\r\n\tThe present book intends to provide to the reader a comprehensive overview of the state of art in empathy studies, embracing the different theoretical points of view and illustrating the advanced research such as the application of new technologies to promote perspective-taking. The critical aspects and the future directions of the study on empathy will also be presented.
",isbn:"978-1-80356-612-2",printIsbn:"978-1-80356-611-5",pdfIsbn:"978-1-80356-613-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"4c1042dfe15aa9cea6019524c4cbff38",bookSignature:"Ph.D. Sara Ventura",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11443.jpg",keywords:"Theoretical Model, Skill, Perspective Taking, Training Programs, Practical Implications, Advanced Research, Future Directions, Virtual Reality, Augmented Reality, New Trends, Assistive Technology",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 1st 2022",dateEndSecondStepPublish:"June 8th 2022",dateEndThirdStepPublish:"August 7th 2022",dateEndFourthStepPublish:"October 26th 2022",dateEndFifthStepPublish:"December 25th 2022",remainingDaysToSecondStep:"21 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Passionate researcher in the application of new technologies to psychological treatments, neuro-rehabilitation, human behavior, and the evolution of the human-computer interaction. In 2017 Dr. Ventura won a competitive grant (Santiago Grisolia) at the University of Valencia at LABPSITEC group, where she was awarded her Ph.D. degree, supervised by Prof. Rosa Baños at the University of Valencia, and co-directed by Prof. Giuseppe Riva of the Catholic University of Milan.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"227763",title:"Ph.D.",name:"Sara",middleName:null,surname:"Ventura",slug:"sara-ventura",fullName:"Sara Ventura",profilePictureURL:"https://mts.intechopen.com/storage/users/227763/images/system/227763.jpg",biography:"Sara Ventura gained a B.Sc in Psychology at the University of Padua (Italy) in 2013 and an M.Sc. in Ergonomic Psychology at the Catholic University of Milan (Italy) in 2015. In 2016, she carried out a postgraduate training at Universidad Nacional Autónoma de Mexico (Mexico) at the Ciberpsychology lab, working on a rehabilitation protocol for people with acquired brain injury through Virtual Reality. In 2020, Sara gained the Ph.D. in Clinical Psychology at University of Valencia (Spain) working with the LabPsitec group and focusing her research on the study of embodiment and empathy with the support of Virtual Reality. Actually, she is working both with Alma Mater Studiorum – University of Bologna (Italy), and the University of Valencia (Spain) on the fields of embodiment, stroke rehabilitation, empathy and patient care. Her research interests mainly focus on the adoption of new technologies, particularly Virtual/Augmented Reality and Artificial Intelligence for the psycho-social wellbeing with clinical and non-clinical populations, the study of human-computer interaction, and the user experience. She is the author of several scientific papers and various presentations at national and international conferences.",institutionString:"University of Valencia",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Valencia",institutionURL:null,country:{name:"Spain"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"21",title:"Psychology",slug:"psychology"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"455410",firstName:"Dajana",lastName:"Jusic",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/455410/images/20500_n.jpeg",email:"dajana.j@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6494",title:"Behavior Analysis",subtitle:null,isOpenForSubmission:!1,hash:"72a81a7163705b2765f9eb0b21dec70e",slug:"behavior-analysis",bookSignature:"Huei-Tse Hou and Carolyn S. Ryan",coverURL:"https://cdn.intechopen.com/books/images_new/6494.jpg",editedByType:"Edited by",editors:[{id:"96493",title:"Prof.",name:"Huei Tse",surname:"Hou",slug:"huei-tse-hou",fullName:"Huei Tse Hou"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9052",title:"Psychoanalysis",subtitle:"A New Overview",isOpenForSubmission:!1,hash:"69cc7a085f5417038f532cf11edee22f",slug:"psychoanalysis-a-new-overview",bookSignature:"Floriana Irtelli, Barbara Marchesi and Federico Durbano",coverURL:"https://cdn.intechopen.com/books/images_new/9052.jpg",editedByType:"Edited by",editors:[{id:"174641",title:"Dr.",name:"Floriana",surname:"Irtelli",slug:"floriana-irtelli",fullName:"Floriana Irtelli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10981",title:"Sport Psychology in Sports, Exercise and Physical Activity",subtitle:null,isOpenForSubmission:!1,hash:"5214c44bdc42978449de0751ca364684",slug:"sport-psychology-in-sports-exercise-and-physical-activity",bookSignature:"Hilde G. Nielsen",coverURL:"https://cdn.intechopen.com/books/images_new/10981.jpg",editedByType:"Edited by",editors:[{id:"158692",title:"Ph.D.",name:"Hilde",surname:"Nielsen",slug:"hilde-nielsen",fullName:"Hilde Nielsen"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10211",title:"The Science of Emotional Intelligence",subtitle:null,isOpenForSubmission:!1,hash:"447fc7884303a10093bc189f4c82dd47",slug:"the-science-of-emotional-intelligence",bookSignature:"Simon George Taukeni",coverURL:"https://cdn.intechopen.com/books/images_new/10211.jpg",editedByType:"Edited by",editors:[{id:"202046",title:"Dr.",name:"Simon George",surname:"Taukeni",slug:"simon-george-taukeni",fullName:"Simon George Taukeni"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7811",title:"Beauty",subtitle:"Cosmetic Science, Cultural Issues and Creative Developments",isOpenForSubmission:!1,hash:"5f6fd59694706550db8dd1082a8e457b",slug:"beauty-cosmetic-science-cultural-issues-and-creative-developments",bookSignature:"Martha Peaslee Levine and Júlia Scherer Santos",coverURL:"https://cdn.intechopen.com/books/images_new/7811.jpg",editedByType:"Edited by",editors:[{id:"186919",title:"Dr.",name:"Martha",surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"61506",title:"Vascular Smooth Muscle Cell",doi:"10.5772/intechopen.77249",slug:"vascular-smooth-muscle-cell",body:'\nVascular smooth muscle cells (VSMCs) are the main cellular components of the normal blood vessel walls, interweaving with elastic fiber layers to form the vascular media that provides structural integrity. VSMCs play an important role in the regulation of blood pressure and blood distribution to various tissues of the body through dynamic contraction and relaxation in response to vasoactive stimuli such as hormones, metabolites and neurotransmitters. Morphological and biochemical studies have revealed that two distinct phenotypes of VSMCs co-exist in the vessel wall, which are the differentiated contractile and the synthetic proliferative phenotypes. These two phenotypes of VSMCs are dictated by their environmental and functional requirements and also reflect differing patterns of gene expression [1, 2, 3].
