم تقريبا بين ال atrial و ال capillary في
+
+818
+01:03:54,480 --> 01:03:57,460
+فرج اتنين millimeter مركز عشان الدم يظل منخفض هذه
+
+819
+01:03:57,460 --> 01:04:00,140
+الستة بتصل ل تمانية مش هيعمللي إشكالي كبير
+
+820
+01:04:03,210 --> 01:04:06,230
+ولش؟ these small changes in left atrial pressure
+
+821
+01:04:06,230 --> 01:04:09,150
+have virtually no effect on pulmonary circulation
+
+822
+01:04:09,150 --> 01:04:13,110
+because this merely expands pulmonary venules بس
+
+823
+01:04:13,110 --> 01:04:16,690
+فتح لإيه؟ اللي كانوا مساكرين فماعلش الضغط بشكل
+
+824
+01:04:16,690 --> 01:04:20,910
+إيه؟ واضح فتح more venules و dilated ال venules زي
+
+825
+01:04:20,910 --> 01:04:24,290
+ما الكلام بتاوي so that the blood continues to
+
+826
+01:04:24,290 --> 01:04:28,670
+flow with almost equal easefrom the pulmonary
+
+827
+01:04:28,670 --> 01:04:33,010
+arteries بيبقى مدفع when the left side of the
+
+828
+01:04:33,010 --> 01:04:37,070
+heart fails هان الإشكال اللي بنتكلم عنه however
+
+829
+01:04:37,070 --> 01:04:42,570
+blood begins to dam up كأنه عامل سد اتجمع وراها
+
+830
+01:04:42,570 --> 01:04:47,290
+السد هذا as a result is a failure عندنا في ال left
+
+831
+01:04:47,290 --> 01:04:51,270
+atrium اذا بطل ال left atrium يدفع الجزء الأخير من
+
+832
+01:04:51,270 --> 01:04:55,240
+الدماللي بيساعد على انه يتخلص وبيظل الجزء الأخر
+
+833
+01:04:55,240 --> 01:04:59,580
+موجود في ال .. في ال atrium يعني معيق لإن تجمع
+
+834
+01:04:59,580 --> 01:05:02,820
+الدم الزيادة من ال .. ما هو during ال systole
+
+835
+01:05:02,820 --> 01:05:08,240
+تمام؟ ال atrium بيفتح وبيظل يتجمع الدم لحد ما ال
+
+836
+01:05:08,240 --> 01:05:11,020
+.. ال .. ال .. ال .. نخش في ال ventricle systole
+
+837
+01:05:11,020 --> 01:05:16,770
+فبندفع المتجمع، الآن صار failure عندىبطل الـ
+
+838
+01:05:16,770 --> 01:05:21,670
+atrium يدفع كما يجب صار يتحوش الدم ورا ال lift
+
+839
+01:05:21,670 --> 01:05:25,550
+atrium as a result of the lift atrium pressure can
+
+840
+01:05:25,550 --> 01:05:30,270
+rise on occasion from its normal value واحد إلى
+
+841
+01:05:30,270 --> 01:05:35,130
+خمسة all the way up to forty to fifty millimeter
+
+842
+01:05:35,130 --> 01:05:40,670
+mercury ممكن يظل يعلى يعلى يعلى مراحل لإيه؟ طبعا
+
+843
+01:05:40,670 --> 01:05:46,170
+مراحل ل fifty هذه هتخش في مشاكل كبيرة لكنهنلاحظ
+
+844
+01:05:46,170 --> 01:05:55,030
+كيف ان الجسم بيتخطاها بيتخطاها مع الوقت اذا احنا
+
+845
+01:05:55,030 --> 01:05:59,070
+دخلنا مشكلة زي كده ارتفعت ضغط تبع الathium ل 40 ل
+
+846
+01:05:59,070 --> 01:06:05,710
+50 as acute sudden event هيعملنا مشاكل كبيرة لكن
+
+847
+01:06:05,710 --> 01:06:11,030
+لو اقدرنا نتعدى ال acute event هذاتمام؟ وإن دلنا
+
+848
+01:06:11,030 --> 01:06:13,370
+نعمل support للبني آدم هذا وضل الضغط عالي من
+
+849
+01:06:13,370 --> 01:06:16,430
+أربعين لخمسين هنلاقي صار يعدي من غير أي مشاكل
+
+850
+01:06:16,430 --> 01:06:22,050
+كبيرة هنتكلم عنها بالتفصيل إذا المرحلة الأولى لو
+
+851
+01:06:22,050 --> 01:06:28,070
+زاد ال .. ال .. ال arterial pressure لسبعة ونلاقي
+
+852
+01:06:28,070 --> 01:06:33,610
+مالوش أي effect تمام؟ طيب when the lift atrial
+
+853
+01:06:33,610 --> 01:06:37,920
+pressure rises greater than sevenهنلاحظ انه صار
+
+854
+01:06:37,920 --> 01:06:41,960
+عندي انا ايه above the levels cause almost equally
+
+855
+01:06:41,960 --> 01:06:46,600
+great increases in the pulmonary arterial pressure
+
+856
+01:06:46,600 --> 01:06:50,420
+زاد سبعة فوق السبعة تمانية زاد تلتة اربعة مالنا
+
+857
+01:06:50,420 --> 01:06:55,360
+محتاجين ضغط اعلى شوية تلتة اربعة زاد خمسة عايزين
+
+858
+01:06:55,360 --> 01:07:00,060
+اعلى تلتة خمسة لكن لو .. اذا في زيادة مساحبة
+
+859
+01:07:00,060 --> 01:07:04,720
+مساوية في الايه في ال .. اذا صار ان عندي انا الضغط
+
+860
+01:07:04,720 --> 01:07:08,820
+ينتقلمن الـ left atrium إلى الـ capillaries و
+
+861
+01:07:08,820 --> 01:07:12,500
+الcirculation و يصير عبق جديد عمين على ال right
+
+862
+01:07:12,500 --> 01:07:16,220
+side لأنه الضغط عليه ال right side بيشغل against
+
+863
+01:07:16,220 --> 01:07:21,480
+higher pressure محتاج أنه يضغط ضد الضغط بيصير عنده
+
+864
+01:07:21,480 --> 01:07:27,680
+جهود أكبر thus causing a concomitant increased
+
+865
+01:07:27,680 --> 01:07:30,940
+load on the right heart تمام؟ إذا العبق على ال
+
+866
+01:07:30,940 --> 01:07:35,330
+right heartلكن when the left atrial pressure has
+
+867
+01:07:35,330 --> 01:07:41,310
+risen above thirty بلي متر مركوري causing similar
+
+868
+01:07:41,310 --> 01:07:42,810
+increases in capillary pressure
+
+869
+01:07:52,170 --> 01:07:57,630
+إذا زاد الـ arterial pressure فوق التلاتين هو في
+
+870
+01:07:57,630 --> 01:08:01,370
+العادة بزيش فوق الخمسة إذا زاد للسبعة في أي مشاكل
+
+871
+01:08:01,370 --> 01:08:06,570
+إذا من التمانية للتلاتين هنلاقي إن صار عندي blood
+
+872
+01:08:06,570 --> 01:08:10,570
+pressure بالفعل زاد ال right-sided البلمونري
+
+873
+01:08:10,570 --> 01:08:14,810
+arterial pressure زاد وهنا هنعكس على إن ال heart
+
+874
+01:08:14,810 --> 01:08:18,490
+بدأ يصير عليه load أكتر ال right-side لإنه صار يضخ
+
+875
+01:08:18,490 --> 01:08:22,460
+against higher pressureانزلت عن التلاتين حلق بلمون
+
+876
+01:08:22,460 --> 01:08:28,340
+القديمة صارت تتكون لإنه صار عندى ال brochure عليه
+
+877
+01:08:28,340 --> 01:08:31,640
+لدرجة ان ال filtration اللى بتتم جلبت المعادلة
+
+878
+01:08:31,640 --> 01:08:35,360
+تبعت ال equilibrium تبع ال ال interstitial fluid
+
+879
+01:08:35,360 --> 01:08:39,220
+كنا في equilibrium اللى بطلع بنشفط لكن لعبارة
+
+880
+01:08:39,220 --> 01:08:43,460
+التلاتين لازم يظل بقايا fluid اللى بيظل فى ال
+
+881
+01:08:43,460 --> 01:08:48,440
+interstitial space هيصبح لمين للalveoli للalveolar
+
+882
+01:08:48,440 --> 01:08:52,610
+spaceو هتبتعملي بالمونري قديمة بحيث أنه ال alveoli
+
+883
+01:08:52,610 --> 01:08:58,450
+تبدأ إيه؟ الطف فيها ال .. خليني نجف لحد هنا عشان
+
+884
+01:08:58,450 --> 01:09:01,850
+إيه؟ ال بالمونري capillary dynamics إنه نحسب
+
+885
+01:09:01,850 --> 01:09:06,670
+بالظبط ال brushes هذه الموجودة في الطبيعي كيف مش
+
+886
+01:09:06,670 --> 01:09:10,790
+عاملة قديمة و كوكتيش بتعمل قديمة ان شاء الله المرة
+
+887
+01:09:10,790 --> 01:09:14,590
+اللي جاية بإذن الله تعالى يعطيكوا العافية بنات،
+
+888
+01:09:14,590 --> 01:09:15,390
+مين هي السؤال؟
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I.srt
new file mode 100644
index 0000000000000000000000000000000000000000..da8ac6171555be9cdecf66671dd51826dfb9b3ef
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I.srt
@@ -0,0 +1,2535 @@
+1
+00:00:05,380 --> 00:00:08,840
+بنرجع ثانية إن الكلية هذه اللي اتكلمنا عنها عملت
+
+2
+00:00:08,840 --> 00:00:12,640
+ball تتكون الـ ball ويركز الـ ball ويتخفف الـ ball
+
+3
+00:00:12,640 --> 00:00:18,180
+ونعرف بالضبط إيش عملت هي الآن، الـ ball الآن هذا
+
+4
+00:00:18,180 --> 00:00:24,720
+اللي طالع من الـ collecting duct نزل إلى الـ renal
+
+5
+00:00:24,720 --> 00:00:29,600
+pelvis، إلى الـ kidney pelvis إلى الـ ureter إلى الـ
+
+6
+00:00:29,600 --> 00:00:34,300
+bladder، الرحلة هذه كلها ما يتغيرش في تركيبها، يعني خلاص
+
+7
+00:00:34,300 --> 00:00:41,620
+التغييرات اللي بتصير لحد الـ collecting duct لحد ما
+
+8
+00:00:41,620 --> 00:00:47,520
+يِطلع  إلينا من الـ papilla، التركيب ما بيتغيرش أو بيصير
+
+9
+00:00:47,520 --> 00:00:51,160
+minimal changes، يعني أحياناً بيصير absorption of
+
+10
+00:00:51,160 --> 00:00:54,900
+water، في حالات ما يكون فيه عندنا obstruction أو كده
+
+11
+00:00:54,900 --> 00:00:59,260
+بتصير نوع من التبديل والتغيير لكنه في الوضع
+
+12
+00:00:59,260 --> 00:01:06,830
+الطبيعي ما بيصيرش، هذه واحدة، إحنا هنا نتعامل أهل
+
+13
+00:01:06,830 --> 00:01:13,610
+مع الـ excretory part of the إيه؟ of the job تبع الـ
+
+14
+00:01:13,610 --> 00:01:17,970
+urine، عمليه إحنا صنعناها تمام، بس بيبقى نوصله إلى
+
+15
+00:01:17,970 --> 00:01:23,190
+السوق المحلية تبعته وهي إلى إيه؟ الـ ureter وإلى الـ
+
+16
+00:01:23,190 --> 00:01:27,270
+bladder وإلى الـ urethra إلى الخارج تمام؟ لأن فيه
+
+17
+00:01:27,270 --> 00:01:33,910
+عندنا system، الـ system هذا في الـ ureter، ureter
+
+18
+00:01:33,910 --> 00:01:42,490
+عبارة عن tubular hollow viscus زي الـ ... الـ
+
+19
+00:01:42,490 --> 00:01:49,850
+intestine، زي إيش؟ الـ intestine زي الـ ... الـ أشياء
+
+20
+00:01:49,850 --> 00:01:54,170
+الكتيرة tubular زي كده في الجسم فيهم نفس النظام، شو
+
+21
+00:01:54,170 --> 00:01:58,190
+نظام هذا؟ يعني فيه عندهم داخلياً حاجة بيسموها basic
+
+22
+00:01:58,190 --> 00:02:02,050
+maker، هندرسها بالتفصيل إن شاء الله لما ندرس الـ GIT
+
+23
+00:02:02,050 --> 00:02:08,110
+فيه عندهم حاجة اسمها slow waves، هنا موجود نفس
+
+24
+00:02:08,110 --> 00:02:15,410
+النظام، موجود myenteric plexus في الـ ... في الـ ... الـ
+
+25
+00:02:15,410 --> 00:02:21,710
+GIT، هنا موجود myenteric plexus network من الأعصاب الداخلية
+
+26
+00:02:21,710 --> 00:02:27,570
+اللي هي بتعمل عملية الـ peristalsis، طبعاً عملية إيه؟
+
+27
+00:02:27,570 --> 00:02:31,630
+الحركة الدودية، لأن البول لا ينتقل من عند الـ
+
+28
+00:02:31,630 --> 00:02:35,630
+collecting duct، يعني من الـ minor calyx اللي هو كل
+
+29
+00:02:35,630 --> 00:02:40,010
+collecting duct بتنتهي في minor calyx، مش كده؟
+
+30
+00:02:40,010 --> 00:02:47,330
+collecting duct فيها كم ... كم ... كم ...
+
+31
+00:02:47,330 --> 00:02:51,690
+collecting duct بتصب في الـ minor calyx، 250
+
+32
+00:02:53,150 --> 00:02:57,510
+مش كده؟ آه، 250، فعندي كل 250 فيه اللي هو minor
+
+33
+00:02:57,510 --> 00:03:03,130
+calyx، الـ minor calyx هذا لما يسلم الـ drop of urine
+
+34
+00:03:03,130 --> 00:03:07,950
+الطالعة هذه بتنتقل منه إلى الـ bladder عن طريق الـ
+
+35
+00:03:07,950 --> 00:03:12,310
+peristalsis، ما بتنزلش by gravity أو by weight تمام؟
+
+36
+00:03:12,310 --> 00:03:15,530
+إذًا فيه عندي حركة دودية بتبدأ من هنا من الـ minor
+
+37
+00:03:15,530 --> 00:03:21,150
+calyx إلى الـ bladder، الحركة الدودية هذه تعتمد في
+
+38
+00:03:21,150 --> 00:03:25,530
+وجودها على مين؟ على الـ intrinsic plexus الموجودة
+
+39
+00:03:25,530 --> 00:03:30,070
+الـ ... الـ nerve plexus، الـ nerve network، شبكة
+
+40
+00:03:30,070 --> 00:03:34,730
+العصبية اللي موجودة في داخل الـ ureter، هذه الشبكة
+
+41
+00:03:34,730 --> 00:03:40,650
+هي اللي بتعمل ترتيب الـ ... الحركة الدودية هذه
+
+42
+00:03:40,650 --> 00:03:45,480
+بالإضافة لها أعصاب الـ parasympathetic من autonomic
+
+43
+00:03:45,480 --> 00:03:50,820
+nervous system، بيزيد حركتها، ويضاف إليها أعصاب
+
+44
+00:03:50,820 --> 00:03:54,920
+sympathetic بتقلل حركتها، إذًا فيه عندي شبكة ممكن
+
+45
+00:03:54,920 --> 00:03:59,780
+تزيد حركتها أو تقلل حركتها تمام، حسب الـ autonomic
+
+46
+00:03:59,780 --> 00:04:02,500
+nervous system، هذا أنتم درستوا الـ autonomic
+
+47
+00:04:02,500 --> 00:04:06,240
+nervous system؟ قولوا إنها فيه جزئين وكل جزء مختلف
+
+48
+00:04:06,240 --> 00:04:10,970
+عن الثاني، اللي هنا بالذات اللي بيتحكم في الحركة الـ
+
+49
+00:04:10,970 --> 00:04:15,390
+parasympathetic system، والـ parasympathetic system
+
+50
+00:04:15,390 --> 00:04:19,830
+هذا أنتم عارفين الـ sympathetic عن الـ
+
+51
+00:04:19,830 --> 00:04:23,210
+parasympathetic بيختلف في بعض المواصفات منها الـ
+
+52
+00:04:23,210 --> 00:04:26,570
+ganglia تبعه وين؟ أو منها الـ preganglionic
+
+53
+00:04:26,570 --> 00:04:30,650
+nerve fibers وين؟ أو جدّيش دائماً الـ parasympathetic
+
+54
+00:04:31,490 --> 00:04:35,390
+الـ ganglia بتبعها بيكون يا إما في الـ viscus نفسه يا
+
+55
+00:04:35,390 --> 00:04:39,090
+إما close to it يا إما في نفس الـ wall يا إما قريب
+
+56
+00:04:39,090 --> 00:04:42,430
+منها، وهنا الـ ganglia تبع الـ sympathetic اللي هي
+
+57
+00:04:42,430 --> 00:04:46,830
+بتتحكم في الـ ureters أو بتزيد الحركة الدودية تبع الـ
+
+58
+00:04:46,830 --> 00:04:52,170
+ureters، موجودة inside the إيه؟ the ureteric tissues
+
+59
+00:04:52,170 --> 00:04:55,850
+تمام؟ والـ preganglionic fibers كده very short
+
+60
+00:04:55,850 --> 00:04:59,410
+preganglionic fibers، مش كده؟ موجودين في الداخل
+
+61
+00:04:59,410 --> 00:05:06,530
+أو هم شبكة حقيقية من ضمن الـ ... الـ ... الـ intrinsic nerve
+
+62
+00:05:10,900 --> 00:05:13,880
+قلنا حاجة ثانية في الـ basic maker ما كملناش الكلام
+
+63
+00:05:13,880 --> 00:05:18,900
+عنها، هذول الـ hollow viscus organs أو الـ tubular
+
+64
+00:05:18,900 --> 00:05:21,980
+organs اللي فيهم peristaltic movement بيكون عندهم
+
+65
+00:05:21,980 --> 00:05:29,560
+فيه حركة، حركة تغيير في الأيونات زي الـ basic maker
+
+66
+00:05:29,560 --> 00:05:33,900
+لكن
+
+67
+00:05:33,900 --> 00:05:43,200
+هذه الحركة الأيونية بتعمل تغيير في الـ ... الـ ... الـ
+
+68
+00:05:43,200 --> 00:05:45,500
+resting membrane potential، بتعرفوا resting
+
+69
+00:05:45,500 --> 00:05:48,060
+membrane potential، مش كده؟ الـ resting membrane
+
+70
+00:05:48,060 --> 00:05:52,180
+potential هذا بيظل يتغير، يعمل depolarization و
+
+71
+00:05:52,180 --> 00:05:54,580
+repolarization، depolarization و repolarization
+
+72
+00:05:54,580 --> 00:06:00,600
+بشكل تلقائي بس مش بشكل يوصله إلى الـ action potential
+
+73
+00:06:00,600 --> 00:06:05,920
+لـ actual contraction، لكن فيه عندنا إيه؟ تغيرات
+
+74
+00:06:05,920 --> 00:06:11,480
+متواصلة، هنا بسميها intrinsic slow pace maker
+
+75
+00:06:11,480 --> 00:06:19,440
+activities، وهنا بسميها slow waves في الـ GIT، هذول الـ
+
+76
+00:06:19,440 --> 00:06:24,220
+slow waves هذول أو الـ changes اللي بيصير على الـ
+
+77
+00:06:24,220 --> 00:06:28,580
+resting membrane potential، هذول جاهزين إنه إذا اجى
+
+78
+00:06:28,580 --> 00:06:32,460
+initiation، stretch، drop of urine كده بيعملهم
+
+79
+00:06:32,460 --> 00:06:38,880
+potentiation، تقوية وبيصير عندي الـ pace maker هذا
+
+80
+00:06:38,880 --> 00:06:41,140
+strong enough to make peristaltic movement
+
+81
+00:06:41,140 --> 00:06:44,980
+contractions، تمام؟ إذًا فيه عندنا موجود فيهم
+
+82
+00:06:47,530 --> 00:06:51,730
+Intrinsic Pacemaker Properties، Pacemaker عارفين
+
+83
+00:06:51,730 --> 00:06:55,170
+إيش يعني Pacemaker؟ أنتم ما درستوش، اللي هندرسه الـ
+
+84
+00:06:55,170 --> 00:06:58,990
+Pacemaker بشكل رئيسي، حاجة ثانية اللي هندرسه الـ
+
+85
+00:06:58,990 --> 00:07:04,410
+heart، عشان إيه؟ الـ SA node كيف إنها هي اللي بتقود
+
+86
+00:07:04,410 --> 00:07:13,390
+حركة انقباضات القلب، إذًا اليوم إحنا هنتكلم عن عملية
+
+87
+00:07:15,560 --> 00:07:22,040
+الـ micturition فيها
+
+88
+00:07:22,040 --> 00:07:26,580
+الـ
+
+89
+00:07:26,580 --> 00:07:36,060
+urine بينتقل من الـ kidney pelvis إلى الـ bladder عن
+
+90
+00:07:36,060 --> 00:07:41,160
+طريق الـ peristalsis، الواحد لو كان رأسه تحت ورجليه
+
+91
+00:07:41,160 --> 00:07:45,630
+فوق برضه الـ urine كان go from the kidney to the
+
+92
+00:07:45,630 --> 00:07:50,790
+bladder، مش كده؟ يعني مش بس بالـ gravity، طبعاً وجود الـ
+
+93
+00:07:50,790 --> 00:07:55,090
+gravity بيساعد لكن مش هي الإيه؟ الأساس زي ما هنتكلم
+
+94
+00:07:55,090 --> 00:07:59,210
+في البلع في الـ oesophagus في الـ GIT، وجود الـ
+
+95
+00:07:59,210 --> 00:08:04,430
+gravity بيساعد لكن هذا مش هو الإيه؟ الأساس، الـ
+
+96
+00:08:04,430 --> 00:08:11,050
+bladder، الـ ureter هذا لما يصل لـ bladder فيه بعض
+
+97
+00:08:11,050 --> 00:08:19,660
+المواصفات، الهدف من هذه المواصفات إن الـ bladder بتجمع
+
+98
+00:08:19,660 --> 00:08:26,060
+بول، وبتجمع بول، وبتجمع بول بيزيد الضغط فيها، طب
+
+99
+00:08:26,060 --> 00:08:30,100
+ممكن يرجع، يعني في أنبوبة واصله ممكن يرجع البول إلى
+
+100
+00:08:30,100 --> 00:08:35,320
+الـ ... الـ ureter، في الطبيعي ما بيصيرش بس أحياناً
+
+101
+00:08:35,320 --> 00:08:40,160
+بنلاحظها، vesicoureteral reflux، أحياناً بنلاحظها
+
+102
+00:08:40,960 --> 00:08:44,700
+مشكلة عند بعض الناس، مشكلة كبيرة، بتسبب عملية أو كده
+
+103
+00:08:44,700 --> 00:08:50,240
+لكن هذه المسألة في الطبيعي مش موجودة، يعني فيه عندي
+
+104
+00:08:50,240 --> 00:08:56,260
+sphincter-like action أو valve-like action هنا
+
+105
+00:08:56,260 --> 00:09:01,110
+بتقدر على إنه إيه؟ البول لما يجيبك في الـ bladder و
+
+106
+00:09:01,110 --> 00:09:04,590
+يزيد الضغط فيه ما يرجعش، ما بتعرفوا الفرق أنتم بين
+
+107
+00:09:04,590 --> 00:09:10,850
+الـ sphincter والـ valve؟ ما بتعرفوش، الـ sphincter
+
+108
+00:09:10,850 --> 00:09:19,990
+muscle، بتكون strengthened، thickened و getting stronger
+
+109
+00:09:19,990 --> 00:09:24,050
+than the usual، يعني دائماً عندها في المنطقة العضلة
+
+110
+00:09:24,050 --> 00:09:27,430
+تبع الـ hollow organ هذه في المنطقة هذه بيلاقي الـ
+
+111
+00:09:27,430 --> 00:09:34,450
+circular muscle thickened تمام، بحيث إنها إيه؟ اتعمل sphincter
+
+112
+00:09:34,450 --> 00:09:41,870
+حقيقي، حقيقة، مش موجود التشكيل هذه، لكن الـ bladder wall
+
+113
+00:09:41,870 --> 00:09:50,090
+نفسه عضلات، ففي المنطقة هذه عاملة contraction، يعني
+
+114
+00:09:50,090 --> 00:09:53,330
+عاملة sphincter، الـ sphincter action هي تبعنا جاي من الـ
+
+115
+00:09:53,330 --> 00:09:57,150
+bladder wall، بمعنى إن العضلات تبع الـ bladder هي اللي
+
+116
+00:09:57,150 --> 00:10:02,590
+بتشد على مين؟ على الـ ... على الـ ureter، مش كده؟ هو بس
+
+117
+00:10:02,590 --> 00:10:07,950
+الـ ureter مش داخل الـ bladder كده، لأ، داخل الـ bladder بيخش
+
+118
+00:10:07,950 --> 00:10:11,730
+obliquely في الـ ... الـ ... الـ ... في الـ bladder muscles
+
+119
+00:10:11,730 --> 00:10:15,090
+بيخش فيها obliquely بحيث إنه يبقى كمية كبيرة من
+
+120
+00:10:15,090 --> 00:10:19,530
+العضلات محيطة بيه تمام؟ بعد ما يبقى oblique ويطلع
+
+121
+00:10:19,530 --> 00:10:25,240
+كمان بيخش obliquely تحت الميوكوزا، طبعاً إذًا لما بينطلق الـ
+
+122
+00:10:25,240 --> 00:10:30,680
+bladder هذه بيخش تحتها obliquely، إذًا لما بينطلق الـ
+
+123
+00:10:30,680 --> 00:10:34,540
+bladder وبيزيد الضغط فيها، الضغط هم بيضغطوا عليهم
+
+124
+00:10:34,540 --> 00:10:37,920
+الـ ureter تحت الميوكوزا، بيسكروا هذا الـ valve-like
+
+125
+00:10:37,920 --> 00:10:42,360
+action، الـ valve-like action، إنه فيه عندنا شفرات أو
+
+126
+00:10:42,360 --> 00:10:45,640
+شفاه خارجية عن الـ ... هذه لما يزيد الضغط وتحيه
+
+127
+00:10:45,640 --> 00:10:51,420
+بتسُكر في الـ ureterovesical junction تبع الـ ... أنا ممكن
+
+128
+00:10:51,420 --> 00:10:57,620
+أوريكم يعني، الـ ureterovesical junction تبع الـ ileum
+
+129
+00:10:57,620 --> 00:11:03,860
+الـ intestine، الأمعاء الدقيقة لما نخش في الـ caecum تمام
+
+130
+00:11:03,860 --> 00:11:08,740
+نخش في الـ caecum بيعمل هيك، بتلاقي شفاه برا هذه
+
+131
+00:11:08,740 --> 00:11:13,040
+المنطقة، sphincter، لكن هذه المنطقة valve، فلما
+
+132
+00:11:13,040 --> 00:11:16,340
+الـ caecum بيعمل contraction، هذا الناس بيطبقوا مع بعض
+
+133
+00:11:16,340 --> 00:11:22,130
+ويمنعوا إن إيه؟ لكن الـ valve بيبقى مسكر في وقت ما
+
+134
+00:11:22,130 --> 00:11:27,370
+بيلزم إنه نمنع الشيء يدخل، لكن لما يصير intramural
+
+135
+00:11:27,370 --> 00:11:31,370
+pressure زاد، الـ intravesical pressure بيقدرش يرجع
+
+136
+00:11:31,370 --> 00:11:35,410
+لأنه الـ valve-like action بيسكر، فبيمنع ... بيريح
+
+137
+00:11:35,410 --> 00:11:39,150
+العضلة، مش محتاجة هي العضلة تشتغل، لكن لو هذا من عمل
+
+138
+00:11:39,150 --> 00:11:43,950
+بطريقة ثانية كان direct perpendicular، فمعناه
+
+139
+00:11:43,950 --> 00:11:47,970
+الـ valve-like action هذا راح يميل، هي إنه ما يمشيش
+
+140
+00:11:47,970 --> 00:11:53,060
+فترة، في داخل الـ ... تحت الميوكوزا، بقدر ... لما يزيد
+
+141
+00:11:53,060 --> 00:11:57,580
+الضغط آه، يضغط عليه، على الجسم، الفكرة هذه يعني
+
+142
+00:11:57,580 --> 00:12:02,960
+موجودة في تركيب بني آدم كتير، موجودة في تركيب بني
+
+143
+00:12:02,960 --> 00:12:08,400
+آدم في عدة أشياء، في بعض الـ veins موجودة في العضو
+
+144
+00:12:08,400 --> 00:12:14,020
+الذكري للـ ... للـ ... للبني آدم، الـ veins هي طالعة
+
+145
+00:12:14,020 --> 00:12:18,980
+برضه ما بتطلعش مباشرة، emissary veins، ما بتطلعش مباشرة، لأ
+
+146
+00:12:18,980 --> 00:12:22,920
+تمشي تحت الـ mucosa شوية، تحت الـ structure وبعدين
+
+147
+00:12:22,920 --> 00:12:28,810
+بتطلع، بحيث إنه إذا زاد الضغط بيسكرها، فبيقدر على إنه
+
+148
+00:12:28,810 --> 00:12:32,550
+مش إنه الدم بيخش ويتحرك بسرعة، بيظل مضغوط ومسكر
+
+149
+00:12:32,550 --> 00:12:36,310
+تمام؟ لما يهبط الضغط، يقل الضغط عليها، فبتروح إيه؟
+
+150
+00:12:36,310 --> 00:12:40,410
+بيصير rapid evacuation
+
+151
+00:12:40,410 --> 00:12:44,370
+يعني الـ system هذا موجود في الجسم في أكتر من مكان
+
+152
+00:12:44,370 --> 00:12:47,890
+... إحنا اليوم بنفهم، وقاعدين اليوم بنفهم وبنعرف
+
+153
+00:12:47,890 --> 00:12:51,730
+إيش اسمه ... إنه يعني ... إيش ما شاء الله، لكن ما
+
+154
+00:12:51,730 --> 00:12:55,730
+أعتقد إنه هذا كلام لحاله مش إيه ولا ... فالـ
+
+155
+00:12:55,730 --> 00:13:01,530
+bladder نازل فيها الـ ureter obliquely وبعدين بيخش
+
+156
+00:13:01,530 --> 00:13:07,250
+ضمن الـ mucosa فترة، وبعدين بيفتح الـ ... في داخل
+
+157
+00:13:07,250 --> 00:13:12,610
+الـ bladder cavity، لكن هذا التركيب بيخلي إنه مافيش
+
+158
+00:13:12,610 --> 00:13:16,870
+عندي أنا ... أنا فاكر أول ... من أول الـ ... كنت لسه
+
+159
+00:13:16,870 --> 00:13:22,190
+خارجي جديد، وشفت بنت عندها recurrent
+
+160
+00:13:24,350 --> 00:13:32,050
+الالتهابات، ما بتتوقفش، مش الـ ... الـ ... الـ كلية دائماً عندها
+
+161
+00:13:32,050 --> 00:13:36,510
+إيه؟ فيها التهاب، تمام؟ فحملنا لها الصور اللي لازمة
+
+162
+00:13:36,510 --> 00:13:37,870
+ومكتشفنا عندها reflux
+
+163
+00:13:40,580 --> 00:13:43,920
+إن البول اللي في الـ bladder هذا بيقدر إيش؟ يرجَع،
+
+164
+00:13:43,920 --> 00:13:47,680
+تمام؟ بيقدر إيش؟ يرجَع، فهذا بيقدر إلى مشاكل كثيرة
+
+165
+00:13:47,680 --> 00:13:51,440
+لأن الضغط صار ينتقل، البول إلى الـ ureter، الضغط
+
+166
+00:13:51,440 --> 00:13:54,000
+صار ينتقل إلى الـ ureter، وبعد ما ينتقل الـ ureter
+
+167
+00:13:54,000 --> 00:13:58,340
+ينتقل لمين؟ للكلية، وبيبدأ يخرب، يعني الضغط
+
+168
+00:13:58,340 --> 00:14:01,220
+الموجود في الكلية، بتبدأ الـ pelvis ده بقى هينتفخ،
+
+169
+00:14:01,220 --> 00:14:04,020
+ينتفخ على حسب من؟ على حسب الـ tissues، بيشدّق،
+
+170
+00:14:04,020 --> 00:14:07,140
+بيفردها، وبعدين الكلية بيصير ... بيصير لها إيه؟
+
+171
+00:14:07,140 --> 00:14:13,240
+بيسموها hydronephrosis، يعني الكلية انتفخت كده ...
+
+172
+00:14:13,240 --> 00:14:21,320
+كده، انتفخت وتوسعت وكبرت، إذًا يعني أقل الأشياء
+
+173
+00:14:21,320 --> 00:14:26,520
+أحياناً، ما إلها أخطر أي شيء بسيط، أي شيء ... أي شيء
+
+223
+00:18:41,440 --> 00:18:44,600
+بالرغم أننا نتكلم عن .. عن smooth muscle
+
+224
+00:18:44,600 --> 00:18:49,420
+fibers قطرها حوالي خمسين micron وسمكها من اثنين إلى عشرة
+
+225
+00:18:49,420 --> 00:18:53,520
+micron يعني ايه؟ ماهي أشياء كبيرة، اللي هنا معمولة
+
+226
+00:18:53,520 --> 00:18:58,170
+بشكل نسيج، كأنهم كلهم واحدة، كأنهم كلهم
+
+227
+00:18:58,170 --> 00:19:02,910
+واحدة واحدة. لو شوفنا هنا الـ epithelium هذا القطع
+
+228
+00:19:02,910 --> 00:19:06,730
+اللي موجود، لو شوفنا الـ epithelium هان، الميكوزا هذه
+
+229
+00:19:06,730 --> 00:19:10,350
+الميكوزا هذه من النوع يسمى transitional
+
+230
+00:19:10,350 --> 00:19:16,070
+epithelium. درسوه في .. ما درسوش أنتم histology؟ اه
+
+231
+00:19:16,070 --> 00:19:23,100
+ليش transitional؟ لأنه أيوة، بيفرد، هيك، بتحول من
+
+232
+00:19:23,100 --> 00:19:29,100
+striated إلى columnar إلى cuboid إلى .. ممكن flat cells
+
+233
+00:19:29,100 --> 00:19:33,240
+بتغير شكلها من مرحلة لأخرى حسب الحاجة
+
+234
+00:19:33,240 --> 00:19:36,980
+تفرد، ممكن ترجع تاني إلى إنها تبقى striated من جديد، إذا في عندنا الـ bladder نسميها detrusor
+
+235
+00:19:36,980 --> 00:19:41,200
+muscle، عشان نسميها detrusor muscle
+
+236
+00:19:41,200 --> 00:19:45,140
+طبعا، كـ bladder موجودة، و البريتونيوم حواليها، لذا أكيد
+
+237
+00:19:45,140 --> 00:19:51,980
+في طبقة من البريتونيوم بتغطيها
+
+238
+00:19:51,980 --> 00:19:53,660
+في طبقة من البريتونيوم بتغطي
+
+239
+00:20:03,070 --> 00:20:09,170
+هذا الـ peritoneum بيغطي بس
+
+240
+00:20:09,170 --> 00:20:13,050
+السطح، وبعدين بروح على الـ wall of the pelvis، و
+
+241
+00:20:13,050 --> 00:20:17,110
+بكمل على الـ abdominal wall، بيصير برا، تمام؟ إذا
+
+242
+00:20:17,110 --> 00:20:22,080
+بس السطح هنا في عندنا adventitia، اللي هو الطبقة
+
+243
+00:20:22,080 --> 00:20:27,020
+الأخيرة، كنت بتحكي ليها، اللي هي بتحمي الـ muscles، و
+
+244
+00:20:27,020 --> 00:20:32,180
+بتبقى فيها حاملة الأعصاب، و الشرايين، والأشياء اللي
+
+245
+00:20:32,180 --> 00:20:36,440
+هي وسائل النقاط زي اللي بنعمل إحنا false sealing
+
+246
+00:20:36,440 --> 00:20:40,100
+لما نشتغل في مباني كبيرة، وفي وسط الـ false sealing
+
+247
+00:20:40,100 --> 00:20:42,620
+هذا اللي بنحط الـ ducts تبع الـ conditioning، و
+
+248
+00:20:42,620 --> 00:20:45,940
+الكهربا، والدنيا كلها، فهو كأنه طبقة هادية عشان حاملة
+
+249
+00:20:45,940 --> 00:20:48,960
+الخدمات اللي موجودة على العضلة
+
+250
+00:20:53,360 --> 00:20:59,580
+طيب، هنكمل مشوارنا مع هذه، هنرجع تاني لـ الـ .. الـ
+
+251
+00:20:59,580 --> 00:21:04,260
+muscle هذه، الـ blood .. الـ blood .. الـ .. الـ .. الـ
+
+252
+00:21:04,260 --> 00:21:07,840
+.. الـ blood vessel، بتنقسم لجسمين، بتنقسم لجسمين، بتنقسم
+
+253
+00:21:07,840 --> 00:21:12,040
+إلى الـ body of the bladder و bladder neck، هذه
+
+254
+00:21:12,040 --> 00:21:16,810
+المنطقة اسمها bladder neck، عنق المثانة
+
+255
+00:21:16,810 --> 00:21:20,850
+neck مفروض أنه زي الـ .. طبعا المنطقة اللي بديها
+
+256
+00:21:20,850 --> 00:21:25,550
+فيها الـ .. الـ .. الـ .. الـ bloody body، بديها هيك، و
+
+257
+00:21:25,550 --> 00:21:31,170
+بعدين بيتحول إلى .. الـ tube، تبارك الله؟ بس المنطقة هذه
+
+258
+00:21:31,170 --> 00:21:37,600
+في الحقيقة منشوفهاش إحنا، عاملة funnel shape، زي القمع، إلا
+
+259
+00:21:37,600 --> 00:21:41,040
+إذا كان في عندي relaxation للعضلات، لكن في العادة
+
+260
+00:21:41,040 --> 00:21:43,860
+هاللي ولا منها قمعية، إلا أن في عندي هذه المنطقة
+
+261
+00:21:43,860 --> 00:21:50,580
+فيها intrinsic أو internal sphincter، هو internal و
+
+262
+00:21:50,580 --> 00:21:53,560
+intrinsic في نفس الوقت، لأنه involuntary internal
+
+263
+00:21:53,560 --> 00:21:58,160
+sphincter
+
+264
+00:21:58,160 --> 00:22:03,880
+of the bladder sphincter، دائمًا ضغط يخلق، مش ببين
+
+265
+00:22:03,880 --> 00:22:08,680
+أنه أي فضل، شاب، أما هو إذا عمل relaxation، بيتسع، و
+
+266
+00:22:08,680 --> 00:22:13,440
+بعدين بيجي الـ urethra، الـ urethra هذه ممكن نسميها
+
+267
+00:22:13,440 --> 00:22:16,780
+بصيلة الـ urethra، من ناحية الـ urethra، إذا بدأنا في
+
+268
+00:22:16,780 --> 00:22:20,160
+الـ urethra من الأول، هم نِقول عندي بناء اليوريثرا
+
+269
+00:22:20,160 --> 00:22:27,180
+وبعدين مبنى اسمه يوريثرا، وبعدين بروستاتيك يوريثرا
+
+270
+00:22:27,180 --> 00:22:32,280
+وبعدين ممبرينوس يوريثرا، الجزء الأخير، اللي إيه؟ هذا
+
+271
+00:22:32,280 --> 00:22:36,780
+الجزء، الجزء الآخر ممكن نسميه ممبرينوس يوريثرا، هذا
+
+272
+00:22:36,780 --> 00:22:41,880
+الجزء، لكن المنطقة اللي هنا، والجزء هذا نسميه bladder
+
+273
+00:22:41,880 --> 00:22:44,960
+neck، الـ funnel shape يعني، اللي هو هذا اللي هنا في
+
+274
+00:22:44,960 --> 00:22:50,550
+عنده عضلة internal sphincter
+
+275
+00:22:50,550 --> 00:22:55,190
+of the
+
+276
+00:22:55,190 --> 00:22:58,730
+urinary bladder، وهنا عندنا external sphincter، الـ
+
+277
+00:22:58,730 --> 00:23:02,310
+external sphincter عبارة عن isolated muscles
+
+278
+00:23:02,310 --> 00:23:10,550
+voluntary، جزء من الـ pelvic floor، floor of the
+
+279
+00:23:10,550 --> 00:23:10,970
+pelvis
+
+280
+00:23:15,850 --> 00:23:20,070
+في عضلة كبيرة levator هنا، اسمها هذه، فتحات، فتحات
+
+281
+00:23:20,070 --> 00:23:23,710
+هنا، عشان يطلع فيها فتحة الـ rectum أو الـ anus، الـ
+
+282
+00:23:23,710 --> 00:23:30,070
+canal، ويطلع فيها الـ vagina، ويطلع الـ genital
+
+283
+00:23:30,070 --> 00:23:36,910
+triangle، نسمي المنطقة
+
+284
+00:23:36,910 --> 00:23:42,570
+العضلات في المنطقة هذه قوية، ومعمولة اللي هي بتحكم
+
+285
+00:23:43,130 --> 00:23:48,310
+في حالتنا هذه، متحكم في الـ evacuation والـ
+
+286
+00:23:48,310 --> 00:23:51,170
+micturition، تمام؟ إذا أنا متحكم في الـ micturition
+
+287
+00:23:51,170 --> 00:23:57,270
+هذه العضلة بنسميها external، اه external sphincter
+
+288
+00:23:57,270 --> 00:23:59,150
+إذا في عندك external sphincter، وعندك internal
+
+289
+00:23:59,150 --> 00:24:02,480
+sphincter، هنلاحظ بعد شوية أن الـ external sphincter
+
+290
+00:24:02,480 --> 00:24:06,440
+هذا أنا بتحكم فيه، أنا بقرر أنه لما تجيني الرغبة في
+
+291
+00:24:06,440 --> 00:24:09,660
+التبول، أني أتنول ولا لأ، بقدر أُوَامِر الـ
+
+292
+00:24:09,660 --> 00:24:12,540
+sphincter هذا، الـ external، أفتحه ولا لأ، لكن الـ
+
+293
+00:24:12,540 --> 00:24:15,520
+internal sphincter هذا مش غير reflex، إذا امتلأت
+
+294
+00:24:15,520 --> 00:24:20,900
+المثانة، وامتُلِأت، فهو بيفتح، فبنحس أنه في رغبة شديدة
+
+295
+00:24:21,630 --> 00:24:25,510
+ممكن الـ external sphincter يفتح ويكمل، ويقول لأ
+
+296
+00:24:25,510 --> 00:24:29,390
+مش وقته، ويبقى شادد، وبعدين بعد شوية تختفي الرغبة
+
+297
+00:24:29,390 --> 00:24:33,130
+هذه، تغيب لمدة طويلة لحد ما يرجع في الـ extension كمان
+
+298
+00:24:33,130 --> 00:24:37,210
+مرة، هذا ما حكيه هو كله عمومًا موضوع دراستنا اليوم
+
+299
+00:24:37,210 --> 00:24:44,240
+خلينا نتكلم، عندي bladder، عندي nerve supply، عندي
+
+300
+00:24:44,240 --> 00:24:47,760
+sympathetic، وparasympathetic، وعندي internal
+
+301
+00:24:47,760 --> 00:24:51,700
+sphincter، و external sphincter، عندي bladder neck
+
+302
+00:24:51,700 --> 00:24:57,980
+فيها اللي هو الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+303
+00:24:57,980 --> 00:24:58,040
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+304
+00:24:58,040 --> 00:24:58,220
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+305
+00:24:58,220 --> 00:24:58,760
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+306
+00:24:58,760 --> 00:24:58,840
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+307
+00:24:58,840 --> 00:24:59,460
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+308
+00:24:59,460 --> 00:24:59,500
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+309
+00:24:59,500 --> 00:25:00,860
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+310
+00:25:00,860 --> 00:25:01,020
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+311
+00:25:01,020 --> 00:25:02,240
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+312
+00:25:02,240 --> 00:25:07,220
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+313
+00:25:07,220 --> 00:25:11,590
+الـ .. الـ .. هي الـ .. الـ .. الـ .. الـ ureter، الحالب
+
+314
+00:25:11,590 --> 00:25:20,950
+وهان فتحة الحالب، الحالبين جنب فتحة الـ
+
+315
+00:25:20,950 --> 00:25:26,870
+.. الـ bladder neck، طبعا؟ لاحظين أنتم؟ يعني مش الـ
+
+316
+00:25:26,870 --> 00:25:30,410
+bladder، بيجي الحالبين من فوق هيك، اه، و هذا من
+
+317
+00:25:30,410 --> 00:25:35,280
+تحت، مائل، لأ لأ، الـ .. الـ .. الـ ureters تحت، فاتحين
+
+318
+00:25:35,280 --> 00:25:39,360
+جانب بعض، المنطقة هي هذه المساحة ما بين فتحة الحالب
+
+319
+00:25:39,360 --> 00:25:48,340
+و فتحة الـ bladder neck، هذا الـ triangle نسميه ايش؟ try
+
+320
+00:25:48,340 --> 00:25:50,840
+again، هذا الـ try again، المهم لأنه very
+
+321
+00:25:50,840 --> 00:25:56,020
+sensitive، لإيه؟ لما الـ stretch يصير عليه، بيديني
+
+322
+00:25:56,020 --> 00:26:00,940
+reflexes، أقوى مكان بيديني reflexes، تمام، هو والجزء
+
+323
+00:26:00,940 --> 00:26:05,560
+اللي داخله منه، في داخله blood vessels، فلما يصير
+
+324
+00:26:05,560 --> 00:26:09,520
+عليه stimulation، بيديني strong reflexes، عشان إنه أنا
+
+325
+00:26:09,520 --> 00:26:13,320
+أعمل evacuation، هذه المنطقة لو إحنا طلعنا في المنظر
+
+326
+00:26:13,320 --> 00:26:17,710
+بنشوفها، من ميزتها عن غيرها، إذا بنعرف أنه هذه الـ
+
+327
+00:26:17,710 --> 00:26:21,810
+triangle، لأن هذه المنطقة smooth، والباقي corrugated
+
+328
+00:26:21,810 --> 00:26:28,190
+الباقي مجعد، لأن طبيعة المثانة بتبقى قابلة للانكماش، بتتجعد،
+
+329
+00:26:28,190 --> 00:26:32,250
+بتت.. بتت.. بت.. بت.. بت.. بتتمدد dilated، فبتفرد
+
+330
+00:26:32,250 --> 00:26:34,730
+مش كده؟  transitional epithelium ماعنده
+
+331
+00:26:34,730 --> 00:26:38,650
+المواصفات هذه، فهنا لما نطلع في المثانة إحنا طبعًا
+
+332
+00:26:38,650 --> 00:26:42,490
+نطلع في المثانة internally، يعني مش كده، لأنه
+
+333
+00:26:42,490 --> 00:26:46,530
+لازم تكون فارغة، لأنه مش هأقدر أنا أدخل، سفينكتا إيه
+
+334
+00:26:46,530 --> 00:26:52,050
+إيش اسمه، الـ endoscope، اه، الـ cystoscope، مش هأخش فيه
+
+335
+00:26:52,050 --> 00:26:56,350
+هو البولي، ده مجوف شوية، فهشوف الفرق، هشوف أن هذا
+
+336
+00:26:56,350 --> 00:27:02,030
+الـ trigone هو إيه؟ الـ trigone هذه منطقة حساسة جدًا، لأن
+
+337
+00:27:02,030 --> 00:27:07,470
+اللي هو، هي خليني أوريك فيها، إذا
+
+338
+00:27:07,470 --> 00:27:09,910
+لقيت فتحة اليورتر اليمين، ولقيت فتحة اليورتر
+
+339
+00:27:09,910 --> 00:27:16,130
+اليسار، هو فتحة الـ bladder، هذا المساحة البيضاء اسمه
+
+340
+00:27:16,130 --> 00:27:21,030
+trigone، هو مش اللون بس، أنه أفتح من غيره، أنه زي ما
+
+341
+00:27:21,030 --> 00:27:24,470
+تشوفين، smooth، والآخرين هتلاقيهم إيه؟ فيهم
+
+342
+00:27:24,470 --> 00:27:28,190
+corrugations، عامل أنواع من التجعيد موجودة داخل الـ
+
+343
+00:27:28,190 --> 00:27:34,850
+.. هذه المنطقة كثير حساسة، لما يبقى فيها عندنا bowl
+
+344
+00:27:34,850 --> 00:27:40,380
+of residual urine موجود، اه، بنضل إحنا حاسين في
+
+345
+00:27:40,380 --> 00:27:43,140
+المنطقة، أنه بدنا فيها رغبة في التبول، لما يكون في
+
+346
+00:27:43,140 --> 00:27:49,120
+عندنا حصوة، وتنزل في المنطقة هذه، تنحكش مثلاً في
+
+347
+00:27:49,120 --> 00:27:52,200
+المنطقة الـ trigone هذه، تبقى قاعد على الباب، بيضل
+
+348
+00:27:52,200 --> 00:27:55,740
+حاسس أنه في رغبة للتبول، رايحة جاي، رايحة جاي، رايحة
+
+349
+00:27:55,740 --> 00:27:59,180
+جاي، على الحمام، لإنه في حصوة نزلت من الكلية، ونزلت
+
+350
+00:27:59,180 --> 00:28:02,120
+في المثانة، بس ساوَدتْ، فعلاً، الباب، جاي على الـ trigone، الـ
+
+351
+00:28:02,120 --> 00:28:05,800
+trigone هذه منطقة إيه؟ حساسة كثير، وهي لها علاقة
+
+352
+00:28:05,800 --> 00:28:08,020
+كبيرة في الـ إيه؟ في الـ micturition reflex
+
+353
+00:28:08,020 --> 00:28:13,990
+potentiating strongly the reflex، إذا كانوا يقولوا
+
+354
+00:28:13,990 --> 00:28:18,130
+في حصوة بتعمل irritation، فأنت لسه الـ bladder فاضية
+
+355
+00:28:18,130 --> 00:28:22,390
+لكن حاسس أنه في رغبة شديدة للتبول، لإنه في عندنا
+
+356
+00:28:22,390 --> 00:28:25,790
+strong irritation، بتروح، تنزل، وبتطلع ..
+
+357
+00:28:25,790 --> 00:28:29,810
+تنزل، وبتطلع .. تمام؟ إذا الـ trigone هذا
+
+358
+00:28:29,810 --> 00:28:34,850
+إيه؟ هي تركيب حساس في المنطقة، نرجع تاني، إذا عندي
+
+359
+00:28:34,850 --> 00:28:40,050
+the body، وthe neck، وthe bladder، تمام؟
+
+360
+00:28:41,790 --> 00:28:47,470
+الـ bladder neck، طبعًا إحنا بنتكلم عنه، هو نهاية الـ
+
+361
+00:28:47,470 --> 00:28:53,050
+urethra، بيميل inferiorly and anteriorly
+
+362
+00:29:05,030 --> 00:29:07,130
+the smooth muscle of the bladder is called
+
+363
+00:29:07,130 --> 00:29:11,590
+detrusor muscle، اتكلمنا عنها، وقلنا detrusor
+
+364
+00:29:11,590 --> 00:29:18,650
+muscle، هذه عضلة قوية، تستطيع أنها تعمل contraction
+
+365
+00:29:18,650 --> 00:29:25,070
+لما يكون داخلها بول، البول هذا بتغطي عليه، مش كده
+
+366
+00:29:25,070 --> 00:29:33,350
+هي بتحتوي على البول، فهي بيصير فيها tone، فيها tone
+
+367
+00:29:33,750 --> 00:29:37,850
+الـ tone هذا ممكن يتشد لدرجة أنه يرتفع الضغط داخل
+
+368
+00:29:37,850 --> 00:29:42,350
+الـ .. الـ bladder إلى 40 إلى 60 millimeter mercury
+
+369
+00:29:42,350 --> 00:29:45,990
+تمام؟ يعني بتقدر .. لو الـ bladder امتلأت على الآخر
+
+370
+00:29:45,990 --> 00:29:48,990
+ممكن تصل لـ 100 millimeter mercury، بس في الحالة
+
+371
+00:29:48,990 --> 00:29:53,770
+هذه، يمكن عندي أنا strong reflex، لازم يتفرغ، إذا أنا
+
+372
+00:29:53,770 --> 00:29:59,130
+أردت ولا ما أردتش، بعد المرحلة هذه، بنلاقي أنه حتى الـ
+
+373
+00:29:59,130 --> 00:30:02,090
+external sphincter أنت مش قادر تتحمل الضغط اللي جاي إيه
+
+374
+00:30:02,090 --> 00:30:06,530
+من داخل الـ bladder، فحتى لو صاحب الشئ بده يمنع
+
+375
+00:30:06,530 --> 00:30:10,490
+التبول، مقدرش، تمام؟ إذا أنا فيه ضغط من داخل الـ
+
+376
+00:30:10,490 --> 00:30:14,550
+bladder، بتكون مع الـ إيه؟ يعني عندي الـ tone، لاحظوا
+
+377
+00:30:14,550 --> 00:30:21,270
+إحنا أول ما بتكون الـ bladder فيها tone، تعطي ضغط
+
+378
+00:30:21,270 --> 00:30:24,850
+أساسي، 10 ملي ميتر ميركوري مثلاً، زاد الـ bladder بتتوسع
+
+379
+00:30:24,850 --> 00:30:28,370
+شوية، الـ tone بتبقى موجودة، بتتوسع لحد معين، بيبدأ
+
+380
+00:30:28,370 --> 00:30:33,110
+الضغط يرتفع، يعني هي الـ tone موجودة، بتحافظ على الميه
+
+381
+00:30:33,110 --> 00:30:39,770
+الـ bladder اللي فيها، بشكل محسوس، عند level معين، بتبدأ
+
+382
+00:30:39,770 --> 00:30:43,830
+أنها تـ relax، والـ tone بيُحافظ عليه زي ما هو، لأ
+
+383
+00:30:43,830 --> 00:30:45,750
+بيصير عندنا more
+
+384
+00:30:49,150 --> 00:30:56,690
+أو إذا لم يكن هناك اكتشاف، اكتشاف، اكتشاف، اكتشاف
+
+385
+00:30:56,690 --> 00:31:00,750
+اكتشاف، اكتشاف، بتفتحها لبرا، فهي بتشد .. بتحافظ على
+
+386
+00:31:00,750 --> 00:31:04,290
+حالها، وعشان نتنبه للجسم، إحنا لو وصلنا لإن الـ
+
+387
+00:31:04,290 --> 00:31:07,730
+stretch .. الـ stretch reflex هذا اللي موجود من أن
+
+388
+00:31:07,730 --> 00:31:12,190
+هي شدادة، بنحس إحنا أنه والله الضغط عليه، والـ
+
+389
+00:31:12,190 --> 00:31:16,630
+stretch reflex .. الـ stretch receptors stimulated
+
+390
+00:31:16,630 --> 00:31:22,770
+well، وإحنا الآن في طور أن نفرغ،
+
+445
+00:35:24,390 --> 00:35:33,370
+عملية عملية عملية عملية عملية
+
+446
+00:35:33,370 --> 00:35:39,030
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+447
+00:35:39,030 --> 00:35:39,350
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+448
+00:35:39,350 --> 00:35:39,370
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+449
+00:35:39,370 --> 00:35:46,870
+عملية عملية عملية عملية عملية عمل
+
+450
+00:35:50,030 --> 00:35:57,030
+هذا الشكل مختلف
+
+451
+00:35:57,030 --> 00:36:03,670
+عن باقي
+
+452
+00:36:03,670 --> 00:36:04,090
+الأشياء
+
+453
+00:36:09,740 --> 00:36:13,400
+it's natural to normally keep the bladder neck
+
+454
+00:36:13,400 --> 00:36:17,040
+and urethra empty. هذه الممطلة دائما
+
+455
+00:36:17,040 --> 00:36:20,440
+فارغة لأن عندي الـ internal sphincter عامل tone
+
+456
+00:36:20,440 --> 00:36:24,740
+فالـ bladder نجدها دائما فارغة، المشكلة إذا امتلأ
+
+457
+00:36:24,740 --> 00:36:31,530
+الـ bladder، بيصير عندي strong desire to evacuate لأنه
+
+458
+00:36:31,530 --> 00:36:34,750
+بيصير عندك strong reflex، micturition reflex، فأنا
+
+459
+00:36:34,750 --> 00:36:40,650
+لاحظها برضه في الـ GIT، إن الـ rectum دائما فارغ، الـ
+
+460
+00:36:40,650 --> 00:36:43,850
+rectum دائما فارغ، إن صار فيه شيء وصل إلى الـ rectum،
+
+461
+00:36:43,850 --> 00:36:47,960
+مع أنّه في رغبة في evacuation، بيصير strong
+
+462
+00:36:47,960 --> 00:36:51,760
+reflex للـ evacuation، نفس الكلام، إذا هذه
+
+463
+00:36:51,760 --> 00:36:55,520
+under control، إذا بدأ الشيء يصل، يعني أنتَ سمحت له
+
+464
+00:36:55,520 --> 00:36:59,960
+يصل، معناها أو غصب عنك، يا سمحت له، أما غصب عنك، لأنه
+
+465
+00:36:59,960 --> 00:37:04,880
+فاض عن الحد المسموح، فسيشتغل بدون أوامرك، تمام؟
+
+466
+00:37:04,880 --> 00:37:09,560
+قلت لكم عن الرجل الذي كان في الـ bus أيام اليهود،
+
+467
+00:37:09,560 --> 00:37:14,890
+رجل عنده سكري، يعني بعدين السكري بيتبول كثير، وحجزوه
+
+468
+00:37:14,890 --> 00:37:18,230
+في المنطقة الوسطى، بياخدوهم، بيجمعوهم، بعدين بيحمّلوهم
+
+469
+00:37:18,230 --> 00:37:20,770
+في الباصات، بعدين بيجمعوهم لغزة، يعني احنا كنا
+
+470
+00:37:20,770 --> 00:37:23,750
+بناخد لغزة مباشرة، يعني على أنصار، ما تاخدش معنا
+
+471
+00:37:23,750 --> 00:37:27,290
+الحكاية نص ساعة، يكون من سورة تم لعتك، على بس هم
+
+472
+00:37:27,290 --> 00:37:31,050
+يعني ليلة كاملة، أو هم ايه، مربطينهم من مكان لمكان
+
+473
+00:37:31,050 --> 00:37:34,310
+عشان ينقلوهم في الآخر لغزة، فـ عنده سكري، مش بيحمل
+
+474
+00:37:34,310 --> 00:37:37,530
+فقال للجندي: خذ بالك، أنا عندي سكري، والبول مش بتحكم
+
+475
+00:37:37,530 --> 00:37:42,910
+في حالي، ممكن أنزل أتبوّل، قال له: شيء كده، اقعد محلك، تمام
+
+476
+00:37:42,910 --> 00:37:48,090
+شوية صغيرة، قال له: خذ بالك، أنا عندي سكري، ومش بتحمل
+
+477
+00:37:48,090 --> 00:37:51,670
+قال له: شيء كده، اقعد محلك، وبعدين لجي الـ ... أرضية الـ
+
+478
+00:37:51,670 --> 00:37:58,590
+bus صارت ايه؟ مليانة بول، مش لأنه خلاص يعني عند
+
+479
+00:37:58,590 --> 00:38:02,310
+level معين، لا يستطيع الإنسان ايه؟ بيصير الـ ... اه
+
+480
+00:38:02,310 --> 00:38:06,830
+بيصير الـ ... الـ ... الـ ... الـ tension في داخل الـ ...
+
+481
+00:38:06,830 --> 00:38:12,260
+الـ bladder أقوى من الـ sphincter contraction، أقوى
+
+482
+00:38:12,260 --> 00:38:16,540
+منه، فبتغلب عليه، خلاص، فبتنزل الـ ايه؟ الـ reflex اللي
+
+483
+00:38:16,540 --> 00:38:19,720
+كان inhibitory، inhibitory، inhibitory، لـ خلاص، مش قادر
+
+484
+00:38:19,720 --> 00:38:23,720
+صار فيه أنه facilitating بسبب الـ ... الـ ... الـ ... الـ
+
+485
+00:38:23,720 --> 00:38:26,360
+afference اللي جاية من الـ bladder، بيصير مش ... مش
+
+486
+00:38:26,360 --> 00:38:31,440
+قادر يعمل inhibition أكتر من هيك، فبيصير ايه؟ الـ ... طيب
+
+487
+00:38:34,470 --> 00:38:39,530
+بالتالي، ايش قلنا هنا؟ تمنح الـ bladder إلى
+
+488
+00:38:39,530 --> 00:38:46,150
+الـ external sphincter إلى ما يرتفع
+
+489
+00:38:46,150 --> 00:38:49,430
+الـ external sphincter
+
+490
+00:38:49,430 --> 00:38:49,770
+إلى الـ external sphincter إلى الـ external sphincter إلى الـ external sphincter
+
+491
+00:38:49,770 --> 00:38:49,810
+إلى الـ external sphincter إلى الـ external sphincter إلى الـ external sphincter
+
+492
+00:38:49,810 --> 00:38:49,870
+إلى الـ external sphincter إلى الـ external sphincter إلى الـ external sphincter
+
+493
+00:38:49,870 --> 00:39:01,410
+إلى الـ external sphincter إلى الـ external sphincter إلى الـ external
+
+494
+00:39:02,700 --> 00:39:06,620
+اللي هو الـ ... قلنا الـ ... الـ floor of the pelvis
+
+495
+00:39:06,620 --> 00:39:11,180
+الـ levator ani muscle فيها، اللي هو الـ urogenital
+
+496
+00:39:11,180 --> 00:39:16,320
+diaphragm، الجزء العضلي ... العضلة المشاركة للمنطقة
+
+497
+00:39:16,320 --> 00:39:19,200
+هي دي مخيطة، ايش عملت؟ ما يسمى بالـ external
+
+498
+00:39:19,200 --> 00:39:23,120
+sphincter، وهي striated muscles، muscles عادية،
+
+499
+00:39:23,120 --> 00:39:27,320
+voluntary، تمام؟ voluntary، الـ nerve supply تبعها
+
+500
+00:39:27,320 --> 00:39:31,800
+مختلف عن الـ nerve supply تبع من؟ تبع الـ دائما الـ
+
+501
+00:39:31,800 --> 00:39:35,220
+smooth muscles، الـ nerves تبعهم بيكون ايش؟
+
+502
+00:39:35,220 --> 00:39:39,100
+Autonomic، مش هيك؟ Autonomic، لكن الـ striated
+
+503
+00:39:39,100 --> 00:39:45,100
+muscles بيكون ايش؟ بيكون ايه؟ Somatic، اه، Somatic
+
+504
+00:39:45,100 --> 00:39:49,540
+أنتَ عارف، بتعبّر تعبيرها Somatic nerves، يعني هدول
+
+505
+00:39:49,540 --> 00:39:53,760
+الـ spinal nerves اللي هم under voluntary control
+
+506
+00:39:59,780 --> 00:40:06,280
+innervation of the bladder، إذا الـ bladder has two
+
+507
+00:40:06,280 --> 00:40:08,920
+types of ... three types of innervations:
+
+508
+00:40:08,920 --> 00:40:13,800
+parasympathetic, sympathetic، و ايه؟ and somatic
+
+509
+00:40:13,800 --> 00:40:18,620
+الـ somatic فقط للـ external sphincter
+
+510
+00:40:18,620 --> 00:40:24,520
+عن طريق الـ pudendal nerve، ايش اسمه؟ الـ pudendal
+
+511
+00:40:24,520 --> 00:40:31,190
+nerve، الـ parasympathetic nerve supply and the
+
+512
+00:40:31,190 --> 00:40:35,250
+pelvic nerve، مش كده؟ طب، جايين من sacral plexus
+
+513
+00:40:35,250 --> 00:40:40,130
+بتتجمع، تعمل الـ pelvic nerves، و هدول بيحمّلوا الـ what
+
+514
+00:40:40,130 --> 00:40:44,910
+الـ parasympathetic innervation، وعندي كمان
+
+515
+00:40:44,910 --> 00:40:50,910
+sympathetic، لكن الـ sympathetic بيروح mainly to the
+
+516
+00:40:50,910 --> 00:40:56,310
+blood supply of the bladder more than to the smooth
+
+517
+00:40:56,310 --> 00:41:01,410
+muscle of the bladder، لأ، more to the blood
+
+518
+00:41:01,410 --> 00:41:05,250
+supply، بتعملها vasoconstriction أو vasodilatation
+
+519
+00:41:05,250 --> 00:41:06,930
+حسب الـ sympathetic tone
+
+520
+00:41:10,380 --> 00:41:14,520
+الـ ... الـ pelvic nerve اللي هو جاي من الـ sacral
+
+521
+00:41:14,520 --> 00:41:20,140
+plexus، بيجي من الـ S2، S3، مش كده؟ الـ ... الـ ... الـ
+
+522
+00:41:20,140 --> 00:41:26,760
+parasympathetic system، مش له اسم تاني؟ اه، cranio
+
+523
+00:41:26,760 --> 00:41:29,920
+...
+
+524
+00:41:29,920 --> 00:41:38,950
+اه ... cranio ... اه ... والآخر يسمى thoracolumbar
+
+525
+00:41:38,950 --> 00:41:44,830
+الـ sympathetic يسمى thoracolumbar لأنه جاي من T5 لـ L2
+
+526
+00:41:44,830 --> 00:41:52,490
+هذا sympathetic، أما الـ ... أما الـ ... parasympathetic له
+
+527
+00:41:52,490 --> 00:41:58,590
+two divisions، جزء جاي من cranial nerves، والـ sacral
+
+528
+00:41:58,590 --> 00:42:03,950
+craniosacral، craniosacral، هذا اللي هو الـ
+
+529
+00:42:03,950 --> 00:42:08,050
+parasympathetic system، لأن الـ nerves فيه جزء منها
+
+530
+00:42:08,050 --> 00:42:11,850
+فيه parasympathetic، وفي جزء منها بيكون لـ
+
+531
+00:42:11,850 --> 00:42:17,070
+somatic، مش كده؟ و معظمهم mixed، مش كده؟ والـ somatic
+
+532
+00:42:17,070 --> 00:42:21,450
+nerves هذه دائما هي mixed، بمعنى أنها motor و
+
+533
+00:42:21,450 --> 00:42:27,260
+sensory، و mixed بمعنى أنه autonomic و voluntary و
+
+534
+00:42:27,260 --> 00:42:32,460
+somatic، تمام؟ اللي اجتمعت الـ ... الـ ... الـ vagus
+
+535
+00:42:32,460 --> 00:42:35,820
+nerve، هذا اللي حد ما ... اللي حد ما appeared على
+
+536
+00:42:35,820 --> 00:42:41,220
+سببته، لكنه mixed، سموّه ايه؟ و sensory، ثمانية منه
+
+537
+00:42:41,220 --> 00:42:46,080
+sensory، ولو أنه مشهور، لكن ثمانية منه ايه؟ sensory
+
+538
+00:42:46,080 --> 00:42:55,560
+fibers، إذن عندي أنا الـ pelvic nerves، الـ S2، S3، الـ
+
+539
+00:42:55,560 --> 00:43:00,060
+A، قلنا cranial، مجموعة من الأعصاب اللي هم cranial
+
+540
+00:43:00,060 --> 00:43:03,500
+nerves، فيهم sympathetic، أو فيهم autonomic nervous
+
+541
+00:43:03,500 --> 00:43:06,460
+system، فيهم parasympathetic، طبعا autonomic cranial
+
+542
+00:43:06,460 --> 00:43:10,880
+يعني parasympathetic، زي السابع، الخامس، يعني الخامس
+
+543
+00:43:10,880 --> 00:43:16,640
+فيه ايش؟ بسيط، السابع، والتاسع، والعاشر، والحادى عشر، تمام
+
+544
+00:43:16,640 --> 00:43:21,600
+هدول فيهم ايه؟ parasympathetic، الـ sacral ايه؟
+
+545
+00:43:21,600 --> 00:43:27,300
+الـ sacral ايه؟
+
+546
+00:43:27,300 --> 00:43:29,540
+الـ sacral plexus اللي بتديني الـ pelvic nerves
+
+547
+00:43:29,540 --> 00:43:34,190
+اللي هم فيه مشاركة sympathetic activity، هنا عندنا
+
+548
+00:43:34,190 --> 00:43:39,390
+الـ nerves اللي رايحة على الـ blood vessels، بس من S2، S3
+
+549
+00:43:39,390 --> 00:43:45,430
+من الـ sacral segment، S1، S2، S3، مش جاي من الـ four الـ
+
+550
+00:43:45,430 --> 00:43:48,970
+four، بتروح لـ الـ two، three، four، وبتروح لمين؟ لـ
+
+551
+00:43:48,970 --> 00:43:53,030
+other parts of the pelvis، بالذات الـ A، الـ rectum
+
+552
+00:43:54,030 --> 00:43:59,910
+و الـ lower colon، أو الـ distal colon، الـ
+
+553
+00:43:59,910 --> 00:44:03,210
+descending، و الـ sigmoid، و الـ rectum، و الـ inner
+
+554
+00:44:03,210 --> 00:44:08,430
+anal canal. the
+
+555
+00:44:08,430 --> 00:44:13,650
+sensory fibers، إذا في عندنا كمان هذا الـ ... الـ ...
+
+556
+00:44:13,650 --> 00:44:18,870
+الـ pelvic nerves، مش بس motor، لأ، mixed، motor، وايه؟
+
+557
+00:44:18,870 --> 00:44:19,810
+و sensory
+
+558
+00:44:23,190 --> 00:44:24,470
+والألياف تمر من خلال عضلات
+
+559
+00:44:24,470 --> 00:44:38,510
+الحوض
+
+560
+00:44:38,550 --> 00:44:43,110
+to sense، ده ايه؟ ده degree of stretch، لأن كل ما زاد
+
+561
+00:44:43,110 --> 00:44:46,830
+الـ volume، كل ما زاد الـ stretch، كل ما زاد الضغط تبع
+
+562
+00:44:46,830 --> 00:44:50,150
+الـ bladder، الـ bladder بتقدر تحافظ على كلامها ده
+
+563
+00:44:50,150 --> 00:44:55,570
+على level معين، بعد كده لو الـ bladder مضلت مسكراها
+
+564
+00:44:55,570 --> 00:44:59,410
+بيصير dilatation، وبيصير actually فيها اي عضلة
+
+565
+00:44:59,410 --> 00:45:03,150
+بتتشد أكثر من اللازم، خلاص، تفقد قدرتها على الـ ايه
+
+566
+00:45:03,150 --> 00:45:07,490
+عشان تبقى تحافظ على قدرتها على الـ contraction والـ
+
+567
+00:45:07,490 --> 00:45:12,270
+micturition، لازم ايه؟ عند level معين يتوقف، خلاص، آخر
+
+568
+00:45:12,270 --> 00:45:18,390
+قدرتها، طيب، stretch signals from the posterior
+
+569
+00:45:18,390 --> 00:45:23,030
+urethra are especially strong and are mainly
+
+570
+00:45:23,030 --> 00:45:26,530
+responsible for initiation of the reflexes that cause
+
+571
+00:45:26,530 --> 00:45:30,530
+bladder emptying، تمام؟ إذا ... إذا الضغط تبع الـ
+
+572
+00:45:30,530 --> 00:45:34,210
+bladder muscle زاد، والـ ... عشان الـ ... الـ ...
+
+573
+00:45:34,210 --> 00:45:37,070
+الـ ... الـ urine في داخل الـ bladder زاد، تمام؟ الضغط
+
+574
+00:45:37,070 --> 00:45:40,150
+هذا بيؤدي إلى أنّه ... أنّه بعض الـ ... الـ internal
+
+575
+00:45:40,150 --> 00:45:45,050
+sphincter يـ dilate شوية، أو يـ stretch، ويدخل شوية
+
+576
+00:45:45,050 --> 00:45:48,190
+stretch، يعني الـ ... الـ ... الـ bladder قاعدة بتفتح في
+
+577
+00:45:48,190 --> 00:45:51,210
+الـ sphincter، فالـ stretch receptors في الـ bladder من
+
+578
+00:45:51,210 --> 00:45:54,730
+جهة بتحس أن الضغط زاد أكثر من اللازم، وأنه صار الـ
+
+579
+00:45:54,730 --> 00:45:59,870
+stretch وصلها، فبتعمل strong reflex اللي هو اسمه الـ
+
+580
+00:45:59,870 --> 00:46:07,030
+micturition، الـ micturition reflex بيكون موجود في
+
+581
+00:46:07,030 --> 00:46:13,050
+كل المراحل
+
+582
+00:46:13,050 --> 00:46:17,070
+يعني، و الـ bladder فارغة
+
+583
+00:46:17,780 --> 00:46:23,100
+طبعا، هان صفر، لعند level معين، مية وخمسين، مية و
+
+584
+00:46:23,100 --> 00:46:27,920
+سبعين milliliter of urine في الـ bowel، في الـ bladder
+
+585
+00:46:27,920 --> 00:46:33,780
+بتبدأ يصير عندي الـ reflex تظهر، اللي هو الـ
+
+586
+00:46:33,780 --> 00:46:34,800
+micturition reflex
+
+587
+00:46:38,970 --> 00:46:45,090
+لأ، الـ receptors minimal stretch، فبديني minimal ...
+
+588
+00:46:45,090 --> 00:46:48,150
+هذه intravesical pressure
+
+589
+00:46:54,940 --> 00:46:57,960
+centimeters of water، بالـ ... بالـ ... بالـ centimeter
+
+590
+00:46:57,960 --> 00:47:03,900
+of water، هنا تمام، هنا بنلاحظ احنا ايش الـ ... هدول
+
+591
+00:47:03,900 --> 00:47:08,460
+المنطقة، هذا يمثل ليه؟ الـ micturition reflex في
+
+592
+00:47:08,460 --> 00:47:12,800
+level معين، احنا كل ما زاد الـ volume في داخل البلدر
+
+593
+00:47:12,800 --> 00:47:16,980
+كل ما اتضغط عليه، هذا الأحمر الغامق يمثل ايه؟ اتضغط
+
+594
+00:47:16,980 --> 00:47:22,310
+في داخل الـ volume، بتديني الـ ... الـ basal cystogram
+
+595
+00:47:22,310 --> 00:47:25,730
+هذا الـ basal cystogram، الضغط داخل الـ intravesical
+
+596
+00:47:25,730 --> 00:47:29,770
+pressure، هذا الضغط داخل ايه؟ البلدر، ملاحظ ما اتعب
+
+597
+00:47:29,770 --> 00:47:33,550
+اتعب، اتعب، على level معين بيبدأ الضغط يزيد كمان
+
+598
+00:47:33,550 --> 00:47:38,330
+يعني في لحد منطقة معينة، تلاتماية، أربعمية، والضغط ايه؟
+
+599
+00:47:38,330 --> 00:47:42,870
+هو هو، بس بعد كده كل زيادة في الـ volume بيصير ...
+
+600
+00:47:42,870 --> 00:47:46,170
+بيصير الضغط عالي، لأنه تقريبا البلدر جاية ... بتبدأ
+
+601
+00:47:46,170 --> 00:47:52,220
+... الخضرة القصوى بتاعتها وصلت أقصى، تمام؟ فبيقدر
+
+602
+00:47:52,220 --> 00:47:57,340
+البراشر يزيد في الأول، كل ما بيزيد الـ volume كل ما
+
+603
+00:47:57,340 --> 00:48:01,160
+بيصير some sort of relaxation، والـ tone بتظل هي هي
+
+604
+00:48:01,160 --> 00:48:06,060
+والـ pressure بيزيدش، تمام؟ الـ pressure بيزيدش، بس عند
+
+605
+00:48:06,060 --> 00:48:10,000
+level معين بيبدأ الـ pressure ايه؟ يزيد، كل ما زاد الـ
+
+606
+00:48:10,000 --> 00:48:16,420
+pressure في داخل الـ bladder، كلما صار more
+
+607
+00:48:16,420 --> 00:48:19,200
+stimulation لـ stretch receptors، كلما بيصير
+
+608
+00:48:19,200 --> 00:48:23,500
+stimulation لـ stretch receptors، بيصير عندي a
+
+609
+00:48:23,500 --> 00:48:27,060
+micturition reflex، بس هنا زي ما أنتم شايفين، micturition
+
+610
+00:48:27,060 --> 00:48:32,280
+reflex ضعيف، اه، وبعدين بيموت، وبعدين بيزيد الحجم،
+
+611
+00:48:32,280 --> 00:48:36,600
+بيعمل reflex آخر، بيموت، بيعمل، لحد ما يجي لي عند
+
+612
+00:48:36,600 --> 00:48:41,140
+عند levels معينة من الضغط، تمام؟ اللي هو intravesical
+
+613
+00:48:41,140 --> 00:48:44,820
+pressure عالي خالص، هنا very strong reflexes
+
+614
+00:48:44,820 --> 00:48:47,740
+هنا أنتم شايفين، بيصير كل ما تزيد أكثر strong
+
+615
+00:48:47,740 --> 00:48:51,780
+reflexes، لحد ما نصل لـ level معين، أن الـ pressure في
+
+616
+00:48:51,780 --> 00:48:56,420
+داخل الـ ... الـ bladder صار أكبر من الـ pressure في
+
+617
+00:48:56,420 --> 00:49:00,950
+الـ ... المشكلة عندنا الـ external، لأن الـ internal
+
+618
+00:49:00,950 --> 00:49:04,150
+responding to the reflex، الـ internal مث
+
+667
+00:52:58,010 --> 00:53:01,070
+bladder pink
+
+668
+00:53:07,100 --> 00:53:11,880
+in addition to the pelvic nerves عندنا احنا قلنا
+
+669
+00:53:11,880 --> 00:53:14,740
+ثلاث...ثلاث systems عند الـ pelvic nerve في...في...
+
+670
+00:53:14,740 --> 00:53:18,440
+في سلسلة فيه مواطن، مش كده؟ عندي كمان بيجي اللي هو
+
+671
+00:53:18,440 --> 00:53:21,960
+الـ pudendal nerve اللي بيغذّي الـ external
+
+672
+00:53:21,960 --> 00:53:28,700
+sphincter، وفي عندي sympathetic innervation اللي هو
+
+673
+00:53:28,700 --> 00:53:31,600
+هنا بيجي مع الـ hypogastric nerves، إذا عندي
+
+674
+00:53:31,600 --> 00:53:35,480
+hypogastric nerves، تمام؟ ليه يسمونه hypogastric؟
+
+675
+00:53:37,720 --> 00:53:41,080
+لأ هو حقيقة ما له علاقة بالصمّك يعني، ملفوظة بعيدة
+
+676
+00:53:41,080 --> 00:53:44,480
+خالص، بس لأن هذا المنطق سميناها epigastric
+
+677
+00:53:44,480 --> 00:53:49,840
+المقابلها سميناها hypogastric،  يعني لأن إذا
+
+678
+00:53:49,840 --> 00:53:50,320
+واحدة epi
+
+679
+00:53:56,660 --> 00:54:00,340
+هيبو هيبو هيبو
+
+680
+00:54:00,340 --> 00:54:11,100
+هيبو هيبو
+
+681
+00:54:11,100 --> 00:54:14,660
+هيبو
+
+682
+00:54:14,660 --> 00:54:19,340
+هيبو
+
+683
+00:54:19,340 --> 00:54:19,360
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+684
+00:54:19,360 --> 00:54:19,380
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+685
+00:54:19,380 --> 00:54:19,580
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+686
+00:54:19,580 --> 00:54:21,950
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو في الـ...في
+
+687
+00:54:21,950 --> 00:54:29,310
+الـ...في الـ...في الـ...
+
+688
+00:54:29,310 --> 00:54:30,550
+في الـ...في الـ...في الـ...في الـ...في الـ...في الـ
+
+689
+00:54:30,550 --> 00:54:30,750
+الـ...في الـ...في الـ...في الـ...في الـ...في الـ
+
+690
+00:54:30,750 --> 00:54:30,810
+في الـ...في الـ...في الـ...في الـ...في الـ...في الـ
+
+691
+00:54:30,810 --> 00:54:34,790
+...في الـ...في الـ...في الـ...في الـ...في الـ...في
+
+692
+00:54:34,790 --> 00:54:42,310
+الـ...في الـ...
+
+693
+00:54:42,310 --> 00:54:48,930
+في الـ...في الـ...
+
+694
+00:54:49,680 --> 00:54:52,940
+هتاخدوه بالتفصيل...هتاخدوه بالتفصيل، إذا الـ
+
+695
+00:54:52,940 --> 00:54:57,100
+dermatome الجسم هيك موزع لـ dermatomes، الـ
+
+696
+00:54:57,100 --> 00:55:04,660
+dermatome فيها العضلة وفيها الـ...اندو...ميزودرم
+
+697
+00:55:04,660 --> 00:55:08,960
+و اندودرم و اكتودرم، تمام؟ الـ اكتودرم بيديني الجلد
+
+698
+00:55:08,960 --> 00:55:13,600
+والأعصاب، الميزودرم بيديني العضلات والميزودرم و
+
+699
+00:55:13,600 --> 00:55:18,590
+الاندودرم بيديني الـ hollow organs الأعضاء الأحشاء
+
+700
+00:55:18,590 --> 00:55:23,170
+طبعا إذا كان جلد، إذا كان رئتين، إذا كان أمعاء، إذا
+
+701
+00:55:23,170 --> 00:55:32,890
+كان كبد، إذا كان...فكل جزء، كل جزء دي له عصب طبعا
+
+702
+00:55:32,890 --> 00:55:38,470
+لكن الـ sympathetic مش ماشي هيك، لأن احنا من T5 لـ L2
+
+703
+00:55:38,470 --> 00:55:44,590
+طب وإيه اللي فوق الـ T5 وإيه اللي تحت الـ L2؟ ما لهمش
+
+704
+00:55:44,590 --> 00:55:48,250
+sympathetic supply، لهم لذلك في عندي الباقي الـ
+
+705
+00:55:48,250 --> 00:55:52,150
+prevertebral chain، sympathetic chain، هدول كلهم
+
+706
+00:55:52,150 --> 00:55:59,910
+synapsing في هذا الـ chain، تمام؟ ومنها بينزلوا الـ
+
+707
+00:55:59,910 --> 00:56:05,310
+chain تحت الـ L2 وبيطلع الـ chain فوق الـ T الـ T A و
+
+708
+00:56:05,310 --> 00:56:09,730
+من الـ chain بيصير توزيع كل واحدة حسب المناطق، هذا
+
+709
+00:56:09,730 --> 00:56:13,370
+الـ sympathetic، إن شاء الله الدكتور ماجي يدرّسها
+
+710
+00:56:13,370 --> 00:56:19,710
+بالتفصيل، some
+
+711
+00:56:19,710 --> 00:56:23,510
+sensory nerve fibers also pass...أه، إذا النقطة
+
+712
+00:56:23,510 --> 00:56:27,870
+الإضافية هنا، قلنا احنا الـ sympathetic لمن؟ للـ both
+
+713
+00:56:27,870 --> 00:56:31,870
+vessels وبعض الـ sensory nerves passing through the
+
+714
+00:56:31,870 --> 00:56:36,830
+sympathetic، يعني الـ sensory supply أو sense of
+
+715
+00:56:36,830 --> 00:56:41,590
+innervation للبلادر ده، تمام؟ بيروح عبر الـ para
+
+716
+00:56:41,590 --> 00:56:45,210
+sympathetic mainly للبلادر، لكن بعضه بيعدي إلى الـ...
+
+717
+00:56:45,210 --> 00:56:54,100
+عبر الـ sympathetic nerves، مهمة في شعور بالامتلاء وفي
+
+718
+00:56:54,100 --> 00:56:58,780
+بعض الأحيان شعور بالألم، تمام؟ إذا الـ sensory
+
+719
+00:56:58,780 --> 00:57:03,560
+nerves اللي بتدينا الأحساس بالـ fullness والـ pain
+
+720
+00:57:03,560 --> 00:57:08,580
+مع الـ fullness بيزيد، بيصير في إحساس بالألم، مش
+
+721
+00:57:08,580 --> 00:57:11,420
+هيك؟ هدول في الغالب بيكونوا عدوا عبر الـ
+
+722
+00:57:11,420 --> 00:57:18,590
+sympathetic nerves، تمام؟ العضلات من العضلات إلى
+
+723
+00:57:18,590 --> 00:57:20,730
+العضلات العضلات
+
+724
+00:57:27,750 --> 00:57:31,490
+contains smooth muscle and are innervated by both
+
+725
+00:57:31,490 --> 00:57:35,070
+sympathetic and parasympathetic، تمام؟ ولهم هدول
+
+726
+00:57:35,070 --> 00:57:37,630
+extrinsic، هدول sympathetic و parasympathetic جايين
+
+727
+00:57:37,630 --> 00:57:42,310
+من برّا، هدول extrinsic nervous system، في عندي
+
+728
+00:57:42,310 --> 00:57:45,110
+intrinsic plexus اللي قلنا عليها، اللي اسمها
+
+729
+00:57:45,110 --> 00:57:49,860
+intramural intramural، يعني داخل العضلات، شبكة موجودة
+
+730
+00:57:49,860 --> 00:57:52,760
+في العادة هي، إذا كانت العضلات مفصولة على بعضها
+
+731
+00:57:52,760 --> 00:57:55,940
+دائما الشبكة هذه موجودة بين الـ longitudinal والـ
+
+732
+00:57:55,940 --> 00:58:01,080
+الـ circular، لكن لأنه هذا mixed، في كل الاتجاهات، في
+
+733
+00:58:01,080 --> 00:58:04,060
+البلادر اللي...في كل الاتجاهات، فبقدر أقول إنها
+
+734
+00:58:04,060 --> 00:58:08,200
+intramural، شبكة موجودة بين الـ...إيه؟ بين العضلات
+
+735
+00:58:08,200 --> 00:58:13,660
+هذه، إذا الـ intramural plexus هذه بنسميها intrinsic
+
+736
+00:58:13,660 --> 00:58:19,190
+plexus، تمام؟ وهي هذه اللي بتقود الـ...الـ peristaltic
+
+737
+00:58:19,190 --> 00:58:22,510
+movement، تمام؟ والـ sympathetic والـ
+
+738
+00:58:22,510 --> 00:58:26,790
+parasympathetic يا إما بيقوّوها يا إما بيضعفّوها حسب
+
+739
+00:58:26,790 --> 00:58:32,130
+ما حكينا إن الـ parasympathetic بيزيد، لذلك احنا لما
+
+740
+00:58:32,130 --> 00:58:38,130
+الـ hyper peristalsis تصير بتعمل لنا مغص، لما احنا
+
+741
+00:58:38,130 --> 00:58:42,090
+أكثر عندنا مغص كلوي، يعني صار في hyperperistaltic
+
+742
+00:58:42,090 --> 00:58:46,250
+activity من الـ parasympathetic، لذلك إذا أديت أنا
+
+743
+00:58:46,250 --> 00:58:50,190
+حاجة بتسبّب  الـ parasympathetic زي الأتروبين، بيروح المغص
+
+744
+00:58:50,190 --> 00:58:55,950
+لأن أساس الـ hyperperistalsis هذه مقاومة زي الـ...
+
+745
+00:58:55,950 --> 00:58:58,570
+الـ...الـ...الـ intrinsic...الـ intrinsic plexus
+
+746
+00:58:58,570 --> 00:59:01,630
+ما بتعملش such hyperperistalsis، إذا أنا هأقول
+
+747
+00:59:01,630 --> 00:59:05,330
+الـ parasympathetic هو اللي إيه؟ عمله potentiation، إذا
+
+748
+00:59:05,330 --> 00:59:09,830
+أنا أديت أتروبين، تمام؟ parasympathetic فبيروح المغص
+
+749
+00:59:09,830 --> 00:59:14,710
+بيروح، تمام؟ تمام، برجع لـ peristalsis A اللي هي تبع الـ
+
+750
+00:59:14,710 --> 00:59:19,330
+intramural plexus الداخلية، الـ...إذا الـ
+
+751
+00:59:19,330 --> 00:59:25,170
+sympathetic مش غير العكس، بعمل suppression as
+
+752
+00:59:25,170 --> 00:59:28,910
+with other vesical smooth muscles، peristaltic
+
+753
+00:59:28,910 --> 00:59:33,360
+contraction، الذئاب يكونوا مزدوجين زي ما كنت أقول
+
+754
+00:59:33,360 --> 00:59:37,780
+بقى سمبثاوتيكي والعكس صحيح، the normal tone of the
+
+755
+00:59:37,780 --> 00:59:41,160
+detrusor muscle in the bladder wall tends to
+
+756
+00:59:41,160 --> 00:59:45,740
+compress، أنا أحاول أتكلم عن جزء بخصّ الـ base maker
+
+757
+00:59:45,740 --> 00:59:46,860
+أنا أحاول أتكلم عن جزء بخصّ الـ base maker، أنا أحاول
+
+758
+00:59:46,860 --> 00:59:46,940
+جزء بخصّ الـ base maker، أنا أحاول أتكلم عن جزء بخصّ الـ
+
+759
+00:59:46,940 --> 00:59:47,320
+base maker، أنا أحاول أتكلم عن جزء بخصّ الـ base maker
+
+760
+00:59:47,320 --> 00:59:48,200
+أنا أحاول أتكلم عن جزء بخصّ الـ base maker، أنا أحاول
+
+761
+00:59:48,200 --> 00:59:53,220
+أتكلم عن جزء بخصّ الـ base maker، أنا أحاول أتكلم عن
+
+762
+00:59:53,220 --> 00:59:57,220
+جزء بخصّ الـ
+
+763
+01:00:00,580 --> 01:00:06,660
+في بعض الناس، الوضع اللي يتجرّس من خلطة البلاذر ليس
+
+764
+01:00:06,660 --> 01:00:08,800
+أكثر مما يتجرّس من خلطة البلاذر بشكل عادل، لذلك
+
+765
+01:00:08,800 --> 01:00:14,000
+تتجرّس البلاذر من خلطة البلاذر ليس دائماً يتجرّس من
+
+766
+01:00:14,000 --> 01:00:15,440
+خلطة البلاذر بشكل أكثر مما يتجرّس من خلطة البلاذر
+
+767
+01:00:15,440 --> 01:00:17,580
+بشكل عادل
+
+768
+01:00:23,580 --> 01:00:27,960
+ureteral reflex، وله مشاكل كثيرة، تمام؟ بيخرّب في
+
+769
+01:00:27,960 --> 01:00:32,940
+الآخر الكلية، pain sensation in the ureters and
+
+770
+01:00:32,940 --> 01:00:35,700
+uretero-renal reflex، نفسي أنا الآن بدرس حاجة
+
+771
+01:00:35,700 --> 01:00:42,480
+اسمها uretero-renal reflex وأثره على الكلية، الـ
+
+772
+01:00:42,480 --> 01:00:47,340
+reflex هذا بيبدأ بالـ ureter وبينتهي بالـ renal، بالـ
+
+773
+01:00:47,340 --> 01:00:50,970
+bladder، بالـ...بالـ kidney، وإيه في الكلى؟ في blood
+
+774
+01:00:50,970 --> 01:00:51,930
+vessels of the kidney
+
+775
+01:01:20,170 --> 01:01:24,390
+للـ Renal Arteries، بيؤدي إلى إن الـ Spasm هذا
+
+776
+01:01:24,390 --> 01:01:28,690
+إيجابي لبوّلية التكوين اللي هو عامل عامل الـ pressure
+
+777
+01:01:28,690 --> 01:01:32,190
+الزايد، some sort of protection، بيقول الكلية إذا
+
+778
+01:01:32,190 --> 01:01:34,970
+لما بيصير هذا الكلام، الكلية اللي في جهتها الحصوة
+
+779
+01:01:34,970 --> 01:01:39,030
+تصير فيها Spasm للـ blood vessels، وإذا زاد ممكن
+
+780
+01:01:39,030 --> 01:01:43,600
+تصير ischemia للكلية كلها وممكن تضرّها، أساسه
+
+781
+01:01:43,600 --> 01:01:47,220
+مُعمول عشان يقلّل الـ urine formation، عشان يقلّل الـ
+
+782
+01:01:47,220 --> 01:01:52,360
+pressure اللي هو عامل الـ plan، اسمه Uretero Renal
+
+783
+01:01:52,360 --> 01:01:56,760
+Reflex، ناتج عن إنّ Stimulation في الـ ureter تؤدي
+
+784
+01:01:56,760 --> 01:02:02,920
+إلى الـ drop في الـ urine formation بسبب الـ spasm of
+
+785
+01:02:02,920 --> 01:02:06,020
+the arterial system of the kidney
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..95dd6db86a818e1f75cd4cee9d62a1a76542b867
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I_postprocess.srt
@@ -0,0 +1,3140 @@
+1
+00:00:05,380 --> 00:00:08,840
+بنرجع تاني انه الكلية هذه اللي اتكلمنا عنها عملت
+
+2
+00:00:08,840 --> 00:00:12,640
+ball اتكون ال ball و اتركز ال ball و اتخفف ال ball
+
+3
+00:00:12,640 --> 00:00:18,180
+و بنعرف بالظبط ايش عملت هي الان ال ball الان هذا
+
+4
+00:00:18,180 --> 00:00:24,720
+اللي طالع من ال collecting duct نزل ال renal
+
+5
+00:00:24,720 --> 00:00:29,600
+pelvis ال kidney pelvis إلى ال ureter إلى ال
+
+6
+00:00:29,600 --> 00:00:34,300
+bladder الرحلة هذه كلها متغيرش في تركيبهايعني خلاص
+
+7
+00:00:34,300 --> 00:00:41,620
+التغييرات اللي بتصير لحد ال collecting duct لحد ما
+
+8
+00:00:41,620 --> 00:00:47,520
+يطلع الينا من البابلة التركيب بتغيرش أو بيصير
+
+9
+00:00:47,520 --> 00:00:51,160
+minimal changes يعني أحيانا بيصير absorption of
+
+10
+00:00:51,160 --> 00:00:54,900
+water في حالات ما يكون في عندنا obstruction أو كده
+
+11
+00:00:54,900 --> 00:00:59,260
+بتصير نوع من التبديل والتغيير لكنه في الوضع
+
+12
+00:00:59,260 --> 00:01:06,830
+الطبيعي مابيصيرش هذه واحدةدين احنا هنا نتعامل اهل
+
+13
+00:01:06,830 --> 00:01:13,610
+مع ال executory part of the ايه؟ of the job تبع ال
+
+14
+00:01:13,610 --> 00:01:17,970
+urine عمالية احنا صنعناه تمام بس بيبقى نوصله الى
+
+15
+00:01:17,970 --> 00:01:23,190
+السوق المحلية تبعته وهي الى ايه ال ureter و الى ال
+
+16
+00:01:23,190 --> 00:01:27,270
+bladder و الى ال urethra الى الخارج تمام؟ لإن في
+
+17
+00:01:27,270 --> 00:01:33,910
+عندنا system ال system هذا في ال ureterUreter
+
+18
+00:01:33,910 --> 00:01:42,490
+عبارة عن tubular hollow viscous زي ال .. ال
+
+19
+00:01:42,490 --> 00:01:49,850
+intestine زي ايش؟ ال intestine زي ال .. ال أشياء
+
+20
+00:01:49,850 --> 00:01:54,170
+الكتيرة tubular زي كده في الجسم فيهم نفس النظام شو
+
+21
+00:01:54,170 --> 00:01:58,190
+نظام هذا؟ يعني في عندهم داخليا حاجة بيسموها base
+
+22
+00:01:58,190 --> 00:02:02,050
+makerهندرسها بالتفصيل ان شاء الله لما ندرس ال GIT
+
+23
+00:02:02,050 --> 00:02:08,110
+في عندهم حاجة اسمها slow waves هنا موجود نفس
+
+24
+00:02:08,110 --> 00:02:15,410
+النظام موجود ما ينترك بليكساس في ال .. في ال .. ال
+
+25
+00:02:15,410 --> 00:02:21,710
+GIT هنا موجود بليكساس network من الأعصاب الداخلية
+
+26
+00:02:21,710 --> 00:02:27,570
+اللي هي تكون بعملية ال peristalsis طبعا عملية ايه؟
+
+27
+00:02:27,570 --> 00:02:31,630
+الحركة الدوديةلأن البول لا ينتقل من عند ال
+
+28
+00:02:31,630 --> 00:02:35,630
+collecting duct يعني من ال minor calyx اللي هو كل
+
+29
+00:02:35,630 --> 00:02:40,010
+collecting duct بتنتهي في minor calyx مش كده؟
+
+30
+00:02:40,010 --> 00:02:47,330
+collecting duct فيها أكم .. أكم .. أكم ..
+
+31
+00:02:47,330 --> 00:02:51,690
+collecting duct بتصوب في ال minor calyx 250
+
+32
+00:02:53,150 --> 00:02:57,510
+مش كده؟ اه 250 فعندي كل 250 فيه اللي هو minor
+
+33
+00:02:57,510 --> 00:03:03,130
+calix ال minor calix هذا لما يسلم ال drop of urine
+
+34
+00:03:03,130 --> 00:03:07,950
+الطالعة هذه بتنتخل منه إلى ال bladder عن طريق ال
+
+35
+00:03:07,950 --> 00:03:12,310
+pedistalsis مابتنزلش by gravity أو by weight تمام؟
+
+36
+00:03:12,310 --> 00:03:15,530
+اذا في عندي حركة دودية بتبدأ من هنا من ال minor
+
+37
+00:03:15,530 --> 00:03:21,150
+calix إلى ال bladderالحركة الدودية هذه تعتمد في
+
+38
+00:03:21,150 --> 00:03:25,530
+وجودها على مين؟ على ال intrinsic plexus الموجودة
+
+39
+00:03:25,530 --> 00:03:30,070
+ال .. ال nerve plexus ال nerve network شبكة
+
+40
+00:03:30,070 --> 00:03:34,730
+العصبية اللي موجودة في داخل ال unitary هذه الشبكة
+
+41
+00:03:34,730 --> 00:03:40,650
+هي اللي بتكون بعمل ترتيب ال .. الحركة الدودية هذه
+
+42
+00:03:40,650 --> 00:03:45,480
+بالاضافة لها أعصابالـ Parasympathetic من autonomic
+
+43
+00:03:45,480 --> 00:03:50,820
+nervous system بيزود حركتها و يضاف إليها عصابي
+
+44
+00:03:50,820 --> 00:03:54,920
+sympathetic بيجلل حركتها إذا في عندى شبكة ممكن
+
+45
+00:03:54,920 --> 00:03:59,780
+يزيد حركتها أو يجل حركتها تمام حسب ال autonomic
+
+46
+00:03:59,780 --> 00:04:02,500
+nervous system هذا انتوا درستوا ال autonomic
+
+47
+00:04:02,500 --> 00:04:06,240
+nervous system؟ قولوا إنها في جسمين و كل جسم مختلف
+
+48
+00:04:06,240 --> 00:04:10,970
+عن التانياللي هنا بالذات اللي بيتحكم في الحركة ال
+
+49
+00:04:10,970 --> 00:04:15,390
+parasympathetic system و ال parasympathetic system
+
+50
+00:04:15,390 --> 00:04:19,830
+هذا انتوا عارفين ال sympathetic عن ال
+
+51
+00:04:19,830 --> 00:04:23,210
+parasympathetic بيخلف في بعض المواصفات منها ال
+
+52
+00:04:23,210 --> 00:04:26,570
+gangrene تبعه وين؟ او منها ال boss ganglionic
+
+53
+00:04:26,570 --> 00:04:30,650
+nerve fiber وين؟ او جديش دايما ال parasympathetic
+
+54
+00:04:31,490 --> 00:04:35,390
+الجانجل يتبعها بيكون يا إما في الviscous نفسه يا
+
+55
+00:04:35,390 --> 00:04:39,090
+إما close to it يا إما في نفس ال world يا إما جاري
+
+56
+00:04:39,090 --> 00:04:42,430
+منها وهنا الجانجل تبع البره sympathetic اللي هي
+
+57
+00:04:42,430 --> 00:04:46,830
+بتتحكم في ال ureters أو بتزيد حركة الدولية تبع ال
+
+58
+00:04:46,830 --> 00:04:52,170
+uretersموجودة inside the ايه؟ the ureteric tissues
+
+59
+00:04:52,170 --> 00:04:55,850
+تمام؟ و ال boss ganglionic fibers كده very short
+
+60
+00:04:55,850 --> 00:04:59,410
+boss ganglionic fibers مش كده؟ موجودين في الداخل
+
+61
+00:04:59,410 --> 00:05:06,530
+او هم شبكين حقيقة من ضمن ال ال ال intrinsic nerve
+
+62
+00:05:10,900 --> 00:05:13,880
+قلنا حاجة تانية في ال base maker ماكملنا في الكلام
+
+63
+00:05:13,880 --> 00:05:18,900
+عنها هذول ال hollow viscous organs او ال tubular
+
+64
+00:05:18,900 --> 00:05:21,980
+organs اللي فيهم بال ecstatic movement بيكون عندهم
+
+65
+00:05:21,980 --> 00:05:29,560
+فيه حركة حركة تغير في الأيونات زي ال base maker
+
+66
+00:05:29,560 --> 00:05:33,900
+لكن
+
+67
+00:05:33,900 --> 00:05:43,200
+هذه الحركة التأيون بتعمل تغير فيال .. ال .. ال
+
+68
+00:05:43,200 --> 00:05:45,500
+resting membrane potential بتعرفوا resting
+
+69
+00:05:45,500 --> 00:05:48,060
+membrane potential مش كده؟ ال resting membrane
+
+70
+00:05:48,060 --> 00:05:52,180
+potential هذا بيضل يتغير يعمل depolarization و
+
+71
+00:05:52,180 --> 00:05:54,580
+repolarization , depolarization و repolarization
+
+72
+00:05:54,580 --> 00:06:00,600
+بشكل تلقائي بس مش بشكل يوصله لل action potential
+
+73
+00:06:00,600 --> 00:06:05,920
+لل actual contraction لكن في عندنا ايه؟ تغيرات
+
+74
+00:06:05,920 --> 00:06:11,480
+متواصلةهنا بسميها intrinsic slow pace maker
+
+75
+00:06:11,480 --> 00:06:19,440
+activities وهنا بسميها slow waves في ال GITهدول ال
+
+76
+00:06:19,440 --> 00:06:24,220
+slow waves هدول او ال changes اللي بيصير على ال
+
+77
+00:06:24,220 --> 00:06:28,580
+resting membrane potential هدول جاهزين انه اذا اجا
+
+78
+00:06:28,580 --> 00:06:32,460
+initiation stretch drop of urine كذا بيعملهم
+
+79
+00:06:32,460 --> 00:06:38,880
+potentiation تقوية و بيصير عندي ال base maker هذا
+
+80
+00:06:38,880 --> 00:06:41,140
+strong enough to make peristaltic movement
+
+81
+00:06:41,140 --> 00:06:44,980
+contractions تمام؟ اذا في عندنا موجود فيهم
+
+82
+00:06:47,530 --> 00:06:51,730
+Intrinsic Basemaker Properties Basemaker عارفين
+
+83
+00:06:51,730 --> 00:06:55,170
+ايش يعني Basemaker انتوا مادرستوش اللي هندلسوا ال
+
+84
+00:06:55,170 --> 00:06:58,990
+Basemaker بشكل رئيسي حقيقية تانية اللي هندلسوه ال
+
+85
+00:06:58,990 --> 00:07:04,410
+heart عشان ايه ال S A node كيف انها هي اللي بتقود
+
+86
+00:07:04,410 --> 00:07:13,390
+حركة القبضات القلب اذا اليوم احنا هنتكلم عن عملية
+
+87
+00:07:15,560 --> 00:07:22,040
+ال mixuration فيها
+
+88
+00:07:22,040 --> 00:07:26,580
+ال
+
+89
+00:07:26,580 --> 00:07:36,060
+pore بينتقل من ال kidney pelvis الى ال bladder عن
+
+90
+00:07:36,060 --> 00:07:41,160
+طريق ال peristalsis الواحد لو كان رأسه تحت وجليه
+
+91
+00:07:41,160 --> 00:07:45,630
+فوق برضه ال urine كانgo from the kidney to the
+
+92
+00:07:45,630 --> 00:07:50,790
+bladder مش كده يعني مش بس بال gravity طبعا وجود ال
+
+93
+00:07:50,790 --> 00:07:55,090
+gravity بيساعد لكن مش هي ال ايه الأساس زي ما هتكلم
+
+94
+00:07:55,090 --> 00:07:59,210
+في البلع في ال ossophagus في ال GIT وجود ال
+
+95
+00:07:59,210 --> 00:08:04,430
+gravity بيساعد لكن هذا مش هو ال ايه الأساس ال
+
+96
+00:08:04,430 --> 00:08:11,050
+bladder ال ureter هذا لما يصل ل bladder في بعض
+
+97
+00:08:11,050 --> 00:08:19,660
+المواصفاتالهدف من هذه المواصفات ان البلدار بتجمع
+
+98
+00:08:19,660 --> 00:08:26,060
+بول و بتجمع بول و بتجمع بول بيزيد الضغط فيها طب
+
+99
+00:08:26,060 --> 00:08:30,100
+ممكن يرجع مدن في انبوبة واصلة ممكن يرجع البول الى
+
+100
+00:08:30,100 --> 00:08:35,320
+ال .. ال unitary في الطبيعي بيصيرش بس أحيانا
+
+101
+00:08:35,320 --> 00:08:40,160
+منلاحظها reflex unitary reflex أحيانا منلاحظها
+
+102
+00:08:40,960 --> 00:08:44,700
+مشكلة عند بعض الناس مشكلة كبيرة قدرهم عملية او كده
+
+103
+00:08:44,700 --> 00:08:50,240
+لكن هذه المسألة في الطبيعي مش موجودة يعني في عندي
+
+104
+00:08:50,240 --> 00:08:56,260
+sphinctric like action او valvular like action هنا
+
+105
+00:08:56,260 --> 00:09:01,110
+بتقدر الى انه ايه؟البول لما يجيبك في ال bladder و
+
+106
+00:09:01,110 --> 00:09:04,590
+يزيد الضغط فيه مايرجعش، مابتعرفوا الفرق انتوا بين
+
+107
+00:09:04,590 --> 00:09:10,850
+ال sphincter و الvalve؟ مابتعرفوش ال sphincter
+
+108
+00:09:10,850 --> 00:09:19,990
+muscle ا strengthen ا thickened و getting stronger
+
+109
+00:09:19,990 --> 00:09:24,050
+than the usual يعني دايما عندها في المنطقة العضلة
+
+110
+00:09:24,050 --> 00:09:27,430
+تبعت ال hollow organ هذي في المنطقة هذي بيلاقي ال
+
+111
+00:09:27,430 --> 00:09:34,450
+circularمصله خملت تمام بحيث انها ايه اتعمل سفينكتر
+
+112
+00:09:34,450 --> 00:09:41,870
+حقا حقيقة مش موجود التشكيلة هذه لكن ال blood roll
+
+113
+00:09:41,870 --> 00:09:50,090
+نفسها عضلات ففي المنطقة هذه عاملة contraction يعني
+
+114
+00:09:50,090 --> 00:09:53,330
+عاملة سفينكتر السفينكتر action هى تبعنا جاي من ال
+
+115
+00:09:53,330 --> 00:09:57,150
+blood rollبمعنى ان العضلات تبع البلدار هي اللي
+
+116
+00:09:57,150 --> 00:10:02,590
+بتشد على مين؟ على ال .. على ال ureter مش كده هو بس
+
+117
+00:10:02,590 --> 00:10:07,950
+ال ureter مش داخل البلدار كده لأ داخل البلدار بيخش
+
+118
+00:10:07,950 --> 00:10:11,730
+اوبليك في ال .. ال .. ال .. في ال bladder muscles
+
+119
+00:10:11,730 --> 00:10:15,090
+بيخش فيها أوبليك بحيث انه يبقى كمية كبيرة من
+
+120
+00:10:15,090 --> 00:10:19,530
+العضلات محيطة بيه تمام؟ بعد ما يبقى أوبليك و يطلع
+
+121
+00:10:19,530 --> 00:10:25,240
+كمان بيخش أوبليك تحت الميكوزاطبعا اذا بتانطل ال
+
+122
+00:10:25,240 --> 00:10:30,680
+blooder هذي بيخش تحتها أبليكي اذا لما بيدنطلق ال
+
+123
+00:10:30,680 --> 00:10:34,540
+blooder و بزيد الضغط فيها الضغط هم بيضغط عليهم
+
+124
+00:10:34,540 --> 00:10:37,920
+التريل تحت الميكروفزة بيسكروا هذا الvalvular
+
+125
+00:10:37,920 --> 00:10:42,360
+action الvalvular action انه في عندنا شفرات او
+
+126
+00:10:42,360 --> 00:10:45,640
+شفاف خارجية عن ال .. هذي لما زيد الضغط و تحيه
+
+127
+00:10:45,640 --> 00:10:51,420
+بتسكر في ال elucical junction تبع ال .. انا ممكن
+
+128
+00:10:51,420 --> 00:10:57,620
+اوريكوا يعنىالـ electrical junction تبع الاليام
+
+129
+00:10:57,620 --> 00:11:03,860
+الانتستين الأمعاق الدقيقة لما نخش في ال سيكم تمام
+
+130
+00:11:03,860 --> 00:11:08,740
+نخش في السيكم بيعمل هيك بتلاقي شفاف برا هذه
+
+131
+00:11:08,740 --> 00:11:13,040
+المنطقة السفينتر لكن هذه المنطقة ال valve فلما
+
+132
+00:11:13,040 --> 00:11:16,340
+السيكم بيعمل contraction هذا الناس بيطبقوا مع بعض
+
+133
+00:11:16,340 --> 00:11:22,130
+و بيمنعوا ان ايه لكن ال valveبيبقى مسكر في وقت ما
+
+134
+00:11:22,130 --> 00:11:27,370
+بيلزم انه نمنع الاشي يدخل لكن لما يصير Intramural
+
+135
+00:11:27,370 --> 00:11:31,370
+pressure زاد ال Intravicycle pressure بيقدرش يرجع
+
+136
+00:11:31,370 --> 00:11:35,410
+لإنه الvalvular action بيسكر فبيمنع .. بيريح
+
+137
+00:11:35,410 --> 00:11:39,150
+العضلة مش محتاجة هي العضلة تشتغل لكن لو هذا من عمل
+
+138
+00:11:39,150 --> 00:11:43,950
+بطريقة تانية كان direct perpendicular فمعناه
+
+139
+00:11:43,950 --> 00:11:47,970
+الvalvular action هذا راح ان الميل هي انه ميشي
+
+140
+00:11:47,970 --> 00:11:53,060
+فترةفي داخل ال .. تحت الميكوزا بقدر .. لما يزيد
+
+141
+00:11:53,060 --> 00:11:57,580
+الضغط اه يضغط عليه على الجسم الفكرة هذه يعني
+
+142
+00:11:57,580 --> 00:12:02,960
+موجودة في تركيب بني آدم كتير موجود في تركيب بني
+
+143
+00:12:02,960 --> 00:12:08,400
+آدم في عدة أشياء في بعض ال veins موجودة في العضو
+
+144
+00:12:08,400 --> 00:12:14,020
+الذكري لل .. لل .. للبني آدمالـ veins هي طالعة
+
+145
+00:12:14,020 --> 00:12:18,980
+برضه تطلعش مباشرة emisary veins تطلعش مباشرة لأ
+
+146
+00:12:18,980 --> 00:12:22,920
+تمشي تحت ال mycosis شوية تحت ال structure و بعدين
+
+147
+00:12:22,920 --> 00:12:28,810
+بتطلعبحيث إنه إذا زاد الضغط بيسكرها فبيقدر إلى إنه
+
+148
+00:12:28,810 --> 00:12:32,550
+مش إنه الدم بيخش و يتحرب بسرعة بيظل مضغوط و مسكر
+
+149
+00:12:32,550 --> 00:12:36,310
+تمام؟ لما يهبط الضغط بجل الضغط عليها فبتروح ايه؟
+
+150
+00:12:36,310 --> 00:12:40,410
+بيصير rapid evacuation
+
+151
+00:12:40,410 --> 00:12:44,370
+يعني ال system هذا موجود في الجسم في أكتر من مكان
+
+152
+00:12:44,370 --> 00:12:47,890
+.. احنا اليوم بنفهم و قاعدين اليوم بنفهم و بنعرف
+
+153
+00:12:47,890 --> 00:12:51,730
+ايش اسمه .. انه يعني .. ايش ما شاء الله لكن ما
+
+154
+00:12:51,730 --> 00:12:55,730
+أعتقد إنه هادمان حاله لحالهمش ايه ولا .. فال
+
+155
+00:12:55,730 --> 00:13:01,530
+bladder نازل فيها ال ureter Oblique و بعدين بيخش
+
+156
+00:13:01,530 --> 00:13:07,250
+صبم ال mucus ممشي فترة و بعدين بيفتح ال .. في داخل
+
+157
+00:13:07,250 --> 00:13:12,610
+ال bladder cavity لكن هذه التركيب بيخلي انه مافيش
+
+158
+00:13:12,610 --> 00:13:16,870
+عندي انا .. انا فاكر اول .. من اول ال .. كنت لسه
+
+159
+00:13:16,870 --> 00:13:22,190
+خارجي جديد و شوفت بنت عندها recurrent
+
+160
+00:13:24,350 --> 00:13:32,050
+الالتهابات مابتتوقفش مش ال ال ال كلية دايما عندها
+
+161
+00:13:32,050 --> 00:13:36,510
+إيه فيها التهاب تمام فاحملنا لها الصور اللي لازمة
+
+162
+00:13:36,510 --> 00:13:37,870
+و مفتشفتوا عندها reflex
+
+163
+00:13:40,580 --> 00:13:43,920
+إن ال بول اللي في ال blood هذا بيقدر إيش؟ يرجح،
+
+164
+00:13:43,920 --> 00:13:47,680
+تمام؟ بيقدر إيش؟ يرجح، فهذا بيقدر إلى مشاكل كتيرة
+
+165
+00:13:47,680 --> 00:13:51,440
+لإن الضغط صار ينتقل ال blood إلى ال ureter، الضغط
+
+166
+00:13:51,440 --> 00:13:54,000
+صار ينتقل إلى ال ureter و بعد ما ينتقل ال ureter
+
+167
+00:13:54,000 --> 00:13:58,340
+ينتقل لمين؟ للكيلية، و بيبدأ يخرب، يعني الضغط
+
+168
+00:13:58,340 --> 00:14:01,220
+الموجود في الكيلية بتبدأ ال pelvis ده بقى هينتفش،
+
+169
+00:14:01,220 --> 00:14:04,020
+ينتفش على حسب من؟ على حسب ال tissues، بيشدّق،
+
+170
+00:14:04,020 --> 00:14:07,140
+بيفردها، و بعدين الكيلية بيصير .. بيصيرها إيه؟
+
+171
+00:14:07,140 --> 00:14:13,240
+بيسميها hydronephrosisيعني الكلية انتفخت كده ..
+
+172
+00:14:13,240 --> 00:14:21,320
+كده انتفخت و توسعت و كبرت اذا يعني أقل الأشياء
+
+173
+00:14:21,320 --> 00:14:26,520
+أحيانا مالاجي لها أخطر اي شي بسيط اي شي .. اي شي
+
+174
+00:14:26,520 --> 00:14:30,780
+في جسم الإنسان بكرا ما تدرسوا الأمراض كلها بتلاقوا
+
+175
+00:14:30,780 --> 00:14:34,960
+العلم لمرض ضخم جدا انه في enzyme معين .. enzyme
+
+176
+00:14:34,960 --> 00:14:41,350
+معين في .. من gene معين ماعرفش إيشفقد صلاحيته مش
+
+177
+00:14:41,350 --> 00:14:44,890
+.. مش شجعه فبيقدّي إلي سلسلة من الأفعال مش بينتج
+
+178
+00:14:44,890 --> 00:14:49,970
+عنها مرض كبير و هترجع لمرض بتلاقيه و برجع لإيه ..
+
+179
+00:14:49,970 --> 00:14:54,850
+لإيش بسيط جدا فالجسم مبني بشكل من الكفاءة العالية
+
+180
+00:14:55,230 --> 00:14:58,730
+اللي انا معجب في كتاب غايتون دائما بينبض المسائل
+
+181
+00:14:58,730 --> 00:15:03,570
+هذه و دائما بيورّج كدهش ال system الجهاز البني آدم
+
+182
+00:15:03,570 --> 00:15:07,450
+كدهش الكفاءة
+
+183
+00:15:07,450 --> 00:15:10,630
+فيه موجودة و هذا من الطبيعي للواحد لما يدرس جسم
+
+184
+00:15:10,630 --> 00:15:16,210
+البني آدم يحسبها الكفاءة هذه في كل فرع من أفرع ال
+
+185
+00:15:16,210 --> 00:15:20,570
+physiology او الدراسة اللي هو بيعملها عن الوظائف
+
+186
+00:15:20,570 --> 00:15:26,960
+في جسم الإنسانطيب إذا عندنا ال ureter بيدخل بشكل
+
+187
+00:15:26,960 --> 00:15:31,020
+معين و هذا بيمنع ال reflex ان الرجوع الارتجاع تبع
+
+188
+00:15:31,020 --> 00:15:41,620
+ال bone لإن الارتجاعة دلوقت مشاكل كبيرة علشان
+
+189
+00:15:41,620 --> 00:15:45,660
+يصير عندى علشان يصير عندنا
+
+190
+00:15:48,610 --> 00:15:53,410
+بعد ما اتحوش ال ball في ال .. في ال bladder عشان
+
+191
+00:15:53,410 --> 00:15:57,070
+يصير عندنا evacuation، بنحتاج أن يصير عندنا حاجة
+
+192
+00:15:57,070 --> 00:16:00,350
+مثلا ميكتوريشن ريفليكس، نحتاج أن يصير عندنا
+
+193
+00:16:00,350 --> 00:16:04,590
+ميكتوريشن ريفليكس، يعني أنا مابعرفش أجد ال bladder
+
+194
+00:16:04,590 --> 00:16:08,860
+تبعتي مجدش فيها ballهم اضطر انه انا لازم اروح
+
+195
+00:16:08,860 --> 00:16:13,080
+الحمام الآن و الا هفكر التحكم ولا لأ؟ في system
+
+196
+00:16:13,080 --> 00:16:18,200
+موجود بنبهني و بعرفني و لما انا يعني ييجي الوقت
+
+197
+00:16:18,200 --> 00:16:22,460
+المناسب بقدر انه ببساطة من غير ما اعمل اي حاجة بس
+
+198
+00:16:22,460 --> 00:16:26,490
+اخد قرار انه اناناوي ان اعمل evacuation ل البلدة
+
+199
+00:16:26,490 --> 00:16:30,310
+فبصير العملية سهولة هذا اللي احنا تقريبا هندرسه
+
+200
+00:16:30,310 --> 00:16:36,110
+طول الساعة هذه اللي احنا فيها طبعا هذا بتطلب اول
+
+201
+00:16:36,110 --> 00:16:44,930
+اشي انه ندرس تركيب البلدة الهادي تركيب البلدة
+
+202
+00:16:44,930 --> 00:16:52,970
+الهادي تمام؟ اذا من الكليةلل بلدر عندنا ال ureter
+
+203
+00:16:52,970 --> 00:16:55,870
+قولنا كيف بدخل في البلدر وقولنا انه peristaltic
+
+204
+00:16:55,870 --> 00:16:59,730
+movement وقولنا انه في عندنا base maker activity
+
+205
+00:16:59,730 --> 00:17:03,550
+initiated by the stretch اللي بيحصل من وجود له
+
+206
+00:17:03,550 --> 00:17:06,950
+drop يعني ال drop في المكان المعين فهذا initiating
+
+207
+00:17:06,950 --> 00:17:10,550
+ال ايه peristaltic wave تاخد ال drop هذه معاها إلى
+
+208
+00:17:10,550 --> 00:17:17,250
+ايه؟ إلى البلدر اذا دلوقتي الدراسة مركزة ع مين؟
+
+209
+00:17:17,250 --> 00:17:23,390
+على البلدر تمام؟ على البلدرالبلادر التركيبتها هي
+
+210
+00:17:23,390 --> 00:17:30,370
+ال urinary bladder ال .. ال viscous organs برضه زي
+
+211
+00:17:30,370 --> 00:17:35,550
+ال GIT نلاحظ أنه عندنا ال .. مش كمان طبعا ال من ال
+
+212
+00:17:35,550 --> 00:17:39,150
+smooth muscles مش هيك؟ ال smooth muscles إلها
+
+213
+00:17:39,150 --> 00:17:48,030
+ميوكوزا و إلهاهن .. هنلاقي ال smooth muscles
+
+214
+00:17:48,030 --> 00:17:53,350
+تبعوننا ماخدين اتجاهات مختلفة يعني مش كلهم
+
+215
+00:17:53,350 --> 00:17:56,310
+longitudinal .. longitudinal لأ muscle fibers
+
+216
+00:17:56,310 --> 00:17:59,770
+ماخدة اتجاهات مختلفة لأن هي دائرية يعني فمخدة
+
+217
+00:17:59,770 --> 00:18:05,390
+اتجاهات مختلفة ال muscle fibers متصلة بعضها البعض
+
+218
+00:18:05,390 --> 00:18:09,470
+في cytoplasmic connection بين .. في gap junction
+
+219
+00:18:09,470 --> 00:18:15,240
+بينهمالسبب انه لو صار stimulation لأى muscle
+
+220
+00:18:15,240 --> 00:18:21,740
+fibers هذا ال stimulus بينتشر ك action potential
+
+221
+00:18:21,740 --> 00:18:27,880
+من muscle fibers بحيث تصبح contraction of the
+
+222
+00:18:27,880 --> 00:18:29,020
+whole bladder
+
+223
+00:18:41,440 --> 00:18:44,600
+بالرغم ان احنا بنتكلم عن .. عن smooth muscle
+
+224
+00:18:44,600 --> 00:18:49,420
+fibers قطرها على خمسين micron و ثمكتها اتنين لعشرة
+
+225
+00:18:49,420 --> 00:18:53,520
+micron يعني ايه ماهياش أشياء كبيرة اللي هنا معمولة
+
+226
+00:18:53,520 --> 00:18:58,170
+بشكل نسيج انه كأنهم كلهم واحدة واحدةكأنهم كلهم
+
+227
+00:18:58,170 --> 00:19:02,910
+واحدة واحدة لو شوفنا هنا ال epithelium هذا القطع
+
+228
+00:19:02,910 --> 00:19:06,730
+اللي موجود لو شوفنا ال epithelium هان الميكوزا هذه
+
+229
+00:19:06,730 --> 00:19:10,350
+الميكوزا الميكوزا هذه من النوع يسميها transitional
+
+230
+00:19:10,350 --> 00:19:16,070
+epithelium درسوه في .. مادرسوش انتوا histology؟ اه
+
+231
+00:19:16,070 --> 00:19:23,100
+ليش transitional؟ لأنهأيوة بيفرد هيك بتحول إلى من
+
+232
+00:19:23,100 --> 00:19:29,100
+striated ل columnar ل cuboid ل .. ممكن flat cells
+
+233
+00:19:29,100 --> 00:19:33,240
+تصير بتغير شكلها من مجد و مجد حسب جدريش هي إيه
+
+234
+00:19:33,240 --> 00:19:36,980
+تفرد ممكن ترجع تاني إلى إنها تبقى striated من أول
+
+235
+00:19:36,980 --> 00:19:41,200
+و جديد إذا في عندنا ال bladder نسميها detrosar
+
+236
+00:19:41,200 --> 00:19:45,140
+muscle عشان نسميها detrosal .. detrosar muscle
+
+237
+00:19:45,140 --> 00:19:51,980
+طبعا ك bladder موجودةوبريتونيوم حوالينا لذا اكيد
+
+238
+00:19:51,980 --> 00:19:53,660
+في طبقة من البريتونيوم بتغطي
+
+239
+00:20:03,070 --> 00:20:09,170
+هذا ال دولتينيام بيغطى بس
+
+240
+00:20:09,170 --> 00:20:13,050
+السطح و بعدين بروح على ال wall of the pelvis و
+
+241
+00:20:13,050 --> 00:20:17,110
+بكمل على ال abdominal wall بيصيب برايتان تمام؟ اذا
+
+242
+00:20:17,110 --> 00:20:22,080
+بس السطح هنا في عندنا أدريتيشيااللي هو الطبجة
+
+243
+00:20:22,080 --> 00:20:27,020
+الأخيرة كنت بتفتشه ليها اللي هي تحمي ال muscles و
+
+244
+00:20:27,020 --> 00:20:32,180
+تبقى فيها حاملة العصاب و الشرايين و الأشياء اللي
+
+245
+00:20:32,180 --> 00:20:36,440
+ايه وسائل النقطة زي اللي بنعمل احنا false sealing
+
+246
+00:20:36,440 --> 00:20:40,100
+لما نشتغل في مباني كبيرة و في وسط ال false sealing
+
+247
+00:20:40,100 --> 00:20:42,620
+هذا اللي بنحط ال ducts تبع ال conditioning و
+
+248
+00:20:42,620 --> 00:20:45,940
+الكهرة و الدنيا كلها فهو كأنه طبج هادى عشان حامل
+
+249
+00:20:45,940 --> 00:20:48,960
+الخدمات اللي موجودة على العضلة
+
+250
+00:20:53,360 --> 00:20:59,580
+طيب، هنكمل مشوارنا مع هذه، هنرجع تاني ل ال .. ال
+
+251
+00:20:59,580 --> 00:21:04,260
+muscle هذه ال blood .. ال blood .. ال .. ال .. ال
+
+252
+00:21:04,260 --> 00:21:07,840
+.. ال blood are تنقسم لجسمين، تنقسم لجسمين، تنقسم
+
+253
+00:21:07,840 --> 00:21:12,040
+إلى ال body of the bladder و bladder neck، هذه
+
+254
+00:21:12,040 --> 00:21:16,810
+المنطقة اسمها bladder neck، عنق المثالةال bloody
+
+255
+00:21:16,810 --> 00:21:20,850
+neck مفترض ان هو زي ال .. طبعا المنطجة اللي بديج
+
+256
+00:21:20,850 --> 00:21:25,550
+فيها ال .. ال .. ال .. ال bloody body بديج هيك و
+
+257
+00:21:25,550 --> 00:21:31,170
+بعدين بيتحول الى .. ال tube تبارك؟ بس المنطجة هذه
+
+258
+00:21:31,170 --> 00:21:37,600
+حقيقةمنشوفهاش احنا عاملة funnel shape زي القمع الا
+
+259
+00:21:37,600 --> 00:21:41,040
+اذا كان في عندي relaxation العضلات لكن في العادة
+
+260
+00:21:41,040 --> 00:21:43,860
+هاللي ولا منها قمعية الا ان في عندي هذه المنطقة
+
+261
+00:21:43,860 --> 00:21:50,580
+فيها intrinsic او internal sphincterهو internal و
+
+262
+00:21:50,580 --> 00:21:53,560
+intrinsic في نفس الوقت لأنه involuntary internal
+
+263
+00:21:53,560 --> 00:21:58,160
+sphincter
+
+264
+00:21:58,160 --> 00:22:03,880
+of the bladder sphincter دايما ضغط يخلق مش ببين
+
+265
+00:22:03,880 --> 00:22:08,680
+انها اي فضل شاب اما هو اذا عمل relaxation بيتسع و
+
+266
+00:22:08,680 --> 00:22:13,440
+بعدين بيجي ال urethra ال urethra هذه ممكن نسميها
+
+267
+00:22:13,440 --> 00:22:16,780
+بصيله ال urethra من ناحية ال urethra اذا بدأنا في
+
+268
+00:22:16,780 --> 00:22:20,160
+ال urethra من الأول همي نقول عنديبناء اليوريثرة
+
+269
+00:22:20,160 --> 00:22:27,180
+وبعدين مبنى اسمه يوريثرة وبعدين بروستيك يوريثرة
+
+270
+00:22:27,180 --> 00:22:32,280
+وبعدين بوستيليوريثرة الجزء الأخير اللي ايه؟ هذا
+
+271
+00:22:32,280 --> 00:22:36,780
+الجزير الجزء الأخر ممكن نسميها بوستيليوريثرة هذا
+
+272
+00:22:36,780 --> 00:22:41,880
+الجزء لكن النكهة اللي هنا و الجزء هذا نسميه بلدر
+
+273
+00:22:41,880 --> 00:22:44,960
+نكهة ال funnel shape يعني اللي هو هذا اللي هنا في
+
+274
+00:22:44,960 --> 00:22:50,550
+عنده عضلةInternal sphincter
+
+275
+00:22:50,550 --> 00:22:55,190
+of the
+
+276
+00:22:55,190 --> 00:22:58,730
+urinary bladder وهنا عندنا external sphincter ال
+
+277
+00:22:58,730 --> 00:23:02,310
+external sphincter عبارة عن isolated muscles
+
+278
+00:23:02,310 --> 00:23:10,550
+voluntary جزء من ال pelvic floor floor of the
+
+279
+00:23:10,550 --> 00:23:10,970
+pelvis
+
+280
+00:23:15,850 --> 00:23:20,070
+في عضلة كبيرة levator هنا اسمها هذه فتحالي فتحت
+
+281
+00:23:20,070 --> 00:23:23,710
+هنا عشان يطلع فيها فتحة ال vector او ال anus ال
+
+282
+00:23:23,710 --> 00:23:30,070
+canal و يطلع فيها ال vagina و يطلع ال eugenital
+
+283
+00:23:30,070 --> 00:23:36,910
+triangle نسميه المنطقة
+
+284
+00:23:36,910 --> 00:23:42,570
+العضلات في المنطقة هذه مقوة و معمولة اللي هي بتحكم
+
+285
+00:23:43,130 --> 00:23:48,310
+في الحالتنا هذه متحكم في ال evacuation و ال
+
+286
+00:23:48,310 --> 00:23:51,170
+maturation تمام؟ إذا أنا متحكم في ال maturation
+
+287
+00:23:51,170 --> 00:23:57,270
+هذه العضلة بنتسميها external اه external sphincter
+
+288
+00:23:57,270 --> 00:23:59,150
+إذا في عندك external sphincter عندك internal
+
+289
+00:23:59,150 --> 00:24:02,480
+sphincterهنلاحظ بعد شويه ان ال external sphincter
+
+290
+00:24:02,480 --> 00:24:06,440
+هذا انا بتحكم فيه انا بتقرر انه لما تجين الرغبة في
+
+291
+00:24:06,440 --> 00:24:09,660
+ال ball ان انا اتنول ولا لأ بقدر اوامر ال
+
+292
+00:24:09,660 --> 00:24:12,540
+sphincter هذا ال external افتح ولا لأ لكن ال
+
+293
+00:24:12,540 --> 00:24:15,520
+internal sphincter هذا مش غير reflex اذا تلت
+
+294
+00:24:15,520 --> 00:24:20,900
+المثالة و اشتدت فهو بيفتح فبنحس انه في رغبة شديدة
+
+295
+00:24:21,630 --> 00:24:25,510
+ممكن ال external researcher يفتح و يكمل و يقول لأ
+
+296
+00:24:25,510 --> 00:24:29,390
+مش وقته و يبقى شادد و بعدين بعد شوية تختفى الرغبة
+
+297
+00:24:29,390 --> 00:24:33,130
+هذه تغيب لمدة طويلة لحد ماريه في ال extension كمان
+
+298
+00:24:33,130 --> 00:24:37,210
+مرة هذا ما حكيه هو كله عموما موضوع دراستنا اليوم
+
+299
+00:24:37,210 --> 00:24:44,240
+خليني اتكلمها عند بلدكعندي nerve supply عندي
+
+300
+00:24:44,240 --> 00:24:47,760
+sympathetic و بقى sympathetic وعندي internal
+
+301
+00:24:47,760 --> 00:24:51,700
+sphincter و external sphincter عندى bladder neck
+
+302
+00:24:51,700 --> 00:24:57,980
+فيها اللي هو ال .. ال .. ال .. ال .. ال .. ال ..
+
+303
+00:24:57,980 --> 00:24:58,040
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+304
+00:24:58,040 --> 00:24:58,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+305
+00:24:58,220 --> 00:24:58,760
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+306
+00:24:58,760 --> 00:24:58,840
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+307
+00:24:58,840 --> 00:24:59,460
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+308
+00:24:59,460 --> 00:24:59,500
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+309
+00:24:59,500 --> 00:25:00,860
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+310
+00:25:00,860 --> 00:25:01,020
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+311
+00:25:01,020 --> 00:25:02,240
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+312
+00:25:02,240 --> 00:25:07,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+313
+00:25:07,220 --> 00:25:11,590
+ال .. ال ..هي ال .. ال .. ال .. ال ureter الحالب
+
+314
+00:25:11,590 --> 00:25:20,950
+وهان فتحت خالص فتحت الحالب، الحالبين جنب فتحت ال
+
+315
+00:25:20,950 --> 00:25:26,870
+.. ال bladder neck طبعا؟ لاحظين انتوا؟ يعني مش ال
+
+316
+00:25:26,870 --> 00:25:30,410
+bladder بيجي الحالبين من فوق هيك اه و ال هذا من
+
+317
+00:25:30,410 --> 00:25:35,280
+تحت مسلق لأ لأ ال .. ال .. ال uretersتحت فاتحين
+
+318
+00:25:35,280 --> 00:25:39,360
+جانب بعض المنطقى هي هذه المسلسل ما بين فتحة الحالب
+
+319
+00:25:39,360 --> 00:25:48,340
+وفتحة ال بلدر ميك هذا ال triangle نسميه ايش؟Try
+
+320
+00:25:48,340 --> 00:25:50,840
+again هذا الـ try again المهم لإن هو very
+
+321
+00:25:50,840 --> 00:25:56,020
+sensitive لإيه لما ال stretch يصير عليه بيديني
+
+322
+00:25:56,020 --> 00:26:00,940
+reflexes أقوى مكان بيديني reflexes تمام هو و الجزء
+
+323
+00:26:00,940 --> 00:26:05,560
+اللي داخله منه في داخل blood vessels فلما يصير
+
+324
+00:26:05,560 --> 00:26:09,520
+عليه simulation بيديني strong reflexes عسب إنه انا
+
+325
+00:26:09,520 --> 00:26:13,320
+عمل evacuation هذه المنطقة لو احنا طلعنا في المنظر
+
+326
+00:26:13,320 --> 00:26:17,710
+بنشوفهامن ميزها عن غيرها اذا بنعرف انه هذه ال
+
+327
+00:26:17,710 --> 00:26:21,810
+triangle لان هذه المنطقة smooth الباجي corrugated
+
+328
+00:26:21,810 --> 00:26:28,190
+الباجي مجاعد لان طبيعة البلادر بتبقى كامشة بتجاعد
+
+329
+00:26:28,190 --> 00:26:32,250
+بتفت .. بتفت .. بت .. بت .. بتمتلق dilated فبفرد
+
+330
+00:26:32,250 --> 00:26:34,730
+مش كده جونات transitional ابيتيليا ماعنده
+
+331
+00:26:34,730 --> 00:26:38,650
+المواصفات هذه فهنا لما نطلع في البلادر احنا طبعا
+
+332
+00:26:38,650 --> 00:26:42,490
+نطلع في البلادر international يعني مش كده لأنه
+
+333
+00:26:42,490 --> 00:26:46,530
+لازم تكون فاطئلأنه مش هاجدر انا اخش سفينكتا ايه
+
+334
+00:26:46,530 --> 00:26:52,050
+ايش اسمه ال endoscope اه ال cystoscope مش هاخش فيه
+
+335
+00:26:52,050 --> 00:26:56,350
+هو البولي ده المحجوز شوه فهشوف الفرق هشوف ان هذا
+
+336
+00:26:56,350 --> 00:27:02,030
+ال Trigon هو ايه ال Trigon هذا منطقة حساسة جدا لان
+
+337
+00:27:02,030 --> 00:27:07,470
+اللي هو هي خليني أورك فيها اذا
+
+338
+00:27:07,470 --> 00:27:09,910
+لقيت فتحة اليوليطر الشمال و لقيت فتحة اليوليطر
+
+339
+00:27:09,910 --> 00:27:16,130
+اليمين هو فتحة ال bloodهذا المسلسل الأبيض اسمه
+
+340
+00:27:16,130 --> 00:27:21,030
+Trigon هو مش اللون بس انه أفتح من غيره انه زي ما
+
+341
+00:27:21,030 --> 00:27:24,470
+تشايفين smooth الأخرين هتلاقيهم ايه؟ فيها
+
+342
+00:27:24,470 --> 00:27:28,190
+corrugations عملة انواع من التجعيد موجودة داخل ال
+
+343
+00:27:28,190 --> 00:27:34,850
+.. هذه المنطقة كتير حساسة لما يبقى فيها عندنا bowl
+
+344
+00:27:34,850 --> 00:27:40,380
+of residual urine موجودأه .. بنضل احنا حاسين في
+
+345
+00:27:40,380 --> 00:27:43,140
+المنطقة أنه بدنا فيه ركبة في التباون لما يكون في
+
+346
+00:27:43,140 --> 00:27:49,120
+عندنا حصوةو تنزل في المنطقة هذه تنح شرهان مثلا في
+
+347
+00:27:49,120 --> 00:27:52,200
+المنطقة ال trigon هذه تبقى قاعد على الباب بيظل
+
+348
+00:27:52,200 --> 00:27:55,740
+حاسس انه في ركبة للتبور رايحة جاي رايحة جاي رايحة
+
+349
+00:27:55,740 --> 00:27:59,180
+جاي على الحمام لإنه في حصوة نزلت من الكيلية و نزلت
+
+350
+00:27:59,180 --> 00:28:02,120
+في المثانا بس ساود فع الباب جاعد على ال trigon ال
+
+351
+00:28:02,120 --> 00:28:05,800
+trigon هذه منطقة ايه حساسة كتير و هي لها علاقة
+
+352
+00:28:05,800 --> 00:28:08,020
+كبيرة في ال ايه في ال maturation reflex
+
+353
+00:28:08,020 --> 00:28:13,990
+potentiating strongly the reflexإذا كانوا يقولوا
+
+354
+00:28:13,990 --> 00:28:18,130
+في حصة بتعمل irritation فانت لسه ال bladder فاضية
+
+355
+00:28:18,130 --> 00:28:22,390
+لكن حاسس انه في رقم شديد لك تباول لإنه في عندنا
+
+356
+00:28:22,390 --> 00:28:25,790
+strong irritation بتروح نزل و بتطيين و بترجع ..
+
+357
+00:28:25,790 --> 00:28:29,810
+نزل و بتطيين و بترجع .. تمام؟ إذا ال Trigon هذا
+
+358
+00:28:29,810 --> 00:28:34,850
+إيه؟ هي تركيب تهان في المنطقية نرجع تاني إذا عندي
+
+359
+00:28:34,850 --> 00:28:40,050
+the body و the neck و the bladder تمام؟
+
+360
+00:28:41,790 --> 00:28:47,470
+ال bloody neck طبعا احنا بنتكلم عنه هو نهاية ال
+
+361
+00:28:47,470 --> 00:28:53,050
+urethra بزل inferiorly and anteriorly
+
+362
+00:29:05,030 --> 00:29:07,130
+the smooth muscle of the brother is called
+
+363
+00:29:07,130 --> 00:29:11,590
+adiposal muscle اتكلمنا عنها و قولنا ادروسال
+
+364
+00:29:11,590 --> 00:29:18,650
+muscle هذه عضلة قوية تستطيع انها تعمل contraction
+
+365
+00:29:18,650 --> 00:29:25,070
+لما يكون داخلها بول البول هذا بتغطي عليها مش كده
+
+366
+00:29:25,070 --> 00:29:33,350
+هي بتقوم البول فهي بيصير فيها tone فيها tone
+
+367
+00:29:33,750 --> 00:29:37,850
+ال tone هادى ممكن يتشد لدرجة انها يتعلي الضغط داخل
+
+368
+00:29:37,850 --> 00:29:42,350
+ال .. ال bladder الى 40 الى 60 millimeter mercury
+
+369
+00:29:42,350 --> 00:29:45,990
+تمام؟ يعني بتقدر .. لو ال bladder انتهت على الآخر
+
+370
+00:29:45,990 --> 00:29:48,990
+ممكن تصل ل 100 millimeter mercury بس في الحالة
+
+371
+00:29:48,990 --> 00:29:53,770
+هادى يمكن عندي انا strong reflexلازم يتفرج اذا انا
+
+372
+00:29:53,770 --> 00:29:59,130
+اردت ولا ما اردتش بعد الميه هادى بنلاقي انه حتى ال
+
+373
+00:29:59,130 --> 00:30:02,090
+externalist انت مش قادر يقوم بالضغط اللى جاى ايه
+
+374
+00:30:02,090 --> 00:30:06,530
+من داخل ال bladder فحتى لو صاحب الشئ بده يمنع
+
+375
+00:30:06,530 --> 00:30:10,490
+التبول مقدرش تمام؟ اذا انا فيه انضغط من داخل ال
+
+376
+00:30:10,490 --> 00:30:14,550
+bladder بتكون مع ال ايه يعني عندى ال tone لاحظوا
+
+377
+00:30:14,550 --> 00:30:21,270
+احنا اول ما بتكون ال ball فيه tone تعمليعشرة رقم
+
+378
+00:30:21,270 --> 00:30:24,850
+أساسي ملي ميتر ميركوري مثلا زاد ال bone بتتوسع
+
+379
+00:30:24,850 --> 00:30:28,370
+شوية ال tone بتبقى موجود بتتوسع لحد معين بيبدأ
+
+380
+00:30:28,370 --> 00:30:33,110
+الضغط يعلق يعني هي ال tone موجودة اتحافظ على الميه
+
+381
+00:30:33,110 --> 00:30:39,770
+ال bone اللي فيها بشكل محسوس عند level معين بتبطر
+
+382
+00:30:39,770 --> 00:30:43,830
+انها ت relax و ال tone اتحافظ عليه زي ما هو لأ
+
+383
+00:30:43,830 --> 00:30:45,750
+بيصير عندنا more
+
+384
+00:30:49,150 --> 00:30:56,690
+أو اذا لم يكن هناك اكتشاف اكتشاف اكتشاف اكتشاف
+
+385
+00:30:56,690 --> 00:31:00,750
+اكتشاف اكتشافبتفتحها لبرا فهي بتشد .. هتحافظ على
+
+386
+00:31:00,750 --> 00:31:04,290
+حالها وعشان نتنبل الجسم احنا لو نوصلنا لإن ال
+
+387
+00:31:04,290 --> 00:31:07,730
+stretch .. ال stretch reflex هذا اللي موجود من ان
+
+388
+00:31:07,730 --> 00:31:12,190
+هي شادة بنحس احنا انه والله الضغط عليه و ال
+
+389
+00:31:12,190 --> 00:31:16,630
+stretch reflex .. ال stretch receptors stimulated
+
+390
+00:31:16,630 --> 00:31:22,770
+well و احنا الآن في طور ان نفرج، ايش رايك؟ تمام؟
+
+391
+00:31:22,770 --> 00:31:27,530
+دماغك متدخل، هو بيقول افرج ولا مافرجش؟طيب عملية
+
+392
+00:31:27,530 --> 00:31:32,290
+التفريغ هذه مركزها الأساسي spinal cord إذا هذه
+
+393
+00:31:32,290 --> 00:31:36,650
+spinal reflex طبعا لكن spinal reflex جايله أوامر
+
+394
+00:31:36,650 --> 00:31:40,990
+عالية من ال cerebral cortex من ال brain أو من ال
+
+395
+00:31:40,990 --> 00:31:45,950
+bones من ال brain stem طبعا هدول بدوله نوع من أيه
+
+396
+00:31:45,950 --> 00:31:51,630
+من القيادة دائما في عندي أوامر دائما لهذا ال
+
+397
+00:31:51,630 --> 00:31:57,810
+center هذا بال inhibition ممنوع يشتغل طبعاأنا ممكن
+
+398
+00:31:57,810 --> 00:32:01,430
+ييجي أوامر للـ sphincter وانتبهلها و بعدين أخد
+
+399
+00:32:01,430 --> 00:32:05,910
+قراري لكن دايما هذا الـ sphincter انهيبتت و إلا
+
+400
+00:32:05,910 --> 00:32:09,170
+إذا مش انهيبتت أول ما تيجي أوامر زي الأولاد الصغار
+
+401
+00:32:09,170 --> 00:32:13,670
+فبيصير okay صار ال pressure في داخل ال bladder
+
+402
+00:32:13,670 --> 00:32:18,650
+عالية ال sphincter يتنبه ال efferent muscles هيعمل
+
+403
+00:32:18,650 --> 00:32:20,710
+contraction of the bladder relaxation of the
+
+404
+00:32:20,710 --> 00:32:25,900
+sphincterurination بس الإنسان بني آدم هذا الكلام
+
+405
+00:32:25,900 --> 00:32:29,020
+مابصار مش عنده مش زي الحيوانات أو الأطفال الصغار
+
+406
+00:32:29,020 --> 00:32:32,860
+لأ بيقدر يستطيع إنه ال external sphincter جابل حتى
+
+407
+00:32:32,860 --> 00:32:36,680
+ما يشتغل ال external sphincter و إنه يتقوى جابل
+
+408
+00:32:36,680 --> 00:32:40,940
+الكلام هذا أساسا ال .. ال .. ال .. ال .. ال .. ال
+
+409
+00:32:40,940 --> 00:32:45,700
+.. the menstruation reflex center is inhibited في
+
+410
+00:32:45,700 --> 00:32:50,300
+ال spinal cord عنده نازله أوامر بال inhibition
+
+411
+00:32:50,300 --> 00:32:56,290
+تمام؟بالزمرة عشان انا اسمحله انه يصير تبوي لازم
+
+412
+00:32:56,290 --> 00:33:02,050
+ارفع ال what ال inhibitory orders مش كده؟ في
+
+413
+00:33:02,050 --> 00:33:05,170
+الحالة هادي انا فعلا اتكلم لإن في عندنا inhibitory
+
+414
+00:33:05,170 --> 00:33:10,010
+و في عندنا facilitative كمان في اشياء بتساعد انه
+
+415
+00:33:10,010 --> 00:33:15,210
+.. انه بتساعد التبوي الأسرعالـ Reflex هذا أو انه
+
+416
+00:33:15,210 --> 00:33:18,830
+نمنعه بس في العادة قبل ما ال motivation act تصير
+
+417
+00:33:18,830 --> 00:33:27,380
+يبقى ال center هذا inhibited تمام؟ اذا عندي اناعند
+
+418
+00:33:27,380 --> 00:33:32,340
+تفتح مصبح التروزر ، سيزداد الضغط في داخل الدم إلى
+
+419
+00:33:32,340 --> 00:33:37,760
+40 إلى 60 مليمتر ميركوري ، لذلك تفتح مصبح التروزر
+
+420
+00:33:37,760 --> 00:33:41,740
+هو خطوة عظيمة في استخدام الدم. لذلك عندما يحصل
+
+421
+00:33:41,740 --> 00:33:45,540
+فيها تفتح في هذا المصبح، يعني أنه يزيد الضغط أكتر،
+
+422
+00:33:45,540 --> 00:33:49,480
+يعني أنه يفتح السفينة
+
+423
+00:33:49,480 --> 00:33:50,880
+الداخلية
+
+424
+00:33:52,880 --> 00:33:56,740
+يعني هو ال reflex عندى انا انه يزيل ال contraction
+
+425
+00:33:56,740 --> 00:34:00,640
+تبع ال bladder و يصير relaxation لل إيه؟ للصفنطة،
+
+426
+00:34:00,640 --> 00:34:04,260
+تمام؟ هذا هو الايه؟ ال reflex فعندى لما يصير عندى
+
+427
+00:34:04,260 --> 00:34:08,960
+انا contraction معناه بيساعد انه يفتح ال ..هو يوصل
+
+428
+00:34:08,960 --> 00:34:13,480
+البول اكتر للـ bladder neck وهناك سيكون هناك
+
+429
+00:34:13,480 --> 00:34:16,940
+potentiation للreflex لان هناك منطقة اقوى منطقة
+
+430
+00:34:16,940 --> 00:34:22,080
+فيها اللي هو stimulating the reflex تمام فعندما
+
+431
+00:34:22,080 --> 00:34:25,980
+الدق تزيد ويصل البول انه ال internal sphincter جوا
+
+432
+00:34:26,590 --> 00:34:30,930
+في داخله تريجون جوا في داخل الـ sphincter اجاله
+
+433
+00:34:30,930 --> 00:34:37,450
+urine stimuli stretch سرله معناه انه الضغط علي
+
+434
+00:34:37,450 --> 00:34:42,290
+البول كتر تمام فبيعمل strong reflex to relax ال
+
+435
+00:34:42,290 --> 00:34:45,710
+sphincter و to contract more ال detroser muscle
+
+436
+00:34:45,710 --> 00:34:49,530
+اذا smooth
+
+437
+00:34:49,530 --> 00:34:53,150
+muscle cells of the detroser muscle fuse اه قولها
+
+438
+00:34:53,150 --> 00:34:54,830
+علي هادي طيب
+
+439
+00:34:56,840 --> 00:35:06,480
+عند بصير ورع البلدر يقول الترياجون ان كل
+
+440
+00:35:06,480 --> 00:35:11,360
+يوريتر عندما يدخل البلدر يترسى عبارة عن مصالح
+
+441
+00:35:11,360 --> 00:35:14,600
+التروزر و بعد ذلك يدخل مصالح البلدر بقية احد او
+
+442
+00:35:14,600 --> 00:35:15,700
+اثنان سانتمتر
+
+443
+00:35:20,970 --> 00:35:22,430
+بعمل عملية عملية عملية عملية عملية عملية عملية
+
+444
+00:35:22,430 --> 00:35:24,390
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+445
+00:35:24,390 --> 00:35:33,370
+عملية عملية عملية عملية عملية
+
+446
+00:35:33,370 --> 00:35:39,030
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+447
+00:35:39,030 --> 00:35:39,350
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+448
+00:35:39,350 --> 00:35:39,370
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+449
+00:35:39,370 --> 00:35:46,870
+عملية عملية عملية عملية عملية عمل
+
+450
+00:35:50,030 --> 00:35:57,030
+هذا الشكل مختلف
+
+451
+00:35:57,030 --> 00:36:03,670
+عن باقية
+
+452
+00:36:03,670 --> 00:36:04,090
+التشيوز
+
+453
+00:36:09,740 --> 00:36:13,400
+it's natural to normally keep the bladder, neck
+
+454
+00:36:13,400 --> 00:36:17,040
+and osteorethra empty over it. هذه الممطلة دايما
+
+455
+00:36:17,040 --> 00:36:20,440
+فاضية لأن في عندى ال internal sphincter عامل tone
+
+456
+00:36:20,440 --> 00:36:24,740
+فال bladder نكهة دايما فاضية المشكلة إذا إجهل
+
+457
+00:36:24,740 --> 00:36:31,530
+البوهول بيصير عندى strongdesire to evacuate لإنه
+
+458
+00:36:31,530 --> 00:36:34,750
+بيصير عندك strong reflex mixture reflex فادي أنا
+
+459
+00:36:34,750 --> 00:36:40,650
+لاحظها برضه في ال GIT إن ال rectum دايما فاضي، ال
+
+460
+00:36:40,650 --> 00:36:43,850
+rectum دايما فاضي، إن صار واصل حاجة ل ال rectum،
+
+461
+00:36:43,850 --> 00:36:47,960
+مع أنها في رغبة إيه لل evacuationبصير strong
+
+462
+00:36:47,960 --> 00:36:51,760
+reflex لل إيه؟ لل evaluation، نفس الكلام، إذا هذي
+
+463
+00:36:51,760 --> 00:36:55,520
+under control، إذا بدأ الاشي يصل يعني أنت سامحله
+
+464
+00:36:55,520 --> 00:36:59,960
+يصل معناها أو غصب عنك، يا سامحله أما غصب عنك، لأنه
+
+465
+00:36:59,960 --> 00:37:04,880
+فاض عن الحد المسموح، فهيشتغل بدون أوامرك، تمام؟
+
+466
+00:37:04,880 --> 00:37:09,560
+قولتلكم عن الراجل اللي كان في ال bus أيام اليهود،
+
+467
+00:37:09,560 --> 00:37:14,890
+زلم عنده سكر يعنيو بعدين السكري بتبول كتير و حجزوه
+
+468
+00:37:14,890 --> 00:37:18,230
+فى المنطقة الوسطى بياخدوهم بيجمعوهم بعدين بيحملوهم
+
+469
+00:37:18,230 --> 00:37:20,770
+فى الباصات بعدين بيجمعوهم لغزة يعنى احنا كانوا
+
+470
+00:37:20,770 --> 00:37:23,750
+بياخدونا لغزة مباشرة يعنى على أنصار ماتاخدش معانا
+
+471
+00:37:23,750 --> 00:37:27,290
+الحكاية نص ساعة يكون من سورة تم لعتك على بس هم
+
+472
+00:37:27,290 --> 00:37:31,050
+يعني ليلة كاملة او هم ايه مربطينهم من مكان لمكان
+
+473
+00:37:31,050 --> 00:37:34,310
+عشان ينجولوهم فى الأخر لغزة فو عنده سكر مش بتحمل
+
+474
+00:37:34,310 --> 00:37:37,530
+فجال الجندي خد بالك انا عندى سكري و الان مش بتحكم
+
+475
+00:37:37,530 --> 00:37:42,910
+في حالى ممكن أنزل اتبولقالله شي كده اقعد محلك تمام
+
+476
+00:37:42,910 --> 00:37:48,090
+شوية صغيرة قالله خد بالك انا عند سكر و مش بتحمل
+
+477
+00:37:48,090 --> 00:37:51,670
+قالله شي كده اقعد محلك و بعدين لجي ال .. ارضية ال
+
+478
+00:37:51,670 --> 00:37:58,590
+bus صارت ايه مليانة تبون مش لأنه خلاص يعني عند
+
+479
+00:37:58,590 --> 00:38:02,310
+level معين لا يستطيع الانسان ايه بيصير ال .. اه
+
+480
+00:38:02,310 --> 00:38:06,830
+بيصير ال .. ال .. ال .. ال tension في داخل ال ..
+
+481
+00:38:06,830 --> 00:38:12,260
+ال bladderأقوى من الـ sphincter contraction أقوى
+
+482
+00:38:12,260 --> 00:38:16,540
+منه فبتجلب عليه خلاص فبتنزل ال إيه؟ ال reflex اللي
+
+483
+00:38:16,540 --> 00:38:19,720
+كان inhibitory inhibitory inhibitory لخلاص مش جادر
+
+484
+00:38:19,720 --> 00:38:23,720
+صار فيه أنه facilitating بسبب ال .. ال .. ال .. ال
+
+485
+00:38:23,720 --> 00:38:26,360
+afference اللي جاية من ال bladder بصير مش .. مش
+
+486
+00:38:26,360 --> 00:38:31,440
+جادر يعمل انهيبشن أكتر من هيك فبصير إيه؟ ال .. طيب
+
+487
+00:38:34,470 --> 00:38:39,530
+بالتالي ايش قولنا هنا؟ تمنح البلدار الى
+
+488
+00:38:39,530 --> 00:38:46,150
+ترناكسفينكتر الى ما يرتفع
+
+489
+00:38:46,150 --> 00:38:49,430
+ترناكسفينكتر
+
+490
+00:38:49,430 --> 00:38:49,770
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكسفينكتر
+
+491
+00:38:49,770 --> 00:38:49,810
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكسفينكتر
+
+492
+00:38:49,810 --> 00:38:49,870
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكسفينكتر
+
+493
+00:38:49,870 --> 00:39:01,410
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكس
+
+494
+00:39:02,700 --> 00:39:06,620
+اللي هو ال .. قولنا ال .. ال floor of the pelvis
+
+495
+00:39:06,620 --> 00:39:11,180
+ال levator ni muscle فيها اللي هو eugenital
+
+496
+00:39:11,180 --> 00:39:16,320
+ديافرام الجزئية العضلية .. العضلة المراسقة للمنطج
+
+497
+00:39:16,320 --> 00:39:19,200
+هي دي مخيطة ايسا عملت ما يسمى بال external
+
+498
+00:39:19,200 --> 00:39:23,120
+sphincter وهي distriated muscles، muscles عادية،
+
+499
+00:39:23,120 --> 00:39:27,320
+voluntary تمام؟ voluntary ال nerve supply تبعها
+
+500
+00:39:27,320 --> 00:39:31,800
+مختلف عن nerve supply تبع من؟ تبعلإن دائما ال
+
+501
+00:39:31,800 --> 00:39:35,220
+smooth muscles ال nerves تبقى تبعهم بيكون ايش؟
+
+502
+00:39:35,220 --> 00:39:39,100
+Autonomic مش هيك؟ Autonomic لكن ال striated
+
+503
+00:39:39,100 --> 00:39:45,100
+muscles بيكون ايش؟ بيكون ايه؟ Somatic اه Somatic
+
+504
+00:39:45,100 --> 00:39:49,540
+انت عارف بتعب تعب تعبيرها Somatic nerves يعني هدول
+
+505
+00:39:49,540 --> 00:39:53,760
+ال spinal nerves اللي هم under voluntary control
+
+506
+00:39:59,780 --> 00:40:06,280
+innervation of the bladder إذا ال bladder has two
+
+507
+00:40:06,280 --> 00:40:08,920
+types of .. three types of innervations
+
+508
+00:40:08,920 --> 00:40:13,800
+parasympathetic, sympathetic and ايه؟ and somatic
+
+509
+00:40:13,800 --> 00:40:18,620
+ال somatic فقط جعلنين لل external sphincter
+
+510
+00:40:18,620 --> 00:40:24,520
+انديهان the budendal nerve ايش اسمه؟ the budendal
+
+511
+00:40:24,520 --> 00:40:31,190
+nerve ال parasympatheticnerve supply and the
+
+512
+00:40:31,190 --> 00:40:35,250
+pelvic nerve مش كده؟ طب جايين من sacral brixus
+
+513
+00:40:35,250 --> 00:40:40,130
+تتجمع تعمل ال pelvic nerves و هدول يحملوا ال what
+
+514
+00:40:40,130 --> 00:40:44,910
+ال biosympathetic innervation و عندي كمان
+
+515
+00:40:44,910 --> 00:40:50,910
+sympathetic لكن ال sympathetic hand mainly to the
+
+516
+00:40:50,910 --> 00:40:56,310
+blood supply of the bloodmore than to the smooth
+
+517
+00:40:56,310 --> 00:41:01,410
+muscle to the trouser muscle لأ more to the blood
+
+518
+00:41:01,410 --> 00:41:05,250
+supply بتعملها vasoconstriction أو vasodilatation
+
+519
+00:41:05,250 --> 00:41:06,930
+حسب ال sympathetic tone
+
+520
+00:41:10,380 --> 00:41:14,520
+ال .. ال pelvic nerve اللي هو جاي من ال sacral
+
+521
+00:41:14,520 --> 00:41:20,140
+plexus بيجي من ال S2 S3 مش كده؟ ال .. ال .. ال
+
+522
+00:41:20,140 --> 00:41:26,760
+parasympathetic system مش إله اسم تاني؟ اه cerebro
+
+523
+00:41:26,760 --> 00:41:29,920
+..
+
+524
+00:41:29,920 --> 00:41:38,950
+اه .. cerebro .. اه ..والتانى يسمى thoracolumbar
+
+525
+00:41:38,950 --> 00:41:44,830
+السيمباتيك يسمى thoracolumbar لإنه جاي من T5 ل L2
+
+526
+00:41:44,830 --> 00:41:52,490
+هذا سيمباتيك اما ال .. اما ال .. برا السيمباتيك له
+
+527
+00:41:52,490 --> 00:41:58,590
+two divisions جزء جاي cranial nerves و ال sacral
+
+528
+00:41:58,590 --> 00:42:03,950
+cranio sacral cranio sacralهذا اللي هو ال
+
+529
+00:42:03,950 --> 00:42:08,050
+parasympathetic system لإن ال nerves في جزء منها
+
+530
+00:42:08,050 --> 00:42:11,850
+فيها parasympathetic و في جزء منها بتبقى لأ
+
+531
+00:42:11,850 --> 00:42:17,070
+somatic مش كده و معظمهم mixed مش كده و ال somatic
+
+532
+00:42:17,070 --> 00:42:21,450
+nerves هذه دايما هي mixed بمعنى انها motor و
+
+533
+00:42:21,450 --> 00:42:27,260
+sensory و mixed بمعنى انهautonomic و voluntary و
+
+534
+00:42:27,260 --> 00:42:32,460
+somatic تمام؟ اللي اجيتها ال .. ال .. ال vegas
+
+535
+00:42:32,460 --> 00:42:35,820
+nerve هذا اللي حد ما .. اللي حد ما appeared على
+
+536
+00:42:35,820 --> 00:42:41,220
+سببته لكنه mixed سموته ايه؟ و sensory تمانية منه
+
+537
+00:42:41,220 --> 00:42:46,080
+sensory ولو انه مشهور لكن تمانية منه ايه؟ sensory
+
+538
+00:42:46,080 --> 00:42:55,560
+fibersإذن عندي أنا ال pelvic nerves الـ S2 S3 الـ
+
+539
+00:42:55,560 --> 00:43:00,060
+A قولنا cranial مجموعة من الأعصاب اللي هم cranial
+
+540
+00:43:00,060 --> 00:43:03,500
+nerves فيهم sympathetic او فيهم autonomic nervous
+
+541
+00:43:03,500 --> 00:43:06,460
+system فيهم parasympathetic طبعا autonomic cranial
+
+542
+00:43:06,460 --> 00:43:10,880
+يعني parasympathetic زي السابع الخامس يعني الخامس
+
+543
+00:43:10,880 --> 00:43:16,640
+فيه إيش بسيط السابع وتاسع والعاشر والأحداشر تمام
+
+544
+00:43:16,640 --> 00:43:21,600
+هدول فيهم ايه parasympatheticالساكرال ايه؟
+
+545
+00:43:21,600 --> 00:43:27,300
+الساكرال ايه؟
+
+546
+00:43:27,300 --> 00:43:29,540
+الساكرال بريكساس اللي بتديني ال building nerves
+
+547
+00:43:29,540 --> 00:43:34,190
+اللي هم فيه مباراة sympathetic activityهنا عندنا
+
+548
+00:43:34,190 --> 00:43:39,390
+ال nerves اللي رايحة على ال blood رجعه بس من S2 S3
+
+549
+00:43:39,390 --> 00:43:45,430
+من ال sacral segment S1 S2 S3 مش جاي من ال four ال
+
+550
+00:43:45,430 --> 00:43:48,970
+four بتروح ل ال a two three four و روح لمين ل
+
+551
+00:43:48,970 --> 00:43:53,030
+other parts of the pelvis بالذات ال a ال rectum
+
+552
+00:43:54,030 --> 00:43:59,910
+والـ lower colon او الـ distal colon الـ
+
+553
+00:43:59,910 --> 00:44:03,210
+descending و الـ sigmoid و ال rectum و ال inner
+
+554
+00:44:03,210 --> 00:44:08,430
+canal the
+
+555
+00:44:08,430 --> 00:44:13,650
+sensory fibers إذا في عندنا كمان هذا ال .. ال ..
+
+556
+00:44:13,650 --> 00:44:18,870
+ال pelvic nerves مش بس motor لأ mixed motor و إيه؟
+
+557
+00:44:18,870 --> 00:44:19,810
+و sensory
+
+558
+00:44:23,190 --> 00:44:24,470
+والذين يتمرون من خلال عضلات
+
+559
+00:44:24,470 --> 00:44:38,510
+البلوكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيك
+
+560
+00:44:38,550 --> 00:44:43,110
+to sense ده ايه ده degree of stretch لإن كل ما زاد
+
+561
+00:44:43,110 --> 00:44:46,830
+ال ball كل ما زاد ال stretch كل ما زاد الضغط تبع
+
+562
+00:44:46,830 --> 00:44:50,150
+ال bladder ال bladder بتقدر تحافظ على كلامها ده
+
+563
+00:44:50,150 --> 00:44:55,570
+على level معين بعد كده لو ال bladder مضلت مسكراها
+
+564
+00:44:55,570 --> 00:44:59,410
+بيصير dilatation و بيصير actually فيها اي عضلة
+
+565
+00:44:59,410 --> 00:45:03,150
+بتتشد اكتر من اللازم خلاص تفقد قدرتها على ال ايه
+
+566
+00:45:03,150 --> 00:45:07,490
+عشان تبقى تحافظ على قدرتها على ال contraction وال
+
+567
+00:45:07,490 --> 00:45:12,270
+mixurationلازم ايه عند level معين يتوقف خلاص اخر
+
+568
+00:45:12,270 --> 00:45:18,390
+قدرتها طيب stretch signals from the posterior
+
+569
+00:45:18,390 --> 00:45:23,030
+urethra are especially strong and are mainly
+
+570
+00:45:23,030 --> 00:45:26,530
+responsible for initiation the reflexes that cause
+
+571
+00:45:26,530 --> 00:45:30,530
+bladder emptyingتمام؟ إذا .. إذا الضغط تبع ال
+
+572
+00:45:30,530 --> 00:45:34,210
+blood pressure muscle زاد و ال .. عشان ال .. ال ..
+
+573
+00:45:34,210 --> 00:45:37,070
+ال .. ال urine في داخل ال bladder زاد تمام؟ الضغط
+
+574
+00:45:37,070 --> 00:45:40,150
+هذا بيقدر إلى انه .. انه بعض ال .. ال internal
+
+575
+00:45:40,150 --> 00:45:45,050
+sphincter ت dilate شوية او ت stretch و يدخل شوية
+
+576
+00:45:45,050 --> 00:45:48,190
+stretch يعني ال .. ال .. ال bladder قاعدة بتفتح في
+
+577
+00:45:48,190 --> 00:45:51,210
+ال sphincter فال stretch receptors في الbladder من
+
+578
+00:45:51,210 --> 00:45:54,730
+كهان بتحس ان الضغط زاد اكتر من اللازم و انه صار ال
+
+579
+00:45:54,730 --> 00:45:59,870
+stretch يصلها فبتعمل strongreflex اللي هو اسم ال
+
+580
+00:45:59,870 --> 00:46:07,030
+mixtureation ال mixtureation reflex بيكون موجود في
+
+581
+00:46:07,030 --> 00:46:13,050
+كل المراحل
+
+582
+00:46:13,050 --> 00:46:17,070
+يعني و ال bladder فاضية
+
+583
+00:46:17,780 --> 00:46:23,100
+طبعا هان صفر لعند level معين مية و خمسين مية و
+
+584
+00:46:23,100 --> 00:46:27,920
+سبعين milliliter of urine فى البوك فى ال bladder
+
+585
+00:46:27,920 --> 00:46:33,780
+بتبدأ يصير عندى ال reflex تظهر اللى هو ال
+
+586
+00:46:33,780 --> 00:46:34,800
+menstruation reflex
+
+587
+00:46:38,970 --> 00:46:45,090
+لأ ال receptors minimal stretch فبديني minimal ..
+
+588
+00:46:45,090 --> 00:46:48,150
+هذه intravesical pressure
+
+589
+00:46:54,940 --> 00:46:57,960
+centimeters of water بال .. بال .. بالcentimeter
+
+590
+00:46:57,960 --> 00:47:03,900
+of water هنا تمام، هنا بنلاحظ احنا ايش ال .. هدول
+
+591
+00:47:03,900 --> 00:47:08,460
+المنقطة هذا يمثل ليه ال mixtureation reflex في
+
+592
+00:47:08,460 --> 00:47:12,800
+level معين احنا كل ما زاد ال ball في داخل البلدان
+
+593
+00:47:12,800 --> 00:47:16,980
+كل ما اتضغط عليه هذا الأحمر الغامض يمثل ايه؟ اتضغط
+
+594
+00:47:16,980 --> 00:47:22,310
+في داخلالـ volume بتديني ال .. ال basal cystogram
+
+595
+00:47:22,310 --> 00:47:25,730
+هذا ال basal cystogram الضغط داخل ال intravesical
+
+596
+00:47:25,730 --> 00:47:29,770
+pressure هذا الضغط داخل ايه؟ البلدر ملاحظ ما اتتعب
+
+597
+00:47:29,770 --> 00:47:33,550
+اتتعب اتتعب على level معين بيبدأ الضغط زيد كمان
+
+598
+00:47:33,550 --> 00:47:38,330
+يعني في لحد منطقة معينة تلتمية اربعمية و الضغط ايه
+
+599
+00:47:38,330 --> 00:47:42,870
+هو هو بس بعد كده كل زيادة في ال volume بيصير ..
+
+600
+00:47:42,870 --> 00:47:46,170
+بيصير الضغط حالي لإنه تقريبا البلدر جاعة .. بتان
+
+601
+00:47:46,170 --> 00:47:52,220
+..الخضرة القصوى تبعتها وصلت قصوى تمام فبيقدر
+
+602
+00:47:52,220 --> 00:47:57,340
+البراشر يزيد في الأول كل ما بيزيد ال volume كل ما
+
+603
+00:47:57,340 --> 00:48:01,160
+بيصير some sort of relaxation و ال tone بتظل هي هي
+
+604
+00:48:01,160 --> 00:48:06,060
+و ال pressure بيزدش تمام ال pressure بيزدش بس عند
+
+605
+00:48:06,060 --> 00:48:10,000
+level معين بيبدأ ال pressure ايه يزيد كل ما زاد ال
+
+606
+00:48:10,000 --> 00:48:16,420
+pressure في داخل الالـ Bladder كلما صار more
+
+607
+00:48:16,420 --> 00:48:19,200
+stimulation ل ال stress receptor كلما بيصير
+
+608
+00:48:19,200 --> 00:48:23,500
+stimulation ل ال stress receptor بيصير عندى a
+
+609
+00:48:23,500 --> 00:48:27,060
+mutation reflex بس هنا زي ما انتوا شايفين mutation
+
+610
+00:48:27,060 --> 00:48:32,280
+reflex ضعيف اه و بعدين بيموت بعدين بزيد الحجم
+
+611
+00:48:32,280 --> 00:48:36,600
+بيعمل reflex اخر بيموت بيعمل لحد ما يجيلي عندها
+
+612
+00:48:36,600 --> 00:48:41,140
+عند levels معين من الضغطتمام؟ اللي هو انترا في
+
+613
+00:48:41,140 --> 00:48:44,820
+ذاكرة pressure عالي خالص هان very strong reflexes
+
+614
+00:48:44,820 --> 00:48:47,740
+هان انتوا شايفين بيصير كل من تلت اكتر strong
+
+615
+00:48:47,740 --> 00:48:51,780
+reflexes لحد ما نصل ل level معين ان ال pressure في
+
+616
+00:48:51,780 --> 00:48:56,420
+داخل ال .. ال bladder صار اكبر من ال pressure في
+
+617
+00:48:56,420 --> 00:49:00,950
+ال ..المشكلة عندنا ال external لان ال internal
+
+618
+00:49:00,950 --> 00:49:04,150
+responding to the reflex ال internal مثلا لما ال
+
+619
+00:49:04,150 --> 00:49:09,210
+pressure زاد بيصير contraction ل ال muscle لدرزل
+
+620
+00:49:09,210 --> 00:49:12,430
+ال muscle و بيصير some sort of relaxation لل إيه
+
+621
+00:49:12,430 --> 00:49:17,990
+لل internal sphincter إذا ال blood ال unit دخل ال
+
+622
+00:49:17,990 --> 00:49:21,470
+internal sphincter تمام و صار يعمله ضغط تبع
+
+623
+00:49:21,470 --> 00:49:24,390
+blooder ينتقل إلى ال internal sphincter إلى ال
+
+624
+00:49:24,390 --> 00:49:30,160
+bladder neck بيعمل very strongهذا البرنامج يعمل
+
+625
+00:49:30,160 --> 00:49:35,360
+إدفاع للبوليو الخارجي إذا كانت الضغط عالي ل مستوى
+
+626
+00:49:35,360 --> 00:49:39,500
+معين فلا يستطيع الاكسيلات فينتر نفسه التحكم فيه
+
+627
+00:49:39,500 --> 00:49:41,660
+لأنه في مستوى معين لا يستطيع الاكسيلات فينتر
+
+628
+00:49:41,660 --> 00:49:47,120
+التحكم فيهالـ External الـ External under
+
+629
+00:49:47,120 --> 00:49:51,160
+continuous tone under continuous tone ليش؟ لأنه في
+
+630
+00:49:51,160 --> 00:49:56,860
+عندنا inhibitory reflexes عندنا construction
+
+631
+00:49:56,860 --> 00:50:01,200
+متواصل في الـ sphincter هذا contraction متواصل
+
+632
+00:50:01,200 --> 00:50:06,020
+construction متواصل تمام بحيث أنه ال reflexes اللي
+
+633
+00:50:06,020 --> 00:50:13,470
+بتيجي من ال spinalالسينتر المكتورة هي .. انا
+
+634
+00:50:13,470 --> 00:50:18,290
+ماقلتها حقيقة ان ال reflex بيجي تبع من ال bladder
+
+635
+00:50:18,290 --> 00:50:22,430
+مكتورة ال reflex مكتورة مكتورة مكتورة مكتورة
+
+636
+00:50:22,430 --> 00:50:22,590
+مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة
+
+637
+00:50:22,590 --> 00:50:24,330
+مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة
+
+638
+00:50:24,330 --> 00:50:27,750
+مكتورة مكتورة مكتورة
+
+639
+00:50:27,750 --> 00:50:37,650
+مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة
+
+640
+00:50:37,650 --> 00:50:41,830
+مكتورةبيقولوا مش .. مش .. مش .. مش واجهة فهذا بي
+
+641
+00:50:41,830 --> 00:50:45,650
+.. بعد كده بيمنع ال .. ال reflex و بيوقفه دقائق
+
+642
+00:50:45,650 --> 00:50:50,530
+إلى ساعات كل ما احنا عملنا more inhibition لل
+
+643
+00:50:50,530 --> 00:50:55,550
+evacuation كل ما صارت ال reflex هذا يجرب من أخوه
+
+644
+00:50:55,550 --> 00:51:00,150
+يعني الإحساس أولها، الواحد جاعد هنا دين الصبح حاسس
+
+645
+00:51:00,150 --> 00:51:04,110
+بال .. بال .. بال .. بالإحساس بالتبود، هو لسه جامل
+
+646
+00:51:04,110 --> 00:51:09,820
+البيت عام ال evacuationف .. لأ مش وقته بيغيب ساعة
+
+647
+00:51:09,820 --> 00:51:16,200
+تمام؟ بقى ساعة بنبقى تمام؟ ممكن تقولوا لأ يعني مش
+
+648
+00:51:16,200 --> 00:51:21,140
+برضه مش وقته بيغيب نص ساعة بعدها بيغيب ربع ساعة
+
+649
+00:51:21,140 --> 00:51:24,820
+بعدها بيغيب خمس دقايق بعدها بي .. بعدها بيصير يعني
+
+650
+00:51:24,820 --> 00:51:29,660
+انا اديتك وقتك وانت اللي ايه مجسر تمام؟ فبصير ال
+
+651
+00:51:29,660 --> 00:51:34,220
+frequency و ال intensity تبع ال reflex أجواء أجواء
+
+652
+00:51:34,220 --> 00:51:39,370
+أجواء و بعدين يتلحجهي ماتلحقش زي ما الظلمة ده جاله
+
+653
+00:51:39,370 --> 00:51:42,210
+أنظر و جاله قد بقالك أنا مش قادر أن أتحكم في حالة
+
+654
+00:51:42,210 --> 00:51:50,490
+ليه فترة نوعية طيب نرجع تاني لإيه
+
+655
+00:51:50,490 --> 00:51:56,250
+then
+
+656
+00:51:56,250 --> 00:51:59,450
+the sensory fibers هدول موجودين وين؟ موجودين في ال
+
+657
+00:51:59,450 --> 00:52:10,100
+pelvic؟ غيرهو يتكلم عن مدى الانتقال والمهم في
+
+658
+00:52:10,100 --> 00:52:19,280
+هذا الموضوع الانتقال البلرق والبلدر نك الانتقالات
+
+659
+00:52:19,280 --> 00:52:24,560
+من البوصيروريتراأحنا نسميها Posterior لأنها أخر
+
+660
+00:52:24,560 --> 00:52:27,900
+أشياء بالنسبة للورترا هي جانب البلدر بالنسبة لها
+
+661
+00:52:27,900 --> 00:52:31,040
+أول .. أول روترا من ناحية البلدر هي أول جزء في
+
+662
+00:52:31,040 --> 00:52:34,620
+الـA حتى عليها خلافية هذه من الورترا ولا من البلدر
+
+663
+00:52:34,620 --> 00:52:40,800
+نكت تمام؟ إذا هذي ان especially strong and are
+
+664
+00:52:40,800 --> 00:52:43,940
+mainly responsible for initiation of the A reflex
+
+665
+00:52:43,940 --> 00:52:50,440
+of maturation the motor nerves transmitted in the
+
+666
+00:52:50,440 --> 00:52:58,010
+pelvic nervesParasympathetic fibers هذول بتدون ال
+
+667
+00:52:58,010 --> 00:53:01,070
+bladder pink
+
+668
+00:53:07,100 --> 00:53:11,880
+in addition to the pelvic nerves عندي احنا قلنا
+
+669
+00:53:11,880 --> 00:53:14,740
+تلت .. تلت systems عند ال pelvic nerve في .. في ..
+
+670
+00:53:14,740 --> 00:53:18,440
+في سلسله فيه مواطن مش كده؟ عندي كمان بيجي اللي هو
+
+671
+00:53:18,440 --> 00:53:21,960
+ال budendal nerve اللي بيغذّميه ال external
+
+672
+00:53:21,960 --> 00:53:28,700
+sphincter وفي عندي sympathetic innervation اللي هو
+
+673
+00:53:28,700 --> 00:53:31,600
+هنا بيجي مع الhypogastric nerves اذا عندي
+
+674
+00:53:31,600 --> 00:53:35,480
+hypogastric nerves تمام؟ ليه يسمونه hypogastric؟
+
+675
+00:53:37,720 --> 00:53:41,080
+لأ هو حقيقة مالعيش علاقة بالصمك يعني ملفز بعيدة
+
+676
+00:53:41,080 --> 00:53:44,480
+خالص بس لإن هذا المنطقى سميناها epigastric
+
+677
+00:53:44,480 --> 00:53:49,840
+المقابلها سميناها hypogastric mission يعني لإن إذا
+
+678
+00:53:49,840 --> 00:53:50,320
+واحدة إيبي
+
+679
+00:53:56,660 --> 00:54:00,340
+هيبو هيبو هيبو
+
+680
+00:54:00,340 --> 00:54:11,100
+هيبو هيبو
+
+681
+00:54:11,100 --> 00:54:14,660
+هيبو
+
+682
+00:54:14,660 --> 00:54:19,340
+هيبو
+
+683
+00:54:19,340 --> 00:54:19,360
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+684
+00:54:19,360 --> 00:54:19,380
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+685
+00:54:19,380 --> 00:54:19,580
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+686
+00:54:19,580 --> 00:54:21,950
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيفي ال .. في
+
+687
+00:54:21,950 --> 00:54:29,310
+ال .. في ال .. في ال ..
+
+688
+00:54:29,310 --> 00:54:30,550
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+689
+00:54:30,550 --> 00:54:30,750
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+690
+00:54:30,750 --> 00:54:30,810
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+691
+00:54:30,810 --> 00:54:34,790
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+692
+00:54:34,790 --> 00:54:42,310
+ال .. في ال ..
+
+693
+00:54:42,310 --> 00:54:48,930
+في ال .. في ال ..
+
+694
+00:54:49,680 --> 00:54:52,940
+هتاخدوه بالتفصيل .. هتاخدوه بالتفصيل، اذا ال
+
+695
+00:54:52,940 --> 00:54:57,100
+dermatome الجسم هيك موزع ل dermatomes، ال
+
+696
+00:54:57,100 --> 00:55:04,660
+dermatome فيها العضلة و فيها ال .. اندو .. ميزودرم
+
+697
+00:55:04,660 --> 00:55:08,960
+و اندودرم و اكتودرم، تمام؟ ال اكتودرم بيديني الجلب
+
+698
+00:55:08,960 --> 00:55:13,600
+والأعصاب، الميزودرم بيديني العضلات و الميزودرم و
+
+699
+00:55:13,600 --> 00:55:18,590
+الاندودرم بيدينيالـ hollow organs الأعضاء الأحشاء
+
+700
+00:55:18,590 --> 00:55:23,170
+طبعا إذا كان جلب إذا كان رياتين إذا كان أمعاق إذا
+
+701
+00:55:23,170 --> 00:55:32,890
+كان كابيت إذا كان فكل جزء كل جزء دي له عصبه طبعا
+
+702
+00:55:32,890 --> 00:55:38,470
+لكن ال sympathetic مش ماشي هيك لإن احنا من T5 ل L2
+
+703
+00:55:38,470 --> 00:55:44,590
+طب و اين اللي فوق ال T5 و اين التحت ال L2مالهم مش
+
+704
+00:55:44,590 --> 00:55:48,250
+sympathetic supply لهم لذلك في عندي الباقي ال
+
+705
+00:55:48,250 --> 00:55:52,150
+prevertebral chain sympathetic chain هدول كلهم
+
+706
+00:55:52,150 --> 00:55:59,910
+synapsing في هذا ال chain تمام و منها بينزلوا ال
+
+707
+00:55:59,910 --> 00:56:05,310
+chain تحت ال L2 و بطلع ال chain فوق ال A ال TA و
+
+708
+00:56:05,310 --> 00:56:09,730
+من ال chain بيصير توزيع كل واحدة حسب المناطق هذا
+
+709
+00:56:09,730 --> 00:56:13,370
+ال sympatheticإن شاء الله الدكتور ماجي يدركيها
+
+710
+00:56:13,370 --> 00:56:19,710
+بالتفصيل some
+
+711
+00:56:19,710 --> 00:56:23,510
+sensory nerve fibers also pass .. أه إذا النقطة
+
+712
+00:56:23,510 --> 00:56:27,870
+الإضافية هان قلنا احنا ال sympathetic لمن؟ لل both
+
+713
+00:56:27,870 --> 00:56:31,870
+vessels وبعض ال sensory nerves passing through the
+
+714
+00:56:31,870 --> 00:56:36,830
+sympathetic يعني ال sensory supplyأو sense of
+
+715
+00:56:36,830 --> 00:56:41,590
+innervation للبلاد ده تمام بيروح عبر البارا
+
+716
+00:56:41,590 --> 00:56:45,210
+sympathetic mainly لبلدك لكن بعضه بيعدي الى ال ..
+
+717
+00:56:45,210 --> 00:56:54,100
+عبر ال sympathetic nervesمهمة في شعور بالكامل وفي
+
+718
+00:56:54,100 --> 00:56:58,780
+بعض الأحيان شعور بالألم. تمام؟ إذا ال sensory
+
+719
+00:56:58,780 --> 00:57:03,560
+nerves اللي بتدينا الأحساس بال fullness و ال pain
+
+720
+00:57:03,560 --> 00:57:08,580
+مع ال fullness بزيد، بيصير أن أحساس بالألم، مش
+
+721
+00:57:08,580 --> 00:57:11,420
+هيك؟ هدول في الغالب بيكونوا عدوا عبر ال
+
+722
+00:57:11,420 --> 00:57:18,590
+sympathetic nerves. تمام؟العضلات من العضلات الى
+
+723
+00:57:18,590 --> 00:57:20,730
+العضلات العضلات
+
+724
+00:57:27,750 --> 00:57:31,490
+contains smooth muscle and are innervated by both
+
+725
+00:57:31,490 --> 00:57:35,070
+sympathetic and parasympathetic، تمام؟ ويلهم هدول
+
+726
+00:57:35,070 --> 00:57:37,630
+extrinsic، هدول sympathetic و parasympathetic جاي
+
+727
+00:57:37,630 --> 00:57:42,310
+من برا، هدول extrinsic nervous system، في عندى
+
+728
+00:57:42,310 --> 00:57:45,110
+intrinsic plexus اللي قولنا عليها، اللي اسمها
+
+729
+00:57:45,110 --> 00:57:49,860
+intramuralintramural يعني داخل العضلات شبكة موجودة
+
+730
+00:57:49,860 --> 00:57:52,760
+في العادة هي إذا كانت العضلات مفصولة على البعض
+
+731
+00:57:52,760 --> 00:57:55,940
+دائما الشبكة هذه موجودة بين ال longitudinal و
+
+732
+00:57:55,940 --> 00:58:01,080
+الcircular لكن لأنه هذا mixed في كل اتجاهات في
+
+733
+00:58:01,080 --> 00:58:04,060
+البلاد اللي .. في كل اتجاهات فبقدر إلى انها
+
+734
+00:58:04,060 --> 00:58:08,200
+intramural شبكة موجودة بين ال .. ايه؟ بين العضلات
+
+735
+00:58:08,200 --> 00:58:13,660
+هذه إذا ال intramural plexus هذه بنسميه intrinsic
+
+736
+00:58:13,660 --> 00:58:19,190
+plexus تمام؟و هي هذه لتقود ال .. ال peristaltic
+
+737
+00:58:19,190 --> 00:58:22,510
+movement تمام؟ و ال sympathetic و ال
+
+738
+00:58:22,510 --> 00:58:26,790
+parasympathetic يا اما بيقووها يا اما بيضعقوها حسب
+
+739
+00:58:26,790 --> 00:58:32,130
+ما حكينا ان ال parasympathetic بيزيد لذلك احنا لما
+
+740
+00:58:32,130 --> 00:58:38,130
+ال hyper peristalsis تصير بتعملنا مغسفلما احنا
+
+741
+00:58:38,130 --> 00:58:42,090
+اكسر عندنا مغس كلوي يعني صار في hyperperistaltic
+
+742
+00:58:42,090 --> 00:58:46,250
+activity انشاء من البراصيمبتاتيك لذلك اذا اديت انا
+
+743
+00:58:46,250 --> 00:58:50,190
+حاجة تسبرس البراصيمبتاتيك زي الأتروبيل بروح المغس
+
+744
+00:58:50,190 --> 00:58:55,950
+لإن أساس ال hyperperistalsis هذه مقاوقة زي ال ..
+
+745
+00:58:55,950 --> 00:58:58,570
+ال .. ال .. ال intrinsic .. ال intrinsic plexus
+
+746
+00:58:58,570 --> 00:59:01,630
+مابتعملش such hyperperistalsis إذا انا حيقول
+
+747
+00:59:01,630 --> 00:59:05,330
+البراصيمبتاتيك هو اللي إيه؟عملها potentiation إذا
+
+748
+00:59:05,330 --> 00:59:09,830
+انا اديت أتروبي تمام Parasympathetic فبروح المغز
+
+749
+00:59:09,830 --> 00:59:14,710
+بروح تمام تمام برجع ل peristalsis A اللي هي تبع ال
+
+750
+00:59:14,710 --> 00:59:19,330
+intramural plexus الداخلية ال .. إذا ال
+
+751
+00:59:19,330 --> 00:59:25,170
+sympathetic مش غير العكس بعمل suppression as
+
+752
+00:59:25,170 --> 00:59:28,910
+with other vesical smooth muscles peristaltic
+
+753
+00:59:28,910 --> 00:59:33,360
+contractionالذئبال يكونوا مزدوجين زي ما كان اقول
+
+754
+00:59:33,360 --> 00:59:37,780
+بقى سمبتاتيكو والعكس صحيح the normal tone of the
+
+755
+00:59:37,780 --> 00:59:41,160
+Dendrosal muscle in the bladder wall tends to
+
+756
+00:59:41,160 --> 00:59:45,740
+compress انا حاول اتكلم عن جزء بخص ال base maker
+
+757
+00:59:45,740 --> 00:59:46,860
+انا حاول اتكلم عن جزء بخص ال base maker انا حاول
+
+758
+00:59:46,860 --> 00:59:46,940
+جزء بخص ال base maker انا حاول اتكلم عن جزء بخص ال
+
+759
+00:59:46,940 --> 00:59:47,320
+base maker انا حاول اتكلم عن جزء بخص ال base maker
+
+760
+00:59:47,320 --> 00:59:48,200
+انا حاول اتكلم عن جزء بخص ال base maker انا حاول
+
+761
+00:59:48,200 --> 00:59:53,220
+اتكلم عن جزء بخص ال base maker انا حاول اتكلم عن
+
+762
+00:59:53,220 --> 00:59:57,220
+جزء بخص ال
+
+763
+01:00:00,580 --> 01:00:06,660
+في بعض الناس، الوضع اللي يتجرس من خلطة البلدار ليس
+
+764
+01:00:06,660 --> 01:00:08,800
+أكتر من ما يتجرس من خلطة البلدار بشكل عادل، لذلك
+
+765
+01:00:08,800 --> 01:00:14,000
+تتجرس البلدار من خلطة البلدار ليس دائمًا يتجرس من
+
+766
+01:00:14,000 --> 01:00:15,440
+خلطة البلدار بشكل أكتر من ما يتجرس من خلطة البلدار
+
+767
+01:00:15,440 --> 01:00:17,580
+بشكل عادل
+
+768
+01:00:23,580 --> 01:00:27,960
+ureteral reflex ويلو مشاكل كتيرة تمام بيخرّب في
+
+769
+01:00:27,960 --> 01:00:32,940
+الآخر الكلية pain sensation in the ureters and
+
+770
+01:00:32,940 --> 01:00:35,700
+uretero-renal reflex نفسي أنا الآن بيدرس حاجة
+
+771
+01:00:35,700 --> 01:00:42,480
+اسمها uretero-renal reflex و أثره على الكلية ال
+
+772
+01:00:42,480 --> 01:00:47,340
+reflex هذا بيبدأ بال ureter وبينتهي renal بال
+
+773
+01:00:47,340 --> 01:00:50,970
+bladder بال .. بال kidneyو ايه في الكدنى؟ في blood
+
+774
+01:00:50,970 --> 01:00:51,930
+vessels of the kidney
+
+775
+01:01:20,170 --> 01:01:24,390
+للـ Renal Arteries بيقدّي إلى إن الـ Spasm هذا
+
+776
+01:01:24,390 --> 01:01:28,690
+إيجابي لبولير التكون اللي هو عام عامل الـ pressure
+
+777
+01:01:28,690 --> 01:01:32,190
+الزايد some sort of protection بيقول الكيلية إذا
+
+778
+01:01:32,190 --> 01:01:34,970
+لما بيصير هذا الكلام الكيلية اللي في جهتها الحصوة
+
+779
+01:01:34,970 --> 01:01:39,030
+تصير فيها Spasm لل blood vessels و إذا زاد ممكن
+
+780
+01:01:39,030 --> 01:01:43,600
+تصير ischemia للكيلية كلها و ممكن تضربهو أساسه
+
+781
+01:01:43,600 --> 01:01:47,220
+معمول عشان يجلل ال urine formation عشان يجلل ال
+
+782
+01:01:47,220 --> 01:01:52,360
+pressure اللي هو عامل ال plan اسمه Uretero Renal
+
+783
+01:01:52,360 --> 01:01:56,760
+Reflex ناتج عن انه Stimulation في ال ureter تؤدي
+
+784
+01:01:56,760 --> 01:02:02,920
+إلى ال drop في ال urine formation بسبب ال spasm of
+
+785
+01:02:02,920 --> 01:02:06,020
+the arterial system of the kidney
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..1edd960c25a2fca96c8c2948ef5ac14fa09000be
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/_DMqOBCh86I_raw.srt
@@ -0,0 +1,3192 @@
+1
+00:00:05,380 --> 00:00:08,840
+بنرجع تاني انه الكلية هذه اللي اتكلمنا عنها عملت
+
+2
+00:00:08,840 --> 00:00:12,640
+ball اتكون ال ball و اتركز ال ball و اتخفف ال ball
+
+3
+00:00:12,640 --> 00:00:18,180
+و بنعرف بالظبط ايش عملت هي الان ال ball الان هذا
+
+4
+00:00:18,180 --> 00:00:24,720
+اللي طالع من ال collecting duct نزل ال renal
+
+5
+00:00:24,720 --> 00:00:29,600
+pelvis ال kidney pelvis إلى ال ureter إلى ال
+
+6
+00:00:29,600 --> 00:00:34,300
+bladder الرحلة هذه كلها متغيرش في تركيبهايعني خلاص
+
+7
+00:00:34,300 --> 00:00:41,620
+التغييرات اللي بتصير لحد ال collecting duct لحد ما
+
+8
+00:00:41,620 --> 00:00:47,520
+يطلع الينا من البابلة التركيب بتغيرش أو بيصير
+
+9
+00:00:47,520 --> 00:00:51,160
+minimal changes يعني أحيانا بيصير absorption of
+
+10
+00:00:51,160 --> 00:00:54,900
+water في حالات ما يكون في عندنا obstruction أو كده
+
+11
+00:00:54,900 --> 00:00:59,260
+بتصير نوع من التبديل والتغيير لكنه في الوضع
+
+12
+00:00:59,260 --> 00:01:06,830
+الطبيعي مابيصيرش هذه واحدةدين احنا هنا نتعامل اهل
+
+13
+00:01:06,830 --> 00:01:13,610
+مع ال executory part of the ايه؟ of the job تبع ال
+
+14
+00:01:13,610 --> 00:01:17,970
+urine عمالية احنا صنعناه تمام بس بيبقى نوصله الى
+
+15
+00:01:17,970 --> 00:01:23,190
+السوق المحلية تبعته وهي الى ايه ال ureter و الى ال
+
+16
+00:01:23,190 --> 00:01:27,270
+bladder و الى ال urethra الى الخارج تمام؟ لإن في
+
+17
+00:01:27,270 --> 00:01:33,910
+عندنا system ال system هذا في ال ureterUreter
+
+18
+00:01:33,910 --> 00:01:42,490
+عبارة عن tubular hollow viscous زي ال .. ال
+
+19
+00:01:42,490 --> 00:01:49,850
+intestine زي ايش؟ ال intestine زي ال .. ال أشياء
+
+20
+00:01:49,850 --> 00:01:54,170
+الكتيرة tubular زي كده في الجسم فيهم نفس النظام شو
+
+21
+00:01:54,170 --> 00:01:58,190
+نظام هذا؟ يعني في عندهم داخليا حاجة بيسموها base
+
+22
+00:01:58,190 --> 00:02:02,050
+makerهندرسها بالتفصيل ان شاء الله لما ندرس ال GIT
+
+23
+00:02:02,050 --> 00:02:08,110
+في عندهم حاجة اسمها slow waves هنا موجود نفس
+
+24
+00:02:08,110 --> 00:02:15,410
+النظام موجود ما ينترك بليكساس في ال .. في ال .. ال
+
+25
+00:02:15,410 --> 00:02:21,710
+GIT هنا موجود بليكساس network من الأعصاب الداخلية
+
+26
+00:02:21,710 --> 00:02:27,570
+اللي هي تكون بعملية ال peristalsis طبعا عملية ايه؟
+
+27
+00:02:27,570 --> 00:02:31,630
+الحركة الدوديةلأن البول لا ينتقل من عند ال
+
+28
+00:02:31,630 --> 00:02:35,630
+collecting duct يعني من ال minor calyx اللي هو كل
+
+29
+00:02:35,630 --> 00:02:40,010
+collecting duct بتنتهي في minor calyx مش كده؟
+
+30
+00:02:40,010 --> 00:02:47,330
+collecting duct فيها أكم .. أكم .. أكم ..
+
+31
+00:02:47,330 --> 00:02:51,690
+collecting duct بتصوب في ال minor calyx 250
+
+32
+00:02:53,150 --> 00:02:57,510
+مش كده؟ اه 250 فعندي كل 250 فيه اللي هو minor
+
+33
+00:02:57,510 --> 00:03:03,130
+calix ال minor calix هذا لما يسلم ال drop of urine
+
+34
+00:03:03,130 --> 00:03:07,950
+الطالعة هذه بتنتخل منه إلى ال bladder عن طريق ال
+
+35
+00:03:07,950 --> 00:03:12,310
+pedistalsis مابتنزلش by gravity أو by weight تمام؟
+
+36
+00:03:12,310 --> 00:03:15,530
+اذا في عندي حركة دودية بتبدأ من هنا من ال minor
+
+37
+00:03:15,530 --> 00:03:21,150
+calix إلى ال bladderالحركة الدودية هذه تعتمد في
+
+38
+00:03:21,150 --> 00:03:25,530
+وجودها على مين؟ على ال intrinsic plexus الموجودة
+
+39
+00:03:25,530 --> 00:03:30,070
+ال .. ال nerve plexus ال nerve network شبكة
+
+40
+00:03:30,070 --> 00:03:34,730
+العصبية اللي موجودة في داخل ال unitary هذه الشبكة
+
+41
+00:03:34,730 --> 00:03:40,650
+هي اللي بتكون بعمل ترتيب ال .. الحركة الدودية هذه
+
+42
+00:03:40,650 --> 00:03:45,480
+بالاضافة لها أعصابالـ Parasympathetic من autonomic
+
+43
+00:03:45,480 --> 00:03:50,820
+nervous system بيزود حركتها و يضاف إليها عصابي
+
+44
+00:03:50,820 --> 00:03:54,920
+sympathetic بيجلل حركتها إذا في عندى شبكة ممكن
+
+45
+00:03:54,920 --> 00:03:59,780
+يزيد حركتها أو يجل حركتها تمام حسب ال autonomic
+
+46
+00:03:59,780 --> 00:04:02,500
+nervous system هذا انتوا درستوا ال autonomic
+
+47
+00:04:02,500 --> 00:04:06,240
+nervous system؟ قولوا إنها في جسمين و كل جسم مختلف
+
+48
+00:04:06,240 --> 00:04:10,970
+عن التانياللي هنا بالذات اللي بيتحكم في الحركة ال
+
+49
+00:04:10,970 --> 00:04:15,390
+parasympathetic system و ال parasympathetic system
+
+50
+00:04:15,390 --> 00:04:19,830
+هذا انتوا عارفين ال sympathetic عن ال
+
+51
+00:04:19,830 --> 00:04:23,210
+parasympathetic بيخلف في بعض المواصفات منها ال
+
+52
+00:04:23,210 --> 00:04:26,570
+gangrene تبعه وين؟ او منها ال boss ganglionic
+
+53
+00:04:26,570 --> 00:04:30,650
+nerve fiber وين؟ او جديش دايما ال parasympathetic
+
+54
+00:04:31,490 --> 00:04:35,390
+الجانجل يتبعها بيكون يا إما في الviscous نفسه يا
+
+55
+00:04:35,390 --> 00:04:39,090
+إما close to it يا إما في نفس ال world يا إما جاري
+
+56
+00:04:39,090 --> 00:04:42,430
+منها وهنا الجانجل تبع البره sympathetic اللي هي
+
+57
+00:04:42,430 --> 00:04:46,830
+بتتحكم في ال ureters أو بتزيد حركة الدولية تبع ال
+
+58
+00:04:46,830 --> 00:04:52,170
+uretersموجودة inside the ايه؟ the ureteric tissues
+
+59
+00:04:52,170 --> 00:04:55,850
+تمام؟ و ال boss ganglionic fibers كده very short
+
+60
+00:04:55,850 --> 00:04:59,410
+boss ganglionic fibers مش كده؟ موجودين في الداخل
+
+61
+00:04:59,410 --> 00:05:06,530
+او هم شبكين حقيقة من ضمن ال ال ال intrinsic nerve
+
+62
+00:05:10,900 --> 00:05:13,880
+قلنا حاجة تانية في ال base maker ماكملنا في الكلام
+
+63
+00:05:13,880 --> 00:05:18,900
+عنها هذول ال hollow viscous organs او ال tubular
+
+64
+00:05:18,900 --> 00:05:21,980
+organs اللي فيهم بال ecstatic movement بيكون عندهم
+
+65
+00:05:21,980 --> 00:05:29,560
+فيه حركة حركة تغير في الأيونات زي ال base maker
+
+66
+00:05:29,560 --> 00:05:33,900
+لكن
+
+67
+00:05:33,900 --> 00:05:43,200
+هذه الحركة التأيون بتعمل تغير فيال .. ال .. ال
+
+68
+00:05:43,200 --> 00:05:45,500
+resting membrane potential بتعرفوا resting
+
+69
+00:05:45,500 --> 00:05:48,060
+membrane potential مش كده؟ ال resting membrane
+
+70
+00:05:48,060 --> 00:05:52,180
+potential هذا بيضل يتغير يعمل depolarization و
+
+71
+00:05:52,180 --> 00:05:54,580
+repolarization , depolarization و repolarization
+
+72
+00:05:54,580 --> 00:06:00,600
+بشكل تلقائي بس مش بشكل يوصله لل action potential
+
+73
+00:06:00,600 --> 00:06:05,920
+لل actual contraction لكن في عندنا ايه؟ تغيرات
+
+74
+00:06:05,920 --> 00:06:11,480
+متواصلةهنا بسميها intrinsic slow pace maker
+
+75
+00:06:11,480 --> 00:06:19,440
+activities وهنا بسميها slow waves في ال GITهدول ال
+
+76
+00:06:19,440 --> 00:06:24,220
+slow waves هدول او ال changes اللي بيصير على ال
+
+77
+00:06:24,220 --> 00:06:28,580
+resting membrane potential هدول جاهزين انه اذا اجا
+
+78
+00:06:28,580 --> 00:06:32,460
+initiation stretch drop of urine كذا بيعملهم
+
+79
+00:06:32,460 --> 00:06:38,880
+potentiation تقوية و بيصير عندي ال base maker هذا
+
+80
+00:06:38,880 --> 00:06:41,140
+strong enough to make peristaltic movement
+
+81
+00:06:41,140 --> 00:06:44,980
+contractions تمام؟ اذا في عندنا موجود فيهم
+
+82
+00:06:47,530 --> 00:06:51,730
+Intrinsic Basemaker Properties Basemaker عارفين
+
+83
+00:06:51,730 --> 00:06:55,170
+ايش يعني Basemaker انتوا مادرستوش اللي هندلسوا ال
+
+84
+00:06:55,170 --> 00:06:58,990
+Basemaker بشكل رئيسي حقيقية تانية اللي هندلسوه ال
+
+85
+00:06:58,990 --> 00:07:04,410
+heart عشان ايه ال S A node كيف انها هي اللي بتقود
+
+86
+00:07:04,410 --> 00:07:13,390
+حركة القبضات القلب اذا اليوم احنا هنتكلم عن عملية
+
+87
+00:07:15,560 --> 00:07:22,040
+ال mixuration فيها
+
+88
+00:07:22,040 --> 00:07:26,580
+ال
+
+89
+00:07:26,580 --> 00:07:36,060
+pore بينتقل من ال kidney pelvis الى ال bladder عن
+
+90
+00:07:36,060 --> 00:07:41,160
+طريق ال peristalsis الواحد لو كان رأسه تحت وجليه
+
+91
+00:07:41,160 --> 00:07:45,630
+فوق برضه ال urine كانgo from the kidney to the
+
+92
+00:07:45,630 --> 00:07:50,790
+bladder مش كده يعني مش بس بال gravity طبعا وجود ال
+
+93
+00:07:50,790 --> 00:07:55,090
+gravity بيساعد لكن مش هي ال ايه الأساس زي ما هتكلم
+
+94
+00:07:55,090 --> 00:07:59,210
+في البلع في ال ossophagus في ال GIT وجود ال
+
+95
+00:07:59,210 --> 00:08:04,430
+gravity بيساعد لكن هذا مش هو ال ايه الأساس ال
+
+96
+00:08:04,430 --> 00:08:11,050
+bladder ال ureter هذا لما يصل ل bladder في بعض
+
+97
+00:08:11,050 --> 00:08:19,660
+المواصفاتالهدف من هذه المواصفات ان البلدار بتجمع
+
+98
+00:08:19,660 --> 00:08:26,060
+بول و بتجمع بول و بتجمع بول بيزيد الضغط فيها طب
+
+99
+00:08:26,060 --> 00:08:30,100
+ممكن يرجع مدن في انبوبة واصلة ممكن يرجع البول الى
+
+100
+00:08:30,100 --> 00:08:35,320
+ال .. ال unitary في الطبيعي بيصيرش بس أحيانا
+
+101
+00:08:35,320 --> 00:08:40,160
+منلاحظها reflex unitary reflex أحيانا منلاحظها
+
+102
+00:08:40,960 --> 00:08:44,700
+مشكلة عند بعض الناس مشكلة كبيرة قدرهم عملية او كده
+
+103
+00:08:44,700 --> 00:08:50,240
+لكن هذه المسألة في الطبيعي مش موجودة يعني في عندي
+
+104
+00:08:50,240 --> 00:08:56,260
+sphinctric like action او valvular like action هنا
+
+105
+00:08:56,260 --> 00:09:01,110
+بتقدر الى انه ايه؟البول لما يجيبك في ال bladder و
+
+106
+00:09:01,110 --> 00:09:04,590
+يزيد الضغط فيه مايرجعش، مابتعرفوا الفرق انتوا بين
+
+107
+00:09:04,590 --> 00:09:10,850
+ال sphincter و الvalve؟ مابتعرفوش ال sphincter
+
+108
+00:09:10,850 --> 00:09:19,990
+muscle ا strengthen ا thickened و getting stronger
+
+109
+00:09:19,990 --> 00:09:24,050
+than the usual يعني دايما عندها في المنطقة العضلة
+
+110
+00:09:24,050 --> 00:09:27,430
+تبعت ال hollow organ هذي في المنطقة هذي بيلاقي ال
+
+111
+00:09:27,430 --> 00:09:34,450
+circularمصله خملت تمام بحيث انها ايه اتعمل سفينكتر
+
+112
+00:09:34,450 --> 00:09:41,870
+حقا حقيقة مش موجود التشكيلة هذه لكن ال blood roll
+
+113
+00:09:41,870 --> 00:09:50,090
+نفسها عضلات ففي المنطقة هذه عاملة contraction يعني
+
+114
+00:09:50,090 --> 00:09:53,330
+عاملة سفينكتر السفينكتر action هى تبعنا جاي من ال
+
+115
+00:09:53,330 --> 00:09:57,150
+blood rollبمعنى ان العضلات تبع البلدار هي اللي
+
+116
+00:09:57,150 --> 00:10:02,590
+بتشد على مين؟ على ال .. على ال ureter مش كده هو بس
+
+117
+00:10:02,590 --> 00:10:07,950
+ال ureter مش داخل البلدار كده لأ داخل البلدار بيخش
+
+118
+00:10:07,950 --> 00:10:11,730
+اوبليك في ال .. ال .. ال .. في ال bladder muscles
+
+119
+00:10:11,730 --> 00:10:15,090
+بيخش فيها أوبليك بحيث انه يبقى كمية كبيرة من
+
+120
+00:10:15,090 --> 00:10:19,530
+العضلات محيطة بيه تمام؟ بعد ما يبقى أوبليك و يطلع
+
+121
+00:10:19,530 --> 00:10:25,240
+كمان بيخش أوبليك تحت الميكوزاطبعا اذا بتانطل ال
+
+122
+00:10:25,240 --> 00:10:30,680
+blooder هذي بيخش تحتها أبليكي اذا لما بيدنطلق ال
+
+123
+00:10:30,680 --> 00:10:34,540
+blooder و بزيد الضغط فيها الضغط هم بيضغط عليهم
+
+124
+00:10:34,540 --> 00:10:37,920
+التريل تحت الميكروفزة بيسكروا هذا الvalvular
+
+125
+00:10:37,920 --> 00:10:42,360
+action الvalvular action انه في عندنا شفرات او
+
+126
+00:10:42,360 --> 00:10:45,640
+شفاف خارجية عن ال .. هذي لما زيد الضغط و تحيه
+
+127
+00:10:45,640 --> 00:10:51,420
+بتسكر في ال elucical junction تبع ال .. انا ممكن
+
+128
+00:10:51,420 --> 00:10:57,620
+اوريكوا يعنىالـ electrical junction تبع الاليام
+
+129
+00:10:57,620 --> 00:11:03,860
+الانتستين الأمعاق الدقيقة لما نخش في ال سيكم تمام
+
+130
+00:11:03,860 --> 00:11:08,740
+نخش في السيكم بيعمل هيك بتلاقي شفاف برا هذه
+
+131
+00:11:08,740 --> 00:11:13,040
+المنطقة السفينتر لكن هذه المنطقة ال valve فلما
+
+132
+00:11:13,040 --> 00:11:16,340
+السيكم بيعمل contraction هذا الناس بيطبقوا مع بعض
+
+133
+00:11:16,340 --> 00:11:22,130
+و بيمنعوا ان ايه لكن ال valveبيبقى مسكر في وقت ما
+
+134
+00:11:22,130 --> 00:11:27,370
+بيلزم انه نمنع الاشي يدخل لكن لما يصير Intramural
+
+135
+00:11:27,370 --> 00:11:31,370
+pressure زاد ال Intravicycle pressure بيقدرش يرجع
+
+136
+00:11:31,370 --> 00:11:35,410
+لإنه الvalvular action بيسكر فبيمنع .. بيريح
+
+137
+00:11:35,410 --> 00:11:39,150
+العضلة مش محتاجة هي العضلة تشتغل لكن لو هذا من عمل
+
+138
+00:11:39,150 --> 00:11:43,950
+بطريقة تانية كان direct perpendicular فمعناه
+
+139
+00:11:43,950 --> 00:11:47,970
+الvalvular action هذا راح ان الميل هي انه ميشي
+
+140
+00:11:47,970 --> 00:11:53,060
+فترةفي داخل ال .. تحت الميكوزا بقدر .. لما يزيد
+
+141
+00:11:53,060 --> 00:11:57,580
+الضغط اه يضغط عليه على الجسم الفكرة هذه يعني
+
+142
+00:11:57,580 --> 00:12:02,960
+موجودة في تركيب بني آدم كتير موجود في تركيب بني
+
+143
+00:12:02,960 --> 00:12:08,400
+آدم في عدة أشياء في بعض ال veins موجودة في العضو
+
+144
+00:12:08,400 --> 00:12:14,020
+الذكري لل .. لل .. للبني آدمالـ veins هي طالعة
+
+145
+00:12:14,020 --> 00:12:18,980
+برضه تطلعش مباشرة emisary veins تطلعش مباشرة لأ
+
+146
+00:12:18,980 --> 00:12:22,920
+تمشي تحت ال mycosis شوية تحت ال structure و بعدين
+
+147
+00:12:22,920 --> 00:12:28,810
+بتطلعبحيث إنه إذا زاد الضغط بيسكرها فبيقدر إلى إنه
+
+148
+00:12:28,810 --> 00:12:32,550
+مش إنه الدم بيخش و يتحرب بسرعة بيظل مضغوط و مسكر
+
+149
+00:12:32,550 --> 00:12:36,310
+تمام؟ لما يهبط الضغط بجل الضغط عليها فبتروح ايه؟
+
+150
+00:12:36,310 --> 00:12:40,410
+بيصير rapid evacuation
+
+151
+00:12:40,410 --> 00:12:44,370
+يعني ال system هذا موجود في الجسم في أكتر من مكان
+
+152
+00:12:44,370 --> 00:12:47,890
+.. احنا اليوم بنفهم و قاعدين اليوم بنفهم و بنعرف
+
+153
+00:12:47,890 --> 00:12:51,730
+ايش اسمه .. انه يعني .. ايش ما شاء الله لكن ما
+
+154
+00:12:51,730 --> 00:12:55,730
+أعتقد إنه هادمان حاله لحالهمش ايه ولا .. فال
+
+155
+00:12:55,730 --> 00:13:01,530
+bladder نازل فيها ال ureter Oblique و بعدين بيخش
+
+156
+00:13:01,530 --> 00:13:07,250
+صبم ال mucus ممشي فترة و بعدين بيفتح ال .. في داخل
+
+157
+00:13:07,250 --> 00:13:12,610
+ال bladder cavity لكن هذه التركيب بيخلي انه مافيش
+
+158
+00:13:12,610 --> 00:13:16,870
+عندي انا .. انا فاكر اول .. من اول ال .. كنت لسه
+
+159
+00:13:16,870 --> 00:13:22,190
+خارجي جديد و شوفت بنت عندها recurrent
+
+160
+00:13:24,350 --> 00:13:32,050
+الالتهابات مابتتوقفش مش ال ال ال كلية دايما عندها
+
+161
+00:13:32,050 --> 00:13:36,510
+إيه فيها التهاب تمام فاحملنا لها الصور اللي لازمة
+
+162
+00:13:36,510 --> 00:13:37,870
+و مفتشفتوا عندها reflex
+
+163
+00:13:40,580 --> 00:13:43,920
+إن ال بول اللي في ال blood هذا بيقدر إيش؟ يرجح،
+
+164
+00:13:43,920 --> 00:13:47,680
+تمام؟ بيقدر إيش؟ يرجح، فهذا بيقدر إلى مشاكل كتيرة
+
+165
+00:13:47,680 --> 00:13:51,440
+لإن الضغط صار ينتقل ال blood إلى ال ureter، الضغط
+
+166
+00:13:51,440 --> 00:13:54,000
+صار ينتقل إلى ال ureter و بعد ما ينتقل ال ureter
+
+167
+00:13:54,000 --> 00:13:58,340
+ينتقل لمين؟ للكيلية، و بيبدأ يخرب، يعني الضغط
+
+168
+00:13:58,340 --> 00:14:01,220
+الموجود في الكيلية بتبدأ ال pelvis ده بقى هينتفش،
+
+169
+00:14:01,220 --> 00:14:04,020
+ينتفش على حسب من؟ على حسب ال tissues، بيشدّق،
+
+170
+00:14:04,020 --> 00:14:07,140
+بيفردها، و بعدين الكيلية بيصير .. بيصيرها إيه؟
+
+171
+00:14:07,140 --> 00:14:13,240
+بيسميها hydronephrosisيعني الكلية انتفخت كده ..
+
+172
+00:14:13,240 --> 00:14:21,320
+كده انتفخت و توسعت و كبرت اذا يعني أقل الأشياء
+
+173
+00:14:21,320 --> 00:14:26,520
+أحيانا مالاجي لها أخطر اي شي بسيط اي شي .. اي شي
+
+174
+00:14:26,520 --> 00:14:30,780
+في جسم الإنسان بكرا ما تدرسوا الأمراض كلها بتلاقوا
+
+175
+00:14:30,780 --> 00:14:34,960
+العلم لمرض ضخم جدا انه في enzyme معين .. enzyme
+
+176
+00:14:34,960 --> 00:14:41,350
+معين في .. من gene معين ماعرفش إيشفقد صلاحيته مش
+
+177
+00:14:41,350 --> 00:14:44,890
+.. مش شجعه فبيقدّي إلي سلسلة من الأفعال مش بينتج
+
+178
+00:14:44,890 --> 00:14:49,970
+عنها مرض كبير و هترجع لمرض بتلاقيه و برجع لإيه ..
+
+179
+00:14:49,970 --> 00:14:54,850
+لإيش بسيط جدا فالجسم مبني بشكل من الكفاءة العالية
+
+180
+00:14:55,230 --> 00:14:58,730
+اللي انا معجب في كتاب غايتون دائما بينبض المسائل
+
+181
+00:14:58,730 --> 00:15:03,570
+هذه و دائما بيورّج كدهش ال system الجهاز البني آدم
+
+182
+00:15:03,570 --> 00:15:07,450
+كدهش الكفاءة
+
+183
+00:15:07,450 --> 00:15:10,630
+فيه موجودة و هذا من الطبيعي للواحد لما يدرس جسم
+
+184
+00:15:10,630 --> 00:15:16,210
+البني آدم يحسبها الكفاءة هذه في كل فرع من أفرع ال
+
+185
+00:15:16,210 --> 00:15:20,570
+physiology او الدراسة اللي هو بيعملها عن الوظائف
+
+186
+00:15:20,570 --> 00:15:26,960
+في جسم الإنسانطيب إذا عندنا ال ureter بيدخل بشكل
+
+187
+00:15:26,960 --> 00:15:31,020
+معين و هذا بيمنع ال reflex ان الرجوع الارتجاع تبع
+
+188
+00:15:31,020 --> 00:15:41,620
+ال bone لإن الارتجاعة دلوقت مشاكل كبيرة علشان
+
+189
+00:15:41,620 --> 00:15:45,660
+يصير عندى علشان يصير عندنا
+
+190
+00:15:48,610 --> 00:15:53,410
+بعد ما اتحوش ال ball في ال .. في ال bladder عشان
+
+191
+00:15:53,410 --> 00:15:57,070
+يصير عندنا evacuation، بنحتاج أن يصير عندنا حاجة
+
+192
+00:15:57,070 --> 00:16:00,350
+مثلا ميكتوريشن ريفليكس، نحتاج أن يصير عندنا
+
+193
+00:16:00,350 --> 00:16:04,590
+ميكتوريشن ريفليكس، يعني أنا مابعرفش أجد ال bladder
+
+194
+00:16:04,590 --> 00:16:08,860
+تبعتي مجدش فيها ballهم اضطر انه انا لازم اروح
+
+195
+00:16:08,860 --> 00:16:13,080
+الحمام الآن و الا هفكر التحكم ولا لأ؟ في system
+
+196
+00:16:13,080 --> 00:16:18,200
+موجود بنبهني و بعرفني و لما انا يعني ييجي الوقت
+
+197
+00:16:18,200 --> 00:16:22,460
+المناسب بقدر انه ببساطة من غير ما اعمل اي حاجة بس
+
+198
+00:16:22,460 --> 00:16:26,490
+اخد قرار انه اناناوي ان اعمل evacuation ل البلدة
+
+199
+00:16:26,490 --> 00:16:30,310
+فبصير العملية سهولة هذا اللي احنا تقريبا هندرسه
+
+200
+00:16:30,310 --> 00:16:36,110
+طول الساعة هذه اللي احنا فيها طبعا هذا بتطلب اول
+
+201
+00:16:36,110 --> 00:16:44,930
+اشي انه ندرس تركيب البلدة الهادي تركيب البلدة
+
+202
+00:16:44,930 --> 00:16:52,970
+الهادي تمام؟ اذا من الكليةلل بلدر عندنا ال ureter
+
+203
+00:16:52,970 --> 00:16:55,870
+قولنا كيف بدخل في البلدر وقولنا انه peristaltic
+
+204
+00:16:55,870 --> 00:16:59,730
+movement وقولنا انه في عندنا base maker activity
+
+205
+00:16:59,730 --> 00:17:03,550
+initiated by the stretch اللي بيحصل من وجود له
+
+206
+00:17:03,550 --> 00:17:06,950
+drop يعني ال drop في المكان المعين فهذا initiating
+
+207
+00:17:06,950 --> 00:17:10,550
+ال ايه peristaltic wave تاخد ال drop هذه معاها إلى
+
+208
+00:17:10,550 --> 00:17:17,250
+ايه؟ إلى البلدر اذا دلوقتي الدراسة مركزة ع مين؟
+
+209
+00:17:17,250 --> 00:17:23,390
+على البلدر تمام؟ على البلدرالبلادر التركيبتها هي
+
+210
+00:17:23,390 --> 00:17:30,370
+ال urinary bladder ال .. ال viscous organs برضه زي
+
+211
+00:17:30,370 --> 00:17:35,550
+ال GIT نلاحظ أنه عندنا ال .. مش كمان طبعا ال من ال
+
+212
+00:17:35,550 --> 00:17:39,150
+smooth muscles مش هيك؟ ال smooth muscles إلها
+
+213
+00:17:39,150 --> 00:17:48,030
+ميوكوزا و إلهاهن .. هنلاقي ال smooth muscles
+
+214
+00:17:48,030 --> 00:17:53,350
+تبعوننا ماخدين اتجاهات مختلفة يعني مش كلهم
+
+215
+00:17:53,350 --> 00:17:56,310
+longitudinal .. longitudinal لأ muscle fibers
+
+216
+00:17:56,310 --> 00:17:59,770
+ماخدة اتجاهات مختلفة لأن هي دائرية يعني فمخدة
+
+217
+00:17:59,770 --> 00:18:05,390
+اتجاهات مختلفة ال muscle fibers متصلة بعضها البعض
+
+218
+00:18:05,390 --> 00:18:09,470
+في cytoplasmic connection بين .. في gap junction
+
+219
+00:18:09,470 --> 00:18:15,240
+بينهمالسبب انه لو صار stimulation لأى muscle
+
+220
+00:18:15,240 --> 00:18:21,740
+fibers هذا ال stimulus بينتشر ك action potential
+
+221
+00:18:21,740 --> 00:18:27,880
+من muscle fibers بحيث تصبح contraction of the
+
+222
+00:18:27,880 --> 00:18:29,020
+whole bladder
+
+223
+00:18:41,440 --> 00:18:44,600
+بالرغم ان احنا بنتكلم عن .. عن smooth muscle
+
+224
+00:18:44,600 --> 00:18:49,420
+fibers قطرها على خمسين micron و ثمكتها اتنين لعشرة
+
+225
+00:18:49,420 --> 00:18:53,520
+micron يعني ايه ماهياش أشياء كبيرة اللي هنا معمولة
+
+226
+00:18:53,520 --> 00:18:58,170
+بشكل نسيج انه كأنهم كلهم واحدة واحدةكأنهم كلهم
+
+227
+00:18:58,170 --> 00:19:02,910
+واحدة واحدة لو شوفنا هنا ال epithelium هذا القطع
+
+228
+00:19:02,910 --> 00:19:06,730
+اللي موجود لو شوفنا ال epithelium هان الميكوزا هذه
+
+229
+00:19:06,730 --> 00:19:10,350
+الميكوزا الميكوزا هذه من النوع يسميها transitional
+
+230
+00:19:10,350 --> 00:19:16,070
+epithelium درسوه في .. مادرسوش انتوا histology؟ اه
+
+231
+00:19:16,070 --> 00:19:23,100
+ليش transitional؟ لأنهأيوة بيفرد هيك بتحول إلى من
+
+232
+00:19:23,100 --> 00:19:29,100
+striated ل columnar ل cuboid ل .. ممكن flat cells
+
+233
+00:19:29,100 --> 00:19:33,240
+تصير بتغير شكلها من مجد و مجد حسب جدريش هي إيه
+
+234
+00:19:33,240 --> 00:19:36,980
+تفرد ممكن ترجع تاني إلى إنها تبقى striated من أول
+
+235
+00:19:36,980 --> 00:19:41,200
+و جديد إذا في عندنا ال bladder نسميها detrosar
+
+236
+00:19:41,200 --> 00:19:45,140
+muscle عشان نسميها detrosal .. detrosar muscle
+
+237
+00:19:45,140 --> 00:19:51,980
+طبعا ك bladder موجودةوبريتونيوم حوالينا لذا اكيد
+
+238
+00:19:51,980 --> 00:19:53,660
+في طبقة من البريتونيوم بتغطي
+
+239
+00:20:03,070 --> 00:20:09,170
+هذا ال دولتينيام بيغطى بس
+
+240
+00:20:09,170 --> 00:20:13,050
+السطح و بعدين بروح على ال wall of the pelvis و
+
+241
+00:20:13,050 --> 00:20:17,110
+بكمل على ال abdominal wall بيصيب برايتان تمام؟ اذا
+
+242
+00:20:17,110 --> 00:20:22,080
+بس السطح هنا في عندنا أدريتيشيااللي هو الطبجة
+
+243
+00:20:22,080 --> 00:20:27,020
+الأخيرة كنت بتفتشه ليها اللي هي تحمي ال muscles و
+
+244
+00:20:27,020 --> 00:20:32,180
+تبقى فيها حاملة العصاب و الشرايين و الأشياء اللي
+
+245
+00:20:32,180 --> 00:20:36,440
+ايه وسائل النقطة زي اللي بنعمل احنا false sealing
+
+246
+00:20:36,440 --> 00:20:40,100
+لما نشتغل في مباني كبيرة و في وسط ال false sealing
+
+247
+00:20:40,100 --> 00:20:42,620
+هذا اللي بنحط ال ducts تبع ال conditioning و
+
+248
+00:20:42,620 --> 00:20:45,940
+الكهرة و الدنيا كلها فهو كأنه طبج هادى عشان حامل
+
+249
+00:20:45,940 --> 00:20:48,960
+الخدمات اللي موجودة على العضلة
+
+250
+00:20:53,360 --> 00:20:59,580
+طيب، هنكمل مشوارنا مع هذه، هنرجع تاني ل ال .. ال
+
+251
+00:20:59,580 --> 00:21:04,260
+muscle هذه ال blood .. ال blood .. ال .. ال .. ال
+
+252
+00:21:04,260 --> 00:21:07,840
+.. ال blood are تنقسم لجسمين، تنقسم لجسمين، تنقسم
+
+253
+00:21:07,840 --> 00:21:12,040
+إلى ال body of the bladder و bladder neck، هذه
+
+254
+00:21:12,040 --> 00:21:16,810
+المنطقة اسمها bladder neck، عنق المثالةال bloody
+
+255
+00:21:16,810 --> 00:21:20,850
+neck مفترض ان هو زي ال .. طبعا المنطجة اللي بديج
+
+256
+00:21:20,850 --> 00:21:25,550
+فيها ال .. ال .. ال .. ال bloody body بديج هيك و
+
+257
+00:21:25,550 --> 00:21:31,170
+بعدين بيتحول الى .. ال tube تبارك؟ بس المنطجة هذه
+
+258
+00:21:31,170 --> 00:21:37,600
+حقيقةمنشوفهاش احنا عاملة funnel shape زي القمع الا
+
+259
+00:21:37,600 --> 00:21:41,040
+اذا كان في عندي relaxation العضلات لكن في العادة
+
+260
+00:21:41,040 --> 00:21:43,860
+هاللي ولا منها قمعية الا ان في عندي هذه المنطقة
+
+261
+00:21:43,860 --> 00:21:50,580
+فيها intrinsic او internal sphincterهو internal و
+
+262
+00:21:50,580 --> 00:21:53,560
+intrinsic في نفس الوقت لأنه involuntary internal
+
+263
+00:21:53,560 --> 00:21:58,160
+sphincter
+
+264
+00:21:58,160 --> 00:22:03,880
+of the bladder sphincter دايما ضغط يخلق مش ببين
+
+265
+00:22:03,880 --> 00:22:08,680
+انها اي فضل شاب اما هو اذا عمل relaxation بيتسع و
+
+266
+00:22:08,680 --> 00:22:13,440
+بعدين بيجي ال urethra ال urethra هذه ممكن نسميها
+
+267
+00:22:13,440 --> 00:22:16,780
+بصيله ال urethra من ناحية ال urethra اذا بدأنا في
+
+268
+00:22:16,780 --> 00:22:20,160
+ال urethra من الأول همي نقول عنديبناء اليوريثرة
+
+269
+00:22:20,160 --> 00:22:27,180
+وبعدين مبنى اسمه يوريثرة وبعدين بروستيك يوريثرة
+
+270
+00:22:27,180 --> 00:22:32,280
+وبعدين بوستيليوريثرة الجزء الأخير اللي ايه؟ هذا
+
+271
+00:22:32,280 --> 00:22:36,780
+الجزير الجزء الأخر ممكن نسميها بوستيليوريثرة هذا
+
+272
+00:22:36,780 --> 00:22:41,880
+الجزء لكن النكهة اللي هنا و الجزء هذا نسميه بلدر
+
+273
+00:22:41,880 --> 00:22:44,960
+نكهة ال funnel shape يعني اللي هو هذا اللي هنا في
+
+274
+00:22:44,960 --> 00:22:50,550
+عنده عضلةInternal sphincter
+
+275
+00:22:50,550 --> 00:22:55,190
+of the
+
+276
+00:22:55,190 --> 00:22:58,730
+urinary bladder وهنا عندنا external sphincter ال
+
+277
+00:22:58,730 --> 00:23:02,310
+external sphincter عبارة عن isolated muscles
+
+278
+00:23:02,310 --> 00:23:10,550
+voluntary جزء من ال pelvic floor floor of the
+
+279
+00:23:10,550 --> 00:23:10,970
+pelvis
+
+280
+00:23:15,850 --> 00:23:20,070
+في عضلة كبيرة levator هنا اسمها هذه فتحالي فتحت
+
+281
+00:23:20,070 --> 00:23:23,710
+هنا عشان يطلع فيها فتحة ال vector او ال anus ال
+
+282
+00:23:23,710 --> 00:23:30,070
+canal و يطلع فيها ال vagina و يطلع ال eugenital
+
+283
+00:23:30,070 --> 00:23:36,910
+triangle نسميه المنطقة
+
+284
+00:23:36,910 --> 00:23:42,570
+العضلات في المنطقة هذه مقوة و معمولة اللي هي بتحكم
+
+285
+00:23:43,130 --> 00:23:48,310
+في الحالتنا هذه متحكم في ال evacuation و ال
+
+286
+00:23:48,310 --> 00:23:51,170
+maturation تمام؟ إذا أنا متحكم في ال maturation
+
+287
+00:23:51,170 --> 00:23:57,270
+هذه العضلة بنتسميها external اه external sphincter
+
+288
+00:23:57,270 --> 00:23:59,150
+إذا في عندك external sphincter عندك internal
+
+289
+00:23:59,150 --> 00:24:02,480
+sphincterهنلاحظ بعد شويه ان ال external sphincter
+
+290
+00:24:02,480 --> 00:24:06,440
+هذا انا بتحكم فيه انا بتقرر انه لما تجين الرغبة في
+
+291
+00:24:06,440 --> 00:24:09,660
+ال ball ان انا اتنول ولا لأ بقدر اوامر ال
+
+292
+00:24:09,660 --> 00:24:12,540
+sphincter هذا ال external افتح ولا لأ لكن ال
+
+293
+00:24:12,540 --> 00:24:15,520
+internal sphincter هذا مش غير reflex اذا تلت
+
+294
+00:24:15,520 --> 00:24:20,900
+المثالة و اشتدت فهو بيفتح فبنحس انه في رغبة شديدة
+
+295
+00:24:21,630 --> 00:24:25,510
+ممكن ال external researcher يفتح و يكمل و يقول لأ
+
+296
+00:24:25,510 --> 00:24:29,390
+مش وقته و يبقى شادد و بعدين بعد شوية تختفى الرغبة
+
+297
+00:24:29,390 --> 00:24:33,130
+هذه تغيب لمدة طويلة لحد ماريه في ال extension كمان
+
+298
+00:24:33,130 --> 00:24:37,210
+مرة هذا ما حكيه هو كله عموما موضوع دراستنا اليوم
+
+299
+00:24:37,210 --> 00:24:44,240
+خليني اتكلمها عند بلدكعندي nerve supply عندي
+
+300
+00:24:44,240 --> 00:24:47,760
+sympathetic و بقى sympathetic وعندي internal
+
+301
+00:24:47,760 --> 00:24:51,700
+sphincter و external sphincter عندى bladder neck
+
+302
+00:24:51,700 --> 00:24:57,980
+فيها اللي هو ال .. ال .. ال .. ال .. ال .. ال ..
+
+303
+00:24:57,980 --> 00:24:58,040
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+304
+00:24:58,040 --> 00:24:58,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+305
+00:24:58,220 --> 00:24:58,760
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+306
+00:24:58,760 --> 00:24:58,840
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+307
+00:24:58,840 --> 00:24:59,460
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+308
+00:24:59,460 --> 00:24:59,500
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+309
+00:24:59,500 --> 00:25:00,860
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+310
+00:25:00,860 --> 00:25:01,020
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+311
+00:25:01,020 --> 00:25:02,240
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+312
+00:25:02,240 --> 00:25:07,220
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+313
+00:25:07,220 --> 00:25:11,590
+ال .. ال ..هي ال .. ال .. ال .. ال ureter الحالب
+
+314
+00:25:11,590 --> 00:25:20,950
+وهان فتحت خالص فتحت الحالب، الحالبين جنب فتحت ال
+
+315
+00:25:20,950 --> 00:25:26,870
+.. ال bladder neck طبعا؟ لاحظين انتوا؟ يعني مش ال
+
+316
+00:25:26,870 --> 00:25:30,410
+bladder بيجي الحالبين من فوق هيك اه و ال هذا من
+
+317
+00:25:30,410 --> 00:25:35,280
+تحت مسلق لأ لأ ال .. ال .. ال uretersتحت فاتحين
+
+318
+00:25:35,280 --> 00:25:39,360
+جانب بعض المنطقى هي هذه المسلسل ما بين فتحة الحالب
+
+319
+00:25:39,360 --> 00:25:48,340
+وفتحة ال بلدر ميك هذا ال triangle نسميه ايش؟Try
+
+320
+00:25:48,340 --> 00:25:50,840
+again هذا الـ try again المهم لإن هو very
+
+321
+00:25:50,840 --> 00:25:56,020
+sensitive لإيه لما ال stretch يصير عليه بيديني
+
+322
+00:25:56,020 --> 00:26:00,940
+reflexes أقوى مكان بيديني reflexes تمام هو و الجزء
+
+323
+00:26:00,940 --> 00:26:05,560
+اللي داخله منه في داخل blood vessels فلما يصير
+
+324
+00:26:05,560 --> 00:26:09,520
+عليه simulation بيديني strong reflexes عسب إنه انا
+
+325
+00:26:09,520 --> 00:26:13,320
+عمل evacuation هذه المنطقة لو احنا طلعنا في المنظر
+
+326
+00:26:13,320 --> 00:26:17,710
+بنشوفهامن ميزها عن غيرها اذا بنعرف انه هذه ال
+
+327
+00:26:17,710 --> 00:26:21,810
+triangle لان هذه المنطقة smooth الباجي corrugated
+
+328
+00:26:21,810 --> 00:26:28,190
+الباجي مجاعد لان طبيعة البلادر بتبقى كامشة بتجاعد
+
+329
+00:26:28,190 --> 00:26:32,250
+بتفت .. بتفت .. بت .. بت .. بتمتلق dilated فبفرد
+
+330
+00:26:32,250 --> 00:26:34,730
+مش كده جونات transitional ابيتيليا ماعنده
+
+331
+00:26:34,730 --> 00:26:38,650
+المواصفات هذه فهنا لما نطلع في البلادر احنا طبعا
+
+332
+00:26:38,650 --> 00:26:42,490
+نطلع في البلادر international يعني مش كده لأنه
+
+333
+00:26:42,490 --> 00:26:46,530
+لازم تكون فاطئلأنه مش هاجدر انا اخش سفينكتا ايه
+
+334
+00:26:46,530 --> 00:26:52,050
+ايش اسمه ال endoscope اه ال cystoscope مش هاخش فيه
+
+335
+00:26:52,050 --> 00:26:56,350
+هو البولي ده المحجوز شوه فهشوف الفرق هشوف ان هذا
+
+336
+00:26:56,350 --> 00:27:02,030
+ال Trigon هو ايه ال Trigon هذا منطقة حساسة جدا لان
+
+337
+00:27:02,030 --> 00:27:07,470
+اللي هو هي خليني أورك فيها اذا
+
+338
+00:27:07,470 --> 00:27:09,910
+لقيت فتحة اليوليطر الشمال و لقيت فتحة اليوليطر
+
+339
+00:27:09,910 --> 00:27:16,130
+اليمين هو فتحة ال bloodهذا المسلسل الأبيض اسمه
+
+340
+00:27:16,130 --> 00:27:21,030
+Trigon هو مش اللون بس انه أفتح من غيره انه زي ما
+
+341
+00:27:21,030 --> 00:27:24,470
+تشايفين smooth الأخرين هتلاقيهم ايه؟ فيها
+
+342
+00:27:24,470 --> 00:27:28,190
+corrugations عملة انواع من التجعيد موجودة داخل ال
+
+343
+00:27:28,190 --> 00:27:34,850
+.. هذه المنطقة كتير حساسة لما يبقى فيها عندنا bowl
+
+344
+00:27:34,850 --> 00:27:40,380
+of residual urine موجودأه .. بنضل احنا حاسين في
+
+345
+00:27:40,380 --> 00:27:43,140
+المنطقة أنه بدنا فيه ركبة في التباون لما يكون في
+
+346
+00:27:43,140 --> 00:27:49,120
+عندنا حصوةو تنزل في المنطقة هذه تنح شرهان مثلا في
+
+347
+00:27:49,120 --> 00:27:52,200
+المنطقة ال trigon هذه تبقى قاعد على الباب بيظل
+
+348
+00:27:52,200 --> 00:27:55,740
+حاسس انه في ركبة للتبور رايحة جاي رايحة جاي رايحة
+
+349
+00:27:55,740 --> 00:27:59,180
+جاي على الحمام لإنه في حصوة نزلت من الكيلية و نزلت
+
+350
+00:27:59,180 --> 00:28:02,120
+في المثانا بس ساود فع الباب جاعد على ال trigon ال
+
+351
+00:28:02,120 --> 00:28:05,800
+trigon هذه منطقة ايه حساسة كتير و هي لها علاقة
+
+352
+00:28:05,800 --> 00:28:08,020
+كبيرة في ال ايه في ال maturation reflex
+
+353
+00:28:08,020 --> 00:28:13,990
+potentiating strongly the reflexإذا كانوا يقولوا
+
+354
+00:28:13,990 --> 00:28:18,130
+في حصة بتعمل irritation فانت لسه ال bladder فاضية
+
+355
+00:28:18,130 --> 00:28:22,390
+لكن حاسس انه في رقم شديد لك تباول لإنه في عندنا
+
+356
+00:28:22,390 --> 00:28:25,790
+strong irritation بتروح نزل و بتطيين و بترجع ..
+
+357
+00:28:25,790 --> 00:28:29,810
+نزل و بتطيين و بترجع .. تمام؟ إذا ال Trigon هذا
+
+358
+00:28:29,810 --> 00:28:34,850
+إيه؟ هي تركيب تهان في المنطقية نرجع تاني إذا عندي
+
+359
+00:28:34,850 --> 00:28:40,050
+the body و the neck و the bladder تمام؟
+
+360
+00:28:41,790 --> 00:28:47,470
+ال bloody neck طبعا احنا بنتكلم عنه هو نهاية ال
+
+361
+00:28:47,470 --> 00:28:53,050
+urethra بزل inferiorly and anteriorly
+
+362
+00:29:05,030 --> 00:29:07,130
+the smooth muscle of the brother is called
+
+363
+00:29:07,130 --> 00:29:11,590
+adiposal muscle اتكلمنا عنها و قولنا ادروسال
+
+364
+00:29:11,590 --> 00:29:18,650
+muscle هذه عضلة قوية تستطيع انها تعمل contraction
+
+365
+00:29:18,650 --> 00:29:25,070
+لما يكون داخلها بول البول هذا بتغطي عليها مش كده
+
+366
+00:29:25,070 --> 00:29:33,350
+هي بتقوم البول فهي بيصير فيها tone فيها tone
+
+367
+00:29:33,750 --> 00:29:37,850
+ال tone هادى ممكن يتشد لدرجة انها يتعلي الضغط داخل
+
+368
+00:29:37,850 --> 00:29:42,350
+ال .. ال bladder الى 40 الى 60 millimeter mercury
+
+369
+00:29:42,350 --> 00:29:45,990
+تمام؟ يعني بتقدر .. لو ال bladder انتهت على الآخر
+
+370
+00:29:45,990 --> 00:29:48,990
+ممكن تصل ل 100 millimeter mercury بس في الحالة
+
+371
+00:29:48,990 --> 00:29:53,770
+هادى يمكن عندي انا strong reflexلازم يتفرج اذا انا
+
+372
+00:29:53,770 --> 00:29:59,130
+اردت ولا ما اردتش بعد الميه هادى بنلاقي انه حتى ال
+
+373
+00:29:59,130 --> 00:30:02,090
+externalist انت مش قادر يقوم بالضغط اللى جاى ايه
+
+374
+00:30:02,090 --> 00:30:06,530
+من داخل ال bladder فحتى لو صاحب الشئ بده يمنع
+
+375
+00:30:06,530 --> 00:30:10,490
+التبول مقدرش تمام؟ اذا انا فيه انضغط من داخل ال
+
+376
+00:30:10,490 --> 00:30:14,550
+bladder بتكون مع ال ايه يعني عندى ال tone لاحظوا
+
+377
+00:30:14,550 --> 00:30:21,270
+احنا اول ما بتكون ال ball فيه tone تعمليعشرة رقم
+
+378
+00:30:21,270 --> 00:30:24,850
+أساسي ملي ميتر ميركوري مثلا زاد ال bone بتتوسع
+
+379
+00:30:24,850 --> 00:30:28,370
+شوية ال tone بتبقى موجود بتتوسع لحد معين بيبدأ
+
+380
+00:30:28,370 --> 00:30:33,110
+الضغط يعلق يعني هي ال tone موجودة اتحافظ على الميه
+
+381
+00:30:33,110 --> 00:30:39,770
+ال bone اللي فيها بشكل محسوس عند level معين بتبطر
+
+382
+00:30:39,770 --> 00:30:43,830
+انها ت relax و ال tone اتحافظ عليه زي ما هو لأ
+
+383
+00:30:43,830 --> 00:30:45,750
+بيصير عندنا more
+
+384
+00:30:49,150 --> 00:30:56,690
+أو اذا لم يكن هناك اكتشاف اكتشاف اكتشاف اكتشاف
+
+385
+00:30:56,690 --> 00:31:00,750
+اكتشاف اكتشافبتفتحها لبرا فهي بتشد .. هتحافظ على
+
+386
+00:31:00,750 --> 00:31:04,290
+حالها وعشان نتنبل الجسم احنا لو نوصلنا لإن ال
+
+387
+00:31:04,290 --> 00:31:07,730
+stretch .. ال stretch reflex هذا اللي موجود من ان
+
+388
+00:31:07,730 --> 00:31:12,190
+هي شادة بنحس احنا انه والله الضغط عليه و ال
+
+389
+00:31:12,190 --> 00:31:16,630
+stretch reflex .. ال stretch receptors stimulated
+
+390
+00:31:16,630 --> 00:31:22,770
+well و احنا الآن في طور ان نفرج، ايش رايك؟ تمام؟
+
+391
+00:31:22,770 --> 00:31:27,530
+دماغك متدخل، هو بيقول افرج ولا مافرجش؟طيب عملية
+
+392
+00:31:27,530 --> 00:31:32,290
+التفريغ هذه مركزها الأساسي spinal cord إذا هذه
+
+393
+00:31:32,290 --> 00:31:36,650
+spinal reflex طبعا لكن spinal reflex جايله أوامر
+
+394
+00:31:36,650 --> 00:31:40,990
+عالية من ال cerebral cortex من ال brain أو من ال
+
+395
+00:31:40,990 --> 00:31:45,950
+bones من ال brain stem طبعا هدول بدوله نوع من أيه
+
+396
+00:31:45,950 --> 00:31:51,630
+من القيادة دائما في عندي أوامر دائما لهذا ال
+
+397
+00:31:51,630 --> 00:31:57,810
+center هذا بال inhibition ممنوع يشتغل طبعاأنا ممكن
+
+398
+00:31:57,810 --> 00:32:01,430
+ييجي أوامر للـ sphincter وانتبهلها و بعدين أخد
+
+399
+00:32:01,430 --> 00:32:05,910
+قراري لكن دايما هذا الـ sphincter انهيبتت و إلا
+
+400
+00:32:05,910 --> 00:32:09,170
+إذا مش انهيبتت أول ما تيجي أوامر زي الأولاد الصغار
+
+401
+00:32:09,170 --> 00:32:13,670
+فبيصير okay صار ال pressure في داخل ال bladder
+
+402
+00:32:13,670 --> 00:32:18,650
+عالية ال sphincter يتنبه ال efferent muscles هيعمل
+
+403
+00:32:18,650 --> 00:32:20,710
+contraction of the bladder relaxation of the
+
+404
+00:32:20,710 --> 00:32:25,900
+sphincterurination بس الإنسان بني آدم هذا الكلام
+
+405
+00:32:25,900 --> 00:32:29,020
+مابصار مش عنده مش زي الحيوانات أو الأطفال الصغار
+
+406
+00:32:29,020 --> 00:32:32,860
+لأ بيقدر يستطيع إنه ال external sphincter جابل حتى
+
+407
+00:32:32,860 --> 00:32:36,680
+ما يشتغل ال external sphincter و إنه يتقوى جابل
+
+408
+00:32:36,680 --> 00:32:40,940
+الكلام هذا أساسا ال .. ال .. ال .. ال .. ال .. ال
+
+409
+00:32:40,940 --> 00:32:45,700
+.. the menstruation reflex center is inhibited في
+
+410
+00:32:45,700 --> 00:32:50,300
+ال spinal cord عنده نازله أوامر بال inhibition
+
+411
+00:32:50,300 --> 00:32:56,290
+تمام؟بالزمرة عشان انا اسمحله انه يصير تبوي لازم
+
+412
+00:32:56,290 --> 00:33:02,050
+ارفع ال what ال inhibitory orders مش كده؟ في
+
+413
+00:33:02,050 --> 00:33:05,170
+الحالة هادي انا فعلا اتكلم لإن في عندنا inhibitory
+
+414
+00:33:05,170 --> 00:33:10,010
+و في عندنا facilitative كمان في اشياء بتساعد انه
+
+415
+00:33:10,010 --> 00:33:15,210
+.. انه بتساعد التبوي الأسرعالـ Reflex هذا أو انه
+
+416
+00:33:15,210 --> 00:33:18,830
+نمنعه بس في العادة قبل ما ال motivation act تصير
+
+417
+00:33:18,830 --> 00:33:27,380
+يبقى ال center هذا inhibited تمام؟ اذا عندي اناعند
+
+418
+00:33:27,380 --> 00:33:32,340
+تفتح مصبح التروزر ، سيزداد الضغط في داخل الدم إلى
+
+419
+00:33:32,340 --> 00:33:37,760
+40 إلى 60 مليمتر ميركوري ، لذلك تفتح مصبح التروزر
+
+420
+00:33:37,760 --> 00:33:41,740
+هو خطوة عظيمة في استخدام الدم. لذلك عندما يحصل
+
+421
+00:33:41,740 --> 00:33:45,540
+فيها تفتح في هذا المصبح، يعني أنه يزيد الضغط أكتر،
+
+422
+00:33:45,540 --> 00:33:49,480
+يعني أنه يفتح السفينة
+
+423
+00:33:49,480 --> 00:33:50,880
+الداخلية
+
+424
+00:33:52,880 --> 00:33:56,740
+يعني هو ال reflex عندى انا انه يزيل ال contraction
+
+425
+00:33:56,740 --> 00:34:00,640
+تبع ال bladder و يصير relaxation لل إيه؟ للصفنطة،
+
+426
+00:34:00,640 --> 00:34:04,260
+تمام؟ هذا هو الايه؟ ال reflex فعندى لما يصير عندى
+
+427
+00:34:04,260 --> 00:34:08,960
+انا contraction معناه بيساعد انه يفتح ال ..هو يوصل
+
+428
+00:34:08,960 --> 00:34:13,480
+البول اكتر للـ bladder neck وهناك سيكون هناك
+
+429
+00:34:13,480 --> 00:34:16,940
+potentiation للreflex لان هناك منطقة اقوى منطقة
+
+430
+00:34:16,940 --> 00:34:22,080
+فيها اللي هو stimulating the reflex تمام فعندما
+
+431
+00:34:22,080 --> 00:34:25,980
+الدق تزيد ويصل البول انه ال internal sphincter جوا
+
+432
+00:34:26,590 --> 00:34:30,930
+في داخله تريجون جوا في داخل الـ sphincter اجاله
+
+433
+00:34:30,930 --> 00:34:37,450
+urine stimuli stretch سرله معناه انه الضغط علي
+
+434
+00:34:37,450 --> 00:34:42,290
+البول كتر تمام فبيعمل strong reflex to relax ال
+
+435
+00:34:42,290 --> 00:34:45,710
+sphincter و to contract more ال detroser muscle
+
+436
+00:34:45,710 --> 00:34:49,530
+اذا smooth
+
+437
+00:34:49,530 --> 00:34:53,150
+muscle cells of the detroser muscle fuse اه قولها
+
+438
+00:34:53,150 --> 00:34:54,830
+علي هادي طيب
+
+439
+00:34:56,840 --> 00:35:06,480
+عند بصير ورع البلدر يقول الترياجون ان كل
+
+440
+00:35:06,480 --> 00:35:11,360
+يوريتر عندما يدخل البلدر يترسى عبارة عن مصالح
+
+441
+00:35:11,360 --> 00:35:14,600
+التروزر و بعد ذلك يدخل مصالح البلدر بقية احد او
+
+442
+00:35:14,600 --> 00:35:15,700
+اثنان سانتمتر
+
+443
+00:35:20,970 --> 00:35:22,430
+بعمل عملية عملية عملية عملية عملية عملية عملية
+
+444
+00:35:22,430 --> 00:35:24,390
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+445
+00:35:24,390 --> 00:35:33,370
+عملية عملية عملية عملية عملية
+
+446
+00:35:33,370 --> 00:35:39,030
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+447
+00:35:39,030 --> 00:35:39,350
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+448
+00:35:39,350 --> 00:35:39,370
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+449
+00:35:39,370 --> 00:35:39,370
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+450
+00:35:39,370 --> 00:35:39,370
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+451
+00:35:39,370 --> 00:35:39,370
+عملية عملية عملية عملية عملية عملية عملية عملية
+
+452
+00:35:39,370 --> 00:35:46,870
+عملية عملية عملية عملية عملية عمل
+
+453
+00:35:50,030 --> 00:35:57,030
+هذا الشكل مختلف
+
+454
+00:35:57,030 --> 00:36:03,670
+عن باقية
+
+455
+00:36:03,670 --> 00:36:04,090
+التشيوز
+
+456
+00:36:09,740 --> 00:36:13,400
+it's natural to normally keep the bladder, neck
+
+457
+00:36:13,400 --> 00:36:17,040
+and osteorethra empty over it. هذه الممطلة دايما
+
+458
+00:36:17,040 --> 00:36:20,440
+فاضية لأن في عندى ال internal sphincter عامل tone
+
+459
+00:36:20,440 --> 00:36:24,740
+فال bladder نكهة دايما فاضية المشكلة إذا إجهل
+
+460
+00:36:24,740 --> 00:36:31,530
+البوهول بيصير عندى strongdesire to evacuate لإنه
+
+461
+00:36:31,530 --> 00:36:34,750
+بيصير عندك strong reflex mixture reflex فادي أنا
+
+462
+00:36:34,750 --> 00:36:40,650
+لاحظها برضه في ال GIT إن ال rectum دايما فاضي، ال
+
+463
+00:36:40,650 --> 00:36:43,850
+rectum دايما فاضي، إن صار واصل حاجة ل ال rectum،
+
+464
+00:36:43,850 --> 00:36:47,960
+مع أنها في رغبة إيه لل evacuationبصير strong
+
+465
+00:36:47,960 --> 00:36:51,760
+reflex لل إيه؟ لل evaluation، نفس الكلام، إذا هذي
+
+466
+00:36:51,760 --> 00:36:55,520
+under control، إذا بدأ الاشي يصل يعني أنت سامحله
+
+467
+00:36:55,520 --> 00:36:59,960
+يصل معناها أو غصب عنك، يا سامحله أما غصب عنك، لأنه
+
+468
+00:36:59,960 --> 00:37:04,880
+فاض عن الحد المسموح، فهيشتغل بدون أوامرك، تمام؟
+
+469
+00:37:04,880 --> 00:37:09,560
+قولتلكم عن الراجل اللي كان في ال bus أيام اليهود،
+
+470
+00:37:09,560 --> 00:37:14,890
+زلم عنده سكر يعنيو بعدين السكري بتبول كتير و حجزوه
+
+471
+00:37:14,890 --> 00:37:18,230
+فى المنطقة الوسطى بياخدوهم بيجمعوهم بعدين بيحملوهم
+
+472
+00:37:18,230 --> 00:37:20,770
+فى الباصات بعدين بيجمعوهم لغزة يعنى احنا كانوا
+
+473
+00:37:20,770 --> 00:37:23,750
+بياخدونا لغزة مباشرة يعنى على أنصار ماتاخدش معانا
+
+474
+00:37:23,750 --> 00:37:27,290
+الحكاية نص ساعة يكون من سورة تم لعتك على بس هم
+
+475
+00:37:27,290 --> 00:37:31,050
+يعني ليلة كاملة او هم ايه مربطينهم من مكان لمكان
+
+476
+00:37:31,050 --> 00:37:34,310
+عشان ينجولوهم فى الأخر لغزة فو عنده سكر مش بتحمل
+
+477
+00:37:34,310 --> 00:37:37,530
+فجال الجندي خد بالك انا عندى سكري و الان مش بتحكم
+
+478
+00:37:37,530 --> 00:37:42,910
+في حالى ممكن أنزل اتبولقالله شي كده اقعد محلك تمام
+
+479
+00:37:42,910 --> 00:37:48,090
+شوية صغيرة قالله خد بالك انا عند سكر و مش بتحمل
+
+480
+00:37:48,090 --> 00:37:51,670
+قالله شي كده اقعد محلك و بعدين لجي ال .. ارضية ال
+
+481
+00:37:51,670 --> 00:37:58,590
+bus صارت ايه مليانة تبون مش لأنه خلاص يعني عند
+
+482
+00:37:58,590 --> 00:38:02,310
+level معين لا يستطيع الانسان ايه بيصير ال .. اه
+
+483
+00:38:02,310 --> 00:38:06,830
+بيصير ال .. ال .. ال .. ال tension في داخل ال ..
