Nets, pulmonary arterial hypertension, and thrombo-inflammation.

Pulmonary arterial hypertension (PAH) is a progressive and fatal vascular disease in which high blood pressure in the pulmonary artery and remodeling of the pulmonary vasculature ensues. This disorder is characterized by the presence of thrombotic lesions, resulting from chronic platelet, coagulation factors, and endothelium activation, which translate into platelet aggregation, vasoconstriction, and medial thickening. Neutrophil extracellular traps (NETs), a network of chromatin and cytoplasmatic enzymes (myeloperoxidase and neutrophil elastase) forming after neutrophil programmed cell death, were described in multiple cardiovascular diseases as thrombotic mediators, by creating a scaffold or by surface receptor interaction. In this review, we analyze the possible involvement of NETs in PAH, to enlighten future studies to explore this hypothesis. NETs may have a determining role in pulmonary hypertension through activation of platelets and endothelial cells. Simultaneously, NETosis may be induced by endothelial signaling and/or cell-cell interaction between platelets and primed neutrophils, creating a positive feedback loop. Confirming its role in the pathophysiology and prognosis of PAH may represent a new opportunity to explore new therapeutic options. KEY MESSAGES: Thrombosis and innate immunity are relevant axes in PAH. Patients with PAH display elevated levels of NETs. NETs could activate platelets/endothelium with proliferative and thrombotic effects. Activated platelets and endothelium could contribute to NETosis. NETs could open new therapy research avenues.

Rethinking Anatomy: How to Overcome Challenges of Medical Education's Evolution.

INTRODUCTION: Due to scientific and technological development, Medical Education has been readjusting its focus and strategies. Medical curriculum has been adopting a vertical integration model, in which basic and clinical sciences coexist during medical instruction. This context favours the introduction of new complementary technology-based pedagogical approaches. Thus, even traditional core sciences of medical curriculum, like Anatomy, are refocusing their teaching/learning paradigm. MATERIAL AND METHODS: We performed a bibliographic review aiming to reflect on Medical Education's current pedagogical trend, by analysing the advantages of the introduction and diversification of pedagogical approaches in Anatomy Education. RESULTS: Anatomy Education's status quo is characterized by: less available teaching time, increasing demands from radiology and endoscopy imaging and other invasive and non-invasive medical techniques, increasing number of medical students and other logistical restrains exposed by the current Medical Education scenario. The traditional learning approach, mainly based on cadaveric dissection, is drifting to complementary newer technologies - such as 3D models or 2D/3D digital imaging - to examine the anatomy of the human body. Also, knowledge transfer is taking different channels, as learning management systems, social networks and computer-assisted learning and assessment are assuming relevant roles. DISCUSSION: The future holds promising approaches for education models. The development of Artificial Intelligence, Virtual Reality and Learning Analytics could provide analytic tools towards a real-time and personalized learning process. CONCLUSION: A reflection on Anatomy Education, as a comprehensive model, allows us to understand Medical Education's complexity. Therefore, the present Medical Education context favours a blended learning approach, in which multi-modality pedagogical strategies may become the landmark.

Introdução: A Educação Médica, face ao desenvolvimento científico e tecnológico, reajustou o enfoque. Progressivamente, o programa curricular em Medicina tem adotado o modelo vertical. Neste modelo, ciências básicas e clínicas coexistem ao longo da formação médica. Este contexto favorece a introdução de novas abordagens pedagógicas de base tecnológica. De facto, áreas de conhecimento tradicionais, como Anatomia, igualmente refocalizaram o seu paradigma de ensino. Material e Métodos: Nesse sentido, realizamos uma revisão bibliográfica com objetivo de refletir a tendência pedagógica atual da Educação Médica, analisando as vantagens da introdução/diversificação de abordagens pedagógicas em Anatomia. Resultados: O status quo da Anatomia é caracterizado por menor tempo disponível para o ensino, pela expansão da imagiologia radiológica e endoscópica, bem como, de outras técnicas médicas invasivas/não-invasivas, pelo aumento do número de estudantes e por restrições logísticas inerentes ao presente contexto da Educação Médica. A abordagem pedagógica tradicional, alicerçada na disseção cadavérica, vem sendo complementada por novas tecnologias auxiliares (modelos 3D ou imagiologia digital 2D/3D) ao estudo anatómico. Também, a transmissão de conhecimento vem adotando diferentes vias. Assim, os Sistemas Gestores de Aprendizagem, redes sociais ou plataformas de aprendizagem/avaliação virtuais assumem papéis relevantes. Discussão: O futuro reserva metodologias educativas promissoras. O desenvolvimento de Inteligência Artificial, da Realidade Virtual e a aplicação dos princípios de Learning Analytics favorece a disponibilização de ferramentas analíticas ao processo de aprendizagem em tempo-real, personalizando-o. Conclusão: A reflexão sobre a Educação em Anatomia, como modelo compreensivo, permite perceber a complexidade da Educação Médica. Assim, o presente contexto favorece a perspectiva de blended learning, sustentada em estratégias pedagógicas multimodais.