\nThe contractile VSMCs are characterized by specific contractile proteins, ion channels, and cellular surface receptors that regulate the contractile process. Synthetic VSMCs, also called secretory VSMCs, are characterized by significant proliferation and migration activity, such as the production of a large amount of extracellular matrix during development, in response to the physiological changes (such as long-term exercise and pregnancy) and pathological injury (such as under the conditions of inflammation, hypertension, diabetes) [4]. It has been shown that the different phenotypes of VSMCs can reversibly switch, but a nonreversible change from the contractile to the synthetic phenotype is a prerequisite for the progression of vascular disease [4]. This chapter will summarize the current state of our knowledge on the origin and the ultrastructure of the VSMCs, and the mechanisms underlying the change in the VSMC phenotypic switch. We will also outline the current progress on the role of the VSMC dysfunction in the development of the vascular diseases and the therapeutic potential of the manipulation of the VSMC gene expression in these diseases.
\nHeterogeneity within the blood vessels is critical to cardiovascular function. In order to meet distinct physiological requirements, different regions of the vasculature exhibit different physical properties. Early studies have shown that the VSMCs of the proximal large vessels (which comprises the arch of the aorta, the common carotids, the common pulmonary trunk, and the brachiocephalic artery) are derived from the neural crest (NC) (ectomesenchymal smooth muscle) [5, 6], while VMSCs of the distal vessels (which includes the abdominal aorta and the right and left carotid arteries) are derived from the mesenchyme [7, 8]. At the region of the interface of these vessels, VSMCs are derived from mixed origins, both of the ectomesenchymal and mesenchymal.
\nThere is abundant evidences showing that the embryonic origin of the VSMCs plays an important role in vascular biology and in the response to the stimuli response [9, 10]. Firstly, the different embryonic origins of VSMCs reflect different gene expression patterns [11]. Secondly, differentiation of VSMCs from embryonic stem cells through NC- or mesoderm-lineages showed that VSMC characteristics are programmed largely based on embryonic origin [12]. These distinct embryonic origin differences also converge in the adult vessels [13]. As noted earlier, the VSMCs of the proximal aorta arise from two distinct embryonic origins: the NC and the somatic mesoderm [14, 15]. This juxtaposition of the VSMCs from different embryonic origins in the aorta contributes to the specific ability of the aorta to respond to high local pressure/force loading and various chemical stimulation as well as neuronal–hormonal–regulation to meet the physiological requirement of circulation. In addition, VSMCs from different embryonic origins may also be responsible for some specific pathogenesis of vascular diseases. For example, studies have shown that when vessels that are prone to atherosclerosis are placed in a vascular region that does not typically develop atherosclerosis, they retain their predisposition to disease [16]. This evidence suggests that individual VSMC characteristics may be linked to embryonic origin. However, definitive evidence that embryonic origin dictates vascular phenotype has not been fully elucidated [17].
\nWhile the embryonic origins of many VSMC populations are known, the exact nature of the VSMC precursor remains elusive. It has been indicated that VSMC progenitors may arise from distinct embryonic sources including the splanchnic mesoderm [18], somatic mesoderm [15, 19], neural crest (NC) [14, 20], mesothelial [21], and other embryonic cell types [22]. In the aorta, splanchnic mesodermal cells are first recruited and differentiate into VSMCs. Before the splanchnic mesoderm cells completely encircle the dorsal aorta, the cells are displaced by the somatic mesodermal cells. Differentiation of these somatic mesodermal cells begins in the ventral anterior end of the vessel. Differentiation then proceeds around the circumference of the vessel and down the length of the aorta toward the diaphragm. Meanwhile, the cardiac NC migrates down the pharyngeal arches to invade the aortic sac. A subset of the cardiac NC participates in septation of the truncus arteriosus into the aortic arch and the pulmonary trunk [23]. The rest of the cardiac NC remains in the pharyngeal arch arteries and become the VSMCs of the aortic arch and the arteries of the head and neck [20]. The border that forms between the NC-derived VSMCs of the ascending aortic arch (aAo) and mesoderm-derived VSMCs of the descending aorta (dAo) is maintained throughout development and into adulthood [14, 20]. Once cells encircle the aorta and differentiate into VSMCs, they undergo a closely regulated process of layer formation within the media.
\nUnder physiological conditions, VSMCs mostly express the contractile phenotype with a spindle-like shape with a length of 50–200 μm, a width of 2–8 μm. The nucleus is located in the center surrounded by smooth endoplasmic reticulum and mitochondria. The cytoplasm is rich in thick and thin myofilaments, with every thick myofilament surrounded by 15 thin myofilaments. The thick myofilaments and thin myofilaments are aggregated into myofilament units, also known as systolic units. The intracellular thin filaments are connected by dense bodies. The adjacent dense bodies are connected by intermediate filaments to form a smooth muscle network. Thin filaments and cell membranes are connected by dense patches. Smooth muscle cells are surrounded by reticulated fibrous connective tissue, including extracellular matrix secreted by VSMCs, which interlaces individual cells into clusters to be functional units [24].
\nThe diameter of thick filaments is 8–16 nm, which is a myosin dimer. The myosin superfamily is subdivided into 18 categories based on their conserved motor domain and systemic development. Type II is the constituent protein of thick filaments found in multiple subtypes of striated muscle, myocardium and smooth muscle. The smooth muscle subtype is encoded by the same gene, with selective splicing producing myosin monomer SMA and SMB [25]. The SMB type is more expressed in phasic contractile smooth muscle such as in the bladder and smooth muscle of the small intestine [26]. The SMA type is more abundant in tensile contractile smooth muscle. Smooth muscle myosin has a molecular weight of about 50 kDa, containing two heavy chains and four light chains. Each heavy chain has a carboxyl-terminal tail and an amino-terminal head, containing approximately 2000 amino acids, approximately 20 kDa. The tails of the two heavy chains are wound in the form of α-crimping spirals to form the skeleton of the thick filaments [25]. The heads of the two heavy chains are separated, face the thin filaments, and form part of the transverse bridge. Myosin is hydrolyzed by trypsin to produce about 350 kDa heavy meromyosin and 150 kDa light meromyosin. Hydrolyzed myosin can be produced by proteases such as papain to generate fragment S1 and S2. The fragment S2 is a helical structure. The fragment S1 is the head of myosin and can be divided into a motor domain and lever arm. The motor domain contains an actin binding site and a nucleotide binding site [27]. The lever arm contains binding site of convert domain, myosin light chain 17 (MLC17) of 17 kDa, and myosin light chain 20 (MLC 20) of 20 kDa. The torsion zone is a site where relative rotation occurs between the motor domain and lever arm to relatively slide actin and myosin. MLCl7 is located near the torsion zone and related to the structural stability of the lever arm. MLC20 is located near the junction of S1 and S2 [27] .