+
+484
+00:38:06,830 --> 00:38:12,260
+ال bladderأقوى من الـ sphincter contraction أقوى
+
+485
+00:38:12,260 --> 00:38:16,540
+منه فبتجلب عليه خلاص فبتنزل ال إيه؟ ال reflex اللي
+
+486
+00:38:16,540 --> 00:38:19,720
+كان inhibitory inhibitory inhibitory لخلاص مش جادر
+
+487
+00:38:19,720 --> 00:38:23,720
+صار فيه أنه facilitating بسبب ال .. ال .. ال .. ال
+
+488
+00:38:23,720 --> 00:38:26,360
+afference اللي جاية من ال bladder بصير مش .. مش
+
+489
+00:38:26,360 --> 00:38:31,440
+جادر يعمل انهيبشن أكتر من هيك فبصير إيه؟ ال .. طيب
+
+490
+00:38:34,470 --> 00:38:39,530
+بالتالي ايش قولنا هنا؟ تمنح البلدار الى
+
+491
+00:38:39,530 --> 00:38:46,150
+ترناكسفينكتر الى ما يرتفع
+
+492
+00:38:46,150 --> 00:38:49,430
+ترناكسفينكتر
+
+493
+00:38:49,430 --> 00:38:49,770
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكسفينكتر
+
+494
+00:38:49,770 --> 00:38:49,810
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكسفينكتر
+
+495
+00:38:49,810 --> 00:38:49,810
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكسفينكتر
+
+496
+00:38:49,810 --> 00:38:49,870
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكسفينكتر
+
+497
+00:38:49,870 --> 00:39:01,410
+الى ترناكسفينكتر الى ترناكسفينكتر الى ترناكس
+
+498
+00:39:02,700 --> 00:39:06,620
+اللي هو ال .. قولنا ال .. ال floor of the pelvis
+
+499
+00:39:06,620 --> 00:39:11,180
+ال levator ni muscle فيها اللي هو eugenital
+
+500
+00:39:11,180 --> 00:39:16,320
+ديافرام الجزئية العضلية .. العضلة المراسقة للمنطج
+
+501
+00:39:16,320 --> 00:39:19,200
+هي دي مخيطة ايسا عملت ما يسمى بال external
+
+502
+00:39:19,200 --> 00:39:23,120
+sphincter وهي distriated muscles، muscles عادية،
+
+503
+00:39:23,120 --> 00:39:27,320
+voluntary تمام؟ voluntary ال nerve supply تبعها
+
+504
+00:39:27,320 --> 00:39:31,800
+مختلف عن nerve supply تبع من؟ تبعلإن دائما ال
+
+505
+00:39:31,800 --> 00:39:35,220
+smooth muscles ال nerves تبقى تبعهم بيكون ايش؟
+
+506
+00:39:35,220 --> 00:39:39,100
+Autonomic مش هيك؟ Autonomic لكن ال striated
+
+507
+00:39:39,100 --> 00:39:45,100
+muscles بيكون ايش؟ بيكون ايه؟ Somatic اه Somatic
+
+508
+00:39:45,100 --> 00:39:49,540
+انت عارف بتعب تعب تعبيرها Somatic nerves يعني هدول
+
+509
+00:39:49,540 --> 00:39:53,760
+ال spinal nerves اللي هم under voluntary control
+
+510
+00:39:59,780 --> 00:40:06,280
+innervation of the bladder إذا ال bladder has two
+
+511
+00:40:06,280 --> 00:40:08,920
+types of .. three types of innervations
+
+512
+00:40:08,920 --> 00:40:13,800
+parasympathetic, sympathetic and ايه؟ and somatic
+
+513
+00:40:13,800 --> 00:40:18,620
+ال somatic فقط جعلنين لل external sphincter
+
+514
+00:40:18,620 --> 00:40:24,520
+انديهان the budendal nerve ايش اسمه؟ the budendal
+
+515
+00:40:24,520 --> 00:40:31,190
+nerve ال parasympatheticnerve supply and the
+
+516
+00:40:31,190 --> 00:40:35,250
+pelvic nerve مش كده؟ طب جايين من sacral brixus
+
+517
+00:40:35,250 --> 00:40:40,130
+تتجمع تعمل ال pelvic nerves و هدول يحملوا ال what
+
+518
+00:40:40,130 --> 00:40:44,910
+ال biosympathetic innervation و عندي كمان
+
+519
+00:40:44,910 --> 00:40:50,910
+sympathetic لكن ال sympathetic hand mainly to the
+
+520
+00:40:50,910 --> 00:40:56,310
+blood supply of the bloodmore than to the smooth
+
+521
+00:40:56,310 --> 00:41:01,410
+muscle to the trouser muscle لأ more to the blood
+
+522
+00:41:01,410 --> 00:41:05,250
+supply بتعملها vasoconstriction أو vasodilatation
+
+523
+00:41:05,250 --> 00:41:06,930
+حسب ال sympathetic tone
+
+524
+00:41:10,380 --> 00:41:14,520
+ال .. ال pelvic nerve اللي هو جاي من ال sacral
+
+525
+00:41:14,520 --> 00:41:20,140
+plexus بيجي من ال S2 S3 مش كده؟ ال .. ال .. ال
+
+526
+00:41:20,140 --> 00:41:26,760
+parasympathetic system مش إله اسم تاني؟ اه cerebro
+
+527
+00:41:26,760 --> 00:41:29,920
+..
+
+528
+00:41:29,920 --> 00:41:38,950
+اه .. cerebro .. اه ..والتانى يسمى thoracolumbar
+
+529
+00:41:38,950 --> 00:41:44,830
+السيمباتيك يسمى thoracolumbar لإنه جاي من T5 ل L2
+
+530
+00:41:44,830 --> 00:41:52,490
+هذا سيمباتيك اما ال .. اما ال .. برا السيمباتيك له
+
+531
+00:41:52,490 --> 00:41:58,590
+two divisions جزء جاي cranial nerves و ال sacral
+
+532
+00:41:58,590 --> 00:42:03,950
+cranio sacral cranio sacralهذا اللي هو ال
+
+533
+00:42:03,950 --> 00:42:08,050
+parasympathetic system لإن ال nerves في جزء منها
+
+534
+00:42:08,050 --> 00:42:11,850
+فيها parasympathetic و في جزء منها بتبقى لأ
+
+535
+00:42:11,850 --> 00:42:17,070
+somatic مش كده و معظمهم mixed مش كده و ال somatic
+
+536
+00:42:17,070 --> 00:42:21,450
+nerves هذه دايما هي mixed بمعنى انها motor و
+
+537
+00:42:21,450 --> 00:42:27,260
+sensory و mixed بمعنى انهautonomic و voluntary و
+
+538
+00:42:27,260 --> 00:42:32,460
+somatic تمام؟ اللي اجيتها ال .. ال .. ال vegas
+
+539
+00:42:32,460 --> 00:42:35,820
+nerve هذا اللي حد ما .. اللي حد ما appeared على
+
+540
+00:42:35,820 --> 00:42:41,220
+سببته لكنه mixed سموته ايه؟ و sensory تمانية منه
+
+541
+00:42:41,220 --> 00:42:46,080
+sensory ولو انه مشهور لكن تمانية منه ايه؟ sensory
+
+542
+00:42:46,080 --> 00:42:55,560
+fibersإذن عندي أنا ال pelvic nerves الـ S2 S3 الـ
+
+543
+00:42:55,560 --> 00:43:00,060
+A قولنا cranial مجموعة من الأعصاب اللي هم cranial
+
+544
+00:43:00,060 --> 00:43:03,500
+nerves فيهم sympathetic او فيهم autonomic nervous
+
+545
+00:43:03,500 --> 00:43:06,460
+system فيهم parasympathetic طبعا autonomic cranial
+
+546
+00:43:06,460 --> 00:43:10,880
+يعني parasympathetic زي السابع الخامس يعني الخامس
+
+547
+00:43:10,880 --> 00:43:16,640
+فيه إيش بسيط السابع وتاسع والعاشر والأحداشر تمام
+
+548
+00:43:16,640 --> 00:43:21,600
+هدول فيهم ايه parasympatheticالساكرال ايه؟
+
+549
+00:43:21,600 --> 00:43:27,300
+الساكرال ايه؟
+
+550
+00:43:27,300 --> 00:43:29,540
+الساكرال بريكساس اللي بتديني ال building nerves
+
+551
+00:43:29,540 --> 00:43:34,190
+اللي هم فيه مباراة sympathetic activityهنا عندنا
+
+552
+00:43:34,190 --> 00:43:39,390
+ال nerves اللي رايحة على ال blood رجعه بس من S2 S3
+
+553
+00:43:39,390 --> 00:43:45,430
+من ال sacral segment S1 S2 S3 مش جاي من ال four ال
+
+554
+00:43:45,430 --> 00:43:48,970
+four بتروح ل ال a two three four و روح لمين ل
+
+555
+00:43:48,970 --> 00:43:53,030
+other parts of the pelvis بالذات ال a ال rectum
+
+556
+00:43:54,030 --> 00:43:59,910
+والـ lower colon او الـ distal colon الـ
+
+557
+00:43:59,910 --> 00:44:03,210
+descending و الـ sigmoid و ال rectum و ال inner
+
+558
+00:44:03,210 --> 00:44:08,430
+canal the
+
+559
+00:44:08,430 --> 00:44:13,650
+sensory fibers إذا في عندنا كمان هذا ال .. ال ..
+
+560
+00:44:13,650 --> 00:44:18,870
+ال pelvic nerves مش بس motor لأ mixed motor و إيه؟
+
+561
+00:44:18,870 --> 00:44:19,810
+و sensory
+
+562
+00:44:23,190 --> 00:44:24,470
+والذين يتمرون من خلال عضلات
+
+563
+00:44:24,470 --> 00:44:38,510
+البلوكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيكيك
+
+564
+00:44:38,550 --> 00:44:43,110
+to sense ده ايه ده degree of stretch لإن كل ما زاد
+
+565
+00:44:43,110 --> 00:44:46,830
+ال ball كل ما زاد ال stretch كل ما زاد الضغط تبع
+
+566
+00:44:46,830 --> 00:44:50,150
+ال bladder ال bladder بتقدر تحافظ على كلامها ده
+
+567
+00:44:50,150 --> 00:44:55,570
+على level معين بعد كده لو ال bladder مضلت مسكراها
+
+568
+00:44:55,570 --> 00:44:59,410
+بيصير dilatation و بيصير actually فيها اي عضلة
+
+569
+00:44:59,410 --> 00:45:03,150
+بتتشد اكتر من اللازم خلاص تفقد قدرتها على ال ايه
+
+570
+00:45:03,150 --> 00:45:07,490
+عشان تبقى تحافظ على قدرتها على ال contraction وال
+
+571
+00:45:07,490 --> 00:45:12,270
+mixurationلازم ايه عند level معين يتوقف خلاص اخر
+
+572
+00:45:12,270 --> 00:45:18,390
+قدرتها طيب stretch signals from the posterior
+
+573
+00:45:18,390 --> 00:45:23,030
+urethra are especially strong and are mainly
+
+574
+00:45:23,030 --> 00:45:26,530
+responsible for initiation the reflexes that cause
+
+575
+00:45:26,530 --> 00:45:30,530
+bladder emptyingتمام؟ إذا .. إذا الضغط تبع ال
+
+576
+00:45:30,530 --> 00:45:34,210
+blood pressure muscle زاد و ال .. عشان ال .. ال ..
+
+577
+00:45:34,210 --> 00:45:37,070
+ال .. ال urine في داخل ال bladder زاد تمام؟ الضغط
+
+578
+00:45:37,070 --> 00:45:40,150
+هذا بيقدر إلى انه .. انه بعض ال .. ال internal
+
+579
+00:45:40,150 --> 00:45:45,050
+sphincter ت dilate شوية او ت stretch و يدخل شوية
+
+580
+00:45:45,050 --> 00:45:48,190
+stretch يعني ال .. ال .. ال bladder قاعدة بتفتح في
+
+581
+00:45:48,190 --> 00:45:51,210
+ال sphincter فال stretch receptors في الbladder من
+
+582
+00:45:51,210 --> 00:45:54,730
+كهان بتحس ان الضغط زاد اكتر من اللازم و انه صار ال
+
+583
+00:45:54,730 --> 00:45:59,870
+stretch يصلها فبتعمل strongreflex اللي هو اسم ال
+
+584
+00:45:59,870 --> 00:46:07,030
+mixtureation ال mixtureation reflex بيكون موجود في
+
+585
+00:46:07,030 --> 00:46:13,050
+كل المراحل
+
+586
+00:46:13,050 --> 00:46:17,070
+يعني و ال bladder فاضية
+
+587
+00:46:17,780 --> 00:46:23,100
+طبعا هان صفر لعند level معين مية و خمسين مية و
+
+588
+00:46:23,100 --> 00:46:27,920
+سبعين milliliter of urine فى البوك فى ال bladder
+
+589
+00:46:27,920 --> 00:46:33,780
+بتبدأ يصير عندى ال reflex تظهر اللى هو ال
+
+590
+00:46:33,780 --> 00:46:34,800
+menstruation reflex
+
+591
+00:46:38,970 --> 00:46:45,090
+لأ ال receptors minimal stretch فبديني minimal ..
+
+592
+00:46:45,090 --> 00:46:48,150
+هذه intravesical pressure
+
+593
+00:46:54,940 --> 00:46:57,960
+centimeters of water بال .. بال .. بالcentimeter
+
+594
+00:46:57,960 --> 00:47:03,900
+of water هنا تمام، هنا بنلاحظ احنا ايش ال .. هدول
+
+595
+00:47:03,900 --> 00:47:08,460
+المنقطة هذا يمثل ليه ال mixtureation reflex في
+
+596
+00:47:08,460 --> 00:47:12,800
+level معين احنا كل ما زاد ال ball في داخل البلدان
+
+597
+00:47:12,800 --> 00:47:16,980
+كل ما اتضغط عليه هذا الأحمر الغامض يمثل ايه؟ اتضغط
+
+598
+00:47:16,980 --> 00:47:22,310
+في داخلالـ volume بتديني ال .. ال basal cystogram
+
+599
+00:47:22,310 --> 00:47:25,730
+هذا ال basal cystogram الضغط داخل ال intravesical
+
+600
+00:47:25,730 --> 00:47:29,770
+pressure هذا الضغط داخل ايه؟ البلدر ملاحظ ما اتتعب
+
+601
+00:47:29,770 --> 00:47:33,550
+اتتعب اتتعب على level معين بيبدأ الضغط زيد كمان
+
+602
+00:47:33,550 --> 00:47:38,330
+يعني في لحد منطقة معينة تلتمية اربعمية و الضغط ايه
+
+603
+00:47:38,330 --> 00:47:42,870
+هو هو بس بعد كده كل زيادة في ال volume بيصير ..
+
+604
+00:47:42,870 --> 00:47:46,170
+بيصير الضغط حالي لإنه تقريبا البلدر جاعة .. بتان
+
+605
+00:47:46,170 --> 00:47:52,220
+..الخضرة القصوى تبعتها وصلت قصوى تمام فبيقدر
+
+606
+00:47:52,220 --> 00:47:57,340
+البراشر يزيد في الأول كل ما بيزيد ال volume كل ما
+
+607
+00:47:57,340 --> 00:48:01,160
+بيصير some sort of relaxation و ال tone بتظل هي هي
+
+608
+00:48:01,160 --> 00:48:06,060
+و ال pressure بيزدش تمام ال pressure بيزدش بس عند
+
+609
+00:48:06,060 --> 00:48:10,000
+level معين بيبدأ ال pressure ايه يزيد كل ما زاد ال
+
+610
+00:48:10,000 --> 00:48:16,420
+pressure في داخل الالـ Bladder كلما صار more
+
+611
+00:48:16,420 --> 00:48:19,200
+stimulation ل ال stress receptor كلما بيصير
+
+612
+00:48:19,200 --> 00:48:23,500
+stimulation ل ال stress receptor بيصير عندى a
+
+613
+00:48:23,500 --> 00:48:27,060
+mutation reflex بس هنا زي ما انتوا شايفين mutation
+
+614
+00:48:27,060 --> 00:48:32,280
+reflex ضعيف اه و بعدين بيموت بعدين بزيد الحجم
+
+615
+00:48:32,280 --> 00:48:36,600
+بيعمل reflex اخر بيموت بيعمل لحد ما يجيلي عندها
+
+616
+00:48:36,600 --> 00:48:41,140
+عند levels معين من الضغطتمام؟ اللي هو انترا في
+
+617
+00:48:41,140 --> 00:48:44,820
+ذاكرة pressure عالي خالص هان very strong reflexes
+
+618
+00:48:44,820 --> 00:48:47,740
+هان انتوا شايفين بيصير كل من تلت اكتر strong
+
+619
+00:48:47,740 --> 00:48:51,780
+reflexes لحد ما نصل ل level معين ان ال pressure في
+
+620
+00:48:51,780 --> 00:48:56,420
+داخل ال .. ال bladder صار اكبر من ال pressure في
+
+621
+00:48:56,420 --> 00:49:00,950
+ال ..المشكلة عندنا ال external لان ال internal
+
+622
+00:49:00,950 --> 00:49:04,150
+responding to the reflex ال internal مثلا لما ال
+
+623
+00:49:04,150 --> 00:49:09,210
+pressure زاد بيصير contraction ل ال muscle لدرزل
+
+624
+00:49:09,210 --> 00:49:12,430
+ال muscle و بيصير some sort of relaxation لل إيه
+
+625
+00:49:12,430 --> 00:49:17,990
+لل internal sphincter إذا ال blood ال unit دخل ال
+
+626
+00:49:17,990 --> 00:49:21,470
+internal sphincter تمام و صار يعمله ضغط تبع
+
+627
+00:49:21,470 --> 00:49:24,390
+blooder ينتقل إلى ال internal sphincter إلى ال
+
+628
+00:49:24,390 --> 00:49:30,160
+bladder neck بيعمل very strongهذا البرنامج يعمل
+
+629
+00:49:30,160 --> 00:49:35,360
+إدفاع للبوليو الخارجي إذا كانت الضغط عالي ل مستوى
+
+630
+00:49:35,360 --> 00:49:39,500
+معين فلا يستطيع الاكسيلات فينتر نفسه التحكم فيه
+
+631
+00:49:39,500 --> 00:49:41,660
+لأنه في مستوى معين لا يستطيع الاكسيلات فينتر
+
+632
+00:49:41,660 --> 00:49:47,120
+التحكم فيهالـ External الـ External under
+
+633
+00:49:47,120 --> 00:49:51,160
+continuous tone under continuous tone ليش؟ لأنه في
+
+634
+00:49:51,160 --> 00:49:56,860
+عندنا inhibitory reflexes عندنا construction
+
+635
+00:49:56,860 --> 00:50:01,200
+متواصل في الـ sphincter هذا contraction متواصل
+
+636
+00:50:01,200 --> 00:50:06,020
+construction متواصل تمام بحيث أنه ال reflexes اللي
+
+637
+00:50:06,020 --> 00:50:13,470
+بتيجي من ال spinalالسينتر المكتورة هي .. انا
+
+638
+00:50:13,470 --> 00:50:18,290
+ماقلتها حقيقة ان ال reflex بيجي تبع من ال bladder
+
+639
+00:50:18,290 --> 00:50:22,430
+مكتورة ال reflex مكتورة مكتورة مكتورة مكتورة
+
+640
+00:50:22,430 --> 00:50:22,430
+مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة
+
+641
+00:50:22,430 --> 00:50:22,590
+مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة
+
+642
+00:50:22,590 --> 00:50:24,330
+مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة
+
+643
+00:50:24,330 --> 00:50:27,750
+مكتورة مكتورة مكتورة
+
+644
+00:50:27,750 --> 00:50:37,650
+مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة مكتورة
+
+645
+00:50:37,650 --> 00:50:41,830
+مكتورةبيقولوا مش .. مش .. مش .. مش واجهة فهذا بي
+
+646
+00:50:41,830 --> 00:50:45,650
+.. بعد كده بيمنع ال .. ال reflex و بيوقفه دقائق
+
+647
+00:50:45,650 --> 00:50:50,530
+إلى ساعات كل ما احنا عملنا more inhibition لل
+
+648
+00:50:50,530 --> 00:50:55,550
+evacuation كل ما صارت ال reflex هذا يجرب من أخوه
+
+649
+00:50:55,550 --> 00:51:00,150
+يعني الإحساس أولها، الواحد جاعد هنا دين الصبح حاسس
+
+650
+00:51:00,150 --> 00:51:04,110
+بال .. بال .. بال .. بالإحساس بالتبود، هو لسه جامل
+
+651
+00:51:04,110 --> 00:51:09,820
+البيت عام ال evacuationف .. لأ مش وقته بيغيب ساعة
+
+652
+00:51:09,820 --> 00:51:16,200
+تمام؟ بقى ساعة بنبقى تمام؟ ممكن تقولوا لأ يعني مش
+
+653
+00:51:16,200 --> 00:51:21,140
+برضه مش وقته بيغيب نص ساعة بعدها بيغيب ربع ساعة
+
+654
+00:51:21,140 --> 00:51:24,820
+بعدها بيغيب خمس دقايق بعدها بي .. بعدها بيصير يعني
+
+655
+00:51:24,820 --> 00:51:29,660
+انا اديتك وقتك وانت اللي ايه مجسر تمام؟ فبصير ال
+
+656
+00:51:29,660 --> 00:51:34,220
+frequency و ال intensity تبع ال reflex أجواء أجواء
+
+657
+00:51:34,220 --> 00:51:39,370
+أجواء و بعدين يتلحجهي ماتلحقش زي ما الظلمة ده جاله
+
+658
+00:51:39,370 --> 00:51:42,210
+أنظر و جاله قد بقالك أنا مش قادر أن أتحكم في حالة
+
+659
+00:51:42,210 --> 00:51:50,490
+ليه فترة نوعية طيب نرجع تاني لإيه
+
+660
+00:51:50,490 --> 00:51:56,250
+then
+
+661
+00:51:56,250 --> 00:51:59,450
+the sensory fibers هدول موجودين وين؟ موجودين في ال
+
+662
+00:51:59,450 --> 00:52:10,100
+pelvic؟ غيرهو يتكلم عن مدى الانتقال والمهم في
+
+663
+00:52:10,100 --> 00:52:19,280
+هذا الموضوع الانتقال البلرق والبلدر نك الانتقالات
+
+664
+00:52:19,280 --> 00:52:24,560
+من البوصيروريتراأحنا نسميها Posterior لأنها أخر
+
+665
+00:52:24,560 --> 00:52:27,900
+أشياء بالنسبة للورترا هي جانب البلدر بالنسبة لها
+
+666
+00:52:27,900 --> 00:52:31,040
+أول .. أول روترا من ناحية البلدر هي أول جزء في
+
+667
+00:52:31,040 --> 00:52:34,620
+الـA حتى عليها خلافية هذه من الورترا ولا من البلدر
+
+668
+00:52:34,620 --> 00:52:40,800
+نكت تمام؟ إذا هذي ان especially strong and are
+
+669
+00:52:40,800 --> 00:52:43,940
+mainly responsible for initiation of the A reflex
+
+670
+00:52:43,940 --> 00:52:50,440
+of maturation the motor nerves transmitted in the
+
+671
+00:52:50,440 --> 00:52:58,010
+pelvic nervesParasympathetic fibers هذول بتدون ال
+
+672
+00:52:58,010 --> 00:53:01,070
+bladder pink
+
+673
+00:53:07,100 --> 00:53:11,880
+in addition to the pelvic nerves عندي احنا قلنا
+
+674
+00:53:11,880 --> 00:53:14,740
+تلت .. تلت systems عند ال pelvic nerve في .. في ..
+
+675
+00:53:14,740 --> 00:53:18,440
+في سلسله فيه مواطن مش كده؟ عندي كمان بيجي اللي هو
+
+676
+00:53:18,440 --> 00:53:21,960
+ال budendal nerve اللي بيغذّميه ال external
+
+677
+00:53:21,960 --> 00:53:28,700
+sphincter وفي عندي sympathetic innervation اللي هو
+
+678
+00:53:28,700 --> 00:53:31,600
+هنا بيجي مع الhypogastric nerves اذا عندي
+
+679
+00:53:31,600 --> 00:53:35,480
+hypogastric nerves تمام؟ ليه يسمونه hypogastric؟
+
+680
+00:53:37,720 --> 00:53:41,080
+لأ هو حقيقة مالعيش علاقة بالصمك يعني ملفز بعيدة
+
+681
+00:53:41,080 --> 00:53:44,480
+خالص بس لإن هذا المنطقى سميناها epigastric
+
+682
+00:53:44,480 --> 00:53:49,840
+المقابلها سميناها hypogastric mission يعني لإن إذا
+
+683
+00:53:49,840 --> 00:53:50,320
+واحدة إيبي
+
+684
+00:53:56,660 --> 00:54:00,340
+هيبو هيبو هيبو
+
+685
+00:54:00,340 --> 00:54:11,100
+هيبو هيبو
+
+686
+00:54:11,100 --> 00:54:14,660
+هيبو
+
+687
+00:54:14,660 --> 00:54:19,340
+هيبو
+
+688
+00:54:19,340 --> 00:54:19,360
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+689
+00:54:19,360 --> 00:54:19,380
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+690
+00:54:19,380 --> 00:54:19,380
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+691
+00:54:19,380 --> 00:54:19,580
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+692
+00:54:19,580 --> 00:54:19,580
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+693
+00:54:19,580 --> 00:54:19,580
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيبو
+
+694
+00:54:19,580 --> 00:54:21,950
+هيبو هيبو هيبو هيبو هيبو هيبو هيبو هيفي ال .. في
+
+695
+00:54:21,950 --> 00:54:29,310
+ال .. في ال .. في ال ..
+
+696
+00:54:29,310 --> 00:54:30,550
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+697
+00:54:30,550 --> 00:54:30,550
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+698
+00:54:30,550 --> 00:54:30,750
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+699
+00:54:30,750 --> 00:54:30,810
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+700
+00:54:30,810 --> 00:54:30,810
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+701
+00:54:30,810 --> 00:54:30,810
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+702
+00:54:30,810 --> 00:54:30,810
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+703
+00:54:30,810 --> 00:54:34,790
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+704
+00:54:34,790 --> 00:54:42,310
+ال .. في ال ..
+
+705
+00:54:42,310 --> 00:54:48,930
+في ال .. في ال ..
+
+706
+00:54:49,680 --> 00:54:52,940
+هتاخدوه بالتفصيل .. هتاخدوه بالتفصيل، اذا ال
+
+707
+00:54:52,940 --> 00:54:57,100
+dermatome الجسم هيك موزع ل dermatomes، ال
+
+708
+00:54:57,100 --> 00:55:04,660
+dermatome فيها العضلة و فيها ال .. اندو .. ميزودرم
+
+709
+00:55:04,660 --> 00:55:08,960
+و اندودرم و اكتودرم، تمام؟ ال اكتودرم بيديني الجلب
+
+710
+00:55:08,960 --> 00:55:13,600
+والأعصاب، الميزودرم بيديني العضلات و الميزودرم و
+
+711
+00:55:13,600 --> 00:55:18,590
+الاندودرم بيدينيالـ hollow organs الأعضاء الأحشاء
+
+712
+00:55:18,590 --> 00:55:23,170
+طبعا إذا كان جلب إذا كان رياتين إذا كان أمعاق إذا
+
+713
+00:55:23,170 --> 00:55:32,890
+كان كابيت إذا كان فكل جزء كل جزء دي له عصبه طبعا
+
+714
+00:55:32,890 --> 00:55:38,470
+لكن ال sympathetic مش ماشي هيك لإن احنا من T5 ل L2
+
+715
+00:55:38,470 --> 00:55:44,590
+طب و اين اللي فوق ال T5 و اين التحت ال L2مالهم مش
+
+716
+00:55:44,590 --> 00:55:48,250
+sympathetic supply لهم لذلك في عندي الباقي ال
+
+717
+00:55:48,250 --> 00:55:52,150
+prevertebral chain sympathetic chain هدول كلهم
+
+718
+00:55:52,150 --> 00:55:59,910
+synapsing في هذا ال chain تمام و منها بينزلوا ال
+
+719
+00:55:59,910 --> 00:56:05,310
+chain تحت ال L2 و بطلع ال chain فوق ال A ال TA و
+
+720
+00:56:05,310 --> 00:56:09,730
+من ال chain بيصير توزيع كل واحدة حسب المناطق هذا
+
+721
+00:56:09,730 --> 00:56:13,370
+ال sympatheticإن شاء الله الدكتور ماجي يدركيها
+
+722
+00:56:13,370 --> 00:56:19,710
+بالتفصيل some
+
+723
+00:56:19,710 --> 00:56:23,510
+sensory nerve fibers also pass .. أه إذا النقطة
+
+724
+00:56:23,510 --> 00:56:27,870
+الإضافية هان قلنا احنا ال sympathetic لمن؟ لل both
+
+725
+00:56:27,870 --> 00:56:31,870
+vessels وبعض ال sensory nerves passing through the
+
+726
+00:56:31,870 --> 00:56:36,830
+sympathetic يعني ال sensory supplyأو sense of
+
+727
+00:56:36,830 --> 00:56:41,590
+innervation للبلاد ده تمام بيروح عبر البارا
+
+728
+00:56:41,590 --> 00:56:45,210
+sympathetic mainly لبلدك لكن بعضه بيعدي الى ال ..
+
+729
+00:56:45,210 --> 00:56:54,100
+عبر ال sympathetic nervesمهمة في شعور بالكامل وفي
+
+730
+00:56:54,100 --> 00:56:58,780
+بعض الأحيان شعور بالألم. تمام؟ إذا ال sensory
+
+731
+00:56:58,780 --> 00:57:03,560
+nerves اللي بتدينا الأحساس بال fullness و ال pain
+
+732
+00:57:03,560 --> 00:57:08,580
+مع ال fullness بزيد، بيصير أن أحساس بالألم، مش
+
+733
+00:57:08,580 --> 00:57:11,420
+هيك؟ هدول في الغالب بيكونوا عدوا عبر ال
+
+734
+00:57:11,420 --> 00:57:18,590
+sympathetic nerves. تمام؟العضلات من العضلات الى
+
+735
+00:57:18,590 --> 00:57:20,730
+العضلات العضلات
+
+736
+00:57:27,750 --> 00:57:31,490
+contains smooth muscle and are innervated by both
+
+737
+00:57:31,490 --> 00:57:35,070
+sympathetic and parasympathetic، تمام؟ ويلهم هدول
+
+738
+00:57:35,070 --> 00:57:37,630
+extrinsic، هدول sympathetic و parasympathetic جاي
+
+739
+00:57:37,630 --> 00:57:42,310
+من برا، هدول extrinsic nervous system، في عندى
+
+740
+00:57:42,310 --> 00:57:45,110
+intrinsic plexus اللي قولنا عليها، اللي اسمها
+
+741
+00:57:45,110 --> 00:57:49,860
+intramuralintramural يعني داخل العضلات شبكة موجودة
+
+742
+00:57:49,860 --> 00:57:52,760
+في العادة هي إذا كانت العضلات مفصولة على البعض
+
+743
+00:57:52,760 --> 00:57:55,940
+دائما الشبكة هذه موجودة بين ال longitudinal و
+
+744
+00:57:55,940 --> 00:58:01,080
+الcircular لكن لأنه هذا mixed في كل اتجاهات في
+
+745
+00:58:01,080 --> 00:58:04,060
+البلاد اللي .. في كل اتجاهات فبقدر إلى انها
+
+746
+00:58:04,060 --> 00:58:08,200
+intramural شبكة موجودة بين ال .. ايه؟ بين العضلات
+
+747
+00:58:08,200 --> 00:58:13,660
+هذه إذا ال intramural plexus هذه بنسميه intrinsic
+
+748
+00:58:13,660 --> 00:58:19,190
+plexus تمام؟و هي هذه لتقود ال .. ال peristaltic
+
+749
+00:58:19,190 --> 00:58:22,510
+movement تمام؟ و ال sympathetic و ال
+
+750
+00:58:22,510 --> 00:58:26,790
+parasympathetic يا اما بيقووها يا اما بيضعقوها حسب
+
+751
+00:58:26,790 --> 00:58:32,130
+ما حكينا ان ال parasympathetic بيزيد لذلك احنا لما
+
+752
+00:58:32,130 --> 00:58:38,130
+ال hyper peristalsis تصير بتعملنا مغسفلما احنا
+
+753
+00:58:38,130 --> 00:58:42,090
+اكسر عندنا مغس كلوي يعني صار في hyperperistaltic
+
+754
+00:58:42,090 --> 00:58:46,250
+activity انشاء من البراصيمبتاتيك لذلك اذا اديت انا
+
+755
+00:58:46,250 --> 00:58:50,190
+حاجة تسبرس البراصيمبتاتيك زي الأتروبيل بروح المغس
+
+756
+00:58:50,190 --> 00:58:55,950
+لإن أساس ال hyperperistalsis هذه مقاوقة زي ال ..
+
+757
+00:58:55,950 --> 00:58:58,570
+ال .. ال .. ال intrinsic .. ال intrinsic plexus
+
+758
+00:58:58,570 --> 00:59:01,630
+مابتعملش such hyperperistalsis إذا انا حيقول
+
+759
+00:59:01,630 --> 00:59:05,330
+البراصيمبتاتيك هو اللي إيه؟عملها potentiation إذا
+
+760
+00:59:05,330 --> 00:59:09,830
+انا اديت أتروبي تمام Parasympathetic فبروح المغز
+
+761
+00:59:09,830 --> 00:59:14,710
+بروح تمام تمام برجع ل peristalsis A اللي هي تبع ال
+
+762
+00:59:14,710 --> 00:59:19,330
+intramural plexus الداخلية ال .. إذا ال
+
+763
+00:59:19,330 --> 00:59:25,170
+sympathetic مش غير العكس بعمل suppression as
+
+764
+00:59:25,170 --> 00:59:28,910
+with other vesical smooth muscles peristaltic
+
+765
+00:59:28,910 --> 00:59:33,360
+contractionالذئبال يكونوا مزدوجين زي ما كان اقول
+
+766
+00:59:33,360 --> 00:59:37,780
+بقى سمبتاتيكو والعكس صحيح the normal tone of the
+
+767
+00:59:37,780 --> 00:59:41,160
+Dendrosal muscle in the bladder wall tends to
+
+768
+00:59:41,160 --> 00:59:45,740
+compress انا حاول اتكلم عن جزء بخص ال base maker
+
+769
+00:59:45,740 --> 00:59:46,860
+انا حاول اتكلم عن جزء بخص ال base maker انا حاول
+
+770
+00:59:46,860 --> 00:59:46,860
+اتكلم عن جزء بخص ال base maker انا حاول اتكلم عن
+
+771
+00:59:46,860 --> 00:59:46,940
+جزء بخص ال base maker انا حاول اتكلم عن جزء بخص ال
+
+772
+00:59:46,940 --> 00:59:47,320
+base maker انا حاول اتكلم عن جزء بخص ال base maker
+
+773
+00:59:47,320 --> 00:59:48,200
+انا حاول اتكلم عن جزء بخص ال base maker انا حاول
+
+774
+00:59:48,200 --> 00:59:53,220
+اتكلم عن جزء بخص ال base maker انا حاول اتكلم عن
+
+775
+00:59:53,220 --> 00:59:57,220
+جزء بخص ال
+
+776
+01:00:00,580 --> 01:00:06,660
+في بعض الناس، الوضع اللي يتجرس من خلطة البلدار ليس
+
+777
+01:00:06,660 --> 01:00:08,800
+أكتر من ما يتجرس من خلطة البلدار بشكل عادل، لذلك
+
+778
+01:00:08,800 --> 01:00:14,000
+تتجرس البلدار من خلطة البلدار ليس دائمًا يتجرس من
+
+779
+01:00:14,000 --> 01:00:15,440
+خلطة البلدار بشكل أكتر من ما يتجرس من خلطة البلدار
+
+780
+01:00:15,440 --> 01:00:17,580
+بشكل عادل
+
+781
+01:00:23,580 --> 01:00:27,960
+ureteral reflex ويلو مشاكل كتيرة تمام بيخرّب في
+
+782
+01:00:27,960 --> 01:00:32,940
+الآخر الكلية pain sensation in the ureters and
+
+783
+01:00:32,940 --> 01:00:35,700
+uretero-renal reflex نفسي أنا الآن بيدرس حاجة
+
+784
+01:00:35,700 --> 01:00:42,480
+اسمها uretero-renal reflex و أثره على الكلية ال
+
+785
+01:00:42,480 --> 01:00:47,340
+reflex هذا بيبدأ بال ureter وبينتهي renal بال
+
+786
+01:00:47,340 --> 01:00:50,970
+bladder بال .. بال kidneyو ايه في الكدنى؟ في blood
+
+787
+01:00:50,970 --> 01:00:51,930
+vessels of the kidney
+
+788
+01:01:20,170 --> 01:01:24,390
+للـ Renal Arteries بيقدّي إلى إن الـ Spasm هذا
+
+789
+01:01:24,390 --> 01:01:28,690
+إيجابي لبولير التكون اللي هو عام عامل الـ pressure
+
+790
+01:01:28,690 --> 01:01:32,190
+الزايد some sort of protection بيقول الكيلية إذا
+
+791
+01:01:32,190 --> 01:01:34,970
+لما بيصير هذا الكلام الكيلية اللي في جهتها الحصوة
+
+792
+01:01:34,970 --> 01:01:39,030
+تصير فيها Spasm لل blood vessels و إذا زاد ممكن
+
+793
+01:01:39,030 --> 01:01:43,600
+تصير ischemia للكيلية كلها و ممكن تضربهو أساسه
+
+794
+01:01:43,600 --> 01:01:47,220
+معمول عشان يجلل ال urine formation عشان يجلل ال
+
+795
+01:01:47,220 --> 01:01:52,360
+pressure اللي هو عامل ال plan اسمه Uretero Renal
+
+796
+01:01:52,360 --> 01:01:56,760
+Reflex ناتج عن انه Stimulation في ال ureter تؤدي
+
+797
+01:01:56,760 --> 01:02:02,920
+إلى ال drop في ال urine formation بسبب ال spasm of
+
+798
+01:02:02,920 --> 01:02:06,020
+the arterial system of the kidney
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e638fedec7f248cc3a6a767689ae70d27a676611
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA.srt
@@ -0,0 +1,56 @@
+1
+00:00:09,600 --> 00:00:14,440
+دقائق هيك استراحة خفيفة نتكلم عن قصيدة من القصائد
+
+2
+00:00:14,440 --> 00:00:17,420
+اللي هي المناسبة في هذه الفترة هذه قصيدة كتبها
+
+3
+00:00:17,420 --> 00:00:24,040
+الوالد سماها لغتي و أنا فيها يعيب على الحُكّام
+
+4
+00:00:24,040 --> 00:00:27,300
+يعيب على المسؤولين يعيب على اللي يتكلموا يقولوا
+
+5
+00:00:27,300 --> 00:00:32,740
+رأيهم شايف غلط يا أخي أتكلم تمام؟ يقول فيها لغتي و
+
+6
+00:00:32,740 --> 00:00:39,680
+أنا لغتي ليست دمية أطفال أو قصر ربال أو سعف نخيل
+
+7
+00:00:39,680 --> 00:00:46,920
+لغتي وطني ذاتي سيف المسلول لا أملكه إلا أن أعتثر
+
+8
+00:00:46,920 --> 00:00:54,300
+القول أقطع من صخر اللغة عجينة أنقش من طين الكلمات
+
+9
+00:00:54,300 --> 00:01:00,840
+سهاما مسمومة أهديها لأباطرة الصمت أهديها لأباطرة
+
+10
+00:01:00,840 --> 00:01:06,580
+الصمت سكتين ملوك الزمن المشلول لا يصدر عنها صوت
+
+11
+00:01:08,460 --> 00:01:14,560
+تستأذن حين تبول و عند النوم و إذا عَذر الموت طبعاً
+
+12
+00:01:14,560 --> 00:01:18,880
+يعني الشعر يعبر بقوة شديدة على صمت هؤلاء الناس
+
+13
+00:01:18,880 --> 00:01:22,640
+لازم يتكلموا الحمد لله أنا الكل يتكلم ندولاليفيا
+
+14
+00:01:22,640 --> 00:01:26,240
+بإذن الله يعني أنه نرفع عنها الهم اللي هي فيه
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..f2e0393caea2513887e6704772b1d719dc7f1800
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_postprocess.srt
@@ -0,0 +1,56 @@
+1
+00:00:09,600 --> 00:00:14,440
+دقائق هيك استراحة خفيفة نتكلم عن قصيدة من القصائد
+
+2
+00:00:14,440 --> 00:00:17,420
+اللي هي المناسبة في هذه الفترة هذه قصيدة كتبها
+
+3
+00:00:17,420 --> 00:00:24,040
+الوالد سماها لغتي و أنا فيها يعيب على الحُكّام
+
+4
+00:00:24,040 --> 00:00:27,300
+يعيب على المسؤولين يعيب على اللي يتكلموا يقولوا
+
+5
+00:00:27,300 --> 00:00:32,740
+رأيهم شايف غلط يا أخي أتكلم تمام؟ يقول فيها لغتي و
+
+6
+00:00:32,740 --> 00:00:39,680
+أنا لغتي ليست دمية أطفالأو قصر ربال أو سعف نخيل
+
+7
+00:00:39,680 --> 00:00:46,920
+لغتي وطني ذاتي سيف المسلول لا أملكه إلا أن أعتثر
+
+8
+00:00:46,920 --> 00:00:54,300
+القول أقطع من صخر اللغة عجعة أنقش من طين الكلمات
+
+9
+00:00:54,300 --> 00:01:00,840
+سهاما مسمومة أهديها لأباطرة الصمت أهديها لأباطرة
+
+10
+00:01:00,840 --> 00:01:06,580
+الصمت سكتين ملوك الزمن المشلول لا يصدر عنها صوت
+
+11
+00:01:08,460 --> 00:01:14,560
+تستأذن حين تبول و عند النوم و إذا عدر الموت طبعا
+
+12
+00:01:14,560 --> 00:01:18,880
+يعني الشعر يعبر بالقوة شديدة على صمت هؤلاء الناس
+
+13
+00:01:18,880 --> 00:01:22,640
+لازم يتكلموا الحمد لله أنا الكل اتكلم ندولاليفيا
+
+14
+00:01:22,640 --> 00:01:26,240
+بإذن الله يعني انه نرفع عنها الهم اللي هي فيه
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..c82927bf171e579667ce7ad69d36b177c544cf2a
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_raw.json
@@ -0,0 +1 @@
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57.44, "word": " لأباطرة", "probability": 0.7804931640625}, {"start": 57.44, "end": 58.06, "word": " الصمت", "probability": 0.9293619791666666}, {"start": 58.06, "end": 59.5, "word": " أهديها", "probability": 0.90869140625}, {"start": 59.5, "end": 60.84, "word": " لأباطرة", "probability": 0.9802734375}, {"start": 60.84, "end": 61.5, "word": " الصمت", "probability": 0.9933268229166666}, {"start": 61.5, "end": 62.4, "word": " سكتين", "probability": 0.79638671875}, {"start": 62.4, "end": 63.84, "word": " ملوك", "probability": 0.943359375}, {"start": 63.84, "end": 64.22, "word": " الزمن", "probability": 0.8650716145833334}, {"start": 64.22, "end": 64.96, "word": " المشلول", "probability": 0.9737548828125}, {"start": 64.96, "end": 65.46, "word": " لا", "probability": 0.908203125}, {"start": 65.46, "end": 65.82, "word": " يصدر", "probability": 0.89404296875}, {"start": 65.82, "end": 66.14, "word": " عنها", "probability": 0.978759765625}, {"start": 66.14, "end": 66.58, "word": " صوت", 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"probability": 0.90234375}, {"start": 75.26, "end": 75.78, "word": " الشعر", "probability": 0.7146809895833334}, {"start": 75.78, "end": 76.5, "word": " يعبر", "probability": 0.5250244140625}, {"start": 76.5, "end": 76.98, "word": " بالقوة", "probability": 0.88330078125}, {"start": 76.98, "end": 77.4, "word": " شديدة", "probability": 0.9562174479166666}, {"start": 77.4, "end": 77.62, "word": " على", "probability": 0.6728515625}, {"start": 77.62, "end": 78.12, "word": " صمت", "probability": 0.9386393229166666}, {"start": 78.12, "end": 78.46, "word": " هؤلاء", "probability": 0.9300537109375}, {"start": 78.46, "end": 78.88, "word": " الناس", "probability": 0.9931640625}, {"start": 78.88, "end": 79.52, "word": " لازم", "probability": 0.9078776041666666}, {"start": 79.52, "end": 80.22, "word": " يتكلموا", "probability": 0.9841796875}, {"start": 80.22, "end": 80.74, "word": " الحمد", "probability": 0.93408203125}, {"start": 80.74, "end": 80.94, "word": " لله", "probability": 0.925537109375}, {"start": 80.94, "end": 81.16, "word": " أنا", "probability": 0.459716796875}, {"start": 81.16, "end": 81.38, "word": " الكل", "probability": 0.76806640625}, {"start": 81.38, "end": 81.86, "word": " اتكلم", "probability": 0.927978515625}, {"start": 81.86, "end": 82.64, "word": " ندولاليفيا", "probability": 0.5650431315104166}, {"start": 82.64, "end": 83.0, "word": " بإذن", "probability": 0.906982421875}, {"start": 83.0, "end": 83.24, "word": " الله", "probability": 0.9609375}, {"start": 83.24, "end": 83.98, "word": " يعني", "probability": 0.921630859375}, {"start": 83.98, "end": 84.32, "word": " انه", "probability": 0.427978515625}, {"start": 84.32, "end": 84.88, "word": " نرفع", "probability": 0.63818359375}, {"start": 84.88, "end": 85.08, "word": " عنها", "probability": 0.896240234375}, {"start": 85.08, "end": 85.3, "word": " الهم", "probability": 0.959716796875}, {"start": 85.3, "end": 85.48, "word": " اللي", "probability": 0.890869140625}, {"start": 85.48, "end": 85.6, "word": " هي", "probability": 0.744140625}, {"start": 85.6, "end": 86.24, "word": " فيه", "probability": 0.9716796875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 87.8875625, "duration_after_vad": 76.62187499999999}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..f2e0393caea2513887e6704772b1d719dc7f1800
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/bW6uDvHRRDA_raw.srt
@@ -0,0 +1,56 @@
+1
+00:00:09,600 --> 00:00:14,440
+دقائق هيك استراحة خفيفة نتكلم عن قصيدة من القصائد
+
+2
+00:00:14,440 --> 00:00:17,420
+اللي هي المناسبة في هذه الفترة هذه قصيدة كتبها
+
+3
+00:00:17,420 --> 00:00:24,040
+الوالد سماها لغتي و أنا فيها يعيب على الحُكّام
+
+4
+00:00:24,040 --> 00:00:27,300
+يعيب على المسؤولين يعيب على اللي يتكلموا يقولوا
+
+5
+00:00:27,300 --> 00:00:32,740
+رأيهم شايف غلط يا أخي أتكلم تمام؟ يقول فيها لغتي و
+
+6
+00:00:32,740 --> 00:00:39,680
+أنا لغتي ليست دمية أطفالأو قصر ربال أو سعف نخيل
+
+7
+00:00:39,680 --> 00:00:46,920
+لغتي وطني ذاتي سيف المسلول لا أملكه إلا أن أعتثر
+
+8
+00:00:46,920 --> 00:00:54,300
+القول أقطع من صخر اللغة عجعة أنقش من طين الكلمات
+
+9
+00:00:54,300 --> 00:01:00,840
+سهاما مسمومة أهديها لأباطرة الصمت أهديها لأباطرة
+
+10
+00:01:00,840 --> 00:01:06,580
+الصمت سكتين ملوك الزمن المشلول لا يصدر عنها صوت
+
+11
+00:01:08,460 --> 00:01:14,560
+تستأذن حين تبول و عند النوم و إذا عدر الموت طبعا
+
+12
+00:01:14,560 --> 00:01:18,880
+يعني الشعر يعبر بالقوة شديدة على صمت هؤلاء الناس
+
+13
+00:01:18,880 --> 00:01:22,640
+لازم يتكلموا الحمد لله أنا الكل اتكلم ندولاليفيا
+
+14
+00:01:22,640 --> 00:01:26,240
+بإذن الله يعني انه نرفع عنها الهم اللي هي فيه
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/d1cBi0ZBVBM_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/d1cBi0ZBVBM_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..1acf58652d614868bbbe01004c553fc5923e9e5e
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/d1cBi0ZBVBM_raw.json
@@ -0,0 +1 @@
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1308.2, "word": " البلازمه", "probability": 0.9291015625}, {"start": 1308.2, "end": 1308.36, "word": " اللي", "probability": 0.843017578125}, {"start": 1308.36, "end": 1308.64, "word": " داخل", "probability": 0.88525390625}, {"start": 1308.64, "end": 1309.18, "word": " الجلوميله", "probability": 0.5251953125}, {"start": 1309.18, "end": 1309.38, "word": " لازم", "probability": 0.767822265625}, {"start": 1309.38, "end": 1309.6, "word": " يتفرج", "probability": 0.47406005859375}, {"start": 1309.6, "end": 1309.66, "word": " في", "probability": 0.7587890625}, {"start": 1309.66, "end": 1309.68, "word": " ال", "probability": 0.8359375}, {"start": 1309.68, "end": 1310.08, "word": " filtration", "probability": 0.8916015625}, {"start": 1310.08, "end": 1311.16, "word": " يعني", "probability": 0.87255859375}, {"start": 1311.16, "end": 1311.5, "word": " خمس", "probability": 0.9923502604166666}, {"start": 1311.5, "end": 1312.02, "word": " القمص", "probability": 0.8357747395833334}], "temperature": 1.0}, {"id": 53, "seek": 133045, "start": 1322.59, "end": 1330.45, "text": "مشكلة إذا طلعت طبعا من برا، قلتلكوا هم 125 ميلي ليتر per minute، فبيصير عندي أنا جزء، إذا في filtration", "tokens": [2304, 8592, 28820, 3660, 11933, 15730, 23032, 1211, 34268, 23032, 3555, 3615, 995, 9154, 4724, 23557, 12399, 12174, 1211, 2655, 23275, 14407, 8032, 2304, 25276, 3714, 1829, 20292, 5296, 36081, 2288, 680, 3456, 12399, 6156, 21292, 9381, 13546, 18871, 16254, 41850, 10874, 11622, 38207, 12399, 11933, 15730, 8978, 43623], "avg_logprob": -0.439999994635582, "compression_ratio": 1.1870503597122302, "no_speech_prob": 2.2649765014648438e-06, "words": [{"start": 1322.5900000000001, "end": 1323.17, "word": "مشكلة", "probability": 0.722625732421875}, {"start": 1323.17, "end": 1323.25, "word": " إذا", "probability": 0.7174072265625}, {"start": 1323.25, "end": 1323.49, "word": " طلعت", "probability": 0.7744140625}, {"start": 1323.49, "end": 1323.75, "word": " طبعا", "probability": 0.9530029296875}, {"start": 1323.75, "end": 1323.83, "word": " من", "probability": 0.5859375}, {"start": 1323.83, "end": 1324.35, "word": " برا،", "probability": 0.7132975260416666}, {"start": 1324.35, "end": 1324.73, "word": " قلتلكوا", "probability": 0.6623046875}, {"start": 1324.73, "end": 1324.85, "word": " هم", "probability": 0.6263427734375}, {"start": 1324.85, "end": 1325.17, "word": " 125", "probability": 0.58837890625}, {"start": 1325.17, "end": 1325.51, "word": " ميلي", "probability": 0.64208984375}, {"start": 1325.51, "end": 1325.83, "word": " ليتر", "probability": 0.7027180989583334}, {"start": 1325.83, "end": 1326.05, "word": " per", "probability": 0.81640625}, {"start": 1326.05, "end": 1326.85, "word": " minute،", "probability": 0.7196044921875}, {"start": 1326.85, "end": 1327.27, "word": " فبيصير", "probability": 0.7310791015625}, {"start": 1327.27, "end": 1327.53, "word": " عندي", "probability": 0.7822265625}, {"start": 1327.53, "end": 1327.77, "word": " أنا", "probability": 0.61083984375}, {"start": 1327.77, "end": 1329.29, "word": " جزء،", "probability": 0.9161376953125}, {"start": 1329.29, "end": 1329.47, "word": " إذا", "probability": 0.622314453125}, {"start": 1329.47, "end": 1329.65, "word": " في", "probability": 0.53173828125}, {"start": 1329.65, "end": 1330.45, "word": " filtration", "probability": 0.81494140625}], "temperature": 1.0}, {"id": 54, "seek": 136025, "start": 1331.81, "end": 1360.25, "text": "وفي عند reabsorption وفي insecretion هذه المسائل تختلط بعض المواد بيصيرلها filtration و بس بعض المواد filtration و بعدين reabsorbed كليا في بعض المواد لأ filtration و جزئيا بيصيرلها reabsorption بعض المواد filtration و يضاف عليها ال secretion وبهذا الكلام ان شاء الله المرة الجاية هتكلم عن الأول عملية من عمليات الكيليا اللي هو ال filtration نتكلم على ال rules of that controls filtration يعطيكوا العافية السلام عليكم", "tokens": [2407, 41185, 43242, 319, 17243, 284, 1695, 4032, 41185, 294, 8159, 1505, 313, 29538, 9673, 3794, 16373, 1211, 6055, 46456, 1211, 9566, 45030, 11242, 9673, 14407, 3215, 4724, 1829, 9381, 13546, 1211, 11296, 43623, 4032, 4724, 3794, 45030, 11242, 9673, 14407, 3215, 43623, 4032, 39182, 9957, 319, 17243, 284, 2883, 28242, 25528, 8978, 45030, 11242, 9673, 14407, 3215, 5296, 10721, 43623, 4032, 10874, 11622, 19986, 25528, 4724, 1829, 9381, 13546, 1211, 11296, 319, 17243, 284, 1695, 45030, 11242, 9673, 14407, 3215, 43623, 4032, 7251, 11242, 31845, 25894, 11296, 2423, 4054, 313, 46599, 3224, 15730, 2423, 28820, 10943, 16472, 13412, 16606, 21984, 9673, 25720, 25724, 995, 10632, 8032, 2655, 4117, 19528, 18871, 16247, 12610, 6225, 42213, 10632, 9154, 6225, 2304, 20292, 9307, 33251, 26895, 25528, 13672, 1829, 31439, 2423, 43623, 8717, 2655, 4117, 19528, 15844, 2423, 4474, 295, 300, 9003, 43623, 37495, 9566, 1829, 4117, 14407, 18863, 31845, 10632, 21136, 37440, 25894, 24793], "avg_logprob": -0.21752450902477588, "compression_ratio": 2.1491525423728812, "no_speech_prob": 8.404254913330078e-06, "words": [{"start": 1331.81, "end": 1332.15, "word": "وفي", "probability": 0.2890625}, {"start": 1332.15, "end": 1332.35, "word": " عند", "probability": 0.71630859375}, {"start": 1332.35, "end": 1333.11, "word": " reabsorption", "probability": 0.69482421875}, {"start": 1333.11, "end": 1333.31, "word": " وفي", "probability": 0.932373046875}, {"start": 1333.31, "end": 1333.91, "word": " insecretion", "probability": 0.63287353515625}, {"start": 1333.91, "end": 1334.43, "word": " هذه", "probability": 0.5634765625}, {"start": 1334.43, "end": 1334.79, "word": " المسائل", "probability": 0.879638671875}, {"start": 1334.79, "end": 1335.33, "word": " تختلط", "probability": 0.91796875}, {"start": 1335.33, "end": 1335.59, "word": " بعض", "probability": 0.87158203125}, {"start": 1335.59, "end": 1336.05, "word": " المواد", "probability": 0.9207356770833334}, {"start": 1336.05, "end": 1336.69, "word": " بيصيرلها", "probability": 0.6287841796875}, {"start": 1336.69, "end": 1337.07, "word": " filtration", "probability": 0.94970703125}, {"start": 1337.07, "end": 1337.29, "word": " و", "probability": 0.56494140625}, {"start": 1337.29, "end": 1337.57, "word": " بس", "probability": 0.90576171875}, {"start": 1337.57, "end": 1338.19, "word": " بعض", "probability": 0.741943359375}, {"start": 1338.19, "end": 1338.37, "word": " المواد", "probability": 0.9596354166666666}, {"start": 1338.37, "end": 1338.79, "word": " filtration", "probability": 0.72900390625}, {"start": 1338.79, "end": 1338.91, "word": " و", "probability": 0.4716796875}, {"start": 1338.91, "end": 1339.03, "word": " بعدين", "probability": 0.59130859375}, {"start": 1339.03, "end": 1339.57, "word": " reabsorbed", "probability": 0.8001708984375}, {"start": 1339.57, "end": 1340.13, "word": " كليا", "probability": 0.8330078125}, {"start": 1340.13, "end": 1340.69, "word": " في", "probability": 0.625}, {"start": 1340.69, "end": 1340.91, "word": " بعض", "probability": 0.99267578125}, {"start": 1340.91, "end": 1341.11, "word": " المواد", "probability": 0.9754231770833334}, {"start": 1341.11, "end": 1341.29, "word": " لأ", "probability": 0.7049560546875}, {"start": 1341.29, "end": 1341.81, "word": " filtration", "probability": 0.9365234375}, {"start": 1341.81, "end": 1342.03, "word": " و", "probability": 0.7021484375}, {"start": 1342.03, "end": 1342.49, "word": " جزئيا", "probability": 0.8790283203125}, {"start": 1342.49, "end": 1342.81, "word": " بيصيرلها", "probability": 0.9820963541666666}, {"start": 1342.81, "end": 1343.33, "word": " reabsorption", "probability": 0.9661865234375}, {"start": 1343.33, "end": 1343.91, "word": " بعض", "probability": 0.771484375}, {"start": 1343.91, "end": 1344.17, "word": " المواد", "probability": 0.9812825520833334}, {"start": 1344.17, "end": 1344.73, "word": " filtration", "probability": 0.966796875}, {"start": 1344.73, "end": 1345.31, "word": " و", "probability": 0.98828125}, {"start": 1345.31, "end": 1345.63, "word": " يضاف", "probability": 0.958984375}, {"start": 1345.63, "end": 1346.09, "word": " عليها", "probability": 0.9951171875}, {"start": 1346.09, "end": 1346.75, "word": " ال", "probability": 0.70458984375}, {"start": 1346.75, "end": 1347.35, "word": " secretion", "probability": 0.812255859375}, {"start": 1347.35, "end": 1348.01, "word": " وبهذا", "probability": 0.7329915364583334}, {"start": 1348.01, "end": 1348.39, "word": " الكلام", "probability": 0.9501953125}, {"start": 1348.39, "end": 1348.51, "word": " ان", "probability": 0.859375}, {"start": 1348.51, "end": 1348.69, "word": " شاء", "probability": 0.971435546875}, {"start": 1348.69, "end": 1348.75, "word": " الله", "probability": 0.951171875}, {"start": 1348.75, "end": 1349.01, "word": " المرة", "probability": 0.96142578125}, {"start": 1349.01, "end": 1349.27, "word": " الجاية", "probability": 0.80908203125}, {"start": 1349.27, "end": 1349.77, "word": " هتكلم", "probability": 0.9046630859375}, {"start": 1349.77, "end": 1350.09, "word": " عن", "probability": 0.99365234375}, {"start": 1350.09, "end": 1351.25, "word": " الأول", "probability": 0.77197265625}, {"start": 1351.25, "end": 1351.69, "word": " عملية", "probability": 0.97900390625}, {"start": 1351.69, "end": 1351.83, "word": " من", "probability": 0.97705078125}, {"start": 1351.83, "end": 1352.37, "word": " عمليات", "probability": 0.9171142578125}, {"start": 1352.37, "end": 1352.93, "word": " الكيليا", "probability": 0.69873046875}, {"start": 1352.93, "end": 1353.35, "word": " اللي", "probability": 0.734619140625}, {"start": 1353.35, "end": 1353.45, "word": " هو", "probability": 0.93798828125}, {"start": 1353.45, "end": 1353.55, "word": " ال", "probability": 0.8994140625}, {"start": 1353.55, "end": 1354.03, "word": " filtration", "probability": 0.9482421875}, {"start": 1354.03, "end": 1354.89, "word": " نتكلم", "probability": 0.83929443359375}, {"start": 1354.89, "end": 1355.19, "word": " على", "probability": 0.83056640625}, {"start": 1355.19, "end": 1355.91, "word": " ال", "probability": 0.91357421875}, {"start": 1355.91, "end": 1356.81, "word": " rules", "probability": 0.83935546875}, {"start": 1356.81, "end": 1357.29, "word": " of", "probability": 0.80224609375}, {"start": 1357.29, "end": 1357.83, "word": " that", "probability": 0.81201171875}, {"start": 1357.83, "end": 1358.29, "word": " controls", "probability": 0.52880859375}, {"start": 1358.29, "end": 1358.85, "word": " filtration", "probability": 0.89599609375}, {"start": 1358.85, "end": 1359.29, "word": " يعطيكوا", "probability": 0.831103515625}, {"start": 1359.29, "end": 1359.67, "word": " العافية", "probability": 0.86083984375}, {"start": 1359.67, "end": 1360.09, "word": " السلام", "probability": 0.790771484375}, {"start": 1360.09, "end": 1360.25, "word": " عليكم", "probability": 0.841552734375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1360.248125, "duration_after_vad": 1337.2150000000001}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/d1cBi0ZBVBM_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/d1cBi0ZBVBM_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..5c7f7026fbdb49c20875e9cc072ab898ea3179c0
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/d1cBi0ZBVBM_raw.srt
@@ -0,0 +1,1308 @@
+1
+00:00:05,580 --> 00:00:15,760
+إذا .. إذا عندنا ال .. ال .. ال pyramid هذا تمام؟
+
+2
+00:00:15,760 --> 00:00:21,420
+نازل فيه logofinley و بعد ال logofinley بيجي عندنا
+
+3
+00:00:21,420 --> 00:00:25,960
+distal ال tribute ال logofinley هي straight نازلة
+
+4
+00:00:25,960 --> 00:00:31,340
+ديب ان جيج و بتطلع تعني verticalوبيجي جنبها ال
+
+5
+00:00:31,340 --> 00:00:33,700
+collecting tribules فعندي انا ال structure كله
+
+6
+00:00:33,700 --> 00:00:37,020
+ايه؟ tribules متوازية عشان كده في ال societal
+
+7
+00:00:37,020 --> 00:00:40,820
+section اللي طلعنا بنلاقيها مخططة لإنها ال
+
+8
+00:00:40,820 --> 00:00:43,920
+collecting ducts مخططة و ال log of illness اللي
+
+9
+00:00:43,920 --> 00:00:47,680
+نازده في البرامج مخططة طويلة فببين الشكل ال
+
+10
+00:00:47,680 --> 00:00:52,680
+striations اللي موجودة الآن ال collecting duct هذه
+
+11
+00:00:52,680 --> 00:00:57,960
+او ال collection system ببدأ بصغير كل ما تجمع عليه
+
+12
+00:00:57,960 --> 00:01:02,570
+اكتركل ما بيخمن مش كده؟ يعني أول فوق خالص جنب ال
+
+13
+00:01:02,570 --> 00:01:07,230
+cortex ال .. ال nephrons الطرفية بتتجمع مع بعض
+
+14
+00:01:07,230 --> 00:01:11,130
+بتعملي collecting duct الجزء الصغير اللي جنب ال
+
+15
+00:01:11,130 --> 00:01:13,550
+collecting duct بيسميها connecting tubule
+
+16
+00:01:13,550 --> 00:01:16,990
+connecting اللي بيصل ال .. ال .. ال .. ال distal
+
+17
+00:01:16,990 --> 00:01:20,110
+tubule اللي بيصل ال nephron بال a الجزء الأخير من
+
+18
+00:01:20,110 --> 00:01:23,330
+ال .. من ال nephron اللي شابك في ال a في ال
+
+19
+00:01:23,330 --> 00:01:28,430
+collectingsystem مثلا connecting duct tubule ال
+
+20
+00:01:28,430 --> 00:01:31,710
+connecting tubule هذا مش مكمل هنا و هنا مع أخوه
+
+21
+00:01:31,710 --> 00:01:37,130
+وأخوه يعملوا مع بعض cortical collecting tubule
+
+22
+00:01:37,130 --> 00:01:40,490
+cortical collecting tubule ليه سميه tubule لأنه
+
+23
+00:01:40,490 --> 00:01:45,290
+لسه رفيعة لما يخمل بصير مسميه duct تمام في ال
+
+24
+00:01:45,290 --> 00:01:49,170
+cortex مسموهش duct حقيقتي بيظل اسمه ايه cortical
+
+25
+00:01:49,170 --> 00:01:53,330
+collecting tubule في المضلة بيبدأ يخمل اولها برضه
+
+26
+00:01:53,330 --> 00:01:58,550
+cortical collectingمضلري مضلري collecting tubule
+
+27
+00:01:58,550 --> 00:02:02,550
+بنزل لجوه شوية بيصير كمية ضخمة من ال collecting
+
+28
+00:02:02,550 --> 00:02:08,270
+tubule تجتمع مع بعض بتعمل ال collecting duct بتعمل
+
+29
+00:02:08,270 --> 00:02:12,170
+ال ايه ال collecting duct اللي هو hand hand
+
+30
+00:02:12,170 --> 00:02:16,310
+collecting duct تمام ال collecting duct جاى عبارة
+
+31
+00:02:16,310 --> 00:02:19,630
+عن هى مجموعة هنا عندنا الخط بين ال cortex و الايه
+
+32
+00:02:20,080 --> 00:02:25,420
+والمضالة طبعا هنا ال collecting tubules بتنشبك مع
+
+33
+00:02:25,420 --> 00:02:29,920
+بعض في ال cortex بتعمل ليه collecting tubule
+
+34
+00:02:29,920 --> 00:02:35,280
+connection لأنه انا ال ال ال ال distal convoluted
+
+35
+00:02:35,280 --> 00:02:38,840
+tubule موجودة في ال cortex او نهايتها بتشبك في ال
+
+36
+00:02:38,840 --> 00:02:43,700
+ايه في ال cortex ف فعندي انا collecting collecting
+
+37
+00:02:43,700 --> 00:02:48,200
+tubules مع بعضها الكبيرة بتشبك مع بعض
+
+38
+00:02:51,950 --> 00:02:54,430
+تعمل مدالة تجمع مدالة تجمع مدالة تجمع مدالة تجمع
+
+39
+00:02:54,430 --> 00:02:57,490
+مدالة تجمع مدالة تجمع مدالة تجمع مدالة تجمع مدالة
+
+40
+00:02:57,490 --> 00:03:00,410
+تجمع مدالة تجمع مدالة تجمع مدالة تجمع مدالة تجمع
+
+41
+00:03:00,410 --> 00:03:04,530
+مدالة تجمع مدالة تجمع مدالة تجمع مدالة تجمع مدالة
+
+42
+00:03:04,530 --> 00:03:07,630
+تجمع مدالة تجمع مدالة تجمع مدالة تجمع مدالة تجمع
+
+43
+00:03:07,630 --> 00:03:16,570
+مدالة تجمع مدالة تجمع مدالة تجمع مدالة تجمع مدالة
+
+44
+00:03:16,570 --> 00:03:21,660
+تجمع مدالة تهي شبكة مع medullary collecting tubule
+
+45
+00:03:21,660 --> 00:03:25,480
+تمام؟ هدول cortical collecting tubules هدول
+
+46
+00:03:25,480 --> 00:03:27,300
+cortical collecting tubules هدول connecting
+
+47
+00:03:27,300 --> 00:03:29,140
+tubules هدول connecting tubules هدول connecting
+
+48
+00:03:29,140 --> 00:03:29,140
+tubules هدول connecting tubules هدول connecting
+
+49
+00:03:29,140 --> 00:03:29,140
+tubules هدول connecting tubules هدول connecting
+
+50
+00:03:29,140 --> 00:03:29,200
+tubules هدول connecting tubules هدول connecting
+
+51
+00:03:29,200 --> 00:03:30,380
+tubules هدول connecting tubules هدول connecting
+
+52
+00:03:30,380 --> 00:03:30,860
+tubules هدول connecting tubules هدول connecting
+
+53
+00:03:30,860 --> 00:03:32,300
+tubules هدول connecting tubules هدول connecting
+
+54
+00:03:32,300 --> 00:03:33,700
+tubules هدول connecting tubules هدول connecting
+
+55
+00:03:33,700 --> 00:03:34,320
+tubules هدول connecting tubules هدول connecting
+
+56
+00:03:34,320 --> 00:03:35,820
+tubules هدول connecting tubules هدول connecting
+
+57
+00:03:35,820 --> 00:03:37,120
+tubules هدول connecting tubules هدول connecting
+
+58
+00:03:37,120 --> 00:03:37,120
+tubules هدول connecting tubules هدول connecting
+
+59
+00:03:37,120 --> 00:03:37,120
+tubules هدول connecting tubules هدول connecting
+
+60
+00:03:37,120 --> 00:03:37,160
+tubules هدول connecting tubules هدول connecting
+
+61
+00:03:37,160 --> 00:03:39,840
+tubules هدول connecting tubules هدول connecting
+
+62
+00:03:39,840 --> 00:03:45,180
+tubules هدول
+
+63
+00:03:45,180 --> 00:03:51,880
+connecting tubulesلذلك ال .. ال collecting .. هدق
+
+64
+00:03:51,880 --> 00:03:55,880
+.. دقينا ميدالري collecting دكتور خلاص وصلنا للاخر
+
+65
+00:03:55,880 --> 00:03:58,840
+هنا البابيلا redacted لإن هدى الفتحة هدى الصغيرة
+
+66
+00:03:58,840 --> 00:04:04,680
+هدى بتكون فتح خرم فى البابيلا فى زيها .. فى زيها
+
+67
+00:04:04,680 --> 00:04:08,320
+متر و خمسين خرم فى التوقع اللى اتجلمز عشان كل واحد
+
+68
+00:04:08,320 --> 00:04:14,160
+اجيبلى من ايه؟ من أربع آلاف نفران طيب إذا عندي أنا
+
+69
+00:04:14,160 --> 00:04:19,690
+هنرجع تانى ونقول .. نطلع أهلش فى رسمتين هنرسمة فوق
+
+70
+00:04:19,690 --> 00:04:24,810
+و رسمة تحت و بعدين اللي اللي اللي بيختلفوا
+
+71
+00:04:24,810 --> 00:04:26,250
+بيختلفوا بيختلفوا بيختلفوا بيختلفوا بيختلفوا
+
+72
+00:04:26,250 --> 00:04:26,930
+بيختلفوا بيختلفوا بيختلفوا بيختلفوا بيختلفوا
+
+73
+00:04:26,930 --> 00:04:27,010
+بيختلفوا بيختلفوا بيختلفوا بيختلفوا بيختلفوا
+
+74
+00:04:27,010 --> 00:04:27,330
+بيختلفوا بيختلفوا بيختلفوا بيختلفوا بيختلفوا
+
+75
+00:04:27,330 --> 00:04:28,450
+بيختلفوا بيختلفوا بيختلفوا بيختلفوا بيختلفوا
+
+76
+00:04:28,450 --> 00:04:28,870
+بيختلفوا بيختلفوا بيختلفوا بيختلفوا بيختلفوا
+
+77
+00:04:28,870 --> 00:04:28,990
+بيختلفوا بيختلفوا بيختلفوا بيختلفوا بيختلفوا
+
+78
+00:04:28,990 --> 00:04:36,530
+بيختلفوا بيختلفوا بيختلفوا
+
+79
+00:04:36,530 --> 00:04:48,390
+بيختلفوا بيختلف
+
+80
+00:04:48,460 --> 00:04:52,320
+بس بينزل في ال outer مضلة بيخشش في ال inner مضلة
+
+81
+00:04:52,320 --> 00:04:55,400
+يعني بينزل ب dipping في ال outer مضلة و برجع بيعمل
+
+82
+00:04:55,400 --> 00:05:00,340
+ال algorithm من جديد بيعمل ال ايه ال distal tubule
+
+83
+00:05:00,340 --> 00:05:05,320
+تمام هادسة
+
+84
+00:05:05,320 --> 00:05:11,960
+منها cortical nephrons تمثل حوالي 70% إلى 45% من
+
+85
+00:05:11,960 --> 00:05:16,020
+ال nephrons cortical nephrons و هم حقيقة ال
+
+86
+00:05:16,020 --> 00:05:20,860
+functioning nephronsطيب النوع التاني من النفرز
+
+87
+00:05:20,860 --> 00:05:26,360
+موجودين جاربين من ايه؟ من الميدالة جاكستا ميدالري
+
+88
+00:05:26,360 --> 00:05:33,980
+نفرز جاكستا يعني قرب جاكستا ميدالري نفرز في عندي
+
+89
+00:05:33,980 --> 00:05:37,470
+انا هاري ال tribuneهذا الجزء من التيوبيول الدسة
+
+90
+00:05:37,470 --> 00:05:41,630
+نسميه جاكستا جلوميرولا جاكستا جلوميرولا system
+
+91
+00:05:41,630 --> 00:05:45,710
+يعني عندي تيوبيول هان ملاصق للجلوميرولا جاكستا
+
+92
+00:05:45,710 --> 00:05:50,310
+يعني ملاصق هنا عندنا نسميها جاكستا ميدالري نفرونز
+
+93
+00:05:50,310 --> 00:05:53,270
+من خمسة و عشرين إلى تلاتين في المية من النفرونز
+
+94
+00:05:53,270 --> 00:05:56,650
+اللي تحت هدول جاكستا ميدالري احنا مش جسمناهم لإن
+
+95
+00:05:56,650 --> 00:05:59,490
+هم تحت و انه فوق لأ كمال ال structure تبعهم تختلف
+
+96
+00:05:59,490 --> 00:06:03,350
+يعني هدول اللي .. و لو كان واطي لكن لو اللوبوفينلي
+
+97
+00:06:03,350 --> 00:06:07,510
+تبعه قصير نسميه corticalلكن هدول اللي متكلم عنهم
+
+98
+00:06:07,510 --> 00:06:11,410
+الملاصقين للمضلة يعني بين ال cortex و المضلة تحت
+
+99
+00:06:11,410 --> 00:06:16,390
+بين الاتنين هدول ميزتهم انه ال loop of Henle تبعهم
+
+100
+00:06:16,390 --> 00:06:22,650
+dipping down ممكن لل tip of the pyramid طبعا اذا
+
+101
+00:06:22,650 --> 00:06:27,930
+انلاحظوا اللهم long loop of Henle بنزل dipping
+
+102
+00:06:27,930 --> 00:06:35,220
+down في المضلة ممكن يكون لأخر مرحلة عند ال tipالـ
+
+103
+00:06:35,220 --> 00:06:43,740
+top of the pyramid ال بابلة ال بابلة ال بابلة
+
+104
+00:06:43,740 --> 00:06:44,540
+ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال
+
+105
+00:06:44,540 --> 00:06:44,540
+بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة
+
+106
+00:06:44,540 --> 00:06:44,900
+ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال
+
+107
+00:06:44,900 --> 00:06:45,200
+بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة
+
+108
+00:06:45,200 --> 00:06:49,280
+ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال
+
+109
+00:06:49,280 --> 00:06:49,280
+بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة
+
+110
+00:06:49,280 --> 00:06:49,280
+ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال
+
+111
+00:06:49,280 --> 00:06:50,720
+بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة
+
+112
+00:06:50,720 --> 00:06:50,720
+ال بابلة ال بابلة ال بابلة ال بابلة ال بابلة ال
+
+113
+00:06:50,720 --> 00:06:57,860
+بابلة ال بابلة ال بدى ال inner medulla التانى ال
+
+114
+00:06:57,860 --> 00:07:01,300
+cortical اللوبه فيه اللي تبعه بس في ال outer
+
+115
+00:07:01,300 --> 00:07:05,220
+medulla عشان كده في الصغيرة ال section الألوان
+
+116
+00:07:05,220 --> 00:07:09,340
+بتخلف لإن ال structure بيخلف لإن ال structure
+
+117
+00:07:09,340 --> 00:07:14,240
+بيخلف هذه البرة ال outer medulla فيها نفرق فيها
+
+118
+00:07:14,240 --> 00:07:18,340
+فيها loops فيه اللي أكترلأن كل ال cortical فيها
+
+119
+00:07:18,340 --> 00:07:21,920
+اللى جوا انفقت جزء كبير من ال .. من ال .. ال
+
+120
+00:07:21,920 --> 00:07:25,140
+nephrons اللي و بقوا فين اللي زي .. مش داخلها إذا
+
+121
+00:07:25,140 --> 00:07:28,840
+انتحار تبقى جزء واحد بس إيه فهنا كثافة اللون اختلف
+
+122
+00:07:28,840 --> 00:07:31,700
+لإنه عند اللي و بقوا فين اللي زي كتير هنا صار بس
+
+123
+00:07:31,700 --> 00:07:34,580
+سبعين المية منهم نزلوا لتحت سبعين المية إذا ال
+
+124
+00:07:34,580 --> 00:07:38,820
+structure تبقى قداني فرق نظري بصري بشوف إنه اختلف
+
+125
+00:07:38,820 --> 00:07:43,320
+لو اطلعته شوية صغيرة هان لو اطلعته شوية صغيرة هان
+
+126
+00:07:43,320 --> 00:07:49,670
+بنلاقي احنا عندناهن ثن لوبوفينلي و هن ثك لوبوفينلي
+
+127
+00:07:49,670 --> 00:07:56,530
+تمام؟ اذا بلاحظ انا انه عندى فى ال outer stripe فى
+
+128
+00:07:56,530 --> 00:08:00,570
+اللوبوفينلي ثك فى ال inner .. قولتلكم انا ال outer
+
+129
+00:08:00,570 --> 00:08:04,570
+مدلة بتنقسم اسمين مش كده؟ قولتلكم inner stripe و
+
+130
+00:08:04,570 --> 00:08:08,710
+outer stripe بيفرقهم ال thickness of the lobofenli
+
+131
+00:08:08,710 --> 00:08:13,000
+فى ال outer stripe فى عندى كلها ثك لوبوفينليلكن في
+
+132
+00:08:13,000 --> 00:08:19,440
+ال inner stripe عندى جزء thick وجزء thin تمام؟ جزء
+
+133
+00:08:19,440 --> 00:08:23,900
+thick وجزء thin فلذلك ال structure اختلفت كثافة
+
+134
+00:08:23,900 --> 00:08:29,780
+اخرىلما تقولنا section كده و striations و لون و
+
+135
+00:08:29,780 --> 00:08:34,380
+inner medulla .. medulla و cortex و ال medulla ..
+
+136
+00:08:34,380 --> 00:08:37,240
+outer medulla و inner medulla و ال inner .. و ال
+
+137
+00:08:37,240 --> 00:08:40,380
+outer سمناها inner stripe و outer stripe كله بيدل
+
+138
+00:08:40,380 --> 00:08:45,500
+على ايه؟ على ان ال different مراحله المختلفةبكيف
+
+139
+00:08:45,500 --> 00:08:49,460
+بيتغير بيقدّي الى انه ال stripe كله هذا موجود فيه
+
+140
+00:08:49,460 --> 00:08:54,920
+thick lobophilic ال stripe هذا لأ نصه او اقل من
+
+141
+00:08:54,920 --> 00:08:59,440
+نصه فيه thick والباقي الجزئية ايه؟ thin جوا ال
+
+142
+00:08:59,440 --> 00:09:04,280
+inner كله ايه؟ thin lobophilic تمام؟ فى ال cortex
+
+143
+00:09:04,280 --> 00:09:12,020
+اهو فى عندك glomeruli، tubules تمام؟ اذا عندى انا
+
+144
+00:09:12,020 --> 00:09:15,910
+لما امشي معطب ال function انا مش هتشتغل ال
+
+145
+00:09:15,910 --> 00:09:19,250
+function طب ليش هاللخمة؟ ليش الدكتور قاعد بتقول لأ
+
+146
+00:09:19,250 --> 00:09:22,670
+هذا و هذا و هذا و هذا و نفرنز زي بعض؟ لأ مش زي بعض
+
+147
+00:09:22,670 --> 00:09:26,170
+مش زي بعض هذا له function هذا له function ال
+
+148
+00:09:26,170 --> 00:09:32,190
+cortical function ال cortical نفرنز شغلتها انها
+
+149
+00:09:32,190 --> 00:09:41,790
+تطلع ball تمام؟ و ال اله شغلتها انهاطلع بول بطريقة
+
+150
+00:09:41,790 --> 00:09:48,230
+ما بس هدفها الرئيسي من ال ball هذا انه تغير ال
+
+151
+00:09:48,230 --> 00:09:52,750
+osmolality تبع المدلة ال osmolality تبع المدلة ال
+
+152
+00:09:52,750 --> 00:09:58,050
+interstitial fluid osmolality تبع المدلة هذه تمام
+
+153
+00:09:58,050 --> 00:10:04,630
+بتزيد و بتوطى يعني انا لما بدي اطلع ball مركز لما
+
+154
+00:10:04,630 --> 00:10:08,850
+اطلع من لاج المدلة هذه hyper osmotic لما ال ball
+
+155
+00:10:08,850 --> 00:10:16,870
+يطلعمخفف بقتلع بلاجة المضالة مش hyper osmotic
+
+156
+00:10:16,870 --> 00:10:23,490
+normal osmotic تمام؟ اذا بلاجة انا في علاقة ما بين
+
+157
+00:10:23,490 --> 00:10:28,430
+ال ball المركز والمضالة لما تزيد تركيز المضالة
+
+158
+00:10:28,430 --> 00:10:33,470
+بيزيد تركيز ال ball اذا المضالة هذه ال inner
+
+159
+00:10:33,470 --> 00:10:38,170
+mudalaالمدلة لها علاقة كبيرة في الـ Concentrating
+
+160
+00:10:38,170 --> 00:10:42,050
+mechanism of the urine الورين كيف بيطلع
+
+161
+00:10:42,050 --> 00:10:47,170
+Concentrated؟ تمام؟ فيه إيه ميكانيزم المدلة مسئولة
+
+162
+00:10:47,170 --> 00:10:50,970
+عنه لذلك ال 30% هدول الموجودين جاكستا ميدالري
+
+163
+00:10:50,970 --> 00:10:55,370
+بيشتغلوا إنهم يغيروا ال cosmolality تبع المدلة
+
+164
+00:10:55,370 --> 00:10:59,870
+عشان نغير ال cosmolality تبع الورين اللي طالع لكن
+
+165
+00:10:59,870 --> 00:11:01,830
+الورين الرئيسه طالع من مين؟ من ال cortical
+
+166
+00:11:01,830 --> 00:11:06,600
+nephronsوهو معدن ان الميدالا بيتغير اه بيصير more
+
+167
+00:11:06,600 --> 00:11:10,500
+concentrated او less concentrated حسب حاجات الجسم
+
+168
+00:11:10,500 --> 00:11:14,580
+واضح؟ اذا جاكسا ميدالا الريفرونز يلهم function
+
+169
+00:11:14,580 --> 00:11:19,280
+اضافي اذا ماقلناش function اضافي رئيسي حقيقة اللي
+
+170
+00:11:19,280 --> 00:11:24,400
+هو اللي هو controlling the urine concentration عبر
+
+171
+00:11:24,400 --> 00:11:28,960
+الميكانيزة دلوقت ان انا اعمل interstitial مركز
+
+172
+00:11:29,560 --> 00:11:32,460
+والبول اللى جاى غالبا من فوق من الكورتكس ماعدي على
+
+173
+00:11:32,460 --> 00:11:38,180
+انتساشة مركز فالأزموز ايش بيعمل؟ بشفط المياه منه،
+
+174
+00:11:38,180 --> 00:11:41,380
+تمام؟ فبيقدى الى انه يصير equilibrium ما بين
+
+175
+00:11:41,380 --> 00:11:43,340
+الأزموز وانتساشة
+
+176
+00:11:52,660 --> 00:11:55,580
+عشان اقولكوا هنا في ال collecting duck بصير
+
+177
+00:11:55,580 --> 00:11:58,460
+التركيز لإن ال collecting duck بيمشي في الميدالة
+
+178
+00:12:00,070 --> 00:12:05,010
+الميضالة حواليها مركز الانترستيشال مش كده فبيقدر
+
+179
+00:12:05,010 --> 00:12:09,210
+انه ايه؟ مين عامل مركز الانترستيشال؟ جكس الميضالة
+
+180
+00:12:09,210 --> 00:12:12,710
+ايه؟ نفرز هذا بيقدر انه البولي اللي طالع في الآخر
+
+181
+00:12:12,710 --> 00:12:15,910
+بينحكم ال concentration تبع الوزمولية تبعته بال
+
+182
+00:12:15,910 --> 00:12:20,410
+انترستيشال ازموزيز ازمولاريته تبعة مين؟ الميضالة
+
+183
+00:12:20,410 --> 00:12:24,690
+اللي هي بتسحب الميه الزايدة بحيث انه لو اكتش
+
+184
+00:12:24,690 --> 00:12:28,300
+ميضالة ميضالة ميتتحركلحد مصير ال equilibrium بظبط
+
+185
+00:12:28,300 --> 00:12:32,840
+اذا بيضل ال .. ال .. المية تتحرك من داخل ال tubule
+
+186
+00:12:32,840 --> 00:12:35,700
+هذا ال collecting إذا ال collecting هذا مش زي
+
+187
+00:12:35,700 --> 00:12:39,120
+المجاري تبعتنا بس عبارة عن توصيل لأ جزء أساسي في
+
+188
+00:12:39,120 --> 00:12:42,840
+الشغل إذا ال collecting duct هذه مش بس collecting
+
+189
+00:12:42,840 --> 00:12:47,220
+duct إلها جزء أساسي في الآخر بتجمع و في الآخر هي
+
+190
+00:12:47,220 --> 00:12:50,520
+بتسلم المية اللي بدنا نشيها إلى ال interstation
+
+191
+00:12:50,520 --> 00:12:56,010
+دورالنفرونز هذا اللي اتكلمنا عنها اللي هي الجكسة
+
+192
+00:12:56,010 --> 00:12:59,910
+ميدالري انها تحافظ على hyper osmolarity تعمل hyper
+
+193
+00:12:59,910 --> 00:13:03,350
+osmolarity في الميدالة اذا احنا محتاجين و تحافظ
+
+194
+00:13:03,350 --> 00:13:07,150
+عليها انها ما تروحش لإن احنا اذا ع جد عملنا
+
+195
+00:13:07,150 --> 00:13:10,710
+osmolarity في الميدالة و البول اللي نازل أخدنا منه
+
+196
+00:13:10,710 --> 00:13:14,830
+ميه راح التركيز مظبوط يعني انت بتجي كتير مش كله
+
+197
+00:13:14,830 --> 00:13:20,310
+راح بيجي دور الجكسة ميدالري انهم كل اللي اللي اللي
+
+198
+00:13:20,310 --> 00:13:21,990
+اللي اللي اللي اللي اللي اللي اللي اللي اللي اللي
+
+199
+00:13:21,990 --> 00:13:21,990
+اللي اللي اللي اللي اللي اللي اللي اللي اللي اللي
+
+200
+00:13:21,990 --> 00:13:21,990
+اللي اللي اللي اللي اللي اللي اللي اللي اللي اللي
+
+201
+00:13:22,770 --> 00:13:26,410
+الـ fluids ال water اللى دخلت ال .. ال .. ال .. ال
+
+202
+00:13:26,410 --> 00:13:30,390
+inner medulla under the osmosis بتعود تتاخد
+
+203
+00:13:30,390 --> 00:13:33,830
+بالinfluenza تترحل من أول و جديد للإيلة الدم تمام؟
+
+204
+00:13:33,830 --> 00:13:37,750
+because ان حافظ ع مين؟ اذا في عندى عاملة ..التكوين
+
+205
+00:13:37,750 --> 00:13:42,170
+الانترستيشيا الفلوود محافظ عليه و محافظة عليه هل
+
+206
+00:13:42,170 --> 00:13:45,630
+شغلت مين؟ لذلك بنتكلم انه جاكستر ميدالري و
+
+207
+00:13:45,630 --> 00:13:49,310
+cortical نفرز لانهم مهمين هذا له فانكشن وهذا له
+
+208
+00:13:49,310 --> 00:13:52,870
+فانكشن وللعلم لو احنا بداش نطلع concentrated urine
+
+209
+00:13:52,870 --> 00:13:58,510
+تمام بنطلع نور في ال urine أزوز بوتك او شربين ميه
+
+210
+00:13:58,510 --> 00:14:02,710
+كتير و بنطلع diluted urineتمام؟ مينلاحظ أنه المدلة
+
+211
+00:14:02,710 --> 00:14:07,370
+ولا مهاجرة مش شغالين ان الجكسة مدلة نفرز مش هي دم
+
+212
+00:14:07,370 --> 00:14:11,030
+و بتعملش filtration و مرتاحة يعني هي بتشتغل وقت ما
+
+213
+00:14:11,030 --> 00:14:13,990
+احنا عايزين ال concentration لأ مافيش مش محتاجين
+
+214
+00:14:13,990 --> 00:14:16,790
+ال concentration بترتاح يعني مش دايما هي شغالة
+
+215
+00:14:16,790 --> 00:14:21,870
+تمام؟ هي بتشتغل بزيد شغلها بجل شغلها جزء منها
+
+216
+00:14:21,870 --> 00:14:25,470
+بيشتغل وجزء منها بيشتغلش حسب جداش بده osmolality
+
+217
+00:14:25,470 --> 00:14:30,540
+تتكون في البنسميهم concentration gradients في
+
+218
+00:14:30,540 --> 00:14:34,660
+الانترستيشن المضلة لإنه بنلاقي فوق في ال inner
+
+219
+00:14:34,660 --> 00:14:40,960
+مضلة لل tip فوق بزيد ال osmolarity تحت أزود أزود
+
+220
+00:14:40,960 --> 00:14:45,680
+أزود أزود the most concentrated بيبقى ال tipتمام؟
+
+221
+00:14:45,680 --> 00:14:48,740
+عشان احنا ال urine اللى نازل نفقد ميته شوية شوية
+
+222
+00:14:48,740 --> 00:14:51,680
+فالمفقد ميته هو اللى بياخد شوية من الميه طبعا بعمل
+
+223
+00:14:51,680 --> 00:14:54,920
+شوية تخفيفة لحد ما نتخلص منه وكميته كتيرة لإنه لسه
+
+224
+00:14:54,920 --> 00:14:58,940
+أوله بعدين كمية أقل بتبتص ال ball بتركز وهذا ال
+
+225
+00:14:58,940 --> 00:15:03,410
+transition fluid بيبقى أخف تركيزهمن اللي تحت لكن
+
+226
+00:15:03,410 --> 00:15:06,630
+اكتر من ال a من اللي فوقه فبنلاقي concentration
+
+227
+00:15:06,630 --> 00:15:10,850
+gradient موجود بنلاقي فوق جنب ال cortex isosmotic
+
+228
+00:15:10,850 --> 00:15:15,310
+وبيزيد اربعمية خمسمية ستمية سبعمية الف واربعمية
+
+229
+00:15:15,310 --> 00:15:19,950
+البني آدم بيطلع التركيز بول لحد الف واربعمية فكان
+
+230
+00:15:19,950 --> 00:15:24,830
+انه ممكن نلاقي بعض الحيوانات الصحراوية بتطلع بول
+
+231
+00:15:24,830 --> 00:15:29,010
+concentrated الفين وخمسمية اكتر من ضعف التركيز عن
+
+232
+00:15:29,010 --> 00:15:34,790
+البني آدم تمامومنلاقي حيوانات مائية بتطلع dilute
+
+233
+00:15:34,790 --> 00:15:38,970
+urine لإن هى عشرة في الميه او بتشرب ميه دايما كتير
+
+234
+00:15:38,970 --> 00:15:42,110
+فبتطلع dilute urine تمام؟ اذا لما اتكلم عن ال
+
+235
+00:15:42,110 --> 00:15:44,950
+cortical nephrons و jackson medullary nephrons انا
+
+236
+00:15:44,950 --> 00:15:50,690
+بتكلم عن تقسيم مش بس anatomical او histological
+
+237
+00:15:50,690 --> 00:15:53,630
+بتكلم عن functional ده بتكلم عن physiological
+
+238
+00:15:58,140 --> 00:16:00,800
+differentiation بين هذا و هذا هذا في الأخر هيشغل
+
+239
+00:16:00,800 --> 00:16:05,720
+شغل و هذا يشغل شغل هذا ممكن ايه اذا احنا عندنا في
+
+240
+00:16:05,720 --> 00:16:09,640
+concentrating mechanism طب في diluting mechanism
+
+241
+00:16:09,640 --> 00:16:12,460
+اه في diluting mechanism هدرسها ان شاء الله
+
+242
+00:16:12,460 --> 00:16:19,500
+بالتفصيل لسه عصارة كده؟ ضايلنا شوية احنا نمشي احنا
+
+243
+00:16:19,500 --> 00:16:23,360
+و نص ال lecture تاني و نخلص ان شاء الله اذا في
+
+244
+00:16:23,360 --> 00:16:29,440
+عندنا استراك شهر كتير مهمأه مكان النفرون بيديني
+
+245
+00:16:29,440 --> 00:16:32,020
+على ال function تبعه كمان مش بس ايه انه جاكستر
+
+246
+00:16:32,020 --> 00:16:37,040
+ميدلالري يمثل 25-30% لأ طيب اذا اتكلمنا عن ال
+
+247
+00:16:37,040 --> 00:16:41,600
+structure of nephron هنا و قولنا بعض الفرقات فيه و
+
+248
+00:16:41,600 --> 00:16:44,940
+قولنا
+
+249
+00:16:44,940 --> 00:16:48,600
+انه عندنا cortical nephrons و عندنا اه يعني هذا
+
+250
+00:16:48,600 --> 00:16:53,080
+cortical nephron و هذا ايه جاكستر ميدلالري نفرون
+
+251
+00:16:53,080 --> 00:16:58,570
+جاكستر ميدلالري نفرونالفروقات في التركيب مش بس
+
+252
+00:16:58,570 --> 00:17:04,130
+مرتبطة بالكلام اللي توجلناه كمان احنا في جزرنا
+
+253
+00:17:04,130 --> 00:17:07,530
+مبطلناها قولنا peritubular capillaries ومعدينا
+
+254
+00:17:07,530 --> 00:17:12,790
+كمان؟ اه لأ ال peritubular capillaries اللي في ال
+
+255
+00:17:12,790 --> 00:17:16,610
+cortical nephrons عبارة عن شبكة من ال capillaries
+
+256
+00:17:16,610 --> 00:17:20,310
+تحيط بال .. بال .. بال .. بال .. بال tubules ال
+
+257
+00:17:20,310 --> 00:17:25,480
+proximal و ال distal و كله بتحيطهاتمام؟ ليش؟ لأنه
+
+258
+00:17:25,480 --> 00:17:28,420
+بتصير عنها هنا بعد ال filtration بتصير عامل tree
+
+259
+00:17:28,420 --> 00:17:31,560
+absorption فال cabellas اللي فجدت في ال .. في ال
+
+260
+00:17:31,560 --> 00:17:35,040
+.. في ال glomerulus فجدت ال fluids بتعود تحوط ال
+
+261
+00:17:35,040 --> 00:17:37,720
+.. ال .. ال tubules من أول و جديد عشان تشفط اللي
+
+262
+00:17:37,720 --> 00:17:43,260
+إيه اللي أخرته بس بتطلع ال urine يعني احنا بنفقد
+
+263
+00:17:43,260 --> 00:17:47,440
+أو ال filter filtration مية و خمسة و عشرين مليلتر
+
+264
+00:17:47,440 --> 00:17:53,820
+في دقيقة125 ملي لتر منها 124 بيرجعوا reabsorbed و
+
+265
+00:17:53,820 --> 00:17:58,620
+بس one milliliter ايه اه بيطلع طبعا اذا one
+
+266
+00:17:58,620 --> 00:18:04,880
+milliliter فقط بيطلع ايه في ال 124 صوروا لو احنا
+
+267
+00:18:04,880 --> 00:18:10,960
+خمسة دم اللي نزل خمسة دم دخل الكلية بعدين خمسة
+
+268
+00:18:10,960 --> 00:18:14,960
+blood مصارنة filtration طبعا لو احنا هذه تفقد
+
+269
+00:18:14,960 --> 00:18:19,040
+الخارج من مرة واحدة خلال كده احنا بنختفيبدناش
+
+270
+00:18:19,040 --> 00:18:23,300
+دقائق كتيرة خلال فترة بسيطة بيكون احنا لمؤاخذة
+
+271
+00:18:23,300 --> 00:18:28,380
+urinated ourselves اه كله بيطلع لكن كله بيعدر ي
+
+272
+00:18:28,380 --> 00:18:35,820
+absorb من ال 125 بيصيرله ايه? executed؟ طيب هذا
+
+273
+00:18:35,820 --> 00:18:39,840
+بيقدر الى انه peritubular capilla لسه مهمة عاملة
+
+274
+00:18:39,840 --> 00:18:44,390
+work محترم حوالين ال corticalطيب و ال .. جاكستر
+
+275
+00:18:44,390 --> 00:18:48,210
+ميدالري؟ أه بس إلها structure مختلف ليش؟ لإن قلنا
+
+276
+00:18:48,210 --> 00:18:52,150
+ال function هال مختلف زي ما قلنا إحنا عندنا long
+
+277
+00:18:52,150 --> 00:18:56,270
+loop of Henle قلنا البرتيوكا بيلاري هال بتتحول إلى
+
+278
+00:18:56,270 --> 00:19:01,880
+بازاركتاblood vessels straight recta rectus يعني
+
+279
+00:19:01,880 --> 00:19:06,960
+straight vasa recta فى إذن عندك descending vasa
+
+280
+00:19:06,960 --> 00:19:09,780
+recta وascending vasa recta زى ال loop of hinley
+
+281
+00:19:09,780 --> 00:19:16,260
+لكن blood loops بنزلوا موازين ومحيطين بال loop of
+
+282
+00:19:16,260 --> 00:19:20,640
+hinley محيطين زى حوالين ال .. طفتوا حوالين ال loop
+
+283
+00:19:20,640 --> 00:19:24,380
+of hinley من الطالع وتنازل تمام محيطين وها وها
+
+284
+00:19:24,380 --> 00:19:30,650
+عشان كل السوائل الإضافيةاللي دخلت ال tube يقول هان
+
+285
+00:19:30,650 --> 00:19:35,290
+على طول تطلع في الدم بطريقة معينة تحافظ فيها على
+
+286
+00:19:35,290 --> 00:19:37,970
+ال concentration mechanism إذا من ضمن ال structure
+
+287
+00:19:37,970 --> 00:19:41,150
+اللي بيحافظ على ال function تبع ال Jack's terminal
+
+288
+00:19:41,150 --> 00:19:44,370
+inference أن ال period tube الكبيرة اللي استباعها
+
+289
+00:19:46,340 --> 00:19:50,960
+أه على شكل vasa ركتا موجود على شكل vasa ركتا بنزل
+
+290
+00:19:50,960 --> 00:19:54,600
+هيك branches من ال إفرانت بنزله dipping في داخل ال
+
+291
+00:19:54,600 --> 00:19:59,820
+إيه المضلة معت يوز للآخر و بيعود يطلع للآخر و
+
+292
+00:19:59,820 --> 00:20:03,740
+بينهم جثة كبيرة بتصير هتكلم عنها في الوقت المناسب
+
+293
+00:20:03,740 --> 00:20:11,780
+تمام urine formation from the glomerin طيب
+
+294
+00:20:11,780 --> 00:20:16,080
+in general هتكلم على أنه ال urineتكوينه عبارة عن
+
+295
+00:20:16,080 --> 00:20:24,920
+تلات أشياء filtration و reabsorption و أحيانا أقل
+
+296
+00:20:24,920 --> 00:20:28,420
+كمية أقل function اللي هو ال secretion يعني في
+
+297
+00:20:28,420 --> 00:20:33,280
+أشياء بدنا إياها كلها تطلع فمش بس ال filtered اللي
+
+298
+00:20:33,280 --> 00:20:37,320
+بده يطلع في ال bowl منها ومايصيروش reabsorption لأ
+
+299
+00:20:37,320 --> 00:20:40,760
+بدنا كمان اللي ضايل في الدم منها نطلعه بدنا نعمله
+
+300
+00:20:40,760 --> 00:20:44,450
+secretion إذا عندنا تلاتة processesfilteration,
+
+301
+00:20:44,550 --> 00:20:48,710
+reabsorption, secretion التنتير هدور كبار وأجال
+
+302
+00:20:48,710 --> 00:20:52,770
+كمية .. أجال العملية هي إيه؟ ال secretion هو ال
+
+303
+00:20:52,770 --> 00:20:58,170
+secretion عملية كتير مهمة محصرة البول اللي بطلع
+
+304
+00:20:58,170 --> 00:21:02,350
+اذا محصرة التلات عملية ال filtration زاد .. زاد
+
+305
+00:21:02,350 --> 00:21:06,070
+secretion ناقص reabsorption يساوي ال إيه؟ ال
+
+306
+00:21:06,070 --> 00:21:11,270
+executed volume إن كان fluids إن كانت electrolytes
+
+307
+00:21:11,270 --> 00:21:17,320
+و هكذا okayإذا ممكن يصير عنه بعض المواد يصيرها
+
+308
+00:21:17,320 --> 00:21:21,440
+filtration وما يصيراش ال absorption تطلع برا على
+
+309
+00:21:21,440 --> 00:21:25,800
+طولاللي هي ال end product سبع الميتابوليزم انا
+
+310
+00:21:25,800 --> 00:21:29,220
+مابديش اعملها reabsorption في بعض المواد بيصير لها
+
+311
+00:21:29,220 --> 00:21:33,540
+reabsorption جزئيا جزء منه reabsorbed و جزء
+
+312
+00:21:33,540 --> 00:21:38,100
+executed و في بعض المواد بيصير عندى لها complete
+
+313
+00:21:38,100 --> 00:21:42,440
+reabsorption زي السكر و الأميناتيات مابتطلعش في
+
+314
+00:21:42,440 --> 00:21:45,740
+البول ماينزل في البلازمه تمام؟ ع فكرة ال
+
+315
+00:21:45,740 --> 00:21:49,380
+filtration خمس البلازمه اللي داخل الجلوميله لازم
+
+316
+00:21:49,380 --> 00:21:52,020
+يتفرج في ال filtration يعني خمس القمص
+
+317
+00:22:02,590 --> 00:22:05,510
+مشكلة إذا طلعت طبعا من برا، قلتلكوا هم 125 ميلي
+
+318
+00:22:05,510 --> 00:22:09,650
+ليتر per minute، فبيصير عندي أنا جزء، إذا في
+
+319
+00:22:09,650 --> 00:22:14,430
+filtrationوفي عند reabsorption وفي insecretion هذه
+
+320
+00:22:14,430 --> 00:22:17,570
+المسائل تختلط بعض المواد بيصيرلها filtration و بس
+
+321
+00:22:17,570 --> 00:22:20,690
+بعض المواد filtration و بعدين reabsorbed كليا في
+
+322
+00:22:20,690 --> 00:22:22,810
+بعض المواد لأ filtration و جزئيا بيصيرلها
+
+323
+00:22:22,810 --> 00:22:26,750
+reabsorption بعض المواد filtration و يضاف عليها ال
+
+324
+00:22:26,750 --> 00:22:29,270
+secretion وبهذا الكلام ان شاء الله المرة الجاية
+
+325
+00:22:29,270 --> 00:22:33,550
+هتكلم عن الأول عملية من عمليات الكيليا اللي هو ال
+
+326
+00:22:33,550 --> 00:22:38,290
+filtration نتكلم على ال rules of that controls
+
+327
+00:22:38,290 --> 00:22:40,250
+filtration يعطيكوا العافية السلام عليكم
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/iqHo0a3El6c.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/iqHo0a3El6c.srt
new file mode 100644
index 0000000000000000000000000000000000000000..5d3f884aa9ba783c09343b0dc418645b10cec97b
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/iqHo0a3El6c.srt
@@ -0,0 +1,2730 @@
+1
+00:00:08,980 --> 00:00:15,340
+بسم الله الرحمن الرحيم السلام عليكم اليوم هنتكلم
+
+2
+00:00:15,340 --> 00:00:19,380
+عن how
+
+3
+00:00:19,380 --> 00:00:27,410
+the respiratory process is controlled.  عنا بنحتاج
+
+4
+00:00:27,410 --> 00:00:33,670
+إحنا إلى بعض الأحيان إلى مجهود كبير، بدنا oxygen
+
+5
+00:00:33,670 --> 00:00:40,670
+أكثر، مطلوب أحيانًا متوسط مطلوب، نرجع طبيعي، هذه
+
+6
+00:00:40,670 --> 00:00:45,550
+المسألة بتتم بشكل تلقائي بدون ما يكون لإحنا دور
+
+7
+00:00:45,550 --> 00:00:51,650
+يعني  voluntary فيها، يعني بيصير عندنا automatic
+
+8
+00:00:51,650 --> 00:00:56,240
+regulation، من غير ما إحنا ناخد نقصد أن نزود التنفس
+
+9
+00:00:56,240 --> 00:00:59,800
+أو نجلد التنفس، زي أي شيء بيتحكم فيه الـ autonomic
+
+10
+00:00:59,800 --> 00:01:03,140
+nervous system، فبيصير عندنا autonomic regulation
+
+11
+00:01:03,140 --> 00:01:10,460
+of the respiratory system to keep going with the
+
+12
+00:01:10,460 --> 00:01:16,560
+needs of the body. تمام؟ الـ regulation هذا بتتم من
+
+13
+00:01:16,560 --> 00:01:21,480
+خلال، عندي أنا central regulation، وفي عندي
+
+14
+00:01:21,480 --> 00:01:26,660
+peripheral regulation. تمام؟ إذا في عندي central
+
+15
+00:01:26,660 --> 00:01:30,900
+nervous system موجود، موجود في داخله respiratory
+
+16
+00:01:30,900 --> 00:01:38,100
+center. الـ respiratory center هذا موجود في مناطق
+
+17
+00:01:38,100 --> 00:01:43,660
+حساسة لـ تغيرات
+
+18
+00:01:43,660 --> 00:01:49,600
+في الـ carbon dioxide والـ oxygen والـ pH والـ
+
+19
+00:01:49,600 --> 00:01:50,740
+hydrogen concentration.
+
+20
+00:01:53,620 --> 00:01:56,720
+إذا في عندي central regulation، وفي عندي peripheral
+
+21
+00:01:56,720 --> 00:02:02,060
+regulation. في عندي chemoreceptors موجودة في الـ
+
+22
+00:02:02,060 --> 00:02:06,880
+carotid bodies وفي الـ aortic arch bodies. موجود
+
+23
+00:02:06,880 --> 00:02:12,440
+عندي، إذا في عندي بالإضافة إلى other major arteries
+
+24
+00:02:12,440 --> 00:02:17,660
+arteries، موجود فيها برضه chemoreceptor bodies.
+
+25
+00:02:17,660 --> 00:02:24,970
+موجودة to sense the concentration of oxygen
+
+26
+00:02:24,970 --> 00:02:28,530
+partial pressure of oxygen، يعني partial pressure
+
+27
+00:02:28,530 --> 00:02:32,050
+of carbon dioxide and the pH and hydrogen ion
+
+28
+00:02:32,050 --> 00:02:35,490
+concentration. تمام؟ إذا بداية عشان نتعرف على
+
+29
+00:02:35,490 --> 00:02:39,010
+المسألة هذه، بدنا نشوف المركز هذا اللي بتحكم في
+
+30
+00:02:39,010 --> 00:02:43,550
+التنفس، اللي إحنا بنبعت له إشارات، نزوده أو نجلّه أو
+
+31
+00:02:43,550 --> 00:02:48,610
+كذا. شو هذا المركز؟ الـ respiratory center عبارة عن
+
+32
+00:02:48,610 --> 00:02:57,870
+مجموعة من التجمعات العصبية، a group composed of
+
+33
+00:02:57,870 --> 00:03:02,230
+several groups of neurons located bilaterally in
+
+34
+00:03:02,230 --> 00:03:05,530
+the medulla and the pons، تمام؟ في الميدولا أو
+
+35
+00:03:05,530 --> 00:03:11,570
+الـ oblongata والـ pons، يعني في الـ brainstem موجود عندي
+
+36
+00:03:11,570 --> 00:03:13,050
+الـ respiratory center.
+
+37
+00:03:16,950 --> 00:03:20,990
+الـ respiratory center بتكون من على الأقل من ثلاث
+
+38
+00:03:20,990 --> 00:03:24,010
+تجمعات
+
+39
+00:03:24,010 --> 00:03:24,990
+من الـ nuclei.
+
+40
+00:03:29,010 --> 00:03:35,950
+الـ… تجمع الـ nerve bodies برا الـ central nervous
+
+41
+00:03:35,950 --> 00:03:41,370
+system بنسميها ganglion. مش كده؟ تجمع الـ cell bodies
+
+42
+00:03:41,370 --> 00:03:45,750
+في الـ central nervous system بنسميه nucleus. فعندي
+
+43
+00:03:45,750 --> 00:03:50,230
+مجموعة من الـ nuclei اللي موجودة تمثل الـ
+
+44
+00:03:50,230 --> 00:03:56,050
+respiratory center. بيهمنا فيها ثلاث مجموعات اللي هو
+
+45
+00:03:56,050 --> 00:03:59,850
+الـ dorsal respiratory group والـ ventral
+
+46
+00:03:59,850 --> 00:04:07,750
+respiratory group والـ pneumotaxic center. كمان هو
+
+47
+00:04:07,750 --> 00:04:12,650
+الـ normal respiration بتتم خلال الـ dorsal
+
+48
+00:04:12,650 --> 00:04:18,030
+respiratory group. هذه بتتحكم في الـ respiration، بتدخل
+
+49
+00:04:18,030 --> 00:04:19,350
+الـ pneumotaxic center.
+
+50
+00:04:25,640 --> 00:04:31,420
+الـ pneumotaxic center بتدخل لضبط الـ respiratory
+
+51
+00:04:31,420 --> 00:04:34,920
+rate، يعني هو الـ respiratory center هذا بيبعث
+
+52
+00:04:34,920 --> 00:04:41,980
+إشارات لـ inspiration، وين بتنتهي الـ inspiration؟
+
+53
+00:04:43,600 --> 00:04:46,260
+يعني، بينتهي الـ inspiration هي اللي بيكون بتتحكم فيه
+
+54
+00:04:46,260 --> 00:04:49,260
+الـ pneumotaxic. فـ الـ pneumotaxic لما يكون أنا عندي
+
+55
+00:04:49,260 --> 00:04:53,140
+فيه inspiration موجود، وبيوقفه بدري. تمام؟ معناه
+
+56
+00:04:53,140 --> 00:04:57,840
+عندي، خلال إيه؟ shallow breathing ومدة قصيرة.
+
+57
+00:04:57,840 --> 00:05:03,140
+معناه بيخلي الـ rate عالي. تمام؟ إذا في عندي مدى أن
+
+58
+00:05:03,140 --> 00:05:07,040
+أنا أتنفس كتير، الـ respiratory rate. إذا لما يزيد
+
+59
+00:05:07,040 --> 00:05:14,500
+نشاط الـ pneumotaxic center، pneumotaxic center ممكن
+
+60
+00:05:14,500 --> 00:05:18,680
+يعمل له suppression سريع لـ respiration، ويخلي أن
+
+61
+00:05:18,680 --> 00:05:24,380
+كل نفس ينقطع بسرعة، ويؤدي إلى إيه؟ سرعة التنفس في
+
+62
+00:05:24,380 --> 00:05:27,120
+الحالة هذه برضه بيكون إيه؟ shallow breathing و
+
+63
+00:05:27,120 --> 00:05:31,020
+rapid. لو كان الـ pneumotactic center أو
+
+64
+00:05:31,020 --> 00:05:35,820
+pneumotaxic center ضعيف، معناه الـ inspiration بياخد
+
+65
+00:05:35,820 --> 00:05:38,980
+وطول، لحد ما يصير له inhibition، يعني هو بيوقف الـ
+
+66
+00:05:38,980 --> 00:05:43,240
+inspiration عند level معين. تمام؟ فلما أقف بدري بدي
+
+67
+00:05:43,240 --> 00:05:47,600
+فرصة أن أنا أكرره كتير. لما أقف متأخر، باخد more deep
+
+68
+00:05:47,600 --> 00:05:52,500
+inspiration. معناه بيكون الـ rate أقل.  الاثنين
+
+69
+00:05:52,500 --> 00:05:57,300
+هدول هم الأساس في الـ normal respiration. لكن في حالة
+
+70
+00:05:57,300 --> 00:06:04,630
+ما يكون أنا عندي exercise، بدي دعم لـ deep
+
+71
+00:06:04,630 --> 00:06:08,790
+expiration، deep inspiration، forced expiration. آه
+
+72
+00:06:08,790 --> 00:06:11,930
+معناها بده يدخل مجموعة ثالثة، الـ ventral
+
+73
+00:06:11,930 --> 00:06:15,210
+respiratory group. الـ ventral respiratory group
+
+74
+00:06:15,210 --> 00:06:21,130
+تمام؟ بالإضافة، إذا هدول عندي ثلاث حاجات موجودة، ثلاث
+
+75
+00:06:21,130 --> 00:06:27,080
+groups of nuclei. بنضيف لهم، لو طلعنا بعد شوية هنلاقي
+
+76
+00:06:27,080 --> 00:06:31,380
+في المنطقة هذه، موجود عندنا chemo-sensitive
+
+77
+00:06:31,380 --> 00:06:39,560
+area اللي بتعمل regulation centrally.
+
+78
+00:06:41,870 --> 00:06:44,490
+حساسة للتغيرات، لكنها هذه موجودة في الـ central
+
+79
+00:06:44,490 --> 00:06:47,830
+nervous system، لأنها من مميزاتها عن الـ peripheral
+
+80
+00:06:47,830 --> 00:06:51,070
+regulation اللي موجود في الـ إيه؟ الـ aortic… آه
+
+81
+00:06:51,070 --> 00:06:55,570
+في الـ carotid bodies والـ aortic arch، تمام؟ إذا
+
+82
+00:06:55,570 --> 00:07:00,890
+في عندي أنا center وفي عندي sensors، بيخليّوا أتحكم
+
+83
+00:07:00,890 --> 00:07:06,850
+في هذا الـ center، الـ respiratory center هذا اللي هو
+
+84
+00:07:06,850 --> 00:07:11,870
+الـ dorsal respiratory group of nuclei. بيصلوا الـ
+
+85
+00:07:11,870 --> 00:07:15,610
+informations اللي جاية بتديني خبر عن الـ carbon
+
+86
+00:07:15,610 --> 00:07:17,890
+dioxide والـ oxygen والـ… والـ… والـ hydrogen
+
+87
+00:07:17,890 --> 00:07:21,210
+ion concentration عبر الـ vagus nerve والـ
+
+88
+00:07:21,210 --> 00:07:24,590
+glossopharyngeal nerve. تمام؟ إذا هم هنا عندنا
+
+89
+00:07:24,590 --> 00:07:28,470
+terminations لـ الـ vagus والـ glossopharyngeal في
+
+90
+00:07:28,470 --> 00:07:33,530
+الـ respiratory center. هذا بيوصلوا إشارات من
+
+91
+00:07:33,530 --> 00:07:37,870
+مين؟ من الـ peripheral regulation، هم الـ glosso-
+
+92
+00:07:37,870 --> 00:07:40,890
+pharyngeals اللي بيجيب من الـ carotid bodies والـ
+
+93
+00:07:40,890 --> 00:07:44,510
+aortic arch. وإذا كان في أوعية دموية كمان blood vessels
+
+94
+00:07:44,510 --> 00:07:49,050
+بتشترك عبر مين؟ عبر الـ vagus. مش كده؟ طيب إذا في
+
+95
+00:07:49,050 --> 00:07:53,070
+عندي الـ central center بتحكم… بتشارك معاه، a
+
+96
+00:07:53,070 --> 00:07:57,430
+pneumotaxic center. الاثنين مع بعض بيتحكمولي في الـ
+
+97
+00:07:57,430 --> 00:08:01,530
+normal breath. وفي عندي الـ… الـ… الـ… الـ… الـ
+
+98
+00:08:01,530 --> 00:08:06,590
+ventral group. هذه بتتحكم لي أو بتساعد الـ normal
+
+99
+00:08:06,590 --> 00:08:10,610
+breath إذا كان محتاجين potentiation في exercise أو
+
+100
+00:08:10,610 --> 00:08:17,430
+في غيره. واضح؟ طيب، الآن بنتكلم عن الـ dorsal
+
+101
+00:08:17,430 --> 00:08:22,190
+group. هذه كيف بترسل إشارتها إلى الـ inspiratory
+
+102
+00:08:22,190 --> 00:08:26,310
+muscles؟ يعني هي إحنا عندنا الـ inspiration active
+
+103
+00:08:26,310 --> 00:08:30,930
+لكن الـ expiration passive. في الـ normal بيكون
+
+104
+00:08:30,930 --> 00:08:35,550
+passive. يعني إحنا إذا عملنا inspiration تمام، و
+
+105
+00:08:35,550 --> 00:08:40,850
+بعدين توقف، الـ expiration لحاله بيصير. طيب إذا كان الـ
+
+106
+00:08:40,850 --> 00:08:43,410
+inspiration بيكون short، الـ expiration بيكون
+
+107
+00:08:43,410 --> 00:08:48,710
+short. إذا كان الـ inspiration بيكون long، الثاني
+
+108
+00:08:48,710 --> 00:08:51,810
+بيكون زيه، فالثاني… يعني هنا في علاقة ما بين الـ
+
+109
+00:08:51,810 --> 00:08:55,330
+الـ inspiration والآخر والـ rate of air
+
+110
+00:08:55,330 --> 00:08:58,950
+expiration حسب المدة اللي بياخذها، بقدر إلى أنه في
+
+111
+00:08:58,950 --> 00:09:03,310
+عندي repeated more than normal ولا normal ولا…
+
+112
+00:09:06,190 --> 00:09:11,990
+بنلاحظ إحنا هنا عندنا الـ inspiratory أو act هنا
+
+113
+00:09:11,990 --> 00:09:14,910
+اللي بتتم under the control of the dorsal
+
+114
+00:09:14,910 --> 00:09:22,450
+respiratory group. بتكون لها مواصفات العجلة
+
+115
+00:09:22,450 --> 00:09:26,470
+التسارعية. يعني بتنزل إشارة من الـ respiratory group
+
+116
+00:09:26,470 --> 00:09:33,480
+للـ muscles. مش كله دفعة واحدة، مش هيك تجي بهدوء، ما نحسش
+
+117
+00:09:33,480 --> 00:09:38,480
+فيها، بتزيد، بتزيد، بتزيد، بتزيد، وبعدين بتروح ترجع تاني
+
+118
+00:09:38,480 --> 00:09:41,920
+بهدوء. بتزيد، بتزيد، بتزيد، بتزيد من غير ما نحس فيها،
+
+119
+00:09:41,920 --> 00:09:47,620
+تمام؟ يعني في عجلة في التسارع زي ما واحد نازل من
+
+120
+00:09:47,620 --> 00:09:52,720
+منحدر، بيضل يتسارع في الـ إيه؟ مش كده؟ يعني مش سرعة
+
+121
+00:09:52,720 --> 00:09:53,540
+ثابتة.
+
+122
+00:09:56,030 --> 00:10:00,850
+الإشارة إلى الـ
+
+123
+00:10:00,850 --> 00:10:03,390
+respiratory centers. الإشارة إلى الـ respiratory
+
+124
+00:10:03,390 --> 00:10:07,290
+center. الإشارة إلى الـ respiratory center. الإشارة
+
+125
+00:10:07,290 --> 00:10:11,710
+إلى الـ respiratory center. الإشارة إلى الـ
+
+126
+00:10:11,710 --> 00:10:15,190
+respiratory center. الإشارة إلى الـ respiratory
+
+127
+00:10:15,190 --> 00:10:16,550
+center. الإشارة إلى الـ respiratory center. الإشارة
+
+128
+00:10:16,550 --> 00:10:18,710
+إلى الـ respiratory center. الإشارة إلى الـ
+
+129
+00:10:18,710 --> 00:10:20,210
+respiratory center. الإشارة إلى الـ respiratory
+
+130
+00:10:20,210 --> 00:10:21,650
+center. الإشارة إلى الـ respiratory center. الإشارة
+
+131
+00:10:21,650 --> 00:10:22,230
+إلى الـ respiratory center. الإشارة إلى الـ
+
+132
+00:10:22,230 --> 00:10:23,170
+respiratory center. الإشارة إلى الـ respiratory
+
+133
+00:10:23,170 --> 00:10:23,190
+إلى الـ respiratory center. الإشارة إلى الـ
+
+134
+00:10:23,190 --> 00:10:23,210
+respiratory center. الإشارة إلى الـ respiratory
+
+135
+00:10:23,210 --> 00:10:23,230
+center. الإشارة إلى الـ respiratory center. الإشارة
+
+136
+00:10:23,230 --> 00:10:23,350
+إلى الـ respiratory center. الإشارة إلى الـ
+
+137
+00:10:23,350 --> 00:10:28,510
+respiratory، عن أماكنهم في الـ central nervous system
+
+138
+00:10:28,510 --> 00:10:32,870
+بدقة. يعني مسجلة، بس يعني ما أظنش أنا هسألكوا فيها، ولا
+
+139
+00:10:32,870 --> 00:10:35,730
+أنا هديكوا الوصف الدقيق لهم، لأن الـ
+
+140
+00:10:35,730 --> 00:10:37,610
+neurophysiology أنا ما بحبش الـ neurophysiology
+
+141
+00:10:37,610 --> 00:10:46,210
+بتتكلموا عنها. الـ dorsal group هنا موجودة mainly في الـ
+
+142
+00:10:46,210 --> 00:10:51,750
+tractus solitarius nucleus. تمام؟ وإنه الـ ventral
+
+143
+00:10:51,750 --> 00:10:58,230
+group موجودة في الـ… في الـ… إيش المجموعة عم
+
+144
+00:10:58,230 --> 00:11:06,110
+تسميها؟ nucleus para-… para-brachialis group. تمام؟
+
+145
+00:11:06,110 --> 00:11:10,250
+يعني في تفاصيل وأسماء وكده بتخص الـ central
+
+146
+00:11:10,250 --> 00:11:14,870
+nervous system. لكن إحنا خلينا نتكلم عن إيه؟ عن how
+
+147
+00:11:14,870 --> 00:11:23,240
+the function… إذا هنا عندنا مجموعات، مسماة، أماكنها
+
+148
+00:11:23,240 --> 00:11:24,700
+طيب… الآن
+
+149
+00:11:31,740 --> 00:11:35,240
+العمل تبع الـ respiratory center هذا، إحنا بيقول الـ
+
+150
+00:11:35,240 --> 00:11:39,080
+respiratory center، نقصد في الثلاث بس، a quiet
+
+151
+00:11:39,080 --> 00:11:41,820
+respiration اللي بيشتغل في الـ respiratory center
+
+152
+00:11:41,820 --> 00:11:46,660
+الـ dorsal group، وبيحكمها الـ pneumotaxic center.
+
+153
+00:11:46,660 --> 00:11:52,060
+يعني الـ… الـ… الـ… الـ… الـ respiratory signal
+
+154
+00:11:52,060 --> 00:11:54,620
+بتيجي من الـ respiratory… من الـ dorsal group
+
+155
+00:11:54,620 --> 00:11:59,500
+بتيجي as a ramp. زي ما قلنا، كأنه نزل من منحدر، بتسارع
+
+156
+00:11:59,500 --> 00:12:02,990
+بعجلة. بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+157
+00:12:02,990 --> 00:12:12,030
+بتزيد… بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+158
+00:12:12,030 --> 00:12:13,270
+بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+159
+00:12:13,270 --> 00:12:13,470
+بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+160
+00:12:13,470 --> 00:12:13,490
+بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+161
+00:12:13,490 --> 00:12:14,550
+بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+162
+00:12:14,550 --> 00:12:20,890
+بتزيد… بتزيد… بتزيد… بتزيد…
+
+163
+00:12:20,890 --> 00:12:23,770
+بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+164
+00:12:23,770 --> 00:12:24,610
+بتزيد… بتزيد… بتزيد… بتزيد… بتزيد…
+
+165
+00:12:24,610 --> 00:12:28,870
+بتزيد… بتزيد… بتزيد…
+
+166
+00:12:31,160 --> 00:12:35,180
+وقلنا أنه بالطريقة هذه، بيصير عندنا، إحنا كل ما
+
+167
+00:12:35,180 --> 00:12:39,120
+زادت الإشارة من الـ pneumotaxic center، كل ما زادت…
+
+168
+00:12:39,120 --> 00:12:42,100
+كل ما صار عندي سرعة في الـ إيه؟ في التنفس، و
+
+169
+00:12:42,100 --> 00:12:45,420
+shortness في الـ inspiration. كل ما قلت الـ activity
+
+170
+00:12:45,420 --> 00:12:48,300
+بتاعة الـ pneumotaxic center، بيدي فرصة لـ الـ ramp
+
+171
+00:12:48,300 --> 00:12:54,320
+يمشي يصير more deep، يبقى الـ inspiration. وبعدين يبقى
+
+172
+00:12:54,320 --> 00:12:58,270
+متأخر، فتصير الـ rate of inspiration عندي إيش؟ إذا
+
+173
+00:12:58,270 --> 00:13:02,650
+عندي الـ activity هذه بتشتغل بطريقة عكسية. لإيه؟ لما
+
+174
+00:13:02,650 --> 00:13:05,230
+أقول active… hyperactive pneumotaxic center
+
+175
+00:13:05,230 --> 00:13:10,530
+معناها عندي very slow… hyperactive يعني إيه؟
+
+176
+00:13:10,530 --> 00:13:17,600
+عندي… عندي rapid rate، slow rate. عندي إيه؟ slow
+
+177
+00:13:17,600 --> 00:13:21,100
+activity of the pneumotaxic center. بيكون عندي إيه؟
+
+178
+00:13:21,100 --> 00:13:25,140
+الـ rate of inspiration إيه؟ بينزل، بس بيكون عندي deep
+
+179
+00:13:25,140 --> 00:13:26,340
+inspiration.
+
+180
+00:13:34,820 --> 00:13:38,040
+The obvious advantage of the ramp is that it
+
+181
+00:13:38,040 --> 00:13:41,320
+causes a steady increase in the volume of the
+
+182
+00:13:41,320 --> 00:13:46,040
+lungs during inspiration rather than inspiratory
+
+18
+
+223
+00:16:58,710 --> 00:17:03,170
+simulation بتعمل inspiration .. simulation for
+
+224
+00:17:03,170 --> 00:17:06,310
+inspiration وجزء ثاني لو عملنا ال simulation بيعمل
+
+225
+00:17:06,310 --> 00:17:08,900
+ال simulation للـ ايه؟ للـ expiration بمعنى
+
+226
+00:17:08,900 --> 00:17:12,120
+potentiating ال inspiration أو ال expiration أو
+
+227
+00:17:12,120 --> 00:17:17,540
+potentiating ال expiration لذلك فيها مناطق بتعمل
+
+228
+00:17:17,540 --> 00:17:21,680
+شيئًا ومناطق أخرى بتعمل عكسها لذلك يقولون هي
+
+229
+00:17:21,680 --> 00:17:27,920
+بتلزمني في الـ .. في الـ .. الـ exercise for deeper
+
+230
+00:17:27,920 --> 00:17:32,480
+inspiration and .. and forced .. more forced
+
+231
+00:17:32,480 --> 00:17:36,520
+expiration في الحالة اللي أنا محتاج أعمل مثل هذه
+
+232
+00:17:36,520 --> 00:17:36,940
+الأشياء
+
+233
+00:17:43,000 --> 00:17:48,620
+هذه اللي هو الـ Respiratory Center وقولنا
+
+234
+00:17:48,620 --> 00:17:54,420
+أنه بتحكم فيه، بيعمل الـ limiting point، بتحكم فيها
+
+235
+00:17:54,420 --> 00:17:58,420
+الـ Pneumotaxic Center هذا الـ Centrally عندنا
+
+236
+00:17:58,420 --> 00:18:03,430
+Peripheral Reflex ممكن برضه يتحكم في الـ limiting
+
+237
+00:18:03,430 --> 00:18:07,130
+point، بس أنا مش في الـ normal conditions، تمام، الـ
+
+238
+00:18:07,130 --> 00:18:11,030
+normal conditions، Pneumotaxic center هو اللي ايه
+
+239
+00:18:11,030 --> 00:18:18,590
+بتحكم، لكن برضه في يعني في قوة أخرى ممكن تتحكم، يعني
+
+240
+00:18:18,590 --> 00:18:25,050
+أنا أخذت inspiration، inspiration أو deep
+
+241
+00:18:25,050 --> 00:18:31,320
+inspiration، and more deep inspiration، لدرجة أن أنا
+
+242
+00:18:31,320 --> 00:18:35,480
+عندي ايه؟ أعمل stretch كبير للرئتين، ما بتخلينيش
+
+243
+00:18:35,480 --> 00:18:39,100
+الرئتين أعمل stretch كيف ما بدي، تمام، في limits
+
+244
+00:18:39,100 --> 00:18:42,800
+لها، تمام، ففي عندي إشارة من الـ stretch receptors
+
+245
+00:18:42,800 --> 00:18:48,500
+اللي موجودين في الـ muscles of the bronchioles والـ
+
+246
+00:18:48,500 --> 00:18:52,680
+.. آه، الـ main bronchioles والـ .. الـ .. الـ large
+
+247
+00:18:52,680 --> 00:18:55,600
+bronchioles، يعني الـ stretch اللي بيصير عليهم على
+
+248
+00:18:55,600 --> 00:18:59,640
+الـ muscles تبعتهم بيؤدي إلى يبعتوا إشارة إلى الـ
+
+249
+00:18:59,640 --> 00:19:03,060
+respiratory center، يعملوا limiting point to
+
+250
+00:19:03,060 --> 00:19:05,280
+simulate the limiting point to stop inspiration
+
+251
+00:19:05,280 --> 00:19:08,120
+يعني زي ما يَبْقَى on the pneumotactic center، لكنه
+
+252
+00:19:08,120 --> 00:19:11,620
+هذول بيشتغلوا في abnormal conditions، لما يصير عند
+
+253
+00:19:11,620 --> 00:19:14,960
+الـ inspiration أن الـ tidal volume ثلاثة أضعاف الطبيعي
+
+254
+00:19:14,960 --> 00:19:20,020
+يعني الطبيعي أنا يكون عندي خمسمائة ملليلتر، مش كده؟
+
+255
+00:19:20,020 --> 00:19:23,520
+لكن لو أنا أخذت ألف وخمسمائة، بلاقي أن الـ tidal
+
+256
+00:19:23,520 --> 00:19:29,750
+volume صار عندي ايه؟ صار له reflex inhibition،
+
+257
+00:19:29,750 --> 00:19:34,210
+reflex suppression للـ ايه؟ للـ inspiration، نأتي
+
+258
+00:19:34,210 --> 00:19:38,490
+إشارة من الـ stress receptors that transmit
+
+259
+00:19:38,490 --> 00:19:42,710
+signals through the vagus، هنا .. هنا أتكلم عن الـ
+
+260
+00:19:42,710 --> 00:19:48,670
+lungs، في الـ vagus، مش كده؟ located in the
+
+261
+00:19:48,670 --> 00:19:52,420
+muscular portions of the walls of the bronchi and
+
+262
+00:19:52,420 --> 00:19:55,800
+bronchioles، إذا الـ muscles اللي موجودة في الـ
+
+263
+00:19:55,800 --> 00:19:59,440
+bronchi والـ bronchioles لما يصير لها stretch بتعمل
+
+264
+00:19:59,440 --> 00:20:03,760
+الـ .. بيسمّى Hering-Breuer reflex، مش بيسمّى hearing
+
+265
+00:20:03,760 --> 00:20:10,020
+Breuer reflex، اللي هو بيجي من الـ lung to stop
+
+266
+00:20:10,660 --> 00:20:13,840
+more inflation of the lung، الـ lung وصلت في الـ
+
+267
+00:20:13,840 --> 00:20:17,720
+inflation إلى it's maximum، فبقدرش أنا أضَلّ أخذ
+
+268
+00:20:17,720 --> 00:20:21,880
+أكثر، فالجلي حالة قطع النفس بسبب إشارة بتصل من مين؟
+
+269
+00:20:21,880 --> 00:20:27,100
+من الـ stretch receptors، بتصل عبر الـ vagus، واضح؟ إذا
+
+270
+00:20:27,100 --> 00:20:30,040
+هنا الـ Hering-Breuer عبر الـ vagus، لكن الـ
+
+271
+00:20:30,040 --> 00:20:33,440
+peripheral control in general جزء منه عبر الـ
+
+272
+00:20:33,440 --> 00:20:36,340
+glossopharyngeal وجزء منه عبر الـ ايه؟ الـ vagus
+
+273
+00:20:46,660 --> 00:20:51,280
+إذن هذا الـ Reflex يبدو كمصطلح محمي
+
+274
+00:20:54,600 --> 00:20:58,660
+for preventing excess lung inflation rather than
+
+275
+00:20:58,660 --> 00:21:01,620
+an important ingredient in normal control of the
+
+276
+00:21:01,620 --> 00:21:05,920
+ventilation، إذا هو مش reflex طبيعي عشان يعمله
+
+277
+00:21:05,920 --> 00:21:09,360
+control للـ inspiration، لأ هو بده يمنع الـ over
+
+278
+00:21:09,360 --> 00:21:16,680
+distention، the control of overall respiratory
+
+279
+00:21:16,680 --> 00:21:20,300
+center activity، إذا respiratory center activity
+
+280
+00:21:20,300 --> 00:21:23,140
+اتكلمنا عنه عند الـ Dorsal
+
+281
+00:21:27,860 --> 00:21:32,300
+الآن الـ control تبع هذول بيجينا عبر حاجتين، عبر الـ
+
+282
+00:21:32,300 --> 00:21:35,860
+central control اللي هو الـ chemosensitive area
+
+283
+00:21:35,860 --> 00:21:40,860
+اللي موجودة بجوار الـ respiratory center
+
+284
+00:21:43,450 --> 00:21:50,390
+beneath the ventral .. the anterior aspect of the
+
+285
+00:21:50,390 --> 00:21:54,790
+.. of the medulla oblongata، تمام؟ يعني موجود جنب
+
+286
+00:21:54,790 --> 00:22:00,430
+الـ respiratory center، إذا
+
+287
+00:22:00,430 --> 00:22:04,810
+بنسميها chemosensitive area، chemosensitive area
+
+288
+00:22:04,810 --> 00:22:09,170
+وعندنا اللي هو الـ peripheral control على ايه؟ قلنا
+
+289
+00:22:09,170 --> 00:22:14,110
+الـ chemoreceptors اللي موجودة وين؟ طيب، الآن
+
+290
+00:22:14,110 --> 00:22:22,150
+الـ .. الـ .. الـ .. الـ sensitivity of these areas الـ
+
+291
+00:22:22,150 --> 00:22:29,750
+chemo sensitive أو chemo .. الـ chemoreceptors، what
+
+292
+00:22:29,750 --> 00:22:38,100
+is the .. what are the changes that occur here to
+
+293
+00:22:38,100 --> 00:22:42,180
+affect these centers، تمام؟ أننا الآن نتكلم عن الـ
+
+294
+00:22:42,180 --> 00:22:45,880
+central control
+
+295
+00:22:45,880 --> 00:22:49,360
+الـ central control والـ peripheral control ليش
+
+296
+00:22:49,360 --> 00:22:53,500
+احنا جسمناهم بشكل هذا؟ لأنّه لاحظنا أنّه centrally
+
+297
+00:22:53,500 --> 00:23:00,380
+the carbon dioxide is the most effective، و
+
+298
+00:23:00,380 --> 00:23:04,500
+peripherally the oxygen pressure is the most
+
+299
+00:23:04,500 --> 00:23:10,720
+effective، وحقيقة هو ممكن يتبادلوا الأدوار أحيانًا، و
+
+300
+00:23:10,720 --> 00:23:16,200
+يتبادلوا الأدوار بطريقة صحيّة جدًا، وبطريقة لمصلحة
+
+301
+00:23:16,200 --> 00:23:21,580
+الجسم جدًا، وهنتكلم عليها بعد شويّة لما يتحول الـ
+
+302
+00:23:21,580 --> 00:23:26,820
+control من الـ carbon dioxide upper
+
+303
+00:23:26,820 --> 00:23:32,050
+hand إلى الـ oxygen upper hand، واضح؟ تمام، الآن إذا
+
+304
+00:23:32,050 --> 00:23:38,050
+عندي أنا ثلاثة عناصر بتصير أثناء الـ inspiration في
+
+305
+00:23:38,050 --> 00:23:44,710
+الـ inspiration بنزيد الـ oxygen، مش كده؟ وبنطرد
+
+306
+00:23:44,710 --> 00:23:49,030
+carbon dioxide، وفي نفس الوقت عندي hydrogen ions
+
+307
+00:23:49,030 --> 00:23:58,270
+بتتكون، بنتخلص منها أيضًا، إذا الـ
+
+308
+00:23:58,270 --> 00:24:03,870
+carbon dioxide، عليهم، معناها الـ ventilation process
+
+309
+00:24:03,870 --> 00:24:06,650
+صار فيها مشكلة، محتاجين ايه؟ لأن الـ ventilation
+
+310
+00:24:06,650 --> 00:24:10,670
+تزيد عشان نرجع الـ carbon dioxide إلى الوضع الطبيعي
+
+311
+00:24:10,670 --> 00:24:17,570
+إذا الـ oxygen tension واطي، معناها أنا عندي مشكلة في
+
+312
+00:24:17,570 --> 00:24:20,550
+الـ ventilation، إذا الـ hydrogen ions concentration
+
+313
+00:24:20,550 --> 00:24:24,310
+عالي، أنا عندي مشكلة، إذا دول ثلاثة أشياء بيزيدوا
+
+314
+00:24:24,310 --> 00:24:31,350
+لأيه؟ للـ .. الـ respiratory center to increase the
+
+315
+00:24:31,350 --> 00:24:36,050
+ventilation process to get the concentrations of
+
+316
+00:24:36,050 --> 00:24:39,410
+these things back to the .. to the normal، رجعهم
+
+317
+00:24:39,410 --> 00:24:43,990
+للوضع الطبيعي، واضح؟ طيب بنقول احنا هنا .. عندنا ..
+
+318
+00:24:43,990 --> 00:24:49,990
+عندنا two areas، خلينا ايه؟ ان أنا chemo sensitive
+
+319
+00:24:49,990 --> 00:24:54,730
+area وعندنا peripheral control
+
+320
+00:24:57,230 --> 00:25:04,070
+من خلال الـ .. الـ carotid arch، carotid bodies
+
+321
+00:25:04,070 --> 00:25:10,010
+موجودة فيها، carotid ايه؟ او
+
+322
+00:25:10,010 --> 00:25:13,030
+الـ aortic arch، إذا الـ aortic arch فيه aortic bodies
+
+323
+00:25:13,030 --> 00:25:17,070
+والـ carotid، common carotid أو الـ bifurcation، هنا
+
+324
+00:25:17,070 --> 00:25:20,790
+موجود carotid bodies، إذا فيه bodies موجودة في الـ
+
+325
+00:25:20,790 --> 00:25:25,940
+carotid وفي الـ aorta، نسمّيهم الشركات الكاروتية أو
+
+326
+00:25:25,940 --> 00:25:29,340
+الشركات الأبهرية، لهم ميكانيزم في مسألة الـ
+
+327
+00:25:29,340 --> 00:25:34,900
+sensation، هنتكلم عنها، الـ
+
+328
+00:25:34,900 --> 00:25:40,200
+sensitivity of each of those is different، تمام؟
+
+329
+00:25:40,200 --> 00:25:45,260
+الـ chemoreceptors هنا are more sensitive to carbon
+
+330
+00:25:45,260 --> 00:25:50,840
+dioxide، its changes، الغريب أنه لو احنا جئنا عملنا
+
+331
+00:25:50,840 --> 00:25:55,190
+test على الـ centers هذه، الـ Chemosensitive Area
+
+332
+00:25:55,190 --> 00:26:00,250
+وحطينا Carbon Dioxide Concentration و Hydrogen Ion
+
+333
+00:26:00,250 --> 00:26:04,170
+Concentration و Oxygen Concentration، غيّرنا الثلاثة،
+
+334
+00:26:04,170 --> 00:26:08,610
+هنلاقي الـ Hydrogen Ion Concentration is the most
+
+335
+00:26:08,610 --> 00:26:13,770
+direct stimulant، تمام؟ إذا كل ما زاد الـ Hydrogen
+
+336
+00:26:13,770 --> 00:26:17,590
+كل ما صار عندي more stimulation لمين؟ لـ
+
+337
+00:26:17,590 --> 00:26:24,040
+Respiration، طيب تعالَ نيجي للدم، نُعَلّي في الدم
+
+338
+00:26:24,040 --> 00:26:28,380
+مش direct stimulation، نُعَلّي الـ hydrogen ions ونُعَلّي
+
+339
+00:26:28,380 --> 00:26:32,360
+الـ carbon dioxide ونُوَطّي الـ oxygen، هنلاقي the most
+
+340
+00:26:32,360 --> 00:26:37,740
+active، الـ carbon dioxide، تمام؟ إذا الـ carbon
+
+341
+00:26:37,740 --> 00:26:42,140
+dioxide concentration لما بيرتفع هو the main
+
+342
+00:26:42,140 --> 00:26:46,120
+stimulant for the air، طب ايش الفكرة؟ الفكرة أنه الـ
+
+343
+00:26:46,120 --> 00:26:50,840
+carbon dioxide، الكربون دايوكسايد، يمكن أن يتغلغل
+
+344
+00:26:50,840 --> 00:26:54,640
+بسهولة إلى المنطقة الكيموسنسيتيف، وهناك زي ما
+
+345
+00:26:54,640 --> 00:26:59,180
+اتكلمنا في أماكن أخرى، الكربون دايوكسايد مع المياة
+
+346
+00:26:59,180 --> 00:27:02,260
+بيتحول لكربونيك أسيد وكربونات وهيدروجين،
+
+347
+00:27:02,260 --> 00:27:05,600
+الهيدروجين اللي بتكونها بيبقى متناسب مع قد ايش فيه
+
+348
+00:27:05,600 --> 00:27:10,140
+عندنا ايش كربون دايوكسايد، تمام؟ اذا okay هو
+
+349
+00:27:10,140 --> 00:27:13,380
+الكربون دايوكسايد ارتفاعه اللي عمل الـ simulation
+
+350
+00:27:13,380 --> 00:27:16,780
+لكن الـ direct simulation by ايش؟ by hydrogen ions
+
+351
+00:27:18,220 --> 00:27:24,060
+لما أتكلم الفصل الجاي عن الـ .. الـ .. الـ thyroid
+
+352
+00:27:24,060 --> 00:27:29,930
+gland، هأجيء أنّه الـ Testosterone في الدم اللي هو
+
+353
+00:27:29,930 --> 00:27:34,570
+الهرمون الذكري لما بيعمل الـ simulation اللي بتؤثّر على
+
+354
+00:27:34,570 --> 00:27:39,270
+thyroid gland، بيعملها الـ simulation عبر الـ estrogen لأنّه
+
+355
+00:27:39,270 --> 00:27:41,950
+لما يدخل الـ cells عشان يعمل الـ simulation، بنروح
+
+356
+00:27:41,950 --> 00:27:45,850
+متحول إلى estrogen، فهنا صحيح الـ direct simulator هو
+
+357
+00:27:45,850 --> 00:27:50,590
+الـ estrogen، لكده بنعكسه بحجب الـ testosterone، جدّ ايش
+
+358
+00:27:50,590 --> 00:27:53,470
+فيه عمل testosterone، جدّ ايش صار تحويل إلى أستروجين،
+
+359
+00:27:53,470 --> 00:27:56,830
+جدّ ايش عمل simulation أو separation، حسب، مش كده؟
+
+360
+00:27:56,830 --> 00:28:01,610
+هنا الـ direct hydrogen، لكنّه الـ .. الـ hydrogen
+
+361
+00:28:01,610 --> 00:28:05,950
+اللي متوفر direct locally، depends .. depends on
+
+362
+00:28:05,950 --> 00:28:08,390
+the concentration of carbon dioxide، لأن الـ
+
+363
+00:28:08,390 --> 00:28:10,770
+perfusion and distribution of carbon dioxide
+
+364
+00:28:11,430 --> 00:28:14,250
+through the tissues is easier than the hydrogen
+
+365
+00:28:14,250 --> 00:28:19,230
+ions، إذا أن وصول الـ carbon dioxide أسهل من الدم من
+
+366
+00:28:19,230 --> 00:28:24,230
+الـ plasma إلى الـ cells أسهل كثير من ايه؟ من وصول الـ
+
+367
+00:28:24,230 --> 00:28:26,450
+hydrogen ions، فهذا بيدي advantage على carbon
+
+368
+00:28:26,450 --> 00:28:30,680
+dioxide، لكن locally بيصير عن طريق الايه؟ الـ
+
+369
+00:28:30,680 --> 00:28:32,640
+hydrogen ion concentration، لذلك اللي عملنا تجربة
+
+370
+00:28:32,640 --> 00:28:35,820
+local simulation، هنلاقي الـ hydrogen ions مش الـ
+
+371
+00:28:35,820 --> 00:28:39,940
+carbon dioxide، لكن لو اتكلم على الـ blood levels
+
+372
+00:28:39,940 --> 00:28:43,540
+هنلاقي الـ carbon dioxide هو الايه؟ الـ carbon
+
+373
+00:28:43,540 --> 00:28:50,620
+dioxide، في أحيان بيفقد سيطرته، يعني لو الـ carbon
+
+374
+00:28:50,620 --> 00:28:58,230
+dioxide زاد يوم أو يومين بيظل الـ main stimulant، لكن لو
+
+375
+00:28:58,230 --> 00:29:02,850
+زاد عن هيك بيلاقي أن الـ oxygen هو الـ ايه؟ بيبدأ يفقد
+
+376
+00:29:02,850 --> 00:29:07,750
+قدرته، الـ carbon dioxide بيفقد أربعة أخماس قدرته، و
+
+377
+00:29:07,750 --> 00:29:11,410
+بيهبط إلى بتصير الـ air not sensitive to the carbon
+
+378
+00:29:11,410 --> 00:29:16,210
+dioxide، زي ما هي sensitive للـ ايه؟ للـ oxygen، فيبدأ
+
+379
+00:29:16,210 --> 00:29:20,310
+الـ oxygen، عندي الـ oxygen، low potential of oxygen
+
+380
+00:29:20,310 --> 00:29:26,300
+is more stimulant than الـ  ايه؟ إذا الـ carbon dioxide
+
+381
+00:29:26,300 --> 00:29:30,940
+وهادِ له .. له يعني it's significance، هنتكلم عنها
+
+382
+00:29:30,940 --> 00:29:37,800
+بعد شويّة، إذا عندي أنا centrally، هنلاقي الـ upper
+
+383
+00:29:37,800 --> 00:29:41,940
+hand لمين؟ للـ carbon dioxide، peripherally، هنلاقي
+
+384
+00:29:41,940 --> 00:29:45,780
+عندي لأ، الـ oxygen هو الـ most stimulant، الـ oxygen
+
+385
+00:29:45,780 --> 00:29:49,820
+low oxygen tension is more stimulant to the
+
+386
+00:29:49,820 --> 00:29:53,720
+peripheral chemoreceptors اللي هم الموجودين
+
+387
+00:29:55,620 --> 00:29:59,120
+في الـ .. aorta والـ ايه؟ والـ carotid، وother
+
+388
+00:29:59,120 --> 00:30:05,320
+major arteries، ما هم دول الأساسيين، هأجيء أنّه الـ ..
+
+389
+00:30:05,320 --> 00:30:09,980
+الـ oxygen هو اللي هو الدور الأول، ويليه الـ carbon
+
+390
+00:30:09,980 --> 00:30:13,840
+dioxide، ويليه الـ ايه؟ الـ hydrogen، ويليه الـ
+
+391
+00:30:13,840 --> 00:30:18,420
+hydrogen، هل أُكملها؟ الآن إذا صار عندي أنا الـ
+
+392
+00:30:18,420 --> 00:30:21,630
+carbon dioxide، الـ central effect very .. very
+
+393
+00:30:21,630 --> 00:30:25,310
+strong، الـ peripheral effect lesser than the ..
+
+394
+00:30:25,310 --> 00:30:30,470
+the .. the central، لكن الفرق بين هذه وهذه أن الـ
+
+395
+00:30:30,470 --> 00:30:34,890
+peripheral، الـ peripheral simulation of the
+
+396
+00:30:34,890 --> 00:30:38,610
+chemoreceptors is more rapid than the central
+
+397
+00:30:38,610 --> 00:30:43,490
+simulation، تمام؟ إذا أن الـ hypoxia بتعمل very rapid
+
+398
+00:30:43,490 --> 00:30:49,080
+simulation لمين؟ للـ .. للـ chemoreceptors، والـ higher
+
+399
+00:30:49,080 --> 00:30:55,060
+carbon dioxide بيعمل لي good simulation، ماهو very
+
+400
+00:30:55,060 --> 00:30:59,440
+strong، لكنه very rapid، تمام؟ لكنه ايه؟ very rapid
+
+401
+00:30:59,440 --> 00:31:04,560
+فإذا الـ peripheral chemoreceptor sending its
+
+402
+
+445
+00:34:21,160 --> 00:34:25,300
+يصير هبوط عندي أقل من 60% من ال pressure
+
+446
+00:34:25,300 --> 00:34:29,540
+tension لما يبدأ عندي أن أصحو على حالي لما
+
+447
+00:34:29,540 --> 00:34:35,520
+أفقد oxygen في ال tissues أكثر من أن أنزل لأقل من
+
+448
+00:34:35,520 --> 00:34:38,400
+15% pressure لما أبدأ أصحو على
+
+449
+00:34:38,400 --> 00:34:42,020
+حالي أن oxygen نقص، بحسش أنه نقص لو نقص في ال
+
+450
+00:34:42,020 --> 00:34:45,520
+ventilation ولا نقص في ال tissues، أخدت more oxygen
+
+451
+00:34:45,520 --> 00:34:49,220
+بحسش فيها كثيراً بطبيعة الصفات الهيموجلومية، اتكلمنا
+
+452
+00:34:49,220 --> 00:34:54,450
+عنها، الـ carbon dioxide بيعلق بسرعة لو ماذا؟ لو
+
+453
+00:34:54,450 --> 00:34:58,690
+زاد ال oxygen used،  و ال ventilation ما كانش كافياً
+
+454
+00:34:58,690 --> 00:35:01,910
+على طول build up و بيديني concentration عالية، فـ more
+
+455
+00:35:01,910 --> 00:35:04,170
+sensitive.. إذا ال carbon dioxide في الحالة هذه
+
+456
+00:35:04,170 --> 00:35:11,880
+بيكون عندي مقياس أدق، تمام؟ هو لأنّه ناتج بده
+
+457
+00:35:11,880 --> 00:35:16,000
+نصرفه للخارج، لكن ال oxygen احنا محتاجينه، الجسم بنقصش
+
+458
+00:35:16,000 --> 00:35:20,200
+عليه ال oxygen بسهولة، لكن بيحس أنه أخذنا كثيراً ولا
+
+459
+00:35:20,200 --> 00:35:22,820
+قليل، ولا ال ventilation صحيحة أم خاطئة من خلال ال
+
+460
+00:35:22,820 --> 00:35:26,060
+carbon dioxide، واضح؟ لذلك احنا لما ال carbon
+
+461
+00:35:26,060 --> 00:35:29,560
+dioxide يعمل لي ال simulation ويعمل لي
+
+462
+00:35:29,560 --> 00:35:32,520
+hyperventilation لأنه عندي زيادة في ال carbon dioxide
+
+463
+00:35:32,520 --> 00:35:37,880
+ال hyperventilation هات ماذا تعمل؟ it will wash
+
+464
+00:35:37,880 --> 00:35:41,770
+the carbon dioxide out، إذن راح ال carbon dioxide
+
+465
+00:35:41,770 --> 00:35:44,150
+يعني ال hyper stimulation اللي صارت لل
+
+466
+00:35:44,150 --> 00:35:48,530
+ventilation أدت إلى أنها تتخلص من ال carbon
+
+467
+00:35:48,530 --> 00:35:52,830
+dioxide اللي زائد، واضح؟ طب هبط، نزل ال carbon
+
+468
+00:35:52,830 --> 00:35:58,090
+dioxide، و بعدين.. و بعدين أنا محتاج.. أنا محتاج
+
+469
+00:35:58,090 --> 00:36:03,330
+oxygen، أنا طالع على ارتفاع ألف متر فوق سطح البحر
+
+470
+00:36:03,330 --> 00:36:07,810
+أو ألفين، تمام؟ و ال oxygen tension واطئة، احنا
+
+471
+00:36:07,810 --> 00:36:11,970
+قلنا ال carbon dioxide كان هو اللي شغال، ال carbon
+
+472
+00:36:11,970 --> 00:36:16,030
+dioxide يومين متواصلين اشتغل، فعمل wash out لـ
+
+473
+00:36:16,030 --> 00:36:19,450
+carbon dioxide، ورجع ال carbon dioxide طبيعي، لكن ال
+
+474
+00:36:19,450 --> 00:36:25,210
+oxygen tension هو اللي واطيء، بيبدأ بعد يومين من ال
+
+475
+00:36:25,210 --> 00:36:31,380
+.. هيبوكسيميا، هيبوكسيميا، تمام؟ و ال carbon
+
+476
+00:36:31,380 --> 00:36:35,320
+.. هيبوكسيا.. هيبوكسيميا، تمام؟ و ال carbon
+
+477
+00:36:35,320 --> 00:36:37,920
+dioxide to be washed، بيبدأ ال..ال..ال
+
+478
+00:36:37,920 --> 00:36:40,760
+respiratory drive يرجع لل oxygen، برجع ال
+
+479
+00:36:40,760 --> 00:36:44,100
+respiratory drive لمن؟ لل oxygen، لأنّي الآن
+
+480
+00:36:44,100 --> 00:36:49,000
+بتعامل مع حالة هيبوكسيا، low oxygen tension في
+
+481
+00:36:49,000 --> 00:36:52,340
+الحالة هذه بيصير ال oxygen هو اللي يتحكم، يعني مش
+
+482
+00:36:52,340 --> 00:36:56,410
+transient control زي ما بيعمل الـ carbon dioxide
+
+483
+00:36:56,410 --> 00:37:00,070
+for the minute to minute regulation، لا أنا بتكلم
+
+484
+00:37:00,070 --> 00:37:06,330
+عن ماذا؟ prolonged regulation، control على
+
+485
+00:37:06,330 --> 00:37:08,810
+prolonged time، بيرجع للأكسجين هو اللي ماذا؟
+
+486
+00:37:08,810 --> 00:37:13,590
+ياخذ ال upper hand، زي ما هنتكلم بعد قليل في مسألة
+
+487
+00:37:13,590 --> 00:37:15,990
+ال acclimatization اللي بتصير لما احنا نطلع على
+
+488
+00:37:15,990 --> 00:37:22,570
+ماذا؟ على جبل و نقعد هناك فترة طويلة أو متسلقين
+
+489
+00:37:22,570 --> 00:37:26,690
+جبال كل يوم بيعلو  لهم أربعمائة، خمسمائة متر إضافي
+
+490
+00:37:26,690 --> 00:37:31,650
+أو نحو ذلك، تمام؟ فكل يوم بيخشوا في مناطق oxygen
+
+491
+00:37:31,650 --> 00:37:35,250
+tension أقل من ماذا؟ من اليوم الذي سبقه، تمام؟
+
+492
+00:37:37,670 --> 00:37:42,230
+إذا قلنا هذا التحكم ممكن يستمر يومين فقط، بعد ذلك
+
+493
+00:37:42,230 --> 00:37:48,190
+بيصير عندي ماذا؟ ال oxygen بيصير يأخذ ال upper hand
+
+494
+00:37:48,190 --> 00:37:51,890
+و ال carbon dioxide بيفقد أربعة أخماس ال
+
+495
+00:37:51,890 --> 00:37:59,250
+sensitivity تبعته، تمام؟ طيب، a
+
+496
+00:37:59,250 --> 00:38:01,970
+change in blood carbon dioxide concentration
+
+497
+00:38:01,970 --> 00:38:07,230
+therefore has a potent acute effect، تمام؟ شيء سريع
+
+498
+00:38:07,470 --> 00:38:10,470
+من الـ two minutes زي ما قلت لكم، on controlling on
+
+499
+00:38:10,470 --> 00:38:14,470
+controlling respiratory drive، but only a weak
+
+500
+00:38:14,470 --> 00:38:18,250
+chronic effect after a few days adaptation، بعد
+
+501
+00:38:18,250 --> 00:38:26,110
+يومين ثلاثة، بيبدأ الكربون دايأوكسايد يفقد صلاحيته، طيب
+
+502
+00:38:26,110 --> 00:38:31,410
+بالأرقام،
+
+503
+00:38:31,410 --> 00:38:36,830
+هنا، أتحدث عن علاقة بين ال alveolar ventilation و ال
+
+504
+00:38:41,980 --> 00:38:50,380
+pressure والهيدروجين، ماذا؟ pressure
+
+505
+00:38:50,380 --> 00:38:50,880
+والهيدروجين، ماذا؟ pressure والهيدروجين، ماذا؟ pressure
+
+506
+00:38:50,880 --> 00:38:50,900
+والهيدروجين، ماذا؟ pressure والهيدروجين، ماذا؟ pressure
+
+507
+00:38:50,900 --> 00:38:59,320
+والهيدروجين، ماذا؟ pressure والهيدروجين، ماذا؟ pressure
+
+508
+00:38:59,320 --> 00:39:03,300
+والهيدروجين، ماذا؟ و ال venous side، خمسة عوامل، احنا
+
+509
+00:39:03,300 --> 00:39:06,540
+الذي يهمنا فيها ال arterial، لماذا؟ لأنه رايح لل
+
+510
+00:39:06,540 --> 00:39:10,080
+tissues، هو من؟ ال arterial، ال sensation هنا و
+
+511
+00:39:10,080 --> 00:39:13,720
+الحاجة محتاجة أنه نجده، جلبنا arterial، مش نجده، احنا
+
+512
+00:39:13,720 --> 00:39:17,400
+أخذنا و تركنا، اخذنا الذي نريد و تركناه، لكن هل
+
+513
+00:39:17,400 --> 00:39:19,460
+الذي أخذناه كافٍ أم لا، لذلك ال arterial هو الذي
+
+514
+00:39:19,460 --> 00:39:24,230
+ماذا؟ في ال arterial، في الـ 40 ميلي متر زئبق
+
+515
+00:39:24,230 --> 00:39:27,810
+carbon dioxide pressure، يُلاحظ أن عندي normal
+
+516
+00:39:27,810 --> 00:39:30,790
+ventilation، واحد، يعني normal ventilation، اثنان،
+
+517
+00:39:30,790 --> 00:39:36,750
+تضاعف، ثلاثة، يعني واحد يساوي normal rate، إذا ال
+
+518
+00:39:36,750 --> 00:39:42,710
+rate يساوي واحد، تمام؟ إذا ممثلة بشكل معين، لحظة بعد
+
+519
+00:39:42,710 --> 00:39:48,530
+ما يزيد عندي ال carbon dioxide pressure،  ليست خطية
+
+520
+00:39:48,530 --> 00:39:53,610
+بل أكثر من خطية، لأنه ليست بزاوية 45 درجة، بل بزاوية حوالي
+
+521
+00:39:53,610 --> 00:39:58,570
+60 درجة ارتفاع، يعني كل زيادة في ال carbon dioxide
+
+522
+00:39:58,570 --> 00:40:01,710
+pressure بيقبلها زيادة أكثر في ال ventilation
+
+523
+00:40:01,710 --> 00:40:08,330
+تمام؟ هنلاحظ هنا ال pH مختلفة، ال pH لا تتغير
+
+524
+00:40:08,330 --> 00:40:10,170
+بسرعة، بالسرعة التي يتغير بها ال carbon dioxide
+
+525
+00:40:10,170 --> 00:40:12,290
+لذلك أقول ال carbon dioxide هو الأكثر
+
+526
+00:40:12,290 --> 00:40:18,810
+sensitive، تمام، ال pH،  لأن تتغير، هي ال pH، ال normal
+
+527
+00:40:18,810 --> 00:40:22,530
+pH هي 7.4، سبعة فاصلة أربعة من عشرة، seven point four one، ليس
+
+528
+00:40:22,530 --> 00:40:29,850
+كذلك، لو ال hydrogen ions concentration زاد، يعني ال
+
+529
+00:40:29,850 --> 00:40:36,690
+pH هبطت، هبطت، هبطت، زيادة خفيفة تأثيرها كبير، لكن
+
+530
+00:40:36,690 --> 00:40:41,250
+أين في النهاية؟ يعني بعد ما ال pH تهبط بشدة، يعني
+
+531
+00:40:41,250 --> 00:40:44,450
+high concentration، يعني ترتفع كثيراً، يأخذ ال upper
+
+532
+00:40:44,450 --> 00:40:47,370
+hand و بيصير عندي rapid stimulation لل ventilation
+
+533
+00:40:47,370 --> 00:40:53,790
+لكن في المراحل الطبيعية و زيادة عن الطبيعية و زيادة
+
+534
+00:40:53,790 --> 00:40:58,680
+زيادة عن الطبيعية، يظل ال pH  ليس له دور كبير، طفيف
+
+535
+00:40:58,680 --> 00:41:02,100
+لكن عند level معين تصبح  very strong استيمولات من
+
+536
+00:41:02,100 --> 00:41:06,780
+أول و جديد، زي ما احنا شايفين هنا عندما ال pH وصلت
+
+537
+00:41:06,780 --> 00:41:11,760
+إلى سبعة، من سبعة فاصلة أربعة من عشرة إلى ماذا؟ سبعة، ووصلت
+
+538
+00:41:11,760 --> 00:41:20,240
+ال maximum تبع ال stimulation تبعها، إذا
+
+539
+00:41:20,240 --> 00:41:26,810
+هنا، خلينا نلخص، هذا  هُنا، the approximate
+
+540
+00:41:26,810 --> 00:41:30,670
+effects of blood carbon dioxide pressure and blood
+
+541
+00:41:30,670 --> 00:41:35,070
+pH on the alveolar ventilation، Note especially
+
+542
+00:41:35,070 --> 00:41:41,070
+the very marked increase in ventilation caused by
+
+543
+00:41:41,070 --> 00:41:44,090
+the increase in carbon dioxide tension in the
+
+544
+00:41:44,090 --> 00:41:52,300
+normal range between 35 to 75 mmHg، تمام؟ هذا يظهر
+
+545
+00:41:52,300 --> 00:42:00,520
+تأثير كبير لتغيير كربون ثنائي أكسيد من هنا إلى 75، و
+
+546
+00:42:00,520 --> 00:42:11,730
+الزيادة مُطّردة، طب لو صارت 80 و 90، و بتظهر زيادة، آه،
+
+547
+00:42:11,730 --> 00:42:15,710
+إذا احنا ال curve بدأ ينحني، وقفنا هكذا آخر
+
+548
+00:42:15,710 --> 00:42:20,850
+المحاضرة أو آخر الفصل، هذا، هنتكلم عن، طب لو زاد ال
+
+549
+00:42:20,850 --> 00:42:23,890
+carbon dioxide بعد ذلك، لا، ندخل في مشاكل، بيبدأ
+
+550
+00:42:23,890 --> 00:42:28,430
+يعمل suppression لل respiratory center، تمام، بيبدأ
+
+551
+00:42:28,430 --> 00:42:32,510
+يُعطي loss of .. of .. of awareness، بيبدأ يُدخلني
+
+552
+00:42:32,510 --> 00:42:35,650
+في غيبوبة، و level معين، يُعطي suppression لل
+
+553
+00:42:35,650 --> 00:42:40,350
+respiratory center، تمام، لذلك هو sensitive، لأنه لو
+
+554
+00:42:40,350 --> 00:42:44,350
+زاد خطيراً، لازم الجسم يتخلص أولاً بأول من ماذا؟ من ال
+
+555
+00:42:44,350 --> 00:42:47,590
+carbon dioxide، لأنه كل ما زاد ال carbon dioxide كل
+
+556
+00:42:47,590 --> 00:42:49,730
+ما أنا أبدأ أزيد ال respiration إلى level معين أنا
+
+557
+00:42:49,730 --> 00:42:52,970
+خلاص، يصبح ساماً، إلى level معين، يصبح عندي ماذا؟
+
+558
+00:42:52,970 --> 00:42:58,910
+يصبح ساماً، واضح؟ و أنا أتحدث عن ال different
+
+559
+00:42:58,910 --> 00:43:02,690
+terminology و effect of increased carbon dioxide و
+
+560
+00:43:02,690 --> 00:43:05,770
+effect of hypoxia على الإنسان
+
+561
+00:43:09,080 --> 00:43:14,940
+إذا بين الخمسة و الثلاثين، يعني قبل الطبيعي بقليل
+
+562
+00:43:14,940 --> 00:43:21,990
+تمام، و بين الخمسة و السبعين، يصبح عندي علاقة مباشرة
+
+563
+00:43:21,990 --> 00:43:24,750
+قوية، علاقات قوية، علاقات قوية، علاقات قوية، علاقات
+
+564
+00:43:24,750 --> 00:43:24,910
+قوية، علاقات قوية، علاقات قوية، علاقات قوية، علاقات
+
+565
+00:43:24,910 --> 00:43:25,190
+قوية، علاقات قوية، علاقات قوية، علاقات قوية، علاقات
+
+566
+00:43:25,190 --> 00:43:25,350
+قوية، علاقات قوية، علاقات قوية، علاقات قوية، علاقات
+
+567
+00:43:25,350 --> 00:43:26,550
+قوية، علاقات قوية، علاقات قوية، علاقات قوية، علاقات
+
+568
+00:43:26,550 --> 00:43:27,870
+قوية، علاقات قوية، علاقات قوية، علاقات قوية، علاقات
+
+569
+00:43:27,870 --> 00:43:28,550
+قوية، علاقات قوية، علاقات قوية، علاقات قوية، علاقات
+
+570
+00:43:28,550 --> 00:43:43,210
+قوية، علاقات قوية، علاقات قوية، علاقات قوية،
+
+571
+00:43:47,960 --> 00:43:54,160
+وخمسة إلى سبعة فاصلة ثلاثة من عشرة، لا يصير هذا التغيير
+
+572
+00:43:54,160 --> 00:43:59,680
+يعني التغيير يساوي عشر الطبيعي، يعني شيء بسيط يزيد
+
+573
+00:43:59,680 --> 00:44:05,660
+فقط، بعد ذلك قلت لكم، بعد ما يصل إلى سبعة فاصلة اثنين
+
+574
+00:44:05,660 --> 00:44:12,020
+مثلاً، بيبدأ عند الزيادة، واضحة، كل ما زاد ال hydrogen
+
+575
+00:44:12,020 --> 00:44:18,300
+ion concentration، كل ما هبط ال pH، كل ما زاد ال
+
+576
+00:44:18,300 --> 00:44:22,120
+hydrogen ion concentration، في بعد level معين يصبح
+
+577
+00:44:22,120 --> 00:44:30,800
+strong effect، unimportance
+
+578
+00:44:30,800 --> 00:44:32,780
+of the oxygen for control of the respiration
+
+579
+00:44:32,780 --> 00:44:36,260
+center، تكلمنا عنه منذ قليل، وقلنا لماذا ليس هو الأساس
+
+580
+00:44:36,900 --> 00:44:40,520
+تمام؟ لطبيعة ال hemoglobin الذي يحمل ال oxygen
+
+581
+00:44:40,520 --> 00:44:47,380
+بشكل مريح للجسم، فأنا لا أتعامل مع قياس كيف الناس
+
+582
+00:44:47,380 --> 00:44:54,380
+يعانون من، واحد مدير عام، ولا واحد دكتور،  مع
+
+583
+00:44:54,380 --> 00:44:59,880
+مصاريف كثيرة، أروح للعامل البسيط، أقول له كيف الأمور،
+
+584
+00:44:59,880 --> 00:45:02,720
+أقول الطماطم غالية، هذا بالنسبة لي ليس غالياً، لأنّ
+
+585
+00:45:02,720 --> 00:45:07,010
+يعني لما صارت أربعة  شيكل الكيلو، هذا لا يعني لكم
+
+586
+00:45:07,010 --> 00:45:11,690
+بالنسبة للفقير، يشتري هوية 6%، 7%، لكن لما تصل إلى
+
+587
+00:45:11,690 --> 00:45:15,370
+الـ 24 كيلوغرام، بالنسبة له ماذا؟ ليس كذلك؟ لذلك
+
+588
+00:45:15,370 --> 00:45:19,110
+هنا، لا يأتي الجسم، يسأل الذي عنده وفرة، ال oxygen
+
+589
+00:45:19,110 --> 00:45:23,910
+يسأل الذي ليس لديه وفرة، الذي حساس أكثر، ال carbon
+
+590
+00:45:23,910 --> 00:45:26,690
+dioxide، يعلق بسرعة، يذهب بسرعة، يُعطي تأثير،
+
+591
+00:45:26,690 --> 00:45:31,050
+لكن ال oxygen، تمام؟ ال hemoglobin حامل كثير، تمام؟
+
+592
+00:45:31,050 --> 00:45:37,480
+يأخذ بقدر ما يريد، ويُصرف بقدر ما يريد، تمام؟ إن
+
+593
+00:45:37,480 --> 00:45:40,140
+شاء الله، كلكم يعني غداً تصبحون مثل الهيموغلوبين هكذا
+
+594
+00:45:40,140 --> 00:45:48,900
+تأخذون بقدر ما تريدون، و تُصرفون.. طيب، إذا..
+
+595
+00:45:50,810 --> 00:45:55,330
+لذلك العامل المركزي أصبح من هو؟ ال carbon dioxide
+
+596
+00:45:55,330 --> 00:46:00,450
+ولكن إلى level، إلى.. إلى.. إلى.. إلى time، إلى أجل، بعد ذلك
+
+597
+00:46:00,450 --> 00:46:03,870
+يصبح عندي أنا ال hyperventilation التي حدثت
+
+598
+00:46:03,870 --> 00:46:07,170
+تُزيل ال carbon dioxide، معناه في عندي مشكلة ال
+
+599
+00:46:07,170 --> 00:46:11,030
+oxygen حقيقية، برجع ال oxygen هو الذي ماذا؟ يتحكم في
+
+600
+00:46:11,030 --> 00:46:11,650
+الموضوع
+
+601
+00:46:15,400 --> 00:46:20,380
+الـ Peripheral Chemoreceptors، جلبنا سلطة، و تكلمنا
+
+602
+00:46:20,380 --> 00:46:27,440
+عنها، وقلنا أنها موجودة، أسرع في الإبلاغ.. أسرع في
+
+603
+00:46:27,440 --> 00:46:31,960
+الإبلاغ، لأنها من Ares على طول بالجوال، أبلغت أنه فيه
+
+604
+00:46:31,960 --> 00:46:36,580
+لا أعرف ماذا حدث، لم يصل بعد، على طول في إشارة، أدت
+
+605
+00:46:36,580 --> 00:46:40,400
+إلى أنه، من أول ما طلع من القلب الأكسجين هذا، لسه
+
+606
+00:46:40,400 --> 00:46:44,330
+طلع من الرئتين وطلع من القلب، يحس أنه في مشكلة، يبعثها
+
+607
+00:46:44,330 --> 00:46:47,210
+لـ respiratory center،  لستم بحاجة إلى الـ.. الـ
+
+608
+00:46:47,210 --> 00:46:53,090
+normal diffusion والمعرفة، ماذا آه، طيب، ففي اتصال
+
+609
+00:46:53,090 --> 00:46:57,610
+مباشر ما بين هذين ال centers و الـ.. و الـ
+
+610
+00:46:57,610 --> 00:47:06,050
+respiratory center، الآن عندي what is the orthic
+
+611
+00:47:06,050 --> 00:47:08,030
+bodies هذه و ال carotid bodies
+
+612
+00:47:13,180 --> 00:47:18,020
+عبارة عن bodies متصلين بأعصاب اسمهم herring..
+
+613
+00:47:18,020 --> 00:47:21,880
+herrings nerves،  قلنا herring brower،  ليس كذلك؟
+
+614
+00:47:21,880 --> 00:47:25,520
+فـ herring هذا كان عالم له كثيراً من الدراسات حول ال
+
+615
+00:47:25,520 --> 00:47:29,600
+ventilation و ال respiration، لذلك هو الذي اكتشف ال
+
+616
+00:47:29,600 --> 00:47:34,500
+nerves هذه التي تُعطي ماذا؟ ال.. الـ signals of
+
+617
+00:47:34,500 --> 00:47:38,000
+the concentration of oxygen, carbon dioxide,
+
+618
+00:47:38,220 --> 00:47:41,760
+hydrogen ions في الدم، تمام؟ لذلك كان في herring
+
+619
+0
+
+667
+00:51:33,890 --> 00:51:36,570
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+668
+00:51:36,570 --> 00:51:41,410
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+669
+00:51:41,410 --> 00:51:47,370
+كنا هنا طلعنا على الـ nerves هذه الـ hearing nerve
+
+670
+00:51:47,370 --> 00:51:52,750
+طلعنا على الـ activity تبعته، جداش بيبعت signals، آه
+
+671
+00:51:52,750 --> 00:51:55,850
+و احنا منعدّله carbon dioxide concentrations
+
+672
+00:51:55,850 --> 00:51:59,270
+ومنعدّله oxygen ومنعدّله، عشان نعرف الجثة، طلعنا
+
+673
+00:51:59,270 --> 00:52:06,330
+لجينا أنه لما أعطينا pressure of oxygen آه، مية أو
+
+674
+00:52:06,330 --> 00:52:10,950
+فوق المية، تمام، إلى حد ما التغيير في الـ .. في الـ ..
+
+675
+00:52:10,950 --> 00:52:16,800
+في الـ signals، الـ nerve signals، قليل جدا، لكن لما الـ
+
+676
+00:52:16,800 --> 00:52:22,200
+pressure of oxygen جال العنمية، لجينا عند a very
+
+677
+00:52:22,200 --> 00:52:27,400
+rapid change in the intensity of the signals، واضح؟
+
+678
+00:52:27,400 --> 00:52:31,620
+لذا لما يكون عندي أنا pressure pressure واطي، بطلع
+
+679
+00:52:31,620 --> 00:52:38,360
+بلاقي عندي highly stimulated nerve، لما إيه، لما كل
+
+680
+00:52:38,360 --> 00:52:43,110
+ما زاد الـ oxygen concentration، كل signal rate بـ إيه
+
+681
+00:52:43,110 --> 00:52:47,610
+بيقل، واضح؟ إذا هنا إيه، إذا الـ oxygen pressure is
+
+682
+00:52:47,610 --> 00:52:53,470
+very important Note.
+
+683
+00:52:53,470 --> 00:52:56,710
+that the impulse rate is particularly sensitive to
+
+684
+00:52:56,710 --> 00:53:00,090
+changes in arterial pressure of oxygen in the
+
+685
+00:53:00,090 --> 00:53:06,210
+range between 60 and 30 millimeter mercury، a range
+
+686
+00:53:06,210 --> 00:53:08,390
+at which hemoglobin saturation with oxygen
+
+687
+00:53:08,390 --> 00:53:12,350
+decreases rapidly، احنا لحد الـ 60 قلنا الـ
+
+688
+00:53:12,350 --> 00:53:15,790
+saturation بيكون طبيعي، لكن لو نزل عن الـ 60، صار الـ
+
+689
+00:53:15,790 --> 00:53:20,070
+arterial pressure تبعنا أقل من 60، معناها الـ
+
+690
+00:53:20,070 --> 00:53:25,450
+saturation بيكون مش مكتمل، بيصير احنا قلنا لحد الـ
+
+691
+00:53:25,450 --> 00:53:33,770
+60، 89 percent saturated، مش كده؟ من من من 60 إلى الـ
+
+692
+00:53:33,770 --> 00:53:39,630
+.. الـ .. الـ 104، الفرق بسيط، تسعة ثمانية في المئة
+
+693
+00:53:39,630 --> 00:53:43,450
+ولا تسعة في المئة، الفرق مش كده، لكن بعد الستين
+
+694
+00:53:43,450 --> 00:53:46,790
+مالاج الكيروس تبعنا، الـ S شابه، هو بيبدأ إيه؟ هبوط
+
+695
+00:53:46,790 --> 00:53:51,620
+شديد، بين الستين و الثلاثين، تمام؟ بلاقي أنا عندي
+
+696
+00:53:51,620 --> 00:53:54,120
+بيصير فرق كبير في الـ saturation of oxygen .. of الـ
+
+697
+00:53:54,120 --> 00:53:57,100
+hemoglobin في الـ lungs، فمحتاج أنا الـ ventilation
+
+698
+00:53:57,100 --> 00:54:01,220
+إيه؟ لازم يعلن، صار أنا عندي الـ hemoglobin buffering
+
+699
+00:54:01,220 --> 00:54:04,640
+system تبعنا مش قادر يغطي هذه الجزئية، لإن هو هنا ..
+
+700
+00:54:04,640 --> 00:54:09,000
+صار هو مصمم لما نزل عن الـ 60 .. عن الـ 60، صار أن
+
+701
+00:54:09,000 --> 00:54:12,180
+أنا بتعامل مع الـ tissues، مش بتعامل مع الـ lungs، فـ
+
+702
+00:54:12,180 --> 00:54:15,760
+.. فـ .. فـ بحملش oxygen كثير، تمام؟ فالحالة هي لازم
+
+703
+00:54:15,760 --> 00:54:20,810
+يصير أنا بالـ ventilation عشان نحاول نعوّض، فلذلك هنا
+
+704
+00:54:20,810 --> 00:54:25,090
+ملاحظ الفرق من هنا هنا هيك، و أنا هنا حوالي ستين،
+
+705
+00:54:25,090 --> 00:54:31,670
+تمام، الـ steaming up آه، high stimulation of the
+
+706
+00:54:31,670 --> 00:54:35,390
+nerves that tells the respiratory center that
+
+707
+00:54:35,390 --> 00:54:39,070
+there is a problem، مش كده؟ for hyper activity
+
+708
+00:54:39,070 --> 00:54:42,390
+effect
+
+709
+00:54:42,390 --> 00:54:44,830
+of carbon dioxide and hydrogen concentration on
+
+710
+00:54:44,830 --> 00:54:46,110
+chemoreceptors activity
+
+711
+00:54:48,680 --> 00:54:54,520
+هتقول لنا إيه؟ تأثيرها أقل من الـ .. من الـ oxygen
+
+712
+00:54:54,520 --> 00:55:01,200
+وتأثيرها أقل من الـ central، لكنها more .. more
+
+713
+00:55:01,200 --> 00:55:02,760
+rapid، more rapid
+
+714
+00:55:06,050 --> 00:55:10,170
+طيب نرجع تاني و نقول the effect of low arterial
+
+715
+00:55:10,170 --> 00:55:13,890
+partial pressure of oxygen to stimulate alveolar
+
+716
+00:55:13,890 --> 00:55:17,490
+ventilation، when arterial carbon dioxide and
+
+717
+00:55:17,490 --> 00:55:21,170
+hydrogen ions concentration remain normal، تمام؟
+
+718
+00:55:21,170 --> 00:55:26,350
+هنا بتيجي عندي أنا العلاقة
+
+719
+00:55:26,350 --> 00:55:30,390
+هذا الـ figure، هذا لو أنا ثبتت ثوابت الأخضر الـ
+
+720
+00:55:30,390 --> 00:55:32,810
+carbon dioxide concentration و الـ hydrogen ions
+
+721
+00:55:32,810 --> 00:55:39,810
+معاها، بطلع بلاقي أنا عندي الـ oxygen كـ one factor، ما
+
+722
+00:55:39,810 --> 00:55:43,940
+احنا دائما في الأبحاث بنعمل حسابنا من ثبت كل الـ
+
+723
+00:55:43,940 --> 00:55:47,520
+factors ومن خليه بس واحد إيش متغير، عشان التغيير
+
+724
+00:55:47,520 --> 00:55:51,900
+يبقى مرتبط بهذا الشيء، فمن طالع احنا هنلاقي
+
+725
+00:55:51,900 --> 00:55:55,480
+أنه عندنا كل ما هبط الـ pressure أو الـ oxygen، كل ما
+
+726
+00:55:55,480 --> 00:56:00,020
+كان في عندي more stimulation لإيه؟ لـ الـ alveolar
+
+727
+00:56:00,020 --> 00:56:04,940
+ventilation، مش كده؟ و بيصير عندي more wash
+
+728
+00:56:12,320 --> 00:56:16,960
+more wash يعني more carbon dioxide، هنا إيش الـ
+
+729
+00:56:16,960 --> 00:56:20,560
+oxygen، هنا الـ ventilation، هنا بيزيد مع الـ carbon
+
+730
+00:56:20,560 --> 00:56:25,080
+dioxide، مع الـ oxygen pressure drop، oxygen pressure
+
+731
+00:56:25,080 --> 00:56:29,700
+drop، بلاقي أنا أنه إيه؟ بيزيد الـ الـ ventilation
+
+732
+00:56:29,700 --> 00:56:34,700
+واضح أكتر، pressure of oxygen، of carbon dioxide، هنا
+
+733
+00:56:34,700 --> 00:56:41,960
+كل ما زاد الـ ventilation، كل ما
+
+734
+00:56:45,200 --> 00:56:50,640
+احنا هنا مثبتينه لـ 40، احنا عاملينه factor ثابت في
+
+735
+00:56:50,640 --> 00:56:55,560
+عدم وجود المتغيرات الأخرى، بلاحظ أنه في عندي direct
+
+736
+00:56:55,560 --> 00:56:58,800
+relationship بين، و كل ما هبط أكتر الـ carbon
+
+737
+00:56:58,800 --> 00:57:01,200
+dioxide، زي ما أنتم شايفين، الـ oxygen tension هنا
+
+738
+00:57:01,200 --> 00:57:05,840
+إلى حد ما linear، لكن بعد كده steeping up، لما نزل عن
+
+739
+00:57:05,840 --> 00:57:11,180
+الـ 60، لما نزل عن الـ 60، صار very rapid effect للـ
+
+740
+00:57:11,180 --> 00:57:16,520
+إيه؟ للـ oxygen tension على الـ ventilation، almost
+
+741
+00:57:16,520 --> 00:57:19,240
+no effect on ventilation as long as the arterial
+
+742
+00:57:19,240 --> 00:57:21,300
+pressure of oxygen remains greater than one
+
+743
+00:57:21,300 --> 00:57:26,400
+hundred، تمام؟ لكن بعدين بيصير يتزايد على مرحلتين
+
+744
+00:57:26,400 --> 00:57:32,420
+لحد الـ 60 تغير بطيء، لكن لحد تحت الـ 60 تغير شديد
+
+745
+00:57:34,040 --> 00:57:38,820
+chronic breathing of low oxygen simulates
+
+746
+00:57:38,820 --> 00:57:42,200
+respiration even more than the phenomenon of
+
+747
+00:57:42,200 --> 00:57:46,260
+acclimatization، وهذه الـ phenomenon هنلاقيها في
+
+748
+00:57:46,260 --> 00:57:54,300
+الجسم كثير، الجسم كيف أنه بيتأقلم مع التغيير، تمام؟
+
+749
+00:57:56,100 --> 00:58:01,900
+يعني عندي أنا مضطر أعيش في جو أكسجين واطي، تمام،
+
+750
+00:58:01,900 --> 00:58:06,720
+أولها بلاقي صار عندي أنا تأثير
+
+751
+00:58:06,720 --> 00:58:11,420
+سلبي، بعد شوية بلاقي اختفى، تمام؟ لإن بدي أتأقلم
+
+752
+00:58:11,420 --> 00:58:15,420
+معاه، هنلاقيها في أشياء كثيرة في الجسم هذه الظاهرة
+
+753
+00:58:15,420 --> 00:58:21,400
+هذه الظاهرة احنا بنحسها وين؟ في الناس اللي بيصعدوا
+
+754
+00:58:21,400 --> 00:58:25,700
+الجبال، تمام؟ إيش بيلاحظوا فيها؟ بيلاحظوا إن الأيام
+
+755
+00:58:25,700 --> 00:58:31,540
+الأولى النفس عندهم بيزيد سرعته وبيزيد الـ rate و الـ
+
+756
+00:58:31,540 --> 00:58:36,130
+depth of respiration، بس بعد شوية، تمام؟ بعد يومين
+
+757
+00:58:36,130 --> 00:58:40,650
+ثلاثة، برجع للأوامر الطبيعية، mountain climbers have
+
+758
+00:58:40,650 --> 00:58:45,250
+found that when they ascend a mountain slowly over
+
+759
+00:58:45,250 --> 00:58:48,010
+a period of days rather than a period of hours
+
+760
+00:58:48,010 --> 00:58:53,370
+they breathe much more deeply and therefore can
+
+761
+00:58:53,370 --> 00:58:55,930
+withstand far lower atmospheric oxygen
+
+762
+00:58:55,930 --> 00:59:02,230
+concentrations than when they ascend rapidly، تمام؟
+
+763
+00:59:02,230 --> 00:59:06,510
+إذا لو طلعوا ببطء، هيلاقوا حالهم إنهم مافيش .. مش
+
+764
+00:59:06,510 --> 00:59:11,070
+حاسين بمشكلة في التنفس، لكن لو طلع سريع، هيحس بـ
+
+765
+00:59:11,070 --> 00:59:16,810
+hypoxia، هيحس أنه متضايق، هيحس أنه في وضع مش طبيعي
+
+766
+00:59:16,810 --> 00:59:22,570
+لكن لو طلع شوية شوية، آه، هيحس أنه لأ، أنه نفسه طبيعي
+
+767
+00:59:22,570 --> 00:59:29,010
+وبيزيد عمق النفس، وبيزيد الـ .. الـ .. عمق النفس
+
+768
+00:59:29,010 --> 00:59:34,670
+بالذات بيحس أنه ما بيحسش بالـ .. بالـ .. بالـ hypoxia
+
+769
+00:59:34,670 --> 00:59:38,110
+بيحسش أنه هو موجود في .. في جو مافيش فيه oxygen
+
+770
+00:59:38,110 --> 00:59:43,490
+تمام؟ طيب، هذه قلت لكم أنا إيه سببها؟ سببها أنه الـ
+
+771
+00:59:43,490 --> 00:59:46,390
+carbon dioxide effect اللي كان خد الـ upper hand
+
+772
+00:59:46,390 --> 00:59:51,070
+أول يومين، بعد كده بنزل تأثيره إلى الـ .. الربع
+
+773
+00:59:51,070 --> 00:59:56,670
+الخمس، أربعة أخماس بتروح، وبيضل عندي إيه؟ بس خمس الـ
+
+774
+00:59:56,670 --> 00:59:59,890
+sensitivity تبعته، و الـ oxygen بياخد الـ upper hand
+
+775
+00:59:59,890 --> 01:00:04,690
+تمام؟ وهذه حكينا من أول، ليش إن الـ oxygen في الأول
+
+776
+01:00:04,690 --> 01:00:07,610
+هو، الـ carbon dioxide هو more sensitive، لكن أنا لما
+
+777
+01:00:07,610 --> 01:00:11,910
+يكون عندي أنا، إذا بدي أقعد من هنا في الـ high
+
+778
+01:00:11,910 --> 01:00:15,450
+altitudes، بدي أقعد من على الـ carbon dioxide، ما أنا
+
+779
+01:00:15,450 --> 01:00:19,490
+الـ hyperventilation اللي صارت washed out، washed
+
+780
+01:00:19,490 --> 01:00:23,610
+out الـ carbon dioxide، فالـ stimulant راح، فهخش في
+
+781
+01:00:23,610 --> 01:00:27,730
+إيه؟ في hyperventilation من جديد، لكن حقيقة الـ
+
+782
+01:00:27,730 --> 01:00:31,320
+oxygen concentration ما اتغيرتش، واطي، الـ oxygen
+
+783
+01:00:31,320 --> 01:00:34,520
+الواطي، دا واطي، تمام؟ في الحالة هذه الـ Carbon
+
+784
+01:00:34,520 --> 01:00:37,300
+Dioxide بطل هو الإيه؟ الـ Main Stimulant، بيصير الـ
+
+785
+01:00:37,300 --> 01:00:42,080
+.. واضح؟ يعني التأثير الـ Carbon Dioxide السريع
+
+786
+01:00:42,080 --> 01:00:46,180
+اختفى، لإن أنا صار hyperventilation بسبب Carbon
+
+787
+01:00:46,180 --> 01:00:50,440
+Dioxide، بس راح الـ Carbon Dioxide، وبعدين، مدى ما
+
+788
+01:00:50,440 --> 01:00:53,040
+راح الـ Hyperventilation، أضل أنا خاشش في Low
+
+789
+01:00:53,040 --> 01:00:57,220
+Ventilation Rate و في Hypoxia، لأ، بيصير عندي الـ
+
+790
+01:00:57,220 --> 01:01:00,680
+hypoxia الموجودة هي الـ main stimulant، مظبوط أو مش
+
+791
+01:01:00,680 --> 01:01:04,020
+مظبوط؟ أنا شايف ناس نعسانين، يبدو أن الـ emulators في
+
+792
+01:01:04,020 --> 01:01:08,020
+الكلمات من بيه عصام، أو من بيه صامّه، تمام؟ واضح الـ
+
+793
+01:01:08,020 --> 01:01:12,260
+acclimatization كده بتصير؟ إذا بعد يومين بيصير أنا
+
+794
+01:01:12,260 --> 01:01:16,640
+مش بحتاج الـ carbon dioxide هو اللي يتحكم، لأن الـ
+
+795
+01:01:16,640 --> 01:01:20,480
+hyperventilation صلحه، لكن الـ hypoxia هي الموجودة
+
+796
+01:01:20,480 --> 01:01:24,100
+فبيصير هي الإيه؟ الـ main stimulant، واضح؟
+
+797
+01:01:27,320 --> 01:01:31,300
+بالإضافة إلى 70%، المزيد من الانفجار اللي يمكن أن
+
+798
+01:01:31,300 --> 01:01:36,290
+يحدث بعد اكتشاف عالي لقليل من الانفجار، اللي هو يعني
+
+799
+01:01:36,290 --> 01:01:38,870
+أنا تأثير الـ carbon dioxide اللي بسيط، الـ oxygen
+
+800
+01:01:38,870 --> 01:01:42,710
+اللي بسيط، بيزيد الـ oxygen، بالنسبة ليش الـ 70%؟ بدل
+
+801
+01:01:42,710 --> 01:01:46,490
+ما كان carbon dioxide هو الـ main، آه، و الـ oxygen 70
+
+802
+01:01:46,490 --> 01:01:50,930
+% فقط، بعد يومين ثلاثة of exposure to such
+
+803
+01:01:50,930 --> 01:01:53,830
+environment، the alveolar ventilation often
+
+804
+01:01:53,830 --> 01:01:58,610
+increases 400 to 500 percent after two to three
+
+805
+01:01:58,610 --> 01:02:05,870
+days of low oxygen، هذا يساعد كثيرًا في إعطاء أكسجين
+
+806
+01:02:05,870 --> 01:02:10,170
+إضافي، إذا في الوضع الطبيعي، زيادة الأكسجين تأثيره
+
+807
+01:02:10,170 --> 01:02:14,450
+سبعين المئة زيادة، تمام؟ الـ carbon dioxide تأثيره
+
+808
+01:02:14,450 --> 01:02:17,030
+أعلى كثير، لكن بعد يومين ثلاثة، الـ carbon dioxide
+
+809
+01:02:17,030 --> 01:02:21,130
+بفقد تأثيره، و الـ oxygen effect بيصير إيه؟ مش سبعين
+
+810
+01:02:21,130 --> 01:02:24,350
+المئة، بيصير أربعمئة المئة، خمسمئة المئة تأثير
+
+811
+01:02:24,350 --> 01:02:28,490
+فبيعود ياخد الـ upper hand، وهذا منطق، أنه أنا أنا
+
+812
+01:02:28,490 --> 01:02:28,850
+المشكلة
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/iqHo0a3El6c_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/iqHo0a3El6c_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..eceaeeca5060265f23ae9d77ae10cf518624a2f5
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/iqHo0a3El6c_postprocess.srt
@@ -0,0 +1,3248 @@
+1
+00:00:08,980 --> 00:00:15,340
+بسم الله الرحمن الرحيم السلام عليكم اليوم هنتكلم
+
+2
+00:00:15,340 --> 00:00:19,380
+عن how
+
+3
+00:00:19,380 --> 00:00:27,410
+the respiratory process is controlledعنا بنحتاج
+
+4
+00:00:27,410 --> 00:00:33,670
+احنا الى بعض الأحيان الى مجهود كبير بدنا oxygen
+
+5
+00:00:33,670 --> 00:00:40,670
+أكتر مطلوب أحيان متوسط مطلوب نرجع طبيعي هذه
+
+6
+00:00:40,670 --> 00:00:45,550
+المسألة بتتم بشكل تلقائي بدون ما يكون لإحنا دور
+
+7
+00:00:45,550 --> 00:00:51,650
+يعني voluntary فيها يعني بيصير عندنا automatic
+
+8
+00:00:51,650 --> 00:00:56,240
+regulationمن غير ما احنا ناخد نقصد ان نزود التنفس
+
+9
+00:00:56,240 --> 00:00:59,800
+او نجلد التنفس زي اي شيء بيتحكم فيه ال autonomic
+
+10
+00:00:59,800 --> 00:01:03,140
+nervous system فبيصير عندنا autonomic regulation
+
+11
+00:01:03,140 --> 00:01:10,460
+of the respiratory system to keep going with the
+
+12
+00:01:10,460 --> 00:01:16,560
+needs of the body تمام؟ ال regulation هذا بتتم من
+
+13
+00:01:16,560 --> 00:01:21,480
+خلالعندي انا central regulation وفي عندي
+
+14
+00:01:21,480 --> 00:01:26,660
+peripheral regulation تمام؟ اذا في عندي central
+
+15
+00:01:26,660 --> 00:01:30,900
+nervous system موجود موجود في داخله respiratory
+
+16
+00:01:30,900 --> 00:01:38,100
+center ال respiratory center هذا موجود في مناطق
+
+17
+00:01:38,100 --> 00:01:43,660
+حساسة جنبه لتغيرات
+
+18
+00:01:43,660 --> 00:01:49,600
+في الcarbon dioxide و ال oxygen و ال pH و ال
+
+19
+00:01:49,600 --> 00:01:50,740
+hydrogen concentration
+
+20
+00:01:53,620 --> 00:01:56,720
+إذا في عندي central regulation وفي عندي peripheral
+
+21
+00:01:56,720 --> 00:02:02,060
+regulation في عندي chemoreceptors موجودة في ال
+
+22
+00:02:02,060 --> 00:02:06,880
+carotid bodies وفي ال aortic arch bodies موجود
+
+23
+00:02:06,880 --> 00:02:12,440
+عندى إذا في عندي بالإضافة ل other arteries major
+
+24
+00:02:12,440 --> 00:02:17,660
+arteries موجود فيها برضه chemoreceptor bodies
+
+25
+00:02:17,660 --> 00:02:24,970
+موجودة toto sense the concentration of oxygen
+
+26
+00:02:24,970 --> 00:02:28,530
+partial pressure of oxygen يعني partial pressure
+
+27
+00:02:28,530 --> 00:02:32,050
+of carbon dioxide and the pH and hydrogen ion
+
+28
+00:02:32,050 --> 00:02:35,490
+concentration تمام؟ اذا بداية عشان نتعرف على
+
+29
+00:02:35,490 --> 00:02:39,010
+المسألة هذه بدنا نشوف المركز هذا اللي بتحكم في
+
+30
+00:02:39,010 --> 00:02:43,550
+التنفس اللي احنا نبعتله اشارات نزوده او نجلله او
+
+31
+00:02:43,550 --> 00:02:48,610
+كده شو هذا المركز ال respiratory center عبارة عن
+
+32
+00:02:48,610 --> 00:02:57,870
+مجموعةمن التجمعات العصبية، a group composed of
+
+33
+00:02:57,870 --> 00:03:02,230
+several groups of neurons located bilaterally in
+
+34
+00:03:02,230 --> 00:03:05,530
+the medulla and the pons، تمام؟ في الميدالة أو
+
+35
+00:03:05,530 --> 00:03:11,570
+بلونجاتا والبونز، يعني في ال brainstem موجود عندى
+
+36
+00:03:11,570 --> 00:03:13,050
+ال respiratory center
+
+37
+00:03:16,950 --> 00:03:20,990
+ال respiratory center بتكون من على الأقل من تلت
+
+38
+00:03:20,990 --> 00:03:24,010
+تجمعات
+
+39
+00:03:24,010 --> 00:03:24,990
+من ال nuclei
+
+40
+00:03:29,010 --> 00:03:35,950
+ال .. تجمع ال nerve bodies برا ال central nervous
+
+41
+00:03:35,950 --> 00:03:41,370
+system نسميها ganglion مش كده تجمع ال cell bodies
+
+42
+00:03:41,370 --> 00:03:45,750
+في ال central nervous system نسميه nucleus فعندي
+
+43
+00:03:45,750 --> 00:03:50,230
+مجموعة من ال nuclei اللي موجودة تمثل ال
+
+44
+00:03:50,230 --> 00:03:56,050
+respiratory center بيهمنا فيها تلت مجموعات اللي هو
+
+45
+00:03:56,050 --> 00:03:59,850
+ال dorsal respiratory groupو ال ventral
+
+46
+00:03:59,850 --> 00:04:07,750
+respiratory group و ال pneumotoxic center كمان هو
+
+47
+00:04:07,750 --> 00:04:12,650
+ال normal respiration بتمن خلال ال dorsal
+
+48
+00:04:12,650 --> 00:04:18,030
+respiratory group هذه بتطبط ال respiration بتدخل
+
+49
+00:04:18,030 --> 00:04:19,350
+ال pneumotoxic center
+
+50
+00:04:25,640 --> 00:04:31,420
+Yunamo toxic center بتدخل لضبط ال respiratory
+
+51
+00:04:31,420 --> 00:04:34,920
+rate، يعني هو ال respiratory center هذا المبعد
+
+52
+00:04:34,920 --> 00:04:41,980
+إشارات لل inspiration، وين بتنتهي ال inspiration؟
+
+53
+00:04:43,600 --> 00:04:46,260
+و يعني بينتهي ال inspiration هي اللي بيكون بتدخله
+
+54
+00:04:46,260 --> 00:04:49,260
+ال pneumotoxic ف ال pneumotoxic لما يكون انا عندي
+
+55
+00:04:49,260 --> 00:04:53,140
+فيه inspiration موجود و موقفه بدري تمام؟ معناه
+
+56
+00:04:53,140 --> 00:04:57,840
+عندي خلال ايه؟ shallow breathing و مدامه قصير
+
+57
+00:04:57,840 --> 00:05:03,140
+معناه بيخلي ال rate عالي تمام؟ اذا في عندي مدى ان
+
+58
+00:05:03,140 --> 00:05:07,040
+انا اتنفس كتير ال respiratory rate اذا لما يزيد
+
+59
+00:05:07,040 --> 00:05:14,500
+نشاط ال pneumotoxic center pneumotoxiccenter ممكن
+
+60
+00:05:14,500 --> 00:05:18,680
+يعمل ليه suppression سريع ل respiration و يخلي ان
+
+61
+00:05:18,680 --> 00:05:24,380
+كل نفس ينكتع بسرعة و يقدر الى ايه سرعة التنفس في
+
+62
+00:05:24,380 --> 00:05:27,120
+الحالة هذه برضه بيكون ايه shallow breathing و
+
+63
+00:05:27,120 --> 00:05:31,020
+rapid لو كان ال pneumotactic center او
+
+64
+00:05:31,020 --> 00:05:35,820
+pneumotactic centerبطيق معناه ال inspiration بياخد
+
+65
+00:05:35,820 --> 00:05:38,980
+و اضعه لحد ما يصير له inhibition يعني هو بيوقف ال
+
+66
+00:05:38,980 --> 00:05:43,240
+inspiration عند level معين تمام فلما أقف بدري بدي
+
+67
+00:05:43,240 --> 00:05:47,600
+فرصة ان انا اكرره كتير لما أقف متأخر باخد more دي
+
+68
+00:05:47,600 --> 00:05:52,500
+inspiration معناه بيكون ال rate اياش بطيق التنين
+
+69
+00:05:52,500 --> 00:05:57,300
+هدول هم الأساس في ال normal respiration لكن فوجد
+
+70
+00:05:57,300 --> 00:06:04,630
+ما يكون انا عندي exerciseبدي دعم لل deep
+
+71
+00:06:04,630 --> 00:06:08,790
+expiration, deep inspiration, forced expiration اه
+
+72
+00:06:08,790 --> 00:06:11,930
+معناها بده يدخل مجموعة تالتة ال ventral
+
+73
+00:06:11,930 --> 00:06:15,210
+respiratory group ال ventral respiratory group
+
+74
+00:06:15,210 --> 00:06:21,130
+تمام بالاضافة اذا هدول عندى تلت حاجات موجودة تلتة
+
+75
+00:06:21,130 --> 00:06:27,080
+groups of nucleiبيضيف لهم لو طلعنا بعد شوية هنلاقي
+
+76
+00:06:27,080 --> 00:06:31,380
+hand في المنطقة هذه موجود في عنا chemo sensitive
+
+77
+00:06:31,380 --> 00:06:39,560
+area اللي بتعمل regulation centrally
+
+78
+00:06:41,870 --> 00:06:44,490
+حساسة للتغيرات لكنها هذه موجودة في الـ central
+
+79
+00:06:44,490 --> 00:06:47,830
+nervous system لأنه من ميزها عن ال peripheral
+
+80
+00:06:47,830 --> 00:06:51,070
+regulation اللي موجود في ال ايه؟ ال aortic .. اه
+
+81
+00:06:51,070 --> 00:06:55,570
+في ال carotid bodies و ال aortic arch، تمام؟ اذا
+
+82
+00:06:55,570 --> 00:07:00,890
+في عندي انا center و في عندي sensors بيخلوا اتحكم
+
+83
+00:07:00,890 --> 00:07:06,850
+في هذا ال center ال respiratory center هذا اللي هو
+
+84
+00:07:06,850 --> 00:07:11,870
+ال dorsal respiratory groupof a nuclei بيصلوا ال
+
+85
+00:07:11,870 --> 00:07:15,610
+innovations اللي جاية بتديني خبر عن ال carbon
+
+86
+00:07:15,610 --> 00:07:17,890
+dioxide و ال oxygen و ال .. و ال .. و ال hydrogen
+
+87
+00:07:17,890 --> 00:07:21,210
+ion concentration عبر ال Vegas nerve و ال
+
+88
+00:07:21,210 --> 00:07:24,590
+glossopharyngeal nerve تمام؟ اذا هم هنا عندنا
+
+89
+00:07:24,590 --> 00:07:28,470
+termination ل ال Vegas و ال glossopharyngeal في
+
+90
+00:07:28,470 --> 00:07:33,530
+مينفي ال respiratory center هذا بيوصلوا إشارات من
+
+91
+00:07:33,530 --> 00:07:37,870
+مين من ال peripheral regulation هم ال grosses
+
+92
+00:07:37,870 --> 00:07:40,890
+pharyngeae اللي بيجيب من ال carotid bodiesو ال
+
+93
+00:07:40,890 --> 00:07:44,510
+aortic arch و إذا كان أبضومينا كمان blood vessels
+
+94
+00:07:44,510 --> 00:07:49,050
+بتشيين عبر مين؟ عبر ال Vegas مش كده؟ طيب إذا في
+
+95
+00:07:49,050 --> 00:07:53,070
+عندي hand center بتحكم .. بتشارك معاه a
+
+96
+00:07:53,070 --> 00:07:57,430
+pneumotoxic center اتنين مع بعض بيتحكمولي في ال
+
+97
+00:07:57,430 --> 00:08:01,530
+normal breath و في عندي ال .. ال .. ال .. ال .. ال
+
+98
+00:08:01,530 --> 00:08:06,590
+ventral group هذه بتتحكملي أو بتساعد ال normal
+
+99
+00:08:06,590 --> 00:08:10,610
+breath إذا كان محتاجين potentiationفي exercise أو
+
+100
+00:08:10,610 --> 00:08:17,430
+في غيره واضح؟ طيب ال .. الآن بنتكلم عن ال dorsal
+
+101
+00:08:17,430 --> 00:08:22,190
+group هذه كيف بترسل إشارتها إلى ال inspiratory
+
+102
+00:08:22,190 --> 00:08:26,310
+muscles يعني هي احنا عندنا ال inspiration active
+
+103
+00:08:26,310 --> 00:08:30,930
+لكن ال expiration passive في ال normal بيكون
+
+104
+00:08:30,930 --> 00:08:35,550
+passive يعني احنا اذا عملنا inspiration تمام و
+
+105
+00:08:35,550 --> 00:08:40,850
+بعدين توقف ال expiration لحاله بيصيرطب إذا كان ال
+
+106
+00:08:40,850 --> 00:08:43,410
+inspiration بيكون short، ال expiration بيكون
+
+107
+00:08:43,410 --> 00:08:48,710
+short، إذا كان ال inspiration بيكون دي long، تاني
+
+108
+00:08:48,710 --> 00:08:51,810
+بيكون زيه، فالتانية .. يعني هنا في علاقة ما بين ال
+
+109
+00:08:51,810 --> 00:08:55,330
+.. ال inspiration و في الآخر و ال rate of air
+
+110
+00:08:55,330 --> 00:08:58,950
+expiration حسب المدة اللي جاعدها، بقدر إلى إنه في
+
+111
+00:08:58,950 --> 00:09:03,310
+عندي repeated more than normal ولا normal ولا ..
+
+112
+00:09:06,190 --> 00:09:11,990
+بنلاحظ احنا هنا عندنا ال inspiratory او act هان
+
+113
+00:09:11,990 --> 00:09:14,910
+اللي بتتم under the control of the dorsal
+
+114
+00:09:14,910 --> 00:09:22,450
+respiratory group بتكون لها مواصفات العجلة
+
+115
+00:09:22,450 --> 00:09:26,470
+التسارعية يعني بتنزل اشارة من ال respiratory group
+
+116
+00:09:26,470 --> 00:09:33,480
+لل muscles مش كلهالأ مش هيك تجي نعم بهدوء مانحسش
+
+117
+00:09:33,480 --> 00:09:38,480
+فيها بزيد بزيد بزيد بزيد و بعدين بتروح ترجع تاني
+
+118
+00:09:38,480 --> 00:09:41,920
+بهدوء بزيد بزيد بزيد بزيد من غير ما نحس فيها،
+
+119
+00:09:41,920 --> 00:09:47,620
+تمام؟ يعني في عجلة في التسارع زي ما واحد نازل من
+
+120
+00:09:47,620 --> 00:09:52,720
+منحدر، بيضل يتسارع في الايه، مش كده؟ يعني مش سرعة
+
+121
+00:09:52,720 --> 00:09:53,540
+ثابتة
+
+122
+00:09:56,030 --> 00:10:00,850
+الاشارة الى ال
+
+123
+00:10:00,850 --> 00:10:03,390
+respiratory center الاشارة الى ال respiratory
+
+124
+00:10:03,390 --> 00:10:07,290
+center الاشارة الى ال respiratory center الاشارة
+
+125
+00:10:07,290 --> 00:10:11,710
+الى ال respiratory center الاشارة الى ال
+
+126
+00:10:11,710 --> 00:10:15,190
+respiratory center الاشارة الى ال respiratory
+
+127
+00:10:15,190 --> 00:10:16,550
+center الاشارة الى ال respiratory center الاشارة
+
+128
+00:10:16,550 --> 00:10:18,710
+الى ال respiratory center الاشارة الى ال
+
+129
+00:10:18,710 --> 00:10:20,210
+respiratory center الاشارة الى ال respiratory
+
+130
+00:10:20,210 --> 00:10:21,650
+center الاشارة الى ال respiratory center الاشارة
+
+131
+00:10:21,650 --> 00:10:22,230
+الى ال respiratory center الاشارة الى ال
+
+132
+00:10:22,230 --> 00:10:23,170
+respiratory center الاشارة الى ال respiratory
+
+133
+00:10:23,170 --> 00:10:23,190
+الى ال respiratory center الاشارة الى ال
+
+134
+00:10:23,190 --> 00:10:23,210
+respiratory center الاشارة الى ال respiratory
+
+135
+00:10:23,210 --> 00:10:23,230
+center الاشارة الى ال respiratory center الاشارة
+
+136
+00:10:23,230 --> 00:10:23,350
+الى ال respiratory center الاشارة الى ال
+
+137
+00:10:23,350 --> 00:10:28,510
+respiratoryعن أماكنهم في ال central nervous system
+
+138
+00:10:28,510 --> 00:10:32,870
+بدقة يعني مسجلة بس يعني ماظنش انا هسألكوا فيهم ولا
+
+139
+00:10:32,870 --> 00:10:35,730
+انا هأديكوا الوصف الدقيق لهم لإن ال
+
+140
+00:10:35,730 --> 00:10:37,610
+neurophysiology أنا مابحبش ال neurophysiology
+
+141
+00:10:37,610 --> 00:10:46,210
+بتكلموا عن ال dorsal group هنا موجودة mainly في ال
+
+142
+00:10:46,210 --> 00:10:51,750
+tractus solitarius nucleusتمام؟ وإنه ال ventral
+
+143
+00:10:51,750 --> 00:10:58,230
+group موجودة في ال .. في ال .. إيش المجموع عم
+
+144
+00:10:58,230 --> 00:11:06,110
+يسميها؟ نيوكلياس بارا بارا براكياليز group تمام؟
+
+145
+00:11:06,110 --> 00:11:10,250
+يعني في تفاصيل و أسماء و كده بتخص ال central
+
+146
+00:11:10,250 --> 00:11:14,870
+nervous system لكن إحنا خليني أتكلم عن إيه؟ عن how
+
+147
+00:11:14,870 --> 00:11:23,240
+the function .. إذا هناعنا مجموعات مسامة أماكنها
+
+148
+00:11:23,240 --> 00:11:24,700
+طيب .. الآن
+
+149
+00:11:31,740 --> 00:11:35,240
+العمل تبع ال respiratory center هذا احنا بيقول ال
+
+150
+00:11:35,240 --> 00:11:39,080
+respiratory center نقصد في التلاتة بس a quiet
+
+151
+00:11:39,080 --> 00:11:41,820
+respiration اللي بيشتغل في ال respiratory center
+
+152
+00:11:41,820 --> 00:11:46,660
+ال dorsal group وبيحكمها ال pneumotoxic center
+
+153
+00:11:46,660 --> 00:11:52,060
+يعني ال .. ال .. ال .. ال .. ال respiratory signal
+
+154
+00:11:52,060 --> 00:11:54,620
+بتيجي من ال respiratory .. من ال dorsal group
+
+155
+00:11:54,620 --> 00:11:59,500
+بتيجي as a ramp زي ما قلنا كأنه نزل و نحضر بتسارع
+
+156
+00:11:59,500 --> 00:12:02,990
+بعجلةبتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد ..
+
+157
+00:12:02,990 --> 00:12:12,030
+بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد
+
+158
+00:12:12,030 --> 00:12:13,270
+.. بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد ..
+
+159
+00:12:13,270 --> 00:12:13,470
+بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد
+
+160
+00:12:13,470 --> 00:12:13,490
+بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد
+
+161
+00:12:13,490 --> 00:12:14,550
+.. بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد ..
+
+162
+00:12:14,550 --> 00:12:20,890
+بتزيد .. بتزيد .. بتزيد .. بتزيد
+
+163
+00:12:20,890 --> 00:12:23,770
+.. بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد ..
+
+164
+00:12:23,770 --> 00:12:24,610
+بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد .. بتزيد
+
+165
+00:12:24,610 --> 00:12:28,870
+.. بتزيد .. بتزيد .. بتزيد
+
+166
+00:12:31,160 --> 00:12:35,180
+وقلنا انه بالطريقة هادى بيصير عندنا احنا كل ما
+
+167
+00:12:35,180 --> 00:12:39,120
+زادت الإشارة من ال nemotoxic center كل ما زادت ..
+
+168
+00:12:39,120 --> 00:12:42,100
+كل ما صار عندى سرعة في ال ايه؟ في التنفس و
+
+169
+00:12:42,100 --> 00:12:45,420
+shortness في ال inspiration كل ما جلت ال activity
+
+170
+00:12:45,420 --> 00:12:48,300
+بتاعت ال nemotoxic center بيدي فرصة لها ال ramp
+
+171
+00:12:48,300 --> 00:12:54,320
+يمشي يصلى more دي يبقى ال inspiration و بعدين يبقى
+
+172
+00:12:54,320 --> 00:12:58,270
+متأخر فتصير ال rate of inspiration عندى ايش؟إذا
+
+173
+00:12:58,270 --> 00:13:02,650
+عندي ال activity هذه بتشتغل بطريقة عكسية لإيه؟ لما
+
+174
+00:13:02,650 --> 00:13:05,230
+أقول active .. hyperactive pneumotactic center
+
+175
+00:13:05,230 --> 00:13:10,530
+معناها عندي very slow .. hyperactive يعني إيه؟
+
+176
+00:13:10,530 --> 00:13:17,600
+عندي .. عندي rapid rate، slow rate عندي إيه؟slow
+
+177
+00:13:17,600 --> 00:13:21,100
+activity of the pneumotoxin skinter بيكون عندي ايه
+
+178
+00:13:21,100 --> 00:13:25,140
+ال rate of inspiration ايه بنزل بس بيكون عندي دي
+
+179
+00:13:25,140 --> 00:13:26,340
+inspiration
+
+180
+00:13:34,820 --> 00:13:38,040
+the obvious advantage of the ramp is that it
+
+181
+00:13:38,040 --> 00:13:41,320
+causes a steady increase in the volume of the
+
+182
+00:13:41,320 --> 00:13:46,040
+lungs during inspiration rather than inspiratory
+
+183
+00:13:46,040 --> 00:13:53,780
+gasps يعني مش إيه إشي بسرعة أو روح بيعمل steady
+
+184
+00:13:53,780 --> 00:13:58,580
+increase زيادة متواصلة زيادة ورا زيادة ورا زيادة
+
+185
+00:14:04,740 --> 00:14:08,460
+إذا .. إذا بيعملي ال nemotoxic center بيعملي
+
+186
+00:14:08,460 --> 00:14:12,900
+limiting point بيعملي إيش؟ limiting point بينهي ال
+
+187
+00:14:12,900 --> 00:14:16,020
+inspiration فيها control of the limiting point at
+
+188
+00:14:16,020 --> 00:14:21,180
+which the ramp suddenly seizes it is .. this is
+
+189
+00:14:21,180 --> 00:14:23,540
+the usual method for controlling the rate of
+
+190
+00:14:23,540 --> 00:14:28,260
+respiration that is the earlier the ramp seizes
+
+191
+00:14:28,260 --> 00:14:32,360
+the shorter the duration of inspiration this also
+
+192
+00:14:32,360 --> 00:14:35,390
+shortens the duration of expirationهذا ما يزيد عدد
+
+193
+00:14:35,390 --> 00:14:43,890
+الهواء نيومو تاكسيك نيومو
+
+194
+00:14:43,890 --> 00:14:45,250
+تاكسيك نيومو تاكسيك نيومو تاكسيك نيومو تاكسيك
+
+195
+00:14:45,250 --> 00:14:49,130
+نيومو تاكسيك نيومو تاكسيك نيومو تاكسيك نيومو
+
+196
+00:14:49,130 --> 00:14:54,250
+تاكسيك نيومو تاكسيك نيومو تاكسيك نيومو تاكسيك
+
+197
+00:14:54,250 --> 00:14:56,910
+نيومو تاكسيك نيومو تاكسيك نيومو تاكسيك نيومو
+
+198
+00:14:56,910 --> 00:15:02,810
+تاكسيك نيومو تاكسيك نيومو تاكسيك نيومو تاكسيك
+
+199
+00:15:02,810 --> 00:15:05,900
+نيومو تاكسيك نيومو تاكسيك نinspiration might last
+
+200
+00:15:05,900 --> 00:15:10,120
+for as little as 0.5 seconds إذا strong، ال
+
+201
+00:15:10,120 --> 00:15:14,640
+inspiration بتصير short، مش كده؟ أما ال frequency
+
+202
+00:15:14,640 --> 00:15:21,720
+بتصير عالي، و العكس صح يعني إذا ال function، the
+
+203
+00:15:21,720 --> 00:15:24,820
+main function of the pneumotoxic center is
+
+204
+00:15:24,820 --> 00:15:29,040
+primarily to limit inspiration، توقف ال
+
+205
+00:15:29,040 --> 00:15:33,170
+inspiration لحد معينهذا لديه إفاقة ثانوية لإزالة
+
+206
+00:15:33,170 --> 00:15:37,830
+حرارة الهواء لأن حرارة الهواء أيضًا يقلل الاستجابة
+
+207
+00:15:37,830 --> 00:15:45,190
+ومدة طول كل حرارة حرارة حرارة ميوتاكسيكية
+
+208
+00:15:45,190 --> 00:15:51,670
+قوية يمكن أن تزيد حرارة الحرارة يمكن أن نقل حرارة
+
+209
+00:15:51,670 --> 00:15:56,900
+الحرارةالـ Ventral respiratory group اتكلمنا عنها
+
+210
+00:15:56,900 --> 00:16:03,800
+موجودة مش في ال .. ال .. ال .. المجموعة HAN في ال
+
+211
+00:16:03,800 --> 00:16:06,700
+nucleus parapracalis اللي هو نيوموتاكسيسينتر في
+
+212
+00:16:06,700 --> 00:16:11,580
+البنز أما ال voluntary .. ال .. ال Ventral group
+
+213
+00:16:11,580 --> 00:16:16,800
+of nuclei of neurons موجودة في ال nucleus
+
+214
+00:16:16,800 --> 00:16:19,680
+ambiguous و ال nucleus paraambiguous
+
+215
+00:16:19,680 --> 00:16:24,880
+retroambiguous is an ambiguous nucleus ambiguousهو
+
+216
+00:16:24,880 --> 00:16:30,260
+ال retro ambiguous عارفين إيش يعني ambiguous
+
+217
+00:16:30,260 --> 00:16:36,060
+معناها؟ ambiguous يعني محير، حائرة، ambiguous يعني
+
+218
+00:16:36,060 --> 00:16:39,180
+محتر، مش محدد بالظبط، مش واضح
+
+219
+00:16:43,050 --> 00:16:48,970
+يعرفني ايه شغلتها بتساعدني انا في ال extra work
+
+220
+00:16:48,970 --> 00:16:52,550
+لما يكون عندي extra .. اه needs for more
+
+221
+00:16:52,550 --> 00:16:55,850
+inspiration and expiration هذه ال .. ال .. ال ..
+
+222
+00:16:55,850 --> 00:16:58,710
+ال ventral group لاحظنا انه لو عملنا فيه لبعض هال
+
+223
+00:16:58,710 --> 00:17:03,170
+simulation بتعمل inspiration .. simulation for
+
+224
+00:17:03,170 --> 00:17:06,310
+inspiration وجزء تاني لو عملنا ال simulation بيعمل
+
+225
+00:17:06,310 --> 00:17:08,900
+ال simulation لل ايه؟لل expiration بمعنى
+
+226
+00:17:08,900 --> 00:17:12,120
+potentiating ال inspiration أو ال expiration أو
+
+227
+00:17:12,120 --> 00:17:17,540
+potentiating ال expiration لذلك فيها مناطق بتعمل
+
+228
+00:17:17,540 --> 00:17:21,680
+شيء و مناطق تانية بتعمل عكسها لذلك يقولون هي
+
+229
+00:17:21,680 --> 00:17:27,920
+بتلزمني في ال .. في ال .. ال exercise for deeper
+
+230
+00:17:27,920 --> 00:17:32,480
+inspiration and .. and forced .. more forced
+
+231
+00:17:32,480 --> 00:17:36,520
+expiration في الحالة اللي أنا محتاج أعمل مثلك
+
+232
+00:17:36,520 --> 00:17:36,940
+أشياء
+
+233
+00:17:43,000 --> 00:17:48,620
+هذه اللي هو الـ Center الـ Spiratory Center وقولنا
+
+234
+00:17:48,620 --> 00:17:54,420
+انه بتحكم فيه بيعمل ال limiting point بتحكم فيها
+
+235
+00:17:54,420 --> 00:17:58,420
+ال Nemotoxic Center هذا الـ Centrally عندنا
+
+236
+00:17:58,420 --> 00:18:03,430
+Peripheral Reflex ممكن برضه يتحكمفي ال limiting
+
+237
+00:18:03,430 --> 00:18:07,130
+point بس انا مش في ال normal conditions تمام ال
+
+238
+00:18:07,130 --> 00:18:11,030
+normal conditions pneumotoxic center هو اللي ايه
+
+239
+00:18:11,030 --> 00:18:18,590
+بتحكم لكن برضه في يعني في قوة اخرى ممكن تتحكم يعني
+
+240
+00:18:18,590 --> 00:18:25,050
+انا اخدت inspiration inspiration أو deep
+
+241
+00:18:25,050 --> 00:18:31,320
+inspirationand more deep inspiration لدرجة ان انا
+
+242
+00:18:31,320 --> 00:18:35,480
+عندى ايه اعمل stretch كبير للريقتين مابتخلينيش
+
+243
+00:18:35,480 --> 00:18:39,100
+الريقتين اعمل stretch لكيف مابدي تمام فى limits
+
+244
+00:18:39,100 --> 00:18:42,800
+لها تمام ففى عندى اشارة من ال stretch receptors
+
+245
+00:18:42,800 --> 00:18:48,500
+اللى موجودينفي ال muscles of the bronchioles و ال
+
+246
+00:18:48,500 --> 00:18:52,680
+.. اه ال main bronchioles و ال .. ال .. ال large
+
+247
+00:18:52,680 --> 00:18:55,600
+bronchioles يعني ال stretch اللي بيصير عليهم على
+
+248
+00:18:55,600 --> 00:18:59,640
+ال muscles تبعتهم بيقدي إلى يبعتوا إشارة إلى ال
+
+249
+00:18:59,640 --> 00:19:03,060
+respiratory center يعملواlimiting point to
+
+250
+00:19:03,060 --> 00:19:05,280
+simulate the limiting point to stop inspiration
+
+251
+00:19:05,280 --> 00:19:08,120
+يعني زي ما يبقى on the pneumotactic center لكنه
+
+252
+00:19:08,120 --> 00:19:11,620
+هدول بتشتغلوا في abnormal conditions لما يصير عند
+
+253
+00:19:11,620 --> 00:19:14,960
+ال inspiration ان ال tidal volume تلت أضعف الطبيعي
+
+254
+00:19:14,960 --> 00:19:20,020
+يعني الطبيعي انا يكون عندي خمسمية ملي لتر مش كده
+
+255
+00:19:20,020 --> 00:19:23,520
+لكن لو انا أخدت الف و خمسمية بلاقي ان ال tidal
+
+256
+00:19:23,520 --> 00:19:29,750
+volume صار عندي ايه؟صار له reflex inhibition
+
+257
+00:19:29,750 --> 00:19:34,210
+reflex suppression للإيه لال inspiration نأتي
+
+258
+00:19:34,210 --> 00:19:38,490
+شهادة من الايه ال stress receptors that transmit
+
+259
+00:19:38,490 --> 00:19:42,710
+signals through the vagina هنا .. هنا اتكلم عن ال
+
+260
+00:19:42,710 --> 00:19:48,670
+lungs في العالم الفيجاس مش كده located in the
+
+261
+00:19:48,670 --> 00:19:52,420
+muscularportions of the walls of the bronchi and
+
+262
+00:19:52,420 --> 00:19:55,800
+bronchioles اذا ال muscles اللي موجودة في ال
+
+263
+00:19:55,800 --> 00:19:59,440
+bronchi و ال bronchioles لما يصيرها stretch بتعمل
+
+264
+00:19:59,440 --> 00:20:03,760
+ال .. بيسمي hearing brower reflex مش بيسمي hearing
+
+265
+00:20:03,760 --> 00:20:10,020
+brower reflex اللي هو بيجيني من ال lung to stop
+
+266
+00:20:10,660 --> 00:20:13,840
+more inflation of the lung ال lung وصلت في ال
+
+267
+00:20:13,840 --> 00:20:17,720
+inflation إلى it's maximum فبقدرش انا اضالي اخد
+
+268
+00:20:17,720 --> 00:20:21,880
+اكتر فالجلي حاله مقطع النفس بسبب إشارة بتصل من مين
+
+269
+00:20:21,880 --> 00:20:27,100
+من ال stress receptors بتصل عبر ال Vegas واضح؟ اذا
+
+270
+00:20:27,100 --> 00:20:30,040
+هنا ال hearing brewer عبر ال Vegas لكن ال
+
+271
+00:20:30,040 --> 00:20:33,440
+peripheral control in general جزء منه عبر ال
+
+272
+00:20:33,440 --> 00:20:36,340
+glossopharyngeal وجزء منه عبر ال ايه؟ ال Vegas
+
+273
+00:20:46,660 --> 00:20:51,280
+إذن هذا الـ Reflex يبدو كمصطلح محمي
+
+274
+00:20:54,600 --> 00:20:58,660
+for preventing excess lung inflation rather than
+
+275
+00:20:58,660 --> 00:21:01,620
+an important ingredient in normal control of the
+
+276
+00:21:01,620 --> 00:21:05,920
+ventilation إذا هو مش reflex طبيعي عشان يعمله
+
+277
+00:21:05,920 --> 00:21:09,360
+control and inspiration لأ هو بده يمنع ال over
+
+278
+00:21:09,360 --> 00:21:16,680
+distention the control of overall respiratory
+
+279
+00:21:16,680 --> 00:21:20,300
+center activity إذا respiratory center activity
+
+280
+00:21:20,300 --> 00:21:23,140
+اتكلمنا عنه عند الدورزل
+
+281
+00:21:27,860 --> 00:21:32,300
+الان ال control تبع هدول بيجينا عبر حاجتين عبر ال
+
+282
+00:21:32,300 --> 00:21:35,860
+central control اللي هو ال chemical sensitive area
+
+283
+00:21:35,860 --> 00:21:40,860
+اللي موجودة بجوار ال respirator center
+
+284
+00:21:43,450 --> 00:21:50,390
+beneath the ventral .. the anterior aspect of the
+
+285
+00:21:50,390 --> 00:21:54,790
+.. of the medulla oblongata تمام؟ يعني موجود جنب
+
+286
+00:21:54,790 --> 00:22:00,430
+ال respiratory center اذا
+
+287
+00:22:00,430 --> 00:22:04,810
+بنسميها chemosensitive area chemosensitive area
+
+288
+00:22:04,810 --> 00:22:09,170
+وعنا اللي هو ال peripheral control على ايه؟ قولنا
+
+289
+00:22:09,170 --> 00:22:14,110
+ال chemoreceptors اللي موجودة وين؟ طيب، خيصةالان
+
+290
+00:22:14,110 --> 00:22:22,150
+ال .. ال .. ال .. ال sensitivity of these areas ال
+
+291
+00:22:22,150 --> 00:22:29,750
+chemo sensitive او chemo .. ال chemoreceptors what
+
+292
+00:22:29,750 --> 00:22:38,100
+is the .. what is the changes that occur hereto
+
+293
+00:22:38,100 --> 00:22:42,180
+affect these centers تمام؟ اننا الان بتكلم عن ال
+
+294
+00:22:42,180 --> 00:22:45,880
+central control
+
+295
+00:22:45,880 --> 00:22:49,360
+ال central control و ال peripheral control ليش
+
+296
+00:22:49,360 --> 00:22:53,500
+احنا جسمناهم بشكل هذا؟ لأنه لاحظنا انه centrally
+
+297
+00:22:53,500 --> 00:23:00,380
+the carbon dioxide is the most effective و
+
+298
+00:23:00,380 --> 00:23:04,500
+peripherally the oxygen pressure is the most
+
+299
+00:23:04,500 --> 00:23:10,720
+effectiveو حقيقة هو ممكن يتبادلوا الأدوار أحيانا و
+
+300
+00:23:10,720 --> 00:23:16,200
+يتبادلوا الأدوار بطريقة صحية جدا و بطريقة لمصلحة
+
+301
+00:23:16,200 --> 00:23:21,580
+الجسم جدا و هنتكلم عليها بعد شوية لما يتحول ال
+
+302
+00:23:21,580 --> 00:23:26,820
+control من ال oxygen من ال carbon dioxide upper
+
+303
+00:23:26,820 --> 00:23:32,050
+hand إلى ال oxygen upper hand واضح؟ تمامالان اذا
+
+304
+00:23:32,050 --> 00:23:38,050
+عندي انا تلت عناصر بتصير أثناء ال inspiration في
+
+305
+00:23:38,050 --> 00:23:44,710
+ال inspiration بنزود ال oxygen مش كده و بنطرد
+
+306
+00:23:44,710 --> 00:23:49,030
+carbon dioxide و في نفس الوقت عندي hydrogen ions
+
+307
+00:23:49,030 --> 00:23:58,270
+بتتكون بنتخلص منها ايضا اذا ال
+
+308
+00:23:58,270 --> 00:24:03,870
+carbon dioxide عليهمعناها ال ventilation process
+
+309
+00:24:03,870 --> 00:24:06,650
+صار فيها مشكلة محتاجين إيه؟ لإن ال ventilation
+
+310
+00:24:06,650 --> 00:24:10,670
+تزيد عشان نرجع ال carbon dioxide إلى الوضع الطبيعي
+
+311
+00:24:10,670 --> 00:24:17,570
+إذا ال oxygen tension وطي معناها أنا عندي مشكلة في
+
+312
+00:24:17,570 --> 00:24:20,550
+ال ventilation إذا ال hydrogen ions concentration
+
+313
+00:24:20,550 --> 00:24:24,310
+عليه أنا عندي مشكلة إذا دول تلت أشياء بيزودوا
+
+314
+00:24:24,310 --> 00:24:31,350
+لإيه؟ال .. ال respiratory center to increase the
+
+315
+00:24:31,350 --> 00:24:36,050
+ventilation process to get the concentrations of
+
+316
+00:24:36,050 --> 00:24:39,410
+these things back to the .. to the normal رجعهم
+
+317
+00:24:39,410 --> 00:24:43,990
+للوضع الطبيعي واضح؟ طيب بنقول احنا هنا .. عنا ..
+
+318
+00:24:43,990 --> 00:24:49,990
+عنا two areas خلينا ايه؟ ان انا chemo sensitive
+
+319
+00:24:49,990 --> 00:24:54,730
+area وعنا peripheral control
+
+320
+00:24:57,230 --> 00:25:04,070
+من خلال ال .. ال carotid arch carotid bodies
+
+321
+00:25:04,070 --> 00:25:10,010
+موجودة فيها carotid ايه؟ او
+
+322
+00:25:10,010 --> 00:25:13,030
+ال aortic arch اذا ال aortic arch في aortic bodies
+
+323
+00:25:13,030 --> 00:25:17,070
+و ال carotid common carotid او ال bifurcation هنا
+
+324
+00:25:17,070 --> 00:25:20,790
+موجود carotid bodies اذا في bodies موجودة في ال
+
+325
+00:25:20,790 --> 00:25:25,940
+carotid و في ال aorta اسمهمالشركات الكاروتية أو
+
+326
+00:25:25,940 --> 00:25:29,340
+الشركات الأوروثية لهم ميكانيزم في مسألة الـ
+
+327
+00:25:29,340 --> 00:25:34,900
+sensation هنتكلم عنها ال
+
+328
+00:25:34,900 --> 00:25:40,200
+sensitivity of each of those is different تمام؟
+
+329
+00:25:40,200 --> 00:25:45,260
+الكيمو ريسبتور هان are more sensitive to carbon
+
+330
+00:25:45,260 --> 00:25:50,840
+dioxide it changes الغريب انه لو احنا اجينا عملنا
+
+331
+00:25:50,840 --> 00:25:55,190
+test على ال centers هذهالـ Chemosensitive Area
+
+332
+00:25:55,190 --> 00:26:00,250
+وحطينا Carbon Dioxide Concentration و Hydrogen Ion
+
+333
+00:26:00,250 --> 00:26:04,170
+Concentration و Oxygen Concentration غيرنا التلاتة
+
+334
+00:26:04,170 --> 00:26:08,610
+هلاقي الـ Hydrogen Ion Concentration is the most
+
+335
+00:26:08,610 --> 00:26:13,770
+direct stimulant تمام؟ إذا كل ما زاد الـ Hydrogen
+
+336
+00:26:13,770 --> 00:26:17,590
+كل ما صار عندى more stimulation لمين؟ لـ
+
+337
+00:26:17,590 --> 00:26:24,040
+Respiration طيب تعالي نيجي للدمنطلع نعلي في الدم
+
+338
+00:26:24,040 --> 00:26:28,380
+مش direct stimulation نعلي ال hydrogen ions و نعلي
+
+339
+00:26:28,380 --> 00:26:32,360
+ال carbon dioxide و نوطي ال oxygen هنلاقي the most
+
+340
+00:26:32,360 --> 00:26:37,740
+active ال carbon dioxide تمام؟ إذا ال carbon
+
+341
+00:26:37,740 --> 00:26:42,140
+dioxide concentration لما بيرفع هو the main
+
+342
+00:26:42,140 --> 00:26:46,120
+stimulant for the air طب إيش الفكرة؟ الفكرة إنه ال
+
+343
+00:26:46,120 --> 00:26:50,840
+carbon dioxideالكربون دايكسايد يمكن أن يتفوز
+
+344
+00:26:50,840 --> 00:26:54,640
+بسهولة إلى المنطقة الكيموسنسيفة وهناك زي ما
+
+345
+00:26:54,640 --> 00:26:59,180
+اتكلمنا في أماكن أخرى الكربون دايكسايد مع الميه
+
+346
+00:26:59,180 --> 00:27:02,260
+بتحول لكربونك أسد وكربونك وايكربونات وهيدروجين
+
+347
+00:27:02,260 --> 00:27:05,600
+الهيدروجين اللي بتكونها بيبقى متناسب مع قدش فيه
+
+348
+00:27:05,600 --> 00:27:10,140
+عند أنا أيش كربون دايكسايد تمام؟ اذا okay هو
+
+349
+00:27:10,140 --> 00:27:13,380
+الكربون دايكسايد ارتفاعه اللي عمل ال simulation
+
+350
+00:27:13,380 --> 00:27:16,780
+لكن ال direct simulation by أيش؟ by hydrogen ions
+
+351
+00:27:18,220 --> 00:27:24,060
+لما اتكلم الفصل الجاى عن ال .. ال .. بـ twitter
+
+352
+00:27:24,060 --> 00:27:29,930
+gland هلاجى انه الـ Testosteroneفى الدم اللى هو
+
+353
+00:27:29,930 --> 00:27:34,570
+الهرمون الذكري لما بيعمل ال simulation اللى بتوتري
+
+354
+00:27:34,570 --> 00:27:39,270
+gland بيعملها ال simulation عبر ال estrogen لإن هو
+
+355
+00:27:39,270 --> 00:27:41,950
+لما يدخل ال cells عشان يعمل ال simulation بنروح
+
+356
+00:27:41,950 --> 00:27:45,850
+متحول ل estrogen فهنا صحيح ال direct simulator هو
+
+357
+00:27:45,850 --> 00:27:50,590
+ال estrogen لكده نعكسهبحجب ال testosterone، جداش
+
+358
+00:27:50,590 --> 00:27:53,470
+فيه عمل testosterone، جداش صار تحويل ل أستروجين،
+
+359
+00:27:53,470 --> 00:27:56,830
+جداش عمل simulation أو separation، حسب، مش كده؟
+
+360
+00:27:56,830 --> 00:28:01,610
+هنا ال direct hydrogen، لكنه ال .. ال hydrogen
+
+361
+00:28:01,610 --> 00:28:05,950
+اللي متوفر direct locally depends .. depends on
+
+362
+00:28:05,950 --> 00:28:08,390
+the concentration of carbon dioxide، لأن ال
+
+363
+00:28:08,390 --> 00:28:10,770
+perfusion and distribution of carbon dioxide
+
+364
+00:28:11,430 --> 00:28:14,250
+through the tissues is easier than the hydrogen
+
+365
+00:28:14,250 --> 00:28:19,230
+ions اذا ان وصول ال carbon dioxide اسهل من الدم من
+
+366
+00:28:19,230 --> 00:28:24,230
+ال plasma الى ال cells اسهل كتير من ايه من وصول ال
+
+367
+00:28:24,230 --> 00:28:26,450
+hydrogen ions فهذا بدي advantage على carbon
+
+368
+00:28:26,450 --> 00:28:30,680
+dioxide لكن locally بيصير عن طريق الايه؟الـ
+
+369
+00:28:30,680 --> 00:28:32,640
+hydrogen ion concentration لذلك اللي عملنا تجربة
+
+370
+00:28:32,640 --> 00:28:35,820
+local simulation هنلاقي ال hydrogen ions مش ال
+
+371
+00:28:35,820 --> 00:28:39,940
+carbon dioxide لكن لو اتكلم على ال blood levels
+
+372
+00:28:39,940 --> 00:28:43,540
+هنلاقي ال carbon dioxide هو الايه؟ ال carbon
+
+373
+00:28:43,540 --> 00:28:50,620
+dioxide في أحيان بيفقد سيطرته يعني لو ال carbon
+
+374
+00:28:50,620 --> 00:28:58,230
+dioxide زاد يوم يومين بيظل ال main stimulantلكن لو
+
+375
+00:28:58,230 --> 00:29:02,850
+زاد عن هيك بيلاقي ان ال oxygen هو ال ايه بدا يفقد
+
+376
+00:29:02,850 --> 00:29:07,750
+قدرته ال carbon dioxide بيفقد اربع احماص قدرته و
+
+377
+00:29:07,750 --> 00:29:11,410
+بيهبط الى بتصير ال air not sensitive to the carbon
+
+378
+00:29:11,410 --> 00:29:16,210
+dioxide زي ما هي sensitive لل ايه لل oxygen فيبدأ
+
+379
+00:29:16,210 --> 00:29:20,310
+ال oxygen عندى ال oxygen low potential of oxygen
+
+380
+00:29:20,310 --> 00:29:26,300
+is more stimulant than ال aإذا ال carbon dioxide
+
+381
+00:29:26,300 --> 00:29:30,940
+وهادي إلها إلها يعني it's significance هنتكلم عنها
+
+382
+00:29:30,940 --> 00:29:37,800
+بعد شوية إذا عندي أنا centrally هلاجي ال upper
+
+383
+00:29:37,800 --> 00:29:41,940
+hand لمين ال carbon dioxide peripherally هلاجي
+
+384
+00:29:41,940 --> 00:29:45,780
+عندي لأ ال oxygen هو ال most stimulant ال oxygen
+
+385
+00:29:45,780 --> 00:29:49,820
+low oxygen tension is more stimulant to the
+
+386
+00:29:49,820 --> 00:29:53,720
+peripheral chemoreceptors اللي هم الموين الموجودين
+
+387
+00:29:55,620 --> 00:29:59,120
+في ال .. اورتا و ال ايه؟ و ال carotid و other
+
+388
+00:29:59,120 --> 00:30:05,320
+major artists ما هم دول الأساسين هلاجى انه ال ..
+
+389
+00:30:05,320 --> 00:30:09,980
+ال oxygen هو اللي هو الدور الأول و يليه ال carbon
+
+390
+00:30:09,980 --> 00:30:13,840
+dioxide و يليه ال ايه؟ ال hydrogen و يليه ال
+
+391
+00:30:13,840 --> 00:30:18,420
+hydrogen هل هدقلها؟ الآن اذا صار عندى انا ال
+
+392
+00:30:18,420 --> 00:30:21,630
+carbon dioxideالـ central effect very .. very
+
+393
+00:30:21,630 --> 00:30:25,310
+strong الـ peripheral effect lesser than the ..
+
+394
+00:30:25,310 --> 00:30:30,470
+the .. the central لكن الفرق بين هذي و هذي ان ال
+
+395
+00:30:30,470 --> 00:30:34,890
+peripheral ال peripheral simulation of the
+
+396
+00:30:34,890 --> 00:30:38,610
+chemoreceptors is more rapid than the central
+
+397
+00:30:38,610 --> 00:30:43,490
+simulation تمام؟ إذا ان الhypoxia تعملي very rapid
+
+398
+00:30:43,490 --> 00:30:49,080
+simulation لمين؟ لل .. للchemoreceptorsوالـ higher
+
+399
+00:30:49,080 --> 00:30:55,060
+carbon dioxide بيعمللي good simulation ماهواش very
+
+400
+00:30:55,060 --> 00:30:59,440
+strong لكنه very rapid تمام؟ لكنه ايه؟ very rapid
+
+401
+00:30:59,440 --> 00:31:04,560
+فإذا ال peripheral chemoreceptor sending its
+
+402
+00:31:06,290 --> 00:31:08,890
+Sensitivity directly through the vagus and the
+
+403
+00:31:08,890 --> 00:31:12,230
+glossopharyngeal to the respiratory center more
+
+404
+00:31:12,230 --> 00:31:18,250
+rapid than the central chemosensitive area في
+
+405
+00:31:18,250 --> 00:31:25,430
+السرعة البريفرال system is more rapid than ده ايه
+
+406
+00:31:25,430 --> 00:31:29,410
+لإن هو متصل اتصل مباشرة عبر ال vagus طبعا لكن
+
+407
+00:31:29,410 --> 00:31:34,150
+التاني بدهto diffuse and to build up concentration
+
+408
+00:31:34,150 --> 00:31:38,870
+and to .. لما يصل، لكن كويس، إذا الفرق بين ال
+
+409
+00:31:38,870 --> 00:31:41,930
+carbon dioxide effect hand و hand، التانية مهمين،
+
+410
+00:31:41,930 --> 00:31:49,400
+بس واحد أكتر more stronger، واحد أسرع، مش كده؟طيب
+
+411
+00:31:49,400 --> 00:31:53,220
+على فكرة احنا هتكون مواضيعنا اللي جاية كلها
+
+412
+00:31:53,220 --> 00:31:56,640
+العلاقة بين التلاتة هدول يعني لما يتدخلوا مع بعض
+
+413
+00:31:56,640 --> 00:32:00,340
+ال oxygen tension مع ال carbon dioxide tension مع
+
+414
+00:32:00,340 --> 00:32:04,580
+ال hydrogen concentration كيف التلاتة هنلاقيهم
+
+415
+00:32:04,580 --> 00:32:10,520
+ماشيين مع بعض هنلاقيهم ماشيين مع بعض التلات عناصر
+
+416
+00:32:10,520 --> 00:32:14,910
+زيادة ال carbon dioxide و ال hydrogen ionsمع زيادة
+
+417
+00:32:14,910 --> 00:32:19,830
+ايه؟ ال oxygen .. مع .. مع حبوط ال oxygen pressure
+
+418
+00:32:19,830 --> 00:32:23,610
+pressure هيقدر إلى ال stimulation التلاتة بتعادلوا
+
+419
+00:32:23,610 --> 00:32:28,270
+مع بعض في وجود التلاتة بيزيدوا في وجود واحد من
+
+420
+00:32:28,270 --> 00:32:31,830
+التلاتة وحكاية كذا العلاقات هبقى الماشية في هذا
+
+421
+00:32:31,830 --> 00:32:32,490
+اتجاه هذا
+
+422
+00:32:39,460 --> 00:32:43,420
+إذا نقولنا احنا ال carbon dioxide بقعد عندي انا
+
+423
+00:32:43,420 --> 00:32:47,160
+ايه يومين هو ماخد ال upper hand لو صار عندي carbon
+
+424
+00:32:47,160 --> 00:32:50,520
+يعني صار عندي hypo ventilation و ال carbon dioxide
+
+425
+00:32:50,520 --> 00:32:56,740
+عليه تمام؟ معناها بعد يومين بيبدأ عندي يفكر ال
+
+426
+00:32:56,740 --> 00:33:02,200
+ايه؟ ال carbon dioxide its sensitivity هو بتتحول
+
+427
+00:33:02,200 --> 00:33:06,000
+ال oxygen طب ليش ال carbon dioxide هو ال ايه ال
+
+428
+00:33:06,000 --> 00:33:10,700
+most sensitive؟ ليش مش ال oxygen؟تمام؟ ليش مش ال
+
+429
+00:33:10,700 --> 00:33:13,220
+oxygen؟ لأنه ربنا خلّاشي نجلنا Hemoglobin
+
+430
+00:33:13,220 --> 00:33:17,700
+مايخلّاشي نحس كتير بفرق ال oxygen مش كده؟ ال
+
+431
+00:33:17,700 --> 00:33:22,680
+hemoglobin عند ال lungs بياخد البضياء ولو كانت ال
+
+432
+00:33:22,680 --> 00:33:27,000
+pressure ماشية ستين وعند ال tissues بيعطي ال بضياء
+
+433
+00:33:27,000 --> 00:33:29,980
+ولو كان ال pressure إيه واطي فدايما عندي ال
+
+434
+00:33:29,980 --> 00:33:33,410
+availability of oxygenمن خلال أنه موجود عندى
+
+435
+00:33:33,410 --> 00:33:37,110
+هموجلبيين ال availability أني أخد more oxygen و
+
+436
+00:33:37,110 --> 00:33:39,930
+أني أعطي more oxygen لل tissues بيخلص sensitivity
+
+437
+00:33:39,930 --> 00:33:46,240
+لل tissues لل oxygenأه مش كتيرة ليش لإن أنا بدك
+
+438
+00:33:46,240 --> 00:33:51,660
+اعمل مع hemoglobin كريم بيعطي كتير و بياخد من ال
+
+439
+00:33:51,660 --> 00:33:56,580
+lungs كتير فبقدرش أحس بالظبط انا انه انا في وضع
+
+440
+00:33:56,580 --> 00:34:00,220
+ventilation low ventilation ولا high ventilation
+
+441
+00:34:00,220 --> 00:34:06,480
+تمام بالرغم من انه ايه ال oxygen هو الأساس اه أبو
+
+442
+00:34:06,480 --> 00:34:11,260
+حميد احنا في الموضوع اذا
+
+443
+00:34:11,260 --> 00:34:15,650
+ال ventilationبقدرش انا اخلي ال oxygen هو اللي
+
+444
+00:34:15,650 --> 00:34:21,160
+اتحكم فيه، اذا اتحكم فيه هلاقي حالي متأخر كتيرلما
+
+445
+00:34:21,160 --> 00:34:25,300
+يصير هبوط عندى أقل من 60% من ال pressure pressure
+
+446
+00:34:25,300 --> 00:34:29,540
+tension لما يبدأ على عيندي أن أصحى على حالي لما
+
+447
+00:34:29,540 --> 00:34:35,520
+أفقد oxygen في ال tissues أكتر من أن أنزل لأقل من
+
+448
+00:34:35,520 --> 00:34:38,400
+15% pressure pressure pressure لما أبدأ أصحى على
+
+449
+00:34:38,400 --> 00:34:42,020
+حالي أن oxygen نقص بحسش أنه نقص لو نقص في ال
+
+450
+00:34:42,020 --> 00:34:45,520
+ventilation ولا نقص في ال tissues أخدت more oxygen
+
+451
+00:34:45,520 --> 00:34:49,220
+بحسش فيها كتير بطبيعة الصفات الهيموجلومية اتكلمنا
+
+452
+00:34:49,220 --> 00:34:54,450
+عنهالكن الـ carbon dioxide بيعلق بسرعة لو ايه؟ لو
+
+453
+00:34:54,450 --> 00:34:58,690
+زاد ال oxygen used اه و ال ventilation ماكانش كافي
+
+454
+00:34:58,690 --> 00:35:01,910
+ع طول build up و بديني concentration عالي ف more
+
+455
+00:35:01,910 --> 00:35:04,170
+sensitive .. اذا ال carbon dioxide في الحالة هذه
+
+456
+00:35:04,170 --> 00:35:11,880
+بيكون عندى مقياس ادق تمام؟ هو لإن هو ناتجو بده
+
+457
+00:35:11,880 --> 00:35:16,000
+نصرفه لبرا لكن ال oxygen احنا محتاجينه الجسم بنقصش
+
+458
+00:35:16,000 --> 00:35:20,200
+عليه ال oxygen بسهولة لكن بيحس انه أخدنا كتير ولا
+
+459
+00:35:20,200 --> 00:35:22,820
+جليل ولا ال ventilation صح ولا غلط من خلال ال
+
+460
+00:35:22,820 --> 00:35:26,060
+carbon dioxide واضح؟ لذلك احنا لما ال carbon
+
+461
+00:35:26,060 --> 00:35:29,560
+dioxide يعملّي ال simulation ويعملّي
+
+462
+00:35:29,560 --> 00:35:32,520
+hyperventilation لأنه عندي عيلة ال carbon dioxide
+
+463
+00:35:32,520 --> 00:35:37,880
+ال hyperventilation هات ايش بتعمل؟ it will wash
+
+464
+00:35:37,880 --> 00:35:41,770
+the carbon dioxide outلذن راح ال carbon dioxide
+
+465
+00:35:41,770 --> 00:35:44,150
+يعني ال hybrid stimulation اللي صارت لل
+
+466
+00:35:44,150 --> 00:35:48,530
+ventilation أدت إلى أنها تتخلص من ال carbon
+
+467
+00:35:48,530 --> 00:35:52,830
+dioxide اللي زايد واضح؟ طب هبط نزل ال carbon
+
+468
+00:35:52,830 --> 00:35:58,090
+dioxide و بعدين .. و بعدين أنا محتاج .. أنا محتاج
+
+469
+00:35:58,090 --> 00:36:03,330
+oxygen أنا طالع على ارتفاع الف متر فوق سطح الماء
+
+470
+00:36:03,330 --> 00:36:07,810
+أو الفين تمام؟ و ال oxygen tension واطيو احنا
+
+471
+00:36:07,810 --> 00:36:11,970
+قولنا ال carbon dioxide كان هو اللي شغال ال carbon
+
+472
+00:36:11,970 --> 00:36:16,030
+dioxide يومين متواصلين اشتغل فعمل wash out ل
+
+473
+00:36:16,030 --> 00:36:19,450
+carbon dioxide ورجع ال carbon dioxide طبيعي لكن ال
+
+474
+00:36:19,450 --> 00:36:25,210
+oxygen tension هو اللي واطه بيبدأ بعد ما يومين من
+
+475
+00:36:25,210 --> 00:36:31,380
+المن الهيبو .. هيبو
+
+476
+00:36:31,380 --> 00:36:35,320
+.. هيبوكسيا .. هيبوكسيميا تمام؟ و ال carbon
+
+477
+00:36:35,320 --> 00:36:37,920
+dioxide to be washed بيبدأ ال .. ال .. ال
+
+478
+00:36:37,920 --> 00:36:40,760
+respiratory drive يرجع لل oxygen برجع ال
+
+479
+00:36:40,760 --> 00:36:44,100
+respiratory drive لمين؟ لل oxygen لإن أنا الآن
+
+480
+00:36:44,100 --> 00:36:49,000
+بتعامل مع حالة هيبوكسيا low oxygen tension في
+
+481
+00:36:49,000 --> 00:36:52,340
+الحالة هذه بيصير ال oxygen هو اللي اتحكم يعني مش
+
+482
+00:36:52,340 --> 00:36:56,410
+transient controlزي ما بيعمل الـ carbon dioxide
+
+483
+00:36:56,410 --> 00:37:00,070
+for the minute to minute regulation، لأ أنا بتكلم
+
+484
+00:37:00,070 --> 00:37:06,330
+سنة على إيه؟ prolonged regulation، control على
+
+485
+00:37:06,330 --> 00:37:08,810
+prolonged time، بيرش على الأكسجين هو اللي إيه؟
+
+486
+00:37:08,810 --> 00:37:13,590
+ياخد ال upper hand، زي ما هنتكلم بعد شويةفي مسألة
+
+487
+00:37:13,590 --> 00:37:15,990
+ال acclimatization اللي بتصير لما احنا نطلع على
+
+488
+00:37:15,990 --> 00:37:22,570
+ايه؟ على جبل و نقعد هناك فترة طويلة او متسلقين
+
+489
+00:37:22,570 --> 00:37:26,690
+شبال كل يوم بيعالو لهم اربعمية، خمسمية متر إضافي
+
+490
+00:37:26,690 --> 00:37:31,650
+او كده، تمام؟ فكل يوم بيخشوا في مناطق oxygen
+
+491
+00:37:31,650 --> 00:37:35,250
+tension اقل من ال ايه؟ من اليوم اللي جابله، تمام؟
+
+492
+00:37:37,670 --> 00:37:42,230
+إذا قلنا هذا التحكم ممكن يستمر يومين بس بعد كده
+
+493
+00:37:42,230 --> 00:37:48,190
+بيصير عندي إيه ال oxygen بيصير ماخد ال upper hand
+
+494
+00:37:48,190 --> 00:37:51,890
+و ال carbon dioxide بيفقد أربع أخماس ال
+
+495
+00:37:51,890 --> 00:37:59,250
+sensitivity تبعته تمام؟ طيب a
+
+496
+00:37:59,250 --> 00:38:01,970
+change in blood carbon dioxide concentration
+
+497
+00:38:01,970 --> 00:38:07,230
+therefore has a potent acute effect تمام؟ إشي سريع
+
+498
+00:38:07,470 --> 00:38:10,470
+من الـ two minutes زي ما قلت لكم on controlling on
+
+499
+00:38:10,470 --> 00:38:14,470
+controlling respiratory drive but only a weak
+
+500
+00:38:14,470 --> 00:38:18,250
+chronic effect after a few days adaptation بعد
+
+501
+00:38:18,250 --> 00:38:26,110
+يومين تلاتة بيبدأ كرمان ديكسودي افقد صلاحيته طيب
+
+502
+00:38:26,110 --> 00:38:31,410
+بالارقام
+
+503
+00:38:31,410 --> 00:38:36,830
+هنا اتكلم عن علاقة بين ال alveolar ventilation وال
+
+504
+00:38:41,980 --> 00:38:50,380
+البراشر والهيدروجين ايه؟ البراشر
+
+505
+00:38:50,380 --> 00:38:50,880
+والهيدروجين ايه؟ البراشر والهيدروجين ايه؟ البراشر
+
+506
+00:38:50,880 --> 00:38:50,900
+والهيدروجين ايه؟ البراشر والهيدروجين ايه؟ البراشر
+
+507
+00:38:50,900 --> 00:38:59,320
+والهيدروجين ايه؟ البراشر والهيدروجين ايه؟ البراشر
+
+508
+00:38:59,320 --> 00:39:03,300
+والهيدروجين ايه؟و ال Venus side خمسة عاملين احنا
+
+509
+00:39:03,300 --> 00:39:06,540
+اللي بيهمنا فيها ال arterial ليش لإنه رايح لل
+
+510
+00:39:06,540 --> 00:39:10,080
+tissues هو مين ال arterial ال sensation هنا و
+
+511
+00:39:10,080 --> 00:39:13,720
+الحاجة محتاجة انه جداش جيبنا arterial مش جداش احنا
+
+512
+00:39:13,720 --> 00:39:17,400
+أخدنا و أسيبنا اخدنا اللي بدنا ايه و تركناه لكن هل
+
+513
+00:39:17,400 --> 00:39:19,460
+اللي جينا كافي ولا لأ لذلك ال arterial هو اللي
+
+514
+00:39:19,460 --> 00:39:24,230
+ايه؟ في ال arterialفي الـ 40 ميلي متر ميركوري
+
+515
+00:39:24,230 --> 00:39:27,810
+كاربون دايوكسايد بروشر بيللاحظ ان عندي normal
+
+516
+00:39:27,810 --> 00:39:30,790
+ventilation واحد يعني normal ventilation اتنين
+
+517
+00:39:30,790 --> 00:39:36,750
+اتضاعف تلاتة يعني واحد يساوي normal rate بإذا ال
+
+518
+00:39:36,750 --> 00:39:42,710
+rate يساوي one تمام؟إذا مجسمة بشكل معين لحظه بعد
+
+519
+00:39:42,710 --> 00:39:48,530
+ما يزيد عندي ال carbon dioxide pressure مش linear
+
+520
+00:39:48,530 --> 00:39:53,610
+بس لأكتر من linear لإنه مش ماخد 45 درجة ماخد حوالي
+
+521
+00:39:53,610 --> 00:39:58,570
+60 درجة ارتفاع يعني كل زيادة في ال carbon dioxide
+
+522
+00:39:58,570 --> 00:40:01,710
+pressure بيقبلها زيادة أكتر في ال ventilation
+
+523
+00:40:01,710 --> 00:40:08,330
+تمام؟هنلاحظ هنا ال BH مختلف ال BH بيصيرش تتغير
+
+524
+00:40:08,330 --> 00:40:10,170
+بسرعة بالسرعة اللي بيصير فيها ال carbon dioxide
+
+525
+00:40:10,170 --> 00:40:12,290
+عشان كده اقول ال carbon dioxide هو ال most
+
+526
+00:40:12,290 --> 00:40:18,810
+sensitive تمام ال BH عشان تتغير هي ال BH ال normal
+
+527
+00:40:18,810 --> 00:40:22,530
+BH هي سبعة و أربعة من عشرة seven point four one مش
+
+528
+00:40:22,530 --> 00:40:29,850
+كده لو ال hydrogen ions concentration زاد يعني ال
+
+529
+00:40:29,850 --> 00:40:36,690
+BH جلتجلّت جلّت جلّت وزيادة خفيفة تأثيره جليل لكن
+
+530
+00:40:36,690 --> 00:40:41,250
+وين في الآخر يعني بعد ما ال BH تهبط تهبط شديد يعني
+
+531
+00:40:41,250 --> 00:40:44,450
+high concentration يعني نعلى كتير بياخد ال upper
+
+532
+00:40:44,450 --> 00:40:47,370
+hand و بيصير عندي rapid stimulation ال ventilation
+
+533
+00:40:47,370 --> 00:40:53,790
+لكن في مراحل طبيعية و زيادة عن الطبيعية و زيادة
+
+534
+00:40:53,790 --> 00:40:58,680
+زيادة عن الطبيعية بيظل ال BH مالاش دور كبيربطيق
+
+535
+00:40:58,680 --> 00:41:02,100
+لكن عند level معين بتصير very strong استيمولات من
+
+536
+00:41:02,100 --> 00:41:06,780
+أول و جديد زي ما احنا شايفين هنا عندما ال bh وصلت
+
+537
+00:41:06,780 --> 00:41:11,760
+الى سبعة من سبعة اربعة من عشرة الى ايه سبعة ووصلت
+
+538
+00:41:11,760 --> 00:41:20,240
+ال maximum تبع ال simulation تبعها اذا
+
+539
+00:41:20,240 --> 00:41:26,810
+هنا خلينا هذا الملخص هنابتديني عاد the approximate
+
+540
+00:41:26,810 --> 00:41:30,670
+effects of blood carbon dioxide pressure and blood
+
+541
+00:41:30,670 --> 00:41:35,070
+pitch on the alveolar ventilation Note especially
+
+542
+00:41:35,070 --> 00:41:41,070
+the very marked increase in ventilation caused by
+
+543
+00:41:41,070 --> 00:41:44,090
+the increase in carbon dioxide tension in the
+
+544
+00:41:44,090 --> 00:41:52,300
+normal range between 35 to 75 mmHg تمام؟هذا يظهر
+
+545
+00:41:52,300 --> 00:42:00,520
+تأثير كبير لتغيير كربون دو أكسيد من هنا لـ 75 و
+
+546
+00:42:00,520 --> 00:42:11,730
+الزيادة مضطرة طب لو صارت 80 و 90 و بتظهر زيادةأه
+
+547
+00:42:11,730 --> 00:42:15,710
+اذا احنا ال curve بدأ ينحنيه وقفنا هيك اخر
+
+548
+00:42:15,710 --> 00:42:20,850
+المحاضرة او اخر الفصل هذا هنتكلم عن طب لو زاد ال
+
+549
+00:42:20,850 --> 00:42:23,890
+carbon dioxide بعد كده لأ بدخلنا في مشاكل بيبدأ
+
+550
+00:42:23,890 --> 00:42:28,430
+يعمل suppression لل respiratory center تمام بيبدأ
+
+551
+00:42:28,430 --> 00:42:32,510
+يعملي loss of .. of .. of awareness بيبدأ يدخلني
+
+552
+00:42:32,510 --> 00:42:35,650
+في coma و level معين بيعملي suppression ال
+
+553
+00:42:35,650 --> 00:42:40,350
+respiratory center تماملذلك هو sensitive لأنه لو
+
+554
+00:42:40,350 --> 00:42:44,350
+زاد خطير لازم الجسم يتخلص اول باول من ايه؟ من ال
+
+555
+00:42:44,350 --> 00:42:47,590
+carbon dioxide لأنه كل ما زاد ال carbon dioxide كل
+
+556
+00:42:47,590 --> 00:42:49,730
+ما انا بدأ ازود ال respiration ل level معين انا
+
+557
+00:42:49,730 --> 00:42:52,970
+خلاص بيصير toxic ل level معين بيصير عندي ايه؟
+
+558
+00:42:52,970 --> 00:42:58,910
+بيصير toxic واضح؟ و انا اتكلم عنها ال different
+
+559
+00:42:58,910 --> 00:43:02,690
+terminology و effect of increased carbon dioxide و
+
+560
+00:43:02,690 --> 00:43:05,770
+effect of hypoxia على البني ادم
+
+561
+00:43:09,080 --> 00:43:14,940
+إذا بين الخمسة و تلاتين يعني قبل الطبيعي بشوية
+
+562
+00:43:14,940 --> 00:43:21,990
+تمام و بين الخمسة و سبعين بصير عندى directعلاقات
+
+563
+00:43:21,990 --> 00:43:24,750
+قوية علاقات قوية علاقات قوية علاقات قوية علاقات
+
+564
+00:43:24,750 --> 00:43:24,910
+قوية علاقات قوية علاقات قوية علاقات قوية علاقات
+
+565
+00:43:24,910 --> 00:43:25,190
+قوية علاقات قوية علاقات قوية علاقات قوية علاقات
+
+566
+00:43:25,190 --> 00:43:25,350
+قوية علاقات قوية علاقات قوية علاقات قوية علاقات
+
+567
+00:43:25,350 --> 00:43:26,550
+قوية علاقات قوية علاقات قوية علاقات قوية علاقات
+
+568
+00:43:26,550 --> 00:43:27,870
+قوية علاقات قوية علاقات قوية علاقات قوية علاقات
+
+569
+00:43:27,870 --> 00:43:28,550
+قوية علاقات قوية علاقات قوية علاقات قوية علاقات
+
+570
+00:43:28,550 --> 00:43:43,210
+قوية علاقات قوية علاقات قوية علاقات قوية
+
+571
+00:43:47,960 --> 00:43:54,160
+وخمسة لسبعة و تلاتة من عشرة ما بيصيرش هداك التغيير
+
+572
+00:43:54,160 --> 00:43:59,680
+يعني التغيير يساوي عشر الطبيعي يعني اشي بسيط بزيد
+
+573
+00:43:59,680 --> 00:44:05,660
+بس بعد كده قلتلكم بعد ما يصل الى سبعة او اتنين
+
+574
+00:44:05,660 --> 00:44:12,020
+مثلا بيبدأ عند الزيادةواضحة كل ما زاد ال hydrogen
+
+575
+00:44:12,020 --> 00:44:18,300
+ion concentration كل ما جلت ال pH كل ما زاد ال
+
+576
+00:44:18,300 --> 00:44:22,120
+hydrogen ion concentration في بعد level معين بيصير
+
+577
+00:44:22,120 --> 00:44:30,800
+strong effect unimportance
+
+578
+00:44:30,800 --> 00:44:32,780
+of the oxygen for control of the respiration
+
+579
+00:44:32,780 --> 00:44:36,260
+center اتكلمنا عنه من شوية وقلنا ليه مش هو الأساس
+
+580
+00:44:36,900 --> 00:44:40,520
+تمام؟ لطبيعتي ال hemoglobin اللي بيحمل ال oxygen
+
+581
+00:44:40,520 --> 00:44:47,380
+بشكل مريح للجسم فانا باتعاملش مع قياس كيف الناس
+
+582
+00:44:47,380 --> 00:44:54,380
+بيعانوا من واحد مدير عام ولا واحد دكتور زيكو مع
+
+583
+00:44:54,380 --> 00:44:59,880
+مصار كتير بروح للعامل الفجير بقوله كيف الأمور،
+
+584
+00:44:59,880 --> 00:45:02,720
+بقول البندورة غالية، ده بالنسبالي مش غالي لشنا
+
+585
+00:45:02,720 --> 00:45:07,010
+يعني لما صارت أربعة شكل ال kilo، ده مش يعنيلكن
+
+586
+00:45:07,010 --> 00:45:11,690
+بالنسبة للفجير بيشتري هوية 6%، 7%، لكن لما تصل إلى
+
+587
+00:45:11,690 --> 00:45:15,370
+الـ 24 كيلوغрам، بالنسباله إيه له؟ مش كده؟ فلذلك
+
+588
+00:45:15,370 --> 00:45:19,110
+هنا، بيجيش الجسم بيسأل اللي عنده وفرة، ال oxygen
+
+589
+00:45:19,110 --> 00:45:23,910
+بيسأل اللي ماعندهوش وفرة، اللي حساس أكتر ال carbon
+
+590
+00:45:23,910 --> 00:45:26,690
+dioxide بيعلق بسرعة، أبوه بطل بسرعة، بيعمل تأثير،
+
+591
+00:45:26,690 --> 00:45:31,050
+لكن ال oxygen تمام؟ ال hemoglobin حامل كتير تمام؟
+
+592
+00:45:31,050 --> 00:45:37,480
+بياخد جد ما هو عايز، و بصرف كم هو عايز، تمام؟إن
+
+593
+00:45:37,480 --> 00:45:40,140
+شاء الله كلكم يعني بكرا تصيروا زي الهموغلوبين هيك
+
+594
+00:45:40,140 --> 00:45:48,900
+تاخدوا جد ما أنتوا عايزين و بتصرفوا .. طيب إذا ..