\nThin filaments, which consists of acting, are 5–8 nm in diameter and 1 µm in average length. Actin is the most abundant protein in eukaryotic cells and accounts for 20% of total protein weight in muscular cells. Actin monomers, which called globular actin (G-actin), are dumbbell-shaped. Microfilaments are formed by the conglomeration of actin monomers into large multimers, which are called fibrous actin (F-actin) [28]. Monomeric actin consists of 375 amino acid residues with a molecular weight of 42 kDa which has three binding sites, one for ATP binding and two for myosin binding. Actin maintains its polymer in a dynamic, polar state by hydrolyzing ATP. Some proteins are closely related to the smooth muscle filament’s function including tropomyosin, caldesmon and calponin [17, 29]. VSMCs expressed at least five tropomyosin subtypes with subtype α displaying the highest abundance. By regulating the binding of other proteins to actin filaments, tropomyosin affects the interaction between actin and myosin and multimerization of actin [30]. The calponin protein is a 34 kDa-sized protein that is present in smooth muscle and non-muscle tissue, and is primarily calponin-l in smooth muscle, which may reduce muscle contraction by inhibiting the myosin ATP enzyme [31].
\nThe skeleton protein plays an important role in maintaining cellular shape, intracellular organelle location, intracellular vesicle trafficking, cell migration, and division [32]. Like all eukaryotic cells, VSMCs mainly contain three skeleton proteins: microfilaments, intermediate filaments and microtubules. The microfilament has a diameter of about 4 nm and consists of linear polymerization of actin. The filaments are connected to each other through dense bodies to form a network structure and are connected to the cell membrane through dense spots. There are four types of actin isoforms in smooth muscle: α-smooth muscle actin, β-non-muscular actin, γ-smooth muscle actin and γ-cytoplasmic actin, all of which are distinct gene products [33, 34]. In VSMC, α- smooth muscle actin is the main subtype interacting with myosin to produce contraction. Approximately 60% of large arterial vascular actin is α-smooth muscle type, 20% is β-non-muscle actin and the remainder is γ-smooth muscle and γ-cytoplasmic actin. Γ-smooth muscle actin is mainly confined to the gastrointestinal muscles. Studies have shown that γ-cytoplasmic actin is confined to the cell cortex, α-actin serpentine longitudinal full-length cells, and β-actin borders dense plaques. The diameter of the intermediate filament is about 10 nm, which is involved in maintaining the three-dimensional structure of the cell, maintaining the proper position of the organelle in the cytoplasm, and participating in the transfer of the membrane receptor signal to the nucleus [35]. The intermediate filaments of VSMC are in the shape of the crest, and the periphery is often accompanied by a dense body [36]. It is abundantly expressed during development and decreased with cell maturation. The intermediate filaments of differentiated vascular smooth muscle are mainly composed of vimentin and desmin [37, 38]. Vimentin, which is generally found in cells of mesenchymal origin, is the major intermediate filament types of aortic smooth muscle [37]. Skeletal proteins make the different components of the VSMCs an organic three-dimensional structure, which is a dynamic process that produces adaptive changes based on changes in cell function.
\nThe sarcoplasmic reticulum, also known as sarcoplasmic reticulum, is a specialized smooth endoplasmic reticulum in muscle cells; a phospholipid bilayer forming a capsular network, which stores a large amount of Ca2+ [39]. At rest, the sarco/endoplasmic reticulum Ca2 + − ATPase (SERCA) transport the cytosolic Ca2+ into the sarcoplasmic reticulum through hydrolyzing ATP. The inositol (1,4,5)-triphosphate receptor (IP3R) and ryanodine receptor (RyR) channel release Ca2+ into the cytoplasm when excited and thus play an important role in the regulation of contraction and relaxation [40, 41]. SERCA is a type of sarcoplasmic reticulum transmembrane Ca2+ transport ATP enzyme, which can transport two Ca2+ per one ATP hydrolyzation. Three major subtypes are known: SERCA1, SERCA2 and SERCA3. SERCA2a is presented in the myocardium, skeletal muscle and multiple smooth muscle cells. The sarcoplasmic reticulum releases calcium ions to the cytoplasm through the IP3R and RyR Ca2+ channels. IP3R is a membrane glycoprotein complex composed of inositol trisphosphate-activated Ca2+ channels. It consists of four subunits with a molecular weight of approximately 300 kDa. The ratio of IP3R and RyR in vascular smooth muscle is 3:1 to 4:1. The RyR can cluster in the sarcoplasmic reticulum near the cellular membrane, so that the local release of Ca2+ is at a high concentration [40].
\nAlthough the primary function of VSMCs in the adult animal and human is contraction, VSMCs maintain considerable plasticity throughout life and can exhibit a phenotypic switch during normal development, the repair of vascular injury, and in disease states [42, 43]. During development, VSMCs exhibit a secretory phenotype that is distinct from the spindle-shaped mature, contractile phenotype present during physiological conditions in the adult. Secretory VSMCs contain a large number of organelles involved in protein synthesis, whereas the main component of contractile smooth muscle cells is myofilaments.
\nSecretory VSMCs show high proliferation rates, apparent migration activity and strong extracellular matrix synthesis [42]. These extracellular matrixes include collagen, elastin, proteoglycan, cadherin, and integrin. At the developmental stage, VSMCs form a large number of gap junctions with endothelial cells, a process that is critical for vascular maturation [44]. In contrast, the contractile phenotype of VSMCs is very low in proliferation and the migration activity and synthesis of extracellular matrix are also low. The expression of some marker proteins is different in different phenotypic smooth muscle cells, for example, PDGF-a, intercellular adhesion molecule 1 (ICAM1), I-caldesmon, osteopontin, matrix Gla protein (MGP), collagen 1 and connexin43 decrease gradually in the process of VSMC transition from secretory to contractile type [45, 46]; whereas αl-, β1- and α7 integrins, transcriptional co-activation factors myocardin, cadherin, α-smooth muscle actin, desmin, smooth muscle protein 22α (SM22α), carboxypeptidase-like protein, smooth muscle calponin, h-calmodulin binding protein, aortic preferentially expressed gene1 (APEG1) cysteine-rich protein 2 (CRP2) gradually increased during VSMC transition from secretory type to contractile type [47, 48, 49] .
\nImportantly, calcium signaling varies between the two phenotypes. Ca2+ signals controlled by large conductance K+ channels KCa1.1, voltage-gated L-type Ca2+ channels and RyR are associated with the transcription of differentiated contractile protein markers while signals controlled by intermediate conductance Ca2+-activated K+ channels (KCa3.1) and TRPC channels are associated with the transcription of pro-proliferative protein markers [50]. Furthermore, the expression levels of intracellular Ca2+release channels, Ca2+-activated proteins and pumps are also altered during VSMC phenotype switching: the synthetic VSMCs lose the RyR3 and the SERCA2a pump and reciprocally regulate isoforms of the ca2+/calmodulin-dependent protein kinase II [50]. Changes in calcium signaling molecules as a result of phenotypic switches reflect changes in the function of the VSMCs as contractility is substituted for proliferation.
\nCurrently, smooth muscle myosin heavy chain (SM-MHC) and smoothelin are two marker proteins that identify the contractile phenotype of smooth muscle. SM-MHC was found only in smooth muscle cells in
The mature skeletal muscle is terminally differentiated, that is, the its ability to be changed is limited. However, the mature VSMC has a strong plasticity, with significant and reversible phenotypic changes occurring when the local environment changes. The VSMCs can quickly transform from a contractile phenotype to a secretory phenotype in response to injury. Significantly, when the injury is repaired and the local environment returns to normal condition, VSMCs can regain the contractile phenotype. Thus, the regulatory mechanisms have to be reversible.
\nAlthough the molecular mechanisms controlling the VSMCs phenotypes switching have not been fully understood and the signaling pathways involved under different conditions may be variant, epigenetic mechanisms have been suggested as a possible explanation of the reversibility of VSMC switching. For example, microRNA 663 and micro RNA 133 have been identified as modulators of VSMC phenotypic switching [52, 53]. In addition, it has been widely-accepted that serum response factor (SRF)-mediated signaling pathways play an important role in the regulation of VSMC phenotype changes [54]. The SRF belongs to the MADS box transcription factor superfamily, through which the cis-element CArG box binding regulates the transcription of smooth muscle marker genes and is closely related to the phenotype of smooth muscle [54]. SiRNA-mediated
The expression of myocardin is down-regulated during hypoxia, leading to enhanced binding of SRF. Elevated PDGF-BB can also promote Elk1 phosphorylation and Elk1-substituted myocardin binding to SRF through the ras/raf/mek/erk kinase pathway, promoting conversion to the secretory phenotype [58]. Activation of RhoA is essential for smooth muscle specific transcriptional up-regulation. RhoA activates multimerization of actin via ROCK and then promotes the translocation of myocardin-related transcription factor (MRTF) into the nucleus and binds to SRF, stimulating smooth muscle marker gene transcription and conversion to a contractile phenotype [59]. Rho-dependent MRTF nuclear translocation is one of the key regulation mechanisms of smooth muscle cell differentiation.
\nAn increase in vascular stiffness is a common vascular pathogenesis of aging and of aging-related cardiovascular disease and has been assumed to be caused by molecular changes of the ECM and the dysfunction of endothelial cells in elastic arteries. It was not until recent years, with the use of two unique techniques, atomic force microscopy (AFM) [60] and a reconstituted tissue model [60], that it was discovered that both the intrinsic mechanisms in VSMCs and the alterations in VSMC-ECM interaction contribute to the increased aortic stiffness in the old non-human primates [21]. The underlying mechanisms involve the increased expression and polymerization of α-smooth muscle actin (a stress fiber-specific isoform of actin for VSMCs), microtubules and myosin light chain kinase (MLCK), and also the increased expression of adhesion molecule β1-integrin and its binding to fibronectin. It was also suggested that the oscillatory behavior of VSMC elasticity and adhesion are affected differently during aging, which may link these events to changes in vascular stiffness. However, the molecular mechanisms are still not fully understood [61].
\nHypertension is one of the most common cardiovascular diseases, which eventually results in heart, renal failure or stroke. Although most of previous studies focused on the changes in the ECM and impaired endothelial control [62, 63, 64], increasing evidences indicate that VSMCs play an important role in the development of hypertension. It has been shown that arterial hypertension is accompanied by the proliferation and migration of VSMCs [65, 66]. One of the most typical features of vascular remodeling in the course of hypertension includes thickening of the middle layer and intima and the increase of the ratio of wall thickness to lumen. These changes are mainly found in the small arteries of hypertension, mainly due to hypertrophy and proliferation of VSMCs and the migration of VSMC into the intima. In addition, recent studies confirmed that the increased intrinsic stiffness of VSMCs from hypertensive aorta contribute to the aortic stiffening and high blood pressure. The underlying mechanisms are involved in the upregulation of ROCK-SRF/myocardin and α-smooth muscle actin signaling in the VSMCs. It is noteworthy that a heterogeneity of mechanical properties in VSMCs between the large aorta and downstream distal arteries in the hypertensive model was shown, which is accompanied with a parallel regional difference of the SRF/myocardin signaling pathway. These observations further support the concept that the different origins of VSCMs plays a role in the development of hypertension. Furthermore, a most recent study from the same group also indicate that VSMCs from hypertensive aorta are able to contribute to hypertensive vessel changes by interrupting synthesis and degradation as well as organization of ECM through the regulation of activity of lysyl oxidase (LOX) and integrin β1. Importantly, targeting the stiffening of VSMCs effectively lowered aortic stiffness and blood pressure which revealed a promising therapeutic potential of anti-hypertension treatment in the future [28, 59].
\nStudies have been shown that VSMCs play a complex role in the formation of atherosclerosis, including increased matrix synthesis, production of multiple proteases, and changes in vascular contractility, in which the proliferation and apoptosis of VSMCs play a major role in the process of intima thickening and formation of atherosclerotic plaque [67]. Prior to the development of atherosclerosis the VSMCs maintain a stable phenotypical features and showed low proliferation. As atherosclerosis developed, the VSMC phenotype changes to a more proliferative nature, with reduced contraction, increased proteoglycans, but reduced expression of the typical smooth muscle markers [68, 69, 70]. The biological effects of VSMCs were discovered during the
Aortic aneurysm (AA) is a life-threatening condition where a bulge forms in the aortic wall. There are abdominal and thoracic AA. The basic structural unit of the aortic wall is the two layers of elastic fibers clamped by the VSMCs to form a sandwich structure. This structure allows the blood vessel wall to have a good contractile strength and elasticity. The abnormality of its composition and function may lead to AA. The development of AA can begin with the degradation of ECM within the media due to a proteolytic process, which loosens the wall tension created by the ECM and VSMCs [79]. Mucoid degeneration in the aortic media can induce the disappearance of VSMCs. Loss of VSMCs inhibits the clearance of proteolytic enzymes, leading to replacement by vacuoles, proteases, apoptotic cells and modified glycosaminoglycans. This state leads to the progression to chronic dilatation and development of thoracic AA [79]. Like atherosclerosis, phenotypic switching and VSMC apoptosis also influence the development and progression of AA [80]. VSMCs express NADPH oxidases isoforms, which then regulates the proliferation migration and apoptosis of the VSMCs [81, 82]. This implicates that oxidative stress also play an influential role in the development of AA. The mutations in some cytoskeletal proteins, such as MYH11, is associated with cellular contractions, may cause AA [83]. The rigidity and function of the cytoskeletal proteins is important to the function of the VSMCs. In the blood vessel wall of patients with MYH11 mutations, the axis of the cytoskeleton/membrane integrin-extracellular matrix is disrupted, there is accumulation of proteoglycans, breakage of elastic fibers and reduction in the number of VSMCs. The typical characteristics of AA include the medial membrane degeneration, abnormal VSMC arrangement and proliferation of epithelial vasodilatation [79]. In addition to systolic function, VSMCs are also capable of trans-differentiation and secretion under mechanical and biochemical stimuli, such as the secretion of a variety of matrix proteins through the interaction with integrins, G protein-coupled receptors (GPCR) and disks on the cell membrane surface [84].