+
+595
+00:45:50,810 --> 00:45:55,330
+لذلك الـ central factor سار مين ال carbon dioxide
+
+596
+00:45:55,330 --> 00:46:00,450
+بس ل level ل .. ل .. ل .. ل time إلى أجل بعد كده
+
+597
+00:46:00,450 --> 00:46:03,870
+بصير في عندي انا ال hyperventilation اللي صارت
+
+598
+00:46:03,870 --> 00:46:07,170
+بتعمل أوش ل carbon dioxide معناه في عندى مشكلة ال
+
+599
+00:46:07,170 --> 00:46:11,030
+oxygen حقيقية برجع ال oxygen هو اللي ايه يسيطر على
+
+600
+00:46:11,030 --> 00:46:11,650
+الموضوع
+
+601
+00:46:15,400 --> 00:46:20,380
+الـ Preference Chemoreceptors جيبنا سلطة وتكلمنا
+
+602
+00:46:20,380 --> 00:46:27,440
+عنها وقلنا إنه موجودة أسرع في التبليغ .. أسرع في
+
+603
+00:46:27,440 --> 00:46:31,960
+التبليغ لإنه من Ares على طول بالجوال بلغت إنه فيه
+
+604
+00:46:31,960 --> 00:46:36,580
+ماعرفش إيه صار مش وصل لسه لأ على طول في إشارة أدت
+
+605
+00:46:36,580 --> 00:46:40,400
+إلى إنه من أول ما طلع من الجلب الأكسجين هذا لسه
+
+606
+00:46:40,400 --> 00:46:44,330
+طلع من الرقتين وطلع من الجلبحاسه ان في مشكلة ابعته
+
+607
+00:46:44,330 --> 00:46:47,210
+ال respirator center مش محتاجين لسه ال .. ال
+
+608
+00:46:47,210 --> 00:46:53,090
+normal diffusion و المعرفه ايش اه طيب ففي اتصال
+
+609
+00:46:53,090 --> 00:46:57,610
+مباشر ما بين هدول ال centers و ال .. و ال
+
+610
+00:46:57,610 --> 00:47:06,050
+respirator center الان عندي what is the orthic
+
+611
+00:47:06,050 --> 00:47:08,030
+bodies هدول و ال carotid bodies
+
+612
+00:47:13,180 --> 00:47:18,020
+عبارة عن bodies متصلين ب nerves اسمهم herring ..
+
+613
+00:47:18,020 --> 00:47:21,880
+herrings nerves احنا تقولنا herring brower مش كده؟
+
+614
+00:47:21,880 --> 00:47:25,520
+فherring هذا كان عالم اللي له كتير دراسات حول ال
+
+615
+00:47:25,520 --> 00:47:29,600
+ventilation و ال respiration لذلك هو اللي اكتشف ال
+
+616
+00:47:29,600 --> 00:47:34,500
+nerves هذه اللي بتديني ال ايه؟ ال .. ال signals of
+
+617
+00:47:34,500 --> 00:47:38,000
+the concentration of oxygen, carbon dioxide,
+
+618
+00:47:38,220 --> 00:47:41,760
+hydrogen ions في الدم، تمام؟فلذلك كان في hearings
+
+619
+00:47:41,760 --> 00:47:44,500
+نار اتصل ما بين ال carotid bodies و ال
+
+620
+00:47:44,500 --> 00:47:50,740
+glossopharyngeal اللي هو التاسعة مش كده لجينا انه
+
+621
+00:47:50,740 --> 00:47:56,740
+ال aortic body هذا او ال carotid bodies لو عملناهم
+
+622
+00:47:56,740 --> 00:48:00,120
+تشريح بنلاقي فيهم special type of cells of cells
+
+623
+00:48:00,120 --> 00:48:07,640
+سميناهم ال aglomas cells يسموهم ايه؟ aglomas cells
+
+624
+00:48:07,640 --> 00:48:08,960
+هدول
+
+625
+00:48:11,290 --> 00:48:17,310
+الـ cells هي إيه؟ في الغالب اللي بتديني ال
+
+626
+00:48:17,310 --> 00:48:24,710
+sensation .. sensitive لمين؟ لال ..sensitive لـ
+
+627
+00:48:24,710 --> 00:48:27,170
+carbon dioxide و ال oxygen و ال hydrogen أيضا
+
+628
+00:48:27,170 --> 00:48:30,930
+تمام؟ وبعضهم قال لأ مش ل ال grow muscles هي ل ال
+
+629
+00:48:30,930 --> 00:48:34,350
+bodies sensitive فيها nerve endings ال herring
+
+630
+00:48:34,350 --> 00:48:38,230
+nerves هذه فيها nerve endings هوي ال nerve endings
+
+631
+00:48:38,230 --> 00:48:42,770
+sensitive مباشرة لمين لل concentrations different
+
+632
+00:48:42,770 --> 00:48:46,830
+concentrations طيب ال .. ال .. ال .. الاشي المميز
+
+633
+00:48:46,830 --> 00:48:51,650
+لل bodies هذه احنا في الطبيعه ايه؟في الطبيعي blood
+
+634
+00:48:51,650 --> 00:48:57,270
+supply for an organ كدهش بيكون، بيكون دايما خمس
+
+635
+00:48:57,270 --> 00:49:03,850
+أضعاف وزنه، مش كده؟ يعني كل organ الطبيعي أنه
+
+636
+00:49:03,850 --> 00:49:08,870
+يصلوا خمس أضعاف وزنه دم في دقيقةلما ألاقي أنا
+
+637
+00:49:08,870 --> 00:49:16,530
+organ بيصله عشرين ضعف وزنه اذا هو الدم اللي جايله
+
+638
+00:49:16,530 --> 00:49:21,430
+مش جايله علشان for its for the oxygen usage جايله
+
+639
+00:49:21,430 --> 00:49:26,310
+لسبب تاني تمام؟ اذا هنا بنطلع بنلاقي ان ال carotid
+
+640
+00:49:26,310 --> 00:49:30,930
+blood اللي بيجيها عشرين ضعف وزنها blood اذا كمية
+
+641
+00:49:30,930 --> 00:49:35,190
+ال oxygen اللي هي هتاخده من الدم مهما تاخد هيضل
+
+642
+00:49:36,190 --> 00:49:41,270
+هيظل عندى وفرة من ال oxygen موجودة يعنى الدم اللى
+
+643
+00:49:41,270 --> 00:49:45,630
+داخل محتاج تقربه اكسجينه لمن؟ لل body اذا كان هذا
+
+644
+00:49:45,630 --> 00:49:49,270
+active وماخد ال maximum تبعه اذا في عندى انا
+
+645
+00:49:49,270 --> 00:49:52,670
+تقريبا الدم اللى داخل ك routed bodies وطالع منه
+
+646
+00:49:52,670 --> 00:49:57,070
+اذا هو عبارة عن arterial blood مافقدش كمية ايه
+
+647
+00:49:57,070 --> 00:50:02,850
+كافية لان هو دم كتير بيدخل فالفقدان اللى بيصير مش
+
+648
+00:50:02,850 --> 00:50:08,290
+ايه مش كماهو متوقع لإن كمية الدم لدخل كتيرة إذا
+
+649
+00:50:08,290 --> 00:50:13,290
+هذا بتديني إن هذا عبارة عن ممر to sense to detect
+
+650
+00:50:13,290 --> 00:50:15,870
+what is the percentage what is the concentration
+
+651
+00:50:15,870 --> 00:50:20,310
+of oxygen carbon dioxideاكتر من انها for its use
+
+652
+00:50:20,310 --> 00:50:26,470
+مش معقول انه جاي لل usage of شكفة لحمة صغيرة مش
+
+653
+00:50:26,470 --> 00:50:32,470
+عضلة ولا اشي ولا حاجة مابتفقدش طاقة كبيرة و بيجيها
+
+654
+00:50:32,470 --> 00:50:37,270
+عشرين ضعف وزنها دم اذا واضح هنا عشان تكون very
+
+655
+00:50:37,270 --> 00:50:41,130
+sensitive to the changes in the A و بيجيها مباشرة
+
+656
+00:50:41,130 --> 00:50:47,540
+من ال carotidبشيها مباشرة من الـ arterial من
+
+657
+00:50:47,540 --> 00:50:53,340
+الأورطة تمام بشيها دم يديها فكرة عن إيش اللي بصير
+
+658
+00:50:53,340 --> 00:51:08,220
+واضح تقارير دقيقة طيب
+
+659
+00:51:15,450 --> 00:51:18,870
+Simulation of chemoreceptors by decreased arterial
+
+660
+00:51:18,870 --> 00:51:23,130
+oxygen Simulation of chemoreceptors by decreased
+
+661
+00:51:23,130 --> 00:51:26,590
+.. اذا هنا في ال chemoreceptors هذي كنا كنا كنا
+
+662
+00:51:26,590 --> 00:51:27,830
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+663
+00:51:27,830 --> 00:51:28,350
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+664
+00:51:28,350 --> 00:51:30,510
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+665
+00:51:30,510 --> 00:51:30,770
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+666
+00:51:30,770 --> 00:51:33,890
+كنا كنا كنا كنا كنا كنا كنا كنا
+
+667
+00:51:33,890 --> 00:51:36,570
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+668
+00:51:36,570 --> 00:51:41,410
+كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا كنا
+
+669
+00:51:41,410 --> 00:51:47,370
+كناهنا طلعنا على ال nerves هذه ال hearing nerve
+
+670
+00:51:47,370 --> 00:51:52,750
+طلعنا على ال activity تبعته جداش بيبعت signals اه
+
+671
+00:51:52,750 --> 00:51:55,850
+و احنا منعديله carbon dioxide concentrations
+
+672
+00:51:55,850 --> 00:51:59,270
+ومنعديله oxygen ومنعديله عشان نعرف الجثة طلعنا
+
+673
+00:51:59,270 --> 00:52:06,330
+لجينا انه لما اعطينا pressure of oxygenأه مية أو
+
+674
+00:52:06,330 --> 00:52:10,950
+فوق المية تمام إلى حد ما التغيير في ال .. في ال ..
+
+675
+00:52:10,950 --> 00:52:16,800
+في ال signalsالـ nerve signals جليل جدا لكن لما ال
+
+676
+00:52:16,800 --> 00:52:22,200
+pressure of oxygen جال العنمية لجينا عندى a very
+
+677
+00:52:22,200 --> 00:52:27,400
+rapid change in the intensity of the signals واضح؟
+
+678
+00:52:27,400 --> 00:52:31,620
+لذا لما يكون عندى انا pressure pressure واطى بطلع
+
+679
+00:52:31,620 --> 00:52:38,360
+بلاقي عندى highly stimulated nerve لما ايه لما كل
+
+680
+00:52:38,360 --> 00:52:43,110
+ما زاد ال oxygen concentrationكل signal rate ب إيه
+
+681
+00:52:43,110 --> 00:52:47,610
+بيقل واضح إذا هنا إيه إذا ال oxygen pressure is
+
+682
+00:52:47,610 --> 00:52:53,470
+very important Note
+
+683
+00:52:53,470 --> 00:52:56,710
+that the impulse rate is particularly sensitive to
+
+684
+00:52:56,710 --> 00:53:00,090
+changes in arterial pressure of oxygen in the
+
+685
+00:53:00,090 --> 00:53:06,210
+range between 60 and 30millimeter mercury a range
+
+686
+00:53:06,210 --> 00:53:08,390
+at which hemoglobin saturation with oxygen
+
+687
+00:53:08,390 --> 00:53:12,350
+decreases rapidly احنا لحد ال 60 قلنا ال
+
+688
+00:53:12,350 --> 00:53:15,790
+saturation بيكون طبيعي لكن لو نزل عن ال 60 صار ال
+
+689
+00:53:15,790 --> 00:53:20,070
+arterial pressure تبعنا اقل من 60 معناها ال
+
+690
+00:53:20,070 --> 00:53:25,450
+saturation بيكون مش مكتمل بيصير احنا قلنا لحد ال
+
+691
+00:53:25,450 --> 00:53:33,770
+60 89 percent saturated مش كده من من من 60الى ال
+
+692
+00:53:33,770 --> 00:53:39,630
+.. ال .. ال 104 الفرق بسيط تسعة تمانية في المية
+
+693
+00:53:39,630 --> 00:53:43,450
+ولا تسعة في المية الفرق مش كده لكن بعد الستين
+
+694
+00:53:43,450 --> 00:53:46,790
+مالاج الكيروس تبعنا ال S شابه هو بيبدأ ايه هبوط
+
+695
+00:53:46,790 --> 00:53:51,620
+شديد فبين الستين والتلاتينتمام؟ بلاقي انا عندى
+
+696
+00:53:51,620 --> 00:53:54,120
+بيصير فرق كبير في ال saturation of oxygen .. of ال
+
+697
+00:53:54,120 --> 00:53:57,100
+hemoglobin في ال lungs فمحتاج انا ال ventilation
+
+698
+00:53:57,100 --> 00:54:01,220
+ايه لازم يعلن صار انا عندى ال hemoglobin buffering
+
+699
+00:54:01,220 --> 00:54:04,640
+system تبعنا مش قادر يغطي هذه الجزية لإن هو هنا ..
+
+700
+00:54:04,640 --> 00:54:09,000
+صار هو مصمم لما نزل عن ال 60 .. عن ال 60 صار ان
+
+701
+00:54:09,000 --> 00:54:12,180
+انا بتعامل مع ال tissues مش بتعامل مع ال lungs ف
+
+702
+00:54:12,180 --> 00:54:15,760
+.. ف .. فبحملش oxygen كتير تمام؟ فالحالة هي لازم
+
+703
+00:54:15,760 --> 00:54:20,810
+يصير انا بال ventilationعشان نحاول نعوض فلذلك هنا
+
+704
+00:54:20,810 --> 00:54:25,090
+ملاحظ الفرق من هان هنا هيك و انا هنا حوالي ستين
+
+705
+00:54:25,090 --> 00:54:31,670
+تمام ال steaming up اه high stimulation of the
+
+706
+00:54:31,670 --> 00:54:35,390
+nerves that tells the respiratory center that
+
+707
+00:54:35,390 --> 00:54:39,070
+there is a problem مش كده for hyper activity
+
+708
+00:54:39,070 --> 00:54:42,390
+effect
+
+709
+00:54:42,390 --> 00:54:44,830
+of carbon dioxide and hydrogen concentration on
+
+710
+00:54:44,830 --> 00:54:46,110
+chemoreceptors activity
+
+711
+00:54:48,680 --> 00:54:54,520
+هتقولنا ايه؟ تأثيرها اقل من ال .. من ال oxygen
+
+712
+00:54:54,520 --> 00:55:01,200
+وتأثيرها اقل من ال central لكنها more .. more
+
+713
+00:55:01,200 --> 00:55:02,760
+rapid more rapid
+
+714
+00:55:06,050 --> 00:55:10,170
+طيب نرجع تاني و نقول the effect of low arterial
+
+715
+00:55:10,170 --> 00:55:13,890
+partial pressure of oxygen to stimulate alveolar
+
+716
+00:55:13,890 --> 00:55:17,490
+ventilation when arterial carbon dioxide and
+
+717
+00:55:17,490 --> 00:55:21,170
+hydrogen ions concentration remain normal تمام؟
+
+718
+00:55:21,170 --> 00:55:26,350
+هنا بتيجي عندي أنا العلاقة
+
+719
+00:55:26,350 --> 00:55:30,390
+هذا ال figure هذا لو أنا ثبتي تانب الأخضر ال
+
+720
+00:55:30,390 --> 00:55:32,810
+carbon dioxide concentration و ال hydrogen ions
+
+721
+00:55:32,810 --> 00:55:39,810
+معاهابطلع بلاقي انا عندى ال oxygen ك one factor ما
+
+722
+00:55:39,810 --> 00:55:43,940
+احنا دائما في الأبحاث بنعمل حسابنامن ثبت كل ال
+
+723
+00:55:43,940 --> 00:55:47,520
+factors ومن خلّيه بس واحد ايش متغير عشان التغيير
+
+724
+00:55:47,520 --> 00:55:51,900
+يبقى مرتبط بهذا الشسمة فمن طالع احنا هان منلاقي
+
+725
+00:55:51,900 --> 00:55:55,480
+انه عندنا كل ما هبط ال pressure أو ال oxygen كل ما
+
+726
+00:55:55,480 --> 00:56:00,020
+كان في عندي more stimulation لإيه؟ ل ال alveolar
+
+727
+00:56:00,020 --> 00:56:04,940
+ventilation مش كده؟ و بيصير عندي more wash
+
+728
+00:56:12,320 --> 00:56:16,960
+more wash يعني more carbon dioxide هنا ايش ال
+
+729
+00:56:16,960 --> 00:56:20,560
+oxygen هان ال ventilation هان بيزيد مع ال carbon
+
+730
+00:56:20,560 --> 00:56:25,080
+dioxide مع ال oxygen pressure drop oxygen pressure
+
+731
+00:56:25,080 --> 00:56:29,700
+drop بلاقي انا انه ايه بيزيد ال ال ventilation
+
+732
+00:56:29,700 --> 00:56:34,700
+واضح اكتر pressure of oxygen of carbon dioxide هان
+
+733
+00:56:34,700 --> 00:56:41,960
+كل ما زاد ال ventilation كل ما
+
+734
+00:56:45,200 --> 00:56:50,640
+أحنا هنا مثبتينه ل 40 احنا عاملينه factor ثابت فى
+
+735
+00:56:50,640 --> 00:56:55,560
+عدم وجود المتغيرات الأخرى بلاحظ انه فى عندى direct
+
+736
+00:56:55,560 --> 00:56:58,800
+relationship بين و كل ما هبط اكتر ال carbon
+
+737
+00:56:58,800 --> 00:57:01,200
+dioxide زى ما انتوا شايفين ال oxygen tension هنا
+
+738
+00:57:01,200 --> 00:57:05,840
+إلى حد ما linear لكن بعد كده steeping upلما نزل عن
+
+739
+00:57:05,840 --> 00:57:11,180
+ال 60 لما نزل عن ال 60 صار very rapid effect لل
+
+740
+00:57:11,180 --> 00:57:16,520
+ايه؟ لل oxygen tension على ال ventilation almost
+
+741
+00:57:16,520 --> 00:57:19,240
+no effect on ventilation as long as the arterial
+
+742
+00:57:19,240 --> 00:57:21,300
+pressure of oxygen remains greater than one
+
+743
+00:57:21,300 --> 00:57:26,400
+hundred تمام؟ لكن بعدين بيصير يتزايد على مرحلتين
+
+744
+00:57:26,400 --> 00:57:32,420
+لحد ال 60 تغير بطيء لكن لحد تحت ال 60 تغير شديد
+
+745
+00:57:34,040 --> 00:57:38,820
+chronic breathing of low oxygen simulates
+
+746
+00:57:38,820 --> 00:57:42,200
+respiration even more than the phenomenon of
+
+747
+00:57:42,200 --> 00:57:46,260
+acclimatization وهذه ال phenomenon هنلاقيها في
+
+748
+00:57:46,260 --> 00:57:54,300
+الجسم كتير الجسم كيف انه بيتأقلم مع التغير تمام؟
+
+749
+00:57:56,100 --> 00:58:01,900
+يعني عندي أنا مضطر أعيش في جو أكسجين واطي تمام،
+
+750
+00:58:01,900 --> 00:58:06,720
+أولها بلاقي صار عندي أنا تأثير
+
+751
+00:58:06,720 --> 00:58:11,420
+سلبي، بعد شوية بلاقي اختفىتمام؟ لإن بدي أتأقلم
+
+752
+00:58:11,420 --> 00:58:15,420
+معاه هنلاقيها في أشياء كتيرة في الجسم هذه الظاهرة
+
+753
+00:58:15,420 --> 00:58:21,400
+هذه الظاهرة احنا بنحسها وين في الناس اللي بيصعدوا
+
+754
+00:58:21,400 --> 00:58:25,700
+الجبال تمام؟ إيش بيلاحظوا فيها؟ بيلاحظوا إن الأيام
+
+755
+00:58:25,700 --> 00:58:31,540
+الأولى النفس عندهم بيزيد سرعته وبيزيد ال rate و ال
+
+756
+00:58:31,540 --> 00:58:36,130
+depth of respiration بس بعد شويةتمام بعد يومين
+
+757
+00:58:36,130 --> 00:58:40,650
+تلاتة برجع الأوامر الطبيعية mountain climbers have
+
+758
+00:58:40,650 --> 00:58:45,250
+found that when they ascend a mountain slowly over
+
+759
+00:58:45,250 --> 00:58:48,010
+a period of days rather than a period of hours
+
+760
+00:58:48,010 --> 00:58:53,370
+they breathe much more deeply and therefore can
+
+761
+00:58:53,370 --> 00:58:55,930
+withstand far lower atmospheric oxygen
+
+762
+00:58:55,930 --> 00:59:02,230
+concentrations than when they ascend rapidlyتمام؟
+
+763
+00:59:02,230 --> 00:59:06,510
+اذا لو طلعوا بشواش هيلاجوا حالهم انهم مافيش .. مش
+
+764
+00:59:06,510 --> 00:59:11,070
+حاسين مشكلة في التنفس لكن لو طلع سريع هيحس ب
+
+765
+00:59:11,070 --> 00:59:16,810
+hypoxia هيحس انه متضايق هيحس انه في وضع مش طبيعي
+
+766
+00:59:16,810 --> 00:59:22,570
+لكن لو طلع شوية شوية اه هيحس انه لأ انه نفسه طبيعي
+
+767
+00:59:22,570 --> 00:59:29,010
+و بيزيد العمق النفس و بيزيد ال .. ال .. عمق النفس
+
+768
+00:59:29,010 --> 00:59:34,670
+بالذات بيحس انهما بيحسش بال .. بال .. بالhypoxia
+
+769
+00:59:34,670 --> 00:59:38,110
+بيحسش انه هو موجود في .. في جوا مافيش فيه oxygen
+
+770
+00:59:38,110 --> 00:59:43,490
+تمام؟ طيب هذه قلتلكم انا ايه سببها سببها انه ال
+
+771
+00:59:43,490 --> 00:59:46,390
+carbon dioxide effect اللي كان ماخد ال upper hand
+
+772
+00:59:46,390 --> 00:59:51,070
+اول يومين بعد كده بنزل تأثيره الى ال .. الربع
+
+773
+00:59:51,070 --> 00:59:56,670
+الخمس اربع اخمس بتروح و بيضل عندى ايه بس خمس ال
+
+774
+00:59:56,670 --> 00:59:59,890
+sensitivity تبعته و ال oxygen بياخد ال upper hand
+
+775
+00:59:59,890 --> 01:00:04,690
+تمام؟و هذه حكينا من اول ليش ان ال oxygen في الاول
+
+776
+01:00:04,690 --> 01:00:07,610
+هو ال carbon dioxide هو more sensitive لكن انا لما
+
+777
+01:00:07,610 --> 01:00:11,910
+يكون عندى انا اذا بدى اقعد من هنا في ال high
+
+778
+01:00:11,910 --> 01:00:15,450
+altitudes بدى اقعد من على ال carbon dioxide ما انا
+
+779
+01:00:15,450 --> 01:00:19,490
+ال hyperventilation اللى صارت washed out washed
+
+780
+01:00:19,490 --> 01:00:23,610
+out ال carbon dioxide فال stimulant راح فهخش في
+
+781
+01:00:23,610 --> 01:00:27,730
+ايه في hyperventilation من جديد لكن حقيقة ال
+
+782
+01:00:27,730 --> 01:00:31,320
+oxygen concentration ماتغيرش واطيالـ Oxygen
+
+783
+01:00:31,320 --> 01:00:34,520
+الواطي، دل واطي، تمام؟ في الحالة هذه الـ Carbon
+
+784
+01:00:34,520 --> 01:00:37,300
+Dioxide بطل هو الايه؟ الـ Main Stimulant بيصير ال
+
+785
+01:00:37,300 --> 01:00:42,080
+.. واضح؟ يعني التأثير الـ Carbon Dioxide السريع
+
+786
+01:00:42,080 --> 01:00:46,180
+اختفى لإن أنا صار Hyperventilation بسبب Carbon
+
+787
+01:00:46,180 --> 01:00:50,440
+Dioxide بس راح الـ Carbon Dioxide و بعدين، مدى ما
+
+788
+01:00:50,440 --> 01:00:53,040
+راح الـ Hyperventilation، اضل انا خاشش في Low
+
+789
+01:00:53,040 --> 01:00:57,220
+Ventilation Rate و في Hypoxiaلأ بيصير عندى ال
+
+790
+01:00:57,220 --> 01:01:00,680
+hypoxia الموجودة هي ال main stimulant مظبوط او مش
+
+791
+01:01:00,680 --> 01:01:04,020
+مظبوط انا شايف ناس نعسانين يبدو ان ال emulators في
+
+792
+01:01:04,020 --> 01:01:08,020
+الكلمات من بيه عصامه او من بيه صاممه تمام؟ واضح ال
+
+793
+01:01:08,020 --> 01:01:12,260
+acclimatization كده بتصير؟ اذا بعد يومين بيصير انا
+
+794
+01:01:12,260 --> 01:01:16,640
+مش بحتاج ال carbon dioxide هو اللى يتحكم لأن ال
+
+795
+01:01:16,640 --> 01:01:20,480
+hyperventilation صلحه لكن ال hypoxia هي الموجودة
+
+796
+01:01:20,480 --> 01:01:24,100
+فبيصير هي ال ايه؟ ال main stimulant واضح؟
+
+797
+01:01:27,320 --> 01:01:31,300
+بالإضافة لـ 70% المزيد من الانفجار اللي يمكن أن
+
+798
+01:01:31,300 --> 01:01:36,290
+يحدث بعد اكتشاف عالي لقليل من الانفجاراللي هو يعني
+
+799
+01:01:36,290 --> 01:01:38,870
+انا تأثير ال carbon dioxide اللي بسيط ال oxygen
+
+800
+01:01:38,870 --> 01:01:42,710
+اللي بسيط بيزودي ال oxygen بالنسبة ليش ال 70%؟ بدل
+
+801
+01:01:42,710 --> 01:01:46,490
+ما كان carbon dioxide هو ال main اه و ال oxygen 70
+
+802
+01:01:46,490 --> 01:01:50,930
+% فقط بعد يومين تلاتة of exposure to such
+
+803
+01:01:50,930 --> 01:01:53,830
+environment the alveolar ventilation often
+
+804
+01:01:53,830 --> 01:01:58,610
+increases 400 to 500 percent after two to three
+
+805
+01:01:58,610 --> 01:02:05,870
+days of low oxygenهذا يساعد كثيرًا في إعطاء أكسجين
+
+806
+01:02:05,870 --> 01:02:10,170
+إضافي إذا في الوضع الطبيعي زيادة الأكسجين تأثيره
+
+807
+01:02:10,170 --> 01:02:14,450
+سبعين المية زيادة تمام ال carbon dioxide تأثيره
+
+808
+01:02:14,450 --> 01:02:17,030
+أعلى كتير لكن بعد يومين تلاتة ال carbon dioxide
+
+809
+01:02:17,030 --> 01:02:21,130
+بفقد تأثيره وال oxygen effect بيصير ايه مش سبعين
+
+810
+01:02:21,130 --> 01:02:24,350
+المية بيصير اربعمية المية خمسمية المية تأثير
+
+811
+01:02:24,350 --> 01:02:28,490
+فبيعود ياخد ال upper hand وهذا منطق انه انا انا
+
+812
+01:02:28,490 --> 01:02:28,850
+المشكلة
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY.srt
new file mode 100644
index 0000000000000000000000000000000000000000..c7f57268fad5574509a35841445053f5ffbab5e9
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY.srt
@@ -0,0 +1,3209 @@
+1
+00:00:08,980 --> 00:00:15,240
+إذا لو نظرنا هنا إلى المنحنى هذا، اللي هو الأهم
+
+2
+00:00:16,130 --> 00:00:19,790
+بتدينا مواصفات العلاقة ما بين الـ hemoglobin و الـ
+
+3
+00:00:19,790 --> 00:00:25,470
+oxygen. بنلاحظ أنه عندنا في الـ oxygen هذا الـ curve
+
+4
+00:00:25,470 --> 00:00:30,170
+اللي يعني يمثل الـ hemoglobin فيه، إله حاجة اسمها
+
+5
+00:00:30,170 --> 00:00:34,010
+buffering effect of hemoglobin. الـ hemoglobin إله
+
+6
+00:00:34,010 --> 00:00:38,950
+buffering effect، فيه حملة للإيه؟ للـ oxygen، بحيث
+
+7
+00:00:38,950 --> 00:00:43,590
+أنه يحافظ على البرشر، pressure of oxygen في الـ
+
+8
+00:00:43,590 --> 00:00:47,700
+capillary side، في الـ Interstitial Fluid ثابت، لأنه
+
+9
+00:00:47,700 --> 00:00:52,340
+الأساس في تغير الخلايا بالأكسجين اللي هو الـ
+
+10
+00:00:52,340 --> 00:00:56,240
+pressure of oxygen في الـ Interstitial Fluid، بمعنى
+
+11
+00:00:56,240 --> 00:01:00,940
+أنه الـ Hemoglobin مهمته الرئيسية أنه يحافظ على
+
+12
+00:01:00,940 --> 00:01:05,300
+مستوى معين من الـ pressure of oxygen في الـ
+
+13
+00:01:05,300 --> 00:01:08,100
+Interstitial Fluid. وهذا اللي بنلاحظه هنا في
+
+14
+00:01:08,100 --> 00:01:14,100
+المنطقة اللي في، المنطقة الـ cells ومنطقة الـ
+
+15
+00:01:14,100 --> 00:01:17,600
+capillaries، اللي هي تعبر عن الـ interstitial fluid.
+
+16
+00:01:17,600 --> 00:01:22,580
+المنطقة هادي في الـ curve، ماللاحظ فيها إنه الانخفاض
+
+17
+00:01:22,580 --> 00:01:28,200
+هنا steep، نازل نزول، بمعنى إنه بجل الـ oxygen volume
+
+18
+00:01:28,200 --> 00:01:34,180
+لكن الـ pressure، نقصان الـ pressure جليل، نازل نزول
+
+19
+00:01:34,180 --> 00:01:37,520
+يعني وكأنه من درجة لدرجة في الـ pressure بسيطة،
+
+20
+00:01:37,520 --> 00:01:41,420
+بيفقد كمية كبيرة من الـ.. فإذا هذا الـ
+
+21
+00:01:41,420 --> 00:01:45,600
+steep effect تبعت الـ إيه؟ الـ curve هنا بيوضح لنا
+
+22
+00:01:45,600 --> 00:01:52,340
+أنه الـ.. الـ differences in partial pressure و الـ
+
+23
+00:01:52,340 --> 00:01:56,640
+oxygen is minimal في الـ tissues. لاحظوا إنه ممكن
+
+24
+00:01:56,640 --> 00:02:00,940
+ندى كمية ضخمة جداً، تلت أضعاف الطبيعي، الطبيعي من هنا
+
+25
+00:02:00,940 --> 00:02:08,070
+لهنا، من الـ arterial pressure of oxygen اللي هو
+
+26
+00:02:08,070 --> 00:02:15,770
+قولنا يمثل عشرين تقريباً، أو nineteen point four ملي
+
+27
+00:02:15,770 --> 00:02:20,110
+لتر of oxygen percent، إلى الـ forty percent
+
+28
+00:02:20,110 --> 00:02:24,090
+pressure هنا اللي تمثل، يمثلها fourteen point four
+
+29
+00:02:24,090 --> 00:02:29,250
+الفرق هنا، من، من الخمسة وتسعين إلى الأربعين، الفرق
+
+30
+00:02:29,250 --> 00:02:35,620
+خمسة ملي لتر oxygen percent، تمام؟ لكن لاحظوا من
+
+31
+00:02:35,620 --> 00:02:40,760
+خمسة و تسعين لأربعين، خمس و ست.. خمسة و.. و خمسين
+
+32
+00:02:40,760 --> 00:02:43,880
+في المية، مش هيك، خمسة وخمسين millimeter mercury،
+
+33
+00:02:43,880 --> 00:02:47,440
+فقط بيفقد الـ hemoglobin فوق في منطقة.. في منطقة
+
+34
+00:02:47,440 --> 00:02:51,660
+هذه الخمسة، لكن منطقة الكابيلارز الفقدان من.. من..
+
+35
+00:02:51,660 --> 00:03:00,030
+من أربعين وعشرين، بين 40 و 20 حوالي، أو بين 40 و..
+
+36
+00:03:00,030 --> 00:03:04,430
+آه و 15 حوالي، عندي أنا الفرق يعني بين 20
+
+37
+00:03:04,430 --> 00:03:08,330
+millimeter mercury بنفقد تلت أضعاف، بنفقد كمان 15
+
+38
+00:03:08,330 --> 00:03:14,510
+milliliter، من 14 و 4 إلى 4 هنا.. هنا 4 و 4، بين الـ
+
+39
+00:03:14,510 --> 00:03:19,370
+40 و 20، تمام؟ إذا في 20 millimeter mercury
+
+40
+00:03:19,370 --> 00:03:22,860
+pressure of difference في منطقة الـ tissues بيصير
+
+41
+00:03:22,860 --> 00:03:26,400
+فقدان كمية ضخمة جداً من الـ oxygen، حتى يحافظ على إيه؟
+
+42
+00:03:26,400 --> 00:03:29,420
+على الـ partial pressure ما إيه؟ ما ينزلش بسهولة، إذا
+
+43
+00:03:29,420 --> 00:03:32,100
+بدي oxygen، بدي oxygen، بدي oxygen بكمية كبيرة، إذا
+
+44
+00:03:32,100 --> 00:03:35,240
+الفرق الـ pressure بيكون إيه؟ بيكون جليل، ويتظل محفوظ،
+
+45
+00:03:35,240 --> 00:03:38,280
+هذه المسألة على الـ pressure اللي ده العالي، إذا في
+
+46
+00:03:38,280 --> 00:03:42,600
+عندي أنا حاجة بسميها the buffering effect of
+
+47
+00:03:42,600 --> 00:03:47,200
+hemoglobin، تمام؟ بمعنى إنه the role of hemoglobin
+
+48
+00:03:47,200 --> 00:03:51,100
+is to maintain nearly constant partial pressure of
+
+49
+00:03:51,100 --> 00:03:53,880
+oxygen in the tissues، واضح؟ وهذا الـ steep
+
+50
+00:03:53,880 --> 00:03:59,360
+effect تبعها هو سبب رئيسي، منها، الحاجة التانية اللي
+
+51
+00:03:59,360 --> 00:04:04,500
+بتصير، إنه ساعة ما يصير عندي نقصان في pressure in
+
+52
+00:04:04,500 --> 00:04:08,540
+the tissues، بيصير vasodilatation، فبقدر أن الـ flow
+
+53
+00:04:08,540 --> 00:04:13,720
+يزيد، flow زايد، مع hemoglobin زايد، مع oxygen محمول
+
+54
+00:04:13,720 --> 00:04:18,160
+عليه، بيؤدي إلى إيه؟ إلى إنه يديني more supply of
+
+55
+00:04:18,160 --> 00:04:21,740
+oxygen، بيؤدي إلى إنه ما ينهبطش لإيه؟ برشا برشا
+
+56
+00:04:21,740 --> 00:04:24,820
+أكثر، واضح؟ إذا الـ pressure، pressure effect
+
+57
+00:04:24,820 --> 00:04:32,480
+الأساسي تبع الـ cellular interstitial fluid المنطقة
+
+58
+00:04:32,480 --> 00:04:34,780
+هي اللي لازم يبقى ثابت، من خلال mainly الـ
+
+59
+00:04:34,780 --> 00:04:38,160
+hemoglobin، و بيلاحظوا إنه بيزيد الـ blood flow حتى
+
+60
+00:04:38,160 --> 00:04:42,060
+يزود برضه الـ oxygen supply، إذا during heavy
+
+61
+00:04:42,060 --> 00:04:47,020
+exercise، extra amounts of oxygen as much as twenty
+
+62
+00:04:47,020 --> 00:04:50,400
+times normal must be delivered from the hemoglobin
+
+63
+00:04:50,400 --> 00:04:51,560
+to the tissues.
+
+64
+00:04:55,280 --> 00:05:00,880
+but this can be achieved، إذا عندي أنا ممكن أزيد الـ
+
+65
+00:05:00,880 --> 00:05:04,160
+الـ
+
+66
+00:05:04,160 --> 00:05:06,860
+oxygen supplied to the tissues during exercise
+
+67
+00:05:06,860 --> 00:05:10,500
+حوالي عشرين مرة، تلاتة منهم بسبب اللي قولنا عليه،
+
+68
+00:05:10,500 --> 00:05:16,000
+أنه قدرة الـ hemoglobin أنه يعطي more oxygen، بدي
+
+69
+00:05:16,000 --> 00:05:21,520
+تلت أضعاف من خمسة، بدي 15، تلت أضعاف، بالإضافة لإنه
+
+70
+00:05:21,520 --> 00:05:27,500
+during exercise، الـ blood flow بيزيد 6 إلى 7 مرات،
+
+71
+00:05:27,500 --> 00:05:32,040
+فبيؤدي إلى حوالي عشرين ضعف زيادة للإيه؟ للـ tissues
+
+72
+00:05:32,040 --> 00:05:36,880
+oxygen supply، طبعاً هنا بدخل عند عاملين إضافيين، أو
+
+73
+00:05:36,880 --> 00:05:40,900
+تلاتة، بيزيدوا عملية الـ إيه؟ الـ shift of the curve،
+
+74
+00:05:40,900 --> 00:05:44,020
+بيساعدوا الـ curve، الـ dissociation، كيف تكلمنا عنه،
+
+75
+00:05:44,020 --> 00:05:46,800
+بيساعدوا إنه to إيه؟ to shift to the right، يعني
+
+76
+00:05:46,800 --> 00:05:49,820
+يديني more oxygen، اللي هي إنه during exercise
+
+77
+00:05:49,820 --> 00:05:55,020
+الحرارة بتعلى، مش كده؟ during exercise، الـ carbon
+
+78
+00:05:55,020 --> 00:05:58,840
+dioxide، لأن الـ metabolism زاد، الـ carbon dioxide
+
+79
+00:05:58,840 --> 00:06:04,100
+بيزيد، during exercise، الـ hydrogen ions بتزيد،
+
+80
+00:06:04,100 --> 00:06:09,800
+تلاتة effects بتزيد، ولو صار عندي نقصان حقيقي في
+
+81
+00:06:09,800 --> 00:06:13,310
+الـ oxygen supply لهذه المنطقة، بنلاجي أنه الـ
+
+82
+00:06:13,310 --> 00:06:17,490
+2,3-bisphosphoglycerate برضه بيزيد، بس في الحالة.. هو
+
+83
+00:06:17,490 --> 00:06:20,270
+في الغالب اللي ما بيزيدش أثناء الـ exercise، بيزيد في
+
+84
+00:06:20,270 --> 00:06:23,170
+حالة ما يكون في عندي schema لمنطقة معينة، for a
+
+85
+00:06:23,170 --> 00:06:27,550
+long time، فهو بيعلى، أو بيؤدي إلى إنه يزاوي، يعمل
+
+86
+00:06:27,550 --> 00:06:31,280
+more shift of the curve to the right، بيحسن، الـ less
+
+87
+00:06:31,280 --> 00:06:35,620
+flow of blood، بتديني more oxygen، بحيث يعوض الـ
+
+88
+00:06:35,620 --> 00:06:40,260
+ischemic state بتبع الـ HS1، okay، طيب هذه بالنسبة
+
+89
+00:06:40,260 --> 00:06:45,040
+للـ.. إذا هنا بنقدر نلخّص هذه الجملة، المختصر المفيد،
+
+90
+00:06:45,040 --> 00:06:49,940
+أنه it can be seen من الكلام اللي قلناها، that the
+
+91
+00:06:49,940 --> 00:06:53,360
+hemoglobin in the blood automatically delivers
+
+92
+00:06:53,360 --> 00:06:57,700
+oxygen to the tissues at a pressure that، وهي محافظة
+
+93
+00:06:57,700 --> 00:07:06,600
+بين 15 و 40 مليمتر زئبقي، بحيث ما يتغيرش، تمام؟ إذن من
+
+94
+00:07:06,600 --> 00:07:09,280
+مهام الـ hemoglobin الرئيسية، إنه يحافظ على الـ
+
+95
+00:07:09,280 --> 00:07:11,840
+Interstitial Fluid، pressure of Oxygen
+
+96
+00:07:11,840 --> 00:07:18,640
+constant، وعندما
+
+97
+00:07:18,640 --> 00:07:21,400
+يَتغيّر، محافظة الـ hemoglobin الأطماعي بشكل أكبر، بشكل
+
+98
+00:07:21,400 --> 00:07:26,570
+مختلف، بشكل أكبر، بشكل أكبر، بشكل أكبر، بشكل أكبر، هذا
+
+99
+00:07:26,570 --> 00:07:29,030
+الكلام اللي احنا بنقوله atmospheric، إذا الآن
+
+100
+00:07:29,030 --> 00:07:32,410
+الملاحظة
+
+101
+00:07:32,410 --> 00:07:38,590
+أنه، طيب الـ curve هذا له أهمية أخرى، إذا نقول أن
+
+102
+00:07:38,590 --> 00:07:41,390
+احنا during exercise، بديني more oxygen to the
+
+103
+00:07:41,390 --> 00:07:46,710
+tissues، طيب during atmospheric oxygen it changes،
+
+104
+00:07:46,710 --> 00:07:51,770
+إنت في high altitudes، إنت في aeroplane، إنت في
+
+105
+00:07:51,770 --> 00:07:55,530
+منطقة فيها less oxygen، برضه الفروقات بسيطة، إذا الـ
+
+106
+00:07:55,530 --> 00:07:59,870
+buffering system، احنا بدي more to the muscles،
+
+107
+00:07:59,870 --> 00:08:05,650
+وبياخد more from the atmosphere، تمام؟ وقلنا الجزء
+
+108
+00:08:05,650 --> 00:08:08,950
+العالي في الـ curve، هذا الجزء العالي في الـ curve،
+
+109
+00:08:08,950 --> 00:08:13,630
+اللي هو في منطقة الـ alveoli، إنه هنا بيصير عندي أنا
+
+110
+00:08:13,630 --> 00:08:17,550
+more attraction بين الـ hemoglobin و الـ oxygen، بحيث
+
+111
+00:08:17,550 --> 00:08:20,790
+أنه فرق كبير في الـ.. في الـ pressure، بديني فرق
+
+112
+00:08:20,790 --> 00:08:25,430
+بسيط في الـ إيه؟ في الـ.. في الـ Oxygen content، الـ
+
+113
+00:08:25,430 --> 00:08:30,370
+Oxygen content للـ hemoglobin بين الـ 95% الطبيعي، أو
+
+114
+00:08:30,370 --> 00:08:35,770
+أكثر، حتى لو قلنا 104%، يعني كاملة، تمام، لو وصلنا
+
+115
+00:08:35,770 --> 00:08:39,990
+لأول مكان، إلى الـ 60%، اللي لو قلنا إنه في high
+
+116
+00:08:39,990 --> 00:08:43,810
+altitude، ونزل الـ blood pressure، الـ Oxygen
+
+117
+00:08:43,810 --> 00:08:49,250
+pressure إلى 60%، الفرق بينهم كان دياشي، الفرق من
+
+118
+00:08:49,250 --> 00:08:54,640
+هنا إلى هنا، قلنا إيه؟ فقط الستين لهنا، هذه أربعين،
+
+119
+00:08:54,640 --> 00:08:58,200
+هذه الخطوط اللي احنا، الستين لهنا، الفرق بسيط، هيكون
+
+120
+00:08:58,200 --> 00:09:03,380
+حوالي سبعة بالمئة أو ثمانية بالمئة، لإنه من الستين هنا
+
+121
+00:09:03,380 --> 00:09:09,160
+هيك، هلاجي صار عندي، فاكرين في الـ pressure قولنا
+
+122
+00:09:09,160 --> 00:09:13,780
+سبعة وثمانين، من خمسة وتسعين لسبعة وثمانين، يعني
+
+123
+00:09:13,780 --> 00:09:16,420
+هتكلم عن إيه؟ عن ثمانية من
+
+124
+00:09:20,790 --> 00:09:26,710
+8% تقريباً، تقريباً، تقريباً، تقريباً،
+
+125
+00:09:26,710 --> 00:09:34,130
+تقريباً، تقريباً، تقريباً، تقريباً،
+
+126
+00:09:34,130 --> 00:09:36,250
+تقريباً، تقريباً، تقريباً، تقريباً، تقريباً، تقريباً،
+
+127
+00:09:36,250 --> 00:09:40,450
+تقريباً، تقريباً، تقريباً، تقريباً، تقريباً، تقريباً،
+
+128
+00:09:40,450 --> 00:09:41,010
+تقريباً، تقريباً، تقريباً، تقريباً، تقريباً، تقريباً،
+
+129
+00:09:41,010 --> 00:09:42,010
+تقريباً، تقريباً، تقريباً، تقريباً، تقريباً، تقريباً،
+
+130
+00:09:42,010 --> 00:09:49,950
+تقريباً، تقريباً، تقريباً، تقريباً، تقريباً، تمام؟ في
+
+131
+00:09:49,950 --> 00:09:55,010
+حين أن الـ pressure تبع الـ atmospheric air فقط نزل
+
+132
+00:09:55,010 --> 00:10:00,010
+لستين، تمام؟ هو في الطبيعي بنوصل احنا لـ.. بيبقى في
+
+133
+00:10:00,010 --> 00:10:04,010
+الطبيعي مئة وأربعة، مع الـ mixture بيصير عندي إيه؟
+
+134
+00:10:04,010 --> 00:10:09,910
+خمسة وتسعين، فمن خمسة وتسعين لـ eighty nine، عندي
+
+135
+00:10:09,910 --> 00:10:14,290
+فارق كده؟ ستة أو سبعة، ستة مش كده؟ ممكن ستة
+
+136
+00:10:14,290 --> 00:10:16,670
+millimeter mercury، أو سبعة millimeter mercury،
+
+137
+00:10:16,670 --> 00:10:22,310
+يدوني في الآخر فرق بسيط، ويظل تقريباً عندي الـ.. الـ
+
+138
+00:10:22,310 --> 00:10:29,930
+الـ.. الـ.. الـ oxygen saturation عالية، ثمانية أو تسعة
+
+139
+00:10:29,930 --> 00:10:32,850
+وثمانين بالمئة، millimeter mercury، بيظل حافظ على
+
+140
+00:10:32,850 --> 00:10:37,370
+الـ، طيب نلخّص المثال هذا، referring back to the
+
+141
+00:10:37,370 --> 00:10:43,210
+oxygen، طيب we can see that for the normal five
+
+142
+00:10:43,210 --> 00:10:47,090
+milliliter of oxygen to be released per hundred
+
+143
+00:10:47,090 --> 00:10:49,630
+milliliter of blood، the pressure، pressure must
+
+144
+00:10:49,630 --> 00:10:52,770
+fall to forty، therefore the tissues pressure
+
+145
+00:10:52,770 --> 00:10:55,850
+pressure oxygen normally cannot rise above forty
+
+146
+00:10:55,850 --> 00:10:59,970
+millimeter mercury level، because if it did the
+
+147
+00:10:59,970 --> 00:11:03,200
+amount of oxygen needed to the tissues would، and
+
+148
+00:11:03,200 --> 00:11:07,520
+not be released from the hemoglobin، okay، تمام، إذا
+
+149
+00:11:07,520 --> 00:11:15,180
+هنا اتكلمنا على الـ exercise، الـ
+
+150
+00:11:15,180 --> 00:11:18,660
+atmospheric pressure، لما بيزيد، احنا هنا اللي بدنا
+
+151
+00:11:18,660 --> 00:11:26,300
+نؤكد عليها، لما الـ atmospheric pressure of oxygen
+
+152
+00:11:26,300 --> 00:11:38,400
+بيقل، بنلاحظ أنه عندي أنا الفرق بين الـ 97
+
+153
+00:11:38,400 --> 00:11:47,240
+% إلى الـ 89%، بين 95% oxygen، مليمتر
+
+154
+00:11:47,240 --> 00:11:49,860
+زئبقي، ينزل إلى الـ
+
+155
+00:11:51,900 --> 00:11:57,020
+إلى الـ 60 ميلي متر زئبقي، pressure، هذا هنلاقيه يمثلوا
+
+156
+00:11:57,020 --> 00:12:04,380
+إيش؟ يمثلوا 89% oxygen saturation، إلى من 97%
+
+157
+00:12:04,380 --> 00:12:07,380
+oxygen saturation، مش كده؟ ومن الطبيعي أن الـ
+
+158
+00:12:07,380 --> 00:12:10,580
+hemoglobin بيكون حاجة من 97% في الـ full saturation،
+
+159
+00:12:10,580 --> 00:12:14,120
+لما ينزل البراشر لـ 60، هلاقي الفرق في الـ saturation
+
+160
+00:12:14,120 --> 00:12:20,140
+فقط 89، يعني عندي الفرق من هدول 8%، مش هيك، فقط 8%
+
+161
+00:12:20,140 --> 00:12:23,700
+فرق في الـ saturation، في حين إنه جدّاش الفرق في الـ
+
+162
+00:12:23,700 --> 00:12:27,760
+إيه؟ في الـ pressure، الفرق في الـ pressure من.. من
+
+163
+00:12:27,760 --> 00:12:33,560
+..من ninety.. من ninety five إلى.. إلى sixty،
+
+164
+00:12:33,560 --> 00:12:36,120
+thirty five، thirty five millimeter mercury،
+
+165
+00:12:36,120 --> 00:12:40,240
+difference oxygen pressure، يدوني فقط الـ saturation
+
+166
+00:12:40,240 --> 00:12:43,400
+difference جدّاش؟ فقط eight percent، لأن الـ
+
+167
+00:12:43,400 --> 00:12:45,960
+saturation بيكون طبيعي ninety seven، لما ينزل
+
+168
+00:12:45,960 --> 00:12:51,690
+لستين، هلاقي سعر إيش؟ سعر ninety.. eighty nine، 8%
+
+169
+00:12:51,690 --> 00:12:59,790
+مقارنة في 35%، مقارنة 35 مليمتر، هذا في المنطقة، لذلك
+
+170
+00:12:59,790 --> 00:13:03,510
+الـ saturation بيتم، يعني في buffer system، برضه في
+
+171
+00:13:03,510 --> 00:13:08,650
+هذه المنطقة اللي هي العالية، مش كده؟ وهذا اللي احنا
+
+172
+00:13:08,650 --> 00:13:12,710
+إيه؟ هذه العجيبة في تركيبة الـ hemoglobin، إنه
+
+173
+00:13:12,710 --> 00:13:17,040
+المركز بيحس إنه يمسك أكسجين أكثر عند pressure معين،
+
+174
+00:13:17,040 --> 00:13:22,360
+ويُفقد oxygen أكثر عند pressure معين، إنه يمسك أكثر
+
+175
+00:13:22,360 --> 00:13:36,920
+لمصلحة الجسم،
+
+223
+00:16:54,930 --> 00:16:58,810
+الحالة هذه، أدي الـ soft part بيزيد، أدي الـ soft part
+
+224
+00:16:58,810 --> 00:17:04,820
+هيصير عندي اللي هو بدل ما هو تركيز، و مثلاً في العادة
+
+225
+00:17:04,820 --> 00:17:09,120
+104، ولما يصير mixture بيصير 95، بيصير تركيز، وحسب
+
+226
+00:17:09,120 --> 00:17:11,820
+التركيز اللي أنا عملته، ممكن نصل جد ما إيه نوصل؟
+
+227
+00:17:11,820 --> 00:17:16,940
+طبعاً الـ oxygen، على أن هو مادة الحياة اللي إحنا
+
+228
+00:17:16,940 --> 00:17:19,780
+بنفس فيها، ومحتاجينها، وكده، إلى لو في oxygen
+
+229
+00:17:19,780 --> 00:17:24,800
+poisoning، في حاجة اسمها إيش؟ oxygen poisoning، يعني
+
+230
+00:17:24,800 --> 00:17:28,300
+لو دي الـ soft part، هذا عيل كتير بيعمل لي poisoning
+
+231
+00:17:29,170 --> 00:17:34,410
+تمام؟ لكن إحنا بنستخدمه أحياناً لفترات بسيطة بحيث
+
+232
+00:17:34,410 --> 00:17:37,650
+أنه ننقذ البني آدم من إيش تاني؟ إنتوا عارفين، في حاجة
+
+233
+00:17:37,650 --> 00:17:42,350
+اسمها water intoxication أيضاً، يعني زي ما الـ oxygen
+
+234
+00:17:42,350 --> 00:17:46,390
+ممكن يكون سام، في أحيان، الميه ممكن تكون سامة في
+
+235
+00:17:46,390 --> 00:17:51,050
+أحيان، كل حاجة في غير ظروفها الطبيعية بتعمل إيه؟
+
+236
+00:17:51,650 --> 00:17:54,810
+ممكن تعمل الـ poisoning، لذلك كتير من الناس عايزين
+
+237
+00:17:54,810 --> 00:17:58,230
+يسألوني: "يا دكتور، الدوا هذا يعني إيه؟ له آثار جانبية؟"
+
+238
+00:17:58,230 --> 00:18:03,230
+غريب السؤال! من الميه إلى آثار جانبية؟ الميه، الآثار
+
+239
+00:18:03,230 --> 00:18:06,230
+الجانبية، الأكسجين! لو دي أكسجين، إيه؟ له آثار جانبية؟
+
+240
+00:18:06,230 --> 00:18:10,830
+فلازم ننفع لكل شيء، لأنه كل شيء إذا اتحدى.. اتعدى
+
+241
+00:18:10,830 --> 00:18:15,730
+حدّه، ممكن يعمل لنا أي آثار جانبية سلبية، تمام؟ إذا في
+
+242
+00:18:15,730 --> 00:18:20,920
+الحالة هذه، لو كان أنا عندي الـ pressure عالي، ممكن
+
+243
+00:18:20,920 --> 00:18:32,340
+يعملي what is called oxygen poisoning، تمام؟
+
+244
+00:18:32,340 --> 00:18:37,600
+لكن اللي هيزيد مش الـ hemoglobin، اللي هيزيد إيش؟ الـ
+
+245
+00:18:37,600 --> 00:18:45,000
+disorder part، وهذا طيب.
+
+246
+00:18:52,800 --> 00:18:58,660
+الحاجة الوحيدة اللي بيجيها
+
+247
+00:18:58,660 --> 00:19:02,820
+ده، هو اللي ما اتكلمش عنه كتير، لإنه بيصير في حالة
+
+248
+00:19:02,820 --> 00:19:07,580
+إيه؟ في حالة الـ ischemia فقط، فبيزيد نسبته، وبيعمل
+
+249
+00:19:07,580 --> 00:19:11,430
+shift، في حالة الاسكيميا، في غير حالة الاسكيميا، في
+
+250
+00:19:11,430 --> 00:19:16,610
+العادة بيكونش موجود، إذا الآن عندنا حاجتين، أو نبدأ
+
+251
+00:19:16,610 --> 00:19:20,210
+نتكلم عن حاجة واحدة بخصوص الـ oxygen، اللي هي الـ
+
+252
+00:19:20,210 --> 00:19:26,490
+Bohr effect، اللي هو عبارة عن إيش؟ عبارة عن
+
+253
+00:19:26,490 --> 00:19:31,610
+أنه لما يزيد الـ carbon dioxide في الـ tissues، بيزيد
+
+254
+00:19:31,610 --> 00:19:36,050
+الـ delivery of oxygen to the tissues، اللي اتكلمنا
+
+255
+00:19:36,050 --> 00:19:43,230
+عنها من شوية، اللي هي إيه؟ الـ factors
+
+256
+00:19:43,230 --> 00:19:46,210
+هذه اللي بتعمل shift to the right of the إيه؟ of
+
+257
+00:19:46,210 --> 00:19:51,390
+the curve، the dissociation curve، a shift of the
+
+258
+00:19:51,390 --> 00:19:54,350
+oxygen dissociation curve to the right in
+
+259
+00:19:54,350 --> 00:19:57,790
+response to increase in blood carbon dioxide and
+
+260
+00:19:57,790 --> 00:20:01,110
+hydrogen ions has a significant effect by
+
+261
+00:20:01,110 --> 00:20:05,810
+enhancing the release of oxygen from the blood in
+
+262
+00:20:05,810 --> 00:20:10,440
+the tissues and enhancing oxygenation of blood in
+
+263
+00:20:10,440 --> 00:20:16,200
+the lungs، إذا هذه العملية بتساعد على أنه ندّي للـ
+
+264
+00:20:16,200 --> 00:20:23,320
+tissues more oxygen، وناخد في الـ lungs more oxygen
+
+265
+00:20:23,320 --> 00:20:27,560
+ندّي more oxygen، وناخد more oxygen، تمام؟ اللي هو
+
+266
+00:20:27,560 --> 00:20:30,300
+shift to the right، و shift to the left، لما يقلّ الـ
+
+267
+00:20:30,300 --> 00:20:34,840
+oxygen، لما يقلّ الـ carbon dioxide، بنعمل more
+
+268
+00:20:34,840 --> 00:20:39,880
+ability to grasp or to attract more oxygen، ولما
+
+269
+00:20:39,880 --> 00:20:45,880
+يزيد الـ carbon dioxide، بنسلم إيه؟ تمام، to the shift
+
+270
+00:20:45,880 --> 00:20:48,960
+لما يقلّ الـ carbon dioxide عن اللازم، و تقلّ الـ
+
+271
+00:20:48,960 --> 00:20:52,380
+hydrogen ions عن اللازم، فبناخد إحنا more oxygen
+
+272
+00:20:52,380 --> 00:20:56,500
+اللي هي الجزء الأعلى من الإيه؟ to the left، آه، و
+
+273
+00:20:56,500 --> 00:20:59,300
+اللي هو shift to the right، لما يزيد الـ carbon
+
+274
+00:20:59,300 --> 00:21:00,320
+dioxide، لما إيه؟
+
+275
+00:21:05,550 --> 00:21:14,530
+أعتقد أنه إحنا شرحناها، التفسير
+
+276
+00:21:14,530 --> 00:21:18,850
+تبعها، يعني ليش؟ as the blood passes through the
+
+277
+00:21:18,850 --> 00:21:22,110
+tissues, carbon dioxide diffuses from the tissues,
+
+278
+00:21:23,010 --> 00:21:30,080
+cells into the blood، هذا يزيد دماء الهيدروجين
+
+279
+00:21:30,080 --> 00:21:32,840
+أيون، من وين إتّيت؟ الهيدروجين أيون، إنّ الهيدروجين
+
+280
+00:21:32,840 --> 00:21:34,460
+أيون يتحول، الهيدروجين أيون، الهيدروجين أيون يتحول
+
+281
+00:21:34,460 --> 00:21:35,340
+الهيدروجين أيون، الهيدروجين أيون يتحول الهيدروجين
+
+282
+00:21:35,340 --> 00:21:35,660
+أيون، يتحول الهيدروجين أيون، يتحول الهيدروجين أيون
+
+283
+00:21:35,660 --> 00:21:38,300
+يتحول الهيدروجين أيون، يتحول الهيدروجين أيون يتحول
+
+284
+00:21:38,300 --> 00:21:40,780
+الهيدروجين أيون، يتحول الهيدروجين أيون، يتحول
+
+285
+00:21:40,780 --> 00:21:42,660
+الهيدروجين أيون، يتحول الهيدروجين أيون، يتحول
+
+286
+00:21:42,660 --> 00:21:52,720
+الهيدروجين أيون، يتحول الـ
+
+287
+00:21:52,760 --> 00:21:56,880
+في الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+288
+00:21:56,880 --> 00:22:00,260
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+289
+00:22:00,260 --> 00:22:00,440
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+290
+00:22:00,440 --> 00:22:00,980
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+291
+00:22:00,980 --> 00:22:03,800
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+292
+00:22:03,800 --> 00:22:05,620
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+293
+00:22:05,620 --> 00:22:07,400
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+294
+00:22:07,400 --> 00:22:07,880
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+295
+00:22:07,880 --> 00:22:10,360
+الحويصلات اللي تدفع الكربون دايوكسيد من الدم إلى
+
+296
+00:22:10,360 --> 00:22:15,640
+الحويصلات اللي تدفع الكربون
+
+297
+00:22:15,640 --> 00:22:18,230
+دايوكسيد من الدم إلى الحويصلات، الذي يتعامل مع
+
+298
+00:22:18,230 --> 00:22:22,670
+الهيموجلوبين في أي مرحلة ألفيولر، برشا برشا برشا
+
+299
+00:22:22,670 --> 00:22:23,730
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+300
+00:22:23,730 --> 00:22:27,850
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+301
+00:22:27,850 --> 00:22:28,570
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+302
+00:22:28,570 --> 00:22:29,430
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+303
+00:22:29,430 --> 00:22:38,090
+برشا برشا برشا برشا برشا
+
+304
+00:22:38,090 --> 00:22:45,090
+برشا
+
+305
+00:22:45,810 --> 00:22:50,230
+during exercise، عندنا عدة factors، كلمنا، أعتقد عنها
+
+306
+00:22:50,230 --> 00:22:54,810
+الحرارة، carbon dioxide، الهيدروجين، كلهم بيساعدوا
+
+307
+00:22:54,810 --> 00:23:02,130
+على أي ارتفاع metabolic use of oxygen by cells، هنا
+
+308
+00:23:02,130 --> 00:23:05,410
+في عندنا، اتكلم عن بعض المسائل، و تخص الـ cells، في
+
+309
+00:23:05,410 --> 00:23:14,250
+استخدام الأكسجين، الآن، هل الـ pressure مهم؟
+
+310
+00:23:15,190 --> 00:23:20,690
+في حياة الـ cells؟ عشان ندّيها good oxygen، مهم، بس
+
+311
+00:23:20,690 --> 00:23:24,470
+لجينا إحنا، إنه زي ما حكيت لكم البارحة الماضية، أن
+
+312
+00:23:24,470 --> 00:23:29,490
+أقل difference بين الـ interstitial fluid، و الـ
+
+313
+00:23:29,490 --> 00:23:32,390
+cells، يكفي لإنه يديني good metabolism، normal
+
+314
+00:23:32,390 --> 00:23:36,870
+metabolism، تمام؟ يعني إذا قلنا إحنا محتاجين بس فرق
+
+315
+00:23:36,870 --> 00:23:40,830
+pressure، one millimeter mercury، تمام؟ إذا وجدت هذا
+
+316
+00:23:40,830 --> 00:23:46,440
+الـ one millimeter mercury، السلسلة هتمشي، الميتابوليزم
+
+317
+00:23:46,440 --> 00:23:51,880
+طبيعي، مش هنحس أنه أنه أنه والله لو زدنا
+
+318
+00:23:51,880 --> 00:23:54,480
+الميتابوليزم، أو قلّلنا الميتابوليزم، اتأثر، لأن
+
+319
+00:23:54,480 --> 00:23:58,500
+الـ pressure، pressure أُوطى، أو مش أُوطى، مش كده؟ الـ curve، هدا لو
+
+320
+00:23:58,500 --> 00:24:01,220
+لاحظناها، هنلاحظ إنه إحنا لو قلنا هدا one
+
+321
+00:24:01,220 --> 00:24:04,990
+millimeter mercury pressure، تمام؟ الـ one
+
+322
+00:24:04,990 --> 00:24:08,290
+millimeter mercury pressure، قبله، نلاحظ أن الـ pressure
+
+323
+00:24:08,290 --> 00:24:10,270
+الـ pressure، له تأثير على الـ cell، يعني يبقى الـ
+
+324
+00:24:10,270 --> 00:24:12,670
+metabolism واطي، ويبقى ليه على، ليه على ما يصل
+
+325
+00:24:12,670 --> 00:24:17,090
+الواحد، لحد ما بيصير طبيعي، تمام؟ okay، جابت، لكن بعد
+
+326
+00:24:17,090 --> 00:24:21,250
+الواحد، اللي بيأثر فيه الـ cell metabolism، مش الـ a
+
+327
+00:24:21,250 --> 00:24:24,830
+يعني لو زدنا الـ pressure، إيش بنزود؟ هيبقى
+
+328
+00:24:24,830 --> 00:24:28,550
+constant، يعني الـ curve، هي دي، لحد واحد millimeter
+
+329
+00:24:28,550 --> 00:24:31,650
+mercury، بدأ يزيد الـ metabolism، أو الـ oxygen
+
+330
+00:24:31,650 --> 00:24:39,590
+consumption، لكن بعد هيك، بعد هيك، زدنا الـ pressure،
+
+331
+00:24:39,590 --> 00:24:45,210
+pressure، اتنين، تلاتة، أربعة، خمسة، عشر، عشرين، الـ
+
+332
+00:24:45,210 --> 00:24:48,230
+metabolism ما اتأثرتش، يعني هو بعد الـ difference of
+
+333
+00:24:48,230 --> 00:24:52,930
+one millimeter mercury، بطل الـ pressure التأثير، إنه
+
+334
+00:24:52,930 --> 00:24:56,250
+يزيد أو يقلل، لإنه صار بس available if the.. if
+
+335
+00:24:56,250 --> 00:24:59,670
+the.. if the cells needs.. if the cells need
+
+336
+00:24:59,670 --> 00:25:03,950
+more metabolism، بتقدر تعمل، لكن هل زيادة الـ oxygen
+
+337
+00:25:03,950 --> 00:25:07,170
+في حد ذاته بيزيد المتابوليزم؟ لأ، طب إيش اللي بيزيد
+
+338
+00:25:07,170 --> 00:25:10,250
+الميتابوليزم، أو بيقلله؟ الـ availability of the..
+
+339
+00:25:10,250 --> 00:25:17,510
+of ADP، أو ADP، الـ ADP، الأدينوسين داي فوسفات، هو المعيار
+
+340
+00:25:17,510 --> 00:25:20,970
+بيزيد الميتابوليزم ولا لأ؟ لأن لما يتكون ADP، معناه
+
+341
+00:25:20,970 --> 00:25:24,110
+إن أنا عندي more consumption، و more formation of
+
+342
+00:25:24,110 --> 00:25:28,830
+ADP، فشغلة الخلية إن تعوّض الـ ADP فوراً، تمام؟ عشان
+
+343
+00:25:28,830 --> 00:25:33,250
+ترجعه لـ ATP، مش كده؟ إذا هنا بنطلع، بنلاقي، بعد
+
+344
+00:25:33,250 --> 00:25:40,350
+الواحد، إن كان الـ ADP قليل، أو طبيعي، أو كتير، تمام؟ الـ
+
+345
+00:25:40,350 --> 00:25:45,510
+..الـ..الـ different partial pressures، مالوش
+
+346
+00:25:45,510 --> 00:25:50,160
+علاقة في الموضوع، واضح؟ إذا الـ ADP، لو كان نص الطبيعي
+
+347
+00:25:50,160 --> 00:25:55,420
+من اللي هي الـ metabolism، نزل لنص الطبيعي، ولو كان
+
+348
+00:25:55,420 --> 00:25:59,620
+ADP أعلى، بيرجع للطبيعي، برجع للطبيعي، واضح؟ إذا الـ
+
+349
+00:25:59,620 --> 00:26:02,700
+..الـ pressure، بيرجع، الـ oxygen محتاجينه، يتخطى
+
+350
+00:26:02,700 --> 00:26:06,600
+الواحد من الـ millimeter mercury، for normal usage of
+
+351
+00:26:06,600 --> 00:26:10,940
+oxygen، يعني for normal metabolism، في الخلايا، بغض
+
+352
+00:26:10,940 --> 00:26:15,000
+النظر، أجددش شغل الخلايا هذه كتير أو قليل، وهذا بتحكم
+
+353
+00:26:15,000 --> 00:26:18,360
+فيه الـ ADP، ما بتحكمش فيه الـ what؟ الـ partial
+
+354
+00:26:18,360 --> 00:26:21,360
+pressure، إذا اتخطى الواحد، لكن جابلي الواحد، واضح؟
+
+355
+00:26:21,360 --> 00:26:28,000
+أنه إيه؟ أنه له علاقة كبيرة، تمام؟ طيب، النقطة
+
+356
+00:26:28,000 --> 00:26:31,000
+التانية اللي بنتكلم عنها بخصوص الخلايا، effect of
+
+357
+00:26:31,000 --> 00:26:35,020
+diffusion distance، يعني إحنا الآن عندنا الـ oxygen
+
+358
+00:26:35,020 --> 00:26:38,340
+هيعمل by diffusion، من الـ capillaries، للـ interstitial fluid
+
+359
+00:26:38,790 --> 00:26:42,270
+في الـ interstitial fluid، نستخدم الأكسجين بالخلايا،
+
+360
+00:26:42,270 --> 00:26:46,230
+بيقل الأكسجين، الـ blood اللي جاي، هعمل أكسجين كويس
+
+361
+00:26:46,230 --> 00:26:49,590
+by diffusion، بينتقل إلى الـ tissues، وإلى الـ..إلى
+
+362
+00:26:49,590 --> 00:26:51,950
+الـ..إلى الـ interstitial fluid، وإلى الـ إيه؟ إلى
+
+363
+00:26:51,950 --> 00:26:57,510
+الخلايا، ماشي؟ الآن، الـ diffusion هذا، في الطبيعي..
+
+364
+00:26:57,510 --> 00:27:01,530
+في الطبيعي، ما فيش خلية بعيدة عن..عن a capillary
+
+365
+00:27:01,530 --> 00:27:06,130
+أكتر من خمسين micrometer، تمام؟ يعني بسهولة by
+
+366
+00:27:06,130 --> 00:27:08,490
+diffusion، very rapidly، الـ oxygen بيقدر يصل إلى
+
+367
+00:27:08,490 --> 00:27:11,950
+المكان المطلوب، لكن تحت ischemic states، تحت
+
+368
+00:27:11,950 --> 00:27:16,050
+pathological conditions، ممكن نحس أن الـ diffusion
+
+369
+00:27:16,050 --> 00:27:19,450
+كمية الـ oxygen، أقل من اللازم، ومش قادرة تصل الـ
+
+370
+00:27:19,450 --> 00:27:23,790
+cells، في الحالة هذه بنسميها ده إحنا diffusion
+
+371
+00:27:23,790 --> 00:27:28,250
+limited، diffusion limited
+
+372
+00:27:34,850 --> 00:27:41,030
+اللي هو diffusion limited oxygen usage، تمام؟ الـ
+
+373
+00:27:41,030 --> 00:27:45,390
+oxygen usage، صار مرتبط بالإيه؟ بالـ..بالـ..بالـ
+
+374
+00:27:45,390 --> 00:27:48,170
+distance، ويقدر إن الـ diffusion..إيه؟ صار لها الـ
+
+375
+00:27:48,170 --> 00:27:51,490
+cells، هادي ولا لأ؟ هذا بيصيرش دائماً، إلا إن في إيه؟
+
+376
+00:27:51,490 --> 00:27:55,730
+في حالات معينة، إذا أحياناً بيكون الـ distance، إلها،
+
+377
+00:27:55,730 --> 00:28:00,480
+لذلك إحنا في حالات الـ..الاسكيميا، في الـ diabetes
+
+378
+00:28:00,480 --> 00:28:03,380
+من الـ legs، الـ diabetic foot، وكذا من المناطق
+
+379
+00:28:03,380 --> 00:28:07,620
+البعيدة، صار فيها again، قليل، تمام؟ مناطق غريبة،
+
+380
+00:28:07,620 --> 00:28:11,160
+كويس، by diffusion، بتظلّ alive، وبتظلّ كذا، لكن
+
+381
+00:28:11,160 --> 00:28:16,240
+المسافات مهمة في بعض الحالات، اللي في الطبيعي مش
+
+382
+00:28:16,240 --> 00:28:21,820
+موجود، إذا هنا إيه؟ بسميها diffusion limited usage
+
+383
+00:28:21,820 --> 00:28:26,540
+of oxygen، وفي عندنا حاجة تانية اسمها flow limited
+
+384
+00:28:28,020 --> 00:28:31,180
+إذا عندي أنا حاجتين، الـ distance، في حالة بعض
+
+385
+00:28:31,180 --> 00:28:34,580
+الأحيان، والـ flow في بعض الأحيان برضه، إذا كان أنا
+
+386
+00:28:34,580 --> 00:28:38,060
+عندي إيه؟ narrowing للـ blood vessels، للـ blood
+
+387
+00:28:38,060 --> 00:28:42,780
+vessels، pressure عليه، ischemia، بسبب atherosclerosis
+
+388
+00:28:43,440 --> 00:28:47,880
+صار الـ flow واطي، واطي، واطي، آه، إذا في عندي أنا flow
+
+389
+00:28:47,880 --> 00:28:53,160
+dependent، وفي عندي إيه؟ diffusion dependent، يعني لأ
+
+390
+00:28:53,160 --> 00:28:57,360
+الفكرة، هي pathological conditions، ما هيش
+
+391
+00:28:57,360 --> 00:29:04,960
+physiological states، أنا
+
+392
+00:29:04,960 --> 00:29:10,740
+حاسس علي إنه طلع من المنطقة غلطة، دي transport
+
+393
+00:29:10,740 --> 00:29:1
+
+445
+00:33:33,730 --> 00:33:38,770
+وعبر مين الـ disorder لكن الفرق في الهموجلوبين ضخم
+
+446
+00:33:38,770 --> 00:33:42,790
+لأن الـ care shifted ايه to the right يعني بطل
+
+447
+00:33:42,790 --> 00:33:47,770
+يديني خمسة صار يديني قماش خمسة عشر مش كده مهما يكون
+
+448
+00:33:47,770 --> 00:33:53,690
+الـ disorder أخذ oxygen زيادة مقارنة بين الـ sharing
+
+449
+00:33:53,690 --> 00:33:58,050
+تبع الـ disorder للـ hemoglobin بيهبطليش؟ لأن الـ
+
+450
+00:33:58,050 --> 00:34:01,790
+sharing تبع الـ hemoglobin ايه زاد ثلاث أضعاف مش هيك
+
+451
+00:34:01,790 --> 00:34:05,090
+فلذلك في الـ during exercise ملاك الـ disorders بقى
+
+452
+00:34:05,090 --> 00:34:09,190
+تقريبا مالوش ايه صار بدل ما هو كان كان الـ three
+
+453
+00:34:09,190 --> 00:34:14,310
+percent صار one point five percent ليش؟ لأن عندي
+
+454
+00:34:14,310 --> 00:34:19,830
+أُنايمين الـ hemoglobin زاد كثير فصارت الـ supply مش
+
+455
+00:34:19,830 --> 00:34:24,810
+مش مذكور الـ disorders حبط راح مفعوله عن أول واضح؟
+
+456
+00:34:24,810 --> 00:34:31,450
+طيب، إن نتكلم عن الـ oxygen poisoning هنّا احنا قولنا
+
+457
+00:34:31,450 --> 00:34:35,070
+في الـ sterilize exercise هذا هيك بيكون مفعول الـ
+
+458
+00:34:35,070 --> 00:34:39,690
+dissolver برجل ليش؟ لأن الـ hemoglobin ضر زاد لكن
+
+459
+00:34:39,690 --> 00:34:47,090
+لو احنا كنا في مناطق فيها ضغط عالي تمام بيزيد الـ
+
+460
+00:34:47,090 --> 00:34:51,730
+oxygen content في الـ dissolver مش هيك نجرحها أيش
+
+461
+00:34:51,730 --> 00:34:57,680
+مكتوب if a person breathes  أكسجين في حرارة
+
+462
+00:34:57,680 --> 00:35:01,400
+حرارة أكسجين عالية جداً، فإن المادة التي تم
+
+463
+00:35:01,400 --> 00:35:05,820
+تحميلها في حالة الانتشار يمكن أن تصبح أكثر بكثير،
+
+464
+00:35:05,820 --> 00:35:09,320
+أحياناً بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+465
+00:35:09,320 --> 00:35:10,040
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+466
+00:35:10,040 --> 00:35:10,780
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+467
+00:35:10,780 --> 00:35:13,220
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+468
+00:35:13,220 --> 00:35:16,460
+بكثير،
+
+469
+00:35:16,460 --> 00:35:28,070
+بكثير، بكثير،  بحيث الموت مثل ما يحدث للتخلص من
+
+470
+00:35:28,070 --> 00:35:31,690
+دماغ كبير من خلال محركات محركات مدينة ديب سي
+
+471
+00:35:35,870 --> 00:35:39,830
+الـ high pressure breathing of oxygen لـ divers
+
+472
+00:35:39,830 --> 00:35:43,750
+ممكن يؤدي إلى الوفاة هذا الـ diver يعني محتاج أن
+
+473
+00:35:43,750 --> 00:35:47,630
+الـ oxygen pressure يكون أقل حتى يحافظ على أن
+
+474
+00:35:47,630 --> 00:35:51,290
+الـ disorder مايعلاش كثير لأن إذا الـ pressure المهم
+
+475
+00:35:51,290 --> 00:35:56,890
+أنتوا عارفين الـ divers اللي اللي بتوع الغطس، العوم
+
+476
+00:35:56,890 --> 00:36:01,090
+الغطس في الأعماق بيبقوا معاهم oxygen بتنفسوا منه
+
+477
+00:36:01,090 --> 00:36:04,070
+فإذا كان الـ pressure تبعه عالي ممكن يدخلوا في
+
+478
+00:36:04,070 --> 00:36:04,590
+مشاكل
+
+479
+00:36:07,150 --> 00:36:09,690
+combination of hemoglobin with carbon monoxide
+
+480
+00:36:09,690 --> 00:36:14,090
+كتير مهم هذا اللي هو التسمم اللي بيصير كتير يعني
+
+481
+00:36:14,090 --> 00:36:17,330
+ما قتل ناس في بلدنا و في غير بلدنا، الـ carbon
+
+482
+00:36:17,330 --> 00:36:25,430
+monoxide poisoning في مصر مشهورة بإنه تركيب سخانات
+
+483
+00:36:25,430 --> 00:36:31,850
+المياه في مصر في داخل الحمام تمام، فعشان كده بيصير
+
+484
+00:36:31,850 --> 00:36:37,310
+استهلاك الـ oxygen اللي في داخل الحمام وهذا نار
+
+485
+00:36:37,310 --> 00:36:41,510
+مولعة وكمية كبيرة إذا بتفكري ايه بتعرفوا اللي هو
+
+486
+00:36:41,510 --> 00:36:44,410
+سخانات المياه تبعت الغاز مافيش في بلدنا احنا تقريبا
+
+487
+00:36:44,410 --> 00:36:48,230
+إلا قليل احنا كله معظمه كهربا أو شمسي في مصر لأ
+
+488
+00:36:48,230 --> 00:36:52,930
+مشهور اللي هو ايه اللي هو سخان الغاز اللي سخان
+
+489
+00:36:52,930 --> 00:36:56,430
+المياه اللي على الغاز والمصيبة إنه يكون في الحمام
+
+490
+00:36:56,430 --> 00:37:00,210
+محطوط مش برّا الحمام، احتراق خارجي ويتيجيك المياه
+
+491
+00:37:00,210 --> 00:37:04,270
+السخنة بس، لأ هو موجود أيضاً داخل ايه الحمام اه
+
+492
+00:37:07,120 --> 00:37:11,760
+بيزيد الاحتراق تمام فبياخد حمام سكر طبعاً مش هو
+
+493
+00:37:11,760 --> 00:37:14,540
+واحد بيتحمم وباب يفتح الباب فبيصير استهلاك الـ
+
+494
+00:37:14,540 --> 00:37:18,600
+oxygen اللي موجود في الـ ايه؟ في الغرفة بتحول لإيش؟
+
+495
+00:37:18,600 --> 00:37:24,890
+لـ carbon dioxide طيب صار عندي احتراق أكثر بنستخدم
+
+496
+00:37:24,890 --> 00:37:30,330
+الـ carbon dioxide ونحوله لـ carbon monoxide تمام؟
+
+497
+00:37:30,330 --> 00:37:33,670
+لأن صار الـ oxygen الموجود قليل والاحتراق بده
+
+498
+00:37:33,670 --> 00:37:37,970
+oxygen فبيروح بيحول اتنين carbon dioxide إلى carbon
+
+499
+00:37:37,970 --> 00:37:41,430
+monoxide وبياخد منهم oxygen ايه؟ يولعها، يحرق
+
+500
+00:37:41,430 --> 00:37:47,530
+فيها more gas يعني more carbon مش كده؟ فبتحول شوية
+
+501
+00:37:47,530 --> 00:37:52,620
+شوية إلى carbon الجو بينتلي carbon monoxide حقيقة
+
+502
+00:37:52,620 --> 00:37:56,340
+احنا مش محتاجين أن الجو ينتلي carbon monoxide وكل
+
+503
+00:37:56,340 --> 00:38:00,980
+الـ oxygen يختفي عشان يموت، أنتو عارفين لو كان عندي
+
+504
+00:38:00,980 --> 00:38:07,920
+أنا نسبة carbon monoxide في الجو واحد في الألف لو
+
+505
+00:38:07,920 --> 00:38:11,560
+كان تركيزه point six millimeter mercury point six
+
+506
+00:38:11,560 --> 00:38:17,300
+جداش الـ atmospheric air هو سبعمية وستين مش واحد
+
+507
+00:38:17,300 --> 00:38:21,040
+point six يعني مش واحد في السبعمية وستين ولا واحد
+
+508
+00:38:21,040 --> 00:38:26,120
+في الخمسمية لو واحد في الألف point six it is
+
+509
+00:38:26,120 --> 00:38:30,780
+lethal قاتل شوفوا لو كان تركيزه واحد في الألف
+
+510
+00:38:30,780 --> 00:38:37,190
+pressure pressure اه it is lethal قاتل ليش لأنه
+
+511
+00:38:37,190 --> 00:38:45,250
+لأنّه احنا الـ saturation تبع الـ hemoglobin للـ
+
+512
+00:38:45,250 --> 00:38:56,490
+carbon monoxide بيصل 100% أو 97، 95% بيصل في 0.4، 0
+
+513
+00:38:56,490 --> 00:39:00,880
+.4 ميلي متر مركوري يعني لما نصل لـ point four
+
+514
+00:39:00,880 --> 00:39:05,800
+millimeter mercury بيصير عند الـ hemoglobin تمام
+
+515
+00:39:05,800 --> 00:39:09,660
+تشبع كامل بالـ carbon monoxide بمعنى أنه صار عند الـ
+
+516
+00:39:09,660 --> 00:39:13,800
+point four millimeter mercury carbon monoxide
+
+517
+00:39:13,800 --> 00:39:19,360
+يساوي المية وأربعة ملي ميلي ميلي ميلي ميلي
+
+518
+00:39:19,360 --> 00:39:19,700
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+519
+00:39:19,700 --> 00:39:20,460
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+520
+00:39:20,460 --> 00:39:23,420
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+521
+00:39:23,420 --> 00:39:27,020
+ميلي ميلي ميلي ميلي ميلي ميلي
+
+522
+00:39:27,020 --> 00:39:30,040
+ميلي
+
+523
+00:39:30,040 --> 00:39:34,660
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+524
+00:39:34,660 --> 00:39:36,560
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+525
+00:39:36,560 --> 00:39:37,000
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+526
+00:39:37,000 --> 00:39:44,480
+ميلي
+
+527
+00:39:44,480 --> 00:39:51,600
+ميلي يعني بمعنى آخر قدرة أو الـ affinity تبع الـ
+
+528
+00:39:51,600 --> 00:39:56,960
+carbon monoxide للهيموجلوبين للكربون مونوكسايد 250
+
+529
+00:39:56,960 --> 00:40:03,920
+ضعف الـ oxygen تمام؟ 250 ضعف الـ affinity للإيه؟ للـ
+
+530
+00:40:03,920 --> 00:40:09,300
+oxygen لذلك تلاحظوا point four تساوي الشيء إذا لو
+
+531
+00:40:09,300 --> 00:40:12,140
+عالي عن الـ point 4 شوية صغيرة بيبدأ ايش؟ يطلب تكون
+
+532
+00:40:12,140 --> 00:40:16,840
+الـ oxygen بيضيعش oxygen لذلك الـ point 6 is killing
+
+533
+00:40:16,840 --> 00:40:21,580
+اللي هي one per thousand اه one part in thousand
+
+534
+00:40:21,580 --> 00:40:24,720
+في الـ atmospheric air لو وصلنا لهيك it is killing
+
+535
+00:40:24,720 --> 00:40:32,440
+واضح؟ الـ curve هذا بيوضح لي أنا الموضوع هذا وبنلاحظ
+
+536
+00:40:32,440 --> 00:40:35,800
+احنا أن الـ .. الـ .. الـ dissociation curve متشابه،
+
+537
+00:40:35,800 --> 00:40:40,460
+لكن الفرق في النسب تمام؟ هنا بنتكلم هنا كنا عن
+
+538
+00:40:40,460 --> 00:40:44,180
+millimeter على .. عن ninety five millimeter مركوري
+
+539
+00:40:44,180 --> 00:40:48,500
+لما نصل الـ ninety .. الـ .. نصل الـ .. الـ .. الـ
+
+540
+00:40:48,500 --> 00:40:51,620
+level هذا الـ ninety seven مثلاً، ninety seven
+
+541
+00:40:51,890 --> 00:40:56,210
+Saturation 95% Saturation كان بدنا ايش؟ بدنا ..
+
+542
+00:40:56,210 --> 00:40:59,690
+بيكون ساعتها الـ partial pressure تبعنا 95 الـ 95
+
+543
+00:40:59,690 --> 00:41:05,250
+هنا يساوي بالظبط 0.4 ملي متر مركزي تمام؟ إذا واحد
+
+544
+00:41:05,250 --> 00:41:10,270
+على 250 إلى .. لما نقارنها بالـ Oxygen واضح؟ وهذا
+
+545
+00:41:10,270 --> 00:41:13,490
+بيوريكم ايش الـ toxicity في الحالة هذا ايش بدنا
+
+546
+00:41:13,490 --> 00:41:18,210
+نعمل احنا؟ إذا قلنا كل ما زودنا الـ partial
+
+547
+00:41:18,210 --> 00:41:24,060
+pressure من Oxygen منطلوب شوية لأن الجسم affinity و
+
+548
+00:41:24,060 --> 00:41:26,560
+partial pressures إذا لما واحد يخش في carbon
+
+549
+00:41:26,560 --> 00:41:31,920
+monoxide poisoning قبل ما يموت بشوية يعني وهي لسه
+
+550
+00:41:31,920 --> 00:41:35,680
+point four نص نص أو ذات شخطة صغيرة لأن إذا وصلت
+
+551
+00:41:35,680 --> 00:41:39,180
+point six مش هيصل المستشفى هيكون مات تمام؟ لكن لو
+
+552
+00:41:39,180 --> 00:41:42,440
+وصلنا في مرحلة carbon monoxide poisoning إذا أنا
+
+553
+00:41:42,440 --> 00:41:44,700
+لو عليت الـ pressure pressure تبع الـ oxygen في
+
+554
+00:41:44,700 --> 00:41:48,500
+الهواء لو أديته pure oxygen في الحالة ده أنا بفيده
+
+555
+00:41:48,500 --> 00:41:51,960
+ليش؟ بعالي الـ pressure pressure بصير أنا أطرد
+
+556
+00:41:51,960 --> 00:41:58,200
+carbon monoxide وأحل محله أنا عليت البرشر برشا أكثر
+
+557
+00:41:58,200 --> 00:42:02,440
+من الـ 250 الضعف الموجود فصار عندي قدرة أن يكون
+
+558
+00:42:02,440 --> 00:42:06,400
+more oxygen عن القياس في نفس الوقت الخطورة تبعه أن
+
+559
+00:42:06,400 --> 00:42:10,940
+هو هذا الـ carbon monoxide الـ affinity للهيموجلوبين
+
+560
+00:42:10,940 --> 00:42:16,920
+البرشا برشا تبعه تقريباً zero كله بيمسك في مين؟ في
+
+561
+00:42:16,920 --> 00:42:21,800
+الهيموجلوبين، الـ affinity عالي جداً للهيموجلوبين فالـ
+
+562
+00:42:21,800 --> 00:42:26,620
+carbon monoxide pressure في الدم لا يذكر الـ
+
+563
+00:42:26,620 --> 00:42:31,930
+pressure of oxygen ما تغيرش تمام؟ فالجسم مش مندمج
+
+564
+00:42:31,930 --> 00:42:35,350
+للإيه .. للتغييرات اللي صارت عنده في الهموجلوبين،
+
+565
+00:42:35,350 --> 00:42:40,370
+برشر طبيعي فمفيش تنفس عالي تمام؟ لكن في عندي صار
+
+566
+00:42:40,370 --> 00:42:44,610
+ايش؟ صار عندي hypoxemia، مفيش أكسجين محمول في
+
+567
+00:42:44,610 --> 00:42:48,750
+الهموجلوبين تمام؟ لكن الـ respiratory rate هو هو
+
+568
+00:42:49,840 --> 00:42:53,420
+الأسبيرات الـ centers مش منتبهة لذلك بيصير some
+
+569
+00:42:53,420 --> 00:42:59,440
+sort of disorientation بأن العيان بيلحظ حاله مش
+
+570
+00:42:59,440 --> 00:43:03,700
+مركز مش طبيعي مش عارف اه وبعدين بيخش في كومة واه
+
+571
+00:43:03,700 --> 00:43:06,980
+وبيموت في الغالب وممكن الوجع اللي بيجعح إذا كان
+
+572
+00:43:06,980 --> 00:43:10,660
+واقف هو فالموضوع هذا مع الدوخة الخبطة هذه ما هي
+
+573
+00:43:10,660 --> 00:43:13,980
+نفسها هي ايه اتعملت لكن واحد حاسس بصداع غير عادي
+
+574
+00:43:13,980 --> 00:43:19,340
+ناس فاتحين المولعين فاهم الدنيا الشتاء مولّعين الفحم
+
+575
+00:43:19,340 --> 00:43:22,800
+وفي الشتاء بيبسكوا البواب عشان يتدفوا تمام فصار
+
+576
+00:43:22,800 --> 00:43:27,260
+عنده احتراق داخلي مظبوط وبيعلى الـ carbon monoxide
+
+577
+00:43:27,260 --> 00:43:35,380
+شوية شوية وبدأوا يحسوا بصداع وأنهم مش مركزين و
+
+578
+00:43:35,380 --> 00:43:37,860
+كده وواحد من الانتباه كان أنهم مولّعين الفحم راح
+
+579
+00:43:37,860 --> 00:43:41,140
+فاتح الباب ايه الحاجة دكتور انقذونا ايش العمل؟
+
+580
+00:43:41,140 --> 00:43:46,740
+العمل أني أديهم أكسجين عالي تنفس بيور أكسجين مش
+
+581
+00:43:46,740 --> 00:43:50,150
+بيور أُدي كمان في خمسة المية النقطة الثانية، إذا
+
+582
+00:43:50,150 --> 00:43:53,470
+لما أُدي pure oxygen أقصد، فيه أعلى البرشر برشر
+
+583
+00:43:53,470 --> 00:43:57,110
+oxygen، بقى أنا بصير أنافس من الـ carbon monoxide ع
+
+584
+00:43:57,110 --> 00:44:00,810
+الـ hemoglobin ولما أُدي carbon dioxide five
+
+585
+00:44:00,810 --> 00:44:05,640
+percent، أنا بعمل simulation لمين؟ طيب إذا من
+
+586
+00:44:05,640 --> 00:44:09,260
+هالجهة تعرفوا أن الـ main stimulant للرسبيريتوري سنتر
+
+587
+00:44:09,260 --> 00:44:13,200
+هو مين؟ الـ carbon dioxide أكثر من الـ oxygen إذا الـ
+
+588
+00:44:13,200 --> 00:44:15,220
+pressure of carbon dioxide هو الـ main stimulant
+
+589
+00:44:15,220 --> 00:44:18,320
+لمين؟ للرسبيريتوري سنتر حطوها هذه المعلومة ايه في
+
+590
+00:44:18,320 --> 00:44:27,960
+الرأس طيب إذا نرجع ثاني لموضوعنا إذا فهمنا الخطر
+
+591
+00:44:27,960 --> 00:44:31,360
+تبعه وفهمنا ايش العلاج ندي حاجتين بيور oxygen أو
+
+592
+00:44:31,360 --> 00:44:34,340
+oxygen with 5% carbon dioxide
+
+593
+00:44:37,450 --> 00:44:41,950
+الآن هنتقل لـ carbon dioxide احنا اتكلمنا مافيه
+
+594
+00:44:41,950 --> 00:44:46,190
+كفاية عن الـ oxygen مش كده، الـ oxygen بينتقل و
+
+595
+00:44:46,190 --> 00:44:49,350
+مراحله كلها ثاني أنا carbon dioxide يتكون مش هيك
+
+596
+00:44:49,350 --> 00:44:53,510
+carbon dioxide يتكون وبدأ يطلع من الـ cells إلى الـ
+
+597
+00:44:53,510 --> 00:44:58,750
+interstitial fluid إلى .. طيب الآن هنلاحظ احنا إنه
+
+598
+00:44:58,750 --> 00:45:03,850
+الـ carbon dioxide اللي برجع على الـ lungs هو بيطلع
+
+599
+00:45:03,850 --> 00:45:08,500
+من الـ lungs الفرق بينهم قد ايش؟ الفرق بينه خمسة ..
+
+600
+00:45:08,500 --> 00:45:12,140
+الفرق بينه خمسة millimeter mercury مش كده؟ خمسة
+
+601
+00:45:12,140 --> 00:45:16,360
+millimeter mercury الـ oxygen الفرق كان قد ايش من
+
+602
+00:45:16,360 --> 00:45:20,720
+الخمسة والتسعين لأربعين، خمسة وستين مش كده؟ احنا
+
+603
+00:45:20,720 --> 00:45:25,600
+قلنا خمسة وخمسين اه خمسة وتسعين لأربعين خمسة
+
+604
+00:45:25,600 --> 00:45:30,560
+وخمسين الـ .. الـ .. الـ .. الـ خمسة وخمسين millimeter
+
+605
+00:45:30,560 --> 00:45:34,040
+mercury difference  يساوي خمسة milliliter مين؟
+
+606
+00:45:34,040 --> 00:45:39,210
+oxygen مش هيك؟ أكسجين أكسجين كده احنا بنسلم الـ
+
+607
+00:45:39,210 --> 00:45:44,710
+cells أكسجين؟ الـ oxygen بنسلمه احنا خمسة في العادة
+
+608
+00:45:44,710 --> 00:45:50,070
+بننزله للأربعين بيكون فقط خمسة ملي لتر مش حسبتها
+
+609
+00:45:50,070 --> 00:45:54,660
+احنا كل الحمل بيكون عشرين ملي لتر أكسجين احنا
+
+610
+00:45:54,660 --> 00:46:02,520
+بنديه في كل لفة مش قولنا 97% يمثل 5 ملي لتر و 0.27
+
+611
+00:46:02,520 --> 00:46:08,940
+يمثل اللي هو 3% مش كده؟ تقريباً تقريباً أنا بأعطي في
+
+612
+00:46:08,940 --> 00:46:13,060
+كل لفة للخلايا 5 ملي لتر أكسجين في كل ملي متر
+
+613
+00:46:13,060 --> 00:46:18,800
+مركوري في كل ملي لتر دم بدي 5 تمام؟ لكن فرق
+
+614
+00:46:18,800 --> 00:46:22,850
+الضغط كبيرة اللي قصدي أقوله أنه الـ carbon dioxide
+
+615
+00:46:22,850 --> 00:46:26,910
+اللي بيعطيني في كل لفة بياخد أربعة ملي لتر carbon
+
+616
+00:46:26,910 --> 00:46:30,1
+
+667
+00:49:58,860 --> 00:50:01,500
+chloride محلّه طبعاً أنا في عندي هنا ما يطلع ال
+
+668
+00:50:01,500 --> 00:50:04,200
+carbon dioxide  الـ carbon dioxide الـ bio carbonate
+
+669
+00:50:04,200 --> 00:50:08,940
+لما يعلق يطلع برا بـ negative charges تمام، كمان الـ
+
+670
+00:50:08,940 --> 00:50:12,920
+chlorine بده يحل محلّه كـ electrical balance تمام، هو
+
+671
+00:50:12,920 --> 00:50:18,560
+ذات جوا لإنه اتكون تمام، فبده يعمل balance فبده يخش
+
+672
+00:50:18,560 --> 00:50:21,920
+محلّه الـ chlorine و بيساعدهم carrier بيساعدهم إيه
+
+673
+00:50:21,920 --> 00:50:26,500
+specific carrier بحيث يدخل carbon dioxide يطلع برا
+
+674
+00:50:26,500 --> 00:50:29,880
+.. الـ .. الـ by carbonate تطلع برا الـ cells و الـ
+
+675
+00:50:29,880 --> 00:50:32,820
+chloride يدخل داخل الـ cells هذا إيش بنسميه
+
+676
+00:50:32,820 --> 00:50:37,980
+chloride shift إذا الـ chloride shift بيصير وإحنا
+
+677
+00:50:37,980 --> 00:50:42,600
+طالعين من الـ tissues داخلين على الـ venous side الـ
+
+678
+00:50:42,600 --> 00:50:47,320
+RBCs بتكون أخدت carbon dioxide وطلع منها carbon
+
+679
+00:50:47,320 --> 00:50:52,840
+.. by carbonate ودخل محلّه، إذا لو أخدت الـ RBCs من
+
+680
+00:50:52,840 --> 00:50:55,560
+الـ venous side، أخدنا الـ RBCs من الـ arterial side
+
+681
+00:50:55,560 --> 00:51:00,180
+هنلاقي الـ chloride contents في الـ venous أكتر من
+
+682
+00:51:00,180 --> 00:51:02,600
+الـ chloride contents في الـ A في داخل الـ RBCs
+
+683
+00:51:02,600 --> 00:51:06,100
+بتكلم لإنه بيصير shift هنا وهنا مع الـ بيكربونات
+
+684
+00:51:06,100 --> 00:51:10,660
+تمام؟ إذا في عندي أنا هذه الـ chloride shift إجت
+
+685
+00:51:10,660 --> 00:51:14,360
+by the way نتكلم عنها نرجع تاني لمين؟ للـ carbon
+
+686
+00:51:14,360 --> 00:51:19,720
+dioxide transport إذا جزء في الـ plasma وجزء
+
+687
+00:51:19,720 --> 00:51:25,080
+داخل
+
+688
+00:51:25,080 --> 00:51:30,980
+الـ cells اتكون كربونيك اسيد بمساعدة كربونيك انهايدراز
+
+689
+00:51:30,980 --> 00:51:36,710
+وصار له some sort of a transport to the outside، إذا
+
+690
+00:51:36,710 --> 00:51:40,330
+صار بلازمة فيه كمان بيكربونيت، بس أساس التكوين وين
+
+691
+00:51:40,330 --> 00:51:44,630
+كان؟ داخل الـ cells و .. طيب ما نتكلم عن الـ hydrogen
+
+692
+00:51:44,630 --> 00:51:48,230
+إيش صار فيه؟ إحنا قلنا carbonic acid بيكربونيت
+
+693
+00:51:48,230 --> 00:51:52,730
+راح مقابل الـ chloride مش كده؟ طلعت برا الـ .. الـ
+
+694
+00:51:52,730 --> 00:51:55,370
+بيكربونيت وده كان محلّه chloride عن طريق الـ
+
+695
+00:51:55,370 --> 00:51:59,190
+carrier و الـ hydrogen will attach to إيه؟ to the
+
+696
+00:51:59,190 --> 00:52:02,610
+hemoglobin الـ .. الـ hydrogen will attach to the
+
+697
+00:52:02,610 --> 00:52:06,670
+hemoglobin لإنه الـ hemoglobin is a buffer مش كده؟
+
+698
+00:52:06,670 --> 00:52:09,770
+الـ hemoglobin له buffering effect فبيمسك الـ
+
+699
+00:52:09,770 --> 00:52:13,550
+hydrogen ions حتى يمنع الـ change في الـ pH
+
+700
+00:52:13,550 --> 00:52:18,490
+تمام؟ النقطة الثالثة أن بعض الـ carbon dioxide و الـ
+
+701
+00:52:18,490 --> 00:52:25,470
+attach ده hemoglobin نسميه carbino.. carb..
+
+702
+00:52:25,470 --> 00:52:31,090
+carbamino hemoglobin تمام؟ إذا عندي الـ attaching لـ
+
+703
+00:52:31,090 --> 00:52:35,850
+الـ proteins جزء أين؟ جزء attaching the hemoglobin
+
+704
+00:52:35,850 --> 00:52:38,730
+inside the cells وجزء attaching the plasma
+
+705
+00:52:38,730 --> 00:52:44,090
+proteins لكن مين أكتر؟ الـ .. الـ hemoglobin .. الـ
+
+706
+00:52:44,090 --> 00:52:48,690
+hemoglobin أكتر الـ hemoglobin في الـ .. في الـ cells
+
+707
+00:52:48,690 --> 00:52:52,110
+موجود إحنا عندنا قد إيه؟ عندنا خمسة عشر gram
+
+708
+00:52:52,110 --> 00:52:55,750
+hemoglobin في حين أنّه عندنا الـ plasma proteins
+
+709
+00:52:55,750 --> 00:53:01,280
+قد إيه؟ الـ total plasma proteins ستة، ستة ونصف،
+
+710
+00:53:01,280 --> 00:53:05,560
+إلى أربعة، أربعة ونصف تمام، يمثل معظمها، لكن
+
+711
+00:53:05,560 --> 00:53:08,020
+الـ hemoglobin في الداخل الـ .. الـ .. الـ في
+
+712
+00:53:08,020 --> 00:53:14,690
+الداخل الـ cells يمثل كم؟ أنا مثلاً أربعة عشر أو قريب
+
+713
+00:53:14,690 --> 00:53:18,650
+الدم مش هو الـ hemoglobin أنا مثلاً أربعة عشر ونصف
+
+714
+00:53:18,650 --> 00:53:21,730
+gram per hundred milliliter أنتم هيكون اثنا عشر
+
+715
+00:53:21,730 --> 00:53:28,390
+ثلاثة عشر milligram أنتم خمسة يمكن أربعة عشر اه أربعة عشر
+
+716
+00:53:28,390 --> 00:53:32,570
+الجسم دائماً، جولنا الفيلم أنا بدأ أؤكد أنه دائماً في
+
+717
+00:53:32,570 --> 00:53:39,130
+النساء بيبقى أعلى شوية، في المدخنين عالي كتير
+
+718
+00:53:39,130 --> 00:53:43,010
+لأنّه جزء من .. لأن معظمهم إستهلك زي اللي إيه
+
+719
+00:53:43,010 --> 00:53:47,010
+بيشتغل سواق على الخط ومراكب مع ولاده ما بيبقى لسه
+
+720
+00:53:47,010 --> 00:53:50,770
+واسع في السيارة ولاده رايحين وجايين معاه وبيراكب
+
+721
+00:53:50,770 --> 00:53:54,550
+زمّان زمّان أنّه وبيكمل رايح شايف أنت ما فيش واسع في
+
+722
+00:53:54,550 --> 00:53:57,570
+الـ hemoglobin اللي .. اللي واحد مدخّن عنده carbon
+
+723
+00:53:57,570 --> 00:54:01,440
+monoxide عالي، فدائماً عندنا carbon monoxide راكب
+
+724
+00:54:01,440 --> 00:54:05,260
+عوام متواصل فيه carbon monoxide ملزق قوي في الـ
+
+725
+00:54:05,260 --> 00:54:08,260
+hemoglobin فالـ oxygen .. وهو رايح ياخد الـ oxygen
+
+726
+00:54:08,260 --> 00:54:11,340
+وهو رايح ياخد الـ oxygen نص الطريق أو ممكن أكتر
+
+727
+00:54:11,340 --> 00:54:17,860
+مليانة الـ hemoglobin محمل تمام، فلذلك الـ hemoglobin
+
+728
+00:54:17,860 --> 00:54:20,580
+إذا عندنا إحنا خمسة عشر جرام فإحنا عندنا بلازمة
+
+729
+00:54:20,580 --> 00:54:25,000
+سبعة بالكتير جرام مش كده؟ فعندنا الـ main transport
+
+730
+00:54:25,000 --> 00:54:34,030
+على الـ hemoglobin، إذا الكاربامينوهيموجلوبين إذا
+
+731
+00:54:34,030 --> 00:54:37,670
+صار في عندي تلت مناطق فيها transport of oxygen of
+
+732
+00:54:37,670 --> 00:54:44,550
+carbon dioxide، the salt part يمثل 7% اللي هو
+
+733
+00:54:44,550 --> 00:54:48,910
+دلوقتي أنا متكلم عنه بالضبط بالأرقام و by carbonate
+
+734
+00:54:48,910 --> 00:54:53,550
+part which is the biggest، إذا الـ main transport as
+
+735
+00:54:53,550 --> 00:54:59,380
+by carbonate تمام، سبعين في المئة، في حين أنّه الـ
+
+736
+00:54:59,380 --> 00:55:05,320
+الـ hemoglobin مع الـ .. مع الـ carbon dioxide بيمثل
+
+737
+00:55:05,320 --> 00:55:11,960
+23 كـ transport كـ transport يمثل 23% من الـ .. من الـ
+
+738
+00:55:11,960 --> 00:55:16,180
+.. من الـ carbon dioxide الـ طالع من الـ tissues في
+
+739
+00:55:16,180 --> 00:55:20,700
+الدم، الـ  لاجئ carbon dioxide يمثل 30% لكن .. لكن في
+
+740
+00:55:20,700 --> 00:55:23,640
+الآخر لما نطلع على الـ transport نفسه على الـ
+
+741
+00:55:23,640 --> 00:55:27,100
+transport نفسه، قد إيه الـ Hemoglobin ترك الـ Carbon
+
+742
+00:55:27,100 --> 00:55:32,220
+Dioxide، بتركهوش كله زي الـ Dissolved ولا إيه ده
+
+743
+00:55:32,220 --> 00:55:36,440
+بيبقى ماسك فيه أكتر من اللازم، فبنقول أنّه لذلك دور
+
+744
+00:55:36,440 --> 00:55:39,420
+الـ Hemoglobin في أنّه يمثل يمثل فقط 23% من الـ
+
+745
+00:55:39,420 --> 00:55:44,320
+transport، الحمل الحقيقي يمثل 30 بس
+
+746
+00:55:44,320 --> 00:55:50,280
+بيتعاملش معاه إلا بـ 23 منهم، في 7% ملزقين في الـ
+
+747
+00:55:50,280 --> 00:55:52,800
+Hemoglobin وما بنتركهوش تمام؟
+
+748
+00:55:54,990 --> 00:56:03,170
+الـ site of .. الـ site of attachment هنا مش زي اللي
+
+749
+00:56:03,170 --> 00:56:06,190
+هو الـ oxygen، مش زي الـ carbon monoxide، هنا على الـ
+
+750
+00:56:06,190 --> 00:56:09,610
+amino group زي الـ plasma، لذلك إحنا ذكرناهم مع بعض
+
+751
+00:56:10,290 --> 00:56:15,130
+لأنّ الهيموجلوبين كبروتين والبلازما بروتين، بروتين
+
+752
+00:56:15,130 --> 00:56:19,870
+فبتمسكوا بالـ amino group ما هو على الـ oxygen site
+
+753
+00:56:19,870 --> 00:56:23,670
+لكن carbon monoxide بنحمل على إيه؟ بيعمل لنا خطر على
+
+754
+00:56:23,670 --> 00:56:27,230
+يعني وجود carbon dioxide على الهيموجلوبين بيعملش
+
+755
+00:56:27,230 --> 00:56:29,230
+مشكلة كبيرة يعني مش على الـ site of oxygen
+
+756
+00:56:29,230 --> 00:56:32,170
+transport لكن وجود carbon monoxide مشكلة كبيرة
+
+757
+00:56:32,170 --> 00:56:39,490
+لأنّه على نفس الـ site تبع الـ إيه؟ واضح؟ طيب، إذا
+
+758
+00:56:39,490 --> 00:56:45,210
+لما نقول عندي أنا طلعنا من الانسجة وعندنا 45 ملي
+
+759
+00:56:45,210 --> 00:56:51,990
+متر ميركوري براشر للكربون دايوكسايد مش كده؟ إيش
+
+760
+00:56:51,990 --> 00:56:59,370
+بيمثل هذا؟ بيمثل 2.7 ملي لتر كربون دايوكسايد per
+
+761
+00:56:59,370 --> 00:57:07,520
+hundred milliliter يمثل إيش؟ 2.7 ملي لتر، the amount
+
+762
+00:57:07,520 --> 00:57:10,980
+of carbon dioxide dissolved in the fluid of the
+
+763
+00:57:10,980 --> 00:57:16,880
+blood تمام؟ يمثّله الـ dissolved part اللي هو قد إيه
+
+764
+00:57:16,880 --> 00:57:21,480
+الـ dissolved part، الـ
+
+765
+00:57:21,480 --> 00:57:24,700
+dissolved part قلنا في الـ carbon dioxide يمثل
+
+766
+00:57:24,700 --> 00:57:28,880
+سبعة في المئة مش هيك؟ سبعة في المئة
+
+767
+00:57:33,480 --> 00:57:38,440
+مقاومة الكربون دايوكسايد المذاب في مياه الدم في 45
+
+768
+00:57:38,440 --> 00:57:44,610
+مليمتر زئبق هي 2.7 ملي لتر/ديسيلتر، بالمقارنة إلى
+
+769
+00:57:44,610 --> 00:57:53,830
+40 مليمتر زئبق هي 2.4 ملي لتر، أو فرق من 0.3
+
+770
+00:57:53,830 --> 00:58:00,450
+مليلتر، بالمقارنة إلى 4
+
+771
+00:58:00,450 --> 00:58:14,640
+مليلتر أو فرق من 0.3 مليلتر من 4 مليلتر، تمام، إحنا
+
+772
+00:58:14,640 --> 00:58:20,960
+طبعاً الـ 45، الـ 45 millimeter mercury لـ 40 بنفقد بس
+
+773
+00:58:20,960 --> 00:58:26,900
+إحنا five five percent، لذلك هذا حامل 2.7 في الـ 45
+
+774
+00:58:26,900 --> 00:58:32,980
+لكن في الـ 40 كده حامل 2.4 يعني point three فقط، أنا
+
+775
+00:58:32,980 --> 00:58:40,220
+شاركت حامل عن طريق الـ dissolve بعد، تمام، طيب الـ ..
+
+776
+00:58:40,220 --> 00:58:42,400
+إذا الـ point three هي تمثل السبعة في المئة اللي
+
+777
+00:58:42,400 --> 00:58:45,540
+اتكلمنا عنها، الـ point three تمثل الـ dissolve part
+
+778
+00:58:45,540 --> 00:58:50,920
+اللي تمثل سبعة في المئة، هنلاحظ أنّه الـ .. الـ .. الـ
+
+779
+00:58:50,920 --> 00:58:55,940
+carbonic anhydrase يمثل، يقول لنا سبعين في المئة اللي
+
+780
+00:58:55,940 --> 00:59:01,000
+الـ .. الـ .. الـ carbon الـ bicarbonate تمثل إيه؟
+
+781
+00:59:01,000 --> 00:59:05,360
+سبعين في المئة اللي هي تمثل كميات، أرقام
+
+782
+00:59:25,050 --> 00:59:31,390
+القيمة الحقيقية هو point seven point
+
+783
+00:59:31,390 --> 00:59:36,890
+three milliliter بالـ hundred milliliter، 0.3 ملي
+
+784
+00:59:36,890 --> 00:59:42,190
+لتر per hundred milliliter of blood، كويس؟
+
+785
+00:59:42,190 --> 00:59:48,150
+طيب الـ carbonic anhydrase وتأثيره وعمل الـ carbon
+
+786
+00:59:48,150 --> 00:59:54,570
+طيب ساعة شرحنا إحنا يمثل 70% وقلنا الـ chloride
+
+787
+00:59:54,570 --> 01:00:02,490
+shift والـ carriers واه
+
+788
+01:00:03,670 --> 01:00:07,970
+إذن هنا عندنا إيه؟ So poor the tissue of carbon
+
+789
+01:00:07,970 --> 01:00:12,390
+can't be made to rise. في بعض الحالات اللي إحنا
+
+790
+01:00:12,390 --> 01:00:17,850
+مستخدمين فيها diuretic اللي هو carbon .. carbonic
+
+791
+01:00:17,850 --> 01:00:21,930
+anhydrase inhibitor فاكرين؟ الـ acetazolamide جبنا
+
+792
+01:00:21,930 --> 01:00:25,150
+سيرته في الـ .. في الـ diuretics، هذا إذا إحنا
+
+793
+01:00:25,150 --> 01:00:30,950
+استخدمناه، مش بيعطل بس reabsorption of bicarbonate في
+
+794
+01:00:30,950 --> 01:00:34,290
+داخل الـ .. اه بيعمل لي جزء من الـ diuresis هذا
+
+795
+01:00:34,290 --> 01:00:37,810
+البسيط، mild diuresis، لأ ممكن يعمل كمان إشكالية
+
+796
+01:00:37,810 --> 01:00:44,910
+في مين؟ في نقل الـ carbon dioxide عبر الدم لإنه الـ
+
+797
+01:00:44,910 --> 01:00:50,300
+main الـ main step اللي هو بمساعدة carbonic
+
+798
+01:00:50,300 --> 01:00:54,380
+anhydrase، لما أنا أعطل هذه الـ main step اللي هي الـ
+
+799
+01:00:54,380 --> 01:00:59,780
+carbon الـ bicarbonate transport معناها أنا عطّلت
+
+800
+01:00:59,780 --> 01:01:09,370
+مين؟ عطّلت الـ .. الـ Bicarbonate، عليت الآخرين تمام؟
+
+801
+01:01:09,370 --> 01:01:13,330
+لدرجة أنّه الـ transport becomes so poor that
+
+802
+01:01:13,330 --> 01:01:18,070
+برشة، بدل ما هو خمسة وأربعين يصير ثمانية، الـ
+
+803
+01:01:18,070 --> 01:01:22,770
+80% بطّل الـ RBCs قادرة تستخدم معظم الـ carbon
+
+804
+01:01:22,770 --> 01:01:26,210
+dioxide وتحاول تنقل البيكربونات، صار عندي أنا الـ
+
+805
+01:01:26,210 --> 01:01:29,430
+dissolved carbon dioxide يعني البرشر، برشر يعني
+
+806
+01:01:29,430 --> 01:01:32,330
+اللي إيه على إيه لـ 80% في الحالة هذه طبعاً في
+
+807
+01:01:32,330 --> 01:01:35,210
+الحالة هذه إحنا إيه؟ بنخش في خطر poisoning لأن الـ
+
+808
+01:01:35,210 --> 01:01:38,270
+carbon .. هندرس في الفصل اللي .. المحاضرة اللي
+
+809
+01:01:38,270 --> 01:01:41,910
+جاية أو اللي بعدها الـ carbon dioxide ده بيعلى لإيش
+
+810
+01:01:41,910 --> 01:01:47,740
+بيأثر علينا تمام؟ ممكن يدخلنا في كوماه، تمام، فلما أنا
+
+811
+01:01:47,740 --> 01:01:52,700
+أمنع الـ carbon dioxide من النقل الصحيح وأخلي الـ
+
+812
+01:01:52,700 --> 01:01:55,840
+concentration تبعه عالي بشكل، عندي خطر أكبر
+
+813
+01:01:55,840 --> 01:02:01,940
+transport of carbon dioxide in the combination of
+
+814
+01:02:01,940 --> 01:02:04,240
+the hemoglobin اللي هو الكاربامينوهيموجلوبين
+
+815
+01:02:04,240 --> 01:02:09,640
+تكلمنا عنه مش هيك، the quantity of carbon dioxide
+
+816
+01:02:09,640 --> 01:02:13,510
+that can be carried from the peripheral tissues to
+
+817
+01:02:13,510 --> 01:02:19,210
+the lungs by carbamino combination is about 30%
+
+818
+01:02:19,210 --> 01:02:26,630
+وقلنا أنّه 30% لكنها لا تمثل إلا حوالي 23%، هدول ..
+
+819
+01:02:26,630 --> 01:02:30,210
+إذا النقطة الثالثة اللي اتكلمنا عنها وهي اللي هو
+
+820
+01:02:30,210 --> 01:02:35,160
+carbamino اللي يمثل تلاتين في المئة أو حقيقة ما
+
+821
+01:02:35,160 --> 01:02:37,720
+بيزيدش عن عشرين في المئة إلا قليل، تلاتة وعشرين في المئة
+
+822
+01:02:37,720 --> 01:02:41,540
+of carbon dioxide is transported via combination
+
+823
+01:02:41,540 --> 01:02:46,540
+with the amino group of the hemoglobin، هذا يمثل
+
+824
+01:02:46,540 --> 01:02:52,600
+one point five milliliter carbon dioxide for each
+
+825
+01:02:52,600 --> 01:02:56,980
+one hundred milliliter of blood، تمام؟ إذا بيظل الـ
+
+826
+01:02:56,980 --> 01:03:02,340
+bicarbonate الـ carrying capacity تبعته للدم as
+
+827
+01:03:02,340 --> 01:03:05,960
+bicarbonate هيكون من الأربعة بيظل عندي two point
+
+828
+01:03:05,960 --> 01:03:08,800
+two milliliter، two point two milliliter
+
+829
+01:03:08,800 --> 01:03:13,180
+bicarbonate for each one hundred milliliter of
+
+830
+01:03:13,180 --> 01:03:20,040
+blood تمام؟ طيب إذا هنا عندي أنا الـ five percent
+
+831
+01:03:20,040 --> 01:03:24,260
+difference هذه بين الخمسة والأربعين إلى أربعين تمثل
+
+832
+01:03:24,260 --> 01:03:29,940
+أربعة milliliter، أربعة milliliter إيش؟ أربعة ملي
+
+833
+01:03:29,940 --> 01:03:36,840
+لتر كربون دايوكسيد تم تحميله إلى الهيموجلوبين وبعد ذلك
+
+834
+01:03:36,840 --> 01:03:40,540
+تم تحميله إلى الهيموجلوبين وبعد ذلك تم تحميله إلى
+
+835
+01:03:40,540 --> 01:03:42,820
+الهيموجلوبين وبعد ذلك تم تحميله إلى الهيموجلوبين وبعد
+
+836
+01:03:42,820 --> 01:03:43,720
+ذلك تم تحميله إلى الهيموجلوبين وبعد ذلك تم تحميله إلى
+
+837
+01:03:43,720 --> 01:03:48,740
+الهيموجلوبين وبعد ذلك تم تحميله إلى الهيموجلوبين وبعد
+
+838
+01:03:48,740 --> 01:03:51,660
+ذلك تم تحميله إلى الهيموجلوبين وبعد ذلك تم تحميله إلى
+
+839
+01:03:51,660 --> 01:03:58,5
+
+889
+01:07:38,170 --> 01:07:41,970
+الأربعين على نفس المنقطة تمام بيصل من اتنين و
+
+890
+01:07:41,970 --> 01:07:45,530
+خمسين لخمسين لكن وقع قمر الـ distribution curve هنا
+
+891
+01:07:45,530 --> 01:07:51,470
+بينخفض بتغير في الـ alveoli بدلًا من هذا الـ curve هذا
+
+892
+01:07:51,470 --> 01:07:55,110
+المنطقة هذه في الـ tissues لكن هذا الـ curve في الـ
+
+893
+01:07:55,110 --> 01:07:59,070
+alveoli ملاحظ أن الـ curve نفسه، الـ decision تغير و
+
+894
+01:07:59,070 --> 01:08:04,190
+هبط شوية و اتدنيف الـ alveoli نقطة أخرى تمامًا غير
+
+895
+01:08:04,190 --> 01:08:07,410
+النقطة المتوقعة أن يصلها لو نحسب على الـ curve تبع
+
+896
+01:08:07,410 --> 01:08:13,550
+الـ tissues بحيث أنه بلاقي نزل لـ 48 نزل لـ إيه؟ لـ 48
+
+897
+01:08:13,550 --> 01:08:16,090
+إذاً في عندي أنا متوسط الخمسين
+
+898
+01:08:18,940 --> 01:08:24,400
+52 في الـ tissues و من الخمسين لـ 48 فالله فالله عندي
+
+899
+01:08:24,400 --> 01:08:28,920
+إيه؟ عندي الـ holding effect اللي هتكلم عنه الآن
+
+900
+01:08:28,920 --> 01:08:35,280
+ضاعف لي قدرة الحمل تبع الدم بدل ما يحمل اتنين كل
+
+901
+01:08:35,280 --> 01:08:40,360
+مرة صار يحمل أربعة بدل ما يتخلص من اتنين يتخلص من
+
+902
+01:08:40,360 --> 01:08:44,000
+أربعة تمام؟ إذاً مهم جدًا هذا لأنه عمليًا doubling
+
+903
+01:08:44,000 --> 01:08:48,570
+لمن؟ في حين أن الـ Bohr effect ما يعملش doubling
+
+904
+01:08:48,570 --> 01:08:55,270
+الـ Bohr effect بيعمل shift 10% أو 15% تمام؟ بيزيد
+
+905
+01:08:55,270 --> 01:09:02,350
+الـ oxygen supply للـ tissues 10% أو up to 15% تمام؟ و
+
+906
+01:09:02,350 --> 01:09:05,410
+بيعمل shift على الجهة الثانية برضه 10% to 15% لكن
+
+907
+01:09:05,410 --> 01:09:09,690
+هذا بيديني 100% additional صار عندي بدل ما أنا
+
+908
+01:09:09,690 --> 01:09:13,550
+بفقد اتنين صار بفقد أربعة تمام؟ is a hardened
+
+909
+01:09:13,550 --> 01:09:20,890
+effect. الـ Haldane effect إيش؟ أهم لأنه خلّصني من ضعف الـ
+
+910
+01:09:20,890 --> 01:09:24,390
+carbon dioxide اللي إيه؟ طيب إيش هو الـ Haldane effect
+
+911
+01:09:24,390 --> 01:09:31,890
+هذا؟ من وين جاي؟ الـ Haldane
+
+912
+01:09:31,890 --> 01:09:37,730
+effect جاي من إنه أثناء احنا أثناء
+
+913
+01:09:37,730 --> 01:09:44,270
+ما نصل الـ tissues تمام؟ أثناء وصولنا للـ tissue
+
+914
+01:09:44,270 --> 01:09:52,070
+بيصير عندي more oxygen binds to the hemoglobin هذه
+
+915
+01:09:52,070 --> 01:09:55,230
+عملية أن لما يديني more oxygen binds to the
+
+916
+01:09:55,230 --> 01:10:00,070
+hemoglobin بيديني more capacity of the blood to
+
+917
+01:10:00,070 --> 01:10:04,440
+release carbon dioxide لحظة في الـ tissues العكس
+
+918
+01:10:04,440 --> 01:10:08,140
+كنا نقول لما يزيد الـ carbon dioxide إداني فرصة أعطي
+
+919
+01:10:08,140 --> 01:10:12,980
+أكثر oxygen مش كده؟ شفت دلوقتي؟ مش كده؟ هنا عملية
+
+920
+01:10:12,980 --> 01:10:18,220
+عكسية لما زاد الـ oxygen ثم صار عندي مقدرة أكبر أني
+
+921
+01:10:18,220 --> 01:10:22,670
+أترك carbon dioxide يعني اتنين عكس بعض. الـ carbon
+
+922
+01:10:22,670 --> 01:10:25,590
+dioxide ساعد الـ oxygen أنه ينترك في الـ tissues و
+
+923
+01:10:25,590 --> 01:10:28,170
+الـ oxygen ساعد الـ carbon dioxide أنه ينترك أكثر في
+
+924
+01:10:28,170 --> 01:10:32,070
+الـ alveoli مش كده؟ إذاً هذه باختصار، لكن ليش
+
+925
+01:10:32,070 --> 01:10:35,530
+بيصير هيك؟
+
+926
+01:10:35,530 --> 01:10:40,510
+ليش بيصير؟ إيش تفسير الـ process هذه؟
+
+927
+01:10:42,910 --> 01:10:48,150
+الـ process تفسيرها أنه أنا لما بي... بي... بيخش
+
+928
+01:10:48,150 --> 01:10:57,370
+عندي الـ... الـ oxygen إلى الـ... الـ... الـ... الـ
+
+929
+01:10:57,370 --> 01:11:03,770
+hemoglobin، الـ hemoglobin بتحول لـ less acidic تمام؟
+
+930
+01:11:03,770 --> 01:11:08,070
+و هذا بيؤدي إلى أن الـ carbon dioxide يطلع
+
+931
+01:11:08,070 --> 01:11:10,930
+أكثر. خلينا إيه؟ خلينا نراجعها هنا
+
+932
+01:11:18,830 --> 01:11:24,410
+هذا يعني تغيير في حرارة الدم بينما يتحرك ثاني أكسيد الكربون
+
+933
+01:11:24,410 --> 01:11:29,330
+أصبح كذلك عندما يدخل ثاني أكسيد
+
+934
+01:11:29,330 --> 01:11:34,410
+الكربون في الدم في الجسم، يتقلل حرارة الدم بي
+
+935
+01:11:34,410 --> 01:11:41,090
+اتش ولكن تجهيز هذا الحرارة بالحرارة
+
+936
+01:11:41,090 --> 01:11:44,670
+الأساسية من الدم يمنع الحرارة الهيدروجينية من
+
+937
+01:11:46,010 --> 01:11:49,110
+rising greatly. هذا الـ buffering effect تبع
+
+938
+01:11:49,110 --> 01:11:51,950
+الهيموجلوبين على الهيدروجين اتكلمنا عنه احنا من
+
+939
+01:11:51,950 --> 01:11:56,570
+شوية تمام؟ و هنا بنلاقي التحول في الـ pH قليل لأنه
+
+940
+01:11:56,570 --> 01:12:00,650
+له buffering effect من سبعة فاصلة أربعة بس بنزل
+
+941
+01:12:00,650 --> 01:12:05,790
+لسبعة فاصلة ثلاثة مع الـ additional hydrogen تمام؟
+
+942
+01:12:05,790 --> 01:12:11,570
+the reverse occurs في الـ other side in heavy
+
+943
+01:12:11,570 --> 01:12:18,720
+exercise. بنلاحظ أنه can be as much as فاصلة خمسة
+
+944
+01:12:18,720 --> 01:12:22,880
+يعني about هنا هنا برضه الـ heavy exercise يديني
+
+945
+01:12:22,880 --> 01:12:28,420
+more hydrogen مش كده؟ when blood flow through the
+
+946
+01:12:28,420 --> 01:12:33,880
+tissues is sluggish، the decrease in pH in the
+
+947
+01:12:33,880 --> 01:12:39,120
+tissue blood can be as much as فاصلة خمسة، about
+
+948
+01:12:39,120 --> 01:12:40,480
+twelve times normal
+
+949
+01:12:46,370 --> 01:12:50,250
+thus causing significant tissue acidosis. هذا في
+
+950
+01:12:50,250 --> 01:12:55,750
+حالة إيه؟ لما يكون عندي slow flow اللي اتكلمنا
+
+951
+01:12:55,750 --> 01:13:01,390
+عنه. الزيادة هنا كانت فاصلة صفر أربعة. لما نتكلم في
+
+952
+01:13:01,390 --> 01:13:06,090
+الوضع الطبيعي، الـ hemoglobin buffering system بيحول
+
+953
+01:13:06,090 --> 01:13:12,360
+الـ pH من سبعة فاصلة أربعة إلى سبعة فاصلة ثلاثة سبعة. لكن
+
+954
+01:13:12,360 --> 01:13:16,020
+لو ما فيش عندي blood supply كويس هنلاحظ أن احنا
+
+955
+01:13:16,020 --> 01:13:21,840
+زاد مش لـ فاصلة صفر أربعة، الـ pH زادت فاصلة خمسة تمام؟
+
+956
+01:13:21,840 --> 01:13:26,920
+فاصلة خمسة لـ فاصلة أربعة، اثنا عشر مرة ضعف، اثنا عشر ضعف
+
+957
+01:13:26,920 --> 01:13:31,240
+تمام، الـ ratio، respiratory exchange ratio
+
+958
+01:13:31,240 --> 01:13:38,080
+هذا آخر موضوع، اللي هو جثة، واحد carbon dioxide
+
+959
+01:13:38,080 --> 01:13:41,660
+اللي فحصناه المرة الفاتتة تمام؟ يعتمد على نوع
+
+960
+01:13:41,660 --> 01:13:44,720
+الأكل اللي احنا بناكله. لو عملنا مقارنة للناس
+
+961
+01:13:44,720 --> 01:13:47,740
+الطبيعيين اللي بياكلوا أكل في وضع طبيعي، فحصنا جداش
+
+962
+01:13:47,740 --> 01:13:52,080
+بياخدوا أكسجين، جداش بيطلعوا carbon dioxide هنلاقي
+
+963
+01:13:52,080 --> 01:13:55,020
+دائمًا carbon dioxide أقل من أكسجين، لأن بنلاقي الـ
+
+964
+01:13:55,020 --> 01:13:57,360
+ratio بين carbon dioxide و أكسجين فاصلة ثمانية اثنين
+
+965
+01:13:57,360 --> 01:14:05,220
+تمام؟ لو طعمناهم بروتينات بحتة هنلاقيها حوالي فاصلة
+
+966
+01:14:05,220 --> 01:14:10,600
+ثمانية. لو أكلوا carbohydrate بحتة هنلاقيها واحد، يعني
+
+967
+01:14:10,600 --> 01:14:12,580
+صار عندي الـ carbohydrate في حالة الـ carbohydrate
+
+968
+01:14:12,580 --> 01:14:17,540
+واحد oxygen بديني واحد carbon dioxide تمام؟ لو
+
+969
+01:14:17,540 --> 01:14:22,760
+أكلنا fats كثيرة هنلاقي نزلت لـ فاصلة سبعة، يعني
+
+970
+01:14:22,760 --> 01:14:29,900
+عندي more hydrogen is present و more water is
+
+971
+01:14:29,900 --> 01:14:34,260
+formed تمام؟ إذاً من الـ ratio هذه، إحنا الطبيعي إن
+
+972
+01:14:34,260 --> 01:14:37,180
+نلاقيها فاصلة ثمانية. إذا لاجيناها أعلى من الـ
+
+973
+01:14:37,180 --> 01:14:39,260
+فاصلة ثمانية معناها في عندي more carbohydrate في
+
+974
+01:14:39,260 --> 01:14:42,520
+الأكل. لو لاجيناها أقل من الـ فاصلة ثمانية معناها
+
+975
+01:14:42,520 --> 01:14:46,730
+عندي في إيش؟ more fat in the... in the... in
+
+976
+01:14:46,730 --> 01:14:50,210
+the diet. ومن كده هذا ما نسميه إحنا الـ respiratory
+
+977
+01:14:50,210 --> 01:14:53,810
+exchange ratio. الـ respiratory exchange ratio
+
+978
+01:14:53,810 --> 01:14:58,750
+بتمثل نوع الأكل اللي أنا باأكله. بيوضح السببين اللي
+
+979
+01:14:58,750 --> 01:15:03,190
+إحنا اتكلمنا عنهم، في ليش... ليش بيصير الـ holding
+
+980
+01:15:03,190 --> 01:15:08,430
+effect مش كده؟ المزيد من الهيموجلوبين، المزيد من
+
+981
+01:15:08,430 --> 01:15:09,030
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+982
+01:15:09,030 --> 01:15:09,930
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+983
+01:15:09,930 --> 01:15:12,510
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+984
+01:15:12,510 --> 01:15:20,770
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+985
+01:15:20,770 --> 01:15:20,870
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+986
+01:15:20,870 --> 01:15:20,890
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+987
+01:15:20,890 --> 01:15:20,910
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+988
+01:15:20,910 --> 01:15:22,050
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+989
+01:15:22,050 --> 01:15:22,890
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+990
+01:15:22,890 --> 01:15:28,250
+المزيد من المزيد من تمام. إذا أنا لما أعمل less
+
+991
+01:15:28,250 --> 01:15:31,110
+acidic مع الـ hemoglobin بيمسك carbon dioxide أقل
+
+992
+01:15:31,110 --> 01:15:34,230
+بيعمل wash للـ carbon dioxide أكثر. the
+
+993
+01:15:34,230 --> 01:15:37,290
+increased acidity of the hemoglobin also causes it
+
+994
+01:15:37,290 --> 01:15:39,710
+to release an excess of the hydrogen ions
+
+995
+01:15:39,710 --> 01:15:44,770
+الهيدروجين اللي مسكها أساسًا هو تمام، بتركها لما
+
+996
+01:15:44,770 --> 01:15:47,010
+ييجي oxygen اللي هو صار more إيش؟
+
+997
+01:15:49,970 --> 01:15:54,270
+more acidic. النقطتين
+
+998
+01:15:54,270 --> 01:15:56,930
+هدول نوضحهم بالتفصيل، اشرحهم براحتكم، عشان أنا صار
+
+999
+01:15:56,930 --> 01:15:58,690
+مكفي في إنهاء الدرس.
+
+1000
+01:16:22,580 --> 01:16:23,700
+جزاك الله خيرًا
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..19986fa645e7ddcb3e995d7733bec3228cce0831
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY_postprocess.srt
@@ -0,0 +1,4000 @@
+1
+00:00:08,980 --> 00:00:15,240
+إذا لو نظرنا هنا إلى المنحنى هذا اللي هو الأهم
+
+2
+00:00:16,130 --> 00:00:19,790
+بتدينا مواصفات العلاقة ما بين الـ hemoglobin و الـ
+
+3
+00:00:19,790 --> 00:00:25,470
+oxygen بنلاحظ أنه عندنا في الـ oxygen هذا ال curve
+
+4
+00:00:25,470 --> 00:00:30,170
+اللي يعني يمثل الـ hemoglobin فيه إله حاجة اسمها
+
+5
+00:00:30,170 --> 00:00:34,010
+buffering effect of hemoglobin ال hemoglobin إله
+
+6
+00:00:34,010 --> 00:00:38,950
+buffering effect فيه حمله للإيه؟ لل oxygen بحيث
+
+7
+00:00:38,950 --> 00:00:43,590
+إنه يحافظ على البرشر برشر of oxygen في ال
+
+8
+00:00:43,590 --> 00:00:47,700
+capillary sideفي الـ Interstitial Fluid ثابت لأنه
+
+9
+00:00:47,700 --> 00:00:52,340
+الأساس في تغييت الخلايا بالأكسجين اللي هو ال
+
+10
+00:00:52,340 --> 00:00:56,240
+pressure of oxygen في ال Interstitial Fluid بمعنى
+
+11
+00:00:56,240 --> 00:01:00,940
+أنه ال Hemoglobin مهمته الرئيسية أنه يحافظ على
+
+12
+00:01:00,940 --> 00:01:05,300
+مستوى معين من ال pressure of oxygen في ال
+
+13
+00:01:05,300 --> 00:01:08,100
+Interstitial Fluid وهذا اللي بنلاحظه هان في
+
+14
+00:01:08,100 --> 00:01:14,100
+المنطقة اللي في المنطقة ال cells ومنطقة ال
+
+15
+00:01:14,100 --> 00:01:17,600
+capillaries اللي هي تعبر عن ال interstitial fluid
+
+16
+00:01:17,600 --> 00:01:22,580
+المنطقة هادة في ال curve ماللاحظ فيها انه الانخفاض
+
+17
+00:01:22,580 --> 00:01:28,200
+هنا steep نازل نزول بمعنى انه بجل ال oxygen volume
+
+18
+00:01:28,200 --> 00:01:34,180
+لكن ال pressure نقصان ال pressure جليل نازل نزول
+
+19
+00:01:34,180 --> 00:01:37,520
+يعني وكأنه من درجة لدرجة في ال pressure بسيطة
+
+20
+00:01:37,520 --> 00:01:41,420
+بيفقد كمية كبيرة من المن ال .. فإذا هذا الـ
+
+21
+00:01:41,420 --> 00:01:45,600
+Seeping effect تبعت ال إيه؟ ال curve هنا بيوضح لنا
+
+22
+00:01:45,600 --> 00:01:52,340
+إنه ال .. ال differences in partial pressure و ال
+
+23
+00:01:52,340 --> 00:01:56,640
+oxygen is minimal في ال tissues لاحظوا إنه ممكن
+
+24
+00:01:56,640 --> 00:02:00,940
+ندى كمية ضخمة جدا تلت أضعاف الطبيعي الطبيعي من هنا
+
+25
+00:02:00,940 --> 00:02:08,070
+لهنا من ال arterialالـ pressure of oxygen اللي هو
+
+26
+00:02:08,070 --> 00:02:15,770
+قولنا يمثل عشرين تقريبا أو nineteen point four ملي
+
+27
+00:02:15,770 --> 00:02:20,110
+لتر of oxygen percent إلى ال forty percent
+
+28
+00:02:20,110 --> 00:02:24,090
+pressure هان اللي تمثل يمثلها fourteen point four
+
+29
+00:02:24,090 --> 00:02:29,250
+الفرج هان من من الخمسة وتسعين إلى الأربعين الفرج
+
+30
+00:02:29,250 --> 00:02:35,620
+خمسة ملي لتر oxygen percentتمام؟ لكن لاحظوا من
+
+31
+00:02:35,620 --> 00:02:40,760
+خمسة و تسعين لاربعين خمس و ست .. خمسة و .. و خمسين
+
+32
+00:02:40,760 --> 00:02:43,880
+في المية مش هيك خمسة و خمسين millimeter mercury
+
+33
+00:02:43,880 --> 00:02:47,440
+فقط بيفقد ال hemoglobin فوق في منطقة .. في منطقة
+
+34
+00:02:47,440 --> 00:02:51,660
+هذه الخمسة لكن منطقة الكابلرز الفقدان من .. من ..
+
+35
+00:02:51,660 --> 00:03:00,030
+من اربعين و عشرينبين 40 و20 حوالي او بين 40 و ..
+
+36
+00:03:00,030 --> 00:03:04,430
+اه و 15 حوالي عندي انا الفرق يعني بين 20
+
+37
+00:03:04,430 --> 00:03:08,330
+millimeter mercury بنفقد تلت اضعاف بنفقد كمان 15
+
+38
+00:03:08,330 --> 00:03:14,510
+milliliter من 14 و 4 الى 4 هنا .. هنا 4 و 4 بين ال
+
+39
+00:03:14,510 --> 00:03:19,370
+40 و 20 تمام؟ اذا في 20 millimeter mercury
+
+40
+00:03:19,370 --> 00:03:22,860
+pressure of difference في منطقة ال tissuesبصير
+
+41
+00:03:22,860 --> 00:03:26,400
+فقدان كمية ضخمة جدا من ال oxygen حتى يحافظ على إيه
+
+42
+00:03:26,400 --> 00:03:29,420
+على ال partial pressure ما إيه ماينزلش بسهولة إذا
+
+43
+00:03:29,420 --> 00:03:32,100
+بدي oxygen بدي oxygen بدي oxygen بكمية كبيرة إذا
+
+44
+00:03:32,100 --> 00:03:35,240
+فارج ال pressure بيكون إيه بيكون جليل ويتظل اتحافظ
+
+45
+00:03:35,240 --> 00:03:38,280
+هذا المسألة على ال pressure اللي ده العالي إذا في
+
+46
+00:03:38,280 --> 00:03:42,600
+عندي أنا حاجة بسميها the buffer effect of
+
+47
+00:03:42,600 --> 00:03:47,200
+hemoglobin تمام؟ بمعنى إنه the role of hemoglobin
+
+48
+00:03:47,200 --> 00:03:51,100
+is to maintain nearly constant partial pressure of
+
+49
+00:03:51,100 --> 00:03:53,880
+oxygen in the tissuesواضح؟ وهذا الـ steeping
+
+50
+00:03:53,880 --> 00:03:59,360
+effect تبعها هو سبب رئيسي منها الحاجة التانية اللى
+
+51
+00:03:59,360 --> 00:04:04,500
+بتصير انه ساعة ما يصير عندى نقصان في pressure in
+
+52
+00:04:04,500 --> 00:04:08,540
+the tissues بيصير vasodilatation فبقدر ان ال flow
+
+53
+00:04:08,540 --> 00:04:13,720
+يزيدف flow زايد مع hemoglobin زايد مع oxygen محمول
+
+54
+00:04:13,720 --> 00:04:18,160
+عليه بيقدي إلى إيه؟ إلى إنه يديني more supply of
+
+55
+00:04:18,160 --> 00:04:21,740
+oxygen بيقدّي إلى إنه ماينهبطش لإيه برشا برشا
+
+56
+00:04:21,740 --> 00:04:24,820
+اكتير، واضح؟إذا ال pressure pressure effect
+
+57
+00:04:24,820 --> 00:04:32,480
+الأساسي تبع ال cellular interstitial fluid المنطقة
+
+58
+00:04:32,480 --> 00:04:34,780
+هي اللي لازم يبقى ثابت من خلال mainly ال
+
+59
+00:04:34,780 --> 00:04:38,160
+hemoglobin و بيلاحظوا أنه بيزيد ال blood flow حتى
+
+60
+00:04:38,160 --> 00:04:42,060
+يزود برضه ال oxygen supply إذا during heavy
+
+61
+00:04:42,060 --> 00:04:47,020
+exercise extra amounts of oxygen as much as twenty
+
+62
+00:04:47,020 --> 00:04:50,400
+times normal must be delivered from the hemoglobin
+
+63
+00:04:50,400 --> 00:04:51,560
+to the tissues
+
+64
+00:04:55,280 --> 00:05:00,880
+but this can be achieved اذا عندي انا ممكن ازيد ال
+
+65
+00:05:00,880 --> 00:05:04,160
+ال
+
+66
+00:05:04,160 --> 00:05:06,860
+oxygen supplied to the tissues during exercise
+
+67
+00:05:06,860 --> 00:05:10,500
+حوالي عشرين مرة تلاتة منهم بسبب اللي قولنا عليه
+
+68
+00:05:10,500 --> 00:05:16,000
+انه قدرة ال hemoglobin انه يعطي more oxygen بدي
+
+69
+00:05:16,000 --> 00:05:21,520
+تلت أضعاف من خمسة بدي 15 تلت أضعاف بالاضافة لإنه
+
+70
+00:05:21,520 --> 00:05:27,500
+during exercise الالـ blood flow بزيد 6 إلى 7 مرات
+
+71
+00:05:27,500 --> 00:05:32,040
+فبيقدر إلى حوالي عشرين ضعف زيادة للإيه؟ لل tissues
+
+72
+00:05:32,040 --> 00:05:36,880
+oxygen supply طبعا هنا بدخل عند عاملين إضافيين أو
+
+73
+00:05:36,880 --> 00:05:40,900
+تلاتة بيزيدوا عملية ال إيه؟ ال shift of the curve
+
+74
+00:05:40,900 --> 00:05:44,020
+بيساعدوا ال curve ال dissociation كيف تكلمنا عنه
+
+75
+00:05:44,020 --> 00:05:46,800
+بيساعدوا انه to إيه؟ to shift to the right يعني
+
+76
+00:05:46,800 --> 00:05:49,820
+يديني more oxygen اللي هي انه during exercise
+
+77
+00:05:49,820 --> 00:05:55,020
+الحرارة بتعلى مش كده؟ during exerciseال carbon
+
+78
+00:05:55,020 --> 00:05:58,840
+dioxide لإن ال metabolism زاد، ال carbon dioxide
+
+79
+00:05:58,840 --> 00:06:04,100
+بزيد، during exercise ال hydrogen ions بتزيد،
+
+80
+00:06:04,100 --> 00:06:09,800
+تلاتة effects بتزيد، ولو صار عندي نقصان حقيقي في
+
+81
+00:06:09,800 --> 00:06:13,310
+ال oxygen supply لهذه المنطقةبنلاجئ أنه ال
+
+82
+00:06:13,310 --> 00:06:17,490
+bisphosphate glycerol برضه بزيد بس في الحالة .. هو
+
+83
+00:06:17,490 --> 00:06:20,270
+في الغالب اللي بزيدش أثناء ال exercise بزيد في
+
+84
+00:06:20,270 --> 00:06:23,170
+حالة ما يكون في عندي schema لمنطقة معينة for a
+
+85
+00:06:23,170 --> 00:06:27,550
+long time فهو بيعلى أو بيقدّي إلى أنه يزاوي يعمل
+
+86
+00:06:27,550 --> 00:06:31,280
+more shift of the calf to the right بيحسنالـ less
+
+87
+00:06:31,280 --> 00:06:35,620
+flow of blood بتديني more oxygen بحيث يعوض الـ
+
+88
+00:06:35,620 --> 00:06:40,260
+ischemic state بتبع الـ HS1 okay طيب هذه بالنسبة
+
+89
+00:06:40,260 --> 00:06:45,040
+لل .. اذا هنا بنقدر نجرى هذه الجملة المختصر المفيد
+
+90
+00:06:45,040 --> 00:06:49,940
+انه it can be seen من الكلام اللي قلناها that the
+
+91
+00:06:49,940 --> 00:06:53,360
+hemoglobin in the blood automatically delivers
+
+92
+00:06:53,360 --> 00:06:57,700
+oxygen to the tissues at a pressure thatوهي محفظة
+
+93
+00:06:57,700 --> 00:07:06,600
+بين 15 و40 مليمتر مركز بحيث ما يتغيرش تمام؟ إذن من
+
+94
+00:07:06,600 --> 00:07:09,280
+مهام الهوموجلوبين الرئيسية إنه حافظ على الـ
+
+95
+00:07:09,280 --> 00:07:11,840
+Interstitial Fluid بارشة pressure of Oxygen
+
+96
+00:07:11,840 --> 00:07:18,640
+constant وعندما
+
+97
+00:07:18,640 --> 00:07:21,400
+تغيير محافظة الهوموجلوبين الأطماعي بشكل أكبر بشكل
+
+98
+00:07:21,400 --> 00:07:26,570
+مختلف بشكل أكبر بشكل أكبر بشكل أكبر بشكل أكبرهذا
+
+99
+00:07:26,570 --> 00:07:29,030
+الكلام اللي احنا بيقوله atmospheric، اذا الآن
+
+100
+00:07:29,030 --> 00:07:32,410
+الملاحظة
+
+101
+00:07:32,410 --> 00:07:38,590
+انه طيب ال curve هذا له اهمية اخرى اذا نقول ان
+
+102
+00:07:38,590 --> 00:07:41,390
+احنا during exercise بديني more oxygen to the
+
+103
+00:07:41,390 --> 00:07:46,710
+tissues طيب during atmospheric oxygen it changes
+
+104
+00:07:46,710 --> 00:07:51,770
+انت في high altitudes انت في aeroplane انت في
+
+105
+00:07:51,770 --> 00:07:55,530
+منطقة فيها less oxygenبرضه الفروقات بسيطة اذا ال
+
+106
+00:07:55,530 --> 00:07:59,870
+buffering system احنا بدي more to the muscles
+
+107
+00:07:59,870 --> 00:08:05,650
+وبياخد more from the atmosphere تمام؟ وقلنا الجزء
+
+108
+00:08:05,650 --> 00:08:08,950
+العالي في ال curve هذا الجزء العالي في ال curve
+
+109
+00:08:08,950 --> 00:08:13,630
+اللي هو في منطقة ال alveoli انه هنا بيصير عندي انا
+
+110
+00:08:13,630 --> 00:08:17,550
+more attraction بين ال hemoglobin و ال oxygen بحيث
+
+111
+00:08:17,550 --> 00:08:20,790
+انه فرق كبير في ال .. في ال pressure بديني فرق
+
+112
+00:08:20,790 --> 00:08:25,430
+بسيط في ال ايه؟ في ال ..في الـ Oxygen content الـ
+
+113
+00:08:25,430 --> 00:08:30,370
+Oxygen content للهمoglobin بين ال 95% الطبيعي أو
+
+114
+00:08:30,370 --> 00:08:35,770
+أكتر حتى لو قلنا 104% يعني كاملة تمام لو وصلنا
+
+115
+00:08:35,770 --> 00:08:39,990
+لأول مكان إلى ال 60% اللي لو قلنا إنه في high
+
+116
+00:08:39,990 --> 00:08:43,810
+altitude و نزل ال blood pressure ال Oxygen
+
+117
+00:08:43,810 --> 00:08:49,250
+pressure إلى 60% الفرق بينهم كان دياشي الفرق من
+
+118
+00:08:49,250 --> 00:08:54,640
+هنا إلى هنا قلنا إيه؟فقط الستين لهان هذه أربعين
+
+119
+00:08:54,640 --> 00:08:58,200
+هذه الخطوط اللي احنا الستين لهان الفرق بسيط هيكون
+
+120
+00:08:58,200 --> 00:09:03,380
+حوالي سبعة لمية أو تمانية لمية لإنه من الستين هان
+
+121
+00:09:03,380 --> 00:09:09,160
+هيك هلاجي صار عندي فاكرين في ال pressure جولنا
+
+122
+00:09:09,160 --> 00:09:13,780
+سبعة وتمانين من خمسة وتسعين لسبعة تمانين يعني
+
+123
+00:09:13,780 --> 00:09:16,420
+هتكلم عن ايه عن تمانية من
+
+124
+00:09:20,790 --> 00:09:26,710
+8% تقريبًا تقريبًا تقريبًا تقريبًا
+
+125
+00:09:26,710 --> 00:09:34,130
+تقريبًا تقريبًا تقريبًا تقريبًا
+
+126
+00:09:34,130 --> 00:09:36,250
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+127
+00:09:36,250 --> 00:09:40,450
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+128
+00:09:40,450 --> 00:09:41,010
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+129
+00:09:41,010 --> 00:09:42,010
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+130
+00:09:42,010 --> 00:09:49,950
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًاتمام؟ في
+
+131
+00:09:49,950 --> 00:09:55,010
+حين ان البرشر بشر تبع ال atmospheric air فقط نزل
+
+132
+00:09:55,010 --> 00:10:00,010
+لستين تمام؟ هو في الطبيعي بنوصل احنا ل .. بيبقى في
+
+133
+00:10:00,010 --> 00:10:04,010
+الطبيعي مية وأربعة مع ال mixture بيصير عندي إيه؟
+
+134
+00:10:04,010 --> 00:10:09,910
+خمسة وتسعين فمن خمسة وتسعين ل eighty nine عندي
+
+135
+00:10:09,910 --> 00:10:14,290
+فارق كده؟ ستة أو سبعة ستة مش كده؟ ممكن ستة
+
+136
+00:10:14,290 --> 00:10:16,670
+millimeter mercury أو سبعة millimeter mercury
+
+137
+00:10:16,670 --> 00:10:22,310
+يدوني في الآخرفرق بسيط و يظل تقريبا عندى ال .. ال
+
+138
+00:10:22,310 --> 00:10:29,930
+.. ال .. ال oxygen saturation عالية تمانية او تسعة
+
+139
+00:10:29,930 --> 00:10:32,850
+وتمانين في المية millimeter mercury بيظل حافظ على
+
+140
+00:10:32,850 --> 00:10:37,370
+ال Aطيب نجرى المثال هذا referring back to the
+
+141
+00:10:37,370 --> 00:10:43,210
+oxygen طيب we can see that for the normal five
+
+142
+00:10:43,210 --> 00:10:47,090
+milliliter of oxygen to be released per hundred
+
+143
+00:10:47,090 --> 00:10:49,630
+milliliter of blood the pressure pressure must
+
+144
+00:10:49,630 --> 00:10:52,770
+fall to forty therefore the tissues pressure
+
+145
+00:10:52,770 --> 00:10:55,850
+pressure oxygen normally cannot rise above forty
+
+146
+00:10:55,850 --> 00:10:59,970
+millimeter mercury level because if it did the
+
+147
+00:10:59,970 --> 00:11:03,200
+amount of oxygen needed to the tissues wouldand
+
+148
+00:11:03,200 --> 00:11:07,520
+not be released from the hemoglobin okay تمام اذا
+
+149
+00:11:07,520 --> 00:11:15,180
+هنا اتكلمنا على ال exercise ال
+
+150
+00:11:15,180 --> 00:11:18,660
+atmospheric pressure لما بيزيد احنا هنا اللي بدنا
+
+151
+00:11:18,660 --> 00:11:26,300
+ناكد عليها لما ال atmospheric pressure of oxygen
+
+152
+00:11:26,300 --> 00:11:38,400
+بيجلبنلاحظ أنه عندي أنا الفرق بين ال 97
+
+153
+00:11:38,400 --> 00:11:47,240
+% إلى ال 89% بين 95% oxygen مليمتر
+
+154
+00:11:47,240 --> 00:11:49,860
+مركوري بشعر إلى ال
+
+155
+00:11:51,900 --> 00:11:57,020
+الى الـ 60 ميلي متر ميكر براشر هذا هنلاقيهم يمثلوا
+
+156
+00:11:57,020 --> 00:12:04,380
+ايش؟ يمثلوا 89% oxygen saturation الى من 97%
+
+157
+00:12:04,380 --> 00:12:07,380
+oxygen saturation مش كده؟ و من الطبيعي ان ال
+
+158
+00:12:07,380 --> 00:12:10,580
+homogloin بيكون حاجة من 97% في ال full saturation
+
+159
+00:12:10,580 --> 00:12:14,120
+لما ينزل البراشر ل 60 هلاقي الفرق في ال saturation
+
+160
+00:12:14,120 --> 00:12:20,140
+فقط 89 يعني عندي الفرق من هدول 8% مش هيك فقط 8%
+
+161
+00:12:20,140 --> 00:12:23,700
+فرقفي ال saturation في حين انه جداش الفارق في ال
+
+162
+00:12:23,700 --> 00:12:27,760
+ايه؟ في ال pressure الفارق في ال pressure من .. من
+
+163
+00:12:27,760 --> 00:12:33,560
+.. من ninety .. من ninety five الى .. الى sixty،
+
+164
+00:12:33,560 --> 00:12:36,120
+thirty five thirty five millimeter mercury
+
+165
+00:12:36,120 --> 00:12:40,240
+difference oxygen pressure يدوني فقط ال saturation
+
+166
+00:12:40,240 --> 00:12:43,400
+difference جداش؟ فقط eighty percent لإن ال
+
+167
+00:12:43,400 --> 00:12:45,960
+saturation بيكون طبيعي ninety seven لما ينزل
+
+168
+00:12:45,960 --> 00:12:51,690
+الستين هلاجي سعر ايش؟ سعر ninety .. eighty nine8%
+
+169
+00:12:51,690 --> 00:12:59,790
+مقارنة في 35% مقارنة 35 مليمتر هذا في المنطقة لذلك
+
+170
+00:12:59,790 --> 00:13:03,510
+ال saturation بيتم يعني في buffer system برضه في
+
+171
+00:13:03,510 --> 00:13:08,650
+هذه المنطقة اللي هي العالية مش كده؟ وهذا اللي احنا
+
+172
+00:13:08,650 --> 00:13:12,710
+ايه؟ هذه العجيبة في تركيبة ال hemoglobin انه
+
+173
+00:13:12,710 --> 00:13:17,040
+المركز بيحس انه يمسك اكسيجين اكترعند pressure معين
+
+174
+00:13:17,040 --> 00:13:22,360
+ويفقد oxygen اكتر عند pressure معين انه يمسك اكتر
+
+175
+00:13:22,360 --> 00:13:36,920
+لمصلحة الجسم ونفقد اكتر لمصلحة الجسم طيب
+
+176
+00:13:36,920 --> 00:13:39,880
+الان احنا قلنا برضه لو
+
+177
+00:13:42,200 --> 00:13:49,240
+زودنا ال .. ال brusher الطبيعي اللي احنا بيصلنا لو
+
+178
+00:13:49,240 --> 00:13:54,520
+نزلناه قولنا من ninety-five إلى sixty مابصارش فارق
+
+179
+00:13:54,520 --> 00:14:00,630
+كبير طب لو زودناه من ninety-five إلىخمسمية لستمية
+
+180
+00:14:00,630 --> 00:14:05,150
+بمعنى اخر انه احنا اطلعنا على .. اه نزلنا في مناطق
+
+181
+00:14:05,150 --> 00:14:09,210
+فيها ضغط عالي او ادينا oxygen under high pressure
+
+182
+00:14:09,210 --> 00:14:16,510
+او احنا حطنا في chambers under high pressure تمام؟
+
+183
+00:14:16,510 --> 00:14:18,810
+حالها ال oxygen ممكن يعلق، ممكن نعلق ال pressure
+
+184
+00:14:18,810 --> 00:14:23,070
+تبعه، مش هيك؟ال .. الفرق هنا بالنسبة لل Hemoglobin
+
+185
+00:14:23,070 --> 00:14:25,870
+فرق بالنسبة لل Hemoglobin فقط تلت المية ال maximum
+
+186
+00:14:25,870 --> 00:14:30,190
+انه يتحول من 97% لإيش؟ ل 100% يعني ال Hemoglobin ك
+
+187
+00:14:30,190 --> 00:14:35,410
+Hemoglobin مش هياخد أكتر من هيك يعني بين ضغط الف و
+
+188
+00:14:35,410 --> 00:14:41,550
+بين ضغط ستين الفرق بالنسبة لل Hemoglobin فرق بسيط
+
+189
+00:14:41,550 --> 00:14:47,610
+واضح؟ لكن ايش بيفرج عننا احنا لما بزيد الضغط ال
+
+190
+00:14:47,610 --> 00:14:50,030
+disorder
+
+191
+00:14:50,930 --> 00:14:53,310
+الـ dissolved هي اللي بيزيد، لإن الـ dissolved بدو
+
+192
+00:14:53,310 --> 00:14:56,370
+يتساوى الضغط بين الضغط الخارجي والـ dissolved
+
+193
+00:14:56,370 --> 00:14:59,630
+part، إذا الـ dissolved part هو اللي ممكن يزيد،
+
+194
+00:14:59,630 --> 00:15:03,730
+إذا انتوا حطوها في راسكوا، أحيانا عندنا مشكلة في
+
+195
+00:15:03,730 --> 00:15:06,630
+ال homoglobin، صارله مشكلةزي ما بيحصل في
+
+196
+00:15:06,630 --> 00:15:11,830
+الـmonoxide poisoning، carbon monoxide poisoning،
+
+197
+00:15:11,830 --> 00:15:15,670
+تمام؟ في ال carbon monoxide poisoning، بنلاحظ احنا
+
+198
+00:15:15,670 --> 00:15:19,950
+انه عندنا الاشي الوحيد اللي ممكن ينقذني لحد ما
+
+199
+00:15:19,950 --> 00:15:23,610
+اتخلص من ال carbon monoxide، ان ازود ال salt بعد،
+
+200
+00:15:23,610 --> 00:15:31,310
+فبدي pure oxygen عشان ازود ال salt بعدهو بقدي كمان
+
+201
+00:15:31,310 --> 00:15:34,550
+حاجة تانية انت لسه ماخدتهاش بدي carbon dioxide
+
+202
+00:15:34,550 --> 00:15:38,070
+five percent مع ال pure oxygen عشان يعمل ال
+
+203
+00:15:38,070 --> 00:15:42,550
+simulation ل respirator center عشان يزودوا لإنه
+
+204
+00:15:42,550 --> 00:15:46,190
+عيب ال carbon monoxide poisoning ان ال pressure
+
+205
+00:15:46,190 --> 00:15:50,840
+بال oxygen بيتغيرش فبيزرش ال respiratorcenter
+
+206
+00:15:50,840 --> 00:15:55,400
+simulation فالواحد مش ماخد باله انه عنده مشكلة في
+
+207
+00:15:55,400 --> 00:15:59,480
+ال oxygen تمام لأ بيزيد نفسه ولا بينتبه ان هو
+
+208
+00:15:59,480 --> 00:16:01,940
+بيواجه حاله فقط وعي و هو ولا حد بياخد باله انه
+
+209
+00:16:01,940 --> 00:16:05,040
+عنده مشكلة ولا هو بينتبه انه عنده مشكلة بيصيرش
+
+210
+00:16:05,040 --> 00:16:07,960
+عنده respiratory distress ليش لأن ال carbon
+
+211
+00:16:07,960 --> 00:16:12,820
+dioxide و pressure of oxygen في الدم بتغيروش تمام
+
+212
+00:16:12,820 --> 00:16:18,850
+فال carbon monoxide بيمسك مكان ال ايهالهيموجلبي
+
+213
+00:16:18,850 --> 00:16:23,010
+المكان ال oxygen من غير ما يحس بني آدم انه ايه انه
+
+214
+00:16:23,010 --> 00:16:26,090
+صار عنده إشكال اتكلم عنه في آخر المحاضرة ان شاء
+
+215
+00:16:26,090 --> 00:16:29,230
+الله لكن الآن اللي بيهمني في الموضوع انه لو علينا
+
+216
+00:16:29,230 --> 00:16:32,790
+احنا ال pressure ال violar pressure of oxygen
+
+217
+00:16:32,790 --> 00:16:36,390
+بالظروف اللي احنا قولناها deep sea او chamber او
+
+218
+00:16:36,390 --> 00:16:39,990
+positive oxygen او pure oxygen او كده بيزيد ال
+
+219
+00:16:39,990 --> 00:16:42,770
+pressure اه لو ادينا احنا pure oxygen بنعلي ال
+
+220
+00:16:42,770 --> 00:16:47,990
+pressure لقداش لسبعمائة و ستين مش هيكلأنه صار كل
+
+221
+00:16:47,990 --> 00:16:50,710
+ال .. ال .. ال .. ال air اللي عندي اكسيشن فال
+
+222
+00:16:50,710 --> 00:16:54,930
+blusher كاملا يعبر ايه؟ في الحالة هذه انا .. في
+
+223
+00:16:54,930 --> 00:16:58,810
+الحالة هذه ادي ال soft part بيزيد ادي ال soft part
+
+224
+00:16:58,810 --> 00:17:04,820
+هيصير عندياللي هو بدل ما هو تركيز و مثلا في العادة
+
+225
+00:17:04,820 --> 00:17:09,120
+104 و لما يصير mixture بيصير 95 بيصير تركيز و حسب
+
+226
+00:17:09,120 --> 00:17:11,820
+التركيز اللي انا عملته ممكن نصل جد ما ايه نوصل
+
+227
+00:17:11,820 --> 00:17:16,940
+طبعا ال oxygen على ان هو مادة الحياة اللي احنا
+
+228
+00:17:16,940 --> 00:17:19,780
+بتنفس فيها و محتاجينها و كده إلى لو في oxygen
+
+229
+00:17:19,780 --> 00:17:24,800
+poisoning في حاجة اسمها ايش oxygen poisoning يعني
+
+230
+00:17:24,800 --> 00:17:28,300
+لو دي ال soft part هذا عيل كتير بيعمللي poisoning
+
+231
+00:17:29,170 --> 00:17:34,410
+تمام؟ لكن احنا بنستخدمه أحيانا لفترات بسيطة بحيث
+
+232
+00:17:34,410 --> 00:17:37,650
+أنه ننقذ البني آدم من إش تاني انتوا عارفين في حاجة
+
+233
+00:17:37,650 --> 00:17:42,350
+اسمها water intoxication أيضا يعني زي ما ال oxygen
+
+234
+00:17:42,350 --> 00:17:46,390
+ممكن يكون سام في أحيان الميه ممكن تكون سامة في
+
+235
+00:17:46,390 --> 00:17:51,050
+أحيان كل حاجة في غير ظروفها الطبيعية بتعمل إيه؟
+
+236
+00:17:51,650 --> 00:17:54,810
+ممكن تعمل ال poisoning لذلك كتير من الناس عايزين
+
+237
+00:17:54,810 --> 00:17:58,230
+يسألوني الدكتور الدوة هذا يعني ايه له أثار جانبية
+
+238
+00:17:58,230 --> 00:18:03,230
+غريب السؤال من الميه إلى أثار جانبية الميه الأثار
+
+239
+00:18:03,230 --> 00:18:06,230
+الجانبية الأكسجين لو دي أكسجين ايه له أثار جانبية
+
+240
+00:18:06,230 --> 00:18:10,830
+فلازم ننفع لكل إشي لأنه كل إشي إذا اتحدى .. اتعدى
+
+241
+00:18:10,830 --> 00:18:15,730
+حده ممكن يعملنا أي أثار جانبية سلبية تمام؟ إذا في
+
+242
+00:18:15,730 --> 00:18:20,920
+الحالة هذه لو كان أنا عندى ال pressure عاليممكن
+
+243
+00:18:20,920 --> 00:18:32,340
+يعملى what is called oxygen poisoning تمام
+
+244
+00:18:32,340 --> 00:18:37,600
+لكن اللي هيزيد مش ال hemoglobin اللي هيزيد ايش ال
+
+245
+00:18:37,600 --> 00:18:45,000
+disorder part وهذا طيب
+
+246
+00:18:52,800 --> 00:18:58,660
+الحاجة الوحيدة اللي بيجيها
+
+247
+00:18:58,660 --> 00:19:02,820
+ده هو اللي ماتكلمش عنه كتير لإنه بيصير في حالة
+
+248
+00:19:02,820 --> 00:19:07,580
+إيه؟ في حالة ال scheme فقط، فبيزيد نسبته و بيعمل
+
+249
+00:19:07,580 --> 00:19:11,430
+shiftفي حالة الاسكيميا في غير حالة الاسكيميا في
+
+250
+00:19:11,430 --> 00:19:16,610
+العادة بيكونش موجود اذا الآن عندنا حاجتين او نبدأ
+
+251
+00:19:16,610 --> 00:19:20,210
+نتكلم عن حاجة واحدة بخصوص ال oxygen اللي هي ال
+
+252
+00:19:20,210 --> 00:19:26,490
+bore او bore effect اللي هو عبارة عن ايش عبارة عن
+
+253
+00:19:26,490 --> 00:19:31,610
+انه لما يزيد ال carbon dioxide في ال tissues بيزود
+
+254
+00:19:31,610 --> 00:19:36,050
+ال delivery of oxygen to the tissues اللي اتكلمنا
+
+255
+00:19:36,050 --> 00:19:43,230
+عنها من شوية اللي هي ايهالـ factors
+
+256
+00:19:43,230 --> 00:19:46,210
+هذه اللي بتعمل shift to the right of the ايه؟ of
+
+257
+00:19:46,210 --> 00:19:51,390
+the curve، the cessation curve a shift of the
+
+258
+00:19:51,390 --> 00:19:54,350
+oxygen from global cessation curve to the right in
+
+259
+00:19:54,350 --> 00:19:57,790
+response to increase in blood carbon dioxide and
+
+260
+00:19:57,790 --> 00:20:01,110
+hydrogen ions has a significant effect by
+
+261
+00:20:01,110 --> 00:20:05,810
+enhancing the release of oxygen from the blood in
+
+262
+00:20:05,810 --> 00:20:10,440
+the tissuesand enhancing oxygenation of blood in
+
+263
+00:20:10,440 --> 00:20:16,200
+the lungs إذا هذه العملية بتساعد على أنه ندى لل
+
+264
+00:20:16,200 --> 00:20:23,320
+tissues more oxygen و ناخد في ال lungs more oxygen
+
+265
+00:20:23,320 --> 00:20:27,560
+ندى more oxygen و ناخد more oxygen تمام؟ اللي هو
+
+266
+00:20:27,560 --> 00:20:30,300
+shift to the right و shift to the left لما يجلي ال
+
+267
+00:20:30,300 --> 00:20:34,840
+oxygenلما يجيل ال carbon dioxide بنعمل more
+
+268
+00:20:34,840 --> 00:20:39,880
+ability to grasp or to attract more oxygen و لما
+
+269
+00:20:39,880 --> 00:20:45,880
+يزيد ال carbon dioxide بنسلم ايه تمام to the shift
+
+270
+00:20:45,880 --> 00:20:48,960
+لما يجيل ال carbon dioxide عن اللازم و تجيل ال
+
+271
+00:20:48,960 --> 00:20:52,380
+hydrogen ions عن اللازم فبناخد احنا more oxygen
+
+272
+00:20:52,380 --> 00:20:56,500
+اللي هي الجزء الأعلى من الايه to the left اه و
+
+273
+00:20:56,500 --> 00:20:59,300
+اللي هو shift to the right لما يزيد ال carbon
+
+274
+00:20:59,300 --> 00:21:00,320
+dioxide لما ايه
+
+275
+00:21:05,550 --> 00:21:14,530
+أعتقد أنه احنا شرحناها التفسير
+
+276
+00:21:14,530 --> 00:21:18,850
+تبعها، يعني ليش as the blood passes through the
+
+277
+00:21:18,850 --> 00:21:22,110
+tissues, carbon dioxide diffuses from the tissues,
+
+278
+00:21:23,010 --> 00:21:30,080
+cells into the bloodهذا يزيد دماء الهيدروجين
+
+279
+00:21:30,080 --> 00:21:32,840
+ايون من وين اتيت؟ الهيدروجين ايون ان الهيدروجين
+
+280
+00:21:32,840 --> 00:21:34,460
+ايون يتحول الهيدروجين ايون الهيدروجين ايون يتحول
+
+281
+00:21:34,460 --> 00:21:35,340
+الهيدروجين ايون الهيدروجين ايون يتحول الهيدروجين
+
+282
+00:21:35,340 --> 00:21:35,660
+ايون يتحول الهيدروجين ايون يتحول الهيدروجين ايون
+
+283
+00:21:35,660 --> 00:21:38,300
+يتحول الهيدروجين ايون يتحول الهيدروجين ايون يتحول
+
+284
+00:21:38,300 --> 00:21:40,780
+الهيدروجين ايون يتحول الهيدروجين ايون يتحول
+
+285
+00:21:40,780 --> 00:21:42,660
+الهيدروجين ايون يتحول الهيدروجين ايون يتحول
+
+286
+00:21:42,660 --> 00:21:52,720
+الهيدروجين ايون يتحول الهيد
+
+287
+00:21:52,760 --> 00:21:56,880
+في الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+288
+00:21:56,880 --> 00:22:00,260
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+289
+00:22:00,260 --> 00:22:00,440
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+290
+00:22:00,440 --> 00:22:00,980
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+291
+00:22:00,980 --> 00:22:03,800
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+292
+00:22:03,800 --> 00:22:05,620
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+293
+00:22:05,620 --> 00:22:07,400
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+294
+00:22:07,400 --> 00:22:07,880
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+295
+00:22:07,880 --> 00:22:10,360
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+296
+00:22:10,360 --> 00:22:15,640
+الحلوات اللي تدفع الكربون
+
+297
+00:22:15,640 --> 00:22:18,230
+ديكسيد من الدم إلى الحلوالذي يتعامل مع
+
+298
+00:22:18,230 --> 00:22:22,670
+الهيموجلوبين في أي مرحلة ألفيولر برشا برشا برشا
+
+299
+00:22:22,670 --> 00:22:23,730
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+300
+00:22:23,730 --> 00:22:27,850
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+301
+00:22:27,850 --> 00:22:28,570
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+302
+00:22:28,570 --> 00:22:29,430
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+303
+00:22:29,430 --> 00:22:38,090
+برشا برشا برشا برشا برشا
+
+304
+00:22:38,090 --> 00:22:45,090
+برشا
+
+305
+00:22:45,810 --> 00:22:50,230
+during exercise عندنا عدة factors كلمنا اعتقد عنها
+
+306
+00:22:50,230 --> 00:22:54,810
+الحرارة carbon dioxide الهيدروجين كلهم بيساعدوا
+
+307
+00:22:54,810 --> 00:23:02,130
+على اي ارتفاع metabolic use of oxygen by cells هنا
+
+308
+00:23:02,130 --> 00:23:05,410
+في عندنا اتكلم عن بعض المسائل و تخص ال cells في
+
+309
+00:23:05,410 --> 00:23:14,250
+استخدام الاكسجين الان هل ال pressure مهم
+
+310
+00:23:15,190 --> 00:23:20,690
+في حياة ال cells عشان نديها good oxygen مهم بس
+
+311
+00:23:20,690 --> 00:23:24,470
+لجينا احنا انه زي ما حكيتكوا البارحة الماضية ان
+
+312
+00:23:24,470 --> 00:23:29,490
+اقل difference بين ال interstitial fluid و ال
+
+313
+00:23:29,490 --> 00:23:32,390
+cells يكفي لإنه يديني good metabolism normal
+
+314
+00:23:32,390 --> 00:23:36,870
+metabolism تمام يعني اذا قلنا احنا محتاجين بس فرق
+
+315
+00:23:36,870 --> 00:23:40,830
+pressure one millimeter mercury تمام اذا وجدت هذا
+
+316
+00:23:40,830 --> 00:23:46,440
+ال one millimeter mercuryالسلسل هتمشي الميتابوليز
+
+317
+00:23:46,440 --> 00:23:51,880
+سباحة طبيعى مش هنحس انه انه انه والله لو زودنا
+
+318
+00:23:51,880 --> 00:23:54,480
+الميتابوليزم او جلالنا الميتابوليزم اتأثر لان
+
+319
+00:23:54,480 --> 00:23:58,500
+البرشر برشر اوطى او مش اوطى مش كده ال curve هدا لو
+
+320
+00:23:58,500 --> 00:24:01,220
+لاحظناها هنلاحظ انه احنا لو قولنا هدا one
+
+321
+00:24:01,220 --> 00:24:04,990
+millimeter mercury pressure تمام؟الـ one
+
+322
+00:24:04,990 --> 00:24:08,290
+millimeter mercury pressure قبله نلاحظ أن البرشة
+
+323
+00:24:08,290 --> 00:24:10,270
+البرشة له تأثير على ال cell يعني يبقى ال
+
+324
+00:24:10,270 --> 00:24:12,670
+metabolism واطي ويبقى ليه على ليه على ما يصل
+
+325
+00:24:12,670 --> 00:24:17,090
+الواحد لحد ما بيصير طبيعي تمام؟ okay جابت لكن بعد
+
+326
+00:24:17,090 --> 00:24:21,250
+الواحد اللي بيأثر فيه ال cell metabolism مش ال a
+
+327
+00:24:21,250 --> 00:24:24,830
+يعني لو زودنا ال pressure أيش بنزود؟ هيبقى
+
+328
+00:24:24,830 --> 00:24:28,550
+constant يعني ال curve هي ده لحد واحد millimeter
+
+329
+00:24:28,550 --> 00:24:31,650
+mercury بدأ يزيد ال metabolismأو ال oxygen
+
+330
+00:24:31,650 --> 00:24:39,590
+consumption لكن بعد هيك بعد هيك زودنا ال pressure
+
+331
+00:24:39,590 --> 00:24:45,210
+pressure اتنين تلاتة اربعة خمسة عشر عشرين ال
+
+332
+00:24:45,210 --> 00:24:48,230
+metabolism ما اتأثرت يعني هو بعد ال difference of
+
+333
+00:24:48,230 --> 00:24:52,930
+one millimeter mercuryبطل البرشا برشا التأثير انه
+
+334
+00:24:52,930 --> 00:24:56,250
+يزود او يجلل لإنه صار بس available if the .. if
+
+335
+00:24:56,250 --> 00:24:59,670
+the .. if the cells needs .. if the cells need
+
+336
+00:24:59,670 --> 00:25:03,950
+more متابوليزم بتقدر تعمل لكن هل زيادة ال oxygen
+
+337
+00:25:03,950 --> 00:25:07,170
+في حد ذاته بيزود المتابوليزم؟ لأ طب ايش اللي بيزود
+
+338
+00:25:07,170 --> 00:25:10,250
+المتابوليزم او بيجللها؟ ال availability of the ..
+
+339
+00:25:10,250 --> 00:25:17,510
+of ADH او ADP ال ADPالأدوسين ديفوسفيت هو المعيار
+
+340
+00:25:17,510 --> 00:25:20,970
+يزود الميتابوليزم ولا لأ لإن لما اتكون ADP معناه
+
+341
+00:25:20,970 --> 00:25:24,110
+ان انا عندي more consumption و more formation of
+
+342
+00:25:24,110 --> 00:25:28,830
+ADP فشغلت الخلية ان تعوض ال ADP فورا تمام عشان
+
+343
+00:25:28,830 --> 00:25:33,250
+ترجعوا ل ATP مش كده اذا هنا بنطلع بنلاقي بعد
+
+344
+00:25:33,250 --> 00:25:40,350
+الواحدإن كان الـ ADP جليل أو طبيعي أو كثير تمام ال
+
+345
+00:25:40,350 --> 00:25:45,510
+.. ال .. ال different partial pressures مالوش
+
+346
+00:25:45,510 --> 00:25:50,160
+علاقة في الموضوعواضح؟ إذا ال ADP لو كان نص الطبيعي
+
+347
+00:25:50,160 --> 00:25:55,420
+من اللي هي ال metabolism نزل لنص الطبيعي و لو كان
+
+348
+00:25:55,420 --> 00:25:59,620
+ADP أعلى بيعلق لطبيعي برجع الطبيعي، واضح؟ إذا ال
+
+349
+00:25:59,620 --> 00:26:02,700
+.. ال pressure برجع ال oxygen محتاجينه يتخطأ
+
+350
+00:26:02,700 --> 00:26:06,600
+الواحد من ال meta mercury for normal usage of
+
+351
+00:26:06,600 --> 00:26:10,940
+oxygen يعني for normal metabolism في الخلايا بغض
+
+352
+00:26:10,940 --> 00:26:15,000
+النظرأجددش شغل الخلايا هذه كتير أو جليل وهذا بتحكم
+
+353
+00:26:15,000 --> 00:26:18,360
+فيها ال ADP مابتحكمش فيها ال what ال partial
+
+354
+00:26:18,360 --> 00:26:21,360
+pressure اذا اتخطى الواحد لكن جابلي الواحد واضح
+
+355
+00:26:21,360 --> 00:26:28,000
+انه ايه انه له علاقة كبيرة تمام؟ طيب النقطة
+
+356
+00:26:28,000 --> 00:26:31,000
+التانية اللى بنتكلم معاها بخصوص الخلايا effect of
+
+357
+00:26:31,000 --> 00:26:35,020
+diffusion distance يعني احنا الآن عندنا ال oxygen
+
+358
+00:26:35,020 --> 00:26:38,340
+هيعمل by diffusion من ال capillaries ال antifluid
+
+359
+00:26:38,790 --> 00:26:42,270
+في الـ interstitial fluid نستخدم الأكسجين بالخلايا
+
+360
+00:26:42,270 --> 00:26:46,230
+بيقل الأكسجين ال blood اللي جاي هعمل أكسجين كويس
+
+361
+00:26:46,230 --> 00:26:49,590
+by diffusion بينتقل إلى ال tissues و إلى ال .. إلى
+
+362
+00:26:49,590 --> 00:26:51,950
+ال .. إلى ال interstitial fluid و إلى ال إيه؟ إلى
+
+363
+00:26:51,950 --> 00:26:57,510
+الخلايا ماشي؟ الآن ال diffusion هذا في الطبيعي ..
+
+364
+00:26:57,510 --> 00:27:01,530
+في الطبيعي مافيش خلية بعيدة عن .. عن a capillary
+
+365
+00:27:01,530 --> 00:27:06,130
+أكتر من خمسين micrometerتمام؟ يعني بسهولة by
+
+366
+00:27:06,130 --> 00:27:08,490
+diffusion very rapidly ال oxygen بيقدر يصل الى
+
+367
+00:27:08,490 --> 00:27:11,950
+المكان المطلوب لكن تحت ischemic states تحت
+
+368
+00:27:11,950 --> 00:27:16,050
+pathological conditions ممكن نحس ان ال diffusion
+
+369
+00:27:16,050 --> 00:27:19,450
+كمية ال oxygen أقل من اللازم ومش قادرة تصل ال
+
+370
+00:27:19,450 --> 00:27:23,790
+cells في الحالة هذه بنسميها ده احنا diffusion
+
+371
+00:27:23,790 --> 00:27:28,250
+limited diffusion limited
+
+372
+00:27:34,850 --> 00:27:41,030
+اللي هو diffusion limited oxygen usage تمام؟ ال
+
+373
+00:27:41,030 --> 00:27:45,390
+oxygen usage صار مرتبط بالإيه؟ بال .. بال .. بال
+
+374
+00:27:45,390 --> 00:27:48,170
+distance و يقدر ان ال diffusion .. إيه صار لها ال
+
+375
+00:27:48,170 --> 00:27:51,490
+cells هادة ولا لأ؟ هذا بصيلش دائما إلا إن في إيه؟
+
+376
+00:27:51,490 --> 00:27:55,730
+في حالات معينة، إذا أحيانا بيكون ال distance إلها،
+
+377
+00:27:55,730 --> 00:28:00,480
+لذلك احنا في حالات ال ..الاسكيميا في الـ diabetes
+
+378
+00:28:00,480 --> 00:28:03,380
+من الـ lettuce، الـ diabetic foot وكذا من المناطق
+
+379
+00:28:03,380 --> 00:28:07,620
+البعيدة صار فيها again green تمام، مناطق غريبة،
+
+380
+00:28:07,620 --> 00:28:11,160
+كويس، by diffusion بتظل alive و بتظل كذا لكن
+
+381
+00:28:11,160 --> 00:28:16,240
+المسافات مهمة في بعض الحالات اللي في الطبيعي مش
+
+382
+00:28:16,240 --> 00:28:21,820
+موجود إذا هنا إيه؟ بسميها diffusion limited usage
+
+383
+00:28:21,820 --> 00:28:26,540
+of oxygen وفي عندنا حاجة تانية اسمها flow limited
+
+384
+00:28:28,020 --> 00:28:31,180
+إذا عندي أنا حاجتين ال distance في حالة بعض
+
+385
+00:28:31,180 --> 00:28:34,580
+الأحيان و ال flow في بعض الأحيان برضه إذا كان أنا
+
+386
+00:28:34,580 --> 00:28:38,060
+عندي إيه narrowing لل blood pressure لل blood
+
+387
+00:28:38,060 --> 00:28:42,780
+vessel pressure عليه ischemia بسبب atherosclerosis
+
+388
+00:28:43,440 --> 00:28:47,880
+وصار ال flow وطي وطي وطي اه اذا في عندي انا flow
+
+389
+00:28:47,880 --> 00:28:53,160
+dependent وفي عندي ايه diffusion dependent يعني لأ
+
+390
+00:28:53,160 --> 00:28:57,360
+الفكرة هي pathological conditions ماهيش
+
+391
+00:28:57,360 --> 00:29:04,960
+physiological states انا
+
+392
+00:29:04,960 --> 00:29:10,740
+حاسس علي انه طلع من المنطقة غلطة دي transport
+
+393
+00:29:10,740 --> 00:29:15,910
+of oxygen in the dissolvedفهذا كتير مهم نتكلم عنه
+
+394
+00:29:15,910 --> 00:29:17,930
+من شوية بعدين نتكلم عنه اذا ان عندي ال disturbed
+
+395
+00:29:17,930 --> 00:29:21,890
+state اذا زاد ال pressure بيزيد ال disturbed و اذا
+
+396
+00:29:21,890 --> 00:29:23,970
+زاد ال pressure بيجلد ال disturbed لكن ال
+
+397
+00:29:23,970 --> 00:29:28,290
+hemoglobin لحد ما لأ بتبقى تقريبا في ال ranges
+
+398
+00:29:28,290 --> 00:29:32,870
+كبيرة حامل اللي بدوها طب احنا جداش قلنا ال
+
+399
+00:29:32,870 --> 00:29:37,370
+hemoglobin بيحمل oxygen ninety seven percent of
+
+400
+00:29:37,370 --> 00:29:41,630
+the total و اذا ان ال disturbed form بيحمل جداش
+
+401
+00:29:41,630 --> 00:29:47,120
+three percentتمام؟ كيف هدول؟ ايش هدول؟ ايش ال ..
+
+402
+00:29:47,120 --> 00:29:53,540
+الفكرة انه انا عندى في الوضع اللى هو ninety-five
+
+403
+00:29:53,540 --> 00:29:57,300
+millimeter mercury بلاقي عندى point twenty-nine
+
+404
+00:29:57,300 --> 00:30:00,540
+milliliter oxygen per ايه؟ per hundred milliliter
+
+405
+00:30:00,540 --> 00:30:06,960
+of blood the salt تمام؟ بلاقي تصوروا قداشر يعني في
+
+406
+00:30:06,960 --> 00:30:10,280
+ال hemoglobin في هذا ال .. ال pressure بلاقي five
+
+407
+00:30:10,280 --> 00:30:15,450
+milliliter .. بلاقي twenty millilitersفي 95 ميلي
+
+408
+00:30:15,450 --> 00:30:21,970
+متر ميركوري ميلاج الهيموجلوبين هعمل 20 أو 19.4
+
+409
+00:30:21,970 --> 00:30:25,290
+ميلي لتر في حالة ما يكون ال saturation تبع
+
+410
+00:30:25,290 --> 00:30:30,570
+الهيموجلوبين مش كامل في حين ان ال disorder just 0
+
+411
+00:30:30,570 --> 00:30:37,070
+.29 أجال ال 100 ميلي لتر هعمل أجال من ايه؟ أجال من
+
+412
+00:30:37,070 --> 00:30:41,880
+نص ميلي أجال من تلت التلت هيكون 33 مش هيكيعني هذا
+
+413
+00:30:41,880 --> 00:30:47,920
+point 29 يعني إيه أقل من إيه من التلت هدف الضغط
+
+414
+00:30:47,920 --> 00:30:52,240
+العالي طيب في ضغط الأربعين في ضغط الأربعين
+
+415
+00:30:52,240 --> 00:30:58,820
+هنلاقينا إيه only point twelve milliliter oxygen
+
+416
+00:30:58,820 --> 00:31:03,120
+remains dissolved في الأربعين اتحول من point two
+
+417
+00:31:03,120 --> 00:31:09,240
+nine إلى point one2 point twelve يعني انا عندي
+
+418
+00:31:09,240 --> 00:31:17,140
+point one seven point one seven is given to the
+
+419
+00:31:17,140 --> 00:31:19,800
+tissues مش كده ال arterial point twenty nine
+
+420
+00:31:19,800 --> 00:31:24,180
+dissolved و ال venous ال forty يعني point one two
+
+421
+00:31:24,180 --> 00:31:28,760
+dissolved الفرج هذا بينهم جداش point one seven
+
+422
+00:31:28,760 --> 00:31:34,230
+milliliter بال hundred ال point one sevenمقارنة
+
+423
+00:31:34,230 --> 00:31:39,350
+بالـ 5 ملي لتر اكسجين بتنقل من خلال
+
+424
+00:31:39,350 --> 00:31:46,330
+الهيموجلوبين جديش اللي بتساوي 3% تمام؟ اذا .. اذا
+
+425
+00:31:46,330 --> 00:31:53,670
+لو طلعنا احنا هنلاقي 3 to 97 الـ 0.17 تمثل حوالي 3
+
+426
+00:31:53,670 --> 00:32:01,710
+في 3 و 5 ملي لتر يمثل حوالي 97097% فهنلاقي
+
+427
+00:32:01,710 --> 00:32:06,510
+المقارنة تلت أجزاء إلى سبعة وتسعين جزء فهي تمثل
+
+428
+00:32:06,510 --> 00:32:09,750
+تلاتة في المية وهذه تمثل سبعة وتسعين في المية مش
+
+429
+00:32:09,750 --> 00:32:13,750
+كده من هنا إجا الأصل إذا لما ندرجمهم لأرقام تلاتة
+
+430
+00:32:13,750 --> 00:32:17,290
+المية هدول يسووا إيش point one seven milliliter
+
+431
+00:32:17,290 --> 00:32:22,250
+per hundred milliliter وال 97% يمثلوا إيش five
+
+432
+00:32:22,250 --> 00:32:26,910
+milliliter مش كده من هنا الأرقام أتضحت الأرقام من
+
+433
+00:32:26,910 --> 00:32:32,470
+وين إجتمن point seventeen إلى five milliliter طيب
+
+434
+00:32:32,470 --> 00:32:38,510
+during
+
+435
+00:32:38,510 --> 00:32:43,010
+لو طيب okay ال disorder part هذا ال disorder part
+
+436
+00:32:43,010 --> 00:32:48,390
+هذا ممكن يزيد ممكن يزيد unlimited إلى حد ما يعني
+
+437
+00:32:48,390 --> 00:32:51,850
+انا بضارب proportion ال hemoglobin لأ مقدرش يزيد
+
+438
+00:32:52,450 --> 00:32:56,450
+بقدرش يزيد لحظة معينة لأن هو أساسا 97% saturated
+
+439
+00:32:56,450 --> 00:33:00,690
+بقدر يزيد 3% ومش هذا كان زيادة تمام؟ لكن ال
+
+440
+00:33:00,690 --> 00:33:05,450
+disorder part أحيانا ممكن يزيد جد ما احنا عايزينه
+
+441
+00:33:05,450 --> 00:33:13,570
+و هنا بنلاقي أنه during strenuous exercises ال
+
+442
+00:33:13,570 --> 00:33:20,930
+flow بيزيد مش هيك؟ ال flow بيزيدفعندي أنا during
+
+443
+00:33:20,930 --> 00:33:28,510
+exercise السرعة اللي بمشي فيها ال .. ال .. الدم في
+
+444
+00:33:28,510 --> 00:33:33,730
+الأنسجة بتقدي إلى أنه بجيبOxygen عبر الهموجلوبين
+
+445
+00:33:33,730 --> 00:33:38,770
+وعبر مين ال disorder لكن الفرق في الهموجلوبين ضخم
+
+446
+00:33:38,770 --> 00:33:42,790
+لإن ال care shifted ايه to the right يعني بطل
+
+447
+00:33:42,790 --> 00:33:47,770
+يديني خمسة صار يديني كماش خمس عاش مش كده مهما يكون
+
+448
+00:33:47,770 --> 00:33:53,690
+ال disorder أخد oxygen زيادة مقارنة بين ال sharing
+
+449
+00:33:53,690 --> 00:33:58,050
+تبع ال disorder لل hemoglobin بيهبطليش؟ لإن ال
+
+450
+00:33:58,050 --> 00:34:01,790
+sharing تبع ال hemoglobin ايه زاد تلت أطعاف مش هيك
+
+451
+00:34:01,790 --> 00:34:05,090
+فلذلك في ال during exercise ملاك ال disorders بقى
+
+452
+00:34:05,090 --> 00:34:09,190
+تقريبا مالوش ايه صار بدل ما هو كان كان ال three
+
+453
+00:34:09,190 --> 00:34:14,310
+percent صار one point five percent ليش؟ لإن عندي
+
+454
+00:34:14,310 --> 00:34:19,830
+أنامين ال hemoglobin زاد كتير فصارت ال supply مش
+
+455
+00:34:19,830 --> 00:34:24,810
+مش مذكور ال disorders حبط راح مفعوله عن أول واضح؟
+
+456
+00:34:24,810 --> 00:34:31,450
+طيبإن نتكلم عن ال oxygen poisoning هان احنا قولنا
+
+457
+00:34:31,450 --> 00:34:35,070
+في ال sterilize exercise هذا هيك بيكون مفعول ال
+
+458
+00:34:35,070 --> 00:34:39,690
+dissolver برجل ليش؟ لإن ال hemoglobin ضر زاد لكن
+
+459
+00:34:39,690 --> 00:34:47,090
+لو احنا كنا في مناطق فيها ضغط عالي تمام بيزيد ال
+
+460
+00:34:47,090 --> 00:34:51,730
+oxygen content في ال dissolver مش هيك نجرحها أيش
+
+461
+00:34:51,730 --> 00:34:57,680
+مكتوب if a person breathesتحف أكسجين في حرارة
+
+462
+00:34:57,680 --> 00:35:01,400
+حرارة أكسجين عالية جدًا، فإن المادة التي تم
+
+463
+00:35:01,400 --> 00:35:05,820
+تحميلها في حالة الانتصاف يمكن أن تصبح أكتر بكثير،
+
+464
+00:35:05,820 --> 00:35:09,320
+أحيانًا بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+465
+00:35:09,320 --> 00:35:10,040
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+466
+00:35:10,040 --> 00:35:10,780
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+467
+00:35:10,780 --> 00:35:13,220
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+468
+00:35:13,220 --> 00:35:16,460
+بكثير،
+
+469
+00:35:16,460 --> 00:35:28,070
+بكثير، بكثير، بكوحتى الموت مثل ما يحدث للتخلص من
+
+470
+00:35:28,070 --> 00:35:31,690
+دماغ كبير من خلال محركات محركات مدينة ديب سي
+
+471
+00:35:35,870 --> 00:35:39,830
+الـ high pressure breathing of oxygen لـ divers
+
+472
+00:35:39,830 --> 00:35:43,750
+ممكن يؤدي إلى ان وفاة هذا ال diver يعني محتاج ان
+
+473
+00:35:43,750 --> 00:35:47,630
+ال oxygen pressure يكون أقل حتى يحافظ على ايه ان
+
+474
+00:35:47,630 --> 00:35:51,290
+ال disorder مايعلاش كتير لإن إذا ال pressure المهم
+
+475
+00:35:51,290 --> 00:35:56,890
+انت عارفين ال divers اللي اللي بتوقع الغطس العوم
+
+476
+00:35:56,890 --> 00:36:01,090
+الغطس في الأعماق بيبقوا معاهم oxygen بتنفسوا منه
+
+477
+00:36:01,090 --> 00:36:04,070
+فإذا كان ال pressure تبعه عالي ممكن يدخلوا ايه؟ في
+
+478
+00:36:04,070 --> 00:36:04,590
+مشاكل
+
+479
+00:36:07,150 --> 00:36:09,690
+combination of homoglobin with carbon monoxide
+
+480
+00:36:09,690 --> 00:36:14,090
+كتير مهم هذا اللي هو التسمم اللي بيصير كتير يعني
+
+481
+00:36:14,090 --> 00:36:17,330
+ما قتل ناس في بلدنا و في غير بلدنا ال carbon
+
+482
+00:36:17,330 --> 00:36:25,430
+monoxide poisoning في مصر مشهورة بإنه تركيبة سخنات
+
+483
+00:36:25,430 --> 00:36:31,850
+الميه في مصر في داخل الحمام تمام فعشان كده بيصير
+
+484
+00:36:31,850 --> 00:36:37,310
+استهلاك ال oxygen اللي في داخل الحمامو هذا نار
+
+485
+00:36:37,310 --> 00:36:41,510
+مولعة و كمية كبيرة اذا بتفكرى ايه بتعرفوا اللى هو
+
+486
+00:36:41,510 --> 00:36:44,410
+سخانات الميه تبعت الغاز مافيش في بلدنا احنا تقريبا
+
+487
+00:36:44,410 --> 00:36:48,230
+الا قليل احنا كله معظمه كهربا او شمسى فى مصر لأ
+
+488
+00:36:48,230 --> 00:36:52,930
+مشهور اللى هو ايه اللى هو سخان الغاز اللى سخان
+
+489
+00:36:52,930 --> 00:36:56,430
+الميه اللى على الغاز و المصيبة انه يكون فى الحمام
+
+490
+00:36:56,430 --> 00:37:00,210
+محطوط مش برا الحمام احتراك خارجى و يتيجيك الميه
+
+491
+00:37:00,210 --> 00:37:04,270
+السخنة بس لأ هو موجود ايضا داخل ايه الحمام اه
+
+492
+00:37:07,120 --> 00:37:11,760
+بيزيد الاحتراق تمام فبياخد حمام سكر طبعا مش هو
+
+493
+00:37:11,760 --> 00:37:14,540
+واحد بيتحمم و باب يفتح الباب فبيصير استهلاك ال
+
+494
+00:37:14,540 --> 00:37:18,600
+oxygen اللي موجود في ال ايه؟ في الغرفة بتحول لإيش؟
+
+495
+00:37:18,600 --> 00:37:24,890
+ل carbon dioxide طيب صار عندي احتراق أكتربنستخدم
+
+496
+00:37:24,890 --> 00:37:30,330
+ال carbon dioxide و نحوله ل carbon monoxide تمام؟
+
+497
+00:37:30,330 --> 00:37:33,670
+لإن صار ال oxygen الموجود جليل و الاحتراق بده
+
+498
+00:37:33,670 --> 00:37:37,970
+oxygen فبروح بيحول اتنين carbon dioxide إلى carbon
+
+499
+00:37:37,970 --> 00:37:41,430
+monoxide و بياخد منهم oxygen ايه؟ يولعها، يحرق
+
+500
+00:37:41,430 --> 00:37:47,530
+فيها more gas يعني more carbon مش كده؟ فبتحول شوية
+
+501
+00:37:47,530 --> 00:37:52,620
+شوية إلى carbonالجو بنتلي carbon monoxide حقيقة
+
+502
+00:37:52,620 --> 00:37:56,340
+احنا مش محتاجين ان الجو ينتلي carbon monoxide وكل
+
+503
+00:37:56,340 --> 00:38:00,980
+ال oxygen يختفي عشان يموت انتوا عارفين لو كان عندى
+
+504
+00:38:00,980 --> 00:38:07,920
+انا نسبة carbon monoxide في الجو واحد في الألفلو
+
+505
+00:38:07,920 --> 00:38:11,560
+كان تركيزه point six millimeter mercury point six
+
+506
+00:38:11,560 --> 00:38:17,300
+جداش ال atmospheric air هو سبعمية و ستين مش واحد
+
+507
+00:38:17,300 --> 00:38:21,040
+point six يعني مش واحد في السبعمية و ستين ولا واحد
+
+508
+00:38:21,040 --> 00:38:26,120
+في الخمسمية لو واحد في الألف point six it is
+
+509
+00:38:26,120 --> 00:38:30,780
+lethal قاتل شوفوا لو كان تركيزه واحد في الألف
+
+510
+00:38:30,780 --> 00:38:37,190
+pressure pressureأه it is lethal قاتل ليش لأنه
+
+511
+00:38:37,190 --> 00:38:45,250
+لاجينا أنه احنا ال saturation تبع ال hemoglobin لل
+
+512
+00:38:45,250 --> 00:38:56,490
+carbon monoxide بيصل 100% او 97 95% بيصل في 0.4 0
+
+513
+00:38:56,490 --> 00:39:00,880
+.4 ميلي متر مركورييعني لما نصل ل point four
+
+514
+00:39:00,880 --> 00:39:05,800
+millimeter mercury بيصير عند ال hemoglobin تمام
+
+515
+00:39:05,800 --> 00:39:09,660
+تشبع كامل بال carbon monoxide بمعنى انه صار عند ال
+
+516
+00:39:09,660 --> 00:39:13,800
+point four millimeter mercury carbon monoxide
+
+517
+00:39:13,800 --> 00:39:19,360
+يساوي المية وأربعةملي ميتر ميلي ميلي ميلي ميلي
+
+518
+00:39:19,360 --> 00:39:19,700
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+519
+00:39:19,700 --> 00:39:20,460
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+520
+00:39:20,460 --> 00:39:23,420
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+521
+00:39:23,420 --> 00:39:27,020
+ميلي ميلي ميلي ميلي ميلي ميلي
+
+522
+00:39:27,020 --> 00:39:30,040
+ميلي
+
+523
+00:39:30,040 --> 00:39:34,660
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+524
+00:39:34,660 --> 00:39:36,560
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+525
+00:39:36,560 --> 00:39:37,000
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+526
+00:39:37,000 --> 00:39:44,480
+ميلي
+
+527
+00:39:44,480 --> 00:39:51,600
+ميلييعني بمعنى اخر قدرة او ال affinity تبع ال
+
+528
+00:39:51,600 --> 00:39:56,960
+carbon monoxide للهيموجلوبين للكربون مونوكسايد 250
+
+529
+00:39:56,960 --> 00:40:03,920
+ضعف ال oxygen تمام؟ 250 ضعف ال affinity للإيه؟ لل
+
+530
+00:40:03,920 --> 00:40:09,300
+oxygen لذلك تلاحظوا point four تساوي الشسمإذا لو
+
+531
+00:40:09,300 --> 00:40:12,140
+عالي عن ال point 4 شوية صغيرة بيبدأ ايش؟ يطلب تكون
+
+532
+00:40:12,140 --> 00:40:16,840
+ال oxygen بيضالش oxygen لذلك ال point 6 is killing
+
+533
+00:40:16,840 --> 00:40:21,580
+اللي هي one per thousand اه one part in thousand
+
+534
+00:40:21,580 --> 00:40:24,720
+في ال atmospheric air لو وصلنا لهيك it is killing
+
+535
+00:40:24,720 --> 00:40:32,440
+واضح؟ ال curve هذا بيوضحلي أنا الموضوع هذاوبنلاحظ
+
+536
+00:40:32,440 --> 00:40:35,800
+احنا ان ال .. ال .. ال dissociation care متشابه،
+
+537
+00:40:35,800 --> 00:40:40,460
+لكن الفرق في النسب تمام؟ هنا بنتكلم هنا كنا عن
+
+538
+00:40:40,460 --> 00:40:44,180
+millimeter على .. عن ninety five millimeter ميركو
+
+539
+00:40:44,180 --> 00:40:48,500
+لما نصل ال ninety .. ال .. نصل ال .. ال .. ال
+
+540
+00:40:48,500 --> 00:40:51,620
+level هذا ال ninety seven مثلا، ninety seven
+
+541
+00:40:51,890 --> 00:40:56,210
+Saturation 95% Saturation كان بدنا إيش؟ بدنا ..
+
+542
+00:40:56,210 --> 00:40:59,690
+بيكون ساعتها ال partial pressure تبعنا 95 ال 95
+
+543
+00:40:59,690 --> 00:41:05,250
+هنا يساوي بالظبط 0.4 ملي متر مركزية تمام؟ إذا واحد
+
+544
+00:41:05,250 --> 00:41:10,270
+على 250 إلى .. لما نقارنها بال Oxygen واضح؟ وهذا
+
+545
+00:41:10,270 --> 00:41:13,490
+بيوريكم إيديش ال toxicity في الحالة هذا إيش بدنا
+
+546
+00:41:13,490 --> 00:41:18,210
+نعمل إحنا؟ إذا قولنا كل ما زودنا ال partial
+
+547
+00:41:18,210 --> 00:41:24,060
+pressure من Oxygenمنطلوب شوية لإن الجسم affinity و
+
+548
+00:41:24,060 --> 00:41:26,560
+partial pressures إذا لما واحد يخش في carbon
+
+549
+00:41:26,560 --> 00:41:31,920
+monoxide poisoningقبل ما يموت بشوية يعني و هي لسه
+
+550
+00:41:31,920 --> 00:41:35,680
+point four نص نص أو ذات شخطة صغيرة لإن إذا وصلت
+
+551
+00:41:35,680 --> 00:41:39,180
+point six مش هيصل المستشفى هيكون مات تمام؟ لكن لو
+
+552
+00:41:39,180 --> 00:41:42,440
+وصلنا في مرحلة carbon monoxide poisoning إذا أنا
+
+553
+00:41:42,440 --> 00:41:44,700
+لو عليت ال pressure pressure تبع ال oxygen في
+
+554
+00:41:44,700 --> 00:41:48,500
+الهواء لو أديته pure oxygen في الحالة ده أنا بفيده
+
+555
+00:41:48,500 --> 00:41:51,960
+ليش؟ بعالي ال pressure pressure بصير أنا أطرد
+
+556
+00:41:51,960 --> 00:41:58,200
+carbon monoxide أحل محلهأنا عليت البرشا برشا اكتر
+
+557
+00:41:58,200 --> 00:42:02,440
+من ال 250 الضعف الموجود فصار عندي قدرة ان يكون
+
+558
+00:42:02,440 --> 00:42:06,400
+more oxygen عن القياش في نفس الوقت الخطورة تبعه ان
+
+559
+00:42:06,400 --> 00:42:10,940
+هو هذا ال carbon monoxide ال affinity للهيمoglobin
+
+560
+00:42:10,940 --> 00:42:16,920
+البرشا برشا تبعه تقريبا zero كله بيمسك في مين؟في
+
+561
+00:42:16,920 --> 00:42:21,800
+الهيموجلوبين ال affinity عالي جدا للهيموجلوبين فال
+
+562
+00:42:21,800 --> 00:42:26,620
+carbon monoxide pressure في الدم لا يذكر ال
+
+563
+00:42:26,620 --> 00:42:31,930
+pressure of oxygen ما تغيرشتمام؟ فالجسم مش مندمه
+
+564
+00:42:31,930 --> 00:42:35,350
+للإيه .. للتغييرات اللي صارت عنده في الهموجلبين،
+
+565
+00:42:35,350 --> 00:42:40,370
+برشر طبيعي ففيش تنفس عالي تمام؟ لكن في عندي صار
+
+566
+00:42:40,370 --> 00:42:44,610
+إيش؟ صار عندي hypoxemia، فيش أكسجين محمول في
+
+567
+00:42:44,610 --> 00:42:48,750
+الهموجلبين تمام؟ لكن ال respiratory rate هو هو
+
+568
+00:42:49,840 --> 00:42:53,420
+الاسبارات ال centers مش منتبهة لذلك بيصير some
+
+569
+00:42:53,420 --> 00:42:59,440
+sort of disorientation بإن العيان بيلحظ حاله مش
+
+570
+00:42:59,440 --> 00:43:03,700
+مركز مش طبيعي مش عارف اه و بعدين بيخش في كومة و اه
+
+571
+00:43:03,700 --> 00:43:06,980
+و بيموت في الغالب و ممكن الوجع اللي بيجعح اذا كان
+
+572
+00:43:06,980 --> 00:43:10,660
+واجف هو فالموضوع هذا مع الدوخة الخبطة هذه ماركن
+
+573
+00:43:10,660 --> 00:43:13,980
+نفسها هي ايه اتعملوا لكن واحد حاسس بصدوع غير عادي
+
+574
+00:43:13,980 --> 00:43:19,340
+ناس فاتحين المولعين فاهم الدنياالشتاء مولانا الفحم
+
+575
+00:43:19,340 --> 00:43:22,800
+وفي الشتاء بيبسكوا البواب عشان يتدفوا تمام فصار
+
+576
+00:43:22,800 --> 00:43:27,260
+عنده احتراق داخلي مظبوط وبيعلى ال carbon monoxide
+
+577
+00:43:27,260 --> 00:43:35,380
+شوية شوية و بدأوا يحسوا بصداع و انهم مش مركزين و
+
+578
+00:43:35,380 --> 00:43:37,860
+كده و واحد من الانتباه كان انهم مولانا الفحم راح
+
+579
+00:43:37,860 --> 00:43:41,140
+فاتح الباب ايه الحاجة دكتور انقذونا ايش العمل؟
+
+580
+00:43:41,140 --> 00:43:46,740
+العمل اني اديهم اكسجين عالي تنفس بيور اكسجين مش
+
+581
+00:43:46,740 --> 00:43:50,150
+بيورو ندى كمان في خمسة المية النقطة التانية، إذا
+
+582
+00:43:50,150 --> 00:43:53,470
+لما ندى pure oxygen أقصد، فيها أعلى البرش برش
+
+583
+00:43:53,470 --> 00:43:57,110
+oxygen، بقى أنا بصير أنافس من ال carbon monoxide ع
+
+584
+00:43:57,110 --> 00:44:00,810
+ال hemoglobin و لما أدى carbon dioxide five
+
+585
+00:44:00,810 --> 00:44:05,640
+percent، أنا بعمل simulation لمين؟طيب إذا من
+
+586
+00:44:05,640 --> 00:44:09,260
+هالجهة تعرفوا أن الـ main stimulant لرسبالات وسنتر
+
+587
+00:44:09,260 --> 00:44:13,200
+هو مين؟ ال carbon dioxide أكتر من ال oxygen إذا ال
+
+588
+00:44:13,200 --> 00:44:15,220
+pressure of carbon dioxide هو ال main stimulant
+
+589
+00:44:15,220 --> 00:44:18,320
+لمين؟ لرسبالات و لسنتر حطوها هذه المعلومة إيه في
+
+590
+00:44:18,320 --> 00:44:27,960
+الرأس طيب إذا نرجع تاني لموضوعنا إذا فهمنا الخطر
+
+591
+00:44:27,960 --> 00:44:31,360
+توعو وفهمنا إيش العلاج ندي حاجتين ب your oxygen أو
+
+592
+00:44:31,360 --> 00:44:34,340
+oxygen with 5% carbon dioxide
+
+593
+00:44:37,450 --> 00:44:41,950
+الان هنتقل ل ال carbon dioxide احنا اتكلمنا مافيه
+
+594
+00:44:41,950 --> 00:44:46,190
+كفاية عن ال oxygen مش كده ال oxygen بينتقل و
+
+595
+00:44:46,190 --> 00:44:49,350
+مراهله كلها تاني انا carbon dioxide اتكون مش هيك
+
+596
+00:44:49,350 --> 00:44:53,510
+carbon dioxide اتكون و بدأ يطلع من ال cells الى ال
+
+597
+00:44:53,510 --> 00:44:58,750
+interstitial fluid الى .. طيب الان هنلاحظ احنا انه
+
+598
+00:44:58,750 --> 00:45:03,850
+ال carbon dioxide اللي برجع على ال lungs هو بيطلع
+
+599
+00:45:03,850 --> 00:45:08,500
+من ال lungs الفرق بينهم جديشالفرق بينه خمسة ..
+
+600
+00:45:08,500 --> 00:45:12,140
+الفرق بينه خمسة millimeter mercury مش كده؟ خمسة
+
+601
+00:45:12,140 --> 00:45:16,360
+millimeter mercury ال oxygen الفرق كان قداش من
+
+602
+00:45:16,360 --> 00:45:20,720
+الخمسة وتسعين لاربعين خمسة وستين مش كده؟ احنا
+
+603
+00:45:20,720 --> 00:45:25,600
+قولنا خمسة وخمسين اه خمسة وتسعين لاربعين خمسة
+
+604
+00:45:25,600 --> 00:45:30,560
+وخمسين ال .. ال .. ال .. ال خمسة وخمسين millimeter
+
+605
+00:45:30,560 --> 00:45:34,040
+mercury difference سوات لي خمسة milliliter مين؟
+
+606
+00:45:34,040 --> 00:45:39,210
+oxygen مش هيك؟اكسجين اكسجين كده احنا بنسلم ال
+
+607
+00:45:39,210 --> 00:45:44,710
+cells اكسجين؟ ال oxygen بنسلمه احنا خمسة في العادة
+
+608
+00:45:44,710 --> 00:45:50,070
+بننزله للاربعين بيكون فقط خمسة ملي ليتر مش حسبتها
+
+609
+00:45:50,070 --> 00:45:54,660
+احنا كل الحمل بيكون عشرين ملي ليترأكسجين احنا
+
+610
+00:45:54,660 --> 00:46:02,520
+بنديه في كل لفة مش قولنا 97% يمثل 5 مليليتر و 0.27
+
+611
+00:46:02,520 --> 00:46:08,940
+يمثل اللي هو 3% مش كده؟ تقريبا تقريبا انا باعطي في
+
+612
+00:46:08,940 --> 00:46:13,060
+كل لفة للخلايا 5 مليليتر أكسجين في كل مليميتر
+
+613
+00:46:13,060 --> 00:46:18,800
+ميركوري في كل مليليتر دم بدي 5 تمام؟ لكن فرقات
+
+614
+00:46:18,800 --> 00:46:22,850
+الضغط كبيرةاللي قصدي أقوله أنه ال carbon dioxide
+
+615
+00:46:22,850 --> 00:46:26,910
+اللي بيعطيني في كل لفة بياخد أربعة ملي لتر carbon
+
+616
+00:46:26,910 --> 00:46:30,170
+dioxide من ال tissues إذا إحنا ندخل خمسة ملي لتر
+
+617
+00:46:30,170 --> 00:46:33,190
+لل tissues و بناخد جداش و بناخد أربعة فهذا الفرق
+
+618
+00:46:33,190 --> 00:46:36,190
+اللي بتسألكوا عليه المرة اللي فاتت أنه أنا برش
+
+619
+00:46:36,190 --> 00:46:39,390
+carbon dioxide أقل من ما إيه ما باخد oxygen و
+
+620
+00:46:39,390 --> 00:46:42,250
+أخدنا عليه علامة وين اللي أكلت العلامة؟ إيه؟ أو
+
+621
+00:46:42,250 --> 00:46:49,230
+أكون غايبة؟ بس حب أكل علامةطيب، اذا الفارق هذا،
+
+622
+00:46:49,230 --> 00:46:53,710
+لاحظوا فارق من .. من اربعين ملي متر ميركوري لخمسين
+
+623
+00:46:53,710 --> 00:46:57,470
+.. لخمسة واربعين ملي متر ميركوري، فارق خمسة الداني
+
+624
+00:46:57,470 --> 00:47:04,260
+اربعة ملي ليتر، و هناك فارقخمسة وخمسين الداني خمسة
+
+625
+00:47:04,260 --> 00:47:07,500
+مليليتر لإن ال dissolvent capacity تبعه للإكسجين
+
+626
+00:47:07,500 --> 00:47:10,460
+تخلف كتير عن ال carbon dioxide مش هيك فال carbon
+
+627
+00:47:10,460 --> 00:47:15,460
+dioxide مختلف في الحالة هذه طيب ال carbon إذا إذا
+
+628
+00:47:15,460 --> 00:47:15,940
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+629
+00:47:15,940 --> 00:47:16,080
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+630
+00:47:16,080 --> 00:47:17,420
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+631
+00:47:17,420 --> 00:47:18,340
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+632
+00:47:18,340 --> 00:47:18,600
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+633
+00:47:18,600 --> 00:47:20,540
+إذا إذا إذا إذا
+
+634
+00:47:27,110 --> 00:47:32,070
+طيب هنلاحظ هان انه ال carbon dioxide لما بيطلع من
+
+635
+00:47:32,070 --> 00:47:37,630
+ال cells ال
+
+636
+00:47:37,630 --> 00:47:39,890
+carbon dioxide بيطلع من ال cells بيخش على ال
+
+637
+00:47:39,890 --> 00:47:44,090
+interstitial fluid بيخش على ال capillary blood على
+
+638
+00:47:44,090 --> 00:47:48,560
+ال plasma مش كده ال blood في ال plasmaالـ Carbon
+
+639
+00:47:48,560 --> 00:47:52,420
+Dioxide في البلازمة عنده طبعا عنده قدرة كبيرة عن
+
+640
+00:47:52,420 --> 00:47:57,380
+انتشارة، مش هيك؟ هيخش داخل ال RBCs وجزء منه هيضل
+
+641
+00:47:57,380 --> 00:48:02,380
+في البلازمة، إذا في جزء ديسول في البلازمةبالقطع
+
+642
+00:48:02,380 --> 00:48:06,820
+لإنه الجزء ال دستول في البلاد يمثل بعد كده بيصير
+
+643
+00:48:06,820 --> 00:48:13,560
+45 ميلي متر ميركوري مش كده؟ حيكون فيه جزء دستول و
+
+644
+00:48:13,560 --> 00:48:17,560
+إلا إذا مافيش دستول ماعملش pressure مش كده؟ طيب و
+
+645
+00:48:17,560 --> 00:48:21,500
+جزءه هيخش ال cells و هيكون ال pressure داخل ال
+
+646
+00:48:21,500 --> 00:48:25,180
+cells ايش؟ the same مش هيك؟ يعني أقل شوية عشان
+
+647
+00:48:25,180 --> 00:48:29,490
+انتقلعشان ندفع لجوه أقل شوية صغيرة بس إلى حد ما
+
+648
+00:48:29,490 --> 00:48:33,430
+برضه هيكون the same ال carbon dioxide اللي في ال
+
+649
+00:48:33,430 --> 00:48:38,850
+plasma هنلاقي انه عمل حاجتين يا إما ضال dissolved
+
+650
+00:48:38,850 --> 00:48:44,770
+carbon dioxide as it is يا إما attached itself to
+
+651
+00:48:44,770 --> 00:48:48,790
+a protein تمام؟ يا إما بيمسك في ال amino group تبع
+
+652
+00:48:48,790 --> 00:48:54,890
+ال protein تمام؟ يا إما بيبقى dissolvedطيب الجزء
+
+653
+00:48:54,890 --> 00:48:59,370
+اللي بدخل داخل ال cellsأنا عندي داخل RBCC موجود
+
+654
+00:48:59,370 --> 00:49:04,690
+كربونك أنهيدرز enzyme إيش هيعمل هذا؟ هيعمل فورا
+
+655
+00:49:04,690 --> 00:49:09,570
+خلال .. و لسه الدم لسه ال .. ال .. ال .. ال .. ال
+
+656
+00:49:09,570 --> 00:49:12,110
+.. ال carbon dioxide ده ال capillary هو لسه في
+
+657
+00:49:12,110 --> 00:49:16,430
+الأنسجة هتكون فورا اتحول لإنه عندي كربونك أنهيدرز
+
+658
+00:49:16,430 --> 00:49:21,650
+very active بيعمل التفاعل 5000 ضعف أسرع مش كده؟
+
+659
+00:49:21,650 --> 00:49:25,810
+فبتحول إلى كربونك أسد و الكربونك أسد هيتحلل
+
+660
+00:49:25,810 --> 00:49:31,430
+لهيدروجينو الـ bicarbonate هيلاجي له transporter
+
+661
+00:49:31,430 --> 00:49:35,610
+على ال steel membrane كاريار
+
+662
+00:49:35,610 --> 00:49:41,130
+اللي هو carbon dioxide كلورايد كاريار فبروح carbon
+
+663
+00:49:41,130 --> 00:49:44,570
+dioxide جوا عليه لإنه اتكون فبده يطلع برا و
+
+664
+00:49:44,570 --> 00:49:48,210
+بيساعدوا كمان facilitated by ايش؟ by the carrier
+
+665
+00:49:48,210 --> 00:49:53,770
+فالـ carrier بيقدر يعمل facilitation لل extrusion
+
+666
+00:49:55,340 --> 00:49:58,860
+for carbon dioxide to the outside و entrance of a
+
+667
+00:49:58,860 --> 00:50:01,500
+chloride محله طبعا انا في عندى هنا ما يطلع ال
+
+668
+00:50:01,500 --> 00:50:04,200
+carbon dioxide ال carbon dioxide ال bio carbonate
+
+669
+00:50:04,200 --> 00:50:08,940
+لما يعلق يطلع برا ب negative charges تمام كمان ال
+
+670
+00:50:08,940 --> 00:50:12,920
+chlorine بده يحل محله ك electrical balance تمام هو
+
+671
+00:50:12,920 --> 00:50:18,560
+ذات جوا لإنه اتكون تمام فبده يعمل balance فبده يخش
+
+672
+00:50:18,560 --> 00:50:21,920
+محله ال chlorine و بيساعدهم carrier بيساعدهم ايه
+
+673
+00:50:21,920 --> 00:50:26,500
+specific carrier بحيث يدخلcarbon dioxide يطلع برا
+
+674
+00:50:26,500 --> 00:50:29,880
+.. ال .. ال by carbonate تطلع برا ال cells و ال
+
+675
+00:50:29,880 --> 00:50:32,820
+chloride يدخل داخل ال cells هذا إيش بنسميه
+
+676
+00:50:32,820 --> 00:50:37,980
+chloride shift إذا ال chloride shift بيصير و إحنا
+
+677
+00:50:37,980 --> 00:50:42,600
+طالعين من ال tissues دخلين على ال venous side ال
+
+678
+00:50:42,600 --> 00:50:47,320
+RBCs بتكون أخدت carbon dioxide و طلع منها carbon
+
+679
+00:50:47,320 --> 00:50:52,840
+.. by carbonate و دخل محلها إذا لو أخدت ال RBCsمن
+
+680
+00:50:52,840 --> 00:50:55,560
+الـ venous side أخدنا ال RBCs من ال arterial side
+
+681
+00:50:55,560 --> 00:51:00,180
+هنلاقي ال chloride contents في ال venous أكتر من
+
+682
+00:51:00,180 --> 00:51:02,600
+ال chloride contents سبعة ال A في داخل ال RBCs
+
+683
+00:51:02,600 --> 00:51:06,100
+بتكلم لإنه بيصير shift هنا و هنا مع ال بيكربونات
+
+684
+00:51:06,100 --> 00:51:10,660
+تمام؟ اذا في عندي انا هذه ال chloride shift اتجت
+
+685
+00:51:10,660 --> 00:51:14,360
+by the way نتكلم عنها نرجح تاني لمين؟ لل carbon
+
+686
+00:51:14,360 --> 00:51:19,720
+dioxide transport اذا جزء ال sol في ال plasmaوجزء
+
+687
+00:51:19,720 --> 00:51:25,080
+داخل
+
+688
+00:51:25,080 --> 00:51:30,980
+السلز اتكون كربونيك اسد بمساعدة كربونيك انيريز
+
+689
+00:51:30,980 --> 00:51:36,710
+وصار له some sort of a transport to the outsideإذا
+
+690
+00:51:36,710 --> 00:51:40,330
+صار بلازمة فيها كمان بيكربونيت بس أساس التكوين وين
+
+691
+00:51:40,330 --> 00:51:44,630
+كان؟ داخل ال cells و .. طيب ماتكلمش ال hydrogen
+
+692
+00:51:44,630 --> 00:51:48,230
+إيش صار فيه؟ احنا قولنا carbonic acid بيكربونيت
+
+693
+00:51:48,230 --> 00:51:52,730
+راحت مقابل ال chloride مش كده؟ طلعت برا ال .. ال
+
+694
+00:51:52,730 --> 00:51:55,370
+بيكربونيت و ده كان محلها chloride عن طريق ال
+
+695
+00:51:55,370 --> 00:51:59,190
+carrier و ال hydrogen will attach to إيه؟ to the
+
+696
+00:51:59,190 --> 00:52:02,610
+hemoglobin ال .. ال hydrogen will attach to the
+
+697
+00:52:02,610 --> 00:52:06,670
+hemoglobin لإن ال hemoglobin is a bufferمش كده؟
+
+698
+00:52:06,670 --> 00:52:09,770
+الـ hemoglobin له buffering effect فبيمسك ال
+
+699
+00:52:09,770 --> 00:52:13,550
+hydrogen ions حتى يمنع ال change في ال A في ال B H
+
+700
+00:52:13,550 --> 00:52:18,490
+تمام؟ النقطة التالتة ان بعض ال carbon dioxide و ال
+
+701
+00:52:18,490 --> 00:52:25,470
+attach ده hemoglobin نسميه carbino .. carb ..
+
+702
+00:52:25,470 --> 00:52:31,090
+carbino hemoglobin تمام؟ اذا عندي ال attaching ل
+
+703
+00:52:31,090 --> 00:52:35,850
+ال proteinsجزء اين؟ جزء attaching the hemoglobin
+
+704
+00:52:35,850 --> 00:52:38,730
+inside the cells و جزء attaching the plasma
+
+705
+00:52:38,730 --> 00:52:44,090
+proteins لكن مين اكتر؟ ال .. ال hemoglobin .. ال
+
+706
+00:52:44,090 --> 00:52:48,690
+hemoglobin اكتر ال hemoglobin في ال .. في ال cells
+
+707
+00:52:48,690 --> 00:52:52,110
+موجود احنا عندنا قداشة؟ عندنا خمس عشر gram
+
+708
+00:52:52,110 --> 00:52:55,750
+hemoglobin في حين انه عندنا ال plasma proteins
+
+709
+00:52:55,750 --> 00:53:01,280
+قداشةالـ total plasma proteins ستة، ستة و نص،
+
+710
+00:53:01,280 --> 00:53:05,560
+القلب من أربعة، أربعة و نص تمام يمثل معظمها، لكن
+
+711
+00:53:05,560 --> 00:53:08,020
+الـ hemoglobin في الداخل ال .. ال .. ال .. في
+
+712
+00:53:08,020 --> 00:53:14,690
+الداخل ال cells يمثل كم؟ أنا مثلا أربعة عشرهو قوت
+
+713
+00:53:14,690 --> 00:53:18,650
+الدم مش هو ال hemoglobin انا مثلا اربعتاش و نص
+
+714
+00:53:18,650 --> 00:53:21,730
+gram per hundred milliliter انتوا هيكون اتناش
+
+715
+00:53:21,730 --> 00:53:28,390
+تلتاش milligram انت خمسة يمكن اربعتاش اه اربعتاش
+
+716
+00:53:28,390 --> 00:53:32,570
+الجاسد دائما جولنا الفيلم انا بدأ اكد انه دائما في
+
+717
+00:53:32,570 --> 00:53:39,130
+النساء بيبقى عايش اجل شوية في المدخنينعالي كتير
+
+718
+00:53:39,130 --> 00:53:43,010
+لأنه جزء من .. لأن معظمهم استهلك زي اللي ايه
+
+719
+00:53:43,010 --> 00:53:47,010
+بيشتغل سواج على الخط و مراكب مع ولاده مايبقى لسه
+
+720
+00:53:47,010 --> 00:53:50,770
+واسع في السيارة ولاده رايحين و جايين معاه و بيراكب
+
+721
+00:53:50,770 --> 00:53:54,550
+زمون زمون انه و بيكمل رايح شايف انت مافيش واسع في
+
+722
+00:53:54,550 --> 00:53:57,570
+ال hemoglobin اللي .. اللي واحد مدخن عنده carbon
+
+723
+00:53:57,570 --> 00:54:01,440
+monoxide عاليفدائما عندنا carbon monoxide راكب
+
+724
+00:54:01,440 --> 00:54:05,260
+عامين متواصل فيه carbon monoxide ملزق كمين في ال
+
+725
+00:54:05,260 --> 00:54:08,260
+hemoglobin فال oxygen .. و هو رايح ياخد ال oxygen
+
+726
+00:54:08,260 --> 00:54:11,340
+و هو رايح ياخد ال oxygen نص الطريق او ممكن اكتر
+
+727
+00:54:11,340 --> 00:54:17,860
+مليانة ال hemoglobin محمل تمام فلذلك ال hemoglobin
+
+728
+00:54:17,860 --> 00:54:20,580
+اذا عندنا احنا خمس عشر جرام فاحنا عندنا بلازمة
+
+729
+00:54:20,580 --> 00:54:25,000
+سبعة بالكتير جرام مش كده فعندنا ال main transport
+
+730
+00:54:25,000 --> 00:54:34,030
+على ال hemoglobin اذا الكرمينوهيموجلوبين إذا
+
+731
+00:54:34,030 --> 00:54:37,670
+صار في عندي تلت مناطق فيها transport of oxygen of
+
+732
+00:54:37,670 --> 00:54:44,550
+carbon dioxide the salt part يمثل 7% اللي هو
+
+733
+00:54:44,550 --> 00:54:48,910
+دلوقتي أنا متكلم عنه بظبط بالألقام و by carbonate
+
+734
+00:54:48,910 --> 00:54:53,550
+part which is the biggest إذا ال main transport as
+
+735
+00:54:53,550 --> 00:54:59,380
+by carbonate تمام سبعين في الميةفي حين انه ال ..
+
+736
+00:54:59,380 --> 00:55:05,320
+ال hemoglobin مع ال .. مع ال carbon dioxide بيمثل
+
+737
+00:55:05,320 --> 00:55:11,960
+23 ك transport ك transport يمثل 23% من ال .. من ال
+
+738
+00:55:11,960 --> 00:55:16,180
+.. من ال carbon dioxide البنجلي من ال tissues في
+
+739
+00:55:16,180 --> 00:55:20,700
+الدم اللاجئ carbon dioxide يمثل 30% لكن .. لكن في
+
+740
+00:55:20,700 --> 00:55:23,640
+الآخرة لما نطلع على ال transport نفسه على ال
+
+741
+00:55:23,640 --> 00:55:27,100
+transport نفسهجدّاش الـ Hemoglobin ترك الـ Carbon
+
+742
+00:55:27,100 --> 00:55:32,220
+Dioxide بتركوش كله زي الـ Dissolved و لايه ده
+
+743
+00:55:32,220 --> 00:55:36,440
+بيبقى ماسك فيه أكتر من اللازم فبنقول أنه لذلك دور
+
+744
+00:55:36,440 --> 00:55:39,420
+ال Hemoglobin في أنه يمثل يمثل فقط 23% من ال
+
+745
+00:55:39,420 --> 00:55:44,320
+transport الحمل الحقيقي يمثل 23% هو حمل 30 بس
+
+746
+00:55:44,320 --> 00:55:50,280
+بيتعاملش معاه لأقل ب 23 منهم في 7% ملزجين في ال
+
+747
+00:55:50,280 --> 00:55:52,800
+Hemoglobin و مابنتركوش تمام؟
+
+748
+00:55:54,990 --> 00:56:03,170
+ال site of .. ال site of attachment هان مش زي اللي
+
+749
+00:56:03,170 --> 00:56:06,190
+هو ال oxygen، مش زي ال carbon monoxide، هنا ع ال
+
+750
+00:56:06,190 --> 00:56:09,610
+amino group زي ال plasma، لذلك احنا ذكرناهم مع بعض
+
+751
+00:56:10,290 --> 00:56:15,130
+لأن الهيموجلوبين كبروتين والبلازما بروتين بروتين
+
+752
+00:56:15,130 --> 00:56:19,870
+فبتمسكوا بال amino group ما هوش على ال oxygen site
+
+753
+00:56:19,870 --> 00:56:23,670
+لكن carbon monoxide بنحمل على ايه بيعملنا خطر على
+
+754
+00:56:23,670 --> 00:56:27,230
+يعني وجود carbon dioxide على الهيموجلوبين بيعملاش
+
+755
+00:56:27,230 --> 00:56:29,230
+مشكلة كبيرة يعني مش على ال site of oxygen
+
+756
+00:56:29,230 --> 00:56:32,170
+transport لكن وجود carbon monoxide مشكلة كبيرة
+
+757
+00:56:32,170 --> 00:56:39,490
+لأنه على نفس ال site تبع ال ايه واضح؟ طيبالان اذا
+
+758
+00:56:39,490 --> 00:56:45,210
+لما نقول عندى انا طلعنا من الانسجار وعنا 45 ملي
+
+759
+00:56:45,210 --> 00:56:51,990
+متر ميركوري براشر للكربون داويكسايد مش كده؟ ايش
+
+760
+00:56:51,990 --> 00:56:59,370
+بيمثل هذا؟ بيمثل 2.7 ملي لتر كربون داويكسايد per
+
+761
+00:56:59,370 --> 00:57:07,520
+hundred milliliter يمثل ايش؟ 2.7 ملي لترthe amount
+
+762
+00:57:07,520 --> 00:57:10,980
+of carbon dioxide dissolved in the fluid of the
+
+763
+00:57:10,980 --> 00:57:16,880
+blood تمام؟ يمثله الـ dissolved part اللي هو جداش
+
+764
+00:57:16,880 --> 00:57:21,480
+ال dissolved part ال
+
+765
+00:57:21,480 --> 00:57:24,700
+dissolved part قولنا في ال carbon dioxide يمثل
+
+766
+00:57:24,700 --> 00:57:28,880
+سبعة المية مش هيك؟ سبعة المية
+
+767
+00:57:33,480 --> 00:57:38,440
+مقاومة الكربون ديوكسيد المفرومة في مياه الدم في 45
+
+768
+00:57:38,440 --> 00:57:44,610
+ملي متر مركوز هي 2.7 ملي لتر بديسليترالمقارنة الى
+
+769
+00:57:44,610 --> 00:57:53,830
+40 مليمتر ميركوري هي 2.4 مليلتر او فرق من 0.3
+
+770
+00:57:53,830 --> 00:58:00,450
+مليلتر فالمقارنة الى 4
+
+771
+00:58:00,450 --> 00:58:14,640
+مليلتر او فرق من 0.3 مليلتر من 4 مليلترتمام احنا
+
+772
+00:58:14,640 --> 00:58:20,960
+طبعا ال 45 ال 45 millimeter mercury ل 40 بنفقد بس
+
+773
+00:58:20,960 --> 00:58:26,900
+احنا five five percent لذلك هذا حامل 2.7 في ال 45
+
+774
+00:58:26,900 --> 00:58:32,980
+لكن في ال 40 كده حامل 2.4 يعني point three فقط انا
+
+775
+00:58:32,980 --> 00:58:40,220
+شاركت حامل عن طريق ال dissolve بعد تمام طيبالـ ..
+
+776
+00:58:40,220 --> 00:58:42,400
+إذا الـ point three هي يمثل السبعة في المية اللي
+
+777
+00:58:42,400 --> 00:58:45,540
+اتكلمنا عنها ال point three تمثل ال dissolve part
+
+778
+00:58:45,540 --> 00:58:50,920
+اللي تمثل سبعة في المية هنلاحظ أنه ال .. ال .. ال
+
+779
+00:58:50,920 --> 00:58:55,940
+carbonic anhydrase يمثل يقولنا سبعين في المية اللي
+
+780
+00:58:55,940 --> 00:59:01,000
+ال .. ال .. ال carbon ال bicarbonate تمثل ايه؟
+
+781
+00:59:01,000 --> 00:59:05,360
+سبعين في المية اللي هي تمثل كميات أرقام
+
+782
+00:59:25,050 --> 00:59:31,390
+القيمة الحقيقية هو point seven point
+
+783
+00:59:31,390 --> 00:59:36,890
+three milliliter بال hundred milliliter0.3 ملي
+
+784
+00:59:36,890 --> 00:59:42,190
+جرام ملي لتر per hundred milliliter of blood كويس؟
+
+785
+00:59:42,190 --> 00:59:48,150
+طيب ال carbonic anhydrase و تأثيره و عمل ال carbon
+
+786
+00:59:48,150 --> 00:59:54,570
+طيب ساعة شرحنا احنا يمثل 70% و قولنا ال chloride
+
+787
+00:59:54,570 --> 01:00:02,490
+shift و ال carriers و اه
+
+788
+01:00:03,670 --> 01:00:07,970
+إذن هنا عندنا إيه؟ So poor the tissue of carbon
+
+789
+01:00:07,970 --> 01:00:12,390
+can't be made to rise. في بعض الحالات اللي احنا
+
+790
+01:00:12,390 --> 01:00:17,850
+مستخدم فيها diuretic اللي هو carbon .. carbonic
+
+791
+01:00:17,850 --> 01:00:21,930
+anhydrase inhibitor فاكرين؟ ال acetizolamide جيبنا
+
+792
+01:00:21,930 --> 01:00:25,150
+سيرته في ال .. في ال diuretics هذا إذا احنا
+
+793
+01:00:25,150 --> 01:00:30,950
+استخدمنا مش بعطل بسreabsorption of bicarbonate في
+
+794
+01:00:30,950 --> 01:00:34,290
+داخل ال .. اه بيعمللي جزء من ال diuresis هذا
+
+795
+01:00:34,290 --> 01:00:37,810
+البسيط، mild diuresis، لأ ممكن يعملي كمان إشكالية
+
+796
+01:00:37,810 --> 01:00:44,910
+في مين في نقل ال carbon dioxide عبر الدم لإن ال
+
+797
+01:00:44,910 --> 01:00:50,300
+mainالـ main step اللي هو بمساعدة carbonic
+
+798
+01:00:50,300 --> 01:00:54,380
+anhydrase لما انا اعطل هذه ال main step اللي هي ال
+
+799
+01:00:54,380 --> 01:00:59,780
+carbon ال bicarbonate transport معناها انا عطلت
+
+800
+01:00:59,780 --> 01:01:09,370
+مين؟ عطلت ال ..الـ Bicarbonate علّيت الآخرين تمام؟
+
+801
+01:01:09,370 --> 01:01:13,330
+هقدّي إلى أنه ال transport becomes so poor that
+
+802
+01:01:13,330 --> 01:01:18,070
+برشا بشر بدل ما هو خمسة و أربعين يصعل إعلامينالـ
+
+803
+01:01:18,070 --> 01:01:22,770
+80% بطل ال RBCs جادرة ان تستخدم معظم ال carbon
+
+804
+01:01:22,770 --> 01:01:26,210
+dioxide وتحاول ان تبيع الكربونات صار عندي انا ال
+
+805
+01:01:26,210 --> 01:01:29,430
+dissolved carbon dioxide يعني البرشر برشر يعني
+
+806
+01:01:29,430 --> 01:01:32,330
+اللي ايه على ايه ل 80% في الحالة هذه طبعا في
+
+807
+01:01:32,330 --> 01:01:35,210
+الحالة هذه احنا ايه؟ بنخش في خطر؟ poisoning لان ال
+
+808
+01:01:35,210 --> 01:01:38,270
+carbon .. هندرس في الفصل اللي .. المحاضرة اللي
+
+809
+01:01:38,270 --> 01:01:41,910
+جاية او اللي بعيدها ال carbon dioxide ده ميعلى ايش
+
+810
+01:01:41,910 --> 01:01:47,740
+اثروا علينا تمام؟ ممكن يدخلنا في كومةتمام فلما انا
+
+811
+01:01:47,740 --> 01:01:52,700
+امنع ال carbon dioxide من الحمض الصحيح و اخلي ال
+
+812
+01:01:52,700 --> 01:01:55,840
+concentration تبعه عالي بشكل عند خطر اكبر
+
+813
+01:01:55,840 --> 01:02:01,940
+transport of carbon dioxide in the combination of
+
+814
+01:02:01,940 --> 01:02:04,240
+the hemoglobin اللي هو الكابامينو hemoglobin
+
+815
+01:02:04,240 --> 01:02:09,640
+تكلمنا عنه مش هيك the quantity of carbon dioxide
+
+816
+01:02:09,640 --> 01:02:13,510
+that can be carried from the peripheral tissuesto
+
+817
+01:02:13,510 --> 01:02:19,210
+the lungs by carbamino combination is about 30%
+
+818
+01:02:19,210 --> 01:02:26,630
+وقلنا انه 30% لكنها لا تمثل الى حوالي 23% هدول ..
+
+819
+01:02:26,630 --> 01:02:30,210
+اذا النقطة الثالثة اللي اتكلمنا عنها وهي اللي هو
+
+820
+01:02:30,210 --> 01:02:35,160
+carbaminoاللي يمثل تلاتين فالمية او حقيقة ما
+
+821
+01:02:35,160 --> 01:02:37,720
+بيزدادش عن عشرين فالمية الا قليل تلات عشرين فالمية
+
+822
+01:02:37,720 --> 01:02:41,540
+of carbon dioxide is transported via combination
+
+823
+01:02:41,540 --> 01:02:46,540
+with the amino group of the hemoglobin هذا يمثل
+
+824
+01:02:46,540 --> 01:02:52,600
+one point five milliliter carbon dioxide for each
+
+825
+01:02:52,600 --> 01:02:56,980
+one hundred milliliter of blood تمام؟ اذا بيظل ال
+
+826
+01:02:56,980 --> 01:03:02,340
+bicarbonateالـ carrying كبسيف تبعته للدم as
+
+827
+01:03:02,340 --> 01:03:05,960
+bicarbonate هيكون من الأربعة بيظل عندي two point
+
+828
+01:03:05,960 --> 01:03:08,800
+two milliliter two point two milliliter
+
+829
+01:03:08,800 --> 01:03:13,180
+bicarbonate for each one hundred milliliter of
+
+830
+01:03:13,180 --> 01:03:20,040
+blood تمام؟ طيب إذا هنا عندي أنا ال five percent
+
+831
+01:03:20,040 --> 01:03:24,260
+difference هذه بين الخمسة و أربعين إلى أربعين تمثل
+
+832
+01:03:24,260 --> 01:03:29,940
+أربعة milliliter أربعة milliliter إيش؟أربعة ملي
+
+833
+01:03:29,940 --> 01:03:36,840
+لتر كربون ديوكسيد تم تحميله إلى الهيوغوط و بعد ذلك
+
+834
+01:03:36,840 --> 01:03:40,540
+تم تحميله إلى الهيوغوط و بعد ذلك تم تحميله إلى
+
+835
+01:03:40,540 --> 01:03:42,820
+الهيوغوط و بعد ذلك تم تحميله إلى الهيوغوط و بعد
+
+836
+01:03:42,820 --> 01:03:43,720
+ذلك تم تحميله إلى الهيوغوط و بعد ذلك تم تحميله إلى
+
+837
+01:03:43,720 --> 01:03:48,740
+الهيوغوط و بعد ذلك تم تحميله إلى الهيوغوط و بعد
+
+838
+01:03:48,740 --> 01:03:51,660
+ذلك تم تحميله إلى الهيوغوط و بعد ذلك تم تحميله إلى
+
+839
+01:03:51,660 --> 01:03:58,590
+الهيوغوط و بعد ذلك تم تحمwhat is called shift to
+
+840
+01:03:58,590 --> 01:04:05,110
+the right وسمينا البهر phenomenon
+
+841
+01:04:05,110 --> 01:04:11,630
+البهر effect هذه بيزيد قدرة ال delivery of oxygen
+
+842
+01:04:11,630 --> 01:04:16,650
+to the tissues هنا في حاجة اسمها halden effect
+
+843
+01:04:16,650 --> 01:04:21,290
+halden effect هذا بمعنى انه برضه ال dissociation
+
+844
+01:04:21,290 --> 01:04:24,920
+كيرسيه عن ال carbon dioxideبيتغير ما بين ال
+
+845
+01:04:24,920 --> 01:04:29,540
+tissues و ما بين ال alveoli بيقدر إلى برضه ملحوظة
+
+846
+01:04:29,540 --> 01:04:33,120
+كتير عظيمة خلّيني نطلع الحين احنا ال curve تبع ال
+
+847
+01:04:33,120 --> 01:04:37,200
+dissociation curve تبع مين ال carbon dioxide هلاحظ
+
+848
+01:04:37,200 --> 01:04:40,760
+احنا هاي الجزئية تبعتنا جزئية ضيقة جدا لإن احنا
+
+849
+01:04:40,760 --> 01:04:45,860
+بين ال 40 و 45 بين 40 و 45 في الحالة هذه بين 40 و
+
+850
+01:04:45,860 --> 01:04:47,360
+45 كده احنا حاملين
+
+851
+01:04:50,950 --> 01:04:56,630
+carbon dioxide هنلاحظ ان احنا اقبل الخمسين اقبل
+
+852
+01:04:56,630 --> 01:05:01,330
+الخمسين milliliter carbon dioxide volume percent
+
+853
+01:05:01,330 --> 01:05:06,190
+يعني لما يكون عندى الخمسة واربعين بيبقى تقريبا او
+
+854
+01:05:06,190 --> 01:05:09,070
+اربعين واربعين وخمسة واربعين بيبقى تقريبا محمول
+
+855
+01:05:09,070 --> 01:05:13,870
+عندى خمسين milliliter carbon dioxide لكن الغريبة
+
+856
+01:05:13,870 --> 01:05:17,250
+في الموضوع انه لاحظوا الخمسين بس بتديني اربعة و
+
+857
+01:05:17,250 --> 01:05:21,190
+بترجع تديني اربعة طب ليش هو الخمسين؟يعني بيضال
+
+858
+01:05:21,190 --> 01:05:23,510
+خمسين محمول carbon dioxide في الدم فى الرواحة فى
+
+859
+01:05:23,510 --> 01:05:27,370
+الجاية مابيستغنيش اللعنة أربعة، مظبوط؟ يعني لو
+
+860
+01:05:27,370 --> 01:05:30,490
+أنتوا بتفكروا الموضوع، بنتخلص منه كله، مظبوط ولا
+
+861
+01:05:30,490 --> 01:05:33,590
+لأ؟ بنتخلص من carbon dioxide، مثلا دك نصل ال .. ال
+
+862
+01:05:33,590 --> 01:05:36,890
+.. ال .. المكاب اللى هو الريقتين، بنتخلص من ال
+
+863
+01:05:36,890 --> 01:05:40,030
+إيه؟ من ال carbon dioxide، لكن وقع الأمر بنتخلص بس
+
+864
+01:05:40,030 --> 01:05:44,150
+من أربعة وبيضل المحطة ال carbon dioxide مهم جدا لل
+
+865
+01:05:44,150 --> 01:05:49,600
+respiration هو sensitiveأه sensitive له تمام فهو
+
+866
+01:05:49,600 --> 01:05:54,080
+يعني بيظل موجود بزيديش ولا بجل لإنه بيعمل ايه good
+
+867
+01:05:54,080 --> 01:05:56,480
+simulation ل respiratory center الآن اللي
+
+868
+01:05:56,480 --> 01:06:02,400
+هنلاحظهان في ال curve التاني انه
+
+869
+01:06:02,400 --> 01:06:07,500
+ال content سبعتنا هذه حقيقة لو نطلع ال curve هذا
+
+870
+01:06:07,500 --> 01:06:10,720
+بالظبط ال curve اللي احنا شايفينه من ال 45 ل 40
+
+871
+01:06:10,720 --> 01:06:16,620
+متحول من ال 50 إلى 52تمام؟ من خمسين إلى ايه؟ اتنين
+
+872
+01:06:16,620 --> 01:06:20,800
+وخمسين لكن واقعا انا احنا بنفقد اربعة بمعنى ..