\nSince VSMCs play a critical role in the cardiovascular diseases such as aortic stiffening, hypertension, atherosclerosis and aortic aneurysm, they have become a therapeutic target in the treatment of these diseases. For example, atorvastatin, one of the most effective drugs for treating cardiovascular diseases, suppresses tacrolimus-stimulated VSMC proliferation via down-regulation of β-catenin, ERK1/2, and cyclin B. Tropoelastin is shown to regulate VSMC phenotypic switch and inhibit VSMC proliferation and migration [22]. Drugs, such as paclitaxel and rapamycin which are eluted in the coronary artery stent inhibit the proliferation of VSMCs and significantly reduces the restenosis rate. In addition, new basic investigation on the VSMCs in aortic stiffness during aging and hypertension also provides new targets for the treatment of vascular diseases. For example, two anti-stiffening treatment of VSMC that act either through the inhibition of ROCK-SRF/myocardin signaling by Rock inhibitor (Y-27632), or through the inhibition of the SRF/myocardin signaling (CCG-100602) have been shown to be able to reduce the aortic stiffness and high blood pressure in hypertension. These suggest that VSMCs can be a promising target of the treatment of hypertension [28, 59]. The successful preclinical application of these VSMC-targeted interventions underscores the promising prospective of medications targeting VSMC. In fact, Plumericin inhibits proliferation of VSMCs by blocking STAT3 signaling via S-glutathionylation, highlighting the feasibility of clinical manipulation of VSMCs [85, 86].
\nAs summarized in the Figure 1, VSMCs are not only the dominant components of the medial layer of blood vessels, but also important endocrine cells which secret various signaling factors promoting the arterial remodeling in the case of pathological stimuli. Multiple factors including embryonic origin, regional mechanical load, pathological stimuli and genetic mutations mediate the gene expression of VSMCs through different signaling pathways which involve the VSMC membrane receptors, calcium channels, miRNAs, DNA methylation, and histone modification. This results in the regulation of VSMC phenotypes, the expression of stiffness-related proteins, and ECM production. These changes subsequently affect VSMCs stiffness, migration, and proliferation, as well as ECM remodeling, thus, playing a role in normal vascular physiology and diseases. Although the mechanisms involved in vascular diseases remain largely unknown, SRF/myocardin mediated signaling pathways have been identified as a key mechanism within the developmental of vascular diseases through their regulations on the VSMC stiffness, phenotypic switching and ECM remodeling. Targeting VSMC is a promising therapeutic of hypertension, atherosclerosis and aortic dissection/aneurisms and other related diseases.
\nSummary of the role of VSMCs in normal vascular physiology and in the development of vascular diseases. Multiple factors including embryonic origin, regional mechanical load, pathological stimuli and genetic mutations mediate the gene expression of VSMCs through different signaling pathways which involves the VSMC membrane receptors, calcium channels, miRNAs, DNA methylation, and histone modification. This results in the regulation of VSMC phenotypes, the expression of stiffness-related proteins, and ECM production. These changes subsequently affect VSMCs stiffness, migration, and proliferation, as well as ECM remodeling, thus, playing a role in vascular normal physiology and diseases.
The pathological changes, especially the phenotypic switching of VSMC, are the most important mechanisms and characteristics of various cardiovascular diseases, including hypertension, atherosclerosis and aortic dissection/aneurisms. Medications targeting VSMCs have been clinically prescribed in the treatment of these diseases. SMC-specific drugs may be achieved through the different approaches: (1) identifying genes/proteins targets that differentially regulate VSMC phenotype changes and identifying markers of synthetic phenotype; (2) identifying genes/proteins that target intrinsic mechanical properties of the VSMCs and developing inhibitors of the proteins; (3) exploring non-coding RNAs, including microRNA, long- or short-non-coding RNA and other epigenomic alterations such as DNA methylation and histone regulation that differentially regulates VSMC function; (4) identifying growth factor/hormones that have differential cellular effects on VSMC; and (5) combined usage of multiple drugs to achieve distinct functions in ECs and VSMCs.
\nThis work is supported by the grants of 1R01 HL115195-01 and HL137962 from NIH/NHLBI (Hongyu Qiu) and the National Natural Science Fund of China (81100087, 81570261, Ning Zhou).
\nNone.
None.
Health science educators were living times of discussion about competency-based education, how this influenced curriculum design, teaching methodologies, and the role of teachers. The beginning of the decade took us in time when medical schools and colleges are incorporating an early approach to the field of practice and have increased the proportion of learning in practice settings. We never assumed a scenario like this. The COVID-19 pandemic is a situation not intended neither for health, nor for the economy, nor medical education. Everything will undoubtedly change during this period. There may be new, moderate forms of quarantine, but the world will certainly not be the same when the pandemic passes.
Medical education is not immune to the heartaches produced by abrupt contemporary changes in our world, such as the COVID-19 pandemic. Unexpectedly, and on very short notice, people can no longer teach or learn alongside other people. The impact on the heart of the educational processes of the health professions is unprecedented. Suddenly, the status quo of undergraduate or graduate medical education has been called into question, perhaps for the better. The key concerns of yesterday, such as the need to improve patient bedside learning or to enhance the experience of students in the clinical setting, in the clinical workplace, have a different meaning.
The arrival of the COVID-19 pandemic caused medical schools and faculties to interrupt their activities abruptly, recovering institutional capacities and making evident the strengths and weaknesses of each educational institution. The response in the undergraduate courses consisted in the migration of classes to virtual media, and the attendance of students to hospitals was interrupted to prevent them from being infected and could spread the virus in the communities.
In the case of students who were in undergraduate boarding school or in residencies, these were suspended and clinical rotations were replaced by the review of clinical cases by digital means. In graduate school, the resident physicians stayed in the hospitals and carried out a certain degree of theoretical activities and review of clinical cases on the Internet. Residents located in COVID hospitals suspended their scheduled clinical rotations and focused on responding to the pandemic by disrupting academic activities.
However, in contrast to the aforesaid, distance education remains rudimentary in supporting holistic professional learning. With the suspension of internships in colleges, medical educators must be creative in offering meaningful alternatives. Although virtual patients are not universally available and teaching practical procedures online is not yet feasible, clinical teachers can take advantage of the changes that are available in healthcare to adapt to COVID-19 crises. Additionally, COVID-19 can lead to unavailability of clinicians to teach as a result of the intense clinical workload generated by the disease. We may not be equipped with the tools to respond effectively [1].
The first response of most of the institutions in the world is to increase the use of “e-learning”, especially online educational platforms and videoconferences. Strategies had already been imposed, more as support systems for face-to-face courses than as real online education. For initial or preclinical cycles, this may be a good answer, but questions immediately arise for which we still do not have an answer regarding the development of professional skills [2]. On the other hand, it highlights the differences in internet accessibility, either due to availability of equipment, connectivity, or the high consumption of data when it is done from mobile devices, which challenge equity in student access. The positive view of these processes is to reflect on how many of our usual face-to-face theoretical classes could be permanently replaced by this modality, accelerating the incorporation of methodologies such as flipped class or team-based learning.
Medical schools and colleges faced the challenge of maintaining their functioning and helping to respond to the pandemic. To this end, the following activities were developed, all of them supported by information and communication technologies (ICT) [3]:
Maintain the undergraduate training processes: Because undergraduate students had to leave hospitals, training had to be migrated to ICT to assume totally a digital education.
Preserve postgraduate training: Resident doctors remained in hospitals and many cases were reassigned to COVID areas, regardless of the specialty they were studying. Academic activities were maintained in most cases virtually.
Strengthen continuing education: Medical schools and faculties implemented courses, webinars, and seminars to update physicians on preventive actions and the management of COVID-19 patients.
Support the institutional management and coordination of telework: With closed institutions and with teachers and students located in different places, the coordination of activities and the organization of telework became decisive to develop synergistic actions between teachers and students and to maintain communication with the population.
Promote access to scientific literature and information on COVID-19, and share it with governments, the health sector, and the general public, to guide evidence-based actions, help to reduce public distress, and avoid false news.
Maintain communication and coordination with national and foreign experts, to keep abreast of the latest advances and set up collaboration networks.
Generate research projects related to COVID-19: both local and participation in international multicenter studies.
Establish advisory groups for governments: through interdisciplinary teams of experts made up of epidemiologists, infectologists, mathematicians, biostatistics, computer scientists, georeference experts, sociologists, and others.
Provide remote medical assistance: through the installation of telephone assistance centers, telemedicine, and virtual hospitals.
Organize volunteer student brigades, to strengthen health institutions with the care of non-COVID patients and facilitate the continuity of medical care.
Take care of the physical and mental health of teachers, students, and workers: The faculties and schools implemented actions to assist their community, maintaining regular contact, establishing support units, and developing protocols for action in mental health.
Produce medical equipment and personal protective equipment, supported by other university entities and businessmen, personal protective equipment was produced and some ventilators were even developed.
Return to classrooms and clinical practices: A large part of the present effort is directed to organizing the return to face-to-face activities, preparing manuals with standards that include the use of masks, hand hygiene, and maintaining the minimum distance between people, or aspects such as ventilation.
Medical educators can leverage technology to enhance medical education at both undergraduate and graduate levels. Although the most recent initiatives, such as remote transmissions, have been introduced for a long time, traditional classes, lectures, and face-to-face didactic tutorials continue to be the most important cornerstone of medical education both in our country and abroad. In the case of the epidemic, we are experiencing and given the highly infectious nature of COVID-19, but as in most emerging infections in recent years, face-to-face interactions in large groups are sources of spread and transmission diseases and therefore should be avoided.
To avoid this, technology, for example, video conferencing and e-learning platforms, can be used to deliver them remotely
Some technological learning tools are also sure to become massive shortly. It will occur in both undergraduate and graduate degrees. Interactive whiteboards, connected to a computer, will be used even more. There the teachers write, project images or videos, and transmit them in real-time to distant places [5]:
Perfecting medical visualizations with 3D images will allow you to learn anatomy or diagnostic imaging.
On the other hand, thanks to the use of virtual microscopes, even more about human cells and tissues will be taught.
The use of mobile phones or electronic tablets for educational purposes will also increase. These devices will allow—thanks to the download of applications—among other things to receive tutoring for a certain exam.
The virtual will allow immersive and augmented reality experiences that will include hospitals, inpatient rooms, or patients. There are already designs that simulate real clinical scenarios, where students assume the professional role, take a medical history, propose diagnoses, and indicate treatments.
Faculties can then set up programs and hold online meetings to continue these types of discussions that further help students and residents consolidate their learning. Courses in subjects such as communication skills, medical ethics, and even clinical or statistical research can also be arranged through these online modalities for medical students or residents. There are already numerous experiences in this regard.
Some countries have shown concern regarding the development of some courses during this pandemic; such is the case of anatomy due to the disposition to cremate the bodies to prevent the spread of the virus, a situation that limits the obtaining of corpses for the development of classes [6]. Furthermore, although virtualization is a viable alternative for many universities, not all have the logistical facilities to implement it. On the other hand, although some contents of the clinical courses can be virtualized, the skills necessary for medical performance—such as performing the physical exam—can only be adequately learned with the patient and virtual adaptations are unsustainable over time; for this reason, some faculties considered it necessary to delay the start of this type of course until the end of the pandemic. While it is true there are many advantages in the virtualization process of courses, it is clear that some universities have and will have limitations to make this process concrete [7].
Advantages and limitations in the virtualization process of undergraduate medicine courses are as follows:
Advantages
Reduces the possibility that students in clinical courses will get sick from COVID-19.
Reduces the possibility of contaminating patients and health personnel if they are asymptomatic carriers of the disease.
Avoid the use of personal protective equipment on non-essential personnel in hospitals.
It allows continuing with academic activities.
Facilitates the timely review of academic material, ensuring the delivery of updated evidence-based content to students.