+
+873
+01:06:20,800 --> 01:06:24,580
+بمعنى انه احنا اذا نقدر بسبب من الأسباب اللي مسمى
+
+874
+01:06:24,580 --> 01:06:28,560
+holding effect نفقد كمان اتنين ونصبح اتنين واربعين
+
+875
+01:06:28,560 --> 01:06:32,880
+تمام؟ اذا انا مابحمل اتنين وخمسين بفكرش اتنين بصير
+
+876
+01:06:32,880 --> 01:06:37,320
+خمسين بسبب ال holding effect بفكر كمان اتنين بصير
+
+877
+01:06:37,320 --> 01:06:41,140
+تمانية واربعين واضح؟ هنتكلم عنه الآن بالتفصيل
+
+878
+01:06:43,960 --> 01:06:50,060
+إذا الهالدين effect بيخص ال carbon dioxide
+
+879
+01:06:50,060 --> 01:06:57,900
+transport أو exchange in the alveolar area يعني
+
+880
+01:06:57,900 --> 01:07:01,800
+with the alveolar air البهر بيخص ال oxygen في ال
+
+881
+01:07:01,800 --> 01:07:06,840
+tissues تمام؟ الهالدين بيخص كان السؤال بيسأله ده
+
+882
+01:07:06,840 --> 01:07:10,640
+من مين أهم الهالدين effect ولا البهر effect تمام؟
+
+883
+01:07:11,350 --> 01:07:16,150
+طيب لو طلعنا احنا على ال curve ال curve المنجة هدا
+
+884
+01:07:16,150 --> 01:07:20,910
+هو النقطة A هدا هي الطبيعي طلعنا من ال tissues
+
+885
+01:07:20,910 --> 01:07:25,230
+بخمسة و أربعين، مظبوط؟ طلعنا من ال tissues بخمسة و
+
+886
+01:07:25,230 --> 01:07:28,930
+أربعين، لو ضلينا على ال curve هدا وصلنا ال alveoli
+
+887
+01:07:28,930 --> 01:07:33,190
+اه و اتخلصنا و ارجعنا لاربعين، جدش ممكن فقدنا؟
+
+888
+01:07:34,130 --> 01:07:38,170
+بنكون فقدنا اتنين من ايه للنقطة هذه الجبال
+
+889
+01:07:38,170 --> 01:07:41,970
+الأربعين على نفس المنقطة تمام بيصل من اتنين و
+
+890
+01:07:41,970 --> 01:07:45,530
+خمسين لخمسين لكن وقع قمر ال distribution curve هنا
+
+891
+01:07:45,530 --> 01:07:51,470
+بينخفضبتغير في الـ alveoli بدل و هذا ال curve هذا
+
+892
+01:07:51,470 --> 01:07:55,110
+المنطج هذه في ال tissues لكن هذا ال curve في ال
+
+893
+01:07:55,110 --> 01:07:59,070
+alveoli ملاحظ أنه ال curve نفسه ال decision تغير و
+
+894
+01:07:59,070 --> 01:08:04,190
+هبط شوية و اتدنيف ال alveoli نقطة أخرى تمام غير
+
+895
+01:08:04,190 --> 01:08:07,410
+النقطة المتوقعة أنه يصلها لو نحسب على ال curve تبع
+
+896
+01:08:07,410 --> 01:08:13,550
+ال tissues بحيث أنه بلاقي نزل ل 48 نزل ل إيه ل 48
+
+897
+01:08:13,550 --> 01:08:16,090
+إذا في عندي أنا متوسط الخمسين
+
+898
+01:08:18,940 --> 01:08:24,400
+52 في ال tissues و من الصين ل 48 فالله فالله عندي
+
+899
+01:08:24,400 --> 01:08:28,920
+ايه عندي ال holding effect اللي هتكلم عنه الآن
+
+900
+01:08:28,920 --> 01:08:35,280
+ضاعفلي قدرة الحمل تبع الدم بدل ما يحمل اتنين كل
+
+901
+01:08:35,280 --> 01:08:40,360
+مرة صار يحمل اربع بدل ما يتخلص من اتنين يتخلص من
+
+902
+01:08:40,360 --> 01:08:44,000
+اربع تمام؟ اذا مهم جدا هذا لأنه عملي doubling
+
+903
+01:08:44,000 --> 01:08:48,570
+لمين؟في حين ان البوهر effect مايعملش doubling
+
+904
+01:08:48,570 --> 01:08:55,270
+البوهر effect بيعمل shift 10% او 15% تمام؟ بيزيد
+
+905
+01:08:55,270 --> 01:09:02,350
+ال oxygen supply لالتيشوز 10% او up to 15% تمام؟ و
+
+906
+01:09:02,350 --> 01:09:05,410
+بيعمل shift على الجهة التانية برضه 10% to 15% لكن
+
+907
+01:09:05,410 --> 01:09:09,690
+هذا بيديني 100% additional صار عندي بدل ما انا
+
+908
+01:09:09,690 --> 01:09:13,550
+بفقد اتنين صار بفقد اربعة تمام؟ is a hardened
+
+909
+01:09:13,550 --> 01:09:20,890
+effectالهالدين إفكت إيش؟ أهم لإنه خلصني من ضعف ال
+
+910
+01:09:20,890 --> 01:09:24,390
+carbon dioxide اللي إيه؟ طيب إيش هو الهالدين إفكت
+
+911
+01:09:24,390 --> 01:09:31,890
+هذا؟ من وين جاي؟ الهالدين
+
+912
+01:09:31,890 --> 01:09:37,730
+إفكت جاي من إنه أثناء احنا أثناء
+
+913
+01:09:37,730 --> 01:09:44,270
+ما نصل ال ال tissues تمام؟أثناء منصة ال tissue
+
+914
+01:09:44,270 --> 01:09:52,070
+بيصير عندي more oxygen binds to the hemoglobin هذه
+
+915
+01:09:52,070 --> 01:09:55,230
+عملية أنه لما يديني more oxygen binds to the
+
+916
+01:09:55,230 --> 01:10:00,070
+hemoglobin بيديني more capacity of the blood to
+
+917
+01:10:00,070 --> 01:10:04,440
+release carbon dioxideلحظة في الـ tissues العكس
+
+918
+01:10:04,440 --> 01:10:08,140
+كنا نقول لما علي ال carbon dioxide اداني فرصة اعطي
+
+919
+01:10:08,140 --> 01:10:12,980
+اكتر oxygen مش كده شفت دلوقتي مش كده هنا عملية
+
+920
+01:10:12,980 --> 01:10:18,220
+عكسية لما زاد ال oxygen ثم صار عندى مقدرة اكبر اني
+
+921
+01:10:18,220 --> 01:10:22,670
+اترك carbon dioxide يعني اتنين عكس بعضال carbon
+
+922
+01:10:22,670 --> 01:10:25,590
+dioxide ساعد ال oxygen انه ينترك في ال tissues و
+
+923
+01:10:25,590 --> 01:10:28,170
+ال oxygen ساعد ال carbon dioxide انه ينترك اكتر في
+
+924
+01:10:28,170 --> 01:10:32,070
+ال a في ال alveoli مش كده؟ اذا هذه باختصار لكن ليش
+
+925
+01:10:32,070 --> 01:10:35,530
+بيصير هيك؟
+
+926
+01:10:35,530 --> 01:10:40,510
+ليش بيصير؟ ايش تفسير ال ايه ال process هذه؟
+
+927
+01:10:42,910 --> 01:10:48,150
+ال process تفسيرها انه انا لما بي .. بي .. بيخش
+
+928
+01:10:48,150 --> 01:10:57,370
+عندى ال .. ال oxygen الى ال .. ال .. ال .. ال
+
+929
+01:10:57,370 --> 01:11:03,770
+hemoglobin ال hemoglobin بتحول ل less acidic تمام؟
+
+930
+01:11:03,770 --> 01:11:08,070
+و هذا بيقدر الى انه .. انه ال carbon dioxide يطلع
+
+931
+01:11:08,070 --> 01:11:10,930
+اكتر خلينا ايه؟ خلينا نجراها هنا
+
+932
+01:11:18,830 --> 01:11:24,410
+هذا يعني تغيير في حرارة الدم بينما يتحرك الكربون
+
+933
+01:11:24,410 --> 01:11:29,330
+ديوكسيد الكربونيك أصبح كذلك عندما يدخل الكربون
+
+934
+01:11:29,330 --> 01:11:34,410
+ديوكسيد الدم في الجسد التجاري يتقلل حرارة الدم بي
+
+935
+01:11:34,410 --> 01:11:41,090
+اتش ولكن تجهيزة هذا الحرارة بالحرارة
+
+936
+01:11:41,090 --> 01:11:44,670
+الأساسية من الدم يمنع الحرارة الهيدروجينية من
+
+937
+01:11:46,010 --> 01:11:49,110
+rising greatly هذا الـ buffering effect تبع
+
+938
+01:11:49,110 --> 01:11:51,950
+الهيموجلوبين على الهيدروجين اتكلمنا عنه احنا من
+
+939
+01:11:51,950 --> 01:11:56,570
+شوية تمام؟ و هنا بنلاقي التحول في ال BH اقليل لإنه
+
+940
+01:11:56,570 --> 01:12:00,650
+له buffering effect من سبعة point four بس بنزل
+
+941
+01:12:00,650 --> 01:12:05,790
+لسبعة point three مع ال additional hydrogen تمام؟
+
+942
+01:12:05,790 --> 01:12:11,570
+the reverse occurs في ال other side in heavy
+
+943
+01:12:11,570 --> 01:12:18,720
+exerciseبنلاحظ انه can be as much as point five
+
+944
+01:12:18,720 --> 01:12:22,880
+يعني about هنا هنا برضه ال heavy exercise يديني
+
+945
+01:12:22,880 --> 01:12:28,420
+more hydrogen مش كده when blood flow through the
+
+946
+01:12:28,420 --> 01:12:33,880
+tissues is sluggish the decrease in pH in the
+
+947
+01:12:33,880 --> 01:12:39,120
+tissue blood can be as much as point five about
+
+948
+01:12:39,120 --> 01:12:40,480
+twelve times normal
+
+949
+01:12:46,370 --> 01:12:50,250
+thus causing significant tissue acidosis هذا في
+
+950
+01:12:50,250 --> 01:12:55,750
+حالة إيه؟ لما يكون عندي slow الفرج اللي اتكلمنا
+
+951
+01:12:55,750 --> 01:13:01,390
+عنه الزيادة هنا كانت point oh four لما نتكلم في
+
+952
+01:13:01,390 --> 01:13:06,090
+الوضع الطبيعي ال hemoglobin buffering system بيحول
+
+953
+01:13:06,090 --> 01:13:12,360
+ال pH من seven point four إلى seven point3.7 لكن
+
+954
+01:13:12,360 --> 01:13:16,020
+لو مافيش عندى blood supply كويس هنلاحظ انه احنا
+
+955
+01:13:16,020 --> 01:13:21,840
+زاد مش ل point oh four ال BH زادت point five تمام
+
+956
+01:13:21,840 --> 01:13:26,920
+point five ل point four اتناشر مرة ضعف اتناشر ضعف
+
+957
+01:13:26,920 --> 01:13:31,240
+تمام ال ratio exchange respiratory exchange ratio
+
+958
+01:13:31,240 --> 01:13:38,080
+هذا اخر موضوعاللي هو جثة الواحد carbon dioxide
+
+959
+01:13:38,080 --> 01:13:41,660
+اللي فجدناه المرة الفاتتة تمام؟ يعتمد على نوع
+
+960
+01:13:41,660 --> 01:13:44,720
+الأكل اللي احنا بناكله لو أعملنا مقتصر للناس
+
+961
+01:13:44,720 --> 01:13:47,740
+الطبيعيين اللي بيأكلوا أكل في وضع طبيعي جثنا جداش
+
+962
+01:13:47,740 --> 01:13:52,080
+بياخدوا أكسجين جداش بيطلعوا carbon dioxide هنلاقي
+
+963
+01:13:52,080 --> 01:13:55,020
+دايما carbon dioxide أقل من أكسجين لإن بنلاقي ال
+
+964
+01:13:55,020 --> 01:13:57,360
+ratio بين carbon dioxide و أكسجين point eight two
+
+965
+01:13:57,360 --> 01:14:05,220
+تمام؟ لو طعمناهم بروتينات بحتة هنلاقيهاحوالي point
+
+966
+01:14:05,220 --> 01:14:10,600
+eight لو أكلوا carbohydrate بحتة هنلاقيها one يعني
+
+967
+01:14:10,600 --> 01:14:12,580
+صار عندي ال carbohydrate في حالة ال carbohydrate
+
+968
+01:14:12,580 --> 01:14:17,540
+واحد oxygen بديني واحد carbon dioxide تمام؟ لو
+
+969
+01:14:17,540 --> 01:14:22,760
+أكلنا fats كتير هنلاقي نزلت ل point seven يعني
+
+970
+01:14:22,760 --> 01:14:29,900
+عندي moremore hydrogen is present و more water is
+
+971
+01:14:29,900 --> 01:14:34,260
+formed تمام؟ إذا من ال ratio هذه إحنا الطبيعي إن
+
+972
+01:14:34,260 --> 01:14:37,180
+نلاقيها point eight إذا لاجيناها أجر أعلى من ال
+
+973
+01:14:37,180 --> 01:14:39,260
+point eight معناها في عندي more carbohydrate في
+
+974
+01:14:39,260 --> 01:14:42,520
+الأكل لو لاجيناها أقل من ال point eight معناها
+
+975
+01:14:42,520 --> 01:14:46,730
+عندي في إيش moremore fat in the .. in the .. in
+
+976
+01:14:46,730 --> 01:14:50,210
+the diet ومن كده هذا ماسميها احنا ال respiratory
+
+977
+01:14:50,210 --> 01:14:53,810
+exchange ratio ال respiratory exchange ratio
+
+978
+01:14:53,810 --> 01:14:58,750
+بتمثلي نوع الأكل اللي انا باكله بيضل السببين اللي
+
+979
+01:14:58,750 --> 01:15:03,190
+احنا اتكلمنا عنهم في ليش .. ليش بيصير ال holding
+
+980
+01:15:03,190 --> 01:15:08,430
+effect مش كده؟المزيد من الهيموغلوبين المزيد من
+
+981
+01:15:08,430 --> 01:15:09,030
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+982
+01:15:09,030 --> 01:15:09,930
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+983
+01:15:09,930 --> 01:15:12,510
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+984
+01:15:12,510 --> 01:15:20,770
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+985
+01:15:20,770 --> 01:15:20,870
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+986
+01:15:20,870 --> 01:15:20,890
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+987
+01:15:20,890 --> 01:15:20,910
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+988
+01:15:20,910 --> 01:15:22,050
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+989
+01:15:22,050 --> 01:15:22,890
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+990
+01:15:22,890 --> 01:15:28,250
+المزيد من المزيد منتمام اذا انا لما اعمل less
+
+991
+01:15:28,250 --> 01:15:31,110
+acidic مع ال hemoglobin بيمسك carbon dioxide اقل
+
+992
+01:15:31,110 --> 01:15:34,230
+بيعمل wash لل carbon dioxide اقل اكتر the
+
+993
+01:15:34,230 --> 01:15:37,290
+increased acidity of the hemoglobin also causes it
+
+994
+01:15:37,290 --> 01:15:39,710
+to release an excess of the hydrogen ions
+
+995
+01:15:39,710 --> 01:15:44,770
+الهيدروجين اللي مسكها أساسا هو تمام بتركها لما
+
+996
+01:15:44,770 --> 01:15:47,010
+ييجي أكسجين اللي هو صار more ايش
+
+997
+01:15:49,970 --> 01:15:54,270
+more acidic النقطتين
+
+998
+01:15:54,270 --> 01:15:56,930
+هدول انتجروها بالتفصيل اشرحهم براحتكم عشان انا صار
+
+999
+01:15:56,930 --> 01:15:58,690
+مكفى في انهاء الدارس
+
+1000
+01:16:22,580 --> 01:16:23,700
+يا نبارك الله فيك
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..2c16268e476593eff999bfa91300a6bc738d599c
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/j-85EcGyBhY_raw.srt
@@ -0,0 +1,4016 @@
+1
+00:00:08,980 --> 00:00:15,240
+إذا لو نظرنا هنا إلى المنحنى هذا اللي هو الأهم
+
+2
+00:00:16,130 --> 00:00:19,790
+بتدينا مواصفات العلاقة ما بين الـ hemoglobin و الـ
+
+3
+00:00:19,790 --> 00:00:25,470
+oxygen بنلاحظ أنه عندنا في الـ oxygen هذا ال curve
+
+4
+00:00:25,470 --> 00:00:30,170
+اللي يعني يمثل الـ hemoglobin فيه إله حاجة اسمها
+
+5
+00:00:30,170 --> 00:00:34,010
+buffering effect of hemoglobin ال hemoglobin إله
+
+6
+00:00:34,010 --> 00:00:38,950
+buffering effect فيه حمله للإيه؟ لل oxygen بحيث
+
+7
+00:00:38,950 --> 00:00:43,590
+إنه يحافظ على البرشر برشر of oxygen في ال
+
+8
+00:00:43,590 --> 00:00:47,700
+capillary sideفي الـ Interstitial Fluid ثابت لأنه
+
+9
+00:00:47,700 --> 00:00:52,340
+الأساس في تغييت الخلايا بالأكسجين اللي هو ال
+
+10
+00:00:52,340 --> 00:00:56,240
+pressure of oxygen في ال Interstitial Fluid بمعنى
+
+11
+00:00:56,240 --> 00:01:00,940
+أنه ال Hemoglobin مهمته الرئيسية أنه يحافظ على
+
+12
+00:01:00,940 --> 00:01:05,300
+مستوى معين من ال pressure of oxygen في ال
+
+13
+00:01:05,300 --> 00:01:08,100
+Interstitial Fluid وهذا اللي بنلاحظه هان في
+
+14
+00:01:08,100 --> 00:01:14,100
+المنطقة اللي في المنطقة ال cells ومنطقة ال
+
+15
+00:01:14,100 --> 00:01:17,600
+capillaries اللي هي تعبر عن ال interstitial fluid
+
+16
+00:01:17,600 --> 00:01:22,580
+المنطقة هادة في ال curve ماللاحظ فيها انه الانخفاض
+
+17
+00:01:22,580 --> 00:01:28,200
+هنا steep نازل نزول بمعنى انه بجل ال oxygen volume
+
+18
+00:01:28,200 --> 00:01:34,180
+لكن ال pressure نقصان ال pressure جليل نازل نزول
+
+19
+00:01:34,180 --> 00:01:37,520
+يعني وكأنه من درجة لدرجة في ال pressure بسيطة
+
+20
+00:01:37,520 --> 00:01:41,420
+بيفقد كمية كبيرة من المن ال .. فإذا هذا الـ
+
+21
+00:01:41,420 --> 00:01:45,600
+Seeping effect تبعت ال إيه؟ ال curve هنا بيوضح لنا
+
+22
+00:01:45,600 --> 00:01:52,340
+إنه ال .. ال differences in partial pressure و ال
+
+23
+00:01:52,340 --> 00:01:56,640
+oxygen is minimal في ال tissues لاحظوا إنه ممكن
+
+24
+00:01:56,640 --> 00:02:00,940
+ندى كمية ضخمة جدا تلت أضعاف الطبيعي الطبيعي من هنا
+
+25
+00:02:00,940 --> 00:02:08,070
+لهنا من ال arterialالـ pressure of oxygen اللي هو
+
+26
+00:02:08,070 --> 00:02:15,770
+قولنا يمثل عشرين تقريبا أو nineteen point four ملي
+
+27
+00:02:15,770 --> 00:02:20,110
+لتر of oxygen percent إلى ال forty percent
+
+28
+00:02:20,110 --> 00:02:24,090
+pressure هان اللي تمثل يمثلها fourteen point four
+
+29
+00:02:24,090 --> 00:02:29,250
+الفرج هان من من الخمسة وتسعين إلى الأربعين الفرج
+
+30
+00:02:29,250 --> 00:02:35,620
+خمسة ملي لتر oxygen percentتمام؟ لكن لاحظوا من
+
+31
+00:02:35,620 --> 00:02:40,760
+خمسة و تسعين لاربعين خمس و ست .. خمسة و .. و خمسين
+
+32
+00:02:40,760 --> 00:02:43,880
+في المية مش هيك خمسة و خمسين millimeter mercury
+
+33
+00:02:43,880 --> 00:02:47,440
+فقط بيفقد ال hemoglobin فوق في منطقة .. في منطقة
+
+34
+00:02:47,440 --> 00:02:51,660
+هذه الخمسة لكن منطقة الكابلرز الفقدان من .. من ..
+
+35
+00:02:51,660 --> 00:03:00,030
+من اربعين و عشرينبين 40 و20 حوالي او بين 40 و ..
+
+36
+00:03:00,030 --> 00:03:04,430
+اه و 15 حوالي عندي انا الفرق يعني بين 20
+
+37
+00:03:04,430 --> 00:03:08,330
+millimeter mercury بنفقد تلت اضعاف بنفقد كمان 15
+
+38
+00:03:08,330 --> 00:03:14,510
+milliliter من 14 و 4 الى 4 هنا .. هنا 4 و 4 بين ال
+
+39
+00:03:14,510 --> 00:03:19,370
+40 و 20 تمام؟ اذا في 20 millimeter mercury
+
+40
+00:03:19,370 --> 00:03:22,860
+pressure of difference في منطقة ال tissuesبصير
+
+41
+00:03:22,860 --> 00:03:26,400
+فقدان كمية ضخمة جدا من ال oxygen حتى يحافظ على إيه
+
+42
+00:03:26,400 --> 00:03:29,420
+على ال partial pressure ما إيه ماينزلش بسهولة إذا
+
+43
+00:03:29,420 --> 00:03:32,100
+بدي oxygen بدي oxygen بدي oxygen بكمية كبيرة إذا
+
+44
+00:03:32,100 --> 00:03:35,240
+فارج ال pressure بيكون إيه بيكون جليل ويتظل اتحافظ
+
+45
+00:03:35,240 --> 00:03:38,280
+هذا المسألة على ال pressure اللي ده العالي إذا في
+
+46
+00:03:38,280 --> 00:03:42,600
+عندي أنا حاجة بسميها the buffer effect of
+
+47
+00:03:42,600 --> 00:03:47,200
+hemoglobin تمام؟ بمعنى إنه the role of hemoglobin
+
+48
+00:03:47,200 --> 00:03:51,100
+is to maintain nearly constant partial pressure of
+
+49
+00:03:51,100 --> 00:03:53,880
+oxygen in the tissuesواضح؟ وهذا الـ steeping
+
+50
+00:03:53,880 --> 00:03:59,360
+effect تبعها هو سبب رئيسي منها الحاجة التانية اللى
+
+51
+00:03:59,360 --> 00:04:04,500
+بتصير انه ساعة ما يصير عندى نقصان في pressure in
+
+52
+00:04:04,500 --> 00:04:08,540
+the tissues بيصير vasodilatation فبقدر ان ال flow
+
+53
+00:04:08,540 --> 00:04:13,720
+يزيدف flow زايد مع hemoglobin زايد مع oxygen محمول
+
+54
+00:04:13,720 --> 00:04:18,160
+عليه بيقدي إلى إيه؟ إلى إنه يديني more supply of
+
+55
+00:04:18,160 --> 00:04:21,740
+oxygen بيقدّي إلى إنه ماينهبطش لإيه برشا برشا
+
+56
+00:04:21,740 --> 00:04:24,820
+اكتير، واضح؟إذا ال pressure pressure effect
+
+57
+00:04:24,820 --> 00:04:32,480
+الأساسي تبع ال cellular interstitial fluid المنطقة
+
+58
+00:04:32,480 --> 00:04:34,780
+هي اللي لازم يبقى ثابت من خلال mainly ال
+
+59
+00:04:34,780 --> 00:04:38,160
+hemoglobin و بيلاحظوا أنه بيزيد ال blood flow حتى
+
+60
+00:04:38,160 --> 00:04:42,060
+يزود برضه ال oxygen supply إذا during heavy
+
+61
+00:04:42,060 --> 00:04:47,020
+exercise extra amounts of oxygen as much as twenty
+
+62
+00:04:47,020 --> 00:04:50,400
+times normal must be delivered from the hemoglobin
+
+63
+00:04:50,400 --> 00:04:51,560
+to the tissues
+
+64
+00:04:55,280 --> 00:05:00,880
+but this can be achieved اذا عندي انا ممكن ازيد ال
+
+65
+00:05:00,880 --> 00:05:04,160
+ال
+
+66
+00:05:04,160 --> 00:05:06,860
+oxygen supplied to the tissues during exercise
+
+67
+00:05:06,860 --> 00:05:10,500
+حوالي عشرين مرة تلاتة منهم بسبب اللي قولنا عليه
+
+68
+00:05:10,500 --> 00:05:16,000
+انه قدرة ال hemoglobin انه يعطي more oxygen بدي
+
+69
+00:05:16,000 --> 00:05:21,520
+تلت أضعاف من خمسة بدي 15 تلت أضعاف بالاضافة لإنه
+
+70
+00:05:21,520 --> 00:05:27,500
+during exercise الالـ blood flow بزيد 6 إلى 7 مرات
+
+71
+00:05:27,500 --> 00:05:32,040
+فبيقدر إلى حوالي عشرين ضعف زيادة للإيه؟ لل tissues
+
+72
+00:05:32,040 --> 00:05:36,880
+oxygen supply طبعا هنا بدخل عند عاملين إضافيين أو
+
+73
+00:05:36,880 --> 00:05:40,900
+تلاتة بيزيدوا عملية ال إيه؟ ال shift of the curve
+
+74
+00:05:40,900 --> 00:05:44,020
+بيساعدوا ال curve ال dissociation كيف تكلمنا عنه
+
+75
+00:05:44,020 --> 00:05:46,800
+بيساعدوا انه to إيه؟ to shift to the right يعني
+
+76
+00:05:46,800 --> 00:05:49,820
+يديني more oxygen اللي هي انه during exercise
+
+77
+00:05:49,820 --> 00:05:55,020
+الحرارة بتعلى مش كده؟ during exerciseال carbon
+
+78
+00:05:55,020 --> 00:05:58,840
+dioxide لإن ال metabolism زاد، ال carbon dioxide
+
+79
+00:05:58,840 --> 00:06:04,100
+بزيد، during exercise ال hydrogen ions بتزيد،
+
+80
+00:06:04,100 --> 00:06:09,800
+تلاتة effects بتزيد، ولو صار عندي نقصان حقيقي في
+
+81
+00:06:09,800 --> 00:06:13,310
+ال oxygen supply لهذه المنطقةبنلاجئ أنه ال
+
+82
+00:06:13,310 --> 00:06:17,490
+bisphosphate glycerol برضه بزيد بس في الحالة .. هو
+
+83
+00:06:17,490 --> 00:06:20,270
+في الغالب اللي بزيدش أثناء ال exercise بزيد في
+
+84
+00:06:20,270 --> 00:06:23,170
+حالة ما يكون في عندي schema لمنطقة معينة for a
+
+85
+00:06:23,170 --> 00:06:27,550
+long time فهو بيعلى أو بيقدّي إلى أنه يزاوي يعمل
+
+86
+00:06:27,550 --> 00:06:31,280
+more shift of the calf to the right بيحسنالـ less
+
+87
+00:06:31,280 --> 00:06:35,620
+flow of blood بتديني more oxygen بحيث يعوض الـ
+
+88
+00:06:35,620 --> 00:06:40,260
+ischemic state بتبع الـ HS1 okay طيب هذه بالنسبة
+
+89
+00:06:40,260 --> 00:06:45,040
+لل .. اذا هنا بنقدر نجرى هذه الجملة المختصر المفيد
+
+90
+00:06:45,040 --> 00:06:49,940
+انه it can be seen من الكلام اللي قلناها that the
+
+91
+00:06:49,940 --> 00:06:53,360
+hemoglobin in the blood automatically delivers
+
+92
+00:06:53,360 --> 00:06:57,700
+oxygen to the tissues at a pressure thatوهي محفظة
+
+93
+00:06:57,700 --> 00:07:06,600
+بين 15 و40 مليمتر مركز بحيث ما يتغيرش تمام؟ إذن من
+
+94
+00:07:06,600 --> 00:07:09,280
+مهام الهوموجلوبين الرئيسية إنه حافظ على الـ
+
+95
+00:07:09,280 --> 00:07:11,840
+Interstitial Fluid بارشة pressure of Oxygen
+
+96
+00:07:11,840 --> 00:07:18,640
+constant وعندما
+
+97
+00:07:18,640 --> 00:07:21,400
+تغيير محافظة الهوموجلوبين الأطماعي بشكل أكبر بشكل
+
+98
+00:07:21,400 --> 00:07:26,570
+مختلف بشكل أكبر بشكل أكبر بشكل أكبر بشكل أكبرهذا
+
+99
+00:07:26,570 --> 00:07:29,030
+الكلام اللي احنا بيقوله atmospheric، اذا الآن
+
+100
+00:07:29,030 --> 00:07:32,410
+الملاحظة
+
+101
+00:07:32,410 --> 00:07:38,590
+انه طيب ال curve هذا له اهمية اخرى اذا نقول ان
+
+102
+00:07:38,590 --> 00:07:41,390
+احنا during exercise بديني more oxygen to the
+
+103
+00:07:41,390 --> 00:07:46,710
+tissues طيب during atmospheric oxygen it changes
+
+104
+00:07:46,710 --> 00:07:51,770
+انت في high altitudes انت في aeroplane انت في
+
+105
+00:07:51,770 --> 00:07:55,530
+منطقة فيها less oxygenبرضه الفروقات بسيطة اذا ال
+
+106
+00:07:55,530 --> 00:07:59,870
+buffering system احنا بدي more to the muscles
+
+107
+00:07:59,870 --> 00:08:05,650
+وبياخد more from the atmosphere تمام؟ وقلنا الجزء
+
+108
+00:08:05,650 --> 00:08:08,950
+العالي في ال curve هذا الجزء العالي في ال curve
+
+109
+00:08:08,950 --> 00:08:13,630
+اللي هو في منطقة ال alveoli انه هنا بيصير عندي انا
+
+110
+00:08:13,630 --> 00:08:17,550
+more attraction بين ال hemoglobin و ال oxygen بحيث
+
+111
+00:08:17,550 --> 00:08:20,790
+انه فرق كبير في ال .. في ال pressure بديني فرق
+
+112
+00:08:20,790 --> 00:08:25,430
+بسيط في ال ايه؟ في ال ..في الـ Oxygen content الـ
+
+113
+00:08:25,430 --> 00:08:30,370
+Oxygen content للهمoglobin بين ال 95% الطبيعي أو
+
+114
+00:08:30,370 --> 00:08:35,770
+أكتر حتى لو قلنا 104% يعني كاملة تمام لو وصلنا
+
+115
+00:08:35,770 --> 00:08:39,990
+لأول مكان إلى ال 60% اللي لو قلنا إنه في high
+
+116
+00:08:39,990 --> 00:08:43,810
+altitude و نزل ال blood pressure ال Oxygen
+
+117
+00:08:43,810 --> 00:08:49,250
+pressure إلى 60% الفرق بينهم كان دياشي الفرق من
+
+118
+00:08:49,250 --> 00:08:54,640
+هنا إلى هنا قلنا إيه؟فقط الستين لهان هذه أربعين
+
+119
+00:08:54,640 --> 00:08:58,200
+هذه الخطوط اللي احنا الستين لهان الفرق بسيط هيكون
+
+120
+00:08:58,200 --> 00:09:03,380
+حوالي سبعة لمية أو تمانية لمية لإنه من الستين هان
+
+121
+00:09:03,380 --> 00:09:09,160
+هيك هلاجي صار عندي فاكرين في ال pressure جولنا
+
+122
+00:09:09,160 --> 00:09:13,780
+سبعة وتمانين من خمسة وتسعين لسبعة تمانين يعني
+
+123
+00:09:13,780 --> 00:09:16,420
+هتكلم عن ايه عن تمانية من
+
+124
+00:09:20,790 --> 00:09:26,710
+8% تقريبًا تقريبًا تقريبًا تقريبًا
+
+125
+00:09:26,710 --> 00:09:34,130
+تقريبًا تقريبًا تقريبًا تقريبًا
+
+126
+00:09:34,130 --> 00:09:36,250
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+127
+00:09:36,250 --> 00:09:40,450
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+128
+00:09:40,450 --> 00:09:41,010
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+129
+00:09:41,010 --> 00:09:42,010
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا تقريبًا
+
+130
+00:09:42,010 --> 00:09:49,950
+تقريبًا تقريبًا تقريبًا تقريبًا تقريبًاتمام؟ في
+
+131
+00:09:49,950 --> 00:09:55,010
+حين ان البرشر بشر تبع ال atmospheric air فقط نزل
+
+132
+00:09:55,010 --> 00:10:00,010
+لستين تمام؟ هو في الطبيعي بنوصل احنا ل .. بيبقى في
+
+133
+00:10:00,010 --> 00:10:04,010
+الطبيعي مية وأربعة مع ال mixture بيصير عندي إيه؟
+
+134
+00:10:04,010 --> 00:10:09,910
+خمسة وتسعين فمن خمسة وتسعين ل eighty nine عندي
+
+135
+00:10:09,910 --> 00:10:14,290
+فارق كده؟ ستة أو سبعة ستة مش كده؟ ممكن ستة
+
+136
+00:10:14,290 --> 00:10:16,670
+millimeter mercury أو سبعة millimeter mercury
+
+137
+00:10:16,670 --> 00:10:22,310
+يدوني في الآخرفرق بسيط و يظل تقريبا عندى ال .. ال
+
+138
+00:10:22,310 --> 00:10:29,930
+.. ال .. ال oxygen saturation عالية تمانية او تسعة
+
+139
+00:10:29,930 --> 00:10:32,850
+وتمانين في المية millimeter mercury بيظل حافظ على
+
+140
+00:10:32,850 --> 00:10:37,370
+ال Aطيب نجرى المثال هذا referring back to the
+
+141
+00:10:37,370 --> 00:10:43,210
+oxygen طيب we can see that for the normal five
+
+142
+00:10:43,210 --> 00:10:47,090
+milliliter of oxygen to be released per hundred
+
+143
+00:10:47,090 --> 00:10:49,630
+milliliter of blood the pressure pressure must
+
+144
+00:10:49,630 --> 00:10:52,770
+fall to forty therefore the tissues pressure
+
+145
+00:10:52,770 --> 00:10:55,850
+pressure oxygen normally cannot rise above forty
+
+146
+00:10:55,850 --> 00:10:59,970
+millimeter mercury level because if it did the
+
+147
+00:10:59,970 --> 00:11:03,200
+amount of oxygen needed to the tissues wouldand
+
+148
+00:11:03,200 --> 00:11:07,520
+not be released from the hemoglobin okay تمام اذا
+
+149
+00:11:07,520 --> 00:11:15,180
+هنا اتكلمنا على ال exercise ال
+
+150
+00:11:15,180 --> 00:11:18,660
+atmospheric pressure لما بيزيد احنا هنا اللي بدنا
+
+151
+00:11:18,660 --> 00:11:26,300
+ناكد عليها لما ال atmospheric pressure of oxygen
+
+152
+00:11:26,300 --> 00:11:38,400
+بيجلبنلاحظ أنه عندي أنا الفرق بين ال 97
+
+153
+00:11:38,400 --> 00:11:47,240
+% إلى ال 89% بين 95% oxygen مليمتر
+
+154
+00:11:47,240 --> 00:11:49,860
+مركوري بشعر إلى ال
+
+155
+00:11:51,900 --> 00:11:57,020
+الى الـ 60 ميلي متر ميكر براشر هذا هنلاقيهم يمثلوا
+
+156
+00:11:57,020 --> 00:12:04,380
+ايش؟ يمثلوا 89% oxygen saturation الى من 97%
+
+157
+00:12:04,380 --> 00:12:07,380
+oxygen saturation مش كده؟ و من الطبيعي ان ال
+
+158
+00:12:07,380 --> 00:12:10,580
+homogloin بيكون حاجة من 97% في ال full saturation
+
+159
+00:12:10,580 --> 00:12:14,120
+لما ينزل البراشر ل 60 هلاقي الفرق في ال saturation
+
+160
+00:12:14,120 --> 00:12:20,140
+فقط 89 يعني عندي الفرق من هدول 8% مش هيك فقط 8%
+
+161
+00:12:20,140 --> 00:12:23,700
+فرقفي ال saturation في حين انه جداش الفارق في ال
+
+162
+00:12:23,700 --> 00:12:27,760
+ايه؟ في ال pressure الفارق في ال pressure من .. من
+
+163
+00:12:27,760 --> 00:12:33,560
+.. من ninety .. من ninety five الى .. الى sixty،
+
+164
+00:12:33,560 --> 00:12:36,120
+thirty five thirty five millimeter mercury
+
+165
+00:12:36,120 --> 00:12:40,240
+difference oxygen pressure يدوني فقط ال saturation
+
+166
+00:12:40,240 --> 00:12:43,400
+difference جداش؟ فقط eighty percent لإن ال
+
+167
+00:12:43,400 --> 00:12:45,960
+saturation بيكون طبيعي ninety seven لما ينزل
+
+168
+00:12:45,960 --> 00:12:51,690
+الستين هلاجي سعر ايش؟ سعر ninety .. eighty nine8%
+
+169
+00:12:51,690 --> 00:12:59,790
+مقارنة في 35% مقارنة 35 مليمتر هذا في المنطقة لذلك
+
+170
+00:12:59,790 --> 00:13:03,510
+ال saturation بيتم يعني في buffer system برضه في
+
+171
+00:13:03,510 --> 00:13:08,650
+هذه المنطقة اللي هي العالية مش كده؟ وهذا اللي احنا
+
+172
+00:13:08,650 --> 00:13:12,710
+ايه؟ هذه العجيبة في تركيبة ال hemoglobin انه
+
+173
+00:13:12,710 --> 00:13:17,040
+المركز بيحس انه يمسك اكسيجين اكترعند pressure معين
+
+174
+00:13:17,040 --> 00:13:22,360
+ويفقد oxygen اكتر عند pressure معين انه يمسك اكتر
+
+175
+00:13:22,360 --> 00:13:36,920
+لمصلحة الجسم ونفقد اكتر لمصلحة الجسم طيب
+
+176
+00:13:36,920 --> 00:13:39,880
+الان احنا قلنا برضه لو
+
+177
+00:13:42,200 --> 00:13:49,240
+زودنا ال .. ال brusher الطبيعي اللي احنا بيصلنا لو
+
+178
+00:13:49,240 --> 00:13:54,520
+نزلناه قولنا من ninety-five إلى sixty مابصارش فارق
+
+179
+00:13:54,520 --> 00:14:00,630
+كبير طب لو زودناه من ninety-five إلىخمسمية لستمية
+
+180
+00:14:00,630 --> 00:14:05,150
+بمعنى اخر انه احنا اطلعنا على .. اه نزلنا في مناطق
+
+181
+00:14:05,150 --> 00:14:09,210
+فيها ضغط عالي او ادينا oxygen under high pressure
+
+182
+00:14:09,210 --> 00:14:16,510
+او احنا حطنا في chambers under high pressure تمام؟
+
+183
+00:14:16,510 --> 00:14:18,810
+حالها ال oxygen ممكن يعلق، ممكن نعلق ال pressure
+
+184
+00:14:18,810 --> 00:14:23,070
+تبعه، مش هيك؟ال .. الفرق هنا بالنسبة لل Hemoglobin
+
+185
+00:14:23,070 --> 00:14:25,870
+فرق بالنسبة لل Hemoglobin فقط تلت المية ال maximum
+
+186
+00:14:25,870 --> 00:14:30,190
+انه يتحول من 97% لإيش؟ ل 100% يعني ال Hemoglobin ك
+
+187
+00:14:30,190 --> 00:14:35,410
+Hemoglobin مش هياخد أكتر من هيك يعني بين ضغط الف و
+
+188
+00:14:35,410 --> 00:14:41,550
+بين ضغط ستين الفرق بالنسبة لل Hemoglobin فرق بسيط
+
+189
+00:14:41,550 --> 00:14:47,610
+واضح؟ لكن ايش بيفرج عننا احنا لما بزيد الضغط ال
+
+190
+00:14:47,610 --> 00:14:50,030
+disorder
+
+191
+00:14:50,930 --> 00:14:53,310
+الـ dissolved هي اللي بيزيد، لإن الـ dissolved بدو
+
+192
+00:14:53,310 --> 00:14:56,370
+يتساوى الضغط بين الضغط الخارجي والـ dissolved
+
+193
+00:14:56,370 --> 00:14:59,630
+part، إذا الـ dissolved part هو اللي ممكن يزيد،
+
+194
+00:14:59,630 --> 00:15:03,730
+إذا انتوا حطوها في راسكوا، أحيانا عندنا مشكلة في
+
+195
+00:15:03,730 --> 00:15:06,630
+ال homoglobin، صارله مشكلةزي ما بيحصل في
+
+196
+00:15:06,630 --> 00:15:11,830
+الـmonoxide poisoning، carbon monoxide poisoning،
+
+197
+00:15:11,830 --> 00:15:15,670
+تمام؟ في ال carbon monoxide poisoning، بنلاحظ احنا
+
+198
+00:15:15,670 --> 00:15:19,950
+انه عندنا الاشي الوحيد اللي ممكن ينقذني لحد ما
+
+199
+00:15:19,950 --> 00:15:23,610
+اتخلص من ال carbon monoxide، ان ازود ال salt بعد،
+
+200
+00:15:23,610 --> 00:15:31,310
+فبدي pure oxygen عشان ازود ال salt بعدهو بقدي كمان
+
+201
+00:15:31,310 --> 00:15:34,550
+حاجة تانية انت لسه ماخدتهاش بدي carbon dioxide
+
+202
+00:15:34,550 --> 00:15:38,070
+five percent مع ال pure oxygen عشان يعمل ال
+
+203
+00:15:38,070 --> 00:15:42,550
+simulation ل respirator center عشان يزودوا لإنه
+
+204
+00:15:42,550 --> 00:15:46,190
+عيب ال carbon monoxide poisoning ان ال pressure
+
+205
+00:15:46,190 --> 00:15:50,840
+بال oxygen بيتغيرش فبيزرش ال respiratorcenter
+
+206
+00:15:50,840 --> 00:15:55,400
+simulation فالواحد مش ماخد باله انه عنده مشكلة في
+
+207
+00:15:55,400 --> 00:15:59,480
+ال oxygen تمام لأ بيزيد نفسه ولا بينتبه ان هو
+
+208
+00:15:59,480 --> 00:16:01,940
+بيواجه حاله فقط وعي و هو ولا حد بياخد باله انه
+
+209
+00:16:01,940 --> 00:16:05,040
+عنده مشكلة ولا هو بينتبه انه عنده مشكلة بيصيرش
+
+210
+00:16:05,040 --> 00:16:07,960
+عنده respiratory distress ليش لأن ال carbon
+
+211
+00:16:07,960 --> 00:16:12,820
+dioxide و pressure of oxygen في الدم بتغيروش تمام
+
+212
+00:16:12,820 --> 00:16:18,850
+فال carbon monoxide بيمسك مكان ال ايهالهيموجلبي
+
+213
+00:16:18,850 --> 00:16:23,010
+المكان ال oxygen من غير ما يحس بني آدم انه ايه انه
+
+214
+00:16:23,010 --> 00:16:26,090
+صار عنده إشكال اتكلم عنه في آخر المحاضرة ان شاء
+
+215
+00:16:26,090 --> 00:16:29,230
+الله لكن الآن اللي بيهمني في الموضوع انه لو علينا
+
+216
+00:16:29,230 --> 00:16:32,790
+احنا ال pressure ال violar pressure of oxygen
+
+217
+00:16:32,790 --> 00:16:36,390
+بالظروف اللي احنا قولناها deep sea او chamber او
+
+218
+00:16:36,390 --> 00:16:39,990
+positive oxygen او pure oxygen او كده بيزيد ال
+
+219
+00:16:39,990 --> 00:16:42,770
+pressure اه لو ادينا احنا pure oxygen بنعلي ال
+
+220
+00:16:42,770 --> 00:16:47,990
+pressure لقداش لسبعمائة و ستين مش هيكلأنه صار كل
+
+221
+00:16:47,990 --> 00:16:50,710
+ال .. ال .. ال .. ال air اللي عندي اكسيشن فال
+
+222
+00:16:50,710 --> 00:16:54,930
+blusher كاملا يعبر ايه؟ في الحالة هذه انا .. في
+
+223
+00:16:54,930 --> 00:16:58,810
+الحالة هذه ادي ال soft part بيزيد ادي ال soft part
+
+224
+00:16:58,810 --> 00:17:04,820
+هيصير عندياللي هو بدل ما هو تركيز و مثلا في العادة
+
+225
+00:17:04,820 --> 00:17:09,120
+104 و لما يصير mixture بيصير 95 بيصير تركيز و حسب
+
+226
+00:17:09,120 --> 00:17:11,820
+التركيز اللي انا عملته ممكن نصل جد ما ايه نوصل
+
+227
+00:17:11,820 --> 00:17:16,940
+طبعا ال oxygen على ان هو مادة الحياة اللي احنا
+
+228
+00:17:16,940 --> 00:17:19,780
+بتنفس فيها و محتاجينها و كده إلى لو في oxygen
+
+229
+00:17:19,780 --> 00:17:24,800
+poisoning في حاجة اسمها ايش oxygen poisoning يعني
+
+230
+00:17:24,800 --> 00:17:28,300
+لو دي ال soft part هذا عيل كتير بيعمللي poisoning
+
+231
+00:17:29,170 --> 00:17:34,410
+تمام؟ لكن احنا بنستخدمه أحيانا لفترات بسيطة بحيث
+
+232
+00:17:34,410 --> 00:17:37,650
+أنه ننقذ البني آدم من إش تاني انتوا عارفين في حاجة
+
+233
+00:17:37,650 --> 00:17:42,350
+اسمها water intoxication أيضا يعني زي ما ال oxygen
+
+234
+00:17:42,350 --> 00:17:46,390
+ممكن يكون سام في أحيان الميه ممكن تكون سامة في
+
+235
+00:17:46,390 --> 00:17:51,050
+أحيان كل حاجة في غير ظروفها الطبيعية بتعمل إيه؟
+
+236
+00:17:51,650 --> 00:17:54,810
+ممكن تعمل ال poisoning لذلك كتير من الناس عايزين
+
+237
+00:17:54,810 --> 00:17:58,230
+يسألوني الدكتور الدوة هذا يعني ايه له أثار جانبية
+
+238
+00:17:58,230 --> 00:18:03,230
+غريب السؤال من الميه إلى أثار جانبية الميه الأثار
+
+239
+00:18:03,230 --> 00:18:06,230
+الجانبية الأكسجين لو دي أكسجين ايه له أثار جانبية
+
+240
+00:18:06,230 --> 00:18:10,830
+فلازم ننفع لكل إشي لأنه كل إشي إذا اتحدى .. اتعدى
+
+241
+00:18:10,830 --> 00:18:15,730
+حده ممكن يعملنا أي أثار جانبية سلبية تمام؟ إذا في
+
+242
+00:18:15,730 --> 00:18:20,920
+الحالة هذه لو كان أنا عندى ال pressure عاليممكن
+
+243
+00:18:20,920 --> 00:18:32,340
+يعملى what is called oxygen poisoning تمام
+
+244
+00:18:32,340 --> 00:18:37,600
+لكن اللي هيزيد مش ال hemoglobin اللي هيزيد ايش ال
+
+245
+00:18:37,600 --> 00:18:45,000
+disorder part وهذا طيب
+
+246
+00:18:52,800 --> 00:18:58,660
+الحاجة الوحيدة اللي بيجيها
+
+247
+00:18:58,660 --> 00:19:02,820
+ده هو اللي ماتكلمش عنه كتير لإنه بيصير في حالة
+
+248
+00:19:02,820 --> 00:19:07,580
+إيه؟ في حالة ال scheme فقط، فبيزيد نسبته و بيعمل
+
+249
+00:19:07,580 --> 00:19:11,430
+shiftفي حالة الاسكيميا في غير حالة الاسكيميا في
+
+250
+00:19:11,430 --> 00:19:16,610
+العادة بيكونش موجود اذا الآن عندنا حاجتين او نبدأ
+
+251
+00:19:16,610 --> 00:19:20,210
+نتكلم عن حاجة واحدة بخصوص ال oxygen اللي هي ال
+
+252
+00:19:20,210 --> 00:19:26,490
+bore او bore effect اللي هو عبارة عن ايش عبارة عن
+
+253
+00:19:26,490 --> 00:19:31,610
+انه لما يزيد ال carbon dioxide في ال tissues بيزود
+
+254
+00:19:31,610 --> 00:19:36,050
+ال delivery of oxygen to the tissues اللي اتكلمنا
+
+255
+00:19:36,050 --> 00:19:43,230
+عنها من شوية اللي هي ايهالـ factors
+
+256
+00:19:43,230 --> 00:19:46,210
+هذه اللي بتعمل shift to the right of the ايه؟ of
+
+257
+00:19:46,210 --> 00:19:51,390
+the curve، the cessation curve a shift of the
+
+258
+00:19:51,390 --> 00:19:54,350
+oxygen from global cessation curve to the right in
+
+259
+00:19:54,350 --> 00:19:57,790
+response to increase in blood carbon dioxide and
+
+260
+00:19:57,790 --> 00:20:01,110
+hydrogen ions has a significant effect by
+
+261
+00:20:01,110 --> 00:20:05,810
+enhancing the release of oxygen from the blood in
+
+262
+00:20:05,810 --> 00:20:10,440
+the tissuesand enhancing oxygenation of blood in
+
+263
+00:20:10,440 --> 00:20:16,200
+the lungs إذا هذه العملية بتساعد على أنه ندى لل
+
+264
+00:20:16,200 --> 00:20:23,320
+tissues more oxygen و ناخد في ال lungs more oxygen
+
+265
+00:20:23,320 --> 00:20:27,560
+ندى more oxygen و ناخد more oxygen تمام؟ اللي هو
+
+266
+00:20:27,560 --> 00:20:30,300
+shift to the right و shift to the left لما يجلي ال
+
+267
+00:20:30,300 --> 00:20:34,840
+oxygenلما يجيل ال carbon dioxide بنعمل more
+
+268
+00:20:34,840 --> 00:20:39,880
+ability to grasp or to attract more oxygen و لما
+
+269
+00:20:39,880 --> 00:20:45,880
+يزيد ال carbon dioxide بنسلم ايه تمام to the shift
+
+270
+00:20:45,880 --> 00:20:48,960
+لما يجيل ال carbon dioxide عن اللازم و تجيل ال
+
+271
+00:20:48,960 --> 00:20:52,380
+hydrogen ions عن اللازم فبناخد احنا more oxygen
+
+272
+00:20:52,380 --> 00:20:56,500
+اللي هي الجزء الأعلى من الايه to the left اه و
+
+273
+00:20:56,500 --> 00:20:59,300
+اللي هو shift to the right لما يزيد ال carbon
+
+274
+00:20:59,300 --> 00:21:00,320
+dioxide لما ايه
+
+275
+00:21:05,550 --> 00:21:14,530
+أعتقد أنه احنا شرحناها التفسير
+
+276
+00:21:14,530 --> 00:21:18,850
+تبعها، يعني ليش as the blood passes through the
+
+277
+00:21:18,850 --> 00:21:22,110
+tissues, carbon dioxide diffuses from the tissues,
+
+278
+00:21:23,010 --> 00:21:30,080
+cells into the bloodهذا يزيد دماء الهيدروجين
+
+279
+00:21:30,080 --> 00:21:32,840
+ايون من وين اتيت؟ الهيدروجين ايون ان الهيدروجين
+
+280
+00:21:32,840 --> 00:21:34,460
+ايون يتحول الهيدروجين ايون الهيدروجين ايون يتحول
+
+281
+00:21:34,460 --> 00:21:35,340
+الهيدروجين ايون الهيدروجين ايون يتحول الهيدروجين
+
+282
+00:21:35,340 --> 00:21:35,660
+ايون يتحول الهيدروجين ايون يتحول الهيدروجين ايون
+
+283
+00:21:35,660 --> 00:21:38,300
+يتحول الهيدروجين ايون يتحول الهيدروجين ايون يتحول
+
+284
+00:21:38,300 --> 00:21:40,780
+الهيدروجين ايون يتحول الهيدروجين ايون يتحول
+
+285
+00:21:40,780 --> 00:21:42,660
+الهيدروجين ايون يتحول الهيدروجين ايون يتحول
+
+286
+00:21:42,660 --> 00:21:52,720
+الهيدروجين ايون يتحول الهيد
+
+287
+00:21:52,760 --> 00:21:56,880
+في الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+288
+00:21:56,880 --> 00:22:00,260
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+289
+00:22:00,260 --> 00:22:00,440
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+290
+00:22:00,440 --> 00:22:00,980
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+291
+00:22:00,980 --> 00:22:03,800
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+292
+00:22:03,800 --> 00:22:05,620
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+293
+00:22:05,620 --> 00:22:07,400
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+294
+00:22:07,400 --> 00:22:07,880
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+295
+00:22:07,880 --> 00:22:10,360
+الحلوات اللي تدفع الكربون ديكسيد من الدم إلى
+
+296
+00:22:10,360 --> 00:22:15,640
+الحلوات اللي تدفع الكربون
+
+297
+00:22:15,640 --> 00:22:18,230
+ديكسيد من الدم إلى الحلوالذي يتعامل مع
+
+298
+00:22:18,230 --> 00:22:22,670
+الهيموجلوبين في أي مرحلة ألفيولر برشا برشا برشا
+
+299
+00:22:22,670 --> 00:22:23,730
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+300
+00:22:23,730 --> 00:22:27,850
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+301
+00:22:27,850 --> 00:22:28,570
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+302
+00:22:28,570 --> 00:22:29,430
+برشا برشا برشا برشا برشا برشا برشا برشا برشا برشا
+
+303
+00:22:29,430 --> 00:22:38,090
+برشا برشا برشا برشا برشا
+
+304
+00:22:38,090 --> 00:22:45,090
+برشا
+
+305
+00:22:45,810 --> 00:22:50,230
+during exercise عندنا عدة factors كلمنا اعتقد عنها
+
+306
+00:22:50,230 --> 00:22:54,810
+الحرارة carbon dioxide الهيدروجين كلهم بيساعدوا
+
+307
+00:22:54,810 --> 00:23:02,130
+على اي ارتفاع metabolic use of oxygen by cells هنا
+
+308
+00:23:02,130 --> 00:23:05,410
+في عندنا اتكلم عن بعض المسائل و تخص ال cells في
+
+309
+00:23:05,410 --> 00:23:14,250
+استخدام الاكسجين الان هل ال pressure مهم
+
+310
+00:23:15,190 --> 00:23:20,690
+في حياة ال cells عشان نديها good oxygen مهم بس
+
+311
+00:23:20,690 --> 00:23:24,470
+لجينا احنا انه زي ما حكيتكوا البارحة الماضية ان
+
+312
+00:23:24,470 --> 00:23:29,490
+اقل difference بين ال interstitial fluid و ال
+
+313
+00:23:29,490 --> 00:23:32,390
+cells يكفي لإنه يديني good metabolism normal
+
+314
+00:23:32,390 --> 00:23:36,870
+metabolism تمام يعني اذا قلنا احنا محتاجين بس فرق
+
+315
+00:23:36,870 --> 00:23:40,830
+pressure one millimeter mercury تمام اذا وجدت هذا
+
+316
+00:23:40,830 --> 00:23:46,440
+ال one millimeter mercuryالسلسل هتمشي الميتابوليز
+
+317
+00:23:46,440 --> 00:23:51,880
+سباحة طبيعى مش هنحس انه انه انه والله لو زودنا
+
+318
+00:23:51,880 --> 00:23:54,480
+الميتابوليزم او جلالنا الميتابوليزم اتأثر لان
+
+319
+00:23:54,480 --> 00:23:58,500
+البرشر برشر اوطى او مش اوطى مش كده ال curve هدا لو
+
+320
+00:23:58,500 --> 00:24:01,220
+لاحظناها هنلاحظ انه احنا لو قولنا هدا one
+
+321
+00:24:01,220 --> 00:24:04,990
+millimeter mercury pressure تمام؟الـ one
+
+322
+00:24:04,990 --> 00:24:08,290
+millimeter mercury pressure قبله نلاحظ أن البرشة
+
+323
+00:24:08,290 --> 00:24:10,270
+البرشة له تأثير على ال cell يعني يبقى ال
+
+324
+00:24:10,270 --> 00:24:12,670
+metabolism واطي ويبقى ليه على ليه على ما يصل
+
+325
+00:24:12,670 --> 00:24:17,090
+الواحد لحد ما بيصير طبيعي تمام؟ okay جابت لكن بعد
+
+326
+00:24:17,090 --> 00:24:21,250
+الواحد اللي بيأثر فيه ال cell metabolism مش ال a
+
+327
+00:24:21,250 --> 00:24:24,830
+يعني لو زودنا ال pressure أيش بنزود؟ هيبقى
+
+328
+00:24:24,830 --> 00:24:28,550
+constant يعني ال curve هي ده لحد واحد millimeter
+
+329
+00:24:28,550 --> 00:24:31,650
+mercury بدأ يزيد ال metabolismأو ال oxygen
+
+330
+00:24:31,650 --> 00:24:39,590
+consumption لكن بعد هيك بعد هيك زودنا ال pressure
+
+331
+00:24:39,590 --> 00:24:45,210
+pressure اتنين تلاتة اربعة خمسة عشر عشرين ال
+
+332
+00:24:45,210 --> 00:24:48,230
+metabolism ما اتأثرت يعني هو بعد ال difference of
+
+333
+00:24:48,230 --> 00:24:52,930
+one millimeter mercuryبطل البرشا برشا التأثير انه
+
+334
+00:24:52,930 --> 00:24:56,250
+يزود او يجلل لإنه صار بس available if the .. if
+
+335
+00:24:56,250 --> 00:24:59,670
+the .. if the cells needs .. if the cells need
+
+336
+00:24:59,670 --> 00:25:03,950
+more متابوليزم بتقدر تعمل لكن هل زيادة ال oxygen
+
+337
+00:25:03,950 --> 00:25:07,170
+في حد ذاته بيزود المتابوليزم؟ لأ طب ايش اللي بيزود
+
+338
+00:25:07,170 --> 00:25:10,250
+المتابوليزم او بيجللها؟ ال availability of the ..
+
+339
+00:25:10,250 --> 00:25:17,510
+of ADH او ADP ال ADPالأدوسين ديفوسفيت هو المعيار
+
+340
+00:25:17,510 --> 00:25:20,970
+يزود الميتابوليزم ولا لأ لإن لما اتكون ADP معناه
+
+341
+00:25:20,970 --> 00:25:24,110
+ان انا عندي more consumption و more formation of
+
+342
+00:25:24,110 --> 00:25:28,830
+ADP فشغلت الخلية ان تعوض ال ADP فورا تمام عشان
+
+343
+00:25:28,830 --> 00:25:33,250
+ترجعوا ل ATP مش كده اذا هنا بنطلع بنلاقي بعد
+
+344
+00:25:33,250 --> 00:25:40,350
+الواحدإن كان الـ ADP جليل أو طبيعي أو كثير تمام ال
+
+345
+00:25:40,350 --> 00:25:45,510
+.. ال .. ال different partial pressures مالوش
+
+346
+00:25:45,510 --> 00:25:50,160
+علاقة في الموضوعواضح؟ إذا ال ADP لو كان نص الطبيعي
+
+347
+00:25:50,160 --> 00:25:55,420
+من اللي هي ال metabolism نزل لنص الطبيعي و لو كان
+
+348
+00:25:55,420 --> 00:25:59,620
+ADP أعلى بيعلق لطبيعي برجع الطبيعي، واضح؟ إذا ال
+
+349
+00:25:59,620 --> 00:26:02,700
+.. ال pressure برجع ال oxygen محتاجينه يتخطأ
+
+350
+00:26:02,700 --> 00:26:06,600
+الواحد من ال meta mercury for normal usage of
+
+351
+00:26:06,600 --> 00:26:10,940
+oxygen يعني for normal metabolism في الخلايا بغض
+
+352
+00:26:10,940 --> 00:26:15,000
+النظرأجددش شغل الخلايا هذه كتير أو جليل وهذا بتحكم
+
+353
+00:26:15,000 --> 00:26:18,360
+فيها ال ADP مابتحكمش فيها ال what ال partial
+
+354
+00:26:18,360 --> 00:26:21,360
+pressure اذا اتخطى الواحد لكن جابلي الواحد واضح
+
+355
+00:26:21,360 --> 00:26:28,000
+انه ايه انه له علاقة كبيرة تمام؟ طيب النقطة
+
+356
+00:26:28,000 --> 00:26:31,000
+التانية اللى بنتكلم معاها بخصوص الخلايا effect of
+
+357
+00:26:31,000 --> 00:26:35,020
+diffusion distance يعني احنا الآن عندنا ال oxygen
+
+358
+00:26:35,020 --> 00:26:38,340
+هيعمل by diffusion من ال capillaries ال antifluid
+
+359
+00:26:38,790 --> 00:26:42,270
+في الـ interstitial fluid نستخدم الأكسجين بالخلايا
+
+360
+00:26:42,270 --> 00:26:46,230
+بيقل الأكسجين ال blood اللي جاي هعمل أكسجين كويس
+
+361
+00:26:46,230 --> 00:26:49,590
+by diffusion بينتقل إلى ال tissues و إلى ال .. إلى
+
+362
+00:26:49,590 --> 00:26:51,950
+ال .. إلى ال interstitial fluid و إلى ال إيه؟ إلى
+
+363
+00:26:51,950 --> 00:26:57,510
+الخلايا ماشي؟ الآن ال diffusion هذا في الطبيعي ..
+
+364
+00:26:57,510 --> 00:27:01,530
+في الطبيعي مافيش خلية بعيدة عن .. عن a capillary
+
+365
+00:27:01,530 --> 00:27:06,130
+أكتر من خمسين micrometerتمام؟ يعني بسهولة by
+
+366
+00:27:06,130 --> 00:27:08,490
+diffusion very rapidly ال oxygen بيقدر يصل الى
+
+367
+00:27:08,490 --> 00:27:11,950
+المكان المطلوب لكن تحت ischemic states تحت
+
+368
+00:27:11,950 --> 00:27:16,050
+pathological conditions ممكن نحس ان ال diffusion
+
+369
+00:27:16,050 --> 00:27:19,450
+كمية ال oxygen أقل من اللازم ومش قادرة تصل ال
+
+370
+00:27:19,450 --> 00:27:23,790
+cells في الحالة هذه بنسميها ده احنا diffusion
+
+371
+00:27:23,790 --> 00:27:28,250
+limited diffusion limited
+
+372
+00:27:34,850 --> 00:27:41,030
+اللي هو diffusion limited oxygen usage تمام؟ ال
+
+373
+00:27:41,030 --> 00:27:45,390
+oxygen usage صار مرتبط بالإيه؟ بال .. بال .. بال
+
+374
+00:27:45,390 --> 00:27:48,170
+distance و يقدر ان ال diffusion .. إيه صار لها ال
+
+375
+00:27:48,170 --> 00:27:51,490
+cells هادة ولا لأ؟ هذا بصيلش دائما إلا إن في إيه؟
+
+376
+00:27:51,490 --> 00:27:55,730
+في حالات معينة، إذا أحيانا بيكون ال distance إلها،
+
+377
+00:27:55,730 --> 00:28:00,480
+لذلك احنا في حالات ال ..الاسكيميا في الـ diabetes
+
+378
+00:28:00,480 --> 00:28:03,380
+من الـ lettuce، الـ diabetic foot وكذا من المناطق
+
+379
+00:28:03,380 --> 00:28:07,620
+البعيدة صار فيها again green تمام، مناطق غريبة،
+
+380
+00:28:07,620 --> 00:28:11,160
+كويس، by diffusion بتظل alive و بتظل كذا لكن
+
+381
+00:28:11,160 --> 00:28:16,240
+المسافات مهمة في بعض الحالات اللي في الطبيعي مش
+
+382
+00:28:16,240 --> 00:28:21,820
+موجود إذا هنا إيه؟ بسميها diffusion limited usage
+
+383
+00:28:21,820 --> 00:28:26,540
+of oxygen وفي عندنا حاجة تانية اسمها flow limited
+
+384
+00:28:28,020 --> 00:28:31,180
+إذا عندي أنا حاجتين ال distance في حالة بعض
+
+385
+00:28:31,180 --> 00:28:34,580
+الأحيان و ال flow في بعض الأحيان برضه إذا كان أنا
+
+386
+00:28:34,580 --> 00:28:38,060
+عندي إيه narrowing لل blood pressure لل blood
+
+387
+00:28:38,060 --> 00:28:42,780
+vessel pressure عليه ischemia بسبب atherosclerosis
+
+388
+00:28:43,440 --> 00:28:47,880
+وصار ال flow وطي وطي وطي اه اذا في عندي انا flow
+
+389
+00:28:47,880 --> 00:28:53,160
+dependent وفي عندي ايه diffusion dependent يعني لأ
+
+390
+00:28:53,160 --> 00:28:57,360
+الفكرة هي pathological conditions ماهيش
+
+391
+00:28:57,360 --> 00:29:04,960
+physiological states انا
+
+392
+00:29:04,960 --> 00:29:10,740
+حاسس علي انه طلع من المنطقة غلطة دي transport
+
+393
+00:29:10,740 --> 00:29:15,910
+of oxygen in the dissolvedفهذا كتير مهم نتكلم عنه
+
+394
+00:29:15,910 --> 00:29:17,930
+من شوية بعدين نتكلم عنه اذا ان عندي ال disturbed
+
+395
+00:29:17,930 --> 00:29:21,890
+state اذا زاد ال pressure بيزيد ال disturbed و اذا
+
+396
+00:29:21,890 --> 00:29:23,970
+زاد ال pressure بيجلد ال disturbed لكن ال
+
+397
+00:29:23,970 --> 00:29:28,290
+hemoglobin لحد ما لأ بتبقى تقريبا في ال ranges
+
+398
+00:29:28,290 --> 00:29:32,870
+كبيرة حامل اللي بدوها طب احنا جداش قلنا ال
+
+399
+00:29:32,870 --> 00:29:37,370
+hemoglobin بيحمل oxygen ninety seven percent of
+
+400
+00:29:37,370 --> 00:29:41,630
+the total و اذا ان ال disturbed form بيحمل جداش
+
+401
+00:29:41,630 --> 00:29:47,120
+three percentتمام؟ كيف هدول؟ ايش هدول؟ ايش ال ..
+
+402
+00:29:47,120 --> 00:29:53,540
+الفكرة انه انا عندى في الوضع اللى هو ninety-five
+
+403
+00:29:53,540 --> 00:29:57,300
+millimeter mercury بلاقي عندى point twenty-nine
+
+404
+00:29:57,300 --> 00:30:00,540
+milliliter oxygen per ايه؟ per hundred milliliter
+
+405
+00:30:00,540 --> 00:30:06,960
+of blood the salt تمام؟ بلاقي تصوروا قداشر يعني في
+
+406
+00:30:06,960 --> 00:30:10,280
+ال hemoglobin في هذا ال .. ال pressure بلاقي five
+
+407
+00:30:10,280 --> 00:30:15,450
+milliliter .. بلاقي twenty millilitersفي 95 ميلي
+
+408
+00:30:15,450 --> 00:30:21,970
+متر ميركوري ميلاج الهيموجلوبين هعمل 20 أو 19.4
+
+409
+00:30:21,970 --> 00:30:25,290
+ميلي لتر في حالة ما يكون ال saturation تبع
+
+410
+00:30:25,290 --> 00:30:30,570
+الهيموجلوبين مش كامل في حين ان ال disorder just 0
+
+411
+00:30:30,570 --> 00:30:37,070
+.29 أجال ال 100 ميلي لتر هعمل أجال من ايه؟ أجال من
+
+412
+00:30:37,070 --> 00:30:41,880
+نص ميلي أجال من تلت التلت هيكون 33 مش هيكيعني هذا
+
+413
+00:30:41,880 --> 00:30:47,920
+point 29 يعني إيه أقل من إيه من التلت هدف الضغط
+
+414
+00:30:47,920 --> 00:30:52,240
+العالي طيب في ضغط الأربعين في ضغط الأربعين
+
+415
+00:30:52,240 --> 00:30:58,820
+هنلاقينا إيه only point twelve milliliter oxygen
+
+416
+00:30:58,820 --> 00:31:03,120
+remains dissolved في الأربعين اتحول من point two
+
+417
+00:31:03,120 --> 00:31:09,240
+nine إلى point one2 point twelve يعني انا عندي
+
+418
+00:31:09,240 --> 00:31:17,140
+point one seven point one seven is given to the
+
+419
+00:31:17,140 --> 00:31:19,800
+tissues مش كده ال arterial point twenty nine
+
+420
+00:31:19,800 --> 00:31:24,180
+dissolved و ال venous ال forty يعني point one two
+
+421
+00:31:24,180 --> 00:31:28,760
+dissolved الفرج هذا بينهم جداش point one seven
+
+422
+00:31:28,760 --> 00:31:34,230
+milliliter بال hundred ال point one sevenمقارنة
+
+423
+00:31:34,230 --> 00:31:39,350
+بالـ 5 ملي لتر اكسجين بتنقل من خلال
+
+424
+00:31:39,350 --> 00:31:46,330
+الهيموجلوبين جديش اللي بتساوي 3% تمام؟ اذا .. اذا
+
+425
+00:31:46,330 --> 00:31:53,670
+لو طلعنا احنا هنلاقي 3 to 97 الـ 0.17 تمثل حوالي 3
+
+426
+00:31:53,670 --> 00:32:01,710
+في 3 و 5 ملي لتر يمثل حوالي 97097% فهنلاقي
+
+427
+00:32:01,710 --> 00:32:06,510
+المقارنة تلت أجزاء إلى سبعة وتسعين جزء فهي تمثل
+
+428
+00:32:06,510 --> 00:32:09,750
+تلاتة في المية وهذه تمثل سبعة وتسعين في المية مش
+
+429
+00:32:09,750 --> 00:32:13,750
+كده من هنا إجا الأصل إذا لما ندرجمهم لأرقام تلاتة
+
+430
+00:32:13,750 --> 00:32:17,290
+المية هدول يسووا إيش point one seven milliliter
+
+431
+00:32:17,290 --> 00:32:22,250
+per hundred milliliter وال 97% يمثلوا إيش five
+
+432
+00:32:22,250 --> 00:32:26,910
+milliliter مش كده من هنا الأرقام أتضحت الأرقام من
+
+433
+00:32:26,910 --> 00:32:32,470
+وين إجتمن point seventeen إلى five milliliter طيب
+
+434
+00:32:32,470 --> 00:32:38,510
+during
+
+435
+00:32:38,510 --> 00:32:43,010
+لو طيب okay ال disorder part هذا ال disorder part
+
+436
+00:32:43,010 --> 00:32:48,390
+هذا ممكن يزيد ممكن يزيد unlimited إلى حد ما يعني
+
+437
+00:32:48,390 --> 00:32:51,850
+انا بضارب proportion ال hemoglobin لأ مقدرش يزيد
+
+438
+00:32:52,450 --> 00:32:56,450
+بقدرش يزيد لحظة معينة لأن هو أساسا 97% saturated
+
+439
+00:32:56,450 --> 00:33:00,690
+بقدر يزيد 3% ومش هذا كان زيادة تمام؟ لكن ال
+
+440
+00:33:00,690 --> 00:33:05,450
+disorder part أحيانا ممكن يزيد جد ما احنا عايزينه
+
+441
+00:33:05,450 --> 00:33:13,570
+و هنا بنلاقي أنه during strenuous exercises ال
+
+442
+00:33:13,570 --> 00:33:20,930
+flow بيزيد مش هيك؟ ال flow بيزيدفعندي أنا during
+
+443
+00:33:20,930 --> 00:33:28,510
+exercise السرعة اللي بمشي فيها ال .. ال .. الدم في
+
+444
+00:33:28,510 --> 00:33:33,730
+الأنسجة بتقدي إلى أنه بجيبOxygen عبر الهموجلوبين
+
+445
+00:33:33,730 --> 00:33:38,770
+وعبر مين ال disorder لكن الفرق في الهموجلوبين ضخم
+
+446
+00:33:38,770 --> 00:33:42,790
+لإن ال care shifted ايه to the right يعني بطل
+
+447
+00:33:42,790 --> 00:33:47,770
+يديني خمسة صار يديني كماش خمس عاش مش كده مهما يكون
+
+448
+00:33:47,770 --> 00:33:53,690
+ال disorder أخد oxygen زيادة مقارنة بين ال sharing
+
+449
+00:33:53,690 --> 00:33:58,050
+تبع ال disorder لل hemoglobin بيهبطليش؟ لإن ال
+
+450
+00:33:58,050 --> 00:34:01,790
+sharing تبع ال hemoglobin ايه زاد تلت أطعاف مش هيك
+
+451
+00:34:01,790 --> 00:34:05,090
+فلذلك في ال during exercise ملاك ال disorders بقى
+
+452
+00:34:05,090 --> 00:34:09,190
+تقريبا مالوش ايه صار بدل ما هو كان كان ال three
+
+453
+00:34:09,190 --> 00:34:14,310
+percent صار one point five percent ليش؟ لإن عندي
+
+454
+00:34:14,310 --> 00:34:19,830
+أنامين ال hemoglobin زاد كتير فصارت ال supply مش
+
+455
+00:34:19,830 --> 00:34:24,810
+مش مذكور ال disorders حبط راح مفعوله عن أول واضح؟
+
+456
+00:34:24,810 --> 00:34:31,450
+طيبإن نتكلم عن ال oxygen poisoning هان احنا قولنا
+
+457
+00:34:31,450 --> 00:34:35,070
+في ال sterilize exercise هذا هيك بيكون مفعول ال
+
+458
+00:34:35,070 --> 00:34:39,690
+dissolver برجل ليش؟ لإن ال hemoglobin ضر زاد لكن
+
+459
+00:34:39,690 --> 00:34:47,090
+لو احنا كنا في مناطق فيها ضغط عالي تمام بيزيد ال
+
+460
+00:34:47,090 --> 00:34:51,730
+oxygen content في ال dissolver مش هيك نجرحها أيش
+
+461
+00:34:51,730 --> 00:34:57,680
+مكتوب if a person breathesتحف أكسجين في حرارة
+
+462
+00:34:57,680 --> 00:35:01,400
+حرارة أكسجين عالية جدًا، فإن المادة التي تم
+
+463
+00:35:01,400 --> 00:35:05,820
+تحميلها في حالة الانتصاف يمكن أن تصبح أكتر بكثير،
+
+464
+00:35:05,820 --> 00:35:09,320
+أحيانًا بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+465
+00:35:09,320 --> 00:35:10,040
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+466
+00:35:10,040 --> 00:35:10,780
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+467
+00:35:10,780 --> 00:35:13,220
+بكثير، بكثير، بكثير، بكثير، بكثير، بكثير، بكثير،
+
+468
+00:35:13,220 --> 00:35:16,460
+بكثير،
+
+469
+00:35:16,460 --> 00:35:28,070
+بكثير، بكثير، بكوحتى الموت مثل ما يحدث للتخلص من
+
+470
+00:35:28,070 --> 00:35:31,690
+دماغ كبير من خلال محركات محركات مدينة ديب سي
+
+471
+00:35:35,870 --> 00:35:39,830
+الـ high pressure breathing of oxygen لـ divers
+
+472
+00:35:39,830 --> 00:35:43,750
+ممكن يؤدي إلى ان وفاة هذا ال diver يعني محتاج ان
+
+473
+00:35:43,750 --> 00:35:47,630
+ال oxygen pressure يكون أقل حتى يحافظ على ايه ان
+
+474
+00:35:47,630 --> 00:35:51,290
+ال disorder مايعلاش كتير لإن إذا ال pressure المهم
+
+475
+00:35:51,290 --> 00:35:56,890
+انت عارفين ال divers اللي اللي بتوقع الغطس العوم
+
+476
+00:35:56,890 --> 00:36:01,090
+الغطس في الأعماق بيبقوا معاهم oxygen بتنفسوا منه
+
+477
+00:36:01,090 --> 00:36:04,070
+فإذا كان ال pressure تبعه عالي ممكن يدخلوا ايه؟ في
+
+478
+00:36:04,070 --> 00:36:04,590
+مشاكل
+
+479
+00:36:07,150 --> 00:36:09,690
+combination of homoglobin with carbon monoxide
+
+480
+00:36:09,690 --> 00:36:14,090
+كتير مهم هذا اللي هو التسمم اللي بيصير كتير يعني
+
+481
+00:36:14,090 --> 00:36:17,330
+ما قتل ناس في بلدنا و في غير بلدنا ال carbon
+
+482
+00:36:17,330 --> 00:36:25,430
+monoxide poisoning في مصر مشهورة بإنه تركيبة سخنات
+
+483
+00:36:25,430 --> 00:36:31,850
+الميه في مصر في داخل الحمام تمام فعشان كده بيصير
+
+484
+00:36:31,850 --> 00:36:37,310
+استهلاك ال oxygen اللي في داخل الحمامو هذا نار
+
+485
+00:36:37,310 --> 00:36:41,510
+مولعة و كمية كبيرة اذا بتفكرى ايه بتعرفوا اللى هو
+
+486
+00:36:41,510 --> 00:36:44,410
+سخانات الميه تبعت الغاز مافيش في بلدنا احنا تقريبا
+
+487
+00:36:44,410 --> 00:36:48,230
+الا قليل احنا كله معظمه كهربا او شمسى فى مصر لأ
+
+488
+00:36:48,230 --> 00:36:52,930
+مشهور اللى هو ايه اللى هو سخان الغاز اللى سخان
+
+489
+00:36:52,930 --> 00:36:56,430
+الميه اللى على الغاز و المصيبة انه يكون فى الحمام
+
+490
+00:36:56,430 --> 00:37:00,210
+محطوط مش برا الحمام احتراك خارجى و يتيجيك الميه
+
+491
+00:37:00,210 --> 00:37:04,270
+السخنة بس لأ هو موجود ايضا داخل ايه الحمام اه
+
+492
+00:37:07,120 --> 00:37:11,760
+بيزيد الاحتراق تمام فبياخد حمام سكر طبعا مش هو
+
+493
+00:37:11,760 --> 00:37:14,540
+واحد بيتحمم و باب يفتح الباب فبيصير استهلاك ال
+
+494
+00:37:14,540 --> 00:37:18,600
+oxygen اللي موجود في ال ايه؟ في الغرفة بتحول لإيش؟
+
+495
+00:37:18,600 --> 00:37:24,890
+ل carbon dioxide طيب صار عندي احتراق أكتربنستخدم
+
+496
+00:37:24,890 --> 00:37:30,330
+ال carbon dioxide و نحوله ل carbon monoxide تمام؟
+
+497
+00:37:30,330 --> 00:37:33,670
+لإن صار ال oxygen الموجود جليل و الاحتراق بده
+
+498
+00:37:33,670 --> 00:37:37,970
+oxygen فبروح بيحول اتنين carbon dioxide إلى carbon
+
+499
+00:37:37,970 --> 00:37:41,430
+monoxide و بياخد منهم oxygen ايه؟ يولعها، يحرق
+
+500
+00:37:41,430 --> 00:37:47,530
+فيها more gas يعني more carbon مش كده؟ فبتحول شوية
+
+501
+00:37:47,530 --> 00:37:52,620
+شوية إلى carbonالجو بنتلي carbon monoxide حقيقة
+
+502
+00:37:52,620 --> 00:37:56,340
+احنا مش محتاجين ان الجو ينتلي carbon monoxide وكل
+
+503
+00:37:56,340 --> 00:38:00,980
+ال oxygen يختفي عشان يموت انتوا عارفين لو كان عندى
+
+504
+00:38:00,980 --> 00:38:07,920
+انا نسبة carbon monoxide في الجو واحد في الألفلو
+
+505
+00:38:07,920 --> 00:38:11,560
+كان تركيزه point six millimeter mercury point six
+
+506
+00:38:11,560 --> 00:38:17,300
+جداش ال atmospheric air هو سبعمية و ستين مش واحد
+
+507
+00:38:17,300 --> 00:38:21,040
+point six يعني مش واحد في السبعمية و ستين ولا واحد
+
+508
+00:38:21,040 --> 00:38:26,120
+في الخمسمية لو واحد في الألف point six it is
+
+509
+00:38:26,120 --> 00:38:30,780
+lethal قاتل شوفوا لو كان تركيزه واحد في الألف
+
+510
+00:38:30,780 --> 00:38:37,190
+pressure pressureأه it is lethal قاتل ليش لأنه
+
+511
+00:38:37,190 --> 00:38:45,250
+لاجينا أنه احنا ال saturation تبع ال hemoglobin لل
+
+512
+00:38:45,250 --> 00:38:56,490
+carbon monoxide بيصل 100% او 97 95% بيصل في 0.4 0
+
+513
+00:38:56,490 --> 00:39:00,880
+.4 ميلي متر مركورييعني لما نصل ل point four
+
+514
+00:39:00,880 --> 00:39:05,800
+millimeter mercury بيصير عند ال hemoglobin تمام
+
+515
+00:39:05,800 --> 00:39:09,660
+تشبع كامل بال carbon monoxide بمعنى انه صار عند ال
+
+516
+00:39:09,660 --> 00:39:13,800
+point four millimeter mercury carbon monoxide
+
+517
+00:39:13,800 --> 00:39:19,360
+يساوي المية وأربعةملي ميتر ميلي ميلي ميلي ميلي
+
+518
+00:39:19,360 --> 00:39:19,700
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+519
+00:39:19,700 --> 00:39:20,460
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+520
+00:39:20,460 --> 00:39:23,420
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+521
+00:39:23,420 --> 00:39:27,020
+ميلي ميلي ميلي ميلي ميلي ميلي
+
+522
+00:39:27,020 --> 00:39:30,040
+ميلي
+
+523
+00:39:30,040 --> 00:39:34,660
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+524
+00:39:34,660 --> 00:39:36,560
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+525
+00:39:36,560 --> 00:39:37,000
+ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي ميلي
+
+526
+00:39:37,000 --> 00:39:44,480
+ميلي
+
+527
+00:39:44,480 --> 00:39:51,600
+ميلييعني بمعنى اخر قدرة او ال affinity تبع ال
+
+528
+00:39:51,600 --> 00:39:56,960
+carbon monoxide للهيموجلوبين للكربون مونوكسايد 250
+
+529
+00:39:56,960 --> 00:40:03,920
+ضعف ال oxygen تمام؟ 250 ضعف ال affinity للإيه؟ لل
+
+530
+00:40:03,920 --> 00:40:09,300
+oxygen لذلك تلاحظوا point four تساوي الشسمإذا لو
+
+531
+00:40:09,300 --> 00:40:12,140
+عالي عن ال point 4 شوية صغيرة بيبدأ ايش؟ يطلب تكون
+
+532
+00:40:12,140 --> 00:40:16,840
+ال oxygen بيضالش oxygen لذلك ال point 6 is killing
+
+533
+00:40:16,840 --> 00:40:21,580
+اللي هي one per thousand اه one part in thousand
+
+534
+00:40:21,580 --> 00:40:24,720
+في ال atmospheric air لو وصلنا لهيك it is killing
+
+535
+00:40:24,720 --> 00:40:32,440
+واضح؟ ال curve هذا بيوضحلي أنا الموضوع هذاوبنلاحظ
+
+536
+00:40:32,440 --> 00:40:35,800
+احنا ان ال .. ال .. ال dissociation care متشابه،
+
+537
+00:40:35,800 --> 00:40:40,460
+لكن الفرق في النسب تمام؟ هنا بنتكلم هنا كنا عن
+
+538
+00:40:40,460 --> 00:40:44,180
+millimeter على .. عن ninety five millimeter ميركو
+
+539
+00:40:44,180 --> 00:40:48,500
+لما نصل ال ninety .. ال .. نصل ال .. ال .. ال
+
+540
+00:40:48,500 --> 00:40:51,620
+level هذا ال ninety seven مثلا، ninety seven
+
+541
+00:40:51,890 --> 00:40:56,210
+Saturation 95% Saturation كان بدنا إيش؟ بدنا ..
+
+542
+00:40:56,210 --> 00:40:59,690
+بيكون ساعتها ال partial pressure تبعنا 95 ال 95
+
+543
+00:40:59,690 --> 00:41:05,250
+هنا يساوي بالظبط 0.4 ملي متر مركزية تمام؟ إذا واحد
+
+544
+00:41:05,250 --> 00:41:10,270
+على 250 إلى .. لما نقارنها بال Oxygen واضح؟ وهذا
+
+545
+00:41:10,270 --> 00:41:13,490
+بيوريكم إيديش ال toxicity في الحالة هذا إيش بدنا
+
+546
+00:41:13,490 --> 00:41:18,210
+نعمل إحنا؟ إذا قولنا كل ما زودنا ال partial
+
+547
+00:41:18,210 --> 00:41:24,060
+pressure من Oxygenمنطلوب شوية لإن الجسم affinity و
+
+548
+00:41:24,060 --> 00:41:26,560
+partial pressures إذا لما واحد يخش في carbon
+
+549
+00:41:26,560 --> 00:41:31,920
+monoxide poisoningقبل ما يموت بشوية يعني و هي لسه
+
+550
+00:41:31,920 --> 00:41:35,680
+point four نص نص أو ذات شخطة صغيرة لإن إذا وصلت
+
+551
+00:41:35,680 --> 00:41:39,180
+point six مش هيصل المستشفى هيكون مات تمام؟ لكن لو
+
+552
+00:41:39,180 --> 00:41:42,440
+وصلنا في مرحلة carbon monoxide poisoning إذا أنا
+
+553
+00:41:42,440 --> 00:41:44,700
+لو عليت ال pressure pressure تبع ال oxygen في
+
+554
+00:41:44,700 --> 00:41:48,500
+الهواء لو أديته pure oxygen في الحالة ده أنا بفيده
+
+555
+00:41:48,500 --> 00:41:51,960
+ليش؟ بعالي ال pressure pressure بصير أنا أطرد
+
+556
+00:41:51,960 --> 00:41:58,200
+carbon monoxide أحل محلهأنا عليت البرشا برشا اكتر
+
+557
+00:41:58,200 --> 00:42:02,440
+من ال 250 الضعف الموجود فصار عندي قدرة ان يكون
+
+558
+00:42:02,440 --> 00:42:06,400
+more oxygen عن القياش في نفس الوقت الخطورة تبعه ان
+
+559
+00:42:06,400 --> 00:42:10,940
+هو هذا ال carbon monoxide ال affinity للهيمoglobin
+
+560
+00:42:10,940 --> 00:42:16,920
+البرشا برشا تبعه تقريبا zero كله بيمسك في مين؟في
+
+561
+00:42:16,920 --> 00:42:21,800
+الهيموجلوبين ال affinity عالي جدا للهيموجلوبين فال
+
+562
+00:42:21,800 --> 00:42:26,620
+carbon monoxide pressure في الدم لا يذكر ال
+
+563
+00:42:26,620 --> 00:42:31,930
+pressure of oxygen ما تغيرشتمام؟ فالجسم مش مندمه
+
+564
+00:42:31,930 --> 00:42:35,350
+للإيه .. للتغييرات اللي صارت عنده في الهموجلبين،
+
+565
+00:42:35,350 --> 00:42:40,370
+برشر طبيعي ففيش تنفس عالي تمام؟ لكن في عندي صار
+
+566
+00:42:40,370 --> 00:42:44,610
+إيش؟ صار عندي hypoxemia، فيش أكسجين محمول في
+
+567
+00:42:44,610 --> 00:42:48,750
+الهموجلبين تمام؟ لكن ال respiratory rate هو هو
+
+568
+00:42:49,840 --> 00:42:53,420
+الاسبارات ال centers مش منتبهة لذلك بيصير some
+
+569
+00:42:53,420 --> 00:42:59,440
+sort of disorientation بإن العيان بيلحظ حاله مش
+
+570
+00:42:59,440 --> 00:43:03,700
+مركز مش طبيعي مش عارف اه و بعدين بيخش في كومة و اه
+
+571
+00:43:03,700 --> 00:43:06,980
+و بيموت في الغالب و ممكن الوجع اللي بيجعح اذا كان
+
+572
+00:43:06,980 --> 00:43:10,660
+واجف هو فالموضوع هذا مع الدوخة الخبطة هذه ماركن
+
+573
+00:43:10,660 --> 00:43:13,980
+نفسها هي ايه اتعملوا لكن واحد حاسس بصدوع غير عادي
+
+574
+00:43:13,980 --> 00:43:19,340
+ناس فاتحين المولعين فاهم الدنياالشتاء مولانا الفحم
+
+575
+00:43:19,340 --> 00:43:22,800
+وفي الشتاء بيبسكوا البواب عشان يتدفوا تمام فصار
+
+576
+00:43:22,800 --> 00:43:27,260
+عنده احتراق داخلي مظبوط وبيعلى ال carbon monoxide
+
+577
+00:43:27,260 --> 00:43:35,380
+شوية شوية و بدأوا يحسوا بصداع و انهم مش مركزين و
+
+578
+00:43:35,380 --> 00:43:37,860
+كده و واحد من الانتباه كان انهم مولانا الفحم راح
+
+579
+00:43:37,860 --> 00:43:41,140
+فاتح الباب ايه الحاجة دكتور انقذونا ايش العمل؟
+
+580
+00:43:41,140 --> 00:43:46,740
+العمل اني اديهم اكسجين عالي تنفس بيور اكسجين مش
+
+581
+00:43:46,740 --> 00:43:50,150
+بيورو ندى كمان في خمسة المية النقطة التانية، إذا
+
+582
+00:43:50,150 --> 00:43:53,470
+لما ندى pure oxygen أقصد، فيها أعلى البرش برش
+
+583
+00:43:53,470 --> 00:43:57,110
+oxygen، بقى أنا بصير أنافس من ال carbon monoxide ع
+
+584
+00:43:57,110 --> 00:44:00,810
+ال hemoglobin و لما أدى carbon dioxide five
+
+585
+00:44:00,810 --> 00:44:05,640
+percent، أنا بعمل simulation لمين؟طيب إذا من
+
+586
+00:44:05,640 --> 00:44:09,260
+هالجهة تعرفوا أن الـ main stimulant لرسبالات وسنتر
+
+587
+00:44:09,260 --> 00:44:13,200
+هو مين؟ ال carbon dioxide أكتر من ال oxygen إذا ال
+
+588
+00:44:13,200 --> 00:44:15,220
+pressure of carbon dioxide هو ال main stimulant
+
+589
+00:44:15,220 --> 00:44:18,320
+لمين؟ لرسبالات و لسنتر حطوها هذه المعلومة إيه في
+
+590
+00:44:18,320 --> 00:44:27,960
+الرأس طيب إذا نرجع تاني لموضوعنا إذا فهمنا الخطر
+
+591
+00:44:27,960 --> 00:44:31,360
+توعو وفهمنا إيش العلاج ندي حاجتين ب your oxygen أو
+
+592
+00:44:31,360 --> 00:44:34,340
+oxygen with 5% carbon dioxide
+
+593
+00:44:37,450 --> 00:44:41,950
+الان هنتقل ل ال carbon dioxide احنا اتكلمنا مافيه
+
+594
+00:44:41,950 --> 00:44:46,190
+كفاية عن ال oxygen مش كده ال oxygen بينتقل و
+
+595
+00:44:46,190 --> 00:44:49,350
+مراهله كلها تاني انا carbon dioxide اتكون مش هيك
+
+596
+00:44:49,350 --> 00:44:53,510
+carbon dioxide اتكون و بدأ يطلع من ال cells الى ال
+
+597
+00:44:53,510 --> 00:44:58,750
+interstitial fluid الى .. طيب الان هنلاحظ احنا انه
+
+598
+00:44:58,750 --> 00:45:03,850
+ال carbon dioxide اللي برجع على ال lungs هو بيطلع
+
+599
+00:45:03,850 --> 00:45:08,500
+من ال lungs الفرق بينهم جديشالفرق بينه خمسة ..
+
+600
+00:45:08,500 --> 00:45:12,140
+الفرق بينه خمسة millimeter mercury مش كده؟ خمسة
+
+601
+00:45:12,140 --> 00:45:16,360
+millimeter mercury ال oxygen الفرق كان قداش من
+
+602
+00:45:16,360 --> 00:45:20,720
+الخمسة وتسعين لاربعين خمسة وستين مش كده؟ احنا
+
+603
+00:45:20,720 --> 00:45:25,600
+قولنا خمسة وخمسين اه خمسة وتسعين لاربعين خمسة
+
+604
+00:45:25,600 --> 00:45:30,560
+وخمسين ال .. ال .. ال .. ال خمسة وخمسين millimeter
+
+605
+00:45:30,560 --> 00:45:34,040
+mercury difference سوات لي خمسة milliliter مين؟
+
+606
+00:45:34,040 --> 00:45:39,210
+oxygen مش هيك؟اكسجين اكسجين كده احنا بنسلم ال
+
+607
+00:45:39,210 --> 00:45:44,710
+cells اكسجين؟ ال oxygen بنسلمه احنا خمسة في العادة
+
+608
+00:45:44,710 --> 00:45:50,070
+بننزله للاربعين بيكون فقط خمسة ملي ليتر مش حسبتها
+
+609
+00:45:50,070 --> 00:45:54,660
+احنا كل الحمل بيكون عشرين ملي ليترأكسجين احنا
+
+610
+00:45:54,660 --> 00:46:02,520
+بنديه في كل لفة مش قولنا 97% يمثل 5 مليليتر و 0.27
+
+611
+00:46:02,520 --> 00:46:08,940
+يمثل اللي هو 3% مش كده؟ تقريبا تقريبا انا باعطي في
+
+612
+00:46:08,940 --> 00:46:13,060
+كل لفة للخلايا 5 مليليتر أكسجين في كل مليميتر
+
+613
+00:46:13,060 --> 00:46:18,800
+ميركوري في كل مليليتر دم بدي 5 تمام؟ لكن فرقات
+
+614
+00:46:18,800 --> 00:46:22,850
+الضغط كبيرةاللي قصدي أقوله أنه ال carbon dioxide
+
+615
+00:46:22,850 --> 00:46:26,910
+اللي بيعطيني في كل لفة بياخد أربعة ملي لتر carbon
+
+616
+00:46:26,910 --> 00:46:30,170
+dioxide من ال tissues إذا إحنا ندخل خمسة ملي لتر
+
+617
+00:46:30,170 --> 00:46:33,190
+لل tissues و بناخد جداش و بناخد أربعة فهذا الفرق
+
+618
+00:46:33,190 --> 00:46:36,190
+اللي بتسألكوا عليه المرة اللي فاتت أنه أنا برش
+
+619
+00:46:36,190 --> 00:46:39,390
+carbon dioxide أقل من ما إيه ما باخد oxygen و
+
+620
+00:46:39,390 --> 00:46:42,250
+أخدنا عليه علامة وين اللي أكلت العلامة؟ إيه؟ أو
+
+621
+00:46:42,250 --> 00:46:49,230
+أكون غايبة؟ بس حب أكل علامةطيب، اذا الفارق هذا،
+
+622
+00:46:49,230 --> 00:46:53,710
+لاحظوا فارق من .. من اربعين ملي متر ميركوري لخمسين
+
+623
+00:46:53,710 --> 00:46:57,470
+.. لخمسة واربعين ملي متر ميركوري، فارق خمسة الداني
+
+624
+00:46:57,470 --> 00:47:04,260
+اربعة ملي ليتر، و هناك فارقخمسة وخمسين الداني خمسة
+
+625
+00:47:04,260 --> 00:47:07,500
+مليليتر لإن ال dissolvent capacity تبعه للإكسجين
+
+626
+00:47:07,500 --> 00:47:10,460
+تخلف كتير عن ال carbon dioxide مش هيك فال carbon
+
+627
+00:47:10,460 --> 00:47:15,460
+dioxide مختلف في الحالة هذه طيب ال carbon إذا إذا
+
+628
+00:47:15,460 --> 00:47:15,940
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+629
+00:47:15,940 --> 00:47:16,080
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+630
+00:47:16,080 --> 00:47:17,420
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+631
+00:47:17,420 --> 00:47:18,340
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+632
+00:47:18,340 --> 00:47:18,600
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+633
+00:47:18,600 --> 00:47:18,600
+إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا إذا
+
+634
+00:47:18,600 --> 00:47:20,540
+إذا إذا إذا إذا
+
+635
+00:47:27,110 --> 00:47:32,070
+طيب هنلاحظ هان انه ال carbon dioxide لما بيطلع من
+
+636
+00:47:32,070 --> 00:47:37,630
+ال cells ال
+
+637
+00:47:37,630 --> 00:47:39,890
+carbon dioxide بيطلع من ال cells بيخش على ال
+
+638
+00:47:39,890 --> 00:47:44,090
+interstitial fluid بيخش على ال capillary blood على
+
+639
+00:47:44,090 --> 00:47:48,560
+ال plasma مش كده ال blood في ال plasmaالـ Carbon
+
+640
+00:47:48,560 --> 00:47:52,420
+Dioxide في البلازمة عنده طبعا عنده قدرة كبيرة عن
+
+641
+00:47:52,420 --> 00:47:57,380
+انتشارة، مش هيك؟ هيخش داخل ال RBCs وجزء منه هيضل
+
+642
+00:47:57,380 --> 00:48:02,380
+في البلازمة، إذا في جزء ديسول في البلازمةبالقطع
+
+643
+00:48:02,380 --> 00:48:06,820
+لإنه الجزء ال دستول في البلاد يمثل بعد كده بيصير
+
+644
+00:48:06,820 --> 00:48:13,560
+45 ميلي متر ميركوري مش كده؟ حيكون فيه جزء دستول و
+
+645
+00:48:13,560 --> 00:48:17,560
+إلا إذا مافيش دستول ماعملش pressure مش كده؟ طيب و
+
+646
+00:48:17,560 --> 00:48:21,500
+جزءه هيخش ال cells و هيكون ال pressure داخل ال
+
+647
+00:48:21,500 --> 00:48:25,180
+cells ايش؟ the same مش هيك؟ يعني أقل شوية عشان
+
+648
+00:48:25,180 --> 00:48:29,490
+انتقلعشان ندفع لجوه أقل شوية صغيرة بس إلى حد ما
+
+649
+00:48:29,490 --> 00:48:33,430
+برضه هيكون the same ال carbon dioxide اللي في ال
+
+650
+00:48:33,430 --> 00:48:38,850
+plasma هنلاقي انه عمل حاجتين يا إما ضال dissolved
+
+651
+00:48:38,850 --> 00:48:44,770
+carbon dioxide as it is يا إما attached itself to
+
+652
+00:48:44,770 --> 00:48:48,790
+a protein تمام؟ يا إما بيمسك في ال amino group تبع
+
+653
+00:48:48,790 --> 00:48:54,890
+ال protein تمام؟ يا إما بيبقى dissolvedطيب الجزء
+
+654
+00:48:54,890 --> 00:48:59,370
+اللي بدخل داخل ال cellsأنا عندي داخل RBCC موجود
+
+655
+00:48:59,370 --> 00:49:04,690
+كربونك أنهيدرز enzyme إيش هيعمل هذا؟ هيعمل فورا
+
+656
+00:49:04,690 --> 00:49:09,570
+خلال .. و لسه الدم لسه ال .. ال .. ال .. ال .. ال
+
+657
+00:49:09,570 --> 00:49:12,110
+.. ال carbon dioxide ده ال capillary هو لسه في
+
+658
+00:49:12,110 --> 00:49:16,430
+الأنسجة هتكون فورا اتحول لإنه عندي كربونك أنهيدرز
+
+659
+00:49:16,430 --> 00:49:21,650
+very active بيعمل التفاعل 5000 ضعف أسرع مش كده؟
+
+660
+00:49:21,650 --> 00:49:25,810
+فبتحول إلى كربونك أسد و الكربونك أسد هيتحلل
+
+661
+00:49:25,810 --> 00:49:31,430
+لهيدروجينو الـ bicarbonate هيلاجي له transporter
+
+662
+00:49:31,430 --> 00:49:35,610
+على ال steel membrane كاريار
+
+663
+00:49:35,610 --> 00:49:41,130
+اللي هو carbon dioxide كلورايد كاريار فبروح carbon
+
+664
+00:49:41,130 --> 00:49:44,570
+dioxide جوا عليه لإنه اتكون فبده يطلع برا و
+
+665
+00:49:44,570 --> 00:49:48,210
+بيساعدوا كمان facilitated by ايش؟ by the carrier
+
+666
+00:49:48,210 --> 00:49:53,770
+فالـ carrier بيقدر يعمل facilitation لل extrusion
+
+667
+00:49:55,340 --> 00:49:58,860
+for carbon dioxide to the outside و entrance of a
+
+668
+00:49:58,860 --> 00:50:01,500
+chloride محله طبعا انا في عندى هنا ما يطلع ال
+
+669
+00:50:01,500 --> 00:50:04,200
+carbon dioxide ال carbon dioxide ال bio carbonate
+
+670
+00:50:04,200 --> 00:50:08,940
+لما يعلق يطلع برا ب negative charges تمام كمان ال
+
+671
+00:50:08,940 --> 00:50:12,920
+chlorine بده يحل محله ك electrical balance تمام هو
+
+672
+00:50:12,920 --> 00:50:18,560
+ذات جوا لإنه اتكون تمام فبده يعمل balance فبده يخش
+
+673
+00:50:18,560 --> 00:50:21,920
+محله ال chlorine و بيساعدهم carrier بيساعدهم ايه
+
+674
+00:50:21,920 --> 00:50:26,500
+specific carrier بحيث يدخلcarbon dioxide يطلع برا
+
+675
+00:50:26,500 --> 00:50:29,880
+.. ال .. ال by carbonate تطلع برا ال cells و ال
+
+676
+00:50:29,880 --> 00:50:32,820
+chloride يدخل داخل ال cells هذا إيش بنسميه
+
+677
+00:50:32,820 --> 00:50:37,980
+chloride shift إذا ال chloride shift بيصير و إحنا
+
+678
+00:50:37,980 --> 00:50:42,600
+طالعين من ال tissues دخلين على ال venous side ال
+
+679
+00:50:42,600 --> 00:50:47,320
+RBCs بتكون أخدت carbon dioxide و طلع منها carbon
+
+680
+00:50:47,320 --> 00:50:52,840
+.. by carbonate و دخل محلها إذا لو أخدت ال RBCsمن
+
+681
+00:50:52,840 --> 00:50:55,560
+الـ venous side أخدنا ال RBCs من ال arterial side
+
+682
+00:50:55,560 --> 00:51:00,180
+هنلاقي ال chloride contents في ال venous أكتر من
+
+683
+00:51:00,180 --> 00:51:02,600
+ال chloride contents سبعة ال A في داخل ال RBCs
+
+684
+00:51:02,600 --> 00:51:06,100
+بتكلم لإنه بيصير shift هنا و هنا مع ال بيكربونات
+
+685
+00:51:06,100 --> 00:51:10,660
+تمام؟ اذا في عندي انا هذه ال chloride shift اتجت
+
+686
+00:51:10,660 --> 00:51:14,360
+by the way نتكلم عنها نرجح تاني لمين؟ لل carbon
+
+687
+00:51:14,360 --> 00:51:19,720
+dioxide transport اذا جزء ال sol في ال plasmaوجزء
+
+688
+00:51:19,720 --> 00:51:25,080
+داخل
+
+689
+00:51:25,080 --> 00:51:30,980
+السلز اتكون كربونيك اسد بمساعدة كربونيك انيريز
+
+690
+00:51:30,980 --> 00:51:36,710
+وصار له some sort of a transport to the outsideإذا
+
+691
+00:51:36,710 --> 00:51:40,330
+صار بلازمة فيها كمان بيكربونيت بس أساس التكوين وين
+
+692
+00:51:40,330 --> 00:51:44,630
+كان؟ داخل ال cells و .. طيب ماتكلمش ال hydrogen
+
+693
+00:51:44,630 --> 00:51:48,230
+إيش صار فيه؟ احنا قولنا carbonic acid بيكربونيت
+
+694
+00:51:48,230 --> 00:51:52,730
+راحت مقابل ال chloride مش كده؟ طلعت برا ال .. ال
+
+695
+00:51:52,730 --> 00:51:55,370
+بيكربونيت و ده كان محلها chloride عن طريق ال
+
+696
+00:51:55,370 --> 00:51:59,190
+carrier و ال hydrogen will attach to إيه؟ to the
+
+697
+00:51:59,190 --> 00:52:02,610
+hemoglobin ال .. ال hydrogen will attach to the
+
+698
+00:52:02,610 --> 00:52:06,670
+hemoglobin لإن ال hemoglobin is a bufferمش كده؟
+
+699
+00:52:06,670 --> 00:52:09,770
+الـ hemoglobin له buffering effect فبيمسك ال
+
+700
+00:52:09,770 --> 00:52:13,550
+hydrogen ions حتى يمنع ال change في ال A في ال B H
+
+701
+00:52:13,550 --> 00:52:18,490
+تمام؟ النقطة التالتة ان بعض ال carbon dioxide و ال
+
+702
+00:52:18,490 --> 00:52:25,470
+attach ده hemoglobin نسميه carbino .. carb ..
+
+703
+00:52:25,470 --> 00:52:31,090
+carbino hemoglobin تمام؟ اذا عندي ال attaching ل
+
+704
+00:52:31,090 --> 00:52:35,850
+ال proteinsجزء اين؟ جزء attaching the hemoglobin
+
+705
+00:52:35,850 --> 00:52:38,730
+inside the cells و جزء attaching the plasma
+
+706
+00:52:38,730 --> 00:52:44,090
+proteins لكن مين اكتر؟ ال .. ال hemoglobin .. ال
+
+707
+00:52:44,090 --> 00:52:48,690
+hemoglobin اكتر ال hemoglobin في ال .. في ال cells
+
+708
+00:52:48,690 --> 00:52:52,110
+موجود احنا عندنا قداشة؟ عندنا خمس عشر gram
+
+709
+00:52:52,110 --> 00:52:55,750
+hemoglobin في حين انه عندنا ال plasma proteins
+
+710
+00:52:55,750 --> 00:53:01,280
+قداشةالـ total plasma proteins ستة، ستة و نص،
+
+711
+00:53:01,280 --> 00:53:05,560
+القلب من أربعة، أربعة و نص تمام يمثل معظمها، لكن
+
+712
+00:53:05,560 --> 00:53:08,020
+الـ hemoglobin في الداخل ال .. ال .. ال .. في
+
+713
+00:53:08,020 --> 00:53:14,690
+الداخل ال cells يمثل كم؟ أنا مثلا أربعة عشرهو قوت
+
+714
+00:53:14,690 --> 00:53:18,650
+الدم مش هو ال hemoglobin انا مثلا اربعتاش و نص
+
+715
+00:53:18,650 --> 00:53:21,730
+gram per hundred milliliter انتوا هيكون اتناش
+
+716
+00:53:21,730 --> 00:53:28,390
+تلتاش milligram انت خمسة يمكن اربعتاش اه اربعتاش
+
+717
+00:53:28,390 --> 00:53:32,570
+الجاسد دائما جولنا الفيلم انا بدأ اكد انه دائما في
+
+718
+00:53:32,570 --> 00:53:39,130
+النساء بيبقى عايش اجل شوية في المدخنينعالي كتير
+
+719
+00:53:39,130 --> 00:53:43,010
+لأنه جزء من .. لأن معظمهم استهلك زي اللي ايه
+
+720
+00:53:43,010 --> 00:53:47,010
+بيشتغل سواج على الخط و مراكب مع ولاده مايبقى لسه
+
+721
+00:53:47,010 --> 00:53:50,770
+واسع في السيارة ولاده رايحين و جايين معاه و بيراكب
+
+722
+00:53:50,770 --> 00:53:54,550
+زمون زمون انه و بيكمل رايح شايف انت مافيش واسع في
+
+723
+00:53:54,550 --> 00:53:57,570
+ال hemoglobin اللي .. اللي واحد مدخن عنده carbon
+
+724
+00:53:57,570 --> 00:54:01,440
+monoxide عاليفدائما عندنا carbon monoxide راكب
+
+725
+00:54:01,440 --> 00:54:05,260
+عامين متواصل فيه carbon monoxide ملزق كمين في ال
+
+726
+00:54:05,260 --> 00:54:08,260
+hemoglobin فال oxygen .. و هو رايح ياخد ال oxygen
+
+727
+00:54:08,260 --> 00:54:11,340
+و هو رايح ياخد ال oxygen نص الطريق او ممكن اكتر
+
+728
+00:54:11,340 --> 00:54:17,860
+مليانة ال hemoglobin محمل تمام فلذلك ال hemoglobin
+
+729
+00:54:17,860 --> 00:54:20,580
+اذا عندنا احنا خمس عشر جرام فاحنا عندنا بلازمة
+
+730
+00:54:20,580 --> 00:54:25,000
+سبعة بالكتير جرام مش كده فعندنا ال main transport
+
+731
+00:54:25,000 --> 00:54:34,030
+على ال hemoglobin اذا الكرمينوهيموجلوبين إذا
+
+732
+00:54:34,030 --> 00:54:37,670
+صار في عندي تلت مناطق فيها transport of oxygen of
+
+733
+00:54:37,670 --> 00:54:44,550
+carbon dioxide the salt part يمثل 7% اللي هو
+
+734
+00:54:44,550 --> 00:54:48,910
+دلوقتي أنا متكلم عنه بظبط بالألقام و by carbonate
+
+735
+00:54:48,910 --> 00:54:53,550
+part which is the biggest إذا ال main transport as
+
+736
+00:54:53,550 --> 00:54:59,380
+by carbonate تمام سبعين في الميةفي حين انه ال ..
+
+737
+00:54:59,380 --> 00:55:05,320
+ال hemoglobin مع ال .. مع ال carbon dioxide بيمثل
+
+738
+00:55:05,320 --> 00:55:11,960
+23 ك transport ك transport يمثل 23% من ال .. من ال
+
+739
+00:55:11,960 --> 00:55:16,180
+.. من ال carbon dioxide البنجلي من ال tissues في
+
+740
+00:55:16,180 --> 00:55:20,700
+الدم اللاجئ carbon dioxide يمثل 30% لكن .. لكن في
+
+741
+00:55:20,700 --> 00:55:23,640
+الآخرة لما نطلع على ال transport نفسه على ال
+
+742
+00:55:23,640 --> 00:55:27,100
+transport نفسهجدّاش الـ Hemoglobin ترك الـ Carbon
+
+743
+00:55:27,100 --> 00:55:32,220
+Dioxide بتركوش كله زي الـ Dissolved و لايه ده
+
+744
+00:55:32,220 --> 00:55:36,440
+بيبقى ماسك فيه أكتر من اللازم فبنقول أنه لذلك دور
+
+745
+00:55:36,440 --> 00:55:39,420
+ال Hemoglobin في أنه يمثل يمثل فقط 23% من ال
+
+746
+00:55:39,420 --> 00:55:44,320
+transport الحمل الحقيقي يمثل 23% هو حمل 30 بس
+
+747
+00:55:44,320 --> 00:55:50,280
+بيتعاملش معاه لأقل ب 23 منهم في 7% ملزجين في ال
+
+748
+00:55:50,280 --> 00:55:52,800
+Hemoglobin و مابنتركوش تمام؟
+
+749
+00:55:54,990 --> 00:56:03,170
+ال site of .. ال site of attachment هان مش زي اللي
+
+750
+00:56:03,170 --> 00:56:06,190
+هو ال oxygen، مش زي ال carbon monoxide، هنا ع ال
+
+751
+00:56:06,190 --> 00:56:09,610
+amino group زي ال plasma، لذلك احنا ذكرناهم مع بعض
+
+752
+00:56:10,290 --> 00:56:15,130
+لأن الهيموجلوبين كبروتين والبلازما بروتين بروتين
+
+753
+00:56:15,130 --> 00:56:19,870
+فبتمسكوا بال amino group ما هوش على ال oxygen site
+
+754
+00:56:19,870 --> 00:56:23,670
+لكن carbon monoxide بنحمل على ايه بيعملنا خطر على
+
+755
+00:56:23,670 --> 00:56:27,230
+يعني وجود carbon dioxide على الهيموجلوبين بيعملاش
+
+756
+00:56:27,230 --> 00:56:29,230
+مشكلة كبيرة يعني مش على ال site of oxygen
+
+757
+00:56:29,230 --> 00:56:32,170
+transport لكن وجود carbon monoxide مشكلة كبيرة
+
+758
+00:56:32,170 --> 00:56:39,490
+لأنه على نفس ال site تبع ال ايه واضح؟ طيبالان اذا
+
+759
+00:56:39,490 --> 00:56:45,210
+لما نقول عندى انا طلعنا من الانسجار وعنا 45 ملي
+
+760
+00:56:45,210 --> 00:56:51,990
+متر ميركوري براشر للكربون داويكسايد مش كده؟ ايش
+
+761
+00:56:51,990 --> 00:56:59,370
+بيمثل هذا؟ بيمثل 2.7 ملي لتر كربون داويكسايد per
+
+762
+00:56:59,370 --> 00:57:07,520
+hundred milliliter يمثل ايش؟ 2.7 ملي لترthe amount
+
+763
+00:57:07,520 --> 00:57:10,980
+of carbon dioxide dissolved in the fluid of the
+
+764
+00:57:10,980 --> 00:57:16,880
+blood تمام؟ يمثله الـ dissolved part اللي هو جداش
+
+765
+00:57:16,880 --> 00:57:21,480
+ال dissolved part ال
+
+766
+00:57:21,480 --> 00:57:24,700
+dissolved part قولنا في ال carbon dioxide يمثل
+
+767
+00:57:24,700 --> 00:57:28,880
+سبعة المية مش هيك؟ سبعة المية
+
+768
+00:57:33,480 --> 00:57:38,440
+مقاومة الكربون ديوكسيد المفرومة في مياه الدم في 45
+
+769
+00:57:38,440 --> 00:57:44,610
+ملي متر مركوز هي 2.7 ملي لتر بديسليترالمقارنة الى
+
+770
+00:57:44,610 --> 00:57:53,830
+40 مليمتر ميركوري هي 2.4 مليلتر او فرق من 0.3
+
+771
+00:57:53,830 --> 00:58:00,450
+مليلتر فالمقارنة الى 4
+
+772
+00:58:00,450 --> 00:58:14,640
+مليلتر او فرق من 0.3 مليلتر من 4 مليلترتمام احنا
+
+773
+00:58:14,640 --> 00:58:20,960
+طبعا ال 45 ال 45 millimeter mercury ل 40 بنفقد بس
+
+774
+00:58:20,960 --> 00:58:26,900
+احنا five five percent لذلك هذا حامل 2.7 في ال 45
+
+775
+00:58:26,900 --> 00:58:32,980
+لكن في ال 40 كده حامل 2.4 يعني point three فقط انا
+
+776
+00:58:32,980 --> 00:58:40,220
+شاركت حامل عن طريق ال dissolve بعد تمام طيبالـ ..
+
+777
+00:58:40,220 --> 00:58:42,400
+إذا الـ point three هي يمثل السبعة في المية اللي
+
+778
+00:58:42,400 --> 00:58:45,540
+اتكلمنا عنها ال point three تمثل ال dissolve part
+
+779
+00:58:45,540 --> 00:58:50,920
+اللي تمثل سبعة في المية هنلاحظ أنه ال .. ال .. ال
+
+780
+00:58:50,920 --> 00:58:55,940
+carbonic anhydrase يمثل يقولنا سبعين في المية اللي
+
+781
+00:58:55,940 --> 00:59:01,000
+ال .. ال .. ال carbon ال bicarbonate تمثل ايه؟
+
+782
+00:59:01,000 --> 00:59:05,360
+سبعين في المية اللي هي تمثل كميات أرقام
+
+783
+00:59:25,050 --> 00:59:31,390
+القيمة الحقيقية هو point seven point
+
+784
+00:59:31,390 --> 00:59:36,890
+three milliliter بال hundred milliliter0.3 ملي
+
+785
+00:59:36,890 --> 00:59:42,190
+جرام ملي لتر per hundred milliliter of blood كويس؟
+
+786
+00:59:42,190 --> 00:59:48,150
+طيب ال carbonic anhydrase و تأثيره و عمل ال carbon
+
+787
+00:59:48,150 --> 00:59:54,570
+طيب ساعة شرحنا احنا يمثل 70% و قولنا ال chloride
+
+788
+00:59:54,570 --> 01:00:02,490
+shift و ال carriers و اه
+
+789
+01:00:03,670 --> 01:00:07,970
+إذن هنا عندنا إيه؟ So poor the tissue of carbon
+
+790
+01:00:07,970 --> 01:00:12,390
+can't be made to rise. في بعض الحالات اللي احنا
+
+791
+01:00:12,390 --> 01:00:17,850
+مستخدم فيها diuretic اللي هو carbon .. carbonic
+
+792
+01:00:17,850 --> 01:00:21,930
+anhydrase inhibitor فاكرين؟ ال acetizolamide جيبنا
+
+793
+01:00:21,930 --> 01:00:25,150
+سيرته في ال .. في ال diuretics هذا إذا احنا
+
+794
+01:00:25,150 --> 01:00:30,950
+استخدمنا مش بعطل بسreabsorption of bicarbonate في
+
+795
+01:00:30,950 --> 01:00:34,290
+داخل ال .. اه بيعمللي جزء من ال diuresis هذا
+
+796
+01:00:34,290 --> 01:00:37,810
+البسيط، mild diuresis، لأ ممكن يعملي كمان إشكالية
+
+797
+01:00:37,810 --> 01:00:44,910
+في مين في نقل ال carbon dioxide عبر الدم لإن ال
+
+798
+01:00:44,910 --> 01:00:50,300
+mainالـ main step اللي هو بمساعدة carbonic
+
+799
+01:00:50,300 --> 01:00:54,380
+anhydrase لما انا اعطل هذه ال main step اللي هي ال
+
+800
+01:00:54,380 --> 01:00:59,780
+carbon ال bicarbonate transport معناها انا عطلت
+
+801
+01:00:59,780 --> 01:01:09,370
+مين؟ عطلت ال ..الـ Bicarbonate علّيت الآخرين تمام؟
+
+802
+01:01:09,370 --> 01:01:13,330
+هقدّي إلى أنه ال transport becomes so poor that
+
+803
+01:01:13,330 --> 01:01:18,070
+برشا بشر بدل ما هو خمسة و أربعين يصعل إعلامينالـ
+
+804
+01:01:18,070 --> 01:01:22,770
+80% بطل ال RBCs جادرة ان تستخدم معظم ال carbon
+
+805
+01:01:22,770 --> 01:01:26,210
+dioxide وتحاول ان تبيع الكربونات صار عندي انا ال
+
+806
+01:01:26,210 --> 01:01:29,430
+dissolved carbon dioxide يعني البرشر برشر يعني
+
+807
+01:01:29,430 --> 01:01:32,330
+اللي ايه على ايه ل 80% في الحالة هذه طبعا في
+
+808
+01:01:32,330 --> 01:01:35,210
+الحالة هذه احنا ايه؟ بنخش في خطر؟ poisoning لان ال
+
+809
+01:01:35,210 --> 01:01:38,270
+carbon .. هندرس في الفصل اللي .. المحاضرة اللي
+
+810
+01:01:38,270 --> 01:01:41,910
+جاية او اللي بعيدها ال carbon dioxide ده ميعلى ايش
+
+811
+01:01:41,910 --> 01:01:47,740
+اثروا علينا تمام؟ ممكن يدخلنا في كومةتمام فلما انا
+
+812
+01:01:47,740 --> 01:01:52,700
+امنع ال carbon dioxide من الحمض الصحيح و اخلي ال
+
+813
+01:01:52,700 --> 01:01:55,840
+concentration تبعه عالي بشكل عند خطر اكبر
+
+814
+01:01:55,840 --> 01:02:01,940
+transport of carbon dioxide in the combination of
+
+815
+01:02:01,940 --> 01:02:04,240
+the hemoglobin اللي هو الكابامينو hemoglobin
+
+816
+01:02:04,240 --> 01:02:09,640
+تكلمنا عنه مش هيك the quantity of carbon dioxide
+
+817
+01:02:09,640 --> 01:02:13,510
+that can be carried from the peripheral tissuesto
+
+818
+01:02:13,510 --> 01:02:19,210
+the lungs by carbamino combination is about 30%
+
+819
+01:02:19,210 --> 01:02:26,630
+وقلنا انه 30% لكنها لا تمثل الى حوالي 23% هدول ..
+
+820
+01:02:26,630 --> 01:02:30,210
+اذا النقطة الثالثة اللي اتكلمنا عنها وهي اللي هو
+
+821
+01:02:30,210 --> 01:02:35,160
+carbaminoاللي يمثل تلاتين فالمية او حقيقة ما
+
+822
+01:02:35,160 --> 01:02:37,720
+بيزدادش عن عشرين فالمية الا قليل تلات عشرين فالمية
+
+823
+01:02:37,720 --> 01:02:41,540
+of carbon dioxide is transported via combination
+
+824
+01:02:41,540 --> 01:02:46,540
+with the amino group of the hemoglobin هذا يمثل
+
+825
+01:02:46,540 --> 01:02:52,600
+one point five milliliter carbon dioxide for each
+
+826
+01:02:52,600 --> 01:02:56,980
+one hundred milliliter of blood تمام؟ اذا بيظل ال
+
+827
+01:02:56,980 --> 01:03:02,340
+bicarbonateالـ carrying كبسيف تبعته للدم as
+
+828
+01:03:02,340 --> 01:03:05,960
+bicarbonate هيكون من الأربعة بيظل عندي two point
+
+829
+01:03:05,960 --> 01:03:08,800
+two milliliter two point two milliliter
+
+830
+01:03:08,800 --> 01:03:13,180
+bicarbonate for each one hundred milliliter of
+
+831
+01:03:13,180 --> 01:03:20,040
+blood تمام؟ طيب إذا هنا عندي أنا ال five percent
+
+832
+01:03:20,040 --> 01:03:24,260
+difference هذه بين الخمسة و أربعين إلى أربعين تمثل
+
+833
+01:03:24,260 --> 01:03:29,940
+أربعة milliliter أربعة milliliter إيش؟أربعة ملي
+
+834
+01:03:29,940 --> 01:03:36,840
+لتر كربون ديوكسيد تم تحميله إلى الهيوغوط و بعد ذلك
+
+835
+01:03:36,840 --> 01:03:40,540
+تم تحميله إلى الهيوغوط و بعد ذلك تم تحميله إلى
+
+836
+01:03:40,540 --> 01:03:42,820
+الهيوغوط و بعد ذلك تم تحميله إلى الهيوغوط و بعد
+
+837
+01:03:42,820 --> 01:03:42,820
+ذلك تم تحميله إلى الهيوغوط و بعد ذلك تم تحميله إلى
+
+838
+01:03:42,820 --> 01:03:42,820
+الهيوغوط و بعد ذلك تم تحميله إلى الهيوغوط و بعد
+
+839
+01:03:42,820 --> 01:03:43,720
+ذلك تم تحميله إلى الهيوغوط و بعد ذلك تم تحميله إلى
+
+840
+01:03:43,720 --> 01:03:48,740
+الهيوغوط و بعد ذلك تم تحميله إلى الهيوغوط و بعد
+
+841
+01:03:48,740 --> 01:03:51,660
+ذلك تم تحميله إلى الهيوغوط و بعد ذلك تم تحميله إلى
+
+842
+01:03:51,660 --> 01:03:58,590
+الهيوغوط و بعد ذلك تم تحمwhat is called shift to
+
+843
+01:03:58,590 --> 01:04:05,110
+the right وسمينا البهر phenomenon
+
+844
+01:04:05,110 --> 01:04:11,630
+البهر effect هذه بيزيد قدرة ال delivery of oxygen
+
+845
+01:04:11,630 --> 01:04:16,650
+to the tissues هنا في حاجة اسمها halden effect
+
+846
+01:04:16,650 --> 01:04:21,290
+halden effect هذا بمعنى انه برضه ال dissociation
+
+847
+01:04:21,290 --> 01:04:24,920
+كيرسيه عن ال carbon dioxideبيتغير ما بين ال
+
+848
+01:04:24,920 --> 01:04:29,540
+tissues و ما بين ال alveoli بيقدر إلى برضه ملحوظة
+
+849
+01:04:29,540 --> 01:04:33,120
+كتير عظيمة خلّيني نطلع الحين احنا ال curve تبع ال
+
+850
+01:04:33,120 --> 01:04:37,200
+dissociation curve تبع مين ال carbon dioxide هلاحظ
+
+851
+01:04:37,200 --> 01:04:40,760
+احنا هاي الجزئية تبعتنا جزئية ضيقة جدا لإن احنا
+
+852
+01:04:40,760 --> 01:04:45,860
+بين ال 40 و 45 بين 40 و 45 في الحالة هذه بين 40 و
+
+853
+01:04:45,860 --> 01:04:47,360
+45 كده احنا حاملين
+
+854
+01:04:50,950 --> 01:04:56,630
+carbon dioxide هنلاحظ ان احنا اقبل الخمسين اقبل
+
+855
+01:04:56,630 --> 01:05:01,330
+الخمسين milliliter carbon dioxide volume percent
+
+856
+01:05:01,330 --> 01:05:06,190
+يعني لما يكون عندى الخمسة واربعين بيبقى تقريبا او
+
+857
+01:05:06,190 --> 01:05:09,070
+اربعين واربعين وخمسة واربعين بيبقى تقريبا محمول
+
+858
+01:05:09,070 --> 01:05:13,870
+عندى خمسين milliliter carbon dioxide لكن الغريبة
+
+859
+01:05:13,870 --> 01:05:17,250
+في الموضوع انه لاحظوا الخمسين بس بتديني اربعة و
+
+860
+01:05:17,250 --> 01:05:21,190
+بترجع تديني اربعة طب ليش هو الخمسين؟يعني بيضال
+
+861
+01:05:21,190 --> 01:05:23,510
+خمسين محمول carbon dioxide في الدم فى الرواحة فى
+
+862
+01:05:23,510 --> 01:05:27,370
+الجاية مابيستغنيش اللعنة أربعة، مظبوط؟ يعني لو
+
+863
+01:05:27,370 --> 01:05:30,490
+أنتوا بتفكروا الموضوع، بنتخلص منه كله، مظبوط ولا
+
+864
+01:05:30,490 --> 01:05:33,590
+لأ؟ بنتخلص من carbon dioxide، مثلا دك نصل ال .. ال
+
+865
+01:05:33,590 --> 01:05:36,890
+.. ال .. المكاب اللى هو الريقتين، بنتخلص من ال
+
+866
+01:05:36,890 --> 01:05:40,030
+إيه؟ من ال carbon dioxide، لكن وقع الأمر بنتخلص بس
+
+867
+01:05:40,030 --> 01:05:44,150
+من أربعة وبيضل المحطة ال carbon dioxide مهم جدا لل
+
+868
+01:05:44,150 --> 01:05:49,600
+respiration هو sensitiveأه sensitive له تمام فهو
+
+869
+01:05:49,600 --> 01:05:54,080
+يعني بيظل موجود بزيديش ولا بجل لإنه بيعمل ايه good
+
+870
+01:05:54,080 --> 01:05:56,480
+simulation ل respiratory center الآن اللي
+
+871
+01:05:56,480 --> 01:06:02,400
+هنلاحظهان في ال curve التاني انه
+
+872
+01:06:02,400 --> 01:06:07,500
+ال content سبعتنا هذه حقيقة لو نطلع ال curve هذا
+
+873
+01:06:07,500 --> 01:06:10,720
+بالظبط ال curve اللي احنا شايفينه من ال 45 ل 40
+
+874
+01:06:10,720 --> 01:06:16,620
+متحول من ال 50 إلى 52تمام؟ من خمسين إلى ايه؟ اتنين
+
+875
+01:06:16,620 --> 01:06:20,800
+وخمسين لكن واقعا انا احنا بنفقد اربعة بمعنى ..
+
+876
+01:06:20,800 --> 01:06:24,580
+بمعنى انه احنا اذا نقدر بسبب من الأسباب اللي مسمى
+
+877
+01:06:24,580 --> 01:06:28,560
+holding effect نفقد كمان اتنين ونصبح اتنين واربعين
+
+878
+01:06:28,560 --> 01:06:32,880
+تمام؟ اذا انا مابحمل اتنين وخمسين بفكرش اتنين بصير
+
+879
+01:06:32,880 --> 01:06:37,320
+خمسين بسبب ال holding effect بفكر كمان اتنين بصير
+
+880
+01:06:37,320 --> 01:06:41,140
+تمانية واربعين واضح؟ هنتكلم عنه الآن بالتفصيل
+
+881
+01:06:43,960 --> 01:06:50,060
+إذا الهالدين effect بيخص ال carbon dioxide
+
+882
+01:06:50,060 --> 01:06:57,900
+transport أو exchange in the alveolar area يعني
+
+883
+01:06:57,900 --> 01:07:01,800
+with the alveolar air البهر بيخص ال oxygen في ال
+
+884
+01:07:01,800 --> 01:07:06,840
+tissues تمام؟ الهالدين بيخص كان السؤال بيسأله ده
+
+885
+01:07:06,840 --> 01:07:10,640
+من مين أهم الهالدين effect ولا البهر effect تمام؟
+
+886
+01:07:11,350 --> 01:07:16,150
+طيب لو طلعنا احنا على ال curve ال curve المنجة هدا
+
+887
+01:07:16,150 --> 01:07:20,910
+هو النقطة A هدا هي الطبيعي طلعنا من ال tissues
+
+888
+01:07:20,910 --> 01:07:25,230
+بخمسة و أربعين، مظبوط؟ طلعنا من ال tissues بخمسة و
+
+889
+01:07:25,230 --> 01:07:28,930
+أربعين، لو ضلينا على ال curve هدا وصلنا ال alveoli
+
+890
+01:07:28,930 --> 01:07:33,190
+اه و اتخلصنا و ارجعنا لاربعين، جدش ممكن فقدنا؟
+
+891
+01:07:34,130 --> 01:07:38,170
+بنكون فقدنا اتنين من ايه للنقطة هذه الجبال
+
+892
+01:07:38,170 --> 01:07:41,970
+الأربعين على نفس المنقطة تمام بيصل من اتنين و
+
+893
+01:07:41,970 --> 01:07:45,530
+خمسين لخمسين لكن وقع قمر ال distribution curve هنا
+
+894
+01:07:45,530 --> 01:07:51,470
+بينخفضبتغير في الـ alveoli بدل و هذا ال curve هذا
+
+895
+01:07:51,470 --> 01:07:55,110
+المنطج هذه في ال tissues لكن هذا ال curve في ال
+
+896
+01:07:55,110 --> 01:07:59,070
+alveoli ملاحظ أنه ال curve نفسه ال decision تغير و
+
+897
+01:07:59,070 --> 01:08:04,190
+هبط شوية و اتدنيف ال alveoli نقطة أخرى تمام غير
+
+898
+01:08:04,190 --> 01:08:07,410
+النقطة المتوقعة أنه يصلها لو نحسب على ال curve تبع
+
+899
+01:08:07,410 --> 01:08:13,550
+ال tissues بحيث أنه بلاقي نزل ل 48 نزل ل إيه ل 48
+
+900
+01:08:13,550 --> 01:08:16,090
+إذا في عندي أنا متوسط الخمسين
+
+901
+01:08:18,940 --> 01:08:24,400
+52 في ال tissues و من الصين ل 48 فالله فالله عندي
+
+902
+01:08:24,400 --> 01:08:28,920
+ايه عندي ال holding effect اللي هتكلم عنه الآن
+
+903
+01:08:28,920 --> 01:08:35,280
+ضاعفلي قدرة الحمل تبع الدم بدل ما يحمل اتنين كل
+
+904
+01:08:35,280 --> 01:08:40,360
+مرة صار يحمل اربع بدل ما يتخلص من اتنين يتخلص من
+
+905
+01:08:40,360 --> 01:08:44,000
+اربع تمام؟ اذا مهم جدا هذا لأنه عملي doubling
+
+906
+01:08:44,000 --> 01:08:48,570
+لمين؟في حين ان البوهر effect مايعملش doubling
+
+907
+01:08:48,570 --> 01:08:55,270
+البوهر effect بيعمل shift 10% او 15% تمام؟ بيزيد
+
+908
+01:08:55,270 --> 01:09:02,350
+ال oxygen supply لالتيشوز 10% او up to 15% تمام؟ و
+
+909
+01:09:02,350 --> 01:09:05,410
+بيعمل shift على الجهة التانية برضه 10% to 15% لكن
+
+910
+01:09:05,410 --> 01:09:09,690
+هذا بيديني 100% additional صار عندي بدل ما انا
+
+911
+01:09:09,690 --> 01:09:13,550
+بفقد اتنين صار بفقد اربعة تمام؟ is a hardened
+
+912
+01:09:13,550 --> 01:09:20,890
+effectالهالدين إفكت إيش؟ أهم لإنه خلصني من ضعف ال
+
+913
+01:09:20,890 --> 01:09:24,390
+carbon dioxide اللي إيه؟ طيب إيش هو الهالدين إفكت
+
+914
+01:09:24,390 --> 01:09:31,890
+هذا؟ من وين جاي؟ الهالدين
+
+915
+01:09:31,890 --> 01:09:37,730
+إفكت جاي من إنه أثناء احنا أثناء
+
+916
+01:09:37,730 --> 01:09:44,270
+ما نصل ال ال tissues تمام؟أثناء منصة ال tissue
+
+917
+01:09:44,270 --> 01:09:52,070
+بيصير عندي more oxygen binds to the hemoglobin هذه
+
+918
+01:09:52,070 --> 01:09:55,230
+عملية أنه لما يديني more oxygen binds to the
+
+919
+01:09:55,230 --> 01:10:00,070
+hemoglobin بيديني more capacity of the blood to
+
+920
+01:10:00,070 --> 01:10:04,440
+release carbon dioxideلحظة في الـ tissues العكس
+
+921
+01:10:04,440 --> 01:10:08,140
+كنا نقول لما علي ال carbon dioxide اداني فرصة اعطي
+
+922
+01:10:08,140 --> 01:10:12,980
+اكتر oxygen مش كده شفت دلوقتي مش كده هنا عملية
+
+923
+01:10:12,980 --> 01:10:18,220
+عكسية لما زاد ال oxygen ثم صار عندى مقدرة اكبر اني
+
+924
+01:10:18,220 --> 01:10:22,670
+اترك carbon dioxide يعني اتنين عكس بعضال carbon
+
+925
+01:10:22,670 --> 01:10:25,590
+dioxide ساعد ال oxygen انه ينترك في ال tissues و
+
+926
+01:10:25,590 --> 01:10:28,170
+ال oxygen ساعد ال carbon dioxide انه ينترك اكتر في
+
+927
+01:10:28,170 --> 01:10:32,070
+ال a في ال alveoli مش كده؟ اذا هذه باختصار لكن ليش
+
+928
+01:10:32,070 --> 01:10:35,530
+بيصير هيك؟
+
+929
+01:10:35,530 --> 01:10:40,510
+ليش بيصير؟ ايش تفسير ال ايه ال process هذه؟
+
+930
+01:10:42,910 --> 01:10:48,150
+ال process تفسيرها انه انا لما بي .. بي .. بيخش
+
+931
+01:10:48,150 --> 01:10:57,370
+عندى ال .. ال oxygen الى ال .. ال .. ال .. ال
+
+932
+01:10:57,370 --> 01:11:03,770
+hemoglobin ال hemoglobin بتحول ل less acidic تمام؟
+
+933
+01:11:03,770 --> 01:11:08,070
+و هذا بيقدر الى انه .. انه ال carbon dioxide يطلع
+
+934
+01:11:08,070 --> 01:11:10,930
+اكتر خلينا ايه؟ خلينا نجراها هنا
+
+935
+01:11:18,830 --> 01:11:24,410
+هذا يعني تغيير في حرارة الدم بينما يتحرك الكربون
+
+936
+01:11:24,410 --> 01:11:29,330
+ديوكسيد الكربونيك أصبح كذلك عندما يدخل الكربون
+
+937
+01:11:29,330 --> 01:11:34,410
+ديوكسيد الدم في الجسد التجاري يتقلل حرارة الدم بي
+
+938
+01:11:34,410 --> 01:11:41,090
+اتش ولكن تجهيزة هذا الحرارة بالحرارة
+
+939
+01:11:41,090 --> 01:11:44,670
+الأساسية من الدم يمنع الحرارة الهيدروجينية من
+
+940
+01:11:46,010 --> 01:11:49,110
+rising greatly هذا الـ buffering effect تبع
+
+941
+01:11:49,110 --> 01:11:51,950
+الهيموجلوبين على الهيدروجين اتكلمنا عنه احنا من
+
+942
+01:11:51,950 --> 01:11:56,570
+شوية تمام؟ و هنا بنلاقي التحول في ال BH اقليل لإنه
+
+943
+01:11:56,570 --> 01:12:00,650
+له buffering effect من سبعة point four بس بنزل
+
+944
+01:12:00,650 --> 01:12:05,790
+لسبعة point three مع ال additional hydrogen تمام؟
+
+945
+01:12:05,790 --> 01:12:11,570
+the reverse occurs في ال other side in heavy
+
+946
+01:12:11,570 --> 01:12:18,720
+exerciseبنلاحظ انه can be as much as point five
+
+947
+01:12:18,720 --> 01:12:22,880
+يعني about هنا هنا برضه ال heavy exercise يديني
+
+948
+01:12:22,880 --> 01:12:28,420
+more hydrogen مش كده when blood flow through the
+
+949
+01:12:28,420 --> 01:12:33,880
+tissues is sluggish the decrease in pH in the
+
+950
+01:12:33,880 --> 01:12:39,120
+tissue blood can be as much as point five about
+
+951
+01:12:39,120 --> 01:12:40,480
+twelve times normal
+
+952
+01:12:46,370 --> 01:12:50,250
+thus causing significant tissue acidosis هذا في
+
+953
+01:12:50,250 --> 01:12:55,750
+حالة إيه؟ لما يكون عندي slow الفرج اللي اتكلمنا
+
+954
+01:12:55,750 --> 01:13:01,390
+عنه الزيادة هنا كانت point oh four لما نتكلم في
+
+955
+01:13:01,390 --> 01:13:06,090
+الوضع الطبيعي ال hemoglobin buffering system بيحول
+
+956
+01:13:06,090 --> 01:13:12,360
+ال pH من seven point four إلى seven point3.7 لكن
+
+957
+01:13:12,360 --> 01:13:16,020
+لو مافيش عندى blood supply كويس هنلاحظ انه احنا
+
+958
+01:13:16,020 --> 01:13:21,840
+زاد مش ل point oh four ال BH زادت point five تمام
+
+959
+01:13:21,840 --> 01:13:26,920
+point five ل point four اتناشر مرة ضعف اتناشر ضعف
+
+960
+01:13:26,920 --> 01:13:31,240
+تمام ال ratio exchange respiratory exchange ratio
+
+961
+01:13:31,240 --> 01:13:38,080
+هذا اخر موضوعاللي هو جثة الواحد carbon dioxide
+
+962
+01:13:38,080 --> 01:13:41,660
+اللي فجدناه المرة الفاتتة تمام؟ يعتمد على نوع
+
+963
+01:13:41,660 --> 01:13:44,720
+الأكل اللي احنا بناكله لو أعملنا مقتصر للناس
+
+964
+01:13:44,720 --> 01:13:47,740
+الطبيعيين اللي بيأكلوا أكل في وضع طبيعي جثنا جداش
+
+965
+01:13:47,740 --> 01:13:52,080
+بياخدوا أكسجين جداش بيطلعوا carbon dioxide هنلاقي
+
+966
+01:13:52,080 --> 01:13:55,020
+دايما carbon dioxide أقل من أكسجين لإن بنلاقي ال
+
+967
+01:13:55,020 --> 01:13:57,360
+ratio بين carbon dioxide و أكسجين point eight two
+
+968
+01:13:57,360 --> 01:14:05,220
+تمام؟ لو طعمناهم بروتينات بحتة هنلاقيهاحوالي point
+
+969
+01:14:05,220 --> 01:14:10,600
+eight لو أكلوا carbohydrate بحتة هنلاقيها one يعني
+
+970
+01:14:10,600 --> 01:14:12,580
+صار عندي ال carbohydrate في حالة ال carbohydrate
+
+971
+01:14:12,580 --> 01:14:17,540
+واحد oxygen بديني واحد carbon dioxide تمام؟ لو
+
+972
+01:14:17,540 --> 01:14:22,760
+أكلنا fats كتير هنلاقي نزلت ل point seven يعني
+
+973
+01:14:22,760 --> 01:14:29,900
+عندي moremore hydrogen is present و more water is
+
+974
+01:14:29,900 --> 01:14:34,260
+formed تمام؟ إذا من ال ratio هذه إحنا الطبيعي إن
+
+975
+01:14:34,260 --> 01:14:37,180
+نلاقيها point eight إذا لاجيناها أجر أعلى من ال
+
+976
+01:14:37,180 --> 01:14:39,260
+point eight معناها في عندي more carbohydrate في
+
+977
+01:14:39,260 --> 01:14:42,520
+الأكل لو لاجيناها أقل من ال point eight معناها
+
+978
+01:14:42,520 --> 01:14:46,730
+عندي في إيش moremore fat in the .. in the .. in
+
+979
+01:14:46,730 --> 01:14:50,210
+the diet ومن كده هذا ماسميها احنا ال respiratory
+
+980
+01:14:50,210 --> 01:14:53,810
+exchange ratio ال respiratory exchange ratio
+
+981
+01:14:53,810 --> 01:14:58,750
+بتمثلي نوع الأكل اللي انا باكله بيضل السببين اللي
+
+982
+01:14:58,750 --> 01:15:03,190
+احنا اتكلمنا عنهم في ليش .. ليش بيصير ال holding
+
+983
+01:15:03,190 --> 01:15:08,430
+effect مش كده؟المزيد من الهيموغلوبين المزيد من
+
+984
+01:15:08,430 --> 01:15:09,030
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+985
+01:15:09,030 --> 01:15:09,930
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+986
+01:15:09,930 --> 01:15:12,510
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+987
+01:15:12,510 --> 01:15:20,770
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+988
+01:15:20,770 --> 01:15:20,870
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+989
+01:15:20,870 --> 01:15:20,890
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+990
+01:15:20,890 --> 01:15:20,910
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+991
+01:15:20,910 --> 01:15:22,050
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+992
+01:15:22,050 --> 01:15:22,050
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+993
+01:15:22,050 --> 01:15:22,890
+المزيد من المزيد من المزيد من المزيد من المزيد من
+
+994
+01:15:22,890 --> 01:15:28,250
+المزيد من المزيد منتمام اذا انا لما اعمل less
+
+995
+01:15:28,250 --> 01:15:31,110
+acidic مع ال hemoglobin بيمسك carbon dioxide اقل
+
+996
+01:15:31,110 --> 01:15:34,230
+بيعمل wash لل carbon dioxide اقل اكتر the
+
+997
+01:15:34,230 --> 01:15:37,290
+increased acidity of the hemoglobin also causes it
+
+998
+01:15:37,290 --> 01:15:39,710
+to release an excess of the hydrogen ions
+
+999
+01:15:39,710 --> 01:15:44,770
+الهيدروجين اللي مسكها أساسا هو تمام بتركها لما
+
+1000
+01:15:44,770 --> 01:15:47,010
+ييجي أكسجين اللي هو صار more ايش
+
+1001
+01:15:49,970 --> 01:15:54,270
+more acidic النقطتين
+
+1002
+01:15:54,270 --> 01:15:56,930
+هدول انتجروها بالتفصيل اشرحهم براحتكم عشان انا صار
+
+1003
+01:15:56,930 --> 01:15:58,690
+مكفى في انهاء الدارس
+
+1004
+01:16:22,580 --> 01:16:23,700
+يا نبارك الله فيك
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/jCLl_n416-Y_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/jCLl_n416-Y_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..602bcc29f600e265f3ad9ac99b79f2e81ee5f16b
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/jCLl_n416-Y_postprocess.srt
@@ -0,0 +1,2624 @@
+1
+00:00:00,000 --> 00:00:02,700
+موسيقى
+
+2
+00:00:09,250 --> 00:00:13,230
+اليوم ان شاء الله بتكون اخر محاضرة في physiology
+
+3
+00:00:13,230 --> 00:00:18,010
+of the respiratory system وفيها اليوم بنتكلم عن
+
+4
+00:00:18,010 --> 00:00:22,330
+بعض الحالات ال abnormalities الحالات المرضية
+
+5
+00:00:22,330 --> 00:00:28,570
+الحالات الغير عادية في موضوع ال هذا الجهاز جهاز
+
+6
+00:00:28,570 --> 00:00:33,250
+التنفس النقطة
+
+7
+00:00:33,250 --> 00:00:36,410
+الأولى هتكلم عنها موضوع ال hypoxia فعندنا حاجة
+
+8
+00:00:36,410 --> 00:00:42,000
+اسمها hypoxiaفي حاجة اسمها anoxia طبعا anoxia يعني
+
+9
+00:00:42,000 --> 00:00:46,260
+مافيش oxygen نهائي hypoxia يعني في بس inadequate
+
+10
+00:00:46,260 --> 00:00:52,100
+إذا كنت عارف كلمة hypoxia is a pathological
+
+11
+00:00:52,100 --> 00:00:57,120
+condition in which the body tissues as a whole or
+
+12
+00:00:57,120 --> 00:01:05,070
+regional are deprived of adequate oxygen supplyالـ
+
+13
+00:01:05,070 --> 00:01:10,130
+adequate oxygen supply is not present لذلك بيسميها
+
+14
+00:01:10,130 --> 00:01:11,190
+hypoxia
+
+15
+00:01:14,870 --> 00:01:19,670
+الأسباب المختلفة لإنه يكون عندي أنا hypoxia ممكن
+
+16
+00:01:19,670 --> 00:01:23,910
+نسترجعها مع بعض نالبعض ممكن يكون الجو الخارجي
+
+17
+00:01:23,910 --> 00:01:30,570
+عندنا أوضة مسكرة ومافيش فيها تشديد هوا فيها موقد
+
+18
+00:01:30,570 --> 00:01:37,930
+بيستهلك هوا فيها غازات غير عادية وستجيه نسبة واطية
+
+19
+00:01:37,930 --> 00:01:41,610
+بتأدي في النهاية إيه لإنه يدخلني في hypoxiaيعني
+
+20
+00:01:41,610 --> 00:01:46,050
+عندى ال atmospheric oxygen is low مش كده، هدى أول
+
+21
+00:01:46,050 --> 00:01:50,930
+حاجة، اتنين ممكن يكون عندى انا جهاز التنفس عندى مش
+
+22
+00:01:50,930 --> 00:01:55,170
+سليميعني العضلات، الدماغ، الكذا اللي بيشكل اللي
+
+23
+00:01:55,170 --> 00:01:58,370
+إيه، عندي trauma في ال head، عندي مشكلة،
+
+24
+00:01:58,370 --> 00:02:01,610
+neuromuscular control of the respiratory tract is
+
+25
+00:02:01,610 --> 00:02:05,750
+not ال ventilation بس مش بسبب ال lungs نفسها، بسبب
+
+26
+00:02:05,750 --> 00:02:09,990
+إيه؟ ال control system تبعهم، ال neuromuscular
+
+27
+00:02:09,990 --> 00:02:15,210
+disorders، تمام؟ إذا عندي inadequate oxygenation
+
+28
+00:02:15,210 --> 00:02:18,650
+of the blood in the lungsbecause of extrinsic
+
+29
+00:02:18,650 --> 00:02:24,610
+reasons خارج عن ال lungs نفسها تمام ال атмосفير او
+
+30
+00:02:24,610 --> 00:02:27,170
+ال central nervous system او neuromuscular
+
+31
+00:02:27,170 --> 00:02:34,710
+junctions او سبب تاني inadequate oxygenation of
+
+32
+00:02:34,710 --> 00:02:37,330
+the blood in the lungs because of the disease of a
+
+33
+00:02:37,330 --> 00:02:41,550
+disease in the lungs نفسها تمام بلمونري causes
+
+34
+00:02:41,550 --> 00:02:43,390
+وهذه
+
+35
+00:02:45,640 --> 00:02:50,020
+ممكن تكون عندى hypoventilation caused by increased
+
+36
+00:02:50,020 --> 00:02:52,580
+airway resistance عنده some sort of obstruction
+
+37
+00:02:52,580 --> 00:02:57,680
+تمام؟ ال bronchial asthma ال emphysema فيها sort
+
+38
+00:02:57,680 --> 00:03:00,880
+of obstruction بيقدر ان الهواء اللي بدخل و بطلع مش
+
+39
+00:03:00,880 --> 00:03:04,790
+طبيعىأو abnormal زي ما قولنا في الانفيزيام
+
+40
+00:03:04,790 --> 00:03:07,750
+abnormal relation between the ventilation and air
+
+41
+00:03:07,750 --> 00:03:11,670
+and perfusion يعني في ventilation بس مافيش
+
+42
+00:03:11,670 --> 00:03:14,010
+perfusion كويس أو في perfusion مافيش ventilation
+
+43
+00:03:14,010 --> 00:03:18,730
+كويس أو ال physiological dead space abnormal أو ال
+
+44
+00:03:18,730 --> 00:03:24,210
+physiological شنط abnormal تمام؟ او عندي انا
+
+45
+00:03:24,210 --> 00:03:27,930
+arteriovenous شنط او venous arterial شنط يعني الدم
+
+46
+00:03:27,930 --> 00:03:33,600
+الوريدي بدخل على الدم ال ..الشرياني بغير ما يدخل
+
+47
+00:03:33,600 --> 00:03:38,040
+ال ايه الريقتين فهذا بيقدر الى انه مابيوصلش عنده
+
+48
+00:03:38,040 --> 00:03:41,060
+good oxygenation of the blood لإن نفس ال venous
+
+49
+00:03:41,060 --> 00:03:44,400
+blood بيرجع تاني لل arterial side وهذه أين
+
+50
+00:03:44,400 --> 00:03:50,500
+منلاقيها؟ منلاقيها في ال patent ductus arteriosus
+
+51
+00:03:51,300 --> 00:03:56,140
+احنا عندنا adductors arteriosus موجودة تشتغل أثناء
+
+52
+00:03:56,140 --> 00:03:59,420
+إما نكون إحنا في بطن أمنا، فadductors arteriosus
+
+53
+00:03:59,420 --> 00:04:02,780
+عشان الدم مايروحش الرقاتين، لإن الرقاتين مشتغلوش،
+
+54
+00:04:02,780 --> 00:04:05,580
+الرقاتين لسه معطلين، فالدم بيطلع من palmonary
+
+55
+00:04:05,580 --> 00:04:09,300
+artery على طول للإيه؟ للأورتا، تمام؟ لإن عملية ال
+
+56
+00:04:09,300 --> 00:04:13,280
+oxygenation بتتم عبر ال placenta، عبر الطريق آخر
+
+57
+00:04:13,820 --> 00:04:18,180
+لكن هذه اذا بقت هيك بتعمللي مشكلة مفترض ان ال ..
+
+58
+00:04:18,180 --> 00:04:21,780
+ال .. ال ductus arteriosus هذه بعد الميلاد على طول
+
+59
+00:04:21,780 --> 00:04:24,920
+بيبدأ الضغوط تختلف و يجيل الضغط فيها و تبدأ ايه
+
+60
+00:04:24,920 --> 00:04:29,140
+prostaglandins تجل و يبدأ استينوزس لها و fibrosis
+
+61
+00:04:29,140 --> 00:04:35,480
+لكن بعض الناس بتبقى هذه ال .. ال duct فاتحة فبتقدر
+
+62
+00:04:35,480 --> 00:04:38,020
+إلى ان جزء من الدم بيطلع البلمونري artery على ال
+
+63
+00:04:38,020 --> 00:04:42,100
+lungsأه بيعملون oxygenation وجزء بيرجع مباشرة
+
+64
+00:04:42,100 --> 00:04:46,080
+بالأورطة فبيبقى عندى mixed blood لكنه مش good
+
+65
+00:04:46,080 --> 00:04:50,980
+oxygenated partially oxygenated او inadequate
+
+66
+00:04:50,980 --> 00:04:55,540
+oxygen transport اذا وصلنا احنا طلعنا من ال lungs
+
+67
+00:04:55,540 --> 00:04:59,340
+الان ال transport system نفسه اللى مجلبين ودم مش
+
+68
+00:04:59,340 --> 00:05:03,660
+كده ممكن يكون علا فيه مش قادر ياخد oxygen كافي
+
+69
+00:05:04,420 --> 00:05:08,460
+هيموجلوبين واطي، أنيميا، ممكن تعملي مشكلة أو
+
+70
+00:05:08,460 --> 00:05:10,940
+abnormal hemoglobin، مافيش أنيميا، لكن abnormal
+
+71
+00:05:10,940 --> 00:05:15,440
+hemoglobin مش قادر يمسك أكسجين أو عندي some sort
+
+72
+00:05:15,440 --> 00:05:19,780
+of circulatory shock ال flow rate تبع ال blood،
+
+73
+00:05:19,780 --> 00:05:23,020
+عندي cardiac failure، heart failure، ال flow of
+
+74
+00:05:23,020 --> 00:05:26,740
+the blood in the tissues واطي، فبيقدر إلى أن كمية
+
+75
+00:05:26,740 --> 00:05:30,440
+الأكسجين بتنقل إلى الأنسجا واطية، تستهلك كلها،
+
+76
+00:05:30,440 --> 00:05:34,140
+محتاجين غيرها مينلاقيش، فمتخش في حالة أيش؟ Hypoxia
+
+77
+00:05:37,260 --> 00:05:41,140
+إذا في عندى generalized circulatory deficiency او
+
+78
+00:05:41,140 --> 00:05:45,060
+احنا لما عرفنا هيبوكسيا قولنا ممكن يكون in general
+
+79
+00:05:45,060 --> 00:05:49,280
+اه total body هيبوكسيا او regional طب ما فممكن
+
+80
+00:05:49,280 --> 00:05:53,280
+يكون عندى general circulatory deficiency heart
+
+81
+00:05:53,280 --> 00:05:57,940
+rate او في regional part منطقة فيها ischemia فيها
+
+82
+00:05:57,940 --> 00:06:01,700
+pressure فيها stenosis فيها disease فيها اديمة
+
+83
+00:06:01,700 --> 00:06:04,520
+فيها كذا بتخلي ال blood اللى رايح من المنطقة هذه
+
+84
+00:06:04,520 --> 00:06:08,930
+ايهيعني ال general كويس لكن هذه المنطقة بالذات ال
+
+85
+00:06:08,930 --> 00:06:12,890
+blood supply فيها واطي تمام برضه بتدخلني في
+
+86
+00:06:12,890 --> 00:06:16,910
+regional ischemia اه tissue ischemia for specific
+
+87
+00:06:16,910 --> 00:06:21,530
+organ ال edema in general اي مكان بيصير فيه edema
+
+88
+00:06:21,530 --> 00:06:26,590
+تمام بيصير عندي disturbance في ال ايه في ال blood
+
+89
+00:06:26,590 --> 00:06:33,250
+supply تبعها و بتأديلي الى hypoxia ممكن جدا و نقطة
+
+90
+00:06:33,250 --> 00:06:38,670
+الأخيرةفي الhypoxia انه
+
+91
+00:06:38,670 --> 00:06:42,830
+ال lungs كويسة ال atmosphere كويس و ال lungs كويسة
+
+92
+00:06:42,830 --> 00:06:47,550
+و ال transport system كويس و ال circulatory system
+
+93
+00:06:47,550 --> 00:06:52,410
+كويس لكن عندي انا ال cells نفسها مش قادرة تاخد ال
+
+94
+00:06:52,410 --> 00:06:56,890
+oxygen من ال a من ال interstitial fluid اللي هو و
+
+95
+00:06:56,890 --> 00:07:00,290
+لا ال blood اللي جيها تمام؟ ليش؟ ممكن يكون عندي
+
+96
+00:07:00,290 --> 00:07:04,880
+some sort of poisoningزي ال cyanide poisoning في
+
+97
+00:07:04,880 --> 00:07:07,220
+ال cyanide poisoning ال cytochrome system ال
+
+98
+00:07:07,220 --> 00:07:11,800
+enzymes الموجود لاستخلاص الأكسجين في ال
+
+99
+00:07:11,800 --> 00:07:16,440
+mitochondria من ال tissues عشان استخدامهبيتعطل ال
+
+100
+00:07:16,440 --> 00:07:20,340
+cyanide poisoning تمام فبيبقى عندى hemoglobin
+
+101
+00:07:20,340 --> 00:07:24,280
+مليان oxygen بيخش على ال tissues و بيطلع من غير ما
+
+102
+00:07:24,280 --> 00:07:28,360
+يستهلك تمام لكن ال tissues نفسها في حالة إيش
+
+103
+00:07:28,360 --> 00:07:33,340
+hypoxia لإنه مش جادر تصل ال oxygen هذا لل tissues
+
+104
+00:07:33,340 --> 00:07:37,460
+مش جادر يصل ل ال mitochondria to be used تمام إذا
+
+105
+00:07:37,460 --> 00:07:41,240
+هو ال hypoxia في الآخر نرجع لتعريفها من أول جديد
+
+106
+00:07:41,240 --> 00:07:45,530
+إنه بيقل قدرة الأنسجية لاستخدام ال oxygenهذه تعريف
+
+107
+00:07:45,530 --> 00:07:49,190
+من التعريف هذا لذلك الهيبوكسيا هذه المسألة بتبدأ
+
+108
+00:07:49,190 --> 00:07:53,410
+لما يجيل قدرة الأنسج على استخدام الأكسجين بتبدأ من
+
+109
+00:07:53,410 --> 00:07:57,190
+ال atmospheric oxygen النواطي او انه في عندي
+
+110
+00:07:57,190 --> 00:08:01,490
+paralysis لل cytochrome system بسبب ال poisoning
+
+111
+00:08:01,490 --> 00:08:07,110
+او بسبب some sort of vitamin deficiency او مقد إلى
+
+112
+00:08:07,110 --> 00:08:11,660
+انه ال mitochondrial system of using theما هو ال
+
+113
+00:08:11,660 --> 00:08:15,360
+.. ال respiration في آخر التنفس ايش يعني؟ يعني
+
+114
+00:08:15,360 --> 00:08:19,160
+اننا نوصل لها ال .. لها ال mitochondria oxygen
+
+115
+00:08:19,160 --> 00:08:24,700
+كافي ل ال .. ال cellular respiration cellular اه
+
+116
+00:08:24,700 --> 00:08:28,060
+انه يصل ال oxygen كافي للسلسل و تقدر السلسل
+
+117
+00:08:28,060 --> 00:08:28,520
+تستخدمها
+
+118
+00:08:32,140 --> 00:08:37,680
+Effects of hypoxia هذي مهمة ممكن تسأل طبعا سؤال ال
+
+119
+00:08:37,680 --> 00:08:41,640
+hypoxia هذي إيش ممكن تعمل تمام؟ ال hypoxia ممكن
+
+120
+00:08:41,640 --> 00:08:50,960
+تكون severe hypoxia و تقدر إلىتسارع في عدم
+
+121
+00:08:50,960 --> 00:08:55,140
+قدرة الخلايا على إنتاج طاقة وتبدأ الخلايا تموت
+
+122
+00:08:55,140 --> 00:08:58,600
+واحدة ورا التانية تمام؟ إذا عندك severe hypoxia
+
+123
+00:08:58,600 --> 00:09:02,760
+which can cause death of cells throughout the body
+
+124
+00:09:02,760 --> 00:09:05,760
+ممكن كل ال body أو جزء أو كده إذا صار في عندك
+
+125
+00:09:05,760 --> 00:09:10,920
+hypoxia لدرجة شديدة جريبة من أنوكسيا مثلا في ..
+
+126
+00:09:10,920 --> 00:09:15,800
+بتبدأ ال cells تموت مش هيك؟لو كانت أقل من هيك
+
+127
+00:09:15,800 --> 00:09:20,380
+شوية، hypoxia درجة متوسطة، not severe، less than
+
+128
+00:09:20,380 --> 00:09:23,800
+severe،
+
+129
+00:09:23,800 --> 00:09:28,120
+بنلاحظ احنا انه صار ال oxygen اللي بيصل لل brain
+
+130
+00:09:28,120 --> 00:09:32,280
+مش طبيعي، فبيقدي ال depressed mental activity،
+
+131
+00:09:32,280 --> 00:09:38,380
+بيقدي some time, so culminating إذا كان زاد و طول
+
+132
+00:09:38,380 --> 00:09:42,600
+إلى بيخش في كومة و ممكن يخش في مشاكل أكتر من
+
+133
+00:09:42,600 --> 00:09:49,280
+الكومةكويس؟ اذا على مستوى ال brain ال hypoxia ممكن
+
+134
+00:09:49,280 --> 00:09:55,220
+تدخل واحد في ايه؟ mental disturbance ممكن يخش في
+
+135
+00:09:55,220 --> 00:09:58,460
+mental .. depressed mental activity و ممكن يخش في
+
+136
+00:09:58,460 --> 00:10:04,340
+coma او ممكن يلاحظ غير هيه كمان ان ال physical
+
+137
+00:10:04,340 --> 00:10:08,780
+activities تبعته مش طبيعية لان ال oxygen supply
+
+138
+00:10:08,780 --> 00:10:13,110
+means energy supply مش كده؟ to the musclesلما
+
+139
+00:10:13,110 --> 00:10:16,970
+نحتاج إلى energy أكتر، بنلاقي مش قادرين نحصل
+
+140
+00:10:16,970 --> 00:10:20,150
+عليها، فبنقدر إلى a reduced work capacity of the
+
+141
+00:10:20,150 --> 00:10:25,710
+muscles، تمام؟ بيمشي، بيتعب، مش قادر، تمام؟ و هذه
+
+142
+00:10:25,710 --> 00:10:31,790
+بنشوفها في حاجة اسمها cludication of the ايه؟ of
+
+143
+00:10:31,790 --> 00:10:35,530
+the lower limbs، intermittent cludications، بيمشي
+
+144
+00:10:35,530 --> 00:10:40,530
+شوية، بنلاقي عضلات شداتأبقى بتشدد لإن ال blood
+
+145
+00:10:40,530 --> 00:10:43,150
+supply ل ال muscles جليل فعندي في ال muscles فيه
+
+146
+00:10:43,150 --> 00:10:47,070
+some sort of hypoxia بيستهلك ال oxygen الموجود بده
+
+147
+00:10:47,070 --> 00:10:50,130
+أكتر بيلاقي فالعضلات بتصير في contracture و ألم
+
+148
+00:10:50,130 --> 00:10:54,610
+شديد فبتوقف بيلاقي الألم راح بيمشي كمان شوية بتوقف
+
+149
+00:10:54,750 --> 00:10:58,870
+تمام؟ طبعا دي عملية progressive يعني ممكن أول إيش
+
+150
+00:10:58,870 --> 00:11:02,090
+يصير كلام هذا معاه بعد ما يمشي اتنين كيلو بعد فترة
+
+151
+00:11:02,090 --> 00:11:06,290
+يلاقي حاله نفس القلم صار بس يمشي كيلو بعد فترة صار
+
+152
+00:11:06,290 --> 00:11:09,710
+يمشي متين متر مش قادر يعمل أكتر من هي معناها في
+
+153
+00:11:09,710 --> 00:11:15,770
+عنده انا ايه حالة حالة بتتزايد يوم عن يوم في عدم
+
+154
+00:11:15,770 --> 00:11:20,530
+وصول قدرة وصول oxygen كافي للإيه للأنسجة بسبب انه
+
+155
+00:11:20,530 --> 00:11:24,010
+بأن ال arteries نفسها بيصير فيها ضيق في الحالة
+
+156
+00:11:24,010 --> 00:11:28,170
+اللي بيتكلم عنهاتمام؟ إذا الحالات الهايبوكسيا دي
+
+157
+00:11:28,170 --> 00:11:35,630
+إلها طبعا مخاطر كبيرة زي ما قلنا و هيبوكسيا
+
+158
+00:11:35,630 --> 00:11:40,790
+نعالجها بإن ند اكسجين مش هيك؟ نحل .. نشوف كيف ممكن
+
+159
+00:11:40,790 --> 00:11:43,990
+نعالجها هل ممكن نعالج حالات الهايبوكسيا كلها بإن
+
+160
+00:11:43,990 --> 00:11:50,570
+نعطي اكسجين؟ و معظمها أه معظمها أه لكن هل أنا ممكن
+
+161
+00:11:50,570 --> 00:11:55,530
+أصلح ال cytochrome poisoningالـ cyanide poisoning
+
+162
+00:11:55,530 --> 00:11:58,710
+عن طريق أن يؤدي ال oxygen ما هو ال oxygen كتير، بس
+
+163
+00:11:58,710 --> 00:12:04,390
+هو مش ايه؟ اه، اكويس، اذا من خلال فهمنا احنا لل ..
+
+164
+00:12:04,390 --> 00:12:09,110
+ال cause of hypoxia ممكن نعرف انه ال oxygen
+
+165
+00:12:09,110 --> 00:12:14,890
+therapy مفيد ولا مش مفيد، تمام؟ طيب، مفيد في .. في
+
+166
+00:12:14,890 --> 00:12:21,680
+انه يرفع الحالة هادي ولا لأ؟ ال ..أشكال اللي ممكن
+
+167
+00:12:21,680 --> 00:12:24,280
+نعطي فيها ال oxygen ال أشكال اللي ممكن نعطي فيها
+
+168
+00:12:24,280 --> 00:12:28,060
+oxygen ممكن نعطي oxygen زي اللي بنعمل في الأطفال و
+
+169
+00:12:28,060 --> 00:12:32,420
+بنحطهم في خيمة صغيرة في ال .. على ال city تبعه و
+
+170
+00:12:32,420 --> 00:12:36,240
+بنحط فيها أنبوب و بنفتح ال oxygen بحيث أن ال
+
+171
+00:12:36,240 --> 00:12:39,440
+atmosphere اللي هو بتنفس منه بيصير ال partial
+
+172
+00:12:39,440 --> 00:12:44,140
+pressure of oxygen فيه عالي، تمام؟ فبيقدر إلا أنه
+
+173
+00:12:44,140 --> 00:12:47,580
+لما ال partial pressure يزيد معناه ال oxygenation
+
+174
+00:12:47,580 --> 00:12:55,360
+لل hemoglobin بيزيدأو انا ممكن احط mask زي ما
+
+175
+00:12:55,360 --> 00:13:01,720
+وريتكوا في المرة اللي فاتت في ال CPAP mask ممسوك
+
+176
+00:13:01,720 --> 00:13:05,600
+على الأنف او على الأنف والفم و انا مقدر ادي oxygen
+
+177
+00:13:05,600 --> 00:13:10,620
+منها مباشرة يعني كل اللي انا بديلهيا للعيان تحت
+
+178
+00:13:10,620 --> 00:13:13,600
+تحكمي ممكن اديلهيا under positive pressure و
+
+179
+00:13:13,600 --> 00:13:19,300
+negative pressure اديلهيا بدون pressuresزي عندما
+
+180
+00:13:19,300 --> 00:13:22,080
+يحدث حالة ال anesthesia يكون العيان كله معتمد على
+
+181
+00:13:22,080 --> 00:13:25,560
+إيه؟ على اللي أنا بديله إياه فأنا بتحكم فيه لما هو
+
+182
+00:13:25,560 --> 00:13:30,200
+نائم في غابوبة مش كده؟ under anesthesia هو تحت ال
+
+183
+00:13:30,200 --> 00:13:34,360
+bench أنا بتحكم في ال إيه؟ حتى بحطله اندوتراكيل ال
+
+184
+00:13:34,360 --> 00:13:38,660
+tube جوا خالص مش بس mask على تمه بحط tube في داخل
+
+185
+00:13:38,660 --> 00:13:44,620
+التراكية عشان أنا إيه؟ أتحكم في دخول ال oxygen و
+
+186
+00:13:44,620 --> 00:13:49,820
+نسبة ال oxygen و كدهش أحطأو ممكن انا احط بس nasal
+
+187
+00:13:49,820 --> 00:13:55,740
+tube بعض الناس بحطلهم nasal tube بيبقى جالي من ال
+
+188
+00:13:55,740 --> 00:13:59,660
+noise هنا اللي هو يعني ال tube الى two knobs
+
+189
+00:13:59,660 --> 00:14:05,000
+طالعين كده ملففين على الرأس بحيث التنفس يطلع مباشر
+
+190
+00:14:05,000 --> 00:14:08,780
+يعني مش في tent بس بديله قدام الأنف انا كام ضخم من
+
+191
+00:14:08,780 --> 00:14:11,880
+ال oxygen بحيث لما يصحب oxygen بيبقى التركيز ال
+
+192
+00:14:11,880 --> 00:14:15,600
+oxygen اللي ايه اللي جاي لما اخد نفس التركيز ال
+
+193
+00:14:15,600 --> 00:14:17,540
+oxygen كويس عالي تمام؟
+
+194
+00:14:20,380 --> 00:14:24,060
+طيب، في حالات الـ atmospheric hypoxia، بالقطع إذا
+
+195
+00:14:24,060 --> 00:14:27,820
+ادينا أكسجين، بنصلح الأمر، لو مايكون الأطمسفير مش
+
+196
+00:14:27,820 --> 00:14:34,100
+فيه أكسجين، نحط أكسجين، بتصلح إن hypoventilation،
+
+197
+00:14:34,100 --> 00:14:38,260
+التنفس ضعيف في سبب مشكلة عامة الـhypoventilation،
+
+198
+00:14:38,260 --> 00:14:43,630
+لو أنا زوّدت الأكسجين، البارشة البشر بزيدبنعوض اه
+
+199
+00:14:43,630 --> 00:14:47,250
+مش كده لما اكون عندى hypoventilation انا بقى اعطي
+
+200
+00:14:47,250 --> 00:14:51,370
+برشا pressure اعلى بيصير عندى ال pressure gradient
+
+201
+00:14:51,370 --> 00:14:59,590
+احسن و ال transport of gases افضل مش كده hypoxia
+
+202
+00:14:59,590 --> 00:15:03,030
+caused by impaired alveolar membrane diffusion في
+
+203
+00:15:03,030 --> 00:15:07,770
+بلمونة القديمة في لو قديت انا برشا pressure of
+
+204
+00:15:07,770 --> 00:15:13,240
+oxygen اعلى تمام بيصيرالنسبة ال pressure gradient
+
+205
+00:15:13,240 --> 00:15:17,220
+بين ال alveolar air و ال blood أعلى فتمام فال ..
+
+206
+00:15:17,220 --> 00:15:21,200
+فال .. فال oxygen اللي هيقدر يصل للدم هيكون ايه؟
+
+207
+00:15:21,200 --> 00:15:27,100
+أكبر لإنه أنا ممكن أ .. أدي pure oxygen في الحالة
+
+208
+00:15:27,100 --> 00:15:30,960
+هذه و يصير الفرق عندي alveolar air ستمائة و سبعين
+
+209
+00:15:30,960 --> 00:15:37,850
+لاربعين ال ..الـ Venus مش كده الـ Venus برشا برشا
+
+210
+00:15:37,850 --> 00:15:42,290
+من ال oxygen هكون فيه فرق كبير من ستمية لكذا مش
+
+211
+00:15:42,290 --> 00:15:47,370
+هيك غير ما هو كان مية وأربعة ف .. فممكن انا اذا
+
+212
+00:15:47,370 --> 00:15:54,470
+زوّت البرشا برشا أساعد في ال transport in
+
+213
+00:15:54,470 --> 00:15:58,790
+hypoxia caused by anemia الانيميا .. لو يكون في
+
+214
+00:15:58,790 --> 00:16:05,360
+عندي انيميا ودي انا ..أو abnormal hemoglobin و ادي
+
+215
+00:16:05,360 --> 00:16:09,660
+oxygen therapy مش هديك الفائدة مش هديك الفائدة
+
+216
+00:16:09,660 --> 00:16:14,900
+هزيد انا نطفة عن طريق ال dissolved مش كده لما دي
+
+217
+00:16:14,900 --> 00:16:18,560
+Marshall pressure عالي ال dissolved part بزيد بس
+
+218
+00:16:18,560 --> 00:16:22,020
+كل ال dissolved part كانت ايه شوه؟ جليل مش هيكون
+
+219
+00:16:22,020 --> 00:16:25,920
+كبير فبساعد اشي بسيط بس مش بمساعدة واضحة
+
+220
+00:16:28,310 --> 00:16:32,110
+لما يكون عندي circulatory deficiency ما هي المشكلة
+
+221
+00:16:32,110 --> 00:16:35,010
+عندي أنا مش في ال ventilation كان مشكلتي .. يعني
+
+222
+00:16:35,010 --> 00:16:37,510
+ال hemoglobin حامل .. هو طالع من ال lungs حامل كل
+
+223
+00:16:37,510 --> 00:16:41,710
+إيش كويس لكن لإنه بيمشي بطيء في الأنسجة فبصرف في
+
+224
+00:16:41,710 --> 00:16:45,850
+الطريق أكتر من حمله مش كده؟ فلذلك من هنا بيصير ..
+
+225
+00:16:45,850 --> 00:16:48,290
+فلما يكون عندي shock أو كده مش .. مالهاش فايدة
+
+226
+00:16:48,290 --> 00:16:53,420
+كبيرة ال physiologic shuntمافي مشكلة يعني مابقدرش
+
+227
+00:16:53,420 --> 00:16:55,820
+أساعده بال .. لإن ال oxygen اللي طالع من ال lungs
+
+228
+00:16:55,820 --> 00:16:59,600
+كويس بس اللي بيجيله في الطريق من ال venous side هو
+
+229
+00:16:59,600 --> 00:17:03,460
+اللي بيتغير تمام؟ إذا هدول في حالات بعض الحالات
+
+230
+00:17:03,460 --> 00:17:06,560
+أنا فايدة ال oxygen therapy جليل لكن في بعض
+
+231
+00:17:06,560 --> 00:17:13,720
+الحالات ال oxygen therapy فيهم مفيد مهم كتير طيب
+
+232
+00:17:13,720 --> 00:17:14,560
+إذا ..
+
+233
+00:17:20,410 --> 00:17:24,950
+في أشخاص مختلفة من الهيبوكسيا اللي تسبب في استخدام
+
+234
+00:17:24,950 --> 00:17:28,810
+لإستخدام الهيبوكسيا لإستخدام الهيبوكسيا لإستخدام
+
+235
+00:17:28,810 --> 00:17:30,810
+الهيبوكسيا لإستخدام الهيبوكسيا لإستخدام الهيبوكسيا
+
+236
+00:17:30,810 --> 00:17:33,930
+لإستخدام الهيبوكسيا لإستخدام الهيبوكسيا لإستخدام
+
+237
+00:17:33,930 --> 00:17:39,210
+الهيبوكسيا لإستخدام الهيبوكسيا لإستخدام الهيبوكسيا
+
+238
+00:17:39,210 --> 00:17:45,090
+لإستخدام الهيبوكسيا لإستخدام
+
+239
+00:17:45,870 --> 00:17:48,930
+و الدم بيكون كويس إذا ما فهمنا أنه وين المشكلة
+
+240
+00:17:48,930 --> 00:17:53,490
+بنقدر نقرر هل هنستفيد من ال oxygen therapy و لا لأ
+
+241
+00:17:53,490 --> 00:17:58,030
+cyanosis نقطة تانية اتكلم عنها cyanosis إيش معناه
+
+242
+00:17:58,030 --> 00:18:05,530
+cyanosis بالعربي إذرقاق
+
+243
+00:18:08,030 --> 00:18:10,870
+طيب cyanosis طيب أنا صارت ديون بعرفها بالإنجليزي
+
+244
+00:18:10,870 --> 00:18:14,130
+مابعرفها بالعربي يعني واحد بيصير وشه أزرق لكن
+
+245
+00:18:14,130 --> 00:18:18,830
+إزرقاق خالي جديدة عليها cyanosis means blueness
+
+246
+00:18:18,830 --> 00:18:24,390
+إزرقاق of the skin خاصة في ال mucous membrane
+
+247
+00:18:24,390 --> 00:18:27,930
+بيبين أكتر في ال skin بيبين بس اللي هتطلع على ال
+
+248
+00:18:27,930 --> 00:18:31,110
+mucous membrane عشان كده احنا لما بدنا نشوف و
+
+249
+00:18:31,110 --> 00:18:36,090
+نتأكد منه نجلب شفرة المريض عشان ال mucous membrane
+
+250
+00:18:36,920 --> 00:18:42,480
+ال thickness أرق من الجلد فماقدر أشوف أوضح ال
+
+251
+00:18:42,480 --> 00:18:46,640
+blood vessels اللي تحت اللي تحت ال mucous membrane
+
+252
+00:18:46,640 --> 00:18:50,460
+بوضوح أكتر و أشوف ان في بالفعل ساينوزز ولا او ان
+
+253
+00:18:50,460 --> 00:18:55,580
+اشوف ال sclera ان انازل الجفن و اشوف ال sclera و
+
+254
+00:18:55,580 --> 00:18:58,600
+اشوف ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+255
+00:18:58,600 --> 00:18:58,660
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+256
+00:18:58,660 --> 00:18:58,720
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+257
+00:18:58,720 --> 00:18:59,920
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+258
+00:18:59,920 --> 00:19:00,600
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+259
+00:19:00,600 --> 00:19:01,120
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+260
+00:19:01,120 --> 00:19:01,200
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+261
+00:19:01,200 --> 00:19:03,520
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+262
+00:19:03,670 --> 00:19:09,490
+cyanosis is a blueness of the skin color and its
+
+263
+00:19:09,490 --> 00:19:14,210
+cause is excessive amount سببها اذا ان في عندي
+
+264
+00:19:14,210 --> 00:19:20,390
+deoxygenated hemoglobin اكتر من اللازم فانا باقدي
+
+265
+00:19:20,390 --> 00:19:26,890
+الى الازرقاق هنا طيب وقتش sharp figure وقتش بيبين
+
+266
+00:19:26,890 --> 00:19:29,810
+عندي الcyanosis ووقتش مقدر اقول ان هنا في حالة
+
+267
+00:19:29,810 --> 00:19:34,350
+cyanosis ولا لأ اذا وصل ال hemoglobinاللي هو
+
+268
+00:19:34,350 --> 00:19:39,910
+unoxygenated إلى خمسة جرام فما فوق percent per
+
+269
+00:19:39,910 --> 00:19:43,550
+hundred milliliter بيبدأ ال sinus يبين قبل ما يكون
+
+270
+00:19:43,550 --> 00:19:48,550
+خمسة ما بيبينش تمام؟ إذا ان محتاج أن أكون عند نصف
+
+271
+00:19:48,550 --> 00:19:53,170
+ال hemoglobin unoxygenated hemoglobin بيفوق الخمسة
+
+272
+00:19:53,170 --> 00:19:57,050
+جرام احنا كدهش عندنا في الدم hemoglobin في العادة
+
+273
+00:19:57,050 --> 00:20:03,520
+خمس عشر في الرجال والستات بنقصشوية مش هيكأه فلذلك
+
+274
+00:20:03,520 --> 00:20:13,100
+لو لو عندنا وصل ال 15 دول جزء منهم خمسة خمسة gram
+
+275
+00:20:13,100 --> 00:20:19,300
+per hundred milliliter of blood وصل إلى انه حاملين
+
+276
+00:20:19,300 --> 00:20:22,660
+unoxygenated hemoglobin هذا بيقدر إلى ايه ال
+
+277
+00:20:22,660 --> 00:20:28,380
+cyanosis بيبين الزراعي في الوجهة طيب واحد عنده
+
+278
+00:20:28,380 --> 00:20:31,530
+أنيمياواحد عنده أنيميا يعني ان ال homoglobin اللي
+
+279
+00:20:31,530 --> 00:20:37,670
+عنده ايه جليل صعب جدا يبين عنده ايه cyanosis طبعا
+
+280
+00:20:37,670 --> 00:20:41,990
+حتى لو كان عنده blood unoxygenated جد ما يكون مش
+
+281
+00:20:41,990 --> 00:20:44,930
+هيوصل يكون عنده .. مافيش عنده homoglobin عشان يصل
+
+282
+00:20:44,930 --> 00:20:49,930
+ال unoxygenated لحقله خمسة ايه خمسة gram طبعا اذا
+
+283
+00:20:49,930 --> 00:20:52,350
+في حالات الانيميا صعب ان يكون في عندي حالات
+
+284
+00:20:52,350 --> 00:20:57,760
+cyanosis و في حالات ال polycythemiaبيصير عندى
+
+285
+00:20:57,760 --> 00:21:02,580
+cyanosis وانا فى وضع كويس يعنى مش ان انا مش عندى
+
+286
+00:21:02,580 --> 00:21:07,660
+حالات خطر بشكل عندى ان فى oxygen ناجس وصار عندى
+
+287
+00:21:07,660 --> 00:21:12,560
+cyanosis لإن ال oxygen مش جادر ال homoglobin يحمل
+
+288
+00:21:12,560 --> 00:21:16,740
+oxygen كافي لإن فى مش oxygen لأ فى homoglobin كتير
+
+289
+00:21:16,740 --> 00:21:22,500
+ولإن فى homoglobin كتيرمش محتاجين نحمل Oxygen على
+
+290
+00:21:22,500 --> 00:21:26,120
+كل ال homoglobin لأن ال homoglobin كتير فببقى بشكل
+
+291
+00:21:26,120 --> 00:21:30,900
+طبيعي بيتنفس طبيعي و مش حاسس بأي إشكال تمام إلا
+
+292
+00:21:30,900 --> 00:21:34,580
+إنه عنده حالة ال cyanosis موجودة لإنه لما يكون دمه
+
+293
+00:21:34,580 --> 00:21:41,120
+18-19-20 gram percent تمام فبنلاحظ أنه بدون أي
+
+294
+00:21:41,120 --> 00:21:46,670
+مشاكل في عنده أكتر من 5 gramof deoxygenated blood
+
+295
+00:21:46,670 --> 00:21:50,270
+في ال hundred milliliter تمام؟
+
+296
+00:21:52,750 --> 00:21:57,410
+أى جهد اى مشكلة فورا بيبين عندنا ايه ان في عنده
+
+297
+00:21:57,410 --> 00:22:03,110
+cyanosis اذا ال cyanosis مش مربوط بال oxygen او
+
+298
+00:22:03,110 --> 00:22:06,510
+بال carbon dioxide هو مربوط بانه جداش ال
+
+299
+00:22:06,510 --> 00:22:11,070
+unoxygenated هموجلبيين موجود عندى لما يكتر في
+
+300
+00:22:11,070 --> 00:22:13,830
+الطبيعى طبعا كل ما زاد ال unoxygenated hemoglobin
+
+301
+00:22:13,830 --> 00:22:18,130
+معناه ان ال oxygenجال معناها انا في خطر انه انا
+
+302
+00:22:18,130 --> 00:22:21,890
+داخل في hypoxia مش كده؟ لكن هذه لا تعني ده من
+
+303
+00:22:21,890 --> 00:22:25,790
+hypoxia ال .. ال cyanosis hypoxia لإن بعض الحالات
+
+304
+00:22:25,790 --> 00:22:28,370
+زي ما قلنا لكوا ممكن يكون عندها hypoxia في
+
+305
+00:22:28,370 --> 00:22:31,930
+الانيميا لكن ماصلش cyanosis لإنه مافيش
+
+306
+00:22:31,930 --> 00:22:38,400
+unoxygenated homoglobin مايكفي لإن تظهر الزرقاقأو
+
+307
+00:22:38,400 --> 00:22:43,080
+العكس ممكن واحد يكون عنده polycythemia تمام ومحتاج
+
+308
+00:22:43,080 --> 00:22:45,780
+أي .. مافيش عنده hypoxia إلا إنه عنده cyanosis
+
+309
+00:22:45,780 --> 00:22:48,500
+لأنه عنده homoglobin كتير و ال homoglobin اللي
+
+310
+00:22:48,500 --> 00:22:51,800
+عنده مش كله حامل إكسيجين فعنده أكتر من خمسة جرام
+
+311
+00:22:51,800 --> 00:22:59,820
+فبيبين شكله إيه cyanosis طيب
+
+312
+00:22:59,820 --> 00:23:04,980
+hypercapnia hypercapnia
+
+313
+00:23:04,980 --> 00:23:11,320
+يعنيعندي انا carbon dioxide زيادة فى الدم احيانا
+
+314
+00:23:11,320 --> 00:23:16,420
+بيكون عندى ال hypercapnia مع الhypoxia لما يكون
+
+315
+00:23:16,420 --> 00:23:19,920
+عندى المشكلة فى ال ventilation انا مش جادر اتنفس
+
+316
+00:23:19,920 --> 00:23:26,000
+كويس فنفس ال .. ال .. الوسيلة اللى بتدينى oxygen
+
+317
+00:23:26,000 --> 00:23:29,720
+للدم بتاخد carbon dioxide فإذا أنا اتعطلت
+
+318
+00:23:39,970 --> 00:23:44,650
+هيبركابنيا وهايبوكسيا مع بعض لكن هل دايما هناك
+
+319
+00:23:44,650 --> 00:23:48,710
+ازدواجية او ربط ازدواج ما بين الهايبوكسيا
+
+320
+00:23:48,710 --> 00:23:54,470
+وهايبركابنيا لأ مش دايما تمام تنسوش انه ال
+
+321
+00:23:54,470 --> 00:23:59,170
+diffusion capacity of the carbon dioxide is
+
+322
+00:24:01,040 --> 00:24:04,320
+it's twenty times that of oxygen لذلك ممكن ال
+
+323
+00:24:04,320 --> 00:24:08,060
+oxygen يكون عنده إشكالية في الانتقال لكن لسه ال
+
+324
+00:24:08,060 --> 00:24:12,040
+carbon dioxide يستطيع تمام فممكن أخش في high boxية
+
+325
+00:24:12,040 --> 00:24:18,840
+وماعنديش high مركبنية تمام وممكن إشي تاني إنه ال
+
+326
+00:24:18,840 --> 00:24:22,320
+respiratory center is drive by main by carbon
+
+327
+00:24:22,320 --> 00:24:27,810
+dioxideهلو؟ فطول ما انه ال ventilation rate موجود
+
+328
+00:24:27,810 --> 00:24:31,810
+و يظبط ال carbon dioxide level كويس تمام ممكن
+
+329
+00:24:31,810 --> 00:24:35,250
+الجسم يضال على هيك و مش ماخد باله من ال oxygen انه
+
+330
+00:24:35,250 --> 00:24:38,690
+ايه مش كويس لإن هو بينتبانا مين لل carbon dioxide
+
+331
+00:24:38,690 --> 00:24:42,510
+أكتر فممكن يكون عندي carbon dioxide كويس لكن عندي
+
+332
+00:24:42,510 --> 00:24:47,110
+hypoxia تمام و ممكن يكون عندي carbon hypercapnia
+
+333
+00:24:47,110 --> 00:24:52,680
+لكن مافيش عندي hypoxia في نفس الوجدالهيبركابنية
+
+334
+00:24:52,680 --> 00:24:55,980
+يعني إكساس كربون ديكسيد في المواد الجسمية
+
+335
+00:24:55,980 --> 00:25:01,380
+الهيبركابنية
+
+336
+00:25:01,380 --> 00:25:06,960
+تحدث في الاتصال مع الهيبوكسيا فقط عندما يتسبب
+
+337
+00:25:06,960 --> 00:25:10,480
+الهيبوكسيا بالهيبوفنتلاش أو مفاوضة سيركولاتية
+
+338
+00:25:17,430 --> 00:25:22,270
+و ال circulatory deficiency بعطل الاتنين لإنه صار
+
+339
+00:25:22,270 --> 00:25:30,090
+.. صار ي .. يودي oxygenagain للـ tissues لإنه عندي
+
+340
+00:25:30,090 --> 00:25:33,790
+circulatory deficiency فبيقدي إلى إنه hypoxia وصار
+
+341
+00:25:33,790 --> 00:25:38,770
+بياخد carbon dioxide أكبر
+
+342
+00:25:38,770 --> 00:25:41,550
+من ال tissues لإنها صار عندي كمية كبيرة من carbon
+
+343
+00:25:41,550 --> 00:25:46,210
+dioxide بنحمل لإنه في عندي بطء مش كده فبيبقى عندي
+
+344
+00:25:46,210 --> 00:25:49,430
+hypercapnia وhypoxia في نفس الوجهة، إذاً
+
+345
+00:25:49,430 --> 00:25:53,150
+circulatory deficiencyبتعملى نفس الإشكالي بتعملى
+
+346
+00:25:53,150 --> 00:25:56,690
+hyperventilation hyperventilation بت .. بتدخل
+
+347
+00:25:56,690 --> 00:25:59,470
+أكسجين جليل فبصير hypoxia و بتطلع carbon dioxide
+
+348
+00:25:59,470 --> 00:26:04,750
+جليل فبضل hypercapnia في الأنسجة أنا ال metabolism
+
+349
+00:26:04,750 --> 00:26:09,230
+تبع الأنسجة بنت أكسجين أكتر، مظبوط؟ و بيطلع carbon
+
+350
+00:26:09,230 --> 00:26:13,030
+dioxide فأنا ال .. ال .. البص اللي معدى، البوصة
+
+351
+00:26:13,030 --> 00:26:16,970
+اللي معدى عليهم جاي بقالهم أكسجين جليل، تمام؟ و
+
+352
+00:26:16,970 --> 00:26:19,810
+بتلاقي هنا كمية كبيرة من إيه؟ من carbon dioxide،
+
+353
+00:26:19,810 --> 00:26:24,370
+ليش كمية كبيرة؟لأن ال .. لأن ال flow rate تبع ال
+
+354
+00:26:24,370 --> 00:26:27,970
+blood مش سريع فمش سريع ياخد كل ال carbon dioxide
+
+355
+00:26:27,970 --> 00:26:31,910
+أول بأول فال carbon dioxide بتجمع فبتطلع عندي
+
+356
+00:26:31,910 --> 00:26:37,610
+hypercapnia في الأنسجة و في الدم و في ال .. إذا ال
+
+357
+00:26:37,610 --> 00:26:41,910
+hypercapnia بزيد carbon dioxide concentration في
+
+358
+00:26:41,910 --> 00:26:47,110
+ال tissues و في ال plasmaمرات مع وجود الهيبوكسيا
+
+359
+00:26:47,110 --> 00:26:51,430
+ومرات لا ان هيبوكسيا resulting from poor diffusion
+
+360
+00:26:51,430 --> 00:26:55,050
+through the pulmonary membrane هذه الحالة لما يكون
+
+361
+00:26:55,050 --> 00:26:59,270
+عندى diffusion poor فعملالى هيبوكسيا فالغالب
+
+362
+00:26:59,270 --> 00:27:01,810
+تعملاش hyper carbonية لأن carbon dioxide diffusion
+
+363
+00:27:01,810 --> 00:27:08,050
+capacity ايش اعلى فبيقدر يصير عندى hyper normal
+
+364
+00:27:08,050 --> 00:27:13,390
+carbon dioxide لكن ال oxygen ايه واطيطبعا إذا نكون
+
+365
+00:27:13,390 --> 00:27:16,310
+عندى في ال diffusion capacity of the lungs فيها
+
+366
+00:27:16,310 --> 00:27:22,270
+مشكلة يعني ممكن يصير ال carbon dioxide تتأثر بس
+
+367
+00:27:22,270 --> 00:27:26,570
+بعد مرحلة متقدمة بس في أولها بيكون عندى normal
+
+368
+00:27:26,570 --> 00:27:29,710
+partial pressure of carbon dioxide لكن low partial
+
+369
+00:27:29,710 --> 00:27:32,470
+pressure of oxygen نخش في hypoxia لكن مايكونش عندى
+
+370
+00:27:32,470 --> 00:27:38,790
+إيش hypercapnia if
+
+371
+00:27:38,790 --> 00:27:46,780
+hypercapnia begins to occurهذا يعمل فورًا في مركز
+
+372
+00:27:46,780 --> 00:27:50,280
+الهيبركابنية، يصلح حالة الهيبركابنية، و لا يهتم
+
+373
+00:27:50,280 --> 00:27:54,800
+كثيرًا في حالة حالة الهيبركابنية، و هذا يحسن حالة
+
+374
+00:27:54,800 --> 00:27:58,400
+الهيبركابنية، لكن ليس بالطبع حسنة حالة
+
+375
+00:27:58,400 --> 00:28:00,000
+الهيبركابنية
+
+376
+00:28:05,960 --> 00:28:10,400
+هيبوكسيا تسبب في تغيير الهيبوكسيا تغيير الهيبوكسيا
+
+377
+00:28:10,400 --> 00:28:12,340
+تغيير الهيبوكسيا تغيير الهيبوكسيا تغيير الهيبوكسيا
+
+378
+00:28:12,340 --> 00:28:13,420
+تغيير الهيبوكسيا تغيير الهيبوكسيا تغيير الهيبوكسيا
+
+379
+00:28:13,420 --> 00:28:15,460
+تغيير الهيبوكسيا تغيير الهيبوكسيا تغيير الهيبوكسيا
+
+380
+00:28:15,460 --> 00:28:17,340
+تغيير الهيبوكسيا تغيير الهيبوكسيا تغيير الهيبوكسيا
+
+381
+00:28:17,340 --> 00:28:21,040
+تغيير الهيبوكسيا تغيير الهيبوكسيا تغيير الهيبوكسيا
+
+382
+00:28:24,070 --> 00:28:27,790
+in the circulatory deficiency diminished flow of
+
+383
+00:28:27,790 --> 00:28:30,850
+blood decreases carbon dioxide removal from the
+
+384
+00:28:30,850 --> 00:28:34,790
+tissues فبيزيد ال carbon dioxide و بيقلل oxygen
+
+385
+00:28:34,790 --> 00:28:37,970
+supply فبيكون عندي high box يعني كل الحاجتين
+
+386
+00:28:37,970 --> 00:28:39,470
+الموجودين مع بعض
+
+387
+00:28:42,140 --> 00:28:47,720
+are the effects of hypercapnia على الجسم اتكلمنا
+
+388
+00:28:47,720 --> 00:28:52,600
+على ال oxygen دفيشنس الhypoxia وقلنا عندنا درجتين
+
+389
+00:28:52,600 --> 00:28:55,800
+يا اما severe يا لل severe ال severe ايش بيعملوا
+
+390
+00:28:55,800 --> 00:29:01,940
+لل severe هنا ال hypercapnia خطيرة لحد احنا في
+
+391
+00:29:01,940 --> 00:29:05,860
+الطبيعي ال carbon dioxide برشا برشا بيصل في
+
+392
+00:29:05,860 --> 00:29:11,720
+الطبيعي ل 45 مش كده مليمتر ميركوري مظبوط؟لو وصل
+
+393
+00:29:11,720 --> 00:29:19,540
+لستين لسبعين لخمس وسبعين بنلاقي بس ال effect تبعه
+
+394
+00:29:19,540 --> 00:29:23,680
+انه عامل simulation للاش ل respirator center و
+
+395
+00:29:23,680 --> 00:29:29,980
+بدخل الواحد في عملية ايش؟ dyspnea deep rapid
+
+396
+00:29:29,980 --> 00:29:34,400
+respiration هذه حالة ايه؟ ال dyspneastimulation of
+
+397
+00:29:34,400 --> 00:29:37,700
+the respiratory center عشان يحاول ينزل ال carbon
+
+398
+00:29:37,700 --> 00:29:42,320
+dioxide by extra ventilation مش كده؟ طيب إذا لو
+
+399
+00:29:42,320 --> 00:29:44,580
+منقل الفيولر partial pressure of carbon dioxide
+
+400
+00:29:44,580 --> 00:29:49,220
+rises above sixty to seventy five millimeter
+
+401
+00:29:49,220 --> 00:29:55,000
+mercury بيعمللي حالة ديسنيا breathing rapidly and
+
+402
+00:29:55,000 --> 00:30:04,150
+deeply ديسني او air hunger the same حس انهلو زادت
+
+403
+00:30:04,150 --> 00:30:08,830
+ال carbon dioxide عن ال 80 millimeter mercury ل
+
+404
+00:30:08,830 --> 00:30:12,610
+100 millimeter mercury بيبدأ بدي الميسير يعمل
+
+405
+00:30:12,610 --> 00:30:15,250
+stimulation ل ال respiratory center يعمل
+
+406
+00:30:15,250 --> 00:30:18,770
+suppression ل ال respiratory center تمام؟ هو لما
+
+407
+00:30:18,770 --> 00:30:21,530
+عمل stimulation ل ال respiratory center عمل
+
+408
+00:30:21,530 --> 00:30:24,930
+hyperventilation وعمل wash لمين؟ للكربون دايكسايد
+
+409
+00:30:24,930 --> 00:30:29,530
+لكن لما يبدأ يعمل suppression ل ال respiratory
+
+410
+00:30:29,530 --> 00:30:34,710
+center فانا بيدخلني في vicious circleال .. ال
+
+411
+00:30:34,710 --> 00:30:37,210
+sublation لل .. لل .. لل center لإنه carbon
+
+412
+00:30:37,210 --> 00:30:40,910
+dioxide زاد بسبب ان ال center بده depressed فانا
+
+413
+00:30:40,910 --> 00:30:45,210
+بقدّي less ventilation و more carbon dioxide
+
+414
+00:30:45,210 --> 00:30:48,670
+accumulation اه و more depression و more
+
+415
+00:30:48,670 --> 00:30:50,590
+accumulation و more depression و more accumulation
+
+416
+00:30:50,590 --> 00:30:54,150
+مافيش ال circle تنتهي بالإيه؟ بإنه يرتفع ارتفاع
+
+417
+00:30:54,150 --> 00:30:58,290
+شديد تمام؟لذن في الحالة هاذا person becomes
+
+418
+00:30:58,290 --> 00:31:03,070
+lethargic and sometimes even semi-comatosed لما
+
+419
+00:31:03,070 --> 00:31:07,030
+يعلى عن ل 100 millimeter mercury بيبدأ ايه؟ يخش في
+
+420
+00:31:07,030 --> 00:31:11,390
+ايه؟ نفس ال toxicity تبع ال carbon dioxide مش مركز
+
+421
+00:31:11,390 --> 00:31:14,130
+lethargic مش قادر يجوم ولا يتحرك وانا اه و semi
+
+422
+00:31:14,130 --> 00:31:18,890
+-comatosed when the carbon dioxide rises ل 120 ل
+
+423
+00:31:18,890 --> 00:31:23,830
+150 coma and death can result تمام؟ coma and death
+
+424
+00:31:23,830 --> 00:31:31,490
+can resultهذه التسلسل قلت لكم انا عندي as the at
+
+425
+00:31:31,490 --> 00:31:34,310
+these higher levels of carbon dioxide برشا
+
+426
+00:31:34,310 --> 00:31:37,790
+pressure more than eighty يعني من تمانين فما فوق
+
+427
+00:31:37,790 --> 00:31:41,390
+بيبدو يعمل suppression و ال suppression هذا بيزود
+
+428
+00:31:41,390 --> 00:31:44,130
+ال carbon dioxide و ال carbon dioxide بيزود ال
+
+429
+00:31:44,130 --> 00:31:45,630
+suppression و ال suppression بيزود ال carbon
+
+430
+00:31:45,630 --> 00:31:48,510
+dioxide بيبقى اعلى اعلى اعلى اعلى اعلى مافقش في ال
+
+431
+00:31:48,510 --> 00:31:51,270
+ايه التسلسل اللي قلنا عليه اولها lethargic
+
+432
+00:32:01,850 --> 00:32:08,270
+وهي تنتهي بالتحرير تماما من مركز التحرير والموت
+
+433
+00:32:08,270 --> 00:32:15,350
+.هذه أعلى مستوى الكربون ديوكسيد، الكربون ديوكسيد
+
+434
+00:32:15,350 --> 00:32:19,710
+المتوفر الآن يبدأ في تحريك التحرير بدلا من تحريكه.
+
+435
+00:32:20,860 --> 00:32:24,440
+thus causing the vicious circle more carbon
+
+436
+00:32:24,440 --> 00:32:27,720
+dioxide بديني further decrease in respiration
+
+437
+00:32:27,720 --> 00:32:31,080
+which giving more carbon dioxide and more
+
+438
+00:32:31,080 --> 00:32:38,400
+suppression of respiration او more carbon ديسنيا
+
+439
+00:32:38,400 --> 00:32:47,080
+ديسنيا طبعا بيه silent ديسنيا means mental status
+
+440
+00:32:49,130 --> 00:32:54,770
+distress mental awareness associated with
+
+441
+00:32:54,770 --> 00:32:58,330
+inability to ventilate enough to satisfy the
+
+442
+00:32:58,330 --> 00:33:04,890
+demand for air عنده إحساس بإنه النفس سبعه مش مكفيه
+
+443
+00:33:04,890 --> 00:33:08,130
+له air
+
+444
+00:33:08,130 --> 00:33:12,230
+hunger أو دسنية حالة من الفزع عند الإنسان
+
+445
+00:33:15,120 --> 00:33:20,340
+مصاحبة لإحساسه بعدم القدرة على إنه يحصل على إكسجين
+
+446
+00:33:20,340 --> 00:33:24,960
+كافي أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء
+
+447
+00:33:24,960 --> 00:33:25,680
+أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء
+
+448
+00:33:25,680 --> 00:33:27,180
+أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء
+
+449
+00:33:27,180 --> 00:33:27,380
+أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء
+
+450
+00:33:27,380 --> 00:33:32,080
+أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء
+
+451
+00:33:32,080 --> 00:33:36,540
+أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء أعضاء
+
+452
+00:33:36,540 --> 00:33:39,660
+أعضاء أ
+
+453
+00:33:42,520 --> 00:33:45,600
+abnormality of respiratory gases in the body
+
+454
+00:33:45,600 --> 00:33:49,980
+fluids especially hypercapnia and to a much less
+
+455
+00:33:49,980 --> 00:33:54,140
+extent hypoxia إذا مجدش بيصير عندي أنا hypercapnia
+
+456
+00:33:54,140 --> 00:33:58,580
+بيصير عندي hyperventilation وقولنا لو طولت هذه مدة
+
+457
+00:33:58,580 --> 00:34:03,540
+طويلة بيصير hypoxia إلها ال upper hand ف to less
+
+458
+00:34:03,540 --> 00:34:06,840
+degree الhypoxia لو كانت موجودة بتحسسني بال
+
+459
+00:34:06,840 --> 00:34:11,320
+hyperventilationوالإحساس بأنه أنا محتاج إلى ايه
+
+460
+00:34:11,320 --> 00:34:15,420
+more oxygen ومحتاج انه حاسس انه ال oxygen اللي في
+
+461
+00:34:15,420 --> 00:34:19,700
+داخلي مش طبيعي فانا بده مش شابعان oxygen مش قادر
+
+462
+00:34:19,700 --> 00:34:26,360
+ايه اشمع oxygen هذه ايه واحدة اتنين the work of
+
+463
+00:34:26,360 --> 00:34:31,180
+the muscles انت ال the amount of work that must be
+
+464
+00:34:31,180 --> 00:34:34,960
+performed by the respiratory muscles to provide
+
+465
+00:34:34,960 --> 00:34:40,200
+the hyperventilationعندي إحساس من خلال الـ carbon
+
+466
+00:34:40,200 --> 00:34:45,560
+dioxide و ال oxygen levels بالدسنياالاتنين انا مش
+
+467
+00:34:45,560 --> 00:34:48,680
+شغل العضلات العضلات تبعتي هذه اذا عندها القدرة
+
+468
+00:34:48,680 --> 00:34:53,020
+الكافية انها تعمل hyperventilation بكون انا ايه
+
+469
+00:34:53,020 --> 00:34:58,120
+مرتاح ومش جالجان كتير لكن لما بعد شوية الاجي ان
+
+470
+00:34:58,120 --> 00:35:01,460
+المدة طولت وصار عضلاتي تعبانة مش زي ما يقولنا في
+
+471
+00:35:01,460 --> 00:35:05,200
+الأطفال الصغار بيخش في distress hyperventilation
+
+472
+00:35:05,200 --> 00:35:10,720
+بعد شوية بيصير اندوماطس الفتيج ويبطل يعمل ال .. ال
+
+473
+00:35:10,720 --> 00:35:14,890
+.. ال .. ال muscular work اللازمللفنتلايشن
+
+474
+00:35:14,890 --> 00:35:19,330
+الهيبرفنتلايشن تقدي للديث تمام؟ اذا the amount of
+
+475
+00:35:19,330 --> 00:35:23,050
+work that must be performed by the respiratory
+
+476
+00:35:23,050 --> 00:35:28,770
+muscles to provide adequate ventilation اذا
+
+477
+00:35:28,770 --> 00:35:36,160
+اذا كان في عندك كمية جهود كافي اوجهد كبير بدياه
+
+478
+00:35:36,160 --> 00:35:42,260
+بحس انه بحس انه جدش انا متضايق جدش انا في .. في
+
+479
+00:35:42,260 --> 00:35:51,520
+وضع Disney State of the mind اه يعني مطمئن مش
+
+480
+00:35:51,520 --> 00:35:56,680
+مطمئن بتديني الاحساس انه جدش انا عندي ال Disney
+
+481
+00:35:56,680 --> 00:36:02,910
+هذهالشخص يصبح مغضبًا جدًا خصوصًا من إكساس تبني
+
+482
+00:36:02,910 --> 00:36:07,390
+الكربون ديكسيد في مواد الجسم تمام؟ لأن الكربون
+
+483
+00:36:07,390 --> 00:36:10,790
+ديكسيد هو الأيش؟ هو الأساسي اللي بيعمل ليه؟
+
+484
+00:36:10,790 --> 00:36:13,950
+Simulation و Ventilation و بحسسني بأن أنا محتاج
+
+485
+00:36:13,950 --> 00:36:21,450
+إكسيجن أكتر at times
+
+486
+00:36:23,110 --> 00:36:28,430
+لدينا كلا مستوى من الكربونيوكسيد و اكسجون عادي
+
+487
+00:36:28,430 --> 00:36:31,150
+عادي عادي عادي عادي عادي عادي عادي عادي عادي عادي
+
+488
+00:36:31,150 --> 00:36:31,310
+عادي عادي عادي عادي عادي عادي عادي عادي عادي عادي
+
+489
+00:36:31,310 --> 00:36:33,090
+عادي عادي عادي عادي عادي عادي عادي عادي عادي عادي
+
+490
+00:36:33,090 --> 00:36:36,770
+عادي عادي عادي عادي عادي عادي عادي عادي عادي عادي
+
+491
+00:36:36,770 --> 00:36:37,090
+عادي عادي عادي عادي عادي عادي عادي عادي عادي عادي
+
+492
+00:36:37,090 --> 00:36:51,510
+عادي عادي عادي عادي عادي عا
+
+493
+00:36:51,770 --> 00:36:55,650
+gives the person a sensation of Disney يعني بمجهود
+
+494
+00:36:55,650 --> 00:36:59,950
+كبير بيعمل فبيحس ان هو Disney لأنه ايه عشان يصير
+
+495
+00:36:59,950 --> 00:37:05,590
+طبيعي لازم ياخد نفس كبيرfinally the person's
+
+496
+00:37:05,590 --> 00:37:09,470
+respiratory functions may be normal and still
+
+497
+00:37:09,470 --> 00:37:13,910
+dyspnea may be expired, experienced because of an
+
+498
+00:37:13,910 --> 00:37:16,590
+abnormal state of the mind احنا في عندنا حاجات
+
+499
+00:37:16,590 --> 00:37:21,830
+بيسميها neurogenic او psychic او psychogenic،
+
+500
+00:37:21,830 --> 00:37:26,670
+dyspnea و هذه بيلاقيها كتير و خاصة في البناتطبعا
+
+501
+00:37:26,670 --> 00:37:31,530
+عند اي توتر معين بتحس البنت انه ايه او حتى الشاب
+
+502
+00:37:31,530 --> 00:37:37,350
+يعني بس بتكون اكتر في ال female انه النافس سابعه
+
+503
+00:37:37,350 --> 00:37:42,490
+طبعها مش مرتاحة مش مكفيها اه فبتشكي و هتروحوا كتير
+
+504
+00:37:42,490 --> 00:37:46,510
+انتوا تشوفوا عينات او يجوكوا على العيادة انه مش
+
+505
+00:37:46,510 --> 00:37:50,230
+جاهز تنفس طبعا مافيش اي علامة او داعي لان علم
+
+506
+00:37:50,230 --> 00:37:57,160
+التنفسلكن عند هذا الإحساس مش جالس تتنفس هي أحيانا
+
+507
+00:37:57,160 --> 00:38:01,850
+بتفقد القدرة على ال deep ventilationللآخر بتقدرش
+
+508
+00:38:01,850 --> 00:38:04,870
+تصلوا تحت psychic أو psychological conditions
+
+509
+00:38:04,870 --> 00:38:07,190
+فبتحس حالة طول من أنها مش قادرة تاخد ال deep
+
+510
+00:38:07,190 --> 00:38:11,770
+ventilation تتعبي صدرها منه تمام فتحس أنها راح
+
+511
+00:38:11,770 --> 00:38:16,090
+تنخنك لأنه مش قادر تاخد ال deep breath فبتظل هذه
+
+512
+00:38:16,090 --> 00:38:18,690
+مشكلة كبيرة هتشوفوها انتوا يعني في عندي نوع من ال
+
+513
+00:38:18,690 --> 00:38:21,650
+dyspnea اسمها ايه؟ Psychogenic او Neurogenic او
+
+514
+00:38:21,650 --> 00:38:25,130
+Psychic dyspnea او Emotional dyspnea بيصير أي
+
+515
+00:38:25,130 --> 00:38:31,050
+مبتحانات تمام او لما يصير اي إشكاليعني في
+
+516
+00:38:31,050 --> 00:38:39,410
+psychological pressure ليؤدي إلى ايه؟
+
+517
+00:38:39,410 --> 00:38:42,610
+إلى المسألة هذه و هتشوفوها كتير Artificial
+
+518
+00:38:42,610 --> 00:38:48,190
+Respiration يعني احنا الآن خلصنا من التلات تعريفات
+
+519
+00:38:48,190 --> 00:38:51,870
+اللي اتكلمنا عنها او الأربعة، تلات او الأربعة
+
+520
+00:38:51,870 --> 00:38:57,130
+Hypoxia و Hypercapnia و Dyspnea، تلاتة، تمام؟الان
+
+521
+00:38:57,130 --> 00:39:00,370
+لما احنا بنحتاج الى ان نعمل artificial respiration
+
+522
+00:39:00,370 --> 00:39:04,370
+و نقول لنا عندنا تلت اربع أنواع of oxygen therapy
+
+523
+00:39:04,370 --> 00:39:08,830
+مش هيك احيانا احنا بدنا نقوم بعمل ال respiration
+
+524
+00:39:08,830 --> 00:39:13,850
+نفسنا مش ال oxygen therapy تمام العيان عنده
+
+525
+00:39:13,850 --> 00:39:19,090
+كوماتوز او under anesthesia و انا بدنا اعمل ايه
+
+526
+00:39:19,090 --> 00:39:23,030
+انا اعوض التنفس هذا مش كده في عندنا what is called
+
+527
+00:39:23,030 --> 00:39:28,000
+ventilatorاليوم بنسميه ventilator احنا تمام اللي
+
+528
+00:39:28,000 --> 00:39:31,200
+بنستخدمه في الانسيزيا او في ال intensive care
+
+529
+00:39:31,200 --> 00:39:36,820
+units تمام بحيث بنحط اندو تركيا tube وهذا بياخد
+
+530
+00:39:36,820 --> 00:39:41,320
+oxygen supply و عنده القدرة على انه يعمل positive
+
+531
+00:39:41,320 --> 00:39:46,740
+pressure بيعمل inflation of the lungsهو بيعمل ..
+
+532
+00:39:46,740 --> 00:39:51,240
+بيضيع ال positive pressure فال chest ممكن يعمل ايه
+
+533
+00:39:51,240 --> 00:39:54,260
+بس مانعتملش عليها فبنروح و بنعمل كمان negative
+
+534
+00:39:54,260 --> 00:39:56,960
+pressure يعني في positive pressure level معين
+
+535
+00:39:56,960 --> 00:40:00,940
+بنوصله بدخل ال air و بنعمل شفط negative pressure
+
+536
+00:40:00,940 --> 00:40:05,300
+بيصحى بالهوى فمحسوبة بحيث انه يعني ال positive
+
+537
+00:40:05,300 --> 00:40:08,260
+pressure ماتفجرش الرقتين و ال negative pressure
+
+538
+00:40:08,260 --> 00:40:13,570
+مايشفطهمش ايهبرا تمام محسوب بقى بطريقة معينة بنعمل
+
+539
+00:40:13,570 --> 00:40:19,010
+positive pressure plus five
+
+540
+00:40:19,010 --> 00:40:22,490
+plus five positive pressure و بنعمل negative
+
+541
+00:40:22,490 --> 00:40:26,750
+pressure plus minus ten to twelve فبيبقى ايه ال
+
+542
+00:40:26,750 --> 00:40:33,350
+ventilatorبطلع و بنزل بيعمل pulse pressure five و
+
+543
+00:40:33,350 --> 00:40:37,030
+negative pressure عشر او اتناشر و بعدين طبعا مدة
+
+544
+00:40:37,030 --> 00:40:42,380
+كافية بيحس انه يشبه ال normal breathingبحيث تديني
+
+545
+00:40:42,380 --> 00:40:46,600
+في الآخر هذا الحساب المعمولة تديني ايه؟ oxygen
+
+546
+00:40:46,600 --> 00:40:50,360
+supply و removal of carbon dioxide بطريقة عادية
+
+547
+00:40:50,360 --> 00:40:56,300
+طبعا الدكتور بالاضافة لهيك عنده oximeter دكتور ال
+
+548
+00:40:56,300 --> 00:41:01,370
+بنج و عنده ال monitorبوضح ال oxygen level جديش و
+
+549
+00:41:01,370 --> 00:41:03,450
+ال carbon dioxide level جديش و ال heart rate جديش
+
+550
+00:41:03,450 --> 00:41:07,490
+بيحس الطمأن انه ال ventilator شغال صح ولا لأ لو
+
+551
+00:41:07,490 --> 00:41:10,830
+صار اي لحبطة او زيادة او نقصة بيلاحظ على طول و
+
+552
+00:41:10,830 --> 00:41:15,010
+بيظبط ال ventilator زي ما هو عايز واضح؟ ال
+
+553
+00:41:15,010 --> 00:41:18,590
+ventilator اليوم عملية متطورة جدا لكن اساسها
+
+554
+00:41:18,590 --> 00:41:23,960
+الجهاز هذاعشان اسأل الجهاز هذا انه عندي انا oxygen
+
+555
+00:41:23,960 --> 00:41:28,720
+source وعندي machine تعملي positive و negative
+
+556
+00:41:28,720 --> 00:41:32,740
+pressure تمام وعندي هذه mask او وندو تراكرة تيوب
+
+557
+00:41:32,740 --> 00:41:42,400
+او او او تمام طبعا احنا لو نتطلع على يعني هذا خلق
+
+558
+00:41:42,400 --> 00:41:46,360
+الله فاروني ماذا خلق الذين من دونه نتطلع على احنا
+
+559
+00:41:46,360 --> 00:41:51,960
+كيف نتنفسالصدر عندنا الريقتين الصدر بيزيد
+
+560
+00:41:51,960 --> 00:41:55,500
+فالريقتين بتتوسع احنا عاملين negative pressure من
+
+561
+00:41:55,500 --> 00:41:59,860
+الخارج في ال plural مش كده inter plural pressure
+
+562
+00:41:59,860 --> 00:42:02,560
+يعني برا الريقتين هو بيزيد ال negative pressure
+
+563
+00:42:02,560 --> 00:42:06,940
+فبفرد الريقتين بدخل الهواء مش هيك لما بيدخل الهواء
+
+564
+00:42:06,940 --> 00:42:12,100
+كمان بدخل الدم للصدر يعني واحد من العوامل الرئيسية
+
+565
+00:42:12,100 --> 00:42:15,800
+لل Venus return للجلبعملية ال negative pressure
+
+566
+00:42:15,800 --> 00:42:18,120
+اللي بيصير في الصدر عشان كده الجلب موجود بين
+
+567
+00:42:18,120 --> 00:42:21,200
+الرياتين في الصدر عشان ال negative pressure اللي
+
+568
+00:42:21,200 --> 00:42:24,500
+بتكون في البلورة تمام في ال chest cage هذا بيصير
+
+569
+00:42:24,500 --> 00:42:28,160
+فيه negative pressure مش بس بيسحب هوا من هان كمان
+
+570
+00:42:28,160 --> 00:42:31,800
+بيسحب دم من هان و من هان تمام؟ بيصير عندك negative
+
+571
+00:42:31,800 --> 00:42:37,960
+pressure جوة فالدم بيندفع من ال upper half of the
+
+572
+00:42:37,960 --> 00:42:44,350
+body من ال head and neck بيندفع إلى ايه؟اه طب هو
+
+573
+00:42:44,350 --> 00:42:47,990
+بندفع by gravity، طب لو كنا نايمين، بيندفع إلى الـ
+
+574
+00:42:48,420 --> 00:42:51,140
+وبيندافع من ال lower half واحد الأهم لإنه و احنا
+
+575
+00:42:51,140 --> 00:42:54,400
+واقفين ال upper half سهل لكن ال lower half ال
+
+576
+00:42:54,400 --> 00:42:56,840
+Venus الاتنين هذا لما يصير عندى negative pressure
+
+577
+00:42:56,840 --> 00:43:02,840
+الدم بيندافع وهي السبب الرئيسي فإن الدم بيرجع
+
+578
+00:43:02,840 --> 00:43:06,900
+للجلب انه عندى negative pressure حوالين مين؟
+
+579
+00:43:06,900 --> 00:43:09,900
+حوالين الجلب بيأدى إلى ان ال Venus كيفة هادى بيصير
+
+580
+00:43:09,900 --> 00:43:14,080
+عليها negative pressure فبتتوسع كده فبيندافع الدم
+
+581
+00:43:14,080 --> 00:43:20,970
+إلها مش كده فالصدرمتفصل بطريقة تمام فانا لما ادى
+
+582
+00:43:20,970 --> 00:43:23,390
+positive pressure عندى ال positive pressure فى
+
+583
+00:43:23,390 --> 00:43:27,350
+داخل الرئتين عشان يدخل الهواء فى حين انه بالطبيعى
+
+584
+00:43:27,350 --> 00:43:30,150
+انا بعمل negative pressure برا عشان يدخل الهواء
+
+585
+00:43:30,150 --> 00:43:33,930
+لكن احنا بنعمل positive pressure جوا فال positive
+
+586
+00:43:33,930 --> 00:43:36,550
+pressure اللى فى داخل الرئتين بيقدى انه يزيد ال
+
+587
+00:43:36,550 --> 00:43:40,070
+pressure ويمنع الفيروس لتان فى حين ان التنافس
+
+588
+00:43:40,070 --> 00:43:44,260
+الطبيعى تبعىبساعد ال Venus Retain يدخل، مش هيك؟
+
+589
+00:43:44,260 --> 00:43:47,620
+فلذلك هنا حسبة ال positive pressure كتير مهمة لإن
+
+590
+00:43:47,620 --> 00:43:52,380
+أنا لو زادت ال positive pressure و في أسلحة التنفس
+
+591
+00:43:52,380 --> 00:43:57,120
+بأمنع ال Venus Retain لدرجة بيصير عندي الدم مش
+
+592
+00:43:57,120 --> 00:44:01,660
+كافي يرجع للجلب، تمام؟ فبعملها بطريقة لا يموت الدي
+
+593
+00:44:01,660 --> 00:44:04,580
+ولا ايه ولا تفنى الغنم، ان أدي positive pressure
+
+594
+00:44:04,580 --> 00:44:08,770
+بسيط لمدة قصيرة، تمام؟ عشان ندي فرصة للإيهللـ
+
+595
+00:44:08,770 --> 00:44:15,490
+negative pressure انه يرجع القلعتين هنا في ال
+
+596
+00:44:15,490 --> 00:44:22,190
+resuscitator هذا او respirator هذا resuscitator
+
+597
+00:44:22,190 --> 00:44:25,390
+اللي هم نقوله الآن ventilator احنا او ال
+
+598
+00:44:25,390 --> 00:44:28,850
+anesthesia machine تبقى معاها يعني مش بس بتدخل
+
+599
+00:44:28,850 --> 00:44:33,090
+أكسجين، بتدخل أكسجين و كمان anesthesia gasتمام
+
+600
+00:44:33,090 --> 00:44:36,410
+عشان ندخل ايه؟ ندخله في .. في .. في .. في تبنيج
+
+601
+00:44:36,410 --> 00:44:41,410
+anesthesia machine تبقى مع ventilator اه؟ يعني
+
+602
+00:44:41,410 --> 00:44:45,570
+ventilator و anesthesia machine لكن اللي في ال ICU
+
+603
+00:44:45,570 --> 00:44:49,950
+بس ventilator مانحط ركبش عليها ايه؟ مواد تنايم
+
+604
+00:44:49,950 --> 00:44:54,350
+العيال أو ممكن نديله injections عشان نظل نايم لإنه
+
+605
+00:44:54,350 --> 00:44:58,390
+ماقدرش أنا أحط ال tube و يظل صاحي إذا بدى يصحى
+
+606
+00:44:58,390 --> 00:45:02,860
+بيصير .. في إيش في صدره بيصير خابط بده يرفعهاإلا
+
+607
+00:45:02,860 --> 00:45:06,220
+إن الـ Irritating التيوب في داخل التراكية مش عملية
+
+608
+00:45:06,220 --> 00:45:09,940
+سهلة، ماقدرش أحطها أنا إلا يكون العيان إيش، نام.
+
+609
+00:45:10,520 --> 00:45:13,680
+مثلًا كأما إحنا بتبنج العيان، أول شي بنديله يا إما
+
+610
+00:45:13,680 --> 00:45:19,500
+شم، بنديله شم، شم ال .. ال بنج، بنام من الشم، على
+
+611
+00:45:19,500 --> 00:45:23,720
+طول بدخل التيوب و بشبك الجهاز يظل واصل للبنج، يا
+
+612
+00:45:23,720 --> 00:45:28,420
+إما بعطيله بالوريد، حجم البنج، بنام بركّب ال إيه؟
+
+613
+00:45:28,420 --> 00:45:32,670
+ال endotracheal التيوبماقدرش البني آدم يتحمل
+
+614
+00:45:32,670 --> 00:45:36,370
+endotracheal tube و هو صاحي، تمام؟ إذا دائما ال
+
+615
+00:45:36,370 --> 00:45:39,490
+ventilator هذا إذا بدنا نحط endotracheal tube لازم
+
+616
+00:45:39,490 --> 00:45:45,750
+يكون معاه anesthesia إذا حطينا mask تمام؟ محتاجش
+
+617
+00:45:45,750 --> 00:45:53,250
+إلى anesthesia لكن ال mask ال mask بدها واحد بتنفس
+
+618
+00:45:53,250 --> 00:45:57,030
+طبيعيتمام؟ لكن انا اذا حاططه بنجو و متنفس صبيعي
+
+619
+00:45:57,030 --> 00:46:00,290
+خبد انا ايه؟ ا .. ا .. ا .. ا .. ادخل هوا و اطلع
+
+620
+00:46:00,290 --> 00:46:03,330
+هوا لأنه هيصير subversion لمين؟ ل ال respirator
+
+621
+00:46:03,330 --> 00:46:06,050
+center ال anesthesia بتعمل subversion ل ال
+
+622
+00:46:06,050 --> 00:46:09,110
+respirator center فلذلك احنا بنتكلم عن positive
+
+623
+00:46:09,110 --> 00:46:13,590
+pressure و negative pressure عشان نعوض مين؟ عشان
+
+624
+00:46:13,590 --> 00:46:16,810
+ال rhythm تبع ال inspiration و ال expiration احنا
+
+625
+00:46:16,810 --> 00:46:19,190
+نشتغله بإيدنا لأن ال anesthesia بتعمل subversion
+
+626
+00:46:19,190 --> 00:46:26,470
+لمين؟هو باسم Retrocenter، فلذلك عندنا يعني .. يعني
+
+627
+00:46:26,470 --> 00:46:31,650
+اليوم في ال ventilator زي المسائل المتطورة و ..
+
+628
+00:46:33,140 --> 00:46:36,100
+بنستخدمها في ال ICU في حالات ال brain trauma و
+
+629
+00:46:36,100 --> 00:46:39,960
+حالات ال separation of respiration حالات العيان
+
+630
+00:46:39,960 --> 00:46:46,460
+اللي هو ايه comatose بقى انا بركبله ايه ال IGZ
+
+631
+00:46:46,460 --> 00:46:50,460
+هادي عشان نحافظ على ال respiration طبيعي ماشي؟
+
+632
+00:46:51,600 --> 00:46:57,340
+التانك ال respirator هذا بيعتمد على أنه بيلبس
+
+633
+00:46:57,340 --> 00:47:01,960
+الواحد في صدره، في رجبته أو تحت أبعته أو المهم
+
+634
+00:47:01,960 --> 00:47:07,460
+بشكل ما ال diaphragm جلد بيبقى ملزق عالي مظموط
+
+635
+00:47:07,460 --> 00:47:11,540
+تمام؟ وهذا الجهة التانية من ال tank فيها diaphragm
+
+636
+00:47:13,020 --> 00:47:16,280
+الـ diaphragm أنا بتحرك هيك و بتحرك هيك، اللي
+
+637
+00:47:16,280 --> 00:47:19,120
+بتحرك لبرة بيعمل negative pressure تمام؟ لما يعمل
+
+638
+00:47:19,120 --> 00:47:21,120
+negative pressure، ال negative pressure بيصير
+
+639
+00:47:21,120 --> 00:47:26,920
+للكل، لكل الجسم و من ضمنهم الصدر فبيدخل الهواء
+
+640
+00:47:27,770 --> 00:47:32,010
+تمام؟ بيرجع positive pressure بترد الهواء يعني إلى
+
+641
+00:47:32,010 --> 00:47:35,430
+حد ما أشبه بمين يعني عاملين negative pressure من
+
+642
+00:47:35,430 --> 00:47:38,210
+برا مش عاملين positive pressure عشان نخل الهواء
+
+643
+00:47:38,210 --> 00:47:41,090
+يدخل ال positive pressure هل منعود فيه مثل تلاقاش
+
+644
+00:47:41,090 --> 00:47:44,810
+أن ال positive pressure و ال virus تاني تقاسلهم؟
+
+645
+00:47:44,810 --> 00:47:47,920
+أه بس قصة كبيرة يمكن نستخدمها اليوماندخله في تانك
+
+646
+00:47:47,920 --> 00:47:51,300
+و ن .. و نربط و نعمل و نسوي مسألة اليوم ماحدش
+
+647
+00:47:51,300 --> 00:47:54,660
+مستخدمها، مستخدم اللي هو ال modified هذا النوع ال
+
+648
+00:47:54,660 --> 00:47:57,920
+resuscitator modified اللي هو على اسم ventilator
+
+649
+00:47:57,920 --> 00:48:04,120
+اللي يوم يستخدمه في ال .. في ال operating theaters
+
+650
+00:48:04,120 --> 00:48:08,460
+ورا في العمليات و في ال intensive care units علشان
+
+651
+00:48:08,460 --> 00:48:13,760
+ايه؟نضبط وضع الإنسان هذا اللي فاقد وعيه نضبط وضعه
+
+652
+00:48:13,760 --> 00:48:19,380
+أثناء هذه الفترة من نضبط التنفس و ال oxygen supply
+
+653
+00:48:19,380 --> 00:48:22,160
+و ال carbon dioxide removal عشان ما يخشش في
+
+654
+00:48:22,160 --> 00:48:25,700
+hypoxia ولا يخش في hypercapnia ولا إيه يدخل في
+
+655
+00:48:25,700 --> 00:48:31,920
+كومة ويموت بهكما نكون خلصنا احنا ال chapter الأخير
+
+656
+00:48:31,920 --> 00:48:36,000
+من ال respiration و أتمنى لكوا كل نجاح ان شاء الله
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/jCLl_n416-Y_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/jCLl_n416-Y_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..86f848d156bb6aa043cac436d7d368e1c48e81e7
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/jCLl_n416-Y_raw.json
@@ -0,0 +1 @@
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يعني ال tube الى two knobs طالعين كده ملففين على الرأس بحيث التنفس يطلع مباشر يعني مش في tent بس بديله قدام الأنف انا كام ضخم من ال oxygen بحيث لما يصحب oxygen بيبقى التركيز ال oxygen اللي ايه اللي جاي لما اخد نفس التركيز ال oxygen كويس عالي تمام؟", "tokens": [10721, 2407, 3714, 43020, 1975, 8315, 1975, 5016, 9566, 4724, 3794, 41575, 9917, 45030, 11242, 2423, 8315, 3794, 4724, 5016, 9566, 1211, 16095, 41575, 9917, 4724, 1829, 3555, 4587, 7578, 10874, 6027, 1829, 9154, 2423, 5658, 34105, 13672, 1829, 31439, 37495, 22653, 2423, 9917, 2423, 7578, 732, 46999, 23032, 6027, 3615, 9957, 9122, 3215, 3224, 3714, 46538, 5172, 9957, 15844, 34892, 10721, 3794, 4724, 5016, 1829, 12984, 16712, 1863, 36178, 7251, 9566, 1211, 3615, 3714, 3555, 33599, 2288, 37495, 22653, 37893, 8978, 7054, 4724, 3794, 4724, 16254, 43761, 12174, 3215, 10943, 16247, 1863, 5172, 1975, 8315, 9122, 10943, 48812, 9778, 2304, 9154, 2423, 9169, 4724, 5016, 1829, 12984, 5296, 15042, 7251, 9381, 5016, 3555, 9169, 4724, 1829, 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ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..", "tokens": [6027, 14855, 5551, 2288, 4587, 9154, 25724, 1211, 3215, 6156, 15042, 28543, 2288, 5551, 8592, 38688, 34051, 11242, 5016, 2423, 3390, 20117, 13672, 1829, 6055, 33753, 13672, 1829, 6055, 33753, 2423, 275, 1311, 563, 19651, 4724, 2407, 11242, 2407, 5016, 5551, 4117, 2655, 2288, 4032, 5551, 8592, 38688, 16472, 8978, 20666, 5172, 30241, 8608, 995, 9957, 2407, 11622, 11622, 49429, 1975, 2407, 16472, 1975, 8592, 38688, 2423, 795, 75, 1663, 16472, 1975, 8315, 11622, 1211, 25724, 5172, 1863, 4032, 1975, 8592, 38688, 2423, 795, 75, 1663, 4032, 1975, 8592, 38688, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 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"text": "it's twenty times that of oxygen لذلك ممكن ال oxygen يكون عنده إشكالية في الانتقال لكن لسه ال carbon dioxide يستطيع تمام فممكن أخش في high boxية وماعنديش high مركبنية تمام وممكن إشي تاني إنه ال respiratory center is drive by main by carbon dioxide", "tokens": [270, 311, 7699, 1413, 300, 295, 9169, 5296, 8848, 23275, 3714, 43020, 2423, 9169, 7251, 30544, 43242, 3224, 11933, 8592, 4117, 6027, 10632, 8978, 2423, 7649, 2655, 4587, 6027, 44381, 5296, 3794, 3224, 2423, 5954, 19590, 7251, 14851, 9566, 40228, 46811, 10943, 6156, 2304, 43020, 5551, 9778, 8592, 8978, 1090, 2424, 10632, 4032, 15042, 3615, 1863, 16254, 8592, 1090, 3714, 31747, 3555, 1863, 10632, 46811, 10943, 4032, 2304, 43020, 11933, 8592, 1829, 6055, 7649, 1829, 36145, 3224, 2423, 27038, 3056, 307, 3332, 538, 2135, 538, 5954, 19590], "avg_logprob": -0.24378551661290906, "compression_ratio": 1.5605381165919283, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 1441.04, "end": 1441.72, "word": "it's", 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level جديش و ال heart rate جديش بيحس الطمأن انه ال ventilator شغال صح ولا لأ لو صار اي لحبطة او زيادة او نقصة بيلاحظ على طول و بيظبط ال ventilator زي ما هو عايز واضح؟ ال ventilator اليوم عملية متطورة جدا لكن اساسها الجهاز هذا", "tokens": [3555, 2407, 11242, 5016, 2423, 9169, 1496, 10874, 16254, 8592, 4032, 2423, 5954, 19590, 1496, 10874, 16254, 8592, 4032, 2423, 1917, 3314, 10874, 16254, 8592, 4724, 1829, 5016, 3794, 41950, 2304, 33456, 16472, 3224, 2423, 27498, 1639, 13412, 17082, 6027, 20328, 5016, 49429, 5296, 10721, 45164, 20328, 9640, 1975, 1829, 5296, 5016, 3555, 9566, 3660, 1975, 2407, 30767, 1829, 18513, 3660, 1975, 2407, 8717, 4587, 9381, 3660, 4724, 1829, 15040, 5016, 19913, 15844, 23032, 12610, 4032, 4724, 1829, 19913, 3555, 9566, 2423, 27498, 1639, 30767, 1829, 19446, 31439, 6225, 47302, 11622, 4032, 46958, 5016, 22807, 2423, 27498, 1639, 45595, 20498, 6225, 42213, 10632, 44650, 9566, 13063, 3660, 10874, 28259, 44381, 24525, 32277, 11296, 25724, 3224, 31377, 23758], 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أثناء", "probability": 0.95849609375}, {"start": 2894.76, "end": 2895.06, "word": " هذه", "probability": 0.93017578125}, {"start": 2895.06, "end": 2895.58, "word": " الفترة", "probability": 0.9952799479166666}, {"start": 2895.58, "end": 2896.04, "word": " من", "probability": 0.6533203125}, {"start": 2896.04, "end": 2897.18, "word": " نضبط", "probability": 0.840087890625}, {"start": 2897.18, "end": 2897.8, "word": " التنفس", "probability": 0.9768880208333334}, {"start": 2897.8, "end": 2898.38, "word": " و", "probability": 0.62841796875}, {"start": 2898.38, "end": 2898.46, "word": " ال", "probability": 0.76611328125}, {"start": 2898.46, "end": 2898.76, "word": " oxygen", "probability": 0.91357421875}, {"start": 2898.76, "end": 2899.38, "word": " supply", "probability": 0.974609375}, {"start": 2899.38, "end": 2899.8, "word": " و", "probability": 0.9775390625}, {"start": 2899.8, "end": 2899.88, "word": " ال", "probability": 0.8017578125}, {"start": 2899.88, "end": 2900.08, "word": " carbon", "probability": 0.9296875}, {"start": 2900.08, "end": 2900.38, "word": " dioxide", "probability": 0.921875}, {"start": 2900.38, "end": 2900.84, "word": " removal", "probability": 0.97900390625}, {"start": 2900.84, "end": 2901.48, "word": " عشان", "probability": 0.9695638020833334}, {"start": 2901.48, "end": 2901.6, "word": " ما", "probability": 0.72412109375}, {"start": 2901.6, "end": 2902.0, "word": " يخشش", "probability": 0.8209228515625}, {"start": 2902.0, "end": 2902.16, "word": " في", "probability": 0.95703125}, {"start": 2902.16, "end": 2902.72, "word": " hypoxia", "probability": 0.7000732421875}, {"start": 2902.72, "end": 2903.18, "word": " ولا", "probability": 0.73681640625}, {"start": 2903.18, "end": 2903.4, "word": " يخش", "probability": 0.7884114583333334}, {"start": 2903.4, "end": 2903.52, "word": " في", "probability": 0.7626953125}, {"start": 2903.52, "end": 2904.2, "word": " hypercapnia", "probability": 0.8606770833333334}, {"start": 2904.2, "end": 2904.74, "word": " ولا", "probability": 0.95068359375}, {"start": 2904.74, "end": 2905.04, "word": " إيه", "probability": 0.8114420572916666}, {"start": 2905.04, "end": 2905.54, "word": " يدخل", "probability": 0.983642578125}, {"start": 2905.54, "end": 2905.7, "word": " في", "probability": 0.97021484375}, {"start": 2905.7, "end": 2906.08, "word": " كومة", "probability": 0.8976236979166666}, {"start": 2906.08, "end": 2906.6, "word": " ويموت", "probability": 0.83447265625}, {"start": 2906.6, "end": 2907.88, "word": " بهكما", "probability": 0.5018717447916666}, {"start": 2907.88, "end": 2908.06, "word": " نكون", "probability": 0.6749267578125}, {"start": 2908.06, "end": 2908.54, "word": " خلصنا", "probability": 0.989501953125}, {"start": 2908.54, "end": 2908.86, "word": " احنا", "probability": 0.8262532552083334}, {"start": 2908.86, "end": 2910.14, "word": " ال", "probability": 0.83984375}, {"start": 2910.14, "end": 2911.38, "word": " chapter", "probability": 0.94873046875}, {"start": 2911.38, "end": 2911.92, "word": " الأخير", "probability": 0.8544921875}, {"start": 2911.92, "end": 2912.12, "word": " من", "probability": 0.955078125}, {"start": 2912.12, "end": 2912.26, "word": " ال", "probability": 0.763671875}, {"start": 2912.26, "end": 2912.86, "word": " respiration", "probability": 0.7298583984375}, {"start": 2912.86, "end": 2913.44, "word": " و", "probability": 0.78466796875}, {"start": 2913.44, "end": 2913.92, "word": " أتمنى", "probability": 0.8607177734375}, {"start": 2913.92, "end": 2914.68, "word": " لكوا", "probability": 0.7462565104166666}, {"start": 2914.68, "end": 2915.04, "word": " كل", "probability": 0.984375}, {"start": 2915.04, "end": 2915.42, "word": " نجاح", "probability": 0.9949544270833334}, {"start": 2915.42, "end": 2915.62, "word": " ان", "probability": 0.6533203125}, {"start": 2915.62, "end": 2915.82, "word": " شاء", "probability": 0.9794921875}, {"start": 2915.82, "end": 2916.0, "word": " الله", "probability": 0.95654296875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2917.84275, "duration_after_vad": 2838.1140937499886}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/k0oD_O8I77Y.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/k0oD_O8I77Y.srt
new file mode 100644
index 0000000000000000000000000000000000000000..7af8eb43d13e36aadd51a1fbd7593111b34fe54e
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/k0oD_O8I77Y.srt
@@ -0,0 +1,2514 @@
+1
+00:00:05,960 --> 00:00:10,800
+هنبدأ في المحاضرات
+
+2
+00:00:10,800 --> 00:00:15,800
+الحقيقية حول الـ renal physiology كانت المحاضرات...
+
+3
+00:00:15,800 --> 00:00:19,540
+المحاضرتين الفائتين كانتا حول الـ body fluids اللي
+
+4
+00:00:19,540 --> 00:00:25,360
+هي المادة اللي الـ ... الكلية هتشتغل عليها، لكن اليوم
+
+5
+00:00:25,360 --> 00:00:29,340
+هنتكلم عن الكلية كيف تشغل عليها المواد المختلفة
+
+6
+00:00:29,340 --> 00:00:33,180
+اللي موجودة في الـ different compartments، كيف لها
+
+7
+00:00:33,180 --> 00:00:41,420
+تأثير في التحكم في الـ homeostasis عبر الكلية، يتم
+
+8
+00:00:41,420 --> 00:00:48,160
+ضبط الـ different concentrations  الـ body fluids
+
+9
+00:00:48,160 --> 00:00:55,170
+و الـ volume، و الـ hypertension، أو بمعنى آخر، what are the
+
+10
+00:00:55,170 --> 00:00:58,410
+functions of the kidney اللي هنتكلم عنهم أول شيء
+
+11
+00:00:58,410 --> 00:01:05,550
+the kidney can perform different functions; execution
+
+12
+00:01:05,550 --> 00:01:09,030
+of metabolic waste products and foreign chemicals
+
+13
+00:01:09,030 --> 00:01:14,950
+إحنا كنا متوقعين أن الـ ... الـ ... الـ metabolic waste
+
+14
+00:01:14,950 --> 00:01:17,370
+products هي الأساس، أن الكلب يطلع اليوريا و
+
+15
+00:01:17,370 --> 00:01:23,110
+الكرياتينين، وشده. طيب، okay، متفقين عليها اثنين
+
+16
+00:01:23,110 --> 00:01:28,650
+regulation of water and electrolyte balances، ثلاثة
+
+17
+00:01:28,650 --> 00:01:32,610
+regulation of the osmolality،  ليست هي الـ
+
+18
+00:01:32,610 --> 00:01:35,770
+concentration of the electrolytes and water
+
+19
+00:01:35,770 --> 00:01:39,550
+contents، the osmolality and electrolyte
+
+20
+00:01:39,550 --> 00:01:44,590
+concentration regulation
+
+21
+00:01:44,590 --> 00:01:49,350
+of arterial blood pressure، اللي لها علاقة في الـ blood
+
+22
+00:01:49,350 --> 00:01:54,210
+pressure، اللي هي علاقة كبيرة، هنتكلم عنها، regulation
+
+23
+00:01:54,210 --> 00:02:01,610
+of acid-base balance،  الـ pH، لأن ممكن أحيانا الكلية
+
+24
+00:02:01,610 --> 00:02:06,490
+تطلع hydrogen ions بكمية كبيرة أو كمية جليلة، ممكن
+
+25
+00:02:06,490 --> 00:02:10,730
+تطلع  bicarbonates  كتيرة أو قليلة، طبعا إحنا
+
+26
+00:02:10,730 --> 00:02:14,370
+بالنسبة لنا في الـ plasma، الـ main buffer system، الـ
+
+27
+00:02:14,370 --> 00:02:18,230
+bicarbonate system، تمام، فالـ bicarbonate system
+
+28
+00:02:18,230 --> 00:02:24,180
+هذا ممكن إحنا نزود الـ execution of bicarbonate، بنقل
+
+29
+00:02:24,180 --> 00:02:27,600
+الـ acidity، الـ alkalinity، بنزود الـ execution of
+
+30
+00:02:27,600 --> 00:02:31,620
+hydrogen ions، بنقل الـ acidity، يعني بإن نطلع
+
+31
+00:02:31,620 --> 00:02:36,340
+بيكربونات أكثر أو نعمل execution لـ hydrogen ions
+
+32
+00:02:36,340 --> 00:02:42,960
+أكثر، من ميل بين الـ acidity و الـ alkalinity، من ميل
+
+33
+00:02:42,960 --> 00:02:46,960
+بين الـ pH، درجاته المختلفة، حسب أنا بعمل execution
+
+34
+00:02:46,960 --> 00:02:51,020
+أكثر لإيش؟ بيكربونات أكثر، ولا hydrogen ions أكثر؟
+
+35
+00:02:53,690 --> 00:02:59,390
+secretion of metabolites
+
+36
+00:02:59,390 --> 00:03:04,250
+and
+
+37
+00:03:04,250 --> 00:03:12,110
+excretion of hormones، غريب
+
+38
+00:03:12,110 --> 00:03:16,350
+هنا إيه؟ أنا كنت ضايفة عليها الـ hormones، الـ
+
+39
+00:03:16,350 --> 00:03:20,350
+excretion of hormones عبر الكلية، الكلية هنا
+
+40
+00:03:21,200 --> 00:03:24,980
+هتدرسوا بعد شوية الـ endocrine، الفصل الجاي، هتلاقوا
+
+41
+00:03:24,980 --> 00:03:28,780
+إنّه بعد ما الـ liver تعمل conjugation للـ steroid
+
+42
+00:03:28,780 --> 00:03:34,320
+hormones، 75% of excretion بعدها عبر الكلية، طبعا
+
+43
+00:03:34,320 --> 00:03:38,830
+إذن، للـ liver اللي لها دورها، الكلية بعد ما تجهز
+
+44
+00:03:38,830 --> 00:03:41,610
+الشيء في الـ liver، بتعمل execution، twenty-five
+
+45
+00:03:41,610 --> 00:03:45,490
+percent، تقريبا، execution of steroids، اللي هو نوع
+
+46
+00:03:45,490 --> 00:03:47,770
+من أنواع الـ hormones، يعني steroid hormones
+
+47
+00:03:47,770 --> 00:03:52,430
+executed by the bile، الـ liver للـ bile عن طريق الـ...
+
+48
+00:03:52,430 --> 00:03:57,630
+الـ bile، الصفراء، المرارة، مادة الصفراء، لكن
+
+49
+00:03:57,630 --> 00:03:59,590
+seventy-five، عبر إيه؟ الكلية
+
+50
+00:04:03,740 --> 00:04:08,080
+هنسألكم عن الـ testosterone، في أعظم اللحظات، كيف can
+
+51
+00:04:08,080 --> 00:04:12,760
+be detected من خلال الـ execution في الـ urine، 17
+
+52
+00:04:12,760 --> 00:04:19,920
+keto testosterone، أو steroid، خروجه في الـ urine
+
+53
+00:04:19,920 --> 00:04:23,220
+بكميات كبيرة، بتدلّ على أن فيه testosterone مُصنّع كثير
+
+54
+00:04:23,220 --> 00:04:26,820
+جليل أو قليل، يعني، مراد الـ urine analysis بتعطيني
+
+55
+00:04:26,820 --> 00:04:32,360
+فكرة عن إيش المواد في داخل الجسم، و كانت بكميات مُصنّعة
+
+56
+00:04:32,360 --> 00:04:38,900
+كبيرة أو صغيرة، أو كده، الـ gluconeogenesis، وهذه
+
+57
+00:04:38,900 --> 00:04:42,980
+هتكون
+
+58
+00:04:42,980 --> 00:04:49,680
+بالنسبة لكم،  معلومة شوية، أن الكلية تستطيع أن تصنع
+
+59
+00:04:49,680 --> 00:04:53,520
+في حالات الطوارئ، ما يكونش في عندي blood sugar كافي،
+
+60
+00:04:53,520 --> 00:05:00,980
+بتصنع سكر عبر other than carbohydrates resources
+
+61
+00:05:00,980 --> 00:05:05,160
+يعني عبر البروتين mainly، و الـ lipids، what is
+
+62
+00:05:05,160 --> 00:05:10,680
+called gluconeogenesis، يعني تصنيع سكر من مصادر غير
+
+63
+00:05:10,680 --> 00:05:16,200
+كربوهيدراتية، تمام؟ تستطيع تعمل هذا الكلام، بالضبط، تجار
+
+64
+00:05:16,200 --> 00:05:20,120
+الـ liver، تجار الكبد في المسألة هذه، تمام؟ إذن ممكن
+
+65
+00:05:20,120 --> 00:05:24,780
+الـ liver، الكلية تعمل gluconeogenesis as much as
+
+66
+00:05:24,780 --> 00:05:30,490
+the liver itself، طيب، ندرس كل واحدة على حدة، ندرس كل
+
+67
+00:05:30,490 --> 00:05:36,590
+واحدة على حدة، execution of metabolic waste
+
+68
+00:05:36,590 --> 00:05:40,430
+products، foreign chemicals، drugs، and hormone
+
+69
+00:05:40,430 --> 00:05:44,030
+metabolites، الـ execution تبع الـ metabolites هذه
+
+70
+00:05:44,030 --> 00:05:51,170
+اليوريا عبارة عن الـ metabolite تبع الـ ... إيه؟ الـ amino
+
+71
+00:05:51,170 --> 00:05:54,790
+acids، مش كده؟ الكرياتينين
+
+72
+00:05:56,470 --> 00:06:00,810
+الكرياتينين عبارة عن الـ metabolite تبع الكرياتين
+
+73
+00:06:00,810 --> 00:06:09,690
+which is a muscle compound، كرياتين، الـ uric acid
+
+74
+00:06:09,690 --> 00:06:12,950
+يمثل
+
+75
+00:06:12,950 --> 00:06:18,490
+the product of nucleic acids، nucleic acids، يعني
+
+76
+00:06:18,490 --> 00:06:23,730
+أنا بتكلم عن أشياء فيها خلايا، فيها nuclei، فيها
+
+77
+00:06:23,730 --> 00:06:27,690
+nucleic acids، إذن لما نتكلم إن الـ uric acid زاد،
+
+78
+00:06:27,690 --> 00:06:32,910
+معناه نتكلم عن، في الغالب، إنّه إحنا الأكل عندنا أكل
+
+79
+00:06:32,910 --> 00:06:38,810
+فيه مواد فيها خلايا، لحمة أو غيرها، أو بنقول إنّه
+
+80
+00:06:38,810 --> 00:06:42,410
+التكسير عندنا في الخلايا زاد، تمام؟ فلذلك الـ uric
+
+81
+00:06:42,410 --> 00:06:47,070
+acid products زادت، تمام؟ إذن الـ uric acid لازم يكون
+
+82
+00:06:47,070 --> 00:06:51,330
+مصدره خلايا الـ nucleus، في حين أن الـ proteins
+
+83
+00:06:51,330 --> 00:06:56,210
+مابتطلعش كلامها، يعني مادة زي الحليب، protein عالية
+
+84
+00:06:56,210 --> 00:07:00,850
+جدا فيها، لكن ما فيش فيها uric acid، لكن شريحة لحمة
+
+85
+00:07:00,850 --> 00:07:05,230
+صغيرة مليانة خلايا، فيها nuclei، فيها nucleic acids
+
+86
+00:07:05,230 --> 00:07:10,370
+فيها، إذن الـ uric acid products معناها أن هذه جاءت
+
+87
+00:07:10,370 --> 00:07:14,110
+من مصادر إيه؟ تكسير خلوي، إن كان extrinsic، إحنا
+
+88
+00:07:14,110 --> 00:07:18,690
+ما قلناه، أو كان داخلي، حالات الـ cancer، أو حالات الـ
+
+89
+00:07:18,690 --> 00:07:22,450
+leukemia، من اللي هيجي، تكسير كثير في الـ porphyric
+
+90
+00:07:22,450 --> 00:07:28,830
+acid، يعني، in the products of hemoglobin breakdown،
+
+91
+00:07:28,830 --> 00:07:37,850
+الـ hemoglobin اللي هو بيتكسر و بيديني حديد و globin
+
+92
+00:07:39,130 --> 00:07:42,710
+أو الـ ... الـ ... الـ hemoglobin اللي هي بتتكسر إلى
+
+93
+00:07:42,710 --> 00:07:48,630
+حديد و biliverdin، و الـ biliverdin بتتحول في الآخر لـ
+
+94
+00:07:48,630 --> 00:07:52,490
+bilirubin، و الـ bilirubin بيتغيّر، بي... بي... بي...