It promotes digital learning in the new generations better adapted for it.
Limitations
Not all universities have a digital platform to teach virtual courses.
Not all teachers have the ability to build adequate virtual content.
Requires a strong sense of self-motivation and good time management skills on the part of students and teachers.
The saturation of care work of doctors who are teachers will not allow them to dedicate themselves to virtual class-work.
It is not possible to virtualize all the contents of the clinical courses and some non-clinical ones (such as anatomy and the like).
Not all students can have access to a laptop, tablet, or smartphone for their classes.
Not everyone has an adequate internet or electricity connection; for example, if they are undergraduate students in rural areas.
Limits the collaborative learning experience.
Limits the presentation experience with live interaction.
Limits real-time feedback from face-to-face classes.
Unethical behaviors may occur more frequently (e.g., cheating during virtual evaluations).
But there is an unavoidable aspect that puts the development of competencies and their evaluation in tension. The presence of the student in the clinical environment is essential in medical teaching to acquire these skills. Presence that must be supervised requires close contact between teacher and students. The appearance of the coronavirus pandemic, highly contagious, in which the student can be a vector of infection, or can become infected, added to the dramatic change in the care model and the practices of health institutions, makes it necessary to recreate new forms of education combining technology and educational strategies to cushion the impact of the pandemic on the entire education process and continue in some creative way our way of teaching. On the other hand, the student’s displays of commitment and enthusiasm that lead to their participation in volunteering should be evaluated in light of the risks involved, if it brings them into contact with potential patients [8].
But medical education is not just about imparting specific knowledge and skills in a particular domain. A highly qualified surgeon or an experienced physician is not necessarily a good physician. In addition to domain-specific knowledge, holistic non-cognitive attributes such as teamwork, empathy, initiative, and compassion are important qualities to convey to medical students and residents. The participation of these medical students and residents as collaborators, the former, and physicians increasingly involved, the latter, to try to alleviate this crisis is something important not only for that purpose but for their general education as physicians. In this sense, we are not inventing anything new, there are antecedents. In 2003, during the height of the SARS outbreak in Singapore, medical students were asked to help with temperature checks [9].
With the COVID-19 crisis, residents of all medical and surgical specialties in very different locations have also been selected to take shifts on the frontline, where they have assisted with the detection of suspected cases in emergencies and elsewhere. In addition to alleviating labor shortages where labor was scarce, this has helped foster camaraderie among residents as part of the medical community, prompting them to feel like part of the teams fighting this pandemic. This, according to very different testimonies, the residents have been taught important lessons about courage, empathy, and teamwork [2]. It has also provided the opportunity for many residents to review their general medical skills, since in many cases many of them, who belonged to highly technical or specialized specialties, have had to care for patients with this infection. This is a great step in their training and development as medical professionals with more holistic perspectives.
In response to the lack of clinical practice, the first alternative seems to be to alter the academic calendar by postponing the practical load and increasing the clinical reasoning activities at this stage, or the elective activities related to the pandemic. Some institutions incorporate the use of virtual cases, surgical videos, and participation in telemedicine. We must also think creatively, how to maintain contact with virtual and real patients, as well as develop new forms of evaluation. This requires clear indications for students and supervisors because the electronic interface modifies the possibilities of giving feedback and modifies the observed competencies. Nor should we lose contact with the human aspects of pandemics, as literature and film can contribute as triggers for this understanding [10].
The COVID-19 pandemic has posed challenges in medical education globally. Each society has responded according to its possibilities and needs to take advantage of this situation as a learning opportunity, continue with education, and incorporate students as health workers in the countries where it was necessary. A crisis such as the COVID-19 pandemic involves making great efforts to carry out contingency plans that minimize disruptions or profound changes that occur in educational programs.
Many university professors who went through this situation agree that preclinical subjects have been taught, overcoming some inconveniences and without being prepared for such a hasty decision. For others, after this pandemic and forced “natural experiment” something may no longer be strange. Why not think about a preclinical cycle entirely online for future doctors. With users located in various parts of the world, even endowed with the ability to find the best teachers or courses thanks to one click. Exchanging face-to-face classes of 1 hour, for sequences of short videos or podcasts of no more than 15 minutes [11].
However, technology can and should be harnessed to allow students and residents to learn from these experiences and gain extra training in skills such as clinical communication and medical ethics. Beyond the knowledge of a particular domain, the participation of medical students and residents in the clinical tasks that a pandemic like the one we are experiencing can be beneficial to develop another perspective on medicine and what clinical practice means and what it means. Time about what is expected of them as physicians. This type of crisis should be used to improve or instill non-cognitive holistic aspects such as leadership and adaptability. As medical educators, we can and must meet the challenge of continuing to teach even in times of crisis.
Before the outbreak of the SARS-COV-2 virus, online medical education had acquired some evolutionary features. She used to dealing with healthcare professionals who were geographically isolated and distant but connected through virtual communication. He provided solutions to hundreds of them immersed in demanding work hours, and with little flexibility in the agenda. It was based on collective learning, online collaboration, proactivity, and self-directed training [12].
Online had dispensed with the presence of educational leaders and managed to optimize interaction with them from a distance. It had generated between the participants an exchange—both synchronous and asynchronous—through chats, forums, or emails. COVID-19 has done nothing but selects those cited features of virtual education. Also, during these months, he has polished virtual-friendly technological educational tools. But it should not be repaired only in this present. It should be noted that the future seems to have changed a bit as well. Even the most skeptical no longer conceives the future of medical education, as something in total separates from technology and online.
In general terms, the educational emergency caused by the epidemic made evident the high frequency that the expository technique or oral presentation has in the educational activity by the teacher, who by not having the students in physical presence, perceived a lack of control and authority. In the same way, the student, under the same system, felt free and without directivity, which generated anxiety and anguish in not feeling his physical presence and having his direct surveillance; the teacher’s immediate action was to commission homework, homework, and more homework, and the students were overwhelmed and disappointed by not receiving feedback.
Online education requires a differential planning of education with physical presence; the conjunction of a team of experts in various disciplinary areas is desirable, such as pedagogues, educational psychologists, software specialists, interactive, and graphic designers, among others, with which the online educational experience is highly meaningful for students [12].
The characteristics of teaching in virtuality include the following: the management of non-face-to-face asynchronous or synchronous educational organizations, transversal (multi or transdisciplinary) and holistic; student-centered, characterized by being flexible, cooperative, personalized, and interactive; the teacher will be a facilitator, who must be more collaborative than lonely, encourage/promote participation, recognize/accept the fact that they no longer have possession, with organizational skills, open to experimentation, and with the ability/ability to modify.