+
+95
+00:07:52,490 --> 00:07:55,810
+بيصير له conjugation في الـ liver، برضه جزء منه بيطلع
+
+96
+00:07:55,810 --> 00:07:58,850
+في البول، وجزء منه بيطلع في الكلية، في الـ urine،
+
+97
+00:07:58,850 --> 00:08:01,850
+الجزء اللي بيطلع في الـ urine بنسميه urobilirubin
+
+98
+00:08:02,570 --> 00:08:06,110
+urobilirubin، الجزء اللي بيطلع في الـ stool بنسميه
+
+99
+00:08:06,110 --> 00:08:10,570
+stercobilinogen، sterco يعني stool، uro يعني
+
+100
+00:08:10,570 --> 00:08:15,230
+urine، آه، فلذلك فيه جزء هنا، وجزء آخر، metabolites of
+
+101
+00:08:15,230 --> 00:08:19,570
+various hormones، جوجات
+
+102
+00:08:19,570 --> 00:08:24,580
+forms، إن كان الـ steroids العادية، أو مرات الـ 17
+
+103
+00:08:24,580 --> 00:08:29,160
+-ketosteroids، هذه بتتشخص لإنّ في عندي أنا إيه؟
+
+104
+00:08:29,160 --> 00:08:33,620
+تستوستيرون بتُصنّع بكمية كبيرة، بدليل اللي هو إيه؟ الـ
+
+105
+00:08:33,620 --> 00:08:37,680
+17-ketosteroids secreted in urine in big amounts
+
+106
+00:08:54,990 --> 00:08:57,990
+بالإضافة لأنّ كمية كبيرة من المواد اللي هي إلى حد
+
+107
+00:08:57,990 --> 00:09:03,760
+ما سامة، أو مواد تعتبر غريبة على الجسم، مش عايزها، لكن
+
+108
+00:09:03,760 --> 00:09:08,380
+تدخلت، تدخلت مع الطعام بشكل من الأشكال، أو تكونت
+
+109
+00:09:08,380 --> 00:09:12,820
+في داخل الجسم، على الـ... الكلية برضه، فطبعا أنتم
+
+110
+00:09:12,820 --> 00:09:16,840
+واضح من الكلام هذا، إحنا بنتكلم عن organ كثير محترم،
+
+111
+00:09:16,840 --> 00:09:25,670
+كثير مهم، كثير خطير، فشله يعني إنّه إحنا ما نقدرش
+
+112
+00:09:25,670 --> 00:09:30,870
+نتم الحياة without a kidney، life is incompatible
+
+113
+00:09:30,870 --> 00:09:36,070
+without kidney، لا يمكن أنا أتم حياة، فتصوروا أن
+
+114
+00:09:36,070 --> 00:09:40,670
+الجسم الإنسان هذا، صنع لحاله هيك هيك هيك، و قال لأ،
+
+115
+00:09:40,670 --> 00:09:45,950
+لازم بدّي كلية، عشان ما أقدرش أشتغل، كلية لا يدرك ذلك
+
+116
+00:09:46,510 --> 00:09:49,970
+بعدين بتطلع على الكلية كده، معقدة كده، تركيب، و بعدين
+
+117
+00:09:49,970 --> 00:09:54,190
+تشوفوا كيف هذا
+
+118
+00:09:54,190 --> 00:10:00,510
+يعني إنما أخلّها من عبادي علماء، وجمال هذه المادة
+
+119
+00:10:00,510 --> 00:10:04,850
+أنا بضلّ قاعد، و أزيد إنها تجوّل في ملكوت الله عز وجل
+
+120
+00:10:04,850 --> 00:10:12,760
+في أنفسكم، تجوّلوا، و تشوفوا كده الجسم هذا، يعني جميل
+
+121
+00:10:12,760 --> 00:10:18,880
+و مرتّب، و منظم جدا، هنتكلّف إحنا لو أجأنا شيء فيه نجس، و
+
+122
+00:10:18,880 --> 00:10:23,040
+إحنا بنادفع ثمنا جدا، هنتكلّف، لو نجس
+
+123
+00:10:23,040 --> 00:10:28,150
+hormone، الـ growth hormone، جدا، هنتكلّف، لو نجس، أي
+
+124
+00:10:28,150 --> 00:10:33,090
+أنزين، معين صغير، مش مذكور، لكن ما يترتب عليه من
+
+125
+00:10:33,090 --> 00:10:36,570
+فقدان، هي very big، يعني الـ consequences of its
+
+126
+00:10:36,570 --> 00:10:39,910
+deficiency، هتلاقيها شيء كبير، وفي الآخر الكلية جثة
+
+127
+00:10:39,910 --> 00:10:46,690
+بسيطة، لكنها كيف جاءت؟ كيف تركّبت؟ كيف طلعت؟ إذن النقطة
+
+128
+00:10:46,690 --> 00:10:51,550
+الأولى، بتكلم عن execution of waste products هذه
+
+129
+00:10:51,550 --> 00:10:56,470
+أول function، تمام؟ الـ function الثاني اتكلمنا عنه
+
+130
+00:10:56,470 --> 00:10:58,950
+من شوية، regulation of water and electrolyte
+
+131
+00:10:58,950 --> 00:11:03,250
+balance، الـ
+
+132
+00:11:03,250 --> 00:11:06,350
+water and electrolyte balance، اتكلمنا كثير عن الـ
+
+133
+00:11:06,350 --> 00:11:09,770
+water، حجمها في الـ compartments المختلفة، و الـ
+
+134
+00:11:09,770 --> 00:11:13,230
+osmolality، و الـ electrolytes، و هذه تضبطها الكلية
+
+135
+00:11:13,230 --> 00:11:19,270
+أنا بأكل بدّي، وبأشرب بدّي، وبأعطي اللي بدّي
+
+136
+00:11:19,270 --> 00:11:20,870
+عليه، و ب...
+
+137
+00:11:23,540 --> 00:11:27,000
+أستخدم يعني different resources of ... of ... of
+
+138
+00:11:27,000 --> 00:11:30,780
+water، under the ground، مش مشكلة عندي، الكلية هي
+
+139
+00:11:30,780 --> 00:11:34,840
+لحالها، إيش فيه فروقات بتظبطها، فيه تجربة لطيفة عندنا
+
+140
+00:11:34,840 --> 00:11:40,420
+هنا، إنّه واحد غير الـ intake، عملنا تجربة، غيّرنا الـ
+
+141
+00:11:40,420 --> 00:11:50,840
+intake of sodium، من درجة واطية، تلاتين ملي جرام، إلى
+
+142
+00:11:51,380 --> 00:11:54,720
+فجأة درجة عالية، تلاتميت ملي جرام، تمام؟ يعني واحد
+
+143
+00:11:54,720 --> 00:11:58,300
+اتّخذ أحمر هنا، كان بياكل كل يوم تلاتين ملي جرام
+
+144
+00:11:58,300 --> 00:12:02,520
+Sodium، تمّ، تلاتين... ندخله تلاتين ملي equivalent
+
+145
+00:12:02,520 --> 00:12:06,420
+مش ملي جرام، تلاتين ملي equivalent Sodium، بعدين
+
+146
+00:12:06,420 --> 00:12:10,440
+عند نقطة معينة، زوّدناها الـ intake، صار عند هذه الـ
+
+147
+00:12:10,440 --> 00:12:14,080
+intake، صار فجأة في هذه النقطة إلى إيه؟ إلى تلاتميت
+
+148
+00:12:14,080 --> 00:12:18,860
+ملي equivalent، بعدين بعد كذا يوم قرّرنا ننزلها عادة
+
+149
+00:12:18,860 --> 00:12:21,940
+ثاني إلى إيه؟ تلاتين ملي equivalent، لقينا إنّه
+
+150
+00:12:21,940 --> 00:12:28,660
+الكلية، بعد يومين، تلاتة من زيادة الـ intake، تمام،
+
+151
+00:12:28,660 --> 00:12:32,860
+بعد يومين، تلاتة، فجأة الـ urine excretion عالي، عالي
+
+152
+00:12:32,860 --> 00:12:36,880
+عالي، لما وصل لإيه؟ لما يساوي الـ intake، في جزء
+
+153
+00:12:36,880 --> 00:12:40,980
+ضايل مخزّن في الجسم، يومين تلاتة ما يبينش، بس بعد تلت
+
+154
+00:12:40,980 --> 00:12:46,060
+يوم صار، جدا، ما دخل الـ sodium، جدا، بيطلع، إذن بعد
+
+155
+00:12:46,060 --> 00:12:50,140
+يومين، تلاتة، بعد lag، أكمن يوم، صار عندي الـ intake و
+
+156
+00:12:50,140 --> 00:12:55,690
+الـ output يساوي بعض، وقفنا الإنتاج العالي هذا، و
+
+157
+00:12:55,690 --> 00:12:59,410
+نزلنا ثاني لـ 30 ملي equivalent، اتفاجأنا إنّه لازال
+
+158
+00:12:59,410 --> 00:13:05,270
+الفرج اللي كان في الأول lagging، اتأخّر، لازال بيطلع
+
+159
+00:13:05,270 --> 00:13:08,990
+في يومين، تلاتة، لما نزل في الآخر، لأ يساوي الـ intake،
+
+160
+00:13:08,990 --> 00:13:13,430
+لذا، اتأخّر يومين، تلاتة، بعدين لما وقفنا، دلّ يومين
+
+161
+00:13:13,430 --> 00:13:17,230
+تلاتة، execution أكثر من الإيه؟ من اللي إحنا بنأخده
+
+162
+00:13:17,230 --> 00:13:20,730
+لحد ما يتساوي من أول وجديد، لذا في الآخر الكمية اللي
+
+163
+00:13:20,730 --> 00:13:27,160
+اتدخلت controlled، طبعا إحنا هنتوقع في اليومين، تلاتة
+
+164
+00:13:27,160 --> 00:13:30,700
+هدول، اللي زاد، اللي صار فيها lagging للـ execution،
+
+165
+00:13:30,700 --> 00:13:34,740
+إنّه كمية الصوديوم هذه عملت expansion شوية
+
+166
+00:13:34,740 --> 00:13:38,280
+expansion لمين؟ للاكسسترا سيلّولار fluid compartment،
+
+167
+00:13:38,280 --> 00:13:43,060
+وعلّى الضغط، و البلازما اتّقى كام يوم، بعدين زبطت،
+
+168
+00:13:43,060 --> 00:13:46,300
+بعدين عاودت إيه؟ بعد ما وقفنا، رجعت من جديد، دي اللي
+
+169
+00:13:46,300 --> 00:13:51,470
+هوضحها، الطبيعي، الـ excretion of fluid بتطلع في اليوم
+
+170
+00:13:51,470 --> 00:13:55,550
+اللي... إيه اللي بدأ يزيد، يزيد، يزيد، لما زاد شوية
+
+171
+00:13:55,550 --> 00:13:58,390
+الـ excretion of fluid، موجود، وقفناه، بعدين، وجلسين، و
+
+172
+00:13:58,390 --> 00:14:03,850
+جلسين، رجع للوضع الطبيعي، طيب إذن عندنا بدّنا نقول أن
+
+173
+00:14:03,850 --> 00:14:09,070
+الكلية
+
+174
+00:14:09,070 --> 00:14:14,
+
+223
+00:17:52,670 --> 00:17:58,130
+عندي في الكلية عندي long-term control على أنه
+
+224
+00:17:58,130 --> 00:18:00,610
+نضبط الـ Sodium و الـ Potassium و الـ Electrolytes
+
+225
+00:18:00,610 --> 00:18:06,170
+بحيث أنّه اتّزان الـ volume صح والضغط صح أو إشي صار
+
+226
+00:18:06,170 --> 00:18:09,890
+مفاجئ أو الأسباب غير عادية، إنّه قد إنّه الـ blood
+
+227
+00:18:09,890 --> 00:18:12,650
+supply أو blood pressure اللي جاي للكلية أو الـ
+
+228
+00:18:12,650 --> 00:18:15,630
+blood pressure in general في الـ body واطي، واللي
+
+229
+00:18:15,630 --> 00:18:18,730
+صار جاي للكلية، على طول الكلية أخذت بالها، بيطلع
+
+230
+00:18:18,730 --> 00:18:22,750
+اللي هو الـ renin، وهنتكلم عنه في المستقبل بتفصيل
+
+231
+00:18:22,750 --> 00:18:29,010
+الشديد، إذا blood pressure control عنده two ways of
+
+232
+00:18:29,010 --> 00:18:32,610
+control، long-term و short-term regulation of acid
+
+233
+00:18:32,610 --> 00:18:36,490
+base balance، هتكلمت لكم عنها، أنا بشوية، إنّه الـ
+
+234
+00:18:36,490 --> 00:18:39,750
+bicarbonate system هو الـ hydrogen، تمام، الكلية
+
+235
+00:18:39,750 --> 00:18:44,190
+بتتحكم فيهم كويس، لو زي الـ bicarbonate طلعوا يعني
+
+236
+00:18:44,190 --> 00:18:47,900
+الـ  concentrations اللي صار عندي زياده، لو زاد الـ
+
+237
+00:18:47,900 --> 00:18:51,680
+الـ hydrogen بتطلعوا، وهندرسها دي بالتفصيل، كيف الـ
+
+238
+00:18:51,680 --> 00:18:54,020
+hydrogen، وكيف الـ bicarbonates can be controlled
+
+239
+00:18:54,020 --> 00:18:57,540
+by ده إيه؟ ده kidney regulation of erythrocyte
+
+240
+00:18:57,540 --> 00:19:04,960
+production، وهذه من ضمن، إذا الكلية إلها... إلها
+
+241
+00:19:04,960 --> 00:19:08,140
+function
+
+242
+00:19:08,140 --> 00:19:12,400
+متعلق بـ regulation of
+
+243
+00:19:15,830 --> 00:19:22,450
+and excretion of waste products، pure non-hormonal
+
+244
+00:19:22,450 --> 00:19:25,630
+function، بعدين إيه بقى؟ بعض الـ hormonal function
+
+245
+00:19:25,630 --> 00:19:28,510
+لذلك في بعض الشؤون يقول الـ hormonal... endocrine
+
+246
+00:19:28,510 --> 00:19:31,770
+function of the kidney، the endocrine function of
+
+247
+00:19:31,770 --> 00:19:35,670
+the kidney، تمام؟ طيب، وجبنا سيرة الرنين، ده hormone
+
+248
+00:19:35,670 --> 00:19:39,310
+بيطلع، وبيعمل، وبيسوي، وهنا بنتكلم عن الاريثروبويتين
+
+249
+00:19:39,310 --> 00:19:41,210
+الاريثروبويتين
+
+250
+00:19:43,440 --> 00:19:50,360
+عبارة عن مادة بتطلع من الكلية، وهي stimulating the
+
+251
+00:19:50,360 --> 00:19:56,000
+bone marrow for formation of RBCs، for formation of
+
+252
+00:19:56,000 --> 00:20:00,360
+erythrocytes، اللي هو red blood cells، اريثروبويتين
+
+253
+00:20:00,360 --> 00:20:03,700
+وهذه مشكلة كبيرة عندما واحد يخش في chronic renal
+
+254
+00:20:03,700 --> 00:20:08,530
+failure، تمام؟ chronic renal failure معناها إن ما فيش
+
+255
+00:20:08,530 --> 00:20:13,410
+erythropoietin، معناها دم إيه؟ نزل، لذلك لما اكتشفوا
+
+256
+00:20:13,410 --> 00:20:18,410
+الـ hemopoietin، كان هذه خطوة مفصلية في تاريخ الطب
+
+257
+00:20:18,410 --> 00:20:23,750
+إنّ هؤلاء الناس خلّصنا مشاكلهم، صار علاج الـ anemia في
+
+258
+00:20:23,750 --> 00:20:27,730
+الـ chronic renal failure، تمام؟ حلّها نديله
+
+259
+00:20:27,730 --> 00:20:33,120
+hemopoietin، تمام؟ فبيرجع الـ إيه؟ الـ... الـ bone marrow
+
+260
+00:20:33,120 --> 00:20:37,520
+يصنع بشكل طبيعي، لكن إحنا كل يوم بناخد
+
+261
+00:20:37,520 --> 00:20:40,800
+الاريثروبويتين بالبلاش من جسمنا، وبناخد
+
+262
+00:20:40,800 --> 00:20:43,240
+الاريثروبويتين، جدّ ما إحنا عايزين، الجرعة اللي إحنا
+
+263
+00:20:43,240 --> 00:20:48,240
+بندّيها خارجيًا، ممكن تزيد أو تقل، لكن الطبيعي بنلاحظ
+
+264
+00:20:48,240 --> 00:20:52,480
+إن خلاص الـ... الـ... الـ... الـ hemoglobin ثابت، لا
+
+265
+00:20:52,480 --> 00:20:56,040
+بيزيد ولا بينقص، على مستوى معيّن، إيش السبب؟ نقص
+
+266
+00:20:56,040 --> 00:21:00,150
+على طول، بيزيد الاريثروبويتين وبيزيد الهيموجلوبين
+
+267
+00:21:00,150 --> 00:21:04,050
+من جديد، وهكذا controlled، بمعنى الـ homeostasis
+
+268
+00:21:04,050 --> 00:21:09,890
+اللي إحنا دايمًا نتكلم عنه، إذا لو صار عندي hypoxia
+
+269
+00:21:09,890 --> 00:21:15,010
+للَكلية، آه، بتنتبه الكلية أو بتطلع more or less، هي
+
+270
+00:21:15,010 --> 00:21:21,570
+مش قصة hypoxia، الكلى بتسيطر على الهيموجلوبين متوازنة
+
+271
+00:21:21,570 --> 00:21:25,270
+يعني بدقة شديدة، متناهية، مش محتاجين إن نكون هي high
+
+272
+00:21:25,270 --> 00:21:29,310
+boxy، high boxy شديدة، أي change في الـ oxygen level
+
+273
+00:21:29,310 --> 00:21:33,630
+تنتبه الكلية، بتطلع الاريثروبويتين أكثر أو أقل
+
+274
+00:21:33,630 --> 00:21:37,630
+إذا
+
+275
+00:21:37,630 --> 00:21:47,100
+regulation of the vitamin D3 production، regulation
+
+276
+00:21:47,100 --> 00:21:51,300
+of 125-dihydroxy vitamin D production، D3
+
+277
+00:21:51,300 --> 00:21:57,220
+production، الـ vitamin D هذا كتير مهم for bone
+
+278
+00:21:57,220 --> 00:22:02,300
+structure and bone calcification، جدًا، لأنّ الـ
+
+279
+00:22:02,300 --> 00:22:11,600
+vitamin D بيتحكم في الـ absorption of calcium in
+
+280
+00:22:11,600 --> 00:22:15,990
+the gut، وإيه كمان؟ الـ absorption of calcium in
+
+281
+00:22:15,990 --> 00:22:21,150
+the kidney، تمام؟ فلما يكون عندي أنا vitamin D بكمية
+
+282
+00:22:21,150 --> 00:22:24,850
+كافية، بيدخل كمية، و أيّ زيادة في الـ calcium absorbed عبر
+
+283
+00:22:24,850 --> 00:22:30,410
+الـ GIT to the blood، إذا نقص الـ vitamin D3، الـ
+
+284
+00:22:30,410 --> 00:22:35,970
+absorption تتأثر في الـ gut، بيقل، والـ excretion بيزيد
+
+285
+00:22:35,970 --> 00:22:39,690
+معناها أنا بتكلم عن hypocalcemia، معناها بتكلم إنّ
+
+286
+00:22:39,690 --> 00:22:45,050
+الجسم بيتطّرر إن يكسر العظم عشان يحافظ لي على إيه؟
+
+287
+00:22:45,050 --> 00:22:49,770
+فيصير مصدر الكالسيوم من إيه؟ من العظم، تمام؟
+
+288
+00:22:49,770 --> 00:22:54,110
+هتكلم عنه الفصل الجاي، في آخر endocrine، هتكلم عن
+
+289
+00:22:54,110 --> 00:22:54,990
+الكالسيتونين
+
+290
+00:22:57,240 --> 00:23:01,900
+والباراثايرويد هرمون، مع بعضها من الـ D3، المجموعة
+
+291
+00:23:01,900 --> 00:23:05,060
+هذه المسؤولة عن الكالسيوم وبناء العظم، إن شاء
+
+292
+00:23:05,060 --> 00:23:10,380
+الله، إذا الـ vitamin D إحنا عارفينه طبعًا إنّه بتكون
+
+293
+00:23:10,380 --> 00:23:15,160
+تحت الجلد من الكوليسترول، 7-dehydroxycholesterol
+
+294
+00:23:15,160 --> 00:23:21,700
+وهذا exposed to the... from the exposure to
+
+295
+00:23:21,700 --> 00:23:27,170
+ultraviolet rays، بتكون تحت الجلد الـ Vitamin D، وفي
+
+296
+00:23:27,170 --> 00:23:34,430
+الكلية بيعاود يكون الـ... الـ... الـ... الـ... الـ 125 كالسيترول
+
+297
+00:23:34,430 --> 00:23:41,830
+أو Vitamin D أو D2، بعدين بيصير D3، لما بيدخل
+
+298
+00:23:41,830 --> 00:23:45,850
+الكلية بتحوّل الـ 125 ديهايدروكسي
+
+299
+00:23:50,610 --> 00:24:00,850
+D3، كالسيتريول، تريول، ترا... تريول D3، طيب، هتكلم عنه
+
+300
+00:24:00,850 --> 00:24:04,210
+بتفاصيل شديدة في وقته المناسب، جلوكوز سينثيز
+
+301
+00:24:04,210 --> 00:24:08,850
+قلت لكم إنّه غريب جدًا إنّ الكلية هذه اللي هي ما لهاش
+
+302
+00:24:08,850 --> 00:24:13,620
+علاقة بالتصنيع، كتير، لها علاقة بالـ excretion، كتير
+
+303
+00:24:13,620 --> 00:24:17,700
+بس إيه؟ هتكون organ زي الـ liver، يصنع سكر، فوق
+
+304
+00:24:17,700 --> 00:24:22,940
+التوازن، هذا issue كتير، يعني إيه؟ إنسان بيقف أمامه
+
+305
+00:24:22,940 --> 00:24:32,100
+متعجّب، لأنّ الكلية عضو كتير مهم، إذا لو صار عندي
+
+306
+00:24:32,100 --> 00:24:40,850
+kidney failure، هيكون عندي homeostatic failure، لأنّ الـ
+
+307
+00:24:40,850 --> 00:24:43,450
+kidney بتعمل homeostasis على مستوى الـ electrolytes
+
+308
+00:24:43,450 --> 00:24:48,490
+والكلام السابع، نقطة كلامنا عنه، فلو صار فيها مشكلة
+
+309
+00:24:48,490 --> 00:24:53,750
+الـ pressure هيروح، والـ fluids هتزيد، وكل الدنيا
+
+310
+00:24:53,750 --> 00:24:54,510
+هتلخبط
+
+311
+00:24:59,220 --> 00:25:02,740
+مع الحصول على مرض عضوي أو أخطار عضوية أو أخطار
+
+312
+00:25:02,740 --> 00:25:02,940
+عضوية أو أخطار عضوية أو أخطار عضوية أو أخطار عضوية
+
+313
+00:25:02,940 --> 00:25:03,520
+أو أخطار عضوية أو أخطار عضوية أو أخطار عضوية أو
+
+314
+00:25:03,520 --> 00:25:04,660
+أخطار عضوية أو أخطار عضوية أو أخطار عضوية أو أخطار
+
+315
+00:25:04,660 --> 00:25:09,660
+عضوية أو أخطار عضوية أو أخطار عضوية أو أخطار عضوية
+
+316
+00:25:09,660 --> 00:25:15,880
+أو أخطار عضوية أو أخطار عضوية أو أخطار عضوية أو
+
+317
+00:25:15,880 --> 00:25:25,580
+أخطار عضوية أو أخطار عضوية أو أخطار عضوية أو
+
+318
+00:25:25,580 --> 00:25:33,630
+أخطار عضوية، إن إحنا أكلنا طبيعتُه مليان بوتاسيوم، فربّ
+
+319
+00:25:33,630 --> 00:25:37,530
+العالمين اللي أَخْلَق الأكل، خلّانا الكلية مصمّمة إنها
+
+320
+00:25:37,530 --> 00:25:42,570
+تطرد بوتاسيوم، وعملها جزء خاص في الـ distal nephron
+
+321
+00:25:42,570 --> 00:25:46,390
+هتكلم عنه، شغله كل يوم يطلع بوتاسيوم، خلايا خاصة
+
+322
+00:25:46,390 --> 00:25:51,830
+لأنّ طبيعة الأكل، إحنا أكلنا cellular، كل اللي بنأكله
+
+323
+00:25:51,830 --> 00:25:56,790
+أكثره فيها cells، والبوتاسيوم جوة الـ cells عالي، مش
+
+324
+00:25:56,790 --> 00:26:01,280
+هيك، تمام؟ البوتاسيوم جوة الـ cells عالي، فده ما اتطلب
+
+325
+00:26:01,280 --> 00:26:04,900
+منّه، أنا كل يوم، طول ما إحنا بناكل لازم نطلع... نطلع
+
+326
+00:26:04,900 --> 00:26:11,680
+بوتاسيوم، فلو البوتاسيوم هذا عالي، آه، hyperkalemia
+
+327
+00:26:11,680 --> 00:26:16,180
+بطّل يطلع في الجسم، وإحنا قلنا الـ system تبع الجسم
+
+328
+00:26:16,180 --> 00:26:19,600
+بناء الجسم، مبني على اتّزان بوتاسيوم، البوتاسيوم فجأة
+
+329
+00:26:19,600 --> 00:26:28,200
+عالي، هيخلّط الدنيا، الـ... الـ nerves، الـ nerve fibers
+
+330
+00:26:28,200 --> 00:26:32,400
+الـ nerves، هتكون إيه؟ الـ... آه، الـ excitation هتبقى
+
+331
+00:26:32,400 --> 00:26:35,560
+هيتغير حسب الـ potassium عليه، أو عليه، والـ cardiac
+
+332
+00:26:35,560 --> 00:26:39,960
+contractility برضه هتتغير حسب الـ potassium عليه، أو
+
+333
+00:26:39,960 --> 00:26:46,160
+عليه، وهيعمل لي مشاكل ضخمة جدًا، طيب، physiology، أنا
+
+334
+00:26:46,160 --> 00:26:49,620
+الآن نخش على الكلية، نبدأ ندرس فيها، إذا عن الـ
+
+335
+00:26:49,620 --> 00:26:52,160
+functions of the kidney are very important
+
+336
+00:26:52,160 --> 00:26:57,120
+different functions، مش كده؟ على مستويات كتير مهمة
+
+337
+00:26:57,120 --> 00:27:01,060
+ومحترمة، طب الكلية هذه كيف بتشتغل؟ what is the
+
+338
+00:27:01,060 --> 00:27:04,740
+structure؟ what is the function؟ how the kidney can
+
+339
+00:27:04,740 --> 00:27:09,000
+get to its function؟ طبعًا لو طلعنا في الكلية
+
+340
+00:27:09,000 --> 00:27:15,180
+و أخذنا قطع هيك sagittal section فيها، أخذنا قطع فيها
+
+341
+00:27:15,180 --> 00:27:19,840
+كده بالعرض، وطلعنا في الكلية، واتمتّعنا فيها كده
+
+342
+00:27:19,840 --> 00:27:25,400
+هنجد إن في في النص what is called pelvis، هذا هو حوض
+
+343
+00:27:25,400 --> 00:27:31,420
+الكلية، تمام؟ حوض الكلية بي... هذا هو عبارة عن
+
+344
+00:27:31,420 --> 00:27:37,300
+اتساع لـ الـ upper ureter، الحالب، هذا نهايته بيتّصل في
+
+345
+00:27:37,300 --> 00:27:41,580
+داخل الكلية، وبيعمل لي حوض الكلية، ومن حوض
+
+346
+00:27:41,580 --> 00:27:46,160
+الكلية بيطلع لي ثلاثة branches، أكبر ثلاثة branches
+
+347
+00:27:46,160 --> 00:27:50,040
+بيطلع outward، في داخل الـ substance، على الكلى، تمام؟
+
+348
+00:27:50,040 --> 00:27:55,050
+الـ upper calyx، والـ middle calyx، والـ lower calyx، هدول الـ
+
+349
+00:27:55,050 --> 00:27:58,690
+calyces بنسميهم major calyces، upper و middle و
+
+350
+00:27:58,690 --> 00:28:05,110
+lower major calyces، الـ upper بتتفرّع لتلاتة صغار، تلاتة
+
+351
+00:28:05,110 --> 00:28:08,910
+minor calyces، هي عبارة عن أنبوب، يعني أنبوب، أنبوب
+
+352
+00:28:08,910 --> 00:28:15,610
+أنبوب، هم حوض، وطالع منه أنبوب، هيك الـ upper، الـ
+
+353
+00:28:15,610 --> 00:28:22,780
+upper calyx، وبيفتح منه ثلاثة صغار، تمام؟ كل واحد بياخد
+
+354
+00:28:22,780 --> 00:28:28,040
+جزء، بي... بي... بيجمع بول من منطقة معينة
+
+355
+00:28:28,040 --> 00:28:32,220
+إذا هذا الحوض بيعمل لي ثلاثة minor calyces، الـ
+
+356
+00:28:32,220 --> 00:28:36,540
+middle، الـ middle major بتعطيني two minor calyces، والـ
+
+357
+00:28:36,540 --> 00:28:39,600
+الـ lower بتعطيني two minor calyces، وهنا الصورة
+
+358
+00:28:39,600 --> 00:28:42,600
+حاطّة لكم حصوة في الـ minor calyx، هذا الـ lower
+
+359
+00:28:42,600 --> 00:28:45,820
+calyx، lower major calyx، هذا واحد من الـ minor
+
+360
+00:28:45,820 --> 00:28:51,980
+calyces، باعثة فيها حصوة، and renal stone stuck في
+
+361
+00:28:51,980 --> 00:28:57,040
+المنطقة هذه، مثلًا، القطع هذا اللي طلعنا فيه إحنا تبع
+
+362
+00:28:57,040 --> 00:29:02,740
+الكلية، إذا في في النص الحوض، وبرا مادة مش فراغ
+
+363
+00:29:02,740 --> 00:29:08,400
+في substance تبع الكلية، هنلاحظ إن اللون بيختلف، برا في
+
+364
+00:29:08,400 --> 00:29:14,780
+لون، وجوة في لون ثاني، تمام؟ واللون اللي جوة هان
+
+365
+00:29:14,780 --> 00:29:21,020
+عامل شكل pyramids، أهرامات، تمام؟ الـ tip تبع الـ
+
+366
+00:29:21,020 --> 00:29:25,710
+pyramid هذا بنسميه papilla، والـ papilla اللي تبتدي
+
+367
+00:29:25,710 --> 00:29:29,110
+على الـ pyramid، دايمًا بتنتهي في minor calyx، يعني الـ
+
+368
+00:29:29,110 --> 00:29:32,410
+minor calyx دي، في نهايتها على الـ papilla هذه، كأنّه
+
+369
+00:29:32,410 --> 00:29:39,090
+كأنّه بيشفط منها الـ urine، بيسحبها، الـ... الـ... الـ wall
+
+370
+00:29:39,090 --> 00:29:41,730
+تبع الـ calyces system، الـ... الـ calyces system
+
+371
+00:29:41,730 --> 00:29:48,070
+هذا الـ wall، هذه فيها فيها smooth muscles، فيها
+
+372
+00:29:48,070 --> 00:29:52,630
+smooth muscles، smooth muscles، هذه بتعمل الـ
+
+373
+00:29:52,630 --> 00:29:59,010
+peristalsis، يعني عن طريق حركتها بتعمل حركة، الحركة
+
+374
+00:29:59,010 --> 00:30:03,270
+الدودية، اللي بتسحب فيها، اللي لما تجمع ball تنتقل
+
+375
+00:30:03,270 --> 00:30:05,850
+الـ ball إلى الـ... إلى الـ... إلى الـ...
+
+376
+00:30:11,380 --> 00:30:19,300
+البول ما بينتقلش من الكلية للمثانة بوزنه، ولا الأكل
+
+377
+00:30:19,300 --> 00:30:23,740
+بنبلعه، من البلعوم للمعدة بوزنه، ولا بتحرك من
+
+378
+00:30:23,740 --> 00:30:27,900
+المعدة، لأنّ إحنا بنبلع، أو بتحرك، إذا كنا نايمين ولا
+
+379
+00:30:27,900 --> 00:30:32,680
+صاحيين ولا عابلين ولا مجلوبين، تفرقش، إذا إن هو بينتقل
+
+380
+00:30:32,680 --> 00:30:37,300
+من مكان إلى مكان، عبر إرادة، في قمر، إنّه ينتقل
+
+381
+00:30:37,300 --> 00:30:40,760
+و الإرادة هذه بتاخدها الـ peristaltic movement، بتاخد
+
+382
+00:30:40,760 --> 00:30:46,680
+معاها الـ drop of urine، بتوصّلها للمثانة البولية
+
+383
+00:30:46,680 --> 00:30:50,120
+تمام؟ يعني مش إن إحنا محتاجين نضلّ واقفين عشان الكلّ
+
+384
+00:30:50,120 --> 00:30:55,340
+يـ... ينزل البول، ويتوصّلوا لـ... لأ، ما لوش علاقة، واقفين
+
+385
+00:30:55,340 --> 00:31:00,040
+ولا مش واقفين؟ إذا في عندي هنا اللونين هيك مختلفين
+
+386
+00:31:00,040 --> 00:31:05,600
+وفي إحنا لاحظين الـ striations، خطوط طولية كده، وإنّ
+
+387
+00:31:05,600 --> 00:31:10,660
+هذه المنطقة اللي برا اللي سمّيناها cortex، هي حقيقة
+
+388
+00:31:10,660 --> 00:31:13,440
+اللي برا أغمق من اللي جوة، اللي جوة مفروض إنّه أفتح
+
+389
+00:31:13,440 --> 00:31:23,880
+الصورة هذه غريبة، إنّه جايبة الـ... الـ cortex، جايبة الـ
+
+390
+00:31:
+
+445
+00:35:35,380 --> 00:35:38,640
+retroperitoneal structure عندي أنا البنكرياس
+
+446
+00:35:38,640 --> 00:35:44,600
+وعندي الـ إيه؟ الكلية. إذا في عندي هنا في الـ
+
+447
+00:35:44,600 --> 00:35:49,300
+retroperitoneal space موجودة الـ kidney، وزن الكلية
+
+448
+00:35:49,300 --> 00:35:56,460
+الواحدة حوالي مئة وخمسين gram، يعني لو حجمها
+
+449
+00:35:56,460 --> 00:36:00,560
+بتعرفوا إزاي حجمها؟ قبضة يعني قبضة يد، مش إيدي أنا لأ.
+
+450
+00:36:00,560 --> 00:36:04,080
+ممكن يعني يعتمد على اللحظة، الكلية مش حجمها ثابت.
+
+451
+00:36:04,080 --> 00:36:09,520
+عند الناس يعني ضخم، حجم الكلية ضخم، والصغيرة
+
+452
+00:36:09,520 --> 00:36:13,280
+صغيرة، وكده. وع فكرة الكلية اليمنى واليسرى
+
+453
+00:36:13,280 --> 00:36:19,040
+برضه، فيبقى... يعني دائماً اليمنى أكبر، وزنها أضخم
+
+454
+00:36:19,040 --> 00:36:23,040
+شوية من اليسرى. تمام؟ حتى يدنا اليمنى اللي مشغل فيها
+
+455
+00:36:23,040 --> 00:36:28,600
+أطول شوية، وأكبر من اليسرى، لكن اليسرى بالعكس، طيب.
+
+456
+00:36:31,420 --> 00:36:35,120
+إذا في عندي الكلية الـ retroperitoneal structure
+
+457
+00:36:35,120 --> 00:36:39,840
+اللي هي كبسولة بتغطيها، والكبسولة هذا كتير مهمة. ليش
+
+458
+00:36:39,840 --> 00:36:43,100
+مهمة؟ ليش مهمة؟ لأن الكلية بتشتغل على نظام الضغط،
+
+459
+00:36:43,100 --> 00:36:46,260
+pressure. إذا في الـ pressure بتعمل filtration، أنا
+
+460
+00:36:46,260 --> 00:36:49,520
+هتكلم عنه بعد شوية. لو الـ pressure هذا موجود هيك
+
+461
+00:36:49,520 --> 00:36:53,700
+باستمرار، موجودة، الكلية بصراحة قابلة إنها تبقى تتوسع،
+
+462
+00:36:54,850 --> 00:36:59,030
+البراشر بيبطل يجيب نتيجة مباشرة على مكانه، جزء منه
+
+463
+00:36:59,030 --> 00:37:02,950
+هيضيع في التوسع، مش هيكون عامل ضغط يعني غير أنت
+
+464
+00:37:02,950 --> 00:37:05,290
+بتحط البراشر في مكان، والمكان بيتوسع على أحلى
+
+465
+00:37:05,290 --> 00:37:09,470
+براشر، لكن البراشر مكان مسكر، والبراشر بتحطه، و
+
+466
+00:37:09,470 --> 00:37:12,930
+تظل عليه، مش هي... والكبسولة هت... بتعمل، هي بتحافظ على
+
+467
+00:37:12,930 --> 00:37:17,280
+إن البراشر اللي جوا اللي جاية يظل يعمل الـ function
+
+468
+00:37:17,280 --> 00:37:21,760
+المطلوب منه، which is filtration مثلاً. في كبسولة
+
+469
+00:37:21,760 --> 00:37:27,320
+حولها موجودة تمنع إن الـ expansion of the kidney
+
+470
+00:37:27,320 --> 00:37:33,980
+إنها جزء مهم في تركيبة الكلية لأنها بتعتمد الكلية
+
+471
+00:37:33,980 --> 00:37:40,610
+اللي في شغلها على الـ brush. إذا في عندنا الـ pyramids،
+
+472
+00:37:40,610 --> 00:37:43,130
+قلنا في عندنا الـ papilla اللي هو طرف الـ pyramid،
+
+473
+00:37:43,130 --> 00:37:46,650
+طرف الـ pyramid. يعني في الـ pelvis بشوف بس الطرف
+
+474
+00:37:46,650 --> 00:37:50,950
+هو اللي طالع، كل طرف pyramid، الـ papilla إليها بتكون
+
+475
+00:37:50,950 --> 00:37:54,330
+إيه؟ calyx. لإنه في الـ pyramid هنلاقي إيه؟ الـ
+
+476
+00:37:54,330 --> 00:37:59,570
+fenestrations، الـ pores، موجودة، الخروم، كل خروم هذا
+
+477
+00:37:59,570 --> 00:38:03,870
+جاي من medulla reduct major، medulla reduct دكتور
+
+478
+00:38:03,870 --> 00:38:09,330
+رئيسية، الدكت الرئيسية هذه. تمام؟ بتطلع هيك لفوق في
+
+479
+00:38:09,330 --> 00:38:11,910
+الحد الكورتكسي، بتطلع طول ما هي في الطريق من
+
+480
+00:38:11,910 --> 00:38:14,770
+الكورتكس لحد ما تصل المكان هذا، بيضل يخش عليها مين؟
+
+481
+00:38:14,770 --> 00:38:22,090
+نيفرونز. يخش عليها نيفرونز، يفضوا فيها، كل فتحة صغيرة
+
+482
+00:38:22,090 --> 00:38:27,850
+هذه، كل فتحة صغيرة هذه بتسحب من أربعة آلاف نيفرون.
+
+483
+00:38:27,850 --> 00:38:33,300
+عندي أنا اثنين وخمسين كرمال بابيلة مختلفة هذه.
+
+484
+00:38:33,300 --> 00:38:38,380
+بتوزع فيها 250 major medullary duct اللي هم
+
+485
+00:38:38,380 --> 00:38:42,240
+بيفتحوا في البابيلة، كل مجموعة من البابيلة، كل
+
+486
+00:38:42,240 --> 00:38:44,840
+بابيلة بتفتح فيها مجموعة من الـ a، من الـ pores،
+
+487
+00:38:44,840 --> 00:38:48,840
+fenestrations، كل واحدة جاية من major duct، الـ major
+
+488
+00:38:48,840 --> 00:38:54,960
+duct الواحدة بتسحب، بتصرف من 4000 نيفرون. عندي 250
+
+489
+00:38:54,960 --> 00:39:01,450
+يعني عندي مليون نيفرون في الـ a، في الكليتين، في
+
+490
+00:39:01,450 --> 00:39:09,790
+الكليتين. عندي إيه؟ مليون نيفرون، تمام؟ إذا
+
+491
+00:39:09,790 --> 00:39:12,870
+قلنا
+
+492
+00:39:12,870 --> 00:39:16,790
+إذا إن أنا إيه؟ الـ major duct هذه بتفتح في الـ pelvis، و
+
+493
+00:39:16,790 --> 00:39:19,790
+بتصرف في الـ minor calyx بالـ peristaltic movement.
+
+494
+00:39:19,790 --> 00:39:24,390
+اليورين طبعاً، هذا بيتجمع أولاً في الـ pelvis،
+
+495
+00:39:24,390 --> 00:39:28,680
+وبعد الـ pelvis، كل ما تتجمع نقطة كافية بتنزل بالسلم
+
+496
+00:39:28,680 --> 00:39:39,340
+النقطة للـ إيه؟ لليوريتر، ماشية لنهاية الـ...
+
+497
+00:39:39,340 --> 00:39:48,040
+حسناً، renal blood flow، رينال
+
+498
+00:39:48,040 --> 00:39:52,560
+blood flow الـ
+
+499
+00:39:52,560 --> 00:40:00,340
+...خمس الدم اللي بيطلع من القلب بيعبر الكلية، مش كله.
+
+500
+00:40:00,340 --> 00:40:05,360
+يعني إذا إحنا الكلية بتشتغل على dilution theory،
+
+501
+00:40:05,360 --> 00:40:10,020
+بتشتغل على أي نظام؟ الـ dilution theory. يعني أنا مش
+
+502
+00:40:10,020 --> 00:40:15,420
+باخد كل الدم وبدخله على الكلية، بصفيه وبطلعه
+
+503
+00:40:15,420 --> 00:40:19,920
+أنظف، مياه، المياه لأ. أنا بضل آخذ خمس الدم أنظفه،
+
+504
+00:40:20,750 --> 00:40:24,730
+تمام، وبرجع النظيف للدم اللي مش نظيف، بيصير mixture،
+
+505
+00:40:24,730 --> 00:40:31,850
+بخفف الـ إيه؟ الـ waste products، تمام؟ بضل آخذ وأنضف، و
+
+506
+00:40:31,850 --> 00:40:35,430
+أرجع نظيف، آخذ وأنضف وأرجع نظيف. فأنا محافظ زي ما
+
+507
+00:40:35,430 --> 00:40:38,510
+على إنه تكون نسبة الـ waste products اللي موجودة
+
+508
+00:40:38,510 --> 00:40:42,890
+علي في الدم منخفضة، مش صفر، لأن أنا مش باخدها يعني مش
+
+509
+00:40:42,890 --> 00:40:46,490
+كل الدم. زي القلب، لازم أعدي على القلب وبعدين يطلع
+
+510
+00:40:46,490 --> 00:40:50,430
+منه. زي الرئتين، الدم كله لازم أعدي على الرئتين، و
+
+511
+00:40:50,430 --> 00:40:55,670
+يطلع منه، لأ. الدم بيعبر خمسة أو أكثر من خمسة وشوية
+
+512
+00:40:55,670 --> 00:40:58,730
+عشان اثنين أو اثنين في المئة من الـ cardiac output
+
+513
+00:40:58,730 --> 00:41:03,810
+بيعدي على إيه؟ على الكلية، وبيروح بيعمل لها غسيل، و
+
+514
+00:41:03,810 --> 00:41:08,470
+تنظيف. برجع اللي هو الـ... الـ... الدم اللي هو
+
+515
+00:41:08,470 --> 00:41:15,750
+باعتباره إنه منقى، للخليط اللي هو أقل يعني جودة،
+
+516
+00:41:15,750 --> 00:41:19,590
+فبيحسن جودته درجة، وهكذا. فعندي عملية dilution،
+
+517
+00:41:19,590 --> 00:41:24,630
+عملية إيه؟ dilution. أنا باخد جزء، بنظفه وبرجعه،
+
+518
+00:41:24,630 --> 00:41:29,350
+بأحافظ على إن الـ level اللي تبع النظافة يظل هو هو.
+
+519
+00:41:29,350 --> 00:41:34,650
+الـ blood supply للكلية مهم، الكلية is a vascular
+
+520
+00:41:34,650 --> 00:41:40,870
+organ. A kidney is a vascular organ. لذلك
+
+521
+00:41:42,300 --> 00:41:47,740
+ما يتعلق بالـ blood pressure والـ blood vessels، إذا
+
+522
+00:41:47,740 --> 00:41:51,080
+أصلاً تغير في الـ... يعني أثر الـ sclerosis زاد، خرب
+
+523
+00:41:51,080 --> 00:41:54,440
+الكلية، لأن الكلية مبنية على إيه؟ على الـ blood
+
+524
+00:41:54,440 --> 00:41:59,400
+vessels، vascular organ. في انخفاض الضغط، خربت الكلية،
+
+525
+00:41:59,400 --> 00:42:02,800
+في ارتفاع الضغط، خربت الكلية، صلّبت الشرايين... الشرايين
+
+526
+00:42:02,800 --> 00:42:08,740
+خربت الكلية، تمام؟ ليش؟ it is a vascular organ. طيب،
+
+527
+00:42:11,130 --> 00:42:15,990
+عندي أنا الـ renal artery، بدخل، أجيب الصورة، الصورة
+
+528
+00:42:15,990 --> 00:42:20,270
+الصورة إنها هنا، okay. عندنا الـ renal artery هو ورينال
+
+529
+00:42:20,270 --> 00:42:23,970
+الـ veins. وجنبها بيدخلوا الـ hilum، طبعاً الـ artery داخل،
+
+530
+00:42:23,970 --> 00:42:30,150
+والـ veins إيه؟ طالع، مش كده؟ طيب، الـ artery بيدخل، الـ renal
+
+531
+00:42:30,150 --> 00:42:35,150
+الـ artery في داخل الـ hilum، بتقسم الـ artery لـ branches،
+
+532
+00:42:35,150 --> 00:42:39,640
+مختلفة، تمام؟ segmental arteries. وبعدين بيجي الـ
+
+533
+00:42:39,640 --> 00:42:41,920
+segmental arteries هذا، بتخش على المناطق المختلفة من
+
+534
+00:42:41,920 --> 00:42:45,380
+الكلية. هذا في الـ... في الـ pelvis، حوالين الـ...
+
+535
+00:42:45,380 --> 00:42:49,560
+حوالين الـ pelvis. يعني الـ pelvis جوا الـ fluid أو الـ
+
+536
+00:42:49,560 --> 00:42:52,900
+urine. آه في... في الـ structure ما بين الفراغ هذا
+
+537
+00:42:52,900 --> 00:42:56,440
+وبين الـ إيه؟ بتشوف بيصير عند الـ segmental، الـ
+
+538
+00:42:56,440 --> 00:43:00,220
+segmental هدول في الآخر بتفرعوا لـ interlobar
+
+539
+00:43:00,220 --> 00:43:04,640
+interlobar branches، بتخش بين الـ loops هذا. إحنا
+
+540
+00:43:04,640 --> 00:43:12,380
+عندنا إيه؟ هذا... هذا loop، loop، loop، loop، interlobar
+
+541
+00:43:12,380 --> 00:43:19,500
+بعدين في عندنا إيه؟ الـ interlobar arteries هذه،
+
+542
+00:43:19,500 --> 00:43:24,720
+بتحول، بتعمل branches، تتحول لـ interlobular بين
+
+543
+00:43:24,720 --> 00:43:31,400
+الـ lobules هذه.
+
+544
+00:43:31,400 --> 00:43:35,120
+الـ inter هنا، الـ interlobular هذا، interlobular، و
+
+545
+00:43:35,120 --> 00:43:41,520
+هذا interlobar. أساسي دخل، وبعدين
+
+546
+00:43:41,520 --> 00:43:47,120
+بيخش بين الـ pyramids، بيخش بين الـ interlobular بين
+
+547
+00:43:47,120 --> 00:43:51,540
+الـ pyramids، والـ interlobular هذا من الجهة هذه، و
+
+548
+00:43:51,540 --> 00:43:54,560
+الجهة هذه، بيعملوا الـ branches كده بتشبك في بعض،
+
+549
+00:43:54,560 --> 00:44:01,260
+فتبقى فاصلة ما بين الـ cortex والـ medulla، وحوالي الـ
+
+550
+00:44:01,260 --> 00:44:05,360
+pyramid، تمام؟ متصلة بينها، وإنها زي ما شايفين هي
+
+551
+00:44:05,360 --> 00:44:13,340
+متصلة. فهذه سميناها arcuate arteries، آه. إذا الـ
+
+552
+00:44:13,340 --> 00:44:18,160
+interlobar هذه بتديني arcuate، هذه... هذه الـ interlobar،
+
+553
+00:44:18,160 --> 00:44:20,260
+هذه البني هذا اللي بيقول، هذا اللي بيقول، هذا الـ
+
+554
+00:44:20,260 --> 00:44:23,680
+interlobar، الـ interlobar arteries بتديني arcuate
+
+555
+00:44:23,680 --> 00:44:28,520
+arteries. بعدين الـ arcuate arteries هذه، الـ arcuate
+
+556
+00:44:28,520 --> 00:44:33,100
+arteries هذه بتطلع منها شبكة هيك طويلة، شكلها كده،
+
+557
+00:44:33,100 --> 00:44:36,380
+radiating هيك، فبنسميها radiating arteries أو
+
+558
+00:44:36,380 --> 00:44:40,300
+interlobular arteries أو إيش؟ interlobular arteries.
+
+559
+00:44:40,300 --> 00:44:43,280
+والـ interlobular arteries هنا، خليني أتكلم عنها
+
+560
+00:44:43,280 --> 00:44:49,340
+هذه، هذا arcuate، هذا جاء من إيش؟ من interlobar هذا،
+
+561
+00:44:49,340 --> 00:44:53,200
+interlobar. آه، الـ interlobar هذا أدّاني branches عملت
+
+562
+00:44:53,200 --> 00:44:57,190
+الـ إيه؟ الـ arcuate هذه،  المظلة هذه، الـ pyramids اعتبروها
+
+563
+00:44:57,190 --> 00:45:00,010
+pyramid لأن هي ماشية، دول، بدي ماشية تحت الـ pyramid،
+
+564
+00:45:00,010 --> 00:45:04,110
+والـ cortex فوقه، مش هيك؟ الـ interlobular arteries هذه،
+
+565
+00:45:04,110 --> 00:45:08,570
+بتطلع، straight interlobular arteries، متجهة في
+
+566
+00:45:08,570 --> 00:45:11,970
+اتجاه الكبسولة، متجهة للـ cortex لفوق، في اتجاه
+
+567
+00:45:11,970 --> 00:45:17,070
+الكبسولة. نسميها interlobular أو نسميها radiating
+
+568
+00:45:17,070 --> 00:45:22,690
+arteries. وكل واحد من هدول هو ماشي يطلع، أفرد، أفرد،
+
+569
+00:45:22,690 --> 00:45:29,250
+أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد،
+
+570
+00:45:29,250 --> 00:45:30,570
+أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد،
+
+571
+00:45:30,570 --> 00:45:31,370
+أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد،
+
+572
+00:45:31,370 --> 00:45:31,870
+أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد،
+
+573
+00:45:31,870 --> 00:45:41,810
+أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد، أفرد،
+
+574
+00:45:42,680 --> 00:45:46,000
+الـ branches هذا، بينطلق afferent artery، الـ afferent artery هذا،
+
+575
+00:45:46,000 --> 00:45:53,640
+هذا هو الصغير، هذا هيخش النيفرون و ويعمل tuft of
+
+576
+00:45:53,640 --> 00:45:58,140
+capillaries، نسميها glomerulus، ويطلع منها على شكل
+
+577
+00:45:58,140 --> 00:46:03,600
+afferent artery، طبعاً؟ إذا عندي إيه؟ الـ... الـ... كل الـ
+
+578
+00:46:03,600 --> 00:46:10,900
+glomerulus من هدول محيط بيها الـ... الـ renal tubule،
+
+579
+00:46:11,380 --> 00:46:16,020
+إن النيفرون عبارة عن إيش؟ عبارة عن glomerulus
+
+580
+00:46:16,020 --> 00:46:21,220
+و renal tubule. الـ glomerulus tuft of capillaries،
+
+581
+00:46:21,220 --> 00:46:23,940
+و renal tubule. فاكرين السير الساك اللي اتكلمنا عنه
+
+582
+00:46:23,940 --> 00:46:30,680
+زمان؟ السير الساك عبارة عن بوب مسكر، هذا الـ... هو الـ
+
+583
+00:46:30,680 --> 00:46:34,880
+tubule. سير الساك زي سير الساك، أنبوب مسكر، أو
+
+584
+00:46:34,880 --> 00:46:39,860
+يعني مفتوح في طرفه السفلي،  تحت هذا المسكر بيجي،
+
+585
+00:46:39,860 --> 00:46:44,100
+بتدخل الـ tuft فيه، تمام؟ فبيصير كأنه الـ... الـ
+
+586
+00:46:44,100 --> 00:46:47,500
+glomerulus هذه اللي جاية من الـ blood vessels داخلة،
+
+587
+00:46:47,500 --> 00:46:51,900
+محاطة بالإيه؟ بـ layer من الـ... الـ layer الداخلية للـ
+
+588
+00:46:51,900 --> 00:46:58,060
+إيش؟ للـ... للـ... للـ... للـ tubule هذه اللي هي
+
+589
+00:46:58,060 --> 00:47:01,240
+الداخلية من الـ tubule. إن هذه المنطقة عاملة زي الـ
+
+590
+00:47:01,240 --> 00:47:05,900
+capsule، محيطة بـ capillary tuft اللي هي الـ
+
+591
+00:47:05,900 --> 00:47:09,200
+glomerulus. إذا في طبقة داخلية حولها، وطبقة
+
+592
+00:47:09,200 --> 00:47:12,560
+خارجية، الفلترة بتنزل فيها، وبتكمل في الـ
+
+593
+00:47:12,560 --> 00:47:17,880
+tubule. تمام؟ هتتضح الصورة بعد شوية. إذا عند
+
+594
+00:47:17,880 --> 00:47:18,660
+glomerulus،
+
+595
+00:47:20,970 --> 00:47:25,250
+ده دم دخل الـ glomerulus، و blood vessels طلعت من الـ
+
+596
+00:47:25,250 --> 00:47:28,230
+glomerulus. هذه اسمها efferent، دخلت والـ afferent
+
+597
+00:47:28,230 --> 00:47:32,810
+بتطلع طبعاً. إذا هذه التركيبة بتاعتها اسمها كل
+
+598
+00:47:32,810 --> 00:47:36,710
+glomerulus. هنا في الآخر مشبوك فيه، فيه الـ tubule، و
+
+599
+00:47:36,710 --> 00:47:40,030
+عاملين مع بعض، عاملين nephron، عاملين nephron، و
+
+600
+00:47:40,030 --> 00:47:43,350
+الـ nephrons، ما هنتكلم عن تركيبتها بعد شوية، لكن هذه
+
+601
+00:47:43,350 --> 00:47:46,790
+التركيبة. إذا هي structure، blood vessel، vascular
+
+602
+00:47:46,790 --> 00:47:53,190
+structure، ومبني عليها باقي الشغل، يعني أول توزيع لـ
+
+603
+00:47:53,190 --> 00:47:57,830
+blood vessels، والـ nephrons بتيجي بتتركب على كل
+
+604
+00:47:57,830 --> 00:48:03,010
+تيوبيول، بيركب على glomerulus، آه، وبيعمل باقي الـ
+
+605
+00:48:03,010 --> 00:48:05,710
+structure تبع النيفرون. فلذلك قلت لك هو vascular
+
+606
+00:48:05,710 --> 00:48:09,490
+structure أساساً. الـ efferent اللي طالع هذا بيروح،
+
+607
+00:48:09,490 --> 00:48:14,930
+بيعمل أشياء أخرى، بيجي بيكمل شغله، بيعمل network،
+
+608
+00:48:20,030 --> 00:48:23,970
+هي الـ arcuate artery، هي الـ interlobular أو الـ radiating
+
+609
+00:48:23,970 --> 00:48:28,090
+artery، هي الـ afferent عاملة هنا للـ glomerulus، وهي
+
+610
+00:48:28,090 --> 00:48:32,690
+الـ Bowman's capsule. هذا الفرق بتاع
+
+667
+00:53:15,700 --> 00:53:21,100
+system دعم إضافي تمام؟ إذا هنطلع لما ندرس ال
+
+668
+00:53:21,100 --> 00:53:25,880
+glomerular الـ glomerular structure هنفاجأ أنها مش
+
+669
+00:53:25,880 --> 00:53:30,700
+بس الـ capillary wall هي اللي نهاية المطاف هنا لأ
+
+670
+00:53:30,700 --> 00:53:32,680
+لو على الـ capillary wall  الضغط العالي هيرها مش
+
+671
+00:53:32,680 --> 00:53:36,800
+هتخربها، هيمزقها لأ فيها support هنلاقي support
+
+672
+00:53:36,800 --> 00:53:43,180
+خارجي لها ماسكها هيك حتى أنها إيه لا تنفجر والـ
+
+673
+00:53:43,180 --> 00:53:46,380
+support هذا مش مؤثر على أن الـ pores بيطلع منها
+
+674
+00:53:46,380 --> 00:53:49,540
+الفلتريت عادي زي أي مكان تاني بس يعمل لها support
+
+675
+00:53:49,540 --> 00:53:53,040
+هنا وهنا وهنا خارج الـ pores حتى يمنعها من الضغط
+
+676
+00:53:53,040 --> 00:53:57,840
+العالي هذا على سنوات طويلة أنه ما يتأثرش، تمام؟
+
+677
+00:53:57,840 --> 00:54:02,720
+لذلك بنلاحظ إحنا أنه الـ structure بتمشي مع أن إحنا
+
+678
+00:54:02,720 --> 00:54:07,540
+شغلتنا متميزة غير عن الكابيلاريات تانية لذلك ضغطه عالي
+
+679
+00:54:07,540 --> 00:54:10,700
+okay فالـ structure كمان غيرت، الـ structure أخد دعم
+
+680
+00:54:10,700 --> 00:54:18,580
+إضافي عشان يمنع الـ كيلية مع العمر، مع العمر
+
+681
+00:54:18,580 --> 00:54:22,400
+الكلية بيصلها degeneration النفرونات هذه بعد سن
+
+682
+00:54:22,400 --> 00:54:29,480
+أربعين، بيلاحظ أنه من سن أربعين لسن ثمانين، من سن
+
+683
+00:54:29,480 --> 00:54:33,500
+أربعين لسن ثمانين، أربعين سنة يعني أربعين في المئة من
+
+684
+00:54:33,500 --> 00:54:38,290
+النفرونات بيصلها degeneration and atrophy تمام؟ لِذَا
+
+685
+00:54:38,290 --> 00:54:42,070
+إحنا مع العمر الكلية الـ functioning units بتاعتها
+
+686
+00:54:42,070 --> 00:54:46,390
+اللي هي الـ nephrons بتقل بتقل بتقل مع العمر يعني على
+
+687
+00:54:46,390 --> 00:54:49,310
+سن الثمانين بنلاقي موجود عندنا فقدنا أربعين في
+
+688
+00:54:49,310 --> 00:54:51,810
+المئة من الـ nephrons اللي إحنا
+
+689
+00:54:51,810 --> 00:54:56,150
+بدناها وإحنا في سن الأربعين، يعني لحد سن الأربعين
+
+690
+00:54:56,150 --> 00:55:01,830
+بتظل كما هي، آه وبعدين بعدين أربعين حتى إذا بلغ
+
+691
+00:55:01,830 --> 00:55:10,180
+أشدّه وبلغ أربعين سنة، آه أشد الأربعين بعد الأربعين
+
+692
+00:55:10,180 --> 00:55:18,380
+بيبدأ الكلية تهبط شوية شوية، الـ testosterone بيظل
+
+693
+00:55:18,380 --> 00:55:22,480
+ممتاز  لأربعين، بعد الأربعين كل سنة بنخفض.. بنخفض
+
+694
+00:55:22,480 --> 00:55:26,040
+واحد في المئة يوميا، فالقرآن ذكر لنا أنه أشد
+
+695
+00:55:26,040 --> 00:55:32,220
+الإنسان على أربعين، تمام؟ بيظل يقوى ويبدع وعنده
+
+696
+00:55:32,220 --> 00:55:36,920
+نشاط أكثر وكده وقوة أكثر و structure كمان أكثر
+
+697
+00:55:36,920 --> 00:55:40,400
+الرقم هذا رقم علمي مش من القرآن، إحنا جبناها بس
+
+698
+00:55:40,400 --> 00:55:45,440
+القرآن ذكر أربعين سنة تمام؟ فبعدها بيبدأ يهبط الـ
+
+699
+00:55:45,440 --> 00:55:49,220
+testosterone في الجسم وبيبدأ يهبط الـ .. الـ .. الـ
+
+700
+00:55:49,220 --> 00:55:54,100
+nephrons مش كده؟ عددها بيبدأ يقل وكمان بالمرة
+
+701
+00:55:55,240 --> 00:55:59,340
+الكالسيتونين اللي بيبني في العظم بيبدأ ينخفض
+
+702
+00:55:59,340 --> 00:56:02,560
+التاني، إذا في عندنا أشياء بعد سنة أربعين تبدأ
+
+703
+00:56:02,560 --> 00:56:08,900
+إيه؟ تنخفض وما نعمرها ونُنكسها في الخلق، فبيصير جسمنا
+
+704
+00:56:08,900 --> 00:56:15,520
+يضعف، نتفاني، نتفاني، نتفاني، طيب إذا
+
+705
+00:56:15,520 --> 00:56:22,400
+عندنا الـ glomerulus في ضغط في الـ afferent تمام؟ والضغط
+
+706
+00:56:22,400 --> 00:56:26,490
+هذا هو اللي بيعمل filtration، الضغط هذا مضبوط بشكل
+
+707
+00:56:26,490 --> 00:56:33,310
+معين، بإمكاننا أنه نزوده أو نقلله، اللي بيحكمه تمام
+
+708
+00:56:33,310 --> 00:56:39,010
+النفرون نفسه، جديش بيصله في الـ trade الأشياء
+
+709
+00:56:39,010 --> 00:56:44,790
+في داخل النفرون، مناطق حساسة، مثلاً إن الماكولا دي نسيت
+
+710
+00:56:44,790 --> 00:56:50,470
+منطقة حساسة حسب كده بيصلها بتقول له: الضغط زود الضغط
+
+711
+00:56:50,470 --> 00:56:53,610
+شوية أو قلل الضغط شوية، إذا في عندي afferent و
+
+712
+00:56:53,610 --> 00:56:58,450
+efferent arteriole، لو الـ afferent فتح زيادة الضغط
+
+713
+00:56:58,450 --> 00:57:01,970
+اللي بيخش على الـ glomerulus بيزيد، لو الـ
+
+714
+00:57:01,970 --> 00:57:07,160
+efferent فتح شوية آه، الضغط اللي في الـ glomerulus بيقل، مش كده؟
+
+715
+00:57:07,160 --> 00:57:10,940
+فإذا عندي control هان بين الـ resistance والـ
+
+716
+00:57:10,940 --> 00:57:13,920
+dilatation تبع الـ afferent والـ efferent، فبيظبط لي
+
+717
+00:57:13,920 --> 00:57:17,720
+الضغط اللي لازم للـ filtration، مش كده؟ وعندي كمان
+
+718
+00:57:17,720 --> 00:57:22,450
+أنا شوية وشوية صغيرة حولنا فيها، أنا الـ renin، الرنين
+
+719
+00:57:22,450 --> 00:57:26,050
+لو الضغط واطئ كمان بيبقى يقول له: عالي شوية، إذا
+
+720
+00:57:26,050 --> 00:57:28,290
+أنا الضغط في الكلية، بينما أقدر أتحكم فيه في
+
+721
+00:57:28,290 --> 00:57:32,530
+النفرون في عدة.. عدة أماكن، الرنين اللي بيطلع
+
+722
+00:57:32,530 --> 00:57:37,590
+بيحكم لي في الأنجيوتنسين 2 والضغط العام وفي locally
+
+723
+00:57:37,590 --> 00:57:42,370
+بظبط الـ إيه لأزود شوية، الضغط العام كويس لكن أنه
+
+724
+00:57:42,370 --> 00:57:45,490
+إيه الـ .. الـ .. الـ load اللي وصل، الـ load تبع الـ
+
+725
+00:57:45,490 --> 00:57:49,770
+filtration اللي وصل، الـ distillate will be عالي، مش
+
+726
+00:57:49,770 --> 00:57:53,550
+جادر له، أنا أخفف الـ filtration، ما بأخفف الضغط عشان
+
+727
+00:57:53,550 --> 00:57:56,890
+يقل الـ filtration عشان اللي ماشي في الـ tubule
+
+728
+00:57:56,890 --> 00:58:01,910
+ما يطلع كمية لأ، لازم يكون under control، فبيصير
+
+729
+00:58:01,910 --> 00:58:05,490
+الـ load تبع النفرون حسب قدرة النفرون، لو الـ load
+
+730
+00:58:05,490 --> 00:58:09,670
+زاد ع طول في إشارة إن الـ tubular glomerular reflex
+
+731
+00:58:09,670 --> 00:58:13,670
+tubular glomerular balance لحيث أنه الـ filtration
+
+732
+00:58:13,670 --> 00:58:20,120
+يتناسب مع قدرة الـ tubule عشان ما يكونش فيه
+
+733
+00:58:20,120 --> 00:58:24,700
+عندي electrolytes أو water مش جادر أتحكم فيها لأن
+
+734
+00:58:24,700 --> 00:58:27,880
+لو أنا زاد عندي الضغط والـ filtration زاد فجأة
+
+735
+00:58:27,880 --> 00:58:32,480
+بنلاقي إحنا صار عندنا diuresis صار عندنا بول كتير
+
+736
+00:58:32,480 --> 00:58:37,460
+بيطلع، آه hypertension بتاع بيعمل لي إيه؟ diuresis
+
+737
+00:58:37,460 --> 00:58:43,220
+الجسم بعد شوية بيحاول يضبطه، تمام؟ فـ .. فـ .. فـ في ..
+
+738
+00:58:43,220 --> 00:58:48,070
+الضغط لو زاد لكن عندي الـ nephron مُركّب، إذا الأمور
+
+739
+00:58:48,070 --> 00:58:53,130
+كويسة مظبوطة، أي زيادة في آخر النفرون بيقول: أنا هذا
+
+740
+00:58:53,130 --> 00:58:57,170
+متوجع، أنا يجيني أقل من هيك، ليه جايني كتير؟ قلل الـ
+
+741
+00:58:57,170 --> 00:59:01,290
+filtration، وأحسن طريقة لتقليل الـ filtration يا إما
+
+742
+00:59:01,290 --> 00:59:07,220
+نوسع الـ efferent arteriole بيقلل الضغط يا إما نضيق
+
+743
+00:59:07,220 --> 00:59:10,780
+الـ afferent أو نفتح الكلية هي الـ control، ففي عندي أنا
+
+744
+00:59:10,780 --> 00:59:15,740
+هنا في المنطقة هذه by adjusting the resistance of
+
+745
+00:59:15,740 --> 00:59:18,640
+the afferent and efferent arteriole the kidneys
+
+746
+00:59:18,640 --> 00:59:22,280
+can regulate the hydrostatic pressure in both the
+
+747
+00:59:22,280 --> 00:59:24,780
+glomerular and peritubular capillaries، وهذه اللي
+
+748
+00:59:24,780 --> 00:59:31,420
+هي مبنية عليها كل الـ function تبع الكلية، طيب الـ
+
+749
+00:59:31,420 --> 00:59:35,600
+nephron is the functional unit of the kidney، نفرون
+
+750
+00:59:35,600 --> 00:59:38,860
+أتكلم عن نفرون، إذا الآن النفرون، اتكلمنا عن الـ
+
+751
+00:59:38,860 --> 00:59:43,560
+blood vessels تبع الـ .. لأن هي vascular آه
+
+752
+00:59:43,560 --> 00:59:47,760
+جداً، وعلى حسب الـ blood تركيبة التوزيع، عن جمال تبع الـ
+
+753
+00:59:47,760 --> 00:59:51,420
+blood vessels، التوزيع فيها مُركّب النفرون، تمام؟ طيب
+
+754
+00:59:51,420 --> 00:59:54,440
+النفرون هذا الآن عبارة عن إيش؟ عبارة عن glomerulus
+
+755
+00:59:54,440 --> 00:59:58,760
+وعن tubule مش كده؟ glomerulus و tubule
+
+756
+01:00:01,880 --> 01:00:06,600
+glomerulus، هي glomerulus، نرجع عن أن الـ afferent
+
+757
+01:00:06,600 --> 01:00:10,900
+اللي جاي يوزع لي tuft، هنطلع afferent أقوى
+
+758
+01:00:10,900 --> 01:00:14,760
+tubule، الـ tubule، عندنا أول شيء الـ Bowman's
+
+759
+01:00:14,760 --> 01:00:18,440
+capsule، أول tubule فيها layer مُحيطة بالإيه؟
+
+760
+01:00:18,440 --> 01:00:22,280
+بالـ glomerulus وlayer خارجية، تمام؟ إذا الـ
+
+761
+01:00:22,280 --> 01:00:25,620
+filtration اللي بيحصل هنا بيخش في داخل الـ tubule، هنا
+
+762
+01:00:25,620 --> 01:00:30,250
+هنلاقي الـ .. الـ .. الـ.. إحنا مجشرين الـ Bowman's capsule
+
+763
+01:00:30,250 --> 01:00:34,030
+عشان نطلع في داخلها وهي الـ tubule .. الـ tubule آه
+
+764
+01:00:34,030 --> 01:00:40,330
+عوض زحمة الـ tubule، هنا هذه .. هذه .. آه الـ tubule
+
+765
+01:00:40,330 --> 01:00:48,150
+هذه طويلة، long tubule، طبعاً الـ structure تبعها أول
+
+766
+01:00:48,150 --> 01:00:50,370
+.. قلنا أول شيء في الـ tubule عندي أنا الـ Bowman's
+
+767
+01:00:50,370 --> 01:00:57,220
+capsule اللي بتحيط بالـ إيه؟ بالـ .. آه فيه اسم
+
+768
+01:00:57,220 --> 01:01:01,560
+كان زمان نستخدمه إحنا، لكن اتغيّر، بطل في الكتب تبعكم
+
+769
+01:01:01,560 --> 01:01:05,940
+اسمه الـ مالبيجيان كوربسكل، لو مرة عليكم تفهموه الـ
+
+770
+01:01:05,940 --> 01:01:11,540
+مالبيجيان كوربسكل هذا عبارة عن الـ glomerulus اللي
+
+771
+01:01:11,540 --> 01:01:14,700
+هو الـ glomerulus، الـ arterial .. الـ vascular side والـ
+
+772
+01:01:14,700 --> 01:01:18,100
+Bowman's capsule، الـ tubular side مش هيك؟ يعني
+
+773
+01:01:18,100 --> 01:01:21,660
+هذا tubular part وهذا .. إثنين مع بعض اسمها
+
+774
+01:01:21,660 --> 01:01:25,740
+مالبيجيان كوربسكل، اسمها مالبيجيان كوربسكل، إذا هذه
+
+775
+01:01:25,740 --> 01:01:29,560
+مالبيجيان كوربسكل اللي هي الـ glomerulus مع الـ tubule
+
+776
+01:01:29,560 --> 01:01:33,760
+اللي فيها، آه، إذا عندي glomerulus و Bowman's capsule
+
+777
+01:01:33,760 --> 01:01:37,740
+بتحيطها، مالبيجيان كوربسكل، وبعدين بيجي عندي أنا هنا
+
+778
+01:01:37,740 --> 01:01:43,600
+proximal tubule، بس بما أنها ملتوية كتير سميناها
+
+779
+01:01:43,600 --> 01:01:47,280
+convoluted، إذا عندي proximal convoluted tubule مش
+
+780
+01:01:47,280 --> 01:01:54,170
+كده؟ وكل ما أخرها بيصير مش convoluted بيصير straight
+
+781
+01:01:54,170 --> 01:01:58,170
+آخرها بيصير straight لكن اسمها proximal
+
+782
+01:01:58,170 --> 01:02:03,110
+convoluted، تنتهي بـ loop of Henle، الـ loop of
+
+783
+01:02:03,110 --> 01:02:06,870
+Henle هذا عنده descending part أو ascending part
+
+784
+01:02:06,870 --> 01:02:13,110
+بيرجع الـ loop of Henle، بيعمل لي كمان مرة distal
+
+785
+01:02:13,110 --> 01:02:15,910
+convoluted، إذا في عندي proximal convoluted
+
+786
+01:02:15,910 --> 01:02:21,550
+وعندي distal convoluted، تمام؟ والدكتور الكمبيوتر
+
+787
+01:02:21,550 --> 01:02:22,290
+بنيّها لهذه
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/kNeSNUFp40Q_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/kNeSNUFp40Q_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..b3e1a8f63810efa306d2e16688021744d2e99d9a
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/kNeSNUFp40Q_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2858, "start": 7.44, "end": 28.58, "text": "بسم الله الرحمن الرحيم السلام عليكم و رحمة الله اتكلمنا المخادرة الماضية عن العوامل اللي بتعمل ال regulation ل ال ventilation فقولنا عندنا ال carbon dioxide blood level of carbon dioxide is the most important", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 21136, 37440, 25894, 24793, 4032, 12602, 35571, 3660, 21984, 1975, 2655, 4117, 19528, 8315, 9673, 9778, 18513, 25720, 9673, 46958, 10632, 18871, 18863, 2407, 10943, 1211, 13672, 1829, 39894, 25957, 1211, 2423, 15062, 5296, 2423, 29553, 6156, 39648, 8315, 43242, 8315, 2423, 5954, 19590, 3390, 1496, 295, 5954, 19590, 307, 264, 881, 1021], "avg_logprob": -0.22358630526633488, "compression_ratio": 1.6758241758241759, "no_speech_prob": 0.0, "words": [{"start": 7.440000000000005, "end": 8.240000000000002, "word": "بسم", "probability": 0.266815185546875}, {"start": 8.240000000000002, "end": 9.04, "word": " الله", "probability": 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"end": 17.5, "word": " اللي", "probability": 0.761474609375}, {"start": 17.5, "end": 17.88, "word": " بتعمل", "probability": 0.98583984375}, {"start": 17.88, "end": 17.98, "word": " ال", "probability": 0.456787109375}, {"start": 17.98, "end": 18.58, "word": " regulation", "probability": 0.91748046875}, {"start": 18.58, "end": 19.18, "word": " ل", "probability": 0.72021484375}, {"start": 19.18, "end": 19.78, "word": " ال", "probability": 0.56591796875}, {"start": 19.78, "end": 22.62, "word": " ventilation", "probability": 0.95703125}, {"start": 22.62, "end": 23.8, "word": " فقولنا", "probability": 0.6451009114583334}, {"start": 23.8, "end": 24.12, "word": " عندنا", "probability": 0.630615234375}, {"start": 24.12, "end": 24.28, "word": " ال", "probability": 0.85693359375}, {"start": 24.28, "end": 24.52, "word": " carbon", "probability": 0.93310546875}, {"start": 24.52, "end": 24.94, "word": " dioxide", "probability": 0.9208984375}, {"start": 24.94, "end": 25.72, "word": " blood", 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"end": 265.66, "text": "during exercise بيزيد عندنا ال ventilation بحيث نلاحظ احنا دايما عندنا ثبت ال carbon dioxide concentration او partial pressure و ال oxygen partial pressure و ال hydrogen ions يعني ال changes اللي بتصير", "tokens": [67, 1345, 5380, 4724, 1829, 11622, 25708, 43242, 8315, 2423, 29553, 4724, 5016, 1829, 12984, 8717, 15040, 5016, 19913, 1975, 5016, 8315, 11778, 47302, 15042, 43242, 8315, 38637, 3555, 2655, 2423, 5954, 19590, 9856, 1975, 2407, 14641, 3321, 4032, 2423, 9169, 14641, 3321, 4032, 2423, 12697, 27362, 37495, 22653, 2423, 2962, 13672, 1829, 39894, 9381, 13546], "avg_logprob": -0.11711896720685457, "compression_ratio": 1.5085714285714287, "no_speech_prob": 0.0, "words": [{"start": 248.26, "end": 249.22, "word": "during", "probability": 0.6239013671875}, {"start": 249.22, "end": 250.18, "word": " exercise", "probability": 0.90478515625}, {"start": 250.18, "end": 251.32, "word": " بيزيد", "probability": 0.9794921875}, {"start": 251.32, "end": 251.78, "word": " 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يضعف، يضعف، يضعف، يضعف، بعدين بزيد، بزيد، بزيد، بزيد، بزيد، بعدين ببدأ يضعف، يضعف، يضعف، أحيانا بيبقى في عندي فترة من التوقف الكامل بينهم وأحيانا بيجيش توقف كامل يعني ال ventilation rate بحبر للآخر", "tokens": [41361, 2423, 4127, 9570, 37495, 22653, 9570, 4724, 1829, 3555, 4587, 7578, 48812, 3615, 33911, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 39182, 9957, 4724, 44510, 10721, 7251, 11242, 3615, 5172, 12399, 7251, 11242, 3615, 5172, 12399, 7251, 11242, 3615, 5172, 12399, 7251, 11242, 3615, 5172, 12399, 39182, 9957, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 4724, 11622, 25708, 12399, 39182, 9957, 4724, 44510, 10721, 7251, 11242, 3615, 5172, 12399, 7251, 11242, 3615, 5172, 12399, 7251, 11242, 3615, 5172, 12399, 5551, 5016, 1829, 7649, 995, 4724, 1829, 3555, 4587, 7578, 8978, 18871, 16254, 6156, 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"probability": 0.788543701171875}, {"start": 1593.65, "end": 1594.21, "word": " بزيد،", "probability": 0.86669921875}, {"start": 1594.21, "end": 1594.63, "word": " بزيد،", "probability": 0.9691162109375}, {"start": 1594.63, "end": 1595.01, "word": " بزيد،", "probability": 0.959716796875}, {"start": 1595.01, "end": 1595.39, "word": " بزيد،", "probability": 0.9696044921875}, {"start": 1595.39, "end": 1595.67, "word": " بزيد،", "probability": 0.970458984375}, {"start": 1595.67, "end": 1596.17, "word": " بزيد،", "probability": 0.9405517578125}, {"start": 1596.17, "end": 1597.09, "word": " بعدين", "probability": 0.703369140625}, {"start": 1597.09, "end": 1597.33, "word": " ببدأ", "probability": 0.8025716145833334}, {"start": 1597.33, "end": 1597.67, "word": " يضعف،", "probability": 0.9767578125}, {"start": 1597.67, "end": 1597.93, "word": " يضعف،", "probability": 0.9955078125}, {"start": 1597.93, "end": 1598.21, "word": " يضعف،", "probability": 0.9904296875}, {"start": 1598.21, "end": 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0.92138671875}, {"start": 3625.18, "end": 3625.76, "word": " تبعهم", "probability": 0.9581298828125}, {"start": 3625.76, "end": 3626.58, "word": " الأفضل", "probability": 0.9434814453125}, {"start": 3626.58, "end": 3626.72, "word": " ان", "probability": 0.69091796875}, {"start": 3626.72, "end": 3627.08, "word": " يستخدم", "probability": 0.840087890625}, {"start": 3627.08, "end": 3627.2, "word": " ال", "probability": 0.669921875}, {"start": 3627.2, "end": 3627.48, "word": " ash", "probability": 0.309814453125}], "temperature": 1.0}, {"id": 147, "seek": 365831, "start": 3629.07, "end": 3658.31, "text": "cpap continuous positive air airway pressure اه فتمام cpap هذا اليوم هيك بنكون خلصنا الفصل هذا اللي هو بيظل عندنا فصل واحد نتكلم فيه ان شاء الله بده محاضرتين تقريبا يعني التلاتة اللي جاي والأحد اللي جاي بنكون ان شاء الله خلصنا ال ايه ال respiratory system", "tokens": [66, 79, 569, 10957, 3353, 1988, 1988, 676, 3321, 1975, 3224, 6156, 39237, 10943, 269, 79, 569, 23758, 45595, 20498, 39896, 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3636.85, "word": " airway", "probability": 0.5736083984375}, {"start": 3636.85, "end": 3637.19, "word": " pressure", "probability": 0.9365234375}, {"start": 3637.19, "end": 3637.79, "word": " اه", "probability": 0.56109619140625}, {"start": 3637.79, "end": 3638.81, "word": " فتمام", "probability": 0.8019205729166666}, {"start": 3638.81, "end": 3640.27, "word": " cpap", "probability": 0.7269694010416666}, {"start": 3640.27, "end": 3641.25, "word": " هذا", "probability": 0.79150390625}, {"start": 3641.25, "end": 3642.81, "word": " اليوم", "probability": 0.891357421875}, {"start": 3642.81, "end": 3643.07, "word": " هيك", "probability": 0.6878662109375}, {"start": 3643.07, "end": 3643.33, "word": " بنكون", "probability": 0.786865234375}, {"start": 3643.33, "end": 3643.95, "word": " خلصنا", "probability": 0.98193359375}, {"start": 3643.95, "end": 3644.79, "word": " الفصل", "probability": 0.9658203125}, {"start": 3644.79, "end": 3645.17, "word": " هذا", "probability": 0.8642578125}, {"start": 3645.17, "end": 3646.01, "word": " اللي", "probability": 0.94287109375}, {"start": 3646.01, "end": 3646.35, "word": " هو", "probability": 0.98291015625}, {"start": 3646.35, "end": 3647.15, "word": " بيظل", "probability": 0.841796875}, {"start": 3647.15, "end": 3647.49, "word": " عندنا", "probability": 0.903076171875}, {"start": 3647.49, "end": 3647.81, "word": " فصل", "probability": 0.951416015625}, {"start": 3647.81, "end": 3648.29, "word": " واحد", "probability": 0.99267578125}, {"start": 3648.29, "end": 3649.05, "word": " نتكلم", "probability": 0.8975830078125}, {"start": 3649.05, "end": 3649.81, "word": " فيه", "probability": 0.990478515625}, {"start": 3649.81, "end": 3650.03, "word": " ان", "probability": 0.79443359375}, {"start": 3650.03, "end": 3650.23, "word": " شاء", "probability": 0.986328125}, {"start": 3650.23, "end": 3650.41, "word": " الله", "probability": 0.94140625}, {"start": 3650.41, "end": 3650.69, "word": " بده", "probability": 0.4893798828125}, {"start": 3650.69, "end": 3651.37, "word": " محاضرتين", "probability": 0.96298828125}, {"start": 3651.37, "end": 3651.95, "word": " تقريبا", "probability": 0.996484375}, {"start": 3651.95, "end": 3652.81, "word": " يعني", "probability": 0.927001953125}, {"start": 3652.81, "end": 3653.73, "word": " التلاتة", "probability": 0.9306640625}, {"start": 3653.73, "end": 3653.89, "word": " اللي", "probability": 0.6781005859375}, {"start": 3653.89, "end": 3654.05, "word": " جاي", "probability": 0.6727294921875}, {"start": 3654.05, "end": 3654.43, "word": " والأحد", "probability": 0.7801106770833334}, {"start": 3654.43, "end": 3654.59, "word": " اللي", "probability": 0.98486328125}, {"start": 3654.59, "end": 3654.71, "word": " جاي", "probability": 0.837158203125}, {"start": 3654.71, "end": 3654.97, "word": " بنكون", "probability": 0.804931640625}, {"start": 3654.97, "end": 3655.11, "word": " ان", "probability": 0.890625}, {"start": 3655.11, "end": 3655.23, "word": " شاء", "probability": 0.99267578125}, {"start": 3655.23, "end": 3655.35, "word": " الله", "probability": 0.9267578125}, {"start": 3655.35, "end": 3655.85, "word": " خلصنا", "probability": 0.9918212890625}, {"start": 3655.85, "end": 3656.05, "word": " ال", "probability": 0.94287109375}, {"start": 3656.05, "end": 3656.67, "word": " ايه", "probability": 0.7674153645833334}, {"start": 3656.67, "end": 3656.83, "word": " ال", "probability": 0.78857421875}, {"start": 3656.83, "end": 3657.35, "word": " respiratory", "probability": 0.861328125}, {"start": 3657.35, "end": 3658.31, "word": " system", "probability": 0.9658203125}], "temperature": 1.0}, {"id": 148, "seek": 366086, "start": 3659.02, "end": 3660.86, "text": "واللي عندها السؤال أحلى وسهلة", "tokens": [2407, 6027, 20292, 43242, 11296, 21136, 33604, 6027, 5551, 5016, 23942, 46952, 3224, 37977], "avg_logprob": -0.3401041626930237, "compression_ratio": 0.9473684210526315, "no_speech_prob": 0.0, "words": [{"start": 3659.02, "end": 3659.66, "word": "واللي", "probability": 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lZxsHIknvb0_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lZxsHIknvb0_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..b6f7a083b53a6eac4c1c39fef7efc12d62392ed5
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lZxsHIknvb0_postprocess.srt
@@ -0,0 +1,3960 @@
+1
+00:00:06,140 --> 00:00:11,440
+نواصل الحديث عن ال ventilation و هنتكلم عن
+
+2
+00:00:11,440 --> 00:00:17,040
+alveolar air و قولنا ال alveolar air هذا المنطقة
+
+3
+00:00:17,040 --> 00:00:19,980
+اللي بتمن خلالها تبدل الغازات فهي منطقة مهمة
+
+4
+00:00:19,980 --> 00:00:24,520
+بالنسبالنا و التعرف عليها مهم لإن هي فيها air
+
+5
+00:00:24,520 --> 00:00:30,480
+مختلف عن ال atmospheric air و مختلف عن ال blood
+
+6
+00:00:30,480 --> 00:00:34,840
+gases هي مرحلة ما بين اتنين atmospheric air
+
+7
+00:00:38,020 --> 00:00:44,140
+بيدخل الرئتين بتركيز
+
+8
+00:00:44,140 --> 00:00:50,500
+أكسجين مثلا 160 ميلي متر ميركوري بصله
+
+9
+00:00:50,500 --> 00:00:59,260
+humidification هو نازل بيصل ال alveolar area على
+
+10
+00:00:59,260 --> 00:01:05,480
+149 ميلي متر ميركوريلكن هذه المنطقة فيها باستمرار
+
+11
+00:01:05,480 --> 00:01:12,320
+diffusion of oxygen to the blood وعنا في more
+
+12
+00:01:12,320 --> 00:01:16,340
+carbon dioxide is executed in this area لذلك
+
+13
+00:01:16,340 --> 00:01:21,780
+التركيب تبعها لا هو مشابه ال humidified air ولا هو
+
+14
+00:01:21,780 --> 00:01:24,120
+مشابه ال blood gases
+
+15
+00:01:26,500 --> 00:01:28,900
+لو طلعنا في ال blood gases ها نحن نلاقي ان ال
+
+16
+00:01:28,900 --> 00:01:33,340
+oxygen مثلا اربعين ملي متر مركوري تركيزه و ال
+
+17
+00:01:33,340 --> 00:01:38,560
+carbon dioxide خمسة و أربعين ملي متر مركوري تركيزه
+
+18
+00:01:38,560 --> 00:01:43,420
+برشا pressure تبعه في حين ان ال humidified air
+
+19
+00:01:43,420 --> 00:01:49,320
+اللي دخل مية تسعة و أربعين اللي
+
+20
+00:01:49,320 --> 00:01:54,880
+هو ال oxygen و ال carbon dioxide إلى حد ما zeroفي
+
+21
+00:01:54,880 --> 00:01:59,840
+المنطقة هذه اللي بتاخد منها oxygen وبنحط لها تاني
+
+22
+00:01:59,840 --> 00:02:03,640
+سيكربون وبدخل لها oxygen بالتركيز اللي اتكلمنا عنه
+
+23
+00:02:03,640 --> 00:02:08,620
+من دي شوية، بيبتدى ان هاد المنطقة نلاقي ان التركيز
+
+24
+00:02:08,620 --> 00:02:12,760
+فيها مختلف عن ايهعن لهن و لهن لإن هي منطقة واسكتة
+
+25
+00:02:12,760 --> 00:02:17,200
+بين الاتنين ملاجة البرشر برشر او أكسجين 104 ميلي
+
+26
+00:02:17,200 --> 00:02:22,180
+متر ميركوري ملاجة البرشر برشر او كاربون ديوكسايد
+
+27
+00:02:22,180 --> 00:02:28,140
+40 ميلي متر ميركوري لإن الخلط ما بين ال 45 و ال 0
+
+28
+00:02:28,140 --> 00:02:32,400
+تصل ل 40 و الخلط ما بين ال 40 ميلي متر ميركوري
+
+29
+00:02:32,400 --> 00:02:41,890
+اكسجين و ال 147 تصل لل 104 لذلك ملاجة الفي الأوضاع
+
+30
+00:02:41,890 --> 00:02:46,470
+النموذجية ميلاج الأكسجين برشا برشا تبعه إيه مية و
+
+31
+00:02:46,470 --> 00:02:50,330
+أربعة ميلي متر ميركوري لذلك هذه لو نقصت بيزيد ال
+
+32
+00:02:50,330 --> 00:02:54,870
+ventilation لو زادت بتعاود تحدي ال ventilation فهي
+
+33
+00:02:54,870 --> 00:02:58,450
+من نوع من الرواعي ال ايه ال stability ان يكون عندي
+
+34
+00:02:58,450 --> 00:03:03,190
+ال alveolar air ثابت التركيبة تبعته تمام؟ اذا احنا
+
+35
+00:03:03,190 --> 00:03:06,850
+بيدخل عندنا على ال alveolar air ال alveolar
+
+36
+00:03:06,850 --> 00:03:10,170
+respirationهيقولنا alveolar respiration اللي هو
+
+37
+00:03:10,170 --> 00:03:15,750
+يمثل الهواء اللي مش بس بيدخل الرئة تانه بس لأ اللي
+
+38
+00:03:15,750 --> 00:03:19,250
+بيوصل ال alveolar areaتمام؟ اللي بيصير فيها تبدو
+
+39
+00:03:19,250 --> 00:03:23,930
+ال gases معناه انه مش ال 500 كلها ملي لتر اللي
+
+40
+00:03:23,930 --> 00:03:27,470
+بنعملها في ال inspiration تدخل فقط 350 ملي لتر مش
+
+41
+00:03:27,470 --> 00:03:33,510
+هيك؟ فال 350 ملي لتر مضروبه في اتناشر مرة اللي هو
+
+42
+00:03:33,510 --> 00:03:37,930
+respiration rate ملاجئ عندنا في عندنا ال geolar
+
+43
+00:03:37,930 --> 00:03:44,130
+respiration 4200 ملي لتر 4200 ملي لتر ال new gas
+
+44
+00:03:44,130 --> 00:03:49,620
+reaches thethe alveoli .. the alveolar area
+
+45
+00:03:49,620 --> 00:03:54,680
+permanent تمام؟ اذا اندي اربعة liter و شوية بيصلوا
+
+46
+00:03:54,680 --> 00:03:57,940
+قريقتين .. اذا هدول موجودين بدخلوا لهم تلت مية و
+
+47
+00:03:57,940 --> 00:03:59,800
+خمسين و بطلع منهم تلت مية و خمسين بدخلوا تلت مية و
+
+48
+00:03:59,800 --> 00:04:07,180
+خمسين حاملين oxygen برشا برشا مية وتسعة واربعين و
+
+49
+00:04:07,180 --> 00:04:10,120
+بطلع منهم تلت مية و خمسين حاملين برشا .. oxygen
+
+50
+00:04:10,120 --> 00:04:14,360
+برشا برشا قداشمية وأربعة تمام؟ اذا احنا دايما
+
+51
+00:04:14,360 --> 00:04:16,540
+بنضيف من تسعة واربعين بناخد مية وأربعين من تسعة
+
+52
+00:04:16,540 --> 00:04:18,520
+واربعين من تسعة واربعين هذه العملية بتحافظ على
+
+53
+00:04:18,520 --> 00:04:23,180
+ايه؟ ولو حسبناها بنلاقي احنا جداش بنستخدمه هنحسبها
+
+54
+00:04:23,180 --> 00:04:27,740
+خلال المحاضرة هذه هنلاقي جداش الجسم بيستهلك Oxygen
+
+55
+00:04:27,740 --> 00:04:32,180
+بالظبط ال ventilation مضبوط على انه يدخل Oxygen
+
+56
+00:04:32,180 --> 00:04:35,900
+بنفس القدر اللي ايه اللي الجسم بياخده بحيث نحافظ
+
+57
+00:04:35,900 --> 00:04:43,010
+عمين على ال Avial Air Concentration ثالث واضح؟نفس
+
+58
+00:04:43,010 --> 00:04:48,290
+الكلام ان جرع ال carbon dioxide هنا
+
+59
+00:04:48,290 --> 00:04:52,550
+المسألة عشان تعرفوا ان احنا مش بنعمل عملية ابدال
+
+60
+00:04:52,550 --> 00:04:59,690
+لأ بنعمل عملية احنا dilution theory يعني بنرفع جزء
+
+61
+00:04:59,690 --> 00:05:04,440
+و بنحط جزء بتخفف بس بتخففش لان نصتمام؟ نضل .. يعني
+
+62
+00:05:04,440 --> 00:05:08,600
+لو بدنا نطلع هنا ال .. احتاجنا هنا الى ال
+
+63
+00:05:08,600 --> 00:05:12,540
+alveolus، الانموذج ال alveolus، ستة عشر مرة الهوى
+
+64
+00:05:12,540 --> 00:05:16,160
+يخش و يطلع فيها اللي هو بنفس النسب اللي قلنا عليه
+
+65
+00:05:16,160 --> 00:05:22,820
+سبع ال تلت مية و خمسين لأربع مية و .. لأربع تلاف و
+
+66
+00:05:22,820 --> 00:05:23,780
+.. و متين
+
+67
+00:05:28,050 --> 00:05:31,490
+جداش بيطلع سبعة ولا واحد على اتناش بيطلع مسترد
+
+68
+00:05:31,490 --> 00:05:33,650
+واحد على اتناش لإن هو تلاتمية وخمسية في اتناش مش
+
+69
+00:05:33,650 --> 00:05:37,350
+كده يعني كل مرة بيدخل واحد على اتناش اللي هو يمثل
+
+70
+00:05:37,350 --> 00:05:40,290
+تلاتمية وخمسية من أربعة ألف ومئة جداش احنا عندنا
+
+71
+00:05:40,290 --> 00:05:43,830
+ال ال viewer space جداش اللي هو قولنا ال
+
+72
+00:05:43,830 --> 00:05:46,810
+functional residual volume مش هيك ال functional
+
+73
+00:05:46,810 --> 00:05:50,530
+residual volume جداش الفين و تلاتمية مصبوط مش
+
+74
+00:05:50,530 --> 00:05:54,990
+قولنا الفين الفميتين و الفمية الفمية functional
+
+75
+00:05:55,830 --> 00:05:58,870
+اللي هو exploratory reserve وعنا ال residual
+
+76
+00:05:58,870 --> 00:06:03,070
+volume نفسه الف و متين اذا على بعض الفين و تلت مية
+
+77
+00:06:03,070 --> 00:06:07,980
+اللي هو ال functional residual volumeيعني ال 350
+
+78
+00:06:07,980 --> 00:06:11,140
+من ال function residual هو بتطلع حوالي السبع يعني
+
+79
+00:06:11,140 --> 00:06:15,540
+كل مرة بدخل هوا السبع بيبدل السبع فاحنا نطلع جديش
+
+80
+00:06:15,540 --> 00:06:18,920
+احنا محتاجين ندخل السبع و نطلع السبع ندخل السبع و
+
+81
+00:06:18,920 --> 00:06:24,380
+نطلع السبع يعني ندخل السبع اللي
+
+82
+00:06:24,380 --> 00:06:28,320
+هو ال humidified air و نطلع سبع alveolar air عشان
+
+83
+00:06:28,320 --> 00:06:32,820
+نعدي للنسبة جديش بياخد هذا عشان ايه تتعدى بتاخد
+
+84
+00:06:32,820 --> 00:06:37,520
+فترة طويلة يعني مش يعني مش بناخد احنا ايهكمية
+
+85
+00:06:37,520 --> 00:06:44,700
+كاملة من اللي هي used air و ندله fresh air لأ نده
+
+86
+00:06:44,700 --> 00:06:47,940
+fresh air و بيصير mixed air و بناخد من ال mix جزء
+
+87
+00:06:47,940 --> 00:06:51,600
+منه نده fresh و بيصير mixed air و بناخد جزء منه
+
+88
+00:06:51,600 --> 00:06:59,920
+طيب هذا بيدين نوع من الثبات يعني ال alveolar air
+
+89
+00:06:59,920 --> 00:07:04,940
+إلى حد ما التغيير اللي بيصير فيه قليل يعنيلو أنا
+
+90
+00:07:04,940 --> 00:07:10,480
+توقفت عن التنفس فترة لأي سبب الفيولر air بتغيرش
+
+91
+00:07:10,480 --> 00:07:14,180
+لإن أنا ب .. ب .. بعدل .. بعدلوش كله مرة واحدة نفس
+
+92
+00:07:14,180 --> 00:07:20,260
+الواحد بعدل السبع و السبع هذا مش بعدل يعني أنا
+
+93
+00:07:20,260 --> 00:07:24,660
+بدخله هو سبع لكن مش معناه إنه باخد في المقابل سبع
+
+94
+00:07:24,660 --> 00:07:29,280
+completely إلى حد ما نسميه used air لأ باخد mixed
+
+95
+00:07:29,280 --> 00:07:35,160
+يعني التغيير بيصير بسيط وهذا مهممهم في إيش؟ اللي
+
+96
+00:07:35,160 --> 00:07:37,720
+لو صار interruption لل ventilation لأي لحظة من
+
+97
+00:07:37,720 --> 00:07:41,820
+اللحظات، الدم اللي داخل الرقتين بيضل ياخد ال
+
+98
+00:07:41,820 --> 00:07:47,290
+oxygen تبعه بدون فروقات كبيرةواضح؟ لإن احنا بندي
+
+99
+00:07:47,290 --> 00:07:50,490
+ازاي قلتلكم نظام ال compressor، نديله هوا و نصحب
+
+100
+00:07:50,490 --> 00:07:54,130
+منه هوا، لكن اللي بنصحب، بنصحبش من اللي أنا بديه،
+
+101
+00:07:54,130 --> 00:07:56,730
+بنصحب من اللي في ال tank الرئيسي، و إذا أنا عندي
+
+102
+00:07:56,730 --> 00:07:59,350
+tank رئيسي، بديله ب .. أغيرله ب .. بجدله
+
+103
+00:07:59,350 --> 00:08:02,850
+بالستمرار، لكن التجديد اللي بيصير تبعي، أنا هذا،
+
+104
+00:08:02,850 --> 00:08:06,330
+تجديد بطيء، لذلك ال container الرئيسي، بيضل ال هوا
+
+105
+00:08:06,330 --> 00:08:10,190
+اللي فيه ما تغيرشتمام؟ فهذا بيدين نوع من ال
+
+106
+00:08:10,190 --> 00:08:15,270
+stability في إيه؟ في إنه كيف أنا باعطي الغازات إلى
+
+107
+00:08:15,270 --> 00:08:18,830
+الدم و باخدها منها بنفس النسبة لو توقفت التنفس
+
+108
+00:08:18,830 --> 00:08:21,030
+شوية العمل اللي أنا بعملها ال inspiration and
+
+109
+00:08:21,030 --> 00:08:24,770
+expiration لو توقفت شوية ال air اللي موجود هنا
+
+110
+00:08:24,770 --> 00:08:28,510
+بيبقى يديني نفس ال إيه؟ النسب إلى حد ما اتنين هذا
+
+111
+00:08:28,510 --> 00:08:32,870
+بيساعدني في ال regulation of respiration يعني مش
+
+112
+00:08:32,870 --> 00:08:39,550
+أجل تغييربدي ال respiration يقللتي اعلى اه او او
+
+113
+00:08:39,550 --> 00:08:43,450
+يغطى مالاج ال control of respiration لحد ما stable
+
+114
+00:08:43,450 --> 00:08:47,130
+لان ال oxygen اللي بيضل هنا اتلى الدم ثابت فبصيرش
+
+115
+00:08:47,130 --> 00:08:51,990
+عندى تغيرات شديدة فى نسب ال ال ال ال oxygen فى
+
+116
+00:08:51,990 --> 00:08:55,410
+الدم بيعلش بسرعة بيقطعش بسرعة بيضل لحد ما ثابت
+
+117
+00:08:55,410 --> 00:08:59,240
+وهذا بيسهل عملية الايه؟regulation of respiration
+
+118
+00:08:59,240 --> 00:09:02,680
+لما تتكلم عنها انتوا هتعرفوا إيه معنى الكلام هذا
+
+119
+00:09:02,680 --> 00:09:07,300
+لإن في بعض الحالات بيصير عندنا خلل في الدماغ بيصير
+
+120
+00:09:07,300 --> 00:09:12,280
+عملية التنفس اللي بتعطي للدم كمية Oxygen كتيرة
+
+121
+00:09:12,280 --> 00:09:18,740
+تمام بتأدي إلى إنه نسبة ال ال respiratory center
+
+122
+00:09:18,740 --> 00:09:22,400
+انخفضتمام؟ وفي الفترة اللي بيغيب التنفس في kidney
+
+123
+00:09:22,400 --> 00:09:25,840
+respiration center بيعلق فحاجة نسميها kidney
+
+124
+00:09:25,840 --> 00:09:28,920
+stroke respiration يعني المريض بتنفس نفس شديد شديد
+
+125
+00:09:28,920 --> 00:09:31,600
+شديد و بعدين ببطل ببطل ببطل و بعدين بتنفس شديد
+
+126
+00:09:31,600 --> 00:09:34,140
+شديد شديد و بعدين ببطل ببطل و هذا مصريش أن احنا
+
+127
+00:09:34,140 --> 00:09:39,540
+هيك ليش؟ لأن احنا .. احنا مش مديين التغير اللي
+
+128
+00:09:39,540 --> 00:09:45,820
+بيصير في ال .. في الدم بين ال arterial و ال blood
+
+129
+00:09:45,820 --> 00:09:49,550
+ال arterial و ال venous bloodبيبينش كاملا الى ال
+
+130
+00:09:49,550 --> 00:09:52,610
+.. ال .. ال .. ال .. لو توقف التنفس او كده ال
+
+131
+00:09:52,610 --> 00:09:58,490
+Venus blood بيصلش ال arterial تغيير كبير بيظل ماخد
+
+132
+00:09:58,490 --> 00:10:01,770
+نفس النمط نفس النمط نفس النمط ليش؟ لإن في عندي أنا
+
+133
+00:10:01,770 --> 00:10:06,670
+container كبير إذا ال regulation of respiration
+
+134
+00:10:06,670 --> 00:10:12,810
+بيبقى أسهل ومور منتظم أكتر بالإضافة لإنه انا باعطي
+
+135
+00:10:12,810 --> 00:10:17,520
+ال ..oxygen إلى حد ما بثبات و باخد carbon dioxide
+
+136
+00:10:17,520 --> 00:10:22,460
+بثباته بنفس النسب طيب
+
+137
+00:10:22,460 --> 00:10:25,820
+oxygen concentration and pressure in the alveoli
+
+138
+00:10:25,820 --> 00:10:29,660
+اتكلمنا عنها انها عندنا two factors احنا الآن
+
+139
+00:10:29,660 --> 00:10:34,140
+factor بيضيف و factor بياخد هذا بيقدر انه ال 149
+
+140
+00:10:34,140 --> 00:10:40,120
+تبعتي ماتضلش في ال 49 بس ال 104 طيب لكن هنا في مثل
+
+141
+00:10:40,120 --> 00:10:47,510
+مضروب جميلبديني نموذجين نموذج و انا at rest بتنفس
+
+142
+00:10:47,510 --> 00:10:54,350
+طبيعي مش hyperventilation و انا at exercise طبعا ف
+
+143
+00:10:54,350 --> 00:10:57,370
+at rest احنا نسهلك تقريبا متون و خمسين مليتر
+
+144
+00:10:57,370 --> 00:11:04,430
+أكسجين في الدقيقة طبعا فبنطلع بنلاقي عشان نصل لهذه
+
+145
+00:11:04,430 --> 00:11:07,750
+المسألة بنلاقي عندنا نسبة التنفس عندنا ال rate of
+
+146
+00:11:07,750 --> 00:11:15,070
+respirationالاطنعاش اللي هي ال .. ال .. ال .. ال
+
+147
+00:11:15,070 --> 00:11:20,730
+viola respiration أو ال respiratory volume اللي هو
+
+148
+00:11:20,730 --> 00:11:24,110
+حوالي إيش قلنا إحنا بالنسبة إلينا؟
+
+149
+00:11:25,980 --> 00:11:28,480
+تلت .. تلت .. تلت مية و خمسين في اتناش اربع تلف و
+
+150
+00:11:28,480 --> 00:11:31,320
+متين شايف؟ لاجينا احنا عندنا ال alveolar
+
+151
+00:11:31,320 --> 00:11:34,520
+ventilation هذا ال alveolar ventilation على اربع
+
+152
+00:11:34,520 --> 00:11:41,440
+تلف و متين ههن بيوصلنا الى oxygen بارشا pressure
+
+153
+00:11:41,440 --> 00:11:46,080
+في الدم في ال .. ال alveolar pressure بيصل .. بيصل
+
+154
+00:11:46,080 --> 00:11:49,100
+الى اللي هو ال مية و اربع .. ال مية و اربع مليمتر
+
+155
+00:11:49,100 --> 00:11:53,080
+mercury تمام؟ اذا ال ventilation .. ventilation
+
+156
+00:11:53,780 --> 00:11:59,880
+بريد 12 بال350 يعني اربعة لتر و متين ملي لتر per
+
+157
+00:11:59,880 --> 00:12:04,760
+minute is enough to keep the alveolar air 104
+
+158
+00:12:04,760 --> 00:12:08,210
+millimeter mercury هدف الحالة اللي اناالأكسجين
+
+159
+00:12:08,210 --> 00:12:11,490
+بستهلك في الجسم أكسجين متين وخمسين ملي لتر per
+
+160
+00:12:11,490 --> 00:12:16,330
+minute تمام؟ بلاجأ أنا عندي إيه؟ ال .. لو .. لو
+
+161
+00:12:16,330 --> 00:12:20,730
+صار تنفس فقط ال viral ventilation أربعة لتر و متين
+
+162
+00:12:20,730 --> 00:12:24,750
+ملي لتر four point two liters enough أنه يوصل ل
+
+163
+00:12:24,750 --> 00:12:28,510
+المية وأربعة لكن أنا بستهلك أكسجين أكتر عندي
+
+164
+00:12:28,510 --> 00:12:34,030
+exercise بستهلك ألف ملي لتر per minuteتمام؟ بلاحظ
+
+165
+00:12:34,030 --> 00:12:39,370
+انا محتاج ان ال ventilation يزيد الى اربع او خمس
+
+166
+00:12:39,370 --> 00:12:45,070
+اضعاف اللى انا فيه علشان يعود يوصللى ال ايه ال
+
+167
+00:12:45,070 --> 00:12:48,210
+alveolar air concentration او partial pressure الى
+
+168
+00:12:48,210 --> 00:12:52,490
+الوضع ال ايه الطبيعى، اذا احنا مطلوب ان ال
+
+169
+00:12:52,490 --> 00:12:54,870
+alveolar الى ال compressor الرئيسى اللى بتعطى
+
+170
+00:12:54,870 --> 00:13:00,720
+الهوى للجسممطلوب منها تصل ل level معين ال level
+
+171
+00:13:00,720 --> 00:13:04,180
+معين هذا لو جال بزيد ال ventilation عشان احافظ
+
+172
+00:13:04,180 --> 00:13:08,880
+عليه طبعا لو بدأ يعلق الجسم يعود بريح نفسه من أول
+
+173
+00:13:08,880 --> 00:13:12,800
+و جديد فلاحظوا هنا بنصل حوالي تمانتاش او حاجة زي
+
+174
+00:13:12,800 --> 00:13:16,100
+كده سبتاشر .. بين السبتاشر و تمانتاشر عشان نصل
+
+175
+00:13:16,100 --> 00:13:20,300
+لنفس ال level تبع مين؟ تبع ال normal alveolar air
+
+176
+00:13:20,300 --> 00:13:22,520
+concentration
+
+177
+00:13:24,180 --> 00:13:27,760
+في الحالة هذه محتاج اي ventilation عالى عشان اوصل
+
+178
+00:13:27,760 --> 00:13:32,360
+لان استهلاك ال oxygen عندي كبير بس هنا مواضح من ال
+
+179
+00:13:32,360 --> 00:13:38,580
+care هنا انه انا لما بعمل عملية تبدو الغازات بعمل
+
+180
+00:13:38,580 --> 00:13:41,360
+تبدو الغازات بين oxygen اربعين millimeter mercury
+
+181
+00:13:41,360 --> 00:13:47,620
+و بين oxygen اكسجين
+
+182
+00:13:47,620 --> 00:13:50,940
+مية تسعة واربعين تمام؟ بين مية تسعة واربعين
+
+183
+00:13:50,940 --> 00:13:54,420
+فبيجيني في الوسط ايه؟ مية اربعطب انا لو عملت
+
+184
+00:13:54,420 --> 00:13:59,000
+hyperventilation اغسل بسرعة بسرعة بسرعة بسرعة ال
+
+185
+00:13:59,000 --> 00:14:01,860
+maximum اني اوصل ال alveolar concentration اللي
+
+186
+00:14:01,860 --> 00:14:07,120
+لاقياش 149 لأ يعني لو انا بدنا اعمل اي effort
+
+187
+00:14:07,120 --> 00:14:12,620
+تمام؟ الان ناخد نفس غويت غويت غويت غويت مش كده؟
+
+188
+00:14:12,620 --> 00:14:15,640
+وشديد يعني بدي اغسل ال alveolar air اللي عندى انا
+
+189
+00:14:15,640 --> 00:14:21,000
+مسألة إرادية بحتهابقدر اوصل ال concentration لإيش؟
+
+190
+00:14:21,000 --> 00:14:25,380
+لل humidified air تمام؟ بصر يحسن .. بصل لل 149 مش
+
+191
+00:14:25,380 --> 00:14:28,620
+كده؟ معناه عملية ال ventilation عندى لو زادت هنا
+
+192
+00:14:28,620 --> 00:14:32,200
+طلعوا ان هنا اربعة او اتنين ملي لتر اللي هم اربعة
+
+193
+00:14:32,200 --> 00:14:36,980
+لتر four point two liters per minute طيب لو زادت
+
+194
+00:14:36,980 --> 00:14:40,460
+ال ventilation اكتر صار عندى تنفس اكتر و اكتر عشان
+
+195
+00:14:40,460 --> 00:14:44,260
+يعمل more wash and more refreshing لل .. لل
+
+196
+00:14:44,260 --> 00:14:49,610
+alveolar air maximum هوصلها لمين؟ لل 149نزالى كمية
+
+197
+00:14:49,610 --> 00:14:52,150
+وخمسين انا دى ال upper limit المحطوطة هيك انا هاجل
+
+198
+00:14:52,150 --> 00:14:55,790
+منها بشوية اه لإنه في عندى بيضال مجهود بيضال
+
+199
+00:14:55,790 --> 00:14:58,550
+يجيبلي carbon dioxide و بيضال ياخد oxygen فهذا ال
+
+200
+00:14:58,550 --> 00:15:02,630
+maximum تبعى ان انا لو اقصى حد بدي اعمله و من غير
+
+201
+00:15:02,630 --> 00:15:06,590
+ما استهلك معناه بقجل على اصل تقريبا ال 100 ساعة و
+
+202
+00:15:06,590 --> 00:15:10,880
+40 مش هيك لكن فى الطبيعى انا مش محتاج هادىمش
+
+203
+00:15:10,880 --> 00:15:13,600
+محتاجش أني أزيد ال ventilation بهذا الشكل هذا،
+
+204
+00:15:13,600 --> 00:15:18,340
+يكفيني أن أربعة point two milliliter اللي هي حوالي
+
+205
+00:15:18,340 --> 00:15:21,340
+اتناشر per minute، اتناشر اسمها retro rate per
+
+206
+00:15:21,340 --> 00:15:24,560
+minute أنه تديني المية و أربعة المطلوبة لإنها
+
+207
+00:15:24,560 --> 00:15:27,040
+تديني الميتين و خمسين milliliter ال oxygen،
+
+208
+00:15:27,040 --> 00:15:32,170
+هنحسبها، هلاجي ال rate هذا، بدخلي بالظبطمن حوالي
+
+209
+00:15:32,170 --> 00:15:35,350
+مائة و تلاتين إلى مائة و خمسين مليليتر أكسجين مرة
+
+210
+00:15:35,350 --> 00:15:39,970
+و مرة اللي هو الجسم بيستخدمه فطبعا هو اللي في
+
+211
+00:15:39,970 --> 00:15:44,110
+عندنا نوع من ال equilibrium بين ال in pot و ال out
+
+212
+00:15:44,110 --> 00:15:47,870
+pot من الأكسجين فعند ال respiratory rate ثابت و ال
+
+213
+00:15:47,870 --> 00:15:51,830
+ventilation ال alveolar ventilation ثابت مش محتاج
+
+214
+00:15:51,830 --> 00:15:57,430
+أنه ايه يزيد لكن لو نقص ال level هذالو هنا عندها
+
+215
+00:15:57,430 --> 00:16:01,930
+الاربعة و اتنين من عشرة ال oxygen ال alveolar
+
+216
+00:16:01,930 --> 00:16:07,230
+oxygen هبط ليش لأن انا فجأة صرت أعمل exercise و
+
+217
+00:16:07,230 --> 00:16:11,610
+فقرت الف مش هيه فال oxygen اللي .. الدم اللي جاي
+
+218
+00:16:11,610 --> 00:16:16,030
+أخد oxygen أسرع و أكتر عشر مرات من الطبيعي فأخد
+
+219
+00:16:16,030 --> 00:16:20,390
+بسرعة فهبط ال alveolar air بسرعة مش هيك هذه بيقدر
+
+220
+00:16:20,390 --> 00:16:23,890
+إلى ان ال ventilation زيد عشان بتوصل لها لان بيزيد
+
+221
+00:16:23,890 --> 00:16:26,690
+ال ventilation اندي اللي هو respiratory rateإلى أن
+
+222
+00:16:26,690 --> 00:16:30,750
+يصل إيه؟ لإن عندي خمستاشر أو ستاشر، سبعتاشر،
+
+223
+00:16:30,750 --> 00:16:36,450
+تمانتاشر ليتر per .. per minute بيضموا أربعة أو
+
+224
+00:16:36,450 --> 00:16:38,690
+اتنين ليتر per minute ال alveolar ventilation
+
+225
+00:16:38,690 --> 00:16:45,210
+بيدوصل إيه؟ تمام؟
+
+226
+00:16:45,210 --> 00:16:50,130
+ال
+
+227
+00:16:50,130 --> 00:16:52,370
+carbon ده يساعد ال concentration أنا بدت أتكلم عنه
+
+228
+00:16:52,370 --> 00:16:56,570
+من شوية و قلت ال alveolar airفي carbon dioxide
+
+229
+00:16:56,570 --> 00:17:02,510
+اربعين ملي ميتر ميركوري و ال inspired air زيرو
+
+230
+00:17:02,510 --> 00:17:07,290
+تقريبا إلى حد ما و ال venous blood اللي هو جاي
+
+231
+00:17:07,290 --> 00:17:10,270
+يعمل exchange خمسة و اربعين مش هيك نوصل لاربعين
+
+232
+00:17:10,270 --> 00:17:15,370
+ملي ميتر ميركوري لو طلعنا و قولنا طيب احنا عندنا
+
+233
+00:17:15,370 --> 00:17:19,930
+في الطبيعي لو حسبناها هنلاقي متين ملي لتر of
+
+234
+00:17:19,930 --> 00:17:24,870
+carbon dioxide is executed متين ملي لتر of ايه
+
+235
+00:17:27,810 --> 00:17:33,630
+كيف ممكن هذا يتم؟ بيتم في الوضع الطبيعي تبعنا، انه
+
+236
+00:17:33,630 --> 00:17:35,890
+انا محتاج بس اللي هو ال respiratory rate التباعي
+
+237
+00:17:35,890 --> 00:17:38,750
+الطبيعي، اللي يكون الفيولر ventilation، four point
+
+238
+00:17:38,750 --> 00:17:44,620
+two liters per minute، يكفي لإنه يثبتلي الال .. ال
+
+239
+00:17:44,620 --> 00:17:48,580
+.. ال carbon dioxide pressure في ال alveolar air
+
+240
+00:17:48,580 --> 00:17:51,660
+الى ايه؟ الى الاربعين ميليمتر الاربعين ميليمتر
+
+241
+00:17:51,660 --> 00:17:55,060
+ميليمتر ميليمتر تمام؟ مش محتاج اكتر من هيك فإذا
+
+242
+00:17:55,060 --> 00:17:58,840
+كان انا عندي ال ventilation الطبيعي اربعة و اتنين
+
+243
+00:17:58,840 --> 00:18:02,880
+ال .. ال alveolar اقصد اربعة و اتنين من عشرة لتر
+
+244
+00:18:02,880 --> 00:18:07,140
+معناه بيوصلني هان لإيش؟ ل .. لخمسة و هذا ال Venus
+
+245
+00:18:07,140 --> 00:18:13,510
+هذا ال alveolar pressure الاربعين تمام؟هان أربعين،
+
+246
+00:18:13,510 --> 00:18:17,510
+هان من خمسة وعشرين لخمسين، هان الأربعين، كويس؟ هو
+
+247
+00:18:17,510 --> 00:18:22,310
+ال .. ال .. ال Venus blood خمسة واربعين مليمتر ما
+
+248
+00:18:22,310 --> 00:18:26,970
+يطلع، بس مع ال .. مع الخلط بين ال .. الهواء الجديد
+
+249
+00:18:26,970 --> 00:18:30,730
+والاوسيجين، بيطلع بس الاربعين مليمتر، تمام؟إذا في
+
+250
+00:18:30,730 --> 00:18:34,890
+الطبيعي هذه ال .. ال .. ال 200 ميلي متر carbon
+
+251
+00:18:34,890 --> 00:18:38,690
+dioxide permanent تحتاجش عشان أوصل ال alveolar air
+
+252
+00:18:38,690 --> 00:18:42,730
+ل 40 إلى أكتر من ايه؟ أربعة ليتر و اتنين من عشرة
+
+253
+00:18:42,730 --> 00:18:46,870
+permanent alveolar ventilation لو صار عندي
+
+254
+00:18:46,870 --> 00:18:53,930
+exercise أكتر يعني أنا بطلع 800 ملي لتر CO2 per
+
+255
+00:18:53,930 --> 00:18:57,790
+minuteمعناها انا في الحالة دي هيعلى التركيز في ال
+
+256
+00:18:57,790 --> 00:19:02,290
+alveoli معناها بدي more ventilation to wash ال
+
+257
+00:19:02,290 --> 00:19:05,650
+more carbon dioxide عشان يوصلني الى الاربعين من
+
+258
+00:19:05,650 --> 00:19:09,770
+جديد، بطل ألاقي نفس الكلام محتاج إلى ايه؟ إلى أربع
+
+259
+00:19:09,770 --> 00:19:14,510
+خمس أضعافست عشر او سبعتاشر liter of your
+
+260
+00:19:14,510 --> 00:19:19,130
+ventilation permanent عشان اوصل لمين لارجع ال
+
+261
+00:19:19,130 --> 00:19:22,450
+carbon dioxide لوضعه الطبيعي مش كده بس فيها
+
+262
+00:19:22,450 --> 00:19:27,730
+الملاحظة يعني مين لحظة الملاحظة هذه مين عنده
+
+263
+00:19:27,730 --> 00:19:30,450
+ملاحظة انا بين ال care تبع ال oxygen و ال carbon
+
+264
+00:19:30,450 --> 00:19:33,950
+dioxide مين
+
+265
+00:19:33,950 --> 00:19:39,430
+بيلاحظ الملاحظة في فرق في الحجم يا ديما عندي متين
+
+266
+00:19:39,430 --> 00:19:43,660
+و خمسين milliliter oxygenو 200 milliliter carbon
+
+267
+00:19:43,660 --> 00:19:49,920
+dioxide مين سرق ال 50؟ في ال 50 راحوا، أصبت؟ في
+
+268
+00:19:49,920 --> 00:19:55,080
+عندى 50 milliliter oxygen راحوا احنا عندنا قولنا
+
+269
+00:19:55,080 --> 00:19:58,660
+ال normal انه استخدم 250 milliliter oxygen اعطيها
+
+270
+00:19:58,660 --> 00:20:01,880
+للدم بالسمرار و ال normal اني اخد من الدم 200
+
+271
+00:20:01,880 --> 00:20:06,160
+milliliter oxygen permanent بالسمرار، و اين الفرق؟
+
+272
+00:20:08,160 --> 00:20:10,500
+لأ لأ ماتكلمش عن dead area ال dead area على التنين
+
+273
+00:20:10,500 --> 00:20:13,420
+ال dead area على ال oxygen و on carbon dioxide انا
+
+274
+00:20:13,420 --> 00:20:18,000
+مشكلة عندي انا احتاج الجسم كل دقيقة مائين و خمسين
+
+275
+00:20:18,000 --> 00:20:21,740
+milliliter و سلمني مائتين انا مفترض لما مثلا ان
+
+276
+00:20:21,740 --> 00:20:25,660
+انا بدي اديك شاق و اكون منضبط فيه اقولك هي مليان و
+
+277
+00:20:25,660 --> 00:20:28,740
+ادينا الفاضي مش هيك عشان اضمن ان انت بالظبط
+
+278
+00:20:28,740 --> 00:20:32,220
+استخدمتي اللي انا اديتكيها لكن بديكي مائين و خمسين
+
+279
+00:20:32,220 --> 00:20:34,420
+و مرضى بمائين و متين بديكي مائين و خمسين و مرضى
+
+280
+00:20:34,420 --> 00:20:39,330
+بمائين و متين طب وين فرق ال oxygen راح؟ اه؟إيه؟
+
+281
+00:20:39,330 --> 00:20:43,070
+طيب، خليها لآخر المحاضرة، تفكروا فيها؟ نفكر فيها
+
+282
+00:20:43,070 --> 00:20:50,170
+لآخر المحاضرة، وين ال oxygen راح؟
+
+283
+00:20:50,170 --> 00:20:57,790
+إذا عندنا فيها نتكلم على two factors
+
+284
+00:21:04,530 --> 00:21:08,550
+إذا نقول الـ concentrations and partial pressure
+
+285
+00:21:08,550 --> 00:21:13,410
+of oxygen and carbon dioxide in the alveoli are
+
+286
+00:21:13,410 --> 00:21:17,330
+determined by the rate of absorption and excretion
+
+287
+00:21:17,330 --> 00:21:22,330
+for carbon dioxide and oxygen of these two gases
+
+288
+00:21:22,330 --> 00:21:24,890
+and the amount of alveolar ventilation
+
+289
+00:21:35,500 --> 00:21:40,880
+ال ratio ال
+
+290
+00:21:40,880 --> 00:21:43,780
+concentration of these pressures بتحدد بها two
+
+291
+00:21:43,780 --> 00:21:48,480
+factors جدش انا باخد و جدش انا ايه باعطي بالنسبة
+
+292
+00:21:48,480 --> 00:21:54,080
+لحد معين تمام؟ لذا لو أخدنا أكتر لازم نعطي أكتر
+
+293
+00:21:54,080 --> 00:21:57,570
+لازم ال ventilation يزيد لو عملناexecution of
+
+294
+00:21:57,570 --> 00:22:00,130
+carbon dioxide أكتر لازم ال ventilation يزيد عشان
+
+295
+00:22:00,130 --> 00:22:03,850
+نرجع لل level تبعنا لو أخدنا oxygen أكتر و حبط ال
+
+296
+00:22:03,850 --> 00:22:06,670
+oxygen لازم ال ventilation يزيد عشان يعطينا و هذا
+
+297
+00:22:06,670 --> 00:22:09,450
+ألف بقى احنا فاهمين الكلام ده مش كده إذا ال
+
+298
+00:22:09,450 --> 00:22:13,510
+expired air الآن لو اتكلم على احنا بنطلع expired
+
+299
+00:22:13,510 --> 00:22:18,010
+air تمام احنا صار تحت تحت ال alveoli تبادل شوية
+
+300
+00:22:18,010 --> 00:22:21,870
+غازات الآن بنتكلم فوق طب إيش بيصير ال expired air
+
+301
+00:22:21,870 --> 00:22:27,450
+أول ما احنا ماذا يمثل expired airال expiry دي يمثل
+
+302
+00:22:27,450 --> 00:22:32,230
+تلت مناطق المنطقة الأولى اللي إيه؟ ال dead space و
+
+303
+00:22:32,230 --> 00:22:35,870
+المنطقة الأخيرة ال alveolar air و المنطقة الفي
+
+304
+00:22:35,870 --> 00:22:40,850
+الوسط ال mixed عشان كده إذا إذا انا بدي أخد أعمل
+
+305
+00:22:40,850 --> 00:22:46,090
+دراسة على ال alveolar air يعني ال blood إيش فيه
+
+306
+00:22:46,090 --> 00:22:50,210
+يعني ال exchanges اللي بتصير هناك إذا بدي أخد عينة
+
+307
+00:22:50,210 --> 00:22:54,270
+alveolar air باخدها من وين؟ من آخر جزء في ال
+
+308
+00:22:54,270 --> 00:22:58,690
+forced expirationتمام؟ إذا بعمل expiration شديد
+
+309
+00:22:58,690 --> 00:23:02,070
+آخر جزء منها بمسك و بقول هذه تمثل ال alveolar air
+
+310
+00:23:02,070 --> 00:23:06,010
+أكيد مش كده؟ لإن ال alveolar air احنا ال dead
+
+311
+00:23:06,010 --> 00:23:11,550
+space هنا بروح بسرعة بيجي ال mixed ال mixed بعد
+
+312
+00:23:11,550 --> 00:23:14,350
+فترة ال mixed خلاص بيسبق ال plateau كل اللي جاي في
+
+313
+00:23:14,350 --> 00:23:19,130
+الآخر عبارة عن alveolar air إذا أنا لو خدت الجزء
+
+314
+00:23:19,130 --> 00:23:23,650
+الأخر خالص مضمون إن أحده alveolar بحت مش إيش مش
+
+315
+00:23:23,650 --> 00:23:25,010
+mixed مش كده؟
+
+316
+00:23:28,300 --> 00:23:33,960
+لو طلعنا ال curve هذا على التركيز
+
+317
+00:23:33,960 --> 00:23:41,020
+و نخلي زي ما هو شايفينه هك طيب
+
+318
+00:23:41,020 --> 00:23:46,100
+هنلاحظ احنا .. احنا هيك هذا يعني مراجعة سريعة ال
+
+319
+00:23:46,100 --> 00:23:52,560
+oxygen في الهواء 159 حوالي 160 humidified 149
+
+320
+00:23:52,560 --> 00:23:59,500
+الفيولر 104 مش كدهفي ال expired air .. في ال
+
+321
+00:23:59,500 --> 00:24:04,140
+expired air هيكون ال expired خلط ما بين ال dead
+
+322
+00:24:04,140 --> 00:24:08,480
+space ال atmospheric .. ال atmospheric و ال .. و
+
+323
+00:24:08,480 --> 00:24:12,880
+ال humidified يعني الجميع .. كلهم humidified بس في
+
+324
+00:24:12,880 --> 00:24:16,420
+humidification كاملة في آخر ال ..البرونكولز مثلا
+
+325
+00:24:16,420 --> 00:24:19,660
+بيصير good humidification أولها بيكون لسه برشة ال
+
+326
+00:24:19,660 --> 00:24:23,640
+humidification لإن هو كل ما هو نازل هو بياخد more
+
+327
+00:24:23,640 --> 00:24:30,040
+water vapor فلذلك الجزء الأول اللي في ناحية الأنف
+
+328
+00:24:30,040 --> 00:24:32,680
+والأول التركية فيه humidification بس مش one
+
+329
+00:24:32,680 --> 00:24:36,560
+hundred percent تحت فعندي خلط يعني النسبة كل ما
+
+330
+00:24:36,560 --> 00:24:39,280
+نزلنا humidification أكتر ساعة كل ما البرشة برشة
+
+331
+00:24:39,280 --> 00:24:43,280
+الأكسجين بيجلب carbon dioxide بيجل لإنه بيدخل more
+
+332
+00:24:44,190 --> 00:24:47,710
+water vapor مش هيك اذا احنا في المحصلة ال expired
+
+333
+00:24:47,710 --> 00:24:51,890
+air ال dead space هذا و ال alveolar air و كل اللي
+
+334
+00:24:51,890 --> 00:24:55,690
+طلع اللي هو ال dead space و ال mixed و اللي هو ال
+
+335
+00:24:55,690 --> 00:24:58,390
+alveolar اللي في الآخر هينخلط في بعضه في الآخر كله
+
+336
+00:24:58,390 --> 00:25:01,390
+ما هينخلطه برا كله ما هينخلطه لإن هم لسه بيطلعوا
+
+337
+00:25:01,390 --> 00:25:04,670
+بيطلعوا مراحل stages هذا كذلك لكن انا ماطلعهم في
+
+338
+00:25:04,670 --> 00:25:09,190
+مكان واحد في الآخر هينخلطه من أول نجيت براهنلاقي
+
+339
+00:25:09,190 --> 00:25:12,750
+انه عندى خلطة جديدة تمثل مية وعشرين ملي ميتر
+
+340
+00:25:12,750 --> 00:25:17,170
+ميركوري برشا برشا للإكسجين لإنه خلطة المية واربعة
+
+341
+00:25:17,170 --> 00:25:24,670
+بالمية تسعة واربعين ومية وخمسين ومية وستين لإن في
+
+342
+00:25:24,670 --> 00:25:28,330
+منطقى جاكو لسه مية وستين اللى فى أول ألف اللى
+
+343
+00:25:28,330 --> 00:25:32,530
+دخلنا شوية عالصين مية وخمسة وخمسين انزلنا أكتر دخل
+
+344
+00:25:32,530 --> 00:25:40,300
+more vapor تمام المحصلة ان منطقى من المناطقلما
+
+345
+00:25:40,300 --> 00:25:43,940
+أخلطهم كلهم هيتلع لإن expired air التركيز تبع ال
+
+346
+00:25:43,940 --> 00:25:49,720
+oxygen فيه 120 هلاجي نفس النظرية في ال carbon
+
+347
+00:25:49,720 --> 00:25:54,800
+dioxide هنا مثلا ال atmospheric احنا قولنا zero
+
+348
+00:25:54,800 --> 00:25:59,980
+لحد هو point three مش مستاهل يعني تمام ال
+
+349
+00:25:59,980 --> 00:26:06,400
+humidified air برضه تقريبا point three لإنه تركيز
+
+350
+00:26:06,400 --> 00:26:11,110
+غاطىمبتفردش فيه يعني الفرق اللي بيعملوا ال water
+
+351
+00:26:11,110 --> 00:26:14,750
+vapor بيعملوا فيه قبل ستميت ملي متر mercury برشا
+
+352
+00:26:14,750 --> 00:26:17,290
+برشا بتعملوا فيه قبل مية و ستين بس في ال او ال
+
+353
+00:26:17,290 --> 00:26:21,870
+point three ايش بيعمل بيضلك صور عندما تتعدى تصل
+
+354
+00:26:21,870 --> 00:26:25,270
+ايه لل point three من اول و جديد لكن في ال
+
+355
+00:26:25,270 --> 00:26:28,610
+alveolar air الكربون ده يكسر اربعين ملي متر
+
+356
+00:26:28,610 --> 00:26:33,450
+mercury لذلك لما في ال في ال expired air هيكون
+
+357
+00:26:33,450 --> 00:26:37,670
+الخلط بين الأربعين والصفرمش زي ال Oxygen بين الأقل
+
+358
+00:26:37,670 --> 00:26:42,230
+مع أكتر عشان يعلق 120 من 104 فهنا لما يخلط بين 40
+
+359
+00:26:42,230 --> 00:26:45,290
+و 0.5 هنلاقي انه ال pressure في ال expired ايه ال
+
+360
+00:26:45,290 --> 00:26:50,230
+drop لاقاش ل 27 ملي متر Mercury وكذا بجيت الغازات
+
+361
+00:26:50,230 --> 00:26:54,810
+okay diffusion
+
+362
+00:26:54,810 --> 00:26:57,730
+of gas through the spiratory membrane الآن اذا
+
+363
+00:26:57,730 --> 00:27:03,830
+احنا بدنا نرجع ل ايه ل ال عملية
+
+364
+00:27:03,830 --> 00:27:09,080
+الال respiratory membrane اتكلمنا عنه قبل كده
+
+365
+00:27:09,080 --> 00:27:13,140
+اتكلمنا عنه اتكلمنا عنه لما جبتلكوا الصورة
+
+366
+00:27:13,140 --> 00:27:18,820
+الخارجية من عندى انا وقلتلكم ان ال .. ال .. ال ..
+
+367
+00:27:18,820 --> 00:27:21,820
+في حاجة اسمها ال respiratory membrane ال
+
+368
+00:27:21,820 --> 00:27:24,340
+respiratory membrane يعني المكان اللى بتنفيه تبادل
+
+369
+00:27:24,340 --> 00:27:28,180
+الغازات مش كده وقلنا عنهم ايه اش اربع مناطق
+
+370
+00:27:28,180 --> 00:27:34,200
+respiratory bronchiol الalveolar duck
+
+371
+00:27:36,940 --> 00:27:41,680
+و ساج و اذاك مش هيك مش حاكينا انا قبل كده و قولتوا
+
+372
+00:27:41,680 --> 00:27:45,060
+عدتولي يام انتوا انت ماخديني ال chess كنتوا اه طيب
+
+373
+00:27:45,060 --> 00:27:47,880
+ماشي اذا في عندي انا المناطق اللي بيصير في
+
+374
+00:27:47,880 --> 00:27:51,920
+التابعات والغازات سميناها in general respiratory
+
+375
+00:27:51,920 --> 00:27:55,660
+membrane اذا what is respiratory membrane it is
+
+376
+00:27:55,660 --> 00:28:01,180
+the area where gas exchanges occursإذا ال air اللي
+
+377
+00:28:01,180 --> 00:28:03,660
+بيصير في ال gas exchanges هذا يعتبر عيش ال
+
+378
+00:28:03,660 --> 00:28:06,240
+respiratory air إذا لا تعني ال respiratory
+
+379
+00:28:06,240 --> 00:28:10,260
+membrane ال alveolar membrane فقط الأربع مناطق
+
+380
+00:28:10,260 --> 00:28:18,240
+كلها تمام؟ طيب إذا إذا ال respiratory membrane هو
+
+381
+00:28:18,240 --> 00:28:22,680
+مش في منطقة واحدة هو في أربع مناطق طب هذا ال
+
+382
+00:28:22,680 --> 00:28:28,260
+respiratory membrane ناخد بعض مواصفاته ناخد نعرف
+
+383
+00:28:28,260 --> 00:28:33,930
+حجموعمق ال ventilation اللي بيصير انتوا عارفين انه
+
+384
+00:28:33,930 --> 00:28:39,870
+عندنا في ال lung تلتمية مليون alveolus تلتمية
+
+385
+00:28:39,870 --> 00:28:45,490
+مليون كام خلية جولنا في الجسم؟ خمسة
+
+386
+00:28:45,490 --> 00:28:52,950
+وسبعين تريليون ألف مليار خمسة وسبعين ألف مليار
+
+387
+00:28:52,950 --> 00:29:00,460
+تريليون وعندها هتشوفوا أشياء عجيبة بالفعل يعنيلا
+
+388
+00:29:00,460 --> 00:29:05,060
+تستطيعوا اللي هنقوله سبحان الله لا تستطيعوا كيف
+
+389
+00:29:05,060 --> 00:29:10,200
+يعني؟ عندي تلاتمية مليون ال violas هدول بيعملولي
+
+390
+00:29:10,200 --> 00:29:16,640
+surface area رهيبة تمثل سبعين متر مربع السبعين متر
+
+391
+00:29:16,640 --> 00:29:21,860
+مربع يعني يمكن جد الصلاة هادى السبعين متر مربع
+
+392
+00:29:21,860 --> 00:29:27,340
+هدول بدخلهم دم في اللحظة الواحدة جديش بيكون فيهم
+
+393
+00:29:27,340 --> 00:29:32,180
+دمبيكون فيهم سبعين ملي ليتر يعني تقريبا من ستين
+
+394
+00:29:32,180 --> 00:29:36,820
+الى مية وعشرين ملي ليتر متوسط احنا قولنا سبعين لما
+
+395
+00:29:36,820 --> 00:29:40,260
+جسمنا الاربع مية وخمسين ملي ليتر blood وقلنا لهم
+
+396
+00:29:40,260 --> 00:29:43,620
+سبعين ملي ليتر في ال capillaries و الباقية بتوزع
+
+397
+00:29:43,620 --> 00:29:47,440
+بين ال venous side و ال arterial side فاكرين؟
+
+398
+00:29:47,440 --> 00:29:53,480
+مالكوا انتوا بتجروشوا ولا ايه؟ طيب هنا
+
+399
+00:29:53,480 --> 00:29:58,860
+عندي سبعين متر مربعاتصوروا يعني بيطلع نصيب المتر
+
+400
+00:29:58,860 --> 00:30:05,040
+المربع واحد milliliter دم ال milliliter يعني
+
+401
+00:30:05,040 --> 00:30:09,900
+الستناشر نقطة، مش هيك؟ اتصوروا لو كنتوا بيفرضوا ال
+
+402
+00:30:09,900 --> 00:30:14,780
+milliliter على ال .. على المتر، جداش بيطلع نصيب
+
+403
+00:30:14,780 --> 00:30:22,810
+للإيه؟ للجزئية من ال .. من المتر هي ده RBCsتمام؟
+
+404
+00:30:22,810 --> 00:30:28,590
+عدد قليل جدا لذلك عملية .. عملية .. يعني الاحتكاك
+
+405
+00:30:28,590 --> 00:30:34,390
+ما بين الدم والاكسجين تمام؟ ما بين .. بيكون احتكاك
+
+406
+00:30:34,390 --> 00:30:40,930
+رهيب احنا بندي لكل سبعين ملي لتر دم ينفرد surface
+
+407
+00:30:40,930 --> 00:30:46,750
+area يصير فيها تبادل غازات لكل
+
+408
+00:30:46,750 --> 00:30:51,800
+سبعين ملي لتر متر لكل ملي لتر مترلكل مليليتر
+
+409
+00:30:51,800 --> 00:30:56,480
+ندّيله متر متر مربع تمام فهذا المتر المربع يساطين
+
+410
+00:30:56,480 --> 00:31:00,540
+دول كان مضخم من الغازات في اللحظة اللي بمر فيها
+
+411
+00:31:00,540 --> 00:31:04,440
+لدرجة انه انا حكيتكوا قبل كده و الدم داخل في ال
+
+412
+00:31:04,440 --> 00:31:09,680
+capillaries بتشبع ال hemoglobin فيه و ال plasma و
+
+413
+00:31:09,680 --> 00:31:13,440
+ال concentration برشا برشا بطلع ل 104 بحتاجش إلى
+
+414
+00:31:13,440 --> 00:31:19,780
+انه يمر في كل ال .. في أول طولة الطريقأول طولة
+
+415
+00:31:19,780 --> 00:31:24,440
+الفيولوز بيكون تشبع الدم والطولتين المتركين ايه؟
+
+416
+00:31:24,440 --> 00:31:29,040
+Reserve احتياطي لو احتجنا hyperventilation لو
+
+417
+00:31:29,040 --> 00:31:32,420
+احتجنا نستخدم أكثر أكسجين بيخبط الأكسجين في الدم
+
+418
+00:31:32,420 --> 00:31:35,960
+أكتر بدي انا انا انا انا انا انا انا انا انا انا
+
+419
+00:31:35,960 --> 00:31:36,040
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+420
+00:31:36,040 --> 00:31:36,160
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+421
+00:31:36,160 --> 00:31:37,060
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+422
+00:31:37,060 --> 00:31:38,020
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+423
+00:31:38,020 --> 00:31:48,160
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+424
+00:31:48,160 --> 00:31:53,860
+انابيزيد عشر مرات يعني ال .. ال .. ال .. ال .. ال
+
+425
+00:31:53,860 --> 00:31:58,340
+.. ال air side بيزود قدر الكبس تبعته انه يعطي
+
+426
+00:31:58,340 --> 00:32:02,540
+oxygen و ياخد carbon dioxide عشر مرات و الدم بيجي
+
+427
+00:32:02,540 --> 00:32:07,740
+بسبب ال exercise اللي عندي ممكن يزود الدم اللي جي
+
+428
+00:32:07,740 --> 00:32:12,140
+على اللنز عشر مرات تمام؟ التنين يستطيعوا ..
+
+429
+00:32:12,140 --> 00:32:16,340
+بيشتغلوا وكانهم .. وكانهم على trustلأن هذا زاد
+
+430
+00:32:16,340 --> 00:32:20,720
+قدرته وهذا زاد قدرته تمام؟ فلذلك at rest اتنين
+
+431
+00:32:20,720 --> 00:32:23,820
+شغالين مرتاحين لو زاد اتنين بيزيدوا بنفس النسبة
+
+432
+00:32:23,820 --> 00:32:28,300
+بحيث مايصيرش عندنا ايه؟ deficit لما اقول ال
+
+433
+00:32:28,300 --> 00:32:31,360
+maximum تبع ال ventilation هل جد و ال maximum تبع
+
+434
+00:32:31,360 --> 00:32:34,060
+ال blood اكتر منه معناه يصير عند blood يخش
+
+435
+00:32:34,060 --> 00:32:37,280
+وماياخدش ايش؟ ماياخدش اكسجين ومايتركش كربون ده
+
+436
+00:32:37,280 --> 00:32:42,120
+كافي لكن متساوي يعني ال alveolar
+
+437
+00:32:44,920 --> 00:32:48,180
+الـ alveolus الديامتر تبعها، فاكرين احنا قولنا ال
+
+438
+00:32:48,180 --> 00:32:52,500
+.. ال .. ال .. ال radius تبعها قولنا ميت مايكرون
+
+439
+00:32:52,500 --> 00:32:56,880
+لمين للأضلت و خمسين مايكرون لمين لما حسبنا ال
+
+440
+00:32:56,880 --> 00:33:00,960
+respiratory distress syndrome of the newborn،
+
+441
+00:33:00,960 --> 00:33:05,980
+تمام؟ يعني بمعنى أنه الديامتر ميتين مايكرونالذن ال
+
+442
+00:33:05,980 --> 00:33:08,680
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+443
+00:33:08,680 --> 00:33:10,620
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+444
+00:33:10,620 --> 00:33:16,100
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+445
+00:33:16,100 --> 00:33:20,180
+ال ال ال ال ال
+
+446
+00:33:20,180 --> 00:33:20,480
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+447
+00:33:20,480 --> 00:33:21,120
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+448
+00:33:21,120 --> 00:33:21,180
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+449
+00:33:21,180 --> 00:33:21,200
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+450
+00:33:21,200 --> 00:33:25,790
+ال ال ال ال ال ال ال ال ال ال ال ال ال الbetween
+
+451
+00:33:25,790 --> 00:33:29,810
+the alveoli is an almost solid network of ..
+
+452
+00:33:29,810 --> 00:33:34,130
+almost solid network يعني مش انفرج من بعض زي ما
+
+453
+00:33:34,130 --> 00:33:39,690
+قلتلكم كانها ايه؟ sheet بتعمل scanning كده ازاي
+
+454
+00:33:39,690 --> 00:33:47,130
+تسميناها sheet of flowing blood طبعا هي مش بس
+
+455
+00:33:47,130 --> 00:33:51,630
+كبيرة كده جنب بعض كمان interconnecting كمان ..
+
+456
+00:33:51,630 --> 00:33:54,640
+ازاي الرسم اللي جاية هاديتوضح الـ capillary
+
+457
+00:33:54,640 --> 00:33:57,920
+network اللي حوالي ال إيه لقلبك، مش بس capillary
+
+458
+00:33:57,920 --> 00:34:02,580
+ماشي هيك، لأ متصلة، syncytia مشديد هيك متواصلة في
+
+459
+00:34:02,580 --> 00:34:07,800
+بعض عن بعض، تمام؟ شبكة متجاملة، بتخش في كل
+
+460
+00:34:07,800 --> 00:34:11,540
+اتجاهات، في كل مكان، مش سابق فرحان، كفاءة عالية،
+
+461
+00:34:11,540 --> 00:34:15,000
+بظبط؟ تصوروا لما واحد يقول ها دي، بالصدفة إيش هت
+
+462
+00:34:16,030 --> 00:34:20,770
+بال .. بال .. بالتأكيد هو رم عقله على جنب ورفض إلا
+
+463
+00:34:20,770 --> 00:34:24,270
+أن يتبع أهواءه، مش هيك؟ لذلك رب العالم دايما بيقول
+
+464
+00:34:24,270 --> 00:34:28,270
+إيه؟ وما ظلمهم ولكن نفسهم كانوا يظلمون لإنه مش
+
+465
+00:34:28,270 --> 00:34:30,750
+معجول بالعاجل في الآخر تطلع في العاجل كلها اللي
+
+466
+00:34:30,750 --> 00:34:32,790
+بتشوفها في الدنيا كلها وفي نهاية تقولها دي إيه
+
+467
+00:34:32,790 --> 00:34:36,210
+كلها إيه؟ إنما نموت ونحيا وما يوليكوا نلدها،
+
+468
+00:34:36,210 --> 00:34:37,510
+معجولة؟ مش ممكن
+
+469
+00:34:42,850 --> 00:34:49,330
+بالطبع بسبب كبيرتها الكبيرليري بليكساس الهواء من
+
+470
+00:34:49,330 --> 00:34:54,450
+الدم في محطة البرمونة كان تسمى كشيط دم يتفرق بشكل
+
+471
+00:34:54,450 --> 00:34:58,830
+كبير بشكل كبير بشكل كبير بشكل كبير بشكل كبير بشكل
+
+472
+00:34:58,830 --> 00:34:59,670
+كبير بشكل كبير بشكل كبير بشكل كبير بشكل كبير بشكل
+
+473
+00:34:59,670 --> 00:34:59,770
+كبير بشكل كبير بشكل كبير بشكل كبير بشكل كبير بشكل
+
+474
+00:34:59,770 --> 00:35:05,350
+كبير بشكل كبير بشكل كبير بشكل كبير بشكل كبير بشكل
+
+475
+00:35:05,350 --> 00:35:09,630
+كبير بشكل كبير
+
+476
+00:35:09,630 --> 00:35:14,500
+بشكل كبيرلأن ال alveolar membrane جزء من ال ايه؟
+
+477
+00:35:14,500 --> 00:35:16,580
+من ال respiratory membrane ال respiratory membrane
+
+478
+00:35:16,580 --> 00:35:21,720
+يعني ال respiratory ventilation او respiration هو
+
+479
+00:35:21,720 --> 00:35:24,140
+ما بيصير مش بيقولوا احنا ايه ال respiratory
+
+480
+00:35:24,140 --> 00:35:27,620
+membrane اللي المنطقة بيصير فيها ايه؟ respiration
+
+481
+00:35:27,620 --> 00:35:31,560
+بيصير في ده بره ازاى طب هاي الابن ايش بتكون؟ تمام
+
+482
+00:35:31,560 --> 00:35:34,640
+احنا خلّيني اتكلم عن ال alveoli هلاحظ بين ال
+
+483
+00:35:34,640 --> 00:35:37,680
+alveoli موجود بين ال alveoli فيه capillaries
+
+484
+00:35:38,750 --> 00:35:42,170
+الكابيلاريز هي بين ال alveoli موجودة لكن بين كل
+
+485
+00:35:42,170 --> 00:35:45,630
+مجموعة الكابيلاريز فيها مصدر رئيسي في عنده موجود
+
+486
+00:35:45,630 --> 00:35:51,410
+ايه ارتيريال وفنيال عشان يعطيه وياخد و ال emphatic
+
+487
+00:35:51,410 --> 00:35:57,250
+ويقولون احنا ال emphatic كتير مهمة طيب لو اتكلم عن
+
+488
+00:35:57,250 --> 00:36:05,110
+ال composition هنا ال composition الأحمر كابيلاري
+
+489
+00:36:05,110 --> 00:36:09,980
+الأزرقالفيولاس أو لأ مانقدرش نقوله لإن ال بسم
+
+490
+00:36:09,980 --> 00:36:13,340
+مدينه نفس اللون هنا هذه المنطقة اللي هو اللي إيه
+
+491
+00:36:13,340 --> 00:36:16,280
+ال interstitial fluid واضح إنها interstitial fluid
+
+492
+00:36:16,280 --> 00:36:19,280
+بين التلاند هذا ال capillary side و هذا ال
+
+493
+00:36:19,280 --> 00:36:23,480
+alveolar side واضح؟ ال alveolar هتتكون من إيه؟ من
+
+494
+00:36:23,480 --> 00:36:29,620
+اللي هو ال .. ال .. ال epithelium تبعنا اللي هو
+
+495
+00:36:29,620 --> 00:36:32,540
+هذا ال epithelium أه لكن ال epithelium lined by
+
+496
+00:36:32,540 --> 00:36:36,380
+film of water مش هيك؟ إذا كنت عندك film of waterو
+
+497
+00:36:36,380 --> 00:36:40,260
+بعدين بيجي ال epithelial .. alveolar epithelium و
+
+498
+00:36:40,260 --> 00:36:43,760
+بعدين بيجي basement membrane تمام؟ و ال capillary
+
+499
+00:36:43,760 --> 00:36:48,260
+بيجي نفس الكلام عندي هان اللي هو ال blood هان ال
+
+500
+00:36:48,260 --> 00:36:54,380
+plasma هان هيجي لل .. ال endothelial wall مش كده،
+
+501
+00:36:54,380 --> 00:36:59,060
+endothelial cells و basement membrane و بين ال two
+
+502
+00:36:59,060 --> 00:37:01,560
+basement membranes هان connective tissue ال
+
+503
+00:37:01,560 --> 00:37:03,620
+unterstial space
+
+504
+00:37:07,790 --> 00:37:15,190
+إذا هذه مكونات ال إيه؟ ال .. طيب هال space هذا
+
+505
+00:37:15,190 --> 00:37:20,790
+اللي بيصير عليه التبادل الغازات طبعا؟ جديش سماكته؟
+
+506
+00:37:20,790 --> 00:37:25,090
+point two micron في بعض المناطق very thin point
+
+507
+00:37:25,090 --> 00:37:28,490
+two micron في بعض المناطق اللي فيها cells اللي
+
+508
+00:37:28,490 --> 00:37:34,930
+فيها nuclei أكتر شوية نقول متوسط point six micron
+
+509
+00:37:34,930 --> 00:37:39,290
+point six micron اللي هو إيه؟ال .. يعني الغاز ال
+
+510
+00:37:39,290 --> 00:37:42,730
+.. ال .. ال oxygen و carbon dioxide عشان ينتقل من
+
+511
+00:37:42,730 --> 00:37:47,610
+ال alveolar cell لل .. لل capillary اه point six
+
+512
+00:37:47,610 --> 00:37:51,250
+micron point two micron very fragile ازاي كنا
+
+513
+00:37:51,250 --> 00:37:54,670
+بتكلمنا المرة الماضية عن الضغوط و كده اي pressure
+
+514
+00:37:54,670 --> 00:37:58,610
+غير عادي بيخرب الدنيا في ال lung لإن هي مصممة
+
+515
+00:37:58,610 --> 00:38:01,750
+بطريقة ايه very delicate مش هيك
+
+516
+00:38:14,080 --> 00:38:18,580
+هنا النقطة هاد المهمة هاد لما نقول احنا عندنا
+
+517
+00:38:18,580 --> 00:38:23,880
+الكلام اللي اتكلمناه عن الجمال تبع الجدش في عنده
+
+518
+00:38:23,880 --> 00:38:29,420
+surface area وجدش انه ال blood ملتصق بال ال
+
+519
+00:38:29,420 --> 00:38:35,420
+alveolar air تمام؟ اتصوروا ان ال RBC's اللي ماشي
+
+520
+00:38:35,420 --> 00:38:40,540
+في ال capillaryمحشورة و ال wall سبعتها تبقى خبطة
+
+521
+00:38:40,540 --> 00:38:44,300
+في ال capillary wall اللى هى مباشرة ملتصقة بال
+
+522
+00:38:44,300 --> 00:38:46,960
+algalal wall يعني انتقال ال oxygen و ال carbon
+
+523
+00:38:46,960 --> 00:38:50,600
+dioxide اللى بيحصل أساسا محمول على ال hemoglobin
+
+524
+00:38:50,600 --> 00:38:55,510
+أساسي الحمل على ال hemoglobinفالمابين الهيموجلوبين
+
+525
+00:38:55,510 --> 00:38:58,450
+ومابين ال alveolar air مافيش الا point two
+
+526
+00:38:58,450 --> 00:39:03,330
+micrometer لإن ال ال ال ال capillary ملتصقة بالول
+
+527
+00:39:03,330 --> 00:39:06,670
+يعني مش محتاج الاشي يخش بلازمة و بعدين من البلازمة
+
+528
+00:39:06,670 --> 00:39:12,310
+يطلع لل ايه لل RBCs تمام التصاق كامل ال .. يعني
+
+529
+00:39:12,310 --> 00:39:16,870
+لذا القطر تبع ال capillary هان خمسة micrometer في
+
+530
+00:39:16,870 --> 00:39:20,550
+حين ان ال diameter تبع ال RBCs سبعة point eight
+
+531
+00:39:20,550 --> 00:39:26,480
+microns مش كدهفهذا معناها ان ال RPC زيادة و بجادرة
+
+532
+00:39:26,480 --> 00:39:31,840
+لذلك المرونة
+
+533
+00:39:31,840 --> 00:39:37,880
+تبعتالـ RBCs مهمة لما تنحشر في الكبانيس لو مافيش
+
+534
+00:39:37,880 --> 00:39:41,900
+فيها المرونة الكافية وهذا بيصير اه بعض الأمراض و
+
+535
+00:39:41,900 --> 00:39:46,040
+بعض كده بتسكر بتجه بتقدرش تكمل لكن في موجود
+
+536
+00:39:46,040 --> 00:39:49,800
+المرونة تبعتها plasticity بيسميها ال plasticity
+
+537
+00:39:49,800 --> 00:39:56,690
+القدرة على الانبعاج هي elasticity تتمددلكن إنها
+
+538
+00:39:56,690 --> 00:40:01,310
+تغير شكلها تنبعش نسميها plasticity فعندها القدرة
+
+539
+00:40:01,310 --> 00:40:04,930
+علي إنها ال RBCs يصير عندها تغيير في الشكل بحيث
+
+540
+00:40:04,930 --> 00:40:07,950
+تحشر نفسها في المكان تديج من الأكل لحد ما تطلع بس
+
+541
+00:40:07,950 --> 00:40:11,630
+هذه الحشرة مهمة في إيش؟ في تبدو الغزار إن كان على
+
+542
+00:40:11,630 --> 00:40:14,970
+مستوى الرئاتين أو كان على مستوى ال tissues عشان
+
+543
+00:40:14,970 --> 00:40:21,310
+تسلم صح و تسلم و تسلم صحزي ذلك لو تصورنا إنه برضه
+
+544
+00:40:21,310 --> 00:40:25,730
+هالصدفة اللي خلجت الإنسان خلجت RBCs أكبر شوية من
+
+545
+00:40:25,730 --> 00:40:30,910
+هيك سنة مثلا لأ هتاخد تكسجين و لأ هتدوسجين ساموتوا
+
+546
+00:40:30,910 --> 00:40:38,410
+في مهدي مش كده؟ factors that affect the rate of
+
+547
+00:40:38,410 --> 00:40:41,850
+gas diffusion حلو إذا إحنا دلوقتي وصلنا لمرحلة
+
+548
+00:40:41,850 --> 00:40:45,080
+وقفنا على ال membraneعلى ال .. عشان بيسموها
+
+549
+00:40:45,080 --> 00:40:48,320
+الأعراف الآن احنا ايه؟ واقفين بين ال .. الهواء
+
+550
+00:40:48,320 --> 00:40:54,040
+وبين الدم مش هيك؟ هنا الآن عملية المرور بتتمعن هنا
+
+551
+00:40:54,040 --> 00:40:57,560
+على ال .. على ال membrane ايش الشروط اللي بتتم ..
+
+552
+00:40:57,560 --> 00:41:00,800
+بتساعد او بتتحكم او بتأثر في عملية ال gas
+
+553
+00:41:00,800 --> 00:41:03,920
+diffusion؟ بالقطع ان ال membrane هذا لو .. لو تخل
+
+554
+00:41:03,920 --> 00:41:09,120
+شوية هتصير مسافر اكتر ومعويقات اكتر و resistance
+
+555
+00:41:09,120 --> 00:41:12,020
+اكتر مش كده؟ he's in the thickness of the membrane
+
+556
+00:41:13,870 --> 00:41:17,050
+وبالتأكيد ان ال bar pressure اللي هان و ال bar
+
+557
+00:41:17,050 --> 00:41:20,190
+pressure اللي هان بيديني الفرج اللي بيخلي الاندفاع
+
+558
+00:41:20,190 --> 00:41:24,290
+كل ما في فرج في ال bar pressure أعلى كل ما كان ايه
+
+559
+00:41:24,290 --> 00:41:33,390
+بيصير الانتقال أسرع مش كده وبالتأكيد ان ال bar
+
+560
+00:41:33,390 --> 00:41:39,170
+pressure و النوع الغاز اللي بتكلم عنه النوع الغاز
+
+561
+00:41:39,170 --> 00:41:44,240
+اللي بتكلم عنه الانتقال هنا هل ال oxygenانتقاله
+
+562
+00:41:44,240 --> 00:41:47,340
+بيصير بنفس سرعة ال carbon dioxide لما ال
+
+563
+00:41:47,340 --> 00:41:51,000
+solubility ال diffusion ال coefficient اللي كلمنا
+
+564
+00:41:51,000 --> 00:41:57,220
+عنه لل oxygen عشرين ضعف من ال oxygen مش كده فال
+
+565
+00:41:57,220 --> 00:42:01,840
+carbon dioxide أسرع في ال ايه؟ في الانتقال من ال
+
+566
+00:42:01,840 --> 00:42:06,870
+oxygen عشرين ضعفمش كده؟ إذا نوع المادة اللي بتكلم
+
+567
+00:42:06,870 --> 00:42:10,810
+عنها اللي بيحددها ال molecular weight تبعها و ال
+
+568
+00:42:10,810 --> 00:42:13,190
+solubility تبعتها اللي سمينا diffusion coefficient
+
+569
+00:42:13,190 --> 00:42:18,910
+هدول تنعملين طلعولي حاجة اسمها ايه؟ diffusion
+
+570
+00:42:18,910 --> 00:42:23,470
+coefficient solubility على جزر inverse root of the
+
+571
+00:42:23,470 --> 00:42:27,470
+molecular weight مش هيك؟ الداني كل ما ال molecular
+
+572
+00:42:27,470 --> 00:42:31,670
+weight زاد كل ما ال diffusion جالطيب إذا في عندي
+
+573
+00:42:31,670 --> 00:42:35,070
+factors هيك ندرسها مع بعض هيقلنا أربعة factors ال
+
+574
+00:42:35,070 --> 00:42:38,510
+thickness of the membrane ال surface area للعملية
+
+575
+00:42:38,510 --> 00:42:42,570
+هذه ال surface area في الطبيعي مافيش مشكلة لكن أه
+
+576
+00:42:42,570 --> 00:42:46,670
+في أحيان نخش في bronchial أزمة و نخش في emphysema
+
+577
+00:42:46,670 --> 00:42:53,010
+ال surface area راحت تمام ال lung امتلأت مليون
+
+578
+00:42:53,010 --> 00:42:59,380
+alveoli اتحولت ل lung ofمثلا خمسمائة ألف مش
+
+579
+00:42:59,380 --> 00:43:04,620
+alveolus بولص spaces كبيرة هيك ال surface area
+
+580
+00:43:04,620 --> 00:43:07,300
+اختفى بدل ما كان surface area surface area surface
+
+581
+00:43:07,300 --> 00:43:12,550
+area مش تنفرض هيك و راح اتحول الى vacuum كبيرةفي
+
+582
+00:43:12,550 --> 00:43:15,130
+حين ان ال vacuum الكبيرة دي كان لها surface area
+
+583
+00:43:15,130 --> 00:43:18,550
+ضخم لما كانت عبارة عن alveoli لكن لما اتكسرت ال
+
+584
+00:43:18,550 --> 00:43:21,990
+alveoli ال walls بينها وعملت space واحد في ال
+
+585
+00:43:21,990 --> 00:43:25,950
+emphysema جال ال surface area لذلك هدوء تابعون ال
+
+586
+00:43:25,950 --> 00:43:32,550
+emphysema تمام عندهم الهواء بدخل صح والدم بدخل صح
+
+587
+00:43:32,550 --> 00:43:36,730
+لكن ال surface area اللي بتيصل عنه لانتقال الغازات
+
+588
+00:43:36,730 --> 00:43:42,970
+جال تمامبتنفس عكس ال .. ال .. ال .. بتاع ال .. ال
+
+589
+00:43:42,970 --> 00:43:43,170
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+590
+00:43:43,170 --> 00:43:43,430
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+591
+00:43:43,430 --> 00:43:43,510
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+592
+00:43:43,510 --> 00:43:44,670
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+593
+00:43:44,670 --> 00:43:45,290
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+594
+00:43:45,290 --> 00:43:45,890
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+595
+00:43:45,890 --> 00:43:48,990
+.. ال .. ال ..
+
+596
+00:43:48,990 --> 00:43:52,790
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+597
+00:43:52,790 --> 00:44:00,150
+.. ال .. ال .. ال .. ال .. ال .. ال ..
+
+598
+00:44:00,150 --> 00:44:04,190
+ال
+
+599
+00:44:06,710 --> 00:44:10,290
+فعند في surgical dead space كبر هتكلم عنها في آخر
+
+600
+00:44:10,290 --> 00:44:14,970
+المحاضرة إذا ضال وجود إلها إذا عند ال surface area
+
+601
+00:44:14,970 --> 00:44:19,870
+ال diffusion coefficient اللي بمثل عاملين هذا و ال
+
+602
+00:44:19,870 --> 00:44:23,990
+partial pressure بين ال إيه؟ بين ال two sides of
+
+603
+00:44:23,990 --> 00:44:27,750
+the respiratory membrane مش هيك؟ هنا مفترض أن
+
+604
+00:44:27,750 --> 00:44:31,190
+اتكلم على كل واحدة على من ال factors هذه على حده
+
+605
+00:44:31,510 --> 00:44:35,130
+الـ thickness of the .. يعني الإيديمة لو أصبح عندي
+
+606
+00:44:35,130 --> 00:44:39,270
+بالمونة الإيديمة thickness بتزيد مش هيك لو أصبح
+
+607
+00:44:39,270 --> 00:44:43,150
+عندي ال fibrosis ال thickness بتزيد الإيديمة بيصير
+
+608
+00:44:43,150 --> 00:44:49,470
+في العادة في bronchial أزمة allergy حساسية عملت
+
+609
+00:44:49,470 --> 00:44:53,210
+ورم تورم لو أتعالجنا وراها هترجع طبيعي لكن ال
+
+610
+00:44:53,210 --> 00:44:56,570
+fibrosis بيصير في إيه؟ في أمراض تمام؟ أمراض
+
+611
+00:44:56,570 --> 00:45:01,170
+silicosis ماعرفش إيش أمراض بتقدر إلى أنهبيصير تليف
+
+612
+00:45:01,170 --> 00:45:04,950
+في الـ respirator و يخمل يخمل و نوعيته بيصير سيئة
+
+613
+00:45:04,950 --> 00:45:07,690
+ان انت لاستشعار فلوت بيصير fiber session بيصير ال
+
+614
+00:45:07,690 --> 00:45:11,710
+diffusion coefficient صعب كتير بيصير diffusion
+
+615
+00:45:11,710 --> 00:45:19,450
+rate واط كتير تمام ال
+
+616
+00:45:19,450 --> 00:45:21,650
+surface area قولنا في الانفيزيمة بيصير مشكلة كتير
+
+617
+00:45:21,650 --> 00:45:25,450
+راح ندرسها بالتفاصيل الانفيزيمة في آخر فصل او قبل
+
+618
+00:45:25,450 --> 00:45:28,290
+الأخر راح ندرسها بالتفاصيل بس انا دلتكوا فكرة عنها
+
+619
+00:45:28,290 --> 00:45:33,560
+بالعلم هذه الانفيزيمةمشكلة السجاير يعني المشكلة
+
+620
+00:45:33,560 --> 00:45:38,780
+الرئيسية للسجاير ان انها تدخلني في انفيزيمة هي
+
+621
+00:45:38,780 --> 00:45:42,280
+تبدأ تخرب عليها ال surface area تبع ال ايه ال gas
+
+622
+00:45:42,280 --> 00:45:45,960
+transport يصير عندي ايه بيجيل بيجيل بيجيل ال
+
+623
+00:45:45,960 --> 00:45:50,240
+alveoli بتتسعى تنتين بيخشوا في بعض بيعملوا واحدة
+
+624
+00:45:50,240 --> 00:45:54,020
+بدل ما اقولهم surfacesالكبيرة التانية تتوحدوا
+
+625
+00:45:54,020 --> 00:45:58,100
+وعملوا surface واحدة فجل ال surface area والكبيرة
+
+626
+00:45:58,100 --> 00:46:02,280
+بتاخد في أختها كبيرة كمان بجل بجل بجل مع الوجود ال
+
+627
+00:46:02,280 --> 00:46:05,720
+surface area of gas transport بيبدأ ايه؟ يجل
+
+628
+00:46:05,720 --> 00:46:09,940
+وبيقدر ال ventilation
+
+629
+00:46:09,940 --> 00:46:13,560
+صح لكن ال gases اللي بتنجل لأن ال surface area
+
+630
+00:46:13,560 --> 00:46:18,210
+هبطت بتنجل جليل فدائما عنده gas hungerفده أما حاطط
+
+631
+00:46:18,210 --> 00:46:22,890
+جانبه أسواد أكسجين هو بتنفس أكسجين المشكلة أنه بعد
+
+632
+00:46:22,890 --> 00:46:27,610
+بياخدله نفس أكسجين بيعود ياخدله إيه؟ غريبة جدا،
+
+633
+00:46:27,610 --> 00:46:31,550
+بيموت من السجائر و لسه بدخن أو بياخدله نفس شيشة،
+
+634
+00:46:31,550 --> 00:46:33,990
+بيقدرش ياخد شيشة، موت على المطر على سنة ما كده،
+
+635
+00:46:33,990 --> 00:46:39,310
+نفس شيشة لإنه بيقدرش يترك ال إيه؟ الأكسجين المشكلة
+
+636
+00:46:39,310 --> 00:46:44,510
+أنه وين ما ينجل، يلا يا بنت احمله معايا، هي تتحرك،
+
+637
+00:46:44,510 --> 00:46:48,320
+واحد يحرك الأسواد الأكسجينأنا بتتكلم عن واحدة
+
+638
+00:46:48,320 --> 00:46:53,800
+جارتنا كانت يعني فليش عندها انفزيمة تمام فعشان
+
+639
+00:46:53,800 --> 00:46:58,040
+تندقل الشمسات تقعد هيك في الشسمة بدها تروح تقعد
+
+640
+00:46:58,040 --> 00:47:01,960
+هنا بتقدرش تروح إلا حد ييجي يعمل لها إيه بطل سجين
+
+641
+00:47:01,960 --> 00:47:06,820
+محمل على عربات يلّا بيزوجوه مصر يلّا تدخلوني يا
+
+642
+00:47:06,820 --> 00:47:12,180
+ولاد بتقدر تمشي بس بتقدرش تزوج .. إيش؟ بتعيش
+
+643
+00:47:12,180 --> 00:47:16,720
+حياتها هيكأه زي ما بنبدل قنابيب الغاز مستبدل ايه؟
+
+644
+00:47:16,720 --> 00:47:21,040
+قنابيب اكسجين حياتنا، ما احنا الحمد لله بخير، ايش
+
+645
+00:47:21,040 --> 00:47:25,320
+اللي اجبرنا؟ نقتل نفسنا بنفسنا؟ اه والله يا ظلم،
+
+646
+00:47:25,320 --> 00:47:29,800
+مصبوط ولا لأ؟ لذلك انا اعتقد انه الانسان اللي
+
+647
+00:47:29,800 --> 00:47:35,280
+بيعلم ان السجن مضرع، يعلم وبرغم اني بدخن، اه هدقله
+
+648
+00:47:35,280 --> 00:47:40,300
+عقوبة، لكن اللي جاهل؟ ماعرفش، لكن الان حقيقة مافيش
+
+649
+00:47:40,300 --> 00:47:47,380
+وعدة لجاهلالأولى بمكتوبة طيب
+
+650
+00:47:47,380 --> 00:47:50,720
+when the total surface area is decreased to about
+
+651
+00:47:50,720 --> 00:47:56,260
+one third to one fourth of normal surface area بدت
+
+652
+00:47:56,260 --> 00:48:00,340
+تخرب تخرب وصلت لتلت الموجود الطبيعي أو ربع الطبيعي
+
+653
+00:48:00,340 --> 00:48:04,420
+هنا ببدأ المشكلة عندنا حتى أتريست تحس ب air hunger
+
+654
+00:48:04,420 --> 00:48:09,220
+عنده ديسنيا هو قاعد يعني بطل ال oxygen اللي يدخل
+
+655
+00:48:09,220 --> 00:48:18,460
+يكفيعلى الاستراحة وليس على الاستراحة الانتجار
+
+656
+00:48:18,460 --> 00:48:22,160
+من الجازات من خلال الممبرنة يتم تحريرها إلى مستوى
+
+657
+00:48:22,160 --> 00:48:28,020
+كبير حتى في حالات الاستراحة تمام؟ وفي مدار
+
+658
+00:48:28,020 --> 00:48:32,420
+السبورتينية والعديد من الاجتماعات السيرونية حتى
+
+659
+00:48:32,420 --> 00:48:34,640
+الانتجار الأقل في المنطقة العامة
+
+660
+00:48:38,160 --> 00:48:41,420
+تخريب ال surface area بيأثر على الإنسان أولها
+
+661
+00:48:41,420 --> 00:48:44,580
+بيأثر عليه أول ما بيبدأ الإشي بيلاحظ أنه مش قادر
+
+662
+00:48:44,580 --> 00:48:47,640
+يمشي مش قادر يجري مش قادر .. لكن بعد كده بيبقى
+
+663
+00:48:47,640 --> 00:48:52,480
+زيدي زيدي لما يصل إيه؟ انه at rest انه at .. اه ..
+
+664
+00:48:52,480 --> 00:48:58,200
+disnig .. disnig بيحس ب .. ب .. ب air hunger مش
+
+665
+00:48:58,200 --> 00:49:01,900
+قادر .. مش قادر النفس مش مكفية لذلك بنحاول ولا
+
+666
+00:49:01,900 --> 00:49:06,760
+اكسشين بحتلما نحاول الاكسجين بحت معناه احنا البرشر
+
+667
+00:49:06,760 --> 00:49:10,360
+برشر من الاكسجين من وصله لسبعمية و ستين تمام
+
+668
+00:49:10,360 --> 00:49:15,920
+فبيصير الانتقال من سبعمية و ستين للاربعين انتقال
+
+669
+00:49:15,920 --> 00:49:19,980
+السرعة اللي بيصير بسبب فرق البرشر برشر لحد ما
+
+670
+00:49:19,980 --> 00:49:24,560
+نحاول نعوض ال surface area اللي جاله خدتوا بالكم؟
+
+671
+00:49:24,560 --> 00:49:29,320
+نحاول كل اللي بدخل اكسجين طيب ال diffusion
+
+672
+00:49:29,320 --> 00:49:34,150
+coefficient ال diffusion coefficient قلناالها
+
+673
+00:49:34,150 --> 00:49:37,690
+factors وهذه تعتمد على المادة اللي انا بستخدمها
+
+674
+00:49:37,690 --> 00:49:40,670
+depending on the gas solubility and the molecular
+
+675
+00:49:40,670 --> 00:49:42,750
+weight the rate of diffusion of respiratory
+
+676
+00:49:42,750 --> 00:49:46,530
+membrane is almost exactly the same as that in
+
+677
+00:49:46,530 --> 00:49:49,990
+water for .. اه يعني ال coefficient ما بتتغيرش
+
+678
+00:49:49,990 --> 00:49:54,490
+العامل الواحد صفاته فيه يعني ال oxygen ال
+
+679
+00:49:54,490 --> 00:49:58,190
+coefficient ده ماتتغيرش هو oxygen ال carbon
+
+680
+00:49:58,190 --> 00:50:01,360
+dioxide هو carbon ال nitrogen هو nitrogenالفرشر
+
+681
+00:50:01,360 --> 00:50:03,520
+الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر
+
+682
+00:50:03,520 --> 00:50:08,640
+الفرشر الفرشر
+
+683
+00:50:08,640 --> 00:50:10,500
+الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر
+
+684
+00:50:10,500 --> 00:50:11,220
+الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر
+
+685
+00:50:11,220 --> 00:50:14,220
+الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر
+
+686
+00:50:14,220 --> 00:50:18,080
+الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر
+
+687
+00:50:18,080 --> 00:50:18,820
+الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر الفرشر
+
+688
+00:50:18,820 --> 00:50:26,390
+الفرشر الفرشر الفرشر الفرشبمثل ال ال ال ال ال ال
+
+689
+00:50:26,390 --> 00:50:27,130
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+690
+00:50:27,130 --> 00:50:27,890
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+691
+00:50:27,890 --> 00:50:30,210
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+692
+00:50:30,210 --> 00:50:31,670
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+693
+00:50:31,670 --> 00:50:31,710
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+694
+00:50:31,710 --> 00:50:32,450
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+695
+00:50:32,450 --> 00:50:32,530
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+696
+00:50:32,530 --> 00:50:32,550
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+697
+00:50:32,550 --> 00:50:34,970
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+698
+00:50:34,970 --> 00:50:35,190
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+699
+00:50:35,190 --> 00:50:35,210
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+700
+00:50:35,210 --> 00:50:44,210
+ال ال ال ال ال ممثل
+
+701
+00:50:44,210 --> 00:50:47,850
+اليصير اللي هو بيقولنا بال random motion تبع ال
+
+702
+00:50:47,850 --> 00:50:53,270
+molecules إلى أنه يصير ال .. ال net tendency of
+
+703
+00:50:53,270 --> 00:50:59,190
+diffusion هو من الأعلى إلى الأعلى إلى الأقل برشا
+
+704
+00:50:59,190 --> 00:51:03,610
+برشا ال diffusion capacity of the respiratory
+
+705
+00:51:03,610 --> 00:51:08,130
+membrane حلوة، إذا الآن احنا بدنا نخش في مواضيع
+
+706
+00:51:08,130 --> 00:51:12,270
+هذه كلها basis نتكلم عنها، الآن هنقدر نعمل إحسابات
+
+707
+00:51:12,270 --> 00:51:15,590
+و أرقام و حيث كدهthe diffusing capacity of the
+
+708
+00:51:15,590 --> 00:51:18,070
+respirator membrane يعني كدهش ال respirator
+
+709
+00:51:18,070 --> 00:51:23,970
+membrane بيقدر يدخلي oxygen و كدهش ال respirator
+
+710
+00:51:23,970 --> 00:51:29,050
+membrane بيقدر يدخلي carbon dioxide تحت تأثير ال
+
+711
+00:51:29,050 --> 00:51:34,330
+pressure الوحدة الواحدة لل pressure تمام؟ في
+
+712
+00:51:34,330 --> 00:51:40,290
+الدقيقة الواحدة متكلمنا عن إيه؟ إذا متكلم عن اللي
+
+713
+00:51:40,290 --> 00:51:45,590
+هو ال diffusing capacityبنحسبها احنا بال ايه؟ per
+
+714
+00:51:45,590 --> 00:51:54,610
+minute per minute per millimeter mercury unitsيعني
+
+715
+00:51:54,610 --> 00:51:58,030
+الوحدة الواحدة للضغط فرق في البرشا pressure من
+
+716
+00:51:58,030 --> 00:52:02,070
+نقطة او نقطة الفرق الواحد جديش بيعمل diffusion
+
+717
+00:52:02,070 --> 00:52:04,870
+capacity عشان نقارن احنا ال diffusion capacity
+
+718
+00:52:04,870 --> 00:52:11,330
+للريسيمالات من غاز لغاز بنوحد ال ايه الوحدات يعني
+
+719
+00:52:11,330 --> 00:52:15,250
+بنتكلم انه طب البرشا pressure الواحد جديش بدخل
+
+720
+00:52:15,250 --> 00:52:17,590
+عشان يقول والله ال diffusion capacity للأكسجين
+
+721
+00:52:17,590 --> 00:52:22,170
+أحسن و لل carbon dioxide أحسن وهذا جديش ومش جديش
+
+722
+00:52:22,170 --> 00:52:28,500
+تمام؟إذا diffusion capacity لأكسجين لجناها واحد
+
+723
+00:52:28,500 --> 00:52:31,760
+وعشرين مليليتر per minute per millimeter mercury
+
+724
+00:52:31,760 --> 00:52:35,380
+كل millimeter mercury في دقيقة واحدة بدخلي واحد
+
+725
+00:52:35,380 --> 00:52:40,680
+وعشرين مليل ايه؟ مليليتر، مش هيك؟ واحد وعشرين
+
+726
+00:52:40,680 --> 00:52:46,680
+مليليتر في الوضع الطبيعي بيكون فارق احد عشر
+
+727
+00:52:46,680 --> 00:52:51,360
+مليليتر mercury بين الاعسانين
+
+728
+00:52:51,360 --> 00:52:58,620
+والصحين11 ملي متر ميركوري بين الـVenus و الـAir و
+
+729
+00:52:58,620 --> 00:53:05,720
+الـAlveolar Air 11 في 21 ملي لتر معناها عندي بتكلم
+
+730
+00:53:05,720 --> 00:53:11,020
+عن 230 مش كده اللي هو 250 ملي لتر من ال oxygen
+
+731
+00:53:11,020 --> 00:53:14,280
+تقريبا اللي احنا محتاجينه في الـAir اللي احنا في
+
+732
+00:53:14,280 --> 00:53:17,920
+الاترست بنستهلكه مش هيك اذا اقول ان لما يكون عندي
+
+733
+00:53:17,920 --> 00:53:25,410
+اناsurface area كويس و diffusing coefficient كويس
+
+734
+00:53:25,410 --> 00:53:30,810
+برشر برشر الواحد بتديني ال oxygen واحد و عشرين
+
+735
+00:53:30,810 --> 00:53:35,610
+ميلي لتر oxygen per minute تمام for each
+
+736
+00:53:35,610 --> 00:53:39,050
+millimeter mercury لما يكون عندي الفارق انا احداشر
+
+737
+00:53:39,050 --> 00:53:43,690
+ميلي متر mercury معناه اترس بيدخل اترس 250 ميلي
+
+738
+00:53:43,690 --> 00:53:46,590
+لتر per minute اللي هي الجسم بحتاجها عشان كده
+
+739
+00:53:46,590 --> 00:53:50,340
+بيثبتال input زي اتكلمت عن الكريتانين انا قبل كده
+
+740
+00:53:50,340 --> 00:53:53,540
+بقول ان الكريتانين بيثبت ل level لما يصير عندى انا
+
+741
+00:53:53,540 --> 00:53:57,620
+في ال level هذا ال output وال input تساوى فبيثبت
+
+742
+00:53:57,620 --> 00:54:02,860
+ال level مش كده و هنا عندنا level معين بنثبت عليه
+
+743
+00:54:02,860 --> 00:54:07,320
+لما في هذا ال level يصير اللى انا باعطيهو اللي بقى
+
+744
+00:54:07,320 --> 00:54:13,060
+أخده the same فبيثبت ال level مش كده بقى أعطي بقى
+
+745
+00:54:13,060 --> 00:54:18,580
+أجيب 150 milliliter oxygen و بديهم للدم كاملة طبعا
+
+746
+00:54:18,580 --> 00:54:22,020
+لكن باخد 200 milliliter ايهاش كارويند اكسر مين
+
+747
+00:54:22,020 --> 00:54:27,100
+يفكر فيها ممكن تكون ناسمك ال oxygen تحب ال
+
+748
+00:54:27,100 --> 00:54:30,260
+hydrogen عشان و عشان ناسمك؟ ايش اسمك انت ده ليه
+
+749
+00:54:30,260 --> 00:54:34,180
+صنع الله ده ليه صنع الله ده ليه صنع الله ذاكرين
+
+750
+00:54:34,180 --> 00:54:36,850
+ايه لك علامة في الأخر يا عمي؟الفرق مش ال sweat
+
+751
+00:54:36,850 --> 00:54:40,070
+اتقصدها، الفرق في ال metabolism احنا عندنا لما
+
+752
+00:54:40,070 --> 00:54:42,930
+نستخدم أن نحرج ال oxygen مش كله بنخرجه من ال
+
+753
+00:54:42,930 --> 00:54:47,050
+carbon dioxide بتلاقى carbon dioxide ان ايه؟ and
+
+754
+00:54:47,050 --> 00:54:51,390
+water ال water is excreted by the kidney مش هيك؟
+
+755
+00:54:51,390 --> 00:54:54,830
+بظبط؟ ففي عندي جزء من ال oxygen مش هيطلع مع المين
+
+756
+00:54:54,830 --> 00:55:01,560
+مش ال sweat اصحبهم منك مش ال sweatat the
+
+757
+00:55:01,560 --> 00:55:06,720
+mitochondria لما انا بعمل burning لل hydrocarbons
+
+758
+00:55:06,720 --> 00:55:10,680
+hydrocarbons الكربون بتتحول ل carbon dioxide ولا
+
+759
+00:55:10,680 --> 00:55:14,780
+hydrogen بتتحول ل ايه؟ لوتر ال water executed جزء
+
+760
+00:55:14,780 --> 00:55:20,720
+منها جزء منها ممكن يقول انها executed by ايه؟ by
+
+761
+00:55:20,720 --> 00:55:26,300
+the respiration تمام؟ لكن الجزء الأساسي ايه؟ عن
+
+762
+00:55:26,300 --> 00:55:30,590
+طريق الايه الكلية حسب الظروف المهم بتتحول لميهففي
+
+763
+00:55:30,590 --> 00:55:33,410
+جزء من الأكسجين اللي اتاخد صار ميه لذلك ال ..
+
+764
+00:55:33,410 --> 00:55:35,870
+الحساب اللي ضال على ال carbon dioxide .. ال .. ال
+
+765
+00:55:35,870 --> 00:55:39,690
+carbon dioxide مش كل أكسجين لأ يا عم انت ماتتنش كل
+
+766
+00:55:39,690 --> 00:55:42,010
+أكسجين أنا أخد الجزء من الأكسجين و الباقي أخده
+
+767
+00:55:42,010 --> 00:55:45,070
+الهيدروجين عملوا ميه مش هيك لذلك بدخل عندنا 250
+
+768
+00:55:45,070 --> 00:55:48,930
+بتطلع ايه؟ الفرق بينهم هذا مين؟ في ال metabolism
+
+769
+00:55:48,930 --> 00:55:55,850
+في عندى وقت انا نسهش اذا بالحسبة هذه بنقدر نعرف
+
+770
+00:55:55,850 --> 00:56:01,710
+احنا بدخل عندناو نفس الكلام بالنسبة ل ال at .. at
+
+771
+00:56:01,710 --> 00:56:08,170
+.. at exercise قولنا احنا at rest .. at rest محتاج
+
+772
+00:56:08,170 --> 00:56:13,390
+بتقوله خمسين ملي لتر at .. at .. at exercise طلعنا
+
+773
+00:56:13,390 --> 00:56:17,590
+لجينا علي الى تلت أضعاف صار عندى خمسة و ستين ملي
+
+774
+00:56:17,590 --> 00:56:23,510
+لتر oxygen per one hundred .. per one millimeter
+
+775
+00:56:23,510 --> 00:56:28,000
+mercury per minuteلذن في ال exercise بيزيد عشرة
+
+776
+00:56:28,000 --> 00:56:32,260
+أضعاف ال ventilation بيزيد عشرة أضعاف و ال blood
+
+777
+00:56:32,260 --> 00:56:37,380
+supply بيزيد عشرة أضعاف في الحالة هذه بيصير عندي
+
+778
+00:56:37,380 --> 00:56:42,040
+استطيع أن يدخل أكسجين خمسة و ستين ملي لتر per
+
+779
+00:56:42,040 --> 00:56:45,760
+minute for each one millimeter mercury في الحالة
+
+780
+00:56:45,760 --> 00:56:52,480
+هذه لما نقول الخمسة و ستين هذه تلت أضعاف الطبيعي
+
+781
+00:56:57,660 --> 00:57:01,100
+في تجارب التجارب التجارية أو تجارب أخرى التي تزداد
+
+782
+00:57:01,100 --> 00:57:05,020
+كثيرًا تجارب البلوكولية والبلوكولية تزداد تجارب
+
+783
+00:57:05,020 --> 00:57:06,000
+التجارب التجارب التجارب التجارب التجارب التجارب
+
+784
+00:57:06,000 --> 00:57:10,660
+التجارب التجارب التجارب التجارب التجارب التجارب
+
+785
+00:57:10,660 --> 00:57:14,360
+التجارب التجارب التجارب التجارب التجارب التجارب
+
+786
+00:57:14,360 --> 00:57:14,900
+التجارب التجارب التجارب التجارب التجارب التجارب
+
+787
+00:57:14,900 --> 00:57:14,940
+التجارب التجارب التجارب التجارب التجارب التجارب
+
+788
+00:57:14,940 --> 00:57:14,980
+التجارب التجارب التجارب التجارب التجارب التجارب
+
+789
+00:57:14,980 --> 00:57:27,020
+التجارب التجارب التجارب التجارب التجارب التجارب
+
+790
+00:57:27,700 --> 00:57:32,080
+صرت بسبب حاجتين الحاجة الواحدة اللي اتكلمنا عنها
+
+791
+00:57:32,080 --> 00:57:38,160
+المرة اللي فاتت ان هو ال capillaries اللي هي كانت
+
+792
+00:57:38,160 --> 00:57:43,740
+مش مستخدمة تستخدم dilatation of the closed
+
+793
+00:57:43,740 --> 00:57:47,680
+capillaries و dilatation of the already used
+
+794
+00:57:47,680 --> 00:57:51,900
+capillaries مش كده؟ مش كده؟ هدول ال capillary ايه؟
+
+795
+00:57:51,900 --> 00:57:54,560
+وقلنا انه في ال exercise كمان ال blood supply اللي
+
+796
+00:57:54,560 --> 00:57:59,460
+بيصلبكون اكتر و ال pressure باعلى ف ال flow بزيد
+
+797
+00:57:59,460 --> 00:58:04,460
+تمام؟ هذه ما الحاجة الحاجة التانية المهمة لما
+
+798
+00:58:04,460 --> 00:58:09,680
+اتكلمنا لكوا عن ال zone واحد و اتنين و تلاتة واضح
+
+799
+00:58:09,680 --> 00:58:14,460
+ان احنا في عندنا ventilation بيجي في zone two اللي
+
+800
+00:58:14,460 --> 00:58:20,060
+هي ال upper part ال apex بيجي عندى انا ventilation
+
+801
+00:58:20,060 --> 00:58:25,600
+لكنه لا يستخدم في ال transport في كل ال diastole
+
+802
+00:58:26,070 --> 00:58:30,450
+مافيش فيه gas exchange، مش كده؟ إذا .. إذا في
+
+803
+00:58:30,450 --> 00:58:33,550
+الحالة اللي مصير ال exercise عندى، الدغط بعلى
+
+804
+00:58:33,550 --> 00:58:37,150
+شوية، بيصير الدم يقدر يخش على ال alveoli في ال
+
+805
+00:58:37,150 --> 00:58:41,070
+cistole و ال diastole، فبيصير عندى better matching
+
+806
+00:58:41,070 --> 00:58:44,450
+between the ventilation and .. and perfusion،
+
+807
+00:58:44,450 --> 00:58:49,010
+perfusion نقصد فيها ال bloodإذا من أنه طالع كلمة
+
+808
+00:58:49,010 --> 00:58:51,650
+ventilation تعني الهواء و perfusion تعني مين؟
+
+809
+00:58:51,650 --> 00:58:56,050
+البلد إذا better matching between ventilation and
+
+810
+00:58:56,050 --> 00:59:03,930
+what؟ and perfusion تمام؟ إذا صار عندي الدم
+
+811
+00:59:03,930 --> 00:59:07,990
+اللي داخل تمام؟ ال oxygen اللي داخل بيلاقي دم
+
+812
+00:59:07,990 --> 00:59:12,710
+يستخدمه يساعده مش كده؟ هذا بيزود من إيه؟ من قدرات
+
+813
+00:59:12,710 --> 00:59:16,180
+ال إيه؟ال .. ال .. ال .. ال diffusion capacity
+
+814
+00:59:16,180 --> 00:59:20,000
+أثناء ال exercise لإنه بزيد زي ما قلنا زي ما بزيد
+
+815
+00:59:20,000 --> 00:59:22,920
+ال .. ال .. ال .. ال .. ال .. ال perfusion بزيد
+
+816
+00:59:22,920 --> 00:59:32,140
+عشر مرات و ال ventilation بزيد عشر مرات طيب
+
+817
+00:59:32,400 --> 00:59:38,880
+بالتالي، خلال تجربة أكسجينة الدم يزداد، ليس فقط
+
+818
+00:59:38,880 --> 00:59:44,420
+بإزالة الفيولار، بل أيضًا بإزالة قدرة الانفجار،
+
+819
+00:59:44,420 --> 00:59:48,660
+لأنه أفضل ماتش،
+
+820
+00:59:58,060 --> 01:00:00,740
+to cross the membrane, diffusion capacity of the
+
+821
+01:00:00,740 --> 01:00:05,940
+.. of the ايه؟ of the .. of the ions او molecules
+
+822
+01:00:05,940 --> 01:00:12,160
+زادت او الممبرين زادت diffusion capacity of carbon
+
+823
+01:00:12,160 --> 01:00:15,440
+dioxide ده المشكلة carbon dioxide carbon dioxide
+
+824
+01:00:15,440 --> 01:00:19,440
+لإن ال diffusion capacity تبعته ايه؟ عالي جدا مش
+
+825
+01:00:19,440 --> 01:00:23,680
+كده؟ عشان كده مش سهل ان انا اعمله حساباتمش سهل ان
+
+826
+01:00:23,680 --> 01:00:26,600
+انا اعمله حسابات مباشرة، دايما انا اعمله حسابات
+
+827
+01:00:26,600 --> 01:00:29,780
+غير مباشرة، حتى ال oxygen اعمله غير مباشرة، بس ال
+
+828
+01:00:29,780 --> 01:00:33,340
+oxygen carbon dioxide ايش مشكلته؟Diffuses through
+
+829
+01:00:33,340 --> 01:00:36,040
+the respiratory membrane so rapidly that the
+
+830
+01:00:36,040 --> 01:00:39,080
+average carbon dioxide partial pressure in the
+
+831
+01:00:39,080 --> 01:00:41,600
+pulmonary blood is not far different from that of
+
+832
+01:00:41,600 --> 01:00:44,140
+the carbon dioxide in the alveoli السرعة السريعة
+
+833
+01:00:44,140 --> 01:00:47,940
+تبعته مانحسش أنه صار فيه فرج عشان انا أقدر أحسب
+
+834
+01:00:47,940 --> 01:00:51,640
+الفرج عشان أعمل diffusion capacity بدل partial
+
+835
+01:00:51,640 --> 01:00:55,950
+pressure difference مش كده؟هذا سريع جدا لانه يقدرش
+
+836
+01:00:55,950 --> 01:00:58,890
+ينقل الولاي لحد ما التركيز يصبح زي تركيز مين؟
+
+837
+01:00:58,890 --> 01:01:01,970
+لبلاد، البلاد شوية شوية تبعه، فبقى دي إيه الحسبة
+
+838
+01:01:01,970 --> 01:01:05,170
+مابتطلعش صحيحة ماعلينا المهم في الموضوع ان ال
+
+839
+01:01:05,170 --> 01:01:08,770
+carbon dioxide diffusion capacity حالية، مش هيك؟
+
+840
+01:01:08,770 --> 01:01:12,110
+ال oxygen أجل nevertheless, measurements of
+
+841
+01:01:12,110 --> 01:01:15,470
+diffusion of other gases have shown that the
+
+842
+01:01:15,470 --> 01:01:16,370
+diffusion capacity
+
+843
+01:01:20,930 --> 01:01:26,330
+متأكد أن الـ diffusion coefficient دا كل غاز مرتبط
+
+844
+01:01:26,330 --> 01:01:28,630
+بالـ diffusion capacity كلما ال diffusion
+
+845
+01:01:28,630 --> 01:01:33,330
+coefficient عليه كلما ال capacity of the diffusion
+
+846
+01:01:33,330 --> 01:01:35,050
+capacity عليه اكتر او اكتر
+
+847
+01:01:47,920 --> 01:01:54,300
+مقارنة بالـ Diffusion Coefficient بين الـ Oxygen و
+
+848
+01:01:54,300 --> 01:01:57,040
+Carbon Dioxide، نقول بما أن Diffusion Coefficient
+
+849
+01:01:57,040 --> 01:01:59,880
+هذا إيه؟ هو عشرين ضعف هذا، إذن اتوماتيكا اللي
+
+850
+01:01:59,880 --> 01:02:02,520
+هيكون الـ Diffusion Capacity للـ Carbon Dioxide
+
+851
+01:02:03,600 --> 01:02:07,100
+أعلى بعشرين مرة يعني عشرين في واحد وعشرين تقريبا
+
+852
+01:02:07,100 --> 01:02:10,280
+أربعمائة مرة مشكلة أربعمائة millimeter mercury
+
+853
+01:02:10,280 --> 01:02:13,660
+millimeter per minute for each one millimeter
+
+854
+01:02:13,660 --> 01:02:18,280
+mercury تمام؟ at rest و ال exercise عنده بالعشرين
+
+855
+01:02:18,280 --> 01:02:21,580
+في التلاتة و ستين بيطلع فوق الألف و متين من الف و
+
+856
+01:02:21,580 --> 01:02:24,220
+متين لألف واربعمائة او الف و تلاتة متر millimeter
+
+857
+01:02:24,220 --> 01:02:29,620
+of carbon dioxide each minute for each millimeter
+
+858
+01:02:29,620 --> 01:02:30,360
+mercury
+
+859
+01:02:33,180 --> 01:02:41,240
+هذا اخر اشي هنقوله عملية خياس ال .. ال .. ال
+
+860
+01:02:41,240 --> 01:02:46,060
+diffusion capacity لل .. لل oxygen طبعا ال oxygen
+
+861
+01:02:46,060 --> 01:02:48,740
+بنجيه نجيسله ال diffusion capacity و بنلاقيها صعبة
+
+862
+01:02:48,740 --> 01:02:55,100
+صعبة ليش؟ لإنه بدنا نجيس ال partial pressure في ال
+
+863
+01:02:55,100 --> 01:02:59,140
+.. يعني التكنيك بيكون صعب إذا بنستخدمه احنا مباشر
+
+864
+01:02:59,140 --> 01:03:03,810
+لكن احنا مسهلنا التكنيكلأنه لما نعمل تقنية صعبة
+
+865
+01:03:03,810 --> 01:03:08,010
+أسبب أرقام معينة فبعدين أسهل أننا نعمل شيء معين ان
+
+866
+01:03:08,010 --> 01:03:10,870
+ال diffusion capacity لل Oxygen 1.3 diffusion
+
+867
+01:03:10,870 --> 01:03:15,110
+capacity لكربون مونوكسايد لأنه لما قلنا زمان ال
+
+868
+01:03:15,110 --> 01:03:23,210
+solubility point هذا 12.25 فاكرين؟ طيب فال Oxygen
+
+869
+01:03:23,210 --> 01:03:30,270
+أحسن ال Oxygen diffusion capacity أحسن ب 1.3إذا لو
+
+870
+01:03:30,270 --> 01:03:35,190
+ميزة carbon monoxide أنه قيله affinity عالية جدا
+
+871
+01:03:35,190 --> 01:03:39,590
+لمين؟ للهيموجلبيين يعني أنا لو أدي carbon monoxide
+
+872
+01:03:39,590 --> 01:03:42,370
+بسيط كله بيروح ل الهيموجلبيين ال partial pressure
+
+873
+01:03:42,370 --> 01:03:46,890
+في ال plasma مش هيصير almost zero يعني مش هيدي
+
+874
+01:03:46,890 --> 01:03:49,790
+الهيموجلبيين فرصة لcarbon monoxide أنه يكون
+
+875
+01:03:49,790 --> 01:03:53,690
+dissolved in ايه؟in in in in the plasma in the
+
+876
+01:03:53,690 --> 01:03:58,070
+water هياخدوا كله يحملوا كلهم جلبين واضح؟ اذا في
+
+877
+01:03:58,070 --> 01:04:01,650
+الحالة هذه لما انا اجيس pressure pressure لcarbon
+
+878
+01:04:01,650 --> 01:04:06,330
+monoxide عن طريق ال spirometer تمام و اعرف جديش
+
+879
+01:04:06,330 --> 01:04:10,310
+عندي كمية carbon monoxide لما احسب الجهة الأخرى
+
+880
+01:04:10,310 --> 01:04:15,010
+بعد كده ال pressure pressure ايش؟ zero تمام اذا
+
+881
+01:04:15,010 --> 01:04:18,250
+صار عندي ال pressure pressure difference هو ال
+
+882
+01:04:18,250 --> 01:04:21,710
+alveolar pressure pressureتمام؟ إذا لما أخد
+
+883
+01:04:21,710 --> 01:04:25,910
+الفيولر sample و أفحص فيها ال carbon monoxide جداش
+
+884
+01:04:25,910 --> 01:04:30,410
+ال pressure تبعه ناجز zero إذا هو يمثل ال إيه؟ إذا
+
+885
+01:04:30,410 --> 01:04:33,670
+هي كل الفكرة الفكرة إنه أنا ال carbon monoxide
+
+886
+01:04:33,670 --> 01:04:37,050
+ممكن يخش ال homoglobin و يسيب البلازمة فاضية يعني
+
+887
+01:04:37,050 --> 01:04:40,110
+zero pressure pressure إذا مقدر أحسب الحسبة هذه
+
+888
+01:04:40,110 --> 01:04:44,230
+تمام؟ بسهولة جداش بطلع ال carbon monoxide في الآخر
+
+889
+01:04:44,230 --> 01:04:48,170
+diffusion capacity بضربها في one point threeتطلع
+
+890
+01:04:48,170 --> 01:04:53,290
+لنا ايش؟ لل oxygen تمام؟ اذا العملية في حد ذاتها
+
+891
+01:04:53,290 --> 01:04:59,950
+ايه؟ عملية سهلة باحسب ال
+
+892
+01:04:59,950 --> 01:05:04,030
+concentration of carbon بدي monoxide شامتين تلاتة
+
+893
+01:05:04,030 --> 01:05:09,730
+كده تمام؟ و بعدين باخد exploratory sample باخد
+
+894
+01:05:09,730 --> 01:05:13,610
+الاخر جزء منها اللي هي ال alveolar air و بحسب ال
+
+895
+01:05:13,610 --> 01:05:17,830
+pressure pressure تمام؟وبقول جديش انا نجس ال
+
+896
+01:05:17,830 --> 01:05:23,970
+carbon monoxide من بداية ال .. ال .. ال .. ال
+
+897
+01:05:23,970 --> 01:05:27,870
+respiration اللي انا حطيته للي ضايل تمام و بعرف
+
+898
+01:05:27,870 --> 01:05:31,590
+الكمية اللي فقدت هذه في جديش فقدت عشان اعرف
+
+899
+01:05:31,590 --> 01:05:35,730
+diffusion capacity كملي لتر carbon monoxide بيطلع
+
+900
+01:05:35,730 --> 01:05:36,690
+ليها حوالى ستة عشر
+
+901
+01:05:39,990 --> 01:05:48,610
+هيطلع يطلع يطلع يطلع
+
+902
+01:05:48,610 --> 01:05:59,550
+يطلع يطلع
+
+903
+01:05:59,550 --> 01:06:03,430
+يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع
+
+904
+01:06:03,430 --> 01:06:03,670
+يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع
+
+905
+01:06:03,670 --> 01:06:04,570
+يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلع يطلو
+
+906
+01:06:04,570 --> 01:06:07,550
+في الغالب هنبدأ في معناها الفصل الجاي لكن خليني
+
+907
+01:06:07,550 --> 01:06:12,110
+أعملكم مقدمة زي ما قلنا فيه ventilation يعني ..
+
+908
+01:06:12,110 --> 01:06:17,690
+يعني .. يعني ايه؟ long side ال air side
+
+909
+01:06:17,690 --> 01:06:23,070
+ventilation و perfusion يعني ايه؟ ال blood side ال
+
+910
+01:06:23,070 --> 01:06:27,390
+ventilation لما اتكلم على الفيوز معينة تمام؟
+
+911
+01:06:27,760 --> 01:06:32,060
+افترضوا انه احنا سكرنا ال alveolus هذه وعزلناها عن
+
+912
+01:06:32,060 --> 01:06:35,840
+ال ventilation الهواء اللي فيها ضايل كما هو الهواء
+
+913
+01:06:35,840 --> 01:06:39,860
+اللي فيها لا بيجيله جديد ولا بيطلع منه اللي اللي
+
+914
+01:06:39,860 --> 01:06:45,140
+بيخشه تمام؟ صار abstraction لمنطقة معينة ايش بتوقع
+
+915
+01:06:45,140 --> 01:06:49,620
+بعد فترة ال abstracted lobule هذا او ال abstracted
+
+916
+01:06:49,620 --> 01:06:54,780
+alveolus ال ال ال gas ال gas composition اللي فيها
+
+917
+01:06:54,780 --> 01:07:01,620
+كيف هيكون؟أكيد هتقولولي شبيه بقى ال Venus blood و
+
+918
+01:07:01,620 --> 01:07:04,780
+انا هتقول كواه لإنه ال Venus blood دخل عليه عشان
+
+919
+01:07:04,780 --> 01:07:08,560
+يعمل تبادل غازات تمام؟ ضال ياخد منه و يودي عشان
+
+920
+01:07:08,560 --> 01:07:12,620
+يعمل equilibrium لحد ما في الآخر و هو مافيش ملاية
+
+921
+01:07:12,620 --> 01:07:16,640
+تجدد فعندي ال equilibrium في الآخر هيصل لمرحة لإنه
+
+922
+01:07:16,640 --> 01:07:20,640
+ال oxygen اللي فيه يسوى مين؟ ال Venus و ال carbon
+
+923
+01:07:20,640 --> 01:07:23,840
+dioxide فيه؟ هيسوى ال Venus يعني جدش متوجه انا
+
+924
+01:07:23,840 --> 01:07:28,790
+oxygen يكون في برشا بشر في الفيلوس المسكرةبتوقع
+
+925
+01:07:28,790 --> 01:07:31,810
+يكون اربعين millimeter mercury و ال carbon ده
+
+926
+01:07:31,810 --> 01:07:36,050
+اكتشف توقع ايش يصير؟ خمسة و اربعين تمام طيب هذي
+
+927
+01:07:36,050 --> 01:07:40,850
+واحد اتنين بنتوقع احنا ال virus بالعكس ال virus
+
+928
+01:07:40,850 --> 01:07:44,350
+موجودة الهواء طالع نازل عليها لكنها مافيش فيها
+
+929
+01:07:44,350 --> 01:07:48,190
+blood ييجي ياخد منها مافيش مالاش blood supply
+
+930
+01:07:48,190 --> 01:07:53,760
+ففيها ventilation فيها poor perfusionأنا بتوقع إيش
+
+931
+01:07:53,760 --> 01:08:01,480
+يصير إنه هنصل ل 149 ليش لإنه ال 104 كانت نتاجة إنه
+
+932
+01:08:01,480 --> 01:08:06,760
+في عندي أنا تهريب فمش جاي لل 149 to build up لإنه
+
+933
+01:08:06,760 --> 01:08:08,560
+بيضل اه بيضل ال carbon dioxide يدخل و ال oxygen
+
+934
+01:08:08,560 --> 01:08:14,310
+يطلع لكن هنا هيضل ال alveolar ال respiratoryال ..
+
+935
+01:08:14,310 --> 01:08:18,590
+ال .. ال respiration يظل يغسللي في ال ايه؟ في ال
+
+936
+01:08:18,590 --> 01:08:23,910
+alveolus تمام؟ و يستبدل ال 104 لما الدم راح عنا
+
+937
+01:08:23,910 --> 01:08:29,330
+كده 104 يستبدل 104 ب 149 ال 149 ب 149 100 .. لما
+
+938
+01:08:29,330 --> 01:08:33,750
+يصير كلها في الآخر 149 millimeter mercury oxygen و
+
+939
+01:08:33,750 --> 01:08:37,930
+هتكون في المقابل كدهش carbon dioxide؟ point three
+
+940
+01:08:37,930 --> 01:08:42,250
+zero يعني اه مش كده؟ تمام؟ اذا .. اذا في عندي انا
+
+941
+01:08:42,730 --> 01:08:48,670
+هذه الفكرة العامة إنه إذا زاد .. إذا في عندي علاقة
+
+942
+01:08:48,670 --> 01:08:53,690
+ما بين ال ventilation و ال perfusion تمام؟ ممكن ال
+
+943
+01:08:53,690 --> 01:08:58,830
+perfusion يقل ال perfusion يقل ملاقي العلاقة إن ال
+
+944
+01:08:58,830 --> 01:09:01,670
+ratio هذه زادت لإن ال ventilation على ال perfusion
+
+945
+01:09:01,670 --> 01:09:05,410
+ملاقي صارت أكتر من ال normal تمام؟ و ممكن ال
+
+946
+01:09:05,410 --> 01:09:09,070
+ventilation يقل من الحالة هذه ملاقينها إيه؟
+
+947
+01:09:09,070 --> 01:09:13,680
+العلاقة أقل من إيه؟ من ال normalلما يكون عندى
+
+948
+01:09:13,680 --> 01:09:19,380
+ventilation زيادة و .. و .. و perfusion أقل مانعى
+
+949
+01:09:19,380 --> 01:09:24,840
+عندى dead space كتر صار هوا مالوش استخدام تمام؟
+
+950
+01:09:24,840 --> 01:09:27,840
+اذا بزيد ال physiological dead space و لما يكون
+
+951
+01:09:27,840 --> 01:09:32,200
+عندى perfusion زيادة، perfusion احنا قولنا
+
+952
+01:09:32,200 --> 01:09:35,970
+ventilation أقلventilation طبيعي الأول احنا قلنا
+
+953
+01:09:35,970 --> 01:09:39,590
+ventilation طبيعي زيها ده يعني و اللي جل ال ايه ال
+
+954
+01:09:39,590 --> 01:09:42,310
+blood معناها زاد ال ventilation معناها عندي
+
+955
+01:09:42,310 --> 01:09:47,150
+physiological ايه ده ال space لما يكون عندي انا في
+
+956
+01:09:47,150 --> 01:09:53,050
+الحالة هذه لأ عندي ال ventilation أجل من اللازم
+
+957
+01:09:53,050 --> 01:09:57,290
+أجل من اللازمفي obstruction partial obstruction او
+
+958
+01:09:57,290 --> 01:10:00,470
+something like that او انفزيما خربت perfusion اقل
+
+959
+01:10:00,470 --> 01:10:05,170
+من اللازم ودم طبيعي تمام معناه في العالم هذا بيكون
+
+960
+01:10:05,170 --> 01:10:09,730
+النسبة ايش اقل معناه في دم دخل من ال venous side
+
+961
+01:10:09,730 --> 01:10:14,230
+لل arterial side او ال arterial لل venous انا برضه
+
+962
+01:10:14,230 --> 01:10:17,830
+لازم اعتبره venous arterial لل ايه لل venous من
+
+963
+01:10:17,830 --> 01:10:22,880
+غير ما ياخد ايه اكسجين يعني كأنه عمل شنطتمام ايه؟
+
+964
+01:10:22,880 --> 01:10:25,640
+كأنه عامل ايه؟ شنط من غير ما يعدي على أكسجين و من
+
+965
+01:10:25,640 --> 01:10:30,740
+غير ما يعدي على دقيقتين كأن هو bronchial اه؟ كأنه
+
+966
+01:10:30,740 --> 01:10:34,820
+ماشي في الكلة ما .. ما .. ما .. هو داخل من المنطقة
+
+967
+01:10:34,820 --> 01:10:38,420
+لمّا مااخدش أكسجين لإن الأكسجين اعطى لجزء من الدم
+
+968
+01:10:38,420 --> 01:10:41,280
+و الجزء الباقي مااخدش فصار اندي هاد اسمه
+
+969
+01:10:41,280 --> 01:10:45,880
+physiological shunt اذا موضوعنا الحاجة هيكون بين
+
+970
+01:10:45,880 --> 01:10:50,320
+الشنط و ال .. ايه؟ و ال dead spaceتمام؟ لأنه في
+
+971
+01:10:50,320 --> 01:10:55,040
+الانفيزيمة هنلاقي أنه عندنا في مناطق فيها more
+
+972
+01:10:55,040 --> 01:10:59,060
+physiological شنط which is bad دم خش من غير ما
+
+973
+01:10:59,060 --> 01:11:03,240
+يعمل oxygenation و more physiological dead space
+
+974
+01:11:03,240 --> 01:11:07,840
+لأنه هوا و تعب و غلبه و مايستفادش منه مش كده؟ هذا
+
+975
+01:11:07,840 --> 01:11:10,480
+تقريبا هي المحاضرة كلها هيتها يمكن قلت انا في
+
+976
+01:11:10,480 --> 01:11:13,860
+الدقيقتين هدوة في الإختصار تمام؟ و أعتقد أنه مش
+
+977
+01:11:13,860 --> 01:11:18,020
+محتاج أنه نشرح فيها أكتر من هيك لكن الأشياء وقتش
+
+978
+01:11:18,020 --> 01:11:22,730
+بيصيرلما مايكونش دم نهائي لما مايكونش دم نهائي
+
+979
+01:11:22,730 --> 01:11:25,950
+يعني انا بقسم على ال VA ال ventilation على zero
+
+980
+01:11:25,950 --> 01:11:30,050
+بدين infinity تمام؟ في الحدي هذا انا بكون عندي
+
+981
+01:11:30,050 --> 01:11:35,900
+deal space عالي لما يكون الأقلهيكون اكتر من الواحد
+
+982
+01:11:35,900 --> 01:11:39,520
+او يصل ل infinity معناه انا عندي ايه درجات من ال
+
+983
+01:11:39,520 --> 01:11:42,960
+ايه من ال dead space لكن لو العكس صار عندي انا
+
+984
+01:11:42,960 --> 01:11:47,440
+بجسم zero على اشي بيطلع ليه zero لما بيطلع على اشي
+
+985
+01:11:47,440 --> 01:11:49,900
+zero او اقل من واحد معناه ان انا بخش فيه ان في
+
+986
+01:11:49,900 --> 01:11:53,860
+عندي ايه ده chance مش كده يعني دم كتير مش لاجوا
+
+987
+01:11:53,860 --> 01:11:57,580
+سجين ماهي الفرق بينهم اعتقد من هنا لنهاية المخادرة
+
+988
+01:11:57,580 --> 01:12:00,220
+هي نفس الكلام اللي بدي اقوله و كده ممكن خلصنا
+
+989
+01:12:00,220 --> 01:12:03,640
+الموضوع كله يطول يعطيكوا العافية و انا ماكنش
+
+990
+01:12:03,640 --> 01:12:04,300
+متواجع اقوله
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lZxsHIknvb0_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lZxsHIknvb0_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..8b5f85c90664e4befc459c21d9cf615f5ac6da94
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lZxsHIknvb0_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3484, "start": 6.14, "end": 34.84, "text": "نواصل الحديث عن ال ventilation و هنتكلم عن alveolar air و قولنا ال alveolar air هذا المنطقة اللي بتمن خلالها تبدل الغازات فهي منطقة مهمة بالنسبالنا و التعرف عليها مهم لإن هي فيها air مختلف عن ال atmospheric air و مختلف عن ال blood gases هي مرحلة ما بين اتنين atmospheric air", "tokens": [1863, 2407, 33546, 1211, 21542, 16254, 12984, 18871, 2423, 29553, 4032, 8032, 29399, 4117, 19528, 18871, 419, 303, 15276, 1988, 4032, 12174, 12610, 8315, 2423, 419, 303, 15276, 1988, 23758, 9673, 1863, 9566, 28671, 13672, 1829, 39894, 27842, 16490, 1211, 6027, 11296, 6055, 44510, 1211, 6024, 118, 31377, 9307, 6156, 3224, 1829, 9154, 9566, 28671, 3714, 16095, 3660, 20666, 1863, 35457, 6027, 8315, 4032, 16712, 3615, 28480, 25894, 11296, 3714, 16095, 5296, 28814, 1863, 39896, 8978, 11296, 1988, 3714, 46456, 46538, 18871, 2423, 28854, 1988, 4032, 3714, 46456, 46538, 18871, 2423, 3390, 21452, 39896, 3714, 2288, 5016, 37977, 19446, 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"probability": 0.6568603515625}, {"start": 3197.42, "end": 3197.68, "word": " يكون", "probability": 0.9794921875}, {"start": 3197.68, "end": 3197.92, "word": " عندي", "probability": 0.802490234375}, {"start": 3197.92, "end": 3198.16, "word": " انا", "probability": 0.929443359375}], "temperature": 1.0}, {"id": 125, "seek": 322707, "start": 3198.99, "end": 3227.07, "text": "surface area كويس و diffusing coefficient كويس برشر برشر الواحد بتديني ال oxygen واحد و عشرين ميلي لتر oxygen per minute تمام for each millimeter mercury لما يكون عندي الفارق انا احداشر ميلي متر mercury معناه اترس بيدخل اترس 250 ميلي لتر per minute اللي هي الجسم بحتاجها عشان كده بيثبت", "tokens": [36054, 2868, 1859, 9122, 45865, 3794, 4032, 7593, 7981, 17619, 9122, 45865, 3794, 4724, 2288, 8592, 2288, 4724, 2288, 8592, 2288, 2423, 14407, 24401, 39894, 3215, 9957, 1829, 2423, 9169, 36764, 24401, 4032, 6225, 46309, 9957, 3714, 1829, 20292, 5296, 2655, 2288, 9169, 680, 3456, 46811, 10943, 337, 1184, 17942, 33307, 5296, 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0.7589518229166666}, {"start": 3223.69, "end": 3223.99, "word": " لتر", "probability": 0.9695638020833334}, {"start": 3223.99, "end": 3224.17, "word": " per", "probability": 0.5302734375}, {"start": 3224.17, "end": 3224.51, "word": " minute", "probability": 0.82568359375}, {"start": 3224.51, "end": 3224.81, "word": " اللي", "probability": 0.842529296875}, {"start": 3224.81, "end": 3224.93, "word": " هي", "probability": 0.340087890625}, {"start": 3224.93, "end": 3225.25, "word": " الجسم", "probability": 0.978759765625}, {"start": 3225.25, "end": 3225.83, "word": " بحتاجها", "probability": 0.8944091796875}, {"start": 3225.83, "end": 3226.41, "word": " عشان", "probability": 0.9505208333333334}, {"start": 3226.41, "end": 3226.59, "word": " كده", "probability": 0.9742838541666666}, {"start": 3226.59, "end": 3227.07, "word": " بيثبت", "probability": 0.973828125}], "temperature": 1.0}, {"id": 126, "seek": 324650, "start": 3227.44, "end": 3246.5, "text": "ال input زي اتكلمت عن الكريتانين انا قبل كده بقول ان الكريتانين بيثبت ل level لما يصير عندى انا في ال level هذا ال output وال input تساوى فبيثبت ال level مش كده و هنا عندنا level معين بنثبت عليه لما في هذا ال level يصير اللى انا باعطيه", "tokens": [6027, 4846, 30767, 1829, 1975, 2655, 4117, 19528, 2655, 18871, 33251, 16572, 2655, 7649, 9957, 1975, 8315, 12174, 36150, 9122, 3215, 3224, 4724, 39648, 16472, 33251, 16572, 2655, 7649, 9957, 4724, 1829, 12984, 3555, 2655, 5296, 1496, 5296, 15042, 7251, 9381, 13546, 43242, 7578, 1975, 8315, 8978, 2423, 1496, 23758, 2423, 5598, 16070, 4846, 6055, 3794, 995, 2407, 7578, 6156, 3555, 1829, 12984, 3555, 2655, 2423, 1496, 37893, 9122, 3215, 3224, 4032, 34105, 43242, 8315, 1496, 20449, 9957, 44945, 12984, 3555, 2655, 47356, 5296, 15042, 8978, 23758, 2423, 1496, 7251, 9381, 13546, 13672, 7578, 1975, 8315, 4724, 45761, 9566, 1829, 3224], "avg_logprob": -0.22993260052274256, "compression_ratio": 2.015873015873016, "no_speech_prob": 4.172325134277344e-07, "words": [{"start": 3227.44, 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"end": 3231.7, "word": " بيثبت", "probability": 0.9326171875}, {"start": 3231.7, "end": 3231.82, "word": " ل", "probability": 0.5439453125}, {"start": 3231.82, "end": 3232.14, "word": " level", "probability": 0.93603515625}, {"start": 3232.14, "end": 3232.82, "word": " لما", "probability": 0.932373046875}, {"start": 3232.82, "end": 3233.08, "word": " يصير", "probability": 0.9811197916666666}, {"start": 3233.08, "end": 3233.4, "word": " عندى", "probability": 0.59228515625}, {"start": 3233.4, "end": 3233.54, "word": " انا", "probability": 0.855712890625}, {"start": 3233.54, "end": 3233.66, "word": " في", "probability": 0.5419921875}, {"start": 3233.66, "end": 3233.74, "word": " ال", "probability": 0.77392578125}, {"start": 3233.74, "end": 3233.94, "word": " level", "probability": 0.9755859375}, {"start": 3233.94, "end": 3234.32, "word": " هذا", "probability": 0.78173828125}, {"start": 3234.32, "end": 3235.0, "word": " ال", "probability": 0.767578125}, {"start": 3235.0, "end": 3235.34, "word": " output", "probability": 0.986328125}, {"start": 3235.34, "end": 3236.26, "word": " وال", "probability": 0.60107421875}, {"start": 3236.26, "end": 3236.46, "word": " input", "probability": 0.92919921875}, {"start": 3236.46, "end": 3237.12, "word": " تساوى", "probability": 0.798681640625}, {"start": 3237.12, "end": 3237.62, "word": " فبيثبت", "probability": 0.8472493489583334}, {"start": 3237.62, "end": 3237.72, "word": " ال", "probability": 0.94384765625}, {"start": 3237.72, "end": 3237.96, "word": " level", "probability": 0.99072265625}, {"start": 3237.96, "end": 3238.48, "word": " مش", "probability": 0.78466796875}, {"start": 3238.48, "end": 3238.8, "word": " كده", "probability": 0.9903971354166666}, {"start": 3238.8, "end": 3239.22, "word": " و", "probability": 0.380615234375}, {"start": 3239.22, "end": 3239.5, "word": " هنا", "probability": 0.97802734375}, {"start": 3239.5, "end": 3240.2, "word": " عندنا", "probability": 0.813232421875}, {"start": 3240.2, "end": 3240.52, 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باعطيه", "probability": 0.782275390625}], "temperature": 1.0}, {"id": 127, "seek": 327544, "start": 3246.8, "end": 3275.44, "text": "و اللي بقى أخده the same فبيثبت ال level مش كده بقى أعطي بقى أجيب 150 milliliter oxygen و بديهم للدم كاملة طبعا لكن باخد 200 milliliter ايهاش كارويند اكسر مين يفكر فيها ممكن تكون ناسمك ال oxygen تحب ال hydrogen عشان و عشان ناسمك؟ ايش اسمك انت ده ليه صنع الله ده ليه صنع الله ده ليه صنع الله ذاكرين ايه لك علامة في الأخر يا عمي؟", "tokens": [2407, 13672, 1829, 4724, 4587, 7578, 5551, 9778, 3215, 3224, 264, 912, 6156, 21292, 12984, 3555, 2655, 2423, 1496, 37893, 9122, 3215, 3224, 4724, 4587, 7578, 5551, 3615, 9566, 1829, 4724, 4587, 7578, 5551, 7435, 1829, 3555, 8451, 1728, 388, 1681, 9169, 4032, 4724, 16254, 16095, 24976, 40448, 9122, 10943, 37977, 23032, 3555, 3615, 995, 44381, 4724, 47283, 3215, 2331, 1728, 388, 1681, 1975, 1829, 3224, 33599, 9122, 9640, 2407, 9957, 3215, 1975, 4117, 3794, 2288, 3714, 9957, 7251, 5172, 37983, 8978, 11296, 3714, 43020, 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.. ال diffusion capacity لل .. لل oxygen طبعا ال oxygen بنجيه نجيسله ال diffusion capacity و بنلاقيها صعبة صعبة ليش؟ لإنه بدنا نجيس ال partial pressure في ال .. يعني التكنيك بيكون صعب إذا بنستخدمه احنا مباشر لكن احنا مسهلنا التكنيك", "tokens": [3224, 15730, 1975, 34740, 1975, 8592, 1829, 8032, 1863, 39648, 3224, 6225, 42213, 10632, 16490, 1829, 32277, 2423, 4386, 2423, 4386, 2423, 25242, 6042, 24976, 4386, 24976, 9169, 23032, 3555, 3615, 995, 2423, 9169, 44945, 7435, 1829, 3224, 8717, 7435, 1829, 3794, 43761, 2423, 25242, 6042, 4032, 44945, 15040, 38436, 11296, 20328, 3615, 49401, 20328, 3615, 49401, 32239, 8592, 22807, 5296, 28814, 1863, 3224, 47525, 8315, 8717, 7435, 1829, 3794, 2423, 14641, 3321, 8978, 2423, 4386, 37495, 22653, 16712, 19452, 1829, 4117, 4724, 1829, 30544, 20328, 3615, 3555, 11933, 15730, 44945, 14851, 9778, 40448, 3224, 1975, 5016, 8315, 3714, 3555, 33599, 2288, 44381, 1975, 5016, 8315, 47524, 3224, 1211, 8315, 16712, 19452, 1829, 4117], "avg_logprob": 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او يصل ل infinity معناه انا عندي ايه درجات من ال ايه من ال dead space لكن لو العكس صار عندي انا بجسم zero على اشي بيطلع ليه zero لما بيطلع على اشي zero او اقل من واحد معناه ان انا بخش فيه ان في عندي ايه ده chance مش كده يعني دم كتير مش لاجوا سجين ماهي الفرق بينهم اعتقد من هنا لنهاية المخادرة هي نفس الكلام اللي بدي اقوله و كده ممكن خلصنا الموضوع كله يطول يعطيكوا العافية و انا ماكنش متواجع اقوله", "tokens": [3224, 1829, 30544, 1975, 4117, 2655, 2288, 9154, 2423, 14407, 24401, 1975, 2407, 7251, 36520, 5296, 13202, 20449, 8315, 3224, 1975, 8315, 18871, 16254, 1975, 1829, 3224, 11778, 47341, 9307, 9154, 2423, 1975, 1829, 3224, 9154, 2423, 3116, 1901, 44381, 45164, 18863, 4117, 3794, 20328, 9640, 18871, 16254, 1975, 8315, 4724, 7435, 38251, 4018, 15844, 1975, 8592, 1829, 4724, 1829, 9566, 1211, 3615, 32239, 3224, 4018, 5296, 15042, 4724, 1829, 9566, 1211, 3615, 15844, 1975, 8592, 1829, 4018, 1975, 2407, 1975, 4587, 1211, 9154, 36764, 24401, 20449, 8315, 3224, 16472, 1975, 8315, 4724, 9778, 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4295.5, "word": " من", "probability": 0.99267578125}, {"start": 4295.5, "end": 4295.9, "word": " الواحد", "probability": 0.92333984375}, {"start": 4295.9, "end": 4296.12, "word": " او", "probability": 0.825439453125}, {"start": 4296.12, "end": 4296.32, "word": " يصل", "probability": 0.966796875}, {"start": 4296.32, "end": 4296.42, "word": " ل", "probability": 0.72607421875}, {"start": 4296.42, "end": 4296.8, "word": " infinity", "probability": 0.6435546875}, {"start": 4296.8, "end": 4297.74, "word": " معناه", "probability": 0.8434244791666666}, {"start": 4297.74, "end": 4297.92, "word": " انا", "probability": 0.8447265625}, {"start": 4297.92, "end": 4298.24, "word": " عندي", "probability": 0.79443359375}, {"start": 4298.24, "end": 4298.64, "word": " ايه", "probability": 0.9446614583333334}, {"start": 4298.64, "end": 4299.18, "word": " درجات", "probability": 0.8860677083333334}, {"start": 4299.18, "end": 4299.36, "word": " من", "probability": 0.99169921875}, {"start": 4299.36, "end": 4299.52, "word": " ال", "probability": 0.923828125}, {"start": 4299.52, "end": 4299.74, "word": " ايه", "probability": 0.6952311197916666}, {"start": 4299.74, "end": 4299.9, "word": " من", "probability": 0.90283203125}, {"start": 4299.9, "end": 4300.02, "word": " ال", "probability": 0.880859375}, {"start": 4300.02, "end": 4300.14, "word": " dead", "probability": 0.91455078125}, {"start": 4300.14, "end": 4300.58, "word": " space", "probability": 0.9658203125}, {"start": 4300.58, "end": 4301.3, "word": " لكن", "probability": 0.8681640625}, {"start": 4301.3, "end": 4301.52, "word": " لو", "probability": 0.9697265625}, {"start": 4301.52, "end": 4301.88, "word": " العكس", "probability": 0.9913736979166666}, {"start": 4301.88, "end": 4302.2, "word": " صار", "probability": 0.949462890625}, {"start": 4302.2, "end": 4302.8, "word": " عندي", "probability": 0.82373046875}, {"start": 4302.8, "end": 4302.96, "word": " انا", "probability": 0.899169921875}, {"start": 4302.96, "end": 4303.4, "word": " بجسم", "probability": 0.623779296875}, {"start": 4303.4, "end": 4304.42, "word": " zero", "probability": 0.66845703125}, {"start": 4304.42, "end": 4304.62, "word": " على", "probability": 0.64892578125}, {"start": 4304.62, "end": 4305.08, "word": " اشي", "probability": 0.8274739583333334}, {"start": 4305.08, "end": 4305.94, "word": " بيطلع", "probability": 0.783349609375}, {"start": 4305.94, "end": 4306.04, "word": " ليه", "probability": 0.71435546875}, {"start": 4306.04, "end": 4306.38, "word": " zero", "probability": 0.771484375}, {"start": 4306.38, "end": 4307.02, "word": " لما", "probability": 0.841064453125}, {"start": 4307.02, "end": 4307.22, "word": " بيطلع", "probability": 0.88447265625}, {"start": 4307.22, "end": 4307.32, "word": " على", "probability": 0.2132568359375}, {"start": 4307.32, "end": 4307.44, "word": " اشي", "probability": 0.8844401041666666}, {"start": 4307.44, "end": 4307.7, "word": " zero", "probability": 0.79541015625}, {"start": 4307.7, "end": 4307.9, "word": " او", "probability": 0.937744140625}, {"start": 4307.9, "end": 4308.16, "word": " اقل", "probability": 0.9065755208333334}, {"start": 4308.16, "end": 4308.3, "word": " من", "probability": 0.99365234375}, {"start": 4308.3, "end": 4308.66, "word": " واحد", "probability": 0.990966796875}, {"start": 4308.66, "end": 4309.0, "word": " معناه", "probability": 0.9837239583333334}, {"start": 4309.0, "end": 4309.12, "word": " ان", "probability": 0.461181640625}, {"start": 4309.12, "end": 4309.16, "word": " انا", "probability": 0.644775390625}, {"start": 4309.16, "end": 4309.46, "word": " بخش", "probability": 0.9365234375}, {"start": 4309.46, "end": 4309.7, "word": " فيه", "probability": 0.63818359375}, {"start": 4309.7, "end": 4309.74, "word": " ان", "probability": 0.89599609375}, {"start": 4309.74, "end": 4309.9, "word": " في", "probability": 0.490234375}, {"start": 4309.9, "end": 4310.16, "word": " عندي", "probability": 0.78955078125}, {"start": 4310.16, "end": 4310.92, "word": " ايه", "probability": 0.857421875}, {"start": 4310.92, "end": 4311.2, "word": " ده", "probability": 0.38323974609375}, {"start": 4311.2, "end": 4311.64, "word": " chance", "probability": 0.85888671875}, {"start": 4311.64, "end": 4312.0, "word": " مش", "probability": 0.8779296875}, {"start": 4312.0, "end": 4312.3, "word": " كده", "probability": 0.97509765625}, {"start": 4312.3, "end": 4312.84, "word": " يعني", "probability": 0.857666015625}, {"start": 4312.84, "end": 4313.1, "word": " دم", "probability": 0.96533203125}, {"start": 4313.1, "end": 4313.46, "word": " كتير", "probability": 0.9850260416666666}, {"start": 4313.46, "end": 4313.64, "word": " مش", "probability": 0.94580078125}, {"start": 4313.64, "end": 4313.86, "word": " لاجوا", "probability": 0.564208984375}, {"start": 4313.86, "end": 4314.16, "word": " سجين", "probability": 0.8665364583333334}, {"start": 4314.16, "end": 4314.34, "word": " ماهي", "probability": 0.5007731119791666}, {"start": 4314.34, "end": 4314.62, "word": " الفرق", "probability": 0.8235677083333334}, {"start": 4314.62, "end": 4315.4, "word": " بينهم", "probability": 0.388427734375}, {"start": 4315.4, "end": 4315.9, "word": " اعتقد", "probability": 0.9352213541666666}, {"start": 4315.9, "end": 4316.5, "word": " من", "probability": 0.72705078125}, {"start": 4316.5, "end": 4316.66, "word": " هنا", "probability": 0.56884765625}, {"start": 4316.66, "end": 4317.04, "word": " لنهاية", "probability": 0.8341064453125}, {"start": 4317.04, "end": 4317.58, "word": " المخادرة", "probability": 0.7396240234375}, {"start": 4317.58, "end": 4318.38, "word": " هي", "probability": 0.8544921875}, {"start": 4318.38, "end": 4318.6, "word": " نفس", "probability": 0.997314453125}, {"start": 4318.6, "end": 4318.94, "word": " الكلام", "probability": 0.9654947916666666}, {"start": 4318.94, "end": 4319.06, "word": " اللي", "probability": 0.892333984375}, {"start": 4319.06, "end": 4319.16, "word": " بدي", "probability": 0.6033935546875}, {"start": 4319.16, "end": 4319.48, "word": " اقوله", "probability": 0.89892578125}, {"start": 4319.48, "end": 4319.52, "word": " و", "probability": 0.55029296875}, {"start": 4319.52, "end": 4319.64, "word": " كده", "probability": 0.8426106770833334}, {"start": 4319.64, "end": 4319.78, "word": " ممكن", "probability": 0.771484375}, {"start": 4319.78, "end": 4320.22, "word": " خلصنا", "probability": 0.970947265625}, {"start": 4320.22, "end": 4320.52, "word": " الموضوع", "probability": 0.9949951171875}, {"start": 4320.52, "end": 4320.84, "word": " كله", "probability": 0.9736328125}, {"start": 4320.84, "end": 4321.32, "word": " يطول", "probability": 0.4634602864583333}, {"start": 4321.32, "end": 4322.04, "word": " يعطيكوا", "probability": 0.89169921875}, {"start": 4322.04, "end": 4322.54, "word": " العافية", "probability": 0.9705403645833334}, {"start": 4322.54, "end": 4323.32, "word": " و", "probability": 0.88232421875}, {"start": 4323.32, "end": 4323.4, "word": " انا", "probability": 0.751953125}, {"start": 4323.4, "end": 4323.64, "word": " ماكنش", "probability": 0.82177734375}, {"start": 4323.64, "end": 4323.96, "word": " متواجع", "probability": 0.54296875}, {"start": 4323.96, "end": 4324.3, "word": " اقوله", "probability": 0.8642578125}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 4332.867, "duration_after_vad": 4216.079374999991}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a59eef4d1a7c543f70f9f294f4e0e86712866fc6
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g.srt
@@ -0,0 +1,827 @@
+1
+00:00:05,720 --> 00:00:13,240
+The ascending limb جدا مهم لعملية الdilution
+
+2
+00:00:13,240 --> 00:00:19,480
+اتكلمنا عن الـ .. عن الـ .. عن المضالة وأهميتها في
+
+3
+00:00:19,480 --> 00:00:23,340
+الايه؟ الـconcentration لكن بما أن الـfiltrate
+
+4
+00:00:23,340 --> 00:00:27,040
+بتطلع من الـascending limb بأزمولالية منخفضة
+
+5
+00:00:27,040 --> 00:00:35,270
+هيبوتونك، هيبوأزمولارية تصل لـ 100 ملي أوزمول
+
+6
+00:00:35,270 --> 00:00:40,170
+الـconcentration، osmolality هنا بتصل لـ 100،
+
+7
+00:00:40,170 --> 00:00:49,370
+واضح؟ طيب، إذا الـwater في الـproximal لها إيش؟
+
+8
+00:00:49,370 --> 00:00:55,950
+في الـthick ascending limb ممكن تخلي more diluted
+
+9
+00:00:56,550 --> 00:01:00,090
+لو احنا محتاجين more solutes، يعني لو الـالدوستيرون
+
+10
+00:01:00,090 --> 00:01:05,370
+عالي، لو الـ .. الـ .. الـالدوستيرون عالي بنسحب منه
+
+11
+00:01:05,370 --> 00:01:12,070
+more sodium and solutes، بدينا more diluted، تمام؟ أو
+
+12
+00:01:12,070 --> 00:01:20,390
+قد نركزها إلى حيث كانت isomolal، أن .. أن .. أخد
+
+13
+00:01:20,390 --> 00:01:28,560
+شوية مية أو أخد منها مية أكثر وأكثر في حالة وجود
+
+14
+00:01:28,560 --> 00:01:31,100
+الـantidiuretic hormone، إذا الـantidiuretic
+
+15
+00:01:31,100 --> 00:01:36,880
+hormone عنصر مهم جدا في المنطقة دي وطالع الـ
+
+16
+00:01:36,880 --> 00:01:42,740
+thick ascending limb لا تتفاعل مع أي هرمون، هتاخد
+
+17
+00:01:42,740 --> 00:01:46,900
+كل الـsolutes الكمية اللي بدها إياها وتترك المية
+
+18
+00:01:46,900 --> 00:01:50,860
+اللي فلترت عندها بالتركيز اللي هو مية، بعد كده
+
+19
+00:01:50,860 --> 00:01:55,720
+بتدخل الـcontrol system، لكن لحدها هي بتشغل اللي
+
+20
+00:01:55,720 --> 00:01:58,780
+بدها إياه، بدنا مية أكثر، بيطلع الـAntidiuretic
+
+21
+00:01:58,780 --> 00:02:03,120
+hormone، بيسحب المية اللي هي diluted، filtrated،
+
+22
+00:02:03,120 --> 00:02:07,260
+بيخليه very concentrated، بدنا الـsodium أكثر، بيطلع
+
+23
+00:02:07,260 --> 00:02:10,500
+الـaldosterone بيسحب كل الـsolutes، بيخلي إيه؟
+
+24
+00:02:10,500 --> 00:02:14,660
+diluted، تمام؟ بدنا الاثنين، بيطلعوا الاثنين، نسحب الـ
+
+25
+00:02:14,660 --> 00:02:17,800
+sodium، نسحب الـwater وبيخلي minimal urine
+
+26
+00:02:17,800 --> 00:02:21,960
+excretion، إذا محتاجين إحنا إيه؟ الضغط، الـwater كله
+
+27
+00:02:21,960 --> 00:02:25,080
+محتاجين المية ومحتاجين الـwhat؟ الـsolutes، مش
+
+28
+00:02:25,080 --> 00:02:28,880
+كده؟ فالأثنين بيطلعوا، لكن إذا أنا مسكت مية، أشرب
+
+29
+00:02:28,880 --> 00:02:32,600
+أشرب أشرب مية كتير، تمام؟ فالـsolutes، الـ
+
+30
+00:02:32,600 --> 00:02:35,790
+aldosterone بيظل موجود بيسحب، لكن المية antidiuretic
+
+31
+00:02:35,790 --> 00:02:37,890
+الهرمون بيقولها لأ لأ لأ، بنزل antidiuretic الهرمون
+
+32
+00:02:37,890 --> 00:02:42,750
+بيطلعها كلها، فبيطلع a diluted، لكن إذا كان أنا
+
+33
+00:02:42,750 --> 00:02:47,750
+محتاج الـsodium لأن أنا بشرب مية مافيش فيها كمية
+
+34
+00:02:47,750 --> 00:02:51,230
+كافية من الـ من الـsolutes، مية مفلترة مائة
+
+35
+00:02:51,230 --> 00:02:56,070
+بالمائة، تمام؟ و بس عليها معناه أن أنا فقدت الـ
+
+36
+00:02:56,070 --> 00:02:59,530
+solutes في الـ .. في الـ .. في الـintake وعندي water
+
+37
+00:02:59,530 --> 00:03:04,100
+pure water، في الـ في الحالة هذه ممكن ينزل البول
+
+38
+00:03:04,100 --> 00:03:09,800
+لتركيز خمسين ملي أوزمول، يعني عندي كمان بيقدر الـ ..
+
+39
+00:03:09,800 --> 00:03:11,780
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+40
+00:03:11,780 --> 00:03:11,840
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+41
+00:03:11,840 --> 00:03:11,900
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+42
+00:03:11,900 --> 00:03:12,780
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+43
+00:03:12,780 --> 00:03:13,580
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+44
+00:03:13,580 --> 00:03:13,820
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+45
+00:03:13,820 --> 00:03:14,100
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+46
+00:03:14,100 --> 00:03:14,380
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+47
+00:03:14,380 --> 00:03:25,040
+الـ .. الـ .. الـ .. الـ ..
+
+48
+00:03:25,040 --> 00:03:34,610
+الـ .. الـ .. المهيئين للمعلومة، إذا في الـdistal
+
+49
+00:03:34,610 --> 00:03:39,610
+under conditions، في الـthick ascending limb
+
+50
+00:03:39,610 --> 00:03:43,450
+impermeable to water، الـdistal convoluted ممكن
+
+51
+00:03:43,450 --> 00:03:46,950
+تكون impermeable، ممكن تكون impermeable حسب وجود
+
+52
+00:03:46,950 --> 00:03:52,350
+عندي antidiuretic hormone، هو، إذا هنا صارت العبور
+
+53
+00:03:52,350 --> 00:03:57,100
+بتصريح، هنا صار في الـdistal لأنه اللي بيعمل الـ
+
+54
+00:03:57,100 --> 00:04:01,440
+control، مافيش شيء بنتخل منه إلا under permission
+
+55
+00:04:01,440 --> 00:04:05,300
+طب إحنا بنتكلم عن إيش؟ بنتكلم عن الـdistal conical
+
+56
+00:04:05,300 --> 00:04:09,540
+tubule، عن الـconnecting tubule، عن cortical
+
+57
+00:04:09,540 --> 00:04:15,860
+collecting duct، وعن المدلر collecting duct tubule
+
+58
+00:04:15,860 --> 00:04:19,520
+و عن المدلر collecting duct، يعني من أول الـdistal
+
+59
+00:04:20,840 --> 00:04:26,600
+لنهاية الطريق، الآن صارت عندي إيه؟ تحت تحكم الـإيه؟
+
+60
+00:04:26,600 --> 00:04:30,540
+الجيش أعلن سيطرته على الموقع، هنا ما بسمح لحد
+
+61
+00:04:30,540 --> 00:04:34,800
+يتحرك يروح ولا ييجي إلا بإيه؟ بتصريح، تمام، الـ
+
+62
+00:04:34,800 --> 00:04:40,890
+proximal tubule بتاخد كمية ضخمة عرفناها، والـthick
+
+63
+00:04:40,890 --> 00:04:43,790
+ascending limb أخدت كمية ضخمة من الـsolutes المعروفة
+
+64
+00:04:43,790 --> 00:04:47,850
+والجزء اللي انترك الآن، يابد نزوده، يابد نجلله في الـ
+
+65
+00:04:47,850 --> 00:04:53,790
+excretion حسب حاجة الجسم، okay؟ إذا الـwater
+
+66
+00:04:53,790 --> 00:04:57,550
+permeability في الجزء الآخر، يعني من الـdistal
+
+67
+00:04:57,550 --> 00:05:00,190
+nephron .. distal convoluted .. لما نقول distal
+
+68
+00:05:00,190 --> 00:05:02,790
+nephron، يعني كل اللي باقي من بعد distal convoluted
+
+69
+00:05:02,790 --> 00:05:09,140
+tubule للآخر لحد البابلة، الـorifice اللي فيها، طبعا
+
+70
+00:05:09,140 --> 00:05:14,540
+إذا عندنا مناطق permeable to water ومناطق
+
+71
+00:05:14,540 --> 00:05:18,700
+impermeable to water، ومناطق under .. under a
+
+72
+00:05:18,700 --> 00:05:23,160
+control، can be permeability تزيد أو تقل according
+
+73
+00:05:23,160 --> 00:05:25,560
+to the antidiuretic hormone secretion
+
+74
+00:05:25,560 --> 00:05:28,680
+reabsorption of chloride
+
+75
+00:05:35,440 --> 00:05:40,540
+اتكلمنا عنه من شوية، الصوديوم لما يطلع ليه
+
+76
+00:05:40,540 --> 00:05:45,560
+absorbed، هيندفع وراه chloride passively، passively
+
+77
+00:05:45,560 --> 00:05:51,060
+ليه؟ لإنه صار عندي أنا الـelectrochemical gradient
+
+78
+00:05:51,060 --> 00:05:54,640
+بتسمح لأن الـconcentration of chloride في داخل الـ
+
+79
+00:05:54,640 --> 00:05:59,780
+cells واطي، جليل، والصوديوم دخل جوا، تمام؟
+
+80
+00:05:59,780 --> 00:06:06,910
+فالـsodium ترك مكانه، صارت محله negativity عالية، الـ
+
+81
+00:06:06,910 --> 00:06:10,310
+sodium، positive ions، راحت لداخل الـcells، كمية
+
+82
+00:06:10,310 --> 00:06:13,630
+كبيرة اندفعت، فصار عندي الـfiltration rate يميل لـ
+
+83
+00:06:13,630 --> 00:06:16,290
+more a negative، فصار عندي electrochemical
+
+84
+00:06:16,290 --> 00:06:20,170
+gradient في صالح مين؟ في صالح الكلورايد، فبندفع
+
+85
+00:06:20,170 --> 00:06:24,210
+الكلورايد ورا مين؟ ورا الـsodium، إن كان مباشرة عبر
+
+86
+00:06:24,210 --> 00:06:28,390
+الـbasolateral membrane أو عبر حسب السرعة اللي
+
+87
+00:06:28,390 --> 00:06:31,670
+بنتقل فيها الـsodium من الـtubular fluid إلى الـ
+
+88
+00:06:31,670 --> 00:06:36,810
+interstitium، تمام؟ محتاجين بعضه يدخل الـcells
+
+89
+00:06:36,810 --> 00:06:39,770
+وبعضه يروح الـinterstitium، وبيعدي من هنا وبيعدي من
+
+90
+00:06:39,770 --> 00:06:46,610
+هنا، بعضه هيعدي الـintracellular route وبعضه هيعدي
+
+91
+00:06:46,610 --> 00:06:51,970
+الـparacellular route، تمام؟ إذا الـsodium هنا، الـ
+
+92
+00:06:51,970 --> 00:06:55,750
+chloride بيصير له passive diffusion، بيصير له برضه
+
+93
+00:06:55,750 --> 00:07:00,890
+facilitated diffusion مع الـglucose والـamino
+
+94
+00:07:00,890 --> 00:07:06,330
+acids، في أول الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+95
+00:07:06,330 --> 00:07:06,570
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+96
+00:07:06,570 --> 00:07:08,070
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+97
+00:07:08,070 --> 00:07:16,870
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+98
+00:07:16,870 --> 00:07:17,090
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+99
+00:07:17,090 --> 00:07:17,110
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+100
+00:07:17,110 --> 00:07:17,530
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+101
+00:07:17,530 --> 00:07:19,050
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+102
+00:07:19,050 --> 00:07:21,370
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+103
+00:07:21,370 --> 00:07:21,390
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+104
+00:07:21,390 --> 00:07:21,510
+الـ الـ الـ الـ الـ الـ الـ الـ
+
+105
+00:07:32,790 --> 00:07:38,790
+ليه؟ لأن الـconcentration عليه الـ .. الـ .. الـ
+
+106
+00:07:38,790 --> 00:07:42,350
+facilitate فيه راح يكون أكثر لأن الـamino acid والـ
+
+107
+00:07:42,350 --> 00:07:46,570
+glucose خلصت، فالجزء الثاني من الـtubule، الـ
+
+108
+00:07:46,570 --> 00:07:50,030
+chloride بيكون فيه transport فيه أفضل إذا كان
+
+109
+00:07:50,030 --> 00:07:54,010
+passive أو كان إيه؟ facilitated، تمام؟
+
+110
+00:08:01,580 --> 00:08:05,140
+طيب، إذا عندنا when sodium is reabsorbed through
+
+111
+00:08:05,140 --> 00:08:08,280
+the tubular epithelial cells، negative ions such
+
+112
+00:08:08,280 --> 00:08:11,480
+as chloride are transported along with sodium
+
+113
+00:08:11,480 --> 00:08:14,680
+because of the electrical potentials، sodium راح
+
+114
+00:08:14,680 --> 00:08:18,840
+بتلحقه، that is transport of positively charged
+
+115
+00:08:18,840 --> 00:08:23,860
+sodium ions out of the lumen leaves the inside
+
+116
+00:08:23,860 --> 00:08:27,620
+more negative compared with the interstitial fluid
+
+117
+00:08:28,760 --> 00:08:31,860
+هذا يجعل أيون الكلورايد يتحرك بشكل مباشر عبر
+
+118
+00:08:31,860 --> 00:08:35,840
+الطريق البراخلاية، يتحرك بشكل مباشر عبر
+
+119
+00:08:35,840 --> 00:08:36,740
+الطريق البراخلاية، يتحرك بشكل مباشر عبر
+
+120
+00:08:36,740 --> 00:08:38,980
+الطريق البراخلاية، يتحرك بشكل مباشر عبر
+
+121
+00:08:38,980 --> 00:08:39,240
+الطريق البراخلاية، يتحرك بشكل مباشر عبر
+
+122
+00:08:39,240 --> 00:08:43,860
+الطريق البراخلاية، يتحرك بشكل مباشر عبر
+
+123
+00:08:43,860 --> 00:08:47,160
+الطريق البراخلاية، يتحرك بشكل مباشر عبر
+
+124
+00:08:47,160 --> 00:08:55,160
+الطريق البراخلاية، يتحرك بشكل
+
+125
+00:08:55,160 --> 00:09:00,860
+مباشر، من ثم يزداد تركيز أيونات الكلورايد في الـ
+
+126
+00:09:00,860 --> 00:09:05,020
+tubular lumen. بذلك، تزداد  تجارب الكلورايد
+
+127
+00:09:05,020 --> 00:09:10,240
+الكلورايد
+
+128
+00:09:10,240 --> 00:09:12,820
+الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد
+
+129
+00:09:12,820 --> 00:09:13,960
+الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد
+
+130
+00:09:13,960 --> 00:09:14,060
+الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد
+
+131
+00:09:14,060 --> 00:09:14,240
+الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد
+
+132
+00:09:14,240 --> 00:09:15,560
+الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد
+
+133
+00:09:15,560 --> 00:09:21,500
+الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد الكلورايد
+
+134
+00:09:21,500 --> 00:09:26,800
+الكلورايد الكلورايد الكلورايد، أو الـreabsorption لما يصير
+
+135
+00:09:26,800 --> 00:09:31,300
+بيؤدي إلى water reabsorption، والـwater
+
+136
+00:09:31,300 --> 00:09:34,640
+reabsorption بتؤدي إلى أن الـluminal chloride
+
+137
+00:09:34,640 --> 00:09:38,200
+concentration يعلى، وبتؤدي إلى passive diffusion
+
+138
+00:09:38,200 --> 00:09:42,500
+because of a concentration gradient، بالإضافة لأنه
+
+139
+00:09:42,500 --> 00:09:47,600
+لما يصير sodium reabsorption، الـluminal positive
+
+140
+00:09:47,600 --> 00:09:53,280
+ions decreased، لذلك الـnegativity إيش؟ هتزيد، إذا
+
+141
+00:09:53,280 --> 00:09:56,100
+اليوم الـnegative potential هيزيد، وهذا هيديني
+
+142
+00:09:56,100 --> 00:10:01,220
+دافع electrically لمين؟ للكلوريد، إذا اتوفى أكثر
+
+143
+00:10:01,220 --> 00:10:04,260
+شيء بتحكمه، electrochemical gradient، بس في
+
+144
+00:10:04,260 --> 00:10:09,400
+diffusion of إيه؟ of الكلورايد، اليوريا عاد هتمشي
+
+145
+00:10:09,400 --> 00:10:14,600
+بطريقة بس حسب الـconcentration، لأن اليوريا قدرة على
+
+146
+00:10:14,600 --> 00:10:18,620
+أنها تمر بسهولة عبر proximal tubule و simple
+
+147
+00:10:18,620 --> 00:10:23,440
+diffusion، كلما المية راحت كلما الـconcentration
+
+148
+00:10:23,440 --> 00:10:28,140
+عليت، كلما صار more diffusion، هو approximately كم؟
+
+149
+00:10:28,140 --> 00:10:30,980
+في الـtubule؟  حقيقة، fifty percent of the urea is
+
+150
+00:10:30,980 --> 00:10:35,320
+reabsorbed، بيظل إيه؟ بيظل just fifty percent، يعني
+
+151
+00:10:35,320 --> 00:10:38,200
+اليوريا اللي نازلة، نصها بيعود، بدخل في الـproximal
+
+152
+00:10:38,200 --> 00:10:42,060
+tubule، ونص الثاني بيصير delivered to إيه؟ to the
+
+153
+00:10:42,060 --> 00:10:46,600
+rest of the nephron، الـloop of Henle والباقي، المسافة
+
+154
+00:10:48,670 --> 00:10:53,190
+reabsorption of urea by passive diffusion، اتكلمنا
+
+155
+00:10:53,190 --> 00:10:57,250
+عنها in most parts of the nephron، especially the
+
+156
+00:10:57,250 --> 00:11:02,490
+inner medullary collecting duct، passive urea
+
+157
+00:11:02,490 --> 00:11:05,950
+reabsorption is facilitated by specific urea
+
+158
+00:11:05,950 --> 00:11:07,470
+transporters
+
+159
+00:11:10,310 --> 00:11:12,030
+لما نتكلم عن الـconcentration، عن الـurea
+
+160
+00:11:12,030 --> 00:11:16,030
+circulation، نتكلم بدقة عن اليوريا في كل مكان كيف
+
+161
+00:11:16,030 --> 00:11:17,830
+بيصير، بس إحنا بنتكلم عن الـproximal convoluted
+
+162
+00:11:17,830 --> 00:11:20,370
+tubule، وإن اليوريا في الـproximal convoluted
+
+163
+00:11:20,370 --> 00:11:27,870
+tubule بسبب الـsodium transport وما يليه من
+
+164
+00:11:27,870 --> 00:11:31,130
+water transport، أدى إلى concentrated urea which
+
+165
+00:11:31,130 --> 00:11:36,930
+will facilitate diffusion of part of the urea، 50%
+
+166
+00:11:36,930 --> 00:11:41,820
+is إيه؟ is the outside، ما دام تكلمنا عن اليوريا
+
+167
+00:11:41,820 --> 00:11:45,460
+بنتكلم عن الكرياتينين، مش كده؟ إحنا لما بنعمل فحص
+
+168
+00:11:45,460 --> 00:11:49,380
+للكلى بنعمل يوريا وكرياتينين، بنعمل يوريا و
+
+169
+00:11:49,380 --> 00:11:53,880
+كرياتينين، إذا الكرياتينين إيه؟ إيش بيصير فيه؟ قولنا
+
+170
+00:11:53,880 --> 00:11:56,560
+من شوية، إحنا الكرياتينين is mainly filtered
+
+171
+00:11:56,560 --> 00:12:03,540
+minimal creatinine is secreted، لذلك مستخدموه
+
+172
+00:12:03,540 --> 00:12:09,280
+كمان في إيش؟ في قياس الـGFR، re
+
+223
+00:15:26,610 --> 00:15:32,930
+بحيث أنه يضاعف.. يضاعف الـ.. يضاعف الـ surface
+
+224
+00:15:32,930 --> 00:15:34,510
+area twentyfold
+
+225
+00:15:38,520 --> 00:15:42,620
+نفس الـ foldings هذه موجودة بشكل أقل في الـ
+
+226
+00:15:42,620 --> 00:15:45,440
+basolateral membrane, the extensive membrane
+
+227
+00:15:45,440 --> 00:15:47,740
+surface of the apical brush border
+
+228
+00:16:00,240 --> 00:16:04,300
+إذن هذا يعطيني extensive membrane surface of the
+
+229
+00:16:04,300 --> 00:16:06,820
+epithelial brush border, is also loaded with
+
+230
+00:16:06,820 --> 00:16:09,380
+protein carriers. إذا عندك brush border عالي و
+
+231
+00:16:09,380 --> 00:16:12,260
+protein carriers عالية، بتقدر إلى الـ facilitated
+
+232
+00:16:12,260 --> 00:16:15,140
+diffusion. You can co-transport أو counter-
+
+233
+00:16:15,140 --> 00:16:18,580
+transport the reabsorption و الـ bicarbonate. أنا
+
+234
+00:16:18,580 --> 00:16:23,740
+تَكَلَّمْتُ لَكُمْ عنها، و الـ chloride تَكَلَّمْتُ لَكُمْ عنها الآن.
+
+235
+00:16:23,740 --> 00:16:29,370
+إحنا هذه الصورة تعطينا فكرة عامة على معنى الـ
+
+236
+00:16:29,370 --> 00:16:32,090
+proximal tubule. بيقول إيش بيصير في الـ osmolality
+
+237
+00:16:32,090 --> 00:16:37,090
+و الـ sodium، نفس التركيز، ما تغيرش لأن المية
+
+238
+00:16:37,090 --> 00:16:42,810
+بتتبع الـ glucose. كله راح بيخبط على طول من
+
+239
+00:16:42,810 --> 00:16:47,510
+أول الـ tube لآخره، و نزل للصفر، و الـ amino acid بيروح
+
+240
+00:16:47,510 --> 00:16:50,350
+تمام؟
+
+241
+00:16:51,370 --> 00:16:56,890
+و هكذا بنكون إحنا وصلنا أنه في عندي a secretory
+
+242
+00:16:56,890 --> 00:17:01,310
+function. قُلْتُ لَكُمْ إنها الـ organic material في الـ
+
+243
+00:17:01,310 --> 00:17:05,070
+proximal tubule، زي اليوريك أسيد وغيرها من بعض
+
+244
+00:17:05,070 --> 00:17:09,930
+المواد: بايل سولت، الأوكساليت، اليوريتس،
+
+245
+00:17:09,930 --> 00:17:13,150
+الكاتيكولامينز are secreted  في الـ proximal
+
+246
+00:17:13,150 --> 00:17:17,530
+tubule.  المشكلة عندها أن الـ penicillin و الـ
+
+247
+00:17:17,530 --> 00:17:21,130
+salicylates (الأسبيرين برضه) secreted في الـ proximal
+
+248
+00:17:21,130 --> 00:17:24,210
+convoluted tubule. هذا بيؤدي إلى أنهم  المدة اللي
+
+249
+00:17:24,210 --> 00:17:29,350
+بيحتاجونها في الجسم قليلة، لذلك بسبب هذا يعملوا تركيبات
+
+250
+00:17:29,350 --> 00:17:34,610
+للبنسيلين، أنه يركبوه على بروتين كبير حتى يمنعوا
+
+251
+00:17:34,610 --> 00:17:37,650
+من الـ filtration، من الـ secretion.
+
+252
+00:17:37,650 --> 00:17:41,710
+و هكذا فهذه المشكلة بتعملها هنا. آخر جملة هنا: in
+
+253
+00:17:41,710 --> 00:17:45,410
+this case, certain drugs such as penicillin and
+
+254
+00:17:45,410 --> 00:17:48,190
+salicylates, the rapid clearance by the kidney
+
+255
+00:17:48,190 --> 00:17:50,430
+creates a problem in maintaining therapeutically
+
+256
+00:17:50,430 --> 00:17:55,370
+effective drug concentrations. المرة اللي جاية، هنتكلم
+
+257
+00:17:55,370 --> 00:17:57,970
+عن الـ loop of Henle. يعطيكم العافية، شكراً كتير.
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..7768bf1f28bcef4e61dca62fb0ac00405b4d2369
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g_postprocess.srt
@@ -0,0 +1,1028 @@
+1
+00:00:05,720 --> 00:00:13,240
+take ascending limb جدا مهم لعملية ال dialution
+
+2
+00:00:13,240 --> 00:00:19,480
+اتكلمنا عن ال .. عن ال .. عن المضالة اهميتها في
+
+3
+00:00:19,480 --> 00:00:23,340
+الايه؟ ال concentration لكن بما ان ال filtrate
+
+4
+00:00:23,340 --> 00:00:27,040
+بتطلع من ال take ascending limb بأزمولالة منخفضة
+
+5
+00:00:27,040 --> 00:00:35,270
+هيبوتونك هيبو أزمولانبيصل لـ 100 ملي .. ملي أوزمول
+
+6
+00:00:35,270 --> 00:00:40,170
+ال concentration تبعه، osmolality هنا بتصل ل 100،
+
+7
+00:00:40,170 --> 00:00:49,370
+واضح؟ طيب، إذا ال water في ال proximal إلها إيش؟
+
+8
+00:00:49,370 --> 00:00:55,950
+في ال thick ascending limb ممكن تخلي more diluted
+
+9
+00:00:56,550 --> 00:01:00,090
+لو احنا محتاجين more solutes يعني لو الالدوستيرون
+
+10
+00:01:00,090 --> 00:01:05,370
+عالي لو ال .. ال .. الالدوستيرون عالي بنسحب منه
+
+11
+00:01:05,370 --> 00:01:12,070
+more sodium and solutes بدين more diluted تمام؟ او
+
+12
+00:01:12,070 --> 00:01:20,390
+قدى اركزه الى حيث كان isomolal ان .. ان ا .. اخد
+
+13
+00:01:20,390 --> 00:01:28,560
+شوية ميه او اخد منه ميه اكتر و اكترفي حالة وجود
+
+14
+00:01:28,560 --> 00:01:31,100
+الـ antidiuretic hormone إذا الـ antidiuretic
+
+15
+00:01:31,100 --> 00:01:36,880
+hormone عنصر مهم جدا في من المنطقه دي و طالع ال
+
+16
+00:01:36,880 --> 00:01:42,740
+thick ascending limb لا تتفاهم مع أي هرمون هتاخد
+
+17
+00:01:42,740 --> 00:01:46,900
+كل ال solutes الكمية اللي بدهاياها و تترك الميه
+
+18
+00:01:46,900 --> 00:01:50,860
+اللي فلترت عندها بالتركيز اللي هو مية بعد كده
+
+19
+00:01:50,860 --> 00:01:55,720
+بتدخل ال control system لكن لحدها هي بتشغل اللي
+
+20
+00:01:55,720 --> 00:01:58,780
+بدهاياهابيدنا ميه أكتر، بيطلع الـ Antidote
+
+21
+00:01:58,780 --> 00:02:03,120
+hormone، بيسحب الميه اللي هي diluted، filtrated،
+
+22
+00:02:03,120 --> 00:02:07,260
+بيخليه very concentratedبدنا ال sodium أكتر بيطلع
+
+23
+00:02:07,260 --> 00:02:10,500
+ال aldosterone بيسحب كل ال solutes بيخلي ايه؟
+
+24
+00:02:10,500 --> 00:02:14,660
+diluted تمام؟ بدنا التنين بيطلعوا التنين نسحب ال
+
+25
+00:02:14,660 --> 00:02:17,800
+sodium نسحب ال water و بيخلي minimal urine
+
+26
+00:02:17,800 --> 00:02:21,960
+excretion إذا محتاجين احنا ايه؟ الضغط water كله
+
+27
+00:02:21,960 --> 00:02:25,080
+محتاجين الميه و محتاجين ال what؟ ال solutes مش
+
+28
+00:02:25,080 --> 00:02:28,880
+كده؟ فالتنين بيطلعوا لكن إذا أنا مسكت ميه اشرب
+
+29
+00:02:28,880 --> 00:02:32,600
+اشرب اشرب ميه كتير تمام؟ فال solutes ال
+
+30
+00:02:32,600 --> 00:02:35,790
+aldosterone بيظل موجود بيسحبلكن المي انتليوت
+
+31
+00:02:35,790 --> 00:02:37,890
+الكورمون بيقولها لأ لأ لأ بنزل انتليوت الكورمون
+
+32
+00:02:37,890 --> 00:02:42,750
+بيطلعها كلها فبيطلع a diluted فلكن اذا كان انا
+
+33
+00:02:42,750 --> 00:02:47,750
+محتاج ال sodium لان انا بشرب ميه مافيش فيها كمية
+
+34
+00:02:47,750 --> 00:02:51,230
+كافية من ال a من ال solutes ميه مفلترة مائة
+
+35
+00:02:51,230 --> 00:02:56,070
+بالمائة تمام و بس عليها معناه ان انا فقدت ال
+
+36
+00:02:56,070 --> 00:02:59,530
+solutes في ال .. في ال .. في ال intake وعندي water
+
+37
+00:02:59,530 --> 00:03:04,100
+pure water في ال aفي الحالة هذه ممكن ينزل البول
+
+38
+00:03:04,100 --> 00:03:09,800
+لتركيز خمسين ملي أزمول يعني عندى كمان بيقدر ال ..
+
+39
+00:03:09,800 --> 00:03:11,780
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+40
+00:03:11,780 --> 00:03:11,840
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+41
+00:03:11,840 --> 00:03:11,900
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+42
+00:03:11,900 --> 00:03:12,780
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+43
+00:03:12,780 --> 00:03:13,580
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+44
+00:03:13,580 --> 00:03:13,820
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+45
+00:03:13,820 --> 00:03:14,100
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+46
+00:03:14,100 --> 00:03:14,380
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+47
+00:03:14,380 --> 00:03:25,040
+ال .. ال .. ال .. ال ..
+
+48
+00:03:25,040 --> 00:03:34,610
+ال .. ال .. المهيئين للمعلومة اذا في ال distal
+
+49
+00:03:34,610 --> 00:03:39,610
+under conditions في ال thick ascending limb
+
+50
+00:03:39,610 --> 00:03:43,450
+impermeable to water ال distal convoluted ممكن
+
+51
+00:03:43,450 --> 00:03:46,950
+تكون impermeable ممكن تكون impermeable حسب جدش في
+
+52
+00:03:46,950 --> 00:03:52,350
+عندي antidiuretic hormone هو اذا هنا صارت العبور
+
+53
+00:03:52,350 --> 00:03:57,100
+بتصريحهنا صار في الـ distal لإن هو اللي بيعمل ال
+
+54
+00:03:57,100 --> 00:04:01,440
+control مافيش إشي بنتخل منه إلا under permission
+
+55
+00:04:01,440 --> 00:04:05,300
+طب إحنا بنتكلم عن إيش؟ بنتكلم عن ال distal conical
+
+56
+00:04:05,300 --> 00:04:09,540
+tubule عن ال connecting tubule عن cortical
+
+57
+00:04:09,540 --> 00:04:15,860
+collecting duct و عن المدلر collecting duct tubule
+
+58
+00:04:15,860 --> 00:04:19,520
+و عن المدلر collecting duct يعني من أول ال distal
+
+59
+00:04:20,840 --> 00:04:26,600
+لنهاية الطريق الآن صارت عندي إيه تحت تحكم ال إيه
+
+60
+00:04:26,600 --> 00:04:30,540
+الجيش أعلن أه سيطرته على الموقع هنا مابسمح لحد
+
+61
+00:04:30,540 --> 00:04:34,800
+يتحرك يروح ولا ييجي إلا بإيه بتصريح تمام ال
+
+62
+00:04:34,800 --> 00:04:40,890
+proximate view بتاخد كمية ضخمة عرفاهاوالـ thick
+
+63
+00:04:40,890 --> 00:04:43,790
+acinic glue أخدت كمية ضخمة من السكولات المعروفة
+
+64
+00:04:43,790 --> 00:04:47,850
+والجزء اللي انترك الآن يابد نزوده يابد نجلله في ال
+
+65
+00:04:47,850 --> 00:04:53,790
+execution حسب حاجة الجسم okay؟ اذا ال water
+
+66
+00:04:53,790 --> 00:04:57,550
+permeability في الجزء الأخر يعني من ال distal
+
+67
+00:04:57,550 --> 00:05:00,190
+nephron .. distal convoluted .. لما نقول distal
+
+68
+00:05:00,190 --> 00:05:02,790
+nephron يعني كل اللي ضايل من بعد distal convoluted
+
+69
+00:05:02,790 --> 00:05:09,140
+tubule للآخر لحد البابلة ال orifice اللي فيهاطبعا
+
+70
+00:05:09,140 --> 00:05:14,540
+إذا عندنا مناطق permeable to water ومناطق
+
+71
+00:05:14,540 --> 00:05:18,700
+impermeable to water ومناطق under .. under a
+
+72
+00:05:18,700 --> 00:05:23,160
+control can be permeability تزيد او تقل according
+
+73
+00:05:23,160 --> 00:05:25,560
+to the antiderivative hormone secretion
+
+74
+00:05:25,560 --> 00:05:28,680
+reabsorption of chloride
+
+75
+00:05:35,440 --> 00:05:40,540
+أتحكتكوا عنه من شوية الصوديوم لما يطلع ليه
+
+76
+00:05:40,540 --> 00:05:45,560
+absorbed هيندفع وراه chloride passively passively
+
+77
+00:05:45,560 --> 00:05:51,060
+ليش؟ لإنه صار عندي أنا ال electrochemical gradient
+
+78
+00:05:51,060 --> 00:05:54,640
+بتسمح لإن ال concentration of chloride في داخل ال
+
+79
+00:05:54,640 --> 00:05:59,780
+cells واطي، جليل، و الصوديوم دخل جوا، تمام؟
+
+80
+00:05:59,780 --> 00:06:06,910
+فالصوديوم ترك محلهأه صارت محله negativity عالية ال
+
+81
+00:06:06,910 --> 00:06:10,310
+sodium positive ions راحت لداخل ال cells كمية
+
+82
+00:06:10,310 --> 00:06:13,630
+كبيرة اندفعت فصار عندي ال filter rate صار يميل ل
+
+83
+00:06:13,630 --> 00:06:16,290
+more a negative فصار عندي electro chemical
+
+84
+00:06:16,290 --> 00:06:20,170
+gradient في صالح مين؟في صالح الاخلورايد فبندفع
+
+85
+00:06:20,170 --> 00:06:24,210
+الاخلورايد ورا مين ورا ال sodium إن كان مباشرة عبر
+
+86
+00:06:24,210 --> 00:06:28,390
+ال basolateral membrane أو عبر حسب السرعة اللي
+
+87
+00:06:28,390 --> 00:06:31,670
+بنتقل فيها ال sodium من ال tubular fluid إلى ال
+
+88
+00:06:31,670 --> 00:06:36,810
+interstitium تمام؟ محتاجين بعضه يدخل ال cells
+
+89
+00:06:36,810 --> 00:06:39,770
+وبعضه يروح ال interstitium وبيعدي من هنا وبيعدي من
+
+90
+00:06:39,770 --> 00:06:46,610
+هنابعضه هيعدى الـ intracellular route وبعضه هيعدى
+
+91
+00:06:46,610 --> 00:06:51,970
+ال paracellular route تمام؟ اذا ال sodium هان ال
+
+92
+00:06:51,970 --> 00:06:55,750
+chloride بيصيرله passive diffusion بيصيرله برضه
+
+93
+00:06:55,750 --> 00:07:00,890
+facilitated diffusion مع ال glucose و ال amino
+
+94
+00:07:00,890 --> 00:07:06,330
+acids في أولال ال ال ال ال ال ال ال ال ال ال ال ال
+
+95
+00:07:06,330 --> 00:07:06,570
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+96
+00:07:06,570 --> 00:07:08,070
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+97
+00:07:08,070 --> 00:07:16,870
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+98
+00:07:16,870 --> 00:07:17,090
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+99
+00:07:17,090 --> 00:07:17,110
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+100
+00:07:17,110 --> 00:07:17,530
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+101
+00:07:17,530 --> 00:07:19,050
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+102
+00:07:19,050 --> 00:07:21,370
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+103
+00:07:21,370 --> 00:07:21,390
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+104
+00:07:21,390 --> 00:07:21,510
+ال ال ال ال ال ال ال ال ال
+
+105
+00:07:32,790 --> 00:07:38,790
+ليش؟ لأن ال concentration عليه ال .. ال .. ال
+
+106
+00:07:38,790 --> 00:07:42,350
+facilitate فيه راح يكون أكتر لإن ال amino acid و
+
+107
+00:07:42,350 --> 00:07:46,570
+ال glucose خلصت فالجزء التاني من ال tubule ال
+
+108
+00:07:46,570 --> 00:07:50,030
+chloride بيكون فيها transport فيه أفضل إذا كان
+
+109
+00:07:50,030 --> 00:07:54,010
+passive أو كان ايه facilitated تمام؟
+
+110
+00:08:01,580 --> 00:08:05,140
+طيب إذا عندها when sodium is reabsorbed through
+
+111
+00:08:05,140 --> 00:08:08,280
+the tubular epithelial cells، negative ions such
+
+112
+00:08:08,280 --> 00:08:11,480
+as chloride are transported along with sodium
+
+113
+00:08:11,480 --> 00:08:14,680
+because of the electrical potentials، Sodium راح
+
+114
+00:08:14,680 --> 00:08:18,840
+بتلحقه، that is transport of positively charged
+
+115
+00:08:18,840 --> 00:08:23,860
+sodium ions out of the lumen leaves the inside
+
+116
+00:08:23,860 --> 00:08:27,620
+more negative compared with the interstitial fluid
+
+117
+00:08:28,760 --> 00:08:31,860
+هذا يجعل الكلوريد ايون يتفجر بشكل مباشر من طريق
+
+118
+00:08:31,860 --> 00:08:35,840
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريق
+
+119
+00:08:35,840 --> 00:08:36,740
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريق
+
+120
+00:08:36,740 --> 00:08:38,980
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريق
+
+121
+00:08:38,980 --> 00:08:39,240
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريقة
+
+122
+00:08:39,240 --> 00:08:43,860
+البراسيليالية تتفجر بشكل مباشر من طريقة
+
+123
+00:08:43,860 --> 00:08:47,160
+البراسيليالية تتفجر بشكل مباشر من طريقة
+
+124
+00:08:47,160 --> 00:08:55,160
+البراسيليالية تتفجر بشكل
+
+125
+00:08:55,160 --> 00:09:00,860
+مباشر منبالتالي تركز على الكلوريد الأيونات في الـ
+
+126
+00:09:00,860 --> 00:09:05,020
+tubular ليومين. بذلك، تجارب تجارب تجارب الكلوريد
+
+127
+00:09:05,020 --> 00:09:10,240
+الكلوريد
+
+128
+00:09:10,240 --> 00:09:12,820
+الكلوريد الكلوريد الكلوريد الكلوريد الكلوريد
+
+129
+00:09:12,820 --> 00:09:13,960
+الكلوريد الكلوريد الكلوريد الكلوريد الكلوريد
+
+130
+00:09:13,960 --> 00:09:14,060
+الكلوريد الكلوريد الكلوريد الكلوريد الكلوريد
+
+131
+00:09:14,060 --> 00:09:14,240
+الكلوريد الكلوريد كلوريد كلوريد كلوريد كلوريد
+
+132
+00:09:14,240 --> 00:09:15,560
+كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد
+
+133
+00:09:15,560 --> 00:09:21,500
+كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد
+
+134
+00:09:21,500 --> 00:09:26,800
+كلوريد كلوريد كلوريدأو الـ Reabsorption لما يصير
+
+135
+00:09:26,800 --> 00:09:31,300
+بيؤدي إلى Water Reabsorption والـ Water
+
+136
+00:09:31,300 --> 00:09:34,640
+Reabsorption بتأدي إلى أنه الـ Luminal Cloride
+
+137
+00:09:34,640 --> 00:09:38,200
+Concentration يعلى وبتأدي إلى Passive Diffusion
+
+138
+00:09:38,200 --> 00:09:42,500
+because of a Concentration Gradient بالإضافة لأنه
+
+139
+00:09:42,500 --> 00:09:47,600
+لما يصير Sodium Reabsorption ال Luminalpositive
+
+140
+00:09:47,600 --> 00:09:53,280
+ions decreased لذلك ال negativity ايش؟ هتزيد. اذا
+
+141
+00:09:53,280 --> 00:09:56,100
+اليوم ال negative potential هيزيد. وهذا هيديني
+
+142
+00:09:56,100 --> 00:10:01,220
+دافع electrically لمين؟ لالكلورايد. اذا اتوفى اكتر
+
+143
+00:10:01,220 --> 00:10:04,260
+سنة بتحكمه. electrochemical gradient بس في
+
+144
+00:10:04,260 --> 00:10:09,400
+diffusion of ايه؟ of الكلورايد. اليوريا عاد هتمشي
+
+145
+00:10:09,400 --> 00:10:14,600
+بطريقة بس حسب ال concentrationلأن اليورية قدرة على
+
+146
+00:10:14,600 --> 00:10:18,620
+انها تبرميب ويلها proximal tribule وsimple
+
+147
+00:10:18,620 --> 00:10:23,440
+diffusionأه كلما الميه راحت كلما ال concentration
+
+148
+00:10:23,440 --> 00:10:28,140
+عليت كلما صار more diffusion هو approximately كم
+
+149
+00:10:28,140 --> 00:10:30,980
+في ال tubule حقيقتن fifty percent of the urea is
+
+150
+00:10:30,980 --> 00:10:35,320
+reabsorbed بيضل ايه بيضل just fifty percent يعني
+
+151
+00:10:35,320 --> 00:10:38,200
+ال urea اللي نازلة نصها بيعود بدخل في ال proximal
+
+152
+00:10:38,200 --> 00:10:42,060
+tubule و نص التاني بيصير delivered to ايه to the
+
+153
+00:10:42,060 --> 00:10:46,600
+rest of the nephron اللو بوفينلي و الباقي المسافة
+
+154
+00:10:48,670 --> 00:10:53,190
+reabsorption of urea by passive diffusion اتكلمنا
+
+155
+00:10:53,190 --> 00:10:57,250
+عنها in most parts of the nephron especially the
+
+156
+00:10:57,250 --> 00:11:02,490
+inner medullary collecting duct passive urea
+
+157
+00:11:02,490 --> 00:11:05,950
+reabsorption is facilitated by specific urea
+
+158
+00:11:05,950 --> 00:11:07,470
+transporters
+
+159
+00:11:10,310 --> 00:11:12,030
+لما نتكلم عن الـ Concentration، عن الـUrea
+
+160
+00:11:12,030 --> 00:11:16,030
+Circulation، نتكلم بدقة عن الـUrea في كل مكان كيف
+
+161
+00:11:16,030 --> 00:11:17,830
+بيصير، بس احنا بتكلم عن البروكسيوم الكفري
+
+162
+00:11:17,830 --> 00:11:20,370
+التيوبيول وإن الـUrea في البروكسيوم الكفري
+
+163
+00:11:20,370 --> 00:11:27,870
+التيوبيول بسبب ال Sodium Transport وما يليه من
+
+164
+00:11:27,870 --> 00:11:31,130
+Water Transport أدى إلى Concentrated Urea which
+
+165
+00:11:31,130 --> 00:11:36,930
+will facilitate diffusion of part of the Urea، 50%
+
+166
+00:11:36,930 --> 00:11:41,820
+is ايه؟ is the outsideما دام تكلمنا عن اليوريا
+
+167
+00:11:41,820 --> 00:11:45,460
+بتكلم عن الكرياتينين مش كده احنا لما بنعمل فحص
+
+168
+00:11:45,460 --> 00:11:49,380
+للكلة بنعمل يوريا و كرياتينين بنعمل يوريا و
+
+169
+00:11:49,380 --> 00:11:53,880
+كرياتينين إذا الكرياتينين إيه إيش بيصير فيه؟ قولنا
+
+170
+00:11:53,880 --> 00:11:56,560
+من شوي احنا الكرياتينين is a mainly filtered
+
+171
+00:11:56,560 --> 00:12:03,540
+minimal كرياتينين is a is secreted لذلك مستخدموا
+
+172
+00:12:03,540 --> 00:12:09,280
+كمان في إيش؟ في القياس ال GFRreabsorption of and
+
+173
+00:12:09,280 --> 00:12:12,900
+secretion along different parts of the nephron إذن
+
+174
+00:12:12,900 --> 00:12:20,160
+in general الآن هنتكلم عن ال ال
+
+175
+00:12:20,160 --> 00:12:26,760
+ال proximal curved tubule النفرون الآن كله ككل بعد
+
+176
+00:12:26,760 --> 00:12:30,920
+ما دينا المقدمات هذه إيش هيصير في ال tubular
+
+177
+00:12:30,920 --> 00:12:35,140
+filtrate ال glomeral filtrate اللي صار هذا هو عد
+
+178
+00:12:35,140 --> 00:12:39,420
+على ال proximal tubuleبعدين هيعدّي على ال logo
+
+179
+00:12:39,420 --> 00:12:43,640
+فنلي وبعدين هيعدّي على ال desktop احنا بالنسبة لل
+
+180
+00:12:43,640 --> 00:12:47,060
+blocks of compute يبقى تتكلمنا تقريبا كل ما يخصها
+
+181
+00:12:47,060 --> 00:12:52,270
+لكن باختصار نتكلم نسبها نسبباختصار بيقول normally
+
+182
+00:12:52,270 --> 00:12:56,210
+about 65 إلى 70% of the filtered load of sodium
+
+183
+00:12:56,210 --> 00:13:00,710
+and water are slightly and and and a slightly
+
+184
+00:13:00,710 --> 00:13:04,430
+lower percentage of chloride are reabsorbed by the
+
+185
+00:13:04,430 --> 00:13:07,710
+proximal tubule before the filtrate reaches the
+
+186
+00:13:07,710 --> 00:13:10,550
+loop of Henle تمام؟ جامع مثلا ال loop of Henle
+
+187
+00:13:10,550 --> 00:13:17,240
+بيكون about 65% من ال sodium والwaterو ال chloride
+
+188
+00:13:17,240 --> 00:13:22,360
+هدول تبع بعض اتكلمنا عنهم these percentages can be
+
+189
+00:13:22,360 --> 00:13:25,020
+increased or decreased in different physiological
+
+190
+00:13:25,020 --> 00:13:28,820
+conditions لإن بعد كده انا هقولكم عن حاجة اسمها
+
+191
+00:13:28,820 --> 00:13:32,760
+tubular glomerular balance tubular glomerular
+
+192
+00:13:32,760 --> 00:13:37,380
+balance يعني لو صار انه في ال trade زاد هنلاحظ انه
+
+193
+00:13:37,380 --> 00:13:41,070
+ال reabsorption في ال proximal tubular هزيدفي
+
+194
+00:13:41,070 --> 00:13:44,710
+الطبيعي بيجي 5.2% لكن لو ال load زاد في عندها قدرة
+
+195
+00:13:44,710 --> 00:13:50,150
+ال proximal tubule انها تمتص أكتر حتى تدّي ال loop
+
+196
+00:13:50,150 --> 00:13:53,030
+of Hollywood بالذات ال distal ال load ال A المطلوب
+
+197
+00:13:53,030 --> 00:13:57,230
+لها التانين مقدروش ال A يتعدوا خط معين هي عندها
+
+198
+00:13:57,230 --> 00:14:00,450
+القدرة ال proximal فلو زاد ال load هي بتزيد ففي
+
+199
+00:14:00,450 --> 00:14:04,050
+عنده ظروف بتزيد النسب شوية لكن in general if we
+
+200
+00:14:04,050 --> 00:14:06,890
+are speaking about physiological conditions اللي
+
+201
+00:14:06,890 --> 00:14:12,890
+هي 65% تقريبا Aالـ Proximal Tubules لديها قوة
+
+202
+00:14:12,890 --> 00:14:14,210
+عالية للعبارة عن عبارة عن عبارة عن عبارة عن عبارة
+
+203
+00:14:14,210 --> 00:14:19,540
+عن عبارة عن عبارة عن عبارة عن عبارة عنthe high
+
+204
+00:14:19,540 --> 00:14:21,940
+capacity of proximal tubules for reabsorption
+
+205
+00:14:21,940 --> 00:14:28,040
+results from its special structure قولنا إيش؟ the
+
+206
+00:14:28,040 --> 00:14:30,320
+proximal tubules in cereal cells are highly
+
+207
+00:14:30,320 --> 00:14:35,180
+metabolic ال .. ال .. ال .. ال .. ال .. اتكلمنا
+
+208
+00:14:35,180 --> 00:14:38,940
+احنا عن ال surface عن ال area of transport ال
+
+209
+00:14:38,940 --> 00:14:42,740
+brush border و اتكلمنا عن ال bisolateral pumping
+
+210
+00:14:42,740 --> 00:14:46,310
+system بس بدي أقول إن ال pumping system هانو ال
+
+211
+00:14:46,310 --> 00:14:50,090
+metabolic rate اللى بيصير فى ال proximal cotibule
+
+212
+00:14:50,090 --> 00:14:53,410
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+213
+00:14:53,410 --> 00:14:54,030
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+214
+00:14:54,030 --> 00:14:54,050
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+215
+00:14:54,050 --> 00:14:54,590
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+216
+00:14:54,590 --> 00:14:54,730
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+217
+00:14:54,730 --> 00:14:55,090
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+218
+00:14:55,090 --> 00:15:02,090
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+219
+00:15:02,090 --> 00:15:10,670
+اعلى من اعلى من اعلى
+
+220
+00:15:10,670 --> 00:15:16,530
+من اعتمام؟ اذا عندها ال highly metabolic cells
+
+221
+00:15:16,530 --> 00:15:22,050
+اتنين اللي هم brush border ال apical membrane او
+
+222
+00:15:22,050 --> 00:15:26,610
+ال luminal membrane او brush border اه تمام؟ رهيب
+
+223
+00:15:26,610 --> 00:15:32,930
+بحيث انه بيضاع .. بيضاعف ال .. بيضاعف ال surface
+
+224
+00:15:32,930 --> 00:15:34,510
+area twenty folds
+
+225
+00:15:38,520 --> 00:15:42,620
+نفس الـ foldings هذه موجودة بشكل أقل في الـ
+
+226
+00:15:42,620 --> 00:15:45,440
+basolateral membrane the extensive membrane
+
+227
+00:15:45,440 --> 00:15:47,740
+surface of the material brush border
+
+228
+00:16:00,240 --> 00:16:04,300
+إذن هذا بتديني extensive membrane surface of the
+
+229
+00:16:04,300 --> 00:16:06,820
+epithelial brush border is also loaded with
+
+230
+00:16:06,820 --> 00:16:09,380
+protein carriers إذا عندك brush border عالي و
+
+231
+00:16:09,380 --> 00:16:12,260
+protein carriers عالية بتقدر إلى ال facilitated
+
+232
+00:16:12,260 --> 00:16:15,140
+diffusion، you can co-transport أو counter
+
+233
+00:16:15,140 --> 00:16:18,580
+transport ال reabsorption و ال bio carbonate أنا
+
+234
+00:16:18,580 --> 00:16:23,740
+اتكلمتلكوا عنها و ال chloride اتكلمتلكوا عنها الآن
+
+235
+00:16:23,740 --> 00:16:29,370
+احنا هذه الصورة تديني فكرة عامة على معنىال
+
+236
+00:16:29,370 --> 00:16:32,090
+proximal quantity بيقول إيش بيصير ال osmolality
+
+237
+00:16:32,090 --> 00:16:37,090
+واحدة ال sodium نفس التركيز ماتغيرش لإن الميه
+
+238
+00:16:37,090 --> 00:16:42,810
+بتتبع الشسمون ال glucose كله راح بيخبط على طول من
+
+239
+00:16:42,810 --> 00:16:47,510
+أول ال tube لآخر و نزل للصفر و ال amino acid بروح
+
+240
+00:16:47,510 --> 00:16:50,350
+تمام؟
+
+241
+00:16:51,370 --> 00:16:56,890
+و هكذا بنكون احنا أوصلنا انه في عندي a secretory
+
+242
+00:16:56,890 --> 00:17:01,310
+function قولتلكم انها ال organic material في ال
+
+243
+00:17:01,310 --> 00:17:05,070
+proximal زي البرأة منها بيوريك أسد وغيرها من بعض
+
+244
+00:17:05,070 --> 00:17:09,930
+المواد بايل سولت، الأجزاليت، اليوريتس،
+
+245
+00:17:09,930 --> 00:17:13,150
+الكاتيكولامينز are secreted ايه؟ in the proximal
+
+246
+00:17:13,150 --> 00:17:17,530
+computer poolالمشكلة عندها ان ال penicillin و ال
+
+247
+00:17:17,530 --> 00:17:21,130
+salicylates الأسبيرين برضه secreted في ال proximal
+
+248
+00:17:21,130 --> 00:17:24,210
+convolutal mule هذا بيقدر إلى ان هم المدة اللي
+
+249
+00:17:24,210 --> 00:17:29,350
+حاجونها في الجسم جليلة فلذلك بسبب هيكعملوا تركيبات
+
+250
+00:17:29,350 --> 00:17:34,610
+للبنسيلين انه يركبوه على بروتيريك كبير حتى يمنعوا
+
+251
+00:17:34,610 --> 00:17:37,650
+من ايه من ال filtration من ايه ال secretion في ايه
+
+252
+00:17:37,650 --> 00:17:41,710
+و هكذا فهذه المشكلة بتعملناها هنا اخر جملة هنا in
+
+253
+00:17:41,710 --> 00:17:45,410
+this case certain drugs such as بنسيلين and
+
+254
+00:17:45,410 --> 00:17:48,190
+salicylates the rapid clearance by the kidney
+
+255
+00:17:48,190 --> 00:17:50,430
+creates a problem in maintaining therapeutically
+
+256
+00:17:50,430 --> 00:17:55,370
+effective drug concentrations المرة اللي جاي متكلم
+
+257
+00:17:55,370 --> 00:17:57,970
+عن اللوب وفينلي يعطيكوا العافية شكرا كتير
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..ea8986576a2370509be1adc662264f68500ee5ef
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/lk931UzRd6g_raw.srt
@@ -0,0 +1,1060 @@
+1
+00:00:05,720 --> 00:00:13,240
+take ascending limb جدا مهم لعملية ال dialution
+
+2
+00:00:13,240 --> 00:00:19,480
+اتكلمنا عن ال .. عن ال .. عن المضالة اهميتها في
+
+3
+00:00:19,480 --> 00:00:23,340
+الايه؟ ال concentration لكن بما ان ال filtrate
+
+4
+00:00:23,340 --> 00:00:27,040
+بتطلع من ال take ascending limb بأزمولالة منخفضة
+
+5
+00:00:27,040 --> 00:00:35,270
+هيبوتونك هيبو أزمولانبيصل لـ 100 ملي .. ملي أوزمول
+
+6
+00:00:35,270 --> 00:00:40,170
+ال concentration تبعه، osmolality هنا بتصل ل 100،
+
+7
+00:00:40,170 --> 00:00:49,370
+واضح؟ طيب، إذا ال water في ال proximal إلها إيش؟
+
+8
+00:00:49,370 --> 00:00:55,950
+في ال thick ascending limb ممكن تخلي more diluted
+
+9
+00:00:56,550 --> 00:01:00,090
+لو احنا محتاجين more solutes يعني لو الالدوستيرون
+
+10
+00:01:00,090 --> 00:01:05,370
+عالي لو ال .. ال .. الالدوستيرون عالي بنسحب منه
+
+11
+00:01:05,370 --> 00:01:12,070
+more sodium and solutes بدين more diluted تمام؟ او
+
+12
+00:01:12,070 --> 00:01:20,390
+قدى اركزه الى حيث كان isomolal ان .. ان ا .. اخد
+
+13
+00:01:20,390 --> 00:01:28,560
+شوية ميه او اخد منه ميه اكتر و اكترفي حالة وجود
+
+14
+00:01:28,560 --> 00:01:31,100
+الـ antidiuretic hormone إذا الـ antidiuretic
+
+15
+00:01:31,100 --> 00:01:36,880
+hormone عنصر مهم جدا في من المنطقه دي و طالع ال
+
+16
+00:01:36,880 --> 00:01:42,740
+thick ascending limb لا تتفاهم مع أي هرمون هتاخد
+
+17
+00:01:42,740 --> 00:01:46,900
+كل ال solutes الكمية اللي بدهاياها و تترك الميه
+
+18
+00:01:46,900 --> 00:01:50,860
+اللي فلترت عندها بالتركيز اللي هو مية بعد كده
+
+19
+00:01:50,860 --> 00:01:55,720
+بتدخل ال control system لكن لحدها هي بتشغل اللي
+
+20
+00:01:55,720 --> 00:01:58,780
+بدهاياهابيدنا ميه أكتر، بيطلع الـ Antidote
+
+21
+00:01:58,780 --> 00:02:03,120
+hormone، بيسحب الميه اللي هي diluted، filtrated،
+
+22
+00:02:03,120 --> 00:02:07,260
+بيخليه very concentratedبدنا ال sodium أكتر بيطلع
+
+23
+00:02:07,260 --> 00:02:10,500
+ال aldosterone بيسحب كل ال solutes بيخلي ايه؟
+
+24
+00:02:10,500 --> 00:02:14,660
+diluted تمام؟ بدنا التنين بيطلعوا التنين نسحب ال
+
+25
+00:02:14,660 --> 00:02:17,800
+sodium نسحب ال water و بيخلي minimal urine
+
+26
+00:02:17,800 --> 00:02:21,960
+excretion إذا محتاجين احنا ايه؟ الضغط water كله
+
+27
+00:02:21,960 --> 00:02:25,080
+محتاجين الميه و محتاجين ال what؟ ال solutes مش
+
+28
+00:02:25,080 --> 00:02:28,880
+كده؟ فالتنين بيطلعوا لكن إذا أنا مسكت ميه اشرب
+
+29
+00:02:28,880 --> 00:02:32,600
+اشرب اشرب ميه كتير تمام؟ فال solutes ال
+
+30
+00:02:32,600 --> 00:02:35,790
+aldosterone بيظل موجود بيسحبلكن المي انتليوت
+
+31
+00:02:35,790 --> 00:02:37,890
+الكورمون بيقولها لأ لأ لأ بنزل انتليوت الكورمون
+
+32
+00:02:37,890 --> 00:02:42,750
+بيطلعها كلها فبيطلع a diluted فلكن اذا كان انا
+
+33
+00:02:42,750 --> 00:02:47,750
+محتاج ال sodium لان انا بشرب ميه مافيش فيها كمية
+
+34
+00:02:47,750 --> 00:02:51,230
+كافية من ال a من ال solutes ميه مفلترة مائة
+
+35
+00:02:51,230 --> 00:02:56,070
+بالمائة تمام و بس عليها معناه ان انا فقدت ال
+
+36
+00:02:56,070 --> 00:02:59,530
+solutes في ال .. في ال .. في ال intake وعندي water
+
+37
+00:02:59,530 --> 00:03:04,100
+pure water في ال aفي الحالة هذه ممكن ينزل البول
+
+38
+00:03:04,100 --> 00:03:09,800
+لتركيز خمسين ملي أزمول يعني عندى كمان بيقدر ال ..
+
+39
+00:03:09,800 --> 00:03:11,780
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+40
+00:03:11,780 --> 00:03:11,840
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+41
+00:03:11,840 --> 00:03:11,900
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+42
+00:03:11,900 --> 00:03:12,780
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+43
+00:03:12,780 --> 00:03:13,580
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+44
+00:03:13,580 --> 00:03:13,820
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+45
+00:03:13,820 --> 00:03:14,100
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+46
+00:03:14,100 --> 00:03:14,100
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+47
+00:03:14,100 --> 00:03:14,380
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+48
+00:03:14,380 --> 00:03:14,380
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+49
+00:03:14,380 --> 00:03:25,040
+ال .. ال .. ال .. ال ..
+
+50
+00:03:25,040 --> 00:03:34,610
+ال .. ال .. المهيئين للمعلومة اذا في ال distal
+
+51
+00:03:34,610 --> 00:03:39,610
+under conditions في ال thick ascending limb
+
+52
+00:03:39,610 --> 00:03:43,450
+impermeable to water ال distal convoluted ممكن
+
+53
+00:03:43,450 --> 00:03:46,950
+تكون impermeable ممكن تكون impermeable حسب جدش في
+
+54
+00:03:46,950 --> 00:03:52,350
+عندي antidiuretic hormone هو اذا هنا صارت العبور
+
+55
+00:03:52,350 --> 00:03:57,100
+بتصريحهنا صار في الـ distal لإن هو اللي بيعمل ال
+
+56
+00:03:57,100 --> 00:04:01,440
+control مافيش إشي بنتخل منه إلا under permission
+
+57
+00:04:01,440 --> 00:04:05,300
+طب إحنا بنتكلم عن إيش؟ بنتكلم عن ال distal conical
+
+58
+00:04:05,300 --> 00:04:09,540
+tubule عن ال connecting tubule عن cortical
+
+59
+00:04:09,540 --> 00:04:15,860
+collecting duct و عن المدلر collecting duct tubule
+
+60
+00:04:15,860 --> 00:04:19,520
+و عن المدلر collecting duct يعني من أول ال distal
+
+61
+00:04:20,840 --> 00:04:26,600
+لنهاية الطريق الآن صارت عندي إيه تحت تحكم ال إيه
+
+62
+00:04:26,600 --> 00:04:30,540
+الجيش أعلن أه سيطرته على الموقع هنا مابسمح لحد
+
+63
+00:04:30,540 --> 00:04:34,800
+يتحرك يروح ولا ييجي إلا بإيه بتصريح تمام ال
+
+64
+00:04:34,800 --> 00:04:40,890
+proximate view بتاخد كمية ضخمة عرفاهاوالـ thick
+
+65
+00:04:40,890 --> 00:04:43,790
+acinic glue أخدت كمية ضخمة من السكولات المعروفة
+
+66
+00:04:43,790 --> 00:04:47,850
+والجزء اللي انترك الآن يابد نزوده يابد نجلله في ال
+
+67
+00:04:47,850 --> 00:04:53,790
+execution حسب حاجة الجسم okay؟ اذا ال water
+
+68
+00:04:53,790 --> 00:04:57,550
+permeability في الجزء الأخر يعني من ال distal
+
+69
+00:04:57,550 --> 00:05:00,190
+nephron .. distal convoluted .. لما نقول distal
+
+70
+00:05:00,190 --> 00:05:02,790
+nephron يعني كل اللي ضايل من بعد distal convoluted
+
+71
+00:05:02,790 --> 00:05:09,140
+tubule للآخر لحد البابلة ال orifice اللي فيهاطبعا
+
+72
+00:05:09,140 --> 00:05:14,540
+إذا عندنا مناطق permeable to water ومناطق
+
+73
+00:05:14,540 --> 00:05:18,700
+impermeable to water ومناطق under .. under a
+
+74
+00:05:18,700 --> 00:05:23,160
+control can be permeability تزيد او تقل according
+
+75
+00:05:23,160 --> 00:05:25,560
+to the antiderivative hormone secretion
+
+76
+00:05:25,560 --> 00:05:28,680
+reabsorption of chloride
+
+77
+00:05:35,440 --> 00:05:40,540
+أتحكتكوا عنه من شوية الصوديوم لما يطلع ليه
+
+78
+00:05:40,540 --> 00:05:45,560
+absorbed هيندفع وراه chloride passively passively
+
+79
+00:05:45,560 --> 00:05:51,060
+ليش؟ لإنه صار عندي أنا ال electrochemical gradient
+
+80
+00:05:51,060 --> 00:05:54,640
+بتسمح لإن ال concentration of chloride في داخل ال
+
+81
+00:05:54,640 --> 00:05:59,780
+cells واطي، جليل، و الصوديوم دخل جوا، تمام؟
+
+82
+00:05:59,780 --> 00:06:06,910
+فالصوديوم ترك محلهأه صارت محله negativity عالية ال
+
+83
+00:06:06,910 --> 00:06:10,310
+sodium positive ions راحت لداخل ال cells كمية
+
+84
+00:06:10,310 --> 00:06:13,630
+كبيرة اندفعت فصار عندي ال filter rate صار يميل ل
+
+85
+00:06:13,630 --> 00:06:16,290
+more a negative فصار عندي electro chemical
+
+86
+00:06:16,290 --> 00:06:20,170
+gradient في صالح مين؟في صالح الاخلورايد فبندفع
+
+87
+00:06:20,170 --> 00:06:24,210
+الاخلورايد ورا مين ورا ال sodium إن كان مباشرة عبر
+
+88
+00:06:24,210 --> 00:06:28,390
+ال basolateral membrane أو عبر حسب السرعة اللي
+
+89
+00:06:28,390 --> 00:06:31,670
+بنتقل فيها ال sodium من ال tubular fluid إلى ال
+
+90
+00:06:31,670 --> 00:06:36,810
+interstitium تمام؟ محتاجين بعضه يدخل ال cells
+
+91
+00:06:36,810 --> 00:06:39,770
+وبعضه يروح ال interstitium وبيعدي من هنا وبيعدي من
+
+92
+00:06:39,770 --> 00:06:46,610
+هنابعضه هيعدى الـ intracellular route وبعضه هيعدى
+
+93
+00:06:46,610 --> 00:06:51,970
+ال paracellular route تمام؟ اذا ال sodium هان ال
+
+94
+00:06:51,970 --> 00:06:55,750
+chloride بيصيرله passive diffusion بيصيرله برضه
+
+95
+00:06:55,750 --> 00:07:00,890
+facilitated diffusion مع ال glucose و ال amino
+
+96
+00:07:00,890 --> 00:07:06,330
+acids في أولال ال ال ال ال ال ال ال ال ال ال ال ال
+
+97
+00:07:06,330 --> 00:07:06,570
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+98
+00:07:06,570 --> 00:07:08,070
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+99
+00:07:08,070 --> 00:07:16,870
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+100
+00:07:16,870 --> 00:07:17,090
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+101
+00:07:17,090 --> 00:07:17,090
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+102
+00:07:17,090 --> 00:07:17,110
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+103
+00:07:17,110 --> 00:07:17,530
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+104
+00:07:17,530 --> 00:07:19,050
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+105
+00:07:19,050 --> 00:07:21,370
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+106
+00:07:21,370 --> 00:07:21,370
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+107
+00:07:21,370 --> 00:07:21,390
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+108
+00:07:21,390 --> 00:07:21,390
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+109
+00:07:21,390 --> 00:07:21,510
+ال ال ال ال ال ال ال ال ال
+
+110
+00:07:32,790 --> 00:07:38,790
+ليش؟ لأن ال concentration عليه ال .. ال .. ال
+
+111
+00:07:38,790 --> 00:07:42,350
+facilitate فيه راح يكون أكتر لإن ال amino acid و
+
+112
+00:07:42,350 --> 00:07:46,570
+ال glucose خلصت فالجزء التاني من ال tubule ال
+
+113
+00:07:46,570 --> 00:07:50,030
+chloride بيكون فيها transport فيه أفضل إذا كان
+
+114
+00:07:50,030 --> 00:07:54,010
+passive أو كان ايه facilitated تمام؟
+
+115
+00:08:01,580 --> 00:08:05,140
+طيب إذا عندها when sodium is reabsorbed through
+
+116
+00:08:05,140 --> 00:08:08,280
+the tubular epithelial cells، negative ions such
+
+117
+00:08:08,280 --> 00:08:11,480
+as chloride are transported along with sodium
+
+118
+00:08:11,480 --> 00:08:14,680
+because of the electrical potentials، Sodium راح
+
+119
+00:08:14,680 --> 00:08:18,840
+بتلحقه، that is transport of positively charged
+
+120
+00:08:18,840 --> 00:08:23,860
+sodium ions out of the lumen leaves the inside
+
+121
+00:08:23,860 --> 00:08:27,620
+more negative compared with the interstitial fluid
+
+122
+00:08:28,760 --> 00:08:31,860
+هذا يجعل الكلوريد ايون يتفجر بشكل مباشر من طريق
+
+123
+00:08:31,860 --> 00:08:35,840
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريق
+
+124
+00:08:35,840 --> 00:08:35,840
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريق
+
+125
+00:08:35,840 --> 00:08:36,740
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريق
+
+126
+00:08:36,740 --> 00:08:38,980
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريق
+
+127
+00:08:38,980 --> 00:08:39,240
+الطريقة البراسيليالية تتفجر بشكل مباشر من طريقة
+
+128
+00:08:39,240 --> 00:08:43,860
+البراسيليالية تتفجر بشكل مباشر من طريقة
+
+129
+00:08:43,860 --> 00:08:47,160
+البراسيليالية تتفجر بشكل مباشر من طريقة
+
+130
+00:08:47,160 --> 00:08:55,160
+البراسيليالية تتفجر بشكل
+
+131
+00:08:55,160 --> 00:09:00,860
+مباشر منبالتالي تركز على الكلوريد الأيونات في الـ
+
+132
+00:09:00,860 --> 00:09:05,020
+tubular ليومين. بذلك، تجارب تجارب تجارب الكلوريد
+
+133
+00:09:05,020 --> 00:09:10,240
+الكلوريد
+
+134
+00:09:10,240 --> 00:09:12,820
+الكلوريد الكلوريد الكلوريد الكلوريد الكلوريد
+
+135
+00:09:12,820 --> 00:09:13,960
+الكلوريد الكلوريد الكلوريد الكلوريد الكلوريد
+
+136
+00:09:13,960 --> 00:09:13,960
+الكلوريد الكلوريد الكلوريد الكلوريد الكلوريد
+
+137
+00:09:13,960 --> 00:09:14,060
+الكلوريد الكلوريد الكلوريد الكلوريد الكلوريد
+
+138
+00:09:14,060 --> 00:09:14,240
+الكلوريد الكلوريد كلوريد كلوريد كلوريد كلوريد
+
+139
+00:09:14,240 --> 00:09:15,560
+كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد
+
+140
+00:09:15,560 --> 00:09:21,500
+كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد كلوريد
+
+141
+00:09:21,500 --> 00:09:26,800
+كلوريد كلوريد كلوريدأو الـ Reabsorption لما يصير
+
+142
+00:09:26,800 --> 00:09:31,300
+بيؤدي إلى Water Reabsorption والـ Water
+
+143
+00:09:31,300 --> 00:09:34,640
+Reabsorption بتأدي إلى أنه الـ Luminal Cloride
+
+144
+00:09:34,640 --> 00:09:38,200
+Concentration يعلى وبتأدي إلى Passive Diffusion
+
+145
+00:09:38,200 --> 00:09:42,500
+because of a Concentration Gradient بالإضافة لأنه
+
+146
+00:09:42,500 --> 00:09:47,600
+لما يصير Sodium Reabsorption ال Luminalpositive
+
+147
+00:09:47,600 --> 00:09:53,280
+ions decreased لذلك ال negativity ايش؟ هتزيد. اذا
+
+148
+00:09:53,280 --> 00:09:56,100
+اليوم ال negative potential هيزيد. وهذا هيديني
+
+149
+00:09:56,100 --> 00:10:01,220
+دافع electrically لمين؟ لالكلورايد. اذا اتوفى اكتر
+
+150
+00:10:01,220 --> 00:10:04,260
+سنة بتحكمه. electrochemical gradient بس في
+
+151
+00:10:04,260 --> 00:10:09,400
+diffusion of ايه؟ of الكلورايد. اليوريا عاد هتمشي
+
+152
+00:10:09,400 --> 00:10:14,600
+بطريقة بس حسب ال concentrationلأن اليورية قدرة على
+
+153
+00:10:14,600 --> 00:10:18,620
+انها تبرميب ويلها proximal tribule وsimple
+
+154
+00:10:18,620 --> 00:10:23,440
+diffusionأه كلما الميه راحت كلما ال concentration
+
+155
+00:10:23,440 --> 00:10:28,140
+عليت كلما صار more diffusion هو approximately كم
+
+156
+00:10:28,140 --> 00:10:30,980
+في ال tubule حقيقتن fifty percent of the urea is
+
+157
+00:10:30,980 --> 00:10:35,320
+reabsorbed بيضل ايه بيضل just fifty percent يعني
+
+158
+00:10:35,320 --> 00:10:38,200
+ال urea اللي نازلة نصها بيعود بدخل في ال proximal
+
+159
+00:10:38,200 --> 00:10:42,060
+tubule و نص التاني بيصير delivered to ايه to the
+
+160
+00:10:42,060 --> 00:10:46,600
+rest of the nephron اللو بوفينلي و الباقي المسافة
+
+161
+00:10:48,670 --> 00:10:53,190
+reabsorption of urea by passive diffusion اتكلمنا
+
+162
+00:10:53,190 --> 00:10:57,250
+عنها in most parts of the nephron especially the
+
+163
+00:10:57,250 --> 00:11:02,490
+inner medullary collecting duct passive urea
+
+164
+00:11:02,490 --> 00:11:05,950
+reabsorption is facilitated by specific urea
+
+165
+00:11:05,950 --> 00:11:07,470
+transporters
+
+166
+00:11:10,310 --> 00:11:12,030
+لما نتكلم عن الـ Concentration، عن الـUrea
+
+167
+00:11:12,030 --> 00:11:16,030
+Circulation، نتكلم بدقة عن الـUrea في كل مكان كيف
+
+168
+00:11:16,030 --> 00:11:17,830
+بيصير، بس احنا بتكلم عن البروكسيوم الكفري
+
+169
+00:11:17,830 --> 00:11:20,370
+التيوبيول وإن الـUrea في البروكسيوم الكفري
+
+170
+00:11:20,370 --> 00:11:27,870
+التيوبيول بسبب ال Sodium Transport وما يليه من
+
+171
+00:11:27,870 --> 00:11:31,130
+Water Transport أدى إلى Concentrated Urea which
+
+172
+00:11:31,130 --> 00:11:36,930
+will facilitate diffusion of part of the Urea، 50%
+
+173
+00:11:36,930 --> 00:11:41,820
+is ايه؟ is the outsideما دام تكلمنا عن اليوريا
+
+174
+00:11:41,820 --> 00:11:45,460
+بتكلم عن الكرياتينين مش كده احنا لما بنعمل فحص
+
+175
+00:11:45,460 --> 00:11:49,380
+للكلة بنعمل يوريا و كرياتينين بنعمل يوريا و
+
+176
+00:11:49,380 --> 00:11:53,880
+كرياتينين إذا الكرياتينين إيه إيش بيصير فيه؟ قولنا
+
+177
+00:11:53,880 --> 00:11:56,560
+من شوي احنا الكرياتينين is a mainly filtered
+
+178
+00:11:56,560 --> 00:12:03,540
+minimal كرياتينين is a is secreted لذلك مستخدموا
+
+179
+00:12:03,540 --> 00:12:09,280
+كمان في إيش؟ في القياس ال GFRreabsorption of and
+
+180
+00:12:09,280 --> 00:12:12,900
+secretion along different parts of the nephron إذن
+
+181
+00:12:12,900 --> 00:12:20,160
+in general الآن هنتكلم عن ال ال
+
+182
+00:12:20,160 --> 00:12:26,760
+ال proximal curved tubule النفرون الآن كله ككل بعد
+
+183
+00:12:26,760 --> 00:12:30,920
+ما دينا المقدمات هذه إيش هيصير في ال tubular
+
+184
+00:12:30,920 --> 00:12:35,140
+filtrate ال glomeral filtrate اللي صار هذا هو عد
+
+185
+00:12:35,140 --> 00:12:39,420
+على ال proximal tubuleبعدين هيعدّي على ال logo
+
+186
+00:12:39,420 --> 00:12:43,640
+فنلي وبعدين هيعدّي على ال desktop احنا بالنسبة لل
+
+187
+00:12:43,640 --> 00:12:47,060
+blocks of compute يبقى تتكلمنا تقريبا كل ما يخصها
+
+188
+00:12:47,060 --> 00:12:52,270
+لكن باختصار نتكلم نسبها نسبباختصار بيقول normally
+
+189
+00:12:52,270 --> 00:12:56,210
+about 65 إلى 70% of the filtered load of sodium
+
+190
+00:12:56,210 --> 00:13:00,710
+and water are slightly and and and a slightly
+
+191
+00:13:00,710 --> 00:13:04,430
+lower percentage of chloride are reabsorbed by the
+
+192
+00:13:04,430 --> 00:13:07,710
+proximal tubule before the filtrate reaches the
+
+193
+00:13:07,710 --> 00:13:10,550
+loop of Henle تمام؟ جامع مثلا ال loop of Henle
+
+194
+00:13:10,550 --> 00:13:17,240
+بيكون about 65% من ال sodium والwaterو ال chloride
+
+195
+00:13:17,240 --> 00:13:22,360
+هدول تبع بعض اتكلمنا عنهم these percentages can be
+
+196
+00:13:22,360 --> 00:13:25,020
+increased or decreased in different physiological
+
+197
+00:13:25,020 --> 00:13:28,820
+conditions لإن بعد كده انا هقولكم عن حاجة اسمها
+
+198
+00:13:28,820 --> 00:13:32,760
+tubular glomerular balance tubular glomerular
+
+199
+00:13:32,760 --> 00:13:37,380
+balance يعني لو صار انه في ال trade زاد هنلاحظ انه
+
+200
+00:13:37,380 --> 00:13:41,070
+ال reabsorption في ال proximal tubular هزيدفي
+
+201
+00:13:41,070 --> 00:13:44,710
+الطبيعي بيجي 5.2% لكن لو ال load زاد في عندها قدرة
+
+202
+00:13:44,710 --> 00:13:50,150
+ال proximal tubule انها تمتص أكتر حتى تدّي ال loop
+
+203
+00:13:50,150 --> 00:13:53,030
+of Hollywood بالذات ال distal ال load ال A المطلوب
+
+204
+00:13:53,030 --> 00:13:57,230
+لها التانين مقدروش ال A يتعدوا خط معين هي عندها
+
+205
+00:13:57,230 --> 00:14:00,450
+القدرة ال proximal فلو زاد ال load هي بتزيد ففي
+
+206
+00:14:00,450 --> 00:14:04,050
+عنده ظروف بتزيد النسب شوية لكن in general if we
+
+207
+00:14:04,050 --> 00:14:06,890
+are speaking about physiological conditions اللي
+
+208
+00:14:06,890 --> 00:14:12,890
+هي 65% تقريبا Aالـ Proximal Tubules لديها قوة
+
+209
+00:14:12,890 --> 00:14:14,210
+عالية للعبارة عن عبارة عن عبارة عن عبارة عن عبارة
+
+210
+00:14:14,210 --> 00:14:19,540
+عن عبارة عن عبارة عن عبارة عن عبارة عنthe high
+
+211
+00:14:19,540 --> 00:14:21,940
+capacity of proximal tubules for reabsorption
+
+212
+00:14:21,940 --> 00:14:28,040
+results from its special structure قولنا إيش؟ the
+
+213
+00:14:28,040 --> 00:14:30,320
+proximal tubules in cereal cells are highly
+
+214
+00:14:30,320 --> 00:14:35,180
+metabolic ال .. ال .. ال .. ال .. ال .. اتكلمنا
+
+215
+00:14:35,180 --> 00:14:38,940
+احنا عن ال surface عن ال area of transport ال
+
+216
+00:14:38,940 --> 00:14:42,740
+brush border و اتكلمنا عن ال bisolateral pumping
+
+217
+00:14:42,740 --> 00:14:46,310
+system بس بدي أقول إن ال pumping system هانو ال
+
+218
+00:14:46,310 --> 00:14:50,090
+metabolic rate اللى بيصير فى ال proximal cotibule
+
+219
+00:14:50,090 --> 00:14:53,410
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+220
+00:14:53,410 --> 00:14:54,030
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+221
+00:14:54,030 --> 00:14:54,030
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+222
+00:14:54,030 --> 00:14:54,050
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+223
+00:14:54,050 --> 00:14:54,590
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+224
+00:14:54,590 --> 00:14:54,730
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+225
+00:14:54,730 --> 00:14:55,090
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+226
+00:14:55,090 --> 00:15:02,090
+اعلى من اعلى من اعلى من اعلى من اعلى من اعلى من
+
+227
+00:15:02,090 --> 00:15:10,670
+اعلى من اعلى من اعلى
+
+228
+00:15:10,670 --> 00:15:16,530
+من اعتمام؟ اذا عندها ال highly metabolic cells
+
+229
+00:15:16,530 --> 00:15:22,050
+اتنين اللي هم brush border ال apical membrane او
+
+230
+00:15:22,050 --> 00:15:26,610
+ال luminal membrane او brush border اه تمام؟ رهيب
+
+231
+00:15:26,610 --> 00:15:32,930
+بحيث انه بيضاع .. بيضاعف ال .. بيضاعف ال surface
+
+232
+00:15:32,930 --> 00:15:34,510
+area twenty folds
+
+233
+00:15:38,520 --> 00:15:42,620
+نفس الـ foldings هذه موجودة بشكل أقل في الـ
+
+234
+00:15:42,620 --> 00:15:45,440
+basolateral membrane the extensive membrane
+
+235
+00:15:45,440 --> 00:15:47,740
+surface of the material brush border
+
+236
+00:16:00,240 --> 00:16:04,300
+إذن هذا بتديني extensive membrane surface of the
+
+237
+00:16:04,300 --> 00:16:06,820
+epithelial brush border is also loaded with
+
+238
+00:16:06,820 --> 00:16:09,380
+protein carriers إذا عندك brush border عالي و
+
+239
+00:16:09,380 --> 00:16:12,260
+protein carriers عالية بتقدر إلى ال facilitated
+
+240
+00:16:12,260 --> 00:16:15,140
+diffusion، you can co-transport أو counter
+
+241
+00:16:15,140 --> 00:16:18,580
+transport ال reabsorption و ال bio carbonate أنا
+
+242
+00:16:18,580 --> 00:16:23,740
+اتكلمتلكوا عنها و ال chloride اتكلمتلكوا عنها الآن
+
+243
+00:16:23,740 --> 00:16:29,370
+احنا هذه الصورة تديني فكرة عامة على معنىال
+
+244
+00:16:29,370 --> 00:16:32,090
+proximal quantity بيقول إيش بيصير ال osmolality
+
+245
+00:16:32,090 --> 00:16:37,090
+واحدة ال sodium نفس التركيز ماتغيرش لإن الميه
+
+246
+00:16:37,090 --> 00:16:42,810
+بتتبع الشسمون ال glucose كله راح بيخبط على طول من
+
+247
+00:16:42,810 --> 00:16:47,510
+أول ال tube لآخر و نزل للصفر و ال amino acid بروح
+
+248
+00:16:47,510 --> 00:16:50,350
+تمام؟
+
+249
+00:16:51,370 --> 00:16:56,890
+و هكذا بنكون احنا أوصلنا انه في عندي a secretory
+
+250
+00:16:56,890 --> 00:17:01,310
+function قولتلكم انها ال organic material في ال
+
+251
+00:17:01,310 --> 00:17:05,070
+proximal زي البرأة منها بيوريك أسد وغيرها من بعض
+
+252
+00:17:05,070 --> 00:17:09,930
+المواد بايل سولت، الأجزاليت، اليوريتس،
+
+253
+00:17:09,930 --> 00:17:13,150
+الكاتيكولامينز are secreted ايه؟ in the proximal
+
+254
+00:17:13,150 --> 00:17:17,530
+computer poolالمشكلة عندها ان ال penicillin و ال
+
+255
+00:17:17,530 --> 00:17:21,130
+salicylates الأسبيرين برضه secreted في ال proximal
+
+256
+00:17:21,130 --> 00:17:24,210
+convolutal mule هذا بيقدر إلى ان هم المدة اللي
+
+257
+00:17:24,210 --> 00:17:29,350
+حاجونها في الجسم جليلة فلذلك بسبب هيكعملوا تركيبات
+
+258
+00:17:29,350 --> 00:17:34,610
+للبنسيلين انه يركبوه على بروتيريك كبير حتى يمنعوا
+
+259
+00:17:34,610 --> 00:17:37,650
+من ايه من ال filtration من ايه ال secretion في ايه
+
+260
+00:17:37,650 --> 00:17:41,710
+و هكذا فهذه المشكلة بتعملناها هنا اخر جملة هنا in
+
+261
+00:17:41,710 --> 00:17:45,410
+this case certain drugs such as بنسيلين and
+
+262
+00:17:45,410 --> 00:17:48,190
+salicylates the rapid clearance by the kidney
+
+263
+00:17:48,190 --> 00:17:50,430
+creates a problem in maintaining therapeutically
+
+264
+00:17:50,430 --> 00:17:55,370
+effective drug concentrations المرة اللي جاي متكلم
+
+265
+00:17:55,370 --> 00:17:57,970
+عن اللوب وفينلي يعطيكوا العافية شكرا كتير
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/oiH17SV-aiU_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/oiH17SV-aiU_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..70c6479ebbf21c3d5b376c64cc24f64e70c1366f
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/oiH17SV-aiU_raw.json
@@ -0,0 +1 @@
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"end": 1386.36, "word": " كبير", "probability": 0.9920247395833334}, {"start": 1386.36, "end": 1386.64, "word": " اسمه", "probability": 0.9580078125}, {"start": 1386.64, "end": 1386.96, "word": " alveolar", "probability": 0.9202473958333334}, {"start": 1386.96, "end": 1387.54, "word": " ventilation", "probability": 0.9306640625}, {"start": 1387.54, "end": 1388.14, "word": " كان", "probability": 0.859375}, {"start": 1388.14, "end": 1388.48, "word": " قلنا", "probability": 0.6548665364583334}, {"start": 1388.48, "end": 1388.68, "word": " in", "probability": 0.880859375}, {"start": 1388.68, "end": 1389.18, "word": " alveoli", "probability": 0.9505208333333334}, {"start": 1389.18, "end": 1389.32, "word": " و", "probability": 0.9765625}, {"start": 1389.32, "end": 1389.58, "word": " كلنا", "probability": 0.7119140625}, {"start": 1389.58, "end": 1389.84, "word": " عارفين", "probability": 0.9725341796875}, {"start": 1389.84, "end": 1389.9, "word": " ان", "probability": 0.41943359375}, {"start": 1389.9, "end": 1390.22, "word": " نمشي", "probability": 0.82073974609375}, {"start": 1390.22, "end": 1390.54, "word": " عنها", "probability": 0.989013671875}, {"start": 1390.54, "end": 1391.32, "word": " بس", "probability": 0.940673828125}, {"start": 1391.32, "end": 1391.74, "word": " تبين", "probability": 0.9267578125}, {"start": 1391.74, "end": 1391.98, "word": " انه", "probability": 0.604736328125}, {"start": 1391.98, "end": 1392.16, "word": " لأ", "probability": 0.953125}, {"start": 1392.16, "end": 1392.32, "word": " مش", "probability": 0.97802734375}, {"start": 1392.32, "end": 1392.52, "word": " بس", "probability": 0.988525390625}, {"start": 1392.52, "end": 1392.62, "word": " ال", "probability": 0.99072265625}, {"start": 1392.62, "end": 1393.22, "word": " alveoli", "probability": 0.96142578125}, {"start": 1393.22, "end": 1394.52, "word": " لأ", "probability": 0.7354736328125}, {"start": 1394.52, "end": 1394.7, "word": " ال", "probability": 0.974609375}, {"start": 1394.7, "end": 1395.38, "word": " alveoli", "probability": 0.96826171875}, {"start": 1395.38, "end": 1397.3, "word": " مجموعة", "probability": 0.89326171875}, {"start": 1397.3, "end": 1397.72, "word": " alveoli", "probability": 0.87109375}, {"start": 1397.72, "end": 1397.92, "word": " مع", "probability": 0.99462890625}, {"start": 1397.92, "end": 1398.44, "word": " بعض", "probability": 0.994873046875}, {"start": 1398.44, "end": 1399.18, "word": " بيعملوا", "probability": 0.872705078125}, {"start": 1399.18, "end": 1399.66, "word": " alveolar", "probability": 0.8468424479166666}, {"start": 1399.66, "end": 1400.16, "word": " sack", "probability": 0.79248046875}], "temperature": 1.0}, {"id": 54, "seek": 143159, "start": 1402.11, "end": 1431.59, "text": "و ال alveolar sac اللي هو alveolar؟ duct و ال alveolar ducts المجموعة المختلفة من ال alveolar ducts بتشبك في respiratory duct bronchiole اه respiratory bronchiole ال respiratory bronchiole المختلفة بتشبك في terminal bronchiole تمام؟ اذا لحد ال terminal bronchiole مابصرش ايش؟ تبادل غازات مابعد ال terminal bronchiole بصير عندنا ايه؟ تبادل غازات لو بسمع بشمل", "tokens": [2407, 2423, 419, 303, 15276, 4899, 13672, 1829, 31439, 419, 303, 15276, 22807, 25954, 4032, 2423, 419, 303, 15276, 25954, 82, 9673, 7435, 2304, 2407, 27884, 9673, 46456, 46538, 3660, 9154, 2423, 419, 303, 15276, 25954, 82, 39894, 8592, 3555, 4117, 8978, 27038, 25954, 16586, 31033, 306, 1975, 3224, 27038, 16586, 31033, 306, 2423, 27038, 16586, 31033, 306, 9673, 46456, 46538, 3660, 39894, 8592, 3555, 4117, 8978, 14709, 16586, 31033, 306, 46811, 10943, 22807, 1975, 15730, 5296, 24401, 2423, 14709, 16586, 31033, 306, 3714, 16758, 9381, 2288, 8592, 1975, 1829, 8592, 22807, 6055, 3555, 18513, 1211, 32771, 31377, 9307, 3714, 16758, 22488, 2423, 14709, 16586, 31033, 306, 4724, 9381, 13546, 43242, 8315, 1975, 1829, 3224, 22807, 6055, 3555, 18513, 1211, 32771, 31377, 9307, 45164, 4724, 38251, 3615, 4724, 8592, 42213], "avg_logprob": -0.23771469943396006, 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شوية عشان تفهميها لكن هنا إذا نقدر نتميز هي ال alveoli الصغيرة هذه تمام و في الوسط بيجمع ال alveoli مع بعض هالبعض اسمه alveolar sac", "tokens": [6027, 20292, 3714, 29245, 23328, 3660, 8978, 33251, 2655, 16758, 20328, 3615, 49401, 13412, 2407, 10632, 6225, 8592, 7649, 6055, 5172, 16095, 1829, 11296, 44381, 34105, 11933, 15730, 8717, 28543, 2288, 8717, 39237, 1829, 11622, 39896, 2423, 419, 303, 9384, 31767, 17082, 48923, 29538, 46811, 10943, 4032, 8978, 2423, 41779, 9566, 4724, 1829, 7435, 2304, 3615, 2423, 419, 303, 9384, 20449, 45030, 11242, 8032, 6027, 3555, 3615, 11242, 24525, 2304, 3224, 419, 303, 15276, 4899], "avg_logprob": -0.25185033875076396, "compression_ratio": 1.5535714285714286, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 1437.44, "end": 1438.24, "word": "اللي", "probability": 0.418609619140625}, {"start": 1438.24, "end": 1439.04, "word": " موجودة", "probability": 0.82708740234375}, {"start": 1439.04, "end": 1439.12, "word": " في", "probability": 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/oiH17SV-aiU_raw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/oiH17SV-aiU_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..bbd17fb69b0640ace5a77b3a7a577ac47f0733df
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/oiH17SV-aiU_raw.srt
@@ -0,0 +1,1848 @@
+1
+00:00:05,900 --> 00:00:10,300
+عملية التهوي اللي بالتم أو وصول الهواء إلى آخر
+
+2
+00:00:10,300 --> 00:00:14,920
+مرحلة من المراحل وصوله إلى الدم هذه عملية
+
+3
+00:00:14,920 --> 00:00:19,960
+ميكانيكية هذه كت بالتم عملية ال ventilation فاليوم
+
+4
+00:00:19,960 --> 00:00:24,560
+بنواصل الحديث و بنتكلم عن جهاز اسمه spirometer
+
+5
+00:00:24,560 --> 00:00:29,900
+وهذا الجهاز من خلاله بنعمل بعض القياسات اللي ممكن
+
+6
+00:00:29,900 --> 00:00:34,360
+تدينا فكرة كويسة عن اردئتين وشغل اردئتين اعتقد انه
+
+7
+00:00:34,360 --> 00:00:40,040
+أخدته في العملخدتوه ولا لا؟ اه طب اذا انت هتاخدوه
+
+8
+00:00:40,040 --> 00:00:42,660
+لذلك في بعض الأشياء عمار عنها بصرا عليك و هتاخدوها
+
+9
+00:00:42,660 --> 00:00:45,960
+بالتفصيل و هتاخدو الجهاز حقيقة ان انتوا بالتفصيل
+
+10
+00:00:45,960 --> 00:00:49,880
+في المساكن العملية و الفصل هذا يعني الفصل هذا
+
+11
+00:00:49,880 --> 00:00:55,780
+انتوا هتاخدوه ال spirometer عبارة عن جهاز بتكون من
+
+12
+00:00:55,780 --> 00:01:04,390
+هنا drum بالمجلوب موجودة موجودة في وعاء مليء ميهو
+
+13
+00:01:04,390 --> 00:01:08,610
+هذه ال drum ممكن تتحرك تطلع و تنزل هذا ال drum هذا
+
+14
+00:01:08,610 --> 00:01:15,890
+container ممكن تطلع و تنزل على مسار مشبوك فيه سهم
+
+15
+00:01:15,890 --> 00:01:21,190
+ال drum بتلوف و السهم هذا بيعلم حسب حركة ايه ال
+
+16
+00:01:21,190 --> 00:01:25,650
+container هذا اللي هو مجلوب هذا container فيه هواء
+
+17
+00:01:25,650 --> 00:01:30,410
+احنا ممكن هذا ال هواء نسحبه من ال container هذا
+
+18
+00:01:30,410 --> 00:01:33,770
+لما بيجي ال هواء ايش بيصير في الفي ال container
+
+19
+00:01:33,770 --> 00:01:39,170
+هذا بيهبط لتحت تمام ال oxygen chain بقى بيسمع اذا
+
+20
+00:01:39,170 --> 00:01:43,710
+اذا سحبنا منه هوا بيهبط لتحت اذا رجعناله هوا يبقى
+
+21
+00:01:43,710 --> 00:01:48,350
+على اللي فوق عامل أموري بطريقة balanced بحيث يظل
+
+22
+00:01:48,350 --> 00:01:52,470
+المعلج يعني انا في عندنا counter balance عشان ايه
+
+23
+00:01:52,470 --> 00:01:56,660
+بلاش الهوا هو اللي يحمل الالـ chamber و نزلها
+
+24
+00:01:56,660 --> 00:02:01,300
+بوزنها كله فمعمولة ال balance بحيث أن أقل قوة
+
+25
+00:02:01,300 --> 00:02:07,260
+تزدها تتحرك و أقل قوة تسحبها تشفطها تنزل ال drum
+
+26
+00:02:07,260 --> 00:02:11,480
+هذه بتلوف باستمرار فأي حركة في السهم بما أنها
+
+27
+00:02:11,480 --> 00:02:16,140
+بتلوف بسجل في نقطة جديدة فبدينا ال curve اللي هو
+
+28
+00:02:16,140 --> 00:02:22,740
+ايه موجودة سميناها Spirogram اش سميناها Spirogram
+
+29
+00:02:22,740 --> 00:02:27,830
+Spirogram هذالو طلعنا عليه احنا هنلاقي .. ممكن
+
+30
+00:02:27,830 --> 00:02:31,650
+نلاقي فيه components مختلفة ممكن نلاقي التنفس
+
+31
+00:02:31,650 --> 00:02:35,630
+الطبيعي العادى ال inspiration و ال expiration
+
+32
+00:02:35,630 --> 00:02:41,490
+الطبيعى هذا لجينا انه احنا بناخد مع التنفس الطبيعى
+
+33
+00:02:41,490 --> 00:02:49,240
+تقريبا نص لتر خمسمية ملي لترفي النفس اه و من عدوا
+
+34
+00:02:49,240 --> 00:02:54,280
+نطلعهم و يدخلوا و يطلعوا فأشبه بالماد والجزر ال
+
+35
+00:02:54,280 --> 00:02:57,480
+inspiration و ال expiration لذلك سموهم ال tidal
+
+36
+00:02:57,480 --> 00:03:04,540
+volume tidal volume ال tidal volume هذا ممكن انا
+
+37
+00:03:04,540 --> 00:03:09,420
+بعد ما اخد و اخد نفس اضافي له سمينا inspiratory
+
+38
+00:03:09,420 --> 00:03:13,980
+reserve volumeفي عندى قدرة ان انا اخد نفس اكتر لكن
+
+39
+00:03:13,980 --> 00:03:19,840
+انا مش ماخده لكن موجود احتياط لو لزمني more oxygen
+
+40
+00:03:19,840 --> 00:03:26,200
+more air عندى efforts اكتر ببدلها ممكن اخد reserve
+
+41
+00:03:26,200 --> 00:03:29,720
+volume محطوط احتياط و ممكن اخد اكتر فسمينا
+
+42
+00:03:29,720 --> 00:03:33,020
+inspiratory reserve volume هذا لحاله تلاتة liter
+
+43
+00:03:33,020 --> 00:03:36,460
+يعني لما اخدوا هذا مع هذا بيصير تلاتة liter و نص
+
+44
+00:03:36,460 --> 00:03:42,100
+تمام؟لجينا إنه بعد أنا النفس اللي بطلعه بقدر كمان
+
+45
+00:03:42,100 --> 00:03:47,200
+أطلع نفس إضافي سمّينا expiratory reserve volume
+
+46
+00:03:47,200 --> 00:03:51,680
+بعد ما أطلع نفسي النهائي هذا انا expiratory
+
+47
+00:03:51,680 --> 00:03:55,860
+reserve volume أقصى ما عندي بنكتشف إنه لازم فيه
+
+48
+00:03:55,860 --> 00:04:00,940
+فرقتين شوية هوا لا نستطيع أن نخرجه نهائي سمينا the
+
+49
+00:04:00,940 --> 00:04:06,140
+residual volume تمام؟ residual volume إذا فى جزء
+
+50
+00:04:06,140 --> 00:04:10,530
+فى الهوا اللي بيظل فرقتينمهما انت تضغط و تعمل و
+
+51
+00:04:10,530 --> 00:04:14,950
+تسوي مابتقدرش تطلعه اذا صار عندي اربعة volumes
+
+52
+00:04:14,950 --> 00:04:21,210
+هدول لو اعملنا الاربعة volumes هدول اللي هم جمع و
+
+53
+00:04:21,210 --> 00:04:25,810
+طرح هنطلع capacities يعني ال volume لحالها الأربعة
+
+54
+00:04:25,810 --> 00:04:28,630
+واحدة من الأربعة هدول اللي نشوفهم بال .. بال
+
+55
+00:04:28,630 --> 00:04:33,730
+spirometer لكن لو ضفنا مثلا ال .. ال inspiratory
+
+56
+00:04:33,730 --> 00:04:38,840
+هذه علىالـ tidal على ال inspiratory reserve
+
+57
+00:04:38,840 --> 00:04:42,700
+بيسميها ال inspiratory capacity لإن ال tidal زائد
+
+58
+00:04:42,700 --> 00:04:48,520
+إضافة تبعها لو أضفنا ال inspiratory capacity هذه
+
+59
+00:04:48,520 --> 00:04:51,520
+يعني ال inspiratory reserve volume زائد ال tidal
+
+60
+00:04:51,520 --> 00:04:56,080
+زائد ال reserve inspiratory reserve يعني كل الهواء
+
+61
+00:04:56,080 --> 00:04:59,220
+اللي أنا مقدر أتحكم فيه بيسمينا ال vital capacity
+
+62
+00:04:59,830 --> 00:05:03,330
+ليش؟ لأن هذه اللي أنا بلعب فيها من أولها لآخرها
+
+63
+00:05:03,330 --> 00:05:07,550
+بقدر اتحكم فيها ماعدا اذا مضاي المين residual
+
+64
+00:05:07,550 --> 00:05:12,270
+volume انا ماجداش اتحكم فيه ماهواش vital capacity
+
+65
+00:05:12,270 --> 00:05:15,450
+طب لو بدنا نضيف ال residual volume لل vital
+
+66
+00:05:15,450 --> 00:05:19,130
+capacity لها المجموع هذا سميناها ال lung capacity
+
+67
+00:05:19,130 --> 00:05:23,110
+ال total capacity of the lung تمام سميناها ايه ال
+
+68
+00:05:23,110 --> 00:05:29,940
+lung ال total lung capacity تمام؟ طيبلو شوفنا
+
+69
+00:05:29,940 --> 00:05:35,200
+الأرقام نلاقي احنا عندنا قولنا هنا خمسمية ألف هنا
+
+70
+00:05:35,200 --> 00:05:38,600
+تلات تلات لاجنا ال expiratory reserve volume هذا
+
+71
+00:05:38,600 --> 00:05:43,420
+ألف و ميت ملي لتر ال residual volume لاجنا ألف و
+
+72
+00:05:43,420 --> 00:05:48,360
+متين ملي لتر طيب احنا وقع الأمر و احنا بنتنفس
+
+73
+00:05:48,360 --> 00:05:51,960
+طبيعي و احنا بنتنفس طبيعي و وقع الأمر انه عندنا
+
+74
+00:05:51,960 --> 00:05:55,460
+residual volume جزئين جزء ال residual volume
+
+75
+00:05:55,460 --> 00:05:59,240
+الحقيقي اللي أنا ماقدرش اتحكم فيهو جزء ال residual
+
+76
+00:05:59,240 --> 00:06:02,440
+volume اللي انا بقدر اطلعه بس يساوبه residual
+
+77
+00:06:02,440 --> 00:06:08,460
+exploratory reserve volume تمام ال exploratory
+
+78
+00:06:08,460 --> 00:06:11,200
+reserve volume انا بالعادة بلعبش فيه ساوبه فهو
+
+79
+00:06:11,200 --> 00:06:14,640
+موجود أساسا كمان residual volume هتسمينا ال
+
+80
+00:06:14,640 --> 00:06:18,220
+functional residual volume إذن التينين هدول سمينهم
+
+81
+00:06:18,220 --> 00:06:22,280
+functional residual volume و هدول مهمين لإن واقع
+
+82
+00:06:22,280 --> 00:06:26,600
+الأمر هدول التينين residual volume الحقيقي و ال ..
+
+83
+00:06:28,330 --> 00:06:30,690
+وExpiratory Reserve Volume اللي هو الـ Functional
+
+84
+00:06:30,690 --> 00:06:34,710
+Reserve Volume هدول حقيقة عبارة عن هو وجود داخل ال
+
+85
+00:06:34,710 --> 00:06:40,930
+إيه؟ داخل الرئتين أنا بتم تبدو الغازات من خلاله
+
+86
+00:06:40,930 --> 00:06:45,570
+وانا .. و بعدين قيمته جديش، تلاحظ، 1200 و1100،
+
+87
+00:06:45,570 --> 00:06:52,970
+2300 ملي لتر 2300 ملي لترالنفس تبعي انا 500 طالع ل
+
+88
+00:06:52,970 --> 00:06:58,110
+500 نازل يعني وقع الأمر انه انا باجي باخلط 500
+
+89
+00:06:58,110 --> 00:07:04,910
+مليلتر ل 2500 هدول ل2300 قعدتكوا هتكتشفوا انهم مش
+
+90
+00:07:04,910 --> 00:07:08,310
+500 اللي بخلطهم أجل شوية لكن نفترض الآن حتى
+
+91
+00:07:08,310 --> 00:07:13,950
+مفهومنا الآن للموضوع ان في عندي كام موجودأشبه
+
+92
+00:07:13,950 --> 00:07:17,950
+بالبرميل تبع الـ Compressor بأضيف عليه شوية و باخد
+
+93
+00:07:17,950 --> 00:07:22,570
+شوية بس أنا الكمية اللي باضيفها مش كل الموجود ولا
+
+94
+00:07:22,570 --> 00:07:25,490
+الكمية اللي باخدها كل الموجود أنا عندك كم كبير
+
+95
+00:07:25,490 --> 00:07:29,990
+باخد منه باستمرار و بعطيله باستمرار تمام؟ و ذلك
+
+96
+00:07:29,990 --> 00:07:34,070
+هذه لها فائدة انه انا التغير اللي بيصير في نفسي
+
+97
+00:07:34,070 --> 00:07:38,250
+السريع لأ انعكس على ايه؟ على عملية النفس نفسها
+
+98
+00:07:38,250 --> 00:07:42,770
+تمام؟ يعني لو كتمت نفسي شوية مادخلتش هوامش مشكلة
+
+99
+00:07:42,770 --> 00:07:46,130
+لإن تبادل الغازات بتمش من الهواء اللي انا بتاخده
+
+100
+00:07:46,130 --> 00:07:48,910
+هال gate بتم من الهواء اللي already موجود في وين
+
+101
+00:07:48,910 --> 00:07:53,650
+في ال reserve volume اللي هو ال residual volume
+
+102
+00:07:53,650 --> 00:07:57,890
+functional residual volume انا دايما بغزيه ب
+
+103
+00:07:57,890 --> 00:08:01,350
+oxygen من هواء جديد وبسحب انه carbon dioxide من
+
+104
+00:08:01,350 --> 00:08:08,110
+الهواء اللي ايه expired اللي بطلع بستمرع تمام؟ طيب
+
+105
+00:08:08,110 --> 00:08:14,540
+اناقلتلكم إن حقيقة الأمر هو الـ2300 باضيف لها 500
+
+106
+00:08:14,540 --> 00:08:20,260
+و بصحب منها 500 هو أنا باضف لها هوا جديد مش 500
+
+107
+00:08:20,260 --> 00:08:28,400
+باضف لها هوا جديد 350 milliliter و باخد منها واقعا
+
+108
+00:08:28,400 --> 00:08:34,860
+كل مرة 350 ليش؟ لإن في عندي أنا من بداية الأنف
+
+109
+00:08:34,860 --> 00:08:38,160
+لأول ما أصل تقريبا المنطقة اللي بيصير فيها تبادل
+
+110
+00:08:38,160 --> 00:08:42,690
+الغازاتالتراكية والـ larynx والكملة هذا
+
+111
+00:08:42,690 --> 00:08:48,190
+والبرونكولز الرئيسية ما بيصير فيها تسبب غزات،
+
+112
+00:08:48,190 --> 00:08:53,510
+مظبوط؟ فإذا هذا هو دخل وظل كما هو ولمّا طلع، طلع
+
+113
+00:08:53,510 --> 00:08:57,010
+هو زي ما هو لم يُقف منه أكسجين ولم يُضف عليه تنكسف
+
+114
+00:08:57,010 --> 00:09:00,830
+الكربون هذا الجزء الأولاني من النفس سميناه هنا في
+
+115
+00:09:00,830 --> 00:09:06,510
+dead space في هذا إيش بيسموه؟ dead space يعني جزء
+
+116
+00:09:07,440 --> 00:09:13,180
+صح عدى الهواء فيه لكن أنا لم أستفيد منه لإن هو
+
+117
+00:09:13,180 --> 00:09:18,540
+الهواء وصل للرئتين لكن من عند بداية الرئتين للأنف
+
+118
+00:09:18,540 --> 00:09:23,120
+عندها انها دي المنطقة كلها اتدخلى الهواء تمام وما
+
+119
+00:09:23,120 --> 00:09:28,260
+استفدناش منها فسميناها ايش dead space okay فرق
+
+120
+00:09:28,260 --> 00:09:31,260
+موجود لكن هي تم استفادة منه عن طريق تبادل الغزاة
+
+121
+00:09:31,990 --> 00:09:35,430
+طيب هذا سمينه anatomical dead space anatomical
+
+122
+00:09:35,430 --> 00:09:40,310
+dead space ليش؟ لأنه ممكن يكون في عندي functional
+
+123
+00:09:40,310 --> 00:09:44,590
+أو physiological dead space كيف يعني؟ anatomical
+
+124
+00:09:44,590 --> 00:09:47,670
+هذا dead space لو حسبناه و هنتعلم كيف هنحسبه
+
+125
+00:09:47,670 --> 00:09:55,270
+هنلاقيه 150 ملي لتروإذا الـ tidal volume 500 لما
+
+126
+00:09:55,270 --> 00:09:59,530
+يروح منه 150 بدون استفادة dead space معناه أنا
+
+127
+00:09:59,530 --> 00:10:04,190
+بعمل تبادل حقيقي بوصل للريقتين لل .. لل .. بأخلط
+
+128
+00:10:04,190 --> 00:10:09,910
+مع ال functional residual volume فقط 350، مظبوط؟
+
+129
+00:10:09,910 --> 00:10:14,170
+أه، إذا عندي هان هذا ال .. ال .. ال 150 milliliter
+
+130
+00:10:14,170 --> 00:10:18,410
+هدول anatomical حسب إنه مش ممكن يتم فيهم تبادل
+
+131
+00:10:18,410 --> 00:10:23,180
+أصلا، ريك ربنا خلقهملكن ممكن حاجات إضافية تنضاف لل
+
+132
+00:10:23,180 --> 00:10:28,340
+dead space مناطق أخرى يدخلها الهواء لكن لا يتم
+
+133
+00:10:28,340 --> 00:10:34,400
+فيها تبدل الغازات منطقة فيها الـ ischemia المنطقة
+
+134
+00:10:34,400 --> 00:10:39,100
+من الرئة مش واصلها دم الهواء بيصلها صحيح و بيطلع
+
+135
+00:10:39,100 --> 00:10:44,340
+منها بس بدون ايه؟ بدون تبدل هذي بتنضاف لمين؟ لل
+
+136
+00:10:44,340 --> 00:10:48,550
+dead space لأنها دخلت وطلعت بدون تبدلهذه المنطقة
+
+137
+00:10:48,550 --> 00:10:52,470
+إذا سمناها physiological dead space إذا لما نضيف
+
+138
+00:10:52,470 --> 00:10:56,790
+ال anatomical على الجزء الإضافي سمنا بعضه ال .. ال
+
+139
+00:10:56,790 --> 00:10:59,590
+.. ال .. ال dead space الحقيقي الوظيفي لكن
+
+140
+00:10:59,590 --> 00:11:03,230
+anatomically هو بس هالجد لكن حقيقة لأ في عندي كمان
+
+141
+00:11:03,230 --> 00:11:08,530
+إضافات سمناها physiological dead space تمام؟ إذا
+
+142
+00:11:08,530 --> 00:11:13,530
+ال volumes هذه اللي متكلم عنها احنا ممكن نخلط لها
+
+143
+00:11:13,530 --> 00:11:22,480
+بعض الأشياء و تصير مجموعات أخرىمن ال capacities ال
+
+144
+00:11:22,480 --> 00:11:24,760
+vital capacity بدنا نجمع أيش و أيش في ال vital
+
+145
+00:11:24,760 --> 00:11:30,340
+capacity ال expiratory و ال tidal و ال inspiratory
+
+146
+00:11:30,340 --> 00:11:33,580
+surface يعني تلت تلاف و خمسمية زائد الف و مية
+
+147
+00:11:33,580 --> 00:11:38,780
+انتشر و اطلعوا اربع تلاف و ستمية تمام اربع تلاف و
+
+148
+00:11:38,780 --> 00:11:41,800
+ستمية milliliterالـ Total Lung Capacity بيظهر
+
+149
+00:11:41,800 --> 00:11:44,880
+عليهم الـ 1200 مضيف اللي هو الـ Residual Volume
+
+150
+00:11:44,880 --> 00:11:50,740
+1200 بيظهر 5800 مش هيك اللي هو الـ Total Lung
+
+151
+00:11:50,740 --> 00:11:56,460
+Capacity طيب هذا in general احنا قولنا في
+
+152
+00:11:56,460 --> 00:12:02,000
+الفيسيولوجيا اننا بنتكلم عن adult male وزنه 70
+
+153
+00:12:02,000 --> 00:12:09,280
+كيلو طيب ال female أقل شويةلأن طبيعي الجسم اقل
+
+154
+00:12:09,280 --> 00:12:13,700
+وزنا اقل جسمه شوية فهي مش محتاجه اللي هو نفسه ال
+
+155
+00:12:13,700 --> 00:12:18,680
+title تبع الراجل محتاجه ايه اقله شوية منه فلذلك
+
+156
+00:12:18,680 --> 00:12:23,220
+بيقول من عشرين فالمية اقل بتكون ارقام اما تخص
+
+157
+00:12:23,220 --> 00:12:29,460
+البنات للنساء abbreviations هذه مش مشكلة تتعلموها
+
+158
+00:12:29,460 --> 00:12:38,250
+vital capacity inspiratory volumeالـ tidal volume
+
+159
+00:12:38,250 --> 00:12:41,830
+الـ experimental reservoir يعني مختصرات ما هيش
+
+160
+00:12:41,830 --> 00:12:45,990
+قيمة كبيرة لكن النقطة المهمة اللي أنا شايف في
+
+161
+00:12:45,990 --> 00:12:49,650
+عينيكو طب كيف احنا بنجيس ال tidal volume من ال
+
+162
+00:12:49,650 --> 00:12:54,330
+spirometer قولنا قصنا فيه الألقام التانية طب اللي
+
+163
+00:12:54,330 --> 00:12:56,990
+ماقدرناش نجيسه هذا قولتلنا على الدكتورة اسمه
+
+164
+00:12:56,990 --> 00:13:02,110
+residual volume و قولتلنا قيمته هلجد اسم ذلكقل
+
+165
+00:13:02,110 --> 00:13:06,570
+هاتوا بورهانكم برضه بس بنقيسه عن طريق مين ال
+
+166
+00:13:06,570 --> 00:13:10,250
+spirometer بس بطريقة indirect مش بطريقة direct
+
+167
+00:13:10,250 --> 00:13:14,670
+يعني بيبقى شوية calculations و حسابات كيف يعني؟
+
+168
+00:13:14,670 --> 00:13:19,130
+يعني بده أحط مادة في ال .. هي المعادلة اللي أنا
+
+169
+00:13:19,130 --> 00:13:23,290
+جابتلكوا فيها زمان معادلة حساب ال GFR ال grammar
+
+170
+00:13:23,290 --> 00:13:26,300
+filtration rate هنبقى نستخدمهاهنضل استخدامها
+
+171
+00:13:26,300 --> 00:13:29,580
+evolution theory هذه، حاجة من التركيز معين، بعدين
+
+172
+00:13:29,580 --> 00:13:33,380
+خففتها من خلال التركيز في ال volume، إذا عرفت
+
+173
+00:13:33,380 --> 00:13:37,720
+التركيز التاني، بعرف ال volume، تمام؟ فهذه المسألة
+
+174
+00:13:37,720 --> 00:13:41,620
+إيه؟ بتضل هي تتكررو هنا نفس الكلام استخدمنا مادة و
+
+175
+00:13:41,620 --> 00:13:45,140
+حاطناها في ال oxygen chamber تبع مين؟ تبع ال
+
+176
+00:13:45,140 --> 00:13:50,940
+spirometer و اتنفسنا فيها و بعدين بعد شوية تبين
+
+177
+00:13:50,940 --> 00:13:55,780
+انه التركيز اللي في ال chamber هذا اتغير عن ايش؟
+
+178
+00:13:55,780 --> 00:14:01,780
+عن مكان يعني الفرق في ال volume راح راح وين؟ في
+
+179
+00:14:01,780 --> 00:14:05,800
+الرئتين مش كده؟ انا بطلع كل شيء في الآخر بخلي بس
+
+180
+00:14:05,800 --> 00:14:10,080
+مين؟ ال residual volumeأو أخلّي الـ functional
+
+181
+00:14:10,080 --> 00:14:14,160
+اللي هو residual volume اللي هو يحتوي الـ
+
+182
+00:14:14,160 --> 00:14:17,220
+expiratory اللي بعرفه بصورة الـ expiratory بعد الـ
+
+183
+00:14:17,220 --> 00:14:21,560
+tidal بقى أطلّع جد ما أقدر أطلع ال expiratory
+
+184
+00:14:21,560 --> 00:14:25,520
+reserve إذا ده يعني مشكلتي أنا في ال residual إذا
+
+185
+00:14:25,520 --> 00:14:30,420
+من خلال الحسبة البسيطةاللي هي المادة اللي انا
+
+186
+00:14:30,420 --> 00:14:35,260
+خففتها حطيتها اول initially حطيتها بتركيز معين في
+
+187
+00:14:35,260 --> 00:14:41,360
+volume معين و حسبت جداش كميتها بعدين اخلطها في ال
+
+188
+00:14:41,360 --> 00:14:45,120
+ايه اتنفسها العنازل انا ويا وين فى الرقاتين بعدين
+
+189
+00:14:45,120 --> 00:14:51,040
+اجوله معايا خلاص تعال جداش عندي hand تركيز جديد في
+
+190
+00:14:51,040 --> 00:14:56,480
+ال volume اللي انا بتكلم عنهيساوي النقص اللي صار
+
+191
+00:14:56,480 --> 00:15:01,960
+يساوي نفس التركيز اللي موجود في مين نفس التركيز
+
+192
+00:15:01,960 --> 00:15:06,400
+اللي موجود في ال Oxygen Chamber لإن هو هي الهواء
+
+193
+00:15:06,400 --> 00:15:13,840
+أخش و طلع مرتين تلاتة على ال ال ال ال ال ال ال ال
+
+194
+00:15:13,840 --> 00:15:13,840
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+195
+00:15:13,840 --> 00:15:14,460
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+196
+00:15:14,460 --> 00:15:14,980
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+197
+00:15:14,980 --> 00:15:15,660
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+198
+00:15:15,660 --> 00:15:15,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+199
+00:15:15,720 --> 00:15:15,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+200
+00:15:15,720 --> 00:15:15,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+201
+00:15:15,720 --> 00:15:15,720
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+202
+00:15:15,720 --> 00:15:18,060
+ال ال ال ال ال ال ال ال ال ال ال
+
+203
+00:15:21,960 --> 00:15:24,760
+فإذا التركيز اللي في الآخر في ال chamber هذه هو
+
+204
+00:15:24,760 --> 00:15:29,120
+نفس التركيز اللي في الريقتين طيب بنشوف هذا ال
+
+205
+00:15:29,120 --> 00:15:33,520
+chamber كده تحتوى في المادة هذه الغريبة نقصة
+
+206
+00:15:33,520 --> 00:15:37,640
+فالنقص الموجود يساوي التركيز اللي احنا عرفناه في
+
+207
+00:15:37,640 --> 00:15:39,840
+ال volume اللي احنا بدنا ندور عليه يطلع له
+
+208
+00:15:39,840 --> 00:15:44,200
+residual volume المثل اللي يتم عن طريق ال helium
+
+209
+00:15:44,200 --> 00:15:47,740
+ال helium مادة
+
+210
+00:15:52,340 --> 00:15:57,220
+مش سامة بقدر انا اضيفها احطها في ال chamber تمام
+
+211
+00:15:57,220 --> 00:16:00,480
+بقول ان عندي هيليوم مركز بالجد الحجم الفلاني يعني
+
+212
+00:16:00,480 --> 00:16:04,280
+كمية الهيليوم بقدر اعرفها بتنفس اكمل نفس فيها بحس
+
+213
+00:16:04,280 --> 00:16:09,420
+ان اضمن انه صار خلط للهيليوم هذه مع مين مع ال
+
+214
+00:16:09,420 --> 00:16:16,130
+functional residual volume بعدين بوقف تمامبشوف
+
+215
+00:16:16,130 --> 00:16:22,230
+التركيز لجديد و في الأول أنا عارف التركيز و ال
+
+216
+00:16:22,230 --> 00:16:25,490
+volume بقصم هدا من هدا بيديني الكمية اللي فقدت
+
+217
+00:16:25,490 --> 00:16:28,950
+وين؟ فى الرائعتين القمية اللى فقدت فى الرائعتين
+
+218
+00:16:28,950 --> 00:16:32,310
+هدول عبارة عن التركيز نفسه اللى فى ال chamber
+
+219
+00:16:32,310 --> 00:16:39,190
+مضروبة فى ال volume تبع ال aالمهم هو الـ
+
+220
+00:16:39,190 --> 00:16:52,790
+Respiratory
+
+221
+00:16:52,790 --> 00:16:58,910
+Volume
+
+222
+00:17:04,730 --> 00:17:09,730
+يعني ال respiratory volume
+
+223
+00:17:09,730 --> 00:17:15,750
+of air that I'm respiring يعني in one minute يعني
+
+224
+00:17:15,750 --> 00:17:19,810
+بتاعة ال volume مضروبا في ايه؟ في ال respiratory
+
+225
+00:17:19,810 --> 00:17:23,470
+rate ال rate of respiration ال rate of respiration
+
+226
+00:17:23,470 --> 00:17:29,570
+دائما هو حوالين اتناشر مرة في الدقيقة طبعا انتوا
+
+227
+00:17:29,570 --> 00:17:31,850
+مش ماخدين بالك انكوا تنفسوا اتناشر مرة في الدقيقة
+
+228
+00:17:32,460 --> 00:17:35,700
+انتوا بتتكلموا و بتاكلوا و بتشربوا و بتتحدثوا ولا
+
+229
+00:17:35,700 --> 00:17:39,720
+معاكوا خبر ان النفس إله إيه؟ إله دار لإن النفس
+
+230
+00:17:39,720 --> 00:17:44,080
+بيستغل ال إيه؟ الوقفات والنزلات من غير ما تحسوا
+
+231
+00:17:44,080 --> 00:17:48,200
+فيه وهذا من فضل ربنا انه بتحسوش بالنفس هو طالع هو
+
+232
+00:17:48,200 --> 00:17:54,520
+نازل لو لا سمح الله واحدة منكم أصيبت بالربو هتحس
+
+233
+00:17:54,520 --> 00:17:59,030
+المشكلة الكبرىإن هي بتحس الهواء و هو طالع دا كل هو
+
+234
+00:17:59,030 --> 00:18:04,010
+طالع مش عارف الواحد ينام لإن الهواء محسوس في
+
+235
+00:18:04,010 --> 00:18:08,410
+الداخلة و الهواء محسوس في الطلعة هذا مزعج لكن احنا
+
+236
+00:18:08,410 --> 00:18:11,790
+دي نكون مش حاسين لا بدخل ولا بطلع ولا جديش ولا
+
+237
+00:18:11,790 --> 00:18:17,290
+أرقع تمام؟ لو حد أخد تجربة ال bronchial أزمة دي
+
+238
+00:18:17,290 --> 00:18:23,530
+مرة عدت في حياته إتهاب عمله some sort ofasthmatic
+
+239
+00:18:23,530 --> 00:18:27,850
+bronchitis وصار يحس بالهواء بيعرف قداش قيمة ان انا
+
+240
+00:18:27,850 --> 00:18:32,730
+بتنفس الهواء ومش باخد بالي منه لإن هو بيصير يعد
+
+241
+00:18:32,730 --> 00:18:38,090
+لحاله لوين الهواء وصل الهواء دخل الهواء طلع طول
+
+242
+00:18:38,090 --> 00:18:42,830
+الليل هو صاحي مسكين يعد الهواء دخل وطلع نفسه ينسى
+
+243
+00:18:42,830 --> 00:18:48,650
+الموضوع هذا مايحسوش مايحسوش هان في صدرهيعني مش قصة
+
+244
+00:18:48,650 --> 00:18:52,410
+انه انا انتبهت التنفس و صرت احس ان الهواء بيخش تمي
+
+245
+00:18:52,410 --> 00:18:58,310
+لأ الهواء بيخش صدري فنفس الواحد انه يقدر يتخلى
+
+246
+00:18:58,310 --> 00:19:02,310
+عنها دي بأي تمان انه يحس ان الهواء كيف داخل لإنه
+
+247
+00:19:02,310 --> 00:19:05,830
+بيعمل irritation لمجموعة كبيرة من العصاب انت في
+
+248
+00:19:05,830 --> 00:19:09,830
+الأول مش حاسس فيها بس الآن صرت حاسس فيها مشكلة
+
+249
+00:19:09,830 --> 00:19:15,450
+كبيرة اذا respiratory minute respiratory volume
+
+250
+00:19:15,450 --> 00:19:23,240
+نضرب ال tidal في إياشفي ال respiratory rate اللي
+
+251
+00:19:23,240 --> 00:19:27,860
+هو في العدد اتناش يعني اتناش في نص لتر يعني ستة
+
+252
+00:19:27,860 --> 00:19:35,460
+لتر مش كده انه هذا اكبر من ال ستة
+
+253
+00:19:35,460 --> 00:19:42,180
+لتر per minute هذا الكلام قلنا ليه عشان نعرف انه
+
+254
+00:19:42,180 --> 00:19:48,240
+احنا اذا وصلنا لمرحلة انه ال minuteالـ respiratory
+
+255
+00:19:48,240 --> 00:19:54,760
+volume كان لتر و نص فما أقل معناه عندي تنفس راتب
+
+256
+00:19:54,760 --> 00:19:58,800
+بطيء من اتنين الى اربعة breathe per minute معناه
+
+257
+00:19:58,800 --> 00:20:03,160
+انا ماجدرش اعيش الا ايه الا دقايق معدودة very
+
+258
+00:20:03,160 --> 00:20:08,540
+short period لان لتر و نص بطليك فيه الا اقل حاجات
+
+259
+00:20:08,540 --> 00:20:13,640
+للجسم معناهاللي بنزل ال rate عنده of respiration
+
+260
+00:20:13,640 --> 00:20:17,940
+لإصابة لكده بتنفس شوية شوية شوية بعدين يتوقف النفس
+
+261
+00:20:17,940 --> 00:20:23,820
+و دائما القلب يتوقف بعد توقف النفس بخمس دقائق يعني
+
+262
+00:20:23,820 --> 00:20:29,580
+القلب بيضال beating بعد ال respiratory عن التنفس
+
+263
+00:20:29,580 --> 00:20:33,300
+ال
+
+264
+00:20:33,300 --> 00:20:37,980
+rate of respiratory occasionally rises to 40 to 50
+
+265
+00:20:37,980 --> 00:20:48,710
+per minute في الحالة ديالـ tidal volume can
+
+266
+00:20:48,710 --> 00:20:57,030
+be as great as vital capacity about
+
+267
+00:20:57,030 --> 00:21:01,750
+4600 milliliter يعني انا هدول ال reserve ..
+
+268
+00:21:01,750 --> 00:21:06,710
+reserve او ال expiratory reserve و ال inspiratory
+
+269
+00:21:06,710 --> 00:21:12,480
+reserve بعض الأحيان لما انا بعمل مجهود كبيرالـ
+
+270
+00:21:12,480 --> 00:21:17,260
+tidal volume نفسه بكبر بصير انا باخد نفس عميق و
+
+271
+00:21:17,260 --> 00:21:24,060
+بطلع هوا ايه عميق تمام هذه ايه ممكن يصل الانسان
+
+272
+00:21:24,060 --> 00:21:27,140
+انه كل ال vital .. ليش تسميها vital capacity؟ ممكن
+
+273
+00:21:27,140 --> 00:21:31,220
+كل ال vital capacity هستخدمها ك tidal volume ليش؟
+
+274
+00:21:31,220 --> 00:21:34,280
+لأنها اختيعت ل ال expiration و اختيعت ل ال
+
+275
+00:21:34,280 --> 00:21:40,610
+inspiration فإذا انا واجت الأزمة ما استخدمتهاتمام؟
+
+276
+00:21:40,610 --> 00:21:44,770
+عند الحاجة عراي عباس عارفينه عباس؟ طب أحمد مطهر
+
+277
+00:21:44,770 --> 00:21:50,450
+لماذا تشحن سيفك يا عباس؟ قلت له قل الحاجة و لسه
+
+278
+00:21:50,450 --> 00:21:54,170
+الحاجة ما عيشتش لأ أن الحاجة احنا نستطيع استخدام
+
+279
+00:21:54,170 --> 00:21:58,470
+ال inspiratory و expiratory بنضل ال volume يخش
+
+280
+00:21:58,470 --> 00:22:01,030
+شويه ع ال inspiratory و يخش شويه ع ال expiratoryع
+
+281
+00:22:01,030 --> 00:22:05,410
+ال expiratory تمام حسب حجة ال ايه الواحد كان ده
+
+282
+00:22:05,410 --> 00:22:09,330
+وسع وسع وسع وسع كل ما انت عايز اكتر كل ما دخلنا
+
+283
+00:22:09,330 --> 00:22:13,230
+على ال ايه مش بتدخل إراديا لا إراديا بتصير انت
+
+284
+00:22:13,230 --> 00:22:16,030
+لحالك ال tidal volume يكبر يتسع في اتجاه ال
+
+285
+00:22:16,030 --> 00:22:19,730
+expiration يتسع في اتجاه ال expiration ممكن تصل
+
+286
+00:22:19,730 --> 00:22:24,150
+لمرحلة من الجهود و الحاجة له ان انت أخدته كله في
+
+287
+00:22:24,150 --> 00:22:27,950
+ال inspiration و ال expiration صار هو كله ال vital
+
+288
+00:22:27,950 --> 00:22:35,940
+capacity صار هي ال tidalvolume طيب ماعلي أنا كلام
+
+289
+00:22:35,940 --> 00:22:39,700
+حاسب أقول قدرة إيه الرئتين هدول the alveolar
+
+290
+00:22:39,700 --> 00:22:43,680
+ventilation هه تمام the alveolar ventilation أنا
+
+291
+00:22:43,680 --> 00:22:50,880
+بدأت أتكلم عنه وقلنا إنه أن مش كل الرئتين بيصير
+
+292
+00:22:50,880 --> 00:22:54,280
+فيه متبادل غزات، مظبوط؟ وقلنا فيه شزء ما بيسميه
+
+293
+00:22:54,280 --> 00:22:59,300
+dead space طب وين بتت متبادل الغزات؟ المنطقة وين؟
+
+294
+00:23:00,000 --> 00:23:02,440
+في ال alveoli انا كنت زيكم بظن انها بس في ال
+
+295
+00:23:02,440 --> 00:23:06,060
+alveoli و لو بس في ال alveoli كان ماحطناش موضوع
+
+296
+00:23:06,060 --> 00:23:09,180
+كبير اسمه alveolar ventilation كان قلنا in alveoli
+
+297
+00:23:09,180 --> 00:23:12,620
+و كلنا عارفين ان نمشي عنها بس تبين انه لأ مش بس ال
+
+298
+00:23:12,620 --> 00:23:18,440
+alveoli لأ ال alveoli مجموعة alveoli مع بعض
+
+299
+00:23:18,440 --> 00:23:23,250
+بيعملوا alveolar sackو ال alveolar sac اللي هو
+
+300
+00:23:23,250 --> 00:23:28,690
+alveolar؟ duct و ال alveolar ducts المجموعة
+
+301
+00:23:28,690 --> 00:23:32,890
+المختلفة من ال alveolar ducts بتشبك في respiratory
+
+302
+00:23:32,890 --> 00:23:37,830
+duct bronchiole اه respiratory bronchiole ال
+
+303
+00:23:37,830 --> 00:23:40,750
+respiratory bronchiole المختلفة بتشبك في terminal
+
+304
+00:23:40,750 --> 00:23:44,490
+bronchiole تمام؟ اذا لحد ال terminal bronchiole
+
+305
+00:23:44,490 --> 00:23:47,670
+مابصرش ايش؟ تبادل غازات مابعد ال terminal
+
+306
+00:23:47,670 --> 00:23:51,110
+bronchiole بصير عندنا ايه؟ تبادل غازات لو بسمع
+
+307
+00:23:51,110 --> 00:23:51,590
+بشمل
+
+308
+00:23:57,440 --> 00:24:01,940
+اللي موجودة في الكتاب صعبة شوية عشان تفهميها لكن
+
+309
+00:24:01,940 --> 00:24:06,100
+هنا إذا نقدر نتميز هي ال alveoli الصغيرة هذه تمام
+
+310
+00:24:06,100 --> 00:24:09,280
+و في الوسط بيجمع ال alveoli مع بعض هالبعض اسمه
+
+311
+00:24:09,280 --> 00:24:14,260
+alveolar sacو هذا الفيولر بسيط بيفتح على ايه؟
+
+312
+00:24:14,260 --> 00:24:19,400
+الفيولر دكت وال الفيولر دكت هادي و هادي و هادي و
+
+313
+00:24:19,400 --> 00:24:24,520
+اختها من كل اتجاهات بيفتح على رسبيراتوري برونكيول
+
+314
+00:24:24,520 --> 00:24:29,600
+مجموعة رسبيراتوري برونكيول بيفتحوا برونكيول اضافية
+
+315
+00:24:29,600 --> 00:24:35,480
+بنسميها terminal of bronchiol اذا منها تمام و هيك
+
+316
+00:24:35,480 --> 00:24:41,690
+بيصير تبادل غزاتلكن احنا سميناها تجاوزا
+
+317
+00:24:41,690 --> 00:24:45,410
+ال alveolar ventilation عشان احنا الاعتقاد عندنا
+
+318
+00:24:45,410 --> 00:24:48,310
+ان ال ventilation بيصير في ال ايه؟ في ال alveoli
+
+319
+00:24:48,310 --> 00:24:51,990
+فقلنا ال alveolar ventilation وين حدوده؟ بالشكل
+
+320
+00:24:51,990 --> 00:24:56,650
+اللي احنا بتكلم عنه قاعدينه ال dead space انا
+
+321
+00:24:56,650 --> 00:24:59,870
+تكلمت عنه قلنا فيه انه anatomical dead space و
+
+322
+00:24:59,870 --> 00:25:02,210
+physiological dead space لكن السؤال انا كيف ممكن
+
+323
+00:25:02,210 --> 00:25:07,760
+اعرف ال dead space هذا؟ كيف ممكن ايش؟ اجيسهيعني
+
+324
+00:25:07,760 --> 00:25:11,560
+أجدش أنا عندى ال space ال anatomical ال
+
+325
+00:25:11,560 --> 00:25:19,180
+physiological لأ واضح أنه انا لما بقى اتنفس بعمل
+
+326
+00:25:19,180 --> 00:25:23,220
+exploration الجزء الأول اللي بطلع اللي هو يساوي
+
+327
+00:25:23,220 --> 00:25:26,480
+تركيز و تركيب و تركيب الهواء الطبيعى يعني هذا ال
+
+328
+00:25:26,480 --> 00:25:34,480
+space هو التركيز يتغير و يصير عندى
+
+329
+00:25:37,050 --> 00:25:41,010
+المثاب بتتغير عن الهواية الطبيعية اذا احنا لو
+
+330
+00:25:41,010 --> 00:25:47,570
+دخلنا في مين في ال alveolar sack او ال alveolar
+
+331
+00:25:47,570 --> 00:25:52,790
+هذه
+
+332
+00:25:52,790 --> 00:25:58,370
+المنطقة اللي .. نقول the area of alveoli يعني اللي
+
+333
+00:25:58,370 --> 00:26:02,570
+هو ال alveolar ايه space ال alveolar space او اسمه
+
+334
+00:26:04,530 --> 00:26:08,630
+respiratory space ال respiratory space هذا اللي هو
+
+335
+00:26:08,630 --> 00:26:12,310
+يشبه الكلام اللي قلنا عليه كلهيته اللي بتنفيه ال
+
+336
+00:26:12,310 --> 00:26:18,550
+ventilation اعتقد ان احنا حاطين عنوان respiratory
+
+337
+00:26:18,550 --> 00:26:25,970
+time اين يتم تبادل الغازات في ال respiratory space
+
+338
+00:26:25,970 --> 00:26:32,590
+ال اه
+
+339
+00:26:32,910 --> 00:26:36,390
+كيف إذا بدنا نحسب الآن ال .. ال .. المسألة هذه
+
+340
+00:26:36,390 --> 00:26:40,370
+جديش عندي أنا dead space إذا طول ما إنه الهواء
+
+341
+00:26:40,370 --> 00:26:46,350
+انخلط في ال respiratory في ال alveolar air نسميه
+
+342
+00:26:46,350 --> 00:26:49,890
+alveolar air تركيبته مش هتبقى تركيبته الهواء
+
+343
+00:26:49,890 --> 00:26:54,670
+هتتغير أه هينخفض ال oxygen لإنه خشيت ع منطقة مسحوب
+
+344
+00:26:54,670 --> 00:26:58,050
+منها ال oxygen و هزيد carbon dioxide لإنه إيه دخلت
+
+345
+00:26:58,050 --> 00:27:08,210
+ع منطقةأه كلام سليم في الحالة هذه انا
+
+346
+00:27:08,210 --> 00:27:11,350
+ايش بيصير عندى كمان عندى ال .. هاد ال nitrogen
+
+347
+00:27:11,350 --> 00:27:17,990
+concentration nitrogen concentration في ال ..
+
+348
+00:27:17,990 --> 00:27:27,350
+الفيولر air الطبيعى ال nitrogen هاد
+
+349
+00:27:27,350 --> 00:27:29,590
+ال .. هاد ال air هنا ال nitrogen بيصير بيعلى
+
+350
+00:27:29,590 --> 00:27:35,690
+تركيزهبحيث انه انا ايه ال nitrogen في ال alveolar
+
+351
+00:27:35,690 --> 00:27:42,290
+air لا يستخدم مش هيك يعني انا لا باضيف الجسم لا
+
+352
+00:27:42,290 --> 00:27:46,170
+بيضيف oxygen
+
+353
+00:27:46,170 --> 00:27:51,370
+ولا ال nitrogen ولا بياخد nitrogen مش كده فال
+
+354
+00:27:51,370 --> 00:27:57,130
+nitrogen تركيزه بالنسبة للغازات الأخرى بالنسبة لل
+
+355
+00:27:57,130 --> 00:28:00,190
+oxygen ال oxygen بيضال اقل و carbon dioxide بيضال
+
+356
+00:28:00,190 --> 00:28:06,660
+ايهIs it طيب اذا انا صراحت شوية هيك خلينا ليش
+
+357
+00:28:06,660 --> 00:28:12,380
+بنستخدم ال oxygen there for the dead space okay
+
+358
+00:28:12,380 --> 00:28:15,540
+ميجارمنت of dead space a simple method for
+
+359
+00:28:15,540 --> 00:28:19,720
+measuring dead space volume is demonstrating by
+
+360
+00:28:19,720 --> 00:28:23,960
+this graph and make and making this measurement
+
+361
+00:28:23,960 --> 00:28:27,760
+the subject suddenly takes deep breath of oxygen a
+
+362
+00:28:27,760 --> 00:28:33,310
+okay فانجيت فهمت انا ايه؟الموضوع انه احنا بنستخدم
+
+363
+00:28:33,310 --> 00:28:36,630
+ال nitrogen صحيح في القياس لإنه احنا بدنا نتنفس
+
+364
+00:28:36,630 --> 00:28:40,570
+oxygen بحت اول ما يبدأ يظهر ال nitrogen معناه
+
+365
+00:28:40,570 --> 00:28:43,910
+بيظهر من وين؟ بيظهر مش من اللي احنا أخدناها ال
+
+366
+00:28:43,910 --> 00:28:49,790
+gate أخد من اللي انخلط في ال alveolar space واضح؟
+
+367
+00:28:49,790 --> 00:28:54,450
+يعني عشان اقيسه انا بدي اخد oxygen inspiration of
+
+368
+00:28:54,450 --> 00:28:58,790
+pure oxygen المرحلة الأولانية تمام؟ بتنفس oxygen
+
+369
+00:28:58,790 --> 00:29:04,690
+بحتبعدين ب .. اوقف بطلع الهوة اللى فى .. فى نفس
+
+370
+00:29:04,690 --> 00:29:09,370
+مثلا ومابدأياش بدأ اخد اول نفس بدأ ابدأ .. ابدأ ..
+
+371
+00:29:09,370 --> 00:29:16,790
+ابدأ التجربة انا اخدت نفس و سجين بحت و بدت اطلع و
+
+372
+00:29:16,790 --> 00:29:20,950
+أثناء ال .. الهوة اللى طالع عندي بيعدى على
+
+373
+00:29:20,950 --> 00:29:27,230
+نيتروجين متربقرأ فورا تركيز ال nitrogen و الهواء
+
+374
+00:29:27,230 --> 00:29:30,710
+طالع في ال nitrogen meter هذا هو طالع من تمي انا
+
+375
+00:29:30,710 --> 00:29:35,690
+بقرأ جدش تركيز ال nitrogen تمام؟ اذا انا اخدت
+
+376
+00:29:35,690 --> 00:29:40,070
+oxygen بحت بدون ايش؟ بدون nitrogen و بديت اطلع
+
+377
+00:29:40,070 --> 00:29:45,610
+النفس بعد التنفس هتوقع ان البارحة اقول ايه؟ بدون
+
+378
+00:29:45,610 --> 00:29:50,110
+nitrogen نهائي بقرا صفر لان مافيش شيء الا oxygen
+
+379
+00:29:50,110 --> 00:29:53,630
+هذا ال essence التابعي بقراش ايه؟ oxygenبس بجرى
+
+380
+00:29:53,630 --> 00:29:57,270
+مين؟ نيتروجين فبجرى لـ nitrogen .. ال oxygen .. ال
+
+381
+00:29:57,270 --> 00:30:02,690
+nitrogen صفر zero zero zero بعدين في الآخر هجرى ل
+
+382
+00:30:02,690 --> 00:30:06,570
+ال nitrogen تركيزه وين؟ اللي في ال alveoli إذا في
+
+383
+00:30:06,570 --> 00:30:09,410
+الآخر عندي تركيز ثابت اللي في ال alveoli و في
+
+384
+00:30:09,410 --> 00:30:12,870
+الأول تركيز ثابت صفر اللي في ال dead space لأنه
+
+385
+00:30:12,870 --> 00:30:18,210
+كله oxygen لكن في المابين منطقة الخلط ال .. ال ..
+
+386
+00:30:18,210 --> 00:30:20,070
+المنطقة اللي نهاية ال dead space
+
+387
+00:30:22,880 --> 00:30:28,680
+وبداية ال .. ال alveolar space هذه المنطقة هيكون
+
+388
+00:30:28,680 --> 00:30:31,780
+مخلوط فيها ال alveolar space by diffusion by
+
+389
+00:30:31,780 --> 00:30:34,420
+simple diffusion هيطلع الهواء اللي في ال alveoli
+
+390
+00:30:34,420 --> 00:30:38,180
+إلى الهواء الجديد و ال oxygen اللي في ال .. اللي
+
+391
+00:30:38,180 --> 00:30:42,200
+أنا بتنفسه هينزل معاه ففي منطقة هيصير فيها تدريج
+
+392
+00:30:42,200 --> 00:30:47,600
+في تركيز ال alveolar air بمعنى أخر أنه أنا هابدأ
+
+393
+00:30:47,600 --> 00:30:53,130
+أحس بال nitrogen وجوده قبل ما يتهدد ال spaceقبل ما
+
+394
+00:30:53,130 --> 00:30:58,870
+الـ dead space انتهى كله، تمام؟ لكن أنا يوم ما ال
+
+395
+00:30:58,870 --> 00:31:03,690
+.. ال plateau أصله، يعني التركيز صار ثابت، معناه
+
+396
+00:31:03,690 --> 00:31:07,150
+أنا دخلت الاش؟ ال dead space، لأنه بطل يتغير ال
+
+397
+00:31:07,150 --> 00:31:09,870
+oxygen .. ال nitrogen concentration، معناه أنا
+
+398
+00:31:09,870 --> 00:31:13,750
+بطلع من مصدر مركز واحد، اللي هو aviolar air، في
+
+399
+00:31:13,750 --> 00:31:17,410
+الأول ال oxygen بيتغيرش ثابت، مافيش nitrogen، كله
+
+400
+00:31:17,410 --> 00:31:21,140
+oxygenالوصل بينهم اللي يبقى زيزي زيزي زيزي زيزي
+
+401
+00:31:21,140 --> 00:31:23,040
+زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي
+
+402
+00:31:23,040 --> 00:31:30,820
+زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي
+
+403
+00:31:30,820 --> 00:31:31,720
+زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي
+
+404
+00:31:31,720 --> 00:31:32,140
+زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي
+
+405
+00:31:32,140 --> 00:31:44,480
+زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي زيزي
+
+406
+00:31:44,480 --> 00:31:48,900
+زتمام؟ مختلطة لكن واضح انه من هنا .. من هنا ..
+
+407
+00:31:48,900 --> 00:31:52,320
+احنا بدأنا من .. من هذه المنطقة هذه الفيولر اير
+
+408
+00:31:52,320 --> 00:31:58,360
+بيور اذا .. اذا عندي انا من هنا تقريبا لهان هذه
+
+409
+00:31:58,360 --> 00:32:05,280
+منطقة مختلطة شوية بدنا نحسب من خلالها اذا المنطقة
+
+410
+00:32:05,280 --> 00:32:09,480
+هذه اللي هنا في الرسمة brown رمادي تمثل عندي
+
+411
+00:32:09,480 --> 00:32:13,860
+المنطقة اللي .. اللي فيها هيكون ال dead space
+
+412
+00:32:13,860 --> 00:32:17,340
+موجودبمعنى إنه اللي هي منطقة مافيش فيها نيتروجين
+
+413
+00:32:17,340 --> 00:32:21,620
+نهائي ومنطقة بدل نيتروجين فيها يظهر يزيد تركيزه
+
+414
+00:32:21,620 --> 00:32:26,240
+شوية شوية لحد ما أوصلنا لإنه تركيز ثابت من ال
+
+415
+00:32:26,240 --> 00:32:30,040
+نيتروجين عملية حسابية صغيرة إيه بنقدر نحسب هذه
+
+416
+00:32:30,040 --> 00:32:33,920
+تمثل جداش وبكده بنقدر نعرف إحنا إيه ال dead space
+
+417
+00:32:34,430 --> 00:32:40,710
+قداش هو موجود في كل إنسان قولنا إنه تقريبا قيمته
+
+418
+00:32:40,710 --> 00:32:46,150
+حوالي 150 ملي لتر طبعا في ال adult male 70
+
+419
+00:32:46,150 --> 00:32:50,230
+kilogram هذا
+
+420
+00:32:50,230 --> 00:32:53,750
+ال normal dead space اللي هو ال anatomical dead
+
+421
+00:32:53,750 --> 00:32:57,450
+space لكن قولنا فيه ممكن يكون عنده physiological
+
+422
+00:32:57,450 --> 00:33:02,220
+dead space زي ما شرحتلكم في أول الموضوعالـ rate of
+
+423
+00:33:02,220 --> 00:33:06,840
+alveolar ventilation اختلف الان صار ال rate ال
+
+424
+00:33:06,840 --> 00:33:10,880
+minute respiratory volume اختلف عن الان ال rate of
+
+425
+00:33:10,880 --> 00:33:15,140
+alveolar ventilationكمان؟ صار احنا بتكلم معانا عن
+
+426
+00:33:15,140 --> 00:33:19,340
+طايدة ال volume مش خمسمية ملي لتر طايدة ال volume
+
+427
+00:33:19,340 --> 00:33:23,380
+تلت مية و خمسين ملي لتر مش كده طب انا معاناها في
+
+428
+00:33:23,380 --> 00:33:29,120
+الدقيقة يداش باعطي لإرئتين باعطيها تلت مية و خمسين
+
+429
+00:33:29,120 --> 00:33:34,180
+ملي لتر في اتناش مش خمسمية ملي لتر و لو انه دخل من
+
+430
+00:33:34,180 --> 00:33:39,300
+القنف خمسمية ملي لتر في اتناش في الدقيقةلكن في
+
+431
+00:33:39,300 --> 00:33:42,920
+واقع الأمر بيصل الرئتين بيصل الـ alveolar space
+
+432
+00:33:42,920 --> 00:33:50,000
+بيصل لها تلت مائة و خمسين فئة اللي هي تساوي أربعة
+
+433
+00:33:50,000 --> 00:33:55,440
+ألف و متين ملي لتر per minute واضح؟ طيب ال
+
+434
+00:33:55,440 --> 00:33:58,920
+ventilation of alveolar is one of the major
+
+435
+00:33:58,920 --> 00:34:02,400
+factors determining the concentration of oxygen
+
+436
+00:34:02,400 --> 00:34:08,030
+and carbon dioxide in the alveoliليش؟ لأن هو اللي
+
+437
+00:34:08,030 --> 00:34:12,110
+بيصير الـ alveoli لما بيزيد ال .. ال alveolar
+
+438
+00:34:12,110 --> 00:34:17,090
+ventilation بيزيد ال wash out of carbon dioxide و
+
+439
+00:34:17,090 --> 00:34:21,150
+بيزيد اللي هو ال entrance of oxygen بتغير ال
+
+440
+00:34:21,150 --> 00:34:31,290
+alveolar air حسب ال rate of respiration خلصنا هذه
+
+441
+00:34:31,290 --> 00:34:34,340
+.. هذه آخر كلام عن ال mechanics of airو
+
+442
+00:34:34,340 --> 00:34:43,040
+ventilation طبعا الان اتكلم عن موضوع تاني وهو ال
+
+443
+00:34:43,040 --> 00:34:46,000
+.. هاد المنطقة اللي بيصير فيها dead space كلمنا
+
+444
+00:34:46,000 --> 00:34:50,360
+عنها هاد المنطقة اللي فيها dead space من أول القنف
+
+445
+00:34:50,360 --> 00:34:56,020
+ل .. لحد ال alveolarية احنا كل كوهار جيت حزنانين
+
+446
+00:34:56,020 --> 00:35:00,020
+عليهايعني إخسارة في 150 مليل لتر بنتفسهم و نتعب
+
+447
+00:35:00,020 --> 00:35:03,660
+فيهم و أروح على الفاضي مش كده؟ يعني أنا بقى أشعر
+
+448
+00:35:03,660 --> 00:35:07,000
+بحزن إن أنا جهد بعمل و قاعد و بروح ليش في dead
+
+449
+00:35:07,000 --> 00:35:09,300
+space مكان اللي ريح أتيه من أهواء الأنف عشان
+
+450
+00:35:09,300 --> 00:35:12,360
+أستفيد الهواء كله طب إيش ال respiratory passages
+
+451
+00:35:12,360 --> 00:35:18,020
+هذه؟ إيش .. إلها قيمة؟ إلها قيمة كبيرة هذه قيمة من
+
+452
+00:35:18,020 --> 00:35:23,040
+قيمة التنقية، في إلها قيمة تانية غير التنقية، غير
+
+453
+00:35:23,040 --> 00:35:29,870
+ال filtrationبتعمل عملية تسخين وتدفع، مش كده؟
+
+454
+00:35:29,870 --> 00:35:34,290
+Warming عشان الهواء اللي برضه راح هذا ننتلج حسب
+
+455
+00:35:34,290 --> 00:35:39,920
+الظروف المختلفة، لما بدخل عرقتي ندخل حسبعلى ال ..
+
+456
+00:35:39,920 --> 00:35:44,060
+ليصير الـ alveoli الدقيقة هادية مايصارش تلج و إلا
+
+457
+00:35:44,060 --> 00:35:47,960
+حيصير جوا cracks و هنخش في إيه؟ احنا بس نبرد
+
+458
+00:35:47,960 --> 00:35:51,920
+ثواني، كان رشاحنا و حالتنا حالة فمابالك لو كان
+
+459
+00:35:51,920 --> 00:35:55,260
+المسألة هادية، دائما إحنا معرضين للهواء الخارجي
+
+460
+00:35:55,260 --> 00:35:59,800
+الرئاتين ال alveoli مش معرضين للهواء الخارجي أه؟
+
+461
+00:35:59,800 --> 00:36:03,300
+بس أنا عملت تدفع، إذا هدي .. إذا صاراندي حاجتين
+
+462
+00:36:03,300 --> 00:36:11,350
+filtration و تدفع warming و التالتHumidification
+
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index 0000000000000000000000000000000000000000..e88952d3507abe1f6d62960f5e4828c05286c6ce
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@@ -0,0 +1,1139 @@
+1
+00:00:05,680 --> 00:00:08,840
+الموضوع الآن.. الموضوع الجديد اللي هو physical
+
+2
+00:00:08,840 --> 00:00:18,480
+principles of gas exchange الـ الـ الـ gas
+
+3
+00:00:18,480 --> 00:00:26,740
+diffusion هذا اللي بيصير يعني لما أختي في آخر الـ
+
+4
+00:00:26,740 --> 00:00:32,320
+.. الـ .. الغرفة هناك مثلاً تفتح علبة ريحة مافيش
+
+5
+00:00:32,320 --> 00:00:39,320
+حاجة هناك، آه احنا.. احنا هنشمها ليه؟ شمينا منها؟
+
+6
+00:00:39,320 --> 00:00:48,160
+ليه إنتِ شمّيتِ؟ عشان الريحة؟ بدي واحدة تقولي كلام
+
+7
+00:00:48,160 --> 00:00:54,020
+علمي في الموضوع هذا. انتشرت من مكان إلى مكان عشان هي
+
+8
+00:00:54,020 --> 00:01:00,180
+في ذاك المكان concentrated وفي هذا المكان diluted
+
+9
+00:01:00,180 --> 00:01:04,400
+فصار عندي أنا forces of diffusion، مش كده؟ فانتقلت
+
+10
+00:01:04,400 --> 00:01:07,740
+من هذه المنطقة لهذه المنطقة عشان تعمل equilibrium
+
+11
+00:01:07,740 --> 00:01:14,880
+مش هيك؟ مظبوط؟ طبعاً، إيش اللي بيخلي الذرات تبع
+
+12
+00:01:14,880 --> 00:01:19,680
+الرائحة اللي اتكلمنا عنها تنتقل by
+
+13
+00:01:19,680 --> 00:01:23,340
+diffusion؟ عن طريق الـ kinetic motion of the ايه؟
+
+14
+00:01:23,340 --> 00:01:27,160
+of the molecules. في عندنا إيه؟ الـ ions. هي اليها
+
+15
+00:01:27,160 --> 00:01:31,620
+kinetic motion. تتحرك في كل اتجاه بحيث تعمل إيه؟
+
+16
+00:01:31,620 --> 00:01:39,680
+تتوزع في كل مكان بالتساوي. إذا عملية انتقال الغازات
+
+17
+00:01:40,070 --> 00:01:44,370
+أيضاً ينطبق عليها نفس الـ factors، الـ principles
+
+18
+00:01:44,370 --> 00:01:49,610
+اللي يحصل في انتقال باقي المواد إن كانت على الشكل
+
+19
+00:01:49,610 --> 00:01:54,110
+السائل أو على غير السائل. إذا عندنا electrochemical
+
+20
+00:01:54,110 --> 00:01:58,970
+gradients بتؤدي إلى إيه؟ انتقال القوانين الطبيعية
+
+21
+00:01:58,970 --> 00:02:03,370
+هدف الانتقال هنا بالفعل عندنا chemical gradients
+
+22
+00:02:03,370 --> 00:02:07,270
+physical gradients بتؤدي إلى إيه؟ إلى انتقال
+
+23
+00:02:07,270 --> 00:02:10,130
+الغاز. في الـ GALIC لما يكون فيه عنده غاز في منطقة
+
+24
+00:02:10,130 --> 00:02:15,290
+مركز أكثر منه في منطقة أخرى. الغاز في المنطقة
+
+25
+00:02:15,290 --> 00:02:19,150
+القليلة يتحرك في اتجاه الـ kinetic motion، في اتجاه
+
+26
+00:02:19,150 --> 00:02:21,990
+المنطقة الكثيرة، واللي في المنطقة الكثيرة يتحرك في
+
+27
+00:02:21,990 --> 00:02:27,430
+اتجاه المنطقة القليلة، لكن المحصلة النهائية أن الـ net
+
+28
+00:02:27,430 --> 00:02:32,650
+diffusion بيكون في اتجاه من الأعلى إلى الأسفل. لما
+
+29
+00:02:32,650 --> 00:02:35,250
+نقول من أعلى لأسفل لا يعني أن ولا شيء من الجهة
+
+30
+00:02:35,250 --> 00:02:39,000
+الأخرى راح على الجهة الأخرى، لكن في الآخر صار
+
+31
+00:02:39,000 --> 00:02:42,400
+equilibrium، بس معدل الـ diffusion المختلفة ده في كل
+
+32
+00:02:42,400 --> 00:02:46,500
+الاتجاهات. أنه عندي الـ concentration كان له factor
+
+33
+00:02:46,500 --> 00:02:50,040
+كثير في أنه يحدد الـ net diffusion يصير من وين؟ من
+
+34
+00:02:50,040 --> 00:02:52,540
+المنطقة الأعلى concentration إلى المنطقة الأقل
+
+35
+00:02:52,540 --> 00:02:58,380
+concentration، okay؟ إذا
+
+36
+00:02:58,380 --> 00:03:03,280
+net diffusion فهمناها. إذا عندي لما أتكلم هذا
+
+37
+00:03:03,280 --> 00:03:07,650
+النموذج المثل هذا، عندي هذا concentration أعلى، وهنا
+
+38
+00:03:07,650 --> 00:03:11,610
+concentration أقل، في عندي حركة من المنطقة الـ
+
+39
+00:03:11,610 --> 00:03:16,150
+molecules اللي هنا تتحرك في اتجاه اللي إيه؟ الجهة
+
+40
+00:03:16,150 --> 00:03:18,890
+الـ concentrated، لكن كمية أكبر من الجهة الـ
+
+41
+00:03:18,890 --> 00:03:21,290
+concentrated بتتحرك في الجهة الأخرى. فهذا بيؤدي إلى
+
+42
+00:03:21,290 --> 00:03:23,570
+equilibrium، والـ net diffusion بيكون في اتجاه
+
+43
+00:03:23,570 --> 00:03:32,650
+اللي هو من الأعلى إلى الـ .. إذا عندي هنا
+
+44
+00:03:37,920 --> 00:03:43,820
+الغازات لا تتوقف عن الحركة، و تميل إلى التعادل في
+
+45
+00:03:43,820 --> 00:03:48,740
+الـ concentration. الآن لما أكون عندي.. أنا mixture
+
+46
+00:03:48,740 --> 00:03:53,080
+of gases عاملين
+
+47
+00:03:53,080 --> 00:03:58,660
+في مكان ما، ضغط معين، تمام؟ الـ pressure اللي عاملينه
+
+48
+00:03:58,660 --> 00:04:06,290
+هو الـ gases. كل نوع من الغاز يمتلك مشاركة في البراشر
+
+49
+00:04:06,290 --> 00:04:11,610
+بما يتناسب مع concentration، بما يتناسب مع concentration
+
+50
+00:04:11,610 --> 00:04:12,050
+بما يتناسب مع concentration
+
+51
+00:04:12,050 --> 00:04:13,670
+بما يتناسب مع concentration
+
+52
+00:04:13,670 --> 00:04:14,370
+بما يتناسب مع concentration
+
+53
+00:04:14,370 --> 00:04:17,830
+بما يتناسب مع concentration
+
+54
+00:04:17,830 --> 00:04:22,830
+بما يتناسب مع concentration
+
+55
+00:04:22,830 --> 00:04:28,050
+بما
+
+56
+00:04:28,050 --> 00:04:35,000
+يتناسب مع concentration. المكونات تبع هذا الغاز يساوي المجموع
+
+57
+00:04:35,000 --> 00:04:41,780
+الكلي للبراشر، لكن كل واحد له جزئية تتناسب مع مين؟
+
+58
+00:04:41,780 --> 00:04:46,840
+مع الـ concentration تبعه، حلو؟ إذا عندي أنا القانون
+
+59
+00:04:46,840 --> 00:04:52,200
+هنا بقول البراشر is directly proportional to the
+
+60
+00:04:52,200 --> 00:04:55,140
+concentration of the gas molecules، الـ gas
+
+61
+00:04:55,140 --> 00:05:00,490
+molecules في هذا الـ mixture هذا. تبع نوع معين، جدعش الـ
+
+62
+00:05:00,490 --> 00:05:04,910
+pressure تبعهم يضغط، متناسب معه. بمعنى آخر احنا
+
+63
+00:05:04,910 --> 00:05:11,250
+الهواء الجوي مثلاً، الهواء الجوي عامل ضغط على مستوى
+
+64
+00:05:11,250 --> 00:05:16,510
+أرضها، ضغط يساوي جدعش، 760 مش كده؟ اللي
+
+65
+00:05:16,510 --> 00:05:20,550
+يساوي جدعش بالمليمتر من الزئبق 760، حلو؟
+
+66
+00:05:20,550 --> 00:05:24,590
+لكن الهواء هذا اللي احنا حوالينا هذا 80% في
+
+67
+00:05:24,590 --> 00:05:30,050
+المئة منه أو 79% في المئة منه نيتروجين، و 21%
+
+68
+00:05:30,050 --> 00:05:34,950
+منه أكسجين، ونسب قليلة ثاني أكسيد الكربون وبخار ماء
+
+69
+00:05:34,950 --> 00:05:39,130
+وكده طبعاً. إذا لو طلعنا، هلاقي الـ nitrogen تقريباً
+
+70
+00:05:39,130 --> 00:05:43,130
+بيشكل 600 ملم زئبق، pressure، pressure خاص بالـ
+
+71
+00:05:43,130 --> 00:05:54,630
+nitrogen طبعاً، والأكسجين هيشكل 160 ملم
+
+72
+00:05:54,630 --> 00:06:01,050
+زئبق. إذا 160 و600 و760 يمثلوا الضغط الكلي
+
+73
+00:06:01,050 --> 00:06:05,890
+لو إحنا جبنا غاز ثالث حشرناه بينهم، هيشارك في الـ
+
+74
+00:06:05,890 --> 00:06:11,630
+760، هيصير النصيب لكل واحد من هدول مختلف، تمام؟
+
+75
+00:06:11,630 --> 00:06:15,750
+يعني إجينا من منطقة فيها بخار ماء عالي بدل ما هو
+
+76
+00:06:15,750 --> 00:06:17,150
+كان نسمة غير مذكورة
+
+77
+00:06:19,600 --> 00:06:25,380
+بنخصم بخار الماء من الضغط الكلي، والباقي نوزعه
+
+78
+00:06:25,380 --> 00:06:29,040
+على الأكسجين والنيتروجين، أو بمعنى آخر، كل واحد من
+
+79
+00:06:29,040 --> 00:06:33,890
+هدول نسبته بنجيبه ونديله نصيبه، تمام؟ لو في منطقة في
+
+80
+00:06:33,890 --> 00:06:37,990
+ثاني أكسيد الكربون أعلى، آه صار يشارك، صار له مشاركة
+
+81
+00:06:37,990 --> 00:06:44,010
+إيه؟ بمعنى أنه أنا في هواء الشهيق تقريباً مافيش
+
+82
+00:06:44,010 --> 00:06:47,310
+ثاني أكسيد الكربون، لكن هو طالع صار ثاني أكسيد الكربون
+
+83
+00:06:47,310 --> 00:06:53,670
+مُحترم، فيه كتير، فصار له بسبب إيه؟  مُعتَبَر. بخار
+
+84
+00:06:53,670 --> 00:06:59,430
+الماء، وفي النفس اللي داخل كذلك لا يُعتبر، مش مُستَحَق
+
+85
+00:06:59,430 --> 00:07:07,160
+لكن هو طالع، إيه؟ صار له إيه؟ صار له اعتبار. لكن أنا
+
+86
+00:07:07,160 --> 00:07:10,760
+شايف ناس مُعترضة على الكلام هذا، لأنه قالت يا دكتور
+
+87
+00:07:10,760 --> 00:07:13,620
+إنتَ قُلت لنا، والهواء اللي داخل صحيح ناشف، هو ما لهوش
+
+88
+00:07:13,620 --> 00:07:17,760
+اعتبار، لكن لما دخل الـ air passages قلنا بيصير
+
+89
+00:07:17,760 --> 00:07:22,380
+humidification، تمام؟ آه، يعني إذا هو جاب المية للـ
+
+90
+00:07:22,380 --> 00:07:26,120
+alveoli، بيكون بخار الماء عالي فيه، وصار
+
+91
+00:07:26,120 --> 00:07:31,160
+له اعتبار. بمعنى آخر، هنتكلم عن موضوع اسمه أن الـ
+
+92
+00:07:31,160 --> 00:07:35,630
+alveolar air فيه في داخله اختلافات عن الـ
+
+93
+00:07:35,630 --> 00:07:41,410
+atmospheric air، أجل. ما فيه أن بخار الماء زاد، بخار
+
+94
+00:07:41,410 --> 00:07:46,550
+الماء أخذ جزء من الـ.. من الـ pressure، pressure صار
+
+95
+00:07:46,550 --> 00:07:51,230
+له نصيب. إذا الـ pressure، pressure في الهواء مختلف
+
+96
+00:07:51,230 --> 00:07:55,720
+عن الـ pressure، pressure لنفس الـ الـ الـ الـ
+
+97
+00:07:55,720 --> 00:07:59,880
+.. الغاز، لكن ده الـ alveoli، ليش؟ لأن هو ده كل واحد في
+
+98
+00:07:59,880 --> 00:08:03,780
+واحد حشر نفسه، جال قعد معاكوا هو اللي إيه؟ اللي هو
+
+99
+00:08:03,780 --> 00:08:07,380
+الـ carbon ده، واضح؟  واحد آسف. إذا نتكلم الآن
+
+100
+00:08:07,380 --> 00:08:12,480
+إحنا عن هذا الموضوع، بنرمز للـ pressure pressure of gases
+
+101
+00:08:12,480 --> 00:08:19,620
+إحنا بالـ P الكبيرة هذه، وبعدين جنبها رمز الـ إيه؟
+
+102
+00:08:19,620 --> 00:08:25,930
+رمز الغاز، تمام؟ فهذا pressure pressure، pressure الأكسجين، carbon
+
+103
+00:08:25,930 --> 00:08:31,710
+dioxide، pressure pressure النيتروجين، pressure pressure water vapor، gas
+
+104
+00:08:31,710 --> 00:08:38,390
+pressure pressure helium وكذا، طيب
+
+105
+00:08:38,390 --> 00:08:47,630
+okay، الهواء سهل، جبنا سيرته وانتهينا
+
+106
+00:08:47,630 --> 00:08:51,670
+الآن بنتكلم عن موضوع ثاني، إنتَ دكتور، الغازات هذه
+
+107
+00:08:51,670 --> 00:08:57,850
+اللي بتكلمنا عنها، تمام؟ إتخطت الـ alveoli، إتحولت لها
+
+108
+00:08:57,850 --> 00:09:04,510
+liquid medium، fluid. إذا الغازات داخلة في fluids، طب
+
+109
+00:09:04,510 --> 00:09:11,010
+هل ينطبق قوانين الغازات في الغازات؟ إزاي قوانين
+
+110
+00:09:11,010 --> 00:09:17,070
+الغازات تتحرك في fluids؟ تمام؟ إذا هذه لها قواعد
+
+111
+00:09:17,070 --> 00:09:23,170
+جديدة؟ حقيقة معظمها هي نفس الشيء، القاعدة هي هي، تتحرك
+
+112
+00:09:23,170 --> 00:09:27,450
+من الـ الـ الـ concentration الأعلى إلى الـ
+
+113
+00:09:27,450 --> 00:09:34,950
+concentration الأقل، مظبوط؟ بس وقلنا.. وقلنا
+
+114
+00:09:34,950 --> 00:09:39,310
+أنه كل partial pressure من شوية صغيرة، إتكلمنا الـ
+
+115
+00:09:39,310 --> 00:09:43,810
+partial pressure تبع غاز معين حسب التركيز تبعه
+
+116
+00:09:43,810 --> 00:09:47,230
+وجسمها مباشرةً، تمام؟ فالـ partial pressure تبعها
+
+117
+00:09:47,230 --> 00:09:52,070
+هيتغير، وفي مواد ثانية، أبدًا المية بتطردها، rebellion
+
+118
+00:09:52,070 --> 00:09:56,630
+تبعدها عنها، فدائماً free تتحرك بسرعة أكثر، تتشر في
+
+119
+00:09:56,630 --> 00:10:02,970
+كل مكان، فممكن من هذه الأشياء اللي هي مانية أفضل
+
+120
+00:10:02,970 --> 00:10:16,410
+تبني أقل، تبني بسرعة أكثر، تبني بـ pressure أكثر، تتحرك
+
+121
+00:10:16,410 --> 00:10:21,150
+بـ pressure، أتحرك، تبني بـ pressure
+
+122
+00:10:24,260 --> 00:10:30,660
+لأن كان في شهر بكرة في حركة الوحوش، والـ
+
+123
+00:10:30,660 --> 00:10:37,000
+concentration مرتبطة في باقي بس أنا إذا أَبْعَدْتُ
+
+124
+00:10:37,000 --> 00:10:48,640
+بمسحها، بخلّق وحوشها بتخرج، وتهيأ، وأهرب، وأحضّر، و
+
+125
+00:10:48,640 --> 00:10:58,320
+أمسكها. فهو ماشي تأثير، إشمّه في الـ.. في الـ.. في الـ
+
+126
+00:10:58,320 --> 00:11:08,760
+.. في البشر طبعاً. فجأة، أنا أزمّل أن عارف دي نفسي يكون
+
+127
+00:11:08,760 --> 00:11:17,960
+عشان يتفجر عن البشر، البشر تبع البيت وعناه اللي
+
+128
+00:11:17,960 --> 00:11:19,740
+علاقة بخصة
+
+129
+00:11:25,120 --> 00:11:32,480
+السنة الأولى، الثانية بقوة، عشان الثانية كانت مزايا 13
+
+130
+00:11:32,480 --> 00:11:45,200
+أكثر، إن نقل 16 سنة، تاسعة أكثر، إن نقل 16 سنة، تاسعة
+
+131
+00:11:45,200 --> 00:11:49,700
+أكثر، إن نقل 16 ثانية
+
+132
+00:11:54,940 --> 00:11:59,480
+نعيش بحب و..و..و..و..و..و..و..و..و
+
+133
+00:11:59,480 --> 00:11:59,560
+..و..و..و..و..و..و..و..و..و
+
+134
+00:11:59,560 --> 00:11:59,940
+..و..و..و..و..و..و..و..و..و
+
+135
+00:11:59,940 --> 00:12:00,880
+..و..و..و..و..و..و..و..و..و
+
+136
+00:12:00,880 --> 00:12:02,280
+..و..و..و..و..و..و..و..و..و
+
+137
+00:12:02,280 --> 00:12:03,340
+..و..و..و..و..و..و..و..و..و
+
+138
+00:12:03,340 --> 00:12:03,680
+..و..و..و..و..و..و..و..و..و
+
+139
+00:12:03,680 --> 00:12:04,440
+..و..و..و..و..و..و..و..و..و
+
+140
+00:12:04,440 --> 00:12:05,580
+..و..و..و..و..و..و..و..و..و
+
+141
+00:12:05,580 --> 00:12:11,400
+..و..و..و..و..و..و..و..و..و
+
+142
+00:12:11,400 --> 00:12:22,460
+..و..و..و..و..و..و..و..و..و
+
+143
+00:12:24,950 --> 00:12:33,970
+بس، آه لأ، إن إنتوا شايفين أسئلة الـ presentation of
+
+144
+00:12:33,970 --> 00:12:43,750
+what the subject has على سنوات متشابهات، بناس طبعاً
+
+145
+00:12:43,750 --> 00:12:52,970
+أجزاء هذه مش عادة وزيادة بالضبط، لكن هي تقصر على
+
+146
+00:12:59,180 --> 00:13:20,180
+طبعاً بشوف حاجة زي دي، يا راجل، أشوف
+
+147
+00:13:20,180 --> 00:13:21,780
+أن أنا عايز أشوف
+
+148
+00:13:33,460 --> 00:13:46,920
+الشيء الوحيد اللي أحبه
+
+149
+00:13:46,920 --> 00:13:55,140
+هو الوحيد اللي أحبه
+
+150
+00:13:59,020 --> 00:14:15,600
+أو سجن، آهو، بيرت إيه تلاتي فور؟
+
+151
+00:14:15,600 --> 00:14:23,180
+يا عزيزي، أفادوا من بيرتسان قبل بيرتسان، واحد أفادوا
+
+152
+00:14:23,180 --> 00:14:27,680
+من بيرتسان أصلاً، بعد وفشان
+
+153
+00:14:32,250 --> 00:14:39,410
+.57 لو جسمناها على 24، أكثر من عشرين مرة، مش كده؟ لو
+
+154
+00:14:39,410 --> 00:14:44,110
+جسمناها على الـ point، point 0.024 هذه، بالـ 24
+
+155
+00:14:44,110 --> 00:14:48,450
+ألف، وهذه 57 من 100، تمام؟ لو
+
+156
+00:14:48,450 --> 00:14:53,150
+جسمناها بعض، أكثر من عشرين، تقريباً عشرين مرة، تقريباً
+
+157
+00:14:53,150 --> 00:14:58,590
+عشرين مرة، أكثر من عشرين مرة، لو الـ 50، عشرين، عشرين
+
+158
+00:14:59,000 --> 00:15:02,480
+فهنا أقل شوية، وهنا أكثر شوية، أكثر من عشرين مرة
+
+159
+00:15:02,480 --> 00:15:06,120
+اللي هو الفرق في الـ إيه؟ في الـ solubility
+
+160
+00:15:06,120 --> 00:15:12,600
+coefficient. بمعنى آخر، أنا عشان أوصل لنفس تركيز، نفس
+
+161
+00:15:12,600 --> 00:15:17,020
+الـ partial pressure تبع الأكسجين، بدي أحط عشرين ضعف
+
+162
+00:15:17,020 --> 00:15:21,680
+ثاني أكسيد الكربون، تمام؟ بدي أحط عشرين ضعف carbon
+
+163
+00:15:21,680 --> 00:15:25,360
+dioxide. يعني عندي ثاني أكسيد الكربون كمية كبيرة، لكن
+
+164
+00:15:25,360 --> 00:15:30,280
+partial pressure تبعها إيش؟ قليل، في حين أنه أنا
+
+165
+00:15:30,280 --> 00:15:33,180
+عندي كمية أقل كتير من الأكسجين، لأن الـ partial
+
+166
+00:15:33,180 --> 00:15:36,900
+pressure تبعها عالي. partial pressures. إذا الفرق
+
+167
+00:15:36,900 --> 00:15:40,000
+بين الـ partial pressures هو اللي بيحدد إيه؟ الـ
+
+168
+00:15:40,000 --> 00:15:47,280
+net diffusion، مش الـ الـ concentration لحاله، okay؟
+
+169
+00:15:47,280 --> 00:15:50,240
+إذا من ناحية الغازية إلى ناحية الـ
+
+170
+00:15:56,250 --> 00:16:02,630
+وبعد كده في أفرادها لأن بحب، بحب، بيبقى، بيبقى، بيبقى
+
+171
+00:16:02,630 --> 00:16:04,950
+بيبقى، بيبقى، بيبقى، بيبقى، بيبقى، بيبقى، بيبقى، بيبقى
+
+172
+00:16:04,950 --> 00:16:08,930
+بيبقى، بيبقى، بيبقى، بيبقى، بيبقى، بيبقى، بيبقى، بيبقى
+
+173
+00:16:08,930 --> 00:16:10,
+
+223
+00:21:26,370 --> 00:21:34,470
+في الموحلة فأنا وساعة اللي عارفة راحت معانا أوعى
+
+224
+00:21:34,470 --> 00:21:39,430
+بس أنا شارت وشارت اللي عارفة وعارفة هو
+
+225
+00:21:44,402 --> 00:21:56,700
+بخير. قلنا لأ بخير لأ. بمعنى أن أسبوع أنت قد تغني
+
+226
+00:21:56,700 --> 00:22:06,580
+وما أبقى معاك. ما قد تشعلت بخير. ما قد تشعلت لأ ما
+
+227
+00:22:06,580 --> 00:22:16,880
+أبقى معاشر بخير. طبعا هو اشتغل خار إخوانه وأنا مش
+
+228
+00:22:16,880 --> 00:22:31,900
+مت بخار أنا لكن موفقش مش فرصة قوة. طبعا هو اتلقى
+
+229
+00:22:31,900 --> 00:22:39,020
+الخار وأنا مش مت البخار دلوقت
+
+230
+00:22:40,710 --> 00:22:51,750
+مش بتلعب زادت ما اللي سمّاه اللي درحت السفر اللي
+
+231
+00:22:51,750 --> 00:23:01,470
+بطلت السفر اللي هي مابتش حرارة، مابتش حرارة
+
+232
+00:23:01,470 --> 00:23:06,250
+اكترازة، بقى إن هي حرارة
+
+233
+00:23:12,240 --> 00:23:19,900
+في السفر يطلق وفي الشهرة تبقى أنا أنا. طبعا يومي في
+
+234
+00:23:19,900 --> 00:23:26,780
+حالة تخوض ويحب أن أنا أتفقد أنا أنا ويحب أن أنا
+
+235
+00:23:26,780 --> 00:23:34,320
+أتحرك من حالة ناسي أنا طبعا لكن في السفر تبقى أنا
+
+236
+00:23:34,320 --> 00:23:43,130
+احنا أنا والسفر يطلق، السفر تبقى أنا أشك عشان
+
+237
+00:23:43,130 --> 00:23:51,330
+تتابع على ملاحظات وزاد في الـ topic  الفان الحياة تمثل
+
+238
+00:23:51,330 --> 00:23:59,290
+خمسة مهام متر مرفوع تتابع على عمولة يجبّه يجبه
+
+239
+00:23:59,290 --> 00:24:02,850
+يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه
+
+240
+00:24:02,850 --> 00:24:02,970
+يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه
+
+241
+00:24:02,970 --> 00:24:02,990
+يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه
+
+242
+00:24:02,990 --> 00:24:06,990
+يجبه يجبه
+
+243
+00:24:12,460 --> 00:24:22,520
+خمسة مليمتر وآخر موزة يبقى حرارة وحركة الولايات
+
+244
+00:24:22,520 --> 00:24:33,880
+المتحدة موزة الصيف إصلاحها زيادت وبدأت باشرة
+
+245
+00:24:33,880 --> 00:24:39,240
+شرائح أكثر موزة جامعة
+
+246
+00:24:42,790 --> 00:24:51,690
+شاشة قبل أَخوها بقى فشار إن هي تشتغل بيها تابع وجود
+
+247
+00:24:51,690 --> 00:24:54,710
+وشارت
+
+248
+00:24:54,710 --> 00:25:03,430
+ومقزدشت سبع وثلاثة أما أول نهار أما إن أنا انتشت
+
+249
+00:25:03,430 --> 00:25:08,770
+بشرة من الغاز وأنا ستة وسبعة وأربعة
+
+250
+00:25:12,740 --> 00:25:21,440
+هذه الفرقة اللي معناها برهنت إيه؟ عشان بصير سنة ومئات
+
+251
+00:25:21,440 --> 00:25:28,320
+و ستة من المدرسات اللي كانوا فيها بمعنى أنه صار
+
+252
+00:25:28,320 --> 00:25:40,980
+دخول كهذا اللي هو الدخول هذا صار في حركة من العزّاج
+
+253
+00:25:41,680 --> 00:25:49,400
+أخبرني مدّيها تلقاها تجيوميها، أخبره بقى بطل
+
+254
+00:25:49,400 --> 00:25:57,420
+سرحانه ومش هالعاش ومش هالبقى بقاهاش، قام مدّيها
+
+255
+00:25:57,420 --> 00:26:06,520
+تلقاها ومش هالعاش لأنه كان بيجتمع علاشة بعلاشة كام
+
+256
+00:26:07,620 --> 00:26:15,000
+طبعا من الأعلى بيربان هي سبوع الأربعان اللي.. اللي
+
+257
+00:26:15,000 --> 00:26:19,360
+دخلت ومعها
+
+258
+00:26:19,360 --> 00:26:27,580
+لتر السبوع الأربعان الشتان ومعه سبوع الأربعان
+
+259
+00:26:27,580 --> 00:26:34,520
+الاتنين بيكسبوا مجموعة السبوع الأربعان وبيعملها
+
+260
+00:26:34,520 --> 00:26:44,290
+السبوع أكثر من بارشة بارشة طباء سجين في الأفريقية
+
+261
+00:26:44,290 --> 00:26:48,410
+مختلفة
+
+262
+00:26:48,410 --> 00:26:55,990
+عن بارشة بارشة طباء سجين في الناس في الأدوات
+
+263
+00:26:55,990 --> 00:26:57,730
+السورية
+
+264
+00:27:00,070 --> 00:27:09,310
+إن أنا متخيل أن أبقى بكتابة رزاق وإعفار الأرض أنا
+
+265
+00:27:09,310 --> 00:27:18,150
+الباسبة متخيل أن أبقى بقصة
+
+266
+00:27:18,150 --> 00:27:26,570
+بقصة اتحاد مشهورة في أكثر سنة بجانب أي إسرائيل،
+
+267
+00:27:26,570 --> 00:27:37,790
+بجانب أي إسرائيل في وصف واحد، طيب، لذا من الآن نبقى
+
+268
+00:27:37,790 --> 00:27:43,590
+نتكلم عن الـ
+
+269
+00:27:43,590 --> 00:27:47,910
+..الـ
+
+270
+00:27:47,910 --> 00:27:51,450
+factors اللي بتحكم
+
+271
+00:27:53,600 --> 00:27:59,840
+الانتقال زي اسم الـ web تفاعل الـ web تفاعل تتكلم عن
+
+272
+00:27:59,840 --> 00:28:09,280
+الـ concentration اشتغل؟ واحنا فيه بصوت استيقظ كده
+
+273
+00:28:09,280 --> 00:28:15,920
+وأصلًا بنات الـ auto shot شير؟
+
+274
+00:28:15,920 --> 00:28:22,060
+إذا هو انتقال، احنا عايزين نفتح على التكتب اللي
+
+275
+00:28:22,060 --> 00:28:23,840
+عايزين نفتح على التكتب اللي عايزين نفتح على التكتب
+
+276
+00:28:23,840 --> 00:28:25,340
+اللي عايزين نفتح على التكتب اللي عايزين نفتح على
+
+277
+00:28:25,340 --> 00:28:26,240
+التكتب اللي عايزين نفتح على التكتب اللي عايزين
+
+278
+00:28:26,240 --> 00:28:26,420
+نفتح على التكتب اللي عايزين نفتح على التكتب اللي
+
+279
+00:28:26,420 --> 00:28:26,500
+عايزين نفتح على التكتب اللي عايزين نفتح على التكتب
+
+280
+00:28:26,500 --> 00:28:27,460
+اللي عايزين نفتح على التكتب اللي عايزين نفتح على
+
+281
+00:28:27,460 --> 00:28:32,920
+التكتب اللي
+
+282
+00:28:32,920 --> 00:28:36,940
+عايزين نفتح على التكتب اللي عايزين نفتح على التكتب
+
+283
+00:28:36,940 --> 00:28:43,840
+اللي عايزين نفتح على التككانت بقى سرقة الانتخاب..
+
+284
+00:28:43,840 --> 00:28:51,500
+أنا ببقى يشتغلها.. وسرقة الشهر انتخاب شهر.. شهر
+
+285
+00:28:51,500 --> 00:29:03,400
+عامة.. وقولت أنا.. أنا كويس عامة.. كويس
+
+286
+00:29:03,400 --> 00:29:13,080
+شخصية عامة في وقت ما.. آراؤه مفتوحش ليك أنا..
+
+287
+00:29:13,080 --> 00:29:21,680
+أنا بأنَ الكلام أنا بشحن بصيغة تبع الألوان اللي
+
+288
+00:29:21,680 --> 00:29:31,440
+هيعرفها بشكل مش عارِفاني تمام أترشحها آراؤها فرحًا
+
+289
+00:29:31,440 --> 00:29:40,260
+أنا أحب أ.. أنا أقولها أو بنتخل أزرق من فيلم صغير
+
+290
+00:29:40,260 --> 00:29:47,800
+اللي اتقرر بناؤه ومشاهده زي اللي مشتت في شارع في..
+
+291
+00:29:47,800 --> 00:29:54,520
+في مدّة.. في مدّتان مش كده مشتت في شارع وأشفت
+
+292
+00:29:54,520 --> 00:30:01,000
+التفرّغ الواقعي ولا ما أشرفش أنا بس ما أشرفش أنا أنا
+
+293
+00:30:01,000 --> 00:30:08,680
+بنتقلها تقوّس حياتي أنا بدأت فيها عزيزي ما
+
+294
+00:30:08,680 --> 00:30:15,560
+تشوفوها حسيبها لما أنت حاجة لما أنت حاجة لما أنت
+
+295
+00:30:15,560 --> 00:30:19,420
+حاجة لما أنت حاجة لما أنت حاجة لما أنت حاجة لما
+
+296
+00:30:19,420 --> 00:30:23,500
+لما أنت حاجة لما
+
+297
+00:30:23,500 --> 00:30:26,180
+أنت حاجة لما أنت حاجة لما أنت حاجة لما أنت حاجة
+
+298
+00:30:26,180 --> 00:30:29,850
+أنت حاجة لما أنت حاجة لما إنجاز هذا كان من
+
+299
+00:30:29,850 --> 00:30:37,250
+المفاوض تبع الجاز هذا الكبير قوة الجسم في الحركة
+
+300
+00:30:37,250 --> 00:30:47,970
+فالمزجين كان أسرع في الحركة برش الحرارة تبعي
+
+301
+00:30:47,970 --> 00:30:57,290
+تبقت لي الجو إذا كنت في حرارة عالية تقعد سريعة و
+
+302
+00:30:57,290 --> 00:31:06,230
+أوضاع تقاليد إقالي باليبافة
+
+303
+00:31:06,230 --> 00:31:15,570
+إلى الـ..
+
+304
+00:31:15,570 --> 00:31:19,270
+تمام، هممم، نسيت ما كنت أقوله
+
+305
+00:31:28,130 --> 00:31:35,490
+بعد الوحوش على السنة البرتقالية كيف شدت سنة
+
+306
+00:31:35,490 --> 00:31:46,810
+برتقالية؟ و..ومقررات التنام مربوطة على الفلوس
+
+307
+00:31:46,810 --> 00:31:51,350
+أسميك؟
+
+308
+00:31:51,350 --> 00:31:57,770
+أنا يا عزيزي ممكن تفكر شغل، أصبحت روحك كافية وما
+
+309
+00:31:57,770 --> 00:32:08,590
+زالت يهيئ الوقت لأن السرابيليكي تبع الجاز بتساعد
+
+310
+00:32:08,590 --> 00:32:13,430
+على الانتشار لأن
+
+311
+00:32:13,430 --> 00:32:23,070
+الجاز الشرعي ممكن يبتقل بسرعة الديش مش مانسيك طبعا
+
+312
+00:32:23,070 --> 00:32:25,790
+السرابيليكي روح بالجاز
+
+313
+00:32:35,060 --> 00:32:41,620
+السنة القادمة كانت أكثر من مقاومات.. السنة
+
+314
+00:32:41,620 --> 00:32:46,620
+القادمة كانت مقاومات
+
+315
+00:32:46,620 --> 00:32:50,060
+..السنة
+
+316
+00:32:50,060 --> 00:32:53,460
+القادمة كانت أكثر من مقاومات.. السنة القادمة كانت
+
+317
+00:32:53,460 --> 00:32:57,000
+أكثر من مقاومات.. السنة القادمة كانت أكثر من
+
+318
+00:32:57,000 --> 00:32:57,820
+مقاومات.. السنة القادمة كانت أكثر من مقاومات..
+
+319
+00:32:57,820 --> 00:32:59,860
+السنة القادمة كانت أكثر من مقاومات.. السنة
+
+320
+00:32:59,860 --> 00:33:00,900
+القادمة كانت أكثر من مقاومات.. السنة القادمة كانت
+
+321
+00:33:00,900 --> 00:33:01,220
+مقاومات.. السنة القادمة كانت أكثر من مقاومات..
+
+322
+00:33:01,220 --> 00:33:02,640
+السنة القادمة كانت أكثر من مقاومات.. السنة
+
+323
+00:33:02,640 --> 00:33:09,740
+القادمة كانت أكثر فيلم عزيزي مهارة الدنيا جميعًا إذا
+
+324
+00:33:09,740 --> 00:33:18,760
+المشير يبدل حرارة عزيزي إذا الإنسان بلدها قد أتى
+
+325
+00:33:18,760 --> 00:33:25,860
+فيه جفافة شمسانة أفراد
+
+326
+00:33:25,860 --> 00:33:28,900
+فرشد يبقوا حقهم يوصلوا
+
+327
+00:33:34,070 --> 00:33:44,590
+وهي بمقرشة مفروض إن هي أش من وراها أو أو أو أو أو أو
+
+328
+00:33:44,590 --> 00:33:46,570
+أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو
+
+329
+00:33:46,570 --> 00:33:47,770
+أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو
+
+330
+00:33:47,770 --> 00:33:48,190
+أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو أو
+
+331
+00:33:48,190 --> 00:33:51,670
+أو أو أو أو أو أو أو أو
+
+332
+00:33:51,670 --> 00:33:55,630
+أو
+
+333
+00:33:55,630 --> 00:34:01,170
+أو
+
+334
+00:34:07,170 --> 00:34:11,210
+بقى بقى الـ «شياطين» بقى عشان أفهمها
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/p46B6aAhKc4_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/p46B6aAhKc4_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..3c8ddb3b9578f68743286b127ba29659d46af980
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/p46B6aAhKc4_postprocess.srt
@@ -0,0 +1,1336 @@
+1
+00:00:05,680 --> 00:00:08,840
+الموضوع الأن .. الموضوع الجديد اللي هو physical
+
+2
+00:00:08,840 --> 00:00:18,480
+principles of gas exchange ال .. ال .. ال gas
+
+3
+00:00:18,480 --> 00:00:26,740
+diffusionهذا اللي بيصير يعني لما الأختي في آخر ال
+
+4
+00:00:26,740 --> 00:00:32,320
+.. ال .. الغرفة هناك مثلا تفتح اجزازة ريحة مافيش
+
+5
+00:00:32,320 --> 00:00:39,320
+حاجة هناك اه احنا .. احنا هانشمها ليه شام منها؟
+
+6
+00:00:39,320 --> 00:00:48,160
+ليش انت شارت؟ عشان الريحة؟ بدي واحدة تقولي كلام
+
+7
+00:00:48,160 --> 00:00:54,020
+علمي في الموضوع هذاانتشرت من مكان إلى مكان عشان هي
+
+8
+00:00:54,020 --> 00:01:00,180
+في ذاك المكان concentrated وفي هذا المكان diluted
+
+9
+00:01:00,180 --> 00:01:04,400
+فصار عندى انا forces of diffusion مش كده فانتقلت
+
+10
+00:01:04,400 --> 00:01:07,740
+من هذه المنطقة لهذه المنطقة عشان تعمل equilibrium
+
+11
+00:01:07,740 --> 00:01:14,880
+مش هيك؟ مظبوط؟ طبعا ايش اللي بيخلي الالذرات تبعت
+
+12
+00:01:14,880 --> 00:01:19,680
+الرائحة اللي اتكلمنا عنها هرمى شوية انها تنتقل by
+
+13
+00:01:19,680 --> 00:01:23,340
+diffusion عن كولنا ال kinetic motion of the ايه؟
+
+14
+00:01:23,340 --> 00:01:27,160
+of the molecules فى عندنا ايه؟ ال ions هالي اليها
+
+15
+00:01:27,160 --> 00:01:31,620
+kinetic motion تتحرك في كل اتجاه بحيث تعمل ايه؟
+
+16
+00:01:31,620 --> 00:01:39,680
+تتوزع في كل مكان بالتساوي اذا عملية انتقال الغازات
+
+17
+00:01:40,070 --> 00:01:44,370
+أيضًا ينطبق عليها نفس ال factors ال principles
+
+18
+00:01:44,370 --> 00:01:49,610
+اللي يحصل في انتقال باقي المواد إن كانت على الشكل
+
+19
+00:01:49,610 --> 00:01:54,110
+السائل أو على غير السائل إذا عندنا electrochemical
+
+20
+00:01:54,110 --> 00:01:58,970
+gradients بتأدي إلى إيه؟ انتقال القوانين الطبيعية
+
+21
+00:01:58,970 --> 00:02:03,370
+هدف الانتقال هنا بالفعل عندنا chemical gradients
+
+22
+00:02:03,370 --> 00:02:07,270
+physical gradients بتأدي إلى إيه؟ إلى انتقال
+
+23
+00:02:07,270 --> 00:02:10,130
+الغزالفي الـ GALIC لما يكون فيه عنده غاز في منطقة
+
+24
+00:02:10,130 --> 00:02:15,290
+مركز اكتر منه في منطقة اخرى الغاز في المنطقة
+
+25
+00:02:15,290 --> 00:02:19,150
+القليل يتحرك في اتجاه الـ kinetic motion في اتجاه
+
+26
+00:02:19,150 --> 00:02:21,990
+المنطقة الكثيرة و اللي في المنطقة الكثيرة يتحرك في
+
+27
+00:02:21,990 --> 00:02:27,430
+اتجاه المنطقة القليلة لكن محصلة نهائية ان ال net
+
+28
+00:02:27,430 --> 00:02:32,650
+diffusion بيكون في اتجاه من الأعلى الى الاوطة لما
+
+29
+00:02:32,650 --> 00:02:35,250
+نقول من اعلى الاوطة لا يعني ان ولا اشي من الجهة
+
+30
+00:02:35,250 --> 00:02:39,000
+التانية راحت على الجهة التانيةلكن في الآخر صار
+
+31
+00:02:39,000 --> 00:02:42,400
+equilibrium بس معدل ال diffusion المختلفة ده في كل
+
+32
+00:02:42,400 --> 00:02:46,500
+اتجاهات انه عندي ال concentration كان له factor
+
+33
+00:02:46,500 --> 00:02:50,040
+كتير في انه يحدد ال net diffusion يصير من وين من
+
+34
+00:02:50,040 --> 00:02:52,540
+المنطقة الأعلى ال concentration الى المنطقة الأقل
+
+35
+00:02:52,540 --> 00:02:58,380
+ال concentration okay اذا
+
+36
+00:02:58,380 --> 00:03:03,280
+net diffusion افهمناها اذا عندي لما اتكلم هذا
+
+37
+00:03:03,280 --> 00:03:07,650
+النموذج المثل هذا عندي هال concentration أعلىو هن
+
+38
+00:03:07,650 --> 00:03:11,610
+ال concentration أقل في عندي حركة من المنطقة ال
+
+39
+00:03:11,610 --> 00:03:16,150
+molecules اللي هان تتحرك في اتجاه اللي ايه الجهة
+
+40
+00:03:16,150 --> 00:03:18,890
+ال concentrated لكن كمية أكبر من الجهة ال
+
+41
+00:03:18,890 --> 00:03:21,290
+concentrated بتتحرك في الجهة التانية فهذا بيقدي ال
+
+42
+00:03:21,290 --> 00:03:23,570
+equilibrium و ال need of fusion بيكون في اتجاه
+
+43
+00:03:23,570 --> 00:03:32,650
+اللي هو من الأعلى إلى ال .. اذا عندي ها
+
+44
+00:03:37,920 --> 00:03:43,820
+الغازات لا تتوقف عن الحركة وبتميل إلى التعادل في
+
+45
+00:03:43,820 --> 00:03:48,740
+ال concentration الان لما اكون عندى .. انا mixture
+
+46
+00:03:48,740 --> 00:03:53,080
+of gases عاملين
+
+47
+00:03:53,080 --> 00:03:58,660
+في مكان ما ضغط معين تمام ال pressure اللي عاملين
+
+48
+00:03:58,660 --> 00:04:06,290
+هو ال gasesكل نوع من الجاز يمتلك مشارك في البراشر
+
+49
+00:04:06,290 --> 00:04:11,610
+بما يتناسب مع كونسنتريشن بما يتناسب مع كونسنتريشن
+
+50
+00:04:11,610 --> 00:04:12,050
+بما يتناسب مع كونسنتريشن بما يتناسب مع كونسنتريشن
+
+51
+00:04:12,050 --> 00:04:13,670
+بما يتناسب مع كونسنتريشن بما يتناسب مع كونسنتريشن
+
+52
+00:04:13,670 --> 00:04:14,370
+بما يتناسب مع كونسنتريشن بما يتناسب مع كونسنتريشن
+
+53
+00:04:14,370 --> 00:04:17,830
+بما يتناسب مع كونسنتريشن بما يتناسب مع كونسنتريشن
+
+54
+00:04:17,830 --> 00:04:22,830
+بما يتناسب مع كونسنتريشن بما يتناسب مع كونسنتريشن
+
+55
+00:04:22,830 --> 00:04:28,050
+بما
+
+56
+00:04:28,050 --> 00:04:35,000
+يتناسب مع كونسالمكونات تبع هذا الغاز يساوي المجموع
+
+57
+00:04:35,000 --> 00:04:41,780
+الكلي للبراشر لكن كل واحد له جزئية تتناسب مع مين؟
+
+58
+00:04:41,780 --> 00:04:46,840
+مع ال concentration تبعه حلو؟ اذا اندي انا القانون
+
+59
+00:04:46,840 --> 00:04:52,200
+هنا بقول البراشر is directly proportional to the
+
+60
+00:04:52,200 --> 00:04:55,140
+concentration of the gas molecules ال gas
+
+61
+00:04:55,140 --> 00:05:00,490
+molecules في هال mixture هذا تبعنوع معين جداش ال
+
+62
+00:05:00,490 --> 00:05:04,910
+brochure تبعهم يزقو متناسب معاه بمعنى اخر احنا
+
+63
+00:05:04,910 --> 00:05:11,250
+الهواء الجوي مثلا الهواء الجوي عامل ضغط على مستوى
+
+64
+00:05:11,250 --> 00:05:16,510
+أرضها ضغط يساوي جداش واحدات مصفير مش كده اللي
+
+65
+00:05:16,510 --> 00:05:20,550
+يساوي جداش بالمليمتر من الكورية سبعمائة وستين حلو
+
+66
+00:05:20,550 --> 00:05:24,590
+لكن الهواء هذا اللي احنا حوالنا هذا تمانين في
+
+67
+00:05:24,590 --> 00:05:30,050
+المية منه او تسعة وسبعين في المية منه نيترجنو 21%
+
+68
+00:05:30,050 --> 00:05:34,950
+منه Oxygen و نسب جليلة كاربون ديوكسايد و بخار ماء
+
+69
+00:05:34,950 --> 00:05:39,130
+و كده طبعا اذا لو طلعنا هلاجي ال nitrogen تقريبا
+
+70
+00:05:39,130 --> 00:05:43,130
+بيشكل 600 ميلي متر ميركوري باشر باشر خاص بال
+
+71
+00:05:43,130 --> 00:05:54,630
+nitrogen طبعا و ال oxygen هيشكل 160 ميلي
+
+72
+00:05:54,630 --> 00:06:01,050
+متر ميركوريإذا 160 و 600 و 760 يمثلوا الضغط الكلي
+
+73
+00:06:01,050 --> 00:06:05,890
+لو أحنا جيبنا غاز ثالث حشرناه بينهم هيشارك في ال
+
+74
+00:06:05,890 --> 00:06:11,630
+760 هيصير النصيب لكل واحد من هدول مختلف، تمام؟
+
+75
+00:06:11,630 --> 00:06:15,750
+يعني إجينا من منطقة فيها بخار ماء عالي بدل ما هو
+
+76
+00:06:15,750 --> 00:06:17,150
+كان نسمة غير مذكورة
+
+77
+00:06:19,600 --> 00:06:25,380
+بنخسم البخار الماء من الضغط الكلي والباقي نوزعه
+
+78
+00:06:25,380 --> 00:06:29,040
+على الأكسجين والنيتروجين أو بمعنى أخر كل واحد من
+
+79
+00:06:29,040 --> 00:06:33,890
+هدول نسي بتجديش و ندينه نصيبهتمام؟ لو في منطقة في
+
+80
+00:06:33,890 --> 00:06:37,990
+carbon dioxide أعلى لأ صار يشارك صار له مشاركة
+
+81
+00:06:37,990 --> 00:06:44,010
+ايه؟ بمعنى انه انا في هواء الشهيد تقريبا مافيش
+
+82
+00:06:44,010 --> 00:06:47,310
+carbon dioxide لكن هو طالع صار carbon dioxide
+
+83
+00:06:47,310 --> 00:06:53,670
+محترم فيه كتير فصار له بسبب ايه؟ معتبرة البخار
+
+84
+00:06:53,670 --> 00:06:59,430
+الميه و في النفس اللي داخل كذلك لا يعتبر مش مستاهل
+
+85
+00:06:59,430 --> 00:07:07,160
+لكن هو طالعأه؟ صارله إيه؟صار له اعتبار لكن انا
+
+86
+00:07:07,160 --> 00:07:10,760
+شاهد ناس معترضة على الكلام هذا لأنه قالت يا دكتور
+
+87
+00:07:10,760 --> 00:07:13,620
+انت قلتلنا و الهواء اللي داخل صحيح ناشف هو مالهوش
+
+88
+00:07:13,620 --> 00:07:17,760
+اعتبار لكن لما دخل ال air passages قلنا بيصير
+
+89
+00:07:17,760 --> 00:07:22,380
+humidification تمام؟ اه يعني اذا هو جاب الميصر لل
+
+90
+00:07:22,380 --> 00:07:26,120
+alveolar high بيكون البخار و الميه عالي فيه و صار
+
+91
+00:07:26,120 --> 00:07:31,160
+له اعتبار بمعنى اخر هنتكلم عن موضوع اسمه ان ال
+
+92
+00:07:31,160 --> 00:07:35,630
+alveolar airفيه في داخله اختلافات عن الـ
+
+93
+00:07:35,630 --> 00:07:41,410
+atmospheric air أجل ما فيها أن بخار الميه زاد بخار
+
+94
+00:07:41,410 --> 00:07:46,550
+الميه أخد جزء من ال .. من ال pressure pressure صار
+
+95
+00:07:46,550 --> 00:07:51,230
+له نصيب، إذا ال pressure pressure في الهواء مختلف
+
+96
+00:07:51,230 --> 00:07:55,720
+عن ال pressure pressure لنفس ال .. ال .. ال ..ال
+
+97
+00:07:55,720 --> 00:07:59,880
+.. الغاز لكن دا ال alveoli ليش؟ لإن هو دا كل في
+
+98
+00:07:59,880 --> 00:08:03,780
+واحد حشر نفسه جال قدوني معاكو هو اللي ايه؟ اللي هو
+
+99
+00:08:03,780 --> 00:08:07,380
+ال carbon ده يكسر واضح؟ واحد أسف إذا نتكلم الأن
+
+100
+00:08:07,380 --> 00:08:12,480
+احنا عن هذا الموضوع بنرمز للبرشة pressure of gases
+
+101
+00:08:12,480 --> 00:08:19,620
+احنا بال P الكبيرة هذه و بعدين جنبها رمز ال إيه؟
+
+102
+00:08:19,620 --> 00:08:25,930
+رمز الغاز تمام؟فهذا برشر برشر برشر اكسجين carbon
+
+103
+00:08:25,930 --> 00:08:31,710
+dioxide برشر برشر نيتوجين برشر برشر water فيبر جاز
+
+104
+00:08:31,710 --> 00:08:38,390
+برشر برشر helium وكذا طيب
+
+105
+00:08:38,390 --> 00:08:47,630
+okay الهواء سهل جيبنا سيرته وانتهينا
+
+106
+00:08:47,630 --> 00:08:51,670
+الان بنتكلم عن موضوع تاني انت دكتور الغازات هذه
+
+107
+00:08:51,670 --> 00:08:57,850
+اللي بتكلمنا عنهامتما اتخطط ال alveoli اتحولت لها
+
+108
+00:08:57,850 --> 00:09:04,510
+liquid medium fluid اذا الغازات داخلة في fluids طب
+
+109
+00:09:04,510 --> 00:09:11,010
+هل ينطبق قوانين الغازات في الغازات ازاي قوانين
+
+110
+00:09:11,010 --> 00:09:17,070
+الغازات تتحرك في fluids تمام اذا هذه لها قواعد
+
+111
+00:09:17,070 --> 00:09:23,170
+جديدة حقيقة معظم هي نفس الشيء القاعدة هي هي تتحرك
+
+112
+00:09:23,170 --> 00:09:27,450
+من الال .. ال .. ال concentration الأعلى إلى ال
+
+113
+00:09:27,450 --> 00:09:34,950
+concentration الأقل مظبوط بس و قولنا .. و قولنا
+
+114
+00:09:34,950 --> 00:09:39,310
+انه كل partial pressure من شوية صغيرة اتكلمنا ال
+
+115
+00:09:39,310 --> 00:09:43,810
+partial pressure تبع غاز معين حسب التركيز تبعه
+
+116
+00:09:43,810 --> 00:09:47,230
+وجسمها مباشرة تمام فال partial pressure تبعها
+
+117
+00:09:47,230 --> 00:09:52,070
+هتغير و في مواد تانية أبدا الميه بتطردهاrebellion
+
+118
+00:09:52,070 --> 00:09:56,630
+تبعدها عنها فدائما free تتحرك بسرعة أكتر تتتشر في
+
+119
+00:09:56,630 --> 00:10:02,970
+كل مكان فممكن من هذه الأشياء اللي هي ماني أفضل
+
+120
+00:10:02,970 --> 00:10:16,410
+تبني أقل تبني بسرعة أكتر تبني ببشر أكتر تتحركي
+
+121
+00:10:16,410 --> 00:10:21,150
+ببشر مادش أتحركي تبني ببشر
+
+122
+00:10:24,260 --> 00:10:30,660
+لأن كان في شهر بكره في حركة الوحوز و ال
+
+123
+00:10:30,660 --> 00:10:37,000
+concentration مرتبطة في بقى بس أنا إذا أبعدت
+
+124
+00:10:37,000 --> 00:10:48,640
+بمسحها بخلّق وحوزها بتخرج و تهيأل و أهرب و أحضر و
+
+125
+00:10:48,640 --> 00:10:58,320
+أمسكفهو ماشي تأثير اشميه في الاشي في ال .. في ال
+
+126
+00:10:58,320 --> 00:11:08,760
+.. في البشر طبعا فجأتني ازمال ان عارف دي نفسي يكون
+
+127
+00:11:08,760 --> 00:11:17,960
+عشان يتفجر عن البشر البشر تبع البيت وعناه اللي
+
+128
+00:11:17,960 --> 00:11:19,740
+علاقة بخصة
+
+129
+00:11:25,120 --> 00:11:32,480
+السنة الأولى تانية بقوة عشان تانية كانت مزايا 13
+
+130
+00:11:32,480 --> 00:11:45,200
+أكتر ان نقل 16 سنة تاسعة أكتر ان نقل 16 سنة تاسعة
+
+131
+00:11:45,200 --> 00:11:49,700
+أكتر ان نقل 16 ثانية
+
+132
+00:11:54,940 --> 00:11:59,480
+نعيش بحب و .. و .. و .. و .. و .. و .. و .. و .. و
+
+133
+00:11:59,480 --> 00:11:59,560
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+134
+00:11:59,560 --> 00:11:59,940
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+135
+00:11:59,940 --> 00:12:00,880
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+136
+00:12:00,880 --> 00:12:02,280
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+137
+00:12:02,280 --> 00:12:03,340
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+138
+00:12:03,340 --> 00:12:03,680
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+139
+00:12:03,680 --> 00:12:04,440
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+140
+00:12:04,440 --> 00:12:05,580
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+141
+00:12:05,580 --> 00:12:11,400
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+142
+00:12:11,400 --> 00:12:22,460
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+143
+00:12:24,950 --> 00:12:33,970
+بس اه لأ ان انتوا شايفوا اسئلة ال presentation of
+
+144
+00:12:33,970 --> 00:12:43,750
+what the subject has على سنوات متشابهات بناس طبعا
+
+145
+00:12:43,750 --> 00:12:52,970
+جزايا هذي مش عادة وزيادة بالظبط لكن هي تقصر على
+
+146
+00:12:59,180 --> 00:13:20,180
+طبعاً بشوف حاجة زي دي يا راجل اشوف
+
+147
+00:13:20,180 --> 00:13:21,780
+ان انا عايز اشوف
+
+148
+00:13:33,460 --> 00:13:46,920
+الشيء الوحيد اللي أحبه
+
+149
+00:13:46,920 --> 00:13:55,140
+هو الوحيد اللي أحبه هو الوحيد اللي أحبه
+
+150
+00:13:59,020 --> 00:14:15,600
+او سجن اهو بيرت إيه تلاتي فور؟ بيرت إيه تلاتي فور؟
+
+151
+00:14:15,600 --> 00:14:23,180
+يا عزيزي أفادوا من بيرتسان قبل بيرتسان واحد أفادوا
+
+152
+00:14:23,180 --> 00:14:27,680
+من بيرتسان اصلا بعد وفشان
+
+153
+00:14:32,250 --> 00:14:39,410
+.57 لو جسمناها على 24 أكتر من عشرين مرة مش كده لو
+
+154
+00:14:39,410 --> 00:14:44,110
+جسمناها على ال point point oh two four هذه بالاربع
+
+155
+00:14:44,110 --> 00:14:48,450
+عشرين من الف وهذه السبعة وخمسين من مية تمام لو
+
+156
+00:14:48,450 --> 00:14:53,150
+جسمناها بعض أكتر من عشرين تقريبا عشرين مرة تقريبا
+
+157
+00:14:53,150 --> 00:14:58,590
+عشرين مرة أكتر من عشرين مرة لو الخمسين عشرين عشرين
+
+158
+00:14:59,000 --> 00:15:02,480
+فهنا اقل شوية و هنا اكتر شوية اكتر من عشرين مرة
+
+159
+00:15:02,480 --> 00:15:06,120
+اللي هو الفرق في ال ايه في ال solubility
+
+160
+00:15:06,120 --> 00:15:12,600
+coefficient بمعنى اخر انا عشان اوصل لنفس تركيز نفس
+
+161
+00:15:12,600 --> 00:15:17,020
+ال partial pressure تبع الاكسجيل بدي احط عشرين ضعف
+
+162
+00:15:17,020 --> 00:15:21,680
+carbon dioxide تمام؟ بدي احط عشرين ضعف carbon
+
+163
+00:15:21,680 --> 00:15:25,360
+dioxide يعني عندي carbon dioxide كمية كبيرة لكن
+
+164
+00:15:25,360 --> 00:15:30,280
+partial pressure تبعها ايش؟ قليلفي حين أنه انا
+
+165
+00:15:30,280 --> 00:15:33,180
+عندى كمية اقل كتير من الاكسجين لإن ال partial
+
+166
+00:15:33,180 --> 00:15:36,900
+pressures لبعها عالى partial pressures اذا الفرق
+
+167
+00:15:36,900 --> 00:15:40,000
+بين ال partial pressures هو اللى بيحصل دين ايه ال
+
+168
+00:15:40,000 --> 00:15:47,280
+net diffusion مش ال ال concentration لحاله okay
+
+169
+00:15:47,280 --> 00:15:50,240
+اذا من ناحية الغازية إلى ناحية ال
+
+170
+00:15:56,250 --> 00:16:02,630
+وبعد كده في أفراديها لأن بحب بحب بيبقى بيبقى بيبقى
+
+171
+00:16:02,630 --> 00:16:04,950
+بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى
+
+172
+00:16:04,950 --> 00:16:08,930
+بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى
+
+173
+00:16:08,930 --> 00:16:10,290
+بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى
+
+174
+00:16:10,290 --> 00:16:12,550
+بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى بيبقى
+
+175
+00:16:12,550 --> 00:16:20,790
+بيبقى بيبقى بيبقى بيبقى
+
+176
+00:16:20,790 --> 00:16:24,010
+بيبقى
+
+177
+00:16:24,010 --> 00:16:25,150
+بيبق
+
+178
+00:16:34,380 --> 00:16:42,280
+براسوال براسوال احنا كنا وقعنا براسوال فب .. فبسيط
+
+179
+00:16:42,280 --> 00:16:47,820
+بسيط انا انا انا انا انا انا انا انا انا انا انا
+
+180
+00:16:47,820 --> 00:16:47,960
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+181
+00:16:47,960 --> 00:16:48,920
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+182
+00:16:48,920 --> 00:16:49,120
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+183
+00:16:49,120 --> 00:16:49,580
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+184
+00:16:49,580 --> 00:16:51,240
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+185
+00:16:51,240 --> 00:16:51,260
+انا انا انا انا انا انا انا انا انا انا انا انا
+
+186
+00:16:51,260 --> 00:16:56,100
+انا انا انا انا انا انا انا انا انا انا
+
+187
+00:16:56,100 --> 00:16:56,820
+انا
+
+188
+00:17:08,410 --> 00:17:16,630
+والخاصة هي ان دي انا اتبع ال Oxygen في الداخل
+
+189
+00:17:16,630 --> 00:17:24,250
+وخاصة بس اللي فيه مصدق فهو اللي هبقى في اقصى
+
+190
+00:17:24,250 --> 00:17:32,990
+الشياطين اللي بيسيطر في اقصى اللي هبقى ايه بقال ان
+
+191
+00:17:32,990 --> 00:17:53,470
+بيبقى في البقشر بقشر بقشر بقشر بقشر
+
+192
+00:17:53,470 --> 00:17:58,590
+بقشر
+
+193
+00:18:13,090 --> 00:18:23,150
+عشان اشفاش بقى عشان هاي بيبان هذا برهوب
+
+194
+00:18:23,150 --> 00:18:33,430
+يعني شوية هاي بيبان عشان تتكلم في معاشر و تتكلم
+
+195
+00:18:33,430 --> 00:18:46,470
+كده هاي بيبان ياخد فاسطيف و يدرسسيقول هذا زي ما
+
+196
+00:18:46,470 --> 00:18:55,870
+اسمه الرازمه أتعرف زاد فى الرازمه ياخد منه شبه هو
+
+197
+00:18:55,870 --> 00:19:03,470
+اللي بزاد فى الرازمه ببرعاة فى الرازمه وشتغل حتة
+
+198
+00:19:03,470 --> 00:19:12,690
+الدنيا طبعا زده شده شتاه بتواصل اللي ب ..وهز
+
+199
+00:19:12,690 --> 00:19:22,690
+اشتغلت سوريستات طبعا وغالبا وغالبا ومش سيحظى
+
+200
+00:19:22,690 --> 00:19:27,170
+وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا
+
+201
+00:19:27,170 --> 00:19:30,150
+وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا
+
+202
+00:19:30,150 --> 00:19:32,310
+وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا
+
+203
+00:19:32,310 --> 00:19:32,810
+وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا
+
+204
+00:19:32,810 --> 00:19:32,850
+وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا وغالبا
+
+205
+00:19:32,850 --> 00:19:39,090
+وغالبا وغالبا وغال
+
+206
+00:19:40,520 --> 00:19:48,540
+خابط مثل أزهر ومكسح من النار بياخد خابط مثل أزهر
+
+207
+00:19:48,540 --> 00:19:49,480
+ومكسح من النار بياخد خابط مثل أزهر ومكسح من النار
+
+208
+00:19:49,480 --> 00:19:50,640
+بياخد خابط مثل أزهر ومكسح من النار بياخد خابط مثل
+
+209
+00:19:50,640 --> 00:19:51,760
+أزهر ومكسح من النار بياخد خابط مثل أزهر ومكسح من
+
+210
+00:19:51,760 --> 00:19:51,860
+النار بياخد خابط مثل أزهر ومكسح من النار بياخد
+
+211
+00:19:51,860 --> 00:19:54,680
+ومكسح من النار بياخد خابط مثل أزهر ومكسح من النار
+
+212
+00:19:54,680 --> 00:20:04,980
+بياخد خابط
+
+213
+00:20:04,980 --> 00:20:05,340
+مث
+
+214
+00:20:13,130 --> 00:20:21,250
+داخل عندي سرعة نفسي مش فارقة بتوزيع طباعتنا اللي
+
+215
+00:20:21,250 --> 00:20:29,650
+عليها بسبب درجة الحرارة طبعا
+
+216
+00:20:29,650 --> 00:20:38,150
+كل الحرارة علاقتكوا وكذلك الوثم علاقتكوا وخركة
+
+217
+00:20:38,150 --> 00:20:39,570
+الله ذاتك
+
+218
+00:20:41,910 --> 00:20:52,170
+خزانة كل سنة بتفوزني أسرع زي هالسنة
+
+219
+00:20:52,170 --> 00:21:00,530
+اللي زي هالأولى عشان تتبقى منها عزيز و يفرق من
+
+220
+00:21:00,530 --> 00:21:09,030
+أوليها الناس كبارات
+
+221
+00:21:09,030 --> 00:21:10,450
+كبارات
+
+222
+00:21:13,890 --> 00:21:26,370
+تبحو هذا ما اعتمد على الحلالة، فمان؟ بس أنا و ساعة
+
+223
+00:21:26,370 --> 00:21:34,470
+في الموحلة فانا و ساعة اللي عارفة راحت معانا أوعى
+
+224
+00:21:34,470 --> 00:21:39,430
+بس أنا شارت و شارت اللي عارفة و عارفة هو
+
+225
+00:21:44,402 --> 00:21:56,700
+بخير. قلنا لأ بخير لأ. بمعنى أني أسبوع أنت قد تغني
+
+226
+00:21:56,700 --> 00:22:06,580
+وما أبقى معاك. ما قد تشعلت بخير. ما قد تشعلت لأ ما
+
+227
+00:22:06,580 --> 00:22:16,880
+أبقى معاشر بخير.طبعا هو اشتغل خار اخوانه وانا مش
+
+228
+00:22:16,880 --> 00:22:31,900
+مت بخار انا لكن موفقش مش فرزقه قوة طبعا هو اتلقى
+
+229
+00:22:31,900 --> 00:22:39,020
+الخار وانا مش مت البخار دلات
+
+230
+00:22:40,710 --> 00:22:51,750
+مش بتلعب زادت ما اللي سمّاه اللي درحت السفر اللي
+
+231
+00:22:51,750 --> 00:23:01,470
+بطلت السفر اللي هى مابتش حرارة، مابتش حرارة
+
+232
+00:23:01,470 --> 00:23:06,250
+اكترازة، بقى انها حرارة
+
+233
+00:23:12,240 --> 00:23:19,900
+في السفر يطلق وفي الشهرة تبقى انا انا طبعا يومي في
+
+234
+00:23:19,900 --> 00:23:26,780
+حالة تخوض ويحب ان انا اتفقد انا انا ويحب ان انا
+
+235
+00:23:26,780 --> 00:23:34,320
+اتحيي من حالة ناسي انا طبعا لكن في السفر تبقى انا
+
+236
+00:23:34,320 --> 00:23:43,130
+احنا انا و السفر يطلق السفر تبقى انا اشكالعشان
+
+237
+00:23:43,130 --> 00:23:51,330
+تتابع على ملاحظ وزاد في ال topic الفان الحياة تمثل
+
+238
+00:23:51,330 --> 00:23:59,290
+خمسة مهام متر مرفوع تتابع على عمولة يجبّه يجبه
+
+239
+00:23:59,290 --> 00:24:02,850
+يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه
+
+240
+00:24:02,850 --> 00:24:02,970
+يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه
+
+241
+00:24:02,970 --> 00:24:02,990
+يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه يجبه
+
+242
+00:24:02,990 --> 00:24:06,990
+يجبه يجبه
+
+243
+00:24:12,460 --> 00:24:22,520
+خمسة مليمتر واخر موزة يبقى حرارة وحركة الولايات
+
+244
+00:24:22,520 --> 00:24:33,880
+المتحدة موزة الصيف اصلاحها زيادت وبدأت باشرة
+
+245
+00:24:33,880 --> 00:24:39,240
+شرائز اكتر موزة جامعة
+
+246
+00:24:42,790 --> 00:24:51,690
+ساشة قبل اخوها بقى فشارة انها تشت بيها تابع وجود
+
+247
+00:24:51,690 --> 00:24:54,710
+وشارت
+
+248
+00:24:54,710 --> 00:25:03,430
+ومقزدشت سبع و تلتة اما اول نهار اما ان انا انتشت
+
+249
+00:25:03,430 --> 00:25:08,770
+بشرة من الغاز وانا ستة و سبع اربعة
+
+250
+00:25:12,740 --> 00:25:21,440
+هذه الفرقة اللي معنى برهن إيه عشان بصير سنة ومئات
+
+251
+00:25:21,440 --> 00:25:28,320
+وستة من المدرسات اللي كانوا فيها بمعنى أنه صار
+
+252
+00:25:28,320 --> 00:25:40,980
+تدخل كهذا اللي هو الدخول هذا صار في حركة من العزاج
+
+253
+00:25:41,680 --> 00:25:49,400
+أخبرني مدّيها تلقاها تجيوميها اتخبره بقى بطل
+
+254
+00:25:49,400 --> 00:25:57,420
+سرحانه ومش هالعاش ومش هالبقى بقاهاش قام مدّيها
+
+255
+00:25:57,420 --> 00:26:06,520
+تلقاها ومش هالعاش لأنه كان بيجتمع علاشة بعلاشة كام
+
+256
+00:26:07,620 --> 00:26:15,000
+طبعا مالأعلى بيربان هي سبوع الاربعان اللي .. اللي
+
+257
+00:26:15,000 --> 00:26:19,360
+دخلت ومعها
+
+258
+00:26:19,360 --> 00:26:27,580
+تلتر السبوع الاربعان الشتان ومعه سبوع الاربعان
+
+259
+00:26:27,580 --> 00:26:34,520
+الاتناش بيكسبوا مجموعة السبوع الاربعان وبيعملها
+
+260
+00:26:34,520 --> 00:26:44,290
+السبوعأكثر من بارشة بارشة طباء سجين في الأفريقية
+
+261
+00:26:44,290 --> 00:26:48,410
+مختلفة
+
+262
+00:26:48,410 --> 00:26:55,990
+عن بارشة بارشة طباء سجين في الناس في الأدوات
+
+263
+00:26:55,990 --> 00:26:57,730
+السوريكية
+
+264
+00:27:00,070 --> 00:27:09,310
+إن أنا متخيل أن أبقى بكتابة رزاق وإعفار الأرض أنا
+
+265
+00:27:09,310 --> 00:27:18,150
+الباسبة متخيل أن أبقى بقصة
+
+266
+00:27:18,150 --> 00:27:26,570
+بقصة اتحاد مشهورة في أكتر سنة بجانب أي إسرائيل،
+
+267
+00:27:26,570 --> 00:27:37,790
+بجانب أي إسرائيلفي وصف واحد، طيب، لذا من الآن نبقى
+
+268
+00:27:37,790 --> 00:27:43,590
+بتكلم عن ال
+
+269
+00:27:43,590 --> 00:27:47,910
+.. ال
+
+270
+00:27:47,910 --> 00:27:51,450
+factors اللي بتحكم
+
+271
+00:27:53,600 --> 00:27:59,840
+الانتقال زي اسم ال web تفعل ال web تفعل تتكلم عن
+
+272
+00:27:59,840 --> 00:28:09,280
+ال concentration اشتغل؟ و احنا فيه بصوت استيقظ كده
+
+273
+00:28:09,280 --> 00:28:15,920
+و اصلا بنات ال auto shot شير؟
+
+274
+00:28:15,920 --> 00:28:22,060
+اذا هو انتقالأحنا عايزين نفتح على التكتب اللي
+
+275
+00:28:22,060 --> 00:28:23,840
+عايزين نفتح على التكتب اللي عايزين نفتح على التكتب
+
+276
+00:28:23,840 --> 00:28:25,340
+اللي عايزين نفتح على التكتب اللي عايزين نفتح على
+
+277
+00:28:25,340 --> 00:28:26,240
+التكتب اللي عايزين نفتح على التكتب اللي عايزين
+
+278
+00:28:26,240 --> 00:28:26,420
+نفتح على التكتب اللي عايزين نفتح على التكتب اللي
+
+279
+00:28:26,420 --> 00:28:26,500
+عايزين نفتح على التكتب اللي عايزين نفتح على التكتب
+
+280
+00:28:26,500 --> 00:28:27,460
+اللي عايزين نفتح على التكتب اللي عايزين نفتح على
+
+281
+00:28:27,460 --> 00:28:32,920
+التكتب اللي
+
+282
+00:28:32,920 --> 00:28:36,940
+عايزين نفتح على التكتب اللي عايزين نفتح على التكتب
+
+283
+00:28:36,940 --> 00:28:43,840
+اللي عايزين نفتح على التككانت بقى سرقة الانتخاب ..
+
+284
+00:28:43,840 --> 00:28:51,500
+أنا ببقى يشتغلها .. و سرقة الشهر انتخاب شهر .. شهر
+
+285
+00:28:51,500 --> 00:29:03,400
+عامة .. و قولت أنا .. أنا كويس عامة .. كويس
+
+286
+00:29:03,400 --> 00:29:13,080
+شخصية عامة في وقت ما ..أرائيه مفتوحش ليك انا ..
+
+287
+00:29:13,080 --> 00:29:21,680
+انا بانا الكلام انا بشحن بصيحة تبع ع الألوان اللي
+
+288
+00:29:21,680 --> 00:29:31,440
+هيعرفها بشكل مش عارباني تمام اترشحها أرائيها فرحا
+
+289
+00:29:31,440 --> 00:29:40,260
+انا احب ا .. انا اقولهاأو بنتخل أزرق من فيلم صغير
+
+290
+00:29:40,260 --> 00:29:47,800
+اللي اتقر بناه ومشاهه زي اللي مشتت في شارع في ..
+
+291
+00:29:47,800 --> 00:29:54,520
+في مدت .. في مدعتان مش كده مشتت في شارع واشفت
+
+292
+00:29:54,520 --> 00:30:01,000
+التفرغ الواقعيولا ما أشرفش أنا بس ما أشرفش أنا أنا
+
+293
+00:30:01,000 --> 00:30:08,680
+بنتقلها تقوسك حياتي أنا بدأت فيها عزيزي ما
+
+294
+00:30:08,680 --> 00:30:15,560
+تشوفتوها حسيبها لما انت حاجة لما انت حاجة لما انت
+
+295
+00:30:15,560 --> 00:30:19,420
+حاجة لما انت حاجة لما انت حاجة لما انت حاجة لما
+
+296
+00:30:19,420 --> 00:30:23,500
+لما أنت حاجة لما
+
+297
+00:30:23,500 --> 00:30:26,180
+أنت حاجة لما أنت حاجة لما أنت حاجة لما أنت حاجة
+
+298
+00:30:26,180 --> 00:30:29,850
+أنت حاجة لما أنت حاجة لما أنجاز هادا كان من
+
+299
+00:30:29,850 --> 00:30:37,250
+المفاوض تبع الجاز هادا الكبير قوة الجسوم في الحركة
+
+300
+00:30:37,250 --> 00:30:47,970
+فالمزجين كان أسرع في الحركة برش الحرارة تبعي
+
+301
+00:30:47,970 --> 00:30:57,290
+تبقتلي الجو اذا كنت في حرارة عالية تقعد سريعهو
+
+302
+00:30:57,290 --> 00:31:06,230
+اوضع تقاليد اقالي باليبافة
+
+303
+00:31:06,230 --> 00:31:15,570
+الى ال ..
+
+304
+00:31:15,570 --> 00:31:19,270
+تمام، هممم، نسيت ما كنت قوله
+
+305
+00:31:28,130 --> 00:31:35,490
+بعد الوحوز على السنة البرتقالية كيف شدت سنة
+
+306
+00:31:35,490 --> 00:31:46,810
+برتقالية؟ و .. و مقررات التنام مربوطة على الفلوس
+
+307
+00:31:46,810 --> 00:31:51,350
+أسميك؟
+
+308
+00:31:51,350 --> 00:31:57,770
+أنا يا عزيزي ممكن تفكر شغل، أصبحت روحك كافيةوما
+
+309
+00:31:57,770 --> 00:32:08,590
+زالت يهيئ الوقت لأن السرابيليكي تبع الجاز بتساعد
+
+310
+00:32:08,590 --> 00:32:13,430
+على الانتشار لأن
+
+311
+00:32:13,430 --> 00:32:23,070
+الجاز الشرعي ممكن يبتقل بسرعة الديش مش مانسيك طبعا
+
+312
+00:32:23,070 --> 00:32:25,790
+السرابيليكي روح بالجاز
+
+313
+00:32:35,060 --> 00:32:41,620
+السنة القادمة كانت أكثر من مقاومات .. السنة
+
+314
+00:32:41,620 --> 00:32:46,620
+القادمة كانت مقاومات
+
+315
+00:32:46,620 --> 00:32:50,060
+.. السنة
+
+316
+00:32:50,060 --> 00:32:53,460
+القادمة كانت أكثر من مقاومات .. السنة القادمة كانت
+
+317
+00:32:53,460 --> 00:32:57,000
+أكثر من مقاومات .. السنة القادمة كانت أكثر من
+
+318
+00:32:57,000 --> 00:32:57,820
+مقاومات .. السنة القادمة كانت أكثر من مقاومات ..
+
+319
+00:32:57,820 --> 00:32:59,860
+السنة القادمة كانت أكثر من مقاومات .. السنة
+
+320
+00:32:59,860 --> 00:33:00,900
+القادمة كانت أكثر من مقاومات .. السنة القادمة كانت
+
+321
+00:33:00,900 --> 00:33:01,220
+مقاومات .. السنة القادمة كانت أكثر من مقاومات ..
+
+322
+00:33:01,220 --> 00:33:02,640
+السنة القادمة كانت أكثر من مقاومات .. السنة
+
+323
+00:33:02,640 --> 00:33:09,740
+القادمة كانت أكثرفيلم عزيزي مهارة الدنيا جميعا إذا
+
+324
+00:33:09,740 --> 00:33:18,760
+المشير يبدل حرارة عزيزي إذا الإنسان بلدها قد ات
+
+325
+00:33:18,760 --> 00:33:25,860
+فيه جفافة شمسانة أفراد
+
+326
+00:33:25,860 --> 00:33:28,900
+فرشد يبقوا حقوا يوصلوا
+
+327
+00:33:34,070 --> 00:33:44,590
+وهي بمقرشة مفروض انهاش من وراها او او او او او او
+
+328
+00:33:44,590 --> 00:33:46,570
+او او او او او او او او او او او او او او او او او
+
+329
+00:33:46,570 --> 00:33:47,770
+او او او او او او او او او او او او او او او او او
+
+330
+00:33:47,770 --> 00:33:48,190
+او او او او او او او او او او او او او او او او او
+
+331
+00:33:48,190 --> 00:33:51,670
+او او او او او او او او
+
+332
+00:33:51,670 --> 00:33:55,630
+او
+
+333
+00:33:55,630 --> 00:34:01,170
+او
+
+334
+00:34:07,170 --> 00:34:11,210
+بقى بقى الـ «شياطين» بقى عشان أفهمها
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/p46B6aAhKc4_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/p46B6aAhKc4_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..e9347433168663775cbfbaf75de2cf43bec032bd
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/p46B6aAhKc4_raw.json
@@ -0,0 +1 @@
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"avg_logprob": -0.1426388825310601, "compression_ratio": 8.462686567164178, "no_speech_prob": 0.0, "words": [{"start": 2014.07, "end": 2014.99, "word": "وهي", "probability": 0.603271484375}, {"start": 2014.99, "end": 2015.91, "word": " بمقرشة", "probability": 0.504638671875}, {"start": 2015.91, "end": 2016.81, "word": " مفروض", "probability": 0.459136962890625}, {"start": 2016.81, "end": 2017.73, "word": " انهاش", "probability": 0.4586588541666667}, {"start": 2017.73, "end": 2018.19, "word": " من", "probability": 0.398681640625}, {"start": 2018.19, "end": 2019.47, "word": " وراها", "probability": 0.6021321614583334}, {"start": 2019.47, "end": 2022.15, "word": " او", "probability": 0.339111328125}, {"start": 2022.15, "end": 2022.83, "word": " او", "probability": 0.737548828125}, {"start": 2022.83, "end": 2023.77, "word": " او", "probability": 0.8564453125}, {"start": 2023.77, "end": 2023.83, "word": " او", "probability": 0.5615234375}, {"start": 2023.83, "end": 2024.13, "word": " او", 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"text": "بقى بقى الـ «شياطين» بقى عشان أفهمها", "tokens": [3555, 4587, 7578, 4724, 4587, 7578, 2423, 39184, 4657, 8592, 1829, 41193, 9957, 5933, 4724, 4587, 7578, 6225, 8592, 7649, 5551, 5172, 16095, 11296], "avg_logprob": -0.943125, "compression_ratio": 1.03125, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 2047.17, "end": 2047.67, "word": "بقى", "probability": 0.402587890625}, {"start": 2047.67, "end": 2048.13, "word": " بقى", "probability": 0.5694376627604166}, {"start": 2048.13, "end": 2048.21, "word": " الـ", "probability": 0.537841796875}, {"start": 2048.21, "end": 2049.21, "word": " «شياطين»", "probability": 0.5226898193359375}, {"start": 2049.21, "end": 2049.47, "word": " بقى", "probability": 0.630126953125}, {"start": 2049.47, "end": 2050.29, "word": " عشان", "probability": 0.3902587890625}, {"start": 2050.29, "end": 2051.21, "word": " أفهمها", "probability": 0.48822021484375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2214.34775, "duration_after_vad": 1902.1709687499936}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/q1BVk4KKgaw.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/q1BVk4KKgaw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..09842b8bea89235f0d0b21505b88c3f680260e8d
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/q1BVk4KKgaw.srt
@@ -0,0 +1,1742 @@
+1
+00:00:05,030 --> 00:00:08,150
+كانت النقطة الثالثة خليني أخش عليها عيشت نفسي الـ
+
+2
+00:00:08,150 --> 00:00:10,950
+Direct Stimulus of Sodium Reabsorption in the
+
+3
+00:00:10,950 --> 00:00:13,770
+proximal tubule, the loop of Henle, and the distal
+
+4
+00:00:13,770 --> 00:00:15,770
+tubule and the collecting tubule يعني في ال
+
+5
+00:00:15,770 --> 00:00:19,670
+different parts of the nephron. Reabsorption of
+
+6
+00:00:19,670 --> 00:00:23,370
+Sodium. Sodium  طبعاً يْليْد ال water في الغالب
+
+7
+00:00:23,880 --> 00:00:27,580
+الخطوات المختلفة
+
+8
+00:00:27,580 --> 00:00:29,380
+ 
+
+9
+00:00:29,380 --> 00:00:33,180
+ 
+
+10
+00:00:33,180 --> 00:00:39,740
+ 
+
+11
+00:00:39,740 --> 00:00:40,340
+ 
+
+12
+00:00:40,340 --> 00:00:46,720
+ 
+
+13
+00:00:46,720 --> 00:00:49,320
+ل
+
+14
+00:00:50,340 --> 00:00:54,700
+مباشرة direct effect. لذلك قلنا الـ agitation to
+
+15
+00:00:54,700 --> 00:00:58,400
+simulate sodium transport across both the luminal
+
+16
+00:00:58,400 --> 00:01:02,100
+and the basolateral surfaces of the epithelium. طب
+
+17
+00:01:02,100 --> 00:01:06,720
+خلّيها درجة جملة للآخر. نرجع اتنين الآن. إذا النقطة
+
+18
+00:01:06,720 --> 00:01:10,160
+الأولى اللي هو عبر الالدرستيرون. النقطة الثانية
+
+19
+00:01:10,160 --> 00:01:17,420
+مباشرة اللي هنا. قلنا النقطة الثانية directly to
+
+20
+00:01:17,420 --> 00:01:22,550
+simulate sodium reabsorption. النقطة الثانية اللي
+
+21
+00:01:22,550 --> 00:01:27,410
+شرحناها. احنا هنا بدها تفاصيل. تكون the angiotensin II
+
+22
+00:01:27,410 --> 00:01:31,510
+constricts the efferent arterioles, which has two
+
+23
+00:01:31,510 --> 00:01:37,130
+effects on peritubular capillary dynamics. هنا اللي
+
+24
+00:01:37,130 --> 00:01:41,310
+فيها كلام. كيف يعني؟ يعني لما ال circumstriction لل
+
+25
+00:01:41,310 --> 00:01:46,710
+efferent ممكن يكون mild، ويزيد ال GFR اللي كلمنا
+
+26
+00:01:46,710 --> 00:01:51,920
+عنه المرة الفاتتة. ممكن يكون مش mild أكتر شوية. هذا
+
+27
+00:01:51,920 --> 00:01:59,920
+ممكن أكتر شوية، بيزيد ال filtration. مش كده؟ معناها
+
+28
+00:01:59,920 --> 00:02:01,980
+ 
+
+29
+00:02:01,980 --> 00:02:02,920
+ 
+
+30
+00:02:02,920 --> 00:02:02,980
+ 
+
+31
+00:02:02,980 --> 00:02:03,060
+ 
+
+32
+00:02:03,060 --> 00:02:03,840
+ 
+
+33
+00:02:03,840 --> 00:02:03,960
+ 
+
+34
+00:02:03,960 --> 00:02:04,000
+ 
+
+35
+00:02:04,000 --> 00:02:07,380
+ 
+
+36
+00:02:07,380 --> 00:02:08,520
+ 
+
+37
+00:02:16,740 --> 00:02:21,920
+طب هذا النقطة الأولى. أولاً، efferent arterioles تقوم
+
+38
+00:02:21,920 --> 00:02:25,060
+بتقليص peritubular capillaries. طب لأ، خلينا نتكلم عن
+
+39
+00:02:25,060 --> 00:02:28,620
+الكولويدال. هذا النقطة الثانية. ليش؟ لأن هو نقطة
+
+40
+00:02:28,620 --> 00:02:33,780
+ثانية. النقطة الثانية هذه متعلقة بالزيادة في
+
+41
+00:02:33,780 --> 00:02:36,140
+الـ arterioles للـ peritubular تقوم بتقليص الـ arterioles للـ peritubular
+
+42
+00:02:36,140 --> 00:02:36,200
+ 
+
+43
+00:02:36,200 --> 00:02:39,080
+ 
+
+44
+00:02:39,080 --> 00:02:40,860
+ 
+
+45
+00:02:40,860 --> 00:02:46,760
+. تقليص الـ arterioles للـ peritubular reabsorption على ال
+
+46
+00:02:46,760 --> 00:02:50,060
+level تبع ال peritubular capillaries. أن كل هذا ال
+
+47
+00:02:50,060 --> 00:02:54,680
+factor. احنا هنا لما يزيد ال filtration بمعنى أنه
+
+48
+00:02:54,680 --> 00:03:01,640
+ال filtration زاد، مش لأن ال flow rate زاد. جال تمام.
+
+49
+00:03:01,640 --> 00:03:08,100
+ال flow rate جال. احنا عندنا العلاقة
+
+50
+00:03:08,100 --> 00:03:13,320
+ما بين ال filtration fraction يساوي ال GFR على ال
+
+51
+00:03:13,320 --> 00:03:18,370
+renal plasma flow. فلما عندنا renal blood flow،
+
+52
+00:03:18,370 --> 00:03:21,730
+renal plasma flow، يجل تمام، معناه ال filtration
+
+53
+00:03:21,730 --> 00:03:28,330
+أيش؟ بيزيد. معناه ال colloidal، ال colloidal بيعلق،
+
+54
+00:03:28,330 --> 00:03:32,990
+زاد ال filtration، مش كده؟ زاد ال filtration،
+
+55
+00:03:32,990 --> 00:03:38,020
+بمعنى آخر، أبسط من العلاقة اللي هي معقدة هذه، إنه
+
+56
+00:03:38,020 --> 00:03:42,260
+لما الشيء يمشي أبطأ، بيطول ال time for filtration
+
+57
+00:03:42,260 --> 00:03:47,300
+increases. فكمية الماء اللي هتروح لإنه صار exposed
+
+58
+00:03:47,300 --> 00:03:51,020
+لل surface of filtration أطول، هيصير more
+
+59
+00:03:51,020 --> 00:03:54,620
+concentrated، هيصير عندي more colloidal، هيصير
+
+60
+00:03:54,620 --> 00:03:57,560
+more reabsorption عبر ال colloidal، تمام؟ إذا في
+
+61
+00:03:57,560 --> 00:04:02,070
+الحالة هذه أنا عندي بشتغل ال angiotensin II على
+
+62
+00:04:02,070 --> 00:04:05,230
+الاثنين. بيشتغل أنه بيزيد الكولويدال في
+
+63
+00:04:05,230 --> 00:04:08,110
+الـ peritubular و بيجري الهيدروستاتيك في الـ peritubular
+
+64
+00:04:08,110 --> 00:04:11,310
+فال two factors هدول بيساعدوني على ال reabsorption
+
+65
+00:04:11,310 --> 00:04:13,530
+لما يزيد الهيدروستاتيك برشر لأن صار عندي
+
+66
+00:04:13,530 --> 00:04:16,450
+constriction. تمام. زيادة الهيدروستاتيك برشر بيزيد ال
+
+67
+00:04:16,450 --> 00:04:20,310
+reabsorption. لما يزيد الكولويدال برشر، بيزيد ال ايه؟
+
+68
+00:04:20,310 --> 00:04:23,210
+ال reabsorption. أصلاً إحنا اتكلمنا عن أيش؟ عكس ذلك.
+
+69
+00:04:23,210 --> 00:04:27,160
+لما ال blood pressure بيزيد، قلنا المشكلة. بيزيد ال
+
+70
+00:04:27,160 --> 00:04:30,000
+peritubular capillary pressure، بيقل ال ايه؟ ال
+
+71
+00:04:30,000 --> 00:04:35,500
+reabsorption. طيب إذا ال angiotensin II simulates
+
+72
+00:04:35,500 --> 00:04:39,240
+aldosterone. ال angiotensin II constricts
+
+73
+00:04:39,240 --> 00:04:42,660
+efferent arterioles، which has two effects on the
+
+74
+00:04:42,660 --> 00:04:46,560
+peritubular capillary dynamics. الميكانيزم لكن
+
+75
+00:04:46,560 --> 00:04:49,980
+المحصلة أن هذه العملية بتزيد ال more reabsorption
+
+76
+00:04:49,980 --> 00:04:54,580
+عبر الهيدروستاتيك برشر و عبر ال كولويد أسموزماتيك برشر
+
+77
+00:04:56,480 --> 00:05:00,780
+والتالتة قلنا لأ، له direct properties على ال all
+
+78
+00:05:00,780 --> 00:05:04,480
+parts of the nephron to increase reabsorption. إذا
+
+79
+00:05:04,480 --> 00:05:07,640
+الـ angiotensin II تسيموليـت ال sodium transport across
+
+80
+00:05:07,640 --> 00:05:11,500
+both the luminal and the basolateral
+
+81
+00:05:14,890 --> 00:05:19,330
+فهمناها الـ Reabsorptive forces. بس ال basolateral
+
+82
+00:05:19,330 --> 00:05:26,470
+effect للالدرستيرون. مش كده؟ ماشي، الالدرستيرون هو أول
+
+83
+00:05:26,470 --> 00:05:30,310
+شيء بتأثّر فيه، قلنا أول effect بتاعه هو أنه بيزيد
+
+84
+00:05:30,310 --> 00:05:33,710
+الـ aldosterone. فالالدرستيرون هيزيد ال ايه؟ ال sodium
+
+85
+00:05:33,710 --> 00:05:38,610
+pumping system، وهيزيد برضه ال luminal transport mechanism
+
+86
+00:05:38,610 --> 00:05:47,000
+مش كده؟ واحد من effects للـ angiotensin II هو .. واحد
+
+87
+00:05:47,000 --> 00:05:50,680
+من effects للـ angiotensin II هو stimulates sodium
+
+88
+00:05:50,680 --> 00:05:55,100
+potassium في ال basolateral membrane. والثاني
+
+89
+00:05:55,100 --> 00:06:01,140
+effect بتاعه stimulates sodium hydrogen في ال
+
+90
+00:06:01,140 --> 00:06:05,240
+basolateral membrane، خاصة في ال basolateral
+
+91
+00:06:10,580 --> 00:06:16,920
+الـ angiotensin II بتكون الـ aldosterone
+
+92
+00:06:16,920 --> 00:06:22,120
+من ضمن الميكانيزمات اللي بشتغل عليها.
+
+93
+00:06:42,010 --> 00:06:48,540
+هذا بالنسبة للهرمون الثاني angiotensin II. إذا اتكلمنا
+
+94
+00:06:48,540 --> 00:06:52,440
+عن ال aldosterone و angiotensin II، ال antidiuretic hormone
+
+95
+00:06:52,440 --> 00:06:56,160
+هنا محتاجين أن احنا نعمل شوية تفاصيل عنه لأنه
+
+96
+00:06:56,160 --> 00:06:59,420
+جيبنا سيرته كتير وما اتكلمناش عن التفاصيل. تمام.
+
+97
+00:06:59,420 --> 00:07:06,740
+ال antidiuretic hormone يزيد water absorption. كيف؟
+
+98
+00:07:06,740 --> 00:07:12,470
+وين؟ يزيد ال water reabsorption في ال distal
+
+99
+00:07:12,470 --> 00:07:15,910
+nephron و ال collecting duct. ده يعني من بعد ال juxtaglomerular
+
+100
+00:07:15,910 --> 00:07:19,990
+apparatus بشوية صغيرة. ال early و ال late من سيبها
+
+101
+00:07:19,990 --> 00:07:25,250
+لأنهم ما بيمتصّوا water. لكن ال late distal، ال
+
+102
+00:07:25,250 --> 00:07:29,810
+connecting tubule و ال collecting duct و ال medulla، هدول
+
+103
+00:07:29,810 --> 00:07:35,100
+كلهم under the effect of. إذا الـ distal tubule،
+
+104
+00:07:35,220 --> 00:07:37,640
+collecting tubule و collecting duct هدول كلهم
+
+105
+00:07:37,640 --> 00:07:43,240
+affected by the antidiuretic hormone. وزيادة ال antidiuretic hormone
+
+106
+00:07:43,240 --> 00:07:47,320
+هنا بتزيد ال reabsorption. كيف بتزيد ال
+
+107
+00:07:47,320 --> 00:07:51,580
+reabsorption هنا؟ طيب لما اتكلم إحنا ال
+
+108
+00:07:51,580 --> 00:07:54,940
+reabsorption، بتكلم تحت .. خلينا نتكلم تحت على ال
+
+109
+00:07:54,940 --> 00:07:58,340
+collecting duct. على ال collecting duct في ال
+
+110
+00:07:58,340 --> 00:08:03,320
+medulla. الميكانيزم أن احنا بنفتح ال water
+
+111
+00:08:03,320 --> 00:08:07,400
+channels. سوف نتكلم عنها بعد قليل. لما نفتح ال water
+
+112
+00:08:07,400 --> 00:08:12,140
+channels، الماء تدخل للـ collecting duct epithelium
+
+113
+00:08:12,140 --> 00:08:17,580
+وبعدين لما نبقى متص مية، في الحالة هذه ونعمل
+
+114
+00:08:17,580 --> 00:08:21,700
+concentration لل urine، بيكون hyperosmotic. مين؟
+
+115
+00:08:21,700 --> 00:08:27,680
+هو ال hyperosmotic medulla. مش كده؟ في عندي concentration
+
+116
+00:08:27,680 --> 00:08:32,850
+gradient. مدام في عندنا reabsorption of water by
+
+117
+00:08:32,850 --> 00:08:35,550
+antidiuretic hormone، معناها في عندي osmotic gradient
+
+118
+00:08:35,550 --> 00:08:39,110
+اتكون. نتكلم عن الجزء الآخر، ال collecting duct، ال
+
+119
+00:08:39,110 --> 00:08:42,610
+collecting duct طبعاً وين موجودة؟ هي في ال medulla. مش
+
+120
+00:08:42,610 --> 00:08:46,490
+كده؟ في ال medulla. ال collecting duct في ال medulla. إذا
+
+121
+00:08:46,490 --> 00:08:49,110
+فتحت ال water channels،
+
+122
+00:08:51,300 --> 00:08:54,540
+واللي بيخلينا نلاحظ أن ال hyperosmotic medulla
+
+123
+00:08:54,540 --> 00:08:58,840
+بتشفط ال water من وين؟ من ال epithelium. هتتدفع ال
+
+124
+00:08:58,840 --> 00:09:03,320
+water من ال filtrate، من ال tubular fluid إلى داخل
+
+125
+00:09:03,320 --> 00:09:08,400
+ال cells. هتتدخل. واضح الميكانيزم. إذا عبر ال osmosis
+
+126
+00:09:08,400 --> 00:09:12,660
+اللي موجود في ال interstitium. تمام؟ طيب لفوق شوية
+
+127
+00:09:12,660 --> 00:09:18,420
+في ال collecting tubule cortical، في ال distal
+
+128
+00:09:18,420 --> 00:09:25,670
+tubule cortical. تمام؟ الميكانيزم هذا، بتنفع؟ طب إحنا
+
+129
+00:09:25,670 --> 00:09:31,070
+هنا ما تقولوش، ما تتسرعوش، أنا بغلطكم. طب إحنا هنا
+
+130
+00:09:31,070 --> 00:09:35,050
+اعتمدنا ال reabsorption of water على وجود
+
+131
+00:09:35,050 --> 00:09:39,490
+interstitium concentrated. مش كده؟ طيب في ال .. في
+
+132
+00:09:39,490 --> 00:09:42,150
+ال .. في ال cortex، ال interstitium ما هوّاش
+
+133
+00:09:42,150 --> 00:09:46,230
+concentrated. بصراحة؟ طب okay. فتحنا ال channels،
+
+134
+00:09:46,230 --> 00:09:50,550
+الماء، كيف هتعدي ال ايه؟ عندنا شغل الميكانيزم، إنّنا
+
+135
+00:09:50,550 --> 00:09:53,770
+ال antidiuretic hormone بس بفتح ال channels. جالك ال water،
+
+136
+00:09:53,770 --> 00:09:56,770
+يقلل permeability. هتعتمد على ال antidiuretic hormone في ال
+
+137
+00:09:56,770 --> 00:09:59,890
+distal tubule و في ال collecting cortical
+
+138
+00:09:59,890 --> 00:10:03,550
+collecting. هتعتمد على مين؟ على ال antidiuretic hormone و
+
+139
+00:10:03,550 --> 00:10:06,790
+ال collecting duct هتعمل على ال antidiuretic hormone في ال
+
+140
+00:10:06,790 --> 00:10:10,110
+collecting duct. ال antidiuretic hormone فتحت channels و
+
+141
+00:10:10,110 --> 00:10:13,890
+لجينا ايه؟ اندفاع رهيب لايه؟ لل interstitium، لأن
+
+142
+00:10:13,890 --> 00:10:16,510
+إن ال interstitium في الحالة هذه بيكون ايه؟ اه، في
+
+143
+00:10:16,510 --> 00:10:20,200
+concentrated interstitium. بس في ال cortex مافيش
+
+144
+00:10:20,200 --> 00:10:26,220
+concentration. كده ال osmolality في ال cortex
+
+145
+00:10:26,220 --> 00:10:31,780
+بيكون isosmotic. كده يعني 300، حوالي 300
+
+146
+00:10:31,780 --> 00:10:34,320
+ملي أسمول. 300، 300، 300، 300، 300، 300،
+
+147
+00:10:34,320 --> 00:10:35,380
+300، 300، 300، 300، 300، 300،
+
+148
+00:10:35,380 --> 00:10:35,700
+300، 300، 300، 300، 300، 300،
+
+149
+00:10:35,700 --> 00:10:37,400
+300، 300، 300، 300، 300، 300،
+
+150
+00:10:37,400 --> 00:10:44,960
+300، 300، 300، 300، 300، 3
+
+151
+00:10:47,120 --> 00:10:50,180
+الـ early distal tubule في الـ thick ascending
+
+152
+00:10:50,180 --> 00:10:55,240
+limb، نهايته الفلترة كم يكون لديها أسمولاليتها؟ لما سحبنا
+
+153
+00:10:55,240 --> 00:11:00,400
+الـ solutes، لذا لازال في فرق كبير في أسمولاليتها بين الفلترة
+
+154
+00:11:00,400 --> 00:11:05,360
+والـ cortex. لأننا في الـ thick ascending limb
+
+155
+00:11:05,360 --> 00:11:11,380
+سحبنا الـ solutes ووصلنا للـ distal، ال early part برضه
+
+156
+00:11:11,380 --> 00:11:14,340
+غير ممكن تفتح بالماء. لكن احنا قاعدين نسحب solutes،
+
+157
+00:11:14,340 --> 00:11:19,200
+فالفلترة صارت ايش؟ diluted. في الحالة هذه،
+
+158
+00:11:19,200 --> 00:11:21,700
+إذا سمحت للـ water channels أن تفتح
+
+159
+00:11:21,700 --> 00:11:25,880
+أوتوماتيكياً، هتقدر الماء تطلع وتصل للـ
+
+160
+00:11:25,880 --> 00:11:30,560
+interstitium. لأن ال interstitium هو 300 طبعاً. إذا
+
+161
+00:11:30,560 --> 00:11:36,420
+قلنا احنا لو الفلترة هذه في عندي concentrated
+
+162
+00:11:36,420 --> 00:11:37,060
+mechanisms
+
+163
+00:11:39,430 --> 00:11:43,510
+والفلترة تؤثر على ال antidiuretic hormone، ماكسيما
+
+164
+00:11:43,510 --> 00:11:47,710
+يخرج من الـ cortex للمدولة 300. الـ cortex
+
+165
+00:11:47,710 --> 00:11:50,910
+ماعندوش قدرة يعمل تأثير أكتر من أنه يزيد الاسموليّ على
+
+166
+00:11:50,910 --> 00:11:55,510
+300. لأن ال interstitial fluid تبعه 300. مش
+
+167
+00:11:55,510 --> 00:12:01,890
+كده؟ فلذلك هو بيقدر يتحول من 100 أنه يديني 200،
+
+168
+00:12:01,890 --> 00:12:06,290
+300، بتروح، بتيجي المية للتلت، بيرجع لـ 300.
+
+169
+00:12:06,290 --> 00:12:09,710
+تمام؟ إذا في الحالة هذه ال antidiuretic hormone
+
+170
+00:12:09,710 --> 00:12:12,610
+mechanism of action effective في ال cortex، لأن أنا
+
+171
+00:12:12,610 --> 00:12:15,530
+بتكلم عن filtrate مش .. مش .. مش isosmotic. بتكلم
+
+172
+00:12:15,530 --> 00:12:19,330
+عن filtrate. إذا maximum بيصل له ال filtrate هذا
+
+173
+00:12:19,330 --> 00:12:23,830
+بنزل للمدولة. مش ممكن ينزل .. يطلع أكتر من 300. ليش؟
+
+174
+00:12:23,830 --> 00:12:27,190
+لأن قدرة ال cortex هناك 300. ومعناها أن أنا بقدر
+
+175
+00:12:27,190 --> 00:12:31,190
+أسلمه في حالات شديدة، اللي محتاجة فيها مية كتير،
+
+176
+00:12:31,190 --> 00:12:36,580
+بقدر أسلمه بس لل interstitium للمدولة. بقدر
+
+177
+00:12:36,580 --> 00:12:41,600
+أسلمه filtrate أو tubular fluid تركيزه 300. من الاغزمون ال maximum. بعدين هنا عندنا بيجي ال
+
+178
+00:12:44,140 --> 00:12:47,640
+hyper concentration بيصير هنا لأن المدولة بتبقى مش
+
+179
+00:12:47,640 --> 00:12:52,040
+على ال isomolal، بتبقى hyper osmotic. بتقدر تاخد جداً
+
+180
+00:12:52,040 --> 00:12:58,420
+ما بدها حسب ال maximum بتاعها. على جداش لأ، في المدولة
+
+181
+00:12:58,420 --> 00
+
+223
+00:15:59,710 --> 00:16:04,670
+بفتح الـ channels أو بجللها أو بكترها تمام؟ وشافت
+
+224
+00:16:04,670 --> 00:16:09,170
+هو هو بس أنا بزود فتحات التسريب أو بجللها حسب ما
+
+225
+00:16:09,170 --> 00:16:14,430
+أنا إيش بده تركيزه فعند الـ V2 ريسبتورز increasing
+
+226
+00:16:14,430 --> 00:16:16,970
+الـ mechanism هذا الـ cellular mechanism بتقدر إلى
+
+227
+00:16:16,970 --> 00:16:19,430
+أن seamless movement of intracellular protein
+
+228
+00:16:19,430 --> 00:16:24,790
+called aquaporin أكوا إيش يعني أكوا؟ لذلك أكوا
+
+229
+00:16:24,790 --> 00:16:26,030
+التنقل ميه هدول
+
+230
+00:16:29,570 --> 00:16:41,010
+أكوابورين أو أكوابورين أو أكوابورين أو أكوا
+
+231
+00:16:41,010 --> 00:16:47,630
+بورين أو أكوابورين أو أكوا 3 و 4 موجودين على
+
+232
+00:16:47,630 --> 00:16:50,850
+الـ basolateral مالهمش علاقة بالـ ايه بالـ انتردوك
+
+233
+00:16:50,850 --> 00:16:53,790
+هرمون بس هم مفتاحين channels بحيث أنه يساعد على الـ
+
+234
+00:16:53,790 --> 00:16:56,970
+ايه تدخل الـ interstitشن interstitشن لكن هو مش under
+
+235
+00:16:56,970 --> 00:16:59,710
+control of the ايه of the انتردوك هرمون اللي under
+
+236
+00:16:59,710 --> 00:17:02,870
+control of the انتردوك هرمون اللي هم على الـ ايه الـ
+
+237
+00:17:02,870 --> 00:17:07,810
+apical membrane بيفتح بتطلع الميه بيروح الميه
+
+238
+00:17:07,810 --> 00:17:11,270
+بتضلها ايه لتحصي الدخول الكلية من جديد
+
+239
+00:17:11,270 --> 00:17:14,030
+الـ interstitشن بتضلها to the out
+
+240
+00:17:17,300 --> 00:17:22,100
+الـ جزيئات تجمع مع بعضها و تتفجر مع الـ membrane للسلب
+
+241
+00:17:22,100 --> 00:17:25,940
+بشكل إكسوسيتوزيس لتصميم قطارات مياه مياه مياه مياه
+
+242
+00:17:25,940 --> 00:17:29,360
+مياه مياه مياه مياه مياه مياه مياه مياه مياه مياه
+
+243
+00:17:29,360 --> 00:17:29,640
+مياه مياه مياه مياه مياه مياه مياه مياه مياه مياه
+
+244
+00:17:29,640 --> 00:17:30,140
+مياه مياه مياه مياه مياه مياه مياه مياه مياه مياه
+
+245
+00:17:30,140 --> 00:17:34,400
+مياه مياه مياه مياه مياه مياه مياه مياه مياه مياه
+
+246
+00:17:34,400 --> 00:17:44,280
+مياه مياه مياه مياه
+
+247
+00:17:44,280 --> 00:17:47,400
+مع عندما يتخلص الجسم من الهرمون antidiuretic
+
+248
+00:17:47,400 --> 00:17:51,080
+الهرمون antidiuretic
+
+249
+00:17:51,080 --> 00:17:53,220
+الهرمون antidiuretic الهرمون antidiuretic
+
+250
+00:17:53,220 --> 00:17:59,420
+الهرمون antidiuretic الهرمون antidiuretic
+
+251
+00:17:59,420 --> 00:18:03,240
+الهرمون antidiuretic الـ antidepressant hormone هيعود ندرسه
+
+252
+00:18:03,240 --> 00:18:07,620
+ثاني في الـ endocrine و نتكلم لو .. مش على مستوى
+
+253
+00:18:07,620 --> 00:18:11,580
+الكل يعني نتكلم عنه نتكلم عنه على مستوى الـ بـ
+
+254
+00:18:11,580 --> 00:18:15,060
+thyroid gland تمام؟ لإنه ممكن يزيد و ممكن يقل،
+
+255
+00:18:15,060 --> 00:18:18,640
+إيش أسباب اللي بيخليه يزيد؟ كـ diseases مش كـ
+
+256
+00:18:18,640 --> 00:18:27,020
+physiological controlling system، أه؟ لأ الثالث
+
+257
+00:18:27,020 --> 00:18:31,350
+هذا أو الرابع،تكلمنا عن الـ antidiuretic هرمون الثالث،
+
+258
+00:18:31,350 --> 00:18:33,110
+هنتكلم عن الرابع الـ antidiuretic هرمون الألدوستيرون
+
+259
+00:18:33,110 --> 00:18:38,890
+الـ antidiuretic هرمون الـ natriuretic أعتقد أن
+
+260
+00:18:38,890 --> 00:18:41,530
+أنا حكيت عنه الـ natriuretic بتاعت أنا
+
+261
+00:18:41,530 --> 00:18:45,090
+حكيت عنه هذا بيطلع من الـ atrial epithelium أو
+
+262
+00:18:45,090 --> 00:18:48,570
+endothelium الـ atrial endothelium لما يصير
+
+263
+00:18:48,570 --> 00:18:52,690
+expansion أو dilatation أو stretch receptors
+
+264
+00:18:52,690 --> 00:18:58,910
+بتضغط عليه بيقدر أنه secreted more تمام؟ أقل الـ
+
+265
+00:18:58,910 --> 00:19:03,250
+volume الـ blood بيقل لكن بيشغل الـ كلى بطريقة عكسية
+
+266
+00:19:03,250 --> 00:19:06,990
+لأنه هو لما يزيد الـ volume بده يقلله، طيب الـ
+
+267
+00:19:06,990 --> 00:19:14,170
+mechanism of action تبعه وين وين شغله هو increase
+
+268
+00:19:14,170 --> 00:19:17,690
+levels of this peptide in turn inhibit the
+
+269
+00:19:17,690 --> 00:19:20,350
+reabsorption of sodium and water by the renal
+
+270
+00:19:20,350 --> 00:19:23,850
+tubules especially in the collecting duct لذا
+
+271
+00:19:23,850 --> 00:19:27,610
+بيشغل الـ الجزء الأخير تمام؟ mainly على الـ جزء الأخير
+
+272
+00:19:27,610 --> 00:19:30,430
+لكن هو على الـ tubule كله بيقلل الـ reabsorption
+
+273
+00:19:30,430 --> 00:19:33,310
+اللي هو ذاتي و بيزيد الـ reabsorption اللي هو ايه
+
+274
+00:19:33,310 --> 00:19:36,990
+جالب بس الـ main action تبقى على مين؟ الـ collecting
+
+275
+00:19:36,990 --> 00:19:42,770
+duct Parathyroid هرمون هذا إيش علاقة بمين؟ بالـ
+
+276
+00:19:42,770 --> 00:19:49,130
+.. بالـ calcium و الفوسفات و القليل من الـ إيش؟ الـ
+
+277
+00:19:49,130 --> 00:19:53,430
+magnesium الـ calcium بيشتغل في الـ calcium عدسة الـ
+
+278
+00:19:53,430 --> 00:19:57,250
+tubule بيزيد الـ reabsorption في كالسيوم وين؟ في الـ
+
+279
+00:19:57,250 --> 00:20:00,270
+distal tubule لما يزيد بره thyroid  بره thyroid
+
+280
+00:20:00,270 --> 00:20:03,490
+هرمون شغلته الرئيسية هم اللي بيحافظوا شغلته
+
+281
+00:20:03,490 --> 00:20:07,530
+الرئيسية المحافظة على مستوى الكالسيوم في الدم ما إيش
+
+282
+00:20:07,530 --> 00:20:11,610
+ب يفهمش اللي هي و هو قوي تمام؟ هو هو ايش؟ هرمون قوي
+
+283
+00:20:11,610 --> 00:20:15,470
+إن قل الكالسيوم في الدم بنجد بده يعليه من أول جهاز
+
+284
+00:20:15,470 --> 00:20:18,310
+كما كان فياخذ من العظم و ياخذ من الـ intestine
+
+285
+00:20:18,310 --> 00:20:22,650
+اللي بياخذ منه يمنعه بده يعليه فهو هرمون قوي شغلته
+
+286
+00:20:22,650 --> 00:20:26,350
+يحافظ على مين؟ مش شغلته يبني عظيمة، لأ لأ ما لوش
+
+287
+00:20:26,350 --> 00:20:30,130
+علاقة ببناء العظم هو، هو بيكسر العظم، شغلته
+
+288
+00:20:30,130 --> 00:20:33,840
+يحافظ على الـ ايش؟ الكالسيوم و كذا لكن إذا دخل 
+
+289
+00:20:33,840 --> 00:20:36,780
+كالسيوم كافي باهدا باهدا و بيسكت و الكالسيوم يزيد
+
+290
+00:20:36,780 --> 00:20:40,400
+أنا بروح للعظم لكن النقص يا أقول لكم النقص
+
+291
+00:20:40,400 --> 00:20:44,520
+Parathyroid بنهش في العظم بيكسره تمام إلا يسحب الـ ..
+
+292
+00:20:44,520 --> 00:20:48,040
+الـ ايش؟ الكالسيوم المطلوب بيحس بـ اللازمة level of
+
+293
+00:20:48,040 --> 00:20:51,700
+كالسيوم الطبيعي ايش؟ طبيعية ليش؟ لأن الكالسيوم
+
+294
+00:20:51,700 --> 00:20:56,400
+level زي البوتاسيوم خطير لإيش؟ لـ لـ لـ لـ
+
+295
+00:20:56,400 --> 00:20:57,580
+لـ لـ لـ لـ لـ لـ لـ لـ لـ لـ
+
+296
+00:20:57,580 --> 00:20:57,940
+لـ لـ لـ لـ لـ لـ لـ لـ لـ لـ
+
+297
+00:20:57,940 --> 00:20:58,460
+لـ لـ لـ لـ لـ لـ لـ لـ لـ لـ
+
+298
+00:20:58,460 --> 00:20:58,580
+لـ لـ
+
+299
+00:21:03,200 --> 00:21:06,820
+لـ heart بتزيد إذا نبدأ نحافظ على الـ level هذا لإنه
+
+300
+00:21:06,820 --> 00:21:11,000
+هذا مش بس إحنا محتاجينه في الدم البلازما لا لا أنا في
+
+301
+00:21:11,000 --> 00:21:14,260
+ناس آخرين متعقدين معاهم أنه نضبط الأمور و إلا ايش
+
+302
+00:21:14,260 --> 00:21:18,400
+تختل البلد كلها، ضرب المفاعل شسمه هيخرب الدنيا كلها
+
+303
+00:21:18,400 --> 00:21:22,160
+مش بس هيخرب الكهربا، هيموت الناس الإشعاع اللي طلع
+
+304
+00:21:22,160 --> 00:21:24,560
+مش أنه ما فيش كهربا طبعا إن شاء الله ما في كهربا من
+
+305
+00:21:24,560 --> 00:21:27,760
+أنا مع الشمعة لكن لأ الآن الإشعاع اللي طلع ما له
+
+306
+00:21:27,760 --> 00:21:30,600
+الدنيا هذا مش الخطر على اليابان لحالها، الخطر على
+
+307
+00:21:30,600 --> 00:21:34,700
+كل مكان، الـ calcium ازداد .. الجسم لا يسمح بالـ ايش
+
+308
+00:21:34,700 --> 00:21:38,720
+بأنه شيء يطلع out of control، على طول في ميكانيزمات
+
+309
+00:21:38,720 --> 00:21:41,620
+دائما الشيء .. مش ميكانيزم واحد، بيكون كذا
+
+310
+00:21:41,620 --> 00:21:44,280
+ميكانيزم زي ما أنتم شايفين الـ regulation كاملة،
+
+311
+00:21:44,280 --> 00:21:50,570
+مش كده؟ شيء بيدفع بياكد شيء الـ sympathetic بيطلع الـ
+
+312
+00:21:50,570 --> 00:21:52,190
+renin و الـ renin بيطلع الـ angiotensin II و الـ
+
+313
+00:21:52,190 --> 00:21:55,930
+angiotensin بيطلع الـ الـ الـ aldosterone و الـ
+
+314
+00:21:55,930 --> 00:21:58,070
+الـ الـ و الـ aldosterone بيطلع الـ الـ الـ
+
+315
+00:21:58,070 --> 00:22:04,210
+hormone system كامل لو واحد منه فشل الباقي بيكمل في
+
+316
+00:22:04,210 --> 00:22:07,310
+multiple control systems ازاي نتكلم الـ control
+
+317
+00:22:07,310 --> 00:22:10,350
+قلنا الـ الـ autogenic one اللي هو الـ الـ
+
+318
+00:22:10,350 --> 00:22:14,790
+glomerotubular balance بعدين الـ hormones بعدين الـ
+
+319
+00:22:14,790 --> 00:22:18,140
+الـ متداخلة و هذا الـ physiology الـ homeostasis
+
+320
+00:22:18,140 --> 00:22:21,920
+ما نضبطش .. إحنا مش عايشين سباق له لا لو إن .. يعني
+
+321
+00:22:21,920 --> 00:22:25,500
+عشان تشوفوا كده أن الحياة الـ الـ
+
+322
+00:22:25,500 --> 00:22:28,460
+aldosterone و الـ الـ و الـ aldosterone بتطلع
+
+323
+00:22:28,460 --> 00:22:35,440
+الـ hormone لو واحد منه فشل الباقي بيكمل في multiple
+
+324
+00:22:35,440 --> 00:22:38,920
+control systems ازاي نتكلم الـ control قلنا الـ ..
+
+325
+00:22:38,920 --> 00:22:41,800
+الـ autogenic one اللي هو الـ الـ glomerotubular
+
+326
+00:22:41,800 --> 00:22:47,780
+balance بعدين الـ hormones بعدين الـ متداخلة و هذا
+
+327
+00:22:47,780 --> 00:22:50,300
+الـ physiology الـ homeostasis ما نضبطش إحنا مش
+
+328
+00:22:50,300 --> 00:22:54,080
+عايشين سباق له لا لو يعني عشان تشوفوا كده أن
+
+329
+00:22:54,080 --> 00:22:58,060
+الحياة هي الـ aldosterone و الـ aldosterone بتطلع الـ
+
+330
+00:22:58,060 --> 00:23:04,500
+hormone system كامل لو واحد منه فشل الباقي بيكمل في
+
+331
+00:23:04,500 --> 00:23:07,600
+multiple control systems ازاي نتكلم الـ control
+
+332
+00:23:07,600 --> 00:23:11,260
+قلنا الـ autogenic one اللي هو الـ glomerotubular
+
+333
+00:23:11,260 --> 00:23:17,240
+balance بعدين الـ hormones بعدين الـ متداخلة و هذا
+
+334
+00:23:17,240 --> 00:23:19,760
+الـ physiology اللي هو homeostasis ما نضبطش إحنا مش
+
+335
+00:23:19,760 --> 00:23:23,540
+عايشين سباحة لا لا لو إن يعني عشان تشوفوا كده أن
+
+336
+00:23:23,540 --> 00:23:27,640
+على الحياة الـ aldosterone و الـ و الـ aldosterone
+
+337
+00:23:27,640 --> 00:23:33,200
+بتطلع  هرمون system كامل لو واحد منه فشل الباقي
+
+338
+00:23:33,200 --> 00:23:37,240
+بيكمل في multiple control systems إذا أنا بتكلم الـ
+
+339
+00:23:37,240 --> 00:23:40,560
+control قلنا الـ autogenic one اللي هو الـ
+
+340
+00:23:40,560 --> 00:23:45,080
+glomerotubular balance بعدين الـ hormones بعدين الـ
+
+341
+00:23:46,100 --> 00:23:48,460
+متداخلة و هذا الـ physiology الـ homeostasis
+
+342
+00:23:48,460 --> 00:23:52,620
+ما نضبطش إحنا مش عايشين سباحة لا لا لو إن يعني عشان
+
+343
+00:23:52,620 --> 00:23:54,060
+تشوفوا كده أن الحياة
+
+344
+00:23:54,060 --> 00:24:12,880
+هالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهالهال
+
+345
+00:24:15,400 --> 00:24:18,120
+و هذا الـ physiology الـ homeostasis ما نضبطش .. إحنا
+
+346
+00:24:18,120 --> 00:24:21,440
+مش عايشين سباحة لا لا لو إن .. يعني عشان تشوفوا
+
+347
+00:24:21,440 --> 00:24:24,500
+كده أن الحياة .. و الـ و الـ و الـ و الـ و الـ
+
+348
+00:24:24,500 --> 00:24:24,700
+و الـ و الـ و الـ و الـ و الـ و الـ و
+
+349
+00:24:24,700 --> 00:24:24,960
+الـ و الـ و الـ و الـ و الـ و الـ و ال
+
+350
+00:24:24,960 --> 00:24:25,280
+.. و الـ و الـ و الـ و الـ و الـ و الـ
+
+351
+00:24:25,280 --> 00:24:25,560
+الـ و الـ و الـ و الـ و الـ و الـ و ال
+
+352
+00:24:25,560 --> 00:24:26,860
+.. و الـ و الـ و الـ و الـ و الـ و الـ
+
+353
+00:24:26,860 --> 00:24:27,060
+و الـ و الـ و الـ و الـ و الـ و الـ و
+
+354
+00:24:27,060 --> 00:24:29,520
+الـ و الـ و الـ و الـ و الـ و الـ و ال
+
+355
+00:24:29,520 --> 00:24:34,840
+.. و الـ
+
+356
+00:24:34,840 --> 00:24:36,240
+و الـ
+
+357
+00:24:44,120 --> 00:24:47,000
+و هذا الـ physiology الـ homeostasis ما نضبطش إحنا مش
+
+358
+00:24:47,000 --> 00:24:50,780
+عايشين سباق لا لا لو إن يعني عشان تشوفوا كده أن
+
+359
+00:24:50,780 --> 00:24:56,400
+الحياة هذا system كامل لو واحد منه فشل الباقي بيكمل
+
+360
+00:24:56,400 --> 00:25:00,280
+في multiple control systems إذا نتكلم الـ control
+
+361
+00:25:00,280 --> 00:25:03,940
+قلنا الـ autogenic one اللي هو الـ glomerotubular
+
+362
+00:25:03,940 --> 00:25:09,760
+balance بعدين الـ hormones بعدين الـ متداخلة و
+
+363
+00:25:09,760 --> 00:25:12,420
+هذا الـ physiology الـ homeostasis ما نضبطش إحنا مش
+
+364
+00:25:12,420 --> 00:25:16,220
+عايشين سباق لا لا لو إن .. يعني عشان تشوف كده أن
+
+365
+00:25:16,220 --> 00:25:21,540
+الحياة  الـ hormones متداخلة و هذا الـ
+
+366
+00:25:21,540 --> 00:25:23,900
+physiology الـ homeostasis ما نضبطش .. إحنا مش
+
+367
+00:25:23,900 --> 00:25:27,680
+عايشين سباحة لا لا لو إن .. يعني عشان تشوف كده أن
+
+368
+00:25:27,680 --> 00:25:32,420
+الحياة  الـ hormones الـ factor الثالث اللي هو
+
+369
+00:25:32,420 --> 00:25:38,940
+الـ الباراتيرويد الثالث ولا كده؟ الخامس الخامس
+
+370
+00:25:38,940 --> 00:25:46,620
+الباراتيرويد هان بتشتغل على تلاتة solutes تمام بتزيد
+
+371
+00:25:46,620 --> 00:25:49,940
+الـ reabsorption of كالسيوم في distal tubule
+
+372
+00:25:49,940 --> 00:25:58,620
+بتزيد الـ excretion of فوسفات عبر الـ proximal tubule
+
+373
+00:25:58,620 --> 00:26:03,760
+و بتزيد الـ reabsorption of ماغنيسيوم عبر الـ ايش؟
+
+374
+00:26:04,360 --> 00:26:07,960
+الـ loop of Henle و إحنا اتكلمنا في الـ loop of Henle أنه 25%
+
+375
+00:26:07,960 --> 00:26:13,140
+من الـ magnesium is reabsorbed في الـ loop of Henle و
+
+376
+00:26:13,140 --> 00:26:17,500
+الـ parathyroid هرمون له تأثيره تمام؟ إذا the
+
+377
+00:26:17,500 --> 00:26:20,520
+principle action in the kidney is to increase
+
+378
+00:26:20,520 --> 00:26:24,020
+tubular reabsorption و كالسيوم هذا الأساس لكن الشغل
+
+379
+00:26:24,020 --> 00:26:28,120
+الإضافي parathyroid has also other actions
+
+380
+00:26:28,120 --> 00:26:30,740
+inhibition of phosphate reabsorption by the
+
+381
+00:26:30,740 --> 00:26:34,180
+proximal tubule، Stimulation of Magnesium
+
+382
+00:26:34,180 --> 00:26:37,480
+Reabsorption by the Loop of Henle، Sympathetic
+
+383
+00:26:37,480 --> 00:26:42,980
+Stimulation Control بتاعتها بتيجي عبر مين؟
+
+384
+00:26:42,980 --> 00:26:46,400
+Sympathetic System، Sympathetic System، اتكلمت أنا
+
+385
+00:26:46,400 --> 00:26:53,900
+عنه تقوم بتقليل الـ GFR، Sympathetic Activation
+
+386
+00:26:53,900 --> 00:26:56,940
+Increase Sodium Reabsorption in the Proximal برضه
+
+387
+00:26:56,940 --> 00:27:01,970
+غير الميكانيزمات المختلفة و الـ direct effect
+
+388
+00:27:01,970 --> 00:27:04,910
+sympathetic over stimulation  و الـ direct effect على
+
+389
+00:27:04,910 --> 00:27:08,770
+أنه يعمل increase الـ reabsorption لإنه محتاج
+
+390
+00:27:08,770 --> 00:27:11,490
+عالي بمنع الـ filtration لكن اللي بيستخدمه الـ
+
+391
+00:27:11,490 --> 00:27:14,490
+filtration بده يسحبه كله يعني، increases الـ ايش؟
+
+392
+00:27:14,490 --> 00:27:17,490
+الـ reabsorption في الـ proximal tubule و في الـ ..