The use of ICT in teachers ranges from the resistance of its use to its formal use in education, with relative or little use for play, recreation, or social networks, while students use them little as an educational tool and their focus is on the play, entertainment, and especially on social networks. The previous dichotomy leads us to think in three moments about the knowledge, attitudes, and practice of ICT: appropriation, use, and access to ICT [13].
Appropriation: There is a difference in conceptualization and use between natives and digital immigrants; the former have grown and have developed as a priority the playful and recreational aspect of digital technologies, especially social networks; in the case of the educational aspect, the job that is done consists of recovering the information, generally without discriminating the objective sources or of scientific certainty, and carries out its work by copying and pasting. The latter, digital immigrant teachers, can discriminate from sources, but their technological management often leaves much to be desired. Both require training, but not the same training, students to consume relevant information for their training and teachers train and train in the use of technology to strengthen the teaching-learning process.
Use: It has to do with knowing the potentialities that it offers in its scope of action, such as contributing to the development of other thinking skills (problem-solving) other than communicative ability. To develop these skills, critical thinking must be forged in the student that allows him to discriminate information on the network, evaluate it, verify its veracity, and be able to build new learning, because when thinking critically, arguments are accepted or rejected that later can be applied in different fields of knowledge, that is, establish a dialog between the student and the information that allows him to assess and abstract the arguments of use to the student, take a position before them, pose questions and answers to his personal and intellectual searches, solve problematic situations of his daily life, apply new knowledge to your life, and seek the improvement of the world around you. Thinking and interpreting in technology entail the creation of new educational scenarios.
Access: Two elements are inherent to access to ICT, one is inherent to the institution and the other to the student. ICTs are resources, tools, and programs that are used to process, manage, and share information through technological supports such as computers, laptops, cell phones, that is, hardware and software. The institution must provide resources and reliable means, of easy access and availability for teachers and students, but it must be ensured that the student has the appropriate resources for their distance education.
Face-to-face and virtual education are not the same, for us to be successful in virtual education we cannot directly apply what we do in physical presence and what is applied online, nor can it be replicated in a face-to-face class, each one has its methodologies and materials to make them work properly. So you have to adapt and redesign; in the virtual environment, people compete for attention, time, and space on the screen; in addition, students have greater control over the content and how they work with it and must take responsibility and practice autonomy, reflection, and reasoning.
Educational institutions must have robust, adequate, and sufficient technology, both intangible resources such as servers, computers, printers, and intangibles, such as platforms that allow them to carry out administrative, school, and teaching process management—learning. The platforms must have some characteristics such as centralization and automation, flexibility, interactivity, standardization, scalability, functionality, usability, ubiquity, and integration.
Educational institutions, in general, must carry out a process of technological reconversion that allows them to sustain the processes adjacent to the use of ICT. Thus, educational institutions should be supported by broadening their horizons to an institutional philosophy that considers ICT as fundamental elements in educational work, having financial sustainability that allows them to maintain high costs, recondition, and maintain the academic infrastructure for the good development of educational processes, in addition, with a teaching staff prone to change. The reconversion must also be carried out in administrative, pedagogical, and institutional management. The training processes in virtual learning environments are essential for the success in the training of students [14].
The migration from virtual to classroom education is essential in medical education. It is not a substitute for clinical practice, face to face with the real patient; however, hybrid or mixed strategies and curricular redesigns should be sought in the immediate and mediate future of the training of the medical professional. Among the fundamental elements are not improvising, but planning in hybrid or mixed options; consider the differences between face-to-face and virtual education; managers must be involved in the transformation; carry out adequate and pertinent teacher training about ICT in daily didactic and pedagogical activity. Acquire the relevant technological equipment for migration, including servers, Internet capacity, and diagnosis of the needs of teachers and students to carry out the migration properly.
Students are comfortable with technology-based solutions to support learning and assessment, and with peer communication tools. Pandemic circumstances have pushed teachers to acquire skills in using online resources to teach and meet students like never before. Now, we lack patients and a professional care environment. A lot of work is needed to ensure the privacy of participants, compliance with data protection regulations, quality, inclusion and fairness, support for students and teachers, among other key issues. They can be resolved effectively through intra- and inter-institutional cooperation, preferably on an international scale. The COVID-19 emergency will eventually end. By then, the whole concept and system of medical education will have been reinvented, having served as an
As of this quarantine, every one of the universities, certain policies were generally adopted that were applied throughout the country: Face-to-face classes became virtual; universities have had to offer platforms to include their students and to be able to have classes online. This requires a smartphone that can connect to the respective platform with Internet paid for by the student, or laptop computers or iPad’s, owned by the student. In the hospitals where I work (General Hospital of Zone No. 36 of the IMSS and General Hospital of Minatitlán) that are public, residents have all the means such as Internet to carry out their academic care work.
We use ICT a lot, whether for conferences
The new insurance doctors will be different from “the old ones.” The simple fact of living in confinement due to the pandemic, implying that they suddenly cut their studies, has made them approach learning issues in different ways. New doctors have to face a “new normal” that we may not know what it will be like once we try to return to the life we had every day. Telemedicine is undoubtedly a tool that has accelerated its use and it seems that it will continue in various ways. They will have to get used to teaching and learning in new formats, but at this point, the fact of reaching the comprehensive review of a patient live and in-person should be landed (see Section 4).
Alemán Bermúdez IJ, Vera León E, Patiño Torres MJ. COVID-19 and medical education: Virtuality from the perspective of the teacher and the student of higher education. Internal Medicine, Medical Education and Community 2020;36(3):116–123
UNAM School of Medicine. Post-COVID-19 medical education [Video Archive]. Available from: https://www.youtube.com/watch?v=WsytNWRtOdA [Accessed: 21 April 2021]
UNAM School of Medicine. Challenges of medical education in times of COVID-19: Institutional decisions in the face of the pandemic [Video Archive]. Available from: https://www.youtube.com/watch?v=RGhn-fW2424 [Accessed: 1 September 2020]
TecSalud. Best practices in medical education in time of COVID-19 [Video File]. Available from: https://www.youtube.com/watch?v=olaDLOBaf7U [Accessed: 7 July 2020]
National Academy of Medical Education. Medical education, from face-to-face to virtual in times of contingency [Video Archive]. Available from: https://www.youtube.com/watch?v=hmmCBSLCNvI [Accessed: 4 June 2020]
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\n\n\n\nAt IntechOpen we realize that exceptional circumstances can occur, resulting in a request for a refund. We will honor all justified requests in the specific instances outlined in our Refund Policy.
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Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/438275",hash:"",query:{},params:{id:"438275"},fullPath:"/profiles/438275",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()