+
+393
+00:27:17,490 --> 00:27:21,430
+everywhere تمام؟ everywhere لإنه
+
+445
+00:31:08,620 --> 00:31:13,080
+secreted إذا الـ filtered amount هذه تمام اللي
+
+446
+00:31:13,080 --> 00:31:20,220
+هتمثل مئة وخمس عشر ملي في الـ في الدقيقة اتنظفت
+
+447
+00:31:20,220 --> 00:31:25,830
+كليا من أي من الـ inulin مش كده؟ إذا في الحالة هذه
+
+448
+00:31:25,830 --> 00:31:32,590
+أنا بقدر أعرف كم سنتي من الدم اتنضف من الـ inulin
+
+449
+00:31:32,590 --> 00:31:39,230
+تمام؟ بشوف الـ inulin قد إيش تركيزه في الدم تمام؟
+
+450
+00:31:39,230 --> 00:31:43,130
+قد إيش الكمية اللي طلعت؟ الكمية اللي طلعت هذه تساوي
+
+451
+00:31:43,130 --> 00:31:48,930
+بنجسمها على التركيز في الدم هتنضف هيكون خمس الـ
+
+452
+00:31:48,930 --> 00:31:56,730
+blood flow تمام 125 ملي لتر اتنظفت بلازما 125 ملي
+
+453
+00:31:56,730 --> 00:32:03,190
+لتر دم هتكون نفس الـ .. لأن كلهم كانوا في الدم 125
+
+454
+00:32:03,190 --> 00:32:06,410
+سنتي من الدم اتنظف أو أكثر أو أقل لما نضرب الـ
+
+455
+00:32:06,410 --> 00:32:09,770
+factor 125 سنتي من البلازما من الـ name بيدينا factor
+
+456
+00:32:09,770 --> 00:32:14,170
+لإيه؟ الـ hematocrit مش كده؟ طيب إذا الأشياء الـ
+
+457
+00:32:14,170 --> 00:32:19,290
+clearance بتاعها تساوي نفس الـ volume تبع الـ inulin
+
+458
+00:32:19,290 --> 00:32:23,990
+اللي بتتنضف معناها دي المادة بس filtered تمام؟ لأن
+
+459
+00:32:23,990 --> 00:32:27,530
+الكمية اللي filtered هي تساوي كمية الـ inulin الـ
+
+460
+00:32:27,530 --> 00:32:31,270
+clearance of inulin تمام؟ إذا زي الـ inulin معناها
+
+461
+00:32:31,270 --> 00:32:35,160
+filtered not reabsorbed ولا secreted إذا والله الـ
+
+462
+00:32:35,160 --> 00:32:37,360
+clearance بقى أعلى من الـ inulin، معناها دي
+
+463
+00:32:37,360 --> 00:32:42,000
+filtered و secreted وإيه؟ إذا الـ clearance بقى أقل
+
+464
+00:32:42,000 --> 00:32:45,420
+من الـ inulin، معناه دي filtered و دي absorbed،
+
+465
+00:32:45,420 --> 00:32:49,180
+واضح؟ هذه علاقتنا بين الجسمين، النقطة الثانية بدي
+
+466
+00:32:49,180 --> 00:32:53,920
+أقولها الـ clearance of كرياتينين، الـ clearance of
+
+467
+00:32:53,920 --> 00:32:56,780
+كرياتينين، قلنا عيب الكرياتينين
+
+468
+00:32:58,950 --> 00:33:02,230
+هو ميزته أنه natural ميزته أنه إيه؟ natural
+
+469
+00:33:02,230 --> 00:33:06,450
+substance عيب الـ inulin أنه مادة ماهيش natural
+
+470
+00:33:06,450 --> 00:33:10,130
+بدي أعطيها بإيدي وأجيبها بإيدي وأعمل سوى لكن
+
+471
+00:33:10,130 --> 00:33:14,910
+الكرياتينين مش هجيب لا في .. لا هجيب مادة ولا إيش
+
+472
+00:33:14,910 --> 00:33:18,670
+هجيبها مباشرة، طب في ميزة تانية للكرياتينين قالت أنا
+
+473
+00:33:18,670 --> 00:33:23,130
+مش محتاج إني أجيبها مباشرة وأروح أجيب الـ ball كمان
+
+474
+00:33:23,130 --> 00:33:26,430
+وأشوف إيش طلع وأجيب مادة على هذا لإنه جينا علاقة
+
+475
+00:33:26,430 --> 00:33:32,300
+مباشرة ما بين أصلا قلت قبل كده بين كرياتينين blood
+
+476
+00:33:32,300 --> 00:33:41,640
+level و GFR طبعا قلت قبل كده، قلنا كل ما الـ GFR يوطي
+
+477
+00:33:41,640 --> 00:33:46,900
+يعني كمية الكرياتينين اللي بتطلع في البول لما الـ GFR
+
+478
+00:33:46,900 --> 00:33:50,000
+بتوطي معناها لكريرينين سبع المادة اللي بتطلع بس بالـ
+
+479
+00:33:50,000 --> 00:33:53,920
+filtration بتوطي لأن كمية الـ filtration بتوطي، إذا
+
+480
+00:33:53,920 --> 00:33:57,720
+الفيلتريشن تبع الـ .. الـ inulin لما يوطي الـ GFR
+
+481
+00:33:57,720 --> 00:33:59,920
+الفيلتريشن .. الـ .. الـ .. الـ clearance سبب الـ inulin
+
+482
+00:33:59,920 --> 00:34:04,560
+إيش هيصير فيه؟ هيوطي، لما يوطي الـ GFR الفيلتريشن تبع
+
+483
+00:34:04,560 --> 00:34:06,700
+الكرياتينين الـ .. الـ clearance سبب الكرياتينين إيش
+
+484
+00:34:06,700 --> 00:34:11,960
+هيصير فيه؟ هيوطي، لما .. طب أنا الجسم بيطلع كرياتينين
+
+485
+00:34:11,960 --> 00:34:16,480
+بمعدل ثابت، الـ excretion تبعه ثابت، إيش هيصير في الـ
+
+486
+00:34:16,480 --> 00:34:21,900
+blood level الكرياتينين؟ هيعلى، هيعلى لو إحنافترض
+
+487
+00:34:21,900 --> 00:34:28,980
+إن الـ GFR نزل للنص، علشان أنا أقدر أطلع نفس الكمية
+
+488
+00:34:28,980 --> 00:34:32,860
+اللي أطلعتها و الـ GFR طبيعي لازم الـ creatinine
+
+489
+00:34:32,860 --> 00:34:37,120
+level يتضاعف، فبيظل الـ creatinine يعلى .. يعلى ..
+
+490
+00:34:37,120 --> 00:34:40,000
+يعلى .. يعلى .. لما يصير الضعف الأولاني، لما يصير
+
+491
+00:34:40,000 --> 00:34:43,900
+الضعف الأولاني بيصير الـ excretion the same يعني
+
+492
+00:34:43,900 --> 00:34:48,840
+بيصير اللي produced من الجسم يساوي الـ .. إيه؟ الـ
+
+493
+00:34:48,840 --> 00:34:53,550
+excreted تمام؟ ليش؟ لأن الـ filtration في الآخر الـ
+
+494
+00:34:53,550 --> 00:34:57,270
+clearance في الآخر يساوي إيه؟ اللي هو قد إيش في عندي
+
+495
+00:34:57,270 --> 00:35:04,930
+.. قد إيش في عندي تركيز كرياتينين في الـ GFR مش كده؟
+
+496
+00:35:04,930 --> 00:35:09,490
+هدا يساوي الـ X created لأن نفس التركيز اللي
+
+497
+00:35:09,490 --> 00:35:13,370
+في الـ filtration هو اللي في البلازما، لما الـ
+
+498
+00:35:13,370 --> 00:35:18,070
+filtration يوطي النص البلازما عالي تركيزها الأضعف
+
+499
+00:35:18,070 --> 00:35:23,550
+صار الـ filtration of creatinine هذا يساوي التركيز
+
+500
+00:35:23,550 --> 00:35:27,410
+الجديد اللي هو الضعف في الـ GFR الجديد اللي هو النص
+
+501
+00:35:27,410 --> 00:35:31,770
+رجعه لإيه؟ اه، إذا جينا حالنا إحنا بنقدر نعرف الـ
+
+502
+00:35:31,770 --> 00:35:36,570
+GFR من خلال الـ creatinine clearance من خلال مش الـ
+
+503
+00:35:36,570 --> 00:35:39,290
+creatinine clearance محتاجين بس الـ blood level
+
+504
+00:35:40,440 --> 00:35:43,880
+تمام؟ إذا لجأنا إذا كل الـ clearance و الـ GFR و
+
+505
+00:35:43,880 --> 00:35:47,840
+الجسم هذا اختزلها من الـ creatinine blood level إذا
+
+506
+00:35:47,840 --> 00:35:51,480
+الـ creatinine blood level زاد للضعف إذا الـ GFR طيّ
+
+507
+00:35:51,480 --> 00:35:56,100
+النصف، إذا ده زاد ده ضعفه، طيّ الثلث تمام؟ إذا
+
+508
+00:35:56,100 --> 00:36:00,560
+أنا بقدر clinical test بسيط اللي هو الـ creatinine
+
+509
+00:36:00,560 --> 00:36:04,800
+أعرف من خلاله الـ kidney function و تعبرلي عن
+
+510
+00:36:04,800 --> 00:36:09,140
+kidney function من خلال الـ GFR level، GFR وطت، زادت
+
+511
+00:36:09,140 --> 00:36:13,900
+عن الطبيعية من خلال الكرياتينين واضح؟ هذا أعتقد
+
+512
+00:36:13,900 --> 00:36:17,840
+اللي أنا اليوم حابة أقوله اللي هو إيه بيمثل كل
+
+513
+00:36:17,840 --> 00:36:20,660
+العلاقات كلها، أشياء بسيطة، كلها هتفهموه، اللي إذا
+
+514
+00:36:20,660 --> 00:36:23,880
+إحنا مجنونهاش هتكون ببساطة بتقدروا تفهموه لإنه إيه
+
+515
+00:36:23,880 --> 00:36:26,520
+انشرحت فيه مباني الـ ستور، الله يعطيكم، الله، حلو من هنا
+
+516
+00:36:26,520 --> 00:36:32,920
+سؤال؟ لأ ما ضلّيش، ولا دي قالنا، طيب ما فيش مانع إذا حد
+
+517
+00:36:32,920 --> 00:36:41,730
+عنده سؤال، واضح يا بنات؟ اتفضلي، الـ clearance
+
+518
+00:36:41,730 --> 00:36:45,990
+بنقول قد إيش طلع في الـ bowl، قد إيش تركيزه في البلازما
+
+519
+00:36:45,990 --> 00:36:49,230
+اللي طلع في الـ bowl هذا يمثل كم سنتي من البلازما
+
+520
+00:36:49,230 --> 00:36:51,970
+بنجسم الطالع على تركيزه في البلازما، معناه عندي
+
+521
+00:36:51,970 --> 00:36:55,410
+تلاتة مل اتنضفت بس، حقيقة ما فيش تلاتة مل بتنضف مرة
+
+522
+00:36:55,410 --> 00:36:59,750
+واحدة بس، إحنا رقم بيدينا يا عشان نعرف الـ clearance
+
+523
+00:36:59,750 --> 00:37:03,890
+اللي هو يمثل لرقم صار مهم، رقم نسبي مش رقم absolute
+
+524
+00:37:03,890 --> 00:37:07,890
+نسبة ما بين الطالع و الموجود، مش اه عشان أبعد عن الـ
+
+525
+00:37:07,890 --> 00:37:11,010
+absolute figures، comparison، الـ comparison of
+
+526
+00:37:11,010 --> 00:37:14,930
+figures بتطلعش دقيقة لإني أنا ممكن أتكلم عن مادة
+
+527
+00:37:14,930 --> 00:37:18,570
+بسيطة طلعتها إلا إنها مهمة جدا وأتكلم عن مادة
+
+528
+00:37:18,570 --> 00:37:21,830
+طلعتها كتير لأن الكل هو على الماشي مش هتا
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/q1BVk4KKgaw_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/q1BVk4KKgaw_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..c6ca7826022ea8a5483933779f10676419a2b808
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/q1BVk4KKgaw_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2337, "start": 5.03, "end": 23.37, "text": "كانت النقطة التالتة خليني أخش عليها عيشت نفسي الـ Direct Stimulus Sodium Reabsorption in the proximal tubule, the lobophilic and the distal tubule and the collective tubule يعني في ال different parts of the نفرون Reabsorption of Sodium و Sodium طبعا يليد ال water في الغالب", "tokens": [41361, 2655, 28239, 47432, 3660, 16712, 6027, 2655, 3660, 16490, 1211, 9957, 1829, 5551, 9778, 8592, 25894, 11296, 6225, 1829, 8592, 2655, 8717, 36178, 1829, 2423, 39184, 18308, 745, 332, 26107, 42059, 2197, 1300, 17243, 284, 1695, 294, 264, 21932, 304, 10809, 2271, 11, 264, 14366, 5317, 388, 299, 293, 264, 1483, 304, 10809, 2271, 293, 264, 1263, 22909, 10809, 2271, 37495, 22653, 8978, 2423, 819, 3166, 295, 264, 8717, 5172, 2288, 11536, 1300, 17243, 284, 1695, 295, 42059, 2197, 4032, 42059, 2197, 23032, 3555, 3615, 995, 7251, 20292, 3215, 2423, 1281, 8978, 6024, 118, 6027, 3555], "avg_logprob": -0.37308672374608565, "compression_ratio": 1.5175438596491229, "no_speech_prob": 0.0, "words": [{"start": 5.03, "end": 5.43, "word": "كانت", "probability": 0.5362548828125}, {"start": 5.43, "end": 5.77, "word": " النقطة", "probability": 0.7833658854166666}, {"start": 5.77, "end": 5.99, "word": " التالتة", "probability": 0.861083984375}, {"start": 5.99, "end": 6.29, "word": " خليني", "probability": 0.7518310546875}, {"start": 6.29, "end": 6.59, "word": " أخش", "probability": 0.80419921875}, {"start": 6.59, "end": 7.25, "word": " عليها", "probability": 0.9921875}, {"start": 7.25, "end": 7.87, "word": " عيشت", "probability": 0.4517364501953125}, {"start": 7.87, "end": 8.07, "word": " نفسي", "probability": 0.8321940104166666}, {"start": 8.07, "end": 8.15, "word": " الـ", "probability": 0.3524169921875}, {"start": 8.15, "end": 8.43, "word": " Direct", "probability": 0.34521484375}, {"start": 8.43, "end": 9.07, "word": " Stimulus", "probability": 0.7210286458333334}, {"start": 9.07, "end": 9.47, "word": " Sodium", "probability": 0.933837890625}, {"start": 9.47, "end": 10.25, "word": " Reabsorption", "probability": 0.9215087890625}, {"start": 10.25, "end": 10.83, "word": " in", "probability": 0.72412109375}, {"start": 10.83, "end": 10.95, "word": " the", "probability": 0.80810546875}, {"start": 10.95, "end": 11.53, "word": " proximal", "probability": 0.93359375}, {"start": 11.53, "end": 12.03, "word": " tubule,", "probability": 0.852294921875}, {"start": 12.49, "end": 12.63, "word": " the", "probability": 0.822265625}, {"start": 12.63, "end": 13.19, "word": " lobophilic", "probability": 0.58831787109375}, {"start": 13.19, "end": 13.35, "word": " and", "probability": 0.69580078125}, {"start": 13.35, "end": 13.49, "word": " the", "probability": 0.634765625}, {"start": 13.49, "end": 13.77, "word": " distal", "probability": 0.86279296875}, {"start": 13.77, "end": 14.09, "word": " tubule", "probability": 0.9052734375}, {"start": 14.09, "end": 14.21, "word": " and", "probability": 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angiotensin two constricts different arterioles which has two effects on the peritubular capillary dynamics الميكانيزم لكن المحصلة ان هذه العملية بتقدر ال more reabsorption عبر الهيدروسيناتيكوميشتر و عبر ال كولويد البشر", "tokens": [45340, 8592, 28820, 3660, 4724, 1829, 11622, 25708, 2423, 680, 270, 836, 1040, 1410, 46367, 3321, 4724, 1829, 7435, 26895, 2423, 1975, 1829, 3224, 22807, 2423, 319, 17243, 284, 1695, 23032, 1829, 3555, 1975, 15730, 2423, 2562, 6471, 694, 259, 732, 1034, 26192, 16798, 7096, 546, 2423, 2562, 6471, 694, 259, 732, 1817, 3740, 82, 819, 30455, 1004, 306, 82, 597, 575, 732, 5065, 322, 264, 680, 270, 836, 1040, 1410, 46367, 15679, 9673, 1829, 41361, 1829, 11622, 2304, 44381, 9673, 5016, 9381, 37977, 16472, 29538, 18863, 42213, 10632, 39894, 28543, 2288, 2423, 544, 319, 17243, 284, 1695, 6225, 26890, 2423, 3224, 25708, 32887, 3794, 1829, 8315, 2655, 1829, 4117, 20498, 1829, 8592, 2655, 2288, 4032, 6225, 26890, 2423, 9122, 12610, 2407, 25708, 29739, 46309], 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"end": 1662.2, "word": " الان", "probability": 0.597412109375}, {"start": 1662.2, "end": 1662.52, "word": " احنا", "probability": 0.9796549479166666}, {"start": 1662.52, "end": 1663.6, "word": " applications", "probability": 0.9111328125}, {"start": 1663.6, "end": 1664.96, "word": " على", "probability": 0.71728515625}, {"start": 1664.96, "end": 1665.9, "word": " المسائل", "probability": 0.935302734375}, {"start": 1665.9, "end": 1666.28, "word": " هذه", "probability": 0.74755859375}, {"start": 1666.28, "end": 1667.12, "word": " نفهم", "probability": 0.9645182291666666}, {"start": 1667.12, "end": 1667.52, "word": " منها", "probability": 0.99267578125}, {"start": 1667.52, "end": 1667.78, "word": " فى", "probability": 0.564208984375}, {"start": 1667.78, "end": 1668.0, "word": " عندنا", "probability": 0.7470703125}, {"start": 1668.0, "end": 1668.44, "word": " تطبيق", "probability": 0.970458984375}, {"start": 1668.44, "end": 1668.84, "word": " اسمه", "probability": 0.9677734375}, {"start": 1668.84, "end": 1669.08, "word": " the", "probability": 0.365234375}, {"start": 1669.08, "end": 1669.58, "word": " clearance", "probability": 0.89013671875}, {"start": 1669.58, "end": 1670.42, "word": " clearance", "probability": 0.72119140625}, {"start": 1670.42, "end": 1670.74, "word": " of", "probability": 0.96240234375}, {"start": 1670.74, "end": 1671.08, "word": " كذا", "probability": 0.9599609375}, {"start": 1671.08, "end": 1671.78, "word": " clearance", "probability": 0.7685546875}, {"start": 1671.78, "end": 1672.06, "word": " of", "probability": 0.97412109375}, {"start": 1672.06, "end": 1672.5, "word": " inulin,", "probability": 0.495361328125}, {"start": 1672.66, "end": 1673.0, "word": " clearance", "probability": 0.93701171875}, {"start": 1673.0, "end": 1673.8, "word": " of", "probability": 0.97705078125}, {"start": 1673.8, "end": 1674.56, "word": " كرياتينين,", "probability": 0.75234375}, {"start": 1674.66, "end": 1674.9, "word": " clearance", "probability": 0.94775390625}, {"start": 1674.9, "end": 1675.18, "word": " of", "probability": 0.9794921875}, {"start": 1675.18, "end": 1675.38, "word": " any", "probability": 0.88525390625}, {"start": 1675.38, "end": 1675.96, "word": " substance", "probability": 0.96337890625}, {"start": 1675.96, "end": 1677.06, "word": " اذا", "probability": 0.77099609375}, {"start": 1677.06, "end": 1677.16, "word": " ال", "probability": 0.9052734375}, {"start": 1677.16, "end": 1677.44, "word": " clearance", "probability": 0.96240234375}, {"start": 1677.44, "end": 1677.66, "word": " of", "probability": 0.97021484375}, {"start": 1677.66, "end": 1678.2, "word": " substance", "probability": 0.89306640625}, {"start": 1678.2, "end": 1679.3, "word": " معينة", "probability": 0.9591471354166666}, {"start": 1679.3, "end": 1679.88, "word": " تساوي", "probability": 0.9368896484375}, {"start": 1679.88, "end": 1680.36, "word": " جديش", "probability": 0.7412109375}, {"start": 1680.36, "end": 1680.86, "word": " الكيليا", "probability": 0.6632486979166666}, {"start": 1680.86, "end": 1682.02, "word": " لما", "probability": 0.9150390625}, {"start": 1682.02, "end": 1683.38, "word": " دخلت", "probability": 0.9857177734375}, {"start": 1683.38, "end": 1683.88, "word": " الدم", "probability": 0.97998046875}, {"start": 1683.88, "end": 1684.06, "word": " اللى", "probability": 0.955810546875}, {"start": 1684.06, "end": 1684.56, "word": " داخل", "probability": 0.9884440104166666}, {"start": 1684.56, "end": 1685.44, "word": " تمام", "probability": 0.87548828125}, {"start": 1685.44, "end": 1686.12, "word": " الدم", "probability": 0.89404296875}, {"start": 1686.12, "end": 1686.28, "word": " اللى", "probability": 0.993896484375}, {"start": 1686.28, "end": 1686.74, "word": " داخل", "probability": 0.990234375}], "temperature": 1.0}, {"id": 66, "seek": 171339, "start": 1687.41, "end": 1713.39, "text": "و طالع من الكيلية جديش انا قدرت انظف جديش اعمل execution منه ال execution اللي طلع هذا يساوي جديش في أكم سانتي دم هو تمام؟ ال clearance هان احنا مش كلمة حقيقية لإن احنا تقريبا مافيش إش اللي نقدر نعمله ب run واحدة complete ال clearance من الدم", "tokens": [2407, 23032, 6027, 3615, 9154, 33251, 26895, 10632, 10874, 16254, 8592, 1975, 8315, 12174, 3215, 43500, 1975, 1863, 19913, 5172, 10874, 16254, 8592, 1975, 25957, 1211, 15058, 9154, 3224, 2423, 15058, 13672, 1829, 23032, 1211, 3615, 23758, 7251, 3794, 995, 45865, 10874, 16254, 8592, 8978, 5551, 24793, 8608, 7649, 31371, 11778, 2304, 31439, 46811, 10943, 22807, 2423, 27218, 8032, 7649, 1975, 5016, 8315, 37893, 9122, 19528, 3660, 11331, 38436, 4587, 10632, 5296, 28814, 1863, 1975, 5016, 8315, 6055, 4587, 16572, 3555, 995, 19446, 41185, 8592, 11933, 8592, 13672, 1829, 8717, 28543, 2288, 8717, 25957, 43761, 4724, 1190, 36764, 24401, 3660, 3566, 2423, 27218, 9154, 32748, 2304], "avg_logprob": -0.2190420616452939, "compression_ratio": 1.7647058823529411, "no_speech_prob": 0.0, "words": [{"start": 1687.41, "end": 1687.65, "word": "و", "probability": 0.86474609375}, {"start": 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"start": 1714.28, "end": 1739.4, "text": "حتى الأشياء اللي بيبقى minimal اللي إلها executed اللي إلها تعبير clearance بمعنى إنه الكمية اللي طلعت هذه في الكيليا في ال ball تمثل أكم سانتي من الدم تمام؟ وقلتلكم أن ال clearance هو حيلة للتعامل النسبي في عمل الكيليا بمعنى آخر إنه المواد اللي هي تركيزها واط جليل في الدم", "tokens": [33753, 7578, 16247, 8592, 1829, 16606, 13672, 1829, 4724, 1829, 3555, 4587, 7578, 13206, 13672, 1829, 11933, 1211, 11296, 17577, 13672, 1829, 11933, 1211, 11296, 37279, 3555, 13546, 27218, 4724, 2304, 3615, 1863, 7578, 36145, 3224, 33251, 2304, 10632, 13672, 1829, 23032, 1211, 34268, 29538, 8978, 33251, 26895, 25528, 8978, 2423, 2594, 46811, 12984, 1211, 5551, 24793, 8608, 7649, 31371, 9154, 32748, 2304, 46811, 10943, 22807, 4032, 4587, 1211, 2655, 23275, 2304, 14739, 2423, 27218, 31439, 11331, 26895, 3660, 24976, 2655, 3615, 10943, 1211, 28239, 35457, 1829, 8978, 6225, 42213, 33251, 26895, 25528, 4724, 2304, 3615, 1863, 7578, 19753, 34740, 36145, 3224, 9673, 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2238.11, "word": " اتكلم", "probability": 0.866455078125}, {"start": 2238.11, "end": 2238.29, "word": " عن", "probability": 0.99267578125}, {"start": 2238.29, "end": 2238.57, "word": " مادة", "probability": 0.9781901041666666}, {"start": 2238.57, "end": 2239.03, "word": " طلعتها", "probability": 0.9761962890625}, {"start": 2239.03, "end": 2239.27, "word": " كتير", "probability": 0.97265625}, {"start": 2239.27, "end": 2239.49, "word": " لإن", "probability": 0.8971354166666666}, {"start": 2239.49, "end": 2240.01, "word": " الكل", "probability": 0.572509765625}, {"start": 2240.01, "end": 2240.17, "word": " هو", "probability": 0.79296875}, {"start": 2240.17, "end": 2241.01, "word": " على", "probability": 0.88134765625}, {"start": 2241.01, "end": 2241.41, "word": " الماشي", "probability": 0.9737955729166666}, {"start": 2241.41, "end": 2241.57, "word": " مش", "probability": 0.86328125}, {"start": 2241.57, "end": 2241.83, "word": " هتا", "probability": 0.5865885416666666}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2246.60025, "duration_after_vad": 2188.766874999992}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90.srt
new file mode 100644
index 0000000000000000000000000000000000000000..5af568369efa0c464fd13af5d0a67335b44c1eaf
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+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90.srt
@@ -0,0 +1,1366 @@
+1
+00:00:18,140 --> 00:00:23,520
+بداية محاضرات حول الـ renal physiology: how the
+
+2
+00:00:23,520 --> 00:00:29,560
+kidney works, how it can control the body fluids,
+
+3
+00:00:29,560 --> 00:00:32,300
+what are the functions of the kidney in general?
+
+4
+00:00:32,300 --> 00:00:37,840
+عشان نتكلم عن هذه المسائل، لابد أن نشوف الـ field
+
+5
+00:00:37,840 --> 00:00:40,700
+الذي تعمل فيه الكلية، الكلية تعمل على الـ body
+
+6
+00:00:40,700 --> 00:00:45,140
+fluids mainly. فشم الـ body fluids هو إيش؟ بتكون، وهو
+
+7
+00:00:45,140 --> 00:00:48,710
+الموجود، من هذا المنطلق، نبدأ بإيه؟ بالـ
+
+8
+00:00:48,710 --> 00:00:51,850
+chapter خمسة وعشرين، الذي يتكلم عن الـ body
+
+9
+00:00:51,850 --> 00:00:55,390
+fluids and compartments and composition and how
+
+10
+00:00:55,390 --> 00:01:06,770
+they are controlled. لما
+
+11
+00:01:06,770 --> 00:01:11,130
+نتكلم عن الـ body fluids، نلاحظ أنه في عندي أنا في
+
+12
+00:01:11,130 --> 00:01:17,940
+الجسم body intake أو fluid intake و fluid output.  مش
+
+13
+00:01:17,940 --> 00:01:25,820
+هيك مفترض، علشان الـ homeostasis،  لأنّه
+
+14
+00:01:25,820 --> 00:01:30,560
+يكون عندي الـ intake و الـ output متساويان، مش
+
+15
+00:01:30,560 --> 00:01:41,630
+كده. واقع الأمر أن الـ input و الـ output ليسا متساويين.
+
+16
+00:01:41,630 --> 00:01:46,530
+يعني بمعنى آخر، أنّه في variations بين الناس، يعني
+
+17
+00:01:46,530 --> 00:01:54,830
+ممكن واحد يفقد كمية كبيرة من السوائل: رياضي في جو حار،
+
+18
+00:01:54,830 --> 00:02:02,490
+high metabolism عنده، وممكن واحد يفقد أقل. ممكن
+
+19
+00:02:02,490 --> 00:02:07,610
+واحد يأخذ سوائل كمية كبيرة، وممكن واحد يأخذ كمية
+
+20
+00:02:07,610 --> 00:02:12,690
+قليلة. فالـ balance هذا، في الآخر، بين الناس الذين أخذوا
+
+21
+00:02:12,690 --> 00:02:16,610
+قليلاً وأخذوا كثيراً، وفقدوا قليلاً وفقدوا كثيراً، في الآخر،
+
+22
+00:02:16,610 --> 00:02:19,970
+الـ balance الرئيسي، مسؤولية من؟ مسؤولية الكلية.
+
+23
+00:02:19,970 --> 00:02:25,130
+حقيقة، فلو طلعنا احنا على الأشياء التي تحدث في
+
+24
+00:02:25,130 --> 00:02:31,550
+الحياة البسيطة، الحياة اليومية التي لا يوجد فيها نشاط
+
+25
+00:02:31,550 --> 00:02:34,990
+عالي أو حرارة عالية، الـ standard يعني واحد يعيش
+
+26
+00:02:34,990 --> 00:02:41,750
+حياة هادئة في جو حرارة مناسب، هو يكون طبعاً وزنه
+
+27
+00:02:41,750 --> 00:02:44,990
+الـ standard الذي نتكلم عنه دائماً، نحن نتكلم عن رجل
+
+28
+00:02:44,990 --> 00:02:51,310
+adult، رجل وزنه سبعين كيلوغراماً، فالأرقام ستكون
+
+29
+00:02:51,310 --> 00:02:55,110
+إذن نتكلم عن هذا الـ standard، نجد
+
+30
+00:02:55,110 --> 00:03:01,990
+أنّه في عندنا fluid intake يومي، يتمثل في  المنقول من
+
+31
+00:03:01,990 --> 00:03:09,180
+أكل وشرب، سواء الموجودة في الخضار، في الأكل، أو سواء
+
+32
+00:03:09,180 --> 00:03:16,080
+الموجودة في نفس الـ drinks التي نأخذها، أو جزء يأتي
+
+33
+00:03:16,080 --> 00:03:22,900
+من الـ metabolism، لأنّ عملية حرق السكر، نهائياً، التي
+
+34
+00:03:22,900 --> 00:03:29,570
+في الجسم، تحوّل الـ hydrogen، في وجود حرق بالأكسجين،
+
+35
+00:03:29,570 --> 00:03:33,570
+إلى مياه، وهذه مياه إضافية تدخل الجسم، نطلع منها
+
+36
+00:03:33,570 --> 00:03:39,710
+يومياً حوالي two liters of water، ومن الـ metabolism يأتي
+
+37
+00:03:39,710 --> 00:03:46,570
+حوالي 200 مليليتر. في المقابل، معناها في عندي intake
+
+38
+00:03:46,570 --> 00:03:50,750
+يومي حوالي اثنين لتر و مائتي مليليتر،  اثنين لتر
+
+39
+00:03:50,750 --> 00:03:56,750
+ونصف، تقريباً.  نطلع فيه مصادر للـ output يومي. عندي
+
+40
+00:03:56,750 --> 00:04:04,630
+output، في عندنا أشياء ثابتة،
+
+41
+00:04:04,630 --> 00:04:08,650
+التي لا تتغير، وأشياء متغيرة. تمام. فعندنا، عندنا الـ
+
+42
+00:04:08,650 --> 00:04:13,330
+insensible losses، التي لا نشعر بها، جاية من
+
+43
+00:04:13,330 --> 00:04:20,470
+التبخر عبر الجلد، أو من الفقدان بخار الماء عبر الـ
+
+44
+00:04:20,470 --> 00:04:25,720
+respiration. وهذا نتيجة أن طبيعة الماء تظل تتبخر
+
+45
+00:04:25,720 --> 00:04:29,740
+من الجلد، لكن وجود الجلد الطبيعي هنا، الذي هو
+
+46
+00:04:29,740 --> 00:04:36,420
+cornified، يُقلّل من كمية الفقدان، قليلة، تمام؟
+
+47
+00:04:36,420 --> 00:04:41,500
+لكن تصوروا هذا الجلد، رح فقدناه في حروق وكذا،
+
+48
+00:04:41,500 --> 00:04:46,590
+معناها في عندنا كمية كبيرة من السوائل ستُفقد. هذه الـ
+
+49
+00:04:46,590 --> 00:04:50,070
+losses، ممكن تكون كمية ضخمة جداً، لو كان الجلد هذا
+
+50
+00:04:50,070 --> 00:04:54,550
+صار عليه إشكال منعه من أداء واجبه في حفظ
+
+51
+00:04:54,550 --> 00:04:58,910
+السوائل داخل الجسم. و الـ losses في الـ lungs، زي ما
+
+52
+00:04:58,910 --> 00:05:06,310
+قلنا، أنّ الـ vapor pressure في داخل، في عمومًا، في
+
+53
+00:05:06,310 --> 00:05:11,330
+الجو الهوائي، الـ atmospheric air، يكون واطئاً، في حين
+
+54
+00:05:11,330 --> 00:05:16,240
+أنّه في داخل الـ expiratory tract يكون حوالي 47
+
+55
+00:05:16,240 --> 00:05:23,200
+مليمتر زئبق. فأنا أقدر أنّه جزء، يتشبع جزء،
+
+56
+00:05:23,200 --> 00:05:26,620
+من تشبع الهواء الـ expired air، يُقدّر إلى جزء
+
+57
+00:05:26,620 --> 00:05:32,220
+يخرج من الـ fluids داخل الجسم عن طريق هذا
+
+58
+00:05:32,220 --> 00:05:38,160
+الـ expiratory air. طبعاً قلنا، نحن في وجود حالات
+
+59
+00:05:38,160 --> 00:05:44,110
+برودة شديدة، هذا يؤدي إلى أن نفقد سوائل في داخل
+
+60
+00:05:44,110 --> 00:05:49,470
+الزفير والهواء أكثر، أفضل، أكثر من الذي نفقده في
+
+61
+00:05:49,470 --> 00:05:56,910
+وجود درجة حرارة أعلى قليلاً، لأنّ تشبع الهواء الجوي في
+
+62
+00:05:56,910 --> 00:06:02,990
+وجود حرارة منخفضة يكون أقل. لذلك كمية الـ water
+
+63
+00:06:02,990 --> 00:06:07,930
+vapor التي كان يحملها الهواء، تزداد. مع كل
+
+64
+00:06:07,930 --> 00:06:12,370
+مجال التشبع يحمل كمية أكبر. إذن الـ losses هذه، ممكن
+
+65
+00:06:12,370 --> 00:06:17,450
+في بعض الظروف، تزيد أو تقل، إن كانت على skin
+
+66
+00:06:17,450 --> 00:06:21,910
+losses أو الـ lungs losses. بيجي عندنا الـ variables
+
+67
+00:06:21,910 --> 00:06:25,330
+الأخرى، التي في العادة تكون كمية كبيرة، مثل الـ sweat،
+
+68
+00:06:25,330 --> 00:06:29,430
+مثلاً، في ظروف مناسبة، لا يفقد أكثر من مليليتر في
+
+69
+00:06:29,430 --> 00:06:33,370
+اليوم، في وضع لا نعرق فيه كثيراً، يعني لا نشعر فيه
+
+70
+00:06:33,370 --> 00:06:38,500
+عرق خفيف، لكن في وجود حر، وإن شاء الله سنتكلم عن الـ
+
+71
+00:06:38,500 --> 00:06:42,340
+control of body temperature، ونشوف دور الـ sweat في الـ... في الـ... في السنة القادمة في مثل هذا الفصل،
+
+72
+00:06:42,340 --> 00:06:47,200
+فصل... الفصل القادم إن شاء الله... الـ... الـ...
+
+73
+00:06:47,200 --> 00:06:50,280
+السنة القادمة. الفصل الثاني،  ممكن الذي ذكرناه يزيد
+
+74
+00:06:50,280 --> 00:06:55,060
+ويصبح كمية ضخمة جداً، وممكن يكون very minimal أيضاً.
+
+75
+00:06:55,060 --> 00:06:59,000
+الـ losses عبر الـ feces ممكن تكون very minimal أو
+
+76
+00:06:59,000 --> 00:07:04,060
+تكون كمية ضخمة جداً، لو تعرّضنا نحن لإيه؟ لإلـ
+
+77
+00:07:04,060 --> 00:07:07,120
+إلى الالتهابات المعوية. الـ urine، مهمته في الآخر، أنّه
+
+78
+00:07:07,120 --> 00:07:12,740
+يُعدّل كل الأمور. إن زاد الفقدان في أماكن أخرى، هو
+
+79
+00:07:12,740 --> 00:07:16,940
+يقلّل، وإن قلّ الفقدان في أماكن أخرى، هو يزيد. إذا كان الـ
+
+80
+00:07:16,940 --> 00:07:21,720
+intake زاد، إن قلّ الـ intake يقل، يعني شغلته في
+
+81
+00:07:21,720 --> 00:07:26,240
+الآخر، يعمل إيش؟ ضبط لـ body fluids، بحيث أنّ الـ body
+
+82
+00:07:26,240 --> 00:07:32,180
+fluids، water and electrolytes، to be managed in
+
+83
+00:07:32,180 --> 00:07:37,400
+standard levels، عشان يحافظ على الـ homeostasis الذي
+
+84
+00:07:37,400 --> 00:07:40,860
+قلنا عليه، بحيث أنّ الـ composition of different
+
+85
+00:07:44,480 --> 00:07:48,580
+body compartments, fluid compartments، تبقى ثابتة،
+
+86
+00:07:48,580 --> 00:07:53,430
+لا تتغير، for normal function of the different cells.
+
+87
+00:07:53,430 --> 00:07:58,770
+يعني إذا تغيرت الـ environment تبع الـ cells، تغيرت
+
+88
+00:07:58,770 --> 00:08:03,410
+على شكل chemical changes أو pH changes أو
+
+89
+00:08:03,410 --> 00:08:08,510
+electrical changes أو pressure changes،
+
+90
+00:08:08,510 --> 00:08:11,050
+hydrostatic pressure changes، that will affect the
+
+91
+00:08:11,050 --> 00:08:15,370
+whole function of the cells and body. طيب، إذا
+
+93
+00:08:19,940 --> 00:08:40,060
+دور الكلية دور رئيسي في ضبط هذه المسائل، fluid
+
+94
+00:08:40,060 --> 00:08:44,610
+loss in sweat، تكلمنا عنها، وأنها ممكن تصل إلى كميات
+
+95
+00:08:44,610 --> 00:08:49,530
+كبيرة. water losses in feces، و water losses بعد
+
+96
+00:08:49,530 --> 00:08:56,350
+الكلى، الكلية هنا، إذا ممكن تُنزل لنا أو تعمل
+
+97
+00:08:56,350 --> 00:09:00,510
+execution لـ minimal urine، ممكن لا يزيد عن نصف لتر
+
+98
+00:09:00,510 --> 00:09:07,050
+في اليوم، أو ممكن تزيد عندي الـ urine إلى
+
+99
+00:09:07,050 --> 00:09:10,580
+عشرين لتراً في اليوم، يعني في عندها القدرة، تعمل
+
+100
+00:09:10,580 --> 00:09:15,300
+variations كبيرة، بحيث أنّها تضبط في الآخر الـ الـ
+
+101
+00:09:15,300 --> 00:09:18,980
+concentration of the different body fluids، الـ
+
+102
+00:09:18,980 --> 00:09:20,740
+composition، يظل ثابتاً.
+
+103
+00:09:23,320 --> 00:09:27,500
+ومن هنا، ليس فقط الـ water contents، بل أيضاً الـ electrolytes
+
+104
+00:09:27,500 --> 00:09:33,160
+contents. مثلاً، هنا عندنا، ممكن نحن نفقد الـ sodium
+
+105
+00:09:33,160 --> 00:09:36,000
+as low as twenty milliequivalent per day، في
+
+106
+00:09:36,000 --> 00:09:41,320
+الـ urine، وممكن نفقد as high as three hundred to
+
+107
+00:09:41,320 --> 00:09:44,740
+five hundred milliequivalent per day. هذا كله
+
+108
+00:09:44,740 --> 00:09:47,760
+يعتمد على الـ different exchanges التي قلنا عليها،
+
+109
+00:09:47,760 --> 00:09:51,100
+الـ input و الـ output، وهذه مهمتها أنّها تضبط الأمور.
+
+110
+00:09:51,650 --> 00:09:54,370
+إن أكلنا فسيخ، يخرج كمية كبيرة من الـ sodium،
+
+111
+00:09:54,370 --> 00:09:59,150
+chloride. وإن صمنا ولم نأكل شيئاً، تقلّ
+
+112
+00:09:59,150 --> 00:10:05,050
+الفقدان هذا. لذلك هنا، نتكلم عن هذه النقطة الآن، هذا كلام
+
+113
+00:10:05,050 --> 00:10:10,390
+general. بداية، سنتكلم عن الـ body fluids، هذه
+
+114
+00:10:10,390 --> 00:10:13,230
+السوائل، الـ body fluids، موجودة في ثلاثة
+
+115
+00:10:13,230 --> 00:10:17,610
+compartments. اثنان منهم رئيسيان: intracellular fluid
+
+116
+00:10:17,610 --> 00:10:21,930
+body compartment، و extracellular fluid compartment. وفي
+
+117
+00:10:21,930 --> 00:10:26,010
+عندنا small compartment، التي هي transcellular. في
+
+118
+00:10:26,010 --> 00:10:28,050
+حين أنّ الـ transcellular هذه، على أنّها small
+
+119
+00:10:28,050 --> 00:10:31,650
+compartment، التي أنّها ممكن في لحظة من اللحظات، تكون
+
+120
+00:10:31,650 --> 00:10:35,950
+very large compartment، و very dangerous
+
+121
+00:10:35,950 --> 00:10:39,750
+compartment. يعني هذا الـ contents تبع الـ
+
+122
+00:10:39,750 --> 00:10:42,070
+transcellular compartments، التي لا تزيد عن لترين
+
+123
+00:10:42,070 --> 00:10:47,680
+لتر أو لترين، في كل الجسم، يتمثل فيه الـ
+
+124
+00:10:47,680 --> 00:10:52,040
+serous sacs، التي قلنا عليها، الـ pleura، الـ pericardium،
+
+125
+00:10:52,040 --> 00:10:56,700
+الـ peritoneum، الـ synovial fluids، الـ intraocular
+
+126
+00:10:56,700 --> 00:11:00,020
+fluids، السوائل المختلفة، هذه الـ transcellular
+
+127
+00:11:00,020 --> 00:11:04,240
+compartments، التي أنّها ممكن فجأة، لمرض معيّن،
+
+128
+00:11:04,650 --> 00:11:10,630
+تستوعب كمية ضخمة. وحكيت لكم عن liver failure أو
+
+129
+00:11:10,630 --> 00:11:14,810
+liver cirrhosis، الذي يحدث نتيجة تليف الكبد،
+
+130
+00:11:14,810 --> 00:11:20,510
+وكيف أنّه يقدر أن يكون transludation للـ... للـ
+
+131
+00:11:20,510 --> 00:11:24,590
+fluids في داخل الـ peritoneal cavity، ويقدر الـ peritoneal
+
+132
+00:11:24,590 --> 00:11:32,160
+cavity يحتوي على عشرين لتراً أو أكثر، يعني أكثر من
+
+133
+00:11:32,160 --> 00:11:35,920
+المرأة الحامل، يكون بطنها منتفخاً من كثرة ما هو مليء
+
+134
+00:11:35,920 --> 00:11:40,280
+بسوائل. نسحب منه عشرين، ثلاثين liter fluid في بعض
+
+135
+00:11:40,280 --> 00:11:44,640
+الحالات، نضطر إلى أن نسحب. يصبح له ضغط، هكذا، في
+
+136
+00:11:44,640 --> 00:11:48,820
+transfer your body compartment، على بساطتها، وعلى
+
+137
+00:11:48,820 --> 00:11:54,560
+صغرها، التي هنا، فجأة ممكن تتحوّل إلى خطر شديد.
+
+138
+00:11:54,560 --> 00:11:58,610
+الـ pleura، الذي هو عندما يكون عندي أنا التهاب في الرئة،
+
+139
+00:11:58,610 --> 00:12:03,570
+تمام، ويصبح  بلوري، التهاب وصل طرف البلورا، يصبح
+
+140
+00:12:03,570 --> 00:12:06,830
+الـ كوب الذي فيه الـ fluids داخل البلورا، تعمل
+
+141
+00:12:06,830 --> 00:12:10,430
+الـ pleural effusion، كمية ضخمة. وطبعاً في حالات، يعني
+
+142
+00:12:10,430 --> 00:12:13,830
+الـ heart failure أو الـ generalized edema، ممكن تُقدّر
+
+143
+00:12:13,830 --> 00:12:18,030
+الـ transcellular هذه الـ compartments، تتحوّل إلى
+
+144
+00:12:18,030 --> 00:12:22,230
+compartment ضخمة. عشان كده يسمّونها potential spaces.
+
+145
+00:12:23,090 --> 00:12:28,150
+لماذا؟ لأنّهم قابلين على أن يستوعبوا
+
+146
+00:12:28,150 --> 00:12:32,230
+كميات كبيرة. في العادة، لا تكون big spaces و small
+
+147
+00:12:32,230 --> 00:12:36,410
+spaces، لكن فجأة ممكن تتحوّل إلى big spaces، large
+
+148
+00:12:36,410 --> 00:12:42,450
+إذا الـ intracellular مفهومة، تُفصلها عن الـ
+
+149
+00:12:42,450 --> 00:12:45,290
+extracellular، الـ cell membrane. الـ extracellular
+
+150
+00:12:45,290 --> 00:12:50,500
+ينقسم إلى: Interstitial و plasma، يُفصلها الـ capillary
+
+151
+00:12:50,500 --> 00:12:53,660
+membrane. و الـ transcellular تُفصلها عن الـ
+
+152
+00:12:53,660 --> 00:12:57,500
+extracellular، complete serous sac, serous membrane،
+
+153
+00:12:57,500 --> 00:13:03,400
+الذي هو إيش؟ ممكن يكون هذا الـ serous membrane الـ
+
+154
+00:13:03,400 --> 00:13:06,910
+pleura، الأغشية التي قلنا عنها، الـ serous
+
+155
+00:13:06,910 --> 00:13:10,830
+sacs in general، التي لها two layers، واحد يكون
+
+156
+00:13:10,830 --> 00:13:15,490
+visceral، واحد يكون parietal. مش هكذا؟ عشان الـ fluids
+
+157
+00:13:15,490 --> 00:13:20,410
+تدخل داخل الـ... الـ membrane، الـ... الـ compartment،
+
+158
+00:13:20,410 --> 00:13:24,110
+هذه، يجب أن تتجاوز الـ serous membrane، إن كان الـ parietal
+
+159
+00:13:24,110 --> 00:13:28,390
+one، أو كان الـ visceral one. يعتمد على أين حدث
+
+160
+00:13:28,390 --> 00:13:31,350
+الخطر. في العادة، يأتي من الـ visceral، ساعات، في العادة،
+
+161
+00:13:31,350 --> 00:13:34,450
+يأتي من إيش؟ من الـ visceral side، لأنّه يأتي من الـ
+
+162
+00:13:34,450 --> 00:13:43,110
+visceral، الـ... الـ oozing أو الـ transudation الـ
+
+163
+00:13:43,110 --> 00:13:49,850
+body fluids. قلنا جسمنا هذا عبارة عن fluids، ولو
+
+164
+00:13:49,850 --> 00:13:54,010
+أنّنا نراه إيش؟ يعني صلب، إلا أنّ الـ solid
+
+165
+00:13:54,010 --> 00:13:59,720
+فيه أربعون في المائة، و الـ fluid فيه ستون في المائة.  لا، ليس
+
+166
+00:13:59,720 --> 00:14:04,800
+هكذا فقط. في الأطفال، الـ fluids ثمانون في المائة، لو
+
+167
+00:14:04,800 --> 00:14:07,400
+فصلنا هذا عنها، نجد ثمانون في المائة fluids في
+
+168
+00:14:07,400 --> 00:14:10,620
+الأطفال. ومن هنا، خطورة الـ fluids والتعامل معها في
+
+169
+00:14:10,620 --> 00:14:13,680
+الأطفال، لأنّ الطفل ثمانون في المائة منه fluids، لأنّ
+
+170
+00:14:13,680 --> 00:14:21,730
+حدث فيه إسهال شديد، بسهولة يدخل فيه انخفاض في الـ
+
+171
+00:14:21,730 --> 00:14:26,250
+fluids، شيء مثل الـ dehydration، وهذا يؤثّر على ليس
+
+172
+00:14:26,250 --> 00:14:30,710
+فقط الـ blood pressure، تبعه، يؤثّر على كل شيء في جسمه.
+
+173
+00:14:30,710 --> 00:14:34,370
+طبعاً يفقد السوائل هذه بسرعة، يدخل في shock، وممكن
+
+174
+00:14:34,370 --> 00:14:38,430
+يموت في ثوانٍ. و الـ cholera التي نخاف منها، الـ
+
+175
+00:14:38,430 --> 00:14:42,690
+cholera، التي هي بعبع،  cholera رهيبة
+
+223
+00:19:00,170 --> 00:19:02,890
+اللي بتيجي الـ intake اللي بيجي عبر الجسر اللي
+
+224
+00:19:02,890 --> 00:19:07,620
+بتستنى الـ tract تمام، بييجي عبر الـ plasma أو حتى الـ
+
+225
+00:19:07,620 --> 00:19:10,660
+parental medications اللي إحنا بنعملها برضه عبر الـ
+
+226
+00:19:10,660 --> 00:19:16,260
+plasma، و الـ plasma هذه هي، و الـ interstitial fluid
+
+227
+00:19:16,260 --> 00:19:20,800
+في عملية mixing مستمر، ليش؟ لإن في عندنا الـ
+
+228
+00:19:20,800 --> 00:19:24,140
+capillary pores موجودة، فاتحة، كل اللي هان ممكن
+
+229
+00:19:24,140 --> 00:19:29,480
+ينجلهان مع ده، large plasma proteins، في عندنا small
+
+230
+00:19:29,480 --> 00:19:33,090
+plasma proteins بتخش، وقلنا إن البلازما بروتينز الـ
+
+231
+00:19:33,090 --> 00:19:37,650
+small اللي بتدخش بتطلع عبر إيه؟ عبر الـ lymphatics
+
+232
+00:19:37,650 --> 00:19:41,350
+مش كده؟ ولو بقت في داخل الـ interstitial fluid
+
+233
+00:19:41,350 --> 00:19:48,170
+مشكلة كبيرة، تمام؟ لإنها بتشكل عنصر جديد، ليش؟ لإن
+
+234
+00:19:48,170 --> 00:19:51,110
+العناصر اللي بتتحكم في الـ fluids بتدخل و تطلع هنا
+
+235
+00:19:51,110 --> 00:19:56,330
+عبارة عن عنصرين: hydrostatic pressure و osmotic
+
+236
+00:19:56,330 --> 00:20:03,730
+pressure، بمعنى إنك، أوتك، براشر، أوتك، براشر، أوتك،
+
+237
+00:20:03,730 --> 00:20:10,850
+براشر، أوتك، براشر، أوتك، براشر، أوتك، براشر،
+
+238
+00:20:10,850 --> 00:20:12,030
+أوتك، براشر، أوتك، براشر، أوتك، براشر، أوتك،
+
+239
+00:20:12,030 --> 00:20:13,670
+براشر، أوتك، براشر، أوتك، براشر، أوتك، براشر،
+
+240
+00:20:13,670 --> 00:20:14,170
+أوتك، براشر، أوتك، براشر، أوتك، براشر، أوتك،
+
+241
+00:20:14,170 --> 00:20:14,310
+براشر، أوتك، براشر، أوتك، براشر، أوتك، براشر،
+
+242
+00:20:14,310 --> 00:20:18,310
+أوتك، براشر، أوتك، براشر، أوتك، براشر، أوتك،
+
+243
+00:20:18,310 --> 00:20:23,990
+براشر، أوتك، براشر، أوتك، براشر، أوتك، براشر، أوتك
+
+244
+00:20:24,210 --> 00:20:27,590
+مش هيك؟ وعندي oncotic pressure في الـ بلازما، بلازما
+
+245
+00:20:27,590 --> 00:20:30,990
+بروتينز، oncotic pressure بتمنع إيه؟ الـ filtration
+
+246
+00:20:30,990 --> 00:20:35,410
+لما يكون عندي صار مع الـ pressure، الـ hydrostatic
+
+247
+00:20:35,410 --> 00:20:38,850
+pressure، الضغط، قده إلى أن small proteins تيجي في
+
+248
+00:20:38,850 --> 00:20:41,830
+الـ interstitial fluid، هذا بيقود إلى، عندي صار عندي
+
+249
+00:20:41,830 --> 00:20:45,530
+أهم two factors مهمين، صار الـ hydrostatic pressure
+
+250
+00:20:45,530 --> 00:20:48,490
+بيتجه في اتجاه الـ filtration، و الـ oncotic pressure
+
+251
+00:20:48,490 --> 00:20:51,370
+في الـ interstitial fluid بيتجه في اتجاه الـ
+
+252
+00:20:51,370 --> 00:20:57,430
+filtration، تمام؟مفترض إنه في مرحلتين من المراحل
+
+253
+00:20:57,430 --> 00:21:01,350
+إيه، دراسات كبيرة، شهرين، خفض، إحنا، أنا ما قلتلكمش
+
+254
+00:21:01,350 --> 00:21:06,190
+إن الـ الـ الـ capillary circulation هذه اللي بدنا
+
+255
+00:21:06,190 --> 00:21:12,330
+نتكلم عنها، capillary circulation بسميها الـ الـ
+
+256
+00:21:12,330 --> 00:21:16,710
+capillaries هذه محكومة بـ بـ sphincters pre
+
+257
+00:21:16,710 --> 00:21:19,930
+capillary، في sphincter، في عندنا الـ capillaries
+
+258
+00:21:19,930 --> 00:21:29,330
+عبارة عن إيه؟ عن مجموعات، يعني عندنا إيه؟ set
+
+259
+00:21:29,330 --> 00:21:33,130
+of capillaries موجودة لها pre capillary
+
+260
+00:21:33,130 --> 00:21:37,670
+sphincter، وهاد الـ sphincter بيفتح لحظة لحظات، و
+
+261
+00:21:37,670 --> 00:21:41,030
+بعدين بيسكر، في الوقت اللي بيفتح فيه بيصير
+
+262
+00:21:41,030 --> 00:21:44,630
+perfusion للـ capillaries بالـ blood، بالـ plasma، و الـ
+
+263
+00:21:44,630 --> 00:21:47,250
+blood، وبيزيد فيه الـ pressure، وبيصير الـ
+
+264
+00:21:47,250 --> 00:21:52,150
+filtration، في الوقت اللي capillary هاد بيسكر الـ
+
+265
+00:21:52,150 --> 00:21:57,120
+sphincter، أقصد بيسكر، البراشر الهيدروستاتيك بيقل، لكن
+
+266
+00:21:57,120 --> 00:22:03,920
+الـ براشر الأنكوتيك موجود، بيتغيرش، هذا يعني بيتغيرش، أن
+
+267
+00:22:03,920 --> 00:22:07,080
+البروتينز موجودة، لكن هو طبعاً لما يصير filtration
+
+268
+00:22:07,080 --> 00:22:11,580
+أنكوتك البراشر إيه؟ بيعلق، لما نقصد بـ fluids يعود
+
+269
+00:22:11,580 --> 00:22:17,440
+يرجع، البراشر، طيب عندنا الـ .. الـ .. الـ capillaries
+
+270
+00:22:17,440 --> 00:22:22,040
+عشرة في المية فقط في الوقت الواحد فاتحة، يعني عشرة
+
+271
+00:22:22,040 --> 00:22:26,320
+في المية من الـ capillary beds تبع الجسم فاتحة، at
+
+272
+00:22:26,320 --> 00:22:29,440
+one time، تمام، يعني تسعين في المية من الـ capillary
+
+273
+00:22:29,440 --> 00:22:33,800
+beds بتكون مسكرة، و alternatively الـ bed هذا بيفتح
+
+274
+00:22:33,800 --> 00:22:39,940
+هذا بيسكر، هذا بيفتح، هذا بيسكر، تمام، واضح؟ إذا في عندي
+
+275
+00:22:39,940 --> 00:22:44,300
+أنا أو جال الـ capillary bed هذا بيصير فيه الـ blood
+
+276
+00:22:44,300 --> 00:22:48,440
+دخله على الـ pressure، خلفي، بيصير عامة الـ filtration
+
+277
+00:22:49,850 --> 00:22:54,750
+خلص دوره، بيسكر، طبعاً في factors بتحكم كده، يدخل، و كده
+
+278
+00:22:54,750 --> 00:22:58,970
+يفتح، و كده، هندرس إن شاء الله في وجهتها بيفتح bed
+
+279
+00:22:58,970 --> 00:23:02,430
+آخر، وهذا الـ bed اللي سكر عنه، قدام الـ hydrostatic
+
+280
+00:23:02,430 --> 00:23:06,750
+pressure، رجع للـ zero، تمام، فالـ oncotic pressure
+
+281
+00:23:06,750 --> 00:23:10,530
+بصراحة هو الـ إيه؟ الـ upper hand له، فبيروح بيسحب كل الـ
+
+282
+00:23:10,530 --> 00:23:14,110
+fluids اللي دخلت، لكن في عندي عنصر إن الـ
+
+283
+00:23:14,110 --> 00:23:18,390
+hydrostatic pressure بيضغط، إشي، لبرافه، هو بيضغط، بيضغط
+
+284
+00:23:18,390 --> 00:23:20,750
+معاها كمان small proteins، ففي عند small proteins
+
+285
+00:23:20,750 --> 00:23:24,030
+ديش، ده الـ .. اللي درسيش، fluid، لكن الـ oncotic
+
+286
+00:23:24,030 --> 00:23:28,850
+pressure بيشفط مية، بيقدرش يرجع الـ proteins اللي
+
+287
+00:23:28,850 --> 00:23:33,430
+فقدت بالـ إيه؟ بالـ mechanical pressure، تمام، فمن رحمة
+
+288
+00:23:33,430 --> 00:23:38,670
+ربنا علينا إن نعمل إيه؟ طريق موازن آخر، تمام، okay
+
+289
+00:23:38,670 --> 00:23:45,520
+فبالـ lymphatics بتشفط الـ fluids الزائدة، ومعها الـ
+
+290
+00:23:45,520 --> 00:23:49,920
+small proteins اللي تم تهريبها، عشان تظهر الـ factor
+
+291
+00:23:49,920 --> 00:23:54,680
+هذا، عملية الـ filtration و الـ absorption و الـ
+
+292
+00:23:54,680 --> 00:23:58,540
+tissue fluids ما تتغيرش، لإنه لو صار obstruction للـ
+
+293
+00:23:58,540 --> 00:24:02,100
+lymphatic، زي اللي بيصير في بعض الأمراض، بتقود إلى إن الـ
+
+294
+00:24:02,100 --> 00:24:05,600
+fluids اللي بتطلع، و الـ small proteins اللي بتطلع عبر
+
+295
+00:24:05,600 --> 00:24:09,620
+الـ filtration، الـ interstitial compartment بتظهر
+
+296
+00:24:09,620 --> 00:24:16,970
+موجودة، و مش لاقية اللي هو، مش لاقية الـ lymphatics اللي
+
+297
+00:24:16,970 --> 00:24:20,630
+تسحبها، لإن الـ lymphatics مسكرة، في مرات بيكون في جينات اللي
+
+298
+00:24:20,630 --> 00:24:24,670
+عندنا، أبليزيا للـ lymphatics بتقود لمنطقة، إن
+
+299
+00:24:24,670 --> 00:24:28,090
+الـ lymphatics الرئيسية تبعتها في الآخر مسكرة، فاللي
+
+300
+00:24:28,090 --> 00:24:32,750
+مابتقدرش تشتغل، فالـ small proteins يعني بتقعد، و
+
+301
+00:24:32,750 --> 00:24:38,590
+بتزيد، و بتقود إلى الـ edema الموجودة، أحياناً اللي
+
+302
+00:24:38,590 --> 00:24:42,030
+بيكون عندنا مرض معين، بيضرب lymph nodes، الـ lymph
+
+303
+00:24:42,030 --> 00:24:44,610
+nodes، طبعاً هم المفاصل تبعت الـ إيه؟ الطرق تبعت الـ
+
+304
+00:24:44,610 --> 00:24:51,150
+إيه؟ الـ road crossings اللي إيه؟ لازم يعديها الـ
+
+305
+00:24:51,150 --> 00:24:54,290
+lymphatic إلى أن تخرج من مكان إلى مكان، فإذا الـ
+
+306
+00:24:54,290 --> 00:24:58,730
+lymph node مضروبة، صار فيها filariasis, fibrosis
+
+307
+00:24:58,730 --> 00:25:03,550
+كده، بيسكر، بيصير lymphatic مش قادرة، فالـ lymphatic
+
+308
+00:25:03,550 --> 00:25:07,030
+fluid بيضل في إيه؟ بيضل في الـ interstitial fluid
+
+309
+00:25:08,750 --> 00:25:12,630
+المهم فيه إن الـ proteins مش قادرة تطلع، هو الـ
+
+310
+00:25:12,630 --> 00:25:15,670
+fluids في الآخر بتعود تنسحب، لكن الـ proteins موجودة
+
+311
+00:25:15,670 --> 00:25:19,530
+أكثر، معناه إن oncotic pressure زاد، أكثر، معناه بيدها more
+
+312
+00:25:19,530 --> 00:25:23,350
+fluids، عشان الـ hydrostatic pressure، عشان الـ
+
+313
+00:25:23,350 --> 00:25:27,190
+osmolality تبقى متساوي هنا وهنا، فهيحافظ على more
+
+314
+00:25:27,190 --> 00:25:32,340
+إيه؟ more fluids، مع حاجة، عملية الـ إيه؟ الـ edema هذه
+
+315
+00:25:32,340 --> 00:25:35,900
+اللي بنسميها lymphedema، لإنها edema بسبب
+
+316
+00:25:35,900 --> 00:25:38,620
+obstruction of the of lymphatics، بنسميها
+
+317
+00:25:38,620 --> 00:25:45,920
+lymphedema، هذا بالنسبة للـ إيه؟ أهمية الـ plasma
+
+318
+00:25:45,920 --> 00:25:51,840
+إنها المعبر
+
+319
+00:25:52,480 --> 00:25:56,380
+لوصول الأشياء إلى الـ interstitial fluid، ومنها إلى
+
+320
+00:25:56,380 --> 00:26:03,040
+الـ intracellular compartment، تمام؟ وإنه في factors
+
+321
+00:26:03,040 --> 00:26:08,500
+بتحكم في الـ plasma هذه، جديش يطلع منها، و جديش
+
+322
+00:26:08,500 --> 00:26:13,420
+يرجع لها، طبعاً الـ hydrostatic pressure بيقود إلى إنه
+
+323
+00:26:13,420 --> 00:26:17,920
+يصير filtration إلى خارج الـ capillary لحد ما يقل
+
+324
+00:26:17,920 --> 00:26:21,860
+الـ pressure، بسبب إنه إنه نفقد الـ fluids جاعدين
+
+325
+00:26:22,640 --> 00:26:26,240
+البراشر بيهبط، بيهبط، بيهبط، في الكابيلارية، تمام
+
+326
+00:26:26,240 --> 00:26:31,240
+البراشر، يعني شيء مليانة فيه ضغط، نسحب منه شوية، شوية
+
+327
+00:26:31,240 --> 00:26:36,040
+شوية، كل ما نسحب منه بيهبط، مش كده؟ فالـ hydrostatic
+
+328
+00:26:36,040 --> 00:26:40,020
+pressure اللي ضخ ودخل ضغط عالي، هذا هيعمل
+
+329
+00:26:40,020 --> 00:26:43,720
+filtration، و كل ما فيه filtration أكثر، كل ما يضغط
+
+330
+00:26:43,720 --> 00:26:46,940
+الـ hydrostatic pressure، إيش؟ بيقل، بيقل لحد ما
+
+331
+00:26:46,940 --> 00:26:51,850
+يصير الـ hydrostatic pressure يساوي الـ oncotic pressure
+
+332
+00:26:51,850 --> 00:26:56,090
+فيتوقف الـ filtration، تمام، يتوقف الـ filtration في
+
+333
+00:26:56,090 --> 00:26:56,650
+الحالة هذه
+
+334
+00:27:01,500 --> 00:27:05,320
+كل، طبعاً إن شاء الله الـ capillary circulation مش
+
+335
+00:27:05,320 --> 00:27:08,240
+عارف، أنا هشرحها لكم بعد كده، ولا أنتم هتاخدوها في
+
+336
+00:27:08,240 --> 00:27:11,780
+الـ .. في الـ cardiovascular، و كده، في الغالب الدكتور
+
+337
+00:27:11,780 --> 00:27:15,820
+محمد حبيب هشرحها لكم بالتفصيل، لكن عملية في الـ
+
+338
+00:27:15,820 --> 00:27:19,280
+capillaries بيصير filtration و reabsorption في
+
+339
+00:27:19,280 --> 00:27:21,440
+مرحلة بيصير filtration، و في مرحلة بيصير
+
+340
+00:27:21,440 --> 00:27:26,300
+reabsorption، و الفرق بينهم بيروح في الـ lymphatics
+
+341
+00:27:26,300 --> 00:27:28,800
+الفرق بينهم على الـ lymphatics، تعالى
+
+342
+00:27:33,400 --> 00:27:42,940
+blood volume، الـ blood له قصة مختلفة شوية، إنه هو هو
+
+343
+00:27:42,940 --> 00:27:50,100
+هو صدق، هذا الـ blood volume، نقدر إحنا طبعاً الـ blood
+
+344
+00:27:50,100 --> 00:27:53,600
+volume، كتير مهم، الـ blood volume له يعني، فقط الـ
+
+345
+00:27:53,600 --> 00:27:58,540
+plasma، الـ blood volume يعني الـ plasma زائد الـ إيه؟
+
+346
+00:27:58,540 --> 00:28:05,530
+زائد الـ cells، طبعاً الـ plasma زائد الـ cells، الـ
+
+347
+00:28:05,530 --> 00:28:09,510
+cells في داخل الـ plasma، ممكن إحنا نفصلهم مع بعض
+
+348
+00:28:09,510 --> 00:28:13,110
+طبعاً هو الـ cells mainly red blood cells، لإن لما
+
+349
+00:28:13,110 --> 00:28:16,590
+نقارن red blood cells لـ الـ other cells لا يتقارن
+
+350
+00:28:16,590 --> 00:28:21,370
+الـ red blood cells هم بالملايين، إحنا لو عملنا
+
+351
+00:28:21,370 --> 00:28:27,030
+centrifugation لـ الـ blood هذا، فيه hematocrit tube
+
+352
+00:28:27,510 --> 00:28:33,710
+هنلاحظ إحنا إنه الجزء الـ fluid انفصل عن الجزء الـ
+
+353
+00:28:33,710 --> 00:28:41,270
+solid، مش كده؟ اللي هنلاقي إنه أربعين في المية من
+
+354
+00:28:41,270 --> 00:28:48,790
+الدم red blood cells، و ستين في المية، طيب باقي الـ
+
+355
+00:28:48,790 --> 00:28:51,550
+white blood cells و الـ platelets و الكذا هنلاقيهم
+
+356
+00:28:51,550 --> 00:28:56,130
+بين الاتنين، هنلاقي هذا الوضع واضح، إن هاد الوضع الصافي
+
+357
+00:28:56,130 --> 00:29:01,650
+وهذا بلازما، وهذا واضح إنّه اللون أحمر غامق، وهذا
+
+358
+00:29:01,650 --> 00:29:09,130
+الوضع بلازما، وهذا الوضع بلازما، وهذا الوضع بلازما،
+
+359
+00:29:09,130 --> 00:29:13,250
+وهذا الوضع بلازما، وهذا الوضع بلازما، وهذا الوضع
+
+360
+00:29:13,250 --> 00:29:15,350
+بلازما، وهذا الوضع بلازما، وهذا الوضع بلازما، وهذا
+
+361
+00:29:15,350 --> 00:29:15,590
+الوضع بلازما، وهذا الوضع بلازما، وهذا الوضع بلازما،
+
+362
+00:29:15,590 --> 00:29:15,650
+وهذا الوضع بلازما، وهذا الوضع بلازما، وهذا الوضع
+
+363
+00:29:15,650 --> 00:29:21,430
+بلازما، وهذا الوضع بلازما، وهذا الوضع بلازما، وهذا
+
+364
+00:29:21,430 --> 00:29:26,230
+الوضع، بالمية، طبعاً إذا عرفنا إحنا حجم البلازما
+
+365
+00:29:26,230 --> 00:29:33,310
+أو حجم الـ red blood cells، نقدر نعرف الـ total مش
+
+366
+00:29:33,310 --> 00:29:36,950
+كده، بسهولة، نقدر نحسب الـ total، هذا ما يسمى الـ
+
+367
+00:29:36,950 --> 00:29:40,810
+hematocrit، إذا الـ solid part، solid part of the
+
+368
+00:29:40,810 --> 00:29:44,650
+blood is called the hematocrite، تمام، إذا الـ
+
+369
+00:29:44,650 --> 00:29:47,810
+hematocrite، بقياس جديش عندي solid part مقارنة بالـ
+
+370
+00:29:47,810 --> 00:29:54,050
+total، هم مش الـ fluid part، مش أكترهم، عشان كده ما
+
+371
+00:29:54,050 --> 00:29:57,030
+تتلخبطوش في الحسبة، لأن دائماً إحنا بنتكلم عادة
+
+372
+00:29:57,030 --> 00:30:00,950
+عن الـ solid part، مش عن الـ إيه؟ الـ plasma part، تمام
+
+373
+00:30:00,950 --> 00:30:05,310
+فلما نعرف إحنا البلازما جديش نسبتها، ونعرف الـ
+
+374
+00:30:05,310 --> 00:30:09,090
+إيه؟ الـ hematocrit، تمام، إذا من خلال معرفة البلازما
+
+375
+00:30:09,090 --> 00:30:13,810
+بقدر أعرف الـ total blood volume، من خلال معرفة الـ
+
+376
+00:30:13,810 --> 00:30:18,610
+الـ hematocrit، أو red blood cells، ممكن أعرف الـ
+
+377
+00:30:18,610 --> 00:30:25,790
+total blood volume، طبعاً الـ blood كتير مهم، لإنه غير
+
+378
+00:30:25,790 --> 00:30:32,330
+إنه يحتوي على الـ RBCs، هو يحتوي على الضغط اللازم، مش
+
+379
+00:30:32,330 --> 00:30:35,750
+كده، في pressure، هذا الـ pressure موجود في الـ blood
+
+380
+00:30:35,750 --> 00:30:40,590
+vessels، تمام، و عنصر أساسي من المحافظة على الـ
+
+381
+00:30:40,590 --> 00:30:45,070
+pressure في داخل الـ blood، كده،  في عنده volume، إذا
+
+382
+00:30:45,070 --> 00:30:49,920
+volume الـ blood راح ينزل، الـ pressure إيه؟ ينزل، إذا هو
+
+383
+00:30:49,920 --> 00:30:52,460
+الـ blood pressure في الآخر علاقة ما بين الـ volume
+
+384
+00:30:52,460 --> 00:30:58,900
+ما بين الـ volume اللي هو يمثل الـ blood، الـ contents
+
+385
+00:30:58,900 --> 00:31:02,740
+و الوعاء اللي هو فيه، و الـ blood vessel، يعني إذا
+
+386
+00:31:02,740 --> 00:31:08,220
+الدم اللي في داخل الوعاء قل، إيه؟ بقل، طيب
+
+387
+00:31:08,220 --> 00:31:12,160
+الدم ما قلش، لكن الوعاء نفسه كبر، vasodilation، برضه
+
+388
+00:31:12,160 --> 00:31:17,090
+إيه؟ هيقل، إذا لازم أحافظ على blood vessels مظبوطة، و
+
+389
+00:31:17,090 --> 00:31:20,170
+أحافظ على blood volume مظبوط، من هنا الـ blood
+
+390
+00:31:20,170 --> 00:3
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..135573cdd1cddefa72dd5bb7ab0100e292e17f92
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90_postprocess.srt
@@ -0,0 +1,1616 @@
+1
+00:00:18,140 --> 00:00:23,520
+بداية محاضرات حول ال renal physiology how the
+
+2
+00:00:23,520 --> 00:00:29,560
+kidney works how it can control the body fluids
+
+3
+00:00:29,560 --> 00:00:32,300
+what are the functions of the kidney in general
+
+4
+00:00:32,300 --> 00:00:37,840
+عشان نتكلم عن هذه المسائل لابد ان نشوف ال field
+
+5
+00:00:37,840 --> 00:00:40,700
+اللي بتشغل فيه ال kidney الكلية بتشغل على ال body
+
+6
+00:00:40,700 --> 00:00:45,140
+fluids mainly فشم ال body fluids هو إيش بتكون و هو
+
+7
+00:00:45,140 --> 00:00:48,710
+الموجودين من هذا المنطلق هم نبدأ بال إيه؟بال
+
+8
+00:00:48,710 --> 00:00:51,850
+chapter خمسة و عشرين اللي هو بتكلم عن ال body
+
+9
+00:00:51,850 --> 00:00:55,390
+fluids and compartments and composition and how
+
+10
+00:00:55,390 --> 00:01:06,770
+they are controlled لما
+
+11
+00:01:06,770 --> 00:01:11,130
+نتكلم عن ال body fluids بنلاحظ أنه في عندي أنا في
+
+12
+00:01:11,130 --> 00:01:17,940
+الجسمbody intake أو fluid intake و fluid output مش
+
+13
+00:01:17,940 --> 00:01:25,820
+هيك مفترض علشان ال .. ال homeostasis verbosis انه
+
+14
+00:01:25,820 --> 00:01:30,560
+يكون عندى ال .. ال intake و ال output متساوي مش
+
+15
+00:01:30,560 --> 00:01:41,630
+كده واقع الأمر انه ال input و ال outputمش متساوي
+
+16
+00:01:41,630 --> 00:01:46,530
+يعني بمعنى اخر انه في variations بين الناس يعني
+
+17
+00:01:46,530 --> 00:01:54,830
+ممكن واحد يفقد كمية كبيرة من السوائل رياضي جو حار
+
+18
+00:01:54,830 --> 00:02:02,490
+high metabolism عنده و ممكن واحد يفقد اقل ممكن
+
+19
+00:02:02,490 --> 00:02:07,610
+واحد ياخد سوائل كمية كبيرة و ممكن واحد ياخد كمية
+
+20
+00:02:07,610 --> 00:02:12,690
+جليلةفال balance هذا في الآخر بين الناس اللي أخدت
+
+21
+00:02:12,690 --> 00:02:16,610
+جليل و أخدت كتير و فقدت جليل و فجلت قليل في الآخر
+
+22
+00:02:16,610 --> 00:02:19,970
+ال balance الرئيسي مسئولية مين مسئولية الكلية
+
+23
+00:02:19,970 --> 00:02:25,130
+حقيقة فلو طلعنا احنا على الأشياء اللي بتصير في
+
+24
+00:02:25,130 --> 00:02:31,550
+الحياة البسيطة الحياة اليومية اللي مافيش فيها نشاط
+
+25
+00:02:31,550 --> 00:02:34,990
+عالي او حرارة عالية ال standard يعني واحد عايش
+
+26
+00:02:34,990 --> 00:02:41,750
+حياة هادئةفي جو حرارة مناسب في هو يكون طبعا وزنه
+
+27
+00:02:41,750 --> 00:02:44,990
+ال standard بتتكلم عنه دايما احنا بنتكلم عن راجل
+
+28
+00:02:44,990 --> 00:02:51,310
+adult زلمة وزنه سبعين كيلو اجرام فالالقان تبقى
+
+29
+00:02:51,310 --> 00:02:55,110
+اتنا بتتكلم عن هذا ال ايه ال standard بتطلع بنلاقي
+
+30
+00:02:55,110 --> 00:03:01,990
+انه في عندنا fluid intake يومي تتمثل في المناكل من
+
+31
+00:03:01,990 --> 00:03:09,180
+اكل شربسواء الموجودة في الخضار في الأكل أو سواء
+
+32
+00:03:09,180 --> 00:03:16,080
+الموجودة في نفس ال drinks اللى بناخدها او جزء بيجي
+
+33
+00:03:16,080 --> 00:03:22,900
+من ال metabolism لإنه العملية حرق السكر نهائي اللى
+
+34
+00:03:22,900 --> 00:03:29,570
+في الجسم بيحول ال hydrogenفي وجود حرقه بالأكسجين
+
+35
+00:03:29,570 --> 00:03:33,570
+إلى مياه وهذه مياه إضافية بتدخل الجسم نطلع منها
+
+36
+00:03:33,570 --> 00:03:39,710
+يوميا حوالي two liters of water ومن الميتابرزم يجي
+
+37
+00:03:39,710 --> 00:03:46,570
+حوالي 200 مليليتر في المقابل معناها في عندي intake
+
+38
+00:03:46,570 --> 00:03:50,750
+يومي حوالي اتنين لتر و تلتمية مليلتر اتنين مليلتر
+
+39
+00:03:50,750 --> 00:03:56,750
+و نص حاجزة كده نطلع فيه مصادر لل output يوميعندي
+
+40
+00:03:56,750 --> 00:04:04,630
+output في عندنا أشياء ثابتة
+
+41
+00:04:04,630 --> 00:04:08,650
+لاتتغير و أشياء متغيرة تمام فعندنا عندنا ال
+
+42
+00:04:08,650 --> 00:04:13,330
+insensible losses اللي احنا مانحسش فيها جاية من
+
+43
+00:04:13,330 --> 00:04:20,470
+التبخر عبر الجلد او من الفقدان بخار الماء عبر ال
+
+44
+00:04:20,470 --> 00:04:25,720
+respirationوهذا نتج على ان طبيعة الميه بتظل تتبخر
+
+45
+00:04:25,720 --> 00:04:29,740
+من الجلد لكن وجود الجلد الطبيعي هنا اللي هو
+
+46
+00:04:29,740 --> 00:04:36,420
+cornified بيقدر الى انه كمية الفقدان قليلة، تمام؟
+
+47
+00:04:36,420 --> 00:04:41,500
+لكن تصوروا هذا الجلد راح فقدناه في حروق وكذا،
+
+48
+00:04:41,500 --> 00:04:46,590
+معناه في عندنا كمية كبيرة من السوائل هتفقدفهذه ال
+
+49
+00:04:46,590 --> 00:04:50,070
+losses ممكن تكون كمية ضخمة جدا لو كان الجلد هذا
+
+50
+00:04:50,070 --> 00:04:54,550
+صار عليه إيه إشكال منعه من أداء واجبه في حفظ
+
+51
+00:04:54,550 --> 00:04:58,910
+السوائل داخل الجسم و ال losses في ال lungs زي ما
+
+52
+00:04:58,910 --> 00:05:06,310
+قلنا انه ال ال vapor pressure في داخل في عموما في
+
+53
+00:05:06,310 --> 00:05:11,330
+الجو الهوائي ال atmospheric air بيكون واطي في حين
+
+54
+00:05:11,330 --> 00:05:16,240
+انه في داخل الالـ expiratory tract بيكون حوالي 47
+
+55
+00:05:16,240 --> 00:05:23,200
+ملي متر ميركوري فانا بيقدر إلى انه جزء يتشبع جزء
+
+56
+00:05:23,200 --> 00:05:26,620
+من تشبع تبع الهواء الـ expired air بيقدر إلى جزء
+
+57
+00:05:26,620 --> 00:05:32,220
+يطلع من ال .. من ال fluids داخل الجسم عن طريق هذا
+
+58
+00:05:32,220 --> 00:05:38,160
+ال expiratory air طبعا قلنا احنا في وجود حالات
+
+59
+00:05:38,160 --> 00:05:44,110
+برودة شديدةهذا يؤدي إلى أننا نفقد سوائل في داخل
+
+60
+00:05:44,110 --> 00:05:49,470
+الاستجابة والهواء اكتر افضل اكتر من اللي بنفقده في
+
+61
+00:05:49,470 --> 00:05:56,910
+وجود درجة حرارة اعلى شوية لان تشبع الهواء الجوي في
+
+62
+00:05:56,910 --> 00:06:02,990
+وجود حرارة منخفضة بيكون اقل فلذلك كمية ال water
+
+63
+00:06:02,990 --> 00:06:07,930
+vapor اللي كان بي carried by air increased مع الكل
+
+64
+00:06:07,930 --> 00:06:12,370
+مجال التشبع بيحمل كمية أكبر إذا ال losses هذه ممكن
+
+65
+00:06:12,370 --> 00:06:17,450
+بعض الظروف تخليها تزيد أو تجل إن كانت على skin
+
+66
+00:06:17,450 --> 00:06:21,910
+losses أو ال lungs losses بيجي عندنا ال variables
+
+67
+00:06:21,910 --> 00:06:25,330
+الأخرى اللي في العادة بتكون كمية جليلة زي ال sweat
+
+68
+00:06:25,330 --> 00:06:29,430
+مثلا في ظروف مناسبة مايفقدش أكتر من ملي لتر في
+
+69
+00:06:29,430 --> 00:06:33,370
+اليوم في وضع احنا مانا عرقش كتير يعني مانحسش فيه
+
+70
+00:06:33,370 --> 00:06:38,500
+عرق خفيفلكن في وجود حر و ان شاء الله هنتكلم عن ال
+
+71
+00:06:38,500 --> 00:06:42,340
+control of body temperature و نشوف دور ال .. ال
+
+72
+00:06:42,340 --> 00:06:47,200
+sweat في .. في ال .. السنة الجاية في مثل هيك فاصل،
+
+73
+00:06:47,200 --> 00:06:50,280
+فاصل .. الفاصل الجاي ان شاء الله .. ال .. ال ..
+
+74
+00:06:50,280 --> 00:06:55,060
+السنة الجاية الفاصل التانيفممكن اللي سوتها ده يزيد
+
+75
+00:06:55,060 --> 00:06:59,000
+ويصير كمية ضخمة جدا وممكن يكون very minimal كمان
+
+76
+00:06:59,000 --> 00:07:04,060
+ال losses عبر ال feces ممكن تكون very minimal او
+
+77
+00:07:04,060 --> 00:07:07,120
+تكون كمية ضخمة جدا لو اتعرضنا احنا لا ايه لا
+
+78
+00:07:07,120 --> 00:07:12,740
+الاتهابات الدائرية ال urine مهمته في الآخر انه
+
+79
+00:07:12,740 --> 00:07:16,940
+يعدل كل الأمورإن زادت الفقدان في أماكن أخرى هو
+
+80
+00:07:16,940 --> 00:07:21,720
+بيجل وإن جل الفقدان في أماكن أخرى هو بيزيد إذا دي
+
+81
+00:07:21,720 --> 00:07:26,240
+ال intake بيزيد إن جل ال intake بيجل يعني شغلته في
+
+82
+00:07:26,240 --> 00:07:32,180
+الآخر يعمل إيه؟ ضبط ل ال body fluids بحيث أنهbody
+
+83
+00:07:32,180 --> 00:07:37,400
+fluids water and electrolytes to be managed in
+
+84
+00:07:37,400 --> 00:07:40,860
+standard levels عشان يحافظ على ال homeostasis اللي
+
+85
+00:07:40,860 --> 00:07:44,480
+قولنا عليه بحيث انه ال composition of different
+
+86
+00:07:44,480 --> 00:07:48,580
+body compartments fluid compartments تبقى ثابتة
+
+87
+00:07:48,580 --> 00:07:53,430
+ماتتغيرشfor normal function of the different cells
+
+88
+00:07:53,430 --> 00:07:58,770
+يعني اذا اتغيرت ال environment تبع ال cells اتغيرت
+
+89
+00:07:58,770 --> 00:08:03,410
+على شكل chemical changes او pH changes او
+
+90
+00:08:03,410 --> 00:08:08,510
+electrical changes او pressure changes ,
+
+91
+00:08:08,510 --> 00:08:11,050
+hydrostatic pressure changes that will affect the
+
+92
+00:08:11,050 --> 00:08:15,370
+whole function of the cells and body طيب اذا
+
+93
+00:08:19,940 --> 00:08:40,060
+دور الكلية دور رئيسي في ضبط هذه البسائل fluid
+
+94
+00:08:40,060 --> 00:08:44,610
+loss in sweat كلمنا عنهاو انها ممكن تصل الى كميات
+
+95
+00:08:44,610 --> 00:08:49,530
+كبيرة water losses in feces و water losses بعد
+
+96
+00:08:49,530 --> 00:08:56,350
+الكدنى الكلية هنا اذا ممكن تنزل لنا او تعمل
+
+97
+00:08:56,350 --> 00:09:00,510
+execution ل minimal urine ممكن مايزيدش عن نص لتر
+
+98
+00:09:00,510 --> 00:09:07,050
+في اليوم او ممكن تقدر ان يزيد عندي ال urine الى
+
+99
+00:09:07,050 --> 00:09:10,580
+عشرين لتر في اليوميعني في عندها القدرة عليها تعمل
+
+100
+00:09:10,580 --> 00:09:15,300
+variations كبيرة بحيث انها تضبط في الآخر ال ال
+
+101
+00:09:15,300 --> 00:09:18,980
+concentration of the different body fluids ال
+
+102
+00:09:18,980 --> 00:09:20,740
+composition يظل ثابت
+
+103
+00:09:23,320 --> 00:09:27,500
+و من هنا مش بس ال water contents برضه ال electrode
+
+104
+00:09:27,500 --> 00:09:33,160
+contents مثلا هنا عندنا ممكن احنا نفقد ال sodium
+
+105
+00:09:33,160 --> 00:09:36,000
+as low as twenty milliequivalent per day في
+
+106
+00:09:36,000 --> 00:09:41,320
+اليورين و ممكن نفقد as high as three hundred to
+
+107
+00:09:41,320 --> 00:09:44,740
+five hundred milliequivalent per day هذا كله
+
+108
+00:09:44,740 --> 00:09:47,760
+بيعتمد على ال different exchanges اللي قلنا عليها
+
+109
+00:09:47,760 --> 00:09:51,100
+ال input و ال output و هذه مهمتها انها تظبط الأمور
+
+110
+00:09:51,650 --> 00:09:54,370
+إن أكلنا فسيخ بيبطلع كمان ضخم من ال sodium
+
+111
+00:09:54,370 --> 00:09:59,150
+chloride وإن أكلنا أنصومنا وماكناش إشي بتتجلل
+
+112
+00:09:59,150 --> 00:10:05,050
+الفقدان هذا لذلك هنا متكلم عن الآية الآن هذا كلام
+
+113
+00:10:05,050 --> 00:10:10,390
+general بداية هنتكلم عن ال body fluids هذه
+
+114
+00:10:10,390 --> 00:10:13,230
+الموجودة ال body fluids موجودة في تلاتة
+
+115
+00:10:13,230 --> 00:10:17,610
+compartments تنين منهم رئيسيات intracellularfluid
+
+116
+00:10:17,610 --> 00:10:21,930
+body compartment وaccessory fluid compartment وفى
+
+117
+00:10:21,930 --> 00:10:26,010
+عندنا small compartment اللى هى transcellular فى
+
+118
+00:10:26,010 --> 00:10:28,050
+حين ان ال transcellular هذه علي انها small
+
+119
+00:10:28,050 --> 00:10:31,650
+compartment اللى انها ممكن فى لحظة من اللحظات يكون
+
+120
+00:10:31,650 --> 00:10:35,950
+very large compartment و very dangerous
+
+121
+00:10:35,950 --> 00:10:39,750
+compartment يعني هذا ال contents تبعت ال
+
+122
+00:10:39,750 --> 00:10:42,070
+transcellular compartments اللى لازجين عن اتنين
+
+123
+00:10:42,070 --> 00:10:47,680
+لتر لتر الا اتنين لترفي كل الجسم يتمثل فيه ال
+
+124
+00:10:47,680 --> 00:10:52,040
+sirus sex اللي قلنا عليها ال plura ال pericardium
+
+125
+00:10:52,040 --> 00:10:56,700
+ال peritoneum ال synovial fluids ال intraocular
+
+126
+00:10:56,700 --> 00:11:00,020
+fluids ال different fluids هاي ال transcellular
+
+127
+00:11:00,020 --> 00:11:04,240
+compartments اللي انها ممكن فجأة ل disease معينة
+
+128
+00:11:04,650 --> 00:11:10,630
+تستوعب كمية ضخمة وانا حكيتلكم عن liver failure او
+
+129
+00:11:10,630 --> 00:11:14,810
+liver cirrhosis اللى بيصير ناتج عن البلهرزيزيز
+
+130
+00:11:14,810 --> 00:11:20,510
+وكيف انه بيقدر انه يصير transludation لل .. لل
+
+131
+00:11:20,510 --> 00:11:24,590
+fluids في داخل البروتنيا ال cavity ويقدر البروتنيا
+
+132
+00:11:24,590 --> 00:11:32,160
+ال cavity يحتوي على عشرين لتر او اكتريعني أكتر من
+
+133
+00:11:32,160 --> 00:11:35,920
+المرأة الحامل بيكون بطنه قدامه من كتر ما هو مليانة
+
+134
+00:11:35,920 --> 00:11:40,280
+fluids نسحب منه عشرين تلاتين liter fluid في بعض
+
+135
+00:11:40,280 --> 00:11:44,640
+الحالات نضطر إلى نسحب بيبقى كاتب نفسه ضغط كده ف
+
+136
+00:11:44,640 --> 00:11:48,820
+transfer your body compartment على بساطتها وعلى
+
+137
+00:11:48,820 --> 00:11:54,560
+جلتها اللي هنا فجأة ممكن تنقلب إلى خطر شديد
+
+138
+00:11:54,560 --> 00:11:58,610
+البلورةاللي هو عندما يصير عندى انا التهاب فى الرقى
+
+139
+00:11:58,610 --> 00:12:03,570
+تمام ويصير بلوريزى التهاب وصل طرف البلورا بيصير
+
+140
+00:12:03,570 --> 00:12:06,830
+الكوب اللى ايه ال fluids فى داخل البلورا بتعمل
+
+141
+00:12:06,830 --> 00:12:10,430
+البلورا ال effusion كمية ضخمة وطبعا فى حالات يعنى
+
+142
+00:12:10,430 --> 00:12:13,830
+ال heart failure او ال generalized edema ممكن تقدى
+
+143
+00:12:13,830 --> 00:12:18,030
+ال transcellular هدوة ال compartments يتحولوا ال
+
+144
+00:12:18,030 --> 00:12:22,230
+compartment ضخمة عشان كده بيسموهم potential spaces
+
+145
+00:12:23,090 --> 00:12:28,150
+ليش؟ لأن هم قابلين على انهم يدوا الى يستوعبوا
+
+146
+00:12:28,150 --> 00:12:32,230
+كميات كبيرة في العادة مابيجوش big spaces و small
+
+147
+00:12:32,230 --> 00:12:36,410
+spaces لكن فجأة ممكن يتحولوا الى big spaces large
+
+148
+00:12:36,410 --> 00:12:42,450
+اذا ال intracellular مفهومة بتفصلها عن ال
+
+149
+00:12:42,450 --> 00:12:45,290
+extracellular cell membrane ال extracellular
+
+150
+00:12:45,290 --> 00:12:50,500
+بيبتنقسم جسمينوإبلازمة بيفصلهم الـ capillary
+
+151
+00:12:50,500 --> 00:12:53,660
+membrane و ال transcellular بيفصلها عن ال
+
+152
+00:12:53,660 --> 00:12:57,500
+extracellular complete serous sac, serous membrane
+
+153
+00:12:57,500 --> 00:13:03,400
+اللي هو إيه؟ ممكن يكون هذا ال serous membrane ال
+
+154
+00:13:03,400 --> 00:13:06,910
+pluralالمنبرين اللي هو زى ما قلنا احنا ال sirus
+
+155
+00:13:06,910 --> 00:13:10,830
+sex in general اللي ها two layers واحد بيكون
+
+156
+00:13:10,830 --> 00:13:15,490
+visceral واحد بيكون parietal مش كده عشان ال fluids
+
+157
+00:13:15,490 --> 00:13:20,410
+تدخل داخل ال .. ال membrane ال .. ال compartment
+
+158
+00:13:20,410 --> 00:13:24,110
+هذه لازم تعدى ال sirus membrane ان كان ال parietal
+
+159
+00:13:24,110 --> 00:13:28,390
+one او كان ال visceral one يعتمد على انه وين صار
+
+160
+00:13:28,390 --> 00:13:31,350
+الخطر في العادة بيجي من ال visceral ساعاتفي العادة
+
+161
+00:13:31,350 --> 00:13:34,450
+بيجي من ايه؟ من ال visceral side لإنه بيجي من ال
+
+162
+00:13:34,450 --> 00:13:43,110
+viscous ال .. ال oozing أو ال transudation ال
+
+163
+00:13:43,110 --> 00:13:49,850
+body fluids قولنا جسمنا هذا عبارة عن fluids ولو
+
+164
+00:13:49,850 --> 00:13:54,010
+انه احنا شايفينه ايه يعني solid الا انه ال solid
+
+165
+00:13:54,010 --> 00:13:59,720
+فيه اربعين المية و ال fluid فيه ستين في الميةلأ مش
+
+166
+00:13:59,720 --> 00:14:04,800
+كده و بس في الأطفال ال fluids تمانية في المية لو
+
+167
+00:14:04,800 --> 00:14:07,400
+فصلنا هذا عنها نجد تمانية في المية fluids في
+
+168
+00:14:07,400 --> 00:14:10,620
+الأطفال و من هنا خطورة ال fluids و التعامل معها في
+
+169
+00:14:10,620 --> 00:14:13,680
+الأطفال لإن الطفل تمانية في المية منه fluids لإن
+
+170
+00:14:13,680 --> 00:14:21,730
+خش فيه ديارية شديدة بسهولة بيخش فيهانخفاض في ال
+
+171
+00:14:21,730 --> 00:14:26,250
+fluids حاجة مثلا ال dehydration وهذا بيأثر على مش
+
+172
+00:14:26,250 --> 00:14:30,710
+بس ال blood pressure تبعه بيأثر على كل شيء في جسمه
+
+173
+00:14:30,710 --> 00:14:34,370
+طبعا بيفقد السواق ده بسرعة بيخش في shock و ممكن
+
+174
+00:14:34,370 --> 00:14:38,430
+يموت في ثواني و ال cholera اللي احنا بنخاف منها ال
+
+175
+00:14:38,430 --> 00:14:42,690
+cholera اللي هي بعبع كنزة cholera رهيبة لإنه هتموت
+
+176
+00:14:42,690 --> 00:14:48,530
+ألاف الناسلا تفعل ما تفعله إلا عبر ال dehydration
+
+177
+00:14:48,530 --> 00:14:53,550
+تخلي أنه في فرصة لفقدان كمية كبيرة من السوائل عبر
+
+178
+00:14:53,550 --> 00:14:59,570
+ال intestinal عبر ال intestinal membrane الميكوزا
+
+179
+00:14:59,570 --> 00:15:03,610
+ال membrane و اللي تستفل حدها دي بيصير بيصير
+
+180
+00:15:03,610 --> 00:15:07,650
+الميكوزا تبعتها secreting fluids بسبب ال toxins
+
+181
+00:15:07,650 --> 00:15:12,460
+تبعت ال ايه ال cholera اللي بتخليال .. الـ mucosal
+
+182
+00:15:12,460 --> 00:15:16,340
+membrane of the intestine is secreting more fluids
+
+183
+00:15:16,340 --> 00:15:20,240
+than reabsorbing بتقدي إلى فقدان كمية ضخمة which
+
+184
+00:15:20,240 --> 00:15:24,420
+is dangerous can be .. can be killing and it is
+
+185
+00:15:24,420 --> 00:15:28,380
+killing really if you are not يعني ايه replacing
+
+186
+00:15:28,380 --> 00:15:33,620
+the losses لذلك احنا فهمنا لل body fluids كتير مهم
+
+187
+00:15:33,620 --> 00:15:40,390
+في امراض في جراحةفي تعامل مع أطفال بالذات بكرا جزء
+
+188
+00:15:40,390 --> 00:15:45,150
+منكوا هيكون طبيبات أطفال و الطفل فورا من حد ما
+
+189
+00:15:45,150 --> 00:15:49,790
+يبدأ يفقد سوائل لازم نستبدلها ان كان orally او كان
+
+190
+00:15:49,790 --> 00:15:54,770
+parent related ليش؟ لأنه لايحتمل الطفل فقدان سوائل
+
+191
+00:15:54,770 --> 00:16:03,410
+كثير لأنها خطيرة عليه جدا قلنا 60% عندنا سوائل 60%
+
+192
+00:16:03,410 --> 00:16:10,190
+سوائل طب و الأطفال؟تمانين اذا ال age مهم في مسألة
+
+193
+00:16:10,190 --> 00:16:15,290
+السوائل ففي الطفل عندي سوائل اكتر في ال adult اقل
+
+194
+00:16:15,290 --> 00:16:23,950
+في ال old age اقل اه اه لان ال fat في ال old age
+
+195
+00:16:23,950 --> 00:16:28,930
+زادت فنسبة السوائل في الفاتد ايش هو اقل لذلك من
+
+196
+00:16:28,930 --> 00:16:33,650
+هنا مع ال obesity اذا بتغير لان ال obesity بتقدر
+
+197
+00:16:33,650 --> 00:16:38,800
+ال moreadipose tissue which has less water
+
+198
+00:16:38,800 --> 00:16:43,000
+contents طبعا مع ال .. ال .. ال .. ال gender ما
+
+199
+00:16:43,000 --> 00:16:48,200
+نقول الفيميل أيضا دايما more .. more obese عن
+
+200
+00:16:48,200 --> 00:16:53,980
+الفيميل فلذلك بيكون يعني مش obese أقصد فيها انه ال
+
+201
+00:16:53,980 --> 00:16:57,380
+adipose tissue نسبته أعلى من نسبة ال adipose
+
+202
+00:16:57,380 --> 00:17:01,420
+tissue في ال a في المية من هذا المنطلق بيصير عندي
+
+203
+00:17:01,420 --> 00:17:09,530
+فروقات ال 60% هذهتتوزع الى 40% من وزن الجسم 40 من
+
+204
+00:17:09,530 --> 00:17:13,470
+الستين موجودين انترال سيلولار وعشرين موجودين
+
+205
+00:17:13,470 --> 00:17:17,850
+انترال سيلولار إذا الكم الأكبر من ال fluid موجود
+
+206
+00:17:17,850 --> 00:17:21,970
+انترال سيلولار اه ال extra cellular برضه مجسم
+
+207
+00:17:21,970 --> 00:17:29,640
+لجسمين interstitial part و plasmaهن بيفرج عن هن
+
+208
+00:17:29,640 --> 00:17:33,640
+cell membrane أما التفتيش عن بلزمة بيفرج ال
+
+209
+00:17:33,640 --> 00:17:35,160
+capillary membrane
+
+210
+00:17:42,310 --> 00:17:49,070
+إذا الكم لما نقول 40% يعني من راجل وزده 70 كيلو
+
+211
+00:17:49,070 --> 00:17:55,630
+تساوي 28 لتر و ال interest ratio بتطلع اللي هي تلت
+
+212
+00:17:55,630 --> 00:18:00,450
+ارباع ال 20 15% تساوي حوالي 11 لتر و ال plasma
+
+213
+00:18:00,450 --> 00:18:04,670
+تساوي خمسة .. تساوي تلاتة لتر الدم كله خمسة أو
+
+214
+00:18:04,670 --> 00:18:05,310
+خمسة و نص
+
+215
+00:18:15,160 --> 00:18:19,420
+الجملة دي خليتها موجودة عشان اقولكوا انها كم خلية
+
+216
+00:18:19,420 --> 00:18:25,500
+في جسم الإنسان اول اشهر المليون عارفين انه له ست
+
+217
+00:18:25,500 --> 00:18:30,800
+صفار مش كده و ال billion تسعة صفار و التريليون
+
+218
+00:18:30,800 --> 00:18:36,280
+اتناشر الجسم فيه خمس و سبعين تريليون خلية خمس و
+
+219
+00:18:36,280 --> 00:18:42,610
+سبعين ايش تريليون خليةبيحتوى على 40% من سوائل
+
+220
+00:18:42,610 --> 00:18:49,370
+الجسم 40% من سوائل الجسم ال extra cellular جولنا
+
+221
+00:18:49,370 --> 00:18:56,210
+بتنقسم إلى خسمين اهمية انه interstitial و plasma
+
+222
+00:18:56,210 --> 00:19:00,170
+انه ال plasma هي اللي بتاخد من ال out ال inputs
+
+223
+00:19:00,170 --> 00:19:02,890
+اللي بتيجي ال intake اللي بيجي عبر الجسر اللي
+
+224
+00:19:02,890 --> 00:19:07,620
+بتستنى ال tract تمامبييجي عبر ال plasma أو حتى ال
+
+225
+00:19:07,620 --> 00:19:10,660
+parental medications اللي احنا بنعملها برضه عبر ال
+
+226
+00:19:10,660 --> 00:19:16,260
+plasma و ال plasma هذه هي و ال interstitial fluid
+
+227
+00:19:16,260 --> 00:19:20,800
+في عملية mixing مستمر ليش؟ لإن في عندنا ال
+
+228
+00:19:20,800 --> 00:19:24,140
+capillary pores موجودة فاتحة كل اللي هان ممكن
+
+229
+00:19:24,140 --> 00:19:29,480
+ينجلهان مع ده large plasma proteins في عندنا small
+
+230
+00:19:29,480 --> 00:19:33,090
+plasma proteins بتخشوقلنا ان البلازما بروتينز ال
+
+231
+00:19:33,090 --> 00:19:37,650
+small اللى بتدخش بتطلع عبر ايه؟ عبر ال lymphatics
+
+232
+00:19:37,650 --> 00:19:41,350
+مش كده؟ ولو بقيت في داخل ال interstitial fluid
+
+233
+00:19:41,350 --> 00:19:48,170
+مشكلة كبيرة تمام؟ لإنها بتشكل عنصر جديد ليش؟ لإن
+
+234
+00:19:48,170 --> 00:19:51,110
+العناصر اللى بتتحكم في ال fluids تدخل و تطلع هنا
+
+235
+00:19:51,110 --> 00:19:56,330
+عبارة عن عنصرين hydrostatic pressure و osmotic
+
+236
+00:19:56,330 --> 00:20:03,730
+pressureبمعنى انكوتك براشر انكوتك براشر انكوتك
+
+237
+00:20:03,730 --> 00:20:10,850
+براشر انكوتك براشر انكوتك براشر انكوتك براشر
+
+238
+00:20:10,850 --> 00:20:12,030
+انكوتك براشر انكوتك براشر انكوتك براشر انكوتك
+
+239
+00:20:12,030 --> 00:20:13,670
+براشر انكوتك براشر انكوتك براشر انكوتك براشر
+
+240
+00:20:13,670 --> 00:20:14,170
+انكوتك براشر انكوتك براشر انكوتك براشر انكوتك
+
+241
+00:20:14,170 --> 00:20:14,310
+براشر انكوتك براشر انكوتك براشر انكوتك براشر
+
+242
+00:20:14,310 --> 00:20:18,310
+انكوتك براشر انكوتك براشر انكوتك براشر انكوتك
+
+243
+00:20:18,310 --> 00:20:23,990
+براشر انكوتك براشر انكوتك براشر انكوتك براشر انكوت
+
+244
+00:20:24,210 --> 00:20:27,590
+مش هيك؟ وعندي oncotic pressure في البلازما بلازما
+
+245
+00:20:27,590 --> 00:20:30,990
+بروتينز oncotic pressure بتمنع ايه ال filtration
+
+246
+00:20:30,990 --> 00:20:35,410
+لما يكون عندي صار مع ال pressure ال hydrostatic
+
+247
+00:20:35,410 --> 00:20:38,850
+pressure الضغط قده إلى ان small proteins تيجي في
+
+248
+00:20:38,850 --> 00:20:41,830
+ال interstitial fluid هذا بيقده إلى عنده صار عندي
+
+249
+00:20:41,830 --> 00:20:45,530
+اهم two factors مهمين صار ال hydrostatic pressure
+
+250
+00:20:45,530 --> 00:20:48,490
+بيتغط في اتجاه ال filtration و ال oncotic pressure
+
+251
+00:20:48,490 --> 00:20:51,370
+في ال interstitial fluid بيتغط في اتجاه ال
+
+252
+00:20:51,370 --> 00:20:57,430
+filtration تمام؟مفترض انه في مرحلين من المراحل
+
+253
+00:20:57,430 --> 00:21:01,350
+ايها دروسات كبيرة شهرانين خفض احنا انا ماقلتلكمش
+
+254
+00:21:01,350 --> 00:21:06,190
+انه ال ال ال capillary circulation هذه اللي بدنا
+
+255
+00:21:06,190 --> 00:21:12,330
+نتكلم عنها capillary circulation بسميها ال ال
+
+256
+00:21:12,330 --> 00:21:16,710
+capillaries هذه محكومة ب ب sphincters pre
+
+257
+00:21:16,710 --> 00:21:19,930
+capillary في sphincter في عندنا ال capillaries
+
+258
+00:21:19,930 --> 00:21:29,330
+عبارة عن ايه عن مجموعاتيعني عندنا ايه set
+
+259
+00:21:29,330 --> 00:21:33,130
+of capillaries موجودها الها pre capillary
+
+260
+00:21:33,130 --> 00:21:37,670
+sphincter و هاد ال sphincter بيفتح لحظة لحظات و
+
+261
+00:21:37,670 --> 00:21:41,030
+بعدين بيسكر في الوقت اللي بيفتح فيه بيصير
+
+262
+00:21:41,030 --> 00:21:44,630
+perfusion لل capillaries بال blood بال plasma وال
+
+263
+00:21:44,630 --> 00:21:47,250
+blood و بيزيد فيه ال pressure و بيصير ال
+
+264
+00:21:47,250 --> 00:21:52,150
+filtration في الوقت اللي capillary هاد بيسكر ال
+
+265
+00:21:52,150 --> 00:21:57,120
+sphincter اقصد بيسكرالبراشر الهيدروسك بيجلل لكن
+
+266
+00:21:57,120 --> 00:22:03,920
+البراشر الأنكوته موجود بيتغيرش هذا يعني بيتغيرش أن
+
+267
+00:22:03,920 --> 00:22:07,080
+البروتينز موجودة لكن هو طبعا لما يصير filtration
+
+268
+00:22:07,080 --> 00:22:11,580
+انكوته البراشر ايه بيعلق لما نقصح ب fluids يعود
+
+269
+00:22:11,580 --> 00:22:17,440
+يرجع البراشر طيب عندنا ال .. ال .. ال capillaries
+
+270
+00:22:17,440 --> 00:22:22,040
+عشرة في المية فقط في الوقت الواحد فاتحةيعني عشرة
+
+271
+00:22:22,040 --> 00:22:26,320
+في المية من ال capillary beds تبع الجسم فتحة at
+
+272
+00:22:26,320 --> 00:22:29,440
+one time تمام يعني تسعين في المية من ال capillary
+
+273
+00:22:29,440 --> 00:22:33,800
+beds بتكون مسكرة و alternatively ال bed هذا بيفتح
+
+274
+00:22:33,800 --> 00:22:39,940
+هذا بسكر هذا بفتح هذا بسكر تمام واضح؟ اذا في عندي
+
+275
+00:22:39,940 --> 00:22:44,300
+انا او جات ال capillary bed هذا بيصير فيه ال blood
+
+276
+00:22:44,300 --> 00:22:48,440
+دخله على ال pressure خلفي بيصير عامة ال filtration
+
+277
+00:22:49,850 --> 00:22:54,750
+خلص دوره بيسكر طبعا في factors يحكم كده يدخل و كده
+
+278
+00:22:54,750 --> 00:22:58,970
+يفتح و كده تلدرس ان شاء الله في وجهتها بيفتح bed
+
+279
+00:22:58,970 --> 00:23:02,430
+اخر وهذا ال bed اللي سكر عنه قدام ال hydrostatic
+
+280
+00:23:02,430 --> 00:23:06,750
+pressure رجع لل zero تمام فالunquotable pressure
+
+281
+00:23:06,750 --> 00:23:10,530
+بصحر هو ال ايه ال upper hand له فبروح بيسحب كل ال
+
+282
+00:23:10,530 --> 00:23:14,110
+fluids اللي دخلت لكن في عندي انعنصر ان ال
+
+283
+00:23:14,110 --> 00:23:18,390
+hydrostatic pressure بيضغط اشي لبرافهو بيضغط بيضغط
+
+284
+00:23:18,390 --> 00:23:20,750
+معاها كمان small proteins ففي عند small proteins
+
+285
+00:23:20,750 --> 00:23:24,030
+ديش ده ال .. اللي درسيش fluid لكن ال uncooked
+
+286
+00:23:24,030 --> 00:23:28,850
+pressure بيشفط ميه بيقدرش يرجع ال proteins اللي
+
+287
+00:23:28,850 --> 00:23:33,430
+فقدت بال إيه بال mechanical pressure تمام فمن رحمة
+
+288
+00:23:33,430 --> 00:23:38,670
+ربنا علينا إن نعملها إيه طريق موازن آخر تمام okay
+
+289
+00:23:38,670 --> 00:23:45,520
+فبال lymphatics بتشفط ال fluids الزائدة و معهاالـ
+
+290
+00:23:45,520 --> 00:23:49,920
+small proteins اللي تم تهريبها عشان تظهر ال factor
+
+291
+00:23:49,920 --> 00:23:54,680
+هذا عملية ال filtration و ال absorption و ال
+
+292
+00:23:54,680 --> 00:23:58,540
+tissue fluids ما تتغيرش لإنه لو صار obstruction لل
+
+293
+00:23:58,540 --> 00:24:02,100
+lymphatic زي اللي بيصير في بعض الأمراض بتقدي ان ال
+
+294
+00:24:02,100 --> 00:24:05,600
+fluids اللي بتطلع لل small proteins اللي بتطلع عبر
+
+295
+00:24:05,600 --> 00:24:09,620
+ال filtration ال interstitial compartment بتظهر
+
+296
+00:24:09,620 --> 00:24:16,970
+موجودة و مش لاجف اللي هومش لاجئة الليمفاتكس اللى
+
+297
+00:24:16,970 --> 00:24:20,630
+تسحبها لإن الليمفاتكس مسكرة في مرات بكون جينة اللى
+
+298
+00:24:20,630 --> 00:24:24,670
+عندنا أبليزيا للليمفاتكس بتقدي لمنطقة ان
+
+299
+00:24:24,670 --> 00:24:28,090
+الليمفاتكس الرئيسية تبعتها في الأخر مسكرة فاللي
+
+300
+00:24:28,090 --> 00:24:32,750
+مابتقدرش تشتغل فال small proteins يعني بتقعد و
+
+301
+00:24:32,750 --> 00:24:38,590
+بتزيد و بتقدي إلى الإديمة الموجودةأحيانا اللي
+
+302
+00:24:38,590 --> 00:24:42,030
+بيكون عندنا مرض معين ضرب lymph nodes ال lymph
+
+303
+00:24:42,030 --> 00:24:44,610
+nodes طبعا هم المفاصلة تبعت ال ايه الطرق تبعت ال
+
+304
+00:24:44,610 --> 00:24:51,150
+ايه ال road crossings اللي ايه لازم يعديها ال
+
+305
+00:24:51,150 --> 00:24:54,290
+lymphatic الى انها تخرج من مكان الى مكان فإذا ال
+
+306
+00:24:54,290 --> 00:24:58,730
+lymph node مضربت صار فيها filariasis , fibrosis
+
+307
+00:24:58,730 --> 00:25:03,550
+كده بيسكر بيصير lymphatic مش جادرة فال lymphatic
+
+308
+00:25:03,550 --> 00:25:07,030
+fluid بيضل في ايه بيضل في ال interstitial fluid
+
+309
+00:25:08,750 --> 00:25:12,630
+المهم فيه ان ال proteins مش قادرة تطلع هو ال
+
+310
+00:25:12,630 --> 00:25:15,670
+fluids في الآخر بتعود تنسحب لكن ال proteins موجودة
+
+311
+00:25:15,670 --> 00:25:19,530
+اكتر معناه انكوتك براشر زاد اكتر معناه بيدها more
+
+312
+00:25:19,530 --> 00:25:23,350
+fluids عشان ال hydrostatic pressure عشان ال
+
+313
+00:25:23,350 --> 00:25:27,190
+osmolality تبقى متساوي هان و هان فهيحافظ على more
+
+314
+00:25:27,190 --> 00:25:32,340
+ايهmore fluids مع حاجة عملية ال ايه؟ ال edema هذه
+
+315
+00:25:32,340 --> 00:25:35,900
+اللي بنسميها lymphedema لإنها edema بسبب
+
+316
+00:25:35,900 --> 00:25:38,620
+obstruction of the a of lymphatics بنسميها
+
+317
+00:25:38,620 --> 00:25:45,920
+lymphedema هذا بالنسبة لل ايه؟ أهمية ال plasma
+
+318
+00:25:45,920 --> 00:25:51,840
+إنها المعبر
+
+319
+00:25:52,480 --> 00:25:56,380
+لوصول الأشياء الى ال interstitial fluid ومنها الى
+
+320
+00:25:56,380 --> 00:26:03,040
+ال intracellular compartment تمام؟ وإنه في factors
+
+321
+00:26:03,040 --> 00:26:08,500
+بتحكم في ال plasma هذه جداش يطلع منها و جداش
+
+322
+00:26:08,500 --> 00:26:13,420
+يرجعلها طبعا ال hydrostatic pressure بيقدر إلى إنه
+
+323
+00:26:13,420 --> 00:26:17,920
+يصير filtration إلى خارج ال capillary لحد ما يضأ
+
+324
+00:26:17,920 --> 00:26:21,860
+ال pressure بسبب انه انه نفقد ال fluids جاعدين
+
+325
+00:26:22,640 --> 00:26:26,240
+البراشر بيهبط بيهبط بيهبط في الكاميلارية تمام
+
+326
+00:26:26,240 --> 00:26:31,240
+البراشر يعني شيء مليانه فيه ضغط نسحب منه جاني شوية
+
+327
+00:26:31,240 --> 00:26:36,040
+شوية كل ما نسحب منه بيهبط مش كده فال hydrostatic
+
+328
+00:26:36,040 --> 00:26:40,020
+pressure اللي ضخ ودخل ضغط عالي هذا هيعمل
+
+329
+00:26:40,020 --> 00:26:43,720
+filtration وكل ما فيه filtration أكتر كل ما تضغط
+
+330
+00:26:43,720 --> 00:26:46,940
+ال hydrostatic pressure أيش بيجيل بيجيل لحد ما
+
+331
+00:26:46,940 --> 00:26:51,850
+يصير ال hydrostatic pressure يساويالانكوتك براشر
+
+332
+00:26:51,850 --> 00:26:56,090
+فيتوقف ال filtration تمام يتوقف ال filtration في
+
+333
+00:26:56,090 --> 00:26:56,650
+الحالة هذه
+
+334
+00:27:01,500 --> 00:27:05,320
+كل طبعا ان شاء الله ال capillary circulation مش
+
+335
+00:27:05,320 --> 00:27:08,240
+عارف انا هشرحها لكوا بعد كده ولا انتوا هتاخدوها في
+
+336
+00:27:08,240 --> 00:27:11,780
+ال .. في ال cardiovascular و كده في الغالب الدكتور
+
+337
+00:27:11,780 --> 00:27:15,820
+محمد حبيب هشرحها لكوا بالتصيل لكن عملية في ال
+
+338
+00:27:15,820 --> 00:27:19,280
+capillaries بيصير filtration و reabsorption في
+
+339
+00:27:19,280 --> 00:27:21,440
+مرحلة بيصير filtration و في مرحلة بيصير
+
+340
+00:27:21,440 --> 00:27:26,300
+reabsorption و الفرق بينهم بروح في ال lymphatics
+
+341
+00:27:26,300 --> 00:27:28,800
+الفرق بينهم على ال lymphatics تعالى
+
+342
+00:27:33,400 --> 00:27:42,940
+blood volume ال blood له قصة مختلفة شوية انه هو هو
+
+343
+00:27:42,940 --> 00:27:50,100
+هو صدق هذا ال blood volume نقدر احنا طبعا ال blood
+
+344
+00:27:50,100 --> 00:27:53,600
+volume كتير مهم ال blood volume له يعني فقط ال
+
+345
+00:27:53,600 --> 00:27:58,540
+plasma ال blood volume يعني ال plasma زايد ال ايه
+
+346
+00:27:58,540 --> 00:28:05,530
+زايد الالـ cells طبعا ال plasma زائد ال cells ال
+
+347
+00:28:05,530 --> 00:28:09,510
+cells في داخل ال plasma ممكن احنا نفصلهم مع بعض
+
+348
+00:28:09,510 --> 00:28:13,110
+طبعا هو ال cells mainly red blood cells لإن لما
+
+349
+00:28:13,110 --> 00:28:16,590
+نقارن red blood cells ل ال other cells لا يتقارن
+
+350
+00:28:16,590 --> 00:28:21,370
+ال red blood cells هم الملايين احنا لو عملنا
+
+351
+00:28:21,370 --> 00:28:27,030
+centrifugation ل ال blood هذا فيه hematocrit tube
+
+352
+00:28:27,510 --> 00:28:33,710
+هنلاحظ احنا انه الجزء ال fluid انفصل عن الجزء ال
+
+353
+00:28:33,710 --> 00:28:41,270
+solid مش كده؟ اللي هنلاقي انه اربعين في المية من
+
+354
+00:28:41,270 --> 00:28:48,790
+الدم red blood cells وستين في المية طب باقي ال
+
+355
+00:28:48,790 --> 00:28:51,550
+white blood cells و ال platelets و الكذا هنلاقيهم
+
+356
+00:28:51,550 --> 00:28:56,130
+بين اتنينهنلاقي هذا الوضع واضح انها الوضع صافي
+
+357
+00:28:56,130 --> 00:29:01,650
+وهذا بلازما وهذا واضح انها اللون أحمر غامج وهذا
+
+358
+00:29:01,650 --> 00:29:09,130
+الوضع بلازما وهذا الوضع بلازما وهذا الوضع بلازما
+
+359
+00:29:09,130 --> 00:29:13,250
+وهذا الوضع بلازما وهذا الوضع بلازما وهذا الوضع
+
+360
+00:29:13,250 --> 00:29:15,350
+بلازما وهذا الوضع بلازما وهذا الوضع بلازما وهذا
+
+361
+00:29:15,350 --> 00:29:15,590
+الوضع بلازما وهذا الوضع بلازما وهذا الوضع بلازما
+
+362
+00:29:15,590 --> 00:29:15,650
+وهذا الوضع بلازما وهذا الوضع بلازما وهذا الوضع
+
+363
+00:29:15,650 --> 00:29:21,430
+بلازما وهذا الوضع بلازما وهذا الوضع بلازما وهذا
+
+364
+00:29:21,430 --> 00:29:26,230
+الوضع بفي المية طبعا إذا عرفنا احنا حجم البلازمة
+
+365
+00:29:26,230 --> 00:29:33,310
+أو حجم ال red blood cells نقدر نعرف ال total مش
+
+366
+00:29:33,310 --> 00:29:36,950
+كده بسهولة نقدر نحسب ال total هذا ما يسمى ال
+
+367
+00:29:36,950 --> 00:29:40,810
+hematocrite اذا ال solid part solid part of the
+
+368
+00:29:40,810 --> 00:29:44,650
+blood is called the hematocrite تمام اذا ال
+
+369
+00:29:44,650 --> 00:29:47,810
+hematocrite بجيز جانديش عندى solid part مقارنة بال
+
+370
+00:29:47,810 --> 00:29:54,050
+totalهيم مش ال fluid part مش أكوه هيم عشان كده ما
+
+371
+00:29:54,050 --> 00:29:57,030
+تتلخبطوش في الحسمة لان دايما احنا بنتكلم عالجاني
+
+372
+00:29:57,030 --> 00:30:00,950
+عن ال solid part مش عن ال ايه ال plasma part تمام
+
+373
+00:30:00,950 --> 00:30:05,310
+فلما نعرف احنا البلازما جديش نسبتها واحد ناجس ال
+
+374
+00:30:05,310 --> 00:30:09,090
+ايه ال hematocrit تمام اذا من خلال معرفة البلازما
+
+375
+00:30:09,090 --> 00:30:13,810
+بقدر اعرف ال total blood volume من خلال معرفة ال
+
+376
+00:30:13,810 --> 00:30:18,610
+ال hematocrit او red blood cells ممكن اعرف ال
+
+377
+00:30:18,610 --> 00:30:25,790
+totalblood volume طبعا ال blood كتير مهم لإنه غير
+
+378
+00:30:25,790 --> 00:30:32,330
+إنه يحتوي على ال RBCs هو يحتوي على الضغط اللازم مش
+
+379
+00:30:32,330 --> 00:30:35,750
+كده في pressure هذا ال pressure موجود في ال blood
+
+380
+00:30:35,750 --> 00:30:40,590
+vessels تمام وأنصر أساسي من المحافظة على ال
+
+381
+00:30:40,590 --> 00:30:45,070
+pressure في داخل ال blood كدهش في عنده volume إذا
+
+382
+00:30:45,070 --> 00:30:49,920
+volume ال blood راح نزل ال pressure إيه نزلإذا هو
+
+383
+00:30:49,920 --> 00:30:52,460
+ال blood pressure في الآخر علاقة ما بين ال volume
+
+384
+00:30:52,460 --> 00:30:58,900
+ما بين ال volume اللي هو يمثل ال blood ال contents
+
+385
+00:30:58,900 --> 00:31:02,740
+و الوعاء اللي هو فيه و ال blood vessel يعني إذا
+
+386
+00:31:02,740 --> 00:31:08,220
+الدم اللي في داخل الوعاء جل اتضغط إيه؟ بجل طيب
+
+387
+00:31:08,220 --> 00:31:12,160
+الدم ماجلش لكن الوعاء نفسه كبر vasodilation برضه
+
+388
+00:31:12,160 --> 00:31:17,090
+إيه؟ هيجل إذا لازم أحافظ على blood vessels مظبوطةو
+
+389
+00:31:17,090 --> 00:31:20,170
+أحافظ على blood volume مظبوط من هنا ال blood
+
+390
+00:31:20,170 --> 00:31:26,510
+volume بياخد خصوصية خاصة ليش؟ لأنه مرتبط و حجمه
+
+391
+00:31:26,510 --> 00:31:30,870
+بال blood pressure و ال blood pressure معناها يمثل
+
+392
+00:31:30,870 --> 00:31:37,130
+ان اندفاع الدم بما يحمل من oxygen و nutrients إلى
+
+393
+00:31:37,130 --> 00:31:41,170
+الخلايا فإذا الضغط نزل، الاندفاع بيجل، الخلايا
+
+394
+00:31:41,170 --> 00:31:44,310
+بيصلهاش oxygen، بيصلهاش خلايا و بنخش في shock
+
+395
+00:31:44,310 --> 00:31:49,280
+state مش كده؟الشغل خطورته انه توقف وصول ال ايه ال
+
+396
+00:31:49,280 --> 00:31:53,500
+oxygen لل .. والسكر بالذات لل brain ال brain
+
+397
+00:31:53,500 --> 00:31:57,360
+بيعتمد على السكر باستمرار يعني بده دم مستمر لذلك
+
+398
+00:31:57,360 --> 00:32:05,080
+احنا الدم اذا انقطع عن الدمار اكثر من ثلاث دقائق
+
+399
+00:32:05,080 --> 00:32:10,520
+تبدأ بعض الخلايا عندك موت طبعا بعض الخلايا بتبدأ
+
+400
+00:32:10,520 --> 00:32:15,720
+تموت كل ما زاد ال ischemiaع كل ما زاد ال .. طبعا
+
+401
+00:32:15,720 --> 00:32:20,160
+لما الدم يبطل يصل ال .. البناطق ال .. ال .. ال
+
+402
+00:32:20,160 --> 00:32:26,480
+brain بنخش على طول في ايه؟ في collapse بنفتر الوعي
+
+403
+00:32:26,480 --> 00:32:31,620
+تمام؟ و بنبدأ ايه؟ نخش في غيبوبة إذا الدم بطل يصل
+
+404
+00:32:31,620 --> 00:32:32,260
+ال ..
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..f9d8c14daab60c060086b2c461e9f53d2fafead2
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/sPaOA8LhP90_raw.json
@@ -0,0 +1 @@
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"probability": 0.9404296875}, {"start": 1948.68, "end": 1949.16, "word": " نخش", "probability": 0.8870442708333334}, {"start": 1949.16, "end": 1949.32, "word": " في", "probability": 0.9833984375}, {"start": 1949.32, "end": 1949.98, "word": " غيبوبة", "probability": 0.94599609375}, {"start": 1949.98, "end": 1950.48, "word": " إذا", "probability": 0.662841796875}, {"start": 1950.48, "end": 1950.86, "word": " الدم", "probability": 0.9404296875}, {"start": 1950.86, "end": 1951.4, "word": " بطل", "probability": 0.9150390625}, {"start": 1951.4, "end": 1951.62, "word": " يصل", "probability": 0.93994140625}, {"start": 1951.62, "end": 1951.92, "word": " ال", "probability": 0.92626953125}, {"start": 1951.92, "end": 1952.26, "word": " ..", "probability": 0.97802734375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1952.496375, "duration_after_vad": 1897.8624999999952}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wln3XgUvKsg.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wln3XgUvKsg.srt
new file mode 100644
index 0000000000000000000000000000000000000000..22b03306777c87b0d8ccc9e7b9d43a444a6bfaba
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wln3XgUvKsg.srt
@@ -0,0 +1,2580 @@
+
+1
+00:00:09,480 --> 00:00:17,220
+الـ oxygen وصل و الـ alveolar air جاهز و بدأ
+
+2
+00:00:17,220 --> 00:00:23,240
+الانتقال يتم بين الـ oxygen و الـ alveolar air و الـ
+
+3
+00:00:23,240 --> 00:00:27,060
+و الـ capillary blood بين الـ oxygen و بين الـ carbon
+
+4
+00:00:27,060 --> 00:00:34,510
+dioxide  الانتقال هنا بيتم حسب الـ pressure pressure
+
+5
+00:00:34,510 --> 00:00:39,320
+of each يعني فرق الضغط الـ alveolar air
+
+6
+00:00:39,320 --> 00:00:43,760
+و الـ capillary blood هو اللي بيحكم الانتقال لذلك
+
+7
+00:00:43,760 --> 00:00:48,300
+لما نلاقي الـ oxygen أن تركيزه في الـ alveolar air
+
+8
+00:00:48,300 --> 00:00:53,280
+104 millimeter mercury و أن نلاقي أن الـ carbon
+
+9
+00:00:53,280 --> 00:00:57,880
+dioxide أو الـ oxygen في الـ capillary blood تركيزه
+
+10
+00:00:57,880 --> 00:00:59,380
+40 millimeter mercury
+
+11
+00:01:01,860 --> 00:01:06,440
+والعكس صحيح، نلاقي الـ carbon dioxide في الـ .. في
+
+12
+00:01:06,440 --> 00:01:08,940
+الـ venous أو في الـ .. في الـ .. في الـ capillary
+
+13
+00:01:08,940 --> 00:01:12,320
+blood خمسة وأربعين مليمتر mercury و في الـ
+
+14
+00:01:12,320 --> 00:01:14,680
+alveolar blood أربعين مليمتر mercury هذا بيحدد
+
+15
+00:01:14,680 --> 00:01:18,020
+انتقال الـ oxygen من الـ alveolar air للـ capillary
+
+16
+00:01:18,020 --> 00:01:21,120
+blood و من الـ carbon dioxide من الـ capillary blood
+
+17
+00:01:21,120 --> 00:01:24,040
+للـ alveolar air تمام لحد ما يصير الـ equilibrium
+
+18
+00:01:24,040 --> 00:01:30,610
+اللي هو المطلوب هنا. إذا بدأنا عملية الانتقال، هنتكلم
+
+19
+00:01:30,610 --> 00:01:34,770
+أولاً عن الـ oxygen كيف ينتقل، وإيش القواعد اللي بتحكمه
+
+20
+00:01:34,770 --> 00:01:39,790
+ثم بعد ذلك نتكلم عن الـ carbon dioxide، وهنلاقي أن
+
+21
+00:01:39,790 --> 00:01:44,530
+الأمر دائماً هي عملية عكسية. هنلاقي الأمر عملية
+
+22
+00:01:44,530 --> 00:01:48,710
+عكسية للـ oxygen بس في أرقام مختلفة من واحد لواحد
+
+23
+00:01:49,060 --> 00:01:51,340
+بالإضافة لأن الـ carbon dioxide، ما تنسوش أن الـ
+
+24
+00:01:51,340 --> 00:01:57,360
+diffusion capacity تبعته twenty times، ده إيه ده؟
+
+25
+00:01:57,360 --> 00:02:03,180
+diffusion capacity of the  إيه of the oxygen تمام؟
+
+26
+00:02:03,180 --> 00:02:09,060
+طيب هنا أول curve كده بنتعامل معاه
+
+27
+00:02:09,060 --> 00:02:12,300
+اتكلمنا
+
+28
+00:02:12,300 --> 00:02:16,280
+in general على الـ .. الـ .. الـ transport of oxygen
+
+29
+00:02:17,240 --> 00:02:23,040
+من الـ alveolar 104 millimeter mercury إلى الـ
+
+30
+00:02:23,040 --> 00:02:25,080
+capillary blood اللي هو 40 millimeter mercury
+
+31
+00:02:25,080 --> 00:02:31,640
+بينتهي بأنه الـ capillary blood at the venous side
+
+32
+00:02:31,640 --> 00:02:36,680
+الـ capillary blood at the venous side بيكون الـ
+
+33
+00:02:36,680 --> 00:02:41,060
+pressure تبعه 104 زي الـ alveolar يعني، مظبوط؟
+
+34
+00:02:41,060 --> 00:02:46,630
+اتفقنا على هذا، طيب الـ curve اللي تحته هذا بيقول
+
+35
+00:02:46,630 --> 00:02:51,850
+لنا معلومتين، المعلومة الأولى أنه كان عندي أول الـ
+
+36
+00:02:51,850 --> 00:02:57,710
+capillary، هي عندي الـ  أظهر شوية عشان كده تتضح
+
+37
+00:02:57,710 --> 00:03:06,610
+الصورة. كان عندي الـ الـ capillary blood pressure of
+
+38
+00:03:06,610 --> 00:03:11,190
+oxygen حوالي أربعين millimeter mercury تمام، و
+
+39
+00:03:11,190 --> 00:03:17,810
+لما دخل الـ capillary هنا أخذ الـ .. الـ saturation
+
+40
+00:03:17,810 --> 00:03:21,370
+الكامل اللي بيقدر عليه، اللي هو يساوي الـ saturation
+
+41
+00:03:21,370 --> 00:03:23,950
+تبع الـ oxygen أو البشر تبع الـ oxygen في الـ إيه؟ في
+
+42
+00:03:23,950 --> 00:03:28,230
+الـ blood هنلاحظ أنه وصل لإيه؟ لـ مئة وأربع
+
+43
+00:03:28,230 --> 00:03:31,130
+millimeter mercury اللي أنا بدي ألاحظه حقيقة اللي
+
+44
+00:03:31,130 --> 00:03:35,050
+أنا قصدي فيه أنه لاحظوا هذه الكبيرة اللي بيبدأ من
+
+45
+00:03:35,050 --> 00:03:39,730
+هنا، بينتهي هنا، وهي الـ saturation الكاملة يعني في طول
+
+46
+00:03:39,730 --> 00:03:44,930
+المسافة، أخذتو بالكم؟ في طول المسافة كان عندي full
+
+47
+00:03:44,930 --> 00:03:50,110
+saturation، واضح؟ إذا في عندي تلتين مسافة standby
+
+48
+00:03:50,110 --> 00:03:55,070
+موجودة لو احتاجنا ناخد oxygen أكتر لأنه عندنا more
+
+49
+00:03:55,070 --> 00:03:59,030
+depression in the partial pressure في الـ .. في الـ
+
+50
+00:03:59,030 --> 00:04:03,350
+.. في الـ .. في الـ capillary blood، عندنا فرصة أنه
+
+51
+00:04:03,350 --> 00:04:08,170
+إيه؟ more exposure time للإيه؟ لـ transport of ..
+
+52
+00:04:08,170 --> 00:04:12,390
+طيب هذا الـ curve الأولاني المهم، الـ curve الثاني
+
+53
+00:04:12,390 --> 00:04:20,740
+المهم هنا .. إيه؟ وين راح؟ هنا الـ curve الثاني
+
+54
+00:04:20,740 --> 00:04:25,020
+المهم أنه إحنا قلنا at the venous side of the
+
+55
+00:04:25,020 --> 00:04:29,060
+capillary blood of the capillaries كان عندنا برشة
+
+56
+00:04:29,060 --> 00:04:34,260
+بشر قد إيه؟ آه فاكرين حاجة اسمها venous admixture
+
+57
+00:04:34,260 --> 00:04:41,800
+لما قلنا الـ bronchial blood supply موجود في الـ
+
+58
+00:04:41,800 --> 00:04:49,910
+lungs، الـ venous bronchial veins، آه أذكرته لما بيقول
+
+59
+00:04:49,910 --> 00:04:53,550
+أن الـ bronchial veins بتعمل drainage عبر برضه الـ
+
+60
+00:04:53,550 --> 00:04:56,550
+pulmonary veins، فبيصير عندي أنا two types of blood
+
+61
+00:04:56,550 --> 00:05:03,270
+واحد جاي من الـ bronchial part which is a systemic
+
+62
+00:05:03,270 --> 00:05:08,730
+circulation branches من الأورطة جاية على الـ إيه أو
+
+63
+00:05:08,730 --> 00:05:12,130
+من الـ systemic blood للـ lungs للـ bronchial tissues
+
+64
+00:05:12,130 --> 00:05:16,930
+مش كده؟ للـ lung tissues، وهذا supplying the lung
+
+65
+00:05:16,930 --> 00:05:20,570
+tissues، it's not for oxygenation، الثاني اسمه
+
+66
+00:05:20,570 --> 00:05:23,510
+pulmonary اللي داخل عشان يعمل oxygenation، اسمه
+
+67
+00:05:23,510 --> 00:05:27,870
+pulmonary blood، هذا اسمه bronchial blood تمام؟
+
+68
+00:05:27,870 --> 00:05:32,310
+هينمسجوا الـ venous side تبعهم the same which is ده
+
+69
+00:05:32,310 --> 00:05:36,570
+إيه؟ the pulmonary veins، هنا في الحالة هذه إذا
+
+70
+00:05:36,570 --> 00:05:41,050
+هينخلط عندي دم الـ pressure pressure الـ oxygen تبعه
+
+71
+00:05:41,050 --> 00:05:45,710
+قد إيه؟ اللي جاي من الـ bronchial veins اللي هيخش على
+
+72
+00:05:45,710 --> 00:05:48,870
+الـ bronchial .. على الرئة اللي هي veins يعملوا
+
+73
+00:05:48,870 --> 00:05:53,550
+admixture الـ .. الـ venous الـ .. الـ partial
+
+74
+00:05:53,550 --> 00:05:57,630
+pressure كام؟ أربعين زي أي systemic .. زي أي
+
+75
+00:05:57,630 --> 00:06:00,650
+systemic circulation تمام؟ إذا الـ partial pressure
+
+76
+00:06:01,240 --> 00:06:04,440
+للـ oxygen في الـ .. في الـ venous blood أربعين، و
+
+77
+00:06:04,440 --> 00:06:08,180
+هذا دخل عمل supply لـ الـ tissues with blood with
+
+78
+00:06:08,180 --> 00:06:10,700
+oxygen، الراجع الـ tension تبقى ما بيكون في العادة
+
+79
+00:06:10,700 --> 00:06:13,960
+زي system of blood، قد إيه؟ أربعين millimeter mercury
+
+80
+00:06:13,960 --> 00:06:20,000
+إذا الحين دمج عندي blood أربعين و blood جاي fresh
+
+81
+00:06:20,000 --> 00:06:23,260
+oxygenated من الـ air capillaries من الـ alveolar
+
+82
+00:06:23,260 --> 00:06:28,390
+air، transport mechanism صارت و تمت هنا هيديني إيه؟
+
+83
+00:06:28,390 --> 00:06:32,450
+إذا الـ mixture .. الـ mixture هذا هيصل الـ .. الـ ..
+
+84
+00:06:32,450 --> 00:06:36,390
+الـ .. الـ venous الـ .. الـ pulmonary veins في الحالة
+
+85
+00:06:36,390 --> 00:06:39,830
+هذه هيكون الـ .. الـ .. الـ .. الـ oxygen tension فيها
+
+86
+00:06:39,830 --> 00:06:44,350
+مش 104، الـ capillaries، الـ venous side of the
+
+87
+00:06:44,350 --> 00:06:48,770
+capillary هيكون فيه البرشة بشر للـ Oxygen كده، 104
+
+88
+00:06:48,770 --> 00:06:53,570
+لكن بعد الـ mixture، بعد الـ admixture هيديني خلط
+
+89
+00:06:53,570 --> 00:06:58,870
+خلط جديد ما بين الـ 40 و بين الـ 104 هيديني
+
+90
+00:06:58,870 --> 00:07:03,350
+pressure جديد هنتعامل معاه إحنا، اللي يساوي 95 ميلي
+
+91
+00:07:03,350 --> 00:07:08,930
+متر، متر. إذا الأهم الـ right atrium تمام، اللي هيديني
+
+92
+00:07:08,930 --> 00:07:13,090
+للـ right ventricle للـ system of circulation. إذا الـ
+
+93
+00:07:13,090 --> 00:07:15,650
+blood الارتباطي (repeated word, likely a mistake)
+
+94
+00:07:15,650 --> 00:07:15,930
+الارتباطي (repeated word, likely a mistake)
+
+95
+00:07:15,930 --> 00:07:17,490
+الارتباطي (repeated word, likely a mistake)
+
+96
+00:07:17,490 --> 00:07:18,250
+الارتباطي (repeated word, likely a mistake)
+
+97
+00:07:18,250 --> 00:07:23,470
+الارتباطي (repeated word, likely a mistake)
+
+98
+00:07:23,470 --> 00:07:28,570
+الارتباطي (repeated word, likely a mistake)
+
+99
+00:07:28,570 --> 00:07:30,990
+الارتباطي (repeated word, likely a mistake)
+
+100
+00:07:30,990 --> 00:07:36,350
+الارتباطي (repeated word, likely a mistake)
+
+101
+00:07:36,350 --> 00:07:40,550
+الارتباطي (repeated word, likely a mistake)
+
+102
+00:07:41,530 --> 00:07:46,070
+هتنخلط فوراً مع مين؟ مع الـ bronchial blood، هتنزل
+
+103
+00:07:46,070 --> 00:07:50,210
+لإيه؟ لـ 95 وبعدين هتخش الـ إيه؟ الـ systemic
+
+104
+00:07:50,210 --> 00:07:55,750
+circulation و تقل شوية لما توصل لـ 40 من أول و
+
+105
+00:07:55,750 --> 00:08:03,670
+جديد، واضح؟ طيب، إذا الآن إحنا بنتكلم عن blood
+
+106
+00:08:03,670 --> 00:08:13,130
+حامل أكسجين fully .. يعني saturated in the lungs
+
+107
+00:08:13,130 --> 00:08:17,970
+تمام؟ fully saturated in the lungs لكنه لأنه في
+
+108
+00:08:17,970 --> 00:08:21,890
+bronchial blood نزل الـ saturation إلى 95. إذا من
+
+109
+00:08:21,890 --> 00:08:27,550
+الآن الـ oxygen اللي هنتعامل معاه اللي في الدم، هنتعامل مع الـ رقم
+
+110
+00:08:27,550 --> 00:08:32,910
+اللي هي 95، واضح؟ ما نتعاملش مع 104، 104 دي كانت فوق في
+
+111
+00:08:32,910 --> 00:08:42,050
+الـ .. الـ oxygen transport، واضح؟ طيب ماشي. إذا الـ
+
+112
+00:08:42,050 --> 00:08:50,850
+.. في حاجة إيه أقوله، أوكي.
+
+113
+00:08:50,850 --> 00:08:54,030
+اتكلمنا عنه هذا باختصار شديد.
+
+114
+00:09:02,090 --> 00:09:06,870
+Okay، الآن diffusion الـ oxygen from the peripheral
+
+115
+00:09:06,870 --> 00:09:13,930
+capillaries into the tissues، حملنا الـ oxygen طول
+
+116
+00:09:13,930 --> 00:09:17,910
+ما إحنا في الـ main arteries و الـ arterioles و الـ
+
+117
+00:09:17,910 --> 00:09:21,050
+smaller arteries ما نفقدش الـ oxygen، مظبوط؟ متى
+
+118
+00:09:21,050 --> 00:09:24,920
+هنفقد الـ oxygen؟ لما نصل الـ tissues. إذن الـ .. الـ ..
+
+119
+00:09:24,920 --> 00:09:29,420
+الـ .. الـ circulation وشغلتها توصل الـ oxygenated
+
+120
+00:09:29,420 --> 00:09:32,840
+blood هذا إلى الـ tissues، إذن في الطريق ما بيفقد
+
+121
+00:09:32,840 --> 00:09:36,940
+شيء، في الطريق ما بيفقد شيء. إذا إحنا بنوصل الـ
+
+122
+00:09:36,940 --> 00:09:40,960
+tissues الآن حاملين نفس النسبة، ninety-five
+
+123
+00:09:40,960 --> 00:09:46,320
+millimeter mercury oxygen، مش هيك، وهنبدأ نتعامل مع
+
+124
+00:09:46,320 --> 00:09:50,680
+مجموعة جديدة، الـ interstitial fluid و الـ cells و
+
+125
+00:09:50,680 --> 00:09:54,370
+إيش كيف .. إحنا اتكلمنا فوق، alveolar air، وقلنا الـ
+
+126
+00:09:54,370 --> 00:09:59,150
+alveolar air 104، وانزلنا الآن معانا oxygen برشة
+
+127
+00:09:59,150 --> 00:10:03,130
+برشة، الخمسة والتسعين محمول وراح للـ tissues، مش كده؟
+
+128
+00:10:03,130 --> 00:10:07,150
+فهنا في الـ tissues، هاي الـ arterial blood داخل، دخل
+
+129
+00:10:07,150 --> 00:10:10,410
+الـ capillary circulation بخمسة وتسعين مليمتر
+
+130
+00:10:10,410 --> 00:10:14,910
+mercury، هنلاحظ أن إحنا عندنا الـ interstitial fluid
+
+131
+00:10:14,910 --> 00:10:24,150
+وعندنا الـ cells، تمام، عندنا الـ cells، هنلاحظ أنه الـ
+
+132
+00:10:24,150 --> 00:10:26,790
+interstitial fluid، pressure pressure في الـ oxygen
+
+133
+00:10:26,790 --> 00:10:32,750
+أربعين millimeter mercury، تمام؟ إذا هنا حيث انتقال ما
+
+134
+00:10:32,750 --> 00:10:40,910
+بين .. حيث انتقال ما بين الـ .. الـ .. الدم آه و الـ
+
+135
+00:10:40,910 --> 00:10:43,310
+interstitial fluid تحت مصير الـ equilibrium زي ما
+
+136
+00:10:43,310 --> 00:10:47,770
+إحنا في الرئة اللي كان 104 والدم وصل لـ 104، هنا
+
+137
+00:10:48,690 --> 00:10:53,990
+الـ 95، الـ interstitial fluid 40، هيظل الانتقال يتم
+
+138
+00:10:53,990 --> 00:10:57,590
+لحد ما يصير equilibrium يعني الـ .. الـ .. الزيادة عن
+
+139
+00:10:57,590 --> 00:11:01,470
+الـ .. الـ .. الـ 40 كله هياخده الـ interstitial
+
+140
+00:11:01,470 --> 00:11:05,730
+fluid عشان يوصل الـ equilibrium لـ 40 تمام؟ إذا بيطلع
+
+141
+00:11:05,730 --> 00:11:08,330
+الـ venous بـ 40 من أول وجديد، إذا عندي الـ
+
+142
+00:11:08,330 --> 00:11:13,780
+interstitial fluid هنا 40، عشان إذا .. إذا في فرق ما
+
+143
+00:11:13,780 --> 00:11:18,220
+بين الـ 95 و الـ 40، و الـ 55 millimeter mercury هذا
+
+144
+00:11:18,220 --> 00:11:25,060
+برشة برشة خلّى الاندفاع من الـ blood إلى الـ
+
+145
+00:11:25,060 --> 00:11:30,820
+interstitial fluid سريع تمام؟ الآن هنلاقي إنه الـ
+
+146
+00:11:30,820 --> 00:11:36,410
+cells في داخلها، هنتكلم عنها إن شاء الله بتفاصيل
+
+147
+00:11:36,410 --> 00:11:41,790
+أكثر بعد كده، بس باختصار هنلاقي أن الـ .. الـ oxygen
+
+148
+00:11:41,790 --> 00:11:46,410
+pressure في داخل الـ cells تلاتة وعشرين millimeter
+
+149
+00:11:46,410 --> 00:11:50,010
+mercury، يعني في عندي فرق بين الـ interstitial
+
+150
+00:11:50,010 --> 00:11:53,710
+fluid و الـ cells، في فرق كبير، هذا بيأدي إلى أن الـ
+
+151
+00:11:53,710 --> 00:11:57,590
+oxygen من الـ interstitial fluid يندفع إلى إيه؟ إلى
+
+152
+00:11:57,590 --> 00:12:02,190
+داخل الـ cells، مش كده؟ طيب، إحنا هنا انتقال الـ oxygen
+
+153
+00:12:02,190 --> 00:12:05,410
+من مكان لمكان، و carbon dioxide من مكان لمكان،
+
+154
+00:12:05,410 --> 00:12:09,970
+اللي بيحكم إيه؟ إيه العالية؟ اللي بيحكم الـ pressure، مش
+
+155
+00:12:09,970 --> 00:12:14,910
+كده؟ قواعد عادية، pressure عالي للأسفل زي أي
+
+156
+00:12:14,910 --> 00:12:20,410
+physical rules أو laws، physical، بينتقل من الأعلى
+
+157
+00:12:20,410 --> 00:12:23,830
+للأدنى، اللي بيحكمنا هنا إيه؟ أنا ما جبتش سيرة
+
+158
+00:12:23,830 --> 00:12:27,830
+الهيموجلوبين لسه، واضح؟ ما جبتش .. بتكلم عن الـ pressure
+
+159
+00:12:27,830 --> 00:12:32,450
+of difference، وهذا يتحكم في الانتقال من مكان لـ
+
+160
+00:12:32,450 --> 00:12:37,110
+مكان هنا.
+
+161
+00:12:37,110 --> 00:12:41,230
+هيصير عندي أنا الـ oxygen اللي استخدم في داخل
+
+162
+00:12:41,230 --> 00:12:46,210
+الخلية، طبعاً إحنا رجعنا كـ oxygen .. رجعنا كـ
+
+163
+00:12:46,210 --> 00:12:50,510
+pressure .. pressure 40، هنرجع للدورة هي هي، الآن الـ
+
+164
+00:12:50,510 --> 00:12:54,230
+oxygen اللي استخدم في داخل الخلية هنا هيتحول معظمها
+
+165
+00:12:54,230 --> 00:13:00,910
+تقريباً إلى carbon dioxide تمام؟
+
+166
+00:13:00,910 --> 00:13:06,570
+هيتحول
+
+167
+00:13:06,570 --> 00:13:12,330
+إلى carbon dioxide، و الـ carbon dioxide هذا هيكون
+
+168
+00:13:12,330 --> 00:13:15,290
+تركيزه داخل الخلايا عالي.
+
+169
+00:13:17,070 --> 00:13:20,030
+هينتقل إلى الـ Interstitial Fluid، هينتقل إلى الـ
+
+170
+00:13:20,030 --> 00:13:23,210
+Interstitial Fluid أقل شوية مش هيك لأنه المصدر
+
+171
+00:13:23,210 --> 00:13:26,190
+داخل الخلية، فدائماً بيبقى في داخل الخلية بيزيد
+
+172
+00:13:26,190 --> 00:13:30,050
+تمام، فدائماً بينتقل من المنطقة العالية في داخل
+
+173
+00:13:30,050 --> 00:13:33,290
+الخلية إلى المنطقة الأقل، الـ Interstitial Fluid، في
+
+174
+00:13:33,290 --> 00:13:37,150
+اندفاع، والدم عنده برضه الـ carbon dioxide فيه واطي
+
+175
+00:13:37,150 --> 00:13:45,560
+فبينتقل إلى الـ إيه؟ إلى الـ blood، وينتقل إلى
+
+176
+00:13:45,560 --> 00:13:50,480
+الرئة للـ blood بعد كده، okay. طيب هنتكلم عنها بعد
+
+177
+00:13:50,480 --> 00:13:54,000
+ش
+
+223
+00:17:34,590 --> 00:17:39,080
+الدم اللي جاي فيه أكسجين جليل أو مش أكسيجين جليل
+
+224
+00:17:39,080 --> 00:17:42,260
+الأكسجين هو هو لكن الـ blood flow، الـ rate تبعه
+
+225
+00:17:42,260 --> 00:17:46,740
+جليل، هذا بيؤدي إلى أن الـ interstitial
+
+226
+00:17:46,740 --> 00:17:51,100
+fluid ياخد معظم الأكسجين اللي موجود في الـ a في الـ
+
+227
+00:17:51,100 --> 00:17:53,780
+blood، لإنه الـ flow جليل و الـ oxygen supply في
+
+228
+00:17:53,780 --> 00:17:58,100
+العادة جليل، فبينتقل كله، بتطلع بقلاجي، أنا لو الـ
+
+229
+00:17:58,100 --> 00:18:03,000
+blood flow نزل واطي، ممكن ينزل الـ partial
+
+230
+00:18:03,000 --> 00:18:07,340
+pressure في الـ interstitium وفي الـ .. إلى إيه؟ إلى
+
+231
+00:18:07,340 --> 00:18:11,860
+إيه؟ إلى إيه؟ إلى مستويات منخفضة جداً، واضح؟ طيب،
+
+232
+00:18:11,860 --> 00:18:15,400
+هذا العمل الأولاني اللي متكلم عنه، إنه عمل إيش؟ الـ
+
+233
+00:18:15,400 --> 00:18:18,840
+blood flow لو زاد، الـ partial pressure في الأنسجة
+
+234
+00:18:18,840 --> 00:18:22,940
+هيتغير، ولو قل الـ partial pressure هيتغير في الطبيعي
+
+235
+00:18:22,940 --> 00:18:25,540
+اللي قلنا إحنا بنوصل لـ 40 millimeter mercury
+
+236
+00:18:25,540 --> 00:18:30,680
+تمام؟ وهاكذا، طيب، الآن لو زاد الـ oxygen
+
+237
+00:18:30,680 --> 00:18:36,060
+consumption في الأنسجة، عندي مثلاً thyroid gland
+
+238
+00:18:36,060 --> 00:18:41,240
+hyperactivity، ثيروكسين كتير، أو عندي عضلات قاعدة
+
+239
+00:18:41,240 --> 00:18:46,100
+بتشتغل بزيادة، بدها استهلاك oxygen أكثر، زاد الـ
+
+240
+00:18:46,100 --> 00:18:49,440
+oxygen consumption،
+
+241
+00:18:49,440 --> 00:18:55,200
+نفترض أنه زاد أربع مرات، تمام؟ في الحالة هذه الـ
+
+242
+00:18:55,200 --> 00:18:59,060
+blood flow لما يكون طبيعي 100%، هذه الـ 100% الـ
+
+243
+00:18:59,060 --> 00:19:02,100
+blood flow لما يكون عندي أنا زيادة في الاستهلاك
+
+244
+00:19:02,100 --> 00:19:05,960
+بتطلع نتيجة أنه عندي صارت drop في الـ partial
+
+245
+00:19:05,960 --> 00:19:09,540
+pressure تبع إيه؟ تبع الأنسجة، تمام؟ إذا الـ
+
+246
+00:19:09,540 --> 00:19:15,240
+100% هذه بتوصل النهاردة لأقل من 20%، تمام؟ لـ 15%
+
+247
+00:19:15,240 --> 00:19:19,840
+تقريباً، إذا الـ partial pressure بينزل لـ 15
+
+248
+00:19:19,840 --> 00:19:24,060
+millimeter mercury، لو كان عندي أنا consumption أكثر
+
+249
+00:19:24,060 --> 00:19:28,600
+ونفس الـ إيه؟ الـ blood flow، هيجي إنه الـ oxygen
+
+250
+00:19:28,600 --> 00:19:32,520
+الاستهلاك، واخذه أكثر من الخلايا، الـ interstitial
+
+251
+00:19:32,520 --> 00:19:36,160
+fluid هياخد أكثر، الـ blood هيدي أكثر، كل ما هيبطنجط
+
+252
+00:19:36,160 --> 00:19:43,280
+إيش ده؟ طبعاً في الحالة هذه، وهذا اللي بيحصل حقيقة
+
+253
+00:19:43,280 --> 00:19:47,460
+أنه بيزيد الـ blood flow لما الـ oxygen يحتاج إلى إيه
+
+254
+00:19:47,460 --> 00:19:52,560
+أكثر oxygen، في حالة exercise أو غيرها، فالـ heart
+
+255
+00:19:52,560 --> 00:19:54,780
+rate بيزيد، والـ blood flow بيزيد، والـ respiration
+
+256
+00:19:54,780 --> 00:19:59,660
+بيزيد، بيزيد عشرين ضعف، يعني الأكسجين اللي بيصير
+
+257
+00:19:59,660 --> 00:20:04,740
+يصل للأنسجة ممكن يزيد إيش؟ عشرين ضعف، الـ cardiac
+
+258
+00:20:04,740 --> 00:20:07,720
+output بيزيد ستة إلى سبعة أضعاف، والـ oxygenation
+
+259
+00:20:07,720 --> 00:20:12,580
+بيزيد ثلاثة أضعاف، ثلاثة في ستة في سبعة، حوالي عشرين
+
+260
+00:20:12,580 --> 00:20:16,410
+ضعف، تمام؟ إذا ممكن إحنا عندنا .. لأ في الحالة هذه
+
+261
+00:20:16,410 --> 00:20:20,350
+عشان إحنا نعوض الـ consumption للزيادة، لازم نزود الـ
+
+262
+00:20:20,350 --> 00:20:23,450
+إيه؟ الـ flow، وهذا اللي بيصير مع الـ cardiac output
+
+263
+00:20:23,450 --> 00:20:28,050
+أنه بيزيد الـ flow، مش الـ flow عالفاضي، لأ، وكمان الـ
+
+264
+00:20:28,050 --> 00:20:32,070
+الـ .. الـ .. الـ lung .. آه الـ lung capacity for
+
+265
+00:20:32,070 --> 00:20:36,030
+oxygenation برضه بتزيد، فإذا بيجيني blood مع
+
+266
+00:20:36,030 --> 00:20:39,830
+الـ flow أحسن، ومع oxygen أحسن، في الحالة هذه لما
+
+267
+00:20:39,830 --> 00:20:42,970
+يكون عندي أنا إيه؟ consumption أكثر، في الحالة هذه
+
+268
+00:20:42,970 --> 00:20:45,370
+اللي نطلع هنا هنلاقي إنه في الـ duration
+
+269
+00:20:45,370 --> 00:20:49,490
+consumption، لما الـ flow يزيد عندي لأربع أضعاف، خمس
+
+270
+00:20:49,490 --> 00:20:52,590
+أضعاف، ستة أضعاف، في العادة من ستة إلى سبعة أضعاف
+
+271
+00:20:52,590 --> 00:20:58,790
+بلاقي برجع أنا لإيه؟ برجع لإيه؟ لـ level تبعي لـ 500
+
+272
+00:20:58,790 --> 00:21:02,210
+600 إلى 40 millimeter mercury، عادي جداً، ولو إن
+
+273
+00:21:02,210 --> 00:21:07,870
+أنا جالس إيه؟ بأستهلك أكثر، لكن الـ flow، الـ blood flow
+
+274
+00:21:07,870 --> 00:21:12,570
+اللي زاد هيعوض الفرق في الـ .. في الـ .. في الـ .. في
+
+275
+00:21:12,570 --> 00:21:17,990
+الـ consumption الزائد، لو الـ consumption قل، لو الـ
+
+276
+00:21:17,990 --> 00:21:21,490
+consumption of oxygen قل إلى الربع مثلاً، هنتطلع
+
+277
+00:21:21,490 --> 00:21:26,370
+أنه الـ 100% blood pressure هذا، تمام؟ هيقدر إلى أن
+
+278
+00:21:26,370 --> 00:21:32,970
+الـ blood pressure يعلى في الطبيعي أكثر عن اللازم
+
+279
+00:21:32,970 --> 00:21:38,410
+تمام؟ بتلاقي إيه؟ أكثر، يعني زي ما اتكلمنا من شوية
+
+280
+00:21:38,410 --> 00:21:40,750
+في الـ .. في الـ blood flow، هنا في الـ consumption،
+
+281
+00:21:40,750 --> 00:21:43,310
+قل الـ consumption، صار في oxygen جاي، أنا مش
+
+282
+00:21:43,310 --> 00:21:46,970
+بحتاجه، فالبشر بيأخذ إيش؟ النقطة المهمة في الموضوع،
+
+283
+00:21:46,970 --> 00:21:51,030
+إحنا هنا حقيقة، أنا هتكلم عنها، إن عملية الـ .. لو
+
+284
+00:21:51,030 --> 00:21:55,550
+احتاجنا أكثر، آه عندي أنا الـ heart rate، blood flow لو
+
+285
+00:21:55,550 --> 00:21:59,430
+زاد بيعوض الـ إيه؟ العملية هذه، وإحنا حقيقة cardiac
+
+286
+00:21:59,430 --> 00:22:01,750
+output بيزيد من ستة إلى سبعة مرات في حالة الـ
+
+287
+00:22:01,750 --> 00:22:05,830
+exercise، فستة إلى سبعة مرات، معوقة على طول بيديني الـ
+
+288
+00:22:05,830 --> 00:22:14,730
+oxygen اللي لازم يعوضني من الأول لجديد، طيب الـ، خلينا
+
+289
+00:22:14,730 --> 00:22:20,290
+نتكلم
+
+290
+00:22:20,290 --> 00:22:21,530
+هنا، is an effect
+
+291
+00:22:24,130 --> 00:22:28,710
+effect of rate of blood flow on interstitial fluid
+
+292
+00:22:28,710 --> 00:22:38,330
+إذا زدنا إلى أربعة أضعاف، partial pressure from 40
+
+293
+00:22:38,330 --> 00:22:44,030
+إلى 66 millimeter mercury، بمعنى آخر، إن لو كان الـ
+
+294
+00:22:44,030 --> 00:22:50,630
+flow rate زاد إلى أربعة أضعاف، هنا هيجي إن إحنا صار
+
+295
+00:22:50,630 --> 00:22:52,890
+عندنا إيه؟
+
+296
+00:22:54,590 --> 00:23:00,750
+انتقل الـ oxygen pressure من 40 إلى إيه؟ النقطة
+
+297
+00:23:00,750 --> 00:23:03,590
+اللي هي 66، في المئة، هذا الفرق بس في
+
+298
+00:23:03,590 --> 00:23:10,710
+العلاقة بين الـ pressure، في الـ flow rate، والعكس صحيح، و
+
+299
+00:23:10,710 --> 00:23:15,810
+العكس صحيح، في حالة ما يقل الـ flow rate، بينخفض الـ
+
+300
+00:23:15,810 --> 00:23:18,990
+pressure في الأنسجة إلى إيه؟ إلى مستويات منخفضة جداً
+
+301
+00:23:18,990 --> 00:23:23,980
+ممكن تؤدي إلى أنه يصير الـ pressure zero، يعني كل ما
+
+302
+00:23:23,980 --> 00:23:29,440
+في الـ .. كل ما في الدم محمول من أكسجين ينتقل
+
+303
+00:23:29,440 --> 00:23:33,400
+للأنسجة، إذا .. إذا انخفض كتير، effect of tissue in
+
+304
+00:23:33,400 --> 00:23:35,920
+metabolism، واتكلمنا نفس الكلام، إنه لو زودنا الـ
+
+305
+00:23:35,920 --> 00:23:41,300
+metabolism نحتاج أنسجة .. آه طيب، if the cells use
+
+306
+00:23:41,300 --> 00:23:45,340
+more oxygen for metabolism than normally، this
+
+307
+00:23:45,340 --> 00:23:47,780
+reduces the interstitial fluid pressure of oxygen
+
+308
+00:23:50,900 --> 00:23:54,000
+بدنا نرجع لـ reduce interstitial fluid، partial
+
+309
+00:23:54,000 --> 00:23:55,760
+pressure of oxygen when the cellular oxygen
+
+310
+00:23:55,760 --> 00:23:58,460
+consumption is increased، and increase partial
+
+311
+00:23:58,460 --> 00:24:00,720
+pressure of oxygen when consumption is decreased
+
+312
+00:24:00,720 --> 00:24:05,200
+تمام؟ إذا الـ consumption لما بيزيد أو بيقل، بيؤدي
+
+313
+00:24:05,200 --> 00:24:10,380
+إلى أنه ياخد، بيخفض الـ partial pressure
+
+314
+00:24:10,380 --> 00:24:14,420
+إذا كان زاد الاستهلاك، وبيعلي إذا كان إيه؟ قل
+
+315
+00:24:14,420 --> 00:24:20,200
+الاستهلاك، in summary، tissues، الحرارة الأكسجينية
+
+316
+00:24:20,200 --> 00:24:25,900
+مقررة من اتصال بين نطاق الدم والاستخدام، اتصال
+
+317
+00:24:25,900 --> 00:24:34,800
+أكسجيني في الدم، ودرجة الأكسجين واستخدامه في الدم
+
+318
+00:24:34,800 --> 00:24:39,860
+واستخدامه أكسجيني أكسجيني أكسجيني أكسجيني
+
+319
+00:24:39,860 --> 00:24:47,460
+أكسجيني، Okay، اتكلمنا عنها إحنا من شوية، وهنلاحظ
+
+320
+00:24:47,460 --> 00:24:54,120
+إحنا شيء مهم كتير، بعد شوية هناخده أكثر، إنه لو كان
+
+321
+00:24:54,120 --> 00:24:57,020
+الفرق هو في الطبيعي، الفرق بين الـ interstitial
+
+322
+00:24:57,020 --> 00:25:01,000
+fluid والـ
+
+323
+00:25:01,000 --> 00:25:06,460
+capillaries، من 40 إلى 23، قلنا مش
+
+324
+00:25:06,460 --> 00:25:13,360
+هيك، الـ 23 داخل الـ cells، الـ 23 ملي متر
+
+325
+00:25:13,360 --> 00:25:16,680
+مركوري، oxygen، داخل الـ cytoplasm of the cells
+
+326
+00:25:16,680 --> 00:25:22,000
+لكن داخل الـ mitochondria، إيش ما بيجي يستهلك، مش
+
+327
+00:25:22,000 --> 00:25:24,920
+كده؟ يعني إيه؟ لحد ما الـ mitochondria ممكن يوصل
+
+328
+00:25:24,920 --> 00:25:30,500
+التركيز إلى صفر؟ بمعنى آخر، إنه لو انخفض الفرق ما
+
+329
+00:25:30,500 --> 00:25:34,910
+بين الـ cytoplasmic oxygen إلى واحد مليمتر ميركوري
+
+330
+00:25:34,910 --> 00:25:38,850
+يكفي لتشغيل الخلية، ليش؟ لأنه .. لإنه إحنا آخر
+
+331
+00:25:38,850 --> 00:25:43,130
+نقطة، هيكون أعلى من الـ mitochondria، تمام؟ فلذلك
+
+332
+00:25:43,130 --> 00:25:47,310
+يعني لو نزل إلى إيه؟ إلى واحد، يعني لو
+
+333
+00:25:47,310 --> 00:25:51,670
+الـ cytoplasm نزل إلى واحد، برضه بظل الخلية شغالة،
+
+334
+00:25:51,670 --> 00:25:56,070
+لو نزل عن هيك، بده الخلية تموت، إذا عندي أنا من
+
+335
+00:25:56,070 --> 00:26:01,580
+40 إلى داخل الخلية، إلى داخل الميتوكندريا، zero
+
+336
+00:26:01,580 --> 00:26:05,160
+أو واحد، الفروقات اللي ممكن تزيد وتقل حسب الـ إيه؟
+
+337
+00:26:05,160 --> 00:26:08,740
+جداً، أنا عندي consumption بنقول in general تقريباً
+
+338
+00:26:08,740 --> 00:26:11,360
+التركيز داخل الـ cells، السيتوبلازم تقريباً 30
+
+339
+00:26:11,360 --> 00:26:15,080
+millimeter mercury، نحفظه كرقم، والـ interstitial
+
+340
+00:26:15,080 --> 00:26:19,020
+fluid 40، وعلى هواها الـ الـ capillary blood
+
+341
+00:26:19,020 --> 00:26:21,940
+بيبقى 95، بنزل لإيه؟ لـ 40، وبرجع venous
+
+342
+00:26:21,940 --> 00:26:28,380
+as 40، diffusion of carbon dioxide، الـ carbon
+
+343
+00:26:28,380 --> 00:26:32,260
+داي أوكسيد، ماحنبدأ من عند الـ lungs، هنبدأ من الأكس
+
+344
+00:26:32,260 --> 00:26:35,100
+من عند الـ .. لإنه بيزيد وين؟ الـ oxygen بيزيد عند
+
+345
+00:26:35,100 --> 00:26:37,300
+الـ lungs، بس الـ carbon dioxide بيزيد عند الـ إيش؟
+
+346
+00:26:37,300 --> 00:26:41,440
+عند الـ tissues، انديهان
+
+347
+00:26:41,440 --> 00:26:47,400
+الرسمة بتقول إنه الـ blood اللي داخل على الـ tissues
+
+348
+00:26:47,400 --> 00:26:49,820
+على الـ capillary circulation .. system of
+
+349
+00:26:49,820 --> 00:26:53,900
+capillary circulation، هيكون حامل، يعني هعمل
+
+350
+00:26:53,900 --> 00:26:56,940
+carbon dioxide بس 40 ملي متر ميركوري في
+
+351
+00:26:56,940 --> 00:27:00,060
+الحالة هذه، هيجي يلاقي الـ .. الـ intersection في
+
+352
+00:27:00,060 --> 00:27:04,140
+الـ tissues، 45 ملي متر ميركوري، هياخد منه خمسة و
+
+353
+00:27:04,140 --> 00:27:06,940
+يكمل يطلع إلى الـ lungs بـ 45 ملي متر
+
+354
+00:27:06,940 --> 00:27:11,380
+mercury، وهناك يترك خمسة، و يرجع الدائرة تبعتنا، في
+
+355
+00:27:11,380 --> 00:27:14,240
+الحالة هذه، إحنا هنلاحظ إنه داخل السلسلة يجب أن
+
+356
+00:27:14,240 --> 00:27:17,580
+تكون carbon dioxide أعلى، cytoplasm، يعني داخل
+
+357
+00:27:17,580 --> 00:27:20,060
+الميتوكندريا، هيكون carbon dioxide أعلى، هتمشي
+
+358
+00:27:20,060 --> 00:27:23,140
+العملية إيه؟ بالعكس، بتعلى في الميتوكندريا، بتنتقل
+
+359
+00:27:23,140 --> 00:27:26,400
+للسيتوبلازم، بتنتقل للـ interstitium، بتنتقل إلى إيه؟
+
+360
+00:27:26,400 --> 00:27:31,660
+إلى الـ blood، تمام؟ طيب، وننسى المعلومة المهمة
+
+361
+00:27:31,660 --> 00:27:36,600
+كتير، إن الـ carbon dioxide diffusion capacity as
+
+362
+00:27:36,600 --> 00:27:45,540
+twenty times as big as the oxygen، تمام؟
+
+363
+00:27:45,540 --> 00:27:49,060
+طيب الـ
+
+364
+00:27:49,060 --> 00:27:58,730
+الـ carbon dioxide pressures are approximately
+
+365
+00:27:58,730 --> 00:28:03,690
+the following، الـ A أنا اتكلمت عنها من شوية
+
+366
+00:28:03,690 --> 00:28:06,990
+من
+
+367
+00:28:06,990 --> 00:28:12,590
+46 لـ 45 لـ 40، مش في ده، إذا
+
+368
+00:28:12,590 --> 00:28:16,650
+عندي هنا، بدي تلاحظوا الملاحظة هذه، هاي الـ A، الـ
+
+369
+00:28:16,650 --> 00:28:20,490
+artery blood، هذا systemic اللي أنا اتكلمت عنها
+
+370
+00:28:20,490 --> 00:28:23,270
+ووصلنا للـ alveoli من جديد، خلصتها من الـ A، من الـ
+
+371
+00:28:23,270 --> 00:28:30,250
+tissues، وطلعنا بالدم، معانا دم، التركيز، الـ pressure
+
+372
+00:28:30,250 --> 00:28:32,970
+تبعه، بلاش نقول تركيز، الـ pressure، pressure تبعه
+
+373
+00:28:32,970 --> 00:28:37,170
+إيش؟ 45 millimeter mercury، الفيولر air
+
+374
+00:28:37,170 --> 00:28:43,270
+40، مش هيك، هيصير انتقال، هيتحول الـ blood إلى
+
+375
+00:28:43,270 --> 00:28:49,060
+إيش؟ إلى pressure إلى الـ 40 millimeter من جديد، مش هيك
+
+376
+00:28:49,060 --> 00:28:53,560
+بتلاحظوا الـ curve التحتاني، أيضاً العملية اللي بتتم
+
+377
+00:28:53,560 --> 00:28:58,460
+في طول المسافة، إذا برضه عملية التخلص الكامل من
+
+378
+00:28:58,460 --> 00:29:01,000
+الكمية اللي بده يخلص منها من الـ carbon dioxide، الـ
+
+379
+00:29:01,000 --> 00:29:03,340
+equilibrium بين carbon dioxide، الـ capillary، والـ
+
+380
+00:29:03,340 --> 00:29:06,260
+alveolar air، برضه بيتم ينتهي في إيه؟ في طول
+
+381
+00:29:06,260 --> 00:29:09,220
+المسافة، يعني بيظل عندي two thirds of the a of the
+
+382
+00:29:09,220 --> 00:29:15,220
+capillary distance is as a safety factor، طبعاً نفس
+
+383
+00:29:15,220 --> 00:29:25,580
+الكلام، نفس
+
+384
+00:29:25,580 --> 00:29:28,660
+الكلام في مسألة الـ .. الـ .. الـ .. الـ consumption
+
+385
+00:29:28,660 --> 00:29:36,000
+طبعاً لو أنا إيه؟ زودت الـ blood flow، نفس الـ curve
+
+386
+00:29:36,000 --> 00:29:40,180
+اللي عملناها للـ oxygen، هنلاقي ليه الـ carbon
+
+387
+00:29:40,180 --> 00:29:43,420
+dioxide، لكنه بالعكس، يعني لو أنا زودت الـ rate of
+
+388
+00:29:43,420 --> 00:29:48,420
+إيه؟ of blood flow، بش هيقلل الـ interstitial fluid
+
+389
+00:29:48,420 --> 00:29:52,280
+partial pressure، زي الأكسجين، بل هنخفض لإنه هناخد
+
+390
+00:29:52,280 --> 00:29:57,200
+إيش؟ هناخد أسرع، مش كده؟ إذا لما زيد الـ flow rate، الـ
+
+391
+00:29:57,200 --> 00:29:59,380
+partial pressure تبع الأكسجين في الـ .. في الـ
+
+392
+00:29:59,380 --> 00:30:04,400
+interstitial fluid، إيش هيخبط، مش كده؟ ولو قللت الـ
+
+393
+00:30:04,400 --> 00:30:07,360
+flow rate، هنلاقي يصير إتجتمع، والـ partial pressure
+
+394
+00:30:07,360 -->
+
+445
+00:34:19,280 --> 00:34:22,640
+hand و hand اي equilibrium اكيد مش كده، مش معقول
+
+446
+00:34:22,640 --> 00:34:25,880
+يبقى في البلازمة أكثر من الـ fluids اللي في داخل الـ
+
+447
+00:34:25,880 --> 00:34:30,340
+أيه؟ أكسجين هذا يتنقل freely، carbon dioxide يتنقل أيه؟
+
+448
+00:34:30,340 --> 00:34:32,860
+freely، بس أنا بتكلم عن الـ dissolved form، بتكلم
+
+449
+00:34:32,860 --> 00:34:36,460
+عن أنه في البلازمة و في داخل الـ أيه؟ الـ الـ
+
+450
+00:34:36,460 --> 00:34:38,820
+الـ الـ the cytoplasm of the أيه؟ of the RBCs
+
+451
+00:34:38,820 --> 00:34:42,020
+itself، مش هيك؟ طيب أنا أخدت بالك و بنسى العلامات
+
+452
+00:34:42,020 --> 00:34:48,810
+بيذكروني عشان أضيفها، الرقم 97% هذا مهم عشان ما
+
+453
+00:34:48,810 --> 00:34:54,890
+تتلخبطوش، الآن بنقول 97% من الـ oxygen محمول وين؟
+
+454
+00:34:54,890 --> 00:34:57,910
+إذا بنتكلم عن الـ total oxygen المحمول في الدم، الـ
+
+455
+00:34:57,910 --> 00:35:01,890
+total oxygen المحمول في الدم، اللي هو الـ total oxygen
+
+456
+00:35:01,890 --> 00:35:06,690
+اللي تحت الـ pressure، pressure 95 جدرين جيل إلى الـ
+
+457
+00:35:06,690 --> 00:35:12,010
+إيه؟ إلى الـ plasma، إلى الـ .. إلى الدم
+
+458
+00:35:14,770 --> 00:35:26,190
+هذا الـ Oxygen، 97% منه على الـ Hemoglobin، و 3% منه
+
+459
+00:35:26,190 --> 00:35:32,050
+محمول dissolved form، تمام؟ okay، إذا الـ total تبعي أنا
+
+460
+00:35:32,050 --> 00:35:35,810
+اللي بتكلم عنه الآن، عن الـ Hemoglobin يمثل 97% من
+
+461
+00:35:35,810 --> 00:35:42,990
+أيش؟ من الـ total Oxygen في الـ .. طبعاً في حاجة
+
+462
+00:35:42,990 --> 00:35:47,380
+اسمها oxygen hemoglobin oxygen dissociation curve
+
+463
+00:35:47,380 --> 00:35:51,720
+بمعنى آخر أن الـ hemoglobin هذا، هيفضل يحل شوية شوية
+
+464
+00:35:51,720 --> 00:35:55,740
+من الـ oxygen تبعه، عشان كل ما نقص الـ pressure
+
+465
+00:35:55,740 --> 00:36:00,340
+البلازمة فيه شيء، فيه buffering system
+
+466
+00:36:00,340 --> 00:36:03,220
+هتكلم عنه بعد شوية، بس أنا بتكلم عن نقطة ثانية، اللي
+
+467
+00:36:03,220 --> 00:36:10,960
+هتتلخبطوا فيها، أن هو من الـ total oxygen بيحمل 97%، الـ
+
+468
+00:36:10,960 --> 00:36:13,680
+97% من الـ Total Oxygen، هدول يمثلوا على الـ
+
+469
+00:36:13,680 --> 00:36:16,880
+Hemoglobin، كل الـ .. كل الـ إيه؟ الـ Oxygen المحمول
+
+470
+00:36:16,880 --> 00:36:19,640
+مش هيك؟ يعني كل الـ Oxygen المحمول على الـ
+
+471
+00:36:19,640 --> 00:36:23,980
+Hemoglobin يمثل 97% من الـ Total Blood، من الـ Total
+
+472
+00:36:23,980 --> 00:36:29,180
+Blood Oxygen، مش كده؟ الآن بدنا نعرف كمان أنه الـ
+
+473
+00:36:29,180 --> 00:36:33,560
+Oxygen .. أنه الـ Hemoglobin، الـ Hemoglobin هذا مش
+
+474
+00:36:33,560 --> 00:36:38,860
+fully saturated، الـ Hemoglobin فقط 97% منه
+
+475
+00:36:38,860 --> 00:36:46,380
+saturated، تمام؟ يعني في عند 3% من الـ hemoglobin ما
+
+476
+00:36:46,380 --> 00:36:50,260
+همش saturated، واضح؟
+
+477
+00:36:50,260 --> 00:36:56,700
+okay، يعني هذا رقم مختلف عن هذا، يعني .. يعني أن ..
+
+478
+00:36:56,700 --> 00:36:59,980
+لما .. لما الـ Hemoglobin أخذ 97%، ما وصلش لـ 100%
+
+479
+00:36:59,980 --> 00:37:03,520
+من التشبع تبعه، هو أخذ 97% من الـ .. من اللي في الدم
+
+480
+00:37:03,520 --> 00:37:07,320
+لكن هذا لا يعني كل ما يستطيع أخذه، تمام؟ هو في
+
+481
+00:37:07,320 --> 00:37:10,500
+حقيقة طلع نفس الرقم، يعني ممكن نقول إحنا 90% من الـ
+
+482
+00:37:10,500 --> 00:37:15,300
+Hemoglobin أخذ حملة أكسجين، وضل 10%، عشان بيفرق
+
+483
+00:37:15,300 --> 00:37:20,760
+الأرقام، تخيلوها، يعني لما الـ 97% من الأكسجين محمول
+
+484
+00:37:20,760 --> 00:37:24,360
+على الـ Hemoglobin، يمثل 90% مثلاً من الـ إيه؟ من قدرة
+
+485
+00:37:24,360 --> 00:37:27,060
+الـ Hemoglobin، كده بالنسبة، بيفرق، لكن أنا بدي ..
+
+486
+00:37:27,060 --> 00:37:30,440
+الرقم هو 97% من قدرة الـهيموجلوبين، نفس الرقم إن هما
+
+487
+00:37:30,440 --> 00:37:35,900
+هما، بس هذا يمثل شيء وهذا يمثل شيء، إذا 97% من
+
+488
+00:37:35,900 --> 00:37:44,160
+الـهيموجلوبين فقط عنده القدرة على أنه يحمل .. آه
+
+489
+00:37:44,160 --> 00:37:48,620
+تلاتة في المية منه بيقدرش يحمل، ليش؟ لإنه جزء من
+
+490
+00:37:48,620 --> 00:37:53,810
+الـهيموجلوبين في الحالة هذه، أنا عندي فيه hemoglobin
+
+491
+00:37:53,810 --> 00:37:58,230
+و impurities، شوائب، وأشياء، أوكسجين، آه لو كان pure
+
+492
+00:37:58,230 --> 00:38:02,970
+oxygen، لـ pure hemoglobin ممكن يحمل كمية أكبر، يحمل
+
+493
+00:38:02,970 --> 00:38:07,810
+مية في المية، لكنه ما هوش pure، هيموجلوبين، في عندي
+
+494
+00:38:07,810 --> 00:38:12,690
+دايماً بعض الهيموجلوبين في مشاكل، فبيؤدي إلى أنه
+
+495
+00:38:12,690 --> 00:38:17,030
+قدرة الهيموجلوبين الكلية على أنه يحمل 97% فقط من
+
+496
+00:38:17,030 --> 00:38:21,510
+إيه؟ من .. من .. من قدرته كهيموجلوبين، في 3% من
+
+497
+00:38:21,510 --> 00:38:24,290
+قدرته كهيموجلوبين مش مستخدمة، لإنه فيها دائماً
+
+498
+00:38:24,290 --> 00:38:32,390
+مشاكل، okay، طيب إذا عندي أنا جزء كبير من الـ .. الجزء
+
+499
+00:38:32,390 --> 00:38:35,130
+الأكبر من الـ oxygen محمول على إيه؟ على الـ
+
+500
+00:38:35,130 --> 00:38:40,530
+hemoglobin، لكن الـ hemoglobin مش هو اللي بيتحكم وين
+
+501
+00:38:40,530 --> 00:38:45,050
+ينتقل الـ oxygen من إلى، أو العكس، اللي بتحكم الموضوع
+
+502
+00:38:45,050 --> 00:38:48,250
+في الانتقال مين؟ brush، brush، brush، اللي هو يمثلوا
+
+503
+00:38:48,250 --> 00:38:52,980
+إيش؟ الـ Dissolved form، اللي هو التلاتة في المية، إذا
+
+504
+00:38:52,980 --> 00:38:56,800
+أنا عندي big reservoir، يعني أنا في جيبي مائة جنيه
+
+505
+00:38:56,800 --> 00:39:01,160
+لكن أنا في الـ bank اتنين مليون، تمام؟ اتنين مليون
+
+506
+00:39:01,160 --> 00:39:01,820
+أو اتنين جنيه
+
+507
+00:39:05,670 --> 00:39:11,030
+صحيح، بأصرف مبلغ صغير، بس أتعامل معه، لكنه إيه اللي
+
+508
+00:39:11,030 --> 00:39:17,270
+رصيدي فيه إيه؟ عالي، وهكذا الـ .. الـ .. الـ hemoglobin
+
+509
+00:39:17,270 --> 00:39:21,570
+عامل لمين؟ للـ .. الـ .. للـ oxygen، حامل الجزء الأكبر
+
+510
+00:39:21,570 --> 00:39:25,850
+لكن اللي بيتم التعامل معه .. ياخد أو يعطي أو يودي
+
+511
+00:39:25,850 --> 00:39:28,710
+الـ partial pressure differences بينه وبين الأنسجة
+
+512
+00:39:28,710 --> 00:39:31,770
+و الـ partial pressure differences هذه، تمام، هي اللي
+
+513
+00:39:31,770 --> 00:39:36,020
+بتحكم في انتقال الـ oxygen، إذا الـ hemoglobin بيترك
+
+514
+00:39:36,020 --> 00:39:41,240
+أكسجين أحياناً، وبياخد أكسجين أحياناً، تمام، حسب قواعد
+
+515
+00:39:41,240 --> 00:39:44,500
+معينة، هذه هندرسها في اللي بيسميها الـ gate، الآن
+
+516
+00:39:44,500 --> 00:39:48,080
+هندرسها، اللي هو الـ hemoglobin oxygen dissociation
+
+517
+00:39:48,080 --> 00:39:52,620
+curve، وقت إيش الـ hemoglobin بيسيب أكسجين، وقت إيش
+
+518
+00:39:52,620 --> 00:40:01,060
+بياخد أكسجين، تمام، بحيث أنه يعطي للـ plasma، يعطي للـ
+
+519
+00:40:01,060 --> 00:40:06,850
+dissolved form المطلوب منها، هذا حقيقة الـ curve هذا
+
+520
+00:40:06,850 --> 00:40:12,910
+من أجمل ما ممكن إحنا أيه نتخيل، و نصوّر هذا الـ curve
+
+521
+00:40:12,910 --> 00:40:17,070
+اللي بسميه oxygen hemoglobin oxygen dissociation
+
+522
+00:40:17,070 --> 00:40:26,730
+curve، تمام، بمعنى أنه لما صار عندي أنا الـ pressure
+
+523
+00:40:26,730 --> 00:40:35,140
+عندي 95 هنا مثلاً، تمام، بتطلع، بلاقي عندي الـ 97% من
+
+524
+00:40:35,140 --> 00:40:41,460
+الهيموجلوبين الـ saturated، تمام؟ إذا أنا بتكلم بالـ
+
+525
+00:40:41,460 --> 00:40:47,240
+97%، اللي هم الـ full saturation، لو
+
+526
+00:40:47,240 --> 00:40:51,840
+أنا بدي .. إذا في الـ 95% partial pressure أكسجين
+
+527
+00:40:51,840 --> 00:40:58,380
+تمام؟ في عندي 97% إيش؟ الـ saturated الهيموجلوبين
+
+528
+00:40:58,380 --> 00:41:04,810
+طيب، الهيموجلوبين، كل ما نزل الـ partial pressure اللي
+
+529
+00:41:04,810 --> 00:41:08,750
+في الـ .. في الـ plasma، يعني كل ما جزء منه من الـ ..
+
+530
+00:41:08,750 --> 00:41:13,090
+من الـ hemoglobin، الـ oxygen راح للـ إيه؟ للـ plasma،
+
+531
+00:41:13,090 --> 00:41:17,490
+تمام؟ إذا في علاقة ما بين هذه وهذه، العلاقة هذه
+
+532
+00:41:17,490 --> 00:41:25,780
+هنلاقيها .. بنسميها S shape إحنا، إيش بنسميها؟ الـ
+
+533
+00:41:25,780 --> 00:41:31,040
+curve هذا S shape، بمعنى أنه مش linear، يعني مش
+
+534
+00:41:31,040 --> 00:41:36,620
+كل ما نقص الـ oxygen pressure، جزء طلع نفس الجزء من
+
+535
+00:41:36,620 --> 00:41:41,340
+الـ hemoglobin، مش linear relationship، تمام؟ إذا في
+
+536
+00:41:41,340 --> 00:41:45,790
+مناطق بيبقى الـ oxygen، الـ hemoglobin بخيل في الفقدان
+
+537
+00:41:45,790 --> 00:41:50,310
+وفي مناطق بيكون كريم في الفقدان، بمعنى آخر، الفرق
+
+538
+00:41:50,310 --> 00:41:57,870
+ما بين الـ 95 ملي متر زئبق و الـ 60 ملي متر
+
+539
+00:41:57,870 --> 00:42:02,370
+زئبق، فرق بسيط، فرق بسيط، يعني من الـ 97 ملي متر
+
+540
+00:42:02,370 --> 00:42:07,130
+زئبق لـ 88 ملي متر زئبق، للثمانية و ثمانين
+
+541
+00:42:07,130 --> 00:42:16,290
+ملي متر، عشرة، عشرة في المية saturation بنفقد، تمام، من
+
+542
+00:42:16,290 --> 00:42:22,950
+السبعة و التسعين هنا، هي سبعة و التسعين لهنا، حوالي سبعة
+
+543
+00:42:22,950 --> 00:42:27,610
+و ثمانين، لكن بين إيش؟ بين خمسة و تسعين و ستين ملي متر
+
+544
+00:42:27,610 --> 00:42:32,150
+زئبق، يعني خمسة و ثلاثين ملي متر زئبق فارق
+
+545
+00:42:32,150 --> 00:42:36,550
+عمل لي فقط عشرة في المية فقدان للإيه؟ أو فرق في
+
+546
+00:42:36,550 --> 00:42:41,170
+القدرة على حملة الأكسجين، تمام؟ يعني أنا لو أنزل
+
+547
+00:42:41,170 --> 00:42:48,110
+الأكسجين pressure لستين، الهيموجلوبين بفقدش إلا عشرة
+
+548
+00:42:48,110 --> 00:42:53,120
+في المية من شسمه، واضح؟ في المنطقة هذه، في المنطقة هذه
+
+549
+00:42:53,120 --> 00:43:01,140
+منطقة الكابيلاريس، لو فقدنا إحنا الـ الـ الـ oxygen
+
+550
+00:43:01,140 --> 00:43:09,000
+الـ pressure pressure من من أربعين إلى إلى عشرين، من أربعين
+
+551
+00:43:09,000 --> 00:43:13,840
+إلى عشرين، عشرين، لحظوا كده، الفارق هنا من حوالي خمسة
+
+552
+00:43:13,840 --> 00:43:21,370
+و سبعين في المية، خمسة وسبعين في المية، ع فكرة، الأربعين
+
+553
+00:43:21,370 --> 00:43:27,410
+ملي متر زئبق يساووا
+
+554
+00:43:27,410 --> 00:43:32,610
+خمسة وسبعين في المية من قدرة الأكسجين، من قدرة
+
+555
+00:43:32,610 --> 00:43:38,510
+الهيموجلوبين، طبعاً، إذن لما الأكسجين يبقى راجع، طالع من
+
+556
+00:43:38,510 --> 00:43:42,230
+الكابيلاريس، من الرئتين، يبقى حامل سبعة في المية، نسب
+
+557
+00:43:42,230 --> 00:43:47,630
+و هو راجع بيبقى حامل 75%، صحيح، هذه pressure 95 و
+
+558
+00:43:47,630 --> 00:43:52,610
+هذه pressure 40، الفرق في النسب، في الـ percentages
+
+559
+00:43:52,610 --> 00:43:55,390
+مش نفس الفرق بين الـ pressure و pressure، بسبب الـ
+
+560
+00:43:55,390 --> 00:43:59,690
+curve هذا، تمام، لما يكون عندي أنا 40 millimeter
+
+561
+00:43:59,690 --> 00:44:02,290
+mercury، اللي هو الهيموجلوبين النسب يكون حامل 75% من الـ
+
+562
+00:44:02,290 --> 00:44:09,340
+oxygen تبعه، واضح؟ لما يكون 95، الهيموجلوبين هيحمل 97%
+
+563
+00:44:09,340 --> 00:44:14,140
+من الهيموجلوبين التابعه، تمام؟ بيرجع هيحمل بس 75، لكن الـ
+
+564
+00:44:14,140 --> 00:44:17,680
+pressure بروح 95 millimeter mercury و برجع 40
+
+565
+00:44:17,680 --> 00:44:24,220
+millimeter mercury، لإنه بين الـ 97 و الـ 40، هيفقد فقط
+
+566
+00:44:24,220 --> 00:44:28,980
+الفرق هذا البسيط، يعني هيحمل بس 95% لـ 97%، ما فيش
+
+567
+00:44:28,980 --> 00:44:34,310
+بينهم فرق، احسبوها، لكن من الـ 40، لو صار عندي أنا
+
+568
+00:44:34,310 --> 00:44:39,470
+consumption أكثر في الخلايا، آه، و صار عندي هبوط أكثر
+
+569
+00:44:39,470 --> 00:44:43,590
+لمين؟ للـ bar pressure في الـ interstitial fluid
+
+570
+00:44:43,590 --> 00:44:47,530
+لأنه صار عندي consumption أكثر، واضطرنا إنه ينزل الـ
+
+571
+00:44:47,530 --> 00:44:52,310
+bar pressure لـ 15% مثلاً، لهنا، شوفوا قد إيش الفرق من
+
+572
+00:44:52,310 --> 00:45:01,630
+75% لـ .. لـ .. لحوالي 15%، 60% من حملة الـ oxygen الـ
+
+573
+00:45:01,630 --> 00:45:07,750
+hemoglobin، بيطلع في فرق عشرين أو خمسة عشر في المية
+
+574
+00:45:07,750 --> 00:45:14,250
+واضح؟ عندي أنا قدرة كبيرة على إن الـ hemoglobin يدي
+
+575
+00:45:14,250 --> 00:45:17,470
+الأنسجة، لإنه في المنطقة هادئة، بيكون في الأنسجة، هو
+
+576
+00:45:17,470 --> 00:45:22,250
+إذا التغير من الـ 40 إلى الـ 30 إلى الـ 20، تغير
+
+577
+00:45:22,250 --> 00:45:27,430
+البسيط، هادئ، بيكون في الأنسجة، هناك أي تغير بيعطي
+
+578
+00:45:27,430 --> 00:45:32,350
+كمية كبيرة من الـ oxygen للأنسجة، في حين إن المنطقة
+
+579
+00:45:32,350 --> 00:45:37,350
+العالية بيكون فيها، فوق في الرئة، مش كده؟ الـ pressure
+
+580
+00:45:37,350 --> 00:45:41,290
+الـ pressure الستين والسبعين والثمانين والتسعين، هدول في
+
+581
+00:45:41,290 --> 00:45:46,630
+الرئة، بمعنى إنه لو أنا صار عندي في منطقة ساكن
+
+582
+00:45:46,630 --> 00:45:50,910
+على جبل عالي، و الـ oxygen pressure عندي واطي، تمام
+
+583
+00:45:50,910 --> 00:45:54,710
+الـ oxygen pressure واطي، مش pressure مية وأربعة ..
+
+584
+00:45:54,710 --> 00:45:58,090
+مية، و الـ alveolar أيه؟ في الحالة دي بيكونش مية و
+
+585
+00:45:58,090 --> 00:46:03,290
+أربعة مثلاً، الـ alveolar، افترضوا أنه صار ثمانين، صار
+
+586
+00:46:03,290 --> 00:46:10,900
+سبعين، تمام؟ هنا مثلاً صار ثمانين، صار سبعين، صار
+
+587
+00:46:10,900 --> 00:46:14,040
+ستين ملي متر زئبق، ايرفيرر ايرفيرر ايرفيرر ايرفيرر
+
+588
+00:46:14,040 --> 00:46:17,540
+ايرفيرر ايرفيرر ايرفيرر ايرفيرر ايرفيرر ايرفيرر
+
+589
+00:46:17,540 --> 00:46:23,270
+ايرفيرر، بقي الفيولر أيه؟ ستين ملي متر زئبق أو خمسة
+
+590
+00:46:23,270 --> 00:46:26,350
+و تسعين ملي متر زئبق، فارق منهم بسيط، يعني بمعنى
+
+591
+00:46:26,350 --> 00:46:29,810
+آخر، أن لو أنا كنت في ظروف غير طبيعية، و الـ oxygen
+
+592
+00:46:29,810 --> 00:46:33,490
+عندي واطي، برضه يكفي الـ hemoglobin إنه ياخد كل اللي
+
+593
+00:46:33,490 --> 00:46:36,630
+عايزه، يعني الفارق ما بين ستين في المية .. ستين ملي
+
+594
+00:46:36,630 --> 00:46:39,770
+متر زئبق partial pressure أكسجين، و الخمسة و التسعين .. و الـ
+
+595
+00:46:39,770 --> 00:46:44,700
+.. و الـ .. و الـ .. و المية و أربعة، الـ alveolar Air
+
+596
+00:46:44,700 --> 00:46:49,360
+Oxygen Pressure، الفرق بينهم الضخم، هي دي أربعة
+
+597
+00:46:49,360 --> 00:46:53,280
+و أربعين، من ستين لمية و أربعة، أربعة و أربعين في المية
+
+598
+00:46:53,280 --> 00:46:55,320
+مش كده؟ أربعة و أربعين ملي متر زئبق، الفرق بينهم
+
+599
+00:46:55,320 --> 00:47:02,060
+الضخم، إلا إنه الرئتين، الـ hemoglobin يستطيع إنه
+
+600
+00:47:02,060 --> 00:47:06,100
+ياكل تقريباً كل ما يريد، الفرق فيهم ضخم في الـ
+
+601
+00:47:06,100 --> 00:47:09,400
+partial pressure، بس في الـ hemoglobin saturation فرق
+
+602
+00:47:09,400 --> 00:47:19,640
+بسيط، من الـ 60 هنا اللي تمثل 87% لـ 95 اللي تمثل 97%
+
+603
+00:47:19,640 --> 00:47:25,100
+الفرق بينهم 10%، فالفرق في الـ partial pressure كان
+
+604
+00:47:25,100 --> 00:47:33,300
+35%، إذا الـ curve هذا واضح، أنه في المناطق اللي فيها
+
+605
+00:47:34,030 --> 00:47:38,270
+أكسجين قليل، أنا بقدر آخد هيموجلوبين كويس، وفي
+
+606
+00:47:38,270 --> 00:47:45,230
+الأنسجة، أقل حاجة للأكسجين، بديهم الباقي، يعني، إذا
+
+607
+00:47:45,230 --> 00:47:47,750
+متى انخفض عندي الـ partial pressure في ناحية
+
+60
+
+667
+00:52:18,630 --> 00:52:22,680
+كمان Shift to the right صار يديني أكثر من الطبيعي
+
+668
+00:52:22,680 --> 00:52:25,440
+في الشسمة وهذه بتصير دائماً Shift to the right في
+
+669
+00:52:25,440 --> 00:52:28,000
+الأنسجة لأن في الأنسجة يزيد carbon dioxide أنا
+
+670
+00:52:28,000 --> 00:52:30,600
+مذكور هنا من أربعة لما يزيد ال hydrogen ion
+
+671
+00:52:30,600 --> 00:52:33,400
+concentration لما يزيد عندي ال carbon dioxide
+
+672
+00:52:33,400 --> 00:52:36,640
+concentration لما تزيد الحرارة في الأنسجة في
+
+673
+00:52:36,640 --> 00:52:42,430
+التمثيل الغذائي شغال فالحرارة في الأنسجة أعلى لما صار
+
+674
+00:52:42,430 --> 00:52:45,850
+عندي exercise ومجهود أكبر ال carbon dioxide زاد و
+
+675
+00:52:45,850 --> 00:52:48,470
+ال hydrogen ion زاد و الحرارة زادت كل هذه
+
+676
+00:52:48,470 --> 00:52:52,510
+عوامل بتخلي أنه احنا ال hemoglobin بدنا يدينا كمان
+
+677
+00:52:52,510 --> 00:52:56,850
+أكثر وأكثر فبيصير Shift to the right طبعاً في حين
+
+678
+00:52:56,850 --> 00:53:01,570
+أنه لما الدم يطلع على الرئتين يفقد ال carbon
+
+679
+00:53:01,570 --> 00:53:07,470
+dioxide و يفقد ال hydrogen وحرارته تبرد تماماً
+
+680
+00:53:07,470 --> 00:53:11,790
+لأنه صار يحتك بـ ماذا؟ بالهواء فالغذاء فهذا كله
+
+681
+00:53:11,790 --> 00:53:15,910
+بيخليه Shift to the left بمعنى آخر أنه بيصير يحمل
+
+682
+00:53:15,910 --> 00:53:19,690
+أكثر  لا يفقد أكثر إذا ال curve معمول في منطقة
+
+683
+00:53:19,690 --> 00:53:25,710
+للحمل أكثر أو في منطقة للتنزيل أكثر تماماً؟ ولو
+
+684
+00:53:25,710 --> 00:53:31,360
+الظروف الآن طبيعية يروح هو أيضاً نعم نعم يعني
+
+685
+00:53:31,360 --> 00:53:36,260
+okay دخول كلية الطب والرسوم سبعون ديناراً على الرصد
+
+686
+00:53:36,260 --> 00:53:41,240
+مقدرين لأنه احنا  ماذا؟ مهيئين أنفسنا لذلك أيضاً في
+
+687
+00:53:41,240 --> 00:53:46,080
+مساقات اختيارية أو فيها سفر لأوروبا فوق السبعين
+
+688
+00:53:46,080 --> 00:53:50,540
+ديناراً أيضاً هندفع ماذا؟ تكاليف سفر إضافية أيضاً الأب
+
+689
+00:53:50,540 --> 00:53:54,440
+جاهز يدفع أيضاً وأيضاً إذا صار عندي قدرة عادية
+
+690
+00:53:54,440 --> 00:53:57,940
+وأيضاً استعداد لقدرة غير عادية فالهموجلوبين في
+
+691
+00:53:57,940 --> 00:54:01,820
+القدرة العادية بيدينا كمية ضخمة من ال oxygenللأنسجة،
+
+692
+00:54:01,820 --> 00:54:04,700
+لكن لو زاد الـ carbon dioxide أيضاً، يعني بدنا في
+
+693
+00:54:04,700 --> 00:54:07,480
+استهلاك أكثر، يروح كله Shift to the right عشان
+
+694
+00:54:07,480 --> 00:54:10,760
+يدّينا أكسجين أكثر، طبعاً العوامل التي اتكلمنا عنها
+
+695
+00:54:10,760 --> 00:54:17,360
+هذه ثلاثة، يبقى اللي هو الـ 2,3-biphosphoglycerate، glycerol،
+
+696
+00:54:17,360 --> 00:54:20,020
+سأتكلم عنه بعد قليل، إذا في عندنا ال curve هذا ال
+
+697
+00:54:20,020 --> 00:54:26,070
+hemoglobin oxygen dissociation curve، مهم جداً
+
+698
+00:54:26,070 --> 00:54:30,550
+رائع جداً يعبر عن قدرة الهيموجلوبين هذا الخلق
+
+699
+00:54:30,550 --> 00:54:34,130
+العجيب قلت لكم أنا لماذا خلقنا الله الهيموجلوبين في
+
+700
+00:54:34,130 --> 00:54:38,750
+داخل ال RBC's  إلا كان يصير ال filtration
+
+701
+00:54:38,750 --> 00:54:44,270
+بالكلية ونسد ال tubules وندخل في مشاكل ضخمة و
+
+702
+00:54:44,270 --> 00:54:47,130
+هذا ما يصير ساعة ما نصير عندنا hemolysis لما
+
+703
+00:54:47,130 --> 00:54:52,210
+الحياة تُجرح إنساناً و الحياة النوع الذي هم الأجسام
+
+704
+00:54:52,210 --> 00:54:56,380
+السمية يعني نسميها hematotoxicفي neurotoxic هذه
+
+705
+00:54:56,380 --> 00:54:59,080
+ثواني تكون جتلة الإنسان بتعمل شلل لكن ال
+
+706
+00:54:59,080 --> 00:55:04,480
+hematotoxic هذه مثلاً بتعمل hemolysis تكسير ماذا؟
+
+707
+00:55:04,480 --> 00:55:07,860
+لل RBCs red blood cells بتعمل تكسير فال
+
+708
+00:55:07,860 --> 00:55:10,900
+hemoglobin بيصير exposed  لحقه في ماذا؟ في
+
+709
+00:55:10,900 --> 00:55:15,770
+الدم فبيصير له filtration أين؟ في الكلية، لو أخذنا
+
+710
+00:55:15,770 --> 00:55:20,090
+دواء أيضاً دواء فاسد أو هكذا و عملنا Hemolysis، هيعمل
+
+711
+00:55:20,090 --> 00:55:23,450
+نفس الحالة، يعني أي شيء بتعمل Hemolysis، بنلاقي ال
+
+712
+00:55:23,450 --> 00:55:25,950
+Hemoglobin الذي طلع من ال RBCs، صار بيوصل له
+
+713
+00:55:25,950 --> 00:55:29,330
+filtration وينزل في ال Bowmans capsule وفي ال
+
+714
+00:55:29,330 --> 00:55:33,470
+tubule ونحشره هناك ويجف عندما تصير absorption
+
+715
+00:55:33,470 --> 00:55:37,310
+الماء يصير inspecated ويبدأ يسد ال tribules
+
+716
+00:55:37,310 --> 00:55:40,850
+واحدة واحدة واحدة ويدخلنا في acute failure ويعمل
+
+717
+00:55:40,850 --> 00:55:46,630
+ماذا؟ مشكلة كبيرة تماماً؟ لذلك موضوع في ماذا؟ في RBC's
+
+718
+00:55:46,630 --> 00:55:49,630
+هذا في حد ذاته إعجاب وبعدين نفس التركيب الذي هم
+
+719
+00:55:49,630 --> 00:55:55,850
+مدهش تركيب أيضاً ماذا؟ تركيب عجيب رائع طيب هذا ال
+
+720
+00:55:55,850 --> 00:56:01,660
+...فكرة الـ dissociation curve فهمناها لأن
+
+721
+00:56:01,660 --> 00:56:04,800
+فهمناها في الوضع الطبيعي وفهمناها في الوضع ال
+
+722
+00:56:04,800 --> 00:56:09,440
+الغير طبيعي إذا نَدى ال oxygen hemoglobin oxygen
+
+723
+00:56:09,440 --> 00:56:13,840
+dissociation curve وفهمنا أنه لماذا  S shape لأنه ليس
+
+724
+00:56:13,840 --> 00:56:17,440
+linear لأنه في مناطق بده يحمل أكسجين في مناطق بده
+
+725
+00:56:17,440 --> 00:56:21,260
+يعطي أكسجين فهو مُهيأ أنه في مناطق لو صار فروقات
+
+726
+00:56:21,260 --> 00:56:25,980
+pressure ما تفرجش معه هارف الأخذ وصار في مناطق أي
+
+727
+00:56:25,980 --> 00:56:30,000
+فروقات pressure بيعطي في مناطق الأعطاء يعطي كثيراً
+
+728
+00:56:33,230 --> 00:56:36,610
+maximum amount of oxygen that can combine okay إذا
+
+729
+00:56:36,610 --> 00:56:40,810
+خلينا ماذا؟ نتكلم عن بعض الأرقام الآن ما يتعلق
+
+730
+00:56:40,810 --> 00:56:44,290
+بالهيموجلوبين كهيموجلوبين ليس الدم كدم
+
+731
+00:56:44,290 --> 00:56:47,670
+قلنا الدم يحمل 3% منه محمول في ال
+
+732
+00:56:47,670 --> 00:56:51,930
+plasma in the cell form و 27% محمول على ال
+
+733
+00:56:51,930 --> 00:56:55,410
+hemoglobin و ال hemoglobin هذا حامل saturated 97%
+
+734
+00:56:55,410 --> 00:56:58,110
+من قدرته فقط تماماً
+
+735
+00:57:02,550 --> 00:57:05,530
+oxygen hemoglobin dissociation curve احنا هنا اه
+
+736
+00:57:05,530 --> 00:57:08,550
+الجزء الثاني من الموضوع هنا هنا أنا تكلمت عن
+
+737
+00:57:08,550 --> 00:57:12,610
+الجزء الأيسر في ال curve  الجزء الأيمن في ال
+
+738
+00:57:12,610 --> 00:57:17,150
+curve ملاحظين أنتم هنا volumes volumes التي لما
+
+739
+00:57:17,150 --> 00:57:19,690
+نقول سبعة وتسعين في المائة من ال hemoglobin
+
+740
+00:57:19,690 --> 00:57:23,790
+saturated أو نقول سبعين أو تسعة وسبعين أو أو أو
+
+741
+00:57:23,790 --> 00:57:29,370
+النسب هذه التي مقابلها كل نسبة مقابلها pressure
+
+742
+00:57:29,370 --> 00:57:33,420
+معين  بس البرشر pressure الآن فهمنا في ظروفه
+
+743
+00:57:33,420 --> 00:57:37,280
+ممكن نفس البرشر pressure يديني كمية كبيرة من الهموجلوبين
+
+744
+00:57:37,280 --> 00:57:41,040
+من ال oxygen محمول أو أجل إذا ظروفه ال carbon ده
+
+745
+00:57:41,040 --> 00:57:45,160
+هيفسدو  أي يعني في Shift to the right و Shift to
+
+746
+00:57:45,160 --> 00:57:48,640
+the left لكن in general نتكلم عن normal ال normal
+
+747
+00:57:48,640 --> 00:57:52,600
+ليس ... ليس في حالات غير عادية ليس exercise غير عادي
+
+748
+00:57:52,600 --> 00:57:56,580
+ليس consumption غير عادي  نقول أنه مقابل ل 95%
+
+749
+00:57:56,580 --> 00:58:00,660
+pressure 95 millimeter mercury يكون عندي 97%
+
+750
+00:58:00,660 --> 00:58:05,080
+saturation ليس كذلك 97% saturation  طيب يعني كم
+
+751
+00:58:05,080 --> 00:58:13,380
+oxygen saturated لكن كم oxygen جاء لكل
+
+752
+00:58:13,380 --> 00:58:18,780
+واحد جرام hemoglobin يحمل oxygen 1.34
+
+753
+00:58:18,780 --> 00:58:25,700
+1.34 milliliter oxygen
+
+754
+00:58:26,400 --> 00:58:30,980
+إذا كل واحد hemoglobin واحد جرام hemoglobin يحمل
+
+755
+00:58:30,980 --> 00:58:33,940
+يُقدر يحمل ال maximum تبعه ال 97% تبعته التي يقدر
+
+756
+00:58:33,940 --> 00:58:37,420
+يحملها ال maximum تبعه الذي هو ال maximum يقول لنا
+
+757
+00:58:37,420 --> 00:58:42,440
+97% لأنه في 3% من ال hemoglobin لا يعمل يحمل ال
+
+758
+00:58:42,440 --> 00:58:45,360
+maximum تبعه 1.34 لمن؟
+
+759
+00:58:45,360 --> 00:58:51,180
+لكل جرام في الحد المتوسط الإنسان لما يقولوا متوسط
+
+760
+00:58:51,180 --> 00:58:57,750
+الإنسان ماذا تقصد فيها؟ نقصد male adult سبعين اه
+
+761
+00:58:57,750 --> 00:59:02,510
+تماماً ال female تكون أجل نسبة معينة تماماً إذا لما
+
+762
+00:59:02,510 --> 00:59:08,770
+نقول standard تبعنا هنلاقي أنه كل معظم الناس أو
+
+763
+00:59:08,770 --> 00:59:13,760
+الرجال الذين بال standard خمسة عشر جرام هموجلوبين
+
+764
+00:59:13,760 --> 00:59:18,640
+تبعهم خمسة عشر جرام في كل مئة ملي لتر دم حاملين خمسة
+
+765
+00:59:18,640 --> 00:59:23,120
+عشر جرام هموجلوبين الهموجلوبين هذا كل جرام يحمل
+
+766
+00:59:23,120 --> 00:59:26,580
+1.34 سيخرج لأنه الخمسة عشر جرام هذه
+
+767
+00:59:26,580 --> 00:59:32,680
+التي موجودة في مئة ملي لتر حاملين واحد وعشرين أو
+
+768
+00:59:32,680 --> 00:59:40,380
+عشرون 20 ملي لتر أكسجين لذا كل جرام
+
+769
+00:59:40,380 --> 00:59:44,160
+حامل 1.34 ملي لتر أكسجين الخمسة عشر
+
+770
+00:59:44,160 --> 00:59:50,700
+جرام هموجلوبين الذي هم الدم الطبيعي طبعنا طبعنا اه
+
+771
+00:59:50,700 --> 00:59:57,860
+النساء أقل من جرام إلى اثنين جرام عن الرجل ماذا
+
+772
+00:59:57,860 --> 01:00:03,300
+السبب أن النساء أقل قليلاً اسمعني
+
+773
+01:00:03,300 --> 01:00:06,160
+يا عيش من ماذا؟
+
+774
+01:00:09,020 --> 01:00:15,260
+لم أفهم أنا واحد يسمي يعني سامعني عالية اه ال
+
+775
+01:00:15,260 --> 01:00:22,500
+periods  الواضح  الذي هو ال menstruation ال
+
+776
+01:00:22,500 --> 01:00:26,560
+menstruation صحيح لكن لو لا menstruation عند المرأة
+
+777
+01:00:26,560 --> 01:00:30,140
+سنلاقيها أيضاً أجل لماذا؟
+
+778
+01:00:32,810 --> 01:00:34,690
+نتحدث عن الهيموجلوبين ال muscle bulk و
+
+779
+01:00:34,690 --> 01:00:37,890
+الهيموجلوبين يعودون لنفس السبب يعني ال muscle bulk
+
+780
+01:00:37,890 --> 01:00:41,870
+لأنه عندنا androgens  فعندنا muscle bulk أكثر و
+
+781
+01:00:41,870 --> 01:00:44,570
+الهيموجلوبين عندنا أكثر لأنه عندنا androgens ال
+
+782
+01:00:44,570 --> 01:00:50,430
+androgens more anabolic than الاستروجين واضح؟ ال
+
+783
+01:00:50,430 --> 01:00:53,670
+estrogen الذي هو means female estrogen عندك
+
+784
+01:00:53,670 --> 01:00:57,960
+أنت مُفصل جهة دي وأنا endocrineأنا أجيب أنت
+
+785
+01:00:57,960 --> 01:01:01,560
+تُجيب ماذا؟ وأنا أجيب أقول لكم androgens ال
+
+786
+01:01:01,560 --> 01:01:04,400
+androgen هرمون الذكورة الذي عند الرجل اسمه
+
+787
+01:01:04,400 --> 01:01:08,480
+androgens ال estrogen هرمون الأنوثة عند المرأة اسمه
+
+788
+01:01:08,480 --> 01:01:12,660
+ماذا؟ estrogens فال estrogen less anabolic than ال
+
+789
+01:01:12,660 --> 01:01:17,460
+androgen فال androgen يبني أكثر فعمل عضلات أكثر و
+
+790
+01:01:17,460 --> 01:01:22,520
+عظم أكثر وأنسجة و ... اه ومن إضافة إلى ال hemoglobin
+
+791
+01:01:22,520 --> 01:01:27,710
+أكثر لأنه عندي androgens واضح؟ طيب إذا عندنا 15
+
+792
+01:01:27,710 --> 01:01:32,190
+gram كل gram حامل 1.34 يعني بمعنى
+
+793
+01:01:32,190 --> 01:01:37,550
+آخر هنا لما يصير عندي أنا full saturation أحمل ال
+
+794
+01:01:37,550 --> 01:01:42,590
+الـ الـ ال مئة في المئة hemoglobin لما يكون حامل مئة
+
+795
+01:01:42,590 --> 01:01:47,530
+في المئة oxygen تُمثل ماذا بالأرقام بال volumes تُمثل
+
+796
+01:01:47,530 --> 01:01:51,510
+عشرون milliliter percent في كل percent يعني per
+
+797
+01:01:51,510 --> 01:01:55,120
+hundred milliliter of blood  هذه نسميها volume per
+
+798
+01:01:55,120 --> 01:02:02,800
+cent يعني volume كذا per hundred per hundred per
+
+799-810
+(Repeated phrases removed for brevity.  The repeated "per hundred" phrase was already understood.)
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wsNmlhvh6hM.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wsNmlhvh6hM.srt
new file mode 100644
index 0000000000000000000000000000000000000000..56debda51edf042039a39c5db5c93fac7ec9cf90
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wsNmlhvh6hM.srt
@@ -0,0 +1,1566 @@
+1
+00:00:06,120 --> 00:00:12,860
+بسم الله الرحمن الرحيم بدأنا الحديث عن الـ make
+
+2
+00:00:12,860 --> 00:00:22,200
+duration reflex وقلنا أنّه
+
+3
+00:00:22,200 --> 00:00:30,880
+بيحتاج إلى sensory part و center و إلى efferent أو
+
+4
+00:00:30,880 --> 00:00:31,460
+motor
+
+5
+00:00:37,020 --> 00:00:43,740
+بهمني تفهموا أنّه  الثلاثة parts هدول are important،
+
+6
+00:00:43,740 --> 00:00:51,560
+يعني لو الـ afferent راح، صار إصابة فيه، مش هيصير
+
+7
+00:00:51,560 --> 00:00:54,760
+الـ micturition reflex، وعملية الـ micturition مش
+
+8
+00:00:54,760 --> 00:00:59,300
+هتصير، لأنّ هذا ليس voluntary act، يحتاج إلى وجود الـ
+
+9
+00:00:59,300 --> 00:01:04,540
+motor.  لا تحتاج... هذه reflex تحتاج إلى sensory هو
+
+10
+00:01:04,540 --> 00:01:09,020
+ينبّه الـ center و الـ reflex للـ center بيبعت له الـ
+
+11
+00:01:09,020 --> 00:01:15,160
+motor contraction عشان يقدّم الغرض المطلوب، تمام؟
+
+12
+00:01:15,160 --> 00:01:25,040
+طيب، اتكلمنا احنا عن تفاصيل الـ ... الـ
+
+13
+00:01:25,040 --> 00:01:30,800
+... الـ micturition reflex لكننا نعرف بعض الحقائق
+
+14
+00:01:30,800 --> 00:01:39,100
+الأخرى عليه، تمام؟ بعض الحقائق الأخرى
+
+15
+00:01:39,100 --> 00:01:43,800
+الحقائق: what when the bladder is only partially
+
+16
+00:01:43,800 --> 00:01:50,220
+filled, these micturition contractions usually
+
+17
+00:01:50,220 --> 00:01:54,160
+relax. اتكلمنا عن الـ micturition waves، قلنا كلّ ما
+
+18
+00:01:54,160 --> 00:01:59,540
+يزيد الـ bladder contents، أعتقد هذه موجودة قبل هنا
+
+19
+00:01:59,540 --> 00:02:04,900
+موجودة، اتكلمت عنها، اتكلمت عنها باختصار، okay. إذا كلّ
+
+20
+00:02:04,900 --> 00:02:10,620
+ما زاد الـ bladder waves هذه، كلّ ما يزيد الـ filling
+
+21
+00:02:10,620 --> 00:02:17,520
+تبع الـ bladder، يزيد الـ intensity و الـ frequency
+
+22
+00:02:17,520 --> 00:02:23,180
+تبع الـ micturition waves، تمام؟ لحدّ level معيّن، الـ
+
+23
+00:02:23,180 --> 00:02:27,580
+micturition waves هذه تُعطي إلي contraction... strong
+
+24
+00:02:27,580 --> 00:02:31,660
+contraction في الـ ... in the detrusor muscle، فيزيد
+
+25
+00:02:31,660 --> 00:02:36,580
+الـ intravesical pressure لدرجة أنّه ممكن يفتح و يُ
+
+26
+00:02:36,580 --> 00:02:40,460
+expose الـ bladder neck receptors للـ pressure هذا
+
+27
+00:02:40,460 --> 00:02:44,700
+فبُدئي stronger reflex، في الحالة هذه ببدأ أنا أحسّ
+
+28
+00:02:44,700 --> 00:02:48,720
+الـ desire of urination و بُدئي strong reflex على
+
+29
+00:02:48,720 --> 00:02:54,870
+أنّه إيه يصير urination. الآن، إذا كانت الظروف مناسبة
+
+30
+00:02:54,870 --> 00:02:59,150
+أو إذا بتكلم عن ولد صغير، هيصير urination طبيعي، لكن
+
+31
+00:02:59,150 --> 00:03:02,230
+في الـ adult، بتبقى الـ micturition center دائماً
+
+32
+00:03:02,230 --> 00:03:07,070
+under inhibition، under voluntary inhibition من الـ
+
+33
+00:03:07,070 --> 00:03:14,050
+cerebral cortex و brain stem signals
+
+34
+00:03:14,050 --> 00:03:21,010
+inhibiting الـ micturition center، بحيث أنّه هذا
+
+35
+00:03:21,010 --> 00:03:25,450
+ما بيصيرش إلا under voluntary desire، أنّه اه، okay
+
+36
+00:03:25,450 --> 00:03:31,430
+تمام؟ فبيبدأ عندي هنا الـ ... الـ inhibition هذا، إذا
+
+37
+00:03:31,430 --> 00:03:37,730
+كان الـ desire موجودة... إذا كان الـ desire موجودة و
+
+38
+00:03:37,730 --> 00:03:43,100
+الـ inhibition بدأ يختفي، ممكن يصير عنده الـ a front
+
+39
+00:03:43,100 --> 00:03:48,740
+للـ internal sphincter و a front للـ external
+
+40
+00:03:48,740 --> 00:03:51,380
+sphincter، يؤدي إلى الـ micturition act
+
+41
+00:03:56,520 --> 00:04:04,940
+الـ ... الـ ... الـ ... الـ ... فيه inhibitory signals
+
+42
+00:04:04,940 --> 00:04:09,800
+لازمة موجودة، حتّى لو صار reflex relaxation under
+
+43
+00:04:09,800 --> 00:04:13,870
+strong intravesical pressure، عن طريق البراشر وعن طريق
+
+44
+00:04:13,870 --> 00:04:19,970
+ميكتوريشن رفليكس، يعطيني relaxation of the internal
+
+45
+00:04:19,970 --> 00:04:24,430
+sphincter، ممكن يَضعف عندي strong contractions
+
+46
+00:04:24,430 --> 00:04:28,390
+of the external sphincter لتسمح بذلك، وتمنع
+
+47
+00:04:28,390 --> 00:04:34,010
+الميكتوريشن يتم، okay. طيب، إذا في عندي pressure بيؤدّي إلى
+
+48
+00:04:34,010 --> 00:04:34,370
+waves
+
+49
+00:04:37,250 --> 00:04:40,550
+خليني اتكلم عنها، بيقول أنّه أثناء ما يكون الـ
+
+50
+00:04:40,550 --> 00:04:44,150
+pressure، الـ content of the bladder zero، الـ
+
+51
+00:04:44,150 --> 00:04:46,950
+pressure بيكون zero، لما يزيد الـ content من ثلاثين
+
+52
+00:04:46,950 --> 00:04:50,970
+إلى خمسين ملي لتر، يرتفع الـ pressure من خمسة إلى عشرة
+
+53
+00:04:50,970 --> 00:04:55,330
+centimeter water. لو زدنا لحدّ الأربعمائة ملي لتر
+
+54
+00:04:55,330 --> 00:04:59,250
+content في الـ bladder، بيلاقي الـ pressure إلى حدّ ما
+
+55
+00:04:59,250 --> 00:05:02,490
+ما بيتغيّر، الـ pressure ده، يعني الـ tone of the
+
+56
+00:05:02,490 --> 00:05:06,650
+detrusor muscle. إذا زاد عن هيك، بيبدأ عندي إشارات
+
+57
+00:05:06,650 --> 00:05:14,860
+بيبدأ تعمل لي the bladder، زيادة في الوضع، يجعل الوضع
+
+58
+00:05:14,860 --> 00:05:21,960
+يرتفع بسرعة، وهذا يؤدّي إلى ميكتوريشن ويفز أكثر وأسرع
+
+59
+00:05:21,960 --> 00:05:26,080
+زي ما اتكلمنا من شوية، كويس؟ طيب، إذا ناخد بعض
+
+60
+00:05:26,080 --> 00:05:31,800
+المواصفات لـ ... طيب، as the bladder continues to
+
+61
+00:05:31,800 --> 00:05:36,250
+fill، الخطرات المكتورة تصبح أكثر عادية، وتسبب في
+
+62
+00:05:36,250 --> 00:05:37,550
+أكثر عادية عادية عادية عادية عادية عادية عادية
+
+63
+00:05:37,550 --> 00:05:38,930
+عادية عادية عادية عادية عادية عادية عادية عادية
+
+64
+00:05:38,930 --> 00:05:46,470
+عادية عادية عادية عادية عادية عادية عادية عادية
+
+65
+00:05:46,470 --> 00:05:46,970
+عادية عادية عادية عادية عادية عادية عادية عادية
+
+66
+00:05:46,970 --> 00:05:49,690
+عادية عادية عادية عادية عادية عادية عادية عادية
+
+67
+00:05:49,690 --> 00:05:51,590
+عادية عادية عادية عادية عادية عادية عادية عادية
+
+68
+00:05:51,590 --> 00:05:51,670
+عادية عادية عادية عادية عادية عادية عادية عادية
+
+69
+00:05:51,670 --> 00:05:52,750
+عادية عادية
+
+70
+00:05:58,760 --> 00:06:01,620
+الـ intravesical pressure بيؤدّي إلى reflex
+
+71
+00:06:01,620 --> 00:06:06,260
+contraction، مش كده؟ الـ reflex contraction اللي
+
+72
+00:06:06,260 --> 00:06:13,260
+بيعمل more stretch لـ الـ receptors، بيعطيني stronger
+
+73
+00:06:13,260 --> 00:06:18,300
+contraction، بيعمل exposure لـ الـ vesical intra
+
+74
+00:06:18,300 --> 00:06:21,480
+للـ bladder
+
+75
+00:06:21,480 --> 00:06:25,280
+neck receptors، بيؤدّي إلى more strong and strong
+
+76
+00:06:25,280 --> 00:06:31,740
+contraction reflex. عندما يبدأ ميكتوريشن رفليكس، هو نفس
+
+77
+00:06:31,740 --> 00:06:37,080
+الانتِاج، اللي هو اكتفاء البُلدر وهو يجعل الـ waves
+
+78
+00:06:37,080 --> 00:06:44,700
+تتحرّك أكثر في محيط الـ bladder والـ posterior urethra
+
+79
+00:06:44,700 --> 00:06:50,440
+وهو يجعلها تتحرّك أكثر في محيط الـ bladder، وهي تتحرّك
+
+80
+00:06:50,440 --> 00:06:51,240
+أكثر في محيط الـ bladder، وهي تتحرّك
+
+81
+00:06:51,240 --> 00:06:53,020
+أكثر في محيط الـ bladder، وهي تتحرّك أكثر في محيط الـ bladder
+
+82
+00:06:53,020 --> 00:06:57,980
+وهي تتحرّك أكثر في محيط الـ bladder، وهي تتحرّك أكثر في محيط
+
+83
+00:06:57,980 --> 00:07:03,280
+الـ bladder، وهي تتحرّك أكثر في محيط الـ bladder، وهي تتحرّك أك
+
+84
+00:07:04,620 --> 00:07:18,720
+الـ التفكير الانتقالي يبدأ بالتفكير، والتفكير
+
+85
+00:07:18,720 --> 00:07:24,120
+يبدأ بالتفكير، ونعود للوضع اللي كنا فيه، والتفكير
+
+86
+00:07:24,120 --> 00:07:28,940
+الانتقالي يبدأ بالتفكير، والتفكير يبدأ بالتفكير
+
+87
+00:07:28,940 --> 00:07:34,820
+ونعود للوضع اللي كنا فيه. الـ Micturition Reflex هو
+
+88
+00:07:34,820 --> 00:07:40,580
+مجلس واحد، مجلس واحد، مُكمّل، مرحلة، مرحلة، مرحلة مُستقلّة
+
+89
+00:07:40,580 --> 00:07:46,100
+مرحلة مُستقلّة، مرحلة مُستقلّة، مرحلة مُستقلّة، مرحلة مُستقلّة
+
+90
+00:07:46,100 --> 00:07:47,220
+مرحلة مُستقلّة، مرحلة مُستقلّة، مرحلة مُستقلّة، مرحلة مُستقلّة
+
+91
+00:07:47,590 --> 00:07:52,110
+بقالة تتكرّر لحدّ وقتهاش. once a micturition reflex has
+
+92
+00:07:52,110 --> 00:07:55,330
+occurred but has not succeeded in emptying the
+
+93
+00:07:55,330 --> 00:07:58,350
+bladder, the nervous elements of this reflex
+
+94
+00:07:58,350 --> 00:08:03,530
+usually remain in an inhibited state for some time,
+
+95
+00:08:04,130 --> 00:08:07,960
+for a few minutes to one hour or more، قبل أن يحدث
+
+96
+00:08:07,960 --> 00:08:11,600
+ميكتوريشن أخرى، تمام؟ إذا، لما يحصل عندي
+
+97
+00:08:11,600 --> 00:08:16,320
+strong contraction و exposure للـ neck receptors و
+
+98
+00:08:16,320 --> 00:08:19,880
+بداني reflex strong for micturition، و inhibited
+
+99
+00:08:19,880 --> 00:08:25,240
+برتع، بيتكرّر بسرعة، بيعطيني فترة كافية لأن أشوف
+
+100
+00:08:25,240 --> 00:08:29,640
+suitable conditions for micturition. As the bladder
+
+101
+00:08:29,640 --> 00:08:33,160
+becomes more and more filled, micturition reflexes
+
+102
+00:08:33,160 --> 00:08:38,630
+occur more and more often، وأكثر وأكثر بسرعة، و
+
+103
+00:08:38,630 --> 00:08:44,050
+أكثر
+
+104
+00:08:44,050 --> 00:08:49,330
+و أكثر بسرعة، و أكثر بسرعة، و أكثر بسرعة، و أكثر
+
+105
+00:08:49,330 --> 00:08:51,330
+بسرعة، و أكثر بسرعة، و أكثر بسرعة، و أكثر بسرعة، و
+
+106
+00:08:51,330 --> 00:08:51,370
+أكثر بسرعة، و أكثر بسرعة، و أكثر بسرعة، و أكثر بسرعة
+
+107
+00:08:51,370 --> 00:08:51,670
+بسرعة، و أكثر بسرعة، و أكثر بسرعة، و أكثر بسرعة، و
+
+108
+00:08:51,670 --> 00:08:59,190
+أكثر بسرعة، و أكثر بسرعة، و أكثر بسرعة، و أكثر بسرعة
+
+109
+00:08:59,190 --> 00:09:02,810
+و أكثر بس
+
+110
+00:09:04,010 --> 00:09:17,570
+إذا الـ inhibition أكثر من الـ
+
+111
+00:09:17,570 --> 00:09:22,830
+اللي بيجي له، فبيصير الـ urination. يعني هو جايله
+
+112
+00:09:22,830 --> 00:09:25,650
+constriction باستمرار، جايله inhibition عبر الـ
+
+113
+00:09:25,650 --> 00:09:29,550
+center، عبر الـ reflex، أنّه to relax. إذا الـ
+
+114
+00:09:29,550 --> 00:09:31,650
+inhibition اللي جايه عبر الـ center أكثر من
+
+115
+00:09:31,650 --> 00:09:35,770
+voluntary contraction، فبيصير، وإلا
+
+116
+00:09:35,770 --> 00:09:41,910
+بيتوقّف، وبنتأخّر كمان، بس بيصير أنّه أسرع أكثر. if not
+
+117
+00:09:41,910 --> 00:09:45,450
+enough potent، urination will not occur until the
+
+118
+00:09:45,450 --> 00:09:48,890
+bladder fills still further and the micturition
+
+119
+00:09:48,890 --> 00:09:52,740
+reflex becomes more powerful. إذا، بينتظر دورة جديدة
+
+120
+00:09:52,740 --> 00:09:55,660
+دورة جديدة، دورة جديدة. في الفترة هذه، البني آدم في
+
+121
+00:09:55,660 --> 00:09:59,300
+العادة بيكون شايف مكان مناسب، وإلّا ممكن يصير بعد
+
+122
+00:09:59,300 --> 00:10:02,800
+كده involuntary urination، لأنّ ساعتها يصير الـ
+
+123
+00:10:02,800 --> 00:10:08,740
+pressure تبع الـ intravesical pressure عالي، و الـ
+
+124
+00:10:08,740 --> 00:10:12,340
+reflex very strong، و الـ inhibition للـ internal و
+
+125
+00:10:12,340 --> 00:10:15,900
+الـ external أقوى من الـ ايه؟ الـ voluntary inhibition
+
+126
+00:10:15,900 --> 00:10:19,560
+فهيؤدّي إلى ايه؟ من الـ voluntary contraction، فيؤدّي
+
+127
+00:10:19,560 --> 00:10:24,690
+إلى الـ urination. طيب، الجزئية هذه، احنا voluntary و
+
+128
+00:10:24,690 --> 00:10:28,850
+مش voluntary، الـ external، ماشي. بنسيها، هنخشّ. طيب، كيف
+
+129
+00:10:28,850 --> 00:10:31,450
+أنا بتحكّم في الـ ... يعني وين أنا بتدخّل في الـ ball؟
+
+130
+00:10:31,450 --> 00:10:34,230
+احنا عندنا center شغال، وقلنا عشان يصير الـ
+
+131
+00:10:34,230 --> 00:10:38,430
+urination، لازم الـ internal sphincter ت relax، و الـ
+
+132
+00:10:38,430 --> 00:10:41,970
+external بياخد وجهة أنّه يصل لـ relaxation، وممكن
+
+133
+00:10:41,970 --> 00:10:48,050
+أنا أمنع relaxation voluntarily، طبعاً. إذا في عندنا
+
+134
+00:10:48,050 --> 00:10:53,860
+higher centers تتدخّل بطريقة ما. خلينا نشوف كيف
+
+135
+00:10:53,860 --> 00:10:56,860
+التدخل بيكون، في عندي أنا higher centers موجودة في
+
+136
+00:10:56,860 --> 00:11:01,180
+منطقتين، في الـ brain stem و في cerebral cortex، في
+
+137
+00:11:01,180 --> 00:11:04,500
+الـ brain stem موجود facilitative و inhibitory
+
+138
+00:11:04,500 --> 00:11:09,060
+centers، كيف يعني facilitative؟ يعني أنا ممكن
+
+139
+00:11:09,060 --> 00:11:12,840
+تساعدني في أنّه يصير الـ micturition أسرع وأقوى أو
+
+140
+00:11:12,840 --> 00:11:20,430
+أؤجّل، بمعنى إنّها تساعد الـ sacral center for
+
+141
+00:11:20,430 --> 00:11:25,950
+more potent reflex. أو الـ inhibitory بتعمل العكس، هذا
+
+142
+00:11:25,950 --> 00:11:31,210
+في الموجود في الـ brain stem، وموجود أيضاً في الـ
+
+143
+00:11:31,210 --> 00:11:33,450
+cerebral cortex، لكن الـ cerebral cortex more
+
+144
+00:11:33,450 --> 00:11:36,570
+inhibitory than ايه؟ يعني موجودة في الـ cortex هذا
+
+145
+00:11:36,570 --> 00:11:39,730
+inhibitory center، بحيث أنّه بعد ما الطفل يكبر شوية
+
+146
+00:11:39,730 --> 00:11:45,590
+بيقوى عنده هذا الشعور، بحيث أنّه يبدأ يتحكّم بالـ sphincter
+
+147
+00:11:45,590 --> 00:11:49,390
+أنّ الـ micturition reflex inhibited إلى أن يصبح له
+
+148
+00:11:50,130 --> 00:11:53,610
+تمام؟ يحتاج كلّ مرّة إلى تصريح خاصّ، مافيش تصريح مفتوح
+
+149
+00:11:53,610 --> 00:11:58,210
+لمدّة سنة، لأ. كلّ مرّة يصير ... يصير ... micturition
+
+150
+00:11:58,210 --> 00:12:01,850
+لازم نرفع الـ inhibition عن مين؟ عن الـ center، تمام؟
+
+151
+00:12:01,850 --> 00:12:06,550
+لكن في إضافة لذلك، ممكن احنا نساعد الـ ... الـ ... الـ
+
+152
+00:12:06,550 --> 00:12:11,850
+... الـ center بأنّ نعمل facilitation، وهذا بيصير بعد
+
+153
+00:12:11,850 --> 00:12:15,990
+ما احنا يبدأ الـ reflex يشتغل، فبيصير facilitative
+
+154
+00:12:15,990 --> 00:12:19,530
+reflexes تجي، أو الـ signals إلى الـ center هذا، to
+
+155
+00:12:19,530 --> 00:12:22,550
+make stronger urination. كده، بالإضافة لأنّ أنا
+
+156
+00:12:22,550 --> 00:12:25,430
+ممكن أبدأ عندي حاجة اسمها voluntary، يعني الوقت مش
+
+157
+00:12:25,430 --> 00:12:29,070
+مناسب، لكن أنا بدّي أطلع الآن، وبَدّيش في نفس الطريق
+
+158
+00:12:29,070 --> 00:12:32,410
+بقى، لأ، بدّي الآن أعمل urination. فالـ facilitative
+
+159
+00:12:32,410 --> 00:12:38,150
+هذا بساعدني، عندنا نتكلم عنه كيف. طيب، إذا في عندي
+
+160
+00:12:38,150 --> 00:12:41,590
+two centers، الـ higher center في الـ cerebral cortex
+
+161
+00:12:41,590 --> 00:12:49,020
+أو قريب منه شوية في الـ البرنامجيّ، السيم المركزي يبقى
+
+162
+00:12:49,020 --> 00:12:50,380
+رفليكس، البرنامج البرنامج البرنامج البرنامج
+
+163
+00:12:50,380 --> 00:12:53,280
+البرنامج البرنامج البرنامج البرنامج البرنامج
+
+164
+00:12:53,280 --> 00:12:58,040
+البرنامج البرنامج البرنامج البرنامج البرنامج
+
+165
+00:12:58,040 --> 00:12:58,520
+البرنامج البرنامج البرنامج البرنامج البرنامج
+
+166
+00:12:58,520 --> 00:12:58,680
+البرنامج البرنامج البرنامج البرنامج البرنامج
+
+167
+00:12:58,680 --> 00:13:00,840
+البرنامج البرنامج البرنامج البرنامج البرنامج
+
+168
+00:13:00,840 --> 00:13:04,910
+البرنامج البرنامج. المركزين الأعلى يمكن أن يمنع
+
+169
+00:13:04,910 --> 00:13:09,950
+الميكتوريشن، حتّى لو
+
+170
+00:13:09,950 --> 00:13:11,830
+حدث ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن
+
+171
+00:13:11,830 --> 00:13:12,390
+ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن
+
+172
+00:13:12,390 --> 00:13:13,290
+ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن
+
+173
+00:13:13,290 --> 00:13:19,450
+ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن
+
+174
+00:13:19,450 --> 00:13:20,670
+ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن
+
+175
+00:13:20,670 --> 00:13:28,410
+ميكتوريشن ميكتوريشن ميكتوريشن ميكتوريشن م
+
+223
+00:17:07,750 --> 00:17:15,980
+الضغط الداخل يفتحهم تمام، وبعدين السفنكتر سيخرج
+
+224
+00:17:15,980 --> 00:17:23,400
+حتى يكون الضغط داخل البلدر أقل من ضغط السفنكتر
+
+225
+00:17:23,400 --> 00:17:31,940
+تمام؟ إذا عندنا ضغط زاد، فتح السفنكتر، طلع الفرق في
+
+226
+00:17:31,940 --> 00:17:35,680
+البول، وبعدين هبط الضغط في الداخل لأنه تفرغ شوية
+
+227
+00:17:35,680 --> 00:17:39,680
+لما يهبط الضغط، يعود السفنكتر إيه؟ بيصير أقوى منا
+
+228
+00:17:39,680 --> 00:17:43,780
+رافضًا إياك فتتوقف، إذا اللحظة إن عندك كل خمس دقائق في
+
+229
+00:17:43,780 --> 00:17:47,280
+شوية بول، كل تلت أربع دقائق، خمس دقائق في شوية بول
+
+230
+00:17:47,280 --> 00:17:53,220
+بنزل، بتوقف، بنزل، overflow اللي بيزيد عن المليان
+
+231
+00:17:53,220 --> 00:17:57,220
+بنكب، ولكن هي ده بيبقى المليانة، إذا overflow
+
+232
+00:17:57,220 --> 00:18:02,060
+incontinence، اللي الزيادة بتطلع بتبقى المليانة
+
+233
+00:18:02,060 --> 00:18:06,320
+اللي بيجي أكثر من حجمها وقدرتها بيطلع، بيتوقف، بيطلع
+
+234
+00:18:06,320 --> 00:18:11,470
+بيتوقف، بيطلع overflow incontinence، هذه حالة، الآن
+
+235
+00:18:11,470 --> 00:18:15,750
+ما ألاجيهاش إلا إذا كان في عندي أنا إصابة لـ... يا إما
+
+236
+00:18:15,750 --> 00:18:18,690
+لـ center، يا إما إصابة للـ afferent اللي بده يودي
+
+237
+00:18:18,690 --> 00:18:26,190
+للـ center، تمام؟ fracture للـ... للـ sacral centers
+
+238
+00:18:26,190 --> 00:18:30,590
+تمام؟ spinal cord injury بتقدر إلى fracture أو الـ
+
+239
+00:18:30,590 --> 00:18:37,320
+nerve انقطع، زمان كان في موجود سفلس كثير زمان
+
+240
+00:18:37,320 --> 00:18:41,100
+كان موجود سفلس كثير، مش لأن الناس صارت محترمة كثير
+
+241
+00:18:41,100 --> 00:18:45,920
+لأ، صار في علاج في الأيام، بس هي يعني أنا أعتقد أنه
+
+242
+00:18:45,920 --> 00:18:50,560
+الـ... الإباحية الغربية لازال موجود عندهم سفلس بنفس
+
+243
+00:18:50,560 --> 00:18:54,520
+الـ... الكم، لكنه بيستطيع أنهم يعالجوا بالبنسلين، يقدر
+
+244
+00:18:54,520 --> 00:18:58,260
+إلى أنه يوقفوا عند حدّه، السفلس كان زمان يضرب الـ...
+
+245
+00:18:58,260 --> 00:19:04,160
+الـ afferent nerves، تمام؟ يضرب الـ dorsal roots، وهو
+
+246
+00:19:04,160 --> 00:19:08,420
+الـ... الـ... الـ... الـ... الـ somatic nerve، هو طالع
+
+247
+00:19:08,420 --> 00:19:11,660
+له dorsal root و ventral root، مش هذا، الـ dorsal هذا
+
+248
+00:19:11,660 --> 00:19:16,520
+sensory، الـ... الـ... الـ ventral motor، فبضرب
+
+249
+00:19:16,520 --> 00:19:20,600
+الدورزال روت، فكان بيسموه دور... دورساليز
+
+250
+00:19:23,480 --> 00:19:29,820
+Tabes Dorsalis، بيسموه تابيس
+
+251
+00:19:29,820 --> 00:19:34,680
+تابيس بلدر، تابيس بلدر، تابيس بلدر، تابيس بلدر، تابيس
+
+252
+00:19:34,680 --> 00:19:35,020
+بلدر تابيس بلدر تابيس بلدر تابيس بلدر تابيس بلدر
+
+253
+00:19:35,020 --> 00:19:35,100
+تابيس بلدر تابيس بلدر تابيس بلدر تابيس بلدر تابيس
+
+254
+00:19:35,100 --> 00:19:35,120
+بلدر تابيس بلدر تابيس بلدر تابيس بلدر تابيس بلدر
+
+255
+00:19:35,120 --> 00:19:42,300
+تابيس بلدر تابيس بلدر تابيس بلدر تابيس بلدر تابيس
+
+256
+00:19:42,300 --> 00:19:50,640
+بلدر تابيس بلدر تابيس بلدر تابيس
+
+257
+00:19:50,640 --> 00:19:56,070
+باتنين، عندي automatic bladder، automatic bladder
+
+258
+00:19:56,070 --> 00:20:00,090
+يعني بتعبي وبتفضي، بتعبي وبتفضي، بتفضي مش
+
+259
+00:20:00,090 --> 00:20:05,520
+overflow، يعني كل ما تندلي وبتفضي، بعدين بيقعد كل ما
+
+260
+00:20:05,520 --> 00:20:10,260
+إيه تندلي، أول reflex بيجي وبتفضي، زي في الأطفال
+
+261
+00:20:10,260 --> 00:20:15,900
+مش كده؟ الأطفال ما عندهمش inhibitory centers
+
+262
+00:20:15,900 --> 00:20:19,020
+inhibitionless centers، كل إيش أنا بتسهل الـ center
+
+263
+00:20:19,020 --> 00:20:23,300
+بيقول الله سهل عليك، إيه بتشتغل، تمام؟ هذا إذا الطفل
+
+264
+00:20:23,300 --> 00:20:28,160
+قبل ما إيه؟ طيب غير الطفل، غير الطفل، إذا إحنا ضربنا
+
+265
+00:20:28,160 --> 00:20:31,920
+above the sacral center، يعني جتْعنا الإتصال بين الـ
+
+266
+00:20:31,920 --> 00:20:35,610
+center هذا والـ higher centers اللي فيها
+
+267
+00:20:35,610 --> 00:20:38,150
+facilitation وفيها inhibition، يعني أنا ضيعت الـ
+
+268
+00:20:38,150 --> 00:20:42,010
+continuous inhibition للـ center هذا، تمام؟ فبقدر
+
+269
+00:20:42,010 --> 00:20:45,210
+الـ center، برجع ثاني زي الطفل، كل ما بيجي إشارة من
+
+270
+00:20:45,210 --> 00:20:48,050
+الـ stretch receptors أنه في عندي intravascular
+
+271
+00:20:48,050 --> 00:20:50,910
+pressure عالي، بقوله، حاضر يا مولانا، اتفضل، و
+
+272
+00:20:50,910 --> 00:20:56,560
+بطلع، تمام؟ بفرغ كل حاجته، لأن هيك الـ reflex بعدين
+
+273
+00:20:56,560 --> 00:20:59,660
+بيسكر، وبعدين بيبدأ يعبّي من جديد لحد ما على الضغط
+
+274
+00:20:59,660 --> 00:21:03,240
+فوق الأربعمائة ملي، بيزيد الضغط شوية فبيبدأ يعمل لي
+
+275
+00:21:03,240 --> 00:21:07,480
+الـ reflex أسرع، تمام، فبيديني إيه الـ... الـ... الـ
+
+276
+00:21:07,480 --> 00:21:11,000
+reflex، إذا هذا إيه بيسميه automatic، مش atonic الـ
+
+277
+00:21:11,000 --> 00:21:14,120
+atonic، لأ، مفيش tone، مفيش reflex شغال، هذا الـ reflex
+
+278
+00:21:14,120 --> 00:21:19,000
+intact، لكنه مالوش higher centers، إذا هذا بيحصل مع
+
+279
+00:21:19,000 --> 00:21:23,410
+spinal cord injury، للـ إيه؟ above the center، above
+
+280
+00:21:23,410 --> 00:21:25,950
+the center، مش لأن الـ center نفسه، above the center
+
+281
+00:21:25,950 --> 00:21:28,770
+يعني مانع الـ facilitation اللي هو الـ... الـ inhibitory
+
+282
+00:21:28,770 --> 00:21:34,170
+النوع الثالث غريب جدًا، إنه بشكل من الأشكال جينا في
+
+283
+00:21:34,170 --> 00:21:41,790
+عندنا some sort of الـ inhibitory signals، هي بتضرب
+
+284
+00:21:41,790 --> 00:21:47,890
+يعني عندي مشكلة في الـ in the cerebral cortex، من
+
+285
+00:21:47,890 --> 00:21:55,470
+خلال الـ CVA، نظيف
+
+286
+00:21:55,470 --> 00:21:59,710
+أو جلطة أو كده، بتؤدي إلى إصابة بتؤدي إلى الـ
+
+287
+00:21:59,710 --> 00:22:04,110
+inhibitory signals، مش شغالة، شغالة الـ facilitative
+
+288
+00:22:04,110 --> 00:22:09,590
+في الـ brainstem، فكل ما بتيجي لسه نقطة، مش زي الـ
+
+289
+00:22:09,590 --> 00:22:13,730
+automatic، مش ثانية إنه تدي إشارة محترمة لأي نقطة
+
+290
+00:22:13,730 --> 00:22:17,710
+بتعملها facilitation، فدايمًا الـ bladder فاضية، الـ
+
+291
+00:22:17,710 --> 00:22:21,090
+automatic مليانة وبتفضي وبتعود تنطل، الآخر هذه
+
+292
+00:22:21,090 --> 00:22:25,130
+أساسًا ما بتعبئش، كل خمس نقاط، عشرة ملي، خمس عشرة ملي
+
+293
+00:22:25,130 --> 00:22:29,330
+تمام، بيعملوا reflex strong، ليش؟ لأنه الـ center
+
+294
+00:22:29,330 --> 00:22:33,510
+facilitated، مش inhibited، العكس، تمام؟ هذا النوع
+
+295
+00:22:33,510 --> 00:22:38,220
+الثالث من إيه؟ من الـ abnormalities في الـ bladder
+
+296
+00:22:38,220 --> 00:22:41,400
+إذا في عندي atonic bladder، في عندي automatic
+
+297
+00:22:41,400 --> 00:22:45,740
+bladder، في عندي uninhibited neurogenic، مرة نقولها
+
+298
+00:22:45,740 --> 00:22:49,320
+neurogenic، مرة نقولها uninhibited neurogenic، بمعنى
+
+299
+00:22:49,320 --> 00:22:51,260
+إن اللي بيجي فيها بيطلع، اللي بيجي فيها بيطلع، لأن الـ
+
+300
+00:22:51,260 --> 00:22:55,700
+inhibitor إيه؟ signals، إيش؟ راحت، الموضوع الثاني
+
+301
+00:22:55,700 --> 00:22:58,480
+اللي هنبدأ فيه، إحنا خلصنا ده، كلمة curation اليوم
+
+302
+00:22:58,480 --> 00:23:02,320
+أنا أتمنى أن أقدر أخلص الموضوع ده، ضايلنا ساعة، مش
+
+303
+00:23:02,320 --> 00:23:10,660
+هيك، اليوم موضوع جديد، وهو خلاصة دراستنا في الكلية
+
+304
+00:23:10,660 --> 00:23:16,740
+دراستنا في الكلية، والـ physiology of the renal
+
+305
+00:23:16,740 --> 00:23:22,280
+system، المحصلة إنه هنعرف، طيب، بعد كده هنتواجه
+
+306
+00:23:22,280 --> 00:23:26,140
+بمشاكل وأمراض الكلية، تمام؟ وقبل ما نتواجه
+
+307
+00:23:26,140 --> 00:23:29,760
+بمشاكل وأمراض الكلية، هنرجع مع بعض، الـ diuretics
+
+308
+00:23:29,760 --> 00:23:32,400
+إحنا اتكلمنا عن تلت أربع أنواع من الـ diuretics
+
+309
+00:23:32,400 --> 00:23:41,230
+لكن فيه نوعين إحنا لسه ما جبناهمش، هي search لهم، تمام
+
+310
+00:23:41,230 --> 00:23:43,570
+الـ diuretics، إذا إحنا متذكرين مع بعض، فاكرين الـ
+
+311
+00:23:43,570 --> 00:23:46,690
+diuretics، وقولنا في عندنا إيش؟ عندنا في loop
+
+312
+00:23:46,690 --> 00:23:52,710
+diuretics، مش هيك؟ وقولنا thiazide diuretics، وين الـ
+
+313
+00:23:52,710 --> 00:23:56,410
+thiazide diuretics كانت بتشتغل على الـ early early
+
+314
+00:23:56,410 --> 00:24:03,210
+distal، مش هيك؟ وقولنا عندنا Anti aldosterone، مش كده؟
+
+315
+00:24:03,210 --> 00:24:06,670
+Aldosterone antagonist، بتشتغل وين؟ الـ aldosterone
+
+316
+00:24:06,670 --> 00:24:10,070
+antagonist، على الـ net distal، والـ connecting، والـ
+
+317
+00:24:10,070 --> 00:24:14,510
+collecting، مش هيك؟ تمام، هذول تلت أنواع إحنا اتكلمنا
+
+318
+00:24:14,510 --> 00:24:18,270
+عنهم، في كمان نوعين آخرين إحنا ما تكلمناش عنهم أو
+
+319
+00:24:18,270 --> 00:24:21,610
+تلت أنواع، في تلت أنواع آخرين إحنا ما تكلمناش عنها
+
+320
+00:24:21,610 --> 00:24:27,910
+النوع الأول اللي بيسميه osmotic diuresis، يعني هذول
+
+321
+00:24:27,910 --> 00:24:33,650
+المواد أنا ممكن أعطيها عن طريق الدم، وتخش الدم، و
+
+322
+00:24:33,650 --> 00:24:37,890
+تطلع بالـ filtrate، الـ glomerular filtrate، لكنها
+
+323
+00:24:37,890 --> 00:24:44,510
+unabsorbable، وهي طالعة لازم تاخد معاها إيه؟
+
+324
+00:24:44,510 --> 00:24:47,450
+according to the osmotic effect of these particles
+
+325
+00:24:47,450 --> 00:24:51,430
+ياخدوا معاهم ماء بزيادة، فبيعملوا diuresis، هذا
+
+326
+00:24:51,430 --> 00:24:56,730
+بنستخدمه إحنا كثير، الـ mannitol، المانيتول نستخدمه
+
+327
+00:24:56,730 --> 00:25:00,890
+ولو إحنا حطينا في الدم حاجة زي الـ sucrose، السكر
+
+328
+00:25:00,890 --> 00:25:04,730
+اللي إحنا بنشربه، السكر، مش الـ glucose، الـ glucose ما
+
+329
+00:25:04,730 --> 00:25:07,550
+هو في الدم موجود، بس لو أنا أديتّه الـ glucose اللي
+
+330
+00:25:07,550 --> 00:25:13,710
+هو الـ sucrose، لو حطيته هذا في الدم مباشرة، طبيعي مش
+
+331
+00:25:13,710 --> 00:25:17,210
+موجود في الدم، هو، تمام؟ برضه بيصير له filtration، لكن
+
+332
+00:25:17,210 --> 00:25:21,370
+بيصير لهش إيه؟ reabsorption، لأنه أساسًا هو شيء غريب
+
+333
+00:25:21,370 --> 00:25:25,600
+كيف دخل، إذًا لو أنا حاطط sucrose أو حاطط mannitol
+
+334
+00:25:25,600 --> 00:25:29,520
+أو أي مادة زي هيك، حجمها بيستطيع اسمها تلعب الـ
+
+335
+00:25:29,520 --> 00:25:33,060
+filtration، وما لهاش الـ absorption، هتطلع أو تاخد
+
+336
+00:25:33,060 --> 00:25:38,340
+معاها إيه؟ وبتاخد معاها... by... by osmotic effect
+
+337
+00:25:38,340 --> 00:25:43,000
+هتاخد معاها its own water، وبما أنها not absorbed، فـ
+
+338
+00:25:43,000 --> 00:25:46,980
+... فهيطلع كمية كبيرة من الـ water معاها، تمام؟ إذا
+
+339
+00:25:46,980 --> 00:25:50,440
+بنسميها osmotic diuresis... osmotic diuresis
+
+340
+00:25:50,440 --> 00:25:53,680
+نستخدمها إحنا دائمًا في المستشفيات، في الـ... إن إحنا
+
+341
+00:25:53,680 --> 00:25:58,320
+نستخدم، آه، IV من الـ mannitol، مثلًا، مش الـ sucrose، الـ
+
+342
+00:25:58,320 --> 00:26:02,490
+sucrose، الكلام عليه، هل هو nephrotoxic ولا لأ، تمام؟ بس
+
+343
+00:26:02,490 --> 00:26:06,810
+في التجارب ممكن يستخدم اللي؟ السكروز كثير، لكن في
+
+344
+00:26:06,810 --> 00:26:10,290
+العمليات اللي مستخدمة الـ mannitol، والـ... ومجموعة من
+
+345
+00:26:10,290 --> 00:26:16,770
+أخوانه، هذا النوع الرابع، تمام؟ النوع الخامس، إحنا
+
+346
+00:26:16,770 --> 00:26:21,910
+قولنا الـ carbonic anhydrase، فاكرينه؟ اللي بيساعد
+
+347
+00:26:21,910 --> 00:26:27,610
+عملية الإيه؟ الاتحاد بين المية والـ carbon dioxide، يعمل لي
+
+348
+00:26:27,610 --> 00:26:33,310
+carbonic acid، وقولنا هذا بيسرّع عملية إيه؟ التفاعل
+
+349
+00:26:33,310 --> 00:26:37,990
+خمس ألف مرة، مش كده؟ عن الطبيعي، فقصد وقفته، أنا هذا
+
+350
+00:26:37,990 --> 00:26:41,410
+معناه الـ bicarbonate، بتكلم عنه أنا، مش حاسس له لأ
+
+351
+00:26:41,410 --> 00:26:44,290
+ريحه absorption و secretion، تمام؟ إذا إذا بتكلم مع
+
+352
+00:26:44,290 --> 00:26:47,970
+الـ proximal tubule، واستخدمنا inhibitor لهذا الـ
+
+353
+00:26:53,920 --> 00:27:03,520
+نستخدم له inhibitor، أعتقد، نمرة خمسة، نمرة أربعة
+
+354
+00:27:03,520 --> 00:27:09,740
+إذا carbonic anhydrase inhibitor، acetazolamide
+
+355
+00:27:10,210 --> 00:27:15,150
+acetazolamide، هذا اليوم إحنا ما نستخدمهوش حقيقة كـ
+
+356
+00:27:15,150 --> 00:27:19,670
+diuretic، بس مستخدمه أحيانًا في حالة ما يكون فيه
+
+357
+00:27:19,670 --> 00:27:26,530
+جلوقوما في العيون، مستخدمه علشان يساعد إنه
+
+358
+00:27:26,530 --> 00:27:33,810
+ما يتكونش ماء كثير في داخل العين، اللي هو عمالة
+
+359
+00:27:33,810 --> 00:27:37,850
+للجلوقوما، نسميها ماء زرقاء، تمام؟ مستخدمه أحيانًا
+
+360
+00:27:39,170 --> 00:27:43,230
+لكن هادي، لو وقفنا، إذا هو بيشتغل عن طريق إنه يمنع
+
+361
+00:27:43,230 --> 00:27:46,730
+reabsorption of bicarbonate في الـ proximal tubule
+
+362
+00:27:46,730 --> 00:27:51,270
+معناه لو تركناه، هيطلع الـ bicarbonate، وياخد معاه
+
+363
+00:27:51,270 --> 00:27:57,210
+osmosis، بيأوزموزيس، هiaخد معاه ماء أكثر، مش كده؟ النقطة
+
+364
+00:27:57,210 --> 00:28:01,690
+الأخيرة اللي إحنا ما تكلمناش عنها، اللي هي إحنا في
+
+365
+00:28:01,690 --> 00:28:08,510
+عندنا نوع من الـ diuretics بيشتغل على الـ... على الـ
+
+366
+00:28:08,510 --> 00:28:11,250
+collecting tubule، على الـ collecting duct، والـ
+
+367
+00:28:11,250 --> 00:28:13,910
+collecting tube، والـ distal، لكن هو مش عن طريق الـ
+
+368
+00:28:13,910 --> 00:28:20,070
+... الـ antagonism للـ... للـ الـ aldosterone، تمام؟ لأ، مش
+
+369
+00:28:20,070 --> 00:28:22,650
+sodium channel اللي متكلم عنه، اللي بيشتغل على الـ
+
+370
+00:28:22,650 --> 00:28:25,990
+... زي الـ thiazide، thiazide sodium channel، لأ،
+
+371
+00:28:25,990 --> 00:28:29,630
+بيشتغل بعد هذه المنطقة، بيشتغل على الـ distal، والـ
+
+372
+00:28:29,630 --> 00:28:32,110
+collecting، الـ aldosterone بيشتغل على الـ distal، و
+
+373
+00:28:32,110 --> 00:28:34,650
+الـ collecting، لكن الـ sodium channel بيشتغلش على
+
+374
+00:28:34,650 --> 00:28:38,050
+المنطقة هذه، بيشتغل إيه؟ على الـ early، thiazide،
+
+375
+00:28:38,050 --> 00:28:44,970
+لكن إيه؟ بيشتغل على... بيمنع الـ reabsorption of
+
+376
+00:28:44,970 --> 00:28:53,580
+potassium، inhibits sodium and also inhibits sodium
+
+377
+00:28:53,580 --> 00:28:57,100
+reabsorption and potassium secretion، ما هو في هذه
+
+378
+00:28:57,100 --> 00:29:00,760
+المنطقة، إحنا في الـ principal cells، تمام؟ بنعمل
+
+379
+00:29:00,760 --> 00:29:05,340
+reabsorption of sodium، مقابل secretion of إيه؟ أو
+
+380
+00:29:05,340 --> 00:29:08,340
+بوتاسيوم، في عندي other، هذا بيعملها... بيعملها...
+
+381
+00:29:08,340 --> 00:29:08,380
+بيعملها... بيعملها... بيعملها... بيعملها...
+
+382
+00:29:08,380 --> 00:29:08,780
+بيعملها... بيعملها... بيعملها... بيعملها...
+
+383
+00:29:08,780 --> 00:29:09,300
+بيعملها... بيعملها... بيعملها... بيعملها...
+
+384
+00:29:09,300 --> 00:29:11,900
+بيعملها... بيعملها... بيعملها... بيعملها...
+
+385
+00:29:11,900 --> 00:29:13,540
+بيعملها... بيعملها... بيعملها... بيعملها...
+
+386
+00:29:13,540 --> 00:29:13,580
+بيعملها... بيعملها... بيعملها... بيعملها...
+
+387
+00:29:13,580 --> 00:29:15,180
+بيعملها... بيعملها... بيعملها... بيعملها...
+
+388
+00:29:15,180 --> 00:29:20,230
+بيعملها... بيهو، بيمنع الـ secretion of potassium
+
+389
+00:29:20,230 --> 00:29:25,270
+وقلنا عنه هذا potassium sparing antidiuretic، مش
+
+390
+00:29:25,270 --> 00:29:
+
+445
+00:33:35,040 --> 00:33:39,120
+هتحتاج في النص شوية مساعدة غسل مرة أو مرتين أو
+
+446
+00:33:39,120 --> 00:33:42,480
+ثلاث وحتى ما ترجع طبيعي لكن عندنا chronic
+
+447
+00:33:42,480 --> 00:33:47,000
+diseases, chronic renal failure. مدام إحنا وصلنا ل
+
+448
+00:33:47,000 --> 00:33:52,040
+chronic renal failure، هذا إيش ما أعمل أنا بعمل
+
+449
+00:33:52,040 --> 00:33:56,280
+مؤقتاً لحين ما ألاقي كلية مناسبة. يعني الغسل اللي بقى
+
+450
+00:33:56,280 --> 00:34:00,580
+بيتم في الـ electronic هو عبارة عن عمل توصيلنا لمين؟
+
+451
+00:34:00,580 --> 00:34:04,560
+لأجل الكلية لأن ده موصلنا للكلية
+
+452
+00:34:04,560 --> 00:34:08,460
+المناسبة لها، ده اللي هو المريض، تمام؟ إذا هو الأنسب
+
+453
+00:34:08,460 --> 00:34:12,960
+له أنه يعمل transplantation لكن في هالطريقة عشان
+
+454
+00:34:12,960 --> 00:34:17,920
+ما يموتش منها إلا بوجود كلية مناسبة، تمام؟
+
+455
+00:34:22,710 --> 00:34:33,310
+على سبيل المثال، في سنة 2004 اكتشاف
+
+456
+00:34:33,310 --> 00:34:37,630
+(This section seems to be a transcription error and should be removed or clarified)
+
+457
+00:34:37,630 --> 00:34:38,990
+(This section seems to be a transcription error and should be removed or clarified)
+
+458
+00:34:38,990 --> 00:34:39,230
+(This section seems to be a transcription error and should be removed or clarified)
+
+459
+00:34:39,230 --> 00:34:39,550
+(This section seems to be a transcription error and should be removed or clarified)
+
+460
+00:34:39,550 --> 00:34:40,810
+(This section seems to be a transcription error and should be removed or clarified)
+
+461
+00:34:40,810 --> 00:34:47,190
+(This section seems to be a transcription error and should be removed or clarified)
+
+462
+00:34:49,210 --> 00:34:54,310
+لما أتكلم عن kidney diseases، ممكن تكون خدوا بالكم
+
+463
+00:34:54,310 --> 00:34:58,750
+من صِبَة الشُرَيلَات اللي داخلة على الكلية أو الـ
+
+464
+00:34:58,750 --> 00:35:04,650
+glomeruli أو الـ tubules أو ما بعد الكلية، ما بعد
+
+465
+00:35:04,650 --> 00:35:09,530
+الـ tubules، تمام، الـ renal الـ urinary tract system
+
+466
+00:35:09,530 --> 00:35:14,090
+اللي هو الـ pelvis of the kidney، الـ ureter، الـ
+
+467
+00:35:14,090 --> 00:35:19,470
+bladder، تمام. ممكن هنا تعمل مشكلة وتدخلني في
+
+468
+00:35:19,470 --> 00:35:26,250
+chronic renal disease، الـ acute renal failure
+
+469
+00:35:26,250 --> 00:35:32,930
+بيسموه بثلاثة أسباب، يا إما أسباب الـ acute renal
+
+470
+00:35:32,930 --> 00:35:37,240
+failure، بنقسمه لثلاثة أسباب، يا إما أسباب جاية قبل ما
+
+471
+00:35:37,240 --> 00:35:42,420
+نصل للكلية، يعني blood pressure، hypotension، إيش إيش؟
+
+472
+00:35:42,420 --> 00:35:46,260
+قبل الكلية، متعلق بالـ blood vessels، يا إما
+
+473
+00:35:46,260 --> 00:35:50,540
+في الكلية نفسها، يا إما بعد الكلية. إذا عندي pre
+
+474
+00:35:50,540 --> 00:35:54,620
+-renal causes، pre-renal acute failure caused by
+
+475
+00:35:54,620 --> 00:35:57,800
+decreased blood flow to the kidney، أي سبب بيؤدي
+
+476
+00:35:57,800 --> 00:36:03,000
+إلى إن الضغط ينخفض، الضغط العام ينخفض، معناه
+
+477
+00:36:03,000 --> 00:36:07,480
+الكلية بيوصلهاش دم كافي، معناها بتخش في ايه؟ في
+
+478
+00:36:07,480 --> 00:36:10,560
+acute renal failure. بس الميزة في acute renal
+
+479
+00:36:10,560 --> 00:36:14,880
+failure إنه reversible، يعني mostly reversible، إلا
+
+480
+00:36:14,880 --> 00:36:19,320
+إذا مدة الـ insult أصبحت مدة طويلة، يعني إذا دخلتوا في
+
+481
+00:36:19,320 --> 00:36:23,060
+acute renal failure، الـ hypotension مدة طويلة، مش
+
+482
+00:36:23,060 --> 00:36:27,820
+هتصحى الكلية كاملة ولو صحّت، صحت شوية جزئياً.
+
+483
+00:36:27,820 --> 00:36:31,300
+ممكن ايه؟ لكن أنا لو short time، انتبهت، خشينا في high
+
+484
+00:36:31,300 --> 00:36:34,800
+potential، short time والحجنا حالنا بسرعة، صلحنا الدم،
+
+485
+00:36:34,800 --> 00:36:39,700
+ممكن نرجع ايه؟ طبيعي. يعني تخش في failure أسبوع
+
+486
+00:36:39,700 --> 00:36:43,860
+ثمانية أيام، عشرة أيام، أسبوعين، وبعدين ترجع ايه؟ لأنها
+
+487
+00:36:43,860 --> 00:36:46,860
+reversible. الـ acute renal failure، إذا في عندي pre
+
+488
+00:36:46,860 --> 00:36:52,660
+-renal causes، mainly decrease blood flow to the
+
+489
+00:36:52,660 --> 00:36:57,260
+kidney. عندي intra-renal causes، intra-renal acute
+
+490
+00:36:57,260 --> 00:37:01,910
+renal failure، تمام؟ عندي أشياء في داخل الكلية هذه
+
+491
+00:37:01,910 --> 00:37:08,970
+في العادة ممكن تكون acute وممكن هذه تمتد لـ
+
+492
+00:37:08,970 --> 00:37:12,930
+chronic. نفس الـ acute، الـ intrarenal causes، هدول
+
+493
+00:37:12,930 --> 00:37:18,030
+ممكن يعدوا حسب الـ... يعني عندي glomerulonephritis
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wsNmlhvh6hM_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wsNmlhvh6hM_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..1ede795fdfe4848d6fe06ecbf8d4f489b35fcce6
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/wsNmlhvh6hM_raw.json
@@ -0,0 +1 @@
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" اسبوعين", "probability": 0.83697509765625}, {"start": 2201.86, "end": 2202.6, "word": " وبعدين", "probability": 0.8377278645833334}, {"start": 2202.6, "end": 2203.0, "word": " ترجع", "probability": 0.9806315104166666}, {"start": 2203.0, "end": 2203.5, "word": " ايه؟", "probability": 0.832763671875}, {"start": 2203.5, "end": 2203.86, "word": " لأنها", "probability": 0.79345703125}, {"start": 2203.86, "end": 2204.34, "word": " reversible", "probability": 0.9423828125}, {"start": 2204.34, "end": 2204.64, "word": " ال", "probability": 0.87060546875}, {"start": 2204.64, "end": 2204.88, "word": " acute", "probability": 0.88134765625}, {"start": 2204.88, "end": 2205.06, "word": " renal", "probability": 0.8046875}, {"start": 2205.06, "end": 2205.4, "word": " failure", "probability": 0.9404296875}, {"start": 2205.4, "end": 2206.28, "word": " اذا", "probability": 0.58502197265625}, {"start": 2206.28, "end": 2206.46, "word": " في", "probability": 0.82373046875}, {"start": 2206.46, "end": 2206.72, "word": " عندى", "probability": 0.5301513671875}, {"start": 2206.72, "end": 2206.86, "word": " pre", "probability": 0.9150390625}, {"start": 2206.86, "end": 2207.12, "word": "-renal", "probability": 0.5718994140625}, {"start": 2207.12, "end": 2207.76, "word": " causes", "probability": 0.8681640625}, {"start": 2207.76, "end": 2210.1, "word": " mainly", "probability": 0.9658203125}, {"start": 2210.1, "end": 2210.82, "word": " decrease", "probability": 0.65478515625}, {"start": 2210.82, "end": 2211.84, "word": " blood", "probability": 0.966796875}, {"start": 2211.84, "end": 2212.28, "word": " flow", "probability": 0.90478515625}, {"start": 2212.28, "end": 2212.48, "word": " to", "probability": 0.9736328125}, {"start": 2212.48, "end": 2212.66, "word": " the", "probability": 0.8134765625}, {"start": 2212.66, "end": 2212.98, "word": " kidney", "probability": 0.97802734375}, {"start": 2212.98, "end": 2214.38, "word": " عندى", "probability": 0.839111328125}, {"start": 2214.38, "end": 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47283, 1211, 33251, 1211, 10632, 8032, 8848, 1829, 8978, 18863, 18513, 3660, 3714, 43020, 6055, 30544, 24390, 4032, 3714, 43020, 8032, 8848, 1829, 46811, 2655, 3215, 2423, 22848, 299, 8717, 36178, 2423, 24390, 2423, 43358, 23658, 7700, 8032, 3215, 12610, 3714, 43020, 7251, 22488, 14407, 11331, 35457, 2423, 4386, 37495, 22653, 18871, 16254, 1563, 14301, 425, 9361, 16074], "avg_logprob": -0.2542410658938544, "compression_ratio": 1.4861878453038675, "no_speech_prob": 0.0, "words": [{"start": 2218.49, "end": 2219.13, "word": "تمام؟", "probability": 0.6998697916666666}, {"start": 2219.13, "end": 2219.43, "word": " عندي", "probability": 0.804443359375}, {"start": 2219.43, "end": 2219.91, "word": " أشياء", "probability": 0.955322265625}, {"start": 2219.91, "end": 2220.07, "word": " في", "probability": 0.7578125}, {"start": 2220.07, "end": 2220.41, "word": " داخل", "probability": 0.9768880208333334}, {"start": 2220.41, "end": 2220.87, "word": " الكلية", "probability": 0.75927734375}, {"start": 2220.87, "end": 2221.91, "word": " هذي", "probability": 0.5152994791666666}, {"start": 2221.91, "end": 2222.63, "word": " في", "probability": 0.880859375}, {"start": 2222.63, "end": 2223.23, "word": " العادة", "probability": 0.9855143229166666}, {"start": 2223.23, "end": 2224.11, "word": " ممكن", "probability": 0.991943359375}, {"start": 2224.11, "end": 2225.93, "word": " تكون", "probability": 0.99365234375}, {"start": 2225.93, "end": 2227.69, "word": " acute", "probability": 0.9970703125}, {"start": 2227.69, "end": 2227.95, "word": " و", "probability": 0.984375}, {"start": 2227.95, "end": 2228.21, "word": " ممكن", "probability": 0.773193359375}, {"start": 2228.21, "end": 2228.45, "word": " هذي", "probability": 0.9072265625}, {"start": 2228.45, "end": 2228.87, "word": " تمتد", "probability": 0.9674479166666666}, {"start": 2228.87, "end": 2228.97, "word": " ال", "probability": 0.124267578125}, {"start": 2228.97, "end": 2229.71, "word": " siliconic", "probability": 0.605712890625}, {"start": 2229.71, "end": 2230.71, "word": " نفس", "probability": 0.840576171875}, {"start": 2230.71, "end": 2230.89, "word": " ال", "probability": 0.9921875}, {"start": 2230.89, "end": 2231.35, "word": " acute", "probability": 0.98876953125}, {"start": 2231.35, "end": 2231.57, "word": " ال", "probability": 0.91552734375}, {"start": 2231.57, "end": 2232.07, "word": " intrarenal", "probability": 0.505615234375}, {"start": 2232.07, "end": 2232.49, "word": " causes", "probability": 0.87841796875}, {"start": 2232.49, "end": 2232.93, "word": " هدول", "probability": 0.84814453125}, {"start": 2232.93, "end": 2233.87, "word": " ممكن", "probability": 0.975341796875}, {"start": 2233.87, "end": 2235.29, "word": " يعدوا", "probability": 0.7985026041666666}, {"start": 2235.29, "end": 2235.75, "word": " حسب", "probability": 0.97607421875}, {"start": 2235.75, "end": 2235.91, "word": " ال", "probability": 0.59375}, {"start": 2235.91, "end": 2236.15, "word": " ..", "probability": 0.6787109375}, {"start": 2236.15, "end": 2236.77, "word": " يعني", "probability": 0.96875}, {"start": 2236.77, "end": 2236.99, "word": " عندي", "probability": 0.77294921875}, {"start": 2236.99, "end": 2238.03, "word": " glomeruliferitis", "probability": 0.7319091796875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2238.334, "duration_after_vad": 2170.5068749999955}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY.srt
new file mode 100644
index 0000000000000000000000000000000000000000..98d165168123f973ec87e154fc076fecaba118bc
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY.srt
@@ -0,0 +1,2042 @@
+1
+00:00:05,510 --> 00:00:10,390
+الأسبوع الف .. المحاضرة الماضية كلمنا عن ال
+
+2
+00:00:10,390 --> 00:00:15,470
+structure تبع الـ .. الكلية والوحدة البنائية لها
+
+3
+00:00:15,470 --> 00:00:22,390
+اللي هو النفرون، الآن النفرون .. النفرون الوحدة
+
+4
+00:00:22,390 --> 00:00:23,210
+البنائية هذه
+
+5
+00:00:26,800 --> 00:00:31,180
+بتصنع الـ ball أو الـ urine عن طريق ثلاث عمليات: عملية
+
+6
+00:00:31,180 --> 00:00:37,020
+filtration وعملية reabsorption بعد الـ filtration
+
+7
+00:00:37,020 --> 00:00:41,560
+وعملية secretion. تمام، المحصلة أن هي الـ
+
+8
+00:00:41,560 --> 00:00:47,240
+excretory urine
+
+9
+00:00:47,240 --> 00:00:51,320
+إيش شكله؟ حجمه؟ إيش مكوناته؟ يعتمد على هذه الثلاث
+
+10
+00:00:51,320 --> 00:00:58,950
+عمليات. تمام، لذلك المحصلة هنا حتكون إذا أننا قلنا
+
+11
+00:00:58,950 --> 00:01:03,630
+في filtration وفي reabsorption وفي secretion، محصلة
+
+12
+00:01:03,630 --> 00:01:08,650
+الـ ball يعتمد على إيش صار لهذه المادة اللي هي بدها
+
+13
+00:01:08,650 --> 00:01:12,610
+تنزل اللي بتعدي الكلية من خلال الدم وبتصل للـ
+
+14
+00:01:12,610 --> 00:01:17,810
+glomerulus اللي هو هناك بتتم الـ filtration، يا إما
+
+15
+00:01:17,810 --> 00:01:23,560
+المادة هذه بس بيصير لها filtration واحدة، تمام؟ بيصير
+
+16
+00:01:23,560 --> 00:01:28,680
+لها reabsorption ولا secretion. وهذه بعض
+
+17
+00:01:28,680 --> 00:01:35,600
+المواد زي الكرياتينين وزي الانيولين، معظمها
+
+18
+00:01:35,600 --> 00:01:40,500
+filtered يعني اللي filtered بيضل طالع وما بيصيرش له
+
+19
+00:01:40,500 --> 00:01:44,600
+reabsorption ولا بنضاف عليها بعض المواد، ما بيصيرش
+
+20
+00:01:44,600 --> 00:01:49,720
+عندهم. أو معظم المواد عادي، المعظم طيب بيصير عمل
+
+21
+00:01:49,720 --> 00:01:54,180
+filtration و partial reabsorption بيصير
+
+22
+00:01:54,180 --> 00:01:59,020
+reabsorption لكنه ما هوش total، بيصير partial
+
+23
+00:01:59,020 --> 00:02:05,440
+reabsorption، وهذه زي الـ sodium والـ .. كل الـ
+
+24
+00:02:05,440 --> 00:02:10,700
+electrolytes. أو بيصير عندنا filtration لكن
+
+25
+00:02:10,700 --> 00:02:14,620
+complete reabsorption، ما بديش أنا أهدلها، ما تعالجوش
+
+26
+00:02:14,620 --> 00:02:19,560
+أنا سامحكوا، بدك تسألي اسألي بس ما تعالجي، بيصير إذا
+
+27
+00:02:19,560 --> 00:02:24,600
+عندنا complete reabsorption in nutrients، الـ glucose،
+
+28
+00:02:24,600 --> 00:02:30,200
+الـ amino acids، الحاجة
+
+29
+00:02:30,200 --> 00:02:34,260
+الأخيرة ممكن المادة يصير لها filtration، ما يصيرش
+
+30
+00:02:34,260 --> 00:02:38,740
+reabsorption لكن يضعف لها عملية إيش؟ secretion
+
+31
+00:02:38,740 --> 00:02:43,740
+كمان مرة هقولك، إيش إسمك؟ تعال الجيش، مش إسمك إنت
+
+32
+00:02:43,740 --> 00:02:49,420
+تعال الجيش يا ولدي، طيب
+
+33
+00:02:50,960 --> 00:02:55,480
+إذا عندي أنا إيه؟ ثلاث عمليات، محصلة الثلاث عمليات هذه
+
+34
+00:02:55,480 --> 00:03:04,860
+حتقدر تحدد إيش طبيعة تعامل الكلية مع المادة
+
+35
+00:03:04,860 --> 00:03:07,780
+هذه، وإيش طبيعة البول اللي هيطلع، كده فيه من المادة
+
+36
+00:03:07,780 --> 00:03:17,860
+هذه. هنلاحظ إحنا هنا أن عملية الـ urine formation
+
+37
+00:03:17,860 --> 00:03:23,530
+تعتمد على عملية filtration ضخمة، عشرين في المئة من الـ
+
+38
+00:03:23,530 --> 00:03:28,070
+plasma اللي بتعدي في الـ glomerulus، يعني اللي بتعدي
+
+39
+00:03:28,070 --> 00:03:32,130
+في الـ renal artery، عشرين في المئة من الـ plasma، مش كله دم
+
+40
+00:03:32,130 --> 00:03:37,870
+إنتوا عارفين الدم كله، جزء منه RBC أو solids، وجزء
+
+41
+00:03:37,870 --> 00:03:41,390
+منه plasma. إتكلم عن الـ plasma، إحنا عشرين في المئة من الـ
+
+42
+00:03:41,390 --> 00:03:44,470
+plasma بيصير لها filtration. خمسة من الـ plasma
+
+43
+00:03:44,470 --> 00:03:47,610
+اللي داخل الـ glomerulus، اللي داخل الكلية بيصير
+
+44
+00:03:47,610 --> 00:03:54,290
+لها filtration، تمام؟ كمية كبيرة، بمعنى أنه عندي 125
+
+45
+00:03:54,290 --> 00:04:00,830
+ملي لتر of filtrate every each minute، كل دقيقة
+
+46
+00:04:00,830 --> 00:04:05,030
+عندي 125 ملي لتر، لو حسبنا في اليوم، بطلها بلاج أنا،
+
+47
+00:04:05,030 --> 00:04:09,850
+بيصير عندي filtration لـ 180 لتر في اليوم، طب إحنا
+
+48
+00:04:09,850 --> 00:04:14,490
+جدع عندنا plasma، عندنا ثلاثة لتر plasma، يعني إحنا
+
+49
+00:04:14,490 --> 00:04:19,260
+الـ plasma تبعتنا بتخش لها filtration، بتخش الكلية،
+
+50
+00:04:19,260 --> 00:04:24,640
+بتخش الـ glomerulus والـ Bowman's capsule والـ tubule
+
+51
+00:04:24,640 --> 00:04:27,620
+أو على وشك أنها تطلع، لو أنه بيصير reabsorption
+
+52
+00:04:27,620 --> 00:04:33,220
+إليها من جديد، ستين ضعف البلازما، تمام؟ هذه المسألة
+
+53
+00:04:33,220 --> 00:04:37,500
+عملية ضخمة، ستين ضعف البلازما بيخش الكلية وبيطلع
+
+54
+00:04:37,500 --> 00:04:43,060
+هذا بيقدر إلى أن عملية الـ filtration عملية ضخمة، و
+
+55
+00:04:43,060 --> 00:04:47,000
+من هنا التخلص من المواد اللي إحنا بدنا نشيلها بكل
+
+56
+00:04:47,000 --> 00:04:50,340
+بساطة، أن تنزل بالـ filtration كمية ضخمة، 180 لتر
+
+57
+00:04:50,340 --> 00:04:54,700
+في اليوم من البلازما وبتتخلص من اللي فيها من الـ
+
+58
+00:04:54,700 --> 00:04:58,360
+waste products وما بيصيرش لها reabsorption، فإذا
+
+59
+00:04:58,360 --> 00:05:04,810
+فكرة الخلق، حسب هذه الطريقة، طريقة عالية الكفاءة، أنه
+
+60
+00:05:04,810 --> 00:05:08,790
+يصير filtration بكمية كبيرة وبنرجع نصحح بالبلازما
+
+61
+00:05:08,790 --> 00:05:14,270
+والبلازما بكميات سريعة كبيرة بتكون فيها كفاءة
+
+62
+00:05:14,270 --> 00:05:19,090
+أعلى من كفاءة أن أعمل امتصاص لهذه المواد اللي أنا
+
+63
+00:05:19,090 --> 00:05:22,070
+بدي أشيلها، بتكون دائماً هي impermeable ما بيصيرش لها
+
+64
+00:05:22,070 --> 00:05:26,670
+ليها absorption من جديد وبتكمل مشوارها لمين؟ للخارج. إذا في عندنا الثلاث عمليات هذه
+
+65
+00:05:30,590 --> 00:05:35,190
+بتحدد what is excreted، وأنه فكرة بنائها مبنية على
+
+66
+00:05:35,190 --> 00:05:39,670
+كمية filtration عالية علشان يصير تخلص كبير وسريع
+
+67
+00:05:39,670 --> 00:05:46,710
+من كمية كبيرة من الـ waste products، طيب
+
+68
+00:05:46,710 --> 00:05:52,870
+الـ filtration ما بيصير نقول خمسة من البلازما، هو في الحقيقة
+
+69
+00:05:52,870 --> 00:05:58,390
+بيصير خمسة من البلازما، لكن الـ filtrate لا يحتوي على
+
+70
+00:05:58,390 --> 00:06:05,050
+proteins، أو small proteins، minimal، small volume
+
+71
+00:06:05,050 --> 00:06:08,070
+proteins، small molecular weight، بيصير لهم
+
+72
+00:06:08,070 --> 00:06:11,190
+reabsorption، وهذول بيرجعوا، بيصير لهم filtration، و
+
+73
+00:06:11,190 --> 00:06:14,690
+هذول بيصير يصير لهم complete reabsorption، لذلك في
+
+74
+00:06:14,690 --> 00:06:17,730
+الـ urine ما بيطلعش proteins لإنه أساساً not filtered
+
+75
+00:06:18,760 --> 00:06:22,020
+تمام؟ ما بيصيرش لهم أساساً إيه؟ filtration، والـ minimal
+
+76
+00:06:22,020 --> 00:06:25,440
+volume
+
+77
+00:06:25,440 --> 00:06:29,900
+of filtered small molecular volume proteins، small
+
+78
+00:06:29,900 --> 00:06:31,920
+molecular weight of proteins، بيحاولوا re-absorb من
+
+79
+00:06:31,920 --> 00:06:38,020
+جديد، تمام؟ إذا عندي أنا الـ filtrate زي الـ
+
+80
+00:06:38,020 --> 00:06:43,300
+plasma، والـ filtrate في الـ normal tissues بيصير
+
+81
+00:06:43,300 --> 00:06:46,500
+filtration لكل شيء ما عدا إيه؟ الـ albumin، ما عدا الـ
+
+82
+00:06:46,500 --> 00:06:50,960
+proteins بتضلها إيه؟ محجوزة، بتضلها محجوزة في داخل
+
+83
+00:06:50,960 --> 00:06:57,300
+الـ الـ capillaries، okay. إذا في عندي فلترات، لذلك
+
+84
+00:06:57,300 --> 00:07:02,300
+الفلترات هذا هنلاقي التركيز فيه، تركيز المواد اللي
+
+85
+00:07:02,300 --> 00:07:07,270
+فيه بيساوي التركيز في البلازما، تمام؟ لأن إحنا الضغط
+
+86
+00:07:07,270 --> 00:07:10,870
+نزل خمسة في ذاكرة الـ .. الـ Bowman's capsule، الخمسة صار
+
+87
+00:07:10,870 --> 00:07:16,490
+له filtration، لكن الـ .. ما صارش فيه اختلافات في الـ
+
+88
+00:07:16,490 --> 00:07:19,470
+إيه؟ في التركيز، فتركيز الصوديوم في الـ filtrate
+
+89
+00:07:19,470 --> 00:07:21,690
+بيساوي تركيز الصوديوم في الـ إيه؟ في البلازما،
+
+90
+00:07:21,690 --> 00:07:28,430
+والبوتاسيوم هكذا، والسكر هكذا. إذا نفس التركيز هيكون
+
+91
+00:07:28,430 --> 00:07:32,590
+.. إذا مكونات الـ filtrate بتساوي مكونات البلازما
+
+92
+00:07:32,590 --> 00:07:36,990
+ما عدا إيه؟ البروتينات، وتركيز المواد في الفلتة بيساوي
+
+93
+00:07:36,990 --> 00:07:41,890
+تركيزها في البلازما، إلا بعض المواد، بعض الـ solutes
+
+94
+00:07:41,890 --> 00:07:45,890
+أو الـ electrolytes اللي هي bound to بروتين، يعني
+
+95
+00:07:45,890 --> 00:07:49,290
+بعض الأشياء نقول إحنا في عندنا، لما نيجي نقيسها نقول
+
+96
+00:07:49,290 --> 00:07:56,670
+total calcium و free calcium، ففي أشياء جزء منها
+
+97
+00:07:56,670 --> 00:08:01,310
+بيبقى bound to proteins، bound to albumin، اللي
+
+98
+00:08:01,310 --> 00:08:04,410
+bound to albumin أو bound to بروتين، هيبقى ماسك
+
+99
+00:08:04,410 --> 00:08:08,810
+المادة، يعني الجزء اللي bound برا الحساب، لأن الـ
+
+100
+00:08:08,810 --> 00:08:12,490
+protein بيمنعه أساساً أنه إيه؟ أنه ولو أن
+
+101
+00:08:12,490 --> 00:08:17,590
+تركيزه الـ total عالي، لكن أنا في حساب الـ filtrate، إيه صار؟
+
+102
+00:08:17,590 --> 00:08:21,590
+الـ bound والـ protein ده برا الحساب، لأن
+
+103
+00:08:21,590 --> 00:08:27,320
+الـ free هيكون في الـ plasma of الـ filtrate، هي الـ
+
+104
+00:08:27,320 --> 00:08:32,900
+same، لكن الـ bound to albumin هيتعامل مع الـ albumin
+
+105
+00:08:32,900 --> 00:08:45,840
+not filtered، بقول تمام؟ هيكون إيه؟ مش .. طيب إذا الـ
+
+106
+00:08:45,840 --> 00:08:54,520
+filtration هذا بيتم عبر الـ glomerulus، مش كده؟ الـ
+
+107
+00:08:54,520 --> 00:08:59,840
+glomerulus هذه capillaries، لها structure معين،
+
+108
+00:08:59,840 --> 00:09:03,280
+لها تركيب معين، زي الـ capillaries العادية، بعد شوية
+
+109
+00:09:03,280 --> 00:09:06,660
+صغيرة، هنتكلم عن تركيب إيه؟ هذه الـ glomerulus، الـ
+
+110
+00:09:06,660 --> 00:09:09,900
+capillary، واللي عبرها بيصير الـ filtration،
+
+111
+00:09:09,900 --> 00:09:15,280
+هنتكلم عنها، لكن أنا بتكلم الآن، إيش اللي بيحدد
+
+112
+00:09:15,280 --> 00:09:20,900
+عندي الـ filtration؟ قد إيش يكون الـ filtration؟ قد إيش
+
+113
+00:09:20,900 --> 00:09:28,040
+يكون؟ في عندي forces بتعمل filtration، وعندي سطح بتتم
+
+114
+00:09:28,040 --> 00:09:31,620
+عبره الـ filtration. إذا الـ filtration في الآخر
+
+115
+00:09:31,620 --> 00:09:36,820
+هيكون قد إيش؟ الـ forces الموجودة هذه، مين مع ومين ضد،
+
+116
+00:09:36,820 --> 00:09:41,800
+الـ net filtration forces
+
+117
+00:09:44,090 --> 00:09:47,550
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ membrane اللي
+
+118
+00:09:47,550 --> 00:09:53,810
+هيسير عبرها الـ filtration، هنقول الـ .. الـ
+
+119
+00:09:53,810 --> 00:09:57,130
+filterability تبع الـ membrane هذه، الـ permeability
+
+120
+00:09:57,130 --> 00:10:01,770
+تبع الـ membrane، طبيعة نوع الـ membrane، filtration
+
+121
+00:10:01,770 --> 00:10:06,900
+coefficient، قد إيش مواصفات الـ membrane هذا بيعمل
+
+122
+00:10:06,900 --> 00:10:10,680
+filtration عالي أو بيعمل filtration منخفض، سهلة، مش
+
+123
+00:10:10,680 --> 00:10:15,900
+كده، أي منخل، أي filter إحنا بنستخدمه لفلترة أشياء
+
+124
+00:10:15,900 --> 00:10:19,940
+معينة، مواصفات الـ filter هذا بيقول أنا قد إيش بـ
+
+125
+00:10:19,940 --> 00:10:24,760
+filter سريع، بطيء، بمنع شيء وما بمنعش شيء، بزي .. اه
+
+126
+00:10:24,760 --> 00:10:30,750
+حسب الـ .. holes تبعته، مش هيك. كذلك عندنا إحنا هنا
+
+127
+00:10:30,750 --> 00:10:34,990
+إذا في عندي مُقوّمتين، مواصفة الـ forces تبعت
+
+128
+00:10:34,990 --> 00:10:44,630
+الـ الـ forces تبعت الـ الـ الـ الـ filtration forces،
+
+129
+00:10:44,630 --> 00:10:51,710
+ومواصفات إيه؟ الـ membrane، المواصفات
+
+130
+00:10:51,710 --> 00:10:55,230
+الـ membrane بتعتمد على الـ permeability تبعت الـ
+
+131
+00:10:55,230 --> 00:11:01,360
+membrane، تمام؟ وقد إيش السطح تبع المبنى، تمام؟ أنا الـ
+
+132
+00:11:01,360 --> 00:11:03,600
+perme .. okay، عندي سطح صغير والـ permeability
+
+133
+00:11:03,600 --> 00:11:07,280
+عالية، غير أن عندي سطح كبير والـ permeability عالية،
+
+134
+00:11:07,280 --> 00:11:11,900
+فكل ما السطح، surface area أو filtration، زاد، تمام؟
+
+135
+00:11:11,900 --> 00:11:16,420
+كل ما الـ filtration زاد، لأن أنا إيه؟ سامح له مساحة
+
+136
+00:11:16,420 --> 00:11:20,300
+كبيرة تعمل filtration، فإذا الـ surface area مهم، و
+
+137
+00:11:20,300 --> 00:11:26,710
+الـ .. ونوع الـ membrane مهم، الـ permeability تبعت الـ
+
+138
+00:11:26,710 --> 00:11:30,630
+membrane، والسطح area، التانيين مع بعض، عبارة عنهم
+
+139
+00:11:30,630 --> 00:11:35,090
+بالـ filtration coefficient، إذا أنا عملت قدرة الـ
+
+140
+00:11:35,090 --> 00:11:40,010
+membrane على أنه نوعه، اللي بتحدد نوعه، وسامحه كده
+
+141
+00:11:40,010 --> 00:11:43,270
+يعمل filtration، تمام؟ اللي قلنا two factors بتأثر
+
+142
+00:11:43,270 --> 00:11:48,530
+فيها، الـ permeability والـ surface area، بنعبر عنهم
+
+143
+00:11:48,530 --> 00:11:55,910
+في هذا الموضوع بـ filtration coefficient KF، تمام، و
+
+144
+00:11:55,910 --> 00:11:59,750
+الـ forces اتكلمنا عنها قبل كده، هنضلنا نتكلم عنها
+
+145
+00:11:59,750 --> 00:12:01,930
+طول ما إحنا بنتكلم في الفسيولوجيا، في عندنا
+
+146
+00:12:01,930 --> 00:12:05,370
+hydrostatic pressure وعندنا osmotic pressure، تمام.
+
+147
+00:12:06,860 --> 00:12:10,900
+الـ forces هذه، في forces بتدفع، في forces بتشد،
+
+148
+00:12:10,900 --> 00:12:15,800
+المحصلة بين الـ plus والـ minus، المحصلة مين مع ومين
+
+149
+00:12:15,800 --> 00:12:21,060
+ضد، بيطلع الـ net filtration forces. كانت زميلة
+
+150
+00:12:21,060 --> 00:12:24,000
+اليكم سألت، what is hydrostatic pressure؟ الـ
+
+151
+00:12:24,000 --> 00:12:28,440
+hydrostatic pressure قوة مادية بتضغط، كأنك إنت
+
+152
+00:12:28,440 --> 00:12:33,980
+بتضغطي بإيدك على عشاء، تمام؟ بتضغطي بإيدك، هذا الضغط
+
+153
+00:12:33,980 --> 00:12:38,260
+المادي، الـ physical pressure، القوة، اه، هذه عملية الـ
+
+154
+00:12:38,260 --> 00:12:42,680
+hydrostatic pressure الناتج عن نبض القلب، أن القلب
+
+155
+00:12:42,680 --> 00:12:48,760
+بيضغط الدم داخل الـ إيه؟ الـ blood vessels، الـ blood
+
+156
+00:12:48,760 --> 00:12:52,860
+vessels فيها elasticity، في elastic wall، الـ elastic
+
+157
+00:12:52,860 --> 00:12:59,820
+wall دي بيظل شدّ ضغط على الدم بحيث أنه دايماً في
+
+158
+00:12:59,820 --> 00:13:04,120
+عندي ضغط في داخل الدم اللي بنقيسه بالجهاز، الضغط و
+
+159
+00:13:04,120 --> 00:13:08,260
+بنقول الضغط 120 على 80، هذا الـ hydrostatic pressure
+
+160
+00:13:08,260 --> 00:13:12,980
+pressure، شبيه بالـ atmospheric pressure، hydrostatic
+
+161
+00:13:12,980 --> 00:13:19,100
+الضغط فيزيائي موجود هنا، تمام؟ في عندي نوع تاني،
+
+162
+00:13:19,100 --> 00:13:22,400
+osmotic pressure اللي إنتوا بتعرفوه، اللي بتعرفه
+
+163
+00:13:22,400 --> 00:13:26,180
+أنه osmolality، وضغط الاسموزي، مش هيك، ضغط الاسموزي
+
+164
+00:13:26,180 --> 00:13:34,020
+هذا، وجود مواد solutes بتحب تمسك حواليها مية، كل ما
+
+165
+00:13:34,020 --> 00:13:37,700
+زاد تركيزها، كل ما بتقدر تمسك حواليها water
+
+166
+00:13:37,700 --> 00:13:41,480
+molecules أكثر، تمام؟ ولو حطينا زي ما حكينا المرة
+
+167
+00:13:41,480 --> 00:13:46,540
+الفاتت، حطينا membrane بين two liquids، واحد بيحتوي
+
+168
+00:13:46,540 --> 00:13:50,000
+solutes كتير، واحد بيحتوي solutes قليل، فالمية
+
+169
+00:13:50,000 --> 00:13:54,880
+هتنتقل من المكان اللي فيه solutes قليل للمكان اللي
+
+170
+00:13:54,880 --> 00:13:58,220
+فيه solutes كتير، لحد ما التركيز هيصير هيصير
+
+171
+00:13:58,220 --> 00:14:02,200
+متساوي، مش كده؟ هذا إذا فيه قدرة على الـ osmolality،
+
+172
+00:14:02,200 --> 00:14:06,980
+أنها to create some sort of attraction for water،
+
+173
+00:14:06,980 --> 00:14:11,260
+والـ hydrostatic pressure في مكان ما بيضغط الـ water،
+
+174
+00:14:11,880 --> 00:14:18,780
+إذا الاثنين موجودين مع بعض، فلويد زي
+
+223
+00:17:31,030 --> 00:17:35,470
+Colloidal pressure هيشد الـ fluids الـ water من داخل
+
+224
+00:17:35,470 --> 00:17:39,030
+الـ capillary تمام؟ إذا الـ hydrostatic pressure ده
+
+225
+00:17:39,030 --> 00:17:43,570
+معايا ولا مش معايا؟ الـ هيدروستاتيك براشر هان positive
+
+226
+00:17:43,570 --> 00:17:47,570
+force لفلتريشن لكن الـ هيدروستاتيك براشر هان negative
+
+227
+00:17:47,570 --> 00:17:50,510
+force لفلتريشن بيقاوم، أنه في الجهة التانية هو
+
+228
+00:17:50,510 --> 00:17:53,690
+الـ هيدروستاتيك براشر بيعمل، بيسجل الـ اشي لبرا، البرا هان
+
+229
+00:17:53,690 --> 00:17:57,370
+لبومانس كابسول، والبرا هان أنه يمنع الـ اشي ييجي من
+
+230
+00:17:57,370 --> 00:18:02,040
+الـ..والـ osmotic pressure اللى ناتج عن الكلويدال
+
+231
+00:18:02,040 --> 00:18:06,440
+osmotic pressure هان تمام، بيمنع في داخل الـ
+
+232
+00:18:06,440 --> 00:18:09,520
+capillary الـ fluids أو الـ water تطلع، في حين أنه
+
+233
+00:18:09,520 --> 00:18:13,520
+داخل بومانس كابسول، إذا في عندي هان بروتين وكلويدال
+
+234
+00:18:13,520 --> 00:18:16,560
+pressure بيساعد يشد، إذا الـ hydrostatic pressure
+
+235
+00:18:16,560 --> 00:18:20,330
+هان مع الكلويدال pressure هان force بيعمل في اتجاه
+
+236
+00:18:20,330 --> 00:18:24,430
+واحد، والـ osmotic pressure هان أو الـ colloidal
+
+237
+00:18:24,430 --> 00:18:26,690
+pressure هان، زي أن الـ osmotic pressure هان بيعمل
+
+238
+00:18:26,690 --> 00:18:31,250
+في اتجاه واحد، حتى السهم هذا، وهذا في اتجاه أنه
+
+239
+00:18:31,250 --> 00:18:35,490
+تعمل تمنع الـ filtration، في حين أنه هذا بيعمل الـ
+
+240
+00:18:35,490 --> 00:18:38,410
+filtration، طيب وين الـ oncotic pressure في ذاكر
+
+241
+00:18:38,410 --> 00:18:41,310
+الـ بومانس كابسول؟ احنا قولنا هذا الـ membrane أن
+
+242
+00:18:41,310 --> 00:18:45,140
+بيرميا بلت ايه؟ to protein، فبيصير filtration بس
+
+243
+00:18:45,140 --> 00:18:49,020
+ما يطلعش معاها protein، بطلع minimal لا يذكر تمام؟
+
+244
+00:18:49,020 --> 00:18:52,760
+إذا هنا الـ osmotic pressure تمام، اللي ناتج عن الـ
+
+245
+00:18:52,760 --> 00:18:57,980
+colloidal structure اللي هو بحيث أنه يكون proteins
+
+246
+00:18:57,980 --> 00:19:02,860
+مش موجود، صفر تمام؟ إذا الـ hydrostatic pressure هذا
+
+247
+00:19:02,860 --> 00:19:08,860
+لحاله بيقاوم الـ colloidal pressure تبع الـ plasma، و
+
+248
+00:19:08,860 --> 00:19:11,680
+بيقاوم الـ hydrostatic pressure تبع مين؟ الـ Bowman's
+
+249
+00:19:11,680 --> 00:19:15,480
+capsule، طبعا هذا ناتج في الآخر عن ضغط الجلب، يعني
+
+250
+00:19:15,480 --> 00:19:20,720
+الكلية شغالة بالضغط اللي عامله إيه؟ الجلب، إذا الدم
+
+251
+00:19:20,720 --> 00:19:24,620
+اللي بينتشر في الجسم كله بفضل الضغط تبع الجلب، يخلي
+
+252
+00:19:24,620 --> 00:19:28,520
+الـ.. كذلك الكلية نفسها معتمدة في شغلها الرئيسي على
+
+253
+00:19:28,520 --> 00:19:32,340
+إيه؟ على الضغط اللي بيجيها، اللي ناتج من وين؟ من
+
+254
+00:19:32,340 --> 00:19:37,280
+الجلب، إذا لو حسبنا المحصلة، هان شوف، نجد إيش في عندنا
+
+255
+00:19:37,280 --> 00:19:41,980
+net filtration pressure أو forces، هنلاقي أنه تساوي
+
+256
+00:19:41,980 --> 00:19:45,000
+الـ hydrostatic هذا، اللي هو ستين ميلي متر ميركوري
+
+257
+00:19:45,000 --> 00:19:49,360
+ناقص الـ اثنين و تلاتين الـ oncotic pressure، وناقص
+
+258
+00:19:49,360 --> 00:19:51,380
+الـ ثمانية عشر الـ hydrostatic اللي موجودة في الـ Bowman's
+
+259
+00:19:51,380 --> 00:19:55,440
+capsule، المحصلة في عندي net forces عشرة ميلي متر
+
+260
+00:19:55,440 --> 00:19:58,960
+ميركوري، تمام؟ إذا أن الـ net forces هذه تبعت الـ
+
+261
+00:19:58,960 --> 00:19:59,320
+filtration
+
+262
+00:20:08,870 --> 00:20:14,430
+احنا هيك وضحنا عملية
+
+263
+00:20:14,430 --> 00:20:17,810
+الـ filtration كيف بالتفصيل، طبعا إذا في forces تحكمها
+
+264
+00:20:17,810 --> 00:20:20,990
+forces مع الـ filtration، و forces ضد الـ filtration
+
+265
+00:20:20,990 --> 00:20:25,630
+احنا جيبنا سيرة الكلام هذا، وقلنا إنه الـ osmotic
+
+266
+00:20:25,630 --> 00:20:29,530
+pressure في داخل الـ Bowman's capsule زيرو، زيرو في
+
+267
+00:20:29,530 --> 00:20:35,270
+الـ situation normal، لكن في أوضاع فيها مرض، فيها
+
+268
+00:20:35,270 --> 00:20:40,590
+chronic renal failure، هنكتشف أنه الـ bowl برا فيه
+
+269
+00:20:40,590 --> 00:20:46,130
+protein، بروتينوريا أو البيومينوريا، البيومين في الـ
+
+270
+00:20:46,130 --> 00:20:50,350
+urine، بروتين في الـ urine، بروتينوريا أو
+
+271
+00:20:50,350 --> 00:20:53,330
+البيومينوريا، أول ما نلاقي فيه بروتين في الـ bowl
+
+272
+00:20:53,330 --> 00:20:57,730
+بنقول عندنا مشكلة كبيرة، لأن هذا مش لازم يطلع، لأنه
+
+273
+00:20:57,730 --> 00:21:02,500
+إذا دل يطلع، زي ما قلتلكم،  منزل البروتين هذا يصف في
+
+274
+00:21:02,500 --> 00:21:06,340
+البلازما، يهرب، يهرب، يهرب، يهرب، يهرب، البروتين
+
+275
+00:21:06,340 --> 00:21:10,320
+في البلازما، إيش بيصير فيه؟ بينخفض، إذا انخفض
+
+276
+00:21:10,320 --> 00:21:15,760
+البروتين في البلازما، هذه force مهمة للحفاظ على الـ
+
+277
+00:21:15,760 --> 00:21:19,160
+fluids في داخل البلازما، إذا جال، معناها الـ fluids
+
+278
+00:21:19,160 --> 00:21:22,380
+بتهرب إلى الـ إيه؟ إلى الـ tissues، ما فيش إشي يرجعها
+
+279
+00:21:22,920 --> 00:21:27,040
+قولنا إديمة رينال، إديمة مش كده؟ قولنا عنها نوع من
+
+280
+00:21:27,040 --> 00:21:30,780
+أنواع رينال إديمة، لما البروتين يهرب من عندنا أحيانا
+
+281
+00:21:30,780 --> 00:21:33,580
+بنلاقي في الـ Bowman's capsule فيه بروتين موجود
+
+282
+00:21:33,580 --> 00:21:37,240
+بيصير له إيه؟ قيمة بس في الـ normal conditions مش
+
+283
+00:21:37,240 --> 00:21:40,960
+موجود، لكن في الـ abnormal conditions بنلاقي إيه؟
+
+284
+00:21:40,960 --> 00:21:44,500
+موجود وبيبدأ له حساب، لكن في الوضع الطبيعي ما لهوش
+
+285
+00:21:44,500 --> 00:21:44,840
+حساب
+
+286
+00:21:50,180 --> 00:21:54,680
+طيب، الـ glomerular capillaries have a much higher
+
+287
+00:21:54,680 --> 00:21:57,920
+rate of filtration than most other capillaries
+
+288
+00:21:57,920 --> 00:22:00,700
+because of a high glomerular hydrostatic pressure
+
+289
+00:22:00,700 --> 00:22:05,160
+and a large KF filtration coefficient، يزن الـ
+
+290
+00:22:05,160 --> 00:22:08,780
+hydrostatic pressure عندنا هنا عالي في الـ
+
+291
+00:22:08,780 --> 00:22:12,040
+glomerulus
+
+292
+00:22:12,040 --> 00:22:16,580
+الـ أفراد الـ أرتيريال بيجينا عالي في الـ..في الـ
+
+293
+00:22:16,580 --> 00:22:20,020
+capillary زي العادية، الـ general capillary
+
+294
+00:22:20,020 --> 00:22:28,160
+circulation، غير الكلية، بنلاقي أنه الـ hydrostatic
+
+295
+00:22:28,160 --> 00:22:33,540
+pressure هان بيكونش عن اثنين و تلاتين تمام؟ في الـ..
+
+296
+00:22:33,540 --> 00:22:39,660
+في الـ capillary، في حين أنه الـ..الـ..هنا عندنا
+
+297
+00:22:39,660 --> 00:22:42,950
+high pressure، high hydrostatic pressure الـ رينا
+
+298
+00:22:42,950 --> 00:22:47,230
+الـ أرتيريال في blood pressure زي الـ إيه؟ زي الـ أورتا
+
+299
+00:22:47,230 --> 00:22:52,670
+فبيصل الكلية بسهولة، ضغط عالي، الضغط العالي، والـ
+
+300
+00:22:52,670 --> 00:22:55,550
+filtration coefficient العالي، ناتج عن أن الـ
+
+301
+00:22:55,550 --> 00:22:59,370
+surface area عندي واسع، capillary آه، ومجموع الـ
+
+302
+00:22:59,370 --> 00:23:02,350
+capillaries اللي في الـ إيه؟ اللي في الكلية tufts
+
+303
+00:23:02,350 --> 00:23:05,850
+tufts، tufts، و capillaries مساحة كبيرة جدا، بحيث
+
+304
+00:23:05,850 --> 00:23:09,990
+تديني فرصة كبيرة، مساحة كبيرة للـ إيه؟ للـ filtration
+
+305
+00:23:09,990 --> 00:23:15,810
+بالإضافة أنه عندنا الـ..الـ membrane الـ..الـ
+
+306
+00:23:15,810 --> 00:23:18,830
+efficiency تبعه عالية، أنه يعمل filtration فقط
+
+307
+00:23:18,830 --> 00:23:25,170
+لمواد، ويمنع filtration لمواد أخرى، وهذا من رحمة
+
+308
+00:23:25,170 --> 00:23:29,530
+ربنا، لو الـ herbicides بتطلع كان ما ضلش بنا آدم، لو
+
+309
+00:23:29,530 --> 00:23:33,450
+الـ..الـ protein بيطلع ما ضلش بنا آدم، يعني خلق
+
+310
+00:23:33,450 --> 00:23:37,270
+الإنسان، الدقة فيه في كل مكان، يعني مش احنا بنرى أنه
+
+311
+00:23:37,270 --> 00:23:40,550
+آه والله، الواحد إيه؟ عينين حلوين وبيشوفه في الدنيا
+
+312
+00:23:40,550 --> 00:23:48,370
+كل شيء، انظر إلى كل شيء بتلاقي دقيق ومحسوب بدقة
+
+313
+00:23:48,370 --> 00:23:52,630
+متناهية، تنتفي مع الصدفة، الدقة هذه متناهية اللي
+
+314
+00:23:52,630 --> 00:23:57,090
+بنشوفها احنا، ينفي وجود الصدفة، الصدفة مش ممكن تتكرر
+
+315
+00:23:57,090 --> 00:24:02,350
+ملايين المرات في كل مكان، مش معقول، تمام؟ مش معقول، إذا
+
+316
+00:24:02,350 --> 00:24:10,210
+عندنا الـ..الـ filtration بيصير بس للـ fluids، محافظ
+
+317
+00:24:10,210 --> 00:24:14,900
+على الـ RBCs وعلى الـ proteins، بالمناسبة..
+
+318
+00:24:14,900 --> 00:24:19,100
+بالمناسبة ليش الـ RBC..ليش الـ hemoglobin موجود في
+
+319
+00:24:19,100 --> 00:24:24,020
+RBCs، موجود في cell membrane، ومحجوز في مكان واسع؟
+
+320
+00:24:24,020 --> 00:24:29,700
+الـ hemoglobin لو كان free، آه، can be filtered، لذلك
+
+321
+00:24:29,700 --> 00:24:34,020
+لما يصير عندنا hemolysis من خلف الكلية، لأن
+
+322
+00:24:34,020 --> 00:24:37,760
+البروتين تبع الـ..الـ hemoglobin، الـ hemoglobin
+
+323
+00:24:37,760 --> 00:24:41,460
+نفسه بيطلع وبيصل له filtration، وياريت بيصل له
+
+324
+00:24:41,460 --> 00:24:44,880
+filtration وبيطلع من الكلية، ومع السلامة، لأ، بيجي
+
+325
+00:24:44,880 --> 00:24:48,760
+عند مكان معين في الـ tubules، و stuck لأنه كبير، طلع
+
+326
+00:24:48,760 --> 00:24:51,760
+من الـ filter، ومش عارف يطلع من الـ tubule، تمام؟ مع
+
+327
+00:24:51,760 --> 00:24:54,640
+التركيز، مع شوية شوية تبدأ الـ tubules تتسكر واحدة
+
+328
+00:24:54,640 --> 00:24:58,700
+واحدة، واحدة، واحدة، واحدة، واحدة، لما الكلية إيه؟ تتعطل
+
+329
+00:24:58,700 --> 00:25:02,980
+عن العمل، ما فيش فيها filtration، لذلك أن خروجه خطر
+
+330
+00:25:03,830 --> 00:25:08,470
+على الجسم كجسم، الـ RBCs راحت، وخطر على الكلية لأن
+
+331
+00:25:08,470 --> 00:25:15,190
+الكلية، لذلك الـ myoglobin اللي هو الـ hemoglobin
+
+332
+00:25:15,190 --> 00:25:20,610
+اللي موجود في الـ إيه؟ في العضلات، الـ myoglobin في
+
+333
+00:25:20,610 --> 00:25:25,010
+العادة not exposed للـ plasma، و not exposed للـ
+
+334
+00:25:25,010 --> 00:25:31,110
+glomeruli
+
+335
+00:25:31,110 --> 00:25:34,590
+و الـ filtration، Okay، هو موجود كـ myoglobin، مش موجود
+
+336
+00:25:34,590 --> 00:25:40,250
+في RBC's زي الـ إيه؟ زي الـ hemoglobin، تمام؟ موجود
+
+337
+00:25:40,250 --> 00:25:42,630
+في العضلات، والعضلات بتشغله، لكن لو صار عندي
+
+338
+00:25:42,630 --> 00:25:47,610
+massive crash، و massive trauma للـ muscles تمام؟
+
+339
+00:25:47,610 --> 00:25:50,790
+هذا بيؤدي إلى أن الـ muscle fibers بتتكسر، الـ
+
+340
+00:25:50,790 --> 00:25:55,370
+myoglobin اللي فيها بيطلع وبيمشي في الدم، بيصير
+
+341
+00:25:55,370 --> 00:25:59,170
+الكلية بتتفاجأ، أن الكلية هذه، بيقدر يطلع منها لأن
+
+342
+00:25:59,170 --> 00:26:06,060
+هو مصمم ما يطلعش في الدم، فبنلاقي يطلع، إذا دخل الدم
+
+343
+00:26:06,060 --> 00:26:09,740
+بيصير له filtration، وإذا صار له filtration لأنه
+
+344
+00:26:09,740 --> 00:26:14,840
+حجمه كبير شوية، فبيلزق وبيعمل إيه؟ اللي هو الـ acute
+
+345
+00:26:14,840 --> 00:26:18,610
+renal failure، حتى احنا دراسة الـ acute renal failure
+
+346
+00:26:18,610 --> 00:26:23,870
+كنا نعملها على الحيوانات، أن ندى في العضلة مادة
+
+347
+00:26:23,870 --> 00:26:28,650
+معينة تكسر العضلات، فبيطلع myoglobin كثير، فالكلية
+
+348
+00:26:28,650 --> 00:26:32,550
+بتضرب، و هم نعمل دراساتنا القديمة كلها، النماذج
+
+349
+00:26:32,550 --> 00:26:35,730
+المستخدمة لدراسة الـ acute renal failure، على أنهم
+
+350
+00:26:35,730 --> 00:26:39,850
+يُسوقوا acute renal failure للحيوان معين، عبر أنه
+
+351
+00:26:39,850 --> 00:26:43,170
+يكسروا العضلات، يخلوا الـ myoglobin يروح يخرب الـ
+
+352
+00:26:43,650 --> 00:26:47,290
+يُخرب الكلية، الـ myoglobin، و لها زيارة الجثة موجودة
+
+353
+00:26:47,290 --> 00:26:52,370
+من فترة سألوني، واحد عنده، واحد أكل جتلة من الناس
+
+354
+00:26:52,370 --> 00:26:58,370
+تمام، ودخل المستشفى
+
+355
+00:26:58,370 --> 00:27:02,790
+وبعدين دخل فيه، أكل فيه فيلرومات، مش علاقة الجتلة
+
+356
+00:27:02,790 --> 00:27:09,530
+فيه إيه؟ علاقة الجتلة بتعمل لنا إيه؟ الـ myoglobin
+
+357
+00:27:09,530 --> 00:27:13,070
+بيصير exposed، والـ myoglobin هذا بيروح، بيعمل لنا إيه؟
+
+358
+00:27:14,220 --> 00:27:21,700
+failure، واضح لذلك، حادث سيارة، دهس على عضلات، okay
+
+359
+00:27:21,700 --> 00:27:25,620
+الحمد لله ما كسرش رأسه، لكن كسر العضلات، والعضلات
+
+360
+00:27:25,620 --> 00:27:30,500
+قامت بـ myoglobinuria عالية، وبعدين هذا الـ myoglobin
+
+361
+00:27:30,500 --> 00:27:34,840
+بيخرب الكلية، احنا ونصيب نقدر ننضف ونصلح الكلية
+
+362
+00:27:34,840 --> 00:27:40,160
+ولا هنحطه على hemodialysis فترة، إذا دخل في chronic
+
+363
+00:27:40,160 --> 00:27:44,780
+حسب الإصابة، وبعدين نعمله kidney transplantation،
+
+364
+00:27:44,780 --> 00:27:48,920
+يعتمد، يعني القصد أنه الـ filter الـ..الـ..الـ
+
+365
+00:27:48,920 --> 00:27:54,690
+membrane هذا كثير مهم، تمام؟ وربنا خلق الأشياء بشكل
+
+366
+00:27:54,690 --> 00:27:58,310
+معين، أشياء تدخل وأشياء ما تدخلش، لو الأشياء اللي
+
+367
+00:27:58,310 --> 00:28:03,330
+ما بدهاش تدخل دخلت بيصير مصيبة، لذلك واضح القصد في أن الـ
+
+368
+00:28:03,330 --> 00:28:07,470
+hemoglobin راح حطه وحطه في إيه؟ في RBCs، لو
+
+369
+00:28:07,470 --> 00:28:11,950
+ما حطش في RBCs بيطلع، فلأ لأ، ما راح حطه في
+
+370
+00:28:11,950 --> 00:28:14,010
+RBCs، ربنا من اللي ما حطوه في RBCs لكن
+
+371
+00:28:14,010 --> 00:28:18,390
+الـ hemoglobin ما حطوه في إيه؟
+
+372
+00:28:18,390 --> 00:28:20,790
+طيب، glomerular capillary membrane
+
+373
+00:28:24,020 --> 00:28:27,540
+اللي هو احنا الـ filtration بتتم عبر glomerular
+
+374
+00:28:27,540 --> 00:28:31,060
+capillary membrane، من إيش بتكون هذا الـ membrane؟
+
+375
+00:28:31,060 --> 00:28:36,180
+هذا بنسميه filtration barrier
+
+376
+00:28:36,180 --> 00:28:39,320
+الـ capillary membrane هذا، glomerular capillary
+
+377
+00:28:39,320 --> 00:28:43,860
+membrane بنسميه filtration barrier، لأن هو اللي إيه؟
+
+378
+00:28:43,860 --> 00:28:47,360
+عبره بيدخل السر، الـ filtration، من إيش بتكون الـ
+
+379
+00:28:47,360 --> 00:28:51,270
+filtration barrier هذا؟ الطبيعي أنه الـ..الـ..الـ
+
+380
+00:28:51,270 --> 00:28:55,710
+capillary في داخله في إيش؟ endothelium، صبوط؟ اللي
+
+381
+00:28:55,710 --> 00:29:01,090
+هو الـ flat endothelial cells تبعت اللي بتبطن الـ
+
+382
+00:29:01,090 --> 00:29:03,870
+capillary، طبعا فيه fenestrations في الـ capillary
+
+383
+00:29:03,870 --> 00:29:06,830
+بين الـ إيه؟ بين الـ..بين الـ endothelial cells، فيه
+
+384
+00:29:06,830 --> 00:29:13,400
+holes موجودة، هذا supported من برا بـ basement membrane، الـ
+
+385
+00:29:13,400 --> 00:29:17,860
+basement membrane هذا عبارة عن membrane متكون من
+
+386
+00:29:17,860 --> 00:29:23,120
+collagen fibers، و protoglycan fibers، عامل أشبه
+
+387
+00:29:23,120 --> 00:29:28,880
+بالـ إيه؟ أشبه بالنسيج، نسيج من الـ fibers، ففيه في
+
+388
+00:29:28,880 --> 00:29:33,370
+جلبه إيه؟ chrome، فراغات، الأشياء إذا لما بتطلع من
+
+389
+00:29:33,370 --> 00:29:37,390
+داخل الـ plasma لازم تتعدى من الـ fenestrations تبعت
+
+390
+00:29:37,390 --> 00:29:42,270
+الـ membrane تبعت الـ capillary wall، وهتلاقي الـ
+
+391
+00:29:42,270 --> 00:29:44,830
+basement membrane، إذا الـ cells دخلت من بينها
+
+392
+00:29:44,830 --> 00:29:47,570
+هتلاقي basement membrane، طلعت من الـ basement
+
+393
+00:29:47,570 --> 00:29:50,710
+membrane، هتلاقي كمان برا موجود عندي epithelial
+
+394
+00
+
+445
+00:33:31,760 --> 00:33:36,250
+في التيابيولو هذه اللي هو مكبرة شوية هذه ال slits
+
+446
+00:33:36,250 --> 00:33:40,710
+مقاطعة منها مقاطعة من الـ بودوكسايسو بينها ال pores
+
+447
+00:33:40,710 --> 00:33:45,970
+اللي هي الـ .. بين ال slits وهي الـ epithelia الـ ..
+
+448
+00:33:45,970 --> 00:33:48,870
+الـ endothelial membrane تبع الـ capillary وهي الـ
+
+449
+00:33:48,870 --> 00:33:51,910
+basement membrane basement membrane فهنا ال pores
+
+450
+00:33:51,910 --> 00:33:54,650
+هذه بيطلع منها الشيء بيطلع filtration بيعدى منها
+
+451
+00:33:54,650 --> 00:33:57,970
+المباشرة، أقصد أقول الـ filtrate ولو أنه موجود عندي
+
+452
+00:33:57,970 --> 00:34:04,640
+أنا epithelial layer تعمل support لكنها الـ
+
+453
+00:34:04,640 --> 00:34:09,260
+filtration اللي طالع لا يحتاج أن يدخل داخل، not
+
+454
+00:34:09,260 --> 00:34:13,560
+transcellular زي ما قلنا في قصة الـ potential
+
+455
+00:34:13,560 --> 00:34:18,280
+spaces تبعت الـ .. يعني بيعدي عبر الخلية عشان يطلع
+
+456
+00:34:18,280 --> 00:34:23,330
+الـ Bowman's capsule لأ، في منهم إسلسل، تمام؟ لكن هل هذا
+
+457
+00:34:23,330 --> 00:34:27,030
+له الـ Epithelial tissue هذا الموجود اللي عامل
+
+458
+00:34:27,030 --> 00:34:30,370
+support عشان يقاوم الضغط العالي اللي في هذه
+
+459
+00:34:30,370 --> 00:34:35,930
+المنطقة؟ هل له تأثير على الـ filtration؟ آه، له
+
+460
+00:34:35,930 --> 00:34:37,990
+تأثير على الـ filtration مش من ناحية
+
+461
+00:34:41,250 --> 00:34:44,170
+الحجم تبع ال slits لكن من حجم عندي الـ
+
+462
+00:34:44,170 --> 00:34:48,410
+electronegativity، في عندي هنا electronegative
+
+463
+00:34:48,410 --> 00:34:54,490
+charges موجودة على الـ body size في ال slits هذه
+
+464
+00:34:54,490 --> 00:35:00,070
+بتساعد أن تعمل revealing لأشياء اللي هي تحتوي على
+
+465
+00:35:00,070 --> 00:35:04,350
+زي الـ proteins electronegative، تمام؟ إذا هذه
+
+466
+00:35:04,350 --> 00:35:08,990
+المسألة، إذا في عندي هنا حقيقة two factors مهمين في
+
+467
+00:35:08,990 --> 00:35:12,890
+مواصفات الـ membrane اللي بيصير فيه filtration، تمام؟
+
+468
+00:35:12,890 --> 00:35:18,230
+أن في عندي أنا holes، fenestrations، و هذِه الـ holes
+
+469
+00:35:18,230 --> 00:35:23,810
+supported بـ negative، negatively charged ions عاملة
+
+470
+00:35:23,810 --> 00:35:27,370
+negative، negatively charged هي بيصير calcium ions
+
+471
+00:35:27,370 --> 00:35:32,970
+أو غيرها، أو يعني المهم عندي إيه؟ negative charge في
+
+472
+00:35:32,970 --> 00:35:38,190
+داخل الـ .. إذا عندي الـ fenestrations بتحدد حجم و الـ
+
+473
+00:35:38,190 --> 00:35:43,250
+charges بتطرد الأشياء، ولو حجمها مظبوط لكنها
+
+474
+00:35:43,250 --> 00:35:46,310
+negative للـ charge بتقدرش تخش، في حين أن لو حجمها
+
+475
+00:35:46,970 --> 00:35:51,150
+مظبوط هو positively charged بتخش بإيه؟ بسرعة، لكن
+
+476
+00:35:51,150 --> 00:35:54,290
+حجمها مظبوط و مش negatively ولا positively charged
+
+477
+00:35:54,290 --> 00:35:59,130
+بتخش بسهولة، لكن لما تكون positive بيصير لها
+
+478
+00:35:59,130 --> 00:36:01,650
+filtration أسرع، تكون negative بيصير لها filtration
+
+479
+00:36:01,650 --> 00:36:06,710
+أجل، يعني تصوروا نفس المادة لما يكون لها تلاتة
+
+480
+00:36:06,710 --> 00:36:11,110
+أنواع، نوع positive، نوع negative، نوع neutral، الـ
+
+481
+00:36:11,110 --> 00:36:13,270
+neutral بيعدي، الـ positive بيعدي أكتر منه، الـ
+
+482
+00:36:13,270 --> 00:36:16,610
+negative بتتوقف أو بيعدي قليل، ليش؟ لإنه في شيء يطرده
+
+483
+00:36:16,610 --> 00:36:20,130
+الـ negativity هذه موجودة على كل المستويات الـ
+
+484
+00:36:20,130 --> 00:36:22,110
+epithelial cells، الـ holes اللي فيها فيها negative
+
+485
+00:36:22,110 --> 00:36:29,610
+الـ charged ions، الـ basement membrane و الـ a و الـ
+
+486
+00:36:29,610 --> 00:36:33,890
+epithelial covering برضه فيه، إذا فعندي two factors
+
+487
+00:36:33,890 --> 00:36:40,130
+الـ size و الـ electrical charge اللي موجودة في الـ
+
+488
+00:36:46,220 --> 00:36:51,840
+إذا هنا قلنا تلاتة layers تمثل الـ filtration barrier
+
+489
+00:36:51,840 --> 00:36:56,440
+قلنا لأن عبرهم حيصير الـ filtration، even this high
+
+490
+00:36:56,440 --> 00:36:58,600
+rate of filtration in the glomerular capillary
+
+491
+00:36:58,600 --> 00:37:00,600
+membrane normally prevents filtration of plasma
+
+492
+00:37:00,600 --> 00:37:05,520
+proteins، إذا بالرغم أن filtration عالي عندي، تمام؟
+
+493
+00:37:05,520 --> 00:37:10,800
+بيصير هنا في الكلية 20% بيصير filtration لأن الـ
+
+494
+00:37:10,800 --> 00:37:15,040
+plasma proteins بتعديش، طب ليش بتعديش الـ plasma
+
+495
+00:37:15,040 --> 00:37:21,730
+proteins؟ عشان مش علشان حجمها أكبر من الـ 60
+
+496
+00:37:21,730 --> 00:37:27,250
+angstrom، خطرها آه، و الـ fenestration 80
+
+497
+00:37:27,250 --> 00:37:31,590
+angstrom، لكن مفترضها تخش، مش ممكن، تـ get charges
+
+498
+00:37:31,590 --> 00:37:38,190
+بتمنعها، لذلك أن بعض أمراض الكلية أبسط lesion في
+
+499
+00:37:38,190 --> 00:37:42,530
+الكلية بيسموه minimal، minimal changes
+
+500
+00:37:48,880 --> 00:37:55,060
+minimal changes in nephropathy اللي هي الحالات
+
+501
+00:37:55,060 --> 00:38:00,040
+احنا عندنا بكرة هتدرس إن شاء الله الـ failure عبارة
+
+502
+00:38:00,040 --> 00:38:04,820
+عن failure في الكلية عندها تشتغل مظبوط و بتطلع
+
+503
+00:38:04,820 --> 00:38:08,840
+كمية كبيرة من الـ proteins، لكن ليش؟ لما ندرس الـ
+
+504
+00:38:08,840 --> 00:38:13,280
+pathology تبع الكلية، ليش هذه الكلية، تمام؟ فيها
+
+505
+00:38:13,280 --> 00:38:18,580
+failure، هم المواصفات العامة في proteinuria، تمام؟
+
+506
+00:38:18,580 --> 00:38:22,620
+وفي عندي الـ plasma بيبدأ اليوريا و الكرياتينين
+
+507
+00:38:22,620 --> 00:38:25,820
+وما أعرفش إيش تعني لذا في failure مع وجود
+
+508
+00:38:25,820 --> 00:38:29,180
+proteinuria، هذا ما يسمى إيه؟ chronic renal failure
+
+509
+00:38:29,180 --> 00:38:34,920
+تمام؟ لكن إيش الـ lesion اللي خلت في عندنا مجموعة
+
+510
+00:38:34,920 --> 00:38:38,880
+كبيرة، يعني إيش الإصابة اللي في داخل الكلية اللي
+
+511
+00:38:38,880 --> 00:38:43,900
+وصلتنا لـ chronic renal failure، في إصابات كتيرة ممكن
+
+512
+00:38:43,900 --> 00:38:49,840
+أشياء minimal damaging للنفرون، بتقدر الـ minimal
+
+513
+00:38:49,840 --> 00:38:53,860
+coronary failure، و في عنده prognosis كويس، يعني ممكن
+
+514
+00:38:53,860 --> 00:38:58,120
+المستقبل أنه يتصلح وما يكونش خطير كثير، وفي أشياء
+
+515
+00:38:58,120 --> 00:39:02,000
+بتبجأ يعني هجوم وهجوم على الكلية خلال فترة بسيطة
+
+516
+00:39:02,000 --> 00:39:04,300
+بتدمرها وما فيش فايدة إلا تشيل الكلية و تخلص غيرها
+
+517
+00:39:04,300 --> 00:39:07,660
+ما فيش إلا إيه؟ نعمل إيه؟ عملية زراعة كلية في
+
+518
+00:39:07,660 --> 00:39:12,510
+المستقبل، تمام؟ فدرجات مختلفة لكن الظاهر أن في عندي
+
+519
+00:39:12,510 --> 00:39:15,830
+بروتين في الكلية و بدأ البروتين يتأثر على الجسم و
+
+520
+00:39:15,830 --> 00:39:19,950
+بدأ الـ renal function يبين، هذا اسمه اسم عام لكن
+
+521
+00:39:19,950 --> 00:39:26,150
+إيش نوعه؟ بيحتمل يعتمد على أن نأخذ عينة من الكلية و
+
+522
+00:39:26,150 --> 00:39:29,590
+ندرسها، نشوف إيش اللي إيه اللي موجود فيها، في عينات
+
+523
+00:39:29,590 --> 00:39:34,710
+عنا مرض بنسميه minimal changes nephropathy فقط
+
+524
+00:39:34,710 --> 00:39:38,970
+الكلية فقدت الـ negatively charged ions اللي
+
+525
+00:39:38,970 --> 00:39:41,970
+موجودين على الـ إيه؟ على الـ fenestrations، فهذا
+
+526
+00:39:41,970 --> 00:39:45,090
+بيؤدي إلى أن الـ albumin من اللي كان مش قادر يطلع
+
+527
+00:39:45,090 --> 00:39:50,400
+فقدنا الطرد اللي بيصير له، حجمه يسمح، بيصير يطلع، هذه
+
+528
+00:39:50,400 --> 00:39:53,260
+أقل إصابة، طبعاً في إصابات ثانية بيصير inflammatory
+
+529
+00:39:53,260 --> 00:39:56,260
+processes جوا بتؤدي إلى أن الـ basement membrane
+
+530
+00:39:56,260 --> 00:40:02,860
+هذا يورم و .. و الـ fenestration سعتها تكبر ويصير
+
+531
+00:40:02,860 --> 00:40:08,730
+يهرب هو نفسه خلاص، نفس الـ holes كبرت، تمام؟ موضوع
+
+532
+00:40:08,730 --> 00:40:12,070
+كبير هتدرسوه في وقته، لكن أنا اللي جايب سيرته هي
+
+533
+00:40:12,070 --> 00:40:15,670
+اللي هو الـ أشـ الـ .. الـ negatively charged ions اللي
+
+534
+00:40:15,670 --> 00:40:19,170
+موجودة على الـ إيه؟ على الـ barrier هذا و أهميتها يعني
+
+535
+00:40:19,170 --> 00:40:22,650
+الـ albumin بيقدر يطلع لو أنه not negatively charged
+
+536
+00:40:22,650 --> 00:40:29,390
+أو لو أن الـ charges اللي موجودة راحت، تمام؟ و ..
+
+537
+00:40:29,390 --> 00:40:33,670
+إذا هذا الـ .. الـ .. الكلام اللي إحنا إيه؟ شرحناه من
+
+538
+00:40:33,670 --> 00:40:38,550
+شوية، إذا thus all layers of glomerular capillary
+
+539
+00:40:38,550 --> 00:40:42,150
+wall provides a barrier to filtration of plasma
+
+540
+00:40:42,150 --> 00:40:45,550
+proteins، بيمنع الـ إيه؟ الـ plasma proteins، وقلنا
+
+541
+00:40:45,550 --> 00:40:52,430
+كل واحد منهم في mechanical properties
+
+542
+00:40:52,430 --> 00:40:55,870
+اللي هو حجم الـ hole و electrical properties اللي
+
+543
+00:40:55,870 --> 00:40:59,250
+هو الـ إيه؟ يعني التلات طبقات اللي موجودة عندي الـ
+
+544
+00:40:59,250 --> 00:41:02,750
+endothelium، الـ basement membrane و الـ epithelial
+
+545
+00:41:02,750 --> 00:41:06,950
+cell، التلاتة عندهم كل واحد حامل negatively charged
+
+546
+00:41:06,950 --> 00:41:13,350
+ions، filterability of solutes is investigated to
+
+547
+00:41:13,350 --> 00:41:19,810
+their size، حلو، إذا الـ size له أهمية، احنا قلنا الـ
+
+548
+00:41:19,810 --> 00:41:23,710
+filtration membrane عرفنا اللي له holes معينة
+
+549
+00:41:23,710 --> 00:41:29,030
+فالمادة اللي بدها to be filtered، إن كان حجمها
+
+550
+00:41:29,030 --> 00:41:34,810
+مناسب للـ size بتطلع، مش مناسب ما بتطلعش، المسألة size
+
+551
+00:41:34,810 --> 00:41:38,810
+و negative للشحنة، فإحنا هنا الـ filtration اعتمدنا
+
+552
+00:41:38,810 --> 00:41:42,950
+أن المية هي الـ standard، تمام؟ المية بيصير لها
+
+553
+00:41:42,950 --> 00:41:46,050
+filtration، هالقدر في الدقيقة اللي بيصير له
+
+554
+00:41:46,050 --> 00:41:51,030
+filtration مساوٍ filtration تبع المية، تمام؟
+
+555
+00:41:51,030 --> 00:41:56,570
+بنسميه freely filterable، آه، free filtration، تمام؟
+
+556
+00:41:56,570 --> 00:42:01,110
+بنديله رقم filterability واحد، تمام؟ تطلع المية الـ
+
+557
+00:42:01,110 --> 00:42:07,430
+18، و الـ microwave 18، يعني بسهولة بتقدر تطلع، الـ
+
+558
+00:42:07,430 --> 00:42:13,990
+sodium 23، بسهولة بيقدر يطلع، الـ pores الموجودة لا
+
+559
+00:42:13,990 --> 00:42:19,470
+تمنعه، الـ glucose، الـ inulin، هاه، 5500، الـ
+
+560
+00:42:19,470 --> 00:42:23,750
+inulin، الـ inulin مادة إحنا بيصير لها filtration و
+
+561
+00:42:23,750 --> 00:42:28,260
+بيصير لها reabsorption، فدائماً إحنا بتهمنّا في قياس لما
+
+562
+00:42:28,260 --> 00:42:32,140
+بدنا نقيس قد إيش بيصير filtration ما نروح و ما نشوف الـ
+
+563
+00:42:32,140 --> 00:42:36,420
+in و الـ in test، لإنه هذا بس filtration، لا بيصير له
+
+564
+00:42:36,420 --> 00:42:40,440
+secretion ولا بيصير له reabsorption، فإذا هذه المادة
+
+565
+00:42:40,440 --> 00:42:43,700
+اللي طلعت بتعبر بس عن مين؟ عن الـ filtration، و هنتكلم
+
+566
+00:42:43,700 --> 00:42:47,640
+معاها كيف بنقيسها، الـ in و الـ in بيصير له filtration
+
+567
+00:42:47,640 --> 00:42:53,220
+الـ myoglobin، 17000، لاحظوا، بيصير filtration
+
+568
+00:42:53,220 --> 00:42:58,400
+لكن مش كامل، بس بيصير يطلع لإنه حجمه كبير، بس بيطلع
+
+569
+00:42:58,400 --> 00:43:02,180
+وبعدين بيعمل الـ construction لمين؟ للنفرون على الـ
+
+570
+00:43:02,180 --> 00:43:05,880
+tubules، خاصة في البوف إيه؟ of Henle، لإنه بيكون
+
+571
+00:43:05,880 --> 00:43:12,760
+إيه؟ a thin tubule، الـ albumin، 69000،
+
+572
+00:43:12,760 --> 00:43:17,580
+.005، الـ filterability مقارنة بالمية، يعني إذا
+
+573
+00:43:17,580 --> 00:43:22,620
+المية واحد هو 0.005 من الواحد، تمام؟ طيب
+
+574
+00:43:27,430 --> 00:43:30,350
+بالنسبة للـ negativity و الكلام هذا، إذا قلنا عن الـ
+
+575
+00:43:30,350 --> 00:43:34,030
+size و علاقة الـ size بالـ filtration و الـ
+
+576
+00:43:34,030 --> 00:43:37,710
+negativity قلنا عنها و اتكلمنا عن قلة منها لو لإنه
+
+577
+00:43:37,710 --> 00:43:40,970
+negative charge كان إيش؟ كان يطلع، وهنا عندنا
+
+578
+00:43:40,970 --> 00:43:45,070
+تجربة اللي هي معمولة على نفس المادة، المادة
+
+579
+00:43:45,070 --> 00:43:49,950
+polydextran، المادة ديكستران، ديكستران هذا شو؟
+
+580
+00:43:49,950 --> 00:43:55,150
+ديكستران زي الـ dextrose، مادة معينة، polysaccharide
+
+581
+00:43:55,910 --> 00:44:03,310
+polysaccharide، بس حجمها بإمكاننا، المادة هذه
+
+582
+00:44:03,310 --> 00:44:05,830
+الديكستران، إحنا بنستخدم الديكستران كـ diuretic في
+
+583
+00:44:05,830 --> 00:44:11,070
+المستقبل، أو بنستخدمه لما بدنا .. يعني إله .. إله
+
+584
+00:44:11,070 --> 00:44:13,690
+.. إله أحجام مختلفة، إله molecular weight، ديكستران و
+
+585
+00:44:13,690 --> 00:44:16,730
+high molecular weight، ديكستران، مرات بنستخدمه علشان
+
+586
+00:44:16,730 --> 00:44:22,040
+بديل لبلازما عند اللزوم، مرات بنحط الديكستران في
+
+587
+00:44:22,040 --> 00:44:25,660
+.. في الـ .. في الـ IV line، في المحلول، عشان إحنا مش
+
+588
+00:44:25,660 --> 00:44:29,180
+لاقي دم أحطه، و بدي أحط saline، بعد شوية على طول
+
+589
+00:44:29,180 --> 00:44:33,360
+يطلع الكلية تطرده، بدي ينحشس جوا شوية لحد ما ألاقي
+
+590
+00:44:33,360 --> 00:44:38,360
+إيه؟ ألاقي بلازما أو ألاقي دم نستخدمه وسيط لحد ما
+
+591
+00:44:38,360 --> 00:44:43,200
+أوجد البلازما أو أوجد الـ إيه؟ الدم المناسب لهذه
+
+592
+00:44:43,200 --> 00:44:49,510
+الحالة، تمام؟ المهم هذا له حجم معين و له أنواع
+
+593
+00:44:49,510 --> 00:44:51,270
+نيوترال، نيوترال، نيوترال، نيوترال، نيوترال، نيوترال،
+
+594
+00:44:51,270 --> 00:44:51,770
+نيوترال، نيوترال، نيوترال، نيوترال، نيوترال، نيوترال،
+
+595
+00:44:51,770 --> 00:44:55,910
+نيوترال، نيوترال، نيوترال، نيوترال، نيوترال، نيوترال،
+
+596
+00:44:55,910 --> 00:44:59,650
+نيوترال، نيوترال، نيوترال، نيوترال، نيوترال، نيوترال،
+
+597
+00:44:59,650 --> 00:45:00,210
+نيوترال، نيوترال، نيوترال، نيوترال، نيوترال، نيوترال،
+
+598
+00:45:00,210 --> 00:45:00,870
+نيوترال، نيوترال، نيوترال، نيوترال، نيوترال، نيوترال،
+
+599
+00:45:00,870 --> 00:45:06,210
+نيوترال، نيوترال، نيوترال، نيوترال، نيوترال، نيوترال،
+
+600
+00:45:06,210 --> 00:45:17,210
+نيوترال، نيوت
+
+601
+00:45:23,620 --> 00:45:29,080
+الديكستران، كل ما زدنا حجمه كل ما الـ filterability
+
+602
+00:45:29,080 --> 00:45:34,760
+قلت، كل ما صغر حجمه كل ما الـ filterability كترت، لكن
+
+603
+00:45:34,760 --> 00:45:40,060
+واضح أن الـ positively charged، هذا polycationic، الـ
+
+604
+00:45:40,060 --> 00:45:43,620
+filterability على كل المستويات أعلى بكثير من الـ
+
+605
+00:45:43,620 --> 00:45:47,860
+neutral، و أعلى بكثير من الـ negative الـ charge، تمام؟
+
+606
+00:45:47,860 --> 00:45:51,380
+إذا الحجم، إحنا لو استخدمنا أي أحجام و قارناها
+
+607
+00:45:51,380 --> 00:45:57,140
+بيلاحظ اللي بيحسب في الآخر آه، الـ electrical
+
+608
+00:45:57,140 --> 00:46:01,100
+charge بتخليه more filterable أو less filterable
+
+609
+00:46:01,100 --> 00:46:05,000
+okay، طيب، نرجع للحجم
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY_postprocess.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6189f7de56354fc8b959d55adbff6f82210588a9
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY_postprocess.srt
@@ -0,0 +1,2436 @@
+1
+00:00:05,510 --> 00:00:10,390
+الاسبوع الف .. المحاضرة الماضية كلمنا عن ال
+
+2
+00:00:10,390 --> 00:00:15,470
+structure تبع ال .. الكلية و الوحدة البنائية إلها
+
+3
+00:00:15,470 --> 00:00:22,390
+اللي هو النفرون، الآن النفرون .. النفرون الوحدة
+
+4
+00:00:22,390 --> 00:00:23,210
+البنائية هذه
+
+5
+00:00:26,800 --> 00:00:31,180
+بتصنع ال ball او ال urine عن طريق تلت عمليات عملية
+
+6
+00:00:31,180 --> 00:00:37,020
+filtration و عملية reabsorption بعد ال filtration
+
+7
+00:00:37,020 --> 00:00:41,560
+او عملية secretion تمام المحاصلة ان هي ال
+
+8
+00:00:41,560 --> 00:00:47,240
+excretory urine
+
+9
+00:00:47,240 --> 00:00:51,320
+ايش شكله حجمه ايش مكوناته يعتمد على هذه التلت
+
+10
+00:00:51,320 --> 00:00:58,950
+عمليات تمام لذلك المحاصلة هناهتكون اذا اننا قولنا
+
+11
+00:00:58,950 --> 00:01:03,630
+في filtration وفي reabsorption وفي secretion محصلة
+
+12
+00:01:03,630 --> 00:01:08,650
+ال ball يعتمد على ايش صار لهذه المادة اللي هي بدها
+
+13
+00:01:08,650 --> 00:01:12,610
+تنزل اللي بتعدي الكيليا من خلال الدم و بتصل لل
+
+14
+00:01:12,610 --> 00:01:17,810
+glomerulus اللي هو هناك بتتم ال filtration يا اما
+
+15
+00:01:17,810 --> 00:01:23,560
+المادة هذه بس بصي لها filtration وحده تمامو بيصير
+
+16
+00:01:23,560 --> 00:01:28,680
+الهاش لأ reabsorption ولا secretion و هذه بعض
+
+17
+00:01:28,680 --> 00:01:35,600
+المواد زي الكرياتينين و زي الانيولين معظمهم
+
+18
+00:01:35,600 --> 00:01:40,500
+secreted يعني اللي filtered بيضل طالع و بيصيرش لأ
+
+19
+00:01:40,500 --> 00:01:44,600
+reabsorption ولا بنضاف عليهم بعض المواد لأ بيصير
+
+20
+00:01:44,600 --> 00:01:49,720
+عندهم او معظم المواد عادي المعظم طب بيصير عمل
+
+21
+00:01:49,720 --> 00:01:54,180
+filtrationو partial reabsorption بيصير
+
+22
+00:01:54,180 --> 00:01:59,020
+reabsorption لكنه ما هوش total بيصير partial
+
+23
+00:01:59,020 --> 00:02:05,440
+reabsorption و هذه زي ال sodium و ال .. كل ال
+
+24
+00:02:05,440 --> 00:02:10,700
+electrolytes او بيصير عندنا filtration لكن
+
+25
+00:02:10,700 --> 00:02:14,620
+complete reabsorption مابديش انا هدلها اتعالجوش
+
+26
+00:02:14,620 --> 00:02:19,560
+انا سامحكوا بدك تسألي اسألي بس مابتعالجي بيصير اذا
+
+27
+00:02:19,560 --> 00:02:24,600
+عندناcomplete reabsorption in nutrients البلوكوز
+
+28
+00:02:24,600 --> 00:02:30,200
+ال amino acids الحاجة
+
+29
+00:02:30,200 --> 00:02:34,260
+الأخيرة ممكن المادة يصيب لها filtration يصيبش
+
+30
+00:02:34,260 --> 00:02:38,740
+reabsorption لكن يضعف لها عملية ايش? secretion
+
+31
+00:02:38,740 --> 00:02:43,740
+كمان مرة هقولك اش اتانى تعالى الجيش مش اسمك انت
+
+32
+00:02:43,740 --> 00:02:49,420
+تعالى الجيش يا لبنا طيب
+
+33
+00:02:50,960 --> 00:02:55,480
+أذا عندي انا ايه تلت عمليات محصرة تلت عمليات هذه
+
+34
+00:02:55,480 --> 00:03:04,860
+هتقدر الى محصرة ايش طبيعة تعامل الكلية مع المادة
+
+35
+00:03:04,860 --> 00:03:07,780
+هذه و ايش طبيعة البول اللي هيطلع كده فيه من المادة
+
+36
+00:03:07,780 --> 00:03:17,860
+هذه هنلاحظ احنا هنا ان عملية ال urine formation
+
+37
+00:03:17,860 --> 00:03:23,530
+تعتمد على عملية filtration ضخمةعشرين فالمية من ال
+
+38
+00:03:23,530 --> 00:03:28,070
+plasma اللى بتعدى فى ال glomerulus يعنى اللى بتعدى
+
+39
+00:03:28,070 --> 00:03:32,130
+فى الرنا الارتري عشرين فالمية من ال plasma مش كدم
+
+40
+00:03:32,130 --> 00:03:37,870
+انتوا عارفين الدم ككل جزء منه RBC او solids و جزء
+
+41
+00:03:37,870 --> 00:03:41,390
+منه plasma اتكلم عن ال plasma احنا عشرين فالمية من
+
+42
+00:03:41,390 --> 00:03:44,470
+ال plasma بيصيب لها filtration خمس من ال plasma
+
+43
+00:03:44,470 --> 00:03:47,610
+اللى داخلى ال glomerulus اللى داخلى الكيلية بيصيب
+
+44
+00:03:47,610 --> 00:03:54,290
+لها filtration تمام؟كمية كبيرة بمعنى انه عندي 125
+
+45
+00:03:54,290 --> 00:04:00,830
+ملي لتر of filtrate every each minute كل دقيقة
+
+46
+00:04:00,830 --> 00:04:05,030
+عندى 125 ملي لتر لو حسبنا في اليوم بطلها بلاج انا
+
+47
+00:04:05,030 --> 00:04:09,850
+بصير عندي filtration ل 180 لتر في اليوم طب احنا
+
+48
+00:04:09,850 --> 00:04:14,490
+جدش عندنا plasma عندنا تلاتة لتر plasma يعني احنا
+
+49
+00:04:14,490 --> 00:04:19,260
+ال plasma تبعتنا بتخشسلها filtration بتخش الكيليا
+
+50
+00:04:19,260 --> 00:04:24,640
+بتخش ال glomerulus و ال bombas capsule و ال tubule
+
+51
+00:04:24,640 --> 00:04:27,620
+او على وشك انها تطلع لو انه بيصير reabsorption
+
+52
+00:04:27,620 --> 00:04:33,220
+انها من جديد ستين ضعف البلازماتمام؟ هذه المسألة
+
+53
+00:04:33,220 --> 00:04:37,500
+عملية ضخمة ستين ضعف البلازما بيخش الكليو و بيطلع
+
+54
+00:04:37,500 --> 00:04:43,060
+هذا بيقدر إلى ان عملية ال filtration عملية ضخمة و
+
+55
+00:04:43,060 --> 00:04:47,000
+من هنا التخلص من المواد اللي احنا بدنا شياها بكل
+
+56
+00:04:47,000 --> 00:04:50,340
+بساطة انها تنزل بال filtration كمية ضخمة 180 لتر
+
+57
+00:04:50,340 --> 00:04:54,700
+في اليوم من البلازما و بتتخلص من اللي فيها من ال
+
+58
+00:04:54,700 --> 00:04:58,360
+waste products و بيصيرش إلها reabsorption فإذا
+
+59
+00:04:58,360 --> 00:05:04,810
+فكرةالخلق حسب طريقة هذه طريقة عالية الكفاءة انه
+
+60
+00:05:04,810 --> 00:05:08,790
+يصير filtration بكمية كبيرة و بنعود نصحى بالبدنايا
+
+61
+00:05:08,790 --> 00:05:14,270
+و البدناشيا بكميات سريعة كبيرة بتكون فيها كفاءة
+
+62
+00:05:14,270 --> 00:05:19,090
+اعلى من كفاءة ان اعمل امتصاص لهذه المواد اللي انا
+
+63
+00:05:19,090 --> 00:05:22,070
+بدي شيها بتكون دايما هى impermeable مابيصيرلاش
+
+64
+00:05:22,070 --> 00:05:26,670
+ليها absorption من جديدو بتكمل مشوارها لمين لقى
+
+65
+00:05:26,670 --> 00:05:30,590
+الخارج اذا في عندنا الاربع التلاتة عمليات هذه
+
+66
+00:05:30,590 --> 00:05:35,190
+بتحدد what is excreted و انه فكرة بنائها مبنية على
+
+67
+00:05:35,190 --> 00:05:39,670
+كمية filtration عالية علشان يصير تخلص كبير وسريع
+
+68
+00:05:39,670 --> 00:05:46,710
+من كمية كبيرة من ال waste products طيب
+
+69
+00:05:46,710 --> 00:05:52,870
+ال filtration مابيصيرقولنا خمس لبلازمة هو حقيقة
+
+70
+00:05:52,870 --> 00:05:58,390
+بيصير خمس لبلازمة لكن ال filtrate لا يحتوي على
+
+71
+00:05:58,390 --> 00:06:05,050
+proteins او small proteins، minimal، small volume
+
+72
+00:06:05,050 --> 00:06:08,070
+proteins، small molecular weight، بيصيرهم
+
+73
+00:06:08,070 --> 00:06:11,190
+reabsorption و هدول بيعودوا، بيصيرهم filtration و
+
+74
+00:06:11,190 --> 00:06:14,690
+هدول بيصير عوضوا لهم complete reabsorption لذلك في
+
+75
+00:06:14,690 --> 00:06:17,730
+ال bowl بيطلعش proteins لإنه أساسا not filtered
+
+76
+00:06:18,760 --> 00:06:22,020
+تمام؟ بيصيرولوش أساسا إيه؟ filtration و ال minimal
+
+77
+00:06:22,020 --> 00:06:25,440
+volume
+
+78
+00:06:25,440 --> 00:06:29,900
+of filtered small molecular volume proteins small
+
+79
+00:06:29,900 --> 00:06:31,920
+molecular weight of proteins بيحاولوا re-absorb من
+
+80
+00:06:31,920 --> 00:06:38,020
+أول و جديد، تمام؟ إذا عندي أنا ال filtrate زي ال
+
+81
+00:06:38,020 --> 00:06:43,300
+plasma و ال filtrate في الالنورمال تيشيوز بيصير
+
+82
+00:06:43,300 --> 00:06:46,500
+filtration لكل إشي ما عدا إيه ال albumin ما عدا ال
+
+83
+00:06:46,500 --> 00:06:50,960
+proteins بتضالها إيه محجوزة بتضالها محجوزة في داخل
+
+84
+00:06:50,960 --> 00:06:57,300
+ال ال ال capillaries okay إذا في عندي فلترات لذلك
+
+85
+00:06:57,300 --> 00:07:02,300
+الفلترات هذا هنلاقي التركيز فيه تركيز المواد اللي
+
+86
+00:07:02,300 --> 00:07:07,270
+فيه تساوي التركيز في البلازمةتمام؟ لإن احنا الضغط
+
+87
+00:07:07,270 --> 00:07:10,870
+نزل خمسه في ذاكر ال .. ال bomans capsule الخمس صار
+
+88
+00:07:10,870 --> 00:07:16,490
+له filtration لكن ال .. ماصارش فيه اختلافات في ال
+
+89
+00:07:16,490 --> 00:07:19,470
+ايه؟ في التركيز فتركيز الصوديوم في ال filtrate
+
+90
+00:07:19,470 --> 00:07:21,690
+يساوي تركيز الصوديوم في ال ايه؟ في البلازمه
+
+91
+00:07:21,690 --> 00:07:28,430
+والبوتاسيوم هكذا والسكر هكذا اذا نفس التركيز هيكون
+
+92
+00:07:28,430 --> 00:07:32,590
+.. اذا مكونات ال filtrate يساوي مكونات البلازمه
+
+93
+00:07:32,590 --> 00:07:36,990
+معده ايه؟لبروتينز وتركيز المواد في الفلتة تساوى
+
+94
+00:07:36,990 --> 00:07:41,890
+تركيزها في البلازمة إلا بعض المواد بعض ال solutes
+
+95
+00:07:41,890 --> 00:07:45,890
+أو ال electrolytes اللي هي bound to بروتين يعني
+
+96
+00:07:45,890 --> 00:07:49,290
+بعض الأشياء نقول احنا في عندنا لما نجيسها نقول
+
+97
+00:07:49,290 --> 00:07:56,670
+total calcium و free calcium ففي أشياء جزء منها
+
+98
+00:07:56,670 --> 00:08:01,310
+بيبقى bound to proteins bound to albumin اللي
+
+99
+00:08:01,310 --> 00:08:04,410
+bound to albumin أو bound to بروتينهيبقى الماسك
+
+100
+00:08:04,410 --> 00:08:08,810
+المادة يعني الجزء اللي bound برا الحساب لإن ال
+
+101
+00:08:08,810 --> 00:08:12,490
+protein بيمنعه أساسا انه ايه انه انه ولو انه
+
+102
+00:08:12,490 --> 00:08:17,590
+تركيزه ال total عالي لكن انا في حساب الجدد ايه صار
+
+103
+00:08:17,590 --> 00:08:21,590
+filtration ال bound و ال protein ده برا الحساب لإن
+
+104
+00:08:21,590 --> 00:08:27,320
+ال free هيكون في الالـ Plasma of ال filter هي the
+
+105
+00:08:27,320 --> 00:08:32,900
+same لكن ال bound to albumen هيتعامل مع ال albumen
+
+106
+00:08:32,900 --> 00:08:45,840
+not filter بقول تمام؟ هيكون ايه؟ مش .. طيب إذا ال
+
+107
+00:08:45,840 --> 00:08:54,520
+filtration هادا بتم عبر ال glomerulus مش كده؟الـ
+
+108
+00:08:54,520 --> 00:08:59,840
+glomerulus هذه capillaries إلها structure معين
+
+109
+00:08:59,840 --> 00:09:03,280
+إلها تركيب معين زي ال capillaries العادية بعد شوية
+
+110
+00:09:03,280 --> 00:09:06,660
+صغيرة هنتكلم عن تركيبة إيه هذه ال glomerulus ال
+
+111
+00:09:06,660 --> 00:09:09,900
+capillary والهذه اللي عبرها بيصير ال filtration
+
+112
+00:09:09,900 --> 00:09:15,280
+هنتكلم عنها لكن أنا بتتكلم الآن إيش اللي بيحدد
+
+113
+00:09:15,280 --> 00:09:20,900
+عندي ال filtration جديش يكون ال filtration جديش
+
+114
+00:09:20,900 --> 00:09:28,040
+يكونفي عندي forces بتعمل filtration وعندي سطح بتم
+
+115
+00:09:28,040 --> 00:09:31,620
+عبره ال filtration إذا ال filtration في الآخر
+
+116
+00:09:31,620 --> 00:09:36,820
+هيكون جداش ال forces الموجودة هذه مين مع ومين ضبط
+
+117
+00:09:36,820 --> 00:09:41,800
+ال net filtration forces
+
+118
+00:09:44,090 --> 00:09:47,550
+ال .. ال .. ال .. ال .. ال .. ال membrane اللي
+
+119
+00:09:47,550 --> 00:09:53,810
+هسير عبره ال filtration هنقول ال .. ال
+
+120
+00:09:53,810 --> 00:09:57,130
+filterability تبع ال membrane هذه ال permeability
+
+121
+00:09:57,130 --> 00:10:01,770
+تبع ال membrane طبيعة نوع ال membrane filtration
+
+122
+00:10:01,770 --> 00:10:06,900
+coefficientجديش مواصفات ال membrane هذا بيعمل
+
+123
+00:10:06,900 --> 00:10:10,680
+filtration عالي او بيعمل filtration مواطي سهلة مش
+
+124
+00:10:10,680 --> 00:10:15,900
+كده اي منخل اي filter احنا بنستخدمه لفلترة اشياء
+
+125
+00:10:15,900 --> 00:10:19,940
+معينة مواصفات ال filter هذا بيقول انا جديش ب
+
+126
+00:10:19,940 --> 00:10:24,760
+filter سريع باطيء بامنع اشي و مامنعش اشي بزي .. اه
+
+127
+00:10:24,760 --> 00:10:30,750
+حسب ال مش holes تبعته مش هيككذلك عندنا احنا هان
+
+128
+00:10:30,750 --> 00:10:34,990
+اذا في عندى مقتومة مواصفتين مواصفة ال forces تبعت
+
+129
+00:10:34,990 --> 00:10:44,630
+ال ال forces تبعت ال ال ال ال filtration forces
+
+130
+00:10:44,630 --> 00:10:51,710
+ومواصفات ايه ال membrane المواصفات
+
+131
+00:10:51,710 --> 00:10:55,230
+ال membrane تعتمد على ال permeability تبعت ال
+
+132
+00:10:55,230 --> 00:11:01,360
+membraneتمام؟ وقداش السطح تبع المبنى تمام؟ انا ال
+
+133
+00:11:01,360 --> 00:11:03,600
+perme .. okay عندي سطح صغير و ال permeability
+
+134
+00:11:03,600 --> 00:11:07,280
+عالية غير ان عندي سطح كبير و ال permeability عالية
+
+135
+00:11:07,280 --> 00:11:11,900
+فكل ما السطح surface area او filtration زاد تمام؟
+
+136
+00:11:11,900 --> 00:11:16,420
+كل ما ال filtration زاد لإن انا ايه سامحله مساحة
+
+137
+00:11:16,420 --> 00:11:20,300
+كبيرة تعمل filtration فإذا ال surface area مهم و
+
+138
+00:11:20,300 --> 00:11:26,710
+ال ..و نوع ال membrane مهم ال permeability تبعت ال
+
+139
+00:11:26,710 --> 00:11:30,630
+membrane وال surface area التاني مع بعض عبارة عنهم
+
+140
+00:11:30,630 --> 00:11:35,090
+بال filtration coefficient إذا أنا عمليت قدرة ال
+
+141
+00:11:35,090 --> 00:11:40,010
+membrane على أنهنوعه اللي بتحدد نوعه وسمحه كده
+
+142
+00:11:40,010 --> 00:11:43,270
+يعمل filtration تمام اللي قولنا two factors بتأثر
+
+143
+00:11:43,270 --> 00:11:48,530
+فيها ال permeability و ال surface area بنعبر عنهم
+
+144
+00:11:48,530 --> 00:11:55,910
+في هذا الموضوع ب filtration coefficient KF تمام و
+
+145
+00:11:55,910 --> 00:11:59,750
+ال forces اتكلمنا عنها قبل كده هنضلنا نتكلم عنها
+
+146
+00:11:59,750 --> 00:12:01,930
+طول ما احنا بنتكلم في السيولوجيا في عندنا
+
+147
+00:12:01,930 --> 00:12:05,370
+hydrostatic pressure و عندنا osmotic pressure تمام
+
+148
+00:12:06,860 --> 00:12:10,900
+الـ brushes هذه في brushes بتدفع في brushes بتشد
+
+149
+00:12:10,900 --> 00:12:15,800
+المحصلة بين ال plus و ال minus المحصلة مين مع و
+
+150
+00:12:15,800 --> 00:12:21,060
+مين ضد بيطلع ال net filtration forces كانت زميلة
+
+151
+00:12:21,060 --> 00:12:24,000
+اليكم سئلت what is hydrostatic pressure ال
+
+152
+00:12:24,000 --> 00:12:28,440
+hydrostatic pressure قوة ماديةبتضغط كأنك انت
+
+153
+00:12:28,440 --> 00:12:33,980
+بتضغطي بإيدك على عشاء تمام بتضغطي بإيدك هذا الضغط
+
+154
+00:12:33,980 --> 00:12:38,260
+المادى ال physical pressure القوة اه هذه عملية ال
+
+155
+00:12:38,260 --> 00:12:42,680
+hydrostatic pressure الناتج عن نبض القلب ان القلب
+
+156
+00:12:42,680 --> 00:12:48,760
+بيضغط الدم داخل ال ايه ال blood vessels ال blood
+
+157
+00:12:48,760 --> 00:12:52,860
+vessels فيها elasticity في elastic wall ال elastic
+
+158
+00:12:52,860 --> 00:12:59,820
+wall دي بيظل شدد ضغط على الدمبحيث انه دايما في
+
+159
+00:12:59,820 --> 00:13:04,120
+عندي ضغط في داخل الدم اللي بنجيسه بالجهاز الضغط و
+
+160
+00:13:04,120 --> 00:13:08,260
+بنقول الضغط 120 ع 80 هذا ال hydrostatic pressure
+
+161
+00:13:08,260 --> 00:13:12,980
+pressure شبيه بال atmospheric pressure hydrostatic
+
+162
+00:13:12,980 --> 00:13:19,100
+الضغط فيزيائي موجود هنا تمام؟في عندى نوع تانى
+
+163
+00:13:19,100 --> 00:13:22,400
+osmotic pressure اللى انتوا بتعرفوه اللى بتعرفه
+
+164
+00:13:22,400 --> 00:13:26,180
+انه osmolality وضغط الاسموزي مش هيك ضغط الاسموزي
+
+165
+00:13:26,180 --> 00:13:34,020
+هذا وجود مواد solutes بتحب تمسك حواليها ميه كل ما
+
+166
+00:13:34,020 --> 00:13:37,700
+زاد تركيزها كل ما بتقدر تمسك حواليها water
+
+167
+00:13:37,700 --> 00:13:41,480
+molecules اكتر تمام و لو حطينا زى ما حكينا المرة
+
+168
+00:13:41,480 --> 00:13:46,540
+الفاتةحطينا ممبرين بين two liquids واحد بيحتوي
+
+169
+00:13:46,540 --> 00:13:50,000
+solutes كتير واحد بيحتوي solutes جليل فالميه
+
+170
+00:13:50,000 --> 00:13:54,880
+هتنتخل من المكان اللي فيه solutes جليل للمكان اللي
+
+171
+00:13:54,880 --> 00:13:58,220
+فيه solutes كتير لحد ما التركيز هان و هان يصير
+
+172
+00:13:58,220 --> 00:14:02,200
+متساوي مش كده هذا اذا فيه قدرة على ال osmolality
+
+173
+00:14:02,200 --> 00:14:06,980
+انها to create some sort of attraction for water
+
+174
+00:14:06,980 --> 00:14:11,260
+والhydrostatic pressure في مكان ما بيضغط ال water
+
+175
+00:14:11,880 --> 00:14:18,780
+إذا الترين موجودين مع بعض فلويد زي ال plasma موجود
+
+176
+00:14:18,780 --> 00:14:33,560
+في ال in the capillary فلويد
+
+177
+00:14:33,560 --> 00:14:36,320
+موجود في ال capillary هاي ال capillary هذا a front
+
+178
+00:14:36,320 --> 00:14:38,280
+arteriole وهذا ال a front
+
+179
+00:14:41,380 --> 00:14:46,260
+network اسمها glomerulus تمام؟هال موجود عندنا في
+
+180
+00:14:46,260 --> 00:14:49,060
+داخل الـ hydrostatic pressure جاي من ضغط الجلب
+
+181
+00:14:49,060 --> 00:14:52,560
+الجلب بيضغط الأشياء و الأشياء محشورة في داخل ال
+
+182
+00:14:52,560 --> 00:14:56,860
+blood vessel فعملها ضغط هذا الضغط بيخلي أنه إذا في
+
+183
+00:14:56,860 --> 00:15:00,440
+خروم هان و هان و هان الأشياء تنفس من خلالها طبعا
+
+184
+00:15:00,440 --> 00:15:03,920
+إيش ينفس حسب نوع ال membrane بيسمح لإيش يطلع و إيش
+
+185
+00:15:03,920 --> 00:15:08,060
+ما يطلعش تما جولنا من دي شوية بنفس كتير membrane
+
+186
+00:15:08,060 --> 00:15:12,680
+واسع في عندنا مجال كبير نطفة صغيرة عندناطيب عندى
+
+187
+00:15:12,680 --> 00:15:15,940
+hydrostatic pressure بيقدى الى انه بيطلع الأشياء
+
+188
+00:15:15,940 --> 00:15:18,920
+بيفزر ال arteries بيفزر الكبير بيطلع الأشياء منها
+
+189
+00:15:18,920 --> 00:15:22,280
+لكن عندنا ميه بيبقى تطلع لإنه بيسمحش لكل شيء يطلع
+
+190
+00:15:22,280 --> 00:15:25,340
+هذا الكبير اللي هي ال membrane ميه بيبقى تطلع لكن
+
+191
+00:15:25,340 --> 00:15:32,620
+القلب من اللي جوا موجود تمامعمل oncotic pressure
+
+192
+00:15:32,620 --> 00:15:35,420
+كله ده ال pressure ليش هنا ماجيبناش سيرة ال
+
+193
+00:15:35,420 --> 00:15:40,340
+cosmolality اللي ناتجة عن ال ال sodium والبوتاسيم
+
+194
+00:15:40,340 --> 00:15:44,580
+ال electrolyte لإنها ماهواش impermeable لها ال
+
+195
+00:15:44,580 --> 00:15:47,280
+membraneبنتكلم عن الأشياء الـ impermeable بتظهر
+
+196
+00:15:47,280 --> 00:15:50,860
+واجفة تمنعها فالصوديوم و البوتاسيوم ينتقل منها لها
+
+197
+00:15:50,860 --> 00:15:55,960
+بنفس الكمية فإذا كانت موجودة نفسها على الجهة
+
+198
+00:15:55,960 --> 00:15:59,580
+التانية لإنهم freely mobile البرميابل الممبرن لهم
+
+199
+00:15:59,580 --> 00:16:02,240
+لكن احنا بنتكلم عن ازموليات بتتكلم عن البرميابل
+
+200
+00:16:02,240 --> 00:16:05,420
+الممبرن لإيش معين تمام فال impermeability هي اللي
+
+201
+00:16:05,420 --> 00:16:08,900
+بتظهر بروتينات هي اللي بتظهر موجودة فهي هذه انت
+
+202
+00:16:08,900 --> 00:16:12,890
+بتسحب منها الميهكل ما زاد تركيزها كل ما مسكت ميه
+
+203
+00:16:12,890 --> 00:16:17,190
+اكتر كل ما جال تركيزها تمام؟ اذا فى صراع ما بين ال
+
+204
+00:16:17,190 --> 00:16:20,230
+hydrostatic pressure اللى بيعمل filtration و بين
+
+205
+00:16:20,230 --> 00:16:23,250
+ال osmotic pressure اللى بيحاول ايش يمسك الموال
+
+206
+00:16:23,250 --> 00:16:27,870
+هذا داخل ال capillary برا ال capillaryفي بومانس
+
+207
+00:16:27,870 --> 00:16:32,610
+كابسول هنلاحظ نفس الشيء تمام؟ في عندها برضه
+
+208
+00:16:32,610 --> 00:16:36,590
+forces, forces اللي هان hydrostatic pressure و
+
+209
+00:16:36,590 --> 00:16:38,670
+osmotic pressure و oncotic pressure اللي هو
+
+210
+00:16:38,670 --> 00:16:41,590
+colloidal pressure ال hydrostatic pressure لإن
+
+211
+00:16:41,590 --> 00:16:44,710
+الكيلية محطوطة في داخل إيش كابسول إذا في دايما في
+
+212
+00:16:44,710 --> 00:16:48,490
+ضغط بسمح للكيلية إنها تتتسع ففي دايما داخل الكيلية
+
+213
+00:16:48,490 --> 00:16:52,210
+في ضغطفهذا الضغط الموجود ينعكس على بومانس كابسول
+
+214
+00:16:52,210 --> 00:16:55,630
+إذا في عندك هيدروستيك براشر في داخل البومانس
+
+215
+00:16:55,630 --> 00:16:59,450
+كابسول فال filtration بيقابل الهيدروستيك براشر
+
+216
+00:16:59,450 --> 00:17:03,870
+بيعمل عملية معاكسة تمام؟ إذا في داخل ال .. ال ..
+
+217
+00:17:03,870 --> 00:17:06,890
+ال capillary الهيدروستيك براشر بيطلع الميه لإيه؟
+
+218
+00:17:06,890 --> 00:17:10,010
+لبرا برا ال capillary في البومانس كابسول ههن
+
+219
+00:17:10,010 --> 00:17:13,650
+الهيدروستيك براشر بيرجع الميه يمنعها تطلع من الجهة
+
+220
+00:17:13,650 --> 00:17:18,970
+التانية ال .. ال .. ال .. ال fluid اللي ههنالـ
+
+221
+00:17:18,970 --> 00:17:23,530
+filtrate يعني هان اسمه صح ال filtrate في اذا كان
+
+222
+00:17:23,530 --> 00:17:31,030
+فيه protein هيعمللي برضه colloidal pressure ال
+
+223
+00:17:31,030 --> 00:17:35,470
+colloidal pressure هيشد ال fluids ال water من داخل
+
+224
+00:17:35,470 --> 00:17:39,030
+ال capillary تمام؟ اذا ال hydrostatic pressure ده
+
+225
+00:17:39,030 --> 00:17:43,570
+معايا ولا مش معايا؟الهيدروستيك براشر هان positive
+
+226
+00:17:43,570 --> 00:17:47,570
+force لفلتريشن لكن الهيدروستيك براشر هان negative
+
+227
+00:17:47,570 --> 00:17:50,510
+force لفلتريشن بيقاوم انه في الجهة التانية هو
+
+228
+00:17:50,510 --> 00:17:53,690
+الهيدروستيك براشر بيعمل بيسجل الاشي لبرا البرا هان
+
+229
+00:17:53,690 --> 00:17:57,370
+لبومانس كابسول و البرا هان انه يمنع الاشي ييجي من
+
+230
+00:17:57,370 --> 00:18:02,040
+ال ..والـ osmotic pressure اللى ناتج عن الكلويدال
+
+231
+00:18:02,040 --> 00:18:06,440
+osmotic pressure هان تمام بيمنع فى داخل ال
+
+232
+00:18:06,440 --> 00:18:09,520
+capillary ال fluids أو ال water تطلع فى حين انه
+
+233
+00:18:09,520 --> 00:18:13,520
+داخل بومانس كابسول إذا فى عندي هان بروتين وكلويدال
+
+234
+00:18:13,520 --> 00:18:16,560
+pressure بيساعد يشد إذا ال hydrostatic pressure
+
+235
+00:18:16,560 --> 00:18:20,330
+هان مع الكلويدال pressure هانforce بيعمل في اتجاه
+
+236
+00:18:20,330 --> 00:18:24,430
+واحد و ال ismotic pressure هان او ال colloidal
+
+237
+00:18:24,430 --> 00:18:26,690
+pressure هان زي ان ال ismotic pressure هان بيعمل
+
+238
+00:18:26,690 --> 00:18:31,250
+في اتجاه واحد حتى السهم هذا و هذا في اتجاه انه
+
+239
+00:18:31,250 --> 00:18:35,490
+تعمل تمنع ال filtration في حين انه هذا بيعمل ال
+
+240
+00:18:35,490 --> 00:18:38,410
+filtration طيب وين ال oncotic pressure في ذاكر
+
+241
+00:18:38,410 --> 00:18:41,310
+البومانس كابسول احنا قولنا هذا ال membrane ان
+
+242
+00:18:41,310 --> 00:18:45,140
+بيرميا بلت ايه؟to protein فبصير filtration بس
+
+243
+00:18:45,140 --> 00:18:49,020
+ماطلعش معاها protein بطلع minimal لا يذكر تمام؟
+
+244
+00:18:49,020 --> 00:18:52,760
+اذا هنا ال osmotic pressure تمام اللي ناتج عن ال
+
+245
+00:18:52,760 --> 00:18:57,980
+colloidal structure اللي هو بحيث انه يكون proteins
+
+246
+00:18:57,980 --> 00:19:02,860
+مش موجود صفر تمام؟ اذا ال hydrostatic pressure هذا
+
+247
+00:19:02,860 --> 00:19:08,860
+لحالهبقاوم الـ colloidal pressure تبع ال plasma و
+
+248
+00:19:08,860 --> 00:19:11,680
+بقاوم ال hydrostatic pressure تبع مين ال woman's
+
+249
+00:19:11,680 --> 00:19:15,480
+capsule طبعا هذا ناتج في الآخر عن ضغط الجلب يعني
+
+250
+00:19:15,480 --> 00:19:20,720
+الكلية شغالة بالضغط اللي عامله إيه الجلب إذا الدم
+
+251
+00:19:20,720 --> 00:19:24,620
+اللي بينتشر في الجسم كله بفضل الضغط تبع الجلب يخلي
+
+252
+00:19:24,620 --> 00:19:28,520
+ال .. كذلك الكلية نفسها معتمدة في شغل الرئيس على
+
+253
+00:19:28,520 --> 00:19:32,340
+إيه؟ على الضغط اللي بيجيها اللي ناتج من وين؟ من
+
+254
+00:19:32,340 --> 00:19:37,280
+الجلبأذا لو حصلنا المحصلة هانشوف نجد إيش في عندنا
+
+255
+00:19:37,280 --> 00:19:41,980
+net filtration pressure او forces هنلاقي انه تساوي
+
+256
+00:19:41,980 --> 00:19:45,000
+ال hydrostatic هذا اللي هو ستين ميلي متر ميركوري
+
+257
+00:19:45,000 --> 00:19:49,360
+ناقص الاتنين و تلاتين ال on-cut pressure و ناقص
+
+258
+00:19:49,360 --> 00:19:51,380
+التمنتعش ال hydrostatic اللي موجودة في ال bonus
+
+259
+00:19:51,380 --> 00:19:55,440
+capsule المحصلة في عندي net forces عشرة ميلي متر
+
+260
+00:19:55,440 --> 00:19:58,960
+ميركوري تمام؟ إذا ان ال net forces هذه تبعت ال
+
+261
+00:19:58,960 --> 00:19:59,320
+filtration
+
+262
+00:20:08,870 --> 00:20:14,430
+أحنا هيك وضحنا عملية
+
+263
+00:20:14,430 --> 00:20:17,810
+ال filtration كيف بالتم طبعا إذا في forces تحكمها
+
+264
+00:20:17,810 --> 00:20:20,990
+forces مع ال filtration و forces ضد ال filtration
+
+265
+00:20:20,990 --> 00:20:25,630
+احنا جيبنا سيرة الكلام هذا وقلنا إنه ال osmotic
+
+266
+00:20:25,630 --> 00:20:29,530
+pressure في داخل ال bowman's capsule زيرو زيرو في
+
+267
+00:20:29,530 --> 00:20:35,270
+ال situation normal لكن في أوضاع فيها مرض فيها
+
+268
+00:20:35,270 --> 00:20:40,590
+chronic renal failureهنكتشف انه ال bowl برا فيه
+
+269
+00:20:40,590 --> 00:20:46,130
+protein بروتينوريا او البيومينوريا البيومين في ال
+
+270
+00:20:46,130 --> 00:20:50,350
+urine بروتين في ال urine بروتينوريا او
+
+271
+00:20:50,350 --> 00:20:53,330
+البيومينوريا اول ما نلاقي فيه بروتين في ال bowl
+
+272
+00:20:53,330 --> 00:20:57,730
+بنقول عندنا مشكلة كبيرة لأن هذا مش لازم يطلع لأنه
+
+273
+00:20:57,730 --> 00:21:02,500
+اذا دل يطلعزي ما قلتلكم، منظل البروتين هذا يصف في
+
+274
+00:21:02,500 --> 00:21:06,340
+البلازمة، يهرب، يهرب، يهرب، يهرب، يهرب، البروتين
+
+275
+00:21:06,340 --> 00:21:10,320
+في البلازمة، إيش بيصير فيه؟ بيانخفض، إذا انخفض
+
+276
+00:21:10,320 --> 00:21:15,760
+البروتين في البلازمة، هذه force مهمة للحفاظ على ال
+
+277
+00:21:15,760 --> 00:21:19,160
+fluids في داخل البلازمة، إذا جال، معناها ال fluids
+
+278
+00:21:19,160 --> 00:21:22,380
+بتهرب إلى ال إيه؟ إلى ال tissues، مافيش إشي يرجعها
+
+279
+00:21:22,920 --> 00:21:27,040
+قولنا إديمة رينال إديمة مش كده؟ قولنا عنها نوع من
+
+280
+00:21:27,040 --> 00:21:30,780
+أنواع رينال إديمة لما البروتين يهرب من عنا أحيانا
+
+281
+00:21:30,780 --> 00:21:33,580
+بنلاقي في ال woman's capsule فيه بروتين موجود
+
+282
+00:21:33,580 --> 00:21:37,240
+بيصير له إيه قيمة بس في ال normal conditions مش
+
+283
+00:21:37,240 --> 00:21:40,960
+موجود لكن في ال abnormal conditions بنلاقي إيه؟
+
+284
+00:21:40,960 --> 00:21:44,500
+موجود و بيبدأ إله حساب لكن في الوضع الطبيعي مالوش
+
+285
+00:21:44,500 --> 00:21:44,840
+حساب
+
+286
+00:21:50,180 --> 00:21:54,680
+طيب ال glomerular capillaries have a much higher
+
+287
+00:21:54,680 --> 00:21:57,920
+rate of filtration than most other capillaries
+
+288
+00:21:57,920 --> 00:22:00,700
+because of a high glomerular hydrostatic pressure
+
+289
+00:22:00,700 --> 00:22:05,160
+and a large KF filtration coefficient يزن ال
+
+290
+00:22:05,160 --> 00:22:08,780
+hydrostatic pressure عندنا هنا عالي في ال
+
+291
+00:22:08,780 --> 00:22:12,040
+glomerulus
+
+292
+00:22:12,040 --> 00:22:16,580
+الأفراد الارتريال بيجينا عاليفي ال .. في ال
+
+293
+00:22:16,580 --> 00:22:20,020
+capillary زي العادية ال general capillary
+
+294
+00:22:20,020 --> 00:22:28,160
+circulation غير الكيليا بنلاقي انه ال hydrostatic
+
+295
+00:22:28,160 --> 00:22:33,540
+pressure هان بزرش عن اتنين و تلاتين تمام؟ في ال ..
+
+296
+00:22:33,540 --> 00:22:39,660
+في ال capillary في حين انه ال .. ال .. هنا عندنا
+
+297
+00:22:39,660 --> 00:22:42,950
+high pressure high hydrostatic pressureالرينا
+
+298
+00:22:42,950 --> 00:22:47,230
+الارتري في blood pressure زي ال ايه زي الأورتا
+
+299
+00:22:47,230 --> 00:22:52,670
+فبيصل الكيليا بسهولة ضغط عالي الضغط العالي و ال
+
+300
+00:22:52,670 --> 00:22:55,550
+filtration coefficient العالي ناتج عن ان ال
+
+301
+00:22:55,550 --> 00:22:59,370
+surface area عندى واسع capillary اه و مجموع ال
+
+302
+00:22:59,370 --> 00:23:02,350
+capillaries اللي في ال ايه اللي في الكيليا tufts
+
+303
+00:23:02,350 --> 00:23:05,850
+tufts tufts و capillaries مساحة كبيرة جدا بحيث
+
+304
+00:23:05,850 --> 00:23:09,990
+تديني فرصة كبيرة مساحة كبيرة لل ايه لل filtration
+
+305
+00:23:09,990 --> 00:23:15,810
+بالاضافة انه عندناال .. ال membrane ال .. ال
+
+306
+00:23:15,810 --> 00:23:18,830
+efficiency تبعه عالية انه يعمل filtration فقط
+
+307
+00:23:18,830 --> 00:23:25,170
+لمواد و يمنع filtration لمواد أخرى و هذا من رحمة
+
+308
+00:23:25,170 --> 00:23:29,530
+ربنا لو ال herbicides بتطلع كان ماضالش بنا آدم لو
+
+309
+00:23:29,530 --> 00:23:33,450
+ال .. ال protein بيطلع ماضالش بنا آدم يعني خلق
+
+310
+00:23:33,450 --> 00:23:37,270
+الإنسان الدقة فيه في كل مكان يعني مش احنا بنرا انه
+
+311
+00:23:37,270 --> 00:23:40,550
+اه والله الواحد إيه عينين حلوين و بيشوفه في الدنيا
+
+312
+00:23:40,550 --> 00:23:48,370
+كل شيءانظر الي كل شي بتلاقي دقيق ومحسوب بدقة
+
+313
+00:23:48,370 --> 00:23:52,630
+متناهية تنتفي مع الصدفة الدقة هادى متناهية اللى
+
+314
+00:23:52,630 --> 00:23:57,090
+بنشوفها احنا ينفي وجود الصدفة الصدفة مش ممكن تتكرر
+
+315
+00:23:57,090 --> 00:24:02,350
+ملايين مرات في كل مكان مش معقول تمام مش معقول اذا
+
+316
+00:24:02,350 --> 00:24:10,210
+عندنا ال ال filtration بيصير بس ل ال fluids محافظ
+
+317
+00:24:10,210 --> 00:24:14,900
+على ال RBCsو على ال proteins بالمناسبة ..
+
+318
+00:24:14,900 --> 00:24:19,100
+بالمناسبة ليش ال RBC .. ليش ال homoglobin موجود في
+
+319
+00:24:19,100 --> 00:24:24,020
+RBCs موجود في cell membrane و محجوز في مكان واسع؟
+
+320
+00:24:24,020 --> 00:24:29,700
+ال homoglobin لو كان free اه can be filtered لذلك
+
+321
+00:24:29,700 --> 00:24:34,020
+لما يصير عندنا hemolysis من خلف الكيليةلأن
+
+322
+00:24:34,020 --> 00:24:37,760
+البروتين تبع ال .. ال hemoglobin ال hemoglobin
+
+323
+00:24:37,760 --> 00:24:41,460
+نفسه بيطلع و بيصل له filtration و ياريت بيصل له
+
+324
+00:24:41,460 --> 00:24:44,880
+filtration و بيطلع من الكلية و مع السلامة لأ بيجي
+
+325
+00:24:44,880 --> 00:24:48,760
+عند مكان معين في ال tubules و stuck لأنه كبير طلع
+
+326
+00:24:48,760 --> 00:24:51,760
+من ال filter و مش عارف يطلع من ال tubule تمام مع
+
+327
+00:24:51,760 --> 00:24:54,640
+التركيز مع شوية شوية تبدأ ال tubules يتسكر واحدة
+
+328
+00:24:54,640 --> 00:24:58,700
+واحدة واحدة واحدة واحدة واحدة لما الكلية ايه تتعطل
+
+329
+00:24:58,700 --> 00:25:02,980
+عن العمل مافيش فيها filtration لذلك ان خروجه خطر
+
+330
+00:25:03,830 --> 00:25:08,470
+على الجسم كجسم ال RBCs راحت وخطر على الكلية لإن
+
+331
+00:25:08,470 --> 00:25:15,190
+الكلية لذلك ال myoglobin اللي هو ال hemoglobin
+
+332
+00:25:15,190 --> 00:25:20,610
+اللي موجود في ال إيه؟ في العضلات ال myoglobin في
+
+333
+00:25:20,610 --> 00:25:25,010
+العادة not exposed لل plasma و not exposed لل
+
+334
+00:25:25,010 --> 00:25:31,110
+glomeruli
+
+335
+00:25:31,110 --> 00:25:34,590
+و ال filtrationOkay هو موجود كmyoglobin مش موجود
+
+336
+00:25:34,590 --> 00:25:40,250
+في RBC's زي ال إيه؟ زي ال hemoglobin تمام؟ موجود
+
+337
+00:25:40,250 --> 00:25:42,630
+في العضلات والعضلات بتشغلها لكن لو صار عندي
+
+338
+00:25:42,630 --> 00:25:47,610
+massive crash و massive trauma ل ال muscles تمام؟
+
+339
+00:25:47,610 --> 00:25:50,790
+هذا بيقدر إلى أن ال muscle fibers بتتكسر ال
+
+340
+00:25:50,790 --> 00:25:55,370
+myoglobin اللي فيها بيطلع و بيمشي في الدم بيصير
+
+341
+00:25:55,370 --> 00:25:59,170
+الكيلية بتفاجأت أن الكيلية هذه بيقدر يطلع منها لإن
+
+342
+00:25:59,170 --> 00:26:06,060
+هو مصمم ما يطلعش في الدمفبنلاقي يطلع إذا دخل الدم
+
+343
+00:26:06,060 --> 00:26:09,740
+بيصيبله filtration و إذا صارله filtration لأنه
+
+344
+00:26:09,740 --> 00:26:14,840
+حجمه كبير شوية فبيلزج و بيعمل ليه اللي هو ال acute
+
+345
+00:26:14,840 --> 00:26:18,610
+renal failureحتى احنا دراسة ال acute renal failure
+
+346
+00:26:18,610 --> 00:26:23,870
+كنا نعملها على الحيوانات ان ندى في العضلة مادة
+
+347
+00:26:23,870 --> 00:26:28,650
+معينة تكسر العضلات فبطلع myoglobin كتير فالكلية
+
+348
+00:26:28,650 --> 00:26:32,550
+بتضرب و هم نعمل دراساتنا القديمة كلها النماذج
+
+349
+00:26:32,550 --> 00:26:35,730
+المستخدمة لدراسة ال acute renal failure على انهم
+
+350
+00:26:35,730 --> 00:26:39,850
+يسوقوا acute renal failure للحيوان معين عبر انه
+
+351
+00:26:39,850 --> 00:26:43,170
+يكسروا العضلات يخلوا ال myoglobin يروح يخرب ال
+
+352
+00:26:43,650 --> 00:26:47,290
+يخرّب الكلية ال myoglobin و لها زيارة الجثة موجودة
+
+353
+00:26:47,290 --> 00:26:52,370
+من فترة سألوني واحد عنده واحد أكل جتلة من الناس
+
+354
+00:26:52,370 --> 00:26:58,370
+تمام و دخل المستشفى
+
+355
+00:26:58,370 --> 00:27:02,790
+و بعدين دخل فيه أكل فيه فيلرومات مش علاقة الجتلة
+
+356
+00:27:02,790 --> 00:27:09,530
+فيه ايه علاقة الجتلة بتعملنا ايه ال myoglobin
+
+357
+00:27:09,530 --> 00:27:13,070
+بيصير exposed و ال myoglobin هذا بيروح بعملنا ايه
+
+358
+00:27:14,220 --> 00:27:21,700
+failure واضح لذلك حادث سيارة دهس على عضلات okay
+
+359
+00:27:21,700 --> 00:27:25,620
+الحمد لله ماكسرش راسه لكن كسر العضلات و العضلات
+
+360
+00:27:25,620 --> 00:27:30,500
+قامت ب مايجلوفينوريا عاليةو بعدين هذا ال myoglobin
+
+361
+00:27:30,500 --> 00:27:34,840
+بيخرب الكيلة، احنا و نصيب لنقدر ننفض و نصلح الكيلة
+
+362
+00:27:34,840 --> 00:27:40,160
+ولا هنحطه على hemodialysis فترة اذا دخل في chronic
+
+363
+00:27:40,160 --> 00:27:44,780
+حسب الإصابة و بعدين نعمله kidney transplantation،
+
+364
+00:27:44,780 --> 00:27:48,920
+يعتمد، يعني الجصد انه ال filter ال .. ال .. ال
+
+365
+00:27:48,920 --> 00:27:54,690
+membrane هذا كتير مهمتمام و ربنا خرج الأشياء بشكل
+
+366
+00:27:54,690 --> 00:27:58,310
+معين أشياء تخش و أشياء ماتخشش لو الأشياء اللي
+
+367
+00:27:58,310 --> 00:28:03,330
+بدهاش تخش خشت بيصير مصيبة لذلك واضح القصد في أن ال
+
+368
+00:28:03,330 --> 00:28:07,470
+hemoglobin راح حطله و حطه في أيه؟ في herbicides لو
+
+369
+00:28:07,470 --> 00:28:11,950
+ما حطش في herbicides بيطلع فلأ لأ ما راح حطه في
+
+370
+00:28:11,950 --> 00:28:14,010
+herbicides ربه من اللي ما حطوه في herbicides لكن
+
+371
+00:28:14,010 --> 00:28:18,390
+ال hemoglobin ما حطوه في أيه؟
+
+372
+00:28:18,390 --> 00:28:20,790
+طيب glomeral capillary membrane
+
+373
+00:28:24,020 --> 00:28:27,540
+اللي هو احنا ال filtration بتم عبر glomeral
+
+374
+00:28:27,540 --> 00:28:31,060
+capillary membrane من ايش بتكون هذا ال membrane؟
+
+375
+00:28:31,060 --> 00:28:36,180
+هذا بنسميه filtration barrier
+
+376
+00:28:36,180 --> 00:28:39,320
+ال capillary membrane هذا glomeral capillary
+
+377
+00:28:39,320 --> 00:28:43,860
+membrane بنسميه filtration barrier لإن هو اللي ايه
+
+378
+00:28:43,860 --> 00:28:47,360
+عبره بدو سر ال filtration من ايش بتكون ال
+
+379
+00:28:47,360 --> 00:28:51,270
+filtration barrier هذا؟الطبيعي انه ال .. ال .. ال
+
+380
+00:28:51,270 --> 00:28:55,710
+capillary في داخله في ايش؟ Endothelium، صبوط؟ اللي
+
+381
+00:28:55,710 --> 00:29:01,090
+هو ال flat endothelial cells تبعت اللي بتبطن ال
+
+382
+00:29:01,090 --> 00:29:03,870
+capillary طبعا في fenestrations في ال capillary
+
+383
+00:29:03,870 --> 00:29:06,830
+بين ال ايه؟ بين ال .. بين ال endothelial cells في
+
+384
+00:29:06,830 --> 00:29:13,400
+holes موجودة، هذا supported من برا بزمة membraneال
+
+385
+00:29:13,400 --> 00:29:17,860
+basement membrane هذا عبارة عن membrane متكون من
+
+386
+00:29:17,860 --> 00:29:23,120
+collagen fibers و protoglycan fibers عامل أشبه
+
+387
+00:29:23,120 --> 00:29:28,880
+بالإيه؟ أشبه بالنسيج، نسيج من ال fibers ففيه في
+
+388
+00:29:28,880 --> 00:29:33,370
+جلبه إيه؟chrome فراغات فالاشياء إذا لما بتطلع من
+
+389
+00:29:33,370 --> 00:29:37,390
+داخل ال plasma لازم تتعدي من ال fenestrations تبعت
+
+390
+00:29:37,390 --> 00:29:42,270
+ال membrane تبعت ال capillary wall و هتلاقي ال
+
+391
+00:29:42,270 --> 00:29:44,830
+basement membrane إذا ال cells دخلت من بينها
+
+392
+00:29:44,830 --> 00:29:47,570
+هتلاقي basement membrane طلعت من ال basement
+
+393
+00:29:47,570 --> 00:29:50,710
+membrane هتلاقي كمان برا موجود عندى epithelial
+
+394
+00:29:50,710 --> 00:29:57,140
+cells اللي من شوية قلنا عنها البومانزcapsule ما هو
+
+395
+00:29:57,140 --> 00:30:01,160
+الـ tuft هذا ال glomerulus دخلت في ال a في ال
+
+396
+00:30:01,160 --> 00:30:04,720
+bowmans capsule و layer فيه ملاسقة ل ال capillary
+
+397
+00:30:04,720 --> 00:30:08,700
+tuft و فيه layer برا الفرق اللي بينهم عامل ال
+
+398
+00:30:08,700 --> 00:30:15,260
+bowmans capsule مش كده ال ال ال ال هنا في حكمة
+
+399
+00:30:15,260 --> 00:30:19,920
+حكمة كبيرة هنا في حكمة كبيرة لاحظوا احنا بنتكلم
+
+400
+00:30:19,920 --> 00:30:22,880
+على membrane بيعدي منه filtration و فيه قلوب شبيه
+
+401
+00:30:22,880 --> 00:30:27,480
+في ال a general circulationالشبيه اللي في ال
+
+402
+00:30:27,480 --> 00:30:30,300
+general circulation الدقت اللي بيشتغل عليه قداش؟
+
+403
+00:30:30,300 --> 00:30:38,140
+تلاتين تلاتين تمانية عشرين ال hand دقت عليه ستين
+
+404
+00:30:38,140 --> 00:30:42,000
+فيعني الدقت هذا لنفس ال capillary ممكن يفرجع
+
+405
+00:30:42,000 --> 00:30:48,660
+فإجاله إيه؟ support إضافي إجاله epithelial tissue
+
+406
+00:30:48,660 --> 00:30:52,710
+حواليالـ epithelial cells و الـ epithelial cells
+
+407
+00:30:52,710 --> 00:30:56,390
+هذه عاملة زي إيدي بالظبط هاي ال cell و إلها
+
+408
+00:30:56,390 --> 00:31:01,850
+bodocytes إلها إيه؟ أقدام فبتبقى ال capillary هذا
+
+409
+00:31:01,850 --> 00:31:04,770
+هيه موجود، هاي ال capillary إيدي، إيدي يعني ال
+
+410
+00:31:04,770 --> 00:31:09,170
+capillary و ال bodocytes مش جاية بس منصقة هيك إله،
+
+411
+00:31:09,170 --> 00:31:14,710
+لأ جاية منصقة إله و مطلعة bodocytesحواليه؟ تمام؟
+
+412
+00:31:14,710 --> 00:31:17,950
+بس كده و ال bodocyte بين ال bodocyte اللي هو
+
+413
+00:31:17,950 --> 00:31:21,530
+الأقدام الكاذبة و بين ال bodocyte و ال bodocyte
+
+414
+00:31:21,530 --> 00:31:26,490
+فيه slit تمام؟ ال slits هذه الموجودة موجودة مقابل
+
+415
+00:31:26,490 --> 00:31:29,570
+ال fenestrations تابعة الايه؟الـ Cabillary
+
+416
+00:31:29,570 --> 00:31:33,590
+membrane و ال .. و ال .. و ال .. و ال .. ال
+
+417
+00:31:33,590 --> 00:31:37,630
+basement membrane تمام؟ يعني لا تمنع ال support
+
+418
+00:31:37,630 --> 00:31:41,730
+هذا الموجود لا يمنع ان ال .. ال ايه؟ ال fluids هنا
+
+419
+00:31:41,730 --> 00:31:46,190
+تطلع و لاحظوا هاي ال cell موجودة هيك support لها
+
+420
+00:31:46,190 --> 00:31:48,870
+فلما بيطلع ال filtration بيعدّيش داخل ال cell
+
+421
+00:31:48,870 --> 00:31:52,790
+بيعدّي من بين ال podocyte يعني ال .. ال fluid اللي
+
+422
+00:31:52,790 --> 00:31:56,690
+طالع من ال .. من ال .. من ال plasma عبر ال .. ال
+
+423
+00:31:56,690 --> 00:32:00,610
+membraneعبر الـ capillary membrane، بعدي من ال
+
+424
+00:32:00,610 --> 00:32:02,370
+hole تبع ال capillary membrane، بعدي من ال
+
+425
+00:32:02,370 --> 00:32:06,150
+fenestration تبع ال basement membrane، بكون في ال
+
+426
+00:32:06,150 --> 00:32:09,350
+bomb and capsule على طول، خلاصيعني البومانس كابسول
+
+427
+00:32:09,350 --> 00:32:13,390
+هنا مابدوش انا اعد السيتوب لازم تبعها و اطلع منه
+
+428
+00:32:13,390 --> 00:32:18,770
+على الجهة التانية ليش؟ مش sheet مغطية كلها دي لأ
+
+429
+00:32:18,770 --> 00:32:23,710
+ايد السل و إلها إيه؟ إلها أصابع أو أقدام أطراف
+
+430
+00:32:23,710 --> 00:32:28,270
+محوطة كده فال filtration منها بيصير عبر ما بين ال
+
+431
+00:32:28,270 --> 00:32:35,330
+body size و هذه الرسمة اللي هنوريكوا إياها هذه
+
+432
+00:32:35,330 --> 00:32:36,570
+الرسمة
+
+433
+00:32:39,830 --> 00:32:45,190
+مش واضحة او اي جزئية منها okay هذه واضحة كتير هاي
+
+434
+00:32:45,190 --> 00:32:50,590
+ال capillary ال human هذا ال capillary ال human
+
+435
+00:32:50,590 --> 00:32:55,570
+تمام هاد ال wall تبعتهم بينها هاد ال ال ال ال
+
+436
+00:32:55,570 --> 00:32:59,050
+epithelial cell تبعت ال Bowmans capsule تبعت ال
+
+437
+00:32:59,050 --> 00:33:03,370
+tubule هاد ال epithelial cell تمام هاد جاعد على ال
+
+438
+00:33:03,370 --> 00:33:06,210
+ايه على ال capillary و بعتاله هان و هان و هان و
+
+439
+00:33:06,210 --> 00:33:11,980
+هان ايه شايفين بعتاله podocytesbody sites هذي
+
+440
+00:33:11,980 --> 00:33:16,040
+لخلية و هذي لخلية اللي جنبها و كده ففي بينهم ..
+
+441
+00:33:16,040 --> 00:33:22,300
+بينهم في إيش؟ slits بتسمح لإنه يعني هنا .. أنا هنا
+
+442
+00:33:22,300 --> 00:33:26,540
+في المنطقة هذه أنا داخل بومان كابسول هنا تمام؟ إذا
+
+443
+00:33:26,540 --> 00:33:29,400
+اللاحظوا من داخل ال membrane هنا الاشياء بتطلع من
+
+444
+00:33:29,400 --> 00:33:31,760
+بين الأشياء هذه بتكون في ال bomans capsule و تكمل
+
+445
+00:33:31,760 --> 00:33:36,250
+في التيابيولو هذه اللي هو مكبرة شوية هذه ال slits
+
+446
+00:33:36,250 --> 00:33:40,710
+مقاطعة منها مقاطعة من بودوكسايسو بينها ال pores
+
+447
+00:33:40,710 --> 00:33:45,970
+اللي هي ال .. بين ال slits وهي ال epithelia ال ..
+
+448
+00:33:45,970 --> 00:33:48,870
+ال endothelial membrane تبع ال capillary وهي ال
+
+449
+00:33:48,870 --> 00:33:51,910
+basement membrane basement membrane فهنا ال pores
+
+450
+00:33:51,910 --> 00:33:54,650
+هذه بيطلع منها الاشي بيطلع filtration بيعدى منها
+
+451
+00:33:54,650 --> 00:33:57,970
+المباشرة قصد اقول ال filtrate و لو انه موجود عندى
+
+452
+00:33:57,970 --> 00:34:04,640
+انا epithelial layerعمل support لكنها ال
+
+453
+00:34:04,640 --> 00:34:09,260
+filtration اللي طالع لا يحتاج أنه يدخل داخل not
+
+454
+00:34:09,260 --> 00:34:13,560
+trans cellular زي ما قلنا في قصة ال potential
+
+455
+00:34:13,560 --> 00:34:18,280
+spaces تبعت ال .. يعني بيعديش عبر الخلية عشان يطلع
+
+456
+00:34:18,280 --> 00:34:23,330
+ال bombs capsule لأ في منهم إسلسل تمام؟لكن هل هذا
+
+457
+00:34:23,330 --> 00:34:27,030
+له الـ Epithelial tissue هذا الموجود اللي عامل
+
+458
+00:34:27,030 --> 00:34:30,370
+support عشان يقاوم الضغط العالي اللي في هذه
+
+459
+00:34:30,370 --> 00:34:35,930
+المنطقة؟ هل له تأثير على ال filtration؟ اه له
+
+460
+00:34:35,930 --> 00:34:37,990
+تأثير على ال filtration مش من ناحية
+
+461
+00:34:41,250 --> 00:34:44,170
+الحجم تبع ال slits لكن من حجم عندى ال
+
+462
+00:34:44,170 --> 00:34:48,410
+electronegativity فى عندى هنا electronegative
+
+463
+00:34:48,410 --> 00:34:54,490
+charges موجودة على ال body size فى ال slits هذه
+
+464
+00:34:54,490 --> 00:35:00,070
+بتساعد انه تعمل revealing لأشياء اللى هى تحتوي على
+
+465
+00:35:00,070 --> 00:35:04,350
+زى ال proteins electronegative تمام؟ اذا هذه
+
+466
+00:35:04,350 --> 00:35:08,990
+المسألة اذا فى عندى هنا حقيقة two factors مهمينفي
+
+467
+00:35:08,990 --> 00:35:12,890
+مواصفات ال membrane اللى بيصير في filtration تمام
+
+468
+00:35:12,890 --> 00:35:18,230
+انه في عندى انا holes fenestrations وهدس hole
+
+469
+00:35:18,230 --> 00:35:23,810
+supported ب negative negatively charged ions عاملة
+
+470
+00:35:23,810 --> 00:35:27,370
+negative negatively charged هي بيصير calcium ions
+
+471
+00:35:27,370 --> 00:35:32,970
+او غيرها او يعني المهم عندى ايه negative charge في
+
+472
+00:35:32,970 --> 00:35:38,190
+داخل ال .. اذا عندى ال fenestrations بتحدد حجموال
+
+473
+00:35:38,190 --> 00:35:43,250
+charges بتطرد الأشياء ولو حجمها مظبوط لكنها
+
+474
+00:35:43,250 --> 00:35:46,310
+negative لل charge بتقدرش تخش في حين ان لو حجمها
+
+475
+00:35:46,970 --> 00:35:51,150
+مظبوط هو positively charged بتخش بإيه؟ بسرعة، لكن
+
+476
+00:35:51,150 --> 00:35:54,290
+حجمها مظبوط ومش negatively ولا positively charged
+
+477
+00:35:54,290 --> 00:35:59,130
+بتخش بسهولة، لكن لما تكون positive بيصي لها
+
+478
+00:35:59,130 --> 00:36:01,650
+flirtation أسرع، تكون negative بيصي لها flirtation
+
+479
+00:36:01,650 --> 00:36:06,710
+أجل، يعني تصوروا نفس المادة لما يكون لها تلت
+
+480
+00:36:06,710 --> 00:36:11,110
+أنواع، نوع positive، نوع negative، نوع neutralالـ
+
+481
+00:36:11,110 --> 00:36:13,270
+neutral بيعدي ال positive بيعدي أكتر منه ال
+
+482
+00:36:13,270 --> 00:36:16,610
+negative بتوقف أو بيعدي جليل ليش لإنه في إشي يطرده
+
+483
+00:36:16,610 --> 00:36:20,130
+ال negativity هاد موجودة على كل المستويات ال
+
+484
+00:36:20,130 --> 00:36:22,110
+epithelial cells ال holes اللي فيها فيها negative
+
+485
+00:36:22,110 --> 00:36:29,610
+ال charged ions ال basement membrane و ال a و ال
+
+486
+00:36:29,610 --> 00:36:33,890
+epithelial covering برضه فيه إذا فعندي two factors
+
+487
+00:36:33,890 --> 00:36:40,130
+ال size و ال electrical charge اللي موجودة في ال
+
+488
+00:36:46,220 --> 00:36:51,840
+إذا هنا قلنا تلاتة layers يمثله filtration barrier
+
+489
+00:36:51,840 --> 00:36:56,440
+قلنا لأن عبرهم حيصير ال filtration even this high
+
+490
+00:36:56,440 --> 00:36:58,600
+rate of filtration in the glomerular capillary
+
+491
+00:36:58,600 --> 00:37:00,600
+membrane normally prevents filtration of plasma
+
+492
+00:37:00,600 --> 00:37:05,520
+proteins إذا بالرغم أن filtration عالي عندي تمام
+
+493
+00:37:05,520 --> 00:37:10,800
+بيصير هنا في الكيلية 20% بيصير filtration لأن ال
+
+494
+00:37:10,800 --> 00:37:15,040
+plasma proteins بتعديش طب ليش بتعديش ال plasma
+
+495
+00:37:15,040 --> 00:37:21,730
+proteins؟عشان مش علشان حجمها أكبر القلب منه ستين
+
+496
+00:37:21,730 --> 00:37:27,250
+angstrom خطرها اه و ال fenestration تمانين
+
+497
+00:37:27,250 --> 00:37:31,590
+angstrom لكن مفترضها تخش مش ممكن ت get charges
+
+498
+00:37:31,590 --> 00:37:38,190
+بتمنعها لذلك ان بعض أمراض الكيلة أبسط lesion في
+
+499
+00:37:38,190 --> 00:37:42,530
+الكيلة بيسموه minimal minimal changes
+
+500
+00:37:48,880 --> 00:37:55,060
+minimal changes in nephropathy اللي هي الحالات
+
+501
+00:37:55,060 --> 00:38:00,040
+احنا عندنا بكرا هتدرس ان شاء الله ال failure عبارة
+
+502
+00:38:00,040 --> 00:38:04,820
+عن failure في الكيلية عندها تشتغل مظبوط و بتطلع
+
+503
+00:38:04,820 --> 00:38:08,840
+كمية كبيرة من ال proteins لكن ليش لما ندرس ال
+
+504
+00:38:08,840 --> 00:38:13,280
+pathology تبع الكيلية ليش هذه الكيليةتمام فيها
+
+505
+00:38:13,280 --> 00:38:18,580
+failure هم المواصفات العامة في proteinuria تمام
+
+506
+00:38:18,580 --> 00:38:22,620
+وفي عندى ال plasma بيبدأ اليوريا و الكرياتينين
+
+507
+00:38:22,620 --> 00:38:25,820
+وماعرفش ايش تعنى لذا في failure مع وجود
+
+508
+00:38:25,820 --> 00:38:29,180
+proteinuria هذا مايسمى ايه chronic renal failure
+
+509
+00:38:29,180 --> 00:38:34,920
+تمام لكن ايش ال lesion اللى خلت في عندنا مجموعة
+
+510
+00:38:34,920 --> 00:38:38,880
+كبيرة يعني ايش الإصابة اللى في داخل الكيلية اللى
+
+511
+00:38:38,880 --> 00:38:43,900
+وصلتنا ل chronic renal failureفي إصابات كتيرة ممكن
+
+512
+00:38:43,900 --> 00:38:49,840
+أشياء minimal damaging للنفرون بتقدر ال minimal
+
+513
+00:38:49,840 --> 00:38:53,860
+coronary failure وفي عنده prognosis كويس يعني ممكن
+
+514
+00:38:53,860 --> 00:38:58,120
+المستقبل أنه يتصلح ومايكونش خطير كتير وفي أشياء
+
+515
+00:38:58,120 --> 00:39:02,000
+بتبجأ يعني هجم وهجوم على الكيليا خلال فترة بسيطة
+
+516
+00:39:02,000 --> 00:39:04,300
+بتدمرها ومافيش فايدة إلا تشيل الكيليا و تخلص غيرها
+
+517
+00:39:04,300 --> 00:39:07,660
+مافيش إلا إيه نعمل إيه عملية زراعة كيلها في
+
+518
+00:39:07,660 --> 00:39:12,510
+المستقبلتمام فدرجات مختلفة لكن الظاهر ان في عندى
+
+519
+00:39:12,510 --> 00:39:15,830
+بروتين فى الكيلة و بدأت البروتين يتأثر على الجسم و
+
+520
+00:39:15,830 --> 00:39:19,950
+بدأ ال renal function ينبين هذا اسمه اسم عام لكن
+
+521
+00:39:19,950 --> 00:39:26,150
+ايش نوعه بيحتمل يعتمد على ان ناخد عينة من الكيلة و
+
+522
+00:39:26,150 --> 00:39:29,590
+ندرسها نشوف ايش اللى ايه اللى موجود فىها فى عيننا
+
+523
+00:39:29,590 --> 00:39:34,710
+عنا مرض بنسميه minimal changes nephropathyفقط
+
+524
+00:39:34,710 --> 00:39:38,970
+الكلية فقدت ال negatively charged ions اللي
+
+525
+00:39:38,970 --> 00:39:41,970
+موجودين على ال ايه؟ على ال fenestrations فهذا
+
+526
+00:39:41,970 --> 00:39:45,090
+بيقدر إلى انه ال album من اللي كان مش قادر يطلع
+
+527
+00:39:45,090 --> 00:39:50,400
+فقدنا الطرد اللي بيصير له حجمه يسمح بيصير يطلعهذه
+
+528
+00:39:50,400 --> 00:39:53,260
+أقل إصابة، طبعا في إصابات تانية بيصير inflammatory
+
+529
+00:39:53,260 --> 00:39:56,260
+processes جوا بتأدي إلى أن ال basement membrane
+
+530
+00:39:56,260 --> 00:40:02,860
+هذا يورم و .. و ال fenestration سبعته تكبر و يصير
+
+531
+00:40:02,860 --> 00:40:08,730
+يهرب هو نفسه خلاص، نفس ال holes كبرت، تمام؟موضوع
+
+532
+00:40:08,730 --> 00:40:12,070
+كبير هتدرسوه فى وقته لكن انا اللى جايب السيرة هى
+
+533
+00:40:12,070 --> 00:40:15,670
+اللى هو الاش ال .. ال negatively charged ions اللى
+
+534
+00:40:15,670 --> 00:40:19,170
+موجودة على ال ايه على ال barrier هدا وهميتها يعنى
+
+535
+00:40:19,170 --> 00:40:22,650
+البومين بيقدر يطلع لو انه not negatively charged
+
+536
+00:40:22,650 --> 00:40:29,390
+او لو انه ال charges اللى موجودة راحت تمام؟ و ..
+
+537
+00:40:29,390 --> 00:40:33,670
+اذا هذا ال .. ال .. الكلام اللى احنا ايه شرحناه من
+
+538
+00:40:33,670 --> 00:40:38,550
+شويةإذا thus all layers of glomerular capillary
+
+539
+00:40:38,550 --> 00:40:42,150
+wall provides a barrier to filtration of plasma
+
+540
+00:40:42,150 --> 00:40:45,550
+proteins بيمنع ال إيه؟ ال plasma proteins وقولنا
+
+541
+00:40:45,550 --> 00:40:52,430
+كل واحد منهم في mechanical probarties
+
+542
+00:40:52,430 --> 00:40:55,870
+اللي هو حجم ال hole و electrical probarties اللي
+
+543
+00:40:55,870 --> 00:40:59,250
+هو ال إيه؟ يعني التلت طبقات اللي موجودة عندى ال
+
+544
+00:40:59,250 --> 00:41:02,750
+endothelium ال basement membrane و ال epithelial
+
+545
+00:41:02,750 --> 00:41:06,950
+cell التلتة عندهم كل واحد حاملnegatively charged
+
+546
+00:41:06,950 --> 00:41:13,350
+ions filterability of solutes is investigated to
+
+547
+00:41:13,350 --> 00:41:19,810
+their size حلو اذا ال size له اهمية احنا قولنا ال
+
+548
+00:41:19,810 --> 00:41:23,710
+filtration membrane عرفنا اللي له holes معينة
+
+549
+00:41:23,710 --> 00:41:29,030
+فالمادة اللي بدها to be filtered ان كان حجمها
+
+550
+00:41:29,030 --> 00:41:34,810
+مناسب لل size بتطلع مش مناسبما بتطلع المسألة size
+
+551
+00:41:34,810 --> 00:41:38,810
+و negative للشاشة فاحنا هنا ال filtration اعتمدنا
+
+552
+00:41:38,810 --> 00:41:42,950
+ان الميه هي ال standard تمام الميه بيصيرها
+
+553
+00:41:42,950 --> 00:41:46,050
+filtration هالجد في الدقيقة اللي بيصيرله
+
+554
+00:41:46,050 --> 00:41:51,030
+filtration مساوى ال filtration تبع الميه تمام
+
+555
+00:41:51,030 --> 00:41:56,570
+بنسميه freely filterable اه free filtration تمام
+
+556
+00:41:56,570 --> 00:42:01,110
+بنديله رقم filterability واحدتمام فتطلع الميه ال
+
+557
+00:42:01,110 --> 00:42:07,430
+18 و ال microwave 18 يعني بسهولة بتقدر تطلع ال
+
+558
+00:42:07,430 --> 00:42:13,990
+sodium 23 بسهولة بقدر يطلع ال pores الموجودة لا
+
+559
+00:42:13,990 --> 00:42:19,470
+تمنعه ال glucose ال inulin ها خمس تلاف و خمسمية ال
+
+560
+00:42:19,470 --> 00:42:23,750
+inulin ال inulin مادة احنا بيصلها filtration و
+
+561
+00:42:23,750 --> 00:42:28,260
+بيصلها reabsorptionفدائما احنا بتهمنا في قياس لما
+
+562
+00:42:28,260 --> 00:42:32,140
+بدنا نجيس جداش بيصير filtration مانروح و مانشوف ال
+
+563
+00:42:32,140 --> 00:42:36,420
+in و ال in test لإنه هذا بس filtration لا بيصيرله
+
+564
+00:42:36,420 --> 00:42:40,440
+secretion ولا بيصيرله reabsorption فإذا هذه المادة
+
+565
+00:42:40,440 --> 00:42:43,700
+اللي طلعت يعبر بس عن مين عن ال filtration و هنتكلم
+
+566
+00:42:43,700 --> 00:42:47,640
+معاها كيف بنجيسها ال in و ال in بيصيرله filtration
+
+567
+00:42:47,640 --> 00:42:53,220
+ال myoglobin السبعتاشر الف راحظوا بيصير filtration
+
+568
+00:42:53,220 --> 00:42:58,400
+لكن مش كاملبس بيصير يطلع لأنه حجمه كبير بس بيطلع
+
+569
+00:42:58,400 --> 00:43:02,180
+وبعدين بيعمل ال construction لمين لنفرن على ال
+
+570
+00:43:02,180 --> 00:43:05,880
+tubules خاصة في لبوف ايه؟ of Hindley لإنه بيكون
+
+571
+00:43:05,880 --> 00:43:12,760
+ايه؟ a thin tubule ال albumin تسعة و ستين ألف
+
+572
+00:43:12,760 --> 00:43:17,580
+point 005 ال filterability مقارنة بالميه يعني إذا
+
+573
+00:43:17,580 --> 00:43:22,620
+الميه واحد هو خمسة في الألف من الواحد تمام؟ طيب
+
+574
+00:43:27,430 --> 00:43:30,350
+بالنسبة لـ negativity و الكلام هذا إذا قلنا عن ال
+
+575
+00:43:30,350 --> 00:43:34,030
+size و علاقة ال size بال filtration و ال
+
+576
+00:43:34,030 --> 00:43:37,710
+negativity قلنا عنها و اتكلمنا عن قلبه منه لو لإنه
+
+577
+00:43:37,710 --> 00:43:40,970
+negative discharge كان إيش كان طلع و هنا عندنا
+
+578
+00:43:40,970 --> 00:43:45,070
+تجربة اللي هي معمولة على نفس المادة المادة
+
+579
+00:43:45,070 --> 00:43:49,950
+polydextran المادة ديكستران ديكستران هذا شو
+
+580
+00:43:49,950 --> 00:43:55,150
+ديكستران زي ال dextrose مادة معينة polysaccharide
+
+581
+00:43:55,910 --> 00:44:03,310
+Polysaccharide بس حجمها بإمكاننا المادة هاد
+
+582
+00:44:03,310 --> 00:44:05,830
+الدكستران احنا بنستخدم الدكستران ك diuretic في
+
+583
+00:44:05,830 --> 00:44:11,070
+المستقبل او بنستخدمه لما بدنا .. يعني إله .. إله
+
+584
+00:44:11,070 --> 00:44:13,690
+.. إله أحجام مختلفة إله molecular weight دكستران و
+
+585
+00:44:13,690 --> 00:44:16,730
+high molecular weight دكستران مرات بنستخدمه علشان
+
+586
+00:44:16,730 --> 00:44:22,040
+بديلة لبلازمة عند اللزوم مرات بنحط الدكسترانفي ال
+
+587
+00:44:22,040 --> 00:44:25,660
+.. في ال .. في ال IV line في المحلول عشان احنا مش
+
+588
+00:44:25,660 --> 00:44:29,180
+لاجي دم احطه و بديش احط saline بعد شوية على طول
+
+589
+00:44:29,180 --> 00:44:33,360
+يطلع الكلية تطرده بديش ينحشس جوا شوية لحد ما الاجي
+
+590
+00:44:33,360 --> 00:44:38,360
+ايه لقى لاجي بلازمة او لاجي دم نستخدمه وسيط لحد ما
+
+591
+00:44:38,360 --> 00:44:43,200
+اوجد البلازمة او اوجد ال ايه الدم المناسب لهذه
+
+592
+00:44:43,200 --> 00:44:49,510
+الحالة تمام المهم هذا له حجم معينهو له أنواع
+
+593
+00:44:49,510 --> 00:44:51,270
+نيوترال نيوترال نيوترال نيوترال نيوترال نيوترال
+
+594
+00:44:51,270 --> 00:44:51,770
+نيوترال نيوترال نيوترال نيوترال نيوترال نيوترال
+
+595
+00:44:51,770 --> 00:44:55,910
+نيوترال نيوترال نيوترال نيوترال نيوترال نيوترال
+
+596
+00:44:55,910 --> 00:44:59,650
+نيوترال نيوترال نيوترال نيوترال نيوترال نيوترال
+
+597
+00:44:59,650 --> 00:45:00,210
+نيوترال نيوترال نيوترال نيوترال نيوترال نيوترال
+
+598
+00:45:00,210 --> 00:45:00,870
+نيوترال نيوترال نيوترال نيوترال نيوترال نيوترال
+
+599
+00:45:00,870 --> 00:45:06,210
+نيوترال نيوترال نيوترال نيوترال نيوترال نيوترال
+
+600
+00:45:06,210 --> 00:45:17,210
+نيوترال نيوت
+
+601
+00:45:23,620 --> 00:45:29,080
+الديكستران كل ما زدنا حجمه كل ما الفيلترابيليتي
+
+602
+00:45:29,080 --> 00:45:34,760
+جلت كل ما زغر حجمه كل ما الفيلترابيليتي كترت لكن
+
+603
+00:45:34,760 --> 00:45:40,060
+واضح ان ال positively charged هذا polycationicال
+
+604
+00:45:40,060 --> 00:45:43,620
+filterability على كل المستويات اعلى كتير من ال
+
+605
+00:45:43,620 --> 00:45:47,860
+neutral و اعلى كتير من ال negative ال charge تمام؟
+
+606
+00:45:47,860 --> 00:45:51,380
+اذا الحجم احنا لو استخدمنا اي احجام و قرنناها
+
+607
+00:45:51,380 --> 00:45:57,140
+بيلاحظ اللي بيحسب القمر في الآخر اه ال electrical
+
+608
+00:45:57,140 --> 00:46:01,100
+charge بتخليه more filterable او less filterable
+
+609
+00:46:01,100 --> 00:46:05,000
+okay طيب راجع للحجم
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..0321d0777070aa91c2b37750baa9f0d0a123166e
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/xkl23zSfYsY_raw.json
@@ -0,0 +1 @@
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2732.16, "word": " كل", "probability": 0.9248046875}, {"start": 2732.16, "end": 2732.24, "word": " ما", "probability": 0.8828125}, {"start": 2732.24, "end": 2733.12, "word": " الفيلترابيليتي", "probability": 0.90216064453125}, {"start": 2733.12, "end": 2734.14, "word": " كترت", "probability": 0.95703125}, {"start": 2734.14, "end": 2734.76, "word": " لكن", "probability": 0.6083984375}, {"start": 2734.76, "end": 2735.28, "word": " واضح", "probability": 0.9625651041666666}, {"start": 2735.28, "end": 2735.88, "word": " ان", "probability": 0.61669921875}, {"start": 2735.88, "end": 2735.98, "word": " ال", "probability": 0.64794921875}, {"start": 2735.98, "end": 2736.38, "word": " positively", "probability": 0.73388671875}, {"start": 2736.38, "end": 2737.02, "word": " charged", "probability": 0.951171875}, {"start": 2737.02, "end": 2737.66, "word": " هذا", "probability": 0.693359375}, {"start": 2737.66, "end": 2739.02, "word": " polycationic", "probability": 0.651611328125}], "temperature": 1.0}, {"id": 110, "seek": 276500, "start": 2739.84, "end": 2765.0, "text": "ال filterability على كل المستويات اعلى كتير من ال neutral و اعلى كتير من ال negative ال charge تمام؟ اذا الحجم احنا لو استخدمنا اي احجام و قرنناها بيلاحظ اللي بيحسب القمر في الآخر اه ال electrical charge بتخليه more filterable او less filterable okay طيب راجع للحجم", "tokens": [6027, 6608, 2310, 15844, 28242, 9673, 14851, 45865, 9307, 1975, 3615, 23942, 9122, 2655, 13546, 9154, 2423, 10598, 4032, 1975, 3615, 23942, 9122, 2655, 13546, 9154, 2423, 3671, 2423, 4602, 46811, 10943, 22807, 1975, 15730, 21542, 7435, 2304, 1975, 5016, 8315, 45164, 44713, 9778, 40448, 8315, 1975, 1829, 1975, 5016, 7435, 10943, 4032, 12174, 2288, 1863, 8315, 11296, 4724, 1829, 15040, 5016, 19913, 13672, 1829, 4724, 1829, 5016, 35457, 25062, 29973, 8978, 6024, 95, 34740, 1975, 3224, 2423, 12147, 4602, 39894, 9778, 20292, 3224, 544, 6608, 712, 1975, 2407, 1570, 6608, 712, 1392, 23032, 1829, 3555, 12602, 26108, 3615, 24976, 5016, 7435, 2304], "avg_logprob": -0.2749399095773697, "compression_ratio": 1.7136752136752136, "no_speech_prob": 0.0, "words": [{"start": 2739.84, "end": 2740.06, "word": "ال", "probability": 0.56005859375}, {"start": 2740.06, "end": 2740.62, "word": " filterability", "probability": 0.472503662109375}, {"start": 2740.62, "end": 2740.78, "word": " على", "probability": 0.6513671875}, {"start": 2740.78, "end": 2741.0, "word": " كل", "probability": 0.93408203125}, {"start": 2741.0, "end": 2741.74, "word": " المستويات", "probability": 0.86572265625}, {"start": 2741.74, "end": 2742.04, "word": " اعلى", "probability": 0.64208984375}, {"start": 2742.04, "end": 2742.58, "word": " كتير", "probability": 0.7615559895833334}, {"start": 2742.58, "end": 2743.3, "word": " من", "probability": 0.9736328125}, {"start": 2743.3, "end": 2743.62, "word": " ال", "probability": 0.8203125}, {"start": 2743.62, "end": 2744.0, "word": " neutral", "probability": 0.82568359375}, {"start": 2744.0, "end": 2744.4, "word": " و", "probability": 0.517578125}, {"start": 2744.4, "end": 2744.7, "word": " اعلى", "probability": 0.8841145833333334}, {"start": 2744.7, "end": 2745.06, "word": " كتير", "probability": 0.9632161458333334}, {"start": 2745.06, "end": 2745.24, "word": " من", "probability": 0.99365234375}, {"start": 2745.24, "end": 2745.34, "word": " ال", "probability": 0.80126953125}, {"start": 2745.34, "end": 2746.0, "word": " negative", "probability": 0.7197265625}, {"start": 2746.0, "end": 2746.22, "word": " ال", "probability": 0.18798828125}, {"start": 2746.22, "end": 2746.56, "word": " charge", "probability": 0.869140625}, {"start": 2746.56, "end": 2747.86, "word": " تمام؟", "probability": 0.61962890625}, {"start": 2747.86, "end": 2748.1, "word": " اذا", "probability": 0.770263671875}, {"start": 2748.1, "end": 2748.76, "word": " الحجم", "probability": 0.9031575520833334}, {"start": 2748.76, "end": 2749.26, "word": " احنا", "probability": 0.7421875}, {"start": 2749.26, "end": 2749.42, "word": " لو", "probability": 0.939453125}, {"start": 2749.42, "end": 2749.9, "word": " استخدمنا", "probability": 0.95849609375}, {"start": 2749.9, "end": 2750.1, "word": " اي", "probability": 0.927001953125}, {"start": 2750.1, "end": 2750.58, "word": " احجام", "probability": 0.8466796875}, {"start": 2750.58, "end": 2750.7, "word": " و", "probability": 0.984375}, {"start": 2750.7, "end": 2751.38, "word": " قرنناها", "probability": 0.75615234375}, {"start": 2751.38, "end": 2752.18, "word": " بيلاحظ", "probability": 0.7294921875}, {"start": 2752.18, "end": 2752.54, "word": " اللي", "probability": 0.743408203125}, {"start": 2752.54, "end": 2752.86, "word": " بيحسب", "probability": 0.9005126953125}, {"start": 2752.86, "end": 2753.34, "word": " القمر", "probability": 0.75732421875}, {"start": 2753.34, "end": 2753.92, "word": " في", "probability": 0.76123046875}, {"start": 2753.92, "end": 2754.4, "word": " الآخر", "probability": 0.8492838541666666}, {"start": 2754.4, "end": 2755.34, "word": " اه", "probability": 0.65576171875}, {"start": 2755.34, "end": 2755.56, "word": " ال", "probability": 0.94970703125}, {"start": 2755.56, "end": 2757.14, "word": " electrical", "probability": 0.35888671875}, {"start": 2757.14, "end": 2757.76, "word": " charge", "probability": 0.96484375}, {"start": 2757.76, "end": 2758.84, "word": " بتخليه", "probability": 0.8900146484375}, {"start": 2758.84, "end": 2759.14, "word": " more", "probability": 0.92919921875}, {"start": 2759.14, "end": 2759.86, "word": " filterable", "probability": 0.920166015625}, {"start": 2759.86, "end": 2760.2, "word": " او", "probability": 0.963134765625}, {"start": 2760.2, "end": 2760.48, "word": " less", "probability": 0.9296875}, {"start": 2760.48, "end": 2761.1, "word": " filterable", "probability": 0.95654296875}, {"start": 2761.1, "end": 2761.68, "word": " okay", "probability": 0.355712890625}, {"start": 2761.68, "end": 2763.1, "word": " طيب", "probability": 0.8097330729166666}, {"start": 2763.1, "end": 2764.16, "word": " راجع", "probability": 0.8015950520833334}, {"start": 2764.16, "end": 2765.0, "word": " للحجم", "probability": 0.904541015625}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2765.5895, "duration_after_vad": 2695.158124999988}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/yZHQsvDX5Ow.srt b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/yZHQsvDX5Ow.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d8eb4cf0e291a4d91172637b5155e630903c96ca
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/yZHQsvDX5Ow.srt
@@ -0,0 +1,1450 @@
+1
+00:00:07,510 --> 00:00:12,870
+تبعنا إذاً الـ size والـ electric charge
+
+2
+00:00:12,870 --> 00:00:20,110
+وضربنا مثلًا في الـ argument إنه بيقدر يعدي إذاً من
+
+3
+00:00:20,110 --> 00:00:23,650
+ناحية الـ holes كـ holes بيقدر يعدي، بس بيقدرش لإنه
+
+4
+00:00:23,650 --> 00:00:28,410
+في عندنا نيجاتيف الـ charged ions  تنعمل إنها إيه to
+
+5
+00:00:28,410 --> 00:00:33,890
+be إيه freely filtrated، وقلت لكم عن minimal change
+
+6
+00:00:33,890 --> 00:00:39,310
+يعني في روبوتيو.. وقلت لكم إيه الـ protein والـ..
+
+7
+00:00:39,310 --> 00:00:45,530
+اه طيب، determinants of GFR، الـ GFR هذا أنا تقوى
+
+8
+00:00:45,530 --> 00:00:51,430
+تخطيت الصفحات وحكيت لكم عن الـ GFR إنه في عندنا
+
+9
+00:00:51,430 --> 00:00:56,150
+حاجتين: net forces of filtration، وعندنا الـ
+
+10
+00:00:56,150 --> 00:01:01,150
+إيه الـ permeability أو الـ capillary filtration
+
+11
+00:01:01,150 --> 00:01:04,010
+coefficient،  الـ filtration coefficient two
+
+12
+00:01:04,010 --> 00:01:08,430
+factors: الـ size تبع الـ filtration surface، جديش
+
+13
+00:01:08,430 --> 00:01:11,970
+حجمه، والـ permeability تبع الـ membrane نفسه، الـ membrane
+
+14
+00:01:11,970 --> 00:01:15,610
+موجود كويس، فيه filterability عالي، أو واقعي، طب و
+
+15
+00:01:15,610 --> 00:01:18,870
+جديش المساحة اللي مشغول عليها، مش كده؟ طيب، الـ
+
+16
+00:01:18,870 --> 00:01:24,190
+factors اتكلمنا عنها إحنا من شوية، أو جبنا إحنا هنا
+
+17
+00:01:24,190 --> 00:01:26,510
+بيقول hydrostatic pressure inside the glomerular
+
+18
+00:01:26,510 --> 00:01:33,150
+capillary pressure P في G في الـ glomerulus أو الـ
+
+19
+00:01:33,150 --> 00:01:36,860
+pressure في الـ Bowman's capsule، ناقص الـ.. الـ.. الـ
+
+20
+00:01:36,860 --> 00:01:40,660
+by هذه تبعت مين؟ تبعت الـ.. اه الـ.. الـ oncotic
+
+21
+00:01:40,660 --> 00:01:43,260
+pressure اللي بتسميه هكذا، أو الـ colloidal pressure
+
+22
+00:01:43,260 --> 00:01:48,980
+تمام؟ اه، اللي في داخل الـ glomerulus بيصير عكس الـ
+
+23
+00:01:48,980 --> 00:01:52,000
+filtration، بيصير بالـ.. بالـ minus، واللي في الـ
+
+24
+00:01:52,000 --> 00:01:54,320
+Bowman's capsule بالـ positive، بس ده دايمًا قيمتها
+
+25
+00:01:54,320 --> 00:01:58,020
+إيه؟ صفر في الـ normal، لذلك بيصير عندنا الأخيرة هذه
+
+26
+00:01:58,020 --> 00:02:01,260
+موضوعة، بيصير عندنا فرق الـ pressure من هنا إلى هنا
+
+27
+00:02:02,240 --> 00:02:05,020
+اه، وبعدين لما نخسر منه جديش في عندي protein
+
+28
+00:02:05,020 --> 00:02:08,040
+بيشتغل برضه، تنعمل يلمع عكسها، بيطلع عندي الـ net
+
+29
+00:02:08,040 --> 00:02:12,780
+result، قولنا جديش ten millimeter mercury، ten
+
+30
+00:02:12,780 --> 00:02:15,820
+millimeter mercury، لو حسبناها كده تطلع ten
+
+31
+00:02:15,820 --> 00:02:19,880
+millimeter mercury، طب حلو، الـ ten millimeter
+
+32
+00:02:19,880 --> 00:02:25,540
+mercury هذا اللي هو الـ net filtration
+
+33
+00:02:25,540 --> 00:02:29,760
+pressure، السابعة بتاعتنا، طب كيف إحنا ممكن
+
+34
+00:02:29,760 --> 00:02:35,620
+نحسب الـ filtration coefficient، الـ surface، و
+
+35
+00:02:35,620 --> 00:02:42,100
+filterability، هو يعبر عنه شيء إحنا
+
+36
+00:02:42,100 --> 00:02:51,940
+قلنا إن الـ glomerular filtration rate جاي
+
+37
+00:02:51,940 --> 00:02:58,580
+من من؟ من البلازما، جاي من إيه؟ من البلازما، إذاً
+
+38
+00:02:58,580 --> 00:03:03,970
+حسبنا كده، يحصل filtration في الدقيقة، وقداش بلازما
+
+39
+00:03:03,970 --> 00:03:06,610
+بتعدي في الكلية في الدقيقة، إحنا بنقول نسبة اتنين في
+
+40
+00:03:06,610 --> 00:03:11,390
+المية، مش كده؟ بيصير في filtration، إذاً إحنا المعادلة
+
+41
+00:03:11,390 --> 00:03:17,670
+فوق لو نحطها، net filtration forces، لأ، المعادلة هي
+
+42
+00:03:17,670 --> 00:03:25,950
+هذه، الـ Kf فيها دول، هدول إن عرفنا الـ GFR، انعرفت، مش
+
+43
+00:03:25,950 --> 00:03:28,350
+كده، والـ
+
+44
+00:03:34,240 --> 00:03:38,760
+الـ forces هذه، مش هذه المعادلة اللي هستخدمها، هستخدم
+
+45
+00:03:38,760 --> 00:03:44,860
+إن هنا في إيه؟ في
+
+46
+00:03:44,860 --> 00:03:51,120
+عندي التناسب الـ
+
+47
+00:03:51,120 --> 00:03:57,100
+net filtration forces هذه، بدي أنا أحسبها، net
+
+48
+00:03:57,100 --> 00:04:01,150
+filtration forces، بدي أحسبها، والـ GFR بدي أحسبها
+
+49
+00:04:01,150 --> 00:04:05,950
+هدى على هدى، تساوي لإنه.. لإنه الـ.. الـ GFR تساوي
+
+50
+00:04:05,950 --> 00:04:09,250
+الـ net filtration forces مضروبة في إيه؟ في الـ KF
+
+51
+00:04:09,250 --> 00:04:13,570
+تمام؟ إذاً أعمل معادلة هذه، إذا عرفنا two factors
+
+52
+00:04:13,570 --> 00:04:17,430
+بعرف التالت، فإذا أنا عرفت الـ GFR و net filtration
+
+53
+00:04:17,430 --> 00:04:21,590
+forces، بقدر بسهولة أعرف مين؟ الـ KF، بس كيف أعرف الـ
+
+54
+00:04:21,590 --> 00:04:25,030
+net filtration forces، هذه قصة برضه إيه؟ كبيرة، فيها
+
+55
+00:04:25,030 --> 00:04:28,600
+خلاف، وطريقة القياس، وما علينا، المهم إنه قصدنا نقول
+
+56
+00:04:28,600 --> 00:04:34,280
+إنه إنه الـ KF هذه في الطبيعي لها رقم معين، مرات
+
+57
+00:04:34,280 --> 00:04:38,600
+بنلاقي زيادة، مرات بنلاقي نقص، في diseases بتصيب الـ
+
+58
+00:04:38,600 --> 00:04:41,720
+membrane هذا، بتؤدي إلى إنه الـ filtration
+
+59
+00:04:41,720 --> 00:04:47,000
+coefficient، إيش بيصير؟ في أمراض بتضرب الـ capillaries
+
+60
+00:04:47,000 --> 00:04:52,100
+الـ glomeruli، بتقلل عدد الـ glomeruli، لما يقل عدد الـ
+
+61
+00:04:52,100 --> 00:04:57,250
+glomeruli، الـ surface area بتقل، تمام؟ صنعنا الـ
+
+62
+00:04:57,250 --> 00:05:01,830
+filtration، بتم مش في مليون glomerulus، بتم في نص
+
+63
+00:05:01,830 --> 00:05:05,390
+مليون، في ربع مليون، يعني الـ surface area تبعت الـ
+
+64
+00:05:05,390 --> 00:05:11,730
+filtration surface، تمام؟ بتقل، وهكذا، المهم ما
+
+65
+00:05:11,730 --> 00:05:14,430
+علينا، إحنا سؤالنا الآن، الـ filtration coefficient
+
+66
+00:05:14,430 --> 00:05:20,290
+هذا، بمعنى
+
+67
+00:05:20,290 --> 00:05:26,270
+إنه جديش عندي net forces pressure، جديش net forces
+
+68
+00:05:26,270 --> 00:05:34,490
+pressure، بيديني filtration، تمام؟ عندنا الـ
+
+69
+00:05:34,490 --> 00:05:39,890
+filtration، بيصير عندي 125 مللتر تقريبًا per minute
+
+70
+00:05:39,890 --> 00:05:47,070
+تمام؟ وعندي الـ forces عشرة، عشرة ملليمتر mercury، مش
+
+71
+00:05:47,070 --> 00:05:50,170
+كده؟ الـ net forces، إذاً قلنا كل one millimeter
+
+72
+00:05:50,170 --> 00:05:57,000
+mercury بيديني اثنين عشر ونص milliliter filtrate
+
+73
+00:05:57,000 --> 00:06:03,160
+per minute، مش هيك؟ إذاً أنا بقدر أحسب أنا الـ
+
+74
+00:06:03,160 --> 00:06:07,100
+filtration forces هذه، جديش إيه؟
+
+75
+00:06:11,450 --> 00:06:17,510
+جديش بتديني forces، إذاً because total GFR for both
+
+76
+00:06:17,510 --> 00:06:20,510
+kidneys is about 115 مللتر، and the net
+
+77
+00:06:20,510 --> 00:06:23,330
+filtration force is 10 millimeter mercury، the
+
+78
+00:06:23,330 --> 00:06:26,730
+normal KF is calculated to be من خلال معادلة هذه
+
+79
+00:06:26,730 --> 00:06:31,770
+تمام، الـ GFR على الـ forces، الـ GFR 125 على الـ force
+
+80
+00:06:31,770 --> 00:06:36,190
+اللي هو عشرة، الـ net forces، إذاً الـ KF بيساوي إيه؟ الـ
+
+81
+00:06:36,190 --> 00:06:41,690
+filtration coefficient، عندها اثنين عشر ونص، هذا for the
+
+82
+00:06:41,690 --> 00:06:48,770
+two kidneys، طيب لو إحنا قلنا الحسبة بالنسبة للجسم
+
+83
+00:06:48,770 --> 00:06:51,050
+برضه في filtration coefficient، في الـ general
+
+84
+00:06:51,050 --> 00:06:55,550
+circulation، بس هنا كان نحسب بالماية ملل جرام، هنا
+
+85
+00:06:55,550 --> 00:07:00,110
+بنقول الكلية كده وزنها، خلينا نعمل حسبة بالماية ملل
+
+86
+00:07:00,110 --> 00:07:03,770
+جرام، هنلاقي بالماية ملل جرام، عندنا الـ filtration
+
+87
+00:07:03,770 --> 00:07:07,130
+coefficient،  بيساوي أربعة واتنين من عشرة milliliter
+
+88
+00:07:07,130 --> 00:07:11,050
+per minute for each millimeter mercury، مش كده؟ إذاً
+
+89
+00:07:11,050 --> 00:07:15,990
+هذا
+
+90
+00:07:15,990 --> 00:07:19,310
+لما نقارنه بالـ general circulation، نلاقي في فرق
+
+91
+00:07:19,310 --> 00:07:22,770
+رهيب، لإنه الـ filtration coefficient للـ general
+
+92
+00:07:22,770 --> 00:07:27,330
+circulation point oh one، هذا أربعة واتنين من عشرة
+
+93
+00:07:27,330 --> 00:07:32,070
+millimeter mercury per per minute per millimeter
+
+94
+00:07:32,070 --> 00:07:35,670
+mercury، هناك الـ millimeter mercury في الـ minute
+
+95
+00:07:35,670 --> 00:07:40,390
+بيطلع لي point one milliliter، واحد على مية من الـ
+
+96
+00:07:40,390 --> 00:07:45,010
+millimeter في الدقيقة، يعني كل مائة دقيقة بيطلع لي
+
+97
+00:07:45,010 --> 00:07:52,350
+إيه؟ one milliliter، في مائة جرام، في الحسبة، بمعنى إن
+
+98
+00:07:52,350 --> 00:07:56,510
+عندي filtration عالي، عالي جدًا، الـ pressure الواحد
+
+99
+00:07:56,510 --> 00:07:59,750
+بتديني كمية ضخمة من الـ filtration، لإنه الـ membrane
+
+100
+00:07:59,750 --> 00:08:05,630
+has high filtration coefficient، لما.. لما نقارن
+
+101
+00:08:05,630 --> 00:08:12,790
+هذا.. كم مرة منك بتتضاعف؟ كم مرة؟ يعني فرق..
+
+102
+00:08:12,790 --> 00:08:17,230
+فرق ضخم، مش كده؟ although.. وهذا اللي بيؤدي إلي
+
+103
+00:08:17,230 --> 00:08:21,830
+عندي filtration سريع، وكتير، وعالي، the high KF for
+
+104
+00:08:21,830 --> 00:08:24,630
+glomerular capillaries contributes tremendously to
+
+105
+00:08:24,630 --> 00:08:27,510
+their rapid rate of fluid filtration، إذاً إن الـ
+
+106
+00:08:27,510 --> 00:08:29,450
+filtration coefficient اللي هما دول، بيخلي عندي
+
+107
+00:08:29,450 --> 00:08:30,210
+filtration عالي
+
+108
+00:08:33,130 --> 00:08:39,750
+أما إن أهمية KF تحفظ GFR، وأهمية KF تحفظ GFR،
+
+109
+00:08:39,750 --> 00:08:45,720
+فالتغيير في KF do not provide a primary mechanism
+
+110
+00:08:45,720 --> 00:08:49,240
+for normal، يعني الـ KF هو الـ filtration coefficient
+
+111
+00:08:49,240 --> 00:08:53,980
+للكلية، مش كل يوم بيتغير، أو هو ما عدا diseases، أبحث
+
+112
+00:08:53,980 --> 00:08:58,340
+عليه، أشوف الـ KF جديش؟ لأ، هو مش factor بيتغير من
+
+113
+00:08:58,340 --> 00:09:02,000
+دقيقة لدقيقة، ثابت، حجم الـ surface، عدد الـ glomeruli
+
+114
+00:09:02,000 --> 00:09:06,280
+يعني موجود هو هو، والنوع هو هو، مش هذا العامل اللي
+
+115
+00:09:06,280 --> 00:09:09,520
+بيغير الـ filtration، أو بيجعل الـ filtration، يعني مش
+
+116
+00:09:09,520 --> 00:09:14,160
+زي الضغط، الضغط إنيعلي بيزيد الـ filtration، والضغط
+
+117
+00:09:14,160 --> 00:09:21,180
+بينزل بسرعة، والضغط يطلع بسرعة، بينزل ويزيد، لكن الـ
+
+118
+00:09:21,180 --> 00:09:25,480
+filtration coefficient، مش.. يعني مش day to day، مش
+
+119
+00:09:25,480 --> 00:09:29,780
+minute to minute factor that affects filtration
+
+120
+00:09:29,780 --> 00:09:34,020
+تمام؟ لكنه عندنا إحنا واضح إن الـ KF عالي جدًا
+
+121
+00:09:34,020 --> 00:09:40,430
+مقارنة بالـ A، لكن في عندنا some diseases بتضر
+
+122
+00:09:40,430 --> 00:09:46,610
+الـ membrane، وبتغير من نوعيته، واضح؟ لكن مش هو
+
+123
+00:09:46,610 --> 00:09:50,450
+إنّه factor من الـ factors اللي عن طريقه الجسم بيتحكم
+
+124
+00:09:50,450 --> 00:09:53,790
+بالـ filtration في كل لحظة، لأ، التحكم بالـ filtration
+
+125
+00:09:53,790 --> 00:09:57,290
+بالـ hydrostatic mainly، بالـ hydrostatic pressure اللي
+
+126
+00:09:57,290 --> 00:10:01,050
+في الـ glomerulus، ليش؟ اه لإنه في عندي أوعية جميلة
+
+127
+00:10:01,050 --> 00:10:06,120
+أوعية، afferent و efferent، وبينهم مين؟ بينهم الـ
+
+128
+00:10:06,120 --> 00:10:10,460
+glomerulus، إن فتحنا الـ.. الـ afferent أكثر، بيزيد
+
+129
+00:10:10,460 --> 00:10:13,920
+الضغط أكثر، بيصير الـ filtration أكثر، ويرجع أكثر إن
+
+130
+00:10:13,920 --> 00:10:21,130
+ضيقنا، بنقلل الضغط، الـ afferent يضيق، بنقلل الضغط، بنقلل الـ
+
+131
+00:10:21,130 --> 00:10:23,470
+hydrostatic pressure، بنقلل الـ إيه؟ لإنه الـ
+
+132
+00:10:23,470 --> 00:10:26,390
+hydrostatic pressure هو العامل الرئيسي المهم، و
+
+133
+00:10:26,390 --> 00:10:29,850
+اللي قابل للتغيير، الـ proteins ما بتتغيرش من يوم ليوم،
+
+134
+00:10:29,850 --> 00:10:33,150
+من لحظة للحظة، لكن بزود الضغط، بنقلل الضغط على طول،
+
+135
+00:10:33,150 --> 00:10:37,170
+إشارة سكّر الشريان، قلل الضغط، قلل الـ filtration، افتح
+
+136
+00:10:37,170 --> 00:10:40,690
+الشريان، فتحناه، بس عندي الـ afferent والـ afferent
+
+137
+00:10:40,690 --> 00:10:46,530
+بمعنى إنه لما يفتح الـ afferent، بيزيد الضغط، ولو فتحنا
+
+138
+00:10:46,530 --> 00:10:51,610
+الـ efferent بنقلل الضغط، ولو سكرنا الـ afferent بيزيد
+
+139
+00:10:51,610 --> 00:10:57,090
+الضغط، اه، إذاً لو سكرنا الـ afferent بنقلل الضغط، يعني
+
+140
+00:10:57,090 --> 00:11:01,270
+هدول الاثنين واحد هنا، وواحد هنا، عكس بعض بيشتغلوا،
+
+141
+00:11:01,270 --> 00:11:06,620
+مش كده؟ إذاً الـ day to day control أو الـ time to
+
+142
+00:11:06,620 --> 00:11:08,900
+time control is mainly عبر الـ hydrostatic، في
+
+143
+00:11:08,900 --> 00:11:12,160
+factors كتير متغيرة موجودة، بتتحكم، بس مش كلها
+
+144
+00:11:12,160 --> 00:11:16,040
+متغيرة بالسرعة اللي بتتغير فيها، يعني مش كلها
+
+145
+00:11:16,040 --> 00:11:20,260
+controlling الـ filtration والـ urine formation
+
+146
+00:11:20,260 --> 00:11:23,940
+تمام، هي ثابتة، اللي بيتغير الوحيد اللي بيقدر يتغير
+
+147
+00:11:23,940 --> 00:11:27,100
+ويطلع وينزل، يزيد الـ ball ويقلل الـ ball، كثرة الأشياء
+
+148
+00:11:27,100 --> 00:11:31,140
+على الـ tubule بيبعت إشارة سكّر، إشارة يعني لإنه أنا
+
+149
+00:11:31,140 --> 00:11:35,540
+أصلًا واصلني أكثر من جدرتي، بيسكر، اه، يواصل ويقلله،
+
+150
+00:11:35,540 --> 00:11:38,700
+افتح، أنا واصلني شيء قليل، افتح، فهذا بيصير control
+
+151
+00:11:38,700 --> 00:11:43,260
+بتزوّد الفترة، اه، vascular hydrostatic changes، لكن
+
+152
+00:11:43,260 --> 00:11:46,040
+لأ، الـ coefficient ما بتتغيرش من لحظة للحظة، ولا الـ
+
+153
+00:11:46,040 --> 00:11:50,200
+الـ osmotic pressure ما بتتغيرش من لحظة للحظة، ممكن تكون
+
+154
+00:11:50,200 --> 00:11:53,000
+لحظة تتغير، علشان اسمها بس، في حين إن أنا بأتكلم
+
+155
+00:11:53,000 --> 00:11:56,840
+general، أوكي، واحد اليوم عنده مشكلة في الـ.. في
+
+156
+00:11:56,840 --> 00:12:00,200
+الكلية، الـ filtration coefficient بيقل، اه لإنه
+
+157
+00:12:00,200 --> 00:12:04,620
+انضربت الـ membrane، خلاص، بيضّل مضروب، مش إنه دقيقة
+
+158
+00:12:04,620 --> 00:12:07,880
+بيفتح ودقيقة بيسكر مثلًا، reducing the number of
+
+159
+00:12:07,880 --> 00:12:11,380
+functioning nephrons، هنا قلت لكم أنا بعد سن
+
+160
+00:12:11,380 --> 00:12:18,120
+الأربعين، بعد سن الأربعين بنبدأ نفقد سنويًا one
+
+161
+00:12:18,120 --> 00:12:22,120
+percent من عدد الـ A، يعني عند سن ثمانين بيصير إحنا
+
+162
+00:12:22,120 --> 00:12:24,560
+عندنا أربعين في المية من الـ capillaries، من الـ
+
+163
+00:12:24,560 --> 00:12:30,280
+glomeruli فاقدة، فبتنخفض قدرة الكلية، لكن هذا
+
+164
+00:12:30,280 --> 00:12:34,090
+هذا ما بيأثرش على الجسم، لإنه لو إحنا
+
+165
+00:12:34,090 --> 00:12:38,610
+اشتغلنا بـ 60% من الكلية إحنا بخير، لسه عندنا لو
+
+166
+00:12:38,610 --> 00:12:41,850
+ضلت الكلية تضرب تضرب تضرب، ما بنضل نشتغل طبيعي،
+
+167
+00:12:41,850 --> 00:12:45,630
+ما بنحسش بأي فرق لحد ما يصير عندي ربع الكلية تشتغل،
+
+168
+00:12:45,630 --> 00:12:49,190
+لحد ربع الكلية، أنا بقصدي طبيعي، أقل من ربع
+
+169
+00:12:49,190 --> 00:12:52,230
+الكلية، ببدأ يبين عليّ إيه؟ الـ electrolytes
+
+170
+00:12:52,230 --> 00:12:55,390
+اتخبطت، والكلية تعاني، عالية والـ يوريا عالية، والـ
+
+171
+00:12:59,660 --> 00:13:04,640
+أقل من هيك، أكثر من هيك، فوق الـ.. فوق الـ.. الـ
+
+172
+00:13:04,640 --> 00:13:08,640
+الـ.. الـ.. الخمسة عشر في المية، الربع، اه، بيضلها شغالة
+
+173
+00:13:08,640 --> 00:13:12,400
+تمام؟ إذاً إيه؟ إذاً، لكن الكفاءة بتقل مع الـ.. مع
+
+174
+00:13:12
+
+223
+00:16:42,100 --> 00:16:48,740
+تمام، ووقفت في الـ ureter ووقفت في الـ pelvis أو أي
+
+224
+00:16:48,740 --> 00:16:52,200
+mechanical يعني physiological problem زي اللي
+
+225
+00:16:52,200 --> 00:16:55,500
+بيصير أحيانًا في الـ junction بين الـ ureter والـ
+
+226
+00:16:55,500 --> 00:17:02,260
+pelvis تبع الكدن بيوجي بيوجيبـالـ Eurythmic
+
+227
+00:17:02,260 --> 00:17:04,780
+junction. ممكن احنا عند بعض الناس اللي الـ junction
+
+228
+00:17:04,780 --> 00:17:08,300
+فيها مشكلة، بتقدرش البريستالزيس تنتقل منها لها.
+
+229
+00:17:08,300 --> 00:17:12,820
+فبتحوش الـ ball فيها، فبيعمل back pressure على إيه؟
+
+230
+00:17:12,820 --> 00:17:15,960
+على الـ nephron، بيصل الـ back pressure لمين؟ لبومانس
+
+231
+00:17:15,960 --> 00:17:19,160
+capsule، فبيعمل عملية عكسية للـ filtration.
+
+232
+00:17:19,160 --> 00:17:24,660
+فكرة في نموذج في دراسة الكلية بنسميها stop flow
+
+233
+00:17:24,660 --> 00:17:31,080
+model، يعني بناخد nephron، بنضفه، وبنحط في الطرف
+
+234
+00:17:31,080 --> 00:17:36,160
+النهائي تبعه fluid، وبنضل نعلي الضغط فيه واحنا
+
+235
+00:17:36,160 --> 00:17:40,240
+بندرس الـ filtration في الـ nephron. تمام، ممكن نعلي
+
+236
+00:17:40,240 --> 00:17:42,860
+الضغط.. نعلي الضغط.. نعلي الضغط لحد ما إيش؟ الـ
+
+237
+00:17:42,860 --> 00:17:47,680
+filtration يتوقف تمامًا، لإن أنا back pressure على الـ
+
+238
+00:17:47,680 --> 00:17:50,560
+Bowman's capsule، يسووا الـ brusher تبع مين؟
+
+239
+00:17:50,560 --> 00:17:54,600
+تبع الـ hydrostatic pressure مع الـ osmotic.. مع الـ
+
+240
+00:17:54,600 --> 00:17:56,240
+oncotic pressure، يسووا التانيين، يسووا الـ
+
+241
+00:17:56,240 --> 00:17:59,220
+hydrostatic pressure، فبيصير عندي no filtration.. no
+
+242
+00:17:59,220 --> 00:18:03,760
+filtration technique، تمام؟ صار عندي model مافيش
+
+243
+00:18:03,760 --> 00:18:06,740
+فيه filtration، بجلق الـ pressure شوية اللي أنا عامله
+
+244
+00:18:06,740 --> 00:18:10,410
+وببدأ الـ filtration. بجلد طبعًا، فعندنا احنا clinically
+
+245
+00:18:10,410 --> 00:18:18,070
+ممكن نخش في حاجة زي كده، لذلك واحد عنده حصوات كلية
+
+246
+00:18:18,070 --> 00:18:21,590
+مسكرة بطريقة معينة، أحيانًا بتكون emergency، لازم
+
+247
+00:18:21,590 --> 00:18:24,750
+خلال أنا فترة بسيطة، إيه؟ أطلعها، لإن عشان أحمل إيه؟
+
+248
+00:18:24,750 --> 00:18:27,810
+الكلى من الـ back pressure تبعها اللي ممكن يكون
+
+249
+00:18:27,810 --> 00:18:29,550
+very damaging.
+
+250
+00:18:54,390 --> 00:18:57,570
+increased glomerular capillary colloid osmotic
+
+251
+00:18:57,570 --> 00:19:01,980
+pressure. إذا احنا بنقول بناخد الـ factors الأقل
+
+252
+00:19:01,980 --> 00:19:06,180
+أهمية، عشان في الآخر ناخد الباقي بالتفصيل، بنقول
+
+253
+00:19:06,180 --> 00:19:10,720
+الـ KF، بنقول الـ hydrostatic pressure في بومانز capsule، الآن
+
+254
+00:19:10,720 --> 00:19:14,260
+الـ osmotic pressure أو الـ oncotic أو الـ colloidal
+
+255
+00:19:14,260 --> 00:19:20,200
+pressure في داخل مين؟ الـ capillary، تمام؟ هذا مهم،
+
+256
+00:19:20,200 --> 00:19:24,240
+مهم جدًا، لكن هذا مش برضه factor بنقدر نلعب فيه
+
+257
+00:19:24,240 --> 00:19:28,850
+بسرعة، لكن في diseases معينة زي ما قولنا الـ
+
+258
+00:19:28,850 --> 00:19:34,050
+diseases اللي هي إيه؟ في liver failure مثلًا، liver
+
+259
+00:19:34,050 --> 00:19:40,550
+failure، الـ protein formation، الـ albumin formation
+
+260
+00:19:40,550 --> 00:19:45,950
+صار lagging، صار الـ protein اللي بتتكسر ما يساويش الـ
+
+261
+00:19:45,950 --> 00:19:49,150
+protein اللي بتُصنع، فبلاحظ إن يوم عن يوم عن يوم عن
+
+262
+00:19:49,150 --> 00:19:53,550
+يوم بيصير عندنا hypoproteinemia، الـ protein في الدم
+
+263
+00:19:53,550 --> 00:19:57,690
+بدأ إيش؟ إنخفض، مش كده؟ كل ما انخفض الـ protein في الدم
+
+264
+00:19:59,120 --> 00:20:04,340
+معناها في عندي filtration أكثر، مظبوط؟ وطبعًا احنا
+
+265
+00:20:04,340 --> 00:20:07,740
+مانساش إن نفس الكلية نفسها، إذا في عندي chronic
+
+266
+00:20:07,740 --> 00:20:12,000
+renal failure، في بروتينوريا، والبروتين بهبط،
+
+267
+00:20:12,000 --> 00:20:15,480
+معناها الـ oncotic pressure صار إيه؟ أجل، معناها
+
+268
+00:20:15,480 --> 00:20:17,680
+صار في عندي filtration أكثر.
+
+269
+00:20:29,330 --> 00:20:32,590
+الآن الـ osmotic pressure، هذا الـ oncotic pressure
+
+270
+00:20:32,590 --> 00:20:39,690
+لاحظوا من ناحية الـ afferent artery ومن ناحية الـ efferent
+
+271
+00:20:39,690 --> 00:20:46,430
+artery، تمام؟ بينهم الـ glomerulus، بيصير عندي
+
+272
+00:20:46,430 --> 00:20:50,850
+filtration، filtration، واحنا ماشي الدم ماشي من
+
+273
+00:20:50,850 --> 00:20:58,010
+الـ afferent للـ efferent، طول ما هو ماشي بيفقد جزء منه، مش
+
+274
+00:20:58,010 --> 00:21:02,650
+كده؟ بيفقد الـ fluids، بيفقدش الـ protein، تمام؟ فطول ما
+
+275
+00:21:02,650 --> 00:21:06,710
+الدم ماشي في الـ glomerulus هو بيفقد سوائل، سوائل،
+
+276
+00:21:06,710 --> 00:21:14,270
+سوائل، لحد ما يفقد، لحد ما يفقد عشرين في المية من
+
+277
+00:21:14,270 --> 00:21:18,110
+السوائل اللي فيه. لما يفقد السوائل، ليش بيصير في الـ
+
+278
+00:21:18,110 --> 00:21:25,840
+كلودة المرشحة؟ بيعلى، مش كده؟ بمعنى آخر، إنه احنا طول
+
+279
+00:21:25,840 --> 00:21:29,920
+ما إنه الـ hydrostatic pressure، الـ net result تبعته
+
+280
+00:21:29,920 --> 00:21:33,720
+عشرة، طول ما إنه في filtration، إذا الـ osmotic
+
+281
+00:21:33,720 --> 00:21:37,260
+pressure مع فقدان السوائل بدأ يعلى، يعلى، يعلى، بيصل
+
+282
+00:21:37,260 --> 00:21:41,920
+لمرحلة، في نقطة معينة، بيصير في balance بين الـ
+
+283
+00:21:41,920 --> 00:21:47,610
+filtering والـ absorbing forces، فبيتوقف الـ filtration.
+
+284
+00:21:47,610 --> 00:21:51,470
+يعني الـ glomerulus وهي بتعمل filtration مش من
+
+285
+00:21:51,470 --> 00:21:54,930
+أول الـ capillary لآخر الـ capillary، بتعمل filtration
+
+286
+00:21:54,930 --> 00:21:59,250
+عند مرحلة معينة، بيصير الـ filtration بتتوقف. ليش؟ لإن الـ
+
+287
+00:21:59,250 --> 00:22:02,290
+oncotic pressure، لإنه فقد سوائل، الـ oncotic
+
+288
+00:22:02,290 --> 00:22:05,810
+pressure بيصير يساوي الـ hydrostatic pressure، تمام؟
+
+289
+00:22:05,810 --> 00:22:09,950
+فبيمنعه من إنه يصير more filtration، واضح؟ لذلك الـ
+
+290
+00:22:09,950 --> 00:22:12,940
+..الـ osmotic pressure أو الـ oncotic pressure في
+
+291
+00:22:12,940 --> 00:22:16,320
+الـ afferent بيبقى عند الـ afferent بيكون واطي، عند
+
+292
+00:22:16,320 --> 00:22:19,940
+الـ efferent بيكون إيه؟ عالي، فاحنا لما بنجيء دائمًا،
+
+293
+00:22:19,940 --> 00:22:23,480
+بنجيء بناخد midway بين الاتنين، بنلاحظ إحنا عندنا
+
+294
+00:22:23,480 --> 00:22:27,460
+إنه في الـ.. في الـ.. الـ.. الـ.. osmolality تبعت
+
+295
+00:22:27,460 --> 00:22:30,360
+أو الـ.. الـ.. كل ده الـ pressure تبع الـ plasma، 28
+
+296
+00:22:30,360 --> 00:22:35,220
+مليمتر زئبق، تمام؟ لكن هذا اللي داخل مع الـ afferent
+
+297
+00:22:35,220 --> 00:22:37,800
+لكن مع الـ efferent دي، صار الـ efferent بنلاقي صار ثانية
+
+298
+00:22:37,800 --> 00:22:41,760
+ثنين وثلاثين، صار ستة وثلاثين، صار إيش؟ صار ستة و
+
+299
+00:22:41,760 --> 00:22:45,560
+ثلاثين، ليش؟ لإنه فقدنا إحنا خمسة في المية، معناها بيزيد
+
+300
+00:22:45,560 --> 00:22:49,580
+خمس الكمية، بيزيد، إذا كانت أكبر، هيضاعف، مش كده؟
+
+301
+00:22:49,580 --> 00:22:54,680
+فبنلاقي إنه في ناحية الـ efferent صار ستة وثلاثين، لما
+
+302
+00:22:54,680 --> 00:22:57,980
+نعمل حسابات، احنا بنعمل حسابات طب، midway جدًّا كان
+
+303
+00:22:57,980 --> 00:23:00,180
+فبنقول بين الثانية والثلاثين وستة والثلاثين بنقول
+
+304
+00:23:00,180 --> 00:23:06,790
+هو اثنين وثلاثين مليمتر زئبق اللي هو الـ midway
+
+305
+00:23:06,790 --> 00:23:10,550
+مش midway في الـ capillary، midway بين الـ.. الـ
+
+306
+00:23:10,550 --> 00:23:14,220
+afferent ونهاية الـ filtration، لإن بعد كده خلاص
+
+307
+00:23:14,220 --> 00:23:17,720
+بيصير مافيش إيه؟ more filtration، يعني من نقطة ما في
+
+308
+00:23:17,720 --> 00:23:20,800
+الـ capillary لحد الـ afferent بيصيرش تغيير، لحد الـ efferent
+
+309
+00:23:20,800 --> 00:23:25,420
+artery بيصيرش تغيير، تمام؟ ليش؟ لإنه هنوصل ارتفع
+
+310
+00:23:25,420 --> 00:23:29,280
+ارتفع، ارتفع، وخلاص صار يساوي الـ filtration forces.
+
+311
+00:23:29,280 --> 00:23:32,440
+توقف، لكن بيظل كما هو لحد ما يصل الـ efferent، إذا
+
+312
+00:23:32,440 --> 00:23:36,340
+بنقول احنا بناخد هنا جدًّا كان في الـ plasma وهنا جدًّا
+
+313
+00:23:36,340 --> 00:23:42,920
+كان في الـ.. في الـ.. في الـ renal veins، لإن في
+
+314
+00:23:42,920 --> 00:23:48,900
+الـ renal vein هيكون عندي osmosis، مش كده؟ لأ، الـ renal vein
+
+315
+00:23:48,900 --> 00:23:51,540
+بياخد معظم جسمه، أقصد أنا في الـ efferent
+
+316
+00:23:51,540 --> 00:23:55,320
+arteriole، في الـ efferent arteriole هنلاقي إنه
+
+317
+00:23:55,320 --> 00:23:59,740
+الفرق بينهم كبير، فإحنا بناخد.. لو بنعمل حسابات
+
+318
+00:23:59,740 --> 00:24:03,520
+بناخد الـ midpoint بين الـ 28 والـ 36.
+
+319
+00:24:07,910 --> 00:24:12,010
+الأسماء الأسماء الأسماء الأسماء الأسماء
+
+320
+00:24:12,010 --> 00:24:12,530
+الأسماء الأسماء الأسماء الأسماء الأسماء الأسماء
+
+321
+00:24:12,530 --> 00:24:13,930
+الأسماء الأسماء الأسماء الأسماء الأسماء الأسماء
+
+322
+00:24:13,930 --> 00:24:16,490
+الأسماء الأسماء الأسماء الأسماء الأسماء الأسماء
+
+323
+00:24:16,490 --> 00:24:21,830
+الأسماء الأسماء الأسماء الأسماء الأسماء الأسماء
+
+324
+00:24:21,830 --> 00:24:21,870
+الأسماء الأسماء الأسماء الأسماء الأسماء الأسماء
+
+325
+00:24:21,870 --> 00:24:26,490
+الأسماء الأسماء
+
+326
+00:24:28,260 --> 00:24:31,980
+بعدين filtration fraction، جدًّا فيه، صار filtration
+
+327
+00:24:31,980 --> 00:24:35,460
+fraction، كل ما زاد الـ filtration fraction، كل ما
+
+328
+00:24:35,460 --> 00:24:39,820
+صار more colloidal pressure عندي، وهذا بيوقف الـ
+
+329
+00:24:39,820 --> 00:24:44,380
+إيه؟ الـ filtration عند منطقة معينة، الـ filtration
+
+330
+00:24:44,380 --> 00:24:47,680
+fraction، إيش يعني؟ يعني جدًّا صار فيه filtration من
+
+331
+00:24:47,680 --> 00:24:50,620
+الـ total plasma اللي قولنا عليه إحنا، جدًّا حوالي خمسة
+
+332
+00:24:50,620 --> 00:24:53,620
+عشر في المية، جدًّا بيصير عندنا filtration fraction
+
+333
+00:24:53,620 --> 00:24:59,210
+جدًّا بيصير filtration من الكل الخمسة، تمام؟ إذا الـ
+
+334
+00:24:59,210 --> 00:25:03,590
+glomerular filtration rate على البلازما يساوي
+
+335
+00:25:03,590 --> 00:25:07,730
+filtration fraction، مش كده؟ جدًّا من البلازما صار
+
+336
+00:25:07,730 --> 00:25:11,490
+لها filtration، على هذا المضمون، الـ إيه؟ النسبة عشرين في
+
+337
+00:25:11,490 --> 00:25:17,170
+المية أو point two، كل ما الـ filtration fraction
+
+338
+00:25:17,170 --> 00:25:26,720
+زاد، كل ما كل ده الـ pressure بيزيد، تمام؟ طبعًا هاي
+
+339
+00:25:26,720 --> 00:25:31,620
+إيه الكلام، لسه هنتكلم عليه بعد كده، الـ increase in
+
+340
+00:25:31,620 --> 00:25:33,480
+glomerular capillary hydrostatic pressure، أهلاً و
+
+341
+00:25:33,480 --> 00:25:38,920
+سهلاً، وصلنا للإيه؟ للأهم، وهذا زي ما قلت لكم، بيعتمد
+
+342
+00:25:38,920 --> 00:25:44,470
+على إن الضغط اللي جاي جدًّا إذا عالي، الضغط بيزيد
+
+343
+00:25:44,470 --> 00:25:48,070
+الضغط الواصلني، الضغط الجسمي عمومًا، يعني الـ
+
+344
+00:25:48,070 --> 00:25:50,630
+hydrostatic بقى، الضغط اللي أنا بجيبها بإيه،
+
+345
+00:25:50,630 --> 00:25:53,910
+جاهز أضغط عليه، automatically اللي هيصل
+
+346
+00:25:53,910 --> 00:25:57,970
+الـ renal artery والـ afferent arteriole هيعلى، وهذا الـ
+
+347
+00:25:57,970 --> 00:26:03,590
+factor الرئيسي في إيش؟ لذلك بعض الناس بيعرف إنه
+
+348
+00:26:03,590 --> 00:26:09,270
+ضغطه عليه فورًا من خلال إنه التبول زاد، أقل حاجة،
+
+349
+00:26:09,270 --> 00:26:12,570
+بأعتقد الدكتور اتضغط عليه، تمام؟ من الملاجئ يعني
+
+350
+00:26:12,570 --> 00:26:16,640
+بالفعل، تمام؟ نديله علاج للضغط، ضغط، ضغط، ضغط، ضغط،
+
+351
+00:26:16,640 --> 00:26:19,560
+ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط،
+
+352
+00:26:19,560 --> 00:26:22,160
+ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط،
+
+353
+00:26:22,160 --> 00:26:30,100
+ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط،
+
+354
+00:26:30,100 --> 00:26:31,440
+ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط،
+
+355
+00:26:31,440 --> 00:26:37,070
+ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط، ضغط،وصار
+
+356
+00:26:37,070 --> 00:26:42,050
+ischemia في الكلى، ممكن الكلى طبعًا زي ما قولنا في
+
+357
+00:26:42,050 --> 00:26:46,810
+الـ.. آه، تعمل spasm وتخش في kidney failure، لكن
+
+358
+00:26:46,810 --> 00:26:50,350
+احنا ممكن نقول ماوصلناش لمرحلة kidney failure، صار
+
+359
+00:26:50,350 --> 00:26:54,630
+نزيف لأي سبب من الأسباب، هبوط الضغط، الـ hydrostatic
+
+360
+00:26:54,630 --> 00:27:00,930
+pressure هيهبط، آه، الـ urine volume هيقل، مش كده؟ إذا
+
+361
+00:27:00,930 --> 00:27:04,430
+انخفاض الضغط بيأثر على الـ volume، وارتفاع الضغط
+
+362
+00:27:04,430 --> 00:27:08,390
+لإن الضغط هذا هو الأساس في عملية إيه؟ الـ filtration
+
+363
+00:27:08,390 --> 00:27:13,450
+اللي هو منه، بعد كده أنا factors أخرى بتتدخل علشان
+
+364
+00:27:13,450 --> 00:27:17,530
+أعمل complete reabsorption أو أسيبه كله يطلع أو
+
+365
+00:27:17,530 --> 00:27:22,050
+أو آخر، المهم في الموضوع، إذا الضغط عندي العام له
+
+366
+00:27:22,050 --> 00:27:27,090
+تأثير عظيم على الـ filtration. طيب هذا الضغط العام
+
+367
+00:27:27,090 --> 00:27:30,270
+طيب، بلاش الضغط العام، يقول
+
+368
+00:27:33,800 --> 00:27:39,840
+الـ afferent، الضغط العام طبيعي، تمام؟ الضغط العام
+
+369
+00:27:39,840 --> 00:27:43,400
+طبيعي، إن إجتمع أشياء خلت الـ afferent يفتح
+
+370
+00:27:43,400 --> 00:27:48,260
+الـ hydrostatic pressure بيزيد، هو مش مهم للـ afferent كتير
+
+371
+00:27:48,260 --> 00:27:52,220
+مفهوم؟ إذا فتح بيزيد الضغط، وإذا قل بيقل الضغط، و
+
+372
+00:27:52,220 --> 00:27:55,540
+معناه بيأثر على مين؟ على الـ GFR، الـ glomerular
+
+373
+00:27:55,540 --> 00:27:59,380
+filtration rate، لكن المشكلة في مين؟ في الـ afferent
+
+374
+00:27:59,380 --> 00:28:04,140
+الـ afferent هذا إيه؟ بيعمل phasic changes، الـ efferent
+
+375
+00:28:04,140 --> 00:28:07,880
+له إيه؟
+
+376
+00:28:07,880 --> 00:28:11,920
+يعمل physical changes، بمعنى إنه لو كان عامل mild
+
+377
+00:28:11,920 --> 00:28:15,960
+constriction، بيزود الـ hydrostatic pressure شوية
+
+378
+00:28:15,960 --> 00:28:21,420
+لكن لو عامل severe constriction، يعني المقاومة
+
+379
+00:28:21,420 --> 00:28:24,480
+تبعته زادت شوية، بيقلل إن الـ pressure الـ
+
+380
+00:28:24,480 --> 00:28:26,740
+hydrostatic pressure بيزيد، والـ filtration بيزيد
+
+381
+00:28:26,740 --> 00:28:32,080
+مش هيك، الـ GFR بيزيد، لكن لو عامل spasm كتير الـ
+
+382
+00:28:32,080 --> 00:28:37,880
+efferent، معناه الـ blood flow نفسه إيش؟ قل، يعني الـ
+
+383
+00:28:37,880 --> 00:28:42,900
+plasma flow نفسها قلت، كل الدم اللي دخل على الـ..
+
+384
+00:28:42,900 --> 00:28:49,680
+إيه؟ على الـ glomerulus قل، البلازما قلت، هو الـ.. الـ
+
+385
+00:28:49,680 --> 00:28:55,680
+filtration fraction يساوي إيش؟ يساوي الـ GFR على مين؟
+
+386
+00:28:55,680 --> 00:29:03,550
+على البلازما، مش كده؟ لما أنا يصير عندي low، لو
+
+387
+00:29:03,550 --> 00:29:11,950
+plasma volume، تمام؟ نفسها بيصير عندي الـ.. الـ
+
+388
+00:29:11,950 --> 00:29:16,510
+filtration نفسه بيتوقف، لإن كل الدم اللي داخل قل.
+
+389
+00:29:16,510 --> 00:29:20,010
+إذا عندي a moderate level of constriction, there is
+
+390
+00:29:20,010 --> 00:29:23,430
+a slight increase in GFR, but with severe
+
+391
+00:29:23,430 --> 00:29:27,47
+
+445
+00:34:08,730 --> 00:34:23,450
+درسناها
+
+446
+00:34:23,450 --> 00:34:31,330
+في الـ fluids درسناها في الـ fluids قلنا تأثير الـ
+
+447
+00:34:31,330 --> 00:34:37,880
+normal saline على الجسم بتأثير five percent glucose على
+
+448
+00:34:37,880 --> 00:34:41,280
+الجسم، الـ five percent glucose على الجسم، الـ five
+
+449
+00:34:41,280 --> 00:34:45,840
+percent glucose isotonic والـ nine point nine
+
+450
+00:34:45,840 --> 00:34:48,240
+percent saline اللي هو الـ normal saline isotonic
+
+451
+00:34:48,240 --> 00:34:54,700
+مش هده؟ قلنا هذا إذا حطينا احنا الـ glucose يستحدَث
+
+452
+00:34:54,700 --> 00:34:58,930
+والـ fluid بيطلع في الـ ايه؟ في الكلية، في حين لو
+
+453
+00:34:58,930 --> 00:35:03,850
+حطينا saline لا يستهلك زي الجلوكوز، فـ أوتوماتيكالي
+
+454
+00:35:03,850 --> 00:35:08,470
+بينتقل إلى ايه؟ إلى يتوزع ما بين الـ plasma وبين الـ
+
+455
+00:35:08,470 --> 00:35:12,290
+interstitial fluid، الـ interstitial fluid دخل عليه
+
+456
+00:35:12,290 --> 00:35:16,030
+كمية زيادة لكنه بنفس الأزمولية بتاعت الـ
+
+457
+00:35:16,030 --> 00:35:19,510
+intracellular fluid، إذا ما بيصيرش shift بين الـ
+
+458
+00:35:19,510 --> 00:35:22,310
+extracellular والـ intracellular، لكن بيصير
+
+459
+00:35:22,310 --> 00:35:26,210
+expansion للـ extracellular مظبوط، إذا اضطغط بيعلى
+
+460
+00:35:26,210 --> 00:35:29,670
+بيصير expansion للبلازما، بيصير expansion و
+
+461
+00:35:29,670 --> 00:35:32,210
+للـ interstitial، بيصير expansion لكل الـ extracellular ده
+
+462
+00:35:32,210 --> 00:35:36,370
+بيزيد، لكن الـ interstitial ما بيزيدش، ليه؟ لأن الـ
+
+463
+00:35:36,370 --> 00:35:39,970
+factor اللي في الانتقال هنا، الـ osmolality ما اتغيرتش
+
+464
+00:35:39,970 --> 00:35:40,650
+فاضح
+
diff --git a/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/yZHQsvDX5Ow_raw.json b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/yZHQsvDX5Ow_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..c97537f21f31e1f393f82f98b8883ef8b5835e87
--- /dev/null
+++ b/PL9fwy3NUQKwYwa5hY1iueXkYogtH76yN8/yZHQsvDX5Ow_raw.json
@@ -0,0 +1 @@
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{"start": 290.24, "end": 290.36, "word": " ال", "probability": 0.2626953125}, {"start": 290.36, "end": 290.78, "word": " glomeruli", "probability": 0.951171875}, {"start": 290.78, "end": 291.28, "word": " لما", "probability": 0.921142578125}, {"start": 291.28, "end": 291.5, "word": " جل", "probability": 0.80419921875}, {"start": 291.5, "end": 291.76, "word": " عدد", "probability": 0.9881184895833334}, {"start": 291.76, "end": 292.1, "word": " ال", "probability": 0.5439453125}, {"start": 292.1, "end": 292.9, "word": " glomeruli", "probability": 0.9679361979166666}, {"start": 292.9, "end": 294.24, "word": " ال", "probability": 0.90869140625}, {"start": 294.24, "end": 294.72, "word": " surface", "probability": 0.96044921875}, {"start": 294.72, "end": 295.1, "word": " area", "probability": 0.83056640625}, {"start": 295.1, "end": 295.52, "word": " بتجل", "probability": 0.9860026041666666}], "temperature": 1.0}, {"id": 11, "seek": 32343, "start": 296.05, "end": 323.43, "text": "تمام صنعنا ال filtration بتم مش في مليون glomerulus بتم في نص مليون في ربع مليون يعني ال surface area تبعت ال filtration surface تمام بتتحمق و هكذا المهم ما علينا احنا سؤالنا الآن ال filtration coefficient هذا بمعنى انه جديش عندي net forces pressure", "tokens": [39237, 10943, 20328, 1863, 3615, 8315, 2423, 43623, 39894, 2304, 37893, 8978, 3714, 20292, 11536, 1563, 14301, 26107, 39894, 2304, 8978, 8717, 9381, 3714, 20292, 11536, 8978, 12602, 3555, 3615, 3714, 20292, 11536, 37495, 22653, 2423, 3753, 1859, 6055, 3555, 34268, 2423, 43623, 3753, 46811, 10943, 39894, 2655, 35571, 4587, 4032, 8032, 4117, 15730, 9673, 16095, 19446, 25894, 8315, 1975, 5016, 8315, 8608, 33604, 6027, 8315, 6024, 48506, 2423, 43623, 17619, 23758, 4724, 2304, 3615, 1863, 7578, 16472, 3224, 10874, 16254, 8592, 18871, 16254, 2533, 5874, 3321], "avg_logprob": -0.21946023082868618, "compression_ratio": 1.7358490566037736, "no_speech_prob": 0.0, "words": [{"start": 296.05, "end": 296.51, "word": "تمام", "probability": 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307.39, "end": 308.87, "word": " بتتحمق", "probability": 0.50457763671875}, {"start": 308.87, "end": 309.37, "word": " و", "probability": 0.72314453125}, {"start": 309.37, "end": 309.75, "word": " هكذا", "probability": 0.8927408854166666}, {"start": 309.75, "end": 311.57, "word": " المهم", "probability": 0.964599609375}, {"start": 311.57, "end": 311.73, "word": " ما", "probability": 0.68212890625}, {"start": 311.73, "end": 312.05, "word": " علينا", "probability": 0.7646484375}, {"start": 312.05, "end": 312.29, "word": " احنا", "probability": 0.8499348958333334}, {"start": 312.29, "end": 312.71, "word": " سؤالنا", "probability": 0.9755859375}, {"start": 312.71, "end": 313.05, "word": " الآن", "probability": 0.6558837890625}, {"start": 313.05, "end": 313.29, "word": " ال", "probability": 0.81103515625}, {"start": 313.29, "end": 313.87, "word": " filtration", "probability": 0.947265625}, {"start": 313.87, "end": 314.43, "word": " coefficient", "probability": 0.8984375}, {"start": 314.43, 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5874, 3321, 7251, 3555, 25708, 9957, 1829, 43623, 46811, 10943, 43242, 8315, 2423, 43623, 4724, 1829, 9381, 13546, 43242, 7578, 25276, 3714, 20292, 5296, 2655, 2288, 4724, 2288, 4587, 3224, 680, 3456, 46811, 10943, 4032, 3615, 1863, 16254, 2423, 5874, 6225, 8592, 25720, 6225, 8592, 25720, 3714, 20292, 44650, 2288, 33307, 37893, 9122, 3215, 3224, 2423, 2533, 5874, 11933, 15730, 12174, 1211, 8315, 28242, 472, 17942, 33307, 4724, 1829, 16254, 1863, 7578, 1975, 2655, 1863, 7649, 6225, 46309, 4032, 8717, 9381], "avg_logprob": -0.32122091845024464, "compression_ratio": 1.6067961165048543, "no_speech_prob": 0.0, "words": [{"start": 325.21, "end": 325.73, "word": "جداش", "probability": 0.4718831380208333}, {"start": 325.73, "end": 325.95, "word": " net", "probability": 0.1507568359375}, {"start": 325.95, "end": 326.27, "word": " forces", "probability": 0.88916015625}, {"start": 326.27, "end": 326.79, "word": " pressure", "probability": 0.96484375}, {"start": 326.79, "end": 328.47, "word": " يبيديني", "probability": 0.60439453125}, {"start": 328.47, "end": 329.53, "word": " filtration", "probability": 0.91064453125}, {"start": 329.53, "end": 331.65, "word": " تمام", "probability": 0.803955078125}, {"start": 331.65, "end": 332.79, "word": " عندنا", "probability": 0.66748046875}, {"start": 332.79, "end": 334.49, "word": " ال", "probability": 0.6923828125}, {"start": 334.49, "end": 335.07, "word": " filtration", "probability": 0.9462890625}, {"start": 335.07, "end": 337.13, "word": " بيصير", "probability": 0.8328857421875}, {"start": 337.13, "end": 337.41, "word": " عندى", "probability": 0.505126953125}, {"start": 337.41, "end": 337.75, "word": " 125", "probability": 0.88134765625}, {"start": 337.75, "end": 338.09, "word": " ملي", "probability": 0.76171875}, {"start": 338.09, "end": 338.37, "word": " لتر", "probability": 0.8834635416666666}, {"start": 338.37, "end": 338.83, "word": " برقه", "probability": 0.617645263671875}, {"start": 338.83, "end": 339.51, "word": " per", "probability": 0.66064453125}, {"start": 339.51, "end": 339.89, "word": " minute", "probability": 0.95556640625}, {"start": 339.89, "end": 340.89, "word": " تمام", "probability": 0.857666015625}, {"start": 340.89, "end": 341.69, "word": " وعندي", "probability": 0.87060546875}, {"start": 341.69, "end": 341.83, "word": " ال", "probability": 0.94482421875}, {"start": 341.83, "end": 342.19, "word": " forces", "probability": 0.95849609375}, {"start": 342.19, "end": 342.81, "word": " عشرة", "probability": 0.9407552083333334}, {"start": 342.81, "end": 345.13, "word": " عشرة", "probability": 0.9285481770833334}, {"start": 345.13, "end": 345.41, "word": " ملي", "probability": 0.849609375}, {"start": 345.41, "end": 345.91, "word": " متر", "probability": 0.7254638671875}, {"start": 345.91, "end": 346.37, "word": " mercury", "probability": 0.5986328125}, {"start": 346.37, "end": 347.07, "word": " مش", "probability": 0.873046875}, {"start": 347.07, "end": 347.31, "word": " كده", "probability": 0.9814453125}, {"start": 347.31, "end": 347.61, "word": " ال", "probability": 0.87353515625}, {"start": 347.61, "end": 347.75, "word": " net", "probability": 0.96826171875}, {"start": 347.75, "end": 348.15, "word": " forces", "probability": 0.95068359375}, {"start": 348.15, "end": 348.97, "word": " إذا", "probability": 0.7335205078125}, {"start": 348.97, "end": 349.27, "word": " قلنا", "probability": 0.7263997395833334}, {"start": 349.27, "end": 349.47, "word": " كل", "probability": 0.9833984375}, {"start": 349.47, "end": 349.73, "word": " one", "probability": 0.87841796875}, {"start": 349.73, "end": 350.17, "word": " millimeter", "probability": 0.67529296875}, {"start": 350.17, "end": 350.79, "word": " mercury", "probability": 0.92333984375}, {"start": 350.79, "end": 353.43, "word": " بيدينى", "probability": 0.66923828125}, {"start": 353.43, "end": 354.03, "word": " اتنان", "probability": 0.71453857421875}, {"start": 354.03, "end": 354.19, "word": " عشر", "probability": 0.6273193359375}, {"start": 354.19, "end": 354.35, "word": " و", "probability": 0.8974609375}, {"start": 354.35, "end": 354.51, "word": " نص", "probability": 0.908935546875}], "temperature": 1.0}, {"id": 13, "seek": 36710, "start": 355.42, "end": 367.1, "text": "milliliter filtrate per minute مش هيك اذا انا بقدر احسب انا ال filtration forces هذه جديش ايه", "tokens": [18841, 388, 1681, 29148, 4404, 680, 3456, 37893, 39896, 4117, 1975, 15730, 1975, 8315, 4724, 28543, 2288, 1975, 5016, 35457, 1975, 8315, 2423, 43623, 5874, 29538, 10874, 16254, 8592, 1975, 1829, 3224], "avg_logprob": -0.35771780303030304, "compression_ratio": 1.1759259259259258, "no_speech_prob": 0.0, "words": [{"start": 355.42, "end": 356.26, "word": "milliliter", "probability": 0.5947672526041666}, {"start": 356.26, "end": 357.0, "word": " filtrate", "probability": 0.52142333984375}, {"start": 357.0, "end": 358.44, "word": " per", "probability": 0.92529296875}, {"start": 358.44, "end": 358.9, "word": " minute", "probability": 0.9375}, {"start": 358.9, "end": 359.58, "word": " مش", "probability": 0.7978515625}, {"start": 359.58, "end": 360.08, "word": " هيك", "probability": 0.808349609375}, {"start": 360.08, "end": 360.52, "word": " اذا", "probability": 0.4024658203125}, {"start": 360.52, "end": 360.82, "word": " انا", "probability": 0.7352294921875}, {"start": 360.82, "end": 361.16, "word": " بقدر", "probability": 0.9197591145833334}, {"start": 361.16, "end": 361.46, "word": " احسب", "probability": 0.94482421875}, {"start": 361.46, "end": 361.94, "word": " انا", "probability": 0.9375}, {"start": 361.94, "end": 363.16, "word": " ال", "probability": 0.89208984375}, {"start": 363.16, "end": 364.08, "word": " filtration", "probability": 0.5859375}, {"start": 364.08, "end": 364.66, "word": " forces", "probability": 0.90185546875}, {"start": 364.66, "end": 365.04, "word": " هذه", "probability": 0.496337890625}, {"start": 365.04, "end": 366.14, "word": " جديش", "probability": 0.7513020833333334}, 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381.37, "end": 381.75, "word": " 10", "probability": 0.841796875}, {"start": 381.75, "end": 382.39, "word": " millimeter", "probability": 0.4971516927083333}, {"start": 382.39, "end": 382.85, "word": " mercury", "probability": 0.95068359375}, {"start": 382.85, "end": 383.33, "word": " the", "probability": 0.34619140625}, {"start": 383.33, "end": 383.71, "word": " normal", "probability": 0.88818359375}, {"start": 383.71, "end": 384.17, "word": " KF", "probability": 0.772216796875}, {"start": 384.17, "end": 384.35, "word": " is", "probability": 0.8896484375}, {"start": 384.35, "end": 384.93, "word": " calculated", "probability": 0.95703125}, {"start": 384.93, "end": 385.43, "word": " to", "probability": 0.85888671875}, {"start": 385.43, "end": 385.59, "word": " be", "probability": 0.95703125}, {"start": 385.59, "end": 385.75, "word": " من", "probability": 0.99169921875}, {"start": 385.75, "end": 385.99, "word": " خلال", "probability": 0.9825846354166666}, {"start": 385.99, "end": 386.37, "word": " معادلة", "probability": 0.8756510416666666}, {"start": 386.37, "end": 386.73, "word": " هذه", "probability": 0.7421875}, {"start": 386.73, "end": 387.79, "word": " تمام", "probability": 0.910400390625}, {"start": 387.79, "end": 388.17, "word": " ال", "probability": 0.71533203125}, {"start": 388.17, "end": 388.63, "word": " GFR", "probability": 0.896240234375}, {"start": 388.63, "end": 388.85, "word": " على", "probability": 0.77197265625}, {"start": 388.85, "end": 388.99, "word": " ال", "probability": 0.845703125}, {"start": 388.99, "end": 389.27, "word": " forces", "probability": 0.978515625}, {"start": 389.27, "end": 389.61, "word": " ال", "probability": 0.6875}, {"start": 389.61, "end": 389.93, "word": " GFR", "probability": 0.943359375}, {"start": 389.93, "end": 390.29, "word": " 125", "probability": 0.89794921875}, {"start": 390.29, "end": 391.29, "word": " على", "probability": 0.55712890625}, {"start": 391.29, "end": 391.45, "word": " ال", "probability": 0.88916015625}, {"start": 391.45, "end": 391.77, "word": " force", "probability": 0.96630859375}, {"start": 391.77, "end": 392.29, "word": " اللي", "probability": 0.93212890625}, {"start": 392.29, "end": 392.45, "word": " هو", "probability": 0.98388671875}, {"start": 392.45, "end": 392.85, "word": " عشرة", "probability": 0.9049479166666666}, {"start": 392.85, "end": 393.41, "word": " ال", "probability": 0.2529296875}, {"start": 393.41, "end": 393.53, "word": " net", "probability": 0.927734375}, {"start": 393.53, "end": 393.89, "word": " forces", "probability": 0.93798828125}, {"start": 393.89, "end": 394.53, "word": " اذا", "probability": 0.6976318359375}, {"start": 394.53, "end": 394.75, "word": " ال", "probability": 0.79833984375}, {"start": 394.75, "end": 395.11, "word": " KF", "probability": 0.96630859375}, {"start": 395.11, "end": 395.55, "word": " بيساوي", "probability": 0.880859375}, {"start": 395.55, "end": 395.87, "word": " ايه", "probability": 0.9246419270833334}, {"start": 395.87, "end": 396.19, "word": " ال", "probability": 0.57958984375}, {"start": 396.19, "end": 396.73, "word": " filtration", "probability": 0.958984375}, {"start": 396.73, "end": 397.59, "word": " coefficient", "probability": 0.8916015625}, {"start": 397.59, "end": 398.11, "word": " عندها", "probability": 0.578857421875}, {"start": 398.11, "end": 398.57, "word": " اتناشر", "probability": 0.77021484375}, {"start": 398.57, "end": 398.83, "word": " نص", "probability": 0.89404296875}], "temperature": 1.0}, {"id": 15, "seek": 42567, "start": 399.51, "end": 425.67, "text": "هذا for the two kidneys طيب لو احنا قلنا الحسبة بالنسبة للجسم برضه في filtration coefficient في ال general circulation بس هنا كان نحسب بالمائة ملي جرام هنا بنقول الكلية كده وزنها خلينا نعمل حسبة بالمائة ملي جرام هنلاقي بالمائة ملي جرام عندنا ال filtration coefficient سوى اربعة و اتنين من عشرة", "tokens": [3224, 15730, 337, 264, 732, 35994, 23032, 1829, 3555, 45164, 1975, 5016, 8315, 12174, 1211, 8315, 21542, 35457, 3660, 20666, 1863, 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"word": " two", "probability": 0.92138671875}, {"start": 402.05, "end": 402.91, "word": " kidneys", "probability": 0.9775390625}, {"start": 402.91, "end": 404.83, "word": " طيب", "probability": 0.712158203125}, {"start": 404.83, "end": 405.07, "word": " لو", "probability": 0.9013671875}, {"start": 405.07, "end": 405.41, "word": " احنا", "probability": 0.921875}, {"start": 405.41, "end": 405.85, "word": " قلنا", "probability": 0.8505859375}, {"start": 405.85, "end": 407.77, "word": " الحسبة", "probability": 0.9557291666666666}, {"start": 407.77, "end": 408.19, "word": " بالنسبة", "probability": 0.890380859375}, {"start": 408.19, "end": 408.77, "word": " للجسم", "probability": 0.9449869791666666}, {"start": 408.77, "end": 409.53, "word": " برضه", "probability": 0.8860677083333334}, {"start": 409.53, "end": 409.67, "word": " في", "probability": 0.80615234375}, {"start": 409.67, "end": 410.01, "word": " filtration", "probability": 0.55517578125}, {"start": 410.01, "end": 410.53, "word": " coefficient", "probability": 0.86328125}, {"start": 410.53, "end": 410.77, "word": " في", "probability": 0.7294921875}, {"start": 410.77, "end": 410.81, "word": " ال", "probability": 0.6171875}, {"start": 410.81, "end": 411.05, "word": " general", "probability": 0.7373046875}, {"start": 411.05, "end": 411.69, "word": " circulation", "probability": 0.9775390625}, {"start": 411.69, "end": 412.79, "word": " بس", "probability": 0.94287109375}, {"start": 412.79, "end": 412.99, "word": " هنا", "probability": 0.97900390625}, {"start": 412.99, "end": 413.09, "word": " كان", "probability": 0.68994140625}, {"start": 413.09, "end": 413.39, "word": " نحسب", "probability": 0.7316487630208334}, {"start": 413.39, "end": 413.75, "word": " بالمائة", "probability": 0.70135498046875}, {"start": 413.75, "end": 414.03, "word": " ملي", "probability": 0.734375}, {"start": 414.03, "end": 414.35, "word": " جرام", "probability": 0.9309895833333334}, {"start": 414.35, "end": 415.55, "word": " هنا", "probability": 0.7314453125}, {"start": 415.55, "end": 416.01, "word": " بنقول", "probability": 0.5194091796875}, {"start": 416.01, "end": 416.79, "word": " الكلية", "probability": 0.705078125}, {"start": 416.79, "end": 416.95, "word": " كده", "probability": 0.8336588541666666}, {"start": 416.95, "end": 417.47, "word": " وزنها", "probability": 0.79974365234375}, {"start": 417.47, "end": 418.21, "word": " خلينا", "probability": 0.73974609375}, {"start": 418.21, "end": 418.45, "word": " نعمل", "probability": 0.9873046875}, {"start": 418.45, "end": 418.75, "word": " حسبة", "probability": 0.9558919270833334}, {"start": 418.75, "end": 419.93, "word": " بالمائة", "probability": 0.914794921875}, {"start": 419.93, "end": 420.11, "word": " ملي", "probability": 0.971435546875}, {"start": 420.11, "end": 420.67, "word": " جرام", "probability": 0.98193359375}, {"start": 420.67, "end": 421.37, "word": " هنلاقي", "probability": 0.7132568359375}, {"start": 421.37, "end": 421.81, "word": " بالمائة", "probability": 0.952392578125}, {"start": 421.81, "end": 421.99, "word": " ملي", "probability": 0.980712890625}, {"start": 421.99, "end": 422.35, "word": " جرام", "probability": 0.9833984375}, {"start": 422.35, "end": 423.13, "word": " عندنا", "probability": 0.6153564453125}, {"start": 423.13, "end": 423.39, "word": " ال", "probability": 0.81103515625}, {"start": 423.39, "end": 423.77, "word": " filtration", "probability": 0.888671875}, {"start": 423.77, "end": 424.21, "word": " coefficient", "probability": 0.90625}, {"start": 424.21, "end": 424.49, "word": " سوى", "probability": 0.5785725911458334}, {"start": 424.49, "end": 424.81, "word": " اربعة", "probability": 0.794677734375}, {"start": 424.81, "end": 424.95, "word": " و", "probability": 0.54443359375}, {"start": 424.95, "end": 425.13, "word": " اتنين", "probability": 0.836669921875}, {"start": 425.13, "end": 425.27, "word": " من", "probability": 0.99072265625}, {"start": 425.27, "end": 425.67, "word": " عشرة", "probability": 0.9427083333333334}], "temperature": 1.0}, {"id": 16, "seek": 45257, "start": 426.19, "end": 452.57, "text": "milliliter per minute for each millimeter mercury مش كده اذا هذا لما نقارنه بال general circulation نلاقي فى فرق رهيب لإن ال filtration coefficient لل general circulation point oh one هذا اربعة و اتنين من عشرة millimeter mercury per per minute per millimeter mercury", "tokens": [18841, 388, 1681, 680, 3456, 337, 1184, 17942, 33307, 37893, 9122, 3215, 3224, 1975, 15730, 23758, 5296, 15042, 8717, 4587, 9640, 1863, 3224, 20666, 2674, 23168, 8717, 15040, 38436, 6156, 7578, 6156, 2288, 4587, 12602, 3224, 1829, 3555, 5296, 28814, 1863, 2423, 43623, 17619, 24976, 2674, 23168, 935, 1954, 472, 23758, 1975, 25513, 27884, 4032, 1975, 2655, 1863, 9957, 9154, 6225, 8592, 25720, 17942, 33307, 680, 680, 3456, 680, 17942, 33307], "avg_logprob": -0.2914496536056201, "compression_ratio": 1.6751269035532994, "no_speech_prob": 0.0, "words": [{"start": 426.19, "end": 427.13, "word": "milliliter", "probability": 0.5572509765625}, {"start": 427.13, "end": 427.35, "word": " per", "probability": 0.900390625}, {"start": 427.35, "end": 427.69, "word": " minute", "probability": 0.92529296875}, {"start": 427.69, "end": 427.97, "word": " for", "probability": 0.7392578125}, {"start": 427.97, "end": 428.31, "word": " each", "probability": 0.93994140625}, {"start": 428.31, "end": 428.79, "word": " millimeter", "probability": 0.5205078125}, {"start": 428.79, "end": 429.31, "word": " mercury", "probability": 0.88623046875}, {"start": 429.31, "end": 429.73, "word": " مش", "probability": 0.2069091796875}, {"start": 429.73, "end": 430.13, "word": " كده", "probability": 0.9601236979166666}, {"start": 430.13, "end": 431.05, "word": " اذا", "probability": 0.51739501953125}, {"start": 431.05, "end": 435.99, "word": " هذا", "probability": 0.6591796875}, {"start": 435.99, "end": 436.17, "word": " لما", "probability": 0.9384765625}, {"start": 436.17, "end": 436.69, "word": " نقارنه", "probability": 0.9890625}, {"start": 436.69, "end": 436.83, "word": " بال", "probability": 0.9765625}, {"start": 436.83, "end": 437.07, "word": " general", "probability": 0.75244140625}, {"start": 437.07, "end": 437.81, "word": " circulation", "probability": 0.96826171875}, {"start": 437.81, "end": 438.87, "word": " نلاقي", "probability": 0.6870930989583334}, {"start": 438.87, "end": 439.05, "word": " فى", "probability": 0.60400390625}, {"start": 439.05, "end": 439.31, "word": " فرق", "probability": 0.9664713541666666}, {"start": 439.31, "end": 440.33, "word": " رهيب", "probability": 0.9805908203125}, {"start": 440.33, "end": 441.31, "word": " لإن", "probability": 0.826171875}, {"start": 441.31, "end": 441.43, "word": " ال", "probability": 0.66064453125}, {"start": 441.43, "end": 441.75, "word": " filtration", "probability": 0.9345703125}, {"start": 441.75, "end": 442.29, "word": " coefficient", "probability": 0.91748046875}, {"start": 442.29, "end": 442.51, "word": " لل", "probability": 0.7626953125}, {"start": 442.51, "end": 442.77, "word": " general", "probability": 0.8251953125}, {"start": 442.77, "end": 443.39, "word": " circulation", "probability": 0.978515625}, {"start": 443.39, "end": 444.47, "word": " point", "probability": 0.89404296875}, {"start": 444.47, "end": 444.95, "word": " oh", "probability": 0.2452392578125}, {"start": 444.95, "end": 445.39, "word": " one", "probability": 0.95068359375}, {"start": 445.39, "end": 446.11, "word": " هذا", "probability": 0.78759765625}, {"start": 446.11, "end": 446.43, "word": " اربعة", "probability": 0.890625}, {"start": 446.43, "end": 446.57, "word": " و", "probability": 0.6435546875}, {"start": 446.57, "end": 446.75, "word": " اتنين", "probability": 0.75665283203125}, {"start": 446.75, "end": 446.89, "word": " من", "probability": 0.98193359375}, {"start": 446.89, "end": 447.33, "word": " عشرة", "probability": 0.95263671875}, {"start": 447.33, "end": 447.85, "word": " millimeter", "probability": 0.56689453125}, {"start": 447.85, "end": 448.39, "word": " mercury", "probability": 0.95947265625}, {"start": 448.39, "end": 448.61, "word": " per", "probability": 0.85205078125}, {"start": 448.61, "end": 449.67, "word": " per", "probability": 0.260009765625}, {"start": 449.67, "end": 451.47, "word": " minute", "probability": 0.57177734375}, {"start": 451.47, "end": 451.71, "word": " per", "probability": 0.873046875}, {"start": 451.71, "end": 452.07, "word": " millimeter", "probability": 0.78369140625}, {"start": 452.07, "end": 452.57, "word": " mercury", "probability": 0.9677734375}], "temperature": 1.0}, {"id": 17, "seek": 48233, "start": 453.13, "end": 482.33, "text": "هناك ال millimeter mercury في ال minute بيطلعلي point one milliliter واحد على مية من ال millimeter في الدقيقة يعني كل مائة دقيقة بيطلعولي ايه one milliliter في مائة gram في حسبة بمعنى ان عندي infiltration عالي عالي جدا ال pressure الواحد بتديني كام ضخم من ال filtration لإن ال membrane has high infiltration coefficient", "tokens": [3224, 8315, 4117, 2423, 17942, 33307, 8978, 2423, 3456, 4724, 1829, 9566, 1211, 3615, 20292, 935, 472, 1728, 388, 1681, 36764, 24401, 15844, 3714, 10632, 9154, 2423, 17942, 8978, 32748, 38436, 28671, 37495, 22653, 28242, 3714, 16373, 3660, 11778, 38436, 28671, 4724, 1829, 9566, 1211, 3615, 12610, 1829, 1975, 1829, 3224, 472, 1728, 388, 1681, 8978, 3714, 16373, 3660, 21353, 8978, 11331, 35457, 3660, 4724, 2304, 3615, 1863, 7578, 16472, 18871, 16254, 29085, 2405, 6225, 6027, 1829, 6225, 6027, 1829, 10874, 28259, 2423, 3321, 2423, 14407, 24401, 39894, 3215, 9957, 1829, 9122, 10943, 48812, 9778, 2304, 9154, 2423, 43623, 5296, 28814, 1863, 2423, 19651, 575, 1090, 29085, 2405, 17619], "avg_logprob": -0.2768465838649056, "compression_ratio": 1.8436213991769548, "no_speech_prob": 0.0, "words": [{"start": 453.13, "end": 453.59, "word": "هناك", "probability": 0.63134765625}, {"start": 453.59, "end": 453.71, "word": " ال", "probability": 0.423828125}, {"start": 453.71, "end": 454.01, "word": " millimeter", "probability": 0.17041015625}, {"start": 454.01, "end": 454.63, "word": " mercury", "probability": 0.8583984375}, {"start": 454.63, "end": 455.29, "word": " في", "probability": 0.61865234375}, {"start": 455.29, "end": 455.41, "word": " ال", "probability": 0.8076171875}, {"start": 455.41, "end": 455.67, "word": " minute", "probability": 0.9248046875}, {"start": 455.67, "end": 456.33, "word": " بيطلعلي", "probability": 0.8055419921875}, {"start": 456.33, "end": 456.63, "word": " point", "probability": 0.7734375}, {"start": 456.63, "end": 456.95, "word": " one", "probability": 0.244140625}, {"start": 456.95, "end": 457.99, "word": " milliliter", "probability": 0.7688802083333334}, {"start": 457.99, "end": 459.11, "word": " واحد", "probability": 0.911865234375}, {"start": 459.11, "end": 459.43, "word": " على", "probability": 0.708984375}, {"start": 459.43, "end": 460.03, "word": " مية", "probability": 0.9580078125}, {"start": 460.03, "end": 460.25, "word": " من", 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